WOO 13 Metropolitan Borough of Woolwich. ANNUAL RETORT OF THE Medical Officer of Health FOR WOOLWICH. 1909. 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. Geo. William Mitchell(Vice-Chairman), 22a Mulgrave Place, Woolwich. Alderman John Perryman, 175 High Street, Plumstead. Alderman Henry Smith Syer, 45 Plumstead Common Road. Leon Charles Chasteauneuf, 224 Burrage Road, Plumstead. Thomas Davis, 2 Greening Street, Plumstead. Joseph Harper, 18 St. Margaret's Road, Plumstead. Lt.-Col. Francis Seymour Leslie, R.E., 24 Wood Street, Woolwich. Jeremiah James Mahony, 67 Beresford Street, Woolwich. James Newman, 92 Rochdale Road, Plumstead. Richard Patrick Purcell, 12 Gatling Road, Plumstead. William Raven, 82 Little Heath, Charlton. William Hardy Ross, 6 Cantwell Road, Plumstead. William Tailby, 89 Herbert Road, Plumstead. Charles watkins, 10 Woolwich Common. 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. 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 Ward's. 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 FitzGehald (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, 1909. Area of Borough 8276.6 Acres Population—Census, 1901 117,178 do. Estimated to middle of 1909 127,993 Inhabited Houses—Census, 1901 18,086 Total Houses to middle of 1909 22,872 Persons to a House Census 6.47 Marriages 847 Births 2,937 Birth Rate 22.9 Deaths 1,585 Death Rate 12.4 Infantile Mortality 82 per 1,000 births. 5 TABLE OF CONTENTS. page. Names of Members of Public Health Committee 2 Names of Members of Sanitary Staff 2 Summary of Statistics 4 Preface 10 Part I.—Statistics. Population—New Houses 12 Births 16 Marriages 18 Deaths—Woolwich Death Rate compared with other Boroughs 19 Lives and Illness saved 23 Infant Mortality—Preventive Measures 23 Still-births 25 Mortality under five years 25 Zymotic Death Rate 26 Inquests and Uncertified Deaths 26 Deaths in Public Institutions 27 Small-Pox and Vaccination 27 Measles 28 Whooping Cough 29 Scarlet Fever—Expense of unnecessary Hospital Isolation— Return Cases—Isolation at Home—Sources of Infection— Provision of Medical Attendance 30 Diphtheria—Sources of Infection 35 Bacteriological Examination 38 Enteric Fever—Source of Infection 40 Diarrhoea—Notification Statistics Erysipelas 55 Puerperal Fever 55 6 page. Influenza, Bronchitis, and Pneumonia 55 Tuberculosis—Voluntary Notification 56 Source of Infection—Occupation 61 Bacteriological Diagnosis 61 Sanatorium Treatment—Results of- The economy of Sanatorium Treatment for five years 62 Cancer—Classification 68 Alcoholism—Public Houses Closed under Licensing Act 72 Syphilis 73 Meteorology 73 Part II.—Administration. Water Supply—Plumstead Well—Additional supplies on upper floors 75 Pood and Drugs Act—Percentage Milk Adulteration 78 Food Inspection 80 Dairies, Cow-sheds, and Milk-Shops 80 Slaughter-houses 81 Nuisances—Complaints, Drains, Water-closets, Ventilation of New Outfall Sewers, Supervision of drainage 81 Public House Urinals 82 House Inspection 83 Medical Officer's Inspections 83 Over-crowding 84 Smoke Nuisance 84 Defective Light 84 Dark Rooms and failure of Building Act 84 Verminous Rooms 86 Dust Removal—Collection, Cost of 86 Trade Refuse— Offensive and Inoffensive 87 Housing of the Working Classes— Houses represented as unfit for habitation 87 7 page. Housing of the Working Classes (continued)— North Woolwich—Concreted Sites 90 Council's Houses 91 Houses Registered under the By-laws 91 Inhabited House Duty 92 Common Lodging-houses 92 Underground Rooms 93 Factories and Workshops—Inspections—Outworkers 93 Bakehouses 93 Ice-cream Shops 93 Disinfection, Disinfectants 94 Health-Shelter 95 Mortuaries 95 Cemeteries 95 Cleansing of Verminous Persons 95 By-laws for Tents, Vans and Sheds 97 Infants' Milk Depot—Statistics—Tables 97 Public Ambulance 107 Notices and Prosecutions under Public Health(London) Act 107 Bacteriological Examinations 107 Women Sanitary Inspectors' Work— Miss Middlebrooke's Report 108 Miss FitzGerald's Report 112 Use of School Playgrounds 116 Report of the Royal Commission on the Poor Law 117 The Children Act 117 Public Health Staff 118 8 LIST OF TABLES. page. Table I.—Population. Births and Deaths for the whole Borough from 1899 to 1909, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 119 Number of Inhabited Houses, the average number per house, and the acreage 119 „ Ia.—Institutions inside and outside the district receiving sick and infirm persons from the district 121 „ II.—Population, Births Registered, Deaths at all ages, and Deaths under One Year, for each Ward during 1901, 1902, 1903, 1904, 1905, 1906, 1907,1908, and 1909 123 „ III.—Cases of Infectious Disease notified at all ages, at various age groups, and distributed according to Wards during 1909 125 „ IV.—Deaths at all ages, at various age groups, from various causes in 1909 127 „ IVa.—Deaths from various causes arranged by Wards in 1909. Total Deaths in Public Institutions in district in 1909 129 „ IVb.—Infantile Mortality during the year 1909 ... 131 „ V.—Case and Death Rate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1909 133 „ VI.—Vital Statistics of the various London Boroughs for 1909 135 „ VIA.—Birth and Death Rates do. do. do. 137 „ VII.—Death Rates and Infant Mortality of the various London Boroughs, 1904-8 and 1909 139 „VIIa.—Death Rates, before and after distribution, of the various London Boroughs, 1909 141 „ VIII.—Meteorology and Registered Deaths from all causes and from certain prevalent diseases in each week of the year 1909 143 „ IX.—Weekly Averages for Meteorology and Registered Deaths from all causes and from certain prevalent diseases 145 „ X.—Summary of Statistics for the first Quarter of 1909, corrected for Public Institutions 146 9 Page. Table XI.—Summary of Statistics for the second Quarter of 1909, corrected for Public Institutions 147 „ XII.—Summary of Statistics for the third Quarter of 1909, corrected for Public Institutions 149 „ XIII.—Summary of Statistics for the fourth Quarter of 1909, corrected for Public Institutions 150 „ XIV.—Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 153 „ XVa.—Summary of the General Work of the Public Health Department for 1909, the number of Nuisances abated, and Notices served in each Ward 155 „ XVB.—Summary of Work of Chief Inspector, and miscellaneous 157 „ XVc. —Inspection of Factories, Workshops and Workplaces 158 „ XVd. —Proceedings during 1909 re Milk-shops, Cow-sheds, Slaughter-houses, &c. 161 „ XVI.—List of Streets Inspected—House-to-House—and number of houses where defects were found 162 „ XVII.—Prosecutions in 1909 under the Public Health (London) Act and By-laws and Housing of the Working Classes Act 168 „ XVIII.—Summary of Articles Analysed under the Sale of Food and Drugs Act 169 „XVIIIA—Proceedings in 1909 under the Sale of Food and Drugs Act 170 „ XIX.—Food seized, or surrendered by Owners, as unfit for consumption 171 „ XX.—List of Level Bakehouses in the Borough, 1909 172 „ XXa.—List of Certified Underground Bakehouses in the Borough, 1909 173 „ XXb.—List of Factory Bakehouses 174 „ XXI.—List of Slaughter-houses in the Borough, 1909 175 „ XXII.—List of Cow-houses in the Borough, 1909 176 „ XXIII.—List of Milk Sellers 177 „ XXIV.—List of Persons Registered as Purveyors of Milk during 1909 180 10 PREFACE. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Woolwich. Me. Mayor and Gentlemen, I herewith present my Ninth Annual Report on the Health of the Borough, including the Eighteenth Annual Report on the Health of Plumstead. The public health continues to improve, and I wish to call special attention to the great decline in infant mortality, from 144 in 1898 to 82 last year. The efforts made to reduce the unnecessarily numerous deaths of infants are described under "Notification of Zymotic Enteritis," "Infants' Milk Depot," and "Women Sanitary Inspectors' Report"(Miss Fitz Gerald's Report). The remarkable success attending the Milk Depot is shown by the fact that during the three years that the Milk Depot has been in existence the death rate of children fed at the Depot was only 81, which compares with a similarly calculated death rate for hand-fed children of 198 per 1000 births. References are made in the Report to the extravagance resulting from providing for institution treatment of such diseases as Scarlet Fever, while making no provision for the cost of home treatment. On the other hand an attempt has been made to express in £ s. d. the economy of sanatorium treatment of Consumption(see Scarlet Fever and Phthisis). 11 The past year has seen the birth of several important Sanitary measures—notably the Children Act, the Housing Act, and the London County Council(General Powers) Act. The latter Act provides that houses newly occupied as tenement-houses must have suitable accommodation for the storage of food. Though much has been done, much remains to do. The By-laws for houses let in lodgings are still unrevised. There are no By-laws for houses let in lodgings in Eltham. The Women Sanitary Inspectors are unable to cope with half the work which should properly be done by them. Other Boroughs have Health Societies and persons of leisure who act as voluntary health-visitors. Woolwich, not possessing these advantages, can only replace them by Municipal effort. Hoping that these matters may receive your early attention. I am, Mr. Mayor and Gentlemen, Your obedient servant, SIDNEY DAVIES. May, 1910. 12 NINTH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1909. PART I. Statistics. 1. Population. The population of the Borough of Woolwich, as estimated by the Registrar-General, to the middle of 1909, on the supposition of a continuous increase since the Census proportional to the increase between the two last Censuses, is 133,374. As estimated on the number of occupied houses, and presuming the same number to a house as at the Census, it is 139,726. The estimate, which has been made for the purpose of the following statistics, is as follows:— Woolwich Parish 38,991 Plumstead Parish(East) 34,500 Do. (West) 40,907 Eltham Parish 13,595 Borough 127,993 13 West Plumstead includes the Burrage, Herbert, Glyndon and St. Margaret's Wards; and East Plumstead the Central and St. Nicholas's Wards. This estimate has been obtained by a careful consideration of the total number of houses in each Ward, and the number of empty houses. 127,993 is probably not far from the correct population, and has been rather under than over stated. The. rates calculated from it may be safely taken as approximately correct. An error of 5,000 in the population would make a difference of only 0.4 in the death-rate. Estimated increase in the year 345 Natural increase(excess of births over deaths)1352 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 18496 New houses to June 30th, 1901 257 do. do. 1902 1292 do. do. 1903 743 do. do. 1904 582 do. do. 1905 483 do. do. 1906 390 do. do. 1907 281 do. do. 1908 191 do. do. 1909 157 22872 Viz.—Woolwich 33 West Plumstead 24 East Plumstead 21 Eltham 79 Half the new houses certified in 1909 were in Eltham Parish. 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, on July 25th, 1909, has been kindly supplied me by the Clerk to the Bating Committee:— Woolwich Parish— Dockyard Ward 107 St. Mary's Ward 76 River Ward 207 St. George's Ward 77 467 Plumstead Parish— Burrage Ward 66 Herbert Ward 85 Glyndon Ward 67 St. Margaret's Ward 130 Central Ward 52 St. Nicholas's Ward 249 649 Eltham Parish 160 Total 1276 Thus the number of empty houses has increased tenfold in Woolwich Parish, and seven times in Plumstead, but has changed little 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. The populations of the wards are estimated by the number of occupied houses in each ward. 15 Wards. Dockyard St. Mary's River Ward. St. George's Burrage Glyndon Herbert St. Margaret's Central St. Nicholas's 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 „ 1908, to „ 1909 7 1 22 3 — — — 4 20 — 21 79 Total Houses 1,393* 1,207* 679 1,708* 879 1,746 1,729 1,886 2467 1,855 4253 2694 Estimated Populations 7,800 9,788 3,396 10,188 7,314 9,184 9,106 9,444 13,173 9,500 25,000 13,595 *In Dockyard, St. Mary's and River(South) Wards the number of new houses is probably less than the number of old houses which have been demolished. †40 flats in Army Quarters, Artillery Place. 16 births. 5. The number of births was 2,937, viz.:—1,015 in Woolwich Parish, 893 in West Plumstead, 763 in East Plumstead, and 266 in Eltham(corrected for children born in the Infirmary, the Female Hospital, and the Wood Street "Home for Mothers and Babies," whose parents reside outside the Borough); and the birth-rate, 22.9, compared with 24.1 in the previous year, and with 28.2 the average for the 10 years 1899-1908. The rate for the County of London was 24.4. Notification of Births. 2,598 births were notified under the Notification of Births Act. This is at the rate of 88 per cent. of the registered births, compared with 83 per cent. in 1908. Of the 2,598 notifications, 1,502 were notified by midwives, and 493 by medical practitioners. 72 still-births were notified. The past year was the first complete year of working of the Notification of Births Act, this Act having been adopted on March 1st, 1908. Though there has been some improvement in notification, it is still unsatisfactory that there should be 12 per cent. of births unnotified. Midwives appear to notify all the births they attend, but doctors, to a large extent, leave it for the fathers to perform this duty, and they frequently neglect it owing, no doubt, to ignorance. 90 per cent. of births were notified in Woolwich and Plumstead Parishes, but only 74 per cent. in Eltham. Some doctors object to the obligation to perform a duty without receiving any recompense, and parents do not understand having to notify the birth to one official, and to register it with another. In spite of these weak points in the Act, it has been of immense benefit in enabling mothers to be instructed in the care of their infants. A card of instructions is sent to the mother of 17 every child at once on notification, and the Lady Health Visitor visits in the course of the next week or two those mothers who are considered to most need instruction. 6. The following table gives the average birth-rate of the Borough during the years 1901-5, 1906, 1907, 1908, and 1909, 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 in London. Birth-rate. Average 1901-5 1906 1907 1908 1909 Greenwich Borough 27.6 25.4 24.2 23.5 22.5 Lewisham 25.7 23.3 23.8 23.0 21.9 West Ham 33.1 30.5 28.6 29.4 28.0 East Ham 33.8 28.1 26.3 24.7 23.5 Erith 34.1 30.0 29.9 25.9 23.4 London 28.2 26.6 25.8 25.2 24.3 England and Wales 28.2 27.0 26.3 26.5 25.6 Woolwich Borough 29.2 27.7 25.6 24.1 22.9 7. By a recent readjustment of the Registrars' districts, Plumstead is now divided into two districts of nearly equal population, and it becomes possible to give birth and death rates for each of these. East Plumstead consists of Central and St. Nicholas's Wards, and West Plumstead of the remainder of the parish. The following table gives the Birth-rate for the Borough, and each parish, for the three past quinquennia, and last four years. Correction has been made for births in the Infirmary, Female Hospital, the Wood Street "Home for Mothers and Babies," and outlying institutions, and the births distributed to the parishes to which they properly belong. Except in Eltham, b 18 there has been a great and progressive decrease in each parish, but greater in Plumstead than in Woolwich. In Eltham, after a decrease in the second quinquennium, there was a marked increase in the third, but the rate has now fallen below the level of 1896-1900. West Plumstead and Elthamhad the lowest birth-rate of the four registration districts. Average of 1891-1895. Average of 1896-1900. Average of 1901-1905. 1906 1907 1908 1909 Woolwich Borough 32.5 30.2 29.2 27.7 25.5 24.1 22.9 Woolwich Parish 31.1 30.1 29.0 29.2 29.1 26.4 26.0 Plumstead „ 33.3 31.0 30.1 27.8 24.1 23.7 W 21.8 E 22.1 Eltham „ 22.8 20.6 24.0 22.0 22.4 20.0 19.6 8. Illegitimate Births. 72 of the births registered were illegitimate, giving a rate of 24 per 1,000 births, compared with 17, 17, 22, 24, and 20, in the five preceding years. The illegitimate birth-rate in England and Wales was 39.9 in 1908. marriages. 9. There were 847 marriages. The marriage rate was 13.2, compared with 16.4, 14.6, and 13.7 in the three preceding years. The great fall in the marriage rate, which was an indication of the prevalent local industrial depression, shows signs of arrest. In 1908, the marriage rate in London was 15.9, and in England and Wales 14.9. It will be seen that a large part of the fall in the birth rate is accounted for by reduction in the number of marriages. Deaths. 10. Table I. gives the gross and nett deaths and death-rates 19 in 1909, 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, deaths upon which inquests were held, and certain other deaths, to their proper locality, according as they occur outside or inside the Borough. But, in order to institute a fair comparison between one district and another, it is necessary to further correct the death-rate for sex and age distribution, for it is obvious that a population containing a large number of young persons between the ages of 5 and 30, when the death-rate is very low, should have a lower death-rate than one containing an excess of aged persons. The factor for the correction of the Woolwich death-rate is 1.0690. 11. The nett deaths were 1585, and the nett death-rate was 12.4. The death-rate in 1908 was 11.6. With this exception, last year had the lowest death-rate recorded for the Borough. 12. By multiplying by 1.0690, the factor for age distribution, we get the corrected death-rate, viz., 13.3, 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 14.5 14.5 76 Large Towns 14.7 15.6 London 14.0 14.7 Greenwich 12.2 12.5 Lewisham 103 10.7 West Ham 14.2 - East Ham 9.4 b 2 20  Nett. Corrected. Erith 8.1 Woolwich 12.4 13.3 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, 1908, and 1909. In 1909, East Plumstead had the lowest death-rate, and Woolwich Parish the highest of the four districts, but the greatest decrease in the past nine years has occurred in Woolwich Parish. Average 1886-1890. Average 1891-1895. Average 1896-1900. Average 1901-1905. 1906 1907 1908 1909 Woolwich Borough 17.2 16.9 13.9 13.1 12.5 11.6 12.4 Woolwich Parish *20.4 19.3 20.1 16.5 15.5 14.6 14.0 14.3 Plumstead 16.4 16.0 15.1 12.9 12.2 11.9 10.8 W. 13.6 E. 9.5 Eltham - 13.0 14.6 10.2 10.2 10.0 9.7 10.5 London 20.0 19.8 18.5 16.1 15.1 14.6 13.8 14.0 *Three years—1888, 1889 and 1890. 14. The death-rate among males was 13.4, and among females was 13.6. The death-rate of males in the three preceding years was 14.7, 13.3, and 13.6, respectively, and of females 13.6, 14.3, and 12.8. These rates are estimated on the the numbers of the two sexes found at the Census of 1901, and, consequently, their relative proportions alone are of value. The relative proportion of the sexes has, not improbably, been recently much modified by emigration of males. The following table gives the numbers dying at various ages in the past nine years:— 21 Deaths—1901 to 1909. Year. Age Period. Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 Over 75 1901 465 126 60 94 - 644 - 325 1902 466 169 64 94 698 351 1903 399 155 30 26 20 50 110 141 142 187 212 165 1904 479 174 53 24 25 44 105 143 158 182 182 194 1905 366 139 47 32 38 40 121 140 156 154 206 166 1906 396 139 50 25 31 38 110 139 174 191 205 168 1907 372 207 37 28 43 52 75 129 148 160 202 162 1908 298 134 51 21 36 33 96 123 134 166 212 212 1909 240 163 55 20 40 37 93 130 165 183 244 167 Deaths from 1902 1903 1904 1905 1906 1907 1908 1909 Apoplexy and all other diseases of the heart and blood vessels 221 212 215 227 216 217 243 268 Nephritis and Bright's disease 32 38 35 46 52 49 42 50 Respiratory diseases—all forms 308 269 285 264 277 209 234 250 22 Comparing the number of deaths in 1908-9 with those in 1903-4, there was in the two latter years a considerable saving of life at nearly all ages under 65. If increase of population were allowed for, the saving of life would be even more marked. Over 65 there were considerably more deaths, and these were from apoplexy and other diseases of the heart, and blood vessels, and to a less extent from nephritis, and diseases of the kidneys. It appears then that more persons are surmounting the perils of childhood, and the diseases which affect early adult life(mainly tuberculous and respiratory) and are living to die of the wear and tear of life, which necessarily kill sooner or later, in old age. These facts disprove the assertion that a diminished infantile mortality only means the survival of delicate children to fall an easy prey to the diseases of childhood, and early manhood. On the contrary it appears to mean a more vigorous and enduring manhood and womanhood. In 1909 there was a considerable increase of deaths from nephritis, respiratory, and heart diseases, cancer and influenza, and a slight increase from the principal zymotics; there was a decrease from tuberculous diseases. 14a. The chart on the opposite page shews graphically, how the birth and death rates have varied in the past 19 years. The death-rate, and infantile death-rate usually rise and fall together, but the birth-rate follows quite a different course, shewing that the fall in the infantile death-rate can only be but slightly, if at all, the result of the fall in the birth-rate. 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 1905-8 and 7.a. Chart showing Death Rate, Birth Rate, and Infantile Death Rate- 1891/1909. (To face par 14a) 23 in 1909. Only three Boroughs had a lower death-rate than Woolwich, viz.—Hampstead, Lewisham, and Stoke Newington. (N.B.—Owing to the Registrar General taking a higher population the birth and death rates come slightly lower than those given above for Woolwich). 16. Lives Saved. In the last two years, I have estimated that 376 and 479 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 1909 would have meant the death of 1968 persons instead of 1585 who actually died. There was thus a saving of 383 lives in 1909. But this is not the whole of the benefit conferred by a reduced deathrate, for each of the 383 lives saved means about 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 240, compared with 292 in 1908. The infant mortality(deaths under one year per thousand births) was 82, compared with 95 last year, and 113 in 1907. The infantile death rate was never below 100 till 1908. This great reduction in infant mortality has exceeded the most sanguine expectations. The figures are not liable to error from possible miscalculation of population, being computed on the known number of births. 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. 1909. Lewisham 112 113 90 86 93 24  1901-5. 1906. 1907. 1908. 1909. Greenwich 137 119 100 120 114 West Ham 158 149 131 128 123 East Ham 131 127 108 104 95 Erith 112 85 88 80 78 London 138 132 115 113 107 Seventy-six Great Towns — 146 127 128 England and Wales 135 133 118 121 109 Woolwich Borough 119 111 113 95 82 18 The following table gives the infantile mortality during 1906-7-8-9, and the four preceding quinquennia in the Borough, and each Parish:— 18861890 18911895 18961900 19011905 1906 1907 1908 1909 Woolwich Parish 151 157 170 134 139 114 111 91 Plumstead 121 120 132 113 97 108 88 W. 82 E. 75 Eltham .. 163 160 97 94 140 75 68 Woolwich Borough .. 