LEW 64 BOROUGH OF LEWISHAM. Annual Report on the VITAL STATISTICS & SANITARY CONDITION of the BOROUGH OF LEWISHAM and REPORT OF THE PUBLIC ANALYST For the Year 1906, 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 Royal 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, 1906. Area in acres, exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1906 148,463 Average number of persons per house (Census, 1901) 5.6 Total number of Births registered in the Borough 3,446 Birth Bate per 1,000 estimated population 23.2 Total number of Deaths registered in the Borough 1,888 Total number of Deaths of residents of the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,777 Deaths of persons under 1 year of age 391 Infantile Death Rate per 1,000 Births registered 113 Total number of Deaths in Public Institutions in the Borough 616 Deaths of non-residents in the Borough 228 Deaths of residents outside the Borough 117 Corrected Death Rate per 1,000 of the estimated population 12.0 CONTENTS. Page Bacterioscopic Examinations 64 Birth Rates 17 Births, illegitimate 18 Butter 108 Cholera contacts 64 Chicken Pox 62 Cocoa 108 Combined drainage 86 Coroner's Court and Mortuary 87 Death Rates 20 „ zymotic 23 Deaths, ages at 21 „ effects of season 22 „ in disease groups 25 Diphtheria, notifications 59 „ deaths from 25 Disinfection 87 Enteric fever, deaths from 25 „ notifications 60 Factory and Workshop Act, homework 91 Factory and Workshop Act, inspection 88 Food analysis, samples submitted 103 „ inspection 73 „ surrendered 76 „ analysis, test samples 103 „ tinned 74 House-to-house inspections 85 Houses unfit for human habitation 81 Page Infant, feeding of 30 „ mortality 28 „ „ combative measures 33 „ „ educational measures 34 „ „ street incidence 38 Infectious diseases, age periods 55 „ „ attack rates 56 „ „ notifications 55 „ „ school closure 62 Legal proceedings 87 Marriage rate 20 Measles 62 Milk, dirty 107 „ on delivery 107 „ preservatives in 105 „ samples 105 „ supply suspected 76 Phthisis, deaths from 26 notification of 65 Plague contacts 64 Premature Births 30 Puerperal fever 60 Scarlet fever, deaths from 25 „ „ notifications 59 Small-Pox contacts 64 Smoke nuisances 86 Whooping cough 62 Women sanitary inspectors 93 Workshops 88 Vital statistics, epitome of 8 5 To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Lewisham. 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, 1906, in compliance with the order of the Local Government Board. The mortality figures contained herein show that Lewisham continues to hold a most favourable position, compared with the other Metropolitan Boroughs. The corrected Death-rate for the year amounted to 12.0 for every 1,000 persons living at all ages, compared with 11.7 for 1905. This Death-rate was the lowest in London with the exception of Hampstead and Stoke Newington. In addition to the general Death-rate, it is interesting to examine the statistics relating to Infant Mortality, Zymotic Diseases, and Phthisis. Infant Mortality.—With regard to infant mortality there was, during the year under review, a marked increase throughout the country, due in a great measure to the high summer temperature. In Lewisham 113 infant deaths occurred in proportion to every 1,000 births recorded, compared with 93 in 1905. Several conditions influence this mortality, and there can be no doubt that many sanitary reforms are urgently needed to assist Sanitary Authorities in their efforts to check the wastage of infant life. Some important measures are receiving the attention of Parliament, and we may, before long, have enactments which will be of considerable value. I refer particularly to the 6 Bill relating to the Registration of Births, wherein it is provided that notification of births shall be sent to the Medical Officer of Health of the district within 48 hours, and to the Infant Life Protection Bill providing for the registration of homes where one or more nursed children are received for gain. In this latter Bill it is to be regretted that no provision is made to make the registration authorities in London the Borough Councils. Zymotic Diseases.—The zymotic death rate of 1.31 per 1,000 inhabitants shows a marked increase over that of 0.83 for 1905. This was largely due to the increased mortality from infantile diarrhoea. Notifications.—There was also an increase in the number of notifications of infectious diseases. This was particularly noticeable in regard to Diphtheria. Not only were a larger number of cases notified, but the disease assumed a more severe and fatal type. With regard to Scarlet Fever, although the actual notifications were practically the same, the case mortality was much greater. On the other hand Measles, so prevalent in 1905, was much less in evidence. Phthisis.—The death rate from Phthisis amounted to 0.80 per 1,000 persons, the lowest but one in the County of London. A system of voluntary notification of Pulmonary Phthisis (consumption) was initiated in June. Only 76 notifications were received. When we consider the cases of consumption existing in the Borough amounted to several hundreds, the small proportion of cases notified is a disappointment and shows voluntary notification practically a failure. The advisability of making 7 this disease compulsorily notifiable has been generally discussed, and many are in favour of adding this disease to the list of dangerous infectious diseases set out in the Public Health (London) Act, 1891. This would render it imperative on the part of each medical attendant to notify each case and further to extend the provisions of the Act contained in Sections 60 to 65 (inclusive) to this disease. I am of opinion that compulsory notification is the only satisfactory form that will be efficient in assisting us in our attempts to adopt combative measures, but this disease differs so considerably from those already made notifiable, that a special enactment would be required for its compulsory notification and other preventive measures, in order to prevent difficulties and hardships which would accrue if the sections of the Public Health (London) Act were extended to this disease without any consideration of its special character. Apart from notification of the cases, the inspection and disinfection of the houses, and the education of the sufferers, there is the important question of the protection of our food supplies. The recent issue of the Second Interim Report of the Royal Commission on Tuberculosis contains evidence of paramount importance proving conclusively that human tuberculosis is, in a certain number of cases, caused by the introduction into the system of bovine tuberculosis. In the majority of these cases the bacillus is introduced through cow's milk. It is clearly out duty, while adopting all preventive measures against the spread of infection from human sources, to press home at every opportunity the urgent need which exists for securing the better control of our milk supply at its source. Staff.—During the year there has been a change in the staff. Miss Irene Whitworth, B.Sc., one of our women inspectors, obtained an appointment in the Home Office. Her services in this district were much appreciated, and while regretting her removal one is glad she has obtained the 8 motion she so well deserved. The vacancy was filled towards the end of the year by the appointment of Miss Moynihan. The whole Staff have done excellent work, and I take this opportunity of expressing my appreciation of the valuable help I have received from them. I remain, Gentlemen, Your obedient Servant, Willesley Harris Medical Officer of Health and Public Analyst. March, 1907. 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 1901-6. Table 2.—Population of the Borough in Divisions obtained at the Census, April, 1901. Also the population estimated at the middle of the years 1901-6. Table 3.—Births and Birth Rates for each Division of the Borough for the years 1901-6. Table 4.—Number of Deaths at various Age Periods and their Percentage to corrected Total Deaths during the years 1902-6. Table. 5.—Percentage of Deaths Under One Year of Age to Total Deaths in Wards and Divisions for the years 1902—6. Table 6.—Corrected Death Totals and Death Sates for the years 1901-6. Table 7.—Analysis of Deaths Under One Year of Age during the years 1903-6. Table 8.—Distribution in Wards of Deaths under One Year, in different disease groups during 1906. Table 9.—Corrected Total Deaths, male and female, from All Causes in Wards occurring during the four quarters of the year 1906. Table 10.—Corrected Death Rates from all Causes in Wards, Divisions and the Whole Borough for the four quarters of the year 1906. Table 11.—Deaths in Disease Groups in the three Divisions and the Whole Borough for the year 1906. 10 Table 12.—Death Rates in Disease Groups in the Wards and Divisions of the Borough for the year 1906. Table 13.—Birth and Death Bates of London and Metropolitan Boroughs during the year 1906, after distribution of deaths in Public Institutions. Table 14.—Death Bates in London and the several Metropolitan Boroughs from All Causes and from Certain Diseases during the year 1906, before distribution and after distribution of deaths in Public Institutions. Table 15.—Causes of, and Ages at, Deaths in the Borough for the year 1906. Table 16.—Besidents and Non-Besidents dying in Public Institutions situated in the Borough. Table 17.—Deaths from Principal Zymotic Diseases in Wards during the year 1906. Table 18.—Death Bates from Principal Zymotic Diseases and Bhthisis, and Infantile Mortality, in the Borough and its Divisions, in the County of London, and in the 76 Great Towns, for the year 1906. Table 19.—Deaths from Principal Zymotic Diseases arranged in Age Groups for the year 1906. Table 20.—Meteorological Table for London for the year 1906. Part II.—Infectious Diseases. Table 21.—Showing Cases of Scarlet Fever and Diphtheria at various Age Periods notified during the year 1906. Table 22.—Number of Cases of Infectious Diseases notified in the ten Wards during the year 1906. Table 23.—Attack Bates from the Principal Infectious Diseases per 1,000 of the population for the Ten Wards and the Whole Borough for the years 1903-6. 11 Table 24.—Attack Rates at All Ages from Small-Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the years 1903-6. Part III.—General. Table 25.—Houses Examined and Certified under the Customs and Inland Revenue Act. Table 26.—Water Certificates Granted. Tables 27.—Details of Inspection of Factories and Workshops and Defects Found. Table 28.—Details of Home Work in the Borough. Table 29.—Details of Workshops in the Borough. Tables 30 and 31.—Register of Sanitary Work for 1906. Part IV.—Report of Public Analyst. Table A.—Showing Number of Samples submitted for Analysis, with Results, for the year ended December 31st, 1906. Table B.—Summary of Samples Analysed in the Borough in each year, 1898 to 1906 (inclusive). Table C.—Showing Results of Total Samples submitted during the years 1902-6. Table D.—Showing Results of Total Samples of Milk submitted during the years 1902-6. Table E.—Average Composition of Milk Samples submitted in 1906. Table F.—Average Composition of Milk Samples submitted during the years 1902-6. Table G.—Details of Adulterated Samples of Milk for the year ended December 31st, 1906. Table H.—Showing the Number of Samples of Butter submitted in the four quarters of the years 1902-6. 12 Table I.—Details of Adulterated Samples of Butter submitted in 1906. Table J.—Details of Other Adulterated Samples and other Prosecutions during the year 1906. Appendices. I.—Local Government Board Tables. Table A.—Vital Statistics of Whole District during the years 1901-6. Table B.—Vital Statistics of Separate Localities in the years 1901-6. Table C.— Cases of Infectious Disease notified during the year 1906. Table D.—Causes of, and Ages at, Death during the year 1906. Table E.—Detailed analysis of Deaths under one year of age during the year 1906. II.—Hints to Consumptive Patients—Copy of Card issued to Phthisis Homes. Charts. Chart A.—Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ended 31st December, 1906. Chart B.—Showing Percentage of Deaths in Eleven Groups to Total Deaths during 1906. Chart C.—Showing Weekly Notifications of All Infectious Diseases, also Weekly Notifications of Scarlet Fever, and Diphtheria, during the year 1906. PART 1. VITAL STATISTICS. 15 REPORT OF THE Medical Officer of Health FOR THE YEAR 1906. 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 1906, which amounted to 148,463, compared with 144,420 for 1905, an increase in one year of 4,043 persons. The increase in the population by natural increment, i.e., the excess of births over deaths, amounted to 1,558. It may be assumed, therefore, that the difference of 2,485 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 29th, 1906, is taken. All mortality 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 1901-1906. Ward. Population at Census, Apr. 1901 Population estimated to the middle of 1901. 1902. 1903. 1904. 1905. 1906. Church 6412 6434 6522 6611 6700 6790 6880 Manor 6734 6761 6872 6983 7095 7207 7320 South 5503 5508 5531 5553 5575 5597 5620 Lee Division 18649 18703 18925 19147 19370 19594 19820 Blackheath 6729 6735 6759 6784 6807 6830 6855 Lewisham Vil. 13842 13887 14070 14253 14437 14622 14808 Lewisham Pk. 11145 11394 12391 13393 14402 15417 16437 Brockley 10952 10984 11114 11245 11377 11510 11643 Catford 23203 23631 25338 27056 28785 30524 32273 Lewisham Div. 65871 66631 69672 72731 75808 78903 82016 Forest Hill 18051 18063 18115 18166 18218 18270 18322 Sydenham 24924 25083 25720 26361 27005 27653 28305 Syd. & Forest Hill Division 42975 43146 43835 44527 45223 45923 46627 17 Table 2. Population of the Borough in Divisions, obtained at the Census April, 1901, also population estimated at the middle of the years 1901-1906. Divisions. Population at Census, Apr. '01 Population estimated to the middle of 1901. 1902. 1903. 1904. 1905. 1906. Lee 18649 18703 18925 19147 19370 19594 19820 Lewisham 65871 66631 69672 72731 75808 78903 82016 Sydenham and Forest Hill 42975 43146 43835 44527 45223 45923 46627 Whole Borough 127495 128480 132432 136405 140401 144420 148463 THE BIRTH RATE. The total number of Births registered in the Borough of Lewisham during the year 1906 was 3,446. Of this total 1,739 were males and 1,707 females. The birth rate for Lewisham is therefore 23.2 per 1,000 inhabitants, compared with 25.2 in the previous year. The birth rate for London was 26.5 per thousand, or 3.3 per thousand in excess of this Borough. Of the total births, 445 were registered in the Lee division, 1,871 in Lewisham, and 1,130 in Sydenham and Forest Hill division. The birth rate in Lee was 22.5, in Lewisham 22.8, and in Sydenham and Forest Hill 24.2 per 1,000 of the inhabitants of each division. 18 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 country during the year under review amounted to 27.0 per 1,000 of the population, which was 0.2 per 1,000 below the rate in 1905, and again lower than any rate on record. The 76 Great Towns for which returns are available showed a birth rate of 27.8 per 1,000 of the population, the rates for the three preceding years having been 29.7, 29.1 and 28.2. It is interesting to note the wide range in the birth rates of various districts: e.g., Hastings 16.3, Bournemouth 17.7, Hornsey 18.4, Halifax 18.9, Bradford 20.6; Rhondda 37.3, Merthyr Tydfil 36.4, Middlesbrough 35.6, Sunderland 34.9, St. Helens and Hanley 34.0. In London the birth rate amounted to 26.5, or 1.5 per 1000 below the average for the past 5 years and also the lowest on record. Here again wide variations occur according to the districts: e.g., Hampstead 16.5, City of London 16.7, City of Westminster 17.2, Kensington 19.2, Stoke Newington 20.8; on the other hand, Stepney 34.2, Bethnal Green 34.5, Shoreditch 31.2, Bermondsey 31.8, Poplar 31.6, Finsbury 30.2, Fulharn 30.0. Illegitimacy.—During the year 1906, 4,838 infants were registered in London as having been born out of wedlock. This figure gives a proportion of 39 per 1,000 births, which is 2 per 1,000 above the average proportion in the preceding 10 years. In Lewisham of the 3,446 registered births, 82 or 23.8 per 1,000 were registered as being illegitimate, compared with 33.3 per 1,000 in the previous year. On reviewing the returns of illegitimate births it is found that 50 per cent. of these children were born to domestic 19 servants, 11 per cent. to laundresses and 6 per cent. to dressmakers' assistants. Of the 82 illegitimate births, 14 under 1 year or 17 per cent. proved fatal, giving an infant mortality of 171 per 1,000 births. Table 3. Births and Birth Rates for each Division of the Borough for the years 1901-1906. Division. 1902. 1903. 1904. 1905. 1906. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Lee 481 25.4 486 25.4 469 24.2 454 23.2 445 22.5 Lewisham 1857 26.6 1979 27.2 1967 25.9 2027 25.7 1871 22.8 Syd.&Forest Hill 1153 26.3 1098 24.7 1153 25.5 1152 25.1 1130 24.2 Whole Borough 3491 26.3 3563 26.1 3589 25.6 3633 25.2 3446 23.2 County of London 130478 28.5 130906 28.4 129335 27.9 126620 27.1 124880 26.5 20 MARRIAGE RATE. The number of Marriages registered in the Borough during the year amounted to 951, compared with 906 in 1905. The Marriage Rate was 12.8, an increase of 0.3 per 1,000 on 1905, while the Marriage Rate for the whole of London was equal to 17.1, and for England and Wales 15.6 per 1,000. MORTALITY. The total number of Deaths registered in the Borough amounted to 1,888, compared with 1,804 for the year 1905. After deducting the deaths of non-residents (228) dying within the Borough, and adding those of residents (117) who died outside the district, a corrected total of 1,777 is obtained, compared with 1,691 in 1905. The corrected total deaths in Lewisham, 1,777, is equivalent to a Death Rate of 12.0 per 1,000 living at all ages, and compares most favourably with the death rate for England and Wales of 15.4 per 1,000 of the population. The death rate for the County of London was 15.1, which is the same rate as in 1905, and is the lowest on record. The rate for the 76 Great Towns equalled 15.9 per 1,000. Compared with other Metropolitan Boroughs, Lewisham has the third lowest death rate in London. Hampstead is the lowest with 9.4, followed by Stoke Newington 11.5, Lewisham 12.0, Paddington 12.5, Wandsworth 12.8 and Westminster 12.9 per 1,000 of the population living at all ages. The districts having the highest death rates in London were Finsbury, 20.7, Bermondsey, 19.7, Shoreditch, 19.6, 21 Bethnal Green, 18.9, Southwark, 18.1, and Holborn, l8.0. (See Table 13). The death rate for Lewisham, 12.0 per 1,000 for the year 1906, shows a very slight increase 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, 10.6, and highest in the Lewisham Division, 12.2, the Sydenham and Forest Hill Division being 12.1. (See Table 5). Carrying the sub-division a step further, the death rates from all causes in the individual Wards show Lewisham Park to have suffered the highest mortality (14.2); on the other hand South claims the lowest mortality for the year with 9.3 per 1,000. (See Table 10). Age in relation to Deaths.