PL44 PLUMSTEAD VESTRY. ANNUAL REPORT OF THE Medical Officer of Health. 1897. H. Pryce & Son, Steam Printers (Reg. L.S.C.), Woolwich. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, PLUMSTEAD, 1897. To the Chairman and Members of the Plumstead Vestry. Gentlemen, I have the honour to present to you my Seventh Annual Report on the health of Plumstead. A.—Vital Statistics. Population. 1. Supposing the population to have continued to increase since April 1st, 1896, at the same rate as it was found to have increased from 1891 to 1896, it would have been 61,090 on the 30th June last. This is the population I have taken as the basis of the various birth and death rates given in the tables. Estimated on this population, the number of persons to a house remains the same as at the Census. But, judging by the well-known fact that the supply of new houses has not kept pace with the demand, it is probable that the number of persons to a house, and the population, are somewhat under-estimated. a 2 2. I have corrected Table VI. by means of the population found at the last Census back to 1892, so that it is now as correct as it can be made. Births. 3. The birth-rate 32.3 was slightly lower than last year, and lower than any previous year recorded except 1895. In West Plumstead it decreased from 29.0 to 27.7, but in East Plumstead it decreased only from 34.1 to 34 0. Deaths. 4. The death-rate 13.6 was lower than in any year since 1885, with the exception of 1894, when it was 12.9. Table A. Year. 1889 1890 1891 1892 1893 1894 1895 1896 1897 Deaths from Influenza.. 0 9 44 27 35 7 17 9 9 „ Bronchitis and Pneumonia 93 136 207 176 204 124 166 138 126 ,, Phthisis 69 95 114 100 111 70 96 81 96 Total 162 240 365 303 350 201 279 228 231 Total deaths, all causes 759 923 920 849 994 736 930 931 835 Table A shows that Influenza did not greatly affect the death-rate last year. The temperature of the first quarter of the year was above the average, as was also that of the fourth quarter. The deaths from Bronchitis and Pneumonia were below the average. All the zymotic diseases with the exception of Diarrhoea were below the average. On the other hand the Summer was warm, and Diarrhoea was in excess. 3 5. The third or Summer quarter had the highest death-rate, the deaths in each quarter being respectively, 209, 190, 222, 214. Infant Mortality. 6. The deaths under 1 year per 1000 births, 116, were fewer than in the two preceding years. In West Plumstead the number was 106, being higher than in the three preceding years. In East Plumstead it was 119, being lower than the four preceding years, with one exception. 7. The Infant mortality in West and East Plumstead, in recent years, is given in Table B. Table B. Deaths under 1 year per 1000 births:— West. East. 1893 132 143 1894 77 100 1895 96 146 1896 98 145 1897 106 119 Zymotic Death-Rate. 8. The death rate from the principal Zymotic diseases (namely, Small Pox, Scarlet Fever, Diphtheria, Enteric Fever, Measles, Whooping Cough, and Diarrhœa) was 2.2, compared with 2.0, 2 5, and 3.5 in the three preceding years. Diarrhoea was the only Zymotic disease which shewed a prevalence above the average. The rate was 2.0 in West and 2 3 in East Plumstead. a 1 4 Uncertified Deaths. 9. There were 11 uncertified deaths, giving a rate of 1.3 per cent. of total deaths, 3 were under and 8 over five years of of age. This shews a great improvement compared with the last two years, when the rates were 3.0 and 2.9 respectively. Inquests. 10. There were 35 Inquests, compared with 43 and 39 in 1895 and 1896 respectively, 9 were on persons under and 16 on persons over five years of age. Five persons committed suicide ; two men, aged 50 and 52, by hanging; man, aged 26, by shooting while drunk; man, aged 24, by drowning; aud a girl, aged 16, by swallowing carbolic acid. Three women were burnt to death by lamps upset. A child of 7 died from scalds through upsetting a kettle. Two children were suffocated in bed, and an infant of two months died from convulsions caused by improper feeding. Two men died by falls from vehicles, a boy by a fall from a horse, another boy by a fall from a bicycle. A child, aged 2, fractured its skull and died by a fall. One man was crushed in the Arsenal by timber, and another struck by a crane at a wharf. One man was run over by a train. Two men were found drowned in the Thames. A child, aged 3, died from ulceration of the head and neck caused by vermin. One man died from alcoholism. The remainder were from natural causes. Other Causes of Death. 11. There were 36 deaths from cancer, compared with 33, 31, and 39 in the three preceding years; 12 were in West 5 Plumstead and 24 in East. 71 infants died of premature birth and low vitality, compared with 77 last year; 8 were in West and 63 in East Plumstead. 12 deaths were due to alcoholism, or to cirrhosis of the liver which is usually caused by alcoholism. But there is no doubt that, directly and indirectly, undue indulgence in alcohol is responsible for a vastly greater number of deaths, which are attributed to heart disease, bronchitis and pneumonia, diseases of the kidney, phthisis, &c. 12 cases of Rheumatic Fever and 5 cases of sub-acute Rheumatism (17 in all) were nursed by the District Nursing Association ; 9 were in West Plumstead and 8 in East. There was one death only, occurring in East Plumstead. In 1896, 15 cases of Rheumatism were nursed, and 4 died. West and East Plumstead compared. 12. Table D gives the vital statistics for West and East Plumstead, respectively, during the year. West. East. Population—Census, 1891 15867 36566 ,, Census, 1896 16714 42538 ,, Estimated to middle of 1897 16933 44178 No. of persons to a house 5.7 6.33 Birth-rate 27.7 34.0 Death-rate 13.5 13.7 Deaths under 1 year per 1000 births 106 119 Zymotic death-rate 2.0 2.3 Phthisis death-rate 1.6 1.5 East Plumstead compares more favourably with West than was the case last year. 6 PLUMSTEAD COMPARED WITH OTHER SANITARY DISTRICTS. 13. Plumstead has a lower death-rate than any of the large towns except Croydon, and a lower infantile death-rate than any without exception. 14. Compared with the forty-three sanitary districts of the Metropolis, Plumstead came sixth in order as regards the general death-rate, Hampstead, Lewisham, St. George's Hanover Square, Lee and Wandsworth having lower rates. As regards the infantile death-rate, Plumstead has the lowest rate of all (See Table VII.) B,—Infectious Diseases. 15. There were 582 notifications of infectious disease compared with 886, 713, 762 and 631 in four preceding years. Of these 325 went to Hospital, compared with 316 last year. During a period of about ten weeks in the early autumn there was considerable delay in getting patients removed to Hospital, but the rest of the year removal was promptly executed. The new Park Hospital, Lewisham, was opened in October, after which the difficulty of getting patients away diminished. During the first half of the year there was remarkably little infectious disease of any kind. Small Pox. 16. There were no cases of Small Pox compared with three in 1896. Scarlet Fever. 17. There were 372 cases of Scarlet Fever compared with 7 61, 584, 527, 480, 328, and 352 in the six preceding years. The cases were 61 per 1000 population. In London there were 5.1 cases per 1000 population. 233 cases went to Hospital compared with 215 in 1896. There were 6 deaths, 5 at Hospital and one at home, giving death-rate of 2.1 at Hospital and 0 7 at home per 1000 cases. These are far the lowest rates I have yet recorded. In 1893 the rates were 4.0 at home and 8.0 in Hospital; in 1894, 3 3 at home and 4.8 in Hospital; in 1895, 3.0 at home and at Hospital; and in 1896, 4 3 at home and 37 at Hospital. 18. The number of deaths from Scarlet Fever is smaller than in any year since 1891. 