140 146 119 111 113 95 82 *1888, 1889, and 1890 All three Parishes had the lowest rate yet recorded, Eltham being the lowest of all 19 Table IVb gives full details as to the ages at death, and causes of death, of the 240 infants dying in 1909 under one year It shows that 36 per cent. of those who died were under one month old, and 23 per cent. under one week old 41 deaths were from premature birth, compared with 65, 75, 61, and 72 in the four preding years, and of the remainder, 43 (27 in 1908) were attributed to Atrophy, Debility and 25 Marasmus, indefinite terms applied to deaths from immaturity, congenital syphilis, and other causes The number of deaths under one week in the past four years were 87, 83, 76, and 55 respectively The death-rate from premature birth in Woolwich Borough was 0.32, compared with 0 48, 0.71, and 0 57 in the three preceding years In England and Wales it was in 1908 18..3 per 1,000 births compared with 14.0 in Woolwich There were 19 deaths of illegitimate infants The deathrate of illegitimate infants under one year was 264 per 1,000 births, and that of legitimate infants, 77 20 Compared with 1908 the past year had, among infants, fewer deaths from premature birth, congenital defects, whooping cough, diarrhoea, tuberculosis, and overlying ; and more from measles and wasting diseases Deaths from overlying were 1, compared with 2, 8, and 5 in the three previous years There were 21 lives saved in the first week of life, and 31 lives saved in the remainder of the first year 21 Still-births 73 still-born children were buried in the Woolwich and Plumstead Cemeteries, compared with 74, 97, and 93 in the three preceding years Only 59 still-births were notified 22 Deaths under five years The total deaths under five years were 403, or 28.1 per thousand population under five at the census The rates in the five preceding years were 47.2, 36.5, 38.3, 41.9, and 313 In five years there has been a diminution of 40 per cent. in the death-rate under five 26 23 Zymotic death-rate The number of deaths from the seven principal zymotic diseases was 136, giving a death-rate of 1.06, compared with 1.49, 1.34, and 0.92 in the three preceding years. The following table gives the zymotic death-rate in each parish during the past nine years:— Average, 1901-5 1906 1907 1908 1909 Woolwich 1.69 1.93 1.67 1.10 1.44 Plumstead 1.53 1.37 1.67 0.84 1.01 Eltham 0.88 0.83 1.02 0.77 0.29 The Borough 1.51 1.49 1.34 0.92 1.06 London — — — — 1.30 24 Inquests There were 105 inquests, compared with 154, 160, 141, 121, 128, and 115 in the six preceding years The following table gives particulars as to the cause of death:— 1. Natural Causes 68 2. Accidental Causes Burns 5 Drowning 3 Falls 7 Fractures — Eun over 2 Suffocation, overlying 1 Other accidental causes 5 23 3. Homicidal Causes:— Suicide 14 Murder and Manslaughter nil 14 Total 105 The "Accidental Causes" were 41, 51, 43, 35, and 49, in the 27 five preceding years The deaths from suffocation or overlying have been 8, 8, 4, 9, and 5, respectively in those five years The "Homicidal Causes" were 11, 11, 15, 7, and 15, in the same years Accidents and overlying are diminishing, but not so suicide One death only from overlying in the year is the smallest number recorded in the past nine years 25 Deaths in Public Institutions Table I shows the actual number of deaths occurring in Public Institutions in the Borough, viz—276, compared with 261, 313, 293, 296, and 289 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 Nearly one-third of the total deaths occurred in the Infirmary or hospitals Small-Pox and vaccination 26 No cases of Small-pox have been notified in the Borough since 1905 27 The number of cases of Small-pox notified in London was 21 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 1908:— Births 3137 Vaccinated 2164 Insusceptible 10 Conscientious objections 535 Died unvaccinated 205 28 Medical postponements 9 Removed 18 Not found and unaccounted for 191 29 The number excused on account of conscientious objections was 535, compared with 109, 170, and 257, in the three preceding years The increase in the three last years is doubtless the result of the recent Vaccination Act, which facilitates the obtaining of exemption certificates Another epidemic of Small-pox may be confidently expected before very long owing to the increase of unprotected children chicken pox 243 cases of Varicella were notified by school teachers, compared with 84, 362 and 286, in the three preceding years 36 were under five years, 197 between five and ten, and ten over ten years Measles 30. There were 55 deaths from Measles, giving a rate of 0.43, compared with 0.24, 0.54, and 0.08, in the three preceding years The rate in London County was 0.48, compared with 0.31 in 1908 31. Of the 55 who died from Measles, 50 were under 5 years of age; 29 were males and 26 females 32. 768 notifications were received from school-teachers, compared with 1,240, 465, 825, 1,453, and 519, in the five preceding years The mortality per cent. of notifications was 7.2, compared with 2.3, 2.8, 3.8, 4.8, and 19, in the five preceding years 162 cases were notified from Woolwich Parish, 594 from Plumstead, and 12 from Eltham 29 33. The following table gives the number of deaths and death-rates from Me asles for the past three years, and three preceding quinquennia, in each parish, and the death-rate in London:— Year. Woolwich Plumstead Eltham The Borough London No. Rate No. Rate No. Rate No. Rate Rate 1891-5 (average) 20 0.49 29 0.51 Not recorded 49 0.51 0.59 1896-1900 (average) 34 0.81 36 0.57 Not recorded 70 0.67 0.57 1901-1905 (average) 9 0.22 15 0.22 1 0.13 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 1909 25 0.64 30 0.40 — .. 55 0.43 0.48 34 Owing to the great prevalence of measles in March, children below the age of five were excluded from all the London County Council schools in the Borough for five weeks, under Art 57 of the Code of Education Dr Kerr closed, or excluded unprotected children from 37 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 15 deaths from Whooping-Cough, compared with 37 and 32 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 0.12, compared with 0.26 in the County of London 30 The following table gives the deaths and death-rates per 1,000 population in each year since the Borough was formed There has been a marked reduction in death-rate since 1904. Year Number Rate 1901 21 0.18 1902 52 0.43 1903 27 0.22 1904 54 0.43 1905 16 0.13 1906 21 0.17 1907 37 0.29 1908 32 0.25 1909 15 0.12 361 cases were notified by school-teachers, compared with 174 and 598 in the two previous years Of these 78 were under five years of age, 282 between five and ten, and one over ten This disease was increasingly prevalent towards the close of the year, and on my suggestion Dr. Kerr excluded children under five from all the L.C.C schools in Woolwich and Plumstead parishes, excepting Elizabeth Street School 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 eases that occur To do so, however, would require an increase of staff The mortality of the disease in the past three years was seven 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 996 cases of Scarlet Fever notified (deducting 31 31 cases of mistaken diagnosis), equivalent to a rate of 7.77 per thousand population, compared with 4.67 in 1908 Except for 1907, this rate is the highest since 1894 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 1909 Borough 3.15 4.15 7.91 4.67 7.77 Woolwich Parish 2.99 3.83 6.10 3.85 10.40 Plumstead Parish 3.24 4.22 8.56 5.22 W. 8.38 E 6.47 Eltham Parish 3.21 4.71 9.65 3.94 4.04 London County 3.57 4.35 5.46 4.52 3.57 38 Table III gives the age distribution, the number in each Parish, and the number removed to hospital Woolwich Parish and West Plumstead were most affected The year 1907 had the highest prevalence of Scarlet Fever (measured by notifications) recorded in the Borough, with the exception of 1892 The disease was much less prevalent in 1908, but in 1909 again increased to almost the same level as in 1907 The numbers notified in each month were as follows:— 63, 73, 128, 66, 100, 143, 89, 98, 99, 75, 65 and 36 The largest number of cases occurred in March and June The disease was very prevalent in army barracks and married quarters, 106 cases being notified from these No explanation can be given of the general prevalence beyond that which has been stated more than once, viz:—the existence of mild undetected cases going about unrestrained; the great 32 number of these cases is largely due to inability to pay for proper medical attendance Some parts of London were affected by a serious milk epidemic due to milk coming from Wiltshire supplied by cows suffering from an eruption of the teats Woolwich had 12 cases due to this cause, most of whom were Officers of the Garrison The Artillery Mess was supplied from this source, but very few private houses A few years ago the Company affected supplied indirectly a large proportion of the population of Woolwich 39 There were 19 deaths, giving a death-rate of 0.15 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 008 The case mortality (proportion of deaths per cent of notifications) was 1.9, compared with 1.5 in 1908 Of the deaths, 5 were in Woolwich Parish, 12 in Plumstead, and 2 in Eltham It appears from the Annual Report of the Medical Officer of Health to the London County Council, that, in the five years 1903-7, only six Metropolitan Boroughs had a lower death-rate from Scarlet Fever than Woolwich 40 Hospital Isolation Of the 1027 cases, 945, or 94 per cent. were removed to one of the Fever Hospitals, compared with 84, 81, 78, 85, and 86, percent in the five preceding years 31 cases, or 3.1 per cent. were reported after observation at hospital, not to be Scarlet Fever The very high percentage of cases removed to hospital is no doubt a measure to some extent of the poverty existing in the town Parents cannot afford the cost of medical attendance There is no power to provide, at the public expense, medical attendance at home, and thus it may be said that the 33 payers of London were last year put to an unnecessary charge of £2000 at least, in respect of Woolwich children, who could have been equally well, and much more economically, treated at home 41 Return Cases There were 58 cases in which infection was attributed to a patient recently returned from hospital, compared with 14, 13, 30, and 38, in the four preceding years The interval between the return of the infecting case and commencement of illness varied from 2 to 22 days Of the infecting cases, 10 had some form of rhinitis on or after their return; 3 otorrhœa; and 1 sore throat The number of return cases was the highest on record ; of course, it by no means follows that, because a case of scarlet fever occurs shortly after contact with a return 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 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 The great majority of the returned cases appeared quite well on return, and no blame can be attached to the staff of the Fever Hospital in any case As a rule, the children returning from hospital are quite well at the moment of leaving, but in many cases develop some nasal discharge on arriving home, or within a few days Illustrative cases of this were given in the 1908 report 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 rhinorrhoea It C 34 would be an advantage perhaps if they also forwarded the 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 Eleven certificates of efficient home isolation were given to enable men to continue their employment, compared with 16 in 1908 81 cases were isolated at home None of these was followed by a secondary case which could be attributed to failure of isolation There was one ' home return case,' which began 10 days after the first case discontinued isolation In 1907 and 1908 home isolation was followed by two return cases and three second cases, due to failure of isolation 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 three years, 5.4 per cent. of failures in the hospital isolation, and 23 per cent. in the home isolation This comparison takes no account of the not inconsiderable number of children who are attacked at hospital by a second infectious disease, and the much shorter period of isolation 43 Other sources of Infection A probable source of infection was found in 186 cases In 124 cases infection was attributed to other inmates of the house Some of these were never notified, and had no distinct symptoms of scarlet fever, 35 but a history of sore throats made it probable that they had had a slight attack of this disease 44 In 36 cases infection was attributed to friends and neighbours, in 15 cases to school attendance, in 3 to travelling, and in 8 to 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 Statistics were given in my last report as to the date of calling in medical attendance in scarlet fever Some remarks were made in the same report as to the recent high prevalence and comparatively low death-rates of scarlet fever and diphtheria in Woolwich Diphtheria 48 240 cases of Diphtheria were notified (excluding 28 cases of mistaken diagnosis), compared with 387, 275, and 362 c 2 36 in the three preceding years The case-rate (number of cases per 1,000 population) corrected for cases of mistaken diagnosis, was 1.88, compared with 2.61 in 1908, and 219, the average of the ten preceding years 4 of the cases were bacteriological, ie, had no symptoms 49 There were 25 deaths, compared with 18, 23, and 15 in the three preceding years The death-rate was 0 20, compared with 016 in 1908, and 0.19 the average of the ten preceding years The London death-rate was 0.12 50 74 cases were in Woolwich Parish, 126 in West Plumstead, 59 in East Plumstead, and 9 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 1909 Borough 1.71 2.80 1.83 2.61 1.88 Woolwich Parish 1.63 3.43 1.85 3.18 1.97 Plumstead Parish 1.87 2.26 2.36 2.88 w. 3.08 E. 1.71 Eltham Parish 1.62 6.70 1.57 1.69 0.68 London 1.90 1.70 1.85 1.64 1.38 51 238 cases, or 89 per cent. of notifications, were removed to hospital, compared with 67, 83, and 89 percent. in the three preceding years A certificate of efficient home isolation was given in 1 case (8 in 1905, 21 in 1906, 30 in 1907, and 7 in 1908) The case mortality was 10.4 per cent. compared with 17.8, 66, 5.7, 6.3, and 5.5, in the five preceding years, and 9.4 in London 37 On February 17th I reported, as follows:—"In several cases the disease has affected mainly the nose, the only obvious symptom being a muco-purulent running of the nostrils In other cases the air-passages have been affected and these have been more serious or fatal Two children died on the day the doctor was called in before they could be moved to hospital One of them had been ill for two days and one for four days, before the doctor was called in Of other four fatal cases, one had been ill six days, one four days, one three days, and one one day, before medical aid was recommended There can be no doubt that several, if not all, of these deaths might have been averted if medical attendance had been obtained earlier" 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 25 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 244 home contacts were examined by the Medical Officer of Health, and 20 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 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 53 Mistaken Diagnosis 28 cases, or 10 per cent of 38 cations, were, after removal to hospital, stated to be not diphtheria The percentage of the three preceding years was 8, 14 and 8, respectively 54. Source of Infection In 50 cases, a probable source of infection was noted, viz—in 31, other inmates of the house were suspected to be the source; in 4, schoolmates; 8, neighbours and friends; 3 return cases; 4 general hospitals The 3 return-cases followed 3 returned cases; 1 of the returned cases went away with scarlet fever, and 2 for diphtheria; the first had otorrhcea in which diphtheria bacilli were found; one had rhinorrhoea One home return-case occurred, the first patient being released from isolation without a bacteriological examination 55 There was an outbreak of diphtheria in connection with Timbercroft Road School Repeated bacteriological examinations were made, and one room was closed for two weeks Several carrier and mild cases attending school were detected and excluded, and the disease abated Elizabeth Street school was also affected 56 Bacteriological Diagnosis 768 swabs were sent to the Lister Institute to be examined for the presence of diphtheria bacillus In 90 the true Klebs Loftier bacillus was found (in 9 of these, Hoffman's bacillus co-existed with the Klebs Loffer bacillus) ; in 189 Hoffman's bacillus was found, and 489 were found free from either the Klebs LolMer bacillus or Hoffman's Of the 768 swabs examined, 244 were taken from school children by myself Of these, 20 contained the true Klebs Loffler bacillus (including 4 with Klebs LofHer and Hoffman's) and 101 Hoffman's bacillus Most of these were contacts seen 39 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, eg where the first case notified in a house was a child not attending school Of the 244, 23 had symptoms, viz, 10 some form of pharyngitis, 12 some form of rhinorrhœa, or rhinitis, and one otorrhœa Of 12 cases with rhinitis or rhinorrhcea, 5 gave a positive result, 6 shewed Hoffman's bacillus, and 1 was negative The 20 contacts found positive on the first examination were re-examined at intervals of 10 days; 12 were found negative on the second examination; in 4 Hoffman's bacillus was found, in 1 a positive result occurred twice, then Hoffman's was found, and on the fifth examination a negative result was obtained 3 were notified as having some symptoms One negative result is usually regarded as sufficient, and Hoffman's is treated as a negative unless in special circumstances, as after a positive result In one case diphtheria bacilli persisted for six examinations and was succeeded by Hoffman's, Positive cases with any symptoms were notified and sent to hospital, or strictly isolated; positive cases without any symptoms were excluded from school and from mixing with other children outside the house 57 Infectious Disease Local Government Board Memorandum on closure of, and exclusion from, School A report on this important memorandum by Dr Newsholme, Medical Officer of the Local Government Board, and Dr Newman, Medical Adviser to the Board of Education, was presented and printed in the Council's Minutes of December 2nd, 1909. 40 Enteric fever 58 There were 11 cases of Enteric Fever, not including two cases of mistaken diagnosis notified as Enteric The caserate was 0.08, compared with 0.23, 0.16, and 0.10, 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 0.21 Out of 13 cases notified, 8 went to hospital 59. There were three deaths, giving a death-rate of 0.02, which is the lowest death-rate recorded The death-rate in London was 003 At the present rate of diminution Enteric Fever will have disappeared in six years 60 The following are the cases notified in each parish during the past six years:— Average, 1901-5 1906 1907 1908 1909 Woolwich 12.6 16 6 4 9 Plumstead 21.2 21 16 W. 3 E. 0 Eltham 8 6 3 5 3 1 61. In two cases the disease was attributed to oysters; in two to mussels; and in one other to shell-fish Two were, no doubt, due to personal infection It has been found that some cases of Enteric continue to be infectious for many months after they are apparently well, and occasionally prove sources of infection to others The Local Government Board are making an enquiry as to the duration of infectiousness of the urine and faeces of enteric patients 41 discharged from the fever hospital, and, by request of the Board, I am assisting in this enquiry 62. Bacteriological Diagnosis 15 samples of blood were sent to the Lister Institute to be examined for Widal's reaction A positive result was obtained in 4 Diarrhœa or Zymotic Enteritis 63 The deaths from Diarrhoea, Dysentery, and Epidemic or Zymotic Enteritis were 19, or 0.15 per 1,000 population, compared with 119, 0.52, 0.81, 0.26, and 0.36, in the five preceding years The rate for London was 0.32 There were, in addition, 12 deaths from enteritis and Gastroenteritis, making a total of 31 deaths, or 11 per 1,000 births, due to diarrhœal diseases 17 of the 31 were under one year of age, and 5 between one and five years 64. The following table shows the death-rate from the above-mentioned diarrhceal diseases per 1,000 births, in each parish during the past nine years:— Diarrhœal Diseases per 1,000 Births Average, 1901-5. 1906. 1907. 1908. 1909. Woolwich Parish 33 44 19 23 14 Plumstead Parish 27 31 16 16 6 Eltham Parish 19 19 11 12 26 The Borough (.02-5) 28 34 18 18 11 London County 35 48 21 31 — Notification Voluntary notification of Zymotic Enteritis commenced in Woolwich in 1905 The Council ordered its trial first for one year, and then for three years The results 42 of four years notification were fully reported (see Council's Minutes, 11th February, 1909), and they were so satisfactory that it was resolved to continue the voluntary notification indefinitely, and to extend the period of notification to June and October, thus making the disease notifiable during five months instead of three 149 cases were notified in the past year The subjoined tables give full particulars of these Owing largely to the mild summer, the notifications were fewer than in any of the past five years excepting 1907. 18 cases were notified in June, 8 in July, 63 in August, 49 in September, and 11 in October 10 deaths occurring in the same period were certified to be from diarrhoea or zymotic enteritis 4 of these were notified during life, and 6 were not notified The fatality (deaths per 100 cases) was 2.4, which is much lower than in the four preceding years, when it was 14.6 As pointed out in the report above referred to, the fatality has been highest when the prevalence was greatest, and vice versa, but the fatality in 1909 was much lower than in any year since notification began Age Distribution Table I gives the age distribution of the cases, the largest number in any three-monthly age period was between 9 and 12 months of age 32 cases over five years were notified ; 28 of these were notified by one medical practitioner Though the disease undoubtedly affects persons at all ages, it seems probable that in the case of the practitioner mentioned there were a good many cases of mistaken diagnosis Local Distribution (See Table II) In proportion to population and births, the largest number of cases was in St Nicholas, Central, and North River Wards, and the smallest in Herbert, Burrage, and St George's 43 Feeding of Infants Table IV shows the manner of feeding of all cases under one year of age 4 had the breast only, 15 breast; milk and other food, and 6 Depot milk 20 had fresh cow's milk, and 15 Nestles condensed milk The use of the long-tube bottle is quickly becoming obsolete ; in 1905, 24 per cent. of the notified cases used tube bottles—in 1909, only 8 per cent. used them Of the 6 Depot cases, one was a very delicate child which began with diarrhoea eight days after beginning Depot milk; the Depot milk was at once discontinued, the child died 13 days later The other Depot cases all recovered, and two were mild cases which soon passed off; one had been on the Depot five weeks, and the others over two months when the diarrhoea began Depot-fed children were only attacked by diarrhoea to onehalf the extent of the hand-fed children, proportionately to the total numbers of each Source of Infection Out of the 149 cases there were 39 in which it appeared probable that the patient was infected, directly or indirectly, by some previous case, either in the same house or in an adjoining house situated within a radius of about 50 yards In 9 of these cases the suspected source was another member of the family, or another inhabitant of the same house In one of these the source was the mother, with an interval of five days between the commencement of diarrhoea in mother and child; in one case (a child of seven years) the infecting case was a baby brother, with an interval of two weeks; in four cases the source was elder brothers and sisters, with intervals of one to ten days; and in three cases lodgers' children with two or three days' interval Five cases occurred 44 in one road of 48 houses; in two cases there was a month's interval, and in two cases a fortnight's interval, between supposed infecting and infected cases Deaths Table VIII shows the death-rate from diarrhoea in London and Woolwich in the summer quarter of every year this century Notification was adopted in Woolwich in 1905, and has not been similarly carried out in any other London Borough The table indicates that whereas, before notification, Woolwich had a slightly higher diarrhoea mortality than London, since notification commenced the Woolwich deathrate has decreased to a marked extent both absolutely and compared with London In 1909 the Woolwich diarrhoea mortality was only one-ninth the average mortality of 1901-4, and only one-third as much as in London There were only eight deaths in the summer quarter, giving a death-rate of 0.25, compared with 2.30, the average of the years 1901-4, and with 0.79 the London death-rate The death-rate in Woolwich was lower than it had been before, and in London lower than any year but 1907 The cool and rainy summer was favourable to a low diarrhoea death-rate, but the existence of notification has shewn us that, even in the most favourable summers, a large number of children suffer from this disease, although usually in a mild form It seems not unreasonable to say that notifications, assisted by the Milk Depot and Health Visitor, saved 17 lives, for, if the death-rate in Woolwich had been the same as in London, there would have been 25 deaths instead of 8 £18 17s 0d was paid for notification of Zymotic Enteritis during the year. 45 NOTIFIED CASES OP ZYMOTIC ENTERITIS Table I Age and, Sex Notifications Year Total M. F. Under 3 mths 3 to 6 months 6 to 9 months 9 to 12 months Total under 1 year 1 to 2 years 2 to 5 years Over 5 years 1905 212 112 100 18 39 34 29 120 56 25 11 1906 366 187 179 31 52 52 59 194 99 39 34 1907 93 48 45 6 18 14 11 49 23 3 18 1908 173 96 77 11 28 25 27 91 55 12 14 + 1 1909 149 79 70 12 10 20 22 64 35 18 32 Total 1905-9 993 522 471 78 147 145 148 518 26 97 110 Deaths op Notified Cases to October 31st 1905 36 20 16 6 9 8 6 29 5 2 .. 1906 46 29 17 8 6 9 10 33 9 1 3 1907 10 4 6 1 4 3 1 9 1 .. .. 