With finding David Compliments PLUMSTEAD VESTRY. ANNUAL REPORT OF THE Medical Officer of Health. 1894. F. J. Cattermole, Printer, Woolwich. SANITARY STAFF. Medical Officer SIDNEY DAVIES, M.A., M.D. (Oxon), D.P.H. (Camb). Chief Sanitary Inspector Mr. A. G. DUCK, Cert. Sanitary lnst.; Cert. Advanced Building Construction; Hygiene and Plumbing. Sanitary Inspector Mr. A. W. MARTIN, Cert. Sany. Inst.; Cert. Advanced Building Construction. Do. Mr. J. W. RANCE, Cert. Sany. Inst. Do. Dust Mr. G. HALE. Clerk Mr. C. ELLIS. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, PLUMSTEAD, YEAR, JAN.-DEC., 1894. To the Plumstead Vestry. Gentlemen, I have the honour to present to you my fourth annual report on the health of Plumstead, embracing the year 1894. A.— Vital Statistics. Population. 1. If the population had increased since the census at the same rate as bet ween 1881 and 1891, it would have been nearly 61,000 in the middle of last year. There are good reasons for thinking, however, that the increase has been less. Work has been slack in the Arsenal in the past three years, there has been much less building, and the birth-rate has diminished. Accordingly I estimate the population of last year to be only 59,233, according to the method adopted in the office of the Registrar General for statistical purposes. 2. For the purposes of the Equalization of Rates Bill, the Registrar General has also calculated a population to April 6th, 1894, on the assumption that the number of persons to a house 4 remained the same as at the census. The population thus estimated on the number of inhabited houses is only 56,810. This figure, however, is not intended and cannot properly be used for statistical purposes, (1) because it is not calculated to the middle of the year, and (2) because it rests on an improbable assumption. I have, however, calculated the death-rate and birth-rate on this population by the wish of the Public Health Committee and have placed them in Table I. along with the rates which I think are the more correct. I estimate the population of West Plumstead for last year to be 17,433 and of East Plumstead 41,800. 3. In my last report I gave a table shewing the numbers living in Plumstead at various groups of ages. From this table I calculated the following to shew hew the age distribution in Plumstead compares with that in England and Wales. Numbers living at different ages per 1000 of total population:— Under 5 5-10 10-15 15-20 20 25 25-35 35-45 45-55 55-65 65-75 Over 75 Plumstead 147 125 106 88 81 166 115 82 49 27 10 England and Wales 136 120 107 97 89 147 113 86 59 33 13 This table is to be read thus: out of each thousand of the population there are under 5 years 136 in England and Wales, 147 in Plumstead; between 25 and 35, 147 in England and Wales, 166 in Plumstead, and so on. We see from it that the age distribution in Plumstead does not vary much from that of 5 England and Wales, the principal differences being that Plumstead contains a greater number of young children and people from 25 to 35, and a smaller number at the ages 15-25, and over 55. Births. 4. The birth-rate 32 2 was the lowest since 1885, though only slightly lower than last year (see Tables L and VI.). This decrease in the birth-rate is not confined to Plumstead, but throughout the country there has been of late years a continuous steady diminution of births in proportion to population. In spite of this low birth-rate, the death-rate was also so low that the natural increase of population (i.e., the excess of births over deaths) was 1174, the highest yet recorded. Tho birth-rate was 33.8 in East Plumstead but only 28 2 in West Plumstead. Deaths. 5. The death-rate (see Table I.) was only 12 4 which is the lowest rate since 1884, if not the lowest yet recorded. The death-rate has only once before been below 15 0 in the last ten years. This was in 1888, when it was 14 9. 6. Probably various causes contributed to this low deathrate. Compared with last year there was a diminution of deaths from all the principal Zymotic diseases cxcept Whooping Cough. There were also fewer deaths from Influenza, Phthisis, Bronchitis, and Pneumonia. 6 7. The following table shews the effect of Influenza on the death-rate in recent years:— 1889 1890 1891 1892 1893 1894 Deaths from Influenza 0 9 44 27 35 7 „ Bronchitis and Pneumonia 93 136 207 176 204 124 „ Phthisis 69 95 114 100 111 70 Total 162 240 365 303 350 201 Total deaths—all causes (corrected) 759 923 920 849 994 736 We see from this table that the deaths from Bronchitis and Pneumonia and also those from Phthisis have increased and diminished with the deaths from Influenza, and concluding that the increase was due to Influenza, it would appear that last year was the first since 1889 that the death-rate has not been greatly swelled by Influenza, directly or indirectly. 8. The death-rate in East Plumstead was 12.6, but in West Plumstead it was only 113. 9. Comparing the four quarters of the year (see Table II.) the first or winter quarter had far the highest mortality, nearly half the deaths from Bronchitis and Pneumonia occurring in that quarter. Infant Mortality. 10. The Infantile death-rate, i.e., the number of deaths under 7 1 year to 1000 births, was only 94, lower than in any year since 1884 (see Tables I. and VI.). This low rate was doubtless largely due to the wet summer, therebeing always less Diarrhoea, when the summer is rainy. 11. The Infantile death-rate in East Plumstead was 100, but in West Plumstead only 77. Zymotic Death-rate. 12. The Zymotic death-rate was 2 06, as compared with 2 48 and 3.71 in the two preceding years (see Tables I. and II.) Uncertified Deaths. 13. There were 27 deaths which were not certified either by a medical practitioner, nor by a coroner after inquest. These give a percentage of 3.6 of total deaths which is higher than in the three preceding years, and much higher than in London as a whole. I am unable to explain why the proportion of uncertified deaths should be so high in Plumstead. They are usually cases in which there has been no medical attendance and the coroner does not think it necessary to hold an inquest; 11 were under 5 and 16 over 5 years of age. In my last report I commented on the desirability of having these cases enquired into by a specially appointed medical man. I believe that a plan is now under consideration by the County Council which will provide for this, by appointing a medical investigator under the coroner in each district. Inquests. 