19. Table IV. gives the cases occurring in each of the eight wards. These varied from 10.3 in the East ward, 8 3 in the South, 5.3 in the South East, 4.9 in the North East and North West, 4.1 in the North, and 3.7 in the South West to 2.8 in the West. 20. Lee Street and Purrett Road Schools were most affected, Plum Lane, Eglinton Road and Vicarage Road least so. (See Table V.) 21. There were 51 cases in the first quarter, 55 in the second, 60 in the third and 206 in the fourth. Thus more than half the cases occurred in the fourth quarter. 22. There were 278 houses in which one case occurred, and 65 houses in which two or more cases occurred. 8 23. Three children attended Lee Street School with Scarlet Fever for several weeks before their mother called in a doctor. I think this was a case of ignorance, but culpable ignorance. 24. Between the 3rd and 28th June, 12 cases of Scarlet Fever were reported to me, all living in the isolated group of streets known as the Slade district; 8 houses were effected, and children from all these houses attended the Slade Board School; 9 of the patients were themselves scholars at the school. Milk was supplied to the above-mentioned houses from five different sources, and there were exceptionally few cases of Scarlet Fever outside this district. I made enquiries at 5 houses and, with one exception, could find no connection between the cases besides the common school. The exception was that the mother of one patient had visited frequently next door, where another case occurred. In pursuit of what I conceived to be my duty, under these circumstances I visited the school, and asked leave of the head teacher to examine the children, with a view to the detection of any mild and unsuspected cases of Scarlet Fever. The examination consisted solely of viewing the face, ears, throat, and hands of each child. Among the thirty children I examined, I discovered two with unhealthy throats, and one with a discharge from the ear, who I requested might be excluded from school as possible conveyers of infection. The teacher now requested me to desist, saying she thought she had better consult the School Board before submitting any further children for examination. Consequently, no more children were examined, but whether as a result of the action taken, or not, no more cases occurred in connection with this school. 9 25. The outcome of the teacher's communicating with the Board was a letter to your Vestry, severely censuring my action in examining the school children, and stating that the Board could not allow me or any other Medical Officer of Health to examine children in their schools. 26. I reported the above facts to your Vestry at the time, and, on your order, the following reply was sent to the School Board:- "In reply to your letter of 15th July, the Vestry desire me "to enclose a copy of a report received from their Medical "Officer, and say that in view of what is contained therein, "they consider the action of their Medical Officer was "taken in the interests of the Public Health, and with "due consideration to the orders under which he acts. "They consider the examination of children in the Board "Schools, as occasion arises, an important and indispens"able means of arresting infection, and under present "conditions, and until the School Board is in a position to "undertake it, it would appear that the responsibility for "such examinations must fall on Medical Officers of "Health. "They gladly recognise the great services of the School "Board to elementary education, and their willingness "hitherto to co-operate with sanitary authorities in all "measures for preventing infectious diseases, and they "hope the Board will re-consider their decision, and "again, as in the past, give all facilities to Medical "Officers of Health in investigating and putting a stop to "infectious diseases." 10 27. It is interesting in view of the School Board's letters to record the fact that this school was closed in 1894 on the recommendation of Dr. Priestly, my locum tenens, on account of an outbreak of Scarlet Fever. At that time on different occasions Dr. Priestly and I examined children in the school and detected cases of Scarlet Fever in actual attendance. On the reassembling of the school I examined the whole of the children to see that they were free of infection. No objection was then taken to such examinations being made, and it is obvious that in the interests of education as well as of health it is desirable that any unsuspected cases of infectious disease should be detected, and so the necessity of closure of the school be prevented. If the parents objected, or were likely to object to such examinations, it would be reasonable for the Board to exercise their undoubted right to refuse them; but my experience convinces me that nine tenths of the parents are only too glad for such measures to be taken; I have never heard of any objection being made except by those whose children were detected at school in an infectious state, and consequently prevented from attending, and their objections must surely not be regarded. 28. I have little doubt that when the School Board come to seriously study this subject the above considerations must have due weight with them, and I think there is good reason to hope that they will in future, as in the past, seek to facilitate the examination of school children by Health Officers, or perhaps they may adopt an even better course and appoint certain special medical men to systematically examine children in schools as is done in New York and other places, for it cannot be denied that schools are largely concerned in the spread of the infection of many diseases besides Scarlet Fever. There were a few cases of Scarlet Fever at Conway Road 11 school, and I visited the school and examined several cases by request of the teachers as on previous occasions (since the School Boards letter I have, of course, abstained from making such examinations). 29. Return Cases.—In five cases of Scarlet Fever it appeared probable that the patient caught the infection from another child in the house who had returned home from the Fever Hospital or Convalescent Home. The intervals that elapsed between the return of one child and commencement of illness of the other varied from five to ten days. In one case, the convalescent child had, on return, a severe cold, with running from the nose and roughness of the skin of hands and legs. In another case, there were sores on the face and nose, and in a third, a sore and discharge from the left nostril. The patients had all been away from home for a considerable time, one as long as 12 weeks. Diphtheria. 30. There were 131 cases of Diphtheria and Croup compared with 37, 118, 179, 118, 148 and 198 in the six preceding years. There were only 24 deaths, which is fewer than in any year since 1891. (See Table VI.) 0 cases went to Hospital, of whom 10 died, giving a death-rate per 100 cases of 12. The death-rate at home was 27 per cent. The death-rate at home in the past five years was 30, 32, 25, 33 and 27 respectively, and at Hospital 50, 35, 19, 26 and 10. I believe this remarkable decrease in the Hospital 12 tality is due to the employment of anti-toxin. It is a subject for congratulation that the employment of this Dew remedy has to a large extent robbed Diphtheria of its terror; the only regret being that its cost and difficulty of application militate against its use in private practice. During the year the Public Health Committee authorised me to procure anti-toxin and supply it free of cost for use by medical men when patients could not be at once removed to Hospital on account of want of accommodation. Later on the Asylums Board undertook to supply Medical Officers of Health with the remedy to be used in the same way, but the opening of the Park Hospital has rendered the proposed course so far unnecessary. Per 1000 population there were 2.2 cases in Plumstead and 2 9 in London. 31. The following are the rates per 1000 population of cases occurring in the several wards:—South, 3.6; South West, 3.0; North West, 2 2; East, 2.0; North, 1.8; South East, 16; West, 1.5; North East, 1.4. As in last year the South and South West shew a comparatively high prevalence, aud the North East a low one. The West Ward on the other hand had less Diphtheria than for many years past, and the South East much less than in 1896. The Slade school was most affected, and after it Burrage Grove, High Street, and Ancona Eoad. No cases occurred at Eglinton Road schools and only 3 at Bloornfield Road. 32. The 132 cases occurred in 111 houses. 