LEW65 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 1907, by A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c., Medical Officer of Health and Public Analyst for the Borough of Lewiskam; Fellow and Member of the Council of the Royal Sanitary Institute ; Fellow of the Royal Society of Medicine- ; 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, 1907. Area in acres, exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1907 152,532 Average number of persons per house (Census, 1901) 5.6 Total number of Births registered in the Borough 3,622 Birth Bate per 1,000 estimated population 23.7 Total number of Deaths registered in the Borough 1,881 Total number of Deaths of residents of the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,749 Deaths of persons under 1 year of age 325 Infantile Death Bate per 1,000 Births registered 90 Total number of Deaths in Public Institutions in the Borough 660 Deaths of non-residents in the Borough 275 Deaths of residents outside the Borough 143 Corrected Death Bate per 1,000 of the estimated population 11.5 CONTENTS. Page Bacterioscopic Examinations 88 Birth Rates 18 Births Act, Notification of 39 illegitimate 19 Butter analysed 127 & 130 and Margarine Act, 1907 95 Cerebrospinal fever 87 Chicken Pox 72 Choler 88 Combined drains 107 Coroner's Court and Mortuary 108 Deaths, ages at 22 Death Rates 21 zymotic 24 Deaths in disease groups 27 infant 30 Diphtheria, deaths from 27 ,, Home for Sick Children 85 ,, notifications 69 Disinfection 109 Education (Administrative Provision) Act, 1907 97 Enteric fever, deaths 28 ,, notifications 70 Erysipelas notifications 70 Factory and Workshop Act, 1907 94 Factory and Workshop Act, inspections 112 Food analysis 127 „ test samples 127 ,, surrendered 1C9 Home Work 113 & 115 Houses unfit for human habitation 107 House-to-house inspection 106 Infant creches 35 ,, deaths, list of streets 48 ,, mortality 30 ,, ,, combative measures 32 Infants. Tuberculosis of 41 Infectious diseases, age periods 06 ,, attack rates 66 Page Infectious diseases, non-notifiable 72 ,, ,, notifiable 65 ,, ,, school notifications 72 Inquests 30 Legal proceedings 109 Legislation, New 93 London County Council (General Powers) Act, 1907 93 Marriages 21 Measles 72 Milk 128 ,, dirty 129 ,, dyed 129 ,, on delivery 129 Phthisis, voluntary notification 86 Population 15 Public Health (Regulations as to Food) Act 96 Puerperal fever notifications 70 Scarlet fever, deaths from 27 ,, exposure of children 78 ,, notifications 69 School children,medical inspection of 97 ,, closure 75 ,, Lewisham Bridge 76 Schools, disinfection of 81 ,, overcrowding of 108 Small-Pox 88 Smoke nuisance , 107 Scuth Suburban Gas Works... Ill Synopsis of tables 9 Tuberculosis. Extracts from report of Royal Commission 41 Unsound Food 109 Whooping cough 72 Women sanitary inspectors 118 ,, industrial employment of 42 Workplaces inspected 113 Workshops inspected 112 5 To the Mayor, Aldermen, and Councillors of the Metropolitan Bo rough of Lewisham. Gentlemen, I have the honour to submit my Annual Raport on the Vital Statistics and Sanitary Coalition of the Borough for the year ended December 31st, 1907, as required by an Order of the Local Government Board. The corrected Death-rate for the Borough equalled 11.5 per 1,000 of the population living at all ages, the lowest Deathrate recorded in London with the exception of Hampstead. We are in an equally fortunate position with regard to the mortality due to the principal epidemic diseases (0.71 per 1,000) tieing with Stoke Newington for second place. With regard to infant mortality, it is satisfactory to record the lowest rate in the history of Lewisham during any period for which statistics are available. The deaths occurring to infants before attaining the age of one year amounted to 90 per 1,000 births, the lowest rate in London except Hampstead, and the fourth lowest among the 76 Great Towns of England and Wales. The certified number of deaths from Phthisis amounted to 138, equal to a death rate of 0.90 per 1,000 of the population, also the lowest rate in London with the exception of Hampstead. A consideration of these figures, which form a good index of the healthiness of a district, shows that with the exception of Hampstead, Lewisham in comparison with other Metropolitan Boroughs holds the most favourable position. 6 The following epitome shows interesting comparisons with previous years and the average for five years:— Borough of Lewisham. Year. Average for five years, 1902-6. Year. 1902 1903 1904 1905 1906 1907 Birth Hate 26.3 26.1 25.6 25.2 23.2 25.3 23.7 Total Death Rate 137 11.1 120 11.7 12.0 12.1 11.5 Infant Mortality Rate 122 92 122 93 113 108 90 Zymotic Death Rate 1.70 082 1.40 0.83 1.31 1.21 071 Phthisis Death Rate 1.06 0.78 0.84 0.87 0.80 0.87 0.90 Notifiable Infeectious Diseases : Attack Rate 9.68 6.09 3. 93 5 .88 608 6.33 6.50 The Public Health Committee recommended the adoption of the Notification of Births Act, 1907, a measure of extreme value in our attempts to lessen infant mortality. Your Council, however, adjourned the consideration of its adoption. The objections raised in many districts have been overcome, and where the Act is in force notification of birth is given without any friction. Seventeen Metropolitan Borough Councils have now adopted the Act, and I trust your Council will reconsider the question at an early opportunity. I desire to draw special attention to the Education (Administrative Provisions) Act, 1907, which provides for the medical inspection of school children, and the memorandum issued by the Board of Education in respect of the same, in which is set out most clearly the scope of the Act. The memorandum points out the new Act is not intended to supersede the 7 powers which have long been exercised by Sanitary Authorities in relation to schools. The Board of Education recommend the use, to the utmost extent, of existing machinery of Medical and Sanitary Administration. It is distinctly stated that the Board view the subject of School Hygiene as an integral factor in the health of the nation and not as a speciality, and that there is objection to a dual jurisdiction in the sanitary control of school premises and the prevention of the spread of infectious diseases, and further that school hygiene cannot be separated from the hygiene of the home. The medical inspection to be of value must in many cases be followed by home visits. The informatian obtained by school inspections would be invaluable to the Medical Officer of Health in studying the health of the inhabitants of his district. It is a matter of regret that this valuable work is not (in London) to be administered by the Sanitary Authorities, but by the London County Council as the Central Education Authority. In conclusion I desire to record my appreciation of the excellent work of the staff and the willing assistance they have always given to me. I remain, Gentlemen, Your obedient Servant, April, 1908. 9 SYNOPSIS OF TABLES AND CHARTS. Part I.—Vital Statistics. Table 1.—Population of the Borough and number of persons per house in Wards obtained at the Census, April, 1901. Also the number of occupied houses at Michaelmas and the estimated population at June 30th, 1907. Table :2.—Births and Birth Rates for each Division of the Borough for the years 1902-7. Table 3.—Number of Deaths at various Age Periods and their Percentage to corrected Total Deaths during the years 1902-7. Table 4.—Corrected Death Totals and Death Rates for the years 1902-7. Table 5.—Percentage of Deaths Under One Year of Age to Total Deaths in Wards and Divisions for the years 1902—7. Table 6.—Analysis of Deaths Un ler One Year of Age during the years 1903-7. Table 7.—Distribution in Wards of Deaths under One Year, in different disease groups during 1907. Table 8.—Corrected Total Deaths, male and female, from All Causes in Wards occurring during the four quarters of the year 1907. Table 9.—Corrected Death Rates from all Causes in Wards, Divisions and the Whole Borough for the four quarters of the year 1907. Table 10.—Deaths in Disease Groups in the three Divisions and the Whole Borough for the year 1907. Table 11.—Death Rates in Disease Groups in the Wards and Divisions of the Borough for the year 1907. 10 Table 12.—Birth and Death Rates of London and Metropolitan Boroughs during the year 1907, after distribution of deaths in Public Institutions. Table 13.—Death Bates in London and the several Metropolitan Boroughs from All Causes and from Certain Diseases during the year 1907, before distribution and after distribution of deaths in Public Institutions. Table 14.—Causes of, and Ages at, Death in the Borough for the year 1907. Table 15.—Residents and Non-Residents dying in Public Institutions situated in the Borough. Table 16.—Deaths from Principal Zymotic Diseases in Wards during the year 1907. Table 17.—Death Rates from Principal Zymotic Diseases and Phthisis, and Infantile Mortality, in the Borough and its Divisions, in the County of London, and in the 76 Great Towns, for the year 1907. Table 18.—Deaths from Principal Zymotic Diseases arranged in Age Groups for the year 1907. Table 19.—Meteorological Table for London for the year 1907. Part II.—Infectious Diseases. Table 20.—Showing Cases of Scarlet Fever and Diphtheria at various Age Periods notified during the year 1907. Table 21.—Number of Cases of Infectious Diseases notified in the ten Wards during the year 1907. Table 22.—Attack Rates from the Principal Infectious Diseases per 1,000 of the population for the Ten Wards and the Whole Borough for the years 1904-7. Table 23.—Attack Rates at All Ages from Small-Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the years 1904-7. 11 Part III.—General. Table 24.—Water Certificates Granted. Table 25.—Houses Examined and Certified under the Customs and Inland Revenue Acts. Table 26.—Details of Inspection of Factories, Workshops and Workplaces with Defects Found. Table 27.—Details of Home Work in the Borough. Table 28.—Details of Workshops and Workplaces in the Borough. Tables 29 and 30.—Register of Sanitary Work for 1907. Part IV.—Report of Public Analyst. Table A.—Showing Number of Samples submitted for Analysis, with Results, for the year ended December 31st, 1907. Table B.—Summary of Samples Analysed in the Borough in each of the years 1898 to 1907 (inclusive). Table C.—Showing Results of Total Samples submitted during the years 1903-7. Table D.—Showing Results of Total Samples of Milk submitted during the years 1903-7. Table E.—Average Composition of Milk Samples submitted in 1907. Table F.—Average Composition of Milk Samples submitted during the years 1902-7. Table G.—Details of Adulterated Samples of Milk for the year ended December 31st, 1907. Table H.—Showing the Number of Samples of Butter submitted in the four quarters of the years 1903-7. Table I.—Details of Adulterated Samples of Butter submitted in 1907. Table J.—Details of Other Adulterated Samples and other Prosecutions during the year 1907. 12 Appendices. I.—Local Government Board Tables Table I.—Vital Statistics of Whole District during the years 1901-7. Table II.—Vital Statistics of Separate Localities in the years 1901-7. Table III.—Cases of Infectious Disease notified during the year 1907. Table IV.—Causes of, and Ages at, Death during the year 1907. Table V.—Detailed analysis of Deaths under one year of age during the year 1907. II.—Copy of Leaflet sent to Measles Homes. Charts. Chart A.—Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ended 28th December, 1907. Chart B.—Showing Percentage of Deaths in Eleven Groups to Total Deaths during 1907. Chart C.—Showing Weekly Notifications of All Infectious Diseases, also Weekly Notifications of Scarlet Fever, and Diphtheria, during the year 1907. PART 1. VITAL STATISTICS. * 15 report OF THE Medical Officer of Health FOR THE YEAR 1907. YITAL STATISTICS. Population—The estimated population for the year 1907 amounted to 152,532, calculated upon the assumption that the increase in the population maintained the same rate of progression each year as it did during the intercensal period 1891 to 1901. It must be understood therefore that the population is purely an estimate, and in districts in which the conditions of the population vary little, such estimates prove remarkably accurate. In other districts, however, great changes may occur in any period, the most important of which are the alterations of population by reason of emigration and immigration. The Borough of Lewisham is rapidly extending its population, and I believe in far greater proportion and with greater rapidity each year than in the intercensal period 18911901. This is due principally to the fact that a considerable portion of the Borough was unbuilt upon. In recent years buildings have been erected in various parts of the district at a rapid rate, particularly in the Catford, Lewisham Park, Sydenham, Forest Hill and Brockley Wards. This fact is well illustrated by Table 1, where it will be seen that the estimated 16 increase of population in the 6½ years which have elapsed since the census was taken amounted to 12,512 in Catford, 6,009 in Lewisham Park, 3,817 in Sydenham, 2,230 in Forest Hill and 2,223 in Brockley. By the courtesy and assistance of Mr. E. H. Oxenham, we have been able to obtain from the Rating Department an accurate return as to the actual number of houses in each Ward known to be occupied in September, 1907. These figures multiplied by the average number of persons per house obtained at the census 1901, give a far more accurate estimate than that based upon the assumption that the population of the district increases each year in the same ratio as it did in the last intercensal period. Taking the number of ascertained occupied houses, and using the factors referred to, we obtained an estimated population in September, 1907, of 156,932. For statistical purposes, however, it is necessary to have the estimated population to the middle of the year, which is calculated as 155.800. When we consider, however, that in comparing the vital statistics of one district with another, the calculations must all be made upon a common basis we are bound to take the Registrar-General's estimate of 152,532, in order to compare fairly the vital statistics of Lewisham with the other Metropolitan Boroughs, the County of London, and other cities and towns. All vital statistics for the Borough as a whole in this report, therefore, are calculated upon the Registrar-General's figure. In some tables, however, we have been able to show comparative figures calculated upon the new estimated population. It is more particularly in relation to the Wards of the Borough thac the new figures have been most useful, as it has been possible to obtain a lar more accurate comparison in regard to their populations. 17 The various rates are per 1,000 persons estimated to be living in either the Ward, Division, or whole Borough, except where otherwise stated. Table 1. Showing the Population and number of persons per house in the Borough in Wards, obtained at the Census, April, 1901 ; also the number of occupied houses at Michaelmas and the Estimated Population at June 30th, 1907. Ward. Enumerated Population Census, April 1st, 1901 Number of Persons per house at Census, 1901 Occupied Mouses on Kate Books, Michaelmas, 1907 Estimated Population at Michaelmas, 1907 Estimated Increase or Decrease in Estimated Population at June 30th, 1907 6½ years 3 mths Church 6412 5.59 1178 6585 + 173 6 6579 Manor 6734 5.65 1342 7582 +848 32 7550 South 5503 6.16 1017 6264 +761 29 6235 Lee Division 18649 — 3537 20431 + 1782 67 20364 Blackheath 6729 5.87 1106 6492 —237 9 6501 Lewisham Village 13842 5.43 2752 14943 + 1101 42 14901 Lewisham Park 11145 6.27 2736 17154 +6009 234 16920 Brockley 10952 5.55 2374 13175 + 2223 85 13090 Catford 23203 5.26 6790 35715 +12512 481 35234 Lewisham Div. 65871 — 15758 87479 + 21608 833 86646 Forest Hill 18051 5.42 3742 20281 +2230 85 20196 Sydenham 24924 5.73 5016 28741 +3817 147 28594 Syd. & Forest Hill Division 42975 — 8758 49022 +6047 232 4879C Whole Borough 127495 — 28053 156932 +29437 1132 155800 18 THE BIRTH RATE. The total number of Births registered in the Borough of Lewisham during the year 1907 was 3,622. Of this total 1,854 were males and 1,768 females. The birth rate for Lewisham is therefore 23.7 per 1,000 inhabitants, compared with 23.2 in the previous year, and 25.3 the average for the past five years. The birth rate for London was 25.6 per thousand, or 1.9 per thousand in excess of this Borough. Of the total births, 446 were registered in the Lee division, 2,063 in Lewisham, and 1,113 in Sydenham and Forest Hill division. The birth rate in Lee was 22.2, in Lewisham 24.2, and in Sydenham and Forest Hill 23.5 per 1,000 of the inhabitants of each division. Declining Birth Rate.—The Annual Summary of the Registrar-General shows that the birth rate continues to decline throughout England and Wales. The birth rate for the whole country during the year under review amounted to 26.3 per 1,000 of the population, which was 0.7 per 1,000 below the rate in 1906, and again lower than any rate on record. The 76 Great Towns for which returns are available showed a birth rate of 27.0 per 1,000 of the population, the rates for the three preceding years having been 29.1, 28.2 and 27.8. It is interesting to note the wide range in the birth rates of various districts : e.g., Hastings 16.6, Hornsey 17.0, Bournemouth 17.3, Halifax 17.4, Bradford 20.0, Northampton 20.6, Coventry 33.0, Warrington 33.6, St. Helen's 34.2, Middlesbrough 34.2, Sunderland 34 3, Merthyr Tydfil 35.9, Rhondda 37.1. 19 In London the birth rate amounted to 25.6, or 2.1 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., City of London 13.7, Hampstead 15.1, City of Westminster 17.2, Kensington 19.0, Holborn 19.4, Stoke Newington 20.0; on the other hand Stepney 88.6, Shoreditch 33.0, Bethnal Green 31.8, Bermondsey 81.7, Poplar 31.0, Finsbury 29.8, Southwark 29.8. Illegitimacy.—During the year 1907, 4,582 infants were registered in London as having been born out of wedlock. This figure gives a proportion of 37 per 1,000 births, which is equal to the average proportion in the preceding ten years. In Lewisham of the 3,622 registered births, 92 or 25.4 per 1,000 were registered as being illegitimate, compared with 23.8 and 33.3 per 1,000 in the two previous ten years. On reviewing the returns of illegitimate births it is found that 52 per cent, of these children were born to domestic servants. Of the 92 illegitimate births, 9 under 1 year or 9.8 per cent, proved fatal, giving an infant mortality of 97.8 per 1,000 births. Table 2. Births and Birth Rates for each Division of the Borough for the years 1902-1907. Division. 1902. 1903. 1904. 1905 • 1906. 1907. Total Number of Births. Birth Kate per 1000 persons. Total Number of Births. Birth Kate per 1000 persons. Total Number of Births. Birth Kat 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. (a) (b) Lee 481 25.4 486 25.4 469 24.2 454 23.2 445 22.5 446 22.2 21.9 Lewisham 1857 26.6 1979 27.2 1967 25.9 2027 25.7 1871 22.8 2063 24.2 23.8 Syd. & Forest Hill 1153 26.3 1098 24.7 1153 25.5 1152 25.1 1130 24.2 1113 23.5 22.8 Whole Borough 3491 26.3 3563 26.1 3589 25.6 3633 25.2 3446 23.2 3622 23.7 23.2 County of London 130478 28.5 130906 28.4 129335 27.9 126620 27.1 124880 26.5 121408 25.6 - NOTE.—(a) Rates in this column are calculated upon the Registrar-General's Estimated Population. (b) These figures are calculated upon the more accurate population estimated from the actual number of occupied houses in 1907. 20 21 MARRIAGE RATE. The number of Marriages registered in the Borough during the year amounted to 1,032, compared with 951 in 1906. The Marriage Rate was 13.5, an increase of 0.7 per 1,000 on 1906, while the Marriage Rate for the whole of London was equal to 17.0, and for England and Wales 15.8 per 1,000. MORTALITY. The total number of Deaths registered in the Borough amounted to 1,881, compared with 1,888 for the year 1906. After deducting the deaths of non-residents (275) dying within the Borough, and adding those of residents (148) who died outside the district, a corrected total of 1.749 is obtained, compared with 1,777 in 1906. The corrected total deaths in Lewisham, 1,749, is equivalent to a Death Rate of 11.5 per 1,000 living at all ages, and compares most favourably with the death rate for England and Wales of 15.0 per 1,000 of the population. The death rate for the County of London was 14.6, which is the lowest on record. The rate for the 76 Great Towns equalled 15.4 per 1,000. Compared with other Metropolitan Boroughs, Lewisham has the second lowest death rate in London. Hampstead is the lowest with 9.0, followed by Lewisham 11.5, Stoke Xewington 11.5, Wandsworth 12.8, Woolwich 12.5, Greenwich 12.7 per 1,000 of the population living at all ages. The districts having the highest death rates in London were Shoreditch 20.5, Finsbury 18.7, Bermondsey 18.3, Southwark 18.0, Bethnal Green 17.5 and Holborn 17.4. (See Table 12). The death rate for Lewisham, 11.5 per 1,000 for the year 1907, shows a decrease of 0.5 over the previous year. 22 On sub-dividing the corrected deaths into the three divisions of the Borough, it will he 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, 10.5, and highest in the Lewisham Division, 11.5, the Sydenham and Forest Hill Division being 11.1. (See Table 9). Carrying the sub-division a step further, the death rates from all causes in the individual Wards show Blackheath to have suffered the highest mortality (15.5) ; on the other hand South claims the lowest mortality for the year with 8.7 per 1,000. (See Table 9). Age in relation to Deaths.—A division of the registered deaths at various age periods is arranged in Table 3. This Table shows a decrease of deaths among children under one, due chiefly to the considerable diminution in infantile diarrhoea. (See Table 6). The percentage deaths at this age period, compared with total deaths amounted to 18.58, compared with 22.00 in 1906. The relation of age periods to mortality from zymotic diseases are set out in Table 18. Of the 108 deaths from these diseases, 80.6 per cent. occurred among children under live years of age. The distribution of zymotic deaths in ward localities appears in Table 16. 23 Age Period. 1902. 1903 1904. 1905 1906. 1907. ANALYSIS OF DEATHS. Table 3. Number of Deaths at Various Age Periods and their Percentage to Corrected Total Deaths during the years 1902-1907. 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. Number of Deaths. Percentage to Total Deaths. Deaths under 1 yr. 428 23.54 328 21.68 440 26.21 338 19.99 391 22.00 325 18.58 Over 1 & under 5 yrs. 200 11.00 142 9.39 140 8.34 130 7.69 160 9.00 146 8.35 ,, 5 ,, 15 ,, 86 4.73 61 4.03 39 2.32 59 3.49 57 3.21 60 3.43 „ 15 „ 25 „ 86 4.73 76 5.02 85 5.06 63 3.72 68 3.83 65 3.72 „ 25 „ 65 „ 547 30.09 478 31.59 470 27.99 547 32.35 596 33.54 577 32.99 Over 65 years 471 25.91 428 28.29 505 30.08 554 32.76 505 28.42 576 32.93 Total 1818 100.0 1513 100.0 1679 100.0 1691 100.0 1777 100.0 1749 100.0 24 Seasonal Mortality.