WOO 65 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. 1908. Woolwich: H. Pryce & Son, Printers (T.U. Federation), 31, 33 & 35, Powis Street. a 2 Public Health and Housing Committee:— His Worship the Mayor. James Oates Widger, B.A., (Chairman), 113, Chesnut Road, Plumstead. William Brown Ingram, (Vice-Chairman), 73, Wellington Street, Woolwich. Alderman Henry Smith Syer, 45, Plumstead Common Road. William Jenkins Bull, 280, Plumstead Common Road. James Cowie, 18, Miriam Road, Plumstead. Alfred Hall, 111, Maxey Road, Plumstead. Joseph Harper, 18, St. Margaret's Road, Plumstead. William Parry Jackson, 7, Woolwich Common. Jeremiah James Mahony, 67, Beresford Street, Woolwich. George William Mitchell, 22a, Mulgrave Place, Woolwich. James Newman, 75, Heavitree Road, Plumstead. William Raven, 82, Little Heath, Charlton. William Hardie Ross, 6, Cantwell Road, Plumstead. Richard Bailey Baxter Wakelen, 194, Greenvale Road, Eltham. Robert Alfred Murrell Walters, 16, Craigton Road, Eltham. Chief Sanitary Inspector:— Albert G. Duck (Cert. San. Inst). District Sanitary Inspectors:— John W. Rance (Cert. San. Inst.), Glyndon Ward. William Little (Cert. San. Inst.), St. Nicholas Ward. William Wood (Cert. San. Inst.), River Ward. Alfred G. Potter (Cert. San. Inst.), Eltham Parish and St. St. George's Ward. William Tedham (Cert. San. Inst.), Central and St, Margaret's Wards. 3 District Sanitary Inspectors (continued):— Thomas Powell (Cert. San. Inst.),Burrage and Herbert Wards. Harry Shaw (Cert. San. Insp. Exam. Bd.), Dockyard and St. Mary's Wards. Inspectors under Food and Drugs Act:— John W. Rance, Parishes of Woolwich and Plumstead. Alfred G. Potter, Parish of Eltham. Women Sanitary Inspectors:— Alice M. Middlebrooke. (Cert. San. Inst. and San. Insprs. Exmn. Board). Marion FitzGerald. (Cert. San. Insprs. Exmn. Bd., and Sch. Hygiene (Univ. Coll.) Public Health and Housing Committee Clerk. Charles Ellis. General Clerks. Amyas Britter (Cert. R. San. Inst.) Harry S. Smith. Junior Clerk. H. M. Collyer. Mortuary Keeper. Frank Leason. Medical Officer of Health. SIDNEY DAVIES, M.A., M.D. Oxon.; D.P.H., Camb.; Fellow of the Incorporated Society of Medical Officers of Health (Vice-President—Metropolitan Branch), and Fellow of the Royal Sanitary Institute. a 2 4 Summary of Statistics, 1908. Area of Borough 8276.6 Acres Population—Census, 1901 117,178 do Estimated to middle of 1908 127,648 Inhabited Houses—Census, 1901 18,086 Total Houses to middle of 1908 22,715 Persons to a House-Census 6.47 Marriages 875 Births 3082 Birth Rate 24.1 Deaths 1487 Death Rate 11.6 Infantile Mortality 95 per 1000 births ■) 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 12 Births 16 Marriages 17 Deaths—Woolwich Death Rate compared with other Boroughs 18 Lives and Illness saved 20 Infant Mortality—Preventive Measures 20 Still-births 22 Mortality under 5 years 22 Zymotic Death Rate 23 Inquests and Uncertified Deaths 23 Deaths in Public Institutions 24 Small-Pox and Vaccination 24 Measles 25 Whooping Cough 26 Scarlet Fever—Return Cases—Isolation at home and hospital —Sources of Infection—Provision of Medical Attendance 27 Diphtheria—Sources of Infection 34 Bacterological Examination 35 Enteric Fever—Source of Infection 38 Diarrhœa 39 Erysipelas 40 Puerperal Fever 41 6 page Influenza, Bronchitis, and Pneumonia 41 Tuberculosis—Voluntary Notification 41 Source of Infection—Occupation 44 Bacteriological Diagnosis 46 Sanatorium Treatment—Results of 46 Cancer—Classification 49 Alcoholism—Public Houses closed under Licensing Act 50 Syphilis 51 Meteorology 51 Part II.—Administration. Water Supply—Plumstead Well—Additional supplies on upper floors 53 Food and Drugs Act—Percentage Milk Adulteration-—Sampling 55 Pood Inspection 59 Dairies, Cow-sheds, and Milk-shops 59 Slaughter-houses 60 Nuisances—Complaints, Drains, Water-closets, Ventilation of new Outfall Sewers, Supervision of drainage 60 Public House Urinals 64 House Inspection 64 Medical Officer's Inspections 65 Over-crowding 65 Smoke Nuisance 65 Defective Light 65 Verminous Rooms 65 Windows opening into Conservatories 66 Dust Removal—Collection, Cost of 67 Trade Refuse—Offensive and Inoffensive 68 Housing of the Working Classes— Houses represented as unfit for habitation 68 7 PAGE Housing of the Working Classes (continued)— Statistics of Special Areas 69 Council's houses 70 Houses Registered under the By-laws 71 Inhabited House Duty 71 Common Lodging-houses 72 Underground Rooms 72 Factories and Workshops—Inspections—Outworkers 73 Bakehouses 73 Ice-cream Shops 73 Disinfection, Disinfectants 74 Health Shelter 74 Mortuaries 75 Cemeteries 75 Cleansing of Persons Act 75 By-laws for Tents, Vans and Sheds 77 Infants'Milk Depot 77 Public Ambulance 77 Notices and Prosecutions under Public Health (London) Act 78 Bacteriological Examinations 78 Women Sanitary Inspectors' Work— Miss Middlebrooke's Report 79 Miss FitzGerald's Report 82 National Union of Public Health Authorities 86 Child-birth and Industrial employment 87 Russian Baths 87 Conference on Infant Mortality 88 Eltham Branch Office 89 Public Health Staff 90 8 LIST OF TABLES. page Table I.—Population. Births and Deaths for the whole Borough from 1896 to 1908, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 91 Number of Inhabited Houses, the average number per house, and the acreage 91 „ Ia.—Institutions inside and outside the district receiving sick and infirm persons from the district 93 „ II.—Population, Births Registered, Deaths at all ages, and Deaths under One Year, for each Ward during 1901,1902,1903, 1904,1905, 1906,1907, and 1908 95 „ III.—Cases of Infectious Disease notified at all ages, at various age groups, and distributed according to Wards during 1908 97 ,, IV.—Deaths at all ages, at various age groups, from various causes in 1908 99 „ IVa.—Deaths from various causes arranged by Wards in 1908. Total Deaths in Public Institutions in district in 1908 101 „ IVb.—Infantile Mortality during the year 1908 103 „ V.—Case and Death Kate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1908 105 „ VI.—Vital Statistics of the various London Boroughs for 1908 107 „ VII.—Ditto ditto 1902 to 1907 and 1908 109 „ VIII.—Meteorology and Registered Deaths from all causes and from certain prevalent diseases in each week of the year 111 „ IX.—Weekly Averages for Meteorology and Registered Deaths from all causes and from certain prevalent diseases 113 „ X.—Summary of Statistics for the first Quarter of 1908 corrected for Public Institutions 114 9 PAGE Table XI.—Summary of Statistics for the second Quarter of 1908 corrected for Public Institutions 115 „ XII.—Summary of Statistics for the third Quarter of 1908 corrected for Public Institutions 117 „ XIII.—Summary of Statistics for the fourth Quarter of 1908 corrected for Public Institutions 118 „ XIV.—Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 121 „ XVa.—Summary of the General Work of the Public Health Department for 1908, the number of Nuisances abated, and Notices served in each Ward 123 „ XVb.—Summary of Work of Chief Inspector and miscellaneous 125 „ XVc.— Inspection of Factories, Workshops and Workplaces 126 „ XVd.—Proceedings during 1908 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 130 „ XVII.—Prosecutions in 1908 under the Public Health (London) Act and By-laws and Housing of the Working Classes Act 135 ,, XVIII.—Summary of Articles Analysed under the Sale of Food and Drugs Act 136 „ XVIIIA.—Proceedings in 1908 under the Sale of Food and Drugs Act 137 „ XIX.- Food seized, or surrendered by Owners as unfit for consumption 138 „ XX.—List of Level Bakehouses in the Borough, 1908 140 „ XXa.—List of Certified Underground Bakehouses in the Borough, 1908 141 „ XXb.—List of Factory Bakehouses 142 ,, XXI.—List of Slaughter-houses in the Borough, 1908 143 „ XXII.—List of Cow-houses in the Borough, 1908 144 „ XXIII.—List of Milk Sellers 145 „ XXIV.—List of Persons Registered as Purveyors of Milk 148 Appendix. Infants' Milk Depot. 10 PREFACE. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Woolwich. Me. Mayor and Gentlemen, I herewith present you with my Eighth Annual Report on the Health of the Borough, including my Seventeenth Annual Report on the Health of Plumstead. The steady decline in serious illness and mortality which has characterised the period of my service still continues. The death-rate last year, for the first time in the history of Woolwich, fell below 12 0 and the infantile deathrate below 100. The action of your Council in taking special measures to deal with infant mortality and consumption has been justified by the great reduction of deaths under both of these heads. The fact that 3,113 notices were served under the Public Health Act, and that it was only necessary to take out a summons in one case to compel compliance with the notice, is evidence that the Public Health Department attains good results with a minimum of friction. 11 The increasing need for another Woman Inspector is referred to under several items of the Report. Miss FitzGerald has found no time to deal with cases of phthisis, measles and whooping-cough, as was intended when she was appointed. Notwithstanding the increased duties thrust upon the Department every year by new Acts of Parliament, only one nett addition has been made to the inspectorial staff since 1902. I have to thank the Chairman and Members of the Public Health and Housing Committee for the careful consideration they have given to the recommendations I have made in the interests of the Health of the Borough. I am, Mr. Mayor and Gentlemen, Your obedient servant, SIDNEY DAVIES. May, 1909. 12 EIGHTH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1908. PART I. Statistics. 1. Population.—The population of the Borough of Woolwich, as estimated by the Registrar General, to the middle of 1908, on the supposition of a continuous increase since the Census proportional to the increase between the two last Censuses, is 131,346. As estimated on the number of houses, and presuming the same number to a house as at the Census, it is 146,966. The estimate, which has been made for the purpose of the following statistics, is as follows:— Woolwich Parish 38,991 Plumstead Parish 75,457 Eltham Parish 13,200 127,648 13 This has been obtained by a careful consideration of the total number of houses in each Ward, the number of empty houses for which abatement of rates has been requested, and the number of empty houses, observed by the Inspectors, in certain parts of the Borough. The latter number was much larger than the number in the Rate Collectors' returns. 127,648 is probably not far from the correct population, and the rates calculated from it may be safely taken as approximately correct. An error of 5,000 in the population would only make a difference of 04 in the death-rate. The year 1908, referred to in this report, consists of 53 weeks, but where any figures are used for calculating rates, or for comparison with previous years and other Boroughs, they have been reduced by 1/53 in order to make them comparable with the ordinary year of 52 weeks. Estimated decrease in the year 1,688 Natural increase (excess of births over deaths) 1,598 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 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 do. do. 1908 191 Total 22,715 14 3. At the Census there were 234 unoccupied houses in the Borough, viz., 46 in Woolwich, 86 in Plumstead, and 102 in Eltham. The following return of empty houses in the Borough, as per Bate Collectors' returns, has been kindly supplied me by the Clerk of the Bating Committee:— Woolwich Pakish— Dockyard Ward 112 St. Mary's Ward 65 Biver Ward (North) 68 Biver Ward (South) 158 St. George's Ward 83 486 Plumstead Pakish— Burrage Ward 71 Herbert Ward 130 Glyndon Ward 70 St. Margaret's Ward 100 Central Ward 60 St. Nicholas's Ward 140 — 571 Eltham Pabish 97 Total 1154 Thus the number of empty houses has increased tenfold in Woolwich Parish and six times in Plumstead, but has diminished in Eltham. 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. 15 The populations of the Wards are estimated by the number of occupied houses in each Ward. Wards. Dockyard. St. Mary's. River Ward. 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 No. 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 ,, 1902, to ,, 1903 12 - 33 - - - 9 40 153 7 239 250 ,, 1903, to „ 1904 4 - 89 14 - 8 - 30 94 7 185 151 ,, 1904, to ,, 1905 5 18 2 - — 2 - 33 102 12 170 139 ,, 1905, to „ 1906 11 14 - 9 - - - 36 69 2 150 99 „ 1906,to „ 1907 21 5 5 6 - - - 27 36 7 91 83 „ 1907,to „ 1908 8 †43 12 5 1 1 7 13 29 1 52 53 Total Houses 1,386* 1,206* 657 1,705* 879 1,746 1,729 1,882 2,447 1,855 4,232 2,615 Estimated Populations 7,800 9,788 3,901 10,188 7,314 9,184 9,106 9,444 13,173 9,500 25,000 13,200 *In Dockyard, St. Mary's and River (South) Wards the number of new houses is probably less than the number of old bouses which have been demolished. †40 flats in Army Quarters, Artillery Place. 16 Births. 5. The number of births was 3,082, viz., 1,030 in Woolwich Parish, 1,788 in Plumstead, and 264 in Eltham (corrected for children born in the Infirmary, Female Hospital, and the Wood Street "Home for Mothers and Babies,'' whose parents reside outside the Borough); and the birth-rate 24T compared with 25.5 in the previous year, and with 284 the average for the ten years 1898-1907. The rate for the County of Loudon was 25.4. 2,194 births were notified, from March 1st to December 31st, under the Notification of Births Act. This is at the rate of 83 per cent. of the registered births. Of the 2,194 notifications, 1,182 were notified by Midwives, and 376 by Medical Practitioners. 62 still-births were notified. 6. The following table gives the average birth-rate of the Borough during the years 1901-5, 1906, 1907 and 1908, and for purposes of comparison the corresponding rates of the neighbouring Boroughs, London, and England. The decrease in the Borough has been much greater than that in London. Birth-rate. Average 1901-5. 1906. 1907. 1908. Greenwich Borough 27.6 25.4 24.2 23.5 Lewisham 25.7 23.3 23.8 23.0 West Ham 33.1 30.5 28.6 29.4 East Ham 33.8 28.1 26.3 24.7 Erith 34.1 30.0 29.9 25.9 London 28.2 26.6 25.8 25.2 England and Wales 28.2 27.0 26.3 26.5 Woolwich Borough 29.2 27.7 25.6 24.1 17 7. The following table gives the birth-rate for the Borough and each parish for the three past quinquennia, and last three years. 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 Parishes to which they properly belong. 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, but the rate has again fallen below the level of 1891-5. Average of 1891-1895. Average of 1896-1900. Average of 1901-1905 1906 1907 1908 Woolwich Borough 32.5 30.2 29.2 27.7 25.5 24.1 Woolwich Parish 31.1 30.1 29.0 29.2 29.1 26.4 Plumstead ,, 33.3 31.0 30.1 27.8 24.1 23.7 Eltham ,, 22.8 20.6 24.0 22.0 22.4 20.0 8. Illegitimate Births.—61 of the births registered were illegitimate, giving a rate of 20 per 1,000 births, compared with 17, 17, 22, and 24, in the four preceding years. The illegitimate birth-rate in London was 37 in 1907. Marriages. 9. There were 875 marriages. The marriage-rate was 13.7 compared with 16.4 and 14.6 in the two preceding years. This great fall in the marriage-rate is an indication of the prevalent local industrial depression. The marriage-rate in London was 17.0 in 1907. b 18 Deaths. 10. Table 1 gives the gross and nett deaths and death-rates in 1908 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 upon 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 deathrate is very low, should have a lower death-rate than one containing an excess of aged persons. The factor for the correction of the Woolwich death-rate is 1.0690. 11. The nett deaths were 1487, and the nett death-rate was 116. The death-rate in 1907 was 12.5. Last year had again 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., 12.4 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:— Nett Corrected. England and Wales 14.7 14.7 76 Large Towns 14.9 15.8 London 13.8 14.5 Greenwich 12.6 12.9 19  Nett. Corrected. Lewisham 11.0 11.4 West Ham 13.9 ... East Ham 9.9 ... Erith 8.3 ... Woolwich 11.6 12.4 13. The following table gives the average death-rate in each Parish of the Borough during the past four quinquennial periods and during 1906, 1907, and 1908. The Parishes of Woolwich and Plumstead have never had so low a death-rate as last year. Eltham had a lower rate in 1902 and 1903, and an equal rate in 1905. In Plumstead there has been a progressive improvement. In Woolwich and Eltham Parishes the live 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 1896-1900. Average 1901-1905. 1906 1907 1908 Woolwich Borough .. 17.2 16.9 13.9 13.1 12.5 11.6 Woolwich Parish *20.4 19.3 20.1 16.5 15.5 14.6 14.0 Plumstead ,, 16.4 16.0 15.1 12.9 12.2 11.9 10.8 Eltham ,, .. 13.0 14.6 10.2 10.2 10.0 9.7 London ,, 20.0 19.8 18.5 16.1 15.1 14.6 13.8 *Three years—1888, 1889 and 1890. 14. The death-rate among males was 12.6, and among females 12.8. In 1906 the numbers were 14.7 and 13.6 respectively, and in 1907, 13.3 and 14.3. These rates are b 2 20 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. 15. 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 1903-7 and in 1908. Only two Boroughs had a lower death-rate than Woolwich, viz., Hampstead and Lewisham. 16. Lives saved.—In the last two years, I have estimated that 259 and 376 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 1908 would have meant the death of 1,966 persons instead of the 1,487 who actually died. There was thus a saving of 479 lives in 1908. But this is not the whole of the benefit conferred by a reduced death-rate, for each of the 479 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. 17. The deaths under one year were only 292, compared with 372 in 1907. The infant mortality (deaths under one year per 1,000 births) was 95, compared with 113 last year, and 103 in 1905, the lowest rate previously recorded. This great reduction in infant mortality is very satisfactory. The figures are not liable to error from possible miscalculation of population, being computed on the known number of births. 21 The following table gives the infantile mortality in the Borough during the past seven years, compared with the neighbouring Boroughs, London, and England:— 1901-5. 1906. 1907. 1908. Lewisham 112 113 90 86 Greenwich 137 119 100 120 West Ham 158 149 131 128 East Ham 131 127 108 104 Erith 112 85 88 80 London 138 132 115 113 Seveny-six Great Towns — 146 127 128 England and Wales 135 133 118 121 Woolwich Borough 119 111 113 95 18. The following table gives the infantile mortality during during 1906-7-8 and the four preceding quinquennia in each parish of the Borough. 1886 1891 1896 1901 1906 1907 1908 1890 1895 1900 1905 Woolwich Parish *151 157 170 134 139 114 111 Plumstead ,, 121 120 132 113 97 108 88 Eltham ,, .. 163 160 97 94 140 75 Woolwich Borough ... 140 146 118 111 113 95 *1888, 1889, and 1890. Woolwich and Plumstead Parishes had the lowest rate yet recorded, Eltham had a lower rate in 1903 (74), and in 1905 (72). 19. Table IVb gives full details as to the ages at death, and causes of death, of the 298 infants dying in 1908 under one year. It shows that 41 per cent of those who died were under 22 one month old, and 26 per cent. under one week old. 72 deaths were from premature birth compared with 65, 75, and 61, in the three preceding years, and of the remainder, 27 (47 in 1907) were attributed to Atrophy, Debility, and Marasmus, indefinite terms applied to deaths from immaturity, congenital debility, and other causes. The number of deaths under one week in the past four years were 70, 87, 83, and 76, respectively. The death-rate from premature birth in Woolwich Borough was 0.57 compared with 0.48 and 0.71 in the two preceding years. In England and Wales it was 0.52 in 1907. There were 20 deaths of illegitimate infants. The death-rate of illegitimate infants under one year was 328 per 1000 births, and that of legitimate infants 92. 20. Compared with 1907, the past year had, among infants, fewer deaths from measles, premature birth, and wasting diseases, bronchitis, pneumonia, and overlying; and more from diarrhœal diseases. The decrease of deaths from bronchitis and pneumonia is attributable to decrease of measles, Deaths from overlying were 5 compared with 2 and 8 in the two previous years. 21. Still-births—93 still-born children were buried in the Woolwich and Plumstead Cemeteries, compared with 97 in 1907. 22. Deaths under five years, and over eighty-five—The total deaths under five years were 424, or 27.7 per thousand population under five at the census. The rates in the four preceding years were 47.2, 36*5, 38.3, and 41.9. 23 23. Zymotic death-rate—The number of deaths from the seven principal zymotic diseases was 117, giving a death-rate of 0.92, compared with 1.0, 1.49, and 1.34, in the three preceding years. The following table gives the zymotic death-rate in each parish during the past 8 years:— Average, 1901-5. 1906. 1907. 1908. Woolwich 1.69 1.93 1.67 1.10 Plumstead 1.53 1.37 1.67 0.84 Eltham 0.88 0.83 1.02 0.77 The Borough 1.51 1.49 1.34 0.92 24. Inquests.—There were 115 inquests compared with 154, 154, 160, 141, 121, and 128, in the six preceding years. The following table gives particulars as to the cause of death:— 1. Natural causes 51 2. Accidental causes— Burns 5 Drowning 8 Falls 9 Fractures 4 Bun over 2 Suffocation, overlying 5 Other accidental causes 16 — 49 3. Homicidal causes — Suicide 15 Murder and Manslaughter nil — 15 115 24 The "Natural Causes" were 63 in 1906, and 86 in 1907. The "Accidental and Homicidal Causes" were 49, 59, 62, 58, and 42, in the five preceding years. The deaths from suffocation or overlying have been 8, 8, 8, 4, and 9, respectively in the last five years. The "Homicidal Causes" were 8, 11, 11, 15, and 7, in the same years. 25. Deaths in Public Institutions.—Table I. shows the actual number of deaths occurring in Public Institutions in the Borough, viz., 289, compared with 272, 261, 313, 293, and 296, 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. Small-pox and Vaccination. 26. No cases of Small-pox have been notified since 1905. 286 cases of Chicken-pox were notified by school-teachers, compared with 84 in 1906, and 362 in 1907. 27. The number of cases of Small-pox in London was 4. 