13 Only in 14 houses did the disease affect more than one person. As in former years the disease fell most heavily on the age period 1-5, and next most heavily on the period 5-10. 33. As possibly connected with the disease of Diphtheria we may take note that up to the middle of the year, 21 ventilating shafts have been erected and 15 manholes closed. These changes were principally in the West and South East wards, viz:—There were 6 shafts erected in the South East ward, and 5 in the West; 3 in the South, 2 in the North West, and 1 each in the North East, North, and East wards. 34. Two cases contracted Diphtheria on their return from Hospital, after having Scarlet Fever, one within nine days, the other within five days of return. 35. There were 16 cases in the first quarter of the year, 20 in the second, 30 in the third, and 66 in the fourth quarter. Thus, as with Scarlet Fever, the great majority of the cases occurred in the fourth quarter. This is usually the case, though not to so marked an extent. 36. I learn from the last annual report of the Medical Officer of the County Council that, in five sanitary districts, arrangements have been made to afford facilities to medical practitioners for bacteriological examination in doubtful cases of Diphtheria. The districts referred to are: St. Pancras, St. Marylebone, St. Olave's, Holborn, and the Strand. St. George's, Southwark, is proposing to follow suit. The same practice is pursued at Aberdeen, Bristol, Croydon, Dundee, Leeds, Liverpool, Londonderry, Manchester, Newcastle, St. Helen's, Sheffield, &c. 14 I would repeat the recommendation made in my last report, that this important means of preventing Diphtheria should be taken in Plumstead. The first requisite for preventing a disease, is the taking of measures for recognizing it when it occurs; and bacteriological examination is the only way of recognizing this disease in many cases. Enteric Fever. 37. There were 25 cases of Enteric Fever, compared with 22, 29, 26, 214, and 29 in the five preceding years. There were 3 deaths, the lowest number since 1892. 12 cases went to Hospital, 2 died there. Table IV. shews the number in each ward, from which it appears that most cases occurred in the East and South wards. This was the same last year. 38. In four cases, the disease appeared to have been contracted at places outside Plumstead, namely, Earle's Colne, Maidstone, Bayswater, and Sandgate. One case was the nurse of a previous one. 39. 14 cases were males, and 11 females; 4 were under 10, 7 from 10 to 20, and 14 over 20 years of age. 40. One patient was a greengrocer, and one had eaten some whelks eight days before the illness began. In 7 cases there were serious sanitary defects in the patient's house, and in other cases minor defects. One man worked on a house refuse tip. 41. There were 0.4 cases per 1000 population. In London there were 0.7, or nearly twice as many in proportion to population. 15 puerperal fever. 42. There were 3 cases of Puerperal Fever, compared with 7 and 3 in the two preceding years. One died. Besides this death, seven women died of labour and its sequelae. Two cases were attended by one midwife. At my request, she abstained temporarily from her profession, performed thorough disinfection, and notified all the cases she attended for a month afterwards. Cholera. 43. The four cases returned as Cholera were all notified by one medical man, and would probably be more correctly named Diarrhoea, or Gastro-Enteritis. None of them died, and none were of the nature of Asiatic Cholera. Erysipelas. 44. There were 46 cases of Erysipelas, compared with 53 and 43 in the two preceding years. Two died, one of whom was over 5 years of age and one under 5. The first of these, an infant of two months, contracted the disease shortly after the second visit to the vaccination station for inspection after vaccination. I have no doubt that the vaccination was not itself the cause of the Erysipelas, but any person with sores on the body is liable to infection by this disease, and it is not unlikely that among the persons with whom the child came into contact at the vaccinating station, there was someone suffering from Erysipelas. It is desirable that vaccination sores should be carefully dressed with antiseptic precautions, until they heal. Two other infants 16 were attacked with Erysipelas about the same time, after the second visit to the vaccination station. Probably they were all affected by the same person. Measles. 45. Only three deaths from Measles occurred during the year, compared with 68 in the previous year. 46. In my last report, reference was made to my unsuccessful efforts to arrange for a school notification of Measles. 1 have now found that the School Board Code already provided for this, but, owing to the paragraph in which it is contained being somewhat ambiguously worded, teachers generally were unaware of their duty in this respect. On my recommendation, the Vestry wrote to the School Board calling their attention to the fact that teachers did not understand the rule concerning notification of absentees on account of infectious diseases, to apply to diseases which, like Measles, were non-notifiable; and asking the Board to call their attention to their duty in this respect. This the Board has done, but I regret to say, there are still a large number of teachers who pay no attention to the Board's instructions. I have, however, already received a large number of notifications, and I have reason to hope that the action I have been able to take upon them has materially contributed to lessen the spread of the Measles epidemic now prevailing. Phthisis. 47. There were 96 deaths from Phthisis, compared with 70, 96, and 81 in the three preceding years. 17 There were, in addition, 26 deaths from other tubercular diseases, 22 being under 5 years of age, and 4 over 5 years. Thus 122 deaths were attributed to tubercle, which is more than one-seventh of the total number of deaths. Of the deaths over 5 years of age, one-fifth were due to tubercle. 48. The death-rate from Phthisis in "West Plumstead was 1.6, and in East Plumstead 1.5. In 1896 it was 1.2 and 1.4 respectively. 49. Disinfecting fluid was supplied to a large number of cases for use in spittoons, but, I regret to say, that only six people availed themselves of the Vestry's willingness to disinfect rooms and bedding after a death from Phthisis, or at other times. Thus, probably, in 90 cases the rooms where people had died from this fatal infectious disease continued to be occupied without any disinfection. 50. In several cases the houses where the patients had died had damp walls. 51. It appears from the annual report for 1896, of the Medical Officer of Health of the County Council, that seven sanitary arrears of London had a lower Phthisis mortality than Plumstead, namely, Stoke Newington, Wandsworth, Lewisham, Lee, Hampstead, Paddington, and St. George's, Hanover Square. Plumstead was 1.35, London 1.68, and Woolwich 209. G.—Sanitary Work. 52. Water Supply.—There has been no complaint as to the water supply, and it appears from the reports of the official Analysts that it maintains its high character. B 18 I have just learnt that the County Council hope to be able to persuade the Kent Water Company to provide a constant supply to houses on the top of Shooters' Hill, though there is no power to compel this. If successful, great advantage will accrue to that part of the parish. The Vestry took proceedings against the owner of the White Cottage, in Bostal Woods, in order to obtain a closing order, on the ground that this house was without a proper and sufficient water supply. Water was supplied at the cottage to visitors to the woods, and it was, therefore, specially desirable that there should be a pure and plentiful supply. But the only source of pure water was a house over a quarter-of-a-mile distant. The magistrate held that the Public Health Act required water to be laid on to every house, and accordingly made a closing order. Water has also been laid on to the Old Manor House, as the result of a similar summons. 