74. PORT OF LONDON SANITARY COMMITTEE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, To 31st December, 1918. Presented 11 th December, 1919. REPORT, For the Year ended 31st December, 1918, OF THE MEDICAL OFFICER OF HEALTH FOR THE PORT OF LONDON. BY WILLOUGHBY MASON WILLOUGHBY, B.A., M.D., B.C., Cantab., D.P.H. Camb., Medical Officer' of Health, Port of London. LONDON: Printed by Chaeles Skipper & East, 49, Great Tower Street, E.Q. 3. COOPER, Mayor. A Common Council holden in the Chamber of the Guildhall of the City of London, on Thursday, the 11 th day of December, 1919. THE Port of London Sanitary Committee did this day deliver into this Court a Report in writing under their hands, of their proceedings, and submitting the Annual Report of the Medical Officer of Health of the Port to the 31st December, 1918 ; which was read. Ordered, That the Report be printed, and a copy sent to every Member of this Court. BELL. To the Right Honourable the Lord Mayor, Aldermen and Commons of the City of London, in Common Council assembled. WE, whose names are hereunto subscribed, of your Port of London Sanitary Committee, to whom it has been referred to carry into execution the powers assigned to the Corporation, as the Port of London Sanitary Authority, by the Local Government Board, under the Public Health (London) Act, 1891, beg to submit for the information of your Honourable Court the Annual Report of Dr. Willoughby Mason Willoughby, the Medical Officer of Health of the Port of London, for the year ended the 31st December, 1918, which Report contains a full and detailed account of the work done in the Port during that period by the Medical Officers and Inspectors. The work of your Medical Officers has been effectively carried out. The total number of cases of infectious disease reported as having occurred on vessels during the voyage was much above the average, and is explained by the prevalence of epidemics of Influenza, &c., on vessels conveying troops. Eight cases of Plague and four of suspected Plague were admitted to hospital. 2 The expert examination of rats for evidence of this disease has been continued together with the systematic destruction of the animals. Inspection of food has been adequately carried out—the total amount condemned as unfit for food being less than usual. The sanitary inspection of shipping, &c., has been maintained, the number of visits of inspection being above the average. The repairs to the hulk "Hygeia" sanctioned by your Honourable Court have proved entirely satisfactory, in all probability prolonging the useful existence of the vessel for many years. The usual report upon the working of the Canal Boats Acts is appended. An Account of Receipts and Expenditure in connection with the Port of London Sanitary Authority for the year ended the 31st March, 1919, is appended, in accordance with the Order of your Honourable Court, for the information of the Court. All which we submit to the judgment of this Honourable Court. Dated this second day of December, 1919. Wm. Gibson. C. J. Smith. Horace S. Dove. B. T. Swjnstead. E. S. Jacob. W. W. Green. A. C. Stanley Stone. George Briggs. H. P. Monckton. J. G. Howell. W. Lindley-Jones. H. Roper Barrett. OFFICES of the Port of London Sanitary Authorrity AND Medical Officer of Health AT 51, KING WILLIAM STREET, GREENWICH S.E. l0 Telegraphic Address - " MEDOFF, GREEN", LONDON." Telephone No. GREENWICH 360. BOARDING STATIONS. RI VER THAMES Hulk " Hygeia," Gravesend. RIVER MEDWAY Garrison Point, Sheekness. Telephone No. (Hulk " Hygeia" ) GRAVESEND 325. HOSPITAL FOR INFECTIOUS DISEASES AT DENTON, near GRAVESEND. Telephone No. (Hospital) GRAVESEND 957. Ditto (Medical Officer of Health) „ 86. LIMITS OF THE PORT OF LONDON. The limits of the Port of London as at present defined commence at High Water Mark in the River Thames at Teddington Lock, in the County of Surrey, and extend down both sides of the River Thames to an imaginary straight line drawn from the Pilot Mark at the entrance of Havengore Creek, in the County of Essex, to the lands end at Warden Point, in the Isle of Sheppey, in the County of Kent, such point being the North-Western limit of the Port of Faversham, and shall extend up and include both sides of the River Medway to an imaginary straight line drawn from the South-East point of land westward of Coalmouth Creek, thence across the said River Medway to the Westernmost point of the piece of land which forms the Eastern side of the Stangate Creek, or, in other words, the North-West. point of Fleet Marsh, and from thence in a Southerly direction to Iwade Church, in the said County of Kent, and thence in a North-Easterly direction to Elmley Chapel, in the said Isle of Sheppey, a supposed direct line from Elmley Chapel to Iwade Church, being the Western limit of the Port of Faversham, and the said Port of London shall include the Islands of Havengore Creek aforesaid, called Potton and Rushey Islands, and so much of the said Creek and watercourse as extends from it to the town of Rochford, and shall also include all other islands, rivers, streams, creeks, waters, watercourses, channels, harbours, docks and places within the before-mentioned limits contained. 4 INDEX. PAGE Acajou Nuts 43 Actinomycosis 37 Australian Beef 37 Beef 36 Beri-Beri 26-28 Biscuits and Confectionery 41 Canal Boats Acts 51-56 Canned Meats 38 Cerebro-spinal Meningitis 17 Chicken-pox 17 Continued Fever 18 Diphtheria 15 Drugs 42 Enteric Fever 14 Establishment, &c. 3 Fish 39 Food Inspection 36 Foreign Meat Regulations 42,4:3 Fruit 39, 40 Fumigating Apparatus £0, 51 German Measles 16,17 Grain 41 Hospital 331 Infectious Disease 9 Influenza 22, 23 lntroductory 7 Launches, Hulks, &c. 51 Malaria 18-20 Meal,and Flour 42 Measles 16, 17 Meats, Canned 38 ,, Smoked, Salted and Sundry 38 Medical Inspection 7, 8 PAGR Mumps 24 Mutton and Lamb 36 Notification of Infectious Disease 10 Nuisances 49 Nuts 40 Offal 38 Offensive Cargoes 50 Onchocerca (see Australian Beef) 37 Plague 11, 12 Pneumonia 22,23 Pork .37 Port, Limits of, &c. 3 Poultry and Game 39 Prepared Foods 41 Preserves, Jam, &c. 40 Provisions 41 Rabbits 38,39 Rat Order, 1918 32 Sanitary Conveniences, &c. 49 Sanitary Inspection 46 Scarlet Fever 15 Shell-fish 41,45 Small-pox 13 Smoked and Salted Meats 35 Staff 6 Sundry Food Stuffs 42 Tinned Meats 35 Tuberculosis (Pulmonary, &c.) 21,22 Unsound Food 34 Vegetables 40 Venereal Disease 45 5 INDEX TO TABLES. TABLE. PAGE I. Medical Inspection 8 II. Infectious Disease—Summary 9 III. Compulsory Notification of Infectious Disease, with number of Deaths 10 IV. Plague 11 V. Small-pox 13 VI. Enteric Fever 14 VII. Diphtheria 15 VIII. Scarlet Fever 15 IX. Measles and German Measles 16 X. Chicken-pox 17 XI. Cerebro-spinal Meningitis 17 XII. Continued Fever 18 XIII. Malaria 18 XIV. Tuberculosis—Pulmonary 21 XV. Ditto Various 22 XVI. Influenza and Pneumonia 22 XVII. Mumps 24 XVIII. Venereal Disease 25 XIX. Beri-Beri 26 XX. Miscellaneous Diseases, &c. 28 XXI. Vessels and Premises Disinfected 29 XXII. Effects 29 XXIII. Rats destroyed 30 XXIV. Rats, Bacteriological Examination of 31 XXV. Hospital—Admissions, Discharges, Deaths, &c. 33 XXVI. Unsound Food—Seized, &c. 34 XXVII. Unsound Meat—Destroyed, Weights, &c. 35 XXVIII. Foreign Meat—Notice to Export 42 XXIX. Sanitary Inspection—Summary 46 XXX. Ditto Nuisances on Vessels 47 XXXL Ditto Ditto Store Rooms 48 XXXII. Ditto New Works 49 XXXIII. Ditto Offensive Cargoes 50 XXXIV. Fumigation of Vessels 50 XXXV. Canal Boats 56 6 STAFF. List of Officers forming the Staff of the Port of London Sanitary Authority, 31st December, 1918. Office. Name of Officer. Date of Appointment to Present Position. Condition as to Military Service. (See footnote. MEDICAL OFFICER OF HEALTH W. M. Willoughby, B.A., M.D., B.C., D.P.H.Camb. February, 1916 0. (Enrolled.) DEPUTY Lieut.-Col. J. S. Warrack, R.A.M.C., T.D., M.A., M.D.. C.M. Aberdeen, D.P.H.Camb., Barrister-at-Law. February, 1916 O.H.M.S. ASSISTANT MEDICAL OFFICERS— W.D.Betenson,M.R.C.S.,L.R.C.P„ Lond., D.P.H. Lond. (Acting Deputy M.O.H. and M.O., Denton Hospital). July, 1907 O. Gravesend A. Kidd, M.R.C.S., L.R.C.P., Lend., D.P.H. 1909 O. Sheerness E. V. Legge, M.A., M.D., B.C., B.A.O., L.M.Dublin. 1909 O. GREENWICH OFFICES— Clerk W. J. Albrow March, 1890 O. 1st Assistant E. A. Sorrell October, 1894 O. (V.T.C.). 2nd ditto W. C. Barham June, 1903 A. Junior ditto T. J. S. Cotterell July, 1910 O.H.M.S. Ditto J. A. Gillis April, 1914 O.H.M.S. Caretaker F. Hudgell November, 1906 O. FOOD INSPECTORS *W. Anderson, Cert.R.San.Inst. July, 1898 O. *T. W. Bailey, Cert.R.San.Inst. July, 1901 O. *A. Garland, Cert.R.San.Inst. December, 1917 O. SANITARY INSPECTORS *W. G. Wetjen, Cert.R.San.Inst. August, 1898 O. »W. W. Burr, Cert.R.San.Inst. August, 1898 O. *H. R. Hopkins, Cert.R.San.Inst. February, 1899 O. (R.N.A.S.) *P. R. Lambe. Cert.R.San.Inst. January, 1900 O. *J. H. Rolfe, Cert.R.San.Inst. September, 1901 O. *W. Elward, Cert.R.San.Inst. March, 1909 O. *F. J. Massie, Cert.R.San.Inst. March, 1909 A. C. A. Shepherd, Cert.R.San.Inst.. January, 1909 O.H.M.S. DENTON HOSPITAL *W. J. Berry, Cert.R.San.Inst. February, 1914 A. Medical Officer Lieut.-Col. J. S. Warrack, 1916 O.H.M.S. R.A.M.C., T.D., M.A., M.D., C.M. Aberdeen, D.P.H. Camb., Barrister-at Law. Matron J. Jackson February, 1918 F. Assistant Nurse (Temporary) . R. Burston 1918 F. Ditto ( Do. ) A. Foggo 1918 F. Ditto ( Do. ) L. Gould 1918 F. Cook, General ( Do. ) M. Moxford 1918 F. Porter, &c. ( Do. ) J. H. Robinson O. STEAM LAUNCHES— "Lady Truscott"- Master W. Jarvis April, 1911 O. Engineer J. A. Hardman December, 1911 O. Mate A. F. Rough November, 1914 A. Stoker A. E. Howard February, 1912 O.H.M.s. W. Thomas (Temporary"). " David Burnett"- Master C. H. Price October, 1913 O.H.M.s. Engineer T. Steen (see " George Briggs ") September, 1914 A. Deckhand V acant Stoker Do. " Geoege Beiggs "—Motor Launch— Master C. Strange October, 1913 A. Engineer J. Steen A. GREENWICH MOORINGS- FUMIGATING BARGE "THOMAS" Stoker, &c. Vacant BARGE "ELLA VICARS"— Watchmen H. A. Clarkson May, 1912 O.H.M.s. E. Ditch - December, 1914 A. GRAVESEND H. E. Martin (Temporary) July, 1914 O. HULK "HYGETA"— Shipkeoper A. Salter July, 1898 0. * These Inspectors possess the Special Certificate of the Royal Sanitary Institute for Inspectors of Food. Note.—O.H.M.S. Active Service. A. Attested. O. Over age. F. Female. 7 PORT OF LONDON SANITARY OFFICES, 51, KING WILLIAM STREET, GREENWICH, S.E. 10. TO THE WORSHIPFUL THE POUT OF LONDON SANITARY COMMITTEE. Gentlemen, I have the honour to present my Annual Report for the year 1918, with details of the work done by ycur Medical Officers and Inspectors. The total number of vessels medically inspected was 409, marking low ebb in the numbers of arrivals of large vessels during the last phase of the War and the immediately ensuing period. Transport of troops on cargo vessels is accountable for the report of a large amount of sickness on incoming ships. Most of the cases among troops, however, were landed in other ports. Amongst seamen, eight cases of Plague and four suspected-cases were landed to Denton Hospital, from two ships; the total number of cases of infectious disease treated in Denton Hospital being 57. * Disinfections were carried out on 54 vessels. Contacts and possible contacts of disease were notified to their Authorities for "surveillance" to the number of 575. 36,342 rats were reported destroyed on ships and in the docks. Upwards of 1,000,000 rats have now been accounted for since 1901, when rat control began. Of 2,315 rats examined for Plague from the docks four were found to be infected. The aggregate weight of food condemned was 1,200 tons, of which 331 tons were meat. Wherever practicable this material was disposed of in ways which preserved whatever value or utility remained after its condemnation as human food. The sanitary inspection of vessels showed a total number of 28,752 visits against a ten-year annual average of 35,968; the average per Inspector employed showed no reduction. 8 The Clayton apparatus was used in the disinfestation o£ 16 vessels. The time and labour involved in transport of the barge from dock to dock added to that of disinfestation, and the uncertainty which existed as to the availability of vessels for disinfestation under the crowded circumstances of the year, was found to leave insufficient margin for exigencies in the normal work of launches and their crews. If this mechanical system were to be used, and especially in case disinfestation became as general as is desirable, a staff entirely devoted to this work would become necessary. The report on Canal Boats included, shows the consistent reduction in work under the Acts over the past eight years, and the marked diminution since 1914. The reopening of the Port to general traffic and the withdrawal of various factors in control of the many branches of the work of the Authority, which though necessary were nevertheless hampering, bring home in a gratifying way the fact of the close of the War. TABLE I. MEDICAL INSPECTION—GRAVESEND. From 1st January to 31st December, 1918. Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total. Number medically inspected 40 33 19 30 62 51 41 47 26 45 37 58 489 Number of passengers 354 475 287 478 933 371 430 402 390 99 686 996 5,901 Number of crew 3,120 2,539 2,916 2,896 4,111 3,557 2,822 3,023 1,649 2,892 3,134 3,361 ' 36,020 9 TABLE II.—INFECTIOUS DISEASE. Disease. 1909. 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. Mean annual number for 10 years ending 31 sc December. 1918. 1918. (a) Cases repokted: Cholera (including suspected cases) 3 5 9 2 19 ... 2 5 2 4.7 ... Yellow Fever (ditto) ... ... ... ... 4 ... ... ... ... 0.4 ... Plague (ditto) 4 . 6 ... 9 4 4 4 ... 18 6.1 12 Small-pox 27 8 13 34 19 9 47 15 2 19.0 16 Scarlet Fever 16 21 11 10 40 30 18 5 ... 15.9 8 Diphtheria 11 11 18 37 16 10 18 7 9 16.0 23 Enteric Fever 36 39 70 61 65 67 64 61.1 43 53.2 26 Measles 19 23 175 61 64 228 337 836 168 216.7 256 German Measles ... ... ... 3 4 ... 10 8 33 6.2 4 Erysipelas 5 5 11 3 3 3 9 1 ... 4.0 ... Typhus Fever ... ... ... 1 ... ... ... ... 1 0.2 ... Continued Fever 10 1 5 9 13 2 7 5 2 5.6 2 Relapsing Fever 1 ... ... ... ... ... ... ... 2.0 19 Tuberculosis :— Pulmonary ... ... ... 71 151 127 96 53 45 58.1 38 Miners' Phthisis ... ... ... ... ... ... ... ... 23 4.2 19 Other kinds ... •" ... ... ... 7 45 6 19 3 8.1 1 Other diseases (including Chicken-pox). 57 25 38 42 38 50 48 44 166 306.0 2,552 Total 189 144 350 343 447 575 666 1,059 ' 515 726.4 2,976 (b) Treated in Port Sanitary Hospital: Cholera (including suspected cases) 1 2 ... ... ... ... ... ... ... 0.3 ... Yellow Fever (ditto) ... ... ... ... ... ... ... ... ... ... ... Plague (ditto) 1 2 ... 1 2 1 ... ... 9 2.8 12 Small-pox 4 2 6 2 9 2 10 2 ... 3.8 1 Scarlet Fever 14 ... 6 ... 3 8 10 2 ... 4.8 5 Diphtheria 1 4 3 ... 7 1 3 1 1 2.1 ... Enteric Fever 11 17 ' 22 35 29 30 17 34 15 21.7 7 Measles 5 2 7 27 18 9 33 * 3 11.0 2 Erysipelas 1 ... ... 1 ... ... 1 1 0.4 ... Typhus Fever ... ... ... ... ... ... ... ... ... ... Continued Fever 10 1 4 7 9 1 5 4 8 5.5 6 Other diseases (including Chicken- pox). 10 7 8 7 14 9 11 6 24 12.0 24 Total 58 37 56 80 91 61 90 53 61 64.4 57 10 TABLE III. Return of the Number of Cases of Infectious Disease Notified to the Local Government Board during the Year 1918, and of Deaths from the Diseases Notified. This Table includes all cases actually introduced or occurring within the Port, but does not include cases 'reported as having occurred on vessels during the voyage, but which had either recovered or been removed from the vessel before arrival at Gravesend. Notified. Deaths. Plague (including Suspected)- 12 1 Small-pox 1 ... Scarlet Fever 8 ... Diphtheria (including Membranous Croup) 20 ... Enteric (Typhoid) Fever 1.5 ... Puerperal'Fever ... ... Typhus Fever ... ... Cholera ... ... Relapsing Fever ... ... Continued Fever 2 ... Cerebro-spinal Fever ... ... Acute Poliomyelitis ... ... Erysipelas ... ... Ophthalmia Neonatorum ... .... Tuberculosis : Pulmonary 31 ... Other kinds 18 ... Chicken-pox 15 ... Whooping Cough ... ... Measles 126 ... German Measles 3 ... Other Diseases 154 3 405 5 NUMBER OF NOTIFICATIONS (SUBVEILLANCE) DURING 1918. Plague :—Passengers - - - 230 Crew ----- - 35 Stevedores, &c. - - 310 Total - 575 Number of Notifications received from Practitioners - 41 11 TABLE IV. Plague (including suspected cases). Date. 1918. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. May-June s.s. " Somali," of Greenock, 114,056 Bombay 6 5 cases removed to Port Sanitary Hospital. 1 case Rochester (fatal). Aug. 8 s.s. " Hector," of Liverpool, 102,991 Calcutta 6 12 Removed to Port Sanitary Hospital. PLAGUE. The s.s. "Somali" arrived from Bombay on the 19th May. Two cases of Bubonic Plague were removed to Denton Hospital, and a third occurred forthwith. The crew consisted of 35 Europeans and 321 natives of India, and there were 113 passengers. The history of the attack is the usual one of a rat infection existing on board. The European storekeeper found several dead rats in the store-room, which communicated directly with the hold; he was taken ill on the 9th May and recovered in Denton Hospital. A native belonging to a supernumerary crew was taken ill on the 18th and another two days after the arrival of the vessel in port. The diagnosis was confirmed microscopically at Denton Hospital on material from the third case, which proved fatal. The names of passengers, crew and men employed in discharging the vessel were notified to the Medical Officers of Health of the districts of destination to the number of:— Passengers 113 Crew 35 Men working on board 155 Total 303 on the principle of " surveillance." Precautionary fumigation of crew's quarters and disinfection of all native clothing and bedding were carried out forthwith on arrival. On completion of cargo discharge the ship was fumigated for the destruction of rats and fleas before moving from the quarantine grounds. The details of fumigation and disinfection were more than usually onerous by reason of the large native supernumerary crew to be dealt with. 12 Three cases and some suspected cases came under treatment in Denton Hospital ; of the latter only one was a case of serious illness and suspicion. Of the three cases of Plague one died and two recovered. One member of the crew under surveillance outside the Port Sanitary District was taken ill after leaving the ship, on the 29th May, and died of Plague on 2nd June. A total of 172 rats were found dead on the ship at Gravesend before and after fumigation ; the death of 103 of these is ascribable to the rat plague existing on board. One of the ship's cats was found to have been affected by Plague and was recovering at the time it was caught and killed. Ninety-seven rats were trapped or found dead on the voyage. The ship was completely fumigated, after discharge of cargo on the 2nd June, by means of the Clayton apparatus. The circumstances of the outbreak of Plague on the s.s. "Somali" were communicated in a technical report to the Local Government Board on the 23th June. s.s. " Hector," crew 59, arrived at Gravesend on August 8th from Calcutta via Suez. Four cases of Plague was removed to Denton Hospital on the 8th, having been first taken ill on July 27th and 31st, August the 3rd and 5th, respectively. A fifth case was taken ill on the 15th on board and was removed to Denton Hospital. All five cases ended in recovery. At Port Said about the 12th July some dozen dead rats were thrown out from the poop space and food store. No significance was attached to the finding of dead rats. The cargo was not attractive to rats and the holds were correspondingly free, the store room in the poop was the focus of infection. The steward, steward's boy, and three inhabitants of the poop were the only persons affected. One half the crew was paid off and put under "surveillance": direct contacts and the remainder of the crew were retained on board under "observation." The total notifications, inclusive of ship workers, were 173 in number. Very few rats were found after fumigation; the total found dead on discharge of cargo was sixteen. The facts were fully and technically reported to the Local Government Board. 13 TABLE V. Small-pox. Date. 1918. Name of Vessel. Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Feb. 15 s.s. "Atreus," of Liverpool, 131,322 Shanghai 1 Landed at Manila. April 9 s.s. "Culna," of Glasgow, 124,164 Karachi 2 1 landed at Karachi. 1 removed to Port Sanitary Hospital. May 7 s.s. "City of Glasgow," of Glasgow, 121,304 Calcutta 6 Removed at Rangoon and Suez. „ 7 s.s. " Nevasa," of Glasgow Bombay 2 Landed at Aden. „ 7 s.s. " Katuna," of London Rangoon 1 Landed at Colombo. „ 9 s.s. " Delta," of Belfast - Bombay 1 Landed at Suez. „ 10 s.s. "Cawdor Castle," of London, 114,823 Bombay 2 Landed at Bombay. „ 19 s.s. "Somali,'' of Greenock, 114,056 Bombay 1 Landed at Suez. 16 s.s. "Culna" arrived on 4th April. It was declared that all on board were well and that no sickness had occurred during the voyage. On the 6th April a case of Varioloid Small-pox was found on board, and it transpired that the man had been suffering from a " cold " when the ship passed Gravesend. It was also ascertained that a native suffering from Small-pox had been landed at Karachi on 22nd February, Karachi being the port of lading. The duty of declaring every case of illness, however mild in appearance, on entering the River Thames was represented by your Medical Officer to the Company concerned. The incident, however, suggests that reasonable vigilance in the completest of systems cannot prevent the introduction of Small-pox in its incubatory or in its early stages before the appearance of a rash. The incidence of Small-pox on six ships arriving in the month of May, in conjunction with the case of s.s. " Culna," suggested possible danger to Customs officers who come into early and close contact with native crews on arriving ships. The question of advisability of re-vaccination of these officers was accordingly brought to the notice of the Inspector-General of the Waterguard. 14 TABLE VI. Enteric Fever. Date. 1918. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Feb. 14 s.s. "Eden Hall," of Liverpool, 87,841. Alexandria 1 Landed at Oran. „ 16 s.s. "Knight of the .Garter," of Liverpool, 115,346. Calcutta 1 Landed at Kantara. „ 25 s.s. "Ingleside," of Whitbv, 13],832. East London 1 Died, and body buried at, sea. March 14 s.s. "Kia Ora," of Southampton, 124.487. Wellington 1 Landed at Panama. May 9 s.s. " Hova " Karachi 1 Landed at Gibraltar, „ 12 s.s. "Commonwealth" Sydney 1 Removed to Port Sanitary Hospital. „ 13 s.s. " San Ricardo," of London, 135,233. Puerto Mexico 1 Ditto. J une 21 s.s. "Columbella " Halifax 1 Ditto. „ 19 s.s. "Cluny Castle" Mombasa 1 Died, and body buried at sea. July 2 s.s. "Ayrshire " Wellington 1 Treated on board. „7 s.s. "Ganges " Bassein 2 Landed at Suez. „8 s.s. "Kazembe," of North Shields, 123,820. Beira 2 Removed to Port Sanitary Hospital. „ 10 s.s. "Holtby," of West Hartlepool, 127,446. Sfax 1 Ditto. Aug. 8 s.s. "Hild " Rouen 1 Ditto. „9 s.s. "Glendene." of Whitby Cuba 2 Died on board. „ 18 s.s. "Chionecto," of Southampton, 98,870. Halifax 1 Removed to Port Sanitary Hospital. Oct. 11 s.s. "Tatsuma Maru " - 1 Removed to Seamen's Hospital, Greenwich, „ 13 s.s. "Suevic," of Liverpool, 113,456. Sydney 3 Removed to Port Sanitary Hospital. „ 28 s.s. "Tunisian," of Glasgow, 111,248. Montreal 1 Removed to Stockwell Hospital. Nov. 13 s.s. "Kawachi Maru " Yokohama 1 Removed to Port Sanitary Hospital. Dec. 24 s.s. "Fanad Head " Montreal 1 Removed to Seamen's Hospital, Greenwich. 26 15 TABLE VII. Diphtheria. Date. 1918. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Jan. 30 Training Ship "Exmouth," Grays 1 Removed to Eastern Hospital (M.A.B.). April 8 Ditto ditto 1 Ditto. ' „ 9 H.M.S. "President," VictoriaEmbankment 1 Removed to Stockwell Hospital (M.A.B.). May 8 Dockmaster's House, Shadwel Pier Head 1 Removed to Eastern Hospital (M.A.B.). „ 23 s.s. "Terresias " St. John s 2 Military cases. June 6 s.s. "City o£ Marseilles," of Montreal Liverpool, 135,436 1 Ditto. „ 6 Training Ship "Arethusa," Pur fleet 1 Removed to Eastern Hospital (M.A.B.). „ 19 Dockmaster's House, Surrey Commercial Dock 1 Removed to South-Eastern Hospital (M.A.B.). „ 24 s.s. "Cassandra,' of Glasgow Montreal 1 Military case. „ 29 s.s. "Bolton Castle" Baltimore 1 Removed to South-Eastern Hospital (M.A.B.). Sept. 10 s.s. "H. C. Folger" Philadelphia 1 Transferred to U.S. " Minneapolis." Oct. 5 Royal Albert Dock 1 Removed to Seamen's Hospital, Greenwich. „ 5 Training Ship "Exmouth," Grays 1 Removed to Eastern Hospital (M.A.B.). „ 28 to Nov. 15 Ditto ditto 7 Ditto. Nov. 25 Training Ship "Arethusa," Greenhithe 1 Ditto. Dec. 9 Ditto ditto 1 Ditto. 23 TABLE VIII. Scarlet Fever. Date. 1918. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Jan. 23 Training Ship "Arethusa," Gre enhithe - 1 Removed to Port Sanitary Hospital. March 26 s.s. "Knight Templar," of Liverpool, 120,900. New York 1 Removed to Military Hospital. May 27 s.s. "Rhesus," of Liverpool, 131,363. Philadelphia - 1 Ditto. „ 27 s.s. "Waitemata" Galveston 1 Removed to Port Sanitary Hospital, June 15, s.s. "Themistocles," of Aberdeen, 129,349. New York 1 Military case. July 4 s.s. Cassandra," of Glasgow, 124,130. Montreal 1 Removed to Port Sanitary Hospital. Dec. 6 H.M.S. "Ebro"- 1 Ditto. „ 17 s.s. "Conway " Barcelona 1 Ditto. 8 16 TABLE IX. Measles and German Measles. Date. 1918. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Jan. 4 s.s. "Llanstephan Castle" Durban 14 Landed at Devonport. 18 Training Ship "Arethusa," Green the 1 Removed to Isolation shelter on shore. 25 Ditto Ditto 2 1 case removed to Port Sanitary Hospital, 1 to Isolation Hospital on shore—Ship's. March 22 s.s. "Beltana," of Greenock. 131,853. Melbourne 1 Military case. May 23 s.s. "Teiresias " St. John's 1 Ditto. June 6 s.s. "Northland " Philadelphia 4 Ditto. „ 6 s.s. "Winifredian" Boston 1 Ditto. 