—The highest mortality occurred during the first and last quarters of the year, the death-rates from all causes being 15.4 and 11.7 per 1,000 respectively. The lowest death-rate was 8.4 for the third quarter. Chart A shows deaths from all causes recorded weekly and the seasonal effect with regard to Infantile Diarrhoea and diseases of the Respiratory Group. Table 10 shows the total deaths in 12 classes registered in each quarter, from which it will be seen that deaths from diseases of the respiratory organs, were the highest during the first and second quarters of the year and infective diseases during the first 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, Dysentery, Epidemic Diarrhoea and Epidemic Enteritis. For the year under review, the zymotic death rate for Lewisham amounted to 0.71 per 1,000 persons, showing a decrease of 0.80 over that of the previous year. The rate compares favourably with the rates 1.42 for the County of London, 1.60 for the 76 Great Towns, and 1.26 for England and Wales during the same period. These rates also show decreases of 0.50, 0.64, and 0.47 per 1,000 respectively over the rates for 1906. Lewisham possesses the lowest zymotic rate of the 10 South Metropolitan Boroughs. Only Hampstead has a lower rate in the whole of London. Chart A. Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 Weeks ended December 28th, 1907. 25 Of the total 108 deaths in Lewisham from the principal infectious diseases, Measles accounted for 17, Scarlet Fever 12, Whooping Cough 50, Diphtheria 17, Enteric Fever 1, Dysentery 1, Epidemic Diarrhoea 5, and Epidemic Enteritis 5. (See Table 16). The death rates from the above diseases for the whole Borough, the County of London, and the 76 Great Towns, have been calculated and are set out in Table 17. 26 Table 4. Corrected Death Totals and Death Rates for the years 1902-1907. Locality. 1902. 1903. 1904. 1905. 1906. 1907. Total Number of Deaths. Death rate per 1,000 of the population. Total Number of Deaths. Deathrateper 1,000 of the population. Total Number of Deaths. Death rateper 1,000 of the population. Total Number of Deaths. Death rateper 1,000 of the population. Total Number of Deaths. Death rateper 1,000 of the population. Total Number of Deaths. Death-rate per 1000 of the population. (a) (b) Lee Division 220 11.6 218 11.1 193 10.0 186 95 211 10.6 214 10.7 10.5 Lewisham Division 991 14.2 816 11.2 941 12.4 966 12.2 1000 12.2 995 11.7 11.5 Sydenham & Forest Hill Division 607 13.8 484 10.9 545 12.1 539 11.7 566 12.1 540 11.4 11.1 Whole Borough 1818 13.7 1513 11.1 1679 12.0 1691 11.7 1777 11.97 1749 11.5 11.2 County of London 80105 17.2 69737 15.2 74556 16.1 70442 15.1 71155 11.5 69268 14.6 — Note.—(a) Rates in this column are calculated upon the Registrar-General's estimated population. (b) These figures are calculated upon the more accurate population estimated from the actual number of occupied houses in 1907. 27 ANALYSIS OF DEATHS AT ALL AGES IN RELATION TO DISEASE GROUPS. GLASS I.—Infective Diseases (148) Small-Pox.—No deaths occurred from this disease. Measles.—Measles was recorded as the cause of 17 deaths, equal to a death rate of 0.11 per 1,000 of the population. This disease was less fatal compared with 1905 and 1906, when the death-rates amounted to 0.28 and 0.14 per 1,000 respectively. It is not a notifiable disease, consequently the case mortality cannot be obtained, but school notifications show that the disease was more prevalent last year than in 1906 (see page 72). Scarlet Fever.—Twelve deaths were notified in the Borough, equal to a mortality rate of 0.08 per 1,000 of the population, compared with 0.09 in 1906. The actual number of cases notified amounted to 584, compared with 543 in 1906. From this it will be seen that during the year under review, more cases of scarlet fever existed. On considering the case mortality it is found that of the 584 recorded cases 2.05 per cent. proved fatal, compared with 2.57 per cent. in 1906. Diphtheria.—There were 17 deaths from diphtheria, giving a mortality rate for the Borough of 0.11 per 1,000 of the population, compared with 0.14 in 1906. The number of notifications amounted to 287, compared with 260 during 1906. Notwithstanding this fact the case mortality was only 5.98 per cent, of the actual cases, compared with 8.6 per cent. in 1906. Whooping Cough.—Fifty deaths were attributed to Whooping Cough, the most fatal zymotic disease during last year. The death-rate equalled 0.33 per 1,000, compared with 0.18 in 1906. Forty-eight of these deaths occurred among children under five years of age. 28 Enteric Fever.—There was only one fatal case, equal to a death rate of 0.01 per 1,000. The case mortality was equal to 3.7 per cent. of the persons affected, compared with 5.0 per cent. for the preceding year. Epidemic Diarrhoea and Epidemic Enteritis.—The total deaths recorded in the year from these two diseases amounted to 10 (compared with 111 in 1906 and 82 in 1905), equivalent to a death-rate of 0.07 per 1000, compared with 0.75 and 0.22 in 1906 and 190.5 respectively, (See Tables 11 and 16). Deaths from other Infective Diseases were:—Dysentery, 1; Influenza, 16; Puerperal Fever, 4; Erysipelas, 7; Venereal Disease, 2; Septicemia not Puerperal, 5; Pyaemia, 4; and Infective Endocarditis 2. GLASS II.—Tuberculous Diseases (194).—Phthisis.—This disease was responsible for 138 deaths, or 7.9 per cent. of the total 1,749 deaths from all causes. This mortality is equal to a death rate of 0.90 per 1,000 (compared with 0.80 in 1906) for the whole Borough, the lowest rate of the ten Southern Metropolitan Boroughs. Of the remaining London sanitary districts, only Hampstead, with 0.73, is lower. The district having the highest mortality from this cause was Holborn, with 2.58 per 1,000. The death rate for the County of London was 1.40. 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 14). GLASS III.—Malignant Diseases (138).—Cancer was the stated cause of 102 deaths (compared with 105 in 1906) equal to a mortality rate of 0.67 per 1,000. On sub-dividing these deaths, 10 were registered in Lee, 57 in Lewisham, and 35 in Sydenham and Forest Hill. For other diseases of this Class see Table 14. 29 CLASS IV.—Nervous Diseases (114). — This class was responsible for 114 deaths, equal to6'5 per cent. of the total deaths. Of this number 81 were cases of insanity, 15 meningitis, 19 convulsions; of the latter 14 were children under 1 year. GLASS Y.—Diseases of Heart and Circulation (268). Diseases of Heart and Blood Vessels accounted for 268 deaths, equal to 15.3 per cent. of the total deaths. Sixty-eight deaths were due to valvular heart disease and endocarditis, and 66 to cerebral haemorrhage. CLASS VI.—Respiratory Diseases (276).—This class was the cause of 276 deaths, equal to 15.8 per cent. of the total deaths from all causes. The highest number of deaths were registered during the second week. (See Chart A). Bronchitis and pneumonia were the most fatal, particularly to children under 5 years of age. (See Table 14). CLASS VII.—Digestive Diseases (208).—To this class 203 deaths, or 11.6 per cent. of the total deaths, were assigned; children under 1 year were the sufferers in 106 cases. Cirrhosis of the Liver (frequently associated with alcoholism) was thecertified cause of 18 deaths, compared with 14 in 1906. CLASS VIII.—Diseases of Urinary Organs (65).—Sixtyfive, or 3.7 per cent. of the total deaths were recorded in this class. CLASS IX.—Diseases of Generative Organs (3).—Only 3 deaths were registered in this group. CLASS X.—General or Constitutional Diseases (278).— Of the 278, or 15.9 per cent. of the total deaths due to disease in this class, old age claimed 134 of the total, premature birth was the certified cause of 68, and alcoholism 3. BO CLASS XI.—Accidents (48).—Forty-eight fatal accidents occurred, 9 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 :—During the period under review 129 inquests were held in the Borough, in relation to which 75 post mortem examinations were made. Eighteen of these inquests were in respect to non-residents who had died in the Borough, representing 12 post mortems. On the other hand 18 inquests, with 7 post mortems, were held in other districts on residents of this Borough. INFANT MORTALITY. This mortality is measured by the proportion of deaths of children under one year to every thousand births registered. England and Wales.—During the year under review a •diminution in this mortality rate has taken place throughout England and Wales, the mortality figures being 118 per 1,000 births, compared with 138 in 1906. The returns for the 76 Great Towns show also a decrease, the rates being 127 in 1907 against 145 in 1906. The lowest infant mortality figures were registered in Hornsey 77, Hastings 79, Bournemouth 88, Reading 90, and Leyton 92. The towns having the highest rates were Stockport 159, Hanley 160, Rhondda 162, Wigan 168, and Nottingham 165. In London the infant mortality amounted to 116 per 1,000 births, compared with 131 in 1906. The lowest rates were recorded in Hampstead 69, Lewisham 90, City of London Chart B. Showing Percentage of Deaths in Eleven Groups to Total Registered Deaths in 1907. 31 94, Wandsworth 99, Greenwich 100, Stoke Newington 100; the highest in Shoreditch 150, Southwark 138, Bethnal Green 138, Holborn 131, and Finsbury 130. The general decrease throughout England and Wales was due in some measure to the prevalence during the summer months of climatic conditions, unfavourable to epidemic diarrhoea, one of the chief causes of infant mortality. In the Borough of Lewisham the infant mortality rate amounted to 90 per 1,000 births, compared with 113 in the preceding year, and 108, the mean rate for the five years 1902-6. It is a matter for congratulation that we can record such a low infant mortality rate, which is the second lowest in London, and ties for the fourth place amongst the 76 Great Towns of England and Wales. It is the lowest rate recorded in the history of Lewisham during any period for which statistics are available. Although we may congratulate ourselves upon this reduced rate, there still remains much to be done to minimise the terrible wastage of life among infants under three months. This is a most fatal period, and although the deaths under one year have been considerably reduced, there is practically no reduction under three months as the following figures will show:— Percentage deaths under three months to total deaths under one year. Year 1903 1904 1905 1906 1907 Rate 56% 50% 57% 51% 58% These figures emphasise the fact of the necessity of beginning at the earliest possible moment to place those in need of advice upon the right track. 32 Causes of Death.—During the year 325 de iths occurred among children under one year, compared with 391 in 1906. Of these 325 deaths, 92 were recorded as due to conditions which must be considered unavoidable, namely, Premature Birth (68) Congenital Defects and Injury at Birth. Again, 70 were registered under the headings of Atrophy, Debility, and Marasmus, diseases mainly due to errors of feeding. Bronchitis and Pneumonia were responsible for 47, Suffocation and Overlaying for nine deaths, diseases which in all probability could have been prevented. Diarrhœal diseases, which include all forms of diarrhoea, enteritis not tuberculous, gastritis, gasto-intestinal catarrh, gastro-enteritis, muco-enteritis, to a very great extent preventable diseases, were responsible for 41. Two deaths were certified as Measles and 18 Whooping Cough, compared with 3 and 12 respectively in 1906. Nine deaths were due to some form of tubercular disease (consumption), and 37 to diseases unclassified or ill-defined, such as convulsions. Illegitimacy.—The deaths among illegitimate children showed a marked improvement in 1907. There were registered during the year 92 illegitimate births. The infant mortality of such children under one year amounted to nine. In 1906 there were 82 illegitimate births with a mortality of 14. Combative Measures.—Although the seasonal influences were favourable to a low rate, I am inclined to think other factors were also at work. For some years past an endeavour has been made to educate the poorer mothers of the district in the successful management of their children, and although much ignorance still prevails among not only the working classes but amongst all classes, a marked improvement has occurred. This 83 has been particularly noticed by your women sanitary inspectors during their visits to selected homes. Furthermore, during the year we have had the advantage of receiving notifications of births from the local registrars, and we shall probably in the future follow the example of other boroughs in adopting the "Notification of Births Act," which will be of the greatest possible value in obtaining early information, and enable visits to be made to selected homes within a reasonable time of birth, before irreparable damage has been done through ignorance. The Act referred to is an adoptive one, which your Public Health Committee recommended should be applied to this Borough. Your Council, however, decided to postpone the consideration of the same. I am in a position to state that the objections which were raised in many districts have been surmounted, and where the Act is now in force, notifications are given by parents without any friction. I, therefore, seriously recommend that the question should be re-considered at an early opportunity. From a return obtained, 17 of the Metropolitan Boroughs have already adopted the Act. Some of these have, I believe, appointed qualified Health Visitors, who are doing valuable work. In addition to the wide distribution of pamphlets on the management of children to homes at which births were registered, visits were made to 452 selected cases. Your inspectors report there has been an increase in breast feeding; 355 were so nourished, whilst 30 were fed with breast and bottle, and 67 artificially fed. Of these 452 mothers 135 followed some employment away from home. 34 Homes were also selected where infants' deaths occurred. Inquiries were made in 165 of such cases, and of these babies 74 were found to be breast fed, 21 with breast and bottle, and 70 artificially. Employment away from home was followed by 48 of these mothers. While upon this subject I take this opportunity of referring to the valuable work which is being conducted in a portion of the district by Miss Pierse Duncombe (one of the Grey Ladies), who has established at St. Mary's Mission House, 45, Lady well Park, practically a school for mothers, the object being to teach expectant mothers during the ante-natal period, their duties and responsibilities towards their offspring. No important subject is omitted, and practical help is given by almost free meals to those who cannot afford to obtain the nourishment which is particularly needed at this period. After birth mothers are invited to bring their babies to the Mission House where Miss Duncombe, assisted by a lady doctor, gives advice on their feeding, clothing and general management. The babies are weighed every week, a record card supplied, and the importance of the increase in weight explained to the parent. Dinners are also provided for nursing mothers and every means taken to encourage breast feeding. Suitable work is found for many people and thrift is encouraged by a provident club. Where breast feeding is impossible and parents unable, through poverty, to obtain milk, an order is given for a free supply. I have had the pleasure of visiting this institution and was particularly struck with the interest which has been aroused among the poorer women of the district. It will have, I am sure, a great educational effect and be productive of excellent results. Not a little of the success will be due to the great tact, courtesy and personal interest displayed by the promoter towards all mothers who visit her. At the 35 same time she is quick to detect impositions and not afraid to adopt prompt remedies. This, I was informed, was seldom necessary. Unfortunately the work is limited to a small area of the Borough. I feel certain that such institutions as this would do much good, and are to be preferred to the establishment of milk depots with the free distribution of artificial food, which is open to much abuse, and certainly does not encourage breast feeding, which is of paramount importance. The pioneer of this good work in Lewisham, is only too anxious to be imitated, and is always willing to give information to those interested in the work. As a result of her example, the Lewisham Women's Health Society have established a similar organisation in Lower Sydenham. They could not have chosen a better locality, and I trust it will meet with a similar success. It is to be regretted that Local Authorities have no power to assist such organisations with contributions. Creches.—We are frequently made aware of the difficulty experienced by working women in placing their young children under suitable protection whilst away at work. Children are handed over to neighbours, who having many children of their own, can only offer indifferent attention to their temporary visitor. To some extent provision is made by philanthropic people in the establishment of creches. The returns of the Catford Creche, situated in Nelgarde Road, show that the home has been of considerable value, 1,803 children having been admitted in 1907. During my visits I have found the children exceedingly well cared for and the institution admirably administered. Another important institution, doing useful work upon the same lines, exists under the title of the Forest Hill Day 36 Nursery, in Beadnell Road. The value of this home may be gauged by perusing the last annual report which shows the number of attendances for the year 1907 amounted to 6,882. The nursery opens daily from 7.45 a.m. to 8 p.m., and children between the ages of one month and three years are received at a charge of 4d. per day for each child, and 6d. per day for two children from one family. The Committee in their report state that at times during the year, children who were doing well have been unavoidably kept from the nursery owing to the inability of the parents, through lack of work, to find the necessary fees. On the return of some of these children they were found to be pale and thin for want of the good food so necessary for their well-being and which they had previously enjoyed. A similar institution is situated at 28, Taunton Road, Lee, where the total attendances for the year equalled 2,600. I feel confident that the good work carried out by the above-mentioned institutions has been of considerable help, not only to young infants, but in educating mothers who have come under their influence. The work has been carried out quietly. In fact few know of their existence except those immediately benefited, and it is with the hope that the organisers and workers may receive public support, and that others may be encouraged to establish similar institutions, that I have ventured to bring this matter before you. We should be grateful for their help. Infant Life Protection.—As I have pointed out in previous reports there is need for the amendment of the existing law governing persons who receive infants for the purpose of nursing or maintaining them apart from their parents. The Infant Life Protection Act of 1897 only applies to persons receiving for hire or reward more than one infant under 37 the age of five years. Representations have already been made by your Council to the Local Government Board of the necessity of bringing under the provisions of the Act persons who at present contract out of the Act by receiving only one child. The subject has been brought before Parliament by a Bill entitled Infant Life Protection, presented by Mr. Staveley Hill. In this Bill it is proposed to raise the age of children, who are to be protected, from five to seven years, and to make the Provisions of the Act of 1897 applicable to persons receiving only one child. A Committee of the House of Commons have had before them special evidence upon this subject. The evidence given by Mr. I). Thomas, Clerk to the Guardians of Bethnal Green, has been most instructive and showed beyond doubt the provisions of the 189 7 Act should be extended to control one-child houses. Mr. Robert J. Parr, Director of the National Society for the Prevention of Cruelty to Children, stated that the society had cause to intervene in a number of one-child cases, and that from January 1st, 1903, to June 30th, 1907, a total number of cases reported to the society in London amounted to 97, and in the provinces 2,001. Some of the children had been permanently injured, whilst others had died of the treatment they had received. In many of the serious cases the own children of the family were well cared for. It was stated that a large trade was carried on in the adoption of one-child cases. From February 3rd to February 17th, 1908, 386 newspaper advertisements, excluding duplicates, were discovered, ottering to adopt children, and in only 11 of these advertisements was any reference made to taking more than one child. The majority of these children boarded out were illegitimate. 88 Mr. Parr, in his evidence further stated, whilst he was in favour of having inspection of all cases, he was of opinion that where childless people adopted children in good faith and where no payment was made, local authorities might grant a certificate of exemption on being satisfied of the bona fides of the persons concerned. Mr. Joseph Brown, President of the Poor Law Unions' Associations of England and Wales, stated that out of 201 unions connected with the Association, 171 were of opinion that protection should be extended to one-child homes. In our own district I am not suggesting that in the onechild houses cruelty towTards the nurse child is at all prevalent, but we do find foster mothers are, in many cases, crassly ignorant of the management of children and totally unfitted to do justice to their charges. In several instances the homes cannot be considered satisfactory. If it is necessary to have examination of homes where two or more children are received, it seems unjust that the single child should be deprived of the same protection. Lady St. Helier, in giving evidence before the Committee, practically objected to the registration of one-child homes. She admitted that her experience on the subject was not recent, as the maternity home which she conducted was closed in 1899. The witness stated that she had looked carefully through her books and had been unable to find a single case of cruelty or ill-treatment recorded in regard to any one of the children who had passed through her hands. She admitted, however, there were cases in which the child had to be removed from the foster parents on account of bad feeding and sometimes overfeeding, and put where the care of the child was better understood. Surely this admission is in favour of registration. The objection 39 was raised by Lady St. Helier that if the one-child homes were t/ 9/ registered, the difficulty of finding good homes for the children would be enormously increased. Of those who gave evidence before the Committee, some have rather laboured the point of the absence of evidence of cruelty, this being their reason for opposing the measure. The insanitary condition of the home and the general unfitness and ignorance of parents who undertake the charge of nursing the children are, in my opinion, just as important. From the Bill to which I have referred, one important point which I raised in my last annual report has been omitted, that is the subject of transferring the powers of the Infant Life Protection Act in London to the Borough Councils. With the increased facilities of the notification of births, and the probable adoption in this district of the Notification of Births Act, we shall have at first hand important information for carrying out the work. I sincerely hope the Bill will become operative, and the administration transferred to the Borough Councils, in which case we shall have additional powers to assist us in our efforts in the reduction of infant mortality. Returning to the subject of the Notification of Births Act, I append herewith a copy of the report submitted to your Council in 1907: — "The Notification of Births Act, 1907.