LEW9 BOROUGH OF LEWI SHAM. Annual Report on the VITAL STATISTICS & SANITARY CONDITION ok the BOROUGH OF LEWISHAM and REPORT OF THE PUBLIC ANALYST For the Year 1912, 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. PUBLIC HEALTH COMMITTEE, 1912=13. Chairman: Councillor James Macgregor. The Mayor (ex-officio): Alderman R. Gordon Brew, J.P. Alderman A. J. Fitzgibbons. „ W. H. Le May (ex-Mayor). „ A. Hume Nicholl. Councillor A. O. Bentley. „ Dr. Octavius Beven. „ Dr. J. Russell Higson. „ G. W. Ilsley. „ A. C. Knight. „ Wallace McCubbin. „ F. J. Marchment. „ W. P. Parry. „ J. Pruddah. „ W. P. Pulley. „ J. Sanger. „ H. B. Sykes. „ A. O. Weeks. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Sanitary Inspectors: J. H. Berry. J. A. K. Cooper. J. Crowther. J. Dai/try. A. H. Gray. H. King. B. A. Knappett. E. T. PlDWELL. R. White. Women Sanitary Inspectors: Miss K. H. Barke. Miss N. F. Jones. Clerks in the Department: F. E. Seckerson. C. C. Summers. P. C. Litten. Medical Officer of Health and Public Analyst: A. Wellbsley Harris, M.R.C.S., D.P.H., &c. 4 To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of 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 1912, together with the Returns required by the Local Government Board and the Home Office. The death rate for the Borough equalled 10.5 per 1000 persons living, compared with 11.4 per 1000 in 1911. The Boroughs of Wandsworth and Hampstead alone recorded lower rates in the Metropolis, 10.2 and 10.4 per 1000 respectively. The birth-rate continues to decline, and the figure for 1912, 20.35 per 1000, is the lowest ever recorded in the Borough. The infant mortality rate equalled 69 per 1000 births registered in the Borough, and it is pleasing to note that in this respect also Lewisham compares very favourably with other districts in the Metropolis, only two Boroughs having a lower rate. 5 On the whole, therefore, Lewisham is to be congratulated on possessing so satisfactory a health record in 1912. I desire to express my cordial appreciation of the support I have always received from your Council and the Chairman and Members of the Public Health Committee, and I also take this opportunity of acknowledging the willing assistance I have received from the staff of the Public Health Department. I am, Gentlemen, Your obedient Servant, Medical Officer of Health. June, 1913. 6 TABLE OF CONTENTS. Page Vital Statistics— Population 9 Births 12 Marriages 13 Deaths 13 ,, in Wards 14 ,, Ages at 15 „ Causes of 15 ,, from Zymotic Diseases 15 ,, Tuberculous Diseases 19 ,, of Infants 21 „ in Public Institutions 22 Metropolitan Boroughs. Births. Deaths, &c. 25 Infectious Diseases— Notifiable Diseases 28 ,, Age Periods 28 ,, in Wards 30 Scarlet Fever 31 Diphtheria 31 Enteric Fever 32 Erysipelas 32 Puerperal Fever 32 Cerebro-Spinal Fever 32 Ophthalmia Neonatorum 32 Polio Myelitis 32 Attack rates in Wards 33 ,, in Metropolitan Boroughs 34 Pulmonary Tuberculosis 35 Administrative Measures re Tuberculosis 38 Report re Proposed Dispensary 38 National Insurance Act:— Sanatorium Benefit 46 Insurance Committees 48 Non-notifiable Diseases 50 Page Infectiods Diseases—contd. School Closure 50 Bacteriological Diagnoses 52 Sanitary Work— Housing, Town Planning, &c. Act 54 House-to-house Inspection 54 Combined Drainage 56 Smoke Nuisances 56 Disinfection 57 Summary of Male Inspectors' Work 58 Summary of Female Inspectors' Work 59 Water Certificates granted 60 Revenue Act Certificates 61 Miscellaneous— Bakehouses 63 Cowhouses 63 Slaughterhouses 64 Unsound Food 65 Coroner's Court and Mortuary 65 Factories and Workshops- Home Office Tables 68 Report of Public Analyst 74 Appendix— Local Government Board Tables— Table I.—Vital Statistics, 1912 and previous year 88 ,, II.—Infectious Diseases 89 ,, III.—Causes of Death 90 „ IV.—Infantile Mortality 91 Table V.—London County Council Summary 92 ,, IV.—Meteorological Table, 1912 94 7 EPITOME OF VITAL STATISTICS, 1912. Area in acres 6,991 Population:— Census, 1901 127,495 „ 1911 160,834 Estimated to the middle of 1912 165,249 Average number of persons per house (Census, 1911) 5.6 Births 3,512 Birth Rate 20.35 Deaths 1,726 Death-rate 10.51 Deaths of infants under 1 year of age 233 Infant mortality per 1,000 Births 69 Zymotic Death-rate 0.57 VITAL STATISTICS. 9 VITAL STATISTICS. Population.—The estimated population of the Borough, based upon the Census returns of 1901 and 1911, is 165,259. This figure is calculated upon the assumption that the increase in the population maintained the same rate of progression in the year, as it did during the intercensal period of 1901-1911. The figure thus obtained, 165,249, shows an increase in one year of 3,572. The increase in the population by natural increment, i.e., the excess of births over deaths, amounted to 1,786, and it is assumed therefore, that the difference of 1,786 between the total estimated increase and that shewn by the natural increment, is due to immigration into the Borough. The statistics contained in this report are calculated upon the estimated population stated above. During 1912 some further results of the 1911 Census have been published. These show the number of males and females in each Ward, the kind of building used as dwelliugs, and the population therein. These particulars are given in the two following tables. 10 Table shewing the Area and Population of the Borough, in Wards Ward. Area in acres. Enumerated Population Census. April, 1901. Enumerated Population Census, April, 1911. In the 10 years 1901-11. Estimated Population June, 1912. Increase. Decrease. Males. Females. Total Persons. No. of Persons. Per centage. N o. of Persons Per centage. Church 202 6412 2392 3583 5975 — — 437 6.8 5917 Manor 175 6734 3574 4476 8050 1316 19.5 — — 8224 South 878 5503 2762 3577 6339 836 15.2 — — 6450 Blackheath 369 6729 2753 3817 6570 — — 159 2.2 6553 Lewisham Village 279 13842 6803 7935 14738 896 6.5 — — 14857 Lewisham Park 350 11145 8015 8734 16749 5604 50.0 — — 17487 Brockley 512 10952 6941 8063 15004 4052 37.0 — — 15540 Catford 2541 23203 18217 20795 39012 15809 68.0 — — 41106 Forest Hill 624 18051 9158 11646 20804 2753 15.2 — — 21169 Sydenham 1084 24924 12165 15428 27593 2669 10.7 — — 27946 Whole Borough 7014 127495 72780 88054 160834 33339 26.0 — — 165249 11 Census, 1911. Classification of Buildings. 1901 Total. 1911. Total (Cols. 4-11.) Buildings used as Dwellings. Vessels, Sheds, Vagrants, &c. Separate Flats (Included In Col.5) Buildings not used as Dwellings. Ordinary Dwelling Houses. Blocks of Flats. Shops. Hotels, Inns, and Public Houses. Offices. Warehouses, Workshops, tories. Institutions. Others. Kind of Buildings. No. Columns 1 2 3 4 5 6 7 8 9 10 11 13 13 14 Number inhabited 22,750 28,723 25,463 828 2,059 98 44 100 131 - 4,118 Places of Worship 100 Separate Occupiers 27,701 37,013 30,174 4,141 2,277 99 48 109 161 4 4,141 Government and Municipal Buildings 22 Population 127,495 160,834 130,221 14,972 9,538 602 181 4,767 546 7 14,972 Shops 421 Offices 45 Uninhabited 1,597 2,534 2,223 17 267 - 9 2 16 - 487 Warehouses, Workshops, Factories 178 Being built 598 144 139 3 2 - - - - - 6 Theatres and other places of Amusements 12 The classification of the kinds of buildings is based on descriptions furnished by the local enumerators; in some cases, especially as regards the distinction between a flat and an ordinary dwelling-house occupied by more than one family, differences in practice are almost inevitable, the numbers under the several headings must therefore be regarded as approximate. 12 BIRTHS. Number of births (corrected) in 1912 3343 Average number in previous 11 years 3512 Birth rate per 1,000 in 1912 20.35 Birth rate, County of London 24.5 „ 95 Great Towns 24.9 „ England and Wales 24.0 The total number of Births registered in the Borough during the year amounted to 3,323. Seventeen of this number were born to parents whose usual place of residence was in other districts, and we were advised by the Registrar-General that 37 children were registered in districts outside, the parents of whom were residents of the Borough of Lewisham. The corrected number of births belonging to this Borough is therefore 3,343, the males numbering 1,698, and the females 1,645. In 1911, 3,421 children were born, which shows in one year a decrease of 78 in the number of births. It is a remarkable fact that the number of births which occurred in 1912 is practically the same as in 1901, despite the fact that during this period of twelve years the population has increased by nearly forty thousand. The birth-rate still continues to decline, and during the year under review amounted to 20.35 per 1,000 compared with 21.22 per 1,000 in the previous year, and 25.9 per 1,000 in 1901. The birth-rate for the County of London was 24'5 per 1,000, for the 97 Great Towns, 24'9 per 1,000, and for the whole of England and Wales, 24'0 per 1,000. Illegitimacy.—The illegitimate births numbered 77, compared with 101 in 1911. 13 The Notification of Births Act, 1907. During the year 3279 notifications of births were received under the above-named Act. In 856 cases the notification was only received after a notice had been sent to the father from this Department. The following Table shows the number of cases notified, the person by whom notified, whether the children were born alive or dead, and the total number of births registered in the Borough:— Total No. of Births Notified. Notified by No Born Alive. No. Born Dead. No. Births Registered. Medical Attendant. Parent. Midwife. Other Person. 3279 1049 1484 679 67 3170 109 3323 MARRIAGES. The number of Marriages in the Borough during the year was 1,101, compared with 1,061 in 1911, and 1,015 in 1910. Of this number, 641 were solemnized at the Established Church, 125 at Nonconformist Places of Worship, and 335 at the Register Office. MORTALITY. Nett number of deaths, 1912 1726 Death rate per 1,000, 1912 10.51 „ County of London 13.6 „ 95 Great Towns 13.8 „ England and Wales 13.4 14 The total number of Deaths registered in the Borough during the year was 1,789. After deducting the deaths of non-residents dying within the Borough (272), and adding those of residents of the Borough dying outside (209), a corrected total of 1,726 is obtained, compared with 1,842 in the previous year. The average number of deaths in the 10 years, 1902-11, was 1,708. The corrected death rate for the Borough was 10.51 per 1,000 of the population, compared with 11.43 per 1,000 in 1911. The following Table shows the death rates in the various Wards of the Borough during the year under review, and the previous year:— Wards. Males. Females. Total Deaths. Death Kates, 1912. Death Rates, 1911. Church Ward 43 26 69 11.73 14.12 Manor Ward 28 54 82 10.03 11.66 South Ward 30 29 59 9.20 10.56 Blackheath Ward 33 42 75 11.52 9.01 Lew. Village Ward 80 79 159 10.76 12.50 Lew. Park Ward 78 91 169 9.72 11.99 Brockley Ward 76 85 161 10.42 10.29 Catford Ward 181 184 365 8.93 9.97 Forest Hill Ward 102 118 220 10.45 12.25 Sydenham Ward 174 170 344 12.41 12.70 Address Unknown 10 13 23 — — Whole Borough 835 891 1726 10.51 11.43 15 Ages at Death.—The following table shows the number of deaths at various age periods in the years 1911 and 1912, and the percentages to the total deaths at all ages:— 1911. 1912. No. of Deaths. Percentage to Total. No. of Deaths. Percentage to Total. Under 1 year 357 19.4 233 13.5 1 year and under 2 68 3.7 38 2.2 2 years and „ 5 62 3.3 50 2.9 5 ,, „ „ m 15 75 4.1 72 4.2 15 „ „ „ 25 67 3.6 53 3.1 25 „ „ ,, 45 222 12.0 236 13.7 45 „ ,, „ 65 401 21.8 407 23.6 65 „ and over 590 32.0 637 36.9 Seasonal Mortality.— In the first, quarter of the year the deaths numbered 524 „ „ second quarter „ „ „ „ 388 „ „ third quarter „ „ „ „ „ 353 „ „ fourth quarter „ „ „ „ „ 461 ANALYSIS OF CAUSES OF DEATH. Zymotic Diseases.—The total number of deaths due to zymotic diseases was 92, compared with 187 in the previous year, and the death-rate from these diseases was 0.57 per 1,000, against 1.16 in 1911. Enteric Fever.— Eight fatal cases of this disease occurred, compared with four in 1911, and an average of 4.1 for the ten years, 1902-11. 16 Measles was certified to be the cause of eight deaths, considerably less than in 1911, when nineteen deaths occurred. Scarlet Fever was the cause of six deaths. Whooping Cough.—Twenty-three deaths were caused by this disease, thirteen of the victims being under one year of age. Diphtheria was the cause of twenty-six deaths, one less than in 1911. Diarrhoea and Enteritis.