PLU 6 PLUMSTEAD VESTRY. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. 1899. H. Pryce & Son, Steam Printers (Reg. L.S.C.) Woolwich. ANNUAL REPORT of the Medical Officer of Health, PLUMSTEAD, 1899. Medical Officer of Health— SIDNEY DAVIES, M.A.. M.D., D.P.H. Chief Sanitary Inspector— Albert G. Duck (Cert. San. Inst.) District Sanitary Inspectors— John W. Rance (Cert. San. Inst.), West District. William Little (Cert. San. Inst.), Central ,, William Wood (Cert. San. Inst.), South ,, Alfred G. Potter (Cert. San. Inst.), East ,, Public Health Committee Clerk— Charles Ellis. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, PLUMSTEAD, 1899. To the Chairman and Members of the Vestry. Gentlemen, I have the honour to present to you my Ninth Annual Report on the health of Plumstead, and it is very satisfactory that, in this my last report to you as the Plumstead Vestry, I am able to point to a much improved state of the public health. A.—Vital Statistics. 1. Population.—In previous years I have estimated the population on the assumption that it had increased since the 1896 Census in the same proportion as it increased in the inter-censal period 1891-96. But the large number of new houses built in recent years, and the well known scarcity of house accommodation make it more than probable that the population is increasing at a more rapid rate than in the period 1891-96. I have, therefore, taken the number of occupied houses as the basis for the population; this was, in June, 10,628, compared with 10,298 in the year 1898, an increase of 330. 4 The number of persons to a house was, in 1891, 6.08, and in 1896, 6 14, i.e., an increase of 0 06. Probably there has been a further slight increase since 1896, but I have supposed that there are still the same number to a house a at the Census. This gives a population to the middle of the year of 65,255, and this is the number on which my statistics are based. 2. There were, in June, 1899, 3,314 houses in the district of the West Rate collector, and 7,314 in the district of the East Eate collector. This shews an increase of 58 houses in the West, and 272 in the East District, compared with 1898. (N.B.—These districts are not quite the same as those referred to in Table C., which are the Eegistrar's districts.) 3. Births.—The birth-rate was 30.2, the same as last year, and, with one exception, lower than in any previous year since 1885. 4. The natural increase of the population was 1,055, and the estimated increase 2,652. This shews that there was an immigration into Plumstead of 1,600 persons from other localities. 5. The births of 1,023 males and 948 females were registered; 240 males and 212 females were born in the West district, and 783 males and 736 females in the East. 6. Deaths.—The death-rate was 14.0. This is the lowest rate recorded since 1885 with two exceptions, viz., 12 9 in 1894 and 13.6 in 1897. The rate in 1898 was 16.2. The deaths of 555 males and 446 females were registered in the Parish, 112 males and 102 females were in the West district, and 443 males and 344 females in the East district. (N.B.— These are the actual numbers registered in Plumstead, and do 5 not, therefore, correspond to the death-rate, which is calculated from death returns corrected for Public Institutions, i.e., by omitting the deaths of non-parishioners occurring in the Workhouse and Infirmary, and adding all deaths of parishioners occurring in outlying institutions, such as the Fever and General Hospitals. For these figures see Table III. All the other tables give the corrected figures.) The highest number of deaths occurred in the 3rd and 4th quarters of the year. 7. Meteorology.—The first or Winter quarter was mild and favourable to health. The Summer quarter was warm and dry, warmer even than 1898, causing, as usual, a large number of deaths among infants from Diarrhoea. December was characterised by a cold spell and by several fogs, and there was an unusually large number of deaths in the last four weeks of the year. 8. Infant Mortality.—The number of deaths under 1 year per 1,000 births was 124, compared with 116 and 156 in the two preceding years. The average infantile mortality of the past five years was 132, and of the five years, 1885-89, only 117. At first sight, this does not appear satisfactory, but, on further examination, we find that the infantile mortality is closely associated with the number of deaths from Diarrhoea, and these again with the temperature of the Summer quarter, which was much lower in the years 1885-89 than in 1895-99, The increased infantile mortality in recent years, in Plumstead, corresponds with a similar increase in the Metropolis. 6 9. The following Table gives the deaths under 1 year per 1,000 births, in recent years, in the two districts:— Table A. West. East. 1893 132 143 1894 77 100 1895 96 146 1896 98 145 1897 106 119 1898 174 150 1899 100 131 This Table shews that, comparing the average of the three years, 1893-4-5, with 1897-8-9, the rate in West Plumstead has increased from 101 to 126, and in East Plumstead from 129 to 133. 10. Sixty-nine of the 245 deaths under 1 year were from premature birth and low vitality, including such indefinite causes as convulsions. Most of the 85 deaths from Diarrhoea were also under 1 year of age. 11. There were 322 deaths under 5 years of age, which is 35 per cent. of the total deaths, and 4.9 per 1,000 population. 12. The Zymotic death-rate (i.e., the death-rate from Small Pox, Scarlet Fever, Diphtheria, Enteric Fever, Measles, Whooping Cough, and Diarrhœa) was 13, which is the lowest it has been since 1885. Last year it was 3.5. The rate was 1.4 in West, and 2.0 in East Plumstead. 13. There were 32 uncertified deaths, or 3.4 per cent. of total deaths, compared with 2.9, l.3, and 4.1 in the three 7 previous years. Fifteen of the uncertified deaths were under 5, and 17 over 5 years of age. Nine of the cases under 5 years were registered as convulsions or supposed convulsions. Now, as almost any morbid condition in a young child may give rise to convulsions, we have practically no light whatever on the cause of death in these cases. We may take for granted that there were no suspicious circumstances connected with the deaths, or an inquest would have been held, but something more than this is wanted for the purposes of preventive medicine. 14. In consequence of the remarks in my last annual report on the high rate of uncertified deaths, the Health Committee communicated with the Coroner for the district, and also with the County Council. The Council pointed out that they had advocated legislation on the lines recommended by the select committee of Parliament on death certification. The principal recommendation from the point of view I am now considering is that medical investigators should be appointed to assist the coroners, who would enquire into all cases where no medical certificate was forthcoming. This is a reform which in my opinion is most needful. 15. There were 38 inquests, compared with 39,35 and 38 in the three preceding years. Seven were on persons under 5 years, and 31 on persons over 5. Of the infants, two were foundlings, who died of want of proper attention at birth; one was accidentally suffocated at birth, and one aged 15 days was suffocated in bed with her mother. Of those over 5, two were suicides, viz., a man of 63, who cut his throat, suffering from mental derangement, and a beerhouse keeper of 54 who hanged himself. Two were run over 8 and one died from a fall. The wife of a publican died in consequence of injuries caused by her husband kneeling on her chest, but he was acquitted on the criminal charge. A man died in the Arsenal from the explosion of a shell; another was drowned in the Serpentine through the upsetting of a boat. A man of 47 died on Bostal Heath, in the middle of December, from exposure and neglect. A boy of 14 died from fracture of the skull, but there was no evidence as to the cause of the injury. In the remaining cases, death was from natural causes, but in five, or more than one-fourth of these so-called natural deaths, the direct or indirect cause was alcoholism. Table B. 16. East and West Plumstead compared. West. East. Population—Census 1891 15,867 36,566 ,, ,, 1896 16,714 42,538 ,, estimated to middle of 1899 17,465 47,790 Birth Bate 25.8 31.8 Death „ 14.8 13.7 Deaths under 1 year per 1,000 births 100 131 Zymotic Death Rate 14 20 Phthisis ,, 1.3 1.4 (N.B.—The population is estimated on the supposition that the total increase of the population of Plumstead, between 1896 and 1899, viz., 6,003, is distributed between West and East in the proportion of 1 to 7, as was the increase between the Censuses of 1891 and 1896). 17. As usual the birth-rate and the infantile death-rate are much lower in West than in East Plumstead. 9 18. Plumstead compared with other sanitary districts.— Only two of the sanitary areas of the metropolis had a lower death-rate than Plumstead (see Table VII). These were Hampstead 116, and Stoke Newington 12.7; if these were corrected for age and sex distribution, they would be but slightly lower than Plumstead, which if similarly corrected would remain unaltered. Two places only had a lower infantile death-rate, Stoke Newington and St. Giles. Six places only had a lower zymotic death-rate. No other district had fewer cases of Measles and Enteric Fever than Plumstead, and the death-rate from all the infectious diseases and from Phthisis was below the average for London, with the exception of the rate from Scarlet Fever which equalled the average. As regards death-rate, Zymotic death-rate, infantile death-rate, and the death-rate from Measles, Diphtheria and Enteric Fever, Plumstead was decidedly the healthiest district south of the Thames. None of the 33 large towns had so low a death rate. Small Pox. 19. There were no cases of Small Pox notified. There have been no cases now since 1896. The new vaccination act is working very satisfactorily. There were 1610 vaccinations (primary) during the year. In the Woolwich Union there were 3204 vaccinations compared with 2774 in 1898. Scarlet Fever. 20. There were 707 cases of Scarlet Fever compared with 61, 584, 527, 480, 328, 352, 372, and 423 in the eight 10 preceding years. The past year was characterised by the occurrence of the largest number of cases of Scarlet Fever since notification commenced. 21. 520 cases, or three-fourths of the whole, were treated in the Fever Hospitals. This shews a further increase in the proportion of cases treated at Hospital. 22. Although the number of cases was the highest, the number of deaths was the lowest since 1891, namely, 6. The death rate per 1000 population was 0.09. In the 33 great towns it was 0.13; in England and Wales, 0.12; and in London, 0.09. Table D gives the death rate per 100 cases at home and at Hospital in recent years. Table D. Treated at Home. Treated at Hospital. 1893 40 8.0 1894 3.3 4.8 1895 3.0 3.0 1896 4.3 3.7 1897 0.7 21 1898 3.1 2.7 1899 10 0.7 23. The number of cases per 1,000 population was 10.9, which much exceeded the rate in all the sanitary districts of the Metropolis. In London the rate was 3.98. In 1898, too, Plumstead had the highest rate, though in that year some other districts were very near. Plumstead usually has a higher rate than London; in 1891-97 the rate was 6.4 for Plumstead and 5.3 for London. As Scarlet Fever chiefly occurs in 11 children, the rate would be more properly estimated, not on the total population, but on the population between the ages of 3 and 15. Now from the census returns of 1891, I have calculated that while in London there were only 206 children between the ages of 5 and 15 in every 1,000 of population, in Plumstead there were 231. If correction is applied for this different age distribution, the figure 10.9 becomes 9.6, and the rate for 1891-97 becomes 5.7. So we see that a large part of the excess of Scarlet Fever in Plumstead over that in London is due to the age distribution of the population. 