—During the "past three years attempts have been made by Sanitary "Authorities throughout the country to reduce the great "sacrifice of infant life, due in a great measure to the ignorance "of parents in nursing and feeding their offspring. "It was not long before it was found that efforts to "remedy many existing evils in the environment and feeding 40 "of children were seriously handicapped by the lack of infor"mation as to births. "The existing law requires the registration of births "within 42 days, and arrangements were made after considerable "trouble to obtain from local Registrars a list of the births so "registered. "Owing to the long period in which births might be "registered, it was found, on visiting the homes of the poor "with the view of instructing the parents in simple rules of "nursing, that irremedial damage had already been done, "through ignorance, the infants having reached the age of six "or seven weeks before the local authority knew of their "existence. "This Council, in 1906, made a representation to the "Local Government Board of the desirability of the period of "registration being considerably reduced. "In June, 1906, a Conference on Infant Mortality was "held in London. Representatives from all parts of the "country were present, and an opening address was given by "the Right Hon. John Burns, President of the Local Govern"ment Board. "Statistics show that Infant Mortality rates have "declined very considerably within the last 30 years, between "the ages of three and twelve months, but in the mortality of "infants between birth and the age of three months there has "been no diminution. "It is obvious, therefore, that if any attempt is to be "made to reduce infant mortality, to be successful we must "direct our attention to the very youngest babies, directing a "proper course of feeding as soon after birth as possible. "The information necessary for any such step can only "be obtained by the prompt and early notification of births as "provided by the Act under consideration. There is little "doubt that the Act will be generally adopted, and in places "where it is not adopted the Local Government Board have "the power to declare it in force. "In addition to ordinary births, the Act also provides "for the notification of stillborn and prematurely-born infants. "The notification will in no way interfere with the "registration with the local Registrars, which will still remain "in force. 41 "Although there are some slight grounds for objection "in the Act, generally, its adoption will be of considerable "value in reducing infant mortality and the consequent wastage "of infant life. "On receipt of the notifications, visits will be made only "to homes selected in the poorer districts. "Town Hall, Catford, "11 th November, 1907." EXTRACT FROM THE REPORT OF THE ROYAL COMMISSION ON TUBERCULOSIS. The second interim report (Jan. 1907) of the Royal Commission on Tuberculosis contains statements which have an important bearing upon the subject of the conveyance of Tuberculosis to infants by milk. The commission reported thereon in the following terms :— "There can be no doubt that in a certain number of "cases the tuberculosis occurring in the human subject, "especially in children, is the direct result of the introduction "into the human body of the bacillus of bovine tuberculosis, "and there can also be no doubt that in the majority, at least, "of these cases the bacillus is introduced through cow's milk. "Cow's milk containing bovine tubercle is clearly a cause of "tuberculosis, and of fatal tuberculosis in man." "A very considerable amount of disease and loss of life, "especially among the young, must be attributed to the use of "cow's milk containing tubercle bacilli. The presence of "tubercle bacilli in cow's milk can be detected, though with "some dimculty, if the proper means be adopted, and such milk ought never to be used for food. There is far less "difficulty in recognising clinically that a cow is distinctly "suffering from tuberculosis, in which case she may be yielding "tuberculous milk. The milk coming from such a cow ought "not to form part of human food, and, indeed, ought not to be "used as food at all. "Our results clearly point to the necessity of measures "more stringent than those at present enforced being taken to "prevent the sale or the consumption of such milk." 42 INDUSTRIAL EMPLOYMENT OF WOMEN. The Home Office have had under consideration the need of further legislation upon this subject as suggested by the Report of the Physical Deterioration Committee, 1904, and the resolutions adopted at the National Conference on Infantile Mortality. The present law prohibits the employment of a woman within four weeks after she has given birth to a child. The conference on infantile mortality passed the following resolutions :— "(a) That the period of one month's abstention from "factory work away from home now imposed on mothers "be extended to at least three months and that, on their "return to work, evidence must be produced satisfactory to "the local authority that proper provision has been made "for the care of the child. "(b) That no employer of labour shall permit a woman "advanced in pregnancy to engage in factory labour unless "her ability therefor has been certified to the satisfaction "of the local authority."' The question of imposing further restrictions presents great difficulties both from a social and administrative point of view. The Home Office considered the subject, but before arriving at any decision, were desirous of obtaining from the various Medical Officers of Health statistics relating to the number of married and unmarried women industrially employed in factories, workshops, and as outworkers in industrial work at home, in their respective districts, together with returns showing certain particulars as to live births (legitimate and illegitimate), still births, and miscarriages among women so employed, and the number of legitimate and illegitimate deaths of infants under one year. 43 These particulars were exceedingly difficult to obtain, but in districts where the Notification of Births Act has been adopted the chief difficulties have been removed. Many suggestions were made to the Home Office and as a result the medical officers were invited to attend a conference held on November (5th at the Home Office. The conference was largely attended and it was generally agreed that the proposed inquiry should be made on the following lines:— (1) Information should be obtained by medical officers in relation to the industrial employment of women (and childbirth) employed in factories and workshops; those employed in industrial work at home; other workers, e.g., charwomen and hawkers; and those employed in domestic duties only. (2) Illegitimate births.—Notwithstanding certain difficulties in the way, the distinction between cases of legitimacy and illegitimacy should, if possible, be made. (8) Miscarriages.—Each medical officer to decide what information (if any) to be collected in his district. (4) Feeding of the child.—Information should be obtained as to the method of feeding during the first six months of life, distinction being drawn between entire and partial breast feeding. (5) Age of infant at death.—The exact age at death to be obtained. (6) Cause of death.—The inclusion of this information to be optional. (7) Nationality and race of mother to be left to the discretion of the Medical Officer of Health. (8) Method of collecting information.—It was agreed that the employment of trained women visitors would be necessary. 44 The Medical Officers of Health were reminded by the Secretary of State that the two main objects of the inquiry are:— (a) To determine the effect of employment of women before and after childbirth on the health of the mother and child. (b) To guage the social and economic effects which further restrictions on the employment of women in factories and workshops before and after childbirth would entail: in particular whether such restrictions would or would not have indirect effects prejudicial to infant life either by adding to the economic burden of child-bearing and thus leading to a further fall in the birth-rate, or by increasing the poverty of the household and so—through worse feeding, &c.—lead to an increase in the infant death-rate. Although one is desirous of assisting in so useful an inquiry we are handicapped in Lewisham by reason of not having in force within the district the Notification of Births Act, 1907, or the staff of health visitors who could collect the information. 45 Table 5. Percentage of Deaths under one year of age to Total Deaths in Wards and Divisions for the years 1902-1907. District. 1902. 1903. 1904. 1905. 1906. 1907. per cent. per cent. per cent. per cent. per cent. per cent. Church Ward 11.8 11.3 19.7 12.7 18.4 14.3 Manor Ward 16.4 26.4 26.0 9.4 20.5 20.0 South Ward 20.3 14.8 13.3 11.8 17.3 5.6 Lee Division 15.9 17.4 20.7 11.3 19.0 14.5 Blackheath Ward 14.5 13.8 13.9 17.0 17.3 8.8 Lew. Village Wd. 18.5 22 2 27.6 20.7 19.3 18.0 Lew. Park Ward 25.1 20.8 31.5 20.5 21.9 20.0 Brockley Ward 26.2 20.0 27.2 15.7 22.7 20.8 Catford Ward 34.6 32.7 31.3 26. 21.9 19.8 Lew. Division 26.9 24.9 28.2 21.5 22.0 18.7 Forest Hill Ward 21.7 13.4 18.6 17.5 20.0 19.1 Sydenham Ward 20.6 21.4 29.1 22.4 25.1 20.7 Sydenhm.& Forest Hill Division 21.0 18.2 24.8 20.2 23.1 20.0 Whole Borough 21.68 23.54 26.21 19.99 22.0 18.6 46 Table 6. Analysis of Deaths under one year of age, during the years 1903-1907. Disease. 1903. 1904. 1905. 1906. 1907. 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 un^er 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 8.0 29 6.6 23 6.8 17 4.3 20 6.2 Diarrhoeal Diseases 60 18.8 122 27.7 59 17.5 123 81.5 41 12.6 Wasting Diseases 124 37.8 151 34.3 139 41.1 147 37.6 162 49.8 Tuberculous Diseases 14 4.3 14 3.2 10 3.0 14 3.6 9 2.8 Respiratory Diseases 58 16.2 64 14.5 43 12.7 46 11.8 50 15.4 Diseases classified under other headings 67 20.4 60 13.6 64 18.9 44 11.3 43 13.2 Total 328 100.0 440 100.0 338 100.0 391 100.0 325 100.0 Note.— For detailed list of these diseases see Table V. of the Local Government Board Tables (page 146). 47 Distribution in Wards.— The following table shows the distribution of infant deaths in the various wards of the Borough. The highest mortality was in the Lewisham Park, Manor and Forest Hill Wards :— Table 7. Ward. Common Infectious Diseases. Diarrhoeal Diseases. Wasting Diseases. Tubercular Diseases. Respiratory Diseases. Other Diseases. Total Infant Deaths Death_rate per. iooo of the Population. a b Church - - 7 1 2 - 10 1.4 1.5 Manor 2 - 11 - 4 1 18 2.4 2.4 South - - 1 - 1 1 3 0.5 0.5 Blackheath 1 1 3 - 2 1 8 1.2 1.2 Lew. Village 1 4 10 - 4 11 30 2.0 2.0 Lew. Park 4 4 26 2 2 4 42 2.4 2.5 Brockley 2 4 12 1 7 4 30 2.5 2.3 Catford 2 17 36 2 8 11 76 2.2 2.2 Forest Hill 3 5 26 1 9 4 48 2.6 2.4 Sydenham 5 6 30 2 11 6 60 2.1 2.1 Total 20 41 163 9 50 43 325 2.1 2.08 .Note: (a) Rates in this column are calculated upon the Registrar_General's estimated Population. (b) These figures are calculated upon the more accurate estimated Population obtained from the actual number of occupied houses ascertained in 1907. 48 LIST OF STREETS in which more than one infant died under the age of 12 months, showing that the majority of infantile deaths occurred among the poorer classes. Lek. Aislibie Road 2 Effingham Road 2 Lampmead Road 2 Belmont Hill 2 Hedgley Street 2 Murillo Road 2 Boone Street 3 High Road 2 Taunton Road 2 Lewisham. Ardmere Road 3 Fernbrook Road 3 Malyons Road 3 Arngask Road 2 High Street 3 Montpelier Vale 2 Barmeeton Road 2 Hither Green Lane 2 Mill Road 2 Broadfield Road 2 Honley Road 3 Rennell Street 3 Brockley Rise 2 Howson Road 3 Sandhurst Road 3 Brookbank Road 3 Killearn Road 5 Sang ley Road 6 Brookdale Road 6 Kneller Road 2 Salehurst Road 4 Courthill Road 2 Knowles Hill Crescent 2 Shell Road 2 Davenport Road 2 Sparta Street 2 Ellerdale Street 4 Lady well Park 4 Sportsbank Street 2 Els wick Road 5 Laleham Road 3 Springbank Road 3 Engleheart Road 4 Lanier Road 2 Theodore Road 2 Ennersdale Road 2 Leahu rat Road 3 Torridon Road 3 Farley Road 3 Longhurst Road 2 Wildfell Road 2 Sydenham and Forest Hill. Beadnell Road 2 Ewart Road 2 Miall Road 2 Bovill Road 3 Herschell Road 3 Perry Hill 2 Bur ford Road 3 Highclere Street 3 Porthcawe Road 4 Colfe Road 2 Holmshaw Road 4 Stanstead Road 3 Dal main Road 8 Hurstbourne Road 2 Stanton Square 2 Devonshire Road 2 Kent House Road 2 Trilby Road 3 Dillwyn Road 2 Larkbere Road 3 Wells Road 2 Elsinore Road 2 Malham Road 3 Winch field Road 2 49 Table 8. Corrected total Deaths from All Causes in Wards occurring during the four quarters of the year 1907. Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total Cburch Ward 10 14 24 7 10 17 .5 2 7 6 16 22 28 42 70 Manor Ward 17 16 33 10 9 19 9 10 19 6 13 19 42 48 90 South Ward 9 9 18 10 7 17 5 5 10 4 5 9 28 26 54 Blackheath Ward 14 20 34 11 11 22 4 13 17 10 8 18 39 52 91 Lewisham Village Ward 24 24 48 16 29 45 15 13 28 20 26 46 75 92 167 Lewisham Park Ward 24 40 64 22 20 42 30 25 55 25 24 49 101 109 210 Brock ley Ward 18 21 39 16 20 36 11 10 21 26 22 48 71 73 144 Catford Ward 68 68 136 41 35 76 42 31 73 32 66 98 183 200 383 Forest Hill Ward 37 41 78 28 28 56 21 29 50 33 34 67 119 132 251 Sydenham Ward 61 54 115 24 37 61 20 22 42 32 39 71 137 152 289 The Whole Borough 282 307 589 185 206 391 162 160 322 194 253 447 823 926 1749 50 Table 9. Corrected Death Rates from All Causes in Wards, Divisions, and the Whole Borough, for the four quarters of the Year 1907. Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. 1907. Church Ward 14.6 10.8 4.8 13.4 10.6 Manor Ward 17.5 10.1 10.1 10.1 11.8 Southward 11.5 10.9 6.4 5.8 8.7 Lee Division 14.7 10.4 7.1 9.8 10.5 Blackheath Ward 20.9 13.5 10.5 11.1 15.5 Lew. Village Ward 12.9 12.1 7.5 12.3 11.2 Lew. Park Ward 15.1 9.9 13.0 11.6 12.4 Brockley Ward 11.9 11.0 6.4 14.7 11.0 Catford Ward 15.4 8.6 8.3 111 10.9 Lewisham Division 14.8 10.2 9.0 12.0 11.5 Forest Hill Ward 15.4 11.1 9'9 13.3 12.4 Sydenham Ward 16.1 8.5 5.9 9.9 10.1 Sydenham & Forest Hill Division 15.8 9.6 7.5 11.3 11.1 *Whole Borough (a) 15.1 10.0 8.3 11.5 11.2 (b) 15.4 10.3 84 11.7 11.5 County of London 18.5 14.0 11.5 14.3 14.6 76 Great Towns 19.0 14.9 12.2 15.4 15.4 England and Wales 18.7 14.6 12.1 14.7 15.0 .Note.—Rates in line (a) are calculated upon the more accurate population obtained from the actual number of occupied houses ascertained in 1907. The rates (b) are calculated upon the Registrar-General's estimated Population. 51 Table 10. Deaths in Disease Groups in the Three Divisions and the whole Borough for the year 1907. Disease Classes. Lee Division. Lewisnam Division. Sydenham and Forest Hill Division Whole Borough 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1st Qr- 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year I. Infective 6 2 1 2 11 31 24 22 16 93 29 5 4 6 44 66 31 27 24 148 II. Tuberculous 6 6 4 6 22 36 23 26 30 115 20 12 13 12 57 62 41 43 48 194 III. Malignant 2 6 2 5 15 22 14 20 18 74 15 11 10 13 49 39 31 32 36 138 IV. Nervous 2 G 2 1 11 25 14 15 18 72 11 7 6 7 31 38 27 23 26 114 V. Heart & Blood Vessels 9 11 6 17 43 46 26 23 50 145 19 18 17 26 80 74 55 46 93 268 VI. Respiratory 21 6 5 5 37 57 38 24 28 147 43 20 7 22 92 121 64 36 55 276 VII. Digestive 9 4 4 5 22 31 25 22 36 114 19 17 11 20 67 59 46 37 61 203 VIII. Urinary 3 2 3 3 11 16 6 8 13 43 2 5 2 2 11 21 13 13 18 65 IX. Generative Organs - — — — — 1 1 — 1 3 — — — — — 1 1 — 1 3 X. General 16 10 6 G 38 39 38 30 38 145 33 17 21 24 95 88 65 57 68 278 XI. Accidents 1 — 1 — 2 14 10 3 9 36 1 3 1 5 10 16 13 5 14 48 XII. Violence — — 2 — 2 3 2 1 2 8 1 2 — 1 4 4 4 3 3 14 Totals 75 53 36 50 214 321 221 194 259 995 193 117 92 138 540 589 391 322 447 1749 52 Table 11. Death Rates per 1,000 of the population, Disease Groups, in the Wards and Divisions of the Borough for the year 1907. Disease Class Wards and Divisions. Church 2 3 4 5 6 7 8 9 10 11 12 13 Whole Borough Manor South Lee Blackheath Lewisham Village Lewisham Park Brockley Catford Lewisham Forest Hill Sydenham Sydenham and Forest Hiil I. Infective 0.7 0.8 0.2 0.5 0.8 0.7 1.0 1.0 1.3 1.1 0.7 1.0 0.9 0.9 II. Tunerculous 0.7 1.5 1.1 1.1 1.1 0.6 1.7 1.0 1.6 1.3 1.4 1.0 1.2 1.2 III. Malignant 1.1 0.4 0.8 0.7 0.6 0.9 1.1 0.7 0.8 0.9 1.4 0.7 10 0.9 IV. Nervous 0.3 0.5 0.8 0.5 .1 0.9 1.3 0.8 0.5 0.8 0.6 0.6 0.6 0.7 V. Heart and Blood Vessels 2.1 2.1 2.1 2.1 2.8 2.0 1.1 2.1 1.4 1.7 2.0 1.4 1.6 1.7 VI. Respiratory 1.8 2.6 0.8 1.8 29 1.7 1.5 1.9 1.5 1.7 2.0 1.8 1.9 1.8 VII. Digestive 1.4 1.2 0.6 1.1 1.4 1.5 1.4 1.4 1.2 1.3 1.7 1.2 1.4 1.3 VIII. Urinary 0.7 0.3 0.8 0.5 0.6 0.6 0.4 0.4 0.5 0.5 0.2 0.2 0.2 0.4 IX. Generative Organs — — — — — — 0.1 0.1 — 0.0 — — — 0.0 X. General Diseases 2.1 2.3 1.1 1.9 2.3 1.3 2.4 1.2 15 1.7 1.8 2.0 1.9 1.8 XI. Accidents — 0.1 0.2 0.1 0.3 0.7 0.3 0.3 0.4 0.4 0.4 0.1 0.2 0.3 XII. Violence — 0.1 0.2 0.1 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 Total Deaths 10.6 11.8 8.7 10.5 15.5 11.2 12.4 11.0 10.9 11.5 12.4 10.1 11.1 11.2 58 Table 12. Birth and Death Rates of London and Metropolitan Boroughs during the year 1907, after distribution of Deaths in Public Institutions. Boroughs Per 1000 Persons Living. Deaths under 1 year to 1000 Births registered Births. Deaths from All Causes Principal Epidemic Diseases Small.Pox Measles Scarlct Fever Diphtheria Whooping.Cough Typhus Enteric Fever Pyrexia* (Origin uncertain) Diarrhoea Phthisis Cntyof L'nd'n 25.6 14.6 14.2 — 0.38 0.14 0.16 0.38 — 0.04 0.00 0.32 1.40 116 West. Paddington 21.8 13.5 1.13 — 0.25 0.09 0.13 0.35 — 0.03 — 0.28 1.09 109 Kensington 19.0 13.7 1.04 — 0.17 0.05 0.13 0.45 — 0.03 — 0.21 1.03 128 Hammersmith 25.3 14.3 1.16 — 0.44 0.08 0.15 0.27 — 0.05 — 017 1.20 117 Fulham 27.8 13.2 1.73 — 0.42 0.08 0.23 0.45 — 0.05 — 0.50 1.19 122 Chelsea 20.3 15.0 1.44 — 0.56 0.03 0.09 0.33 — 0.04 — 0.39 1.50 122 Ctyof Wstmstr 17.2 13.0 0.72 — 0.11 0.07 0.10 0.15 — 0.05 — 0.24 1.37 102 North. St. Marylebone 20.9 15.0 0.97 — 0.14 0.15 0.12 0.35 — 0.02 — 0.19 1.48 101 Hampstead 15.1 9.0 0.51 — 0.13 0.06 0.08 0.13 — 0.02 — 0.09 0.70 69 St. Pancras 24.7 15.0 1.17 0.37 0.11 0.13 0.33 — 0.02 — 0.21 1.66 108 Islington 25.0 14.7 1.25 0.38 0.06 0.12 0.36 — 0.04 0.00 0.29 1.32 116 Stoke Nwingtn 20.0 11.5 1.02 — 0.13 0.19 0.13 0.36 — 0.06 — 0.15 0.94 100 Hackney 24.3 13.6 1.37 — 0.26 0.19 0.20 0.29 — 0.09 — 0.34 1.17 112 Central. Holborn 19.4 17.4 1.28 — 0.22 0.04 0.18 0.51 — 0.04 — 0.29 2.58 131 Finsbury 29.8 18.7 1.83 — 0.51 0.18 0.17 0.54 — 0.02 — 0.41 2.33 130 City of London 13.7 16.8 0.85 — 0.05 0.05 0.25 0.35 — 0.10 — 0.05 2.02 94 East. Shoreditch 33.0 20.5 3.01 — 1.03 0.24 0.17 0.88 — 0.05 — 0.64 2.10 150 Bethnal Green 31.8 17.5 1.96 — 0.54 0.33 0.14 0.46 — 0.05 — 0.44 1.90 138 Stepney 33.6 15.9 1.97 — 0.50 0.27 0.30 0.33 — 0.07 0.00 0.50 1.56 117 Poplar 31.0 16.9 2.11 — 0.56 0.26 0.29 0.48 — 0.06 — 0.46 1.33 124 South. South wark 29.8 18.0 1.90 — 0.54 0.17 017 0.49 — 0.05 — 0.48 2.03 138 Bermondsey 31.7 18.3 1.71 — 0.41 0.28 0160.43 — 0.05 — 038 1.88 123 Lambeth 24.6 14.6 1 28 — 0.34 0.13 015 0.35 — 0.02 — 0.29 1.53 120 Batter sea 25.5 13.3 1.34 — 0.38 0.10 0.210.38 — 0.02 — 0.25 1.25 114 Wandsworth 25.6 12.3 1.16 — 0.23 0.09 0.14 0.40 — 0.04 — 0.26 0.95 99 Camberwell 24.4 13.9 1.43 — 0.44 0.13 0.14 0.43 — 0.03 — 0.26 1 31 115 Deptford 28.3 14.1 1.47 — 0.46 0.12 0.22 0.32 — 0.05 0.01 0.29 1.34 108 Greenwich 24.3 12.7 1.44 — 0.54 0.09 0.17 0.24 — 0.05 — 0.35 1.08 100 Lewisham 23.7 11.5 0.71 — 0.11 0.08 .0.11 0.33 — 0.01 — 0.07 0.190 90 Woolwich 25.8 12.5 1.38 — 0.56 0.11 0.12 0.29 — 0.03 0.01 0.26 1.25 112 In this Table O'OO indicates that the deaths were too few to give a rate of 0.005; where no death occurred, — is inserted. *Called Simple Continued Fever previous to 1901. 54 *Table 13. Death-rates during 1907 in London and the several Metropolitan Boroughs, from All Causes, and from Certain Diseases (1) before Distribution, (2) after Distribution of Deaths in Public Institutions, etc. Boroughs. Death-rates per 1000 Living. All Causes. Scarlet Fever. Diphtheria Enteric Fever Phthisis. Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distri bution County of London 14.8 14.6 0.12 0.14 0.16 0.16 0.04 0.04 1.38 1.40 West. Paddington 14.4 13.5 0.01 0.09 0.09 0.13 0.05 0.03 1.01 1.09 Kensington 15.6 13.7 — 0.05 0.03 0.13 0.03 0.03 1.79 1.03 Hammersmith 14.6 14.3 0.01 0.08 0.07 0.15 0.06 0.05 1.11 1.20 Fulham 11.8 13.2 0.20 0.08 0.58 0.23 0.08 0.05 1.09 1.19 Chelsea 22.6 15.0 0.01 0.03 0.04 0.09 0.04 0.04 2.89 1.50 City of Westm'r 14.0 13.0 0.01 0.07 0.05 0.10 0.04 0.05 0.87 1.37 North. St. Marylebone 14.0 15.0 0.02 0.15 0.05 0.12 0.02 0.02 0.84 1.48 Hampstead 11.6 9.0 0.70 0.06 0.46 0.08 0.04 0.02 1.54 0.70 St. Pancras 15.4 15.0 0.00 0.11 0.06 0.13 0.02 0.02 1.72 1.66 Islington 14.4 14.7 0.02 0.06 0.03 0.12 0.02 0.04 1.57 1.32 Stoke Newington 9.4 11.5 0.06 0.19 0.06 0.13 0.04 0.06 0.79 0.94 Hackney 14.4 13.6 0.28 0.19 0.34 0.20 0.12 0.09 1.29 1.17 Central. Holborn 20.6 17.4 — 0.04 0.22 0.18 0.05 0.04 1.71 2.58 Finsbury 9.6 18.7 — 0.18 0.01 0.17 — 0.02 0.85 2.33 City of London 43.9 16.8 0.05 0.05 0.69 0.25 0.20 0.10 1.98 2.02 East. Shored itch 19.0 20.5 — 0.24 0.02 0.17 — 0.05 2.19 2.10 Bethnal Green 16.9 17.5 0.03 0.33 0.03 0.14 0.06 0.05 2.00 1.90 Stepney 17.0 15.9 0.01 0.27 0.14 0.30 0.05 0.07 1.39 1.56 Poplar 17.0 16.9 0.03 0.26 0.08 0.29 0.05 0.06 1.47 1.33 South. South wark 14.7 18.0 — 0.17 0.10 0.17 0.02 0.05 0.94 2.03 Bermondsey 14.5 18.3 0.02 0.28 0.02 0.16 0.02 0.05 1.72 1.88 Lambeth 15.5 14.6 0.15 0.13 0.22 0.15 0.03 0.02 1.50 1.53 Battersea 13.4 13.3 0.01 0.10 0.03 0.21 0.01 0.02 1.22 1.25 Wandsworth 11.9 12.3 0.26 0.09 0.29 0.14 0.03 0.04 0.89 0 95 Caraberwell 15.4 13.9 0.01 0.13 0.05 0.14 0.03 0.03 1.87 1.31 Deptford 11.5 14.1 0.60 0.12 0.85 0.22 0.15 0.05 0.96 1.34 Greenwich 17.0 12.7 0.75 0.09 0.46 0.17 0.10 0.05 1.62 1.08 Lewisham 12.4 11.5 0.51 0.08 0.29 0.11 0 .03 0.01 0.87 0.90 Woolwich 11.5 12.5 — 0.11 0.01 0.12 0.02 0.03 1.15 1.25 . The deaths "before Distribution" are those actually registered in the several Boroughs without any correction whatever. 55 Table 14. Causes of, and Ages at, Death in the Borough of Lewisham for the year 1907. Causes of Death. Deaths Whoi.e Borough Borough Divisions Deaths in Public Institutions in the Boroueh. Deaths ol Residents outside the Boroueh Deaths of Non-residents in the Borough Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee Lewisham Sydenham and Forest i Hill 1 2 3 4 5 6 7 8 9 10 11 12 13 Class I.—Infective Diseases 1 Small-Pox — — — — — — — — — — — — — 2 Measles 2 11 4 — — — 17 — 15 2 4 3 8 Scarlet Fever — 6 5 1 — — 12 2 8 2 72 — 64 4 Typhus Fever — — — — — — — — — — — — 5 Plague — — — — — — — — — — — — 6 Influenza — — — — 10 6 10 3 9 4 2 — — 7 Whooping Cough 18 30 2 — — — 50 4 23 23 7 — — 8 Diphtheria — 10 7 — — — 17 — 13 4 42 — 29 9 Enteric Fever — — — 1 — — 1 — 1 — 3 — 3 10 Epidemic Diarrhœa 5 — — — — — 5 — 4 1 — — — 11 Epidemic Enteritis 5 — — — — — 5 — 3 2 1 — — 12 Dysentry — — — — 1 — 1 — 1 — — 1 — 13 Venereal Diseases — — — — 1 1 2 — 2 — 3 — 1 14 Puerperal Septicœemia Fev — — — — 4 — 4 — 3 1 1 — — 15 Infective Endocarditis — — — — 1 1 2 — 2 — — 1 — 1G Erysipelas — 1 — — 5 1 7 — 4 3 4 — — 17 Septicoemia not Puerperal 2 — 2 — 1 — 5 — 3 2 3 — 2 18 Pyaemia — 1 — 1 2 — 4 2 2 — 1 3 1 19 Other Septic Diseases — — — — — — — — — — — — — Class III.— Malign- Class II.