WOO 14 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. i 1910. Woolwich: H. Pryce. & Son, Printers (T.U. Federation), 31, 33 & 35 Powia Street. 2 Public Health and Housing Committee: His Worship the Mayor. James Oates Widger, B. A. (Chairman), 113, Chesnut Road, Plumstead. George William Mitchell ('Vice-Chairman), 22a, Mulgrave Place, Woolwich. Alderman Henry Smith Syer, 45, Plumstead Common Road. William Williams Bullworthy, 243b, Eglinton Road, Plumstead. Leon Charles Chasteauneuf, 224, Burrage Road, Plumstead. Alfred Hall, 111, Maxey Road, Plumstead. Rev. Lewis Jenkins Jones, " Broomhill," Shrewsbury Lane, Plumstead Lieut.-Col. Francis Seymour Leslie, 24, Wood Street, Woolwich. -Jeremiah James Mahony, 67, Beresford Street, Woolwich. James Newman, 92, Rochdale Road, Plumstead. Frederick George Penny, 8, Blendon Terrace, Plumstead. William Raven, 82, Little Heath, Charlton. William Hardy Ross, 54, Sandy Hill 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. 3 Alfred G. Potter (Cert. San. Inst.), Eltham Parish and St. George's Ward. William Tedham (Cert. San. Inst.), Central and St. Margaret's Wards. Thomas Powell (Cert. San. Inst.), Burrage and Herbert Wards. Harry Shaw (Cert. San. Insp. Exam. Bd.), Dockyard and St. Mary's Wards. Inspectors under Food and Drugs Act: John W. Range, Parishes of Woolwich and Plumstead. Alfred G. Potter, Parish of Eltham. Women Sanitary Inspectors: Alice M. Middlebrooke (Cert. San. Inst, and San. Insprs. Exmn. Board). Marion FitzGerald {Cert. San. Insprs. Exmn. Bd., and Sch. Hygiene (Univ. Coll.). Chief Clerk: Amyas Britter (Cert. R. San. Inst.) Assistant Clerks; Harry S. Smith. H. M. Collyer. Mortuary Keeper: Frank Leason. Medical Officer of Health: Sidney Davies, M. A., M.D., Oxon.; D.P.H., Carnb.; 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, 1910 Area of Borough 8,276-6 Acres Population—Census, 1901 117,178 do. Estimated to middle of 1910 128,448 Inhabited Houses—Census, 1901 18,086 Total Houses to middle of 1910 22,995 Persons to a House Census 6.47 Marriages 912 Births 2,844 Birth Rate 22.1 Deaths 1,410 Death Rate 11.0 Infantile Mortality 84 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 24 Still-births 26 Mortality under five years 26 Zymotic Death Rate 26 Inquests and Uncertified Deaths 27 Deaths in Public Institutions 28 Small-pox and Vaccination 28 Chicken-pox 29 Measles 29 Whooping Cough 31 Scarlet Fever—Expense of unnecessary Hospital IsolationReturn Cases—Isolation at Home—Sources of Infection— Provision of Medical Attendance—Incubation period 33 Diphtheria—Sources of Infection 40 Mistaken Diagnosis 42 Bacteriological Examination 42 Anti-toxin—Free supply 44 Enteric Fever—Source of Infection 46 6 page Diarrhoea—Notification Statistics—Tables 48 Erysipelas 61 Cerebro-spinal Meningitis 61 Puerperal Fever 61 Influenza, Bronchitis, and Pneumonia 62 Tuberculosis—Voluntary Notification 62 Source of Infection—Occupation 65 Bacteriological Diagnosis 68 Sanatorium Treatment—Results of 68 Nature of Cases 69 Charge for Beds 73 Shelters for Consumptives 73 Cancer—Classification 76 Alcoholism—Public Houses Closed under Licensing Act 80 Syphilis 81 Ophthalmia Neonaturum 81 Meteorology 81 Part II.— Administration. Water Supply— Plumstead Well 83 Food and Drugs Act—Percentage Milk Adulteration 85 Food Inspection 86 Dairies, Cow-sheds, and Milk-shops 87 Slaughter-houses 90 Nuisances—Complaints, Drains, Water-closets, Ventilation of New Outfall Sewers, Supervision of drainage 90 Public House Urinals 92 House Inspection 92 Medical Officer's Inspections 93 Over-crowding 93 Smoke Nuisance 93 7 Page Nuisances—Defective Light 94 Dark Rooms and failure of Building Act 94 Verminous Rooms 94 Dust Removal—Collection, Cost of 94 Trade Refuse—Offensive and Inoffensive 95 Housing of the Working Classes— Houses represented as unfit for habitation 96 Council's Houses 99 Houses Registered under the By-laws 100 Inhabited House Duty 101 Common Lodging-houses 101 Underground Rooms 102 Factories and Workshops—Inspections—Outworker 102 Bakehouses 103 Ice-cream Shops 103 Disinfection, Disinfectants 104 Health-Shelter 104 Mortuaries 105 Cemeteries 105 Cleansing of Verminous Persons 106 By-laws for Tents, Vans and Sheds 107 Infants'Milk Depot—Statistics—Tables 107 Notices and Prosecutions under Public Health (London) Act 107 Bacteriological Examinations 107 Women Sanitary Inspectors' Work- Miss Middlebrooke's Report 112 Miss FitzGerald's Report 115 Public Ambulance 119 Conference of Metropolitan Borough Councils re Sanatorium Accommodation for the Metropolis 119 School Medals 122 Public Health Staff 124 8 LIST OF TABLES. Page Table I.— Population. Births and Deaths for the whole Borough from 1900 to 1910, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 125 Number of Inhabited Houses, the average number per house, and the acreage125 „ Ia.— Institutions inside and outside the district receiving sick and infirm persons from the district 127 „ II.— Population, Births Registered, Deaths at all ages, and Deaths under One Year, for each Ward during 1901,1902, 1903, 1904, 1905, 1900, 1907, 1908, 1909, and for each Parish during 1910 129 „ III.— Cases of Infectious Disease notified at all ages, at various age groups, and distributed according to Wards during 1910 133 „ IV.— Deaths at all ages, at various age groups, from various causes, arranged by Parishes in 1910. Total Deaths in Public Institutions in district in 1910 135 „ IVa.— Infantile Mortality during the year 1910 137 „ V.— Case and Death Rate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1910 139 VI.— Vital Statistics of the various London Boroughs for 1910 141 „ VIA.— Birth and Death Rates do. do. do.143 „ VII.— Death Rates and Infant Mortality of the various London Boroughs, 1905-9 and 1910 145 „VIIa.— Death Rates, before and after distribution, of the various London Boroughs, 1910 147 „ VIII.