Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE MEDICAL OFFICER of HEALTH FOR WOOLWICH. 1904. Woolwich: H. Pryce & Son, Printers (Regd. L.S.C.), 33 & 35, Powis Street. 2 Public Health Committee:— Jones, Eev. L. J., " Broomhill," Shrewsbury Lane, Plumstead (Mayor). Bourne, E. J., 196, Lakedale Eoad, Plumstead (Chairman). Meekitt, W. J., 50, Herbert Eoad, Plumstead (Vice-Chairman) Broughton, Alderman J., 166, Eglinton Eoad, Plumstead. Harper, Alderman J., 18, St. Margaret's Eoad, Plumstead. Adshead, J. B., 100a, High Street, Plumstead. Baglow, J., 67, Whitworth Eoad, Plumstead. Bull, W. J., 280, Plumstead Common Eoad, Plumstead. Francis, W. J., 4 & 5, Green's End, Woolwich. Hall, A., 98, Vicarage Eoad, Plumstead. Jones, F., 73, Sladedale Eoad, Plumstead. Pringle, P., 28, Wrottesley Eoad, Plumstead. Slater, G., 84, Eglinton Eoad, PlumBtead. Medical Officer of Health:— SIDNEY DAVIES, M.A., M.D., Oxon., D.P.H , Camb., Fellow and Member of the Council of Incorporated Society Medical Officers of Health. Chief Sanitary Inspector:— Albert G. Duck (Cert. San. Inst.) 3 District Sanitary Inspectors:— William Woolley (Cert. King's College), Herbert Ward. John W. Rance (Cert. San. Inst.), Dockyard and St. Mary's Ward. William Little (Cert. San. Inst.), St. Margaret's, and part of St. Nicholas Wards. William Wood (Cert. San. Inst.), Parish of Eltham and St. George's Ward. Alfred G. Potter (Cert. San. Inst.), Eiver Ward. William Tedham (Cert. San. Inst.), St. Nicholas Ward. Thomas W. Dee (Cert. San. Inspectors' Examination Board), Central and Glyndon Wards. Thomas Powell (Cert. San. Inst.), Burrage Ward. Inspector of Cowsheds and Slaughter-houses (Woolwich and Plumstead), Workshops, Milkshops, Ice Cream Vendors, and Eestaurants. Inspectors under Food and Drugs Act:— William Woolley, Parishes of Woolwich and Plumstead. William Wood, Parish of Eltham. Lady Sanitary Inspector:— Alice M. Middlebrooke. (Cert. San. Inst, and San. Insp. Exam. Board). Public Health Committee Clerk:— Charles Ellis. General Clerks:— Amyas Britter. F. Harris Deans. Mortuary Keeper:— Frank Leason. 4 Summary of Statistics, 1904. Area of Borough 8276.6 Acres Population—Census, 1901 117,178 „ Estimated to middle of 1904 125,791 Inhabited Houses-Census, 1901 18,086 Total Houses to middle of 1904 21,024 Persons to a House—Census 6.47 Marriages 910 Births 3531 Birth Rate 28.2 Deaths 1765 Death Rate 14.0 Infantile Mortality 134 per 1000 births 5 TABLE OF CONTENTS. page Names of Members of Public Health Committee 2 Names of Members of Sanitary Staff 3 Summary of Statistics 4 Preface 10 Part I.—Statistics. Population—New Houses 11 Births 14 Marriages 16 Deaths—Corrections Applied 16 Woolwich Death Rate compared with other Boroughs 17 Life Capital Saved 18 Infant Mortality 19 Zymotic Death Rate 21 Inquest* and Uncertified Deaths 22 Deaths in Public Institutions 23 Small-Pox and Vaccination 23 Measles—Early Closure of Infant Classes—Results 25 Statistics of notification 26 Scarlet Fever—Return Cases—Hospital Isolation—Sources of Infection 31 Diphtheria—Sources of Infection—Return Cases 36 Enteric Fever—Source of Infection 39 Diarrhoea—Distribution of Leaflets 41 Erysipelas 42 Puerperal Fever 43 Influenza 43 Bronchitis and Pneumonia 43 Phthisis—Voluntary Notification—Incidence in Royal Arsenal, &c. 43 Infection in Public Houses 50 Sanatorium Treatment—Results of 51 Cancer—Classification 55 Alcoholism—Death Rate in Public Houses 56 Meteorology 57 6 Pakt II.—Administration. page Water Supply 59 Food and Drugs Act—Percentage Milk Adulteration 60 Food Inspection 61 Dairies, Cow Sheds, and Milk Shops Order 61 Cow Sheds 62 Slaughter Houses 62 Nuisances—Complaints, Sewers, Drains, Public Urinals, House Inspections 62 Over-crowding 65 Smoke Nuisance 66 Defective Light 66 Want of proper Water Closets 66 Flooding of Houses 67 Verminous Rooms 67 Dust Removal—Collection, Cost of 67 Trade Refuse—Offensive and Inoffensive 68 Housing of the Working Classes—Houses Represented as unfit for Habitation 69 Vital Statistics of Special Areas 70 Council's Houses, North Woolwich 70 Houses Registered under the By-Laws 70 New By-Laws 71 Common Lodging Houses 72 Underground Rooms 72 Factories and Workshops—Table of Inspections. Outworkers 72 7 page Bakehouses 73 lee Cream Shops 73 Disinfection 74 Health Shelter 74 Mortuaries 74 Cemeteries 75 Cleansing of Persons Act 75 By-Laws for Vans and Sheds 75 Public Ambulance 76 Health Leaflets 76 Soldiers' Married Quarters 77 Bactericlogical Examinations 77 Report of Departmental Committee on Physical Deterioration 77 Public Health Acts—London County Council Conference on Administration 77 Vagrants and Infectious Disease—London County Council Conference 78 Sanitary Staff 78 8 LIST OF TABLES. page Table I.—Population. Births and Deaths for the whole Borough from 1894 to 1904, including Deaths of NonResidents in the District, also Deaths in Public Institutions in the District, and Deaths of Residents Registered beyond the District 79 Number of Inhabited Houses, the Average Number per House and the Acreage 79 „ Ia.—Institutions inside and outside the District receiving Sick and Infirm Persons from the District 81 Ib.—Deaths of Persons belonging to the Borough of Woolwich occurring in various Institutions—1904 82 II.—Population, Births Registered, Deaths at all Ages, and Deaths under One Year for each Ward during 1901, 19C2, 1903 and 1904 83 ,, III.—Cases of Infectious Disease Notified at all Ages, at various Age Groups, and Distributed according to Wards during 1904 83 ,, IV.—Deaths at all Ages, at various Age Groups, from Various Causes in 1904 85 ,, IVa.—Deaths from Various Causes arranged by Wards in 1904 Total deaths in Public Institutions in District in 1904 87 „ V.—Case and Death Rate for various Diseases per 1,000 Persons on the Population estimated to the middle of the year for 1891 to 1904 89 ,, VI.—Ages, Schools, and other Particulars of the Cases of Scarlet Fever and Diphtheria during 1904 90 „ VII.—Vital Statistics of the various London Boroughs for 1904 91 ,, VIII,—Meteorology and Registered Deaths from all causes and from certain prevalent Diseases in each week of the year 93 ,, VIIIa.—Weekly Averages for Meteorology and Registered Deaths from all Causes and from certain prevalent Diseases 95 ,, IX.—Summary of Statistics for the First Quarter of 1904, Corrected for Public Institutions 96 ,, X.—Summary of Statistics for the Second Quarter of 1904 Corrected for Public Institutions 97 ,, XI.—Summary of Statistics for the Third Quarter of 1904 Corrected for Public Institutions 99 ,, XII.—Summary of Statistics for the Fourth Quarter of 1904 Corrected for Public Institutions 100 9 LIST OF TABLES— continued. Table page „ XIII.—Birth and Death Rates for each Parish for the Year 1904 102 „ XIV.—Deaths from Various Causes for the whole Borough in each week, Corrected for Public Institutions 103 ,, XIVA.—Total of persons belonging to the County of London, and registered in the 52 weeks ending 2nd January, 1904 105 ,, XV.—Summary of the General Work of the Public Health Department for 1904, the Number of Nuisances Abated, and the Notices Served in each Ward 107 „ XVa.—Summary of Work of Chief Inspector & miscellaneous 109 ,, XVb.—Inspection of Factories, Workshops and Workplaces 110 ,, XVc.—Proceedings during 1904 re Milkshops, Cowhouses, Slaughterhouses, &c. 112 ,, XVI.—List of Streets Inspected—House to House—and Number of Houses where Defects were found 113 ,, XVII.—Prosecutions in 1904 under the Public Health (London) Act and By-laws 119 ,, XVIII—Summary of Articles Analysed under the Sale of Food and Drugs Act 120 ,,XVIIIa—Proceedings in 1904 under the Sale of Food and Drugs' Act 121 ,, XIX.—Food Destroyed on Application of Owners and Seizures Condemned by a Magistrate 123 ,, XX.—List of level Bake-Houses in the Borough, 1904 125 ,, XXa.—List of certificated underground Bakehouses in the Borough,1904 126 „ XXI.—List of Slaughter-Houses in the Borough, 1904 127 ,, XXII.—List of Cow-Houses in the Borough, 1904 128 Appendices :—(1) Measles—Occurrence in Classes, Christmas to May, 1904 129 (2) Report of Proceedings re want of proper and sufficient Supply of Water 135 (3) Report of Proceedings re Premises without proper Light 136 (4) Infantile Diarrhoea Leaflet 137 (5) Duties of Clerks and Sanitary Inspectors re Infectious Diseases 138 (6) Report by Miss Middlebrooke re General Health Work 139 10 PREFACE. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Woolwich. Me. Mayok and Gentlemen, I have the pleasure of presenting you with my Fourth Annual Report. The general Sanitary condition of the Borough is most satisfactory. Seven other Metropolitan Boroughs had a lower death rate, viz: Hampstead, Lewisham, Stoke Newington, Wandsworth, Greenwich, Paddington, and Westminster ; but none of these are working class districts like Woolwich. Woolwich takes the first place among the essentially working class Boroughs of the Metropolis as regards its death rate. Among the many matters dealt with in the Report, Measles and Tuberculosis have received special attention, and the reduction in the death-rate from Measles is matter for congratulation. I am able to report that the Sanitary Staff have worked with praiseworthy industry, and my thanks are due to them for their conscientious devotion to their duties, and intelligent assistance in my efforts to diminish mortality and disease in the Borough. I have to thank you, Gentlemen, for the way in which you have received and adopted the many recommendations I have made for improving the public health. I am, Mr. Mayor and Gentlemen, Your obedient Servant, SIDNEY DAVIES. 1st May, 1905. FOURTH ANNUAL REPORT ON THE HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1904. PART I. Statistics. 1. Population.—The population to the middle of the year 1904 has been estimated as follows:— The parishes of Woolwich and Plumstead are supposed to have remained stationary for one year, but otherwise to have increased at the same rate as between the two preceding censuses; the population of Eltham is estimated on the 12 number of houses occupied in the middle of 1903, neglecting those built between July, 1903, and June, 1904, and assuming that the number of persons to a house has continued the same as at the Census 1901. This gives:— Woolwich Parish 41,765 Plumstead ,, 72,873 Eltham ,, 11,153 Total for Borough 125,791 Estimated increase in the year, 2,619. Natural increase (excess of births over deaths), 1,765. 2. The following table shows the present number and increase siuce the census of houses in the Borough; houses rebuilt are not included among new houses. Houses in Borough at Census, 1901 18,086 New houses to June 30th, 1901 321 ,, ,,1902 1,292 ,, ,,1903 743 ,, ,,1904 582 Total to middle of 1904 21,024 3. The population of each ward has been calculated on the number of houses in the ward multiplied by the number of persons to a house in each parish. The following table gives for each ward the population and number of inhabited houses at the Census, the number of persons to a house, the number of new houses certified for water certificates, and the present estimated population. Wards. Dockyard. St. Mary's. River St. George's. Burrage. Herbert. St. Margaret's. Central. Glyndon. St. Nicholas. Eltham. North. South. Population 8,712 10,439 2,991 11,405 8,078 9,837 9,080 9,842 10,118 9,810 19,640 7,226 No. of Inhabited Houses 1,325 1,126 441 1,671 878 1,735 1,612 1,638 1,805 1,697 2,805 1,353 Persons to a House 6.57 9.27 6.78 6.83 9.20 5.67 5.63 6.00 5.61 5.78 7.00 5.34 New Houses— April to June, 1901 - - 4 — — — 12 61 7 8 85 80 June, 1901, to June, 1902 - - 71 - - - 79 265 7 8 455 407 June, 1902, to June, 1903 12 - 33 - - - 40 153 7 9 239 250 June, 1903, to June, 1904 4 - 89 14 - 8 30 94 7 - 185 151 Total Houses 1,341 1,126 638 1,685 878 1,743 1,773 2,211 1,833 1,722 3,769 2,241 Populations 8,712 *9,788 3,991 11,405 8,078 9,726 9,893 12,337 10,228 9,609 21,031 11,153 * Deduction made re 101 houses demolished in Artillery Place, &c. 13 14 Births. 4. The number of births was 3,531, and the birth rate 28.1 compared with 30.0, 29.9, and 30.0 in the three previous years, and 30.9 the average of the ten years 1892—1901. The rate for the County of London was 28.0. 5. The following table gives the birth rate of each parish and ward during the past four years, and for purposes of comparison the corresponding rates of neighbouring Boroughs, London and England. It will be seen that Erith, West Ham, and East Ham have all had a great reduction in birth rate than Woolwich. The table also shows that the chief reduction in birth rate has occurred in Plumstead parish, and St. Mary's, South River, Herbert, and St. Margaret's Wards. 1901. Birth rate. 1904. 1902. 1903. Woolwich Paeish 28.5 28.8 29.1 28.2 Wards. Dockyard 32.3 32.2 31.5 32.8 St. Mary's 19.9 21.2 21.3 18.8 River 28.7 N. 39.1 40.6 38.8 S. 25.6 24.2 21.7 St. George's 36.0 34.4 37.5 39.7 Plumstead Parish 31.5 31.5 31.4 28.5 Wards. Burrage 25.7 22.7 23.9 22.5 Herbert 26.1 26.4 27.0 22.2 St. Margaret's 31.6 37.2 33.7 31.4 Central 29.3 32.6 26.9 26.1 Glyndon 32.4 28.5 31.7 30.3 St. Nicholas 36.4 29.8 31.8 32.6 Eltham 22.3 23.8 24.1 24.9 Greenwich Borough 29.0 28.1 27.3 27.7 Lewisham Borough 25.8 25.7 26.2 25.6 West Ham 35.0 34.1 33.6 32.2 East Ham 36.4 36.4 34.4 31.7 Erith 30.9 37.3 38.9 33.2 London 29.0 28.5 28.4 28.0 England & Wales - 28.6 28.4 27.9 Woolwich Borough 30.0 29.9 30.0 28.1 15 The Eltham birth rate has steadily increased since 1900. The reduction of the birth rate in this and other countries has been going on for several years. The birth rate varies to a certain extent with the marriage rate, which itself depends upon the prosperity of the country, but there has been clear evidence of the steady decline during the past twenty years, and this decline has given rise to much concern and discussion on the part of social scientists. So long however, as is the case in Woolwich, the death rate also continues to decline, there need be no anxiety as to the maintenance of the population, but probably in a few years' time it will be a serious question whether some means should not be taken to encourage both the birth and successful rearing of children. 6. The following table gives for each parish the birth rate in the two Quinq.uennia 1891-1895 and 1896-1900, and each of the four past years:— Average of years '91 to' 95 Average of years '96 to '00 1901 1902 1903 1904 Woolwich 31.1 30.1 28.5 28.8 29.1 28.2 Plumstead 33.3 31.0 31.5 31.5 31.4 28.5 Eltham 22.8 20.6 22.3 23.8 24.1 4.9 7. Illegitimate Births.—60 of the births registered were illegitimate, which is equal to a rate of 17 per thousand total births, compared with 13 in 1904. The illegitimate birth rate in England and Wales was 39 in 1902. The lowest rate in any County in that year was 26 in Essex, the rate in Middlesex was 28. 16 Marriages. 8. There were 910 marriages compared with 937 in the previous year. The marriage rate was 14.5 compared with 15.2 in 1903, and with 17.4 in London in the same year. 387 Marriages were performed in the Registry Office and 523 in places of worship. Deaths. 9. Table 1 gives the gross and nett deaths and death rates in 1904, and each of the past ten years, and shows how the nett deaths are arrived at. The nett death rates (which are the only ones referred to unless otherwise specified) are obtained by distribution of deaths in public institutions, and by accident to their proper locality, according as they occur outside or inside the Borough. But in order to institute a fair comparison between one district and another, it is necessary to further correct the death rate for sex and age distribution, for it is obvious that a population containing a large number of young persons between the ages of 5 and 30, when the death rate is very low, should have a lower death rate than one containing an excess of aged persons. The factor for the correction of the Woolwich death rate is 1.0690. 10. The death rate was 14.0 compared with 14.6 and 13.3 in the two previous years, and with 16'6, the average of the ten preceding years. With the exception of 1903, the death rate was lower than is recorded in any year before. By the use of the factor given above, we find that the death rate when corrected for sex and age distribution is 15.0 The death rate in the County of London was 16.6 The factor for correction of the London death rate is 1.05107, and by the use of this we get the corrected London death rate, viz. 17.5. 17 11. Table VII., taken from the "Lancet," shows how Woolwich compares with the County and other Metropolitan Boroughs. Six Boroughs had a lower death rata, including Lewisham only in the South Eastern district. Nett. Corrected. The death rate in West Ham was 16.8 17.9 „ East Ham „ 13.5 14.4 „ Erith „ 11.4 „ England & Wales was 16.2 16.2 ,, 76 large towns „ 17.2 ,, London ,, 16.6 17.5 ,, Woolwich 14.0 15.0 The following table gives the death rate in each Parish and Ward of the Borough for each of the past four years:— 1901. 1902. 1903. 1904. Woolwich Parish 16.8 17.1 16.3 16.5 Wards. River 201 N 18.7 14.5 17.8 s 18.7 17.9 16.9 Dockyard 15.7 16.4 16.2 18.3 St. Mary's 11.6 14.0 14.1 12.4 St. George's 18.5 16.4 16.8 17.7 Plumstead Parish 13.2 14.3 12.3 13.1 Wards. St. Nicholas 13.0 13.3 10. 15.2 Central 13.9 13.2 9.6 8.5 Glyndon 14.2 14.5 14.6 17.2 St. Margaret's 11.7 13.5 14.0 13.0 Herbert 11.3 13.1 9.7 9.9 Burrage 13.5 15.4 13.5 12.6 Eltham 13.6 8.5 8.2 10.8 18 12. Compared with 1903 there was an increased death rate in the following wards:—Dockyard, Eiver North, St. George's, Herbert, Glyndon, St. Nicholas, and Eltham; and a diminished rate in St. Mary's, Eiver South, Burrage, St. Margaret's, and Central. The Central Ward had the lowest death rate, and Dockyard the highest. 13. The following table gives the death rate in each parish for the four past years, compared with the two preceding quinquennia (five years):— Averg. '86-'90 Averg. '91-'95 Averg. '96-'00 1901 1902 1903 1904 Woolwich 20.4* 19.3 20.1 16.8 17.1 16.3 16.5 Plumstead 16.4 16.0 15.1 13.2 14.3 12.3 13.1 Eltham - 13.0 14.6 13.6 8.5 8.2 10.8 * 3 years 1888-1890. It will be seen that whereas in the quinquennium 1896-1900, compared with the preceding five years, there was an increase in Woolwich and Eltham parishes, there has since 1900 been a notable decrease. In Plumstead on the other hand the second quinquennium showed a decrease compared with the first, and the decrease has continued since 1900, but is not so marked as in Woolwich and Eltham parishes. 14. The death rate for males was 14.5 and for females 13.4. 15. Life Capital Saved.—The past year like the three preceding years shows a great improvement in the death rate compared with the ten previous years. This improvement 19 means the saving of a large number of lives. Supposing the death rate last year had been 16'4 as in the decennium 1893 1902, instead of 14 0 as was actually the case, 2065 persons would have died instead of 1763. There was thus a saving of 302 lives. This diminished death rate may be due to general climatic or social conditions, or it may be due to improved sanitary administration; most probably both factors have been at work. But whatever is the cause the saving in life capital is immense, and may be expressed in terms of money. Particulars on the monetary value of life capital saved are given in my Annual Reports for 1902 and 1903. Infant Mortality. 16. The infant mortality or deaths under one year per 1000 births was 134. This is higher than it has been since 1900,but below the average of the ten preceding years. The following table gives the rate in each parish and each ward during the past four years, compared with the rate in London and neighbouring districts. 1901. 1902. 1903. 1904. Woolwich Parish 137 119 132 160 Wards. River (North) 158 192 114 193 River (South) 109 155 156 Dockyard 141 98 102 136 St. Mary's 123 133 176 190 St. George's 118 127 129 150 20 Plumstead Parish 122 129 95 124 Wards. St. Nicholas 143 152 97 166 Central 120 135 94 90 Glyndon 94 119 105 144 St. Margaret's 130 112 95 90 Herbert 91 107 80 91 Burrage 94 123 72 105 Eltham 141 95 74 101 Greenwich 140 149 137 142 West Ham 172 149 148 165 East Ham 156 119 113 140 Erith 141 103 93 132 London 148 139 130 144 England & Wales — — 132 146 Woolwich Borough 128 124 106 134 17. The above table shows that the increase of infant mortality during 1904 was principally in Woolwich parish and in the North River, St. Mary's, and St. George's Wards. There was also a marked increase in St. Nicholas and Glyndon Wards, whereas Herbert, St. Margaret's and Central Wards showed a decrease compared with the average of the three preceding years. 18. On comparing Table IV. with the corresponding table in the Report for 1903, it appears that the total number of deaths under one in the past year only exceeded the number in 1903 by 80, whereas the number of deaths under one in 1904 from diarrhœal diseases exceeded the number in 1903 by 95. It appears, therefore, that the whole increase in infantile mortality during 1904 was due to increased prevalence of diarrhoea, and that the infantile mortality from other diseases somewhat diminished last year. 21 19. The following table gives the death rate under one year per 1,000 births during the two quinquennia 1891 to 1895, and 1896 to 1900, and during the past four years in each of the three parishes of the Borough '86-'90 '91-'95 '96-'00 1901 1902 1903 1904 Woolwich 151* 157 170 137 119 132 160 Plumstead 121 120 132 122 129 95 124 Eltham - 163 160 141 95 74 101 * 1888-'89 & '90. The infantile death rate of Woolwich parish was higher than in the three preceding years, but much less than in the five years 1896-1900. The Plumstead rate was exceeded in the same quinquennium and also in 1902. The Eltham rate was lower in 1902 and 1903, but the rate for 1904 was far below the average of the last fourteen years. 20. Table VII. shows how Woolwich compared with other Metropolitan Boroughs as respects infant mortality. Nine Boroughs had a lower infantile death rate. In the southeastern Boroughs, Lewisham alone had a lower infantile death rate. 21. Deaths under five years.—The total deaths under five years were 653, giving a death rate per 1,000 population under five at the Census of 47.2, compared with 40.8 in 1903. 22. 26 deaths occurred over 85 years, compared with 35 in 1903. 23. Zymotic death rate.—The number of deaths from the principal zymotic diseases was 283, giving a death rate of 2.2 compared with 1.51,1.88 and 0.96 in the three preceding years. 22 25. Inquests.—There were 141 inquests, compared with 145, 154, 154 and 160 in the four preceding years. The following table gives particulars as to causes of death 1. Natural causes 90 90 2. Accidental causes:— Burns 4 Drowning 3 Palls 5 Fractures 3 Gunshot 1 Run over 5 Suffocation, being overlain in bed 8 Other accidental causes 12 41 3. Homicidal causes:— Suicide 6 Murder and Manslaughter 2 4. Found drowned 2 2 Total 141 Of the above, two were certified by the Coroner to be accelerated by alcoholism. 26. The accidental and homicidal causes were only 49 as compared with 85 in 1903. 24. The following table gives the zymotic death rate in each parish during the past five years:— 1900. 1901. 1902. 1903. 1904. Woolwich 3.8 1.61 1.74 1.08 2.69 Plumstead 2.1 1.42 2.20 0.92 2.17 Eltham 0.33 1.51 0.19 0.84 1.18 23 Deaths from burns were 4, as compared with 4, 6 and 11 in the three preceding years. Suffocation from overlying in bed numbered 8 victims, compared with 2, 5, and 10 in the three preceding years. Homicides were 8 compared with 22, 9, and 20 in 1901, 1902 and 1903. 27. Deaths in Public Institutions.—Table I. shows the actual number of deaths occurring in Public Institutions in the Borough, viz : 261 compared with 269, 278 and 272 in the three preceding years. The great majority of these deaths occur in the Poor Law Infirmary. Table IVA. gives the number of deaths from each disease of Woolwich residents occurring in Public Institutions inside and outside the Borough. Table IB. gives a list of these Institutions. Of 206 deaths from phthisis, 61 occurred in the Poor Law Infirmary, and 17 in outlying institutions. Small-pox and Vaccination. 