14. There were 35 Inquests compared with 45 last year: 14 of these were on children under 5 and 21 on persons over 5. 19 were the result of accident or violence, the remainder from 8 "natural causes." There were no murders, but four suicides. Three deaths resulted from alcoholism. Three children were suffocated in bed with their parents, and one in its mother's arms, after improper feeding. The mother in this case was told by the coroner that she had narrowly escaped being committed for manslaughter. One death resulted from burns by upsetting a paraffin lamp, and one from dropping a lighted match. Though alcohol was only given as the direct cause of death in three cases it was probably the indirect cause in the majority of the deaths from violence. Phthisis. 15. The corrected number of deaths from Phthisis was 70, giving a death-rate of 1.1 per 1000 compared with 14 and 12 in the two preceding years. The lowest rate on record for England and Wales is 1.4 in 1892. In the same year the rate for London was 1.8. As has been pointed out by the Medical Officer of Health for Woolwich the death-rate from Phthisis is a very good index of the Sanitary condition of a community, and the low rate in Plumstead is therefore very satisfactory. As I pointed out last year Phthisis is more prevalent in West Plumstead than in East. Measles and Whooping Cough. 16. Whooping Cough was fatal in the first quarter of the year, causing 22 deaths, and 30 in the whole year. Measles caused 20 deaths, 19 being in the last quarter of the year, and mainly in December. There is little doubt that the mortality of this disease might bo greatly lessened if it was regarded more seriously and its dangerousness better known. By direction of 9 the Vestry I have since the close of the year written and had distributed at all houses a card giving brief instructions as to the necessity of carefully treating all cases of measles, and pointing out the fatality of the disease, and the necessity of isolating the patients. Owing, however, to the infection being usually communicated before the nature of the disease is recognized it is not easy to prevent its spread, and I do not think much will be gained by making it a notifiable disease. Diarrhœa. 17. Diarrhœa caused only 10 deaths, compared with 26 in 1893. This is the lowest number recorded since 1885. This low figure is no donbt largely due to the wetness and low day temperatures of the summer months, July, August, and September, but it is also satisfactory evidence of good sanitary condition. Meteorology of the Year. 18. The average temperature at Greenwich of the first three months was 41°.4, or 2°.5 above the average of 53 years, and the weather was on the whole mild and genial. The rainfall was slightly above and the amount of sunshine 8 percent, above the average. In the spring (April-June) the average temperature was 1°.0 above the average, but the amount of sunshine was below the average, although the rainfall was also below. In the summer months (July-September) the temperature was 1°.2 below the average, and the amount of sunshine was 10 per cent, below the average. The weather was damp and cloudy on the whole, though the amount of rain measured was below the 10 average. October to December were mild and wet, the temperature and rainfall being above the average, the sunshine below. It was thus on the whole a year without extremes of heat or cold—a mild winter and wet summer, conditions always favourable to a low death-rate. Plumstead compared with London and 33 large towns. 19. The birth-rate was 2.1 above London and 1.5 above the average of the 33 towns. The death-rate was only two-thirds that of London, and lower than any of the large towns, Croydon coming nearest to it with a rate of 13.2. The Zymotic death-rate was a little below London and the average of the large towns, but 15 towns had a lower rate. The Infantile death-rate was far below that of any of the large towns, Croydon being the lowest with 123. The rate of Uncertified deaths, however, was far higher in Plumstead than in London and most of the towns: five only had a higher rate, viz., Preston, Halifax, Birmingham, Hull, and West Ham. (For comparison with London see Table 1.) Of the 43 Sanitary areas of London, two only had a lower death-rate than Plumstead, viz., Stoke Newington and Hampstead. Stoke Newington only had a lower Infantile death-rate (see Table VII.). 11 B.— Infectious Diseases. (See Tables II., III., and IY.) 1. A total of 713 notifications of infectious disease were received by me during the year, compared with 160, 790, and 886 in the three preceding years. 400 of these, or more than half, were treated in the isolation Hospitals of the Asylums Board. This shews a great advance in the use of these Hospitals. The increased willingness to let patients go to the Fever Hospital dates from the middle of 1893, when the Arsenal regulations as to infectious disease pay were altered. But the effect did not become visible till 1894, because in the latter half of 1893 the Asylums Board Hospitals were crowded out. During the year 1894 more Hospital accommodation became available and there was less prevalence of Scarlet Fever in London. 2. It is very satisfactory that a larger proportion of infectious cases should be treated in isolation Hospitals, and the desire of the Arsenal authorities to co-operate with the local Sanitary authorities is most praiseworthy. But there is no advantage without its attendant disadvantage, and I have reason to think that the gain in getting more cases isolated in Hospital is partly counterbalanced by the fact that the strictness of the new regulations induces some parents to conceal the existence of infectious disease (usually Scarlet Fever), in order to avoid the alternative of losing the bread-winner's earnings or pariting with their child. During the year I discovered several cases of Scarlet Fever which had not been notified, and had been attending school, and mixing with other children. The parents in these cases had not called in a medical man and stated that they thought they were cases of measles. Although I had reason to think this statement was not correct, there was no clear evidence 12 to the contrary and consequently no chance of obtaining a conviction before a magistrate, as the Public Health Act only requires notification when the head of the family is aware of the existence of infectious disease, and does not require him to take any means to become aware, such as obtaining medical advice. 