Woo 66 Metropolitan Borough of Woolwich. ANNUAL RETORT OF THE Medical Officer of Health FOR WOOLWICH. 1907. Woolwich: H. Pryce & Son, Printers (T.U. Federation), 31, 33 & 35, Powis Street, Woolwich. A 2 Public Health and Housing Committee:— Henry Smith Syer (Chairman), 45, Plumstead Common Road. William Parry Jackson (Vice-Chairman), 7, Woolwich Common. Alderman Thomas Macnamara, 42, Wilmount Street, Woolwich. Alderman Angus Macdonald Tynemouth, 25, Greenvale Road, Eltham. William Jenkins Bull, 280, Plumstead Common Road, Plumstead. Alfred Hall, 111, Maxey Road, Plumstead. Joseph Harper, 18. St. Margaret's Road, Plumstead. James Henry Hodgin, 45, Thomas Street, Woolwich. William Brown Ingram, 73, Wellington Street, Woolwich. Jeremiah James Mahony, 67, Beresford Street, Woolwich. James Newman, 75, Heavitree Road, Plumstead. William Raven, 72, Samuel Street, Woolwich. William Hardie Ross, 6, Cantwell Road, Plumstead. Richard Bailey Baxter Wakelen, 194, Greenvale Road, Eltham. James Oates Widger, B.A., 113, Cliesnut Road, Plumstead. Chief Sanitary Inspector:— Albert G. Duck (Cert. San. Inst.) District Sanitary Inspectors:— William Woolley (Cert. King's College), Herbert Ward. John W. Range (Cert. San. Inst.), Dockyard and St. Mary's Wards. William Little (Cert. San. Ins.), St. Margaret's and Central Wards. William Wood (Cert. Sah. Inst.), Parish of Eltham and St. George's Ward. Alfred G. Potter (Cert. San. Inst.), River Ward. William Tedham (Cert. San. Inst.), St. Nicholas Ward. Thomas Powell (Cert. San. Inst.), Burrage and Glyndon Wards. 3 Inspectors under Food and Drugs Act:— William Woolley, Parishes of Woolwich and Plumstead. William Wood, Parish of Eltham. Women Sanitary Inspectors : Alice M. Middlebrooke. (Cert. San. Inst and San. Insp. Exam. Board). Marion FitzGerald. (Cert. San. Insp. Exam. Board and A.R. San. I.) Public Health and Housing Committee Clerk:— Charles Ellis. General Clerks:— Amyas Britter (A.R. San. I.) Geo. H. Triggs (A.R. San. I.) Junior Clerk:— H. M. Collyer. Mortuary Keeper:— Frank Leason. Medical Officer of Health SIDNEY DA VIES, M.A., M.D., Oxon ; D.P.H., Camb.; Fellow and Member of Council of the Incorporated Society of Medical Officers of Health (President—Metropolitan Branch), and Fellow of the Royal Sanitary Institute. a 2 4 Summary of Statistics, 1907. Area of Borough 8276-6 Acres Population—Census, 1901 117,178 do Estimated to middle of 1907 129,336 Inhabited Houses—Census, 1901 18,086 Total Houses to middle of 1907 22,524 Persons to a House-Census 6.47 Marriages 945 Births 3295 Birth Rate 25.5 Deaths 1616 Death Rate 12.5 Infantile Mortality 113 per 1000 births 5 TABLE OF CONTENTS. page. Names of Members of Public Health Committee 2 Names of Members of Sanitary Staff 2 Summary of Statistics 4 Preface 10 Part I.—Statistics. Population—New Houses 11 Births 14 Marriages 16 Deaths—Woolwich Death Rate compared with other Boroughs 16 Lives and Illness saved 19 Infant Mortality—Preventive Measures—Feeding of Infants 19 Still-births 23 Mortality under 5 years 23 Zymotic Death Rate 23 Inquests and Uncertified Deaths 23 Deaths in Public Institutions 24 Small-Pox and Vaccination 24 Measles 25 Whooping Cough 28 Scarlet Fever—Return Cases—Isolation at home and hospital —Sources of Infection—School Medals 29 Diphtheria—Sources of Infection 35 Bacteriological Examination 38 Enteric Fever—Source of Infection 41 Diarrhœa—Notification of Zymotic Enteritis—Report and Tables 42 Erysipelas 52 6  page Puerperal Fever 52 Influenza, Bronchitis, and Pneumonia 52 Tuberculosis—Voluntary Notification 53 Source of Infection—Occupation 55 Bacteriological Diagnosis 56 Sanatorium Treatment—Results of 57 Cancer—Classification 60 Alcoholism 62 Syphilis 62 Meteorology 63 Part II.—Administration. Water Supply—Plumstead Well 64 Food and Drugs Act—Percentage Milk Adulteration—Average Composition 68 Food Inspection 69 Dairies, Cow-sheds, and Milk-shops 70 Milk Supply 70 Slaughter-houses 70 Nuisances—Complaints, Sewers, Drains, Public Urinals, House Inspections 71 Medical Officer's Inspections 73 Over-crowding 74 Smoke Nuisance 74 Defective Light 74 Verminous Rooms 74 Dust Removal—Collection, Cost of 74 Trade Refuse—Offensive and Inoffensive 75 Housing of the Working Classes- Houses represented as unfit for habitation 75 7  page. Housing of the Working Classes (continued)— Statistics of Special Areas 75 Unoccupied and new houses 76 Council's houses, North Woolwich 76 Houses Registered under the By-laws 76 Inhabited House Duty 77 Common Lodging-houses 77 Underground Rooms 78 Factories and Workshops—Inspections—Outworkers 78 Bakehouses 78 Ice-cream Shops 78 Disinfection, Disinfectants 79 Health Shelter 79 Mortuaries 80 Cemeteries 80 Cleansing of Persons Act 80 By-laws for Tents, Vans and Sheds 82 Infants' Milk Depot 82 Public Ambulance 82 Notices and Prosecutions under Public Health (London) Act.. 83 Bacteriological Examinations 83 Women Sanitary Inspectors' Work— Miss Middlebrooke's Report 83 Miss Fitzgerald's Report 87 Public Conferences 90 Eltham Branch Office 92 Public Health Staff 92 8 LIST OF TABLES. page. Table I. —Population. Births and Deaths for the whole Borough from 1895 to 1907, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 93 Number of Inhabited Houses, the average number per house, and the acreage 94 „ Ia. —Institutions inside and outside the district receiving sick and infirm persons from the district 95 „ II. —Population, Births Registered, Deaths at all ages, and Deaths under One Year, for each Ward during 1901. 1902,1903,1904, 1905,1906, and 1907 97 „ III. —Cases of Infectious Disease notified at all ages, at various age groups, and distributed according to Wards during 1907 99 „ IV. —Deaths at all ages, at various age groups, from various causes in 1907 101 „ IVa. —Deaths from various causes arranged by Wards in 1907. Total Deaths in Public Institutions in district in 1907 103 „ IVb. —Infantile Mortality during the year 1907 105 „ V. —Case and Death Rate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1907 107 „VI. —Vital Statistics of the various London Boroughs for 1907 109 „ VII. —Ditto ditto 1902 to 1906 and 1907 111 „VIII. —Meteorology and Registered Deaths from all causes and from certain prevalent diseases in each week of the year 113 „ IX. —Weekly Averages for Meteorology and Registered Deaths from all causes and from certain prevalent diseases 115 „ X. —Summary of Statistics for the first Quarter of 1907 corrected for Public Institutions 116 9   Table XI. —Summary of Statistics for the second Quarter of 1907 corrected for Public Institutions 117 „ XII. —Summary of Statistics for the third Quarter of 1907 corrected for Public Institutions 119 „ XIII. —Summary of Statistics for the fourth Quarter of 1907 corrected for Public Institutions 120 „ xiv. —Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 123 „ xva. —Summary of the General Work of the Public Health Department for 1907, the number of Nuisances abated, and Notices served in each Ward 125 „ xvb. —Summary of Work of Chief Inspector and miscellaneous 127 „ XVc. —Inspection of Factories, Workshops and Workplaces 128 „ XVd. —Proceedings during 1907 re Milk-shops, Cow-sheds, Slaughter-houses, &c. 129 „ xvi. —List of Streets Inspected—House-to-House—and number of houses where defects were found 132 „ xvii. —Prosecutions in 1907 under the Public Health (London) Act and By-laws and Housing of the Working Classes Act 137 „ xviii. —Summary of Articles Analysed under the Sale of Food and Drugs Act 138 „ xviiia. —Proceedings in 1907 under the Sale of Food and Drugs Act 139 „ xix. —Food seized, or surrendered by Owners as unfit for consumption 141 „ XX. —List of Level Bakehouses in the Borough, 1907 ... 143 „ XXa. —List of Certified Underground Bakehouses in the Borough, 1907 144 „ XXb. —List of Factory Bakehouses 145 „ XXI. —List of Slaughter-houses in the Borough, 1907 146 „ XXII. —List of Cow-houses in the Borough, 1907 147 „ XXIII. —List of Milk Sellers 148 Appendices. Infants' Milk Depot. Advice to Mothers. 10 PREFACE. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Woohvich. Me. Mayor and Gentlemen, I have much pleasure in presenting you with my Seventh Annual Report on the Health of the Borough, and the means taken for promoting the same. It includes my Sixteenth Annual Report on the Health of Plumstead Parish. It is satisfactory to be able to report once more that the lowest death-rate recorded occurred in the past year. Poverty and distress have lately been widespread, and must necessarily have diminished the resistance to disease ; but in spite of this, the general health continues to improve. The steady fall in the death-rate from infectious diseases is particularly encouraging. Special consideration has been given in this report to the following subjects:—(1) Home Isolation of Scarlet Fever, and missed cases of this disease. (2) Phthisis (results of Sanatorium treatment). (3) Notification of Zymotic Enteritis. (4) Infants' Milk Depot—see Appendix. (5) Health-visiting re Infant Mortality—see Miss FitzGerald's Report. My thanks are due to the Chairman and Members of the Committee for the courtesy with which they have received the recommendations regarding the public health, which it is my duty to make from time to time. I am, Mr. Mayor and Gentlemen, Your obedient servant, SIDNEY DA VIES. May, 1908. 11 SEVENTH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1907. PART I. Statistics. 1. Population. The population of the Borough to the middle of 1907 has been estimated on the supposition that the increase since 1901 has been proportional to that between the last two decennial censuses, thus giving 129,336. Dividing this number by the number of houses, 22,524, we get 5.75 persons per house. The number of persons per house at the census was 6'47. It has been assumed that the population of each parish has diminished or increased proportionately to the number of new houses. We thus get the following figures for the three parishes:— Woolwich Parish 39,993 Plumstead Parish 76,595 Eltham Parish 12,748 129,336 12 If all the houses in the Borough were occupied, and the number of persons to a house were the same as at the last Census, the population would be 146,000, or about 17,000 more than estimated. Estimated increase in the year 1991 Natural increase (excess of births over deaths) 1682 2. The following table shows the number of houses at the Census, and the number certified for water each year since:— Total houses in Borough at Census, 1901 18,496 New houses to June 30th, 1901 257 do. do. 1902 1,292 do. do. 1903 743 do. do. 1904 582 do. do. 1905 483 do. do. 1906 390 do. do. 1907 281 Total 22,524 3. At the Census there were 176 unoccupied houses in the Borough. In December, 1906, the Rate-collectors counted the empty houses while on their rounds and found 1,192, viz., 429 in Woolwich, 669 in Plumstead, and 94 in Eltham. Doubtless there are, in addition to these, many unoccupied rooms and flats. 4. 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. The populations of the Wards are estimated by the number of occupied houses in each Ward. There populations, added together, give a different total to that estimated for the Borough. give a different total to that estimated for the Borough. Wards. Dockyard. St. Mary's. River. St. George's. Burrage. Glyndon. Herbert. St. Margaret's. Central. St. Nicholas. Eltham. North. South. Population 8,712 10,439 2,991 11,405 8,078 9,837 9,810 9,080 9,842 10,118 19,640 7,226 Number of Inhabited Houses 1,325 1,126 441 1,671 878 1,735 1,697 1,612 1,638 1,805 2,805 1,353 Persons to a House 6.57 9.27 6.78 6.83 9.20 5.67 5.78 5.63 6.00 5.61 7.00 5.34 New Houses— April to June, 1901 - - 4 - - - 8 12 61 7 85 80 June, 1901, to June, 1902 — — 71 — - — 8 79 265 7 455 407 June, 1902, to June, 1903 12 — 33 — - — 9 40 153 7 239 250 June, 1903, to June, 1904 4 — 89 14 — 8 — 30 94 7 185 151 June, 1904, to June, 1905 5 18 2 - - 2 — 33 102 12 170 139 June, 1905, to June, 1900 11 14 — 9 - — — 36 69 2 150 99 Juue, 1906, to June, 1907 21 5 5 6 - - - 27 36 7 91 83 Total Houses 1,378* 1,163* 645 1,700* 878 1,745 1,722 1,869 2,418 1,854 4,180 2,562 Estimated Populations 7,800 9,788 3,841 10,360 8,078 9,726 9,609 10,182 13,173 10,100 22,775 12,745 * In Dockyard, St. Mary's and River South Wards the number of new houses is probably less than the number of old houses which have been demolished. 13 14 births. 5. The number of births was 3295 (corrected for children born in the Infirmary, Female Hospital, and Wood Street "Home for Mothers and Babies," whose parents reside outside the Borough), and the birth-rate 25.5 compared with 27.7 in the previous year, and with 29.1 the average for the ten years 1897-1906. The rate for the County of London was 25.8. 6. The following table gives the average birth-rate of each parish and ward during the years 1901-5, 1906, and 1907, and for purposes of comparison the corresponding rates of the neighbouring Boroughs, London, and England. There has been a great decrease in Plumstead Parish, and a slight increase in Woolwich. The decrease in the Borough has been much greater than that in London. BIRTH-RATE. Average 1901-5. 1906. 1907. Woolwich Parish 29.0 29.2 29.1 Dockyard Ward 33.2 28.0 34.4 St. Mary's „ 19.8 21.4 18.5 River „ North South 36.5 33.8 39.0 24.4 23.3 25.5 St. George's „ 36.9 35.0 37.0 Plumstead Parish 30.1 27.8 24.1 Barrage Ward 23.4 23.4 20.8 Herbert „ 25.3 24.0 21.8 St. Margaret's „ 33.6 33.6 27.5 Central „ 27.5 24.6 19.6 Glyndon „ 30.6 28.3 25.3 St. Nicholas „ 32.5 31.1 27.3 Eltham Parish 24.0 22.0 22.4 Greenwich Borough 27.6 25.4 24.2 Lewisham 25.7 23.3 23.8 15 Average 1901-5. 1906. 1907. West Ham 33.1 30.5 28.6 East Ham 33.8 28.1 26.3 Erith 34.1 30.0 29.9 London 28.2 26.6 25.8 England and Wales . 28.2 27.0 26.3 Woolwich Borough 29.2 27 7 25.5 Correction has been made for births in the Infirmary, Female Hospital, and Wood Street "Home for Mothers and Babies;" and the births distributed to the Wards to which they properly belong. 7. The following table gives the birth-rate for the Borough and each Parish for the three past quinquennia, and last two years. Except in Eltham the decrease has been progressive in each Parish, but greater in Plumstead than in Woolwich. In Eltham, on the other hand, after a decrease in the second quinquennium, there was a marked increase in the third, due, no doubt, to the building of the Well Hall Estate and its occupation by a large proportion of young married people. Average of 1891-1895 Average of 1896-1900 Average of 1901-1905 1906 1907 Woolwich Boro' 32.5 30.2 29.2 27.7 25.5 Woolwich Parish 31.1 30.1 29.0 29.2 29.1 Plumstead „ 33.3 31.0 30.1 27.8 241 Eltham „ 22.8 20.6 24.0 22.0 22.4 Of the 3,295 births, 1,307 at least were attended by midwives. 8. Illegitimate Births. 79 of the births registered were illegitimate, giving a rate of 24 per 1,000 births, compared with 13, 17, 17, and 22 in the four preceding years. The illegitimate birth-rate in London was 37. 16 Marriages. 9. There were 945 marriages. The marriage rate was 14.6 compared with 16.4 in 1906; 407 marriages were performed in the Registry Office, and 538 in places of worship. The marriage-rate in London was 17.0. deaths. 10. Table I. gives the gross and nett deaths and death-rates in 1907, 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 deaths on which inquests were held, 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 deathrate is 1.0690. 11. The nett deaths were 1,616, and the nett death-rate was 12.5. The death-rate in 1906 was 13.1. Last year had the lowest death-rate recorded for the Borough. 12. By multiplying by 1.0690, the factor for age distribution, we get the corrected death-rate, viz., 13 4, which rate should be used in comparing Woolwich with other places. The following table shows the nett and corrected death-rates of Woolwich, compared with London and the adjoining Boroughs :— 17  Nett. Corrected. England and Wales 15.0 15.0 7 6 Large Towns 15.4 16.34 London 14.6 15.35 Greenwich 12.7 13.01 Lewisham 11.5 11.96 West Ham 14.6 15.65 East Ham 11.2 11.92 Woolwich 12.5 13.4 13. The following table gives the average death-rate in each Parish and Ward of the Borough during the five years 1901-5, and the rates for 1906 and 1907. 1901-5. 1906. 1907. Woolwich Parish 16.5 15.5 14.6 River Ward 17.8 18.1 15.3 18.8 14.3 17.7 Dockyard „ 16.5 16.8 15.6 St. Mary's ,, 12.5 10.0 11.5 St. George's „ ... 16.8 12.8 13.2 Plumstead Parish 12.9 12.2 11.9 St. Nicholas Ward 12.8 12.7 12.9 Central ,, 11.0 10.1 9.9 Glyndon ,, 15.1 15.1 13.8 St. Margaret's ,, 12.9 11.2 12.1 Herbert ,, 10.9 10.6 10.9 Burrage ,, 13.4 14.4 11.2 Eltham Parish 10.2 10.2 10.0 The Parish of Woolwich has never had so low a death-rate as last year. Plumstead had a lower rate in 1905, and Eltham in 1902, 1903, and 1905. Central, Herbert, and Eltham wards had the lowest death-rates. River South had the highest. The improvement in North River Ward is noteworthy. B 18 14. The table below gives the death-rate of the Borough and each parish during the past four quinquennial periods, and last two years, compared with London. It is seen that in Plumstead Parish there has been a progressive improvement, though the last five years show a more marked decline than the previous ones. In Woolwich and Eltham Parishes the five years, 1896-1900 had a higher rate than the previous five years, but the decline in death-rate since 1901 has been much more marked than in Plumstead. Average 1886-1890 Average 1891-1895 Average 1890-1900 Average 1901-1905 1906 1907 Woolwich Boro' ... 17.2 16.9 13.9 13.1 12.5 Woolwich Parish *20.4 19.3 20.1 16.5 15.5 14.6 Plumstead „ 16.4 16.0 15.1 12.9 12.2 11.9 Eltham „ ... 13.0 14.6 10.2 10.2 10.0 London „ 20.0 19.8 18.5 16.1 15.1 14.6 * Three years—1888,1889 and 1890. 15. The death-rate among males was 13'3 and among females 143. In 1905 the numbers were 14 0 and 13'4 respectively, and in 1906, 14 7 and 13'6. These rates are estimated on the numbers of the two sexes found at the census of 1901. The relative proportion of the sexes has, not improbably, been recently much modified by emigration of males. 16. Tables VI. and VII., kindly supplied by the Registrar General, give a summary of the Vital Statistics of the County and Metropolitan Boroughs in the five years 1902-6 and in 1907. Only four Boroughs had a lower death-rate than Woolwich, viz., Hampstead, Stoke Xewington, Lewisham, and Wandsworth. It 19 will be noted that each of these is a residential Borough, i.e., a district where those who can afford to chose their locality prefer to reside. Such people are, for the most part, of the well-to-do classes, who, being better able to provide against illness and bad health, have normally a lower death-rate. Correction can be applied for age distribution but not for class distribution. 17. Lives saved. In the last two years, I have estimated that 384 and 259 lives, respectively, were saved owing to the reduction of the death-rate. The average death-rate in the years 1896-1905 was 15.4. Such a rate in 1907 would have meant the death of 1992 persons instead of the 1616 who actually died. There was thus a saving of 376 lives in 1906. This is good in itself, but each of the 376 lives saved means ten others who have escaped a weakening illness, or have weathered illness with less damaging effects, for a lower death-rate means improved health of the surviving population. infant mortality. 18. The deaths under one year were only 372 compared with 391 in 1906. Owing, however, to the rapid fall of the birth-rate the infant mortalily (deaths under one year per 1000 births) was higher, viz., 113 compared with 111 last year. It was, however, below the average of the five preceeding years, viz., 119. The following table gives the infantile mortality in each parish and ward of the Borough during the past seven years, compared with the neighbouring Boroughs, London, and England :— Average 1901-5. 1906. 1907. Woolwich Parish 134 139 114 River Ward North 180 141 127 South 139 186 106 Dockyard Ward 116 152 86 St. Maiy's „ 149 124 171 St. George's „ 126 88 107 b 2 20 Average 1901-5. 1906. 1907 Plumstead Parish 113 97 108 St. Nicholas Ward 135 107 121 Central „ 105 81 111 Glyndon „ 107 118 86 St. Margaret's „ 100 78 119 Herbert „ 89 71 99 Burrage „ 94 134 79 Eltham 97 94 140 Greenwich 137 119 100 West Ham 158 149 131 East Ham 131 127 108 Erith 112 85 London 138 132 115 Seventy-Six Towns — 146 127 England and Wales 135 133 118 Borough of Woolwich 119 111 113 19. In Woolwich Parish the rate, 114, was far the lowest recorded, the previous lowest being 119 in 1902. Plumstead has four times had a lower rate, viz., in 1894, 1903, 1905, and 1906. The rate in Eltham was higher than it has been since 1901, but below the average of the previous ten years. The County of London had the lowest infantile mortality recorded. 20. The following table gives the infantile mortality during the four past quinquennia in each parish of the Borough. 1886-1890 1891-1895 1890-1900 1901-1905 1900 1907 Woolwich Parish *151 157 170 134 139 114 Plumstead „ 121 120 132 113 97 108 Eltham „ — 103 100 97 94 140 Woolwich Boro' — 140 146 119 111 113 * 1888, 1889 and 1890. 21 21. Table IVb gives full details as to the ages at death, and causes of death, of the 372 infants dying in 1907 under one year. It shows that over one-third of those who died were under one month old, and nearly one-fourth under one week old. Fifty-four deaths were from premature birth, compared with 65 and 75 in the two preceding years, and of the remainder, 20 (24 in 1906) were attributed to Atrophy, Debility, and Marasmus, indefinite terms applied to deaths from immaturity, congenital debility, and other causes. The death-rate from premature birth in Woolwich Borough was 0'48 compared with 0.71 in 1906. In London it was There were 21 deaths of illegitimate infants. The death-rate of illegitimate infants under one year was 304 per 1000 births, and that of legitimate infants 108. 22. Compared with 1906, the past year had, among infants, fewer deaths from premature birth, diarrhœal diseases, and convulsions, and more from measles, whooping-cough, bronchitis, pneumonia, and overlying. There was a gain of 52 lives by diminution of diarrhceal diseases and a loss of 46 lives by increase of measles, whooping-cough, bronchitis, and pneumonia. There is no doubt that a large proportion, if not the whole, of the increase of deaths from bronchitis and pneumonia is really attributable to measles and whooping-cough. But for the prevalence of these diseases the infant death-rate of the Borough would have been far lower than it has ever been. 23. The local Registrars supplied weekly birth-returns as before, for which £30 8s. l0d. was paid. 1307 births were notified by midwives through the London County Council. Miss FitzGerald visited nearly all those occurring in Woolwich Parish, and a large number in Plumstead and Eltham, and left and explained a card of instructions on infant feeding. The card of instructions is sent 22 by post to all suitable cases which cannot be visited,- but this is far from having the same effect as a Health Visitor's personaladvice, and there is much need for an additional visitor. This is more important now that the Notification of Births Act has received the sanction of the Local Government Board and came into operation on March 2nd, 1908. The Council resolved to adopt the Act in November last. The health of an infant depends largely on the health of the mother during pregnancy. In view of this fact, a leaflet was prepared giving "Advice to Mothers" as to the care of their health during and after pregnancy, with instructions as to the very early care of infants. This leaflet is printed in an appendix. Miss FitzGerald has obtained the following important information as to the feeding of infants in Woolwich Parish, and as to the method of feeding of 115 infants who died in the Borough under one year. Report on Method of Feeding of 500 Infants Visited in Woolwich Parish. (From notes made on first visits.) Breast-fed 415 Hand-fed 53 "Mixed"-fed 32 Breast-fed 83 per cent. Hand-fed 10.6 per cent. " Mixed"-fed 6.4 per cent. Method of Feeding (Recorded at time of first visit) of 115 Infants who died under one year of age. Breast-fed. Hand-fed. Mixed. Woolwich 47 13 6 Plumstead 32 14 3 79 27 9 23 The visits were made from one week to two months after birth. It is satisfactory to find that 83 per cent of babies are breast-fed for at least one month. The figures in the second table shew how much greater is the mortality among hand-fed children even in a year when diarrhœa was at a minimum. In a hot year the difference would be much greater. The great reduction of infant mortality in Woolwich Parish is striking testimony to the value of health-visiting, when supplemented by an Infants' Milk Depot. 23a. Still-births. 97 still-born children were buried in the Woolwich and Plumstead Cemeteries. 24. Deaths under five years and over eighty-five. The total deaths under five years were 579 or 41.9 per thousand population under five at the census. The rates in the three preceding years were 47.2, 36.5, and 38.3. 35 deaths occurred over 85 compared with 26, 36, and 38 in the three preceding years. 25. Zymotic Death-rate. The number of deaths from the seven principal zymotic diseases was 174, giving a death-rate of 1.34, compared with 2.2, 1.0, and 1.49 in the three preceding years. The following table gives the zymotic death-rate in each Parish during the past six years:— Average, 1901-5. 1906. 1907. Woolwich ... 1.69 1.93 1.67 Plumstead ... 1.53 1.37 1.67 Eltham ... 0.88 0.83 1.02 The Borough ... 1.51 1.49 1.34 26. Inquests. There were 128 inquests compared with 154, 154, 160, 141, and 121 in the five preceding years. The following table gives particulars as to the cause of death:- 1. Natural Causes 86 24 2. Accidental Causes:— Burns 9 Drowning 2 Falls 8 Fractures 3 Run over 3 Suffocation, overlying 9 Other accidental causes 1 — 35 3. Homicidal Causes:— Suicide 5 Murder and Manslaughter 2 — 7 128 The "Natural Causes" were 78 in 1905, and 63 in 1906. The "Accidental" and "Homicidal Causes" were 85, 49, 59, 62, and 58 in the five preceding years. The deaths from suffocation or overlying have been 5, 10, 8, 8, 8, 4, respectively in the last six years; the homicidal causes were 9, 20; 8, 11, 11, and 15 in the same years. There was a striking reduction last year in the number of accidents and homicides. 27. Deaths in Public Institutions. Table I. shows the actual number of deaths occurring in Public Institutions in the Borough, viz., 296, compared with 278, 272, 261, 313, and 293 in the five preceding years. Table Ia. shows the Institutions inside and outside the Borough receiving sick and infirm persons belonging to the Borough, and Table IVa. shows the number of deaths from each disease occurring in Public Institutions. The increased number of deaths in the Infirmary in the past three years is indicative of the increasing poverty in the Borough. Small-pox and Vaccination. 28. No cases of Small-pox were notified, compared with nil in 1906 and 7 in 1905. This is the second year since 1899 in which 25 no cases have been notified. 362 cases of Chicken-pox were notified by school-teachers, compared with 84 in 1906. 29. The number of cases of Small-pox in London was 8. 30. The following return, kindly furnished by the Vaccination • Officers, Mrs. Taylor and Mr. Atkins, gives particulars as to the vaccination of children born in Woolwich, Plumstead, and Eltham Parishes in 1906:— Births 3559 Vaccinated 2926 Insusceptible 9 Conscientious objections 170 Died unvaccinated 271 Medical postponements 13 Removed 52 Not found, and unaccounted for 118 31. The following have been the numbers excused on account of conscientious objections since 1901, in Woolwich and Plum stead Parishes: 127, 78, 108, 96, 101, 109, and 170. The lowest number, 78, was in 1902, the year of the Small-pox epidemic. The increase last year is doubtless the result of the recent Vaccination Act, which facilitates the obtaining of exemption certificates. Measles. 32. There were 70 deaths from Measles, giving a rate of 0.54 compared with 0.10 and 0.24 in the two preceding years. The rate in London County was 0.38 compared with 0.40 in 1906. The death-rate in the 76 Great Towns was 0.43. 33. Of the 70 who died from Measles, 64 were under 5 years of age; 41 were males; 29 females; 35 were in Woolwich Parish, 28 in Plumstead, and 7 in Eltham. 26 34. 