— Meteorology and Registered Deaths from all causes and from certain prevalent diseases in each week of the year 1910 149 „ IX.— Weekly Averages for Meteorology and Registered Deaths from all causes and from certain prevalent diseases 151 „ X.— Summary of Statistics for the first Quarter of 1910, corrected for Public Institutions 152 „ XI.— Summary of Statistics for the second Quarter of 1910, corrected for Public Institutions 153 9 Page Table XII.— Summary of Statistics for the third Quarter of 1910, corrected for Public Institutions 155 „ XIII.— Summary of Statistics for the fourth Quarter of 1910, corrected for Public Institutions 156 „ XIV.— Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 159 „ XVa.— Summary of the General Work of the Public Health Department for 1910, the number of Nuisances abated, and Notices served in each Ward 161 „ XVb.— Summary of Work of Chief Inspector, and miscellaneous 163 „ XVc.— Inspection of Factories, Workshops and Workplaces 164 „ XVd.— Proceedings during 1910 re Milk-shops, Cowsheds, Slaughter-houses, &c. 167 „ XVI.— List of Streets Inspected—House to House—and number of houses where defects were found 168 „ XVII. Prosecutions in 1910 under the Public Health (London) Act and By-laws and Housing of the Working Classes Act 174 „ XVIII.— Summary of Articles Analysed under the Sale of Food and Drugs Act 175 ,,XVIIIa.— Proceedings in 1910 under the Sale of Food and Drugs Act 176 „ XIX.— Food seized or surrendered by Owners, as unlit for consumption 177 XX.— List of Level Bakehouses in the Borough, 1910 178 „ XXa.— List of Certified Underground Bakehouses in the Borough, 1910 179 ,, XXb.— List of Factory Bakehouses in the Borough, 1910 180 „ XXI.— List of Slaughterhouses in the Borough, 1910 181 .,, XXII.— List of Cowhouses in the Borough, 1910 182 „ XXIII.— List of Milk Sellers 183 „ XXIV.— List of Persons Registered as Purveyors of Milk during 1910 186 CHARTS:— Showing Death Rate, Birth Rate, and Infantile Death Rate, 1891-1910 Phthisis— Death Rate and Temperature, 1891-1910— England, London, Woolwich, Greenwich and Lewisham. 10 PREFACE. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor and Gentlemen, I herewith present my Tenth Annual Report on the Health of the Borough, including the Nineteenth Annual Report on the Health of Plumstead. The general health conditions in 1910 were decidedly satisfactory, and the general death-rate reached the lowest point recorded. The infantile death-rate, however, did not fall so low as in 1909. This is noteworthy in view of the fact that in England and Wales, in London, and in the neighbouring Boroughs, the infantile death-rate was lower than ever recorded previously. From a historical point of view the year was chiefly characterised by your determination to close the Infants' Milk Depot, which was started in 1906 with a view to diminishing infant mortality. By this step you effected a small financial economy. Although there has on the whole been in recent years a very satisfactory diminution In the death-rate of infants, there is no doubt that the number of deaths of infants is still very greatly in excess of what it should be, and' the most satisfactory results which have followed the measures taken in "this and other Boroughs for reducing infant mortality show clearly that it is perfectly practicable to very much further diminish this waste of life. I have repeatedly 11 pointed out that one of the most economical ways of doingthis is the appointment of Women Health Visitors. As yet, however, you have not determined to increase the number of these officials beyond the two who have been at work since 1906. The Public Health Committee took an important and most useful step in purchasing two Shelters for the use of consumptives in their own gardens. Particulars as to these will be found in the body of the report (paragraph 84a). I have reason to hope that by further provision of such shelters a great deal will be done for diminishing the prevalence of this fatal disease. The population of the Borough, as obtained by the recent Census, and published while this report is passing through the press, shows that I have over-estimated the population by some 7,000 and that the Registrar-General over-estimated it by twice this amount. The effect of taking the Census population will be to raise the death-rate from 11.0 to 11.6, and the birth-rate from 22 1 to 23.4. The infantile deathrate is unaffected, being estimated on the known number of births. Other death-rate6 given in the report are very little affected. I have to thank you for the careful consideration you have given to many recommendations I have made on behalf of the public health, and congratulate you that on the whole I am able to make such a satisfactory report on the health of the Borough. I am, Mr. Mayor and Gentlemen, your obedient servant, SIDNEY DAVIES. 12 TENTH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1910. PART I. Statistics. 1. Population. The population of the Borough of Woolwich, as estimated by the Registrar-General, to the middle of 1910, on the supposition of a continuous increase since the Census proportional to the increase between the two last Censuses, is 135,422. As estimated on the number of occupied houses, and presuming the same number to a house as at the Census, it is 141,110. The estimate, which has been made for the purpose of the following statistics, is as follows :— Woolwich Parish 38,991 Plumstead Parish (West) 40,907 do. (East) 34,500 Eltham Parish 14,050 Borough 128,448 13 West Plumstead includes the Burrage, Herbert, Glyndon and St. Margaret's Wards, and East Plumstead the Central and St. Nicholas Wards. The estimated populations for Woolwich, West and East Plumstead, are the same as in 1909. Eltham has been increased by 455. Estimated increase in the year 455 Natural increase (excess of births over deaths) 1434 2. The following table shows the number of houses at the Census, and the number certified for water each year since :—- Total houses in Borough at Census, 1901 18,496 New houses to June 30th, 1901 257 ditto 1902 1,292 ditto 1903 743 ditto 1904 582 ditto 1905 483 ditto 1906 390 ditto 1907 281 ditto 1908 191 ditto 1909 157 ditto 1910 123* 22,995 *viz., Woolwich 22 West Plumstead 7 East Plumstead 7 Eltham 87 Most of the new houses certified in 1910 were in Eltham Parish. 