—A division of the registered deaths at various age periods is arranged in Table 4. This Table shows an increase of deaths among children under one, chiefly due to Diarrhoeal diseases. (See Table 7). The percentage deaths at this age period, compared with total deaths, amounted to 22.00, compared with 19.99 in 1905. There was also an increased mortality between the ages of 25 and 65. The number of deaths recorded at this age period equalled 33.54 per cent. of the total, compared with 32.35 in the previous year. The relation of age periods to mortality from zymotic diseases are set out in Table 19. Of the 194 deaths from these diseases, 91.8 per cent. occurred among children under five years of age. The distribution of zymotic deaths in ward localities appears in Table 17. 22 Age Period. 1902. 1903. 1904. 1905 1906. ANALYSIS OF DEATHS. Table 4. Number of Deaths at Various Age Periods and their Percentage to Corrected Total Deaths during the years 1902-1906. 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. Number of Deaths. Percentage to Total Deaths. Deaths under 1 yr. 428 23.54 328 21.68 440 26.21 338 19.99 391 22.00 Over 1 & under 5 yrs. 200 11.00 142 9.39 140 8.34 130 7.69 160 9.00 „ 5 „ 15 „ 86 4.73 61 4.03 39 2.32 59 3.49 57 3.21 „ 15 „ 25 „ 86 4.73 76 5.02 85 5.06 63 3.72 68 3.83 „ 25 „ 65 „ 547 30.09 478 31.59 470 27.99 547 32.35 596 33.54 Over 65 years 471 25.91 428 28.29 505 30.08 554 32.76 505 28.42 Total 1818 100.0 1513 100.0 1679 100.0 1691 100.0 1777 100.0 Seasonal Mortality.—The highest mortality occurred during the first and third quarters of the year, the death-rates Chart A. Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ended December 29th, 1906. REFERENCES. Deaths from All Causes shown in Black Deaths from Respiratory Diseases in Red Deaths from Infantile Diarrhoea (Epidemic)in Green 23 from all causes being 13.3 and 12.2 per 1,000 respectively. The lowest death-rate was 10.5 for the second quarter. Chart A shows deaths from all causes recorded weekly and the seasonal effect with regard to Infantile Diarrhoea and diseases of the Respiratory Group. Table 11 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. 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, Diphtheria, Scarlet, Typhus and Typhoid Fevers, Whooping Cough, Epidemic Diarrhoea and Epidemic Enteritis. For the year under review, the zymotic death rate for Lewisham amounted to 1.31 per 1,000 persons, showing an increase of 0.48 over that of the previous year. The rate, however, compares favourably with the rates 1.92 for the County of London, 2.24 for the 76 Great Towns, and 1.73 for England and Wales during the same period. These rates also show increases of 0.22, 0.36, and 0.21 per 1,000 respectively over the rates for 1905. Summer Diarrhoea was chiefly responsible for the heavier zymotic death rates throughout England and Wales as well as in Lewisham. Lewisham possesses the lowest zymotic rate of the 10 South Metropolitan Boroughs. Of the total 194 deaths in Lewisham from the principal infectious diseases, Measles accounted for 21, Scarlet Fever 14, Table 5. Corrected Death Totals and Death Rates for the years 1902-1906. Locality. 1902. 1903. 1904. 1905. 1906. Total Number of Deaths. Death rate per 1,000 of the population. Total Number of Deaths. Death rate per 1,000 of the population. Total Number of Deaths. Death rate per 1.000 of the population. Total Number of Deaths. Death rate per 1,000 of the population. Total Number of Deaths. Death rate per 1,000 of the population. Lee Division 220 11.6 213 11.1 193 10.0 186 9.5 211 10.6 Lewisham Division 991 14.2 816 11.2 941 12.4 966 12.2 1000 12.2 Sydenham & Forest Hill Division 607 13.8 484 10.9 545 12.1 539 11.7 566 12.1 Whole Borough 1818 13.7 1513 11.1 1679 12.0 1691 11.7 1777 11.97 County of London 80105 17.2 69737 15.2 74556 16.1 70442 15.1 71155 11.5 24 Whooping Cough 26, Diphtheria 21, Enteric Fever 1, and Epidemic Diarrhoea and Enteritis 111. (See Table 17). The death rates from the above diseases for the whole Borough, the County of London, and the 76 Great Towns, have been calculated and are set out in Table 18. 25 ANALYSIS OF DEATHS AT ALL AGES IN RELATION TO DISEASE GROUPS. CLASS I.—Infective Diseases (240). Small-Pox.—No deaths occurred from this disease. Measles.—Measles was recorded as the cause of 21 deaths, equal to a death rate of 0.14 per 1,000 of the population. There is reason to believe that this disease was far less prevalent, compared with 1905, when the death-rate amounted to 0.28 per 1,000. It is not a notifiable disease, consequently the case mortality cannot be obtained. Scarlet Fever.—Fourteen deaths were notified in the Borough, equal to a mortality rate of 0.09 per 1,000 of the population, compared with 0.03 in 1905. The actual number of cases notified amounted to 543, compared with 548 in 1905. From this it will lie seen that during the year under review, fewer cases of scarlet fever existed. Notwithstanding this fact the deatli-rate was higher. On considering the case mortality it is found that of the 543 recorded cases 2.57 per cent, proved fatal, compared with 0.9 per cent, in 1905. Diphtheria.-There were 21 deaths from diphtheria, giving a mortality rate for the Borough of 0.14 per 1,000 of the population, compared with 0.06 in 1905. In regard to this disease, not only was there a considerable increase in the number of notifications but the disease assumed a more fatal form, the case mortality being 8.6 per cent, of the actual cases, compared with 5.6 in 1905. Whooping Cough.—Twenty-six deaths occurred from Whooping Cough, equivalent to a death rate of 0.18 per 1,000, the figure for 1905 being 0.17. Enteric Fever.—There was only one fatal case, equal to a death rate of 0.01 per 1,000. The case mortality was equal 26 to 5.0 per cent. of the persons affected, compared with 18.2 per cent. for the preceding year. Epidemic Diarrhoea and Epidemic Enteritis.—The total deaths recorded in the year from these two diseases amounted to 111. compared with 32 in 1905 and 112 in 1904. Thus summer diarrhoea was the most fatal zymotic disease during the year, producing a death-rate of 0.75 per 1,000 of the population, compared with 0.22 in 1905 and 0.80 in 1904. (See Tables 13 and 17). Deaths from other Infective Diseases were:—Influenza, 20; Puerperal Fever, 2; Erysipelas, 3; Venereal Disease, 5; Septicoemia not Puerperal, 7; Pyaemia, 3; and other Septic Diseases, 6. CLASS II.—Tuberculous Diseases (175).- Phthisis.—This disease was responsible for 119 deaths, or 6.7 per cent. of the total 1,777 deaths from all causes. This mortality is equal to a death rate of 0.80 per 1,000 (compared with 0.87 in 1905) for the whole Borough, the lowest rate of the ten Southern Metropolitan Boroughs. Of the remaining London sanitary districts, only Hampstead, with 0.07, is lower. The district having the highest mortality from this cause was Holborn, with 2.37 per 1,000. The death rate for the County of London was 1.44. The position of Lewisham, therefore, in comparison with other Boroughs, is most satisfactory. In addition to Phthisis, 56 deaths were registered as due to various forms of tubercular disease. (See Table 15). CLASS III.--Malignant Diseases (136).—Cancer was the stated cause of 105 deaths, compared with 104 in 1905, equal to a mortality rate of 0.71 per 1,000. On sub-dividing these deaths, 16 were registered in Lee, 61 in Lewisham, and 28 in Sydenham and Forest Hill. For other diseases of this Class. (see Table 15.) 27 CLASS IV.—Nervous Diseases (118).— This class was responsible for 118 deaths, equal to 6.6 per cent. of the total deaths. Of this number 32 were cases of insanity, 28 meningitis, 18 convulsions; of the latter 11 were children under 1 year. CLASS V. Diseases of Heart and Circulation (277). Diseases of Heart and Blood Vessels accounted for 277 deaths, equal to 15.6 per cent. of the total deaths. Eighty-three deaths were due to valvular heart disease and endocarditis, and 60 to cerebral haemorrhage. CLASS VI.—Respiratory Diseases (260).—This class was the cause of 260 deaths, equal to 14.6 per cent. of the total deaths from all causes. The highest number cf deaths were registered during the 52nd week. (See Chart A). Bronchitis and pneumonia were the most fatal, particularly to children under 5 years of ago. (See Table 15). CLASS VII. Digestive Diseases (182).—To this class 182 deaths, or 10.2 per cent. of the total deaths, were assigned; children under 1 year were the sufferers in 93 cases. Cirrhosis of the Liver (frequently associated with alcoholism) was the certified cause of 14 deaths, compared with 25 in 1905. CLASS VIII.—Diseases of Urinary Organs (57).—Fiftyseven, or 3.2 per cent. of the total deaths were recorded in this class. CLASS IX.-Diseases of Generative Organs (4).—Only 4 deaths were registered in this group. CLASS X.General or Constitutional Diseases (272).— Of the 272, or 15.3 per cent. of the total deaths due to disease in this class, old age claimed 130 of the total, premature birth was the certified cause of 65, and alcoholism 9. 28 CLASS XI.—Accidents (42).—Forty-two fatal accidents occurred, 4 of which were due to overlaying. CLASS XII.—Violence, Suicides, &c. (14).—Fourteen suicides occurred in the Borough. NOTE:—Chart B contains a diagramatic comparison of deaths occurring in various groups. Inquests:—One hundred and twenty-one inquests were held and 76 post mortem examinations made during the year. INFANT MORTALITY. The infant mortality of a district is measured by the proportion of deaths of infants under one year to every thousand births registered. England and Wales.—Throughout England and Wales the infant mortality rate exceeded that of the preceding year, 1905. The mortality figure recorded in 1906 was 133 per 1,000 births, compared with 128 in 1905. The returns for the 76 Great Towns show also a slight increase, the rates being 145 in 1906 and 140 in 1905. The lowest infant mortality figures were registered in Hornsey 85, King's Norton 103, Brighton 111, Devonport 111, and Southampton 113. The towns having the highest rates were Burnley 212, Preston 199, Stockport 186, Grimsby 180, and Merthyr Tydfil 179. In London the infant mortality amounted to 131 per 1,000 births, compared with 129 in 1905. The lowest rates were recorded in Hampstead 77, City of London 101, Stoke Newington 102, Paddington 105, Woolwich 109, Westminster 110 and Lewisham 113; the highest, Shoreditch 163, Finsbury 160, Bethnal Green 155, Bermondsey 153 and Poplar 152. Chart B. Showing Percentage of Deaths in Eleven Groups to Total Registered Deaths in 1906. 29 In Lewisham there was a marked increase over the rate for the previous year, owing to an outbreak of Epidemic Diarrhoea during the summer months, favoured by the excessive summer heat. The infant mortality rate for the borough amounted to 113 per 1,000 births, compared with 93 in the preceding year, and 113 the mean for the five years 1901-1905. On reference to Table A in the Appendix it will be seen that with the exception of the years 1903 and 1905 the rate recorded this year is the lowest. Chart A shows distinctly the effect of the continued high temperature in relation to infantile diarrhoea deaths when examined in conjunction with the maximum and mean summer temperatures recorded in Table 20. During the year 391 deaths occurred among children under one year, compared with 338 in 1905. Of the total infant deaths the greater proportion, 147 or 37.6 per cent. were attributed to Wasting Diseases under which heading the following are included:—Premature Birth, Congenital Defects, Injury at Birth, Want of Breast Milk, Atrophy, Debility, Marasmus, Asthenia, Inanition, Malnutrition. Diarrhoeal diseases, which include all forms of diarrhoea, enteritis not tuberculous, gastritis, gasto-intestinal catarrh, gastro-enteritis, muco-enteritis, were responsible for 123 or 31.5 per cent. of the total. Diseases in both these classes are to a very great extent preventable diseases. Three deaths were certified as Measles and 12 Whooping Cough, compared with 8 and 13 respectively in 1905. Fourteen deaths were due to some form of tubercular disease (consumption), 46 to respiratory diseases, either bronchitis, laryngitis, or 30 pneumonia, and 44 to diseases unclassified or ill-defined, such as convulsions, suffocation, over-laying, &c. Premature Birth—or Immaturity, was the cause attributed to 65 or 16.6 per cent. of the recorded infant deaths, compared with 57 in 1905. 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. 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. How to check the serious wastage of infant life remains a difficult problem. In Lewisham over 11 per cent. of the children born in 1906 succumbed, in many instances before attaining the age of four weeks. In some less fortunate and poorer districts of London 16 per cent. died. In some of the manufacturing towns a much greater loss occurred. Environment.—Circumstances affecting the infant mortality rate are numerous, among them being the conditions under which mothers exist during the anti-natal period. Young mothers have yet to learn the importance of living under strict hygienic rules during this period, including the avoidance of alcoholic excess, the necessity of good and suitable food, the enjoyment of fresh air and moderate exercise. Natural or Artificial Feeding.—As might be expected, the mortality is highest among infants artificially fed. It is satisfactory to note, however, that there appears to be a greater willingness and desire amongst mothers to feed their children with breast milk. Our investigations at the homes clearly establish this fact, and there is reason to believe that some good has followed the circulation of educational pamphlets to homes where births occur. That there still exists lamentable ignorance among many mothers is evident from the fact that a 31 very large proportion of infant deaths were due to diseases resulting from errors in feeding. I am of opinion much more might be done to reduce infant mortality if our actions were not restricted by technical obstructions by other authorities. The women sanitary inspectors might visit the homes in poorer districts and advise young and often ignorant mothers in relation to simple rules for the successful feeding and rearing of their young. Unfortunately, some time ago when such a scheme was proposed, the London County Council pointed out that such work did not come within the scope of the women sanitary inspectors, and if they were so employed the moiety of their salary would be disallowed. The duties of the women sanitary inspectors, as sanctioned by the Local Government Board, are as follows:— (1) The routine inspection of work-shops, work-places and laundries where females are employed. (2) The inspection of homes of female outworkers. (3) The examination of sanitary conveniences used by females at railway stations, restaurants, underground, &c. (4) Special investigations in poor districts as to cause of infant mortality. (5) Investigations in regard to homes where female cases of phthisis are known to exist, giving information as to precautious to be taken 10 prevent the spread of such disease to others. (6) Visiting homes where deaths from phthisis have occurred, and at which cases of infectious disease have been notified. (7) Visiting schools from which notifications have been received from teachers of the absence of scholars in consequence of the existence of notifiable and non-notifiable 32 infectious diseases, when so directed by the Medical Officer of Health. In consequence of these restrictions we are only enabled to inquire into conditions existing in homes where infant deaths occur, to find out the cause of death. The results of these investigations are generally interesting. They frequently reveal almost pathetic ignorance on the part of the mother in the elementary principles necessary for the successful management of their children. But as a means of preventing the existing mischief these visits are useless. As a result of inquiry in 235 homes after death, amongst other particulars the following facts were elicited:— That 92 per cent. of the fatal cases of diarrhoeal diseases occurred to artificially-fed children. Of the total 235 infant deaths from all causes investigated, 47, or 20 per cent., were first children—22, or 9 per cent., illegitimate—61, or 26 per cent., children of working mothers —37, or 16 per cent., children put out to nurse. In regard to the method of feeding adopted 41, or 17 per cent., were breast-fed, and the remainder, 83 per cent. artificially fed. Miss Jones reports, as a result of her investigations at the homes where infant deaths occurred, that fatal cases of infantile diarrhoea were not limited to the homes of the very poor classes. The mothers appeared totally ignorant of the danger of allowing diarrhoea to continue unchecked, and in many instances did not seek medical aid until too late. Many mothers had an idea, amounting almost to a superstition, that diarrhoea during the teething period was natural, and if checked would lead to convulsions or serious illness. In several instances the disease commenced at the time of weaning. Mothers are still ignorant 33 of the grave risks attending weaning in the hottest summer months. Combative Measures.—In 1905 we were permitted to obtain from the registrars a list of births registered in the district. From these lists a selection of homes is made, to which is sent a pamphlet dealing with infant management and rearing. Unfortunately, the existing law permits the registration to be made at any time within 42 days, so that a pernicious system of feeding may have been adopted and continued for weeks before we are actually aware of the birth. Your Council made a special representation to the Local Government Board in regard to this subject, pointing out the benefits that would accrue if the period of registration were considerably curtailed. A Government Bill has since been framed to provide for the early notification of births. The Bill suggests that the notification of a birth shall be sent by the father if he is actually residing in the house where the birth takes place, or in his absence, by any person attending upon the mother at the time, to the Medical Officer of Health of the district, within 48 hours of such birth. This information shall apply to stillborn children as well as to children born alive. If such a measure is adopted by Parliament it will greatly assist sanitary authorities in their endeavour to reduce infant mortality. It would be necessary to have the assistance of Health Visitors to follow up these notifications and to instruct parents residing in the poorer districts as to the general principles of feeding and rearing infants. I suggest that as our women inspectors are prohibited from carrying out such work, your Council should consider the advisability of at once securing the services of Voluntary Health Visitors. The information already set out in regard to infant mortality fully justifies your consideration of this suggestion. 