24. Still, even after allowance has been made for the age distribution of the population, it is obvious that in the past two years Plumstead has experienced an exceptional prevalence of Scarlet Fever, which, although fortunately the number of deaths is slight, from the amount of illness and inconvenience caused, demands most serious attention. 26. 1 find that 499 cases, or 70 per cent. of the whole, were between the ages 3 and 15, i.e., were of school age. The number of males and females affected was about equal. In more than two-thirds of the cases the disease only affected one person in the house. 582 houses were affected, and in only 21 were there more than two cases. 27. Table VI. shews that out of about 200 streets in the Parish, cases occurred in 156, or more than three-fourths of them:—27 occurred in High Street, 19 in Griffin Road, 14 in Frederick Place, Orchard Road, and Piedmont Road, 13 in Sutcliffe Road and Parkdale Road, 12 in Kashngar Road, Llanover Road, Tewson Road, and Ann Street, 11 in Francis Street, Chesnut Road, Plumstead Common Road, Riverdale Road, and Sandy Hill Road, and smaller numbers in the remaining streets. 12 Having regard to the number of Louses in each street, it would appear that there was an especial prevalence in Griffin Eoad, Frederick Place, Sutcliffe Road, and Francis Street. 28. Table V. also shews that, among Schools, Ancona Road was most affected, and, after it, Purrett Road, Burrage Grove, Earl Street, and the Slade. Two of these Schools, viz., Earl Street and Ancona Road, had the highest number of cases last year. It is noteworthy that of the three neighbouring Schools, Ancona Road, Plumstead Road, and High Street, whereas at the first, one child was affected out of every 12, at the other two, only one child out of 50, and one out of 60, respectively, were affected. 29. Table XI. gives, in graphic form, the number of cases which occurred in each week of the year. It shews that the two highest number of cases occurred in January and February, and the third highest in November. 30. In seeking for the source of an increased prevalence of Scarlet Fever it must be remembered that this disease is considered to be caused solely by infection, which is usually conveyed directly from person to person by the breath, and by particles of secretion, discharges and desquamating skin ; less often indirectly by clothing, toys, &c., or by a third person. It is also known that milk may convey the infection, and it seems probable that there is a diseased condition of the cow corresponding to Scarlet Fever which causes the milk to produce that disease in consumers. Insanitary conditions, such as defective drains, polluted soil, surface filth, &c., are not regarded as a cause of Scarlet Fever, though they no doubt increase the fatality of Scarlet Fever where it exists. It must 13 also be borne in mind that Scarlet Fever and other infectious diseases are liable to periodic fluctuations which are as yet unexplained. 31. The means directed against the spread of infection are disinfection and isolation. Disinfection in Plumstead is performed as follows:—As soon as possible after receipt of information that the premises are ready for disinfection, the officer fumigates with Formaline the rooms recently occupied by the patients. All fabrics and wearing apparel are hung round the room, the bed loosened, and the palliasses stood on end. Twentyfive Formaline tablets are used for every 1,000 cubic ft. All cracks and openings are stopped, and the room is closed for 6 hours, more or less. The following day the fabrics, bedding and garments are taken to the Steam Disinfector and exposed for twenty minutes to a steam pressure of 25 lbs. to the square inch, which represents a temperature of 267° Fah. At the same time a tablet of disinfecting soap is given to the occupier, with which to scrub the wood work of the room. Solution of corrosive sublimate (1 in 1000), and solution of permanganate of potash (a drachm in 14-ozs.) are supplied free on application for disinfection of underclothing, utensils, &c. The steam apparatus is an old fashioned Washington Lyons, with only one door, so that articles have to be put in and taken out the same way and in the same place. It is desirable that no time should be lost in providing the proposed new building and improved apparatus by which the articles would be put in in one room and removed in another. 14 32. With a view to considering whether any of the cases can be reasonably attributed to failure of disinfection I have examined all the secondary cases, i.e., the 228 cases which occurred in houses where one case had already occurred during the year. The majority of these cases occurred within three or four days of the primary case and no doubt derived the infection from the same source as the primary case, or else from that case itself before it had been diagnosed and isolated; 14 were so called return cases, i.e., cases occurring within a few days of the return from Hospital of the primary case. I find there were only eight secondary cases which could not be accounted for in either of these ways, and which might conceivably be due to failure of disinfection. It is more likely, however, that their occurrence in the same house as a previous case is purely in accordance with the law of probability. It does not appear then that the Scarlet Fever prevalence can be attributed to failure of disinfection. 33. Isolation is, in my opinion, of far more importance than disinfection, and in this respect matters are eminently satisfactory. 74 per cent. of the cases were isolated in the Fever Hospitals, and I believe all the remainder had the means for satisfactory isolation at home. 34. The propinquity of the Brook Fever Hospital has been itself suggested as a cause of the prevalence of Scarlet Fever. But this explanation I consider absolutely untenable. The Hospital is separated by at least a mile from nine-tenths of the population; the first years of its occupation were years of diminished prevalence of fever: the South-West Ward, the 15 nearest to the Hospital, has usually the lowest percentage of Scarlet Fever, and, finally, where Fever Hospitals have existed with crowded populations immediately outside their walls, they have never been known to increase the Scarlet Fever mortality of those populations (see Allbutt's system of medicine). 35. Milk supply. I reported on the possibility of the milk supply being the cause of infection at the beginning of the year (see Appendix). Although the evidence implicating any particular supply was quite inconclusive, owing to the insuperable difficulties in tracing the origin of the milk, in the absence of other satisfactory explanation, I am still inclined to suspect that milk infection gave a fresh impetus to the prevalence already existing at the commencement of 1899, as was also the case eight years ago. 36. Unsuspected Cases.—The very mildness of the form of Scarlet Fever lately existing, is a source of danger, for many of the cases are so mild that either they are never suspected, or parents easily persuade themselves that their children are not ill enough to have 'the Fever': the result is, children attending school in an infectious condition. I believe this is one of the most important factors in keeping up the prevalence of the disease, and it can only be prevented by the most careful periodic examination of children attending school. Some two or three school teachers render most valuable assistance in detecting cases of infectious disease attending school, but, from most schools, my attention has never been called to such cases. 37. Arsenal Regulations.—The Arsenal Authorities have, since notification began, most sedulously backed the efforts of Sanitary Authorities, first by preventing employes from coming 16 to work from infected houses, and, more recently, by refusing infectious pay when patients are not sent to the Fever Hospitals. Both regulations have had a good effect, the first in impressing on people the necessity of precautions to avoid the personal conveyance of infection, and the second in increasing the use of the Fever Hospitals. But, in view of the fact of the continued and increased prevalence of Scarlet Fever in a place where more is probably done in this way to prevent infection than in any other part of London, it is well worth considering whether the present action of these regulations has the desired result. 38. The figures in Table V. shew that the affection attacks very few adults: only 39 of the 707 cases were over 15, and only 13 were over 20. Then again, although women who fondle children are not unlikely to carry infection from one child to another without themselves being affected, men, who seldom come into close contact with their children, are very unlikely to convey it to other men. Further, I am inclined to think that the Fever Hospitals have become so popular that, for the most part, no inducement is now needed to attract patients to them. 39. On the other hand, the Arsenal regulations, in cases where parents are tender-hearted and loath to part with their children, more especially when the children are only slightly affected, act as a powerful incentive to concealment. I have myself been urged with most plausible arguments by an Arsenal employe in a good position not to notify a mild case of Scarlet Fever. More especially among the higher class of artisans the fact that notification means practically enforced removal to Hospital, cannot but result in mild cases being disregarded. 17 Whether the harm done in this way does not more than counterbalance the good effect of the regulations I am discussing is matter for serious consideration. 40. Return Cases.—There were 14 cases which occurred within less than two weeks of the return of a brother or sister (or other inmate of the house) from the Fever Hospital, where they had gone for the same disease. Nine of these occurred within seven days of the return. Eight of the returned patients had either discharge or sores of the nose; one had sores on the face and fingers, one had a rash, and one was desquamating on the thighs. The mother of one case made the following suggestive remark: she had had seven children in the Fever Hospital, and as far as she remembered they all came back with a cold. Has this anything to do with the routine warm bath before dismissal? In 1898 I recorded 4 "return cases"; no doubt some of these returned infectious children infect children of other families after re-commencing school attendance. The School Board has not yet made public the outcome of Dr. Simpson's investigation of these cases. 41. To summarise:— (i.) There is usually more Scarlet Fever in Plumstead than in London, owing mainly to the different age distribution of the population. (ii.) During the past two years there has been an unusually excessive prevalence in Plumstead of a mild form ot Scarlet Fever. (iii.) The death rate from Scarlet Fever per 1,000 living in 1899 was lower in Plumstead than in England and Wales, and the same as London. Per 1,000 children of school age it is even lower than London. 