LEW8 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 1911, BY A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c., Medical Officer of Health and Public Analyst for the Borough of Lewisham; Fellow and Member of the Council of the Royal Sanitary Institute; Fellow of the Royal Society of Medicine; Fellow of the Royal Institute of Public Health; Formerly Medical Officer of Health for the Borough and Port of Southampton and Medical Superintendent of the Southampton Small-Pox and Fever Hospitals, & c. 3 BOROUGH OF LEWISHAM. EPITOME OF VITAL STATISTICS, 1911. Area in acres 6,991 Population :— Census, 1901 127,495 „ 1911 160,834 Estimated to the middle of 1911 161,677 Average number of persons per house (Census, 1901) 5.6 Births 3,421 Birth Rate 21-22 Deaths 1,842 Death-rate 1143 Deaths of infants under 1 year of age 357 Infant mortality per 1,000 Births 104 Zymotic Death-rats 1-16 4 CONTENTS. Page Area of the Borough 11 Bacteriological Examinations 48 Birth Rate 13 Cancer Deaths 23 Combined Drainage 57 Contacts, Small-Pox &c 43 Coroner's Court and Mortuary 59 Customs and Inland Revenue Acts, houses examined 52 Diphtheria cases 41 Enteric Fever cases 42 Factory and Workshop Act 60 House-to-house inspection 56 Housing, Town Planning, &c., Act 53 Infant mortality 25 Infectious disease notifications 37 Infectious diseases, non-notifiable 44 Infective diseases, deaths 22 Local Government Board Tables 87 Marriages 14 Meteorological Table 34 Mortality 14 Notification of Births Act 59 Population 11 Public Analyst, Report of 73 Pulmonary Tuberculosis, deaths 22 Pulmonary Tuberculosis, notifications 47 Sanitary Wwk, record of 69 Scarlet Fever cases 41 Schools, closure of 45 Seasonal mortality 15 Separated Milk 74 Smoke nuisances 58 Tuberculous diseases, deaths 22 Unsound food 59 Water certificates granted 51 Women Sanitary Inspectors, work of 66 Zymotic deaths 18 5 To the Mayor, Aldermen, and Councillors of the Metropolitan Borough oj Lewisham Gentlemen, I have the honour to submit to you my Report on the Vital Statistics and Sanitary Condition of the Borough for the year 1911, together with the Returns required by the Local Government Board and the Home Office. The Vital Statistics for the year under review show that Lewisham continues to retain its position as the second healthiest Borough in the Metropolis. The corrected death-rate from all causes amounted to 11.4 per 1,000 persons living at all ages, compared with 15.5 per 1,000 for the 77 Great Towns and 15.8 per 1,000 for the County of London. The lowest death-rate in London, 10.9 per 1,000, was recorded in the Borough of Hampstead. Owing to the exceptionally high temperature existing during the summer months, epidemic diarrhoea and enteritis were very prevalent throughout the country. In this Borough 113 deaths among children under one year of age were caused by this disease, which had the effect of raising the infant mortality rate to 104 per 1,000 births, compared with 79 per 6 1,000 in 1910. During this outbreak special efforts were made by your women inspectors to pay repeated visits to certain homes of infants under one year of age selected from our records. Their good work was greatly enhanced by the untiring efforts and valuable nursing assistance given by the nurses working in the district under the auspices of the Eanyard Nursing Association. I desire to record my appreciation of the excellent work performed by the whole of the staff of the Public Health Department, and the cordial support I have invariably received. I am, Gentlemen, Your obedient Servant, Medical Officer of Health. May, 1912. 7 LIST OF TABLES AND CHARTS. Part I.—Vital Statistics. Table 1.—Population. Table 2.—Deaths at Age Periods. Table 3.—Deaths and Death Rates in Wards. Table 4.—Zymotic Diseases, Deaths and Death Rates in Wards. Table 5.—Zymotic Diseases, Phthisis and Infant Mortality, Death Rates. Table 6.—Zymotic Diseases, Deaths in Disease Groups. Table 7.—Disease Groups, Deaths and Death Rates. Table 8.—Deaths under One Year of Age, Percentage to Total Deaths. Table 9.—Deaths under One Year of Age, Analysis of. Table 10.—Deaths, Causes of, and Ages at. Table 11.—Metropolitan Boroughs, Populations, Birth and Death Rates, and Infantile Mortality. Table 12.—Metropolitan Boroughs, Principal Infectious Diseases. Number of Deaths and Death Rates. Table 13.—Public Institutions in the Borough, Deaths of Residents and Non-Residents. Table 14.—Meteriological Table. Part II.—Infectious Diseases. Table 15.—Scarlet Fever and Diphtheria, Age Periods. Table 16.—Wards, Number of Cases. Table 17.—Attack Rates, Principal Infectious Diseases Table 18.—Metropolitan Boroughs, Attack Rates. 8 Part III.—General. Table 19.—Water Certificates Granted. Table 20.—Customs and Inland Revenue Acts, Certificates issued. Table 21.—Inspection of Factories, Workshops and Workplaces (Home Office Tables Nos. 1 and 2). Table 22.—Home Work, Outworkers, &c. (Home Office Table No. 3). Table 23.—Workshops, Workplaces and Workrooms on Register (Home Office Table No. 4). Table 24.—Routine Inspection. Tables 25.—Register of Sanitary Work. Part IV.—Report of Public Analyst. Table A.—Number of Samples submitted, with Results. Table B.—Summary of Samples Analysed, 1898 to 1911. Table C.—Number of Samples, 1907-1911. Table D.—Milk Samples, 1907-1911. Table E.— „ „ Average Composition, 1911. Table F.— „ „ „ „ 1902-1911. Table G.— „ „ „ Adulterated, 1911. Table H.—Butter Samples, 1907-11. Table I.— ,, „ Adulterated, 1911. Table J.—Other Samples, 1911. Appendix.—Local Government Board Tables. Table I.—Vital Statistics of Whole District, 1906-1911. „ II.—Cases of Infectious Disease notified during 1911. „ III.—Causes of, and Ages at, Death during 1911. „ IV.—Infant mortality, 1911. „ V.—Phthisis, Sanatorium and Hospital Accommodation. PART 1 . VITAL STATISTICS. II report of the Medical Officer of Health FOR THE YEAR 1911. AREA AND POPULATION. The population of the Borough at the Census taken on April 3rd, 1911, was 160,834. The estimated population to the middle of the year 1911, based upon the figures given by the Census of 1911 and that of 1901, is 161,677, and this figure is used in calculating the birth and death rates given in this Report. The area of the Borough is 7,014 acres, and the density of the population, based upc the atbove estimate, is 23 persons per acre. In 1901 the density was equivalent to 18-8 persons per acre. In the years from 1901 to 1911, the population of the Borough increased from 127,495 to 160,834, a total increase of 33,339 persons. In the Catford Ward, during the ten years, the population rose from 23,203 to 39,012, an increase of 15,809 persons, or 68 per cent. No other Ward in the Borough showed so great a proportional increase, although Lewisham Park Ward, with an increase of 50 per cent., was very near. Two Wards showed a decrease in population, viz., Church Ward, Lee, and Blackheath. Table 1 shows in detail the population of the various Wards. 12 Ward Area in acres. Enumerated Population Census, April, 1901. Enumerated Population Census, April, 1911. In the 10 years 1901-11. Estimated Population June, 1911. Table 1. Population of the Borough, in Wards. Increase. Decrease. Males. Females. Total Persons. No. of Persons. Per centage. No. of Persons Per centage. Church 202 6412 2392 3583 5975 - 437 6-8 5964 Manor 175 6734 3574 4476 8050 1316 19-5 __ 8083 South 878 5503 2762 3577 6339 836 15-2 — — 6360 Blackheath 369 6729 2753 3817 6570 — — 159 2-2 6566 Lewisham Village 279 13842 6803 7935 14738 896 6-5 — — 14761 Lewisham Park 350 11145 8015 8734 16749 5604 50-0 — — 16891 Brockley 512 10952 6941 8063 15004 4052 37-0 — — 15106 Catford 2541 23203 18217 20795 39012 15809 68-0 — — 39412 Forest Hill 624 18051 9158 11646 20804 2753 15-2 — — 20874 Sydenham 1084 24924 12165 15428 27593 2669 10 7 — — 27660 W hole Borough ... 7 014 127495 72780 88054 160834 33339 26-0 _ — 161677 13 BIRTH RATE. Number of births 3421 Average number of births in previous 10 years 3521 Birth rate per 1,000 in 1911 21.22 Birth rate, County of London 24.8 „ 77 Great Towns 25-6 „ England and Wales 24.4 The total number of Births registered in the Borough during the year amounted to 3,397. A number of children are registered every year in the Borough, whose parents are only temporarily residing in the district ; on the other hand, children are born in other boroughs, in various nursing homes and Lying-in Institutions, whose parents really belong to this Borough. In previous years no corrections have been made for these transferable births, but now, by the courtesy of the Registrar General, we are supplied with the figures necessary to make these corrections. During 1911 live births registered in in Lewisham were transferred to other districts, and 29 outside births transferred to this Borough. The corrected number of births is therefore 3,421, compared with 3,412 in 1910, a very slight increase, or probably no increase at all, if figures for correction had been available in the previous year. In 1901, 3,320 births were registered, so that in ten years the annual number of births has increased by only 101. The number of females born in 1911 was 1,641, and males 1,780. The birth rate for the year is 21-22 per 1,000 of the estimated population. In 1901, the previous Census year, the birth rate was 25.9 per 1,000, a decrease of 4.7 having taken place in the ten years. The birth rate for the County of London was 24.8 per 1,000, and for the 77 Great Towns 25'6 per 1,000. Illegitimacy.—The illegitimate births numbered 101. 14 MARRIAGE RATE. The number of Marriages in the Borough during the year was 1,061, compared with 1,015 in 1910 and 966 in 1909. The Marriage Rate was equal to 6.5 per 1,000 of the population. Of the 1061 marriages in this Borough, 630 were solemnized at the Established Church, 134 at Nonconformist Places of Worship, and 297 at the Register Office. MORTALITY. Nett number of deaths, 1911 1842 Death rate per 1,000, 1911 11.43 „ County of London 15.8 „ 77 Great Towns 15.5 „ England and Wales 14-6 The total number of Deaths registered in the Borough during the year was 1,879. After deducting the deaths of non-residents dying within the Borough (255), and adding those of residents of the Borough dying outside (218), a corrected total of 1,842 is obtained, compared with 1,590 in the previous year. Prior to 1911, corrections for deaths of residents dying outside the Borough have been confined to residents dying in the Metropolis and in Public Institutions belonging to the Metropolis. The Registrar General has now made arrangements to supply particulars of residents dying in other parts of the country, and thus the number of deaths of actual residents can be arrived at with greater accuracy. These further corrections have only been made for the first three quarters of the year, as 15 the preparation of the Report was commenced before the corrections for the fourth quarter had come to hand. The corrected death rate for the Borough equalled 11.43 per 1,000 of the population. In 1901 the death rate was 13.0 per 1,000. The death rate for the County of London was 15.8 per 1,000, and that for the 77 Great Towns, 15.5 per 1,000. With the exception of Hampstead (10.9) our death rate is the lowest of all Metropolitan Boroughs. Ages at Death.—A division of the deaths at various age periods is arranged in Table 2. The percentage of deaths under one year of age is slightly higher than in any previous year since 1906. Seasonal Mortality.— In the first quarter the deaths numbered 186 „ „ second quarter „ „ „ 398 „ „ third quarter „ „ 508 „ „ fourth quarter „ „ „ 450 16 1904. 1905. 1906. 1907. 1908.* 1909. 1910. 