3. It is to be hoped that the Act will be improved in this respect before long. The Health Committee did what was possible under the circumstances; on my suggestion they directed me to write a notice of warning, threatening legal proceedings against any one who was found to be concealing the existence of infectious disease, or exposing any one suffering from such disease. This was printed and 9000 copies distributed house to house. 4. I have been in communication with the Director General of Ordnance Factories on the above subject, and am at present considering with the Medical Officers of the Arsenal the whole question of the working of the Arsenal regulations as to infectious diseases with a view to encouraging the use of the Fever Hospital without being too strict in making it obligatory. The question is beset with difficulties, but I hope a via media may be found. Small Pox. 5. There were 22 cases of Small Pox compared with 2 and 51 cases in the two preceding years. 15 went to hospital and 2 died, 1 at home and 1 at hospital. Only one of the cases notified was under 5 years of age. 6. I beg to refer to my last report (p. 6) as to the necessity of re-vaccination. 13 Scarlet Fever. 7. There were 480 cases of Scarlet Fever notified, compared with 61, 584, and 527 in the three preceding years. 331 or twothirds of these cases went to hospital, whereas last year only one half went. 5 died at home and 16 in hospital, giving mortalities of 3.3 and 4.8 per cent, respectively. This is a great improvement on last year when 29 died altogether and the mortality was 4 per cent, at home and 8 per cent, at hospital. 8. About one-third of the cases of Scarlet Fever were pupils attending the Slade Board School. During the first half of the year the outbreak of the two last years appeared to be gradually dying out, as it has done to a great extent in London as a whole. But in June and July a number of cases occurred in the Slade School, causing quite an epidemic in the neighbourhood. This school had been very little affected in the two preceding years, and therefore contained a large number of unprotected children. 9. Apparently the disease was spread in the school by mild undetected cases, for my locum tenens, Dr. Priestley in my absence, and I myself on my return discovered several cases which had not been notified. On Dr. Priestley's advice and the Committee's recommendation, the School Board closed the school on the 21st July until the end of the summer holidays. On the reassembling of the school I inspected every child in it, but found none with symptoms of Scarlet Fever. The school had been, meantime, thoroughly disinfected. The houses also where cases occurred •were disinfected throughout. There was no special incidence of 14 the disease in this school after the holidays, but apparently this local outbreak set the infection going again all over the parish, for there has continued to be an undue prevalence up to the present time. For age distribution, second attacks, &c., see Table V. Diphtheria and Membranous Croup. 10. There were 118 cases of Diphtheria and Croup notified, compared with 118 and 179 in the two preceding years. St. Margaret's parish was most affected having a per centage of '36 cases; the other parishes varied from 12 in St. John's, T9 in All Saints' and St. James', to 25 in St. Nicholas'. As with Scarlet Fever the Slade School was most affected, this school being attended by children from the patient's house in 25 cases out of 88 in which some school was attended. This does not mean, however, that the patient attended this school in 25 cases ; on the other hand, it is very often the case that the first patient in a house does not attend school at all. In 24 cases of Diphtheria out of 46, of which I have kept records, the patient did not attend school and 22 of them were the first cases in the house. Table V. gives the figures for the other schools; it is to be read thus:— in 11 cases of Diphtheria, children from the same house as the patient attended Ancona Road School, in 6 cases Earl Street School, and so on. The disease was most prevalent in the last quarter of the year, when there were 49 cases, the numbers for the first three quarters being 27, 28, and 14. 11. Table V. also shews that nearly half the cases were under 5 years of age, and that in 9 cases only out of 118 was a 15 second individual attacked in the same house. In six houses there were three patients attacked. 12. Out of the 118 cases of Diphtheria and Croup 39 went to hospital. There were altogether 40 deaths, 26 being at home and 14 at the hospital. This gives a death-rate of 32 per cent, at home and 35 per cent, at hospital. In 1893 the death-rate was 30 at home and 50 at hospital. It is satisfactory to note the lower death-rate at hospital. It may be confidently hoped that when the new remedy for Diphtheria—Antitoxin—comes to be generally used, the death-rate may be much reduced. The Asylums Board have earned the gratitude of the public by the enlightened way in which they have helped to introduce this invaluable remedy. 13. The following table shews the cases of Diphtheria and deaths for each quarter of the year:— Cases. Deaths. Total. Treated in Hospital Total. In Hospital 1st Quarter 49 5 8 2 2nd „ 28 6 8 1 3rd „ 14 4 7 2 4th „ 49 22 17 9 14. The drains at 77 houses in which cases of Diphtheria occurred were tested by the smoke machine and defects were found at 38, or just one half. In most cases these defects only 16 shewed that sewer gas might escape into the yard or immediate surroundings of the house, but in several it was found that the smoke did (and therefore the sewer gas might) make its way into the house, under the flooring. Enteric Fever. 15. There were 26 cases of Enteric Fever compared with 22 and 29 in the two preceding years. 13 went to hospital and 6 died. 16 houses in which cases occurred were examined by the smoke machine and 8 were found to be defective. 17 out of 26 or two-thirds of the cases occurred in St. Nicholas' sub-district. The cases included 11 men, 5 women, and 10 children. One of the men owned to prinking water from a canal in the Arsenal used for engines. I suspect this was the source of the disease in other cases. 10 of the cases occurred in three adjoining streets, viz.: Mabyn Road, Gunning Street, and Reidhaven Road. 5 were in houses situated on the same combined drain. This drain became obstructed, and when taken up was found very defective. One man, who died, worked at the Crossness outfall. Case of English Cholera. 