28. Six cases of Small-pox were notified, but one of these was proved by susceptibility to vaccination to be varicella (chicken-pox) and not Small-pox. The five true cases all occurred in December. The first (J.L.) was a man out of work living in Siemen's Road. He had been looking for work in the Docks. The second (S.A.) was a small shopkeeper in Samuel Street. The third (E.C.) lived in Samuel Street just opposite S.A. The fourth (W.McC.) was a young man discovered by myself in the same house as E.C. The fifth was the sister of S.A. ; she visited S.A.'s house after removal of the patient and before disinfection, and her visit was concealed from myself and the Sanitary Inspector, so that she escaped vaccination. 24 29. The fourth case to be discovered (W.McC.) was the first to commence. About ten days before J.L. began, W.McC. played football in a field opposite J.L.'s house, and his ordinary boots were brought into this house and left in J.L.'s bedroom during the game. There is little doubt that he was the source of infection of J. L., S. A. and E. C. He stayed in bed two days, and was away from work only a few days. He had resumed work some time when the notification of E. C., led to his detection and removal to Hospital He worked in Pentonville Road, Finsbury; but no other cases were reported at these works, nor does he appear to have infected anyone in transit. Apparently his infectiousness was of short duration though temporarily of great activity. The three cases known that were probably infected by him must have contracted the infection within ten days of the commencement of his illness. The diagnosis in his case was doubtful owing to his almost complete recovery when seen, but it was confirmed by the medical officers of the Asylums Board, and he was detained in Hospital over four weeks. 30. The usual methods of Hospital isolation, disinfection, vaccination, and observation of contacts were successfully carried out. Twenty-three contacts were re-vaccinated, and the only known contacts who contracted the disease were two whose visit to the infected house was concealed and who were consequently not vaccinated. 31. The case rate was 0.05 and there were no deaths. In London the case rate was 106 and the death rate 0.01. 25 32. The following return kindly furnished by the "Vaccination Officer gives particulars as to vaccination of children born in Woolwich and Plumstead parishes in 1903. Births 3450 Vaccinated 2922 Insusceptible 14 Conscientious objections 108 Dead unvaccinated 272 Medical postponements 15 Removed, Vaccination Officer apprised 11 Removed, not found, &c. 107 Not accounted for 1 Compared with 1902, there has been a further slight increase in vaccinations (3435 in 1902), but an increase also of conscientious objections; these were 127 in 1901, and 78 in 1902. Evidently conscientious objections are most numerous when cases of Small-pox are least numerous. Measles. 33. There were 28 deaths from Measles, giving a death rate of 0.22 compared with 018, 0 33 and 0'20 in the three preceding years. The death rate in London was 0.49, and only five Metropolitan Boroughs had a lower rate, viz.:— Lewisham, City, Westminster, Hampstead and Stoke Newington. 10 of those who died were under one year, 14 between one and five years, and 4 between five and ten. 17 were males, and 11 females. 11 were in Woolwich parish, 15 in Plumstead, and 2 in Eltham, giving death rates of 0.26, 0.21 and 0.18 respectively. 26 The greater number of cases occurred in the second and fourth quarters of the year. 34. 1240 notifications of Measles were received from School Teachers and others, compared with 323, 646 and 661 in the three preceding years. The mortality was thus 2.3 per cent, of notifications compared with 3'8 in 1903. The actual case mortality was probably not much below 2.3, as probably there are but few cases in houses from which no one attends any school, and which would consequently escape notification. 35. The following table gives the number of deaths and death rate from Measles for the four past years, and two preceding quinquennia in each parish (as far as known) and the death rate in London:— Woolwich. Plumstead. Eltham. London Year. No. Rate. No. Rate. No. Rate. Rate. 1891-5 (average) 20 0.49 29 0.51 — — 0.59 1896.1900 (average) 34 0.81 36 0.57 — — 0.57 1901 11 0.26 9 0.13 1 0 1.1 0.43 1902 10 0.24 31 0.43 0 — 0.51 1903 8 0.19 14 0.20 3 0.28 0.40 1904 11 0.26 15 0.21 2 018 0.49 36. Although last year brought a great increase of notified cases, it is satisfactory to be able still to point to the continued diminution of deaths from Measles which began in 1901. In 27 the five years 1896-1900, the death rate from Measles in Woolwich and Plumstead exceeded the rate in London, but in the past four years, although the London Measles death rate has itself diminished, it has been twice as high as the rate in the Borough. If the death rate prevailing from 1896 to 1900 had continued during the past four years, 96 children would have died from Measles in Woolwich parish, and 75 in Plumstead, who are now living. The number of cases occurring has not apparently diminished, but the effect of closure of infected classes has, no doubt, been to raise the age at which children have contracted Measles, and the higher the age of the children attacked, the fewer the deaths. The distribution of leaflets has also educated parents in the proper treatment of the disease, and so diminished its severity. 37. Of the 1,240 Measles cases notified, 1,048 were actually attending school, and 192 not attending. The following table gives the number of cases attending each school, with the number of scholars on the roll. The schools are arranged in two groups, according as they are situated in the district in which class closure is adopted immediately on the occurrence of Measles in a child while attending school, or not. It appears that in the schools in which early closure was enforced the number of Measles cases was 4-07 per cent, of the number on the roll, and in non-closure schools 4-37 per cent. 28 This means that early closure of schools had the effect of saving about 40 children from having Measles, and probably one from dying. Non-closure Schools. No. on Roll, No. of eases of Measles. Closure Schools. No. on Roll. No. of cases of Measles. Union Street 589 42 Slade 962 66 St. Mary's 752 20 Earl Street 1008 57 Bloomfield Road 1631 134 Vicarage Road 1012 59 Elizabeth Street 793 72 Church Manorway 388 13 Plum Lane 757 53 Bostall Lane 894 45 Eglinton Road 1234 50 Conway Road 1346 30 Burrage Grove 963 13 Ancona Road 1221 43 All Saints 452 8 Timbercroft Road 403 63 Mulgrave Place 881 30 Central 585 24 Wood Street 1050 18 Purrett Road 1098 84 St. Michael's 638 25 High Street 1268 24 St. Peter's 638 1 Wickham Lane 485 33 Pox Hill 227 1 Plumstead Road 846 7 Ancona Road (Mentally defective) 33 — Deansfield Road 214 5 Gordon 569 — Powis Street (Blind and Deaf) 27 — Pope Street 588 — Roper Street 400 — Union Street (Mentally defective) 28 - Christ Church 110 — St. Patrick's 182 — 10693 467 13579 553 38. 65 Classes of Elementary Schools were closed for the prevention of Measles. The period of closure averaged a little under 13 days; all the classes closed were in the Infant School, and most of them were junior classes, so that there has been very little interference with education. Indeed it may be maintained that the majority of children excluded being under six years of age, are much better out of school than in it. Dr. Newsholme and other authorities are of opinion that no children under five years should be allowed to attend primary schools. The average age of the children notified was 4$ years. At any rate the loss to education is much too slight to weigh against any saving of health and life attributable to closure. 29 39. It appears from the figures given in Dr. Kerr's Annual Report for the year ending 25th March, 1904, that in a group of six schools in the western or non-closure division of the Borough the cases of Measles were 10-2 per cent, of the scholars in the infant department, and in the closure division only 6.6 per cent. 40. Altogether it may be said that closing of classes for the prevention of Measles immediately on becoming aware of the first case in a class has proved successful in diminishing the number of cases, though not to the extent that might have been hoped for. Drs. Kerr and Thomas (Principal and Assistant School Medical Officers of the County Council) have shown that school closure to be successful, must take place before the first crop of cases has time to occur. If the children infected by the first case in a class are allowed to attend in an infectious state, they will infect the major part of the remaining susceptible children, and closure then is too late to be of appreciable advantage. 41. Out of 23 classes closed in the first five months of the year, the results of closure may be considered successful in seven, unsuccessful in six, and in ten no more cases occurred after the case or cases for which the class was closed. In all the unsuccessful cases the first case appears to have been missed, and only the notification of cases in the first crop made known the infection of the class. 42. What is required to make closure more successful is improved means of gaining early information of the occurrence of cases of infection. The school teachers have not the time to do this satisfactorily. Probably it could be best done by making notification of all infectious diseases compulsory on 30 parents, and throwing on them the onus of becoming aware that the disease was infectious. This would no doubt involve the provision of medical attendance free of charge for diagnostic purposes. But a useful if less complete means of gaining the necessary information would be the provision of trained nurses to visit immediately any children absent from school, and to report any suspicious cases, which could then be visited by the School or Borough Medical Officer. Such a staff would be beneficial in many ways as health visitors. 43. In an appendix is given a list of the classes in which Measles occurred up to May, 1904, with the proportion in each class who had previously bad Measles, the date3 of commencement of each case, and the dates of closure of classes closed. The appendix gives an opportunity of studying the spread of Measles in a class. It is curious to find that in some classes and schools in spite of frequent introduction of Measles, and of the presence of many susceptible children, the disease only spreads to a very slight extent. 44. Second Attacks.—Out of 438 cases enquired into, 69 or 16 per cent, were stated to have had Measles previously. Duration of Outbreaks.—In eight classes in three schools where no closure was enforced, the duration of the outbreak or period between the first and last notified cases varied from one to five weeks. Incubation.—The average incubation or interval between the commencement of illness in primary and secondary cases occurring in 35 families was 1½ days. Ages of Attacked, Medical Attendance, dc.—Of 1748 cases notified in the past four years, 8 were under six months, 31 22 between sis and twelve months, 770 between one and five years, 910 between five and ten, and 38 over ten. Of the 1748 cases, 875 were attended by a medical practitioner, 1480 attended day schools, and 669 Sunday Schools. Scarlet Fever, 45. There were 472 eases of Scarlet Fever notified, equivalent to a case rate of 3 75 per thousand population. This is the highest rate recorded since 1900, but it is lower than the rate in any of the nine years—1892 to 1900. (See Table V.). 46. The following table shows the case rates of Scarlet Fever in the Borough and each parish during the past four years, compared with London1:— 1901. 1902. 1903. 1904. Borough 2.64 2.14 3.16 3.75 Woolwich Parish 2.55 2.49 3.05 3.76 Plumstead „ 2.63 1.88 3.19 4.08 Eltham „ 3.42 2.45 3.40 1.44 London County 4.1 4.0 2.75 2.89 47. Table III. gives the age distribution, the number of cases in each ward, and the number of these removed to Hospital. St. Nicholas', St. Margaret's, and North River Wards were most affected, and St. Mary's and Eltham least so. Table VI. gives the numbers attending each of the principal schools, with the number on the roll. The Schools principally affected were Elizabeth Street, Bloomfield Road, Central and Wickham Lane. 32 48. There were 16 deaths, giving a death rate of 0.13 per 1000 population, which is higher than a.ny rate since 1898. (See Table V.). The following table shows the Scarlet Fever case mortality (deaths per 100 cases) compared with London in the past four years:— 1901. 1902. 1903. 1904. The Borough 1.6 3.0 1.0 3.4 London County 3.2 2.8 2.9 2.8 49. Hospital Isolation.—Of the 472 cases, 397, or 84 per cent, were removed to the Asylums Board's Hospitals, compared with 85 and 86 per cent, in the two preceding years. Three cases only were reported after observation at the Hospital not to be Scarlet Fever, compared with 11 in 1903. The average duration of stay in the Hospital was ten weeks and one day, compared with eight weeks and four days in 1903. 50. Return Cases.—There were 18 cases in which infection was traced to a patient recently returned from the Fever Hospital, compared with 19 and 10 in the two preceding years. The interval between return of the primary cases and commencement of illness in the secondary cases varied from 2 to 20 days, being between 3 and 7 days in 9 cases. The infecting cases numbered 15, and 6 of these had some abnormal condition of the nasal mucous membrane on arriving home. Another infecting case was well on return, but had "cold" two weeks after, 5 days before the secondary case began. Two cases showed no abnormal symptoms, and 6 were not observed. 51. In order to enable precautions to be taken as far as possible against the occurrence of return cases, since the middle 33 of last year, a letter has been sent out to the mother of each child on its return from Hospital. Since this practice was begun, there have certainly been fewer return cases observed. The following are the terms of the letter:— "Dear Madam, Scaelet Fever and Return Cases. Your child is expected to return home from the Fever Hospital very shortly. As far as the Medical Officers of the Hospital are able, they will see that no patient is discharged who is not free from infection, but, unfortunately, there are no means of making sure that any one is absolutely free from the infection of Scarlet Fever, and it sometimes happens that persons continue to be infectious for several weeks after they appear to be quite well in themselves. Usually those who retain infection for long periods have a weak throat, a running at the nose, a soreness of the nose, or a discharge from the ear. You are therefore requested to take the following precautions on the return of your child:— 1. The child should sleep in a bed separate from the other children for a fortnight, or until the discharge has ceased; 2. He should not return to school for a fortnight, or as long as there is any discharge from ear or nose. 3. If there is any discharge, word should be sent to the Medical Officer of Health. I am, Yours faithfully, SIDNEY DAVIES, Medical Officer of Health. c 84 52. The occurrence of secondary cases associated with the cessation of isolation in private houses is exceptional, but one such case occurred last year. The primary case was isolated for 37 days. Six days after she was released her sister began with Scarlet Fever. I could find no symptoms of disease or infection when I examined her a few days later, nor were any circumstances discovered to explain the infection. 53. Probnged Incubation.—In another instance there was an interval of six weeks between the occurrence of the first and second cases in one house. The primary case went to Hospital and had not returned when the second one began. There were no other cases in the neighbourhood, nor was any circumstance discovered to account for infection, unless it be supposed that incubation may be as long as six weeks. Two other cases occurred in which the incubation period appeared to be at least 13 and 18 days respectively. 54. Although probably all the so called return cases are not due to infection brought from Hospital, I believe most are, and that prolonged infectiousness is to a large extent the result of Hospital Isolation, though the way in which this acts I do not attempt to explain. It is still the practice to give a hot bath immediately before discharge, though this was condemned by Professor Simpson years ago in his report to the Asylums Board. The result is in many cases to cause a nasal discharge which appears to act as a vehicle of infection. One child was seriously ill with fever and rheumatic pains on arriving home; she had walked home on a very cold day just after the hot bath. Any personal disinfection should take place the evening before the day of discharge. 55. The subject of Hospital Isolation in Scarlet Fever, and its cost, was more fully dealt with in my Annual Report for 1903 (page 29). 35 56. Sources of Infection.—The following were special sources of infection besides the return cases referred to. 21 cases occurred at the Poor Law Children's Homes, Goldie Leigh. Cases commenced on the 22nd December, 1903, January 9th, 13th, 15th, 16th, 17th, 18th, 19th, 19th, 26th, 27th, 29th, 30th, February 2nd and 3rd, among the boys ; and on March 7th; 19th, 25th, April 29th, May 5th and 15th, among the girls. The first case was not detected and isolated till the 8th January, and no doubt infected several of the subsequent ones, but others were probably infected in the very early stage of the disease, before the appearance of the rash led to isolation, and thus kept up the sequence. The early cases occurred in Goldie Lodge (containing about 40 boys). Subsequent cases occurred in six other cottages or blocks. I visited the Homes with Dr. Boulter, the Medical Superintendent, and found their general sanitary condition excellent. I also examined many of the children with Dr. "Boulter to detect unsuspected cases of infection, but without any result. 57. Three cases occurred in the practice of a midwife, two parturient women, and one child; one of the women died. A few days before the first case commeuced a grand-daughter of the midwife had sickened with Scarlet Fever and been removed to hospital. The midwife left her house immediately there was any suspicion of the grand-daughter having any infection, and did not return till after removal. She discontinued practising for three weeks, and her clothes, bag and instruments were disinfected. 58. A large number of cases occurred in barracks, both among soldiers and families. One special outbreak was among the Officers of the A.S.C. Mess. Five of these sickened between the 19th and 21st July. c 2 36 The most careful enquiry on the part of the Army Medical Staff and myself failed to discover the source of infection. A sixth case occurred on the 22nd September, which was probably a return case, several of the five officers having been meanwhile discharged, and visited the Mess before going on leave. 59. In 35 cases, the infection was attributed to brothers or sisters previously affected and isolated; the diagnosis and isolation were, however, too late to prevent other members of the family being infected. In 5 cases the source was traced to friends or neighbours. 4 were put down to school sports or treats, one to failure of home isolation, and one was a tram conductor. Diphtheria. 60. 163 cases of diphtheria were notified compared with 216, 233, and 186 in the preceding years. The case rate (number of cases per 1,000 population) was 1-30, the lowest recorded since 1891. 61. There were 29 deaths compared with 23 and 13 in the two preceding years. The death rate was 0.23, which is higher than in the three preceding years, but lower than in any of the nine years 1892—1900. (See Table V.). The London death rate was 0-16. 62. Fifty-one cases were in Woolwich parish, 107 in Plumstead, and 5 in Eltham. The following table shows the case rate in each parish in the past three years compared with London:— 1901. 1902. 1903. 1904. The Borough 1.84 1.87 1.51 1.30 Woolwich Parish 1.56 1.67 1.27 1.22 Plumstead 1.9 2.09 1.67 1.47 Eltham ,, 2.33 1.08 1.40 0.45 London ,, 2.7 2.3 1.64 1.52 37 63. 134 Cases, or 82 per cent, were removed to hospital. The case mortality (deaths per 100 cases) was 17 8, compared with 8.8, 9 9, and 7 0 in the three preceding years, and with 10-6 in London. This is the highest case mortality since treatment with antitoxin became general. 21 of the deaths occurred in the Fever and Metropolitan Hospitals, one in the Poor Law Homes, Goldie Leigh, and seven at home. 64. Now that there is an almost certain means of diagnosing diphtheria at its very outset, and a remedy which rarely fails if administered at the beginning, there should be few, if any, deaths, from this disease. What is needed is the more prompt application for medical attendance on the part of parents and friends, and more speedy use of the means of diagnosis and treatment on the part of some medical practitioners. Neglect of procuring early medical attendance led, in one family, to four cases being infected, and two dying. 65. Ward distribution.—The largest number of cases, proportionally to population, occurred in St. Margaret's and Central Wards, and the smallest number in Eltham. 66. School attendance.—14 cases attended Ancona Road School, 9 Mulgrave Place, and 8 the Central Schools. (See Table VI.) 67. Bacteriological diagnosis.— Swabs from the throat or nose of 73 persons suspected to have Diphtheria were examined bacteriologically by the Lister Institute. The result was positive in twelve cases, negative in 61, and pseudo-diphtheria 38 bacilli were found in 3. In 1901, 26 swabs were examined with 7 positive results; in 1902, 97 swabs, 27 being positive; in 1903, 66 swabs, 15 being positive. 68. Mistaken diagnosis.—11 cases or 7 per cent, of admissions were found not to be Diphtheria after removal to Hospital, compared with 12 per cent, in 1903. 69. Source of infection.—In 25 cases the apparent source of infection was some member of the family whose illness was not diagnosed, or whosa isolation was not enforced soon enough to prevent the spread of infection. At two houses which I visited after cases had been notified, I found children with nasal discharges, which bacteriological examination proved to be Diphtheritic. One of these had infected three brothers and sisters. At another house, where four children were infected, and two had died, I found a brother who had recently had a sore throat. Three were infected by neighbours or friends, one probably in a tram car, two on a railway journey, one by visiting the Fever Hospital to see the body of a deceased friend, and two were return cases. 70. Return cases.—As I pointed out in my last Annual Report, return cases after diphtheria are now exceptional as all patients are examined bacteriologically and pronounced free from diphtheria bacilli before discharge. Two apparent return cases occurred however last year. One occurred nineteen days after return home of a patient convalescent with Scarlet Fever, who had a nasal discharge. This discharge was however found free from diphtheria bacilli. In the other case a diphtheria patient after return home was found to have a very slight 39 occasional nasal discharge, which contained diphtheria bacilli. Probably no nasal discharge was apparent in Hospital, and it may not have been thought necessary to swab the nose. 71. The diphtheria of last year was characterised by its fatality and the rapidity of spread in certain families. Four cases occurred in each of four families, and five in two families. It was also characterised by the very low ebb to which it sank in the first half of the year (a total of only 49 cases), and the rapid increase from October to December (Tables IX to XII C). Enteric Fever. 72. There were 24 cases of Enteric Fever (excluding one mistaken diagnosis), giving a case rate of 0.19. This is far the lowest rate yet recorded, the previous lowest being 0.34 in 1903. The case rate in London was 0.41. Chelsea alone of the London Boroughs had a smaller case rate. 73. There were 6 deaths giving a death rate of 005, as in the preceding year, which was the lowest recorded death rate. The London death rate was 0'06. 74. The following are the cases occurring in each parish during the past five years:— 1900. 