— ant Tuberculous Diseases Diseases 20 Phthisis 2 2 4 20 104 6 138 15 79 44 38 14 8 21 Meningitis 2 10 7 — — — 19 3 14 2 7 2 3 22 Peritonitis 2 2 1 — 1 — 6 1 3 2 1 — 23 Scrofula — — — — — — — — — — — — 24 Other Tuberculous Dis 3 13 4 2 7 2 31 3 19 9 12 5 2 25 Cancer, Carcinoma — — — — 58 44 102 10 57 35 23 16 3 26 Sarcoma — 1 1 — 6 1 9 — 5 4 1 2 — 27 Other Malignant Diseases — — — — 11 16 27 5 12 10 4 1 — '28 Meningitis (not Tuber.) 6 4 3 — 1 1 15 — 11 4 2 2 — Class IV.— Nervous Diseases 29 Insanity (G. P. Insane) . — — 1 1 14 15 31 1 22 8 4 15 — 30 Epilepsy — — — 1 10 5 16 3 8 5 6 3 — 31 Convulsions 14 5 — — . — — 19 2 13 4 1 — — 32 Locomotor Ataxy — — — — 2 3 5 1 2 2 1 — — 33 Paraplegia, Dis. of Cord — — — — 4 1 5 — 2 3 2 — 2 34 Other Nervous Diseases — — 2 2 12 7 23 4 14 5 11 6 6 Class V.— Diseases of Heart and Blood Vessels 35 Valvular Disease, Endocarditis — 1 3 4 41 19 68 7 39 22 19 5 2 36 Cerebral Haemorrhage — — — — 27 39 66 13 30 23 38 1 17 37 Thrombosis — — — — 1 2 3 — 2 1 1 — 1 38 Apoplexy, Hemiplegia — — — 1 6 15 22 4 10 8 2 2 1 39 Aneurysm — — — — 7 — 7 1 3 3 — —- —- 40 Embolism — — — 1 1 3 5 3 2 — 1 — —- 41 Thrombosis, not Cerebral — — — 1 — 1 1 — — — — — 42 Other Dis. Heart and Blood Vessels 11 — — 4 34 47 96 14 59 23 25 7 19 56 Table 14—continued. Deaths Whole Borough Borough Divisions Deaths in Public Institutions in Borough Deaths of Residents outside Borough Deaths of Non-residents in Borough Causes of Death Under 1 year 1 and under 3 years 5 and under 18 years 15 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee Lewisham bydenham and rorest Hill | 1 2 3 4 5 6 7 8 9 10 11 12 13 Class VI.— Respiratory Diseases 43 Croup (not Spasm, or Membranous) 1 — — — — — 1 — — 1 — — — 44 Bronchitis 45 Pneumonia 17 30 8 21 2 1 1 23 31 91 28 140 113 20 13 68 65 52 35 67 27 3 10 34 11 46 Asthma Emphysema — — — — 3 — 3 2 1 — — — — 47 Pleurisy — — — 1 4 3 8 — 7 1 — — — 48 Other Respiratory Dis. 2 3 1 1 2 2 11 2 6 3 1 2 — Class VII.— Digestive Diseases 49 Enteritis (not Epidemic) 9 1 — — 2 1 13 — 8 5 4 1 2 50 Gastro Enteritis 5 1 — — 3 4 13 — 12 1 — — — 51 Peritonitis (not Puerperal) 1 — — — 9 1 11 1 7 3 7 — 2 52 Cirrhosis of Liver — — — — 13 5 18 1 8 9 6 — 2 53 Gastric Ulcer (Perforation of) — — 1 2 12 1 16 2 10 4 5 2 — 54 Other Digestive Diseases 91 6 2 5 11 17 132 18 69 45 55 6 8 Class VIII.— Class Urinary IX. Diseases 55 Nephritis, Acute — — 1 — 2 — 3 — 2 1 2 1 1 56 Bright's Disease — — — 1 26 14 41 6 30 5 12 4 2 57 Other Urinary Diseases — — 1 2 5 13 21 5 11 5 5 8 — 58 Generative Organs, eases of — — — — 2 1 3 — 3 — — 1 — 59 Old Age — — — — 2 132 134 16 72 46 82 1 31 Class X.— General Diseases _ 60 Premature Birth 68 — — — — — 68 7 40 21 7 2 — 61 Chronic Rheumatism — — — — 2 3 5 3 — 2 2 — 2 62 Rheumatic Fever — — 2 2 2 — 6 1 3 2 2 — 1 63 Parturition, Diseases and Accidents of — — — — 5 — 5 1 3 1 1 2 — 64 Alcoholism — — — — 3 — 3 1 2 — 1 — — 65 Gout — — — — — 3 3 — — 3 — — — 66 Diabetes Melletus — — 1 8 4 13 3 5 5 1 3 — Class XI.— Accidents 67 All Other Diseases 18 3 2 3 8 7 41 6 20 15 11 1 1 68 Burning — 3 — 2 1 1 7 1 6 — 5 1 1 69 Overlaying 9 — — — — — 9 — 7 2 — — — 70 Poison — — — — — — — — — — — — — 71 Drowning — — — 1 1 — 2 — 2 -— — 1 — 72 Other Accidents 2 3 2 1 12 10 30 1 21 8 15 6 9 Class XII.Vio lence 73 Homicide — — — — — — — — — — — — — 74 Suicide — — — 2 12 — 14 2 8 4 — 2 1 Grand Totals 325 146 60 65 577 576 1749 214 995 54C 660 143 275 Note—Columns 1 to 10 include deaths of Residents in the Borough, in outside Districts and in Public Institutions. 57 Table 15. Residents and Non-Residents dying in Public Institutions situated in the Borough. Institution. Deaths of Residents. Deaths of NonResidents. Total. The Park Hospital 22 98 120 Lewisham Infirmary 827 29 356 Lewisham Workhouse 37 1 38 Bermondsey (St. Olave's) Workhouse - 110 110 St. John's Hospital 7 15 22 Home for Sick Children, Lower Sydenham 2 3 5 Greenwich Union Workhouse, Grove Park — 6 6 Flower House, Southend Catford 2 1 3 Totals 397 263 660 In addition to the above, deaths of non-residents occurred as follows:— Three on the London, Brighton and South Coast Railway, four in public highways, one at the Lower Sydenham Gas Works, and four at various addresses in the Borough. 58 Deaths of Residents Belonging to the Borough occurring in Public Institutions, etc., in districts outside, during the year 1907. General Hospitals :— Other Institutions :— St. Thomas' Hospital 10 Continued. Guy's Hospital 9 Kidbrook Hse Nursing Home 2 St. Bartholomew's Hospital 5 Salvation Army Maternity Miller Hospital, Greenwich 5 Hospital 2 Charing Cross Hospital 4 St. Pancras Infirmary 2 London Hospital 3 Brompton Hospital 1 King's College Hospital 2 RoyalChest Hosp'l,City Road 1 Middlesex Hospital 2 Royal Free Hospital, Water- Children's Hospital, Great loo Road 1 Ormonde Street 2 Cancer Hospital, Chelsea 1 Seamen's Hosp'l, Greenwich 1 Evelina Hospital (Children) 1 French Hospital 1 Heart Hospital, Soho Square 1 German Hospital 1 St. Mark's Hospital 1 Poplar Hospital 1 Bethlem Hospital 1 Royal Free Hospital 1 St. Luke's Hse, Kensington 1 Hospital of St. John's and Throat Hospital, Golden Sq. 1 Elizabeth 1 Southwark Infirmary 1 Westminster Hospital 1 Greenwich Infirmary 1 • Asylums:- Holborn Workhouse 1 Lambeth Workhouse 1 Dartford Heath Asylum 25 Cane Hill Asylum 7 Various:— Banstead Asylum 4 Clay bury Asylum 2 On the way to Charing Cross Darenth Asylum 2 Hospital 1 Peokham House Asylum 2 Biver Thames 1 Caterbam Asylum 1 Home for Invalids,Highbury Camberwell House Asylum 1 Terrace 1 City of LondonAsylum,Stone 1 Ilbert Street, W 1 Hanwell Asylum 1 Dunston Road, Dulwich 1 Leavesden Asylum 1 Armitage Eoad, Greenwich Manor Asylum 1 Royal Hill, Greenwich 1 North Side, C1 apham Other Institutions: — Common 1 Victoria Hospital 3 Caurobert St.,BethnalGreen 1 National Hosp'l, Queen's Sq. 2 Beaumont St., Marylebone 1 Blackheath and Charlton The Grove, Blackheath 1 Cottage Hospital 2 Grove Hill Road,Camberwell 1 Hospital for Women, Soho Park Hill Road, Hampstead 1 Square 2 Welbeck Street 1 Friedenheim Hospital 2 St. George's Road, Lambeth 1 59 Table 16. Deaths from Principal Zymotic Diseases in Wards, during the year 1907. Localities Small-Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhus Fever Enteric Fever Pyrexia *(origin uncertain) Epidemic Diarrhœa & Epidemic Enteritis Dysentery Totals † Death Rates from Principal Zymotic Diseases. (a) (b) Church Ward - - - - 1 - - - - - 1 0.14 0.15 Manor Ward — — 2 — 3 — — — — — 5 0.67 0.66 South Ward — — — — — — — — — — — - — Lee Division — — 2 — 4 — — - - 6 0.30 0.29 Blackheath Wd — 1 — 1 1 — — — - — 3 0.44 0.46 Lew. Vill. Wd. — — — 4 5 — — — — — 9 0.60 0.60 Lew. Pk. Wd. — 4 2 — 5 — 1 — 1 1 14 0.80 0.83 Brockley Ward — 1 3 — 2 — — — — — 6 0.51 0.46 Catford Ward — 9 3 8 10 — — — 6 — 36 1.06 1.02 Lewisham Div. — 15 8 13 23 — 1 — 7 1 68 0.80 0.78 Forest Hill Wd. — — 1 1 7 - - - - - 9 0.49 0.45 Sydenham Ward — 2 1 3 16 — — — 3 — 25 0.86 0.87 Sydenham and Forest Hill Div. — 2 2 4 23 — — — 3 — 34 0.72 0.70 Whole Borough — 17 12 17 50 — 1 — 10 1 108 0 .71 0.69 County of London — 1801 644 781 1786 — 194 4 1510 6654 1.42 — 76 Great Towns 6 6838 1958 2786 5641 — 1093 6377 24699 1.54 - * Originally termed Simple Continued Fever. Note.—† Rates in column (a) calculated per 1,ooo of the Registrar-General's estimated population. Rates in column (6) calculated per 1,000 of the population estimated from the actual number of occupied houses in 1907. 60 Table 17. Death Rates from principal Zymotic Diseases and Phthisis, and Infantile Mortality in the Borough and its Divisions, in the County of London, and in the 76 Great Towns, for the Year 1907. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough County of London. 76 Great Towns. Small-Pox - - - - - 0.00 Measles - 0.18 0.04 0.11 0.38 0.43 Scarlet Fever 0.10 0.09 0.04 0.08 0.14 0.12 Diphtheria — 0.15 0.08 0.11 0.16 0.17 Whooping Cough 0.20 0.27 0.49 0.33 0.88 0.35 Enteric Fever — 0.01 — 0.01 0.04 0.07 EpidemicDiarrhœa and Enteritis — 0.08 0.06 0.07 0.32 0.40 Dysentery — 0.01 - 0.01 Total Zymotic Death Rates 0.30 0.80 0.72 0.71 1.42 1.54 Infantile Mortality Rate 70 90 97 90 116 127 Phthisis Death Rate 0.75 0.93 0.93 0.90 1.40 — Comparative Rates for other Boroughs will be found in Table 12. 61 Table 18. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1907. Ages. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Epidemic Diarrhoea and Enteritis. Dysentry. Totals in Age Groups. Under 1 year - 2 - - 18 - 10 - 30 1 and under 5 years - 11 6 10 30 - — - 57 5 and under 15 years - 4 5 7 2 - — - 18 15 and under 25 years - - 1 — — 1 — - 2 25 years and upwards - - - - - - - 1 1 Total all ages - 17 12 17 50 1 10 1 108 Note.—Typhus Fever should be included in the list of Principal Zymotic Diseases. It is omitted in the above table, as no cases occurred during the year. Table 19. Meteriological Table for London for the Year 1907. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1907- Barometer. AIR TEMPERATURE. Bright Sunshine. Rain and other forms of Precipitation. Mean pressure at 320 F. at Station Level (Bar. 159 ft. 1 above M.S.L.) Mean of Absolute Minimum & Maximum. Total possible. Total observed Number of Days. Total Fall. Most in a day. Month. Minimum A Maximum B Minimum. Day of Month Maximum. Day of Month. Amount Day of Month Ins 0 0 0 Hours Hours Ins. Ins. January 30.158 33.8 42.7 22 24 51 1 259 37 10 1.09 0.32 2 February 29.851 32.3 42.8 24 7 51 17 276 58 14 1.27 0.40 12 March 30.015 34.3 53.6 24 12 69 31 365 170 10 0.91 0.20 13 April 29.615 38. 56.0 29 19 72 24 413 125 16 3.14 0.52 26 May 29.706 44.6 62.3 34 20 82 12 481 159 18 1.47 0.21 7 June 29.712 49.3 66.2 43 17 76 9 494 168 15 2.65 1.03 29 July 29.875 50.3 69.8 43 11 79 19 498 182 13 0.97 0.42 22 August 29.839 52.0 71.2 44 2 79 4 451 180 13 1.92 0.41 18 September 29.957 48.0 69.5 35 23 83 25 380 154 6 0.62 0.18 2 October 29.496 43.5 58.7 36 25 68 1 331 99 24 3.25 0.39 6 November 29.814 38.9 50.8 29 22 60 9 266 37 9 2.23 0.56 26 December 29600 37.2 46.1 28 16 57 8 244 47 15 2.73 0.71 12 Year 29.803 41.9 57.5 — — — — 4458 1417 163 22.25 — — 62 PART 2. INFECTIOUS DISEASES. 65 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 1,028, of which number 784, or 76 per cent., were removed for isolation to the Metropolitan Asylums Board's Hospitals or other Institutions. In 37 instances, or 4.72 per cent. of the cases removed, the Hospital authorities returned the patient as not suffering from any notifiable disease. Deducting these from the gross total, we have a corrected total of 991 cases of infectious disease notified as occurring in the Borough during the year, an increase of 81 over the number notified in the preceding year, which was 910. In 1905, 850 cases were notified. Age Periods.—46.7 per cent. of the Scarlet Fever cases, compared with 47.8 per cent. in 1906, and 52.6 per cent. of the Diphtheria cases, compared with 54.9 per cent. in 1906, occurred among children aged six years and under. The following figures show the percentage of cases occuring among children of the age of six years and under to the total notifications of Scarlet Fever and Diphtheria:— Scarlet Fever. Diphtheria. Age. 1905. 1906. 1907 1905. 1906. 1907. 6 years and under 50.0% 47.8% 46.7% 50.0% 54.9% 52.6% 5 ,, „ 36.0% 39.0% 35.8% 42.0% 44.6% 44.3% 4 „ ,, 25.0% 28.0% 25.5% 34.0% 32.0% 25.4% 66 Table 20. Age Periods of Scarlet Fever and Diphtheria, notified during the year 1907. Age Periods. Scarlet Fever. Diphtheria. Number, of Cases. Percentage to Total Cases Number of Cases. Percentage to Total Cases. Under 1 year 4 0.68 1 0.35 1 to 2 years 17 2.91 5 1.74 2 ,, 3 ,, 24 4.10 15 5.23 3 ,, 4 ,, 49 8.39 23 8.01 4 „ 5 „ 55 9.41 29 10.10 5 „ 10 „ 244 41.78 132 45.99 10 „ 15 „ 96 16.43 41 14.28 15 „ 25 „ 65 11.13 22 7.66 25 years and over 30 5.13 19 6.62 At all ages 584 100.00 287 100.00 Attack Rates represent the number of cases occurring to every 1,000 persons living at all ages. These rates are useful for comparison with other Boroughs in regard to the incidence of infectious diseases. (See Table 23). The attack rate from all infectious diseases (excluding Puerperal Fever) during the year amounted to 6.31 per 1,000 of the population, compared with 6.08 in 1906, and 5.88 in 1905. This slight increase is due to a small rise in the attack rates from both Scarlet Fever and Diphtheria as will be seen in Table 23. The attack rate for the County of London was 8.61, compared with 7.42 in 1906. The attack rates for the Wards will be found in Table 22. It will be seen that Lewisham Park Ward had the largest 67 number of cases in proportion to its population, having an attack rate of 8.86 per 1,000. The lowest attack rate was in South Ward, Lee, 3.20 per 1,000. Table 21. Number of Cases of Infectious Diseases notified in the Ten Wards and the Whole Borough during the Year 1907. Wards. Scarlet Fever. Diphtheria. Enteric Fever Puerperal Fever. Erysipelas. Total. 1 Church 24 4 2 - 6 36 2 Manor 21 7 2 - 1 31 3 South 15 2 1 - 2 20 Lee Division 60 13 5 - 9 87 4 Blackheath 17 2 — - 2 21 5 Lewisham Village 41 29 3 - 8 81 6 Lewisham Park 103 30 5 1 12 151 7 Brockley 56 16 2 - 8 82 8 Catford 184 86 5 3 19 297 Blackheath & Lewisham Div. 401 163 15 4 49 632 9 Forest Hill 68 30 2 2 10 112 10 Sydenham 55 81 5 1 18 160 Sydenham and Forest Hill Division 123 111 7 3 28 272 Whole Borough 584 287 27 7 86 991 Table 22. Attack rates from the Principal Infectious Diseases per 1,000 of the population for the ten Wards, and the whole Borough in the years 1904-1907. Wards. Diseases Scarlet Fever Diphtheria Enteric Fever Erysipelas Total 1904 1905 1906 1907 1904 1905 1906 1907 1904 1905 1906 1907 1904 1905 1906 1907 1904 1905 1906 1907 Church 0.74 2.06 1.88 3.64 0.74 1.18 1.16 0.61 - 029 — 0 30 0 45 0.73 0.72 0.91 2.08 4.56 3.77 5.47 Manor 2.25 8.74 3.82 2.78 0.28 1.38 0..95 0.92 — — 013 0 26 — 1.11 0.27 0.13 2.53 11.10 5.19 4.10 South 2.87 5.89 3.73 2.40 1.07 0.71 1.60 0.32 0.36 0 35 — 0 16 — 0.17 0.17 0.32 4.30 7.14 5.51 3.20 Blackheath 2.20 3 .36 6.27 2.61 1.17 1.75 2.04 0.31 — — 029 — 117 0.58 0.58 0.31 4.70 5.71 9.19 3.23 Lewisham Village 3.39 4.85 4.52 2.76 0.62 0.75 1.21 1.94 0.27 0.34 — 0.20 0.76 0.82 0.40 0.53 5.05 7.24 6.28 5.43 Lewisham Park 2.29 3.76 4.74 6.08 0.90 0.84 1.70 1.77 0.07 0.13 012 0.29 0.55 0.64 1.03 0.71 3.82 5.44 7.66 8.86 Brockley 3.87 4.77 3 .51 4.27 0.97 0.34 1.46 1.22 0 .17 0.26 — 0.15 0.43 1.21 1.28 0.61 5.53 6.60 6.27 6.26 Catford 1.90 3.66 3.62 5.22 0.83 0.81 2.14 2.44 0.10 0.29 0.12 0.14 0.52 0.78 0.65 0.54 3.43 5.60 6.53 8.34 Forest Hill 1.97 3.93 3.49 3.36 0.71 1.69 1.58 1.48 0.22 0.27 0.21 0.09 0.88 0.82 0.38 0.49 3.89 6.78 5.67 5.44 Sydenham 1.96 1.69 2.50 1.92 0 .96 0.90 1.59 2.83 0.26 0.18 0.24 0 .17 0.59 0.57 0.67 0.62 3.81 3.61 5.01 5.56 Whole Borough 2.29 3.79 3.65 3 74 0.83 0.98 1.64 1.84 0.16 0.22 0.13 0.17 0.58 0.75 0.65 0.55 3.93 5.88 6.08 6.31 68 Chart C. Showing Weekly Notifications of all Infectious Diseases, also Weekly Notifications of Scarlet Fever and Diphtheria, during the year 1907. 69 SCARLET FEYER.—The total number of cases notified during the year amounted to 603, compared with 558 in 1906. Of this number, 483, or 80 per cent., were removed to the Metropolitan Asylums Board's Hospitals. Subsequently 19 cases were returned to their homes and stated not to be suffering from any notifiable disease Deducting this number, a corrected total of 584 is obtained, compared with 543 in 1906, equal to an attack rate of 3.74 per 1,000 persons, compared with 3.65 in 1906, a slight increase. The attack rate for the County of London was 5.46 per 1,000. An examination of the attack rates for the various Wards shows that the highest occurred in Lewisham Park Ward (6.08 per 1,000) and that the Ward least affected was Sydenham, with 1.92 per 1,000. Nearly 42 per cent. of the cases occurred among children between the ages of 5 and 10 years, and 25.5 per cent. to children under the age of five years. Case Mortality.—Twelve deaths occurred in the Borough from Scarlet Fever, equal to 2.05 per cent. of the cases notified, compared with 2.57 in the previous year. DIPHTHERIA.—Three hundred cases of Diphtheria were notified, compared with 260 in 1906, and of this number 227, or 75 per cent. were removed to hospital. Thirteen patients were returned home as not suffering, giving a corrected total of 287, an increase of 43 over the number for 1906 (244). The attack rate per 1,000 of the population amounted to 1.84, compared with 1.64 in the preceding year. The rate for the County of London was 1.85 per 1,000. Sydenham Ward suffered most from this disease, having 81 cases, equal to an attack rate of 2.83 per 1,000. Blackheath 70 Ward was least affected, having an attack rate of only 0.31 per 1,000. Case Mortality.—Seventeen deaths occurred from this disease, equal to 5.92 per cent. of the cases notified, compared with 8.6 per cent. in the previous year. ENTERIC or TYPHOID FEVER.—Thirty-two cases were notified, 15 of which were removed to Hospital. Five cases were returned home as not suffering, giving a corrected total of 27, an increase of seven on the preceding year. The attack rate for the whole Borough was 0.17 per 1,000, compared with 0.13 in 1906. The highest attack rate was in Church Ward, Lee, 0.30 per 1,000. The case mortality equalled 3.7 per cent., against 5 per cent. in 1906. ERYSIPELAS.—Eighty-six cases of Erysipelas were notified, compared with 97 in the preceding year. PUERPERAL FEYER.—Seven cases of Puerperal fever were notified, three of which were removed to the Infirmary for treatment. Four of the cases proved fatal. Case 1 Hither Green Lane. Case 2 Stanstead Road, Catford. Case 3 Blythe Hill, Catford. Case 4 Holbeach Road, Catford. Case 5 Stanstead Road, Forest Hill. Case 6 Fermor Road, Forest Hill. Case 7 Haseltine Road, Lower Sydenham. 71 Table 23. 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 1904-1907. Borough. Small-Pox. Scarlet Fever. Diphtheria. *All Notifiable Infectious Diseases. 1904. 1905. 1906 1907. 1904. 1905. 1906. 1907. 1904. 1905. 1906. 1907. 1904. 1905. 1906. 1907. Battersea 004 — — — 2.19 4.77 5.83 5.39 1.29 1.08 1.53 1.98 4.84 7.13 8.51 8.66 Bermondsey 0.14 — 0.00 —, 3.50 5.82 7.69 7.98 1.49 1.29 2.61 2.49 7.19 8.73 12.16 11.98 Bethnal Green 0.96 0.03 0.04 — 5.07 6.09 4.97 9.87 3.26 2.33 1.92 2.22 11.59 10.53 9.24 14.45 Camberwell 0.07 0.04 0.02 — 3.52 4.46 4.23 5.69 1.00 0.91 1.29 1.47 6.20 7.04 6.87 8.48 Chelsea — — — — 1.45 3.03 3.62 2.93 0.82 0.72 2.16 2.12 3.14 5.15 6.82 5.97 Deptford 0.09 0.01 0.00 — 3.56 5.30 5.56 6.69 1.72 1.29 2.64 2.74 7.06 8.30 9. 93 11.05 Finsbury 0.15 0.01 — — 3.34 4.88 4.60 5.24 1.47 1.42 2.31 1.61 6.56 8.01 8.52 8.25 Fulham — — — — 1.93 4.96 4.16 4.02 1.96 1.81 2.49 3.64 5.06 8.21 7.79 8.89 Greenwich 0.01 0.03 — — 2.09 2.77 5.38 6.18 1.49 1.40 3.88 2.40 4.94 5.42 10.62 9.64 Hackney 0.05 0.01 0.03 — 3.79 4.66 4.54 7.78 2.33 1.68 1.68 2.34 8.48 8.40 7.99 11.99 Hammersmith — — — — 2.42 3.02 3.62 4.76 1.74 2.03 2.33 1.76 5.64 6*53 7-24 755 Hampstead 0 01 — — 001 1-83 2 04 431 3-52 066 074 1-10 1-23 366 3.52 6.23 5.64 Holborn 0.10 0.01 — — 1.71 2.76 2.47 2.86 0.80 0.81 1.18 1.16 4.79 4.65 4.94 5.02 Islington 0.05 0.00 0.00 — 3.37 3.49 4.03 3.51 1.01 1.02 1.27 1.39 5.71 5.62 6.54 5.97 Kensington 0.02 — — — 1.48 1.87 2.65 2.93 1.04 0.72 0.98 1.38 3.67 3.79 4.62 5.26 Lambeth 0.08 — — — 2.12 3.27 4.00 4.65 1.05 1.46 1.33 1.03 4.44 5.96 6.49 6.65 Lewisham — 0.05 — — 2.29 3.79 3.65 3.74 0.83 0.98 1.64 1.84 3.93 5.88 6.98 6.31 London, City of 0.08 — — 0.10 1.36 3.38 5.28 4.79 1.70 0.71 0.84 1.38 4.64 5.35 7.44 7.45 Paddington 0.08 0.01 0.00 — 2.47 1.88 4.81 3.86 0.96 0.65 1.22 1.13 4.66 3.82 7.28 6.10 Poplar 0.24 — 0.0.1 0. 01 3.22 5.81 3.34 7.53 3.94 2.88 1.45 2.11 9.25 10.38 6.52 11.30 St. Marvlebone 0.06 — — 0.01 2.25 2.14 3.07 3.42 0.90 1.01 1.09 1.00 4.98 4.80 5.70 5.77 St. Pancras 0.03 0.01 — 0.00 3.59 4.17 3.37 3.59 1.48 1.21 1.18 1.48 6.81 6.71 5.95 6.10 Shoreditch 0.12 0. 01 — 001 2.93 6.80 5.40 7.60 1.66 1.56 1.24 1.93 6.64 9.11 8.25 11.08 Southwark 0.13 — — — 1.99 3.72 7.02 6.09 1.34 1.45 1.91 2.02 5.41 7.00 11.06 9.80 Stepney 0.29 0.03 0.01 — 4.15 6.03 3.93 10.15 2.70 2.09 1.96 2.44 9.38 10.29 7.70 14.60 StokeNewington 0.15 0.02 — — 2.93 3.36 2.53 4.71 1.16 1.49 0.88 2.21 5.58 5.62 4.49 7.80 Wandsworth 0.02 0.00 — — 2.95 5.61 3.91 4.71 1.56 1.31 2.03 2.27 5.94 8.33 7.27 8.09 Wtmstr., City of 0.03 0.01 — — 1.76 2.09 3.08 2.43 0.81 0.68 1.20 0.84 3.66 3.79 5.3C 4.19 Woolwich 0.06 0.05 — — 3.80 4.09 4.12 7.96 1.32 2.18 3.03 2.16 6.04 7.31 8.15 11.26 London, Cnty. of 0.10 0.01 0.00 0.00 2.89 4.15 4.30 5.46 1.55 1.38 1.70 1.85 6.08 7.01 7.42 8.61 *Note.—Chicken Pox, which was notifiable during parts of 1903 and 1904, has been omitted from this Table 72 MEASLES, WHOOPING COUGH, AND CHICKEN POX. These diseases, which are not compulsorily notifiable, are brought to our notice chiefly by notifications from the Head Teachers of the Elementary Schools in the Borough, in compliance with the regulations contained in the School Management Code. Measles.—The number of cases brought to our notice in this manner shows an increase over the preceding year, 546 cases being notified, as compared with 349 in 1906. Where cases occurred in the poorer districts the houses were visited by the Women Sanitary Inspectors with the object of impressing upon the parents the very infectious nature of the disease, and the need of exercising every precaution to prevent its spread. Four hundred and seventy-eight visits were made for this purpose. A leaflet, copy of which is in the Appendices, page 147, was distributed in the localities where measles was most prevalent. Chicken-Pox.