1,453 notifications were received from school-teachers, compared with 646, 661, 1,240, 465, and 825 in the five preceding years. The mortality per cent. of notifications was 4.8, compared with 3.8, 2.3, 2.8, and 3.8 in the four preceding years. 35. The following table gives the number of deaths and death-rates from Measles for the past five years, and two preceding quinquennia, in each parish (as far as known), and the death rate in London:— Year. Woolwich. Plumstead. Eltham. The Borough. London. No. Rate. No. Rate. No. Rate. No. Rate. Rate. 1891-5 (average) 20 0.49 29 0.51 Not recorded 49 0.51 0.59 1896-1900 (average) 34 0.81 36 0.57 Not recorded 70 0.67 0.57 1901 11 0.26 9 0.13 1 0.14 21 0.18 0.43 1902 10 0.24 31 0.43 ... ... 41 0.33 0.51 1903 8 0.19 14 0.20 3 0.28 25 0.20 0.40 1904 11 0.26 15 0.21 2 0.18 28 0.22 0.49 1905 4 0.10 8 0.11 1 0.09 13 0.10 0.36 1906 7 0.18 21 0.28 ... ... 28 0.24 0.40 1907 35 0.87 28 0.37 7 0.55 70 0.54 0.38 27 35. The Borough experienced in the winter of 1906-7 a severer epidemic of measles than has occurred in recent years. The measles death-rate of last year was, however, below the average of the ten years 1891-1900, and the death-rate of the two years 1906-7 (0.39) was very much less than the average of 1891-1900. In fact, the epidemic of the end of 1906 and the beginning of 1907, though the most severe during this century, was mild compared with several epidemics of the preceding decennium. As in all measles epidemics the total deaths caused are not found under measles. There was last year an excess of 53 deaths from pneumonia and bronchitis at ages under five compared with 1906. At ages over five there were fewer deaths from these causes than in the preceding year. I have no doubt that most of these 53 deaths (perhaps more than 53) were really due to measles and whooping cough. As noted above, the rash in measles is often absent and perhaps more often is not noticed or forgotten when the doctor is called in for the more urgent chest symptoms. Consequently, knowing nothing of the measles, he attributes the death to bronchitis or pneumonia. The fact that the epidemic was at its height in the middle of a rather cold winter may possibly partly account for the excessive mortality due to the secondary symptoms of bronchitis and pneumonia. Though it is a great mistake to think that exposure to cold during convalescence is the principal cause of death from measles, no doubt it is a cause, especially in severe weather. The fatality of the disease was much greater last year in Woolwich parish, though the number of cases reported by school teachers proportionally to population was greatest in Plumstead. Hence the difference of fatality in the two parishes cannot be ascribed to any measures such as school-closure aimed at reducing the spread of infection. As was indicated in the special report presented last year, and more fully developed in joint papers read by Dr. C. J. Thomas 28 and myself at the International Congress on School Hygiene, early school-closure must be allowed to have failed as a means of preventing the spread of measles, and, except in special cases, has been discontinued. Under present conditions it seems hopeless to appreciably lesson the occurrence of measles, but measures directed to diminish the fatality of cases that occur have been much more successful. The simple distribution of printed directions for the hygienic treatment of the disease has apparently brought about the marked fall in its mortality in Woolwich. More lives still might be saved if these directions could be explained by an increased staff of health-visitors, and if all cases which were seriously ill could have skilled nursing. Early medical attendance is also necessary but often lacking through inability to pay the doctor. Whooping Cough. 35a. There were 37 deaths from whooping cough compared with 21 in 1906, and, as mentioned above, no doubt many deaths of young children attributed to bronchitis and pneumonia were really due to this cause. 598 cases were notified by school-teachers. As with measles, it is very difficult if not impossible to control the infection of this disease, but general sanitary measures and improved conditions of housing and more hygienic treatment of those affected are steadily reducing its fatality. Education of mothers by leaflets and health-visitors as to the hygienic treatment of children affected would doubtless still furtherreduce the mortality. The disease being chiefly fatal under two, and rarely over five, one great object should be to postpone it as long as possible, or at any rate until the child is over five years. School attendance being the chief source of infection, it is advisable, as with measles, that children under five should not attend school when these 29 diseases are prevalent or threatened, and their exclusion has lately been recommended by the Assistant Medical Officer of the Local Government Board in an official memorandum. Scarlet Fever. 36. There were 1023 cases of scarlet fever notified, equivalent to a rate of 7.91 per thousand population. This is the highest rate since 1892, when it was 9.4. 37. The following table shews the case-rates of scarlet fever in the Borough and each parish during 1901-5 and the past two years, compared with London. Average 1901-5. 1906. 1907. Borough ... 3.15 4.15 7.91 Woolwich Parish ... 2.99 3.83 6.10 Plumstead Parish ... 3.24 4.22 8.56 Eltham Parish ... 3.21 4.71 9.65 London County ... 3.57 4.35 5.46 38. Table III. gives the age distribution, the number in each ward, and the number removed to hospital. St. Nicholas's, St. Margaret's, St. George's and Eltham Wards were most affected. 39. There were 14 deaths, giving a death-rate of 0.11 per 1000 population, compared with an average of 0.06, in the six preceding years, and 0.19 in the ten years, 1891-1900. The deathrate in London was 0.14. The case mortality (proportion of deaths per cent. of notifications), 1.4, was again very low. 40. Hospital Isolation. Of the 1023 cases, 868, or 85 per cent., were removed to one of the Fever Hospitals, compared with 86, 84, 81, and 78 per cent. in the four preceding years. 47 cases, or 4 per cent., were reported, after observation at hospital, not to be scarlet fever. 30 41. Return Cases. There were 30 cases in which infection was attributed to a patient recently returned from hospital, compared with 10, 18. 14, and 13, in the four preceding years. The interval between return of the infecting case and commencement of illness, in 13 cases, was from three to fourteen days, and in 12 cases from 2 to 5 weeks. Of the infecting cases, 5 had some form of rhinitis, on or after their return; 1, otorrhoea; and 1, cough. The following notice is now sent to the friends of all children discharged from hospital after scarlet fever, by the Asylums Board:— "It is recommended:— 1. That for three weeks after leaving hospital, the patient should not sleep in the same bed (or, if possible, the same room) as children who have not had scarlet fever. 2. That during this period articles used by the patient (such as cup, plate, spoon, handkerchiefs, towels, and toys) should be kept distinct from those used by other children. 3. That the patient should not attend school for three weeks. The above precautions are specially important in the case of those patients who suffer from Discharge from either Nose or Ears." 42. Home Isolation. Hospital isolation means much greater expense, longer isolation, and often the contraction of secondary infection. It becomes, therefore, important to inquire whether satisfactory results are obtained by home isolation. Last year, out of 155 cases isolated at home, 15 were followed by 18 secondary cases in the same house; of these, however, 12 began within seven days of notification and were therefore almost certainly infected before isolation commenced, and would have occurred just the same if 31 the first case had been removed to hospital. Of the remaining six secondary cases, 2 in one house occurred five days after cessation of isolation of the primary case, and 1 twenty-two days after. These must be looked on as probably "Home Return Cases," i.e., infected by the primary case after the latter was supposed to be free from infection; the primary cases had been isolated for five weeks and four weeks respectively. One case, occurring 29 days after isolation, must be considered as due to ineffectual isolation. The remaining two secondary cases occurred 13 and 14 days after commencement of isolation. It cannot be said that these were due to failure of isolation as it is well known that the incubation of scarlet fever is, occasionally, as long as three weeks and longer. It is equally probable that they were infected by the primary case. (Thirteen cases in 1906 removed to hospital were followed by secondary cases at intervals of 7 to 23 days after removal.) It would, however, be reasonable to attribute one of them to insufficient precautions being taken. It may then be said that home isolation was followed by two return cases and two second cases, due to failure of isolation, or two per cent. of failure. These results are not unfavourable when the shorter duration and other advantages of home isolation are considered. 43. Other sources of Infection. A probable source of infection was found in 267 cases. In 118 cases infection was attributed to other members of the family. Some of these were never notified and had no distinct symptoms of scarlet fever, but a history of sore throats made it probable that they had had a slight attack of this disease. 44. In 42 cases infection was attributed to friends and neighbours, and in 79 cases to school attendance; in 9 to fellow lodgers; and in 9 to travelling or visiting hospitals. The number of mild 32 cases undetected or concealed, which go about and attend school, is no doubt very large and mainly accounts for the spread of infection. Special outbreaks occurred at Goldie Leigh Poor Law Schools, Eltham National and Gordon Schools. 30 cases occurred at Goldie Leigh. These children attended Wickham Lane County Council School, and were said to have no other place of general meeting. No other children attending this school had recently been notified with Scarlet Fever, and there was hence no reason to suspect that the infection originally came from the school. As, however, it obviously spread through the attendance of the Goldie Leigh children at the Wickham Lane School, the children were excluded from school for three weeks, after which the outbreak ceased. For the second year in succession, Gordon School was the seat of a considerable outbreak. After the occurrence of five cases at this school, Dr. Thomas, of the London County Council Education Department, examined the children in affected classes at my request. The probable source of the outbreak was found in two children—a boy who had been absent from school for two weeks with vomiting, headache and sore throat, and was found to have nasal discharge by Dr. Thomas, after being back several days at school— and his sister, who, though she was not known to have been ill, was found to be desquamating on her hands. The boy had had medical attendance, but the doctor had not diagnosed Scarlet Fever. The first notified cases sat in school near these children. They, and other suspicious cases, were excluded until certified free from infection. A large number of suspicious cases absent from school were visited by your Medical Officer of Health, and one at least was found to be suffering from a mild form of Scarlet Fever. Notwithstanding these steps, the disease continued to spread till, on my request, the school was closed for three weeks on October 21st. From October 31st to the end of 33 the year, only six cases were notified attending Gordon School, and these appeared to be independent of school attendance. 45. Children, no doubt, often attend school in an infectious state without spreading the infection as the following instance shows. An anonymous letter informed me that two boys were at home with Scarlet Fever, which was being concealed. On visiting the house I found that the boys had returned to school where I found them in class freely desquamating. They had been absent for a few days, and admitted they had had a rash and sore throat. This was probably a case of intentional concealment, but it is impossible to show in such cases that the parents were aware that their children were suffering from an infectious disease. There had been no medical attendance. The boys were aged 10 and 13 respectively, and in classes where probably most susceptible children had already had the disease. This may account for the fact that no other cases occurred at this school. 46. After 17 years' energetic administration of the notification and isolation enactments of the Public Health (London) Act, there is some reason for surprise and disappointment at the occurrence of so much scarlet fever last year. On the whole, however, there has been in the last 20 years a decided fall in the number of cases of scarlet fever and a great fall in the death-rate from this cause. The disease is now spread by mild cases, many of which are never suspected; others are concealed to avoid interference with the course of family life, as by removal to hospital, and exclusion from school. 47. The Annual Report for 1905 contained a special report on a statistical investigation into school incidence of scarlet fever and diphtheria during the ten years 1896-1905. c 34 48. In November I reported as follows on medals for school attendance:— "The recent outbreaks of Scarlet Fever and Diphtheria have emphasized the well-known connection between the spread of infectious disease and the attendance of children at school in an infectious condition. There is no doubt that a very large proportion of the cases of Scarlet Fever, Diphtheria, Measles, Whooping Cough, and other infectious diseases, are due to school infection. Although, unfortunately, children may sometimes be carriers of infection without having any symptoms of disease, it is probable that most often infectious disease is spread by children who have slight but obvious symptoms of the disease. Such children are usually not seriously ill, though cases not unfrequently occur, in which children, who are actually seriously ill, have been found in school. There are two principal reasons why children go to school when poorly and suffering from infectious disease. These are, anxiety not to miss school attendance, and neglect or inability to obtain medical advice. The first is probably much the most important. School medals are given to children if they attend punctually and regularly throughout the school term, and do not stay away for more than two days after due notice is given. No allowance is made for accidents or illness of the child or for infectious disease in the house. The medals appear to be a very great attraction to the children, but, if they are not of themselves sufficient attraction, the school attendance officers apply compulsion where attraction fails. The result is that children commonly attend when their health requires that they should be kept at home. They go to school with toothache, ear-ache, bad colds, and often more serious diseases. The educational authorities do not seem to have 35 nised that it is just as important, from the point of view of health, to keep children at home when ill, as it is, from, the point of view of education, to get them to school when well. The Education Committee of the London County Council have been considering the question, and a proposal to abolish the medal system has been mooted. The Council, however, decided instead to amend the rules in reference to the award of medals." This was done, and the London County Council have since revised this rule, so that absence on account of illness will not in future be a barrier to obtaining the medal. Diphtheria. 49. 275 cases of Diphtheria were notified, compared with 163, 273, and 387 in the three preceding years. The case-rate (number of cases per thousand population) corrected for cases of mistaken diagnosis of which 39 were noted was 1.83. The rate has only been twice lower since 1894, viz., in 1903 and 1904. 24 of the notified cases were bacteriological, i.e., had no symptoms. 50. There were 15 deaths, compared with 29, 18, and 23 in the three preceding years. The death-rate was 0.12; the rate was lower in 1903 (viz., 0.11), but higher in all the remaining years since 1891 (see Table V.). The London death-rate was 0.16. The death-rate in the 76 great Towns was 0.18. 51. Seventy-four cases were in Woolwich Parish, 181 in Plumstead, and 20 in Eltham. The following table shows in case- rate in each parish (not corrected for mistaken diagnosis) in the past seven years compared with London and the Borough:- 1901-5. 1906. 1907. The Borough 1.71 2.80 1.83 Woolwich Parish. 1.63 3.43 1.85 c 2 36 1901-5. 1906. 1907. Plumstead 1.87 2.26 2.36 Eltham 1.62 6.70 1.57 London 1.90 1.70 1.85 52. 230 cases, or 83 per cent. of notifications, were removed to hospital, compared with 67 per cent. in 1906. Certificates of efficient home-isolation were given in 30 cases (21 in 1906, 8 in 1905). The case mortality was only 6'3 per cent. compared with 9.9, 7.0, 17.8, 6.6, and 5.7 in the five preceding years, and with 8.9 in London. If the Diphtheria death-rate which prevailed from 1896-1900 had been in operation last year, there would have been 60 deaths from this disease last year instead of 15—the actual number. 53. Bacteriology is now systematically used to prevent children attending London County Council Schools in an infectious state. After a case has been notified in a house, no children from that house are allowed to return to school until they have been certified free from infection after a bacteriological examination. 175 home contacts were examined by the Medical Officer of Health, and 26 carriers found and excluded from school until the diphtheria bacillus had disappeared. The Medical Officers of the Royal Arsenal examined employees from infected houses before allowing them to return to work, and discovered several bacteriological carrier cases. Altogether, 24 cases, found to be "carriers" of the diphtheria bacillus, without having any symptoms, were notified. Five cases were reported as nasal. 54. Mistaken Diagnosis. 39 cases, or 14 per cent. of notifications, were, after removal to hospital, stated not to be 37 theria. The percentage of the three preceding years was 7, 14, and 8 respectively. 55. Source of Infection. In 74 cases, a probable source of infection was noted, viz., in 41, other inmates of the house were suspected to be the source; in 14, school-mates; 9, neighbours and friends; 4, return cases; 1, travelling; 2, general hospitals (out-patients' departments); and in 3, other surces. E.D., found to have a sore nostril, but not to have been otherwise unwell was bacteriologically examined and the diphtheria bacillus found. He was sent to hospital, but not before he had infected a sister and three neighbours. He was kept at hospital three months before he was free from infection. On inquiring at a house where two cases of diphtheria had occurred a boy living next door was found to have a sore nostril; he also had diphtheria bacilli and was sent to hospital. These cases show how infection is carried, and demonstrate the advantage of examining bacteriologically all children in houses where diphtheria has occurred, before their return to school. 56. School Infection. Since the practice just referred to has been carried out, school infection has been decidedly less prevalent. There was, however, a well-marked outbreak, or rather two outbreaks last year at Bostall Lane school. 26 cases occurred from September to December. In the beginning of September a young man died of laryngitis, which was probably diphtheritic, but the true nature of his disease was not suspected till afterwards. A child in the same house attended school for three days with a running at the nose before she was notified as having diphtheria. Within ten days of her ceasing attendance six other children began with diphtheria. Six further cases occurred up to the end of November. Then a similar occurrence took place, a boy with nasal discharge attended school five days before being notified. 38 He infected his sister, brother, and six school-fellows, and cases continued to occur in connection with the school until the Christmas holidays. An examination was made of all children in affected classes, and suspicious cases were examined bacteriologically. All absentees for sore throat were visited at their homes, and in this way some cases of diphtheria were found and the outbreak limited in its spread. The holidays were extended for two weeks and the outbreak finally ceased. 58. Bacteriological Diagnosis.—679 swabs were sent to the Lister Institute to be examined for the presence of diphtheria bacillus. In 128 the true Klebs Loffler bacillus was found (in 6 of these, Hoffman's Bacillus co-existed with the Klebs Loffler bacillus); in 171 Hoffman's Bacillus was found, and 380 were found free from either the Klebs Loffler bacillus or Hoffman's. Of the 679 swabs examined, 175 were taken from school children by myself. Of these 26 contained the true Klebs Loffler bacillus, and 67 Hoffman's bacillus. Most of these were contacts seen about 10 days after notification of the primary case, for the purpose of giving certificates to enable pupils to return to County Council Schools. Others were examined with the object of finding possible sources of infection, e.g. where the first case notified in a house was a child not attending school. Of the 175, 148 had no noteworthy abnormal symptoms, while 27 had symptoms, viz., 6 had tonsilitis, 9 congestion or exudation of fauces, 1 clinical diphtheria, and 13 some form of rhinitis. Of the 27 cases which had symptoms, 7, or 26 per cent., were positive, while of the 148 cases with no noteworthy symptoms, only 19, or 13 per cent., gave positive results. Of 4 cases with purulent discharge, encrustation and soreness of the nostrils, 2 gave a positive result, 1 shewed Hoffman's bacillus, and 1 was negative. 39 Hoffman's bacillus was found in 7, or 26 per cent of cases with symptoms, and in 20, or 14 per cent of cases with no symptoms. The following new directions were issued for use at houses where a case of Scarlet Fever or Diphtheria had occurred:— "METROPOLITAN BOROUGH OF WOOLWICH. Scarlet Fever and Diphtheria. School Attendance.—Children from this house should not attend day school or Sunday school or other place of meeting until permission is given by the Medical Officer of Health. Library Books.—Public Library Books must be delivered to the Disinfecting Officer when he calls, and no books borrowed until the house has been disinfected. If the patient is treated at home, the following precautions should be carefully observed to prevent the spread of the disease and hasten the recovery of the patient:— 1. Isolation.—The patient must be confined to one room, and no one, except the person in charge and the doctor, allowed to enter the room. A notice should be fixed outside the door saying "No admission." All carpets, curtains, and unnecessary furniture and clothing should be removed from the room at once, and the floor and furniture frequently wiped with a damp cloth. Do not allow dogs or cats to enter—they may carry infection. The cups, spoons, and other articles used by the patient should be kept and washed in the sick room; books, toys, &c., must be kept in the room until they are disinfected or destroyed. 2. Nursing. It is advisable that the person acting as nurse should, whilst in the sick room, wear a loose cotton gown or overall over her dress; this must be removed and her hands washed every time before leaving the room. She 40 must keep away altogether from other children and, as far as possible from adults. 3. Ventilation. Admit fresh air by opening wide the upper sash of the window. The fireplace should be kept open, and a fire lighted in cold weather. Fresh air should be freely admitted through the whole house by means of open windows and doors. 4. Recovery. A patient suffering from this disease is generally dangerous to others for six to eight weeks, and must not be allowed to mix with other people until the Medical Attendant certifies that there is no danger. In Diphtheria, a bacteriological examination will show when the patient is free from infection. 5. Unrecognised Cases. Many cases of Scarlet Fever and theria are very mild and the rash of Scarlet Fever may be absent or so slight that unless it is carefully looked for it may be entirely overlooked. Such cases are often looked upon as being merely "feverish colds" or "simple sore throat," &c. In Scarlet Fever the "peeling" in the course of two or three weeks will often show the real nature of the illness, but meantime the disease may have spread to others. Hence in all doubtful cases (as where there is sore throat, sickness, and slight feverishness), careful search for a rash on the body should be made for several days and medical attendance sought. If there has been a previous case of Diphtheria in the house, the school, or the neighbourhood, a bacteriological examination should be made. 6. Disinfection. All soiled linen should at once be placed in a tub of water to which a handful of ordinary washingsoda has been added, soaked for 12 hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in Corrosive Sublimate solution mixed with two parts of water. 41 Special cups, saucers, and spoons should be used for the patients, and any spare food from the sick-room destroyed. Discharges from ear, nose, or mouth, should he received on a rag or piece of soft paper (e.g., Japanese serviette), which should he at once burnt. During recovery the patient should have frequent warm baths unless the doctor orders otherwise. Special precautions should be taken to cleanse thoroughly the hair and scalp before finally leaving the sick-room. When the patient is free from infection, the Public Health Department undertakes the disinfection of the sick-room, bedding, &c., free of cost. The accompanying certificate should be returned when the patient is free from infection. The following disinfectants are supplied on application at Council's Offices, Maxey Road; Disinfecting Station, White Hart Road; The Health Shelter, Sun Street; 112, High Street, Eltham; and 18, Bargehouse Boad, North Woolwich:— A. Solution of Corrosive Sublimate (1 in 1,000). B. Solution of Permanganate of Potash, about the same strength as Condy's Fluid, for personal use by patient or nurse as directed by the Medical Attendant. N.B.—It is, of course, understood that the above directions are dependent on the approval of the Medical Attendant, who may find it desirable to modify them in special cases. SIDNEY DAVIES, M.D., January, 1907. Medical Officer of Health.'''' Enteric fever. 59. There were 20 cases of Enteric Fever, not including 7 cases of mistaken diagnosis notified as enteric. The case-rate was 0.16, compared with 0.19, 0.17, and 0.23 in the three preceding years; this is again the lowest rate recorded in the 42 Borough. For the ten years 1892-1901, the rate never fell below 0.41. The case-rate in London was 0.29. Out of 27 cases notified, 18 went to hospital. 60. There were four deaths giving a death-rate of 0.03 which is the lowest death-rate recorded. The death-rate in London was 0.04 and in the 76 great towns 0.07. At the present rate of diminution enteric fever will have practically disappeared in five years' time. 61. The following are the cases notified in each parish during the past six years:— Average, 1901-5. 1906. 1907. Woolwich 12.6 16 6 Plumstead 21.2 21 16 Eltham 8.6 3 5 62. In one case the disease was attributed to oysters from the Mumbles; in one to cockles; one to whelks; and one to periwinkles. Five were secondary cases, i.e., contracted from a previous case in the family. These were all in one family in which the first case was not diagnosed and consequently infected the others before isolation was carried out. 63. Bacteriological Diagnosis. 34 samples of blood were sent to the Lister Institute to be examined for Widal's reaction. A positive result was obtained in 12. Diarrhœa or Zymotic Enteritis. 64. The deaths from diarrhoea, dysentery, and epidemic or zymotic enteritis were 34 or 0.26 per 1000 population, compared with 0.48, 0.36, 1.19, 0.52, and 0.81 in the five preceding years. The rate for the 76 great Towns was 0.43 and for London 0.32. 43 There were, in addition, 25 deaths from enteritis and gastroenteritis, making a total of 59 deaths or 18 per 1000 births, due to diarrliœal diseases. 