1901. 1902. 1903. 1904. Woolwich 23 21 17 10 8 Plumstead 39 32 24 22 9 Eltham 4 15 9 10 8 75. Source of Infection.—Four were attributed to eating shell fish, viz:—one oysters at Dinard (France), one oysters and mussels, and two mussels. Three had eaten water-cress 40 recently, one at Dublin, and two at home. Two were in the habit of eating fried fish. Three were obviously cases of secondary infection, one being a sister, one a fellow servant, and the third a fellow lodger and bedfellow of the primary case. Another was possibly infected by a gardener discharged from hospital after Enteric, who helped to prepare the food of the household. Of the remainder, three were probably contracted outside the Borough, one at Newchurch, one at Lee Bridge, and one near Ashford. 76. The proportion of cases occurring in Eltham parish was again excessive. Only one (in whose case the diagnosis was doubtful) partook of the milk supply, which had caused the prevalence in the two preceding years (See Annual Beport, 1903, page 35). One was the fellow servant of one of the milk cases which occurred in the preceding year, and was no doubt infected by her. This and the five other cases are referred to in the preceding paragraph, one being secondary, three due to water-cress, and one to shell fish. 77. The result of the steps taken in the previous year as to the infected milk supply was practically to put a stop to its sale in Eltham. I inquired as to any occurrence of Enteric in the adjoining Borough, where I understood it was being sold, but was informed that there had been no cases. 78. Bacteriological Diagnosis.—Blood serum from eleven cases of suspected Enteric Fever were submitted to the Lister Institute for the application of the Widal test, compared with 27, 30, and 23 in the three preceding years. A positive result was obtained in five cases. 79. Twenty-one cases were removed to the Fever Hospital. 41 Diarrhœa. 80. The deaths from diarrhœa, dysentery, and epidemic or zymotic enteritis numbered 150, or 1.19 per thousand population, compared with 0'82, 0 48 and 0.36 in the three preceding years. The rate for London County was 1.02. There were in addition 19 deaths from Enteritis and Gastroenteritis, making a total of 169 deaths (or 47 per 1000 births), probably due to the same disease under different names; 138 were under one year of age. The corresponding death rate in London was 41. 81. The following table shows the death rate from all the above-mentioned diseases per 1000 births in each ward and parish during the past four years:— Diarrhœal diseases per 1,000 births. 1901. 1902. 1903. 1904. Woolwich Parish 37 19 22 57 Wards. River (North) 62 37 35 103 River (South) 23 28 46 Dockyard 32 17 18 42 St. Mary's 19 18 31 76 St. George's 20 7 6 44 Plumstead Parish 31 23 13 48 Wards. St. Nicholas 43 29 21 69 Central 20 12 7 26 Glyndon 34 31 9 79 St. Margaret's 22 25 12 33 Herbert 21 11 11 32 Burrage 23 22 0 9 Eltham 39 9 11 11 The Borough ... ... ... 47 London County ••• ••• ••• 41 42 82. The North River Ward had the highest diarrhoea death rate for the fourth year in succession, and Glyndon and St. Nicholas came next highest. Probably many births of soldiers' children living in St. Mary's Ward occur in the Female Hospital in St. George's Ward. These two Wards should therefore be considered as one as regards diarrhœal and infantile death rates ; the diarrhceal death rate would thus be 60 for each Ward, bringing them up to the fourth highest place. The Burrage and Eltham Wards had the lowest rates, and were the only Wards in which the diarrhoea death rate did not exceed the average of the three preceding years. 83. I have already reported fully on the deaths from Diarrhoea occurring in the months of July, August, and September of 1904, which included all but fifteen of the deaths occurring during the year (see Summer Diarrhoea, Report on the prevalence of Zymotic Enteritis in 1904), there is therefore no need to say more here, except that weekly returns of all births are now received from the Registrars, and instructions as to feeding infants taken to the house where the birth occurs in all cases where advice is likely to be needed and appreciated. The Lady Sanitary Inspector visits the homes and distributes the instructions in Woolwich Parish, and the District Inspectors in the rest of the Borough. 84. Leaflets giving instructions for the prevention of Infantile Diarrhoea, were distributed house to house over a large part of the Borough during the Summer quarter. Erysipelas. 85. There were 74 cases of Erysipelas compared with 72, 98, and 58 in the three preceding years. The case rate was 0.59, the lowest recorded with the exception of the two years 43 1891 and 1903. There were four deaths, giving a death rate of 0.03. The Loudon case rate was 1.07. Puerperal Fever. 86. There were 5 cases of Puerperal Fever notified, compared with 8, 11 and 2 in the three preceding years. There were 2 deaths. The case rate was 0 04, and the death rate 0-02, the first being the lowest recorded with two exceptions, and the second the lowest with three exceptions. Three were attended in the confinement by medical men, and two by midwives ; one of the former, however, was not properly a case of Puerperal Fever, being due to the bursting of an old pelvic abscess. Influenza, Bronchitis and Pneumonia. 87. Influenza caused 23 deaths, compared with 62, 22, 60, and 27 in the four preceding years. Bronchitis and Pneumonia caused 278 deaths, compared with 407, 245, 299, and 258 in the four preceding years. Tuberculosis. 88. There were 259 deaths from tuberculous disease, giving a death rate of 2.06, compared with 2.29, 1.86, and 1.92 in the three preceding years. The following table gives the number of deaths from each oi the various forms of tuberculosis in the past four years, as well as the deaths from simple meningitis:— 1901. 1902. 1903. 1904. Tuberculous meningitis 17 20 28 16 Simple meningitis 26 19 24 16 Tuberculosis intestines and peritoneum 37 29 14 12 ,, other forms 24 25 Phthisis 215 183 171 206 44 It thus appears that in the past year there was an increased mortality from phthisis, but a decrease in the deaths from meningeal and adominal tuberculosis. 89. The deaths from phthisis were 206, giving a death rate of 1.64, compared with 1.79, l.80, 1.47, and 1.39 in the four preceding years. The following table gives the death rate from phthisis per 1,000 population in each parish and ward during the past four years compared with London:— 1901. 1902. 1903. 1904. No. Rate. No. Rate. No. Rate. No. Rate. Woolwich Parish 105 2.52 83 1.99 81 1.94 93 2.23 River, North 46 3.17 4 1.16 4 1.16 8 2.00 ,, South 25 2.15 26 2.27 29 2.54 Dockyard 17 1.95 18 2.03 13 1.49 22 2.53 St. Mary's 23 2.20 19 1.79 22 2.10 19 1.94 St. George's 19 2.35 17 2.06 16 1.98 15 1.86 Plumstead 104 1.49 94 1.30 84 1.18 104 1.43 St. Nicholas 33 1.63 25 1.08 29 1.26 41 1.95 Central 15 1.46 13 1.24 8 0.78 13 1.27 Glyndon 18 1.13 14 1.39 11 1.11 16 1.67 St. Margaret's. 14 1.37 17 1.41 12 1.01 17 1.38 Herbert 12 1.30 9 0.91 7 0.72 7 0.71 Burrage 12 1.22 16 1.59 17 1.72 10 1.03 Eltham 6 0.77 6 0.59 6 0.56 9 0.81 The Borough 215 1.80 183 1.47 171 1.39 206 1.64 London .. 1.66 .. 1.60 •• 1.55 •• 1.62 45 90. It appears that the phthisis death rate rose last year in the County as well as in the Borough, as compared with the two preceding years. The increase occurred in all three parishes, and in each ward, except St. Mary's, St. George's, Herbert and Burrage. The River and Dockyard Wards had the highest rate, and Herbert and Eltham the lowest. 91. The following table shows the death rate from Phthisis in recent years in Woolwich and Plumstead parishes:— Average. Average. 1901 1902 1903 1904 1891-1895 1896-1900 Woolwich 2.8 2.16 2.52 1.99 1.94 2.23 Plumstead 1.78 1.40 1.51 1.30 1.18 1.43 The rate in Woolwich parish has been higher in three years, and in Plumstead in five years, during the past ten years. 92. The increase of deaths from Phthisis during the past year is disappointing, in view of the efforts made to deal with this disease. In attempting to account for the causa of this increase it must be remembered that the duration of the disease is on an average at least two years, so that the increase of deaths in 1904 does not mean increase of infection in that year. Many causes may, however, determine a fatal end to the subjects of phthisis, such as intercurrent illness and hardships of all kinds, especially want of proper food. Although owing to careful administration the Poor Law statistics have not shown a serious increase of pauperism during the past year in the Woolwich Union, any one acquainted with the district knows that there has been much poverty compared with preceding years, which has greatly prejudiced the nutrition of the 46 very poor. It seems most probable that this has caused an early termination of many lives which, under more favourable circumstances, would have survived to later years, and that there has not been an increase in the number of cases of phthisis. 93. Sex and Age.—135 of those who died from phthisis were males and 71 females. Other forms of tuberculosis were nearly equally divided between the two sexes. Twenty-three deaths from phthisis were in persons under 20 years of age; 8 only of the 53 deaths from other forms of tuberculosis were in persons over 20 years of age. The largest number of deaths proportionally to numbers living from phthisis was at the age period 45 to 55. 94. Notifications.—Voluntary notification of phthisis has now been in force in the Borough for three years. 186 cases were notified, compared with 189 and 167 in the two preceding years. 47 of these were in the Poor Law Infirmary, 24 others were notified by the Poor Law Medical Officers, 29 by the Medical Officers of the Eoyal Arsenal, 23 by Clergymen, philanthropic societies, or by applicants for the Peppard Sanatorium, and the remainder 63 by private medical practitioners. £7 12s. 6d. was paid during the year for notification of phthisis. 95. Duration.—Of the 186 cases notified during 1904, 137 are still living, and of 167 notified during 1903, 94 are still living. Of the notified cases, in 37 the illness was under six months duration ; in 14 between six and twelve months; in 22 between one and two years; in 28 between two and three years, and in 55 over three years. 47 96. The source of infection of the notified cases was probably as follows:— Belatives, 41—viz. (father 9, mother 9, brother 8, sister 7, son 2, husband 4, mother-in-law 1, wife 1.) Lodgers 7 Nursing 1 Workshop 24 Train 1 Public house 35 Laundry 1 India 1 Servant 1 Friends 1 Mistress 1 Army 3 Office 1 Undetermined 68 97. Of 140 adults (viz.: 90 notified cases, and 50 deaths) as to whom information was obtained, 21 were stated to be teetotalers, 76 temperate, and 43 intemperate. Thus 30 per cent, of consumptives were allowed by themselves or friends to be intemperate. 98. Of the houses of notified consumptives, 31 were to some extent dirty, 3 had damp walls, 5 were overcrowded, 2 were unventilated, and 9 had dark rooms. 99. Age distribution.—The following table gives the age of notified cases:— 0-1 1-5 5-15 15-25 25-45 45-65 over 65 0 1 11 45 87 40 2 Sex.—136 were males, and 50 females. 100. Occupation.—Of the 136 notified males, 55 were Arsenal employees, of whom 22 were labourers. The Departments and Workshops affected are as follows:— 48 Royal Laboeatoey. Main Factory 3 Electric Branch 3 Rifle Shell Foundry 2 No. 1 Cartridge Factory 1 No. 2 „ „ 2 No. 3 ,, ,, 1 Detonating Factory 1 Examining Branch 2 Gauge Branch 1 No. 1 Magazine 1 Tailors' Shop 3 Book-keeper 1 Case Bepair Shop 1 Fireman Unspecified 3 Total 26 Royal Caeeiage Depaetment. Tinman's Shop 1 Saw Mills 3 Carpenter's Shop 1 Painter's Shop 2 Inspection Branch 1 Brass Moulder 1 Unspecified 1 Total 10 Royal Gun Factoey. Engine Repair Shop 2 Torpedo Factory 3 5 49 Army Ordnance Department 4 Building Works Department 4 Dockyard 7 19 outside the Arsenal were labourers (2 being Dock labourers), 4 were potmen, 5 soldiers, 3 clerks, 3 carters, 3 schoolboys, 2 errand boys, 2 bakers, 2 coal porters; the remainder included a barber, a rag and bone picker, a porter, a machinist, a ship's steward, a grocer, a coal heaver, a tram driver, a shop assistant, a house decorator, a van boy, a fishmonger, a racquet maker, a blacksmith, a schoolmaster, a furniture hand, a wood chopper, a plumber, and a tailor, making a total of 62 employed outside the Arsenal. The 50 females included 4 laundry maids, 3 charwomen, 2 teachers, 3 scholars, 2 needlowomen, a machinist, a servant, a monthly nurse, a waitress, a fruit picker, a cook, and a dressmaker. 101. In my last Annual Report I considered the incidence of phthisis in the Royal Arsenal, and gave certain incidence rates, expressing the opinion that the figures did not indicate special incidence on any one or more workshops, and that these were not frequent sources of infection. I have no means of giving incidence rates this year, but the figures, as far as they go, point to the same conclusion as last year. In 1903, the notified phthisis cases among Arsenal employees somewhat exceeded the cases among those employed outside the Arsenal: in 1904, the reverse was the case. The total number of Arsenal employees far exceeds the total males in other occupations living in the Borough, so evidently the Arsenal workshops as a whole cannot be looked on as an important source of phthisis. d 50 102. The Public House as a source of infection.—In my last Annual Report, I gave reasons for regarding the public house as an important, if not the principal, source of infection. The experience of last year tends to confirm this conclusion. There was an excess of phthisis among the intemperate, those employed in the liquor trade, casual labourers, and those specially exposed to the temptation to drink. During the past three years there have been 11 deaths from phthisis among persons employed in the liquor trade, giving a mortality of 15.2 per 1,000 persons so employed, which is ten times the mortality of the Borough, and five times the mortality of the population between the ages of 20 and 55. 103. Chronic Tuberculosis of Children.—Information was obtained through the Invalid Children's Association as to 26 children suffering from chronic tuberculosis, chiefly of the hip, knee and spine. Enquiries were made as to the source of infection of these cases, with the following result:— 6 had fathers who had died, or were still suffering from phthisis. 1 had a mother who died of phthisis. 1 had an uncle who died of phthisis in the same house. 1 had a grandmother and aunt who died of phthisis. 1 had a next door neighbour who died of phthisis. 5 had been largely fed on unboiled cow's milk. 104. Bacteriological Diagnosis.—Sputum from 116 cases of suspected phthisis was examined by the Lister Institute, and the tubercle bacillus was found in 43 cases. The numbers for the two previous years were 36 samples and 12 positive results, 144 samples and 44 positive results. 105. Disinfection was performed by the Health Department at 192 premises compared with 18, 86, 89 and 108, in the four preceding years. Of the 192 premises, deaths from phthisis 51 had occurred at 140, and in the 52 other cases removal to Infirmary, or Sanatorium, or other conditions allowed of disinfection taking place. A large number of phthisical rooms were specially stripped and cleansed. 106. Sanatorium Treatment.—The two beds at Peppard Common Sanatorium first engaged by the Borough Council in 1903, have continued to be maintained, and in May, 1904, a third bed was retained for women. During the year 10 men and 3 women were admitted, 7 men and 3 women were discharged, 1 man died, and 2 men and 1 woman remained under treatment on the 31st December. The following report presented in March, 1905, described the results of the Sanatorium treatment from the commencement up to date:- In December last I reported that since the Council had maintained three beds at the Peppard Sanatorium (May, 1904), two for males, and one for females, the beds had been continually occupied. Since then the same condition has been maintained, and there have been a large number of applicants who have been unable to obtain admission (total applicants entered, 42). The object of the Council in providing for Sanatorium treatment of Phthisis is threefold:- (1) The isolation of infectious patients in order to prevent them infecting other members of the family; (2) Their education in open air treatment and preventive measures, which would enable them to continue the treatment after return home, and prevent them from continuing to be a source of infection to others ; (3) Treatment with a view to recovery. d 2 52 I have previously pointed out that although the two first objects might be completely attained, it could not be expected that three months treatment would be sufficient in most cases to complete the cure. For this six months at least is generally required. On the other hand, the first two objects might be attained by a shorter period of treatment, say two months. The period which has been adopted of three months, has been to a certain extent a compromise between the periods demanded for the two different objects, i.e., isolation and education on the one hand, and treatment on the other. But as a matter of fact, although three months has been the maximum time allowed in the Council's beds, five of the patients have been kept on longer at the Sanatorium and supported by a Charitable Fund, the Superintendent hoping in this way to produce more permanent results. There are actually at the present time two Woolwich patients who have had three months' treatment in the Council's beds, but are continuing at Peppard and doing a certain amount of work as part payment for their keep; another one is on the point of returning home, but has been kept for four weeks over her time on the same Charitable Fund in consideration of the difficulty her friends had in receiving her home. The time is as yet too short to say much as to the results obtained by the treatment of patients. I think, however, I am justified in saying that the results are quite satisfactory as regards the education of patients passing through the Sanatorium. I have visited the homes of five patients since return from the Sanatorium, who are at present living in the Borough, and in every case I found open air treatment being continued, and proper isolation and other precautions maintained. In each case the patient had a room to themselves, although no doubt this was arranged at some sacrifice on the 53 part of other members of the family; but during their stay at the Sanatorium they had learnt the importance of open air treatment and of sleeping in separate rooms. As regards cure, sufficient time has not elapsed to form a trustworthy opinion. Out of seventeen patients who have been in the Sanatorium, three are at present occupying the Council's beds, and three have died. Of the remainder (eleven) all were much improved in weight and other ways by their stay. Two are at home, apparently perfectly well; one in work, and the other seeking for work. Two as I have said above are still at the Sanatorium continuing the treatment and doing a little work; one at least is quite well and will shortly leave for America. Four have relapsed since their return; of these One has been in another Sanatorium, and is now in Brompton Hospital; One is at work, but getting worse ; One is at home in bed; One is being treated at home. In three the treatment did not arrest the disease, though it improved the patient's general condition. 106a. Isolation of Advanced Cases.—It is well known that there is practically no hospital accommodation for advanced cases of phthisis outside the Poor Law Infirmaries; all other hospitals refuse advanced cases; yet it is most important that these should be treated in hospital when they exist in the homes of the poor. Such homes have usually no facilities for properly nursing cases of serious illness, and they certainly are unsuitable for isolating infectious disease, and Dr. Koch considers these advanced cases the most infectious, and the chief 54 source of the spread of consumption. When the patient is the bread winner, the illness means usually cessation of wages, and he consequently becomes destitute and goes to the Infirmary as a matter of course. When, however, the patient is the wife of the bread winner, and in other cases where there is no destitution, there is no legal claim on the Guardians for Poor Law relief; nevertheless such cases may be, and frequently are, received into the Infirmary, and often the cost of the maintenance is partly or wholly recovered from the persons responsible. In such cases, however, admission becomes a matter of special consideration; some cases are admitted, Others refused, and unfortunately the worst cases from the Public Health point of view are sometimes refused admission. Until the Asylums Board provides for the treatment of consumption, I thick Boards of Guardians should assist Sanitary Authorities in every way possible to deal with this fatal disease, and for this purpose should offer every facility for the admission of advanced cases from poor homes. There is no fear of too many applying; the patients are usually very unwilling to enter. 107. The Prevention of Improper Spitting. The London County Council bye-law prohibiting spitting in public places has not as far as I am aware been enforced, though no doubt it has had some educational value. The police alone appear to be responsible for enforcing it, but they are seldom or never on duty in the places where the breaches of the bye-law chiefly occur, e.g. railway carriages. Having found that the notices ' not to spit' distributed at public houses two or three years ago had to a large extent been removed, 170 were taken round and posted, and 170 letters to landlords and managers as to the danger of spitting and sweeping of floors and the best means of avoiding the risk were distributed. 55 Thirty-five spitting flasks were supplied at cost price (6d. or 5d.) compared with 23 during 1903. Cancer. 108. There were 93 deaths from cancer (malignant tumours) giving a death rate of 0.74 compared with 0.70, 0.83 and 0.75 in the three preceding years. Thirty-four of those who died were males, and 59 females. Fifty-eight deaths were of persons over 55 years of,age, giving a death rate of 5.8 per 1000 at this age. The highest mortality from this cause was in the South River, Dockyard, and St. Margaret's Wards, and the lowest in Central and Herbert. 109. The following table shews the sex and the region affected of all the cases of malignant disease:- Carcinoma. Seat of primary disease:- Male. Female. Head and face - 1 Mouth and tongue 5 3 Pharynx, larynx and neck 3 - Thyroid gland • 1 Stomach and Pylorus 5 8 Intestines (excluding rectum) 2 1 Bowel 1 - Rectum 4 4 Liver 3 7 Peritoneum and Omentum 2 - Male urinary organs 3 - „ genital „ 2 - Female urinary „ - 1 „ genital „ - 16 ,, breast - 11 Pelvis - 1 111 defined 1 1 31 55 56 Sarcoma. Mouth 1 - Intestines - 1 Liver 1 - Pancreas 1 - Female genital organs - 1 Tibia .. - 1 Multiple Osteo Sarcomata - 1 3 4 34 59 Alcoholism. 110. There were 5 deaths from alcoholism, and 22 certified as cirrhosis of the liver, making a total of 27 deaths actually caused by alcohol, compared with 52, 40 and 42 in the three preceding years. The recent reduction in alcoholism is probably to a large extent an indication of the poverty that has prevailed in the Borough during the last two years; but it may be hoped that some of the improvement is due to recent legislation and to public enlightenment as to the evils of intemperance. In addition to the above deaths, there were 335 deaths from diseases of the brain, nervous system, heart, blood vessels and kidneys, of which a large proportion were certainly caused directly or indirectly by alcohol. The deaths from these causes in 1903 were 313. 111.-The following table shows the death rate from alcoholism (including cirrhosis of the liver) in the past three 57 years in various divisions of the Borough compared with London:. Public Houses per cent. of total houses. 1901. 1902. 1903. 