18 (iv.) The cause of the excessive prevalence is probably to be looked for in the milk supply, and the opportunities for infection afforded by the large Board Schools. (v.) The mildness of type of recent Scarlet Fever causes many cases to be unsuspected, and still more to be undetected, before they have attended school and infected many others. 42. The additional measures desirable for controlling the spread of Scarlet Fever are:— (i.) The thorough inspection of country cowsheds and the registration of the source of supply of every milk vendor. (ii.) The periodic inspection of school children. (iii.) Some modification in the direction of diminished stringency of the Arsenal regulations re infectious diseases. Diphtheria. 43. There were 183 cases of Diphtheria, compared with 110 in 1898. Table E gives the number of cases and of deaths in recent years. Table E. No. of Cases. Case rate per 1,000 population. No. of Deaths. Death rate per 1,000 population. 1891 37 0.7 6 0.11 1892 118 2.0 38 0.70 1893 179 3.2 65 1.17 1894 118 2.0 34 0.59 1895 148 2.5 34 0.58 1896 198 3.3 60 100 1897 131 2.2 24 0.39 1898 110 1.7 15 0.24 1899 182 2.8 16 0.24 19 44. The number of cases is thus seen to have only once been exceeded since 1891, but the number of deaths is smaller than any year since 1891, except 1898. 45. There were 2.80 cases per 1,000 population, compared with 3.02 in London. The Plumstead rate was the lowest of the sanitary districts south of the Thames. The death rate per 1,000 population was 0.24, compared with 0.43 in London. The case death rate was 8.8 per cent., compared with 13.6 in 1898, which was then the lowest since notification began. 46. 133 cases were treated at Hospital, or about threefourths of the whole number. There were 9 deaths at Hospital and 7 at home, giving death rates per 100 cases of 6'7 at Hospital and 14.0 at home. The case death rates of Hospital treated cases have been in the past seven years—50, 35, 19, 26, 10, 13 6, and 6.7, and of home-treated cases—30, 32, 25, 33, 27, 13 6, and 14.0. These figures illustrate the advantage of Hospital treatment since the introduction of Antitoxin. 47. Table V. shews that most of the cases were between the ages of 1 and 13, but that a larger proportion were under 5 than was the case with Scarlet Fever. As with Scarlet Fever, Ancona Eoad School was most affected, and after it, Burrage Grove. Eighty-two cases, or nearly one half, did not attend any school. Of the Scarlet Fever cases, 192, or about a quarter did not attend school. This shews that School influence is a less important factor with Diphtheria than with Scarlet Fever, 20 48. Table XIII. gives the number of cases occurring in each street. The 183 cases occurred in 86 streets, the highest number being in Robert Street (7), Sandy Hill Road and Heavitree Road (6). 49. Four of the cases developed the Diphtheria while in Hospital for Scarlet Fever, or within three or four days of returning. One case began to be ill two days after a sister returned from Hospital after Diphtheria: the sister had a running from the nose. 50. Two cases were reported from the Fever Hospital as having no infectious disease. If it can be taken that the diagnosis was confirmed in every other case, it is highly creditable to the local medical practitioners. 51. The throat secretions of 15 patients with doubtful affections were examined bacteriologically by the Clinical Research Society, and later the Jenner Institute. Two were found to be cases of Diphtheria and in one the pseudo-diphtheria bacillus was found. I heard of cases which were notified wrongly as Diphtheria and others which probably should have been so notified, in which it is to be regretted that use was not made of this means of diagnosis, provided free of charge. The trouble involved is but slight. Enteric Fever. 52. There were 25 cases of Enteric Fever notified compared with 29, 25, and 28 in the three preceding years. There was only one death, the smallest number of victims to this disease since 1885. 21 The rate per 1,000 population was 0.38, which is lower than that of any of the sanitary districts of the Metropolis. The rate of the whole of London was 0.98. The prevalence of Enteric Fever is a better index of the sanitary condition of a district than is the occurrence of any other infectious disease. 53. The 25 cases occurred in 20 streets, six lying north of Plumstead Road and High Street. Two houses each had three eases, in one they occurred about the same time, apparently from a common undiscovered scource; in the other the infection was doubtless due to want of isolation. The roads affected are Sandy Hill Road, Raglan Road, Plumstead Common Road, Manthorp Road, Crescent Road, BurwashRoad, Whitworth Road, Ann Street, Gallosson Road, Lakedale Road, Speranza Street, Saunders Road, High Street, Viewland Road, Church Manorway, Barth Road, Kentmere Road, White Hart Lane, Marmadon Road, and Ceres Road. 54. In four doubtful cases a bacteriological examination was made by the Jenner Institute, on behalf of the Vestry, and three were declared to be Enteric. 55. Eleven cases were males and 14 females; 1 was under five years of age. In one case the disease was plainly contracted outside the district. In two cases eating insufficiently cooked mussels may have been the cause, and in one case oysters. One case was notified from the Fever Hospital as a mistaken diagnosis. Erysipelas. 56. There were 64 cases of Erysipelas compared with 43, 46 and 54 in the three preceding years. Eight were under 22 and 56 over 5 years of age. The rate per 1,000 population was 0-98, compared with 1.23 in London. There were two deaths, one over and one under 5 years of age. Puerperal Fever. 57. There were 5 cases of Puerperal Fever notified, compared with 3, 3, and 7 in the three preceding years. There were only two deaths compared with 7 in 1898. Three cases were attended by midwives. Measles. 58. There were 3 deaths from Measles compared with 3 and 59 in the two preceding years. The smallest number before that since 1888 was 19 in 1892. Plumstead had the lowest death-rate from Measles of all the.London Sanitary areas, viz.: 0.05 per 1,000; London was 0.47. 59. I received 52 notifications of children kept from school for Measles; 15 being from Eglinton Road School; 12 from Burrage Grove, and 10 from Earl Street. Four other schools notified smaller numbers of cases, but no notifications were received from Conway Road, Purrett Eoad, or the Slade Schools. In 1898, 609 notifications were received. 60. Steps were taken for the closure of the following classes of Infant Departments on account of Measles:—Classes 3 and 4, at Eglinton Road, on July 14th and 18th; Classes 5 and 6, at Eglinton Road, on July 11th (81 children out of 262 were absent on account of Measles); Class rooms D, E, F and G, of Burrage Grove, on December 22nd (36 had Measles out of 201); and Class 6, at Vicarage Road, on December 23rd (8 had Measles out of 61). 23 Each Class was closed for one month, but, as this included holidays, education was really interfered with to a very small extent. Most of the cases of Measles at Eglinton Road School lived iu Woolwich, where 13 deaths from this disease occurred during the year, 9 being in the third quarter. I consider that the action taken in closing classes at this School prevented the disease spreading into Plumstead. Whooping Cough. 61. There were 10 cases of Whooping Cough, the lowest number, with one exception, since 1882. Iu proportion to population, the mortality from WhoopingCough in the three years, 1885-7, was twice that in 1897-9. Phthisis. 62. There were 95 deaths from Phthisis compared with 96 and 88 in the two preceding years. Twenty of these occurred in the Workhouse Infirmary. There were besides 24 deaths from other tubercular diseases. The death rate from Phthisis was l.45. In London it was 1.88. In South London, Lee, Lewisham, and Wandsworth alone had lower rates. By your order, a copy of the "Precautions against Consumption" (Appendix II. of my report for 1898), printed on cardboard, was left at every house and tenement in the parish. 63. Cases occurred in 54 streets, 3 each in Ann Street Robert Street, and Bramblebury Road ; and 2 each iu Benares 24 Road, Tewson Road, Plumstead Road, Old Mill Road, Anglesea Road, Sutcliffe Road, Station Road, East Street, Maxey Road, Manthorp Road, Westdale Road, High Street, Walmer Road, Brewery Road, Orchard Road, Sladedale Road, Raglan Road, Reidhaven Road, and Liffler Road. Of these roads, Ann Street and Walmer Road had three cases each, and Maxey Road five, in 1898. 64. The houses where cases of Phthisis occurred were visited by the Sanitary Inspector, a circular of precautions left, and disinfection offered. Out of 82 cases visited, disinfection was agreed to and performed in 11. Out of 72 cases in which particulars were obtained, 41 were males, and 25 were Arsenal employes. 65. I have to acknowledge the kind assistance of the Medical Officer of the Workhouse Infirmary (Dr. Boulter), and the Plumstead Poor Law Medical Officer (Dr. Wise), who are now sending a weekly return of fresh cases of Phthisis coming under their treatment. 66. In response to an enquiry as to the legality of paying for voluntary notification of Phthisis, made by the Society of Medical Officers of Health, the Local Government Board have recently stated " that, in the Board's opinion, local Authorities " have power, under the provisions of the Public Health Act, " 1875, to make reasonable payments in respect of the notifi" cations of cases of infectious disease occurring in their " districts." It appears then that there is nothing to prevent your Yestry paying for the voluntary notification of Phthisis, as I have recommended, and I consider that the doing so would be of distinct advantage. 25 Diaeehœa. 67. There were 35 deaths from Diarrhœa, compared with 30, 81, and 105 in the three preceding years. The number of deaths from Diarrhoea in the past three years has greatly exceeded that in any previous years since 1885, even allowing for increase of population. This is, no doubt, mainly due to the fact of the succession of three warm summers, which has not occurred previously since 1885. Eighty of the deaths were in children under 5 years of age. Fifteen occurred in West and 70 in East Plumstead. (N.B.—These numbers include Gastro-Enteritis, which are excluded by the Registrar-General). 68. The death-rate, per 1,000 population, as given by the Registrar-General for 1898, was 0.78 in Plumstead and 0.91 in London. But, owing to the uncertainty as to the nomenclature of this disease, some practitioners calling it GastroEnteritis, &c., it is hardly safe to compare death-rates. 69. Dr. Newsholme, in an exhaustive examination of the causes of Diarrhoea, concludes that the principal factors in producing a high mortality from this disease are a permeable soil, surface filth from imperfect removal of house refuse, &c., and a warm and dry season. The germs of disease are conveyed in dust, and in food, such as milk. Thorough watering of streets, open spaces, yards, &c., has much effect in diminishing it. Last summer, by your order, I prepared a circular on the feeding of infants: this has been distributed through District Visitors and others. It is appended to this Report. Alcoholism. 