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 1909, BY A. WELLESLEY HARRIS, M.R.C.S., &c., Medical Officer of Health and Public Analyst for the Borough of Lewisham ; Fellow and Member of the Council of the Royal Sanitary Institute ; Fellow of the 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. LEW 6 3 BOROUGH OF LEWISHAM. EPITOME OF VITAL STATISTICS, 1909. Area in acres, exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1909 160,749 Average number of persons per house (Census, 1901) 5.6 Total number of Births registered in the Borough 3,507 Birth Rate per 1,000 estimated population 21.9 Total number of Deaths registered in the Borough 1,707 Total number of Deaths of residents of the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,664 Deaths of persons under 1 year of age 262 Infantile Death Rate per 1,000 Births registered 75 Total number of Deaths in Public Institutions in the Borough 570 Deaths of non-residents in the Borough 174 Deaths of residents outside the Borough 131 Corrected Death Rate per 1,000 of the estimated population 10.4 4 CONTENTS. Page Bacterioscopic Examinations 62 Births, illegitimate 18 Birth Rates 17 Butter 88 „ milk blended 88 Chicken-Pox 59 Cholera contacts 63 Combined drains 70 Coroner's Court and Mortuary 70 Deaths in disease groups 56 ,, infant 29 ,, of residents in other boroughs 43 Death rates 20 & 35 ,, ,, zymotic 23 Diphtheria, deaths 26 ,, notifications 55 Disinfection 71 Enteric fever, deaths 26 ,, notifications 56 Factory and Workshop inspections 74 Home Work 75 House-to-house inspections 68 Houses unfit for human habitation 69 Page Infectious diseases, age periods 52 ,, ,, attack rates 54 ,, ,, notifiable... 51 Inspections, routine 81 & 83 Legal proceedings 71 Marriages 20 Measles, deaths 26 „ notifications 59 Milk 87 .. dyed 87 ,, on delivery 88 Phthisis, deaths 27 new regulations 60 ,, voluntary notifications 59 Population 15 Puerperal fever 56 Samples analysed 87 Scarlet fever, deaths 26 notifications 55 School closure 58 Small-Pox contacts 63 Smoke nuisances 70 Synopsis of tables 9 Unsound Food 71 Whooping Cough 26 & 59 Women sanitary inspectors 79 Workshops and workplaces 73 & 77 5 To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Lewisham Gentlemen, I have the honour to submit my Annual Report on the Vital Statistics and Sanitary Condition of the Borough for the year 1909, as required by an Order of the Local Government Board. The Borough continues to maintain its reputation as one of the most healthy districts in England. The death rate for the year equalled 10.4 per thousand of the population living at all ages—the lowest in London, with the exception of Hampstead—and the lowest rate recorded in Lewisham in any year for which statistics are available. With regard to the Infant Mortality, it is satisfactory to report that the mortality rate of 75 per thousand registered births is the lowest in London and also the lowest on record in this Borough. It is hoped that the efforts of your Public Health Committee to educate parents in the matter of properly nursing and rearing their children may be bearing good fruit. It is unfortunate that they have been somewhat handicapped by the necessary withdrawal (in consequence of the decision of the Local Government Board Auditor) of a pamphlet of instructions, which had been much appreciated. 6 The following epitome shows interesting comparisons with previous years and the average for seven years:— Borough of Lewisham. Year. Average for seven years. 1902-8. Year. 1902 1903 1904 1905 1906 1907 1908 1909 Birth Rate 26.3 26.1 25.6 25.2 23.2 237 22 8 24.7 21.9 Total Death Rate 13.7 11.1 12.0 11.7 12.0 11.5 11. 0 11.9 10.4 Infant Mortality Rate 122 92 122 93 113 90 87 1.03 75 Zymotic Death Rate 1.70 0.82 1.40 0.83 1.81 0.71 1.14 1.13 0.47 Phthisis Death Rate 1.06 0.78 0.84 0.87 0.80 0.90 0.85 0.87 0.78 Notifiable *Infectious Diseases: Attack Rate 9.68 6.09 3.93 5.88 6.08 6.45 7 .41 6.50 8.64 *Not including Puerperal Fever. On reviewing the recorded incidence of Infectious Disease, it will be found that 1,442 cases were notified during the year, compared with 1,220 in 1908. The increase was mainly due to the prevalence of Scarlet Fever, of which disease 903 cases were notified during the year, compared with 600 in 1908. On the other hand, it is satisfactory to note that Diphtheria was less prevalent, 361 cases being recorded, against 458 in 1908. In order to control the outbreak of Scarlet Fever, your Medical Officer of Health made frequent visits to the various schools in the Borough, and an examination of the scholars often lead to the exclusion and subsequent examination in their homes of suspected children. In this way many cases of Scarlet Fever, which otherwise would probably have been missed, were detected and isolated. In this work I received considerable help and valuable assistance from Miss Jones and Miss Stevens, your women Sanitary Inspectors, and also from 7 the school teachers. Cases occur daily which emphasise more and more the necessity for the control and examination of school children (as far as infectious disease is concerned) being in the hands of the local sanitary authority. By notifications from the head teachers of schools we received information of 383 cases of Measles, compared with 1,174 in 1908, and these figures may be considered very favourable. Measles, at times, proves exceedingly disastrous to young lives, and no opportunity is lost, when signs of increased prevalence are noted, of excluding from school all children under the age of five. The compulsory notification of all Poor Law Cases of Phthisis was established under the provisions of the Public Health (Tuberculosis) Regulations, 1908, and beneficial results may be expected from the same. Towards the end of the year the Notification of Births Act, 1907, was declared to be in operation within the Borough, and our opportunities of good work in relation to infants will be increased by the powers conferred by the Act, more particularly in the poorer parts of the Borough. I recommend for the consideration of your Council the question of appointing women health visitors to carry out the work which devolves upon the department under the Act. In addition to other work your women Inspectors have devoted much time to the inspection of workrooms, workplaces, and laundries in the Borough. During recent years the conditions under which women work have been much improved. Special legislative power is much needed to prevent the use of underground rooms as workrooms or workplaces. With regard to schools, it is a curious anomaly that while the children of the poorer sections of the community are well 8 housed in modern sanitary school buildings, planned and furnished to meet modern scientific requirements, thousands of children are permitted to attend schools which are under no sort of control, and without any guarantee of the fitness of the premises for the purpose they serve. Frequently one finds small private houses used as schools, in which it is impossible to obtain efficient lighting and ventilation, both of which are so essential to the health of the scholars. There is, I feel confident, urgent need for the registration of all premises used as private boarding or day schools, in order that the use of suitable premises may be ensured, and that periodical medical inspection may take place, in order to secure the best hygienic conditions and the healthy environment of the scholars. At the present time the conditions existing in many such schools must undoubtedly have a disastrous effect upon the young growing child. In conclusion I desire to express my appreciation of the able and valuable assistance I have received from all members of the staff of the department. I am, Gentlemen, Your obedient Servant, Medical Officer of Health and Public Analyst. May, 1910. 9 SYNOPSIS OF TABLES AND CHARTS. Part I.—Vital Statistics Table 1.—Population of the Borough in Wards obtained at the Census, April, 1901. Also the estimated population for the years 1905-9. Table 2.—Births and Birth Rates for each Division of the Borough for the years 1902-9. Table 3.—Number of Deaths at various Age Periods and their Percentage to corrected Total Deaths during the years 1902-9. Table 4.—Corrected Death Totals and Death Rates for the years 1902-9. Table 5.—Percentage of Deaths Under One Year of Age to Total Deaths in Wards and Divisions for the years 1902-9. Table 6.—Analysis of Deaths Under One Year of Age during the years 1903-9. Table 7.—Distribution in Wards of Deaths under One Year, in different disease groups during 1909. Table 8.—Corrected Total Deaths, male and female, from All Causes in Wards occurring during the four quarters of the year 1909. Table 9.—Corrected Death Rates from all Causes in Wards, Divisions and the Whole Borough for the four quarters of the year 1909. Table 10.—Deaths in Disease Groups in the three Divisions and the Whole Borough for the year 1909. Table 11.—Death Rates in Disease Groups in the Wards and Divisions of the Borough for the year 1909. 10 Table 12.—Birth and Death Rates of London and Metropolitan Boroughs during the year 1909, after distribution of deaths in Public Institutions. Table 13.—Death Rates in London and the several Metropolitan Boroughs from All Causes and from Certain Diseases during the year 1909, before distribution and after distribution of deaths in Public Institutions. Table 14.—Causes of, and Ages at, Death in the Borough for the year 1909. 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 1909. Table 17.—Death Rates from Principal Zymotic Diseases and Phthisis, and Infantile Mortality, in the Borough, in the County of London, and in the 76 Great Towns, for the year 1909. Table 18.—Deaths from Principal Zymotic Diseases arranged in Age Groups for the year 1909. Table 19.—Meteorological Table for London for the year 1909. Part II.— Infectious Diseases. Table 20.—Showing Cases of Scarlet Fever and Diphtheria at various Age Periods notified during the year 1909. Table 21.—Number of Cases of Infectious Diseases notified in the ten Wards during the year 1909. Table 22.—Attack Rates from the Principal Infectious Diseases per 1,000 of the population for the Ten Wards and the Whole Borough for the years 1903-9. Table 23.—Attack Rates at All Ages from Small-Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the years 1903-9. 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 1909. Part IV.—Report of Public Analyst. Table A.—Showing Number of Samples submitted for Analysis, with Results, for the year ended December 31st, 1909. Table B.—Summary of Samples Analysed in the Borough in each of the years 1898 to 1909. Table C.—Showing Results of Total Samples submitted during the years 1905-9. Table D.—Showing Results of Total Samples of Milk submitted during the years 1905-9. Table E.—Average Composition of Milk Samples submitted in 1909. Table F.—Average Composition of Milk Samples submitted during the years 1902-9. Table G.—Details of Adulterated Samples of Milk for the year ended December 31st, 1909. Table H.—Showing the Number of Samples of Butter submitted in the four quarters of the years 1905-9. Table J.—Details of Other Adulterated Samples and other Prosecutions during the year 1909. 12 Appendices. I.—Local Government Board Tables Table I.—Vital Statistics of Whole District during the years 1901-9. Table II.—Vital Statistics of Separate Localities in the years 1901-9. Table III.—Cases of Infectious Disease notified during the year 1909. Table IV.—Causes of, and Ages at, Death during the year 1909. Table V.—Detailed analysis of Deaths under one year of age during the year 1909. Charts. Chart A.—Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ended January 1st, 1910. Chart B.—Showing Percentage of Deaths in Eleven Groups to Total Deaths during 1909. Chart C.