LEW10 BOROUGH OF LEWISHAM. Annual Report on the VITAL STATISTICS & SANITARY CONDITION of the BOROUGH OF LEWI SHAM For the Year 1913, by A. YVELLESLEY 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; Formerly Medical Officer of Health for the Borough and Port of Southampton and Medical Superintendent of the Southampton Small-Pox and Fever Hospitals, &c. 3 PUBLIC HEALTH COMMITTEE, 1912-13. Chairman: Councillor James Macgregor. The Mayor (ex-officio) : Alderman R. Gordon Brew, J.P. Alderman A. J. Fitzgibbons. „ A. Hume Nicholl. Councillor A. 0. 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. 0. Weeks. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Sanitary Inspectors: J. H. Berhy. J. A. K. Cooper. J. Crowther. J. Daltry. A. H. Gray. H. King. B. A. Knappett. e. T. pldwell. R. White. Women Sanitary Inspectors: Miss K. H. Barke. Miss N. F. Jones. Tuberculosis Health Visttor: Miss Freda Hall. Clerks in the Department: F. E. Seckebson. C. C. Summers. P. C. Litten. Medical Officer of Health and Public Analyst: A. Wellesley Harris, M.R.C.S., D.P.H., &c. 5 TABLE OF CONTENTS. Page Page Vital Statistics— Sanitary Work— Housing, Town Planning, &c., Population 12 Act 71 Census, 1911 14 House-to-house Inspection 72 Births 22 Combined Drainage 73 Marriages 24 Smoke Nuisances 73 Deaths 24 Disinfection 74 ,, in Wards 25 Coroner's Court and Mortuary 75 ,, Ages at 25 Summary of Male Inspectors' ,, Causes of 26 Work 76 ,, from Zymotic Diseases 27 Summary of Female Inspectors' Tuberculous Diseases 30 Work 77 ,, of Infants 32 Water Certificates granted 78 ,, in Public Institutions 33 Revenue Act Certificates 79 Metropolitan Boroughs, Births, Deaths, &c 49,50 Food Supply - Bakehouses 83 Dairies, Milk Shops, &c 83 Cowhouses 83 Slaughterhouses 84 Infectious Diseases— Unsound Food 85 Sale of Food and Drugs Acts 85-93 Notifiable Diseases 53 Age Periods 54 Factories and Workshops — ,, in Wards 55 Home Office Tables ... 98-102 Scarlet Fever 56 Diphtheria 56 ApPendix Enteric Fever 57 Local Government Board Tables — Erysipelas 57 Table I.—Vital Statistics, 1913 Puerperal Fever 57 and previous years 105 Ophthalmia Neonatorum 57 ,, II—Infectious Diseases 106 Polio Myelitis 57 ,, III.—Causes of Death 107 Attack rates in Wards 58 „ IV.—Infantile Mortality 108 Pulmonary Tuberculosis 59 Table V.—London County Non-notifiable Diseases C7 Council Summary ... 109 School Closure 67 „ IV.—Meteorological Bacteriological Diagnoses 68 Table. 1913 111 6 To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Lewisham Gentlemen, I have the honour to submit to you my Thirteenth Annual Report on the Vital Statistics and Sanitary Condition of the Borough, together with the Returns required by the Local Government Board and the Home Office. The death-rate for the Borough equalled 10.6 per 1,000 persons living, compared with 10.5 per 1,000 in 1912. In previous years we have recorded the second or third lowest rate, but this year we are in the happy position of recording the lowest death-rate in the Metropolis. The birth-rate remains practically stationary, the figures for this year being 20.33 per 1,000, compared with 20.35 in 1912. It is satisfactory to record that the infant mortality rate equalled only 76 per 1,000, which, with the single exception of Hampstead, is the lowest of all the Metropolitan Boroughs. 7 From the statistics contained in this report it will be seen that Lewisham continues to maintain its position as one of the healthiest Boroughs in London. I desire to express my cordial appreciation of the support I have always received from your Council and the Public Health Committee, and I also take this opportunity of acknowledging the willing assistance I have received from the inspectorial and clerical staff. I am, Gentlemen, Your obedient Servant, Medical Officer of Health. May, 1914. VITAL STAT I ST I C S. 11 EPITOME OF VITAL STATISTICS, 1913. Area in acres 7,014 Population:— Census, 1901 127,495 „ 1911 160,834 Estimated to the middle of 1913 168,822 Average number of persons per house (Census, 1911) 5-6 Births 3,502 Birth Rate 20-33 Deaths 1,841 Death-rate 1068 Deaths of infants under 1 year of age 269 Infant mortality per 1,000 Births 76 Zymotic Death-rate 0.84 12 YITAL STATISTICS. Population.—The population of the Borough, estimated to the middle of the year 1913, and based upon the Census returns, was 168,822. This figure is calculated upon the assumption that the increase in the population maintained the same rater of progression in the year, as it did during the intercensal period of 1901-1911. The figure thus obtained, 168,822, shows an increase in one year of 3,573. The increase in the population by natural increment, i.e., the excess of births over deaths amounted to 1,661, and it is assumed, therefore, that the difference of 1,912 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. Census, 1911.—Several volumes of the Census Returns have been issued since the publication of my last report, and some of the figures have been extracted and included in this volume. 13 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, 1913. Increase. Decrease Males. Females. Total Persons. No. of Persons. Per centage. No. of Persons Per centage. Church 202 6412 2392 3583 5975 — — 437 6.8 5870 Manor 175 6734 3574 4476 8050 1316 19.5 — — 8365 South 878 5503 2762 3577 6339 836 15.2 — — 6540 Blackheath 369 6729 2753 3817 6570 — — 159 2.2 6540 Lewisham Village 279 13842 6803 7935 14738 896 6.5 — — 14953 Lewisham Park 350 11145 8015 8734 16749 5604 50.0 — — 18083 Brockley 512 10952 6941 8063 15004 4052 37.0 — — 15974 Catford 2541 23203 18217 20795 39012 15809 68.0 — — 42801 Forest Hill 624 18051 9158 11646 20804 2753 15.2 — — 21464 Sydenham 1084 24924 12165 15428 27593 2669 10.7 — — 28232 Whole Borough 7014 127495 72780 88054 160834 33339 26.0 — — 168822 14 CENSUS 1911. There were 37,013 Families or Separate Occupiers (36,863 of these being "Private Families" as distinguished from Institutions, &c.), compared with 27,701 in 1901. The number of persons in "Private Families" was 155,211. The number of tenements with less than five rooms was 14,204, compared with 8,561 in 1901, and the total population living in tenements of less than five rooms was 48,458 as against 15,958 in 1901. The proportion of the population residing in tenements of less than five rooms was 30.12 per cent. compared with 22.67 per cent. in 1901. From the proportion of families living in tenements of less than five rooms one can form a fairly accurate idea of the social condition of a district. Of every 1,000 tenements of all kinds in the Borough 884 only consist of less than five rooms. The average for the County of London is 695, while the largest proportion is in the Borough of Finsbury, were 891 of every 1,000 tenements consist of less than five rooms. One roomed tenements.—There were 1,303 one roomed tenements in the Borough, housing a population of 1,921. Of these 1,303 tenements— 865 contained 1 person 306 „ 2 persons 90 „ 8 ,, 36 „ 4 „ 6 „ 5 „ So far as these one roomed tenements are concerned, Lewisham also has the lowest proportion in London, only 35 out of each 1,000 tenements consisting of one room, exactly the same proportion as in 1901. The number of tenements containing an average of more than two occupants per room was 850, housing a population of 6036. The percentage of the total population living more than two in a room in tenements of less than five rooms was 3.36, and again, in this direction, Lewisham enjoys the lowest proportion in the Metropolis. 15 Census 1911.—Table showing number of Tenements in the Occupation of Private Families. No. of Rooms per Tenement. Number of Persons in Private Families (or Tenements). Total number of Private Families (or Tenements). Population. 1 2 3 4 5 6 7 8 9 10 11 12 persons & upwards Number of Private Families (or Tenements). 1 room 865 306 90 36 6 — — — — — — — 1303 1921 2 rooms 489 715 514 298 139 54 18 6 1 — — — 2234 5855 3 rooms 267 1251 1326 978 584 299 162 90 28 9 3 1 4998 17614 4 rooms 150 1113 1299 1138 811 495 335 169 92 48 16 3 5669 23068 Totals 1 to 4 rooms 1771 3385 3229 2450 1540 848 515 265 121 57 19 4 14204 48458 5 rooms 89 870 1366 1417 1096 721 481 305 162 81 23 23 6634 30013 6 rooms 65 697 1098 1160 881 621 374 209 132 75 46 31 5389 24637 7 rooms 50 504 893 1021 911 558 321 153 87 49 35 14 4596 21027 8 rooms 22 189 417 515 487 321 196 109 70 21 14 11 2372 11448 9 rooms 11 93 187 321 259 220 125 70 36 16 8 5 1351 6726 10 rooms and upwards 10 116 257 402 440 402 287 181 102 66 22 32 2317 12932 Totals 2018 5854 7447 7286 5614 3691 2299 1292 710 365 167 120 36863 155241 16 Census 1911.—Table showing Occupations of Males and Females in the Borough, aged 10 years and upwards. Males. Occupied and Unoccupied. Females. Total Males. FEMALES. 72,780 All Ages. 88,054 18,029 Under 10 years. 15,515 Unmarried. Married. Widowed. Total Females. 56,751 10 years & upwards. 72,539 OCCUPATIONS. AT AGES 10 YEARS AND UPWARDS. Total Occupied and Unoccupied 56751 35043 30583 6913 72539 Retired or Unoccupied (Order XXIII.) 10723 15687 28330 5117 49134 Engaged in Occupations (Orders I.—XXII.) 46028 19356 2253 1796 23405 (16) I.—General or Local Government of the Country. 1. National Government 1733 342 2 4 348 2. Local Government 829 134 8 28 170 Police 369 — — — — II.—Defence of the Country. 1. Army (at Home) 120 — — — — 2. Navy and Marines (Ashore and in Port) 88 — — — — III.—Professional Occupations and their Subordinate Services. 1. Clerical— Clergymen, Priests, Ministers 116 — — — — Others 112 97 12 4 113 2. Legal— Barristers, Solicitors 152 — — — — Law Clerks 452 36 — — 36 17 Census Table.—continued. (16) 3. Medical- Physicians, Surgeons, Registered Practitioners 131 1 — — 1 Midwives, Sick Nurses, Invalid Attendants 5 464 105 141 710 Others 90 17 1 — 18 4 Teaching 094 1148 183 31 1302 5. Literary, Scientific and Political 282 63 4 1 68 6. Engineers and Surveyors 194 — — — — 7 and 8. Art, Music, Drama, &c. IV.—Domestic Offices or Services. 787. 411 47 23 481 1. Domestic Indoor Service— In Hotels, Lodging and Eating Houses 13 120 7 4 137 Other Domestic Indoor Servants 98 8390 233 461 9084 2. Domestic Outdoor Service 573 1 1 — 2 3. Other Service— Hospital, Institution and Benevolent Society Service 99 178 8 15 201 Day Girls, Day Servants — 368 7 8 383 Charwomen — 122 202 256 580 Laundry Workers, Washers, Ironers, Manglers, &c. 130 563 406 245 1214 Others 419 42 90 55 187 V.—Commercial Occupations. 1. Merchants, Agents and Accountants 2319 22 8 3 33 2. Commercial or Business Clerks 5463 1019 17 13 1649 3 and 4. Dealers in Money, Insurance 2063 142 — 2 144 VI.—Conveyance of Men, Goods and Messages. 1. On Railways 1483 12 — 11 23 2. On Roads— Coachmen (not Domestic), Cabmen 177 — — — — Horsekeepers, Grooms, Stablemen (not Domestic) 148 — — — — Motor Car Drivers (not Domestic), Motor Cab, Motor Van, &c., Drivers 87 — — — — Carmen, Carriers, Carters, Wagoners (not Farm) 995 — — — — Van, &c., Guard Boys 54 — — — — Others 495 14 3 1 18 18 Census Table.—continued. (16) 3. On Seas, Rivers and Canals 221 1 2 1 4 4. In Docks, Harbours, &c. 187 — — — — 5. In Storage, Porterage and Messages— Messengers, Porters, Watchmen (not Rly. or Government) 1216 5 — — 5 Others 224 119 — — 119 VII.—Agriculture (on Farms, Woods and Gardens). 1. Farmers, Graziers, Farm Workers 195 3 3 3 9 2. Gardeners (not Domestic), Nurserymen, Seedsmen 797 7 4 1 12 Others — — — — — VIII.—Fishing. IX.—In and about and Working and Dealing in the Products of Mines and Quarries. 1. Workers 34 — — — — 2. Dealers 69 — — 1 1 X.—Metals, Machines, Implements and Conveyances. 1 and 2. Iron, Steel, &c., Manufacture 14 — — — — 3. General Engineering and Machine Making— Iron Founders 49 — — — — Blacksmiths, Strikers 238 — — 1 1 Erectors, Fitters, Turners (including Labourers) 337 — — — — Others 772 2 — — 2 4. Electrical Apparatus 694 6 — — 6 5—8. Tools, Dies, &c., Arms, Miscellaneous Metal Trades 443 20 3 2 25 9. Ships and Boats 49 — — — — 10. Vehicles— Cycle and Motor Car Makers, Mechanics 264 1 — — 1 Others 204 2 — — 2 11. Dealers 297 14 4 2 20 19 Census Table.—continued. (16) XI.—Precious Metals, Jewels, Watches, Intsruments and Games. 1. Workers 501 21 2 — 23 2. Dealers 115 17 5 1 23 XII.—Building and Works of Construction. 1. House Building, &c.— Builders 303 — — — — Builders Labourers 487 — — — — Carpenters, Joiners (including Labourers) 985 — —' — — Bricklayers, Bricklayers' Labourers 617 — — — — Painters, Decorators, Glaziers 1342 — — — — Masons, Masons' Labourers 82 — — — — Plumbers 419 — — — — Others 557 — — — — 2. Other Works of Construction, and Roads— Navvies, &c., Paviors, Road Labourers 145 — — — — Others 21 — — — — XIII.—Wood Furniture, Fittings, Decorations. 1. Cabinet Makers, French Polishers, Upholsterers 226 20 1 4 25 2. Other Workers in Furniture, Fittings, &c. 186 2 3 1 6 3. Workers in Wood and Bark 206 1 — 1 2 4. Dealers 294 11 16 4 31 XIV.—Brick, Cement, Pottery and Glass. 1. Workers 49 3 — 1 4 2. Dealers 45 20 3 1 24 XV.—Chemicals, Oil, Grease, Soap, Resin. &c. 1 and 3. Colouring Matter, Drugs, Chemicals, &c.— • Chemists, Druggists 206 24 1 1 26 Others 98 1] 2 — 13 2. Explosives and Matches 21 — — — — 4. Oil, Grease, Soap, Resin, &c.— Workers 67 8 — 1 9 Dealers 155 6 3 3 12 20 Census Table.— continued. (16) XVI.—Skins, Leather, Hair and Feathers. 1. Skins and Leather 173 17 2 2 21 2. Saddlery and Harness 53 — 1 — 1 3. Hair and Feathers 23 12 — — 12 4. Dealers in Skins, Leather, Hair and Feathers 112 10 1 — 11 XVII.—Paper, Prints, Books and Stationery. 