16. The other notifications of Infectious disease are shewn in Table IV. The one case of Cholera was an old man who lived at Abbey Wood. He died in October after three days' illness. I communicated with Dr. Klein, who had been appointed by the Local Government Board to investigate the bacteriology of such cases and obtained for him some of the intestinal contents. I reported at the time that there was no reason for supposing it to be other than a specially severe case of Diarrhoea in an 17 alcoholic subject. Dr. Klein reports that he found no Cholera bacilli. Consultations for Diagnosis. 17. In nine cases of suspected Infectious disease my opinion was requested by other medical practitioners, and I saw the cases in consultation with them. In the majority I was able to confirm the diagnosis of the medical attendant. The larger number were cases of Small Pox. In addition to the above my assistance was called for by the Medical Officer of the Cordwainers' School, on the occurrence successively of three cases of Scarlet Fever among the girls there. I advised as to diagnosis and examined all the girls, one of whom was found to be in a suspicious condition as to desquamation. After she was isolated no further cases occurred. I also advised the governors to build an isolation ward. C.—Sanitary Work. Sewers. 1. During the year the new sewer, taking the drainage of the low lying district, called Abbey Wood was completed, and is now working satisfactorily. It is great matter for congratulation that the constantly recurring nuisance from the formerly existing cesspools is thus abolished. These cesspools have been all filled in. 2. The nuisance from the cesspools on the Heathfield Estate and in King's Highway has continued unabated. Great complaints were made in the summer as to the foul odours from the 18 ditch and water course which flows down the Wickham Valley and takes the overflow of these cesspools and others in Wickham Lane. I frequently inspected these nuisances, and pressed on the Vestry the need of constructing a new sewer. The Vestry decided to do this and plans were prepared. Some delay occurred in obtaining the sanction of the County Council, but the work has now been advertized for contract, and will I hope be completed before my next report. 3. Inspector Rance discovered, in testing with the smoke machine, an obstructed double combined drain passing under a house in Barth Road into the sewer which goes along Hartville Road. I visited it with Inspector Duck and found the pipes three parts full and the sewage almost stagnant. The sewer was also found silted up, running half full with an almost imperceptible flow. The matter was referred to the Surveyor, who filled up the combined drain under the house, and constructed a new drain at the back of the houses opening into a sewer in Benares Road. The sewer is frequently flushed with a water cart. Drain Testing. 4. Previous to 1894 the Vestry, and its predecessor, the Board of Works, had employed no system of drain testing. The Inspectors had occasionally used smoke rockets and tests, such as Kemp's, for discovering the soundness of traps, and a few drains had been tested by a smoke machine, borrowed from the Woolwich Local Board. In March of last year the Vestry on my advice purchased an improved form of smoke machine, made by Burns Brothers, which has been found to act in a very 19 searching way and proved very useful in discovering defects in drains under ground, as well as defective traps and pipes in direct connection with drains above ground. It has been used at all houses where cases of Diphtheria and Enteric Fever have occurred, and at other houses where there has been special reason to suspect defective drainage. About 130 drains (representing perhaps 500 or 600 houses) were tested and about one half were found defective. When the drains are near the surface probably this test is sufficient, but for deeply laid drains the water test should be used. The use of this has, however, not yet been sanctioned by the Vestry. 5. The advance which I consider the most beneficial in the Sanitary work of the year is the order which was made that all new drains should be tested by the smoke machine before being passed by the Surveyor. The necessity of testing new drains had been pointed out by me to the Board of Works at frequent intervals since I have been Medical Officer, but not until the advent to power of the Vestry were my recommendations attended to. 6. I also reported as to the necessity of the County Council bye-laws with respect to the drainage and water closets of new houses being enforced by the Surveyor's department. I believe this is now more effectively done. It formerly frequently happened that the Sanitary Inspectors discovered defects in drainage, and faulty arrangements (such as long hoppers without flushing rims) in water closets, which had been recently passed by the old Board. Table IX. shews that a much larger number of defective drains and water closets are found in East Plumstead than in 20 "West. This shews the bad work executed in recently built houses, and the consequent need for thorough inspection. The Churchyard. 7. The overcrowded condition of the Churchyard again occupied the attention of the Vestry and myself at the beginning of the year. By request of the Health Committee I visited the Churchyard with the Chief Sanitary Inspector. We discovered breaches of the regulations in three newly opened graves. I also paid a visit to Dr. Hoffmann, the Inspector of Burial Places at the Home Office, and laid before him the evidences of the regulations being persistently broken, and made certain suggestions. Dr. Hoffmann though convinced that the regulations were not kept, did not see any way to doing more than he had already done. The Clerk (Mr. Whale) also gave the opinion that the Board could not take summary proceedings in a Police Court for breach of the regulations. Under these circumstances the Board did all that could be done, viz. : they made strong representations to the Home Office on the subject, but no action has yet been taken. The County Council also took up the subject and Dr. Young one of their Medical Officers inspected the Churchyard with me. During the year notices of 318 interments were received by the Chief Inspector. Bakehouses. 