43 of the 59 were under one year of age. 65. The following table shows the death-rate from the abovementioned diarrliœal diseases per 1000 births, in each parish during the past seven years:— Diarrhœal. Disease per 1000 Births. Average, 1901-5. 1906. 1907. Woolwich Parish 332 44 19 Plumstead „ 26.6 31 16 Eltham „ 18.8 19 11 The Borough (1902-5) 26.7 34 18 London County (1904-5) 40.0 48 21 North River, St. George's, and St. Nicholas's Ward had the highest death-rate; Barrage, St. Margaret's, St. Mary's, and Eltham, the lowest. The Council decided in the spring of 1905 to pay for voluntary notifications of the first case of Zymotic Enteritis occurring in a family during the months of July, August, and September; and in January, 1906, it was decided to continue the experiment for three years more. Nos. I. to VI. in the following tables summarise the notifications received and the results of the inquiries made in the third year of notification. Altogether 94 cases were notified (compared with 212 and 366 in 1905 and 1906), of whom 11 died up to October 31st, giving a case death-rate of 11 per cent.; 22 deaths occurring during the same period were certified to be from diarrhoea or zymotic enteritis, so that 11 children died of this disease who were not notified. It appears therefore, that half the cases for which medical attendance was called in were notified. Most cases were notified within three or four days of the commencement of illness. 44 Only 11 deaths occurred before September 30th, and 11 occurred in October. In addition to these 22 deaths, 5 further deaths occurred in November. From this and other information it appears that the greater part of the zymotic enteritis occurring this year came on after September 30th, and consequently the majority of the cases that have occurred have not been notified. Age Distribution. Table I. shows that nearly half the cases notified were between 3 and 12 months of age, the largest number in any three months being between 9 and 12 months of age. 18 cases over 5 years of age were notified. From inquiries made, I have no doubt that the disease affects persons at all ages, but it is much more serious under the age of 2, and in extreme old age. Local Distribution. As notification is voluntary, it was to be expected that some doctors would be more inclined to notify than others, and this will necessarily affect the local distribution as indicated by notification, and consequently too much reliance must not be placed on the figures given for the Wards. The largest number of cases occurred, proportionally to population, in River North, St. Nicholas's, and Dockyard Wards. Table III. shows the condition of the 93 houses affected as regards crowding and cleanliness. 10 houses were found to have more than two persons to a room, and 34 were found to have more than 1 1/2 persons to a room. 14 were very clean, 39 clean, 27 indifferent, and 13 dirty. Table IV. shows the manner of feeding of all cases under one year of age. Only 4, or 8 per cent. were fed on the breast alone and 9, or 18 per cent., on breast and other food. 3, or 6 per cent., were fed on depot milk; one of these, however, no doubt had other food given as well. The remaining 68 per cent. were nearly all fed on fresh cows' milk or Nestle's condensed milk. In 1905 and 1906, 20 per cent., and in 1907, 26 per cent., were fed wholly or partially on the breast. An enquiry made in 1904 45 showed that 82 per cent. of all infants under 12 months were fed wholly or partially on the breast. In my report on Summer Diarrhoea, previously referred to, I estimated that an artificiallyfed child was 45 times more likely to die of diarrhœa than a breast-fed child. Of the three children who were fed on depot-milk, all had been taking the milk for at least two months before the zymotic enteritis began. In one, the conditions of the house were satisfactory, the mother careful and intelligent, and there was nothing to account for the infection having been conveyed. The child had done very well on the milk, and it soon regained its normal health. In the two other depot-fed cases, the mothers were ignorant, and did not attend to the directions as to the use of the milk. One of these no doubt gave the child other food besides the depot-milk. In one of them the child and the home were not kept clean; the baby was wasting and suffering from indigestion at the time of beginning the milk. This one also recovered. The other had had an attack of diarrhoea and vomiting before commencing the depot-milk. The mother, in spite of directions to the contrary, insisted on putting depot-milk into a long-tube bottle, and, on being blamed for this, she discontinued the milk. The child died a month later. Table V. shows the cause of weaning of 34 cases which were weaned under the age of six months. It appears from this table that only three children were weaned on account of the mothers' going to work. 26 children were weaned owing to the failure of the milk, and to death, illness, or other condition of the mother. Action taken.—The cases notified were visited by Miss FitzGerald. A leaflet of instructions as to cleanliness, feeding of infants, disinfection, and other matters, was left and explained. Mothers were particularly directed to wash their hands before preparing the baby's food. When any insanitary conditions were found at the house, the usual steps were taken for remedying them. 46 Source of Infection.—Some probable source of infection was discovered in 18 cases, viz., mother, 1; sister, 2; brother, 3; neighbour, 12. Deaths.—Table VIII. gives the death-rate from diarrliœal diseases in the summer quarter during the past six years, and infantile death-rates for the year in London and Woolwich during the past six years. With this is also given the maximum temperature of the 3 ft. ground-thermometer, and the average temperature of the same thermometer for the 13 weeks of each summer quarter of the years 1901 to 1907. It is well known that diarrhœa is much more prevalent during warm weather. The past quarter had the lowest average temperature of the air (58.87) of any summer quarter in the past seven years. It was therefore to be expected that the diarrliœal mortality of this year would be lower than in any of the past six years. As a fact, the deaths from diarrhoea (including epidemic or zymotic enteritis, dysentery, and infantile cholera) were 0.34 per 1,000 living, which is much below the rate for the past six years (see Table VIII). The diarrhoea death-rate in the County of London was 0.46, the lowest rate for any of the past seven years. In order to test the advantage derived from notification of zymotic enteritis, I have compared the diarrhœa death-rate of the summer quarter of London and Woolwich in the two periods 1901-4 and 1905-7. In the earlier period, zymotic enteritis was neither notifiable in Woolwich nor in any other part of London. In the past three years it has been notifiable in Woolwich, but not in any other part of the County. Deaths from Diarrhœa—Summer Quarter. 1901-4. 1905-7. Rate per 1,000 living—London 2.27 1.91 Woolwich 2.30 1.53 47 It thus appears that while in London the diarrhoea death-rate has decreased in the past three years 16 per cent., in Woolwich the rate has declined 34 per cent., so that as far as statistics can be relied upon, this indicates a decided advantage derived from notification. If the rate in Woolwich had maintained during the years 1905-7 the same proportion to the London rate as it had during 1901-4 there would have been, in those three years, 39 more deaths from diarrhoea, which represents about ten times as many children whose health would have been seriously injured. The total cost of notification in the three years was £78 2s. Notified Cases of Zymotic Enteritis. (July 1st to September 30th, 1907.) Table I. Age and Sex. Total. Males. Females. Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Total under 1 year. 1 to 2 years. 2 to 5 years. Over 5 years. - 93 48 43 6 18 14 11 49 23 3 18 Notifications 10 4 6 1 4 3 1 9 1 - — Deaths to October 31st Table II. Distribution in Wards and Parishes. Notifications. Deaths to Oct. 31st. Woolwich Parish 26 — River Ward (North) 9 2 River Ward (South) 1 Dockyard Ward 12 1 St. Mary's Ward 2 St. George's Ward 2 48 Notifications. Deaths to Oct. 31st. Plumstead Parish 57 St. Nicholas's Ward 43 5 Central Ward 4 Glyndon Ward 3 1 St. Margaret's Ward 5 1 Herbert Ward 1 Burrage Ward 1 Eltham Parish 10 10 93 93 10 Table III. Houses affected. Total. Number under 1 1/2 to a room. Number with over 1 1/2 and under 2 to a room. Number with over 2 to a room. Standards of Cleanliness. 93 49 34 10 * 14 † 39 ‡ 27 || 13 § o N.B.—* signifies very clean, † clean, ‡ indifferent, || dirty, § very dirty. Table IV. Principal Diet of Cases under 1 year. Total cases 49 Breast only 4 Breast and other food 9 Fresh cow's milk 10 Fresh cow's milk and farinaceous food 11 Nestle's condensed milk 11 Depot milk 2 Depot milk and other food 1 Not stated 1 49 Bottle used. Tube bottles used 15 Tubeless bottles used 23 Both bottles used 3 Table V. Cause of weaning of cases under 6 months of age. Total Oases Weaned under 8 months Death of Mother. Illness of Mother. Failure of Milk. Mother at Work. Other Causes. 33 - 8 18 3 4 Table VI. Number of Cases notified each week, with mean temperature of 3 ft. ground-thermometer during week. July Weekended 7th 14th 21st 28th Cases 2 1 0 5 Temperature 56.71 57.00 58.53 59.67 August Weekended 4th 11th 18th 25th Cases 2 7 5 7 Temperature 60.10 60.34 60.84 60.26 September Weekended 1st 8th 15th 22nd 29th Cases 17 10 8 12 17 Temperature 59.67 59.45 59.43 58.77 58.18 D 50 Table VII. Deaths from Diarrhoea and Zymotic Enteritis, classified by Wards and Ages, during the 4 months ended 31st October, 1907. Ward. Under 1 year. 1 to 5 years. 5 to 60 years. Over 60 years. Total Cases. 1 to 3 months. 3 to 6 months. 0 to 9 months. 9 to 12 months. Woolwich— River North ... 1 2 1 ... ... ... 4 South ... ... ... ... 1 ... ... 1 Dockyard ... ... ... 1 ... ... ... 1 St. Mary's ... 1 ... ... ... ... ... 1 St. George's ... ... 1 ... ... ... ... 1 Plumstead— ... ... ... ... ... ... ... ... St. Nicholas' ... 5 2 ... 2 ... ... 9 Central ... ... ... ... ... ... ... ... Glyndon 1 ... ... ... ... ... ... 1 St. Margaret's ... 2 ... ... ... ... ... 2 Herbert ... ... ... ... 1 ... ... 1 Burrage ... ... 1 ... ... ... ... 1 Eltham ... ... ... ... ... ... ... ... Totals 1 9 6 2 4 ... ... 22 51 Table VIII. Diarrhoea, Infantile Mortality, and Temperature of Summer Quarter in London and Woolwich. District. 1901. 1902. 1903. 1904. 1905. 1906. 1907. Annual Death-rate from Diarrhœa in Summer Quarter per 1,000 living London 2.77 1.42 1.49 3.39 2.28 3.00 0.46 Woolwich 2.76 0.97 0.96 4.52 1.72 2.54 0.34 Infantile Death-rate for year (deaths under 1 year per 1,000 births) London 148 139 130 144 131 132 115 Woolwich 129 125 108 135 103 111 113 Maximum Weekly Average Temperature of 3 ft. groundthermometer in 13 weeks of Summer Quarter ... 63.54 61.09 61.64 64.62 64.11 64.00 60.84 Average Temperature of 3 ft. ground-thermometer in Summer Quarter ... 62.06 59.68 60.18 61.45 61.62 62.08 59.16 D 2 52 Erysipelas. 67. There were 110 cases of erysipelas notified, compared with 58, 74, 83, and 110 in the four preceding years. There were six deaths. The case rate was 0.85 and the death rate 0.04. These rates are the highest since 1900. Epidemic Cerebro-Spinal Meningitis. 68. In consequence of the serious epidemic of this disease in certain towns in Ireland and Scotland, cerebro-spinal meningitis was made a notifiable disease under the Public Health (London) Act by the London County Council. Only one case was notified in the Borough, which proved fatal. It seems probable that the disease is always present in London, but is not usually distinguished from other forms of meningitis. Puerperal Fever. 69. There were six cases of puerperal fever notified, compared with two, five, twelve, and eight in the four preceding years. There was one death. The case rate was 0.04 and the death-rate 0.01. The case-rate has only twice, and the death-rate has never been lower since 1891. The death-rate has twice been as low. One case was attended in confinement by a qualified medical man, and seven by midwives. The London death-rate was 0.03. In no case was there any ground to suppose that infection was conveyed by the professional attendant from a previous case. Influenza, Bronchitis, Pneumonia. 70. Influenza caused 30 deaths, compared with 62, 22, 60, 27,. 23 and 33, in the six preceding years. Bronchitis and pneumonia caused 298 deaths, compared with 299, 258, 278, 255 and 265, in the five preceding years (re cause of increase see "Infant Mortality"). 53 Tuberculosis. 71. Deaths. There were 206 deaths from Tuberculous disease, giving a death-rate of 160 compared with 1.86, 1.92, 2.06, 1.83, and 1.71, in the five preceding years. This is the lowest death-rate recorded. The London death-rate was 1.95. 72. The following table gives the number of deaths from each of the various forms of tuberculosis in the past seven years, and also the deaths from simple meningitis:— Average, 1901-5. 1906. 1907. Tubercular meningitis 20.0 22 19 Simple meningitis 22.0 15 20 Tuberculosis of intestines and peritoneum 13.0 14 11 Tuberculosis, other forms 20.8 21 22 Phthisis 192.0 164 154 73. The deaths from phthisis were 154, giving a death-rate of 1.19 compared with 1.49, 1.39, 1.64, 1.47, and 1.29, in the five preceding years. This is the lowest death-rate recorded; the reduction in death-rate since 1901 represents a saving of 75 lives last year. The following table gives the death-rate from phthisis in each parish during the five years 1901-5 and in 1906 and 1907 compared with London. There was a great reduction in the parish of Woolwich, but an increase in Eltham:— Average 1901-5 1900. 1907. No. Rate No. Rate No. Rate Woolwich Parish 89 2.15 67 1.68 52 1.30 Plumstead „ 97 1.34 90 1.20 92 1.20 Eltham „ 6 0.03 7 0.58 10 0.78 The Borough 192 1.56 164 1.29 154 1.19 London — 1.57 6969 1.47 6654 1.39 54 74. The following table shows the death-rate from phthisis in Woolwich and Plumstead parishes, in each of the three past quinquennia:— 1891-5. 1896-1900. 1901-5. Woolwich 2.80 2.16 2.15 Plumstead 1.78 1.40 1.35 75. The reduction of the phthisis death-rate in the past two years, especially in Woolwich parish, is very marked. The deathrate from other forms of tuberculosis has diminished but very slightly. 76. 82 of those who died from Phthisis were males and 72 females. In 1905 there were 110 males and 75 females, and in 1906-7, 97 males and 67 females. The death-rate of males is decreasing faster than that of females. 77. Out of 20 who died, with regard to whom information on this point was obtained, 3 were stated to be teetotalers, 10 temperate, and 7 intemperate. 78. The source of infection was attributed, in 86 deaths from tuberculosis, with more or less probabability, as follows:— Family or personal—Father 18 Husband 3 Mother 13 Brother 5 Sister 6 Other relatives 5 Other inmates of house and friends 5 Workplace 6 Public House, or Licensed Restaurant 20 Milk 5 86 55 One who died was engaged in the liquor traffic. The mother of an infant who died at six months of general tuberculosis was starving—even as to bread—during pregnancy. 79. Notifications. Voluntary notification of Phthisis has now been in force in the Borough for six years. 150 cases were notified last year, compared with 167, 145, and 176 in the three preceding years. 28 of these were in the Poor Law Infirmary, 17 others were notified by the District Medical Officers of the Poor Law Unions, 20 by the Medical Officers of the Royal Arsenal, and the remainder by clergymen, philanthropic societies, applicants for admission to the Peppard Sanatorium, and by private medical practitioners. £9 13s. Od. was paid during the year for the notification of phthisis. Duration. Of the 150 cases notified during 1907, at least 32 have since died, and of 176 notified during 1906, at least 67 have since died (February 15th, 1908). 80. The source of infection of the notified cases was probably as follows Family or personal, 34, viz.:— Father 12, Mother 5, Brother 6, Sister 1, Husband 2, Other members of family 3, Friends, lodgers, &c., 5 (including one patient nursed). Workshop and office 18. Public House 20. School 2. Navy and Army 8. Milk 1. Undetermined 67. 56 81. Of the 43 adults about whom information was obtained, 8 were stated to be teetotalers, 24 temperate, and 11 intemperate. Of the houses of notified consumptives, ten were to some extent dirty, and one had dark rooms. 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. 1 0 10 36 75 26 2. Sex. 97 males; 53 females. 82. Occupation. Of the 97 notified males, 34 were Arsenal employees. The Department and Workshops affected are as follows— Royal Laboratory 10 Electrical branch 1 Danger Buildings 0 Royal Carriage Department 5 Royal Gun Factory 3 Royal Shell Factory 2 Army Ordnance Department 2 Building Works Department 3 Torpedo Factory 2 Central Office... 3 Naval Ordnance Department 1 Royal Dockyard 2 One case was engaged in the liquor traffic. 83. Bacteriological Diagnosis. Sputum from 171 cases of suspected phthisis was examined at the Lister Institute, and tubercle bacilli were found in 55 cases. The number of examinations for the 5 previous years were 36, 144, 116, 130, and 130 respectively. 57 84. In my Annual Report for 1904 some figures were given as to the "Public House as a source of Infection," and "Chronic Tuberculosis in Children." (See page 50 of that Report.) The managers of licensed houses were all visited and supplied with one or more notices asking customers not to spit on the floor. Such notices are generally hung up when supplied, but soon displaced. It is a pity Publicans do not realize that it is to their advantage, and to that of their servants, to discourage spitting on the floor, and to keep the floor cleansed with disinfectants. 85. Disinfection was performed by the Public Health Department at 1(35 premises, compared with 192, 142, and 169 in the three preceding years. Of these, 105 were disinfected after the death of the patient, and 60 after removal to hospital, sanatorium, or on other opportunity. 86. Sanatorium Treatment. All the Council's seven beds at the Peppard Sanatorium were kept occupied throughout the year, except for a few days in the case of one female bed. There were always more male patients anxious to go than could be accommodated. The male applicants greatly outnumbered the female. 40 patients were admitted, and 40 discharged. Of those discharged 22 stayed for one month, 8 for two months, 2 for four months, 3 for five months, and 5 for six months. None died, and all but three returned home in improved general health, and shewing a decided increase in weight. Most shewed very great improvement, and were able to resume there ordinary duties. Three, however, were reported to be severe or acute cases which shewed little or no signs of improvement in the lungs. Several were kept for a time at the Sanatorium, after ceasing to be chargeable to the Council. Some of these earned their keep by performing light duties, and others were supported by a charitable fund. 58 87. From August 1903 up to June 30th, 1907, 76 patients had passed through the Council's beds at the Sanatorium, and the following table shows the condition of these up to February 1st, 1908. At work and well 34 At work but relapsed 2 Ill and unfit for work 6 Moved and not heard of 8 Died 26 76 All the 34 at work and well were seen or heard from this year (1908); four of the eight moved and not heard of went to Canada and three of these were well and at work six or twelve months ago; two others were well at these dates. It may be safely estimated that 40 of the 76 are now well and at work, or fit for work. 88. H. C. was at the Sanatorium two months, left in June, 1905, much improved though still with distinct symptoms; not finding work in Woolwich he went to Canada in March, 1906, and got work on a farm. He had excellent health while there and, having saved enough money to pay his return passage, thought he would spend Christmas at home and unfortunately caught cold on the journey. His disease recurred and he again obtained admission to the Sanatorium, recovered, returned to Canada, worked for six months, again relapsed and was sent home by the Emigration Office. 89. The following table, recommended by the Local Government Board shews the condition in each subsequent year of the survivors from the cases treated in each year. The difference between the numbers dead and the survivors in any year shows the cases lost sight of. 59 Number of Patients Discharged in each year who were (a) Alive, (b) at Work, Seeking Work, or performing their ordinary duties in January of each of the under-mentioned Years. Year. Number Discharged. Dead Jan., 1908. 1904. 1905. 1906. 1907. 1908. A B A B A B A B A B 1903 1 1 1 ... 1 ... ... ... ... ... ... ... 1904 11 5 ... ... 8 7 5 4 4 4 2 2 1905 10 9 ... ... ... ... 13 11 10 9 6 5 1906 29 5 ... ... ... ... ... ... 29 22 21 16 1907 37 5 ... ... ... ... ... ... ... ... 32 22 94 25 1 ... 9 7 18 15 43 35 61 45 N.B.—Some half-dozen of those recorded as at work are employed at the Sanatorium in various capacities, receiving board and a small wage. At least six of these not accounted for in 190S are believed to be well and at work, four in Canada and one at Lowestoft employed in fishing. 90. The limitations of Sanatorium treatment were referred to in the 1906 Report. Phthisis cannot be prevented from recurring in susceptible subjects who return to unfavourable conditions, but a few months stay at a Sanatorium is a very successful means of re-establishing health temporarily in nearly all, and permanently in a large proportion. The result of sending patients for only one month has been decidedly satisfactory. For many the period seems sufficient to re-establish their health and enable them to resume work and keep well under favourable conditions. At least four who left the Sanatorium in 1906 after one month's treatment are now well and 60 at work. Those who prove to be in too advanced a condition to benefit, even by prolonged treatment, at any rate have their lives lengthened and learn how to continue the treatment at home and avoid being a source of danger to their relatives and friends, and the Medical Superintendent is able to pick out those who will best profit by further stay in the long-treatment beds. 91. Educational Sanatorium Treatment.—Three consumptive patients are now receiving educational treatment every month, by passing at least one month at the Sanatorium. The fact that 36 consumptive patients are there trained every year how to preserve their health and how to avoid infecting others will undoubtedly do much to diminish the tuberculosis death-rate, and the figures of the last two years indicate that it has already done so. The names of 59 applicants for admission to the Sanatorium were entered on the register during the year, compared with 50 and 65 in the two previous years. Of these, 40 were admitted; eight were too far advanced to be accepted; others were admitted to Convalescent Homes. Consumption Hospitals, other Sanatoriums, or to the Workhouse Infirmary, but all received instructions as to means to be taken to promote their own health and avoid infecting others. Indeed, the Sanatorium is found a very useful means of obtaining notifications of phthisis which would otherwise not be heard of until death occurred. 92. Thirty-two spitting-flasks were supplied at cost price (5d.), compared with 23, 35, 14, and 22, in the four previous years. Cancer. 95. There were 107 cases of cancer (malignant tumour), giving a death-rate of 0.83 compared with 0.83, 0.75, 0.74, 0.70, and 0.90, in the five preceding years. 44 of the deaths were in males and 63 in females. 73 of the deaths were in persons over 61 55. The highest mortality was in South River ward. The London death-rate was 103. 96. The following table shews the sex and region affected of all cases of malignant disease: — Carcinoma. Seat of Primary Disease— Males. Females. Head and face 1 2 Mouth and tongue 1 — Pharynx, oesophagus, larynx and neck 8 1 Pleura, lung, mediastinum 1 1 Stomach and pylorus 9 5 Intestines (including rectum) 3 2 Rectum 3 7 Liver 7 10 Peritoneum and omentum — 1 Kidney and bladder 3 2 Female genital organs — 19 Female breasts — 11 Male genital organs 2 — Pancreas 1 — Undefined 1 — 40 61 Sarcoma. Tonsil 1 — Pancreas 1 — Leg 1 1 Undefined 1 1 4 2 62 Alcoholism. 97. There were four deaths from alcoholism and 14 from cirrhosis of the liver, making a total of 18 deaths definitely attributed to alcohol, compared with 40, 42, 27, 24, and 17 in the five preceding years. In addition to these there were 327 deaths from diseases of the brain and nervous system (excluding meningitis), heart, bloodvessels, and kidneys, of which a large proportion were certainly caused, directly or indirectly, by alcohol. The deaths from these causes in the four preceding years were 313, 335, 336, and 347 respectively. 98. The death-rate from alcoholism,and cirrhosis of the liver was 0.14 in the Borough, and 0.25 in the County. There is one licensed house per 658 population in the Borough, and one per 266 in River Ward. Four licensed houses in River Ward have been closed under the Licensing Act, 1904. The statement respecting "Physical Deterioration and Alcoholism," which was issued as a poster in 1905, is now appended to the other leaflets, and left at all houses in the course of house-tohouse inspection. (See Annual Report, 1905, page 59). The example of Woolwich in issuing the statement re "Physical Deterioration" has since been followed in nearly all the Metropolitan Boroughs, and about 100 provincial Boroughs, Urban and Rural areas. Syphilis. 99. There were 9 deaths from syphilis compared with 8, 14, 14, and 10, in the four preceding years. Five of these occurred in the Workhouse Infirmary, and one in an outlying Institution. Five were males and four females; four were infants under five years. There were in addition 15 deaths from general paralysis, tabes dorsalis (locomotor-ataxy), and peripheral neuritis (diseases 63 which are now considered to be usually due to syphilis), compared with 19 and 14 in the two previous years. These figures are far from representing the total mortality caused by this disease. Meteorology. (See Table VIII). 100. The temperature of the winter quarter of the year was nearly normal; it had nine weeks with an average temperature above the normal and four below, but three of these were very cold weeks. The spring quarter had five weeks above the normal temperature and eight below. The summer quarter had four weeks above the average and nine below; its average temperature was one degree below the normal. In the autumn quarter every week the temperature was above the average. The lowest temperature 19.8 occurred in the first week of the year, and the highest 82.7 occurred in the week ending the 28th September. The rainfall, 23.48 in., was below the average; the deficiency being specially in the summer quarter. Altogether the effect of the weather was favourable to health, the cool summer being particularly healthy. The largest number of deaths, 61, took place in the week ending February 2nd; this and the preceding week had the lowest average temperature of the year. The smallest number of deaths was in the week ending July 6th. 64 PART II. ADMINISTRATION. Water Supply. 1. In March, 1906, I reported on the result of examinations of the water of the Plumstead Well, made by the director of water examinations for the Metropolitan Water Board. The report showed that the water of the Plumstead Well had been in a comparatively impure condition. This was attributed to excessive pumping, causing the Thames water to be drawn through the chalk more quickly than was desirable. On pumping less quickly, the quality of the water improved. The Council requested the Board to have monthly examinations made of the water of the Plumstead Well, and to furnish the Borough Council with copies forthwith on the report being presented to the Water Board. Fifteen samples of the Plumstead Well Water were analysed, and examined bacteriologically between December 4th, 1905, and and July 12th, 1906. A Report of the Metropolitan Water Board, printed in July, 1906, says "All the Kent Wells have been examined once a "month bacteriologically, and once a quarter chemically, " but the results obtained have been grouped together as " averages— a procedure open to some objection, scientifi" cally. The time has now come when it is desirable to take " stock of these observations. This is the more important " since but little is known of the bacteriological (as com" pared with the chemical) qualities of deep well waters." 