70. Seventeen deaths were certified as due to alcoholism or diseases the direct result of alcohol, eight being in West and 26 nine in East Plumstead. Out of 31 deaths over 5 years of age on which inquests were held, 5 were found to have been the result of drink, or about one-sixth. Though this proportion would be natura'ly greater than that among the whole population, it nevertheless gives a startling indication of the tremendous mortality attributed to alcohol where there is no fear of wounding the susceptibilities of friends. Rheumatism. 71. There were 7 deaths from Acute Rheumatism compared with 4, 1, and 2 in the three preceding years. All were in East Plumstead. Twenty-four cases of Acute Rheumatism and 3 chronic were nursed by the District Nursing Association. The same Association nursed 87 cases of pneumonia. B.—Administration. 72. Water Supply.—The water supply continues to maintain its high quality. There is a constant supply all over the parish, except on Shooters' Hill, above the level of Cantwell and Nithdale Roads, where it is intermittent. 73. Sewers.—The flooding in Benares Road, due to reflux from the Sewer during heavy rain, referred to iu my last report has not recurred. The Sewer was examined and found, in one portion, below the affected houses, to have no fall. This has been relaid. Flooding again occurred at 28-30, Reidhaven Road, and, on examination, the back flap in the manhole at No. 28 was found set fast. This is being attended to by the Works Department. The long combined drain in Crescent Road, where flooding 27 occurred in 1898, has been relieved, by a second connection, with Crescent Road sewer, and another with Armstrong Street sewer. 74. It is satisfactory to know that the County Council are about to construct another Outfall Sewer. Although it will be at a higher level than the present outfall, by relieving the latter, it will, doubtless, enable the Reidhaven Road sewer to empty itself more continually. 75. The Level Ditches.—These have received a good deal of attention during the year from the Chief Inspector, and I reported on their unsatisfactory condition. Your newly appointed Surveyor took the matter in hand, and has constructed a penstock on the river, by which a more thorough flushing is made practicable: owing partly to this, and partly to the increased care given by the Works Department (which now cleanses the ditches by direct labour) their present condition is better than it has been for years. 76. Cemetery.—I inspected the cemetery and found it well kept as before. There were 812 interments here. 77. Churchyard.—There were 149 interments in the Churchyard as compared with 253, 177, and 193 in the three preceding years. This number is still much more than it should be, if the interments were all of those having relatives already buried there. 78. The Mortuary was used for 49 bodies, compared with 31, and 33 in the two preceding years, one was an infectious case, viz., diphtheria. 28 There were inquests on 47 of the bodies, and post-mortem examinations on 38. I inspected the Mortuary and gave directions for its being cleansed. The Committee ordered that it should be white-washed every year. Plans for the new Mortuary are awaiting the confirmation of the County Council. 79. The Health Refuge was not used once during the year. 80. Bakehouses.—I inspected all the bakehouses in April and October, and found them up to the usual standard. 81. Cowhouses and Milk Supply.—I inspected all the cowhouses in company with Chief Inspector Duck, and found a decided improvement compared with 1898. I found greater cleanliness of the cows and the floors of the sheds. 82. Twelve specimens of milk were submitted to the Clinical Research Association, Ltd., for examination as to the presence of Tubercle bacilli. The bacilli were found in none of them, which is so far satisfactory; but pus and strepto-cocci were found in several, indicating inflammation of the udder, and one case was so bad that the Medical Officer of the County Council was informed, and the cow was sent to grass. 83. It is satisfactory to find as the result of the systematic inspection of cows in London cowsheds by the Veterinary Surgeon of the County Council that very few indeed of the cows have tubercle affecting the udder. But one cannot have the same assurance with respect to cows in the country, from which most of the milk sold in Plumstead comes. 29 84. The Health Committee made an enquiry into the methods of the various London Sanitary Authorities with respect to milk analysis. This enquiry had the interesting and useful result of showing that there has been great discrepancy in the standard of pure milk adopted by different analysts. It appeared from the statements of the analysts of several local authorities, that the Somerset House Analysts were credited with adopting a standard of 2.75 per cent. fat and that to avoid any conflict with Somerset House, these analysts adopted the same low standard. But in a letter from Somerset House, it was stated that the standard adopted in the Government Laboratory was 3.0 per cent. fat, and that all analysts used the same standard. The Government Analyst was informed of the result of the enquiry, and it is to be hoped that means have been taken to correct the misapprehension which existed as to the Somerset House standard. 85. I believe a Committee of the Agricultural Board is now sitting to settle the Standards to be used under the Food and Drugs Act of 1899. 86. Dust Shoots.—The house refuse has continued to be deposited on the levels, at a distance of about 200 yards from the Railway, and over 300 yards from houses. I did not hear of any complaints of nuisance arising from it. It cannot, however, be considered satisfactory to have a large accumulation of air polluting material in a neighbourhood which is used for public recreation (as football, cricket, gardening, walking, &c.) to a considerable extent, and might, with advantage, be so used much more largely. Houses too are gradually approaching the site, and, in a year or two, the dust will have to be taken farther afield to be outside the bye-law limit. The 30 greatly increased price at which the new Contract for Dust Removal has been accepted has lessened the strength of one of the arguments in favour of this method of disposal. On the whole, I believe, the day is rapidly approaching when it will have to be considered whether a dust constructor will not be the most satisfactory solution of the difficulty. 87. It was found that some house refuse was being deposited in the South Metropolitan brickfield, within 300 yards of houses, by the Vestry's Contractor. A prosecution was accordingly instituted, with the result that the Company undertook not to allow any more refuse to be deposited, and paid the costs of the proceedings. A small deposit also was found in Brookdene Road, but the owner removed it when his attention was called to it. 88. Dust Collection.—There was no improvement in the dust collection as regards method, it having been done, as before, in a slovenly manner. As regards regularity it quite broke down again at Christmas. Two hundred and sixty-one complaints were received, during the year, of non-removal; and, unfortunately, the poorer class of tenants, at whose houses there is likely to be most harm from accumulation of dust, do not usually send complaints. For the discovery of neglect to collect from these we have to depend, in the absence of a dust inspector, on the chance call of a sanitary inspector. For some weeks after Christmas the Vestry had to supplement the dust collection by direct labour, the organisation of which mainly fell on the Chief Sanitary Inspector. The Contractor having been mulcted in £132 2s. 7d. costs of work done, 31 and £114 fine for breach of contract, a new Contractor has recently been appointed at £2660 a year, compared with £1100 which was paid to the late Contractor. 89. Reidhaven Road District.—The statistics of the Reidhaven Road District show again a great improvement. The birth-rate, death-rate, infantile death-rate, and deaths from diphtheria, enteric fever, diarrhcea, and phthisis, are all lower than in the two preceding years. The very great diminuation in the birth-rate strongly suggests, what there are positive reasons for believing, that there has been a considerable diminution in the population, from the abatement of overcrowding. So that in all probability the improvement in sanitary condition is not so great as the diminished death-rate indicates. But the number of deaths under 1 year per 1,000 births, which is independent of population, may be taken as a fair index of the improved sanitary condition ; this rate is 150 compared with 124 in Plumstead, i.e., twenty per cent. more, whereas in 1898, it was sixty per cent. more. The notifications of Diphtheria are this time much less in the Reidhaven Road district than in Plumstead, and the deaths from Phthisis slightly less in proportion, but the deaths from Diarrhoea and the notifications of Enteric Fever are still much more numerous, though in Diarrhaea there is an improvement compared with the preceding years. The improvement in this district, following so quickly the measures described in my last report, is highly satisfactory. 32 Table F. Reidhaven Road District. Plumstead. Population 8733 65255 1894 1894 1896 1897 1898 1899 1894 1895 1896 1897 1898 1899 Total Births .. .. .. 169 143 120 1910 1866 1950 1975 1896 1971 Birth Rate .. .. .. 45.2 38.3 32.1 33.6 32.0 32.7 32.3 30.2 30.2 Total Deaths 72 84 61 79 74 55 736 930 931 835 1016 916 Death Rate 19.8 23.1 16.2 21.1 19.8 14.7 12.9 15.9 15.6 13.6 16.2 14.0 Deaths under 1 year . 15 42 26 31 25 18 180 250 261 230 296 245 „ per 1000 births • • .. .. 183 174 150 94 134 133 116 156 124 „ 1-5 years 17 18 14 13 14 7 127 143 176 99 156 77 Diphtheria deaths 1 3 5 2 .. • • 40 31 60 24 15 16 „ notifications 5 11 15 6 4 5 118 148 198 132 110 183 Enteric Fever deaths. 2 .. .. .. 1 .. 6 30 4 3 2 1 „ notifications 13 2 3 2 3 4 26 214 29 25 28 25 Diarrhœa deaths 5 12 8 13 15 8 10 48 30 81 105 85 Phthisis „ .. .. .. 12 7 5 70 96 81 96 88 95 90. Sewer Ventilation.— As in previous warm dry summers, many complaints were received as to foul smells from road surface sewer ventilators. These complaints are however growing less numerous, as the open manholes are gradually being fitted with close covers, and shafts erected to take their place as ventilators. The Surveyor states that in all the enquiries made up to the present, it has been found possible to close the manholes complained of without depriving the sewers of sufficient vent. 33 91. The sewers are still flushed—if at all—only by water carts. Automatic flushing tanks continue to be a desideratum, specially for some of the low-lying flat sewers. 92. Drains at the Woolwich Union Workhouse.—A foul smell having been observed in the Receiving Ward of the Workhouse, the Chief Inspector examined the drains and found that this ward had been built over a drain which was very defective, and on which there was a defective manhole where a stoppage had occurred, converting the manhole into a cesspool. When the whole course and branches of this drain were examined, by openings in 15 places, the joints of 48 out of 50 pipes were found defective. The drain under the Receiving Ward is now being re-laid. 93. Houses unfit for occupation.