1908 23 9 14 4 7 5 4 20 3 .. .. 1909 6 2 4 3 1 .. 1 5 1 .. .. Total 1905-9 121 64 57 22 27 25 22 96 19 3 3 46 Table II. DISTRIBUTION IN WARDS AND PARISHES. Notifications. Deaths to October 31st. » Average Births in 1905-6-7 1905 1906 1907 1908 Total Rate per 1000 Births 1909 1905 1906 1907 1908 Total. Rate per 1000 Births. Rate per 1000 Population 1909 Woolwich Parish 1171 111 77 26 62 276 59.0 21 19 12 3 10 44 9.4 0.27 3 River Ward, N. 142 22 10 9 14 55 96.8 6 4 1 2 1 8 14.0 0.5 1 River Ward, S. 269 14 20 1 13 48 44.6 2 5 4 .. 3 12 11.1 0.3 1 Dockyard 279 33 22 12 27 94 84.2 7 4 7 1 5 17 15.2 0.5 1 St. Mary's 188 14 9 2 6 31 41.2 6 3 .. .. .. 3 4.0 0.08 .. St. George's 293 28 16 2 2 48 41 0 — 3 •• .. 1 4 34 0.12 .. Plumstead Parish 2004 76 242 57 93 468 58.3 122 12 33 7 12 64 8.0 0.21 3 St. Nicholas's 660 26 88 43 43 200 757 71 9 14 5 8 36 13.6 0.4 2 Central 226 9 38 4 13 64 70.8 22 .. 3 .. 1 4 4.4 0.1 .. Glyndon 268 11 48 3 17 77 71.8 10 1 10 1 1 13 12.1 0.4 1 St. Margaret's 407 16 44 5 11 76 46.6 14 .. 3 l .. 4 2.4 0.08 .. Herbert 236 5 14 1 5 25 26.4 1 1 1 .. .. 2 2.1 0.05 .. Burrage 207 9 10 1 4 24 290 4 1 2 .. 2 5 60 0.13 .. Eltham Parish 281 25 47 10 18 100 88.9 6 5 1 .. 1 7 6.2 0.15 .. 3456 212 366 93 173 844 61.0 149 36 46 10 23 115 8.3 0.22 6 47 Table III HOUSES AFFECTED Year Total No under 1½ to a room No with over 1½ and under 2 to a room No with over 2 to a room 1905 212 156 45 11 1906 366 225 92 49 1907 93 49 34 10 1908 149 86 33 30 1909 145 91 38 16 965 607 242 116 CLEANLINESS OF HOUSES Total houses of which information was obtained Clean. Dirty. Indifferent. 1905 205 166 39 .. 1906 360 289 71 .. 1907 93 53 13 27 1908 156 51 22 83 1909 145 89 11 45 959 648 156 155 48 Table IV (A) PRINCIPAL DIET OF CASES UNDER 1 YEAR OLD. 1905 1906 1907 1903 1909 Totals 1905-9 Breast only 15 12 4 9 4 44 Breast and other foods 10 28 9 10 15 72 Depot milk 4 2 & 12 Depot milk and other food .. .. 1 .. .. 1 Fresh cows milk alone 54 59 10 12 10 226 Fresh cows milk with farinaceous food, etc 39 11 21 10 Fresh milk and Nestle's .. .. .. 1 .. 1 Nestles condensed 34 49 11 20 15 129 Dried milk, Allenbury's etc 3 2 .. 1 1 7 Sterilised whole milk 1 1 .. 1 .. 3 Separated condensed .. .. .. 1 .. 1 Other foods, and "not stated" 5 4 1 13 2 25 122 194 51 91 63 521 (B) BOTTLES USED 1905 1906 1907 1908 1909 Total Tube bottles 51 74 15 29 12 181 Tubeless 53 85 23 42 35 238 Both 3 6 3 1 13 Cases notified 212 366 93 173 149 993 49 (C). PERCENTAGE OF NOTIFICATIONS. 1905 1906 1907 1908 1909 Total. Tube bottles 24.0 20.2 16.1 16.7 8.0 18.2 Tubeless 25.0 23.3 24.7 24.2 23.5 24.0 Both 1.4 1.6 3.2 00.0 0.7 1.3 No information, and breast-fed 49.6 54.9 56.0 59.1 67.8 56.5 Table V. CAUSE OP WEANING OF CASES UNDER 8 MONTHS OF AGE. Total cases weaned under 8 months. Death of Mother. Illness of Mother. Failure of Milk. Mother at Work. Other Causes. 1905 120 2 14 82 7 15 1906 185 3 37 102 5 38 1907 33 — 8 18 3 4 1908 68 — 6 49 3 10 1909 54 — 9 27 1 17 Total 460 5 74 278 19 84 50 Table VI. NUMBER OF CASES NOTIFIED EACH WEEK, with MEAN TEMPERATURE of 3 feet Ground Thermometer during Week. July to September Quarter. Cases. Year. 1st Week 2nd Week 3rd Week 4th Week 5th Week 6th Week 7th Week 8th Week 9th Week 10th Week llth Week 12th Week 13th Week 1905 3 3 10 8 24 34 27 36 30 12 11 9 4 1906 1 3 5 5 13 38 65 56 27 52 58 28 15 1907 2 1 0 5 2 7 5 7 17 10 8 12 17 1908 5 4 2 6 11 27 24 30 20 13 7 10 13 1909 - 4 1 2 4 7 14 24 23 18 11 7 8 Total 11 15 18 26 54 113 135 153 117 105 95 66 57 Temperature. 1905 60.68 62.17 63.59 64.21 64.19 63.04 62 62 62.37 61 33 60.97 59.96 58.47 57*43 1906 59 16 60.68 61.29 62.26 63.25 64.00 63.80 62.80 63.08 63.83 62.89 60.80 59 24 1907 56.71 57.00 58.53 59.67 60.10 60.34 60.84 60.26 59.67 59.45 59.43 58.77 58.18 1908 61.34 60.97 60.47 62.15 62.65 62.18 61.26 60.88 59.51 58.02 57.11 57.86 58.21 1909 57.20 57.59 59.39 59.49 59.68 61.25 62.79 61.48 60.19 58.70 57.87 57.60 57*11 Average 59.01 59.68 60.65 61.55 61.97 62.16 62.26 61.55 60.75 60.19 59.45 58.70 58.03 51-52 Table VII. DEATHS FROM DIARRHŒA AND ZYMOTIC ENTERITIS, classified by Wards and Ages, during the Four Months ended 31st October, 1905, 1906, 1907, 1908, 1909. Ward. Total, 1905 to 1909 Under One Year. Over One Year. 1-3 months. 3-6 months. 6-9 months. 9-12 months. 1-5 years. 5-60 years. Over 60 years. 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 Woolwich— River, North 24 1 .. .. .. .. 3 3 1 1 .. 4 2 2 1 .. 1 .. 1 1 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. River, South 27 1 1 .. 1 2 5 2 .. .. .. 1 3 .. 2 .. .. 2 .. 1 .. 1 1 1 1 .. .. .. .. .. .. .. 2 .. .. .. Dockyard 22 •• 1 .. 2 •• .. 2 .. 3 2 1 1 .. 1 .. 3 2 1 1 .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. St. Mary's 10 1 .. .. .. .. 1 .. 1 .. .. 1 2 .. .. .. 2 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. St. George's 8 .. .. .. .. .. 2 .. .. 1 .. 1 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Plumstead— St. Nicholas's 58 3 1 .. 1 2 3 4 5 2 .. 3 6 2 1 .. 4 4 .. 4 .. .. 4 2 5 .. 1 .. .. .. .. .. 1 .. .. .. Central 5 .. 1 .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glyndon 18 .. 3 1 .. •• 1 2 .. 1 .. 1 4 .. .. 1 .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. 1 .. .. .. .. St. Margaret's 14 1 1 •• 1 •• •• 2 2 .. .. 1 2 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. 1 .. Herbert 8 1 1 .. .. .. 1 .. .. .. .. .. 2 .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. Burrage 9 .. .. .. .. .. .. .. .. 1 .. .. 1 1 3 .. .. 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Eltham 9 1 .. •• 1 •• •• 2 .. .. .. 2 .. .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals, 1905-09. 212 9 9 1 6 4 16 17 9 9 2 15 25 6 9 2 11 14 2 7 1 6 9 4 6 1 2 1 •• .. .. 2 6 .. 1 .. 29 53 77 35 26 3 9 53 Table VIII. DIARRHŒA, INFANTILE MORTALITY, AND TEMPERATURE OF SUMMER QUARTER IN LONDON AND WOOLWICH. 1901 1902 1903 1904 Average 1905 1906 1907 1908 1909 Average Annual death rate from diarrhoea in summer quarter per 1,000 living London 2.77 1.42 1.49 3.39 2.27 2.28 3.00 0.46 1.36 0.79 1.58 Woolwich 276 0.97 0.96 4.52 2.30 1.72 2.54 0.34 0.87 0.25 1.14 Max. weekly average temperature of 3 ft. ground thermometer in 13 weeks of summer quarter .. 63.54 61.09 61.64 64.62 62.72 64.11 64.00 60.84 62.65 62.79 62.88 Average temperature of 3 ft. ground thermometer in summer quarter .. 62.06 59.68 60.18 61.45 60.84 61.62 62.08 59.16 60.35 59.25 60.49 D 2 54 Table IX. ZYMOTIC ENTERITIS AND METEOROLOGY. Summer Quarter. 1902 1903 1904 1905 1906 1907 1908 1909 Number of oases notified - - - 212 366 93 173 149 Number of deaths, Diarrhœa (to October 81st) 40 37 139 56 93 22 38 10 Mean temperature of air 59.1 59.0 60.08 60.6 62.4 58.87 59.3 58.7 Mean temperature 3 ft. below ground 59.68 60.18 61.45 61.62 62.08 59.15 60.35 59.25 Mean humidity 75 77 72 75 70 74.6 77 80 Number of days on which rain fell - 46 34 33 26 32 38 46 Rainfall in inches 5.91 12.32 4.88 5.65 3.78 3.77 8.15 7.43 Number of hours bright sunshine 485 541 671 529 697 516 532 530 55 Erysipelas. 65. There were 103 cases of Erysipelas notified, compared with 83, 110, 110, and 90, in the four preceding years. There was 1 death. The case-rate was 0.80, and the death-rate 0 01. The London case-rate was 0.87. The London death-rate was 0.3 in 1908. The Woolwich case-rate has only once been higher, and the death-rate has only twice been lower, since the Borough was formed. Epidemic Cerebrospinal Meningitis. 66. In consequence of the serious epidemic of this disease in certain towns of Ireland and Scotland, cerebro-spinal meningitis was made, in 1907, a notifiable disease under the Public Health (London) Act, by the London County Council. One case was notified in the Borough in each of the two years 1907.8, but none in 1909. Puerperal Fever. 67. There were 9 cases of Puerperal Fever notified, compared with 5, 12, 8, 6, and 6, in the five preceding years. There was 1 death. The case-rate was 0.07, and the death. rate 0.01. The death-rate has never been lower. The London case-rate was 0.06, and death-rate in 1908, 0.03. influenza, bronchitis, pneumonia. 68. Influenza caused 36 deaths, compared with 27, 23, 33, 30, and 29, in the five preceding years. Bronchitis and Pneumonia caused 245 deaths, compared with 278, 255, 265, 298, and 228, in the five preceding years. The deaths from 56 these causes under five years were 86, compared with 140 and 81 in the two preceding years. Tuberculosis. 69. Deaths. There were 209 deaths from Tuberculous disease, giving a death-rate of 1.63 compared with 2.06, l.83, 1.71, 1.60 and 1.76, in the five preceding years. The tuberculosis death.rate was 1.60 in 1907, but with that exception, last year had the lowest rate recorded. 70. The following table gives the number of deaths from each of the various forms of tuberculosis in the past 8 years, and also the deaths from simple meningitis:— Average 1901-5 1906 1907 1908 1909 Tuberculous meningitis 200 22 19 27 27 Simple meningitis 22.0 15 20 14 14 Tuberculosis of intestines and peritoneum 13.0 14 11 13 9 Tuberculosis, other forms 20.8 21 22 28 23 Phthisis 192.0 164 154 156 150 71. The deaths from phthisis were 150, giving a death-rate of 147, compared with 164, 1.47, 1.29, 1.19 and 123, in the five preceding years. This is the lowest death-rate recorded. The reduction in the death-rate since 1901 represents a saving of 83 lives last year. The following table gives the death-rate from phthisis in each parish during the five years 1901.5, and in 1906, 1907,1908 and 1909, compared with London. The greatest reduction was in the parish of Woolwich. 57 No. Rate No. Rate No Rate No. Rate No. Rate Woolwich Parish 89 2.15 67 1.68 52 1.30 59 1.51 49 1.25 Plumstead „ 97 1.34 90 1.20 92 1.20 90 1.19 W. 56 W 0.96 Eltham „ 6 0.63 7 0.58 10 0.78 7 0.54 12 0.91 The Borough 192 1.56 164 1.29 154 1.19 156 1.23 150 1.17 London — 1.57 6969 1.47 6654 1 39 6419 1.32 — 1.31 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, and 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. 58 Until last year there was 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 until some radical step was taken for preventing the importation into the Borough of such milk. Such a step was taken when the London County Council (General Powers) Act, 1907, came into operation in 1908, and the decrease of deaths from tuberculosis of the abdomen may be the direct result of this action, but it is too soon to draw this conclusion. For fiteen years the inhabitants of Woolwich have been advised to make, and have to a large extent made, a practice of boiling all milk before consumption, and to this fact is probably due that Woolwich has so small a death.rate from consumption of the bowels. 74. 88 of those who died from phthisis were males, and 62 females. In 1906 there were 97 males and 67 females; in 1907, 82 males and 72 females; and in 1908, 101 males and 55 females. 75. The source of infection was attributed in 93 deaths from tuberculosis, with more or less probability, as follows:— Family or personal—Father 16 Husband 4 Mother 15 Brother 5 Sister 5 Other relatives 8 Carried forward 53 59 Brought forward 53 Family or personal—Other inmates of house and friends 4 Workplace 7 Public house or licensed restaurant 23 Milk 1 Army and Navy 4 Hospital 1 93 Five who died were engaged in the liquor traffic as potmen, etc. Several had been out of work some time, one for four years. Local Government Board's Circular re Tuberculosis. This circular was issued by the Local Government Board on the 18th December, 1908. I reported fully on the circular to the Public Health Committee on the 8th January, 1909, and the report was printed in the Council's Minutes. The circular requires notification of pulmonary tuberculosis by Medical Officers of the Poor Law Infirmaries and District Medical Officers. It further authorises Sanitary Authorities to furnish for the use of poor persons suffering from Consumption any appliances, apparatus, or utensils, which will be of assistance for the purpose of protection against the spread of infection. Apparently the circular has in view such conveniences as beds and bedding, and additional bedrooms, which would enable consumptive persons to be properly isolated. On October 27th I recommended that a poor consumptive, who with a wife and six children was occupying two bedrooms, should be provided with an additional bed and bedroom. The Public Health Committee decided, however, to take no action. 60 76. Notifications. Voluntary notification of phthisis has now been in force in the Borough for eight years. Last year notification of cases attended by Poor Law Medical Officers was made compulsory, and, though they had been in the habit of notifying many cases before, the Local Government Board Order has certainly been followed by a larger number of notifications of paupers. 206 cases were notified last year, compared with 176, 150, and 154, in the three preceding years. 56 of these were in the Poor Law Infirmary. 41 others were notified by the District Medical Officers of the Poor Law Unions, 14 by the Medical Officers of the Royal Arsenal, and the remainder by clergymen, philanthropic societies, applicants for admission to Peppard Common Sanatorium, and by private medical practitioners. £14 14s. 3d. was paid during the year for the notification of phthisis. Duration. Of the 206 cases notified during 1909, at least 44 have since died, and of 154 notified during 1908, at least 54 have since died (March 1st, 1910). 77. The source of infection of the notified cases was probably as follows :— Family or personal—Father, 16; mother, 15; wife, 2; brother, 6; sister, 7; husband, 6; other members of family, 2; friends, lodgers, etc., 4 . 56 Workshop and Office 12 Public House 27 Navy and Army 3 Milk 1 Undetermined 105 61 78. Of the 32 adults about whom information was obtained, one was stated to be a teetotaller, 12 temperate, and 19 intemperate. 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 5 15 33 105 48 0 Sex. 133 males; 73 females. 79. Occupation. Of the 133 notified males, 28 were Arsenal employees. The Department and Workshops affected are as follows:— Royal Laboratory 5 Danger Buildings 1 Royal Carriage Department 6 Royal Gun Factory 2 Army Ordnance Department 2 Building Works Department 4 Torpedo Factory 1 Central Office 3 Naval Ordnance Department 2 Royal Dockyard 1 Unknown 1 80. Bacteriological Diagnosis. Sputum from 179 cases of suspected phthisis was examined at the Lister Institute, and tubercle bacilli was found in 55 cases. The number of examinations for the five previous years was 116, 130, 130, 171, and 175, respectively. 81. In my annual report for 1904 some figures were given as to the " Public House as a source of Infection," and 62 "Chronic Tuberculosis in Children," (see page 50 of that report). 82. Disinfection was performed by the Public Health Department at 146 premises, compared with 169, 165, and 157, in the three preceding years. Of these, 76 were disinfected after the death of the patient, and 70 after removal to hospital, sanatorium, or other opportunity. 82a. Sanatorium Treatment. Since the year 1904 the Council has had an arrangement with Dr. Carling, the Superintendent and Proprietor of the Maitland Cottage Sanatorium, Peppard, by which the Council maintains beds at the sanatorium, paying a fixed charge of 28s. a week for each bed when occupied, and 20s. a week when unoccupied. Dr. Carling during the year made arrangements to vest the sanatorium in trustees, and put it under the control of a Management Committee appointed by the Governors. The Governors consist of the trustees, and also of such donors and annual subscribers as shall give a donation of not less than five guineas, or shall subscribe not less than one guinea per annum, including public bodies which maintain beds at the sanatorium. The charge for treatment was fixed at 30s. a week per patient, but the Committee has power to make special arrangements as to terms. The Medical Superintendent is to be appointed by a General Meeting of the Governors. Dr. Carling will continue to hold that position. The sanatorium will remain under the general management of the Medical Superintendent, who will decide whether any patient is suitable for admission. Your Medical Officer of Health has been appointed on the Committee of Management. For further particulars see page 842 of the Council's Minutes. 63 83. Numbers treated. 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. 41 patients were admitted, 39 discharged, and one died. Of those discharged, 18 stayed for one month, 9 for two months, 10 for three months, 1 for four months, and 1 for six months. One died from acute pneumonia, which began two days after his admission. All the others returned home in improved general health, and showed 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. 84. The following table, recommended by the Local Government Board, shews the condition in each subsequent year of the survivors from the cases treated in each year. The difference between the sum of the numbers dead and the survivors, and the number discharged, in any year, shews 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 undermentioned years. Dead Year No. discharged Jan. 1904 1905 1906 1907 1908 1909 1910 ab ab ab ab ab ab ab 1 1903 1 1 1 1 1904 11 6 3 6 5 5 5 4 4 1905 16 11 2 12 29152212 1906 29 9 3 26 2 20 4 16 2 13 1907 37 14 10 20 4 20 6 15 1908 30 5 8 17 4 14 Total 124 46 1 4 6 2 17 5 40 13 50 18 59 13 48 64 Some half-dozen of those recorded as at work are employed at the Sanatorium in various capacities, receiving board and a small wage. Of the 17 patients not accounted for, the majority are believed to be well and at work, one at Lowestoft employed in fishing, others in Canada, Australia, South Africa, etc. The above table accounts for all patients who left the Sanatorium up to December 31st, 1908. Out of 124 who have left over one year, 48 are now well and at work, 13 are unwell, 46 have died, and 17 have been lost sight of. 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 receur. rences 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 work and keep well under favourable conditions. Those who prove to be in too advanced a condion 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 65 those who will best profit by a further stay in the long. treatment beds. 86a. The Economy of Sanatorium Treatment. The provision of sanatorium treatment for consumptives has the following ends in view :— 1. Temporary isolation of the patients and relief from fatiguing duties of the wives, producing diminished infection and increased efficiency on the part of the mother. 2. Education of the patient in how to carry out open.air treatment, so as to avoid being a source of infection to his family ; this again produces a great diminution of infection in the future. 3. Diminution of suffering, and increased enjoyment of life. 4. Restoration to health and to a condition of wage. earning, whether temporary or permanent. All these objects are of great importance, and several of them can be considered economical from a money point of view. With the exception of the last, however, it is impossible to form even an approximate estimate of the financial economy attending on treatment; but as regards the effect of sanatorium treatment in restoring patients to such a degree of health that they are able to resume work and continue earning wages, it is possible to form some rough estimate of the amount of money saved to the rates. It is not here suggested that the benefits from sanatorium treatment, which cannot be expressed in terms of money, are of no importance ; far from it. But there is obvious justification for Sanitary Authorities providing such sanatorium treatment if it can be shown to be of benefit from this point of view. 66 An average of 36 patients are now treated every year at a cost of £500, or £14 a head, in the Council's beds at Peppard Sanatorium, Of the 57 patients who were discharged from the sanatorium up to the end of 1906, 19 are now well and at work, 3 are not well enough to work, and 27 have died, leaving 8 who are unaccounted for, not having been recently heard of. I have previously given good reasons for thinking that the majority of these are well and at work in the Colonies and other places, but, disregarding this probability, it is seen that at least one.third of the patients are well and at work three years after leaving the sanatorium, and may therefore ba considered permanently cured. The other two.thirds who have died, or are now unwell, or not heard of, are known to have done an average of 9 months work each subsequent to leaving the sanatorium. They may then be said to have justified the expenditure of £14 on themselves. Presuming that the above proportions hold for the patients treated each year, we have two.thirds of the patients sufficiently restored to health to work for nine months, and consequently earning four times the amount that their treatment has cost, Let us now see the economic effect of the restoration to health of the other one.third, or 12 patients a year. If they had been left untreated most of them would have died within two or three years, many—say one.half—after spending an average of 6 months in the Infirmary. Two.thirds would be adult men and one.third would have on an average a wife and three children each, who would in all probability become chargeable to the Guardians when the wage.earner went into the Infirmary. The following is given as a rough approximation of the cost on the rates of these men and their wives and families. 67 £ Cost of 6 months Infirmary treatment of 6 men 156 Out or in-door relief of 4 wives at 1/. a week for 10 years 104 Ditto 12 children at 10/. a week for 5 years 1560 £1820 Thus a cost of £500 not only makes 24 men wage-earners for nine months, and postpones and diminishes their chargeableness to the Guardians in that time, but also makes 8 men permanent wage.earners, and saves an expense from the rates within the next ten years of £1820. The cost of maintenance of wives and children given above is estimated on the amount which is usually allowed by Poor Law Guardians, but it must be remembered that this amount has been decided by the Poor Law Commissioners to be insufficient, and its insufficiency has probably to a large extent the effect of causing later expense to the rates in supporting men and women who become chargeable, by sickness and physical and mental incapacity, through not having been properly nourished and cared for immediately need arose. On the whole I think it must be allowed that the estimate of money saved to the rates is rather below than above the mark. Four of the 12 patients restored to health, permanently, would be women and children. If not so restored a certain proportion of these would come on the rates sooner or later, but no allowance has been made for this as it is difficult to estimate. 87. The names of 71 applicants were entered on the register e 68 during the year for admission to the Sanatorium, compared with 65, 59 and 70, in the 3 previous years. Of these 41 have been admitted, 8 were too far advanced to be accepted, and 4 were found not to be tuberculous. Others were admitted to Convalescent Homes, Consumption Hospitals, others 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. Nineteen spitting.flasks were supplied at cost price, 6d., compared with 5, 14, 22, 32, and 23, in the five previous years. Cancer. 89. There were 119 cases of cancer (malignant tumour), giving a death.rate of 093, compared with 0.74, 0.70, 0.90, 0.83, and 0.75, in the five preceding years. 53 of the deaths were in males, and 66 in females. 76 of the deaths were in persons over 55. The highest mortality was in Glyndon and Dockyard Wards. The London death.rate was 0.96 in 1908. 90. The following table shews the sex and region affected of all cases of malignant disease:— Carcinoma. Seat of Primary Disease— Males. Females. Head and Pace 4 2 Mouth and Tongue 3 1 Pharynx, œsophagus, larynx, and neck 9 1 Carried forward 16 4 69 Seat of Primary Disease— Males. Females. Brought forward 16 4 Pleura, lung, mediastinum — — Stomach and pylorus 12 12 Intestines (excluding rectum) 4 7 Rectum 5 9 Liver 5 5 Kidney and bladder 2 — Female genital organs — 13 Female breasts — 8 Male genital organs — — Pancreas 1 — Thigh — 1 Undefined 5 3 50 62 Sarcoma. Neck 1 — Hip — 1 Thigh — 1 Testicle 1 — Suprarenals — 1 Yetebræ 1 — Ovary — 1 3 4 90a. The apparent increase of cancer in recent years makes it desirable to give special attention to the statistics of this disease. The deaths from cancer bave been classified under the organs affected since 1903, and the following table shows the result for males and females separately:— e 2 70 Carcinoma. Males. Seat of Primary Disease. 1903 1904 1905 1906 1907 1908 1909 Total Head and face 1 .. 4 1 1 .. 4 11 Mouth and tongue 3 5 4 7 1 6 3 29 Pharynx, oesophagus, larynx, and neck 5 3 7 18 8 2 9 52 Pleura, lung, mediastinum 1 .. .. 1 1 .. .. 3 Stomach and pylorus 6 5 5 9 9 12 12 58 Intestines (excluding rectum) 2 3 3 5 3 2 4 22 Rectum and anus 6 4 2 3 3 5 5 28 Peritoneum and omentum .. 