28. The following return, kindly furnished by the Vaccination Officers—Mr. Greenhill and Mr. Atkins—gives particulars as to the vaccination of children born in Woolwich, Plumstead and Eltham Parishes in 1907:— Births 3333 Vaccinated 2553 Insusceptible 9 Conscientious objections 257 Died unvaccinated 261 25 Medical postponements 25 Removed 53 Not found and unaccounted for 175 29. The following have been the numbers excused on account of conscientious objections, since 1901, in Woolwich and Plumstead Parishes: 127, 78, 108, 96, 101, 109, 170 and 257. The lowest number, 78, was in 1902, the year of the Small Pox epidemic. The increase in the two last years is doubtless the result of the recent Vaccination Act, which facilitates the obtaining of exemption certificates. Measles. 30. There were 10 deaths from Measles, giving a rate of 0.08, compared with 0.10, 0.24, and 0.54 in the three preceding years. The rate in London County was 031, compared with 0.38 in 1907. 31. Of the 10 who-died from Measles, all were under 5 years of age; four were males and six females; five were in Woolwich Parish, two in Plumstead, and three in Eltham. 32. 519 notifications were received from school teachers compared with 661, 1,240, 465, 825, and 1,453, in the five preceding years. The mortality per cent. of notifications was 19 compared with 3.8, 2.3, 2.8, 3.8, and 4.8, in the five preceding years. 33. The following table gives the number of deaths and death rates from Measles for the past three years, and three preceding quinquennia, in each parish (as far as known), and the death rate in London:— 26 Year. Woolwich. Plumstead Eltham. The Borough. London. No. Bate. 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) 84 0.81 36 0.57 Not recorded 70 0.67 0.57 1901.1905 (average) 9 0.22 15 0.22 1 013 26 0.21 0.44 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 1908 5 0.13 2 0.03 3 0.23 10 0.08 0.31 34. Last year Measles was at an ebb-tide in the Borough. Not only was the number of cases much below the average, but, as often occurs, the mortality of the disease was exceptionally low. The schools principally affected were those at Eltham, the Slade, Bostall Lane, and Vicarage Road, in the beginning of the year; and Wood Street and St. Thomas's in the autumn. Dr. Kerr closed, or excluded unprotected children from, several classes. In many cases this was done immediately on the occurrence of one case. The period of exclusion or closure was usually for a few days only, not exceeding one week. Whooping-cough. 35. There were 32 deaths from Whooping-cough, compared with 21 and 37 in the two preceding years. No doubt some deaths of young children attributed to Bronchitis and Pneumonia were really due to this cause. The death-rate was 0.25, compared with 0.20 in the County of London. 27 174 cases were notified by school-teachers, compared with 598 in 1907. 18 of the deaths occurred in the first quarter of the year. There can be little doubt that the mortality from this disease might be diminished by instructing parents, through leaflets and health-visitors, as to the hygienic treatment of the cases that occur. To do so, however, would require an increase of staff. The mortality of the disease in 1907 and 1908 was nine per cent. of notified cases, more than double the mortality of Measles, and several times greater than that of Scarlet Fever. Scarlet fever. 36. There were 596 cases of Scarlet Fever notified, equivalent to a rate of 4.67 per thousand population, compared with 7.91 in 1907. Except for 1908, this rate is the highest since 1899. 37. The following table shows the case-rates of Scarlet Fever in the Borough and each Parish during 1901.5 and the past three years, compared with London:— Average, 1901-5. 1906. 1907. 1908. Borough 3.15 4.15 7.91 4.67 Woolwich Parish 2.99 3.83 6.10 3.85 Plumstead 3.24 4.22 8.56 5.22 Eltham 3.21 4.71 9.65 3.94 London County 3.57 4.35 5.46 4.52 38. Table III. gives the age distribution, the number in each Ward, and the number removed to hospital. River, St. Nicholas, St. Margaret's, and Central Wards, were most affected. 28 39. There were nine deaths, giving a death-rate of 0.07 per 1000 population, compared with an average of 0.08 in the five preceding years, and 0.19 in the ten years 1891-1900. The death-rate in London was 0.11. The case mortality (proportion of deaths per cent of notifications), 1.5, was again very low. It appears from the annual report of the Medical Officer of Health to the London County Council, that, in the five years 1902-6, only two Metropolitan Boroughs had a lower death-rate from Scarlet Fever than Woolwich; these were Hampstead and Stoke Newington. 40. Hospital Isolation—Of the 596 cases, 515, or 86 per cent. were removed to one of the Fever Hospitals, compared with 86, 84, 81, 78, and 85, per cent in the five preceding years. 21 cases, of 3.5 per cent, were reported, after observation at hospital, not to be scarlet fever. 41. Return Cases—There were 38 cases in which infection was attributed to a patient recently returned from hospital, compared with 18, 14, 13, and 30, in the four preceding years. The interval between return of the infecting case and commencement of illness, in 29 cases, was from three to fourteen days, and in 9 cases from 2 to 12 weeks. Of the 27 infecting cases 10 had some form of Rhinitis, on or after their return; 2 otorrhœa; and 1 enlarged cervical glands. The number of return cases was the highest on record; this may be partially due to the large number of cases discharged in the beginning of the year. Of course, it by no means follows that, because a case of scarlet fever occurs shortly after contact with a returned case of that disease, therefore the returned case was necessarily the source of infection. It may only have been a coincidence. Out of a large number 29 of cases there are sure to be a certain number of such coincidences. But it seems probable that the majority are something more than coincidences. Where, after the return of a case from hospital with a running at the nose, one, two, three or more brothers and sisters successively go down with scarlet fever, the connection between the returned case and the subsequent ones can hardly be denied. As a rule the children returning from hospital are quite well at the moment of discharge, but in many cases develope some nasal discharge on arriving home, or within a few days. The following are illustrative cases:— (1). A.B. had had nasal discharge for two weeks before leaving hospital. "Was well on leaving hospital but the running recurred the day after reaching home. (2). B.C. returned well, but had purulent rhinorrhœa 24 days after. Three days after this began her mother sickened with scarlet fever. (3). D.E. had a cold just after coming home. (4). F.G. began with rhinorrhoea three days after discharge; a brother sickened with scarlet fever four days later. (5). M.N. was sent out with rhinorrhoea after three months isolation at hospital. Special precautions were taken for treating the nose and isolating the patient, but, in spite of these, the running continued, and a brother sickened twelve weeks later. As recorded in previous reports, special instructions are given to parents of returning cases, but it does not appear that much advantage has ensued. The Hospital Superintendents forward the names of any children discharged while still suffering from rhinorrhœa. It would be an advantage perhaps if they also forwarded the 30 names of children who had suffered from a rhinorrhœa which appeared to have ceased. It must be confessed that, so far, there has been failure to deal with this difficult problem, and perhaps there will be until the germ of the disease is discovered. It will be seen presently that few return cases of diphtheria have recently occurred—cases of this disease being isolated until the germ is found to have disappeared. 42. Home Isolation.—Sixteen certificates of efficient home isolation were given to enable men to continue their employment. 81 cases were isolated at home. Only one of these was followed by a secondary case which could be attributed to failure of isolation, and there was no 'home return case." In 1907 home isolation was followed by two return eases and two second cases, due to failure of isolation, or two per cent. of failure. Taking the hospital return cases on one side, and the failure of home isolation and home return cases on the other side, it may be said that there were, in the two years, 4 per cent. of failures in the hospital isolation, and 2 per cent. in the home isolation. 43. Other sources of Infection.—A probable source of infecwas found in 144 cases. In 79 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 22 cases infection was attributed to friends and neighbours, and in 32 cases to school attendance; in 3 to fellow 31 lodgers ; and in 6 to travelling or visiting hospitals. The number of mild cases undetected or concealed, which go about and attend school, is no doubt very large, and mainly accounts for the spread of infection. There were, however, no special school outbreaks last year. 45. 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. 46. Absence on account of illness is not now, as it was till recently, a barrier to obtaining a school medal. The mere records of school attendance are, however, still the basis of school grants, and consequently it is the main object of teachers to keep up the attendance. This leads to children being encouraged to go to school at an age when they are unfit to leave home, and when they are more liable to succumb to infectious disease. It also indirectly leads to children attending school in an infectious state. 47. Information was obtained as to the date of calling in medical attendance in 81 cases of Scarlet Fever. In only 10 was the doctor summoned on the first day of illness; and in more than half the cases the attendance was deferred for more than two days. The following instance shows how inability to pay for medical attendance leads to concealment of illness and exposure of patients in an infectious state:— On the 8th May, 1908, I was informed by a London County Council school nurse that she had excluded from Earl Street school a girl of 13 who was peeling. I visited the house and found the girl there alone and in charge 32 of the house, her aunt and uncle being both out. Her tongue and the desquamation of the skin clearly indicated that she was suffering from Scarlet Fever, and she stated that she had had a sore throat and rash from Easter Tuesday (21st April) till the following Sunday. She returned to school a week later (May 4th). No doctor was called in because her uncle was out of work. The mother called to see me next day, and denied the girl's statement as to the rash. I am of opinion that this was a case of Scarlet Fever deliberately concealed, followed by exposure in an infectious state. The following report was presented to your Council in May:— "In my last report to your Committee, it was stated that the death-rates in the Borough, both from Scarlet Fever and Diphtheria, have been less in the past five years than in any previous period, and are also less than the average for London. Since that report was written the Registrar-General's Annual Summary has been issued, and shows that the London death-rate from Scarlet Fever, during the five years 1903-7, was 0.11 per 1000; in Woolwich it was 0.08, or only about two-thirds as much as London. During the same period the London death rate from Diphtheria was 0.15, and in Woolwich it was the same, but last year Woolwich was one of the seven Metropolitan Boroughs having the lowest deathrate from Diphtheria. The death-rate in Woolwich was 0.12, and in London 0.16. The death-rate from both these diseases has steadily declined, and the Diphtheria death-rate is now only about one-third of what it was between 1890 and 1900; and the Scarlet Fever deathrate less than one-half. Hence, as far as death-rates 33 are concerned, the position of Woolwich is decidedly satisfactory. It is quite true that it is a serious matter to have a large amount of non-fatal preventable disease which causes suffering, inconvenience, and expense; but, on the whole, notifications have been less since 1900 than in the previous ten years. In the four years 1901-4, there was a very marked diminution. The last three years, however, have again shown a rise, but this rise did not reach nearly the high-water mark which was attained by both these diseases in the previous decade. As I have already pointed out, deaths are a much more reliable measure of serious illness than are notifications. It must be remembered that only a certain proportion of the cases of infectious disease which occur are notified, and this proportion varies from different causes. The poor cannot afford to call in medical advice, and among them a large proportion of cases of infectious disease are never detected. This was even more the case in past years than it is now. Although the number of notifications of Diphtheria has been larger in the past three years than for some five years before, I have little doubt that the actual number of cases of Diphtheria has been no greater. Many cases are now discovered by bacteriology and notified, which could not have been discovered before bacteriology was used for this purpose. The more active the sanitary administration of a borough, the larger the number of mild, infectious cases discovered, and hence the number of notifications increased. Probably one reason why Woolwich has more notifications but fewer deaths from Scarlet Fever and Diphtheria than the rest of London, is that more mild cases of these diseases are detected and notified. Another reason is that owing to the c 34 former higher birth-rate and the present lower infantile death-rate of Woolwich, there is in this Borough a larger proportion of children of school age. It will be found that Boroughs with a similar population to that of Woolwich, such as East Ham, Tottenham, Leyton, and Walthamstow, also have a large porportion of notifications. I have no doubt that the former is the chief reason why the number of notified cases is larger and the number of deaths smaller in Plumstead than in Woolwich, though the second reason applies here also to a considerable extent. Although the notification of slight forms of disease causes much inconvenience, it must be regarded as preventing a worse evil, viz., serious disease and death. Infectious disease now spreads chiefly by mild undected cases which have not been seen by a doctor. The most effectual means to deal with these is to put prompt medical attendance within the easy reach of all, and prevent sick children from being driven to school (unknowingly) by the Attendance Officer. diphtheria. 48. 362 cases of diphtheria were notified, compared with 273, 387 and 275, in the three preceding years. The case-rate (number of cases per thousand population) corrected for cases of mistaken diagnosis (of which 29 were noted) was 2.61. This is the highest rate since 1900, with one exception. 13 of the notified cases were bacteriological, i.e. had no symptoms. 49. There were 20 deaths, compared with 18, 23, and 15, in the three preceding years. The death-rate was 0.16; the rate has only been lower in three years since 1891 (see Table V). The London death-rate was 0.15. 35 50. 124 cases were in Woolwich Parish, 216 in Plumstead, and 22 in Eltham. The following table shows the 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 1908 The Borough 1.71 2.80 1.83 2.61 Woolwich Parish 1.63 3.43 1.85 3.18 Plumstead ,, 1.87 2.26 2.36 2.88 Eltham ,, 1.62 6.70 1.57 1.69 Loudon 1.90 1.70 1.85 1.64 51. 321 cases, or 89 per cent of notifications, were removed to hospital, compared with 67 and 83 per cent in the two preceding years. Certificates of efficient home-isolation were given in 7 cases (8 in 1905, 21 in 1906, and 30 in 1907). The case mortality was only 5.5 per cent, compared with 7.0, 17.8, 6.6, 5.7, and 6.3, in the five preceding years, and 9.1 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 20 the actual number. 52. 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. 341 home contacts were examined by the Medical Officer of Health, and 25 carriers, or mild cases of diphtheria, were found. The carriers were excluded from school until the diphtheria bacillus had disappeared; the cases shewing any symptoms were notified and isolated. c 2 36 The Medical Officers of the Royal Arsenal examined employees from infected houses before allowing them to return to work, and discovered several bacteriological or carrier cases. Altogether 13 cases, found to be "carriers" of the diphtheria bacillus, without having any symptoms, were notified. 53. Mistaken Diagnosis. 29 cases, or 8 per cent of notifications, were, after removal to hospital, stated to be not diphtheria. The percentage of the three preceding years was 14, 8, and 14, respectively. 54. Source of Infection. In 107 cases, a probable source of infection was noted, viz., in 56, other inmates of the house were suspected to be the source; in 30, schoolmates; 14, neighbours and friends; 6, return cases; 1, a general hospital. The 6 return-cases followed 5 returned cases ; 4 of the returned cases went away for Scarlet Fever, and one for Diphtheria. Two were swabbed but no Diphtheria bacilli found. 55. For the third year in succession there was an outbreak of Diphtheria in connection with Bostall Lane school, which persisted intermittently for some three months, in spite of repeated bacteriological examinations, the Easter holidays, and the close of the whole school for two weeks. Several carrier and mild cases attending school were detected and excluded, and finally the disease abated. A special enquiry into the cause of the recurrence at the school was made by Dr. Thomson of the Local Government Board, and Dr. Thomas of the L.C.C., but so far without any light being thrown on the matter. One of the cases which helped to spread the disease was a girl who had a slight 37 attack; her mother could not afford medical attendance, and for fear of the attendance officer sent her to school before she was well. Elizabeth Street school was also specially affected at the close of the year. 56. Bacteriological Diagnosis.— 828 swabs were sent to the Lister Institute to be examined for the presence of diphtheria bacillus. In 123 the true Klebs Loffler bacillus was found (in 15 of these, Hoffman's bacillus co-existed with the Klebs Loffler bacillus); in 278 Hoffman's bacillus was found, and 427 were found free from either the Klebs Loffler bacillus or Hoffman's. The increase of cases having Hoffman's bacillus is noteworthy. Of the 828 swabs examined, 341 were taken from school children by myself. Of these 25 contained the true Klebs Loffler bacillus (including 9 with Klebs Loffler and Hoffman's), and 167 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 341, 28 had symptoms, viz., 3 tonsilitis, 4 congestion or exudation of fauces, 2 clinical diphtheria, 18 some form of rhinitis, and 1 enlarged cervical glands. Of the positive cases, 32 per cent. had symptoms; of Hoffman cases, 7 per cent, and of negative cases, 8 per cent, had symptoms. Of 7 cases with purulent discharge, encrustation and soreness of the nostrils, 4 gave a positive result, 1 showed Hoffman's bacillus, and 3 were negative. 38 Positive cases with any symptoms were notified and sent to hospital, or strictly isolated; positive cases without symptoms were excluded from school and from mixing with other children outside the house. 12 cases without symptoms were re-examined at intervals of 10 days. In 1 positive reports recurred six times, in 1 three times, and in 2 twice. Usually one negative or Hoffman result was accepted as evidence of the disappearance of the Klebs Loffler bacillus. 57. It appears that the majority of the deaths from Diphtheria would be obviated if medical attendance were obtained earlier in the illness. Information was received as to the date of summoning the doctor in 64 cases. A little more than onethird obtained medical attendance on the first day, and nearly one-third were not seen by the doctor till two days had elapsed. No doubt the chief cause of this delay is the poverty of the parents which makes them avoid calling in a doctor before they are obliged. The only practical remedy seems to be to put free medical attendance within the easy reach of all, at any rate so far as is necessary for diagnosis. Enteric Fever. 58. There were 13 cases of Enteric Fever, not including 6 cases of mistaken diagnosis notified as Enteric. The case-rate was 0.10, compared with 0.17, 0.23, and 0.16, in the three preceding years; this is again the lowest rate recorded in the Borough. For the ten years 1892-1901, the rate never fell below 0.41. The case-rate in London was 0.27. Out of 19 cases notified, 14 went to hospital. 59. There were two deaths, giving a death-rate of 0.02, which is the lowest death-rate recorded. The death-rate in London was 0.05. 39 At the present rate of diminution Enteric Fever will have practically disappeared in four years. 60. The following are the cases notified in each parish during the past six years:— Average, 1901-5. 1906. 1907. 1908. Woolwich 12.6 16 6 4 Plumstead 21.2 21 16 12 Eltham 8.6 3 5 3 61. In two cases the disease was attributed to oysters; in one to mussels; and in two others to shell-fish. A master and servant began the same day with the disease. No suspicious food had been taken by both, but the servant often had shellfish, and prepared her master's food. She probably infected his food by preparing it with hands fresh from touching shellfish. 62. Bacteriological Diagnosis.—17 samples of blood were sent to the Lister Institute to be examined for Widal's reaction. A positive result was obtained in 4. diarrhcea or zymotic enteritis. 63. The deaths from diarrhoea, dysentery, and epidemic or zymotic enteritis, were 46. or 0.36 per 1,000 population, compared with 0.36, 1.19, 0.52, 0.81 and 0.26, in the five preceding years. The rate for London was 0.53. There were, in addition, 11 deaths from enteritis and gastroenteritis, making a total of 57 deaths, or 18 per 1,000 births, due to diarrhœal diseases. 34 of the 57 were under one year of age. 40 64. The following table shows the death-rate from the above-mentioned diarrhœal diseases per 1,000 births, in each parish during the past eight years:— Diarrhœal Disease per 1,000 Births. Average, 1901-5. 1906. 1907. 1908. Woolwich Parish 33.2 44 19 23 Plumstead Parish 26.6 31 16 16 Eltham Parish 18.8 19 11 12 The Borough (02-5) 26.7 34 18 18 London County (04-5) 40.0 48 21 — 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 contiue the experiment for three years more. A full report on the notifications received in the four years, 1905-8, was presented and printed in the Council's Minutes of the meeting on the 11th February, 1909. As the result of the report, your Council resolved that voluntary notification of Zymotic Enteritis should be continued, and that the disease should be made notifiable in June and October as well as in the three summer months. Erysipelas. 