—Proceedings were taken under the Housing of the Working Classes Act, Part II., for the closure of 49—53, Red Lion Lane, a block of back to back houses of great age, and in a very dirty and dilapidated condition. There was no through ventilation, the upstair rooms were only 6 feet high, the windows insufficient, and three houses were without a proper and sufficient water supply. The magistrate made a closing order with costs. 94. Proceedings were also taken, under the Public Health Act, against the owners of 11, Princes Road, which was in my opinion so damp as to be unfit for habitation. The Magistrate, however, who first heard the case, took rather a curious view of it. The tenant, who gave evidence, had occupied the house some years, in spite of its being so 34 damp, and although she stated that she and her husband suffered from Rheumatism, she remained a big stout woman. The owner gave her notice to quit, after the Sanitary Inspector served him with a notice to abate the nuisance, and was, at the time, taking the usual proceedings in the County Court for getting the tenant out. The Magistrate expressed the opinion that the woman's appearance belied her statement that her health had suffered, as did also the fact that she had remained in the house so long, and could not be got out without the help of the County Court. He sympathised with the landlord, and refused the Closing Order, but adjourned the case for the landlord to remedy the dampness and other defects. After repeated adjournments, and some tinkering on the part of the landlord, the case was again heard by another Magistrate, who made an Order for a damp course to be put in and 42/- costs. 95. Smoke Nuisance.—There was again, during the year, a large and unnecessary amount of black smoke emitted from the Arsenal chimneys. By your orders, a letter was written to the Superintendent of Ordnance Factories, calling his attention to the nuisance and danger to health caused by smoke, and requesting him to use his best endeavours to have the nuisance abated. It must be borne in mind that black smoke does not indicate activity of the furnace, but it means careless firing and imperfect apparatus. 96. A circular letter was also ordered to be sent to all places in the parish where a furnace or fireplace is used in any manufacturing or trade process, calling the occupier's 35 attention to Section 24 of the Public Health Act. This Section states that such furnaces "must be constructed as far as practicable to consume their own smoke, and any chimney, not being the chimney of a private dwelling house, sending forth black smoke in such quantity as to be a nuisance, shall be a nuisance liable to be dealt with summarily under the Act." This circular was sent to all the bakehouses, slaughterhouses, and other places where trade processes are carried on. 97. Registration of houses let to two or more families.—At the beginning of the year twenty houses were on the register. During the year I recommended the registration of 16, and the Committee ordered 13 of these to be registered, most of them being at Abbey Wood. Nearly all were on receipt of the notice reduced to occupation by one family, and others have been taken off the register for the same reason. There remained on the register at the close of the year 18 houses. 98. Under the present condition of things in Plumstead, one may say that the bye-laws for houses let in lodgings, as drafted, are practically useless, I mean that as long as it is necessary to go through the process of registration before the bye-laws apply to any house, the bye-laws will remain a dead letter, for the simple reason that a prejudice exists among landlords against registration, and they prefer to turn out the tenants and let to someone who promises not to sublet, which they usually have no difficulty in doing. 99. But there is no reason why the bye-laws should not be drafted, as indeed they are in many parts of London, so that they shall apply to all houses below a certain rental occupied by more than one family, whether they are registered or not. There are probably 500 houses in Plumstead which ought to bo under the bye-laws. 36 I think it would be of great advantage if the bye-laws were re-drafted in the way I have indicated. 100. Overcrowding.—I visited 17 houses in respect to overcrowding and indecency, and overcrowding was abated, after visits from the Inspector in 72 cases. In the three previous years, 21, 38, and 90 cases of overcrowding, respectively, were found. Out of the 3518 houses inspected, house to house, there were 227 in which there were two or more persons to a room; thus 6 per cent. of these houses may be said to be overcrowded in this sense. But no action was taken in cases in which each adult inmate had 300 cubic feet of space in rooms used for sleeping only, and 400 cubic feet in rooms used for living and sleeping. With regard to the difficulty in dealing with cases of overcrowding, in the well-known absence of sufficient house accommodation, I have only to refer to previous reports. The absence of sufficient houses at reasonable rents, militates more than anything else against improvement in the sanitary condition of houses. Applicants for every vacant house being so numerous the landlord is the master of the situation, and the bad landlord has no inducement but the pressure of the sanitary authority to maintain his property in good condition. 101. Removal of infectious cases from the Arsenal Surgery to their own homes.—The Principal Medical Officer of the Arsenal raised a question as to the responsibility of payment for removal of infectious cases to their homes after having been diagnosed in the Arsenal Surgery. The Asylums Board charge 5/- for removal in their ambulances, and Major Dodd represented that many employees were unable to meet this payment, 37 and that if they returned home any other way, they would be liable to penalties. After discussion, the matter was finally settled by the War Office agreeing to meet the charge as suggested by the Health Committee. 102. Inspectors' Work (see Table IX.)—3518 houses were inspected house to house, compared with 2895 in 1898. In addition to these, 3736 houses were inspected on complaint or for infectious diseases, &c., compared with 3105 in the year before. 777 choked and defective drains were dealt with, and 66 combined drains found faulty were examined before referring them to the Works Department. In 1898 there were 731 choked and defective drains, and 54 combined drains. 455 damp walls were remedied, compared with 510 in 1898. Through ventilation was provided in 26 houses. 103. Prosecutions.—2551 intimation notices were served, and 757 were followed by statutory notices: 176 of these not having been attended to were reported to the Vestry Clerk for proceedings, and, after the Clerk had written to each of the defaulters, 59 summonses were issued against those who disregarded the Clerk's letter. Particulars of the prosecutions are given in Table Xa. Every case went in favour of the Vestry. 28 fines were inflicted, the principal being £5 for selling unsound meat, £4 for improper repair of a drain, 40/for improper repair of a water closet, and 40/- for improper repair of a drain. Fines of 10/- and 5/- were inflicted in a large number of cases for letting houses without having obtained a water certificate. 15/6 costs were obtained in one 38 case, and 12/- in another, but in the remainder the costs were under 5/-. In 1898, 137 cases were reported to the Clerk and 31 summonses taken out, in 1897 these numbers were 191 and 42 respectively. 104. Adulteration under Sale of Food and Drugs Act. (See Table X b.)—Out of 200 samples taken by Chief Inspector Duck, 14, or 7 per cent., were found adulterated; proceedings were taken in each case, ten convictions were obtained and two cases were dismissed; two are still pending. A penalty of £5 was inflicted for selling butter one half margarine. A dairyman, for selling milk with 10 per cent. added water, was fined £3, a very inadequate penalty considering that this was the second conviction of the man, and that for the first offence he was liable to a fine of £20. Another man was fined £3 for selling butter three-fourths margarine. One man was fined 20/- for refusal to serve the inspector. Of the cases dismissed, one pleaded that the adulterated milk was sold as skim milk, although the Inspector denied this; and the other was a case in which it was shewn that the cow was yielding milk of an abnormal composition which did not correspond with the supposed adulteration. 105. The adulterations were in 1896-7, 2½ per cent. of samples ; and in 1897-8, 3½ per cent. The increase to 7 per cent. has occurred since Mr. Duck was appointed analyst's Inspector. 39 106. In addition to the work just referred to, Mr. Duck has in the past 12 months sent 81 samples of cheese, butter, margarine, bacon, preserves, &c., to the Government Laboratory for the use of the Preservatives Committee of the Local Government Board recently appointed to report on preserved food. There has been no change in the sanitary staff since my last report. In conclusion, I have to congratulate you, gentlemen, on the very satisfactory sanitary condition in which you will be able to hand over the parish to tbe new Borough Council, and to thank you for the support you have accorded me in my work. I have also to acknowledge the conscientious work of the Chief Inspector and the whole sanitary staff. I am, Gentlemen, Your obedient servant, SIDNEY DAYIES. 40 TABLE I. Summary of Statistics for 1899, compared with Registration London. Plumstead. London. 1. Area 3,388 acres 77,410 acres Inhabited Houses (June, 1899) 10,628 544,977 Number of Persona to a House 6.08 7.7 2. Population (Census 1896) 59,252 4,421,955 Population, estimated to June 30th, 1899 65,255 4,546,752 Total Deaths (corrected fo Public tions) 916 89,689 Total Births 1,971 133,120 Natural increase of population 1,055 43,431 Estimated increase 2,652 42,182 3 Birth Rate 30.2 29.4 Death Rate 14.0 19.8 Zymotic Death Rate 1.3 2.48 Deaths under 1 year, per 1000 births 124 167 4. Uncertified deaths, per cent. of total deaths 3.5 0.6 Deaths from violence 17 3,765 Inquest cases 35 — 5. Death Rate, 1897 13.6 17.7 1898 16.2 16.3 1899 14.0 19.8 TABLE II. Births and Deaths for each Quarter of the Year, corrected for Deaths in Workhouse, Infirmary, and Out-lying Institutions. These Figures are 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 Typhus. Enteric. Continued. Relapsing. Puerperal. Cholera. Erysipelas. Measles. Whooping. Cough. Diarrhcea & Dysentery. .Rheumatic Fever. Cancer. 1 Other Tuber1 culou8 Diseases Phthisis. Bronchitis, Pneumonia, Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Influenza. Alcohol. Labour and Sequelae. Prem. Birth and 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. West Plumstead. 1st Qr. 105 57 8 6 2 1 27 13 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 5 1 1 6 11 .. 9 .. .. 9 12 14 43 .. .. .. 2 .. .. 3 .. .. 2 1 4 2nd Qr. 135 66 6 1 3 2 28 26 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 6 .. .. .. 7 .. 7 .. 17 .. 1 6 20 7 59 .. 1 2 .. .. 3 .. .. 2 1 3 3rd Qr. 98 65 21 3 1 1 22 17 .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 13 1 .. .. .. 6 1 1 6 .. 4 .. 3 .. 1 8 18 24 41 .. .. .. 3 .. .. 5 .. 2 2 .. 2 4th Qr. 114 71 10 6 7 3 26 19 .. .. .. 1 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 8 .. .. •• 4 5 10 .. 8 .. .. 9 23 16 55 1 1 .. 1 .. .. 5 .. .. 2 1 2 Total 452 259 45 16 13 7 103 75 .. .. 2 1 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 1 .. .. 1 25 2 1 1 23 5 32 37 •• 2 32 73 61 198 1 2 .. 