—Showing Weekly Notifications of All Infectious Diseases, also Weekly Notifications of Scarlet Fever, and Diphtheria, during the year 1909. PART 1. VITAL STATISTICS. report OF THE Medical Officer of Health FOR THE YEAR 1909. YITAL STATISTICS. Population—The estimated population for the year 1909 amounted to 160,749, the figure adopted by the RegistrarGeneral. This population is 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, 1891-1901. The population thus obtained, 160,749, compared with 156,627 for 1908, shows an increase in one year of 4,122 persons. The increase in the population by natural increment, i.e., the excess of births over deaths, amounted to 1,800. It may be assumed, therefore, that the difference of 2,322 between the total estimated increase and that shown by the natural increment is due to immigration into the district. In order to make the statistical returns in this report comparable with other districts and with the Returns of the Registrar-General, a period of 52 weeks ended January 1st, 1910, has been taken. All mortality statistics contained in the report are based upon the figures recorded during this period. The various rates are per 1,000 persons estimated to be living in either Ward, Division or whole Borough, except where otherwise stated. The death rates calculated for the wards Brockley, Catford and Forest Hill, are, in all probability, somewhat 16 higher than they should really be. When the next census is taken it will probably be found that the population of these Wards has increased more in proportion than during the last intercensal period, owing to the very large building operations which have taken place during recent years. Table 1. Showing the Population of the Borough, in Wards, obtained at the Census, April, 1901; also the Estimated Population for the years 1905-1909. Ward. Enumerated Population Census, April 1st, 1901. Population Estimated to June 30th, 1905. Population Estimated to June 30th, 1906. Population Estimated to June 30th, 1907. Population Estimated to June 30th, 1908. Population Estimated to June 30th, 1909. Church 6412 6790 6880 6971 7062 7154 Manor 6734 7207 7320 7433 7548 7663 South 5503 5597 5620 5643 5666 5689 Lee Division 18649 19594 19820 20047 20276 20506 Blackheath 6729 6830 6855 6880 6904 6928 Lewisham Village 13842 14622 14808 14995 15183 15373 Lewisham Park 11145 15417 16437 17464 18497 19538 Brockley 10952 11510 11643 11777 11913 12049 Catford 23203 30524 32273 34033 35805 37588 Lewisham Div. 65871 78903 82016 85149 88302 91476 Forest Hill 18051 18270 18322 18374 18427 18480 Sydenham 24924 27653 28305 28962 29622 30287 Sydenham & Forest Hill Div. 42975 45923 46627 47336 48049 48767 Whole Borough 127495 144420 148463 152532 156627 160749 17 BIRTH RATES. The total number of Births registered in the Borough of Lewisham during the year 1909 was 3,507. Of this total 1,802 were males and 1,705 females. The birth rate for Lewisham is therefore 21.9 per 1,000 inhabitants, compared with 22.8 in the previous year, and 24.7 the average for the past seven years. The birth rate for London was 24.2 per 1,000, or l.4 per 1,000 in excess of this Borough. Of the total births, 472 were registered in the Lee division, 1,930 in Lewisham division, and 1,105 in Sydenham and Forest Hill division. Declining Birth Rate.—A decline in the birth rate still continues, the rates for the year under review for England and Wales (25.6), 76 Great Towns (25.7) and London (24.2), being the lowest on record. It will be observed also that the birth rate for Lewisham 21.9 is the lowest rate recorded in Lewisham, and 2.8 below the average rate for the past seven years. The wide range in the birth rates of the various districts is shown by the following extreme rates recorded amongst the 76 Great Towns:— Hastings 15.1, Hornsey 15.3, Halifax 16.5, Bournemouth 16.7, Bradford 18.8, and Northampton 20.1 ; St. Helens 32.1, Coventry 82.5, Swansea 33.0, Tynemouth 33.5, Merthyr Tydfil 35.7, and Rhondda 41.2. Births.—In the annual summary of the Registrar-General Lewisham is credited with 3526 births, showing a difference of 22 with those actually registered in this Borough. This is accounted for by the information received by the Registrar-General from the various maternity institutions outside this Borough of births occurring therein to Lewisham mothers. 18 In London the lowest rates were recorded in City of London 13.6, Hampstead 14.1, City of Westminster 16.2, Holborn 18.2, Kensington 18.4, and Chelsea 18.5; on the other hand the highest were in Shoreditch 31.7, Behnal Green 31.6, Stepney 30.5, Poplar 30.3, Bermondsey 32.3, and Finsbury 29.6. Illegitimacy—During the year 1909, 4,044 infants were registered in London as having been born out of wedlock. This figure gives a proportion of 35 per 1,000 total births, whilst the average proportion in the preceding ten years was 34. In Lewisham of the 3,507 registered births, 107 or 30.5 per 1,000 births were recorded as being illegitimate, compared with 25.4, 23.8, 33.3, and 25.1 per 1,000 in the four previous years. On reviewing the returns of illegitimate births in this Borough it is found that 60.7 percent. of these children were born to domestic servants. 19 Table 2. Births and Birth Rates for each Division of the Borough for the years 1902-1909. Division. 1902. 1903. I904. 1905. I906. 1907. 1908. 1909. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Lee 481 25.4 486 25.4 469 24.2 454 23.2 445 22.5 446 22.2 473 23.0 472 23.09 Lewisham 1857 26.6 1979 27.2 1967 25.9 2027 25.7 1871 22.8 2063 24.2 2058 22.9 1930 21.16 Sydm. & ForestHill 1153 26.3 1098 24.7 1153 25.5 1152 25.1 1130 24.2 1113 23.5 1101 22.6 1105 22.73 Whole Borough 3491 26.3 3563 26.1 3589 25.6 3633 25.2 3446 23.2 3622 23.7 3632 22.8 3507 21.88 County of London 130478 28.5 130906 28.4 129335 27.9 126620 27.1 124880 26.5 121408 25.6 122898 25.2 116559 24.2 20 MARRIAGE RATE. The number of Marriages registered in the Borough during the year amounted to 966, compared with 992 in 1908. The Marriage Rate was 12.0, a decrease of 0.7 per 1,000 on the rate for 1908, while the Marriage Rate for the whole of London was equal to 15.8, and for England and Wales 14.6 per 1,000. Of the 966 marriages which occurred in Lewisham, 114 took place at the Nonconformist Chapels, 587 at the Established Churches, and 265 at the Register Office. MORTALITY. The total number of Deaths registered in the Borough amounted to 1,707, compared with 1,858 for the year 1908. After deducting the deaths of non-residents (174) dying within the Borough, and adding those of residents (l31) who died outside the district, a corrected total of 1,664 is obtained, compared with 1,757 in 1908. The corrected total deaths in Lewisham, 1,664, is equivalent to a Death Rate of 10.4 per 1,000 living at all ages, and compares most favourably with the death rate for England and Wales of 14.5 per 1,000 of the population. The death rate for the County of London was 14.0, whilst the rate for the 76 Great Towns equalled 14.7 per 1,000. Compared with other Metropolitan Boroughs, Lewisham again has the second lowest death rate in London. Hampstead is the lowest with 8.9, followed by Lewisham 104, Stoke Newington ll.3, Wandsworth 11.9, Woolwich 11.9, and Fulham 12.0 per 1,000 of the population living at all ages. 21 The districts having the highest death rates in London were City of London 20.8, Finsbury 19.2, Shoreditch 19.0, Bermondsey 18.8, Southwark 16.8, and Bethnal Green 16.8. (See Table 12). The death rate for Lewisham, 10.4 per 1,000 for the year 1909, shows a decrease of 0'6 over the previous year, and it is satisfactory to note this is again the lowest rate recorded during any period for which statistics are available. On sub-dividing the corrected deaths into the three divisions of the Borough, it will be noted that the mortality rate (i.e., the number of deaths per 1,000 persons estimated to be living in each Division referred to), was lowest in the Lewisham Division, 10.1, and highest in the Lee Division, ll.3 the Sydenham and Forest Hill Division being 10.9. (See Table 9). Carrying the sub-division a step further, the death rates from all causes in the individual Wards show Church to have suffered the highest mortality (13.5); on the other hand Catford claims the lowest mortality for the year with 9.2 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 8. It is satisfactory to note that there is a gradual decrease in the percentage of deaths under one year to total deaths at all ages, with a corresponding increase in the percentage of deaths of people over 65 to total deaths. The relation of age periods to mortality from zymotic diseases is set out in Table 18. Of the 75 deaths from these diseases, 74.7 percent. occurred among children under five years of age. The distribution of zymotic deaths in ward localities appears in Table 16. 22 ANALYSIS OF DEATHS. Table 3. Number of Deaths at Various Age Periods and their Percentage to Corrected Total Deaths during the years 1902-1909 Age Period. 1902 1903 1904 1905 1906 1907 1908 1909 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. 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 18.58 315 17.93 2.62 15.75 Over 1 & under 5 yrs. 200 11.00 142 9.39 140 8.34 130 7.69 160 9.00 146 8.35 163 9.28 102 6.13 „ 5 „ 15 „ 86 4.73 61 4.03 39 2.32 59 3.49 57 3.21 60 3.43 64 3.64 65 3.91 „ 15 „ 25 ,, 86 4.73 76 5.02 85 5.06 63 3.72 68 3.83 65 3.72 61 3.47 54 3.25 „ 25 „ 65 „ 547 30.09 478 31.59 470 27.99 547 32.35 596 33.54 577 32.99 593 33.75 562 33.77 Over 65 years 471 25.91 428 28.29 505 30.08 554 32.76 505 28.42 576 32.93 561 31.93 619 37.20 Total 1818 100.0 1513 100.0 1679 100.0 1691 100.0 1777 100.0 1749 100.0 1757 100.0 1664 100.0 CHART A. Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 Weeks ended January 1st, 1910. 23 Seasonal Mortality.—The highest mortality occurred during the first and last quarters of the year, the death-rates from all causes being 13.2 and 10.7 per 1,000 respectively. The lowest death-rate was 8'2 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 gives the total deaths in 12 classes registered in each quarter, from which it will be seen that deaths from diseases of the respiratory organs and infective diseases were the highest during the first quarter of the year. 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 47 per 1,000 persons, compared with 1.14 for the previous year, or a decrease of 0.67 per 1,000. This improvement has been general, and is the consequence of fewer fatalities in all the common infectious diseases with the exception of Scarlet Fever, as shown in Table 18. The Lewisham zymotic death rate, 0.47, compares favourably with the rates 1.31 for the County of London, 1.42 for the 76 Great Towns, and 1.12 for England and Wales during the same period, and is considerably below the average for Lewisham (1.13) for the past seven years. 24 Of the total 75 deaths in Lewisham from the principal infectious diseases, Measles accounted for 7, Scarlet Fever 16, Whooping Cough 20, Diphtheria 21, Enteric Fever 2, Epidemic Diarrhoea 5, and Epidemic Enteritis 4. (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. 25 Table 4. Corrected Death Totals and Death Bates for the years 1902-1909. Locality. 1902. 1903. 1904. 1903. 1906. 1907. 1908. 1909 Total Number of Deaths. Death rate per 1,000 of the population Total N umber 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. Total Number of Deaths. Death rateper 1,000 of the population. Total Number of Deaths. Death rate per 1,000 of the population. Lee Division 220 11.6 213 11.1 193 10.0 186 9.5 211 10.6 214 10.7 211 10.2 232 11.3 Lewisham Division 991 14.2 816 11.2 941 12.4 966 12.2 1000 12.2 995 11.7 1005 11.2 903 10.1 Sydm. & Forest Hill Division 607 13.8 484 10.9 545 12.1 539 11.7 566 12.1 540 11.4 541 11.1 529 10.9 Whole Borough 1818 13.7 1513 11.1 1679 12.0 1691 11.7 1777 11.97 1749 11.5 1757 11.0 1664 10.4 County of London 80105 17.2 69737 15.2 74556 16.1 70442 15.1 71155 11.5 69268 14.6 67353 13.8 67632 14.0 26 ANALYSIS OF DEATHS AT ALL AGES IN RELATION TO DISEASE GROUPS. CLASS I.—Infective Diseases (99) Small-Pox.—No deaths occurred from this disease. Measles.—Measles was recorded as the cause of 7 deaths, equal to a death rate of 0.04 per 1,000 of the population, compared with 0.29 in 1908. It is not a notifiable disease, consequently the case mortality cannot be obtained, but school notifications show that the disease was much less prevalent last year, than in 1908 (see page 59). Scarlet Fever.—Sixteen deaths were notified in the Borough, equal to a mortality rate of 0.10 per 1,000 of the population, compared with 0.07 in 1908. The actual number of cases notified amounted to 903, compared with 600 in 1908. 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 903 recorded cases l.77 per cent, proved fatal, compared with 1.83 per cent. in 1908. Diphtheria.—There were 21 deaths from Diphtheria, giving a mortality rat3 for the Borough of 0.13 per 1,000 of the population, compared with 0.28 in 1908. The number of notifications amounted to 361, compared with 458 during 1908. The case mortality was 5.82 per cent. of the actual cases, compared with 9.61 per cent. in 1908, showing that not only was this disease less prevalent but its variety less severe. Whooping Cough.—Twenty deaths were attributed to Whooping Cough during 1909, compared with 30 in 1908. All the 20 deaths were of children under five years of age. Enteric Fever.—There were only two fatal cases, equal to a death rate of 0.01 per 1,000. The case mortality was equal to 12.5 per cent. of the persons affected, compared with 12.9 per cent. for the preceding year. 27 Epidemic Diarrhœa and Epidemic Enteritis.—The total deaths recorded in the year from these two diseases amounted to 9 (compared with 48, 10 and 111 in 1908, 1907 and 1906, respectively), equivalent to a death rate of 0.06 per 1,000, compared with 0.27, 0.07 and 0.75 in 1908, 1907 and 1906, respectively, (See Tables 14 and 16). Deaths from other Infective Diseases were:—Influenza, 4; Puerperal Fever, 2; Erysipelas, 2; Venereal Disease, 2; Septicoemia not Puerperal, 8; Pyaemia, 2; and Other Septic Diseases, 4. GLASS II.