—Four hundred and thirteen school children were notified to be suffering from this disease, compared with 168 in 1906. The Women Sanitary Inspectors made 358 visits to various homes on this account. The following is a summary of the cases notified from Schools:— Number of children suffering. Children excluded on account of infection in their homes. Measles 546 377 Chicken Pox 413 293 Whooping Cough 389 77 Mumps 99 58 Ringworm 229 - SCHOOL NOTIFICATIONS TO SANITARY AUTHORITIES. The chief source of information of the existence of nonnotifiable infectious disease is by notice from the Head Teachers 73 of the London County Council Schools, who are required by Article 111 of the School Management Code of the London County Council " to forward, on the same day, the names and " addresses of all children affected (whether suffering or excluded " on account of the disease being in the home) to the Medical " Officer of Health on S.M. Form 84." Of the non-notifiable diseases, the most important is Measles, and it is recognised by the Education Authority themselves, that it is little use closing schools where outbreaks of Measles occur, unless such closure of a school or part of a school is enforced at the onset of the first cases. There is room for considerable improvement in the system at present adopted for notifying the Local Authorities. The present method is briefly as follows:— The London County Council Attendance Officer attends every Friday at the schools and receives a list of absentees. Where it is found that the absence of the children is due to an infectious disease, no action is taken in reporting either to the School Teachers or the Local Authority until the following Friday. The. Attendance Officer then returns to the school for a fresh list and reports to the Teachers the reason of absence of the children whose names are upon the list he received the previous Friday. They in turn notify on Form 84 to the Local Authorities. Thus a week at least is often lost. There are occasions when the Attendance Officer is deputed to other work, which, I believe, is scheduling. During these periods apparently no home visits are made or returns issued in regard to infectious diseases. The School Teachers themselves, I am sure, are not only desirous but anxious to do all in their power to prevent the spread of Measles, Whooping Cough and similar diseases, and where they get direct information from parents they, with few 74 exceptions send to us immediately. There are some Teachers however who do not seem to be aware of the necessity of notifying to the Sanitary Authority. While writing this report I have before me many instances which I have noted of delayed notification of Measles which illustrate the unreliability of the system at present in vogue :— Case. Age. Last Attendance at School. Date of Notification to Sanitary Authority. No. of Days Interval K. B. 7 11 2 07 23 2 07 12 H. W. 5 25 2 „ 9 3 „ 13 J. C. 6 1 3 „ 16 3 „ 15 G. C. 4 1 3 „ 16 3 „ 15 R. B. 5 11 3 „ 23 3 „ 12 W. P. 4 10 4 „ 7 5 „ 27 G. K. 6 22 4 „ 4 5 „ 12 H. H. 5 26 4 „ 11 5 „ 15 V. W. 6 18 4 „ 4 5 „ 16 S. S. 4 25 4 „ 18 5 „ 23 V. B. 6 18 4 „ 13 5 „ 25 G. W. 4 22 5 „ 6 6 „ 15 W. F. 5 20 5 „ 6 6 „ 17 A. M. 9 5 „ 1 6 „ 23 A. H. 6 15 5 „ 1 6 „ 17 M. C. 6 7 5 „ 6 6 „ 30 H. R. 4 6 5 „ 18 5 „ 12 F. R. 3 16 5 „ 1 6 „ 16 C. R. 5 16 5 „ 1 6 „ 16 K. H. 5 11 6 „ 2 7 „ 21 D. M. 5 3 6 „ 29 6 „ 26 R. B. 4 17 6 „ 6 7 „ 19 H. W. 6 3 7 „ 13 7 „ 10 E. B. 3 22 9 „ 5 10 „ 13 Where so much delay is occasioned in notification the opportunity of prompt and effective preventive measures is lost. There is great need for some alteration in the system now followed, either by the Attendance Officers making daily reports to the Teachers or sending daily direct to the Medical Officer of Health the names of children absent on account of infectious 75 disease, the nature of illness and address of their homes, and date of last attendance at school. The Attendance Officer should also receive daily from schools a list of absentees. The information received under the present system is frequently useless. SCHOOL CLOSURE. The following is a list of schools closed either by this Council or the London County Council, with a view of preventing the spread of infectious diseases:— On account of Measles. Brockley Road L.C.C. School.—Infants' Department closed by the Council on February 20th for three weeks. St. Michael's School, Lower Sydenham.—Infants' Department closed by Council on March 25th for three weeks. Haseltine Road L.C.C. School.—Class-rooms A and B of Infants' Department closed by London County Council on April BOth for three weeks. Sandhurst Road L.C.C. School.—Class-room D of Infants' Department closed by Council on May 6th for three weeks. Lewisham Bridge L.C.C. School.—Infants' Department closed by Council on June 6th for three weeks. Haseltine Road L.C.C. School.—Class-rooms H and I of Infants' Department closed by Council on June lltli for three weeks. Hither Green L.C.C. School.—Infants' Department closed by Council on June 17th for three weeks. Sandhurst Road L.C.C. School.—Infants' Department closed by London County Council on June 18th for two weeks. Hither Green L.C.C. School.—Class-room B of Infants' Department closed by Council on September 25th for three weeks.. 76 On account of Scarlet Fever. Manor Lane L.C.C. School.—Infants' Department closed by Council 011 June lltli for one week. Brownhill Road L.C.C. School.—Class-room E of Infants' Department closed by Council 011 October 80th for three weeks. On account of Diphtheria. St. Philip's School, Coombe Road, Sydenham.—School closed by Council 011 January 31st for two weeks. Lewisham Bridge L.C.C. School.—Class-rooms E and F of Infants' Department closed by Council on September 26th for two weeks. Durinq the re-construction of the Drainage Systems. Christ Church School, Forest Hill.—School closed on January 3rd. St. Michael's School, Lower Sydenham.—Infants' Department closed on September 20th. LEWISHAM BRIDGE SCHOOLS. An outbreak of diphtheria threatened the children attending the Infants' Department of the Lewisham Bridge Schools towards the end of September. Seven cases occurred, distributed over classrooms A, E and F. I made a personal inspection on September 24th and from the conditions found, recommended the closure of classrooms E and F. An order for closing was given the same day, the Medical Officer of the London County Council Education Authority being informed of the fact. On the 26th I received a communication from the Medical Officer of the Education Authority stating that instructions had 77 been issued to the Head Teacher of the Infants' Department of the Lewisham Bridge School to exclude all children from classrooms A, E and F who were suffering from sore throats, and to forward their names and addresses to me. Such children were not to be permitted to resume attendance at school until a certificate, based upon bacteriological examination, had been furnished, stating they were free from infection. This was subsequent to our closing classrooms E and F. One always hesitates before closing schools or parts of schools 011 account of infectious diseases, being fully aware of the seriousness of such action from an educational point of view. In regard to diphtheria, an attempt is sometimes made by the Education Authority to exclude what are termed carrier cases. t/ These are cases having the disease in such a mild form as to permit attendance at school without detection. A bacteriological examination is made in regard to a selected few, and the children who are reported to be suffering from pseudo-diphtheria or diphtheria are excluded. There is much to be said for this plan, provided that a swab is taken from evert) child in the classroom. The mere selection of a few is not sufficient, nor can absolute reliance be placed upon bacteriological examination of one swab only. We have many instances in which various reports are obtained in regard to two or three successive swabs from the same child, and it would be necessary for the swabbing to be carried out at repeated intervals. The system of excluding carrier cases has been tried, and but for our insistence 011 closing the classrooms of certain schools, serious results might have occurred. It is unfortunate, in many respects, that there is a dual control 111 London over school attendance and infectious disease. The Borough Councils are the responsible custodians of the Public Health of the inhabitants of their districts, and in my 78 opinion, should have the same control over school children as they have over others residing within their boundaries. Dual control is irritating, confusing, and leads to difficulties. EXPOSURE OF CHILDREN SUFFERING FROM SCARLET FEYER IN LONDON COUNTY COUNCIL SCHOOL. On Wednesday, October 2nd, I received information that the Head Mistress of the Plassy Road School had discovered a girl in the peeling stage of scarlet fever in classroom G and had taken her home to Engleheart Road, Catford. On investigation the following facts were elicited:— On Tuesday, October 1st, G. S. commenced to attend Plassy Road School, classroom G. The following day, Wednesday, October 2nd, the Head Teacher received a complaint that the new girl had soiled the pinafore of another scholar; this led to an examination of the child's hands, which were found to be peeling. The teacher took the child home to Engleheart Road^ where she saw the girl's aunt M. M. and told her the child had scarlet fever.- The aunt admitted knowledge of this fact. On visiting the child at her house I found that she was suffering from scarlet fever, and peeling profusely, three weeks having probably elapsed since the onset of the disease. The child, a new scholar, was first admitted at Plassy Road School on October 1st. After enquiry I was informed by the aunt that a boy, aged 10, had also been ill, but that he was then at Sandhurst Road School, which school he had entered that morning. I proceeded to the school and found the boy in classroom C. He also showed unmistakeable signs of scarlet fever and was peeling profusely. Both children were removed to hospital without delay and the premises in Engleheart Road were disinfected. While the disinfection of the house was being carried out under 79 the superintendence of the Sanitary Inspector he discovered A. M. (grandmother of the children and in charge of them) leaving the house with a parcel which contained the infected clothing of C. S. She admitted to him that she intended taking the articles to a pawnbroker. Both A. M. and M. M., the persons in charge, admitted that they knew the children had scarlatina. Our investigations showed also that other 1 louses had been infected by these cases, as the following facts will show:— C. S. at the commencement of his illness lived at one house in Engleheart Road. He was then removed to a second house in this street to live with his grandfather, who about the 18th September removed with his family to a third house in Engleheart Road, Meanwhile the people with whom he had been living at the first house vacated their rooms. G. S. at the beginning of her illness lived in Beacon Road, but was subsequently removed to the above mentioned second house in Engleheart Road, after which Mr. C. with whom she lived vacated the rooms and removed to another house in Beacon Road. The live houses mentioned were disinfected; also classroom G at Plassy Road School was thoroughly disinfected by us on Wednesday, October 2nd. Every assistance was given by the Schoolkeeper to our Officers, and consequently there was no disturbance of the ordinary school routine. Proceedings were instituted against A. M. for wilfully exposing the children whilst suffering from scarlet fever. The defendant pleaded ignorance and stated that in her earlier days no notice was taken of such diseases. The magistrate 80 after hearing the evidence, remarked that it was a proper case for the Borough Council to bring before the Court, but that there was a slight doubt as to whether the defendant was aware that the children wTere suffering from scarlet fever, and giving her the benefit of the doubt he dismissed the summons. While investigating the cases referred to one important point has occurred to me. The Education Authority do not appear to have adopted any measures to prevent the introduction of infectious disease into their schools when the children re-join after holidays or when admitted as new scholars. It is customary in almost every other school, public or private, to require a certificate before the admission of a child to the school, to the effect that such child has not suffered from or been in contact with any infectious disease for a certain number of weeks prior to return or admission to school. I believe that in many cases, among the people from whom the London County Council draw their scholars, such certificate would be of little avail, but I think that if a statutory obligation were imposed upon parents to make a declaration in a prescribed form, and a penalty followed a false declaration or a refusal to make such declaration, it would be a most valuable safeguard of the health of the school children. Bearing in mind the well-known connection between the spread of infectious disease and school attendance great benefit would result if absence 011 account of infectious disease, when certified by the Medical Officer of Health, was not treated in the ordinary sense of school absence in considering the allocation of Education Grants. 81 DISINFECTION OF SCHOOLS: OBSTRUCTION BY EDUCATION AUTHORITY. In consequence of the prevalence of measles at the Brownhill Road, Manor Lane and Ennersiale Road Council Schools, it was found necessary to carry out disinfection at each of the Infants' departments during August. On application at the Brownhill Road Schools by our officers to be admitted to carry out the work, the school keeper informed them that he had been instructed by the Education Authority that 110 disinfection was to be carried out without their sanction, and referred us to the London County Council Gazette of July 8th, 1907, in which thefollowingorder appeared : "Schoolkeepers are hereby instructed that they must not allow "any disinfection of the school premises without sanction from "the Education Office." I then communicated with the Clerk to the Education Authority as follows:— "The Clerk to the "Education Committee, "Loudon County Council. "8th August, 1907. "Dear Sir, "Bvownhill Road School, Catfovd. "Manor Lane School, Lee. "Ennevsdale Road School, Lewisham. "In consequence of the prevalence of measles at the "above schools, we deemed it necessary to carry out disinfection "in the Infants' Department of each school, and in the usuil "way we attempted to make the necessary arringements early "in the vacation. To my surprise we were informed by the "schoolkeeper at Brownhill Road Schools that he could not "allow us to carry out disinfection, and he referred us to an "order printed in the London County Council Gazette, of July "8th, which reads as follows:— 'Schoolkeepers are hereby instructed that they must 'not allow any disinfection of the school premises without 'sanction from the Education Office.' 82 "This seems to me an extraordinary procedure, more "particularly since the County Council fully recognise the "infective nature of the disease, and it was upon their action "that the disinfection clauses of the Public Health (London) "Act were applied to Measles. I suppose we are now in the "position of a Sanitary Authority in London being under the "necessity of serving a notice on the County Council to carry "out disinfection, and in default carrying it out ourselves. It "would also appear that if this course were adopted wre should "still be obstructed by the Schoolkeeper. As the Council are "now in recess, I cannot get the necessary order to serve "a notice. I am sure you will appreciate the anomalous "position in which we are placed, and I shall be glad to hear "whether it is the intention of the County Council to disinfect "the Schools in question to our satisfaction, or whether in "future cases we shall meet with these difficulties and delays." "Yours faithfully, "A. Wellesley Harris, "Medical Officer of Health." In answer to this communication I received the following letter from Dr. Kerr:— "Education Offices, "Victoria Embankment, W.C. "13th August, 1907. "Dear Dr. Harris, "Brownhill Road School, Catford. "Manor Lane School, Lee. "Ennersdale Road School, Leivisham. "Your letter of the 8th instant, addressed to the Clerk, "has been referred to me. "The Instruction to the School Keepers was issued "to prevent disturbance of the ordinary school routine. "These regulations will be revised in the first issue of "the London County Council Gazette, when School Keepers "will be instructed to allow disinfection witli formalin, after "school hours, without communicating with the Bead Office. "I have instructed the School Keepers to allow your "men to disinfect the above Schools. "Yours faithfully, "James Kerr, "Medical Officer (Education)." 83 It would appear from this letter that the regulation above referred to was ill-advised. It seems to me extraordinary that on the one hand the London County Council, no doubt upon the recommendation of the Public Health Committee, should have added measles to the list of infectious diseases for the purpose of disinfection, whilst another branch of the Council, namely the Education Authority, should issue instructions which render it most difficult to put into operation the sections of the Public Health (London) Act, which the London County Council themselves made applicable to this disease. It is unfortunate that we should receive 110 direct intimation of important regulations in which we are interested and which may affect our administration. The publication of the special regulation referred to in the London County Council Gazette was only discovered by accident. Notwithstanding the undertaking to have this obstructive regulation revised, further difficulties arose 011 October 2nd, in relation to a classroom at the Sandhurst Road School, which had been exposed to infection from Scarlet Fever (already previously referred to). Our officers proceeded to this school with instructions to disinfect classroom C. They were, however, refused admission by the Schoolkeeper, who stated that he was acting upon instructions from the Education Department, contained in the London County Council Gazette of July 8th, 1907. In consequence of this refusal, I at once communicated with the Head Teacher, informing him of the obstruction, and at the same time pointing out to him that in my opinion classroom C should remain closed until disinfection had been carried out. 84 On Thursday, October 3rd, I certified, in pursuance of the Public Health (London) Act, "That the cleansing and "disinfection of part of a house, viz.,"classroom C of Sandhurst "Road School would tend to prevent or check Scarlet Fever," following which certificate a notice was served upon the London County Council to the effect that the Lawisham Borough Council would enter the premises and carry out disinfection unless they received within 24 hours an undertaking that the London County Council would themselves cleanse and disinfect the infected premises to the satisfaction of the Medical Officer of Health or any other legally qualified medical practitioner. This notice was served upon the Clerk to the London County Council on October 3rd at 1.30 p.m. During the afternoon of October 3rd I saw the Head Teacher and showred him Dr. Kerr's letter of August 13th. He informed me that neither he or the schoolkeeper were aware of the Order of July 8th having been withdrawn; that he had written for permission to admit us and had telephoned, but without result. We received no information from the Education Department, but on Friday, Oct. 4th about 4 p.m. we heard from the Head teacher that the caretaker had received instructions to cleanse classroom C. Mr. King, one of our Sanitary Inspectors, at once visited the Schoolkeeper who stated that he had received a telegram which he considered permission for the work to be done. This telegram was worded: "To Schoolkeeper, Sandhurst Road School, Catford. "Cleanse classroom C at once—Boys Department, Kerr." The telegram undoubtedly meant that the schoolkeeper himself was to cleanse the room, which shock led him to construe it to mean that he was to admit our men. It is unfortunate that schoolkeepers, and for that matter, the London County Council, should place difficulties in the way of Sanitary 85 Authorities who desire to take prompt action to prevent or check the spread of infection. Subsequently I discovered that the order of .July 8th had been varied by the publication of the following notice in the London County Council Gazette on September 2nd:— "Disinfection of School Premises.—Schoolkeepers are hereby instructed that they must not allow any disinfection of the school premises during school hours without sanction from the Education Offices; but those medical officers who use formalin spray may be allowed to disinfect before or after school hours without sanction from the office." The Lewisham Borough Council and the Public Health Committee are the custodians of the public health of the Borough. It is their duty to investigate and deal with all conditions which may endanger the health of the inhabitants. 1 think they may also be allowed to judge which is the best method of disinfection. It is therefore unfortunate that such extraordinary orders should be issued by the Education Authority, practically to exclude the Sanitary Authority. Moreover, we are left to learn the existence of such orders through the medium of the School caretakers. OUTBREAK OF DIPHTHERIA AT THE HOME FOR SICK CHILDREN, LOWER SYDENHAM. In November an outbreak of Diphtheria occurred among the children in the Home for Sick Children. On investigation it was difficult to locate the exact cause but there is reason to believe that the infection arose from an unrecognised case. Swabs were taken for bacteriological examination from all the children and the staff, and as a result 13 cases of Pseudo-diphtheria were isolated in a special ward. 86 Subsequent swabbing of these showed five to have true diphtheria, although in the majority of cases there were 110 clinical symptoms of the disease. I advised that the institution should be closed against all new cases, that careful watch should be kept upon all the children remaining in the home, and further bacteriological examinations made. Eight children and two nurses who showed clinical signs of diphtheria, as well as positive bacteriological results, were removed to the Metropolitan Asylums Board hospitals. The other patients having Pseudo-diphtheria and 110 clinical symptoms, were detained at the Home until the negative swabs were obtained. Finally, 011 December 24th, when all the children had been distributed to their homes, the whole of the institution was thoroughly disinfected and all bedding and other contents removed to the disinfecting station for steam disinfection. In this way the outbreak was stopped and 110 recurrence of cases occurred on the re-opening of the institution which took place on February 3rd, 1908. VOLUNTARY NOTIFICATION OF PHTHISIS. During the year 56 cases of phthisis were notified as existing in the district. Of the certificates received 14 were endorsed with the request that 110 visits should be made by the sanitary authority. The other 42 homes were visited and details of the precautions necessary to prevent the spread of the disease to others explained. Information was also given in relation to feeding and ventilation, so important to patients. These visits were very much appreciated. In many instances the sufferers showed considerable ignorance in relation to this disease, many being unaware of its infectivity. Few recognised 87 the necessity of a separate bed, and a separate sleeping room was difficult to obtain. The voluntary notification of phthisis has not been acted upon to any extent in the district, the number of notifications received representing only a fractional number of the cases which must exist. Although Lewisham showed the lowest death rate of the Metropolitan Boroughs except Hampstead, judging from the numbar of daaths reoried a large number of actual cases must exist. The number of deaths registered was 138, and the majority of these homes were visited by your women sanitary inspectors, who reported that in 46 homes where phthisis occurred other members of the same family had previously succumbed to the disease. In eight cases association with consumptive patients outside the family was stated to be the probable source of infection. In no, instance was there evidence of overcrowding, It was impossible in all cases to obtain the consent for disinfection after death occurred; permission was given in respect of 54 homes only. CEREBROSPINAL FEVER. In accordance with the provisions of section 56 of the Public Health (London) Act, 1891, cerebrospinal fever was added to the list of compulsory notifiable diseases, for a period of six months, by an order of the London County Council, dated March 4th, 1907. Some scare was occasioned in London about this time and many cases were reported which subsequently proved to be some disease other than cerebrospinal fever. In Lewisham, three suspected cases arose, and I was invited by the medical practitioners to see Cases 1 and 2. 