—Twenty children under the age of two years died from these diseases, compared with 108 in the preceding year. We have to thank the exceedingly wet summer for this very small mortality. The following table shows the death-rates from the principal zymotic diseases in this Borough, and in the County of London, the 95 Great Towns, and England and Wales:— Enteric Fever. Measles. Scarlet Fever. Whooping Cough. Diphtheria Number of deaths in 1912 8 8 6 23 26 Death-rate „ „ 0.05 0.05 0.04 0.4 0.15 Average number of deaths in the ten years, 1902-11 4 25 11 30 23 Death-rate, County of London 0.02 0.40 0.04 0.22 0.10 ,, 95 Great Towns 0.04 0.46 0.06 0.26 0.13 „ England and Wales 0.04 0.35 0.05 0.22 0.11 17 Zymotic Death-rates in Wards.—The following table shows the deaths and death-rates from Zymotic disease in Wards of the Borough:— Ward. Enteric Fever. Measles. j Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis. (Under 2 years). Totals. No. Rate. No. Rate. No. Rate. No. Rate. So. Rate. No. Rate. No. Rate. Church — — — — — — — — 1 0.17 — — 1 0.17 Manor — — — — — — — — — — — — — — South — — — — 1 0.15 1 0.15 — — 1 0.15 3 0.46 Blackheath — — 1 0.15 — — 1 0.15 — 0.30 — — 4 0.61 Lewisham Vill. — — 4 0.26 — — — — 5 0.34 1 0.06 10 0.67 Lewisham Park — — — — 1 0.06 2 0.11 1 0.06 5 0.29 9 0.52 Brockley 2 0.13 1 0.06 2 0.13 1 0.06 — — 3 0.19 9 0.58 Catford 3 0.07 2 0.05 — — 6 0.14 9 0.21 3 0.07 23 0.56 Forest Hill 3 0.14 — — 1 0.05 2 0.09 1 0.05 2 0.09 9 0.43 Sydenham — — — 1 0.03 10 0.36 6 0.21 7 0.25 24 0.86 Whole Borough 8 0.05 8 0.05 6 0.04 23 0.14 25 0.15 22 0.13 92 0.57 18 Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1912. Ages. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea and Enteritis. Totals in Age Groups. Under 1 year — 3 — l 13 — 20 37 1 and under 2 years — 2 — 2 4 — 2 10 2 and under 5 — 2 3 8 4 — 2 19 5 and under 15 — 1 3 14 2 2 — 22 15 and under 25 — — — 1 — 2 — 3 25 years and upwards — — — — — 4 8 12 Total all ages 1912 — 8 6 26 23 8 32 103 Total all ages 1911 — 19 5 27 17 4 115 187 19 Pulmonary Tuberculosis.—This disease was the cause of 112 deaths in 1912, compared with 104 in 1911. The average number of deaths in the ten years, 1902-11, was 120. The death-rate from pulmonary tuberculosis amounted to 0'68 per 1,000, compared with 0.64 per 1,000 in the preceding year. The deaths and death-rates from pulmonary tuberculosis in the various Wards .are set out in the following table:— ward. No. of Deaths. Death Rate. ward. No. of Deaths. Death Rate. Church 1 0.17 Lewisham Park 13 0.75 Manor 9 1.10 Brockley 9 0.58 South 2 0.30 Catford 32 0.78 Blackheath 2 0.30 Forest Hill 5 0.24 Lewisham Vill 11 0.74 Sydenham 26 0.94 Address Unknown 2 — Whole Borough 112 0.68 Ages at Death:— Under 5 years 1 death. 5 and under 15 2 deaths. 15 „ „ 25 17 ,, 25 ,, „ 45 52 ,, 45 „ „ 65 80 „ 65 and over 10 „ All Ages 112 „ Tuberculous Meningitis and other tuberculous diseases were the cause of 34 deaths. 20 Cancer and Malignant Diseases were the cause of 174 deaths, compared with 171 in 1911. The average yearly number of deaths in the ten years, 1902-11, was 189. The deaths occurred at the following ages:— Under 25 2 deaths. 25 and under 45 15 „ 45 „ 65 79 „ Over 65 years 78 „ Bronchitis.—This disease was the cause of 146 deaths, compared with 136 in 1911, and an average of 129 yearly in the ten years, 1902-11. The deaths took place at the following ages:— Under 1 year 19 1 year and under 45 17 45 years and under 65 28 Over 65 years 82 Pneumonia.—The deaths from all forms of pneumonia numbered 104, compared with 119 in 1911, and an average during the ten years, 1902-11, of 108. The deaths occurred at the following ages :— Under 1 year 20 1 year and under 5 11 5 years „ 25 6 25 „ „ 45 19 45 „ „ 65 19 Over 65 years 29 Other forms of disease of the Respiratory Organs were responsible for 33 deaths. CHART A. Showing the principal causes of Death during the year 1912. 21 INFANT MORTALITY. During 1912, 233 children died before reaching the age of one year, equal to 13.5 per cent. of the whole of the deaths in the Borough. The infant mortality rate is therefore 69 per 1,000 births, compared with 104 per 1,000 in 1911. With the exception of Chelsea and Hampstead (68 and 62 per 1,000 respectively) this rate is the lowest of all the Metropolitan Boroughs. The infant mortality rate for the County of London was 91 per 1,000. Causes of Death.—The following list shows the principal causes of death among infants under one year of age:— Measles 3 AVhooping Cough 13 Diphtheria and Croup 1 Tuberculous Diseases 3 Convulsions 11 Bronchitis 19 Pneumonia 20 Diarrhoea and Enteritis 20 Suffocation in bed with parents 4 Injury at Birth 3 Atelactasis 7 Congenital Malformations 14 Premature Birth 45 Atrophy, Debility and Marasmus 49 Other causes 21 233 S 22 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—The deaths which occurred in the Public Institutions in the Borough numbered 633, of which number 372 were residents, the remainder having been brought from other districts for treatment The deaths were distributed as follows:— Institution. Number of Deaths. Residents. Non-Residents. Lewisham Infirmary 324 19 „ Workhouse 28 3 Park Hospital for Children 3 153 Bermondsey Workhouse — 61 St. John's Hospital 9 12 Home for Sick Children, Sydenham 8 6 Greenwich Workhouse, Grove Park — 3 Flower House, Asylum, Southend — 2 372 259 Without the Borough.—The deaths of residents who died in Public Institutions outside the Borough were distributed as follows:— Asylums:— Banstead, 9; Cane Hill, 8; Caterham, 4; Dartford Heath, 9; Horton, 7; others, 10. Poor Law Institutions:—4 deaths. Infectious Disease Hospitals:— Brook, 28; South. Eastern, 7 ; South-Western, 1. General Hospitals.—Charing Cross, 2; Children's Hospital, Great Ormond Street, 2; Evelina Hospital for Children, 2; Guy's, 11; Homœpathic, 2; London, 3; Middlesex, 2; Norwood Cottage Hospital, 2; Royal Free, 2; St. Bartholomew's, 6; St. Thomas's, 9; Seamen's, Greenwich, 5 ; Westminster, 4; others, 18. Table shewing Causes of, and Ages at Death, and Distribution in Wards, 1912. Causes of Death. Ages at Death. Total all ages. Wards. se address unknown. Under 1 year. 1 and under 2 yrs. 2 and under 5 yrs. 5 and under 15 yrs. 15 and under 25yrs. 25 and under 45 yrs. 45 and under 65yrs. 65yrs.and upwards Church. Manor. South. Blackheath. Lewisham Vill. Lewisham Park. Brockley. Catford. Forest Hill. Sydenham. 1 2 3 4 5 6 7 8 9 10 Enteric Fever – – – 2 2 4 – – 8 – – – – – – 2 3 3 – – Small Pox – – – – – – – – – – – – – – – – – – – – Measles 3 2 2 1 — — — — 8 — — — 1 4 — 1 2 – — — Scarlet Fever — — 3 3 — — — — 6 — — 1 — — 1 2 — 1 1 — Whooping Cough 13 4 4 2 — — — — 23 — — 1 1 — 2 1 6 2 10 — Diphtheria and Croup 1 2 8 14 1 — — — 26 1 — — 2 5 1 — 9 1 6 1 Influenza — 1 — — — 1 — 9 11 — — — 1 1 — 2 2 1 4 — Erysipelas 1 — 1 — — — — — 2 — — — — — — — 2 — — — Pulmonary Tuberculosis — — 1 2 17 52 30 10 112 1 9 2 2 11 13 9 32 5 26 2 Tuberculous Meningitis 2 1 7 2 1 — 1 1 15 1 — — — 3 2 — 3 3 3 — Other Tuberculous Diseases 1 1 2 4 1 4 5 1 19 — 1 1 1 — 4 4 6 1 1 — Cancer, Malignant Disease — — — 1 1 15 79 78 174 9 6 5 5 17 15 13 41 23 38 2 Rheumatic Fever — — — 3 1 2 1 1 8 — 2 — — — — 1 2 2 1 - Meningitis 1 4 — 2 2 1 1 — 11 — — 1 1 4 — 2 2 — 1 — Organic Heart Disease – — — 5 7 17 59 74 162 8 4 7 7 14 17 16 39 17 31 2 Bronchitis 19 5 3 2 1 6 28 82 146 4 7 5 4 13 10 18 27 24 30 4 Pneumonia (all forms) 20 6 5 4 2 19 19 29 104 3 5 4 6 10 11 12 17 12 21 3 Other diseases of Respiratory Organs 3 2 1 1 – 5 11 10 33 1 1 2 3 2 4 6 3 11 – Diarrhoea and Enteritis 20 2 2 — — 3 3 2 32 1 — 1 — 3 4 3 4 6 9 1 Appendictis and Typhilitis — — 1 2 1 1 1 — 6 — 1 — 1 — — — 3 1 – — Cirrhosis of Liver — — — — — 2 10 7 19 3 — — — 2 3 — 1 8 1 1 Alcoholism — — — — — 1 1 1 3 – – – – – – – 2 – 1 — Nephritis & Bright's Disease — — 1 1 1 11 15 24 53 1 — 3 — 6 7 9 7 9 10 1 Puerperal Fever – – – – – – – – – – – – – – – – – – – – Other Accidents and Diseases of Pregnancy & Parturition — — — —- 1 8 1 — 10 — 1 — — 2 — 1 4 1 2 — Congenital Debility and Malformation Premature Birth 108 — 2 3 — — — — 113 3 3 2 2 8 13 15 26 15 25 1 Violent Deaths (excluding suicide) 7 – 3 9 6 16 9 8 52 3 2 2 – 6 7 1 8 7 16 – Suicide – — — — 1 2 7 — 10 — 2 1 1 2 1 1 2 – – — Other defined Diseases 33 5 3 15 7 65 125 299 552 30 38 21 40 45 55 44 107 73 94 5 Diseases ill-defined or unknown 1 3 1 – – 1 1 1 8 – – – – 1 1 – 2 2 2 – 233 38 50 72 53 236 407 637 1726 69 82 59 75 159 169 161 365 220 344 23 25 Table showing Population, Birth and Death Rates, and Infant Mortality, in the Metropolitan Boroughs and the County of London. Boroughs. Population estimated to the middle of 1912. Births. | Deaths. Birth Rate. Death Rate. Deaths of Infants under 1 year of age. Number. Rate per 1000 Births. County of London 4519754 110353 61100 24.5 13.6 10056 91 West. Paddington 142362 3021 1751 21.3 12.3 296 98 Kensington 171746 3320 2226 19.4 12.9 303 91 Hammersmith 122750 2880 1606 23.5 13.0 259 90 Fulham 155402 4213 1985 27.2 13.2 396 94 Chelsea 65397 1229 949 18.8 13.8 84 68 City of Westminster 157248 2348 1942 15.0 13.0 197 84 North. St. Marylebone 116155 2243 1602 19.4 14.1 209 93 Hampstead 85966 1281 942 14.9 10.4 79 62 St. Pancras 216145 5367 3148 24.9 14.6 472 88 Islington 326398 8213 4662 25.2 14.0 712 87 Stoke Newington 50581 1033 611 20.5 11.5 74 72 Hackney ... 222986 5266 2691 23.7 12.2 421 80 Central. Holborn 48026 902 733 18.8 15.4 72 80 Finsbury 86130 2575 1612 30.0 18.6 294 114 City of London 18695 185 251 9 9 14.0 15 81 East. Shoreditch 110430 3562 1997 32.3 18.7 439 123 Bethnal Green ... 127985 3902 1954 30.6 15.9 375 96 Stepney 277315 8533 4211 30.9 15.9 897 105 Poplar 161597 5045 2635 31.3 16.2 541 107 South. Southwark 190017 5587 3164 29.5 16.8 587 105 Bermondsey 125260 3872 2098 31.0 16.8 431 111 Lambeth 297550 6952 3950 23.4 l3.0 601 86 Battersea 167589 4258 2042 25.5 12.3 358 84 Wandsworth 321831 6757 3265 21.0 10.2 513 76 Camberwell 261591 6422 3362 24.6 12.7 535 83 Deptford 109377 2896 1432 26.6 13.0 259 89 Greenwich 95994 2391 1254 25.0 12.9 201 84 Lewisham 165249 3343 1726 20.4 10.5 233 69 Woolwich 121932 2738 1411 22.5 11.9 200 73 26 Table showing Deaths and Death Rates from the Principal Infectious Diseases in the Metropolitan Boroughs and the County of London. Boroughs. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Diarrhœa & Enteritis (under 2). Phthisis. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. codnty of L'nd'n 117 003 1 000 1799 0.40 159 0.04 970 0.22 452 0.10 1371 12.42 6069 1.35 West. Paddington 1 0.01 – – 81 0.22 3 0.02 20 0.14 6 0.04 43 14.23 124 0.87 Kensington 4 0.02 — — 27 0.16 5 0.03 24 0.14 6 0.04 87 11.12 183 1.07 Hammersmith 4 0.03 — — 29 0.24 4 0.03 17 0.14 13 0.11 29 10.07 165 1.35 Fulham 8 0.05 — – 65 0.42 6 0.04 45 0 29 15 0.10 33 7.83 209 1.35 Chelsea ... 1 0.02 – – 22 0.34 2 0.03 14 0.21 5 0.08 8 6.51 85 1.30 City of Westm'er 4 0.03 — — 37 0.24 4 0 03 16 0.10 11 0.07 38 16.18 193 1.17 North. St. Marylebone... 5 004 — — 40 0.35 11 0.09 19 016 8 0.07 26 11.59 146 1.26 Hampstead 1 0 01 11 0.13 1 0.01 4 005 17 0.20 1 0.78 55 0.64 St. Pancras 3 0 01 95 0.44 5 0.02 44 020 25 0.12 37 6.89 341 1.58 Islington 8 002 — 151 0.46 9 0.03 57 0 18 39 0.12 90 10.96 441 1.35 Stoke Newington - — — — 5 0.10 — — 3 006 — — 3 2.90 44 0.87 Hackney . 3 001 — — 19 0.09 8 0.04 33 015 12 0.05 60 11.39 303 1.36 Central. Holborn 1 0.02 — — 25 0.52 — — 7 0.15 7 0.15 8 8.87 99 2.07 Finsbury 1 0.01 — — 129 1.50 5 0.06 29 0.34 13 0.15 44 17.09 165 1.92 City of London... — — — — 2 0.11 — — 1 0.05 1 0.05 4 21.62 37 1.98 East. Shoreditch 4 0.04 — — 116 1.05 5 0.05 47 0.43 19 0.17 94 26.39 231 2.10 Bethnal Green 3 0.02 — — 91 0.71 2 0.02 32 0.25 12 0.09 48 12.30 216 1.69 Stepney 9 0.03 — — 170 0.61 13 0.05 96 0.35 26 0.09 153 17.93! 465 1.68 Poplar 7 0.04 — — 112 0.69 3 0.02 64 0.40 17 0.11 68 13.48 243 1.51 South. Southwark 4 0.02 — — 139 0.73 6 0.03 49 0.26 27 0.14 104 18.61 354 1.87 Bermondsey 5 0.04 — — 102 0.82 8 0.06 36 0.29 16 0.13 67 17.30 218 1.75 Lambeth 13 0.04 – – 97 0.33 9 0.03 55 0.19 29 0.10 98 14.10 406 1.37 Battersea 2 0.01 — — 55 0.33 6 0.04 40 0.24 15 0.09 50 11.74 195 1.17 Wandsworth 8 0.02 — — 50 0.16 11 0.03 61 0.19 19 0.06 73 10.80 297 0.93 Camberwell 6 0.02 – – 81 0.31 8 0.03 51 0.20 21 0.08 65 10.12 339 1.30 Deptford 2 0.02 — — 28 0.26 6 0.06 25 0.23 11 0.10 29 10.01 147 1.35 Greenwich 2 0.02 — — 28 0.29 9 0.09 30 0.31 15 0.16 25 10.46 135 1.41 Lewisham 8 0.05 — — 8 0.05 6 0.04 23 0.14 26 0.15 22 7.75 112 0.68 Woolwich 2 0.02 10.01 31 0.25 4 0.03 27 0.22 20 0.16 10 3.65 128 1.05 INFECTIOUS DISEASES. 28 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 Acute Polio-Myelitis or PolioEncephalitis. The total number of cases notified during the year 1912 amounted to 1043, of which number 811, or 77.67 per cent. were removed for isolation to the Metropolitan Asylums Board's Hospitals or other Institutions. In 24 instances, or 2.95 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 1019 cases of infectious disease notified as occurring in the Borough during the year, an increase of 174 compared with the total for the preceding year, which was 835. In 1910, 848 cases were notified. Age Periods.