65 The report proceeds:- "The Plumstead Well is affected by its propinquity " to the River Thames and the river marshes." "The Plumstead Well, doubtless, owing to its pro" pinquity to the River Thames and river marshes, contains " a slight excess of chlorine." Comparing the Plumstead Well with others, it was found to have the highest quantity of oxidized nitrogen ; the highest capacity for abstracting oxygen from permanganate, and the highest proportion of chlorine and of total hardness. The Plumstead Well, as regards presence of bacteria, was one of the least satisfactory, containing, in one sample, coli-like microbes in 10 c.c., but not in 1 c.c., and no flaginac B. coli in either 10 or 100 c.c. Four samples of the Plumstead water contained coli-like microbes in 100 c.c., and not in 10 c.c., and in one of these, the microbes were flaginac B. coli, i.e., microbes satisfying all the tests which distinguish B. coli. Fifteen samples of Plumstead water were taken. In November, 1907, I reported as follows:— "In the July monthly report on the Metropolitan " water-supply further particulars are given of the results " of the chemical and bacteriological examinations of the Kent " deep wells. It will be remembered that in October, 1905, " the water of the Plumstead well was found to be very " impure, so much so that it was considered necessary to " suspend its use temporarily and afterwards only to pump slowly. I reported fully on the matter on the 14th "March and on the 14th December, 1906. The explanation " given of the impurity was that, owing to hard pumping, " Thames water was being drawn through the chalk. As a " result of the measures taken the quality of the water im- 66 " proved, but I pointed out in December that it was still one of " the least pure of the Kent waters, and but little purer than " Thames-derived waters. The July report shows that this " is still the case. The full reports of the bacteriological and chemical examinations are given of each of the Kent " waters. It appears that the average number of bacteria " per cubic centimetre in all the Kent waters on the number " of examinations was 7'0, whereas the Plumstead well" water contained, on a similar number of examinations, " an average of 14'3 bacteria. Only three wells showed " a higher average, viz.: Westerham Hill, Westerham "Town and Shortlands, and of these the Westerham Town " well has since been closed. The Plumstead well water " gave, with one exception, the lowest percentage of samples " containing no bacillus coli in 100 cubic centimetres of "water, viz.: 83.3, as compared with 100 for the best '' waters. As regards the chemical examinations, Plumstead " well water contained far the highest amount of total and " permanent hardness, viz.: 37.86 and 14.5 respectively, " and also far the highest amount of chlorine, viz: 6.07 " parts per 100,000. The average amount of hardness "appears to be about 27, and the Deptford wells (the ''highest next Plumstead) give a hardness of 31. " Plumstead water is also above the average as regards the " ammoniacal nitrogen, albumenoid nitrogen, oxidised " nitrogen, and oxygen absorbed from permanganate. With " the analyses given with the official report I have com" pared an analysis of the water at the Plumstead Baths, " supplied by Professor Smith on August 26th last. Al" though the two wells are within about ½ mile from each " other there is considerable difference in the composition of " the two waters. The Baths water contains only 3.1 parts of " chlorine per 100,000 and only 24.3 parts total hardness. " The presumption appears to be that the Plumstead well- 67 " water is still impure as compared with other Kent waters " owing to the well being pumped to too great an extent. "Probably the Borough is mainly supplied with water " from this well. It is, therefore, desirable that the Water " Board should be requested to take steps to improve the " quality of the Plumstead well water, or to provide the " Borough with a new source which would be at least "equal in quality to the average of the Kent waters." As a result of this report the Water Examinations Committee of the Board instructed their officers to make an enquiry into the condition of the Plumstead well water. They have not yet informed your Council as to the results of the enquiry. The Plumstead well yields far the hardest water supplied in the Metropolis. A report on a proposal for softening the Kent water was presented in November, 1907, to the Public Health and Housing Committee, and printed in the Council's minutes. The supply is constant throughout the Borough with the exception of houses on Shooter's Hill (including Eglinton Road above Genesta Road, Brent Road, Dallin Road, Plum Lane above Dallin Road, and all houses above Red Lion Lane), which have an intermittent water-supply only. 2. Three tenement houses were found to have insufficient water-supply for each of the families occupying them (see Annual Report, 1904, page 59, and Appendix II.). An additional tap and sink were supplied on at least one upper floor at each of these houses. Altogether eighteen tenement houses have now been fitted with an additional supply, under the Public Health (London) Act, Sec. 48. Under the London County Council (General Powers) Act, 1907, a suitable water-supply can be required on each separately occupied floor of a tenement house. This Act has now come into force and will facilitate the provision of proper water-supply in lodging-houses. E 2 68 3. Defective and foul storage cisterns were found and remedied at 77 houses, compared with 90, 106, and 51 in three precedingyears. At 53 houses the supply was found insufficient or temporarily cut off. Food and Drugs Act. 4. 443 samples were submitted to the public analyst and 19 or 4.3 per cent., were found to be adulterated, compared with 4.1, 5.7, 8.4, 7.4, and 9.3 in the five preceding years. 5. Proceedings were taken in every case adulterated; 3 were dismissed, 2 on proof of warranty. A conviction was obtained in 16 cases (these figures refer to proceedings actually taken during the year, and consequently do not correspond with the figures in the preceding paragraph). 6. A total of £88 12s. Od. was imposed in fines and £11 16s. 6d. in costs. 7. 346 of the samples were fresh milk, 3 separated milk, and 6 condensed milk. 17 of these or 4.8 per cent. were adulterated, compared with 48, 6.1, 9.3, 6.5, and 8.7 in the five preceding years. 72 samples were bought as butter, and 2 were found to be adulterated. Table XVIII. shews the other articles analysed, all of which were found genuine. 8. Of the 18 adulterated milk samples for which proceedings were undertaken, 8 were for abstraction of fat, 11 for addition of water, one being for both. 69 One sample was adulterated with 152 per cent. of water, and one had 20 per cent. of fat abstracted; the fine inflicted in the latter case was £30. 9. Of the 346 milk samples, 81 were taken on Sunday or Bank Holidays, and 2, or 2.5 per cent., were found adulterated. In 1905, 11 per cent. of samples taken on Sunday were found adulterated; and in 1906, 6.3 per cent. 10. A record is now kept of all analyses of milk made by the Public Analyst. The average percentage of fat in all unadulterated samples taken last year was 3.6, and of non-fatty solids 8.8. From 9 to 18 samples were taken of the milk supplied by each of six large retailers; the average of unadulterated samples for each firm only varied from 3.5 to 3.7 per cent. of fat, and from 8.7 to 8.9 non-fatty solids. food inspection. 11. The inspection of meat and other food received particular attention, and the same arrangements were in force as described in previous reports. There was one seizure, and 59 surrenders. The seizure was of 33 unsound kippers; these were condemned by a magistrate, and destroyed. The owner was cautioned. Of the surrenders, 7 were tuberculous, 20 unsound, and 19 livers or other organs affected with parasitic disease. The meat affected with tuberculosis was pork in all cases. The food surrendered as unsound consisted of meat, fish and fruit, and three butts of Guinness's Stout which had been sunk in the river. A full list is given in Table XIX. A special report on the existing provisions against the sale of unsound and diseased meat was presented and printed in your Council's Minutes of 25th January, 1906. 70 Dairies, Cowsheds and Milkshops. 12. On January 1st, there were 150 milkshops on the Register; 21 were added and 28 removed during the year, leaving 113 on the Register at the close of 1907. There were 340 inspections made. Owing to the steps taken by the Health Department, requiring persons not to sell milk in unsuitable general shops, the number of milk shops has been reduced from 196 to 143 in three years. 13. The number of cowsheds remained as before, 17. These were all inspected 4 times, and 10 notices were served for dirty conditions, &c. There were no prosecutions. Milk-Supply. 14. Much has been done in this Borough to obtain a pure milk-supply, by the improvement of the existing law and byinculcating a higher standard of cleanliness. But much more remains to be done, and little advance can be made until the law is strengthened. The Local Government Board, on the request of the London County Council, is considering the issue of a new Dairies and Cowsheds Order. The London County Council has obtained powers under the General Powers Act, 1907, to deal with tuberculous milk coming from outside the County. The same Council proposed to deal with dirty milk in a similar way, but the Sections in their General Powers Bill, 1908, dealing with this subject, have been withdrawn on a promise of the Government to introduce at an early date a Bill dealing with the milk-supply of the whole country. At present there is no satisfactory legal provision for requiring milk to be clean and free from impurity. Slaughterhouses. 15 There are 11 slaughterhouses on the register; 97 inspections were made, and 5 notices served and complied with. 71 Nuisances. (See Table XVa.). 16. 366 complaints of sanitary defects were received and investigated, compared with 457, 380, and 498 in the three preceding years. 43 complaints of non-removal of dust were made and attended to, compared with 42, 40, and 43 in the three preceding years. 2 of the dust complaints came from Woolwich Parish, 22 from Plumstead, and 19 from Eltham. The dust in Woolwich is collected by your Council's employees, but that in Plumstead and Eltham by two different contractors. 17. Drains and Water-closets. Twenty-nine defective combined drains were investigated, and reported on, by the Chief Sanitary Inspector, compared with 22, 26, and 25 in the three preceding years. These drains affected 236 houses. 451 private drains, found choked and defective, were examined, cleared, and relaid, compared with 573, 590, and 557 in the three preceding years. The majority were found in the River Ward. 1131 water-closets and w.c.-cisterns were repaired, compared with 1498, 1278, and 931, in the three preceding years. 175 foul w.c.-pans were cleansed by tenants, compared with 231, 247, and 160 in the three preceding years. 18. Ventilation of the New Outfall Sewers. During the past year repeated complaints were received as to offensive odours proceeding from the road-level ventilators on the new L.C.C. outfall sewers where they pass through the Borough. The L.C.C. had previously been asked to provide some system of ventilation which would obviate nuisance, but they replied that when nuisance did occur it would be time enough to take steps to deal with it. 72 The Borough of Greenwich which also suffered in the same way, called a conference on the subject in April, at which it was resolved:— "That in the opinion of this conference the ventilation of the new L.C.C. sewers by means of surface ventilators will be open to grave objection, and will constitute a a danger and injury to the district, and this conference calls upon the L.C.C. to adopt some other and less objectionable method of ventilation." The adoption of raised ventilators or other appliances was suggested. As no radical action was taken by the L.C.C. this conference was called together again in November when your Medical Officer of Health moved the following resolution:— " That a letter be sent to the L.C.C. requesting them to take immediate steps to abate the nuisance existing in Greenwich, Lewisham and Woolwich, from escape of sewer gas from the outfall sewers, and that failing a satisfactory answer, and early abatement, the Councils of these Boroughs be requested to instruct their Town Clerks to jointly institute legal proceedings for the abatement of the nuisance." Temporarily the nuisance has been abated by closing the roadlevel ventilators complained of, but this obviously can only be a temporary remedy as it is essential that these sewers shall be ventilated. It appears that the L.C.C., though anxious to avoid any cause of complaint, are not prepared to go to the expense of providing any new system of ventilation. The making of the new sewers would have given the Council a good opportunity of trying some of the methods of ventilation which have been found to obviate nuisance in other towns, and it is greatly to be regretted that the wealthiest city in the world should have been deterred from doing this by short-sighted considerations as to expense. 73 19. Public-house Urinals. The urinals attached to publichouses and accessible to the public have been regularly inspected during the year, 606 inspections being made. Regular cleansing has been required. 20. House Inspection. 6092 houses were inspected, house-tohouse, compared with 6604, 6160, and 4709 in the three preceding years; 7573 were inspected re infectious diseases and complaints, compared with 7673, 9604, and 10291. In addition to these the 332 registered houses were inspected two or more times. 21. Table XVI. shows the streets inspected and number of houses found defective in each. At 2193 houses, interiors were cleansed or defective roofs repaired, compared with 2917, 2693, and 2066 in the three preceding years. 369 houses with damp walls were remedied, compared with 885, 442, and 287 in the three previous years. Improved ventilation was provided in 117 houses, compared with 129 in 1906. 675 new dust-pails were supplied compared with 679, 444, and 498 in the three preceding years. 22. Medical Officer's Inspections. These amounted to a total of 582. Special inspections were made of the cow-sheds, milkshops, bakehouses, many of the houses registered under the bylaws, and other tenement houses re water-supply. The other inspections were chiefly on account of tuberculosis, diphtheria, scarlet-fever, and zymotic enteritis. 25 visits were paid for purposes of diagnosis, mostly at the request of medical men, and a few for school-teachers. Eleven of these cases were varicella, resembling small-pox. One was a case of suppuration of the mastoid in which enteric fever was suspected, and one was tuberculous meningitis, in which epidemic cerebro-spinal meningitis was feared. 74 23. Overcrowding. 85 cases of overcrowding were found and remedied, compared with 178, 154, and 80 in the three preceding years, or 14 per cent. of house-to-house inspections. Most of the cases of overcrowding are found in house-to-house inspection. 24. Smoke Nuisance. 106 observations on smoke nuisances were made, and 10 nuisances from black smoke observed. These were all abated on service of notice. Frequent observations were made on smoke nuisances occurring at North Woolwich. Many complaints were received as to smoke nuisance at the factories in that district, both from the London County Council and the Coal Smoke Abatement Society. The term Black Smoke is evidently differently interpreted by different observers. The term should be re-placed by the words "dense smoke" or "Smoke such as to be a nuisance." Smoke issuing from the Arsenal chimneys is much less in evidence now than used to be the case. 25. Defective Light. At 66 houses, new windows were supplied, or existing ones enlarged, or other work done to improve the lighting by daylight. Most of these were in Woolwich Parish. 26. Verminous Rooms. 148 verminous rooms were cleansed under the London County Council (General Powers) Act of 1904, or were dealt with as dirty rooms under the Nuisance Section, compared with 156 in 1906. Dust Removal 27. In Woolwich parish 7517 loads of house and trade refuse were removed by direct labour and destroyed at the Woolwich Destructor. In the three preceding years, 7352, 6959, and 6808 loads respectively were removed. In Plumstead 13295 loads weighing 11487 tons were removed by the contractors, Messrs. Tuff & Hoar, and destroyed by the Plumstead Destructor. £2879 1s. 3d. was paid for collection. 75 In Eltham the sum of £770 l1s. 1d. was paid to the contractor, Mr. Tucker, for removal of Eltham dust, which was deposited on fields in the parish. Trade Refuse. 28. During the past year there have been 7747 (7967 in 1906), receptacles of offensive refuse removed. There are now 57 (63 in 1905) tradesmen on the books from whom offensive trade refuse is collected. There were no complaints of nuisance arising from collection. Chloride of lime is used as a deodorant. The cost of removal was £417. The charge made for inoffensive refuse is 1s. 6d. 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. Housing of the Working Classes. 29. Four houses were represented as unfit for human habitation under Section 32 of the Housing of the Working Classes Act, viz., Keighley House, Southwood Road; and three of the Farm Cottages, Woolwich Road; all in Eltham Parish. These have all been closed with consent of the owner. A special inquiry into the causes of the unliealthiness of North Woolwich was described in the Annual Report for 1906. The low-lying damp soil is the chief cause of the high death-rate in this district. 30. Statistics of Special Areas. By the courtesy of the Secretary of the Royal Arsenal Co-operative Society, I was enabled to obtain a census of the Bostal Estate, and was then able to prepare statistics for this area. These were printed in the Council's Minutes for January 2nd, 1908. Statistics of infant mortality for Bostal Estate, Well Hall Estate, and Woolwich Barracks, were printed in the Minutes of December 5th. 76 31. Unoccupied Houses and New Houses. Owing to the reduction of work in the Royal Arsenal and trade depression, there have been in recent years a large number of empty houses or unoccupied rooms, as compared with previous years. In March, 1908, 278 houses were found unoccupied out of 3,521 in St. Nicholas Ward, or about eight per cent. 224 new houses were passed for water certificates in 1907. The great majority of the new houses are four or five-roomed dwellings, or consist of two flats of separately contained three or four-roomed tenements. The general demand is for a small separate house. 32. Council's North Woolwich Houses. All the Council's 25 houses were occupied throughout the year, with the exception of one which was vacant two weeks. Two houses changed occupiers. The number of persons at present housed is 129, or about 5 to a house. For particulars as to rent and cubic space of these houses, see Annual Report, 1904, page 70. 33. Houses Registered under the By-laws. At the commencement of the year, 307 houses were on the register; 29 were newly registered and 4 taken off the register, leaving 332 on the register at the close of the year, compared with 123, 235, 265, and 307 in each of the four preceding years. 34. These houses were inspected, some quarterly, and others half-yearly. 758 inspections were made in all, and 263 intimations, and 74 statutory notices were served. Proceedings were taken for breach of by-laws at four houses; fines of 2s. to 20s. were inflicted. 35. The registered houses were under the care of Miss Middlebrooke, and further particulars will be found in the report of her work given further on. 77 inhabited house duty. 36. One application was received under this Act. The certificate required was refused, as the general arrangements of each tenement were unsatisfactory. Common Lodging-Houses. 37. There are 24 common lodging-houses in the Borough—19 for men, 4 for women, and 1 for couples. Total accommodation for 597 persons is available. The following is the list:— Common Lodging House. Accommodation. Total. Men. Women. Couples. 60 Beresford Street 58 ... ... 58 5 High Street 40 ... ... 40 52 „ 22 ... ... 22 50 „ 15 ... ... 15 56a „ 18 ... ... 18 70 „ ... 16 ... 10 77 „ ... 13 ... 13 81 „ ... 5 ... 5 82 „ ... 14 ... 14 93 „ 30 ... ... 30 102 „ 28 ... ... 28 1 Hope Yard Rails 14 ... ... 14 2 „ 17 ... ... 17 4 „ 17 ... ... 17 7 „ ... ... 11* 22 9 „ 32 ... ... 32 10 „ 51 ... ... 51 10a „ 32 ... ... 32 11 „ 30 ... ... 30 21 „ 21 ... ... 21 21a „ 21 ... ... 21 4 Warren Lane 31 ... ... 31 11 & 12 „ 39 ... ... 39 13 „ 11 ... ... 11 Totals 527 48 11* 597 * i.e., 22 persons. 78 underground rooms. 38. No underground rooms, separately occupied, were found not in accordance with the Act. Factories, Workshops, and Workplaces. 39. There were, at the close of the year, 221 (215 in 1906) workshops and workplaces on the register. 286 inspections were made, and 40 notices served and complied with. 28 factories were inspected regarding the sanitary accommodation, and four notices served and complied with. 360 inspections of homeworkers' premises were made, and 40 notices sent and attended to. Miss Middlebrooke devoted a large amount of her time to the inspection of workshops and factories where women are employed ; 46 new workrooms were measured and put on the register. Factories and workshops, where no females are employed, are inspected by Mr. Powell. 40. A special report on home-work was presented to your Council on October 31st, 1906, and printed in the Annual Report of that year. Bakehouses. 41. The number of bakehouses on the register is now 56, 25 being underground. They were all inspected twice. In my personal inspections, I found all but four satisfactory; in these the defects were chiefly dirty floors, walls, and mixing-boards. These were remedied on service of notice. Ice-cream Shops. 42. Seventy-six Ice-cream shops were on the register at the close of the year, compared with 83, 87, and 68 in the three previous years. There were 219 inspections made, and 3 notices 79 served. Regulations, embodying the provisions for ice-cream shops contained in the Loudon County Council (General Powers) Act, are distributed at every shop ou the register. disinfection. 43. The mode of disinfection, cost of appliances, staff, &c., were fully described in my Annual Report, 1903, pages 73-76. Rooms at 1,392 houses were disinfected, compared with 842, 910, and 987 in the three preceding years. The disinfecting apparatus was used 1,325 times for 14,116 articles. 345 books from the Free Libraries were disinfected. The sum of £2 11s. 6d. was received for disinfection of rooms in special cases on request of the occupier. Disinfectants are supplied by the Department for disinfecting infected soiled linen, infected stools, sputa in phthisis, and for personal use in infectious disease. They are dispensed at the Maxey Road Offices; the Sun Street Mortuary (64 persons were supplied last rear); 18 Barge House Road, North Woolwich; and the Eltham Office, 112 High Street. The cost of disinfectants used by the department in 1907 was £28 18s. 6d. The disinfectants used were Jeyes' Soap, Corrosive Sublimate, Formalin Tablets (for fumigation); Formaldehyde (for spraying and disinfecting books and use in the Mortuary); Cyllin (for sputa in phthisis); Permanganate of Potash; Coarse Carbolic (for dustpails) ; and Chloride of Lime (for offal-tins, etc.). Health Shelter. 44. The Health Shelter was not once used. On the Report of the Health Committee, the Establishment Committee has decided on letting one of the two flats. The shelter was used twice in 1906, but otherwise has not been used for five years. 80 The Mortuaries. 45. The Sun Street Mortuary was used for 171 bodies compared with 164, 190, and 162 in the three preceding years. 143 were deposited for inquest, and 28 for custody. Ninety post-mortem examinations were made. Two bodies were deposited in the Infectious Mortuary, compared with one in 1906. The Eltham Mortuary was used for 4 bodies brought for custody only, compared with 4 in 1906. Cemeteries. 46. The two Borough Cemeteries were well maintained as visual. 670 bodies were buried in the Woolwich Cemetery compared with 690, 611, and 669 in the three previous years. There were 753 interments in the Plumstead Cemetery compared with 694, 789, and 745 in the three previous years. Only 40 burials took place in Plumstead Churchyard, compared with 164, 144, 125, 115, 123, 62 and 60, in the seven preceding years. This marked reduction is satisfactory, and indicates that the regulation as to burying only near relatives of those already interred in the Churchyard is now being carried out. Cleansing of Verminous Persons. 47. The Station for Cleansing Verminous Persons was opened in November, 1906, and 19 persons used it in that year. During 1907 it was used by 257 persons, viz., 60 adult males, 2 adult females, and 195 children under 16 years of age. 87 of these persons applied on account of verminous bodies, and 170 for verminous heads. The adults came mainly from common lodging houses, and the children were mostly sent from County Council Schools. 1,470 articles of clothing, &c., belonging to these persons were disinfected. The construction and modus operandi of the station were fully described in the 1906 report. It is to 81 be remembered that there is no female attendant for the bath, the only person in charge being the man who has the care of the general disinfecting station. To this fact may be ascribed the small number of females who patronised the bath. The need of a female attendant is also noticed for the children who come in large numbers. It is often very difficult to get the mothers or other responsible female to accompany the children, and, as it is not safe to allow children to use the bath by themselves, they often have to be refused admission. A female attendant to be at the Cleansing-Station at certain fixed hours every week would be a great advantage, and materially increase the usefulness of the bath. The following directions for using the bath are posted in the Station :—- " METROPOLITAN BOROUGH OF WOOLWICH. (Public Health Department). Personal Cleansing-Station. Persons whose bodies are infested with parasites should act as follows :— (1) Take a hot bath and wash the whole body thoroughly with soap. Meanwhile, the clothes will be disinfected, and a small box of ointment provided. (2) After drying, smear the ointment in the armpits and the other hairy parts of the body. (3) Repeat this process three times on alternate days. (4) The bed-clothes should be disinfected. The attendant at the cleansing-station will send for them on request and return them the same day. If the head is infested:— (1) The hair should be cut short. (2) The head should be well washed with soft soap and hot water. f 82 (3) When dried, the ointment should be well rubbed into the roots of the hair all over the head. The washing and anointing should be repeated three times on alternate days. The use of a small-tooth comb is also advantageous. SIDNEY DA VIES, Medical Officer of Health." Tents, vans, and Sheds. 48. During the year, 102 tents, vans, and sheds were inspected, and 2 notices served. Infants' Milk Depot. 49. The staff of the Depot consists of a Manageress (Miss Bagshaw), two female assistants, a man who delivers the milk and assists with the boiler, and a boy. A full report on the work of the Depot will be found in an Appendix. Public Ambulance. 50. The public ambulance for accidents, and non-infectious illness, was used 122 times, compared with 90, 97, 110, and 104 in the four preceding years. The following were the journeys made:— To Guy's Hospital 30 ,, Cottage Hospitals 20 „ Seaman's & Miller Hospitals 6 ,, King's Hospital 10 ,, St. Thomas's Hospital 8 „ London „ 13 „ Charing Cross „ 8 „ Union Infirmary 5 83 To Other Hospitals ... ... 