1. Paper Box, Bag Makers, Stationery Manufacturers 64 47 2 — 49 2. Printers, Lithographers 1154 61 6 1 68 3. Bookbinders 110 45 4 2 51 4. Other Workers 27 6 — — 6 5. Publishers, Booksellers, Stationers, Newagents and other Dealers 479 86 25 10 121 XVIII.—Textile Fabrics. 1—5. Textile Manufacturers 65 67 5 9 81 6. Bleaching, Printing, Dyeing, &c. 17 28 3 3 34 7. Dealers (Drapers and Others) 829 625 38 16 679 XIX.—Dress. 1. Tailors 402 117 17 13 147 2. Milliners 6 388 12 6 406 3 Dressmakers 30 1620 142 106 1868 1. Shirt Makers, Seamstresses 79 292 35 73 400 5, Boot, Shoe, Slipper. Patten and Clog Makers 413 4 4 — 8 6. Wig Makers, Hairdressers 188 25 6 4 35 7. Other Workers 86 34 8 6 48 8. Dealers 504 167 39 10 216 XX.—Food, Tobacco, Drink and Lodging. 1 F ood— Milksellers, Dairymen 486 50 28 2 80 Butchers, Meat Salesmen 598 9 25 1 35 Bread, liiscuit, Cake, Sc., Makers 441 7 3 — 10 Bakers, Confectioners (Dealers) 219 206 82 28 316 Grocers, Tea, Coffee, Chocolate JJealers 778 34 36 13 83 Other Workers 190 67 3 — 70 Other Dealers 1071 56 84 13 153 21 Census Table.—continued. (16) 2. Tobacco— Tobacco Manufacture 15 4 2 — 6 Tobacconists 105 32 15 5 52 3. Makers of Spirituous Drinks — — — — — 4. Hoard, Lodging and Dealing in Spirituous Drinks— Coflee, Eating Lodging, Boarding House Keepers 89 107 81 87 275 Inn, Hotel Keepers, Publicans, &c. 170 12 59 15 86 Cellarmen, Beer Bottlers 62 4 — — 4 Barmen 164 97 6 4 07 Waiters (not Domestic) 54 143 2 3 148 Others in Inn, Hotel, Eating House, &c., Service 58 46 6 4 56 Wine and Spirit Merchants, Agents 88 7 1 3 11 XXI.—Gas, Water and Electricity Supply and Sanitary Service. 1. Gas, Water, Electricity 654 1 — — 1 Gas Works Service 540 — — — — 2. Sanitary Service 133 — — — — XXII.—Other General and Undefined Workers and Dealers. 1. General Shopkeepers, Dealers, Pawnbrokers 242 128 48 15 191 2 Costermongers, Hawkers, Street Sellers 92 5 16 5 26 3. Newsboys, Vendors (Street or Undefined) 96 — — — — 4. General Labourers 1036 — — — — 6. Engine Drivers, Stokers, Firemen (not Railway, Marine, or Agricultere) 166 6. Others 283 54 10 2 66 XXIII.—Without Specified Occupations, or Unoccupied. 1. Retired (not Army or Navy) Pensioners 2523 226 46 359 631 2. Private means 295 1164 200 1126 2490 3. Others aged 10 years and upwards (including Scholars and Students) 7905 14297 28084 3632 46013 22 BIRTHS. Number of births (corrected) in 1913 3502 Average number in previous 10 years 3517 Birth rate per 1,000 in 1913 20.33 Birth rate, County of London 24.5 „ 96 Great Towns 25.1 „ England and Wales 23.9 The total number of Births registered in the Borough during the year amounted to 3,587. Twenty-eight 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 43 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 3,502, the males numbering 1,780, and the females 1,722, which is equivalent to a birth-rate of 20.33 per 1,000 inhabitants. In 1912, 3,343 children were born, which shows in one year an increase of 159 in the number of births. The birth-rate for the County of London was 24.5 per 1,000, for the 96 Great Towns, 25.1 per 1,000, and for the whole of England and Wales, 23.9 per 1,000. Illegitimacy.—The illegitimate births numbered 95, compared with 77 in 1912. 23 The following table shows the number of births occurring in the various Wards of the Borough, together with the rate per 1000 inhabitants:— Wards. Males. Females. Total. Birth Rate. Church 54 45 99 16.52 Manor 114 103 217 25.42 South 48 45 93 13.93 Blackheath 46 53 99 14.83 Lewisham Village 129 156 285 18.68 Lewisham Park 289 197 436 23.63 Brockley 193 164 357 21.90 Catford 414 401 815 18.66 Forest Hill 205 212 417 19.04 Sydenham 316 325 641 22.24 Births registered outside the Borough 22 21 43 — Whole Borough 1,780 1,722 3,502 20.33 The Notification of Births Act, 1907. During the year 35.28 notifications of births were received under the above-named Act. In 315 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. 8528 1109 1589 778 5'2 3439 89 3502 24 MARRIAGES. The number of Marriages in the Borough during the year was 1,070, compared with 1,101 in 1912, and 1,061 in 1911. Of this number, 619 were solemnized at the Established Church, 121 at Nonconformist Places of Worship, and 330 at the Register Office. MORTALITY. Nett number of deaths, 1913 1841 Death rate per 1,000, 1913 10.68 „ County of London 14.2 „ 96 Great Towns 14.7 „ England and Wales 13.4 The total number of Deaths registered in the Borough during the year was 1,911. After deducting the deaths of non-residents dying within the Borough (311), and adding those of residents of the Borough dying outside (241), a corrected total of 1,841 is obtained, compared with 1,726 in the previous year. The average number of deaths in the 10 years, 1903-12, was 1,699. The corrected death rate for the Borough was 10.68 per 1,000 of the population, compared with 10'51 per 1,000 in 1912. 25 The following Table shows the death rates in the various Wards of the Borough during the year under review, and the previous year:— Wards. Total Deaths. Death Rates, 1913. Death Rates, 1912. Church Ward 77 12.85 11.73 Manor Ward 96 11.24 10.03 South Ward 58 8.68 9.20 Blackheath Ward 60 8.99 11.52 Lew. Village Ward 178 10.66 10.76 Lew. Park Ward 176 8.53 9.72 Brockley Ward 178 10.92 10.42 Catford Ward 385 8.81 8.93 Forest Hill AVard 277 12.64 10.45 Sydenham Ward 347 12.04 12.41 Address Unknown 9 — — Whole Borough 1841 10.63 10.51 Ages at Death.—The following table shows the number of deaths at various age periods in the years 1912 and 1913, and the percentages to the total deaths at all ages:— 1912. 1913. No. of Deaths. Percentage to Total. No. of Deaths. Percentage to Total. Under 1 year 233 13.5 269 14.6 1 year and under 2 38 2.2 66 3.6 2 years and „ 5 50 2.9 70 3.8 5 „ ,, ,, 15 72 4.2 75 4.0 15 ,, ,, ,, 25 53 3.1 78 4.1 25 „ „ „ 45 236 13.7 226 12.2 45 „ ,, „ 65 407 23.6 418 22.7 65 „ and over 637 36.9 639 34.7 26 Seasonal Mortality.— In the first quarter of the year the deaths numbered 522 „ „ second quarter „ „ „ „ „ 480 ,, ,, third quarter ,, ,, ,, ,, ,, 374 „ ,, fourth quarter „ „ „ „ „ . 465 ANALYSIS OF CAUSES OF DEATH. Zymotic Diseases.—The total number of deaths due to zymotic diseases was 162, compared with 92 in the previous year, and the death-rate from these diseases was 0.84 per 1,000, against 0'57 in 1912. Enteric Fever.—Eight fatal cases of this disease occurred, the same number as in 1912, and an average of 4'0 for the ten years, 1903-12. Measles was certified to be the cause of twenty-five deaths, a large increase on 1912, when only eight deaths occurred. Scarlet Fever was the cause of five deaths. Whooping Cough.—Twenty-two deaths were caused by this disease, nine of the victims being under one year of age. Diphtheria was the cause of thirty-five deaths, compared with twenty-six in 1912. Diarrhoea and Enteritis.—Fifty-one children under the age of two years died from these diseases, compared with twenty in the preceding year. 27 The following table shows the death-rates from the principal zymotic diseases in this Borough, and in the County of London, the 96 Great Towns, and England and Wales:— Enteric Fever. Measles. Scarlet Fever. Whooping Cough. Diphtheria Number of deaths in 1913 8 25 5 22 35 Death-rate „ „ 0.04 0.14 0.02 0.13 0.20 Average number of deaths in the ten years, 1903-12 4 23 10 26 21 Death-rate, County of London 0.02 0.34 0.04 0.17 0.09 „ 96 Great Towns 0.04 0.34 0.07 0.17 0.13 „ England and Wales 0.04 0.28 0.06 0.14 0.12 28 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. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis. (Under 2 years). Totals. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Church — — — — — — — — — — 1 0.17 1 0.17 Manor 1 0.12 — — 1 0.12 l 0.12 — — — — 3 0.35 South 1 0.15 — — 1 0.15 l 0.15 — — 3 0.45 6 0.89 Blackheath — — 2 0.30 — — l 0.15 1 0.15 2 0.30 6 0.89 Lewisham Vill. — — 2 0.13 — — 2 0.13 — — 3 0.19 7 0.46 Lewisham Park l 0.05 2 0.11 1 0.05 2 0.11 5 0.27 10 0.54 21 1.13 Brockley l 0.06 1 0.06 1 0.06 3 0.18 3 0.18 8 0.49 17 1.04 Catford 3 0.07 5 0.11 1 0.02 6 0.14 5 0.11 10 0.23 30 0.68 Forest Hill — — 1 0.04 — — — — 16 0.74 6 0.27 23 1.05 Sydenham 1 0.03 12 0.42 — — 6 0.21 5 0.17 8 0.27 32 1.11 Whole Borough 8 0.04 25 0.14 5 0.02 22 0.13 35 0.20 51 0.29 146 0.84 29 Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1913. Ages. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa and Enteritis. Totals in Age Groups. Under1 year — 5 — 2 9 — 43 59 1 and under 2 years — 11 — — 11 — 8 30 2 and under 5 — 4 l 17 2 l 4 29 5 and under 15 — 5 4 14 — 2 2 27 15 and under 25 — — — — — 1 — 1 25years and upwards — — — 2 — 4 10 16 Total all ages 1913 — 25 5 35 22 8 67 162 Total all ages 1912 — 8 6 26 23 8 32 103 Pulmonary Tuberculosis.—This disease was the cause of 126 deaths in 1912, compared with 112 in 1911. The average number of deaths in the ten years, 1903-12, was 117. The death-rate from pulmonary tuberculosis amounted to 0.73 per 1,000, compared with 0.68 per 1,000 in the preceding year. 30 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 7 1.16 Lewisham Park 7 0.38 Manor 8 0.95 Brockley 14 0.87 South 4 0.61 Catford 32 0.74 Blackheath 8 0.45 Forest Hill 15 0.69 Lewisham Vill 16 1.07 Sydenham 20 0.70 Whole Borough 126 0.73 Ages at Death:— Under 5 years 4 deaths. 5 and under 15 7 „ 15 „ „ 25 21 „ 25 „ „ 45 59 „ 45 „ „ 65 31 „ 65 and over 4 „ All Ages 126 „ Tuberculous Meningitis and other tuberculous diseases were the cause of 43 deaths. Cancer and Malignant Diseases were the cause of 194 deaths, compared with 174 in 1912. The average yearly number of deaths in the ten years, 1903-12, was 143. 31 The deaths occurred at the following ages:— Under 25 2 deaths. 25 and under 45 17 „ 45 „ 65 90 „ Over 65 years 85 „ Bronchitis.—This disease was the cause of 137 deaths, compared with 146 in 1912, and an average of 131 yearly in the ten years, 1903-12. The deaths occurred at the following ages :— Under 1 year ... 31 1 year and under 5 26 5 years „ 25 12 25 ,, 45 14 45 ,, 65 18 Over 65 years 26 Other forms of disease of the Respiratory Organs were responsible for 30 deaths. Pneumonia.—The deaths from all forms of pneumonia numbered 127, compared with 104 in 1912, and an average during the ten years, 1903-12, of 107. 32 INFANT MORTALITY. During 1913, 269 children died before reaching the age of one year, equal to 14-6 per cent, of the whole of the deaths in the Borough. The infant mortality rate is therefore 76 per 1,000 births, compared with 69 per 1,000 in 1912. With the exception of Hampstead (73 per 1,000) this rate is the lowest of all the Metropolitan Boroughs. The infant mortality rate for the County of London was 105 per 1,000. Causes of Death.—The following list shows the principal causes of death among infants under one year of age :— Measles 5 Whooping Cough 9 Diphtheria and Croup 2 Tuberculous Diseases 7 Convulsions 10 Bronchitis 16 Pneumonia 31 Diarrhoea and Enteritis 43 Suffocation in bed with parents 3 Injury at Birth 4 Atelactasis 2 Congenital Malformations 13 Premature Birth 40 Atrophy, Debility and Marasmus 54 Other causes 30 269 83 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—The deaths which occurred in the Public Institutions in the Borough numbered 721, of which number 426 were residents, the remainder having been brought from other districts for treatment The deaths were distributed as follows:— Number of Deaths. Institution. Residents. Non-Residents. Lewisham Infirmary 378 24 „ Workhouse 85 5 Park Hospital for Children — 160 Bermondsey Workhouse — 70 St, John's Hospital 10 20 Home for Sick Children, Sydenham 8 13 Greenwich Workhouse, Grove Park — 1 Flower House, Asylum, Southern — 2 426 295 Without the Borough.—The deaths of residents who died in Public Institutions outside the Borough were distributed as follows:— Asylums : — Banstead, 6 ; Cane Hill, 6 ; Dartford Heath, 21 ; others, 17. Poor Law Institutions:—6 deaths. Infectious Disease Hospitals: — Brook, 30; SouthEastern, 17 ; South-Western, 2 ; Grove, 2. General Hospitals.—Charing Cross, 2 ; Children's Hospital, Great Ormond Street, 1; Evelina Hospital for Children, 2. Guy's, 14 ; London, 3 ; Middlesex, 4 ; Miller, 8; Royal Free, 2; St. Bartholomew's, 3 ; St. George's, 2 ; St. Thomas's, 4 ; Seamen's, Greenwich, 2 ; Westminster, 3 ; others, 28. Causes of, and Ages at, Death during the year 1913. 34 Excluding Deaths of Non-Residents at Public Institutions and other places in the Borough, and adding Deaths ot Lewisham Residents known to have occurred outside the Borough. Schedule Number. Causes of Death in Lewisham during the 53 weeks ended 3rd January, 1914. Nett Deaths at the subjoined ages of " Residents," whether occurring within or without the Borough. Nett Deaths at all ages of " Residents " belonging to Wards, whether occurring in or beyond the Borough. Males Females Total Deaths in Public Institutions in the Borough | All Ages Under 1 | 1 and under 2 | 2 and under 5 5 and under 15 15 and under25 25 and under 45 .45 and under 65 65 and upwards Church Manor South Blackheath Lewisham Vill. Lewisham Park Brockley Catford Forest Hill Sydenham Precise address unknown Residents Non-Residents Col. / 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 I.—General Diseases. 