6 s.s. "Morvada" New York 3 Ditto. „ 21 s.s. "Atreus," of Liverpool, 131,322. Montreal 1 Ditto. 24 s.s. "Ascanus," of Liverpool Ditto 15 Ditto. „ 24 s.s. "Berrima," of Glasgow New York 3 Ditto. „ 24 s.s. "Cassandra" Montreal 15 Ditto. 24 s.s. "Belle Rothan" 2 Removed to Eastern Hospital (M.A.B.) July 7 H.M.S. "Gloucestershire" Halifax 2 Military Cases. „ 9 s.s. "Waimana," of Southampton, 131,795. Montreal 10 Ditto. „ 22 s.s. "Benalda" New York 6 Ditto. „ 22 s.s. "Thongwa" Halifax 9 Ditto. „ 22 s.s. "Ajax" Boston 1 Ditto. „ 22 s.s. "Saturnia " Montreal 11 Ditto. „ 23 Royal Albert Dock, South Side 1 Removed to South Eastern Hospital (M.A.B.) Aug. 8 s.s. "Tydeus" 5 Ditto. „ 8 s.s. "Beltana" Boston 1 Landed at Halifax. „ 18 s.s. "Galway Castle" Durban 37 25 Military cases—11 proceeded home, 1 to Port Sanitary Hospital. „ 26 s.s. "City of Bombay " Philadelphia 1 Military case. „ 26 s.s. "Kia Ora" Montreal 2 Ditto. „ 26 Training Ship "Arethusa," Greenhithe 2 Removed to Knockhall Grove Hospital. „ 27 s.s. "Field Marshal" Sydney 3 Military cases. „ 27 s.s. "Laomedon," of Liverpool, 131,442. New York 2 Ditto. „ 28 s.s. "Berrima" Boston 4 Ditto, Carried forward 160 17 Measles and German Measles—continued. Date. 1918 Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Brought forward 161 Sept. 10 s.s. "Khvber," of Liverpool, 135,564. New York 1 Military case. „ 10 s.s. "Titau" Baltimore 10 Ditto. „ 10 s.s. "Cardiganshire" Boston 28 Ditto. „ 10 Reyal Albert Dock 5 Removed to South Eastern Hospital (M.A.B.) Nov. 15 s.s. "Bakara" Sydney 15 Military cases. Dec. 2 s.s. "Tyndareus," of Liverpool, 137,527. Hong Kong 1 Isolated on board. „ 6 s.s. "Zealandic Melbourne 40 Military cases. 260 Measles 256 German Measles 4 Total 260 TABLE X. Chicken-pox. Date. 1918. Name of Vessel. Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Feb. 28 s.s. "Nagoya." of Greenock, 135,323. Bombay 2 Landed at Port Said. April 2 Training Ship " Worcester," Green the 5 Removed to Ship's Hospital on shore. 3 s.s. "Woolwich Belle," of London, 98,936. Laid up in West India Dock. 5 Isolated on board. May 10 s.s. "Agamemnon," of Liverpool Lisbon 1 Removed to Port Sanitary Hospital. June 7 s.s. "Nagoya," of Greenock, 135,323. Bombay 2 Isolated on board. J uly 9 s.s. ''Waimana," of Southampton, 131,795. Montreal 4 Removed to Military Hospital. Aug. 24 s.s. "Stockport," of Grimsbv, 132,111. Boulogne 1 Removed to South Eastern Hospital (M.A.B.). 20 TABLE XI. Cerebro-spinal Meningitis. Date. 1918. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Oct. 8 s.s. "Marathon," of Aberdeen, 118,184. Melbourne 3 Removed to Military Hospital. Dec. 6 s.s. "Zealandic" Ditto 1 Ditto. 4 18 TABLE XII. Continued Fever. Date. 1918. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. May 28 s.s. "Fermia " (Swedish) Rouen 1 Removed to Port Hospital Hospital. June 23 s.s. "Queensland Transport " Gul£ Ports 1 Ditto. 2 TABLE XIII. Malaria. Date. 1918. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Feb. 10 s.s. "Venetian" Alexandria 1 Remained at work. 16 s.s. "Kenilworth Castle Natal 23 Removed to Military Hospital. March 7 s.s. "Santa Theresa" Sapele 10 Remained on board. „ 22 s.s. "Ellaline" Mauritius 2 Ditto. April 5 s.s. "Mentor" Yokohama 2 Ditto. „ 15 s.s. "Prometheus" Sourabaya 1 Ditto. May 12 s.s. "Commonwealth" 2 Removed to Port Sanitary Hospital. 12 s.s. "San Ricardo" 1 Ditto. June 5 s.s. "Durham Castle" Durban 2 Remained on board. „ 27 s.s. "Gambia" Opobo 2 Died on beard. July 7 s.s. "Kazembe" Beira 4 2 cases removed to Port Sanitary Hospital. 2 cases treated on board. „ 29 s.s. "Black Prince" Buenos Ayres 2 Treated on board. Aug. 8 s.s. "Huntscliffe" Calcutta 1 Ditto. „ 17 s.s. "Clan Macrae" Tamatave 2 Ditto. „ 25 s.s. "Patarri" Forcados 2 Ditto. 25 s.s. "North Pacific" Bathurst t 2 Ditto. „ 26 s.s. "Sunray" Cardenas 1 Ditto. Sept. 7 s.s. "Clan Maclaren" Sekondi 6 Ditto. Oct. 11 s.s. "Professor" Bahia Blanca 1 Ditto. „30 s.s. "Eastwood" Morandavo 2 Ditto. „30 s.s. "Antilochus" Yokohama 1 Died on board. Nov. 3 s.s. "Roumelian" Port Sudan 4 Treated on board. Carried forward 74 19 Malaria—continued. Date. 1918 1 Name o£ Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Brought forward 74 Nov. 3 s.s. "Kwarra" Durban 4 3 treated on board. 1 removed to Denton Hospital. „3 s.s. "War Daffodil" Mombasa 18 7 cases removed to Port Sanitary Hospital. Remainder treated on board. „3 s.s. "Griqua" East London 7 Treated on board. „7 s.s. "Suevic" Sydney 1 Removed to Port Sanitary Hospital. „10 s.s. "Swainby" Tanga 3 Treated on board. „ 26 s.s. "Deucalion" Java 2 Ditto. Dec. 15 s.s. "Arden Hall" Sapele 1 Ditto. „16 s.s. "Gaboon" Burutu 16 Ditto. 126 Blackwateu Fever. Date. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. ealt with. May 28 s.s. "Dunvegan Castle"' Sierra Leone 1 Removed to Seamen's Hospital, Royal Albert Dock. As anticipated in my Report on Malaria for 1917, the free supply and use of quinine on vessels trading to West Coast Ports and the increased knowledge among shipmasters of the danger of those ports has resulted in much betterment as regards Malaria. The "War Daffodil" presented a series of cases which were all infected in the port of Dakar. This port was the one of especially evil repute in 1917. The ship lay there from the 2nd to the 15th October; cases began to appear from the 17th October onward. The condition of the crew would have been very serious in the absence of quinine treatment during the voyage; but the majority had recovered, by the time Gravesend was reached on 3rd November, under quinine. Seven cases were admitted to Denton Hospital for a course of treatment. s.s. "Roumelian," s.s. "Kwarra" and s.s. "Griqua" presented similar histories to that of s.s. " War Daffodil," and Dakar was the infecting port. It was usually found that prophylaxis and treatment had both been practised on ships using West African Ports. The following Letter was received from the Local Government Board:— 12th March, 1918. Sir, Malaria. I am directed by the President of the Local Government Board to inform the London Port Sanitary Authority that in consequence of the occurrence last 20 year of cases of malignant Malaria on ships from the West Coast of Africa notably the ports of Dakar and Freetown, a Committee representing the Admiralty, the Board, and other Departments concerned, are now considering the precautions against the infection of passengers and crews of ships when calling at these ports with a view to making them more efficient. In connexion with this matter it is important that the Board should obtain information as to cases of Malaria on ships arriving from ports on the West African Coast, and that certain precautionary measures should be taken, and I am to request the Port Sanitary Authority to be good enough to authorise their Medical Officer of Health in connexion with vessels arriving from West African Ports this year to (1) inquire as to the dates on which the vessel was in the port in question, and as to the occurrence of cases of Malaria among the passengers or crew after the vessels left the ports; (2) provide or assist in securing hospital treatment for severe cases of Malaria brought into the Port Sanitary District. Where cases of Malaria have occurred which apparently have contracted the disease during the stay of the vessel in ports on the West African Coast, or where there is special reason to suspect that passengers or crew may be incubating Malaria as a result of the circumstances in which the vessel stayed in these ports, it is very desirable that the Medical Officer of Health should (a) take the names and addresses of the destinations of passengers and forward them to the Medical Officer of Health of the district concerned asking to be informed if Malaria develops in any case ; (b) keep the crew under observation and secure quinine treatment, and if necessary hospital treatment, of any case of Malaria among them whilst the vessel is in port, and also, if required, inform the Medical Officer of Health of any other British port to which the vessel proceeds ; (c) report the facts to the Board. I am, Sir, Your obedient Servant, (Signed) H. 0. STUTCHBURY, for Assistant Secretary. The Clerk to the London Port Sanitary Authority. The measures suggested fitted into the system at present at work under your Worshipful Committee, by which serious ship-borne infections are dealt with, with such modifications as are suitable to the peculiar cause and cure of Malaria. / Provision of hospital treatment at Denton was during 1917 approved by your Worshipful Committee. No legal compulsion for the patient is implied. 21 TABLE XIV. Pulmonary Tuberculosis. Date. 1918. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Jan. 8 s.s. "Mandingo," of Liverpool Sierra Leone 1 Proceeded home. „24 s.s. "Novara" Calcutta 2 Ditto. Feb. 11 s.s. "Kenilworth Castle" Durban 2 Ditto. April 6 s.s. "Lycaon," of Liverpool, 135.467. Yokohama 3 Ditto. „6 s.s. "Mahratta," of Liverpool, 140,545. Calcutta 1 Landed at Colombo. „ 15 s.s. "Gaika" Beira 1 Died, and body buried at sea. Sent to hospital in London. May 19 s.s. "Clan Macfadyen" Alexandria 1 June 5 s.s. "Seangbee" Bombay 1 Proceeded home. „ 6 Training Ship "Cornwall," Pur fleet 1 Isolated in tent ashore. „ 7 s.s. "Nagoya" of Greenock, 135,323. Bombay 1 Isolated on board. July 5 s.s. "Umtali," of London, 105,810. Freetown 1 Proceeded home. „ 10 s.s. "Clan Mackinnon," of Glasgow, 115,746. Calcutta 1 Landed at Colombo. „ 17 H.M.S. "Wyncote" Philadelphia 1 Removed to Naval Hospital. Aug. 2 s.s. "City of Karachi" Cape Town 1 Proceeded home. „ 8 s.s. "Merkara" Calcutta 1 Died on board. „ 27 s.s. "Highland Loch," of London, 129,182. Buenos Ayres 1 Removed to hospital at Leytonstone. „ 27 s.s. "Campos" 1 Remained on board. Sept. 4 s.s. "Highland Piper" Buenos Ayres 1 Died, and body buried at sea. Military case. „ io s.s. "Titan" Baltimore ]. „ 26 s.s. "Seangbee" 1 Removed to Seamen's Hospital, Greenwich. „ 27 Barge "Good Templar" Rochester 1 Remained on board. „ 27 s.s. "Michigan" Montreal 1 Died on board. Oct. 4 s.s. "Ulimaroa" Wellington Military cases. „23 „28 s.s. "Junin," of Liverpool s.s. "Dunbridge" Bahia Blanea Montreal 1 1 Removed to Seamen's Hospital, Greenwich. Died on board. „31 s.s. "Glenavy,"of Glasgow Shanghai 1 Proceeded home. Dec. 2 s.s. "Manhattan" Baltimore 1 Ditto. „5 s.s. "Highland Loch" Buenos Ayres 4 Ditto. 38 22 TABLE XV. Tuberculosis (Other kinds, including Miners' Phthisis). Date. 1918. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Jan. 24 s.s. "Novara" Calcutta 1 Proceeded home. Feb. 18 April 16 s.s. "Kenilworth Castle," of London, 118,433. s.s. " Gaika " Durban Beira 2 3 Ditto. Ditto. May 2 s.s. "Galway Castle" Cape Town 2 Ditto. „ 13 s.s. "Benalla" Ditto 2 Ditto. „ 14 s.s. "Norman" Ditto 1 Ditto. June 10 s.s. "Kenilworth Castle" Durban 3 Ditto. „ 19 s.s. "Cluny Castle" Mombasa 4 Ditto. Aug. 8 s.s. "Hector" Calcutta 1 Ditto. Dec. 4 s.s. "Highland Loch" Buenos Ayres 1 Ditto. 20 . Miners' Phthisis 17 cases. Tuberculosis, Other 20 cases. TABLE XVI. Influenza and Pneumonia. Date. 1918. Name of Vessel. Port of Registry and Official No. Where from. No. of Cases. How dealt with. April 28 s.s. "Santeramo" St. John's I Isolated on board. June 19 s.s. "Takada" Bombay 3 Ditto. July 5 s.s. "Sardinia" Ditto 1 Ditto. „ 22 s.s. "Thongwa" Halifax 1 Military case. „ 29 s.s. "Kenora" Christiania 1 Isolated on board. Sept. 11 s.s. "Tajima Maru" Yokohama 13 Ditto. „ 14 s.s. "Chepstow Castle" Durban 600 Military cases (39 deaths). Oct. 1 s.s. "Skipton Castle" Calcutta 3 Isolated on board. „ 14 s.s. "Irishman" Newport News 4 Military cases. „ 14 s.s. "City of Cairo" Montreal 30 Military cases (fatal). „ 19 s.s. "River Lagan" Jersey 7 Isolated on board. „ 25 s.s. "Highland Heather" Buenos Ayres 4 Removed to Port Sanitary Hospital. „ 25 s.s. "Ninian'' Boston 6 Removed at Boston. Carried forward 674 23 Influenza and Pneumonia—continued. Date. 1981. Name of Vessel, Port of Registry and Official No. Where from. No. of Gases. How dealt with. Brought forward 674 Oct. 26 s.s. "Cufic" Buenos Ayres 1 Died on board. „ 27 s.s. "Jason" Montreal 5 Treated on board. ., 29 s.s. "Ruahine" Wellington 252 Military cases (1 death). „ 30 s.s. "British Ensign" Thameshaveu 1 Died on board. „ 30 s.s. "Orita" Quebec 1 Removed to Port Sanitary Hospital. „ 30 s.s. "Japan" Bombay 1 Died on board. Nov. 2 s.s. "Fanad Head" Montreal 1 Removed to Seamen's Hospital, Greenwich. „ 7 s.s. "Corinthian" Ditto 14 Treated on board (3 deaths). „ 25 s.s. "Barambah" Melbourne 1,062 Military cases (1(5 deaths). „ 25 s.s. "Dunedin" Lavrion Bay 25 Treated on board (3 deaths). Dec. 11 s.s. "Clan Macdonald" Montreal 71 Treated onboard (31 deaths). 