3. At the Census there were 234 unoccupied houses in 14 the Borough, viz., 46 in Woolwich, 86 in Plumstead, and 102 in Eltham. The following return of empty houses in the Borough in April, 1910, has been kindly supplied me by the Clerk to the Rating Committee :— Woolwich Parish— Dockyard Ward 98 St. Mary's Ward 65 River Ward 186 St. George's Ward 71 - 420 Plumstead Parish— Burrage Ward 62 Herbert Ward 80 Glyndon Ward 53 St. Margaret's Ward 162 Central Ward 41 St. Nicholas Ward 210 - 628 Eltham Parish 140 Total 1188 Thus the number of empty houses has increased pine times 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 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 6.83 920 5.67 5.78 5.63 600 5.61 700 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 ,, 1909, to ,, 1910 1 1 19 1 — 3 2 2 — — 7 87 Total Houses 1,394* 1,208* 6S8 1,709* 879 1,749 1,731 1,888 2,467 1,855 4,260 2,781 Estimated Populations 7,800 9,788 3,396 10,188 7,314 9,184 9,106 9,444 13,173 9,500 25,000 14,050 *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 2844, viz., 979 in Woolwich Parish, 881 in West Plumstead, 711 in East Plumstead, and 273 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, 22.1, compared with 22.9 in the previous year, and with 27.5 the average for the ten years 1900-09. The rate for the County of London was 23.6. Notification of Births. 2653 births were notified under the Notification of Births Act. This is at the rate of 93 per cent, of the registered births, compared with 83 and 88 per cent in 1908 and 1909. 1549 births were notified by midwives, 284 by the Home for Mothers and Babies, and Military Families Hospitals, and 546 by medical practitioners. 94 still-births were notified. The Notification of Births Act was adopted on March 1st, 1908. There has been decided improvement in the number notified by medical practitioners There were still about 190 births last year which were not notified. 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. 95 per cent, of births were notified in Woolwich, and 94 per cent, in Plumstead Parish, but only 87 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 a birth to one official, and to register it with another. 17 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 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. All mothers are invited to bring their infants for weighing and advice at the Town Hall, where an Infant Consultation is held every Wednesday afternoon by the Lady Health Visitor and Medical Officer of Health. 6. The following table gives the average birth-rate of the Borough during the years 1901.5, 1906, 1907, 1908, 1909, and 1910, and for purposes of comparison the corresponding rates of the neighbouring Boroughs, London, and England:— Birth.rate. Average 1901.5 1906 1907 1908 1909 1910 Greenwich Borough 27.6 25.4 24.2 23.5 22.5 21.6 Lewisham 25.7 23.3 23.8 23.0 21.9 20.9 West Ham 331 30.5 28.6 29.4 28.0 26.4 East Ham 33.8 28.1 26.3 24.7 23.5 22:0 Erith 34.1 30.0 29.9 25.9 23.4 21 .8 London 28.2 26.6 25.8 25.2 24.3 236 England and Wales 28.2 27.0 26.3 26.5 25.6 24.8 Woolwich Borough 29.2 27.7 25.6 24.1 22.9 22.1 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 Wards, and West Plumstead of the Remainder of the parish. b 18 The following table gives the Birth-rate for the Borough, and each registration district, for the three past quinquennia, and last five 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, there has been a great and progressive decrease in each parish, but greatest in East Plumstead. 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. East Plumstead and Eltham had the lowest birth-rate of the four registration districts. Average of 1891-1895. Average of 1896-1900. Average of 1901-1006. 1906 1907 1908 1909 1010 Woolwich Borough 32.5 30.2 29.2 27.7 25 5 24.1 22.9 22.1 Woolwich Parish 31.1 30.1 29.0 29.2 29.1 26'4 26 0 25.1 Plumstead West 333 31'0 30.1 27.8 24.1 23.7 W 21.8 21.5 East E 22.1 20.6 Eltham Parish 22.8 20.6 24..0 22.0 22.4 200 19.6 19.4 8. Illegitimate Births. 53 of the births registered were illegitimate, giving a rate of 19 per 1,000 births, compared with 17, 22, 24, 20, and 24, in the five preceding years. The illegitimate birth-rate in England and Wales was 41.0 in 1909. Marriages. 9. There were 912 marriages. The marriage rate was 14.2, compared with 16.4, 14 6, 13.7, and 13.2, in the four preceding years. The great fall in the marriage rate, which 19 was an indication of the prevalent local industrial depression, has ceased. In 1909, the marriage rate in London was 15.8, and in England and Wales 14.6. Deaths. 10. Table 1 gives the gross and net deaths and deathrates in 1910, and each of the past ten years, and shows how the net deaths are arrived at. The net 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 and 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 five and thirty, 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 net deaths were 1410, and the net death-rate 11.0. The death-rate in 1909 was 12.4. Last year had the lowest death-rate ever recorded for the Borough. 12. By multiplying by 1.0690, the factor for age distribution, we get the corrected death-rate, viz., 11.8, which rate should be used in comparing Woolwich with other places in which the death-rate is similarly corrected. The following table shows the net and corrected death-rates of Woolwich, compared with London and the adjoining Boroughs:— Net. Corrected. England and Wales 13.4 13.4 20 Net. Corrected. 