2 .. .. .. .. .. 2 Liver 9 3 12 7 7 6 5 49 Kidney and bladder .. .. .. 1 3 1 2 7 Male genital and external urinary organs 3 5 .. .. 2 2 .. 12 Pancreas 1 .. .. 3 1 1 1 7 Pelvis and groin 1 .. .... .. .. .. .. 1 Undefined .. 1 .. 1 1 2 5 10 38 31 37 56 40 39 50 291 Females. Seat of Primary Disease. 1903 1904 1905 1906 1907 1908 1909 Total Head and face .. 1 1 2 2 1 2 9 Mouth and tongue 2 3 .. 1 .. .. 1 7 Pharynx, oesophagus, larynx, and neck 1 1 3 2 1 1 1 10 Pleura, lung, mediastinum 1 .. 1 .. 1 2 .. 5 Stomach and pylorus 8 8 1 7 5 7 12 48 Intestines (excluding rectum) 1 1 .. 5 2 5 7 21 Rectum and anus 2 4 3 5 7 10 9 40 Liver 6 7 9 6 10 12 5 55 Peritoneum and omentum .. .. 1 1 1 .. .. 3 Kidney and Bladder .. .. .. .. 2 1 .. 3 Female genital organs 20 17 11 11 19 11 13 102 Female breasts 8 11 10 11 11 3 8 62 Limbs .. .. .. 1 .. .. 1 2 Pancreas .. .. .. .. .. .. .. .. Pelvis and groin 1 1 .. .. .. .. .. 2 Undefined .. 1 1 2 .. .. 3 7 50 55 41 54 61 53 62 376 71 Sarcoma. Male. 1903 1904 1905 1906 1907 1908 1909 Total. Mouth .. 1 .. .. .. .. .. 1 Liver .. 1 .. .. .. .. .. 1 Pancreas .. 1 .. .. 1 .. .. 2 Bones .. .. 1 .. .. .. .. 1 Humerus .. .. 1 .. .. .. .. 1 Femur .. .. 1 .. .. .. .. 1 Skin .. .. 1 .. .. .. .. 1 Male genital and urinary organs .. .. .. 1 .. .. .. 1 Diffused .. .. .. 1 .. .. .. 1 Tonsil .. .. .. .. 1 .. .. 1 Leg .. .. .. .. l .. .. 1 Neck .. .. .. .. .. .. 1 1 Testicle .. .. .. .. .. .. 1 1 Vetebræ .. .. .. .. .. .. 1 1 Undefined .. .. 1 1 l .. .. 3 .. 3 5 3 4 .. 3 18 Female. 1903 1904 1905 1906 1907 1908 1909 Total. Intestines .. 1 .. .. .. .. .. 1 Female genital and urinary organs .. 1 .. .. .. .. .. I Tibia .. 1 .. .. .. .. .. 1 Multiple Osteo Sarcomata .. 1 .. .. .. 1 .. 2 Femur .. .. 1 .. .. .. .. 1 Kidney .. .. 1 .. .. 1 .. 2 Orbit .. .. .. 1 .. .. .. 1 Leg .. .. .. .. 1 .. .. 1 Cerebellum .. .. .. .. .. l .. 1 Hip .. .. .. .. .. .. 1 1 Thigh .. .. .. .. .. .. l 1 Suprarenals .. .. .. .. .. .. l 1 Ovary .. .. .. .. .. .. l 1 Undefined .. .. 1 1 1 .. .. 3 .. 4 3 2 2 3 4 18 72 Comparing 1909 with 1903, there has been an increase of 12 deaths in both males and females, or 24 deaths in all. In males the most notable increase is in cancer of the stomach and pylorus, and in females, cancer of the stomach, pylorus, intestines, and rectum. Whether this increase is real, or due to improved diagnosis, it is impossible to say. On the other hand, there has been a marked decrease of cancer in the female genital organs, comparing the two years 1903.4 with 1908.9. There is also a decrease of cancer in the female breasts. This decrease may possibly be the result of more early detection of, and operation on, the disease, owing to the advancement of surgery. These latter diseases are more easily diagnosed than those of the stomach and intestines, and the fact that the former appear to have decreased, and the latter increased, strengthens the opinion that the supposed increase of cancer is largely due to improved diagnosis. It is seen from the two tables that cancer affects the mouth, tongue, pharynx, cesophagus, and larynx of men, much more than similar organs of females, and to a small extent men have more cancer of the stomach than women. Cancer of the rectum, however, is more frequent in women. Alcoholism. 91. There were four deaths from Alcoholism, and 16 from Cirrhosis of the Liver, making a total of 20 deaths probably due to alcohol, compared with 27, 24, 17,18, and 21, in the five preceding years. In addition to these there were 335 deaths from diseases of the brain and nervous system (excluding meningitis), heart, blood vessels, and kidneys, of which a large proportion was certainly caused directly or indirectly by alcohol. The deaths from these causes in the five preceding years were 335, 336, 347, 327, and 346, respectively. 73 92. The death-rate from alcoholism and cirrhosis of the liver was 0.16 in the Borough, and 0.19 in the County There is one licensed house per 658 population in the Borough, and one per 266 in Biver Ward. Eleven licensed houses in Biver and St. Mary's Wards have been closed under the Licensing Act, 1904. Syphilis. 93. There were 10 deaths from syphilis, compared with 14, 14, 10, 9, and 7, in the five preceding years. Five of these occurred in the Workhouse Infirmary. Five were males and five were females ; seven were infants under one year. There were in addition 15 deaths from general paralysis and tabes dorsalis (locomotor.ataxy), diseases which are now considered to be usually due to syphilis, compared with 14, 15, and 9, in the three previous years. These figures are far from representing the total mortality caused by this disease. Dr. Mott has recently given good reasons for regarding aneurysm as being usually a form of syphilis. Meteorology. (See Table VIII). 94. The temperature of the winter quarter of the year was low ; it had four weeks with an average temperature above the normal, and nine below. The spring quarter had an average temperature. The summer quarter had three weeks above the average, and ten below; its average temperature was 58.7, which is 1.4 degrees below the average. In the autumn quarter the temperature was above the average in seven weeks, and below in six. 74 The lowest temperature, 13.6 degrees F., occurred in the first week of March, and the highest, 86.2 degrees F., occurred in the second week of August. The rainfall, 25.28 in., was near the average; the deficiency being specially in the autumn quarter. The largest weekly number of deaths, 50, took place in the week ending March 20th; the smallest number of deaths was in the week ending October 2nd. (See also under Diarrhœa). 75 PART II. Administration. Water Supply. 1. The supply is constant throughout the Borough, with the exception of houses on Shooters Hill (including Eglinton Road above Genesta Boad, Brent Boad, Dallin Boad, and all houses above Bed 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. A water-tower is in process of construction to enable these houses to have a constant supply. Plumstead Well. In previous years I have repeatedly called attention to the unsatisfactory condition of the water supplied by the Blumstead Well. The analyses and bacteriological examinations reported by the Metropolitan Water Board did not show any distinct improvement in the condition of this well. But the Water Board realize the seriousness of the question, and last year decided to make monthly examinations of the water. In this way any serious contamination would be very quickly discovered. 2. Water supply in tenement-houses. An additional tap and sink were supplied on at least one upper floor of 18 tenementhouses, 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 76 tenement-house. Under this Act an additional supply was required and provided at 25 houses in 1908, and at 30 houses in 1909. 16 of these houses were in the Dockyard or St. Mary's Wards, 13 in Eiver Ward, and 22 in St. George's Ward. There were three prosecutions which deserve recording in full. Notice to provide sufficient water supply for the use of the occupants of the upper floors of three tenement-houses not having been complied with, proceedings were taken by the Woolwich Borough Council at the Police Court. Two cases were heard by Mr. Gill on the 11th October, 1909, and one case by Mr. Hutton on the 20th. The two cases heard by Mr. Gill were very similar. The houses consisted of six rooms on three floors, the washhouse, where the water supply originally was situated, being two steps below the basement. In both houses the families living in the house had joint use of the washhouse. One—No. 8— was occupied as follows:—one family occupied the ground floor front room and first floor front room; another family the basement back room, first floor back, and front floor backThe basement front was closed as unfit for occupation. In the other—No. 9—one family occupied the first floor, and another family the basement and ground floor. The upper flight of stairs consisted of 15 steps and the lower of 14. As a result of the notice, a water-tap and sink were fixed in each house in the passage on the ground (or middle) floor, but no waste-pipe was provided; and a control stop-cock was fixed in the basement washhouse on the branch water-pipe supplying the new tap. It was proved in evidence that, as the result of some seven inspections made by two inspectors and the Medical Officer of Health, at intervals in the three months succeeding the tap being provided, the water was found turned off at the control cock 77 on all occasions but one, this being done presumably to prevent the new tap dripping, filling the small sink, and overflowing, so causing a nuisance. Mr. Gill, after taking a week to consider the case, decided in favour of the defendant in the case of No. 8, and in favour of the Woolwich Borough Council re No. 9. He held that, as regards No. 8, the General Powers Act did not apply, as each of the occupiers of the house had separate occupation of a room on each floor, the tenant who sub-let to the other occupiers having sole legal occupation of the washhouse, although he permitted the other occupiers to use it. With regard to No. 9, the occupier of the two upper rooms had no water supply on the floor on which his rooms were situated, and he held it reasonable that there should be a supply, and fined the defendant 20s. and 23s. costs. The 3rd case was also a six-roomed house on three floors. The basement consisted of a washhouse with tap and sink (the only water supply in the house) and a room recently vacated on account of its low height and dark condition. A family of a man and wife and one child lived on the ground floor, and a man, wife, and two children, on the top floor. The staircase, consisting of 22 steps, in two flights, is in the middle of the the house, hence unlighted, and the lower flight very dark. A notice having been served to provide a proper and sufficient supply for the tenants on the top floor, the owner fixed an additional tap outside of the house on the same level as the existing tap in the basement, but approached without the necessity of going to the basement. This was, as stated to the Medical Officer of Health on inspection, no improvement, the tenant of the top room still using the tap in the basement. She had the alternative of coming down one flight of stairs, going outside the house by a side door 78 on the ground floor, descending three more steps and a sloping passage, and so reaching the tap in the yard at the back; but she preferred, she said to the Medical Officer of Health, going down the dark lower staircase inside the house. The owner, refusing to provide a water supply on the top floor, was summoned and the case heard by Mr. Hutton. Having heard the evidence, he adjourned the consideration, on his own suggestion, to view the premises. On the further hearing he asked the tenant of the top floor whether she was satisfied with the water supply and which tap she used. She stated that she was satisfied and used the new outside tap. Mr. Hutton said personally he would not be satisfied, and if the tenant had said she used the tap in the basement he would have convicted the owner, but as it was he did not think it reasonably necessary to require a water supply on the top floor. 3. Defective and foul storage cisterns were found and remedied at 35 houses, compared with 51, 77, and 67, in the three preceding years. At 31 houses the supply was found insufficient or temporarily cut off. Food and Drugs act. 4. 552 samples were submitted to the Public Analyst, and 19, or 3.4 per cent. were found to be adulterated, compared with 8.4, 7.4, 9.3, 4.3, and 2.5, in the five preceding years. The very small percentage of adulterations in the past two years is noteworthy. 5. Proceedings were taken in 14 cases. Seven convictions were obtained. Six cases were dismissed and one was withdrawn. Two cases were dismissed owing to the proof of warranties. In one case, the Magistrate was convinced that 79 the milk, which contained only 2.7 per cent. fat, was sold as it came from the cow. It is curious that people are willing to buy such poor milk when, for the same money, they could get milk with 4 per cent. fat. 6. A total of £16 was imposed in fines, and £5 10s. 6d. in costs. 7. 348 of the samples were fresh milk. 13 of these, or 3.7 per cent, were adulterated, compared with 9.3, 6.5, 8.7, 4.8, and 1.7, in the five preceding years. 68 samples were bought as butter, and two were found to be adulterated. 6 samples of condensed milk were analysed, and all found to be genuine. Table XVIII. shows the other articles analysed. Three samples of coffee out of 27, and one of cocoa out of 13, were adulterated ; the remainder were genuine. 8. Of the 11 adulterated milk samples for which proceedings were taken, 8 were for abstraction of fat, and 3 for addition of water. 9. Of the 348 milk samples, 118 were taken on Sunday or Bank Holidays; three of these were found adulterated. In the past four years 5 per cent. of samples taken on Sunday were found adulterated. 10. A record is now kept of all analyses of milk made by the Public Analyst. The average percentage of fat in all 80 unadulterated samples taken last year was the same as in 1907 and 1908, viz., 36; and of non-fatty solids, 8.8. Out of 355 unadulterated samples, 125 had less than 3.5 per cent. fat, 184 had from 3.5 to 4.0 per cent., and 46 over 4.0 per cent. fat. 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 was one seizure and forty surrenders. The seizure was of a sheep's pluck affected with strongylus rufescens. This was condemned by a magistrate and destroyed. Of the surrenders, 3 were tuberculous, 24 unsound, and 13 livers, or other organs, affected with parasitic disease, or otherwise diseased. The meat affected with tuberculosis was pork in all eases. The food surrendered as unsound consisted principally of fish. A full list is given in Table XIX. Dairies, Cowsheds, and Milkshops. 12. On January 1st, 1909, there were 134 milkshops on the register; 37 were added, and 43 removed during the year, leaving a total of 128 on the register at the close of 1909. There were 217 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 128 in five years. 81 As it was found that several persons were selling milk without being registered, an advertisement was issued in the local newspapers, in April, calling attention to the illegality of selling milk without being registered. 13. Under the London County Council (General Powers) Act, 1908, the Council has power to refuse to register, and to remove from the register, shops which are unsuitable for the sale of milk. During 1909, nine applications were refused, and nine 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. There were 68 inspections, and 7 notices were served for dirty conditions, &c. There were no prosecutions. Slaughterhouses. 15. There are 11 slaughterhouses on the register. 44 inspections were made, and 3 notices served and complied with. Nuisances (See Table xva.) 16. 157 complaints of sanitary defects were received and investigated, compared with 498, 366, and 399, in the three preceding years. Twenty-eight complaints of non-removal of dust were made and attended to, compared with 43, 43, and 18, in the three preceding years. 18 of the dust complaints came from Woolwich Parish, 7 from Plumstead, and 3 from Eltham. 82 The dust in Woolwich is collected by your Council's employees, but that in Plumstead and Eltham by two different contractors. 17. Drains and Water-closets. Twenty-two defective combined drains were investigated and reported on by the Chief Sanitary Inspector, compared with 25, 29, and 16, in the three preceding years. These drains affected 121 houses. 440 private drains, found choked and defective, were examined, cleared, and relaid, compared with 557, 451 and 371, in the three preceding years. The largest number were found in Eiver Ward. 992 water-closets and w.c. cisterns were repaired, compared with 931, 1131, and 944, in the three preceding years. 197 foul w.c. pans were cleansed by tenants, compared with 160, 175, and 193, in the three preceding years. 18. Ventilation of Outfall Sewers. There were no complaints during the year as to nuisance from the new outfall sewers, but two complaints were received in August as to bad smells from shafts ventilating the outfall sewer in Plumstead Eoad. These were referred to the L.C.C. 19. Supervision of Drainage. In the Annual Report for 1908, full particulars were given as to the respective responsibility for supervision of reconstructed drains of the Public Health and Works Departments. 20. Public House Urinals. The urinals attached to public houses, and accessible to the public, have been regularly inspected during the year, 532 inspections being made. Regular cleansing has been required. 83 21. House Inspection. 5512 houses were inspected, house to house, compared with 4709, 6092 and 5384, in the three preceding years; 7377 were inspected re infectious diseases and complaints, compared with 10,291, 7573, and 7,600. In addition to these, 730 inspections of registered houses were made. 22. Table XVI. shows the streets inspected and number of houses found defective in each. At 1,957 houses interiors were cleansed, or defective roofs repaired, compared with 2,066, 2,193, and 2026, in the three preceding years. 450 houses with damp walls were remedied, compared with 287, 369, and 368, in the three preceding years. Improved ventilation was provided in 120 houses, compared with 129, 117, and 187, in the three preceding years. 681 new dustpails were supplied compared with 498, 675, and 612, in the three preceding years. 23. Medical Officer's Inspections. These amounted to a total of 732. Special inspections were made at the cowsheds, milkshops, bakehouses, workshops, 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. 14 visits were made by request of the medical attendants for the purpose of diagnosing doubtful cases of infectious disease. 13 of these were suspected cases of scarlet fever or diphtheria, and one a supposed ease of small-pox which proved to be varicella. Many other visits re infectious disease were made at the request of school teachers and others. Special house-to-house inspections were made of Limbrey's Buildings, Lower Pellipar Eoad Hylton, and Balgowan Streets, and Kendal Terrace. f 84 24. Overcrowding. 97 cases of overcrowding were found and remedied (compared with 86, 85, and 72, in the three preceding years), or 1.8 per cent. of house-to-house inspections. Most of the cases of overcrowding are found in house-to-house inspection. 25. Smoke Nuisance. 31 observations of smoke nuisance were made, and 13 nuisances of black smoke observed. The nuisances were abated on service of notices. There was no prosecution. In 1901 eight firms were prosecuted for smoke nuisance, in 1902 five firms, and in 1903 and 1908 one firm each. There were convictions against all the firms but one, and fines varying from £1 to £10 were imposed. The proceedings were taken under Section 24 (a) "a furnace which does not, as far practicable, consume the smoke." The nuisance has been decidedly less since the prosecutions. The works are all still actively engaged in the Borough, and there has been no complaint that the measures taken to prevent smoke have in any way hampered the business. 26. Defective Light. At 18 houses new windows were supplied or existing ones enlarged, or other work done to improve the lighting by daylight. 26a. In January, I reported as follows:— "Dark Rooms in Houses and Failure of the Building Act. I have had occasion in past years to call attention to the erection of new houses in which rooms used for living-rooms were so dark as to be injurious to health. A notable instance was Scotch Flats where, owing to the peculiar plan of the building and precautions required by the Building Act to 85 prevent fire, several rooms were exceedingly dark. The attention of the County Council was called to the matter, and on service of notices under the Public Health Act some improvement was effected. It was pointed out at the time that the Building Act contained very insufficient requirements for securing sufficient light to new houses, and that it was possible for the houses to comply in all respects with the Building Act and yet be very unhealthy as regards light and access of air. In other instances new buildings are erected so as to shut off the light from existing houses. My attention has recently been called to instances of the failure of the Building Act to prevent injury to health in each of these two ways. In one case some new back additions have been erected to old houses. These are two floors high instead of one as formerly, and having thicker walls they are wider. The effect was, that a living room at an adjoining house was rendered so dark that in the middle of the day it was impossible to read in it, and practically it required artificial light nearly all day. I immediately wrote to the owner asking him to abate the nuisance, and he has undertaken to whitewash the opposite wall every six months and to inform the tenant that the room must not be used as a living-room. In a similar case, which occurred some four years ago, the owner, neglecting to comply with the Council's notice, was prosecuted and an order obtained to abate the nuisance. The other case is a block of shops with three floors of flats over them. These have extensive back additions and an iron outside staircase for escape from fire, with gangways stretching across between the back additions of adjoining houses. The result is that some of the principal living rooms are so dark as to be injurious to health. The rooms are at present unoccupied but I do not think it will be practicable to obtain any distinct improvement in the supply of light. f 2 86 At a meeting of the Sanitary Institute two years ago I presented a paper on this subject, and the following resolution was passed:— 'That, in the opinion of this Conference, it is desirable that the provisions of the Public Health Acts, which prevent occupation of new houses until they have been certified to have a proper water supply, should be extended to include other sanitary requirements.' I would suggest that the attention of the London County Council be again called to the matter, and that they should be recommended to take steps to secure the carrying out of the above resolution, either by an amendment of the Building Act, or by the insertion of a clause in their next General Powers Act." This was done, and the L.C.C., having investigated the above statement, have noted the matter for future legislation. 27. Verminous Booms. 159 verminous rooms were cleansed, under the London County Council (General Powers) Act, 1904, or were dealt with as dirty rooms under the Nuisance Section, compared with 156,148, and 183, in the three preceding years. Dust Removal. 28. In Woolwich Parish, 5,951 loads of house and trade refuse were removed by direct labour, and destroyed at the Woolwich Destructor. In the three preceding years 6,808,. 7,517, and 6,477 loads, respectively, were removed. In Plumstead, 14,548 loads, weighing 12,173 tons, were removed by the contractors, Messrs. Tuff & Hoar, and destroyed by the Plumstead Destructor. £2,801 19s. 9d. was paid for collection, compared with £2,808 in 1908. Messrs. Tuff and 87 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 1st, 1908. In Eltham, the sum of £812 19s. 7d., compared with £792 19s. 7d. in 1908, was paid to the contractor, Mr. Tucker, for removal of Eltham dust, I had to report that the contractor did not comply with the requirements of the contract, that all papers, vegetable, or other objectionable matters, should be raked off and buried or burnt. The shoot was kept in a very objectionable state. Later, the shoot was moved to some fields outside the eastern boundary of the parish. Temporarily, however, the dust was deposited in Ridewood's farmyard. Notice was at once served to abate this nuisance, and Mr. Tucker covered it with a good layer of clean earth. Trade refuse. 29. During the past year there have been 7,321 (7,119 in 1908) receptacles of offensive trade refuse removed. There are now 57 (58 in 1908) tradesmen on the books from whom offensive trade refuse is removed. There are no complaints of nuisance arising from collection. Chloride of Lime is used as a deodorant. The cost of removal was £335. The charge made for inoffensive refuse is 1s. 6d. per load, and 2d. per 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. 