2,108 Influenza 2,096 cases. Pneumonia 12 „ 2,108 cases. INFLUENZA. Influenza on inward bound vessels was at no time a marked feature of the Influenza epidemic in the Thames. From the middle of the year, the customary history of Influenza outbreaks among crews on ships was an epidemic after arrival, and infection was brought to the ships from the shore. The conditions in a ship's forecastle are just such as would quickly cause the illness, once introduced, to become epidemic, and the natives of India suffered severely. A few cases were admitted to Denton Hospital from inward bound ships, but more were received into Gravesend Military Hospital by arrangement with the War Office through the Local Government Board. Transports—or rather the cargo ships which had brought troops and had landed them elsewhere—came on to London to discharge cargo, and are responsible for the large numbers (mostly military cases already landed) appearing in the Table. Large numbers of cases, of which there is no record, occurred in the Port under circumstances stated above, with which the organisation of the Port Sanitary Authority -could not deal in any way. The Seamen's Hospital, Greenwich, did very great service in dealing with bad cases, and the Gravesend Military Hospital relieved difficult shipping situations on many occasions. Major Skinner, R.A.M.C., of the Army Medical Transport Service at Gravesend, gave most cordial and effective help in this. 24 TABLE XVII. Mumps. Date. 1918. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Jan. 1 s.s. "Aeneas" Sydney 39 Military cases. „ 4 s.s. "Llanstephan Castle" Durban 12 Landed at Plymouth. May 23 s.s. "City of Brisbane" New York 1 Landed at Halifax. „ 27 s.s. "Rhesus" Philadelphia 5 Military cases. „ 27 s.s. "Teiresias" St. John's 7 Ditto. June 4 s.s. "Corinthic" Sydney 4 Ditto. „ 4 s.s. "Saxonia" New York 6 Landed at Halifax. „ 6 s.s. "Winifredian" Boston 1 Military case. „ 15 s.s. "Themistocles" New York 1 Ditto. „ 24 s.s. "Berrima" Ditto 9 Ditto. „ 24 s.s. "Cassandra" Montreal 29 Ditto. July 7 s.s. "Gloucestershire" Halifax 1 Ditto. „ 22 s.s. "Thongwa" Ditto 4 Ditto. Aug. 26 H.M.S. "Hearty" 1 Removed to South Eastern Hospital (M.A.B.). Sept. 10 s.s. "Titan" Baltimore 6 Military cases. „ 10 s.s. "Cardiganshire" Boston 2 . Ditto. „ 10 Royal Albert Dock Shore Quarters 16 Removed to South Eastern Hospital (M.A.B.). Nov. 14 s.s. "Barambah" Melbourne 29 Military cases. Dec. 5 s.s. "Zealandic" Wellington 40 Ditto. 213 25 TABLE XVIII. Venereal Disease (cases on vessels arriving at Gravesend). Date. 1918. Case. No. of Cases Rating. Advice Given. Jan. 4 Syphilis 1 Fireman To attend Seamen's 4 Ditto l. D.B. Seaman- pital. Ditto April 5 Chancre 1 Chinese Ditto 5 Bubo Soft Sore 1 Seaman Ditto „ 26 Soft Sores 1 Fireman Ditto May 24 Secondary Syphilis 1 A.B. Ditto 2 4 Syphilis 1 Do. Ditto June 15 Chancres 2 Firemen To attend a hospital in London. J uly 7 Gleet. Right Inguinal Bubo 1 Fireman To attend Gravesend 7 Soft Chancre and Bubo 1 Seaman pital. To attend Seamen's „ 7 Syphilis 2 Lascars pital. To attend Gravesend „ 21 Gonorrhœa 1 Lascar pital. Ditto „ 21 Ditto 2 Seamen Ditto „ 21 Gleet 1 Fireman To attend a hospital until cured. Aug. 7 Syphilitic Bubo 1 A.B. To attend Seamen's 8 Syphilis 2 Firemen pital. To attend Gravesend Sept. 27 Gonorrhœa 3 Passengers pital. To consult Specialist. Nov. 3 Syphilis 1 Gunner To attend a hospital in London. 3 Ditto - - - - - 1 Seaman Ditto „ 25 Ditto 2 Seamen Landed at Malta. „ 30 Sores. Hard Chancre 1 Fireman To attend Seamen's pital. Dec. 2 Syphilis 2 Seamen Ditto „ 17 Venereal Sore 1 Lascar Treated by Ship's Surgeon Total 31 In every case which came under the notice of the Medical Officers or Inspectors, the patient was advised to attend at one of the Treatment Centres for Venereal Diseases. 26 TABLE XIX. Beri-Beri. Date. 1918. Name of Vessel. Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Jan. 15 s.s. " War Wolf" Java 41 Sixteen removed to Seamen's Hospital, Greenwich. Others remained on board. „ 15 s.s. "War Hero" Mediterranean 9 Eight removed to Seamen's Hospital, Greenwich. ,, 15 s.s. "War Tiger" Ditto 1 One landed at Colombo. Remained on board. „ • 21 s.s. "Clan Macfadyen Ditto 6 Three landed at Malta. Three removed to Seamen's Hospital, Greenwich. Mar. 30 s.s. "War Dame" Java 5 Remained on board. 62 BERI-BERI. In January of 1918, four ships arrived in the Port of London presenting Beri-Beri, The number of the cases suggested that this was an opportunity for inquiry into those conditions which might produce the disease on shipboard. Beri-Beri is stated to be a "deficiency" disease akin to Scurvy. Much research has been made in attempts to connect the disease with certain foods. This first threw suspicion on rice, and secondly on a deficiency of a certain kind inherent in rice which has been highly polished—i.e., a rice which has been stripped of its germ and aleurone layer, as the causal factor. This deficiency could only have its effect in those who use rice as the staple food, and it is amongst natives of the East that the disease is most commonly though not exclusively found. Experiment, sometimes on a large scale, has shown that a varied diet containing much fresh food—meat, potatoes and vegetables—is both preventative and curative of the beri-beri condition. Unintentional experiment has shown that the disease can appear amongst Europeans whose food lacks the quality of freshness, apart from rice as a staple cereal in the diet; therefore a deficiency akin to that to which the aleurone layer and germ of rice are said to be complementary can exist in rice free diets. / One of the difficulties that confront every medical officer of health in dealing with food stuffs is want of proof that this or that departure from the natural or normal will produce a lowering of the public health. There is practical certainty that such conditions as rancidity, staleness, wholesale sterilisation of food, preservatives, and unnatural refinement (as in the rice in question) insidiously produce a lower state of vitality than is compatible with full health in the nation, though this might never become sufficiently marked to impress the sufferers at large and lead to effective disclosure of the devitalising factors and the share of each in the evil. The inquiry on these ships was especially interesting, as three of them were exactly comparable vessels—From Japan, with 40 to 42 Japanese crew each, of similar build and with crews shipped under similar conditions, viz., that they received money in lieu of food. 27 All three ships called at many ports on the way to England, two of them ran neck and neck. Of these two ships one had nine pronounced cases of Beri-Beri and many slight cases, and the other one case only. On the third ship, which used the Cape route and was four months on the voyage, as against three months for the two ships which used the Mediterranean route, every member of the crew was more or less affected. "War Wolf" Crew 41 - Kobe and Batavia 41 cases via Cape " War Hero" ,, 42 via Mediterranean 9 „ (other slight cases,) "War Tiger" „ 42 Ditto 1 „ All three crews laid in stocks of Japanese food at Moji, in Japan, and polished rice was the staple cereal. Sea-weed, pickled fish, dried fish, tinned fish and shellfish, tinned vegetables, soya paste, dykoon and sliced bean were amongst the Japanese foods found. An important point of difference in catering was disclosed as between the " War Hero " and " War Tiger." The notes made were as follows:— "War Hero.''—Japanese crew would not ship under other conditions than that of cash payment in lieu of rations. Provisioned itself at Kobi and Moji. No fresh meat bought on voyage, and practically no fresh vegetables. Never more than one day's rations of vegetables bought at a time in ports of call. Limejuice was procured by the master at Port Said, and had since been served out regularly. "War Tiger."—Japanese crew found its own provisions, bought fresh provisions extensively at each port of call—vegetables, meat and fish. Took large quantities of meat to form a supply between ports of call. Fresh meat for at least one meal a day was used throughout the whole voyage. More than 21. per man was drawn at Port Said for purposes of catering. 300 rupees in all was drawn at Colombo and expended on meat, carrots, cabbage and turnips. The crew pooled resources and appointed a caterer. The difference in true economy in catering on the two ships is paralleled by the difference in the state of health of the crews. At Port Said the Beri-Beri on the " War Hero" was pronounced, while on the " War Tiger" one case only had occurred. On inspection of the food stores on the "War Tiger" an ample stock of some crushed cereal was discovered; each grain was whole, but flattened. Information volunteered by an intelligent member of the crew showed that this was Muji (barley) and was "Beri-Beri medicine." This crushed "whole-meal" barley was used in the proportions of one to four of rice. It was found that the "Beri-Beri medicine" had not been used on board the "War Hero" since Gibraltar, the supply having given out at that point in the voyage. The evidence left a question as to the extent of the use of barley up to Gibraltar ; too much conflicting interest had been aroused on the ship for satisfactory elucidation. The conditions on the "War Wolf" were such that around the Cape and up to Dakar there was a daily meat ration which failed at the latter port. Plenty of fresh vegetables and fish had been bought by the crew. The use or absence of Muji (barley) was not specially noted; the samples of the food obtained included none of this " Beri-Beri medicine." 28 On all three ships Beri-Beri was present from Batavia homewards, but did not develop seriously on the "War Tiger." On the "War Hero "the condition is said to have been at its worst before Port Said and again just before arrival in England. On the" War Wolf" there appears to have been a progressive incapacity amongst the crew, which became very acute after leaving the coast of East Africa. From amid the broken English of a "War Wolf" boatswain who on a Japanese sailing ship had been one of the four survivors of an epidemic of Beri-Beri, it was gathered that on a line of steamers carrying Japanese crews and sailing to England, and utilising English food, there Avas no Beri-Beri during his three years' experience, and that on the "War Wolf" Japanese food was considered to be the cause of the condition. It any weight is to be given to the striking alternative name for the wholemeal Muji volunteered on the "War Tiger"—namely, Beri-Beri medicine—it is a matter for congratulation that the aleurone layer in wheat comparable to that on the Muji, and on rice before polishing, was during the War finding its natural place in bread in Britain. The salient points elucidated in connection with the inquiry are(l) the use of Muji; (2) the conditions of catering under which the crews shipped. These appear to me to be determinants of the comparative health conditions found. In especial the catering for long voyages should not be at the indiscretion of the crew. TABLE XX. Miscellaneous Diseases, &c., 1918. Disease. No. of Cases. Disease. No. of Cases. Adenitis 1 Brought forward 22 Aortic Aneurism 1 Hepatitis 1 Apoplexy 1 Inguinal Bubo 1 Appendicitis 1 Injury, accidental 3 Carcinoma of Stomach 1 Nephritis 1 Congestion of Lungs 1 Pleurisy 1 Diphtheritic Tonsillitis 2 Rheumatism 1 Enteritis 1 Scabies 11 Epilepsy 1 Scurvy 1 Gastric Ulcer 1 Senile Decay 1 Gastritis 2 Suffocation 1 Hsemorrhage 1 Trachoma 3 Heart Failure 6 Twisted Colon 1 Hemiplegia 1 Vincent's Angina 1 Hepatic Abscess 1 Total 49 Carried forward 22 29 TABLE XXL Vessels and Premises Disinfected, from 1st January to 31st December, 1918. Month. Cerebro-spinal Meningitis. Chicken-pox Cholera. Continued Fever. — Diphtheria. Enteric Fever. Reason for Disinfection. Scarlet Fever, Small-pox. Pulmonary Tuberculosis, &c, Precautionary Measure. Vessels Fumigated and Sprayed. Total number of Disinfections. Erysipelas. Malaria Measles. Influenza. Plague. Remittent Fever. January ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... February ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 8 March ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... 1 ... ... 4 April ... 2 ... ... 2 ... ... ... ... ... ... ... ... 1 1 ... ... 6 May ... 1 ... 1 1 1 ... ... ... ... ... ... 1 ... ... ... ... 5 Juue ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 4 July ... ... ... ... ... 2 ... ... 1 ... ... ... ... 1 ... 1 4 August ... ... ... ... ... 3 ... 4 ... 1 ... ... 1 ... 2 11 September ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 October ... ... ... 2 ... ... ... 1 ... ... ... •• ... 3 November ... ... ... ... ... ... 1 2 ... ... ... ... ... 1 4 December ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Totals 3 ... 2 4 9 ... 1 6 3 2 ... 2 1 4 ; ••• 17 54 TABLE XXII. Number of Disinfections of Effects, Bedding, &c., from 1st January to 31st December, 1918. Month. Reason for Disinfection. Hospital Bedding, &c. Total Effects. Number of times Steam Disinfector was use l. Disinfected by Fumigation. Cholera. Chicken-pox. Cerebro-spinal Meningitis. Continued Fever. Diphtheria. Enteric Fever. Malaria. Measles. Pulmonary Tuberculosis, &c. Plague. Influenza. Scarlet Fever. Small-pox Precautionary Measure. January ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... February ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... March ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I April ... 