34 In previous reports I have drawn attention to the absurdities of the existing Infant Life Protection Act, which provides for the control of homes where two or more infants under five years of age are received for the purpose of nursing or maintaining of such infants apart from their parents for a period of more than forty-eight hours. Notice has to be given to the Local Authority; in London, to the London County Council. In effect this Act is useless in protecting children who are taken by persons cute enough to avoid registration and inspection by only accepting one child at a time, and there are many children so placed. It was also pointed out to you that the administration of the Act in London was with the London County Council, who for some unknown reason had relegated the administration of the Act to the Public Control Department. Your Council made representation to the Local Government Board of the necessity of an amending Act to bring within its scope persons receiving only one child, and further the importance of the administration of the Act being transferred to the Local Borough Councils. A Bill has been introduced by Mr. Staveley Hill, which provides all that was asked for, except the transference of its administration to Borough Councils. Educational Measures.—When motherhood is established and women have obtained set ideas gained from their parents who, too often are not fitted to instruct their daughters of the duties of motherhood, it is late to improve conditions. Our attempts to educate parents are frequently disappointing. It is only after disappointment and failure in the management such mothers are prepared to listen, and I am of opinion education in matters of personal hygiene, the value of food, the nutrition of the body, and the normal growth and healthy living of the individual should form an important part of the general education in our schools. 35 Table 6. Percentage of Deaths under one year of age to Total Deaths in Wards and Divisions for the years 1902-1906. District. 1902. per cent. 1903. per cent. 1904. per cent. 1905. per cent. 1906. per cent. Church Ward 11.8 11.3 19.7 12.7 18.4 Manor Ward 16.4 26.4 26.0 9.4 20.5 South Ward 20.3 14.8 13.3 11.8 17.3 Lee Division 15.9 17.4 20.7 11.3 19.0 Blackheath Ward 14.5 13.8 13.9 17.0 17.3 Lewisham Village Ward 18.5 22.2 27.6 20.7 19.3 Lewisham Park Ward 25.1 20.8 31.5 20.5 21.9 Brockley Ward 26.2 20.0 27.2 15.7 22.7 Catford Ward 34.6 32.7 31.3 26.0 24.9 Lewisham Division 26.9 24.9 282. 21.5 22.0 Forest Hill Ward 21.7 13.4 18.6 17.5 20.0 Sydenham Ward 20.6 21.4 29.1 22.4 25.1 Sydenham & Forest Hill Division 21.0 18.2 24.8 20.2 23.1 Whole Borough 21.68 23.54 26.21 19.99 22.00 36 Table 7. Analysis of Deaths under one year of age, during the years 1903-1906. Disease. 1903. 1904. 1905. 1906. 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. 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 17 4.3 Diarrhceal Diseases 60 18.3 122 27.7 59 17.5 123 31.5 Wasting Diseases 124 37.8 151 34.3 139 41.1 147 37.6 Tuberculous Diseases 14 4.3 14 3.2 10 3.0 14 3.6 Respiratory Diseases 53 16.2 64 14.5 43 12.7 46 11.8 Diseases classified under other headings 67 20.4 60 13.6 64 18.9 44 11.3 Total 328 100.0 440 100.0 338 100.0 391 100.0 Note.—For detailed list of these diseases sec Table E of the Local Government Board Tables (page 123). 37 D1str1but1on 1n Wards.—The follow1ng table shows the d1str1but1on of 1nfant deaths 1n the var1ous wards of the Borough. The h1ghest mortal1ty was 1n the Lew1sham Park and Sydenham Wards:— Table 8. Ward. Common 1nfect1ous D1seases. D1arrhœal D1seases. Wast1ng D1seases. Tubercular D1seases. Resp1ratory D1seases. Other D1seases. Total 1nfant Deaths. Death.rate per 1,ooo of the Populat1on. Church . 4 3 l 4 2 14 2.0 Manor — 4 8 l 2 2 17 2.3 South — 3 2 — 3 1 9 1.6 Blackheath l 5 3 — 2 3 14 2.0 Lew1sham V1llage l 8 12 — 4 8 33 2.2 Lew1sham Park 2 12 28 2 1 6 51 3.1 Brockley 1 12 12 1 2 1 29 2.5 Catford 7 39 28 1 11 7 93 2.9 Forest H1ll — 11 18 2 8 4 43 2.3 Sydenham 5 25 33 6 9 10 88 3.1 Total 17 123 147 14 46 44 391 2.6 38 L1ST OF STREETS 1n wh1ch more than one 1nfant d1ed under the age of 12 months, show1ng that the major1ty of 1nfant1le deaths occurred among the poorer classes. Lee. Abernethy Road 2 ! Church Street 3 Taunton Road 2 Br1ghtf1eld Road 3 Dacre Street 2 Turner Road 2 Ronver Road 3 Lew1sham Ardmere Road 2 Farley Road 2 Marsala Road 3 Beacon Road 5 Felday Road 3 Maybank Cottages 2 Ben1n Street 2 Fernbrook Road 2 Nelgarde Road 2 Blashford Street 2 G1ll1an Street 2 Pascoe Koad 2 Bradgate Road 5 Glenv1ew Road 4 Pattenden Road 2 Br1ghts1de Road 3 Hazelbank Road 2 Porson Street 2 Brockley Cottages 2 E1ther Green Lane 2 Rhyme Road 3 l1rookdale Road 7 Honley Road 3 Sandhurst Road 5 Con1ngton Road 3 Howson Road 4 Sangley Road 8 Courth1ll Road 3 K1llearn Road 2 Sdvermere Road 5 Darf1eld Road 2 Kneller Road 2 Sparta Street 2 Davenport Road 3 Ladywell Park 2 Sportsbank Street 2 Doggett Road 3 Laleham Road 4 Thurston Road 2 Dowanh1ll Road 2 Lew1sham Road 3 Torr1don Road 3 Elsw1ck Road 3 Loamp1t Vale 2 Wh1tbread Road 2 Engleheart Road 4 Longhurst Road 2 W1ldfell Road 2 Ennersdale Road 3 Malyons Road 2 Woodlands Street 2 Manor Lane 3 Sydenham and Forest H1ll. Acac1a Road 5 D1llwyn Road 6 Larkbere Road 3 Ueadnell Road 2 Els1nore Road 4 London Road 2 Bov1ll Road 4 Ewart Road 3 Malham Road 6 Bradford Road 3 East Terrace, M1all Road 6 Burlord Road 3 Fa1rlawn Park 2 Port.hcawe Road 11 Champ1on Park 2 Holmshaw Road 2 Watl1ngton Grove 4 Dalma1n Road 3 Kent Eouse Road 2 West Terrace, Dav1ds Road 3 K1mberley Terrace 2 Fa1rlawn Park 2 39 Table 9. Corrected total Deaths f rom All Causes 1n Wards occurr1ng dur1ng the four quarters of the year 1906. Local1t1es. F1rst Quarter. Second Quarter. Th1rd Quarter. Fourth Quarter. Whole Year. M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total Church Ward 12 14 26 7 7 14 7 12 19 6 11 17 32 44 76 Manor Ward 10 14 24 7 5 12 10 10 20 10 17 27 37 46 83 South Ward 7 8 15 3 5 8 5 4 9 9 11 20 24 28 52 Blackheath Ward 8 11 19 12 11 23 8 11 19 8 12 20 36 45 81 Lew1sham V1llage Ward 20 22 42 21 22 43 31 19 50 26 23 49 98 86 184 Lew1sham Park Ward 22 34 56 30 25 55 35 23 58 30 34 64 117 116 233 Brockley Ward 11 24 35 19 13 32 21 17 38 13 10 23 64 64 128 Catford Ward 57 56 113 38 46 84 52 44 96 36 45 81 183 191 374 Forest H1ll Ward 27 36 63 21 27 48 21 27 48 29 27 56 98 117 215 Sydenham Ward 57 44 101 30 41 71 50 47 97 32 50 82 169 182 351 The Whole Borough 231 263 494 188 202 390 240 214 454 199 240 439 858 919 1777 40 Table 10. Corrected Death Rates from All Causes 1n Wards, D1v1s1ons, and the Whole Borough, for the four quarters of the Year 1906. Local1t1es. F1rst Quarter. Second Quarter. Th1rd Quarter. Fourth Quarter 1906. Church Ward 15.1 8.1 11.0 9.9 11.0 Manor Ward 13.1 6.6 10.9 13.9 11.3 South Ward 10.7 5.7 6.4 14.2 9.3 Lee D1v1s1on 13.1 6.9 9.7 12.9 10.6 Blackheath Ward 11.1 13.4 11.1 11.7 11.8 Lew. V1llage Ward 11.3 11.6 13.5 13.2 12.4 Lew. Park Ward 13.6 13.4 14.1 15.6 14.2 Brockley Ward 12.0 11.0 13.1 7.9 11.0 Catford Ward 14.0 10.4 14.9 10.0 11.6 Lew1sham D1v1s1on 12.9 11.6 12.7 12.7 12.2 Forest H1ll Ward 13.8 10.5 10.5 12.2 11.7 Sydenham Ward 11.3 10.0 13.7 11.6 12.4 Sydenham & Forest H1ll D1v1s1on 14.1 10.2 12.4 11.8 12.1 Whole Borough 18.3 10.5 12.2 11.8 12.0 Count of London 16.0 14.2 14.8 15.4 15.1 76 Great Towns 16.6 14.9 16.2 16.2 15.9 England and Wales 16.5 14.6 14.9 15.6 15.4 41 .Table 11. Deaths 1n D1sease Groups 1n the Three D1v1s1ons and the whole Borough for the year 1906. D1sease Classes. Lee D1v1s1on. Lew1sham D1v1s1on. Sydenham and Forest H1ll D1v1s1on 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 1. 1nfect1ve 6 8 9 7 25 22 26 75 24 147 13 10 33 12 68 41 39 117 43 240 11. Tuberculous 4 2 2 6 14 29 22 23 27 101 15 9 17 19 60 48 33 42 52 175 111. Mal1gnant 9 2 7 5 23 22 11 22 21 76 7 8 14 8 37 38 21 43 34 136 1V. Nervous 4 1 4 3 12 13 23 21 20 77 11 4 9 5 29 28 28 34 28 118 V. Heart & Blood Vessels. 5 9 11 14 39 31 44 23 41 139 20 31 20 28 99 56 84 54 83 277 V1. Resp1ratory 17 3 — 11 31 51 37 18 41 147 45 11 7 19 82 113 51 25 71 260 V11. D1gest1ve 7 4 5 9 25 25 22 30 17 95 22 10 21 9 62 54 36 56 35 182 V111. Ur1nary 3 2 2 3 10 11 6 7 8 32 7 2 4 2 15 21 10 13 13 57 1X. Generat1ve Organs . 1 — . 1 — . — 1 1 — 1 — 1 2 — 2 — 2 4 X. General 9 7 7 6 29 50 38 29 30 146 19 29 16 33 97 78 74 52 69 272 X1. Acc1dents 1 — 1 — 2 10 5 9 5 29 4 3 2 2 11 15 8 12 7 42 X11. V1olence — — — — — 1 3 4 2 10 1 1 2 — 4 2 4 6 2 14 Totals 65 34 48 64 211 265 237 261 237 1000 164 119 145 138 566 494 390 454 439 1777 . For D1seases 1n each Class see Table 14. 42 Table 12. Death Rates per 1,000 of the populat1on, 1n D1sease Groups, 1n the Wards and D1v1s1ons of the Borough for the year 1906. D1sease Class Wards and D1v1s1ons. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Church Manor South Lee Blackheath Lew1sham V1llage Lew1sham Park Brockley Catford Lew1sham Forest H1ll Sydenham Sydenham and Forest H11l Whole Borough 1. 1nfect1ve 1.6 1.0 1.2 1.3 1.8 1.5 1.8 1.8 1.9 1.8 1.0 1.8 1.5 1.6 11. Tuberculous 0.7 0.8 0.5 0.7 0.9 1.2 1.9 1.3 1.0 1.2 1.0 1.4 1.3 1.2 111. Mal1gnant 0.7 1.4 1.4 1.2 0.6 1.1 1.1 0.5 1.0 0.9 0.9 0.7 0.8 0.9 1V. Nervous 0.6 0.8 0.4 0.6 1.2 1.1 1.3 0.9 0.7 0.9 0.3 0.8 0.6 0.8 V. Heart and Blood Vessels 1.7 2.9 1.1 2.0 2.6 1.8 1.7 1.5 1.5 1.7 2.1 2.1 2.1 1.9 V1. Resp1ratory 1.9 1.0 2.0 1.6 1.3 1.4 2.1 1.8 1.9 1.8 2.1 1.5 1.8 1.8 V11. D1gest1ve 1.2 1.4 1.2 1.3 1.0 0.9 1.4 1.1 1.2 1.2 1.2 1.4 1.3 1.2 V111. Ur1nary 0.4 0.7 0.4 0.5 0.1 0.5 0.2 0.5 0.4 0.4 0.5 0.2 0.3 0.4 1X. Generat1ve Organs . . 0.2 0.1 . . . . 0.0 0.0 . 0.1 0.0 0. 0 X. General D1seases 1.9 1.5 0.9 1.5 1.3 2.2 2.3 1.5 1.5 1.8 2.3 1.9 2.1 1.8 X1. Acc1dents 0.3 — — 0.1 0.9 0.4 0. 2 0. 2 0.3 0. 4 0.2 0.3 0.2 0.3 X11. V1olence — — — . 0.1 0.3 0.1 — 0.1 0.1 0 .1 0. 1 0.1 0.1 Total Deaths. 11.0 11.3 9.3 10.6 11.8 12.4 14.2 11.0 11.6 12.2 11.7 12.4 12.1 12.0 43 Table 13. B1rth and Death Rates of London and Metropol1tan Boroughs dur1ng the year 1906, after d1str1but1on of Deaths 1n Publ1c 1nst1tut1ons. Boroughs Per 1000 Persons L1v1ng. B1rths. Deaths from Deaths under 1 year to 100) B1rths reg1stered All Causes Pr1nc1pal Ep1dem1c D1seases Small.Pox Measles Scarlet Fever D1phther1a Whoop1ng.Cough Typhus [ Enter1c Fever Pyrex1a. (Or1g1n uncerta1n) D1arrhoea Phth1s1s Cnty of L.nD.n 26.5 15.1 1.92 — 0.40 0.11 0.15 0. 26 . 0.06 0.00 0.94 1.44 131 West. Padd1ngton 22.7 12.5 1.30 — 0.11 0.12 0.10 0.08 — 0.05 . 0.84 1.12 105 Kens1ngton 19.2 13. 8 1.56 — 0.45 0.06 0.11 0.11 — 0.03 . 0.80 1.27 132 Hammersm1th 25.9 14.8 2.13 — 0.47 0.12 0.22 0.16 — 0.07 — 1.09 1.25 138 Pulham 30.0 13.7 2. 40 — 0.33 0.11 0.20 0.19 — 0.08 — 1.49 1.13 134 Chelsea 21.4 15.7 2.03 — 0.78 0.12 0. 20 0 .23 — — — 0.70 1. 57 133 Cty of Wstmstr 172 129 0.84 . 0.10 0.08 0.09 0.13 — 0.03 0.01 0.40 1.39 110 North St. Marylebone 21.2 14.9 1.28 . 0.37 0.11 0.09 0.09 . 0.02 . 0.60 1. 56 117 Hampstead 16.5 9.4 0.57 — 0.11 0.06 0.09 0.02 . 0.03 . 0.26 0.67 77 St. Panoras 26.0 15.9 1 .65 — 0.41 0.14 0.10 0.30 . 0.06 0.00 0.64 1.81 123 1sl1ngton 25.5 14.7 1.62 — 0.56 0.11 0.09 0.22 . 0.06 — 0.58 1.23 124 Stoke Nw1ngtn 20.8 11.5 1.10 — 0.21 0.02 0.08 0.32 . . . 0 .47 1.04 102 Hackney 24.7 13.3 1.58 — 0.28 0.10 0.09 0.17 — 0.06 — 0.88 1. 30 119 Central. Holborn 22.3 18.0 1.44 — 0.45 0.05 0.11 0. 18 — 0 .02 — 0.63 2. 37 120 F1nsbury 30.2 20. 7 3.59 — 1.27 0.15 0.24 0.56 . 0.14 — 1.23 2.18 160 C1ty of London 16.7 17.3 1.08 — 0. 14 0.33 0.09 0.19 . 0.05 — 0.28 1.74 101 East. Shored1tch 34.2 19.6 3.13 — 0.65 0.16 0. 13 0.53 . 0.04 . 1.62 2.01 163 Bethnal Green 34.5 18.9 2.55 — 0.46 0.17 0.15 0.48 . 0.11 — 1.18 2.25 155 Stepney 35.3 17.7 ..74 — 0.57 0.12 0.20 0.34 . 0. 08 . 1.43 1.72 134 Poplar 31.6 17.6 2 .95 — 0.63 0.08 0.16 0. 31 — 0.06 — 1.71 1.55 152 South. Southwark 29. 8 18.1 2.23 — 0.46 0.22 0.15 0. 26 . 0.06 . 1.08 2.06 144 Bermondsey 31.8 19.7 2.94 — 0.73 0.23 0.26 0.40 . 0.03 . 1.29 2.01 153 Lambeth 26.3 15.0 1.69 — 0.24 0.09 0.16 0.23 . 0. 07 0.00 0.90 1.37 131 Battersea 26.2 13.4 1. 82 — 0.23 0.13 0.10 0.44 . 0.04 — 0.88 1.28 126 Wandsworth 26 .4 12.8 1.60 — 0.24 0.07 0.18 0.22 . 0.06 . 0.83 1.01 121 Camberwell 25.7 14.6 1.88 — 0.41 0.09 0.15 0.28 . 0.05 — 0 .90 1.26 130 Deptford 28.6 16. 1 2.69 — 0.60 0.13 0.17 0.54 . 0.05 — 1.20 1.28 143 Greenw1ch 25.4 13.5 1.87 — 0.29 0.16 0.28 0.40 . 0.05 . 0.69 1.19 119 Lew1sham 23.2 12. 0 1. 31 . 0.14 0.09 0.14 0.18 . 0. 01 . 0.75 0.80 113 Woolw1ch 27.9 13.1 1.52 — 0.24 0.04 0.17 0.17 — 0.07 — 0.83 1.33 109 1n th1s Table 0.00 1nd1cates that the deaths were too few to g1ve a rate of 0.005; where no death occurred, — 1s 1nserted. "Or1g1nally descr1bed S1mple Cont1nued Fever. 44 .Table 14. Death.rates dur1ng 1906 1n London and the several Metropol1tan Boroughs, from All Causes, and from Certa1n D1seases (1) before D1str1but1on, (2) after D1str1but1on of Deaths 1n Publ1c 1nst1tut1ons, etc. Boroughs. Death.rates per 1000 L1v1ng. All Causes. Scarlet Fever. D1phther1a Enter1c Fever Phth1s1s Before D1str1but1on After D1str1but1on Before D1str1but1on After D1str1but1on Before D1str1but1on After D1str1but1on Before D1str1but1on After D1str1but1on Before D1str1but1on After D1str1but1on County of London 15.3 15.1 0.10 0.11 0.14 0.15 0. 05 0.06 1.42 1.44 West. Padd1ngton 13 .7 12. 5 0.01 0. 12 0.05 0.10 0. 05 0.05 1.13 1. 12 Kens1ngton 15.6 13.8 0.01 0.06 0.04 0.11 o.01 0.03 1.93 1.27 Hammersm1th 13.2 14.8 — 0.12 0.04 0.22 0.02 0.07 0.90 1.25 Fulham 13.6 13.7 0.41 0.11 0. 55 0.20 0.15 0.08 1.15 1.13 Chelsea 22. 9 15.7 0.01 0.12 0.08 0.20 . . 3.10 1.57 C1ty of Westm'r 14.3 12. 9 0. 01 0.08 0.06 0.09 0.02 0.03 0.84 1. 39 North. St. Marylebone 13.6 14.9 — 0.11 0.07 0.09 . 0.02 0.86 1.56 Hampstead 12.3 9.4 0.82 0.06 0.40 0.09 0.08 0.03 1.72 0.67 St. Pancras 16.1 15.9 0.01 0.14 0.06 0.10 0.03 0.06 1.81 1.81 1sl1ngton 14.5 14.7 0.03 0.11 0. 05 0.09 0.04 0.06 1.40 1.23 Stoke New1ngton 9.3 11.5 — 0.02 0.02 0.08 — . 0.83 1.04 Hackney 14.4 13.3 0.22 0.10 0.23 0.09 0.12 0.06 1.45 1.30 Central. Holborn 21.8 18.0 . 0 .05 0. 16 0.11 . 0.02 1.53 2.37 F1nsbury 10.5 20.7 0.01 0.15 . 0.24 . 0.14 0.80 2.18 C1ty of London 44.5 1.73 0.05 0.33 0.80 0.09 0.56 0.05 2.16 1.74 East. Shored1tch 18.5 19. 6 . 0.16 0.03 0.13 0.01 0.04 1.96 2.01 Bethnal Green 18.4 18.9 0.03 0.17 0. 06 0.15 0.05 0.11 2.40 2.25 Stepney 19.1 17.7 0.01 0.12 0.12 0.20 0.10 0.08 1.46 1.72 Poplar 1.80 17.6 0.01 0.08 0.05 0.16 0.06 0.06 1.81 1.55 South. Southwark 15.6 18.1 . 0.22 0.11 0.15 0.02 0.06 1.15 2.06 Bermondsey 15.4 19.7 — 0.23 0.04 0.26 0. 01 0. 03 1.73 2.01 Lambeth 16.0 15.0 0.17 0.09 0.22 0.16 0.10 0.07 1.32 1.37 Battersea 13.5 13. 4 — 0.13 0.02 0.10 0.01 0.04 1.32 1.28 Wandsworth 12.3 12.8 0.22 0.07 0.26 0.18 0.07 0.06 1.05 1.01 Camberwell 15.8 14.6 0.00 0.09 0.06 0.15 0.02 0.05 1.81 1.26 Deptford 12.1 16.1 0.20 0.13 0.30 0.17 0.06 0.05 0.80 1.28 Greenwich 17.5 13. 5 0.47 0.16 0.57 0.28 0.17 0.05 1.71 1.19 Lew1sham 12 .8 12.0 0.44 0 .09 0.37 0.14 0.01 0.01 0.80 0.80 Woolwich 12.1 13.1 0. 02 0.04 0. 05 0.17 0.03 0.07 1. 28 1. 33 .Taken from Reg1strar.General.s Summary. 45 Table 15. Causes of, and Ages at, Death in the Borough of Lewisham for the year 1906. Causes ok Death. Deaths Whole Borough Borough Divisions Deaths in Public Institutions in the Bornncrh Deaths of Residents outside the Boronph 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 1 2 3 4 5 6 7 8 9 10 11 12 13 Class I.—Infective Diseases 1 Small.Pox . . . . . . . . . . . . . 2 Measles 3 17 1 — . — 21 3 12 6 3 . 1 3 Scarlet Fever — 10 4 — — — 14 3 10 1 64 5 56 4 Typhus Fever — — — — — . . . . . . . . 5 Plague — — — — . — . . . . . . . 6 Influenza 1 1 — 1 9 8 20 4 7 9 2 . 2 7 Whooping Cough 12 14 — — — — 26 . 20 6 1 . . 8 Diphtheria 2 9 10 — — — 21 1 10 10 50 3 37 9 Enteric Fever — — — — 1 — 1 . 1 . 1 1 1 10 Epidemic Diarrhoea 57 11 — . — — 68 7 43 18 . 2 . 11 Epidemic Enteritis 39 4 — . . . 43 4 26 13 16 2 1 12 Dysentry — — — . . — . . . . . . . 13 Venereal Diseases 5 — . — . . 5 1 4 . . 1 . 14 Puerperal Septicœmia Fev — — — — 2 — 2 1 1 . . . . 15 Infective Endocarditis — — — — . _ . . . . . . . 16 Erysipelas — — . 1 2 . 3 . 2 1 3 . . 17 Septiccemia not Puerperal 2 1 — 1 2 1 7 1 4 2 2 1 . 18 Pysemia 2 — 1 — . . 3 . 2 1 2 1 1 19 Other Septic Diseases 2 — . 1 2 1 6 . 5 1 3 . . Class II.— Tuberculous ; Diseases 20 Phthisis — 1 1 25 89 3 119 6 76 37 42 11 8 21 Meningitis 8 7 3 — — — 18 5 4 9 6 . 2 22 Peritonitis 1 2 1 2 . . 6 1 4 1 1 . 1 23 Scrofula . — . . . . . . . . . . 24 Other Tuberculous Dis 5 9 8 2 7 1 32 2 17 13 15 2 2 lass III. Malignant Diseases 25 Cancer, Carcinoma — — . . 65 40 105 16 61 28 30 9 4 26 Sarcoma — 1 ] . 2 4 8 . 5 3 1 . . 27 Other Malignant Diseases — — . . 15 8 23 7 10 6 4 2 1 C Class IV.— Nervous Diseases 28 Meningitis (not Tuber.) 4 10 6 2 5 1 28 2 22 4 3 4 2 29 Insanity (G. P. Insane) — — . — 19 13 32 1 21 10 7 18 30 Epilepsy 2 — — — 5 3 10 2 6 2 3 2 1 31 Convulsions 11 7 . . . . 18 3 10 5 2 . 1 32 Locomotor Ataxy — — . . . 1 1 . 1 . . . . 33 Paraplegia, Dis. of Cord — — . . 5 . 5 2 2 1 4 1 2 34 Other Nervous Diseases 1 1 . 1 19 2 24 2 15 7 9 3 3 Class .V.— Diseases of Heart and Blood Vessels 35 Valvular Disease, Endocarditis — — 1 7 51 24 83 11 44 28 21 4 1 36 37 Cerebral Haemorrhage — — . . 25 35 60 9 26 25 32 6 14 Thrombosis . . . . . 2 2 . 1 1 . . . 38 Apoplexy, Hemiplegia — — . . 31 16 27 4 13 10 1 . . .89 Aneurysm — — — . 8 1 4 . 1 3 1 1 1 40 Embolism — — 1 . 1 . 2 . 2 . . . . 41 Thrombosis, not Cerebral . — . . 2 . 2 . 1 1 . . . 42 Other Dis. Heart and Blood Vessels 9 — 4 1 41 42 97 15 51 31 21 11 12 46 Table 15—continued. Causes of Death Deaths Whole Borough Borough Divisions Deaths in Public Institutions in Borough Deaths of Residents outside Borough Deaths of Non.residents in Borough Under 1 year 1 and under 9 years 3 and under 19 years 13 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee Lewisham Sydenham ana forest Hill 1 2 3 4 3 6 7 8 9 10 11 12 13 Class VI.— Respiratory Diseases 43 Croup (not Spasm, or Membranous) — 1 — — — — 1 — — 1 — — — 44 Bronchitis 18 6 — 1 20 69 114 13 64 37 45 — 18 45 Pneumonia 24 24 4 1 47 19 119 14 75 30 35 6 11 46 Asthma Emphysema — — — — 4 1 5 1 2 2 — — — 47 Pleurisy — — — — 3 2 5 2 2 1 — — — 48 Other Respiratory Dis. 4 2 — — 6 4 16 1 4 11 3 — 2 Class VII.