1811. Table 2 ANALYSIS OF DEATHS. Number of Deaths at Various Age Periods and their Percentage tc Corrected Total Deaths during the years 1904-1911. AGE PERIOD. Number of Deaths. Percentage to 1 Total Deaths. Number oi 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 1 Deaths. Percentage to Total Deaths. Deaths under 1 yr. 440 26.21 338 19.99 391 22.00 325 18.58 315 17.93 262 15.75 271 17.04 357 19.38 Over 1 & under 5 yrs. 140 8.34 130 7.69 160 9.00 146 8.35 163 9.28 102 6.13 112 7.04 130 7.05 >> 5 ,, 15 ,, 39 2.32 59 3.49 57 3.21 60 3.43 64 3.64 65 3.91 66 4.17 75 4.07 „ 15 ,, 25 ,, 85 5.06 63 3.72 68 3.83 65 3.72 61 3.47 54 3.25 60 3.77 67 3.63 ,, 25 ,, 65 ,, 470 27.99 547 32.35 596 33.54 577 32.99 593 33.75 562 33.77 522 32.83 623 33.07 Over 65 years 505 30.08 554 32.76 505 28.42 576 32.93 561 31.93 619 37.20 559 35.15 590 32.03 Total ... 1679 100.0 1691 100.0 1777 100.00 1749 100.0 1757 100.0 1664 100.0 1590 100.0 1842 100.00 CHART A. Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 Weeks ended December 30th, 1911. 17 Table 3. Corrected Deaths and Death Rates from All Causes in Wards, Divisions, and the Whole Borough, in the Year 1911. Localities. Males. Females. Total Deaths. Death Rates. Church Ward 42 42 84 14.12 Manor Ward 40 54 94 11.66 South Ward 33 34 67 10.56 Lee Division 115 180 245 12.04 Blackheath Ward 33 26 59 9.01 Lew. Village Ward 99 85 184 12.50 Lew. Park Ward 97 105 202 11.99 Brockley Ward 73 82 155 10.29 Catford Ward 211 181 392 9.97 Lewisham Division 513 479 992 10.73 Forest Hill Ward 129 126 255 12.25 Sydenham Ward 176 174 350 12.70 Sydenham & Forest Hill Division 305 300 605 12.50 Whole Borough 933 909 1842 11.43 18 ZYMOTIC DEATH RATE. The zymotic death rate is calculated upon the number of 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. During the year under review the deaths from zymotic diseases amounted to 187, compared with 85 deaths in 1910. This increase is accounted for by the fact that 115 deaths were certified to be due to Epidemic Diarrhoea and Enteritis, an unfortunate result of the extraordinarily hot and dry weather experienced in the summer months. The zymotic death rate for the Borough was 1.16 per 1,000. In 1901, in which year 103 deaths from Epidemic Diarrhoea occurred, the zymotic rate was 1.62 per 1,000. The rate for the County of London was 2.17 and for the 77 Great Towns, 2.29 per 1,000. It will be seen from Table 6 that the great majority of the deaths from zymotic diseases were of children under one year of age. 19 Table 4. Deaths and Death Rates from Principal Zymotic Diseases in Wards, during the year 1911. Localities Small-Pox Measles Scarlet Fever Diphtheria Whooping Cough Enteric Fever Epidemic Diarrhoea & Epidemic Enteritis Totals Death Kates from Principal Zymotic Diseases. Church Ward — — — 2 — 4 7 1.17 Manor Ward — 5 — 1 — — 7 13 1-61 South Ward — 3 — — — — 4 7 1.10 Lee Division — 9 — 1 2 — 15 27 1.33 Blackheath Wd — — — 2 — _ 2 4 0 .61 Lew. Vill. Wd. — — 1 2 — — 8 11 0.75 Lew. Pk. Wd. — 6 — 5 2 — 14 27 1.60 Brockley Ward — — — 2 — — 12 14 0.90 Catford Ward — 1 i 6 3 1 31 43 1.09 Lewisham Div. — 7 2 17 5 1 67 99 1.07 Forest Hill Wd. — — — 2 1 1 15 19 0.91 Sydenham Ward — 3 3 7 9 2 18 42 1.52 Sydenham and Forest Hill Div. — 3 3 9 10 3 33 63 1.30 Whole Borough — 19 5 27 17 4 115 187 1.16 20 Table 5. Death Rates from principal Zymotic Diseases and Phthisis, and Infantile Mortality in the Borough and its Divisions, for the Year 1911. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough Small-Pox — — — _ Measles 0.44 0.07 0.06 0.12 Scarlet Fever — 0.02 0.06 0.03 Diphtheria 0.05 0.18 0.18 0.17 Whooping Cough 0.09 0.05 0.20 0.10 Enteric Fever — 0.01 0.06 0.02 Epidemic Diarrhoea and Enteritis 0.73 0.72 0.08 0.71 Total Zymotic Death Rates 1.33 1.07 1.30 1.16 Infantile Mortality Rate 111 99 111 104 Phthisis Death Rate 0.64 0.51 0.74 0.64 Comparative Rates for other Boroughs will be found in Table 12. 21 Table 6. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1911. Ages. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Epidemic Diarrhoea and Enteritis. Totals in Age Groups. Under 1 year — 3 — l 5 — 102 111 1 and under 2 years _ 7 — 3 5 _ 6 21 2 and under 5 _ 8 2 8 6 _ 1 25 5 and under 15 — 1 3 15 1 _ 1 21 15 and under 25 _ _ _ _ _ l — 1 25years and upwards — _ — _ — 3 5 8 Total all ages 1911 — 19 5 27 17 4 115 187 Total all ages 1910 — 12 12 19 26 3 11 85 22 ANALYSIS OF DEATHS IN DISEASE GROUPS. Infective Diseases.—-209 deaths. Enteric Fever.—Only four fatal cases of this disease occurred. Measles was certified to be the cause of 19 deaths, compared with 12 in 1910. Scarlet Fever.—Five deaths from this disease occurred, and 12 in 1910. Whooping Cough was the cause of 17 deaths, 16 of the victims being under five years of age, and 10 under two years. In 1910, 26 deaths were due to this disease. Diphtheria was the cause of 27 deaths, eight more than last year. Epidemic Diarrhoea and Enteritis.—The number of deaths due to these diseases was 115, and of these, 108 were under the age of two years. Tuberculous Diseases.—140 deaths. Phthisis or Pulmonary Tuberculosis, was the cause of 104 deaths, or 14 more than in 1910. Seventy-one of the victims were under 45 years of age. This mortality is equal to a death rate of 0.64 per 1,000. In 1901, 120 deaths from Phthisis were recorded, and the death rate was 0.93 per 1,000, showing that in ten years the death rate from this disease has decreased by over 30 per cent. In the County of London, 6,034 deaths occurred from Phthisis, equal to a death rate of 1.35 per 1,000. Malignant Diseases.—171 deaths. 23 Cancer was the cause of 136 deaths, or 17 more than last year, and equal to a death rate of 0.84 per 1,000. In 1901 the rate was 0.93 per 1,000. Diseases of the Nervous System.—85 deaths. Eightyfive deaths were certified in this Class, 27 being due to Insanity, 16 to Meningitis, and 11 to Epilepsy. Diseases of the Heart and Circulatory System.—302 deaths. The deaths in this Class represent 16 per cent, of the total. Diseases of the Valves of the Heart were responsible for 91 deaths, and Cerebral Haemorrhage, 64. Respiratory Diseases.—286 deaths. Bronchitis (136 deaths) and Pneumonia (119 deaths) are the cause of the majority of deaths from diseases of the respiratory organs, and the first three months of the year prove the most fatal, especially to aged people, 77 of the victims of bronchitis being over 65 years of age. Diseases of the Digestive System.—141 deaths. Diseases of the Urinary Organs.—06 deaths. Nephritis and Bright s Disease were the certified causes of 42 deaths. Diseases of Generative Organs.—7 deaths. Unclassified Diseases.—362 deaths. 151 persons died from Old Age, 43 from Premature Birth, and 80 from Congenital Debility and Malformation (73 being under one year old). Accidents.—57 deaths. Burning and Scalding, 7 deaths, Overlaying, 6, Poison, 1, and Drowning, 3. Deaths from Violence.—16 deaths. Sixteen persons committed suicide. 24 Disease Groups. Lee Division. Lewisham Division. Sydenham and Forest Hill Division. Whole Borough. Table 7. Deaths and Death Rates in Disease Groups in each Division of the Borough for the year 1911. Deaths. Death Rate. Deaths. Death Rate. Deaths. Death Rate. Deaths. Death Rate. per 1000. per 1000. per 1000. per 1000. Infective 30 1.47 112 1.21 67 1.38 209 1.29 Tuberculous 18 0.88 77 0.83 45 0.93 140 0.87 Malignant 25 1.22 94 1.01 52 1.07 171 1.06 Nervous System 9 0.44 48 0.51 28 0.57 85 0.53 Heart and Circulatory 29 1.42 168 1.81 105 2.17 302 1.92 Respiratory System 38 1.86 147 1.59 101 2.08 286 1.77 Digestive System 20 0.98 71 0.76 50 1.04 141 0.88 Urinary Organs 17 0.83 30 0.32 19 0.39 66 041 Generative 1 0.05 3 0.03 3 0.06 7 004 General and Unclassified 53 2.65 200 2.16 109 2.22 362 2.25 Accidents 3 0.14 36 0.38 18 0.37 57 0.35 Violence 2 0.10 6 0.06 8 0.17 16 0.09 Totals 245 12.04 992 10.73 605 12.50 1842 11.43 CHART B. Showing the principal causes of Death during the year 1911. 25 INFANT MORTALITY. The infant mortality rate represents the proportion of deaths of children under one year of age to every thousand births registered. During 1911, 357 children died before reaching the age of one year, or nearly 20 per cent. of the whole of the deaths in the Borough. The infant mortality rate is therefore 104 per 1,000 births, which is much higher than the rate for the previous year (79), but is only very slightly higher than the average for the previous ten years. The rate for the County of London was 129 per 1,000, and for the 77 Great Towns, 140 per 1,000. Causes of Death.—The following list shows the principal causes of the deaths of infants under one year of age during 1911 :— Epidemic Diarrhoea and Enteritis 114 Debility and Marasmus 59 Premature Birth 43 Whooping Cough 5 Measles 3 Bronchitis 24 Pneumonia 25 Suffocation in bed with parents 6 Congenital Malformations 14 Atelactasis and Injury at Birth 6 Other causes 58 357 26 Percentage of Deaths under one year of age to Total Deaths in Wards and Divisions for the years 1904-1911. District. 1904. 1905. 1906. 1907. 1908. 1909. 1910 1911. per cent. per cent. per cent, per cent. per cent. per cent. per cent. per cent. Church Wd. 19.7 12.7 18.4 14.3 10.8 8.3 12.9 17.8 Manor Ward 26.0 9.4 20.5 20.0 12.7 8.0 12.4 18.0 South Ward 13.3 11.8 17.3 5.6 12.1 11.6 14.3 11.9 Lee Division 20.7 11.3 19.0 14.5 11.8 9.1 13.1 16.3 Blackheath Ward 13.9 17.0 17.3 8.8 15.3 10.5 10.3 10.2 Lew. Village Ward 27.6 20.7 19.3 18.0 21.2 16.8 23.4 17.9 Lew.Pk.Wd. 31.5 20.5 21.9 20.0 19.6 21.7 16.7 16.3 Brockley Ward 27.2 15.7 22.7 20.8 17.2 14.2 22.0 29.0 Catford Wd. 31.3 26.0 24.9 19.8 20.3 21.8 18.8 21.4 Lew. Div. 28.2 21.5 22.0 18.7 19.5 18.8 18.9 20.4 Forest Hill Ward 18.6 17.5 20.0 19.1 17.7 10.7 14.2 20.0 Sydm. Ward 29.1 22.4 25.1 20.7 17.1 15.2 16.4 18.3 Sydm. & Forest Hill Division 24.8 20.2 23.1 20.0 17.4 13.4 13.4 19.0 Whole Borough 26.21 19.99 22.0 18.6 17.9 15.7 17.0 19.4 27 Disease. 1905. 1906. 1907. I908. 1909 1910. 1911. Table 9. Analysis of Deaths under one year of age, during the years 1905 1911. Number of Deaths under 1 year. Percentage Deaths to total Deaths under 1 year. Number of Deaths under 1 year Percentage Deaths to total Deaths under 1 year. Number of Deaths under 1 year. Percentage Deaths to total deaths under 1 year. Number of Deaths under 1 year. Percentage Deaths to total _ Deaths under 1 year. 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 23 6.8 17 4.8 20 6.2 25 7.9 13 5.0 18 6.6 9 2.5 Diarrhoeal Diseases 59 17.5 128 81.5 41 12.6 49 15.6 82 12.2 22 8.1 114 31.9 Wasting Diseases 139 41.1 147 87.6 162 49.8 140 44.4 137 52.3 143 52.8 116 82.5 Tuberculous Diseases 10 3.0 14 3.6 9 2.8 13 4.1 7 2.7 6 2.2 6 1.7 Respiratory Diseases 43 12.7 46 11.8 50 15.4 47 14.9 35 13.4 45 16.6 52 14.6 Diseases classified under other headings 64 18.9 44 11.3 43 13.2 41 13.0 38 14.5 37 13.2 60 17.0 Total 388 100.0 391 100.0 325 100.0 315 100.0 262 100.0 271 100.0 357 100.0 Note.—For detailed list of these diseases see Table IV. of the Local Government Board Tables (page 90). 28 Table 10. Causes of, and Ages at, Death in the Borough of Lewisham during the year ended December 30th. 1911. Causes ok Death Deaths Whoi.b Borough Total all Ages Borough Divisions Deaths of Residents 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 2 years 2 and under 5 years 5 and under 15 years 15 and under 23 years 25 and under 43 years 45 and under 63 years 65 years and upwards Lee Lewisham Sydenham and Forest Hill | In Public Institutions In other places. 1 2 3 4 5 6 7 8 9 10 ii 12 13 14 IB 16 Class A.