1 Enteric Fever 8 - - 1 2 1 2 2 - - 1 1 - - 1 1 3 - 1 - 4 4 - - 2 Typhus - - - - - - - - - - - - - - - - - - - - - - - - 3 (A.B.) Relapsing Fever a Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - b Mediterranean Fever - - - - - - - - - - - - - - - - - - - 4 Malaria - - - - - - - - - - - - - - - - - - - - - - - - 5 Small Pox a Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - b Not Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - c Doubtful - - - - - - - - - - - - - - - - - - - - - - - - 6 Measles 25 5 11 4 5 - - — - - 2 2 2 1 5 1 12 — 15 10 — 14 35 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 7 Scarlet Fever 5 — — 1 4 — — — — — 1 1 — — 1 1 1 — — — 3 2 — — 8 Whooping Cough 22 9 11 2 — — — — — — 1 1 1 2 2 3 6 — 6 — 13 9 — 7 y (A) Diphtheria 35 — — 17 14 — 1 1 — — — — 1 — 5 3 5 16 5 — 20 15 — 2 (B.C.) Croup b Membranous Laryngitis — — — — — — — — — — — — — — — — — — — — — — — — c Croup ... — — — — — — — — — — — — — — — — — — — — — — — — 10 Influenza 27 — — — 1 3 2 9 12 — — — 2 3 4 2 6 4 6 — 15 12 2 1 11 Miliary Fever — — — — — — — — — — — — — — — — — — — — — — — — 12 Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — 13 Cholera Nostras — — — — — — — — — — — — — — — — — — — — — — — — 14 Dysentry 1 — — — — — — 1 — — 1 — — — — — — — — — — 1 — — 15 Plague — — — — — — — — — — — — — — — — — — — — — — — — 16 Yellow Fever — — — — — — — — — — — — — — — — — — — — — — — — 17 Leprosy — — — — — — — — — — — — — — — — — — — — — — — — 18 Erysipelas 5 1 1 — — 1 — 1 1 — — — — 2 — — 1 — 2 — 5 — 2 — 19 (A.B.C.D.) Other Epidemic Diseases a Mumps 1 — 1 — — — — — — — — — — — — — 1 — — — 1 — — — b German Measles — — — — — — — — — — — — — — — — — — — — — — — — c Varicella — — — — — — — — — — — — — — — — — — — — — — — — d Other Diseases included under 19 — — — — — — — — — — — — — — — — — — — — — — — — 20 (A.B.C.) Pyaemia Septicaemia a Pyaemia — — — — — — — — — — — — — — — — — — — — — — — — b Septicaemia 2 — — — — 1 1 — — — — — 1 1 — — — — — — — 2 — — c Vaccinia — — — — — — — — — — — — — — — — — — — — — — — — 21 Glanders — — — — — — — — — — — — — — — — — — — — — — — 1 22 Anthrax (Splenic Fever) — — — — — — — — — — — — — — — — — — — — — — — — 23 Rabies — — — — — — — — — — — — — — — — — — — — — — — — 24 Tetanus 1 — — — — — 1 — — — — — — — — — — — 1 — — 1 — — 25 (A.B.) Mycoses a Actinomycosis b Other Mycoses — — — — — — — — — — — — — — — — — — — — — — — — 26 Pellagra — — — — — — — — — — — — — — — — — — — — — — — 27 Beri-beri — — — — — — — —- — — — — — — — — — — — — — — — — 98 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 28 (A.B.) Pulmonary Tuberculosis (not acute) a Pulmonary Tuberculosis 89 1 — — 6 14 42 23 3 5 4 2 1 11 4 12 21 10 19 58 31 31 7 b Phthisis (not defined as tuberculous) 27 — — 1 — 4 15 6 1 1 4 2 2 3 2 2 6 5 — — 15 12 — 1 29 (A) Acute Phthisis 6 — — — 1 2 1 2 — — — — — 2 1 — 3 — — — 1 5 —, 1 (B) Acute Miliary Tuberculosis 4 — 1 1 — 1 1 —. — 1 — — — — — — 2 — 1 — 2 2 1 — 30 Tuberculosis Meningitis 23 5 5 7 2 2 2 — — — 1 1 1 1 2 3 7 2 5 13 10 9 8 31 (A.B.) Tuberculosis of Peritoneum and Intestines a Tabes Mesenterica — — — — — — — — — — — — — — — — — — — — — — — 1 b Other Peritoneal and Intestinal Tubercle 8 1 1 2 2 2 — — — 1 — 2 1 1 2 3 5 2 1 32 Tuberculosis of Spinal Column 3 — — — — — 1 1 1 — — — 1 — 1 — — 1 — — 1 2 1 — 33 Tuberculosis of Joints 3 — — 1 — 1 — 1 — — 1 — — — — — 1 — 1 — 1 2 1 — 34 (A.B.C.) Tuberculosis of other Organs a Lupus 1 — — — — — — — 1 — — — — — 1 — — 1 1 — b Scrofula — — — — — — — — — — — — — — — — — — — — — — — — c Other Tuberculosis included under 34 3 — — — — 1 1 1 — — — — — — 1 — 1 1 — — 2 1 — 2 35 Disseminated Tuberculosis 2 — 1 — 1 — — — — — — — — — — — 1 1 — — 1 1 — 2 36 (A.B.) Rickets, Softening of Bones a Rickets 2 1 1 — — — — — — — — — — 1 — — 1 — — — 1 1 — 2 b Other forms of Bone Softening — — — — — — — — — — — — — — — — — — — — — — — — 37 Syphilis 7 4 — — — — 1 2 — — — — — 1 1 — 2 1 2 — 2 5 4 5 38 (A.B.C.) Other Venereal Diseases a Soft Chancre — — — — — — — — — — — — — — — — — — — — — — — — b Gonococcus Infection — — — — — — — — — — — — — — — — — — — — — — — — c Purulent Ophthalmia — — — — — — — — — — — — — — — — — — — — — — — — 39 Cancer of the Buccal Cavity 9 — — — — — 1 5 3 — — — — 3 — 2 2 2 — 9 — 3 1 40 Cancer of the Stomach, Liver, &c. 59 — — — — — 1 28 30 2 3 2 2 7 7 6 12 8 9 1 30 29 9 3 41 Cancer of the Peritoneum, Intestines and Rectum 54 — — — — — 6 16 32 5 3 — 1 6 2 7 13 15 2 — 22 32 20 — 42 Cancer of the Female Genital Organs 25 — — — — — 4 16 5 2 1 1 1 1 3 2 9 4 1 — — 25 9 1 43 Cancer of the Breast 21 — — — 4 10 7 3 2 2 — — 2 1 5 2 4 — — 21 5 1 44 ] Cancer of the Skin 2 — — — — — 1 — 1 — — — — — 1 — 1 — — — 1 1 1 — 37 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 | 17 | 18 19 20 21 22 23 24 45 Cancer of other or unspecified Organs 24 — 1 — — 1 — 15 7 — 2 3 — 3 3 3 2 3 4 1 13 11 1 — 46 (A.B.C.) Other Tumours (situation undefined) a Angioma — — — — — — — — — — — — — — — — — — — — — — — — b Adenoma — — — — — — — — — — — — — — — — — — — — — — — — c Other tumours included under 46 1 — — — — — — — — — — — — — — — — — — — — — — 1 47 Rheumatic Fever 9 — — 2 — 4 3 — — — — — 2 — — 4 3 — — 4 5 — — 48 (A.B.) Chronic Rheumatism, Osteo-arthritis a Chronic Rhematism — — — — — — — — — — — — — — — — — — — — — — — — b Osteo-arthritis 7 — — — — — — 2 5 — — — — — 1 — 3 — 3 — 1 6 3 1 48c (C) Gout 3 — — — — — — 1 2 — — — — — — — — 2 1 — 2 1 1 — 49 Scurvy — — — — — — — — — — — — — — — — — — — — — — — — 50 Diabetes 19 — — — 1 — 4 9 4 — — 1 — 1 — 1 8 3 5 — 11 8 5 — 51 Exophthalmic Goitre 1 — — — — — 1 — — — — — — — — — — — 1 — — 1 1 — 52 Addison's Disease 1 — — — — — — — — — — — — — — — 1 — 1 — 53 (A.B.) Leucocythæmia, Lymphadenoma a Leucocythæmia (Leuchæmia) 1 — — — — — — — — — — — — — — — — — — — — — — — b Lymphadenoma — — — — — — — — — — — — — — — — — — — — — — — — 54 Anaemia, Chlorosis 4 — — — — — — 3 — — — 1 — — 1 1 1 — 2 2 2 — 55 (A.B.C.D.) Other General Diseases a Diabetes Insipidus — 1 — — — — — — — — — — — — — — — — — — — — — — b Purpura 2 — — — — — — — — — — — — — 1 1 — — — — 2 1 c Haemophilia 1 1 — — — — — — — — — — — — — — — — — — — — — — d Other diseases included under 55 1 — — — — — — — — — — — — — — — — — — — — — — 56 Alcoholism (acute or chronic) 3 — — — — — — 2 1 — — — 1 — — — — — 2 — — 2 — — 57 (A.B.) Chronic Lead Poisoning a Occupational lead poisoning — — — — — — — — — — — — — — — — — — — — — — — — b Non-occupational lead poisoning — — — — — — — — — — — — — — — — — — — — — — — — 58 Other chronic occupational poisonings — — — — — — — — — — — — — — — — — — — — — — — — 59 Other chronic poisonings — — — — — — — — — — —- — — — — — — — — — — — — 38 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 II.—Diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — 6] (A) Cerebro-spinal Fever — — — — — — — — — — — — — — — — — — — — — — — — 61 (B.C.) Meningitis, other forms or undefined b Posterior basal meningitis 2 — — — 1 1 — — — — — — — 1 — — — — — 1 1 1 1 — c Meningitis, other forms 10 — 1 4 3 — — 1 1 — 1 — 1 1 — 1 3 3 — 5 5 1 1 62 Locomotor Ataxy 5 — — — — — — 4 1 — — 1 1 1 — 1 — — 1 — 4 1 3 — 63 (A B.) Other diseases of the Spinal Cord a Diseases formerly classed to "Other nervous affections" 2 — — — — — — 1 1 — — — — — — — 1 i — — 2 — — b Other diseases included under 63 4 — — — — — 1 3 — — — — — 1 — — 1 1 1 — 2 2 3 — 64 (A.B.C.D.E.) Cerebral haemorrhage, Apoplexy a Apoplexy 13 — — — — — — 3 10 — — 2 — 1 — 1 3 3 2 — 7 6 — — b Serous apoplexy and oedema of brain 1 — — — — — — — 1 — — — — — — — — — — — — — — — c Cerebral congestion — — — — — — — — — — — — — — — — — — — — — — — — d Cerebral atheroma — — — — — — — — — — — — — — — — — — — — — — — 1 e Cerebral hæmorrhage 48 — — — — — 2 13 33 3 3 2 1 5 3 9 6 10 5 1 18 30 8 12 65 Softening of Brain 2 — — — — — — — 2 1 — — — — — — — 1 — — — 2 — — 66 (A.B.C.) Paralysis without specified cause a Hemiplegia 4 — — — — — — 2 2 — 1 1 2 1 3 1 — b Paraplegia 2 — — — 1 — — 1 — — — — — — — — 1 1 — — — 2 — c Other forms of paralysis 3 — — — — — — 1 2 — — — — — — 1 — 1 1 — 2 1 — 2 67 General Paralysis of the Insane 13 — — — — 1 5 7 — — 1 — 1 2 2 1 2 1 2 1 12 1 2 2 68 Other forms of Mental Alienation 3 — — — — 1 — 1 1 — — - — 1 — 1 — 1 — — 1 2 2 — 69 Epilepsy 14 — — — — — 3 8 3 1 1 1 — 1 2 — 2 3 3 — 5 9 3 — 70 (A.B.) Convulsions (non-puerperal 5 years and over) a Epileptiform convulsions — — — — — — — — — — — — — — — — — — — — — — — — b Others included under 70 — — — — — — — — — — — — — — — — — — — — — — — — 39 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 J 4 5 6 7 8 V 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 71 (A.B.) Infantile Convulsions under 5 years a Convulsions with teething 2 2 1 2 1 11 2 — 1 b Other infantile convulsions 14 R 1 5 — — — — — — 1 — 1 (> — 3 '2 — 72 Chorea 1 73 (A.B.) Hysteria, Neuralgia, Neuritis a Hysteria, Neuralgia, Sciatica 1 1 1 1 1 b Neuritis 4 — — — — — 2 — 2 — — — — — — 1 1 — 3 — 74 (A.B.C.D.) Other Diseases of the Nervous System a Idiocy. Imbecility 1 1 b Cretinism c Cerebral tumour G — — 4 1 1 — — — 2 2 — 1 — 1 — 2 4 1 — d Other diseases included under 74 3 1 1 1 — — — — — — 1 2 — — 2 1 — 1 75 Diseases of the Eyes and Annexa 2 1 76 (A) Mastoid disease ... 2 — 1 1 2 76 (B) Other diseases of the Ears 1 — — — — 1 — — — — — — — — — — — 1 . — — 1 — III.—Diseases of tiie Circulatory System. 77 Pericarditis 3 — — — 1 — 1 1 — — — 1 — — 1 1 — 1 2 2 — 78 (A.B.C.) Acute Endocarditis a Acute myocarditis 1 2 i 1 3 b Infective endocarditis 6 — — — 1 2 3 — — — — — — 1 1 — 3 1 — c Other acute endocarditis 1 — — — — 1 — — — — — — — — 1 — — — — 1 — 1 79 (A) Valvular disease 8G — 1 — 1 7 20 29 28 3 4 1 a 9 9 9 20 11 17 — 39 47 24 7 79 (B) Fatty Degeneration of the Heart ... 17 — — — — — — 8 9 2 11 1 4 1 2 4 1 1 — 10 7 — 3 79 (C) Other Organic disease of the Heart... 54 — — — — 5 20 29 4 2 2 7 7 3 9 6 11 — 16 38 10 7 80 Angina Pectoris 9 — — — — — — 2 7 — — i 1 1 1 — 1 4 — C 3 — — 81 (A) Aneurysm 2 — — — 1 — 1 — — 1 — 1 — 2 — — — — 2 — — — 81 (B) Arterial Sclerosis 21 — — — — — — 12 9 3 1 3 l 4 — 2 2 8 — 14 7 4 — 81 (C) Other diseases of Arteries 1 — — — — — — 1 — - — — — — — — — 1 — 1 — — — 82 (A) Cerebral Embolism and Thrombosis... 4 — — — — 1 3 — i — — — 1 2 — 2 2 — — 82 (B) Other Embolism and Thrombosis 1 - 1 40 Causes of, and Ages at, Death during the year 1913.- continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 83 (A.B.C.D.) Diseases of the Veins— (Varices, Hemorrhoids, Phlebitis, &c.) a Phlebitis — — — — — — — — — — — — — — — — — — — — — — — — b Varix — — — — — — — — — — — — — — — — — — — — — — — — c Pylephlebitis — — — — — — — — — — — — — — — — — — — — — — — — d Varicocele — — — — — — — — — — — — — — — — — — — — — — — — 84 (A) Status Lymphaticus — — — — — — — — — — — — — — — — — — — — — — — 84 (B) Other diseases of the Lymphatic System 85 (A.B.C.) Haemorrhage; other diseases of the Circulatory System a Functional disease of the heart 1 1 — — — — — — — — — 1 — — — — — — — — 1 — — — b Epistaxis — — — — — — — — — — — — — — — — — — — — — — — — c Other diseases included under 85 — — — — — — — — — — — — — — — — — — — — — — — — IV.—Diseases of the Respiratory System. 86 Diseases of the Nasal Fossæ — — — — — — — — — — — — — — — — — — — — — — — — 87 (A.B.C.) Diseases of the Larynx a Laryngismus stridulus — — — — — — — — — — — — — — — — — — — — — — — — b Laryngitis — — — — — — — — — — — — — — — — — — — — — — — — c Other diseases of larynx — — — — — — — — — — — — — — — — — — — — — — — — 88 Diseases of the Thyroid Body 2 — — — — — — 2 — — — — — — 1 — — — 1 — — 2 — 89 & (A.B.) Bronchitis a Bronchiectasis, Bronchial Catarrh, &c. — — — — — — — — — — — — — — — — — — — — — — — — 90 b Other bronchitis 137 16 2 1 1 — 4 22 91 6 6 — 8 14 15 17 21 18 30 2 68 69 37 25 91 Broncho-pneumonia 60 25 10 10 3 — — 7 5 3 — 1 2 8 5 5 15 7 14 — 33 27 9 29 92 a Lobar pneumonia 28 2 — 3 1 1 6 5 10 2 2 1 — 3 3 1 7 3 6 10 12 3 4 92 Pneumonia (type not stated) 39 4 2 1 4| 3 8 6 11 1 2 — 2 8 6 5 7 3 5 — 20 19 6 13 Causes of, and Ages at, Death during the year 1913. — continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 93 (A.B.) Pleurisy a Empyema 2 1 1 — - - — — - — - — — 1 - — — — 1 — 1 1 - 2 b Other pleurisy 4 - - — — — - 2 2 — - — — — - — 2 1 — — 2 2 - — 94 (A.B.C.D.) Pulmonary Congestion, Pulmonary Apoplexy a Pulmonary apoplexy and infarction 2 — — — — 1 — — 1 — — - — 1 — — 1 — — — 1 1 - — b Pulmonary œdema and congestion 7 1 — — — — 1 — 5 1 — — 1 1 — — 2 — 2 — 2 5 - — c Hypostatic pneumonia 1 - - - - - - - 1 - - - - - - - 1 - - - - 1 - — d Collapse of lung, 3 months and over — - - - - - - - - - - - - - - - - - - - - - - — 95 Gangrene of the Lung 1 — — — — 1 — — — — — — — — — 1 — - — — - 1 - — 96 Asthma 5 - — — — — 1 1 3 — — — — — — 1 2 — 2 — 2 3 - — 97 Pulmonary Emphysema 1 - — — — — — — 1 — — — — — - — — 1 — — 1 - - — 98 (A) Fibroid disease of Lung 4 - — — — — 1 2 1 — — — — — 1 — 1 — 2 — 2 2 - — 98 (B) Other diseases of the Respiratory System 1 - - - - - - 1 - - - - - - - - - 1 - - 1 - - 1 V.—Diseases of the Digestive System. 