— Digestive ; Diseases 49 Enteritis (not Epidemic) 4 2 — — 1 1 8 — 5 3 3 — 2 50 Gastro Enteritis 17 4 1 — 1 2 25 2 15 8 7 1 — 51 Peritonitis (not Puerperal) — — 1 2 7 3 13 3 6 4 6 1 52 Cirrhosis of Liver. — — — — 11 3 14 2 6 6 1 — 1 53 Gastric Ulcer (Perforation of) . . . . 7 — 7 3 2 2 2 1 — 54 Other Digestive Diseases 72 7 2 2 14 18 115 15 61 39 46 1 6 Class VIII.— Urinary Diseases 55 Nephritis. Acute — — 1 1 1 — 3 1 1 1 2 — 1 56 Bright's Disease — — — 2 23 13 38 7 22 9 9 1 2 57 Other Urinary Diseases — — — — 6 10 16 2 9 5 7 2 — Class \ IX. I 58 Generative Organs, Diseases of . . . . 4 — 4 1 1 2 1 — — 59 Old Age — — — — 1 129 130 17 65 48 54 — 17 Class X.— General Diseases 60 Premature Birth 65 — — — — 65 4 40 21 — 1 — 61 Chronic Rheumatism . — — — — 1 1 — 1 — 2 . 2 62 Rheumatic Fever . . — 2 3 1 6 1 4 1 2 — 2 6.3 Parturition, Diseases and Accidents of — — 1 4 — 5 — 4 1 1 — 64 Alcoholism — — 1 9 1 5 3 1 — 65 Gout — _ 2 2 4 — 2 2 — 1 66 Diabetes Melletus — — 3 6 15 2 5 2 — — 67 All Other Diseases 13 5 2 1 13 3 37 4 20 13 10 2 1 Class XI.— Accidents 68 Burning 1 1 1 — 1 4 — 4 3 1 — 69 Overlaying 4 — — — — 4 — 4 — — — 70 Poison 2 2 — — 71 Drowning — 1 — 1 1 — 1 — 72 Other Accidents 2 3 3 5 8 10 31 2 20 16 7 6 Class XII.. Vio. lence 73 Homicide — . — — — — — — — — — 1 74 Suicide — . 2 11 1 14 10 4 3 1 1 Grand Totals 391 160 57 68 596 505 1777 211 1000 56( 61C 117 228 Note . Columns 1 to 10 include deaths of Residents in the Borough, in outside Districts and in Public Institutions. 47 Table 16. Residents and Non Residents dying in Public Institutions situated in the Borough. Institution. Deaths of Residents. Deaths of Non. Residents. Total The Park Hospital 20 97 117 Lewisham Infirmary 349 28 377 Lewisham Workhouse 13 — 13 Bermondsey (St. Olave's) Workhouse 1 71 72 St. John's Hospital 6 10 16 Home for Sick Children, Lower Sydenham 4 9 13 Greenwich Union Work. house, Grove Park 1 6 7 Flower House, Southend Catford 1 — 1 Totals 395 221 616 In addition to the above, deaths of non.residents occurred as follows:— Two on the London, Brighton and South Coast Railway, thrHee on the South Eastern and Chatham Railway, one in Stanstead Road and 1 in Beckenham Place Park. 48 Deaths of Residents Belonging to the Borough occurring in Public Institutions, etc., in districts outside during the year 1906. Fever Hospitals:— Brook Hospital 8 South.Eastern Hospital 1 General Hospitals:— Guy's Hospital 12 Charing Cross Hospital 5 St. Thomas' Hospital 4 St. Bartholomew's Hospital 3 Middlesex Hospital 2 Miller Hospital, Greenwich 2 Westminster Hospital 2 London Temperance Hospital 2 Children's Hospital, Great Ormonde Street 1 London Hospital 1 University College Hospital 1 St. George's Hospital 1 Asylums:— Dartford Heath Asylum 20 Cane Hill Asylum 6 Caterham Asylum 4 Banstead Asylum .. 2 Claybury Asylum 2 Peckham House Asylum 2 Horton Asylum 1 Camberwell House Asylum 1 City of London Asylum, Stone 1 Manor Asylum, Epsom 1 Other Institutions: — Blaekheath and Charlton Cottage Hospital 1 Brompton Hosipital 1 Bolingbroke Hospital 1 Cancer Hospital, Chelsea 1 Clapham Maternity Hospital 1 Other Institutions: Continued. Cotswold Sanatorium, ham 1 East London Industrial Hospital, Sliadwell 1 Friedenheim Hospital, Hampstead 2 Greenwich Workhouse 1 Hackney Infirmary 1 Hostel of God 1 Home for Friendless Girls, Carshalton 1 Kvidbrook House Nursing Home 1 London Homoeopathic Hospital 1 Salvation Army Maternity Hospital .. 1 St. Luke's House, Kensington 1 Throat Hospital, Golden Square 1 Various:— Upper Wimpole Street, W. 1 Central Park, Ilford 1 Creek Street, Deptlord 1 Abcliurch Lane 1 In a Restaurant, Cheapside 1 Clacton.on.Sea 1 Maida Vale 1 On the way to St. George's Hospital 1 Pelham Place, Broinpton 1 L. B. & S. C. Railway, Leigham Vale 1 S.E. & C. Railway, St. Paul's 1 S.E. & C. Railway, Waterloo 1 River Thames 1 Sewer Works, Shooter's Hill Road 1 49 Table 17. Deaths from Principal Zymotic Diseases in Wards, during the year 1906. Localities Small.Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhus Fever Enteric Fever Pyrexia (origin uncertain) Epidemic Diarrhœa & Epidemic Enteritis Totals Death Hates from Principal Zymotic Diseases. Church Ward — 2 2 1 . — — — 4 9 1.81 Manor Ward — — 1 — — — — — 4 5 0.68 South Ward — 1 — — — — — — 3 4 0.55 Lee Division — 3 3 1 — . — — 11 18 0.91 Blackheath Wd — 1 1 1 2 . — — 4 9 1.31 Lew. Vill. Wd. — 2 6 2 2 — — — 7 19 1.28 Lew. Pk. Wd. — 5 1 1 4 — — — 14 25 1.52 Brockley Ward — 1 1 1 2 — — — 10 15 1.29 Catford Ward — 3 1 5 10 — 1 — 34 54 1.67 Lewisham Div. — 12 10 10 20 — 1 — 69 122 1.49 Forest Hill Wd. 1 1 1 — — 9 12 0 .65 Sydenham Ward — 5 — 9 6 — — — 22 42 1.48 Sydenham and Forest Hill Div. — 6 1 10 6 — — — 31 54 1.16 Whole Borough — 21 14 21 26 — 1 — 111 194 1.31 County of Loudon — 1909 533 691 1226 — 260 4 4424 9047 1.92 76 Great Towns 18 6258 1948 2982 4405 — 1448 18371 35430 2.24 . Originally termed Simple Continued Fever. 50 Table 18. 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 1906. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough County of London. 76 Great Towns. Small.Pox . . . — . 0.00 Measles 0.15 0.15 0.13 0.14 0.40 0.40 Scarlet Fever 0.15 0.12 0.02 0.09 0.11 0.12 Diphtheria 0.05 0.12 0.21 0.14 0.15 0.19 Whooping Cough — 0.24 0.13 0.18 0.26 0.28 Enteric Fever — 0.01 — 0.01 0.06 0.09 Epidemic Diarrhoea and Enteritis 0.55 0.84 0.66 0.75 0.94 116 Total Zymotic Death Rates 0.91 1.49 1.16 131 1.92 2.24 Infantile Mortality Rate 90 118 116 113 131 146 Phthisis Death Rate 0.30 0.93 0.79 0.80 1.44 — Comparative Rates for other Boroughs will be found in Table 13. 51 Table 19. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1906. Ages. Small.Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Epidemic Diarrhoea and Enteritis. Dysentry. Totals in Age Groups. Under 1 year . 3 — 2 12 — 96 . 113 1 and under 5 years . 17 10 9 14 — 15 . 65 5 and under 15 years . 1 4 10 — — — . 15 15 and under 25 years . . . . . l . . 1 25 years and upwards . . . . . . . . . Total all ages . 21 14 21 26 1 111 . 194 Note.—Typhus h'ever should be included in the list of Principal Zymotic Diseases. It is omitted in the above table, as no cases occurred during the year. 52 Table 20. Meteriological Table for London for the Year 1906. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1906. Month. Barometer. AIR TEMPERATURE. Bright Sunshine. Rain and other forms of Precipitation Mean pressure at 32 F. at Station Level (Bar. 159 ft. above M.S.L.) Mean of Absolute Minimum & Maximum. Total possible. Total observed Nu+mber of Days. Total Fall. Most in a day. Minimum A Maximum B Minimum. Day of' Month Maximum. Day of Month. Amount Day of Month Ins. 0 0 0 0 Hours Hours Ins. Ins. January 29.793 37.4 46.9 25.8 23 53.2 13 259 54.9 18 3.71 0.61 16 February 29.601 33.5 44.3 26.1 22 50.7 16 277 62.8 18 1.80 0.60 17 March 29.833 35.6 48.8 27.4 3 65.0 7 365 101.4 18 1.09 0.23 10 April 29.904 35.2 57. 28.1 20 73.2 12 413 218.5 9 0.67 0.26 28 May 29.696 44.4 H 31.6 18 76.2 8 481 153.0 12 1.57 0.79 20 June 29.951 47.9 69.8 37.6 5 82.0 20 495 241.2 7 2.80 1.90 29 July 29.865 53 3 75.4 45.1 1 86.2 18 498 262.6 7 0.41 0.17 19 August 29.831 54.4 77.0 44.1 29 94.3 31 451 248.7 8 1.39 0.79 2 September 30.026 49.3 69.8 37.1 27 93.5 2 379 185.7 11 1.97 0.57 5 October 29.684 46.9 61.8 32.1 26 71.8 1 331 128.0 17 3.04 0.92 30 November 29.711 40.4 51.5 28.5 19 60.3 22 266 45.1 17 4.11 1.28 8 December 29.787 32.0 42.3 19.8 30 54.3 3 244 32.6 19 2.16 0.47 16 Year 29.807 42.5 58.9 — — — — 4459 1734.5 161 24.72 — — Abstracted from the report of the Registrar.General PART 2. INFECTIOUS DISEASES. 55 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 945, of which number 731, or 77 per cent., were removed for isolation to the Metropolitan Asylums Board's Hospitals or other Institutions. In 35 instances, or 4.78 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, we have a corrected total of 910 cases of infectious disease notified as occurring in the Borough during the year, an increase of 60 over the number notified in the preceding year, which was 850. In 1904, 552 cases were notified, and in 1903, 832. Age Periods.—47.8 per cent. of the Scarlet Fever cases, compared with 50 per cent. in 1905, and 54.9 per cent. of the Diphtheria cases, compared with 50 per cent. in 1905, occurred among children aged six years and under. The following figures show the percentage of cases occur. ing among children of the age of six years and under to the total notifications of Scarlet Fever and Diphtheria:— Age. Scarlet Fever. Diphtheria. 1904 1905 1906. 1904. 1905. 1906. 6 years and under 54% 50% 47.8% 44% 50% 54.9% 5 „ 44% 36% 39% 40% 42% 44.6% 4 „ 29% 25% 28% 34% 34% 32% 56 Table 21. Age Periods of Scarlet Fever and Diphtheria, notified during the year 1906. Age Periods. Scarlet Fever. Diphtheria. Number, of Cases. Percentage to Total Cases Number of Cases. Percentage to Total Cases Under 1 year 2 0.37 2 0.8.2 1 to 2 years 18 3.31 14 5.74 2 „ 3 „ 31 5.70 12 4.91 3 ,, 4 ,, 50 9.20 24 9.83 4 „ 5 „ 51 9.39 27 11.06 5 „ 10 „ 235 43.27 93 38.11 10 „ 15 „ 89 16.39 36 14.75 15 „ 25 „ 45 8.28 11 4.50 25 years and over 22 4.05 25 10.24 At all ages 543 100.00 244 100.00 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 '24). The attack rate from all notifiable diseases (excluding Puerperal Fever) during the year amounted to 6.08 per 1,000 of the population, compared with 5.88 in 1905, and 3.93 in 1904. This slight increase is due to increased attack rate from Diphtheria as will be seen in Table 23. The attack rate for the County of London was 7.42, compared with 7.01 in 1905. The attack rates for the Wards will be found in Table 23. It will be seen that Blaekheath Ward had the greatest 57 number of cases in comparison with its population. having an attack rate of 9.19 per 1.000. The lowest attack rate was in Church Ward. Lee. 3.77 per 1.000. Table 22. Number of Cases of Infectious Diseases notified in the Ten Wards and the Whole Borough during the Year 1906. Wards. Scarlet Fever. Diphtheria. Enteric Fever Puerperal Fever. | Erysipelas. Total. 1 Church 13 8 . . 5 26 2 Manor 28 7 l . 2 38 3 South 21 9 — l 1 32 Lee Division 62 24 l l 8 96 4 Blackheath 43 14 2 — 4 63 5 Lewisham Village 67 18 — — 6 91 6 Lewisham Park 78 28 2 l 17 126 7 Brockley 41 17 — — 15 73 8 Catford 117 69 4 l 21 212 Blackheath & Lewisham Div. 346 146 8 2 63 565 9 Forest Hill 64 29 4 2 7 106 10 Sydenham 71 45 7 1 19 143 Sydenham and Forest Hill Division 135 74 11 3 26 249 Whole Borough 553 244 20 6 97 910 58 Table 23. Attack rates from the Principal Infectious Diseases per 1.000 of the population for the ten Wards. and the whole Borough in the years 1903. 1904. 1905 and 1906. Wards. Diseases Scarlet Fever Diphtheria Enteric Fever Erysipelas Total 1903 1904 1905 1906 1903 1904 1905 1906 1903 1904 1905 1906 1903 1904 1905 1906 1903 1904 1905 1906 Church 166 0.74 2.06 1.88 3.02 0.74 1.18 1.16 0.15 — 0.29 — 0.60 0. 45 0.73 0. 72 5.44 2 08 4.56 3. 77 Manor 4.44 .2.25 8.74 3 .82 4.44 0.28 1.38 0. 95 0.43 — — 0.13 0.56 — 1.11 0. 27 9.88 2.53 11.10 5.19 South 2.70 2.87 5.89 3. 73 1.08 1.07 0.71 1. 60 — 0.36 0. 35 — 0.18 — 0.17 0. 17 3.96 4.30 7.14 5. 51 Blackheath 2.80 2.20 3.36 6.27 3.39 1.17 1.75 2. 04 0.29 — — 0. 29 0.44 1.17 0.58 0.58 6.92 4.70 5.71 9.19 Lewisham Village 1.96 3.39 4.85 4.52 3.64 0.62 0.75 1. 21 0.35 0.27 0.34 — 0.77 0.76 0.82 0. 40 6.87 5.05 7.24 6. 28 Lewisham Park 4.25 2.29 3.76 4.74 1.12 0.90 0.84 1.70 0.37 0.07 0.13 0.12 0.44 0.55 0.64 1.03 6.19 3.82 5.44 7. 66 Brockley 2.40 3.87 4.77 3. 51 1.42 0.97 0.34 1. 46 0.17 0.17 0.26 — 0.44 0.43 1.21 1. 28 4.44 5.53 6.60 6. 27 Catford 5.43 1.90 3.66 3 .62 1.25 0.83 0.81 2.14 0.29 0.10 0.29 0. 12 0.51 0.52 0.78 0.65 7.68 3.43 5.60 6.53 Forest Hill 2.47 1.97 3.93 3.49 0.99 0.71 1.69 1. 58 0.16 0. 22 0.27 0. 21 1. 04 0. 88 0.82 0 .38 4. 73 3. 89 6.78 5. 67 Sydenham 2.57 1.96 1.69 2. 50 1.32 0.96 0.90 1. 59 0.53 0. 26 0.18 0. 24 0.56 0.59 0.57 0. 67 5.04 3.81 3. 61 5. 01 Whole Borough 3.28 2.29 3.79 3. 65 1.83 0.83 0.98 1. 64 0.31 0.16 0.22 0 .13 0.60 0.58 0.75 0. 65 6. 09 3.93 5.88 6. 08 Chart C. Showing Weekly Notifications of all Infectious Diseases; also Weekly Notifications of Scarlet Fever and Diphtheria. during the year 1906. 59 SCARLET FEVER.— The total number of cases notified daring the year amounted to 558. compared with 576 in 1905. Of this number. 469. or 85 per cent were removed to the Metropolitan Asylums Board.s Hospitals. Subsequently 15 cases stated to be not suffering from any infectious disease were returned to their homes. Deducting this number. a corrected total of 543 is obtained. compared with 548 in 1905. equal to an attack rate of 3.65 per 1.000 persons. compared with 3.79 in 1905. a slight decrease. The attack rate for the County of London was 4.30. An examination of the attack rates for the various Wards shows that the highest occurred in Blackheath Ward (0.37 per 1.000) and that the Ward least affected was Church Ward. Lee. with 1.88. Forty.three per cent. of the cases occurred among children between the ages of 5 and 10 years. and 28 per cent. to children under the age of five. Case Mortality.—Of the 543 cases. 2.57 per cent. proved fatal. compared with 0.91 per cent. in the preceding year. from which it will be seen that although the number of cases notified was less than in 1905. the disease assumed a more severe type. causing a much higher mortality. DIPHTHERIA.—Two hundred and sixty cases of Diphtheria were notified. compared with 157 in 1905. of which number 210. or 81 per cent were removed to hospital. Sixteen cases were returned home as not suffering. giving a corrected total of 244. an increase of 102 over the figure for 1905 (142). The attack rate per 1.000 of the population amounted to 1.64. compared with 0.98 in 1905. The rate for the County of London was 1.70. 60 Catford Ward suffered most from this disease. having an attack rate of 2.14. Manor Ward. Lee. was least affected. having an attack rate of 0.95 per 1.000. The number of cases of Diphtheria notified in London generally during the year showed a marked increase in the prevalence of the disease compared with 1905. Case Mortality.— Of the 244 cases. 8.6 per cent. proved fatal. compared with 5.6 per cent. in 1905. ENTERIC or TYPHOID FEVER.— Twenty.four cases were notified. 15 of which were removed to Hospital. Four were returned home as not suffering. giving a corrected total of 20. a decrease of 13 from the preceding year. The attack rate for the whole Borough was 0.13 per 1.000. compared with 0.22 in 1905. The highest attack rate was in Blackheath Ward 0.29. The case mortality equalled 5 per cent against 18.18 per cent. in 1905. ERYSIPELAS.— Ninety.seven cases of Erysipelas were notified. compared with 109 in the preceding year. PUERPERAL FEVER.— Six cases of Puerperal fever were notified during the year. 1 of which was removed to the Infirmary. Three of the cases proved fatal. Case 1 The Woodlands. Hither Green. Case 2 Whatman Road. Forest Hill. Case 3 Ronver Road. Lee. Case 4 Sangley Road. Catford. Case 5 Porthcawe Road. Lower Sydenham. Case 6 Malham Road. Forest Hill. 61 Table 24. Attack Rates per 1.000 persons living at all ages from Small.Pox. Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the Years 1903. 1904. 1905 and 1906. Borough. Small.Pox. Scarlet Fever. Diphtheria. All Notifiable Infectious Diseases. 1903 1904. 1905. 1906 1903. 1904. 1905 1906 1903. 1904 1905. 1906 1903. 1904. 1905. 1906 Battersea 0 .21 0.04 — — 2.73 2.19 4.77 5.83 1.81 1.29 1.08 1.53 6. 18 4.84 7.13 8.51 Bermondsey 0.05 014 — 0.00 3.08 3.50 5.82 7.69 1. 34 1.49 1.29 2.61 6 66 7 .19 8.73 12.16 Bethnal Green 0.02 0.96 0.00 0.04 3.01 5.07 6.09 4.97 1.86 3.26 2.33 1.92 7.07 11.59 10.53 9.24 Camber well 0.07 007 0 .04 0.02 2.50 3.52 4.46 4.23 1.37 1.00 0.91 1 .29 5.25 6.20 7.04 6.87 Chelsea 0.09 — — 2.81 1.45 3.03 3.62 1.32 0.82 0.72 2 .16 5. 23 3.14 5.15 6.82 Deptford 0.01 009 0 .1 0.00 4.46 3.56 5.30 5.56 4.05 1.72 1.29 2.64 10.08 7 .06 8. 30 9.93 Finsbury 0.02 015 0.1 — 2.93 3.34 4.88 4.60 1 29 1.47 1.42 2.31 5.92 6.56 8. 01 8.52 Fulham 0.07 — — — 2.74 1.93 4.96 4.16 1.98 1.96 1 81 2.49 6. 27 5 .06 8. 21 7.79 Greenwich 0.04 0 01 0.3 — 1.64 2.09 2.77 5.38 2 08 1 .49 1.40 3.88 5. 01 4.94 5.42 10.62 Hackney 0.01 005 0.1 0.03 2.97 3.79 4.66 4.54 2.43 2.33 1.68 1.68 8. 01 8.48 8.40 7.99 Hammersmith 0.06 — — — 2.72 2.42 3.02 3.62 1.43 1.74 2 03 2. 33 5.73 5 .64 6.53 7.24 Hampstead 0.01 0 01 — — 2.04 1.83 2.04 4.31 1.00 0.66 074 1.10 3. 90 3. 66 3.52 6.23 Holborn 0.03 010 0.1 — 2 .48 1.71 2.76 2.47 0.89 0. 60 0 81 1.18 6.02 4.79 4.65 4.94 Islington 0.03 005 0.00 0.00 2.55 3.37 3.49 4.03 2.21 1.01 1.02 1.27 5. 06 5. 71 5.62 6.54 Kensington 0 .02 002 — . 1.87 1.48 1.87 2.65 1.00 1.04 0.72 0.98 4. 31 3.67 3.79 4.62 Lambeth 0.23 008 — . 2.42 2.12 3.27 4.00 1.12 1.05 1.46 1.33 5.06 4.44 5.96 6.49 Lewisham 0 .00 — 0 .5 — 3.28 2.29 3.79 3 .65 1.83 0.83 0 .98 1.64 6.09 3.93 5.88 6.08 London. City of — 008 — — 2.97 1.36 3.38 5.28 1.10 1.70 0.71 0.84 5.09 4.64 5.35 7.44 Padding ton 0.03 0 03 0.01 0.00 2.85 2.47 1.88 4.81 1.02 0.96 0.65 1.22 5 .09 4.66 3.82 7.28 Poplar 0.16 024 . 0 .01 2.65 3.22 5.81 3 .34 2. 50 3 94 2.88 1.45 6.77 9. 25 10.38 6.52 St. Marylebone 0.03 0.00 — — 3.15 2.25 2.14 3.07 1.73 0.90 101 1.09 6.87 4.98 4.80 5.70 St. Pancras 0.13 0 .3 001 — 2.79 3.59 4.17 3.37 2.21 1.48 1.21 1.18 6.48 6.81 6.71 5.95 Shoreditch — 0.2 0 01 — 2.20 2.93 6.80 5.40 1.31 1.66 1.56 1.24 5.68 6.64 9.11 8.25 Southwark 0.19 0.3 — — 2.46 1.99 3.72 7.02 1.70 1.34 1.45 1 .91 6.17 5.41 7.00 11.06 Stepney 0.08 0 .9 003 0.01 2.90 4.15 6.03 3 .93 1.79 2 .70 2 09 1.96 6 .73 9.38 10.29 7.70 StokeNewington 0.03 0.5 002 — 1.67 2.93 3.36 2 .53 0.76 1.16 1.49 0.88 3.78 5.58 5.62 4.49 Wandsworth 0.11 0.2 000 — 3.28 2.95 5.61 3 .91 2.13 1.56 1 31 2.03 6.94 5.94 8.33 7.27 Wtmstr., City ol 0.26 0.3 0 01 — 1.96 1.76 2. 09 3 .08 1.03 0.81 0.68 1.20 4.31 3.66 3.79 5.30 Woolwich 0.04 0.00 005 . 3.21 3.80 4.09 4.12 1.51 1.32 2.18 3.03 5.64 6.04 7.31 8.15 London. Cnty. of 0.09 0.10 001 0.00 2. 71 2.89 4.15 4.30 1. 67 1.55 1.38 1.70 6 .00 6.08 7.01 7.42 *Note.—Chicken Pox. which was notifiable during parts of 1903 and 1904. has been omitted from this Table 62 MEASLES, WHOOPING COUGH, AND CHICKEN POX. These diseases, not being compulsorily notifiable, are brought to our notice 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.— The number of cases of measles brought to our notice in this manner showed a considerable decrease over the preceding year, only 349 cases being notified, as against 1205 in 1905. Where cases occurred in the poorer districts the homes were visited by the Women Sanitary Inspectors with the object of impressing the parents with the very infectious nature of the disease, and the need of precautions to prevent its spread. One hundred and twenty.three visits were made for this purpose. Chicken.pox.