—Tuberculous Diseases (161). Phthisis. —This disease was responsible for 125 deaths, or 7.5 per cent. of the total 1,664 deaths from all causes. This mortality is equal to a death rate of 0.78 per 1,000 (compared with 0.85 in 1908) for the whole Borough, the lowest rate on record for Lewisham, and the lowest rate of the Ten Southern Metropolitan Boroughs. Of the remaining London sanitary districts, only Hampstead, with 0.61, is lower. The district having the highest mortality from this cause was Finsbury, with 2.22 per 1,000. The death rate for the County of London was 1.81. The position of Lewisham, therefore, in comparison with other Boroughs, is most satisfactory. In addition to Phthisis, 36 deaths were registered as due to various forms of tubercular disease. (See Table 14). CLASS III. Malignant Diseases (151). Cancer was the stated cause of 121 deaths (compared with 110 in 1908) equal to a mortality rate of 0.69 per 1,000. On sub-dividing these deaths, 23 were registered in Lee, 58 in Lewisham, and 40 in Sydenham and Forest Hill. For other diseases of this Class see Table 14. 28 CLASS IY.—Neryous Diseases (110). — This class was responsible for 110 deaths,equal to 6.6 per cent. of the total deaths. Of this number 27 were cases of insanity, 11 meningitis, and 12 convulsions; of the latter 7 were children under 1 year. CLASS Y.—Diseases of Heart and Circulation (286). Diseases of Heart and Blood Vessels accounted for 286 deaths, equal to 17.2 per cent. of the total deaths. Sixty-one deaths were due to valvular heart disease and endocarditis, and 76 to cerebral hajmorrhage. CLASS YI.—Respiratory Diseases (289).—This class was the cause of 289 deaths, equal to 17.4 per cent. of the total deaths from all causes. The highest number of deaths were registered during the twelfth week. (See Chart A). Bronchitis and pneumonia were the most fatal, particularly to children under 5 years of age. (See Table 14). CLASS YII.—Digestive Diseases (143).—To this class 143 deaths, or 8.6 per cent, of the total deaths, were assigned; children under 1 year were the sufferers in 81 cases. Cirrhosis of the Liver (frequently associated with alcoholism) was the certified cause of 11 deaths, compared with 19 in 1908. CLASS VIII.—Diseases of Urinary Organs (68).—Sixtyeight, or 4.1 per cent. of the total deaths were recorded in this class. CLASS IX.—Diseases of Generative Organs (6).—Only 6 deaths were registered in this group. CLASS X. General or Constitutional Diseases (290).— Of the 290, or 17.4 per cent. of the total deaths due to disease in this class, old age claimed 149 of the total, premature birth was the certified cause of 58, and alcoholism 4. CLASS XI.—Accidents (45).—Forty-five fatal accidents occurred, 6 of which were due to overlaying. 29 CLASS XII.—Violence, Suicides, &c. (16). — Sixteen residents of the Borough committed suicide. 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 79 post mortem examinations were made. Nine of these inquests were in respect to non-residents who had died in the Borough, representing 5 post mortems. On the other hand 11 inquests, with 9 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 the infant mortality rate throughout England and Wales was 109 per 1,000 births, which is the lowest on record, and 12 per 1,000 below the rate for 1908. The returns for the 76 Great Towns also show a considerable decrease, the rates being 118 in 1909, against 128 in 1908. The lowest infant mortality figures were registered in Hornsey 61, King's Norton 72, Hastings 79, Croydon 80, Barrow-in-Furrow 81, Leyton 82. The towns having the highest rates were Nottingham and St. Helen's 150, Hanley 155, Burnley 156, Middlesborough 158, Swansea 159, Wigan 173. In London the infant mortality rate amounted to 108 per 1,000 births, compared with 113 in 1908. The lowest rates in the Metropolis were recorded in Lewisham 75, Hampstead 75, Stoke Newington 80, Woolwich 82, and Wandsworth 86: the highest in Shoreditch 140, Bermondsey 138, Fins bury 131, Poplar 129, and Bethnal Green 129. 30 In the Borough of Lewisham the infant mortality rate amounted to 75 per 1,000 births, compared with 87 in the preceding year, and 103, the mean rate for the seven years 1902-8. This rate is the lowest in London and the lowest rate recorded in the history of Lewisham daring any period for which statistics are available. Causes of Death.—During the year 262 deaths occurred among children under one year, compared with 315 in 1908. Of these 262 deaths, 85 were recorded as due to conditions which must be considered unavoidable, namely, Premature Birth (58) Congenital Defects (20) and Injury at Birth (7). Again, 52 were registered under the headings of Atrophy, Debility, and Marasmus, diseases mainly due to errors of feeding. Bronchitis and Pneumonia were responsible for 35, Suffocation and Overlaying for six deaths, which in all probability could have been prevented. Diarrhœal diseases, which include all forms of diarrhœa, enteritis not tuberculous, gastritis, gastro-intestinal catarrh, gastro-enteritis and muco-enteritis, to a very great extent preventable diseases, were responsible for 32. Seven deaths were certified as Measles and 17 Whooping Cough, compared with 7 and 17 respectively in 1908. Scarlet Fever and Diptheria were each responsible for one death. Seven deaths were due to some form of tubercular disease (consumption), and 32 to diseases unclassified or ill-defined, such as convulsions. The Percentage of deaths under three months to total deaths under one year shews a slight improvement, the figures being as follows:— Year 1903 1904 1905 1906 1907 1908 1909 Rate 56% 50% 57% 51% 58% 57% 47% 31 Table 5. Percentage of Deaths under one year of age to Total Deaths in Wards and Divisions for the years 1902-1909. District. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Church Wd. per cent. 11.8 per cent. 11.8 per cent. 19.7 per cent. 12.7 per cent. 18.4 per cent. 14.3 per cent. 10.8 per cent. 8.3 Manor Ward 16.4 26.4 26.0 9.4 20.5 20.0 12.7 8.0 South Ward 20.8 14.8 13.3 11.8 17.3 5.6 12.1 11.6 Lee Division 15.9 17.4 20.7 11.3 19.0 14.5 11.8 9.1 Blackheath Ward 14.5 13.8 13.9 17.0 17.3 8.8 15.3 10.5 Lew. Village Ward 18.5 22.2 27.6 20.7 19.3 18.0 21.2 16.8 Lew.Pk. Wd. Brockley 25.1 20.8 31.5 20.5 21.9 20.0 19.6 21.7 Ward 26.2 20.0 27.2 15.7 22.7 20.8 17.2 14.2 Catford Wd. 34.6 32.7 81.8 26.0 24.9 19.8 20.3 21.8 Lew. Div. 26.9 24.9 28.2 21.5 22.0 18.7 19.5 18.8 Forest Hill Ward 21.7 13.4 18.6 17.5 20.0 19.1 17.7 10.7 Sydm. Ward 20.6 21.4 29.1 22.4 25.1 20.7 17.1 15.2 Sydm. & Forest Hill Division 21.0 18.2 24.8 20.2 23.1 20.0 17.4 13.4 Whole Borough 21.68 23.54 26.21 19.99 22.0 18.6 17.9 15.7 32 Table 6. Analysis of Deaths under one year of age, during the years 1903-1909. Disease. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Number of 1 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. Number of Deaths under 1 year. Percentage Deaths to total Deaths under 1 year. Number of Deaths under 1 year. Percentage Deaths to total Deaths under 1 year. Common Infectious Diseases 10 3.0 29 6.6 23 6.8 17 4.3 20 6.2 25 7.9 13 5.0 Diarrhœal Diseases 60 18.3 122 27.7 59 17.5 123 31.5 41 12.6 49 15.6 32 12.2 Wasting Diseases 124 37.8 151 34.3 139 41.1 147 37.6 162 49.8 140 44.4 137 52.3 Tuberculous Diseases 14 4.3 14 3.2 10 3.0 14 3.6 9 2.8 13 4.1 7 2.7 Respiratory Diseases 53 16.2 64 14.5 43 12.7 46 11.8 50 15.4 47 14.9 35 13.4 Diseases classified under other headings 67 20.4 60 13.6 64 18.9 44 11.3 43 13.2 41 13.0 38 14.5 Total 329 100.0 440 100.0 338 100.0 391 100.0 325 100.0 315 100.0 262 100.0 Note.—For detailed list oj these diseases see Table V. of the Local Government Hoard Tables (page 104). 83 Distribution in Wards.-The following table shows the distribution of infant deaths in the various wards of the Borough. The highest mortality rates were in the Lewisham Park, Lewisham Village arad Catford Wards:— Table 7. Ward. Common Infectious Diseases. Diarrhœa Diseases. Wasting Diseases. Tubercular Diseases. Respiratory Diseases. Other Diseases. Total Infant Deaths. Death rate per 1000 of the Population. Church 1 - 5 l - 1 8 1.1 Manor 1 - 4 — — 1 6 0.8 South — — 5 — 1 l 7 1.2 Blackheath — l - l 2 4 8 1.2 Lew. Village l 8 13 l 3 4 30 2.0 Lew. Park 3 3 21 l 8 4 40 2.1 Brockley 1 — 10 — 3 3 17 1.4 Catford 4 11 39 2 10 9 75 2.0 Forest Hill 1 1 16 — 3 2 23 1.2 Sydenham 1 8 24 1 5 9 48 1.6 Total 13 32 137 7 35 38 262 1.6 34 Table 8. Corrected total Deaths from All Causes in Wards occurring during the four quarters of the year 1909. Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total Churchward 14 23 37 6 17 23 9 9 18 4 14 18 33 63 96 Manor Ward 7 26 33 8 7 15 3 5 8 9 10 19 27 48 75 South Ward 7 9 16 8 5 13 8 4 12 13 7 20 36 25 61 Blackheath Ward 12 9 21 11 9 20 6 8 14 9 12 21 38 38 76 Lewisham Village Ward 29 36 65 18 23 41 19 17 36 18 19 37 84 95 179 Lewisham Park Ward 28 29 57 16 22 38 17 19 36 24 29 53 85 99 184 Brockley Ward 20 15 35 10 11 21 11 15 26 17 21 38 58 62 120 Catford Ward 53 51 104 37 53 90 37 30 67 43 40 83 170 174 344 Forest Hill Ward 34 28 62 22 26 48 20 27 47 30 27 57 106 108 214 Sydenham Ward 43 55 98 30 39 69 36 30 66 39 43 82 148 167 315 The Whole Borough 247 251 528 166 212 378 166 164 330 206 222 428 785 879 1664 35 Table 9 Corrected Death Bates from All Causes in Wards, Divisions, and the Whole Borough, for the four quarters of the Year 1909. Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter 1909. Church Ward 20.8 12.9 10.1 10.1 13.5 Manor Ward 17.3 7.9 4.2 9.9 9.8 South Ward 11.3 9.2 8.5 14.1 10.8 Lee Division 16.8 10.0 7.4 11.2 11.3 Blackheath Ward 12.2 11.6 8.1 12.2 11.0 Lew. Village Ward 17.0 10.7 9.4 9.7 11.7 Lew. Park Ward 11.7 7.8 7.4 10.9 9.4 Brockley Ward 11.7 7.0 8.7 12.7 10.0 Catford Ward 11.1 9.6 7.2 8.9 9.2 Lewisham Division 12.4 9.2 7.9 10.2 9.9 Forest Hill Ward 13.4 10.4 10.2 12.4 11.6 Sydenham Ward 13.0 9.1 8.7 10.9 10.4 Sydenham & Forest Hill Division 13.2 9.6 9.3 11.4 10.9 Whole Borough 13.2 8.8 8.2 10.7 10.4 County of London 19.0 12.8 10.8 13.5 14.0 76 Great Towns 18.7 13.9 11.8 14.3 14.7 England and Wales 18.2 14.0 11.6 14.1 14.5 36 Table 10. Deaths in Disease Groups in the Three Divisions and the whole Borough for the year 1909. Disease Classes. Lee Division. Lewisham Division. Sydenham and Forest Hill Division Whole Borough 1St Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1St Qr- 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1St Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year I. Infective 3 2 2 5 12 23 14 17 8 62 7 3 6 9 25 33 19 25 22 99 II. Tuberculous 6 7 4 2 19 25 28 16 25 94 12 20 6 10 48 43 55 26 37 161 III. Malignant 7 8 5 7 27 15 19 21 19 74 16 9 17 8 50 38 36 43 34 151 IV. Nervous 4 3 6 2 15 25 10 14 16 65 6 4 12 8 30 35 17 32 26 110 V. Heart & Blood Vessels 15 8 8 10 41 45 45 26 38 154 29 17 18 27 91 89 70 52 75 286 VI. Respiratory 21 8 2 10 41 64 23 20 41 154 42 20 10 22 94 127 57 32 73 289 VII. Digestive 3 3 2 4 12 19 20 2-2 20 81 14 9 .7 20 50 36 32 31 44 143 VIII. Urinary 4 3 3 2 12 11 6 7 9 33 7 4 6 6 23 22 13 16 17 68 IX. Generative Organs 1 — 1 — 2 — 1 — 2 3 - — — 1 1 1 1 1 3 6 X. General 20 7 5 12 44 48 32 27 42 149 22 28 26 21 97 90 67 58 75 290 XI. Accidents 1 2 — 2 5 5 4 7 9 25 4 2 3 6 15 10 8 10 17 45 XII. Violence 1 — — 1 2 2 2 2 3 9 1 1 2 1 5 4 3 4 5 16 Totals 86 51 38 57 232 282 210 179 232 903 160 117 113 139 529 528 378 330 428 1664 37 Table 11. Death Rates per 1,000 of the population, in Disease Groups, in the Wards and Divisions of the Borough for the year 1909. Disease Class Wards and Divisions. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Church Manor South Lee Blackheath Lewisham Village Lewisham Park Brockley Catford Lewisham Forest Hill Sydenham Sydenham and Forest Hiil Whole Borough I. Infective 0.7 0.5 0.5 0.6 0.3 0.7 1.0 0.6 0.6 0.7 0.2 0.7 0.5 0.6 II. Tuberculous 1.1 0.8 0.9 0.9 0.8 1.0 1.0 1.0 1.1 1.0 0.9 1.0 1.0 1.0 III. Malignant 1.0 1.4 1.6 1.3 1.0 0.9 0.7 1.3 0.6 0.8 1.0 1.0 1.0 0.9 IV. Nervous 1.0 0.5 0.7 0.7 1.0 0.9 0.3 1.1 0.7 0.7 0.8 0.5 0.6 0.7 V. Heart and Blood Vessels 2.7 1.6 1.8 2.0 2.5 2.3 1.5 1.6 1.5 1.7 2.2 1.7 1.9 1.8 VI. Respiratory 2.2 2.1 1.6 2.0 2.6 1.6 1.8 1.7 1.5 1.7 2.0 1.9 1.9 1.8 VII. Digestive 0.8 0.5 0.4 0.6 0.4 1.3 0.7 0.3 1.1 0.9 1.1 1.0 1.0 0.9 VIII. Urinary 0.7 0.7 0.4 0.6 0.3 0.5 0.3 0.3 0.3 0.4 0.6 0.4 0.5 0.4 IX. Generative Organs - - 0.4 0.1 - 0.1 0.1 — 0.0 0.0 — 0.0 0.0 0.0 X. General Diseases 2.8 1.4 2.3 2.2 1.6 2.0 2.0 1.7 1.3 1.6 2.2 1.9 2.0 1.8 XI. Accidents 0.4 0.1 0.2 0.2 0.3 0.3 0.2 0.2 0.3 0.3 0.8 0.8 0.3 0.3 XII. Violence - 0.1 0.2 0.1 0.1 0.1 0.1 0.2 0.1 0.1 0.2 0.1 0.1 0.1 Total Deaths 13.5 9.8 10.8 11.3 11.0 11.7 9.4 10.0 9.2 9.9 11.6 10.4 10.9 10.4 38 Table 12. Birth and Death Rates of London and Metropolitan Boroughs during the year 1909, after distribution of Deaths in Public Institutions. Boroughs Per 1000 Persons Living. Births. Deaths from Deaths under 1 year to 1000 Biiths All Causes Principal Epidemic Diseases Small-Pox Measles Scarlet Fever Diphtheria Whooping-Cough Typhus Enteric Fever Pyrcxia† (Origin uncertain) Diarrhœa Phthisis CntyopL'nd'n 24.2 14.0 1.31 0.00 0.48 0.08 0.13 0.26 - 0.03 0.00 0.33 1.31 108 West. Paddington 20.6 12.9 0.91 - 0.24 0.09 0.07 0.24 - 0.08 - 0.24 1.08 100 Kensington 18.4 13.3 1.00 - 0.32 0.05 0.10 0.22 - 0.04 — 0.27 0.96 113 Hammersmith 23.9 14.3 1.87 - 0.64 0.09 0.18 0.37 — 0.04 — 0.35 1.09 120 Fnlham 24.5 12.0 1.57 — 0.42 0.06 0.23 0.28 — 0.02 — 0.56 1.17 108 Chelsea 18.5 14.4 1.00 — 0.32 0.08 0.20 0.17 — 0.03 — 0.20 1.45 107 Cty of Wstmstr 16.2 13.1 0.63 0.01 0.15 0.11 0.11 0.11 — 0.04 — 0.10 1.34 95 North St. Marylebone 20.6 14.6 0.83 - 0.26 0.06 0.07 0.20 - 0.01 - 0.23 1.35 99 Hampstead 14.1 8.9 0.52 — 0.15 0.04 0.05 0.19 — 0.05 - 0.04 0.61 75 St. Pancras 23.7 14.8 0.97 — 0.44 0.07 0.11 0.13 — 0.03 — 0.19 1.61 102 Islington 23.8 14.0 1.22 — 0.57 0.07 0.09 0.25 — 0.04 - 0.20 1.23 101 Stoke Nwingtn 18.9 11.3 0.63 - 0.18 0.06 0.04 0.26 - 0.02 - 0.07 0.83 80 Hackney 22.9 12.6 0.93 — 0.24 0.04 0.08 0.22 — 0.03 - 0.32 1.22 102 Central Holborn 18.2 15.6 0.85 — 0.26 0.06 0.06 0.28 — 0.02 - 0.17 2.05 102 Finsbury 29.6 19.2 2.36 — 0.89 0.12 0.15 0.54 — 0.03 - 0.63 2.22 131 City of London 13.6 20.3 0.72 — 0.33 — — 0.22 — 0.06 - 0.11 2.15 113 East. Shoreditch 31.7 19.0 2.87 - 1.14 0.08 0.19 0.63 - 0.05 - 0.78 1.75 140 Bethnal Green 31.6 16.8 1.99 — 0.60 0.19 0.13 0.01 — 0.03 — 0.73 1.54 129 Stepney 30.5 15.3 1.68 0.00 0.76 0.08 0.16 0.22 — 0.02 — 0.44 1.67 119 Poplar 30.3 16.3 2.37 — 0.91 0.13 0.12 0.49 — 0.08 — 0.64 1.29 129 South. South wark 28.3 16.8 1.67 — 0.60 0.07 0.16 0.27 — 0.03 — 0.54 1.79 119 Bermondsey 32.3 18.8 2.74 — 1.57 0.12 0.07 0.43 — 0.02 — 0.53 1.78 138 Lambeth 23.4 14.1 1.19 — 0.32 0.08 0.18 0.26 — 0.03 0.00 0.32 1.41 109 Battersea 24.0 13.0 1.29 — 0.49 0.04 0.12 0.34 — 0.04 — 0.26 1.22 107 Wandsworth 23.6 11.9 0.96 — 0.37 0.05 0.09 0.23 - 0.02 0.00 0.20 0.93 86 Camberwell 23.7 13.4 1.08 — 0.37 0.06 0.15 0.18 — 0.02 — 0.30 1.19 100 Deptford 26.4 13.6 1.51 — 0.57 0.10 0.13 0.40 — 0.05 — 0.26 1.25 102 Greenwich 22.4 12.2 1.03 — 0.34 0.08 0.06 0.18 — 0.04 — 0.33 0.99 100 Lewisham 21.9 10.4 0.47 — 0.04 0.10 0.13 0.12 — 0.01 — 0.06 0.78 75 Woolwich 22.2 11.9 1.02 - 0.41 0.14 0.20 0.11 - 0.02 - 0.14 1.20 82 In this Table 0.00 indicates that the deaths were too few to give a rate of 0.005; where no death occurred, — is inserted.