53. Sewer Ventilation.—I have already stated, in para. 33, that 21 new ventilating shafts have been erected, and 15 open manholes have been closed. I am glad to be able to say, that the fear I expressed in my last report, that nuisances would arise by sewer gas passing from the shafts to the upper windows of houses on a higher level has not been realised. So far, I have heard no complaints of this nature, and the shafts seem to be fulfilling their end satisfactorily. There were, during the year, very numerous and repeated complaints of nuisance from the open manholes, largely due, 19 no doubt to the small rainfall. I consider that the flushing of sewers, in dry weather, should be carried out systematically and thoroughly. 54. Sewer Insufficiencies.—During some of the heavy rainfalls which occurred last Summer, flooding occurred at certain houses, more especially at Raglan Road and Crescent Road. At one house in Crescent Road very serious and repeated nuisance was caused by the drain of the house backing up, owing to the sewer being surcharged. Water was observed to spout out like a fountain from the manhole in the road opposite this house, and this again caused flooding of other houses. The Health Committee visited the spot with the Surveyor and myself, and it was decided to drain the house into the Eton Road Sewer. 55. The Level Ditches.—I inspected the level ditches and found them to be in a very unsatisfactory state, as regards cleanliness. The Surveyor was instructed to report on the matter, and made several recommendations for improving their condition. I also communicated, unofficially, with the Arsenal Authorities, and was assured by them that the temporarily interrupted flushing performed by them would be continued. This promise has been kept. There is no doubt that the cleanliness of these ditches will require increased vigilence now that the population has so much increased, and the levels are more used and frequented for various purposes. b 2 20 It should be a matter for consideration by the Works Committee which ditches may be dispensed with and filled up. 56. The Churchyard.—There were 177 interments in the churchyard, as compared with 318, 358 and 253 in the three preceding years. I inspected it and found it maintained as before. 57. The Cemetery.—I inspected the Cemetery and found it in a satisfactory condition as before. 58. The Mortuary.—I visited the Mortuary and found it was kept clean. It was used for 31 bodies as compared with 19, 35 and 23 the three preceding years. Two bodies died of infectious diseases. There were 16 post mortems. The new mortuary is still in abeyance, though much required. The existing one offers very inadequate accommodation, and a better appointed building would probably be more used, and found a great convenience in many cases, to people with inadequate house accommodation. 59. The Health Refuge.—The new Health Refuge was completed in the early part of the year. I inspected it and found it satisfactory and well kept. It was not once used during the year. 60. Bakehouses.—I inspected the Bakehouses as usual, and found them, on the whole, in a satisfactory condition. 18 out of the 38 are underground; one of these has been much improved during the year. As a rule, it is the bakehouses where pastry is made in which it is most difficult to secure thorough cleanliness. 21 61. Cowhouses.—I inspected all the Cowhouses in company with the Chief Sanitary Inspector. Compared with previous years they shewed some slight improvement. I observe however, with regret, that there is an increased tendency to keep the cows in the sheds all the year, instead of sending them out to grass as formerly. There is no doubt that continual confinement conduces to the spread of tubercle. As I remarked last year, we are, in London, far behind many foreign towns in the conduct of dairies and cowsheds. It is common abroad to have the cows systematically inspected by trained veterinary surgeons, for the detection of tubercle and other infectious diseases. Further, at many places, both abroad and in England, measures are taken to detect and separate all cows suffering from tubercle by means of the injection of Koch's tuberculine. In this way cowsheds can be pronounced with certainty free from the infection of tubercle, and milk from them can be drunk with confidence. The introduction of similar measures in London is one of our most urgent needs, and would probably save the lives of thousands of young children. 62. Slaughterhouses.—I also inspected the slaughterhouses. With one or two exceptions their conditions was found satisfactory, and the defective conditions observed have since been remedied. 63. Gipsy Tents and Vans.—As the number of gipsy tents and vans in the parish has shewn a marked tendency to 22 increase of late years, and some trouble has been found in controlling them, the Vestry determined to adopt bye-laws for promoting their cleanliness and habitual condition and the prevention of infectious diseases and nuisances. Power is given to do this under Sec. 95 (2) of the Public Health Act. Some bye-laws were accordingly drawn up and are awaiting approval by the Local Government Board. 64. Workshops.—I inspected 17 workshops, including 12 dressmakers', 2 tailors', 2 laundries, and 1 soda water. In several cases there was not more than one employe, but in others overcrowding and other insanitary conditions were found and have since been remedied. 65. Dust Shoots.—The bulk of the House Refuse of the Parish was deposited on a shoot on the levels more than 300 yards away from houses. But, on the 7th April, I reported that "I found that house refuse was being shot on Wright's " estate, High Street, within 100 yards of houses." "I wrote to the Contractor, asking him to stop the deposit "at once, and to kindly inform me who had authorized it. I "have received a reply, stating that the Contractor's men shot "the refuse contrary to orders, and that strict orders had been " given not to do so again." The deposit was discontinued for a time, but I have recently learnt that it was recommenced by the new dust contractor. The Public Health Committee have taken steps to prevent this. 66. Dust Collection.—In the middle of the year, the dust collection was given to a new Contractor, who made the lowest tender for the undertaking. 23 I had had to report that the collection was unsatisfactory under the former contractor, but, since the contract was transferred, matters have been far worse, and came to a crisis at Christmas-time, when the collection quite broke down, and in a large number of streets the dust was not collected for three weeks. The Public Health Committee, on the 8th December, ordered proceedings to be taken against the Contractor, but, as it appeared that the Vestry had power to exact a fine without proceedings, no summons was applied for, nor, in the end, was a fine inflicted. The Works Committee instructed the Surveyor to employ men and carts to collect the dust at the Contractor's expense if he did not re-establish a proper collection before a certain date. This threat had the desired effect, and since then the collection has been more satisfactory, though there is still much room for improvement. The dust carts were frequently noticed to be over full and insufficiently covered; the attention of the Contractor was called to this and there has been some improvement, but until proper carts with hinged doors are provided the collection must necessarily be slovenly. In view of the fact that there is now no dust inspector it is of all the more importance that any discovered failure to fulfill his contract on the part of the Contractor should be severely dealt with, for it is more than probable that for one complaint, there are a dozen cases of omission to remove the dust. 67. Smoke Nuisance.