8 .. .. 16 .. 2 8 3 11 East Plumstead. | 368 144 38 13 8 2 50 33 .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 2 .. .. 1 .. 7 3 .. .. 15 18 27 .. 11 .. 2 27 28 51 93 1 3 .. .. .. .. 8 .. 6 2 1 1 2nd Qr. 382 133 37 12 5 6 55 18 .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 .. 2 .. 3 .. 1 2 .. 9 5 1 14 7 16 .. 10 2 2 25 29 49 84 1 4 .. 3 .. 1 15 .. 3 3 2 3 3rd Qr. 378 198 83 21 7 10 53 24 .. .. .. 1 8 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 5 •• 54 3 .. .. .. 13 8 .. 1 14 6 9 1 13 .. 5 26 34 101 94 .. 1 .. 5 .. .. 12 .. 2 3 .. 6 4th Qr. 391 182 42 15 12 11 66 36 .. .. .. .. 4 3 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 7 1 .. 3 .. 7 2 2 .. 27 14 23 .. 18 1 3 28 37 57 125 .. 5 .. 1 .. .. 18 .. 2 1 1 8 Total 1519 657 200 61 32 29 224 111 .. .. 1 2 9 4 .. .. .. .. .. .. .. .. .. 2 .. .. 1 1 2 .. 7 1 66 4 1 6 .. 36 18 3 l 70 45 75 1 52 3 12 106 128 261 396 2 13 9 •• 1 53 .. 13 9 4 18 Plumstead. | Total. 1st Qr. 473 201 46 19 10 3 77 46 .. .. 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 3 .. .. 1 .. 12 4 .. l 21 18 38 20 .. 2 36 40 65 136 1 3 .. 2 .. .. 11 .. 6 4 2 5 2nd Qr. 517 199 43 13 8 8 83 44 .. .. .. 2 .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 •• 1 .. 2 .. 3 .. 1 .. 1 15 5 1 .. 21 7 23 .. 27 2 3 31 49 56 143 1 5 .. 5 .. 1 18 3 5 3 6 476 263 104 24 8 11 75 41 • • .. 1 1 3 2 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 5 .. 67 4 .. .. .. 19 9 1 1 20 6 13 1 16 .. 6 34 52 128 135 .. 1 .. 8 .. .. 17 .. 4 5 .. 8 4th Qr. 505 253 52 21 19 14 92 55 .. .. .. 1 5 4 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 .. 7 1 .. 3 .. 15 2 2 .. 31 19 33 .. 26 1 3 37 60 73 180 1 6 .. 2 .. .. 23 .. 3 4 2 12 Total 1971 916 245 77 45 36 327 186 .. .. 3 3 10 6 .. .. .. 1 .. .. .. .. .. .. .. .. 1 1 3 .. 9 1 80 5 1 6 1 61 20 4 2 93 50 107 1 89 3 14 138 201 322 594 3 15 .. 17 .. 1 69 •• 16 18 7 31 (A) TABLE III. Table of DEATHS during the year 1899, in the Parish of Plumstead, London District, classified according to Diseases, Ages, and Localities. Names or Localities adopted for the purpose of these Statistics; Public Institutions being shewn as separate localities. Mortality from all causes, at subjoined ages. (i) Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all Ages Under 1 year 1 & under 5 5 & under 15 15 & under 25 25 & under 65 65 A upwards 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Small Pox Scarlatina Diphtheria Meuibranous Croup FEVERS. Cholera Erysipelas 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) (h) Under 5 1 1 1 2 14 1 5 1 33 59 WEST PLUMSTEAD 214 44 15 10 4 78 63 5 upwds. 1 1 18 29 32 17 1 56 155 Under 5 5 2 7 65 1 1 45 1 3 121 251 EAST PLUMSTEAD 540 196 55 21 18 166 84 5 upwds. 1 1 2 1 1 3 5 46 64 40 31 6 88 289 Under 5 1 7 8 INFIRMARY & WORKHOUSE 247 6 2 2 10 141 86 5 upwds. i 1 3 65 30 23 14 13 89 239 Under 5 1 6 3 9 79 1 2 51 1 1 3 161 318 Totals 1001 246 72 33 32 385 233 5 upwds. 1 1 2 3 1 1 7 5 129 123 95 62 20 233 683 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Under 5 2 4 1 1 1 9 Deaths occurring outside the district 78 2 7 14 9 43 3 among persons belonging thereto. 5 upwds. 2 5 1 9 6 3 8 3 32 69 Under 5 1 4 5 Deaths occurring within the district 163 3 2 2 5 101 50 among persons not belonging thereto 5 upwds. 1 1 2 45 22 9 9 9 60 158 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 1899, in the Parish of Plumstead; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being: shown as separate localities Population at All Ages. Registered Births. Aged under 5 or over 5 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 1896. Estimated to middle of 1899. 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. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid, Continued. Relapsing. Puerperal. | Typhus. Enteric or Typhoid. Continued. Relapsing. | Puerperal. (a) (b) e d e Under 5 .. 221 67 1 1 .. .. .. .. 8 .. .. 157 54 .. .. 1 .. .. .. .. .. .. PLUMSTEAD 59252 65255 1971 (Excluding Workhouse and Infirmary) 5 upwds. .. 480 115 .. .. 24 1 .. 5 .. 56 .. .. 361 79 .. .. 17 .. .. .. .. .. .. WORKHOUSE AND Under 5 .. 4 .. .. .. .. .. .. .. .. .. .. .. 4 .. .. .. .. .. .. .. .. .. .. INFIRMARY .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. TOTALS 59252 65255 1971 Under 5 .. 225 67 1 .. 1 .. .. .. .. 8 .. .. 161 54 .. .. 1 .. .. .. .. .. 5 upwds. .. 482 115 .. .. 24 1 .. 5 56 .. .. 363 79 .. .. 17 .. .. .. .. .. .. 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 15 Over 15 Males. Females SCARLET FEVER 707 9 212 245 102 39 359 348 482 79 18 3 520 DIPHTHERIA AND MEMBRANOUS CROUP 183 3 66 58 27 29 96 87 136 14 5 1 133 Number of Patients Attending Each School. Ancona Road. Earl Street. Vicarage Road. Plumstead Eoad. Purrett Road. Bloomfield Road. The Slade Burrage Grove. Eglinton Road. High Street. Conway Road. Knee Hill, Abbey Wood Plum Lane. Lee Street. Other Schools. Total. On Roll 1316 On Roll 1025 On Roll 1048 On Roll 881 On Roll 1268 On Roll 1920 On Roll 1006 On Roll 976 On Roll 1292 On Roll 1211 On Roll 1357 On Roll 155 On Roll 396 On Roll SCARLET FEVER 113 40 23 17 58 57 35 40 13 20 37 16 10 1 35 515 DIPHTHERIA & MEMBRANOUS CROUP 18 9 8 0 5 15 7 9 4 0 10 0 3 1 12 101 TABLE VI. Summary of the Vital Statistics of the Parish of Plumstead, 1885-1899. Year. Estimated Population middle of year. Births. Deaths, Annual Bate per 1000 living. Deaths from Principal Zymotic Disease. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. simple and Undefined Fever. Diarrhœa. Phthisis. Other Tuberculous Diseases. Deaths of Children under 1 year of age to 1000 births. Births. Deaths. Principal Zymotic Disease. 1885 40,354 1390 607 34.4 15.1 1.71 69 3 14 2 4 27 .. 5 .. 14 .. .. 120 1S86 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 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 .. 124 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 49 140 1894 56,770 1910 736 33.6 12.9 2.06 123 2 20 21 34 30 .. 6 .. 10 70 25 94 1895 58,175 1866 930 32.0 15.9 2.5 153 2 24 10 34 5 .. 30 .. 48 96 26 134 1896 59,615 1950 931 32.7 15.6 3.5 213 .. 68 14 60 35 .. 4 .. 30 81 26 133 1897 61,090 1975 835 32.3 13.6 2.2 138 .. 3 6 24 21 .. 3 .. 81 96 26 116 1898 62,603 1896 1016 30.2 16.2 3.5 224 • • 59 12 15 31 .. 2 .. 105 88 30 156 1899 65,255 1971 916 30.2 14.0 1.3 121 .. 3 6 16 10 .. 1 .. 85 95 24 124 TABLE VII. Analysis of the Vital and Mortal Statistics of the Sanitary Districts of the Metropolis after Distribution of Deaths occurring in Public Institutions during the year 1899. Sanitaby Areas. Estimated Population in the middle of 1899. 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. Diarrhcea. Phthisis. Deaths of Children under 1 year of age to 1000 births. Births. Deaths. Principal Zymotic Diseases London West Districts. 4,546,752 133,120 87,530 29.4 19.3 2.46 11,147 3 2,141 398 1946 1717 2 758 1 4,181 8,275 166 Faddington 128,794 2,941 2,065 22.9 16.1 1.55 198 .. 6 5 29 43 .. 9 .. 106 148 151 Kensington 172,899 3,590 3,054 20.8 17.7 1.53 263 .. 24 10 43 61 .. 24 .. 101 231 180 Hammersmith 108,785 3,061 2,058 28.2 19 0 2.11 230 .. 22 13 25 46 .. 23 .. 101 187 183 F ulham 130,720 4,574 2,507 35.1 19.2 3.23 423 .. 68 33 59 54 .. 25 .. 183 238 189 Chelsea 96,72; 2,381 1,893 24.7 19.6 213 205 .. 18 8 26 71 .. 18 .. 64 173 164 St. George, Hanover Sq. 80,876 1,348 1.142 16.7 14.2 1 09 98 .. 17 7 12 14 .. 9 .. 29 110 129 Westminster 52,117 1,115 1,159 21.5 22.3 1.64 85 .. 17 5 10 5 .. 9 .. 39 172 207 St. James, Westminster North Districts. 21,827 437 389 20.1 17.9 1.12 24 .. 3 1 3 6 .. 3 .. 8 46 142 Marylebone 140,139 3,987 2,596 28.5 18.6 1.70 236 1 24 15 36 34 .. 26 .. 100 277 124 Hampstead 80,252 1,577 926 19.8 11 6 1.16 93 .. 22 6 15 11 .. .. 35 67 129 St. Pancras 244,548 6,621 4,948 27.1 20.3 2.69 653 .. 102 25 111 142 .. 42 .. 231 489 178 Islington 348,085 9,658 6,299 27.8 181 2.30 798 .. 164 34 126 176 .. 48 .. 256 552 160 Stoke Newington 35,187 799 446 22.8 12.7 1 .33 47 .. 10 3 6 4 .. 5 .. 19 31 103 Hackney Central Districts. 222,571 6,453 3,753 29.1 16.9 2.22 492 .. 110 16 89 48 .. 35 .. 194 332 153 St. Giles 37,196 1,132 739 30.5 19.9 1.40 52 .. 16 .. 5 1 .. 4 .. 26 116 112 St. Martin.in.the.Fields 12,142 148 189 12.2 15.6 1.07 13 .. 5 .. 1 .. .. 1 .. 6 22 203 Strand 23,016 472 521 20.6 22.7 1.30 30 .. 5 1 7 .. .. .. .. 17 62 189 Holborn 29,621 721 737 24.4 24.9 2.23 66 .. 11 3 6 13 .. 7 .. 26 91 226 Clerkenwell 66,068 2,050 1,492 31.1 22.6 3.04 200 .. 36 13 28 30 .. 23 .. 70 153 193 St. Luke 40,868 1,811 1,159 44.4 28 4 3.03 123 .. 26 8 10 14 .. 6 .. 59 144 149 London City East Districts. 27,986 416 599 14 9 21.5 1.36 38 .. 4 1 7 5 .. 12 .. 9 61 144 Shoreditch 121,071 4,132 2,857 34.2 238 3.64 438 .. 90 13 65 47 .. 25 .. 198 253 204 Bethnal Green 128,939 4,753 2,936 37.0 22.8 3.15 405 .. 98 9 59 45 .. 38 .. 156 303 174 Whitechapel 81,391 3,000 1,714 37.0 211 2.12 173 .. 58 2 27 24 .. 15 .. 46 194 147 St. George.in.the.East 48,560 2,068 1,312 42.7 27.1 3.44 166 .. 58 3 12 25 .. 9 .. 59 121 200 Limehouse 58.807 1,933 1,500 33.0 25.6 3.78 221 .. 62 1 34 31 .. 22 .. 71 135 216 Mile End Old Town 113,161 4,250 2,406 37 7 21.3 2.72 307 .. 52 5 65 48 .. 26 .. 111 205 158 Poplar South Districts. 170,606 5,918 3,762 34.8 22.1 3.41 582 .. 104 10 77 106 .. 38 .. 247 364 176 St. Saviour, Southwark 24,207 694 607 28.7 25.1 3.51 85 .. 21 2 17 10 .. 1 .. 34 83 203 St. George, Southwark 60,536 2,128 1,673 35.2 27.7 4.53 274 .. 63 6 63 32 .. 8 .. 102 213 205 Newington 124,166 4,178 2,969 33.7 24.0 3.67 455 .. 87 13 104 104 .. 23 .. 124 325 191 St. Olave, Southwark 11,098 361 276 32.6 24.9 2.61 29 .. 10 2 9 .. .. 2 .. 6 28 147 Bermondsey 85,835 3,063 2,063 35.8 24.1 3.46 296 .. 68 10 88 29 1 18 .. 82 183 187 Rotherhithe 41,050 1,266 865 30.9 211 2.80 115 .. 14 11 32 14 1 11 .. 32 75 170 Lambeth 308,108 9,433 5,894 30.7 19 2 2 .65 819 .. 170 25 158 130 .. 50 .. 286 537 158 Battersea 174,996 5,179 2,910 29.7 16.7 2.22 387 .. 105 14 62 52 .. 38 .. 116 277 162 Wandsworth 209,655 5,542 3,203 26.5 15 3 1.89 395 .. 59 9 68 65 .. 18 .. 176 253 153 Camberwell 264,817 7,444 4,602 28.2 17.4 2.52 667 .. 130 19 160 86 .. 33 .. 239 404 158 Greenwich 182,513 5,682 3,415 31.2 18'8 2.76 503 .. 127 17 73 53 .. 30 .. 203 281 167 Lee 40,219 976 606 24.3 15.1 2.06 83 .. 25 4 14 9 .. 4 .. 27 40 141 Lewisham 91,027 2,597 1,478 28.6 163 2.23 203 .. 14 6 68 12 .. 11 .. 91 104 143 Woolwich 41,542 1,260 879 30.4 21.2 2.44 101 .. 13 4 21 13 .. 5 .. 45 102 163 Plumstead 65,255 1,971 916 30.2 14.0 1.3 121 .. 3 6 16 10 .. 1 .. 51 95 124 49 TABLE VIII. Abstract from Mortuary Register for 1899. Date. Age. Sex. Inquest or no. Post Mortem or no. Cause of Death. Jan. 9 Yes Ye3 Convulsions „ 20 27 years Male Yes No Accidental death „ 23 3 weeks Female Yes Yes Suffocation „ 24 36 years Male Yes No Accidental death „ 27 65 Male Yes Yes Paralysis of the throat Feb. 20 51 „ Female Yes Yes Liver complaint Mar. 4 64 „ Female Yes No Suicide whilst temporarily deranged „ 8 20 months Female Yes Yes Coma following peritonitis April 4 57 years Male Yes Yes Disease of brain and lungs „ 4 59 ,, Female Yes Yes General debility „ 12 42 „ Female Yes No Inflammation of brain, caused by a fall „ 24 1 week Male Yes Yes Inattention at birth „ 26 39 year9 Female Yes Yes Consumption „ 26 77 „ Female Yes Yes Natural causes May 9 49 „ Male Yes Yes Syncope, valvular disease of heart „ 21 newly born Male Yes Yes Inattention at birth June 12 15 days Male Yes Yes Accidental suffocation „ 12 49 years Female Yes Yes Pleurisy and pneumonia ,, 18 70 „ Male No No July 1 54 „ Male Yes No Suicide during temporary insanity „ 13 14 „ Male Yes Yes Fractured skull „ 25 62 „ Male Yes Yes Broke blood vessel of lung, probably due to lung disease „ 31 44 „ Male Yes No Accidental death ,, 31 28 ,, Male Yes No Accidental death Aug. 5 64 „ Female Yes Yes Acute inflammation of stomach „ 7 40 „ Male Yes No Accidental death „ 14 Female Yes Yes Delirium tremens ,, 23 35 „ Female Yes Yes Hemorrhage in the front of brain „ 27 64 „ Female Yes Yes Heart disease Sep. 13 45 „ Male No No Cancer „ 30 51 „ Male Yes Yes Inflammation of the lungs 50 TABLE VIII.