99 (A) Diseases of the Teeth and Gums - - - - - - - - - - - - - - - - - - - - - - - - 99 (B.C.D.) Other diseases of the Mouth and Annexa b Thrush, Aphthous stomatitis - - - - - - - - - - - - - - - - - - - - - - - — c Parotitis — — — — — — — — - — — — — — — — — - - — - - - — d Other diseases included under 99 1 - - - - - - - 1 - - - - - - - - - 1 - - 1 - - 100 (A.B.C.) Diseases of Pharynx, Tonsillitis - - - - - - - - - - - - - - - - - - - - - - - - a Tonsillitis 2 — — — 1 — — — 1 — 1 - - - - - - 1 — — 1 1 — — Ludwig's Angina - - - - - - - - - - - - - - - - - - - - - - - - c Other diseases of the pharynx - - - - - - - - - - - - - - - - - - - - - - - - 101 Diseases of æsophagus - — — — — — — 1 — - — — — — — — — 1 - — — 1 — — 102 Perforating Ulcer of Stomach 9 — — — — 2 2 4 1 1 — 1 — — — 1 4 2 — — 3 6 3 1 103 (A) Inflammation of Stomach 2 1 — — — — — — 1 - — — — - — — — 1 - — 1 1 — 1 103 (B) Other Diseases of the Stomach 5 1 — - - 2 2 - - — 1 — — 1 — — 1 2 — 2 3 2 — 41 42 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 191 20 21 22 23 24 104 & (A.B.C.D.E.F.G.H.) Diarrhæa and Enteritis a Infective enteritis 26 19 3 2 1 — — 1 — 1 1 — — 2 6 3 4 3 6 — 12 14 17 2 105 b Diarrhæa, not returned as infective 9 6 1 — — — — — 2 1 — 3 — — 1 2 1 — 1 — 4 5 — 6 c Enteritis, not returned as infective 8 7 1 — — — — — — — — 1 1 — 2 — 1 3 — — 5 3 — 12 d Gastro-enteritis, not returned as infective 19 9 3 2 1 — — 2 2 — 3 — 1 4 2 1 6 1 1 — 10 9 4 18 e Dyspepsia, under 2 years — — — — — — — — — — — — — — — — — — — — — — — 3 f Colic 2 2 — — — — — — — — — — — — — 2 — — — — — 2 — — g Ulceration of intestines 2 — — — — — 2 — — — — — — — — — 1 — 1 — 1 1 — — h Duodenal ulcer 1 — — — — — — — 1 — — — — — 1 — — — — — 1 — — — 106 Ankylostomiasis — — — — — — — — — — — — — — — — — — — — — — — — 107 Olher Intestinal Parasites — — — — — — — — — — — — — — — — — — — — — — — — 108 Appendicitis 13 — — 1 4 3 1 3 1 1 — — 1 — 1 4 3 1 2 — 5 8 3 3 109 (A) Hernia 10 — — — 1 1 3 3 2 1 — — 1 1 1 — 2 1 3 — 5 5 3 — 109 (13) Intestinal Obstruction 11 2 — — — — 1 5 3 1 — 1 — — 2 1 3 2 1 — 5 6 2 — 110 Other Diseases of the Intestines 3 — — — — 1 — 1 1 — — — — — — 1 — 1 1 — — 3 3 — 111 Acutc Yellow Atrophy of Liver — — — — — — — — — — — — — — — — — — — — — — — — 112 Hydatid of Liver — — — — — — — — — — — — — — — — — — — — — — — — 113 (A.B.C.) Cirrhosis of the Liver a Cirrhosis of the liver, not returned as alcoholic 24 — — — — — 3 15 6 3 2 — — 2 2 1 3 2 9 — 13 11 7 1 b Cirrhosis of the liver, returned as alcoholic — — — — — — — — — — — — — — — — — — — — — — — — c Diseases formerly classed to "Other diseases of liver and gall bladder" — — — — — — — — — — — — — — — — — — — — — — — — 114 Biliary Calculi 3 — — — — — — 1 2 — 1 — — — — 2 — — — 1 2 — — 115 Other diseases of the Liver 2 — — — — — — 1 1 — — — — — — — — 2 — — 1 1 — — 116 (A.B.) Diseases of the Spleen a Infarcation of spleen — — — — — — — — — — — — — — — — — — — — — — — — b Other diseases of the spleen 1 — — — — — — — — — — — — — — — — 1 — — — 1 — — 117 Peritonitis, cause unstated 3 — — — — 1 2 — — — — — — — 1 — 1 1 — — 2 1 2 1 43 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 118 (A.IJ.) Other Diseases of the Digestive System a Abdominal abscess, Sub-phrenic abscess — — — — — — — — — — — — — — — — — — — — — — — — b Other diseases included under 118 1 — — — — — — — 1 — — 1 — — — — — — — — — — — — VI.- NON-VENEREAL DISEASES OF THE GENITO-URINARY SYSTEM AND ANNEXA. 110 Acute Nephritis 8 1 — — — — — 1 — — — — — — — 2 — — 1 — 1 2 — — 1-20 (A.B.) Bright's Disease a Bright's disease as in 1901 list 45 — — — — — 8 16 21 4 1 2 — 5 2 1 9 10 11 — 21 24 7 4 b Nephritis (unqualified), 10 years and over, and Uræmia. 5 — — — — — — 5 — — — — — — — 1 2 1 1 — 3 2 1 — 121 Chyluria — — — — — — — — — — — — — — — — — — — — — — — — 122 (A.B.C.D.) Other Diseases of the Kidney and Annexa a Abscess of kidney — — — — — — — — — — — — — — — — — — — — — — — — b Cystic disease — — — — — — — — — — — — — — — — — — — — — — — — c Suppression of urine — — — — — — — — — — — — — — — — — — — — — — — — d Other diseases included under 122 — — — — — — — — — — — — — — — — — — — — — — — — 123 Calculi of the Urinary Passages — — — — — — — — — — — — — — — — — — — — — — — — 124 Diseases of the Bladdei 5 — — — — 1 — 1 3 — 1 — — — 1 — 1 2 — — 5 — 1 — 125 (A.B.) Diseases of the Urethra, Urinary abscess, &c. a Perineal abscess... — — — — — — — — — — — — — — — — — — — — — — — b Other diseases of urethra, &c. 1 — — — — — — — — — — — — — — — — — — — — — — — 126 Diseases of the Prostate 6 — — — 1 5 — — — 1 — — — 3 2 — — 6 — — — 127 Non-venereal Diseases of Male Genital Organs — — — — — — — — — — — — — — — — — — — — — — — — 128 (A.B.) Uterine Haemorrhage—Non-Puerperal a Menorrhagia — — — — — — — — — — — — — — — — — — — — — — — — b Other uterine hæmorrhage — — — — — — — — — — — — — — — — — — — — — — — — 44 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 129 Uterine Tumour, non-cancerous 2 — — — — — 1 1 — — — — — — — — — — 2 — — 2 — 1 130 (A.B.) Other Diseases of the Uterus a Disorders of menstruation, except menorrhagia — — — — — — — — — — — — — — — — — — — — — — — — b Other diseases included under 130 1 — — — — — — 1 — — 1 — — — — — — — — — — 1 — — 131 Ovarian Cyst, Tumour—non-cancerous 2 — — — — — — — 1 — 1 — — — 1 — — — — — — 2 — — 132 (A.B.) Other Diseases of the Female Genital Organs a Diseases of ovary, excluding ovarian tumour — — — — — — — — — — — — — — — — — — — — — — — — b Other diseases included under 132 1 — — — — — 1 — — — — — — — 1 — — — — — 1 1 — 133 Non-puerperal Diseases of the Breast (non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — VII.—The Puerperal State. 134 (A.B.C.D.E.) Accidents of Pregnancy a Abortion 1 — — — — — 1 — — — 1 — — — — — — — — — — 1 — — b Hæmorrhage of pregnancy — — — — — — — — — — — — — — — — — — — — — — — — c Uncontrollable vomiting 1 — — — — — 1 — — — — — — — — — — — 1 — — 1 — — d Ectopic gestation — — — —— — — — — — — — — — — — — — — — — — — — — e Other accidents of pregnancy 2 — — — — — 2 — — — — — — — — — 2 — — — 2 1 — 135 Puerperal Hæmorrhage 1 — — — — — 1 — — — — — — — 1 — — — — — — 1 — — 136 Other Accidents of Childbirth — — — — — — — — — — — — — — — — — — — — — — — — 137 Puerperal Fever 3 — — — — 3 — — — — 1 — 1 — — — 1 — — — — 3 — — 138 (A.B.C.) Puerperal Albuminuria and Convulsions a Puerperal nephritis and uræmia — — — — — — — — — — — — — — — — — — — — — — — — b Puerperal albuminuria and Blight's disease — — — — — — — — — — — — — — — — — — — — — — — — c Puerperal convulsions 1 — — — — — 1 — — — — — — — — — 1 — — — — 1 1 — 45 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 139 (A.B.) Puerperal Phlegmasia Alba Dolens, Embolism, and Sudden Death a Puerperal phlegmasia, alba dolens and phlebitis — — — — — — — — — — — — — — — — — — — — — — — — b Puerperal embolism and sudden death — — — — — — — — — — — — — — — — — — — — — — — — 140 Puerperal Insanity — — — — — — — — — — — — — — — — — — — — — — — — 141 Puerperal Diseases of the Breast — — — — — — — — — — — — — — — — — — — — — — — VIII.—Diseases of the Skin and of tHe Cellular Tissue. 142 (A) Senile Gangrene 2 — — — — — — — 2 — _ 1 — 1 — — — — 2 — 1 142 (B.C.D.) Gangrene, other types b Noma gangrene of mouth — — — — — — — — — — — — — — — — — — — — — — — — c Noma pudendi — — — — — — — — — — — — — — — — — — — — — — — — d Other gangrene — — — — — _ — — — — — — — — — — — — — — 143 Carbuncle, Boil — — — — — — — — — — — — — — — — — — — — — — — — 144 (A.B.) Phlegmon, Acute Abscess a Phlegmon 2 1 — — — — — 1 — — — — — — — — 2 — — — — 2 1 1 b Acute abscess 1 1 — _ — — — — — — — 1 — — — 1 — 1 — 145 (A.B.C.D.) Diseases of the Integumentary System a Ulcer, Bedsore b Eczema — — — — — — — — — — — — — — — — — — c Pemphigus — — — — — — — — — _ — — — — — — — — — — — d Other diseases of integumentary system 1 — — — — — — — 1 — — — 1 — — — — 1 — — — IX.—Diseases of the Bones and of the Organs of Locomotion. 14G Diseases of the Bones 8 1 1 1 — — — 1 — — 1 — — 1 — 1 2 2 — 147 Diseases of the Joints 1 — — — 1 _ — — — — 1 — — — 1 — — — 148 Amputations — — — — — — — — — — — — — — — — — — — — — — — — 149 Other Diseases of Locomotor System 1 — — — — — — — 1 — — — — — — — — 1 — — 1 — — 1 46 Causes of, and Ages at, Death during the year 1913.—continued. . Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 X.—Malformations. 150 (A.B.C.D.) Congenital Malformations a Congenital hydrocephalus — — — — — — — — — — — — — — — — — — — — — — — 1 b Phimosis — — — — — — — — — — — — — — — — — — — — — — — — c Congenital malformation of heart 7 7 — — — — — — — 2 — — — 1 2 1 1 — — — 5 2 1 2 d Other congenital malformations 7 6 — — 1 — — — — — 1 — — 1 1 — 2 1 1 — 4 3 2 — XI.—Diseases of Early Infancy. 151 (A) Premature Birth 40 40 — — — — — — — 3 1 — 1 3 2 5 12 4 9 21 19 2 1 151 (B.C.D.E.) Infantile Debility, Icterus, and Sclerema b Infantile atrophy, debility, and marasmus 51 51 — — — — — — — 1 5 1 1 4 6 5 11 6 11 — 28 23 16 23 c Icterus neonatorum 3 3 — _ — — _ 1 — 1 1 — — 2 1 — d Sclerema and oedema neonatorum — — — — — — — — — — — — — — — — — — — — — — — — e Want of breast milk — — — — — — — — — — — — — — — — — — — — — — — — 152 (A.B.C.D.) Other Diseases peculiar to Early Infancy a Diseases of umbilicus, &c. 1 1 — _ — 1 1 — — — b Atelectasis 2 2 — 1 1 1 1 — c Injuries at birth 3 3 — — — — — — — — 1 2 2 1 — d Cyanosis neonatorum — — — — — — — — — — — — — — — — — — — — — — — — 153 Lack of Care 1 1 — — — — — — — — — — — — — — — — — 1 1 — — — XII.—Old Age. 154 (A.B.) Old Age a Senile dementia 6 — — — — — — — 6 — 1 — — — — 2 — 1 2 — — 6 2 — b Senile decay 160 — — — — — 160 6 14 7 6 13 15 17 27 24 31 — 56 104 66 20 47 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 XIII.—Affections Produced by Externai. Causes. 155 Suicide by Poison 3 2 1 1 1 1 2 1 3 1 156 Suicide by Asphyxia 3 — — — — — 2 — 1 1 — — — — — 1 — 1 — 1 2 — — 157 Suicide by Hanging or Strangulation 1 — — — — — — 1 — — — — — — — — — — 1 — 1 — — — 158 Suicide by Drowning 2 — — — — — 1 1 — 1 — — — 1 — — — — — — 1 1 — 159 Suicide by Firearms 3 — — — — — 1 2 — — — — — — 2 — — 1 —- — 3 — — — 160 Suicide by cutting and piercing instruments 4 — — — — 1 — 3 — — — — — 1 1 — 1 1 — — 3 1 1 — 161 Suicide from jumping from high place 1 — — — — — 1 — — — — — — — — — — — 1 — 1 — — — 162 Suicide by Crushing — — — — — — — — — — — — — — — — — — — — — — — — 168 Other Suicides — — — — — — — — — — — — — — — — — — — — — — — — 164 Poisoning by Food — — — — — — — — — — — — — — — — — — — — — — — — 105 Other Acute Poisonings 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — 161 Conflagration — — — — — — — — — — — — — — — — — — — — — — — — 167 Burns, Conflagration excepted 5 2 — 2 — — — 1 — — 1 1 — — — — 1 1 1 — 3 2 3 — 168 Absorption of Deleterious Gases, Conflagration excepted 8 7 — — 1 — — — — 1 — — — — 1 — 4 1 1 — 6 2 — — 169 Accidental Drowning 5 — — — — — 4 1 — — — — — 1 — 1 2 — 1 — 5 — — — 170 Injury by Firearms 1 — — — — 1 — — — — — 1 — — — — — — — — 1 — 1 — 171 Injury by cutting or piercing instruments — — — — — — — — — — — — — — — — — — — — — — — — 17 a Injury by Fall 15 1 1 — 1 2 2 1 7 — 2 — — 1 1 3 4 1 3 — 10 5 6 1 173 Injury in mines and quarries — — — — — — — — — — — — — — — — — — — — — — — — 174 Injury by Machines — — — — — — — — — — — — — — — — — — — — — — — — 175 Injury by other Crushing—vehicles, railways, landslides, &c. 20 — — 1 3 2 7 6 1 — 1 1 — 4 2 — 5 4 3 14 6 5 1 176 Injury by Animals — — — — — — — — — — — — — — — — — — — — — — — — 177 Starvation 1 — — — — — — — 1 — — — — — — — — — 1 — — 1 — — 178 Excessive — — — — — — — — — — — — — — — — — — — — — — — — 179 Effects of heat — — — — — — — — — — — — — — — — — — — — — — — 180 Lightning — — — — — — — — — — — — — — — — — — — — — — — — 181 Electricity, lighting excepted — — — — — — — — — — — — — — — — — — — — — — — — 48 Causes of, and Ages at, Death during the year 1913.—continued. Col. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 182 Homicide by Firearms — — — — — — — — — — — — — — — — — — — — — — — — 183 Homicide by cutting and piercing instruments 1 — — — — 1 — — — — — — — — — — — 1 — — — 1 — — 184 Homicide by other means — — — — — — — — — — — — — — — — — — — — — — — 1 185 Fractures, cause not specified 2 — — — — — — 1 l — — — — — — — — 1 1 — 1 1 1 — 186 Other violence 6 3 — — 1 1 1 — — — — — — — — 1 — 3 '2 — 4 2 3 1 XIV.—Ill-Defined Causes. 187 Dropsy — — — — — — — — — — — — — — — — — — — — — — — — 188 (A) Syncope, aged 1 year and under 70 — — — — — — — — — — — — — — — — — — — — — — — — 188 (B) Sudden Death, not otherwise defined — — — — — — — — — — — — — — — — — — — — — — — — 139 (A) Heart Failure, aged 1 year and under 70 5 — — — — — 1 2 2 — 1 — — — 1 — — — 3 — 3 2 4 — 189 (B.C.D.E.) Other Ill-defined Causes b Atrophy, debility, marasmus (aged 1 year and under 70) 4 — 4 — — — — — — — — — — — — — 2 2 — — 4 — 2 9 c Teething — — — — — — — — — — — — — — — — — — — — — — — — d Pyrexia — — — — — — — — — — — — — — — — — — — — — — — — e Other ill-defined deaths 1 — — — — — 1 — — — — — — — — — — — 1 — 1 — — — 189 (F) Cause not specified 1 — — — — — — — 1 — — — — — — — — — 1 — 1 — — Total 1841 269 66 70 75 78 226 418 639 77 96 58 60 178 176 178 385 277 347 9 899 942 126 295 49 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 1913. Births. Deaths. Birth Rate. Death Rate. Deaths of Infants under 1 year of age. Number. Rate per 1000 Births. County of London 4518191 112637 65030 24.5 14.2 11869 105 West. Paddington 142210 3055 1941 21.1 13.4 305 100 Kensington 171284 3357 2377 19.3 13.6 375 112 Hammersmith 123745 3043 1754 24.2 13.8 314 103 Fulham 157117 4302 1992 26.9 12.9 414 96 Chelsea 64598 1257 911 19.1 13.2 113 90 City of Westminster 154810 2227 1992 14.2 13.3 213 96 North. St. Marylebone 114532 2221 1633 19.1 14.3 202 91 Hampstend 86346 1326 938 15.1 11.3 97 73 St. Pancras 214330 5512 3321 25.3 15.2 508 92 Islington 325585 8357 5009 25.3 14.8 894 107 Stoke Newington 50518 1144 698 22.3 12.9 94 82 Hackney 223353 5522 3037 24.3 13.5 549 99 Central. Holborn 46949 798 698 16.7 14.7 83 104 Finsbury 84679 2547 1576 29.6 18.1 352 138 City of London 17916 167 276 9.2 15.8 16 96 East. Shoreditch 109654 3513 2068 31.5 19.2 546 155 Bethnal Green 127824 3998 2006 30.8 16.1 470 118 Stepney 275300 8187 4172 29.3 15.6 916 112 Poplar 160913 5230 2668 32.0 16.1 586 112 South. Southwark 188487 5936 3343 31.0 17.6 682 115 Bermondsey 124739 3896 2266 30.7 17.8 513 132 Lambeth 297139 7233 4314 23.9 14.0 736 102 Battersea 167464 4239 2361 24.9 14.0 469 111 Wandsworth 330395 6840 3550 20.4 10.6 603 88 Camberwell 261805 6671 3653 25.1 13.6 708 106 Deptford 109280 3103 1704 27.9 15.2 347 112 Greenwich 96015 2541 1385 26.0 14.0 262 103 Lewisham 168822 3502 1841 20.3 10.4 269 76 Woolwich 122382 2893 1573 23.3 13.0 229 79 Note.