—51.19 per cent. of the Scarlet Fever cases, compared with 41.21 per cent. in 1911, and 46.54 per cent. of the Diphtheria cases, compared with 49.84 per cent. in 1911, occurred among children aged six years and under. The following figures show the percentage of cases occurring among children of the age of six years and under to the total notifications of Scarlet Fever and Diphtheria:— Age. Scarlet Fever. Diphtheria. 1910. 1911. 1912. 1910. 1911. 1912. 6 years and under 48.7% 41.24% 51.19% 47.6% 49.84% 46.54% 5 „ ,, 37.0% 30.56% 39.43% 34.7% 35.56% 34.84% 4 ,, ,, 24.1% 20.47% 27.01% 23.3% 24.92% 23.86% 29 Age Periods of Scarlet Fever ami Diphtheria, notified during the year 1912. Age Periods Scarlet Fever. Diphtheria. Number of Cases. Percentage to Total Cases Number of Cases. Percentage to Total Cases. Under 1 year 3 .65 4 .95 1 to 2 years 6 1.30 8 1.91 2 ,, 3 ,, 26 5.66 15 3.58 3 ,, 4 „ 37 8.06 33 7.87 4 ,, 5 ,, 52 11.33 40 9.55 5 „ 10 „ 207 45.10 201 47.87 10 „ 15 „ 83 18.08 79 18.85 15 „ 25 „ 31 6.75 22 5.25 25 years and over 14 3.05 17 4.05 At all ages 459 100.00 419 100.00 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. The attack rate from all infectious diseases (excluding Puerperal Fever) during the year amounted to 6.13 per 1,000 of the population, compared with 511 in 1911, and 5.12 in 1910. The attack rate for the County of London was 5.24, compared with 5.31 in 1911. The attack rates for the Wards will be found on page 33. It will be seen that Catford Ward had the largest number of cases in proportion to its population, having an attack rate of 7.63 per 1,000. The lowest attack rate was in Forest Hill Ward, 4.40 per 1,000. 30 Number of Cases of Infectious Diseases notified in the Ten Wards and the Whole Borough during the Year 1912. Wards Scarlet Fever Diphtheria. Enteric Fever Erysipelas. Puerperal Fever. Ophthalmia Neonatorum. Polio-Myelitis or Polio-Encephalitis Total. 1 Church 24 n l l – – – 37 2 Manor 18 18 — 3 — – — 39 3 South 10 16 — 3 l – — 30 Lee Division 52 45 l 7 l – — 106 4 Blackheath 28 13 – 2 — – — 43 5 Lewisham Village 32 28 — 14 — – — 74 6 Lewisham Park 47 54 2 19 l 1 — 124 7 Brockley 60 24 2 8 — 1 — 95 8 Catford 118 160 12 21 2 l l 315 Blackheath & Lewisham Division 285 279 16 64 3 3 l 651 9 Forest Hill 41 33 4 14 – 1 — 93 10 Sydenham 81 62 4 17 3 1 l 169 Sydenham & Forest Hill Division 122 95 8 31 3 2 l 262 Whole Borough 459 419 25 102 7 5 2 1019 CHART B. Showing Weekly Notifications of all Infectious Diseases and of Scarlet Fever and Diphtheria, during the year 1912. - 31 SCARLET FEVER.—The total number of cases notified during the year amounted to 466, compared with 348 in 1911. Of this number, 392, or 84.12 per cent., were removed to the Metropolitan Asylums Board's Hospitals. Subsequently 7 cases were returned to their homes and stated not to be suffering from any notifiable disease. Deducting this number, a corrected total of 459 is obtained, compared with 337 in 1911, equal to an attack rate of 2.78 per 1,000 persons, compared with 2.09 in 1911. The attack rate for the County of London was 2.51 per 1,000. An examination of the attack rates for the various Wards of the Borough shows that the highest occurred in Blackheath Ward (4.28 per 1,000) and that the Ward least affected was South, with 1.55 per 1,000. 45.10 per cent. of the cases occurred among children between the ages of 5 and 10 years, and 27.01 per cent. among children under the age of five. Case Mortality.—Six deaths from Scarlet Fever occurred to residents in the Borough, equal to 1.30 per cent. of the cases notified, compared with 1.48 in the previous year. DIPHTHERIA.—Four hundred and thirty-four cases of Diphtheria were notified, compared with 342 in 1911, and of this number 372, or 85.71 per cent., were removed to hospital. Fifteen patients (or 4.03 per cent. of the number removed) were returned as not suffering, giving a corrected total of 419, an increase of 90 on the number notified in 1911. The attack rate per 1,000 of the population amounted to 254, compared with 2.04 in 1911. The rate for the County of London was 1.58 per 1,000. Catford Ward suffered most from this disease, in proportion to its population, having an attack rate of 3.90 32 per 1,000. Brockley Ward was least affected, having an attack rate of 1.54 per 1,000. Case Mortality.—Twenty-six deaths occurred from this disease, equal to 6.20 per cent. of the cases notified, compared with 8.20 per cent. in 1911. ENTERIC or TYPHOID FEVER.—Twenty-six cases were notified, 19 of which were removed to Hospital. One case was returned home as not suffering, giving a corrected total of 25, a decrease of 10 on the previous year. The attack rate for the whole Borough was 0.15 per 1,000, compared with 0.22 in 1911. The case mortality equalled 32.00 per cent., against 11.4 per cent. in 1911. ERYSIPELAS.—102 cases of Erysipelas were notified, compared with 103 in the preceding year. Twenty-four cases were removed to the Lewisham Infirmary and other Institutions for treatment. Two of the cases proved fatal. PUERPERAL FEVER.—Seven cases of Puerperal fever were notified, one of which was removed to the Infirmary for treatment. 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 and was subsequently returned home as "not suffering." OPHTHALMIA NEONATORUM.—Five cases of Ophthalmia Neonatorum occurred during the year, compared with sixteen for the previous year. One of the cases was removed to hospital for treatment. POLIO-MYELITIS or POLIO-ENCEPHALITIS.—Only two cases of this disease occurred during the year, one of which died. 33 Table showing the Attack rates from the Principal Infectious Diseases per 1,000 of the population for the ten Wards, and the whole Borough in the years 1909-1912. Wards. Diseases Scarlet Fever Diphtheria Enteric Fever Erysipelas Total All Diseases. 1909 1910 1911 1912 1909 L910 1911 1912 1909 1910 1911 1912 1909 1910 1911 1912 1909 1910 1911 1912 Church 3.50 4.01 1.34 4.06 2.24 0.69 1.85 1.86 — — 0.16 0.17 0.14 0.27 0.33 0.17 5.88 4.98 3.70 6.27 Manor 4.19 4.12 2.73 2.19 2.88 0.64 11 2.19 0.26 0.25 0.12 – 1.17 0.90 0.87 0.36 8.51 5.93 5.83 4.73 South 7.05 2.80 1.42 1.55 1.76 0.17 1.10 2.48 — 0.52 – — 1.23 — 0.31 0.46 10.04 3.51 2.84 4.51 Blackheath 4.77 2.30 1.53 4.28 0.72 1.29 1.22 1.99 0.14 0.14 — — 1.01 0.43 0.76 0.31 6.66 4.18 3.82 6.58 Lewisham Village 2.54 1.74 1.02 2.16 1.69 0.64 1.70 1.89 — 0.12 0.13 – 0.39 0.38 0.88 0.94 4.63 2.88 4.01 4.99 Lewisham Park 7.91 4.48 2.43 2.69 2.15 1.16 3.21 3.09 0.05 0.14 0.11 0.11 0.82 0.58 0.89 1.09 10.93 6.38 6.82 7.05 Brockley 6.16 2.79 3.05 3.87 2.16 1.07 0.99 1.54 0.08 — — 0.12 0.99 0.16 0.38 0.51 9.41 4.03 4.44 6.13 Catford 5.95 2.54 2.26 2.87 2.75 1.17 1.98 3.90 0.11 0.22 0.38 0.29 0.56 0.28 0.41 0.51 9.36 4.22 5.14 7.63 Forest Hill 3.96 2.54 1.34 1.94 1.95 1.18 2.16 1.56 0.16 0.05 0.19 0.19 0.54 0.43 0.86 0.66 6.62 4.22 4.66 4.40 Sydenham 6.95 4.83 2.50 2.90 2.48 2.43 2.50 2.22 0.13 0.19 0.36 0.14 0.53 0.35 0.72 0.61 10.11 7.80 6.23 5.95 Whole Borough 5.63 3.29 2.09 2.78 2.25 1.27 2.04 2.54 0.10 0.16 0.22 0.15 0.65 0.37 0.64 0.62 8.64 5.12 5.11 6.13 34 Table showing the 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 1909-1912. Borough. Small-Pox. Scarlet Fever. Diphtheria. All Notifiable Infectious Diseases. 1909. 1910. 1911. 1912. 1909. 1910. 1911. 1912. 1909. 1910. 1911. 1912. 1909. 1910. 1911. 1912. Battersea — — — — 3.95 2.60 2.12 2.77 1.55 1.21 1.34 1.39 6.71 5.06 4.65 5.18 Bermondsey — 0.01 – — 3.61 2.87 2.42 3.35 1.55 1.65 2.03 1.75 6.60 5.90 5.88 6.87 Bethnal Green 0.01 — 0.03 — 4.32 1.80 1.91 2.22 1.40 1.39 1.58 1.72 7.29 5.45 5.71 5.81 Camberwell 0.00 — 0.01 — 3.62 1.79 2.44 2.43 1.33 0.95 1.35 1.22 6.00 3.82 4.90 4.66 Chelsea — — — — 4.09 1.59 2.17 1.93 1.31 1.10 1.26 1.36 6.13 3.21 4.34 4.01 Deptford – — 0.01 — 3.16 2.52 3.43 3.70 1.65 1.09 1.51 1.55 6.72 5.06 6.75 7.16 Finsbury — — 0.01 – 2.53 1.75 2.05 1.83 1.76 1.59 2.05 1.68 5.88 5.53 7.58 5.43 Fulham — — — — 2.91 1.96 2.49 3.13 1.83 1.42 2.05 1.50 5.82 4.22 5.56 5.73 Greenwich — — — — 3.52 1.52 3.16 4.59 1.47 1.49 3.26 2.65 6.21 4.02 7.79 8.42 Hackney 0.00 — 0.02 — 3.31 1.68 2.77 2.32 1.11 0.79 1.42 1.13 5.87 3.87 6.10 4.63 Hammersmith — — – — 3.10 2.68 1.97 2.72 1.53 1.30 1.61 1.44 5.48 4.80 4.63 5.14 Hampstead — — — 2.76 1.51 1.52 1.25 0.50 0.53 1.77 1.88 3.80 2.61 4.04 3.80 Holborn 0.02 — — — 1.81 1.28 2.45 2.38 0.88 0.85 1.74 1.86 3.85 3.39 5.1 5.47 Islington 0.01 0.00 0.00 — 3.67 2.07 2.47 2.49 1.23 1.34 1.82 1.59 5.85 4.32 5.36 4.85 Kensington — — — – 2.29 1.43 1.37 1.77 0.97 0.84 1.28 1.05 4.30 3.31 3.52 3.65 Lambeth — — 0.00 — 3.62 2.78 2.58 2.01 1.17 1.00 1.36 1.13 5.58 4.67 4.99 4.18 Lewisham — – — — 5.63 3.29 2.09 2.78 2.23 1.27 2.04 2.51 8.64 3.12 5.11 6.13 London, City of 0.06 — — — 2.09 1.23 1.18 1.77 1.05 1.17 1.18 0.91 4.03 3.63 3.54 3.54 Paddington — 0.01 — 4.16 1.71 1.60 1.90 1.21 0.79 1.21 1.79 6.28 3.47 3.92 4.70 Poplar — 0.01 0.01 0.01 4.26 2.73 2.32 1.95 1.24 1.02 1.77 1.57 6.92 5.44 5.82 5.10 St. Marylebone — – — – 3.64 1.67 2.80 2.24 0-90 1.02 1.15 1.29 5.80 3.85 5.06 4.44 St. Pancras 0.00 – — – 3.26 2.87 2.04 2.77 1.35 1.11 1.94 2.55 5.53 5.11 5.22 6.42 Shoreditch — 0.02 0.03 – 2.97 1.87 2.16 1.39 1.62 1.15 1.58 1.20 6.42 4.67 5.42 4.19 Southwark 0.01 — — – 2.80 1.98 2.48 2.64 1.22 1.34 1.54 1.49 5.29 4.82 5.94 5.84 Stepney 0.03 — 0.14 — 3.33 1.77 1.68 3.36 1.87 1.29 1.86 1.31 7.07 4.75 5.75 6.22 StokeNewington — — — – 2.03 1.55 1.96 1.78 0.52 0.97 1.58 1.09 3.32 3.32 4.49 3.64 Wandsworth — — — — 3.36 2.23 2.78 2.53 1.25 0.94 1.64 1.33 5.58 4.02 5.27 4.81 Wtmstr City of 0.01 0.01 0.01 — 3.50 1.48 1.60 1.52 1.34 0.89 0.92 1.02 5.64 3.08 3.24 3.36 Woolwich — 0.01 — 0.02 7.72 3.89 4.24 3.88 2.01 1.27 1.96 3.49 10 .65 5.79 7.03 8.31 London County 0.00 – 0.02 0.00 3.58 2.16 2.33 2.51 1.39 1.13 1.64 1.58 6.12 4.43 5.31 5.24 35 PULMONARY TUBERCULOSIS. Prior to the year 1912 cases of Pulmonary Tuberculosis were notifiable under the following Regulations:— The Public Health (Tuberculosis) Regulations, 1908 (which required the notification of cases of Pulmonary Tuberculosis coming under the notice of certain Poor Law Officers); The Public Health (Tuberculosis in Hospitals) Regulations, 1911, which came into force on May 1st, 1911, and require the notification of cases of Pulmonary Tuberculosis in attendance at hospitals, dispensaries, sanatoria, and similar institutions. At the end of 1911 the Public Health (Tuberculosis) Regulations, 1911, were issued by the Local Government Board, and came into operation on January 1st, 1912. These latter regulations make it the duty of a medical practitioner to notify every case of Pulmonary Tuberculosis in his private or public practice. The following are among the duties cast upon the Medical Officer of Health under the Regulations:— To transmit to the proper authorities all notifications addressed to him in error, and to inform the person notifying that he has done so. To keep a register of all cases notified, and to enter therein the full particulars contained in every notification, and a statement of the action taken in regard to the patient. To make such enquiries and to take such steps as may appear to him necessary or desirable for preventing the spread of infection and for removing conditions favourable to infection. 36 To transmit to the Medical Officer of the London County Council at the end of the week a statement of every notification received during the week. Special Powers of Councils. The Regulations empower a Council, on the advice of their Medical Officer of Health, to supply all such medical or other assistance, and all such facilities and articles as may reasonably be required for the detection of Pulmonary Tuberculosis, and for preventing the spread of infection, and for removing conditions favourable to infection, and for that purpose to appoint such officers, do such acts and make such arrangements as may be necessary. To provide and publish or distribute in the form of placards, handbills or leaflets, suitable summaries of information and instructions respecting Pulmonary Tuberculosis, and the precautions to be taken against the spread of infection from the disease. Notifications received in 1912. During the year 1912, 344 fresh cases were notified by the following persons:— Under the 1908 Regulations:— Poor Law District Medical Officers 13 cases. Other Poor Law Officers 26 „ Under the (Hospital) Regulations 89 „ Under the 1911 Regulations:— Private Practitioners 215 „ School Medical Officer 1 case. Total 344 37 Ages of Persons Notified. Age. No. of Cases. Under 1 year 1—5 5—15 15—25 25—45 45—65 65 years and over 1 1 36 60 181 55 10 Total 344 Residence of Persons summarised in Wards. Name of Ward. No. of Cases. Church Manor South Blackheath Lewisham Village Lewisham Park Brockley Catford Forest Hill Sydenham Total 12 15 10 21 35 49 32 79 30 61 344 The notifications were followed by a visit to the home of the patient, and our enquiries elicited the fact that in 16'2 cases there was previous family history of the disease. In only 19 cases could the disease be traced to actual contact with another sufferer in the house. It was found that many of the patients were sadly ignorant of the precautions which they should have adopted for the protection of other occupants of the house, and, in some cases, subsequent visits were made with a view to affording assistance in this direction. In only 202 instances, out of the 344 cases notified, was it possible for the patient to have a separate room or a separate bed. Many of the sufferers could only afford occasional medical treatment locally, and others were in attendance at one or other of the London Hospitals as out-patients. 