1904. The Borough 1.0 0.44 0.32 0.34 0.21 Woolwich Parish 2.0 0.74 0.61 0.41 0.24 River Ward, South 2.9 1.10 0.94 0.70 0.35 Plumstead Parish 0.5 0.27 019 0.35 0.23 St. Nicholas Ward 0.2 0.49 0.17 0.26 0.33 Eltham 0.6 0.25 nil nil nil London County - 0.31 0.30 0.28 - The reduction of alcoholism in Woolwich Parish and the River Ward is more marked than in Plumstead and St. Nicholas Ward. Syphilis. 112. There were 8 deaths from syphilis, compared with 14 in 1903. 4 of these deaths occurred in the Infirmary, and 1 in an outlying institution, indicating that the death returns do not represent the real number of deaths from this disease. 4 deaths were due to congenital syphilis. 6 were males, and 2 females. Meteorology. 113. The weather of 1904 may be described as of a decidedly average type. In the first or winter quarter 6 weeks had a temperature above the average, and 7 weeks below. In the second quarter, 7 weeks, had a temperature above the average, and 6 below. In the third or summer quarter the temperature was above the average in the first five weeks, and the ninth, and below in the remaining 7. 58 The temperature three feet below the ground varied from 40°.57 in the first week of March to 64°.62 in the second week in August, compared with 40°.90 and 61°.64 in 1903. The average temperature of the third quarter was 61° 45 compared with 60°.18 in 1903. Although the duration of warm weather was slightly below the average the intensity of the warmth was decidedly above, and to this fact no doubt was mainly due the excessive prevalence of summer diarrhoea. The rainfall was 20 32 inches, compared with 20.16, 20 13, and 35 33 in the three preceding years. The highest rainfall was in the first quarter, 6 38 inches. The rainfall of the summer quarter was 4.88 inches, compared with 12.32 inches in 1903. The lowest temperature of the air was 260.2 in the third week of January, and the highest 91° 0 in the first week in August. The largest number of deaths in one week—53—was registered in the second week of August, i.e., the week succeeding that which had the highest air temperature. The lowest weekly number—19—was registered in the second week of June. 59 PART II.—ADMINISTRATION. Water Supply. 1. The constant supply of water by the Rent and East London Companies (now the Metropolitan Water Board) continued as in previous years. The upper part of Shooters' Hill has still only an intermittent supply. No complaints were received (otherwise than from the water officials) as to water being turned off by the water authority. Only two houses have been found not to be supplied with water from the above two sources. These are isolated cottages supplied with wells—one in Plumstead and one in Eltham. 2. The question of the sufficiency of the water supply in tenement houses of several floors has engaged my attention for some years, and in December I reported that, in my opinion, a house (No. 1, High Street), occupied by three families, on three floors, which had one tap in the yard, had not a proper and sufficient water supply. On that report your Health Committee determined to take proceedings, with the result that the owner was ordered to provide a tap and sink on each floor. As this is the first Magisterial decision of the kind, a full report is appended. (See Appendix II.) 3. Defective and foul drinking-water cisterns were found and remedied in 90 houses, compared with 70 in 1903. At 65 houses the supply was found insufficient or temporarily cut off. 60 Most of these were cases where the Water Authority cut off the supply on account of non.payment or leakage. In all cases immediate steps were taken to have the supply improved or re.instated. Food and Drugs Act. 4. 498 samples were submitted to the Public Analyst, and 42, or 8.4 per cent. were found adulterated, compared with 5.5, 4.1, and 5'7 in the three preceding years, and about 15 per cent, in London County. Proceedings were taken in 27 cases ; 5 were dismissed on proof of warranty, 2 were withdrawn, and a conviction was obtained in 20. A total of £55 13s. Od. was imposed in penalties, and £17 13s. in costs. 5. 366 of the samples were milk, and 34 of these, or 9.3 per cent. were adulterated, compared with 4.8 and 6.1 in the two preceding years. 78 samples were bought as butter, and 4 found to be adulterated with margarine, two being all margarine. Table XVIII. shows the other 54 articles analysed. Only 4 were found adulterated, viz.4 brandies, which were found to contain spirit other than grape spirit, but as the vendor gave notice of this, there was no case for prosecution. Of the 24 adulterated milk samples for which prosecutions were instituted, 17 were for abstraction of fat, 4 for added water, and 3 for addition of Formalin. One of the Formalin cases was dismissed, owing to the Analyst having omitted to state the amount of Formalin present; convictions were obtained in the other three. 61 6. The highest penalty inflicted was £10 on a large dealer, for 10 per cent. fat abstracted. 7. The increase in the percentage of milk adulteration found was explained in my last Annual Report; it does not mean increased adulteration, but a higher standard of milk purity adopted by the Borough Council. Food Inspection. 8. Inspectors Eance, Tedham and Dee continued to act as special food and meat Inspectors on Friday and Saturday. There were two seizures (pork and beef), and 47 surrenders of unsound food, compared with a total of 23 seizures and surrenders in 1903, and 20 in 1902. 34 of the lots surrendered were pork affected with tuberculosis. Prosecutions were undertaken on account of both seizures, and the defendants fined respectively £150 or five months imprisonment, and £50 or three months imprisonment. In another case where the unsound meat was seized in 1903, the defendant was fined £10. Of the remaining lots surrendered, 6 were fish, 2 beef, and others veal, oysters, tomatoes, and rabbits. Dairies, Cowsheds and Milk Shops. 9. On January 1st, there were 154 milk shops on the register; 54 were added and 12 removed during the year, leaving 196 registered at the close of the year, compared with 123 and 154 in the two previous years. These were all inspected at least once during the year by Mr. Powell and 9 notices served for sanitary defects, which were complied with. 62 All the vendors were served with a notice requiring them to keep the milk covered, either with a permanent cover or piece of wet muslin. This requirement it has been found is now seldom neglected. Several keepers of shops where milk was sold in conjunction with articles such as old clothes, coal, greengrocery, &c., were required to discontinue selling either the milk or the other articles which interfered with its cleanliness. Regulation No. 32 under the Dairies Order requires purveyors of milk to adopt such precautions as may be necessary for preserving the purity of the milk, and it is under this regulation that the above requirements have been made. 10. The number of Cowsheds remained as before, 18. Fifty-six inspections were made by Messrs. Powell and Wood. Before the County Council licensing sessions all the sheds were inspected by Chief Inspector Duck and myself. Nine notices were served and complied with. Five sheds were found dirty and cleansed. A new milk store was built to avoid keeping the milk in the cowshed, and several improvements in paving, dung pits, &c., effected. All the sheds were whitewashed twice during the year. Slaughtekhouses. 11. There was no change in the number of Slaughterhouses registered, which remained 11 as in the two previous years. 83 Inspections were made and 6 notices served and complied with. Nuisances (See Table XVa.) 12. Complaints.—All complaints received are investigated, whether anonymous or otherwise, but it would be of great 63 assistance to the department if those who complain would give more definite information as to the place, time and nature of the nuisance complained of. Some complaints are fanciful, and many are inspired by spite against landlords, neighbours, &c., but these are soon sifted. 457 Complaints of sanitary defects were received, compared with 623, 458 and 493 in the three preceding years. 42 Complaints of non-removal of dust were received compared with 160, 114 and 70 in 1901, 1902 and 1903 ; 18 of the latter referred to Woolwich parish, 19 to Plumstead, and 5 to Eltham. 13. Drains and Waterclosets.—22 Defective combined drains affecting 129 houses were investigated and reported on by the Chief Sanitary Inspector. In the three previous years 52, 29 and 28 combined drains, respectively, were dealt with. These were all referred after investigation and report to the Borough Engineer. 573 Private drains found choked and defective were examined, cleared and relaid where necessary at the expense of the owners. By far the largest number proportionally to population were in the River Ward. The number of defective drains found in the three preceding years was 786, 693 and 722 respectively. 233 Drains were tested with the smoke test, and 237 by the water test after relaying. 709 Water closets, and 789 defective W.C. cisterns (total 1498) were repaired, compared with 1864, 1444, and 1532 in the three preceding years. 231 Foul pans were cleansed compared with 120, 54, and 179, in the three preceding years. 2 Additional water closets were provided to workplaces. 64 Chapel Farm, Eltham, was redrained and connected with the special sewer made by the Council in the previous year. 14. Public Urinals.—The public lavatories and urinals maintained by your Council were kept scrupulously clean. The urinals attached to public houses were regularly inspected and many notices served, and complied with. In 28 cases letters were written to the landlords threatening that their license would be opposed unless certain work required to prevent a nuisance were complied with. This had the desired effect in every case but one, as to which it was not thought necessary to proceed. The work required consisted chiefly of providing a light and making small structural alterations. 15. House Inspection.—6604 houses were inspected house to house, and 7673 for infectious disease, complaints, &c. The house to house inspections in 1901, 1902, 1903 and 1904 respectively are as follows :—4797, 4526, 6223 and 6604 ; and the miscellaneous inspections 7123, 10956, 7791 and 7673. It will be seen that the total number of inspections has greatly increased. The miscellaneous inspections vary largely with the amount of infectious diseases. The inspections of houses let in lodgings are not included in the above figures as has been the case in previous years ; there were 371, so that the total house to house inspections was 6975. 16. Table XVI. shows the streets inspected, and number of defective houses found in each. The largest number of defects was found in River, St. Mary's, and Dockyard Wards. In all the Wards except Herbert and Burrage, the majority of the houses inspected had some defect. At 2,917 houses, interiors were cleansed or roofs repaired, compared with 3,082, 2,318, and 2,711 in the three preceding years. 65 885 Damp walls were remedied compared with 608, 369 and 580 in the previous years. 225 of these were in Central and Glyndon Wards, mainly in the latter. Through ventilation was provided in 138 houses, 679 dust pails were supplied, compared with 269, 1,008, and 708 in the preceding years. 17. Medical Officer's Inspection.—120 house to house inspections were personally made by the Medical Officer of Health, in addition to 777 inspections for purposes of enquiry, and diagnosis of infectious diseases, and special inspections re complaints, and by request of the Sanitary Inspectors. The 120 house to house inspections were in the following streets : Auberon Street and Kate's Place, North Woolwich; Mulgrave Place, Howick Mansions, Rope Yard Eails, High Street, Frances Street, Glass Yard and Elizabeth Place (River, Dockyard and St. Mary's Wards). Frith's Buildings, Kirk's Yard, High Street, &c., Eltham. Of the 120 houses, 51 were found in a dirty condition, dark rooms at 20, want of ventilation at 19, overcrowding at 14 (11-7 per cent.), and other insanitary conditions at 48. 18. Overcrowding.—178 cases of overcrowding were found compared with 145, 137 and 126, in the three preceding years, The largest number of cases was found in the Dockyard, River and St. Margaret's Wards. Per cent, of houses inspected, there were 2'7 cases overcrowding. In my own house to house inspections I found L17 per cent., but I specially chose the most insanitary districts. Probably St. Margaret's Ward has no real excess of overcrowding, but an Inspector more particular in applying the standard, viz., less than 300 cubic feet per head for sleeping, and 400 for living and sleeping. It is noteworthy that more cases of overcrowding were found last year than in any previous year. e 66 19. Smoke Nuisance.—136 observations of smoke nuisance were made compared with 105 and 133 in the two previous years. 29 nuisances were discovered, and notices served. There were no prosecutions. The notice of the Chief Superintendent of the Eoyal Arsenal was again called to smoke nuisance from the Arsenal chimneys, one of which was a special offender. A reply was received that the matter was receiving attention, but no remedy has yet been applied. Much smoke nuisance occurred at the Council's own Electric Light Station in Globe Lane, but this has siuce been remedied. With a view to seeing what could be done to lessen smoke production from ordinary fireplaces, trial was made at the Council's Offices, Maxey Eoad, of a Florence Stove, recommended as smoke consuming. It was found to be a good and economical heat producer, but the smoke caused was fully equal to the ordinary grate with which it was compared. 20. Defective Light.—At 138 houses new windows were Bupplied, or existing windows enlarged, or light improved in other ways. Proceedings had to be taken in one of these cases to compel the owner to improve the lighting of a basement, and as this is perhaps the first case of its kind decided, a full account of the prosecution is given in Appendix III. 21. In my last report I showed how inadequate are the requirements of the London Building Act in ensuring adequate lighting. The Act allows of back additions which exclude all sunlight, and make the back rooms of a house quite dark. 22. Want of Proper and Sufficient Water Closets.—Several houses were found which did not comply with the L.C.C. Byelaw as to having at least one water closet for every 12 persons. Where the number of persons in a house with only one closet 67 was found to exceed 12, notice was served to provide an additional closet, but this usually resulted in the number being reduced. The L.C.C. Bye-law has been re-drafted so as to require the service of notice before any action in this respect is taken against a landlord. 23. Flooding of Houses—No complaints of flooding were received during the year, and Charlton Vale where such serious flooding occurred in 1903 was found to have escaped a repetition of this nuisance. 24. Verminous Rooms.—Under the London County Council General Powers Act of 1904, it is now compulsory on owners or occupiers after notice to strip and take steps to destroy and remove vermin from verminous rooms. Previous to this Act it was the custom of the Department to treat verminous rooms as a nuisance, but the new Act has decidedly strengthened the hands of the Borough Councils in this matter, and enabled cases to be dealt with which would formerly have been allowed to pass. Several verminous rooms were thus dealt with ; these are included among the 2917 interiors cleansed. Dust Bemova-l. 25. Only 42 complaints of non-removal of dust were received, 18 being from Woolwich parish, 19 from Plumstead, and 5 from Eltham. This is the smallest number of complaints received in Plumstead and Eltham since the union of the parishes. The Woolwich Destructor received and destroyed 7352 loads of house and trade refuse, weighing 8658 tons at a cost for collection of £1692, compared with 9291 loads and £1600 cost e 2 68 in 1903. The cost of destruction was £1197 less £180 for sale of clinkers, (re trade refuse see next paragraph). The Plumstead destructor which commenced work in May, 1903, dealt with 12038 loads weighing 10141 tons. The cost of collection of house refuse paid to the Contractors, Messrs. Tuff & Hoar was £2638 17s. 4d., compared with £3,100 and £2,909 in the two preceding years (contract price reduced on account of use of dust destructor). The amount paid for the Eltham dust collection to Mr. Tucker was £649 17s. 4d. compared with £480 in the previous year. This refuse was deposited at Cassell's brickfield, New Eltham. The Sanitary Inspectors have special instructions to see that dust pails are kept covered, and defaulters reported. This precaution serves the double purpose of preventing nuisance and by keeping the refuse dry, increasing its value as fuel. Trade Refuse. 26. During the year there have been 9,581 receptacles of offensive refuse removed, for which a sum of £119 17s. 9d. has been paid. There are now 55 tradesmen on the books from whom offensive trade refuse is collected. There were no complaints of nuisance arising from the collection. Chloride of lime is used as a deodorant. 1480 Loads and 797 bushels of inoffensive refuse were collected in Woolwich Parish, and destroyed, for which the sum of £117 12s. l0d. was paid by tradesmen, etc. This is included in the figures of the Woolwich dust collection. The charge made for inoffensive refuse is 1/6 a load, and 2d. a bushel, and for offensive refuse at the rate of 3d. a receptacle, charged per quarter in advance on the amount collected in the previous quarter. 69 Housing of the Working Classes. 27. The following 10 houses were represented as unfit for human habitation under Sec. 32 of the Housing of the Working Classes Act:— 31, 32 & 45, Chapel Street; 18, Kate's Place; 12, 14, 18 & 20, High Street, Eltham ; 141, Park Road; 44, Ropeyard Rails. Notices (Form A) were served in each case, and the work required done at seven houses without closing orders being obtained ; a closing order was made by a Magistrate for 31, Chapel Street; 32 and 45, Chapel Street were closed without an order; the work required has been done at No. 45, and the premises re-opened; Nos. 31 and 32 remain closed. The improvements effected at the houses re-opened were of a very considerable structural nature ; new water closets, washhouses and windows were provided in several cases, and in one the floor was lowered to increase the height. Two houses (not included above) were closed as the result of notices to drain, remedy dampness, and improve light and ventilation, viz. :— 1 & 2, Well Hall Cottages. 28. The following are the number of houses represented as unfit for human habitation in each year since the Borough Council was formed:—34, 10, 6, 10. Of these houses 19 have been closed, and the remainder improved. 70 29. Death rates of special areas.—Statistics have been given in previous Annual Reports for the following special areas:— Death rate. Princes Road area 23.9 Globe Lane and New Street 29. 5 Salutation Alley 42.2 Dicey, Delvin and James Street 19.4 Fore, Albert, Stanley and Sidney Houses 20.8 Reidhaven Road area 17.1 30. Council's North Woolwich Houses.—On the 1st April, 24 of the Council's 25 houses were occupied; 15 were vacated during the year ending 31st March, 1905, and 11 re-let; one was let for the first time in August; 4 were unoccupied March 31st, 1905. The number of persons at present housed is 71 adults and 38 children, total 109, or 5 to a house. The rooms have all been measured, and a table drawn up showing how many persons may occupy each room, allowing 400 cubic feet per head for sleeping, and 500 for living and sleeping, two children under 10 counting as an adult. The clerk of the Housing Committee, when letting the houses, calls attention to this regulation. 7 of the houses are rented at 8/-, 9 at 8/6, 2 at 10/-, and 2 at 11/-. A cupboard is being provided on the upper floor of each house, and partitions between the front door and living room have been, or are being, erected in 16 of the houses. Houses Registeked undee the By-Laws. 31. At the commencement of the year, 123 houses were on the register. 116 were newly registered during the year (80 in Woolwich parish, and 36 in Plumstead), and 4 were removed, leaving 235 on the register at the close of the year (164 in Woolwich parish and 71 in Plumstead), compared with 88, 103, 132 and 123 in each of the four preceding years. 71 32. These houses were inspected quarterly or half yearly. 371 inspections were made in all, and 233 notices served, 8 being for overcrowding, and 225 for other matters. No proceedings were taken. 33. The registered houses were put under the care of Miss Middlebrooke on her appointment in July. The following is her report for the time she has served, July 5th to December 31st, 1904:- Number of houses Inspected 335 „ „ found satisfactory 142 „ Notices served 193 „ remedied 193 Notices. Served. Remedied. On Landlords for Cleansing 106 106 „ Tenants 15 15 „ Landlords for Overcrowding - - „ Tenants „ 7 7 ,, „ and Landlords for other defects 115115 Number of cases referred to District Inspectors 35 „ „ of overcrowding remedied by redistribution without notice 5 „ newly registered houses measured up 79 34. New Bye-laws.—The new Bye-laws for houses let in lodgings approved by the Borough Council on the 16th March have not yet received the sanction of the Local Government Board. The Board has agreed to the principle of the Byelaws being applicable to all houses without rent limit or other exception, but insists on a provision requiring a notice to be 72 served on all landlords whether resident or non-resident before proceedings are taken for overcrowding and certain other offences; the Council on the other hand, while consenting to a notice being given to non-resident landlords, holds that such a step would defeat the object of the Bye-laws in the case of resident landlords. The Bye-laws at present in force are inapplicable to Eltham. They only affect tenants and landlords, and it has been held that owners are not landlords except when they receive the rent themselves from each tenant. Common Lodging Houses. 35. There are now 24 common lodging houses licensed and inspected by the County Council. Four were closed during the year, and the licenses of four others have been withheld pending compliance with certain improvements. There has been considerable reduction in the numbers of occupants allowed in each house, and a rule is now made not to allow beds to be let to single men and single women in the same house. Underground Rooms. 36. Six underground rooms separately occupied were dealt with; three were closed, viz., at 12, Lower Pellipar Road; 177, Powis Street; and 12, Kidd Street; at three the rooms ceased to be occupied as sleeping rooms. Factories and Workshops. 37. There were at the close of the year 226 workshops and workplaces on the register. 334 inspections were made of these, and 55 written notices were served and complied with. A full summary of the work done is given in Table XV. C. 73 The workshops where females are employed (109) were inspected after her appointment by Miss Middlebrooke, and the remainder by Inspector Powell. Forty-seven places where food is prepared, chiefly restaurant kitchens, were inspected, and 15 notices were served and complied with. The sanitary accommodation of 22 factories was inspected, 2 notices served and complied with. outworkers. 38. Homeworkers' premises were inspected at 180 houses, 353 inspections were made, and 30 notices were served and complied with. Bakehouses. 39. Of the 62 bakehouses on the register at the close of 1903, three have been closed and two new ones have been opened, leaving 61 on the register at the close of 1904. The new ones are both in St, Nicholas Ward, and those that have been closed in River, St. George's and Dockyard. These bakehouses were all inspected twice, and a great improvement found compared with previous years, especially in the underground bakehouses. All but seven were found satisfactory on the last inspection; these seven showed dirty conditions of floor, walls, mixing boards, &c., these were all remedied on the service of notice. There were no prosecutions. Ice-Cream Shops. 