† Called Simple Continued Fever previous to 1901. 39 *Table 13. Death-rates during 1909 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 Distri bution After distribution Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distri bution County of London 14.2 14.0 0.07 0.08 0.13 0.13 0.03 0.03 1.29 1.31 West. Paddington 14.2 12.9 0.01 0.09 0.03 0.07 0.02 0.03 1.03 1.08 Kensington 15.1 13.3 — 0.05 0.01 0.10 0.03 0.04 1.65 0.96 Hammersmith 14.2 14.3 0.01 0.09 0.05 0.18 0.02 0.04 0.93 1.09 Fulham 11.0 12.0 0.27 0.06 0.56 0.23 0.09 0.02 1.03 1.17 Chelsea 21.8 14.4 0.01 0.08 0.09 0.20 0.01 0.03 2.69 1.45 City of Westm'r 14.3 13.1 — 0.11 0.04 0.11 0.04 0.04 0.75 1.34 North. St. Marylebone 14.0 14.6 0.02 0.06 0.02 0.07 0.02 0.01 0.79 1.35 Hampstead 11.3 8.9 0.37 0.04 0.39 0.05 0.05 0.05 1.47 0.61 St . Pancras 15.2 14.8 — 0.07 0.05 0.11 0.03 0.03 1.54 1.61 Islington 13.7 14.0 0.03 0.07 0.02 0.09 0.03 0.04 1.46 1.23 Stoke Newington 8.6 11.3 0.02 0.06 0.04 - 0.02 0.59 0.83 Hackney 13.0 12.6 0.11 0.04 0.23 0.08 0.04 0.03 1.30 1.22 Central. Holborn 19.9 15.6 - 0.06 0.11 0.06 0.04 0.02 1.47 2.05 Finsbury 9.2 19.2 - 0.12 0.15 0.01 0.03 0.74 2.22 City of London 50.7 20.3 — - 0.88 - 0.17 0.06 2.48 2.15 East. Shoreditch 17.7 19.0 - 0.08 0.02 0.19 0.04 0.05 1.74 1.75 Bethnal Green 17.1 16.8 0.01 0.19 0.05 0.13 0.03 0.03 1.63 1.54 Stepney 16.7 15.3 0.01 0.08 0.11 0.16 0.03 0.02 1.50 1.67 Poplar 16.2 16.3 0.02 0.13 0.04 0.12 0.03 0.08 1.37 1.29 South. South wark 14.2 16.8 0.01 0.07 0.09 0.16 0.01 0.03 0.93 1.79 Hermondsey 15.4 18.8 0.01 0.12 - 0.07 - 0.02 1.60 1.78 Lambeth 15.1 14.1 0.12 0.08 0.26 0.18 0.05 0.03 1.37 1.41 Batterrsea 13.2 13.0 - 0.04 0.01 0.12 0.01 0.04 1.30 1.22 Wandsworth 11.1 11.9 0.0 0.05 0.16 0.09 0.01 0.02 0.89 0.93 Camberwell 14.6 13.4 - 0.06 0.04 0.15 0.01 0.02 1.73 1.19 Deptford 10.3 13.6 0.46 0.10 0.33 0.13 0.08 0.05 0.74 1.25 Greenwich 15.6 12.2 0.41 0.08 0.33 0.06 0.14 0.04 1.45 0.99 Lewisham 10.7 10.4 0.26 0.10 0.32 0.13 0.01 0.01 0.78 0.78 Woolwich 10.6 11.9 0.01 0.14 0.05 0.20 - 0.02 1.08 1.20 *The deaths ' before Distribution " are those actually registered in the several Boroughs without any correction whatever. 40 Table 14. Causes of, and Ages at, Death in the Borough of Lewisham for the year 1909. Causes ok Death. Deaths Whole Borough Borough Divisions Deaths in Public Institutions in the Borough. Deaths of Residents outside the Borough Deaths of Non-residents in the Borough Under 1 year 1 and under 8 years 5 and under 19 years 15 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee I Lewisham Sydenham and Forest 1 Hill Class I.—Infective Diseases j 1 2 3 4 5 6 7 8 9 10 11 12 13 1 Small-Pox - - - - - - - - - - - - - 2 Measles — 7 — — — — 7 1 6 — 7 — 5 3 Scarlet Fever 1 10 3 1 1 — 16 3 7 6 40 2 28 4 Typhus Fever — — — — — — — — — — — — — 5 Plague — - 6 Influenza — — — — 1 3 4 — 3 1 — — — 7 Whooping Cough 11 9 — — — — 20 2 16 2 3 — 1 8 Diphtheria 1 8 12 — — — 21 3 13 5 46 — 31 9 Enteric Fever — — — — 2 — 2 — — 2 — 1 — 10 Epidemic Diarrhœa 5 — — — — — 5 — 2 3 — — — 11 Epidemic Enteritis 4 4 — 2 2 2 — — 12 Dysentry 13 Venereal Diseases 2 — — — — — 2 — 2 — — 1 — 14 Puerperal Septicœmia Fev — — — — 2 — 2 — 1 1 2 — — 15 Infective Endocarditis 16 Erysipelas — — — — 1 1 2 1 1 — — — — 17 Septiccemia not Puerperal 1 — — — 5 2 8 — 8 — — 1 — 18 Pyæmia — — 1 — 1 2 1 — 1 2 1 1 Class III.— Malign- Class II.— ant Tuberculous Diseases Diseases 19 Other Septic Diseases 2 — — — 1 1 4 1 1 2 1 — — 20 Phthisis — 2 5 19 94 5 125 14 75 36 51 5 5 21 Meningitis 4 10 6 — 1 — 21 1 13 7 9 2 2 22 Peritonitis 1 1 3 — — — 5 — 2 3 1 2 — 23 Scrofula — — — — — — — — — — — — — 24 Other Tuberculous Dis 2 1 1 2 2 2 10 4 4 2 — 3 — 25 Cancer, Carcinoma — — — — 71 50 121 23 58 40 28 17 3 26 Sarcoma — — — — 4 2 C» — 5 1 2 1 — 27 Other Malignant Diseases — — — — 9 15 24 4 11 9 6 1 1 28 Meningitis not Tuber 2 5 1 2 1 — 11 — 10 1 — — — Class IV.— Nervous Diseases 29 Insanity (G. P. Insane) — — — — 18 9 27 5 14 8 2 15 — 30 Epilepsy — — — 2 6 2 10 2 3 5 2 2 — 31 Convulsions 7 4 1 — — — 12 — 10 2 3 — 1 32 Locomotor Ataxy — — — — — 2 2 — 2 — — — — 33 Paraplegia, Dis. of Cord — — — — 2 1 3 2 1 — — — — 34 Other Nervous Diseases 1 3 2 3 22 14 45 6 25 14 13 8 1 35 Valvular Disease, carditis - - 1 5 28 27 61 11 29 21 12 3 1 Class V.— Diseases of Heart and Blood Vessels 36 Cerebral Hœmorrhage 1 — — - 35 40 76 9 38 29 34 1 16 37 Thrombosis — — — — 4 6 10 1 9 — 2 — 1 38 Apoplexy, Hemiplegia — — - — 8 18 26 8 15 3 5 1 1 39 Aneurysm — — — - 2 — 2 — 2 — 1 1 1 40 Embolism — — — - 3 3 6 2 2 2 1 1 — 41 Thrombosis, not Cerebral - - - - - - - - - - - - — 42 Other Dis. Heart and Blood Vessels 8 - 4 2 46 45 105 10 59 36 39 7 16 41 Table 14 continued. Causes of Death Deaths Whole Borough Borough Divisions Deaths in Public Institutions in Borough Deaths of Residents outside Borough Deaths of Non-residents in Borough Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee Lewisham Sydenham and Forest Hill Class VI.— Respiratory Diseases 1 2 3 4 5 6 7 8 9 10 11 12 13 43 Croup (not Spasm. or Membranous) - 1 - - - - 1 1 - - - - - 44 Bronchitis 14 6 3 — 34 104 161 19 87 55 57 2 16 45 Pneumonia 21 17 4 4 25 29 100 15 58 27 22 5 6 46 Asthma Emphysema — — — — 1 3 4 1 2 1 - 1 - 47 Pleurisy — — — — 5 - 5 1 1 3 - - - 48 Other Respiratory Dis. 6 4 3 1 3 1 18 4 6 - 4 1 - Class VII.— Digestive Diseases 49 Enteritis (not Epidemic) 8 — — — — 1 9 - 8 1 1 - 1 50 Gastro Enteritis 3 1 - — 1 - 5 - 3 2 1 - - 51 Peritonitis (not Puerperal) 1 1 3 - 6 - 11 - 7 4 9 3 2 52 Cirrhosis of Liver — — - — 7 4 11 1 5 5 3 1 2 53 Gastric Ulcer (Perforation of) - - - - 3 2 5 1 1 3 - 1 - Class VIII.— Class Urinary IX. Diseases 54 Other Digestive Diseases 69 3 2 3 10 15 102 10 57 35 34 12 4 55 Nephritis, Acute — — 1 1 2 - 4 1 2 1 1 1 - 56 Bright's Disease — - - 1 27 21 49 8 24 17 9 8 1 57 Other Urinary Diseases — - - - 8 7 15 3 7 5 6 3 - 58 Generative Organs, Diseases of - - - - 4 2 6 2 3 1 1 - - 59 Old Age — — - - - 149 149 23 75 51 68 6 19 Class X.— General Diseases 60 Premature Birth 58 - - - - - 58 4 37 17 5 1 - 61 Chronic Rheumatism - - - - 1 2 3 1 1 1 - - 62 Rheumatic Fever - 1 1 1 2 1 6 1 3 2 1 - - 63 Parturition, Diseases and Accidents of - - - - 5 - 5 - 3 2 2 - 1 64 Alcoholism — - - - 3 1 4 2 1 1 1 - - 65 Gout - - - - - - - - - - 1 - 1 66 Diabetes Melletus - - - 1 7 9 17 3 6 8 1 3 1 Class XLAccidents 67 All Other Diseases 19 3 4 1 18 3 48 10 23 15 8 4 2 68 Burning and Braiding - 2 2 - - 3 7 1 2 4 5 - - 69 Overlaying 6 - - - - - 6 - 5 1 - - - 70 Poison - - - - - - - - - - - - - 71 Drowning 1 - - - 1 - 2 - 2 - - 1 - 72 Other Accidents 3 3 2 3 7 12 30 4 16 10 13 1 2 Class XII¬Vio lence 73 Homicide — - - — - - - - - - - - - 74 Suicide — — — 2 12 2 16 2 9 5 3 1 1 Grand Totals 262 102 65 54 562 619 1664 232 903 521 570 131 174 Note Columns 1 to 10 include deaths of Residents in the Borough, in outside Districts and in Public Institutions. 42 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 31 61 92 Lewisham Infirmary 307 18 325 Lewisham Workhouse 46 6 52 Bermondsey (St. Olave's) Workhouse — 58 58 St. John's Hospital 13 16 29 Home for Sick Children, Lower Sydenham 6 1 7 Greenwich Union Workhouse, Grove Park 1 5 6 Flower House, Southend Catford — — — Nursing Home, Manor Park, Lee — 1 1 Totals 404 166 570 In addition to the above, deaths of non-residents occurred, as follows :—Two in public highways, one at a railway station,, three at Lee, and two at Sydenham. 43 Deaths of Residents Belonging to the Borough occurring in Public Institutions, etc., in districts outside, during the year 1909. Fever Hospitals: Other Institutions (continued):— Gore Farm Hospital 2 Aged Pilgrim's Asylum, Camberwell 1 General Hospitals:— Brompton Hospital 1 Cancer Hospital, Chelsea 1 Charing Cross Hospital 2 East London Children's Guy's Hospital 14 Hospital, Shadwell 1 King's College Hospital 1 Evelina (Children's) Hospital 2 London Hospital 3 Friedenheim Hospital 1 Miller Hospital, Greenwich 2 Greenwich Union Infirmary 2 Middlesex Hospital 2 Greenwich Union Royal Free Hospital 1 house 1 St. Bartholomew s Hospital 4 Holborn Workhouse St. George's Hospital 2 ditch) 1 St. Luke s Hospital 1 Infants' Hospital, Vincent St. Mary's Hospital 1 Square 1 St. Peter's Hospital 1 Kidbrook Cottage Hospital 1 St. Thomas s Hospital 5 Maternity Hospital, Hackney 1 Seamen s Hosp 1, Greenwich National Hospital, Queen's University College Hospital 1 Square 3 West London Hospital 1 Nursing Home, Shooter's Westminster Hospital 4 Hill Road 1 St. Luke's House, Kensington 3 Asylums: St. Pancras Infirmary 1 Banstead Asylum 6 Thomas 8 Home 1 Caterham Asylum 6 Shoreditch Infirmary 1 Cane Hill Asylum 3 Soho Hospital for Women 1 Colney Hatch Asylum 1 West End Hospital 2 Dartford Heath Asylum 16 Darenth Asylum 2 Various:— Hanwell Asylum 1 New Cross Railway Station 1 Horton (Epsom) Asylum 2 Long Grove Asylum 2 Victoria Railway Station 1 Manor Asylum 1 Grand Junction Canal Peckham House Asylum 3 Fulham (Parson s Green) 1 Tooting Bee Asylum 1 Hackney (Richmond Road) 1 Islington (Shaftesbury Road) 1 Other Institutions:- Paddington (Thorngate Rd.) 1 Streatham (Besley Street) 1 Aged Pilgrim's Asylum, Deptford (Lewisham High Holloway 1 Road) 1 44 Table 16. Deaths from Principal Zymotic Diseases in Wards, during the year 1909. Localities Small-Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhus Fever Enteric Fever Pyrexia *(origin uncertain) Epidemic Diarrhoea& Epidemic Enteritis Dysentery Totals Death Hates from Principal Zymotic Diseases. Church Ward — — 2 1 1 - - - - 4 0.56 Manor Ward — — — 2 1 - — — - — 3 0.39 South Ward — 1 1 - - - - - - 2 0.35 Lee Division — 1 3 3 2 - — — — — 9 0.44 Blackheath Wd. - - - - - - - - - - — Lew. Vill. Wd. — — 2 1 1 - - - - 4 0.26 Lew. Pk. Wd. — 3 2 4 7 - — — 2 — 18 0.92 Brockley Ward — — 2 1 2 - - - - - 5 0.42 Catford Ward — 3 1 7 6 — — — 2 — 19 0.51 Lewisham Div. — 6 7 13 16 — — - 4 — 46 0.50 Forest Hill Wd. - - - 1 2 — — — — — 3 0.16 Sydenham Ward — — 6 4 — — 2 — 5 — 17 0.56 Sydenham and Forest Hill Div. — - 6 5 2 - 2 — 5 — 20 0.41 Whole Borough — 7 16 21 20 — 2 — 9 — 75 0.47 County of London 2 2324 383 605 1246 - 146 2 1577 6285 1.31 76 Great Towns 14 7810 1826 2409 3872 — 953 6223 23107 142 * Originally termed Simple Continued Fever 45 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 1909. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough County of London. 76 Great Towns. Small-Pox — — — • 0.00 0.00 Measles 0.05 0.07 — 0.04 0.48 0.48 Scarlet Fever 0.15 0.08 0.12 0.10 0.08 0.11 Diphtheria 0.15 0.14 0.10 0.13 0.13 0.15 Whooping Congh 0.01 0.18 0.04 0.12 0.26 0.24 Enteric Fever — — 0.04 0.01 0.03 0.06 Epidemic Diarrhœa and Enteritis - 0.04 0.10 0.06 0.33 0.38 Dysentery — — — — Total Zymotic Death Rates 0.44 0.50 0.41 0.47 1.31 1.42 Infantile Mortality Rate 44 88 64 75 108 118 Phthisis Death Rate 0.68 0.82 0.74 0.78 1.81 Comparative Rates for other Boroughs will be found in Table 12. 46 Table 18. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1909. Ages. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Epidemi Diarrhœa and Enteritis. Dysentry. Totals in Age Groups. Under 1 year — — 1 1 11 - 9 — 22 1 and under 5 years — 7 10 8 9 — — — 34 5 and under 15 years — — 3 12 — — — — 15 15 and under 25 years — — 1 — — — — — 1 25 years and upwards — — 1 — — 2 — — 3 Total all ages 1909 — 7 16 21 20 2 9 — 75 Total all ages 1908 — 47 11 44 30 4 43 2 181 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 1909. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 19 07. Barometer. AIR TEMPERATURE Bright Sunshine. Rain and other forms of Precipitation ' Mean pressure at 32w F. at j Station Level (Bar. 159 ft. above M.S.L ) Mean of Absolute Minimum & Maximum. Total observed Per cent, of possible. Total Fall. Most in a day. Month. Minimum > Maximum EC Minimum. Day of Month Maximuu . Pay of Month. Amount Day of Month Ins 0 0 0 0 Hours % Ins. Ins. January 29.991 34-0 43-0 21 28 50 11,15 61 23 0-77 0-26 15 February ... 