—Nuisance by black smoke from the Arsenal chimneys was not so pronounced as in some former 24 years. At the same time there was certainly much more than is desired for the purity of the atmosphere, and more, I think, than is at all necessary. In relation to this I may mention that the question of the exemption of government buildings from the sanitary control of local authorities has recently been the subject of unfavorable comment, and several of the London Vestries, including your own, have made representations to the Local Government Board, asking that this exemption should be discontinued. As things are at present, infectious disease may rage in military barracks unknown to the Medical Officer of Health of the Sanitary district in which they are situated, and nuisances may exist on Government property which, perhaps, seriously affect the health of those living in the neighbourhood, and yet there is no power to deal with them. No doubt Government officials are usually very careful to avoid anything prejudicial to the public, but this cannot always be counted on. 68. Beidhaven Road District.—Since the beginning of 1897, I have obtained returns of the births in this district, and at the end of the year, the Public Health Committee had a Census of the district taken, so that it now possible to give vital statistics of this locality with more accuracy. The results of the Census were as follows:— Houses 567 Population 3733 „ under 1 year 115 „ under 21 years 1951 25 The Census shews an increase of 102 persons over the num bers at which I estimated the population in 1896, from the figures obtained by Mr. Ranee in 1895, thus confirming his figures, and shewing that the population has practically remained stationary. 69. Reidhaven Road Dist. Plumstead. 1894 1895 1896 1897 1894 1895 1896 1897 Total Births .. .. .. 169 1910 1866 1950 1975 Birth Rate .. .. .. 452 336 320 327 323 Total Deaths 72 84 61 79 726 930 931 835 Death Bate 198 231 166 211 124 159 156 13 6 Deaths under 1 year 15 42 26 31 180 250 261 230 „ per 1000 births .. .. .. 183 94 134 133 116 „ from 15 years 17 18 14 13 127 143 176 99 Diphtheria deaths 1 3 5 2 40 31 60 24 „ notifications 5 11 15 6 118 148 198 132 Enteric Fever deaths 2 .. .. .. 6 30 4 3 „ notifications 13 2 3 2 26 214 29 25 Diarrhoea deaths.. 5 12 8 13 10 48 30 81 Phthisis „ .. .. .. 12 70 96 81 96 The adjoining table gives a summary of vital statistics of the Reidhaven Road District during the past four years compared with the whole of Plumstead. The figures for 1894, 1895 and 1896 are those given in my last year's report. 26 I have left out the births and the rates calculated from them in the Reidhaven Road District for the years 1894-96 as these have been found to be under-estimated. The births for 1897 are the actual numbers supplied by the Registrar. I also now obtain from the Registrar the previous addresses of persons dying in the infirmary. Formerly I only knew whether they belonged to Plumstead or other districts. In this way I have learned that a much larger number of deaths from Phthisis belonging to Reidhaven Road District occur in the Infirmary than I was aware of. The numbers for the years 94-96 are thus seen to be under-estimated and I have omitted them. 70. The result of last year's statistics is to shew in the first place a much higher birth-rate (45'2) than I had anticipated. The only sanitary area of the metropolis which has so high a birth-rate is St. Luke's which has also usually a preeminently high death-rate. 71. The death-rate of Reidhaven Road District last year was more than half as high again as in Plumstead. 72. The infantile death-rate, reckoned per 1000 births, was also more than half as high again as in Plumstead. It must be remembered that this rate being reckoned on the number of births, its excessiveness cannot be explained by saying that the birth-rate is high. On the other hand the very high mortality amongst infants under 1 year is no doubt one cause of the high birth-rate; for when a mother loses her baby at the age of 3 months, for instance, lactation ceasing, she will be likely to bear another child six months sooner than she would have done if the first child had lived. 27 73. The deaths from Diarrhœa are, in proportion to population, more than twice as numerous as in Plumstead, and the deaths from Phthisis just twice as numerous ; the notifications from Enteric Fever were more numerous, and the deaths from Diphtheria; but the notifications of Diphtheria were less numerous, and there were no deaths from Enteric Fever. 74. The above results corroborate the conclusions I arrived at in my special report on this district, and shew that there is as yet no marked improvement in the insanitary conditions there pointed out. 75. I believe the chief among the many insanitary conditions conducing to cause so high a mortality are (1) the lowness of the site of this district and the consequent high level of the ground water; (2) the fact that the subsoil is largely contaminated with organic matter, partly from previous dust deposits, partly from defective drains; (3) the overcrowded and dirty condition of many of the houses. And the remedies are (1) to prevent the rising of ground air by cementing the basement of houses not already thus protected ; (2) the more thorough inspection of, and use of, the water test for all relaid drains ; and (3) the enforcement of the bye-laws for houses occupied by more than one family. 76. The County Couucil bye-laws for new drains, &c., which enforce the use of the water test, still await confirmation, but will not, I understand, be long delayed. The Inspectoks' Work (see Table IX.) 77. The number of houses inspected, house to house, by Inspectors was 2082, or 460 more than last year. Besides 28 tbese 2342 houses were inspected re Infectious Disease and Complaints, making a total of 4424. 1884 intimation notices were served, and following on them and the subsequent 555 statutory notices, there were 5720 re-inspections, making an average of over 3 re-inspections for each notice. But we may take it that approximately 1329 cases in which no statutory notice was served only required one re-inspection, and consequently there were 4391 re-inspection3 for the remaining 555 houses, or 8 a-piece. 78. Of course there are certain nuisances of a difficult and complicated nature which require repeated visits to determine the nature of the remedy to be applied, but after due allowance is made for these there Will remain a large number in which it is evident, from the above figures, that the Inspectors' time and consequently the ratepayers' money is grossly wasted by the neglect of certain landlords, to attend to the notices they receive. It will be noticed that 191 cases were reported to the Clerk for proceedings, but only in 42 of them were summonses taken out (the work being done in the other cases after a letter from the Clerk), only in one case was a fine inflicted, and only in two cases did the costs obtained exceed 3/- (there was a conviction in every case but one). Now I cannot but think that if proceedings had been taken in every one of the 191 cases, and the Magistrates pressed to impose a penalty and costs which would cover the Officer's loss of time, there would ensue a very marked increase of attention to the notices which the Vestry serves, a great advantage to the public health, and a great saving in Officers' time. 79. The sole occasion of a fine being inflicted was when a caretaker obstructed a Sanitary Inspector by refusing entry after due notice. The penalty paid for this offence was 20/-. 29 80. The Inspectors found several cases in which the County Council Bye-Laws for new houses were not carried out, the principal contraventions being cheap, improper forms of traps, no windows in w.c.'s, and defective joints of the house ventilating shafts. I have pointed out in previous reports the great desirability of these bye-laws being enforced, when the houses are being built. 