77 Great Towns 13.4 14.3 London 12.7 13.4 Greenwich 11.6 11.8 Lewisham 9.6 100 West Ham 11.7 East Ham 8.9 Erith 7.3 Woolwich 11.0 11*8 13. The following table gives the average death-rate in each registration district of the Borough during the past four quinquennial periods, and during 1906, 1907, 1908, 1909, and 1910. In 1910, Eltham had the lowest death-rate, and Woolwich Parish the highest of the four districts ; the greatest decrease in the past nine years has occurred in Woolwich and Eltham Parishes. Average 1886-1890. Average 1891-1895. Average 1896-1900 Average 1901-1905. 1906 1907 1908 1909 1910 Woolwich Borough .. 17.2 18.9 13.9 13.1 12.5 • 11.6 12.4 11.0 Woolwich Parish 20 4 19.3 20.1 16.5 15.5 14.6 14.0 14.3 12.7 Plumstead W. 16.4 160 15.1 12.9 12.2 11.9 10.8 W.13.6 11.9 E. E. 9.5 9.3 Eltham .. 13.0 14.6 10.2 10.2 10'0 9.7 10.5 7.9 London 20.0 19.8 18.5 161 15.1 14.6 13.8 14.0 12.7 •Three years—1888, 1889 and 1890. 14. The death-rate among males was 118, and among females was 12'3. The death-rate of males in the four preceding years was 14 7, 13 3, 13.6, and 13.4 respectively, and of females 13 6, 14 3, 12 8, and 13.6. These rates are estimated on the numbers of the two sexes found at the Census of 1901, and, consequently, their relative proportions alone are of value. 21 The following table gives the numbers dying at various ages in the past nine years from all causes, and .certain diseases not hereafter referred to:— Deaths—1901 to 1910. 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 1910 240 105 35 25 26 34 81 127 131 202 201 203 Deaths from 1902 1903 1904 1905 1906 1907 1908 1909 1910 Apoplexy and all other diseases of the heart and blood vessels 221 212 215 227 216 217 243 268 248 Nephritis and Bright's disease 32 38 35 46 52 49 42 50 43 Respiratory diseases—all forms (except Phthisis) 308 269 285 264 277 209 234 250 236 22 Comparing the years 1903-4 with 1909-10, it is seen that in the latter period there were fewer deaths at each of the nine age periods under fifty-five, with two exceptions. At all the periods over fifty-five there were more deaths in 1909-10 than in 1903-4. As the population has increased, an increase at most age periods was to be expected. Owing to the fall of the birth rate, the population under five years has probably slightly decreased, but not enough to invalidate the conclusion that there has been a remarkable saving of life at all ages under fifty-five. It is also seen that whereas in 1909-10 there were fewer deaths from respiratory diseases than in 1903-4, there were more from diseases of the heart, blood vessels and kidneys, viz., the diseases belonging specially to advanced ages. Table 4 shows that there was a decrease of deaths in 1910 compared with 1909, under most heads. Two diseases have been added to this Table, viz., Aneurism and Appendicitis. The former will be referred to under Syphilis (see paragraph 93). Appendicitis has come into prominence of late years and is probably increasing. If so, the cause of such increase is to be looked for probably under the habits of civilisation, and especially those connected with diet. Constipation, excessive meat eating, and irritation by such substances as metal from flour mill rollers have all been suggested as a probable cause. There were only three deaths from this cause in 1910, but these represent a number of persons who were ill, and recovered with or without operation. It appears then that more persons are surmounting the perils of childhood, and the diseases which affect early adult Chart showing Death Rate, Birth Rate and Infantile Death Rate - 1891/1910. 23 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. 14a. The chart on the opposite page shows 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, showing 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 6 and 7, kindly supplied by the RegistrarGeneral, give a summary of the Vital Statistics of the County and Metropolitan Boroughs in the five years 19059, and in 1910. Only four Boroughs had a lower death-rate than Woolwich, viz., Hampstead, Lewisham, Fulham, and Wandsworth. (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 479 and 383 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 1910 would have meant the death of 1,978 persons instead of 1,410 who actually died. There was thus a saving of 568 lives in 1910. But this is not the whole of the benefit con- 24 ferred by a reduced death-rate, for each of the 568 lives saved means about ten others who have escaped a weakening illness, or who 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 241, compared with 240 in 1909. The infant mortality (deaths under one year per 1,000 births) was 84, compared with 82 last year, and with 95 in 1908. During the past three years there has been a great reduction of the infantile death-rate. During the first nine months of 1910 this mortality was as low as during the corresponding period of 1909, but in the fourth quarter the rate rose to 115, higher than in any quarter for three years. The Infants' Milk Depot was closed in the third quarter, viz., on July 31st. The following table gives the infantile mortality in the Borough during the past seven years, compared with the neighbouring Boroughs, London, and Eng'land:— 1901-5. 1906. 1907. 1908. 1909. 1910. Lewisham 112 113 90 86 93 80 Greenwich 137 119 100 120 114 107 West Ham 158 149 131 128 123 101 East Ham 131 127 108 104 95 94 Erith 112 85 88 80 78 71 London 138 132 115 113 107 103 77 Great Towns 146 127 128 118 115 England and Wales 135 133 118 121 109 96 Woolwich Borough 119 111 113 95 82 84 25 It is seen that comparing 1910 with 1909, there has been a slight rise in Woolwich, but a fall in all other districts. 