29.965 30-9 43-5 19 23 56 4 91 33 0-63 0-19 28 March 29-355 33-8 45-5 14 5 62 29 75 •21 3-08 0-51 6 April 29-818 38-6 60-6 29 2 71 11 250 60 1-64 0-41 19 May... 29-934 41-V 64-fe 33 16 84 22 326 68 1-24 0-66 25 June 29-792 4V -2 62*4 38 11 74 19 107 22 3-67 1-08 24 July... 29-763 525 70-1 46 1 78 18 179 36 3-16 0-81 27 August 29-832 52-5 72-9 45 31 86 12 228 50 1-80 0-47 24 September 29-862 47'5 62*8 37 2 71 6 106 2 2-48 0-40 13 October 29-646 45*6 59-5 28 30 68 4 91 27 4-06 0-66 26 November 29-849 36-2 47-2 28 25 57 6 78 29 0-79 0-41 29 December 29510 35-0 45"2 22 21 54 28 50 21 2-40 0-33 4 Yeah 29-776 41-3 56-5 — — — 1642 87 25-72 — — PART 2. INFECTIOUS DISEASES. 51 NOTIFIABLE INFECTIOUS DISEASES. The infectious diseases notiiiable 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 1,442, of which number 1,138, or 78'92 per cent., were removed for isolation to the Metropolitan Asylums Board's Hospitals or other Institutions. In 52 instances, or 4"58 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 1390 cases of infectious disease notified as occurring in the Borough during the year, an increase of 203 over the number notified in the preceding year, which was 1187. In 1907, 1,028 cases were notified. Age Periods.—45.6 per cent, of the Scarlet Fever cases, compared with 45.8 per cent, in 1908, and nearly 50 per cent, of the Diphtheria cases, compared with 53 per cent, in 1908, occurred among children aged six years and under. The following figures show the percentage of cases occurring among children of the age of six years and under to the total notifications of Scarlet Fever and Diphtheria:— Scarlet Fever. Diphtheria. Age. 1907. 1908. 1909. 1907. 1908. 1909. 6 years and under 46-7% 45-8% 45-6% ... 52.6% 53.0% 49-9% 5 „ „ 35-8% 34-5% 35-3% ... 44-3% 41-3% 37-1% 4 „ „ 25-5% 22-6% 25-5% ... 25-4% 27-2% 25-2% 52 Table 20. Age Periods of Scarlet Fever and Diphtheria, notified during the year 1909. Age Periods. Scarlet Fever. Diphtheria Number, of Cases. Percentage to Total Cases Number of Cases. Percentage to Total Cases. Under 1 year 3 033 5 1-38 1 to 2 years 22 2-43 6 1-66 2 ,, 3 „ 63 6-97 19 5-26 8 „ 4 „ 60 6*64 20 5-54 '1 » 5 „ 82 9*08 41 11-35 5 „ 10 „ 397 43*96 171 47-36 10 „ 15 „ 166 18-38 48 13-29 15 „ 25 „ 69 7-64 30 8-31 25 years and over 41 4-53 21 5-81 At all ages 903 100-00 361 100-00 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 8.64 per 1,000 of the population, compared with 7.41 in 1908, and 6.45 in 1907. This increase is due to a rise in the attack rate from Scarlet Fever as will be seen from Table 22. The attack rate for the County of London was 6"12, compared with 7.36 in 1908. The attack rates for the Wards will be found in Table 22. It will be seen that Lewisham Park Ward had the largest 53 number of cases in proportion to its population, having an attack rate of 10-93 per 1,000. The lowest attack rate was in Lewisham Village Ward, 4.63 per 1,000. Table 21. Number of Gases of Infectious Diseases notified in the Ten Wards and the Whole Borough during the Year 1909. Wards. Scarlet Fever. Diphtheria. Enteric Fever Erysipelas. Puerperal Fever. Continued Fever. Total. 1 Church ... 25 16 — l — — 42 2 Manor ... 32 22 2 9 — — 65 3 South 40 10 — 7 — — 57 Lee Division ... 97 48 2 17 — — 164 4 Blackheath 33 5 1 7 l — 47 5 Lewisham Village 39 26 — 6 l — 72 6 Lewisham Park 154 42 1 16 — — 213 7 Brockley 74 26 1 12 — — 113 8 Catford ... 223 103 4 21 — l 352 Blackheath and ham Division 523 202 7 62 2 l 797 9 Forest Hill 73 36 3 10 122 10 Sydenham 210 75 4 16 2 — 307 Sydenham and Forest Hill Division 283 111 7 26 2 — 429 Whole Borough 903 361 16 105 4 l 1390 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 1906-1909. Wards. Diseases Scarlet Fever Diphtheria Enteric Fever Erysipelas Total 1906 1907 1908 1909 1906 1907 1908 1909 1906 1907 1908 1909 1906 1907 1908 1909 1906 1907 1908 1909 Church ... 1-88 3-44 3-34 3 50 116 0-57 055 2 24 — 028 0 26 — 0-72 0-85 0-69 0 14 3-77 515 4-87 5 88 Manor 3'82 2-82 4-43 4 19 0-95 094 1-56 2 88 013 027 - 0 26 0-27 013 0-78 1 17 519 417 6-78 8 51 South 3 73 266 594 7 05 1-60 035 2-77 1 76 — 017 052 — 0-17 0 35 0-69 1 23 5-51 3-54 9-90 10 04 Blackheath 6-27 2-47 3 27 4 77 2 04 0-29 2-71 0 72 029 — — 0 14 0-58 029 0-28 1 01 9-19 3 05 6-27 6 66 Lewisham Village 4 52 2-73 414 2 54 1 21 1-93 3-82 1 69 - 020 0 06 — 0-40 053 0-64 0 39 6 28 5-40 8-68 4 63 Lewisham Park 4-74 5-89 4-31 7 91 1'70 1-71 2-71 2 15 012 028 053 0 05 103 0-680-75 0 82 7 66 8-58 8-30 10 93 Brockley 3-51 4-75 2 89 6 16 1-46 1-35 413 2 16 — 017 008 0 08 1-28 0 67 0-49 0 99 6 27 6-96 7-60 9 41 Catford 362 5-40 5'27 5 95 214 2-23 3 60 2 75 012 014 011 0 11 0-65 0 550 55 0 56 6 53 8-64 9-53 9 36 Forest Hill 3 49 3-70 309 3 96 1-58 1-63 2-72 1 95 0-21 010 026 0 16 038 0-54 0-53 0 54 5 67 5 98 6 62 6 62 Sydenham 2-50 1-84 1 82 1 6 95 1-59 2-71 215 2 48 0-24 016 016 0 13 0-67 0-60 co o 0 53 501 5-32 4-58 10 11 Whole Borough 365 3-82 1 377 5 63 1-64 1-88 2 87 2 25 013 017 019 0 10 065 0 56 0-56 0 65 608 6-45 741 8 64 55 SCARLET FEVER. —The total number of cases notified during the year amounted to 923, compared with 617 in 1908. Of this number, 792, or 85 per cent., were removed to the Metropolitan Asylums Board's Hospitals. Subsequently 20 cases were returned to their homes and stated not to be suffering from any notifiable disease. Deducting this number, a corrected total of 903 is obtained, compared with (500 in 1908, equal to an attack rate of 5.63 per 1,000 persons, compared with 3.77 in 1908. The attack rate for the County of London was 3.58 per 1,000. An examination of the attack rates for the various Wards of the Borough shows that the highest occurred in Lewisham Park Ward (7.91 per 1,000) and that the Ward least affected was Lewisham Village, with 2.54 per 1,000. Nearly 44 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. Case Mortality. Sixteen deaths from Scarlet Fever occurred to residents of the Borough, equal to 177 per cent, of the cases notified, compared with 1.83 in the previous year. DIPHTHERIA. -Three hundred and ninety cases of Diphtheria were notified, compared with 472 in 1908, and of this , number 311, or 79 percent., were removed to hospital. Twentyl| nine patients (or 9.32 of the number removed) were returned as not suffering, giving a corrected total of 361, a decrease of 97 on the number notified in 1908. The attack rate per 1,000 of the population amounted to 2.25, compared with 2.87. The i rate for the County of London was 1.39 per 1,000. Manor Ward, Lee suffered most from this disease, in proportion to its population, having an attack rate of 2.88 56 per 1,000. Blackheath Ward was least affected, having an attack rate of only 0'72 per 1,000. Case Mortality.—Twenty-one deaths occurred from this disease, equal to 5'82 per cent, of the cases notified, compared with 9'6 per cent, in 1908. ENTERIC or TYPHOID FEYER.—Eighteen cases only were notified, five of which were removed to Hospital. Two cases were returned home as not suffering, giving a corrected total of 16, a decrease of 15 on the previous year. The attack rate for the whole Borough was 0*10 per 1,000, compared with 0'19 in 1908. The case mortality equalled 12-5 per cent., against 12"8 per cent, in 1908. ERYSIPELAS.—One hundred and five cases of Erysipelas were notified, compared with 90 in the preceding year. Twentyeight cases were removed to the Lewisham Infirmary. PUERPERAL FEYER.—Four cases of Puerperal fever were notified, two of which were removed to the Infirmary for treatment. Two of the cases proved fatal. 57 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 1906.1909. Borough. Small.Pox. Scarlet Fever. Diphtheria. All Notihable Infectious Diseases. 1906 1907. 1908. 1909 1906. 1907. 1908. 1909 1906. 1907. 1908. 1909 1906. 1907 1908. 1909 Battersea — — — — 5.83 5.39 616 3.95 1.53 1.98 1 96 1.55 8.51 8 66 918 6.71 Bermondsey o.oo — — — 7.69 7.98 4 93 361 1.94 1.55 1216 11 98 8 68 6.60 Bethnal Green 004 — — 001 4.97 9 87 758 432 2 09 1 40 9'24 14 45 12.19 7.29 Camberwell 0.02 — — 000 4.23 5.69 3.70 362 1.29 1.47 1.40 1.33 6.87 8 48 6 09 600 Chelsea — — — — 3.62 2.93 2.28 4 09 2 16 212 1.85 1.31 6.82 5.97 5.07 6 13 Deptford 000 — — — 5.56 6.69 6 05 316 2.64 2.74 1 74 1.65 9 93 11.05 9 48 672 Finsbury — — — — 4.60 524 4 19 2.53 2 31 1.61 1.74 1.76 8.52 8 25 7.44 5 88 Fulham — — — — 4.16 4.02 ^ 42 2 91 2 49 364 2 29 1 83 779 8.89 6 76 5 82 Greenwich — — — — 5 38 618 3 86 3.52 388 2.40 2 01 1.47 10 62 9.64 6 32 6 21 Hackney 0.03 — 0 01 000 4 54 7'78 5 34 331 1.68 2 34 1 63 111 799 11.99 8 31 5 87 Hammersmith — — — — 3 62 4. 76 3.12 3.11 2 33 1.76 1.62 1.58 7.24 7.55 5 59 5.48 Hampstead — 001 — — 4.31 3.52 2.97 276 110 1.23 0 68 0.50 6.23 5 64 4 34 380 Holborn — — — 0 02 2 47 2 86 3 51 1.81 118 1 .16 0 90 0 88 4.94 5 02 5 73 385 Islington 0.00 — — 0 01 4 03 3.51 3 98 3.67 1.27 1. 39 1 .49 1.23 6 .54 5 .97 6. 46 5.85 Kensington . — — — 265 293 2 44 2 29 0.98 1 38 1 25 0.97 4.62 5.26 4 73 4.30 Lambeth — — — — 4.00 4.65 4.45 3 .62 1.33 1.03 1.06 1.17 6.49 6.65 6.44 5.58 Lewisham — — — — 3.65 3.82 3.77 5.63 1.64 1.88 2.87 2.25 6.08 6.45 7.41 8.64 London, City of — 010 — 006 5.28 4.79 2.71 2.09 0.84 1.38 1.48 1.05 7.44 7.45 5.06 4.03 Paddington 0.00 — — — 4.81 3.86 1.45 4.16 1.22 1.13 0. 98 1.21 7.28 6.10 6. 36 6.28 Poplar 0.01 0. 01 — — 3 .34 7.53 7.34 4 .26 1. 45 2 .11 1.81 1.24 6 .52 11. 30 10 .68 6 .92 St. Marylebon — 0.01 — — 3 .07 3.42 3 .19 3.64 1. 09 1. 00 0. 92 0.90 5.70 5.77 5.42 5.80 St. Pancras — 0.00 0 01 0 00 3.37 3.59 3. 95 3 .26 1.18 1 48 1. 28 1.35 5.95 6 10 6 18 5.53 Shoreditch — 001 — — 5.40 7.60 5. 12 2.97 1 .24 1.93 1.79 1.62 8.25 11.08 8.94 6.42 Southwark — — . 0 .01 7 .02 6.09 3 .62 2.80 1 .91 2. 02 1. 26 1.22 11.06 9.80 6.26 5.29 Stepney o.o1 — — 0.03 3. 93 10.15 7.45 3.33 1 96 2.44 2.08 1.87 7.70 14.60 11.23 7.07 StokeN ewingtor — — — — 2.53 4.71 3.66 2.03 0.88 2.21 1.18 0. 52 ' 4.49 7.80 5 .59 3.32 Wandsworth — — — — 3.91 4.71 4.28 3.36 203 2.27 2.01 1.25 7.27 8.09 7.25 5.58 Wtmstr City of — — 0.01 0.01 3.08 2.43 3.61 3.50 1.90 0.84 1.06 1.34 5.30 4.19 5.44 5.64 Woolwich — — — 4.12 7.96 4.50 17.72 3.03 2.16 2.76 2.01 8.15 11.26 8.13 10 .65 London C ounh o.o0 OOOOO0 0.004.30 5.46 4.53 .3 56 1 .70 1.8E 1 64 1.38 704 8.61 7.36 6 .12 58 SCHOOL CLOSURE. The following is a list of schools in which class-rooms were closed with a view of preventing the spread of infectious diseases:— On account of Measles. Hither Green L.C.C. School. — Four class-rooms in Infants' Department closed on February 9th for three weeks. Holbeach Road L.C.C. School.—Two class-rooms in Infants' Department closed on July 6th for three weeks. Plassy Road L.C.C. School.—One class-room in Infants' Department closed on December 17th for three weeks. On account of Scarlet Fever. Haseltine Road L.C.C. School.—One class-room in Infants' Department closed for two weeks on 15th November. On account of Diphtheria. Stillness Road L.C.C. School.—One class-room in Infants' Department closed for two weeks on 15th November. The following is a list of schools at which children under the age of compulsory school attendance (i.e., under five years of age) were excluded, owing to the prevalence of Measles or other infectious disease in the neighbourhood of the school:— St. Mary's School, High Street, Lewisham, February 25th. Measles. Baring Road L.C.C. School, March 19th. Measles. Torridon Road L.C.C. School, April 2nd. Measles. Stillness Road L.C.C. School, March 19th. Whooping Cough. Brockley Road L.C.C. School, April 27th. Whooping Cough. Haseltine Road L.C.C. School, 27th September. Scarlet Fever. 59 MEASLES, WHOOPING COUGH. AND CHICKEN POX. These diseases, which are not compulsorily notifiable, are brought to our notice by notifications from the various Elementary Schools in the Borough, in compliance with the regulations contained in the School Management Code. Measles.—The number of cases of this disease brought to our notice shows a considerable decrease over the preceding year, 383 cases being notified, as compared with 1,174 in 1908. Where cases occurred in the poorer districts of the Borough, the homes are visited by the Women Sanitary Inspectors who try to impress upon the parents the very infectious nature of the disease, and the need of every care to prevent its spread. One hundred and sixty-one visits were made for this purpose. Chicken-Pox.—Three hundred and seventy-six children were notified to be suffering from this disease, compared with 404 in 1908. The Women Sanitary Inspectors made 83 visits to various homes on this account. The following is a summary of the cases notified from Schools : Number Children excluded of on account children of infection in suffering. their homes. Measles ... 383 235 Chicken-Pox ... ... 376 174 Whooping Cough ... 459 100 Mumps ... ... 313 133 Ringworm ... ... 227 VOLUNTARY NOTIFICATIONS OF PHTHISIS. During the year 26 voluntary notifications of Phthisis were received, nine of which were endorsed with a request that no visit should be made to the home from this Department. 