—Infective Diseases 1 Enteric Fever _ 1 2 1 4 – 1 3 – 4 – – 2 Small-Pox — — — — — — — — — — — — — — — – 3 Measles 3 7 8 1 — — — — 19 9 7 3 — 3 4 — 4 Scarlet Fever — — 2 3 — — — — 5 2 3 — 4 — — 5 Whooping Cough 5 5 6 1 — — — — 17 2 5 10 1 5 1 — 6 Diphtheria 1 3 8 15 — — — — 27 1 17 9 — 21 1 — 7 Croup — — — — — — — — — — — — — — — — 8 Influenza 2 – — 1 — 1 — 1 5 — 4 1 — — — — 9 Erysipelas – — — — – — — — — — — — — — — — 10 Cerebrospinal Fever — — — — — — — — — — — — — — — — 11 Epidemic Diarrhœa 57 2 1 — — — — 2 62 12 32 18 11 — 5 1 12 Epidemic Enteritis 45 4 — 1 — 1 2 — 53 3 35 15 12 2 5 1 13 Dysentry — — — — — — — — — — — — — — — – 14 Venereal Diseases 3 – — — — — — — 3 — 1 2 — 1 5 — 15 Puerperal Disea e – — — — 1 2 — — 3 — 1 2 2 1 — — 16 Septicœmia — 2 1 — — 3 — — 6 2 4 — 2 3 1 — 17 Pyæmia 1 — — — — — — — 1 — 1 — — 1 2 — 18 Infective Endocarditis — — — — — 1 — — 1 — 1 — — 1 2 — 19 Other Infective Diseases — — — 1 — — 1 1 3 1 1 1 — 1 1 — Class B.— Tuberculous Diseases 20 Phthisis (Pulmonary Tuberculous) — 2 21 48 25 8 104 13 55 36 26 17 5 1 21 Meningitis 4 6 0 3 — 1 — — 20 4 8 8 5 1 3 I 22 Peritonitis 1 1 1 1 1 1 — — 6 — 6 — 1 2 2 — 23 Scrofula — — — — — — — — — — — — — — — — ,24 Other Tuberculous Dis. 2 — — 4 1 3 — — 10 1 8 1 2 2 6 — ClassC.— Malignant Diseases 25 Cancer, Carcinoma — – — 1 — 13 64 58 136 20 78 38 26 10 5 1 26 Sarcoma — — 2 1 1 4 1 2 11 — 6 5 4 2 — — 27 Other Malignant Dis. — — — — — 1 12 11 24 5 10 9 2 2 — — 28 Meningitis (not Tuber.) 3 2 3 2 4 1 1 — 16 — 13 3 4 2 — — Class D.— Nervous Diseases 29 Insanity — — — — 1 5 11 9 26 3 14 9 4 15 2 — 30 Epilepsy — — — — 3 3 3 2 11 — 4 7 2 3 2 — 31 Convulsions 7 — 1 — — — — — 8 — 3 5 — — — — 32 Locomotor Ataxy — — — — — — 2 1 3 1 2 — 1 — — — 33 Paraplegia(Dis.of Cord) — — — — — 1 1 2 4 1 3 — 1 1 — — 34 Other Nervous Diseases 1 — — 2 — 3 8 3 17 4 9 4 2 6 2 — Class E.— Diseases of Heart and Blood Vessels 35 Valvular Disease, Endocarditis — — 6 9 16 28 32 91 10 47 34 18 7 7 2 36 Cerebral Hemorrhage — — — — — 3 28 33 64 4 38 22 12 3 11 — 37 Thrombosis – – – – – – 2 4 6 1 3 2 — — — — 38 Apoplexy, Hemiplegia — — — — — 2 6 13 21 1 13 7 4 1 — — 39 Aneurysm — — — — — — 5 1 6 — 6 — 1 3 — — 40 Embolism — — — — — 2 2 2 6 2 1 3 2 — — — 41 Thrombosis, not Cereb. — — — — — — — 1 1 — 1 — — — — — 42 Pericarditis — — — — — 1 — — 1 — 1 — — — 1 — 43 Other Dis. of Heart and Blood Vessels 6 1 — 1 3 12 33 50 106 11 58 37 12 18 8 — 29 Table 10—continued. Causes or Death Deaths Whole Borough Total all Ages Borough Divisions Deaths of Residents in Public Institutions in Borough Deaths of Residents outside the Borough Deaths of Non-residents in the Borough Under 1 year 1 and under 2 years 2 and under 9 years 5 and under 19 years 15 and under 29 years 25 and under 4B years 45 and under 69 years 65 years and upwards Lee Lewisham Sydenham and Forest Hill In Public Institutions In other places 1 2 3 4 5 6 7 8 9 10 11 13 13 14 15 16 Class F.— Respiratory Diseases 44 Croup (Spasmodic, &c.) — — — — — — — — — — — — — 45 Bronchitis 24 5 2 I — 4 23 77 136 17 72 47 28 1 31 — 46 Broncho-pneumonia 17 15 4 1 — 2 2 8 49 5 25 19 5 4 13 1 47 Pneumonia (all other forms) 8 1 4 4 4 18 19 12 70 9 36 25 21 6 11 — 48 Asthma, Emphysema — — — — — 1 4 3 8 3 4 1 1 — — — 49 Pleurisy — — — — — 2 1 — 3 1 2 — — 1 — — 50 Other Respiratory Dis. 11 — — 1 — 4 1 3 20 3 8 9 4 — 2 — Class G.— Digestive Diseases 51 Enteritis(not Epidemic) 4 2 1 — — — 1 1 9 1 6 2 – – 8 _ 52 Gastro-enteritis 8 3 1 1 _ 1 1 5 20 2 12 6 2 1 1 — 53 Gastro-intestinal Catar. — — — — — 1 — 2 3 — 2 1 — — — — 54 Peritonitis (not Puerperal) 1 1 1 3 2 1 — 2 55 Appendicitis&Typhlitis — — 1 5 6 2 4 1 19 5 11 3 8 6 1 — 56 Gastric Ulcer 1 — 1 3 3 2 10 3 5 2 5 1 1 — 57 Cirrhosis of Liver — — — – — 1 9 7 17 2 7 8 2 — — — 58 Other Diseases of Liver 1 — — — — 2 4 5 12 1 6 5 — 1 — — 59 Other Digestive Diseases 7 3 3 1 2 1 9 22 48 6 20 22 11 6 7 1 Class H. Urinary Diseases 60 Nephritis and Bright's Disease — — — 1 2 10 18 11 42 12 17 13 11 6 3 — 61 Other Urinary Diseases — — — — — 2 10 12 24 5 13 6 12 2 1 — Class 62 Generative Organs, Diseases of — — — — — 2 5 — 7 1 3 3 3 2 — — 63 Old Age — — — — — — 1 150 151 27 83 41 57 5 25 — Class J— General Diseases 64 Premature Birth 43 — — — — — — — 43 8 24 11 1 1 1 1 65 Congenital Debility ana Malformation 73 4 3 — — — — — 80 6 49 25 28 2 42 1 66 Chronic Rheumatism — — — — — — 1 2 3 — 1 2 — — — — 67 Rheumatic Fever — — — 4 — — 1 — 5 — 3 2 — — — — 68 Diseases and Accidents of Parturition 1 — — — 1 3 — — 5 — 1 4 1 — — — 69 Alcoholism _ — — — 1 1 2 2 — 1 — — — 70 Gout — — — — — — 1 1 2 1 1 1 — — — 71 Diabetes Mellitus — — — 2 — 6 12 4 24 1 14 9 6 3 — — 72 All Other Diseases 8 2 2 4 1 4 16 10 47 11 22 14 12 6 4 — Class K— Accidents 73 Burning: and Scalding 2 — 1 — 1 1 — 2 7 — 7 — 4 — — — 74 Overlaying 6 — — — — — — — 6 — 2 4 — — — — 75 Poison — — — — 1 — — 1 1 — — — 1 — — 76 Drowning 1 — — — 1 1 — 3 — 2 1 — 2 — — 77 Other Accidents 1 — 1 3 2 10 12 11 40 2 25 13 13 12 6 3 Class L— Violence 78 Homicide — — — — — — — — — — — — — — — — 79 Suicide — — — — 1 9 5 1 16 2 6 8 2 5 — 2 Grand Totals 357 68 62 75 67 222 401 590 1842 245 992 605 396 218 239 16 30 Table 11. Metropolitan Boroughs.—Population, Birth and Death Rates and Infantile Mortality. Boroughs. Population estimated to the middle of 1911. Births. Deaths. Birth Rate. Death Rate. Deaths of Infants under I year of age. Number. Rate per 1000 Births. County of London 4521301 111738 67826 24.8 15.8 14440 129 West. Paddington 142513 3038 1897 21.4 14.3 387 127 Kensington 172203 3252 2349 18.9 14.7 432 133 Hammersmith 121766 2927 1891 24.1 16.2 428 146 Fulham 153705 4121 2203 26.9 15.0 517 125 Chelsea 66189 1269 1020 19.2 16.0 138 109 City of Westminster 159662 2358 1383 14.8 14.0 244 103 North. St. Marylebone 117761 2376 1772 20.2 16.1 257 108 Hampstead 85589 1276 323 14.9 10.9 99 78 St. Pancras 217941 5559 3371 25.6 16.2 624 112 Islington 327203 8108 4853 24.8 15.5 1032 127 Stoke Newington 50614 1045 658 20.7 13.6 107 102 Hackney 222623 5226 3185 23.5 15.0 621 119 Central. Holborn 49092 945 768 19.3 16.9 109 115 Finsbury 87566 2674 1728 30.6 20.5 418 156 City of London 19466 226 293 11.6 16.6 28 124 East. Shoreditch 111199 3533 2226 31.9 21.1 601 170 Bethnal Green 128144 4029 2320 31.5 18.3 610 151 Stepney 279309 8743 4833 31.4 18.1 1261 144 Poplar 162274 5015 3054 31.0 19.5 787 157 South. South wark 191531 5693 3509 29.8 19.2 818 144 Bermondsey 125775 3908 2311 31.2 18.9 609 156 Lambeth 297957 7292 4430 24.5 15.4 897 123 Battersea 167712 4372 2391 26.1 15.3 540 124 Wandsworth 313453 6747 3743 21.6 12.6 823 122 Camberwell 261380 6399 3724 24.5 14.8 696 109 Deptford 109472 3000 1706 27.5 16.4 425 142 Greenwich 95973 2376 1409 24.8 15.0 305 128 Lewisham 161677 3420 1842 21.2 11.4 354 104 Woolwich 121487 2811 1555 23.2 13.7 273 97 31 Table 12. Metropolitan Boroughs.—Principal Infectious Diseases, Number of Deaths, and Rates per 1,000 of the Population. Boroughs. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Diarrhoea & Enteritis (under 2) Phthisis. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. County of L'nd'n 144 0.03 9 0.00 2570 0.57 172 0.04 1038 0.23 612 0.14 5313 1.18 6084 1.35 West. Paddington 5 0.04 — — 48 0.34 3 0.02 44 0.31 11 0.08 134 0.94 173 1.22 Kensington 4 0.02 — — 94 0.55 2 0.01 54 0.31 18 0.10 146 0.85 159 0.93 Hammersmith 7 0.06 — — 36 0.30 5 0.04 35 0.29 28 0.23 178 1.47 153 1.26 Fulham 8 0.05 — — 64 0.42 7 0.05 28 0.18 27 0.18 213 1.39 224 1.46 Chelsea — — — _ 30 0.45 1 0.02 10 0.15 5 0.08 55 0.83 96 1.45 City of Westm'er 4 0.03 — — 23 0.14 3 0.02 26 0.16 14 0.09 63 0.40 193 1.21 North. St. Marylebone 2 0.02 — — 66 0.56 7 0.06 28 0.24 5 0.04 83 0.71 172 1.46 Hampstead 2 0.02 — — 14 0.16 — — 3 0.04 17 0.20 22 0.26 52 0.61 St. Pancras 7 0.03 — — 108 0.50 12 0.06 55 0.25 37 0.17 201 0.92 342 1.57 Islington 12 0.04 — — 130 0.40 21 0.06 70 0.21 51 0.16 365 1.12 405 1.24 Stoke Newington 1 0.02 — — 28 0.55 3 0.06 18 0.36 3 0.06 28 0.55 55 1.09 Hackney 8 0.01 — — 148 0.67 11 0.05 58 0.26 20 0.09 195 0.88 311 1.40 Central. Holborn 3 0.06 — — 15 0.31 3 0.06 3 0.06 3 0.06 34 0.69 102 2.08 Finsbury 8 0.09 — — 79 0.90 6 0.07 24 0.27 17 0.19 142 1.63 163 1.87 City of London — — — 1 0.05 1 0.05 1 0.05 1 0.05 10 0.52 31 1.60 East. Shoreditch 1 0.01 — — 128 1.15 6 0.05 32 0.29 24 0.22 222 2.00 204 1.84 Bethnal Green 3 0.02 — — 130 1.02 5 0.04 49 0.38 21 0.16 248 1.94 208 1.63 Stepney 6 0.02 7 0.03 303 1.09 7 0.03 49 0.18 32 0.11 468 1.68 493 1.77 Poplar 14 0.09 2 0.01 225 1.39 10 0.06 44 0.27 44 0.27 316 1.95 213 1.32 South. South wark 5 0.03 — — 120 0.63 6 0.03 64 0.34 30 0.16 298 1.56 326 1.71 Bermondsey 5 0.04 — — 55 0.44 6 0.05 50 0.40 13 0.10 212 1.69 223 1.78 Lambeth 12 0.04 — — 112 0.38 8 0.03 67 0.23 43 0.14 336 1.13 419 1.41 Battersea 3 0.02 — — 112 0.67 4 0.02 36 0.22 20 0.12 222 1.33 223 1.33 Wandsworth 9 0.03 — — 230 0.74 10 0.03 70 0.22 33 0.11 293 0.94 277 0.89 Camber well 5 0.02 — — 112 0.43 7 0.03 45 0.17 25 0.10 270 1.06 350 1.34 Deptford 2 0.02 — — 69 0.63 7 0.06 37 0.34 15 0.14 171 1.57 139 1.27 Greenwich 3 0.03 — — 41 0.43 3 0.03 14 0.15 16 0.17 152 1.59 112 1.17 Lewisham 4 0.03 — — 19 0.13 5 0.03 17 0.11 27 0.17 108 0.66 104 0.64 Woolwich — — — — 28 0.23 3 0.02 6 0.05 11 0.09 102 0.84 162 1.34 32 Table 13. Residents and Non-Residents dying in Public Institutions situated in the Borough. Institution Deaths of Residents. Deaths of NonResidents. Total. The Park Children's Hospital 2 110 112 Lewisham Union Infirmary Lewisham Union 843 20 368 Workhouse 28 1 29 Bermondsey (St. Olave's) Workhouse – 74 74 St. John's Hospital 13 13 26 Home for Sick Children, Lower Sydenham 10 16 26 Greenwich Union Workhouse, Grove Park – 8 3 Flower House, Southend Catford 2 2 Totals 396 239 635 Deaths of Residents Of the Borough occurring in Public Institutions, etc., in districts outside, during the year 1911. Fever Hospitals :— Brook, 23 ; South-Eastern, 14 ; South Western, 2 ; East Ham, 1. Asylums for the Insane:— Banstead Asylum, 3 ; Bethlehem Royal Hospital, 2 ; Brookwood, 1 . Cane Hill, 5 ; Camberwell House, 1; Caterham, 3 ; City of London Asylum, Stone, 1; Claybury, 2 ; Dartford Heath, 23 ; Hants County, 1; Horton, (Epsom) 2 ; Leavesden, 1; Long Grove, 2 ; Maidstone, 1 ; Manor, (Epsom) 1; Peckham House, 2; Tooting Bee, 1; Whitecroft, Carisbrooke, 1. 33 Hospitals and other Public Institutions. — Guy's, 18; Evelina, 6 ; St. Thomas's, 5 ; Cancer Hospital, Chelsea, 4; Charing Cross, 3 ; Seaman's Hospital, Greenwich, 3 ; Children's Hospital, Great Ormonde Street, 2 ; London, 2 ; Metropolitan, 2 ; Miller, 2 ; Royal Waterloo, 2 ; St. Bartholomew's, 2 ; Westminster, 2 ; Bermondsey Infirmary, Bristol Royal Infirmary, Bromley (Kent) Infirmary, Brompton Hospital, Camberwell Infirmary, Clapham Maternity Hospital, Eltham Cottage Hospital, Friedenheim Hospital, German Hospital, Great Northern Hospital, Greenwich Workhouse, Heart Hospital, Soho ; Home Hospital, Fitzroy Square ; Infant's Hospital, Vincent Square ; King Edward Hospital, Windsor ; King's College Hospital, Queen Mary's Hospital, Carshalton ; Royal Free Hospital, St. George's Hospital, St. Joseph's Hospice, Hackney; Hospital of St. John and St. Elizabeth, and Sick Asylum, Bromley, E., 1 death in each. Deaths of fifty residents occurred in various other places outside the Borough. 34 Table 14. Meteriological Table for 1911. (Records taken at Greenwich). 1911. Month. Barometer. AIR TEMPERATURE Rainfall. Bright Sunshine. Mean pressure at 32° F. at Station Level (Bar. 159 ft. above M.S.L ) Mean of Total observed Per cent. of possible. Maximum Minimum ins ° ° Ins. Hours % January 30.147 42.0 34.2 1.23 33 13 February 30.009 46.0 35.3 1.38 64 23 March 29.738 48.4 35.8 1.66 76 21 April 29.846 55.3 38.6 1.73 151 37 May 29.815 68.1 46.3 1.88 221 46 June 29.827 70.9 50.3 2.10 225 45 July 29.990 81.1 55.0 0.27 334 67 August 29.845 81.1 57.0 1.34 260 58 September 29.892 72.1 47.9 1.34 234 62 October 29.742 57.4 43.9 3.30 97 29 November 29.569 49.2 38.4 3.42 55 21 December 29.577 48.6 39.7 4.02 41 17 Means 29.833 60.0 43.5 23.67 Total 1791 Total — PART 2. INFECTIOUS DISEASES. 