8. I made the usual half-yearly inspections of the bakehouses and am able to report that there is a general improvement in their condition as regards lighting, cleansing, &c. In many of 21 the old cellar bakehouses there is still much room for improvement, but this cannot be expected as long as they are allowed to be occupied without certification. I did not find serious sanitary defects in any. Dost Collection. 9. There is now a weekly collection of house refuse all over the parish, provided the dust is brought outside the house by the occupier. When this is not done the collection is for the most part left for at least a fortnight. There is as yet no uniformity in the dust receptacles, but pails according to the County Council bye-laws are becoming commoner, and their provision enforced by the Inspectors wherever no proper dust bin exists, which is found to be the case in the majority of the houses inspected. There is a daily collection in Plumstead Road and High Street. It is very desirable that the collection should be at least weekly in all cases, and should not depend on the occupiers bringing the dnst out. Dust Deposits. 10. I have frequently inspected and reported on deposits of offensive refuse within the prohibited distance (300 yards) of houses, of which the chief were Timbercroft Lane, Roydene Road, and Hargor Road. I have advised the Vestry that these deposits are both temporarily and permanently injurious to health when they are in the neighbourhood of houses already existing, or on ground soon to be built on, and that covering several feet of offensive matter with a few inches of non-offensive earth does not remedy the evil. The Vestry has not, however, been guided by my advice in this matter, and their attitude has 22 no doubt been strengthened by the action of the County Council in allowing deposits on the Common, and by certain recent magisterial decisions on the subject. 13ye-laws for Houses let to two on more families. 11. The Vestry soon after coming into power adopted unchanged the Local Government Board Model bye-laws for "Houses let in lodgings." There has been, however, very considerable unwillingness on the part of the Health Committee to put them in force, and still more dislike on the part of landlords to having their houses registered. I have repeatedly pointed out that the dislike to having houses registered is based on a misapprehension, and Lave pointed to the experience of places like Camberwell, where a large number of houses have been registered without any opposition. So far only three houses have been registered in Plumstead. Houses Inspected. 12. I have kept notes of 93 inspections of houses and premises, but besides these I have inspected a large number in the course of paying medical visits, and of which I have not preserved notes. I found several houses in Thomas Street in a very bad condition as to dirty walls and general dilapidations. They were remedied. I have had frequently to inspect some houses at the top of Palmerston Road on account of basements so damp as to be unfit for habitation. The owner has done a good deal to lessen the dampness. I also frequently inspected come houses in Timbercroft Lane on account of dampness and dilapidations. They have now been placed in a satisfactory condition. 23 13. In one of these houses a woman died suddenly, and a suggestion was made that her death was accelerated by the insanitary condition of the house; an inquest was held and the insanitary condition of the house gone into. I attended and gave evidence shewing that the vestry had in no way neglected to use its powers in the matter. 14 In Llanover Road my attention was called at a meeting of the Charity Organisation Society to a stable, the four rooms over which were inhabited by three families, living in a very neglected and insanitary condition. Notice was served for the sanitary defects and application was made to have the house registered, but the landlord turned the people out, and the house 13 now unoccupied. I found in one of the rooms three children living in a state of great neglect; the Society for Prevention of Cruelty to Children were informed and the father prosecuted and imprisoned. Disinfection in Phthisis. 15. In the spring of last year I obtained the permission of the Yestry to disinfect rooms which had been occupied by cases of consumption, after either death or removal. I wrote to all the local medical practitioners informing them of the willingness of the Vestry to disinfect free of charge in such cases, but so far only three applications have been received. Disinfectants are also supplied gratis for use in spittoons, when application is made. The Arsenal Ditch. 16. This ditch continues to be a nuisaoce between the intervals when it is cleaned out. The War Office is unwilling to have it filled in, which is the only permanent remedy. 24 Police Court Proceedings. 17. There have been but very few, 13, prosecutions during the year under the Public Health Act. Last year the number was 35. The Clerk to the vestry, unlike the Clerk of the defunct Board of Works, makes a practice of writing to defaulters after the expiration of the notice warning them that proceedings will be taken if the work ordered is not executed forthwith Thus a little more time is gained and the work is usually commenced before a summons has been applied for. Whatever the merits or demerits of this practice in other ways it certainly reduces the number of Police Court proceedings. 18. Smart and Campbell. There was one case in which two men, named Smart and Campbell, were summoned for improperly repairing a drain in White Hart Lane. An obstruction had been caused by driving a paling through a combined drain, and when the drain had been partially cleared a large hole in one pipe was covered by laying over it a piece of slate. The offence was admitted but a defence was made that the repair was only meant to be temporary, and as less than one week had expired since the work was done the magistrate refused to convict. He stated however that it was a very serious offence and that if there had been proof that the work was meant to be permanent, he would have inflicted the full penalty of £20. He ordered the defendants to pay the costs. 19. Purches. A man named Purches was also summoned for a similar offence committed in Coxwell Road. He had repaired a drain by laying an old tea-tray over it. He made the same defence as to the work not being intended to be permanent, but the magistrate fined him £5 and costs. 