60 THE PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1908. Regulations bearing the above title, and made by the Local Government Board, came into force throughout England and Wales on the 1st January, 1909. The following is a brief summary of the Regulations:— Article IV. directs that the Medical Officer of a Poor Law Institution shall within 48 hours after his first recognition of the symptons of pulmonary tuberculosis in the case of a poor person who is an inmate of the institution, post to the Medical Officer of Health for the sanitary district in which the person resided immediately before he became an inmate of the institution, a notification of the case. Article V. directs that a similar notification shall be made by the District Medical Officers in respect of persons upon whom he is in attendance. Article VI. requires the Superintending Officer of a Poor Law Institution to notify to the Medical Officer of Health the actual or intended address of any person leaving the institution in respect of whom a notification has been made by the Medical Officer of the Institution under Article IV. Article VII. requires a Relieving Officer to notify to the Medical Officer of Health any change of address (other than by admission to a Poor Law Institution) of a person 61 in respect of whom a notification has been made by a District Medical Officer under Article V. Article VIII. provides for the payment of one shilling to Medical Officers for primary notifications of a case, and sixpence if a second notification is necessary. The sum of three pence is to be paid to Superintending or Relieving Officers for each notification. The Local Government Board, recognising that some of the provisions of the Public Health Acts relating to infectious disease are not usually appropriate in cases of pulmonary tuberculosis, have, by Article IX. (1) provided that nothing in the regulations shall have effect so as to apply or to authorise any one to put in force any enactment with respect to a person in relation to whom a notification has been made, which would render him or any other person liable to a penalty or subject him to any restriction, prohibition, or disability affecting him or his employment, occupation, means of livelihood, or residence, on the ground of his suffering from pulmonary tuberculosis. Subject to what is stated in the preceding paragraphs, the Board consider it desirable that Sanitary Authorities, acting upon the advice of their Medical Officers of Health, should utilise their powers for the purpose of preventing the spread «f infection from pulmonary tuberculosis. The order confers some special powers which the Board consider suitable for the purpose, and which are set out in Article IX (2) of the Order, as follows :— Take such measures as are authorised by any enactment relating to public health, relating to the destruction and disinfection of infected articles, or the cleansing or disinfection of premises ; 62 Take such measures as are appropriate and necessary for the safe disposal or destruction of material infected as a result of pulmonary tuberculosis ; Afford or supply all such assistance, facilities, or articles, within reasonable limits, as will obviate, remove or diminish the risk of infection arising from the conditions affecting the use of any room used as a sleeping apartment by a poor person in respect of whom a notification has been received ; Furnish for the use of the patient, on loan, or otherwise, any appliance, apparatus, or utensil which will be of assistance for the purpose of any precaution against the spread of infection. Article IX. (3) authorises a Council, on the advice of their Medical Officer of Health, to provide and publish or distribute in the form of placards, handbills, or leaflets, suitable summaries of information and instruction respecting Pulmonary Tuberculosis, and the precautions to be taken against the spread of infection from that disease. In accordance with the regulations, 282 notifications were received during the year, relating to 164 cases of Pulmonary Tuberculosis. Of these cases, 135 were notified from the Lewisham Infirmary. In 49 instances we were notified of the intended address of persons leaving the Infirmary, and a change of address was notified by the Relieving Officer in three cases. BACTERIOLOGICAL EXAMINATIONS. Facilities were continued for the examination of specimens from doubtful cases of Diphtheria, Phthisis and Typhoid Fever. The total number of specimens examined was 63 650, compared with 538 in the previous year. The details of the examinations were as follows :— 1905. 1906. 1907. 1908. 1909. re Diphtheria negative 72 148 248 269 392 positive 34 68 93 144 146 doubtful 1 1 2 4 12 re Phthisis negative 22 41 55 50 48 positive 7 20 21 36 26 re Typhoid Fever negative 4 6 15 21 19 positive 2 3 3 9 2 doubtful '— — — 1 2 re Cerebro-spinal Fever negative — — 3 — — Food Samples, &c. 2 9 13 4 3 Totals 144 296 453 538 650 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 2 and Cholera 39. PART 3. GENERAL 67 Table 24. Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the years 1903-1909. Ward. Number of Water Certificates Granted. 1903 1904 1905 1906 1907 1908 1909 Church - 12 40 23 33 29 17 Manor 17 41 9 7 46 101 68 South 30 25 33 47 13 17 10 Lee Division 47 78 82 77 92 147 95 Blackheath 5 5 1 4 Lewisham Village 72 56 10 5 24 11 15 Lewisham Park 159 71 67 114 55 87 17 Brockley 112 109 154 120 84 72 94 Catford ... 495 270 297 258 322 177 122 Lewisham Division 843 506 533 498 485 347 252 Forest Hill 199 139 95 63 30 42 8 Sydenham 210 176 208 156 157 98 57 Sydenham & Forest Hill Division 409 815 303 219 187 140 65 Whole Borough 1299 899 918 794 764 634 412 68 Table 25. Houses Examined and Certified under the Customs and Inland Revenue Acts during 1909. Name of Street. Applications. Certificates Date. Number of Houses. Number of | Dwellings. Granted. Refused. Abernethy Road 6 12 12 -- December Beacon Road 8 16 16 June Belmont Park 1 3 3 March Blackheath Hill 1 3 3 February Blagdon Road 2 4 4 June Burnt Ash Hill 2 4 4 March Burnt Ash Road 1 2 2 April George Lane 1 2 2 — ' June High Road, Lee 1 3 3 April Manor Park 1 4 4 December Sydenham Road 2 4 4 February West Hill 1 2 2 May Totals 27 59 59 HOUSE-TO-HOUSE INSPECTION. During the year house-to-house inspection was made in the following roads and streets :—Champion Park (part), Craythorne Street, Dillwyn Road, Eddystone Road, Gillian Street, Horton Street, Kirtley Road, Loampit Vale, Ladywell Road (part), Mill Road, Porthcawe Road, Railway Terrace, Ronver Road, and Thurston Road. In the course of this systematic inspection only one case of overcrowding came to our notice. Of the 675 houses inspected however, only 50 or 7.4 per cent. were without a nuisance of 69 some kind, whilst 354 or 52.4 per cent, required cleansing notices, showing the necessity of this work. The following is a summary of the principal nuisances :— Defective drains 29 Vent shafts and soil pipes defective 54 Water closets and apparatus foul or defective 80 Insufficient water supply to water closets 88 Defective yard traps, sink wastes, gullies, &c. 688 Dirty premises 354 Overcrowding 1 Drinking water cisterns defective or uncovered 90 Defective roofs 151 Damp premises 73 Insufficient floor ventilation 7 Defective yard pavings 169 Offensive accumulations 7 Animals so kept as to cause a nuisance 6 Other minor nuisances (ashbins, &c.) 461 Total 2,258 The whole of the above-mentioned defects were remedied on the service of notices, and no summary proceedings were necessary. HOUSES UNFIT FOR HUMAN HABITATION. Brockley Cottages.—In 1897 a Magistrate's order was obtained for the closure of these cottages which were then unfit for human habitation. During the past year, six of these dwellings (Nos. 11, 12, 13, 14, 15 and 16) have been put into repair, and upon application to the Magistrate the closing order in respect of such premises was rescinded. 70 COMBINED DRAINAGE. The following combined drains were found to be in bad order and condition, and 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:— Algernon Eoad, 109 to 119. Jerrard Street, 13 to 17. „ 169 to 175. „ „ 18 to 26. „ „ 202 to 214. Kent House Road, 53 to 57. Catford Hill, 62 to 66. Leathwell Road, 1 to 11, and Dalmain Road, 74 to 82, and Elverson Road, 28 to 34. Wastdale Road, 18 to 24. Southend Lane, 2 to 9, and Horton Street, 28 to 35. Railway Tavern Thurston Road, 12 to 19. Sydenham Road, 160 to 168. Thurston Road, 20 to 29. SMOKE NUISANCES. The Inspector entrusted with this duty made 115 investigations, compared with 182 during 1908. The observations were made in respect of laundries 41, breweries 10, silk mills 5, jam works 16, fiour mills 9, railway engines 11, saw mills 9, and miscellaneous 14. The duration of the observations varied from fralf-anhour to two hours each. Black smoke was recorded in very few instances and only one intimation notice was required on account of a nuisance. The calls of the Inspector produced the necessary abatement, no legal proceedings being necessary. CORONER'S COURT AND MORTUARY. One hundred and forty-one bodies were removed to the public Mortuary, nine of which were from outside districts and 22 from the Lewisham Union Infirmary. Inquests were held in 138 cases, and post-mortem examinations carried out in 88 instances. 71 The portion of the Mortuary specially allocated for infectious diseases was made use of for the bodies of three persons. DISINFECTION. During the year 3,121 rooms were disinfected by formalin spray, and textile articles such as bedding, clothing, &c., (in all 57,835 articles), 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 by the owners as unfit for human food and subsequently destroyed:— I box kippers 1 case lemon soles 1 box mackerel 1 case hake 1 box plaice J case fresh herrings 1 trunk codling 1 barrel pears 1 trunk dabs 1 case pears 1 case dabs 13 baskets raspberries 6 rabbits During the summer months a careful examination was made of the stalls in the various open maikets of the Borough with a view of preventing the sale of wet and unsound fruit. 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: — Adulterations : Summonses issued 5 Convictions obtained 5 Fines imposed £11 Costs imposed £4 14s. 72 Proceedings taken under the Public Health (London) Act, 1891, or Bye-laws made thereunder:— For erecting new dwellings (2) and letting same without providing a proper and sufficient supply of water, R. F., was ordered to pay £4 4s. costs. 73 ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901. Workshops:—There are in the borough 577 workshops, containing 918 workrooms to which provisions of the Factory and Workshop Act apply. The number of workers found on inspection amounted to 2194, of which 496 were men, 1343 women, and 355 young persons. The largest proportion of these workers were engaged in the dressmaking, laundry, and millinery trades, there being 1325 women, 300 young persons and 35 men so employed. These premises are inspected by the women sanitary inspectors (see work of women sanitary inspectors, page 79), together with the workshops employing women in other trades. Only 18 women and 55 young persons were employed in all other trades. In workshops employing male labour, 496 men were engaged. Domestic and Part Time Work Places.—There are 321 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 50 restaurants and 47 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. In addition to the above there are 93 bakehouses in the Borough, of which 20 are underground. 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. 74 Table 26. Inspection of Factories, Workshops & Workplaces. (1) Premises, Inspections Notices served. Proceedings Factories (including factory laundries) 154 21 - Workshops (including workshop laundries) 1803 129 - Workplaces (other than outworkers' premises) 392 23 - Total 2349 173 - Statement of Defects Found. (2) Particulars. Defects. Referred to H.M. Inspector No. of Prosecutions. Found Remedied. Dealt with under Public Health (London) Act—* Want of cleanliness 150 150 — i — Want of ventilation 1 1 — — Overcrowding 11 11 — — Want of drainage of floors 2 2 - Other nuisances 59 59 - — Sanitary accommodation : Insufficient 1 1 - - Defective or unsuitable 61 61 - — Not separate for sexes 3 3 - — Under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouses ss. (97100) 10 10 - - Other offences — — - — Total 298 298 - — * Including those specified in Sections 2, 3, 7 and 8. of the Factory and Workshop Act as remediable under the Public Health Acts. Table 27. HOME WORK. (3). #]OUTWORKERS' LISTS, SECTION 107. Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. NATURE OF WORK.* Lists received from Employers. Addresses of Outworkers. N otices served on Occupiers as to keeping or sending lists. 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 t"1 other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers.† Lists. Outworkers.