65. There were 90 cases of Erysipelas notified, compared with 74, 83, 110, and 110, in the four preceding years. There were 7 deaths. The case-rate was 0.70, and the death-rate 0.05 The London case-rate was 0.86, Epidemic Cerebro-spinal Meningitis. 66. In consequence of the serious epidemic of this disease in certain towns of Ireland and Scotland, Cerebro-spinal menin- 41 gitis was made, in 1907, a notifiable disease under the Public Health (London) Act, by the London County Council. One case has been notified in the Borough in each of the two years 1907-8. It seems probable that the disease is always present in London, but is not usually distinguished from other forms of meningitis. Puerperal Fever. 67. There were 6 cases of Puerperal Fever notified, compared with 5, 12, 8, and 6, in the four preceding years. There were 2 deaths. The case-rate was 0.04, and the death-rate 0.02. The case-rate has only twice been lower since 1891. The London case rate was 0.04. influenza, bronchitis, pneumonia. 68. Influenza caused 29 deaths, compared with 22, 60, 27, 23, 33, and 30, in the six preceding years. Bronchitis and Pneumonia caused 228 deaths, compared with 258, 278, 255, 265, and 298, in the five preceding years. The deaths from these causes under five years were only 81, compared with 140 in 1907. Thus most of the diminution, compared with 1907, is in deaths under 5 years, and probably represents largely diminished deaths from Measles and Whooping-cough. Tuberculosis. 69. Deaths.— There were 224 deaths from Tuberculous disease, giving a death-rate of 1.76, compared with 1.92, 2.06, 1.83, 1.71, and 1.60 in the five preceding years. This is lower than the death-rate recorded in any year before 1906. The London death-rate was l.95 in 1907. 42 70. The following table gives the number of deaths from each of the various forms of tuberculosis in the past eight years, and also the deaths from simple meningitis: — Average 1901.5 1906 1907 1908 Tubercular meningitis 20.0 22 19 27 Simple meningitis 22.0 15 20 14 Tuberculosis of intestines and peritoneum 13.0 14 11 13 Tuberculosis, other forms 20.8 21 22 28 Phthisis 192.0 164 154 156 71. The deaths from Phthisis were 156, giving a death.rate of 1'23, compared with 1.39, 1'64, 147, 1.29, and 1.19, in the five preceding years. This is the lowest death.rate recorded, except that in 1907. The reduction in the death.rate since 1901 represents a saving of 73 lives last year. The following table gives the death.rate from phthisis in each parish during the five years 1901.5 and in 1906, 07, and 08, compared with London. The greatest reduction was in the parish of Woolwich. Average 1901.5 1906 1907 1908 No. Rate No. Rate No, Rate No. Rate Woolwich Parish 89 2.15 67 1.68 52 1.30 59 1.51 Plurastead ,, 97 1.34 90 1.20 92 1.20 90 1.19 Eltham ,, 6 0.63 7 0.58 10 0.78 7 0.54 The Borough 192 1.56 164 1.29 154 1.19 156 1.23 London — 1.57 6969 1.47 6654 1.39 6419 1.32 43 72. 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 73. To judge of the decrease of tuberculosis it is necessary to consider carefully the figures given above for the various forms of the disease. It is seen that the number of cases of simple meningitis has considerably diminished, while that of tuberculous meningitis has increased. The number of the two together has remained nearly uniform. There can be little doubt that cases which were formerly called simple meningitis are now certified as tuberculous meningitis, and that the increase of the latter is only apparent. Again it has become increasingly the practice to certify deaths from such diseases as hip and spinal disease as tuberculous ; hence the increase from tuberculosis, in other forms, is also probably apparent only. It appears, therefore, that the real diminution of tuberculosis other than phthisis is greater than appears on the surface. The reduction of phthisis in the past three years, especially in Woolwich parish, is very marked. There has been but very slight reduction in tuberculosis of intestines and peritoneum; if this disease, as Dr. Koch and others think, is mainly contracted from other persons in the home suffering from phthisis, the reduction should have been greater. If, on the other hand, it is mainly due to the consumption of tuberculous milk, little diminution could be expected, for until this year there has been no radical step taken for preventing the importation into the Borough of such 44 milk, and for fifteen years the inhabitants have been advised to make, and have to a large extent made, a practice of boiling all milk before consumption. The London County Council now has powers which should lead to the cessation of the sale of tuberculous milk. 74. 101 of those who died from phthisis were males, and 55 females. In 1905 there were 110 males and 75 females; in 1906, 97 males and 67 females; and in 1907, 82 males and 72 females. 75. The source of infection was attributed in 81 deaths from tuberculosis, with more or less probability, as follows:— Family or personal— Father 19 Husband 1 Mother 15 Brother 3 Sister 2 Other relatives 4 Other inmates of house and friends 3 Workplace 13 Public House or Licensed Restaurant 16 Milk 5 81 Two who died were engaged in the liquor traffic as potmen. Several had been out of work some time, one for four years. 76. Notifications.— Voluntary notification of phthisis has now been in force in the Borough for seven years. 154 cases were notified last year, compared with 145, 176 and 150, in the three preceding years. 46 of these were in the Poor Law 45 Infirmary. 13 others were notified by the District Medical Officers of the Poor Law Unions, 16 by the Medical Officers of the Eoyal Arsenal, and the remainder by clergymen, philanthropic societies, applicants for admission to Peppard Common Sanatorium, and by private medical practitioners. £8 10s. 6d. was paid during the year for the notification of phthisis. Duration. Of the 154 cases notified during 1908, at least 29 have since died, and of 150 notified during 1907, at least 54 have since died (February 11th, 1909). 77. The source of infection of the notified cases was probably as follows:— Family or personal 44, viz., Father 13, mother 9, brother 7, sister 5, husband 3, other members of family 4, friends, lodgers, etc., 3. Workshop and Office 18 Public house 12 School 1 Navy and army 1 Milk 2 Undetermined 75 78. Of the 24 adults about whom information was obtained, 2 were stated to be teetotallers, 18 temperate, and 4 intemperate. Of the houses of notified consumptives, 9 were to some extent dirty, 5 had dark rooms, 1 damp rooms, 3 were overcrowded, and two had insufficient ventilation. Age Distribution. The following table gives the age of notified cases:— 0-1 1-5 5-15 15-25 25-45 45-65 Over 65 0 2 11 34 78 29 0 Sex—101 males; 53 females. 46 79. Occupation. Of the 101 notified males, 28 were Arsenal employees. The Department and Workshops affected are as follows:— Eoyal Laboratory 4 Building Works Dept. 2 Electrical Branch 3 Torpedo Factory 1 Danger Buildings 1 Central Office 1 Royal Carriage Dept. 3 Naval Ordnance Dept. 1 Royal Gun Factory 1 Royal Dockyard 4 Army Ordnance Dept. 2 80. Bacteriological diagnosis. Sputum from 175 cases of suspected phthisis was examined at the Lister Institute, and tubercle bacilli were found in 54 cases. The number of examinations for the five previous years was 144, 116, 130, 130, and 171, respectively. 81. 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). 82. Disinfection was performed by the Public Health Department at 157 premises, compared with 142, 169 and 165, in the three preceding years. Of these, 93 were disinfected after the death of the patient, and 64 after removal to hospital, sanatorium, or other opportunity. 83. Sanatorium Treatment.— All the Council's seven beds at the Peppard Sanatorium were kept occupied throughout the year. There were generally more patients anxious to go than could be accommodated. The male applicants greatly outnumbered the female. 38 patients were admitted, and 38 discharged. Of those discharged, 14 stayed for one month, 8 47 for two months, 6 for three months, 5 for four months, 3 for five months, and 1 for six months. None died at the sanatorium, and all but three returned home in improved general health, and showing a decided increase in weight. Most showed very great improvement, and were able to resume their ordinary duties. 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. 84. The following table, recommended by the Local Government Board, shows the condition in each subsequent year of the survivors from the cases treated in each year. The difference between the sum of the numbers dead and the survivors, and the number discharged, in any year, shows the cases lost sight of. Number of patients discharged in each year who were (A) alive, but not well enough to work; (B) at work, seeking work, or performing their ordinary duties in January of each of the under-mentioned years. Year. Number Discharged. Dead Jan., 1909. 1904. 1905. 1906. 1907. 1908. 1909. a. b. A. b. a. b. a. b. a. b. a. B. 1903 1 1 1 .. 1 .. .. .. .. .. .. .. .. .. 1904 12 7 .. .. 3 6 .. 5 .. 4 .. 3 .. 3 1905 16 9 .. .. .. .. 2 12 2 9 1 5 2 2 1900 29 7 .. .. .. .. .. .. 3 26 2 20 4 16 1907 38 12 .. .. .. .. .. .. .. .. 10 20 3 18 96 36 1 .. 4 6 2 17 5 39 13 48 9 39 Some half-dozen of those recorded as at work are employed at the sanatorium in various capacities, receiving board and a small wage. Several of those not accounted for are believed 48 to be well and at work— one at Lowestoft employed in fishing, others in Canada, Australia, South Africa, &c. The above table accounts for all patients who left the sanatorium up to December 31st, 1907. Out of 96 who have left over one year, 39 are now well and at work, 9 are unwell, 36 have died, and 12 have been lost sight of. Probably the majority of the 12 are also alive, and at work; all deaths registered in London, and many of those registered in the provinces, are communicated to the Medical Officer of Health of the place of previous residence. Two who fell ill in Canada were refused admission into the local hospital and returned to England by the authorities. In one ease at least a few weeks' treatment would probably have enabled the man to resume his work, but the local authorities seem very anxious not to be responsible for emigrants whose health has failed. 85. Sanatorium treatment can nearly always, in cases not advanced, improve health and lengthen life. In order for health to be fully re-established and strength maintained, the cases must be sufficiently early, and suitable conditions of life and employment found. Unfortunately the latter condition can seldom be fulfilled, and hence the large number of recurrences after work has been resumed. Many, too, have suffered from not being able to find work, or have hurried back to work before they were fit, for fear of being discharged. Many are unfit for sanatorium treatment when they first give up work, owing to having persisted at work too long under the same fear. Consumption is largely a question of poverty. 86. 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 49 work and keep well under favourable conditions. 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. 87. The names of 70 applicants were entered on the register during the year for admission to the Sanatorium, compared with 50, 65, and 59 in the three previous years. Of these, 40 have been admitted; 11 were too far advanced to be accepted; 3 were found not to be tuberculous, and one could not afford to give up work. He, like many others, would be obliged to go on working until there was no chance of his recovery. Others were admitted to Convalescent Homes, Consumption Hospitals, other Sanatoriums, or the Workhouse Infirmary, but all received instructions as to means to be taken to promote their own health and avoid infecting others. 88. Twenty-three spitting flasks were supplied at cost price (6d.), compared with 5, 14, 22, and 32, in the four previous years. Cancer. 89. There were 96 cases of cancer (malignant tumour), giving a death-rate of 0.75, compared with 0.75, 0.74, 0.70, 0.90 and 0.83 in the five preceding years. 39 of the deaths were in males and 57 in females. 72 of the deaths were in persons over 55. The highest mortality was in Eltham and Dockyard Wards. The London death-rate was 1.03 in 1907. 90. The following table shews the sex and region affected of all cases of malignant disease:— D 50 Carcinoma. Males. Females Seat of Primary Disease— Head and face — 1 Mouth and tongue 6 — Pharynx, oesophagus, larynx and neck 2 1 Pleura, lung, mediastinum — 2 Stomach and pylorus 12 7 Intestines (excluding rectum) 2 5 Rectum 5 10 Liver 6 12 Kidney and bladder 1 1 Female genital organs — 11 Female breasts — 3 Male genital organs 2 — Pancreas 1 — Undefined 2 — 39 53 Sarcoma. Females. Cerebellum 1 Kidney 1 Multiple 2 4 alcoholism. 91. There were five deaths from alcoholism and 16 from cirrhosis of the liver, making a total of 21 deaths definitely attributed to alcohol, compared with 42, 27, 24, 17, and 18, in the five preceding years. In addition to these there were 346 deaths from diseases of the brain and nervous system (excluding meningitis), heart, blood vessels and kidneys, of 51 which a large proportion were certainly caused directly or indirectly by alcohol. The deaths from these causes in the four preceding years were 335, 336, 347, and 327, respectively. 92. The death rate from alcoholism and cirrhosis of the liver was 0.16 in the Borough, and 0.25 in the County in 1907. There is one licensed house per 658 population in the Borough, and one per 266 in River Ward. Five licensed houses in River Ward, and one in St. Mary's Ward, have been closed under the Licensing Act, 1904. Syphilis. 93. There were 7 deaths from Syphilis, compared with 14, 14, 10, and 9, in the four preceding years. Pour of these occurred in the Workhouse Infirmary, and two in an outlying institution. Two were males, and five females; five were iufants under one year. There were in addition 9 deaths from general paralysis and tabes dorsalis (locomotor-ataxy), diseases which are now considered to be usually due to syphilis, compared with 14 and 15 in the two previous years. These figures are far from representing the total mortality caused by this disease. The fact that six out of seven deaths from syphilis occurred in public institutions indicates that deaths from persons attended by private practitioners, due to this cause, are commonly certified under some other disease. Meteorology. (Sec Table VIII.) 94. The temperature of the winter quarter of the year was nearly normal; it had six weeks with an average temperature above the normal and seven below. The same is true of the spring quarter. D 2 52 The summer quarter had three weeks above the average and ten below; its average temperature was 0.8 degree below the average. In the autumn quarter the temperature was above the average in twelve weeks and below in two. The lowest temperature, 12.1 degrees F., occurred in the last week of the year, and the highest, 88.3 degrees F., occurred in the week ending the 9th May. The rainfall, 23.74 in., was below the average; the deficiency being specially in the autumn quarter. As regards the effect of the weather on health, the year was an average one. The largest number of deaths, 44, took place in the week ending Feb. 22nd; the smallest number of deaths was in the week ending June 13th. 53 PART II. ADMINISTRATION. Water Supply. 1. Iq June, 1908, I reported, as follows: — Plumstead Well. Last year the Metropolitan Water Roard informed the Rorough Council that investigation should be made as to the unsatisfactory condition of the Plumstead "Well. The Water Examination Committee now reports that the well has been kept under close observation by the Roard's officers, who find that the water is much influenced at periods "when excessive pumping is being carried out. Arrangements were made by the Chief Engineer to work the pumps at a slower rate, and as the result of this action the chlorine present in the water has been reduced from about 10 parts to 6 parts per 100,000. The Committee reports the opinion of the Director that neither chlorine nor hardness can reasonably be considered prejudicial to health, and that the well is in every respect chemically satisfactory and bacteriologically a good water. It must be remembered, however, that the importance of the presence of chlorine is due not so much to its being prejudicial in itself as to its being frequently an indication of the access of foreign matter to a water-supply. It was suggested, by an Officer of the Metropolitan Water Eoard, that the cause of the excess of chlorine in the Plumstead Well was that water was being drawn through from the river into the chalk by excessive pumping. As Thames water is impregnated with sewage, this is a very unsatisfactory condition of things, and the Water Roard should not be satisfied until the proportion of 54 chlorine is reduced to that of the average of the Kent Waters. The average amount of chlorine in the Kent waters is less than 3 per 100,000, and last year when the chlorine in the Plumstead Well water was 6 per 100,000, this was far the highest proportion of any of the Kent waters analysed. Further, the chlorine in the water of the well supplying Plumstead Baths, which is only half a mile from the Plumstead Well, was found to contain only 31 parts per 100,000. It is obvious, therefore, that there is no satisfaction to the people of this Borough to know that their water still contains 6 narts of chlorine per 100,000. As regards the hardness of the water, this also cannot be said to be absolutely favourabe to health, but granting that the injury to health by a hard water is slight, it is economically very prejudicial. The fact that the Plumstead well water contains 30 per cent, more total hardness than the other Kent waters, means that 30 per cent more soap is required for all washing purposes. This obviously involves a very considerable pecuniary loss to the inhabitants. Although the Director assured the Committee that in all other respects the water was satisfactory, no evidence is given of this. Last year the Plumstead water contained more than the average amount of ammoniacal nitrogen, albumenoid nitrogen, oxidised nitrogen and oxygen absorbed from permanganate, and presumably this condition is still maintained. I am decidedly of opinion that the Borough Council should not be satisfied with the condition of the water which is mainly supplied in the Borough. It should continue to press the Water Board to close the Plumstead Well, unless it can be made to supply water of as good quality as the average of the other Kent Wells, The Plumstead Well yields far the hardest water supplied in the Metropolis. A report on a proposal to soften the Kent water was presented in November, 1907, to the Public Health and Housing Committee, and printed in the Council's minutes. 55 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, and all houses above Red Lion Lane), which have an intermittent water supply. In these pumping provides a supply from 6 a.m. to 1 or 2 p.m., and from 4 to 6 p.m. 2. Water Supply in Tenement Houses. An additional tap and sink were supplied on at least one upper floor of eighteen tenement houses, under the Public Health (London) Act, Sec. 48, previously to the coming into force of the London County Council (General Powers) Act, 1907, by which a suitable water supply can be required on each separately occupied floor of a tenement-house. Under this Act an additional supply was required and provided at 25 houses during the past year. 11 of these houses were in the Dockyard or St. Mary's Wards, and 10 in the River Ward. 3. Defective and foul storage cisterns were found and remedied at 67 houses, compared with 106, 51, and 77, in the three preceding years. At 40 houses the supply was found insufficient or temporarily cut off. Food and Drugs act. 4. 521 samples were submitted to the Public Analyst, and 13 or 2.5 per cent, were found to be adulterated, compared with 5.7, 8.4, 7.4, 9.3 and 4.3, in the five preceding years. The very small percentage of adulterations is remarkable. 5. Proceedings were ordered in seven cases. Sis convictions were obtained, and one case is still undecided. 56 6. A total of £25 Os. Od. was imposed in fines, and £8 2s. in costs. 7. 357 of the samples were fresh milk, and three separated milk. Six of these, or 1.7 per cent, were adulterated, compared with 6.1, 9.3, 6.5, 8.7, and 4.8, in the five preceding years. 83 samples were bought as butter, and four were found to be adulterated. Table XVIII. shews the other articles analysed. Two samples of coffee and one of camphorated oil were adulterated ; the remainder were genuine. 8. Of the 3 adulterated milk samples for which proceedings were taken, 2 were for abstraction of fat, and 1 for addition of water. 