30. Ten houses were represented as unfit for human 88 tation under Section 32 of the Housing of the Working Classes Act, viz., 61 & 63 High Street, Woolwich, 51 & 51a Beresford Street, 191, 193 & 199, Albert Road, North Woolwich, 2 Davey's Place, North Woolwich, and 1 & 4 Dingley Cottages, Abbey Wood. No notices were served under the Housing of the Working Classes Act. For seven houses, notices were served under the Public Health (London) Act. 61 & 63 High Street were demolished without the service of notices, and the owner undertook to demolish No. 2 Davey's Place, which was already vacated. The Albert Eoad houses, and Dingley Cottages, were very damp, and damp-proof courses and concreted sites were put in. The Albert Eoad houses were vacated duiing the work, but in Dingley Cottages the tenants continued occupation. North Woohvich—Concreted Sites. I have previously reported on the high death rates which prevail in North Woolwich compared with other parts of the Borough. In pursuance of enquiries as to the cause of these high death rates, I have endeavoured to investigate the connection of the entrance of ground water into the houses, with health. I reported previously that, in all probability, the fact that North Woolwich is situated on low-lying ground in which the level of the ground water is very high, had a good deal to do with the unhealthiness of the district. If this is the case it is obvious that an impermeable layer of concrete on the sites of the houses would diminish the unhealthiness of persons living in the district. In 1891 by-laws were made by the London County Council, one of which required that the site of every house or building should be covered with a layer of good concrete, at least 6 in. thick, and smooth on the upper surface; the concrete must be composed of clean gravel, broken hard brick properly burned, 89 ballast, or other hard material, to be approved by the District Surveyor, well mixed with fresh burned lime or cement in the proportion of one of lime to six, and one of cement to eight of the other material. This by-law does not appear to have been put into force until about 1894, and it is of course impossible to say that it was strictly enforced in all houses built after that date. On the supposition that this was the case, I have compared the health of houses in North Woolwich which were built before 1894, and that of houses built since, and the following statistics are the result. They refer to the four years 1905-1908, with the exception of the notified births which are for the period July, 1908, to June, 1909. The numbers are on the whole small and therefore must be received with caution, as it is a law of statistics that the smaller the numbers dealt with the more liable they are to vary. But allowing for this, the superiority of the death rates in the more recently built houses is so marked that it can be safely taken as something more than accidental. The death rate, infant death rate, and diarrhoea mortality are all markedly lower. The births taken are notified births. As all births are not notified this does not represent the total number of births, but they may be safely used for comparison of the two sets of houses, though the infantile death rate in both sets of houses comes out higher perhaps by 20 per cent. than is really the case. The social condition of the people is much the same in both the old and the new houses, so that it appears safe to attribute the greater healthiness of the new houses to their structural condition. Wherever houses are found decidedly damp attempts are made to secure concreting of the site, and the figures attached show the importance of doing this. 90 North Woolwich—Statistics 1905-1908 (4 Years). Old part, i.e., houses built before concreted site was required. New part, i.e., houses built with concreted sites. Old part New part Population, obtained by inspection 1613 1388 Notified Births—30/6/08 to 30/6/09 37 56 Birth Bate 23.4 40.3 Deaths 131 87 Death Bate 20.7 15.7 Deaths under one year 42 40 Infantile Death Bate (per 1,000 notified births) 284 178 Diarrhoea Deaths 16 14 Diarrhoea Death Bate per 1,000 births 108 63 Tuberculosis Deaths 19 18 Other infectious disease 12 8 Notifications of diarrhoea 27 26 Do. per 1,000 births 182 116 Statistics of Special Areas. 31. Inspection of Balgowan and Hylton Streets. I have made a special inspection of Balgowan and Hylton Streets, and the following is the result of the inspection:— Houses inspected 45 Dirty interiors (at least two rooms) 13 Defective roof 1 Dilapidations such as to be a nuisance 10 Dampness 9 Overcrowding 3 Dirty yards 7 91 Notices have been served for the remedying of the defects found. 32. Council's Houses. All the Council's 25 houses in North Woolwich were occupied throughout the year, with the exception of four, which were vacant six weeks, two weeks (2), and one week respectively. The number of persons at present housed is 129, or about five to a house. For particulars as to rent and cubic space of these houses, see Annual Report, 1904, page 70. Of the Council's twelve houses in Gossage, Park, and Parkdale Eoads, 10 were occupied throughout the year; 5 Gossage Road and 70 Parkdale Road were empty for periods of 43 and 48 weeks respectively. 5 Gossage Road was put in a satisfactory condition as regards dampness, &c., at a cost of £88 16s. 9d. 33. Houses Begistered under the By-laws. At the commencement of the year 359 houses were on the register; 41 were newly registered, and 5 taken off the register, leaving 395 on the register at the close of the year, compared with 235, 265, 307, 332, and 359, in each of the five preceding years. 34. These houses were inspected, some quarterly, others half-yearly. 730 inspections were made in all, and 140 notices were served. Proceedings were taken for breach of the By-laws at one house, on account of rooms not being kept clean. The defendant was warned and the summons withdrawn. 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. 92 Inhabited House Duty. 35. An application was received under this Act, for 16 houses in Blanmerle Eoad, Eltham. The certificates were deferred for the remedying of various minor sanitary defects. These having been satisfactorily completed, and the general sanitary arrangements being good, the certificates have since been granted. 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 & 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. 93 Underground Rooms. 37. One underground room, separately occupied, in Burrage "Ward, was found not in accordance with the Act. The service of notice led to cessation of occupation. Factories, Workshops, and Workplaces. 38. There were, at the close of the year 227 (229 in 1908) workshops and workplaces on the register. 323 inspections were made, and 47 notices served and complied with. 55 inspections of factories were made regarding the sanitary accommodation, and 17 notices served and complied with. 275 inspections of homeworkers' premises were made, and 14 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; 33 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 Eeport of that year. Bakehouses. 40. The number of bakehouses in use is now 51, 17 being underground. They were all inspected twice. I inspected most of them personally, and found them generally satisfactory. Eight certified underground bakehouses are not in use. Ice-cream Shops. 41. Ninety-eight Ice-cream shops were on the register at the close of the year, compared with 68, 76, and 108, in the 94 three previous years. There were 207 inspections made, and 6 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. Disinfection. 42. The mode of disinfection, cost of appliances, staff, &c., were fully described in my Annual Report, 1903, pages 73-76. Rooms at 1,408 houses were disinfected, compared with 987, 1,392, and 1,133, in the three preceding years. The disinfecting apparatus was used 1,302 times for 18,581 articles. 319 books from the Free Libraries were disinfected. The sum of £7 1s. 0d. 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, for personal use in infectious disease, and for use by the contractor in dust receptacles. They are dispensed at the Maxey Eoad offices; the Sun Street Mortuary (73 persons were supplied in 1908, and 110 in 1909); 18, Barge House Eoad, North Woolwich; and at the Eltham office, 144a, High Street (23 persons supplied). The cost of disinfectants used by the department in 1909 was £35 6s. 9d. The disinfectants used were Corrosive Sublimate; Sulphur and Formalin tablets (for fumigation); Formaldehyde (for spraying and disinfecting books, and for use in the Mortuary); Cyllin (for sputa in phthisis); Permanganate of Potash; Jeyes Corporation Fluid (for dust-pails); and Chloride of Lime (for offal tins). 95 Health Shelter. 43. The Health Shelter was not used duriug the year. It was used twice in 1906, once in 1908, 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 1908, and has been; occupied since on a weekly tenancy. The Mortuaries. 44. The Sun Street Mortuary was used for 146 bodies, compared with 162, 171, and 151, in the three preceding years. 133 were deposited for inquest, and 13 for custody. 81 postmortem examinations were made. One body was deposited in the infectious mortuary, compared with two in 1907, and none in 1908. The Eltham Mortuary was used for one body brought for custody only, compared with four and one in the two preceding years. Cemeteries. 45. The two Borough Cemeteries were well maintained as usual. 613 bodies were buried in the Woolwich Cemetery, compared with 669, 670, and 609, in the three previous years. There were 732 interments in the Plumstead Cemetery, compared with 745, 753, and 656, in the three previous years. 59 burials took place in Plumstead Church-yard. 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 267 persons, viz.—60 adult males, 96 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 1909, baths were taken by 408 persons, viz., 115 adult males, and 293 children; 392 for verminous bodies, 13 for verminous heads, and 3 for itch. 2462 articles were disinfected, and the disinfector was used 298 times. The adults came mainly from common lodginghouses, and the children were mostly sent from County Council Schools. It is seen that there has been an increasd use of the Station by school children, who nearly all come now for verminous bodies. Verminous heads can be dealt with at home. The increase of children bathing is due to the greater stringency of the Education Authority in requiring cleanliness of scholars. The construction and modus operandi of the Station were fully 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 may be ascribed the fact that no adult females 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. A box of white precipitate ointment is supplied to each bather with instructions for its use. The names and addresses of bathers are entered in a book, and the Lady Inspector calls at the houses, and arranges for necessary disinfection, and cleansing of bedding and rooms. 97 Tents, Vans, and Sheds. 47. During the year, 27 tents, vans, and sheds, were inspected (26 in 1908), and the bye-laws enforced. Infants' Milk Depôt. 48. Full particulars as to the establishment, objects, mode of working, and apparatus, of the Infants' Milk Depot, have been given in three previous Reports, the first one being separately printed in 1906, and the second and third forming part of the Annual Reports of 1907 and 1908. 332 infants were supplied with milk in 1909, compared with 313 in 1907, and 368 in 1908. The actual number of children being fed at one time averaged 110, varying for the most part between 115 and 90. Duration of Feeding. 175 children discontinuing the milk in 1909, had been on the Depot for more than one month, and only 50 were on less than one month. 94 had the milk for over six months. The average duration of feeding has been estimated at five months. This indicates that for the most part mothers obtain the milk, not as a temporary fancy, but from a conviction of its utility which is confirmed by trial; for the Depot milk costs parents slightly more than ordinary fresh milk and preserved milk, if given in proper quantity and quality, and considerably more if condensed milk is given in insufficient quantity. The table (see below) of reasons for discontinuing the milk, shows why the duration of feeding was curtailed in most cases. Only 57, or one-fourth of the total discontinuing, did so on account of the baby having reached an age not to need the milk. 38 mothers left the Borough, 19 gave up the milk on 98 account of the expense, and 14 were refused milk for non-payment. The Health Committee decided last year that the rule as to prepayment for the milk must be strictly enforced; in consequence, a number of mothers who were unable to produce ready money, were refused the milk. Age of Infants Fed. The average age of the children taken on at the Depot in 1908 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 217 infants who commenced Depot milk in 1909, 82, or two-fifths of the whole, were unwell at the time of commencing—18 suffered from indigestion, 41 were wasting or delicate, 6 had diarrhoea, 7 were premature infants, 1 had tuberculosis, and 9 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 milk as long as their infant appears to flourish. Many only come to the Depot when the baby's health fails. The following sample cases of delicate and premature infants, successfully reared on Depot milk, show the great importance of the Depot in saving the lives and restoring the health of children who would otherwise probably have succumbed:— 64a. H.D. (m.) Premature, very feeble at birth, under 5 lbs. Started Depot milk when 3 months old: was then very delicate, and there was digestive trouble necessitating special modifications until 7 months old. Gain in weight was satisfactory from the time he began Depot milk. Weighed 19 lbs. at 1 year old. 99 376. E.L. (m.). Very small at birth (4½ lbs.), and wasting when coming on the Depot at 6 weeks old. Took the milk well, and gained weight steadily. Was 16 lbs. 13 oz. at 10 months old (last time of weighing); was Depot fed for 14 months, and was well and healthy on leaving Depot. 341. H.B. (m.) Born in the Home for Mothers and Babies, premature, very delicate, 4 lb. 15 oz. at birth. Depot fed from two weeks old. Weighed 21 lb. 4 oz. at a year old. Was quite strong and healthy on ceasing Depot milk at 19 months. 431. A.L. (f.) Mother in an advanced state of Phthisis when this child was born, and died within a month after confinement. The child was Depot fed from a few days old, and made good progress on the whole in spite of delicacy, and two attacks of broncho-pneumonia. 3a. E.E. (f.) Started Depot milk when three weeks old. Was very small at birth, and had a very weak digestion. She required special modification, and much watching throughout the first year. She is a fragile kind of child. Weighed 20 lbs. at one year old. 53a. A.B. (m.) Started Depot milk at five months old. He was then much wasted, and only weighed 8 lb. 12 oz. Just before he came on the Depot he had been refused by the Infants' Hospital in Vincent Square as a hopeless case. He began to gain weight at once on Depot milk, and although he had had two severe attacks of bronchitis, he seemed likely to thrive when his parents left the district. He was 14 months old. Deaths of Depot-fed Infants. The health of Depot infants, as judged by the number of deaths, was more satisfactory last year than in 1907 and 1908. Only four children died while on G 100 the Depôt; one was prematurely born, one had bronchitis and diarrhoea, and the other two were wasting on admission. Seven additional infants died after having left the Depot for an interval varying from two days to two months. It is difficult to give a Milk Depôt death-rate. I have elsewhere shown that such death-rates, as often estimated, are quite incomparable to the infantile death-rates of a normal population. The fairest way is to take the deaths occurring while children are actually being fed at the Depot (deducting those dying within a week of coming on, and adding deaths occurring within a week of going off) and estimate the rate on the average numbers being fed at one time. Adopting this method, the death-rate last year was only 52 per 1,000. During the three years that the Milk Depot has been running, 25 Depot fed children died while on the Depot, and the death-rate was 81 per 1,000. This may be compared with the death-rate of ordinary hand-fed children which has been estimated at 198 per 1,000, excluding the deaths of children in the first week of life, whose inclusion would greatly raise the death-rate. Depôt fed children are seldom under one week old. Without the Depot 59 children would have died instead of 25; thus 34 lives were saved, to say nothing of the much larger number of children whose health was established. 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 last two years. 207 (229 in 1908) Depot fed infants were weighed, with a total of 952 weighings. 138 (122 in 1908) of these were weighed at least three times at intervals of about a fortnight; of these 49 gained more than the average 101 weight, 43 gained the average weight, and 46 gained less than the average. Thus, although nearly 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. 88 were brought (58 in 1908), and there were 283 weighings; 44 were weighed at least thrice, of which 19 gained more than the average, 10 gained the average, and 15 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 conditions of the child. Some very delicate children are unable to take fresh milk in any form, and for these some form of dried milk, as Glaxo, has been found useful. 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. Diarrhoea 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. g 2 102 Theoretically, Depôt-fed children should not be liable to the infection of diarrhoea any more than those breast-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. The cost of the Depot was less than in 1907, but more than 1908. The total loss on working expenses and loan charges was £460 10s. 5¼d., compared with £500 11s. 3d., the loss for 1907, and £418 7s. 4d. in 1908. The income decreased by some £46, while the expenditure remained about the same. Milk cost £20 more, but the other expenses were reduced. The cost to the ratepayers of the Depôt is equal to a rate of one-seventh of a penny, the return for which is many lives saved, and many infants growing up stronger and more useful citizens than they would otherwise be. The Borough Treasurer has kindly supplied a full revenue account which is given below. Statistics. Numbers Fed. Number having milk on January 1st, 1909 115 New cases taken on between December 31st, 1908, and December 31st, 1909 217 Total cases which had milk in 1909 332 Cases discontinuing in 1909 225 Total on books having milk on December 31st, 1909 107 Average number being fed 110 Average duration of feeding 5 months 103 Condition of Health of Infants commencing Depot Milk in 1909. Number well on commencing 135 Number unwell on commencing 82 viz. Wasting 12 Premature birth 7 Delicate 29 Indigestion 18 Diarrhœa 6 Tubercle 1 Other diseases 9 82 Period for which children leaving the Depot in 1909 were supplied.—Under 1 month, 50; 1 to 3 months, 44; 3 to 6 months, 37; 6 to 9 months, 43; 9 to 12 months, 22; over 12 months, 29. Average duration of feeding 5 months Reasons for discontinuing Depot Milk. Left Borough 38 Too old 57 Died 4 Expense 19 Mother dissatisfied 27 Doctor's advice 25 Went to hospital or infirmary 5 Baby refused milk 11 Too ill 2 Mother's milk returned 8 Carried forward 196 104 Brought forward 196 Not stated 11 Non-payment 14 Scarlet fever 2 223 Infants weighed—Depot fed. Number of Infants weighed 207 Number of Infants weighed 3 times or more 138 Number of weighings 952 Of those weighed 3 times or more— Number who gained more than average amount 49 Number who gained average amount 43 Number who gained less than the average amount or lost 46 Breast fed. Number of Infants weighed 88 Number of Infants weighed 3 times or more 44 Number of weighings 283 Of those weighed 3 times or more— Number who gained more than average amount 19 Number who gained average amount 10 Number who gained less than average amount or lost 15 105 Deaths of Infants who were on the Depot at time of Death during the Year ended 31st December, 1909. No. Date of Death. Decease. Age at Death. Received Milk for 31 15/2/09 Premature 6 months 4 months 124 31/10/09 Gastro-intestinal Catarrh & Bronchitis 8 months 8 months 127 8/4/09 Marasmus 3½ months 1 month 260 10/11/09 General Atrophy 1 month 2 weeks Total deaths 4. 1 death was in the first month of feeding. The following 7 deaths occurred in 1909, after the Infants had discontinued having Depot Milk. No. Date of Death. Disease. Age at time of discontinuing Received Milk for Discontinued Milk. 69 10/4/09 Marasmus 4½ months 2½ months 10/2/09 80 25/1/09 Mal-nutrition & br. pneu. 10 months 1 month 15/1/09 99 16/12/09 Diarrhoea & dentition 11 months 9 months 29/10/09 131 25/7/09 Ulcerative colitis 6 months 4½ months 13/7/09 198 20/9/09 Zymotic Enteritis 4 months 2½ months 18/9/09 205 27/12/09 General Atrophy & Bronchitis 5½ months 5 months 24/12/09 227 17/9/09 Zymotic Enteritis 1¼months 1 week 4/9/09 Deaths within 1 week of discontinuing depot milk 2. Deaths within the following three weeks 3. MILK DEPOT, MAXEY ROAD. Approximate Revenue Account for Year ended 31st December, 1909. Expenditure. £ s. d. Income. £ 8. d. To Wages 222 8 7 By Sale of Milk— „ Salaries 80 13 0 Sterilised 549 5 7 „ Rent 40 0 0 Separated 12 15 1 „ Gas „ Horse Hire 1 68 12 0 10 4 562 0 8 „ Milk 396 5 0 „ Sugar of Milk, Castor Sugar, Citrate of Soda, etc. 15 17 10 „ Milk Bottles, Stoppers, Teats, Washers, Utensils, etc. 69 4 0 „ Machinery, Repairs and Maintenance of same 16 7 1 „ Coke, Coal & Fuel 25 8 7 „ Telephone Subscription 1 10 0 „ Fire and Boiler Insurance, Xmas, 1908 to Xmas, 1909 1 2 0 „ Cleaning Materials 9 7 4 Balance carried to Net Revenue Account being loss on Working Expenses 395 19 9½ „ Sundries 10 3 10½ £958 0 5½ £958 0 5½ 106 Approximate Net Revenue Account for Year ended 31st December, 1909. To Balance brought down from Revenue Account £ s. d. By Balance, being Approximate Loss on Milk Depot Account for year 460 10 5½ 395 19 9½ Loan Charges— Repayment of Principal 50 0 0 Interest on Loans 14 10 8 £460 10 5½ £460 10 5½ 4th April, 1910. ALEX. THOMAS, Borough Treasurer. 107 Public Ambulance. 49. The Public Ambulance, for accidents and non-infectious illness, was used 123 times, compared with 97, 110, 104, 122 and 143, in the five preceding years. The following were the journeys made:— To Guy's Hospital 43 Cottage Hospitals 25 Seamen's and Miller Hospitals 6 King's Hospital 7 St. Thomas's 1 London 5 Charing Cross 1 Union Infirmary 5 Other hospitals 5 Private houses 25 Particulars of this ambulance were given in my Annual Report 1903, page 78. The ambulance is kept in good repair. Notices and Prosecutions. 50. 2991 written intimation notices, and 550 statutory notices were served. 66 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 seven defaulters were summoned at the Police Court. The results are given in Table XVII. bacteriological examination. 51. 951 bacteriological examinations were made for the Public Health Department by the Lister Institute, viz., 757 for Diphtheria, 179 for Phthisis, and 15 for Enteric Fever. The total cost was £148 18s. 10d., compared with £164 14s. 10d., in 1908. 