—The figures in this table are extracted from the Registrar General's Annual Summary. The death-rates appearing herein are standardised in order to make correction for differences of age and sex constitution of the several populations in 1911 as compared with that of England and Wales in 1901. 50 Table showing Deaths and Death Rates from the Principal Infectious Diseases in the Metropolitan Boroughs and the County of London. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Pulmonary Tuberculosis. Diarrhoea & Enteritis (under 2). Boroughs. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate. Number. Rate per | 1000 births County of L'nd'n 114 0.02 — — 1570 0.34 188 0.04 800 0.17 431 0.09 5981 1.30 3098 27.50 West. Paddington 6 0.04 _ 55 0.38 7 0.05 37 0.26 12 0.08 157 1.09 71 23.24 Kensington 4 0.02 84 0.48 3 0.02 29 0.17 6 0.03 188 1.08 80 23.83 Hammersmith — — — 47 0.37 7 0.06 47 0.37 12 0.10 151 1.20 64 21.03 Fulham 8 0.05 50 0.31 3 0.02 27 0.17 14 0.09 209 1.31 98 22.78 Chelsea 1 0.02 18 0.27 3 0.05 5 0.08 1 0.02 81 1.23 24 19.09 City of Westm'er 3 0.02 — 22 0.14 7 0.04 7 0.04 8 0.05 206 1.31 52 23.35 North. St. Marylebone 5 0.04 33 0.28 10 0.09 10 0.09 6 0.05 158 1.36 37 16.66 Hampstead 1 0.01 21 0.24 4 0.05 11 0.13 3 0.03 50 0.57 18 13.57 St. Pancras 6 0.03 _ 41 0.19 6 0.03 31 0.14 16 0.07 327 1.50 114 20.68 Islington 5 0.02 — 107 0.32 17 0.05 61 0.18 34 0.10 441 1.33 221 26.44 Stoke Newington 2 0.04 — — 11 0.21 1 0.02 6 0.12 6 0.12 48 0.93 16 13.99 Hackney 4 0.02 — — 68 0.30 11 0.05 23 0.10 11 0.05 261 1.15 141 25.53 Central. Holborn _ — 10 0.21 6 0.13 4 0.08 89 1.87 15 18.80 Finsbury 30 0.35 4 0.05 31 0.36 9 0.10 173 2.01 97 38.08 City of London 2 0.11 — — - - 1 0.05 2 0.11 1 0.05 27 1.48 2 11.98 East. Shoreditch 1 0.01 - 52 0.47 3 0.03 29 0.26 14 0.13 200 1.79 207 58.92 Bethnal Green 4 0.03 ' 62 0.48 3 0.02 34 0.26 10 0.08 201 1.55 151 37.77 Stepney 11 0.04 — — 95 0.34 8 0.03 26 0.09 22 0.08 471 1.68 287 35.00 Poplar 5 0.03 — — 69 0.42 12 0.07 38 0.23 34 0.21 239 1.46 159 30.40 South. South wark 6 0.03 — — 105 0.55 11 0.06 38 0.20 19 0.10 354 1.85 182 30.66 Bermondsey 3 0.02 — — 90 0.71 4 0.03 47 0.37 17 0.13 204 1.61 165 42.35 Lambeth 8 0.03 — — 99 0.33 14 0.05 47 0.16 37 0.12 389 1.29 202 27.93 Battersea 6 0.04 - 93 0.55 7 0.04 28 0.16 20 0.12 192 1.13 125 29.49 Wandsworth 5 0.01 — — 116 0.35 11 0.03 23 0.07 16 0.05 288 0.86 148 21.64 Camberwell 5 0.02 — — 68 0.26 13 0.05 54 0.20 18 0.07 306 1.15 179 26.83 Deptford 2 0.02 — — 50 0.45 3 0.03 46 0.41 17 0.15 144 1.30 93 29.97 Greenwich 2 0.02 — — 40 0.41 2 0.02 24 0.25 12 0.12 114 1.17 52 20.46 Lewisham 8 0.04 — — 25 0.14 5 0.02 22 0.13 35 0.20 126 0.73 51 14.56 Woolwich 1 0.01 - - 9 0.07 8 0.06 10 0.08 17 0.14 186 1.50 48 16.59 INFECTIOUS DISEASES. The following figures show the percentage of cases occurring among children of the age of six years and under to the total notifications of Scarlet Fever and Diphtheria:— Scarlet Fever. Diphtheria. Age. 1911. 1912. 1913. 1911. 1912. 1913. 6 years and under 41.24% 51.19% 41.71% 49.84% 46.54% 47.52% 5 ,, ,, 30.56% 39.43% 32.10% 35.56% 34.84% 36.38% 4 ,, ,, 20.47% 27.01% 20.26% 24.92% 23.86% , 22.03% 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, Enter'c, Relapsing, Continued or Puerperal; Cerebro-Spinal Meningitis, Ophthalmia Neonatorum, and Acute Polio-Myelitis or PolioEnceplialilis. The total number of cases notified during the year 1913 amounted to 1248, of which number 975, or 78.12 per cent, were removed for isolation to the Metropolitan Asylums Board's Hospitals or other Institutions. In 33 instances, or 3.38 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 1215 cases of infectious disease notified as occurring in the Borough during the year, an increase of 196 compared with the total for the preceding year, which was 1019. In 1911, 835 cases were notified. Age Periods.—41.71 per cent, of the Scarlet Fever cases, compared with 51.19 per cent, in 1912, and 47.52 per cent, of the Diphtheria cases, compared with 46.54 per cent, in 1912, occurred among children acred six years and under. 53 54 Age Periods of Scarlet Fever and Diphtheria, notified during the year 1913. Scarlet Fever. Diphtheria. Age Periods Number, of Cases. Percentage to Total Cases Number of Cases. Percentage to Total Cases. Under 1 year 2 0.29 6 1.48 1 to 2 years 13 1.92 8 1.98 2 „ 3 „ 31 4.58 25 6.18 3 „ 4 „ 35 5.17 29 7.17 4 „ 5 „ 58 8.58 37 9.16 5 „ 10 „ 307 45.41 169 41.83 10 „ 15 „ 140 20.71 66 16.33 15 „ 25 „ 61 9.02 29 7.18 25 years and over 29 4.17 35 8.60 At all ages 676 100.00 404 100.00 Attack Rates represent the number of cases occurring to every 1,000 persons living at all ages. The attack rate from all infectious diseases (excluding Puerperal Fever) during the year amounted to 7.02 per 1,000 of the population, compared with 6.13 in 1912, and 5.11 in 1911. The attack rate for the County of London was 6.96, compared with 5.24 in 1912. The attack rates for the Wards will be found on page 56. It will be seen that Forest Hill Ward had the largest number of cases in proportion to its population, having an attack rate of 9.21 per 1,000. The lowest attack rate was in Church Ward, 2.99 per 1,000. Number of Cases of Infectious Diseases notified in the Ten Wards and the Whole Borough during the Year 1913. Wards Scarlet Fever Diphtheria. Enteric Fever Erysipelas. Puerperal Fever. Ophthalmia Neonatorum. Polio-Myelitis or polio-Encephalitis Total. 1 Church 9 8 — — l — — 18 2 Manor 34 18 l 7 — 2 1 63 3 South 16 9 l 1 — — — 27 Lee Division 59 35 2 8 l 2 1 108 4 Blackheath 3 15 1 1 l 1 — 22 5 Lewisham Village 33 17 — 12 — 1 — 63 6 Lewisham Park 94 40 7 15 — 1 — 157 7 Brockley 95 31 1 8 — 1 — 136 8 Catford 187 99 18 10 — 2 2 318 Blackheath & Lewisham Division 412 202 27 46 l 6 2 696 9 Forest Hill 101 96 3 11 — 1 212 10 Sydenham 104 71 — 19 l 3 1 199 Sydenham & Forest Hill Division 205 167 3 30 l 3 2 411 Whole Borough 676 404 32 84 3 11 5 1215 55 SCARLET FEVER.—The total number of cases notified during the year amounted to 682, compared with 466 in 1912. Of this number, 566, or 83.0 per cent., were removed to the Metropolitan Asylums Board's Hospitals. Subsequently 6 cases were returned to their homes and stated not to be suffering from any notifiable disease. Deducting this number, a corrected total of 676 is obtained, compared with 459 in 1912, equal to an attack rate of 3.92 per 1,000 persons, compared with 2.78 in 1912. The attack rate for the County of London was 3.89 per 1,000. An examination of the attack rates for the various Wards of the Borough shows that the highest occurred in Brockley Ward (5.82 per 1,000) and that the Ward least affected was Blackheath, with 0.44 per 1,000. 45.41 per cent, of the cases occurred among children between the ages of 5 and 10 years, and 20.26 per cent, among children under the age of five. Case Mortality.—Five deaths from Scarlet Fever occurred to residents in the Borough, equal to 0.74 per cent, of the cases notified, compared with 1.30 in the previous year. DIPHTHERIA.—Four hundred and twenty-nine cases of Diphtheria were notified, compared with 434 in 1912, and of this number 360, or 83.91 per cent., were removed to hospital. Twenty-five patients (or 6.94 per cent, of the number removed) were returned as not suffering, giving a corrected total of 404, a decrease of 15 on the number notified in 1912. The attack rate per 1,000 of the population amounted to 2.34, compared with 2.54 in 1912. The rate for the County of London was 1.70 per 1,000. Forest Hill Ward suffered most from this disease, in proportion to its population, having an attack rate of 4.38 56 CHART B. Showing Weekly Notifications of all Infectious Diseases and of Scarlet Fever and Diphtheria. during year 1913. 57 per 1,000. South Ward was least affected, having an attack rate of 0.89 per 1,000. Case Mortality.—Thirty.five deaths occurred from this disease, equal to 8.66 per cent. of the cases notified, compared with 6.20 per cent, in 1912. ENTERIC or TYPHOID FEVER..Thirty .four cases were notified, 29 of which were removed to Hospital. Two cases were returned home as not suffering, giving a corrected total of 32, an increase of 7 on the previous year. The attack rate for the whole Borough was 0.17 per 1,000, compared with 0.15 in 1912. The case mortality equalled 25 per cent., against 32 per cent. in 1912. ERYSIPELAS.—84 cases of Erysipelas were notified, compared with 102 in the preceding year. Sixteen cases were removed to the Lewisham Infirmary and other Institutions for treatment. Five of the cases proved fatal. PUERPERAL FEYER.—Three cases of Puerperal fever were notified. OPHTHALMIA NEONATORUM.—Eleven cases of Ophthalmia Neonatorum occurred during the year, compared with five for the previous year. One of the cases was removed to hospital for treatment. POLIO.MYELITIS or POLIO.ENCEPHALITIS.—Five cases of this disease occurred during the year, compared with two for the year 1912. 58 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 1910.1913. Wards. Diseases Scarlet Fever Diphtheria Enteric Fever Erysipelas Total All Diseases. 1910 1911 1912 1913 1910 1911 1912 1913 1910 1911 1912 1913 1910 1911 1912 1913 1910 1911 1912 1913 Church 4.01 1.34 4.06 1.50 0.69 1.85 1.86 1.33 — 0.16 0.17 — 0.27 0.33 0.17 — 4.98 3.70 6.27 2.99 Manor 4.12 2.73 2.19 3.98 0.64 11 2.19 2.10 0.25 0.12 — 0.11 0.90 0.87 0.36 0.81 5.93 5.83 4.75 7.38 South 2.80 1.42 1.55 2.39 0.17 1.10 2.48 0.89 0.52 — — 0.14 — 0.31 0.46 0.14 3.51 2.84 4.51 4.03 Blackheath 2.30 1.53 4.28 0.44 1.29 1.22 1.99 2.24 0.14 — — 0.14 0.43 0.76 0.31 0.14 4.18 3.82 6.58 3.29 Lewisham Village 1.74 1.02 2.16 2.15 0.64 1.70 1.89 1.10 0.12 0.13 — — 0.38 0.88 0.94 0.78 2.88 4. 01 4.99 4.12 Lewisham Park 4.48 2.43 2.69 3.09 1.16 3.21 3.09 2.16 0.14 0.11 0.11 0.37 0.58 0.89 1.09 0.80 6.38 6. 82 7.05 8.50 Brockley 2.79 3.05 3.87 5.82 1.07 0.99 1.54 1.90 — — 0.12 0.06 0.16 0.33 0.51 0.49 4 .03 4.44 6.13 8.33 Catford 2.54 2.26 2.87 4.27 1.17 1. 98 3.90 2.04 0.22 0.38 0.29 0.41 0.28 0.41 0.51 0.22 4.22 5.14 7.63 7.28 Forest Hill 2.54 1.34 1.94 4.60 1.18 2.16 1.56 4.38 0.05 0.19 0.19 0.13 0.43 0.86 0.66 0.50 4.22 4.66 4.40 9.21 Sydenham 4.83 2.50 2.90 3.60 2.43 2.50 2.22 2.46 0.19 0.36 0.14 — 0.35 0.72 0.61 0.65 7.80 6.23 5.95 6.90 Whole Borough 3.29 2.09 2.76 3.92 1.27 2.04 2.54 2.34 0.16 0.22 0.15 0.17 0.37 0.64 0.62 0.48 5.12 5.11 6.13 7.02 59 NOTIFICATION OF TUBERCULOSIS. During the year, notifications were received relating to 440 cases of Tuberculosis, in accordance with the Public Health (Tuberculosis) Regulations, 1912. The disease was of the pulmonary type in 317 cases, and in the remaining 123 cases, other organs of the body were affected. The ages of the patients, and the Wards in which they were residing at the time of notification, are classified in the following tables:— Ages of Persons Notified. Pulmonary cases. Non.pulmonary cases. Under 1 year 1 3 1 year and under 2 2 3 2 years „ 5 1 17 5 „ „ 10 16 25 10 „ „ 15 16 27 15 „ „ 25 70 27 25 „ „ 35 87 8 35 „ „ 45 50 7 45 „ „ 65 69 6 65 years and over 5 — Total 317 123 Residence of Persons notified, summarised in Wards. Ward. Pulmonary cases. Non-pulmonary cases. Church 14 2 Manor 15 7 South 7 3 Blackheath 9 6 Lewisham Village 43 10 Lewisham Park 40 15 Brockley 30 12 Catford 81 34 Forest Hill 34 11 Sydenham 40 23 Precise residence unknown 4 — 317 123 60 The following is a short resume of the action taken by the Public Health Department on receipt of Notification of all forms of Tuberculosis. As a preliminary it may be useful to outline the progressive steps in Notification since 1906. Voluntary Notification.—A system of voluntary notification of Pulmonary Tuberculosis was adopted by this Council in May, 1906, and continued in operation until February, 1912. Local Government Board Regulations ior partial notification.