38 It will be noticed that more than half the persons notified were between the age of 25 and 45 years, the period of life at which the greatest responsibility is incurred. The notifications for the year amounted to 344, but it is estimated that between 800 and 1,000 persons in the Borough are suffering from pulmonary tuberculosis, and it is probable that only about 20 per cent., or 25 per cent. at the most, are entitled to benefits under the National Insurance Act. The deaths from pulmonary tuberculosis in 1912 amounted to 112, which is equivalent to a death rate of 0.68 per 1,000 persons living. With the exception of Hampstead, this rate is the lowest of all the Metropolitan Boroughs. Administrative Measures in Relation to Tuberculosis. In October last I had the honour of presenting the following report to a Joint Committee of the Public Health and General Purposes Committees, which was adopted by your Council at their meeting on October 23rd, 1912:— We move slowly, and although so much has been done by voluntary agencies in the curative treatment of tuberculosis, we have sadly neglected the more rational and economical method of instituting measures for the prevention of the disease, and the suffering, misery, and economic waste which follows in its train. Much has been done to improve the environment of the people, and vast sums have been spent in better housing. That these measures have been successful in a degree is Shown by the decreased mortality from tuberculosis during the past decade. Nevertheless, the disease still exists to an appalling extent. All previous efforts and schemes have been more or less piecemeal, and have been handicapped by their dependence to a large extent upon voluntary agencies. Most of the efforts in the past have been directed to actual sufferers, and no co-ordinated or exhaustive scheme has been directed to the work of prevention. This is due possibly 39 to the exceptional character of the disease, the difficulty of obtaining knowledge of cases, and also to the apathy of the public, and even the sufferers themselves. These conditions have now been changed, education being the chief factor. For the past two or three years almost every newspaper and magazine has in a popular way sought to draw the attention of its readers to the fact that this canker of civilisation can be prevented, and that its prevention is a national duty. It would now seem that the public has awakened, and is demanding protection from the State, and the institution of a crusade against this disease. Sanitary Authorities have been handicapped in the past by lack of the necessary statutory powers to institute the required machinery for curative and preventive treatment, but the difficulties have recently been removed, and every Sanitary Authority may now join in the great crusade against tuberculosis. I now present to you a brief summary of the statutory powers regulating the treatment of persons suffering from tuberculosis and the administrative measures adopted for its prevention. The Public Health (Tuberculosis) Regulations, 1908, provided for the compulsory notification to the Sanitary Authority of cases of pulmonary tuberculosis occurring amongst the inmates of Poor Law Institutions or under the care of District Medical Officers. The Public Health (Tuberculosis in Hospitals) Regulations, 1911, extended the notification to persons treated in Hospitals or similar Institutions other than those supported by rates or taxes. This Order gave special powers to Sanitary Authorities, including power to disinfect infected premises or articles, to supply sputum boxes, paper handkerchiefs and disinfectants, and to publish and issue leallets, &c., for educational purposes. The Regulations afforded the Local Authorities opportunities of investigating the conditions under which the patient had been living, and of ascertaining whether other members of the family were in need of encouragement to obtain medical advice. The Regulations removed any doubt that existed as to the legality of a Local Authority establishing a Tuberculosis Dispensary. 40 The Public Health (Tuberculosis) Regulations, 1911, which came into operation on January 1st, 1912, extended the compulsory notification to all cases of pulmonary tuberculosis coming under the notice of medical practitioners. These Regulations imposed special duties upon the Medical Officer of Health, more particularly in regard to the investigation of probable factors concerned in producing the disease, in dealing with contacts, the institution of measures to prevent infection, the removal of insanitary conditions, and in aiding the patient himself or any other patients who might be discovered. In a circular letter accompanying these Regulations the Local Government Board pointed out that much progress had been made in the organization of preventive measures against the disease. The Board drew attention to the fact that local authorities would be enabled to take action with a view of preventing the spread of infection or removing conditions favourable to infection, and emphasised the fact that in a disease like tuberculosis the prevention of infection and the. treatment of the patient frequently cannot be separated. The Board further pointed out that local authorities were empowered to establish dispensaries, and on the advice of the Medical Officer of Health to provide medical assistance and such facilities and articles as may be necessary for the detection of the disease and the prevention of its spread. Power was also given to appoint any necessary additional officers. The next important measure bearing upon the subject is the National Insurance Act, 1911, under which sanatorium benefits are provided. The term Sanatorium Benefit is a comprehensive one, and includes treatment in a sanatorium or approved dispensary and the home treatment of persons suffering from tuberculosis. Although these institutions are provided in the first instance to grapple with the scourge of consumption, the Local Government Board may, with the consent of the Treasury, enlarge the field of action and include cancer, syphilis, and other diseases. The administration of sanatorium benefit for insured persons has been entrusted in London to the County Insurance Committee. For uninsured persons the local authority is still responsible. By far the most important step yet taken in the effort to deal with the problem of tuberculosis in the United Kingdom was the appointment in February this year of a Departmental 41 Committee, which is known as the Astor Committee. The Report of the Committee contains valuable observations and recommendations based upon present knowledge of the disease. The scheme which the Committee recommends for the prevention and treatment of the disease is intended to complete the existing public health administration throughout the Kingdom and consists of two units, the first being the establishment of Tuberculosis Dispensaries, and the second the establishment of Sanatoria and Hospitals. We may dispose of the second unit, viz., the provision of sanatoria, inasmuch as the Council have already, conjointly with other London Sanitary Authorities, expressed the opinion that sanatorium treatment in London should be provided and maintained by the Metropolitan Asylums Board for insured and uninsured persons alike. This clears the ground for the consideration of the first unit proposed by the Departmental Committee, viz., the establishment of Tuberculosis Dispensaries. The Committee are of opinion that the Tuberculosis Dispensary should be the common centre for the organization of treatment in each area, and the object to be attained should be that no single case in the community remained uncared for. The Functions of a Tuberculosis Dispensary. The Dispensary should be a receiving house and centre for diagnosis, patients in every stage of the disease, and e\en suspected cases will come or be sent for treatment, and thus the possibility of early detection will be much increased. The Dispensary as a Clearing House. It is intended that the Dispensary should form a clearinghouse through which sufferers from various forms of the disease should be passed on to the person or institution which provides the treatment appropriate to the case. For this system to be successful the Medical Officer of the Dispensary must be in close touch with the general medical practitioner and the directors of public institutions. Insured persons suitable for sanatorium treatment would be handed over to the County Insurance Committee, while efforts would be made to place uninsured persons in other sanatoria or hospitals. 42 The Dispensary as a Centre for Curative Treatment. A large proportion of cases can be treated at the Dispensary, usually persons who are able to follow their various occupations with safety. Treatment at the Dispensary should include treatment by tuberculin. Care must be taken to work in harmony with the medical practitioners, and to this end a distinction would probably be made between insured and uninsured persons. The former would be provided with home treatment at the hands of a private practitioner by the Insurance Committee, who would have funds for the purpose, and the latter would receive treatment at the Dispensary. The tuberculin treatment would also be available for insured persons on the recommendation of the medical attendant. The Dispensary as a Centre for the. Examination of Contacts. The examination of persons who had been in contact with tuberculosis cases would be very valuable and possibly would lead to the detection of the disease in its early stages in cases which might otherwise have been neglected and overlooked. The After Care of Patients. The Dispensary would provide the means of keeping in touch with persons discharged from sanatoria and hospitals, who would be referred to the Dispensary for continued observation. In this way the benefits of institutional treatment could be maintained and a relapse prevented. The Dispensary as a Centre of Education. The Dispensary should constitute a centre to which all interested persons could turn for information and guidance. A nurse from the Dispensary would visit the patients in their homes to instruct them in the best course to adopt in their own interests and to prevent the spread of the disease to others. The nurse would also search out contacts for examination by the Tuberculosis Officer. The Constitution of the Dispensary. The Dispensary should be established and controlled by the Borough Council, and administered through the Public Health Committee. 