88 Case 1 was C. C., aged 2£ years, residing at Paragon Place, Blackheath. I saw the case with the medical practitioner in attendance, and although it presented many symptoms of cerebrospinal fever, we both were of opinion the case was most probably simple meningitis. We decided to have a specimen of the cerebro spinal fluid submitted for bacteriological examination. This was effected, but the result proved negative. Case 2 was V. B., aged 9 months, of Sydenham Park. Symptoms of cerebrospinal fever were absent and the case was tubercular meningitis. Case 8 was I. T., aged 8 months, of Holmshaw Road, Sydenham. This case was notified as cerebrospinal fever and removed to hospital. After observation it proved to be a case of ordinary meningitis. Disinfection was carried out after each of these cases as a precautionary measure. SMALL POX AND CHOLERA. 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 and cholera patients. These persons 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 was:—Small-pox 8 and Cholera 1. BACTERIOSCOPIC EXAMINATIONS. Facilities were continued for the examination of specimens from doubtful cases of Diphtheria. Phthisis and Typhoid Fever. These examinations proved of the greatest 89 value to medical practitioners and to the Public Health Department by securing an earlier diagnosis than would be possible without them. The total number of examinations made amounted to 453, compared with 296 in the previous year. The details of the examinations were as follows:— 1905. 1906. 1907. re Diphtheria negative 72 148 248 positive 34 68 93 doubtful 1 1 2 re Phthisis negative 22 41 55 positive 7 20 21 re Typhoid Fever negative 4 6 15 positive 2 3 3 re Cerebrospinal Fever — — 3 Food Samples, &c. 2 9 13 Total 144 296 453 PART 3. GENERAL 98 NEW LEGISLATION. London County Council General Powers Act, 1907.— The London County Council General Powers Act, 1907, came into operation January 1st, 1908. By this Act the London County Council have obtained additional sanitary powers as set out in Parts IV. and V. In Part IV. power is given to the medical officer of the London County Council to take, in any district within the County of London, samples of milk produced or sold or intended for sale within the County, and outside the County samples of milk intended for sale within London, when authorised by a justice having jurisdiction in the place where the sample is to be taken. The object of this power is to prevent tuberculous milk entering London. The samples generally will be taken at various railway stations within the County. As originally drafted the Borough Councils and the City of London were precluded from exercising similar powers and your Council with others asked for concurrent powers. The City Corporation secured concurrent powers by a special clause (35), while the Borough Councils can only have them at the discretion of the London County Council. Personally I think the measures will be of little use. It is an attempt to control the milk supply at the point of distribution instead of at the source. Moreover after a sample is taken a considerable delay must occur before a bacteriological report can be obtained, while the remainder of the diseased milk has been distributed and consumed. There is also another serious objection. Power is only given to exclude milk found to be tuberculous from the County. There is nothing to prevent its distribution to other districts when excluded from London. 94 In Part II. of the London County Council General Powers Bill of 1908 it is sought to obtain powers of control by the London County Council over milk which shall be found to contain any matter unwholesome or unfit for the food of man. These clauses were deleted on the second reading in the House of Commons in consequence of an undertaking given by the President of the Local Government Board to introduce a General Bill dealing with the milk supply of the whole county. The importance of such a uniform measure cannot be overestimated. Part V. of the London County Council General Powers Act, 1907, gives powers to the London County Council to enforce the cleansing of children attending school, and inmates of common lodging houses and their clothing. In regard to children vast powers are given in section 36, viz.:—"Where after notice a parent or guardian or other person who is liable to maintain or has the actual custody of a child in respect of whom a written notice has been served requiring the parent, guardian, or such other person to cleanse properly the person and clothing of such child within 24 hours of the receipt of such notice, fails to comply with such notice, the child may be removed from any school to suitable premises to be cleansed. The County medical officer or some person provided with authority may remove such child for this special purpose without any warrant other than this Act, to suitable premises and there detain such child until the required cleansing is effected. The Act also gives power to the London County Council to enter into agreements with the Borough Councils and Sanitary Authorities for the use of suitable places and appliances for effecting such cleansing. Factory and Workshop Act, 1907.—The Act secured the lioyal Assent on the 28th of August, 1907. The chief points are:— 95 The extension of the provisions of the Factory and Workshop Act, 1901, to laundries carried on by way of trade or for the purpose of gain or as an ancillary to another business or incidentally to the purpose of any public institution. To regulate the hours of employment of women and young persons in laundries other than laundries ancillary to a business carried on in any premises which, apart from the provisions of this Act, are a factory or workshop. Special regulations applicable to laundries for regulating the temperature of every ironing room and for carrying away steam in every wash-house; for controlling the use of heating irons; for the efficient draining of floors to allow water to flow off freely. Butter and Margarine Act, 1907.—This Act came into operation on the first day of January, 1908, and is the outcome of a report of a Select Committee appointed (1906) to consider whether any, and if so, what further legislation was required in order to secure the better control and conduct of the trade in butter and butter substitutes. Registration.—Provision is made in the Act for registration of factories and consignments. The provision of Section 9 of the Margarine Act, 1887, as amended by Section 7 of the Sale of Food and Drugs Act, 1899, shall apply to butter factories, that is to say any premises on which, by way of trade, butter is blended, re-worked, or any premises on which there is manufactured any milk-blended butter. Inspection.—An officer if specially authorised by the local authority, shall have power to enter at all reasonable times any premises registered under the Sale of Food and Drugs Act, or this Act, and take samples for analysis of any butter, margarine, margarine cheese, milk blended butter or any 96 article capable of being used in the manufacture, treatment or adulteration of the aforesaid articles. Section 3 prohibits the storage in any butter factory of any substance which may be used for adulteration of butter. Section 4 limits the percentage of water in butter to a maximum of 16 per cent., and in milk blended butter to 24 per cent. Section 6 and 14 give power to the Board of Agriculture to make regulations as to the proportion of any milk solid other than milk fat in any sample of butter or milk blended butter. Section 7 gives power to the Local Government Board to make regulations prohibiting the use of or limiting the extent to which preservative substances may be used in butter, margarine or milk blended butter. Section 8 provides for the marking of wrapper used in connection with margarine. Section 9 regulates the conditions of sale for milk blended butter. Vendors may use an approved name in substitution for the word margarine. Application has been made to the Board of Agriculture for a list of names appoved by them. The following list was supplied :—Brenco, Consumo, Sasora, Casmon, Casova, Casana, Casoa, Casa, Iveldale, Iveldene, Iveleat, Ivelene, Ivelette, Ivelike, Ivelmene, Ivelmore, Pearks' Bread mate, Pearks' Bredspred, and Pearksown. This Act further complicates legislation relating to the sale of food and drugs. It would be of considerable advantage if the several enactments now controlling the sale of food and drugs could be consolidated. Public Health (Regulations as to Food) Act.—This Act gives power to the Local Government Board to make regulations 97 authorising measures to be taken for the prevention of danger arising to public health from the importation, preparation, storage and distribution of articles of food and drink (other than drugs or water) intended for sale for human consumption. Education (Administrative Provisions) Act, 1907.— Medical Inspection of School Children.—This Act received Royal Assent on the 28th of August, 1907, and is a measure for the better administration by central and local authorities in England and Wales, of the enactments relating to Education. The portion of the Act (section 13) with which we are directly interested concerns the medical inspection of school children and is as follows :— "13 (1) The powers and duties of a local education "authority under Part III. of the Education Act, 1902, shall "include :— "(a) Power to provide for children attending a public "elementary school, vacation schools, vacation classes, play "centres, or other means of recreation during their holidays or "at such other times as the local education authority may "prescribe, in the schoolhouse or in some other suitable place "in the vicinity, so far as the local education authority, in the "case of a schoolhouse or place not belonging to them, can "obtain for the purpose the use of the schoolhouse or place ; "and "(b) The duty to provide for the medical inspection of "children immediately before or at the time of or as soon as "possible after their admission to a public elementary school, "and on such other occasions as the Board of Education "direct, and the power to make such arrangements as may be "sanctioned by the Board of Education for attending to the "health and physical condition of the children educated in " public elementary schools : "Provided that in any exercise of powers under this "section, the local education authority may encourage and "assist the establishment or continuance of voluntary agencies, "and associate with itself representatives of voluntary associa"tions for the purpose. 98 "(2) This section shall come into operation on the 1st "day of January, 1908." The aims of the new Act and its scope have been most ably and clearly set out in the Memorandum on medical inspection of School Children in Public Elementary Schools issued by the Board of Education in November, 1907, from which I make the following extracts :— " The Education (Administrative Provisions) Act, 1907, " in so far as it concerns the medical inspection of school " children, is the outcome of a steady movement of public " opinion throughout the entire community. For some years " past evidence has been accumulating that there exists in " certain classes of the English people a somewhat high degree " of physical unfitness which calls for amelioration, and, as far " possible, for prevention. The Legislature resolved that to " grapple effectively with this problem, or at least part of it, " it was necessary first to improve the health conditions, both " personal and in regard to environment, of the children of the " nation. A consideration of the gravity of the need led to the " conclusion that medical inspection of school children is not " only reasonable but necessary as a first practical step towards " remedy. Without such inspection we not only lack data, but " we fail to begin at the beginning in any measure of reform. " The reasonableness of such inspection, if it is conducted on " sensible lines leading to an improvement of the surroundings " and physical life of the children, must become evident both " to their parents and to the nation as a whole. " The Board desire therefore at the outset to emphasise " that this new legislation aims not merely at a physical or " anthropometric survey or at a. record of defects disclosed by " medical inspection, but at the physical improvement, and, as " a natural corollary, the mental and mural improvement, of " coming generations. The broad requirements of a healthy " life are comparatively few and elementary, but they are " essential, and should not be regarded as applicable only to the " case of the rich. In point of fact, if rightly administered, the " new enactment is economical in the best sense of the word. " Its justification is not to be measured in terms of money but in " the decrease of sickness and incapacity among children and " in the ultimate decrease of inefficiency and poverty in after " life arising from physical disabilities." 99 It will be seen that two main provisions are incorporated in section 13. " First, the duty, laid upon all local education authorities, " of the medical inspection of children at a stated time and on " such other occasions as the Board of Education may direct; " and secondly, the power given to all local education authorities " of making arrangements, to be sanctioned by the Board, for " attending to the health and physical condition of the children " in elementary schools." The memorandam states :— " The present Act is not intended to supersede the " powers which have long been exercised by sanitary authorities " under various Public Health Acts, but is meant to serve " rather as an amplification and a natural development of " previous legislation." " Organisation.—The duties thrown upon the Board " consist in advising local education authorities as to the " manner in which they should carry out the provisions of the " Act, and in supervising the work they are called upon to " undertake ; in giving such directions as may be necessary " regarding the frequency and method of inspection in particular " areas; and in considering and sanctioning such arrangements " for attending to the health and physical condition of the " children as maybe submitted to them by individual authorities. " The Board will also collate the records and reports made by " the Authorities and will present an annual report to " Parliament." " The duty of carrying out the actual inspection has " necessarily been entrusted by Parliament to the local " education authorities and not to the Board." " In view of the varied influences which affect, directly " or indirectly, the health of the children of the nation, it is " manifestly of the highest importance that the administration " of this Act should rest upon a broad basis of public health. " The Board advise the use to the utmost extent the existing " machinery of Medical and Sanitary Administration, developing " and supplementing it as required, rather than supplanting it " by bringing into existence new agencies, partially redundant " and possibly competing." " The Board view the entire subject of school hygiene " not as a speciality or as a group of specialities existing by and 100 " of themselves but as an integral factor in the health of the " nation. The application of this principal requires that the " work of medical inspection should be carried out in intimate " conjunction with the Public Health Authorities and under " the direct supervision of the Medical Officer of Health. The " advantages of such unification of the Public Health services " have already been recognised by the Inter-Departmental " Committee on Medical Inspection and the Feeding of School " Children, and also by the Local Government Board, who " specifically require every Medical Officer of Health to report " officially upon matters relating to the sanitary condition of all " schools, including the 'action taken (by the sanitary authority) " in relation to the health of the scholars and for preventing " the spread of infectious disease.'" " Dual Control.—It is unnecessary to emphasise the " objections to a dual jurisdiction in such matters as the " sanitary control of school premises and the notification and " prevention of the spread of infectious diseases in which the " duties of the Medical Officer of Health and the School " Medical Officer necessarily and obviously overlap. If they " are to be effectively carried out the interests and activities of " the School Medical Officer must extend over the whole " external environment of the child. School hygiene cannot " be divorced from home hygiene, and this in turn is intimately " bound up with the hygienic conditions of the community. " Efficiency and economy require, therefore, an organic " relationship between the daily work of the school authority " and of the authority responsible for the administration of the " wider branches of public health, including the supervision of " water and milk supplies, food, housing, and sanitation, " inquiries into matters affecting infant mortality (including " ante-natal influences), home visiting by men and women " inspectors, sanitary and bacteriological investigations, the " provision of hospital accommodation, disinfection, the " cleansing of verminous persons, the notification of the " prevalence or otherwise of diseases, such as phthisis, " affecting the adult population, and the consideration of social " factors, such as the occupation of the parents, or the health, " habits, and physical conditions of the family, all of which " have a bearing, direct or indirect, upon the children's health." " Conversely this organic relationship will provide in" creased opportunity and facilities for the Medical Officer of " Health to study all the conditions affecting the health of the " community at all age-periods, and will bring him into closer 101 " touch with the personal hygiene of the population. While " it is not expected that by establishing the necessary adminis" tration on the broad basis of public health all difficulties will " be avoided, the Board are convinced that this is the only " practicable method and that which is most likely to promote " economy, harmony, and efficiency.'' " It is imperative that the close inter-relation between " school hygiene and general hygiene, particularly that of the " home of the child, should be secured and maintained." Since the issue of the Memorandum, Local Authorities have been most active throughout the country in making arrangements to put into operation the provision in relation to the medical examination of school children upon the lines suggested by the Board of Education. I11 most towns the medical officer of health is the medical adviser to the Education Authority, and, where necessary, medical assistants have been appointed to act under his direction and supervision in the new work, thus preventing dual control and maintaining the close inter-relation between school hygiene and general hygiene. Such a system increases the effectiveness of school inspection, as it is carried out in conjunction with the general public health work of the community. In London, however, it is proposed to divert school hygiene from the authority responsible for the other branches of public health work, the London County Council being the Education Authority. No definite scheme has been formulated yet, but probably a very large number of medical inspectors will be appointed to act under their direct control. There are nearly a million children attending the London County Council schools in London. It will be impossible for the inspectors to have knowledge of the home condition of the children, or to take action in relation to infectious sickness in the homes. Arrangements could no doubt have been made to secure the assistance of the 28 Borough Councils (the sanitary authorities in London) 102 and their medical officers of health and organised staffs, which could have been supplemented with necessary additional assistance, the County Council paying the cost due to medical inspection. This would, no doubt, have led to a considerable saving in expenditure. The information gained by school medical inspection would have been invaluable to the medical officer of health in each particular district. There would be no overlapping of duties by different authorities ; no dual control, a condition not calculated to promote "economy," "harmony " or "efficiency." We are at present required by the Local Government Board to report officially upon all matters relating to the sanitary condition of all schools, including the action taken by the sanitary authority in relation to the health of the scholars and for preventing the spread of disease. The extracts quoted from the Memorandum of the Board of Education contain the strongest possible arguments in favour of inspection of school children being performed by the medical officers of health. Your Council have already approached the London County Council upon this subject as the following communication shows:— 30th January, 1908. " Sir, " I beg to inform you that this Council have had under " consideration the question of the medical inspection of children " in Public Elementary Schools, under Section 13 of the " Education (Administrative Provisions) Act, 1907, together " with the Memorandum dated 22nd November, 1907, issued " by the Board of Education on the subject. " This Council have received a report from their Public " Health Committee, and on their recommendation have arrived " at the following conclusions with reference thereto :— 103 " (1) That it is desirable ' on the grounds of efficiency, " economy, and harmony, that the work of medical " inspection of school children under the provisions of " the Education (Administrative Provisions) Act, should " be carried out in intimate conjunction with public " health authorities' as set out in Paragraphs 5 and 6 " of the Memorandum of the Board of Education, and " that the Cities of London and Westminster and the " Metropolitan Boroughs should for this purpose be " made the units of administration. " (2) That it is desirable that the Medical Officers of Health " of the Cities of London and Westminster and the " Metropolitan Boroughs be appointed (by the London " County Council) as the local administrative officers, " co-operating for this purpose with the Medical " Officer of Health for the County of London. " (3) That it is desirable that any necessary executive assis" tants should be appointed by the London County " Council and allocated to the Cities of London and " Westminster and the Metropolitan Boroughs, such " assistants to be under the control of, and to receive " instructions from, and report directly to the Medical " Officers of Health. " (4) That it is desirable that the Medical Officers of Health " should report directly to the London County Council " on all matters relating to the administration of the " Act. " In forwarding these conclusions I am directed to ask " that the London County Council will be good enough to con" sider the same with a view to adopting and incorporating " such proposals in any scheme to be prepared by them under " the Education (Administrative Provisions) Act, 1907. " The Clerk, " London County Council." 104 Table 24. Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the years 1903-7 Ward. Number of Water Certificates Granted. 