81. Only 193 houses were tested with the smoke test compared with 408 in the previous year. As indicating fewer defective drains found this is satisfactory. 82. 39 defective combined drains were examined, compared with 31 in 1896. 83. 38 cases of overcrowding were found, compared with 21 last year. 14 of these I inspected personally. The great increase this year is remarkable. There is no doubt that considerable difficulty is found by people with families in getting house accommodation, owing to the building of houses not keeping pace with the increase of population. There is a crying need for cheaper house accommodation. In several cases, even when overcrowding was not marked, I found cases of indecency in sleeping arrangements. Thus in one case a daughter over 20 slept in the same bedroom as her parents, and in two or three other cases grown up sons slept in the same room as their widowed mother. The cases of overcrowding were mostly remedied by rearrangement of sleeping accommodation. In others notices 30 were served, but it was necessary usually to give a protracted period for the families affected to find a new house. 84. Twelve houses were proposed to be registered during the year, under the bye-laws for houses let in lodgings, but in all cases but one, the registration notices resulted in the tenants being turned out, and the house being occupied by one family only. At the beginning of the year only four houses remained on the register; 92, Reidhaven Road, 91, Hudson Road, 16|, Pattiaon Road, and 2, Plumstead Common Road. 85. Additional Inspector.—Your Vestry decided in the middle of the year to obtain the services of an additional Sanitary Inspector, and Mr. Wood was chosen out of 87 who applied. So far he has fully justified the Vestry's choice. 86. I acknowledge with gratitude the assistance I have received in all ways from the Chief Inspector, and the conscientious work of the whole of the staff. I have the honour to be, Gentlemen, Your obedient Servant, SIDNEY DAVIES. TABLES. 32 TABLE I. Summary of Statistics for 1897, compared with Registration London. Plumstead. London. 1. Area 3,388 acres 77,410 acres Inhabited houses (June, 1897) 9,934 Number of persons to a house 614 2. Population (Census 1896) 59,252 4,421,955 Population estimated to June 30th, 1897 61,090 4,463,169 Total Deaths (corrected for Public tions) 835 80943 Total Births 1975 133,618 Natural increase of population 1140 52,675 Estimated increase 1475 41,214 3. Birth Rate 32.3 30.0 Death Rate 13.6 18.2 Zymotic Death Rate 2.2 2.58 Deaths under 1 year to 1000 births 116 159 4. Uncertified deaths per cent, of total deaths 1.3 0.6 Deaths from violence 25 Inquest cases 35 5. Death Rate, 1895 15.9 19.4 „ 1896 15.6 18.2 „ 1897 13.6 18.2 TABLE II. Births and Deaths for each quarter of the year, corrected for Deaths in Workhouse, Infirmary, and Out-lying Institutions. Other diseases included under all other diseases. Date. Births. Total Deaths. Under 1 Year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. Over 65. Small Pox. Scarlatina. Diphtheria. Memb. Croup. Typhus. Enteric. Continued. Relapsing. Puerperal. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea Dysentery. Rheumatic Fever. Cancer. Other Tubercular Diseases Phthisis Bronchitis, Pneumonia, Pleurisy. Heart Disease. Injuries. All other Diseases. Total Influenza. Alcohol. Labour and Sequelae. Prem. birth & low vitality Not certified. Inquests. 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. under 5. over 5. under 5. over 5. under 5. over 5. West Plum- stead. 1st Qr. 113 62 14 6 1 3 21 17 3 2 2 7 8 6 7 7 20 20 42 5 3 1 1 1 1 2nd Qr. 111 49 9 6 1 2 20 11 1 1 3 2 7 4 4 5 7 15 15 34 1 1 4 2 1 3rd Qr. 133 59 17 6 1 5 22 7 1 1 1 1 12 1 3 2 9 4 2 1 1 5 14 23 35 2 1 1 1 4th Qr. 112 60 10 6 3 3 20 18 4 1 1 1 2 1 1 4 5 4 13 5 1 4 13 16 44 Total 469 229 50 24 6 13 83 53 1 5 1 1 1 1 1 6 16 2 12 4 28 16 27 19 1 2 23 62 74 155 1 5 3 8 1 3 2 3 East Plum- stead. 1st Qr. 392 147 36 27 3 4 52 25 1 2 8 1 1 4 4 1 13 16 17 11 6 31 31 63 84 3 2 3 18 1 1 2 7 2nd Qr. 368 141 26 13 4 9 59 30 1 1 2 1 l 4 4 3 2 18 4 10 19 1 7 19 41 39 102 1 4 2 1 12 1 2 9 3rd Qr. 395 164 82 14 6 6 40 16 3 1 1 1 55 2 9 5 1 14 2 5 9 1 3 29 22 96 68 1 20 1 1 1 4th Qr. 351 154 36 21 14 5 49 29 1 4 5 1 2 1 1 3 1 7 6 2 21 17 11 7 4 23 36 57 97 2 13 1 2 2 6 Total 150G 606 180 75 27 24 200 100 2 3 9 5 3 3 2 1 1 1 15 60 3 1 24 18 4 2 66 40 43 46 2 20 102 130 255 351 1 7 7 4 63 2 5 7 23 Totals for the Parish 1975 835 230 99 33 37 283 153 3 3 14 6 4 3 3 1 1 2 1 21 76 5 1 36 22 4 2 94 56 70 65 3 22 125 192 329 506 1 8 12 7 71 3 8 9 26 TABLE VI. Summary of the Vital Statistics of the Parish of Plumstead, 1885.1897. Year. Estimated Population middle of year. Births. Deaths. Annual Rate per 1000 living. Deaths from Principal Zymotic Diseases Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough Typhus. Enteric Fever. Simple and Undefined Fever. Diarrh6a. Phthisis. Deaths of Children under 1 year of age to 1000 births. Births. Deaths. Principal Zymotic Diseases. 1885 40,354 1390 607 34.4 15.1 1.71 69 3 14 2 4 27 .. 5 .. 14 .. 120 1886 4.2,235 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 2.35 104 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 69 115 1890 50,676 1933 923 37.5 17.9 2.47 127 .. 33 11 14 44 .. 2 .. 22 95 137 1891 52,754 1867 920 35.3 17.4 1 57 83 .. 33 1 6 24 .. 4 .. 15 114 121 1892 54,060 1932 849 35.7 15.7 2.48 136 .. 19 25 38 29 .. 3 .. 22 100 108 1893 55,398 1914 994 34.5 17.9 3.71 211 2 47 31 65 23 .. 8 .. 35 111 140 1894 56,770 1910 736 33.6 12 9 2.06 123 2 20 21 34 30 .. 6 .. 10 70 94 1895 58,175 1866 930 3.20 15.9 2.5 153 2 24 10 34 5 .. 30 .. 48 96 134 1896 59,615 1950 931 32.7 15.6 3.5 213 .. 68 14 60 35 .. 4 .. 30 81 133 1897 61,090 1975 835 32.3 13.6 2.2 138 •• 3 6 24 21 .. 3 .. 81 96 116 TABLE V. Ages, Schools and other particulars of the cases of SCARLET FEVER AND DIPHTHERIA. Total Cases. AGES. SEX. Houses with 1 Case only. Houses with 2 Cases. Houses with 3 Cases. Houses with 4 Cases or more No. treated in Hospital Under 1 1 to 5 5 to 10 10 to 20 Over 20 Males. Females SCARLET FEVER 372 6 105 175 76 10 184 188 213 44 14 7 233 DIPHTHERIA & MEMBRANOUS CROUP 132 2 50 43 21 16 64 68 97 7 7 80 Number op Patients Attending Each School. Ancona Road. Earl Street. Vicarage Road. Plumstead Road. Purrett Road. Bloomfield Road. The Slade. Burrage Grove. EglintoD Road. High Street. Conway Road. Knee Hill, Abbey Wood Plum Lane. Lee Street. Other Schools. On Roll 1357 On Roll 1141 Ou Roll 1149 Ou Roll 1058 On Roll 1207 On Roll 1360 On Roll 934 On Roll 1053 On Roll 1301 On Roll 1219 On Roll 763 On Roll 142 On Roll 351 On Roll 389 ] SCARLET FEVER 23 19 6 10 44 19 15 17 3 22 19 5 0 24 32 DIPHTHERIA AND MEMBRANOUS CROUP 7 2 4 2 1 3 12 8 0 7 1 1 3 3 13 TABLE IV. (B), Table of POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming of he knowledge of the Medical Officer of Health, during the year 1897, in the Parish of Plumstead ; classified according to Diseases, Ages, and Looauties. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shewn as separate localities. Population at All Ages. Registered Births. Aged under 5 or over 5 New Casks 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 1896. Estimated to middle of 1897. 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. Fevers. Cholera. Erysipelas. Total. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera Erysipelas. Total. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) c d e NORTH WARD 5329 .. .. Under 5 .. 9 4 .. .. .. .. .. .. .. .. 13 .. 7 4 .. .. .. .. .. .. .. .. 11 Over 5 .. 13 6 .. .. 1 .. .. .. .. 3 23 .. 11 4 .. .. 1 .. .. .. .. .. 16 NORTH-EAST „ 5651 .. .. Under 5 .. 9 4 .. .. .. .. .. .. .. 1 14 .. 7 5 .. .. .. .. .. .. .. .. 12 Over 5 .. 19 4 .. .. 1 .. .. 1 .. 4 29 .. 11 3 .. .. 2 .. .. .. .. .. 16 NORTH-WEST „ 5289 .. .. Under 5 .. 10 6 .. .. .. .. .. .. .. .. 16 .. 9 3 .. .. .. .. .. .. .. .. 5 Over 5 .. 16 6 .. .. 2 .. .. .. .. 3 97 .. 8 9 .. .. .. .. .. .. .. .. 