† Lists. † Contractors. Work- Contractors. Workmen 1 2 3 4 5 6 7 8 9 10 11 12 18 14 15 10 17 18 19 Wearing Apparel— (1) making, &c. 74 - 208 16 - 34 228 95 - - - 349 5 5 — - - - (2) cleaning and washing - - - - - - 7 - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - 12 - - - - - - Artificial flowers - — — - - — - - - - - — — - - - - - Nets, other than Wire Nets - - - - - - - - - - - - - - - - - - Tents - - — - - — - - - - - — - - - - - - Sacks - - — - - - - - - - - — — - - - - - Furniture and Upholstery - - - - - - 5 - - - - 5 - - - - - - Fur pulling - - - - - — — - - - - — - - - - - - Feather sorting - - - - - - - - - - - — - - - - - - Umbrellas, &c. - - - - - - - - - - - - - - - - - - Carding, &c., of buttons, &c. - - - - - - - - - - - - - - - - - - Paper Bags and Boxes - - - - - - 1 - - - - -4 - - - - - - Basket making - - - - - - - - - - - - - - - - - - Brush making - - — - — — — - - - - - - — - - - - Stuffed Toys - - — - - — — - - - - — - - - - - - File making - — — - - — — — - - - — - - - - - - Electro Plate - - — - - — — - - - - — - - - - - - Cables and Chains - - — - - — — - - - - — — - — — - - Anchors and Grapnels - - - - - - - - - - - - - - - - - - Cart Gear - - — - - — — - - - - — — - — - - - Locks, Latches and Keys - - - - - - - - - - - - - - - - - - Pea picking - - — - - - — - - - - - — - - - - - Total 74 - 208 16 — 34 241 95 - — — 370 5 5 - - - - * 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 the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The figures in columns 3 and 4 are (approximately double of the number of individual outworkers whose 11 names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 75 77 Table 28. Workshops (sec. 131) and Workplaces and Workrooms on the Register at the end of 1909. Class of Work Number of Rooms. Number of Workers Allowed. Number of Workers Found. Part Time and Domestic. Workplaces. No. Day Artificial Light Overtime. Men. Women. Young Persons Number. No of Rooms. Dress 212 245 1594 1424 975 2 675 238 69 69 Millinery 47 56 320 307 185 — 139 58 48 73 Laundry 69 313 1038 984 624 33 511 4 4 4 Tailor 39 41 160 148 100 74 6 5 10 10 Boot 67 68 235 217 148 99 — 9 100 100 Joiner 19 31 532 497 376 41 — 5 8 8 Smith 27 30 346 317 243 61 — 6 3 3 Dentist 3 3 16 14 10 9 — — 1 1 Cycles 15 20 133 116 87 25 — 4 16 16 Coachbuilder 7 16 197 186 142 27 — 3 — — Cabinet and Upholsterer 18 24 322 308 228 37 8 4 8 8 Blindmaker 1 1 8 8 5 2 — — — — Photographer and Pictureframer 10 18 79 73 51 18 2 14 14 Jeweller 14 15 72 63 43 21 — 6 27 27 Piano 1 1 5 5 3 1 — — — — Saddler 9 9 40 41 27 14 — 1 2 2 Mason 2 3 31 31 20 5 — 2 — — Lathrender 2 3 20 16 13 5 — — — — Various 15 21 189 183 119 22 9 8 11 11 Total †577 918 5337 4938 3394 496 1343 355 ‡321 346 * Note:—Not including Bakehouses (93), Restaurants (50) and Stableyards, &c. (47). † This figure includes 42 Outworkers. ‡ Including 91 Homc-workerp. 78 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 65 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 - 1909 nil In use at end of 1909 20 Workshops and Workplaces on the Register at the end of 1908:— Workshops (details in Table 28) 577 Workplaces part time and domestic (details Table 29) 321 Bakehouses 73 „ underground 20 Restaurants (workplaces) 50 Workplaces (stable yards, contractors' yards, etc.) 47 Tota 1088 79 WORK OF WOMEN SANITARY INSPECTORS. During the year Miss Tones and Miss Stevens have performed most useful work in connection with the Health Department. The total number of visits made by these inspectors amounted to 4,658, reporting 332 nuisances. Many defects they were able to have remedied without the service of legal notices. It was, however, necessary to serve 255 intimation notices and 62 statutory notices, which were all complied with. In addition to their principal duties, viz., that of visiting and inspecting workrooms where women were employed, the homes of outworkers, &c., they made 157 visits to schools which were of great assistance in our efforts to check and prevent the spread of infectious diseases; 161 visits were made to homes in relation to measles, 83 re chicken pox, and 615 re whooping cough and other non-notifiable diseases. Under the Factory and Workshop Act, 524 visits were made to factories, workshops, workplaces and laundries where women are employed, and 138 to homes of outworkers. One hundred and eighty visits were made after deaths of infants under one year and 480 selected homes at which births occurred. This work was carried out tactfully and without friction. We frequently received communications requesting a visit from the women inspectors. Fourteen visits were made in regard to puerperal fever and 413 re phthisis homes and deaths, also essentially work for women sanitary inspectors. SUMMARY OF VISITS OF WOMEN SANITARY INSPECTORS. During the year under review the Women Sanitary Inspectors have made 4,653 visits throughout the Borough. 80 The following is a summary of the work done:— Factory and Workshop Act.— Miss Jones. Miss Stevens. Total. To Factories 19 27 46 „ Workshops 272 367 639 „ Workplaces 96 103 199 „ Laundries 137 148 285 „ Outworkers' homes 138 141 279 Infectious Diseases.— To Phthisis homes 214 100 314 Re Phthisis deaths 52 47 99 „ Chicken-pox 31 52 83 „ Measles 80 81 161 „ Puerperal fever 3 11 14 „ School Notifications 328 287 615 Other Visits.— On complaint from residents 38 15 53 To Selected homes from which births were registered 480 433 913 Investigations re Infant mortality 82 98 180 To Schools 75 82 157 Re-visits and re-inspections 343 218 561 Miscellaneous inquiries 36 19 55 Total 2424 2229 4653 Nuisances, Defects, &c.— Abstract not affixed in workshops 26 39 65 Overcrowding of Workshops 4 7 11 Other nuisances in workshops, &c. 33 45 78 Total number of nuisances found 186 146 332 Notices, &c.— Intimation notices served 133 122 255 Statutory notices served 41 21 62 Verbal notices complied with 17 15 32 Referred to District Inspector 9 3 12 81 Table 29. ROUTINE INSPECTIONS. Premises. Number of Places. No. of Inspections 1909 No. of Notices 1909. No. of Prosecutions 1909. On Register at end of 1908. Added in 1909. Removed in 1909. On Register at end of 1909 Milk premises 178 57 49 186 530 16 - Cow sheds 14 — — 14 126 2 - Slaughter houses 16 — 1 15 106 — - Other offensive Trade premises - - - - - - - Ice cream premises - - - - - - - Registered houses Let in Lodgings 15 - - 15 50 a 3 - b 3 Restaurants 54 - 4 50 83 12 - Bakehouses 98 2 7 93 279 6 - Stable Yards, etc. 49 3 5 47 55 - - a Overcrowding. b Other conditions. Total number of intimation notices served for all purposes, male inspectors 1829, female inspectors 255—Total 2084. Overcrowding:-Number of dwelling rooms overcrowded 18, and workrooms 11-remedied all, proceedings, nil. Underground rooms:—Illegal occupation dealt with and number of rooms closed, nil. Insanitary HousesNumber closed under the Public Health (London) Act and Housing of the Working Classes Act, nil: Numbers repaired and re-opened 6. Premises cleansed under Section 20 of the London County Council (General Powers) Act, 1904, 6. 82 Number of persons accommodated during the year in shelter provided under Section 60 (4) of the Public Health (London) Act, 1891, nil. Revenue Acts:—Houses for which application were received 27, number of tenements comprised therein 59, certificates granted 59, refused nil, deferred nil. Prosecutions under By-laws under the Public Health (London) Act:— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c. (c) For the prevention of keeping of animals in such a manner as to be injurious to health (d) As to paving of yards, &c., of dwelling houses (e) In connection with the removal of offensive matter, &c. — (f) As to cesspools and privies, removal and disposal of refuse, &c. — (g) For securing the cleanliness of tanks, cisterns, &c. (h) With respect to water-closets, earth-closets, &c. (i) With respect to sufficiency of water supply to water-closets (j) With respect to drainage, &c. (Metropolis Management Act, Section 202) (k) With respect to deposit of plans as to drainage, &c. (Metropolis Management Acts Amendment (Bylaws) Act, 1899). Mortuaries:— Total number of bodies removed 141 Total number of infectious bodies removed 3 Note.—This table was formulated to meet the requirements of the London County Council. 83 Table 30. REGISTER OF SANITARY WORK. (Male Inspectors ) For the year ended 31st December, 1909. Lewisham Division. Sydenham and Forest Hill Division. Lee Division Workshops House to House Description OF Woks Mr. J. A. K. Cooper Mr. H. King Mr. E. T Pidwell Mr. B. A. Knappett Mr. R. White Mr. J. Daltry Mr. A. H. Gray Total for Whole Boro. Complaints by Residents 65 90 79 116 188 13 42 593 Premises inspected 661 576 762 784 653 1996 873 6305 Re-inspections of Works in progress 2096 1729 1343 2260 1734 842 5658 15662 Intimation Notices served 250 226 104 269 184 138 658 1829 Statutory Notices ordered 187 154 86 133 134 54 84 832 Statutory Notices served 61 36 22 51 26 6 18 220 Premises repaired, cleansed, &c. 120 79 110 125 57 214 407 1112 Defective Roofs, Stackpipes, &c., remedied 57 11 55 63 55 18 305 564 Drains re-constructed 208 44 36 95 68 — 27 478 Drains repaired 28 61 32 91 65 5 20 302 Drains ventilated 39 15 13 19 65 - 7 158 Stackpipes, Sinks, Bath Wastes, &c., disconnected from drains 102 78 9 25 121 - 367 702 Gulley Traps provided 185 48 80 216 194 1 60 784 Water Closets reconstructed 151 43 80 132 100 2 43 551 Water Closets repaired 30 26 30 49 65 119 52 371 Water Closets supplied with water 15 29 3 1 76 3 96 223 Soil Pipes reconstructed 56 23 29 38 41 - - 187 Soil Pipes repaired and ventilated 6 19 14 15 19 25 77 175 Dustbins provided 38 35 21 31 69 21 149 364 Water Supply to Houses reinstated 4 10 12 24 2 1 1 54 Cisterns repaired, cleansed or covered 12 11 66 17 5 51 87 249 Water Certificates issued — 3 29 1 93 135 151 412 Premises over-crowded 3 3 - 4 - 3 4 17 Yards paved 75 44 21 152 57 43 157 549 Removal of offensive accumulations 9 29 10 22 34 11 10 125 Dung Vaults erected or repaired 1 2 — - - 2 4 9 Animals improperly kept 2 6 3 4 1 2 10 28 Visits to houses let in lodgings 45 5 - - - - - 50 Bake-house inspections — — 11 8 7 253 - 279 Milk-shop ,, — 1 20 34 20 455 - 530 Cow-shed ,, 7 24 24 12 59 - - 126 Workshop „ - - - - - 820 - 820 Slaughter-house ,, 19 12 36 13 26 - - 106 House-to-house ,, - - - - - - 675 675 Legal proceedings — — — - 2 - - 2 PART 4. REPORT OF PUBLIC ANALYST 87 REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1909. SAMPLES SUBMITTED.—During the period under review 514 samples were submitted for analysis. Of this number, 469 were purchased by your inspectors in conformity with the provisions of the Sale of Food and Drugs Acts. The remaining 45 samples were purchased as test samples, and without declaration to vendors. ADULTERATED SAMPLES.—Of the 469 official samples submitted, 14, or 2.99 per cent, were adulterated, compared with 8.25 per cent. in the previous year (1908) and 7.26 per cent. in 1907. 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 45 samples so purchased, 3, or 6'90 per cent., were found to be adulterated, compared with 11*67 per cent. in 1908, and 19.15 per cent, in 1907. MILK.—Of the 235 official samples submitted, 11, or 5.97 per cent., were adulterated or below the standard fixed by the Board of Agriculture, compared with 1908, when the adulterated samples equalled 9.13 per cent. Dyed Milk.—Of the milks examined during 1909, 68.1 per cent. were artificially coloured, compared with 51'5 per cent. in 1908 and 66.4 in 1907. From these figures it will be observed that the decrease in the practice of colouring milk has not been maintained. 88 Annatto is the material most commonly used, hut aniline dyes are not infrequently reverted to. Sunday Samples.—Twenty-five samples of milk were obtained on Sundays, two of which (Nos. 365 and 467) were below standard. Average Composition.—The average composition of all samples of milk submitted during 1909 was well above the standard, with 3.55 per cent. Milk Fat and 8.80 per cent. Solids Not Fat. The average composition of the genuine samples alone was 3.60 per cent. of Milk Fat and 8.81 per cent. Solids Not Fat. (See Tables E and F). Milk Samples taken in course of Delivery.—Twentynine samples were taken in course of delivery, as follows:— Park Fever Hospital 11; Railway Stations 17; Private Dwelling Houses 1. Of these samples thus obtained only one was below standard (No. 50). BUTTER.—One hundred and ten samples were purchased in conformity with the Food and Drugs Acts, all of which number were genuine (compared with 6.45 per cent. adulterated in 1908). In addition, .29 test samples were taken, 2, or 6.89 per cent. of which were adulterated. Milk Blended Butter.—Thirty-seven samples of butter submitted to me were milk blended, 10 being "test" samples and 27 officially purchased. The milk blended butters which have been purchased by your inspectors, were sold in wrappers without any description or distinctive marks. The amount of water in these milk blended butters, however, did not exceed the standard fixed by the Butter and Margarine Act, 1907. 