37 NOTIFIABLE INFECTIOUS DISEASES. The infectious diseases notifiable under Section 55 of the Public Health (London) Act, 1891, are:—Small-Pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the diseases known as Scarlatina or Scarlet Fever, and the Fevers known by any of the following names:—Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal. Cerebro-Spinal Meningitis, Ophthalmia Neonatorum, and Polio-Myelitis or Polio-Encephalitis, have now been added to this list. The total number of cases notified during the year amounted to 8(50, of which number 630, or 73.25 per cent. were removed for isolation to the Metropolitan Asylums Board's Hospitals or other Institutions. In 25 instances, or 3.96 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 835 cases of infectious disease notified as occurring in the Borough during the year, a decrease of 13 compared with the total for the preceding year, which was 848. In 1909, 1,390 cases were notified. Owing to a slight outbreak of Small-Pox in London, Chicken-Pox was made compulsorily notifiable for a period of three months, from 22nd March to 22nd June. During this time 129 cases were notified. Age Periods.—41.24 per cent. of the Scarlet Fever cases, compared with 48.7 per cent. in 1910, and 49.84 per cent. of the Diphtheria cases, compared with 47.6 per cent. in 1910, occurred among children aged six years and under. 38 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:— Age. Scarlet Fever. Diphtheria. 1909. 1910. 1911. 1909. 1910. 1911 6 years and under 45.6% 48.7% 41.24% 49.9% 47.6% 49.84% 5 „ „ 35.3% 37.0% 30.56% 37.1% 34.7% 35.56% 4 „ „ 25.5% 24.1% 20.47% 25.2% 23.3% 24.92% Table 15. Age Periods of Scarlet Fever and Diphtheria, notified during the year 1911. Age Periods. Scarlet Fever. Diphtheria Number. of Cases. Percentage to Total Cases Number of Cases. Percentage to Total Cases. Under 1 year 4 1.18 7 2.06 1 to 2 years 11 3.26 7 2.06 2 „ 3 „ 16 4.74 19 5.77 3 „ 4 „ 17 5.04 16 4.86 4 „ 5 „ 21 6.23 33 10.03 5 „ 10 „ 166 49.25 153 46.50 10 „ 15 „ 65 19.29 55 16.71 15 „ 25 „ 25 7.42 24 7.29 25 years and over 12 3.59 15 4.56 At all ages 337 100 .00 329 100.00 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 18). The attack rate from all infectious diseases (excluding Puerperal Fever) during the year amounted to 5.11 per 1,000 of the population, compared with 5.12 in 1910, and 8.64 in 39 1909. The attack rate for the County of London was 5*31, compared with 4-43 in 1910. The attack rates for the Wards will be found in Table 17. It will be seen that Lewisham Park Ward had the largest number of cases in proportion to its population, having an attack rate of 6'82 per 1,000. The lowest attack rate was in South Ward, 2*84 per 1,000. Table 16. Number of Cases of Infectious Diseases notified in the Ten Wards and the Whole Borough during the Year 1911. Wards. Scarlet Fever Diphtheria. Knteric Fever Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis or Polio-Encephalitis Total. 1 Church 8 11 l 2 — — — 22 2 Manor 22 17 l 7 — — — — 47 3 South 9 7 — 2 — — — — 18 Lee Division 39 35 2 11 — — — — 87 4 Blackheath 10 8 5 l 2 — 26 5 Lewisham Village 15 25 2 13 l — 4 — 60 6 Lewisham Park 41 54 2 15 2 — 2 l 117 7 Brockley 46 15 — 5 — — 1 — 67 8 Catford 89 78 15 16 1 — 2 2 203 Blackheath & Lewisham Division 201 180 19 54 5 — 11 3 473 9 Forest Hill 28 45 4 18 2 — 97 10 Sydenham 69 69 10 20 6 l 3 — 178 Sydenham & Forest Hill Division 97 114 14 88 6 l 5 — 275 Whole Borough 337 329 35 103 11 l 16 3 835 40 Table 17. Attack rates from the Principal Infectious Diseases per 1,000 of the population for the ten Wards, arid the whole Borough in the years 1908-1911. Wards. Diseases Scarlet Fever Diphtheria Enteric Fever Erysipelas Total All Diseases. 1908 1909 1910 1911 1908 1909 1910 1911 1908 1909 1910 1911 1908 1909 1910 1911 1908 1909 1910 1911 Church 3.34 3.50 4.01 1.34 0.55 2.24 0.69 1.35 0.26 — — 0.16 0.69 0.14 0.27 0.33 4.87 5.88 4.98 3.70 Manor 4.43 4.19 4.12 2.73 1.56 2.88 0.64 11 – 0.26 0.25 0.12 0.78 1.17 0.90 0.87 6.78 8.51 5.93 5.83 South 5.94 7.05 2.80 1.42 2.77 1.76 0.17 1.10 0.52 — 0.52 — 0.69 1.23 — 0.31 9.90 10.04 3.51 2.84 Blackheath 3.27 4.77 2.30 1.53 2.71 0.72 1.29 1.22 — 0.14 0.14 — 0.28 1.01 0.43 0.76 6.27 6.66 4.18 3.82 Lewisham Village 4.14 2.54 1.71 1.02 3.82 1.69 0.64 1.70 0.06 – 0.12 0.13 0.64 0.39 0.38 0.86 8.68 4.63 2.88 4.01 Lewisham Park 4.31 7.91 4.18 2.43 2.71 2.15 1.16 3.21 0.53 0.05 0.14 0.11 0.75 0.82 0.58 0.89 8.30 10.93 6.38 6.82 Brockley 2.89 6.16 2.79 3.05 4.13 2.16 1.07 0.99 0.08 0.08 — – 0.49 0.99 0.16 0.33 7.60 9.41 4.03 4.44 Catford 5.27 5.95 2.54 2.26 3.60 2.75 1.17 1.98 0.11 0.11 0.22 0.38 0.55 0.56 0.28 0.41 9.53 9.36 4.22 5.14 Forest Hill 3.09 3.96 2.54 1.34 2.72 1.95 1.18 2.16 0.26 0.16 0.05 0.19 0.53 0.54 0.43 0.86 6.62 6.62 4.22 4.66 Sydenham 1.82 6.95 4.83 2.50 2.15 2.48 2.43 2.50 0.16 0.13 0.19 0.36 0.43 0.53 0.35 0.72 4.58 10.11 7.80 6.23 Whole Borough 3.77 5.63 3.20 2.09 2.87 2.25 1.27 2.04 0.19 0. 10 0.16 0.22 0.56 0.65 0.37 0.64 7.41 8.64 5.12 5.11 CHART C. Showing Weekly Notifications of all Infectious Diseases and of Scarlet Fever and Diphtheria, during: the year 1911. REFERENCES. Total Notifications shown in Black Scarlet Fever „ „ „ Red Diphtheria „ „ „ Green School Holidays shown thus 41 SCARLET FEVER.—The total number of cases notified during the year amounted to 348, compared with 573 in 1910. Of this number, 290, or 83.3 per cent., were removed to the Metropolitan Asylums Board's Hospitals. Subsequently 11 cases were returned to their homes and stated not to be suffering from any notifiable disease. Deducting this number, a corrected total of 337 is obtained, compared with 542 in 1910, equal to an attack rate of 2.09 per 1,000 persons, compared with 3.29 in 1910. The attack rate for the County of London was 2.33 per 1,000. An examination of the attack rates for the various Wards of the Borough shows that the highest occurred in Brockley Ward (3'05 per 1,000) and that the Ward least affected was Lewisham Village, with 1.02 per 1,000. 49.25 per cent. of the cases occurred among children between the ages of 5 and 10 years, and 20'47 per cent. among children under the age of five. Case Mortality. —Five deaths from Scarlet Fever occurred to residents in the Borough, equal to 1.48 per cent. of the cases notified, compared with 2.21 in the previous year. DIPHTHERIA.—Three hundred and forty-two cases of Diphtheria were notified, compared with 224 in 1910, and of this number 291, or 85.08 per cent., were removed to hospital. Thirteen patients (or 4.46 per cent. of the number removed) were returned as not suffering, giving a corrected total of 329, an increase of 119 on the number notified in 1910. The attack rate per 1,000 of the population amounted to 2 04, compared with 1*27 in 1910. The rate for the County of London was 1*64 per 1,000. Lewisham Park Ward suffered most from this disease, in proportion to its population, having an attack rate of 3.21 42 per 1,000. Brockley Ward, Lee, was least affected, having an attack rate of 0.99 per 1,000. Case Mortality.—Twenty-seven deaths occurred from this disease, equal to 8.20 per cent. of the cases notified, compared with 9.05 per cent. in 1910. ENTERIC or TYPHOID FEVER. —Thirty-six cases were notified, 22 of which were removed to Hospital. One case was returned home as not suffering, giving a corrected total of 35, an increase of 8 on the previous year. The attack rate for the whole Borough was 0.22 per 1,000 compared with 0.16 in 1910. The case mortality equalled 11.4 per cent., against 11.1 per cent. in 1910. ERYSIPELAS. 103 cases of Erysipelas were notified, compared with 62 in the preceding year. Sixteen cases were removed to the Lewisham Infirmary and other Institutions. PUERPERAL FEVER. Eleven cases of Puerperal fever were notified, five of which were removed to the Infirmary for treatment. Three of the cases proved fatal CEREBRO-SPINAL FEVER. One case of Cerebrospinal Fever was notified during the year. The patient was was removed to the South Eastern Hospital for treatment. OPHTHALMIA NEONATORUM. -Since the date that Ophthalmia Neonatorum became notifiable (13th March, 11), sixteen cases were notified, 5 of which were removed to Hospital for treatment. POLIO-MYELITIS or POLIO-ENCEPHALITIS. — This disease was made notifiable 1st September, '11. Since then three cases have been notified. All of the patients were treated at home. 43 Table 18. 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 1908-1911. Borough. Small-Pox. Scarlet Fever. Diphtheria. All Notifiable Infectious Diseases. 1908 1909 1910. 1911 1908. 1909. 1910. 1911 1908. 1909 1910 1911 1908. 1909 1910. 1911. Battersea — — — — 6.16 3.95 2.60 2.12 1.96 1.55 1.21 1.34 9.18 6.71 5.06 4.65 Bermondsey — — 0.01 — 4.93 3.61 2.87 2.42 1.94 1.55 1.65 2.03 8.68 6.60 5.90 5.88 Bethnal Green — 0.01 — 0.03 7.58 4.32 1.80 1.91 2.09 1.40 1.39 1.58 12.19 7.29 5.45 5.71 Camberwell — 0.00 — 0.01 3.70 3.62 1.79 2.44 1.40 1.33 0.95 1.35 6.09 6.00 3.82 4.90 Chelsea — — — — 2.28 4.09 1.59 2.17 1.85 1.31 1.10 1.26 5.07 6.13 3.21 4.34 Deptford — — — 0.01 6.05 3.16 2.52 3.43 1.74 1.65 1.09 1.51 9.48 6.72 5.06 6.75 Finsbury — — — 0.01 4.19 2.53 1.75 2.05 1.74 1.76 1.59 2.05 7.44 5.88 5.53 7.58 Fulham — — — — 3.42 2.91 1.96 2.49 2.29 1.83 1.42 2.05 6.76 5.82 4.22 5.56 Greenwich — — — — 3.86 3.52 1.52 3.16 2.01 1.47 1.49 3.26 6.32 6.21 4.02 7.79 Hackney 0.01 0.00 — 0.02 5.34 3.31 1.68 2.77 1.63 1.11 0.79 1.42 8.31 5.87 3.87 6.10 Hammersmith — — — — 3.12 3.10 2.68 1.97 1.62 1.53 1.30 1.61 5.59 5.48 4.80 4.63 Hampstead — — — — 2.97 2.76 1.51 1.52 0.68 0.50 0.53 1.77 4.34 3.80 2.61 4.04 Holborn — 0.02 — — 3.51 1.81 1.28 2.45 0.90 0.88 0. 85 1.74 5.73 3.85 3.39 5.19 Islington — 0.01 0.00 0.00 3.98 3.67 2.07 2.47 1.49 1.23 1.34 1.82 6.46 5.85 4.32 5.36 Kensington — — — — 2.44 2.29 1.43 1.37 1.28 0.97 0.84 1.28 4.73 4.30 3.31 3.52 Lambeth — — — 0.00 4.45 3.62 2.78 2.58 1.06 1.17 1.00 1.36 6.44 5.58 4.67 4.99 Lewisham — — — — 3.77 5.63 3.29 2.09 2.87 2.25 1.27 2.04 7.41 8.64 5.12 5.11 London, City of — 0.06 — — 2.71 2.09 1.23 1.18 1.48 1.05 1.17 1.18 5.06 4.03 3.63 3.54 Paddington — — — 0.01 4.45 4.16 1.71 1.60 0.98 1.21 0.79 1.21 6.36 6.28 3.47 3.92 Poplar — — 0.01 0.01 7.34 4.26 2.73 2.32 1.81 1.24 1.02 1.77 10.68 6.92 5.44 5.82 St. Marylebone — — — — 3.19 3.64 1.67 2.80 0.92 0.90 1.02 1.15 5.42 5.80 3.85 5.06 St. Pancras 0.01 0.00 — — 3.95 3.26 2.87 2.04 1.28 1.35 1.11 1.94 6.18 5.53 5.11 5.22 Shoreditch — — 0.02 3.03 5.12 2.97 1.87 2.16 1.79 1.62 1.15 1.58 8.94 6.42 4.67 5.42 South wark — 0.01 — — 3.62 2.80 1.98 2.48 1.26 1.22 1.34 1.54 6.26 5.29 4.82 5.94 Stepney — 0.03 — 3.14 7.45 3.33 1.77 1.68 2.08 1.87 1.29 1.86 11.23 7.07 4.75 5.75 StokeNewington — — — — 3.68 2.03 1.55 1.96 1.18 3.52 0.97 1.58 5.59 3.32 3.32 4.49 Wandsworth — — — — 4.28 3.36 2.23 2.78 2.01 1.25 0.94 1.64 7.25 5.58 4.02 5.27 Wtmstr., City of 0.01 0.01 0.01 0.01 3.61 3.50 1.48 1.60 1.08 1.34 0.89 0.92 5.44 5.64 3.08 3.24 Woolwich — — 0.01 — 4.50 7.72 3.89 4.24 2.76 2.01 1.27 1.96 8.13 10.65 5.79 7.03 London County 0.00 0.00 — 0.02 5.53 3.58 2.16 2.33 1.64 1.39 1.13 1.64 7.36 6.12 4.43 5.31 Note —These rates do not include Chicken-pox, which was made notifiable for a period of three months from 22nd March to 22nd June, 1911. 44 NON-NOTIFIABLE INFECTIOUS DISEASES. The principal infectious diseases which are not compulsorily notifiable by medical practitioners, are Measles, Whooping Cough, Chicken-Pox, Mumps, and Ringworm. The existence of these diseases in children attending the elementary schools is brought to our notice by the Head Teachers, and, also, in the case of Measles, by the School Attendance Officers. The following is a summary of the cases notified from Schools:— Number of children suffering. Children excluded on account of infection in their homes. Measles 2047 871 Whooping Cough 208 44 Chicken-Pox 410 155 Mumps 216 4 Ringworm 181 — Measlt's.