14 „ Private Houses ... ... 8 Particulars as to this ambulance were given in my Annual Report, 1903, page 78. The ambulance is kept in good repair. Notices and Prosecutions. 51. 3,302 written intimation notices and 453 statutory notices were served. 74 of the latter, not having been complied with in the time specified, were referred to the Town Clerk, who, before taking proceedings, wrote a warning letter in each case. Finally, three defaulters were summoned at the Police Court, and convictions obtained in each case. Fines amounting to £2 15s. Od. were inflicted, and costs. bacteriological examinations. 52. 884 bacteriological examinations were made for the Public Health Department by the Lister Institute, viz., 679 for diphtheria, 171 for phthisis, and 34 for enteric fever. The total cost was £141 4s. 9d. Women Sanitary Inspectors' Work. 53. The following is a summary of Miss Middlebrooke's work for the twelve months Houses Let in Lodgings. Total number on Register ... ... 330 Number of Inspections ... ... 758 ,, of Re-inspections (estimated) ... 1820 „ found satisfactory ... ... 238 ,, of Intimation Notices served ... 263 „ of Statutory ,, ,, ... 74 f 2 84 Number of Auisances, defects, and offences against the By-laws dealt with and remedied 1042 „ of Cases of Overcrowding remedied by re-distribution without notice 37 „ Houses measured 30 ,, Prosecutions 4 Notices. Served. Remedied. Oil Landlords for Cleansing 185 185 On Tenants for Cleansing 127 127 On Landlords for Overcrowding 6 6 On Tenants for Overcrowding 39 39 On Landlords and Tenants for other Defects 503 503 On Landlords and Tenants for Verminous Rooms 02 02 Women's Lavatories at Railway Stations, &c. Number of Inspections 56 „ found defective or dirty 10 Restaurants and Eating Houses. Number of Inspections 132 „ of defects, and dirty conditions found and remedied 91 Factories and Workshops. Number of Inspections of Factories 11 ,, of Inspections of Workshops 226 ,, of Notices served 31 „ New Workrooms measured 46 85 Homeworkers' Premises. Number of Inspections 360 ,, of Cases referred to District Inspectors 40 Total number of Houses visited re Phthisis, Measles, and Zymotic Enteritis 94 ,, Visits paid for various causes, viz., Complaints, and verminous and dirty houses and bedding 270 ,, Intimation Notices served 361 ,, Statutory „ „ 103 ,, Cases referred to District Inspectors 188 ,, Dustbins supplied 91 „ Accumulations of refuse moved 17 „ Cases where animals were kept in such a state as to be a nuisance 7 54. Miss Middlebrooke describes the nature of her work in dirty houses as follows “ In visiting the houses let in lodgings, not only is attention paid to the condition of the walls, ceilings, floors, roofs, window sash-frames, and other structural defects, but an endeavour is also made to educate the tenants to a higher standard of cleanliness and decency of living. Efforts are made to induce those housewives who are inclined to be slatternly to be orderly and methodical in their houses. Many women are under the impression that, so long as they wash their floors, the rest of the room does not matter in the least. They are apparently blind to the cobwebs on the walls and ceilings, the paint-work coated with 86 black grease, the accumulations of dirt in the corners of the rooms, and filthy carpets which would be better dispensed with altogether. Special attention is given to the following : (1) To the state of the bedding, which is too often found in a deplorable condition, out of repair, soaked with filthy matter, offensive and verminous, destitute of proper coverings, pillow-slips and sheets. (2) To the receptacles for slops ; these are often coated with a slimy foul matter, and are frequently the cause of a serious nuisance. (3) To the spaces under the beds, which are used for the disposal of dirty clothing, old boots, and rubbish. (4) To the cupboards used for the storage of food ; these are usually found in a most unsatisfactory state as regards cleanliness and order. (5) To the use of heavy, dirty, light-obstructing materials as window curtains and blinds. These conditions are as much the result of negligence, ignorance, want of thrift, and (very often) alcoholic habits, as of poverty. A great deal of time has been devoted to special cases in houses which are not on the register of houses let in lodgings, but where verminous and dirty conditions have been found to exist. These cases were notified by the school authorities, the National Society for Prevention of Cruelty to Children, district visitors, etc. Written notices were served requiring the person responsible for the dirty conditions to remedy them. Where the bedding was verminous, it was removed for disinfection ; in extreme cases, the owner's consent in writing was obtained and the bedding taken away and destroyed. Where the children in these houses were found to be in a verminous state, they were sent to the Cleansing Station to have a bath and their clothing disinfected. 87 Many visits and much patience are generally necessary before any satisfactory results are obtained." 55. The following is Miss FitzGerald's Report:— Summary of Inspections. Visits to houses after notification of Births 2397 Re-visits 409 Visits after infant deaths 91 Visits to houses re zymotic enteritis 78 Re-visits 15 Visits to houses re phthisis 19 Visits to Depot-fed infants 638 Special visits 43 Reported to District Inspectors— Structural defects 4 Other „ 7 Dirty interior walls 3 Overcrowding 3 Accumulation of refuse 1 “All births registered in Woolwich Parish are visited, except those occurring in the better-class homes ; and as many in the poorer districts of Plumstead and Eltham as time will permit. It is not possible to visit all the births in Plumstead and Eltham which should be visited, as so much time must necessarily be spent on Depot-fed infants. These have, as a rule, to be visited before the Depot milk is supplied, in order that the age and condition of the child may be ascertained, and the proper use of the milk explained to the mother. It is also necessary, in cases where no doctor's certificate is received, to make sure that the case is a fit one for the Depôt; no child is admitted to the Depot whose mother is able to feed it at the breast. Applications for the milk are sometimes received from mothers who imagine their milk is inadequate either in quality or quantity for their infants : 88 in many of these cases all that is needed is advice as to regular feeding and the mother's diet, and breast-feeding can be successfully carried on. After a child has started Depot milk, the home is always visited in order to ascertain that the milk is agreeing, and that proper use is being made of it. As a large proportion of the depot-fed infants are delicate, special modifications have often to be prepared, and the case must be visited at frequent intervals until the child begins to take the milk well and to make progress. A few cases have to be specially watched in order to detect abuse of the milk. There is a tendency on the part of some of the mothers, to pour the Depot milk into long-tube bottles ; others want to add solid food in some form or other to the milk. These practices are as a rule abandoned upon remonstrance, and it has been found necessary in only two cases to stop the supply of milk for persistent refusal to keep the rules. Every Thursday afternoon is devoted to giving advice and instruction to mothers who bring their babies to the Depot to be weighed. This gives one of the most favourable opportunities for proffering advice not only on feeding, but on clothing, cleanliness, the need of fresh air and management generally. The time devoted to Depot-fed infants is considerable but it is spent to good purpose. Real educational work can be done by frequent visiting at the homes and by interviews on weighing days. The mothers realize that the Public Health Department is a reliable source of information on infant rearing and that application for advice may always be made. A great number of letters asking for advice of one kind or another, are received in the course of a year from the parents of Depot-fed children. Although the infant death-rate of the Borough as a whole is relatively low compared with that of other places, there are not lacking in Woolwich instances of a lamentable waste of infant life which come to light in the routine of visiting after births. 89 In 26 families in Woolwich parish 220 children had been born, of these only 95 were surviving in 1907. These 26 families form exceptionally bad instances, and in most cases there were evidences of alcoholism on the part of the parents. The following are typical of the worst cases met with in visiting infants. (a) Mother mentally deficient, has lost 6 children out of 10; house very dirty, smells foul; 3 rooms, family income about 27s. a week. Baby apparently healthy at first, but shortly began to waste ; older children sickly, dirty, ragged. The mother's entire lack of capacity rather than drink probably accounted for the state of the home. (a) 14 children born, 7 living ; mother alcoholic, has also had 3 miscarriages. Father at Labour Colony. 3 rooms, very dirty ; children dirty and verminous. (c) Baby small and delicate; when visited at a month old, mother was giving it baked flour and water, said she gave it that in addition to the breast as she wanted it to get on; tenth child, 9 living; house dirty, foul atmosphere. (d) 8 children born, 4 have died of tubercular disease, mother probably consumptive, living in half-basement tenement; very dark, fairly clean. Baby appeared healthy at 3 weeks old, but older children looked sickly. Cases such as the foregoing require frequent visiting before any appreciable effect is obtained. Every effort is made to revisit urgent cases as often as possible, but time does not admit of their being re-visited as often as is really necessary. As stated in last year's report there is no opposition to visits being made after a birth has occurred. In a few instances the mothers think a visit means that something is wrong and has been complained of, but a little explanation to the effect that the visit is a friendly one soon puts their apprehensions at rest. 90 As a matter of fact, it is not the paying of a visit, but the omission of a visit which is more often regarded as a grievance. As the result of a leaflet (see Appendix) written by the Medical Officer of Health, addressed to expectant mothers, and circulated by means of the midwives, requests for visits have in several instances been made by post. Cases where advice is needed and would be welcomed are also reported by some of the Clergy and by Church and other workers." National union of Public Health authorities. 56. On the invitation of the Newcastle-on-Tyne County Borough a conference was held on November 15th to consider the establishment of a National Union of Public Health Authorities. The Public Health Committee appointed Mr. Councillor Wakelen, the Town Clerk and myself as representatives at the conference, which was largely attended. It was resolved to approve of the establishment of a Union which would have for its immediate objects :— (a) To secure, as far as may be practicable, harmony of interest and uniformity of action among Public Health Authorities in general, on matters relating to the Public Health. (b) To stimulate and concentrate effort for the purpose of effecting necessary sanitary reforms, whether for the public weal or the benefit of individual sanitary districts. (c) To encourage and promote the study of practical hygiene, and to educate opinion with respect to the national as well as the local importance of public health work in general. (d) To consider the different conditions and circumstances, general or local, whereby disease is liable to be caused to man and, as far as may be, to obtain their removal. 91 Royal Commmission on the Poor Law. 57. By request of Lord George Hamilton, Chairman of the Royal Commission on the Poor Law, I prepared a statement as to the medical assistance of the poor in the Borough of Woolwich. The statement deals with the existing agencies for medically assisting the poor, insufficiency of medical provision, and proposed remedies with the object of bringing into co-ordination preventive medicine and medical relief. It will be printed with the report of the Royal Commission. Child-Birth and Industrial Employment. 58. In May last His Majesty's Home Secretary invited my cooperation in obtaining information as to the connection between infant mortality and industrial employment, and you agreed that all the necessary facilities should be afforded in the matter. A Conference of all the Medical Officers of Health who are prepared to assist in the enquiry was held on the 6th November last at the Home Office to discuss the lines on which it should be conducted. The principal end the enquiry has in view is to determine whether or not industrial employment of mothers has a prejudicial effect on the vitality of their children, especially as to increasing mortality of children under one year of age. It was decided to classify mothers under four classes. (1) Those working in Factories and Workshops ; (2) Homeworkers ; (3) Charwomen, and other industries; (4) unoccupied. It was also determined to obtain statistics as to illegitimate births, and the mode of feeding of infants in the first six months of their age. It will be necessary to keep the children under observation from their birth for twelve months, or until their death, if taking place within twelve months. The enquiry is to commence from the 1st January, 1908, and to deal with all the children born in a certain district during the year. Consequently the enquiry will last until the end of 1909, and the results will not be available until some time in 1910. I 92 propose to deal with the district of Woolwich Parish. Miss FitzCerald already obtains most of the particulars which the enquiry has in view. The additional labour involved will be chiefly a matter of following up the births more particularly and classifying them. The Eltham branch Office. 59. The Eltham Sanitary Inspector's Office, 112, High Street, provides a place to take messages, and to give out disinfectants, and a room for the Inspector to call at daily and see visitors by appointment. It is found very useful for this purpose, but would be still more so if connected with the telephone. Public Health staff. GO. There was no change in the staff of the department during the year. I have to acknowledge with thanks the valuable assistance of all the members of the staff who have loyally co-operated with me in maintaining the high standard of the sanitary administration of the Borough. A large amount of work has recently been thrown on the clerical staff, who have had frequently to work overtime. TABLE I. Borough of Woolwich. Vital Statistics of the whole District (hiring 1907 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 of Age. 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 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 29.9 462 124 1678 13.7 278 43 208 1843 14.7 1903 123172 3691 30.0 390 106 1511 12.3 272 41 175 1637 13.3 1904 125791 3531 28.1 466 132 1636 13.0 261 40 169 1765 14.0 1905 125885 3549 28.2 364 103 1463 ... 313 50 192 1605 12.7 1906 127345 3524 27.7 391 111 1530 ... 293 48 183 1666 13.1 Average for years 1897 to 1906 J-118996 J 3489 29*3 445 128 1776 14*9 1907 129336 3295 25-4 367 111 1479 296 50 184 1613 12*5 93—94 * Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Note.-—The deaths 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 " taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or intimity, such as hospitals, workhouses and lunatic asylums. Area of District in "j acres (exclusive | _ of area covered j by water) j Total Population at all Ages ... 117,1781 Number of Inhabited Houses ... 18,080 | At Census Average Number of Persons per | of 1901. House . ... ... 6*47 J i 95 TABLE 1a. I. 11. 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 Herbert Hospital Auxiliary Hospital Blackheath Cottage Hospital Woolwich and Plumstead Cottage Seamen's Hospital Hospital Brook do. Eltham Cottage Hospital Park do. Home for Mothers and Babies Gore Farm do. Guy's do. King's College Hospital London do. St. Bartholomew's do. Charing Cross do. Westminster do. St. Thomas's. do. East London do. Poplar do. St. Peter's do. St. John's, Lewisham, Hospital Children's Hospital West London do. Fulham Road Consumption Hospital Ear and Nose Hospital Brompton do. Bethnal Green do. Cane Hill Asylum Dartford Heath Asylum Colney Hatch do. Claybury do. Tooting Bec do. Darenth do. Cater ham do. Stone do. Banstead do. Horton do. Hostel of God do. 97—98 TABLE II. Vital Statistics of Separate Localities, 1901-2-3-4-5-6-7. 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. 1905. 1906. 1907. 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. 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 8712 326 140 33 8712 244 146 37 7800 268 122 23 St. Mary's 10439 203 122 25 10439 226 149 30 10439 222 147 39 9788 184 121 35 9788 174 104 21 9788 209 98 26 9788 181 133 31 River N.. 14504 410 292 661 N. 3450 135 66 26 3450 140 50 16 3991 155 71 30 3991 141 72 31 3991 135 62 19 3841 150 55 19 S. S.11444 293 219 32 11444 277 205 43 11405 237 193 37 11405 247 190 33 11405 296 214 55 10360 264 183 28 at. George s 8078 298 151 35 8078 284 135 36 8078 303 136 39 8078 321 143 48 8078 297 116 31 8078 283 103 25 8078 299 107 32 Burrage 9837 253 133 24 9837 228 154 ?8 9837 235 133 17 9726 219 123 23 9726 217 119 17 9726 201 140 27 9726 202 109 16 Herbert 9195 240 104 22 9679 261 129 28 9679 261 94 21 9893 220 98 20 9893 245 100 19 10034 241 106 17 10182 222 111 22 St. Margaret's 10193 325 120 42 11826 448 163 50 11826 399 166 38 12337 388 161 35 12337 423 151 31 12975 436 145 34 13173 362 160 43 Central 10220 299 142 36 10263 341 138 46 10263 276 99 26 10228 267 87 24 10228 ?33 99 20 10061 248 102 20 10100 198 100 22 Glyndon 9829 319 140 30 9882 287 146 34 9882 313 144 33 9609 291 165 42 9609 290 145 21 9609 '272 145 32 9609 243 133 21 St. Nicholas 20239 737 265 106 22985 698 312 106 22985 731 235 71 21031 685 319 114 21031 667 257 80 22274 693 282 74 22775 621 295 75 Eltham 7787 177 108 26 10002 243 85 23 10669 258 87 19 11153 278 123 28 11617 291 112 23 11919 266 123 25 12745 285 128 40 99 TABLE III. Cases of Infectious Disease notified during the year 1907. Notifiable Diseases. Cases notified in whole District. Total Cases notified in each Locality. No. of cases of mistaken diagnosis (included in preceding figures). Cases removed to Hospital. All Ages. Age—Periods. 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. North. South. Small Pox ... ... ... ... ... ... ... ... • • • • • • ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 275 4 65 151 25 30 ... 4 20 9 23 18 26 25 18 18 19 75 20 39 230 Membranous Croup • • • ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 110 5 4 6 9 74 12 3 7 7 9 3 3 15 6 9 11 31 6 ... ... Scarlet Fever 1023 4 233 638 110 38 ... 17 36 30 55 106 60 123 56 81 93 243 123 41 868 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 27 ... 3 8 8 8 ... 1 1 2 ... 2 1 2 2 4 2 5 5 7 18 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... • • • ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1442 13 305 804 153 155 12 25 64 48 87 129 90 l65 82 112 125 355 154 ... ... 101—102 TABLE IV.—Causes of, and Ages at Death during the Year 1907. 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 70 41 29 14 50 5 ... 1 ... ... ... ... ... ... ... ... Scarlet Fever 14 10 4 ... 5 2 4 2 ... ... 1 ... ... ... ... ... Tuphus Fevere ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 30 15 15 ... 1 1 ... ... 1 ... 3 3 4 9 5 3 Whooping Cough 37 11 26 12 24 1 ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 15 6 9 2 8 3 ... ... ... 1 ... 1 ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fevcr 4 1 3 ... 2 ... ... ... ... ... 1 1 ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœ and Dysentry 11 8 3 8 3 ... ... ... ... ... ... ... ... ... ... ... Epidemic or Zymotic Enteritis 23 13 10 21 2 ... ... ... ... ... ... ... ... ... ... ... Enteritis 25 16 9 14 1 1 ... ... 2 1 2 ... ... 3 1 ... Other Continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 6 4 2 3 ... ... ... ... ... ... 1 ... 1 ... ... 1 Puerperal Fever l ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Other Septic Diseases 8 7 1 2 1 1 ... 1 ... ... ... 1 1 1 ... ... Syphilis 9 5 4 3 1 ... ... ... ... l 1 1 2 ... ... ... Rheumatism 7 4 3 ... ... 1 3 ... ... ... 2 1 ... ... ... ... Gout 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Intermittent Fever and Malarial Cachexia 1 1 ... ... ... ... ... ... ... l ... ... ... ... ... ... Tuberculosis of Meninges 19 11 8 4 7 7 1 ... ... ... ... ... ... ... ... ... Tuberculosis of Lungs (Phthisis) 154 82 72 1 4 1 6 14 22 25 36 29 9 6 1 ... Tuerculosis of Intestines and Peritoneum 11 8 3 3 3 2 ... ... ... 1 1 ... 1 ... ... ... Other forms of Tuberculosis 22 12 10 3 7 1 3 4 ... 2 ... 2 ... ... ... ... Alcoholism 4 2 2 ... ... ... ... ... ... ... ... 1 1 1 1 ... Cancer 107 44 63 1 ... ... ... ... 1 3 13 16 28 32 13 ... Diabetes 11 6 5 ... ... 1 ... ... 1 1 3 1 1 3 ... ... Premature Birth 61 31 30 61 ... ... ... ... ... ... ... ... ... ... ... ... Developmental Diseases 86 51 35 77 6 1 ... ... 1 1 ... ... ... ... ... ... Old Age 67 31 36 ... ... ... ... ... ... ... ... ... ... 16 36 15 Meningitis 20 9 11 9 8 1 ... 1 1 ... ... ... ... ... ... ... Inflammation and Softening of Brain 4 4 ... ... ... ... ... ... ... ... ... 1 1 ... 2 ... Epilepsy 5 4 1 ... 1 ... ... 1 1 ... 1 ... ... 1 ... ... General Paralysis 6 2 4 ... ... ... ... ... ... ... 3 l 1 ... 1 ... Tabes Dorsalis and Locomotor Ataxia 6 6 ... ... ... ... ... ... ... ... 2 l 2 1 ... ... Peripheral Neuritis 3 1 2 ... ... ... ... ... ... 1 1 ... 1 ... ... ... Other Diseases of Brain and Nervous System 37 20 17 12 2 1 ... 2 ... 1 1 3 6 6 2 1 Organic Diseases of the Heart 128 63 65 1 ... 1 4 5 5 9 15 25 19 32 9 3 Cerebral Hæmorrhage, Embolism and Thrombosis 41 22 19 ... ... ... ... ... ... 3 1 6 6 15 7 3 Apoplexy and Hemiplegia 18 9 9 ... 1 ... ... ... ... ... 1 ... 8 5 3 ... Other Diseases of Blood Vessels and Heart 30 19 11 1 ... ... 1 ... 1 2 5 4 6 6 4 ... Acute Bronchtitis 115 48 67 50 20 ... 1 1 ... 2 1 4 7 14 9 6 Chronic Bronchitis 54 27 27 ... ... ... 1 ... ... 1 ... 6 15 19 12 ... Lobar (Croupous) Pneumonia 16 9 7 ... 2 ... ... 1 ... 3 2 2 2 1 3 ... Lobular (Broncho) Pneumonia 74 41 33 32 28 1 ... ... ... 3 1 2 3 3 1 ... Pneumonia 39 27 12 6 2 1 ... 1 2 3 7 3 5 4 5 ... Other Diseases of Respiratory System 11 9 2 2 1 ... ... 1 1 ... ... 3 ... 1 1 1 Diseases of Stomach 10 7 3 1 1 ... ... 2 ... 2 1 2 ... 1 ... ... Obstruction of Intestines 14 6 8 2 1 ... ... ... ... 1 3 1 2 2 2 ... Cirrhosis of Liver 14 9 5 ... 1 ... ... ... ... ... 1 6 5 1 ... ... Other Diseases of the Digestive System 20 11 9 2 2 ... 3 l 3 1 2 4 2 ... ... ... Nephritis and Bright's Disease 49 22 27 ... 1 ... ... 2 3 1 6 13 12 7 4 ... Tumours and other Affections of Female Genital Organs 2 ... 2 ... ... ... ... ... ... 1 ... ... ... 1 ... ... Accidents and Diseases of Parturition 5 ... 5 ... ... ... ... ... ... 1 3 ... ... ... 1 ... Deaths by Accidents or Negligence 34 21 13 12 9 2 ... 1 3 ... 1 ... 2 2 1 1 Deaths by Suicide or Homicide 7 4 3 2 ... ... ... ... 2 ... 1 ... 1 1 ... ... Deaths from ill-defined causes 14 4 10 3 ... ... ... 1 ... ... 3 2 2 2 ... 1 All other Diseases 35 21 14 8 2 2 1 1 2 2 3 2 4 5 3 ... Totals 1615 815 800 372 207 37 28 43 52 75 129 148 160 202 127 35 103—104 TABLE IVa. Disease. Deaths in or belonging to Localities, at all ages in Wards. 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 ... 11 8 9 7 15 1 3 4 1 4 7 4 5 Scarlet Fever 1 ... ... 1 4 2 ... 1 4 1 ... ... ... 13 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza ... 3 3 2 5 9 1 2 1 3 1 ... 11 ... Whooping Cough 4 2 ... 3 ... 5 ... 5 12 3 1 2 1 ... Diphtheria and Membranous Croup ... 1 ... 1 2 6 ... 1 1 1 2 ... ... 14 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... 1 ... ... ... ... ... 1 ... ... ... 2 ... 1 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea and Dysentery ... 2 ... 2 1 2 ... ... 3 1 ... ... 2 1 Epidemic or Zymotic Enteritis 5 1 1 ... ... 8 ... 2 1 2 1 2 ... 1 Enteritis ... 1 2 ... 7 6 3 1 ... 4 ... 1 2 2 Other continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ••• ... Erysipelas ... ... ... ... ... 2 ... ... 1 1 1 ... 1 ... Puerperal Fever ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... 1 3 1 1 1 ... 1 1 2 4 Syphilis ... 3 ... ... 2 2 ... 1 1 ... ... ... 5 1 Rheumatism ... ... ... 1 ... 4 ... ... ... ... 2 ... 1 ... Gout ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Tuberculosis of Meninges 1 ... 3 2 1 4 2 2 2 ... ... 2 1 1 Tuberculosis of Lungs (Phthisis) 5 17 12 13 5 28 17 12 12 12 11 10 39 17 Tuberculosis of Intestines and Peritoneum ... ... 3 1 ... 3 ... 2 2 ... ... ... 1 1 Other forms of Tuberculosis 1 2 ... 2 1 6 2 4 2 ... 1 1 6 5 Alcoholism ... 1 ... 1 ... 1 ... ... 1 ... ... ... 3 ... Cancer ... 17 11 3 6 23 6 7 8 11 5 10 26 17 Diabetes 1 ... 1 ... 1 1 2 1 1 1 1 1 1 3 Premature Births 4 4 5 8 2 6 4 4 7 6 2 9 5 ... Developmental Diseases 1 9 2 2 9 24 6 8 8 2 4 11 9 5 Old Age 1 8 3 7 1 6 4 7 8 9 10 3 20 5 Meningitis 1 2 1 ... 1 5 1 ... 2 1 1 4 3 ... Inflammation and Softening of Brain ... 2 ... ... ... ... 1 ... ... 1 ... ... ... 2 Epilepsy 1 1 ... 1 1 ... ... 1 ... ... ... ... 2 1 General Paralysis ... ... 1 ... 1 2 1 1 ... ... ... ... ... 3 Tabes Dorsalis (Locomotor Ataxia) ... 1 1 ... 2 ... ... 1 ... ... 1 ... 5 ... Peripheral Neuritis ... ... ... ... ... ... 2 ... 1 ... ... ... 2 ... Other Diseases of Brain and Nervous System 1 6 4 3 3 4 3 1 4 ... 4 4 5 4 Organic Diseases of the Heart 4 23 5 7 5 24 5 14 14 7 12 8 22 9 Cerebral Hæmorrhage, Embolism and Thrombosis 1 6 1 2 1 9 3 4 3 2 3 6 13 3 Apoplexy and Hemiplegia ... ... 1 3 ... 2 ... 4 ... 3 3 2 2 ... Other Diseases of Blood Vessels and Heart 1 4 2 2 2 4 ... 1 4 2 2 6 5 5 Acute Bronchitis 6 11 8 7 5 19 10 9 22 5 6 7 3 2 Chronic Bronchitis 3 6 4 3 4 8 4 5 5 4 3 5 12 4 Lobar (Croupous) Pneumonia 1 1 2 2 2 ... I 1 2 ... 3 1 2 3 Lobular (Broncho) Pneumonia 4 4 11 9 4 17 2 7 6 5 2 3 3 3 Pneumonia 1 4 2 3 6 10 1 1 3 2 3 3 6 4 Other Diseases of Respiratory System ... 1 1 ... ... 5 2 ... 1 ... ... 1 1 2 Diseases of Stomach 2 2 3 ... ... ... 1 ... 1 ... 1 ... 1 1 Obstruction of Intestines ... 1 3 ... 1 1 ... ... 1 3 2 2 3 3 Cirrhosis of Liver ... 3 3 1 ... 2 1 ... 2 ... 2 ... 3 2 Other Diseases of Digestive System 1 2 2 1 2 2 3 2 2 1 1 1 ... 12 Nephritis and Bright's Disease 1 6 4 3 1 7 4 8 3 3 7 2 9 9 Tumours and other Affections of Female Genital Organs ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 Accidents and Diseases of Parturition ... ... 2 1 ... ... ... ... ... 1 1 ... 2 ... Deaths by Accidents or Negligence 1 4 2 5 3 4 2 3 1 4 2 3 9 4 Deaths by Suicide or Homicide ... 3 ... ... 2 ... 1 ... ... ... ... 1 ... 1 Deaths from ill-defined Causes ... 1 ... ... 3 1 1 2 2 3 ... 1 1 1 All other Diseases 2 6 4 1 3 3 1 2 1 4 2 6 7 6 Totals 55 183 121 113 107 295 100 133 160 111 109 128 261 181 105—106 TABLE IVb. Infantile Mortality during the Year 1907. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week. 1 to 2 Weeks. 2 to 3 Weeks. 3 to 4 Weeks. Total under 1 Month. 1 to 2 Months. 2 to 3 Months. 3 to 4 Months. 4 to 5 Months. 5 to 6 Months. 6 to 7 Months. 7 to 8 Months. 8 to 9 Months. 9 to 10 Months. 10 to 11 Mont hs. 11 to 12 Months. Total Deaths under 1 Year. All Causes- Certified 83 19 16 22 140 40 36 27 19 17 23 17 8 18 17 10 372 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases— Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... 1 2 1 1 3 ... 5 13 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 2 Whooping Cough ... ... ... 1 1 1 ... 4 ... 2 2 1 ... 1 ... ... 12 Diarrhoœl Diseases— Diarrhœa, all forms ... ... ... ... ... ... 4 3 4 4 6 2 ... 1 3 ... 27 Enteritis, Muco-Enteritis, Gastro-En teritis ... 1 ... 1 2 4 3 ... 3 ... ... ... 1 1 1 ... 15 Gastritis, Gastro-intestinal Catarrh ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Wasting Diseases— Premature Birth 42 5 3 4 54 2 3 1 ... 1 ... ... ... ... ... ... 61 Congenital Defects 18 2 1 2 23 3 1 1 ... ... ... 1 ... ... ... ... 29 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 11 4 4 5 24 8 6 4 2 2 1 ... ... ... ... ... 47 Tuberculous Diseases— Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 1 ... 4 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 ... 