9. Of the 346 milk samples, 105 were taken on Sunday or Bank holidays; none of these were found adulterated. In 1905, 11 per cent, of samples taken on Sunday were found adulterated ; in 1906, 6 3 per cent.; and in 1907, 2 5 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 the same as in 1907, viz., 3.6, and of non-fatty solids 8.8. From 9 to 18 samples were taken in 1907 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. Sampling under the Food and Drugs Acts. On the 1st May I reported as follows :— 57 The Local Government Board has called attention to the large proportion which the number of dairy-produce samples, taken in this Borough, bears to the number of samples of other articles of food and drugs, and enquires the reason for this. In the first place I have to point out that in 1904, immediately preceding the three years mentioned in the letter of the L.G.B., 50 samples of articles other than dairy produce were taken, the total number for the past five years being 126. Out of this number 6 samples were returned as adulterated, or 4-8 per cent, but in not one of these cases of adulteration were proceedings taken. One was a sample of camphorated oil which gave 2-3 per cent, deficiency of camphor, but the deficiency was not considered sufficient to justify a prosecution. Four were samples of brandy, but notices were posted in the houses where they were bought stating that the brandy was not guaranteed to be wholly distilled from grape spirit. One was a sample of coffee which had a wrapper on which it was described to contain a mixture of coffee and cbicory. On the other hand, of the samples of milk taken during the past 6 years, 6.7 per cent, were found to be adulterated and proceedings were taken in the great majority; and of the samples of butter taken during the same period, 7.9 per cent, were adulterated and proceedings taken in almost every case. It appears tben that in this Borough (1) there is less adulteration of non-dairy produce than of milk and butter, and (2) such adulteration as occurs is so covered by the exhibition of legal notices as to render its suppression difficult or impossible. It is further to be noted that the adulterations which are met with of articles other than dairy produce rarely, if ever, are such as to injuriously affect health. The adulterations of spirits which have been met with recently, although a fraud on the purchaser, are by no means prejudicial to health. It is to be regretted that the British Public should not appreciate a good cup of coffee, but it must 58 be allowed that the popular taste seems to be better pleased with a mixture of coffee and chicory, and here again it is difficult to say that their health suffers in any way, and similar observations might be made with respect to other articles. Undoubtedly it is the duty of the Public Health Department, under the Food and Drugs Act, to protect the purchaser independently of considerations of health, and the above remarks are made, not as an excuse for not putting in force the Act as regards articles such as spirits, coffee, etc., but as a reason why, the number of samples being limited, a larger proportion of articles whose adulteration is injurious to health, such as milk, should be taken. It appears that in the Metropolis generally it is the practice to analyse a very much larger proportion of samples of dairy produce than of other articles. According to the 36th Annual Report of the Local Government Board, page 222, it appears that in 1906, 17438 samples, out of a total of 22,400, were milk and butter, or about 78 per cent. In this Borough, in which a very large proportion of the population consists of children, milk and butter form two of the most important articles of diet, and the adulteration of milk very seriously interferes with health. It is, therefore, obviously important that a large number of samples of milk should be taken, It would appear from the report above mentioned that in London generally there has been a larger proportion of adulterations of articles other than dairy produce than in this Borough, but the report unfortunately does not show to what extent prosecutions were instituted for these samples, so that it is not possible to judge as to whether the sampling has led to any practical results. As it would appear from the Local Government Board's letter to be the wish of the Board that a larger proportion of samples of non-dairy produce should be taken, 1 have already given instruction for this to be done. 59 Food Inspection. 11. The inspection of meat and other food received the usual attention. Inspectors Little, Tedham, and Powell, made special inspections in rotation. There were 2 seizures and 77 surrenders. The seizures were four pieces of beef, weighing 59 lbs., on October 1st, at the Workhouse, and one piece weighing 7 lbs. These were condemned by a magistrate and destroyed. Of the surrenders, 3 were tuberculous, 41 unsound, and 21 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 tomatoes. 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. Dairies, Cowsheds and Milkshops. 12. On January 1st, 1908, there were 143 milkshops on the Register; 31 were added and 40 removed during the year, leaving 134 on the Register at the close of 1908. There were 308 inspections made. Owing to the steps taken by the Health Department, requiring persons not to sell milk in unsuitable general shops, the number of milkshops has been reduced from 196 to 134 in four years. 13. Under the L.C.C. (General Powers) Act, 1908, the Council has power to refuse to register, and to remove from 60 the register, shops which are unsuitable for the sale of milk. During 1908 one application was refused, and five shops were removed from the register under the Act. In other cases the requirements of the Health Department for securing the purity of the milk were complied with. 14. The number of cowsheds remained as before, 17. These were all inspected 4 times, and 12 notices were served for dirty conditions, &c. There were no prosecutions. Slaughterhouses. 15. There are 11 slaughterhouses on the register, 56 inspections were made, and 4 notices served and complied with. Nuisances. (See Table XV.a.) 16. 399 complaints of sanitary defects were received and investigated compared with 380, 498, and 366, in the three preceding years. Eighteen complaints of non-removal of dust were made and attended to, compared with 40, 43, and 43, in the three preceding years. Three of the dust complaints came from Woolwich Parish, 8 from Plumstead, and 7 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. Sixteen defective combined drains were investigated and reported on by the Chief Sanitary Inspector, compared with 26, 25 and 29 in the three preceding years. These drains affected 128 houses. 61 371 private drains, found choked and defective, were examined, cleared and relaid, compared with 590, 557, and 451, in the three preceding years. The majority were found in the River, Dockyard, St. Mary's, Burrage and Glyndon Wards. 944 water-closets and W.C. cisterns were repaired, compared with 1278, 931, and 1131, in the three preceding years. 193 foul W.C. pans were cleansed by tenants, compared with 247, 160, and 175, in the three preceding years. 18. Ventilation of the New Outfall Sewers. At a conference of representatives of Deptford, Greenwich, Lewisham and Woolwich Borough Councils, and certain local bodies, it was decided to send 6 delegates to the Main Drainage Committee of the London County Council to call their attention to the various nuisances caused by the road level ventilators on the new outfall sewers, and ask them to adopt some remedy. The deputation attended on the 20th February. Councillor Harper and your Medical Officer of Health were the Woolwich representatives, but the former was unable to attend. Councillor Stone, Ex-Mayor of Greenwich, was the chief speaker, and a few words were added by the Medical Officers of Health of Greenwich and Woolwich. The deputation met with a very sympathetic hearing, and were promised that the L.C.C. would erect shaft ventilators wherever the Local Authorities will find suitable sites. As there is no agreement as to the satisfaction given by any special forms of ventilators, this is the only practical step which could be asked of the L.C.C. It was, however, suggested that they should make experiments in particular methods of ventilation, but this the Committee did not seem inclined to undertake. The Works Committee was asked to arrange for suitable sites for shaft ventilators and submit them to the L.C.C. 62 Nuisance from one of these ventilators in Artillery Place was complained of by the Garrison, and the L.C.C. promised to provide a remedy. As a result one of Mr. Reeves' patent ventilators was fixed, and has certainly to some extent mitigated the nuisance. Mr. Reeves says of these ventilators— "The principle on which they work is the production of chilled and chemically saturated air, which prevents the formation of sewer gas." I consider they are worthy of further trial. 18a. Supervision of Drainage. The question as to the responsibility for supervision of reconstructed drains has been for years occasionally the cause of some difficulty between the Public Health and Works Departments. Certain occurrences at Eltham led to the necessity of reconsidering the understanding between the two departments, and the By-laws on the subject. The matter was considered by the Public Health, Works, and General Purposes Committees, and the following recommendation to the Council was passed by the General Purposes Committee:— That the drainage work be apportioned between the Public Health and Works Departments as set out in the the new By-laws and Standing Orders given below, and agreed between the officers concerned, and for that purpose By-law No. 179 (2) and Standing Orders Nos. 117 & 118 be rescinded, and the following new By-law and Standing Orders substituted therefor- By-law.—The following matters shall be dealt with by the Works Committee:— (2) The construction and the supervision of the construction of all new sewers, new drains and drainage apparatus, the maintenance, repair, and cleansing of existing sewers, the reconstruction and 63 repair of combined drains where work is carried out in default of compliance with notice, the supervision of all drainage work other than that carried out in compliance with a notice served by an officer of the Public Health Department, under the Public Health (London) Act, 1891, or the Metropolis Management Acts, and which does not involve an entirely new system of drainage, the examination of building and drainage plans required to be deposited by law to which approval of the Council is necessary, and the enforcement of all by-laws relating thereto. Standing Order 117. The Medical Officer of Health shall deal with and hereafter be responsible for the repair and reconstruction of drains not involving an entirely new system of drainage as to which notices are served by an Officer of the Pubic Health Department, under the Public Health (London) Act, 1891, or the Metropolis Management Acts, and shall receive and deal with any plans submitted in connection therewith, except in the case of a combined drain where work is carried out in default in compliance with a statutory notice, or where the work proposed to be carried out would have the effect of converting the drain into a combined drain. New Standing Order 118. The Medical Officer shall inform the Borough Engineer in writing in all cases where alterations in any drainage occur from any cause whatever, and, when required, furnish such plans as may be neccessary for the purpose of official record. 64 As this was a rescinding motion it was ruled that a twothirds majority was necessary, and this was not obtained in the Council. As the matters contained in it are only a question of the interpretation of existing by-laws and standing orders, it was agreed between the Borough Engineer and myself that in future the question of responsibility for the supervision of any drainage work should be determined according to the recommendation above given. This new understanding has worked well during the past nine months. 19. Public House Urinals. The urinals attached to public houses and accessible to the public have been regularly inspected during the year, 632 inspections being made. Regular cleansing has been required. 20. House Inspection. 5,384 houses were inspected, houseto-house, compared with 6,160, 4,709 and 6,092, in the three preceding years; 7,600 were inspected re infectious diseases and complaints, compared with 9,604, 10,291 and 7,573. In addition to these, 720 inspections of registered houses were made. 21. Table XVI. shows the streets inspected and number of houses found defective in each. At 2,026 houses interiors were cleansed or defective roofs repaired, compared with 2,693, 2,066, and 2,193, in the three preceding years. 368 houses with damp walls were remedied, compared with 442, 287, and 369, in the three previous years. Improved ventilation was provided in 187 houses, compared with 129 and 117 in the two preceding years. 612 new dustpails were supplied, compared with 444, 498, and 675, in the three preceding years. 65 22. Medical Officer's Inspections. These amounted to a total of 711. Special inspections were made of the cowsheds, milkshops, bakehouses, many of the houses registered under the By-laws, and other tenement houses re water-supply. The other inspections were chiefly on account of tuberculosis, diphtheria and scarlet fever. Special house-to-house inspections were made of Morris Street, Morris Place, Trinity Street, Warwick Street, Harrington Buildings and Stevens Cottages. 23. Overcrowding. 72 cases of overcrowding were found and remedied, compared with 154, 86, and 85, in the three preceding years, or 1.3 per cent. of house-to-house inspections. Most of the cases of overcrowding are found in house-to-house inspection. 24. Smoke Nuisance. 75 observations on smoke nuisance were made, and 8 nuisances from black smoke observed. The District Chemical Co. was summoned for permitting the chimney of their factory in North Woolwich to send forth black smoke. The nuisance having been abated the summons was withdrawn on payment of £2 2s. costs. The chimney is used in common by this Company and Messrs. Moore and Nettlefold, but the day the nuisance occurred the latter firm were not working. The other nuisances were abated on service of notices. 25. Defective Light—At 119 houses, new windows were supplied, or existing ones enlarged, or other work done to improve the lighting by daylight. 26. Verminous Booms—183 verminous rooms were cleansed, under the L.C.C. General Powers Act, 1904, or were dealt with e 66 as dirty rooms under the Nuisance Section, compared with 156 and 148, in the two previous years. 26a. Windows opening into Conservatories. Cases are frequently met with in which the living-room, in comparatively recently built houses, is insufficiently lighted and ventilated owing to its not opening directly into the open air but into another structure commonly used as a scullery. Such condition is very much opposed to health, both the darkness and want of complete ventilation tending to deterioration of health, and an increase of consumption and infectious diseases. The London Building Act endeavoured to prevent this insanitary state of things by requiring that every habitable room should have a window opening directly into the exterior air, or into a conservatory, with a total area of at least one-tenth of the floor area, and of which one-half should be made to open. Abuse of this provision has occurred by a lax interpretation of the word "conservatory." No definition of this word is given in the Act, but what is popularly understood by it is "green-house or place for keeping exotic plants," and this is one meaning given in Chambers's dictionary. The others are (1) Storehouse; (2) School of music. I think it is obvious that the Act intended it to mean a green-house for plants, but it has been interpreted by builders, and apparently to some extent by District Surveyors, as meaning any structure in which glass takes a large share, and as a result it has become common to erect a structure, with one side aud a roof chiefly of glass, outside one of the back rooms on the ground floor, and use it for a scullery. It appears to me that this is a distinct breach, both of the letter and of the spirit, of the London Building Act, 1894. The 2nd sub-section of section 70, dealing with this matter, states that any person who knowingly suffers any room, constructed after the commencement of this Act, not in 67 conformity with this section, to be inhabited, shall be liable to a penalty for every day during which such room is inhabited. It is not made clear, however, how this sub-section is to be enforced. The authority to take proceedings is the L.C.C., but the District Surveyor, who enforces the principal part of the Act, is hardly in a position to enforce this sub-section. I recommend that the attention of the L.C.C. be called to the matter, and that they be asked to take steps to see that the Act is carried out so as to prevent serious interference with light and ventilation of living-rooms. A communication was sent to the L.C.C. and action has been taken which will probably prevent future lax interpretation of the section referred to. Dust Removal. 27. In Woolwich Parish 6477 loads of house and trade refuse were removed by direct labour, and destroyed at the Woolwich Destructor. In the three preceding years, 6959, 6808, and 7517 loads, respectively, were removed. In Plumstead, 13071 loads, weighing 11156 tons, were removed. by the contractors, Messrs. Tuff & Hoar, and destroyed by the Plumstead Destructor. £2808 9s. 0d. was paid for collection, compared with £2879 in 1907. Messrs. Tuff & Hoar's contract provided for a pro rata increase for new houses but made no provision for diminished work through houses becoming empty. The Contractors were consequently being paid much more than was equitable. On my pointing this out, however, they willingly agreed to a pro rata reduction for empty houses from March 31st, 1908. In Eltham the sum of £792 19s. 7d. was paid to the contractor, Mr. Tucker, for removal of Eltham dust, which was 68 deposited on fields in the parish. Mr. Tucker's attention was called to the necessity of complying with the requirements of the contract, that all papers, vegetable, or other objectionable matters should be raked off and buried or burnt. Trade Refuse. 28. During the past year there have been 7119 (7747 in 1907) receptacles of offensive trade refuse removed. There are now 58 (57 in 1907) tradesmen on the books from whom offensive trade refuse is removed. There were no complaints of nuisance arising from collection. Chloride of lime is used as a deodorant. The cost of removal was £315 8s. 4d. 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 act. 29. 18 houses were represented as unfit for human habitation under Section 32 of the Housing of the Working Classes Act, viz., 64 High Street, 5 Market Hill, 2, 3, 4, 5, Stevens' Cottages, 16 Godfrey Street, 30, 32, 34, 35, Trinity Street, 1 to 6 Harrington Buildings, and 55 Henry Street. Proceedings were taken and Closing Orders made re 64 High Street, 2, 3, 4, 5, Stevens' Cottages, 16 Godfrey Street, and 55 Henry Street. The other houses have been or are being put in habitable condition by the owners without the service of notices. 55, Henry Street, was demolished. The condition which made 1—6, Harrington Buildings unfit for habitation was the want of a proper water-supply. This has been remedied by turning. No. 1 into a washhouse. 69 Statistics of Special Areas. 30. Inspection of Morris Street and Morris Place.—I have made a special inspection of Morris Street and Morris Place, and calculated certain death rates for the seven years, 1901/7. Morris Place and Street consist of 40 small four-roomed houses, four of which were found to be unoccupied. The following are the death statistics :— Population on Inspection 233 ,, Census, 1901 295 Average 264 Statistics, 1901-7. Year. Total Deaths. Under 1 year. 1-5 years. Seven Principal Zymotic Diseases. Phthisis 1901 3 2 .. .. .. 1902 7 2 1 1 2 1903 4 1 1 2 .. 1904 7 2 2 3 .. 1905 2 -.. .. .. 2 1906 5 1 .. .. .. 1907 8 1 3 1 1 36 9 7 7 5 Death Rate 19.5 Zymotic Death Rate 3.8 Phthisis Death Rate 2.7 The death rate for the seven years was found to be 19.5, compared with 13.6 in the Borough. The Zymotic death rate was 3.8, compared with 1.45; and the death rate from Phthisis 2.7, compared with 1.35. The following death rates of special areas have been previously found (but these refer to an earlier period when the Borough death rate was higher):— 70 Princes Road area 23.9 Globe Lane and New Street 29.5 Salutation Alley 42.2 Dicey, Delvan, and James Street 19.4 Fore, Albert, Stanley, and Sidney Houses 20.8 Reidhaven Road area 17.1 If a comparison be made, Morris Street is to be placed, as regards the health conditions, on a level with Dicey Street, Delvan Street, and James Street, and the block of industrial houses in High Street. The following is the result of the inspection:— 33 houses inspected—some defective structure or sanitary defects in all. Dirty interiors (at least two rooms) 15 Defective roof 9 Dilapidations such as to be a nuisance 13 Dampness 5 Defective yard paving 5 Overcrowding 9 Notices have been served for the remedying of the defects found. The necessity for a frequent inspection of such property is shown by the fact that although these houses were inspected in October last, so many were found to be in a seriously insanitary condition. 31. Council's Houses. All the Council's 25 houses in North Woolwich were occupied throughout the year, with the exception of 2 which were vacant 3 weeks, and 2 vacant 1 week. 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. 71 Of the Council's 11 houses in Gossage, Park, and Parkdale Roads, 9 were occupied throughout the year, and 2 were empty all the year, viz., 5, Gossage Road and 72, Parkdale Road. The remedying of the dampness of 3, 5 and 9, Gossage Road has been under the Public Health Committee's consideration. 32. Houses Registered under the By-laws. At the commencement of the year 330 houses were on the register; 38 were newly registered, and 9 taken off the register, leaving 359 on the register at the close of the year, compared with 123, 235, 265, 307, and 332, in each of the five preceding years. 33. These houses were inspected, some quarterly, others half-yearly. 720 inspections were made in all, and 250 notices were served. Proceedings were taken for breach of the Bye-laws at two houses; a fine was inflicted in one case of £1; the other case was withdrawn. 34. 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. Inhabited house duty. 35. One application was received under this Act, for 90, Eltham Road. The certificate required was given, the sanitary arrangements of each tenement being satisfactory. The tenements, however, were not separate, doors, passages and staircase being used in common. The occupants were not persons of the working class. 72 Common Lodging Houses. 36. There are 18 common lodging-houses in the Borough, 16 for men, and 2 for women. Total accommodation for 563 persons is available. The following is the list: — Common Lodging-house. Accommodation. Men. Women. Total. 60 Beresford Street 58 .. 58 5 High Street 40 .. 40 50 do 22 .. 22 56 do 14 .. 14 57 do 18 .. 18 76 & 77 do .. 25 25 81 & 82 do .. 19 19 93 do 30 .. 30 1 Ropeyard Rails 14 .. 14 2 do 17 .. 17 4 do 15 .. 15 7 do 23 .. 23 9 do 32 .. 32 10 do 51 .. 51 10a & 11 do 62 .. 62 21 & 21a do 42 .. 42 4 Warren Lane 31 .. 31 12 4 13 do 50 .. 50 Totals 519 44 563 On the night of the 15th January, 1909, 436 males and 26 females occupied these beds; 83 male and 18 female beds were empty, and 20 males were turned away unable to pay. Underground Rooms. 37. One underground room, separately occupied, in River Ward, was found not in accordance with the Act. The service of notice led to cessation of occupation. 73 Factories, Workshops & workplaces. 38. There were, at the close of the year, 229 (221 in 1907) workshops and workplaces on the register. 