10 WEST „ 5222 .. .. Under 5 .. 1 2 .. .. 1 .. .. .. .. .. 4 .. .. .. .. .. .. .. .. .. .. .. 1 Over 5 .. 14 6 .. .. 2 .. .. .. .. 5 97 .. 10 3 .. .. 1 .. .. .. .. .. 14 SOUTH-WEST „ 7152 .. .. Under 5 .. 5 8 .. .. .. .. .. .. .. .. 13 .. 3 3 .. .. .. .. .. .. .. .. 6 Over 5 .. 22 14 .. .. .. .. .. .. .. 5 41 .. 11 8 .. .. .. .. .. .. .. .. 19 SOUTH-EAST „ 10616 .. .. Under 5 11 6 1 .. .. .. .. .. .. 1 19 .. 8 6 .. .. .. .. .. .. .. .. 14 Over 5 .. 40 10 .. .. 3 .. .. .. .. 2 61 .. 33 5 .. .. 2 .. .. .. .. .. 40 EAST „ 11011 .. .. Under .. 39 9 1 .. .. .. .. .. 4 53 .. 94 7 .. .. .. .. .. .. .. .. 31 Over 5 .. 75 11 1 .. 9 .. .. 1 3 9 109 .. 49 6 .. .. 3 .. .. .. .. .. 58 SOUTH „ 8952 .. .. Under 5 .. 96 11 .. .. .. .. .. .. .. 3 40 .. 15 8 .. .. .. .... .. .. .. 23 Over 5 .. 49 22 .. .. 6 .. .. 1 1 5 84 .. 32 19 .. .. 3 .. .. .. .. .. 47 INFIRMARY „ .. .. .. Under 5 .. 4 .. .. .. .. .. .. .. .. .. 4 .. .. .. .. .. .. .. .. .. .. .. .. Over 5 .. 3 .. .. .. .. .. .. .. .. 1 4 .. 2 .. .. .. .. .. .. .. .. .. 2 WORKHOUSE „ .. .. .. Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Over 5 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. TOTALS 59252 61090 1975 Under 5 .. 114 50 2 .. 1 .. .. .. .. 9 176 .. 66 37 .. .. .. .. .. .. .. .. 103 Over 5 .. 253 79 1 .. 24 .. .. 3 4 37 406 .. 167 43 .. .. 12 .. .. .. .. .. 222 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. (A ) TABLE III. Table of DEATHS during the year 1897, in the Plumstead Sanitary Area, London District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shewn as separate localities. Mortality from all causes, at subjoined ages. Mortality from subjoined caubes, distinguishing Deaths of Childj:en under Fivf. Years of Agk. At all Ages Under 1 year 1 & under 5 5 & under 15 15 & under 25 25 & under 65 65 & upwards 1 2 3 4 5 6 7 8 9 10 ii 12 13 14 15 16 17 18 19 20 21 22 Small Pox Scarlatina Diphtheria Mem bran- ous Croup fevers. Cholera | Erysipelas j Measles Whooping Cough Diarrhoea & Dysentery | Rheumatic Fever Phthisis Bronchitis, Pneumonia and Pleurisy Heart Disease Cancer Injuries All other Diseases Total Typhus Enteric or Typhoid Continued Relapsing Puerperal (a) (b) (c) (d) (e) (f) (g) WEST PLUMSTEAD 195 45 19 5 12 69 45 Under 5 3 6 14 16 1 24 64 5 upwds. 1 1 2 24 22 18 10 1 52 131 EAST PLUMSTEAD 497 177 61 21 17 149 72 Under 5 3 3 1 15 59 2 40 2 113 238 5 upwds. 1 5 1 2 1 2 51 36 38 17 10 95 259 WORKHOUSE AND INFIRMARY 203 8 4 2 5 97 87 Under 5 1 3 2 6 12 5 upwds. 1 4 1 36 30 18 18 16 67 191 Totals 895 230 84 28 34 315 204 Under 5 3 3 1 22 76 2 58 3 143 314 5 upwds 1 8 1 3 2 1 8 1 111 88 74 45 27 214 581 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 78 5 16 5 8 36 8 Under 5 3 9 2 7 21 5 upwds. 2 1 2 10 1 5 6 3 27 57 Deaths occurring within the district among persons not belonging thereto 129 5 1 4 63 56 Under 5 1 2 3 6 5 upwds. 1 3 21 19 13 14 8 41 123 TABLE VII. TABLE VII .Continued. Analysis of Vital and Mortal Statistics of the Sanitary Districts of the Metropolis after Distribution of Deaths occurring in Public Institutions during the year 1897. Sanitary Areas. Estimated Population in the middle of 1897. Births. Deaths. Annual Rate per 1000 living. Deaths from Principal Zymotic Diseases. Small Pox. Measles. Searlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple and Undefined Fever. Diarrhœa. Phthisis. Deaths of Children under 1 year of age to 1000 births. Births. Deaths. Principal Zy. motic Diseases. London 4,463,169 13.3,618 78,971 300 17.7 2.56 11,453 16 1927 778 2240 1837 1 557 8 4089 7629 158 West Districts. Paddington 126,161 3,018 1,814 24.0 14.4 1.94 243 2 21 64 44 9 1 102 142 149 Kensington 171,4.27 3,683 2,677 21.5 15.7 1.78 304 32 30 81 19 21 1 120 247 166 Hammersmith 105,959 3,139 1,760 29.7 16.7 1.99 211 5 11 30 28 8 1 128 146 171 Fulham 120.040 4,106 2,034 34.3 17.0 3.0 362 51 26 63 61 12 1 148 184 162 Chelsea 96,692 2,549 1,713 26.4 17.8 2.55 244 18 17 54 41 14 100 175 161 St. George, Hanover sq 80,330 1,369 1,059 17.1 13.2 1.10 89 17 7 17 13 10 25 93 133 Westminster 53,027 1,237 1,004 23.4 19.0 2.47 131 26 13 23 16 6 47 143 166 St. James, Westminster 22,576 459 393 20.4 17.5 1.87 42 13 8 3 6 3 9 51 163 North Districts Marylebone 140,808 4,135 2,572 29.5 18.3 1.61 227 9 9 46 41 14 108 246 136 Hampstead 77,275 1,479 911 19.2 11.8 1.16 90 9 6 17 25 5 28 57 127 St. Pancras 242,255 7,017 4,518 29.0 18.7 2.47 597 1 87 24 114 124 38 209 486 168 Islington 341,134 9,845 5,387 28.9 15.8 1.91 653 1 99 61 129 134 45 184 491 136 Stoke Newington 34,136 835 488 24.5 14.3 2.12 72 7 2 19 15 10 19 40 121 Hackney 216,698 6,312 3,573 29.2 16.5 2.90 626 127 37 134 97 35 190 310 147 Central Districts. St. Giles 37,840 981 696 26.0 18.4 1.63 61 9 7 7 18 6 14 113 146 St. Martin.in.the.Fields 12,711 169 206 13.3 16.3 1.19 15 1 1 2 3 5 1 2 33 178 Strand 23,552 570 501 24.3 21.3 2.06 48 2 10 3 5 6 4 18 79 161 Holborn 30,49? 781 703 25.7 23.1 2.79 85 6 14 16 19 5 35 84 184 Clerkenwell 66,162 2,092 1,459 31.7 22.1 3.61 238 1 49 14 48 49 11 66 155 184 St. Luke 41,279 1,860 1,056 45.2 25.7 3.82 157 40 13 21 28 4 51 128 149 London, City 30,228 478 642 15.9 21.3 1.66 50 1 7 8 10 10 9 5 57 130 East Districts. Shoreditch 121,883 4,314 2,627 35.5 21.6 4.07 496 1 116 29 78 63 20 189 247 183 Bethnal Green 129,09« 4,818 2,761 37.4 21.4 3.41. 439 114 25 84 57 1 17 1 140 255 171 Whitechapel 79,724 3,150 1,623 39.6 20.4 2.16 171 45 15 34 16 8 53 200 148 St. George.in.the.East 47,917 2,029 1,262 42.5 26.4 4.27 204 68 14 28 24 10 60 132 197 Limehouse 58 508 1,997 1,462 34.2 25.1 3.54 206 63 12 29 37 4 61 149 193 Mile End Old Town 111,883 4,257 2,085 38.2 18.7 2.97 330 77 12 62 58 23 98 156 149 Poplar 169,811 5,849 3,353 34.5 19.8 3.07 519 83 28 120 83 30 175 319 170 South Districts. St. Saviour, Southwark 24,919 769 611 30.9 24.6 3.66 91 32 7 12 12 2 26 80 195 St. George, Southwark 60,388 2,114 1,426 35.1 23.7 4.35 262 1 67 14 28 32 10 1 109 171 189 N ewington 122,191 4,248 2,588 34.9 21.2 3.59 439 85 33 65 82 9 165 269 177 St. Olave, Southwark 11,480 434 253 37.9 22.1 2.96 34 6 2 2 8 1 15 33 154 Bermondsey 85,629 3,176 1,883 37.2 22.1 4.35 371 76 34 62 62 13 124 174 190 Rotherhithe 40,643 1.C58 766 31.0 18.9 3.26 132 21 22 21 17 2 49 64 174 Lambeth 300,048 9,388 5,247 31.4 17.5 2.65 791 140 42 144 144 26 295 500 151 Battersea 168,877 5,266 2.734 31.3 16.2 2.79 470 79 47 106 79 19 140 251 162 Wandsworth 195,612 5,042 2,606 25.8 13.4 1.91 370 27 29 111 42 16 1 144 222 135 Camberwell 257,575 7,483 4,276 29.1 16.6 2.91 750 5 141 32 170 111 31 260 386 159 Greenwich 178,367 5,563 3,058 31.3 17.2 2.27 405 2 35 32 70 57 29 180 263 157 Lee 39,215 881 516 22.5 13.2 1.43 56 6 3 17 5 3 22 43 135 Lewisham 86,152 2,186 1,099 25.4 12.8 1.71 147 17 9 36 19 7 59 81 129 Woolwich 41,409 1,307 735 31.7 17.8 2.54 105 2 8 33 8 4 50 79 158 Plumstead 61,057 1,975 834 32.4 13.7 1.97 120 3 6 24 22 3 1 61 95 116 45 TABLE VIII. Abstract from Mortuary Register for 1897. Date. Age. Sex. Inquest or no. Post Mortem or no. Cause of Death. Jan. 1st 2 months Male Yes Yes Convulsions. „ 4th 7 Male Yes Yes Congestion of lungs. 6 th 37 years Male Yes No Accidental death. 20 th 46 Male Yes No Suicide during temporary insanity. „ 23rd 49 „ Male No No Natural causes. „ 25 th 74 „ Female Yes Yes Haemorrhage into left side of brain. Feb. 7th 21 „ Male Yes No Found drowned. „ 17th 61 Male Yes Yes Aortic disease and pneumonia April 20th 47 „ Male Yes Yes Heart disease. .. 27th 37 „ Male Yes No Accidental death. „ 28th 20 „ Male Yes Yes Syncope ; Valvular disease of heart; Congestion uf lungs 28th 1 month Female Yes Yes Suffocation. May 8th 35 years Male Yes Yes Heart disease. „ 31st 11 months Female Yes Yes Convulsions. June 13 th not known notknown Yes Yes 25 th 67 years Female No No Natural causes. July 14th 44 „ Male Yes No Accidental death. „ 17th 50 „ Female No No Natural causes. „ 19th 18 „ Female Yes Yes Puerperal Eclampsia. Aug. 5th 5 „ Female Yes Yes Fracture of skull. „ 24th „ Male No No Sept. 17 th 40 years Male No No Heart disease. Oct. 26th 33 „ Female Yes Yes Natural causes. „ 27 th Female Yes Yes Natural causes. Nov. 19th 39 years Male No No Consumption. „ 29th 32 „ Female Yes Yes Abscess on the brain. Dec. 4th „ Male Yes No Found drowned. „ 10th 46 years Male Yes No Accidental death. „ 10th 4 months Male Yes Yes Bronchial pneumonia and bronchitis. „ 13th 35 years Female Yes Yes Syncope and fatty degeneration of heart. „ 20 th 24 „ Male Yes No Suicide during temporary derangement. „ 25th „ Female No No Scarlet Fever. „ 29 th 44 years Male Yes Yes Consumption. 