—The number of measles cases notified was much in excess of previous years, 2,047 cases being brought to our notice compared with 1,001 in 1910. Fortunately, in comparison with the large number of cases which existed, the mortality was very low, only nineteen deaths being recorded, and, according to the Registrar General's figures, the death rate from this disease was lower in this Borough than in any of the Metropolitan Boroughs. The outbreak occurred in January, and was most severe during February. The disease is not notifiable by medical practitioners, and we were greatly indebted to the School Teachers for the prompt manner in which they notified actual or suspected cases, which enabled us to follow up cases at the homes of the infected or suspected children. In this work your women sanitary inspectors rendered most valuable assistance. After personal investigation it was necessary in several cases to temporarily close certain class-rooms, or exclude all 69 45 infants under the age of five, from Schools in the infected areas, notwithstanding the fact that in some cases the London County Council, as the Education Authority, attempted to deal with the position by ordering the exclusion only of unprotected children, in my opinion a useless measure owing to the impossibility of ascertaining which children are unprotected. Many parents still fail to recognise the seriousness of measles, and are not disposed to admit that their children are unprotected, knowing that they will be excluded. Experience has shown us that it is useless to rely on this system. The only way to check the spread of the disease is to close the affected classrooms sufficiently early and to exclude altogether infants under live, who run the greatest risk in continuing school attendance in an affected area. Much benefit has followed the recent provision by the Metropolitan Asylums Board of Hospital accommodation for cases which could not properly be treated in their own homes. SCHOOLS. The following is a list of Schools in which classrooms were closed with a view of preventing the spread of infection. On account of Measles Brownhill Road Council School.— Whole of Infants Department, three weeks, 23rd February. Christ Church School, Forest Hill.— Classroom A, Infants' Department, three weeks, 10th March. Church Street School, Lee.— Infants' Department closed three weeks, 24th January. Dalmain Road Council School.— Classrooms F and H, Infants' Department, three weeks, 16th May. Kilmorie Road Council School.— Classroom B, Infants' Department, three weeks, 22nd February. 46 Northbrook School, Lee.— Classrooms A, B, C and D, Infants' Department, three weeks, 10th January. Rathfern Road Council School.— Classroom B, Infants' Department, three weeks, 1st December. Sandhurst Road Council School.— Classroom C, Infants' Department, three weeks, 20th February. Sandhurst Road Council School.— Whole of Infants' Department, three weeks, 27th February. Stillness Road Council School.— Classroom B, Infants' Department, three weeks, 23rd February. Torridon Road Council School.— Classroom E, Junior Mixed Department, three weeks, 20th February. On account of Diphtheria. St. Bartholomew's School, Sydenham.— Infant's Department, three weeks, 4th December. Exclusion of Infant Scholars from School :— In the following Schools all children under the age of compulsory school attendance, i.e., five years old, were excluded for periods of three weeks, when Measles was prevalent in the neighbourhood. All Saints' School, Blackheath, l5th March and 29th May. Baring Road Council School, 13th March. Brockley Road Council School, 20th March and 3rd May. Brownhill Road Council School, 15th March. Christ Church School, Forest Hill, 28th February. Church Street School, Lee, 18th January and 10th June. Dalmain Road Council School, 1st March. The " Ennersdale" Council School, 1st February and 28th February. Gordonbrock Council School, 24th May and 6th March Haseltine Road Council School, 20th March and 1st May. Hither Green Council School, 15th March and 24th May. Holbeach Road Council School, 20th February. 47 Holy Trinity School, Forest Hill, 15th March. Kilmorie Road Council School, loth March. Lewisham Bridge Council School, 8th March. Northbrook School, Lee, 28th February and 4th July. Plassy Road Council School, 27th February and 15th May. Rathfern Road Council School, 15th March, 4th May, and 15th November. St. Mary's School, Lewisham, 8th February, 15th March, and 24th May. St. Mary Magdalene R.C. School, Brockley, 21st March. St. Phillip's School, Wells Road, Sydenham, 1st February and 25th May. St. Stephen's School, Lewisham, 15th March and 11th November. Sandhurst Road Council School, 15th March. Stillness Road Council School, 15th March and 24th May. Torridon Road Council School, 15th March. PULMONARY TUBERCULOSIS. During the year 348 notifications of Pulmonary Tuberculosis were received, relating to 213 fresh cases. 95 of these cases were notified by Poor Law Medical Officers, 89 by the Medical Officers of various Hospitals and Sanatoria, and 29 voluntarily by medical practitioners. In some instances of voluntarily notified cases, requests were made by the medical practitioner certifying, that no visit should be made to the home by officers of the Public Health Department. From the remainder, 165 cases were selected in which it was thought a visit would be beneficial, and the women inspectors made 218 visits for this purpose, giving advice as to precautions to be adopted in the home. Of the 165 cases so visited, it was found that in 92 instances previous cases of the disease had existed in the same family. In many cases it was found to be difficult to obtain separate sleeping accommodation for the sufferer, and of the 165 cases visited separate 48 modation could only be secured in 67 instances. There is every reason to believe that the visits to the homes made by the women inspectors, and the advice and instruction given by them, proved beneficial. The establishment of a Central Tuberculosis Dispensary in the Borough, and greater facilities for the admission of suitable cases to Sanatoria, are urgently needed. 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 662, compared with 466 in the previous year. The details of the examinations were as follows :— 1905. 1906 1907. 1908. 1909. 1910. 1911. re Diphtheria negative 72 148 248 269 392 237 369 positive 34 68 93 144 146 79 125 doubtful 1 1 2 4 12 10 16 re Phthisis negative 22 41 55 50 48 74 79 positive 7 20 21 36 26 38 48 re Typhoid Fever negative 4 6 15 21 19 23 14 positive 2 3 3 9 2 5 11 doubtful — — — 1 2 — — Food Samples, &c. 2 9 13 4 3 — — Totals 144 296 450 538 650 466 662 SMALL-POX AND PLAGUE CONTACTS. Information was received from various Port Medical Officers of the arrival in this district of persons who had been in contact with small-pox and plague patients, or had come from an infected port. These persons were immediately visited, and kept under observation during the full period of incubation. In no case was there any development of the disease. The number of contacts visited was :—Small-pox 8, and Plague 2. PART 3. GENERAL. 51 Table 19. Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the years 1905-1911. Ward. Number of Water Certificates Granted. 1905 1900 1907 1908 1909 1910 1911 Church 40 23 33 29 17 24 2 Manor 9 7 46 101 68 34 43 South 33 47 13 17 10 7 6 Lee Division 82 77 92 147 95 65 51 Blackheath 5 1 — — 4 — 23 Lewisham Village 10 5 '24 11 15 20 9 Lewisham Park 67 114 55 87 17 29 30 Brock ley 154 120 84 72 91 76 68 Catford 297 258 322 177 122 90 108 Lewisham Division 533 498 485 347 252 215 238 Forest Hill 95 63 30 42 8 22 9 Sydenham 208 156 157 98 57 99 40 Sydenham & Forest Hill Division 303 219 187 140 65 121 49 Whole Borough 918 794 764 634 41'2 401 338 52 Table 20. Houses Examined and Certified under the Customs and Inland Revenue Acts during 1911. Applications Received. Certificates Granted. Certificates Refused. Name of Street or Road. Number of Houses. Number of Tenements Number of Houses. Number of Tenements Number of Houses. Number of Tenements Belmont Park l 3 l 3 — — Benin Street 9 18 7 14 2 4 Blashford Street 5 10 5 10 — — Burnt Ash Hill 4 8 4 8 — — Butterfield Street 8 8 8 8 — — Elthruda Road 2 4 2 4 — — Fransfield Grove 2 4 2 4 — — George Lane 6 12 16 12 — — Glenton Road 7 14 7 14 — — Handen Road 1 2 1 2 — — High Road, Lee 8 16 7 14 1 2 Hither Green Lane 10 20 10 20 — — Holmshaw Road 3 6 3 6 — — Lanier Road 6 12 4 8 2 4 Leyland Road 3 7 3 7 — — Littlewood 11 22 11 22 — — Manor Park 1 3 1 3 — — Marlborough Road 1 2 1 2 — — Mount Pleasant Road 2 4 2 4 — — Ronver Road 51 55 51 55 — — Bushey Green 1 2 — — 1 2 Woodlands Street 6 12 6 12 — — Totals 118 244 142 232 6 12 53 SANITARY INSPECTION. During the year the district Sanitary Inspectors, inspected 5,531 premises, necessitating 17,224 subsequent visits to examine works ordered to be earried out to remedy the nuisances discovered. The details are set out in Table 25. THE HOUSING, TOWN PLANNING, &c. ACT, 1909. Sections 15 and 17 of the Housing, Town Planning, &c. Act Section 15 of the Act provides for the keeping of houses let to persons of the working class in all respects in a fit state for habitation, where any house or part of a house is let at a rental not exceeding £40 per annum, and for a term of less than three years. Authority is given for entry at all reasonable times of the day by any persons authorised in writing by the Local Authority, on 24 hours written notice being given to the tenant. The Local Authority are authorised to require the landlord to execute the necessary works within 31 days by notice. If the landlord fails to comply with the notice within the time specified, the Local Authority may enter and do the work, and recover the expenses from tbe landlord. The landlord may appeal to the Local Government Board against the notice of the Local Authority or their demand for expenses in carrying out the work. Section 17 imposes upon the Local Authority the duty of causing to be made from time an inspection of their district with a view of ascertaining whether any house is in such a state as to be unfit for habitation, and specifies the procedure for closing houses unfit for habitation. Taking these Sections into consideration, together with the Circular letter issued by the Local Government Board with 54 the Inspection of District Regulations, there is no doubt that the Local Government Board will require a more extensive inspection of working class dwellings throughout tbe district than has hitherto been made. It is also probable that the Health Insurance Commissioners will also insist upon increased inspection. The number of houses in the Borough in March 1911 is estimated from the rate-books to be 82,453. Of this number 29,300 are let at a rental not exceeding £40 per annum. A knowledge of the condition of these houses, and the particulars required by the Local Government Board, can only be obtained by systematic inspection. Of the 29,300 houses let at rentals not exceeding £40, a very large number are let for periods of less than three years. The mere inspection by an officer does not present any great difficulty. It is the keeping of the records, the service of notices, the frequent subsequent visits to see that the required works are executed which takes the time. Recognising this fact, your Council have appointed an additional Inspector for this special work. The details of the records which must be kept, and the items upon which particular information is required, are set out in Articles II. and III. of the Inspection of District Regulations, as follows :— 1. The situation of the dwelling-house, and its name or number, 2. The name of the officer who made the inspection. 3. The date when the dwelling-house was inspected. 