331 inspections were made, and 55 notices served and complied with. 30 factories were inspected regarding the sanitary accommodation, and two notices served and complied with. 220 inspections of homeworkers' premises were made, and 11 notices sent and attended to. Miss Middlebrooke devoted a large amount of her time to the inspection of workshops, factories, and houses, where women are employed; 58 new workrooms were measured up and put on the register. 39. 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. 40. The number of bakehouses in use is now 52, 25 being underground. They were all inspected twice. I inspected most of them personally and found them generally satisfactory. Ice-Cream Shops. 41. 108 ice-cream shops were on the register at the close of the year, compared with 87, 68, and 76, in the three previous years. There were 187 inspections made, and 12 notices served. Regulations, embodying the provisions for ice-cream shops contained in the London County Council (General Powers) Act, are distributed at every shop on the register. 74 Disinfection. 42. The mode of disinfection, cost of appliances, staff, etc., were fully described in my Annual Report, 1903, pages 73-76. Rooms at 1133 bouses were disinfected, compared with 910, 987, and 1392, in tbe three preceding years. The disinfecting apparatus was used 886 times for 11,111 articles. 291 books from the Free Libraries were disinfected. The sum of £3 3s. 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 (73 persons were supplied last year); 18, Bargehouse Road, North Woolwich (50 persons supplied last year); and at the Eltham Office, 144a, High Street. The cost of disinfectants used by the department in 1908 was £45 14s. 0d. The disinfectants used were Corrosive Sublimate ; Formalin tablets (for fumigation); Formaldehyde (for spraying and disinfecting books, and for use in the Mortuary); Cyllin (for sputa in phthisis); Permanganate of Potash; Coarse Carbolic (for dust-pails); and Chloride of Lime (for offal tins). Health Shelter. 43. The Health Shelter was used once for three persons. The Health Shelter was used twice in 1906, and not at all in 1903, 1904, 1905 and 1907. In view of the small use to which it is put, the upper of the two flats was let in the spring, and has been occupied since on a weekly tenancy. 75 The Mortuaries. 44. The Sun Street Mortuary was used for 151 bodies, compared with 190, 162, and 171, in the three preceding years. 133 were deposited for inquest and 18 for custody. 83 postmortem examinations were made. One body was deposited in the infectious mortuary, compared with two in 1907. The Eltham Mortuary was used for one body brought for custody only, compared with 4 in each of the two preceding years. Cemeteries. 45. The two Borough Cemeteries were well maintained as usual. 609 bodies were buried in the Woolwich Cemetery, compared with 611, 669, and 670, in the three previous years. There were 656 interments in the Plumstead Cemetery, compared with 789, 745, and 753, in the three previous years. Only 22 burials took place in Plumstead Churchyard, compared with 123, 62, 60, and 40, in the four preceding years. Cleansing of Verminous Persons. 46. 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. In 1908 baths were taken by 262 persons, viz., 101 adult males and 161 children; 186 for verminous bodies, and 76 for verminous heads. 1,226 articles were disinfected, and the disinfector was used 182 times. The adults came mainly from common lodging-houses, and the children were mostly sent from County Council Schools. The construction and modus operandi of the Station were fully 76 described in the 1906 report. It is to 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 patronise the bath. The need of a female is also noticed for the children, who come in large numbers. It is often very difficult to get the mother, 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. The following directions for using the bath are posted in the Station:— "METROPOLITAN BOROUGH OP 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. 77 (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 DAVIES, Medical Officer of Health." Tents, Vans, and Sheds. 47. Daring the year, 26 tents, vans, and sheds, were inspected (102 in 1907), and 2 notices served. Infants' Milk Depot. 48. The staff of the Depot consists of a Manageress (Miss Bagshaw), two female assistants, a man who delivers the milk by horse and van, and assists with the boiler, and a boy who has a hand barrow. A full report on the work of the depot will be found in an Appendix. Messrs. Higgs having given notice to terminate their contract to supply milk, on December 31st, Mr. Chard of Little Heath, entered into a contract to supply milk on similar terms at 1s. per gallon in winter and 11½d. in summer. Public Ambulance 49. The public ambulance for accidents and non-infectious illness, was used 143 times, compared with 90, 97,110, 104, and 122, in the five preceding years. The following were the journeys made:— 78 To Guy's Hospital 26 Cottage Hospitals 24 Seamen's and Miller Hospitals 6 King's Hospital 12 St. Thomas's Hospital 8 London „ 9 Charing Cross „ 9 Union Infirmary 4 Other hospitals 21 Private houses 14 Particulars as to this ambulance were given in my Annual Report 1903, page 78. The ambulance is kept in good repair. Mr. Lewis having left the district, Mr. Sutton Messent was appointed by the trustees as treasurer, and Mr. Kelham having deceased, Mr. Driver, J.P., has succeeded him as one of the trustees. Notices and Prosecutions. 50. 3113 written intimation notices and 499 statutory notices were served. 67 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 one defaulter was summoned at the Police Court. The nuisance having abated, the summons was withdrawn on payment of £2 2s. Od. costs. Bacteriological examinations. 51. 1,020 bacteriological examinations were made for the Public Health Department by the Lister Institute, viz., 828 for diphtheria, 175 for phthisis, and 17 for enteric fever. The total cost was £164 14s. 10d., compared with £141in 1907. 79 Women Sanitary inspectors' Work. 52. The following is a summary of Miss Middlebrooke's work for the twelve months:— Houses Let in Lodgings. Total number on register 359 Number of Inspections 720 Re-inspections (estimated) 1,800 ,, Found satisfactory 151 ,, Notices served 250 ,, Nuisances, defects and offences against the By-laws dealt with and remedied 884 ,, Cases of overcrowding remedied by redistribution without notice 8 ,, Houses measured 47 „ Prosecutions 2 Notices. On Landlords for Cleansing 162 ,, Tenants for Cleansing 229 ,, Landlords for Overcrowding 2 „ Tenants for Overcrowding 53 ,, Landlords and Tenants for other defects 658 ,, Landlords and Tenants for Verminous Rooms 67 Women's Lavatories at Railway Stations, &c. Number of inspections 51 ,, Pound defective and dirty 7 Restaurants and Eating Houses. Number of inspections 85 ,, Defects and dirty conditions found and remedied 30 80 Factories and Workshops. Number of inspections of Factories 7 ,, ,, ,, Workshops 207 „ Notices served 21 ,, New workrooms measured . 58 Homeworkers' Premises. Number of inspections 220 ,, cases referred to district inspectors 11 Total number of houses visited re Phthisis, Measles, and Zymotic Enteritis 148 ,, Visits paid for various causes, viz., complaints, and verminous and dirty houses and bedding 573 ,, Intimation Notices served 311 ,, Statutory 98 ,, Cases referred to District Inspectors 177 ,, Dustbins supplied 66 ,, Accumulations of refuse removed 28 ,, Oases where animals were kept in such a state as to be a nuisance 9 ,, Re-inspections (excluding registered houses) estimated 500 ,, Early morning inspections 7 Miss Middlebrooke describes the nature of her work as follows:— Satisfactory results have been obtained from the continued supervision of the registered houses. Great improvement has been noticed in the state of the bedding, etc. in some of the houses. There has been less tendency to overcrowd the rooms, and efforts are made to separate the older children of different sexes. 81 A water-supply on the upper floors, where occupied by a separate family, has been provided, as required by the London County Council (General Powers) Act. This encourages the lodgers to keep their rooms cleaner than they would if the water had to be carried some distance instead of being close to hand. A strict supervision is maintained over negligent and dirty lodgers to prevent abuse where a separate water supply and sink are provided, to prevent the sinks from becoming foul and nuisance arising. Where there are young children, the parents are warned against leaving the children in a room with an unprotected fire. In one instance, two children, aged respectively two and three years, were left quite alone for hours in a room with a fire without a fire-guard on: and in another instance, in addition to there being no fire guard, the kettle placed on the stove was boiling over. The latter case was referred to the N.S.P.C.C. Society, the mother being in the habit of spending most of her mornings in the public house, and leaving her five children (ages ranging from ten months to eight years) to manage as best they could. Animals are often a great source of nuisance in a house occupied by several families. Very often one finds four or five cats of uncleanly habits in a tiny room occupied by one person for sleeping and living purposes. In one very dirty house a donkey was found occupying the scullery. A satisfactory remedy was brought about in all cases. The work in respect of verminous conditions is increasing and takes up much time, numerous revisits being necessary to effect a lasting improvement. There is great difficulty in dealing with these cases owing to the fact that the London County Council (General Powers) Act, whilst giving power to deal with verminous premises (i.e., structures), makes no provision for dealing with verminous bedding, etc. f 82 54. The following is Miss Fitz Gerald's report:— Summary of Inspections. Visits to houses after notifications of births 1767 Re-visits 317 Visits after infant deaths 97 Visits re Zymotic Enteritis 124 Re-visits 30 Visits to depot-fed infants 904 Special visits 74 Reported to District Inspectors— Structural defects 8 Other defects 7 Dirty interior walls 6 Overcrowding 2 Other matters 19 "Visiting the homes where births have occurred has been carried on in 1908 under somewhat different conditions from previous years. The Notification of Births Act was adopted in Woolwich and came into force on March 2nd. Under this Act it is the duty of the father, or of any person in attendance on the mother within 6 hours of the birth of a child, to notify the fact to the Medical Officer of Health within 36 hours. 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. The great advantage derived from the Act is that we know of all births within a very short time of their occurrence, instead of, as formerly, having to wait until the lists of births registered were received from the registrars. From that time 6 or 7 weeks had usually elapsed. Now it is possible to visit as soon as the lying-in period is over. I consider it wholly inadvisable to visit during that period. 83 About half the cases were notified by midwives, one-sixth by doctors, and one-third by the fathers. I do not find that many of the mothers are aware of the notification, consequently the way is not prepared for my visit in the manner in which I thought it would be wheu the Act came into force Although the Notification of Births Act gives a kind of indirect legal sanction to the visitation of homes where births have occurred, it does not confer any power of eatry upon the Health Visitor, nor is it at all desirable that it should do so. But, at the same time, the very absence of definite legal powers, and definite legal limitations, increases the responsibility and difficulty of the work. I make it an invariable rule never to enter without asking permission, and once inside one has to use much tact and sometimes diplomacy if it becomes necessary to make suggestions where the feeding and treatment are unwise; and still more so in calling attention to such serious matters as a dirty feeding-bottle or a general lack of cleanliness. A full account of the work was given in the Beport for 1906, but briefly the matters on which one concentrates attention in visiting new-born infants may be summarised as follows:— Feeding (especially urging the importance of breastfeeding); clothing; the cleanliness of the child and its surroundings; the need of fresh air; the danger of giving drugs and alcohol (except under doctor's orders); and the risks attending the use of teething powders and soothing mixtures. Where it seems necessary, some simple advice on the hygiene of the home, including (if opportunity is given) the choice and preparation of cheap and nutritious food, is offered. At a time when distress is so prevalent, it is most important that the money which is available for food should be spent to the best possible advantage. f 2 84 In infant visiting attention is not wholly restricted to the latest baby. The condition of the older children, especially those under school age, is noted. It is very common to find children suffering from various ailments for whom no medical advice has been obtained. Such neglect has now been made a penal offence. The condition of the children of two years of age and upwards is often the best guide to the advice one should give the mother about the new baby. It is not at all uncommon to find a mother with a healthy baby at the breast, and older children looking pale and sickly, and perhaps suffering from rickets. A little questioning generally elicits the fact that they have been prematurely weaned, and fed upon starchy food or condensed milk; or they may have been breast-fed for nine months or so, and then put straight away upon practically an adult diet. One endeavours then to see that the same thing does not happen with the latest baby. I have been impressed by the frequency with which it happens, that those families where I have had most trouble on accouut of the improper feeding of the baby are just those where the help of the Invalid Children's Aid Committee has been sought on behalf of one or more older children suffering from rickets, debility, or other ills. The aim of health-visiting is not only to prevent deaths of infants, but also the permanent injury of the survivors which may result from unwise treatment in infancy. One side of the work has developed very much during 1908. This is the weekly weighing of infants and advising mothers at the Milk Depot on Thursday afternoons. It is open to any mother, who promises to attend regularly, to bring her child to be weighed, and to obtain any advice she may need as to its rearing. The Depot on Thursday afternoons thus serves the purpose of an "Infant Consultation," an institution that is very popular on the Continent, and of great service in the saving of infant lives. 85 I find that the opportunity to see the mothers and weigh the babies at the Depot at regular intervals is a most valuable adjunct to the work of visiting the infants at home. For one thing it saves much visiting, and is therefore an economy in time. For another, although the actual weighing is but a rough test of the child's well-being, it enables one to watch its general condition, and to give instructions to the mother in the way she assimilates it best, namely, by degrees, and as the child grows and develops. An invitation to mothers to bring their babies to be weighed is printed on the card of instructions on infant rearing which is sent by post to every home in the Borough where a birth is notified. The Matron of the Home for Mothers and Babies also urges her patients to bring their babies for weighing. I think there is a great deal to be hoped for from the development of this side of the work, and from the fact that the women are in increasing numbers coming to ask for instruction, realising that they need it, instead of being content to passively submit to knowledge being carried to their doors. It is frequently necessary to urge a mother to get medical advice for her baby, but never in any circumstances is a doctor's advice interfered with. It may be necessary to show her how to carry out the doctor's instructions, and it is very often necessary to urge her to perseverance and regularity in carrying out his recommendations. It is not possible in this, the educational side of sanitary work, to tabulate results, as may be done in the more purely administrative branches, but there are not lacking signs that the work done is bearing fruit. I should like to be able to devote still more time to re-visiting in those homes where apathy, dirt, and disorder, reign. The women are visited as often as as possible, but they need the perpetual encouragement which only personal influence, repeated at very frequent intervals, 86 can give. As I stated in last year's report, a very large amount of time has to be devoted to visiting depot-fed infants, in order to make sure that the modifications supplied are adapted to the individual needs of each child, and to secure the proper carrying out of the rules by the mother. This is absolutely necessary to make a depot really efficient, but it absorbs time that could be used in other directions." It will be seen from the table above that owing to the increased work of the Milk Depot, Miss FitzGerald has not been able to visit so many houses where births have occured. The need of an additional woman inspector is becoming increasingly obvious. National union of Public Health Authorities. 55. On the invitation of the Newcastle-on-Tyne County Borough, a conference was held in November, 1907, which led to the establishment of a National Union of Public Health Authorities. Tour Council's representatives—Mr. Councillor Wakelen, the Town Clerk, and myself, took an active part in the establishment of the Union, which has 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 87 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. Subscriptions were fixed according to population, that for Woolwich being £3 3s. 0d. The Health Committee resolved not to incur this expense and the connection of the Borough Council with the Union has accordingly ceased. Child-Birth and Industrial employment. 57. In May, 1907, His Majesty's Home Secretary invited my co-operation 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. Miss FitzGerald is obtaining, in the course of her other duties, information on this question in River Ward (See also Annual Report, 1907). Russian Baths. 58. I presented the following report in May:— "The Borough Council has provided, at the Plumstead Baths, a vapour bath known by the name of "Russian." In this bath bathers are exposed to a high temperature in moist air. The bath is prepared for them but the attendant then goes away and can only be summoned by a bell. No printed directions or advice are supplied, and bathers are at liberty to stay in the bath as long as they like. The bath may be used for cleansing but is probably most often used for healing purposes. It exerts a depressing effect on the action of the 88 heart in proportion to the time spent in the hot chamber. This may be very serious to people with a weak heart, and it is advisable that no delicate persons should use the bath, and no one at all should stay in beyond a very limited time, except under definite medical advice. Directions should be prepared and posted in the bath, and the attention of bathers should be specially drawn to them." Conference on Infant mortality. 59. The second National Conference on Infant Mortality was held at the Caxton Hall, Westminster, on the 24th and 25th March, 1908. I attended as your representative. The conference was largely occupied by the consideration of intemperance, ignorance, and general neglect, of parents and others having the care of children, as affecting the health of infants. Several resolutions were passed, including the following:— That this Conference expresses its appreciation of Parliament having passed the Notification of Births Act, 1907, and urges upon all Local Authorities the importance of adopting the Act and appointing qualified women to carry out its provisions. That, in order to combat the prevalent ignorance resulting in wastage of infant life and injury to the health of many survivors, the Conference urges upon the Board of Education, and upon Educational Authorities generally, the importance of securing to all girls in every grade of school a satisfactory training in domestic and personal hygiene. That the Conference welcomes most gladly the Children's Bill, introduced into the House of Commons by Mr. Herbert Samuel, M.P., for the amendment of the 89 Infant Life Protection Act, 1897, and recommends tbe Executive Committee to ask that the Bill be specially amended to include the cas6 in which one child only is put out to nurse for reward; and that the Bill be further amended to empower Local Authorities to charge upon the rates the cost of carrying out the existing statutory provisions for the prevention of cruelty to children. That the Conference, being convinced of the injury done to infant life and health through infants being taken into public-houses, urges upon Parliament the necessity of providing such legislation as will prevent this. That all preparations offered or sold as foods or drugs for infants should be certified by a Government Analyst as non-injurious, and that each packet should contain its analysis. That, in view of the unsatisfactory conditions under which milk is produced and distributed, the Conference, being of opinion that immediate amendment of the law is desirable, urges upon Parliament the necessity of at once taking such steps as are necessary to effect this." The Eltham Branch Office. 60. The Eltham Sanitary Inspector's Office was moved from 112 High Street. Messages are now left and the Inspector calls daily to see visitors by appointment at the Eltham Library. Arrangements have been made with Messrs. B. W. Smith & Co., 144a, High Street (opposite the Library), to supply disinfectants provided by the Council, for a weekly rent of 2/-. 90 Public Health Staff. 61. There was no change in the staff of the department during the year, but in February, 1909, Mr. Triggs, Clerk, resigned, and Mr. H. Smith has been appointed in his place. In the same month Inspector Woolley died, after a long and painful illness, and I take this opportunity of acknowledging his devoted service, during 19 years, to the Local Authority. Mr. H. Shaw has been appointed in his place. I have to acknowledge, with thanks, the valuable assistance of Chief Inspector Duck and the other members of the staff, who have loyally co-operated with me in maintaining the high standard of the sanitary administration of the Borough. The foregoing report shews how great and extensive is the amount of work with which they have to deal. 91-92 TABLE I. Borough of Woolwich. Vital Statistics of the whole District during 1908 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. Net Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1000 Births Registd. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1898 110273 3269 29.6 472 144 ... ... ... ... ... 1935 17.5 1899 113148 3867 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 1907 3295 25.4 367 111 1479 ... 296 50 184 1613 12.5 Average for years 1898 to 1907 121069 3479 28.7 437 126 ... ... ... ... ... 1773 14.7 1908 127648 3082 24.1 292 95 1374 ... 333 60 170 1487 11.6 * 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 infirmity, such as hospitals, workhouses and lunatic asylums. Area of District in acres (exclusive of area covered by water) 8239.7 Total Population at all Ages117,178 Number of Inhabited Houses 18,086 Average Number of Persons per House 6.47 At Census of 1901. 93 TABLE IA. I. II. Institutions within the District receiving Sick and Infirm Persons from outside the District. Institutions outside the District receiving Sick and Infirm Persons from the District. Woolwich Union Infirmary Lewisham Infirmary Royal Arsenal Hospital Herbert Hospital Auxiliary Hospital Blackheath Cottage Hospital Woolwich and Plumstead Cottage Hospital Seamen's 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 Bee do. Darenth do. Caterham do. Stone do. Banstead do. Horton do. Hostel of God do. 95—96 TABLE II. Vital Statistics of Separate Localities, 1901-2-3-4-5-6-7-8. 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. 1908. 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 }ear. 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 7800 ... 120 28 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 9788 ... 110 23 River N. 14504 416 292 66 | N. 3450 135 66 26 3450 140 50 16 3991 155 71 30 3991 141 72 31 8991 135 62 19 3841 150 55 19 3901 ... 54 15 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 10188 ... 176 32 St. 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 7314 ... 95 21 Burrage 9837 253 133 24 9837 228 154 28 9837 235 133 17 9726 219 123 23 9726 217 119 17 9726 201 140 27 9726 202 109 16 9184 ... 142 15 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 9444 ... 96 19 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 13173 ... 137 23 Central 10220 299 142 36 10263 341 138 46 10263 276 99 26 10228 267 87 24 10228 233 99 20 10061 248 102 20 10100 198 100 22 9500 ... 93 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 9106 ... 130 22 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 25000 ... 232 56 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 13200 ... 131 20 97 TABLE III. Cases of Infectious Disease notified daring the year,-1908. 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. Barrage. 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 362 6 89 220 24 22 1 41 19 23 21 20 21 33 16 19 14 113 22 321 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 596 4 132 372 63 25 ... 17 69 28 9 27 16 93 21 39 71 154 52 ... 515 Typhus ,, ... ... • • • • • • ... • • • ... ... ... ... ... ... .. . ... ... ... ... ... ... ... ... Enteric „ 19 ... 1 2 4 12 ... ... 1 ... 1 ... 6 3 1 1 ... 1 4 6 14 Relapsing,, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued,, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal „ 6 ... ... ... 2 4 ... ... 1 ... • • • ... • • • 1 ... 1 ... 1 2 ... ... Erysipelas 90 3 7 8 4 57 11 5 3 3 5 1 10 7 7 10 15 20 4 ... ... Plague ... • • • ... ... ... ... • • • ... • • • ... ... ... ... • • • • • • • • • ... • • • ... ... ... Cerebro spinal Meningitis 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Totals 1074 13 229 602 98 120 12 63 93 54 36 48 53 138 46 70 100 289 84 6 851 99—100 TABLE IV.—Causes of, and Ages at Death during the Year 1908 (53 weeks). 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. Over 75. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 10 4 6 1 9 ... ... ... ... ... ... ... ... ... ... Scarlet Fever 9 5 4 ... 4 2 1 1 ... ... 1 ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 29 10 19 2 1 ... ... 2 ... 3 2 2 4 8 5 Whooping Cough 32 10 22 13 19 ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 20 6 14 1 10 7 1 ... ... ... ... ... ... 1 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea and Dysentery 9 4 5 8 ... ... ... ... ... ... ... ... ... ... ... Epidemic or Zymotic Enteritis 37 22 15 31 6 ... ... ... ... ... ... ... ... ... ... Enteritis 11 8 3 7 2 ... ... ... 1 ... ... ... ... ... 1 Other Continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 7 3 4 1 ... ... ... ... ... ... 1 ... 3 2 ... Puerperal Fever 2 ... 2 ... ... ... ... 1 ... ... 1 ... ... ... ... Other Septic Diseases 9 9 ... ... ... 1 ... ... 1 1 2 1 3 ... ... Syphilis 7 2 5 5 ... ... ... ... ... ... ... 1 1 ... ... Rheumatism 6 3 3 ... 1 1 1 1 1 ... ... 1 ... ... ... Gout 2 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Meninges 27 14 13 4 13 7 1 ... ... 2 ... ... ... ... ... Tuberculosis of Lungs (Phthisis) 159 103 56 1 3 ... 3 12 10 42 43 29 12 1 3 Tuberculosis of Intestines and Peritoneum 13 8 5 2 5 1 2 1 ... 1 1 ... ... ... ... Other forms of Tuberculosis 29 16 13 5 7 3 1 6 1 3 2 ... ... 1 ... Alcoholism 5 3 2 ... ... ... ... ... ... 1 ... 2 1 1 ... Cancer 96 39 57 ... ... ... ... ... ... 1 8 15 31 27 14 Diabetes 13 10 3 ... 1 ... ... ... 1 1 ... 1 5 9 2 Premature Birth 72 41 31 72 ... ... ... ... ... ... ... ... ... ... ... Developmental Diseases 55 30 25 51 4 ... ... ... ... ... ... ... ... ... ... Old Age 84 34 50 ... ... ... ... ... ... ... ... ... 1 14 69 Meningitis 14 7 7 1 6 2 2 2 ... 1 ... ... ... ... ... Inflammation and Softening of Brain 5 4 1 ... ... ... ... ... ... 1 ... ... 2 9 ... Epilepsy 5 2 3 ... ... ... ... ... 2 1 ... 2 ... ... ... General Paralysis 8 7 1 ... ... ... ... ... ... ... 3 3 ... 1 1 Tabes Dorsalis and Locomotor Ataxia 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Peripheral Neuritis 3 ... 3 ... ... ... ... ... ... ... 1 ... 9 ... ... Other Diseases of Brain and Nervous System 39 21 18 16 5 2 ... 1 ... 1 ... 4 2 3 5 Organic Diseases of the Heart 120 61 65 ... ... 3 3 3 1 13 15 20 16 33 19 Cerebral Haemorrhage, Embolism and Thrombosis 62 23 39 ... ... ... ... ... 1 ... 2 5 15 23 16 Apoplexy and Hemiplegia 13 7 6 ... ... ... ... ... ... ... 1 2 2 5 3 Other Diseases of Blood Vessels and Heart 42 17 25 1 ... ... 1 ... 1 ... 2 5 11 10 11 Acute Bronchitis 62 29 33 28 9 1 ... ... ... ... 1 ... 5 5 13 Chronic Bronchitis 72 35 37 ... ... ... ... ... ... ... 1 4 12 24 31 Lobar (Croupous,) Pneumonia 10 5 5 ... 2 ... ... ... ... 2 1 1 2 2 ... Lobular (Broncho) Pneumonia 47 26 21 20 13 2 ... ... ... ... 1 3 1 3 4 Pneumonia 37 22 15 4 5 5 ... 1 ... 4 4 3 6 5 ... Other Diseases of Respiratory System 6 2 4 ... 1 1 ... ... ... ... 1 ... 1 2 ... Diseases of Stomach 18 10 8 4 ... 1 ... ... ... 3 1 2 1 5 1 Obstruction of Intestines 16 12 4 2 ... 1 2 ... 1 ... 1 3 2 3 1 Cirrhosis of Liver 16 6 10 ... ... ... ... ... ... ... 1 7 5 3 ... Other Diseases of the Digestive System 14 8 6 1 ... 2 1 ... 2 3 ... 1 2 1 1 Nephritis and Bright's Disease 42 24 18 ... ... 1 1 2 3 ... 5 7 10 8 5 Tumours and other Affections of Female Genital Organs ... 3 ... ... ... ... ... ... ... 2 ... ... 1 ... Accidents and Diseases of Parturition 7 ... 7 ... ... ... ... ... 1 3 3 ... ... ... ... Deaths by Accident or Negligence 42 28 14 8 7 3 ... 2 I 5 2 1 4 4 5 Deaths by Suicide or Homicide 14 10 4 ... ... ... ... ... 3 2 6 1 ... 2 ... Deaths from ill-defined causes 11 6 5 5 1 ... ... ... ... ... 2 ... ... 3 ... All other Diseases 36 25 11 4 ... 5 1 1 2 2 4 8 3 4 2 Totals 1516 786 730 298 134 51 21 36 33 96 123 134 166 212 212 N-B.—These figures should be reduced by 1/53 before comparing them with previous years. 101—102 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. Bnrrage. Eltham. North. South. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 ... 3 1 ... ... ... 1 ... ... 1 3 ... 2 Scarlet Fever ... 2 ... ... ... 5 ... 1 ... ... 1 ... ... 8 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza ... 5 1 3 1 6 2 2 4 3 1 1 4 1 Whooping Cough 1 2 2 3 6 10 1 2 1 2 1 1 5 ... Diphtheria and Membranous Croup ... 1 ... 2 2 6 1 ... 3 1 2 2 ... 16 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... 1 1 ... 1 1 1 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa and Dysentery ... 1 1 ... ... 2 ... ... 3 1 1 ... 2 ... Epidemic or Zymotic Enteritis 5 4 7 ... 2 12 1 1 ... ... 4 3 2 1 Enteritis 1 2 ... 2 1 2 ... 1 ... ... ... 2 1 1 Other continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 ... ... ... ... 3 1 ... 1 ... 1 ... 3 ... Puerperal Fever 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Other Septic Diseases ... ... 1 ... 1 1 ... 1 ... 2 1 2 3 3 Syphilis ... 2 1 1 ... ... ... 1 ... 1 1 ... 4 2 Rheumatism 1 1 ... ... ... 1 ... 1 2 ... ... ... 1 ... Gout ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Meninges 3 2 4 1 2 5 1 3 1 1 2 2 2 1 Tuberculosis of Lungs (Phthisis) 3 31 9 6 11 27 3 14 20 7 21 7 50 15 Tuberculosis of Intestines and Peritoneum ... 1 1 1 ... 2 2 1 3 ... ... 2 ... 5 Other forms of Tuberculosis 2 2 1 6 ... 7 1 6 ... ... 2 2 8 7 Alcoholism ... ... 2 1 1 ... ... ... ... 1 ... 2 1 Cancer 4 12 13 6 8 6 7 7 8 3 6 16 25 10 Diabetes ... 3 ... ... 1 1 3 ... ... ... 3 1 3 ... Premature Births 7 4 5 4 7 12 6 2 5 9 1 10 10 1 Developmental Diseases 2 6 2 2 4 14 6 5 5 4 2 3 3 4 Old Age ... 11 3 10 3 13 7 14 9 6 7 1 35 4 Meningitis ... 1 4 ... ... 2 1 2 1 1 1 1 1 3 Inflammation and Softening of Brain ... ... ... ... ... ... 1 ... ... 1 2 1 2 2 Epilepsy 1 1 ... ... ... 2 ... ... ... 1 ... ... 1 ... General Paralysis ... 2 1 ... ... ... 2 1 ... 1 1 ... ... 6 Tabes Dorsalis (Locomotor Ataxia) ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Peripheral Neuritis 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... Other Diseases of Brain and Nervous System ... 4 1 3 3 5 6 2 2 3 9 2 4 6 Organic Diseases of the Heart 2 14 14 13 5 18 5 12 11 7 14 11 24 13 Cerebral Hemorrhage, Embolism and Thrombosis 4 2 3 3 2 9 3 5 8 7 9 7 11 2 Apoplexy and Hemiplegia ... 2 2 2 1 1 ... 2 1 1 1 ... 2 ... Other Diseases of Blood Vessels and Heart ... 8 1 3 2 4 1 5 4 3 3 8 4 7 Acute Bronchitis ... 6 7 5 2 10 5 7 9 3 2 6 ... 2 Chronic Bronchitis 5 10 11 3 3 9 7 4 6 4 5 5 17 4 Lobar (Croupous) Pneumonia ... 1 ... 1 1 1 1 2 1 1 ... 1 2 1 Lobular (Broncho) Pneumonia 4 5 7 4 2 10 1 3 7 ... 1 3 7 1 Pneumonia ... 3 ... 6 4 4 5 2 4 3 3 3 5 3 Other Diseases of Respiratory System ... ... 1 ... 2 ... ... ... 1 ... 1 1 ... 1 Diseases of Stomach 1 3 ... 1 1 1 3 1 1 ... 6 ... 3 3 Obstruction of Intestines ... 1 1 2 1 2 1 ... 2 ... 2 4 6 5 Cirrhosis of Liver 1 2 ... 3 1 2 2 1 ... 1 3 ... 6 1 Other Diseases of Digestive System ... 1 ... 1 1 ... 2 2 2 4 ... 1 3 6 Nephritis and Bright's Disease 1 4 1 2 3 5 3 4 4 4 5 6 6 6 Tumours and other Affections of Female Genital Organs ... ... ... ... ... ... ... ... 1 ... ... 2 1 1 Accidents and Diseases of Parturition ... ... 2 ... 1 ... ... ... 1 1 1 1 1 ... Deaths by Accidents or Negligence 3 8 5 3 4 1 1 5 2 2 8 ... 6 10 Deaths by Suicide or Homicide ... 2 1 1 1 4 1 ... 1 ... 2 1 4 2 Deaths from ill-defined Causes 1 1 1 2 1 2 ... 1 1 ... ... 1 2 1 All other Diseases ... 2 1 3 4 5 1 4 1 6 3 6 9 10 Totals 54 176 120 110 95 232 93 130 137 96 142 131 289 180 103—104 TABLE IVb. Infantile Mortality during the Year 1908 (53 Weeks). Deaths from stated Causes in Weeks and Months under One Year of Age. o Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 Year. All Causes— Certified Uncertified Common Infectious Diseases— Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Whooping Cough .. .. .. .. .. 2 1 3 .. .. .. 4 1 1 .. 1 13 Diarrhœal Diseases— Diarrhœa, all forms .. .. .. 1 1 1 4 5 6 2 1 3 6 6 2 2 39 Enteritis, Muco-enteritis, Gastro-enteritis .. .. .. .. .. .. 2 .. 1 .. 1 1 .. .. .. 2 7 Gastritis, Gastro-intestinal Catarrh .. .. .. 1 1 .. 1 .. 1 .. .. 1 .. .. .. .. 4 Wasting Diseases— Premature Birth 50 5 3 4 62 6 2 1 .. .. .. .. .. .. 1 .. 72 Congenital Defects 13 .. 2 1 16 2 1 .. 1 .. .. .. .. .. .. .. 20 Injury at Birth 3 .. .. .. 3 .. .. .. .. .. .. .. .. .. .. .. 3 Want of Breast-milk, Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Atrophy, Debility, Marasmus 4 2 4 3 13 7 2 1 2 1 1 .. .. .. .. .. 27 Tuberculous Diseases— Tuberculous Meningitis .. .. .. .. .. .. .. .. .. 1 1 .. .. 1 1 .. 4 Tuberculous Peritonitis, Tabes Mesenterica .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. 2 Other Tuberculous Diseases .. .. .. .. .. 1 .. 1 1 .. .. .. .. 1 1 1 6 Other Causes— Erysipelas 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Syphilis 1 1 .. .. 2 1 2 .. .. .. .. .. .. .. .. .. 5 Rickets .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 2 Convulsions 4 3 .. 1 8 1 1 .. 1 .. .. 3 1 .. 2 .. 17 Bronchitis 1 .. 4 .. 5 3 4 2 3 1 3 1 .. 1 2 3 28 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. .. .. 2 .. .. 2 2 2 6 3 1 2 4 24 Suffocation, overlying .. .. 1 .. 1 2 1 .. .. .. 1 .. .. .. .. .. 5 Other Causes 1 2 2 .. 5 2 1 1 .. 1 1 .. 2 1 .. 1 15 Reduced to year of 52 weeks 78 13 16 11 118 30 23 14 18 9 12 20 13 14 13 14 298 76 13 16 11 116 29 22 14 17 9 12 19 13 14 13 14 292 Population, Estimated to middle of 1908, 127,648. births in the year: Legitimate, 3,021. Deaths during the year: Legitimate infants, 298 Illegitimate infants, 20. Illgitimate, 61. Deaths from all Causes at all Ages, 1,516, 105 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 0.04 1.7 0.56 7.8 0.42 ... ... 0.47 0.11 ... ... 0.04 0.03 1895 0.19 0.01 ... ... 0.93 0.02 2.0 0.47 5.5 0.20 ... ... 2.5 0.38 ... ... 0.08 0.03 1896 0.03 ... ... ... 1.03 0.04 2.8 0.87 5.0 0.24 ... ... 0.62 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 ... 0.80 0.02 2.2 0.31 5.7 0.16 ... ... 0.52 0.11 ... ... 0.09 0.08 1899 ... ... ... ... 0.83 0.06 3.0 0.30 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 ... ... 0.06 0.02 1907 • • • ... ... ... 0.85 0.04 1.83 0.12 7.91 0.11 ... ... 0.16 0.03 ... ... 0.04 001 1908 ... ... ... ... ... ... 2.61 0.16 4.67 0.07 ... ... 0.10 0.02 ... ... 0.04 0.02 Note.—Data for 1893 could not be obtained. 107—108 TABLE VI. London and the Metropolitan Boroughs.—Birth-rates and Death-rates of persons belonging to London and the Metropolitan Boroughs during the 53 weeks of 1908. Boroughs. Per 1,000 Persons Living. Deaths under 1 year to 1000 Births. Births. Deaths from All Causes. Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Typhus. Enteric Fever. Pyrexia † (Origin uncertain). Diarrhoea. Phthisis. County of London 25.2 Crude 13.8 *Corrected 14.5 1.35 — 0.31 0.11 0.15 0.20 — 0.05 0.00 0.53 1.32 113 West. Paddington 22.1 12.4 13.2 0.87 — 0.23 0.10 0.10 0.07 - 0.03 - 0.34 1.01 103 Kensington 19.2 12.9 13.9 0.92 — 0.17 0.05 0.15 0.04 — 0.03 — 0.48 0.98 119 Hammersmith 25.4 14.0 14.5 1.09 — 0.12 0.09 0.10 0.15 — 0.04 - 0.59 1.26 120 Fulham 27.0 12.4 12.9 1.59 — 0.41 0.10 0.18 0.19 — 0.06 - 0.65 1.14 116 Chelsea 20.4 14.5 15.0 1.18 — 0.16 0.10 0.16 0.22 — 0.07 — 0.47 1.27 107 City of Westminster 16.7 12.6 14.2 0.58 — 0.13 0.04 0.09 0.05 — 0.03 — 0.24 1.23 102 North. St. Marylebone 20.6 14.2 15.1 0.85 - 0.19 0.10 0.11 0.10 - 0.05 - 0.30 1.16 101 Hampstead 14.9 8.5 9.6 0.40 — 0.05 0.07 0.05 0.05 - 0.05 - 0.13 0.78 69 St. Pancras 24.6 14.7 15.4 1.06 — 0.19 0.08 0.09 0.29 — 0.04 - 0.37 1.51 107 Islington 24.7 13.2 13.7 1.01 — 0.23 0.09 0.16 0.16 — 0.05 — 0.32 1.24 102 Stoke Newington 19.7 12.3 12.9 0.82 — 0.18 0.09 0.02 0.11 — 0.07 — 0.35 1.07 92 Hackney 23.3 13.2 13.7 1.52 — 0.31 0.13 0.19 0.18 — 0.03 — 0.68 1.22 115 Central. Holborn 19.6 16.4 17.6 1.07 - 0.20 0.13 0.09 0.14 - 0.09 - 0.42 2.11 113 Finsbury 81.1 18.6 19.3 2.09 — 0.45 0.13 0.16 0.26 — 0.12 — 0.97 2.15 133 City of London 14.9 17.7 19.4 0.40 — 0.15 — 0.10 0.05 — — — 0.10 1.79 92 East. Shoreditch 32.0 17.4 18.3 2.09 - 0.44 0.25 0.11 0.20 - 0.09 - 1.00 2.00 139 Bethnal Green 32.6 17.1 17.3 2.48 — 0.78 0.30 0.21 0.32 - 0.10 - 0.77 1.61 132 Stepney 32.1 16.4 17'.1 2.53 — 0.84 0.17 0.24 0.41 - 0.04 0.00 0.83 1.56 130 Poplar 31.5 15.9 16.3 2.26 - 0.47 0.21 0.19 0.42 — 0.08 - 0.89 1.34 123 South. Southwark 29.2 16.3 17.0 1.76 - 0.30 0.11 0.15 0.23 - 0.03 - 0.88 1.88 131 Bermondsey 32.5 18.8 19.2 2.30 — 0.82 0.19 0.18 0.17 — 0.09 0.01 0.84 1.89 144 Lambeth 24.6 13.3 13.7 1.18 - 0.31 0.13 0.14 0.15 — 0.02 - 0.43 1.45 104 Battersea 24.9 12.2 13.1 1.19 - 0.20 0.13 0.12 0.21 - 0.03 - 0.44 1.19 106 Wandsworth 25.2 11.6 12.2 0.93 - 0.15 0.07 0.13 0.21 - 0.02 - 0.35 0.96 97 Camberwell 24.2 12.7 13.1 1.06 — 0.19 0.08 0.14 0.19 - 0.02 — 0.44 1.12 104 Deptford 26.4 13.8 14.5 1.32 — 0.28 0.06 0.08 0.20 — 0.07 — 0.63 1.16 122 Greenwich 23.5 12.6 12.9 1.25 — 0.14 0.05 0.16 0.28 — 0.08 - 0.54 1.10 120 Lewisham 230 11.0 11.4 1.25 — 0.29 0.07 0.27 0.19 - 0.03 - 0.40 0.85 86 Woolwich 23.8 11.4 12.1 0.92 — 0.07 0.07 0.16 0.24 — 0.02 — 0.36 1.20 94 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 corrected death-rates represent the Crude death-rates multiplied by the respective factors for correction for differences of sex and age constitution of population. † Called Simple Continued Fever previous to 1901. 109—110 TABLE VII. London and the Metropolitan Boroughs.—Death Rates per 1000 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 1903-7, and in 1908. Boroughs. All Causes. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Diarrhoea. Phthisis. Deaths under One Year to 1000 Births. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. 19031907. 1908. County of London 15.2 13.8 0.00 0.42 0.31 0.11 0.11 0.15 0.15 0.33 0.20 0.00 ... 0.06 0.05 0.00 0.00 0.73 0.53 1.49 1.32 130 113 Paddingtion 13.3 12.4 0.00 ... 0.26 0.23 0.08 0.10 0.10 0.10 0.25 0.07 ... ... 0.05 0.03 ... ... 0.60 0.34 1.09 1.01 115 103 Kensington 13.9 12.9 0.00 Kensington 0.30 0.17 0.07 0.05 0.10 0.15 0.30 0.04 ... ... 0.04 0.03 0.00 ... 0.58 0.48 1.23 0.98 137 119 Hammersmith 14.6 14.0 ... ... 0.40 0.12 0.08 0.09 0.18 0.10 0.30 0.15 ... ... 0.06 0.04 0.00 ... 0.75 0.59 1.29 1.26 133 120 Fulham 14.3 12.4 ... ... 0.43 0.41 0.08 0.10 0.18 0.18 0.37 0.19 ... ... 0.07 0.06 ... ... 0.18 0.65 1.27 1.14 136 116 Chelsea 15.5 14.5 ... ... 0.39 0.10 0.08 0.10 0.10 0.16 0.32 0.22 ... ... 0.03 0.07 ... ... 0.51 0.47 1.59 1.27 131 107 City of Westminster 13.3 12.6 0.00 ... 0.17 0.13 0.07 0.04 0.07 0.09 0.15 0.05 ... ... 0.05 0.03 0.00 ... 0.34 0.24 1.50 1.23 110 102 St. Marylebone 15.6 14.2 ... ... 0.29 0.19 0.12 0.10 0.11 0.11 0.23 0.10 ... ... 0.04 0.05 0.01 ... 0.50 0.30 1.60 1.16 122 101 Hampstead 9.6 8.5 ... ... 0.12 0.05 0.05 0.07 0.07 0.05 0.12 0.05 ... ... 0.03 0.05 ... ... 0.17 0.13 0.75 0.78 87 69 St. Pancras 16.1 14.7 ... ... 0.50 0.19 0.11 0.08 0.13 0.09 0.34 0.29 ... ... 0.05 0.04 0.00 ... 0.52 0.37 1.71 1.51 125 107 Islington 14.7 13.2 0.00 ... 0.44 0.23 0.09 0.09 0.10 0.16 0.32 0.16 ... ... 0.05 0.05 0.00 ... 0.50 0.32 1.35 1.24 122 102 Stoke Newington 12.4 12.3 ... ... 0.23 0.18 0.07 0.09 0.12 0.02 0.29 0.11 ... ... 0.04 0.07 ... ... 0.42 0.35 1.25 1.07 109 92 Hackney 13.9 13.2 0.00 ... 0.35 0.31 0.11 0.13 0.17 0.19 0.26 0.18 ... ... 0.11 0.03 ... ... 0.77 0.68 1.26 1.22 126 115 Holborn 18.0 16.4 0.01 ... 0.38 0.20 0.05 0.13 0.11 0.09 0.29 0.14 ... ... 0.06 0.09 ... ... 0.51 0.42 2.76 2.11 125 113 Finsbury 20.0 18.6 0.01 ... 0.70 0.45 0.16 0.13 0.16 0.16 0.45 0.26 ... ... 0.09 0.12 ... ... 0.93 0.97 2.24 2.15 147 133 City of London 16.6 17.7 ... ... 0.07 0.15 0.10 ... 0.12 0.10 0.22 0.05 ... ... 0.05 ... ... ... 0.23 0.10 1.65 1.79 115 92 Shoreditch 19.9 17.4 0.01 ... 0.76 0.44 0.16 0.25 0.16 0.11 0.62 0.20 ... ... 0.06 0.09 ... ... 1.28 1.00 2.11 2.00 167 139 Bethnal Green 18.5 17.1 0.01 ... 0.54 0.78 0.19 0.30 0.22 0.21 0.42 0.32 ... ... 0.07 0.10 0.00 ... 0.94 0.77 2.09 1.61 147 132 Stepney 17.7 16.4 0.00 ... 0.55 0.84 0.15 0.17 0.24 0.24 0.38 0.41 ... ... 0.08 0.04 0.00 0.00 1.10 0.83 1.84 1.56 138 130 Poplar 17.8 15.9 0.01 ... 0.63 0.47 0.15 0.21 0.31 0.19 0.41 0.42 ... ... 0.07 0.08 ... ... 1.20 0.89 1.58 1.34 146 123 Southwark 18.6 16.3 0.00 ... 0.61 0.36 0.13 0.11 0.15 0.15 0.41 0.23 ... ... 0.07 0.03 0.00 ... 0.95 0.88 2.20 1.88 148 131 Bermondsey 19.0 18.8 ... ... 0.61 0.82 0.19 0.19 0.16 0.18 0.39 0.17 0.00 ... 0.07 0.09 0.00 0.01 1.04 0.84 1.91 1.89 150 144 Lambeth 15.1 13.3 0.00 ... 0.37 0.31 0.09 0.13 0.13 0.14 0.32 0.15 ... ... 0.05 0.02 ... ... 0.70 0.43 1.43 1.45 131 104 Battersea 14.0 12.2 ... ... 0.40 0.26 0.09 0.13 0.13 0.12 0.38 0.21 ... ... 0.05 0.03 ... ... 0.72 0.44 1.32 1.19 128 106 Wandsworth 12.7 11.6 ... ... 0.33 0.15 0.08 0.07 0.15 0.13 0.29 0.21 ... ... 0.05 0.02 ... ... 0.61 0.35 1.01 0.96 114 97 Camberwell 14 .2 12.7 ... ... 0.37 0.19 0.09 0.08 0.11 0.14 0.32 0.19 ... ... 0.05 0.02 ... ... 0.63 0.44 1.27 1.12 126 104 Deptford 15.1 13.8 ... ... 0.48 0.28 0.12 0.06 0.20 0.08 0.37 0.20 ... ... 0.04 0.07 0.00 ... 0.78 0.63 1.32 1.16 128 122 Greenwich 13.5 12.6 ... ... 0.33 0.14 0.08 0.05 0.20 0.16 0.34 0.28 ... ... 0.05 0.08 ... ... 0.71 0.54 1.20 1.10 123 120 Lewisham 11.7 11.0 0.01 ... 0.19 0.29 0.07 0.07 0.11 0.27 0.20 0.19 ... ... 0.03 0.03 0.00 ... 0.52 0.40 0.87 0.85 102 86 Woolwich 13.2 11.4 ... ... 0.27 0.07 0.08 0.07 0.16 0.16 0.25 0.24 ... ... 0.05 0.02 0.00 ... 0.68 0.36 1.44 1.20 113 94 111—112 TABLE VIII. Meteorology and Registered Deaths from all Causes and from Certain Prevalent Diseases of the Year 1908. 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. Diarrhoea. Bronchitis and Pneumonia. All Causes. January 4 38.4 24.1 32.2 - 43.90 67 1 0.01 .. 7 31 „ 11 49.8 17.9 34.2 - 41.72 81 3 1.17 .. 6 33 „ 18 52.0 17.9 40.0 + 40.82 88 3 0.04 .. 14 38 „ 25 44.0 25.6 34.4 — 41.43 97 3 0.04 .. 10 40 February 1 53.6 33.4 41.8 + 41.85 76 5 0.24 8 36 „ 8 49.2 28.3 39.7 + 41.20 84 2 0.05 1 6 34 „ 15 52.0 28.7 41.8 + 41.72 86 2 0.12 .. 8 41 „ 22 54.5 33.7 45.4 + 42.35 83 4 0.83 .. 11 44 „ 29 50.5 31.0 40.2 - 42.98 78 6 0.45 1 5 30 March 7 51.0 31.4 38.3 - 41,70 83 5 0,71 .. 7 35 „ 14 56.0 28.3 40.7 - 42.17 78 4 0.18 .. 5 25 „ 21 48.5 24.3 36.6 - 41.60 78 2 0.06 .. 7 25 „ 28 59.2 31.0 43.8 + 41.76 80 4 0.89 1 8 41 1st Quarter 59.2 17.9 39.2 41.94 81 44 4.79 3 102 453 April 4 60.3 36.2 45.8 + 43.28 70 4 0.42 .. 4 31 „ 11 58.1 28.4 40.7 - 43.93 77 2 0.31 .. 6 30 „ 18 59.1 34.7 44.3 - 44,45 71 1 0,01 .. 7 32 „ 25 55.2 30.5 38.5 - 44.50 79 6 0.98 .. 5 31 May 2 75.5 32.4 51.0 + 44.46 83 4 0.75 .. 3 28 „ 9 88.3 43.6 53.2 + 47.90 83 5 0.31 .. 3 30 „ 16 66.5 39.6 52.1 - 49.92 77 6 0.53 .. 6 34 „ 23 77.0 42.0 57.5 + 51.90 73 1 0.04 .. 2 31 „ 30 74.6 37.8 58.0 + 53.39 74 3 0l64 .. 1 25 June 6 81.5 45.8 62.8 + 56.19 74 3 1.49 .. 