108 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 394 Number of Inspections 730 „ Re-inspections (estimated) 1,850 „ Pound satisfactory 174 „ Notices served 250 „ Nuisances, defects and offences against the By-laws dealt with and remedied 1,015 „ Cases of overcrowding remedied by re-distribution without notice 7 „ Houses measured 45 „ Prosecutions 3 Notices. On Landlords for Cleansing 280 „ Tenants for Cleansing 346 „ Landlords for Overcrowding 3 „ Tenants for Overcrowding 37 „ Landlords and Tenants for other defects 554 „ Landlords and Tenants for Verminous Booms — Women's Lavatories at Railway Stations, &c. Number of inspections 64 „ Found defective and dirty 7 Restaurants and Eating-Houses. Number of inspections 83 „ Defects and dirty conditions found and remedied 24 109 Factories and Workshops. Number of inspections of Factories and Workshops 223 „ Notices served 15 „ New workrooms measured 33 Homeworkers' Premises. Number of inspections 275 „ cases referred to district inspectors 14 Miscellaneous. Total number of houses visited re Phthisis, Measles, and Zymotic Enteritis 131 „ Visits paid for various causes, viz., complaints, and verminous and dirty houses and bedding 575 „ Intimation Notices served 219 „ Statutory 60 „ Cases referred to District Inspectors 264 „ Dustbins supplied 76 „ Accumulations of refuse removed 25 „ Cases where animals were kept in such a state as to be a nuisance 5 „ Re-inspections (excluding registered houses) estimated 550 „ Early morning inspections 5 53. Miss Middlebrooke describes the nature of her work as follows:— "The work connected with the verminous, dirty and illkept homes and children seems to become more and more urgent as the medical inspection at the schools is gradually requiring a higher standard of cleanliness in the scholars. Some of the cases are most difficult to deal with, the parents 110 resenting any interference with their children's bodily condition. It does not occur to them at all that the bad condition in which a child is found is due to their own neglect, and they apparently suffer from defective sight, for when the vermin on the child's head or body is shown to them, they very often deny that any vermin is there, and a magnifying glass has to be produced to convince them of the truth. Various reasons are then given as excuses for neglect, such as 'the purchase of some second-hand clothing '; 'the child having been placed in proximity to dirty children in the class-room'; and very often the old superstition is quoted that some children 'breed' vermin, or that ill-health is responsible. I have frequently to combat the opinion of dirty mothers that fleas are the universal result of poverty, that it is impossible to get rid of the pests, therefore the insects must be taken as a matter of course and their presence tolerated; they are surprised and very sceptical when told that it is possible to eradicate fleas by persistent cleansing of floors, bedding, clothing, &c., and the removal of carpets and hangings from infested rooms. In houses where the bedding has been left undisturbed for some days, or maybe weeks, one finds a mass of wriggling microscopic threadlike worms all over the bedding. These have been hatched from the eggs of fleas and deposited in the dusty portions of the room. If the bedding at this stage is thoroughly beaten, the coverings washed, and the room scrubbed, the fleas may be considerably reduced in numbers, and in time exterminated; but where energy and perseverance are lacking the larva is allowed to go through its usual development into the adult flea. Children sleeping in beds infested with fleas or other vermin, are usually found to be pale and nervous; they do not get their proper amount of sleep and rest. 1ll Women who have neglected their homes and maternal responsibilities need to be very carefully dealt with in order to obtain the bgst results. Some, having gradually drifted through misfortune or adverse circumstances into careless and thriftless ways, require sympathy and encouragement. Others, who have contracted bad habits through alcoholism, &c., require very plain speaking, firmness, and warnings of proceedings to be taken under the Children Act should the instructions given for improvement fail to be carried out. When once they can be induced to admit that the state of affairs is unsatisfactory, the difficulty is almost surmounted, and, after a few visits, during which remedies for the various undesirable conditions are suggested by the inspector (who, in the meantime, sees that dirty and verminous walls and ceilings are cleansed and structural defects remedied), a fresh start is made. Of course, continued supervision is necessary in the worst cases, otherwise "backsliding" takes place, but unfortunately the cases are far too numerous to permit of constant visiting for an indefinite period. Amongst the most hopeless are the mothers who are mentally deficient, and who from sheer incapacity are unable to care for their children properly. Under such circumstances, I have found it best to invoke the aid of the Rescue Officer, who induces the parents to contribute towards the child's maintenance in an institution. At least twenty of such mothers are under supervision. On the whole I feel quite sure that the work done is bearing fruit, that we are, slowly but surely, rousing indifferent parents to a more lively sense of their responsibilities, that they will gradually become more self-respecting and more careful of the welfare of their offspring. 54. The following is Miss Fitz-Gerald's Report:— 112 Summary of Inspections. Visits to houses after notifications of births 1699 Re-visits 299 Visits after infant deaths 79 Visits re Zymotic Enteritis 155 Revisits 43 Visits to Depot-fed infants 703 Special visits 59 Infants weighed at Milk Depot 1077 Reported to District Inspectors Structural defects 16 Dirty interior walls 10 Overcrowding 3 Other matters 16 In 1907 the Home Office requested that special enquiries should be made in the different sanitary areas with regard to births occurring in 1908, with a view to ascertaining the relation between infant mortality, and the industrial employment of mothers. Woolwich has a low percentage of occupied married women, but it was thought that the comparison of results obtained in this Borough, and in other districts where similar conditions prevail, with those obtained in towns with a high percentage of occupied married women, would be useful. The inquiry commenced on January 1st, 1908, and lasted until the end of 1909. River ward was chosen as being on the whole the most suitable, and altogether 182 investigations were made. This does not represent the total number of births occurring in that ward during 1908. Some were in houses where it was not deemed advisable to visit. In some cases the people had removed before the first visit could be paid, and in some instances the full inquiries could not be made. The 113 Home Office asked for information to be obtained in each case under no less than 32 headings, which of course necessitated a good deal of questioning, and where this appeared likely to be distasteful the inquiry was abandoned; it seemed better to lose some statistical material, rather than run the risk of hurting people's feelings. Aliens in North Woolwich were also omitted from the inquiry. The statistical material, which is of a decidedly elaborate nature, has not yet been compiled in detail, and will be dealt with in a future report. The following figures, relating to the relative percentage of breast-fed infants, and the number of deaths occuring in each class are of much interest, and may be given at once. Total eases investigated 182. On first visit 153 were breast-fed. 2 „ mixed-fed. 20 „ hand-fed. 7 had died within 3 weeks of birth. Omitting the 7 who had died— = 11% hand-fed on 1st visit. = 87% wholly breast-fed on 1st visit. The first visit was made about one month after birth. Of these 182, 20 died before the end of the first year, 46 had removed and could not be traced, leaving 116 kept under observation until the end of the first year of life. Of the 20 who died, 8 were breast-fed on the first visit (but five of these subsequently became hand-fed), 5 were hand-fed on the first visit, and 7 died so soon after birth that the nourishment they took was a negligible quantity. 114 Of the 116 living of whom the record is complete for the first year, 106 were breast-fed on the first visit; of these, 95, or 82 per cent. were breast-fed for six months or longer, and 11 became hand-fed before six months of age. 55. With the permission of the Public Health Committee, I attended the Health Congress at Leeds in July, 1909, and contributed a paper in the Preventive Medicine Section on "Educational Aspects of a Municipal Milk Depot, of which the following is a summary, which indicates in few words the aims and scope of Health Visitor's work:— "The object of this paper is to give some account of the supplemental usefulness of a Municipal Milk Depot in furthering the education of mothers and the experience of Women Health Workers. It is not concerned with the arguments for its primary object, i.e., the supply of pure milk for infants. • The ultimate factor in the reduction of infant mortality is an educated motherhood. We have to replace ignorant tradition with a widespread simple scientific teaching. All possible aids on the educational side must be used; the ignorant adult mind being harder to teach than the child mind. Schools for mothers are not yet within the scope of municipal enterprise. A milk depot may be made into a genuine centre of education by developing the "consultation" side by means of a properly organised periodical weighing day, which is open to breast-fed as well as depot·fed infants. The educational ends of the depot may be summarised as follows:— 1. By its actual existence it demonstrates that infant feeding is a matter of some real importance; imperceptibly this affects the general conciousness. 115 2. On "weighing day" the mother comes herself to get advice and instruction, instead of passively submitting to having it taken to her. She therefore values it more and is more receptive, 3. Instruction can be given in the way it is best assimilated, i.e., by degrees and as the child grows and develops. 4. It is possible to give teaching of a more advanced nature to those who need it. Among the higher type of working-class mothers there are many of these. They will attend regularly and become capable of a genuine child-study for which the development of their own child offers opportunity. Child-study to be of real use must not be restricted to experts, but must penetrate to the parents generally. Weighing a baby regularly and commenting on its growth and development to its mother is one way in which to help to make the child of real mental interest to the woman. Milk depot work can further the education of women health officers by giving opportunity for concentrated minute study of the individual differences of the normal healthy infant. There is need for centres where the child in health can be observed widely. Hospitals give opportunity for the study of sick children. Women inspectors and health visitors have not now to be content with combating gross errors in infant management, but must have an expert knowledge of infant life. Work in connection with depot-fed infants needs so concentrated an attention because we are ourselves responsible for the feeding and for adapting it to individual needs, that one is compelled to recognise and try to understand this marked individuality of the human infant, with its own rate of development, its own need for and capacity to assimilate food, and its own response to environment generally. h 116 Weighing day at the depot should be open to breast-fed infants that they may be used for purposes of comparison. (A large number of breast-fed infants are brought to the Woolwich Depot for weighing). Roughly about 60 per cent. of depot-fed infants may be classed as normally healthy." Use of School Playgrounds. 56. In former years I have reported as to the great importance of there being good provision for the playing of games by children. This want is partly met by the school playgrounds, but, as is shown in previous reports, these playgrounds are not used to anything like the extent which is desirable. In March, 1909, a letter was received from the St. Pancras Borough Council, calling attention to this fact and asking the Woolwich Borough Council to support St. Pancras in a recommendation to the London County Council as to the exhibition of notice boards showing when the playgrounds were opened. I recommended that the Council should also be asked to arrange for the opening of more playgrounds on Saturday and Sunday. Healthy children must play and those who can not use playgrounds will probably play in the street and so interfere with traffic and run the risk of being fatally injured. The London County Council replied that notice-boards were already in existence and that they were considering the opening of additional playgrounds on Saturday and Sunday in this Borough. Unfortunately, though notice-boards exist, they are not as prominent as is desirable, and the use of playgrounds does not seem to be encouraged by those in charge of them. No doubt one need is for the organisation of games. If there are no properly organised amusements children are liable to get into 117 mischief. It should not be beyond the power of the London County Council to adopt some system of having regular and orderly games. Report of the royal commission on the Poor law. 57. This report, as far as it dealt with Public Health, was summarised and commented on by your Medical Officer of Health (see Council's Minutes, page 713), and the Council resolved:— " That the Government be asked to arrange for early legislation to reform the abuses of the Poor Law pointed out by both majority and minority reports, and more especially to provide for immediate medical treatment for all persons requiring and unable to pay for it." The Children Act. 58. This Act, which came into force at the beginning of 1909, is an important contribution to Public Health legislation. By making neglect to provide adequate food, clothing, medical aid, or lodging, a penal offence, the law has laid down emphatically the responsibility of the parents or other persons for the proper nurture and medical care of children. The provisions, too, with regard to exclusion of children from Public Houses, and the penalty for giving intoxicating liquor to a child, must be productive of the very best results. Unfortunately the Borough Councils have no power to enforce the Act, though, as regards the provision of medical attendance, they are the Authority which has the best means of knowing when this has been neglected. The enforcement of the Act depends primarily upon the police, but it appears that the police are leaving it to h 2 118 the Society for the Prevention of Cruelty to Children to institute proceedings. This Society has done most excellent work on behalf of the health of children, but it is open to question whether it is desirable that the carrying out of so important an Act should be delegated to a voluntary and non-responsible authority. 59. There was no change in the staff of the department during the year. I have gratefully to acknowledge the loyal co-operation of Chief Inspector Duck and other members of the Public Health Staff who have, often under discouraging conditions, conscientiously devoted their best energies to the improvement of the public health and the diminution of sickness and physicial inefficiency. 119—120 TABLE I. Borough of Woolwich. Vital Statistics of the whole District during 1909 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 1899 113148 3367 29.8 534 158 ... ... ... ... ... 1889 16.6 1900 115498 3303 28.6 469 142 ... ... ... ... ... 2057 17.8 1901 117740 3535 30.0 465 128 1600 13.6 433 42 164 1722 14.6 1902 122505 3730 29.9 466 124 1678 13.7 278 43 208 1843 14.7 1903 123172 3691 30.0 399 106 1511 12.3 272 41 175 1637 13.3 1904 125791 3531 28.1 479 132 1636 13.0 261 40 169 1765 14.0 1905 125885 3549 28.2 366 103 1463 313 50 192 1605 12.7 1906 127345 3524 27.7 396 111 1530 293 48 183 1666 13.1 1907 129336 3295 25.4 372 111 1479 296 50 184 1613 12.5 1908 127648 3082 24.1 298 95 1374 333 60 170 1487 11.6 Average for years 1899 to 1908 122816 3460 28.2 419 121 ... ... ... ... ... 1728 14.1 1909 127993 2937 22.9 240 82 1415 ... 323 51 223 1585 12.4 * 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 Ages 117,178 Number of Inhabited Houses 18,086 Average Number of Persons per House 6.47 At Census of 1901. 121 TABLE IA. I. Insitutions within the District receiving Sick and Infirm Persons from outside the District. II. Institutions outside the District receiving Sick and Infirm Persons from the District. Woolwich Union Infirmary Royal Arsenal Hospital Auxiliary Hospital Woolwich and Plumstead Cottage Hospital Eltham Cottage Hospital Home for Mothers and Babies Lewisham Infirmary Herbert Hospital Blackheath Cottage Hospital Seamen's Hospital Brook do. Park do. 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 Comsumption Hospital Ear and Nose Hospital Brompton do. Bethnal Green do. Cane Hill Asylum Dartford Heath Asylum Colney Hatch do. Claybury do. Tooting Bec do. Darenth do. Caterham do. Stone do. Banstead do. Horton do. Hostel of God do. 123—124 TABLE II. Vital Statistics of Separate Localities, 1901-2-3-4-5-6-7-8-9. Increase of Population since 1901 Census, estimated by number of new houses oocupied, and number of persons to a house in the Parish. Wards. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births. 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 7800 227 116 12 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 9788 165 120 22 River N. 14504 416 292 66 N. 3450 135 66 26 3450 140 50 16 3991 155 71 30 3991 141 72 31 3991 135 62 19 3841 150 55 19 3901 ... 54 15 3397 119 52 9 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 10188 242 167 30 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 7314 267 104 22 Barrage 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 9184 206 143 19 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 9444 167 104 15 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 13173 299 148 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 9500 192 76 7 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 9106 237 162 25 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 25000 576 252 38 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 13595 240 142 18 N.B.—The births in 1909 are the notified births increased in the proportion of Registered to notified births in the whole Borough. 125 TABLE III. Cases of Infectious Disease notified during the year 1909. 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. Woolwich.: Plumstead. Eltham. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. East. West. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 268 2 75 156 19 16 ... 74 59 126 9 28 238 Membranous Croup • • • ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 1027 6 224 637 135 25 ... 406 223 343 55 31 945 Typhus Fever • • • ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 13 ... ... 3 4 6 ... 9 ... 3 1 2 8 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 9 ... ... ... 3 6 ... 1 6 2 ... ... ... Erysipelas 113 3 7 15 17 49 12 30 34 33 6 ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1420 11 306 811 178 102 12 520 322 507 71 61 1191 127—128 TABLE IV.—Causes of, and Ages at Death during the Year 1909. Deaths in or belonging to whole District at subjoined ages. Disease. All Ages. Male. Female. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. Over 85. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 55 29 26 13 37 5 ... ... ... ... ... ... ... ... ... ... Scarlet Fever 19 12 7 1 7 8 1 1 1 ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 30 13 23 1 1 1 1 ... 1 3 2 5 8 7 4 2 Whooping Cough 15 6 9 5 ... 1 ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 25 11 14 1 ... 12 1 ... ... 1 ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 3 ... ... ... ... ... ... 1 1 1 ... ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa and Dysentery 10 4 6 4 1 ... ... ... ... ... ... ... ... 3 2 ... Epidemic or Zymotic Enteritis 9 3 6 7 2 ... ... ... ... ... ... ... ... ... ... ... Enteritis 12 7 5 6 2 1 ... ... ... ... ... 1 1 ... 1 ... Other Continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 12 7 5 1 1 ... 3 ... 2 ... 2 1 ... 1 1 ... Syphilis 10 5 5 7 1 ... ... ... ... ... 1 1 ... ... ... ... Rheumatism 12 3 9 ... ... 2 1 1 2 1 2 ... ... 2 1 ... Gout 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Meninges 27 10 17 3 15 5 2 1 ... 1 ... ... ... ... ... ... Tuberculosis of Lungs (Phthisis) 150 88 62 5 2 5 7 13 32 35 32 ... 5 1 ... Tuberculosis of Intestines and Peritoneum 9 6 3 3 3 1 ... 1 1 ... ... ... ... ... ... ... Other forms of Tuberculosis 23 12 11 3 3 ... ... 2 2 3 3 2 4 1 ... ... Alcoholism 4 2 2 ... ... ... ... ... ... ... 2 ... ... 2 ... ... Cancer 119 53 66 ... 1 • • • ... 2 ... 3 9 28 31 27 15 3 Diabetes 10 8 2 ... 1 ... ... ... ... ... 2 3 1 2 1 ... Premature Birth 42 29 13 42 ... ... ... ... ... ... ... ... ... ... ... ... Developmental Diseases 66 37 29 62 4 ... ... ... ... ... ... ... ... ... ... ... Old Age 87 38 49 ... ... ... ... ... ... ... ... ... 2 15 44 26 Meningitis 14 9 5 3 8 ... 1 2 ... ... ... ... ... ... ... ... Inflammation and Softening of Brain 10 6 4 ... ... ... ... ... 1 1 ... ... 2 3 3 ... Epilepsy 5 3 2 ... ... ... ... ... ... ... ... 1 3 ... 1 ... General Paralysis 11 10 1 ... ... ... ... 1 ... 1 4 3 ... 2 ... ... Tabes Dorsalis and Locomotor Ataxia 4 3 1 ... ... ... ... ... ... ... ... 2 1 1 ... ... Peripheral Neuritis 3 ... 3 ... ... ... ... ... ... ... ... 2 1 ... ... ... Other Diseases of Brain and Nervous System 38 19 19 13 5 2 ... 1 1 ... 2 3 5 4 1 1 Organic Diseases of the Heart 147 80 67 ... ... 1 2 10 3 8 17 23 32 37 13 1 Cerebral Hæmorrhage, Embolism and Thrombosis 61 22 39 ... ... ... ... ... ... 2 3 4 13 22 15 2 Apoplexy and Hemiplegia 17 8 9 ... ... ... ... ... ... ... ... 1 2 7 6 1 Other Diseases of Blood "Vessels and Heart 43 31 12 1 ... ... ... ... 1 2 3 12 5 14 4 1 Acute Bronchitis 70 34 36 27 10 ... 1 ... ... 1 1 3 7 6 10 4 Chronic Bronchitis 68 28 40 ... ... ... ... ... ... 2 2 5 5 31 20 3 Lobar (Croupous) Pneumonia 9 6 3 ... 1 ... ... ... ... 1 4 1 1 ... 1 ... Lobular (Broncho) Pneumonia 45 24 21 16 16 1 ... ... ... 1 ... 2 4 2 2 1 Pneumonia 53 30 23 6 5 4 ... 2 1 5 7 4 6 9 3 1 Other Diseases of Respiratory System 5 4 1 ... 1 ... ... 1 ... ... ... 1 ... 2 ... ... Diseases of Stomach 14 11 3 ... 2 ... 1 1 1 1 2 1 3 1 1 ... Obstruction of Intestines 16 3 13 4 1 1 ... ... ... 1 ... ... 4 3 2 ... Cirrhosis of Liver 16 9 7 • • • 1 ... ... ... 1 2 5 4 3 ... ... Other Diseases of the Digestive System 14 9 5 2 ... 3 ... 1 ... 1 2 1 2 1 1 ... Nephritis and Bright's Disease 50 24 26 ... ... 1 ... ... 1 5 7 4 13 11 8 ... Tumours and other Affections of Female Genital Organs 2 ... 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... Accidents and Diseases of Parturition 7 ... 7 ... ... ... ... ... 3 3 1 ... ... ... ... ... Deaths by Accidents or Negligence 27 17 10 2 6 1 ... 2 1 3 3 2 1 2 2 2 Deaths by Suicide or Homicide 15 10 5 ... ... ... ... 1 ... 4 4 2 1 3 ... ... Deaths from ill-defined causes 14 9 5 2 ... 1 ... ... ... 2 ... 1 3 4 1 ... All other Diseases 49 26 23 5 5 1 1 3 1 3 6 5 5 11 3 ... Totals 1585 822 763 240 163 55 20 40 37 93 130 165 183 244 167 48 129—130 TABLE IVa. Deaths in or belonging to Localities, at all ages in wards. Deaths in Public Institutions, in the District. Deaths in Outlying Institutions. Disease. River. Dockyard. St. Mary's. St. George's St. Nicholas. Central. Glyndon. St. Margaret's Herbert. Burrage. Eltham. North. South. Smail-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 8 7 ... 6 4 15 1 4 2 2 6 ... 11 2 Scarlet Fever 1 3 1 ... ... 2 ... 2 4 2 2 2 ... 18 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 1 2 2 ... 1 12 1 3 5 3 2 4 4 2 Whooping Cough 1 1 2 4 ... 2 ... 3 ... 1 1 ... ... ... Diphtheria and Membranous Croup 1 1 1 1 2 3 1 3 6 2 3 1 ... 20 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... 1 ... ... 1 ... ... ... 1 ... ... ... ... 3 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea and Dysentery 1 2 ... ... 2 ... ... 2 1 2 ... ... 5 1 Epidemic or Zymotic Enteritis 2 1 2 ... ... 2 ... 1 ... ... ... 1 ... ... Enteritis ... 1 2 1 ... 1 ... ... ... 1 ... 6 1 1 Other continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Fever ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Other Septic Diseases 1 2 l ... 2 2 ... 2 ... l ... 1 l 6 Syphilis ... 1 1 1 3 1 ... 2 ... ... 1 ... 5 ... Rheumatism 1 1 3 1 ... 3 1 ... 1 ... ... l 3 1 Gout ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Meninges 2 4 1 3 1 3 2 3 2 2 3 1 3 6 Tuberculosis of Lungs (Phthisis) 6 17 9 10 7 29 4 22 13 7 14 12 31 22 Tuberculosis of Intestines and Peritoneum ... 3 ... ... 2 2 ... ... ... 1 1 ... 1 3 Other forms of Tuberculosis ... 4 1 2 3 2 1 1 2 2 2 3 4 4 Alcoholism ... ... ... ... ... ... ... ... ... 1 2 1 1 ... Cancer 1 9 15 5 4 18 10 16 16 7 7 11 21 15 Diabetes ... ... ... 1 ... ... 1 2 ... 2 ... 4 4 1 Prem ature Birth 2 6 1 9 4 3 ... 2 7 2 3 3 8 ... Developmental Diseases 1 11 4 2 3 16 3 7 5 2 4 8 2 7 Old Age ... 6 8 8 2 11 5 8 9 8 10 12 23 10 Meningitis ... ... 2 ... 4 3 2 ... 1 ... ... 2 2 1 Inflammation and Softening of Brain ... 3 ... ... 1 1 ... 1 1 2 1 ... 2 1 Epilepsy ... 1 2 1 ... ... ... ... ... ... ... 1 ... 1 General Paralysis 1 1 ... ... ... 2 ... 1 1 1 1 3 ... 9 Tabes Dorsalis (Locomotor Ataxia) ... ... ... ... ... 1 1 ... 2 ... ... ... 1 1 Peripheral Neuritis 1 ... ... ... ... 1 ... ... ... ... ... 1 2 1 Other Diseases of Brain and Nervous System 1 3 3 5 5 7 1 4 2 2 1 4 7 7 Organic Diseases of the Heart 1 19 14 18 8 20 7 19 8 10 14 9 29 7 Cerebral Hmæorrhage, Embolism and Thrombosis 4 4 4 3 2 14 6 8 5 2 6 3 14 4 Apoplexy and Hemiplegia ... 4 2 3 ... 2 ... 3 1 ... 1 1 6 ... Other Diseases of Blood Vessels and Heart 1 3 4 5 3 6 2 7 4 2 2 4 4 7 Acute Bronchitis 3 3 3 8 5 15 4 5 9 3 9 3 ... ... Chronic Bronchitis ... 10 5 5 3 6 4 5 3 6 14 7 18 7 Lobar (Croupous) Pneumonia ... 3 1 ... 1 1 ... 2 ... 1 ... ... ... 1 Lobular (Broncho) Pneumonia 3 4 2 3 5 4 2 4 11 ... 6 1 3 3 Pneumonia 3 5 9 1 4 8 2 4 5 4 4 4 8 6 Other Diseases of Respiratory System ... ... ... 2 ... ... 1 ... 1 1 ... ... ... 1 Diseases of Stomach 2 1 ... ... 2 ... 3 1 1 1 1 1 4 1 Obstruction of Intestines ... 2 ... 1 2 ... ... 1 ... 6 2 2 2 4 Cirrhosis of Liver ... 3 1 1 3 1 ... 2 1 2 2 ... 7 ... Other Diseases of Digestive System 1 1 ... 1 2 2 1 2 1 ... 1 2 3 5 Nephritis and Bright's Disease ... 8 2 3 1 10 4 3 3 1 7 8 10 7 Tumours and other affections of Female Genital Organs ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 Accidents and Diseases of Parturition ... ... ... ... 