1903 1904 1905 1906 1907 Church 12 40 23 33 Manor 17 41 9 7 46 South 30 25 33 47 13 Lee Division 47 78 82 77 92 Blackheath 5 5 1 Lewisham Milage 72 56 10 5 24 Lewisham Park 159 71 67 114 55 Brockley 112 109 154 120 84 Catford 495 270 297 258 322 Lewisham Division 843 506 533 498 485 Forest Hill 199 139 95 63 30 Sydenham 210 176 208 156 157 Sydenham & Forest Hill Division 409 315 303 219 187 Whole Borough 1299 899 918 794 764 105 Table 25. Houses Examined and Certified under the Customs and Inland Revenue Acts during 1907. Name of Street. Applications. Certificates Date. Number of Houses. Number of Dwellings. Granted. Refused. Abernethy Terrace 3 6 6 — April Benin Street 28 56 — 56 February Blashford Street 34 68 — 68 February Bovill Road 9 18 18 — February Bradford Road 2 4 4 — February Brightside Road 1 2 2 — May Brightside Terrace 1 2 2 — May Brookdale Road 9 18 8 10 April Clarens Street 1 2 2 — February Davenport Road 14 28 28 — February Effingham Road 31 62 62 — February Empire Parade 7 12 12 — April Engleheart Road 10 20 — 20 March Farley Road 46 92 4 88 January Fernbrook Road 1 2 — 2 March Fransfield drove 1 2 2 — February Helvetia Street 5 10 10 — February Hither Green Lane 6 12 12 — February Holbeach Road 5 10 — 10 January Laleham Road 11 22 8 14 January Lanier Road 2 4 4 — March Leahurst Road 13 26 26 — July Lochaber Road 4 8 8 — April Manor Park 1 3 — 3 September Myrtle Grove 2 4 4 — March Neuchatel Road 1 2 2 — February Rembrandt Terrace 2 4 4 — July Springrice Road 30 60 60 — February Sydenham Mansions 1 6 6 — March Woodlands Street 27 54 — 54 February Totals 308 619 294 325 106 HOUSE-TO-HOUSE INSPECTION. During the year house-to-house inspection was made of 612 dwellings, distributed in the following roads and streets:— Avenue Road, Avenue Square, Bradford Road, Engate Street, Fullers Place, Hindsley Place, John's Place, Knighton Park Road, Mallet Road (part), Mercy Terrace, Molesworth Street, Rennell Street, Rhyme Road, Romer Place, Railway Terrace and Sandhurst Road (part). The following is a summary of the principal nuisances found and shows the need for systematic inspection:— Defective drains 93 Vent shafts and soil pipes defective 87 Water closets and apparatus defective 115 Insufficient water supply to water closets 65 Defective yard traps, sink wastes, gullies, &c. 209 Dirty premises 227 Overcrowding 8 Drinking water cisterns defective 145 Defective roofs 88 Damp premises 56 Insufficient floor ventilation 8 Defective yard pavings 113 Offensive accumulations 3 Animals so kept as to cause a nuisance 2 Other minor nuisances (ashbins, &c.) 271 Total 1,490 The whole of the above-mentioned defects were remedied on the service of notices, and no summary proceedings were necessary. Only eight cases of overcrowding were discovered. 107 HOUSE UNFIT FOR HUMAN HABITATION. Brockley Cottages.—Nos. 17 and 18, Brockley Cottages, which have remained closed in consequence of a magistrate's order for some considerable period, have been repaired by the owners, who made application to the Court of Summary Jurisdiction for a rescinding order in accordance with the Housing of the Working Classes Acts. After hearing the evidence, the magistrate granted the order as requested. COMBINED DRAINAGE. It was found necessary to serve notices under the Metropolis Management Acts upon the respective owners in order to obtain the necessary alteration and amendment of the following combined drains :— Adelaide Road, 2 to 12. Barmeston Road, 82 to 88. Burghill Road, 3 and 5. Clifford Terrace, 1 to 5. Como Road, 37 to 67. Courthill Road, 75 to 79. Ellerdale Street, 22 to 38. Kangley Bridge Road, 11 and 13. Kent House Road, 34 and 36. Kilmorie Road, 2 to 16. „ „ 20 to 24. Knighton Park Road, 45 to 51. Lower Winchester Road,l to 7. Mayow Road, 129 to 131. Princes Road, 1 to 4. Ravensbourne Road, 17 to 19. Stanstead Road, 119 to 121. „ „ 141 to 147. „ „ 196 to 208. SMOKE NUISANCES. The Inspector entrusted with this duty made 176 investigations, compared with 538 during 1906. The observations were made in respect of laundries 53, breweries 36, silk mills 23, jam works 22, flour mills 12, railway engines 13, sawmills 8, sewer works 3, and miscellaneous 6. Seven intimation and 2 statutory notices were served for the abatement of nuisances reported. Fewer complaints were received during the year. Of the nuisances which 108 occurred the majority arose in connection with laundry chimneys. The service of the notices and the frequent calls of the inspector produced satisfactory results. Proceedings were taken in one case (see Summary of Proceedings, page 110). OVERCROWDING OF SCHOOLS. Lewisham Bridge Schools.—In October the London County Council were called upon to remedy the overcrowded condition of a temporary classroom of the Lewisham Bridge School, Girls' Department. On the 16th of October I received a communication from the executive officer of the Education Authority, stating that arrangements had been made to insure that the average attendance of the children on the roll, for this room should not exceed 89. In reply to their communication I pointed out to the executive officer that the arrangements made to ensure that the average attendance in this classroom should not exceed 89, would apparently not preclude a larger number on some occasions, and that when tires were commenced it would be necessary to still further reduce the number. CORONER'S COURT AND MORTUARY. One hundred and forty-one bodies were removed to the Mortuary. Eighteen of these were from outside districts and twenty-nine from the Lewisham Union Infirmary. Inquests were held in 187 cases. The bodies of five persons who died from an infectious disease were removed from their homes to the portion of the Mortuary specially allocated for such cases. 109 DISINFECTION. During the year 2,000 rooms were disinfected by formalin spray, and textile articles such as bedding, clothing, &c., removed from infected homes to the Council's Disinfecting Station for treatment in the steam disinfector. UNSOUND FOOD. The following parcels of food were surrendered as unfit for human consumption and subsequently destroyed:— 6 bags greens 2 boxes roker 6 pecks strawberries 1 trunk plaice 24 rabbits 1 box mackerel 1 buttock beef (82 lbs.) 1 trunk whiting 3 tins condensed milk 4 boxes kippers 10 tins sardines 1 trunk small haddocks 1 box cole fish 1 box large haddocks 1 barrel and 2 parcels crabs (in all 197). 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 11 Fines imposed £30 10s. Costs imposed £10 12s. 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. 110 (b) Offences Other than Adulterations: For selling five samples of margarine in unlabelled wrappers, as required by the Margarine Act, summonses were issued against H. A., of Kennington, but the vendor absconded. Metropolis Management Acts:—For failing to comply with notices served under the Metropolis Management Acts requiring the amendment of the combined drain in connection with the premises known as Nos. 95-105 Dartmouth Road in bad order and condition, the owners were fined £2 2s. and £4 4s. costs. Proceedings taken under the Public Health (London) Act, 1891, or Bye-laws made thereunder:— For allowing black smoke to issue from the chimney of a laundry in Lewisham in such quantities as to be a nuisance, A. E. N. was fined £10 and £2 2s. costs. For carrying out alterations to a water closet at 46 Aislibie Road without giving the necessary notice to the Sanitary Authority, F. E. A., of Lee, was fined 5s. and 10s. 6<L costs. For carrying offensive matter (i.e. fish offal) through the Borough during prohibited hours and in vessels not properly constructed, J. M., of Catford, was fined £1 and 2s. costs for each offence. Proceedings were taken against a person for failing to notify a case of scarlet fever and for exposing the patient in a public place, the particulars of which are given on page 78. The details of the proceedings instituted against the South Suburban Gas Company for an alleged effluvia nuisance are as follows :— 111 NUISANCE AT SOUTH SUBURBAN GAS WORKS. On the evening of April the 18th, between the hours of 11.30 p.m. and 12, a nuisance existed in the district more particularly noticeable between the Exbury Road and High Street, Lewisham, and appeared to be due to emanations from the sewer openings. The distinctive character of these emanations showed the presence of gas refuse in the sewers. On Friday the 19th a visit was made to the Gas Company's works, where the engineer admitted to me in the presence of two inspectors that the company had been discharging into the County Council's sewer (which runs through their works), certain offensive material, the residue of one of the gasholders then under repair, and stated that he had no other means of disposing of the material which had been in the gasholder for many years. The engineer explained that they were enlarging the gasholder, and that the material was not formed in the manufacture of gas, but that it was merely an accidental accumulation which they were bound to get rid of before they could carry out their works. The covering of one of the large gasholders had been removed to a considerable extent in the process of inserting an extra lift. As a result emanations from the foul residue which had been accumulating for many years escaped freely into the atmosphere, creating a serious nuisance in the neighbourhood. When there was a little movement in the atmosphere the nuisance was greatly increased and extended considerable distances from the works, as is shown by the addresses of the persons who signed a petition to your Council. The London County Council were informed on the 19th of the fact that the Gas Company had been discharging offensive material into their sewer. 112 The petition was as follows :— " We, the undersigned, being 10 inhabitants of the " Borough, do hereby, in pursuance of the provisions in that " behalf of the Public Health (London) Act, 1891, that a certain " manufactory, building or premises used for a trade, business " process or manufacture causing effluvia, at the gasworks " situate at Lower Sydenham, the trade within is carried on " by South Suburban Gas Company is a nuisance. " W. M., Dacres Road " P. K., Dacres Road " G. R. R., Silverdale " G. J. F., Dacres Road 44 J. H. S. Mayow Road " J. R. F., Mayow Road.'' W. I. C., De Frene Road T. F. A., Dacres Road C. N., Dacres Road O. R., Dacres Road S. T. A., Dacres Road The petition was in conformity with Section 21 of the Public Health (London) Act, 1891, consequently your Council were bound to take proceedings before the magistrate. The case was partly heard on the 18th and 26th July and then adjourned. The further hearing was on the 18th and 20th of January, 1908. The magistrate in giving his decision said he had come to the conclusion that the nuisance was a greater one than was admitted by the defendants, and that the Borough Council were bound to take proceedings. On the other hand he was of opinion that the defendants had made out their case, and they had used the best practicable means to prevent the nuisance. He therefore dismissed the summons. ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901. Workshops :—There are in the borough 572 workshops, containing 931 workrooms to which provisions of the Factory and Workshop Act apply. The number of workers found on 118 inspection amounted to 2189, of which 549 were men, 1316 women, and 324 young persons. The largest proportion of these workers were engaged in the dressmaking, laundry, and millinery trades, there being 1,281 women, 251 young persons and 34 men so employed. These premises are inspected by the women sanitary inspectors (see work of women sanitary inspectors, page 118), together with the workshops employing women in other trades. Only 35 women and 73 young persons were employed in all other trades. In workshops employing male labour, 549 men were engaged. Domestic and Part-Time Work Places.—There are 342 part-time and domestic workplaces, i.e., private houses, places or rooms, where no power is used, and in which only the occupiers themselves are employed. Besides these there are 53 restaurants and 42 stable yards, contractors' yards, &c., which might be termed workplaces. For the purpose of their inspection a special clause was added to section 2 of the Public Health (London) Act. Home Work.—In February last several small employers failed to send a list of outworkers employed by them. The Committee, however, decided to send cautions and in reply these lists were at once supplied. On the whole the sanitary condition of the workshops in the Borough is very satisfactory. Where defects were found a verbal complaint to the owner was very often sufficient for the immediate remedy of same. 114 Table 26. Inspection of Factories, Workshops & Workplaces. (1) Premises, Inspections Notices served. Proceedings Factories (including factory laundries) 142 18 - Workshops (including workshop laundries) 1814 80 - Workplaces (other than outworkers' premises) 689 33 - - Total 2145 131 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 114 114 — — Want of ventilation 3 3 — — Overcrowding 8 8 — — Want of drainage of floors — — — — Other nuisances 45 44 — — Sanitary accommodation— Insufficient 1 1 — — Defective or unsuitable * 75 75 — — Not separate for sexes — — — — Under the Factory and «/ Workshop Act— Illegal occupation of under-ground bakehouse — — — — Other offences — — — — Total 246 245 — — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 115 Table 27. HOME WORK. (3). NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Addresses of Outworkers. Prosecutions. Instances Notices served. Prosecutions. Instances Orders made, Sec. 110. Prosecutions. Sections 109, 110. Twice in the year. Once in the year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists.1 Outworkers.† Lists. Outworkers.† Con- Workmen. Contractors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Wearing Apparel— (1) making, &c. 84 1 208 26 5 50 170 115 – – 289 7 4 – – – – (2) cleaning and washing – – – – – – – – – – – – – – – – – Lace, lace curtains and nets – – – 2 – 2 2 – – – 9 – – – – – – Artificial flowers – – – – – – – – – – – – – – – – – Nets, other than Wire Nets – – – – – – – – – – – – – – – – – Tents – – – – – – – – – – – – – – – – – Sacks – – – – – – – – – – – – – – – – – Furniture and Upholstery – – – 1 – 1 1 – – – 4 – – – – – – Fur pulling – – – – – – – – – – – – – – – – – Feather sorting – – – – – – – – – – – – – – – – – Umbrellas, &c. – – – – – – – – – – – – – – – – – Carding, &c., of buttons, &c. – – – – – – – – – – – – – – – – – Paper Bags and Boxes – – – – – – – – – – – – – – – – – Basket making – – – – – – – – – – – – – – – – – Brush making 2 – 2 – – – – – – – 2 – – – – – – Racquet and tennis balls – – – – – – – – – – – – – – – – – Stuffed Toys – – – – – – – – – – – – – – – – – File making – – – – – – – – – – – – – – – – – Electro Plate – – – – – – – – – – – – – – – – – Cables and Chains – – – – – – – – – – – – – – – – – Anchors and Grapnels – – – – – – – – – – – – – – – – – Cart Gear – – – – – – – – – – – – – – – – – Locks, Latches and Keys – – – – – – – – – – – – – – – – – Pea picking – – – – – – – – – – – – – – – Total 86 1 210 29 5 53 173 115 – – 304 7 4 – – – – * If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list is included among those in column 2 (or 5 as the case may be) against the principal-class only, but the outworkers are assigned in columns 3 and 4 (or 6 and 7) into their respective classes. † The figures in columns 2, 3 and 4 are the total number of lists (received from employers who sent them both in February and August as required by the Act) and of the entries of names of outworkers in those lists. They are, therefore, usually double of the number of such employers and (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name is often repeated. 117 Table 28. *Workshops (sec. 131) and Workplaces and Workrooms on the Register at the end of 1907. Class of Work. No. Number of Rooms. Number of Workers Allowed. Number of Workers Found. Part Time and Domestic. Workplaces. Day. Artificial Light Overtime. Men. Women. Young Persons Number. No. of Rooms. Dress 187 229 1516 1337 930 2 657 201 63 63 Millinery 45 51 276 266 165 – 116 49 6 6 Laundry 74 322 1047 981 639 32 508 1 108 144 Tailor 42 45 195 183 124 81 16 10 13 13 Boot 77 78 273 258 172 109 – 10 79 79 Joiner 19 31 532 497 378 57 – 10 7 7 Smith 27 30 346 327 244 72 – 5 6 6 Furrier 2 2 10 10 6 3 3 – – – Cycles 19 26 185 165 126 37 – 6 12 12 Coachbuilder 7 16 186 177 135 23 – 4 – – Cabinet and Upholsterer 16 24 337 323 238 39 5 5 5 5 Blindmaker 2 4 25 23 15 3 – 1 1 1 Photographer and Pictureframer 12 17 75 70 47 13 2 3 8 8 Jeweller 12 13 61 53 36 19 – 5 20 20 Piano 2 2 9 9 6 2 – 1 1 1 Saddler 10 11 54 47 35 18 – 3 4 4 Mason 3 4 42 41 28 6 – 1 – – Lathrender 2 4 22 18 14 8 – – – – Various 14 22 148 140 89 25 9 9 9 9 Total 572 931 5339 4925 3427 549 1316 324 342 378 Note:—Not including Bakehouses (96), Restaurants (53) and Various Workplaces (42). 118 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 24 Action taken in matters referred. Notified by H.M. Inby H.M. Inspectors as remedi- spector 2 able under the Public Health - (London) Act, but not under the Reports of action taken, Factory Act (Sec. 5). sent to H.M. Inspector 2 Underground Bakehouses (Section 101):— In use during 1903 23 Certificates granted in 1903 23 1904 - 1907 nil In use at end of 1907 23 Workshops and Workplaces on the Register at the end of 1907:— Workshops (details in Table 29) 572 Workplaces part time and domestic (details Table 29) 342 Bakehouses 76 ,, underground 23 Restaurants (workplaces) 53 Workplaces (stable yards, contractors' yards, etc.) 42 Total 1108 WORK OF WOMEN SANITARY INSPECTORS. During the year Miss Jones and Miss Moynihan have performed most useful work in connection with the Health Department. The total number of visits made by these inspectors amounted to 5,594, reporting 429 nuisances. Many defects they were able to have remedied without the service of legal notices. It was, however, necessary to serve 275 intimation notices and 80 statutory notices, which were complied with. 119 In addition to their principal duties, viz., that of visiting and inspecting workrooms where women were employed, the homes of outworkers, &c., they made 232 visits to schools which were of great assistance in our efforts to check and prevent the spread of infectious diseases. Five hundred and eighty six visits were made to homes in relation to measles, 358 re chicken pox, and 222 re whooping cough and other nonnotifiable diseases. Under the Factory and Workshop Act, 1,165 visits were made to factories, workshops, workplaces and laundries where women are employed, and 348 to homes of outworkers. Three hundred and fifty-nine homes were visited after deaths of infants under one year and 882 selected homes at which births occured. This work was carried out tactfully and without friction. We frequently received communications requesting a visit from the women inspectors. Nineteen visits were made in regard to puerperal fever and 260 re phthisis homes and deaths, also essentially work for women sanitary inspectors. SUMMARY OF WORK OF WOMEN SANITARY INSPECTORS. During the year under review the Women Sanitary Inspectors have made 5,594 visits throughout the Borough. The following is a summary of the work done:— Factory and Workshop Act.— Miss Jones. Miss Moynihan. Total. To Factories 25 29 54 „ Workshops 203 288 491 „ Workplaces 181 163 344 „ Laundries 137 139 276 „ Outworkers' homes 99 249 318 120 Miss Jones. Miss Moynihan. Total. Infectious Diseases.— To Phthisis homes 52 55 107 Be Phthisis deaths 83 70 153 „ Chicken-pox 199 159 358 „ Measles 237 349 586 „ Puerperal fever 12 7 19 „ School diseases 97 125 222 Other Visits.— On complaint from residents 74 43 117 To Selected homes from which births were registered 433 449 882 Investigations re Infant mortality 146 213 359 To Schools 135 97 232 Re-visits and re-inspections 563 321 884 Miscellaneous inquiries 86 76 161 Total 2762 2832 5594 Nuisances, Defects, &c.— Abstract not affixed in workshops 12 12 24 Overcrowding found 1 7 8 Other nuisances in workshops 59 63 122 Total number of nuisances found 231 198 429 Notices, &c.— Intimation notices served 170 105 275 Statutory notices served 49 31 80 Verbal notices complied with 39 32 71 121 Table 29. ROUTINE INSPECTIONS. Premises. Number of Places No. of Inspections 1907. No. of Notices 1907. No. of Prosecutions 1907 On Register at end of 1906. Added in 1907. Removed in 1907. On Register at end of 1907 Milk premises 160 32 27 165 311 8 – Cow sheds 15 – 1 14 169 – – Slaughter houses 16 – – 16 170 1 – Other offensive Trade premises – – – – – – – Ice cream premises – – – – – – – Registered houses Let in Lodgings 15 – – 15 159 a 4 b 29 – a Overcrowding. b For other conditions. Total number of intimation notices served for all purposes, 1895. Overcrowding:—Number of dwelling rooms overcrowded 36, also schoolroom 1, and workrooms 8, remedied all, 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, 6. Number of persons accommodated during the year in shelter provided under Section 60 (4) of the Public Health (London) Act, 1891, nil. 122 Revenue Acts:—Houses for which application were received 308, number of tenements comprised therein 619, certificates granted 294, refused 325, deferred nil. Prosecutions under By-laws under the Public Health (Loudon) 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. 2 (/) As to cesspools and privies, removal and disposal of refuse, &c. – (g) For securing the cleanliness of tanks, cisterns, &c. – (h) With respect to water-closets, earth-closets, &c. 1 (i) With respect to sufficiency of water supply to water-closets – (j) With respect to drainage, &c. (Metropolis Management Act, Section 202) – (A) With respect to deposit of plans as to drainage, &c. (Metropolis Management Acts Amendment (Bylaws) Act, 1899) – Mortuaries:— Total number of bodies removed 141 Total number of infectious bodies removed 5 Note.—This table was formulated to meet the requirements of the London County Council. 123 Table 30. REGISTER OF SANITARY WORK. (Male Inspectors) For the year ended 31st December, 1907. Lewisham Division Sydenham and Forest Hill Division. Lee Division Workshops House to House Description of Work Mr. J. A. K. Cooper Mr. H. King Mr. H. L. Hyde Mr. E. T. Pi dwell Mr. B. A. Knappett Mr. R. White Mr. J. Daltry Mr, A. H. Grat Total for Whole Boro. Complaints by Residents 54 98 71 70 163 233 7 1 697 Premises inspected 420 581 680 704 720 542 1490 745 5882 lie-inspections of Works in progress 1408 1351 1208 1233 1780 2043 456 3716 13195 Intimation Notices served 132 243 203 96 175 169 77 525 1620 Statutory Notices ordered 121 208 139 60 90 119 31 33 801 Statutory Notices served 24 59 19 29 43 25 7 11 217 Premises repaired, cleansed, &c. 78 102 103 87 104 72 168 237 951 Defective Roofs, Stackpipes, &c., remedied 29 27 57 29 38 46 28 187 441 Drains re-constructed 92 70 72 69 55 73 — 59 490 Drains repaired 20 54 39 37 65 63 1 20 299 Drains ventilated 22 13 30 38 9 77 – 17 206 Stackpipes, sinks, Bath Wastes, &c., disconnected from drains 39 103 58 40 26 112 16 334 Gulley Traps provided 107 93 103 144 208 205 1 84 945 Water Closets reconstructed 87 81 29 80 92 137 1 78 585 Water Closets repaired 16 26 56 28 34 65 72 32 329 Water Closets supplied with water 18 46 41 12 5 69 26 77 294 Soil Pipes reconstructed 47 39 34 29 35 56 — 33 273 Soil Pipes repaired and ventilated 5 28 9 21 10 35 29 26 163 Dustbins provided 35 49 74 41 18 69 16 139 441 Water Supply to Houses reinstated 4 7 2 14 21 _ – 48 Cisterns repaired, cleansed or covered 10 12 14 91 25 15 103 165 435 Water Certificates issued 53 19 51 85 15 91 306 144 764 Premises over-crowded 2 9 19 1 4 — 2 37 Yards paved 44 41 57 41 82 45 58 155 523 Removal of offensive accumulations 13 21 16 20 21 19 5 5 120 Dung Vaults erected or repaired 1 1 2 — 1 4 1 — 10 Animals improperly kept 2 8 1 4 3 3 2 1 24 Visits to houses let in lodgings 6 — 153 — — — — 159 Bake-house inspections — 1 17 25 22 29 161 — 255 Milk-shop ,, 4 1 – 10 26 35 235 — 311 Cow-shed ,, 12 47 6 24 13 67 — — 169 Workshop ,, — — – — — 630 — 630 Slaughter-house ,, 44 19 9 46 14 38 – – 170 House-to-house ,, – – 24 – – – – 591 615 Legal proceedings 7 4 4 3 3 3 1 – 25 PART 4. REPORT OF PUBLIC ANALYST 127 REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1907. SAMPLES SUBMITTED.