2 23 „ 13 74.8 41.7 57.7 - 57.27 76 1 0.03 .. .. 15 „ 20 72.0 43.3 57.6 - 58.04 73 2 0.55 1 3 21 „ 27 78.6 43.6 59.0 - 58.53 70 0 0.00 .. 1 26 2nd Quarter 88.3 28.4 52.2 50.29 75 38 6.06 2 43 357 July 4 84.0 49.6 63.5 + 60.24 71 1 0.54 .. 2 25 „ 11 75.5 49.9 61.5 - 61.34 78 4 0.35 .. .. 17 „ 18 73.0 51.1 58.9 - 60.97 86 6 2.76 1 2 19 „ 25 82.9 47.1 62.4 - 60.47 80 1 0.01 .. 1 23 August 1 83.1 47.6 64.3 + 62.15 65 0 0.00 .. 1 16 „ 8 83.0 47.1 62.1 - 62l65 73 1 0.07 1 4 22 „ 15 78.0 46.9 58.8 - 62.18 71 2 0.22 3 1 30 „ 22 74.9 47.2 59.2 - 61.26 81 2 0.61 1 1 25 „ 29 77.3 51.3 58.9 - 60.88 81 7 1.99 5 1 27 September 5 69.2 40.0 53.2 - 59.51 82 6 1.35 7 3 32 „ 12 74.3 40.1 54.5 - 58.02 72 2 0.03 3 1 28 „ 19 74.1 36.1 56.5 - 57.11 79 2 0.11 4 3 28 „ 26 77.2 41.5 57.3 + 57.86 88 4 0.11 3 2 27 3rd Quarter 84.0 36.1 59.3 60.36 77 38 8.15 28 22 319 October 3 79.9 50.1 62.9 + 58.21 84 3 0.03 4 5 24 „ 10 75.2 42.5 57.6 + 58.31 89 5 0.25 2 3 30 „ 17 71.0 43.7 56.3 + 57.51 88 4 0.72 .. 1 20 „ 24 65.1 34.5 47.8 - 56.49 84 3 0.26 1 2 22 „ 31 67.7 33.1 50.2 + 53.63 89 4 0.73 3 5 25 November 7 58.5 34.2 47.3 + 53.36 87 0 0.00 .. 2 29 „ 14 58.3 22.1 45.1 + 51.01 80 4 0.28 1 4 34 „ 21 51.3 31.0 44.7 + 50.52 84 4 0.39 .. 5 27 „ 28 58.0 32.1 47.6 + 49.46 81 3 0.07 .. 1 23 December 5 54.4 34.5 43.5 + 49.26 94 2 0.08 .. 5 30 „ 12 52.9 33.6 42.8 + 48.25 87 5 0.62 .. 10 40 „ 19 54.2 36.0 45.4 + 47.46 92 5 0.81 1 6 29 „ 26 49.0 34.1 40.2 + 46.99 91 1 0.02 1 6 17 January 2 48.2 12.1 31.5 - 44.41 85 3 0.48 .. 4 32 4th Quarter (14 weeks) 79.9 12.1 47.3 51.78 87 46 4.74 13 59 382 Totals for Whole Year 88.3 12.1 49.5 51.09 80 166 23.74 46 226 1511 113 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. Average weekly Rainfall in inches. Deaths Corrected for Public Institutions. Average of Weekly Maxima. Average of Weekly Minima. Average of Weekly Means. Diarrhoea. Bronchitis and Pneumonia. All Causes. 1st Quarter 50.7 22.2 39.2 41.94 81 3.4 0.37 .23 8 35 2nd Quarter 70.9 38.4 52.2 50.29 75 3.0 0.46 .15 3 27 3rd Quarter 77.4 45.8 59.3 60.36 77 3.0 0.63 2.15 2 25 4th Quarter (14 weeks) 60.3 33.8 47.3 51.78 87 3.3 0.34 1.0 4 27 G 114 TABLE X. Summary of Statistics for the First Quarter, ending 28th March, 1908, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population Births, Deaths under one year of age. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Population estimated to middle of Year. Number. Rate. Number. Bate per 1,000 Births Registered. Number. Number. Rale. 129,336 802 24.8 85 106 428 87 16 41 453 14.0 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 1,000 births. Population estimated to middle of year. Birth Bate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. A B C D A B C D A B C D 39,993 26.7 17.2 86 76,595 23.7 12.7 121 12,748 25.7 11.3 85 115 C. Notifications of Infectious Disease. Disease. Woolwich. Plumstead. Eltham. Total. Average for 1st Qrs. of year3 1903/4/5/6/7. Smallpox - - - - .4 Scarlet Fever 26 120 14 160 143.0 Diphtheria 26 51 8 85 80.8 Enteric Fever 1 1 1 3 7.8 Erysipelas 8 9 - 17 24.6 Puerperal Fever 1 2 - 3 1.6 Phthisis 12 22 1 35 38.2 Cercbro Spinal Meningitis — 1 — 1 - Measles (Notified by School Teachers) 1 108 9 118 385.8 TABLE XI. Summary of Statistics for the Second Quarter, ended 27th June, 1908, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population Births. Deaths under one year of age. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Population estimated to middle of Year. Number. Rate. Number. Bate per 1,000 Births Registered. Number. Number. Rate. 129,336 781 24.1 65 83 329 98 16 44 357 11.0 G 2 116 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Bate at all ages. Deaths under 1 year, per 1000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth 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 25.9 12.8 105 76,595 23.9 10.5 76 12,748 200 8.8 47 C. Notification of Infectious Disease. Disease. Woolwich. Plumstead. Eltham. Total. Average for 2nd Qrs. of years 1903/4/5/6/7. Smallpox - - - - 2.0 Scarlet Fever 29 80 14 123 138.8 Diphtheria 23 52 3 78 51.6 Enteric Fever — 1 - 1 5.0 Erysipelas 3 12 2 17 16.4 Puerperal Fever — — 1 1 0.8 Phthisis 10 17 2 29 44.4 Cerebro Spinal Meningitis — — — — — Measles (Notified by School Teachers) 13 117 96 226 266.8 117 TABLE XII. Summary of Statistics for the Third Quarter, ended 26th September, 1908, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population Births. Deaths under one year of age. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Population estimated to middle of Year. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 129,601 757 23.36 78 103 303 71 15 31 319 9.84 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 1,000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year per 1,000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year per 1,000 births. A B C D A B C D A B C D 39,993 25.40 11.5 153.5 76,595 22.76 9.19 78 13,013 20.59 8.60 74.6 118 C. Notifications of Infectious Disease. Disease. Woolwich. Plumstead. Eltham. Total. Average for 3rd Qrs. of years 1903/4/5/6/7. Smallpox - - - - - Scarlet Fever 26 105 6 137 132.4 Diphtheria 23 46 3 72 44.6 Enteric Fever 1 1 1 3 8.8 Erysipelas 1 23 — 24 18.2 Puerperal Fever — 1 1 2 2.4 Phthisis 16 25 — 41 37.0 Cerebro Spinal Meningitis — — — — — Measles (Notified by School Teachers) 20 75 1 96 55.6 TABLE XIII. Summary of Statistics for the Fourth Quarter ended 2nd January, 1909, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Bates calculated per 1,000 Population. Births. Deaths under one year of age. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Population estimated to middle of Year. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 129,601 742 22.9 62 83.5 314 77 13 54 355 10.9 119 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Bate. Death Bate at all ages. Deaths under 1 year per 1,000 births. Population estimated to middle of year, Birth Rate. Death Rate at all ages. Deaths under 1 year per 1,000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year per 1,000 births. A B C D A B C D A B C D 39,993 25.75 13.6 109 76,595 23.3 10.6 87.8 13,013 20.3 9.8 75.7 C. Notifications of Infectious Disease. Disease. Woolwich. Plumstead. Eltham. Total. Average for 4th Qrs. of years 1903/4/5/6/7. Small Pox .. .. .. .. 1.0 Scarlet Fever 59 93 22 174 187.0 Diphtheria 49 53 12 114 78.0 Enteric Fever 1 4 2 7 11.0 Erysipelas 6 21 2 29 24.0 Puerperal Fever .. .. .. .. 3.0 Phthisis 23 28 4 55 42.0 Measles (Notified by School Teachers) 68 10 1 79 225.0 121—122 TABLE XIV. Deaths from Various Causes for Whole Borough, 1908, corrected for Public Institutions—Nett. Week ending. Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Mem. Croup. Enteric Fever. Diarrhoea and Dysentery. Erysipelas. Puerperal Fever. Rheumatism. Tubercle. Alcoholism. Cancer. Bronchitis. Pneumonia Accidents. Homicide and Suicide. January 4 .. .. .. .. 1 .. .. .. .. .. .. 4 2 2 5 2 .. .. „ 11 .. .. 1 2 1 1 .. .. .. .. .. 4 .. 1 5 1 .. .. „ 18 .. 2 .. 1 .. .. .. .. 1 1 .. 4 .. 4 8 6 .. .. „ 25 .. .. .. 3 .. 1 .. .. 1 .. .. 6 .. 1 3 7 .. .. February 1 .. .. .. 1 2 2 .. .. .. .. .. 2 1 .. 5 3 1 .. „ 8 .. .. .. .. 1 1 .. 1 .. .. .. 4 .. 3 4 2 3 .. „ 15 .. .. .. 1 4 .. .. .. .. .. .. 6 .. 3 6 2 1 2 „ 22 .. .. .. 2 1 .. .. .. .. .. .. 10 .. 2 6 5 .. 1 „ 29 .. .. .. 1 1 .. .. 1 .. .. .. 4 .. 1 3 2 .. .. March 7 .. .. .. 2 1 1 .. .. .. .. .. 2 .. 1 6 1 1 .. „ 14 .. .. .. .. 2 .. .. .. .. .. .. 4 .. 5 2 3 .. .. „ 21 .. .. 1 1 3 .. .. .. .. .. .. 4 .. .. 4 3 .. .. „ 28 .. .. .. 3 1 .. .. 1 .. 1 .. 3 2 1 6 2 2 .. 1st Quarter .. 2 2 17 18 6 .. 3 2 2 .. 57 5 24 63 39 8 3 April 4 .. .. 1 2 .. 1 .. .. .. .. 1 5 1 1 4 .. .. .. „ 11 .. .. .. 1 .. 2 .. .. .. .. .. 7 .. 1 5 1 1 .. „ 18 .. .. .. .. .. 1 .. .. .. .. 1 7 2 .. 5 2 1 .. „ 25 .. .. .. 1 3 .. .. .. .. .. 1 6 3 .. 2 3 .. .. May 2 .. .. .. .. 1 .. .. .. .. .. .. 8 .. 3 1 2 3 .. „ 9 .. .. .. 1 .. .. .. .. .. .. .. 5 1 1 3 .. 2 .. „ 16 .. .. .. 1 2 .. .. .. .. .. .. 5 .. .. 2 4 2 .. „ 23 .. .. .. .. .. .. .. .. .. .. .. 7 .. 2 1 1 3 .. „ 30 .. .. .. 1 .. 1 .. .. .. .. .. 5 .. 2 .. 1 .. .. June 6 .. 2 .. 1 .. .. .. .. .. .. .. 4 .. 1 .. 2 1 .. „ 13 .. .. .. .. .. .. .. .. .. .. .. 3 1 2 .. .. .. 1 „ 20 .. .. .. .. 1 .. .. 1 .. .. .. 5 .. .. 1 2 1 .. „ 27 .. .. .. .. 1 .. .. .. .. .. .. 4 1 2 .. 1 .. 3 2nd Quarter .. .. 2 8 8 5 .. 2 .. .. 3 71 9 15 24 19 14 4 July 4 .. .. .. .. 1 .. .. .. .. .. .. 3 .. 2 .. 2 1 1 „ 11 .. .. .. .. .. .. .. .. .. .. .. 3 .. 1 .. .. 1 .. „ 18 .. .. .. .. .. .. .. 1 .. .. .. 4 .. 3 .. 2 .. .. „ 25 .. .. 1 .. .. .. .. .. .. .. .. 3 .. .. .. 1 1 .. August 1 .. 1 .. .. .. .. .. .. 1 .. .. 3 .. 2 1 .. .. .. „ 8 .. .. .. .. .. .. .. 1 .. .. .. 5 .. 4 3 1 .. 1 „ 15 .. .. .. .. .. .. .. 3 .. .. .. 5 1 2 1 .. 2 .. „ 22 .. .. 1 .. .. .. .. 1 1 .. .. 5 .. 4 .. 1 .. .. „ 29 .. .. .. .. .. .. 1 5 .. .. .. 5 .. 2 1 .. .. .. September 5 .. .. .. .. 1 .. .. 7 .. .. 1 3 1 2 2 1 .. .. „ 12 .. .. .. .. .. .. .. 3 .. .. .. 6 .. 3 1 .. 2 .. „ 19 .. .. .. .. 1 .. .. 4 .. .. .. 2 1 1 1 2 .. 2 „ 26 .. .. .. .. .. .. 1 3 .. .. .. 6 1 3 2 .. .. 1 3rd Quarter .. 1 2 .. 3 .. 2 28 3 .. 1 53 4 29 12 10 7 5 October 3 .. .. .. .. 1 .. .. 4 .. .. .. 1 .. 3 1 4 .. 1 „ 10 .. .. .. .. .. .. .. 2 .. .. .. 2 1 4 2 1 1 1 „ 17 .. .. .. .. .. .. .. .. 1 .. .. 8 .. 3 .. 1 1 .. „ 24 .. .. .. .. .. .. .. 1 .. .. .. 3 .. 3 2 .. .. .. „ 31 .. .. .. .. .. .. .. 3 .. .. .. 4 .. .. 3 2 1 .. November 7 .. .. .. .. 1 2 .. .. .. .. .. 2 1 .. 1 1 .. .. „ 14 .. .. .. .. 1 1 .. 1 .. .. .. 4 .. 2 2 2 2 .. „ 21 .. .. .. .. .. .. .. .. .. .. .. 4 1 3 5 .. .. .. „ 28 .. .. .. .. .. 2 .. .. .. .. .. 5 .. 3 1 .. .. .. December 5 .. 1 .. .. .. .. .. .. .. .. .. 1 1 2 2 3 1 .. „ 12 .. 2 .. 3 .. 1 .. .. .. .. 1 2 .. 1 5 5 1 .. „ 19 .. 1 .. .. .. 1 .. 1 .. .. .. 5 1 1 3 3 .. .. „ 26 .. .. .. .. .. .. .. 1 .. .. .. 1 .. 2 5 1 .. .. January 2 .. 1 .. .. .. 1 .. .. .. .. .. 5 1 .. .. 4 1 1 4th Quarter (14 weeks) .. 5 3 4 3 8 .. 13 2 .. 1 47 6 27 32 27 8 3 Total for Year .. 10 9 29 32 19 2 46 7 2 5 228 24 95 131 95 37 15 123—124 TABLE XVa. Summary of Nuisances Abated, Notices Served, and General Work of Public Health Department, 1908. Sanitary Inspectors' Districts. St. Mary's and Dockyard. River. Herbert. Central and St. Margaret's. St. Nicholas. Burrage and Glyndon. Eltham. St. George's. Total. PREMISES INSPECTHED. No. of Houses inspected, house to house 723 501 578 911 894 984 112 681 5384 „ Re-inspections after service of Notice (estimated) 1504 1978 1050 2035 1754 2133 655 864 11973 „ Houses and premises specially inspected, including infectious diseases and complaints 1258 1624 321 1050 1298 1183 612 253 7600 „ Houses where drains have been tested by smoke test 36 32 15 28 49 38 13 10 221 „ Houses where drains have been tested by water test 29 28 2 14 3 9 12 3 100 „ New Houses inspected for Water Certificates 13 16 5 48 44 2 51 - 179 NUISANCES ABATED—DRAINS. Waste pipes from baths, lavatories, and wash-house sinks, repaired or disconnected 36 40 15 23 18 28 5 7 172 Choked and defective drains 62 70 19 61 39 62 36 22 371 Defective traps 15 12 2 3 8 18 - 3 61 Defective and unventilated soil pipes - 7 - 2 3 1 1 8 22 W.C.'s. W.C.'s repaired, new traps or pans provided, fittings repaired 123 106 17 42 12 68 26 46 440 Water supply apparatus repaired 94 74 42 72 87 87 13 35 504 Foul pans cleansed 17 44 12 34 48 27 2 9 193 Additional w.c.'s provided to Factories and Workshops, etc. - 1 - - - - - - 1 Do. do. dwelling houses — 1 — — — — — — 1 PREMISES. Underground rooms not in accordance with Act - 1 - - - - - - 1 Interiors cleansed and defective roofs repaired 392 283 140 216 201 472 55 267 2026 Damp walls remedied 51 39 21 83 10 80 10 74 308 Paving in yards and wash-houses repaired 89 52 33 41 37 55 19 34 360 Improved ventilation provided 31 9 3 42 73 22 2 5 187 Wash-houses without sink and outlets for waste water 3 - - - - 4 - 4 11 Defective guttering and rain-water pipes 69 56 48 30 63 57 7 18 348 Dustbins supplied 84 107 39 104 82 105 20 71 612 Dung pits provided - 2 - 2 1 3 - - 8 Cases of overcrowding remedied 16 11 5 13 10 9 1 7 72 Deficient light—windows supplied, or enlarged, or other works 51 7 2 26 4 23 3 3 119 Dampness in premises from defective water pipes 51 18 3 15 28 11 1 13 140 ANIMALS. Animals (including pigs) kept in such a state as to be a nuisance - 2 2 4 2 6 2 - 18 Accumulations of manure removed 12 44 - 8 10 3 8 3 88 WATER. Defective and foul cisterns used for dietary purposes - 9 l 26 31 - - - 67 Defective and foul rain-water tanks remedied - 3 - 1 - 7 - - 11 Insufficient supply, and water cut off by Water Board 8 11 - 1 2 14 4 - 40 Additional water supply for two or more families 11 10 — 1 - - - 3 25 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 17 25 21 8 - 2 2 - 75 No. of smoke nuisances observed - 3 - 3 - - 2 - 8 Tents, Vans, etc., inspected - - - 8 - 18 - 26 Notices served with respect to tents and vans - - - - 3 - - - 3 Inspection of Urinals accessible to the public 90 110 74 125 118 102 9 4 632 Verminous rooms cleansed 41 10 3 4 62 34 7 22 183 Intimation notices served 723 364 170 406 442 628 90 290 3113 Statutory 97 61 22 112 77 82 23 25 499 125 TABLE XVB. SUMMARY OF WORK OF CHIEF INSPECTOR. Premises Inspected 1113 New Buildings Inspected 35 Defective Combined Drains Investigated and Reported on 16 Number of Houses referred to in such Combined Drains 128 Cow-houses and Slaughter-houses Inspection 41 Complaints Investigated 168 Attendance at Police Court 7 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for proceedings 62 Summonses at Police Court 19 Bake-houses Inspected and Cleansed twice during the year 52 Number of Houses Disinfected after Infectious Disease 1133 Letters written 4667 Notifications received 1936 Certificates issued after Disinfection 2832 ,, of Infectious Disease forwarded to Schools 2266 Complaints of Sanitary Defects 399 ,, of Non-removal of Dust, viz.:— Woolwich 3 Plumstead 8 Eltham 7 Written Intimation Notices 3113 Statutory Notices 499 126 TABLE XVc. Factories, Workshops, Laundries, Workplaces, and Homeworkers' Premises. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Factories (Including Factory Laundries) 30 2 Workshops (Including Workshop Laundries) 246 25 Workplaces 85 30 Homeworkers' Premises 220 11 Total 581 68 2.— Defects found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Acts:— Want of Cleanliness 40 40 Want of Ventilation 17 17 Overcrowding 6 6 Want of drainage of floors — — Other nuisances 13 13 Sanitary accommodation. insufficient, unsuitable, or defective 14 14 not separate for) sexes 5 5 Total 95 95 127 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 2 Reports (of action taken) sent to H. M. Inspectors 0 Underground Bakehouses (S. 101):— In use during 1903 24 Certificates granted in 1903 24 in 1904 — in 1905 — in 1906 1 in 1907 — in 1908 - In use at the end of 1908 25 Workshops on the Register (S. 131) at the end of 1908— Workshop Laundries 19 „ Bakehouses 58 Other Workshops 152 Total number of Workshops on Register 229 128 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 Tailoring 22 155 8 13 .. .. .. .. .. .. .. .. .. .. .. Shirt makers 1 40 1 1 .. .. .. .. .. .. .. .. .. .. .. Corset makers 1 13 .. .. .. .. .. .. .. .. .. .. .. .. .. Gold braid makers .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. Tennis Balls, etc. 3 304 2 13 .. .. .. .. .. .. .. .. .. .. .. 27 512 12 28 68 70 .. .. 220 11 11 .. .. .. .. 129 TABLE XVD. Proceedings during 1908. Premises. Number of Places. Number of Inspections, 1908. Number of Notices, 1908. Number of Prosecutions, 1908. On Register at end of 1907. Added at 1908. Removed in 1908. On Register at end of 1908. Milk Premises 143 31 40 134 309 10 - Cowsheds 17 — — 17 78 12 — Slaughter-houses 11 — — 11 56 4 — Ice Cream Premises 76 35 3 108 187 12 — Registered houses let in Lodgings 330 38 9 359 720 250 2 Overcrowding, 1908— Number of Dwelling Rooms overcrowded 72 Number remedied 72 Underground Rooms— Illegal occupation dealt with during year 1 Number of rooms closed 0 Insanitary Houses— Number closed under the Housing of the Working Classes Act 7 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 151 Total number of Infectious Bodies removed 1 Inspections of premises where food is prepared for sale.. 188 Number of Public Sanitary Conveniences removed or altered 0 Number of fixed ashpits removed 0 130 TABLE XVI. Details of House to House Inspections. ' Name of Street. Number of Houses Inspected. Number where Defects were found. BCRRAGE AND GLYNDON WARDS. Ann Street 82 56 Frederick Place 89 46 Plumstead Road 98 48 Scott's Passage 4 2 Spray Street 41 22 East Street 27 17 Earl Street 92 56 Parry Place 37 21 Burrage Road 167 71 Mount Pleasant 21 11 Hanover Road 57 23 Raglan Road 57 26 Elm Street 114 63 Eton Street 36 10 Bloomfield Road 62 23 984 511 ELTH AM WARD. Mottingham Lane 19 8 Osborne Terrace 8 4 Meadowcourt Road 16 3 Farm Cottages 5 2 Blanmerle Road 42 20 Footscray Road 22- 17 112 St. GEORGE'S WARD. Manor Street 69 34 James Street 64 30 Jackson Street 52 18 Milward Street 41 14 Dicey Street 37 17 131 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. St. GEORGE'S WARD.—continued. Delvan Street 15 5 Ordnance Road 59 25 Eglinton Road 14 6 Fenwick Street 51 24 Gildersome Street 54 16 Engineer Road 33 11 Keemor Street 34 7 Ritter Street 29 10 Brookhill Road 77 23 Hanover Terrace 8 1 Sandy Hill Road 11 3 Nightingale Vale 33 15 681 259 CENTRAL AND St. MARGARET'S WARDS. Francis Street 30 11 Elm Grove 45 23 Sutcliffe Road 37 25 The Slade 39 22 W i n n's Cottages 7 4 Garland Street 42 21 Upper Garland Street 5 1 Pendrell Street 35 24 Flax ton Road (Upper) 26 12 Harden Street 11 5 Timbercroft Lane (part of) 9 3 Mineral Street 61 26 Hector Street 30 11 Salisbury Cottages, High St. 3 2 Park Road 57 26 Lee Street 41 18 St. Margaret's Terrace 19 4 Lakedale Road (W. side) 97 36 Vicarage Park 39 26 Welling Street 31 10 Malton Street 44 12 Kirkhara Street 57 17 132 TABLE XVI.— continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. CENTRAL and St. MARGARET'S WARDS .—continued. Griffin Road (E. side) 80 32 Inverary Place 10 3 Chesnut Road (part of) 50 19 911 393 St. NICHOLAS WARD. High Street 44 25 Camrose Street 19 7 Hull Place 8 4 Balgowan Street 20 11 Hylton Street 39 23 Acacia Terrace 50 20 Abbey Wood Road 58 28 Stratton Terrace 9 5 Rippolson Road 52 27 Tewson Road 106 50 Wickham Lane 139 52 Bassant Road 47 20 Ceres Road 91 24 Benares Road 133 41 Brookdene Road 41 31 Reidhaven Road 32 14 894 388 RIVER WARD. Auberon Street 00 28 Ann's Place, North Woolwich 4 2 Barge House Road 60 20 Bell Water Gate 0 3 Beresford Street 82 43 Brookhill Road 28 11 Cock Yard 0 4 Collingwood Street 13 11 Dock Street 20 13 133 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD.—continued. Fernhill Street 9 4 High Street 90 39 High Street, North Woolwich 8 3 Kate's Place 18 6 Mary Ann Street 9 5 Surgeon Street 3 1 Walpole Place 30 21 Warren Lane 24 4 Wiseman Street 19 2 501 226 St.. MARY'S and DOCKYARD WARDS. Joseph Street 25 13 Siemen's Road 25 16 Bowater Road 9 8 Harden Street 42 22 Prospect Row 44 32 Prospect Place 48 27 Kingsman Street 120 73 Short Street 1 1 Sun Street 23 17 St. Mary Street 68 37 Orchard Street 28 23 Orchard Place 30 26 Simms'Buildings 9 8 Eustace Place 11 6 Limbrey's Buildings 9 8 Harrington Buildings 6 1 Railway Cottages 5 4 Warwick Street 64 48 Hill Street 34 12 Martyr's Passage 6 6 Wick Cottages 10 7 Ann Street 22 14 Pellipar Road 27 19 Pellipar Road, Lower 19 12 Frances Street 28 15 H 134 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. St. MARY'S and DOCKYARD WARDS.—continued. Lower Wood Street 31 20 Woodville Street 8 3 Godfrey Street 27 14 Godfrey Hill 16 3 Henry Street 64 37 Chapel Street 12 6 821 498 135 TABLE XVII. Prosecutions under the Public Health and Housing of the Working Classes Acts. No. Date of Final Hearing. Offence. Situation. Result. 1 6/2/08 House unfit for habitation 64, High Street, Woolwich Closing order made, 2s. costs 2 27/3/08 Breach of By-laws, Houses let in lodgings 61, Warwick Street, Woolwich Fine £1 and 10s. 6d. costs 3 14/7/08 House unfit for habitation 2, Stevens Cottages, Barnfield Road Closing order made, 7s. costs 4 14/7/08 House unfit for habitation 3, Stevens Cottages Closing order made, 7s. costs 5 14/7/08 House unfit for habitation 4, Stevens Cottages Closing order made, 7s. costs 6 14/7/08 House unfit for habitation 5, Stevens Cottages Closing order made, 7s. costs 7 17/7/08 Breach of By-laws, Houses let in lodgings 1, Richmond Placc, Plunistead Withdrawn 8 27/10/03 Making a drain without notice to the Council 2, 3, & 4, Montague Cottages, Nightingale Vale Fine 40s. and £2 2s. costs 9 1/12/08 House unfit for habitation 1£, Godfrey Street, Woolwich Closing order made, 6s. costs 10 22/12/08 Smoke from factory chimney a nuisance Factory, Green Lane, North Woolwich £2 2s. costs H 2 136 TABLE XVIII. Summary of Articles Analysed under the Sale of Food and Drugs Act, during the year ended 31st December, 1908. Article. Number Analysed. Number Adulterated Milk 357 6 Butter 83 4 Flour 5 ... Vinegar 2 ... Margarine 2 ... Cheese 3 ... Sugar 5 ... Coffee 15 2 Separated Milk 3 ... Cocoa 12 ... Sweets 5 ... Ammoniated Tincture of Quinine 3 ... Camphorated Oil 2 ... Pepper 1 ... Mustard 4 ... Strawberry Jam 1 ... Black-Currant Jam 2 ... Plum Jam 3 ... Apricot Jam 1 ... Tincture of Iodine 2 ... Paregoric 2 ... Syrup 1 ... Treacle 1 ... Sausages 6 ... Totals 521 13 137 TABLE XVIIIA. Proceedings under the Food and Drugs Act for the Year, 1908. No. Article.. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 5.8% added water George Brown, 9, Elizabeth Street Fine £2 2s. 0d., and £2 2s. 0d. costs. 2 3 Butter 23.4% foreign fat James Batchelor, 10, Albion Road Fine £3 3s. 0d., and £2 2s. 0d. costs. Milk 19.6% fat abstracted John Howe, 82, High Street, Eltham Fine £1 0s. 0d., and £2 2s. 0d. costs. 4 Milk 22% fat abstracted Fanny Branford, 52, High Street, Woolwich Fine £1 0s. 0d., and 12s. 6d. costs. 5 Butter 44 foreign fat George Radford, 50, Vicarage Road Fine £2 0s. 0d., and £2 12s. 0d. costs. 6 Butter All margarine David Jones, 65, Maxey Road Fine £15 0s. 0d., and £2 12s. 0d. costs. 7 Coffee 60% chicory George Radford, 56, Vicarage Road Fine £1 0s. 0d., and £2 12s. 6d. costs. 8 Coffee 55 chicory George Greene, 59, Plumstead Road Fine £5 0s. 0d., and £1 3s. 0d. costs. 