1 ... ... ... ... ... ... ... ... 1 ... ... 2 3 ... May ... 1 ... 1 1 2 ... ... ... 1 ... ... ... .... ... 6 5 ... June ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 1 4 5 1 July ... ... ... ... ... 2 ... 1 ... ... ... 1 ... ... ... 4 3 ... August ... 1 ... ... 3 ... 1 ... 1 ... ... ... ... 3 9 5 1 September ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... October ... ... ... ... ... 2 ... ... ... ... 3 ... ... ... ... 5 3 2 November ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... ... 3 2 1 December ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 ... Totals ... 3 ... 2 2 12 ... 2 ... 2 4 1 1 ... 5 34 30 30 TABLE XXIII. Return of Rats caught and destroyed during 1918. The entire cost of destroying these rats has been borne by the Shipowners and Port of London Authority. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals. Millwall Dock— Warehouses 146 152 143 151 162 221 126 157 80 67 358 261 2,024 Vessels during voyage 15 50 — 10 — 40 — — 20 20 45 — 200 „ while in dock - 217 64 8 240 122 190 56 151 201 44 108 94 1,495 Surrey Commercial Dk.— Warehouses 76 91 76 62 111 149 78 75 131 172 161 91 1273 Vessels during voyage - - - - - - - - - - - „ while in dock - 23 — 97 — 11 — 34 81 — — 22 — 268 Regent's Canal Dock— Warehouses - - - - - - - - - - - Vessels during voyage - - - - - - - - - - - - - „While in dock - - - - - - - - - - - - - St. Katharine's Dock— Warehouses 50 56 70 55 55 76 52 93 73 71 71 47 7 69 Vessels during voyage - - - - - - - - - - - - „ while in dock - - - - - - - - - - - - - London Dock— Warehouses 289 275 237 209 315 363 222 293 283 280 414 292 3,472 Vessels during voyage - - - - - - - - - - - - - „ while in dock - - - - - - - - - - - - - Albert and Victoria Dks.— Warehouses 272 295 325 320 297 337 322 417 287 422 485 282 4,061 Vessels during voyage 13 - 309 70 41 110 6 175 199 100 271 - 1,300 ,, while in dock 554 345 589 1,510 448 527 425 595 525 490 550 574 7,132 West India Dock— Warehouses 122 183 217 131 167 156 148 209 193 72 157 104 1,859 Vessels during voyage 130 130 30 148 55 20 65 20 25 27 20 45 715 „ while in dock - 377 236 344 134 316 482 173 389 90 284 406 249 3,480 ■ East India Dock— Warehouses 17 23 5 4 — 7 32 7 39 8 117 20 279 Vessels during voyage — — — — — — — — — — — — — „ while in dock 80 127 49 34 6 29 61 73 144 12 38 53 706 Tilbury Dock— Warehouses 214 210 297 264 302 277 191 210 265 266 377 285 3,158 Vessels during voyage - 264 — — 590 225 — — — — — - 1,079 „ while in dock - 303 206 440 51 263 335 289 301 151 124 249 360 3,072 River— During voyage - - - - - - - - - - - - - While in river - - - - - - - - - - - - - Totals - 2,898 2,449 3,500 3,393 2,671 3,909 2,505 3,246 2,696 2,469 3,849 2,757 36,342 Total from February, 1901, to 31st December, 1917 976,263 Total from 1st January to 31st December, 1918:— In Dock Warehouses 16,895 On Vessels during voyage 3,294 36,342 On Vessels while in Dock and River - 16,153 TOTAL 1,012,605 31 TABLE XXIV. RETURN OF RATS EXAMINED BACTERIOLOGICALLY—YEA.R ENDED 31ST DECEMBER, 1918. DOCK. Number fiom each Dock. Found Dead. Trapped. Found Dead. Trapped. Infected. NonInfected. Infected. Non-Infected. Infected. Non-Infected. Royal Victoria Dock 358 1 357 M.D. M.R. M.A. M. M. M.M. M.R. M.A. M.M. ... 358 M.D. M.H. M.A. M.M. M.D. M.R. M.A. M.M. Found Dead. Trapped. Found Dead. Trapped. 1 ... ... ... 252 86 17 2 ... ... ... 253 86 17 2 ... ... l 357 Royal Albert Dock 1,330 12 1,318 10 2 ... ... 1,025 229 63 1 2 1,328 1 1 ... 1,034 230 63 1 ... 2 12 1,316 St. Katharine's Dock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... London Dock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Millwall Dock 326 10 316 10 ... ... ... 232 69 15 ... 1 325 1 ... ... ... 241 69 15 ... ... 1 10 315 East India Dock 13 ... 13 ... ... ... ... 8 5 ... ... ... 13 ... ... ... ... 8 5 ... ... ... ... ... 13 West India Dock 24 1 23 1 ... ... ... 18 4 1 ... ... 24 ... .. ... ... 19 4 1 ... ... 1 23 Surrey Commercial Dock 10 1 9 1 ... ... ... 4 1 4 ... ... 10 ... ... ... ... 5 1 4 ... ... ... 1 9 Tilbury Dock 181 ... 181 ... ... ... ... 142 35 7 ... 1 183 1 ... ... ... 141 35 7 ... ... 1 ... 183 Unknown Dock 70 ... 70 ...... ... ... ... 52 14 4 ... ... 70 ... ... ... ... 52 14 4 ... ... ... ... 70 2,315 25 2,286 23 \ 2 ... ... 1,733 443 111 3 4 2,311 3 1 ... ... 1,753 444 111 3 ... 4 25 2,286 2,315 2,315 ... 2,315 2,315 ... 2,315 Summary— Total Rats examined 2,315 „ „ infected 4 *Species— M.A.=Mus alexandrinus 111 M.D.=Mus decumanus (Norvegieus) 1,756 M.R.=Mus rattus 445 M.M.—Mus musculns 3 Total 2,315 32 MINISTRY OF FOOD. Rat Order, 1918. The Ministry of Food Rat Order, 1918, was reported to your Worshipful Committee in the following terms :— "This Order confers power on' Local Authorities' to take any measures thought proper for the destruction of rats where these are causing preventable damage or destruction to foodstuffs. "Under the Order the owner or occupier of neglected lands or buildings infested with rats, or the owner or occupier on whose lands rubbish attractive to rats accumulates by neglect of removal, is responsible for the infestation and for its abatement. "On failure of the owners or occupiers to comply with reasonable directions of the Local Authority, the Authority may enter and take measures, and may recover expenses incurred under the failure of the owner or occupier to carry out his obligations and attributable to this. "In the exercise of its powers, the Local Authority has regard to recommendations made by the Board of Agriculture and Fisheries or a War Executive Committee in the area. "The Local Authority may prosecute for breaches of the Order, and failure of the owner or occupier to comply with directions is a summary offence. "The constituted Local Authorities are County Councils and County Borough Councils. "In view of the valuable powers given by the Rat Order and the impetus, where necessary, to the campaign against rats which would accrue, I would recommend to your Worshipful Committee that the Ministry of Food be requested to forthwith constitute the Port of London Sanitary Authority a ' Local Authority' for their district for the purposes of the Rat Order, 1918. " The recommendation is made on the following grounds:— "1. The Port Sanitary Authority already exercises powers in destroying rats throughout the Port Sanitary District for the prevention of plague infection. "2. These powers are not in themselves sufficient to secure similar action in the case of foodstuffs; though food is stored in, or is in transit through the district in immense quantity. "3. A County Council does not otherwise] than by the Order exercise jurisdiction in the Port Sanitary District. "4. Three County and County Borough Councils under the present Order would exei'cise jurisdiction in one dock, and four in the whole district of the Authority." It was further recommended that your Worshipful Committee should request the following extension of the Order be made:— "For the purpose of this Order any vessel lying in any water within the district of the Port Sanitary Authority shall be subject to the jurisdiction of the Authority as if it were a ' building on the grounds that— "1. The ship is a perennial source of rat supply to docks and wharves. 33 "2. Powers similar to those exercised on plague-infected ships are needed in dealing with rat-ridden ships in general, to bring about reduction or extermination of rats thereon. "3. The ship is eminently a 'building' from which rats can by suitable measures be exterminated rather than driven off to other quarters. "4. Food damage and destruction on ships is in the total very large." Representation was made accordingly. An amending Order, dated March 26th, 1919, constitutes the Port Sanitary Authority the "Local Authority" for the Port Sanitary District ashore, and extends the provisions of the Order to any ship within the limits of the Port in like manner as nearly as may be as if it were a building. TABLE XXV. HOSPITAL. Number of Cases Admitted, Cost of Maintenance, &c. Patients remaining in Hospital on 31st December, 1917 1 Admitted. Discharged Died, Remaining under treatment. Cholera 0 0 0 0 Cholera (suspected) 0 0 0 0 Plague 8 7 I 0 Plague (suspected) 4 4 0 0 Small-pox 1 1 0 0 Scarlet Fever 5 3 0 2 Enteric Fever 7 7 1 0 Continued Fever 6 6 0 0 Diphtheria 0 0 0 0 Measles 2 2 0 0 Erysipelas 0 0 0 0 Chicken-pox 1 1 0 0 Cerebro-spinal Fever 0 0 0 0 Other Diseases 22 20 1 1 Totals 56 51 3 o o Remaining in Hospital on 31st December, 1918 - - - - 3' Total number of days treatment during the year .... 1,074 Average number of days treatment for each case ■ 18*84 Average daily number of patients in Hospital .... 6'40 Average daily cost of maintenance per patient ... 2s. 1 '6d. Average total cost of maintenance per patient - - - £1 18s. 10c?. 34 TABLE XXVI. Quantity and Description of Unsound Food Seized and Disposed of as Unfit for Human Food for the Year ended 31st December, 1918. Original packages. Sundry quantities by weight. Loose Articles. Approximate Total weight of Goods destroyed. MEAT— No. Description. Tons. cwts. qrs. lbs. No. Description. Tons. cwts. qrs. lbs. Fresh and Frozen— 1 Beef 29141 quarters, &c. ... ... ... 417 pieces,&c. 274 15 0 2 Mutton and Lamb 185 carcases 6 3 4 107 pieces ft 5 1 20 Veal, Pork and Offal 286 bao-s,&c. 3 1 1 11 407 varicus 19 16 0 3 Preserved— Tinned 949 cases ... ... ... 103 tins 30 14 0 12 Smoked and Salted ... ... ... .. .. 91 hams, &c. .. 10 2 16 Sundry ... ... ... ... ... ... ... ... ... ... ... RABBITS— Frozen 147 crates, &c. ... ... ... 14 rabbits 4 5 2 24 Tinned ... ... ... ... ... ... ... ... ... ... POULTRY and GAME— F rozen ... ... ... ... ... ... ... ... ... ... ... FISH— Preserved, Dried 3 bags ... ... ... ... ... ... 3 0 0 „ Tinned and Bottled 78 cases ... ... ... 314 tins 1 16 1 8 Shell ... ... ... ... ... ... ... ... ... ... ... Wet 47 boxes, &c. ... ... ... ... ... ... 14 0 6 FRUIT— Fresh 100 various 3 0 o 0 ... ... 6 0 0 0 Preserved, Dried 467 . various ... 4 1 7 ... ... 11 0 •J 15 „ Tinned and Bottled 61 cases, &c. ... ... ... ... ... ... . . . 17 2 16 „ Jam and Marmalade 28 cases ... ... ... 86 tins ... 17 1 14 VEGETABLES- Fresh 444 various 32 0 0 0 ... ... 54 2 0 0 Preserved, Dried 54 various 3 16 2 0 ... ... 6 17 0 0 „ Tinned 9 cases ... ... ... ... 19 tins ... 5 3 9 NUTS- Whole 20 bags ... . . . • . . ... ... 1 9 2 12 Desiccated and Shelled ... ... ... ... ... ... ... ... ... ... PROVISIONS— Tea 1 chest .. * 13 tins ... 2 0 18 Coffee ... ... 4 2 16 ... ... ... 4 2 16 Cocoa ... ... ... ... ... ... ... ... ... ... Butter, Cheese, Lard, Margarine 90 boxes, &c. ... ... ... ... ... 4 17 2 2 Condensed Milk 3,522 casks, &c. ... ... ... ... 103 tins 261 4 0 27 Prepared Foods 193 cases 3 16 1 21 ... ... 10 11 2 0 Biscuits and Confectionery 518 barrels, &c. ... ... . . . ... 469 tins 38 15 2 5 Sugar 4 cases, &c. ... ... ... ... ... ... 2 2 0 Sundry ... ... .i. ... ... ... ... ... ... ... ... GRAIN Wheat, Maize, Barley, Rice, &c. ... 385 8 0 3 ... ... 385 8 0 3 MEAL and FLOUR 27 7 2 11 .. ... 27 7 2 11 CONDIMENTS and SPICES ... ... . •. ... ... ... ... ... ... EGGS ... ... ... ... ... ... ... EGG YOLK ... ... ... ... ... ... ... ... ... ... DRUGS 8 bags,&c. ... ... ... ... ... 12 3 21 SUNDRIES 614 bags ... ... ... ... ... 51 10 0 19 Total ... ... ... ... ... ... ... ... 1,200 7 0 27 Approximate Total weight of Goods destroyed during the year 1909 1,415 7 0 22 1910 2,483 6 2 13 1911 1.408 4 3 1 1912 3,758 7 1 2 1913 2,458 0 2 21 1914 1,184 11 1 1 1915 3,118 5 3 19 1916 5,664 9 2 5 1917 4,847 8 1 5 „ „ „ 1918 1,200 7 0 27 Average for 9 years, 1909 to 1917:—2,926 tons 9 cwts. 0 qrs. 7 lbs. 35 TABLE XXVII. Description of Meat Df,sti?oyft>. Year. Beef. Mutton. Veal, Pork, Offal. Tinned. Smoked and Salted, &c. Dotal. Tohs civts. (J)S. lbs. Ions cu-ts. qrs. lbs. Tor s cw is. <jrs. lbs. Tons cicls. qrs lbs. Tom cwts. qrs. lbs. Ions cwts. q rs. lbs. 1909 19 11 3 7 21 3 1 "{ Pork and Veal— V 2 10 2 19 0 2 3 22 113 9 1 19 4 15 3 23 Offal— 65 4 2 15 1910 1,100 0 0 27 50 8 1 13 / Pork and Veal— ( 3 2 2 2 32 13 1 6 1,234 1 3 24 a 0 u 13 Offal— 44 12 1 19 3911 341 6 3 18 25 9 1 6 J Prvrlr n.r»d VpsiI— ( 6 0 8 2 5 3 18 2 0 462 11 0 0 4 8 1 19 Offal— 80 19 1 8 1912 58 3 0 3 14 3 2 zl Pork and Veal— r 5 17 3 17 3 2 2 16 108 11 3 6 7 .14 2 13 Offal— 19 10 0 10 1913 31 13 0 18 134 5 3 14 J Pork and Veal— V 1 14 3 22 14 14 3 6 252 8 1 20 0 16 1 2 Offal— 69 3 1 14 1914 82 9 3 26 161 11 1 221 Pork and Veal— I / o 8 0 13 1 19 0 3 316 13 0 24 11 6 1 27 Offal— 55 18 0 17 191^ ... ••• 294 18 2 20 64 2 1 L5 < Pork pmH VpbI— V 6 3 0 15 17 2 0 2 453 14 2 26 13 7 0 27 Offal— 58 1 1 3 1916 162 7 2 4 10 12 1 10 \ Pork and Veal— V 6 15 1 26 693 6 2 9 918 17 0 0 21 9 2 4 Offal— 24 5 2 3 1917 227 11 18 44 10 2 1.9 J Pork and Veal — \ 1 10 0 18 78 17 3 16 361 13 0 1 0 9 2 15 Offal- 8 13 u 27 1918 274 15 0 2 5 5 1 20 | Pork and Veal — > 30 14 0 12 0 10 2 6 331 1 0 25 0 16 3 1 Offal— 18 19 1 2 ) Tofal for ten years ... 