—In January, 1909, the Public Health (Tuberculosis) Regulations, 1908, came into force, and provided for notification by the Medical Officers of Poor Law. Institutions and District Medical Officers of the Poor Law. On May 1st, 1911, the Public Health (Tuberculosis in Hospitals) Regulations, 1911, were brought into operation, and required notification by the Medical Officers of all Hospitals, and this was followed by the Public Health (Tuberculosis) Regulations, 1911, which placed upon medical practitioners and School Medical Inspectors the duty of notification. Up to this time only pulmonary forms of tuberculosis were notifiable, but in December, 1912, the Public Health (Tuberculosis) Regulations, 1912, were issued, and superseded all the previous Regulations which were in force. These Regulations provide for the notification of Pulmonary and all other forms of Tuberculosis by medical practitioners in private practice and by Medical Officers of Hospitals, Sanatoria, and Poor Law Institutions. The voluntary system was not altogether a success in this Borough. During the six years in which it was in operation only 221 cases were notified, and in 60 instances we were asked by the medical practitioner notifying not to send our Health Visitor to the patient's home. Under the "Poor Law" Regulations of 1908, 371 notifications were received during the four years 1909.12. The "Hospital" Regulations resulted in 89 cases being notified in each of the two years 1911 and 1912, and 61 a further 216 cases were notified in 1912 under the 1911 Regulations. In 1913, the first year in which the general regulations came into operation, 317 cases of Pulmonary Tuberculosis and 123 cases of Tuberculosis of other organs were notified. Prior to the appointment of Miss Hall as Tuberculosis Health Visitor, the visitation of cases of pulmonary tuberculosis and of homes in which deaths from this disease occurred, was carried out by the Women Sanitary Inspectors, and in the eight years 1906.13 about 2,500 visits were made by these officers. Each case was visited at least once, and advice given to the patient and family as to precautions which should be taken, but owing to the many other duties these Inspectors had to perform, it was not possible for many re.visits to be made after the first visit and enquiry. After the appointment of Miss Hall, for the special work, and consequent upon the fact that all forms of Tuberculosis came within the scope of notification, detailed investigations were carried out at the homes of all notified cases. The following is a summary of the work carried out by Miss Hall from October 23rd to December 31st: — Primary Visits:— To cases of Pulmonary Tuberculosis 93 To cases of other forms of Tuberculosis 15 Secondary Visits (including those made to cases on admission to or discharge from curative institutions, and after death, with reference to disinfection) 110 Number of patients found occupying separate room 52 Number of patients sharing room with one other person 31 two other persons 20 three „ „ 5 Number of patients occupying separate beds 68 Patients sharing bed with one other 33 „ „ ,, two others 7 Total number of contacts to primary cases visited 520 62 Miss Hall reports that in a large number of cases enquiry was made of her as to the probability of being able in the near future to attend a Dispensary in the Borough for the treatment of tuberculosis. Many patients have been recommended by their doctors to seek treatment at some Institution for the special treatment of tuberculosis, but in the majority of cases this is found almost impracticable owing to the expense of travelling and the time taken up by the journey to London. The number of persons in contact with the 108 cases visited amounted to 522, and there is every reason to believe that a large proportion of these persons would willingly attend a Dispensary for the purpose of examination, although investigation has shown that they would in very few cases voluntarily consult a medical practitioner owing to the expense incurred. Miss Hall has frequently been asked if such a course were possible at any free institution in the Borough at the present time, as many people appear to realise the importance of members of the family other than the patient, being watched. There have been several cases notified during the past few months, other members of whose family have been visited by the Health Department staff during the past year or two for tuberculosis. In the majority of cases it is quite impossible for the patient to be sufficiently isolated as not to jeopardise the health of other inmates of the house. From the figures given above it will be seen that of the 108 cases visited only 52 were in a position to occupy a separate bedroom, and in 40 cases the patient had to share a bed with other persons. Realising the importance to themselves and others of isolation and fresh air, we have been asked by some patients if it were possible to obtain the loan of a temporary shelter. In the majority of cases there is ample room for such an erection in the rear of the dwelling. Owing to the time occupied in making the primary investigation into each case, it has not been possible to re-visit as often as is desirable to keep in touch with the patients, and so ensure the continued observance of the necessary preventive measures and the immediate disinfection, before re-occupation, of the rooms vacated by a patient. It will be necessary in the near future to consider the appointment of another health visitor for this special 63 work. This was contemplated in the scheme previously presented to the Council. . A copy of the pamphlet which is left at the home, and which sets out the chief points of care required to be exercised by the patient, is printed in this Report. This, or a similar pamphlet, has been distributed since 1906. It will be admitted, I think, that we are doing all we can with the machinery at our disposal, but I am strongly of opinion that this is not sufficient, and that little benefit will result unless a complete scheme is formed, available for the whole Borough, for the detection, treatment and prevention of the disease in all its varying manifestations. 64 ADVICE ON THE PREVENTION OF CONSUMPTION. Consumption is not inherited; but, like many other well-known diseases, it is caught either from a person who is suffering from the disease, or through infected milk, and possibly meat. The spread of consumption can be largely prevented. If the succeeding directions be obeyed, there is no need for fear in ordinary intercourse zvith patients. The breath of the consumptive is not directly infectious. Some persons are born with a constitution which strongly favours their catching Consumption, although it is not born with them. Such persons ought to be very careful to avoid exposure to the disease. The most important predisposing causes are the following :—(1) Overcrowded and ill.ventilated bed.rooms and living rooms; (2) keeping the windows closed; (3) living in dark rooms, often made so by unnecessary curtains being put up in front of the windows, or by leaving the windows dirty for a long time ; (4) Intemperance, which renders people easily susceptible to the disease; (5) living in a damp house, which weakens the general health. Good health is the best precaution against the disease, and to maintain good health it is necessary to lead a temperate life and to live in fresh air and in a dry house, with plenty of sunlight. A proper amount of suitable food is also very necessary. It is important to rest both before and after a meal. Consumption is caused by a germ which abounds in the spit of consumptive persons, and in the spray given off in the act of coughing. Every person suffering from Consumption is liable to give the disease to other persons, chielly by means of the spit, but also by the spray given off when coughing. It is very dangerous to allow spit to become dry, for it then may become dust, containing consumptive germs, which get into the air and are carried to other persons. It is also equally dangerous to cough without holding a piece of rag, paper, or the hand before the mouth. (The 65 rag should be burned, the paper burned or put down a water.closet, and the hands washed as soon as possible). Consumptive persons should never spit upon the floor, nor into a handkerchief which has to be put into the pocket, or under a pillow. They should take care that no spit is smeared over their bed.clothes or night.dresses, or on their beards or moustaches. Ordinary handkerchiefs should not be used. Japanese paper handkerchiefs can be purchased very cheaply, and after use should be burned. The germ causing Consumption may also cause disease of other parts of the body, besides the chest, such as the bowels, especially in children, who are often attacked if infected milk is used. All milk should therefore be boiled, by which the germs are killed. When indoors a consumptive person should use a spit cup or jar, containing a little water or water and carbolic acid. When out of doors a pocket spit flask, which can be purchased cheaply, should always be used. Never spit in a tramcar, omnibus, cab, or railway carriage, or on the footpath. Consumptive persons must not swallow their spit, as by so doing the disease may be conveyed to parts of the body not already affected. If a handkerchief or any article of clothing has been soiled with spit, it should be kept wet until it can be boiled and washed. Twice a day the contents of the spit.cup or spit.flask should be emptied down a water.closet or drain, and the bottle or cup should be cleaned with boiling water, with or without a disinfectant. No spoon, cup, or other article which has touched the mouth of a consumptive person should be used by anyone else until it has been carefully washed in boiling water. Food which has been left by a consumptive should not be eaten by another person. No mother who is consumptive should suckle a baby. All persons who are consumptive should have sleeping rooms to themselves. The windows of the sleeping room 66 should either be taken out altogether, or kept open day and night to their full extent. The room chosen should face south if possible, as sunlight and fresh air are important disinfectants. If it is impossible for a consumptive to have a bedroom for his own use, it is absolutely necessary for him to have a bed to himself. Neglect of this precaution often results in several members of a family catching the disease. In cleaning rooms, damp dusters should be used and wet tea leaves or sawdust should be put down before sweeping, so that the dust may be removed without being spread through the air. The dusters should be boiled, and the sawdust or tea leaves burned. After the removal of a consumptive patient from a house, or after a death, it is essential that disinfection should be thoroughly carried out. This disinfection will be done by the Public Health Department free of charge on notice being sent to the Medical Officer of Health. In addition to this disinfection, the floors and wood work should be washed with soft soap and soda, and all articles of clothing thoroughly washed so that infection may not be handed on to other occupants of the house. Disinfecting fluid can be obtained gratis at the various Borough Council Depots, which are situated as follows: — Town Hall Yard, Catford. Molesworth Street, Lewisham. Waldram Road, Forest Hill. Woodstock Road, Lee. Home Park, Sydenham Road. Wells Road, Sydenham (Saturday morning only). N.B.—Any change of Address should be reported at once to the Medical Officer of Health, so that the house can be disinfected. 67 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 956 379 Whooping Cough 333 98 Chicken-Pox 366 124 Mumps 620 5 Ringworm 299 — SCHOOLS. The following is a list of Schools in which classrooms were closed with a view of preventing the spread of infection :— Northbrook School, Lee.—Infants' Department, closed from 12th February to 3rd March.—Measles. Stillness Road School.—Girls' Department, closed on 16th April for 14 days.—Scarlet Fever. Haseltine Road School.—Infants' Department, closed from 29th April to 19th May.—Measles. Bell Green School, Lower Sydenham.— Infants' Department, closed from 29th April to 19th May.—Measles. St. Philip's R.C. School, Lower Sydenham.—Infants' Department, closed from 29th April to 19th May.—Measles. 68 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. Date of exclusion. Disease. Sandhurst Road 25th January Whooping Cough Stillness Road 19th February Measles Gordonbrock 12th March Whooping Cough Haseltine Road 17th April Measles Plassy Road 18th April Measles Holbeach Road 80th April Measles Manor Lane 5th May Measles Hither Green 16th May Measles BACTERIOLOGICAL DIAGNOSES. During the period under review 1,182 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 294, or 24.87 per cent., gave positive results. Disease. No. Negative. No. Positive. No. Doubtful. Totals. Diphtheria 633 206 23 1913 1912 862 796 Tuberculosis 213 78 1 292 212 Enteric Fever 17 10 1 28 26 Total 863 294 25 1182 1034 SANITARY WORK. 71 HOUSING, TOWN PLANNING, &c., ACT, 1909. Summary of Action taken in respect of premises unfit for human habitation :— No. 6 Gordon Terrace, Porthcawe Road. June 10, 1913.—Representation by Medical Officer of Health that premises unfit for human habitation. July 16, 1913.—Closing Order made by Council. Nov. 5, 1913.—Closing Order determined by Council, the owner having executed the work necessary to render the premises habitable. Nos. 2 and 3, Porthcawe Road. April 1, 1913.—Representation by Medical Officer of Health that premises unfit for human habitation. April 23, 1913.—Closing Order made by Council. Jan. 14, 1914.—Demolition Order made by Council. No. 28, Willow Walk, Sydenham. March 4, 1913.—Representation by Medical Officer of Health that premises unfit for human habitation. April 9, 1913.—Closing Order made by Council. Jan. 28, 1914.—Closing Order determined by Council, owner having executed work necessary to render the premises habitable. 72 HOUSE-TO HOUSE INSPECTION. During the year house-to-house inspection was carried out in the following roads:— Bath Place, Bird-in-hand Passage Blackshaw's Alley, Bradford Road, Chaplin Street, Coombe Road, Dallas Road, Fir Street, Hindsley Place, Kent House Lane, Maddin Road, Mill Road, Plane Street, Patrol Place, Porthcawe Road, Prospect Road, Rosamond Street, Relinque Road, Rowland Grove, Taylor's Lane, Wells Road, Willow Walk, Sydenham, Winchfield Road. The total number of houses inspected was 7(54, and the nature of the defects found and remedied is shewn in the following summary. In 68 houses no nuisance was found which necessitated the service of a notice under the Public Health (London) Act. Dirty premises 377 Dilapidated premises 229 Defective drains 7 2 Defective vent shafts and soil pipes 113 Defective or foul w.c.'s 124 Insufficient water to w.c. 53 Defective sink waste pipes 110 Defective yard traps and gullies 75 Defective rain-water pipes 101 Defective rain-water gutters 109 Defective and leaky roofs 194 Damp walls 147 Defective window frames 130 Insufficiently ventilated floors 74 Defective dustbins 174 Defective yard paving 268 Uncovered drinking water cisterns 176 Insufficient lighting 194 Insufficient ventilation 76 Over-crowded rooms 2 Verminous premises 32 Other defects 186 73 Number of families in occupation :— 6 houses contained three families. 