25 20. It is much to be regretted that proceedings taken in the Woolwich Police Court for the remedying of nuisances do not obtain more publicity. The publicity which usually attends legal proceedings has a most valuable educational effect and is more deterrent than the fear of a fine. But it repeatedly happens that important prosecutions like that of Smart and Campbell and Purches are hardly noticed in the local newspapers. Tents and Vans. 21. In the beginning of last year there was an encampment of gipsies in a field in Timbercroft Lane. This was frequently visited by the Inspectors and I also inspected it myself. The occupants of about half-a-dozen tents and vans were drinking the water of a neighbouring pond and defiling the field with accumulations of filth. A notice was served on the owner of the field to remedy the nuisance and the gipsies as a result took their departure. Seeing that it is seldom there are not some tents and vans in the parish used for habitation it would be advisable for the vestry to use its powers and adopt some bye-laws for their sanitary regulation. Overcrowding. 22. Fourteen cases of overcrowding were found, all of which were abated, most of them without notices being served. Health Refuge. 23. The Health Refuge was used on nine occasions by families comprising about 20 people. In all cases I saw the family before they went to the refuge and satisfied myself that there was no danger of infection by their removal pending the disinfection of their premises. 26 House to house inspection. 24. Table IX. shews the tabulated work of the Sanitary Inspectors during the year. The house to house inspection has continued but not so rapidly as in 1893, as more time has been occupied in thoroughly examining the drainage of all houses in which there was reason for suspecting anything amiss. Altogether nearly 2000 houses were inspected house to house, at which rate the whole parish would be re-inspected in five years. The whole parish has already been inspected house to house in the years 1892 and 1893, so that it is not necessary to reinspect the whole at the same rate, but rather to make frequent inspection of those houses and streets which have been found to require it. This is what is being done. 25. On the whole the sanitary work of the year will compare favourably with that of preceding years; it was more thorough and very much more has been done in improving drainage. More damp walls have also been remedied. Mortjary. 26. I visited the Mortuary on different occasions and found it kept in a satisfactory condition. During the year a gas stove was provided and other small improvements made. No steps have yet been taken for providing a mortuary more adequate for the size of the parish. 27. Various arrangements resulting from the separation of Plumstead and the constituting of the Vestry as Sanitary authority, have helped to facilitate the working of the sanitary 27 department. Chief among these is the fact that all the meetings are held and clerical work performed at the Vestry Offices; then the recommendations of the Health Committee only have to be considered at one other meeting of the Sanitary Authority if at all. The fact, too, that the Vestry Clerk can be seen every morning in his office on the Vestry premises is a very great convenience to the Sanitary officers. 28. In conclusion I have much pleasure in acknowledging the unflagging and conssientious work of the Sanitary Staff, and the kind co-operation of the other Officers of the Vestry. I am, Gentlemen, Tour obedient Servant, SIDNEY DAVIES. March 31st, 1895. 28 TABLE I. Summary of Statistics for 1894, compared with Registration London. Plumstead. London. 1. Area 3,388 acres. 77,410 acres. Inhabited houses, June, 1894 9,329 Number of persons to a house 6.2 2. Population—Census, 1891 52,436 4,221,452 Population estimated to the middle of 1894 in method adopted by Registrar General (1) 59,233 4,349,166 Population estimated for Equalisation of Rates Bill (2) 56,810 Total deaths—corrected 736 77,039 Total births 1,910 130,552 Natural increase of population 1,174 Estimated increase 2,160 3. Birth-rate 32.2 301 Death-rate (1) 12.4 17.8 „ „ (2) 12.9 Zymotic death-rate (1) 2.06 2.7 „ „ (2) 2.16 Deaths under 1 year to 1000 births (Infantile death-rate.) 94 143 4. Uncertified deaths (Per cent, of total deaths.) 3.6 0.8 Deaths from violence 19 Inquest cases 35 5. Death-rate, 1892 15.2 20.3 „ „ 1893 17.5 21.3 „ „ 1894 (1) 12.4 17.8 „ „ (2) 12.9 TABLE II. Births and Deaths for each Quarter of the year corrected for deaths in Union and outlying Hospitals. Date. Births. Deaths. Small Pox. Scarlet Fever. Diphtheria. Membranous Croup. Enteric Fever. Puerperal Fever. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea. Rheumatic Fever. Influenza. Phthisis. Other Tubercular Diseases. Cancer and Neoplasms. Alcoholic Diseases. Bronchitis Pneumonia Pleurisy. Heart Disease. Labour and Sequelae. Prem. Birth and Low Vitality Injuries. All other Diseases. Total. Not certified. Inquests. under 1 year 1 and under 5 5—15 15—25 25—65 over 65 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 under 5 over 5 Jan.-Mar 490 230 52 46 16 14 66 36 1 3 2 2 4 1 1 22 1 1 1 1 5 22 6 1 7 7 31 28 14 4 17 2 2 11 33 98 132 4 4 6 6 Apr.-June 502 162 38 26 12 6 51 29 1 4 3 5 2 1 1 4 1 1 5 1 12 1 1 4 9 14 13 16 2 4 20 37 64 98 3 3 4 4 July-Sep 478 162 42 19 9 8 59 25 3 3 4 1 1 1 2 1 6 1 18 7 3 15 2 2 8 11 2 22 3 4 12 30 61 101 2 4 3 6 Oct.-Dec. 440 182 48 36 14 8 50 26 2 1 11 5 1 1 1 17 3 3 1 1 18 4 2 5 5 20 12 13 3 14 2 8 27 84 98 2 5 1 5 Total 1910 736 180 127 51 36 226 116 2 12 9 22 12 4 2 1 5 3 1 1 18 2 30 10 2 3 1 6 70 18 7 31 14 62 62 51 9 69 7 12 51 127 307 429 11 16 14 21 TABLE . (A.) Table of DEATHS during the Year 1894 in Plumstead Parish, classified according to Diseases, Ages, and Localities. Names or Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. (Columns for Population and Births are in Table B. (a.) Mortality from all causes, at subjoined Ages. (i) Mortality from subjoined causes, distinguishing Deaths of Children under Five Years or Age. At all ages. (b) Under 1 year. (c) 1 and under 5 (d) 5 and under 15 (e) 15 and under 25 (f) 25 and under 65 (g) 65 and upwards (h) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentry. Rheumatic Fever. Ague. Phthisis Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All Other Diseases. Total. Typhus. Enteric or Typhoid. Continued Relapsing Puerperal west plumstead 172 38 31 5 6 58 34 Under 5 0 2 3 1 0 1 0 0 0 0 0 5 7 1 0 0 0 14 0 2 33 69 5 upwds. 