40. These shops are now subject to special bye-laws made by the London County Council under a General Powers Act. 64 were on the register at the beginning of the year, 20 were 74 added during the year, and one removed, leaving 83 on the register at the end of 1904. These were all inspected in April and August and were found satisfactory, with three exceptions for which notices were served. The notices were complied with, and there were no prosecutions. Disinfection. 41. In my last Report a detailed statement was given as to your Council's disinfecting establishment, the method of disinfecting rooms, clothes, bedding, and books, together with cost of appliances, fitting up, and staff, &c. (see Annual Report, 1903, pp. 73-76). There has been no change in the establishment or system. Rooms at 842 houses were disinfected, compared with 687, 945 and 744 in the three previous years. The disinfecting apparatus was used 610 times for 7127 articles In 1903 there were 514 disinfections in cases of infectious disease, and 6451 articles disinfected. 115 Books belonging to the Free Library were disinfected. £1 4s. Od. was received from private persons for disinfection in non-notifiable diseases where disinfection was not required by the Medical Officer of Health. Health Shelter. 42. The Health Shelter was not once used during the year. It has not been used since the Small-pox epidemic of 1902. Only one of the two sets of rooms has ever been used in the four years since the Shelter was erected. The Mortualies. 43. The Sun Street Mortuary was used for 164 bodies compared with 156, 164 and 183 in the three preceding years. 75 151 were deposited for inquest and 13 for custody. 100 post mortem examinations were made. Two bodies were deposited in the infectious disease chamber. The Eltham Mortuary was used for two bodies; in both cases they were brought for custody only. Cemeteries. 44. The two Borough Cemeteries were properly maintained and gave rise to no complaints of nuisance. 690 Bodies were buried in the Woolwich Cemetery compared with 691, 695 and 663 in the three previous years. There were 789 interments in the Plumstead Cemetery, compared with 788, 817 and 694 in the three previous years. 123 burials took place in the Plumstead Churchyard, compared with 146, 164, 144, 125 and 115 in the five preceding years. Cleansing of Persons Act. 45. Your Public Health Committee had this Act under their consideration, and it was decided to erect a bath or batbs for verminous persons adjoining the Disinfecting Station, White Hart Road. An estimate for this purpose has been passed and plans are under consideration. By-Laws for Tents, Vans and Sheds. 46. During the year, 38 tents, vans, and sheds were inspected as to compliance with the By-laws. 14 notices were served, and either complied with, or the tents and vans removed. The nuisances were mainly want of sanitary accommodation, and want of cleanliness. In one case earth closets and dust pails were provided. A number of sheds at Horn Park used by fruit pickers were whitewashed and the ditches adjoining cleansed. 76 Public Ambulance. 47. The public non-infectious ambulance continues to be maintained as described in my last Annual Report (p. 78). It was used 97 times last year compared with 90 times in 1903. The following were the journeys made Guy's Hospital 26 London Hospital 8 Cottage Hospital Charing Cross 7 Seamen's and Miller 10 Other Hospitals 6 King's Hospital 12 Union Infirmary 11 St. Thomas' Hospital 10 Private Houses 7 Health Leaflets, 48. The Health Rules which were printed in 1902, and published with the Annual Report for 1901, are now left at every house which is inspected house to house. These, or the special cards containing the rules " How to Feed Baby" were distributed at every house in about half the streets of the Borough during the prevalence of diarrhoea last summer. For the benefit of a number of foreigners, mostly coming from Austria and Germany, living in North Woolwich, the Health Leaflets were translated into German and distributed at the houses where these persons live, which are chiefly in Auberon Street. Overcrowding was suspected in these houses for some time, but the Sanitary Inspectors were unable to obtain information as to the numbers occupying them as the occupiers did not speak English. Consequently, your Medical Officer of Health went through all these houses personally, and by aid of his slight knowledge of the German language, was able to detect a number of cases of overcrowding. 77 Soldiers' Married Quarters. 49. When making some enquiries re infectious disease in married quarters at Cambridge Cottages, it was found that these quarters were very inadequately supplied with water and sanitary conveniences. The attention of the War Office was called unofficially to the fact that these quarters, if they were not Government Buildings, would not satisfy the requirements of the Public Health Act as to water supply and water closets. I am pleased to be able to report that the War Office has already commenced to construct washhouses and water-closets attached to each set of quarters. Bacteriological Examinations. 50. Bacteriological Examinations were made last year in 202 cases, viz: 74 for Diphtheria, 117 Phthisis, and 11 Enteric Fever. The total cost was £32 18s. 4d., viz: £25 5s. Od. for examinations, and £7 13s. 4d. for boxes and telegrams. Report of the Departmental Committee on Physical Deterioration. 51. This report has called public attention to various public health problems, and given a stimulus to the carrying out of many useful administrative measures. I presented full reports on the recommendations of the Committee (see Council's Minutes, 20th October, 1904, p. 843, and 1st December, p. 84), and the action taken by your Council is found in the Minutes of 1st December, p. 84. London County Council Conference on Administration of Public Health Acts. 52. You appointed me to attend this Conference in company with Councillor Hall. Many important resolutions were 78 passed on which legislation has since been based. The full Minutes of the Conference, and the resolutions, were separately printed. I reported to you on the principal resolutions on the 16th November. London County Council Conference re Vagrants and Infectious Disease. 53. This Conference was called mainly to discuss what further measures might be taken to limit the spread of Smallpox through Vagrants. Councillor Pringle and your Medical Officer of Health represented your Council. The resolutions of the Conference are contained in the Minutes of your Meeting on the 22nd December, p. 132. Sanitary Staff. 54. During the year, Inspector Mackie resigned his office, and Mr. Powell was appointed Sanitary Inspector to succeed him. The first lady Inspector was also appointed in the person of Miss Middlebrooke. Mr. Powell commenced work 18th April, and Miss Middlebrooke 7th July. Miss Middlebrooke was provided with a bicycle, making a total of six bicycles now provided for the Department. I presented in December a special report by Miss Middlebrooke on her work (see Appendix V.). Inspector Powell passed the examination of the Sanitary Institute in food and meat inspection, making now four inspectors who are thus qualified. I am, Gentlemen, Your obedient Servant, SIDNEY DAVIES. 79—80 Borough of Woolwich. Vital Statistics of Whole District during 1904 and previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of NonResidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all ages belonging to the District. Number. Rate. Under 1 Year. At all Ages. Number. Rate per 1.000 Births Registd. Number. Rate Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1894 103727 3304 31.8 362 109 ... ... ... ... ... 1566 15.1 1895 105265 3321 31.5 476 143 ... ... ... ... ... 1757 16.7 1896 106840 3363 31.5 508 151 ... ... ... ... ... 1878 17.5 1897 108611 3406 31.3 455 133 ... ... ... ... ... 1642 15.1 1898 110273 3269 29.6 472 144 ... ... ... ... ... 1935 17.5 1899 113148 3367 29.8 534 158 ... ... ... ... ... 1889 16.6 1900 115498 3303 28.6 469 142 ... ... ... ... ... 2057 17.8 1901 117740 3535 30.0 455 128 1600 13.6 433 42 164 1722 14.6 1902 122505 3730 29.9 462 121 1678 13.7 278 43 208 1843 14.7 1903 123172 36591 30.0 390 106 1511 12.3 272 41 175 1637 13.3 Averages for 10 vears 1894 IMS 112678 ) 3429 30.4 458 134 ... ... ... ... ... 1793 15.9 1904 125791 3531 28.1 466 132 1636 130 261 40 169 1765 14.0 * Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Note. The deaths to be included in column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in column 12 are the number in column 7, corrected by the subtraction of the number in column 10 and the addition of the number in column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there ; and by the term " Residents " is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. Area of District in Total Population at all ages 117,178. acres'exclusiveof Number of Inhabited Houses ... 18,080 At Census of area covered by Average number of Persons per 1901. water. House 6.47 81 TABLE 1a. I. II. Institutions within the District receiving Sick and Infirm Persons from outside the District. Institutions outside the District receiving Sick and Infirm Persons from the District. Woolwich Union Infirmary Lewisham Infirmary Royal Arsenal Hospital Greenwich do. Auxiliary Hospital Herbert Hospital Woolwich and Plumstead Cottage Seamen's do. Hospital Brook do. Eltham Cottage Hospital Park do. Guy's do. King's College do. Charing Cross do. Middlesex do. St. Bartholomew's do. St. Thomas's do. Children's do. City of London do. Brompton do. National do. University do. Bethnal Green Chest Hospital L.C.C. Asylum, Dartford Banstead Asylum Cane Hill do. Caterham do. Claybury do- Horton do. Leavesden do. 82 TABLE 1b. Deaths of Persons belonging to the Borough of Woolwich occurring in various Institutions, 1904. Names of Institutions, &c. Number of Deaths. Grand Totals. M. F. Total. Woolwich Union Infirmary 128 86 214 Greenwich do. 1 0 1 Lewisham do. 7 5 12 Total Poor Law Infirmaries ... ... 227 Herbert Hospital 16 0 16 Female do. 2 3 5 Royal Arsenal Hospital 5 0 5 Total in Government Hospitals ... ... 26 Cottage Hospital, Woolwich 3 2 5 Do. Eltham 4 3 7 Do. Blackheath and Charlton 1 1 2 Do. Kidbrooke 0 1 1 Total in Cottage Hospitals 15 Fever Hospitals 21 17 38 38 Seamen's Hospital 2 0 2 Guy's do. 11 3 14 King's College do 2 0 2 London do. 4 1 5 St. Bartholomew's Hospital 2 1 3 Charing Cross do. 8 1 4 Middlesex Hospital 0 2 2 St. Thomas's do. 1 0 1 National do. 2 1 3 St. George's do. 1 0 1 University do. 1 0 1 Total in General Hospitals ... ... 38 Children's Hospitals 3 0 3 3 Brompton Chest Hospital 0 1 1 Bethnal Green do. 3 1 4 Total in Chest Hospitals ... ... 5 Lunatic Asylums 19 17 36 36 Four other Institutions 5 5 10 10 Totals 247 151 398 398 83 TABLE II. Vital Statistics of Separate Localities, 1901-2-3-4. Increase of Population since 1901 Census, estimated by number of new houses occupied, and number of persons to a house in the Parish. Wards. 1901. 1902. 1903. 1904. Population estimated to middle of year Births Registered. Deaths at all ages. Deaths under 1 Year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 Year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 Year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 Year. Dockyard 8712 282 137 40 8712 286 146 28 8712 275 141 28 8712 286 159 39 St. Mary's 10439 203 122 25 10439 226 149 30 10439 222 147 39 9788 184 121 35 River N. 14504 416 292 66 N. 3450 135 66 26 3450 140 50 16 3991 155 71 30 s S.11444 293 219 32 11444 277 205 43 11405 237 193 37 St. George s 8078 298 151 35 8078 284 135 36 8078 303 136 39 8078 321 143 48 Burrage 9837 253 133 24 9837 228 154 28 9837 235 133 17 9726 219 123 23 Herbert 9195 240 104 22 9679 261 129 28 9679 261 94 21 9893 220 98 20 St. Margaret's 10193 325 120 42 11826 448 163 50 11826 399 166 38 12337 388 161 35 Central 10220 299 142 36 10263 341 138 46 1026.3 276 99 26 10228 267 87 24 Glyndon 9829 319 140 30 9882 287 146 34 9882 313 144 33 9609 291 165 42 St. Nicholas 20239 737 265 106 22985 698 312 106 22985 731 235 71 21031 685 319 114 Eltham 7787 177 108 26 10002 243 85 23 10669 258 87 19 11153 278 123 28 84 TABLE III. Cases of Infectious Disease Notified during the year 1904. Notifiable Disease. Cases Notified in Whole District. Total cases notified in each locality. No. of cases removed to Hospital. No. of cases of Mistaken Diagnosis (included in preceding figures). At all Ages. At Ages—Years. River. Dockyard. St. Mary's. St. George's. Burrage. St. Margaret's. Herbert. Glyndon. Central. St. Nicholas. Eltham. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small Pox 6 ... ... ... 1 5 ... 1 4 ... ... ... ... ... ... 1 ... ... 6 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 163 3 59 78 16 13 ... 16 11 13 11 12 30 11 8 22 24 5 134 11 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erisipelas 74 ... 4 6 9 43 ... 12 5 ... 9 ... 9 1 8 1 7 12 0 0 Scarlet Fever 472 ... 122 280 46 20 ... 61 34 16 39 44 69 42 20 31 100 16 397 3 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 25 ... ... 7 8 10 ... 1 ... ... 5 1 ... ... ... ... 6 8 21 1 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever l ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 0 ... Puerperal Fever 5 ... ... ... 2 3 ... ... ... ... ... 1 1 ... 1 ... 2 ... 0 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 186 ... 1 11 45 127 2 28 25 16 9 15 21 7 6i 17 35 "7 ... ... Totals 932 7 186 383 121 221 14 119 81 45 73 80 131 61 43 77 174 48 558 16 85-86 TABLE IV.—Causes of, and Ages at Death during the Year, 1904. Disease. Deaths in or belonging to whole District at subjoined ages. All Ages. Males Females Under 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 over 85 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 28 17 11 10 14 4 .. .. .. .. .. .. .. .. .. .. Scarlet Fever 16 11 5 1 8 6 .. .. 1 .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 23 13 10 3 .. .. .. .. 2 .. .. .. .. .. .. .. Whooping Cough 54 23 31 26 28 .. .. .. .. .. .. .. .. .. .. .. Diphtheria and Membranous Croup 29 14 15 1 16 9 3 .. .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 6 4 2 .. .. 1 .. .. 1 1 3 .. .. .. .. .. Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa and Dysentery 55 25 30 44 5 1 1 .. .. .. .. .. 1 1 2 .. Epidemic or Zymotic Enteritis 95 50 45 82 11 .. .. .. .. .. .. .. .. 1 1 .. Enteritis 19 11 8 12 2 1 .. .. .. .. .. .. .. 2 .. .. Other Continued Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 4 4 .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. Puerperal Fever 2 .. 2 .. .. .. .. .. .. 2 .. .. .. .. .. .. Syphilis 8 2 6 4 .. .. .. .. 2 1 .. .. 1 .. .. .. Rheumatism 11 7 4 .. .. .. .. .. 1 3 3 1 1 .. .. .. Gout 4 4 .. .. .. .. .. .. .. .. .. .. 1 3 .. .. Other Septic Diseases 4 2 2 1 .. .. .. .. .. 1 .. .. 1 .. .. .. Intermittent Fever and Malaria Cachexia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Meninges 16 10 6 5 5 5 1 .. .. .. .. .. .. .. .. .. Tuberculosis of Lungs (Phthisis) 206 135 71 1 5 2 5 10 20 54 49 38 17 3 2 .. Tuberculosis of Intestines and Peritoneum 12 7 5 4 5 2 1 .. .. .. .. .. .. .. .. .. Other forms of Tuberculosis 25 11 14 4 4 7 1 1 3 1 1 .. 2 .. .. Alcoholism 5 4 1 .. .. .. .. .. .. 1 2 1 1 .. .. .. Cancer 93 34 59 .. .. 1 .. .. 1 1 16 15 26 21 10 1 Diabetes 6 4 2 .. .. .. .. .. .. 2 .. 1 3 .. .. .. Premature Birth 71 40 31 71 .. .. .. .. .. .. .. .. .. .. .. .. Developmental Diseases 90 51 39 82 5 1 2 .. .. .. .. .. .. .. .. .. Old Age 80 38 42 .. .. .. .. .. .. .. .. .. 1 13 53 13 Meningitis 16 7 9 4 5 2 .. .. .. .. 4 .. 1 .. .. .. Inflammation and Softening of Brain. Other Diseases of Brain and Nervous 9 3 6 .. .. .. •• .. .. .. .. 1 2 3 3 .. System 76 36 40 22 5 .. 1 2 2 8 5 11 9 7 3 1 Organic Diseases of the Heart 103 56 47 .. 2 1 4 1 1 4 18 12 24 28 8 .. Cerebral Hoemorrhage, Embolism and Thrombosis 62 33 29 .. .. .. .. 1 1 .. 5 11 9 17 14 4 Apoplexy and Hemiplegia 18 9 9 .. .. .. .. .. .. .. 1 1 5 6 5 .. Other diseases of Blood Vessels and Heart 32 15 17 .. .. .. .. 1 2 1 5 6 10 3 3 1 Acute Bronchitis 78 47 31 34 19 1 .. .. .. 1 .. 7 3 6 6 1 Chronic Bronchitis 72 36 36 1 .. .. .. .. .. 1 2 5 12 26 23 2 Lobar (Croupous) Pneumonia 9 5 4 1 .. .. 1 .. .. 2 .. 3 1 .. .. .. Lobular (Broncho) " 56 28 28 19 19 .. 1 .. 2 .. 3 .. 4 2 4 .. Pneumonia 63 39 24 9 5 1 .. 2 1 6 7 14 8 7 3 .. Other diseases of Respiratory System 7 4 3 .. 1 .. .. .. 1 1 .. .. 2 2 .. .. Diseases of Stomach 9 4 5 .. .. .. .. .. .. .. 1 .. 1 .. 1 .. Obstruction of Intestines 9 6 3 5 .. .. .. .. .. 1 .. .. .. 2 1 .. Cirrhosis of Liver 22 9 13 .. .. .. .. .. .. .. 3 7 9 3 .. .. Other diseases of Digestive System Nephritis and Bright's Diseases 16 7 9 8 .. .. 1 .. .. 3 1 1 2 2 1 .. 35 21 14 .. .. .. .. .. .. 1 4 5 9 9 7 .. Tumours and other Affections of Female Genital Organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Accidents and Diseases of Parturition 3 .. 3 .. .. .. .. .. 1 1 1 .. .. .. .. .. Deaths by Accidents or Negligence 42 30 12 9 6 3 .. 2 2 4 4 7 2 2 1 .. Deaths by Suicide or Homicide 8 4 4 .. .. .. .. .. .. .. 1 3 2 1 1 .. Deaths from ill-defined causes 25 16 9 9 1 .. .. .. 1 .. 1 2 3 3 4 1 All other Diseases 31 21 10 5 3 1 1 1 1 1 .. 2 3 5 6 2 Totals 1763 957 806 479 174 53 24 25 44 105 143 158 182 182 168 26 87-88 TABLE IVA. Disease. Deaths in or belonging to Localities, at all Ages in Wabds. Deaths in Public Institutions in the District. Deaths in Outlying Institutions. River. Dockyard. St. Mary's. St. George's. St. Nicholas. Central. Glyndon. St. Margaret's. Herbert. Burrage. Eltham. North. South. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 3 2 2 '2 2 5 .. 2 4 1 3 2 .. 2 Scarlet Fever 1 1 2 .. 2 1 .. .. 2 2 3 2 .. 13 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza .. 5 2 .. 2 5 1 1 2 2 3 .. 2 .. Whooping Cough .. 5 3 3 10 5 1 2 11 5 4 5 .. .. Diphtheria and Membranous Croup 2 4 2 3 .. 7 1 1 5 3 1 .. 1 .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. 2 1 .. .. .. .. .. .. .. .. Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea and Dysentry .. 8 2 5 5 11 1 8 7 6 2 .. 2 .. Epidemic or Zymotic Enteritis 14 3 7 8 7 33 6 10 4 .. .. .. 3 .. Enteritis 2 .. 3 1 2 3 .. 5 2 1 .. .. 1 .. Other continued Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. 1 .. .. .1 1 .. 1 .. .. .. Puerperal Fever .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. Syphilis 2 .. .. .. 2 1 .. 2 .. 1 .. .. 4 .. Rheumatism .. .. 1 .. 1 2 3 3 .. .. 1 .. .. .. Gout .. .. .. .. .. .. .. 1 .. 2 .. .. 1 .. Other Septic Diseases 1 1 .. .. .. 1 .. .. .. .. 1 .. 1 2 Intermittent Fever and Malaria Cachexia .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Meninges 1 2 1 1 .. 3 1 3 1 .. 2 1 .. .. Tuberculosis of Lungs (Phthisis) 8 29 22 19 15 41 13 16 17 7 10 9 61 17 Tuberculosis of Intestines and Peritoneum .. 1 2 1 2 2 .. .. 2 1 .. 1 .. 1 Other forms of Tuberculosis .. 4 3 1 2 10 2 1 1 .. 1 .. 3 4 Alcoholism .. 2 .. .. 1 .. .. .. 1 1 .. .. 3 1 Cancer 1 13 11 4 5 13 3 10 14 4 8 7 17 12 Diabetes .. .. 1 .. 1 .. .. .. 1 2 .. 1 2 .. Premature Births 2 7 5 2 12 15 6 6 4 .. 6 6 5 1 Developmental Diseases 3 5 11 7 4 26 5 8 8 4 5 4 1 1 Old Age 3 7 6 8 7 11 3 10 6 6 6 7 28 4 Meningitis 1 5 .. 1 .. 5 .. 1 .. 1 1 1 2 .. .Inflamation and Softening of Brain .. 2 .. 1 .. 1 .. .. 2 1 .. 2 .. 3 Other Diseases of Brain and Nervous System 2 9 6 6 5 13 2 9 4 5 10 5 9 22 Organic Diseases of the Heart 2 14 8 10 6 16 5 7 13 8 4 10 18 4 Cerebral Hemorrhage, Embolism and Thrombosis 1 4 6 9 1 6 4 3 8 5 7 8 11 3 Apoplexy and Hemiplegia 1 6 1 .. .. 1 .. 3 .. 2 3 1 4 .. Other Diseases of Blood Vessels and Heart .. 4 4 1 2 4 2 5 1 2 2 5 1 8 Acute Bronchitis 2 7 6 8 8 14 4 7 .. 7 5 6 3 2 Chronic Bronchitis .. 11 6 4 2 8 5 5 7 3 14 7 11 6 Lobar (Croupous) Pneumonia .. .. 1 1 1 2 .. 2 1 .. 1 .. .. 2 Lobular (Broncho) Pneumonia 7 9 11 2 4 7 5 4 .. 3 2 2 2 2 Pneumonia 4 5 6 3 8 8 .. 5 7 4 6 7 3 5 Other Diseases of Respiratory System .. 1 1 .. 1 1 .. 1 1 .. .. .. .. 2 Diseases of Stomach .. 3 .. .. .. 1 .. 1 1 .. .. 3 .. .. Obstruction of Intestines .. 1 2 .. 1 2 .. 1 .. .. 1 .. 3 Cirrhosis of Liver .. 2 2 .. 3 7 2 2 .. 2 2 .. 4 1 Other Diseases of Digestive System .. 1 1 2 2 3 4 1 .. .. .. 2 2 3 Nephritis and Bright's Disease 1 2 4 2 .. 7 2 3 5 2 3 4 3 2 Tumours and other Affections of Female Genital Organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. Accidents and Diseases of Parturition .. .. .. .. .. .. .. .. 1 .. .. 2 Deaths by Accidents or Negligence 2 5 2 2 6 5 8 7 1 1 3 7 8 Deaths by Suicide or Homicide .. .. 1 .. 2 .. .. 1 .. 2 1 1 2 .. Deaths from Ill-Defined Causes 1 .. 2 1 5 6 1 1 5 1 2 .. 3 All other Diseases 2 3 3 2 1 5 5 4 1 1 1 3 4 6 Totals 71 193 159 121 143 319 87 165 161 98 123 123 221 169 89 TABLE V. Rates per 1,000 Persons on the Population, estimated to the Middle of the Year. Year Small Pox, Cholera. Erysipelas. Diphtheria and Membranous Croup. Scarlet Fever. Typhus Fever. Enteric and Continued Fevers. Relapsing Fever. Puerperal Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1891 0.01 .. .. .. 0.58 0.05 0.51 0.08 1.52 0.04 0.01 .. 0.37 0.06 .. .. 0.15 0.03 189'2 0.04 .. .. .. 100 007 1.3 0.41 9.4 0.33 .. .. 0.41 0.13 .. .. 0.09 0.02 1893 .. .. .. .. .... .. .. .. .. ... .. .. .. .. .. .. .. .. 1894 0.35 0.03 .. .. 0.96 0.04 1.7 0.56 7.8 0.42 .. .. 0.47 0.11 .. .. 0.04 0.03 1895 0.19 0.01 .. .. 0.93 0.02 2.0 0.47 5.5 0.20 .. .. 2.35 0.38 .. .. 0.08 .. 1896 0.03 .. .. .. 1.03 0.04 2.8 0.87 5.0 0.24 .. .. 0.62 0.07 .. .. 0.303 0.01 1897 0.01 .. 0.03 .. 0.83 0.04 2.6 0.58 6.0 0.12 .. .. 0.45 0.05 .. .. 0.04 0.02 1898 .. .. 0.02 .. 0.86 0.02 2.2 0.31 5.7 0.16 .. .. 0.52 0.11 .. .. 0.09 0.08 1899 .. .. .. .. 0.83 0.06 3.0 0.36 7.8 0.09 .. .. 0.52 0.09 .. .. 0.09 0.07 1900 0.01 .. .. .. 0.91 005 3.1 0.27 3.9 0.09 .. .. 0.59 0.10 .. .. .. .. 1901 0.18 .. .. .. 0.61 .. 1.8 0.16 2.6 0.04 .. .. 0.58 0.11 .. .. .. .. 1902 1.82 0.30 .. .. 0.78 0.01 1.87 0.18 2.14 0.06 .. .. 0.40 0.10 .. .. 0.09 0.05 1903 0.05 .. .. .. 0.47 .. 1.51 0.11 3.16 0.03 .. .. 0.34 0.05 .. .. 0.02 0.01 1904 0.05 .. .. .. 0.59 0.03 1.30 0.23 3.75 0.13 .. .. 0.19 0.05 .. .. 0.04 0.02 Note.—Data for 1893 could not be obtained. 90 TABLE VI. Scarlet Fever aNd Diphtheria. Number of Patients attending each School. School. On Roll. Scarlet Fever. Diphtheria and Membranous Croup. Wood Street 1050 6 2 Maryon Park 754 2 1 Mulgrave Place 881 12 9 Union Street 859 7 — Elizabeth Street 793 24 3 Eglinton Road 1234 8 3 Fox Hill 227 3 - Bloomfield Road 1631 43 5 Burrage Grove 963 4 8 "Vicarage Road 1012 6 1 Plum Lane 757 11 1 Earl Street 1008 5 1 Ancona Road 1221 13 14 Plumstead Road 846 6 3 The Slade 962 12 4 High Street 1268 17 2 Conway Road 1346 25 7 Purrett Road 1098 3 — Tiinbercroft Road 403 5 1 Wickham Lane 485 20 3 Bostall Lane 894 1 4 Church Manorway 388 7 2 Grangehill Road 569 6 1 Pope Street 588 3 — Deansfield Road 214 — — St. Mary 752 7 2 St. Peter 638 1 3 St. Michael 638 6 1 St. Thomas — 7 1 Christ Church 110 - — All Saints 452 7 — Central 585 16 8 St. Patrick 182 — — Roper Street 400 1 — All other Schools — 26 5 Total 25208 300 95 91-92 TABLE VII.—Analysis of Sickness and Mortality Statistics in London during the year 1904. Cities and Boroughs. Estimated population in the middle of 1904. Notified Cases of Infectious Disease. t Deaths fbom Principal Infectious Diseases. Deaths from all causes. Death rate per 1,000 living. Deaths of infants under one year to 1,000 births. Small-pox. Scarlet fever. Diphtheria.* Typhus fever. Enteric fever. Other continued fevers. Puerperal fever. Erysipelas. Cholera. Total. Annual rate per 1,000 persons living. Small-pox. Measles. | Scarlet fever. Diphtheria.* Whoopingcough Typhus fever. Enteric fever. Other continued fevers. Diarrhoea. Total. ; Annual rate per 1,000 persons living. London 4,648,950 491 13,438 7220 3 1896 27 273 4947 - 28,295 6.1 25 2,256 365 723 1495 - 286 6 4750 9906 2.14 74,555 16.1 144 West Districts. Paddington 146,975 4 363 143 - 48 — 10 117 - 685 4.7 2 40 10 19 16 - 10 — 132 229 1.56 2017 13.8 136 Kensington 179,236 3 267 187 - 47 3 11 141 - 659 3.7 1 68 5 17 19 - 6 1 139 256 1.45 2558 14.3 150 Hammersmith 117,412 - 285 204 - 39 1 12 123 - 664 5.7 — 106 6 22 36 - 5 — 121 296 2.53 1840 15.7 152 Fulham 152,482 - 295 300 - 39 - 8 130 - 772 5.1 — 64 4 23 58 - 6 — 224 379 2.49 2346 15.4 153 Chelsea 74,329 - 108 61 - 13 - 7 45 - 234 3.2 — 25 6 5 26 - 2 — 46 110 1.49 1225 16.5 156 City of Westminster 177,321 6 313 145 - 51 2 5 126 — 649 3.7 — 23 9 7 18 - 10 2 84 153 0.87 2396 13.5 125 North Districts. St. Marylebone 130,337 8 295 118 - 50 — 3 187 - 661 5.1 — 50 9 14 13 - 3 — 108 197 1.51 2109 16.2 94 Hampstead 86,663 1 169 58 - 27 1 6 56 318 3.7 — 17 2 4 8 - 5 — 21 57 0.66 884 10.2 113 St. Pancras 235,936 7 848 349 - 136 — 10 258 1608 6.8 — 127 2.7 38 82 - 17 — 183 474 2.01 4102 17.4 150 Islington 341,044 18 1150 347 1 128 — 24 280 - 1948 5.7 1 181 35 29 84 - 18 — 248 596 1.75 5243 15.4 129 Stoke Newington . 