4. The date of the last previous inspection and a reference to the record thereof, 55 5. The state of the dwelling-house in regard to each of the matters referred to in Article II. of these Regulations, 6. Any action taken by the Medical Officer of Health, or other Officer of the local authority, either indepen. dently or on the directions of the local authority, 7. The result of any action so taken, 8. Any further action which should be taken in respect of the dwelling-house. There is little doubt that in the Borough of Lewisham there exists ample housing accommodation for the working classes. It may fairly be stated that the supply up to the present has exceeded the demand, less marked perhaps since the advent of electric tramways in Catford. The condition of the premises can only be ascertained by a house-to-house inspection, and at present we have two Inspectors engaged in this duty. During the year 1911, 781 houses were inspected. The nuisances found during these inspections were chiefly dirty premises, due to the filthy habits of the tenants. Overcrowding was found in seven instances only. This is a condition which can seldom be detected in the ordinary course of the inspection, without some outside information, and is exceedingly difficult to prove, as an inspection cannot be made at night, the only time at which overcrowding can be proved. During 1911 representations were made in respect to five houses, with a view to closing orders being made, and closing orders were made in regard to the following premises:— 20a, Dalmain Road, Forest Hill. 28, Russell Street, Sydenham. 56 For many years one Inspector has been employed in house-to-house inspection in such portions of the Borough as was, from time to time, deemed necsssary. The inspections are made with the view of discovering any nuisances, or conditions, prejudicial to the health of the occupants. These investigations practically cover the details set out in Article II, of the Housing Regulations, issued by the Local Government Board in 1910. HOUSE TO HOUSE INSPECTION The following is a list of the roads in which a systematic inspection was carried out during the year 1911, by the houseto-house Inspector:— No. of houses in street. Beadnell Road, Forest Hill 72 Boones Road, Lee 40 Church Street, Lee 61 Dalmain Road, Forest Hill 123 Edney Street, Sydenham 18 Ewart Road, Forest Hill 123 Malham Road, Forest Hill 130 Royal Oak Place, Lee 19 Springfield, Sydenham 48 Taunton Road, Lee 124 Turner Road, Lee 49 In 97 of these houses no nuisance was found, and the following is a summary of the defects discovered, and for 57 which it was necessary to serve notices upon the respective owners :— Dirty premises 382 Drains defective 36 Vent shafts and soil pipes defective 170 Water closets and apparatus foul or defective 170 Water closets with insufficient water supply 130 Sink waste pipes defective or non-existent 123 Yard traps and gullies defective 20 Rain-water pipes defective 104 Rain-water gutters defective 116 Floors, walls, &c., dilapidated 145 Roofs leaky and defective 215 Window frames, &c., defective 109 Walls damp 133 Floors insufficiently ventilated 24 Ashpit accommodation, absence of 191 Yard paving defective or dilapidated 159 Drinking water cisterns, absence of cover 172 Accumulations of refuse 5 Other nuisances 74 Total 2,391 569 houses each contained one family. 209 „ „ „ two families. 3 „ „ „ three COMBINED DRAINAGE. The combined drains of the undermentioned premises were found to be in bad order and condition, and by order of the Council notices were served upon the respective owners, 58 under the provisions of the Metropolis Management Acts, requiring the necessary alteration and amendment of the drains. In the case of the premises marked with an asterisk, the notices were not complied with and the work was subsequently executed by the Council and the cost of the same charged to and recovered from the respective owners :— "Suffield" and "Claremont," Addington Grove*; Nos. 4 and 6, Brownhill Road; Nos, 24, 26, 28 and 30, Church Road, Forest Hill; Nos. 1, 3 and 5, Cranston Road*; Nos. 33, 35, 37 and 39, Cressingham Road*; Nos. 194 and 196, Devonshire Road*; Nos. 1, 2, 3, 4 and 5, Longton Grove Terrace*; Nos. 26, 28, 30, 32 and 34, Perry Hill* ; Nos. 12, 14, 16, 18, 20, 22 and 24, Sandrock Road*; Nos. 24 to 40, Springfield, and 1, 2, 3 and 4, Springfield Cottages*; Nos. 4, 5 and 6, Albert Villas, and Durham and Plumbley Cottages, Sydenham Hill Road*; Nos. 54, 56, 58 and 60, Vancouver Road*; Nos. 73 and 75, Willow Walk, Sydenham*: Nos. 9, 11, 13, 15, 17 and 19, Wisteria Road; Nos. 19 and 20, Wynell Road.* SMOKE NUISANCES. The Inspector entrusted with the duty of keeping observation for the emission of black smoke, made 317 investigations during the year, compared with 259 during 1910. The details of his observations are as follows:—laundries 91, breweries 5, silk mills 2, preserve works 88, flour mills 22, railway locomotives 24, saw mills 4, public institutions 40, bakehouses 8, sewer works 50, miscellaneous premises 9. The duration of the observations varied from 1-an-hour to 1 hour each. In consequence of offences observed,11 intimation notices were served and 1 statutory notice. No legal proceedings were instituted. 59 CORONER'S COURT AND MORTUARY. One hundred and fifty-two bodies were removed to the public Mortuary, eighteen being from districts outside the Borough. Inquests were held on 141 cases, and 78 post-mortem examinations made. The portion of the mortuary specially allocated for infectious cases was not used. DISINFECTION. During the year 2,638 rooms were disinfected by formalin spray, and textile articles such as bedding, clothing, &c., (in all 31,298 articles), removed from infected homes to the Council's Disinfecting Station for treatment in the steam disinfector. UNSOUND FOOD. The following articles of food were surrendered by the owners as unfit for human food and subsequently destroyed :— 1½-stones hake; 206 lbs. beef; 1 box kippers; 12 boxes tomatoes; 2 boxes codfish; 1 sack winkles; 1 sack potatoes; 1 box codlings; ½-stone soles; 1 box haddock; 1 trunk haddock; 1 box mackerel. THE NOTIFICATION OF BIRTHS ACT, 1907. During the year 3455 notifications of births were received, in addition to 97 notifications relating to stillborn children. In 425 cases the notification was only received after a letter had been sent to the father from this Department, the Registrar's returns having revealed the fact that no notification had been received. In these instances of failure to notify, ignorance of the Act was pleaded in almost every case. Certain homes were selected to which it was considered that a visit from the woman sanitary inspector would be useful, and during the year 1125 visits were made for this purpose. 60 ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1910. Workshops:—There are in the borough 560 workshops, containing 873 workrooms to which the provisions of the Factory and Workshop Act apply. The number of workers found on inspection amounted to 187S, of which 452 were men, 1058 women, and 369 young persons. The largest proportion of these workers were engaged in the dressmaking, laundry, and millinery trades, there being 1044 women, 333 young persons and 31 men so employed. These premises are inspected by the women sanitary inspectors (see "Work of women sanitary inspectors," page 66), together with the workshops employing women in other trades. Only 14 women and 36 young persons were employed in all other trades. Domestic and Part Time Work Places. —There are 237 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 49 restaurants and 40 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 89 bakehouses in the Borough, of which 20 are underground. On the whole the sanitary condition of the workshops in the Borough is very satisfactory. 61 Table 21. Inspection of Factories, Workshops & Workplaces. (Home Office Table, No. 1). Premises, Inspections Written Notices. Prosecutions Factories (including factory laundries) 87 8 — Workshops (including workshop laundries) 1490 59 — Workplaces (other than outworkers' premises) 316 17 — Total 1893 84 — Statement of Defects Found. (Home Office Table, No. 2). Particulars. Defects. Referred to H M. Inspector No. of Prosecutions. Found. Remedied. Dealt with under Public Health (London) Act—* Want of cleanliness 146 146 — — Want of ventilation — — — — Overcrowding 5 5 — — Want of drainage of floors 1 1 — — Other nuisances 47 47 — — Sanitary accommodation : Insufficient 2 2 — — Defective or unsuitable 40 40 — — Not separate for sexes — — — — Under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97100) 40 40 — — Other offences — — — — Total 281 281 — — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 64 Table 23. Workshops (sec. 131) and Workplaces and Workrooms on the Register at the end of 1911 (Home Office Table, No. 4). Class of Work. No. Number of Rooms. Number of Workers Found. Part Time and Domestic. Workplaces. Men. Women. Young Persons Number. No of Rooms. Dress 232 262 2 704 268 25 25 Millinery 52 60 — 145 62 2 2 Laundry 66 298 29 195 3 22 37 Tailor 28 30 59 3 1 17 17 Boot 60 61 84 — 4 97 97 Joiner 16 28 38 — 4 4 4 Smith 23 25 57 — 7 3 3 Dentist 3 3 9 — — 2 2 Cycles 12 15 22 — 6 10 10 Coachbuilder 6 12 33 — 4 1 1 Cabinet and Upholsterer 16 21 37 3 2 8 3 Photographer and Pictureframer 9 12 11 — 2 10 10 Jeweller 13 14 24 — 4 20 20 Piano 1 2 4 — — — — Saddler 7 7 13 — — 2 2 Mason 2 3 5 — — 1 1 Lathrender 2 3 6 — — — — Various 12 17 19 8 2 18 18 Total 560873 452 1058 369 287 252 62 Table No. 22. HOME WORK. (Home Office Table, No. 3). NATURE OF WORK.* 1 OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110, Lists received from Employers. Notices 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. Failing to keep or permit inspection of lists. Failing to send lists. Lists.† Outworkers.† Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. 2 2 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing Apparel— (1) making, &c. 60 – 161 11 – 41 – – – 14 14 – – – – (2) cleaning and washing – – – – – – – – – – – – – – – Household linen 6 – 6 3 – 4 – – – – – – – – – Lace, lace curtains and nets – – – – – – – – – – – – – – – Curtains & furniture hangings 2 – 2 1 – 3 – – – 2 2 – – – – Furniture and upholstery – – – – – – – – – – – – – – – Electro-plate – – – – – – – – – – – – – – – File making – – – – – – – – – – – – – – – Brass and brass articles – – – – – – – – – – – – – – – Fur pulling – – – – – – – – – – – – – – – Cables and chains – – – – – – – – – – – – – – – Anchors and grapnels – – – – – – – – – – – – – – – Cart gear – – – – – – – – – – – – – – – Locks, latches and keys – – – – – – – – – – – – – – – Umbrellas, &c. – – – – – – – – – – – – – – – Artificial flowers – – – – – – – – – – – – – – – Nets, other than wire nets – – – – – – – – – – – – – – – Tents – – – – – – – – – – – – – – – Sacks – – – – – – – – – – – – – – – Racquet and tennis balls 2 – 2 1 – 1 – – – – – – – – – Paper bags and boxes – – – – – – – – – – – – – – – Brush making – – – – – – – – – – – – – – – Pea picking – – – – – – – – – – – – – – – Feather sorting – – – – – – – – – – – – – – – Carding, &c., of buttons, &c. – – – – – – – – – – – – – – – Stuffed toys – – – – – – – – – – – – – – – Basket making – – – – – – – – – – – – – – – Total 70 – 171 16 – 49 – – – 16 16 – – — — * 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 should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. + The figures required 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 entries in column 2 must necessarily be even numbers, as there will be two lists for each employer— in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 65 Other Matters (Home Office Table, No. 5). Failure to affix Abstract required by Section 133 of the Factory and Workshop Act, 1901, and notified to H.M. Inspector of Factories 24 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health (London) Act, but not under the Factory Act (Sec. 5). Notified by H.M. Inspector 3 Reports of action taken, sent toH.M. Inspector 3 Other 3 Underground Bakehouses (Section 101) In use during 1903 23 Certificates granted in 1903 23 1904 - 1911 nil In use at end of 1911 20 Workshops and Workplaces on the Register at the end of 1910 :— Workshops (details in Table 23) 560 Workplaces part time and domestic (details Table 23) 237 Bakehouses 69 „ underground 20 Restaurants (workplaces) 49 Workplaces (stable yards, contractors' yards, etc.) 40 Total 975 66 WORK OF WOMEN SANITARY INSPECTORS. The following is a summary of work carried out by your Women Sanitary Inspectors:— Factory and Workshop Act.