— One hundred and sixty.eight children were notified to be suffering from this disease, compared with 342 in 1905. The Women Sanitary Inspectors made 230 visits to the various homes on this account. The following is a summary of the cases notified from the various Schools :— Number of children suffering. Children excluded on account of infection in their homes. Measles 349 329 Chicken Pox 168 146 Whooping Cough 417 168 Mumps 200 91 Ringworm 193 6 The following is a list of schools closed with a view of preventing the spread of infectious diseases:— On account of Measles. Baking Road L. C.C. School.—Class.room D of Infants' Department closed by the London County Council on February 26th for one week. 63 Brockley Road L. C.C. School.— Infants' Department closed by the Council on March 30th for three weeks. Church Street National School.— Infants' Department closed by Council on April 7th for 14 days. Hazelbank Road L.C.C. School.— Class.rooms A and B of Infants' Department closed by Council on February 27th for 14 days. Northjjrook L.C.C. Schools, Lee.— Infants' Department closed by Council on February 23rd for three weeks, and again on May 9th for 14 days. St. Mary's National School.—Infants' Department closed by Council on March 28th for three weeks. On account of Measles and Scarlet Fever. Manor Lane L.C.C. School.—Whole of School closed for one week by Council on July 19th. On account of Scarlet Fever. St. Michael's School, Lower Sydenham.—Infants' Department closed by Council on November 2nd for 14 days. Lewisham Bridge L.C.C. School.—Class.room H of Boys' Department closed on .Tune 20th by Council for three weeks. On account of Diphtheria. Plassy Road L.C.C. School.—Infants' Department (class.rooms Bi and B2) closed by London County Council from November 13th to November 19th. During the re.laying of the Drainage Systems. St. Stephen's School.—Boys' and Girls' Departments closed by Council from October 30th to November 12th. St. Mary's National School.—Whole of Schools closed by Council on September 7th until September 24th. 64 CHOLERA, PLAGUE AND SMALL.POX. 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 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 Plague 7 and Small.Pox 4. BACTERIOSCOPIC EXAMINATIONS. Facilites were continued for the examination of doubtful cases of Diphtheria. Phthisis and Typhoid Fever. Such examinations are of extreme value to medical practitioners and to the public health department. In many instances the examination prevents the extension of infection by securing an earlier diagnosis than would be possible without it, and so prevents the necessity of keeping an infective person in contact with others in the home until the symptoms become so distinct as to remove all doubt. Many more examinations were made than in the previous year, as the following return will show:— 1905. 1906. re Diphtheria negative 72 148 positive 34 68 doubtful 1 1 re Phthisis negative 22 41 positive 7 20 re Typhoid Fever negative 4 6 positive 2 3 Food Samples 2 9 Total 144 296 65 NOTIFICATION OF PHTHISIS. In January a communication was received from the London County Council asking for the opinion of your Council as to the desirability of compulsory or voluntary notification of phthisis cases being adopted in London. In reference to this matter the following report was submitted:— " So far this disease has been notified voluntarily in 18 " of the 29 Metropolitan Boroughs. " Pulmonary Phthisis (consumption of the lungs) is the " form of Tubercular disease to which we must direct our " special attention. It is due to a living organism which enters " the lungs, where it rapidly multiplies, and finally destroys " these organs, so essential to life. " The disease differs in severity. Acute pulmonary " phthisis may prove fatal in a few weeks, while chronic forms " of the disease may be so insiduous as to escape recognition " for months, and affected persons may live for years suffering " from its effects. " Pulmonary Phthisis is infectious, and is properly " termed an infectious disease. The character of the disease " and the method of its spread differs entirely from any of the " diseases which are already notifiable under the Public Health " Act. At a certain stage of the disease the act of coughing " expels from the lungs large quantities of phlegm, which is " crowded with the infective baccilii or germs. If this is " allowed to fall upon the floor or upon articles of clothing or " furniture it quickly dries and scatters in the form of dust. " If this infected dust be inhaled by other persons it frequently " results in their contracting the disease, while those who are " predisposed by hereditary tendencies and weakness fall " victims to the infection more easily. " Prevalence.— Deaths from the disease unfortunately " formed a marked proportion of the total deaths recorded in " England and Wales. In London alone in 1901, 7,514 deaths " were due to consumption of the lungs. This number equals " a rate of 1.66 per 1,000 of the population. Some of the " poorer districts showed a heavier mortality, while the lowest " rates of mortality were in Lewisham (0.93 per 1,000) and " Hampstead (0.91 per 1,000). 66 Death Rates from Phthisis, 1901.1905. 1901 1902 1903 1904 1905 County of London 1.66 1.60 1.55 1.62 1.41 Highest rates:— Holborn 2.81 3.01 3.14 2.86 2.83 Finsbury — — — 2.39 — Southwark 2.51 2.62 2.40 2.36 2.12 Lowest rates :— Hampstead 0.91 0.85 0.74 0.83 0.83 Lewisham 0.93 1.06 0.78 0.84 0.87 Wandsworth — 0.90 — Paddington — 1.05 — — " The loss sustained by a community in consequence of " this disease is more readily appreciated when we consider " that for every death recorded there are many more persons " living affected with the disease. As the disease usually exists " in a chronic form, the expenses of a long illness must press " severely upon the resources of the family of the patient, thus " depriving many a family of its means of support and " eventually bringing the sufferer and those dependent upon " him to seek financial help and the necessities of life from the " more fortunate members of the community through the " medium of the Poor Law Guardians. " Compulsory notification as a means of prevention " requires serious consideration. It is suggested by many that " this disease should be added to the list of notifiable diseases, " and that the sections of the Public Health (London) Act " relating to infectious diseases should then apply to " consumptives. " Owing to the totally different character of this disease " compared with those already notifiable, compulsory notification " would be irksome and prove a great hardship to many " sufferers, and would also present many difficulties in adminis. " tration. If compulsory notification were adopted power " should be obtained by a statutory measure, which would " provide for the special circumstances of the disease in " question. " Voluntary Notification.—It has been found that only " a very small proportion of the actual cases have been notified " to the Medical Officer of Health under this system. Private " medical practitioners raise the difficulty that unless legally 67 "compelled to comply, any other form of notification might be "considered a breach of trust on their part. This difficulty "removed, voluntary notification would be encouraged and "rendered more useful. "As the cases we most desire information of are among the "poorer classes, I think the Poor Law District Medical Officers "and Medical Superintendents of Poor Law Infirmaries, Work"houses and Charitable Institutions should notify cases direct "to the Medical Officer of Health of the District, while the "London County Council might usefully obtain information "from the special hospitals in London, afterwards forwarding "the names to the various districts. "I think private medical practitioners might with advant"age be invited to notify the Public Health Authority of any "cases of consumption, when the patient consents, and where "they are desirous of the patient having the benefit of advice "from a specially-trained officer as to the precautions to be "taken for their own comfort and benefit, and the protection of "others. "Expectoration being the chief means of disseminating the "disease, all medical practitioners should be reminded of the "facilities which are offered by your Council for the free bacteriological examination of suspicious material (phlegm). "An enactment to provide for disinfection of infected "houses and their contents after a death from Phthisis or on "the removal of the patient to Hospital or to another house, is "needed. "Every effort should be made to educate the public in "regard to the special risks attending the disease, and of its "infectivity. "In conclusion I suggest that your Council agree to "Voluntary Notification of Phthisis cases in which expectoration "is present, although I fear that it will not be so generally acted "upon as many suppose. I also wish to emphasise the "necessity of returns from the Medical Officers of Poor Law "Institutions and districts previously referred to." Your Council having fully considered the matter decided to adopt the voluntary system of notification of phthisis and the following circular letter was addressed to all medical practitioners in the district 68 31s/ May, 1906. " Dear Sib, re VOLUNTARY NOTIFICATION OF PHTHISIS. " I am directed by the Public Health Committee to invite "you to notify to this Department any cases of Pulmonary " Phthisis (Consumption) which may occur in your practice. " The Public Health Committee have had under their con" sideration the importance of taking such measures as will tend " to reduce the mortality from this disease, render its spread " from person to person less likely, and lead to an improvement " in the conditions under which Phthisical patients may be " living. " On receipt of notifications a competent inspector will " call at the house, make a few necessary inquiries, and " examine the sanitary condition of the house*. A card con" taining precautionary instructions will be left with the patient " or relatives. Where possible, disinfection will be carried out " on the death or removal of a patient. " In no case will there be any official interference with the " patient, either at home or at work, beyond the visit of the " Inspector and the distribution of circulars containing an " epitome of precautionary measures to be adopted in the " house. In cases where the medical attendant thinks such " visits, &c., unnecessary or undesirable, the certificate of " notification should be endorsed " Not to be Visited," which " request will be complied with. " Notifications of cases may be made on special forms (a " book of which will be forwarded on application), or by letter, " but it is hoped that the official forms may be adhered to as " far as possible. " A fee of 2s. 6d. will be paid to the medical attendant for " each case notified occurring in his private practice, and Is. if " the case is in his public practice or if it has been previously " notified. " It will be understood that in both their private and " public practice, medical practitioners will only notify cases " whose usual place of residence is in the Borough of Lewisham. " I would like to remind you that the Council have " already made arrangements whereby specimens of suspected " sputum may be examined free of charge if they are sent to * Note.—Copy of the card is included in the Appendix. 69 " the Medical Officer of Health, and outfits and suitable boxes " for same may be obtained on application. " Yours faithfully, " A. Wellesley Harris, 11 Medical Officer of Health." This system has been in force for seven months and the total number of cases notified during this period amounted to 76. In a few instances only were the certificates endorsed " not to be visited." The number of deaths from phthisis during the year was 119. The total number of persons living afflicted with the disease would bs considerably greater, probably between 1,000 and '2,000, so that the 76 notifications is exceedingly small and cannot be considered to be of very great utility in our endeavours to check the disease. I think, therefore, the advisability of compulsory notification should be considered, provided special powers can be obtained which would take into account the totally distinct and different character of this disease compared with other notifiable diseases. PART 3. GENERAL 73 FOOD INSPECTION Tinned and Preserved Foods.—The examination of tinned foods is surrounded with many difficulties. If a tin presents a blown appearence, i.e., if fermentation takes place, gases are found in the tin as a result of putrefaction which cause the ends of the tin to bulge to varying extents, such tins are easily recognised by the inspector, or salesman, and no doubt exists as to the unwholesome condition of its contents. The difficult cases are those in which the food was diseased or decomposed prior to canning. The boiling of the tins and addition of preservatives before the tins are sealed prevent further putrefaction, and the tins from outward appearance give no indications of the unwholesome condition of the contents. Again because one or two tins may be blown it does not follow that the remainder of the parcel are in the same condition, consequently if a seizure is comtemplated, each tin must be opened and examined. In some cases putrefactive bacteria have formed sufficiently to liquefy the gelatine present in the tin, which fact would be ascertained on shaking the tin, when the liquid nature of the contents would be noted—the only sign causing suspicion. During the year under review 4,300 tins of canned meats, vegetables and fruits were examined. Of this number 50 were surrendered on their suspicious condition being pointed out. These were as follows:— 11 tins boiled rabbit 12 tins sardines 2 „ ox tongues 1 tin herrings in 1 tin pork and beans tomato sauce 2 tins condensed milk 5 tins peaches 10 „ salmon 4 „ tomatoes 1 tin apricots 1 tin pineapple 74 Upon opening the suspicious tins, in many instances, it was found that the contents were, owing to advanced decomposition, obviously unfit for human food. In the case of four tins of boiled rabbit and one tin of oxtongue, the jelly was liquified. Apart from this fact there was no evidence of the contents being unfit for human food. Three tins of salmon suspected, showed no distinct signs of unfitness upon being opened. These, with other suspicious tins of various foods which had been surrendered, were submitted for bacteriological examination, with the following results One tin boiled rabbit (A- brand):— The tin of boiled rabbit marked A— brand has been found to contain living motile bacilli, which by their action have completely liquified the jelly in which the meat was embedded. One tin of boiled rabbit (B— brand):— The contents of this tin were found to be free from living organisms. One tin boiled rabbit (C— brand):— The contents are free from organisms. One tin boiled rabbit (A— brand):— The contents of this tin are seen to be free from living organisms. One tin of ox tongue (D— brand):— After a few hours' incubation at 37 degrees C. the tin became distended with gas. Numerous microorganisms were seen in a hanging drop preparation made from the contents. 75 One tin of salmon (E— brand):— The contents of this tin are seen to be free from living organisms. One tin of salmon (E— brand):— This tin appeared to be slightly distended with gas, but no living organisms were found in its contents. One tin of salmon (F— brand) :— The contents of this tin are free from living organisms of any kind, There are seen to be considerable numbers of dead organisms, however, which suggest that the fish had undergone slight decomposition before being tinned and sterilised. One tin of sardines (G— brand):- This tin appeared to be slightly distended with gas, but no living organisms were detached in its contents. Other samples of food were purchased as test samples, comprising ham and tongue, bloater paste, beef loaf, ham and chicken, chicken, ham and tongue, and salmon and shrimp paste. Six of these contained preservatives in the form of boracic acid. The contents were otherwise satisfactory. So far this report deals with preserved foods, and the details stated above show the necessity for systematic inspection. Other Foods.-With regard to meat, fruit and vegetables sold in their natural condition, occasional inspection only has been made. From personal observations one is led to believe that particularly in the poorer districts a more systematic inspection of the food offered for sale is needed. How this is to be carried into effect is a question which requires much careful consideration. I may say at once that the inspection of meat and other foods is surrounded with many difficulties and 76 requires almost expert knowledge. The whole of your staff of sanitary inspectors have been endeavouring to obtain special knowledge in this direction, and it may be possible in the near future to arrange for a more perfect system of inspection. Condensed Milk.—On the 31st August, one of the inspectors brought to me for an opinion some tins of condensed milk. On examination I found a clamping method had been adopted for fixing the top of the tins. Such method was unsatisfactory. The tins I examined showed signs of leakage and it was fair to assume that under such conditions air could gain access to the tins. On opening the tins the contents were found to be decomposed. As a result of the examination the whole stock consisting of 53 tins were surrendered by the local vendor and destroyed. Surrenders.