52,445 8 154 61 — 14 — 3 53 293 5.6 — 7 3 8 12 - 3 — 26 59 1.13 697 13.3 114 Hackney 226,266 13 858 571 - 185 3 23 266 - 1919 8.5 — 76 20 55 55 - 26 — 249 481 2.13 3366 14.9 142 Central Districts. Holborn 57,161 6 98 46 - 41 — 7 76 274 4.8 2 42 — 4 9 - 4 — 41 102 1.80 1054 18.5 109 Finsbury 98,958 15 330 146 - 46 — 5 106 - 648 6.6 3 58 17 16 28 - 9 — 123 254 2.57 2100 21.3 140 City of London 23,482 2 32 40 - 14 — - 21 - 109 4.7 — — 1 2 7 - - — 4 14 0.60 390 16.7 104 East Districts. Shoreditch 117,033 14 343 188 - 48 1 5 178 — 777 6.7 2 81 13 18 63 - 8 — 189 374 3.20 2378 20.4 188 Bethnal Green 130,207 126 661 425 - 58 4 12 224 - 1510 11.6 7 90 18 47 52 - 6 1 162 383 2.95 2500 19.3 157 Stepney 303,791 90 1258 821 1 198 _ 15 470 - 2853 9.4 3 174 33 90 126 - 30 — 403 859 2.84 5876 19.4 155 Poplar 169,905 42 547 670 - 93 — 15 204 - 1571 9.3 3 91 24 84 81 - 13 — 272 568 3.35 3149 18.6 154 South Districts. Southwark 207,937 28 415 281 - 92 — 12 298 1126 5.4 1 191 12 26 118 - 18 1 282 649 3.13 4169 20.1 174 Bermondsey 129,397 310,359 19 454 193 - 73 1 5 186 - 931 7.2 — 136 18 16 69 - 16 1 200 456 3.52 2582 20.0 172 Lambeth 28 658 326 - 100 4 16 248 - 1380 4.5 — 164 16 34 109 - 11 — 316 650 2.10 4884 15.8 138 Battersea 175,465 7 385 227 - 63 2 7 161 - 852 4.9 — 59 10 14 59 - 13 — 198 353 2.02 2541 14.5 147 Wandsworth 257,448 6 772 404 - 71 3 14 270 1540 6.0 — 106 14 42 50 11 — 225 448 1.73 3435 13.4 122 Camberwell 268,384 19 956 270 - 78 1 13 327 - 1664 6.2 — 110 17 21 99 - 16 — 246 509 1.90 3992 14.9 144 Deptford 113,509 11 405 196 - 30 10 151 - 803 7.1 — 76 10 16 49 - 3 — 124 278 2.46 1823 16.1 145 Greenwich 101,651 1 213 152 - 49 - 2 86 - 503 5.0 — 40 3 11 56 - 9 — 110 229 2.26 1455 14.4 142 Lewisham 140,401 - 337 130 - 29 - 8 83 - 587 4.2 — 25 7 12 37 - 2 — 115 196 1.41 1681 12.0 123 Woolwich 123,416 8 468 161 - 27 1 5 75 - 745 6.1 - 29 16 29 56 - 6 — 159 295 2 .40 1763 14 .3 135 Port of London — 1 1 - - 9 - - - - 12 - - - - - - - - - - - - - - - * Including membranous croup. 93 Table VIII. Meteorology and Registered Deaths from all causes, and from certain prevalent Diseases in each week of the year, 1904. Week. Date of ending. Temperature of Air. Temperature 3 feet below ground. Mean Humidity, Complete Saturation = 100. No. of days Rainfall. Rainfall in Inches. Deaths corrected for Public Institutions. Highest during Week. Lowest during Week. Mean Temperature. All Causes. Diarrhoea. Six other Zymotic Diseases. Bronchitis and Pneumonia. Tubercle. J an. 9 47.7 29.3 39.8 + 42.10 91 5 0.29 30 0 0 6 7 „ 16 51.8 33.0 42 1 + 42.83 82 4 0.69 36 0 4 5 9 „ 23 48.9 26.2 35-7 — 42.26 92 3 0.18 37 0 1 7 4 30 50.9 28.8 40-9 + 41.38 86 3 0.92 35 0 4 5 7 Feb. 6 49.5 31.7 40-6 + 42.24 87 7 1.15 43 2 1 10 6 „ 13 49.9 32.4 42-1 + 42.12 81 6 1.27 33 0 3 5 1 „ 20 53.7 29.8 38-8 — 41.83 81 5 0.45 34 0 4 9 8 „27 54.2 29.2 38 3 - 41.96 75 1 0.03 42 0 9 7 5 Mar. 5 41.2 27.2 33 3 — 40.57 82 3 0.52 29 1 4 7 5 „ 12 59.1 27.2 405 — 40.62 84 2 0.24 42 0 1 9 4 „ 19 555 26.4 40-8 — 41.23 77 2 0 .06 31 1 2 4 5 „ 26 54.0 31.8 43 3 + 42.47 80 4 0.13 36 0 0 10 3 April 2 55.7 31.4 42 0 - 42.75 79 3 0.45 36 0 1 14 8 1 st Qr 59.1 26.2 6 + 7 — 41.87 83 48 6.38 469 4 34 98 72 April 9 64.0 37.3 48.0 + 43.91 71 6 0.37 49 0 6 8 8 „ 16 66.9 36.5 49 .6 + 45.54 71 2 0.32 42 0 2 10 4 „23 64.0 33.2 49.1 + 47.19 71 2 0.24 30 0 1 3 7 „ 30 60.9 33.8 49.6 + 47.66 72 2 0.65 32 0 2 8 6 May 7 63.9 39.2 49.0 — 48.72 70 3 0.55 45 0 4 4 8 ., 14 69.9 34.2 49.7 — 48.68 81 3 0.29 36 0 6 5 5 „ 21 72.6 39.2 54.0 + 51.24 65 2 0 .35 27 1 5 2 6 „ 28 75.1 46.5 57.3 + 52.44 86 4 0.30 25 2 6 0 4 June 4 68.8 43.9 56.0 — 54.22 84 3 0.71 25 0 5 4 4 „ 11 71.2 46.7 55.9 — 55.17 75 2 0.12 19 0 0 2 3 „ 18 740 476 59.6 + 56.30 72 2 0.27 28 2 3 5 4 „ 25 76.1 44.3 58.6 — 57.74 68 2 0.17 29 0 4 2 9 July 2 73.9 44.5 59.7 — 58.39 67 3 0.15 22 0 1 1 4 2nd Qr 76.1 33.2 7 + 6 — 51.32 73 36 3 89 409 5 45 54 72 Note. 1- Means higher and — lower than the average of 60 years. 94 Table VIII.—continued. Week. Date of ending. Temperature of Air. Temperature 3 feet below ground. Mean Humidity, Complete Saturation = 100. No. of days Rainfall. Rainfall in Inches. Deaths corrected for Public Institutions. Highest during Week. Lowest during Week. Mean Temperature. All Causes. Diarrhoea. Six other Zymotic Diseases. Bronchitis and Pneumonia. Tubercle. July 9 82.2 49.2 63.2 + 59.43 70 2 0.22 21 0 0 3 5 „ 16 85.2 53.8 68.1 + 61.52 62 1 0.01 33 5 3 2 5 23 85.0 54.2 67.1 + 63.58 61 2 0.04 33 5 2 2 3 „ 30 83.9 52.2 65.4 + 64.23 75 6 1.83 32 9 1 2 1 Aug. 6 91.0 53.0 681. + 64.53 65 2 0.08 45 13 0 1 8 „ 13 75.0 45.4 61.0 — 64.62 66 1 0.06 53 21 d 5 4 ,, 20 75.0 45.5 59.5 — 03.26 75 3 0.47 45 17 3 2 4 „27 72.7 43.5 57.6 — 61.58 76 3 0.22 49 20 5 2 4 Sept. 3 81.9 51.0 61.0 + 61.37 75 3 1.01 26 10 0 1 2 „ 10. 74.6 42.2 57.0 — 60.57 77 3 0.36 37 15 2 0 4 „ 17 71.4 41.2 56.4 — 59.29 81 3 0.24 33 11 1 2 5 „ 2 i 64.1 40.5 53.6 — 58.13 70 3 0.20 25 6 1 4 3 Oct. 1 65.7 38.8 52.1 — 56.72 87 2 0.14 26 4 0 5 4 3rd Qr 91.0 38.8 6 + 7 — 61.45 72 34 4.88 458 136 21 31 52 Oct. 8 58.0 37.9 50.3 — 56.03 81 4 0.55 36 2 3 o 6 ,, 15 59.2 31.9 47.8 — 54.46 85 1 0.02 32 1 4 5 6 „ 22 66.5 36.4 54.9 + 53.74 89 2 0.43 37 0 2 5 3 „ 29 59.9 36.2 49.9 + 54.19 84 1 0.20 27 0 2 6 4 Nov. 5 56.4 44.2 49.3 + 52.62 84 2 0.11 37 2 2 8 5 „ 12 58.8 3£.4 48.8 + 51.89 83 5 1.40 34 0 3 9 5 „ 19 53.6 30.0 42.2 50.23 94 2 0.04 41 0 2 11 6 „26 46.9 23.2 33.7 — 47.86 82 2 0.18 24 0 1 8 4 Dec. 3 52.3 25.9 40.5 — 44.98 87 2 0.07 30 0 2 6 6 „10 53.7 26.2 42.3 + 45.77 88 6 1.54 26 0 4 8 4 „ 17 56.0 31.5 43.4 + 44.73 87 6 0.50 31 0 2 8 4 ,, 21 54.0 24.8 34.1 — 44.80 97 1 0.04 41 0 3 9 4 „ 81 55.7 30.5 41.6 + 43.32 85 4 0.09 34 0 4 5 5 61 4th Qr 66.5 23.2 V + 6 — 49.59 87 38 5.17 430 5 34 90 Whole Yr. 91.0 23.2 26 + 26 — 51.06 79 156 20.32 1766 150 134 273 257 Note. + Means higher and — lower than the average of 50 years. 95 Table VIIIa. Weekly Averages. Temperature of the air. Temperature 3 feet below ground. Mean Humidity Complete Saturation = 100 No. of days Rainfall. Rainfall in inches. Deaths corrected for Public Institutions. Average of weekly maxima. Average of weekly minima. Average of weekly means. All Causes. Diarrhoea. Six other Zymotic Diseases. Bronchitis and Pneumonia. Tubercle. 1st Quarter 51.9 29.6 39.9 41.87 83 4 0.49 36 .30 3 8 6 2nd Quarter 69.3 40.5 53.5 51.32 73 3 0.30 31 .38 3 4 6 3rd Quarter 77.5 47.0 60.8 61.45 72 3 0.38 35 10.5 2 2 4 4th Quarter 56.2 31.9 44.5 49.59 87 3 0.40 33 .38 3 7 5 96 TABLE IX. Summary of Statistics for the first Quarter, 13 weeks ended 2nd April, 1904, corrected for Pubiic Institutions. A.—Birth, and Death Statistics for the Borough of Woolwich. Rates calculated per 1000 Population. Births. Deaths under one year of age. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Population estimated to middle of year. Number. Rate. Number. Rate per 1000 Births registered. / Number. Number. Rate. 125,791 913 29.0 105 115 443 83 16 40 467 14.8 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. A B C D A B C D A B C D 41,765 30.5 18.5 151 72,873 29.0 13.0 95 11,153 24.0 13.3 104 97 C.—Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Small Pox - - - - Scarlet Fever 25 84 7 116 Diphtheria 7 19 1 27 Enteric Fever 3 2 4 9 Erysipelas 6 5 4 15 Puerperal Fever - 2 - 2 Phthisis 23 19 1 43 Measles (Notified by School Teachers) 107 215 2 324 TABLE X. Summary of Statistics for the second Quarter, 13 weeks ended 2nd July, 1904, corrected for Public Institutions. A.—Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1000 population. Population estimated to middle of year. Births. Deaths under one year of age. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Number. Bate. Number. Rate per 1000 Births Registered. Number. Number Rate. 125,791 877 27.9 75 86 372 59 6 43 409 13.0 98 B.—Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Kate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. A B C D A B C D A B c D 41,765 25.2 15.6 118 72,873 30.3 11.7 69 11,153 22.2 11.5 97 C.-—Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Small Pox 1 1 Scarlet Fever 28 58 1 87 Diphtheria 9 9 2 20 Enteric Fever — 1 1 Erysipelas 3 6 1 10 Puerperal Fever 1 1 Chicken Pox 76 100 4 180 Phthisis 20 22 3 45 Measles (Notified by School Teachers) 72 376 448 99 TABLE XI. Summary of Statistics for the Third Quarter, 13 weeks ended 1st October, 1904, corrected for Public Institutions. A.—Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1000 population. Population estimated to middle of year. Births Deaths under one year of age. Deaths at all ages—Gross Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Number. Bate. Number. Bate per 1000 Births registered. Number. Number. Rate.  125,791 888 28.2 185 209 427 65 6 37 458 14.6 B.—Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Bate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Bate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. A B C D A B C D A B C D 130 41,765 29.5 16.3 224 72,873 28.0 14.4 209 11,153 24.8 8.6 100 C.—Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Small Pox - - - - Scarlet Fever 57 72 2 131 Diphtheria 13 19 — 32 Enteric Fever 4 7 2 13 Erysipelas 5 8 3 16 Puerperal Fever — 1 — 1 Chicken Pox 31 37 9 77 Phthisis 13 28 1 42 Measles 44 107 — 151 (Notified by School Teachers) TABLE XII. Summary of Statistics for the Fourth Quarter, 13 weeks ended 31st December, 1904, corrected for Public Institutions. A.—Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1000 population. Population estimated to middle of year. Births. Deaths under one year of age. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Number. Rate. Number. Rate per 1000 Births Registered. Number. Number. Rate. 125,791 852 271 101 119 394 54 12 48 430 13.7 101 B.—Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. A B C D A B C D A B c D 41,765 27.7 15.5 128 72,873 26.5 13.1 122 11,153 28.7 100 63 C.—Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Small Pox 4 1 5 Scarlet Fever 47 83 6 136 Diphtheria 22 58 2 82 Enteric Fever 1 1 1 3 Erysipelas 13 15 4 32 Puerperal Fever 1 — — 1 Chicken Pox 51 26 — 77 Phthisis 22 26 2 50 Measles 93 218 — 311 (Notified by School Teachers) 102 TABLE XIII. Birtli and Death Rates for each Parish for the year 190.1. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. A B C D A B C D A B C D 41,765 28.2 16.5 157 72,873 28.5 13.1 122 11,153 24.9 10.8 97 103-104 TABLE XIV. Deaths from Various Causes for the whole Borough, corrected for Public Institutions, nett. Week ending. Small-Pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Membranous Croup. Enteric Fever. Diarrhoea and Dysentry. Erysipelas. Puerperal Fever. Rheumatism. Tubercle. Alcoholism. Cancer. Bronchitis. Pneumonia. Accidents. Homicide I and Suicide. 1 January 9 .. .. .. .. .. .. .. .. .. .. .. 7 1 3 3 3 .. .. „ 16 .. .. .. .. 3 1 .. .. .. .. .. 9 .. 1 1 4 2 .. „ 23 .. .. 1 .. .. .. .. .. .. .. .. 4 .. 1 3 4 .. .. „ 30 .. .. 2 1 2 .. .. .. .. .. .. 7 .. 1 3 2 2 .. February 6 .. .. .. 2 1 .. .. 2 .. .. .. 6 .. 4 6 4 1 .. „ 13 .. .. .. 1 3 .. .. .. .. .. 1 1 2 3 1 4 3 .. „ 20 .. .. .. .. 4 .. .. .. .. .. .. 8 .. 1 5 4 .. .. „ 27 .. 2 .. .. 4 2 1 .. .. .. .. 5 .. 1 6 1 .. .. March 5 .. .. .. .. 3 1 .. 1 .. .. 1 5 1 2 4 3 .. .. „ 12 .. .. .. .. 1 .. .. .. .. .. 1 4 .. 2 7 2 2 .. „ 19 .. 1 .. .. 1 .. .. 1 .. .. .. 5 1 .. 2 2 .. .. „ 26 .. .. .. 1 .. .. .. .. .. .. .. 3 .. 2 7 3 .. .. April 2 .. 1 •• 2 •• .. .. .. .. .. .. 8 .. 4 7 7 1 .. 1st Quarter .. 4 3 7 22 4 1 4 .. .. 3 72 5 25 55 43 11 3 April 9 .. 4 .. 3 2 .. .. .. .. .. 1 8 .. 4 5 3 .. .. „ 16 .. 1 • • .. 1 .. .. .. .. .. 1 4 3 1 5 5 2 .. „23 .. .. 1 1 .. .. .. .. .. .. .. 7 .. 1 1 2 1 .. „ 30 .. .. .. 2 2 .. .. .. .. .. .. 6 .. 1 4 4 .. .. May 7 .. .. .. .. 4 .. .. .. 1 .. .. 8 .. 2 3 1 2 .. „ 14 .. 2 .. .. 4 .. .. .. .. .. 1 5 1 2 3 2 1 .. „ 21 .. 1 .. .. 1 2 1 1 .. .. .. 6 1 2 1 1 2 .. „ 28 .. .. .. .. 5 1 .. 2 .. .. .. 4 .. 2 .. .. .. .. June 4 .. 2 2 .. 1 .. .. .. .. .. .. 4 .. 3 1 3 1 .. „ 11 .. .. .. .. .. .. .. .. 1 .. .. 3 1 1 1 1 l .. „ 18 .. 1 1 .. 1 .. .. 2 .. .. .. 4 1 1 4 1 .. .. „ 25 .. 1 .. .. 3 .. .. .. .. .. 1 9 1 2 1 1 .. 1 July 2 .. •• 1 .. •• .. .. .. .. .. .. 4 2 2 •• 1 l .. 2nd Quarter .. 12 5 6 24 3 1 5 2 .. 4 72 10 24 29 25 11 1 July 9 .. .. .. .. .. .. .. .. .. .. .. 5 .. 3 1 2 .. .. „ 16 .. .. 1 .. 2 .. .. 5 .. .. .. 5 .. 4 2 .. .. .. „ 23 .. 1 .. .. 1 .. .. 5 .. .. .. 3 4 1 1 1 2 .. „ 30 .. .. .. .. 1 .. .. 9 .. .. .. 1 .. 1 .. 2 1 .. August 6 .. .. .. .. .. .. .. 13 .. .. .. 8 .. 1 .. 1 2 .. „ 13 .. 1 .. .. .. 2 .. 21 .. .. .. 4 1 2 1 4 3 .. „ 20 .. .. .. .. 1 1 17 1 .. .. 4 1 1 .. 2 .. .. „ 27 .. .. .. .. .. 5 20 .. .. .. 4 .. 2 2 .. .. .. September 3 .. .. .. .. .. .. .. 10 1 .. .. 2 .. 2 .. 1 .. .. „ 10 .. .. .. .. 1 .. .. 15 .. .. .. 4 2 2 .. .. 1 .. „ 17 .. .. .. .. .. 1 .. 11 .. .. .. 5 .. .. 1 1 2 .. „ 24 .. l .. .. .. .. 6 .. .. .. 4 .. .. 2 2 2 .. October 1 .. •• .. .. .. .. .. 4 .. .. .. 4 .. •• 2 3 .. .. 3rd Quarter .. 3 2 .. 6 9 1 136 2 .. .. 53 8 19 12 19 13 .. October 8 .. .. .. 1 .. 1 1 2 .. .. .. 6 .. 3 2 .. 1 .. „ 15 .. .. 1 .. 1 2 .. 1 .. .. .. 6 .. 4 3 2 .. .. „ 22 .. 1 .. .. .. 1 .. .. .. .. .. 3 .. 3 2 3 .. .. „ 29 .. .. .. 1 l 1 .. .. .. .. .. 4 .. .. 6 .. 1 1 November 5 .. 1 .. .. .. 1 .. .. .. .. .. 5 .. 1 5 3 .. 1 „ 12 .. .. .. 1 .. 1 .. .. .. .. 1 5 .. .. 4 5 .. .. „ 19 .. .. .. .. .. .. .. .. .. .. 1 5 .. 5 5 6 .. .. „ 26 .. 1 .. .. .. .. .. .. .. .. .. 4 .. .. 7 1 1 .. December 3 .. 1 .. 1 l .. .. .. .. .. .. 6 .. 3 3 3 1 1 „ 10 .. 1 .. .. .. 2 .. .. .. .. 1 4 .. 2 5 3 .. .. „ 17 .. 1 .. 2 .. 1 .. .. .. .. .. 4 .. 2 4 4 .. .. „ 24 .. 1 1 4 .. 1 .. .. .. .. .. 4 .. 1 3 6 1 1 „ 31 .. 1 1 •• .. 2 •• .. .. 1 1 5 .. 2 3 2 1 •• 4th Quarter .. 8 6 10 3 13 3 5 • • 2 4 61 3 26 52 38 9 4 Total for Year .. 27 16 23 55 29 6 150 4 2 11 258 26 94 148 125 44 8 105 TABLE XIVa. Total Deaths of Persons belonging to the County of London and Registered in the 52 weeks ending 31st December, 1904. All Causes. Small.pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia (origin uncertain). Diarrhoea. Phthisis. Deaths of Infants under 1 year of age. Deaths under 1 year to 1,000 Births Registered. 1st Quarter 20,604 8 070 81 204 595 ... 54 1 239 2055 4438 133 "2nd Quarter 10,546 12 930 81 103 505 ... 42 2 246 1815 3475 107 3rd Quarter 18,352 5 369 87 150 240 ... 85 2 3931 1577 6666 208 4th Quarter 19,054 ... 287 116 206 155 ... 105 1 335 2079 4020 128 Whole year 74,556 2256 365 723 1495 ... 286 0 4751 7526 18599 ... Death Rates 16.3 0.00 0.49 009 0.16 0.32 ... 0.06 0.00 1.02 1.62 ... 144 107-108 TABLE XV. Summary of Nuisances Abated, Notices Served and General Work of Public Health Department, 1904. Sanitary Inspectors' Districts. St. Mary's and Dockyard. River. Herbert. Central and Glyndon. St. Margaret's and part of St. Nicholas. St. Nicholas, Burrage. Eltham and St. George's. Total. PREMISES INSPECTED. No. of Houses inspected, house to house 644 732 882 801 857 974 705 1009 6,604 „ Re-inspections after service of notice 1760 2250 1864 1980 2005 2090 1860 1900 15,709 ,, Houses and premises specially inspected, including 1685 970 483 1091 1179 1024 737 504 7,673 infectious diseases and complaints „ Houses where drains have been tested by smoke test 55 30 25 27 20 49 15 12 233 ,, Houses where drains have been tested by water test 57 51 48 20 12 12 9 28 237 „ New houses inspected for Water Certificates. 6 32 3 7 123 110 6 131 418 NUISANCES ABATED—DRAINS. Waste pipes from baths, lavatories and wash-house sinks 80 58 24 61 30 30 10 18 311 repaired or disconnected Choked and defective drains 91 133 40 89 91 29 31 69 573 Defective traps 51 47 16 83 26 32 6 23 284 Defective and unventilated soil pipes 55 12 5 5 1 3 4 12 97 Cesspools abolished 1 - - - - - 1 — 2 W.C.'s. W.C.'s repaired, new traps or pans provided, fittings 164 179 53 62 40 39 64 108 709 repaired Water supply apparatus repaired 95 93 116 97 116 132 62 78 789 Foul pans cleansed 10 38 31 29 35 53 29 6 231 Additional w.c.'s provided to Factories and Workshops, &c — 2 — — — — — — 2 Do. do. Dwelling houses — 1 - - - - - - 1 PREMISES. Underground Rooms not in accordance with Act - 1 - — — — — 5 6 Interiors cleansed and defective roofs repaired 339 439 167 350 258 463 271 630 2,917 Damp walls remedied 36 55 55 143 148 59 46 128 670 Paving in yards and wash houses repaired 92 127 95 225 121 89 52 84 885 Through ventilation provided 17 5 30 37 16 9 1 23 138 Wash-houses without sinks and outlets for waste water 7 2 3 1 2 — — 5 20 Defective guttering and rain water pipes 49 72 43 106 80 112 19 42 523 Dustbins supplied 105 110 59 128 79 95 52 51 679 Dung pits provided 2 3 — 5 4 — — — 14 Cases of overcrowding remedied 7 35 11 17 33 18 5 52 178 Deficient light—windows supplied, or enlarged, or other 43 8 5 13 36 1 10 22 138 works Dampness in premises from defective water pipes 6 5 4 31 2 59 4 7 118 ANIMALS. Animals kept in such a state as to be a nuisance - 2 2 6 13 6 1 4 34 Accumulations of manure removed 4 31 3 20 9 12 12 3 94 WATER. Defective and foul cisterns used for dietary purposes 11 16 3 - 41 14 — 16 101 Defective and foul rain water tanks remedied 8 — 4 14 1 — 8 — 35 Insufficient supply and water cut of! by Water Company 8 25 1 4 8 18 7 2 73 No. of observations made of chimneys in connection with 25 46 30 6 21 1 1 6 136 smoke nuisances No. of smoke nuisances observed 3 9 15 — 2 — — — 29 Tents, vans, etc., inspected — — — — 2 16 — 20 38 Notices served with respect to Tents and Vans — — — — — 2 — 12 14 Inspections of Urinals accessible to the public 33 82 52 65 86 94 70 16 498 N.B.—For the most part the figures above give the nuisances found in each ward, but in certain cases—e.g., smoke observation, they shew the work of the Ward Inspector, outside as well as inside his special district. 109 Table XVa. SUMMARY OF WORK OF CHIEF INSPECTOR. Premises Inspected 1320 New Buildings Inspected 147 Ditches Cleansed 5 Defective Combined Drains Investigated and Reported on 22 Number of Houses referred to in such Combined Drains 129 Cowhouses and Slaughterhouses Inspection 25 Complaints Investigated 148 Attendances at Police Court . • 37 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for Proceedings 94 Summonses at Police Court 24 Bakehouses Inspected and Cleansed twice during the year . 63 Number of Houses Disinfected after Infectious Disease 857 Letters received 3989 „ written 3272 Notifications received 931 Certificates issued after Disinfection 1667 „ of Infectious Disease forwarded to Schools 1002 Complaints of Sanitary Defects 457 „ of Non-removal of Dust, viz. :— Woolwich 18 Plumstead 19 Eltham 5 Written Intimation Notices 4272 Statutory Notices 614 g 110 TABLE XVb. Factories, Workshops, Laundries, Workplaces, and Homework. 1.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Factories (Including Factory Laundries) 22 2 Workshops (Including Workshop Laundries) 107 10 Workplaces 47 15 Homeworkers'Premises.. 353 30 Total 529 57 2.—Defects found. Particulars. Number of Defects. Found. Remedied. Nuisances under the Public Health Acts:— Want of Cleanliness 24 24 Want of Ventilation 6 6 Overcrowding 3 8 Want of drainage of floors 1 1 Other nuisances 11 11 Sanitary accommodation insufficient unsuitable or defective 1 1 not separate for sexes Total 46 46 111 TABLE XVb. (continued). 3.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affii Abstract of the Factory and Workshop Act (S. 133) 1 Action taken in matters referred to H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory -Act (S. 5) ' Notified by H.M. Inspectors 2 Reports (of action taken) sent to H.M.Inspectors 3 Underground Bakehouses (S. 101):— In use during 1903 24 Certificates granted in 1903 24 in 1904 0 In use at the end of 1904 24 Number of Homework:— List of Outworkers (S. 107): — t :_f Outworkers. Lists received 81 353 Addresses of outworkers forwarded to other Authorities 38 received from other Authorities 41 Workshops on the Register (S. 131) at the end of 1904:— Workshop Laundries 17 ,, Bakehouses 62 Other Workshops 162 Total Number of Workshops on Register 241 G 2 112 TABLE XVc. Proceedings during 1904. Premises. Number of Places. Number of inspections, 1904. Number of notices, 1904. On register at end of 1903. Added in 1904. Removed in 1904. On register at end of 1904. Milk premises 154 54 12 196 196 9 Cowsheds 18 — — 18 56 9 Slaughter-houses 11 — — 11 83 6 Ice Cream premises 64 20 1 83 151 3 Registered Houses let in Lodgings 123 116 4 235 371 | * 8 f225 * For overcrowding. †For other conditions. Overcrowding, 1904— Number of Dwelling Rooms overcrowded 178 Number remedied 178 Underground Rooms— Illegal occupation dealt with during year 6 Number of rooms closed 3 Insanitary Houses— Number closed under the Housing of the Working Classes Act 1 Number of Prosecutions under By-laws under Public Health A ct, 1891— With respect to water closets, earth closets, etc. 1 With respect to sufficiency of water supply to water closets 2 With respect to drainage, etc. (Metropolis Management Act, section 202) 1 Mortuaries— Total number of Bodies removed 164 Total number of Infectious Bodies removed 2 113 TABLE XVI. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were Found. St. MARY'S AND DOCK YARD WARDS. Henry Street 13 10 Chapel Street 39 35 Station Road 9 7 Cambridge Terrace 8 6 Cambridge Place 7 5 North Kent Terrace 24 22 Rectory Grove 55 33 Paradise Hill 22 20 Frances Street 24 13 Kidd Street 54 21 Artillery Place 25 20 Back Lane 2 1 Orchard Street 30 25 Orchard Place 43 13 Warwick Street 67 50 Albion Road 50 27 George Street 22 16 Church Street 80 44 Parson's Hill 16 7 Siemens' Road 26 15 Trinity Street 18 8 Samuel Street 13 10 Delvin Street 15 13 Nightingale Place 19 15 The Common 50 48 Joseph Street 22 8 Ann Street 24 16 Prospect Place 34 16 Prospect Row 37 26 Bowling Green Row 10 6 Lower Wood Street 54 27 Ogilby Street 48 35 Robert Street 19 14 St. James' Place 13 12 Lower Pellipar Road 19 8 Godfrey Street 28 17 Marshall's Grove (including Grove Place, Sussex Place, Maria Terrace) 38 18 Kidd Street 27 18 Total 1104 705 —— 114 TABLE XVI.—continued. Name of Street. Number of Houses Inspected. Number where Defects were Found. RIVER WARD. Alexandra Street 25 16 Cock Yard, High Street 9 9 Eleanor Road 52 '39 Elizabeth Place, High Street 6 6 Fore, Albert, Sidney, and Stanley Houses, High Street 38 27 Glass Yard, High Street 6 6 Gough Street 31 16 Green's End 26 13 High Street (Part of) 11 11 Mulgrave Place 25 18 Nelson Street 10 9 Rodney Street 3 3 Taylor's Buildings 6 3 Union Street 21 9 Upper Market Street 21 13 Wellington Street 90 51 Albert Road, North Woolwich .. 151 112 Auberon Terrace, „ 12 11 Ann's Place ,, 4 4 Barge House Road, ,, 40 31 Davey's Square, ,, 11 6 Kate's Place, „ 10 9 Rhea Street, ,, 95 33 Winifred Street, ,, 29 12 Total .. 732 467 HERBERT WARD. Vambery Road 6 0 Brent Road 7 6 Cantwell Road 39 8 May Place 4 3 Cumberland Place 3 3 Nithdale Road 47 6 Edge Hill 12 3 Ripon Road 36 10 Graydon Street 12 11 Princes Road 80 43 Brookhill Row Cottages 5 4 St. Thomas's Cottages 6 0 115 TABLE XVI.—continued. Name of Street. Number of Houses Inspected. Number where Defects were Found. HERBERT WARD—continued. Portland Place 15 2 Bamfield Road 6(3 25 Barnfield Place 7 5 Red Lion Lane 57 31 Wesidale Road 51 24 Eglinton Road 99 47 Red Lion Place, Shooters' Hill 9 2 Herbert. Road 74 31 Llanover Road 57 20 Whitworth Road 76 29 Paget Road 46 16 Paget Terrace 11 4 Plumstead Common Road 43 18 Edge Hill Road 12 5 Total 882 356 CENTRAL AND GLYNDON WARDS. Oliver Street 26 16 Maxey Road 65 43 Villas Road 130 89 Majendie Road 46 23 Durham Road 18 12 Gossage Road 15 13 Park Road 66 32 High Street 69 30 Lakedale Road 108 55 Plumstead Road 103 54 Ann Street 155 114 Total 801 481 ST. MARGARET AND PART OF ST. NIOHOL AS WARD. Manthorp Road 29 25 Vicarage Park (East side) 25 25 Waverley Road 46 28 Maxey Road (Part) 38 26 116 TABLE XVI.