—(continued). Date. Age. Sex. Inquest or no. Post Mortem or no. Cause of Death. Oct. 2 66 years Female Yes Yes Misadventure, through deceased having taken opium to produce sleep „ 17 50 „ Male Yes Yes Apoplexy „ 17 65 ,, Female Yes Yes Fatty degeneration of heart „ 24 40 „ Male Yes Yes Pneumonia Nov. 14 4 months Male Yes Yes Convulsions 15 59 years Female Yes Yes Accidental burns, caused by the explosion of a paraffin lamp „ 19 47 „ Male Yes Yes Syncope „ 22 19 „ Male Yes Yes Consumption „ 30 41 ,, Male Yes Yes Natural causes, death hastened by alcoholism Dec. 2 27 „ Male Yes No Found drowned „ 2 50 „ Male Yes Yes Natural causes, death hastened by alcoholism „ 8 4 ,, Female Yes Yes Diphtheria ,, 8 Male Yes Yes Rupture of an aneurism by overlifting „ 16 59 „ Male Yes Yes Diseased heart, lungs, kidneys, and spleen „ 18 70 „ Female Yes Yes Heart disease ,. 20 53 ,, Male Yes Yes Consumption and Pneumonia „ 20 4 ,, Male Yes Yes Chronic bronchitis „ 21 Male Yes Yes Fatty degeneration of heart 51 TABLE IX Summary of Nuisances abated, Notices served, and General Work of the Public Health Department for 12 months ending 31st December, 1899. PREMISES INSPECTED. West District Inspector. Central District Inspector. South District Inspector. East District Inspector. . Chief Inspector. Total No. of Houses inspected, House to house 690 982 1113 733 — 3518 „ Re-inspections after service of notices 1985 1875 1645 1535 965 8005 „ Houses and Premises specially inspected, including infectious diseases and complaints 700 434 731 780 1091 3736 „ New buildings re water certificates — — — — 375 375 „ Houses where drains have been tested by smoke test 29 53 60 161 13 336 „ Houses where drains have been tested by water 65 35 22 68 4 194 NUISANCES ABATED. Drains. Waste pipes from baths, lavatories and washhouse sinks, repaired or disconnected 34 74 22 40 3 173 Choked and defective drains 122 252 170 177 56 777 Defective traps 57 24 17 55 7 160 Defective and unventilated soil pipes 7 15 44 7 2 75 Combined drains examined and referred to Works Department 66 66 No. of houses affected by the defective combined drains — — — — — 342 W.C.'s W.C.'s repaired, new traps or pans provided, fittings repaired 270 318 285 230 20 1123 Water supply apparatus repaired 97 204 90 208 11 610 Premises. Interiors cleansed, repaired, and defective roofs repaired 269 236 115 245 16 881 Damp walls remedied 147 123 103 77 5 455 Paving in yards and wash-houses repaired 124 132 57 153 7 473 Through ventilation provided — 16 9 1 — 26 Wash-houses without sinks and outlets for waste water 18 3 15 2 1 39 Defective guttering and rain-water pipes 54 214 72 140 5 485 Dustbins supplied 105 159 77 154 381 876 Dung pits provided 8 6 7 — — 21 Cases of overcrowding remedied — 40 14 13 5 72 52 TABLE IX —Continued. Animals. West District Inspector. Central District Inspector. South District Inspector. East District Inspector. Chief Inspector. Total Animals kept in such a state, as to be a nuisance 2 8 6 5 5 26 Accumulations of manure removed — 4 — 1 10 15 Water. Defective and foul cisterns used for dietary purposes — 1 17 13 2 33 Defective and foul rain-water tanks remedied 19 2 2 2 1 26 Defective water pipes, rendering premises damp 7 6 10 28 3 54 Insufficient supply and water cut off by Water Company 4 10 6 4 4 27 MISCELLANEOUS. Total. Obstructions of footpaths 20 Number of cases of inattention to notices reported to Vestry Clerk for proceedings 176 Summonses at the Police Court 59 Ditches cleansed Bakehouses cleansed twice during the year 23 38 Cowhouses and Slaughterhouses inspected during the year 13 Notices under Bye-laws, Tents and Vans 25 DISINFECTION. No. of houses disinfected after Infectious disease 885 „ cases disinfected for other parishes (Lee and Eltham) 45 CLERICAL WORK. Letters received 1164 „ written 1775 Notifications received 985 Certificates issued after disinfection 2703 ,, of infectious disease forwarded to schools 1660 Complaints of Sanitary defects 343 „ non-removal of dust 261 Written Intimation Notices 2551 Statutory Notices 757 53 TABLE Xa. Prosecutions under Public Health Department. Date. Offence. Situation. Result. 1899 January 5 Constructing dungpit contrary to L.C.C. Bye-laws 79, Frederick Place Fined 5/-, and 2/- costs „ 19 Nuisance 48, Red Lion Lane Order to abate, and 4/- costs „ „ Nuisance 52 Do. do. February 16 Improper repair of drain 115, Elm Street Fined 40/-, and 3/- costs March 2 Non-provision of dungpit 3, Ripon Road Work done, 12/- costs April 13 Obstruction of footpath 264, High Street Fined £1, & 2/- costs 2 offences „ £3 „ „ „ Nuisance 152, Plumstead Road Work done, 3/- costs „ „ Nuisance 64, Robert Street Do. do. „ „ Nuisance 51, Orchard Road Order to abate within 14 days, 3/- costs „ „ Defective yard paving 62, Earl Street Work done, 2/- costs „ „ Obstruction on footpath 65, High Street Fined 30/-, and 2/- costs „ 27 Improper repair of w.c. 35, Riverdale Road „ 40/- „ May 4 Nuisance 52, Robert Street Work done, 3/- costs „ „ Obstruction 71, High Street Withdrawn, 2/- costs June 1 Nuisance 35, Elm Street Work done, 2/- costs „ „ House unfit for human habitation (Housing of Working Classes Act) 49, Red Lion Lane Summonses withdrawn on payment of costs, the houses having been evacuated, and the owner undertaking to pull them down. „ „ Do. 50 „ „ Do. 51 „ „ Do. 52 „ „ Do. 53 „ 15 Defective yard paving 114, Station Road Work done, 2/- costs „ „ Improper repair of drain 131, Plumstead Common Road Fined £4, and 2/- costs July 27 Letting house without water certificate ?03, High Street „ 10/- „ „ „ Do. 73, Barnfield Road „ 7/- „ August 3 Nuisance 51, Glyndon Road Order to abate in 7 days, and 3/- costs „ „ Nuisance 68, Chesnut Road Do. do. „ „ Nuisance 90, Glyndon Road Order to abate in 14 days, and 3/- costs „ „ Nuisance 98 Do. do. „ „ Nuisance 92 Do. do. „ „ Nuisance 77 Work done, 3/- costs „ 8 Unsound meat 138, Plumstead Common Road Fined £5, and 2/- costs 54 Prosecutions under Public Health Department—Continued. Date. Offence. Situation. Result. 1899 October 5 Letting houses without water certificate 27, Plumstead Common Road Fined 10/-, and 2/- costs „ „ Do. 29 Do. do. „ „ Do. 31 Do. do. „ „ Do. 33 Do. do. „ „ Do. 35 Do. do. „ „ Do. 37 Do. do. „ „ Do. 39 Do. do. „ „ Do. 156, Sandy Hill Road Do. do. „ „ Do. 2, Kashgar Road Do. do. „ „ Deposit of offensive refuse South Metropolitan Brick Company's Land, Wickham Lane Brick Co. to pay 15/6 costs „ 12 Nuisance 33, Walmer Road Work done, 3/- costs „ „ Nuisance 29, Park Road Do. do. „ „ Nuisance 31 Do. do. „ „ Nuisance 16, Majendie Road Do. do. „ „ Nuisance 33, Park Road Do. do. „ 26 Nuisance 25a Do. do. Nov. 23 Letting houses without water certificate 58, Wickham Lane Fined 5/-, and 2/- costs „ „ Do. 59 „ Do. do. „ „ Do. 60 „ Do. do. „ „ Do. 61 „ Do. do. „ „ Do. 62 „ Do. do. „ „ Do. 63 „ Do. do. „ „ Do. 64 „ Do. do. „ „ Do. 65 „ Do, do. Dec. 14 Do. 66 „ Do. do. Nuisance 18, Rippolson Road Work done, 13/- costs „ „ Nuisance 50, Durham Road Order to abate, and 16/-costs „ „ Defective yard paving 20, Orchard Road Fined 10/-, and 2/- costs TABLE XI. Shewing the number of cases of Scarlet Fever notified in each week of 1899. SCHOOL HOLIDAYS. Easter Commenced 30th March, Ended 9th April. Summer ,, 26th July ,, 27th Aug. Christmas ,, 21st Dec. ,, 7th Jan. (1900.) TABLE Xb. SALE OF FOOD AND DRUGS ACT. Particulars of Adulterations and Results of Proceedings, 26th March 1899 to 25th March, 1900. No. Abticle. Result of Analysis. Name and Address of Vendor. Date of Hearing. Result of Summonses. Remarks. 823 Milk 32 per cent. added water Edwin Curtis, 10, Eltham Cottages 1899 8th June 10/- Fine, 12/6 Costs 828 Butter ¼ butter, ¾ margarine .. John Collison, 115, Chesnut Road 15th „ £3 „ 16/- „ 830 Butter 1/3 butter, 2/3 margarine .. Jane Padley, 2, Parkdale Road 15th „ 20/- „ 16/- „ 883 Milk 80 per cent. fat abstracted William West, 60, Barth Road 3rd Aug. Dismissed. Stated to have been sold as Skim Milk. 911 Butter 1/3 butter, 2/3 margarine .. Henry Freeman, 181, Plum. Com. Road 26th Oct. £1 Fine, 12/- Costs 914 Milk 10 per cent. added water Edwin Curtis, 10, Eltham Cottages 17th Nov. Dismissed. Milk fresh from cow analyzed by order of Magistrate, abnormal result obtained 923 Milk 10 per cent. added water Henry Robinson, Ripon Road 26th Oct. £3 Fine, 12/- Costs 934 Butter ¾ butter, ½ margarine .. George Collins, 32b, Plumstead Road 7th Dec. £5 „ 12/6 „ 937 Butter 1/5 butter, 4/5 margarine .. G. Mortimer, 3, Park Road 7 th „ 10/- „ 12/6 „ 3 Milk 10 per cent. fat abstracted Walter Elliott, 289, High Street 1900 8th Feb. 10/- Fine, 12/6 Costs 7 Milk 10 per cent. fat abstracted F. G. Cock, 13. Raglan Road 8th „ 20/- „ 12/6 „ 19 Milk 12 per cent. fat abstracted James Taylor, 68, Walmer Road 29th Mar. 40/- „ 12/- „ Sample sent to Somerset House whose certificate said 16 per cent fat extracted. 20 Milk ] 3 per cent. fat abstracted Margaret Goddard, 6, Westdale Road 8th „ 15/- „ 12/- „ 40 Milk 16 per cent. added water Charles Jones, 6, Florence Terrace. 29th „ 40/- „ 12/- „ Refusal to Serve Milk Richard Still, 65, Vicarage Road 8th Feb. 20/- 2/- „ 56 TABLE XII. SCARLET FEVER. Cases occurring in each Street. Street. Under 5. Over 5. Total. Street. Under 5. Over 5. Total. High Street 5 22 27 Burwash Road 6 6 Griffin Road 5 14 19 Purrett Road 1 5 6 Frederick Place 1 13 14 Bastion Road 2 4 6 Orchard Road 7 7 14 Speranza Street 2 3 5 Piedmont Road 2 12 14 Oliver Street 1 4 5 Sutcliffe Road 6 7 13 Coupland Terrace 3 2 5 Parkdale Road 4 9 13 Bostal Hill 3 2 5 Kashgar Road 5 7 12 Villas Road 1 4 5 Llanover Road 5 7 12 Plum Lane 1 4 5 Tewson Road 5 7 12 Majendie Road 2 3 5 Ann Street 3 9 12 Eglinton Road 1 4 5 Francis Street 1 10 11 Shooters' Hill 5 5 Chesnut Road 1 10 11 Viewland Road 1 4 5 Plumatead Common Road 1 10 11 Benares Road 4 4 Sandy Hill Road 2 9 11 Edge Hill Road 4 4 Riverdale Road 2 9 11 Herbert Road 2 2 4 Burrage Road 3 7 10 Timbercroft Lane 3 1 4 Bramblebury Road 3 6 9 Radnor Terrace 1 3 4 Conway Road 2 7 9 Waverley Road 2 2 4 Robert Street 1 8 9 Ennis Road 2 2 4 Park Road 4 5 9 Liffler Road 1 3 4 Maxey Road 5 4 9 Coxwell Road 4 4 Hargor Road 3 6 9 Pattison Road 4 4 Reidhaven Road 7 2 9 Glyndon Road 2 2 4 Durham Road 3 6 9 Walmer Road 2 2 4 Plumstead Road 2 7 9 Rippolson Road 1 3 4 Brewery Road 4 5 9 Miriam Road 4 4 Macoma Road 2 7 9 Hudson Road 2 2 4 Grove Road, Abbey Wood 2 7 9 Sladedale Road 2 2 4 Station Road 3 5 8 Acacia Villas 2 2 4 Elm Street 4 4 8 Elm Grove 1 3 4 Ancona Road 3 5 8 Swetenham Place 2 2 4 Crescent Road 4 4 8 Palmerston Road 2 1 8 Raglan Road 1 6 7 Slade 1 2 3 Ingledew Road.. 2 5 7 Winn's Cottages 3 3 Workhouse 7 Acacia Parade 1 2 3 Lakedale Road.. 3 3 6 Ceres Road 3 3 Heverham Road 1 5 6 Vernham Road 1 2 3 Armstrong Street 1 5 6 Tormount Road 3 3 Saunders Road.. 1 5 6 Old Mill Road 1 2 3 57 TABLE XII.