—During the period under review 543 samples were submitted for analysis. Of this number, 496 were purchased by your inspectors in conformity with the provisions of the Sale of Food and Drugs Acts. The remaining 47 samples were purchased as test samples, and without declaration to vendors. ADULTERATED SAMPLES.—Of the 496 official samples submitted, 36, or 7.26 per cent. were adulterated, compared with 9.29 per cent. in the previous year (1906) and 7.98 per cent. in 1905. TEST SAMPLES.—These are samples purchased by assistants without following the formalities prescribed by the Food and Drugs Acts, the purchases being made in a manner similar to that adopted by the ordinary householder. Of the 47 samples so purchased, 9, or 19.15 per cent., were found to be adulterated. Three of the adulterated samples were butter obtained from vendors who were employed in a house-to-house sale. House-to-House Sale of Sophisticated Butter.—In consequence of complaints received from a resident in the district, samples of butter were taken in the course of delivery at his house. At first the samples were obtained as test samples, and were purchased for us by the consignee. On analysis some of 128 these proved to be margarine. Subsequently official samples were procured, numbered 502 to 506 (inclusive), the analysis of which showed that margarine had been supplied. The consignor was an itinerant vendor residing at Kennington. No time was lost in applying for summonses, but unfortunately we received information from the Court that the service was ineffectual, the consignor having absconded. Samples Nos. 62 and 4.22 (Table I.) were obtained at shops in which we had reason to believe margarine was being sold to persons known as regular customers. The Inspector's agent purchased several test samples and was at first supplied with butter, but ultimately with margarine. PURCHASE OF SAMPLES BY DEPUTY.—This practice was adopted in 232 purchases, and resulted in the detection of sophistication in 29 cases, or 12.5 per cent. MILK.—Of the 288 samples submitted, 19, or 6.60 per cent., were adulterated or below the standard fixed by the Board of Agriculture, compared with 1906, when the adulterated samples equalled 10.19 per cent.; this is a marked improvement. We have in the Borough several well-known and reliable firms who are themselves constantly taking samples from their employees in order to prevent fraud and to maintain the standard of quality. These firms are gradually absorbing the smaller vendors, and to some extent this fact is responsible for the improvement found. Preservatives in Milk.—In 1906 a circular letter was issued to all milk vendors in the Borough drawing attention to the fact that the addition of preservatives to milk was unnecessary and harmful, and stating the determination of the 129 Borough Council to take summary proceedings where the addition of preservatives was reported. Dirty Milk.—In several instances centrifugalized milk showed a deposit of foreign material, chiefly sand and dust. In four instances, however, the deposit consisted of filth. Dyed Milk.—The practice of colouring milk with various colouring matters to suit the demands of the public is still in vogue. Of the milks examined 66.4 per cent. were artificially coloured, compared with 77.4 per cent. in 1906. Annatto is the material most commonly used, but aniline dyes are not infrequently used. Sunday Samples.—Fourteen samples of milk were obtained on Sundays, and two only of these (Nos. 387 and 390) were below the standard. Average Composition.—The average composition of all samples submitted during 1907 was well above the standard, being 3.47 per cent. Milk Fat and 8.81 per cent. Solids Not Fat. The average composition of the genuine samples alone was 3.53 per cent. Milk Fat and 8.83 per cent. Solids Not Fat. (see Table E). Milk Samples taken in course of Delivery.—Twentysix samples were taken in course of delivery, as follows:— Bermondsey Workhouse 2; Railway Stations 21; Shops 1; Private Dwelling Houses 2. Of these three were below standard (Nos. 163, 164 and 325). In the first two instances the vendors were cautioned, and in the case of No. 325 proceedings were instituted against the farmer, but failed on his proving a warranty. (See Table G). The difficulty of obtaining convictions for milk adulteration is becoming greater each year by reason of the warranty clauses 130 of the Food and Drugs Acts. Many difficulties would be obviated where a warranty is relied upon if the person giving the warranty could be made a co-defendant in the first proceedings. BUTTER.—One hundred and sixteen samples were purchased in conformity with the Food and Drugs Act, of which number, nine, or 7.76 per cent. (compared with 12.12 per cent. in 1906) proved adulterated. Forty-two test samples were taken, nine, or 21.43 per cent. of which were adulterated. SPIRITS.—Of the ten samples examined, two were found to be below the legal standard strength. The vendors protect themselves by affixing a small label (reproduced below in actual size) which, even if discovered by the ordinary purchaser, would, I think, be unintelligible to many. STRENGTH ABOUT UP 35 131 Table A. Showing number of Samples submitted for Analysis, with Results for the year ended December 31 st, 1907. (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 288 269 19 6 .60 Skimmed Milk 4 4 – – Butter 116 107 9 7.76 Lard 1 1 – – Cheese 2 2 – – Cream 1 1 – – Margarine 2 2 – – Coffee 41 37 4 9.76 Cocoa 7 7 – – Demerara Sugar 5 5 – – Flour 7 7 – – Oatmeal 1 1 – – Arrowroot 1 1 – – Olive Oil 1 1 – – Mustard 3 3 – – Pepper 1 1 – – Brandy 2 2 – – Gin 3 3 – – Rum 3 2 1 33 .33 Whiskey 2 1 1 50.00 Tincture of Bark 2 1 1 50.00 Compound Drug 1 1 – – Lime Water 2 1 1 50.00 Total official samples 496 460 36 7.26 (b) Test Samples purchased without the formalities of the Act. Butter 42 33 9 21.43 Coffee 2 2 – – Honey 1 1 – – Golden Syrup 1 1 – – Machine Skimmed Condensed Milk 1 1 – – Total “test” samples 47 38 9 19.15 Total all samples 543 498 45 8.29 182 Year. No. of Samples (not including Test Samples). Genuine. Adulterated. Percentage Adulterated. No. of Prosecutions. Fines and Costs imposed. Table B. Summary of Samples Analysed in the Borough in each Year, 1898-1907. 1898 Total Samples ... 36 31 5 13.88 2 Fines £3, costs 15s. 6d. 1899 Total Samples ... 41 37 4 9.75 1 Fines £5, costs 14s. 6d. 1900 Total Samples ... 68 61 7 10.29 7 Fines £14 15s., costs £2 13s. 6d. 1901 Total Samples ... 3 –– 3 100.00 2 Fines £5, costs £1 1s. 1902 Milk 228 Butter 149 458 389 69 15.07 34 Fines £123, costs £24 18s. 6d. Various 81 1903 Milk 270 Butter 76 451 390 61 1353 19 Fine3 £50 15s., costs £11 7s. Various 105 1904 Milk 257 Butter 101 416 376 39 9.38 26 Fines £88 10s , costs £18. Various 58 1905 Milk 282 Butter 91 476 438 38 7.98 19 Fines £56 4s., costs £10 4s. Various 103 1906 Milk 275 Butter 99 Coffee 37 495 449 46 9.29 14 Fines £108, costs £6 13s. 6d. Wines and Spirits 12 Drugs 8 Sundries 64 1907 Milk 292 Butter 116 Coffee 41 496 460 36 7.26 17 Fines £30 10s., costs £10 12s. Wines and Spirits 10 Drug's 5 Sundries 32 133 Table C. Showing Total Samples submitted with results during the years 1903-1907. (Test samples not included). Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 First 111 114 123 146 126 12 16 13 12 9 10.81 14.04 10.57 8.22 7.14 Second 72 67 103 88 119 4 12 9 6 5 5.55 18.90 8.74 6.82 4.20 Third 152 123 129 102 123 30 7 6 15 11 19.74 5.69 4.65 14.71 8.94 Fourth 116 112 121 159 128 15 4 10 13 11 12.93 3.57 8.26 8.18 8.60 Total for Year 451 416 476 195 496 61 39 38 46 36 13.53 9.38 7.98 9.29 7.26 Table D. Showing results of Total Samples of Milk submitted during the years 1903-1907. Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1903 1904 1905 190(5 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 First 70 58 88 63 55 11 9 8 6 5 15.71 15 .52 9.09 9.52 9.09 Second 31 48 53 41 77 1 10 5 4 5 3.23 20.83 9.43 9.76 6.49 Third 124 91 68 77 95 30 6 3 12 8 24.19 6.59 4.41 15.58 8.42 Fourth 45 53 69 84 61 5 2 4 5 1 11.11 3.77 5.80 5.95 1.64 Total for Year •270 250 278 265 288 47 27 20 27 19 17.41 10.80 7.19 10.19 6.60 134 Table E. Average Composition of Milk Samples submitted in 1907. 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 tat. First Quarter 8.48 8.48 3.54 8.85 3.0 8.5 Second „ ... 8.42 8.77 3.45 8.78 Third „ ... 8.45 8.74 3.49 8.77 Fourth „ ... 8.61 8.95 3.66 8.95 Total for Year 8.47 8.81 3.53 8.83 135 Table F. Average Composition of Milk Samples submitted during the Years 1902-1907. 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 ... 8.55 8.62 3.66 8.71 . „ 1903 3.67 8.63 3.81 8.72 „ 1904 3.63 8.69 3.69 8.74 3.0 8.5 „ 1905 3.58 8.75 3.62 8.78 „ 1906 3.56 8.74 3.62 8.77 „ 1907 3.47 8.81 3.53 8.83 186 Table G. Details of Adulterated Samples of Milk during the Year ended December 31st, 1907. No. Adulteration. Remarks. 4 11 percent. deficient in milk fat Vendor fined £4 and 23s. costs. 23 5 per cent, added water Vendor cautioned. 26 3 per cent, deficient in milk fat Vendor cautioned. 113 3 per cent, deficient in milk fat Vendor cautioned. 142 96'6 per cent, deficient in milk fat Vendor fined £5 and 23s. costs. 89 5 per cent, deficient in milk fat Vendor cautioned. 163 2 9 per cent, added water t Samples on delivery ; consignor cautioned. 164 2.2 per cent, added water \ 208 12 per cent. deficient in milk fat Vendor fined £1 and 23s. costs. 227 4 per cent. deficient in milk fat Vendor cautioned. 279 5 per cent. deficient in milk fat Vendor cautioned. 283 5 per cent. deficient in milk fat Vendor cautioned. 289 10 per cent. deficient in milk fat Vendor fined 10s. and 2s. costs. 293 12 per cent. deficient in milk fat Vendor fined £1 aud 2s. cost'. 309 3 per cent. deficient in milk fat Vendor c -utioned. 325 8 per cent. deficient in milk fat Taken on delivery to vendor of a\To. 289; larmer proved warranty ; proceedings dismissed. 387 5 per cent. deficient in milk fat Sunday sample ; vendor cautiontd 390 3 percent. added water. Sunday sample ; vendor cautioned 466 93 per cent. deficient ill milk fat Vendor fined £1 and 26s. costs. 137 Table H. Showing the number of samples of Butter submitted in the Four Quarters of the years 1903-1907. Quarter. No. ot Samples. No. Adulterated. Percentage Adulterated. 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 1903 1904 1905 1906 1907 First 22 35 22 33 34 — 5 3 4 1 — 14.29 13.62 1212 2-94 Second 13 9 17 23 25 — 1 — 1 — — 11.11 — 4.35 — Third 15 22 21 9 20 — 1 — 1 2 — 455 — 11.11 10.00 Fourth 26 35 31 34 37 2 — 4 6 6 7.69 — 12.90 17.65 16.22 Total for 3.ear 76 101 91 99 116 2 7 7 12 9 2.63 693 7.69 12.12 7.76 Table I. Details of Adulterated Samples of Butter for the Year ended December 31st, 1907. No. Adulteration. Results. 56 Margarine "Test" sample; official sample was genuine 58 Margarine " Test " sample ; see official sample No. 62 61 Margarine ."Test" sample; official sample was genuine 62 87 per cent. foreign fat Vendor fined £4 and £1 3s. costs 217 Margarine "Test" sample; official sample was genuine 319 96 per cent. foreign fat Vendor fined £2 and 12s. 6d. costs 353 2^ per cent. excess of water, No action 401 Margarine 44 Test" sample ; see No?. 498, 501. 502, 503, 504, 505 and 506 419 Margarine " Test" sample ; see Nos. 422 and 426 422 76 per cent. foreign fat Vendor fined £5 and £1 13s. 6d costs 426 Margarine "Test" sample ; see Nos. 419 and 422 498 Margarine 14 Test" sample ; see Nos. 401, 501, 502, 503, 504, 505 and 506 501 Margarine "Test" sample; see Nos. 401, 498, 502, 503, 504, 505 and 506 502 92 per cent. foreign fat Taken on delivery ; summonses issued but vendor absconded 503 92 per cent. foreign fat 504 96 per cent. foreign fat 505 92 tier cent. foreign fat 506 96 per cent. foreign fat 138 Table J. Details of Other Samples Adulterated during the year ended December 31st, 1907. No. Article. Adulteration. Remarks. 18 Coffee 10 per cent. added chicory Mixture declared on label 100 Coffee 35 per cent. added chicory Vendor fined £5 and 23s. costs 386 Coffee 35 per cent. added chicory Vendor fined £2 and 21s. costs 455 Coffee Mixture of coffee and chicory Declared as mixture on wrapper ; no action 514 Rum 30 degrees under proof Protected by microscopic label on bottle 5.29 Whiskey 35 degrees under proof Protected by microscopic label on bottle 50 Lime Water Slightly below standard; much sediment Probably old stock; no action 478 Tincture of Bark Deficient in quinine Compound tincture of bark substituted ; vendor cautioned APPENDICES. 141 I.—Local Government Board Tables. Table I. Vital Statistics of Whole District during the Years 1901-1907. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District Nett Deaths at all Ages eel jng1ng to the District. Number. Rate.* Under 1 Year of Age At all Ages. Number. Rate.* Number. Rate per iooo Births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1901 ]28480 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 261 330 93 1566 11.5 480 152 99 1513 11.1 1904 140401 3589 256 448 125 1799 12.8 542 210 90 1679 12.0 1905 144420 3633 252 338 93 1804 12.5 569 232 119 1691 11.7 1906 148463 3446 232 391 113 1888 12.7 616 228 117 1777 12.0 1907 152532 3622 237 325 90 1881 12.3 660 275 143 1749 11.5 Note.—Figures for years prior bo 1901 are unobtainable. * Kates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Area of District in Acres (exclusive of area covered by water) — 6,991 At Census of 1901—Total population at all ages — 127,495 ,, „ Number of inhabited houses — 22,750 ,, ,, Average number of persons per house 5.6 142 Table II. Vital Statistics of Separate Localities in the Years 1901-1907. 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 i year. Population estimated to middle of each Year. Births registered. Deaths at all ages. Deaths under 1 Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under i Year Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under i year. 1901 18708 398 255 — 66631 1882 856 _ 43146 1040 557 — 128480 3320 1668 — 190*2 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 .40401 3589 1679 440 1905 19594 454 186 21 78903 2027 966 209 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 1907 20047 446 214 31 85149 2063 995 186 47336 1113 540 108 152532 3622 1749 325 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 ; Bermondsey (St.- Olave's) Union Workhouse ; St. John's Hospital, Morden Hill; Home for Sick Children, Lower Sydenham ; Flower House Asylum, Southend. Outside Institutions in which deaths of residents of this District have occurred were:—St. Thomas's, Guy's, St. Bartholomew's, Greenwich Miller, London, King's College, Middlesex, Charing Cross, Greenwich Seamen's, French, German, 143 Poplar, Royal Free, Westminster, St. John's and Elizabeth, and the Great Ormonde Street Children's Hospitals; Dartford Heath, Cane Hill, Banstead, Claybury, Darenth, Peckham House, Caterham, Camberwell House, City of London (Stone), Hanwell, Leavesden, and Manor Asylums ; Victoria Hospital, National Hospital (Queen's Square), Blackheath and Charlton Cottage Hospital,. Hospital for Women (Soho Square), Friedenlieim Hospital, Kidbrook House Nursing Home, Salvation Army Maternity Hospital, Brompton Hospital, Royal Chest Hospital (City Road), Royal Free Hospital (Waterloo Road), Cancer Hospital (Chelsea), Evelina (Children's) Hospital, Heart Hospital (Soho Square), St. Mark's Hospital, Bethlem Hospital, St. Luke's House (Kensington), Throat Hospital (Golden Square), St. Pancras, Southwark and Greenwich Infirmaries, Holborn and Lambeth Workhouses. Corrections were also made for deaths occurring as follows :—River Thames, Home for Invalids (Highbury Terrace), Ilbert Street, Dunstan Road (Dulwich), Armitage Road (Greenwich), Royal Hill (Greenwich), North Side (Clapham Common), Caurobert Street (Bethnal Green), Beaumont Street (Marylebone), The Grove (Blackheath), Grove Hill Road (Camberwell), Park Hill Road (Hampstead), Welbeck Street, St. George's Road (Lambeth), and on the way to Charing Cross Hospital. 144 Table III. Cases of Infectious Disease Notified during, the Year 1907. 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. Total Cases Removed to Hospital At all Ages At Ages—Years. Lee. Lewisham. Sydenham and Forest Hill. Lee. Lewisham. Sydenham and Forest Hill. Under 1 1 to 5. 5 to 15 15 to 25 25 to 65 65 and upwards Small-Pox – – – – – – – – – – – – – – Cholera – – – – – – – – – – – – – – Diphtheria including Membranous croup 287 1 72 173 22 19 — 13 163 111 6 137 84 227 Erysipelas 86 — 1 8 14 57 6 9 49 28 1 12 6 19 Scarlet fever 584 4 145 340 65 30 — 60 401 123 48 334 101 483 Typhus fever — — — — — — — — — — — — — — Enteric fever 27 — — 4 10 13 — 5 15 7 2 8 5 15 Relapsing fever — — — — — — — — — — — — — — Continued fever — — — — — — — — — — — — — — Puerperal fever 7 — — — 1 6 — — 4 3 — 2 1 3 Plague — — — — — — — — — — — — — — Totals 991 5 218 525 112 125 6 87 632 272 57 493 197 747 145 Table IV. Causes of, and Ages at, Death during Year 1907. Causes or Death. Deaths in ok 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 i year. i 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 17 2 11 4 — — — — 15 2 4 Scarlet fever 12 6 5 1 2 8 2 72 Whooping-cough 50 18 30 2 — — 4 23 23 7 Diphtheria and membranous croup 17 10 7 — — — — — 13 4 42 Croup 1 1 — — — — — — — 1 — Fever Typhus — — — — — — — — — — — Enteric 1 — — . 1 — — — 1 — 3 Other continued — — — — — — — — — — — Epidemic influenza 16 — — — — 10 6 3 9 4 2 Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Diarrhoea (all forms) 42 41 — — — 1 — — 31 11 5 Enteritis (Gastro-Enteritis, &c.) 12 2 — — 5 5 _ 10 2 3 Puerperal fever 4 — — — — 4 — — 3 1 1 Erysipelas 7 — 1 — — 5 1 — 4 3 4 Other septic diseases 11 2 1 2 1 4 1 2 7 2 4 Phthisis (Pulmonary Tuberculosis) 138 2 2 4 20 104 6 15 79 44 38 Other tubercular diseases 56 7 25 12 2 8 2 7 36 13 20 Cancer, malignant disease. 138 1 1 — 75 61 15 74 49 28 Bronchitis 140 17 8 — 1 23 91 20 68 52 67 Pneumonia 113 30 21 2 1 31 28 13 65 35 27 Pleurisy 8 — — — 1 4 3 — 7 1 Other diseases of Respiratory organs 14 2 3 1 1 5 2 4 7 3 1 Alcoholism Cirrhosis of liver 21 — — — — 16 5 2 10 9 7 Venereal diseases 2 — — — — 1 1 — 2 — 3 Premature birth 68 68 — — — — — 7 40 21 7 Diseases and accidents of parturition. 5 — — — — 5 1 3 1 1 Heart diseases 268 11 1 3 10 118 125 43 145 80 86 Accidents 48 11 6 2 4 14 11 2 36 10 20 Suicides 14 — — — 2 12 — 2 8 4 — All other causes 526 103 21 22 20 132 228 72 291 163 208 All causes 1749 325 146 60 65 577 576 214 995 540 660 146 Table Y. INFANTILE MORTALITY DURING THE YEAR 1907. Deaths from stated Causes in Wezhs and Months under One Year of Age. Cause of Death. Under i Week. i-2 Weeks. 1-3 Weeks. 3-4 Weeks. Total under i Month. i 2 Months. 2-3 Months. j-4 Months. j-5 Months. 5-6 Months. [6-7 Months. 7-8 Months. 8-9 Months. g-io Months. ro-ii Months. ti-i2 Months. Total Deaths under One Year. All Cause Certified 73 27 17 10 127 41 22 29 19 14 18 13 12 15 8 7 325 Uncertified — — — — — — — — — — — — — — — — Common I Infectious Diseases Small-pox — — — — — — — — — — — — — — — — — Chicken-pox — — — — — — — — — — — — — — — — — Measles — — 1 — 1 — — — — — 1 — — — — — 2 Scarlet Fever — — — — — — — — — — — — — — — — — Diphtheria: Memb. Croup — — — — — — — — — — — — — — — — — Whooping Cougrh — — — — 1 3 2 2 8 1 2 2 — 1 1 18 Diarrhœal Diseases Diarrhoea, all forms — — — — — 1 2 3 2 — 4 1 3 2 1 2 21 Enteritis Muco-enteritis Gastro-enteritis — — 1 1 2 3 1 2 — 2 — 1 — 2 — 1 14 Gastritis, Gastrointestinal Catarrh — 1 1 — 2 1 — — — — 1 — — 1 1 — 6 Wasting Diseases Premature Birth 39 19 5 6 62 6 — — — — — — — — — — 68 Congenital Defects 13 1 1 — 15 3 — 2 1 — — — — — — — 21 Injury at Birth 3 — — — 3 — — — — — — — — — — — 3 Want of Breast-milk — — — — — — — — — — — — — — — — — Atrophy, Debility, Marasmus 7 4 5 1 17 14 7 10 8 2 4 2 3 2 1 — 70 Tuberculous Diseases Tuberculous Meningitis — 1 — — 1 — — — — 1 — — — — — — 2 Tuberculous Peritonitis: Tabes Mesenterica — — — — — 1 — — — 1 — — — — — — 2 Other Tuberculous Diseases — — — — — 2 1 — — 1 — — 1 — — 5 Other Causes /Erysipelas — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — 1 1 — 2 1 1 — — — 6 Convulsions 3 1 2 1 7 2 1 2 1 — — — — 1 — — 14 Bronchitis 1 1 — 1 3 5 — 1 — 1 2 3 — — 2 — 17 Laryngitis — — — — — — — — — — — — — — — Pneumonia — 1 — — 1 2 4 3 1 3 2 2 3 4 2 3 30 Suffocation, overlaying 3 2 1 — 6 1 2 — — — — — — — — — 9 lOther Causes 4 3 — — 7 1 — 2 3 1 — 1 — 2 — — 17 73 27 17 10 127 41 22 29 19 14 18 13 12 15 8 7 325 * Including 3eatTI^romnalnutrition, Inanition and Asthenia. Population (estimated to middle of 1907), 152,532. Births in the year—legitimate, 3,530; illegitimate, 92. Deaths from all causes at all ages, 1,749. Deaths under one year—legitimate 317, illegitimate 8. 147 II.—COPY OF LEAFLET ON MEASLES. important. Borough of Lewisham. PUBLIC HEALTH DEPARTMENT. MEASLES. Cake Notice, that in consequence of an outbreak of Measles affecting children in the Borough, it is desirable that the contents of this circular should receive the serious attention of all parents and guardians with a view of preventing the spread of the infection. Symptoms.—The disease generally begins with severe cold in the head, marked heat of the body, and coated tongue, followed by swelling of the eyelids and a watery appearance of the eyes. On the fourth day after the onset a rash appears on the forehead and face of the patient, quickly extending to the rest of the body, in the form of slightly raised spots of a dull red colour. All discharges from the eyes, mouth and nose are infectious from the first. Directly a child is found to be suffering from the disease he (or she) should be put to bed and nursed in a warm room for at least a fortnight, and all other occupants of the house, especially children, excluded from the room. Measles among young children is a dangerous infectious disease and must NOT be treated lightly. The greatest care must be taken to avoid exposure to cold, or the consequences may be fatal. Medical advice should be obtained in all cases. Remember that more young children die from measles and the diseases resulting therefrom, than from Scarlet Fever and Diphtheria together. To prevent the spread of infection the room used by the patient should be thoroughly disinfected. This will be done free of charge by the Sanitary Authority, on receipt of a postcard addressed to the Medical Officer of Health, at the Town Hall, Catford, at the termination of the case. All the clothing and bedding should be placed in a solution of disinfectant (which can be obtained gratuitously at the Town Hall Yard) and afterwards boiled. All children suffering from Measles must be kept from school for at least one month from the onset of the disease. Other school children in the house, who are not suffering from the disease, must be treated as follows :— Infant Scholars.—All children attending the Infants' Department must be kept from school until the Monday following 14 days from the occurrence of the last case. Senior Scholars.—Children attending the Senior Departments of the school, if they have had the disease, need not be kept from school. If, however, they have not had the disease, they must be kept from school until the Monday following 14 days from the occurrence of the first case. A. WELLESLEY HARRIS, Town Hall, Catford. Medical Officer of Health