0 0 2 0 0 1 0 0 1 0 0 1 0 0 1 0 22 16 15 1 43 103 east plumstead (Exclusive of Union.) 437 139 78 29 22 116 53 Under 5 0 1 11 3 0 0 0 0 0 0 0 13 23 9 2 0 0 46 0 5 104 217 5 upwds. 1 2 4 2 0 3 0 0 1 1 0 1 0 0 2 0 33 34 28 4 104 220 union workhouse & infirmary 167 4 7 2 5 88 61 Under 5 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 4 0 0 6 11 5 upwds. 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 31 35 9 8 71 156 TOTALS 776 181 116 36 33 262 148 Under 5 0 3 14 4 0 1 0 0 0 0 0 18 30 11 2 0 0 64 0 7 143 297 5 upwds. 1 2 6 2 0 4 0 0 3 1 1 2 0 0 3 0 86 85 62 13 218 479 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. 69 2 17 16 6 24 4 Under 5 0 9 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 19 5 upwds. 1 7 6 0 0 1 0 0 0 0 0 0 0 0 0 0 8 1 7 4 15 50 Deaths occurring within the district among persons not belonging thereto. 109 3 6 1 3 60 36 Under 5 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 3 0 0 5 9 5 upwds. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24 24 8 5 39 100 TABLE IV. (B) Table of POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1894, in the Parish of Plumstead, London District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. (a) Population at all Ages. Registered Births. Aged under 5 or over 5. (e) New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census 1891. (b) Estimated to middle of 1894. (c) 1 2 3 4 5 6 7 8 9 10 11 Total. 1 2 3 4 5 6 7 8 9 10 11 12 Smallpox. Scarlatina j Diphtheria. Membranous Croup Fevers. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas, Total. Typhus. Enteric or Typhoid. Continued Relapsing Puerperal Cholera. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal st. james 4696 .. .. Under 5 0 12 3 0 0 0 0 0 0 0 0 15 0 9 2 0 0 0 0 0 0 0 0 11 5 upwds. 0 19 6 0 0 2 0 0 1 0 4 32 0 13 2 0 0 0 0 0 0 0 0 15 st. margaret 12550 .. .. Under 5 0 39 6 1 0 0 0 0 0 0 2 48 0 28 3 0 0 0 0 0 0 0 0 31 5 upwds. 4 101 26 0 0 2 0 0 1 0 19 153 3 76 11 0 0 0 0 0 0 0 1 91 all saints 5966 .. .. Under 5 0 14 5 0 0 1 0 0 0 0 1 21 0 7 2 0 0 0 0 0 0 0 0 9 5 upwds. 4 16 6 0 0 0 0 0 0 0 10 36 1 9 4 0 0 0 0 0 0 0 1 15 st. john 5752 .. .. Under 5 0 12 2 0 0 0 0 0 0 0 1 15 0 10 0 0 0 0 0 0 0 0 0 10 5 upwds. 4 18 5 0 0 4 0 0 0 0 6 37 3 8 3 0 0 2 0 0 0 0 0 16 st. nicholas 23207 .. .. Under 5 1 79 25 8 0 2 0 0 0 0 1 116 1 41 7 0 0 2 0 0 0 0 0 51 5 upwds. 9 170 23 2 0 15 0 0 0 1 16 236 7 130 5 0 0 9 0 0 0 0 0 151 workhouse .. .. .. Under 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 upwds. 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 infirmary .. .. .. Under 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 upwds. 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 totals 52436 59233 1910 Under 5 1 156 41 9 0 3 0 0 0 0 5 215 1 95 14 0 0 2 0 0 0 0 0 112 5 upwds. 21 324 66 2 0 23 0 0 2 1 59 498 14 236 25 0 0 11 0 0 0 0 2 288 State here whether "Notification of Infectious Disease " is compulsory in the District—Yes. Since when ?—Notification Act. State here the name of the Isolation Hospital used by the sick of the District. Mark (H) the Locality in which such Hospital is situated; and if not within the District, state where it is situated—South Eastern Fever Hospital, Deptford. TABLE V. SCARLET FEVER AND DIPHTHERIA. Total Cases. AGES. SEX. Houses with 1 Case Houses with 2 Cases Houses with 3 Cases No. to Hospital Ancona Road. Earl Street. Vicarage Road. Plumstead Road. Purrett Road. Bloomfield Road. The lade. Burrage Grove. Church Terrace. Eglinton Road. High Street. Conway Road. Knee Hill Abbey Wood. Under 1 1 to 5 5 to 10 10 to 20 Over 20 Males. Females On Roll 1355 On Roll 936 On Roll 1214 On Roll 1178 On Roll 1132 On Roll 1438 On Roll 890 On Roll 1112 On Roll 195 On Roll 1298 On Roll 974 On Roll 408 On Roll 122 SCARLET FEVER 480 10 142 198 109 21 213 267 480 47 24 331 35 18 20 35 19 25 157 41 5 11 37 6 DIPHTHERIA AND MEMBRANOUS CROUP 118 7 42 41 17 11 45 73 118 9 6 39 11 6 4 8 2 6 25 7 2 2 11 4 TABLE VI. Summary of the Vital Statistics of the Parish of Plumstead, 1885-1894. Year. Estimated Population middle of year. Births. Deaths. Annual Rate per 1000 living. Deaths from Principal Zymotic Diseases Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple and Undefined Fever. Diarrhoea. Deaths of Children under 1 year of age to 1000 births. Births. Deaths. Principal Zymotic Diseases. 1885 40,354 1390 607 34.5 15.1 1.71 69 3 14 2 4 27 .. 5 .. 14 120 1886 42,235 1609 735 38.2 17.5 2.64 111 .. 48 2 11 12 .. 3 1 34 124 1887 44,204 1667 714 37.8 16.2 2.36 104 2 22 2 11 32 .. 2 .. 33 116 1888 46,264 1703 689 36.9 14.9 1.58 73 .. .. 3 19 33 .. 2 .. 16 112 1889 48,420 1852 759 38.4 15.7 2.03 98 .. 43 5 13 14 .. 2 .. 21 115 1890 50,676 1933 923 37.5 17.9 2.47 127 .. 33 11 14 44 1 2 .. 22 137 1891 53,037 1867 920 35.3 17.4 1.57 83 .. 33 1 6 24 .. 4 .. 15 124 1892 55,009 1932 849 35.2 15.5 2.48 136 .. 19 25 38 29 .. 3 .. 22 108 1893 57,073 1914 994 33.6 17.5 3.71 211 2 47 31 65 23 .. 8 .. 35 140 1894 59,233 1910 736 32.2 12.4 2.06 123 2 20 21 34 30 .. 6 •• 10 94 TABLE VII. Analysis of Statistics of the Sanitary Districts of the Metropolis in 1694, after distribution of deaths occurring in Public Institutions. SANITARY AREAS. Estimated Population middle of 1894. Births. Deaths. Annual Rate per 1000 living. Deaths from Principal Zymotic Diseases Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough Typhus. Enteric Fever. Simple and undefined Fever. Diarrhoea. Phthisis. Deaths of Children under 1 year of age to 1000 births. Births. Deaths. Principal Zymotic Diseases. London 4,349,166 130553 75,434 30.1 174 2.6 11,467 89 3,291 961 2,637 2,094 5 608 13 1,769 .. 143 West Districts— Paddington 121,583 2,837 1,826 23.4 15.1 2.4 289 3 66 14 93 45 .. 19 .. 49 .. 137 Kensington 167,350 3,673 2,647 220 15.9 2.1 349 .. 111 22 77 58 .. 21 3 57 .. 173 Hammersmith 105,696 2,901 1,712 27.5 16.2 2.4 256 .. 71 14 50 59 .. 15 .. 47 .. 147 Fulham 110,993 3,763 1,897 34.0 17.1 3.8 425 3 161 33 105 60 .. 5 1 57 .. 149 Chelsea 99,052 2,700 1,619 27.3 16.4 2.3 224 .. 70 16 52 38 .. 14 1 33 .. 131 St. George, Hanover Square 75,033 1,501 1,088 20.1 14.5 1.4 105 1 31 11 19 21 .. 12 .. 10 .. 115 Westminster 54,414 1,235 991 22.8 18.3 20 108 .. 35 7 26 21 .. 5 .. 14 .. 138 St. James, Westminster 23,571 464 393 19.7 16.7 2.2 52 l 13 3 15 7 .. 8 .. 5 .. 144 North Districts— Marylebone 138,554 4,304 2,662 31.2 19.3 2.4 328 29 88 40 73 40 .. '23 .. 