89 Table A. Showing number of Samples submitted for Analysis, with Results for the year ended December 31st, 1909. (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 235 224 11 5.97 Separated Milk 7 6 1 14.28 Butter 110 110 — — Margarine 1 1 — — Coffee 51 50 1 1.96 Coffee and Chicory 2 2 - - Cocoa 9 9 - — Cocoa Mixture 1 1 — — Demerara Sugar 10 10 — — Castor Sugar 1 1 — — Flour 10 10 — — Bread 1 1 — — Cheese 1 1 — — Mustard 5 5 — — Sweets 1 1 — — Whiskey 10 10 — — Rum 6 5 1 16.67 Gin 8 8 — — Total official samples 469 455 14 2.99 (b) Test Samples purchased without the formalities of the Act. Milk 2 1 1 50.00 Butter 29 27 2 6.89 Margarine 1 1 — — Coffee 11 11 — Coffee and Chicory 1 1 — — Cocoa 1 1 — — Total "test" samples 45 42 3 6.90 Total all samples 514 497 17 3.31 90 Year. No. of Samples *(not including Test Samples). Genuine. Adulterated. Percentage Adulterated. No. of Prosecutions. Fines and Costs imposed. Table B. Summary of Samples {not including test samples) Analysed in the Borough in each Year, 1898-1909. 1898 Total Samples 36 31 5 13.88 2 Fines £3, costs 15s. 6d. 1899 Total Samples 41 37 4 97.5 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 Total Samples 458 389 69 15.07 34 Fines £123, costs £24 18s. 6d. 1903 Total Samples 451 390 61 13.53 19 Fines £50 15s., costs £11 7s. 1904 Total Samples 416 376 39 9.38 26 Fines £88 10s., costs £18. 1905 Milk 282 476 438 38 7.98 19 Fines £56 4s., costs £10 4s. Butter 91 Various 103 1906 Milk 275 *495 449 46 9.29 14 Fines £108, costs £6 13s. 6d. Butter 99 Various 121 1907 Milk 292 *496 460 36 7.26 17 Fines £30 10s., costs £10 12s. Butter 116 Various 88 1908 Milk 269 *412 378 34 8.25 15 Fines £28 10s., costs £1015s. 6d. Butter 93 Coffee 26 Wines and Spirits 15 Drugs 1 Sundries 8 1909 Milk 242 *469 455 14 2.99 5 Fined £11, costs £4 14s. Butter 110 Coffee 51 Wines and Spirits 24 Sundries 42 91 Table C. Showing Total Samples submitted with results during the years 1905-1909. (Test samples not included). Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1905 1906 1907 1908 1909 1905 1906 1907 1908 | 1909 1905 1906 1907 1908 1909 First 123 146 126 79 95 13 12 9 12 3 10.57 8.22 7.14 15.19 3.16 Second 103 88 119 147 128 9 6 5 13 6 8.74 6.82 4.20 8.84 4.69 Third 129 102 123 104 131 6 15 11 7 2 4.65 14.71 8.94 6.73 1.53 Fourth 121 159 128 82 115 10 13 11 2 3 8.26 8.18 8.60 2.44 2.61 Total for Year 476 495 496 412 469 38 46 36 34 14 7.98 9.29 7.26 8.25 2.99 Table D. Showing results of Total Samples of Milk submitted during the Years 1905-1909. Quarter. No. of Samples.* No. Adulterated. Percentage Adulterated. 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 First 88 63 55 53 56 8 6 5 9 2 9.09 9.52 9.09 16.98 3.57 Second 53 41 77 100 61 5 4 5 12 6 9.43 9.76 6.49 12.00 9.84 Third 68 77 95 55 78 3 12 8 3 2 4.41 15.58 8.42 5.45 2.56 Fourth 69 84 61 55 40 4 5 1 - 1 5.80 5.95 1.64 — 2.50 Total for Year 278 265 288 263 235 20 27 19 24 11 7.19 10.19 6.60 9.13 4.68 * Not including test samples. 92 Table E. Average Composition of Milk Samples submitted in 1909. Period. Average Composition of all samples submitted genuine and adulterated. Average Composition of genuine samples. Board of Agriculture Standard. Percentage of Milk fat. Percentage of Solids not fat. Percentage of Milk fat. Percentage of Solids not fat. Percentage of Milk fat. Percentage of Solids not fat. First Quarter 8.44 8.83 3.51 8.84 8.0 8.5 Second „ 3.37 8.82 3.43 8.84 Third „ 3.64 8.69 3.66 8.69 Fourth „ 3.80 8.92 3.82 8.94 Total for Year 3.55 8.80 3.60 8.81 93 Table F. Average Composition of Milk Samples submitted during the Years 1902-1909. Period. Average Composition of all samples submitted genuine and adulterated. Average Composition of genuine samples. Board of Agriculture standard. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. Year 1902 3.55 8.62 3.66 8.71 3.0 8.5 „ 1903 3.67 8.63 3.81 8.72 „ 1904 3.63 8.69 3.69 8.74 „ 1905 3.58 8.75 3.62 8.78 „ 1906 3.56 8.74 3.62 8.77 „ 1907 3.47 8.81 3.53 8.83 „ 1908 3.50 8.80 3.58 8.81 „ 1909 3.55 8.80 3.60 8.81 94 Table G. Details of Adulterated Samples of Milk during the Year ended December 31st, 1909. No. Adulteration. Remarks. 2 80 per cent. milk fat abstracted Unofficial sample; subsequent official sample genuine 50 4 per cent. milk fat abstracted Taken on delivery; further sample genuine 100 10 per cent. milk fat abstracted Vendor fined £3 and 12s. 6d. costs. 177 6 per cent. milk fat abstracted Vendor cautioned 197 4 per cent. milk fat abstracted Vendor cautioned 223 3 per cent. milk fat abstracted 228 3 per cent. milk fat abstracted 232 3 per cent. milk fat abstracted 248 12 per cent. milk fat abstracted Vendor ordered to pay 12s. 6d. costs 330 5 per cent. milk fat abstracted Vendor cautioned 365 20 per cent. milk fat abstracted Vendor fined £3 and £1 3s. costs 468 4 per cent. added water Further sample to be taken 467 Separated milk: 37 per cent. added water Vendor fined £2 and £1 3s. costs Table H. Showing the number of samples of Butter submitted in the Four Quarters of the years 1905-1909. Quarter. No. of Samples.* No. Adulterated. Percentage Adulterated. 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 First 22 33 34 20 22 3 4 1 3 — 13.62 12.12 2.94 15.00 — Second 17 23 25 34 26 — 1 — 1 — — 4.35 — 2.94 — Third 21 9 20 18 18 - 1 2 1 — — 11.11 10.00 5.56 — Fourth 31 34 37 21 44 4 6 6 1 — 12.90 17.65 16.22 4.76 — Total for year 91 99 116 93 110 7 12 9 6 — 7.69 12.12 7.76 6.45 — * Test samples not included. 95 Table J. Details of Other Samples Adulterated during the rear ended December 31st, 1909. No. Article. Adulteration. Remarks. 24 Butter Margarine Test samples: official sample genuine 56 Butter Margarine 26 Coffee 15 percent. chicory Vendor fined £3 and 23s. costs 43 Coffee 20 percent. chicory Declared as a mixture at time of purchase 493 Rum 3 degrees below standard No action :s. 99 I.—Local Government Board Tables. Table I. Vital Statistics of Whole District during the Years 1901-1909. 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 belonging to the District. Number. Rate.* Under i Year of Age At all Ages. Number. Rate.* Number. Rate per 1000 Births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1901 ]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 26.1 330 93 1566 11.5 480 152 99 1513 11.1 1904 140401 3589 25.6 448 125 1799 12.8 542 210 90 1679 12.0 1905 144420 3633 25.2 338 93 1804 12.5 569 232 119 1691 11.7 1906 148463 3446 23.2 391 113 1888 12.7 616 228 117 1777 12.0 1907 152532 3622 23.7 325 90 1881 12 3 660 275 143 1749 11.5 1908 156627 3632 22.8 315 87 1858 11.7 655 243 143 1757 11.0 1909 160749 3507 21.9 262 75 1707 10.7 570 174 131 1664 1.4 Note.—Figures for years prior to 1901 are unobtainable. *Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Area of District in Acres (exclusive of area covered by water)-6,991 At Census of 1901—Total population at all ages-27,495 ,, „ Number of inhabited houses -22,750 ,, ,,Average number of persons per house 5.6 100 Table II. Vital Statistics of Separate Localities in the Years 1901-1909. 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 18703 398 255 — 66631 1882 856 — 43146 1040 557 — 128480 3320 1668 — 1902 18925 481 220 37 69672 1857 991 261 43835 1153 607 130 132432 3491 1818 428 1903 19147 486 213 37 72731 1979 816 203 44527 1098 484 88 136405 3563 1513 328 1904 19370 469 193 40 75808 1967 941 265 45223 1153 545 135 140401 3589 1679 440 1905 19594 454 186 21 78903 2027 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 1908 20276 473 211 25 88302 2058 1005 196 48049 1101 541 94 156627 3632 1757 315 1909 20506 472 232 21 91476 1930 903 l70 48767 1105 529 71 160749 3507 1664 262 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; Nursing Home, Manor Park. Outside Institutions in which deaths of residents of this District have occurred were:—Gore Farm Hospital, Charing Cross, Guy's, King's College, London, Miller (Greenwich), 101 Middlesex, Royal, St. Bartholomew's, St. George's, St. Luke's, St. Mary's, St. Peter's, St. Thomas's, Greenwich Seamen's, University College, West London and Westminster Hospitals; Banstead, Caterham, Cane Hill, Colney Hatch, Dartford Heath, Darenth, Hanwell, Horton (Epsom), Long Grove, Manor, Peckham House and Tooting Bec Asylums; Brompton Hospital, Cancer Hospital, Chelsea, East London (Children's) Hospital, Evelina (Children's) Hospital, Friedenheim Hospital, Greenwich Union Infirmary, Greenwich Union Workhouse, Holborn Workhouse, Kidbrook Cottage Hospital, Maternity Hospital (Hackney), St. Luke's House, Kensington, St. Pancras Infirmary, St. Thomas's Home, Shoreditch Infirmary, Soho Hospital for Women, West End Hospital, Nursing Home (Shooter's Hill Road), Infants' Hospital (Vincent Square), Aged Pilgrims' Asylum, Camberwell, and Aged Pilgrims' Asylum, Holloway. Corrections were also made for deaths occurring as follows:-New Cross Railway Station, Victoria Railway Station, Grand Junction Canal, Fulham (Parson's Green), Hackney (Richmond Road), Islington (Shaftesbury Road), Paddington (Thorngate Road), Streatham (Besley Street), and Deptford (Lewisham High Road). 102 Table III. Cases of Infectious Disease Notified during the Year 1909. 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 361 5 86 219 30 21 - 48 202 111 48 179 84 311 Erysipelas 105 1 1 5 9 71 18 17 62 26 3 18 7 28 Scarlet fever 903 3 227 563 69 41 - 97 523 283 87 445 260 792 Typhus fever — — — — — — — — — — — — — — Enteric fever 16 — 1 6 3 6 - 2 7 7 1 1 3 5 Relapsing fever - - - - - - - - - - - - - Continued fever 1 - - - - 1 - - 1 - - - - - Puerperal fever 4 - - - - 4 - - 2 , 1 1 2 Plague... — — — — — — 2 — - - - Totals 1390 9 315 793 111 144 18 164 797 429 139 644 355 1138 *The cases from the Borough of Lewisham are treated chiefly at the Park Hospital of the Metropolitan Asylums Board, which is situated in the Lewisham Division of the Borough. Table IV. Causes of, and Ages at, Death during Year 1909. Cuses of Death. 1 Deaths in or Total Deaths in Public Institutions in the District Deaths in or be lo nqing to whole belonging District at subjoined Ages. to Localities (at all Ages). 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. 2 3 4 5 6 7 8 9 10 11 12 Small-Pox - - - - - - - - - - - Measles 7 - 7 — — - — 1 6 - 7 Scarlet fever 16 1 10 3 1 1 — 3 7 6 40 Whooping-cough 20 11 9 — — — — 2 16 2 3 Diphtheria and membranous croup 21 1 8 12 - - - 3 13 5 46 Croup 1 — 1 — — — — 1 — — — Fever Typhus - - - - - - - - - - - Enteric 2 — — — — 2 — — — 2 — Other continued - - - - - - - - - - - Epidemic influenza 4 — — — — 1 3 - 3 1 - Cholera — — — — — - — — — - - Plague — — - - - - - - - - - Diarrhoea (all forms) 15 15 - - - - - - 9 6 4 Enteritis and Gastro-Enteritis 14 11 1 - - 1 1 - 11 3 2 Gastritis 6 6 - - - - - - 5 1 - Puerperal fever 2 — — — — 2 — — 1 1 2 Erysipelas 2 — — — — 1 1 1 1 — — Phthisis (Pulmonary Tuberculosis) 125 2 5 19 94 5 14 75 36 51 Other tubercular diseases 36 7 12 10 2 3 2 5 19 12 10 Cancer, malignant disease 151 - - - - 84 67 27 74 50 36 Bronchitis 161 14 6 3 — 34 104 19 87 55 57 Pneumonia 100 21 17 4 4 25 29 15 58 27 22 Pleurisy 5 — — — — 5 - 1 1 3 — Other diseases of Respiratory organs 22 6 4 3 1 4 4 5 8 9 4 Alcoholism and Cirrhosis of liver 15 - - - - 10 5 3 6 6 4 Venereal diseases 2 2 - - - - - - 2 - - Premature birth 58 58 - - - - - 4 37 17 5 Diseases and accidents of parturition. 5 - - - - 5 - - 3 2 2 Heart diseases 286 9 — 5 7 126 139 41 154 91 94 Accidents 45 10 5 4 3 8 15 5 25 15 18 Suicides 16 - - — 2 12 2 2 9 5 3 All other causes 527 90 20 16 15 144 242 80 273 174 160 All causes 1664 262 102 65 54 562 619 232 903 529 570 103 104 Table V. INFANTILE MORTALITY DURING THE YEAR 1909. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. [Under I Week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under I Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year . All Causes. Certified 71 18 13 20 123 26 22 15 14 16 6 10 7 4 12 7 26l Uncertified 1 — — — - - - - - - - - - - — — 1 Common Infectious Diseases Small-pox - - - - - - - - - - - - - - - - - Chicken-pox - — — — - - - - - - - - - - - — — Measles - — — — — - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - 1 1 Diphtheria: Memb. Croup — — — - - - - - — 1 - — - - - 1 Whooping Cough - — — — - 2 3 — — 2 1 - 2 1 — - 11 Diarrhœal Disease Diarrhoea, all forms - — — — 3 1 1 3 1 1 1 1 — 2 - 15 Enteritis Muco-enteritis Gastro-enteritis — — — - — 1 3 - 1 4 1 — - — — 1 11 Gastritis, Gastrointestinal Catarrh 1 1 - - 2 3 — - - — — 1 — — — - 6 Wasting Diseases Premature Birth 42 3 3 7 55 1 _- 1 - 1 - - - - - 58 Congenital Defects 8 7 — — 15 1 2 1 1 - - - - - - - 20 Injury at Birth 7 — - — 7 - - - - - - - - - - - 7 Want of Breast-milk — - - - - - - - - - - - - - - - - •Atrophy, Debility, Marasmus 5 3 5 8 21 8 5 3 3 6 1 2 - 1 1 1 52 Tuberculous Diseases Tuberculous Meningitis — — - - - - - 1 - - - - 1 - 1 1 4 Tuberculous Peritonitis: Tabes Mesenterial - - - - - - - 1 1 1 - - - - - - 3 Other Tuberculous Disease - - - - - - - - - - - - - - - - - Other Causes Erysipelas - - - - - - - - - - - - - - - - - Syphilis — - - 2 2 - - - - - - - - - - - 9. Rickets — - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - 1 - - - - - 1 — 2 Convulsions 3 — - — 3 — 1 2 — — 1 — - — - — 7 Bronchitis — 1 — — 1 1 1 2 1 1 4 1 — 2 — 14 Laryngitis — - — — — — — — — — - — — — — — Pneumonia — - 1 — 1 3 4 1 2 — 2 1 1 5 1 21 Suffocation, overlaying 1 — — — 1 3 2 - — — — - — - — 6 Other Causes 5 3 4 3 15 — — 2 1 — — — 1 1 - 1 21 Totals 72 18 13 20 123 26 22 15 14 16 6 10 7 4 12 7 262 * Note.—Includes malnutrition, inanition, wasting, and asthenia. Population (estimated to middle of 1909), 160,749. Births in the year—legitimate, 3,400; illegitimate, 107. Deaths from all causes at all ages, 1,864. Deaths under one year—legitimate 256, illegitimate 6.