—continued. Street, Under 5. Over 5. Total. Street. Under 5. Over 5. Total. St. James' Place 1 2 3 Genesta Road 2 2 Vambery Road.. 1 2 3 Eton Street 2 2 Olven Road 1 2 3 Vicarage Road.. 1 1 2 Warwick Terrace 2 1 3 Wood Villa, Abbey Wood 2 2 Leghorn Road 5 3 Thomas Street 2 2 Whitworth Road 8 3 Shrewsbury Lane 2 2 Vicarage Park 3 3 Bebbington Road 1 2 Garland Street 3 3 Red Lion Lane 1 1 2 Kentmere Road 1 2 3 St. Margaret's Road 1 Herbert Stores, Abbey Wood 1 2 3 Willenhall Road 1 1 Gavin Street 1 Station Road, AbbeyWood 3 3 Grange, Plumstead Common 1 Bloomfield Road 1 2 3 St. John's Road 2 1 3 Lee Street 1 1 Rock Terrace 2 2 Dawson Street 1 1 Barth Road 1 1 2 Bateson Street 1 1 Earl Street 2 2 Post Office, Abbey Wood 1 1 Bignell Road 2 2 Gunning Street 1 1 Bassant Road 2 2 Roydene Road 1 1 Mabyn Road 1 1 2 Hartville Road 1 1 Bannockburn Road 2 2 Police Quarters, Royal Arsenal 1 1 Heathfield Terrace 2 2 Anglesea Road 2 2 East Street 1 1 Westdale Road 2 2 Heath Villas, Plumstead Common 1 1 Arthur Street 1 1 2 Southland Road 2 2 Wrottesley Road 1 1 Bleak Hill 1 1 2 Church Manorway 1 1 Eton Road 1 1 2 Sandbach Place 1 1 Barnfield Road 2 2 Congo Road 1 1 Abbey Grove, Abbey Wood 2 2 Benares Road 1 1 Manthorp Road 2 2 Gossage Road 1 1 Hanover Road 2 2 King's Highway 1 1 Heavitree Road 1 1 2 Paget Road 1 1 Orissa Road 2 2 Hinstock Road 1 1 Parry Place 2 2 Tuscan Road 1 1 Richmond Place 1 1 2 Nithdale Road 1 1 Brookdene Road 2 2 Wickham Lane 1 1 58 TABLE XIII. DIPHTHERIA, 1899. Cases occurring in each Street. Street, Under 5. Over 5. Total. Street. Under 5. Over 5. Total. Earl Street 1 1 Princes Road 1 1 Orchard Road 1 1 2 Shooter's Hill 1 1 Sandy Hill Road 2 4 6 Bassant Road 1 1 Coxwell Road 1 2 3 Parry Place 1 1 Ennis Road 2 2 Eton Road 1 1 Burrage Road 2 2 Chesnut Road 1 1 2 Radnor Terrace, K.H. 1 2 3 Blendon Road 1 1 2 Cantwell Road 1 1 Vicarage Park 2 2 Crescent Road 1 2 3 Sandbach Place 1 1 Station Road 2 1 3 Olven Road 1 1 Bannockburn Road 1 1 Wickham Lane 1 1 Red Lion Lane 4 1 5 Thomas Street 3 3 Adelaide Terrace, Ancona Road 2 1 3 Tormount Road 1 1 2 Reidhaven Road 1 1 Ann Street 1 1 Hudson Road 1 3 4 Armstrong Place 1 1 Sladedale Road 2 1 3 Oliver Street 1 1 2 Maxey Road 2 2 Lakedale Road 3 3 Walmer Road 2 2 Heavitree Road 3 8 6 Slade 1 1 2 Plumstead Common Road 2 2 4 Elm Street 1 1 Griffin Road 4 4 Galloson Road 1 1 Robert Street 3 4 7 Brewery Road 1 1 Barth Road 2 2 Armstrong Street 1 I Ripon Road 3 3 Majendie Road 1 1 2 Macoma Road 2 1 3 Charles Street 2 2 Richmond Place 2 2 Genesta Road 1 1 East Street 1 1 Speranza Street 1 1 Park Road 2 2 Ingledew Road 1 1 2 Bostal Hill 1 1 Miriam Road 1 1 Conduit Road 1 1 Anglesea Hill 2 2 Conway Road 2 1 3 Plum Lane 1 1 Herbert Road 2 3 5 Bostal Lane 2 2 Purrett Road 1 1 Frederick Place 2 1 3 Elm Grove 1 1 Wernbrook Street 2 2 Sutcliffe Road 1 1 Old Mill Road 1 2 3 Eglinton Road 3 3 Leghorn Road 2 2 Plumstead Road 1 4 5 Paget Road 1 1 Manthorp Road 1 1 2 Durham Road 1 1 Vicarage Road 2 2 Bleak Hill 1 1 Barnfield Road 3 3 Gunning Street 1 1 Piedmont Road 2 1 3 High Street 1 1 Raglan Road 1 3 4 Gavin Street 1 1 Bloomfield Road 2 2 Lee Street 1 1 Benares Road 2 2 183 About 200 Roads in Parish. 59 APPENDIX A. List of Bake-houses. No. Name. Address. 1 W. Jefferey 123, Burrage Road 2 W. Rose 57, Burrage Road 3 J. Farrier 30, Burrage Road 4 W. T. Akers.. 16, Armstrong Place 5 J. H. Dalton 13, Eton Road g 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 O. Degen 20, Conway Road 15 A. F. Jewis 68, Glyndon Road 16 F. Phillips 53, Ann Street 17 F. Grant 102, Ann Street 18 T. Maynard 64, Villas Road 19 J. Werner 1, Park Road 20 J. T. Alderton 81, Park Road 21 Mrs. S. Medcraf 58, Pattison Road 22 E. Plummer 46, Hudson Road 60 Appendix A.—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 P. Hallam 73, Lakedale Road 28 Goddard & Co. 14, Gunning Street 29 H. C. Haynes 307, High Street 30 C. Betchley 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 38 C. Pullen 105, Plumstead Common Road 61 APPENDIX B. REPORT AS TO THE PREVALENCE OP SCARLET FEVER. 22nd February, 1899. There has been a greatly increased prevalence of Scarlet Fever. In the corresponding period last year there were 17 cases only. The prevalence is distributed all over the parish, and does not seem to be specially connected with any one school. I have endeavoured to trace some connection between the milk supply and the Scarlet Fever. There appeared no reason to suspect any local cowshed, and when I came to examine the source of supply of dairies whose milk is imported, the matter became very complicated, and so far I have been unable to localise all tbe dairy supplies. I find that milk provided by one firm, having apparently three dairies in a distant county, supply directly or indirectly, regularly or occasionally, nine local dealers. These dealers supplied about half the families where cases have occurred. Looking at the number of dealers in the district, this proportion cannot be said to give any strong reasons for suspecting the milk of tbe Company referred to. On the other hand, one Company of milk contractors has practically refused to tell me the source of their milk, and as the previously mentioned Company's supply is so wide, it is possible that I have not found all the dairymen who deal with him. Knowing as we do, that milk frequently does convey the infection of Scarlet Fever, and that there was a considerable prevalence in P umstead from this cause some five years ago, I am inclined to attribute the present prevalence to the imported milk supply. It is obvious that local authorities have not sufficient powers for dealing with imported milk, and I recommend that the Local Government Board and County Council be written to as to the necessity for milk contractors being compelled to declare the source of their milk. It is useless having power to prevent the sale of milk from a dairy, if there is no power to discover what dairy the milk comes from. Meanwhile, I can only recommend that people should be again warned by hand-bill to boil their milk, especially milk not coming from local cowsheds. There is an increased prevalence of Scarlet Fever also in Charlton and Woolwich. The cases appear to be, on the whole, of a mild nature. So far, I have only heard of two deaths. 62 APPENDIX C. REPORT AS TO THE PREVALENCE OF SCARLET FEVER. November 22nd, 1899. The great prevalence of Scarlet Fever in Plumstead during the past 18 months has led me to examine into the comparative number of cases occurring in Plumstead and other parts of London. It appears that in 1898, Plumstead had the highest case rate (i.e., number of cases per 1,000 population) of all the London districts, but at least six districts had a higher death rate from Scarlet Fever. In 1897, ten districts had a higher case rate than Plumstead, but the Scarlet Fever death rate in Plumstead was lower than all the other districts with six exceptions (i.e., 28 had a higher rate). In 1896, twelve districts had a higher case rate, but only four had a higher death rate. On the whole it appears that the figures as usually given show that Plumstead has a Scarlet Fever case rate considerably above the average, and a death rate a little above. But if these figures were reckoned per 1,000 children at the susceptible age instead of 1,000 population, I have no doubt Plumstead's position would be altered. I have only had time to do this for Woolwich and Plumstead. For the past three years the case rate for Plumstead was 6.2, and Woolwich 4 6, reckoned in the usual way. But when we and the Woolwich cases which occurred in Government buildings and were not counted in the Asylums Board's returns of cases, and allow for the higher proportional number of children in Plumstead under 10, the figures come to 5.2 for Plumstead, and 5.5 for Woolwich, i.e., in proportion to the number of children, Woolwich has more Scarlet Fever than Plumstead. 63 APPENDIX D. PLUMSTEAD VESTRY. Issued in consequence of the large number of deaths under one year of age. How to Feed Baby. 1. With few exceptions, mother's milk is baby's best food till he is nine months old, but infants must always be weaned before they are a year old. 2. They should have the breast at first about every two hours by day and every four hours at night, the interval being gradually increased to three or four hours by day and six to eight hours at night. 3. If mother's milk does not appear to satisfy, do not on any account give biscuits or other food without medical advice. It may be that the breast is being given too often and baby overfed. If the mother is unable to nurse her child entirely, cows' milk prepared as described below should be given alternately with the breast. 4. The mother should have four good meals a day of plain food, and perhaps one or two glasses of milk between; but intoxicating drinks, as spirits and beer, should be avoided. It is a mistake to think that nursing mothers require stimulants. 5. The baby's mouth and the mother's nipples should be carefully cleansed after each suckling. 6. When for any reason a baby cannot be nursed at the breast, it must be fed on milk, and usually fresh cows' milk is the best. This should be prepared as follows:—Three table-spoonfuls of boiled milk should be mixed with six table-spoonfuls of barley water and a quarter of a teaspoonful of white sugar; the mixture when warmed will make a meal for a child a month old. At two months of age milk and barley water should be given in equal quantities, and the proportion of barley water then gradually decreased till the child is eight or nine months old, when pure milk should be given. 64 APPENDIX D.— Continued. 7. The milk should be boiled or scalded immediately it comes, and then stood in a clean jug in a cool place with a piece of muslin over it. 8. To make barley water, put two good tea-spoonfuls of washed pearl barley in a pint of cold water, boil down to two-thirds of a pint and strain. This must be kept in a clean jug and covered with muslin, like the milk. 9. A bottle without a tube should always be used, and the bottle and teat cleaned with scalding water after each meal. 10. At the age of nine to twelve months, baby may have farinaceous food with the milk, oatmeal porridge, bread and milk and plain biscuits; and after twelve months, bread and butter, bread and potatoes and gravy and eggs, but milk must be the principal food till the age of two years. 11. Before the age of three children should have no meat, and all rich and indigestible foods such as pork, shell fish, lobsters, baked pastry, new bread and hot cakes, are liable to cause convulsions and must be carefully avoided. 12. The cheap brands of condensed milk are not really milk, and should never be used for children or invalids. 13. The continued use of condensed milk is not recommended, but when as a matter of convenience it is used for a time the best brands should be carefully chosen. For children under two months, one large tea-spoonful should be given with four table-spoonfuls of warm water and half a tea-spoonful of cream. The strength of the milk and the amount of cream should be gradually increased as age advances. At six months there should be one table-spoonful of milk in seven of water. 14. In order that the food may be well-digested, abundance of fresh air is necessary. Not only should children be out of doors as long as possible, but indoors the windows of sitting and bedrooms should always be kept open, wide open in summer, and a few inches at the top, according to the coldness of the weather, in winter. July, 1899. SIDNEY DAYIES, M.A., M.D., Medical Officer of Health.