18. The following table gives the infantile mortality during 1906, 1907, 1908, 1909, and 1910, and the four preceding quinquennia in the Borough, and each registration district:— 18861890 18911895 18961900 19011905 1906 1907 1908 1909 1910 Woolwich Parish *151 157 170 134 139 114 111 91 89 Plumstead 121 120 132 113 97 108 88 W.82 79 E. 75 90 Eltham .. 163 160 97 94 140 75 68 70 Woolwich Borough .. 140 146 119 111 113 95 82 84 *1898, 1889, and 1890. 19. Table 4b gives full details as to the ages at death and causes of death of the 241 infants dying in 1910 under one year. It shows that 43 per cent. (36 in 1909) of (those who died were under one month old, and 30 per cent. (23 in 1909) under one week old. 51 deaths were from premature birth, compared with 65, 75, 61, 72, and 41 in the five preceding years, and of the remainder, 27 (43 in 1909) were attributed to Atrophy, Debility, and Marasmus, indefinite terms applied to deaths from immaturity, congenital syphilis, and other causes. The number of deaths under one week in the past five years was 87, 83, 76, 55, and 72, respectively. The death-rate per 1,000 births from premature birth in Woolwich Borough was 17.9, compared with 23.3 and 14.0 in the two preceding years. In England and Wales it was in 1909 19.9. 26 There were 16 deaths of illegitimate infants. The deathrate of illegitimate infants under one year was 302 per 1,000 births, and that of legitimate children 81. 20. Compared with 1909, the past year had among infante more deaths from premature birth, congenital defects, whooping cough, diarrhoea, and overlying; and fewer from measles, wasting diseases, convulsions, bronchitis, and pneumonia. Deaths from overlying were 5, compared with 2, 8, 5, and 1 in the previous four years. 21. Still-Births. 92 still-born children were buried in Woolwich and Plumstead Cemeteries, compared with 97, 9.3, and 92, in the three preceding years. 94 still-births were notified. 22. Deaths under five years. The total deaths under five years were 345, or 25.0 per thousand population under five at the Census. The rates in the five preceding years were 36.5, 38.3, 41.9, 31.3, and 28.3. The death-rate of children under five in 1910 was only 60 per cent. of the death-rate in 1905, which means that 305 children are living who would have died last year if the former high death-rate had continued. 23. Zymotic death-rate. The number of deaths from the seven principal zymotic diseases was 82, giving a death-rate of 0.63, compared with 1.34, 0.92, and 1.06 in the three preceding years. The following table gives the zymotic death-rate in each parish during the past nine years:— 27 Average, 1901-5. 1906. 1907. 1908. 1909. 1910. Woolwich 1.69 1.93 1.67 1.10 1.44 0.72 Plumstead 1.53 1.37 1.67 0.84 1.01 0.64 Eltham 0.88 0.83 1.02 0.77 0.29 0.43 The Borough 1.51 1.49 1.34 0.92 1.06 0.63 London — — — — 1.30 1.14 24. Inquests. There were 107 inquests, compared with 154, 160, 141, 121, 128, 115, and 105 in the seven preceding years. The following table gives particulars as to the cause of death:- 1. Natural Causes 59 2. Accidental Causes:— Burns and Scalds 7 Drowning 4 Falls 5 Fractures 6 Bun over 3 Suffocation, overlying 4 Poison 4 Other accidental causes 9 - 42 3. Homicidal causes:— Suicide 6 Murder and Manslaughter nil - 6 107 The "Accidental Causes" were 51, 43, 35, 49, and 23 in the five preceding years. The "Homicidal Causes" were 11, 15, 7, 15, and 14 in the same years. 28 25. Deaths in Public Institutions. Table 1 shows the actual number of deaths occurring in Public Institutions in the Borough, viz., 272, compared with 313, 293, 296, 289, and 276, in the five preceding years. Table 1a shows the Institutions, inside and outside the Borough, receiving sick and infirm persons belonging to the Borough, and Table 4a 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. One case of Small-pox was notified; this is the first case that has occurred since 1905. It was a man living as deputy in a common lodging house, who was not known to have been out of Woolwich for several weeks. He was at once removed to Hospital, and two of the immediate contacts were vaccinated. Most of the men in the lodging house, however, refused vaccination on the ground that they would lose some days work by it. All the contacts were kept under observation and no further cases occurred. 27. The number of cases of Small-pox notified in London was 7. 28. The following return, kindly furnished by the Vaccination Officers, Mr. Greenhill and Mr. Atkins, gives particulars of the vaccination of children born in Woolwich, Plumstead, and Eltham Parishes in 1909:— Births 3,409 Vaccinated 2,410 Insusceptible 8 29 Conscientious objections 598 Died unvaccinated 190 Medical postponements Nil Removed 33 Not found and unaccounted for 145 29. The number excused on account of conscientious objections was 598, compared with 109, 170, 257, and 535, in the four preceding years. The increase in the four last years is doubtless the result of the recent Vaccination "Act, which facilitates the obtaining of exemption certificates. The number of children unprotected by vaccination is rapidly increasing. Chicken-pox. 29a. 327 cases of Varicella were notified by school teachers, compared with 362, 286, and 327, in the three preceding years. 78 were under five years, 237 between five and ten, and 12 over ten years. Measles. 30. There were 21 deaths from Measles, giving a rate of 0.16,, compared with 0.54, 0.08, and 0.43, in the three preceding years. The rate in London County was 0.41, compared with 0.48 in 1909. 31. Of the 21 who died from Measles, 18 were under five years of age ; 12 were males and 9 females. 32. 