2,592 17 3 3 531 12 2 27 513 17 1 10 68 5 2 9 846 8 1 12 4,553 1 3 5 36 FOOD INSPECTION. The Regulations issued by the Local Government Board, under the Public Health (Regulations as to Food) Act, 1907, were carried out in the Port of London, and resulted in 1,200 tons 7 cwts. 0 qrs. 27 lbs. of Unsound Food being destroyed or disposed of in such a manner as to prevent its being used for human consumption. An exception is shown in the disposal of a quantity for the "manufacture of biscuits and confectionery."This was entirely a question of a yeast fermentation of condensed milk, in which the deleterious qualities were entirely removed by the process of re-manufacture, and thus the use of a considerable quantity of valuable food material was retained. The goods were disposed of as follows, only those which could not be used for some useful purpose being actually destroyed:— Tons. cwts. qrs. lbs. Boiled down (recovery of fat, &c.) 335 10 1 15 Cattle and poultry food 550 15 3 24 Manufacture of biscuits and confectionery 234 1 0 8 Ditto dog biscuits 17 16 0 0 Ditto adhesive (" gum ") 10 1 1 2 Ditto glucoae 8 10 0 6 , Ditto ink 0 1 0 0 Destroyed Buried 40 13 3 14 Burned 2 17 2 14 Total 1,200 7 0 27 The total shows a reduction of 75"25 per cent, compared with the year 1917. A summary of the Unsound Food disposed of is shown in Table XXVI. In no instance was it necessary to apply for a Magistrate's order for the condemnation and destruction of Unsound Food seized by your Officers. A list of the Notices served under Articles III (5), IV. (1) and VI. of the Public Health (Foreign Meat) Regulations, 1908, requiring the exportation of foreign meat imported contrary to the Regulations, is shown on page 42. BEEF. The total quantity of beef seized and disposed of as unfit for human consumption was 2,684 quarters, 1 crop, 417 pieces, 229 bags and a quantity of trimmings, weighing 274 tons 15 cwts. 0 qrs. 2 lbs. against 227 tons 11 cwts. 1 qr. 18 lbs. in 1917. The largest quantity seized on any vessel was 950 quarters, &c., weighing 66 tons 7 cwts. 0 qrs. 6 lbs. MUTTON AND LAMB. The mutton and lamb seized and disposed of totalled 185 carcases, 106 part carcases, and 6 cwts. 3 qrs. 4 lbs. of trimmings, weighing in all 5 tons 5 cwts. 1 qr. 20 lbs., against 44 tons 10 cwts. 2 qrs. 19 lbs. in 1917. The largest seizure on any vessel was 153 carcases, weighing 2 tons, 10 cwts. 3 qrs. 25 lbs. 37 AUSTRALIAN BEEF AFFECTED WITH "WORM" (ONCHOCERCA). No beef affected with "Worm" (Onchocerca) came under the notice of your Officers during the year. ACTINOMYCOSIS IN OX-TONGUES. Most of the ox-tongues which arrived in the Port of London were, at the request ofithe consignees, removed from the district of the Port Sanitary Authority (without inspection) to cold stores within the City of London and the Metropolitan Boroughs of Bermondsey and Finsbury, to be examined there under the supervision of the Medical Officers of Health of those districts. The following shows the results of the examination of some of the consignments O carried out in the Port of London by your Inspectors :— 500 tongues examined. 14 found diseased. 252 ,, l ,, ,, ,, 250 ,, ,, 1 ,, ,, 228 „ „ Nil „ 144 1 ,, ,, ,, ,, 252 1 ,, ,, ,, ,, PORK. Daring the year detailed examination was made of 5,300 carcases and 200 sides, with the result that 9 carcases, 3 sides, and 3 heads were found to be affected with tuberculosis. The pork seized and destroyed during the year was as follows:— From. Tuberculous, Carcases. Sides. Heads. United States 2 ... ••• Argentina 7 3 2 Ship's Stores ... ... 1 Total 9 3 3 During December three consignments, comprising 296 sides of pork, arrived in the Port of London. This meat came within the definition of "Foreign Meat Class 1," the importation of which is prohibited. The matter was brought to the notice of the Importers, who stated that "In October last we received several consignments of heavy pigs which showed signs of bone-taint resulting from the difficulty in freeing such heavy carcases from natural heat before freezing. To obviate a recurrence, thereby wasting valuable food and refrigerating space on steamers, the method of siding ' was adopted. 38 "As this appears to be contrary to import regulations we have cabled to-day stopping further shipments." The sides were admitted after thorough examination, on the understanding that in future shipments the regulations were to be adhered to. OFFAL. The offal seized as unfit for human consumption was 17 tons 15 cwts. 0 qrs. 7 lbs., more than double the quantity in the previous year, and comprised :— Tons. Cwts. Qrs. Lbs. Livers, Ox—2 bags, 329 loose 2 14 0 1 „ Sheep—1 crate, 5 bags 0 4 3 11 ,, Pig—13 lbs. 0 0 0 13 Sweetbreads— 2 bags 0 1 0 0 Kidneys—17 bags, 3 part bags 1 6 1 25 Hearts—47 bags, 6 boxes, 47 loose 2 8 0 19 Tongues—6 cases, 32 bags, 13 loose 2 0 2 12 Cheeks—17 bags, 12 loose 0 19 3 21 Tripe—44 bags, 4 cases 1 12 2 21 Tails—15 bags 0 17 0 4 Skirts—18 bags 1 9 1 26 Sundries 4 0 2 22 Total weight 17 15 0 7 MEATS—CANNED. The tinned meats seized and disposed of comprised:— 949 cases and 103 tins, weighing 30 tons 14 cwts. 2 qrs. 21 lbs. MEAT—SMOKED AND SALTED. Tons. Cwts. Qrs. Lbs. Bacon—6 pieces 0 0 1 3 Hams—85 loose 0 10 1 13 Total weight 0 10 2 16 SUNDRY MEAT. Meat coming under this heading, seized, consisted of 1 ton 4 cwts. 0 qrs. 23 lbs. of sausage meat, contained in 24 bags. RABBITS (Frozen). Only 139 crates, 8 bags and 14 lose rabbits, weighing 4 tons 5 cwts. 2 qrs. 24 lbs. were seized during the year. 39 RABBITS (Tinned), POULTRY AND GAME. No goods of these kinds were seized. FISH. Goods of this description seized and destroyed included : — Tons. Cwts. Qrs. Lbs Wet—30 boxes, 15 bags, 2 casks 0 14 0 6 Dried—3 bags 0 3 0 0 Tinned—Lobster, 2 cases, 54 tins 0 1 1 26 „ Sardines, 76 cases, 260 tins 1 14 3 10 Total weight 2 13 1 14 FRUIT (Green). Only 6 tons of this class of goods were destroyed, compared with 132 tons in the preceding year:— Tons. Cwts. Qrs. Lbs. Apples—66 boxes 1 16 0 0 Bananas —33 crates 1 3 2 0 Oranges—Loose 1 10 0 0 Lemons—Loose I 10 0 0 Quinces—1 basket - 0 0 2 0 Total weight 6 0 0 0 FRUIT (Dried). Most of the goods included under this heading .were old stock which had been lying at the Docks for some considerable time:— Tons. Cwts. Qrs. Lbs. Dates—3 boxes 0 1 3 14 Apricots—1 box 0 0 0 14 Figs—4 barrels, 232 boxes, 131 bags 8 16 1 25 Peaches—5 boxes 0 1 o o 0 Plums—50 boxes 0 13 0 12 Raisins—7 cases 0 2 2 0 Prunes—18 boxes 0 2 1 27 Sultanas—Loose 0 2 0 8 Currants—3 cases, 5 qr.-cases 0 2 0 0 Sundries—16 barrels 0 18 0 27 Total weight 11 0 2 15 40 FRUIT (Tinned and Bottled). Only 17 cwts. 2 qrs. 16 lbs. of goods of this class were seized and destroyed, compared with upwards of 92 tons in the preceding year:— Tods. Cwts. Qrs. Lbs. Fruit pulp—52 cases 0 5 2 0 Tomato puree—8 cases 0 7 0 16 Cherries—1 barrel 0 5 0 0 Total weight 0 17 2 16 JAM AND MARMALADE. Twenty-eight cases and 86 tins, weighing 17 cwts. 1 qr. 14 lbs., were seized and destroyed : — VEGETABLES. Fresh— Tons. Cwts. Qrs. Lbs. Potatoes—392 bags 19 12 0 0 Swedes—37 bags 1 15 0 0 Parsnips—1 bag 0 1 0 0 Carrots—8 bags 0 8 0 0 Beetroots—1 bag 0 1 0 0 Onions—5 boxes, 32 tons loose 32 5 0 0 Dried— Beans—½ barrel - 0 1 0 0 Peas—52 bags, 23½ cwts. loose 4 2 1 16 Split Peas—1 bag - 0 0 2 12 Sundries 2 13 0 0 Tinned— Beans—9 cases, 19 tins 0 5 3 9 Total weight 61 4 V 3 9 NUTS. The only goods of this class consisted of:— Tons. Cwts. Qrs. Lbs. Walnuts—9 bags , 0 9 2 12 Peanuts —11 bags 1 0 0 0 Total weight 1 9 2 12 41 PROVISIONS. The total quantity of this class of goods disposed of as unfit for human consumption shows an increase of about 170 tons compared with the previous year, and was due to several consignments of condensed milk which arrived in very bad condition:— Tons. Cwts. Qrs. Lbs. Tea—1 chest, 13 tins 0 2 0 18 Coffee—128 tins and a quantity loose 0 4 2 16 Cocoa—Nil 0 0 0 0 Cheese—15 casks, 66 boxes, 9 bags 4 17 2 12 Margarine—Nil 0 0 0 0 Butter—Nil 0 0 0 0 Sugar—1 bag, 3 cases 0 2 2 0 Condensed Milk—1,199 cases, 2,323 casks, 103 tins 261 4 0 27 Total weight • 266 11 0 17 PREPARED FOODS. Tons. Cwts. Qrs, Lbs Macaroni—193 cases 7 7 3 24 Rolled Oats—Loose 3 3 0 4 Total weight 10 11 0 0 BISCUITS AND CONFECTIONERY. Practically the whole of these goods came from a vessel which had been damaged by fire:— Tons. Cwts. Qrs. Lbs. Biscuits—17 cases. 19 barrels, 59 tins 1 3 2 25 Confectionery—482 cases, 410 tins 37 11 3 8 Total weight 38 15 2 5 GRAIN. Tons. Cwts. Qrs. Lbs. Wheat 303 6 1 18 Maize 29 17 2 9 Oats 26 7 1 16 Barley 12 17 3 18 Rye 8 4 3 6 Rice 4 13 3 20 Total weight 385 8 0 3 42 MEAL AND FLOUR. Tons. Cwts. Qrs. Lbs. Meal—2 barrels, 2 bags 0 5 0 6 Flour—443 bags 27 2 9 5 Total weight 27 7 2 11 DRUGS. Tons. Cwts. Qrs. Lbs. 5 bags, 1 bale, 2 cases - - Weight 0 12 3 21 SUNDRIES. Tons. Cwts. Qrs. Lbs. Sago flour—614 bags - - Weight 51 10 0 19 TABLE XX VIII. PUBLIC HEALTH (FOREIGN MEAT) REGULATIONS, 1908. During the year Notices were served under Articles III. (5). IV. (1) of the above-mentioned Regulations, for the exportation of the following foreign meat : — Date of Arrival. 1918. Name of Vessel. Where from. Where lying. Description and quantity of meat in respect of which Notices were served. Aug. 25 *s.s. "Highland Locli" - Argentina - Royal Albert Dock 110 bags pork loins, 5 bags nog livers, 5 bags hams, 5 bags butts. Dec. 4 s.s. "Highland Loch" - Do. Do. 40 pig-sides. „ 7 s.s, "Duquesa" Do. Royal Victoria Dock 200 pig-sides. „ 7 s.s. "Highland Piper " Do. Royal Albert Dock 56 pig-sides. In the case of the vessel marked * the consignees were called upon for an explanation in respect of the importation of the meat, and they reported that the meat came from a new meat works at Montevideo, the proprietors of which were entirely ignorant of the existing Regulations regarding the importation of pork products into England. The matter was brought to the notice of the Local Government Board. On an examination of the livers, 10 per cent. were found to be diseased and unfit for human consumption. Daring the year applications were received from Importers to be allowed to remove various foodstuffs from the district of the Port of London without examination by your Officers, on the understanding that the goods would be examined and dealt with under the supervision of the Medical Officer of Health of the district to which the goods were removed. 43 The permission asked for was given in respect of the following foodstuffs:— For removal to the City of London— 20,272 bags of ox-tongues. 266 pig-carcases. 3,296 boxes of boneless beef. 97 cases of damaged macaroni. 478 crates of ox-kidneys. For removal to the Metropolitan Borough of Bermondsey— 6,140 bags of ox-tongues. 429 bags of damaged peas. 1,000 bags of damaged sago flour. 170 cases of damaged macaroni. 9,000 bags of damaged flour. 123 cwts. 2 qrs. 20 lbs. damaged wheat. For removal to the Metropolitan Borough of Finsbury— 29,757 bags and cases of ox-tongues. For removal to the Metropolitan Borough of Lambeth— 2,900 boxes of damaged butter. For removal to the Metropolitan Borough of Stepney— 17,419 cases of tinned sardines. 414 cases of tinned crayfish. 443 bags of damaged flour. ACAJOU ("CASHEW") NUTS. In July last the undermentioned goods arrived in the Port of London from Bombay:— 100 cases of "Cashew" nuts, mark J K. 100 „ „ „ „ „ S D. 100 „ „ „ „ „ <CD> The importers gave instructions for the goods marked J K and S D to be sampled and tared, but no such instructions were given in respect of the 100 cases marked as these had been already sold to a margarine factor. Fifteen cases of each mark J K and S D were sampled and found to contain "cashew" nuts, but the 100 cases marked were, on examination, found to contain an admixture of nux vomica beans. The cases found to contain the nux vomica beans were dealt with by being sifted to remove all dust and refuse, and the material garbled in such a way that only recognisable portions of "cashew nuts were retained for human consumption. As a result of the sifting and garbling, 42 lbs. of nux vomica beans and 3 bags of siftings were removed from the cases as unfit for human consumption. The matter was reported to the Local Government Board. I have to acknowledge the assistance rendered to this Authority by the Surveyor of His Majesty's Customs and Excise at London Dock, who brought the goods to the notice of one of your Food Inspectors. 