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... 1 2 1 .. ... ... ... 4 Other Causes Erysipelas ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... 3 Syphilis ... 1 1 ... 2 ... ... 1 ... ... ... ... ... ... ... ... 3 Rickets ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... .. 1 1 ... ... ... 2 1 ... 1 2 1 9 Convulsions 3 1 2 ... 6 2 ... 4 1 ... 1 ... ... 1 ... 1 16 Bronchitis ... 3 4 3 10 7 9 4 2 3 3 2 1 5 2 2 50 Laryngitis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Pneumonia ... ... ... 1 1 6 2 1 4 2 2 6 4 2 5 ... 38 Suffocation (Overlying) 3 1 ... 2 6 1 1 ... ... ... ... ... ... ... ... ... 8 Other Causes 6 1 1 3 11 3 3 ... 1 ... 1 2 ... 2 1 1 25 83 19 16 22 140 40 36 27 19 17 23 17 8 18 17 10 372 Population (estimated to middle of 1907) :—129,336. Births in the year:- Legitimate, 3,216; Illegitimate, 79. Deaths in the year:- Legitimate Infants, 348 ; Illegitimate Infants, 24. Deaths from all Causes at all Ages, 1616. 201 TABLE V. Rates per 1,000 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 1892 0.04 ... ... ... 1.00 0.07 1.3 0.41 9.4 0.33 ... ... 0.41 0.13 ... ... 0.09 0.02 1893 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1894 0.35 0.03 ... ... 0.96 004 1.7 0456 7.8 0.42 ... ... 0.47 0.11 ... ... 0.04 0.03 1895 0.19 o.o1 ... ... 0.93 0.02 2.0 0.47 5.5 0.20 ... ... 2.5 0.38 ... ... 0.08 0.03 1896 0.03 ... ... ... 1.03 0.04 2.8 0.87 5.0 0.24 ... ... 0.02 0.07 ... ... 0.03 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 9.9 0.31 5.7 0.16 ... ... 0.52 0.11 ... ... 0.09 0.08 1899 ... ... ... ... 0.83 0.06 3.0 0.80 6.8 0.09 ... ... 0.52 0.09 ... ... 0.09 0.07 1900 0.01 ... ... ... 0.91 0.05 3.1 0.27 3.9 0.09 ... ... 0.59 0.10 ... ... 0.06 0.01 1901 0.18 ... ... ... 0.61 ... 1.8 0.16 2.6 0.04 ... ... 0.58 0.11 ... ... 0.06 0.02 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 1905 0.04 ... ... ... 0.66 0.04 2.08 0.14 4.08 0.08 ... ... 0.17 0.06 ... ... 0.10 0.05 1906 ... ... ... ... 0.76 0.02 2.80 0.17 4.14 0.04 ... ... 0.22 0.06 ... ... 0.00 0.02 1907 ... ... ... ... 0.85 0.04 1.83 0.12 7.91 0.11 ... ... 0.16 0.03 ... ... 0.04 0.01 Note.—Data for 1893 could not be obtained. G 109—110 TABLE VI. London and no: Metropolitan Boroughs—Birth Rates and Death Rates of persons belonging to London and the Metropolitan Boroughs during the 52 weeks of 1907.* Boroughs. Per 1,000 Persons Living. Deaths under 1 year to 1,000 Births. Deaths from— Births. All Causes. Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever Diphtheria. Whooping Cough. Typhus. Enteric Fever. †Pyrexia (Origin uncertain). Diarrhoea. Phthisis. County of London 2.56 14.0 1.42 ... 0.38 0.14 0.16 0.38 ... 0.04 0.00 0.32 1.40 116 West Districts. Paddington 21.8 13.5 1.13 ... 0.25 0.09 0.13 0.35 ... 0.03 ... 0.28 1.09 109 Kensington 19.0 13.7 1.04 ... 0.17 0.05 0.13 0.45 ... 0.03 ... 0.21 1.03 128 Hammersmith 25.3 14.3 1.16 ... 0.44 0.08 0.15 0.27 ... 0.05 ... 0.17 1.20 117 Fulham 27.8 13.2 1.73 ... 0.42 0.08 0.23 0.45 ... 0.05 ... 0.50 1.19 122 Chelsea 20.3 15.0 1.44 ... 0.56 0.03 0.09 0.33 ... 0.04 ... 0.39 1.50 122 City of Westminster 17.2 13.0 0.72 ... 0.11 0.07 0.10 0.15 ... 0.05 ... 0.24 1.37 102 North Districts. St. Marylebone 20.9 15.0 0.97 ... 0.14 0.15 0.12 0.35 ... 0.02 ... 0.19 1.48 101 Hampstead 15.1 9.0 0.51 ... 0.13 0.06 0.08 0.13 ... 0.02 ... 0.09 0.70 69 St. Pancras 24.7 15.0 1.17 ... 0.37 0.11 0.13 0.33 ... 0.02 ... 0.21 1.66 108 Islington 25.0 14.7 1.25 ... 0.38 0.06 0.12 0.36 ... 0.04 0.00 0.29 1.32 116 Stoke Newington 20.0 11.5 1.02 ... 0.13 0.19 0.13 0.36 ... 0.6 ... 0.15 0.94 100 Hackney 24.3 13.6 1.37 ... 0.26 0.19 0.20 0.29 ... 0.09 ... 0.34 1.17 112 Central Districts. Holborn 19.4 17.4 1.28 ... 0.22 0.04 0.18 0.51 ... 0.04 ... 0.29 2.58 131 Finsbury 29.8 18.7 1.83 ... 0.51 0.18 0.17 0.54 ... 0.02 ... 0.41 2.33 130 City of London 13.7 16.8 0.85 ... 0.05 0.05 0.25 0.35 ... 0.10 ... 0.05 2.02 94 East Districts. Shoreditch 33.0 20.5 3.01 ... 1.03 0.24 0.17 0.88 ... 0.05 ... 0.64 2.10 150 Bethnal Green 31.8 17.5 1.96 ... 0.54 0.33 0.14 0.46 ... 0.05 ... 0.44 1.90 138 Stepney 33.6 15.9 1.97 ... 0.50 0.27 0.30 033 ... 0.07 0.00 0.50 1.56 117 Poplar 31.0 16.9 2.11 ... 0.50 0.26 0.29 0.48 ... 0.06 ... 0.46 1.33 124 South Districts. Southwark 29.8 18.0 1.90 ... 0.54 0.17 0.17 0.49 ... 0.05 ... 0.48 2.03 138 Bermondsey 31.7 18.3 1.71 ... 0.41 0.28 0.16 0.43 ... 005 ... 0.38 1.88 123 Lambeth 24.6 14.6 1.28 ... 0.34 0.13 015 0.35 ... 0.02 ... 0.29 1.53 120 Battersea . 25.5 13.3 1.34 ... 0.38 0.10 0.21 0.38 ... 0.02 ... 0.25 1.25 114 Wandsworth 25.6 12.3 1.16 ... 0.23 0.09 0.14 0.40 ... 0.04 ... 0.26 0.95 99 Camberwell 24.4 13.9 1.43 ... 0.44 0.13 0.14 0.43 ... 0.03 ... 0.26 1.31 115 Deptford 28.3 14.1 1.47 ... 0.46 0.12 0.22 0.32 ... 0.05 0.01 0.29 1.34 108 Greenwich 24.3 12.7 1.44 ... 0.54 0.09 0.17 0.24 ... 0.05 ... 0.35 1.08 100 Lewisham 23.9 11.5 0.85 ... 0.11 0.08 0.12 0.34 ... 0.01 ... 0.19 0.93 90 WOOLWICH 25.8 12.5 1.38 ... 0.56 0.11 0.12 0.29 ... 0.03 0.01 0.26 1.25 112 In this Table 0.00 indicates that the deaths were too few to give a rate of 0.005; where no death occurred is inserted. * The rates for the County of London do not in all cases agree with those in some of the other Tables. †Called Simple Continued Fever previous to 1901. ll1_112 TABLE VII. London and the Metropolitan Boroughs.— Death Rates per 1,000 persons living, and Infantile Mortality, after Distribution of Births in the Chief Lying-in Institutions and of Deaths in all Public Institutions, &c., in the Five Years 1902-6, and in 1907.* Boroughs. All Causes. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Diarrhoea. Phthisis. Deaths under One year to 1,000 Births. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. 19021906. 1907. County of London 15.7 14.6 0.06 — 0.44 0.38 0.10 0.14 0.17 0.16 0.33 0.38 0.00 — 0.07 0.04 0.00 0.00 0.77 0.32 1.53 1.40 135 116 Paddington 13.5 13.5 0.03 — 0.33 0.25 0.07 0.09 0.11 0.13 0.21 0.35 — — 0.06 0.03 — — 0.05 0.28 1.08 1.09 118 109 Kensington 14.3 13.7 0.01 — 0.37 0.17 0.08 0.05 0.10 0.13 0.24 0.45 — — 0.06 0.03 0.00 — 0.63 0.21 1.28 103 140 128 Hammersmith 15.0 14.3 0.02 — 0.50 0.44 0.08 0.08 0.19 0.15 0.29 0.27 — — 0.06 0.05 0.00 — 0.83 0.17 1.34 1.20 140 117 Fulhara ... 15.0 13.2 0.02 — 0.57 0.42 0.09 0.08 0.20 0.23 0.37 0.45 — — 0.07 0.05 — — 1.26 0.50 1.31 1.19 140 122 Chelsea... 16.1 15.0 0.02 — 0.15 0.56 0.09 0.03 0.11 0.09 0.29 0.33 — — 0.04 0.04 — — 0.54 0.39 1.58 1.50 135 122 City of Westminster 13.9 13.0 0.05 — 0.19 0.11 0.07 0.07 0.08 0.10 0.15 0.15 — — 0.06 0.05 0.01 — 0.35 0.24 1.58 1.37 115 102 St. Marylebone ... 16.3 15.0 0.04 — 0.41 0.14 0.11 0.15 0.13 0.12 0.20 0.35 — — 0.06 0.02 0.01 — 0.56 0.19 1.69 1.48 130 101 Hampstead 9.9 9.0 0.01 — 013 0.13 0.06 006 0.08 0.08 0.12 0.13 — — 0.05 0.02 — .— 0.18 0.09 0.78 0.70 90 69 St. Pancras 16.8 15.0 0.07 — 0.52 0.37 0.13 0.11 0.20 0.13 0.37 0.33 — — 0.08 0.02 0.00 — 0.54 0.21 1.78 1.66 132 108 Islington 15.1 14.7 0.03 — 0.43 0.38 0.10 0.06 0.14 0.12 0.34 0.36 — — 0.07 0.04 0.00 0.00 0.50 0.29 1.39 1.32 125 116 Stoke Newington 12.7 11.5 0.03 — 0.23 0.13 0.05 019 0.11 0.13 0.28 0.36 — — 0.05 0.06 0.00 — 0.46 0.15 1.32 0.94 113 100 Hackney 14.2 13.6 0.06 — 0.37 0.26 0.09 0.19 0.18 0.20 0.28 0.29 — — 0.12 0.09 —— — 0.78 0.34 1.32 1.17 128 112 Holborn... 18.8 17.4 0.16 — 0.44 0.22 0.07 0.04 0.11 0.18 0.28 0.51 — — 0.07 0.04 — — 0.52 0.29 2.84 2.58 132 131 Finsbury 20.8 18.7 0.08 — 0.76 0.51 0.16 0.18 0.20 0.17 0.49 0.54 — — 0.10 0.02 — — 0.98 0.41 2.23 2.33 159 130 City of London ... 17.3 16.8 0.05 — 0.14 0.05 0.10 0.05 0.15 0.25 0.18 0.35 — — 0.05 0.10 — — 0.23 0.05 1.59 2.02 121 94 Shoreditch 20.0 20.5 0.13 — 0.70 1.03 0.13 0.24 0.17 0.17 0.57 0.88 — — 0.09 0.05 — — 1.37 0.64 2. 06 2.10 167 150 Bethnal Green 19.2 17.5 0.11 — 0.52 0.54 0.15 0.33 0.24 0.14 0.46 0.46 — — 0.08 0.05 0.00 — 0.95 0.44 2.10 1.00 151 138 Stepney 18.7 15.9 0.17 — 0.55 0.50 0.12 0.27 0.23 0.30 0.44 0.33 — — 0.09 0.07 0.00 0.00 1.15 0.50 1.91 1.56 144 117 Poplar ... 18.3 16.9 0.11 — 0.60 0.56 0.12 0.26 0.32 0.29 0.46 0.48 — — 0.09 0.06 — — 1.24 0.46 1.65 1.33 152 124 Southwark 19.2 18.0 0.07 — 0.66 0.54 0.14 0.17 0.18 0.17 0.42 0.49 — — 0.08 0.05 0.00 — 1.01 0.18 2.31 2.03 153 138 Bermondsey 19.5 18.3 0.05 — 0.76 0.41 0.17 0.28 0.18 0.16 0.41 0.43 0.00 — 0.08 0.05 0.00 — 1.10 0.38 1.91 1.88 156 123 Lambeth 15.7 14.6 0.04 — 0.35 0.34 0.09 0.13 0.13 0.15 0.33 0.35 — — 0.07 0.02 0.00 — 0.76 0.29 1.46 1.53 134 120 Battersea 14.3 13.3 0.03 — 0.50 0.38 0.10 0.10 0.10 0.21 0.38 0.38 — — 0.07 0.02 — — 0.78 0.25 1.33 1.25 131 114 Wandsworth 12.9 12.3 0.02 — 0.36 0.23 0.08 0.09 0.18 0.14 0.26 0.40 — — 0.07 0.04 — — 0.64 0.26 1.00 0.95 118 99 Camberwell 14.6 13.9 0.05 — 0.38 0.44 0.09 0.13 0.15 0.14 0.32 0.43 — — 0.06 0.03 — — 0.69 0.26 1.31 1.31 131 115 Deptford 15.6 14.1 0.06 — 0.52 0.46 0.13 0.12 0.19 0.22 0.38 0.32 — — 0.06 0.05 0.00 0.01 0.85 0.29 1.28 1.34 136 108 Greenwich 14.0 12.7 0.04 — 0.31 0.54 0.08 0.09 0.19 0.17 0.33 0.24 — — 0.06 0.05 — — 0.74 0.35 1.22 1.08 129 100 Lewisham 12.1 11.5 * 0.02 — 0.21 0.11 0.08 0.08 0.15 0.12 0.23 0.34 — — 0.04 0.01 0.00 — 0.57 0.19 0.89 0.93 109 80 Woolwich 13.8 12.5 0.06 — 0.22 0.56 0.07 0.11 0.17 0.12 0.28 0.29 — — 0.07 0.03 — 0.01 0.72 0.26 1.49 1.25 116 112 * The rates for the County of London do not in all eases agree with those in some of the other Tables. 113-114 TABLE VIII. Meteorology and Registered Deaths from all causes, and from certain prevalent Diseases in each week of the year 1907. Week. Date of ending. Temperature of the Air. Temperature three feet below ground. Mean Humidity, complete Saturation = 100. No. of days on which rain fell. 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. January 5 51.0 19.8 39.3 + 42.10 83 5 0.98 59 1 11 15 6 ,, 12 48.4 33.7 42.8 + 42.97 83 3 0.18 53 ... 5 12 7 ,, 19 48.2 26.1 40.7 + 43.71 81 1 0.01 43 ... 8 12 4 26 44.0 22.4 30.5 + 42.50 74 2 0.04 44 1 7 15 1 February 2 49.8 22.5 36.1 + 40.45 77 3 0.19 61 ... 9 19 1 ,, 9 41.2 23.5 33.0 + 39.67 76 4 0.19 46 ... 4 18 4 ,, 16 48.6 28.0 39.7 + 39.56 85 5 0.77 47 ... 5 11 1 ,, 23 51.4 25.5 39.9 + 41.26 72 3 0.29 40 1 5 5 6 March 2 55.0 24.4 40.6 + 40.64 81 1 0.01 43 1 6 7 4 ,, 9 49.0 26.2 40.1 - 41.08 80 3 0.37 38 ... 5 12 4 ,, 16 55.1 24.1 42.8 + 41.57 74 4 0.40 49 ... 7 12 7 ,, 23 58.2 29.1 46.1 + 42.94 64 2 0.13 34 ... 1 10 3 ,, 30 66.6 28.0 46.5 + 43.26 71 0 0.00 22 ... 1 4 5 1st Quarter 66.6 19.8 39.85 41.67 77 36 3.56 579 4 74 152 53 April 6 69.4 35.1 49.6 + 44.80 69 2 0.17 40 ... 4 3 11 ,, 13 58.3 32.3 44.1 - 45.26 86 5 1.42 23 1 ... 7 1 ,, 20 57.0 29.1 43.7 - 45.75 76 4 0.63 18 ... ... 3 2 ,, 27 72.0 35.1 49.4 + 46.43 79 3 0.90 US ... 3 4 3 May 4 60.4 35.0 46.4 - 46.95 69 5 0.59 20 ... 1 4 1 ,, 11 78.0 37.3 56.0 + 48.36 72 4 0.36 19 ... ... 1 6 ,, 18 81.5 38.1 53.2 + 51.92 72 3 0.35 32 1 3 3 7 ,, 25 72.2 33.5 50 6 - 51.10 78 6 0.35 36 ... 2 6 6 June 1 69.8 41.1 53.4 - 52.59 83 3 0.67 24 ... ... 2 5 ,, 8 69.5 45.2 54.7 - 53.19 75 3 0.42 24 ... 2 3 3 ,, 15 75.7 47.1 58.7 + 55.25 75 5 0.41 26 1 1 5 3 ,, 22 70.3 43.1 56.7 - 56.29 65 1 0.01 28 ... 1 1 5 ,, 29 71.0 44.3 56.4 - 56.70 77 5 1.30 13 ... 4 1 2 2nd Quarter 81.5 29.1 51.76 50.35 75 49 7.58 326 3 21 43 55 July 6 68.4 43.6 54.7 - 56.71 73 3 0.16 12 ... ... 4 1 ,, 13 72.6 42.8 56.3 - 57.00 71 4 0.22 16 ... 1 2 5 ,, 20 79.0 48.7 62.7 - 58.53 72 ... 0.00 23 ... ... 3 7 ,, 27 76.0 44.5 59.5 - 59.67 78 3 0.51 27 ... 3 2 5 August 3 76.5 44.1 59.7 - 60.10 74 5 0.40 24 ... 1 3 . ,, 10 79.0 49.9 62.3 + 60.34 73 2 0.18 16 ... ... 2 3 ,, 17 76.0 50.9 61.5 - 60.84 73 4 0.71 24 ... 1 2 5 ,, 24 72.1 46.1 57.0 - 60.26 74 5 0.96 26 2 3 1 3 ,, 31 77.5 45.9 61.1 + 59.67 76 1 0.16 27 1 2 2 4 September 7 74.0 44.1 56.8 - 59.45 79 4 0.44 27 1 3 2 6 ,, 14 76.6 36.9 58.6 + 59.48 81 ... 0.00 29 2 3 ... 4 ,, 21 71.9 42.1 56.8 - 58.77 73 ... 0.00 31 1 3 3 3 ,, 28 82.7 34.5 58.4 + 58.18 73 1 0.03 27 4 ... 1 3 3rd Quarter 82.7 34.5 58.87 59.15 74.6 32 3.77 309 11 20 27 51 October 5 68.0 40.8 55.4 + 58.34 83 6 0.85 35 4 2 6 4 ,, 12 64.5 40.1 52.7 + 56.88 85 7 1.13 31 3 3 2 5 ,, 19 63.0 39.1 51.4 + 55.59 84 6 0.79 21 1 1 5 1 ,, 26 64.0 35.6 48.8 + 54.53 87 3 0.50 29 3 4 1 2 November 2 59.1 36.9 48.4 + 52.97 91 3 0.34 25 ... ... 5 4 „ 9 60.3 41.3 49.8 + 52.55 90 1 0.03 24 3 2 4 ... ,, 16 53.2 31.5 43.8 + 51.49 87 1 0.13 30 2 2 7 4 ,, 23 53.0 29.1 42.6 + 50.20 92 2 0.70 41 ... ... 6 10 ,, 30 56.1 30.6 42.7 + 48.45 89 4 1.37 31 ... 2 5 4 December 7 51.5 32.1 42.2 + 17.57 86 5 0.75 39 ... 2 14 5 „ 14 56.7 36.3 45.2 + 46.77 82 6 1.82 31 ... 6 8 2 ,, 21 55.3 28.2 44.2 + 45.69 89 2 0.04 35 ... 1 5 3 ,, 28 53.6 32.3 39.5 + 46.38 82 2 0.12 26 ... ... 7 6 4th Quarter 68.0 28.2 46.67 51.34 86.7 48 8.57 398 16 25 75 50 For whole Year 82.7 19.8 49.29 50.63 78.3 165 23.48 1612 34 140 297 209 115 TABLE IX. Weekly Averages. Period. Temperature of the Air. Temperature 3 feet below ground. Mean Humidity Complete Saturation = 100. Number of days on which rain fell in each week. 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 51.3 25.6 39.85 41.67 77 2.8 0.27 45 .31 6 12 4 2nd Quarter 69.6 38.2 51.76 50.35 75 3.8 0.58 25 .23 1.6 3 4 3rd Quarter 75.6 44.2 58.87 59.15 74.6 2.5 0.29 24 .85 1.6 2 4 4th Quarter 58.3 34.9 46.67 51.34 86.7 3.7 0.66 31 1.2 20 6 4 116 TABLE X. Summary of Statistics for the 1st Quarter, 1907 :— A. Birth and Death Statistics for the Borough of Woolwich. Bates calculated per 1,000 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. Kate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 129,336 880 27.2 131 149 539 107 17 57 579 17.9 B. Birth and Death Bates 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 0 D A B C D 39,993 32.1 22.3 146 76,595 25.2 16.0 147 12,748 21.7 15.4 159 117 C. Notifications of Infectious Diseases. Disease. Woolwich. Plumstead. Eltham. Total. Average for 1st Quarters in Previous 5 years. Small-pox .. .. .. .. 22.0 Scarlet Fever 37 198 22 257 105.8 Diphtheria 23 53 5 81 75.0 Enteric Fever 1 6 2 9 8.2 Erysipelas 9 24 5 38 21.8 Puerperal .. .. • • .. 2.0 Phthisis 11 26 .. 37 43.6 Measles (Notified by School Teachers) 398 820 52 1270 Average for last four years 165 Cerebro-Spinal Meningitis .. 1 .. 1 .. TABLE XI. Summary of Statistics for the 2nd Quarter, 1907. A. Birth and Death Statistics for the Borough of Woolwich. Eates calculated per 1,000 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 1,000 Births Registered. Number. Number. Rate. 129,336 845 26.1 63 75 290 59 13 50 327 10.1 118 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 39,993 305 12.0 95 76,595 24.6 9.6 66 12,748 21.6 7.8 43 C. Notifications of Infectious Disease. Disease. Woolwich. Plumstead. Eltham. Total. Average for 2nd Quarters in Previous 5 years. Small-pox — — — — 25.4 Scarlet Fever 73 173 9 255 103.0 Diphtheria 12 49 5 66 47.4 Enteric Fever — 6 — 6 5.4 Erysipelas 8 12 1 21 17.2 Puerperal Fever 1 — — 1 1.2 Phthisis 8 26 1 35 46.8 Measles (Notified by School Teachers) 12 96 10 118 304.0 119 TABLE XII. Summary of Statistics for the 3rd Quarter (13 weeks) ending 29th September, 1907, corrected for Public Institutions. A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 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. 129,936 807 250 71 88 286 53 10 33 309 9.56 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 39,993 28.8 10.5 56 76,595 22.7 9.3 103 12,748 24.5 8.0 128 120 C. Notifications of Infectious Diseases. Disease. Woolwich. - Plumstead. Eltham. Total. Average for 3rd quarters in previous 5 years. Small-pox — — — — — Scarlet Fever 79 157 13 249 132.4 Diphtheria 10 37 2 49 44.6 Enteric Fever 2 . _ 1 3 8.8 Erysipelas 3 25 . — 27 18.0 Puerperal Fever 1 1 — 2 2.4 Phthisis 15 21 4 40 37.0 Measles (Notified by School Teachers) 10 16 — 26 55.6 Zymotic Enteritis 59 25 10 94 124.6 (1905-6-7) TABLE XIII. Summary of Statistics for the 4th Quarter (13 weeks) ending 30th December* 1907, corrected for Public Institutions. A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 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. 129,336 782 24.2 102 130 364 77 10 44 398 12.3 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 39,993 26.9 14.5 145 76,595 23.2 11.7 110 12,748 21.7 91 202 C. Notifications of Infectious Diseases. Disease. Woolwich. Plumstead. Eltham. Total. Average for 4th quarters in previous 5 years. Small-pox – – – – 1.4 Scarlet Fever 49 129 73 251 122.6 Diphtheria 19 43 7 69 85.8 Enteric Fever 3 2 3 8 13.0 Erysipelas 8 16 – 24 24.0 Puerperal Fever 3 1 – 4 1.4 Phthisis 13 26 1 40 46.4 Measles (Notified by School Teachers) 4 32 3 39 230.6 121 TABLE XIV. Deaths from Various Causes for whole Borough, 1907, corrected for Public Institutions—Nett. Week ending. Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Membranous Croup. Enteric Fever. Diarrhœa and Dysentery. Erysipelas. Puerperal Fever Rheumatism. Tubercle. Alcoholism. Cancer. Bronchitis. Pneumonia. Accidents. Homicide and Suicide. January 5 ... 8 ... 4 1 1 1 1 ... ... ... 6 ... 5 7 8 2 ... ,, 12 ... 5 ... 3 ... ... ... ••• 1 ... ... 7 ... 1 8 4 1 1 ,, 19 ... 7 1 2 ... ... ... ... ... ... ... 4 ... 4 7 5 ... ... „ 26 ... 6 ... 1 ... 1 ... 1 ... ... ... 1 ... 4 6 9 2 ... February 2 ... 6 ... 2 1 1 1 ... ... 1 1 1 1 15 4 3 ... ,, 9 ... 4 ... 2 ... ... ... ... ... ... ... 4 ... 1 12 6 1 ... ,, 16 ... 5 ... ... ... ... ... ... 1 ... ... 1 ... 4 9 2 2 ... ,, 23 ... 5 ... 3 ... ... ... 1 ... ... 2 6 ... 1 2 3 ... ... March 2 ... 4 2 1 ... ... ... 1 ... ... ... 4 ... ... 5 2 1 ... ,, 9 ... 5 ... 1 ... ... ... ... ... ... 1 4 ... 2 8 4 ... ... ,, 16 ... 6 ... 1 ... 1 ... ... ... ... ... 7 1 5 6 6 2 ... ,, 23 ... 1 ... ... ... ... ... ... 1 ... 1 3 ... 1 6 4 1 ... ,, 30 ... 1 ... 1 ... ... ... ... ... ... ... 5 ... 3 2 2 ... ... 1st Quarter ... 63 3 21 2 4 2 4 3 ... 5 53 2 32 93 59 15 1 April 6 ... 2 ... ... ... 2 ... ... ... ... ... 11 ... 4 2 1 2 1 ,, 13 ... ... ... 1 ... ... 1 1 ... ... ... 1 ... 3 1 6 ... ... ,, 20 ... ... ... 1 ... ... ... ... ... ... ... 2 ... 1 ... 3 ... ... ,, 27 ... 3 ... ... ... ... ... ... ... ... ... 3 ... 2 2 2 1 ... May 4 ... ... ... 1 ... 1 ... ... ... ... ... 1 ... 2 2 2 1 ... ,, 11 ... ... ... ... ... ... ... ... ... ... ... 6 ... 2 ... 1 1 ... „ 18 ... 1 1 ... ... 1 ... 1 ... ... ... 7 ... 1 ... 3 1 ... ,, 25 ... ... 2 ... ... ... ... ... ... ... ... 6 ... 1 4 2 1 ... June 1 ... ... ... ... ... ... ... ... ... ... ... 5 1 3 2 ... ... ... ,, 8 ... ... 1 ... ... 1 ... ... 1 ... ... 3 ... 1 1 2 ... ... „ 15 ... ... ... ... ... ... ... 1 ... ... ... 3 1 1 3 2 1 ... ,, 22 ... ... ... 1 1 ... ... ... ... ... ... 5 3 1 ... 1 ... ... ,, 29 ... ... ... ... 3 1 ... ... ... ... ... 2 ... 1 ... 1 ... ... 2nd Quarter ... 6 4 4 5 6 1 3 1 ... ... 55 5 23 17 26 8 1 July 6 ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 2 ... ... ,, 13 ... 1 ... ... ... ... ... ... ... ... ... 5 ... 3 ... ... 1 ... ,, 20 ... ... ... ... ... ... ... ... ... ... ... 7 ... ... 2 1 ... 1 ,, 27 ... ... ... ... 3 ... ... ... ... ... ... 5 ... 3 ... ... 1 ... August 3 ... ... ... 1 1 ... ... ... ... ... ... 2 ... 1 ... 3 1 ... ,, 10 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 2 ... ... ... ,, 17 ... ... ... ... ... 1 ... ... ... ... ... 5 ... ... 2 ... ... 1 ,, 24 ... 1 ... ... 2 ... ... 2 ... ... ... 3 1 2 ... 1 2 ... „ 31 ... ... ... ... 2 ... ... 1 ... ... ... 4 ... 1 ... ... ... 2 September 7 ... ... 1 ... 2 ... ... 1 ... ... 1 6 ... 2 1 1 ... ... ,, 14 ... ... 1 ... 2 ... ... 2 ... ... ... 4 ... 2 ... ... 1 ... ,, 21 ... ... ... ... 3 ... ... 1 ... ... ... 3 1 1 2 1 2 1 ,, 28 ... ... ... 1 ... ... ... 4 ... ... ... 3 ... 4 ... 1 1 ... 3rd Quarter ... 2 2 2 15 1 ... 11 ... ... 2 51 3 20 11 16 9 5 October 5 ... ... 1 ... ... 1 ... 4 ... ... ... 4 1 4 4 2 ... ... ,, 12 ... ... ... ... 3 ... ... 3 ... ... ... 5 2 5 1 1 ... ... ,, 19 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... 2 3 1 ... „ 26 ... ... 1 ... 2 ... 1 3 ... ... ... 2 ... 2 1 ... ... ... November 2 ... ... ... ... ... ... ... ... ... ... ... 4 1 1 2 3 1 ... „ 9 ... ... ... ... 2 ... ... 3 ... ... ... ... ... 3 3 1 ... ... ,, 16 ... ... ... ... 2 ... ... 2 ... ... ... 4 1 3 7 ... ... ... ,, 23 ... ... ... ... ... ... ... ... ... ... ... 10 1 3 2 4 ... ... ,, 30 ... ... ... ... 1 1 ... ... 2 ... ... 4 ... 1 3 2 ... ... December 7 ... ... 1 1 1 ... ... ... ... ... ... 5 ... 4 8 6 ... ... ,, 14 ... ... 1 ... 4 1 ... ... ... ... ... 2 ... 2 5 3 1 ... ,, 21 ... ... 1 ... ... ... ... ... ... ... ... 3 l 4 5 ... ... ... ,, 28 ... ... ... 1 ... ... ... ... ... ... ... 6 1 ... 4 3 ... ... 4th Quarter ... ... 5 2 15 4 l 16 2 1 ... 50 8 32 47 28 3 ... Total for Year ... 71 14 29 37 15 4 34 6 1 7 209 18 107 168 129 35 7 123—124 TABLE XVa. Summary of Nuisances Abated, Notices Served, and General Work of Public Health Department, 1907. St. Mary's and Dockyard. Sanitary Inspectors' Districts. St. George's. Total. River. Herbert. Central and St. Margaret's St. Nicholas. Burrage and Glyndon. Eltham. PREMISES INSPECTED. No. of Houses inspected, house to house 717 624 815 1095 919 929 451 542 6092 „ Re-inspections after service of Notice (estimated) 1580 2105 1690 2050 1655 2120 710 870 12780 „ Houses and premises specially inspected, including infectious diseases and complaints 2992 1426 437 1087 603 1262 523 243 8573 „ Houses where drains have been tested by smoke test 35 23 26 22 20 48 14 4 192 „ Houses where drains have been tested by water test 41 63 33 4 3 30 20 10 204 „ New Houses inspected for Water Certificates 3 19 4 41 68 7 58 1 201 NUISANCES ABATED—DRAINS. Waste pipes from baths, lavatories, and washhouse sinks, repaired or disconnected 28 45 23 21 18 26 7 9 177 Choked and defective drains 84 122 30 67 25 65 43 15 451 Defective traps 22 23 4 1 22 19 4 14 109 Defective and unventilated soil pipes 2 4 2 4 3 2 ... ... 17 W.C.'s. W.C.'s repaired, new traps or pans provided, fittings repaired 75 123 24 49 28 87 35 68 489 Water supply apparatus repaired 96 104 62 93 103 113 30 41 642 Foul pans cleansed 9 34 18 39 34 35 2 4 175 Additional w.c.'s provided to Factories and Workshops, etc. ... ... ... ... ... ... ... ... ... Do. do. dwelling houses ... ... ... ... ... ... ... ... ... PREMISES. Underground rooms not in accordance with Act ... ... ... ... ... ... ... ... ... Interiors cleansed and defective roofs repaired 312 339 193 297 249 500 161 142 2193 Damp walls remedied 42 36 34 107 22 71 31 26 369 Paving in yards and wash-houses repaired 63 69 46 59 40 109 61 65 512 Improved ventilation provided 25 13 8 33 29 4 5 ... 117 Wash-houses without sink and outlets for waste water 2 1 1 1 ... 12 1 ... 18 Defective guttering and rain-water pipes 76 56 93 56 68 54 8 4 415 Dustbins supplied 81 109 51 105 95 133 55 46 675 Dung pits provided 1 3 1 1 1 4 ... ... 11 Cases of overcrowding remedied 9 21 3 15 9 11 11 6 85 Deficient light—windows supplied, or enlarged, or other works 15 10 4 25 ... ... 5 1 60 Dampness in premises from defective water pipes 25 23 8 5 31 13 3 4 112 ANIMALS. Animals (including pigs) kept in such a state as to be a nuisance 2 4 3 6 7 2 1 1 26 Accumulations of manure removed 8 33 2 3 13 6 3 2 70 WATER. Defective and foul cisterns used for dietary purposes 6 23 2 34 10 ... 1 1 77 Defective and foul rain-water tanks remedied ... 1 ... 1 ... 4 ... ... 6 Insufficient supply, and water cut off by Water Board 16 8 1 7 4 11 6 ... 53 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 4 23 59 13 ... 1 4 2 106 No. of smoke nuisances observed ... 3 3 4 ... ... ... ... 10 Tents, Vans, etc., inspected 1 ... ... 8 13 ... 80 ... 102 Notices served with respect to tents and vans 2 ... ... ... ... ... ... ... 2 Inspection of Urinals accessible to the public 1 155 60 140 101 97 36 16 606 Verminous rooms cleansed 2 23 ... 10 33 26 20 34 148 Intimation notices served 518 498 292 508 449 515 256 266 3302 Statutory „ „ 53 63 33 173 109 66 30 26 553 125-126 127 TABLE XVb. SUMMARY OF WORK OF CHIEF INSPECTOR. Premises Inspected 1249 New Buildings Inspected 67 Defective Combined Drained Invested and Reported on 29 Number of Houses referred to in such Combined Drains 236 Cow-houses and Slaughter-houses Inspection 39 Complaints Investigated 145 Attendance at Police Court 13 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for Proceedings 74 Summonses at Police Court 6 Bake-houses Inspected and Cleansed twice during the year 56 Number of Houses Disinfected after Infectious Disease 1392 Letters written 2918 Notifications received 1705 Certificates issued after Disinfection 1961 „ of Infectious Disease forwarded to Schools 1932 Complaints of Sanitary Defects 366 „ of Non-removal of Dust, viz.:— Woolwich 2 Plumstead 22 Eltham 19 Written Intimation Notices 3302 Statutory Notices 453 128 TABLE XVc. Factories, Workshops, Laundries, Workplaces, and Homeworkers' Premises. 1 —Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices Factories (Including Factory Laundries) 28 4 Workshops ... (Including Workshop Laundries) 286 40 Workplaces — — Homeworkers' Premises 360 40 Total 674 84 2.—Defects found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Acts; Want of Cleanliness 63 63 Want of Ventilation 10 10 Overcrowding 14 14 Want of drainage of floors 5 5 Other nuisances 60 60 Sanitary accommodation. insufficient, unsuitable, or defective 8 8 not separate for sexes 1 1 Total 161 161 129 TABLE XVc.—continued. 3.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshop Act (S. 133) 3 Action taken in matters remediable under the Public Health Acts, but not under the Factory Act (S. 5). Notified by H.M. Inspector — Reports(of action taken) sent to H.M. Inspectors Underground Bakehouses (S. 101):— In use during 1903 24 Certificates granted in 1903 24 in 1904 — in 1905 — in 1900 1 in 1907 — In use at the end of 1907 25 Workshops on the Register (S. 131) at the end of 1907— Workshop Laundries 17 „ Bakehouses 56 Other Workshops 148 Total number of Workshops on Register 221 TABLE XVc.—continued. 4.—Home Work. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Nature of Work. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Sees. 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing apparel making, &c. 20 190 17 191 52 30 Nil Nil 360 Nil Nil Nil Nil Nil Nil 130 131 TABLE XVd. Proceedings during 1907. Premises. Number of Places. Number of Inspections, 1907. Number of notices, 1907. Number of Prosecutions, 1907. On Register at end of 1906. Added in 1907. Removed in 1907. On Register a t end of 1907. Milk Premises 150 21 28 143 340 – – Cowsheds 17 — – 17 85 10 — Slaughter-houses 11 — — 11 97 5 – Ice Cream Premises 68 20 12 76 219 3 — Registered houses let in Lodgings 307 28 5 330 758 337 4 Overcrowding, 1906— Number of Dwelling Rooms overcrowded 85 Number remedied 85 Underground Rooms— Illegal occupation dealt with during year 0 Number of rooms closed 0 Insanitary Houses— Number closed under the Housing of the Working Classes Act 4 Number of Prosecutions under By-laws under Public Health Act, 1891— With respect to water closets, earth closets, etc 0 With respect to sufficiency of water supply to water closets 0 With respect to drainage, etc. (Metropolis Management Act, Sec. 202) 1 Mortuaries— Total number of Bodies removed 171 Total number of Infectious Bodies removed 2 Inspections of premises where food is prepared for sale 127 Number of Public Sanitary Conveniences removed or altered 0 Number of fixed ashpits removed 0 132 TABLE XVI. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD. Brewer Street 77 39 Creton Street 24 9 Davey Square 11 9 Eleanor Road 50 37 Gough Street 30 21 Glass Yard, High Street 6 5 Helen Street 11 7 High Street, Nos. 1 to 39 04 29 Kates Place 15 14 Masons Avenue 6 2 Meeting House Lane 11 8 Myrtle Street 9 6 Nile Cottages 6 6 Powis Street 00 29 Rhea Street 93 36 Sandy Hill Road 16 15 Union Street 20 6 Wellington Street 26 18 Winifred Street 89 60 624 356 DOCKYARD AND St. MARY'S WARDS. Siemens Road 27 22 Kidd Street 72 32 Lyford Street 19 10 Lower Wood Street 44 23 Mulgrave Place 8 3 Rectory Place, 22 8 Rectory Grove 49 19 Albion Road 49 22 George Street 29 15 Church Street 77 36 Marshall's Grove ... 28 22 Caroline Place 3 3 Station Road 33 16 North Kent Grove 15 9 North Kent Place 5 4 Paradise Place 21 14 Parsons Hill 17 12 Selina Place 12 8 133 TABLE XVI.—continued. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. DOCKYARD AND St. MARY's WARDS—cont. Maryon Vale 14 14 Woolwich Road 16 8 Morris Street 28 23 Morris Place 6 5 Sand Street 72 37 Acorn Street 25 19 Oak Street 17 12 Glenalvon Street 9 5 717 401 St. GEORGE'S WARD. Manor Street 17 11 Jaines Street 40 17 Jackson Street 54 25 Millward Street 38 10 Dicey Street 40 26 Fenwick Street 51 24 Ordnance Road 56 28 Eglinton Road 14 3 Delvan Street 13 5 Gildersome Street 58 16 Engineer Street 30 14 Nightingale Vale 43 21 Keemor Street 28 10 Ritter Street 41 14 Sandy Hill 10 4 Hanover Terrace 9 6 542 234 ELTHAM WARD. Blanmerle Road 36 19 Green Lane 19 9 Frith's Buildings 12 6 Elizabeth Terrace 23 3 Lee Green 27 8 Pelham Terrace 21 12 Reventlow Road 24 11 h 134 TABLE XVI.