46 TABLE IX. Summary of Nuisances abated, Notices served, and General Work of the Sanitary Department for 12 months ended 31st December, 1897:— PREMISES INSPECTED. From 1st Sep. to 31st Dec. East District Inspector. Central District Inspector. Chief Inspector. Totla West District Inspector. No. of Houses inspected, House to house 330 831 921 .. 2082 „ Re-inspections, after service of notices 550 1850 1980 1340 5720 „ Houses and premises specially inspected, including infectious diseases and complaints 194 468 524 1156 2342 „ New buildings, re water certificates .. .. .. 206 206 „ Houses where drains have been tested by smoke test 29 66 53 45 193 NUISANCES ABATED. Drains. Waste pipes from baths, lavatories, and washhouse sinks, repaired or disconnected .. 85 76 25 186 Choked and defective drains 95 219 136 135 585 Defective traps 14 83 91 28 216 Defective and unventilated soil pipes 9 97 42 20 168 Combined drains examined and referred to Works Department .. .. .. 39 39 No. of houses affected by the defective bined drains W.C.'s .. .. .. 152 152 W.C.'s repaired, new traps or pans provided, fittings repaired 58 215 206 64 543 Water supply apparatus repaired 22 203 135 68 428 Premises. Interiors cleansed, repaired, and defective roofs repaired 104 150 266 42 562 Damp walls remedied 24 175 223 22 444 Paving in yards and wash-houses repaired 76 165 143 28 412 Through ventilation provided .. 14 14 4 32 Wash-houses without sinks and outlets for waste water .. 20 6 5 31 Defective guttering and rain-water pipes 37 208 114 39 398 Dustbins supplied 114 385 353 240 1092 Dung pits provided .. 6 2 4 12 47 TABLE IX.—continued. From 1st Septo 81st Dec- East District Inspector. Central District Inspector. Chief Inspector. Total West District Inspector. Animals. Accumulations of manure removed 1 4 4 24 33 Animals kept in such a state, as to be a nuisance 1 5 1 14 21 Water. Defective and foul rain-water tanks remedied 3 6 3 2 14 Defective water pipes, rendering premises damp .. 10 15 12 37 Insufficient supply and water cut of! by Water Company 1 2 31 36 70 Defective and foul cisterns used for dietary purposes .. .. .. 3 3 Miscellaneous. Obstructions of footpaths 3 2 2 59 66 Number of cases of inattention to notices re ported to Vestry Clerk for proceedings . .. .. .. .. 191 Summonses at the Police Court .. .. .. .. 42 Cases of overcrowding remedied 6 4 14 14 38 Ditches cleansed .. .. .. 8 8 Bakehouses cleansed twice during the year . .. .. .. .. 38 Cowhouses and Slaughterhouses inspected . .. .. .. 13 13 DISINFECTION. Total. No. of houses disinfected after infectious disease 468 „ cases disinfected for other parishes (Lec and Eltham) 66 CLERICAL WORK. Letters received 868 ,, written 1140 Notifications received 588 Certificates issued after disinfection 1983 ,, of infectious disease forwarded to schools 931 Complaints of Sanitary defects, non-removal of dust, &c. 532 Written Intimation Notices 1884 Statutory Notices 555 Dust-bin Notices 954 48 TABLE X. Prosecutions under Public Health Act (London). Date. Offence. Situation. Result. 1897 8th Jan. Nuisance 131, Tewson Road 3/- costs paid 8th Jan. Nuisance 24, Vicarage Park Order for 13/- costs 8th Jan. Nuisance 25, Vicarage Park 3/- costs,work done 8th Jan. Nuisance 26, Vicarage Park 3/- costs,work done 8th Jan. 8th Jan. Nuisance (Dungpit) Non-provision of Ashpit Stable, rear of 73, Plumstead Road 88, Crescent Road Work to be done in 14 days & 6/- costs Supplied, 2/- costs 5th Feb. Defective Yard Paving 26, Bloomfield Road Work done,3/-costs 15th Jan. Obstructing Officer by refusing entry House near Goldie Leigh Lodge, Bostal Fine 20/- and 2/costs 5th Feb Keeping Swine in place unfit 5, Garland Street Pigs removed, 3/costs 5th Feb. Keeping Swine in place unfit 6, Garland Street Summons withdrawn 5th Feb. Keeping Swine in place unfit 14, Garland Streei „ 3/- costs 5th Feb. Keeping Swine in place unfit 6, Timbercroft Lane „ 3/- costs 5th Feb. Non-compliance with Nuisance Order 31, Maxey Road Work done,2/-costs 19th Mar. Overcrowding 16, Abbey Grove Abated, summons withdrawn 2nd April Nuisances House at Old Park, Bostal Work done, 25/- costs 2nd April No water supply to w.c. Ditto 2nd April Nuisances 70, Raglan Road Work to be done, 3/- costs 6th May Nuisance 21, Westdale Road Work done „ 6th May Nuisance 19, Westdale Road „ „ 6th May Nuisance 17, Westdale Road „ „ 6th May Nuisance 12, Westdale Road „ „ 6th May Nuisance 10, Westdale Road „ „ 6th May Nuisance 3, Stevens' Cottages, „ „ 49 TABLE X.—Continued. Date. Offence, Situation. Result. 6th Hay Nuisance Barnfield Road Work done,3/-costs 6th May Nuisance 5 Ditto „ „ 6th May Defective Yard Paving 1 to 5 Ditto „ „ 3rd June Unsuitable Water Supply Apparatus 55, Eglinton Road „ 2/- costs 3rd June Nuisance 16, Brookhill Road „ 3/- costs 3rd June Nuisance 157, Eglinton Road „ „ 3rd June Nuisance 35, Westdale Road „ „ 2nd July Nuisance 22, Conway Road „ „ 2nd July Nuisance 26, Conway Road „ „ 2nd July Nuisance 6, Station Road „ „ 2nd July Nuisance 26, Reidhaven Road „ „ 2nd July Nuisance 23, Reidhaven Road „ „ 2nd July Nuisance 30, Reidhaven Road „ „ 2nd July Dwelling house without proper and sufficient water supply White Cottage, Bostal Wood ClosingOrder made by consent of defendant 8th Oct. Nuisance 30, Liffler Road Work done,3/- costs 8th Oct. Nuisance 68a, Whitworth Rd. „ „ 8th Oct Nuisance 62, Whitworth Road „ „ 8th Oct. Nuisance 61b, Vicarage Road „ „ 29th Oct. Nuisance 9, Tewson Road „ „ 9th Dec. Defective apparatus to w.c. cistern 135, Tewson Road „ 2/- costs TABLE XI. Census 1891. No. of Schedules. Houses. Persons. Ecclesiastical Districts. Inhabited. Uninhabited Buildings. Less than 5 rooms. Males. Females. Total. St. James'. St. Margaret's. All Saints'. Christ Church. St. John's. St. Nicholas' West Plumstead 3783 2755 42 23 2089 7642 8225 15867 4442 5197 5966 262 .. .. East Plumstead .. 7644 5872 109 93 4808 18599 17967 36566 254 7353 .. .. 5752 23207 Census 1896. No. of Schedules. Houses. Persons. North Ward. North-East Ward North-WestWard South Ward. South-East Ward South-WestWard Ea9t Ward. West Ward. Total Inhabited. Uninhabited Males. Females. Total. West Plumstead 3933 2924 55 8135 8579 16714 15329 5651 5289 8952 10646 7152 11011 5222 59,252 East Plumstead 9179 6717 34 21789 20748 42537 Ox o 51 APPENDIX, List of Bake-houses. No. Name. Address. 1 W. Jefferey 123, Burrage Road 2 A. Alford 57, Burrage Road 2 J. Farrier 30, Burrage Road 4 W. T. Akers 16, Armstrong Place 5 J. H. Dalton 18, Eton Road 6 H. W. Blacknell 12, Spray Street 7 W. Arnold 57, Plumstead Road 8 J.Fletcher 92, Plumstead Road 9 E. Page 109, Plumstead Road 10 J. Tait 136, Plumstead Road 11 J. Clarke 152, Plumstead Road 12 A. V. Chapman 2, High Street 13 R. Moakes 54, Parkdale Road 14 0. Degen 20, Conway Road 15 A. F. Jewis 68, Glyndon Road 16 F. Phillips 53, Ann Street 17 J. Alderton 102, Ann Street 18 T. Maynard 64, Villas Road 19 T.Collins 1, Park Road 20 J. T. Alderton 81, Park Road 21 S. Medcraf 58, Pattison Road 22 E. Plummer 46, Hudson Road 52 Appendix.—List of Bake-houses—Continued. No. Name. Address. 23 J. Allway 126, High Street 24 H. Percival 223, High Street 25 The Guardians Woolwich Union 26 J. Porter 1, Riverdale Road 27 H. Poster 73, r.akedale Road 28 E.Parker 14, Gunning Street 29 A. C. Thorogood 307, High Street 30 H. P. Croucher 33, Eglinton Road 31 Mrs. Colver 165, Sandy Hill Road 32 Merritt & Co. 50, Herbert Road 33 Mrs. S. Fuller 48, Princes Road 34 Chadwell Brothers 60, Plumstead Common Road 35 R. C. Davis 2, Crescent Road 36 W. H. Hughesdon 24, St. James' Place 37 R. Gilder 14, Westdale Road