396 notifications were received from school teachers, compared with 465, 825, 1,453, 519, and 768, in the five preceding years. The mortality per cent. Of notifications was 30 5.3, compared with 2.8, 3.8, 4.8, 1.9, and 7.2, in the five preceding years. 205 of the 396 cases were found on visiting to be having medical attendance. 33. The following table gives the number of deaths and death-rates from Measles for the past four years and three preceding quinquennia in each parish, and the death-rate in London:— Year. Woolwich Plumstead Eltham The Borough London No. Rate No. Bate. No. Rate. No. Rate Rate. 1891-5 20 0.49 29 0.51 Not recorded 49 0.51 0.59 1896-1900 34 0.81 36 0.57 Not recorded 70 0.67 0.57 (average) 1901-1905 9 0.22 15 0.22 1 0.13 26 0.21 0.44 (average) 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 1910 11 0.28 7 0.09 3 0.22 21 0.16 0.41 It appears from this table that whereas from 1891-1900 Woolwich had a somewhat higher Measles mortality than London, since that date the Measles death-rate in Woolwich has greatly diminished, and is now very much lower than in London. 34. Owing to the prevalence of Measles all unprotected children below the age of five were excluded from 12 London 31 County Council Schools in the Borough. Dr. Kerr closed, or excluded unprotected children from, 16 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, in some cases for two weeks. The practice of leaving instructions at the home of every notified case was continued. Whooping-cough. 35. There were 25 deaths from Whooping Cough, compared with 37, 32, and 15, in the three preceding years. No doubt some deaths of young children attributed to bronchitis and pneumonia were really due to this cause. The deathrate was 0.20, compared with 0.12 in 1909, and 0.28 in the County of London. The following table gives the deaths and death-rates per 1,000 population since the Borough was formed, compared with London. There has been a marked reduction in deathrate since 1904:— Woolwich. London. Number. Bate. Bate. 1901-5, Averages 34 0.28 0.35 1906 21 0.17 0.26 1907 37 0.29 0.38 1908 32 0.25 0.20 1909 15 0.12 0.26 1910 25 0.20 0.28 377 cases were notified by school teachers, compared with 174, 598, and 361, in the three previous years. 98 were under five years of age, 272 between five and ten, and 7 over ten. 32 Owing to the prevalence of Whooping Cough a short series of precautions was drawn up by your instructions 'and printed on cards. These are left at houses where cases are notified by school teachers. The following are the precautions advised:— The Dangers of Whooping Cough. (1) Whooping Cough is a very dangerous infectious disease, and kills twice as many children in Woolwich as Scarlet Fever. (2) It is infectious before the whoop begins, and the infection lasts as long as there is cough and expectoration (phlegm). (3) Young infants are specially liable to die of Whooping Cough and should never be taken into a house where the disease is present. (4) Wool or flannel should be worn next the skin. (5) It is advisable to consult the doctor in all cases, but especially:—(1) when infants are attacked; (2) when the paroxysms of cough are very frequent; (3) when the breathing is short and the child goes off his food. When the cough is bad the child should be kept in bed with the window open, and a fire in cold weather. The child must be protected from draught by a screen if necessary. (6) If there is much vomiting, food should be given frequently in small quantities (little and often), and the best time is just after a fit of coughing. (7) Children suffering from Whooping Cough must be kept from school as long as the cough lasts and for at least five weeks from the commencement of whooping. They must not go to church, &c., they must not enter a train, tram, or other public 33 conveyance, or a house where there are young children. No children should be allowed to visit a house where there is Whooping Cough. (8) Where there is Whooping Cough in a house, infants and older children who have not had the disease must be kept from school for two weeks; they must not go then if they have any cough or cold. The mortality of the disease in the past three years was 5.4 per cent. of notified cases, more than twice as great as that of Scarlet Fever. Owing to the prevalence of Whooping Cough in East Plumstead in January, i communicated with the Medical Officer (Education), London County Council, who gave instructions for the exclusion of all unprotected children under the age of five years, for a period of four weeks, from nine schools in the affected area. Scarlet-fever. 36. There were 506 cases of Scarlet Fever notified (deducting 18 cases of mistaken diagnosis), equivalent to a rate of 3.94 per thousand population, compared with 7.77 in 1909. This rate is the lowest since 1905. 37. The following table Shows the case-rates of Scarlet Fever in the Borough and each registration district during 1901-5 and the past five years, compared with London.:— Average, 1901-5 1906 1907 1908 1909 1910 Borough 3.15 4.15 7.91 4.67 7.77 3.94 Woolwich Parish 2.99 3.83 6.10 3.85 10.40 3.46 Plumstead West 3.24 4.22 8.56 5.22 W. 8.38 3.94 East E. 6.47 5.94 Eltham Parish 3.21 4.71 9.65 3.94 4.04 1.64 London County 3.57 4.35 5.46 4.52 3.57 2.16 c 34 38. Table 3 gives the age distribution, the number in each parish, and the number removed to hospital. East Plumstead was most affected. 39. There were 13 deaths, giving a death-rate of 0 10 per 1,000 population, compared with an average of 0 09 in the five preceding years, and 019 in the ten years 18911900. The death-rate in London was 0.04. The case mortality (of deaths per cent. of notifications) was 2.6 compared with 1.5 and 1.9 in the two preceding years. Of the deaths, 2 were in Woolwich parish and 11 in Plumstead. 