—continued. Name of Street. Number of Houses Inspected. Number where Defects were Found. St. Margaret and Part of St. Nicholas Ward —continued. Hargor Road 61 42 Melling Street 23 9 Malton Street 47 13 St. John's Road 36 19 Lee Street 41 22 St. Margaret's Terrace 17 7 Park Road (West side) 36 14 Plumstead Common (Part) 20 9 King's Highway 34 20 Cemetery Cottages 7 5 Southland Road 7 3 Wood View Terrace 27 23 Holt Terrace 8 7 Bleak Hill 12 9 Scotch Flats 15 10 Timbercroft Lane 42 30 Albatross Street 44 25 Alabama Street 12 8 Heath Villas 7 4 Ennis Road 55 9 Heathfield Terrace 21 11 Francis Street 48 28 Elm Grove 35 25 Sutcliffe Road 42 26 Nyanza Street 15 5 Total 850 487 ST. NICHOLAS WARD. Reidhaven Road 129 101 Balgowan Street 30 20 Hylton Street 44 20 Kashgar Road 47 15 Abbey Grove 32 19 Gunning Street 29 18 Glenside Road 26 16 Hartville Road 41 25 Mabyn Road 29 19 Gavin Street 14 6 Heverham Road 29 10 117 TABLE XVI.—continued. Name of Street. Number of Houses Inspected. Number where Defects were Found. ST. NICHOLAS WARD—continued. Bateson Street 13 7 Abery Street 25 19 Garibaldi Street 24 9 Barth Road 85 47 White Halt Road 20 17 Brookdene Road 40 36 Marmadon Road 78 43 Kentmere Road 40 24 Bannockburn Road 91 51 High Street 102 22 Wiekham Lane 6 0 Total 974 544 BURRAGE WARD. Armstrong Street 31 15 Armstrong Place 30 18 Burrage Road 168 76 Burrage Grove 37 15 Crescent Road 53 37 East Street 26 15 Eton Street 37 16 Helen Street 11 8 Parry Place 38 19 Bloomfield Road 5 1 Frederick Place 93 29 Mount Pleasant 22 8 Mason'B Avenue 6 4 Maxey Road 103 26 Scott's Passage 4 0 Spray Street 7 3 Whitworth Place 27 6 Willenhall Road 26 13 Total 724 309 118 TABLE XVI.—continued. Name of Street. Number of Houses Inspected. Number where Defects were Found. ST. GEORGE'S WARD. Manor Street 36 31 Jackson Street 58 25 Milward Street 52 24 James Street 46 33 Dicey Street 35 19 Delvin Street 15 5 Ordnance Road 56 23 Fenwick Street 18 5 Total 316 165 . ELTHAM WARD. Reventlow Road 32 15 Lannoy Road 13 9 Blanmerle Road 39 30 Hainault Street 5 3 Green Lane (Victoria Cottages) 24 16 Pope Street (Pelbam Terrace) 21 16 Pope Street (Brentwood Cottages) 14 10 Gaitskill Road 9 0 Novar Road 10 6 Merchland Road 13 5 Blunt's Road 20 14 Elm Terrace 22 11 Messeter Place 7 5 Pound Place 18 13 Elizabeth Terrace, High Street 18 8 Roper Street 15 6 Jubilee Cottages 28 20 Cooper's Place 8 7 Frith's Buildings 12 6 Farm Cettages (Dairy Farm) 15 8 Court Yard 9 3 Osborne Terrace 8 5 Total 360 216 119 Table XVII. Prosecutions under Public Health and Housing of the Working Classes Act. Date of Final Hearing. Offence. Situation. Result. 1904. Jan. 14 Unsound Food 25, Park Road, Plumstead Fined £10and £3 3s. costs May 10 Sanitary defects 18, Bastion Road, Plumstead Fined 20s. and 23s. costs Mar. 22 Failure to provide w.c. Stable Yard, Powis Street Fined 3s. and £3 3s. costs „ 25 Premises unfit for human habitation 31, Chapel Street Closing order made, £2 4s. costs June 1 Sanitary defects 38, Rectory Grove Order to abate in 14 days, 23s. costs „ 1 do. 10, Gunning Street 24s. costs „ 1 do. U 3s. costs. „1 do. 14, Kasbgar Road 3s. costs July 1 „ 11 Insufficient water supply do. 24 & 24a, Green's End do. Dismissed on technical objection to summons Fined £3 and £2 2s. costs Dec. 29 Premises unfit for human habitation 44, Ropeyard Rails (occupier) Withdrawn „ 29 do. 44, Ropeyard Rails (owner) Work done, withdrawn ; £3 3s. costs Nov. 4 do. 141, Park Road (owner) Work done, £1 14s. 6d. costs „ 4 do. 141, Park Road (freeholder) Work done, £1 14s. 6d. COBtS „ 4 do. 141, Park Road (occupier) Withdrawn Aug. 3 Premises without water supply 13, Parson's Hill Work done, 3s. costs Sept. 9 Sanitary defects 38, The Common, Woolwich 23s. costs „ 20 do. 46, Majendie Road 23s. costs Oct. 20 Unsound meat (beef) 157, High Street, Plumstead Fine £150 and £4 4s. costs, or 5 months 20 do. (pork) do. J „ 20 do. (beef) do. £50 and £4 4s. costs, or 3 months „ 20 do. (pork) do. 26 Insufficient water supply 24 & 24a, Green's End £3 and 23s. costs, order to abate in 14 days „ 26 Defective repair of drain 12, Isla Road £5 and £3 3s. costs Dec. .16 Insufficient water supply 1, High Street, Woolwich Order to abate in 1 month and £5 5s. costs „ 16 Insufficient light 1, James Street, W. Order to abate in 1 month and 23s. costs 120 TABLE XVni. Summary of Articles Analysed, under the Sale of Food and Drugs Act, during the Year ending 31st December, 1904. Article. Number analysed. Number adulterated. Milk 364 32 Milk—Separated 1 1 Milk—Skimmed 1 1 Milk—Condensed 4 0 Butter 78 4 Blaud's Pills 2 0 Bovril 1 0 Olive Oil 2 0 Lard 2 0 Brand's Essences 1 0 Cod Liver Oil 4 0 Sweet Spirits of Nitre Liebig's Extract 2 0 1 0 Coffee 2 0 Borthwick's Beef Fluid 1 0 Vinum. Ipecac 1 0 Pulv. Rhe. Co. 1 0 Tea 9 0 Amnion. Tine. Quinine 1 0 Sugar 1 0 Magnesia 1 0 Camphorated Oil 1 0 Vinegar 6 0 Bread 3 0 Flour 4 0 Brandy 4 4 Total 498 42 121 TABLE XVIIIa. Proceedings under the Food and Drugs Act for the Year 1904. Article. Nature of Adulteration. Name and Address of Vendor. Remarks and Result of Proceedings (if any). Milk 7 6 per cent.fat abstracted E. Hiscock, 315, High Street, Plumstead Warranty proved—dismissed Milk 6 per cent.added water.. J. Swaisland, 53a, High Street, Woolwich Fine 30/- and 12/6 costs Milk 9 per cent.fat abstracted R. Mehew, 16, Lakedale Road, Plumstead Fine £5 and 23/- costs Milk 22 per cent.added water F. Lambeth, 2, Griffin Road, Plumstead £3 and 23/- costs Milk 12 per cent.fat abstracted F. Westaway, 1, Hartville Road, Plumstead Fine 10/- and 23/- costs Milk 10 per cent.fat abstracted A. E. Butter, 10, Jackson Street, Woolwich Fine 30/- and 12/6 costs Milk 5 per cent.fat abstracted A. Handsley, Kenuington Green Dismissed—warranty proved Butter .. All Margarine W. S. Francis, 170, Albert Road, North Woolwich Fine £5 and 23/- costs Milk 16 per cent.fat abstracted A. Handsley, Kennington Green Dismissed—warranty proved Milk 8 per cent.fat abstracted F. Wilson, 13, Ripon Road, Plumstead Fine 10/- and 23/- costs Milk 6 per cent.fat abstracted H. Perrett, 2, Parade, Eltham Warranty produced— Fine 10/- and 23/- costs Milk 13 per cent.fat abstracted F. J. Grant, 102, Ann Street, Plumstead Fine 10/- and 12/6 costs Milk 26 per cent.fat abstracted R. A. Pearce, 177, Plumstead Common Road, Plumstead Dismissed—warranty proved 122 Table XVI IIa.—continued. Article. Nature of Adulteration. Name and Address of Vendor. Remarks and Result of Proceedings (if any). Milk 26 per cent.fat abstracted B. A. Pearc9, 177, Plumstead Common Road, Plumstead Dismissed—warranty proved Milk 20 per cent.fat abstracted W. J. Tye, 102, Raglan Road, Plumstead Fine 10/- and 12/6 costs Milk 13 per cent.fat abstracted J. P. Earl, 24a, Glyndon Road, Plumstead Fine 10/- and 12/6 costs Milk 10 per cent.fat abstracted W. F. Corp, 3, Wellington Street, Woolwich Fine £10 and 23/- costs Milk 26 per cent.fat abstracted A. Swaisland, 53a, High Street, Woolwich Fine £5 and 23/- costs Milk 6 per cent.fat abstracted H. Willis, 2, Ritter Street, Woolwich Fine £3 and 23/- costs Milk Skimmed, with a quantity of Formalin in it W. H. Coppen, 7, Waverley Cottages, Woolwich Withdrawn—incomplete Analyst's certificate Milk 15 per cent.added water J. Ring, 44, Brewer Street, Woolwich Withdrawn Milk 15 per cent.fat abstracted E. J. Clements, 2, Cross Street, Woolwich Warranty incomplete—Fine 1/- and 12/6 costs Milk 4 per cent.added water, •001 per cent. Formic Aldehyde W. H. J. West, 31, Benares Road, Plumstead Fine £5 and 12/6 costs Milk 8 per cent.added water.. H. Willis, 2, Ritter Street, Woolwich Fine £5 and 23/- costs Milk •001 per cent. Formalin.. D. J. Large, 6, Herbert Road, Plumstead Fine £2 2s. Od. and 23/- costs Butter .. 17 per cent.added water J. Berry, 3c, George Street, Woolwich Fine 10/- and 23/- costs Butter .. Practically all margarine J. Sanders, 6, Sand Street, Woolwich Fine £6 and 12/6 costs 123 TABLE XIX. Food Seized, or Surrendered by Owners, as unfit for consumption. Articles. Quantity or Weight. Date of Seizure or Surrender. Remarks. Reason of Seizure or Condemnation. 1904. Pish 1 barrel 8th Jan. Surrendered Unsound Pork 51 lbs. 13th Feb. do. Tuberculosis Pork 42 lbs. 13th Feb. do do. Pork 64 lbs. 13th Feb. do. do. Pork 69 lbs. 20th Feb. do. do. Pork 5½ lbs. 20th Feb. do. do. Pork 99 lbs. 4th March do. do. Pork 70 lbs. 9th March do. do. Beef 97 lbs. 19th March do. Bone taint Cod Roes 1 box 25th March do. Unsound Pork 90 lbs. 25th March do. Tuberculosis Pork Head (7½ lbs.) 26th March do. do. Pork 54 lbs. 26th March do. do. Oysters 500 8th April do. Unsound Pork 101 Pigs'Maws (87 lbs.) 22nd April do. do. Beef Carcase of Cow 27th April do. Pneumonia, Emaciation and Dropsy Pork 65 lbs. 29th April do. Tuberculosis Pork 68 lbs. 3rd May do. do. Pork 73 lbs. 4th May do. do. Pork 70 lbs. 4 th May do. do Pork 87 lbs. 6th May do do. Pork 75 lbs. 13th May do. do. Mackerel 1 box (58 fish) 17th May do. Unsound Pork 41 lbs. 25th May do. Tuberculosis Tomatoes 6 cases 1st June do. Unsound Pork 85 lbs. 3rd June do. Swine Fever 124 TABLE XIX. (continued). Articles. Quantity or Weight. Date of Seizure or Surrender. Remarks. Reason of Seizure or Condemnation. 1904. Pork 76 lbs. 10th June Surrendered Tuberculosis Veal 59 lbs. 18th June do. Unsound (tainted) Kippers 7 boxes 13th July do. Unsound Pork 33 lbs. 22nd July do. Tuberculosis Pork 23 lbs. 22nd July do. do. Pigs' Kidneys 2 boxes (321bs.) 16th July do. Unsound Herrings 1 barrel 15th Aug. do. do. Rabbit One 12th Sept. do. Decomposed Skate 2 boxes 12th Sept. do. Unsound Beef 347 lbs. 16th Sept. Seized Tuberculosis Pork 36 lbs. 16th Sept. do. do. Pork 56 lbs. 23rd Sept. Surrendered do. Pork 168 lbs. 14th Oct. do. Tuberculosis and Nephritis Pork 43 lbs. 15th Oct. do. Tuberculosis Pork 61 lbs. 28th Oct. do. do. Pork 69 lbs. 11th Nov, do. Dropsy and Inflammation of Pleura Pork 74 lbs. 18th Nov. do. Tuberculosis Pork 64 lbs. 18th Nov. do. do. Pork 1 Head (8 lbs.) 19th Nov. do. do. Pork 75 lbs. 22nd Nov. do. do. Pork 44 lbs. 16th Dec. do. do. Pork 82 lbs. 20th Dec. do. do. Pork 20 lbs. 30th Dec. do. do. 125 TABLE XX. List of Level Bakehouses. Name. Address. Mrs. S. Fuller 48, Princes Road, Plumstead Chadwell Bros. GO, Plumstead Common Road C. Pullen 105, Plumstead Common Road J. R. All way 12G, High Street, Plumstead J. E. Porter 1, Riverdale Road do. E. Goodsell 307, High Street do. A. E. Paine 14, Gunning Street do. A. Jewiss 68, Glyndon Road do. F. Grant 102, Ann Street do. A. Chapman 2, High Street do. J.Fletcher 92, Plumstead Road do. — Letchford 109 do. do. J. Tait 136 do. do. J. Clark 152 do. do. G. Mackintosh 64, Villas Road do. R. Moaks 54, Parkdale Road do. W.C.Hill 82, Bannockburn Road do. J. Stratton 2, Stratton Terrace, Bostall Lane, Plumstead S. Harrison 122, Benares Road, Plumstead W. Jeflery 123, Burrage Road do. P. H. Mack Ill, High Street, Woolwich T. Newman 94, Wellington Street do. H. Moore 100, High Street do. A. Bradshaw 3. Green's End do. G. Porter 29, Charles Street do. F. W. Jackson 184, Elizabeth Street, North Woolwich C. Haas 122, Albert Road do. Mrs. Dennis 90, Brookhill Road, Woolwich H. Myers 33, Samuel Street do. E. Ewell 36, Chapel Street do. F. Holcombe 45, Warwick Street, do. G. West 10, King Street do. C. H. Wyatt 94, High Street, Eltham E. Scriven 111 do. do. F. Cook 142 do. do. C. Worboys 5, The Parade, New Eltham F. A. Finch 13 do. do. E. Hobbs 6, Well Hall Parade, Eltham H 126 TABLE XXa. List of Certified Underground Bakehouses. Name. ss. S. Betchley 33, Eglinton Road, Plumstead Merritt & Co. 50, Herbert Road do. H. Gilder 14, Westdale Road do. H. Percival 223, High Street do. J. Werner 1, Park Road do. S. Colin 58, Pattison Road do. E. Phillips 53, Ann Street do. — Plummer 46, Hudson Road do. O. Degen 14, Conway Road do. F. Farrier 30, Burrage Road do. W. T. Akers 16, Armstrong Place do. Dalton & Sons 13, Eton Road do. W. Arnold 57, Plumstead Road do. R. C. Davis 2, Crescent Road do. A. B. Sims 24, St. James' Place do. J. Colver 165, Sandy Hill Road do. E. Fairbrother 16, Woolwich Common, Woolwich B. Flood 31, Beresford Street do. L. Wilkenning 72, Henry Street do. F. Ginger 8, Hill Street do. W. C. Clothier 51, Albion Road do. F. Harper 23, George Street do. J. Franklin 21, Albion Road do. A. Hills 32, Church Street do. Mrs. Attenborough 60, Sand Street do. 127 TABLE XXI. List of Slaughterhouses. No. Name of Owner. Situation. 1 Eliza Biggs 1C8, High Street, Eltham. 2 Joseph Leech 78, Frederick Place, Plumstead 3 H. T. J. Reed & J. W. Funnell 25, Parry Place, Plumstead. 4 T. Mead C, High Street, Plumstead. 5 Hedley Vicars 41, Church Street, Woolwich. 6 Walter Monk 14, Church Street, Woolwich. 7 Frederink Bucknell Love Lane (rear of Wellington Street), Woolwich. 8 James and George Mitchell 25, Hare Street, Woolwich. 9 Hedley Vicars 30, Hare Street, Woolwich. 10 H. T. J. Reed & J. W. Funnell 38, Plumstead Common Road, Plumstead 11 Henry Fretter 33, Herbert Road, Plumstead. H 2 128 TABLE XXII. List of Cowhouses. No. Name and Address of Owner Situation. 1 Wm. J. Miller Keightley House Farm, Southwood Road, Eltham 2 Richard Higgs Coldharbour Farm, Chislehurst 3 John & Alfred Low, Avery Hill Farm, Eltham Park Farm, Eltham 4 W. F. Corp Lyme Farm, Eltham 5 E. Fisher & Sons, Crescent Farm, Sidcup Belmont Park Farm, Eltham 6 John Grace Pippinhall Farm, Eltham 7 William Ridewood Chapel Farm, Eltham 8 George Keen Clay Farm, New Eltham 9 Maurice Bayley Middle Park Farm, Eltham 10 Harry Furber Victoria Road Farm, Southend, Eltham 11 William Killick 52, St. James' Place, Plumstead 12 W. F. Corp, Lyme Farm, Eltham 13, Princes Road, Plumstead 13 Henry Woolsey 50, Francis Street, Plumstead 14 F. W. Webb 16, Lakedale Road, Plumstead 15 W. Ridewood, Chapel Farm, Elthan 3, Ripon Road, Plumstead 16 F. G. Cook, 13, Raglan Road, Plumstead 17 Lambeth Bros. 1, Griffin Road, Plumstead 18 John Chas. Terrington, 117, Shooters' Hill Road, Blackheath Rear of 14, 15, 16, Pellipar Road, Woolwich 129 APPENDIX I. Measles. Occurrence in Classes, Xmas to May, 1904. School. Proportion who have previously had Measles. Class. Date of Illness. Total cases in class. Class closed. Bloomfield Road 58/76 1 3/1/04. 2/2/04, 4/3/04, 5/3/04 4 52/75 2 29/2/04 (2), 5/3/04, 2/3/04, 6/3/04, 7/3/04, 13/3/04. 14/3/04, 17/3/04 9 58/77 3 20/2/04 (3), 23/2/04, 28/2/04, 29/2/04, 1/3/04, 2/3/04, 3/3/04 9 19/42 4 20/2/04 (2), 21/2/04 (2), 23/2/04, 25/2/04 (2), 2/3/04 (2), 4/3/04, 5/3/04, 6/3/04 12 65/102 5 28/1/04, 2/2/04, 12/2/04, 24/2/04, 25/2/04, 2/3/04 (2), 12/3/04, 12/5/04, 13/5/04 10 23/56 6 5/1/04, 18/2/04, 19/2/04 (2), 20/2/04, 21/2/04 (2), 22/2/04, 23/2/04 9 22/50 7 25/2/04, 4/3/04, 7/3/04, 9/3/04, 16/3/04, 28/3/04, 29/3/04, 11/4/04 8 43/129 8 26/12/03, 19/2/04, 24/2/04 (3), 26/2/04 (2), 3/3/04, 4/3/04 (2), 7/3/04 (4), 9/3/04 (2), 10/3/04, 11/3/04, 12/3/04, 15/3/04, 16/3/04 (2), 18/3/04, 21/3/04, 23/3/04 25 Girls 13/2/04, 18/2/04, 21/2/04 3 130 APPENDIX I. (continued). School. Proportion who have previously had Measles. Class. Date of Illness. Total cases in Class. Class closed. Union Street 47/65 2 6/2/04, 13/2/04 2 35/57 3 11/1/04, 12/1/04, 13/1/04 1/2/04 4 50/89 1 23/12/03, 25/12/03 2 Vicarage Eoad 48/55 2 29/12/03, 1/1/04 2 42/63 3 5/1/04, 10/1/04, 26/5/04, 30/5/04 4 38/83 4 14/12/03 (3), 20/12/03, 21/12/03, 22/12/03 (2), 23/12/03, 24/12/03 (4), 25/12/03, 31/12/03 24/5/04, 20/5/04 14 2 15/12/03 26/5/04, 17 days 23/59 5 25/12/03, 28/12/03, 6/1/04, 14/3/04, 28/4/04, 22/5/04, 24/5/04 (2), 26/5/04 (3), 27/5/04, 29/5/04 12 17th to 28th March 26/5/04 17 days 23/72 6 8/1/04, 10/5/04 (2), 13/5/04 (3), 16/5/04, 18/5/04 (2), 19/5/04 (2), 20/5/04 (3), 21/5/04 (4), 22/5/04 (2), 23/5/04 (2), 26/5/04, 31/5/04 24 13/5/04 3 weeks Elizabeth Street 80/92 1 16/1/04, 28/1/04, 2/2/04, 6/2/04, 14/2/04 5 42/67 2 28/1/04, 29/1/04 (2), 30/1/04 (2), 31/1/04 (3), 7/2/04(2) 10 41/62 3 14/1/04, 26/1/04 (2), 27/1/04 (2), 28/1/04 (2), 30/1/04, 31/1/04,1/2/04,2/2/04(2), 16/5/04, 20/5/04, 21/5/04, 22/5/04 16 131 APPENDIX I. (continued). School. Proportion who have previously had measles Class. Date of Illness. Total cases in class. Class closed Elizabeth Street 31/90 4 14/1/04, 15/1/04, 26/1/04, 27/1/04 (5), 28/1/04 (2), 29/1/04, 30/1/04 (2), 1/2/04 (3), 2/2/04 (3), 3/2/04 (2), 6/2/04, 7/2/04, 8/2/04, 9/2/04, 11/2/04, 17/5/04 (2), 18/5/04, 20/5/04 (2) 31 Bostall Lane 37/58 1 8/1/04 1 22/67 5 22/5/04, 1/6/04, 3/6/04, 4/6/04, 5/6/04 5 26/5/04, 2 weeks Plum Lane 50/58 1 20/3/04, 21/3/04, 1/4/04, 5/4/04 4 45/59 2 9/3/04, 11/3/04, 17/3/04, 22/3/04, 23/3/04 5 35/77 3 9/3/04, 26/3/04, 27/3/04, 31/3/04 (2), 1/4/04 (3), 2/4/04, 4/4/04, 13/4/04 11 Slade 54/65 1 26/4/04, 4/5/04 2/5/04, 2 weeks 49/63 2 13/5/04 1 18/5/04, 11 days 48/60 3 6/5/04 1 41/84 5 6/5/04 1 Bobrage Grove 34/60 B 5/3/04, 15/3/04 2 26/57 D 4/3/04 1 28/59 C 3/3/04, 4/3/04 2 Boys 21/2/04 1 Girls 18/3/04, 21/4/04 2 132 APPENDIX I. (continued). School. Proportion who have previously had Measles. Class. Date of Illness. Total cases in Class. Class closed. Timbercroft Road 44/70 1 & 2 3/3/04, 22/3/04 2 9/3/04, 10 days 28/3/04, 10 days High Street 33/91 7 21/5/04, 23/5/04(7), 24/5/04, 25/5/04 (2), 26/5/04, 28/5/04 13 28/5/04, 3 weeks Mulgrave Place 44/54 3 1/5/04 1 29/71 Babies 12/4/04. 25/4/04 (2), G/5/04, 12/6/04 5 Purrett Boad 30/82 A 24/4/04, 26/4/04, 28/4/04, 3/5/04, 4/5/04 (2), 7/5/04 (2), 8/5/04 (4), 9/5/04 (6), 10/5/04 (9), 11/5/04 (4), 12/5/04 (2), 14/5/04 34 28/4/04 to Whitsun 34/70 B 11/4/04, 22/4/04 (2), 23/4/04 (2), 24/4/04 (4), 25/4/04 (5), 26/4/04 (2), 27/4/04, 2/5/04 , 3/5/04 (2), 5/5/04 21 27/4/04, 3 weeks 37/59 C 25/4/04, 27/4/04, 29/4/04, 7/5/04, 8/5/04, 9/5/04 (3), 10/5/04 (3), 11/5/04 (2), 12/5/04 (2), 14/5/04, 16/5/04 17 2/5/04, 2 weeks 52/65 D 9/5/04, 10/5/04 (2), 11/5/04 (2), 30/5/04 6 14/5/04, 2 weeks All Saints' 34/30 1 22/3/04, 31/3/04, 10/4/04 3 24/37 2 21/3/04, 23/3/04 2 11/27 3 2/4/04, 3/4/04 2 133 APPENDIX I. (continued). School. Proportion who have previously had Measles. Class. Date of Illness. Total cases in class. Class closed. Conway Road 62/111 A 17/1/04, 16/5/04, 23/5/04 3 22/1/04, 2 weeks 19/5/04, 1 week 73/133 B 26/5/04, 29/5/04 2 1/6/04 59/80 C 29/5/04 1 1/6/04 67/73 F 27/4/04 1 48/64 G 13/5/04 1 Wood Street 30/70 6 7/5/04, 21/5/04, 22/5/04 (2) 4 23/53 7 20/5/04, 21/5/04, 23/5/04, 5/6/04, 9/6/04 5 Eglinton Road 45/132 7 25/3/04, 27/3/04, 3/4/04, 4/4/04 (3), 7/4/04 (2), 8/4/04, 10/4/04, 15/4/04, 18/4/04, 21/4/04 (3), 22/4/04, 23/4/04 (7) 24/4/04 (2), 25/4/04, 26/4/04 (2), 27/4/04 (2), 14/5/04 31 28/63 6 17/3/04, 26/4/04, 27/4/04, 28/4/04 (3), 10/5/04 7 55/66 4 10/4/04 1 46/54 3 10/5/04 1 Central 29/41 Room 1, Class 1 5/3/04, 7/4/04, 22/4/04, 1/5/04, 26/5/04 5 9/21 March 30/5/04, 2 weeks 19/66 Room 2, 4 & 5 4/3/04, 7/4/04, 17/4/04, 19/4/04, 23/4/04, 1/5/04 (2), 5/5/04 (2), 6/5/04, 7/5/04, 29/5/04 12 21/4/04, 3 weeks Boys 4/3/04 134 APPENDIX I. (continued). School. Proportion who have previously had Measles. Class. Date of Illness. Total cases in class. Class closed. Earl Street 37/40 4 17/12/03,18/12/03,23/12/03, 25/12/03, 27/12/03 (2), 28/12/03 (2) 8 18/12/03 to Xmas 66/111 6 28/12/03, 2/3/04 (2). 3/3/04 (2), 4/3/04, 12/4/04 7 4/3/04, 2 weeks 53/64 2 23/12/03, 10/1/04 2 SCHOOL. No. of Cases of Measles, 1904 No. previously had Measles. Bloomfield Road 86 14 Union Street 8 7 Earl Street 19 3 Vicarage Road 58 5 Conway Road 8 5 Elizabeth Street 62 9 Bostal Lane 6 0 Plum Lane 18 2 Slade 5 2 Burrage Grove 5 1 Timbercroft Road 2 1 High Street 13 2 Purrett Road 76 8 Wood Street 9 2 Eglinton Road 40 5 Central 17 2 Mulgrave Place 6 1 Total 438 69 135 Appendix II. Report of Proceedings by the Woolwich Borough Council in respect of a Nuisance arising from a want of a proper and sufficient Supply of Water. The Medical Officer of Health having reported in September, 1904, that No. 1, High Street, Woolwich, a house consisting of six rooms on three floors, with an unoccupied basement, and occupied by five families, was dependent for its water supply upon a stand pipe in a yard approached from the rear of the premises, the Public Health Committee of the Council decided to serve the owner of the premises with a Statutory Notice requiring him to provide a water supply to the first and second floors of the house with properly fitted stoneware sinks, and trapped waste pipes to discharge over the yard gully. Failing compliance with the terms of this notice, the Council, on the 2nd December, 1904, issued a summons, under the provisions of Sections 5 and 48 of the Public Health (London) Act, 1891, against the owner alleging default in compliance with the Statutory Notice, whereby a nuisance arose. The Town Clerk appeared to prosecute, and the proceedings were defended by a Solicitor on behalf of the Owner. It was proved on the hearing that each floor was occupied by different families, together comprising nine persons; that from the yard, where the supply of water was, to the top floor there were 34 stairs; that beyond a dilapidated unusable copper and a standpipe, both in the yard, there was no other provision of water, sink, scullery or wash-house; that in consequence the tenants stored water in open vessels on each floor, where it was liable to pollution; and that owing to the labour involved in carrying up the water, an insufficient quantity was used to ensure cleanliness, both of persons and rooms. It was also proved that a draw-off tap and sink could be fixed on each landing. The Defendant contended that there was au ample supply of water available, if the tenants chose to fetch it, that it was not practicable, or necessary, to provide a separate supply to each floor, and that no nuisance existed upon the premises. The Medical Officer of Health, Dr. Sidney Davies, Dr. Annis, the Medical Officer of Health for the Borough of Greenwich, and Dr. Hamer, the Assistant Medical Officer of Health of the London County Council, in support of the prosecution, gave evidence that in their opinion the want of a separate supply was a nuisance dangerous or injurious to health. The Magistrate, Mr. Rupert Kettle, in giving his decision, said that the stand-pipe in the yard was not a proper and sufficient supply within the meaning of the Act, and that there should be a separate supply to each floor, and made an Order to abate the nuisance accordingly, with £5 5s. costs. A sink and tap have since been provided on the landings of each of the first and second floors with very satisfactory results. 136 Appendix II.—(continued.) As to Premises Without Proper Light. In this case the Medical Officer of Health had reported an underground room, not separately occupied, at No. 1, James Street, Woolwich, which was without sufficient natural light, and which was, in consequence, alleged to be in a state dangerous or injurious to health. A Statutory Notice having failed, proceedings were taken under Section 5 of the Public Health (London) Act, 1891. The Town Clerk appeared to prosecute, and the Defendant was defended by a Solicitor. The room in question, a front basement room, was lighted by a window looking into a small area, having over it a covered grating, through which only light could be obtained, and it was proved on the hearing that it was too dark to read large print in the middle of the room on a clear day an hour before sunset, and that as light was essential to health, both in its effect on vital processes, and indirectly as preventing dirt, the condition of the room was such as to be dangerous or injurious to health. In every other respect the conditions of the room were satisfactory. The Medical Officer of Health and Dr. Annis, of Greenwich, gave evidence in support of the prosecution. Mr, Rupert Kettle, the Magistrate, made an Order to abate the nuisance, with 23s. costs. 137 Appendix III. Infantile Diarrhœa. This disease being now very prevalent in consequence of the warm weather, mothers and others having the care of children are strongly advised to attend to the following rules:— 1. Infantile or Summer diarrhoea is infectious, the infection being contained in what passes from the body. 2. The infection is usually taken in by the mouth with the food, which is contaminated by flies, dust, and dirt conveyed by fingers. 