—Other items of unsound food examined at the request of their respective owners, and surrendered as unfit for human food, were:— 2 cases of Australian rabbits 12 rabbits 4 boxes of skate 1 trunk of skate 3 „ hake 1 box of kippers 2 „ mackerel 53 ling SUSPECTED MILK. On the morning of Tuesday, the 20th November, I received telephone message from the Medical Officer of Camberwell, stating that he had received a letter from the Sanitary Inspector of the East Grinstead Urban District Council conveying the information that a case of Anthrax had occurred on the farm of F. M., in the neighbourhood of East Grinstead. The farmer was believed to be supplying milk to a dairyman in the Borough of Lewisham. The animal affected was a milch cow from which milk had been obtained the previous day, and 77 sent to a dealer in this Borough. This information was sent to Camberwell, in the belief that the address to which the milk was consigned was in that Borough. Immediately on receipt of this information the dairyman was interviewed, and we were told that he had been receiving milk from the farm, and as a matter of fact was expecting a further consignment to arrive at Forest Hill Railway Station about 12.15. Steps were at once taken to obtain possession of the churn upon its arrival at the station, and the milk was destroyed, after a sample had been taken for bacteriological examination. From the facts that came to my knowledge I considered it necessary to immediately proceed to East Grinstead, and so olitain the fullest information possible, with a view if necessary of visiting the farm and setting in motion steps to prevent milk being sent to this Borough. I was fortunate enough to see Dr. Wallis, the medical officer of health, and Mr. Woollam, the sanitary inspector, from whom I ascertained that the affected cow was found dead at F-Farm on Saturday, the 17th inst. This information was conveyed to them by a police-constable. The Veterinary Surgeon who had seen the animal had submitted material for bacteriological examination, and Dr. Wallis had examined and found it to contain anthrax bacilli. I was also informed that the milk obtained from the animal previous to its death had been sent to Forest Hill. Dr. Wallis agreed with me as to the necessity of at once taking steps to prevent milk from this farm being sold, as the supply must for a time remain under suspicion. He also undertook to obtain a magistrate's order to visit the farm and subsequently to obtain an order of the Sanitary Authority to prohibit the sale of milk. 78 For your information I may say that when a case of Anthrax occurs the farm comes under the control of the Board of Agriculture. I was informed by Dr. Wallis that the farmer was not registered as a dairyman, and that the farm generally was in a bad condition. Isolated cases of Anthrax have been known to exist on a farm, and, when the body has not been opened, the spread of the disease to other animals has rarely occurred. It is satisfactory to note that the dairyman in Lewisham to whom the milk was consigned took immediate steps to stop all supplies from the farm in question. Fortunately no ill effect resulted in our district. The following is the report of the bacteriologist upon the sample of milk taken from the churn at Forest Hill:— "Neither pus nor tubercle bacilli could be detected "in the centrifugalised deposit and cream of this milk. A "fair number of streptococci were present, but in the "absence of pus they are probably adventitious and not "of pathologic significance. There is, of course, the "possibility that the milk from one cow with a bovine "mastitis may be mixed and so diluted by normal milk "that its detection in a mixed sample is almost impossible. "The milk has been specially examined for anthrax " bacilli, but with negative results." The recital of the above facts is a good example of a danger which may occur at any time owing, in some instances, to the indifferent and not infrequently entire absence of control and safe sanitary supervision which exists in regard to daily farms in many country districts. A grave danger probably exists from the frequency with which milk from tuberculous cows may be sent to London. 79 The existing laws and regulations in regard to the occurence of Anthrax and the prevention of the spread of this disease are complicated. They may be summarised as follows Administration.—The Order of the Board of Agriculture, 17th January, 1899, made in pursuance of the Diseases of Animals Acts, 1894 & 1896, provides that every person having in his possession an animal affected with, or suspected to be affected with anthrax shall, with all practical speed give notice of the fact to a constable of the police force within the area wherein the animal is or was. The constable shall forthwith give the information received by him to the inspector. This inspector is not the ordinary sanitary inspector, but one appointed by the Board of Agriculture or the Local Authority for the performance of special duties under the Diseases of Animals Acts. The inspector shall in his turn give information to the Medical Officer of Health of the sanitary district, and he shall also proceed to the place to see executed the necessary requirements of the Order. The Local Authority shall instruct a veterinary inspector to institute an inquiry and report theron. The Order provides that the milk of a diseased cow shall not be removed. It also provides restrictions on the removal of animals out of or into the infected place, and for the disposal of the infected carcase and disinfection There is no legal provision by which the sale of milk from the other cows at the farm or from any suspected animal could be prohibited. The Dairies, Cowsheds and Milkshops Order prohibits the sale of, or mixing with other milk, that obtained from a diseased animal. Section 71 of the Public Health (London) Act, 1891—and in districts outside London, Section 4 of the Infectious Diseases 80 Prevention Act, 1890—provide power for prohibiting the supply of milk, but only where the Medical Officer of Health is in possession of evidence that any person in the district is Buffering from infectious disease attributable to milk supplied within (or from without) the district, or that the consumption of milk from such dairy is likely to cause infectious disease to any person residing in the district. Unfortunately, these powers only refer to infectious diseases specified in the Acts referred to, and are Small-Pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, Scarlet Fever or Scarlatina, and the Fevers known as Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal, and in these specific cases the procedure is surrounded by delays and difficulties. In consequence of a previous report, your Council in 1905 addressed a communication to the Local Government Board upon this subject, a copy of which is appended. From these observations it is evident that there is urgent need of further powers for the better protection of our milk supplies. Town Hall, Catfoed, S.E. 11th July, 1905. Sir, "I beg to inform you that this Council have had under "consideration the question of the steps to be taken to stop "the supply of milk from a farm at which a case of infectious "disease has occurred. It has been pointed out to the Council "that, should it at any time be deemed necessary to stop the "supply of milk from any particular dairy where there was "evidence that the consumption of milk from such dairy was "likely to cause any infectious disease to any person residing "in the district, considerable difficulty would be met with and "delay occasioned, as under the existing provisions of the 81 "Public Health (London) Act, 1891, the Medical Officer of "Health would first have to obtain an order of a Justice having "jurisdiction in the place where the dairy was situated to "inspect the dairy, and if then of opinion that any infectious "disease was caused from consumption of the milk supplied "would report the same to the Sanitary Authority, who would "have to serve on the dairyman not less than 24 hours' notice "to appear before them to show cause why an order should "not be made requiring him not to supply any milk therefrom "within the district until the order had been withdrawn. "This Council are of opinion that in view of the danger "of the spread of infection whilst these proceedings were being "taken it is very 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 was reason "to believe that the consumption of such milk would be likely "to cause any infectious disease, and they suggest 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. "This Council have accordingly directed me to "communicate with the Local Government Board urging that "they will be good enough to consider the matter with a view "to steps being taken to promote legislation with a view to "giving effect to the above suggestion. "I am Sir, "Your obedient Servant, " (Signed) Edwd. Wright, " Town Clerk." HOUSES UNFIT FOR HUMAN HABITATION. Brockley Cottages.—The Public Health Committee considered the question of calling upon the owners of Nos. 1 to 4 and 11 to 26 (inclusive), Brockley Cottages (in respect of which a closing order was made in 1897), to demolish the buildings which were in a dangerous condition. The necessary notices 82 were served upon the owner to attend before the Committee to show why a demolition order should not be made. After hearing the owner's objections, the consideration was adjourned for six months, the owner undertaking to carry out the necessary repairs. Subsequently the owner, having carried out the repairs, applied for the closing order to be revoked in respect of Nos. 19, 20, 23, 24, 25 and 26. A formal summons having been served upon the Council, the Town Clerk attended Court on their behalf. The Magistrate, after hearing the application, granted the rescinding order asked for by the owner. Southbrook Mews.—Five of the cottages known as Southbrook Mews (Nos. 1, 3, 4, 5 and 6) were reported in April to be in a bad state of repair, and notices served on the owner. A representation was made to Council by the Medical Officer of Health, but the owner put the matter in the hands of his builders immediately and the necessary repairs were carried out. 83 Table 25. Houses Examined and Certified under the Customs and Inland Revenue Acts during 1906. Name of Street. N umber of Houses. Number of Dwellings. Certificates Granted. Refused. Champion Park 2 4 4 - October Clavens Street 7 14 14 - December Coombe Road 4 8 8 - November Dartmouth Place 4 8 8 - October Davenport Road 6 12 12 - October Davids Road 6 18 18 - October Devonshire Road 3 6 6 - August Empire Parade 3 4 4 - August George Lane 20 52 52 - April & Sept. Helvetia Street 5 10 10 - December Holbeach Road 5 11 - 11 December Holmshaw Road 12 24 24 - Sept. & Oct. Jutland Road 11 21 20 l November Knighton Park Road 7 14 14 - August Larkbere Terrace 2 4 4 - October London Road 9 36 36 - July & October Marvels Terrace 6 24 24 - September Neuchatel Road 6 12 12 - December Pascoe Road 4 8 8 .- October Peak Hill 16 32 32 - July Pearcefield Avenue 14 28 28 - October Queens Road 1 8 8 - July Rubens Street 5 10 10 - October Silvermere Road 3 6 6 - November Springrice Road 2 4 4 - October Totals 169 378 366 12 84 Table 26. Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the years 1903-6 Ward Number of Water Certificates Granted. 1903 1904 1905 1906 Church - 12 40 23 Manor 17 41 9 7 South 30 25 33 47 Lee Division 47 78 82 77 Blackheath 5 - 5 1 Lewisham Village 72 56 10 5 Lewisham Park Brockley 159 112 71 109 67 154 114 120 Catford 495 270 297 258 Lewisham Division 843 506 533 498 Forest Hill 199 139 95 63 Sydenham 210 176 208 156 Syd. & For. Hill Division 409 315 303 219 Whole Borough 1299 899 918 794 85 HOUSE-TO-HOUSE INSPECTION. During the year house-to-house inspection was made of 405 dwellings, distributed in the following roads and streets:— Acacia Road, Coombe Road, Elderton Road, Holmshaw Road, Hope Cottages, Prospect Road, Southbrook Mews and Tenements and Summerfield Street. The following is a summary of the principal nuisances found and shows the need for systematic inspection:— Defective drains 116 Vent shafts and soil pipes defective 34 Water closets and apparatus defective 40 Insufficient water supply to water closets 65 Defective yard traps, sink wastes, gullies, &c. 105 Dirty premises 212 Overcrowding 4 Drinking water cisterns defective 142 Defective roofs 78 Damp premises 90 Insufficient floor ventilation 76 Defective yard pavings 135 Offensive accumulations 5 Animals so kept as to cause a nuisance 1 Other minor nuisances (ashbins, &c.) 312 Total 1,315 The whole of the above-mentioned defects were remedied on the service of notices, and no summary proceedings were necessary. Only four cases of overcrowding were discovered. 86 COMBINED DRAINAGE. It was found necessary to serve notices under the Metropolis Management Act upon the respective owners in order to obtain the necessary alteration and amendment of the following combined drains:— SMOKE NUISANCES. The Inspector entrusted with this duty made 538 observations, varying from one to three hours at a time, compared with 254 observations during 1905. The observations were made in respect of laundries 56, temporary vertical boilers providing power for working cranes used in the construction of the new London County Council sewer in the district 223, bakehouses 5, breweries 42, silk mills 6, jam works 21, saw mills 18, flour mills 5, railway engines 150, miscellaneous 12. Fifteen intimation and 5 statutory notices were served. In the case of nuisances from railway engines a warning notice was sent to the company concerned. It was found necessary to take out a summons against the contractors before we could obtain the abatement of the nuisance in Courthill Road (see Legal Proceedings). Generally better stoking has been brought about, and in two cases the chimneys have been heightened. Coke has been substituted at laundries in several instances. Blythe Hill, 1 to 21. Colfe Road, 48 to 52. Coombe Road, 5 to 15. Dartmouth Road, 95 to 105. Ellerdale Street, 1 to 17. Elsinore Road, 9 to 17. Holmshaw Road, 26 to 36. Kilmorie Road, 17 to 23. „ „ 25 and 27. Miall Road, 11 to 21. Mount Ash Road, 7 to 14. Ravenshourne Road, 5 and 7. 87 CORONER'S COURT AND MORTUARY. One hundred and twenty-nine bodies were removed to the Mortuary. Thirteen of these were from outside districts and twenty-nine from the Lewisham Union Infirmary. Inquests were held in 123 cases. The bodies of three persons dying from an infectious disease were removed from their homes to the portion of the Mortuary specially allocated for such eases. DISINFECTION. During the year 1,315 rooms were disinfected by formalin spray, and 28,322 articles of bedding, clothing, &c., removed from infected homes to the Council's Disinfecting Station for treatment in the steam disinfector. The figures for the previous year were 1,873 rooms and 28,135 articles. LEGAL PROCEEDINGS. The following is a Summary of the Legal Proceedings instituted by order of your Council:— Proceedings under the Sale of Food and Drugs and Margarine Acts:- (a) Adulterations: Summonses issued 12 Convictions obtained 8 Fines imposed £78 Costs imposed £5 8s. 6d. 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. 88 (b) Offences Other than Adulterations: For selling two samples of margarine in unlabelled wrappers, as required by the Margarine Act, W. N., of South Norwood, was fined £15 and 12s. 6d, costs in each case. Proceedings taken for offences under the Public Health (London) Act, 1891, or Bye-laws made thereunder:— For failing to comply with notices requiring the abatement of overcrowding of workrooms, W. C., of Sydenham, was fined £2 and £ 1s. costs. Proceedings were taken against S. P. and S. L. for permitting a chimney of a vertical boiler employed in connection with the sewer construction works in Courthill Road. The defendants were ordered to pay £2 12s. 6d. costs. Three occupiers of dwellings (one in Kent House Road, one in Addington Grove and one in Venner Road) were summoned for failing to comply with notices requiring the abatement of a nuisance caused by the absence of proper and sufficient supplies of water. Orders were made by the Magistrate for the abatement of the nuisances and the owners ordered to pay costs of 6s., 3s. and 6s. respectively. ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901. Workshops:—There are in the borough 597 workshops, containing 879 workrooms to which provisions of the Factory and Workshop Act apply. The number of workers found on inspection amounted to 2173, of which 539 were men, 1239 women, and 395 young persons. The largest proportion of these workers were engaged in the dressmaking, laundry, and millinery trades, there being 1,196 women, 300 young persons and 19 men so employed. These premises are inspected by the women 89 sanitary inspectors (see work of women sanitary inspectors, page 93), together with the workshops employing women in other trades. Only 43 women and 95 young persons were employed in all other trades. In workshops employing male labour, 520 men were engaged. Domestic Workshops:—i.e., private houses, places, or rooms, where no power is used, and in which the only persons employed are members of the same family dwelling there, are like domestic factories, subject to special regulations with regard to hours of labour, and not subject to the provisions of the Act which relate to meal times, affixing notices, holidays, notices of accidents, keeping a general register, the means of ventilation, thermometers, and the drainage of floors. There are 387 domestic workshops in the district. Although registration is not required a list of these premises is kept and the premises visited with a view to remedying any insanitary conditions. A detailed analysis of workshops is set out in Table 29. 90 Table 27. Inspection of Factories, Workshops, &c. (1) Premises. Inspections Notices served. Proceedings Factories (including factory laundries) 150 22 - Workshops (including workshop laundries) 1297 135 1 Workplaces 465 55 - Homeworkers' premises 261 22 - Restaurants 58 20 - Total 2231 254 1 Statement of Defects Found. (2) Defects. Referred to H.M. Inspector. No. of Prosecutions Found. Remedied. Dealt with under Public Health (London)Act— Want of cleanliness 192 189 - - Want of ventilation 5 5 - - Overcrowding 9 9 - 1 Want of drainage of floors 12 12 - - Other nuisances 54 54 - - Sanitary accommodation— Insufficient 5 5 - - Defective or unsuitable 63 63 - - Not separable for sexes 1 1 - - Under the Factory and Workshop Act— Illegal occupation of under-ground bakehouse - - - - Other offences - - - - Total 841 338 - 1 91 Table 28. HOME WORK. (3). Outworkers' Lists, Section 107 No. of Inspections of Outworkers' Premises Outwoik in Unwholesome Prem. Section 108 Outwork in Infected Premises, Sections 109, 110 Nature of WoRk. Lists received from Employers No. of Addresses of Outworkers received from other Councils No. of Addresses of Outworkers forwarded to other Councils Prosecutions Failing to keep or permit inspection of lists Failing to send lists Twice in year) Once in year Instances Noticesserved Prosecutions Instances Orders made, Sect. 109 Prosecutions, Sect. 109, no *Lists *Outworkers Lists Outworkers 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel— (1) making, &c. 122 236 54 88 126 96 - - 252 - - - - - - (2) cleaning and washing - - - - - - - - - - - - - - - Lace, lace curtains and nets - - 2 2 - - - - 4 - - - - - Furniture and Upholstery - - l 1 - - - - 4 - - - - - - Fur pulling - - - - - - - - - - - - - - - Umbrellas - - - - - - - - - - - - - - - Paper Bags and Boxes - - - - - - - - - - - - - - - Brush making - - 1 1 - - - - 1 - - - - - - Stuffed Toys - - - - - - - - - - - - - - - File making - - - - - - - - - - - - - - - Electro Plate - - - - - - - - - - - - - - - Cables and Chains - - - - - - - - - - - - - - - Anchors and Grapnels - - - - - - - - - - - - - - - Cart Gear - - - - - - - - - - - - - - - Locks, Latches and Keys - - - - - - - - - - - - - - - Total 122 236 58 92 126 96 - - 261 - - - - - - +The figures given here are the total number of lists received from employers who sect them both in February and August as required by the Act and of the entries of names of outworkers in those lists. 