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, but in 1909 the death-rate in Woolwich was the highest of all. 40. Hospital Isolation. Of the 524 cases, 470, or 90 per cent., were removed to one of the Fever Hospitals, compared with 81, 78, 85, 86, and 94, per cent. in the five preceding years. 18 cases, or 3.4 per cent., were reported after observation at hospital, not to be Scarlet Fever. The very high percentage of cases removed to hospital was slightly reduced last year, "but it is still a fact that a large proportion, say one-third of notified cases, are removed to hospital, not because they cannot be efficiently isolated at home, but because the parents cannot afford the cost of medical attendance and nursing. Much might be saved to the rates if there was power to provide this at the public cost. 41. Return Cases. There were 27 cases in which 35 fection was attributed to 17 patients recently returned from hospital, compared with 13, 30, 38, and 58, 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 17 infecting cases, 11 had some form of rhinitis on or after their return, 2 otorrhœa, and 1 a rash. Most of the return 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 arrivng 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 rhinorrhœa. It would be an advantage perhaps if they also forwarded the names of children who had suffered from a rhinorrhcea which appeared to have ceased. 42. Home Isolation. 13 certificates of efficient home isolation were given to enable men to continue their employment in the Arsenal, compared with 16 and 11 in the two previous years. 54 cases were isolated at home. None of these was followed by a secondary case which could be attributed to failure of isolation or persistence of infection. In 1907-8-9 home isolation was followed by three return cases and three secondary cases, making a total of six cases, c 2 36 due to failure of isolation. Taking the 128 hospital return cases in 1907-10 on one side, and the six failures of home isolation and home return cases on the other side, and comparing these with the 2,798 cases isolated in hospital and 371 isolated at home respectively, it may be said that there were, in the four years, 4.6 per cent. of failures in the hospital isolation, and 1.6 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 117 cases. In 58 cases infection was attributed to other inmates of the house. Some of these were never notified, and had no distinct symptoms of Scarlet Fever, but a history of sore throats made it probable that they "had had a slight attack of this disease. 44. In 8 cases infection was attributed to friends and neighbours, in 15 cases to school attendance, in 5 to visiting hospitals, in 2 to entertainments, and 1 was a relapse shortly after leaving hospital. Schools. Abbey Wood, Purrett Road, and Ancona Road Schools were specially affected, and on my request medical examinations were made of children in certain classes. Exclusion of Contacts. Children living in the same house as a notified case are now excluded two weeks instead of one as previously. 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 18961905. 37 46. Statistics were given in the Annual Report for 1908 as to the date of calling in medical attendance in Scarlet Fever. Some remarks were made in the same report as to the high prevalence and comparatively low death-rates of Scarlet Fever and Diphtheria in Woolwich. Incubation Period. The incubation period of an infectious disease is the period between the exposure to infection and the commencement of symptoms. This period for Scarlet Fever has usually been considered to be from three to seven days, and it is often stated not to exceed seven days. In order to trace the source of infection and to take measures for the prevention of spread, it is very important to know how long the incubation may last. For this purpose I have been observing the intervals between the occurrence of first and secondary cases in the same house. If one child began with Scarlet Fever, say on the first day of the month, was at once removed to hospital, and the secondary case commenced on the seventh of the same month, it would be justifiable to conclude that the incubation period was six days. As a rule, however, the patient remains at home for several days before removal to hospital, so that it is only possible to give the period of incubation within certain limits which may be called the maximum and minimum periods. I have got out the minimum incubation of 155 cases and the maximum of 296. In 76 cases (or 50 per cent.) the minimum incubation was from 1 to 7 days; in 40 cases (or 25 per cent.) from 1 to 4 weeks; in 31 cases (or 20 per cent.) from 5 to 12 weeks; in 8 cases (or five per cent.) it was over 12 weeks. Out of the 315 secondary cases the maximum period of incubation was from 1 to 7 days in 149 cases (or 48 per cent.); from 1 to 4 weeks in 99 (or 31 per cent.); from 5 to 12 38 weeks in 37 (or 11 per cent.); and over 3 months in 11 (or 3 per cent.). Of course it is impossible to say that the secondary cases were not exposed to other sources of infection, but it seems extremely probable that the first case was the source of infection in the great majority of them, and this conclusion is borne out by the rapid fall in the number of secondary cases occurring after the first four days' incubation, and especially after the first two weeks. It must also be remembered that both the primary and secondary cases may have been due to a common source of infection, especially as regards the cases in which the interval was under one week; and as regards cases where the interval was longer, there may possibly have been an intermediate case, i.e., a child who, without having any symptoms recognised as those of Scarlet Fever, has taken the infection from the primary case and passed it on to the secondary case. But the occurrence of such missed cases only strengthens the opinion that a case of Scarlet Fever occurring in a house may be due to a source of infection which occurred several weeks before. It is now known that persons may carry the germs of Diphtheria in their throat for weeks and months without showing any symptoms of the disease, and may occasionally after this long interval of time develop the disease. Probably the same is the case with Scarlet Fever, and if so it is not to be wondered at that the apparent period of incubation is in exceptional cases as long as six months. It would appear, therefore, from the figures given (1) that the period of incubation varies from one day to six months; (2) that it is barely the majority of the total cases in which the incubation is under seven days; (3) that in a considerable proportion of cases it is over four weeks; and 39 (4) that the days from the second to the fifth after exposure are those in which most secondary cases occur. Scarlet Fever.