43 The staff should consist of:— (a) A Medical Officer, possessing expert knowledge and special experience in tuberculosis, who would be styled "Consultive Tuberculosis Officer and Assistant Medical Officer of Health." This Officer would devote the whole of his time to the work, and for administrative purposes would be under the direction of the Medical Officer of Health, who should be the chief executive officer responsible to the Council. (b) One health visitor, with nursing experience, to visit cases. (c) One trained nurse attendant at the Dispensary. (d) One clerk-dispenser. Position of Dispensary. A central position should be chosen, and one easy of access for the working-class population of the Borough. Accommodation. The building should be a detached one, allowing free circulation of air and sunlight. In design the building should be made as attractive as possible, and contain one storey only. Where possible all the rooms should be provided with cross ventilation, so that it is possible to completely flush them with air. Provision should be made for the following offices:— Waiting-room, size about 12 ft. by 16 ft., with two dressing-rooms attached. Consulting-room, about 12 ft. by 18 ft. Lavatory and w.c. accommodation attached to consulting-room and waiting-room. Laboratory and dispensary. The interior of the building should be so constructed that all the surfaces could be easily and completely washed. I have visited several dispensaries, and I gathered the most useful information at Portsmouth, thanks to the courtesy of Dr. Mearns Fraser, the Medical Officer of Health, and Dr. Clark, the Dispensary Medical Officer. This dispensary has proved a great success. It forms part of the machinery instituted by the Corporation for the treatment and prevention of consumption, and is completely under the control of the 44 Health Department. The whole system is thus co-ordinated, and there is no overlapping. Consequently there is greater efficiency and economy. The success of dispensary treatment is greatly increased when facilities are available for visiting the homes of consumptives, examining contacts, and securing unsuspected cases for treatment while in the early stages. It must also be borne in mind that the treatment will be handicapped unless the patient can obtain nourishing food, sufficient clothing, and good home conditions. On this point the Astor Committee suggest the importance of linking up the Dispensary with voluntary organizations to secure help in this direction. Estimated Cost. I estimate the cost of establishing a Tuberculosis Dispensary to be:— For land and buildings £1,000 For this amount a loan would be sanctioned by the Local Government Board, the annual re-payment of which would amount to £60 per annum. The cost of furniture and fittings will be, approximately, £100. Annual Expenditure. £ Re-payment of principal and interest on loan for land and building 60 Salary of Assistant Medical Officer of Health (Tuberculosis) (£400 rising to £500) 400 Salary of Nurse (£100 to £120) 100 Salary of Health Visitor (£100 to £120) 100 Salary of Woman Clerk-dispenser 100 Cleaning 30 Drugs, Instruments, &c. 100 Uniforms of Nurse and Visitor 12 Rates, taxes, lighting, sundry appliances for patients 70 £972 From the above it will be seen that the annual cost is estimated at £972 for the first year, and when full salaries are being paid, about £1,120 per annum. 45 An addendum to this report relating to grants in aid has been omitted in consequence of variations necessitated by the circular letter from the Local Government Board dated December 6th, 1912. Under the heading "Finance," this circular letter contains the following:— "As regards capital expenditure the Board indicated in "their circular letter of the 14th of May last the amounts of " the grants which they are prepared to make." (The circular letter of the 14th of May referred to indicated that the grant will amount to four-fifths of the capital outlay on Dispensaries, subject to certain limitations, viz., that the grant should not exceed £240 for one Dispensary.) The Circular letter of December 6th also states, in regard to grants in aid of annual charges and expenses,— "The intention is that the amount of the annual grant "should be one-half of the total net cost incurred, within "reasonable limits, by or on behalf of a County or County "Borough Council, or combinations of these bodies, in the "treatment in dispensaries, sanatoria, and hospitals which "form parts of a scheme approved by the Board for the "general treatment of tuberculosis in the area, of all "persons, whether insured persons, dependants of insured "persons, or persons who are neither themselves insured "persons nor their dependants, after deducting the amounts "received from Insurance Committees out of the moneys "available under the National Insurance Act for sanatorium "benefit, and any sums received in respect of the treatment "of non-insured persons or otherwise. "The Local Authority and the Exchequer would thus "each be responsible for one-half of the net deficiency on the "whole scheme." It will be noticed that it is intended that treatment shall be given to insured persons, and their dependants, and to persons who are not insured under the National Insurance Act. 46 Great difficulty has been experienced in obtaining a suitable site or building for the proposed Dispensary, and negotiations have in several instances fallen through. Latterly, however, the sanction of the Local Government Board has been obtained for the use of a piece of land already in the possession of your Council at Ladywell, and I think it may be considered that the site is in all respects satisfactory for the purpose. No time will be lost in the preparation of plans for the erection of a suitable building. Under the heading of "Preventive Measures," in the circular letter of December 6th, the Local Government Board emphasise the fact that "it is the duty of the Medical Officer "of Health of the sanitary district, upon the receipt of a "notification under the Tuberculosis Regulations, either himself, "or through an officer acting under his instructions, to make "such enquiries and take such steps as may appear to him "necessary or desirable for preventing the spread of infection "and for removing conditions favourable to infection. These "inquiries will necessarily include investigation into sources "of infection, search for contacts, and inquiry into housing "conditions. "Where the population served by a dispensary is not "sufficient to require that the staff of the dispensary should "devote the whole of their time to the work of the dispensary, "one or more of the officers of the dispensary may properly "undertake, under the direction of the Medical Officer of "Health of the sanitary district, the duties in question." Sanatorium Benefit. The term "Sanatorium Benefit" contained in the National Insurance Act is not generally clearly understood by the public, many of whom are under the impression that an 47 insured person suffering from pulmonary tuberculosis is entitled, irrespective of the stage at which the disease exists, to immediate admission into, and treatment in a sanatorium. Nor is it realised that only in certain cases is treatment in a sanatorium likely to prove beneficial. The term " Sanatorium Benefit" is a comprehensive term, embracing— (a) Treatment at home (domiciliary treatment); (b) Treatment at a Tuberculosis Dispensary; (c) Treatment as an out-patient of a Hospital; (d) Treatment as an in-patient of a Hospital; (e) Treatment in a Sanatorium. Section 16 of the National Insurance Act provides for Sanatorium benefit for insured persons suffering from all forms of tuberculosis, subject to the case being recommended by the Insurance Committee. Section 17 extends sanatorium benefit to the dependants of insured persons if the Insurance Committee think it desirable. I may say that so far no instance of the Insurance Committee having availed themselves of the power given by this Section has come to my knowledge, as far as this Borough is concerned. The fund originally set aside for sanatorium benefit in London (1s. 3d. annually in respect of each insured person) which amounts to about £80,000 per annum, has been depleted to the extent of £30,000 per annum to provide for the payment to medical practitioners on the " Panel" of an additional sixpence per annum in respect of persons receiving domiciliary treatment. As a result of this redaction of the amount available the London Insurance Committee does not possess sufficient 48 funds to provide for Dispensary and Hospital out-patient treatment. It is probable that other forms of sanatorium benefit will be severely handicapped. Insurance Committees. In London the administration of sanatorium benefit under the Act is vested entirely in the County of London Insurance Committee. This Committee is charged with the duty of arranging for the treatment of insured persons at Hospitals, Sanatoria, and other Institutions already in existence (other than Poor Law Institutions), but is not empowered to erect or provide buildings for the purpose. When the Insurance Act came into force temporary Local Sub-Committees were formed in each Metropolitan Borough. The system temporarily adopted by the London Insurance Committee in making arrangements for the domiciliary treatment of insured persons recommended for this form of treatment worked very well, and, as far as we were concerned, proved very useful. A case was referred to the Medical Officer of Health of the Borough, who was asked to arrange for the treatment of the patient. In most of the cases which were referred to us we were able to arrange for the patient to be attended by his own doctor, who was paid in accordance with a scale of fees arranged. In this way the Public Health Department was enabled to get into touch with the patient, and, in many instances, to effect an improvement in his environment. In January, 1913, when the whole scheme of medical benefit came into operation, this arrangement ceased. New applicants were referred directly to a doctor on the " Panel," and no information was sent to the Public Health Department by the 49 Insurance Committee in respect of these applicants. In several instances much hardship resulted from the new arrangement. Persons for whom domiciliary treatment had already been arranged, were advised that if the doctor attending was not already on the panel such treatment must cease, and application would have to be made to a doctor whose name appeared on the panel. If the patient was so unfortunate as not to have made the necessary arrangements by the specified date, it was possible that he would be unsuccessful in his application to a panel doctor for treatment. The temporary Local Sub-Committees had only a short existence and recently a new District Committee has been formed. As far as one can see, this Committee will possess no executive, administrative, or discretionary powers whatever, and the London Insurance Committee will continue to retain the supreme control. In my opinion it is very desirable that all applications for sanatorium benefit should be considered, primarily, by the Local Committee. This Conimittee should have power, on the advice of the Local Consultive Tuberculosis Officer, to immediately arrange for domiciliary or dispensary treatment, and, when treatment in a Hospital or Sanatorium was necessary, to arrange for the same through the County Committee. It cannot be disputed that much time would be saved, and greater efficiency effected, if all applicants were examined by the Local Tuberculosis Officer, instead of, as at present, the applicant having to attend before the Expert of the County Committee in London. An arrangement of this description would enable the Local Committee to get into closer touch with the patient than is possible with the County Committee, and to become conversant with the environment and particular needs of the patient. 50 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 351 162 Whooping Cough 578 110 Chicken-Pox 407 180 Mumps 53 5 Ringworm 100 — The number of cases of Measles is very much below the normal, while the cases of Whooping Cough show rather a large increase. SCHOOLS. The following is a list of Schools in which classrooms were closed with a view of preventing the spread of infection:— Holy Trinity School, Forest Hill.— Classroom I. (Infants'), closed on 19th February, for 3 weeks.— Whooping Cough. Lewisham Bridge Council School.—Infants' Department, closed on 30th April, for 3 weeks.—Measles. 14th May, closure extended for two weeks. 51 Torridon Road Council School. — Whole of School closed on 13th December until expiration of Christmas vacation. Diphtheria. Rathfern Road Council School.—Classroom A (Infants') closed on 15th November for 10 days.—Scarlet Fever. Sydenham Hill Road Council School.—Girls' Department, closed on 2nd December for 14 days.—Scarlet Fever. Exclusion of Infant Scholars :— In the following Schools children under the age of compulsory school attendance, i.e., five years of age, were excluded when infectious disease was prevalent in the neighbourhood. Name of School. Brockley Road Ennersdale Gordonbrock Lewisham Bridge Plassy Road St. Phillip's, Wells Road St. Stephen's, Lewisham Stillness Road Sydenham Hill Road Torridon Road Date of exclusion. 29th June 14th May 30th October 19th April 22nd March 20th May 14th May 18th July 24th April 5th December Disease. Measles. Measles. Scarlet Fever Measles Diphtheria Whooping Cough Measles Whooping Cough Whooping Cough Diphtheria 52 BACTERIOLOGICAL DIAGNOSES. During the period under review 1,034 Examinations were made of the sputum, blood or throat membrane and mucus of persons suspected to be suffering from either Pulmonary Tuberculosis, Enteric Fever or Diphtheria, of which 316, or 30 per cent., gave positive results. Disease. No. Negative. No. Positive. No. Doubtful. Total. Diphtheria 531 244 21 796 Tuberculosis 146 66 — 212 Enteric Fever 20 6 — 26 Total 697 316 21 1034 It would appear that the facilities afforded by this Council for these examinations are becoming better known among the medical profession, as nearly 400 more specimens were forwarded during 1912 than in 1911. SANITARY WORK. 54 HOUSING, TOWN PLANNING, &c., ACT, 1909. Summary of Action taken :— Nos. 1 and 2, Crossley's Cottages, Rushey Green. Jan. 23, 1912.