138 TABLE XIX. Food Seized or Surrendered by Owners as unfit for consumption. Articles. Quantity. Date. Remarks. Reason. Salt Beef 46 1bs. Jan. 4 Surrendered Acid spilt in brine *Sheep's Omentum ... „ 8 „ Cystic Pig's Head ... „ 10 „ Tuberculosis Pig's Liver ... „ 11 „ „ Rabbits 25 „ 17 „ Unsound *Pig's Head and Shoulder ... „ 17 „ Abscess Norwegian Herrings 7 boxes „ 22 „ Unsound Norwegian Herrings 1 box „ 22 „ „ *Sheep Liver ... „ 22 „ Echinococcus Winkles 2 bushels 29 „ Unsound *Sheep's Omentum ... ... Feb. 5 „ Cystic Forequarter of Pork ... „ 8 „ Tuberculosis *Sheep's Pluck and 2 Livers ... „ 12 „ Echinococcus *1 Liver and Sheep's Omentum ... „ 19 „ „ 2 Sheep's Plucks ... „ 19 „ Unsound Roker 1 box 21 „ „ *Sheep's Liver ... „ 26 „ Echinococcus *Sheep's Liver and Omentum ... March 4 „ „ *Sheep's Liver ... „ 4 „ „ *Pig's Liver ... „ 11 „ „ *Sheep's Liver ... „ 17 „ „ Rabbits 3 boxes „ 18 „ Unsound Carcase of Mutton ... ,, 21 „ Dropsical *Sheep's Liver ... „ 25 „ Echinococcus Tomatoes 12 boxes „ 28 „ Unsound *Ox Liver ... April 1 „ Distoma Hepataca Tomatoes 24½ bundles „ 4 „ Unsound Ox Liver 7 1bs. 12 „ Cavernous Angioma Fish 3 boxes „ 13 „ Unsound Shrimps 1 basket „ 20 „ „ Ox Liver 15 1bs. „ 28 „ Echinococcus Mackerel 10 boxes May 9 „ Unsound Kippers 20 boxes „ 23 „ „ Condensed Milk 409 tins J une 3 „ „ Mackerel 1 box „ 11 „ „ Fillets 3 boxes „ 30 „ „ 139 Table XIX.—continued. Articles. Quantity. Date. Remarks. Reason. Carcase of Sheep ... July 3 Surrendered Unsound Apples 10 boxes „ 6 „ „ Coaley 1 case „ 9 „ „ Hake 1 box „ 9 „ „ Kippers 4 boxes „ 22 „ „ Kippers 2 boxes „ 28 „ „ Coal Fish 1 box Aug. 25 „ „ Cod 1 box „ 25 „ „ Hake 1 box „ 27 „ „ Haddocks 1 box Sept. 8 „ „ *Ox Liver ... „ 9 „ Cirrhosis *Ox Lung ... „ 9 „ Cysts Sheep's Omentum (part of) ... „ 9 „ Cystic Haddocks 1 box „ 10 „ Unsound Coal Fish 1 box „ 15 „ „ Hake 1 box „ 19 „ „ Herrings 1 barrel „ 21 „ „ Haddocks 1 box „ 21 „ „ Kippers 2 boxes „ 23 „ „ *Pig's Liver ... „ 23 „ Cystic *Pig's Liver ... „ 24 „ Necrosis Bream 1 case „ 29 „ Unsound 4 pieces of Beef 59 1bs. Oct. 1 Seized „ Beef 7 1bs. „ 2 „ „ Crabs 1 barrel „ 5 Surrendered „ Coal Fish 1 box „ 7 „ „ Skate 1 box „ 9 „ „ Winkles 1 bag „ 9 „ „ *Bullock's Liver ... „ 14 „ Cirrhosis *2 Sheep's Omentums ... „ 14 „ Cystic Plaice 1 box „ 15 „ Unsound Haddocks 1 box „ 19 „ „ *3 Sheep's Cauls ... „ 28 „ Cystic Mackerel 4 barrels „ 29 „ Unsound *Pig's Liver ... „ 29 „ Necrosis *2 Sheep's Cauls ... Nov. 4 „ Cystic *Pig's Liver ... „ 4 „ Cirrhosis *Sheep's Caul ... „ 18 „ Cystic *Pig's Lungs ... „ 25 „ Inflammation *Ox Kidney ... Dec. 2 „ Nephritis *Sheep's Liver ... „ 2 „ Congested Ling 2 cases „ 28 „ Unsound Those marked *were found in a Slaughter-house. 140 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. Bohmer 307, High Street, do A. E. Paine 14, Gunning Street, do A. Jewiss 68, Glyndon Road, do (unoccupied) 102, Ann Street, do C. Letchford 109, Plumstead Road, do J. Clark 152, do do (unoccupied) 82, Bannockburn Road, Plumstead (unoccupied) 2, Stratton Terrace, Bostall Lane, Plumstead W. Jeffery 123, Burrage Road, Plumstead P. H. Mack 111, High Street, Woolwich A. Bradshaw 3, Green's End, do B. Renshaw 184, Elizabeth Street, North Woolwich C. Haas 122, Albert Road, do H. Myers 33, Samuel Street, Woolsvich Mrs. Dennis 90, Brookhill Road, do E. Ewell 36, Chapel Street, do A. Adams 10, Eingsman Street, do (unoccupied) 94, High Street, Eltham H. Westbrook 114, do do F.Cook 142, do do F. J. Cook 5, The Parade, New Eltham F. A. Finch 13, do do E. Hobbs 6, Well Hall Parade, Eltham R. Moakes 53, Cordite Street, Plumstead W. Stead 53, Lakedale Road, do G. H. Porter 29, Charles Street, Woolwich E. Dalton and F. Mendham 4, Plumstead Road H. Kempton 71, Bloomfield Road 141 TABLE XXa. List of Certified Underground Bakehouses. Name. Address. P. Erden 33, Eglinton Road, Plumstead Merritt & Co. 50, Herbert Road, do. R. Gilder 14, Westdale Road, do. H. Percival 223, High Street, do. J. Werner 1, Park Road, do. — Lloyd 58, Pattison Road, do. P. Cox 46, Hudson Road, do. W. Jerrard 14, Conway Road, do. P. Farrier 30, Burrage Road, do. W. T. Akers 16, Armstrong Place, do. B. Dalton 13, Eton Road, do. S.Collins 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. T. Newman 16, Woolwich Common, Woolwich B. Flood 31, Beresford Street, do. F. Wilkening 72, Henry Street, do. W. C. Clothier 51, Albion Road, do. — Simmons 23, George Street, do. - (unoccupied) 21, Albion Road, do. A. Hills 32, Church Street, do. Mrs. Attenborough 60, Sand Street, do. E. Tucker 81 & 82, Brookhill Road, do. - (unoccupied) 8, Hill Street, do. 142 TABLE XXn. 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 Malton Street, Plumstead G. Mackintosh Warwick Terrace, Plumstead Common J. Werner 1, Park Road, Plumstead A. Chapman 2, High Street, Plumstead 143 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 & Ganis William Funnell 25, Parry Place, Plumstead 4 Do. 6, High Street, Plumstead 5 Hedley Vicars 41, Church Street, Woolwich 6 William Francis Bartlett 14, Church Street, Woolwich 7 Henry Reed Love Lane (near Wellington Street), Woolwich 8 James & George Mitchell 25, Hare Street, Woolwich 9 Hedley Yicars 30, Hare Street, Woolwich 10 Henry Reed & Ganis William Funnell 38, Plumstead Common Road, Plumstead 11 Henry Fretter 33, Herbert Road, Plumstead 144 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 Cold Harbour Farm, Chislehurst 3 John and Alfred Low, Avery Hill Farm, Eltham Park Farm, Eltham 4 W. F. Corp Lyme Farm, Eltham 5 Charles Umfreville Fisher and William F. Fisher, Crescent Farm, Sidcup Belmont Park Farm, Eltham 6 John Grace Pippinghall Farm, Eltham 7 William Ridewood Chapel Farm, Eltham 8 George Keen Clay Farm, New Eltham 9 Maurice Bayley Middle Park Farm, Eltham 10 Harry Furber Victoria Road Farm, Southend, Eltham 11 Charles William Killick 52, St. James' Place, Plumstead 12 Charles William Killick 52, St. James' Place 13, Princes Road, Plumstead 13 Henry 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, Frederick Lambeth, and George Pannell Lambeth 1, Griffin Road, Plumstead 17 John Charles Terrington, 16, Pellipar Road Rear of 14, 15 & 16, Pellipar Road, Woolwich 145 TABLE XXIII. List of Milk Sellebs. No. Name. Address. 1 Perrett, H. N. 2, The Parade, New Eltham 2 James, J. R. W. 26, Parry Place 3 Webb, F. W. 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. 68j, Bloomfield Road 13 Cock, G. 13, Raglan Road 14 Espline, C. 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, Po wis 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 Russell, 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 Green, R. 13, Saunders Road 37 Butter & Sons 49, Woolwich Common 38 Do. 10, Jackson Street 39 Reed, Ruth C. 120a, Plumstead Road 40 Ward, Samuel 1, Nightingale Yale 41 Mack, P. H. 111, High Street, Woolwich 42 Webb, Younger 10, Beresford Square 140 TABLE XXHL—continued. No. Name. Address. 43 Dennis, Ellen 90, Brookhill Road 44 Prowett, J. 25, Plum Lane 45 Nicholls, D. 25a, Garland Street 40 Newman, F. 1, Orchard Terrace, Timbercroft Road 47 Bayley, M. Middle Park Farm, Eltham 48 Yelland, W. 2, Westdale Road 4!) Godden, A. A. 229, High Street, Plumstead 50 Palmer, D. 46, Church Street 51 Wilton, M. M. 77, Powis Street 52 Corp, W. F. Lyme Farm, Eltham 53 Do. 3, Wellington Street 54 Pearce, R. A. 175, Plumstead Common Road 55 Christmas, Hannah 18, Well Hall Parade, Eltham 50 Dodson, W. 138, Plumstead Common Road 57 Dowsett, J. 105, Crescent Road 58 Wyatt, J. 141, Albert Road 59 Nelson, J. 9, Parson's Hill 60 Dolphin, T. G. 89, Maxey Road 61 Rumsey, E. 186, Powis Street 62 Tyler, C. W. 142, High Street, Woolwich 63 Ludlow, E. D. 2a, Brewery Road 64 Clements, E. J. 2, Cross Street 65 Bohmer, H. 307, High Street, Plumstead 66 Green, H. G. 17, Kashgar Road 67 Couzens, Jesse 10, Chapel Street 68 Oliver, Clara 101, Sand Street 69 Bollen, W. 1, Warwick Terrace 70 Stevens, F. 100, Roydene Road 71 Ridewood, W. 116, High Street, Eltham 72 Rose, J. 04, Hargor Road 73 Corp, W. F. 90a, High Street, Eltham 74 Do. 13, Princes Road 75 Trodd, W. J. 113a, High Street, Woolwich 76 Stevens, H. 27, Church Street 77 Hassan, Fred 182, Elizabeth Street 78 Howard, Esther 80, Benares Road 79 Needham, Elizabeth 94, High Street, Woolwich 80 Webb, F. W., & Co. 16, Lakedale Road 81 Finch, G. A. 13, The Parade, New Eltham 82 Davis, D. H. 170, Albert Road 83 Willis, H. 2, Ritter Street 84 West, W.H.J. Rear of 49, Lakedale Road 85 Phipps, H. 15a, Sand Street 86 Reynolds 24b & 26b, Glyndon Road 87 Smith, Elizabeth 12, The Broadway, Eltham 147 TABLE XXIII.—continued. No. Name. Address. 88 Bennett, Rose 22, Glyndon Road 89 Williams, Ellen 12, Thomas Street 90 Reynolds, C. W. 10, Basildon Terrace 91 Griffith, Elizabeth 153, High Street, Plumstead 92 Bartrum, Abner 167, Kingsman Street 93 Briggs, A. C. 6, Bloomfield Road 94 Groves, Mrs. 40, Orchard Road 95 Jones, David 65, Maxey Road 96 Mackintosh, G. H. 16, Warwick Terrace 97 Daveney, T. 24, Maxey Road 98 Jaques, Herbert 56, Anglesea Road 99 Killick, C. W. 52, St. James's Place 100 Jones, Mary 35, High Street, Woolwich 101 Stitson, A. G. 2, Brewery Road 102 Callaghan, J. A. 89, Brookhill Road 103 Eaddy, T. J. 107, Pattison Road 104 Hawkins, Emily 77, Powis Street 105 Campion, H. E. 105, Pattison Road 106 Parker, J. Fountain Stores, The Slade 107 Lamb, Annie 29, Admaston Road 108 Norton, Emma 28, Conway Road 109 Townsend, J. 21, Wilmount Street 110 Jones, E. C. 6, Samuel Street 111 Ellicott, Annie M. 52, Raglan Road 112 Harrington, James 26, Prospect Row 113 Clark, H. "Ashurst," Shrewsbury Lane 114 Greatrex, P. Lydwin Cottage, Plumstead Common 115 Oakham, J. J. 3, Brentwood Cottages, Pope Street, New Eltham 148 TABLE XXIV. Applicants Registered during 1908 as Purveyors of Milk. Date. Applicant's Name. Premises. Remarks. Jan. 2 Edwin J. Cole 18, Camrose Street Jan. 23 Henry Moore 28, High Street, Woolwich Discontinued Jan. 23 W. J. Finnemore 21, Walpole Place Feb. 13 J. Cowell 6, Bloomfield Road Discontinued Mar. 26 S. R. Smith 6, Bloomfield Road Mar. 26 J. E. Groves 40, Orchard Road, Plumstead Mar. 26 J. Lyons & Co., Ltd. 99, Powis Street Apr. 24 Fanny Breanford 52, High Street Discontinued Apr. 24 Jane McGee 42, Mulgrave Place Apr. 24 Caroline Attenborough & Son 18, Prospect Place May 14 A.Bell 28, High Street, Woolwich Discontinued May 14 J. H. Johnson 29, Wilmount Street Removed by Order of Council, 31/12/08 May 14 J. H. Whiffin 108, Burrage Road May 14 E.J.Tucker 82, Brookhill Road Removed by Order of Council, 12/11/08 June 4 F. Perry 27a, Herbert Road Discontinued June 4 C. Marsh "Ashurst," Shrewsbury Lane July 2 W. & E. Addis and A. Usherwood, Ld. 1, Ordnance Road Removed by Order of Council, 31/12/08 July 2 Anne Palmer 127, Plumstead Road July 2 C. W. Killick 52, St. James' Place July 23 W. E. Hills 64, Villas Road July 23 C. E. Rich 69, Glyndon Road July 23 E. A. Pearson 118, Plumstead Road Discontinued Oct. 1 Kate F. Mumford 22, Cross Street Oct. 1 Martha Sutherland 2a, Brewerv Road Oct. 1 Blanche Holmes 43, Bostall Hill Oct. 1 Rose M. Wainwright 36a, Mulgrave Place Nov. 12 Emily Annie Gill & Sons (Wn. Gill and A. Gill) 398, High St ect, Plumstead Nov. 12 Ernest Morley 31, Craighton Road Dec. 31 T. Fairservice 12a, New Road Dec. 31 W. J. Brinkworth 82, Purrett Road Dec. 31 Perkin Palmer 82, Purrett Road 149 Appendix. INFANTS' MILK DEPOT. Full particulars as to the establishment, objects, mode of working, and apparatus, of the Infants' Milk Depot have been given in two previous reports, the first one being separately printed in 1900, and the second forming part of the Annual Report of 1907. 308 Infants were supplied with milk in 1908, compared with 313 in 1907. The actual number of children being fed at one time averaged 110, varying for the most part between 110 and 130. This average was reached at the close of 1907, and agrees very closely with the number given by your Medical Officer of Health as the maximum likely to make use of a Depot. It is estimated that 600 infants under one in this Borough are hand-fed, so that the Depot provides for about one-fifth of these. Duration op Feeding.—It is satisfactory to find that there were fewer cases last year in which the milk was tried and given up in a few days. 207 children discontinuing the milk in 1908 had been on the depot for more than one month, and only 46 were on less than one month. 99 had the milk for over six months. The average duration of feeding was five months. This indicates that for the most part, mothers obtained the milk, not as a temporary fancy, but from a conviction of its utility which was confirmed by trial; for the Depot milk costs parents more than ordinary fresh milk and preserved milk. The table (see below) of reasons for discontinuing the milk shows why the duration of feeding was curtailed in most cases. Only 42, or one-sixth of the total discontinuing, did so on account of the baby having reached an age not to need the milk. 56 mothers left the Borough, and 56 gave up the milk on account of the expense. No milk is supplied to any mother who gets a week behind in her payments, and the strict application of this rule led to many infants having to taken off the Depot. 150 It was decided during the year not to supply any milk to persons residing out of the Borough, although enhanced prices had been originally fixed for such cases, which gave a profit to the ratepayers on the working expenses of the Depot. This led to the exclusion of several children in Charlton who were taking the milk. One mother, who was refused the milk because she lived just outside the Borough boundary, took lodgings for her baby and nurse inside the Borough, and was supplied with the milk at a heavy additional cost to herself, and a loss to the ratepayers. Age of Infants Fed.—The average age of the children taken on at the Depot was three months. The average duration of feeding was five months, thus the average age of those fed was five and a half months. Health of Infants coming on Depot. Of the 245 infants who commenced Depot milk in 1908, 130, or more than half, were unwell at the time of commencing—30 suffered from indigestion, 48 were wasting or delicate, 15 had diarrhoea, 12 were premature infants or twins, 2 had tuberculosis, and 23, other diseases. The large proportion of delicate infants should be particularly noticed, and indicates that the Depot is as much used for curative as for preventive purposes. Only the more enlightened parents seek the Depot milkas long as their infant appears to flourish. Many only come to the Depot when the baby's health fails. Deaths of Depot-Fed Infants. The health of Depot infants, as judged by the number of deaths, was even more satisfactory last year than in 1907. Only six children died while on the Depot; one of these had only been on one day, one 9 days, and ono 10 days. One died from whooping cough, two from diarrhoea, two from bronchitis, and one from convulsions. Nine additional infants died after having left the Depot for an interval varying from three days to three months. As ordinarily estimated the death-rate per 1,000 infants fed would be only 38, but I have elsewhere given reasons for considering all such death-rates totally incomparable with normal infantile deathrates. There can be no doubt, however, that many more children would have died but for the Depot milk. 151 Weighing of Infants. This part of the work of the Depot, which corresponds to some extent to the School for Mothers inaugurated in the Borough of St. Pancras, has largely developed in the past year. 229 Depot-fed infants were weighed, with a total of 970 weighings. 122 of these were weighed at least three times at intervals of about a fortnight; of these 45 gained more than the average weight, 27 gained the average weight, and 55 gained less than the average. Thus, although more than half were delicate infants, the large majority gained the average or more than the average amount. Mothers were also encouraged to bring their breast-fed babies to be weighed, and for consultation as to feeding. 58 were brought, and there were 142 weighings; 20 were weighed at least thrice, of which 10 gained more than the average, 3 gained the average, and 7 less than the average. At these consultations mothers are advised as to the general management of their infants, and the modification and quantity of the milk is altered according to the weight and general condition of the child. If there is any illness requiring medical treatment the mother is advised to take the baby to a doctor. Medical practitioners are beginning to recommend the particular modification suitable to their infantile patients, but full advantage is not yet taken of the facility with which any desired modification of milk can be supplied at the Depot as desired by the medical man. Frequently, when a particular modification does not suit, the child is taken off the Depot and the food changed, whereas probably it would be safer and more satisfactory to order a different modification at the Depot. Miss Dodd, M.B., B.S., kindly gave her services in assisting on weighing days at the consultations; her assistance was of great value. Diarrhcea in Depot-Fed Infants. Full particulars on this subject were given in my special report on "Summer Diarrhoea and Notification." It appears that Depot-fed infants only run one-fourth the risk of getting diarrhoea that other hand-fed children are exposed to. They have, however, been found much more prone to this disease than breast-fed children. Theoretically, Depot-fed children should not be liable to the infection of diarrhoea any more than those breast- l 2 152 fed, provided their general health makes them equally resistant, and provided the rules of the Depot as regards the use of the Depot bottles are strictly adhered to; but in practice both these provisions frequently fail to be complied with. Cost of the Depot. It is satisfactory to find that, although more children have been fed, the cost of the Depot was slightly less than in 1907, and the loss consequently less. The total loss on working expenses and loan charges was £418 7s. 4d., compared with £500 11s. 3d., the loss for 1907. The income increased by some £80, while the expenditure remained about the same. The cost to the ratepayers of the Depot is equal to a rate of oneeighth of a penny. The Borough Treasurer has kindly supplied a full revenue account which is given below. STATISTICS—Numbers Fed. Number having milk on January 1st, 1908 123 New cases taken on between December 31st, 1907, and December 31st, 1908 245 Total cases which had milk in 1908 308 Cases discontinuing in 1908 253 Total on books having milk on December 31st, 1908 115 Average number being fed 116 Average duration of feeding 5 months Condition of Health of Infants Commencing Depot-Milk in 1908. Number well on commencing ... 115 Number unwell on commencing ... 130 viz:—Wasting 24 Premature birth 10 Twins 2 Delicate 24 153 Indigestion 30 Diarrhoea 15 Tubercle 2 Whoop ing-cough 1 Other diseases 22 130 Reasons For Discontinuing Depot-Milk. Left Borough 56 Too old 42 Died 6 Expense 56 Mother dissatisfied 28 Doctor's advice 33 Did not keep rules 1 Went to hospital or infirmary 10 Baby refused milk 8 Guardians stopped milk 3 Too ill 4 Mother's milk returned 5 Not stated 1 253 Deaths of Infants who were on the Depot at time of death during the year ended 31st december, 1908. No. Date of Death. Disease. Age at Death. Received milk for 285 1-10-08 Eclampsia 1 year 2 mths. 11 months 357 9-2-08 Whooping-cough 3 months 9 days 372 25- 9-08 Bronchitis 10 months 10 days 405 7-8-08 Diarrhoea 1 year 1 mth. 3 months 19 1-10-08 Zymotic Enteritis 3 months 1 day 320 31- 8-08 Bronchitis 11 months 9 months Total deaths, 0. Deaths in first week of feeding, 1. Deaths in following three weeks, 2. 154 The following deaths occurred in 1908, after the infants had discontinued having depot-milk. No. Date of Death. Disease. Age at time of discontinuing. Received milk for Discontinued milk 329 11-4-08 Congenital heart disease 4 months 3 months 28-3-08 350 2-9-08 Mastoid disease 9 „ 5 „ 28-6-08 351 6-8-08 Meningitis Bronchopneumonia 7 „ 6 .. 23-7-08 371 28-2-08 Hydrocephalus 9 „ 9 days 25-2-08 375 21-8-08 Zymotic Enteritis 10 „ 6 months 1-8-08 382 20-6-08 Diarrhoea 4 „ 3 „ 12-6-08 424 17-7-08 Do. 3 ,, 2 „ 10-7-08 430 2-9-08 Tubercular Mesentery 7 „ 3 „ 7-8-08 460 14-10-08 Gastritis 4 „ 2 weeks 17-7-08 Total deaths, 9. Deaths within one week of discontinuing Depot-milk, 1. Deaths within following three weeks, 5. Causes of Death—Diarrhoea, 5; Whooping Cough, 1; Bronchitis, 2; Eclampsia, 1; Heart Disease, 1; Mastoid Disease, 1; Meningitis 1; Hydrocephalus, 1; Tubercular Mesentery, 1; Gastritis, 1. Total 15. Children who went off the Depot in 1908 253 Period for which they were supplied:—Under 1 month, 40; 1 to 3 months, 55; 3 to 6 months, 53; 6 to 9 months, 42; 9 to 12 months, 31; over 12 months, 26. Average duration of feeding months INFANTS WEIGHED—Depot-Fed. Number of Infants weighed 29 Number of Infants weighed 3 times or more 22 Number of weighings 70 Of those weighed 3 times or more— Number who gained more than average amount 5 Number who gained average amount 7 Number who gained less than the average amount or lost 50 155 Breast-Fed. Number of Infants weighed 58 Number of Infants weighed 3 times or more 20 Number of weighings 142 Of those weighed 3 times or more— Number who gained more than average amount 10 Number who gained average amount 3 Number who gained less than average amount or lost 7 157-158 Dr. MILK DEPOT, MAXEY ROAD. Cr. Approximate Revenue Account for Year ended 31st December, 1908. Expenditure to 31/3/08 (3 months). Expenditure 1/4/08 to 31/12/08 (9 months). Total. Income, 3 months to 31/3/08. Income, 9 months to 31/12/08. Total. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. To Wages 47 17 7 152 10 4 200 7 11 By Sale of Milk— Salaries 17 10 0 56 10 9 74 0 9 Sterilised 153 7 5 433 5 8 586 13 1 Rent 10 0 0 30 0 0 40 0 0 Separated 6 3 6 15 11 11 21 15 5 Gas 13 4 15 6 1 8 10 £159 10 11 £448 17 7 608 8 6 Horse Hire 17 11 0 53 8 0 70 19 0 Milk 94 5 10 281 11 6 375 17 4 Sugar of Milk, Castor Sugar &c. 8 8 4 23 18 2 32 6 6 Milk Bottles, Stoppers Washers, Utensils, &c. 20 12 3 66 11 0 87 3 3 Machinery and Repair and Maintenance of same 5 16 6 16 10 7 22 7 1 Coal, Coke, and Fuel 6 19 3 19 1 1 2 26 13 5 Telephone Subscription ... 1 10 0 1 10 0 Fire and Boiler Insurance, Xmas, 1907, to Xmas, 1908 1 3 9 ... 1 3 9 Cleaning Materials 1 9 4 5 13 10 7 o o 2 Thermometers 1 18 2 1 18 2 Milk Truck 6 12 6 6 12 6 Sundries 3 11 8 J 6 0 6½ 9 12 3 Balance carried to Net Revenue Account, being loss on Working Expenses 351 19 1 Ice ... 1 3 8 1 3 8 £237 17 0½ £722 10 6½ £960 7 7 £960 7 7 Approximate Net Revenue Account for Year ended 31st December, 1908. £ s. d. £ s. d. £ s. d. £ s. d. To Balance brought down from Revenue account ... ... 351 19 1 By Balance, being Approximate Loss on Milk Depot Account for year 418 7 4 Loan Charges— Repayment of Principal 50 0 0 50 0 0 Interest on Loans 4 4 5 12 3 10 16 8 3 £4 4 5 £62 3 10 £418 7 4 £418 7 4 ALEXr. THOMAS, 23rd March, 1909. Borough Treasurer.