—continued. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. ELTHAM WARD—cont. Lannoy Road 26 14 Novar Road 13 5 Gaitskell Road 24 7 Brentwood Cottages 19 10 Merchland Road 20 3 Elm Terrace 19 8 Pound Place 22 9 Jubilee Cottages 31 10 Sherard Road 17 5 Court Road 44 12 Roper Street 23 6 Blunt's Road 31 17 451 174 HERBERT WARD. Red Lion Lane 26 15 Red Lion Terrace 5 2 Red Lion Place 4 2 Post Office Cottages 5 — Shooters Hill Road 6 1 Eglinton Road 216 51 Westdale Road 48 14 Graydon Street 14 9 Princes Road 91 40 Brookhill Row 6 3 Portland Place 16 4 Barnfield Road 68 27 Stevens Cottages 4 2 Barnfield Place 9 0 Llanover Road 53 15 Whitworth Road 74 26 Paget Road 48 14 Paget Terrace 14 3 Nithdale Road 92 4 Isla Road 16 1 815 239 135 TABLE XVI.—continued. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. ST. NICHOLAS WARD. Abbey Grove 26 13 Grove Road 20 13 Station Road, Abbey Wood 16 9 King's Highway 33 23 Southland Road 9 2 Cemetery Cottages 7 6 Bleak Hill 12 4 Lakedale Road 36 22 Bannockburn Road 91 37 Marmadon Road 110 51 Bostall Hill 35 19 Kentmere Road 38 16 Heathfield Terrace 19 7 Bassant Road 31 20 Scotch Flats 10 6 Swingate Lane 26 13 Cordite Street 22 4 Mitton Terrace 27 5 Woodhurst Road 27 10 Bastion Road 24 21 Gatling Road 32 14 Speranza Street 43 26 Purrett Road 88 25 High Street 137 46 919 412 BURRAGE AND GLYNDON WARDS. Charlotte Street 5 3 Charlotte Place 6 4 Richmond Place 42 20 Inverness Place 33 17 Yicarage Road 59 41 Hudson Road 31 15 Pattison Road 86 52 Villas Road 125 78 Armstrong Street 33 18 Armstrong Place 33 27 Whitworth Place 25 11 Burrage Grove 36 25 Helen Street 11 6 h 2 136 TABLE XVI.—continued. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. BURRAGE AND GLYNDON WARDS—cont. Maxey Road 172 84 Oliver Street 25 18 Raglan Road 27 16 Park Road 52 26 Durham Road 17 10 The Avenue, Sandy Hill 17 13 Ann Street 94 66 929 550 CENTRAL AND ST. MARG ARETS WARDS. Piedmont Road 23 3 Ancona Road 64 22 Brewery Road 85 26 Orchard Road 126 76 Goldsmid Street 10 4 Sladedale Road 76 36 Roydene Road 102 38 Parkdale Road 116 65 Durham Road 52 24 Bramblebury Road 64 19 Waverley Road 47 14 Maxey Road 45 16 Hargor Road 52 31 Timbercroft Lane 40 30 Albatross Street 42 21 Nyanza Street 14 7 Alabama Street 25 12 Palmerston Road 61 32 Francis Street 51 28 1095 504 TABLE XVII. Prosecutions under the Public Health and Housing of the Working Classes Acts. No. Date of Final Hearing. Offence. Situation. Result. 1 1907. April 9 Non-Provision of Dustbin 43, Nightingale Yale Fined 20s. and 23s. costs 2 April 19 Non-Repair of Drain 336 to 356, Albert Road . 23s. costs 3 May 30 Breach of By-laws—Houses Let in Lodgings 80, Brookhill Road Fined 10s. and 2s. costs 4 May 30 do. do. 80, Brookhill Road 2s. costs 5 Nov. 21 do. do. 31, Dicey Street Fined 20s. and 10s. 6d. costs or 14 days 6 Nov. 21 do. do. 31, Dicey Street 2s. costs 7 Nov. 21 Non-Provision of sufficient Ashpit 1, Beresford Street Fined 5s. and 10s. 6d. costs 137 138 TABLE XVIII. Summary of Articles Analysed, under the Sale of Food and Drugs Act, during the year ended 31st December, 1907. Article. Number Analysed. Number Adulterated Milk 346 17 Butter 72 2 Condensed Milk 5 0 Separated Milk 3 0 Skimmed Condensed Milk 1 0 Cheese 3 0 Flour 2 0 Vinegar 3 0 Corned Beef 3 0 Salmon Steak 1 0 Mustard 2 0 Pepper 2 0 Total 443 19 TABLE XVniA. Proceedings under the Food and Drugs Act for the Year 1907. No. Article. Nature of Adulteration. Name and Address of Vendor. Result of Proceedings. 1 Milk 6 % fat abracted James H. Harrington, 187, Powis Street Fine £1 and 12/6 costs 2 Milk 5 % added water Charles Ridewood, 116, High Street, Eltham Fine £4 and 12/6 costs 3 Milk 13 % fat abstracted F. J. Flood and A. B. Flood, 31, Beresford Street Fine £1 10s. and 12/6 costs 4 Butter Foreign fat XV. G. Mills, 101, Maxey Road Fine £10 and 23/- costs 5 Milk 15 % added water Thos. Lambeth, East Wickham Farm Fine £15 and 23/- costs 6 Milk 20 % fat abstracted W. F. Corp, 2, Wellington Street Fine £30 and 23/- costs 7 Milk 10 % fat abstracted Margaret Kimber, 3, Ropeyard Rails Fine £1 and 12/6 costs 8 ' Milk 6 % added water Sarah Crouch, 31, Riverdale Road Fine £3 and 12/6 costs 9 Milk 1 % added water and 5 % fat abstracted Thos. G. Dolphin, 89, Maxey Road Fine £1 and 12/6 costs 139 TABLE XVIIIa.— continued. No. Article. Nature of Adulteration. Name and Address of Vendor. Result of Proceedings. 10 Milk- 6 fat abstracted J. A. Finnimore, 83, Park Road Fine £10 and 23/- costs 11 Milk 6 % added water James Hoar, 67, Reidhaven Road Fine £3 and 12/6 costs 12 Milk 7 % fat abstracted H. A. Holland, 74, Little Heath £2 2/- costs 13 Milk 15.2 % added water A. Handsley, 2, Stannary Street, Kennington Green, S.E. 12/6 costs 14 Milk 9.3 % fat abstracted F. G. Cock, 13, Raglan Road Fine £2 and 2/- costs 15 Milk 7.7 % added water S. Harrison, 52, Beresford Street Pine £3 and 23/- costs 16 Milk 6.4 % added water R. A. Pearce, 175, Plumstead Common Road Warranty proved 17 Milk 11.1 % added water A. Groves, 40, Orchard Road, Plumstead Fine £2 and 23/- costs 18 Milk 4.3 % added water W. F. Corp, 3, Wellington Street Case dismissed 19 Milk 5.1 % added water Harry Willis, 2, Ritter Stret Warranty proved—Case dismissed 140 141 TABLE XIX. Food seized or surrendered by Owners as unfit for consumption. Articles. Quantity. Date. Remarks. Reason. Ox Liver *16 lbs. 2nd Jan. Surrendered Distoma Frozen Rabbits. 1 case 9th „ „ Unsound Ox Liver * 30th „ „ Distoma Carcase of Pork 55 lbs. 11th Feb. „ Fever and Nephritis Sheep's Pluck . * 13th „ „ Echinococcus Ox Liver * 13th „ „ Distoma * 27th „ „ „ ,, * 6th Mar. „ Abscesses Carcase of Pork 77 lbs. 8th „ „ Tuberculosis Herrings 2 cases . (3 cwt.) 12th „ „ Unsound Ox Liver * 13th „ „ Abscesses Sheep's Omentum * 13th „ „ Cystic Forequarter of Pork 15th „ „ Tuberculosis Ox Liver * 20th „ „ Distoma Forequarter of Pork 391 lbs. 22nd „ „ Tuberculosis ,, 40 lbs. 22nd ,, „ Norwegian Herrings 1 box 27th „ „ Unsound Sheep's Omentum * 10th Apl. „ Cystic Ox Liver * 10th „ „ Distoma Pig's Head 9' lbs. 12th „ „ Tuberculosis Haddocks 55 stone . 25th „ „ Unsound Pig's Head 5 lbs. 26th „ „ Tuberculosis Pig's Head 5; lbs. 4 th May „ Sheep's Liver . * 8th „ „ Echinococcus Two Omentum . * 15th ,, „ Cystic Sheep's Liver . * 22nd „ „ Echinococcus Oranges 12 cases. 24th „ „ Unsound Ox Liver * 29th „ „ Distoma ,, * 5th June „ „ ,, * 12th „ „ „ ,, * 19th „ „ „ Sheep's Liver * 19th „ „ Echinococcus 142 TABLE XIX—continued. Food seized or surrendered by Owners as unfit for consumption. Articles. Quantity. Date. Remarks. Reason. Sheep's Liver * 20th June Surrendered Echinococcus Sheep's Omentum * 10th July ,, Cystic Sheep's Liver & Omentum * 31st „ ,, cus Sheep's Liver & Lungs * 7th Aug. ,, ,, Lobsters 17 15th „ ,, Unsound Pig's Kidneys 10 lbs. 9th Sept. ,, ,, Rabbits 2 ewts. 9th ,, Sheep's Liver & Omentum * 11th „ ,, cus Haddocks Trunk 25th ,, Unsound Herrings Barrel 3rd Oct. ,, ,, Sheep's Omentum * 9th „ ,, Cvstic Ox Liver * 9th „ ,, Distoma and Abscesses Sheep's Liver * 16th „ ,, Echinococcus Ox Liver * 16th „ ,, Abscesses Rabbits 3 cases 21st ,, ,, Unsound Sheep's Liver *2 cases 22nd „ ,, Echinococcus Cods & Haddocks 3 trunks 23rd „ ,, Unsound Herrings 1 barrel 7th Nov. ,, ,, Kippers 33 8th „ Seized ,, ,, 1 box & 12 odd ones 8th „ Surrendered ,, Box of Soles 20th „ ,, ,, Walnuts 2 bags 26th „ ,, ,, Gninness's Stout 3 butts 29th „ ,, Sunk in river, under water for one tide, discove red in different partsof river Ox Liver * 18th Dec. ,, Distoma Sheep's Liver * 20th „ ,, Echinoeoceus Pork and four Geese 3 cwts. 2 qr. 17 lbs. 30 th „ ,, Unsound Kippers 1 box 31st „ ,, ,, Those marked * were found in a slaughter-house. 143 TABLE XX. List of Level Bakehouses. Name. Address. Mrs.8. Fuller 48, Princes Road, Plumstead Chadwell Bros. 60, Plumstead Common Road C. Pullen 105 do Werner 126. High Street, Plumstead J. E. Porter 1, Riverdale Road do F. Bolimer 307, High Street do A. E. Paine 14, Gunning Street do A. Jewiss 68, Glyndon Road do Dalton 102, Ann Street do C. Letch ford 109, Plumstead Road do J.Clark 152 do do W.C.Hill 82, Bannockburn Road, Plumstead R. Farnely 2, Stratton Tcrrace, Bostall Lane, Plumstead W. Jefferv 123, Burrage Road, Plumstead P. H. Mack 111, High Street, Woolwich A. Bradsliaw 3, Green's End do F. W. Jackson 184, Elizabeth Street, North Woolwich C.Haas 122, Albert Road do H. Myers 33, Samuel Street, Woolwich Mrs. Dennis 90, Brookhill Road do E. Ewell 36, Chapel Street do A. Adams 10, Kingsman Street do C. H. Wyatt 94, High Street, Eltham H. Westbrook 114 do do F. Cook 142 do do C. Warboys 5, The Parade, New Eltham F. A. Finch 13 do do E. Hobbs 6, Well Hall Parade, Eltham R. Moakes 53, Cordite Street, Plumstead J. H. Cocks 53, Lakedale Road do G. H. Porter 29, Charles Street, Woolwich 144 TABLE XXA. List of Certified Underground Bakehouses-. Name Address S. Betchley 33, Eglinton Road, Plumstead Merritt & Co. 30, Herbert Road, do. H. Gilder 14, Westdale Road, do. H. Percival 223, High Street, do. J. Werner 1, Park Road, do. S. Collin 58, Pattison Road, do. F. Cox 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. E. Sims 24, St. James's 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. W. C. Clothier 51, Albion Road, do. Simmons 23, George Street, do. Mrs. Kessler 21, Albion Road, do. A. Hills 32, Church Street, do. Mrs. Attenborough 60, Sand Street, do. E. Tucker 81 & 82, Brookhill Road, do. 145 TABLE XXb. List of Factory Bakehouses. Name. Address. J. Fletcher 57, Barrage Road, Plumstead J. Fletcher 92, Plumstead Road, Plumstead T. Newman 94, Wellington Street, Woolwich Royal Arsenal Co-operative Society 127 to 153, Powis Street, Woolwich J. Alderton 16, Swingate Lane, Plumstead G. Mackintosh Warwick Terrace, Plumstead Common J.Werner 1, Park Road, Plumstead A. Chapman 2, High Street, Plumstead 146 TABLE XXI. List of Slaughterhouses. No. Name of Owner. Situation. 1 Eliza Biggs 168, High Street, Eltham 2 Joseph John Leech 78, Frederick Place, Plumstead 3 Henry Reed & Gains William Funnell 25, Parry Place, Plumstead 4 Bo. 6, High Street, Plumstead 5 Hedley Vicars 41, Church Street, Woolwich (5 Walter Monk 14, Church Street, Woolwich 7 Frederick Bucknell Love Lane (near Wellington Street); Woolwich 8 James & George Mitchell 25, Hare Street, Woolwich 9 Hedley Vicars 30, Hare Street, Woolwich 10 Henry Keed & Gains William Funnell 38, Plumstead Common Road, Plumstead 11 Henry Fretter 33, Herbert Road, Plumstead 147 TABLE XXII. List of Cowhouses. No. Name and Address of Owner. Situation. 1 John Marshall Miller Keightley House Farm, Southwood Road, Eltham 2 Richard and James Higgs Coldharbour Farm, Chisleliurst 3 John and Alfred Low, Avery Hill Farm, Eltham Park Farm, Eltham 4 W. F. Corp Lyme Farm, Eltham 0 Charles Umfreville Fisher and William F. Fisher, Crescent Farm, Sidcup Belmont Park Farm, Eltham 6 John Grace Pippinghall Farm, Eltham 7 William Hide wood Chapel Farm, Eltham 8 George Keen Clay Farm, Now Eltham 9 Maurice Bayley Middle Park Farm, Eltham 10 Harry Furber Victoria Road Farm, Southend, Eltham 11 William Ivillick 52, St. James's Place, Plumstead 12 W. F. Corp, Lyme Farm, Eltham 13, Princes Road, Plumstead 13 Hen ry Woolsey 50, Francis Street, Plumstead 14 William Ridewood, Chapel Farm, Eltham 3, Ripon Road. Plumstead 15 F. G. Cock 13, Raglan Road, Plumstead 16 Charles George Lambeth, Frank Seymour Lambeth, 1 Frederick Lambeth, and 1 George Pannell Lambeth J 1, Griffin Road, Plumstead 17 John Charles Terrington, 16, Pellipar Road Rear of 14, 15 and 10, Pellipar Road, Woolwich 148 TABLE XXIII. List of Milk Sellers. No. Name. Address. 1 Perrett, H. N. 2, The Parade, New Eltham 2 James, J. R. W. 26, Parry Place 3 Webb, P. V/. 58, Brewery Road 4 Balster, H. 97, Plumstead Common Road 5 Carr, E 46, Kingsman Street 6 Finnimore, J. A. 83, Park Road 7 Palmer, M. A. 127, Plumstead Road 8 Day, W. 147, Plumstead Road 9 Digby, W. J. 82, Plumstead Road 10 Squirrell,J. 57, Church Street 11 Jeal,W.H. 139, Plumstead Road 12 Handsley, A. 68 J, Bloomlield Road 13 Cock, G. 13, Raglan Road 14 Espline, G. 48, High Street, Woolwich 15 Royal Arsenal Co-op. Society Lakedale Road 16 Do. 15, Brewery Road 17 Do. 143, Powis Street 18 Do. Herbert Road 19 Do. 147 & 151, Powis Street 20 Fletcher, J. 92, Plumstead Road 21 Brooks, H. 2, Richmond Place 22 Dalton & Son 13, Eton Road 23 Smith, Harriet 30, High Street, Eltham 24 Miller, W.J. Southwood Road, Eltham 25 Woolsey, H. 50, Francis Street 26 Howe, J. R. 82, High Street, Eltham 27 ltussell, Nellie 96, Macoma Road 28 Pearce, R, A. Lydwin Dairy, The Slade 29 Hawkins. Ellen M 2, St. Nicholas Road 30 Furber, Harry Southend, Eltham 31 Large, Daniel J. 6, Herbert Road 32 Hiscock, C. T. & E. 14, Blenheim Terrace 33 Dalton, R. G. 55, Eglinton Road 34 Buckley, Mary 28, Conway Road 35 Jones, C. A. 14, Bostall Hill 36 Vaughan, J. C. 36, Armstrong Street 37 Green, R. 13, Saunders Road 38 Butter & Sons 49, Woolwich Common 39 Do. 10, Jackson Street 149 TABLE XXIII .— continued. No. Name. Address. 40 Reed, Ruth C. 120a, Plumstead Road 41 McGee, J. M. 42, Mulgrave Place 42 Ward, Samuel 1, Nightingale Yale 43 Mack, P. H. 111, High Street, Woolwich 44 Webb, Younger 10, Beresford Square 45 Morgan, E. 17, Lakedale Road 46 Dennis, Ellen 90, Brookhill Road 47 Prowett, J. 25, Plum Lane 48 Nicholls, D. 25a, Garland Street 49 Newman, P. 1, Orchard Terrace,Timbercroft Road 50 Bayley, M. Middle Park Farm, Eltham 51 Bassett, Thomas 61, Bannockburn Road 52 Yelland, W. 2, Westdale Road 53 Godden, A. A. 229, High Street, Plumstead 54 Palmer, D. 46, Church Street 55 Wilton, M. M. 77, Powis Street 56 Corp, W. F. Lyme Farm, Eltham 57 Do. 3, Wellington Street 58 Pearce, R. A. 175, Plumstead Common Road 59 Christmas, Hannah 18, Well Hall Parade, Eltham 60 Dodson, W. 138, Plumstead Common Road 61 Dowsett, J. 105, Crescent Road 62 Wyatt, J. 141, Albert Road 63 Nelson, J. 9, Parson's Hill 64 Dolphin, T. G. 89, Maxey Road 65 Rumsey, E. 186, Powis Street 66 Tyler, C. W. 142, High Street, Woolwich 67 Ludlow, E. D. 2a, Brewery Road 68 Woolsey, W. 118, Swingate Lane 69 Harrington, H. 187, Powis Street 70 Wilde, Ernest 13, New Road 71 Jenkins, J. 28, High Street. Woolwich 72 Clements, E. J. 2, Cross Street 73 Bohmer, H. 307, High Street, Plumstead 74 Green, H. G. 17, Kashgar Road 75 Couzens, Jesse 10, Chapel Street 76 Oliver, Clara 101, Sand Street 77 Bollen, W. 1, Warwick Terrace 78 Stevens, F. 100, Roydene Road 79 Ridewood, W. 116, High Street, Eltham 80 Rose, J. 64, Hargor Road I 150 TABLE XXIII .—continued. No. Name. Address. 81 Corp, W. P. 90a, High Street, Eltham 82 Do. 13, Princes Road 83 Hawkes, G. 143, Kingsman Street 84 Parsons, W. 29, Wilmount Street 85 Trodd, W. J. 113a, High Street, Woolwich 86 Green, S. O. 6, Samuel Street 87 Stevens, H. 27, Church Street 88 Nelson, W. J. 9, Parson's Hill 89 Hassan, Fred 182, Elizabeth Street 90 Hobbs, E.J. 6, The Parade, Well Hall 91 Howard, Esther 80, Benares Road 92 Moss, A. J. 13, Hinstock Road 93 Needham, Elizabeth 94, H igh Street, Woolwich 94 Webb, P. W & Co. 16, Lakedale Road 95 Pinch, G. A. 13, The Parade, New Eltham 96 Young, Lily 11, Armstrong Street 97 Davis, D. H. 170, Albert Road 98 Willis, H. 2, Ritter Street 99 West, W. H. J. Rear of 49, Lakedale Road 100 Phipps, H. 15a, Sand Street 101 Reynolds 24b & 26b, Glyndon Road " Hammerwood," Shooters Hill 102 Hutchings, T. H. 103 Smith, Elizabeth 12, The Broadway, Eltham 104 Bennett, Rose 22, Glyndon Road 105 Weston, Elizabeth 83, Station Road, Plumstead 106 Boasden, Lucy 1, Walmer Road 107 Williams, Ellen 12, Thomas Street 108 Reynolds, C. W. 10, Basildon Terrace 109 Edwards, J. C. 16, Albion Road no Holdway, J. A. 12, Bostall Hill 111 Griffith, Elizabeth 153, High Street, Plumstead 112 Boyce, G. 127, Burrage Grove 113 Bartrum, Abner 167, Kingsman Street 114 Briggs, A. C. 6, Bloomfield Road 115 Groves, Mrs. 40, Orchard Road 116 Holmes, Blanche 107, Pattison Road 117 Jones, David 65, Maxey Road 118 Wainwright, W. T 60, Henry Street 119 Harley, J. 30 High Street, Plumstead 120 Mackintosh, G. H 16, Warwick Terrace 121 Daveney, T. 24, Maxey Road 122 Jaques, Herbert 56, Anglesea Road 151 TABLE XXIII .—continued. No. Name. Address. 123 Killick, C. W. 52, St. James Place 124 Jones, Mary 35, High Street, Woolwich 125 Stitson, A. G. 2, Brewery Road 126 Callaghan, J. A. 89, Brookhill Road 127 Baddy, T.J. 107, Pattison Road 128 Hawkins, Emily 77, Powis Street 129 Campion, H. E. 105, Pattison Road 130 Brinkworth, W. J. 41, Lakedale Road 131 Parker, J. Fountain Stores, The Slade 132 Lamb, Annie 29, Admaston Road 133 Norton, Emma 28, Conway Road 134 Henderson, G. S. Wellington Cottage, Anglesea Road 135 Townsend, J. 21, Wilmount Street 136 .Tones, E. C. 6, Samuel Street 137 Fox, W 228, High Street, Plumstead 138 Ellicott, Annie M 52, Raglan Road 139 Harrington, James 26, Prospect Row 140 Hadlow, G. 187, Powis Street 141 Clark,H. "Ashurst," Shrewsbury Lane 142 Greatrex, F. Lydwin Cottage, Plumstead Common 143 Oakham, J. J. 3, Brentwood Cottages, Pope Street, New Eltham I 2 152 TABLE XXIV. Applicants Registered as Purveyors of Milk during 1007. Date. Applicant's Name. Address of Applicant. 1907. Mar. 15 James Harrington 26, Prospect Row Mar. 15 John George Hadlow 187, Powis Street May 3 Annie Maria Ellicott 52, Raglan Road May 31 George Selkirk Henderson Wellington Cottage, Anglesea Road May 31 John Townsend 21, Wilmount Street May 31 Edwin Charles Jones 6, Samuel Street May 31 William Cox 228, High Street, Plumstead June 21 Annie Lamb 20. Admaston Road June 21 Emma Norton 28, Conway Road July 12 Thomas J. Eaddy 107, Pattison Road July 12 Emily Hawkins 77, Powis Street July 12 Henry E. Campion 105, Pattison Road J uly 12 William J. Brinkworth 41, Lakedale Road July 12 J.Parker „ Fountain Stores,„ The Slade Sept. 20 Ada G. Stitson 2, Brewery Road Sept. 20 John A. Callaghan 89, Brookhill Road Oct. 11 Charles William Killick 52, St. James's Place Oct. 11 Mary Jones 35, High Street, Woolwich Nov. 1 Harry Clark „ Ashurst, "Shrewsbury Lane Nov. 1 Frances Greatrex Lydwin Cottage," Plumstead Common Nov. 22 Joseph John Oakham . 3, Brentwood Cottages, Pope Street, New Eltham 153 Appendix I. INFANTS' .MILK DEPOT. The Infants' Milk Depot was opened on November 5th, 1906, at the old Plumstead Vestry Office in .Maxey Road. The object of the Depot is to provide- the best substitute for mother's milk to those children whose mothers are unable to nourish them at the breast. The Depot is not a milk-shop where anyone can buy milk ; it does not sell milk to anyone as such ; what it does is to undertake to provide, under medical supervision, the best substitute for mother's milk to infants requiring it, at a fixed charge per week. The milk is not sold by the pint; but payment is made according to the age of the infants, viz., Is. 6d. per week to -children under six months old ; 2s. to those from six months to twelve months ; and 2s. 6d. to those over twelve months. The Milk Depot aims at reducing the excessive infant mortality which has been found to be due to hand-feeding, especially to feeding infants on condensed milk. It may be said at once that the Depot has been an unqualified success, the numbers taking the milk having increased beyond expectations. Excellent milk has been obtained within the Borough. The planning of the rooms and the apparatus installed have worked most satisfactorily, and great credit is due to Miss Petty and Miss -Bagsliaw and staff of the Depot for the way in which the work has been carried out. Admission to the Depot. When anyone applies for an infant to be fed from the Depot, if a doctor's certificate is receved, the milk is supplied at once. But otherwise, Miss FitzGerald, Woman Inspector, visits the house and enquires into the circumstances. If the child is still being fed from the breast the mother is encouraged to continue this and advised as to her own diet. Sometimes she is asked to come to the Depot with the baby and the latter is weighed before and after 154 a test feed. This indicates whether the breast is yielding sufficient milk. If the breast is found to be insufficient it is supplemented, and if weaning has already taken place, Miss FitzGerald advises the Manageress of the Milk Depot what "modification" of milk the child requires. There are three different modifications of quality and seven of quantity for children of different ages. Any doubtful cases are referred to the Medical Officer of Health, and for children who cannot take the ordinary modification special adaptations of the milk have to be prepared. The Depot and apparatus were fully described in a previous report. The Process of Modification. The quantities of milk, cream, and sugar for each modification have to be daily calculated for so many infants from given formulse. These calculations are made at the close of the day's work when the number requiring milk next day is known. The quantity of fresh milk required is then estimated and the order for milk telephoned to the farm. The milk is received at 7 in the morning and strained through a Ulax filter. A certain part is taken and separated in order to supply the additional cream. Each of the three modifications is then separately prepared by measuring, weighing, and mixing so much milk, cream, sugar and water. The mixture must then be passed into an automatic bottle-filling apparatus, by means of which four bottles can be filled at once. When the bottles have been stoppered, they are placed in a cradle, transferred to a trolley, and wheeled into the sterilizer. The door of this is shut, steam turned on, and the temperature raised to 170 degrees. The temperature is maintained for 15 minutes. In hot weather the temperature is raised to 212 degrees for 20 minutes. On taking the bottles out they are put into a tank filled with hot water which is gradually cooled to about 53 degrees by running in cold water. The bottles are then ready for delivery. The Milk and the Farm. For modified milk to be satisfactory, it is necessary that it be produced from healthy cows who are kept under good sanitary conditions. A farm was found within the Borough which complied satisfactorily with these requirements It is situated on high ground, has been recently re-drained, the cows go daily to the fields, the sheds are large and well lit and ventilated, the cows are kept clean, and the milkers wash their hands 155 before milking. The milk is frequently examined, and always found to be of good quality. It usually gives about 4 per cent. of fat After cooling it is delivered at the Depot by cart every morning within an hour of milking. The cows are frequently inspected by the London County Council veterinary inspectors and have been each time pronounced healthy. Home Visiting. The homes of infants are always visited by Miss FitzGerald after the child commences the milk and the visits are repeated at intervals according to the needs of each case, and when Miss FitzGerald can spare time from her other work. The printed instructions are explained and the importance of strictly complying with them enforced. Sometimes it is found that the milk is poured from the bottle, in which it is sent, into a feedingbottle with a long tube. This undoes much of the good of Depotfeeding, giving opportunity for home contamination of the milk. Some mothers need to be continually warned against giving other food besides the milk. Miss FitzGerald also notes whether the food is agreeing with the child and reports if a different modification seems to be required. The food cannot be regulated purely by the age of the child ; some want more and some want less than the average. Numbers Fed. The Depot has not been publicly advertised, and indeed, the object has been to make it known only to medical practitioners and others likely to meet with children who could not be satisfactorily fed at the breast. Many mothers who applied for the milk while they were still able to suckle their infants have been refused. Notwithstanding, the numbers very steadily mounted up from 49 on January 1st, 1907, till in the middle of the year they reached 128 infants supplied daily. After that there was a slight decline, and on December 31st 117 were having the milk. When the Depot was first proposed I estimated 120 as the maximum number likely to make use of it, and certainly did not expect this figure to be reached so quickly. 264 new infants were taken on in the year and 196 discontinued. Altogether, 313 children were fed during the year. Duration of Feeding. Of 196 who discontinued taking the milk in 1907, 18 gave it up within one week, and 38 more before the 156 pletion of a month, leaving 145, or three-fourths, who persevered with the milk for more than one month ; of these 90 continued for over three months, and 52 over six months. The average duration of feeding was three months. Reasons i-oit Discontinuing. Satisfactory reasons for discontinuing such as age of child, moving out of the Borough, etc., were given in 100 cases ; unsatisfactory reasons, such as inability to meet the expense, dissatisfaction of mother, etc., in 89 cases. Of these, 2 were refused the milk because the mothers persistently neglected to keep the rules. It is satisfactory to note that in 6 cases the Depot-milk was given up because the mother was able to resume suckling her child. There is always a readiness with certain persons to try a new thing and to discard it again without a fair trial; this quality of the mind no doubt accounts for a large proportion of those who discontinued within a month—" mother dissatisfied." Of genuine complaints against the milk the number has been exceedingly small. Delicate and diseased children of course are frequently unable to digest any form of milk, and though perseverance with the Depot milk would probably be the best course in most cases, it is not to be wondered at that the mother is anxious to try any new food recommended. The expense was given as the reason for discontinuing in 21 cases, but no doubt it was the chief or secondary reason why several other mothers gave up Depot-milk. The charge made for the milk is on the whole about the same as would have to be paid for unmodified cow's milk, if given in sufficient quantity, so that it may be concluded that children who are denied Depot-milk on account of the cost either get an insufficient supply of cordinary milk or else some form of condensed milk. In either case they will be insufficiently nourished and their health will necessarily suffer. Many children have been paid for by a few charitable persons or societies, but there is great need for more help of this kind. Reasons for coming ox Depot. Any artifical feeding being only a regrettable alternative to breast-feeding it is necessary to give a reason for 204 children admitted to the Depot in 1907 not being able to have their own natural food. The table below gives full particulars. It is to be noted that 153 mothers were unable to suckle on account of illness or entire loss of milk from other causes, and with 62 the 157 mother's milk was so poor that the child was wasting and its food had to be supplemented ; 7 were twin children. In only three cases of married women did the mother's occupation prevent her suckling, but 6 children were illegitimate and no doubt in most of these the mother was obliged to go to work to support herself. It must be remembered that the milk was never supplied to a child not already weaned without a doctor's certificate so there was no encouragement given to discontinue breast-feeding. Social Condition of Parents. The social condition of the parents who came to the Depot for milk is best indicated by the number of rooms occupied by each family. Out of "295 cases in which information was obtained, 14 families occupied one room only per family, 75 occupied two rooms, 79 three rooms, and the remaining 127 four or more rooms. Thus considerably more than half the families were living in tenements of one, two, or three rooms. The largest number of families proportionately to population lived in St. George's and Glyndon Wards. Both these facts shew conclusively that the Depot is being used by the class who most need it, when they can afford to pay for it. Age of Infants taking Depot Milk. This is an important matter as affecting the death-rate of the children fed, for the infantile death-rate rapidly diminishes with the age of the child. Twice as many children die in the first three months as in the second three, and twice as many in the first six months as in the second six. The average age when commencing was 2'9 or a little under three months. We have seen that the average duration of taking the milk was three months ; it follows then that the average age of infants taking the milk was 4½ months. In Finsbury the average age on admission was 3½ months, in Battersea 4 months, and in Liverpool 4½- months. Health of Infants commencing the Milk. Of 313 children who had Depot-milk in 1907,170, considerably more than half, were ill or in delicate health at the time of admission; 5 were tuberculous, 9 had whooping-cough or measles, 14 diarrhoea ; 16 were wasting ; 42 had indigestion (indicated by vomiting, colic, &c.); 11 were prematurely born, and 58 were delicate or not thriving. Such children could not, of course, be expected to thrive like average babies, and would, under ordinary circumstances, have a very high death-rate. 158 The large proportion of delicate children is also indicated by the fact that 125 infants were recommended by medical practitioners who are seldom consulted as to feeding a baby so long as he keeps well. 45 were sent from lying-in hospitals, and 20 by the Woman Inspector. Weighing of Infants, The weight is by no means theoretically the best way of judging of the health of a baby. Activity, liveliness, contentment, colour of skin, are together a better test of health at any one time, but there is no scale by which these can be measured. By general consent, a weekly or fortnightly weighing has been adopted as the best practicable means of judging of the progress of an infant. Statistics as to the average weight of infants under one year have been obtained by various persons. Dufour's standard and weight chart have been adopted for the Woolwich Depot. The bringing of children to be weighed every fortnight is a condition of having the Depot-milk, but inasmuch as most of the families supplied live a considerable distance from the Depot, and that mothers are often prevented by illness, weather, and family circumstances, from leaving home, it is not possible to absolutely insist on the infants being brought. In all, 171 Depot-fed children were weighed at least twice, and of these 75 gained more than the average weight (several very much more), 19 gained just the average, and 77 gained less than the average. Of the latter, in most eases the gain was very little less than the average, and may be considered as showing very satisfactory progress of the child; but 39 of these children were weighed only twice and their progress was not therefore fairly tested. 