3. Children under two years are most affected, especially those fed with bottles. The directions "How to Feed Baby" should be carefully studied and carried out; a copy can be obtained at the Health Office, Maxey Road. 4. Babies nursed entirely at the breast seldom have diarrhoea. Children should be always nursed at the breast, if possible, till they are nine months old. Mother's milk is far the best, and prevents diarrhoea and other diseases. 5. If, however, this is impossible, the next best food is fresh cow's milk, or milk and barley water. The milk should be boiled as soon as it comes, and then stood, in a clean jug with a piece of wet muslin over it, in a cool place. 6. To make barley water, put two good teaspoonfuls of washed pearl barley in a pint of cold water, boil down to two-thirds of a pint, and strain. This must be kept in a clean jug and covered with muslin like the milk. 7. Children of two months should have milk and barley water in equal quantities; at six months there should be three parts of milk to one of barley water, and at eight months the milk may be given pure. The food should be warmed before being given and half a teaspoonful of white sugar added. 8. All other moist and liquid food should be kept covered with a wet cloth or wet muslin in a cool, clean, well-ventilated place. 9. Bottles with tubes should never be used; in France they are called baby-killers. 10. Medical attendance should be at once obtained for children a Sected with diarrhoea, however slight. 11. The excreta passed by the sick child should be immediately covered with disinfectants (to be obtained at the Public Health Office) and emptied down the w.c. Soiled napkins and clothes should be at once soaked in water containing a disinfectant, and left there till they are washed. 12. The mother's or nurse's hands should be always washed every time they are soiled, and especially before preparing baby's food. 13. Infants, their clothes, utensils, living room, and back yards, must be kept scrupulously clean. 14. All animal and vegetable refuse, waste food, dirt and slops of all kinds should be quickly removed from the house and covered up in the dustpail or emptied down the drains. (Signed) SIDNEY DAVIES, M.D., Medical Officer of Health. August, 1904. 138 Appendix IV. Duties of the Clerks and Sanitary Inspectors re Infectious Diseases. 1. On receipt of notification of an infectious disease, the case is to be entered by the responsible Clerk in the proper register. 2. The Clerk will also arrange for removal to Hospital of such cases as are received by the Asylums Board, and whose removal is desired. 3. The Inspector of the district, or any other Inspector available, will take a copy of the certificate to the home, and find out if removal is desired. 4. The Inspector will at the same time obtain full particulars as to the patient, family, house, and source of infection, on the special form provided, and at once give them to the Clerk for entry in the register. 5. In such cases as are removed to Hospital, the Clerk will see that the necessary directions are at once given for disinfection. 6. The responsible Clerk will send copies of the notification certificate to the Asylums Board, to the Head Teachers of the Schools affected, and to the P.M.O. of the Royal Arsenal, when Arsenal Employees live in the home of the patient. 7. As soon as intimation is received from the Isolation Hospital as to the return of a patient, the Clerk will send a copy of instructions as to precautions to be taken with respect to children returning from Hospital. He will also send word to the Head Teacher of the School affected, stating that the child may return to school a fortnight after return from Hospital. 8. When patients are not removed to hospital, disinfection will not be performed until a certificate has been received from the medical practitioner in attendance that the patient is free from infection. After such certificate has been received, the Clerk will intimate to the Head Teacher of any school affected that the child may return a fortnight after disinfection has been performed. 9. Sanitary inspectors should insist on removal to Hospital of all such patients as cannot be properly isolated at their own homes. But whenever it is considered that effectual isolation can be obtained at home, and where the number of people in the house does not exceed the number of rooms, and the cleanliness and sanitary conditions are in all respects satisfactory, the Inspector should encourage home isolation, and the Medical Officer of Health will give a certificate to any Arsenal employee living in the house, for the P.M.O. of the Arsenal, that the patient can be effectually isolated at home; the employee will then be allowed to attend his work. 10. Special forms for information to be obtained are provided for the following diseases :— (1) Scarlet Fever and Diphtheria; (2) Enteric Fever; (3) Puerperal Fever; (4) Small Pox. SIDNEY DAVIES, Medical Officer of Health. 8th April, 1905. 139 Appendix V. Report by Miss Middlebrooke re General Health Work. Instruction is given in the care, cleanliness and feeding of infants, the necessity (in the case of bottle fed babies) of using properly cleansed tubeless bottles, the proper sterilization and storage of milk, etc., before use. Suggestions of simple external remedies for small ailments. In cases of Consumption, the importance of thorough ventilation ; where possible the occupation of a room with a southern aspect. Great care in the disinfection and disposal of the sputum and other discharges from the patient. Thorough cleanliness and a separate sleeping apartment. Frequent disinfection of the room and antiseptic treatment of all underlinen before washing. Unnecessary furniture, draperies and carpets dispensed with. In house inspection, the advantages of fresh air and clean bright rooms are strongly advocated. The plentiful application of soap and water. The cleansing of yards, sinks, gullies, water-closets and bedroom utensils. Practical suggestions with regard to personal cleanliness. The substitution of light short window curtains for heavy dirt collecting, light-obstructing draperies. The leaflets, cards, eto., issued by the Medical Officer of Health are much appreciated where delivered. My observations and suggestions are invariably well received and I am frequently asked for advice on matters of hygiene. I have found that the use of kindness and tact combined with firmness ensures my suggestions being carried out. Metropolitan Borough of Woolwich SUMMER DIARRHŒA. REPORT ON THE PREVALENCE OF ZYMOTIC ENTERITIS, or SUMMER DIARRHŒA, in 1904, BY SIDNEY DAVIES, M.D., Medical Officer of Health. SUMMER DIARRHŒA. A special enquiry has been made into 135 deaths from Zymotic Enteritis, or Summer Diarrhœa occurring during the three months, July to September. Diarrhoea was very fatal during the third quarter of this year, more so than it has been for four years past. The prevalence of this disease, which is usual in warm summers, began this year in the second week of July, reached its height in the second week of August, and came to an end at the beginning of October (the prevalence being measured by the deaths registered). The temperature three feet below the ground reached 61° in the first week of July, gained its highest point—65.09°— on the 7th August, and fell below 57° in the last week of September. In 1903, the three foot thermometer never exceeded 62°. During each week of July and the first and last weeks of August, the temperature of the air was above the average; the remaining seven weeks of the quarter however had a temperature below the average. The Rainfall for the quarter, 4.88 in., was below the average (7.0 in.). The number of deaths in each week shows a fairly close connection with the temperature, rising as the temperature rises and falling as it falls. The mortality, however, did not rise at once, and it persisted for several weeks after the temperature had fallen below the point where the mortality began to rise, indicating that the deaths from diarrhoea are 4 not a direct, but an indirect result of the high temperature, the connecting link being an infection whose activity is in some way dependent on the temperature and other conditions. Age Incidence.—Of the 135 cases, 111 were under one year of age, and 10 only over two years. Of these, 7 were persons over 60 years of age. The greatest incidence was between three and six months, and over half the deaths were between three and nine months. Information obtained in the enquiry showed that very many non-fatal cases occurred both among infants and adults. Dr. Ballard found in Dispensary practice that 15 per cent. of the cases treated were children under one year, 32 per cent. between one and five years, and 52 per cent. over five. It appears then that this disease attacks a very considerable portion of adults, but is in them seldom fatal. Dr. Ballard found the incidence proportional to population to be greatest between one and two years, and least between five and twenty-five years. Manner of Feeding.—Out of 128 cases, 7 had the breast only, 5 the breast and other food; 99 were fed with the bottle, and 17 by hand. Of 16 children between 9 and 12 months, 14 were fed by the bottle, 1 by the breast, and 1 by hand. Of 4 children between 12 and 15 months, 3 were fed by the bottle, and 1 by hand. Of 3 children between 15 and 18 months, 1 was fed by the bottle, and 2 by hand; and Of 4 children over 18 months, all were fed by hand. Thus 77 per cent. of the cases were bottle fed, and 23 per cent. breast fed, or hand fed (including those self fed). 5 To discover what proportion of children were normally fed at the breast an enquiry was made. At 174 houses where babies under one year were found in the course of house to house inspection, it appeared that 82 per cent. of children under one year were breast fed, and 91 per cent. of those under 3 months. The following table shows the proportion of breast fed and artificially fed children under one year among average infants and those suffering from diarrhœa. Average children. Diarrhoea children. Breast fed 82 per cent. 9 per cent. Artificially fed 18 „ 91 „ It follows from this table that an artificially fed child is 45 times more likely to get diarrhœa than a breast fed baby. (In the above table children partly fed by the bottle or hand, and partly suckled, are included with those wholly breast fed). Of those artificially fed among the average children, 17 had Nestle's Milk, and 14 cows milk, and among the diarrhoea children, 50 had Nestle's and 68 cows milk. As far as these small numbers go they indicate that there is little difference between the incidence of diarrhoea on Nestle's fed and fresh cow-milk-fed children, what difference there is being favourable to the Nestle fed. This differs from the experience of other observers. The following interesting facts relating to infantile feeding stand out clearly:— 1. That the great majority of infants in the Borough are still fed naturally for about 12 months. 2. Of those fed artificially, the great bulk are nourished either on fresh cows milk or on Nestle's condensed milk; the use of the cheap brands of condensed milk for the sole food 6 of infants is very exceptional, only one instance having been found among over 300 infants: two others were fed on cheap condensed milk along with cows milk in one case, and goat's milk in another. 3. The cause of artificial feeding in the great majority of cases is the weakness of the mothers, causing loss or insufficiency of milk, or the weakness or defect of the child disabling it from suckling. In three cases only was the mother's going out to work given as a reason of her not suckling her child. In one case a landlady stated that the mother found it too much trouble to suckle. 4. Artificial feeding enormously increases the liability to diarrhœa. Prevalence of the Disease.—The house to house enquiry showed that 44 out of 211 children had had diarrhœa. If these are taken as a sample of the infantile population it follows that 20 per cent. of the whole number of children living under one year were affected by the recent epidemic. As the poorer streets are usually chosen for house to house inspection this estimate is probably in excess of the actual prevalence of the disease, but it undoubtedly shows a very widespread occurrence. At 40 out of the 136 houses where diarrhœa occurred a history was obtained of other members of the family or near neighbours having had non fatal attacks of the same malady. In many cases the majority of the family had recently suffered from some degree of diarrhœa. Fatality.—The proportion of deaths to cases of diarrhœa (if any reliance can be placed on the figures given above) is about 15 per cent. in children under one year of age. The fatality in older children and adults must be much less than this 7 judging from the information I obtained of mild cases occurring in families where children had died. In old people the disease seems to become again more fatal. Causes and mode of spread.—Infancy, artificial feeding, and high temperature, are seen to be three conditions attending a high diarrhoea mortality. Probably also the occurrence of these three conditions is necessary for a wide prevalence of the disease. It is, however, now well known that none of these conditions are indispensable. Cases of zymotic enteritis do undoubtedly occur and prove fatal in children entirely breast fed, in adults, and in the absence of a high temperature. As its name implies, this is a germ disease, and the presence of the micro-organism is the only essential factor. High temperature acts in two ways by favouring the activity of the germs and diminishing the resistance of the patient. Artificial feeding also to the extent to which it is less nutritious than human milk diminishes resistance, but probably the principal reason why diarrhcea is so prevalent in bottle babies is the facility that bottle feeding offers for the conveyance of the infection from one patient to another. A mother who having attended to some one suffering from diarrhcea without washing her hands goes and prepares the baby's bottle, is almost certain to infect the food. Other food besides baby's is likely to be infected in this way, and no doubt is; thus various members of a family are infected, just as often occurs when Enteric Fever attacks a household where cleanliness is lacking. Then again flies may carry the infection from a patient, not only to others of the same family, but to neighbouring households, and infect any food, such as fresh or condensed milk which is standing unprotected. It may be too that the food contained in the bottle acts as a good breeding ground for the infection, causing it to multiply rapidly: this is a matter for enquiry. Dr. Newsholme accounting for the liability to diarrhœa of babies fed with condensed milk, 8 suggests that the bacillus of diarrhœa may not only exist, but multiply in condensed milk, and thinks enquiry on this point is necessary. On the whole it appears probable that in most cases the milk and other food which conveys the infection is infected in the house, and not beforehand. The mode of infection is through dirt conveyed by hands, flies, and perhaps wind. The germs may come from previous cases, or from horse dung, or from impure soil on which houses stand. It appears to me probable that most cases are infected by previous cases; the fact that in 40 out of 135 cases information was obtained as to two or more members of a family suffering from the disease, with a few days' interval between the first and subsequent cases, is strong evidence of this. Uncleanliness is certainly a contributory cause; 37 out of 105 diarrhœa houses inspected were found dirty. In 124 houses where phthisis occurred, only 28 were found dirty, although dirt is a contributory cause of phthisis. Out of 51 cases having fresh cows' milk in 48 instances the milk was always boiled before use. It follows that the infection can not often be conveyed from the farm or other place outside the house by milk. Previous Health.—Out of 56 cases, 41 were stated to have been previously delicate, and 15 strong; 10 were twins, and 5 illegitimate. Of those breast fed, 9 out of 12 were delicate. Whether the delicate are more prone to the disease, it is impossible to say ; but certainly they are much more liable to die of it. The excessive mortality of infants generally from diarrhœa is not due so much to the disease attacking them in larger proportion than adults, as to the fact that they easily succumb. Diarrhœa arrests nutrition, and infants are specially susceptible to anything that dœs this. Duration of Illness.—Out of 110 cases, 25 died within three days of the onset, and 64 within one week. Thus in half the cases the duration was under one week. 9 Distribution.—The cases occurred— (1). Mainly in the poorer parts of the town; (2). In the newer streets where the birth-rate is higher; (3). There is a distinct inclination to small groups of cases; (4). The district between Plumstead High Street, and the Railway (including the Reidhaven Road District) and North Woolwich are specially affected. These districts contain for the most part a poor population with a high birthrate; they also lie low, and consequently the level of the ground water in them is high; and lastly, they are to a certain extent built on made ground. The North River Ward has had the highest diarrhœa death-rate proportional to births in each of the previous three years, and the St. Nicholas Ward has had the next highest rate in two of those years. Woolwich compared with London and other Towns.— The death rate from diarrhœa in the Borough during the third quarter was 4.52 compared with 3.39 in the County. Only four Boroughs had a higher rate, viz: Bermondsey, Fulham, Poplar, Shoreditch. East Ham, West Ham, Leyton and other Essex towns had a higher rate than Woolwich, and in Erith the rate was nearly the same. In the three preceding years the diarrhœa death rate was lower in Woolwich than in the County. Summary. (1). Woolwich had in the Summer Quarter of 1903, an excessive prevalence of Zymotic Diarrhœa, compared with previous years, and with other London Boroughs. 10 (2). The neighbouring large Essex towns and Erith shared in this excessive prevalence. (3). The North-west part of St. Nicholas Ward and North Woolwich were the districts most affected, but no Wards were exempt. (4). Many persons at all ages were affected, but 82 per cent. of the deaths were in children under one year of age. Nearly 20 per cent. of the whole population under one year were probably affected by the disease. (5). Infants entirely breast fed are for the most part exempt from the disease, the great majority of the deaths occurring among bottle fed children. (6). There is no great difference as regards susceptibility to the disease between children fed with fresh cows' milk and those fed with condensed milk. (7). It is probable that in the great majority of the cases the infection gains access to the food in the home of the patient. (8). The disease is largely influenced by conditions of soil and climate which are not under control. (9). The principal causes which are preventable are dirty habits, infection and improper feeding. (10). There seems good reason to believe that a very large number of the cases are due to personal infection. If this is so it is probable that a few simple precautions would prevent a very large proportion of the deaths from diarrhœa which now occur year after year. 11 Recommendations. Since breast fed children for the most part escape the disease, it follows that breast feeding should be practised as far as possible. The enquiry shows however that in this Borough mothers with few exceptions, suckle their infants as far as they are able, hence there is no opportunity for much improvement in this direction. The exceptions are frequently mothers who have recently lost their husbands, or whose husbands are ill and unable to work. When feeding is by bottle or by hand, the main indication for avoiding the disease is the protection of the milk and other food from contamination in the home of the patient. When diarrhoea occurs in a family, the same precautions should be taken as with Enteric Fever, viz: isolation, disinfection, and absolute cleanliness. Isolation is seldom practised, involving as it does not only a separate room but a separate attendant; but cleanliness is of most importance, and if scrupulously carried out probably isolation is not necessary. Careful disinfection of excreta should be practised, not only for the protection of the family affected but also to avoid the risk of flies conveying the infection to neighbouring households. It is necessary first to know of the existence of cases as soon as they occur, it will then be possible for a Lady Inspector to visit the houses and give the necessary directions as to isolation, cleanliness and disinfection. As fatal cases are exceptional, except in the Summer quarter, I only suggest that cases should be notified during July, August and September, and only the first case in a family need be notified. This will much diminish the cost of notification. It is to be feared that in many cases no medical man is called in until the case is serious, but it is to be expected that a large number may be received in time to take precautions. 12 A third and perhaps the most hopeful way of avoiding the infection of zymotic enteritis in infants, is by the provision of milk specially prepared so as to be free from germs, and placed in bottles, one of which is sufficient for each meal. The bottle is not opened until the child is fed, and then all that is not consumed at each meal is thrown away, so that the risk of the milk being contaminated in the home is reduced to a minimum. The establishment of a sterilized and humanized milk depot is an important means of combating summer diarrhoea; it has been found where such depots exist that children are comparatively exempt from diarrhœa while receiving the specially prepared and bottled milk. I therefore make the following recommendations:— (1). That the distribution of leaflets educating mothers in the care and feeding of infants be continued and extended. (2). That the usual payment be made to medical practitioners for the notification of first cases of zymotic enteritis during the Summer quarter. (3). That a Municipal milk depot be established to provide pure milk in bottles containing sufficient for one meal only, as soon as the legal powers now being sought are obtained. (4). That the Guardians be asked to give such adequate relief to all chargeable mothers having infants under nine months, as will obviate the necessity of their going out to work, and that the attention of the relieving officers be specially called to the importance of mothers suckling their infants. 13 ZYMOTIC ENTERITIS ENQUIRY. Summary of Information obtained as to 135 Deaths occurring in 3rd Quarter of 1901. Age of Patients— 0—3 months 23 3—6 „ 40 6—9 „ 30 9—12 „ 18 12—15 „ 8 15—18 „ 4 18—24 „ 2 Over 2 years 10 All Ages 135 Duration of Illness— Under 3 days 25 3—7 days 39 Over 1 week 46 110 Feeding— Bottle fed 99 *Breast Fed 12 Neither 17 128 * 7 had breast only; 5 had breast and other food. Type of Bottle used— With Tube 58 Tubeless 40 98 14 Food— Nestle's Milk 50 Fresh cows' milk 68 *Other food 8 126 Goat milk and cheap condensed *{Cows' do. do. Cheap condensed only. Weaned— Under one month 46 1 to 3 months 27 Over 3 months 6 79 Weaned because— Mother had no milk 47 Other causes 33 80 Milk boiled 48 Milk not boiled 3 51 House clean 68 House dirty 37 105 Other cases indicating infection 10 Previous Health— Delicate 41 Strong 15 56 15 Manner of Feeding of 255 Average Children. Summary of information obtained. Under 3 Months— Breast 52 Nestle's Milk 4 Other foods 2 Children who had diarrhœa 6 91 per cent. have breast. (Including those partially breast fed). 3—6 Months— Breast 35 Nestles 1 Other foods 7 Children who had diarrhœa 8 6—9 Months— Breast 32 Nestles 7 Other foods 3 Children who had diarrhœa 7 9—12 Months— Breast 55 Nestles 5 Other foods 8 Children who had diarrhœa 23 If. Total under 1 year- Breast 174 Nestle's Milk 17 Other foods 20 Children who had diarrhœa 44 82 per cent have breast. (Including those partially breast fed). 21 per cent. had Diarrhœa. Of 37 not having the breast 25 or 68 per cent. had Diarrhoea. H. PRYCE & SON, Steam Printers, 33 & 35, Powis Street Woolwich,