44 SHELL-FISH. I record below the confirmation of the Orders which were recommended by your Worshipful Committee and made by the Port Sanitary Authority on November 16th, 1916, and were the subject of appeal to and enquiry by the Local Government Board. The chief points in the appeal concerned the time over which oysters from a foul laying were to be submitted to cleansing, and the question as to whether winkles from such a laying might not be boiled by the salesman rather than by the distributor, without any relaying and with safety to the public. Shortly, your requirements demanded that oysters and other shell-fish, including winkles, should be relaid in pure water for one month, with the proviso that winkles and cockles, if boiled for fifteen minutes before distribution for sale, need not be subject to relaying. Public Health (Shell-Fish) Regulations, 1915. Decision of Appeal against Prohibition Orders. Port of London. To the Mayor, Aldermen and Commons of the City of London, in Common Council assembled. To the Kent and Essex Sea Fisheries Committee. And to all others whom it may concern. Whereas the Mayor, Aldermen and Commons of the City of London, in Common Council assembled being the Port Sanitary Authority for the Port of London, duly made, on the 16th day of November, 1916, two Orders (hereinafter referred to as "the Prohibitory Orders") under the Public Health (Shell-Fish) Regulations, 1915 (hereinafter referred to as "the Regulations"), prohibiting, subject as therein mentioned, the distribution for sale for human consumption of shell-fish brought from certain layings (specified in the Prohibitory Orders) in the estuary of the River Thames, within the area of jurisdiction of the said Port Sanitary Authority ; t And whereas the Kent and Essex Sea Fisheries Committee, being interested in the layings referred to in the Prohibitory Orders, appealed to Us, the Local Government Board, against the Prohibitory Orders by giving notice of Appeal to Us in accordance with Article XI. of the Regulations; and We appointed an Officer to hear the Appeal, and Report has been made to Us thereon: Now therefore, in pursuance of Our powers in that behalf, We hereby Confirm the Prohibitory Orders. Given under the Seal of Office of the Local Government Board this fifth day of March, in the year One thousand nine hundred and eighteen. W. HAYES FISHER, President. WALTER T. JERRED, Assistant Secretary. 45 It is noticeable that these are referred to as "Prohibitory Order," but they do not in fact prevent the sale of shell-fish taken from polluted foreshores if the food be properly dealt with and rendered unharmful. Pending appeal and the confirmation the Orders were operative. An Order was issued in Liverpool, dated 9th January, 1918, in which the terms and proviso were closely in accordance with those put forward in 1916 by the Port Sanitary Authority and recently confirmed by the Local Government Board, except that the relaying period is fixed at "at least two weeks" instead of one month. The lesser period of two weeks would appear to be of acceptable duration for the relaying of shell-fish brought from a polluted area. The Local Government Board have issued special regulations with regard to certain shell-fish layings, of which I bring the following chief requirements to the notice of your Worshipful Committee for comparison with Orders issued in the district of the Port of London Sanitary Authority:— Oysters.—To remain in the place of cleansing for at least fifteen days. Cockles, Mussels and Butterfisii.—All distribution for sale prohibited unless and until they have been subjected to a process of sterilisation by steaming under pressure in a suitable apparatus for at least six minutes. Butterfisii is an eel of salt or brackish water habitat. Your Worshipful Committee will temetnbsr that in drawing up Orders comparable to these special regulations, objection was taken to the separation of shell-fish into categories as unprovided for in the 1915 regulations, and conformably the Order was made to include all kinds of shell-fish. A proviso was, however, added that sterilised cockles and winkles were outside the Order as to relaying. It will be noted that the special regulations referred to above separate the categories of shell-fish and provide differing treatment, and include fish which, like shell-fish, is dangerous if taken from a polluted area; and that the more ready cleansing of oysters than other shell-fish by relaying, is recognised in the minimum relaying time required, namely, fifteen days. 46 TABLE XXIX. General Summary, and Analysis, of the Sanitary Inspections of Vessels, &c., in the Port of London, for the year ended 31st December, 1918. Foreign. Coastwise. Inland Navigation. Shore Premises. Sick Seamen referred to Hospital. Water Barge. Steam. Sail. Steam. Sail. Steam. Sail. Lighters (uninhabited). Canal Boats. Inspected. Defective. To be Cleaned, j Inspected. Defective. To be Cleared. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned, j Inspected. Defective. To be Cleaned. inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. | Inspected. Defective. To be Cleaned. No. in District in good condition. 31 st December, 1918. New Barges Condemned. j Use Discontinued. No. in District j 31st December, 1918. 7281 45 733 1081 14 52 947 8 108 359 7 12 738 1 45 8 126 41 399 4425 4 43 205 26 4 5590 21 518 - - - - - - Docks and River. No. Total Inspections to 31st December, 1917 - 1,194,663 Total Inspections from 1st January to 31st December, 1918 — St. Katharine's 1,172 Foreign 8,362 London 1,771 Coastwise 1,306 Regent's canal 996 Millwall 1,256 Inland Navigation 13,494 West India 1,699 Premises on shore 5,590 Poplar 84 28,752 Total 1,223,415 East India 1,226 Victoria 2,397 Cleansing of Crew's Quarters, &c.:— Total to 31st December, 1917 78,387 Royal Albert 1,858 Commercial 1,628 Total No. of Vessels from 1st January to 31st December, 1918 1,496 Tilbury 1,143 Total 79,883 Gravesend District - River—*Upper District 3,066 Number of vessels inspected: — "Middle „ 1,075 In the Launches— *Lower „ 3,491 "Lady Truscott" 3,491 "David Burnett." Total vessels 23,162 "George Briggs" 4,141 Shore premises 5,590 Total 7,632 Total 28,752 In the Docks, &c. - - 15,530 *Upper District extends from Greenwich to Teddington. Total 23,162 *Middle „ „ „ Greenwich to Erith. *Lower ,, ,, ,, Erith to outer limits of thee Port of London COMPARATIVE TABLE. Total number of Inspections of vessels from— 1909. 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918. Yearly average for the 10 years ending 31st December, 1918. "Foreign" - 14,887 13,710 14,015 15,17714,425 13,539 12,472 10,244 8,365 8,362 12,519-6 "Coastwise,' "Inland Navigation," and other Inspections - 25,469 24,857 24,009 28,035 24.501 24,475 22,237 19,634 20,881 20,390 23,448-8 Total - 40,356 38,567 38,024 43,212 38,926 38,014 34,709 29,878 29,246 28,752 35,968-4 47 TABLE XXX. NUMBER OF NUISANCES ON VESSELS REPORTED AND DEALT WITH during the year ended 31st December, 1918. Description of Nuisances. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Smoke Nuisances:— Number of complaints received ... ... ... • • • ... ... ... ... ... ... ... ... ... Number of recurrences reported ... ... ... ... ... ... ... ... ... ... ... ... ... Offrnrtvr CARGOES (Bye-laws):— Number of Infringements reported ... 1 ... 3 1 2 ... ... ... ... ... ... 7 Structural and other Defects:— Ventilation 4 5 3 5 4 1 1 5 5 11 4 11 59 Lighting 7 3 1 3 3 ... 1 5 7 6 2 10 48 Heating 3 1 1 1 ... ... 1 ... 1 2 ... 2 12 Bare iron in crew's quarters 1 ... ... 1 ... ... ... ... 1 2 2 7 Leaky decks, hawse-pipes, cable casings, &c. 6 2 2 3 1 2 5 2 3 7 3 8 44 Defective bulkheads and floors ... ... ... ... ... 3 2 ... 3 ... 2 ... 11 Sanitary conveniences ... 1 ... 1 2 2 3 ... ... 5 ... ... 14 Ship's gear or stores stowed in crew's quarters ... 2 2 ... ... ... 1 ... ... 1 1 ... ... 7 Foul bilges and peaks ... ... ... ... ... 2 2 ... 1 ... ... 2 7 Storage of drinking water (dirty or defective tanks) ... 1 ... ... ... . .. 1 1 ... ... ... 2 5 Dirty quarters 123 140 134 154 119 116 97 88 119 140 112 154 1,496 Accumulation of offensive matter ... ... ... ... ... 2 ... ... ... ... ... ... 2 Miscellaneous Nuisances 5 3 1 4 3 2 6 1 2 3 3 3 36 Totals 151 159 142 175 133 133 119 102 143 177 126 195 1,755 Total number of vessels on which structural alterations were ordered 11 8 4 5 7 5 9 6 9 15 7 13 99 Total number of vessels on which structural alterations were reported as carried out 7 5 2 ... 4 3 3 3 1 4 8 ... 40 NUMBER OF NUISANCES IN THE RIVER REPORTED AND DEALT WITH during the year ended 31st December, 1918. From discharge of foul liquid, sewage, Ac., into the River ... ... ... ... ... ... ... ... ... ... ... ... ... Offensive condition of River water ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ... ... ... ... ... ... ... ... ... ... ... ... ... ... 48 TABLE XXXI. NUMBER OF NUISANCES ON SHORE PREMISES REPORTED AND DEALT WITH during the year ended 31 st December, 1918. Description of Nuisances. January. February. March. April. May. J une. July. August. September. October. November. December. Totals. Smoke Nuisances:— Number of complaints received ... ... ... ... ... ... ... ... ... ... ... ... ... Number of recurrences reported ... ... ... ... ... ... ... ... ... * * * ... ... ... Structural and other Defects :— Ventilation 2 ... ... 1 1 ... 1 ... ... ... ... ... 5 Lighting 1 . . . ... . . . ... . . . 1 ... . . . . . . ... . . . 2 Heating ... . . . ... ... ... ... ... ... ... ... ... ... ... Dilapidations 1 2 1 1 ... 1 1 ... ... ... ... 7 Sanitary conveniences 2 2 ... ... 1 1 1 ... ... ... 1 3 11 Water supply ... ... ... ... ... ... ... ... ... ... ... ... ... Dirty premises 43 49 ... 38 38 29 30 35 55 69 45 50 518 Accumulation of offensive matter ... 2 ... ... ... ... 1 ... ... ... ... ... 4 Drainage 1 ... ... 3 ... ... ... ... ... ... ... 1 5 Foul cesspits, latrines, &c. ... 2 ... ... ... ... ... ... ... ... ... ... 2 Miscellaneous nuisances 1 1 ... 2 1 1 2 2 3 ... 1 1 15 Totals 51 58 37 45 42 31 37 38 58 70 47 55 569 Number of shore premises on which structural alterations were ordered 3 2 ... 2 2 ... 2 1 ... ... 1 4 17 Number of shore premises on which structural alterations were reported as carried out 1 2 2 1 1 ... 1 ... ... 1 ... 1 10 SUMMARY. Smoke. Structural. Offensive Cargoes. Drainage, Sewage, &c. Miscellaneous. Totals. Number of Nuisances reported— (a) On vessels ... 207 7 ■ 1,541 1,755 (b) On shore ... ... 25 7 537 569 (c) On the River ... ... ... ... ... ... Totals ... 232 7 7 2,078 2,324 Number of written Intimations— (a) On vessels ... 76 7 ... 15 98 (b) On shore ... ... ... ... 9 ... 1 10 20 (c) On the River ... ... ... ... ... ... Totals ... 85 7 1 25 118 Number of Statutory Notices— (a) On vessels ... ... ... ... ... ... (b) On shore ... ... ... ... . . . (c) On the River ... ... ... ... ... ... Totals ... ... ... ... ... ... 49 TABLE XXXII. SANITARY WORKS. Part I. Date completed. Works. 1918. April 4 Millwall Dock, B2 Shed—Provision of sanitary conveniences at Military Sack Store, May 11 Ditto— Construction of drainage, &c., for M2 Shed. „ 18 Ditto—Construction of drainage for new Railway and Grain Offices. July 15 Surrey Commercial Dock—Construction of drainage for Centre Pond Cottage. „ 16 Regent's Canal Dock—Construction of drainage for new Offices, North Quay. „ 16 Ditto—New closets, &c., for W.D. Salvage Depot. Part II. Sanitary Works and alterations, not yet reported as completed:— Date Plan submitted. Works. 1918. April 27 London Dock—Proposed drainage for West Quay Show Floor. May 10 Royal Albert Dock—Proposed latrine at the rear of Messrs. Scrutton's Offices. Aug. 28 Ditto—Proposed drainage, &c., for Messrs. Lester and Perkins' new Offices. Nov. 14 Ditto—Proposed removal of latrines, Dry Dock Equipment.* * Temporary measure only. NUISANCES. A complaint was received on the 2nd March from the Port of London Authority, supported by reports from the Authority's Police Officer, of a nuisance involving damage to some foodstuffs by the use of a closet on a vessel lying in the Surrey Commercial Dock, the closet being cleansed while a barge laden with floor was lying alongside. With the question of damage to the flour the Port Sanitary Authority had naturally nothing to do, but on the question of the use of closets on vessels while lying in the Docks this is a matter which has the constant attention of your Officers, and is prohibited when accommodation is available on shore within a convenient distance from the vessel. In the present case appropriate action was taken to prevent any recurrence of the nuisance. 50 TABLE XXXIII. BYE-LAWS—OFFENSIVE CARGOES. Seven cases of infringement of the above-mentioned Bye-laws were reported during the year. In each case written notice was sent to the owners of the barges concerned:— Date. 1918. Name of Vessel. Infringement. Feb. 22 Lighter "Pansy" Loaded with an offensive cargo not properly and securely covered so as to prevent any nuisance arising therefrom and also loaded above the coamings. April 4 Lighter "C. I.V." Ditto Ditto. 4 Lighter "Hettie" Ditto Ditto. 