69 children were weighed five and more times at fortnightly intervals, and their progress was thus a much better test of the value of Depot milk. Of these 39 gained more than the average, 2 gained just the average weight, and 28 less than the average. On the whole then, judging by the weight gained by infants who had the milk long enough to give it a fair trial, we may conclude that while taking Depot milk more than the average weight is gained. As the average is mainly compiled from healthy breastfed children this is a very satisfactory result. Mothers feeding their infants on the breast were encouraged to bring them to be weighed; altogether 17 breast-fed infants were 150 weighed, but only 7 came two or more times. Of these, 3 gained more than the average, 2 gained the average weight, and 2 less than the average. Three children found to be losing, or not gaining average weight on the breast, were put on Depot milk and while taking it gained at least the average. B.S. was twice put on Depot milk and twice taken off and fed on milk and barley water, as generally directed for hand-fed children. She was brought regularly to be weighed all through and while taking Depot milk she gained more than the average, but while taking the ordinary milk and barley water she gained less than the average. A.B. was found to be gaining very little weight on the breast— much below the average ; he was given a half supply of Depot milk and then gained more than the average weight. 143 of the total cases fed were not brought to be weighed at all or not more than once. These were all visited by Miss FitzGerald and in most cases found to be progressing satisfactorily. It may be safely concluded that those who persisted with Depot milk but did not come to be weighed, progressed at least as satisfactorily as those who were brought to the Depot. Diarrhcea in Depot-Fed Infants. Although Depot-fed infants are much less liable to diarrhcea than other hand-fed children, they are like breast-fed babies, not entirely exempt from attack by this disease. Only four eases of diarrhcea among these children were notified, of which two died. In two of these cases, including one that died, the regulations were not carried out. The following are the full particulars obtained by Miss FitzGerald:— S.M., born November 4th, 1906 ; started Depot milk November 5tli, 1906 ; was a healthy child and did extremely well on the milk. Notilied as suffering from zymotic enteritis on July 24th, 1907 ; house very clean and sanitary condition satisfactory ; mother very careful and intelligent; she stated that the baby had an occasional crust in addition to Depot milk. Child recovered and soon regained its normal state of health. On 160 November 7th 1907, when a year old, weighed 22 lbs 15 ozs., which is much over the average. W.S., born February 4th, 1907 ; started Depot milk April 16th, 1907 ; weaned by doctor's orders, on account of the mother's health. Baby was wasting and suffering from indigestion at the time of starting Depot milk. Notified as suffering from zymotic enteritis on July 28tli ; mother ignorant and neglectful ; cleanliness of the premises and of the child not satisfactory. The mother asserted that she did not give the child any other food besides Depot milk, but her statements are not reliable. L.B., born February 28th, 1907 ; started Depot milk June 13th, 1907 ; was not in good health at the time ; had recently suffered from an attack of diarrhoea and vomiting. Notified as suffering from zymotic enteritis on September 5th. Premises clean but the mother admitted that she put the Depot milk into a long-tube bottle; Baby ceased having Depot milk September 6th ; died October 2nd of zymotic enteritis 11. T., born April 11th, 1907, started Depot-milk 18th May. Child did very well on the milk, doubling its weight in four months. Mother very careful and premises very clean. Died 24th October, 1907, of epidemic enteritis. Deaths of Infants havin'o Depot Mii.k. We have seen that although Depot-fed infants are to the extent of more than one-half ill or delicate when commencing Depot-milk, those who gave the milk a fair trial gained in weight more than average children mostly breast-fed. As regards death-rate, infants who are not breast-fed have a very high infant mortality, which in Derby was found to be three times that of breast-fed children. There are no statistics at present available for Woolwich, but it is probable that the death-rate of hand-fed children in the Borough is twice as great as the general infant death-rate (including both breast and hand-fed infants). It is therefore very satisfactory to find the small number of deaths of children fed on Depot-milk. Other milk-depots have given a death-rate for the children fed, but,proper allowance does not appear to have been made always for deaths of children who have left the Depot. A large number of these 161 arc found in Woolwich to have removed and many to have left the Borough; it is consequently impossible to find out how many have died. 18 deaths in all occurred, among the 313 children fed last year, while on the Depôt, and 4 deaths occurred within a month of leaving the Depôt. A full list of these is appended. It will bo seen that 6 died within a week of coming on the Depôt, indicating that they did not have the milk long enough to be of any value. An effort was made to follow up 70 children who had been on the Depôt for at least one month and had left. 43 were found to be living and 3 dead, the remainder having removed and left no address. Careful study of the question, and of the reports of other milkdepôts, convinces me that no death-rate can be given for a milkdepôt which is in any way comparable with the general infantile death-rate. Even if all the children could be followed up to the end of the first year—which is impossible in Woolwich—the fact would remain that the Depôt children are a specially selected class of mostly delicate children, at a particular age, and that they do not usually remain on the Depôt long enough to enable the effects of Depôt-feeding to be compared with those of ordinary feeding. Dr. McCleary, who inaugurated the first London Depôt, came to the same conclusion. It would be, therefore, misleading to attempt to give a death-rate. Before any comparison can be made between Depôt children and other hand-fed children it will be necessary to know the death-rate of hand-fed children in each month of the first year, and at present there are no such statistics available. Meanwhile, I can only express my own strong opinion, based on personal observation, that the chances of life of hand-fed children are very greatly increased by being taken on the Depôt, and that many lives were saved last year through this means. The following are some of the cases on which this opinion is based :— 259. C.A.L. (male), born August 15th, 1907; child of a domestic servant; had been much neglected before its present fostermother took charge of it on 15th September, 1907. She at once put it on Depôt-milk; it was then in an emaciated condition 162 and suffering from indigestion. It improved rapidly; gained 10 oz. in the first week, and was in good general heath, and over average weight at age of 5 months. 224. G.C. (female), born June 6th, 1907; began Depôt-milk to supplement breast-milk, which was scanty, 30th July, 1907. was born prematurely, and was not thriving when first put on Depôt-milk. Mother delicate and nervous; father a labourer; family occupying two rooms; home conditions satisfactory. Child at 2 months weighed only 5 lbs. 13 ozs., which is below the average weight at birth, and began to gain weight rapidly after starting Depôt-milk; on January 30th, 1908, at age of 7½ months, was very strong and healthy, and weighed 14 lbs. 10 ozs.; is still partially breast-fed. 274. F. B. (male), born 24th July, 1907, began Depôt-milk on 9th October, 1907, was then wasting and suffering from indigestion, the mother's milk had failed at the end of 10 days, and the child had been fed on Nestlé's milk. Mother's health not very good; father a labourer; home conditions fairly clean but poor, and the child was insufficiently clothed. This child was too delicate to take the ordinary modification, and special, milk had to be prepared for it until November 21st, when it was able to take the strength and quantity proper to its age Prom that time it began to do well, and the mother having been persuaded to give it warmer clothing it has done well ever since. At 3 months old, weighed only 6 lbs. 13 oz., about the weight of a new-born baby. In two months it reached 10 lhs. 3 oz. 42. E.T. (female), born August 26th, 1906, mother died 8 days later, puerperal fever. Child started Depôt milk 27th November, 1906 ; made very good progress and weighed 24 lbs. 3 oz. at 1 year old. 5 lbs. over the average. 231. T.B. (son of a domestic servant), born March 15th, 1907. Brought to Depôt August 19th, in an emaciated condition; had been semi-starved on separated condensed milk. Took Depôt milk well and began to put on flesh at once. At 10 months old weighed 19½ lbs. This child's life was certainly saved by the Milk Depôt. 163 013. L.C. (male), born September 23rd, 1907; father a soldier; began Depot-milk on November 29th, 1907; was then suffering from gastro-enteritis and recommended to Depot by doctor. Did very well on the milk until February 8th when parents removed from Woolwich. 283. C.E.C. (male), born October 2nd, 1907 ; premature ; very small and feeble; doctor did not expect it to live; started Depôtmilk when 14 days old; the mother's milk disappeared through shock. The child took the milk very well and thrived upon it; went to South Africa at end of January, 1908. 314. C.M. (male), born 25th December, 1900; started Depôt-milk November, 30th 1907, when 11 months old. Milk supplied by Guardians' order. Child suffering from diarrhoea and sickness and was poorly developed when commencing the milk. Home conditions unsatisfactory, and child's clothing insufficient and dirty. After having Depôt-milk for 2½ months the child's health greatly improved ; it has also been possible to improve the state of its surroundings by repeated visiting. 266. F.J.B. (female), born May 20th, 1907; was healthy at birth; fed on Ridge's Food and Nestle's Milk; feeding bottles (long tube) were frequently found dirty on visiting; house dirty; child had zymotic enteritis in September, 1907; on recovering the doctor recommended Depôt milk which was started on September 28th. Was on Depôt milk three months and improved greatly. 265. J. L. (female), born August 23rd, 1907 (mother in advanced stage of phthisis) never suckled ; started Depôt-milk when 11 days old, is now a healthy child doing well on the milk. Mother died in February. 210. P. W. (female) born March 15th, 1907; very small and delicate, weighed 5 lbs. 5 oz., came on Depôt June 29th when 3 months old, feeble and wasting, mother's milk was failing. Child improved markedly after starting Depôt-milk, and though still needing medical advice for chest ailments took milk well and gained weight steadily. These cases well illustrate the useful work the Depôt is doing They indicate that the Depôt is not so much a milk shop as a 164 Dispensary for the scientific feeding of infants, especially delicate infants. Cost of the Depôt. It was always recognised that the MilkDepôt could not be entirely self supporting, and that part of the cost would have to come on the rates. The commercial price of modified milk has always exceeded that of unmodified milk, by from one hundred to five hundred per cent. All existing milk Depôts involve considerable financial loss, and none, except Woolwich, have undertaken delivery of the milk at customer's homes. Owing to the widely scattered population of the Borough, it was felt that the Depôt could not be successful if the milk had to be fetched, and consequently provision has been made for delivery at considerable expense. An additional charge of 3d. per week was made to the customers whose milk is delivered, and this was increased to 4d. in the middle of the year. This pays roughly about half the cost of delivery. A balance sheet for the past year is appended. From this it will be seen that the total working cost of the Depôt was £962 0s. 6d., and the total income £529 14s. 11d. £68 5s. 8d. was paid for interest and repayment of loan, making a total loss of £500 l1s. 3d. equal to a rate of about one-seventh of a penny. This is not a large amount to pay for improving the health of 250 children and saving several of these from an early death. It must be remembered that every human life is worth to the State a capital value of £200 on an average. Summary. (1). The Milk Depôt is not a milk-shop where anyone can buy milk. It is a municipal institution for feeding under medical supervision infants who are unable to be fed at the breast. (2). The homes of all Depôt-fed infants are visited by Miss Fitz- Gerald, the Woman Inspector. 165 (8). Only those children are admitted to the Depôt whose mothers are unable to suckle them, or who are actually found to be wasting on the mother's milk. (4). The milk is Pasteurized (i.e., raised to a temperature of 170°.) during the chief part of the year, and sterilized (i.e., raised to a temperature of 212°) in hot weather. (5). The Depôt is supplied with milk produced from healthy cows under cleanly conditions. (G). 313 children were fed during the year; 117 were being fed daily on December 31st, 1907. The average duration of feeding was three months. (7). The cost of the milk prevents many children from having it who require it. (8). The reason for children coming on the Depôt was in nearly all cases illness of the mother or failure or insufficiency of the mother's milk. (9). More than half the families of children fed lived in tenements of one, two, or three rooms. (10). The average age of the children when commencing the milk was 2.9 months. (11). Of the 313 children, 170 were ill or in delicate health when commencing the milk. 170 children were recommended to the Depôt by medical men or by lying-in-hospitals. (12). 171 children were weighed two or more times. Of these, 94 gained the average or more than the average weight. (13). Of the 94 notified cases of zymotic enteritis (diarrhoea), only four were Depôt-fed infants. (14). Only 18 deaths occurred among the infants while having Depôt- milk. Six of these were dying when admitted and died within a week. Two further deaths occurred within a week of giving up the milk. This is a very small number of deaths considering the large proportion of delicate children. Most of the infants throve well, and many who were ill made remarkable progess. (15). The cost of the Depôt was equivalent to a rate of 1/7 penny. K 166 STATISTICS. Numbers Fed. Number having milk on December 31st, 1906 ... 49 New cases taken on between December 31st, 1900 and December 31st, 1907 ... 204 Cases discontinuing in 1907 ... 190 Total on books having milk on December 31st, 1907 ... 117 Total cases which had milk in 1907 ... 313 Condition of Health of Infants Fed in 1907. Number well on commencing ... 137 Number unwell on commencing ... 176 viz.:—Wasting ... 10 Premature Birth ... 11 Twins ... 5 Delicate ... 58 Indigestion ... 42 Diarrhœa ... 14 Tubercle ... 5 Infectious Disease, Measles ... 3 Whooping Cough ... 6 Other Diseases ... 16 Reasons for Discontinuing Depot Milk. Left Borough ... 42 Too old ... 45 Died ... 18 Expense ... 21 Mother dissatisfied ... 47 Doctor's advice ... 19 Did not keep rules ... 2 Mother's operation deferred ... 1 Going to hospital ... 6 Mother's milk returned ... 6 Not stated ... 7 Total ... 214 167 Table showing Number of Rooms Occupied by Parents of Children Fed by Depot-milk Number of Rooms 1 2 3 4 5 6 7 8 Families 14 75 79 72 25 18 6 6 Number of Children Fed by Depot, allocated to the Wards in which their Parents Live Ward. Number. Rate per 1000 of Ward Population. River, North 1 0.26 „ South 32 3.2 Dockyard 24 3.0 St. Mary's 21 2.1 St. George's 39 5.0 St. Nicholas's 49 2.1 Central 19 1.9 Glyndon 37 4.0 St. Margaret's 40 3.5 Herbert 21 2.0 Barrage 35 3.6 Eltham 4 0.3 Deaths of Infants who were on the Depot at time of Death during Year ending December 31st, 1907. No. Died. Disease. Age at death. Received milk for 113 14-9-07 Enteritis 9 months 6 months 126 24- 3-07 Tuberculosis 4 „ 4 days 146 17-10-07 Bronchitis 6 „ 6 months 169 12- 7-07 Multiple Abscesses 12 „ 2 „ 171 7- 6-07 Marasmus and Prem. Birth 2 „ 1 „ 174 15- 6-07 Pneumonia 4½ 2 „ k 2 168 No. Died. Disease. Age at death. Received milk for 181 30- 9-07 Bronchitis 5 months 3 „ 183 24-10-07 Ep. Diarrhœa 6 „ 5 „ 198 4- 7-07 Wasting 2 weeks 2 days 209 4- 7-07 Bronchitis 3 months 6 „ 230 18- 8-07 Marasmus 2½ 5 „ 277 28-12-07 Pneumonia 5 ,, 3 months 292 30-10-07 Gastro-Enteritis 2 „ 2 days 305 21-11-07 Gastro-Enteritis 1¼ ,, 4 „ 3 10- 1-07 Broncho-Pneumonia 3 „ 2 months 4 16- 1-07 Broncho-Pneumonia 3 ,, 2 „ 24 3- 3-07 Congenital Heart 5 „ 2 „ 25 21- 4-07 Broncho-Pneumonia and Heart Failure 7 „ 5 „ The following Deaths occurred in 1907 after the infants had discontinued having milk from the Depot:— No. Died. Age at time of discontinuing. Received Milk for Discontd. Milk. 54 12- 7-07 Meningitis 9 months 6 months. 21- 6-07 153 13- 5-07 Abscess in Tubercle; nomia Lung; 7 „ 3 weeks 9- 5-07 (In Hospital). Pneu- 190 7- 7-07 Bronchitis and mouia Pneu- 8 „ 1 month . 3- 7-07 (In Infirmary). 198 2-10-07 Bad Diarrhoea 7 „ 3 months. 6- 9-07 And 3 children of whom no particulars could be learnt. Causes of Death:— Gastro-Enteritis 4 Marasmus ... 3 Enteritis ... 1 Meningitis ... 1 Pneumonia ... 7 Other causes ... 6 Total ... 25 Bronchitis ... 3 169 Reasons for discontinuing Suckling :— Death of mother ... 1 Illness .. ... 50 Loss of milk from other causes ... 103 Poverty of milk—child wasting 62 Twins ... 7 Occupation ... 3 Illegitimate children 6 Age 4 Mother ran away 1 Baby would not take it ... 5 Cleft lip ... 1 No reason stated 21 264 Children who went off the Depôt in 1907 ... 196. Period for which they were supplied:— Under 1 month. 1 to 3 months. 3 to 6 months. 51 49 44 6 to 9 months. 9 to 12 months. Over 12 months. 31 17 4 170 Milk Depot, Maxey Road. Approximate Revenue Account for Year ended 31st December, 1907. Dr. Expenditure to 31/3/07 (3 months). Expenditure 1/4/07 to 31/12/07 (9 months). Total. Cr. Income 3 months to 31/3/07. Income 9 months to 31/12/07. Total. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. To Wages 33 11 9 146 12 2 180 3 11 By Sale of Milk— Sterilised 80 3 6 426 4 3 506 7 9 „ Salaries 21 5 0 60 6 3 81 11 3 „ Rent 10 0 0 30 0 0 40 0 0 Separated 2 18 2 20 9 0 23 7 2 „ Gas 3 7 14 5 18 0 83 1 8 446 13 3 529 14 11 „ Horse Hire 22 8 6 67 17 6 90 6 0 „ Milk 47 2 6 280 10 5 327 12 11 „ Milk, Sugar and Castor Sugar 9 2 0 24 1 11 33 3 11 „ Stoppers,Washers, Utensils, &c. 25 9 2 121 17 8 147 6 10 „ Analysis of Milk Samples — 5 5 0 5 5 0 „ Ice - 1 15 8 1 15 8 „ Repairs, Machines, &c. 3 6 6 11 17 6 15 4 0 ., Coal, Coke, and Fuel 5 12 6 19 17 4 25 9 10 „ Telephone Sub. (to 19/3/08) & extending wiring 2 7 0 2 7 0 „ Balance carried to Net Rev. A/e being Loss on Working Expenses „ Sundries 2 11 0 8 5 2 10 16 2 432 5 7 £180 12 6 £781 8 0 £962 0 9 £962 0 6 171 Dr. Approximate Net Revenue Account for Year ended 31st December, 1007. Cr. £ s. d. £ s. d. £ s. d. £ s. d. To Balance brought down from Revenue Account 432 5 7 By Balance, being approximate loss on Milk Depot Account for year 500 11 3 „ Loan Charges:— Repayment of Principal 50 0 0 50 0 0 Interest on Loans 4 13 9 13 11 11 18 5 8 £4 13 0 £63 11 11 £500 11 3 £500 11 3 £ s. d. £ s. d. Total Capital Expenditure 662 10 1 Met by :— Loans 500 0 0 Direct charge to Revenue Account 162 10 1 662 10 1 ALEXR. THOMAS, £662 10 1 Borouah Treasurer. 6th January, 1908. 172 Appendix II. ADVICE TO MOTHERS. The Public Health Committee of the Woolwich Borough Council is advised that much ill-health in married women, and much sickness and many deaths of infants are due to want of knowledge among mothers of certain simple rules for preserving their own health and having healthy children. They have accordingly directed the following plain rules to be prepared and distributed :- (a) Health of Mothers. 1. It is most important that a woman who knows she is about to become a mother should study her own health from the very first. The chief requisites are a proper diet, suitable clothing, fresh air, exercise and cleanliness. 2. Food should be plentiful, but light and simple. Oatmeal porridge and milk form an excellent breakfast or supper. As much milk as possible should be taken, but no beer, wine or spirits, unless specially ordered by a medical man. Stimulants, as commonly taken, do harm to both mother and child and are a frequent cause of premature birth, still-births, and loss of breast milk. Tea should be taken weak, and only once or twice a day. Coffee and cocoa are better. Whole-meal bread or household bread made from seconds flour is more wholesome than white bread, and pea-soup and lentil-soup are more nourishing than beef or mutton. Nursing-mothers should take at least a pint of milk a day, which it is safer to boil. 3. During pregnancy the mother's clothes should be easy and loose. No corsets should be worn. Tight corsets are most injurious. Pressure on the breasts must be specially avoided as it may cause the nipples to be pressed in and make suckling difficult or impossible. 4. The. breasts should be specially prepared during the last two months of pregnancy. Night and morning the nipples should be washed and afterwards bathed with a mixture of equal parts of methylated spirits and olive oil. This will prevent cracked and painful nipples while suckling. 173 5. A woman who is expecting her confinement should be careful to keep her body and her clothing very clean; she should also see that the house is thoroughly cleaned throughout, and should pay particular attention to the bedding. 6. Nobody can be healthy if she does not breathe plenty of fresh air and have sufficient exercise. The duties of many mothers confine them to the house and give them plenty of hard work there; but the windows should always be kept open—wide open as a rule, but if very cold a few inches at the top. As much of the work as possible should be done out of doors. Those who have spare time should go out for at least an hour's walk every day. The windows should be kept open at night as well as by day. 7. Over exertion, such as lifting heavy weights, and over fatigue must be avoided. 8. Medicine is sometimes taken by foolish, ignorant mothers to produce a miscarriage. It generally fails to do this, but always injures the mother's and infant's health. Such practices are wicked, and may lead to serious consequences, such as paralysis and even the death of the mother. (b) Health of the Baby. 9. The Baby's Clothes should be prepared in good time in case it comes before it is expected. The binders, the vest, and the clothes, as far as possible, should be made of flannel or wool. The legs and arms should be well covered; a baby must not be hardened by leaving these exposed, or it may get bronchitis and die. No stiff cotton binder is required; babies' backs do not need support; they should be kept lying down until strong enough to sit up without support. Every baby should have a long-sleeved, high-necked woollen vest, or else a long flannel made with high neck and long sleeves. Clothes should not be tight. 10. A baby should always sleep in a separate cradle or cot—not in bed with its parents. A good temporary cradle can be made out of an orange box, or a banana crate. Instructions for making temporary cradles, and patterns for clothing may be had on application to the Lady Health Visitor, at the Town Hall, between 9 and 10 a.m. 174 11. Food. There is no food equal to mother's milk. Few mothers — not seriously ill— but can suckle their baby if they take plenty of nourishing food and no beer or spirits. Feeding must be regular by the clock, and care taken not to over-feed. The breast must not be given simply because the baby cries. It may be crying because it has had too much, or has wind. 12. The breast should be given every two hours by day and every four hours by night. After the baby is two months old the intervals should be gradually increased to three by day, and at night it should go six or eight hours without food, so allowing the mother undisturbed rest. 13. The breast milk does not usually flow freely for two or three days after confinement, but the baby should be put to the breast from the first; it will usually get as much as it needs, and no other food need be given. 14. The mother's breasts and nipples should be washed after each meal with warm water and carefully dried. 15. The best test of a baby's getting on is the weight; it should gain at least four ounces a week. Any infant can be brought to be weighed at the Milk Depot, Maxey Road, on Thursday afternoons between 2.30 and 4.0. l6. No other food should be given without medical advice. 17. Babies should not be given comforters ; they often cause diarrhoea. 18. Babies should never be taken into public houses where they are very likely to get the infection of consumption and consumptive bowels; of course they should never be given any stimulants, tea, or anything but the breast. 19. Infants should be weaned about nine months of age, and always before they are a year old. 20. If for any reason a mother cannot suckle her baby, or the baby does not seem to be satisfied, she should either obtain medical advice or apply to the Lady Health Visitor at the Town Hall. 21. No medicine should be given unless prescribed by a doctor; avoid soothing medicines and teething powders. SIDNEY DAVIES, M.D., Medical Officer of Health. Woolwich H. Pryce & Son, Steam Printers, (T. u. Fed.) 31-35, Powis Street. 1908.