1 4 1 ... 1 ... ... ... 1 1 Deaths by Accidents or Negligence 1 3 3 2 3 7 • • • 1 2 3 ... 2 11 4 Deaths by Suicide or Homicide ... ... 1 ... 3 1 3 3 1 1 2 ... 1 1 Deaths from ill-defined Causes ... ... 1 ... 1 ... ... ... 4 1 2 5 1 1 All other Diseases ... 3 2 4 4 6 1 2 6 7 6 8 12 17 Totals 52 167 116 120 104 252 76 162 148 104 143 142 276 223 131—132 TABLE IYb. Infantile Mortality during the Year 1909. Deaths from stated Causes in Weeks and Months under One Year of Age. 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 Nil Nil Common Infectious Diseases— Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Measles ... ... ... ... ... ... 1 ... ... 1 1 2 ... 2 4 3 14 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Diphtheria (including Membranous Croup) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 1 5 Diarrhoeal Diseases— Diarrhoea, all forms ... ... ... ... ... 3 2 2 1 ... 1 ... 1 ... ... 1 11 Enteritis, Muco-enteritis, Gastro-enteritis ... ... 1 1 2 1 ... ... ... 1 1 ... ... ... ... ... 5 Gastritis, Gastro-intestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Wasting Diseases— Premature Birth 35 2 ... ... 37 2 1 ... ... 1 ... ... ... ... ... ... 41 Congenital Defects 10 1 ... ... 11 1 2 ... ... ... 1 ... 1 ... ... ... 16 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk, Starvation ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Atrophy, Debility, Marasmus 5 1 3 6 15 8 3 5 4 1 1 2 2 1 ... 1 43 Tuberculous Diseases— Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 Tuberculous Peritonitis, Tabes Mesenterica ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 2 ... 1 1 ... 1 ... ... 5 Other Causes— Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 ... 1 3 1 ... ... ... 1 ... ... ... ... ... 6 Rickets ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... 3 Convulsions 2 4 ... ... 6 3 1 2 ... 1 1 1 1 ... ... ... 16 Bronchitis ... 1 1 2 4 6 2 2 ... 2 1 1 2 1 5 2 28 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... 2 ... 1 3 4 1 ... ... ... 2 1 4 3 2 2 22 Suffocation, overlying ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Causes 2 4 ... ... 6 1 ... 2 2 1 1 1 ... ... ... ... 14 55 16 6 10 87 33 15 14 10 9 12 12 12 11 13 12 240 Five years, 1905-9 371 95 77 76 619 179 121 108 89 85 90 83 74 82 61 67 1658 Population, Estimated to middle of 1909, 127,993. Legitimate, 2865 Legitimate infants, 221. in the year : Illegitimate 22 Deaths in the year of Illegitimate, 19. Deaths from all Causes at all Ages, 1585. 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. 86 0.02 2.2 0.31 5.7 0.16 ... ... 0.52 0.11 ... ... 0.09 0.08 1899 ... ... ... ... 0.83 0.06 3.0 0.36 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 0.01 1908 ... ... ... ... 0.70 0.05 2.61 0.16 4.67 0.07 ... ... 0.10 0.02 ... ... 0.04 0.02 1909 ... ... ... ... 0.80 0.01 1.88 0.20 7.80 0.15 ... ... 0.08 0.02 ... ... 0.07 0.01 Note.—Data for 1893 could not be obtained. 133 135—136 TABLE VI. London and the Metropolitan Boroughs.—Births and Deaths of Persons belonging to London and the Metropolitan" Boroughs during the 52 Weeks of 1909.* Boroughs. Population estimated to the middle of 1909. Births. Deaths from Deaths under 1 year of age. All Causes. Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. W hooping-cough. Typhus. Enteric Fever. Pyrexia† (Origin uncertain). Diarrhoea. Phthisis. County of London 4,833,938 116,559 67632 6285 2 2324 383 605 1246 146 2 1577 6337 12582 West. Paddington 151,955 3120 1956 136 — 36 14 10 36 4 36 164 312 Kensington 183,663 3362 2440 183 — 58 9 19 40 — 8 — 49 176 379 Hammersmith 125,704 2995 1791 210 — 80 11 23 47 — 5 — 44 137 360 Fulham 176.406 4307 2113 276 - 74 10 40 49 - 4 — 99 205 466 Chelsea 75.249 1391 1084 75 — 24 6 15 13 — 2 — 15 109 149 City of Westminster 168.883 2730 2212 104 1 25 18 18 19 — 7 — 16 225 260 North. St. Marylebone 126 027 2595 1836 105 33 8 9 25 1 - 29 170 258 Hampstead 94,185 1328 839 50 — 14 4 5 18 — 5 — 4 57 99 St. Pancras 237,422 5609 3510 230 — 105 17 27 30 — 6 — 45 382 570 Islington 351,202 8320 4913 423 — 199 26 30 86 — 13 — 69 430 843 Stoke Newington 54,423 1025 612 34 - 10 3 2 14 — 1 — 4 45 82 Hackney 237,601 5416 2988 220 - 57 10 19 51 — 6 — 77 289 550 Central. Holborn 53,802 976 836 45 - 14 3 3 15 - 1 - 9 110 100 Finsbury 95,289 2810 1829 224 - 85 11 14 51 - 3 — 60 211 367 City of London 18,193 247 368 13 - 6 — — 4 — 1 — 2 39 28 East. Shoreditch 114,802 3632 2178 328 - 130 9 22 72 — 6 — 89 200 510 Bethnal Green 131,316 4132 2201 260 - 79 25 17 40 — 4 — 95 202 535 Stepney 312,525 9506 4759 526 1 236 26 51 69 — 6 — 137 521 1130 Poplar 171,965 5192 2787 405 - 156 23 20 84 — 13 — 109 221 669 South. Southwark 211,125 5969 3528 350 - 127 14 33 57 — 6 — 113 377 711 Bermondsey 127,569 4104 2388 348 - 200 15 9 55 — 2 — 67 227 567 Lambeth 324,188 7578 4544 337 - 104 27 58 85 — 9 1 103 455 823 Battersea 186,036 4447 2416 239 — 90 8 22 63 — 7 — 49 227 477 Wandsworth 297,646 7005 3524 286 - 111 14 27 69 — 6 1 58 275 601 Camberwell 283,022 6689 3776 306 — 105 17 43 52 — 5 — 84 337 666 Deptford 118,583 3117 1611 178 — 67 12 15 47 — 6 — 31 148 317 Greenwich 111,014 2481 1350 114 - 38 9 7 20 — 4 — 36 110 249 Lewisham 160,749 3529 1656 93 — 6 15 21 20 — 2 — 29 128 262 Woolwich 133,374 2947 1587 137 — 55 19 26 15 — 3 — 19 160 242 * The Births in this Table have been corrected by distributing those which occurred in the chief Institutions, treating Maternity cases to the boroughs in wnich the mothers had resided previous to admission. In 988 cases the residence was outside the County of London, and these cases have been excluded from this Table. With regard to Deaths, all those of persons in, or on the way to Hospitals and other Public Institutions, as well as those of persons under treatment in surgical homes, or dying by accident or otherwise in the streets, have been distributed, as far as practicable, to the boroughs in which the deceased had previously resided. The deaths of 2528 London residents who died outside the County of London in Metropolitan Workhouses, Hospitals, and Lunatic and Imbecile Asylums, have been similarly distributed. Of the deaths registered in London, the previous residence was outside the County in 3162 cases, and these have been excluded from the above Table, † Called Simple Continued Fever previous to 1901 137—138 TABLE VIa. London and the Metropolitan Boroughs.—Birth-rates and Death-rates of Persons belonging to the London and the Metropolitan Boroughs during the 52 Weeks of 1909.° Boroughs. Per 1,000 Persons Living. Deaths from Deaths under 1 year to 1000 Births Births All Causes Principal Epidemic Diseases. Small-pox Measles Scarlet Fever Diphtheria Whooping-cough Typhus Enteric Fever Pyrexia † (Origin uncertain) Diarrhoea Phthisis County of London 24.2 Crude 14.0 Corrected 14.7 1.31 0.00 0.48 0.08 0.13 0.26 0.03 0.00 0.33 1.31 108 West Paddington 20.6 12.9 13.8 0.91 ... 0.24 0.09 0.07 0.24... 0.03 ... 0.24 1.08 100 Kensington 18.4 13.3 14.4 1.00 ... 0.32 0.05 0.10 0.22 ... 0.04 ... 0.27 0.96 113 Hammersmith 23.9 14.3 14.9 1.67 ... 0.64 0.09 0.18 0.37 ... 0.04 ... 0.35 1.09 120 Ful ham 24.5 12.0 12.6 1.57 ... 0.42 0.06 0.23 0.28 ... 0.02 ... 0.56 1.17 108 Chelsea 18.5 14.4 15.0 1.00 ... 0.32 0.08 0.20 0.17 ... 0.03 ... 0.20 1.45 107 City of Westminster 16.2 13.1 14.7 0.63 0.01 0.15 0.11 0.11 0.11 ... 0.04 ... 0.10 1.34 95 North St. Marylebone 20.6 14.6 15.6 0.83 ... 0.26 0.06 0.07 0.20 ... 0.01 ... 0.23 1.35 99 Hampstead 14.1 8.9 10.1 0.52 ... 0.15 0.04 0.05 0.19 ... 0.05 ... 0.04 0.61 75 St. Pancras 23.7 14.8 15.5 0.97 ... 0.44 0.07 0.11 0.13 ... 0.03 ... 0.19 1.61 102 Islington 23.8 14.0 14.6 1.22 ... 0.57 0.07 0.09 0.25 ... 0.01 ... 0.20 1.23 101 Stoke Newington 18.9 11.3 11.8 0.63 ... 0.18 0.06 0.04 0.26 ... 0.02 007 0*83 80 Hackney 229 12*6 13-1 0*93 024 0*04 0.08 0*22 0*03 0-32 1-22 102 Central Holborn 18.2 15.6 16.8 0.85 ... 0.26 0.06 0.06 0.28 ... 0.02 ... 017 2.05 102 Finsbury 29.6 19.2 19.9 2.36 ... 0.89 0.12 0.15 0.54 ... 0.03 ... 0.63 2.22 131 City of London 13.6 20.3 22.3 0.72 ... 0.33 ... ... 0.22 ... 0.06 ... 0.11 2.15 113 East Shoreditch 31.7 19.0 20.0 2.87 ... 1.14 0.08 0.19 0.63 ... 0.05 ... 0.78 1.75 140 Bethnal Green 31.6 16.8 17.0 1.99 .... 0.60 0.19 0.13 0.31 ... 0.03 ... 0.73 1.54 129 Stepney 30.5 15.3 16.0 1.68 0.00 0.76 0.08 0.16 0.22 ... 0.02 ... 0.44 1.67 119 Poplar 30.3 16.3 16.8 2.37 ... 0.91 0.13 0.12 0.49 ... 0.08 ... 0.64 1.29 129 South Southwark 28.3 16.8 17 .5 1.67 ... 0.60 0.07 0.16 0.27 ... 0.03 ... 0.54 1.79 119 Bermondsey 32.3 18.8 19.2 2.74 ... 1.57 0.12 0.07 0. 43 ... 0.02 ... 0.53 1.78 138 Lambeth 23.4 14.1 14.5 1.19 ... 0.32 0.08 0.18 0.26 ... 0.03 0.00 0.32 1.41 109 Battersea 24.0 13.0 14.0 1.29 0.49 0.04 0.12 0.34 ... 0.04 ... 0.26 1.22 107 W ands worth 23.6 11.9 12.5 0.96 ... 0.37 0.05 0.09 0.23 ... 0.02 0.00 0.20 0.93 86 Camberwell 23.7 13.4 13.9 1.08 ... 0.37 0.06 0.15 0.18 ... 0.02 ... 0.30 1.19 100 Deptford 26.4 13.6 14.3 1.51 ... 0.57 0.10 0.13 0.40 ... 0.05 ... 0.26 1.25 102 Greenwich 22.4 12.2 12.4 1.03 ... 0.34 0.08 0.06 0.18 ... 0.04 ... 0.33 0.99 100 Lewisham 220 10.3 10.8 0.57 ... 0.04 0.09 0.13 0.12 ... 0.01 ... 0.18 0.80 74 Woolwich 22.2 11.9 12.8 1.02 ... 0.41 0.14 0.20 0.11 .. 0.02 ... 0.14 1.20 82 In this Table 0.00 indicates that the deaths were too few to give a rate of 00.05; where no death occurred, is inserted. * The Corrected Death-rates represented the Crude Death-rates multiplied by the respective Factors for Correction for differences of sex and age constitution of population. (See Table D, page xxiii). † Called Simple Continued Fever previous to 1901. 139—140 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 1904-8, and in 1909. Boroughs. All Causes. Small-pox. Measles. Scarlet Fever. Diptheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Diarrhoea. Phthisis. Deaths under One Year to 1000 Births. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. 1904 1908. 1909. County of London 14.9 14.0 0.000 0.00 0.39 0.48 0.11 0.08 0.15 0.13 0.30 0.26 .... ... 0.05 0.03 0.00 0.00 0.71 0.33 1.44 1.31 127 108 Paddington 13.1 12.9 0.00 ... 0.26 0.24 0.09 0.09 0.10 0.07 0.19 0.24 ... ... 0.04 0.03 ... ... 0.58 0.24 1.08 1.08 113 100 Kensington 13.7 13.3 0.00 ... 0.30 0.32 0.06 0.05 0.11 0.10 0.21 0 22 ... ... 0.04 0.04 0.00 ... 0.56 0.27 1.17 0.96 132 113 Hammersmith 14.5 14.3 ... ... 0.44 0.64 0.09 0.09 0.17 0.18 0.27 0.37 .... ... 0.05 0.04 ... ... 0.71 0.35 1.25 1.09 130 120 Fulham 14.0 12.0 ... ... 0.42 0.42 0.09 0.06 0.18 0.23 0.35 0.28 ... ... 0.06 0.02 ... ... 1.08 0.50 1.22 1.17 134 108 Chelsea 15.3 14.4 ... ... 0.38 0.32 0.09 0.08 0.12 0.20 0.29 0.17 ... ... 0.04 0.03 ... ... 0.52 0.20 1 .53 1.45 125 107 City of Westminster 13.1 13.1 ... 0.01 0.13 0.15 0.07 0.11 0.07 0.11 0.12 0.11 ... ... 0.04 0.04 0.00 ... 0.33 0.10 1.40 1.34 107 95 St. Marylebone 15.2 14.6 ... ... 0.27 0.26 0.11 0.06 0.09 0.07 0.17 0.20 ... ... 0.03 0.01 0.00 ... 0.47 0.23 1.47 1.35 116 99 Hampstead 9.3 8.9 ... ... 0.12 0.15 0.06 0.04 0.06 0.05 0.10 0.19 ... ... 0.04 0.05 ... ... 0.17 0.04 0.76 0.61 83 75 St. Pancras 15.8 14.8 ... .... 0.37 0.44 0.11 0.07 0.12 0.11 0.32 0.13 ... ... 0.04 0.03 0.00 ... 0.51 0.19 1.68 1.61 121 102 Islington 14.5 14.0 0.00 ... 0.41 0.57 0.09 0.07 0.11 0.09 0.20 0.25 ... ... 0.05 0.04 0.00 ... 0.49 0.20 1.32 1.23 118 101 Stoke Newington 12.3 11.3 ... ... 0.18 0.18 0.08 0.06 0.09 0.04 0.24 0.20 ... ... 0.04 0.02 ... ... 0.41 0.07 1.22 0.83 104 80 Hackney 13.8 12.6 0.00 ... 0.31 0.24 0.12 0.04 0.17 0.08 0.23 0.22 ... ... 0.08 0.03 ... ... 0.80 0.32 1.25 1.22 125 102 Hol born 17.5 15.6 0.01 ... 0.36 0.20 0.06 0.06 0.10 0.06 0.26 0.28 ... ... 0.06 0.02 ... ... 0.49 0.17 2.55 2.05 124 102 Finsbury 19.7 19.2 0.01 ... 0.65 0.89 0.17 0.12 0.17 0.15 0.39 0.54 ... ... 0.09 0.03 ... ... 0.97 0.63 2.21 2.22 144 131 City of London 17.2 20.3 ... ... 0.08 0.33 0.09 ... 0.12 ... 0.20 0.22 ... ... 0.03 0.06 ... ... 0.18 0.11 1.69 2.15 106 113 Shored itch 19.5 19.0 0.01 ... 0.67 1.14 0.20 0.08 0.14 0.19 0.58 0.63 ... ... 0.06 0.05 ... ... 1.22 0.78 2.05 1.75 161 140 Bethnal Green 18.3 16.8 0.10 ... 0.57 0.60 0.23 0.19 0.22 0.13 0.42 0.31 ... ... 0.07 0.03 0.00 ... 0.92 0.73 1.99 1.54 145 129 Stepney 17.4 15.3 0.00 0.00 0.60 0.76 0.17 0.08 0.25 0.16 0.39 0.22 ... ... 0.07 0.02 0.00 ... 1.05 0.44 1.74 1.67 136 119 Poplar 17.3 16.3 0.00 ... 0.53 0.91 0.17 0.13 0.28 0.12 0.43 0.49 ... ... 0.07 0.08 .... ... 1.18 0.64 1.50 1.29 140 129 Southwark 18.2 16.8 0.00 ... 0.60 0.60 0.14 0.07 0.10 0.16 0.39 0.27 ... ... 0.06 0.03 0.00 ... 0.94 0.54 2.09 1.79 146 119 Ber mondsey 19.1 18.8 ... ... 0.70 1.57 0.19 0.12 0.17 0.07 0.30 0.43 ... ... 0.07 0.02 0.00 ... 1.03 0.53 1.94 1.78 147 138 Lambeth 14.7 14.1 ... ... 0.35 0.32 0.10 0.08 0.14 0.18 0.27 0.20 ... ... 0.04 0.03 0.00 0.00 0.66 0.32 1.44 1.41 125 109 Battersea 13.0 13.0 ... ... 0.38 0.49 0.11 0.04 0.12 0.12 0.33 0.34 ... ... 0.04 0.04 ... ... 0.69 0.26 1.30 1.22 123 107 Wandsworth 12.5 11.9 ... ... 0.27 0.37 0.08 0.05 0.14 0.09 0.26 0.23 ... ... 0.04 0.02 ... 0.00 0.58 0.20 1.01 0.93 112 86 Camber well 140 13.4 ... ... 0.35 0.37 0.09 0.06 0.12 0.15 0.30 0.18 ... ... 0.04 0.02 ... ... 0.61 0.30 1.25 1.19 123 100 Deptford 14.9 13.6 ... ... 0.43 0.57 0.10 0.10 0.14 0.13 0.33 0.40 ... ... 0.05 0.05 0.00 ... 0.78 0.26 1.28 1.25 126 102 Greenwich 13.3 12.2 ... ... 0.31 0.34 0.08 0.08 0.18 0.06 0.32 0.18 ... ... 0.06 0.04 ... ... 0.68 0.33 1.19 0.99 121 100 Lewisham 11.6 10.3 0.01 ... 0.20 0.04 0.06 0.09 0.14 0.13 0.23 0.12 ... ... 0.02 0.01 0.00 ... 0.52 0.18 0.87 0.80 101 74 Woolwich 12.8 11. 9 .... ... 0.24 0. 41 0. 09 0. 14 0. 17 0. 20 0. 26 0. 11 ... ... 0. 05 0. 02 0. 00 ... 0. 65 0. 14 1. 39 1. 20 110 82 ' 141—142 TABLE VIIA. Death Rates during 1909 in London and the several Metropolitan Boroughs, from All Causes, and from Certain Diseases (1) before Distribution* and (2) after Distribution of Deaths in Public Institutions, &c. Death-rates per 1000 living. Boroughs. All Causes. Scarlet Fever. Diphtheria. Enteric Fever. Phthisis. Before Distribution. After Distribution. Before Distribution. After Distribution. Before Distribution. After Distribution. Before Distribution. After Distribution. Before Distribution. After Distribution. County of London 14.2 14.0 0.07 0.08 0.13 0.13 0.03 0.03 1.29 1.31 West. Paddington 14.2 12.9 0.01 0.09 0.03 0.07 0.02 0.03 1.03 1.08 Kensington 15.1 13.3 — 0.05 0. 01 0. 10 0.03 0.04 1.65 0.96 Hammersmith 14.2 14.3 0.01 0.09 0.05 0.18 0.02 0.04 0.93 1.09 Fulham 11.0 12.0 0.27 0.06 0.56 0.23 0.09 0.02 1.03 1.17 Chelsea 21.8 14.4 0.01 0.08 0.09 0.20 0.01 0.03 2.69 1.45 City of Westminster 14.3 13.1 — 0.11 0.04 0.11 0.04 0.04 0.75 1.34 North. St. Marylebone 14.0 14.6 0.02 0.06 0.02 0.07 0.02 0.01 0.79 1.35 Hampstead 11.3 8.9 0.37 0.04 0.39 0.05 0.05 0.05 1.47 0.61 St. Pancras 15.2 14.8 — 0.07 0.05 0.11 0.03 0.03 1.54 1.61 Islington 13.7 14.0 0.03 0.07 0.02 0.09 0.03 0.04 1.46 1.23 Stoke Newington 8.6 11.3 0.02 0.06 — 0.04 — 0.02 0.59 0.83 Hackney 13.0 12.6 0.11 0.04 0.23 0.08 0.04 0.03 1.30 1.22 Central. Holborn 19.9 15.6 — 0.06 0.11 0.06 0.04 0.02 1.47 2.05 Finsbury 9.2 19.2 — 0.12 — 0.15 0.01 0.03 0.74 2.22 City of London 50.7 20.3 — — 0.88 — 0.17 0.06 2.48 2.15 East. Shoreditch 17. 7 19.0 — 0.08 0.02 0.19 0.04 0.05 1.74 1.75 Bethnal Green 17.1 16.8 0.01 0.19 0.05 0.13 0.03 0.03 1.63 1.54 Stepney 16.7 15.3 0.01 0.08 0.11 0.16 0.03 0.02 1.50 1.67 Poplar 16.2 16.3 0.02 0.13 0.04 0.12 0.03 0.08 1.37 1.29 South. Southwark 14.2 16.8 0.01 0.07 0.09 0.16 0.01 0.03 0.93 1.79 Bermondsey 15.4 18.8 0.01 0.12 — 0.07 0.05 0.02 1.60 1.78 Lambeth 15.1 14.1 0.12 0.08 0.26 0. 18 0.05 0.03 1.37 1. 41 Battersea 13.2 13.0 — 0.04 0.01 0.12 0.01 0.04 1.30 1.22 Wandsworth 11.1 11.9 0.10 0.05 0.16 0.09 0.01 0.02 0.89 0.93 Camberwell 14.6 13.4 — 0.06 0.04 0.15 0.01 0.02 1.73 119 Deptford 10.3 13.6 0.46 0.10 0.33 0.13 0.08 0.05 0.74 1.25 Greenwich 15.6 12.2 0.41 0.08 0.33 0.06 0.14 0.04 1.45 0.99 Lewisham 10.7 10.3 0.26 0.09 0.32 0.13 0.01 0.01 0.78 0.80 Woolwich 10.6 11.9 0.01 0.14 0.05 0.20 - 0.02 1.08 1.20 * The deaths "before distribution" are those actually registered in the several Boroughs without any correction whatever. 143-144 TABLE VIE. Meteorology, and Registered Deaths from all causes and from certain prevalent diseases during the Year 1909. Week. Date of ending. Temperature of the Air. Temperature 3 feet below ground. Mean Humidity complete Saturation = 100 No. of days in 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. 1909. January 9 47.4 32.5 40.7 + 44.26 86 4 .13 .. 6 40 16 50.4 34.1 42.2 + 44.02 80 5 .49 .. 5 37 23 49 7 29.0 38.7 — 43.67 81 2 .12 .. 4 19 30 45.5 20.8 31.8— 41.77 88 2 .02 .. 8 30 February 6 56.1 29.2 42.7 + 41 25 79 2 .04 .. 9 31 13 44.1 26.1 34.8— 41.85 81 4 .29 2 6 43 20 50.0 25 0 37.4- 40.56 75 1 .01 .. 8 37 27 52.1 19.4 33.4— 39.69 79 2 .08 . 8 48 March 6 41.7 13.6 30.1— 38.78 85 5 1.23 .. 9 41 13 49. 2 30.2 36.5— 38.52 84 4 .46 .. 10 40 20 57.0 23.1 38.8— 38.91 81 5 .41 .. 12 50 27 54.0 42. 1 44.8 + 41.34 81 5 .51 1 6 37 April 3 62.1 29. 0 44.7— 43.08 80 4 .66 .. 12 48 1st Quarter 62.1 13.6 38.1 41.37 81 40 3.96 3 103 501 April 10 69.0 30.1 46.9 + 43.26 58 .. .. .. 7 46 17 71.3 35 2 51.5 + 45.09 70 4 .22 .. 10 53 24 68.7 34.4 52.2 + 47.37 69 6 .72 .. 5 29 May 1 08 1 35. 1 48.6— 48.65 69 7 .77 .. 3 32 8 64.0 34.5 50.6+ 48.60 60 .. .. .. 2 23 „ 15 73.9 33 8 48.5— 50.13 67 2 .11 2 5 37 22 84. 0 33.1 54.9 + 50.29 66 2 .13 .. 2 28 29 81.2 46.1 57.5 + 53.19 72 5 .95 .. 1 26 June 5 76.0 45.2 54.2— 54.36 81 3 .94 .. 4 29 12 68 0 38 3 50.2— 53.69 84 4 0.79 .. 5 31 19 74. 3 45.1 56.3— 53.96 79 2 0.05 .. 2 23 26 73.0 48.3 55.8— 56.09 81 5 1.45 .. 4 27 July 3 75. 6 44 6 55.9— 55.80 80 2 0 44 .. 3 24 2nd Quarter 84.0 30. 1 52.5 50.80 72 42 6.57 2 53 408 July 10 74.0 46.1 58.5— 57.20 77 6 0.99 .. 4 20 ,, 17 76. 5 49.6 60. 0 - 57.59 82 4 0.71 .. .. 20 24 77.7 48.8 61.9— 59.39 71 2 015 .. 3 27 31 76.0 47.3 59.9— 59.49 79 6 1.31 1 2 17 August 7 79.9 46. 9 60.8— 59.68 76 2 0 26 .. .. 17 14 86.2 52.0 66. 9 + 61.25 70 .. 0.00 .. .. 21 21 85.7 50.7 63.3 + 62.79* 79 5 0.82 .. 1 20 28 72.1 45. 2 58.1— 61.48 83 3 0.70 .. 1 19 September 4 71.7 37.1 54.5— 60.19 75 3 0.30 .. 1 31 11 71.0 40.6 54.5— 58.70 83 6 0.32 .. .. 18 18 69.0 44.3 55.3— 57.87 86 3 0.58 3 4 27 25 68. 6 40.6 56.3 + 57.60 87 3 0.57 2 2 37 October 2 66 .0 43.1 53.1— 57.11 94 3 0.72 1 1 15 3rd Quarter 86.2 37.1 58.7 59.25 80 46 7.43 8 19 289 October 9 68.0 39.2 55.8 + 57.04 81 5 1.01 .. 3 24 ,, 16 65.9 39.7 56.4 + 56.28 84 5 0 .59 1 5 32 ,, 16 ,, 23 64 .0 45. 4 55.7 + 56.38 88 4 0.46 1 2 24 ,, 30 55.1 28.2 41.9— 54.20 86 4 1.87 .. 1 18 November 6 56.7 34.2 47.1 + 51.30 90 3 0.15 .. 2 28 33 53. 8 29.l 42.3— 49.98 82 3 0.03 2 2 33 20 48.0 32.2 38.7- 47.98 85 6 0.28 1 6 35 27 44.8 27.6 37.0— 45.72 86 1 0 01 .. 9 42 December 4 53.0 34.3 44. 6+ 45.56 85 6 1. 40 .. 7 30 11 47.9 28.8 38.6— 44.55 91 5 0.36 .. 4 24 18 42.6 33. 1 38.4— 44.05 89 5 0.43 1 12 28 25 53.2 22.1 39.04+ 43.10 84 4 0.46 .. 8 28 1910 January 1 53 5 28.2 44.4 + 43.86 87 5 0.27 .. 11 41 4th Quarter 68.0 22.1 44.6 49.23 86 56 7. 32 6 72 387 Total whole year 86 2 13.6 48.5 50.16 80 46 25.28 19 247 1585 * Highest in week 63.08. 145 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. Diarrhcea. Bronchitis and Pneumonia. All Causes. 1st Quarter 50.7 27.2 38.2 41.37 81 3.0 0.30 .23 8 39 2nd Quarter 72.9 38.7 52.5 50.80 72 3.2 0.51 •15 4 31 3rd Quarter 75.0 45.6 58.7 59.25 80 3.5 0.57 •62 1 22 4th Quarter (14 weeks) 54.3 31.7 44.6 49.23 86 4.3 0.54 •46 5 27 146 TABLE X. Summary of Statistics for the First Quarter, ending 28th March, 1909, corrected for Public Institutions: — A. Birth and Death Statistics for the Borough of Woolwich. Bates calculated per 1,000 Population. Population estimated to middle of Year. Births. Deaths under one year of age. Deaths at all ages—Gross Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Number. Bate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 127,938 774 24.2 71 92 447 95 17 73 503 15.7 B. Birth and Death Bates for each Parish. Woolwich. Plumsteade. 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 1years,per 1,000 births. A B C D A B C D A B C D 38,991 27.3 13.4 117 East 34,500 West 40,907 23.7 23.9 10.4 19.2 78 90 13,540 17.7 11.2 33 147 C. Notifications of Infectious Disease. Disease. Woolwich. plHMSTEAD. Eltham. Total. Average for 1st Quarters of 1903/4/5/6/7/8. East. West. Smallpox _ _ •33 Scarlet fever 107 46 64 31 248 145.8 Diphtheria 28 16 50 2 96 81.5 Enteric Fever 2 — 1 1 4 7.0 Erysipelas 6 6 14 3 29 23.3 Puerperal Fever — — — — — 1.8 Phthisis 17 20 14 4 55 37.6 Measles (Notified by School Teachers) 143 82 267 - 492 341.1 TABLE XI. Summary of Statistics for the Second Quarter, ending 27th June, 1909, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 population. Population estimated to middle of Year. Births. Deaths under 1 year. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths o£ NonBesidents in District. Deaths of Besidents Begistered beyond District Deaths at all ages corrected for Public Institutions. Number. Bate. Number. Bate per 1,000 Births Begistered. Number. Number. Bate. 127,938 717 22.4 50 70 352 86 11 67 408 12.8 B. Birth and Death Rate for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Kate 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 38,991 26.4 14.6 82 West 40,907 East 34,500 20.2 21 .1 12.5 12.1 43 71 13,540 21.0 10.1 99 C. Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Average for 2nd Quarters of 1904/5/6/7/8. West. East. Small-pox - - - - - 08 Scarlet Fever 137 77 75 15 304 138 Diphtheria 6 24 10 2 42 56.8 Enteric Fever — — — — — 3.6 Erysipelas 9 6 5 — 20 17 Puerperal Fever - - 3 — 3 1 Phthisis 20 20 14 3 57 40.4 Measles (Notified by School Teachers) 21 108 169 6 304 234.6 148 149 TABLE XII. Summary of Statistics for the Third Quarter, ended '26th September, 1909, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population. ation estimated to middle of Year. Births. Deaths under one year. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 127,993 709 22.2 45 64 270 69 12 31 289 9.03 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. A B c D A B C D A B c D 38,991 24.7 11.1 83 West 40,907 20.6 10.6 76 13,595 19.7 8.5 45 East 34,500 22.0 5.1 32 150 C. Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Average for 3rd Quarters of 1904/5/6/7/8. West East Smallpox Scarlet Fever 93 109 08 G 270 142.6 Diphtheria 15 16 12 43 50.8 Enteric Fever 2 2 — — 4 6.6 Erysipelas 9 8 13 2 32 19.0 Puerperal Fever — 1 1 — 2 2.4 Phthisis 13 17 12 2 44 37.6 Measles (Notified by School Teachers) 1 1 4 6 12 70.2 TABLE XIII. Summary of Statistics for the Fourth Quarter, ending 2nd January, 1910, corrected for Public Institutions:— Births and Deaths Statistics for the Borough of Woolwich. Bates calculated per 1,000 population Births. Deaths under 1 year. 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. 127,993 737 23.0 72 98 346 73 11 52 387 12.1 151 B. 'Birth and Death Rates for each Parish. Woolwich. Plumstead. Elthan. 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 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. A B C D A B C D A B C D 38,991 25.7 13.0 80 West 40,907 22.6 11.5 103 13.595 20.0 12.4 88 East 34,500 21.7 11.6 112 C. Notifications of Infectious Disease. Woolwich. Plumstead . Eltham. Total. Average for 4th Quarters o 1904/5/6/7/8. West. East. Small-pox _ _ 1 Scarlet Fever 54 62 50 6 172 177.8 Diphtheria 18 20 17 2 57 89.2 Enteric Fever 3 1 - - 4 8.4 Erysipelas 4 5 12 - 21 28.4 Puerperal Fever 1 1 2 - 4 2 .2 Phthisis 15 17 14 4 50 47.2 Measles (Notified by School Teachers) 1 5 6 235.8 TABLE XIV. Deaths from Various Causes for whole Borough, 1909, corrected for Public Institutions. endiDg. Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cougb. Diphtheria and Mem. Croup. Enteric Fever. Diarrhoea and Dysentery. Erysipelas. Puerperal Fever. Rheumatism. Tubercle. Alcoholism. Cancer. Bronchitis. Pneumonia. Accidents. Homicide and Suicide. January 9 .. .. 1 .. .. 1 .. .. .. .. .. 6 1 3 5 1 1 .. 16 1 1 .. .. .. 2 .. .. .. .. 2 5 1 4 2 3 .. .. 23 .. .. 1 1 .. .. .. .. .. .. .. 2 .. .. 1 3 .. .. 30 .. 1 .. .. .. 2 .. .. .. .. .. 5 .. 1 8 .. 2 .. February 6 .. .. 1 1 .. 3 1 .. .. .. .. 3 .. .. 7 2 1 .. 13 .. .. 1 1 .. 1 1 2 .. .. 1 9 .. 3 3 3 1 1 20 .. .. .. 2 .. 1 .. .. .. .. 2 1 .. 3 7 1 1 .. 27 .. 4 .. 1 .. 1 .. .. .. .. .. 8 1 4 5 3 .. 1 March 6 .. 4 1 1 .. .. .. .. .. .. .. 6 .. 1 6 3 .. .. 13 .. 2 .. 1 .. 1 .. .. .. .. 2 6 .. 2 4 6 .. .. 20 .. 4 .. 3 .. 2 .. .. .. .. .. 7 .. 1 8 4 1 1 27 .. 5 .. 3 .. .. .. 1 .. .. .. 2 1 1 6 .. 1 2 April 3 .. 3 .. 2 .. .. .. .. .. .. .. 7 .. 1 7 5 2 .. 1st Quarter •• 24 5 16 .. 14 2 3 .. .. 7 67 4 24 69 34 10 5 April 10 .. 8 .. 4 .. 1 .. .. .. .. .. 4 1 4 1 6 1 .. 17 .. 5 .. 2 1 .. .. .. .. .. .. 5 1 3 3 7 .. 1 24 .. 1 .. .. .. .. .. .. .. .. .. 4 .. 2 4 1 .. 1 May 1 .. 2 2 4 .. 1 .. .. .. .. .. 4 .. 2 2 1 .. .. ,, 8 .. 3 1 .. .. .. .. .. .. .. .. 2 1 4 .. 2 .. 1 15 .. 1 2 .. .. .. .. .. .. .. .. 4 1 1 2 3 .. .. 22 .. 1 .. 1 .. .. .. .. .. .. .. 6 .. 4 1 .. .. .. 29 .. 1 .. .. .. 2 .. .. .. .. .. 4 2 5 .. 1 .. .. June 5 .. .. .. .. .. 1 .. .. .. .. .. 