—Representation by Medical Officer of Health that premises unfit for habitation. Feb. 28, 1912.—Closing Order made by Council. Premises subsequently vacated and closed. Nos. 1, 3 and 4, Dawson's Cottages, Sydenham Road. Nos. 1 to 11, Scrooby Street. Representations made by Medical Officer of Health. Owners carried out necessary repairs, and rendered further action by Council unnecessary. HOUSE-TO-HOUSE INSPECTION. During the year house-to-house inspection was carried out in the following roads:— Bovill Road Brookdale Road Bryden Grove Cibber Road Como Road Elvino Road Fairlawn Park (North, South and West Terrace) Herschell Road Hillmore Grove Kemble Road Mount Pleasant Cottages Normanton Street Russell Street Scrooby Street Siddons Road Shipman Road Treviso Road Trilby Road Vestris Road Wastdale Road Wildfell Road Willow Walk, Catford „ „ Sydenham 55 The total number of houses inspected was 1058, and the nature of the defects found and remedied is shewn in the following summary:— Dirty premises 309 Dilapidated premises 192 Defective drains 52 Defective vent shafts and soil pipes 272 Defective or foul w.c.'s 188 Insufficient water to w.c. 169 Defective sink waste pipes 218 Defective yard traps and gullies 57 Defective rain-water pipes 163 Defective rain-water gutters 286 Dilapidated floors and walls 192 Defective and leaky roofs 207 Damp walls 120 Defective window frames 30 Insufficiently ventilated floors 35 Defective dustbins 170 Defective yard paving 249 Uncovered drinking water cisterns 207 Insufficient lighting 60 Insufficient ventilation 6 Over-crowded rooms 4 Other defects 191 Number of families in occupation 26 houses contained three families. 205 „ „ two „ 827 „ „ one family. 56 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, 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:— 32 to 60, Adelaide Road*; 1 to 6, Bertrand Street* ; 65 to 75, Brookdale Road ; 149, 151 and 153, Burnt Ash Hill* ; 10 and 12, Charleville Circus; 29 to 39, Embleton Road*; 2 and 4, Engate Street*; 44 to 64, Wastdale Road and 62 and 64, Ewart Road ; 9 and 11, Farley Road* ; 2 to 16, Felday Road; 12 to 24, Hurstbourne Road* ; 2 to 8, Kemble Road*; 10 to 16, Kemble Road*; 13 to 23, Kemble Road*; 50 to 64, Ladywell Park*; 29 to 43, Morena Street*; 31 to 33, Northwood Road*; 1 to 5, Oxford Terrace, Malham Road*; 15 to 25, Park Road*; 1 and 2, The Avenue, Rojack Road*; 1 to 7, Springfield Park Crescent*; 203 to 209, Sydenham Road*; 53, 55 and 57, Venner Road. SMOKE NUISANCES. The Inspector entrusted with the duty of keeping observation for the emission of black smoke, made 228 investigations during the year, compared with 317 during 1911. The details of his observations are as follows:—laundries 67, 57 breweries 5, silk mills 1, preserve works 32, flour mills 9, saw mills 1, public institutions 55, bakehouses 17, sewer works 23, miscellaneous premises 18. The duration of the observations varied from ¼-an-hour to 1½ hours each. In consequence of offences observed, 5 intimation notices were served. No legal proceedings were instituted. DISINFECTION. During the year disinfection was carried out at 1,188 houses or premises in the Borough, a total of 2,771 rooms being sprayed. The number of articles removed to the Council's Station for disinfection, either by steam or the formalin process, was 39,247. The details of the work carried out are as follows:— Premises. Rooms, Articles. Scarlet Fever 432 1064 19241 Diphtheria 412 1035 16141 Enteric Fever 26 65 1068 Puerperal Fever 6 7 124 Pulmonary Tuberculosis 154 228 920 Erysipelas 12 12 54 Cancer 26 54 360 Other diseases 120 306 799 Verminous premises. — In addition to the above, 39 verminous rooms were fumigated with sulphur. 58 SUMMARY OF SANITARY WORK carried out by the Male Sanitary Inspectors During the year ended 31st December, 1912. Description of Work Lewisham Division. Sydenham and Forest Hill Division Lee Division Workshops House to House. Total for Who!e Boro. Mr. J. A. K.Cooper Mr. H. King Mr. J. Crowther Mr. E. T Ptdwell Mr. B. A . Knappett Mr. R. White Mr. J. Daltry Mr. a. H. Gray Mr. J. H. Berry. Complaints by Residents 86 87 108 85 168 233 14 15 17 813 Premises inspected 320 490 343 717 686 505 1368 802 425 5656 Re-inspections of works in progress 1761 2298 2108 1493 3059 1756 501 6079 2028 21083 Intimation Notices served 130 198 209 93 188 159 66 583 240 1866 Statutory Notices ordered 119 219 209 76 100 118 8 87 59 995 Statutory Notices served 33 56 84 27 65 36 — 41 35 377 Premises repaired,cleansed,&c 92 111 108 104 105 66 148 312 200 1246 Defective Roofs, Stackpipes, &c., remedied 40 30 52 48 60 41 8 304 138 721 Drains re-constructed 76 79 36 47 72 62 — 6 5 383 Drains repaired 23 50 25 32 75 67 8 15 29 324 Drains ventilated 36 11 2 19 17 66 — — 1 152 Stackpipes, Sinks, Bath Wastes, &c., disconnected from drains 61 66 29 8 27 139 139 44 513 Gulley Traps provided 57 80 51 78 237 168 — 31 — 702 Water Closets re-constructed 47 75 47 62 99 99 — 101 5 535 Water Closets repaired 22 48 47 29 36 56 75 51 42 406 Water Closets supplied with water 12 13 15 2 66 1 148 21 278 Soil Pipes re-constructed 22 42 23 22 29 53 — 23 — 214 Soil Pipes repaired & ventilated 2 9 40 16 6 26 10 96 5 210 Dustbins provided 29 66 46 16 18 61 16 125 42 419 Water Supply to Houses reinstated 7 6 1 13 11 — — — — 49 Cisterns repaired, cleansed or covered 2 29 10 . 85 24 4 39 160 36 389 Water Certificates issued 1 1 14 11 — 16 59 114 — 216 Premises over-crowded 2 7 2 2 — — 1 2 1 17 Yards paved 42 80 22 26 131 48 37 147 57 590 Removal of offensive accumulations 12 8 23 19 25 25 — 2 3 117 Dung Vaults erected or repaired 3 2 — 4 — 1 — 10 Animals improperly kept 2 1 6 1 8 3 2 3 — 26 Visits to Houses let in lodgings — — — — — — — — — 3 Bake-houses visited — — — 1 — 10 316 — — 327 Milk-shops visited — — — — 11 5 475 — — 491 Cow-sheds visited 11 40 — 24 12 54 — — — 141 Workshops visited — — 4 — — — 684 — — 688 Slaughter-houses visited 29 13 24 24 7 29 — — — 126 House-to-house inspections — — — — — — — 672 363 1035 59 WORK OF WOMEN SANITARY INSPECTORS. The following is a summary of the work carried out by the Women Sanitary Inspectors :— Miss Jones. Misses Stevens & Barke. Total To Schools 32 45 77 Re School Notifications 183 177 360 „ Measles 50 39 89 „ Measles deaths 2 5 7 ,, Chicken-pox 12 40 52 „ Puerperal fever 16 4 20 „ Ophthalmia Neonatorum. 10 2 12 „ Polio-Myelitis — — — „ Phthisis homes 265 300 565 „ Phthisis deaths 25 23 48 „ Birth notifications 633 643 1276 „ Infant mortality 130 71 201 On complaint 13 26 39 To Factories 24 21 45 „ Workshops 277 267 544 „ Workplaces 34 13 47 „ Laundries 118 80 198 „ Outworkers' homes 183 181 364 Re-visits and re-inspections 304 179 483 Miscellaneous visits 17 22 39 Total 2328 2138 4466 Nuisances found 136 107 243 Intimations served 105 88 193 Statutory notices served 15 17 32 Abstract not affixed 22 13 35 Overcrowded workrooms — 4 4 60 Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the years 1906-1912. Ward. Number of Water Certificates Granted. 1906 1907 1908 1909 1910 1911 1912 Church 23 33 29 17 24 2 1 Manor 7 46 101 68 34 43 4 South 47 13 17 10 7 6 11 Lee Division 77 92 147 95 65 51 16 Blackheath 1 4 23 1 Lewisham Village 5 24 11 15 20 9 6 Lewisham Park 114 55 87 17 29 30 8 Brockley 120 84 72 94 76 68 85 Catford 258 322 177 122 90 108 66 Lewisham Division 498 485 347 252 215 238 166 Forest Hill 63 30 42 8 22 9 14 Sydenham 156 157 98 57 99 40 20 Sydenham &F orest Hill Division 219 187 140 65 121 49 34 Whole Borough 794 764 634 412 401 338 216 61 Houses Examined and Certified under the Customs and Inland Revenue Acts during 1912. Name of Street or Road. Applications Received. Certificates Granted. Certificates Refused. Number of Houses. Number of Tenements Number of Houses. Number of Tenements Number of Houses. Number of Tenements Abernethy Road l 2 l 2 — — Avenue, Blackheath 2 4 2 4 — — Baring Road 1 2 1 2 — — Barmeston Road 2 4 — — 2 4 Belmont Park 2 5 2 5 — — Blessingham Road 1 2 1 2 — — Bowness Road 2 4 2 4 — — Bradford Road 3 6 3 6 — — Brandram Road 2 4 2 4 — — Brookdale Road 3 6 3 6 — — Burnt Ash Hill 4 8 4 8 — — Charsley Road 2 4 — — 2 4 Effingham Road 2 4 2 4 — — George Lane 2 4 2 4 — — Glenton Road 1 2 1 2 — — High Road, Lee 2 5 2 5 — — Lady well Park 5 10 5 10 — — Lanier Road 2 4 2 4 — — Lansdowne Road 1 2 1 2 — — Lee Park 3 7 3 7 — — Leyland Road 3 8 3 8 — — Limes Grove 2 4 2 4 — — Manor Park 1 2 1 2 — — Mount Pleasant Road 2 4 1 2 1 2 Perry Vale 1 2 1 2 — — Quentin Road 4 6 4 6 — — Ringstead Road 2 4 1 2 1 2 Ryecroft Road 1 2 1 2 — — Silverdale 2 4 2 4 — — Tressillian Road 1 2 1 2 — — Tyrwhitt Koad 2 4 — — 2 4 Wemyss Road 1 2 1 2 — — Totals 65 133 57 117 8 16 MISCELLANEOUS. 63 BAKEHOUSES. The number of bakehouses on the Register at the end of the year was 91, and 327 inspections were made in the period under review. Fifty-seven nuisances were found, chiefly due to dirty ceilings or sanitary conveniences, and it was necessary to serve 11 intimation notices, all of which were complied with without the necessity of further action. DAIRIES, MILK SHOPS AND PURVEYORS OF MILK. The number of these premises on the Register at the end of the year was 163. During the year 31 were added, and 26 removed. The inspections numbered 491, and in 14 instances a nuisance was discovered, necessitating the service of six intimation notices, which were complied with. COWHOUSES. There were within the Borough at the end of 1911 13 cowhouses, and at the annual Licensing Meeting of the London County Council, held in October, 1912, the licenses for the same were renewed. The following is a list of the cowhouses:— Situation. Number ot Cows for which licensed. Occupier. Beckenham Park Farm 63 Perkins & Richmond Burnt Ash Farm, Lee 56 Edwards & Sons, Ltd. Butterfield Dairy, Lee 28 Thomas Clark College Farm,Burnt Ash Hill 36 Edwards & Sons, Ltd. Durham Farm, Grove Park 50 Ernest Adams 110, High Street, Sydenham 19 George Stimpson Holloway Farm, Southend, Catford 49 Daniel H. Dutton 64 COWHOUSES—continued. Situation. Number of Cows for which licensed. Occupier. 87, Loampit Vale, Lewisham 3 George Attwater Shroffold's Farm, Southend, Catford 87 Henry Panter Spicer's Meadow, Claypit Lane, Lee 6 William Winckworth 206, Sydenham Road 10 Thos. H. Lockyer 82, Wells Road, Sydenham 9 John Parker White House Farm, Southend, Catford 74 Welford's Surrey Dairies, Ltd. SLAUGHTERHOUSES. The following are the slaughterhouses in the Borough at present licensed by the London County Council:— Situation. Occupier. Myron Place, Lee H. J. Climpson 182, High Road, Lee Thoroughgood & Co. 434, High Road, Lee J. T. Dennis 1, Weardale Road, Lee A. Munyard Havelock Street, Forest Hill Chalk & Cox 50, High Street, Lewisham A. J. Airey 160 „ ,, ,, A. J. Airey 291 „ ,, ,, J. Balsdon 94 „ ,, ,, H. A. Field 69, Loampit Yale, Lewisham C. M. Sanders 12, Montpelier Yale, Blackheath B. W. Parsons 13, Rushey Green, Catford Chalk & Cox l58, ,, ,, ,, C. Hardstone 65 UNSOUND FOOD. The following articles of food were surrendered by the owners as unfit for human food and subsequently destroyed :— 1 barrel Dogfish (14 stone); 2 trunks Whiting; 12 bags Greens; 2 boxes Smoked Codlings ; 1 basket Tomatoes ; 16 boxes Tomatoes; 1 trunk Haddocks. CORONER'S COURT AND MORTUARY. The Mortuary was used for the reception of 133 bodies, removed from the following places :— From houses in the Borough 77 „ „ outside the Borough 8 „ Lewisham Infirmary 38 „ Bermondsey Workhouse 5 „ Other places 10 The portion of the Mortuary reserved for infectious cases was occupied by four bodies. Inquests were held upon 125 of the bodies, and a post-mortem examination was made in 79 cases. FACTORIES AND WORKSHOPS. 67 FACTORIES AND WORKSHOPS. Under Section 132 of the Factory and Workshop Act, 1901, the Medical Officer of Health is required to report on the workshops and workplaces in his district, and to forward to the Secretary of State a copy of his Annual Report. Workshops where men are employed are placed under the supervision of one of the sanitary inspectors, and workshops where women are employed are visited by the women sanitary inspectors, who also visit the homes of female out-workers. The total number of workshops on the Council's Registers at the end of 1912, was 495. During the year 1898 inspections of these premises were made; and defects to the number of 197 were found. Want of cleanliness was reported in 71 instances. In only 4 cases was overcrowding of workrooms found. In no case was it found necessary to institute legal proceedings to obtain a remedy of the defects. In addition to the workshops mentioned in the preceding paragraph there are 218 part-time and domestic work-places, i.e., private houses or rooms where no power is used, and in which only the occupiers themselves are employed. The total number of workers employed in the 495 workshops referred to was 2057, of which number 1249 were women, 414 men, and 394 " young persons." 