92 Table 29. *Workshops (4) and Workrooms on the Register at the end of 1906. 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 198 233 1618 1437 992 - 726 258 86 86 Millinery 44 49 282 273 167 - 70 38 8 8 Laundry 83 259 1170 1101 708 19 400 4 133 248 Tailor 45 49 208 193 134 84 13 9 13 13 Boot 73 74 264 245 165 113 - 17 81 81 Joiner 19 31 492 456 352 55 - 10 4 4 Smith 26 29 334 307 235 65 - 7 6 6 Furrier 2 2 10 10 6 1 2 - - - Cycles 19 24 188 170 128 39 - 8 9 9 Coachbuilder 7 16 186 177 135 21 - 6 - - Cabinet and Upholsterer 19 26 336 321 237 46 6 9 5 5 Blindmaker 3 5 28 26 17 5 - 1 - - Photographer and Pictureframer 13 22 105 100 68 15 10 6 9 9 Jeweller 13 14 66 58 39 19 - 6 23 23 Piano 2 2 9 9 6 2 - 1 2 2 Saddler 10 11 54 47 35 17 - 2 4 4 Mason 3 4 42 41 28 5 - 1 4 4 Lathrender 2 4 16 13 10 7 - - - - Various 16 25 154 136 93 26 6 12 - - Total 597 879 5562 5120 3555 539 1239 395 387 502 * Note:—Not including Bakehouses (99) and Restaurants (53). 93 Other Matters (5). Failure to affix Abstract required by Section 133 of the Factory and Workshop Act, 1901, and notified to H.M. Inspector of Factories 21 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health (London) Act, but not under the Factory Act (Sec. 5). Notified by H.M. Inspector 5 Beports of action taken, sent to H.M. Inspector 5 Underground Bakehouses (Section 101):- In use during 1903 23 Certificates granted in 1903 23 ” ” 1904 and 1905 - In use at end of 1906 23 Workshops on the Register at the end of 1905 :— Workshops (details in Table 29) 597 „ part time and domestic (details Table 29) 387 Bakehouses 76 „ underground 23 Restaurants 53 Total 1136 WORK OF WOMEN SANITARY INSPECTORS. The staff consists of two women sanitary inspectors, namely, Miss N. Jones and Miss I. Whitworth (B.Sc.) Both inspectors rendered most valuable assistance to the department. Jointly they made 4,645 visits to various premises in the Borough. They reported the existence of 438 nuisances. In 94 172 instances remedy was obtained by verbal notice; 266 required intimation notices, and 64 statutory notices. Legal proceedings were taken in a case of overcrowding of workrooms belonging to a large draper's, and a conviction obtained. The owner of the premises had been previously cautioned. These inspectors paid 964 visits to factories, workshops, workplaces, and laundries where women were employed. In 21 cases the official Abstract of the Factory and Workshop Act was not fixed upon the premises, as required by the Act. Overcrowding was found and remedied in respect of nine premises. Other nuisances, due mainly to the dirty condition of workrooms or workplaces, were reported as existing in 157 premises. One hundred and sixty-three visits were made to the homes of outworkers. Generally the conditions of the outworkers' homes from a sanitary point of view were satisfactory. A small percentage of the homes were dirty, which conditions were remedied prior to a second visit from the inspectors. It is interesting to note that many residents appreciate the visits of the women inspectors, and frequently write requesting a visit. Information is received from school-teachers of varying conditions of certain school children, which suggest the advisability of home inspection. In this manner several dirty premises have been cleansed, and in not a few cases the children have also benefited by the inspector's visit. One hundred and sixty-three visits were made to homes where deaths from phthisis had occurred. It was reported that in 36 such homes previous deaths from this disease had occurred to members of the same family. In four cases it was suggested 95 by relatives that alcoholism was a predisposing cause. In 66 cases thorough disinfection of the infected premises was carried out by the public health department, with the consent of the occupiers. Miss Jones reports that she often experiences difficulty in obtaining consent from the poorer and more ignorant residents of the Borough for disinfection of the premises after phthisis deaths. This is due to the disbelief in the infectivity of this disease. It is very desirable that disinfection of infected premises, bedding, clothing, &c., should be made obligatory. Another danger arises from the frequency with which phthisical patients change their abode, leaving their former residence a fertile source of infection to those who may follow them as tenants. SUMMARY OF WORK OF WOMEN SANITARY INSPECTORS. During the year under review the Women Sanitary Inspectors have made 4,645 visits throughout the Borough. The following is a summary of the work done:— Factory and Workshop Act.- Miss Whitworth (and her successors) Miss Jones. Total. Factories 33 11 44 Workshops 254 207 461 Workplaces 44 181 225 Laundries 103 131 234 Outworkers' homes 47 116 163 Infectious Diseases.— Phthisis 59 104 163 Chicken-pox 65 165 230 Measles 28 95 123 Puerperal fever 5 15 20 96 Other Visits.— Miss Whitworth (and her successors) Miss Jones. Total. On complaint from residents - 32 32 On complaint from school teachers - 49 49 Selected homes from which births were registered 508 250 758 Investigations re Infant mortality 133 335 468 Schools 62 52 114 He repairs, cleansing, &c. 567 757 1324 Miscellaneous inquiries 145 92 237 Total 2053 2592 4645 Nuisances, Defects, &c.— Abstract not affixed in workshops 18 3 21 Overcrowding found 7 2 9 Other nuisances in workshops 80 77 157 Total number of nuisances found 179 259 438 Notices, &c.— Intimation notices served 100 166 266 Statutory notices served 28 36 64 Verbal notices complied with 108 64 172 97 Table 30. ROUTINE INSPECTIONS. Premises. Number of Places No. of Inspections 1906 No. of Notices 1906. No. of Prosecutions 1906 On Register at end of 1905. Added in 1906. Removed in 1906. On Register at end of 1906 Milk premises 163 54 57 160 299 23 - Cow sheds 15 — — 15 133 7 - Slaughter houses 16 — — 16 152 2 - Other offensive Trade premises - - - - - - - Ice cream premises - - - - - - - Registered houses Let in Lodgings 15 - - - 180 a 9 - b 20 a Overcrowding. b For other conditions. Total number of intimation notices served for all purposes, 1920. Overcrowding:—Number of dwelling rooms overcrowded 20, remedied 20, 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, nil. 98 Revenue Acts:—Houses for which application were received 169, number of tenements comprised therein 378, certificates granted 366, refused 12, deferred nil. Prosecutions under By-laws under the Public Health (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. — (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. (i) With respect to sufficiency of water supply to water-closets — (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 129 Total number of infectious bodies removed 3 Note.—This table was formulated to meet the requirements of the London County Council. 99 Table 31. REGISTER OF SANITARY WORK. (Male Inspectors.) For the year ended 31st December, 1906. Lewisham Division. Sydenham and Forest Hill Division. Lee Division Workshops House to House Description or Work Mr. J. A. K. Cooper Mr. H. King Mr. H. L. Hyde Mr. E. T. Pidwell Mr. B. A. Knappett Mr. R. White Mr. J. Daltry Mr. A. H. Gray Total for Whole Boro. Complaints by Residents 74 99 72 86 164 236 4 10 745 Premises inspected 442 575 669 768 693 404 1597 491 5639 Re-inspections of Works in progress 1516 1758 2109 1091 1747 1800 748 4338 15107 Intimation Notices served 160 274 257 107 207 177 150 322 1654 Statutory Notices ordered 134 176 134 68 97 118 34 44 805 Statutory Notices served 25 75 43 41 56 15 6 3 264 Premises repaired, cleansed, &c. 74 99 122 63 79 100 181 145 863 Defective Roofs, Stackpipes, &c., remedied 31 8 62 35 42 46 33 145 402 Drains re-constructed 100 57 58 59 63 58 — 115 510 Drains repaired 39 56 49 47 78 81 26 23 399 Drains ventilated 21 10 36 27 16 66 1 32 209 Stackpipes, Sinks, Bath Wastes, &c., disconnected from drains 68 38 67 34 60 103 - 44 414 Grulley Traps provided 153 55 77 111 263 141 - 213 1013 Water Closets reconstructed 119 33 42 84 97 94 3 65 537 Water Closets repaired 16 24 79 24 42 75 73 10 343 Water Closets supplied with water 35 34 61 2 3 39 9 67 250 Soil Pipes reconstructed 48 32 34 25 35 37 - 12 223 Soil Pipes repaired and ventilated 7 18 33 13 19 15 33 10 148 Dustbins provided 30 38 43 31 18 46 5 84 295 Water Supply to Houses reinstated 5 21 16 11 24 4 1 1 83 Cisterns repaired, cleansed or covered 11 17 22 72 16 15 84 141 378 Water Certificates issued 107 — 104 93 — 66 315 109 794 Premises over-crowded 6 9 - 3 - - 2 20 Yards paved 49 28 69 8 70 58 45 171 498 Removal of offensive accumulations 16 29 21 19 42 21 7 - 155 Dung Vaults erected or repaired 5 5 8 - 2 14 1 - 35 Animals improperly kept 1 7 2 2 9 - 2 - 23 Houses let in lodgings visited 6 53 121 — — — — - 180 Bake-houses visited — — — 2 4 20 248 - 274 Milk-shops visited - 7 — 2 11 35 244 - 299 Cow-sheds visited 11 46 4 24 13 35 — — 133 Workshops visited - — — - — — 568 - 568 Slaughter-houses visited 38 22 5 48 15 24 - - 152 House-to-house inspections — - 86 - - — — 320 406 Legal proceedings 8 1 1 2 3 1 1 - 12 PART 4. REPORT OF PUBLIC ANALYST. 103 REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1906. SAMPLES SUBMITTED.—During the period under review 524 samples were submitted for analysis. Of this number, 495 were purchased by your inspectors in conformity with the provisions of the Sale of Food and Drugs Acts. The remaining 29 samples were purchased as test samples, and without declaration to vendors. ADULTERATED SAMPLES.—Of the 495 official samples submitted, 46, or 9.29 per cent. were adulterated, compared with 7'98 per cent. in the previous year (1905) and 9.38 per cent. in 1904. TEST SAMPLES.—Of the 29 test samples submitted, 11, or 37'93 per cent., were 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. House-to-House Sale of Sophisticated Butter.—Towards the end of the year 1905, information was received that a firm situated outside the Borough was manufacturing margarine into pats to represent butter, and effecting a large sale in a portion of our district, through the agency of a man who conducted a 104 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 (February 6th) by a householder who consented to act as a deputy to the inspector. In this manner sample No. 37 was purchased, which proved to be a mixture containing 97 per cent. of foreign fat. On completion of the purchase the inspector demanded further samples from the other parcels in the cart. The vendor supplied these (Nos. 38 and 39), but declared them to be margarine. The samples were sold contrary to the Margarine Act. Prosecution followed and the vendor was fined £15 and 12s. 6d. costs in each case. A few days later (February 9th) we had reason to believe that the same vendor was again in the district. A test sample was obtained indirectly (No. 81) which proved to be margarine; the vendor disappeared and no further opportunity occurred for the purchase of an official sample. There is little doubt that as a result of these salutory fines the practice has ceased so far as our district is concerned. Sale at the Counter.—In consequence of information received test sample No. 136 was purchased. The analysis showed the sample to be margarine, and an official sample was obtained on the following day. This contained 83 per cent of foreign fat, and the vendor was fined £3 and 12s. 6d. costs. The vendor of sample No. 350 (90 per cent. foreign fat) who was fined £10 and £1 1s. costs, was again sampled within a short time, there being reason to suspect that he was continuing the practice of substituting margarine for butter. A number of test samples were first purchased, followed by an official sample No. 485 (80 per cent. foreign fat). Proceedings were instituted resulting in a second fine of £40 and 12s. 6d. costs. 105 Coffee.—A test sample of coffee, No. 52, contained 40 per cent. of chicory, but official samples subsequently purchased proved to be genuine. The remainder of the test samples were found on analysis to be genuine. PURCHASE OF SAMPLES BY DEPUTY.—The system of purchasing by deputy has been continued, and of the total 524 samples, 269 or 51.34 per cent., were so purchased. MILK.—Of the 265 samples submitted, 27, or 10.19 per cent., were adulterated or below the standard fixed by the Board of Agriculture. This shows an increased percentage of adulteration compared with 7.19 in the previous year. The milk supply of the district is every year becoming controlled to a greater extent by well-known large milk dealers, who themselves adopt measures to prevent adulteration by their servants, and refrain from adding preservatives. The bulk of the adulterations found occurred in smaller milk shops of the poorer districts. Many of these small vendors are unprotected by warranty, and in several cases warranty is refused them. Preservatives in Milk.—In nine of the milks preservatives were discovered, formalin being used in one, and boracic acid in eight cases. Also three of the skimmed milks contained boracic acid. The amounts were exceedingly small and your Committee decided not to prosecute. A circular letter from the Local Government Board dated 11th July, relating to preservatives in milk was considered by your Committee, and acting upon the advice contained therein, your Council notified all milk traders by circular to the effect 106 that in future action would be taken under the Sale of Food and Drugs Acts in all instances where preservatives were reported in milk. A copy of the circular addressed to the milk dealers is appended. Prosecutions in these cases would be greatly facilitated if the addition of preservatives to milk could be prohibited by statute. The fact that the Departmental Committee's recommendation against the use of preservatives in milk have not resulted in any measure which would legally prohibit their use is frequently made a strong point for comment by the defence when prosecutions in such cases are taken, and there still remains the difficulty of the difference of expert opinion in regard to the seriousness of such additions, together with the costs which such prosecutions entail upon local authorities. 13th September, 1906. "Dear Sir, "I am directed to inform you that the Public Health "Committee of this Council have had under consideration the "question of the addition of preservatives to milk, and their "attention has been called by the Local Government Board "to the report of the Departmental Committee on Preservatives "and Colouring matters in food, in which it is stated that the "Committee, after hearing evidence from milk traders, con"cluded that the addition of a preservative to milk was not "necessary for the purpose of the milk trade, even in hot "weather, or where the supply of so large a place as London "was concerned, and they recommended that no preservatives "should be added to milk. "The Public Health Committee, after considering the "matter, have directed me to inform milk traders in the "Borough that summary proceedings will be taken under the "Sale of Food and Drugs Acts in instances where preservatives "are found upon analysis to have been added to milk. "Yours faithfully, "Edw. Wright, "Town Clerk." 107 Dirty Milks.—Seven samples of milk contained evidence of contamination arising possibly from carelessness which permitted the entrance of dust and filth, the latter probably derived from the uncleanly condition in which cows were allowed to exist. There is urgent need for legislation which would lead to the more frequent inspection of all dairy farms in order to ensure cleanliness, and for the protection of the public against milk infected by infectious disease organisms, more particularly tuberculosis. Dyed Milk.—No diminution has taken place in the practice of artificially colouring milk, or is this likely to occur whilst the public prefer such supplies; 77.4 per cent. of the samples were coloured. Average Composition.—The average composition of all samples of milk submitted during 1906 was 3.56 per cent. milk fat and 8.74 per cent. solids not fat. This is well above the standard fixed by the Board of Agriculture, which is 3.0 per cent. milk fat and 8.5 per cent. solids not fat. Sunday Samples.—Thirteen samples were purchased on Sundays, of which one was adulterated (See No. 25, Table G). The vendor was fined £4 and 12s. 6d. costs. Samples on Delivery.—Thirty-three samples were taken in course of delivery, as follows:— From Public Institutions:—Lewisham Union Infirmary 10 (1 adulterated—See Table G, No. 296); Lewisham Union Workhouse 8, and Grove Park Workhouse 2. From Other Places:—At Railway Stations 7—(See Nos. 1 and 2 Table G); at Retail Shops 5; at a private dwelling 1. 108 BUTTER.—One hundred and twenty-four samples of butter were submitted, 25 of which were test samples. Of the 99 samples submitted officially, 12, or 12.12 per cent., were adulterated, compared with 7.69 per cent. in 1905. With the exception of one, all the samples of butter were taken with the aid of an assistant. COCOA.—In September your Committee ordered proceedings against the vendor of adulterated Sample of Cocoa No. 342. The analysis of this sample was as follows Cocoa (52 per cent., sugar 28 per cent., and starch 10 per cent., showing that this was a mixture of cocoa, sugar and starch, the two latter materials being of considerably less value than the pure cocoa. The case was heard at tbe Greenwich Police Court on the 26th October, 1906. The defence submitted that it was impossible to use cocoa in its natural state, and, in order that it could be used for food, cocoa must be mixed with starch and sugar. It is true that cocoa in its natural state is unpleasant, but the only alteration permitted is the removal of the natural fat. The ingredients added to this sample were obviously for the purpose of adulteration, but the magistrate dismissed the case by reason of there being no evidence before him of the standard or legal composition of the substance known as cocoa. This is an excellent illustration of the difficulties which surround the administration of the Food and Drugs Acts, and it seems absurd that where an article is found to be largely adulterated, and the certificate of the analyst admitted to be correct by the defence, that the action of those responsible for the administration of the Acts should be rendered useless by an unsupported statement, such as was made by the defendant's solicitor in this case. 109 Table A. Showing number of Samples submitted for Analysis, with Results for the year ended December 31 st, 1906. (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 265 238 27 10.19 Skimmed Milk 10 8 2 20.00 Cream 5 5 - - Butter 99 87 12 12.12 Margarine 2 2 - — Lard. 2 2 - - Coffee 37 35 2 5.41 Cocoa 9 8 1 11.11 Demerara Sugar 23 22 1 4.35 Cheese 5 5 — — Flour 3 3 — — Arrowroot 3 3 — — Mustard 5 5 — — Pepper 2 2 — — Vinegar 3 2 1 33.33 Olive Oil 2 2 — — Whiskey 4 4 — — Rum 3 3 — — Gin 3 3 — — Brandy 1 1 — — Quinine Wine 1 1 — — Tincture of Bark 2 2 - - Tincture of Iodine 1 1 .