— Miss Jones Miss Stevens. Total To Factories 7 13 20 „ Workshops 284 267 501 „ Workplaces 15 20 35 „ Laundries 154 76 230 ,, Outworkers' homes 112 139 251 Infectious Diseases.— To Phthisis homes 103 115 218 Re Phthisis deaths 38 37 70 „ Chicken-pox 14 40 54 „ Measles 305 353 658 „ Puerperal fever 23 14 37 ,, School Notifications 182 190 372 „ Ophthalmia Neonatorum 15 15 30 „ Polio-Myelitis – 1 1 To Schools 54 67 121 Other Visits.— On complaint from residents 18 20 38 To Selected homes from which births were notified 575 550 1125 Investigations re Infant mortality 129 127 256 Re-visits and re-inspections 180 109 289 Miscellaneous inquiries 17 38 55 Total 2170 2191 4361 Nuisances, Defects, &c.— Abstract not affixed in workshops 10 11 21 Overcrowding of Workshops 1 3 4 Total number of nuisances found 178 142 320 Notices, &c.— Intimation notices served 130 97 227 Statutory notices served 18 25 43 67 Table 24. ROUTINE INSPECTIONS. Premises. Number of Places No. of Inspections 1911 No. of Notices 1911. No. of Prosecutions 1911. On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end of 1911 Milk premises 199 18 59 158 514 5 – Cow sheds 14 – – 14 145 2 – Slaughter houses 15 – – 15 131 – – Other offensive Trade premises – – – – – – – Ice cream premises – – – – – – – Registered houses Let in Lodgings 15 1 5 11 70 a 1 – b10 Restaurants 58 – 9 49 67 9 – Bakehouses 94 – 5 89 324 20 – Stable Yards, etc. 44 2 6 40 64 5 – a Overcrowding 6 Other conditions. Total number of intimation notices served for all purposes, male inspectors 1747, female inspectors 227— Total 1974. Overcrowding:— Number of dwelling rooms overcrowded 27, and workrooms 4, remedied all, proceedings nil. Underground rooms:— Illegal occupation dealt with and number of rooms closed nil. Insanitary Houses:— Number closed under the Public Health (London) Act and Housing of the Working Classes Act, nil; Numbers repaired and re-opened, nil. Premises cleansed under Section 20 of the London County Council (General Powers) Act, 1904, nil. 68 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, 148, number of tenements comprised therein, 244; certificates granted in respect of 142 houses (282 tenements); refused in respect of 6 houses (12 tenements), 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 152 Total number of infectious bodies removed nil (Note.— This table was formulated to meet the requirements of the London County Council). 69 Table 25. REGISTER OF SANITARY WORK. (Male Inspectors.) For the year ended 3 1st December, 1911. Lewisham Sydenham and Forest Hill Division. Lee Division Workshops House to House Description or Work Mr. J. A. K.Cooper Mr. H. King Mr. J. Crowther 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 91 93 111 88 159 238 11 22 813 Premises inspected 336 435 406 638 606 584 1777 920 5702 Re-inspections of Works in progress 1388 1647 2620 2272 2869 2105 378 6218 19527 Intimation Notices served 156 182 195 132 193 154 57 684 1753 Statutory Notices ordered 137 158 148 94 114 111 25 145 932 Statutory Notices served 19 73 49 47 56 16 2 82 344 Premises repaired, cleansed, &c. 82 100 90 138 94 62 205 439 1210 Defective Roofs, Stackpipes, &c., remedied 36 21 61 60 69 41 5 341 634 Drains re-constructed 81 52 46 65 47 77 — 18 386 Drains repaired 31 45 32 46 64 91 8 26 343 Drains ventilated 21 16 1 18 15 72 — 6 149 Stackpipes, Sinks, Rath Wastes, &c., disconnected from drains 59 43 30 19 15 128 — 106 400 Gulley Traps provided 60 53 36 93 172 213 — 49 676 Water Closets reconstructed 66 65 73 84 73 94 — 54 509 Water Closets repaired 19 42 35 39 37 55 101 47 375 Water Closets supplied with water 16 25 25 1 2 51 3 123 246 Soil Pipes reconstructed 27 19 39 26 27 42 — 6 186 Soil Pipes repaired and ventilated 9 7 13 8 4 22 25 80 168 Dustbins provided 29 44 42 47 24 49 1 185 421 Water Supply to Houses reinstated 3 8 5 4 21 11 1 — 54 Cisterns repaired, cleansed or covered 10 36 28 88 32 4 65 161 424 Water Certificates issued 1 5 31 27 — 48 99 127 338 Premises over-crowded 3 4 4 2 5 1 1 7 27 Yards paved 29 41 14 38 89 45 57 168 481 Removal of offensive accumulations 18 11 39 33 38 48 2 4 193 Dung Vaults erected or repaired 1 2 — — 3 — — 3 9 Animals improperly kept 4 3 4 — 3 5 — 8 29 Visits to houses let in lodgings — — 69 1 — — — — 70 Hake-house inspections — — — — 13 3 308 — 324 Milk-shop „ — 2 1 — 27 25 459 — 514 Cow-shed ,, 12 36 — 24 12 61 — — 145 Workshop „ — — — — — — 649 — 649 Slaughter-house ,, 24 12 23 34 12 26 — — 131 House-to-house ,, — — — — — — — 781 781 Legal proceedings — — — — — — — — — PART 4. REPORT OF PUBLIC ANALYST. 73 REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1911. SAMPLES SUBMITTED. —During the period under review 559 samples of food and drugs were submitted for analysis. Of this number 495 were purchased by your inspectors in conformity with the provisions of the Sale of Food and Drugs Acts. The remaining t54 samples were purchased as test samples, and without declaration to vendors. ADULTERATED SAMPLES.—Of the 495 official samples 80, or 6.06 per cent. were adulterated, compared with 4.95 per cent. in the previous year (1910) and 2.99 per cent. in 1910. TEST SAMPLES. These samples are 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 64 samples so purchased, 5, or 7.81 per cent., were found to be adulterated, and these were followed up by official pin-chases. MILK. Of the 292 official samples of milk submitted, 18, or 6.16 per cent., were adulterated or below the standard fixed by the Board of Agriculture. In 1910 the adulterated samples equalled 5.30 per cent. 74 Dyed Milk.—Of the milks examined during the year, 65 per cent. were artificially coloured, compared with 63 per cent. in 1910. Sunday Samples.—Six samples of milk were obtained on Sundays, one of which (No. 335) was below standard. Average Composition. The average composition of all samples of milk examined during the year equalled 3.50 per cent. Milk Fat and 8.80 per cent. Solids Not Fat. The average composition of the genuine samples alone was 3.55 per cent. Milk Fat and 8.83 per cent. Solids Not Fat. The results in both cases being well above the standard, viz., 3 per cent. Milk Fat and 8.5 per cent. Solids Not Fat. Milk Samples taken in course of Delivery.—Eighteen samples were taken in course of deliver}', as follows:—Forest Hill Railway Station, 4; Hither Green Railway Station, 4; Sydenham Railway Station, 8; and two were taken at a dairy. Three of these samples were found to be below standard (Nos. 289, 324 and 523). Separated Milk.-I again desire to draw attention to a growing practice adopted by astute milk vendors, namely, the adulteration of Milk with water, and evading the Regulations by declaring it to be "Separated Milk" when sampled, although no such declaration is made to the ordinary purchaser. Samples Nos. 456 and 472 afford very good examples of the ingenuity of these vendors. Sample No. 456 was declared to be Separated Milk at the time of purchase, and was found on analysis to contain:— Total solids 8 per cent. Milk Fat 2.2 „ Solids not Fat 5.8 „ 75 From these figures there can be little doubt that the sample was ordinary milk adulterated by the addition of 32 per cent. water. As the vendor declared it to be separated milk, the result of the analysis must be calculated in accordance with the existing standard for skimmed or separated milk, namely 9 per cent. total solids, and upon this basis one was obliged to return it as adulterated with 10 per cent. of water. The vendor in this case was fined ten shillings, a fine not likely to deter him from continuing his practice. Sample No. 472 was found to contain:— Total Solids 10 per cent. Milk Fat 2.8 „ Solids not Fat 7.2 ,, This also was declared to be Separated Milk, but from its composition it is obvious that the sample was Milk adulterated by the addition of 15 per cent. of water. The vendor in this case was content with less adulteration, the total solids amounted to 10 per cent. Notwithstanding the fact that the solids not fat reached only 7.2 per cent., one had to return this sample as genuine separated milk. No definition is given in the Regulations of Skimmed or Separated Milk, and the term is understood to apply to milk from which the bulk of the fat has been removed. In mechanically separated milk the percentage of fat remaining seldom exceeds 0.5 per cent., and in the absence of any definitions in the Regulations, a means of escaping proceedings for adulteration has been found. I submit, therefore, that there is urgent need for the amendment of the Sale of Milk Regulations, 1901, particularly in their application to Skimmed or Separated Milk. The 76 standard of 9 per cent. total solids should be abolished, and in lieu thereof a standard of 8.5 per cent. solids not fat should be substituted. Such a standard would have permitted us to have taken action against the vendor of Sample No. 472 for adulteration by 15 per cent. of added water, and sample 456 would have been returned as adulterated by 32 per cent. of water instead of 10 per cent. I also submit that the restriction as to the sale of Condensed Skimmed or Separated Milk, contained in Section 11 of the Sale of Food and Drugs Acts, 1899, should be extended so as to apply to skimmed or separated milk other than condensed. The case of French r. Card made it clear that this section of the Act applies only to Condensed Machine Skimmed or Separated Milk. Every tin or other receptacle containing machine skimmed or separated milk should be required to bear a label, clearly visible to the purchaser, stating the fact. BUTTER.—One hundred and twenty-eight samples of Butter were purchased in conformity with the Sale of Food and Drugs Acts. Only seven, or 5 46 per cent., of these samples were adulterated, compared with 1.96 per cent. in 1910. In addition, 37 test samples were taken, 4, or 10.8 per cent., of which were adulterated. 77 Table A. Showing number of Samples submitted for Analysis, with Results, for the year ended December 1911. (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 292 274 18 6.16 Separated Milk 7 6 1 14.2 Butter 128 121 7 5.46 Coffee 33 29 4 1.21 Mustard 11 11 — Pepper 1 1 — — Cocoa 4 4 — Margarine 1 1 — — Flour 12 12 — — Gin 2 2 — — Rum 2 2 — — Arrowroot 1 1 — — Lard 1 1 — — Total official samples 495 465 30 6.06 (b) Test Samples purchased without the formalities of the Act. Butter 37 33 4 10.8 Milk 1 0 1 — Mustard 6 6 — — Pepper 4 4 — — Coffee 3 3 — — Tea 1 1 — — Castor Sugar 2 2 — — Lard 2 2 — — Flour 3 3 — — Cocoa 4 4 — — Peas (Dried) 1 1 — — Total "test" samples 64 59 5 781 Total all samples 559 524 35 6 26 78 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, 1898-1911. 