169 „ „ two „ 589 „ „ one family. In accordance with the requirements of the Housing, Town Planning, &c., Act, 1909, the particulars in regard to each inspection specified by the Housing (Inspection of District) Regulation, 1910, have been duly recorded. 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:— Nos. 21 and 23, Arabin Road; Nos. 41 to 51, Blythe Yale; Nos. 38 to 50, and 85 to 93, Brookbank Road ; Nos. 34 and 36, Devonshire Road; Nos. 78 to 84, Ewart Road; Nos. 26 to 40, Gilmore Road; Nos. 54 and 56, Glenwood Road; Nos. 181 to 187, Hither Green Lane; Nos. 1 to 11, Kemble Road; Nos. 1 to 3, Leahurst Road; No. 42, Dermody Road; Nos. 1 to 8 (inclusive), Lindal Road; Nos. 27 to 37, Park Road; Nos. 34 to 44, Porson Street; Nos. 15 to 27, Relinque Road; Nos. 12 to 20, Scrooby Street; Nos. 93 and 95, Stanstead Road ; Nos. 24 to 36, Vancouver Road ; Nos. 6 and 6a, Wastdale Road; Nos. 36 to 52, and 61 and 63, Willow Walk, Sydenham. SMOKE NUISANCES. The Inspector entrusted with the duty of keeping observation for the emission of black smoke, made 244 74 gations during the year. The details of his observations are as follows :—laundries 115, silk mills 10, preserve works 59, flour mills 6, saw mills 10, public institutions '20, bakehouses 10, miscellaneous premises 24. The duration of the observations varied from J.an.hour to 1J hours each. In consequence of offences observed, 4 intimation notices were served. Proceedings were taken against the proprietors of a large steam laundry in respect of a nuisance caused by the emission of black smoke. The magistrate made an order prohibiting the recurrence of the nuisance, with costs against the defendants. DISINFECTION. During the year disinfection was carried out at 1,422 houses or premises in the Borough, a total of 3,181 rooms being sprayed. The number of articles removed to the Council's Station for disinfection, either by steam or the formalin process was 45,824. The details of the work carried out are as follows:— Premises. Room..*, Articles. Scarlet Fever 630 1687 26300 Diphtheria ... 365 682 15769 Enteric Fever 29 74 1234 Puerperal Fever 3 3 12 Pulmonary Tuberculosis 162 213 833 Erysipelas ... 11 11 28 Cancer 32 45 382 Other diseases 163 411 1147 Verminous premises. — In addition to the above, 27 verminous rooms were fumigated with sulphur. 75 CORONER'S COURT AND MORTUARY. The Mortuary was used for the reception of 142 bodies, removed from the following places:— From houses in the Borough 90 „ „ outside the Borough 11 ,, Lewisham Infirmary 31 „ Bermondsey Workhouse ... 5 „ Other places 5 The portion of the Mortuary reserved for infectious cases was not used. Inquests were held upon 137 of the bodies, and a post.mortem examination was made in 90 cases. 76 SUMMARY OF SANITARY WORK carried out by the Male Sanitary Inspectors During the year ended 31st December, 1913. Lewisham Division. Sydenham aud Forest Hill Diviision Lee Division Work- shop House to House. Description or Work Mr. J. A. K. Cooper Mr. H. King Mr. J. Crowther Mr. E. T PI dwell Mr. B. A . Knappett Mr. R. White Mr. J. Dal try Mr. A. H. Gray Mr. J. H. Berry. Total for Whole Boro. Complaints by Residents 72 80 88 87 135 193 5 26 29 715 Premises inspected 314 419 341 641 760 502 1241 703 374 5295 Re-inspections of works in progress 1423 1318 2280 1620 2699 1861 365 6466 2707 20739 Premises repaired.cleansed.&c 90 74 99 103 106 82 126 383 175 1238 Defective Roofs, Stackpipes, &c., remedied 29 25 43 56 51 36 1 264 67 572 Drains re-constructed 71 39 48 46 67 51 — 1 27 350 Drains repaired 27 51 21 45 79 49 5 30 15 322 Drains ventilated 28 1 6 11 28 51 — — 8 133 Stackpipes, Sinks, Bath Wastes, &c., disconnected from drains 67 31 79 8 52 126 — 69 13 445 Gulley Traps provided 59 13 105 86 189 127 — 8 39 626 Water Closets re-constructed 79 40 61 65 112 98 — 56 25 536 Water Closets repaired 18 42 25 25 44 40 60 42 25 321 Water Closets supplied with water 13 8 13 — 1 59 — 163 8 265 Soil Pipes re-constructed 21 11 21 20 29 53 — 5 — 160 Soil Pipes repaired & ventilated 10 3 11 19 5 16 10 60 — 134 Dustbins provided 22 34 33 17 31 58 27 137 42 401 Water Supply to Houses reinstated 11 — 2 3 4 10 — 3 — 33 Cisterns repaired, cleansed or covered 7 15 8 42 21 4 41 187 15 340 Water Certificates issued — 1 2 9 3 47 61 81 — 204 Premises over-crowded 1 3 —. 1 1 1 — 26 — 33 Yards paved 42 20 42 25 118 45 40 171 31 534 Removal of offensive accumulations 10 14 31 18 15 27 1 5 — 121 Dung Vaultserected or repaired — 2 5 1 5 2 1 5 — 21 Animals improperly kept 1 5 3 1 4 2 1 20 — 37 Visits to Houses let in lodgings — — 14 — — — — — — 14 Bake-houses visited — — — — — 2 196 — — 198 Milk-shops visited 1 — — 1 11 13 248 — — 274 Cow-sheds visited 9 35 — 24 9 48 — — — 125 Workshops visited — — — .— — 1 590 — — 591 Slaughter-houses visited 28 13 24 24 3 23 — — — 115 77 WORK OF WOMEN SANITARY INSPECTORS. The following is a summary of the work carried out by the Women Sanitary Inspectors :— Miss Jones. Miss Barke. Total To Schools 38 15 53 Re School Notifications 234 337 571 „ Measles 242 226 468 „ Measles deaths 21 4 25 „ Chicken-pox 10 5 15 „ Puerperal fever — 3 3 ,, Ophthalmia Neonatorum. 4 14 18 „ Polio-Myelitis — .. 1 1 „ Phthisis homes 190 229 419 „ Phthisis deaths 43 37 80 „ Birth notifications 819 777 1596 „ Infant mortality 62 63 125 On complaint 21 15 36 To Factories 10 26 36 „ Workshops 250 256 „ Workplaces 38 24 62 „ Laundries 101 95 196 „ Outworkers' homes 217 191 408 Re-visits and re-inspections. 268 193 461 Miscellaneous visits 32 36 68 Total 2600 2547 5147 Nuisances found 156 98 254 Intimations served 105 83 188 Statutory notices served 14 22 36 Abstract not affixed 10 7 17 Overcrowded workrooms 2 1 3 78 Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the years 1906.1913. Ward. Number of Water Certificates Granted. 1906 1907 1908 1909 1910 1911 1912 1913 Church 23 33 29 17 24 2 1 - Manor 7 46 101 68 34 43 4 9 South 47 13 17 10 7 6 11 37 Blackheath 1 - - 4 - 23 1 2 Lewisham Village 5 24 11 15 20 9 6 14 Lewisham Park 114 55 87 17 29 30 8 - Brockley 120 84 72 94 76 68 85 58 Catford 258 322 177 122 90 108 66 74 Forest Hill 63 30 42 8 22 9 14 9 Sydenham 156 157 98 57 99 40 20 11 Whole Borough 794 764 634 412 401 338 218 214 79 Houses Examined and Certified under the Customs and Inland Revenue Acts during 1913. 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 Blessingham Road 1 2 l 2 - - Burnt Ash Hill 4 8 4 8 - - Burnt Ash Road 1 2 1 2 - - Fairlawn Park 1 2 1 2 - - Glenton Road 1 2 1 2 - - High Road, Lee 1 2 1 2 - - Hither Green Lane 1 2 1 2 - - Holmshaw Road 1 2 1 2 - - Lanier Road 1 2 1 2 - - Larkbere Road 8 16 8 16 - - Lee Park 2 5 2 5 - - Leyland Road 2 5 2 5 - - Limes Grove 2 4 2 4 - - Marlborough Road 1 2 1 2 - - Montem Road 1 2 1 2 - - Newstead Road 2 4 2 4 - - Queen's Road 2 4 2 4 - - Quentin Road 12 18 12 18 - Torridon Road 6 12 5 10 1 2 Wisteria Road 1 2 1 2 - Totals 51 98 50 96 1 2 FOOD SUPPLY. 83 BAKEHOUSES. The number of bakehouses on the Register at the end of the year was 85, and 198 inspections were made in the period under review. Twenty-one nuisances were found, chiefly due to dirty ceilings or sanitary conveniences, and it was necessary to serve 21 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 10(5. During the year 13 were added, and 10 removed. The inspections numbered 274, and in 7 instances a nuisance was discovered, necessitating the service of three intimation notices, which were complied with. COWHOUSES. There were within the Borough at the end of 1912 13 cowhouses, and at the annual Licensing Meeting of the London County Council, held in October, 1913, the licenses for the same were renewed. The following is a list of the cowhouses:— Situation. Number of( 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 84 COWHOUSES—continued. Situation. Number of Cows for which licensed. Occupier. 87, Loampit Yale, Lewisham 3 George Attwater Shroffold'sFarm, Southend, Catford 37 Henry Panter Spicer's Meadow, Claypit Lane, Lee ... 6 William Winckworth 296, 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 Vale Blackheath B. W. Parsons 13, Rushey Green Catford Chalk & Cox 158 C. Hardstone 85 UNSOUND FOOD. The following articles of food were surrendered by the owners as unfit for human food and subsequently destroyed:— 17 barrels of Apples; 1 barrel Grapes; 49 boxes Tomatoes; 3 boxes Dabs; 1 kit Escallops; 1 trunk Codling; 12 pieces Skate; 4 trunks Haddocks; 1½ stone Hake; 2 cases Herrings; 30 tins Salmon Trout; 1 box Mackerel; 1 box Roes; 1 trunk Whiting. SALE OF FOOD AND DRUGS ACTS. During the year 1913, 543 samples of food and drugs were examined by the Public Analyst. The following is a list of the articles purchased, with the results of the analyses. 86 Table Showing number of Samples submitted for Analysis, with Results for the year ended, December 31st, 1913. (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 287 272 15 5.23 Separated Milk 15 13 2 13.3 Butter 59 57 2 3.38 Margarine 3 3 — — Coffee 16 16 — — Cream 2 2 — Lard 6 6 — — Mustard 7 7 — — Pepper 7 7 - Flour 4 4 — — Olive Oil 1 1 — — Whisky 2 2 — Rum 2 1 1 50.0 Gin 1 1 Tincture of Bark 1 1 phorated Oil 1 1 — - Total official sample 414 394 20 4.28 (b) Test Samples purchased without the formalities of the Act. Milk 27 16 11 40.74 Butter 50 44 6 12.0 Margarine 6 6 — — Coffee 11 11 — — Cocoa 2 2 Cream 12 12 Mustard 3 3 Pepper 3 3 — — Camphorated Oil 1 1 - — Ammoniated Tincture of Quinine 2 2 Tincture of Bark 3 3 — — Sal Volatile 2 2 — — Olive Oil 3 3 Honey 2 2 — Flour 1 1 Lard 1 1 — — Total Informal samples 129 112 17 13.10 Total all samples 543 506 37 6.81 87 Adulterated Samples—Twenty of the official samples were not satisfactory, and, therefore, the percentage of adulterated articles amounted to 4.83 per cent., compared with 5.36 per cent, in the previous year. Of the 129 informal samples seventeen, or 13.10 per cent., were found to be adulterated or not up to standard. MILK. Two hundred and eighty-seven official samples of milk were analysed during the year, and of this number fifteen, or 5.23 per cent, were certified as adulterated or below the standard of the Board of Agriculture and Fisheries. The average composition of all samples of milk analysed during the period under review equalled 3.41 per cent, milk fat and 8.75 per cent, solids not fat, while the average composition of the genuine samples alone was 3.45 per cent, milk fat and 8.76 solids not fat. All the milk samples were examined for the presence of preservatives and in each instance a negative result was given. Sixty-nine of the milks were found to contain colouring matter- 88 Details of Adulterated Samples of Milk during the Year ended December 31st, 1913. Sample Marked. Adulteration. Remarks. Official Samples. 8 3 per cent, deficient in milk fat Vendor cautioned by direction of the Public Health Committee 16 3 102 3 103 4.5 104 4.5 124 43 Proceedings were taken against master and servant, and they were fined £5 and £1 3s. costs, and £4 and £1 3s. costs respectively 128 4 Vendor cautioned by direction of the Public Health Committee 163 10 Summons dismissed on proof of warranty 288 3 Vendor cautioned by direction of the Public Health Committee 291 3 297 30 Summons dismissed on proof of warranty 337 20 Vendor fined 10s. and £1 3s. costs 344 1.0 Vendor ordered to pay costs, 2s., and his servant fined £2 10s. and £1 3s. costs 848 . 3 No action 464 3 Vendor cautioned by direction of the Public Health Committee Separated Milk : 48 26 per cent, added water Vendor fined £2 and £1 3s. costs 120 28 Vendor fined £4 and £1 3s. costs Test Samples. 122 23 per cent, deficient in milk fat Subsequent Official Sample No. 124 123 20 328 26 per cent, deficient in milk fat Subsequent Official Sample | No. 337 329 16 330 11 451 10 percent, deficient in milk fat Subsequent Official Samples were genuine 452 16 454 16 457 16 458 96 460 3 89 Table Showing Average Composition of Milk Samples submitted in 1913. 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 3.36 8.78 3.42 8.79 Second 3.37 8.86 3.41 8.85 3.0 8.5 Third 3.51 8.86 3.58 8.62 Fourth 3.45 8.75 3.44 8.76 Total for Year 3.41 8.75 3.45 8.76 90 Average Composition of Milk Samples submitted during the Years 1903-1913. 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. Percenta of Solids no Fat. Percentage of Milk Fat. Percentage of Solids not Fat. Year 1903 3.67 8.69 3.81 8.72 1904 •63 8.69 3.69 8.74 1905 3.58 8.75 3.62 8.78 1906 3.56 8.74 3.53 8.77 1907 3.47 8.81 3.53 8.83 1908 3.50 8.80 3.58 8.81 3.0 8.5 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 1913 3.41 8.75 3.45 8.76 91 Table Showing results of Total Samples of Milk submitted during the Years 1909-1913. Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 First 56 56 90 91 84 2 2 1 7 8 3.57 3.6 1.2 7.6 9.5 Second 61 62 94 63 91 6 4 7 10 4 9.84 6.4 7.4 15.8 4.39 Third 78 79 47 57 75 2 4 5 2 2 2.56 5.06 10.6 3.5 2.6 Fourth 40 86 61 39 37 1 5 5 2 1 2.50 5.8 8.19 5.1 2.7 Total for Year 235 283 292 250 287 11 15 18 21 15 4.68 5.3 6.16 8.4 5.23 Not including test samples. Table Showing Total Samples submitted with results during the years 1909-1913. (Test samples not included). Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 First 95 87 141 130 111 3 3 2 8 10 3.16 3.4 1.41 6.15 9.0 Second 128 102 136 140 143 6 6 9 10 5 4.69 5.9 6.62 7.14 3.49 Third 131 95 72 87 84 2 4 7 3 3 1.53 4.2 9.72 3.4 3.57 Fourth 115 181 146 146 76 3 10 12 6 2 2.61 5.5 8.21 4.1 2.26 Total for Year 469 465 495 503 414 14 23 30 27 20 2.99 4.95 6.06 5.36 4.83 92 Table Showing the number of samples of Butter submitted in the Four Quarters of the years 1909-1913. Quarter. No. of Samples. No. Adulterated. Percentage Adulterated. 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 First 22 20 36 21 12 1 — — — — 5.0 — — — Second 26 31 29 19 26 — — 2 — 1 — — 6.9 — 3.8 Third 18 5 22 16 7 - — 1 — 1 — — 4.5 — 14.3 Fourth 44 46 41 54 14 — 1 4 2 — — 2.2 9.8 3.7 — Total for year 110 102 128 110 59 2 7 2 2 — 1.96 5.46 1.8 3 38 * Test samples not included. Details of Adulterated Samples of Butter for the Year ended December 31st, 1913. No. Adulteration. Remarks. Official Samples. 272 92 per cent, of foreign fat Vendor fined £3 and £1 3e. costs 263 95 Vendor fined £1 10s. and £1 3s. costa Test Samples. 92 Margarine 136 1 Subsequent Official samples f genuine 179 238 488 497 Details of Other Samples Adulterated during the year ended December 31st, 1913. No. Article. Adulteration. Remarks. 479 Rum 44 degrees under proof Protected by a declaratory label ou bottle 93 Year. No. of Samples (not including Test Samples). Genuine. Adulterated. Percentage Adulterated. No. of Prosecutions. Fines and Costs imposed. Summary of Samples (not including test samples) Analysed in the Borough in each Year, 1907-1913. 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 10.2 Coffee 28 Wines and Spirits 18 Various 34 1911 Milk 292 *495 465 30 6.06 20 Fines £50, costs £23 la. Butter 28 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 1913 Milk 287 - *414 395 20 4.83 10 Fines £23 10s., costs £10 9s. Butter 59 Coffee 16 Various 52 FACTORIES AND WORKSHOPS. 97 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 1913, was 518. During the year 1467 inspections of these premises were made; and defects to the number of 153 were found. Want of cleanliness was reported in 45 instances. In only 2 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 221 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 518 workshops referred to was 2073, of which number 1257 were women, 458 men, and 358 "young persons" 98 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) 72 15 Workshops (including workshop laundries) 1293 57 Workplaces (other than outworkers' premises included in Table 3) 102 3 Total ... 1467 75 — 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 45 45 - — Want of ventilation 13 13 - — Overcrowding 2 2 - — Want of drainage of floors Other nuisances 15 15 — — Sanitary accommodation Insufficient — — — Unsuitable or defective 57 57 - — 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) 21 21 Other offences — — (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 153 153 - — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 99 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 Employer. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Instances Notices served. Prosecutions. Instances Orders made, Sec. 110. Prosecu tions. Sections 109, 110. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing Apparel— (1) making&c. 44 - 134 11 - 30 - - — 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 54 144 16 33 * 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 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 foo note 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• 101 Workshops (sec. 131) and Workplaces and Workrooms on the Register at the end of 1913 (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 165 228 3 715 247 26 26 Millinery 39 46 - 123 67 1 1 Laundry 85 229 26 375 - 13 18 Tailor 34 36 68 19 5 17 17 Boot 64 64 86 - 8 101 101 Joiner 18 30 39 - 5 - - Smith 23 25 57 - 5 - Dentist 5 5 12 - - - Cycles 14 17 24 - 6 15 15 Coach builder 5 10 30 5 Cabinet and Upholsterer 15 20 31 3 2 2 2 Photographer and Pictureframer 13 14 12 16 5 9 9 Jeweller 13 14 24 4 23 23 Piano 1 2 2 2 - - Saddler 7 7 13 Mason 2 3 4 f - Lathrender 2 3 5 - - - - Various 13 17 2.2 6 2 14 14 Total 518 770 458 1257 358 221 226 102 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 ... Action taken in matters referred, by H.M. Inspectors as remediable under the Public Health (London) Act, but not under the Factory Act (Sec. 5). Notified by H.M. Inspector 7 - Reports of action taken, sent to H.M. Inspector 7 Other - Underground Bakehouses (Section 101):— In use during 1903 23 Certificates granted in 1903 23 1904-1912 nil In use at end of 1913 20 Workshops and Workplaces on the Register at the end of 1913:— Workshops (details in Table 4) 518 Workplaces part time and domestic (details Table 4) 221 Bakehouses 71 underground 20 Restaurants (workplaces) 46 Workplaces (stable yards, contractors' yards, etc.) 36 Total 912 APPENDIX. LOCAL GOVERNMENT BOARD TABLES. LONDON COUNTY COUNCIL SUMMARY. METEOROLOGICAL TABLE. 1913. 105 Table I. Vital Statistics of Whole District during 1913 and previous Years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transfer'LE Deaths. Nett Deaths eslonging to the District. Uncorrected Number. Nett. of Non-residents registered in the District. of Residents not registered in the District Under i Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per iooo Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 9.67 191) 161677 3397 3421 21.22 1879 11.6 255 218 357 104 1842 11.43 191-2 165249 3223 3343 20.35 1789 10.89 272 209 233 69 1726 10.51 1913 168822 3187 3502 20.33 1911 11.09 311 241 269 76 1841 10.68 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 28,7'23 Average number of persons per house 5.6 106 TABLE II. Cases of Infectious Disease notified during the Year 1913. 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. Church Manor South Blackheath Lewisham Village Lewisham Park Brockley Catford Forest Hill Sydenham Precise Residence unknown. Under I i and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 5 and under 65 years 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 - - - - - - - - - - - - - - - - - - - - Cholera (C) Plague (P) - - - - - - - - - - - - - -- - - - - - - Diphtheria (including membranous Croup) 404 6 99 235 29 33 2 - 8 18 9 15 17 40 31 99 96 71 360 Erysipelas 84 1 3 6 11 22 31 10 — 7 1 1 12 15 8 10 11 19 — 16 Scarlet Fever 676 2 137 447 61 28 1 — 9 34 16 3 33 94 95 187 101 104 — 566 Typhus Fever — — — — — — — — — — — — — — — — - Enteric Fever 32 2 11 5 11 3 — — 1 1 1 — 7 1 18 3 — — 29 Relapsing Fever (R) Continued Fever (C) - - - - - - - - - - - - - - - - - - - - Puerperal Fever 3 - - - 1 2 - - 1 - - 1 - - - - - 1 - - Cerebro-spinal Meningitis — - - - - - - - - - - - - - - - - - - - Poliomyelitis 5 - 3 2 - - - — — 1 -— — — — — 2 1 1 — 3 Pulmonary Tuberculosis... 317 1 3 32 70 137 69 5 14 15 7 9 43 40 30 81 34 40 4 — Other forms of Tuberculosis 123 3 20 52 27 15 6 — 2 7 3 6 10 15 12 34 11 23 — — Ophthalmia Neonatorum 11 11 — - — — — — — 2 — 1 1 1 1 2 — 3 — 1 Totals 1655 24 267 785 204 248 112 15 34 85 37 37 116 212 178 433 257 262 4 975 107 Table III. Causes of, and Ages at, Death during the Year 1913. 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 i 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. All causes 1 2 3 4 5 6 7 8 9 10 11 Certified 1841 269 66 70 75 79 227 417 638 721 Uncertified — — — — — — — 1. Enteric Fever 8 — — 1 2 1 2 2 — — 2. Small Pox — 3. Measles 25 5 11 4 5 — — — - 14 4. Scarlet Fever 5 — — 1 4 — — — — — 5. Whooping Cough 22 9 11 — — — — — 7 6. Diphtheria and Croup 35 2 — 17 14 — 1 1 — 2 7. Influenza 27 — — — 1 3 2 9 12 .3 8. Erysipelas 5 1 1 — — 1 — 1 1 2 9. Phthisis (Pulmonary Tuberculosis) 126 1 1 2 7 21 59 31 4 42 10. Tuberculous Meningitis 23 20 5 5 7 2 2 2 — — 17 11. Other Tuberculous Diseases 1 2 1 3 2 4 3 4 11 12. Cancer, malignant disease 194 — 1 — — 1 17 90 85 54 13. Rheumatic Fever 9 — — - 2 — 4 3 — — 14. Meningitis 12 — 1 4 4 1 — 1 1 3 15. Organic Heart Disease 157 — 1 — 1 7 25 57 66 51 16. Bronchitis 137 16 2 1 1 4 22 91 63 17. Pneumonia (all forms) 127 31 12 14 8 4 14 18 26 63 18. Other diseases of Respiratory organs 30 2 1 2 3 8 14 3 19. Diarrhoea and Enteritis 51 43 8 55 20. Appendicitis and Typhlitis 13 — — 1 4 3 1 3 1 6 21. Cirrhosis of Liver 24 - - - - - 3 15 6 8 21a.Alcoholism 3 - - - - - - 2 1 — 22. Nephritis & Bright's Disease 53 1 — 1 — — 8 22 21 12 23. Puerperal Fever... 3 — — — — 3 — — —. 24 Other accidents and diseases of Pregnancy & Parturition 6 - - - - 6 - - 2 25 Congenital Debility and Malformation, including Premature Birth 108 107 - 1 - - - - 48 26. Violent Deaths, excluding Suicide 65 13 1 4 6 7 14 10 10 23 27. Suicide 17 — — — — 1 7 7 2 5 28. Other Defined Diseases 525 32 4 10 10 19 48 111 291 212 29. Diseases ill-defined or unknown 11 — 4 —I — 2 2 3 15 Totals 1841 269 66 70 75 79 227 417 638 721 SubEntries. included in above figures. 14(a). Cerebro-spinal Meningitis - - - - - - - - - - 28(a). Poliomyelitis ... - - - - - - - - - - 17 (a). Lobar-pneumonia 28 2 — 3 1 1 6 5 10 7 17(b). Pneumonia (type not stated) 39 4 2 1 4 3 8 6 11 19 108 Table IV. INFANT MORTALITY. 1913—Nett Deaths from stated Causes at various ages under One Year of Age. 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 — — — — — — Uncertified - - - - - - - — - - Small-pox - - - - - - Chicken-pox — — — — — — — — — — Measles — — — 5 5 Scarlet Fever — — — — — — — — - Whooping Cough — — — — — 1 3 1 4 9 Diphtheria and Croup — 1 — — 1 — — — 1 2 Erysipelas — — — — — 1 — 1 Tuberculous Meningitis — — — — — — 2 1 2 5 Abdominal Tuberculosis — — — — — — 1 — — 1 Other Tuberculous Diseases — — — — — — — — 1 1 Meningitis (not Tuberculous) — — — — — — — — — Convulsions 2 — 1 — 3 4 2 1 — 10 Laryngitis — — — — — — — — — Bronchitis — 1 1 — 2 4 3 2 5 16 Pneumonia (all forms) — 2 1 1 4 6 7 8 6 31 Diarrhoea — 1 1 3 2 3 2 11 Enteritis — 1 1 — 2 10 13 5 2 32 Gastritis — — — — 1 — — 1 Syphilis — 1 — — 1 3 — — — 4 Rickets — — — — — — — — 1 1 Suffocation, overlying 2 — — 2 1 — — — 3 Injury at birth 4 — — 4 — — 4 Atelectasis 2 — — — 2 — — 2 Congenital Malformations 5 2 - — 7 4 1 — 1 13 Premature birth 30 5 3 — 38 2 — — — 40 Atrophy, Debility and Marasmus 13 2 5 4 24 14 9 4 3 54 Other Causes 2 3 1 — 6 6 4 2 5 23 Totals 60 18 14 5 97 59 47 28 38 269 Nett Births in the year—lgitimate, 3407; illegitimate, 95. Nett Deaths in the year of—litimate infants, 251; illegitimate infants 18. 109 Table V. LONDON COUNTY COUNCIL SUMMARY. Premises. Number of Places No. of Inspections 1913 No. of Notices 1913. No. of Prosecutions 1913. On Register at end of 1912. Added in 1913. Removed in 1913. On Register at end of 1913 Milk premises 163 13 10 166 274 Cow sheds 14 — — 14 125 Slaughter houses 15 — — 15 115 Other offensive Trade premises - - - - - - - Ice cream premises - - - - - - - Registered houses Let in Lodgings 3 2 — 5 - (a)— (b)3 Restaurants 46 — — 46 65 8 Bakehouses 91 — 6 85 198 21 Stable Yards, &c. 36 — — 36 44 — a Overcrowding. b Other conditions. Total number of intimation notices served for all purposes, male inspectors 1832, female inspectors 188—Total 2020. Overcrowding:—Number of dwelling rooms overcrowded 33, and workrooms 3, 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, 5; Numbers repaired and re-opened, 3. Premises cleansed under Section 20 of the London County Council (General Powers) Act, 1904, nil. 110 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, 51 , number of tenements comprised therein, 98; certificates granted in respect of 56 houses (96 tenements); refused in respect of one house (2 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 142 Total number of infectious bodies removed 1ll Table YI. METEOROLOGICAL TABLE for LONDON, 1913. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1913. AIR TEMPERATURE. Bright Sunshine. Rain and other forms of Precipitation. Mean of Mean of A an«l B. Difference from Normal. + Absolute Maximum and Minimum. Difference from Normal.t Per cent, of Possible. Total Fall. Difference from Normal. \ Most in a day. Maximum. > Minimum, cc Maximum. Day of Mouth Minimum. Day of Month. Daily Mean. Amount. Day of Month. January o 46.1 o 35.9 ° 41.0 o + 2.4 0 52 23 o 26 13 hrs 1.76 hrs. + 0.39 % 21 ins. 2.65 ins. +0.77 ins. 0 38 22 February 46.7 35.6 41.0 + 1.7 55 4 24 23 2.08 -0.05 21 0.81 -0.67 0.23 1 March 52.0 38.3 45.1 + 3.3 59 6 28 18 2.98 -0.36 25 2.43 +0.91 0.33 16.20 April 55.4 38.9 47.1 0.0 67 24 29 13 4.00 -1.18 29 2.23 + 0.66 0.41 11 May 6.66 45.3 56.0 + 3.0 84 27 36 7 6.50 +0.12 42 1.16 - 0.76 0.37 29 June 71.4 49.2 60.3 + 1.1 87 17 42 1 6.81 +0.28 41 0.73 -1.31 0.30 19 July 68.2 54.8 60.0 +2.4 76 12 46 8 3.05 -4.08 19 2.12 -0.28 082 10 August 71.1 52.0 61.6 +0.1 80 21 45 25 4.61 -1.98 32 2.07 -0.27 0.78 31 September 67.8 50.2 59.6 + 1.9 77 26 42 19 4.95 -0.19 39 1.25 -0.90 0.40 16 October 61.2 45.9 53.6 + 3.5 67 4 36 23 3.57 +0.43 34 3.58 +0.80 0.78 26 November 54.2 42.0 48.1 +4.6 60 17 28 23 2.39 +0.72 27 2.53 +0.31 0.63 10 December 45.9 37.7 41.8 + 1.8 55 9 28 31 0.87 -0.21 11 0.88 -0.95 0.32 23 Year 58.9 43.6 51.3 + 1.8 — — — - 3.63 -052 30 22.44 -1 68 - | — * The hours of observation are 9 a.m. and 9 p.m. local time. The averages used are obtained from observations extending over 65 years for Rain and Temperature, and 15 years for Sunshine.