35 .. 130 Hampstead 75,443 1,472 798 19.6 10.6 1.4 104 3 31 10 19 26 .. 6 1 8 .. 113 St. Pancras 233,739 6,967 4,256 29.9 18.3 2.2 510 8 95 51 118 115 1 38 .. 84 .. 145 Islington 331,900 9,500 5,266 28.7 15.9 2.6 847 3 204 69 221 195 .. 36 .. 119 .. 139 Stoke Newington 34,172 757 334 22.2 9.8 0.9 29 .. 2 6 5 8 .. 3 .. 5 .. 86 Hackney 211,493 6,073 3,241 28.8 15.4 2.6 554 1 186 57 122 68 .. 38 .. 82 .. 127 Central Districts— St. Giles 38,144 1,069 757 28.1 19.9 2.1 78 1 15 2 14 27 .. 8 .. 11 .. 132 St. Martin-in-the-Fields 13,783 23 3 266 17.0 19.4 2.0 27 .. 9 1 6 5 .. 2 .. 4 .. 210 Strand 23,179 547 524 23.7 22.7 2.7 62 .. 16 1 9 21 .. 7 .. 8 .. 179 Holborn 32,438 832 660 25.7 20.4 2.5 81 .. 23 .. 20 21 .. 7 .. 10 .. 180 Clerkenwell 65,312 2,180 1,243 33.5 19.1 2.7 174 .. 49 10 34 38 .. 8 .. 35 .. 145 St. Luke 41,168 1,879 965 45.8 23.5 2.1 87 1 14 10 15 18 .. 3 .. 26 .. 123 London City 34,832 525 679 15.1 19.5 1.1 39 .. 3 9 6 11 .. 6 .. 4 .. 160 East Districts— Shoreditch 123,186 4,332 2,450 35.3 19.9 2.8 350 2 69 28 75 93 1 11 .. 70 .. 160 Bethnal Green 129,840 4,636 2,642 35.8 20.4 3.5 457 5 135 27 133 70 .. 27 .. 60 .. 151 Whitechapel 75,498 3,178 1,613 42.2 21.4 3.1 231 .. 66 23 46 52 .. 10 .. 34 .. 154 St. George-in-the-East 45,360 1,877 1,196 41.5 26.4 5.0 224 .. 49 18 51 41 .. 6 .. 59 .. 185 Limehouse 57,000 1,906 1,403 33.5 24.7 4.3 244 1 93 33 51 27 .. 8 .. 31 .. 174 Mile End Old Town 108,242 4,042 2,281 37.5 21.1 4.1 439 4 157 37 82 74 .. 13 2 70 .. 156 Poplar 170,217 5,800 3,225 34.2 19.0 3.2 549 10 214 40 108 77 .. 31 1 68 .. 153 South Districts— St. Saviour, Southwark 26,712 770 560 28.9 21.0 3.3 87 .. 46 6 20 9 .. 2 .. 4 .. 145 St. George, Southwark 60,060 2,071 1,384 34.6 23.1 3.6 217 .. 80 17 49 27 .. 5 .. 39 .. 186 Newington 118,512 4.201 2,369 35.6 20.0 2.8 327 2 103 19 61 75 .. 14 .. 13 .. 158 St. Olave, Southwark 12,984 431 268 33.3 20.7 2.8 36 .. 19 4 3 7 .. .. 3 .. 128 Bermondsey 84,053 3,095 1,734 36.9 20.7 3.3 279 1 79 23 66 51 1 16 .. 42 .. 146 Rotherhithe 40,365 1,353 764 33.6 19.0 3.3 134 .. 41 15 31 13 .. 2 .. 32 .. 161 Lambeth 282,574 9,231 4,845 32.8 17.2 2.4 676 1 181 64 141 109 .. 46 .. 134 .. 133 Battersea 161,558 5,024 2,573 31.2 16.0 3.1 493 2 151 32 116 75 .. 28 1 88 .. 146 Wandsworth 179,518 4,423 2,224 24.7 12.4 1.8 317 .. 75 20 80 55 .. 21 2 64 .. 114 Camberwell 248,893 7,382 4,045 29.7 16.3 2.8 687 2 186 46 192 137 1 22 .. 101 .. 148 Greenwich 173,128 5,374 2,976 31.1 17.2 3.1 540 .. 144 59 132 112 .. 32 1 60 .. 138 Lee 38,172 794 472 20.9 12.4 1.7 64 2 11 7 21 11 1 3 .. 8 .. 94 Lewisham 79,903 2,040 1,097 25.6 13.8 1.9 154 .. 39 12 30 35 .. 14 .. 24 .. 128 Woolwich 42,309 1,271 753 30.1 17.8 2.6 110 1 39 22 14 12 .. 6 .. 16 .. 136 Plumstead 59,233 1,910 736 32.3 12.5 2.1 124 2 21 23 36 30 - 6 - 6 ... 94 TABLE VIII. Abstract from Mortuary Register for 1894. Date. Age. Sex. Inquest or No. Post Mortem or No. Cause of Death. 1894 Jan. 1st 40 years Female Yes Yes. Failure of heart's action from excessive uterine hemorrhage „ 15th 1 month Male Yes Yes Convulsions „ 27th 34 years Female No No „ 28th 8 weeks Female Yes Yes Suffocation Feb. 6th 49 years Male Yes Yes Fatty degeneration of the heart „ 13th 19 months Female Yes Yes Empyema April 22nd 2 months Male Yes Yes Suffocated by misadventure May 7th 2 years Male Yes Yes Diphtheria „ 30th 21 years Just Male Yes Committed suicide by blowing his head off with a gun whilst temporarily deranged „ 31st breathed Female Yes Yes Suffocated by smothering under bed clothes July 7th 39 years Male Yes Yes Committed suicide during temporary derangement „ 16th Female Yes Fatty degeneration of the heart, nervous exhaustion caused by excessive snuff taking and chronic Alcoholism „ 17th 32 years Male Yes Committed suicide during temporary derangement „ 17th 42 years Male Yes Yes Natural causes Aug. 1st 3 years Male Yes Accidental death (killed on the up-line on South Eastern Railway bottom of Bannockbnrn Road) Sept. 26th 23 years Female Yes Yes Natural causes Oct. 10th 3 weeks Male Yes Yes Nov. 11th 25 years Female Yes Yes Natural causes „ 26th 4 years Male Yes Yes Diphtheria 31 TABLE IX. Summary of Nuisances abated, Notices served, and General Work of the Sanitary Department for 12 months, ended 31st December, 1894:— PREMISES INSPECTED. Inspections and Results. Special in both Districts. Total. West East No. of houses inspected, House to house 1144 749 1893 „ „ re-inspected after service of notices 2048 1589 923 4560 „ ,, houses and premises specially inspected, re infectious diseases and complaints 435 321 845 1601 „ „ new buildings re certificates .. — — 163 163 „ „ where drains have been tested by smoke test 52 74 23 149 NUISANCES ABATED— Drains. Waste pipes from baths, lavatories, and wash-house sinks, repaired or disconnected from drains 11 17 12 40 Choked and defective drains remedied 201 305 102 608 Defective traps abolished 24 49 19 92 Defective and unventilated soil pipes remedied 15 18 12 45 Stables drained — 1 — 1 Combined drains taken up and relaid — — 24 24 No. of houses re-drained by combined drains — — 161 161 W.C's W.C.'s repaired, new traps or pans provided, fittings repaired 58 217 23 298 Water supply apparatus repaired 237 193 43 473 Premises. Interiors cleansed, repaired, and defective roofs repaired 157 250 33 446 Damp walls remedied 40 56 10 106 Paving in yards and wash-houses repaired 129 108 19 256 Through ventilation provided 6 14 2 22 Wash-houses without sinks and outlets for waste water 23 36 59 Defective guttering and rain water pipes 124 83 15 222 Dustbins supplied 134 — — 134 32 TABLE IX.—continued. Inspections and Results. Special in both Districts. Total West East Animals. Accumulations of manure removed 3 22 9 34 Animals kept in such a state, as to be a nuisance 4 7 5 16 Water. Defective and foul rain water tanks remedied 13 .. 3 16 Defective water pipes flooding premises remedied 23 23 10 56 Insufficient supply for domestic purposes 13 11 5 29 Miscellaneous. Seizures of unsound food .. .. 3 3 Obstructions of footpaths .. .. 10 10 Summonses at the Police Court .. .. 18 18 Cases of overcrowding remedied 6 1 7 14 Ditches cleansed Bakehouses cleansed 23 .. ..9 9 23 DISINFECTION. Total No of houses disinfected after infectious disease 679 „ Cases disinfected for other parishes (Lee & Eltham) 66 CLERICAL WORK. Letters received 745 „ written 924 Notifications received 713 Certificates issued after disinfection 2716 Certificates of infectious disease forwarded to schools 1193 2756