1898 Total Samples 36 31 5 13.88 2 Fines £3, costs 15s. 6d. 1899 Total Samples 41 37 4 9.75 1 Fines £5, costs 14s. 6d. 1900 Total Samples 68 61 7 10.29 7 Fines £14 15s., costs £2 13s. 6d. 1901 Total Samples 3 — 3 100.00 2 Fines £5, costs £1 1s. 1902 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 Total Samples 476 438 38 7.98 19 Fines £56 4s., costs £10 4s. Milk 275 *495 449 46 9.29 14 Fines £108, costs £6 13s. 6d. 1906 Butter 99 Various 121 Milk 292 *496 460 36 7.26 17 Fines £30 10s., costs £10 12s. 1907 Butter 116 Various 88 Milk 269 *412 378 34 8.25 15 Fines £28 10s., costs £10 15s. 6d. 1908 Butter 93 Various 50 Milk 242 *469 455 14 2.99 5 Fines £11 costs £4 14s. 1909 Butter 110 Various 117 Milk 283 465 442 23 4.95 8 Fines £13, costs £9 4s. Butter 102 1910 Coffee 28 Wines and Sp'rits 18 Various 34 Milk 292 *495 465 30 6.06 20 Fines £50, costs £23 1s. Butter 128 1911 Coffee 33 Wines and Spirits 4 Various 38 79 Table C. Showing Total Samples submitted with results during the years 1907-1911. (Test samples not included). Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 First 126 79 95 87 141 9 12 3 3 2 7.14 15.19 3.16 3.4 1.41 Second 119 147 128 102 136 5 13 6 6 9 4.20 8.84 4.69 5.9 6.62 Third 123 104 131 95 72 11 7 2 4 7 8 94 6.73 1.53 4.2 9.72 Fourth 128 82 115 181 146 11 2 3 10 12 8.60 2.44 2.61 5.5 8.21 Total for Year 496 412 469 465 495 36 34 14 23 30 7.26 8.25 2.99 4.95 6.06 Table D. Showing results of Total Samples of Milk submitted during the Years 1907-1911. Quarter. No. of Samples.* No. Adulterated. Percentage Adulterated. 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 First 55 53 56 56 90 5 9 2 2 1 9.09 16.98 3.57 3.6 1.2 Second 77 100 61 62 94 5 12 6 4 7 6.49 12.00 9.84 6.4 7.4 Third 95 55 78 79 47 8 3 2 4 5 8.42 5.45 2.56 5.06 10. 6 Fourth 61 55 40 86 61 1 — 1 5 5 1.64 — 2.50 5.8 8.19 Total for Year 288 263 235 283 292 19 24 11 15 18 6.60 9.13 4.68 5.3 6.16 * Not including test samples. 80 Table E. Average Composition of Milk Samples submitted in 1911. 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 8.68 8.83 3.69 8.84 Second 3.36 8.93 3.50 8.95 3.0 8.5 Third 3.39 8.57 3.47 8.61 . Fourth 3.53 8.74 3.60 8.76 Total for Year 3.50 8.80 3.55 8.88 81 Table F. Average Composition of Milk Samples submitted during the Years 1902-1911. 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 „ 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 3.0 8.5 „ 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 „ 1910 3.51 8.78 3.56 8.79 „ 1911 3.50 8.80 3.55 8.83 82 Table G. Details of Adulterated Samples of Milk during the Year ended December 31st, 1911. No. Adulteration. Remarks. 57 11 per cent. deficient in milk fat Vendor fined £1 and £1 2s. costs 196 3 per cent. deficient in milk fat No action 201 3 per cent. deficient in milk fat No action 213 3 per cent. deficient in milk fat No action 261 8 per cent. deficient in milk fat Vendor fined £2 and £1 3s. costs 281 19 per cent. added water Summons not. proceeded with owing to bursting of bottle containing reserve portion of sample 282 8 per cent. deficient in milk fat Vendor fined £2 and £1 3s. costs 289 5 per cent. deficient in milk fat No aotion: subsequent sample No. 324 295 15 per cent. deficient in milk fat Vendor fined £4 and £1 3s. costs 324 16 per cent. deficient in milk fat Vendor fined £2 and £1 3s. costs 335 3 per cent. deficient in milk fat No action 355 15 per cent. deficient in milk fat Vendor fined 10s. and 2s. costs 370 18 per cent. added water Declared to be "milk and water" at. time of purchase 380 4 per cent. deficient in milk fat Vendor cautioned 354 15 per cent. deficient in milk fat Vendor fined £1 10s. and £1 3s. costs 395 11 per cent. deficient in milk fat Summons dismissed on proof of warranty 421 4 per cent. added water No action 523 4 per cent. added water No action 456 Separated Milk : 10 per cent. added water Vendor fined 10s and £1 3s. costs Table H Showing the number of samples of Butter submitted in the Four Quarters of the years 1907-1911. Quarter. No. of Samples.* No. Adulterated. Percentage Adulterated. 1907 1908 1909 1910 1911 1907 1908 1909 | 1910 1911 1907 1908 1909 1910 1911 First 34 20 22 20 36 1 3 — 1 — 2.94 15.00 — 5.0 — Second 25 34 26 31 29 — 1 — — 2 — 2.94 — — 6.9 Third 20 18 18 5 22 2 1 — — 1 10.00 5.56 — — 4.5 Fourth 37 21 44 46 41 6 1 — 1 4 16.22 4.76 — 2.2 98 Total for year 11G 93 110 102 128 9 6 — 2 7 7.76 6.45 — 1.96 5.46 * Test samples not included. 83 Table I. Details of Adulterated Samples of Butter for the Year ended December 31st, 1911. No. Adulteration. Remarks. Official Samples. 269 84 per cent. foreign fat Vendor fined £2 and £1 3a. costs 293 54 per cent. foreign fat Vendor fined £7 and £1 3s. costs 375 85 per cent. foreign fat Vendor fined £2 and £1 3s. costs 433 90 per cent. foreign fat Defendant ordered to pay costs, 12s. 435 90 per cent. foreign fat Vendor fined £10 and £3 3s. costs 451 and 452 87 per cent. foreign fat Samples declared to be margarine at time of purchase, but the vendor was fined £3 and £3 3s. costs for selling margarine in a package not branded or durably marked Test Samples 358 Margarine Official sample genuine 391 Margarine Official sample No. 433 409 Margarine Official sample genuine 447 Margarine Official samples Nos. 435, 451 and 452 Table J. Details of Other Samples Adulterated during the year ended December 31st, 1911. No Article. Adulteration. Remarks. 149 Coffee 5 per cent. added chicory No action 378 Coffee 35 per cent. added chicory Vendor fined £2 and £1 3s costs 525 Coffee 30 per cent. added chicory Vendor fined £5 and £1 3s. costs 553 Coffee 50 per cent. added chicory Vendor fined 10s and £1 3s. costs APPENDIX. LOCAL GOVERNMENT BOARD TABLES. 87 Local Government Board Tables. Table I. Vital Statistics of Whole District during 1911 and previous Years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transfer'le. Deaths. Nett Deaths belonging to the District. Nett. of Non residents registered in the District. of Residents not registered in the District Under i Year of Age. At all Ages. Uncorrected Number. Number. Rate. Number. Rate. Number. Rate per 1000 Net Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 148463 3446 — 23.2 1888 12.7 228 117 391 113 1777 12.0 1907 152532 3622 — 23.7 1881 11.8 275 143 325 90 1749 11.5 1908 156627 3632 — 22.8 1857 11.9 243 143 315 87 1757 11.0 1909 160749 3507 — 21.9 1707 10.6 174 131 262 75 1664 10.4 1910 164899 3412 — 20.75 1565 9.5 131 156 271 79 1590 9.67 1911 161677 3397 3421 21.22 j 1879 11.66 255 218 357 104 1842 11.43 Area of District in Acres (exclusive of area covered by water) — 6,991 At Census of 1911—Total population at all ages — 160,834 88 Table II. Cases of Infectious Disease notified during the Year 1911. Notifiable Disease. Number of Cases Notified. Total Cases Notified in Each Ward (e.g., Parish or Ward) of the District. Total Cases Removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 8 9 10 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Church. Manor. South. Blackheath. Lewisham Village. Lewisham Park. Brockley. Cat ford. Forest Hill. Sydenham. Small-pox — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 329 7 75 208 24 15 — — 11 17 7 8 25 54 15 78 45 6 291 Erysipelas 103 4 2 4 11 36 35 11 2 7 2 5 13 15 5 16 18 20 16 Scarlet Fever 337 4 05 231 25 12 — — 8 22 9 10 15 41 46 89 28 69 290 Typhus Fever — — — — — — — — — — — — — — — — — — — Enteric Fever 35 — 1 8 8 12 6 — 1 1 — — 2 2 — 15 4 10 22 Relapsing Fever — — — — — —— — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — Puerperal Fever 11 — — — 3 8 — — — — — 1 1 2 — 1 — 6 5 Plague — — — — — — — — — — — — — — — — — — — Phthisis Under Tuberculosis Regulations, 1908 95 — 1 15 16 44 14 5 2 4 6 1 7 23 7 20 11 14 — Under Tuberculosis Regulations, 1911 89 — — 3 19 56 9 2 2 5 — 4 10 15 12 14 10 17 — Others 29 — 2 2 11 11 2 1 2 3 1 5 5 3 2 2 6 — Cerebro-Spinal Fever 1 — 1 — — — — — — — — — — — — — — 1 1 Ophthalmia Neonatorum 16 16 — — — — — — — — — 2 4 2 1 2 2 3 5 Polio-Myelitis and Encephalitis 3 — 1 2 — — — — — — — — 1 — 2 — — — Totals 1048 31 148 473 117 194 66 19 26 58 27 32 82 160 89 239 120 215 630 89 Table III. Causes of, and Ages at, Death duving Yeav 1911. Nett Deaths at the subjoined ages of Residents whether occurring within or without the District. Total Deaths whrther of residents or Non-Residents in Institutions in the District. Causes of Death. All Ages Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All Causes Certified 1842 357 68 62 75 67 222 401 590 — Uncertified — — — — — — — — — — Enteric Fever 4 — — — — 1 2 — 1 — Small-Pox — — — — — — — — — — Measles 19 3 7 8 1 — — — — 4 Scarlet fever 5 — — 2 3 — — — — — Whooping-cough 17 5 5 6 1 — — — — 2 Diphtheria and croup 27 1 3 8 15 — — — — 1 Influenza 5 2 — — 1 — 1 — 1 — Erysipelas — — — — — —: — — — — Cerebro-spinal Fever — — —: — — — — — — — Phthisis (Pulmonary Tuberculosis) 104 — — — 2 21 48 25 8 31 Tuberculous Meningitis 20 4 6 6 3 — 1 — — 8 Other tubercular diseases 16 3 1 1 5 2 4 — — 11 Rheumatic Fever 5 — — — 4 — — 1 — — Cancer, malignant disease 171 — — 2 2 1 18 77 71 37 Bronchitis 136 24 5 2 1 — 4 23 77 59 Broncho- Pneumonia 49 17 15 4 1 — 2 2 8 18 Pneumonia, (all other forms) 70 8 1 4 4 4 18 19 12 32 Other diseases of Respiratory organs 31 11 — — 1 — 7 6 6 7 Diarrhœa and Enteritis 147 114 11 3 2 — 3 4 10 47 Appendicitis & Typhlitis 19 — — 1 5 6 2 4 1 9 Alcoholism 2 — — — — — 1 1 — 1 Cirrhosis of liver 17 — — — — — 1 9 7 2 Nephritis and Bright's Disease 42 — — — 1 2 10 18 11 27 Puerperal fever 3 — — — — 1 2 — — 2 Other accidents and diseases of Pregnancy and Parturition 5 1 — — — 1 3 — — 1 Congenital Debility and Malformation, including Premature Firth 123 116 4 3 — — — — — 72 Violent Deaths, excluding Suicide 57 10 — 2 3 3 13 13 13 23 Suicides 16 — — — — 1 9 5 1 2 Other defined Diseases 685 30 8 8 16 23 69 178 353 223 Diseases ill-defined or unknown 47 8 2 2 4 1 4 16 10 16 1842 357 68 62| 75 67 222 401 590 635 90 Table IV. INFANT MORTALITY. 1911.—Nett Deaths from stated Causes at various ages under One Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year All Causes. Certified 67 20 12 5 104 67 81 65 40 357 Uncertified Small-pox — — — — — — — — — Chicken-pox — — — — — — — — — Measles — — —• — — 1 2 3 Scarlet Fever — — — — — — — — — — Diphtheria and Croup — — — — — — — 1 — 1 Whooping Cough — — — — — — 1 3 1 5 Diarrhoea — — — — 11 21 19 7 58 Enteritis — 1 1 — 2 17 19 12 6 56 Tuberculous Meningitis — — — — — 3 1 — 4 Abdominal Tuberculosis — — — — — 1 1 — 2 Other Tuberculous Diseases — — — — — — — — 1 1 Congenital Malformations 8 — 1 — 9 — 5 — — 14 Premature Birth 31 5 1 1 38 5 — — — 43 Atrophy, Debility and Marasmus 10 8 3 2 23 13 17 4 2 59 Atelectasis 5 — — — 5 — — — — 5 Injury at Birth 1 — — — 1 — — — — 1 Erysipelas — — — — — — — — — — Syphilis — 1 — — 1 1 1 — — 3 Rickets — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — 1 1 1 3 Convulsions — 2 — — 2 3 — 1 1 7 Gastritis — — 1 — 1 — — — — 1 Laryngitis — — — — — — — 3 — 3 Bronchitis 2 — 1 — 3 6 4 5 6 24 Pneumonia (all forms) 1 2 — 1 4 5 2 7 7 25 Suffocation, overlaying 1 1 — — 2 1 3 — — 6 Other Causes 8 — 4 1 13 5 3 6 6 33 Totals 67 20 12 5 104 67 81 65 40 357 Nett Births in the year—legitimate, 3320; illegitimate, 101. Nett Deaths in the year of—legitimate infants, 331; illegitimate infants, 26. 91 Table V. Metropolitan Borough of Lewisham. Phthisis: Sanatorium and Hospital Accommodation. Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are patients selected ? Are patients under the care of a resident Medical Officer ? What charge, if any. is made for the use of Beds? Do the Sanitary Authority use— (1) their Isolation Hospital, or (2) their Smallpox Hospital, for cases of Phthisis? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium: If so, how many, and in what Sanatorium? Do the Sanitary Authority provide portable open-air Shelters or Tents ? (a) Early cases ... No accommod ation provided ... ... ... No. No. (b) Intermediate cases ... No accommod ation provided ... ... ... No. No. (c) Advanced cases ... No accommod ation provided ... ... ... No. No. Have the Council, or any Private Body, provided a Dispensary. No.