68 Inspection of Factories, Workshops & Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. (Home Office Table, No. 1). Premises, Inspections Written Notices. Prosecutions Factories (including factory laundries) 94 6 — Workshops (including workshop laundries) 1630 27 — Workplaces (other than outworkers' premises included in Table 3) 174 — — Total 1898 33 — Defects found in Factories, Workshops and Workplaces. (Home Office Table, No. 2). Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts—* Want of cleanliness 71 71 — — Want of ventilation 2 2 — — Overcrowding 4 4 — — Want of drainage of floors 2 2 — — Other nuisances 17 17 — — Sanitary accommodation : Insufficient 1 1 — — Unsuitable or defective 43 43 — — Not separate for sexes — — — — Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses(ss. 97-100) 57 57 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) — — — — Total 197 197 — — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 69 HOME WORK. (Home Office Table, No. 3). NATURE OF WORK.* 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. 1 2 3 4 5 6 7 8 9 10 11 12 18 14 15 16 Wearing Apparel— (1) making, &c. 68 — 176 16 — 38 — — — 6 6 — — — — (2) cleaning and washing — — — — — — — — — — — — — — — Household linen — — — — — — — — — — — — — — — Lace, lace curtains and nets — — — — — — — — — — — — — — — Curtains & furniture hangings — — — — — — — — — — — — — — — Furniture and upholstery 2 — 2 3 — 1 — — — — — — — — — 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, etc., boxes & paper bags 2 — 2 1 — 1 — — — — — — — — — Brush making 4 — 4 — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — Carding, &c., of buttons, &c. — — — — — — — — — — — — — — — Stuffed toys — — — — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — Chocolates and Sweetmeats — — — — — — — — — — — — — — — Total 78 — 186 21 — 41 — — — — — — — — — * 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. 71 Workshops (sec. 131) and Workplaces and Workrooms on the Register at the end of 1912 (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 178 247 2 787 302 29 29 Millinery 27 32 - 86 48 6 6 Laundry 82 216 18 338 1 13 17 Tailor 31 34 64 17 4 18 18 Boot 56 56 79 — 6 96 96 Joiner 17 29 40 - 5 - - Smith 21 23 44 — 3 — - Dentist 3 3 9 - - - - Cycles 12 15 20 - 5 14 14 Coachbuilder 5 10 30 - 5 - - Cabinet and Upholsterer 15 20 32 3 2 2 2 Photographer and Picture,framer 13 14 12 15 4 9 9 Jeweller 12 13 19 - 3 22 22 Piano 1 2 2 - 2 - - Saddler 7 7 14 - - - - Mason 2 3 4 - 2 - - Lathrender 2 3 5 - - - - Various 11 16 20 3 2 9 9 Total 495 743 414 1240 394 218 222 72 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 35 Action taken in matters referred. Notified by H.M. In- by H.M. Inspectors as remedi spector 3 able under the Public Health Reports of action taken, (London) Act, but not under the sent toH.M. Inspector 3 Factory Act (Sec. 5). Other — Underground Bakehouses (Section 101):— In use during 1903 23 Certificates granted in 1903 23 1904 - 1912 nil In use at end of 1912 20 Workshops and Workplaces on the Register at the end of 1912:— Workshops (details in Table 4) 495 Workplaces part time and domestic (details Table 4) 218 Bakehouses 71 „ underground 20 Restaurants (workplaces) 46 Workplaces (stable yards, contractors' yards, etc.) 36 Total 886 PART 4. REPORT OF PUBLIC ANALYST. 74 REPORT OF THE PUBLIC ANALYST ON ARTICLES ANALYSED DURING THE YEAR ENDED DECEMBER 31st, 1912. Samples Submitted.—During the past year 575 samples of food aud drugs were submitted for analysis. Of this number 503 were purchased by your inspectors in conformity with the provisions of the Sale of Food and Drugs Acts, while the remaining 72 samples were procured as test or informal samples. • Adulterated Samples.—Of the 503 official samples '27, or 5.36 per cent. were reported as adulterated, compared with 6.06 per cent. in the previous year and 4.95 per cent. in 1910. Of the 72 test or informal samples eleven, or 15.27 per cent. were found to be adulterated or not up to standard. These informal samples were obtained by assistants without any declaration at the time of purchase, and much useful information as to the procuring of official samples was obtained in this manner. MILK. Two hundred and fifty official samples of milk were analysed during the year, and of this number twenty-one, or 8.4 per cent., were certified as adulterated or below the standard fixed by the Board of Agriculture and Fisheries. A list of the milk samples not reported as genuine will be found in Table G of this report. 75 Average Composition.—The average composition of all samples of milk analysed during the period under review equalled 3.35 per cent. milk fat and 8.73 per cent. solids not fat. The average composition of the genuine samples alone was 342 per cent. milk fat and 8.76 per cent. solids not fat. In each case these figures are above the statutory limit. Dyed Milks.—Seventy-nine, or 3.16 per cent., of the milks analysed were found to contain colouring matter. Preservatives. All the milk samples were examined for the presence of preservatives, and in every case a negative result was obtained. Samples taken in course of Delivery.—Thirty-four samples of milk were taken in course of delivery, as follows:— Park Hospital, 3; St. Olave's Workhouse, 2; Catford Railway Station, 4; Hither Green Railway Station, 1; Sydenham Railway Station, 19; Forest Hill Railway Station, 4; and one at a dairy. Two of these samples (Nos. 15 and 320) were found to be below the legal standard. The Sale of Milk Regulations, 1912. It is satisfactory to record that in consequence of representations which have been made from local authorities (including your Borough Council) of the necessity for the amendment of the standard for Skimmed or Separated Milk, the Board of Agriculture and Fisheries on the 20th August, 1912, issued the Sale of Milk Regulations, 1912, and these Regulations came into operation on the 1st day of September, 1912. 76 The Regulations amend the Sale of Milk Regulations, 1901, in so far as they relate to skimmed or separated milk, and replace the limit of 9 per cent. of total milk-solids, on which under Article 3 of those Regulations a presumption that the milk is not genuine is based, by a limit of 8.7 per cent. of milksolids other than milk-fat. In the past considerable difficulty has been experienced in instituting proceedings in cases in which water has been added to skimmed milk, as, owing to the fact that the milk has been imperfectly skimmed, the total solids have not fallen below 9 per cent. Attention was drawn to this point in my last Annual Report. The present Regulations are intended to obviate these difficulties and to facilitate the prevention of the adulteration of skimmed milk with water. In a letter from the Board of Agriculture and Fisheries, dated the 20th August, 1912, enclosing a copy of the Regulations it is stated that the fixing of the percentage at 8.7 per cent. of milk-solids other than milk fat may result in some hardship in cases where the milk is imperfectly skimmed. Thus, if milk containing 3 per cent. of milk fat and 8.5 per cent. of milk-solids other than milk fat is imperfectly skimmed so that 1.5 per cent. of milk fat remains, the proportion of milk solids other than milk fat will rise only to 8.63 per cent., and the Board suggest that this point should be taken into account by the Lewisham Borough Council in considering the question whether they should institute proceedings on the presumption of adulteration based on the Regulations in cases where the deficiency of milk-solids other than milk fat is slight and the skimmed milk contains a considerable proportion of milk fat. 77 The Public Health (Milk and Cream) Regulations, 1912. The Public Health (Milk and Cream) Regulations, 1912, made by the Local Government Board in pursuance of the powers conferred by Section 1 of the Public Health (Regulations as to Food) Act, 1907, came into force on the 1st October, 1912. The Regulations are designed to secure that no preservative shall be added to milk, or to cream containing less than 35 per cent. of milk fat at any stage from the place of production to that of delivery to the purchaser. In cream containing more than 35 per cent. of milk fat the addition of boric acid, borax, or a mixture of these preservative substances or of hydrogen peroxide is not prohibited, but is subject to a system of declaration set out in the Regulations, as follows:— Label I. PRESERVED CREAM CONTAINING BORIC ACID NOT EXCEEDING PER CENT. Label II. PRESERVED CREAM (PEROXIDE). The size of the declaratory label shall be determined as follows:— Capacity of Receptacle. Size of Label. Inches Inches. Not exceeding 1 pint ¾ by 1¾ Exceeding 1 pint 3 by 5 78 Legal Proceedings. Legal proceedings were instituted against the vendors of adulterated samples in fourteen cases, but only seven convictions were obtained. In two cases warranties were successfully set up as a defence; four summonses were dismissed, the Magistrate being of opinion that the milk had not been tampered with, and in one case the summons was withdrawn. The penalties inflicted amounted to £14 2s. and the costs to £7 10s. 6d., a total of £21 12s. 6d. The fines imposed in the cases taken to Court by this Council were very small, and are hardly likely to serve as a warning to the unscrupulous trader. 79 Table A. Showing number of Samples submitted for Analysis, with Results for the year ended December 31s£, 1912. (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 250 229 21 8.4 Separated Milk 12 11 1 8.3 Butter 110 108 2 1.8 Coffee 54 53 1 1.8 Mustard 13 13 - - Pepper 11 11 - - Cocoa 10 10 — - Flour 3 3 - - Lard 10 10 - - Demerara Sugar 5 5 - - Cream of Tartar 3 3 - - Tincture of Bark 3 3 - - Sweet Spirits of Nitre 3 3 - - Brandy 1 1 - - Whisky 6 6 - - Gin 5 5 - - Rum 4 2 2 50.0 Total official samples 503 476 27 5.36 (b) Test Samples purchased without the formalities of the Act. Milk 5 0 5 100. 0 Buuer 19 16 3 15.8 Mustard 7 7 0 - Coffee 10 7 3 30.0 Flour 1 1 — - Honey 1 1 — — Olive Oil 1 1 — — Ginger 1 1 — — Arrowroot 1 1 — — Red Currant Jelly 12 12 - - Black Currant Jelly 2 2 - - Cream 6 6 - - Cocoa 3 3 - - Lard 1 1 - - Cheese 1 1 - - Pepper 1 1 — - Total Informal samples 72 61 11 15.27 Total all samples 575 537 38 6.60 80 Year. No. of Samples (not including Test Samples). Genuine. Adulterated. Per- centage Adulterated. No. of Prosecutions. Fines and Costs imposed. Table B Summary of Samples {not including test samples) Analysed in the Borough in each Year. 1906-1912. 1906 Milk 275 *495 449 46 9.29 14 Fines £108, costs £6 13s. 6d. Butter 99 Various 121 1907 Milk 292 *496 460 36 7.26 17 Fines £30 10s., costs £10 12s. Butter 116 Various 88 1908 Milk 269 •412 378 34 8.25 15 Fines £28 10s., costs £1015s. 6d. Butter 93 Various 50 1909 Milk 242 ; *469 455 14 2.99 5 Fines £11, costs £4 14s. Butter 110 Various 117 1910 Milk 283 *465 442 23 4.95 8 Fines £13, costs £9 4s. Butter 102 Coffee 28 Wines and Spirits 18 Various 34 1911 Milk 292 *495 465 30 6.06 20 Fines £50, costs £23 1s. Butter 128 Coffee 33 Wines and Spirits 4 Various 38 1912 Milk 250 *503 476 27 5.36 15 Fines £14 2s., costs £7 10s. 6d. Butter 110 Coffee 54 Various 89 81 Table C. Showing Total Samples submitted with results during the years 1908-1912. (Test samples not included). Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1908 1909 1910 1911 1912 1908 1909 1910 1911 1912 1908 1909 1910 1911 1912 First 79 95 87 141 130 12 3 3 2 8 15.19 3.16 3.4 1.41 6.15 Second 147 128 102 136 140 13 6 6 9 10 8.84 4.69 5.9 6.62 7.14 Third 104 131 95 72 87 7 2 4 7 3 6.73 1.53 4.2 9.72 3.4 Fourth 82 115 181 146 146 2 3 10 12 6 2.44 2.61 5.5 8.21 4.1 Total for Year 412 469 465 495 503 34 14 23 30 27 8.25 2.99 4.95 6.06 5.36 Table D. Showing results of Total Samples of Milk submitted during the Years 1908-1912. Quarter. No. of Samples.* No. Adulterated. Percentage Adulterated. 1908 1909 1910 1911 1912 1908 1909 1910 1911 1912 1908 1909 1910 1911 1912 First 53 56 56 90 91 9 2 2 1 7 16.98 3.57 3.6 1.2 7.6 Second 100 61 62 94 63 12 6 4 7 10 12.00 9.84 6.4 7.4 15.8 Third 55 78 79 47 57 3 2 4 5 2 5.45 2.56 5.06 10.6 3.5 Fourth 55 40 86 61 39 - 1 5 5 2 — 2.50 5.8 8.19 5.1 Total for Year 263 235 283 292 250 24 11 15 18 21 9.13 4.68 5.3 6.16 8.4 * Not including test samples. 