6 .. .. .. 4 .. .. 12 .. .. 1 .. .. 1 .. .. .. .. .. 3 1 .. 2 3 .. .. 19 .. 1 .. .. .. .. .. .. .. .. .. 4 .. 1 2 .. .. 2 26 .. 1 .. .. .. .. .. .. .. 1 .. 6 1 1 1 3 .. .. July 3 .. 2 •• .. .. .. .. .. 1 .. .. 4 .. 1 2 1 1 .. 2nd Quarter •• 26 6 11 1 6 1 2 1 1 1 56 8 28 20 32 3 5 July 10 .. 1 .. .. .. .. .. .. .. .. .. 3 .. 2 2 2 .. 1 17 .. .. 1 .. .. .. .. .. .. .. .. 5 .. 5 .. .. 1 .. 24 .. 4 1 .. .. .. .. .. .. .. .. 4 .. 3 1 2 .. .. 31 .. .. .. .. .. .. .. 1 .. .. .. 2 .. .. 1 1 3 1 August 7 .. .. .. .. 1 .. .. .. .. .. .. 5 .. 1 .. .. .. .. 14 .. .. .. .. .. .. .. .. .. .. .. 4 .. 3 .. .. 1 .. 21 .. .. .. .. .. .. .. .. .. .. .. 4 .. 1 .. 1 .. .. 28 .. .. .. .. .. .. .. .. .. .. .. 1 .. 2 .. 1 .. 1 September 4 .. .. .. .. 2 .. .. 1 .. .. .. 3 .. 4 1 .. 1 1 ,, 11 .. .. .. .. .. .. .. .. .. .. .. 3 .. 3 .. .. .. .. ,, 18 .. .. .. .. 1 .. .. 3 .. .. •• 4 .. 2 .. 1 .. 1 ,, 25 .. .. 1 .. 2 .. .. 2 .. .. .. 3 1 7 1 1 4 .. October 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. 2 1 .. 1 .. 3rd Quarter .. 5 3 .. 6 2 .. 8 .. .. 1 41 3 35 10 9 11 5 October 9 .. .. .. .. 1 .. .. .. .. .. .. 4 1 1 .. 3 .. .. 16 .. .. 1 .. 1 .. .. 1 .. .. .. 3 1 1 3 2 2 .. 23 .. .. .. .. .. 1 .. 1 .. .. .. 4 9 3 .. 2 1 .. 30 .. .. .. .. .. .. .. .. .. .. .. 2 .. 3 .. 1 1 .. November 6 .. .. .. .. 1 1 .. .. .. .. .. 6 1 4 2 .. .. .. 13 .. .. .. .. 1 .. .. 2 .. .. .. 5 1 5 1 1 .. .. 20 .. .. .. 1 1 .. .. 1 .. .. .. 3 .. 6 5 1 .. .. 27 .. .. .. 1 .. .. .. .. .. .. .. 4 1 1 4 5 .. .. December 4 .. .. .. 2 .. .. .. .. .. .. .. 5 .. 1 4 3 .. .. 11 .. .. .. 2 .. .. .. .. .. .. .. 4 .. 1 4 .. .. .. ,,18 .. .. .. 1 2 .. .. 1 .. .. .. 1 .. 3 8 4 .. .. ,, 25 .. .. .. 1 .. 1 .. .. .. .. .. .. .. 1 7 1 .. .. 1910. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. January 1 .. .. 3 .. 1 .. .. .. .. .. 1 5 .. 2 5 6 .. .. 4th Quarter .. .. 5 8 8 3 .. 6 .. .. 3 46 7 32 43 29 4 .. Whole Year •• 55 19 35 15 25 3 19 1 1 12 210 22 119 142 104 28 15 155—156 TABLE XVA. Summary of Nuisances Abated, Notices served, and General Work of Public Health Department, 1909. St. Mary's and Dockyard. River. Burrage and Herbert. Central and St. Margaret's. St. Nicholas. Glyndon. Eltham. St. George's. Total. PREMISES INSPECTED No. of Houses inspected, house to house 850 990 747 853 952 428 386 306 5512 „ Re-inspections after service of Notice (estimated) 1980 1811 1847 2134 1980 823 995 569 12139 „ Houses and premises specially inspected, including infectious diseases and complaints 1138 821 1530 1381 1240 395 609 263 7377 „ Houses where drains have been tested by smoke test 40 24 45 42 15 14 14 3 197 „ Houses where drains have been tested by water test. 55 14 15 4 ... 22 23 3 136 „ New Houses inspected for Water Certificates 2 9 1 1 5 90 108 NUISANCES ABATED-DRAINS. Waste-pipes from baths, lavatories, and wash-house sinks, repaired or disconnected 57 24 18 15 44 21 22 12 213 Choked and defective drains 91 94 63 27 71 43 37 14 440 Defective traps 32 13 10 3 15 4 3 80 Defective and unventilated soil pipes ... 3 5 7 ... 1 9 2 27 W.C.'s. W.C.'s repaired, new traps or pans provided 124 112 60 26 44 61 39 29 492 Water supply apparatus repaired or renewed 77 74 56 73 117 43 41 23 504 Foul pans cleansed 45 24 22 34 32 9 21 10 197 Additional w.c.'s provided to Factories and Workshops, etc ... ... ... ... ... ... ... ... ... Do. do. dwelling houses ... ... ... ... ... ... ... ... ... PREMISES. Underground rooms not in accordance with Act ... ... 1 ... ... ... ... ... 1 Interiors cleansed and defective roofs repaired 401 442 320 162 205 174 136 117 1957 Damp walls remedied 89 138 44 29 72 27 28 23 450 Paving in yards and wash-houses repaired 133 66 87 29 79 47 45 11 497 Improved ventilation provided 4 41 5 13 23 27 6 1 120 Wash-houses without sink and outlets for waste water ... ... ... ... ... ... ... ... ... Defective guttering and rain-water pipes 92 48 43 51 69 26 52 12 393 Dustbins supplied 166 144 94 62 90 34 45 46 681 Dung pits provided 1 2 2 2 2 9 Cases of overcrowding remedied 17 17 8 15 22 7 5 6 97 Deficient light—windows supplied, or enlarged, or other works 12 ... ... 1 5 ... ... ... 18 Dampness in premises from defective water pipes 31 10 7 13 16 4 7 l2 100 ANIMALS. Animals (including pigs) kept in such a state as to be a nuisance 1 2 4 2 8 2 1 ... 20 Accumulations of manure removed 29 17 5 9 24 4 15 3 106 WATER. Defective and foul cisterns used for dietary purposes ... 3 1 ... 35 ... 4 ... 43 Defective and foul rain-water tanks remedied 8 ... 8 ... ... ... ... ... 16 Insufficient supply, and water cut off by Water Board 15 5 1 3 6 1 31 Additional water supply for two or more families 5 3 ... ... ... ... ... 22 30 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 9 2 3 13 ... 2 2 31 No. of smoke nuisances observed ... ... ... ... 9 ... 2 2 13 Tents, Vans, etc., inspected ... ... ... 2 7 ... 18 ... 27 Notices served with respect to tents and vans ... ... ... 1 3 ... 3 ... 7 Inspection of Urinals accessible to the public 87 34 93 197 72 .... 34 15 532 Verminous rooms cleansed 17 76 19 22 8 ... 11 6 159 Intimation notices served 707 610 446 259 491 214 68 196 2991 Statutory „ „ 102 89 88 54 154 5 1 13 45 550 157 TABLE XVb. SUMMARY OF WORK OF CHIEF INSPECTOR. Premises Inspected 1275 New Buildings Inspected 23 Defective Combined Drains Investigated and Reported on 22 Number of Houses referred to in such Combined Drains 121 Cow-houses and Slaughter-houses Inspections 40 Complaints Investigated 157 Attendances at Police Court 11 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for proceedings 68 Summonses at Police Court 21 Bake-houses Inspected and Cleansed twice during the year 51 Number of Houses Disinfected after Infectious Disease 1408 Letters written 5416 Notifications received 1804 Certificates issued after Disinfection 1990 „ of Infectious Disease forwarded to Schools 2006 Complaints of Sanitary Defects .. 497 ,, of Non-removal of Dust, viz.— Woolwich 18 Plumstead 7 Eltham 3 Written Intimation Notices 2991 Statutory Notices 550 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) 55 17 Workshops (Including Workshop Laundries) 238 23 Workplaces 85 24 Homeworkers' Premises 275 14 Total 653 78 2.—Defects found. Description. Number of Defects. Pound. Remedied. Nuisances under Public Health Acts Want of Cleanliness 55 55 Want of Ventilation 27 27 Overcrowding 1 1 Want of Drainage of floors 1 1 Other nuisances 37 37 Sanitary accommodation. insufficient, unsuitable, or de- fective 12 12 not separate for sexes 3 3 Total 136 136 .159 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) 2 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 •• Underground Bakehouse (s.101):- In use during 1903 24 Certificates granted - in 1903 24 in 1904 • • in 1905.. • • in 1906 1 in 1907 .. in 1908 • • in 1909 •• In use during 1909 17 Workshops on the Register (S. 131) at the end of 1909 :— Workshop Laundries 18 ,, Bakehouses 46 Other Workshops 163 Total number of Workshops on Register 227 160 TABLE XVc.—continued. 4.—Ilome 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 of 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 16 55 15 52 12 .. .. .. .. .. .. .. .. .. Shirt makers 2 4 2 38 2 .. .. .. .. .. .. .. .. .. Corset makers .. .. .. .. .. .. .. .. .. .. .. .. .. .. Gold braid makers .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tennis Balls, etc. 4 334 2 24 66 .. .. .. .. .. .. .. .. .. 22 393 19 114 62 80 •• .. 275 14 14 •• •• .. •• 161 TABLE XVD. Proceedings during 1909. Premises. Number of Places. Number of Inspections, 1909. Number of Notices, 1909. Number of Prosecutions, 1909. On Register at end of 1908. Added at 1909. Removed in 1909. On Register at end of 1909. Milk Premises 134 37 43 128 217 9 .. Cowsheds 17 • • • • 17 68 7 .. Slaughter-houses 11 •• •• 11 44 3 .. Ice Cream Premises 108 12 22 98 207 6 .. Registered houses let in Lodgings 359 41 5 395 730 140 3 Overcrowding, 1909— Number of Dwelling Rooms overcrowded 32 Number remedied 32 Underground Rooms— Illegal occupation dealt with during year 1 Number of rooms closed Insanitary Souses— Number closed under the Housing of the Working Classes Act Number of Prosecutions under By-laws under Public Health Act, 1891— With respect to water closets, earth closets, etc. With respect to sufficiency of water supply to water closets With respect to drainage, etc. (Metropolis Management Act, Sec. 202) - Mortuaries— Total number of Bodies removed 146 Total number of Infectious Bodies removed 1 Inspections of premises where food is prepared for sale 83 Number of Public Sanitary Conveniences removed or altered - Number of fixed ashpits removed - 162 TABLE XVI. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. St. MARY'S and DOCKYARD WARDS. Chapel Street 31 15 Samuel Street 114 58 Ogilby Street 44 29 Waverley Cottages 6 2 Margaret Cottages, Back Lane 1 1 Dairy Cottages, Back Lane 4 4 St. James Place 11 5 Robert Street 16 10 Bowling Green Row 9 5 Elgin Terrace 8 8 Marshall's Grove 30 20 Sarah Place 5 5 Bowater Road 9 7 Siemens Road 27 23 Harrington Road 1 .. Glenalvon Street 10 9 Selina Place 12 8 Artillery Place 18 12 Lyford Street 18 10 Mary Place 9 9 Paradise Place 18 12 Church Street 78 34 George Street 24 9 Hulk Cottages, Church Street . 5 3 Acorn Street 23 10 Oak Street 19 12 Kidd Street 73 31 Sand Street 70 31 Albion Road 43 19 Parsons Hill 12 7 Borgard Road 11 5 North Kent Place 3 2 North Kent Grove 19 7 Mulgrave Place 10 4 Rectory Place 16 4 Woolwich Road 13 7 Maryon Yale 3 1 Harrington's Buildings 5 .. Morris Street 22 12 850 450 Defects = 52'94% 163 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspectied. Number where Defects were found. RIVER WARD. Taylor Street 21 8 Taylor's Buildings 6 1 Wilmount Street 45 21 Anglesea Avenue Mason's Avenue 10 6 7 1 Anglesea Road 40 12 Globe Lane 20 8 Nelson Street 17 9 Collingwood Street 16 6 New Street 8 5 Albert Houses 10 6 Stanley Houses 10 3 Sidney Houses 10 4 Pore Houses 10 5 Rodney Street 14 8 Meeting House Lane 10 9 Nile Cottages 5 4 Glass Yard 7 0 Rope Yard Rails 43 13 Warren Lane 26 2 High Street 57 11 Salutation Alley 10 6 Cock Yard 6 2 Powis Street 37 14 Albert Road 149 59 Kate's Place 18 4 Davey's Square 7 3 Clara Place 13 7 Monk Street 20 9 Charles Street 65 15 Kingsman Street 24 4 St. Mary Street 8 2 Red Lion Street 19 7 Mulgrave Place 20 7 Davey's Place 6 5 Rhea Street 83 31 Winifred Street 87 41 Auberon Street 52 19 Dock Street 20 9 Mary Ann Street 8 1 Barge House Road 37 17 164 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. River ward.-continnued. Drew Road 12 3 Fernhill Street 8 0 Elizabeth Place 6 4 358 144 St. GEORGE'S WARD. Delvan Street 15 10 Dicey Street 38 21 Eglinton Road 10 4 Fenwick Street 55 19 Jackson Street 56 20 James Street (part of) 26 15 Milward Street 53 34 Ordnance Road 53 23 306 146 ELTHAM WARD. Bowness Terrace 8 8 Craigton Road 12 5 Deansfield Road 102 25 Dumbreck Road (part of) 39 18 Gaiteskell Road 27 13 Grangehill Road 124 39 Kendal Terrace 8 8 Lannoy Road 29 19 Reventlow Road 37 24 386 159 BURRAGE and HERBERT WARDS. Bloomfield Road 44 17 Sandy Hill Road 136 70 Bignell Road 15 7 165 TABLE XVI.—continued. Details of House to House Inspections, Name of Street. Number of Houses Inspected. Number where Defects were found. BURRAGE and HERBERT WARDS.— continued. The Avenue 20 12 Arthur Street 39 18 Armstrong Place 30 21 Armstrong Street 31 15 Whitworth Place 25 10 Cambridge Place 7 3 Chester Place 12 4 Charles Street 17 11 Burrage Grove 39 27 Eton Road 30 18 Plumstead Common Road 42 10 St. James Place 70 25 Crescent Road 141 56 Willenhall Road 26 10 Princes Road 23 10 747 344 GLYNDON WARD. (7 mont hs only). Down Street 12 10 Down Place 7 7 Thomas Street 9 9 Robert Street 28 21 Inverness Place 27 19 Charlotte Street 36 20 Charlotte Place 4 4 Robert Street 95 28 Glyndon Road 82 34 Dawson Street 22 11 Swetenham Place 23 16 Sandbach Place 15 4 Railway Place 15 4 Walmer Road 54 25 Brewery Road 19 3 428 216 166 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. St. MARGARET'S and CENTRAL WAR D. Chesnut Road 61 23 Tuscan Road 34 5 Leghorn Road 40 10 Congo Road 38 10 High Street 61 24 Gossage Road 14 4 Coupland Terrace 41 19 Coxwell Road 60 17 Ingledew Road 59 17 Liffler Road 60 13 Miriam Road 54 7 Orissa Road 24 9 Conway Road 98 25 Burwash Road 50 10 Paimerston Road 60 33 Hudson Road 75 22 Vicarage Road 24 5 853 253 Defects = 29 66 % St. NICHOLAS WARD. Reidhaven Road 80 31 Gunning Street 30 12 Garibaldi Street 23 13 Hartville Road 41 14 Glenside Road 23 4 Mabyn Road 29 17 Gavin Street 14 4 Heverham Road 29 6 Abery Street 25 6 Saunders Road 38 11 Riverdale Road 112 42 Barth Road 82 50 Bateson Street 10 6 Kashgar Road 43 28 Marmadon Road 125 53 Abbey Grove 98 53 Grove Road 20 8 167 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspeoted. Number where Defects were found. St. NICHOLAS WARD.—continued. White Hart Road 18 14 Speranza Street 44 18 Bannockburn Road 68 35 952 425 168 TABLE XVII. Prosecutions under the Public Health, L.C.C (General Powers), and Housing of the Working Classes Acts. No. Date of Pinal Hearing. Offence. Situation. Result. l 18/8/09 Breach of By-laws for Houses let in Lodgings 10, Warwick Street Withdrawn 2 21/7/09 Non-provision of dust bin 2, Nelson Street Withdrawn 3 21/7/09 Do 3, Nelson Street. Withdrawn 4 21/7/09 Various defects 81, St. Mary's Street Order to abate in 14 days. Costs 10/6 5 28/10/09 No water to upper storey 8, Dicey Street Dismissed with £2 2s. costs 6 28/10/09 Do 9, Dicey Street Pined 20/- and 23/- costs 7 3/11/09 Do 108, Brookhill Road Dismissed 169 TABLE XVIII. Summary of Articles Analysed under the Sale of Food and Drugs Act, during the year ended 31st December, 1909. Article. Number Analysed. Number Adulterated. Milk 348 13 Butter 68 2 Cream 3 . . Coffee 27 3 Tea 12 .. Honey 1 .. Jam 2 .. Lard 5 .. Flour 8 .. Vinegar 8 .. Pepper 5 .. Mustard 10 .. Olive Oil 3 .. Lime Juice Cordial 3 .. Lime Juice 1 .. Ammoniated Tincture Quinine 8 .. Sweet Spirits of Nitre 1 .. Gregory Powder 1 .. Sulphur Lozenges 1 .. Cheese 6 .. Sausage 3 .. Brawn 3 .. Condensed Milk 6 .. Kice 6 .. Cocoa 13 1 Totals 552 19 170 TABLE XVIIIA. Proceedings under the Food and Drugs Act during the year 1909. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 7.64 % added water Ethelbert Hiscook, 14, Blenheim Terrace, Wickham Lane Warranty proved—dismissed 2 Milk 53.34 % fat abstracted Ernest Hall, 131, Taunton Road, Lee Dismissed 3 Coffee 75 % chicory Jane Clunson, 4 Spray Street.. Fine 40/- and 12/6 costs 4 Milk 10 % fat abstracted Chas. W. Killick, 52, St. James's Place Fine 40/- and 12/6 costs 5 Milk 10 % fat abstracted John Grace, Pippin Hall Farm, Eltham Dismissed. Milk proved to be direct from cows 6 Milk 6 % fat abstracted David Jones, 65, Maxey Road Dismissed, Warranty proved 7 Milk 5 % fat abstracted Palmer Perkins, 82, Purrett Road Withdrawn 8 Milk 21 % fat abstracted Edward Stroud & Walter M. Stroud, 25, Orohard Road Each fined 30/- and 12/6 costs 9 Butter Adulterated with mar- Daniel Lewis, 17, Lakedale Road Fine £3 and £1 3s. costs 10 Milk garine 6.67 % fat abstracted .. Lambeth Bros., 2, Griffin Road Dismissed, Warranty proved 11 Milk 5.88 % added water Frederick Hassan, 182, Elizabeth Street.. Fine 40/- and 12/6 costs 12 Milk 6.67 % fat abstracted Georgina Holdway, 45, Bostall Hill Fine 20/- and 12/6 costs 13 Butter 70 % foreign fat Freak. Heineman, 65, Vicarage Road Fine £3 and 12/6 costs 14 Milk 7 % added water Henry J. Burgess Dismissed, Warranty proved 171 TABLE XIX. Food Seized, or Surrendered by Owners, as unfit for consumption. Articles. Quantity. Date. Remarks. Reason. Cod 1 box Jan. 7 Surrendered Unsound Sheep's Spleen .. „ 20 ,, Cystic Sheep's Caul .. Feb. 3 ,, ,, Pig's Liver . . Mar. 4 ,, Cirrhosis Haddocks 1 box 19 ,, Unsound Tomatoes 40 boxes ,, 19 ,, ,, Beef 115½ lbs ,, 20 ,, ,, Sheep's Liver 1 ,, 22 ,, Cirrhosis Winkles 2 baskets ,, 29 ,, Unsound Bloaters 15 boxes ,, 30 ,, ,, Greens 6 bags 11 27 ,, ,, Ox Liver 1 ,, 31 ,, Cirrhosis and Flukes Roes 1 box April 6 ,, Unsound Winkles 1 bushel 24 ,, ,, Skate and Roker 1 kit May 5 ,, ,, Mackerel 1 box 10 ,, Fibrous Nodules Sheep's Liver 1 ,, 12 ,, Bullock's Liver 1 ,, 12 ,, Abscesses Pork (with Liver, Lungs, etc.) 1 carcase ,, 13 ,, Tubercle Beef Clods and Sticking Pieces 100 lbs ,, 24 ,, Unsound Mackerel 1 box June 17 ,, ,, Mackerel 4 boxes ,, 22 ,, ,, Hake 1 box July 8 ,, ,, Sheep's Cauls (Parts of) 3 June 30 ,, Cystic Pig's Liver 1 July 1 ,, ,, Spleen's 2 Tripe, etc. - Codlings 10 boxes Aug. 4 ,, Unsound Bananas 3| cwt. ,, 2 ,, Rotten Haddocks 4 boxes ,, 14 ,, Unsound Hake 2 boxes ,, 13 ,, ,, Potatoes ½ sack ,, 30 ,, ,, Plaice 4 stone ,, 31 ,, ,, Haddocks 3 boxes Sept. 14 ,, ,, Codlings 1 box 15 ,, ,, Pig's Crow Pats 2 ,, 30 ,, Tubercle Sheep's Pluck 1 Oct. 8 Seized Strongylus Rufescens Sheep's Liver 1 ,, 20 Surrendered Cirrhosis Ox Liver Part of ,, 20 ,, Flukes Pigs (with offals, etc 7 ,, 21 ,, Tubercle Ox Liver and Lungs 1 Dec 1 ,, Echinococcus Rabbits 30 ,, 18 ,, Unsound Ox Liver 1 ,, 20 ,, Abscesses 172 TABLE XX. List of Level Bakehouses. Name. Address. Mrs. S. Fuller 48 Princes Road, Plumstead Chadwell Bros. 60 Plumstead Common Road C. Pullen 105 do F. J. Knight 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. Jefiery 123 Burrage Road, Plumstead P. H. Mack 111 High Street, Woolwich A. Bradshaw 3 Green's End, do (Unoccupied) 184 Elizabeth Street, North Woolwich C. Haas 122 Albert Road, do H. Meyer 33 Samuel Street, Woolwich Mrs. Dennis 90 Brookhill Road, do E. Ewell 36 Chapel Street, do A. Adams 168 Kingsman Street, do J. B. Fyson 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 R. Tsinn 100 High Street, Woolwich 173 TABLE XXa. List of Certified Undekgkound Bakehouses. Name. Address. (unoccupied) 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. (unoccupied) 58, Pattison Road, do. P. Gox 46, Hudson Road, do. - (unoccupied) 14, Conway Road, do. J. Farrier 30, Burrage Road, do. W. T. Alters 16, Armstrong Place, do. G. Paterson 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. - (unoccupied) 16, Woolwich Common, Woolwich B. Flood 31, Beresford Street, do. F. Wilkening 72, Henry Street, do. W. C. Clothier 51, Albion Road, do. (unoccupied) 23, George Street, do. (unoccupied) 21, Albion Road, do. (unoccupied) 32, Church Street, do. Mrs. Attenborough 60, Sand Street, do. E.Tucker 81 & 82, Brookhill Road, do. (unoccupied) 8, Hill Street, do. 174 TABLE XXb. List of Factory Bakehouses. Name. Address. J. Fletcher 57, Burrage 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 G. Paterson 13, Eton Road, Plumstead 175 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 Vicars 30 Hare Street, Woolwich 10 Henry Reed & Ganis William Funnell 38 Plumstead Common Road, Plumstead 11 Henry Fretter 33 Herbert Road, Plumstead 176 TABLE XXII. List of Cowhouses. No. Name and Address of Owner. Situation. 1 Robert E. Puller 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 Pippinhall Farm, Eltham 7 William Ridewood Chapel Farm, Eltham 8 George Keen Clay Farm, New Eltham 9 Maurice Bayley Middle Park Farm, Eltham 10 Harry Furber Southend Farm, 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. Cook 13, Raglan Road, Plumstead 16 Charles George Lambeth, Frank Seymour Lambeth, Frederick Lambeth, and George Pannell Lambeth 1, Griffin Road, Plumstead 17 Jas. Buckingham, 16, Pellipar Road Rear of 14, 15 & 16, Pellipar Road, Road, Woolwich 177 TABLE XXIII. List of Milk Sellers. No. Name. Address. l Perrett, H. N. 2 The Parade, New Eltham 2 James, J. R. w. 26 Parry Place 3 Webb, P. W. 58 Brewery Road 4 Balater, 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 Digby, W.J. 82 Plumstead Road 9 Squirrell, J. 57 Church Street 10 Jeal, W. H. 139 Plumstead Road 11 Handsley, A. 68½ Bloomfield Road 12 Cook, G. 13 Raglan Road 13 Royal Arsenal Co-op. Society Lakedale Road 14 Do. 15 Brewery Road 15 Do. 143 Powis Street 16 Do. Herbert Road 17 Do. 147 & 151 Powis Street 18 Fletcher, J. 92 Plumstead Road 19 Brooks, H. 2 Richmond Place 20 Smith, Harriet 30 High Street, Eltham 21 Woolsey, H. 50 Francis Street 22 Howe, J. R. 82 High Street, Eltham 23 Russell, Nellie 96 Maeoma Road 24 Pearce, R. A. Lydwin Dairy, The Slade 25 Hawkins, Ellen M. 2 St. Nicholas Road 26 Furber, Harry Southend. Eltham 27 Large, Daniel J. 6 Herbert Road 28 Hiseock, C. T. & E. 14 Blenheim Terrace 29 Dalton, R. G. 55 Eglinton Road 30 Buckley, Mary 28 Conway Road 31 Green, R. 13 Saunders Road 32 Butter & Sons 49 Woolwich Common 33 Do. 10 Jackson Street 34 Ward, Samuel 1 Nightingale Vale 35 36 Mack, P. H. Webb, Younger 111 High Street, Woolwich 10 Beresford Square 37 Dennis, Ellen 90 Brookhill Road 38 Prowett, J. 25 Plum Lane 39 Bayley, M. Middle Park Farm, Eltham 40 Yelland, W. 2 Westdale Road 41 Godden, A. A. 229 High Street, Plumstead 42 Palmer, D. 46 Church Street 43 Wilton, M. M. 77 Powis Street 44 Corp, w. F. Lyme Farm, Eltham 178 TABLE XXIII.—continued. No. Name. Address. 45 Pearce, R. A. 175 Plumstead Common Road 46 Christmas, Hannah 18 Well Hall Parade, Eltham 47 Dodson, W. 138 Plumstead Common Road 48 Dowsett, J. 105 Crescent Road 49 Wyatt, J. 141 Albert Road 50 Nelson, J. 9 Parson's Hill 51 Dolphin, T. G. 89 Maxey Road 52 Rumsey, E. 186 Powis Street 53 Tyler, C. W. 142 High Street, Woolwich 54 Clements, E. J. 2 Cross Street 55 Bohmer, H, 307 High Street, Plumstead 56 Couzens, Jesse 10 Chapel Street 57 Oliver, Clara 101 Sand Street 58 Bollen, W. 1 Warwick Terrace 59 Stevens, F. 100 Roydene Road 60 Ridewood, W. 116 High Street, Eltham 61 Rose, J. 64 Hargor Road 62 Trodd, W. J. 113a High Street, Woolwich 63 Stevens, H. 27 Church Street 64 Hassan, Fred 182 Elizabeth Street 65 Needham, Elizabeth 94 High Street, Woolwich 66 Webb, F. W., & Co. 16 Lakedale Road 67 Finch, G. A. 13 The Parade, New Eltham 68 Davis, D. H. 170 Albert Road 69 Willis, H. 2 Ritter Street 70 West, W.H.J. Rear of 49 Lakedale Road 71 Phipps, H. 15a Sand Street 72 Reynolds 24b & 26b Glyndon Road 73 Smith, Elizabeth 12 The Broadway, Eltham 74 Bennett, Rose 22 Glyndon Road 75 Williams, Ellen 12 Thomas Street, Woolwich 76 Bartrum, Abner 167 Kingsman Street 77 Jones, David 65 Maxey Road 78 Mackintosh, G. H. 16 Warwick Terrace 79 Daveney, T. 24 Maxey Road 80 Jaques, Herbert 56 Angle sea Road 81 Killick, C. W. 52 St. James's Place 82 Hawkins, Emily 77 Powis Street 83 Campion, H. E. 105 Pattison Road 84 Parkes, J. Fountain Stores, The Slade 85 Lamb. Annie 29 Admaston Road 86 Norton, Emma 28 Conway Road 87 Townsend, J. 21 Wilmount Street 88 Jones, E. C. 6 Samuel Street 89 Harrington, James 26 Prospect Row 90 Greatrex, F. Lydwin Cottage, Plumstead Common 179 TABLE XXIII.—continued. No. Name. Address. 91 Oakham, J. J. 3 Brentwood Cottages, Pope Street, New Eltham 92 Cole, E.J. 18 Camrose Street 93 Finnimore, W. J. 21 Walpole Place 94 Smith, S. R. 6 Bloomfield Road 95 Lyons, J., & Co., Ltd. 99 Powis Street 96 McGee, Jane 42 Mulgrave Place 97 Attenborough, Caroline 18 Prospect Place 98 Whiffin, J. H. 108 Burrage Road 99 Marsh, C. Askhurst, Shrewsbury Lane 100 Palmer, Annie 127 Plumstead Road 101 Rich, E, C. 16 Helen Street 102 Mumford, Kate F. 22 Cross Street 103 Holmes, Blanche 43 Bostall Hill 104 Wainwright 36a Mulgrave Place 105 Gill, Emily A. 398 High Street, Plumstead 106 Morley, Ernest 31 Craigton Road 107 Brinkworth, W. J. 82 Purrett Road 108 Palmer, P. 82 Purrett Road 109 Elliott, W. G. 289 High Street, Plumstead 110 Espline, G. 48 High Street, Woolwich 111 Crawford, F. 13 Hinstock Road 112 Bassett, T. 69 Bannockburn Road 113 R.A. Co-operative The Links, Plumstead Common Road 114 Stroud Bros. 25 Orchard Road 115 Jones, W. H. 39 Beresford Street 116 Holdway, Georgina H. 45 Brookhill Road 117 Buck, E. V. 52 Raglan Road 118 Challis, P. W. 4 High Street, Woolwich 119 Frost, W. D. 44 Powis Street 120 Gee, A. J. 147 Plumstead Road 121 Dick, J. 107 Pattison Road 122 Joy, W. G. 36 Thomas Street 123 Fuller, R. E. Southwood Road Farm, Eltham 124 Jones, Elizabeth 35 High Street, Woolwich 125 Corp, W. J. 98c High Street, Eltham 126 Moore, James 12 Bostall Hill 127 Crayfourd, J. E. 40 Orchard Road 128 Leaver, E. A. 25 Garland Street 180 TABLE XXIV. Applicants Registered as Purveyors of Milk during 1909. Date. Applicant's Name. Premises. Remarks. Jan. 29 Elliott, Walter G. 289, High Street, Plumstead Mar. 12 Espline, G. 48, High Street, Woolwich Mar. 12 Crawford, Frederick 13, Hinstock Road April 2 Baasett, Thos 69. Bannockburu Road May 30 Royal Arsenal Cooperative Society "The Links," Plumstead Common Road June 10 Stroud Bros. 25, Orchard Road July 1 Jones, William H. 39, Beresford Street July 1 Holdway, Georgina H. 45, Brookhill Road July 1 Buck, Edward V. 52, Raglan Road July 22 Challis, Percival W. 4 High Street, North Woolwich July 22 Frost, William D. 44, Powis Street Sep. 30 Gee, Albert J. 147, Plumstead Road Sep. 30 Dick, John 107, Pattison Road Oct. 21 Joy, William J. 90, High Street, Woolwich Nov. 11 Fuller, Robert E. Southwood Road Farm, Eltham Dec. 2 Jones, Elizabeth 35, High Street, Woolwich Dec. 2 Corp, William J. 98c, High Street, Eltham Dec. 2 Moore, James 12, Bostall Hill Dec. 30 Cray ford, J. E. 40, Orchard Road Dec. 30 Leaver, E. A. 25, Garland Street