25 Lighter "Taw" Ditto Ditto. May 10 Lighter "Albion" Ditto Ditto. J une 14 Lighter "C. I.V." Ditto Ditto. „ 28 Lighter "Fred" Not thoroughly cleansed and deodorised within six hours after the discharge therefrom of an offensive cargo. FUMIGATING APPARATUS, BARGE "THOMAS." The fumigating plant was used on 16 occasions during the year. TABLE XXXIV. Date. 1918. No. of Vessels. Capacity in Cubic Feet of Space Fumigated. February - 1 418,100 ,, 1 424,200 ,, 1 90,000 ,, 1 152,060 ,, 1 540,730 ,, 1 328,000 ,, 1 463,130 ,, 1 401,840 June 1 617,500 August 1 458,758 September 1 611,720 ,, 1 161,500 ,, 1 470,915 November 1 599,715 December 1 805,470 ,, 1 196,486 Totals 16 6,740,124 The largest capacity fumigated on any one ship was 805,470 cubic feet. 51 HULK "HYGEIA." The hulk "Hygeia" was docked at Messrs. Mills and Knight's slipway on May 16th and undocked on May 30th after extensive repair. The thorough examination of the whole bottom entailed in the light caulking of every seam below the water line and the affixing of battens over felt to these and the butts, showed several places which required graving, and treenails which required boring out and renewal. There were also many minor repairs needed in the upperworks. The result has hitherto proved satisfactory. After the seams had taken up, on refloating, the leakage was found to be reduced to a regular and negligible amount. The time at which the hulk gave out was one of the greatest difficulty for getting the necessary work done or attempted, and on the other hand her replacement was found to be impossible. She is now, as far as can be foreseen, good for some years of useful work. CANAL BOATS ACTS. In accordance with Section 3 of the Canal Boats Act, 1884, I beg to present herewith the Annual Report on the working of the Canal Boats Acts and Regulations within the district of the Port of London Sanitary Authority during the year ended 31st December, 1918. The Acts and Regulations apply within the whole of the district under the jurisdiction of the Port of London Sanitary Authority, including the River and Docks —as a "canal," for the purposes of the Act, "includes any river, inland navigation, lake, or water being within the body of a county, whether it is or is not within the ebb or flow of the tide." The navigation, in addition to the enclosed Docks, includes the following navigable tributary waters and creeks of the River Thames:— On the right bank from Teddinffton downwards:— Wandsworth Creek (River Wandle). Hay's Dock. St. Saviour's Dock. Part of the Grand Surrey Canal within the Surrey Commercial Docks. Deadman's Dock. Deptford Creek (River Ravensbourne). Dartford Creek (Rivers Cray and Darenth). The entrance to the Gravesend Canal. Cliffe Creek. Yantlet and Coalmouth Creeks. Part of the River Medway, and of the Swale. 52 On the left bank from Teddington downwards:— The entrance to the River Brent. Chelsea Dock. Grosvenor Dock. Limekiln Creek. Bow Creek (River Lea). Barking Creek (River Roding). Rainham Creek (River Ingrebourne). Mucking Creek. Thames Haven. Hole Haven. Potton and Rushley Creeks. River Roach as far up as Rochford. The whole of this area is divided into three districts, known as the Upper, Middle and Lower, each district being in charge of an Inspector, as follows :— RIVER. Upper District. Teddington to Greenwich. Inspector Lambe 230/. per annum. Middle District. Greenwich to Erith. Inspector Lambe 2301, per annum. Lower District. Erith to seaward limits of the Port of London (including part of the River Medway). Inspector Berry 169/. per annum. The Docks are divided into four districts, known as the Central, Eastern, Western and the Gravesend district. Central District. West India Dock. South West India Dock. Poplar Dock. Millwall Dock. Inspector Rolfe 2501. per annum. Eastern District. Royal Victoria Dock. East India Dock. Inspector Burr 250/. per annum. Royal Albert Dock. Inspector Wetjen 250/. per annum. Western District. London Dock. St. Katharine Dock. Regent's Dock. Inspector Hopkins 250/. per annum Surrey Commercial Dock. Inspector Elward 208/. per annum. 53 Gravesend District. Tilbury Dock. Left Shore, from Purfleet down. Right Shore, from Erith down. Inspector Massie 201/. 10s. per annum. (2) The total number of inspections for the year was 188, representing a net number of 109 boats. The remainder, 79, represents repeated visits by Inspectors of this Authority. The number of boats not conforming to the Acts and Regulations was 39 (inspected on 48 occasions, or 21-27 per cent. of the total inspections, the percentage for the previous five years being 14'70 per cent.). In addition to the above, 17 boats were at the time of visit found with the cabin doors locked, there being no persons on board. Inspection was therefore impossible, and these visits are not included in the number of boats inspected. (3) With reference to the various infringements of the Act: — Unregistered Boats. The following boats were found, on inspection, to be unregistered within the meaning of the Act:— 1918. Feb. 15 "Whitehaven." March 22 "Ready" (New boat, registered Port of London). April 18 "Richard." 27 "Wandle." Sept. 30 "Constant." Nov. 26 "Darnley." Notification of Change of Master. Nil. Certificates. Absence of Certificate of Registration was found in the following cases, a complaint being sent to the owners. In the case of those boats marked * information was received that the Certificates were subsequently placed on board :— 1918. Jan. 21 *"Nellie" Registered Brierley Hill, No. 220. ,, 21 * "Nora" „ „ „ No. 239. April 10 "Avon" ,, Brentford, No. 341. ,, 17 "Emily" „ Berkhamsted, No. 319. June 12 "Searchlight " Port of London, No. 432. July 1 "Emily" „ Berkhamsted, No. 319. ,, 18 *"Kuroki" „ Port of London, No. 428. 18 "Colue" „ Berkhamsted, No. 333. J} 30 "Emily" „ Berkhamsted, No. 319. Aug. 26 * "Providence" „ Brentford, No. 282. Oct. 7 "Northern" „ Paddington, No. 245. Nov. 21 * "Sunbeam" „ Brentford, No. 348. 54 Certificate not Identifying Owner with Boat. 1918. Aug. 21 "Reliance" Registered Guildford, No. 1. Nov. 12 ,, ,, ,, ,, Marking, &c. 1918. Feb. 27 *"Betsy" Registered Brentford, No. 340. April 10 ,, ,, ,, ,, July 23 * "Humber" Registered Berkhamsted, No. 334. Nov. 21 * "Sunbeam" „ Brentford, No. 348. Overcrowding. 1918. Sept. 6 "Rose" Registered Brentford, No. 367. Separation of the Sexes. Nil. Cleanliness. 1918. April 10 "Avon" Registered Brentford, No. 341. Painting. Nil. Ventilation. 1918. Sept. 19 "Mole" Registered Berkhamsted, No. 334. Dilapidation. 1918. Jan. 26 ''Sarah" Registered Berkhamsted, No. 408. Feb. 27 *"Betsy" „Brentford, No. 340. April 10 "Avon" ,, Brentford, No. 341. „ 10 "Betsy" „ Brentford, No. 340. May 14 "Leeds" „ Berkhamsted, No. 273. June 5 "Sarah Ann" „ Port of London, No. 480. „ 25 *"Betsy" „ Brentferd, No. 340. July 17 "Medway" „ Brentford, No. 347. ,, 24 "Reliance" „ Berkhamsted, No. 441. ,, 30 "Windsor" „ Uxbridge, No. 448. Aug. 16 "Eric" ,, Brierley Hill, No. 231. „ 16 "Vera" „ „ „ No. 236. „ 31 "Sarah Ann" „ Port of London, No. 480, Sept. 6 "Richard" „ Reading, No. 49. ,, 6 "Rose" „ Brentford, No. 367. „ 28 "Trent" „ Uxbridge, No. 392. „ 30 "Prudence" „ Ware, No. 38. „ 30 "Constant" Unregistered. Nov. 21 ''Sunbeam" Registered Brentford, No. 348. Removal of Bilge Water. Nil. Provision of Water Cask. 1918. April 10 "Avon" Registered Brentford, No. 341. July 18 "Colne" „ Berkhamsted, No. 333. 55 Notification of Infectious Disease. Nil. Admittance of Inspector. No difficulty has been experienced in regard to the visits of the Inspectors of this Authority. Legal Proceedings. Nil. (5) The total number of infringements found was 48 on 39 boats, inspected on 48 occasions. Formal notice of each infringement was at once given to the owners, and in many cases they were remedied without further complaint. The number of written notices was 36, and the number which has been certified as attended to was 9. Double Bulkheads. (6) There were no infringements with regard to the provision of these. (7) No boats have been detained for cleansing. (8) On December 31st, 1918, there were 270 boats on the Register:— Propelled by Tug and Oars 252 „ „ Steam 15 „ „ Motors 3 Total270 (9) One boat was registered in 1918. This was a new boat. Table of Canal Boats Carrying Children on Board. Y ear. No. of boats. No. of boats with children. No. of children. Average No. of children per boat. Average No. of boats with children. 1908 1,168 206 459 2.18 17.63 1909 1,432 219 495 2.26 15.29 1910 908 172 354 2.05 18.94 1911 926 173 400 2.31 18.03 1912 841 197 409 2.07 23.42 1913 451 61 196 3.21 13.52 1914 237 82 214 2.60 34.62 1915 197 56 256 4.57 21.52 1916 156 36 101 2.80 23.07 1917 118 41 134 3.26 34.74 1918 109 22 74 3.36 20.18 I have the honour to be, Gentlemen, Your obedient Servant, W. M. WILLOUGHBY, Medical Officer of Health, Port of London. TABLE XXXV. SUMMARY OF CANAL BOATS FOR THE YEAR ENDED 31ST DECEMBER, 1918. January. February. March. April. May. June. July. August. September. October. November. December. TOTAL. 1913. total 1914. For the 1915. vear 1916. 1917 New boats registered ... ... ... 1 ... ... ... ... ... ... ... ... 1 3 3 7 4 2 Registration owing to structural alterations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Registration for other purposes ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 2 ... No. of Visits of Inspection 16 21 11 21 12 16 22 20 18 8 16 7 188 576 571 413 280 280 Conforming to Acts and Regulations 13 19 10 16 11 12 14 15 12 7 ... 7 149 506 473 328 , 228 225 Infringements in respect to:— Registration ... 1 1 2 ... ... ... ... 1 ... 1 ... 6 4 20 23 9 8 Notification of change of master ... ... ... ... ... ... ... ... ... ... ... ... ... . . . 1 ... ... . . . Absence of certificate 2 ... ... 2 ... 1 4 1 ... 1 1 ... 12 17 18 19 10 19 Certificate not identifying owner with boat ... ... ... ... ... ... ... 1 ... ... 1 ... 2 4 4 1 2 1 Marking, &c. ... 1 ... 1 ... ... ... ... ... ... 1 ... 4 7 14 6 9 6 Overcrowding ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 1 ... 1 Partition separating sexes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Males over age . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... Females over age ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Cleanliness ... ... ... 1 ... ... ... ... ... ... ... ... 1 11 14 10 4 ... Painting ... ... ... ... ... ... ... ... ... ... ... ... ... 17 23 12 14 2 Ventilation ... ... ... ... ... ... ... ... 1 ... ... ... 1 6 6 7 3 2 Dilapidation 1 1 ... 2 ... ... ... 3 5 ... 1 ... 19 39 52 37 22 25 Removal of bilge water ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 2 Without pump . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . Refusal to admit Inspector ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No proper wafer vessel ... ... ... 1 ... ... ... ... ... ... ... ... 2 8 7 8 7 2 Without double bulkhead ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Notification of infectious disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Detained for cleansing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Proceedings taken ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... Cautions given 2 2 ... 5 ... ... 7 5 6 1 2 ... 36 59 79 69 39 34 ,, attended to ... 2 ... ... ... ... 1 2 ... ... ... 4 9 00 81 54 38 21 Total registered by Fort sanitary Authority since 1887 486 Registered for 676 person. Cancelled 216 Carrying males241. females70. Actual number on the Register, 31st December, 1918 270 children 74. 56 57 ADMINISTRATION OF THE PORT OF LONDON PUBLIC HEALTH (LONDON) ACT, 1891. Dr. REVENUE ACCOUNT for the Year ended 31st March, 1919. Cr. £ s. d. £ s. d. £ s. d. £ s. d. To Salaries of Medical Officers and Clerk 3,016 2 1 By Proceeds of Sale of Unsound Food (for amounts paid to Consignees see contra) 2,846 1 9 „ Payments to Locum Tenens 2 2 0 „ Wages 6,174 14 4 ,, Sundry Fees 704 6 0 „ Contributions to Officers' Pension Funds 338 10 1 ,, Refund of proportion of Medical Officer's Salary, &c., by Rochester Port Sanitary Authority 100 0 0 „ Ditto for Pensions 128 9 11 „ Pensions 476 13 4 3,650 7 9 ,, Fidelity Guarantee 1 16 0 „ Balance to General Revenue Account 3,164 3 6 ,, Employers' Liability under Workmen's Compensation Acts 27 12 6 ,, National Health Insurance 13 12 7 „ Officers' Uniforms 170 14 5 „ Expenses of Steam Launches and Hulk 2,234 11 4 ,, Expenses of Offices at Greenwich, including Rent, Rates, Taxes, Lighting, Heating and Repairs 139 7 5 „ Expenses of Medical Officer, including Office Expenses, Postage and Petty Cash Charges 403 18 3 13,128 4 3 ,, Hospital at Denton, viz.:— Expenses of Nursing Staff 184 3 2 Rent, Rates, Taxes and Insurance 99 5 1 Maintenance and Repairs 39 7 4 Maintenance of Patients, &c. 120 6 10 Miscellaneous Expenses, including Coal, Stores, and Telephone 228 14 0 671 16 5 „ Printing and Stationery 36 4 6 ,, Expenses re Epidemic precautions, Examination of Rats, and Analysis of Food Samples 549 5 7 „ Proceeds of Unsound Food paid to Consignees (for amounts received see contra) 2,168 7 5 ,, Expenses of Inspection of River and Canvey Island 75 0 0 „ Disinfectants 92 3 4 ,, Committee Allowance 75 0 0 ,, Miscellaneous Expenses 18 9 9 £16,814 11 3 £16,814 11 3 Chamber of London, 28th June, 1919. Charles Skipper and East, Printers, 19, Great Tower Street, E.C. 3.