82 Table E. Average Composition of Milk Samples submitted in 1912. Period. Average Composition of all samples submitted genuine and adulterated. Average Composition of genuine samples. Board of Agriculture Standard. Percentage of Milk fat. Percentage of Solids not fat. Percentage of Milk fat. Percentage of Solids not fat. Percentage of Milk fat. Percentage of Solids not fat. First Quarter 3.27 8.75 3.30 8.78 3.0 8.5 Second „ 3.29 8.71 3.40 8.73 Third „ 3.49 8.73 3.52 8.73 Fourth „ 3.41 8.75 3.58 8.80 Total for Year 3.35 8.73 3.42 8.76 83 Table F. Average Composition of Milk Samples submitted during the Years 1902-1912. 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 s 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 „ 1907 3.47 8.81 3.53 8.83 3.0 8.5 „ 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 „ 1912 3.35 8.73 3.42 8.76 84 Table G. Details of Adulterated Samples of Milk during the Year ended December 31st, 1912. Sample Marked. Adulteration. Remarks. 7 25 per cent, deficient in milk fat Vendor fined £1 and £ 13s. costs 15 5 per cent. added water Vendor cautioned by direction of the Public Health Committee 35 3 per cent. deficient in milk fat No action 74 8 per cent, deficient in milk fat Summons dismissed. Defendant proved warranty 81 3 per cent. added water No action 90 15 per cent. added water Vendor fined £4 and £1 3s. costs 136 3 per cent, deficient in milk fat Vendor cautioned by direction of the Public Health Committee 154 10 per cent, deficient in milk fat Summonses dismissed, the 155 12 per cent, deficient in milk fat Magistrate being of opinion 156 • 5 percent, deficient in milk fat that the Milk had not been tampered with 171 5 per cent, deficient in milk fat Vendor cautioned by direction of the Public Health Committee 194 12 per cent. deficient in milk fat Summons withdrawn 201 3 per cent. deficient in milk fat No action Subsequent Sample No. 208 20*2 3 per cent. deficient in milk fat No action 203 5 per cent. deficient in milk fat No action 207 3 per cent. deficient in milk fat No action 208 22 per cent. deficient in milk fat Summons dismissed, the Magistrate beinsr of opinion that the Milk had not been tampered with 320 10 per cent. deficient in milk fat Summons dismissed, the Magistrate being of opinion that the Milk was sold in the same state as given by the cow 323 8 per cent. deficient in milk fat Summons dismissed. Warranty proved. 451 3 per cent. deficient in milk fat. Cautioned by order of the Public Health Committee 550 30 per cent. deficient in milk fat Separated Milk: Summons dismissed 339 4 per cent. added water Proceedings were taken against matter and servant, and they were fined 2s. and £1 3s. costs, and £5 and £1 3s. costs respectively Test Samples. 531 3 per cent. deficient in milk fat Subsequent Official Sample No. 550 532 20 per cent. deficient in milk fat 533 Slightly deficient in milk fat 534 26 per cent. deficient in milk fat 544 33 per cent. deficient in milk fat 85 Table H. Showing the number of samples of Butter submitted in the Four Quarters of the years 1908-1912. Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1908 1909 1910 1911 1912 1908 1909 1910 1911 1912 1908 1909 1910 1911 1912 First 20 22 20 36 21 3 — 1 — — 15.00 — 5.0 - — Second 34 26 31 29 19 1 - — 2 - 2.94 — — 6.9 — Third 18 18 5 22 16 1 — — 1 — 5.56 - — 4.5 — Fourth 21 44 46 41 54 1 - 1 4 2 4.76 — 2.2 9.8 3.7 Total for year 93 110 10.2 128 110 6 - 2 7 2 6.45 — 1.96 5.46 1.8 * Test samples not included. Table I. Details of Adulterated Samples of Butter for the Year ended December 31s/, 1912. No. Adulteration. Remarks. Official Samples. 434 25 per cent, of foreign fat. Vendor fined £3 and £1 3a. coats 519 58 per cent of foreign fat. Vendor fined 10s. andfl 3a. costs Test Samples. 415 Margarine Subsequent Official sample No. 434 511 Margarine Official sample No. 519 514 Margarine Subsequent Official sample genuine 86 Table J. Details of Other Samples Adulterated during the year ended December 31st, 1912. No. Article. Adulteration. Remarks. 107 Coffee 24 per cent. added chicory Vendor fined 10s. and 12s. 6d. costs 400 Rum 45 degrees under proof Protected by label on bottle 447 Bum 35 degrees under proof Protected by label on bottle TEST SAMPLES. 189 Coffee 35 per cent. added chicory Subsequent official sample genuine 262 Coffee 40 per cent. added chicory Subsequent official sample genuine 481 Coffee 15 per cent. added chicory Subsequent official sample genuine APPENDIX. LOCAL GOVERNMENT BOARD TABLES. LONDON COUNTY COUNCIL SUMMARY. METEOROLOGICAL TABLE. 1912. 88 Table I. Vital Statistics of Whole District during 1912 and previous Years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferee Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Non-residents registered in the District. of Residents not registered in the District Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1879 11.6 255 218 357 104 1842 11.43 1912 165249 3323 3343 20.35 1789 10.89 272 209 233 69 1726 10.51 Area of District in Acres (land and inland water) 7,014 At Census of 1911—Total population at all ages 160,834 Number of inhabited houses 28,728 Average number of persons per house 5.6 89 TABLE II. Cases of Infectious Disease notified during the Year 1912. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality (e.g. Parish or Ward) of the District. Total Cases Removed to Hospital. At all Ages. At Ages—Years. 1 Church 2 Manor 3 South 4 Blackheath 5 Lewisham Village 6 Lewisham Park 7 Brockley 8 Catford 9 Forest Hill 10 Sydenham Under 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Small-pox — — — — — — — — — — — — — — — — — — Cholera (C) Plague (P) — — — — — — — — — — — — — — — — — — — Diphtheria (including membranous Croup) 419 4 06 280 92 16 1 — 11 18 16 13 28 54 24 160 33 62 372 Erysipelas 102 4 6 8 7 29 36 12 1 3 3 2 14 19 8 21 14 17 24 Scarlet Fever 459 3 121 290 31 14 — — 24 18 10 28 32 47 60 118 41 81 392 Typhus Fever — — — — — — — — — — — — — — — — — — — Enteric Fever 25 — — 7 7 8 3 — 1 — — — — 2 2 12 4 4 19 Relapsing Fever (R) Continued Fever (C) — — — — — — — — — — — — — — — — — — — Puerperal Fever 7 — — — 3 4 — — — — 1 — — 1 — 2 — 3 2 Cerebro-spinal Meningitis — — — — — — — — — — — — — — — — — — — Poliomyelitis ... 2 — 1 — — 1 — — — — — — — — — 1 — 1 — Pulmonary Tuberculosis 344 1 1 36 60 181 55 10 12 15 10 21 35 49 32 79 30 61 — Ophthalmia Neonatorum 5 5 — — — — — — — — — — — 1 1 1 1 1 1 Totals 1363 17 225 621 130 253 95 22 49 54 40 64 109 173 127 394 123 230 810 90 Table III. Causes of, and Ages at, Death during the Year 1912. Causes of Death. Nett Deaths at the subjoined ages of Residents whether occurring within cr without the District. Total Deaths whether of residents or Non-Residents in Institutions in the District. 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 1726 233 38 50 72 53 236 407 637 631 Uncertified — — — — — — — — — — 1. Enteric Fever 8 — — — 2 2 4 — — 2 2. Small Pox — — — — — — — — — — 3. Measles 8 3 2 2 1 — — — — 1 4. Scarlet Fever 6 — — 3 3 — — — — — 5. Whooping Cough 23 13 4 4 2 — — — — — 6. Diphtheria and Croup 26 1 2 8 14 1 — — — 1 7. Influenza 11 — 1 — — — 1 — 9 1 8. Erysipelas 2 1 — 1 — — — — — 2 9. Phthisis (Pulmonary Tuberculosis) 112 — — 1 2 17 52 30 10 39 10. Tuberculous Meningitis 15 2 1 7 2 1 — 1 1 12 11. Other Tuberculous Diseases 19 1 1 2 4 1 4 5 1 15 12. Cancer, malignant disease 174 — — — 1 1 15 79 78 20 13. Rheumatic Fever 8 — — — 3 1 2 1 1 1 14. Meningitis 11 1 4 — 2 2 1 1 — 1 15. Organic Heart Disease 162 — — — 5 7 17 59 74 41 16. Bronchitis 146 19 5 3 2 1 6 28 82 69 17. Pneumonia (all forms) 104 20 6 5 4 2 19 19 29 30 18. Other diseases of Respiratory organs 33 3 2 1 1 — 5 11 10 3 19. Diarrhæa and Enteritis 32 20 2 2 — — 3 3 2 49 20. Appendicitis and Typhlitis 6 — — 1 2 1 1 1 — 5 21. Cirrhosis of Liver 19 — — — — — 2 10 7 6 21a. Alcoholism 3 — — — — — 1 1 1 1 22. Nephritis& Bright'sDisease 53 — — 1 1 1 11 15 24 19 23. Puerperal Fever — — — — — — — — — — 24. Otheraccidents and diseases of Pregnancy & Parturition 10 — — — — 1 8 1 — 3 25 Congenital Debility and Malformation, including Premature Birth 113 108 — 2 3 — — — — 87 26. Violent Deaths, excluding Suicide 52 7 — 3 3 6 16 9 8 24 27. Suicide 10 — — — — 1 2 7 — 2 28. Other Defined Diseases 552 33 5 3 15 7 65 125 299 193 29. Diseases ill-defined or un known 8 1 3 1 — — 1 1 1 5 SubEntries. included in above figures. 14(a). Cerebro-spinal Meningitis 1 — — — — 1 — — — — 28(a). Poliomyelitis 1 — — — — — 1 — — — 17(a). Pneumonia (other than Bronchopneumonia) 65 6 — 3 2 2 17 15 20 — 91 Table IV. INFANT MORTALITY. 1912.—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 4 Weeks 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year All Causes. Certified 57 16 15 12 100 38 41 28 26 233 Uncertified Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles — — - — — — — 1 2 3 Scarlet Fever — — - - — — — — — — Whooping Cough — — - - — 2 3 5 3 13 Diphtheria and Croup - - - - - - - - 1 1 Erysipelas — — — — — 1 — — — 1 Tuberculous Meningitis — — - — — — 1 1 — 2 Abdominal Tuberculosis — — - — — — — — — — Other Tuberculous Diseases - - - - - - - - - 1 Meningitis (not Tuberculous) — — - — — 1 — — — 1 Convulsions 2 3 - — 5 — 3 1 2 11 Laryngitis — — - — — — — — — — Bronchitis — 1 2 — 3 3 5 5 3 19 Pneumonia (all forms) — - — — — 3 7 5 5 20 Diarrhæa — — — — — — 1 — 1 2 Enteritis — 1 2 — 3 5 3 5 2 18 Gastritis — — — — — 1 — — — 1 Syphilis — — 1 1 2 — 1 - — 3 Rickets — — — — — — — - 1 1 Suffocation, overlying 1 — — — 1 2 — - 1 4 Injury at birth 3 — — — 3 — — - — 3 Atelectasis 7 — — — 7 — — — — 7 Congenital Malformations 2 2 1 2 7 3 2 — 2 14 Premature birth 31 6 2 3 42 3 — — — 45 Atrophy, Debility and Marasmus 4 3 7 5 19 12 11 5 2 49 Other Causes 7 - — 1 8 2 3 — 1 14 Totals 57 16 15 12 100 38 41 28 26 233 Nett Births in the year—legitimate, 3266; illegitimate, 77. Nett Deaths in the year of—legitimate infants, *211; illegitimate infants, 22. 92 Table V. LONDON COUNTY COUNCIL SUMMARY. Premises. Number of Places No. of Inspections 1912 No. of Notices 1912. No. of Prosecutions 1912. On Register at end of 1911. Added in 1912. Removed in 1912. On Register at end of 1912 Milk premises 158 31 26 163 491 - - Cow sheds 14 - - 14 141 - - Slaughter houses 15 - - 15 126 - - Other offensive Trade premises - - - - - - - Ice cream premises - - - - - - - Registered houses Let in Lodgings 11 — 8 3 3 (a)— - (4)1 - Restaurants 49 3 46 57 1 - Bakehouses 89 2 — 91 327 - - Stable Yards, &c. 40 — 4 36 46 1 - a Overcrowding, b Other conditions. Total number of intimation notices served for all purposes, male inspectors 1866, female inspectors 193—Total 2059. Overcrowding:—Number of dwelling rooms overcrowded 17, 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 Acts, 2; Numbers repaired and re-opened, nil. Premises cleansed under Section 20 of the London County Council (General Powers) Act, 1904, nil. 93 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, 65, number of tenements comprised therein, 133; certificates granted in respect of 57 houses (117 tenements); refused in respect of 8 houses (16 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 133 Total number of infectious bodies removed 4 94 Table VI. METEOROLOGICAL TABLE for LONDON, 1912. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1912. AIR TEMPERATURE. Bright Sunshine. Rain and other forms of Precipitation. Mean of Mean of A and B. Difference from Normal.+ Absolute Maximum and Minimum. Daily Mean. Difference from Normal. + Per cent, of Possible. Total Fall. Difference from Normal.+ Most in a day. Maximum. A Minimum. B Maximum. Day of Month Minimum. Day of Month. Amount. Day of Month. January 0 41.9 36.0 0 40.4 0 + 2.0 0 51 6 0 19 29 hrs. 0.89 hrs. -0.51 % 11 ins. 3.03 ins. +1.15 ins. 0.49 17 February 48.6 38.6 43.6 + 3.8 60 -28 19 3 1.33 -0.78 13 1.73 + 0.25 0.39 23 March 53.3 40.5 46.9 + 4.4 62 25 31 21 2.97 -0.39 25 2.58 + 1.06 0.56 4 April 59.8 39.4 49.6 + 1.5 71 21 32 11 7.47 +2.44 54 0.04 - 1.53 0.02 9 May 67.5 46.5 57.0 + 3.2 83 11 36 26 6.15 -0.26 40 1.29 - 0.63 0.36 15 June 69.5 49.3 59.4 -0.9 84 19 42 3 7.29 +0.81 44 2.35 +0.31 0.58 15 July 74.9 51.4 64.6 +0.9 90 12 48 19 5.34 -1.91 33 1.24 -1.16 0.30 2 August 66.7 50.1 58.4 -4.5 73 4 42 28 3.69 -3.09 25 4.27 + 1.93 0.86 25 September 60.8 40.5 53.7 -4.5 69 4 37 27 3.96 -1.26 31 2.11 -0.04 1.18 30 October 57.1 39.3 48.2 -2.2 66 13 29 6 3.96 +0.88 37 1.88 -0.90 0.44 20 November 48.3 39.3 43.8 +0.4 57 7 29 4 0.89 -0.83 10 1.55 -0.67 0.34 28 December 50.6 40.7 45.7 + 6.1 57 14 26 1 0.97 -0.12 12 2.80 +0.97 0.48 15 Year 58.5 43.4 51.0 +0.9 — - — - 3.74 -0.43 31 24.87 +0.75 — — * The hours of observation are 9 a.m. and 9 p.m. local time. f The averages used are obtained from observations extending over 65 years for Rain and Temperature, and 15 years for Sunshine.