— — Camphorated Oil 3 3 — — Lime Water 2 2 — — Total official samples 495 449 46 9.29 (b) Samples purchased without the formalities of the Act. Butter 25 15 10 40.00 Coffee 2 1 1 50.00 Milk 1 1 - — Liquid Extract of Sarsaparilla 1 1 — — Total "test" samples 29 18 11 37.93 Total all samples 524 467 57 10.88 Table B. Summary of Samples Analysed in the Borough in each Year. 1898-1906. Year. No. of Samples (not including Test Samples). Genuine. Adulterated. Percentage Adulterated. No. of Prosecutions. Fines and Costs imposed. 1898 Total Samples 36 31 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 1s. 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 Fines £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 1905 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 1900 Milk 275 495 449 46 9.29 14 Fines £108, costs £6 13s. 6d. Butter 99 Coffee 37 Wines and Spirits 12 Drugs 8 Sundries 04 110 111 Table C. Showing Total Samples submitted with results during the years 1902-1906. (Test samples not included). Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 First 115 111 114 123 146 27 12 16 13 12 23.48 10.81 14.04 10.57 8.22 Second 167 72 67 103 88 22 4 12 9 6 13.17 5.55 18.90 8.74 6.82 Third 108 152 123 129 102 14 30 7 6 15 12.96 19.74 5.69 4.65 14.71 Fourth 68 116 112 121 159 6 15 4 10 13 8.82 12.93 3.57 8.26 8.18 Total for Year 458 451 416 476 495 69 61 39 38 46 15.07 13.53 9.38 7.98 9.29 Table D. Showing results of Total Samples of Milk submitted during the years 1902-1906. Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 First 60 70 58 88 63 15 11 9 8 6 25.00 15.71 15.52 9.09 9.52 Second 70 31 48 53 41 15 1 10 5 4 21.43 3.23 20.83 9.43 9.76 Third 54 124 91 68 77 12 30 6 3 12 22.22 24.19 6.59 4.41 15.58 Fourth 44 45 53 69 84 5 5 2 4 5 11.36 11.11 3.77 5.80 5.95 Total for Year 228 270 250 278 265 47 47 27 20 27 20.61 17.41 10.80 7.19 10.19 Table E. Average Composition of Milk Samples submitted in 1906. 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 3.56 8.80 3.64 8.84 3.0 8.5 Second „ 3.35 8.78 3.40 8.81 Third „ 3.57 8.66 3.66 8.70 Fourth „ 3.65 8.75 3.67 8.77 Total for Year 3.56 8.74 3.62 8.77 112 Table F. Average Composition of Milk Samples submitted during the Years 1902-1906. 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 „ 1906 3.56 8.74 3.62 8.77 113 114 Table G. Details of Adulterated Samples of Milk during the Year ended December 31st, 1906. No. Adulteration. Remarks. 1 4 per cent. added water Taken on delivery at railway tion; vendor cautioned. 2 2 per cent. added water 25 40 per cent. deficient in milk fat Vendor fined £4 and 12s. 6d. costs. 77 3 per cent. added water Vendor cautioned. 92 4 5 percent. deficientin milk fat Vendor cautioned. 120 11 per cent. deficient in milk fat Vendor fined £2 and 12s. 6d. costs. 157 4 5 per cent. deficient in milk fat Vendor cautioned. 169 2 per cent. added water No action. 179 4 per cent. deficient in milk fat No action. 197 8 per cent. deficient in milk fat Summons withdrawn; bottle burst. 251 6 per cent. deficient in milk fat Vendor cautioned. 27] 13 per cent. deficient in milk fat Proceedings taken; vendor proved warranty; summons dismissed. 278 5 per cent. deficient in milk fat Vendor cautioned. 289 12 per cent. added water Vendor fined £3 and 12s. 6d. costs. 296 3 per cent. deficient in milk fat Vendor cautioned. 302 3 per cent. deficient in milk fat Vendor cautioned. 303 3 per cent. deficient in milk fat Vendor cautioned. 306 3 per cent. deficient in milk fat Vendor cautioned. 313 2 per cent. added water Vendor cautioned. 320 4 per cent. deficient in milk fat Vendor cautioned. 321 4 per cent. added water Vendor cautioned. 326 2.3 per cent. added water Vendor cautioned. 386 2 per cent. added water Noaction. 389 4.7 per cent. added water Vendor cautioned. 410 4.5 per cent. added water Vendor cautioned. 420 4.7 per cent. added water Vendor cautioned. 442 5 per cent. deficient in milk fat Vendor cautioned. Skimmed Milk. 288 4 per cent. added water Vendor cautioned. 500 2 per cent. added water. No action. 115 Table H. Showing the number of samples of Butter submitted in the Four Quarters of the years 1902-1906. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 First 44 22 35 22 33 9 — 5 3 4 20.45 — 14.29 13.62 12.12 Second 63 13 9 17 23 4 — 1 — 1 6.35 — 11.11 — 4.35 Third 26 15 22 21 9 1 — 1 — 1 3.85 — 4.55 — 11.11 Fourth 16 26 35 31 34 1 2 — 4 6 6.25 769 — 12.90 17.65 Total for year 149 76 101 91 99 15 2 7 7 12 10.07 2.63 6.93 7.69 12.12 Table I. Details of Adulterated Samples of Butter for the Year ended December 31st, 1906. No. Adulteration. Results. 27 90 per cent. foreign fat "Test" sample; official samples Nos. 37, 38, 39 and 81 37 97 per cent. foreign fat Vendor fined £15 and 12s. 6d. costs; see also Nos. 38 and 39 45 Slight excess of water Vendor cautioned 55 Slight excess of water No action 81 Margarine "Test'' sample 136 83 per cent. foreign fat "Test sample"; see No. 137 137 83 per cent. foreign fat Vendor fined £3 and 12s. 6d. costs 173 25 per cent. foreign fat Vendor fined £1 and 12s. 6d. costs 350 90 per cent. foreign fat Vendor fined £10and £1 1s. costs: see subsequent test samples and No. 485 379 95 per cent. foreign fat "Test" samples; see No. 350 and 485 428 95 per cent. foreign fat 430 92 per cent. foreign fat 453 92 per cent. foreign fat 454 95 per cent. foreign fat 455 95 per cent. foreign fat 481 80 per cent. foreign fat 485 80 per cent. foreign fat Vendor's second offence; fined £40 and 12s. 6d. costs 363 2.5 per cent. excess of water No action 375 3 per cent. excess of water, milk blended No action 382 2 per cent. excess cf water No action 407 2 per cent. excess of water No action 408 2 per cent. excess of water No action 116 Table J. Details of Other Samples Adulterated during the year ended December 31st, 1906. No. Article. Adulteration. Remarks. 16 Coffee 6 per cent. added chicory Proceedings instituted; case dismissed 52 Coffee 40 per cent. added chicory "Test" sample—official sample genuine 117 Coffee 8 per cent. added chicory Vendor cautioned 342 Cocoa 28 per cent. added sugar and 10 per cent. added starch Proceedings instituted; case dismissed without costs. See report 113 Demerara Sugar Best crystals dyed with auramine Evidence considered insufficient for action 215 Vinegar Wood Vinegar No action Other Prosecutions taken under the Sale of Food and Drugs Acts or Margarine Act. No. Article. Adulteration. Result. 38 Margarine Sold in unlabelled wrapper contrary to Margarine Act. Vendor fined £15 and 12s. 6d. costs 39 Margarine Sold in unlabelled wrapper contrary to Margarine Act Vendor fined £15 and 12s. 6d. costs (See report on house-to-house sale of sophisticated Butter.) APPENDICES. 119 I.—Local Government Board Tables. Table A. Vital Statistics of Whole District during the Years 1901-1906. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public nstitutions in the district. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District Nett Deaths at all Ages belonging to the District. Number. Rate.* Under Year of Age At all Ages. Number. Rate.* Number. Rate per 1ooo Births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1901 128480 3320 25.9 426 128 1875 14.5 613 289 82 1668 13.0 1902 132432 3491 26.3 438 125 1942 13.9 568 241 117 1818 13.7 1903 136405 3563 20.1 330 93 1566 11.5 480 152 99 1513 11.1 1904 140401 3589 25.0 448 125 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 1906 148463 3446 23.2 391 113 1888 12.7 616 228 117 1777 12.0 Note.— Figures for years prior bo 1901 are unobtainable. *Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Area of District in Acres (exclusive of area covered by water) — 6,991 At Census of 1901—Total population at all ages — 127,495 „ „ Number of inhabited houses — 22,750 „ „ Average number of persons per house 5.6 Institutions within the District receiving sick and infirm persons from outside the District:—Lewisham Union Infirmary; Lewisham Union Workhouse; Greenwich Union Workhouse, Grove Park; Park Fever Hospital; 120 Bermondsey (St. Olave's) Union Workhouse; St. John's Hospital, Morden Hill; Home for Sick Children, Lower Sydenham; Flower House Asylum, Southend. Other Institutions in which deaths of residents of this District have occurred were:- Brook Fever Hospital, South Eastern Fever Hospital, Guy's Hospital, Charing Cross Hospital, St. Thomas' Hospital, St. Bartholomew's Hospital, Middlesex Hospital, Miller Hospital, Greenwich, Westminster Hospital, London Temperance Hospital, Great Ormonde Street Children's Hospital, London Hospital, University College Hospital, St. George's Hospital, Dartford Heath Asylum, Cane Hill Asylum, Caterham Asylum, Banstead Asylum, Claybury Asylum, Peckham House Asylum, Horton Asylum, Camberwell House Asylum, City of London (Stone) Asylum, Manor Asylum (Epsom), Blackheath and Charlton Cottage Hospital, Brompton Hospital, Bolingbroke Hospital, Chelsea Cancer Hospital, Clapham Maternity Hospital, Cotswold (Cranham) Sanatorium, East London (Shadwell) Industrial Hospital, Friedenheim (Hampstead) Hospital, Greenwich Workhouse, Hackney Infirmary, Hostel of God, Carshalton Home for Friendless Girls, Kidbrook House Nursing Home, London Homoepathic Hospital, Salvation Army Maternity Hospital, St. Luke's House, Kensington, and Golden Square Throat Hospital. Corrections were also made for deaths occurring as follows:—Upper Wimpole Street, Central Park, Ilford, Creek Street, Deptford, Abchurch Lane, Cheapside, Clacton-on-Sea, Maida Vale, On the way to St. George's Hospital, Pelham Place, Brompton, L. B. & S. C. and S. E. & C. Railways, River Thames and Shooters Hill Road Sewer Works. 121 Table B. Vital Statistics of Separate Localities in the Years 1901-1906. 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 18703 398 255 - 66631 1882 856 — 43146 1040 557 - 128480 3320 1668 — 1902 18925 481 220 37 69672 1857 991 261 43835 1153 607 130 132432 3491 1818 428 1903 19147 486 213 37 72731 1979 816 203 44527 1098 484 88 136405 3563 1513 328 1904 19370 469 193 40 75808 1967 941 265 45223 1153 545 135 140401 3589 1679 440 1905 19594 454 186 21 78903 2027 906 209 45923 1152 539 108 144420 3633 1691 338 1906 19820 445 211 40 82016 1871 1000 220 46627 1130 566 131 148463 3446 1777 391 Note:—Figures for years prior to 1901 are unobtainable. Table C. Cases of Infectious Disease Notified during the Year 1906. Notifiable Disease. Cases notified in whole district. Total Cases Notified in each Locality at all Ages. No. of Cases Removed to Hospital from each Locality. At all Ages At Ages—Years. Lee. Lewisham. Sydenham and Forest Hill. Lee. Lewisham. Sydenham and Forest Hill. Under 1 1 to 5. 5 to 15 15 to 25 25 to 05 65 and upwards Small-Pox - - - - - - - - - - - - - Cholera — — — — — — — — - - - — — Diphtheria Membranous croup 244 2 77 129 11 25 — 24 146 74 21 110 63 Erysipelas 97 — 2 7 14 14 10 8 63 26 2 15 4 Scarlet fever 543 2 150 324 45 22 — 62 346 135 49 309 111 Typhus fever — — — — — — — — — — — — — Enteric fever 20 — — 6 6 8 — 1 8 11 — 2 9 Relapsing fever - - - - - - - - - - - - - Continued fever - - - - - - - - - - - - - Puerperal fever 6 — — — 2 4 — 1 2 3 — — 1 Plague — — — — —- — — — - - - - - Totals 910 4 229 466 78 123 10 96 565 249 72 436 188 122 Table D. Causes of, and Ages at, Death during Year 1906. Causes o Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages). Total Deaths in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Lee Division. Lewisham Division. Sydenham & Forest Hill Division. 1 2 3 4 5 6 7 8 9 10 11 12 Small-Pox — — — — — — — — — — - Measles 21 3 17 1 — — — 3 12 6 3 Scarlet fever 14 .— 10 4 — — — 3 10 1 64 Whooping-cough 26 12 14 - - - - - 20 6 1 Diphtheria and membranous croup 21 2 9 10 - - - 1 10 10 50 Croup 1 — 1 - - - - - - 1 — Typhus - - - - - - - - - - - Fever Enteric 1 — — — — 1 — — 1 — 1 Other continued — — - - - - - - - - - Epidemic influenza 20 1 1 — 1 9 8 4 7 9 2 Cholera - - - - - - - - - - - Plague — — — — — - — — — - — Diarrhoea (all forms) 138 123 15 — — - — 12 84 42 23 Enteritis (Gastro-Euteritis, &c.) 12 - 6 1 - 2 3 1 7 4 5 Puerperal fever 2 — — — — 2 — 1 1 — — Erysipelas 3 — — — 1 2 — — 2 1 3 Other septic diseases 16 6 1 1 2 4 2 1 11 4 7 Phthisis (Pulmonary Tuberculosis) 119 - 1 1 25 89 3 6 76 37 42 Other tubercular diseases 56 14 18 12 4 7 1 8 25 23 22 Cancer, malignant disease. 136 - 1 1 - 82 52 23 76 37 35 Bronchitis 114 18 6 — 1 20 69 13 64 37 15 Pneumonia 119 24 24 4 1 47 19 14 75 30 35 Pleurisy 5 — — — — 3 2 2 2 1 - Other diseases of Respiratory organs 21 4 2 - - 10 5 2 5 13 3 Alcoholism Cirrhosis of liver 23 - - - - 19 4 3 11 9 5 Venereal diseases 5 5 - - - - - 1 4 - - Premature birth 65 65 — — — — — 4 40 21 — Diseases and accidents of parturition. 5 - - - 1 4 - - 4 1 1 Heart diseases 277 9 - 6 8 134 120 39 139 99 76 Accidents 42 7 4 4 6 10 11 2 29 11 19 Suicides 14 — - — 2 11 1 10 4 3 All other causes 501 98 30 12 16 140 205 68 274 159 171 All causes 1777 391 160 57 68 596 505 211 1000 566 616 123 Table E. INFANTILE MORTALITY DURING THE YEAR 1906. 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 72 13 20 9 114 48 35 38 36 19 19 17 19 23 6 16 390 Uncertified — — — 1 1 — — — — - - - - - - - 1 Common Infectious Diseases Small-pox - - - - - - - - - - - - - - - - - Chicken-pox — — — — - - - - - - - - — - - - - Measles — — — — - - - - - — 1 1 - 1 — — 3 Scarlet Fever — — — — - - — — — — — — — — - — - Diphtheria: Croup — — — — — — — — — — - - - 1 1 2 Whooping Cough — — — — — 2 — — 1 8 — 1 2 3 — — 12 Diarrhoeal Diseases Diarrhoea, all forms - — — 2 2 9 11 14 13 4 10 10 10 6 2 9 100 Enteritis Muco-enteritis Gastro-enteritis - — 1 — 1 3 2 4 1 4 1 1 - - - - 17 Gastritis, Gastrointestinal Catarrh - — — - - 2 — 2 1 — - - — — - 1 6 Wasting Diseases Premature Birth 42 6 7 3 58 5 - 1 - - - 1 - - - - 65 Congenital Defects 7 1 1 — 9 2 1 — 1 1 — — — — — — 14 Injury at Birth 8 — — - 3 - — - - — — — - — — - 3 Want of Breast-milk - - - - - - - - - - - - - - - - - *Atrophy, Debility, Marasmus 8 2 7 8 20 13 11 9 7 - — — 3 1 1 — 65 Tuberculous Diseases Tuberculous Meningitis - - - - - - - 1 2 1 1 1 1 - - 1 8 Tuberculous Peritonitis: Tabes Mesenterica - - - - - - 1 1 1 - - - - - - - 3 Other Tuberculous Diseases - - - - - - - - - 2 - 1 - - - - 3 Other Causes Erysipelas — — — — — — — — - — — — - — - - Syphilis — 1 — — 1 3 1 - - — - — - - — — 5 Rickets - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) — - - - - - - 1 - — 1 — - 1 — 1 4 Convulsions Bronchitis 2 - 1 - 2 - — - 3 2 3 2 2 1 - 1 1 2 - 2 — 1 1 1 4 —- 1 11 18 Laryngitis - - - - - - - - - - - - - - - - - Pneumonia 1 - 1 1 3 1 3 3 2 1 - - - 5 2 1 24 Suffocation, overlaying 2 1 - - 3 - 1 1 - - - - - - - 5 Other Causes 7 1 1 1 10 3 1 1 3 1 - 1 1 1 — 1 23 72 13 20 10 115 48 35 38 36 19 j!9 17 19 23 6 16 391 * Including Asthenia, Malnutrition and Inanition. Population (estimated to middle of 1906), 148,463. Births in the year—legitimate, 3,364 ; illegitimate, 82 Deaths from all causes at all ages, 1,777. Deaths under one year—legitimate 377, illegitimate 14. 124 II.—CARD ON PREVENTION OF CONSUMPTION. Borough of Lewisham. Public Health Department. THE PREVENTION OF CONSUMPTION. The phlegm or expectoration which is coughed up from the lungs of consumptive persons is exceedingly dangerous to others, as it often contains the infection of the disease. If deposited on the floor of a room this phlegm becomes dry, and may then be distributed in the form of dust and inhaled by healthy persons. In this way the disease is frequently spread. Consumptive persons should not, therefore, spit on the floors of dwelling rooms or public places. A spit-cup or a pocket spittoon, containing a disinfecting fluid such as carbolic acid or cyllin, should be used. Pocket spittoons may be obtained at most chemists. After the spittoon is emptied it should be placed in boiling water for ten minutes. Consumptive persons should not use ordinary handkerchiefs, but pieces of linen rag or Japanese fibre handkerchiefs, which can be burned when soiled. The Japanese handkerchiefs, can be obtained in boxes of 120 for about 1/-. If the ordinary handkerchief is used, it should be placed in boiling water before being washed or sent to the laundry. Consumptive persons should always cover the mouth when conghing. Small particles of phlegm thrown off in the act of coughing are liable to convey infection to others. The room occupied by a consumptive person should be kept very clean, wellaired, and ventilated. It should be the lightest room in the house, and the windows should be kept open day and night, a screen being provided to prevent draught. The room should contain no more furniture than is absolutely necessary. Wet cloths should be used for dusting the room, to prevent the distribution of dust which may contain infection. When possible, a consumptive person should have a room to himself, or if this is impossible, at least a separate bed. Any room that has recently been occupied by a consumptive person should not be occupied by anyone else until the room has been thoroughly cleansed and disinfected. If by any chance the pillows or bed-clothing should become soiled by expectoration, they should at once be placed in boiling water, and then washed. Dust should not be allowed to accumulate anywhere. The germs of consumption have been discovered in dust which remained in a room many months after it had ceased to be occupied by a consumptive person. Bright sunlight is extremely fatal to the germs of consumption. These germs or microbes thrive in dark and dirty places, under insanitary conditions, and in unventilated, stuffy, or overcrowded rooms. The germs or microbes of the disease readily take root and grow in persons debilitated by illness or alcoholic excess. On the removal of a consumptive patient, either to hospital or to another residence, immediate notice should be given to the Health Department in order that the room vacated may be disinfected. Disinfection of infected rooms and articles will be carried out free of charge by the Health Department. The methods used in disinfection cause little or no inconvenience to the occupants of the house. Disinfectants can be obtained gratis on application at the various Depots of the Borough Council. 1906.