—Four Years, 1905-8. Minimum Incubation, i.e., Period between Removal to Hospital of first case and commencement of second case. Days. Weeks. Weeks. Weeks. Months. Months. Months 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 3 to 4 4 to 5 5 to 6 No. of Cases 18 20 7 11 6 8 6 21 15 3 1 2 5 5 2 4 11 1 1 5 2 1 76 40 14 17 5 2 1 Total 155 Maximum Incubation, i.e., Interval between commencement of first case and commencement of second case. Days. Weeks. Weeks. Weeks. Months. Months. Months 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 3 to 4 4 to 5 5 to 6 No. of Cases 35 31 21 23 9 18 12 51 32 9 7 4 3 7 5 2 8 6 2 4 3 4 149 99 19 18 4 3 4 Total 296 40 diphtheria. 47. 147 cases of Diphtheria were notified (excluding 24 cases of mistaken diagnosis), compared with 275, 362, and 240, in the three preceding years. The case-rate (number of cases per 1,000 population) corrected for cases of mistaken diagnosis, was 1.15, compared with l.88 in 1909, and 2.15, the average of the ten preceding years. 6 of the cases were bacteriological, i.e., had no symptoms. This is the lowest case-rate recorded since 1891. 48. There were only 5 deaths, compared with 23, 15, and 25, in the three preceding years. The death-rate was 0.04, compared with 0.120 in "1909, and with 018, the average of the ten preceding years. The Woolwich deathrate is the lowest ever recorded. The previous lowest was 0.08 in 1891. The London death-rate was 0.09. 49. 41 cases were in Woolwich parish, 68 in West Plumstead, 55 in East Plumstead, and 7 in Eltham. The following table shows the case-rate in each registration district (not corrected for mistaken diagnosis) in the past seven years, compared with London and the Borough:— 1901-5 1906 1907 1908 1909 1910 Borough 1.71 2.80 1.83 2.61 1.88 1.15 Woolwich Parish 1.63 3.43 1.85 3.18 1.97 1.06 Plumstead Parish 1.87 2.26 2.36 2.88 W 3.08 1.66 E. 1.71 1.63 Eltham Parish 1.62 6.70 1.57 1.69 0.68 0.50 London 1.90 1.70 1.85 1.64 1.38 1.13 50. 139 cases, or 81 per cent. of notifications, were removed to hospital, compared with 67, 83, 89 and 89 per cent. 41 in the four preceding years. A certificate of efficient home isolation was given in 1 case (8 in 1905, 21 in 1906, 30 in 1907, 7 in 1908, and 1 in 1909). The case mortality was 3.4 per cent., compared with 6.6, 5.7, 6.3, 5.5, and 10.4, in the five preceding years, and 8 0 in London. In 5 cases there were no throat symptoms, 4 had discharge or soreness of the nose, and 1 had otorrhoea (running at the ear). Such cases rarely have medical attendance, and would escape detection if other cases in the family or school did not lead to a search for the source of infection. It is mainly mild cases of nasal diphtheria or children with other nasal affections, acting as carriers, who prevent the abolition of this disease. Owing to the occurrence of several cases at Purrett Road School, a medical examination of the children in certain classes was made and one child detected with nasal diphtheria, and two who had diphtheria bacilli in their throats, but with no symptoms of illness. Healthy children acting as carriers of this disease were also found at Plum Lane, High Street, and Earl Street Schools. If the Diphtheria death-rate which prevailed from 18961900 had been in operation last year, there would have been 60 deaths from this disease last year instead of 5, the actual number. 51. Bacteriology is now systematically used to prevent children attending London County Schools in an infectious state. After a case has been notified in a house, no children 42 from that house are allowed to return to school until they have been certified free from infection after a bacteriological examination. 189 home contacts were examined by the Medical Officer of Health, and 26 carriers, or mild cases of Diphtheria, were found. The carriers were excluded from school until the diphtheria bacillus had disappeared ; the eases showing any symptoms were notified and isolated. The Medical Officer from the Royal Arsenal examined employees from infected houses before allowing them to return to work, and discovered four bacteriological or carrier cases. 52. Mistaken Diagnosis. 18 cases, or 10 per cent. of notifications, were, after removal to hospital, stated to be not Diphtheria. The percentage of the three preceding years was 14, 8, and 10, respectively. 53. Source of Injection. In 39 cases, a probable source of infection was noted, viz., in 16, other inmates of the house were known or suspected to be the source; in 5, schoolmates; 5, neighbours and friends; 1, a return case; 2, general hospitals; and in 5 the infection was caught while in the Fever Hospital on account of Scarlet Fever. The one return case had rhinorrhcea, but Diphtheria bacilli were not found. One home return case occurred, after release of a patient notified with Scarlet Fever. 54. Bacteriological Diagnosis. 526 (768 in 1909) swabs were sent to the Lister Institute to be examined for the presence of Diphtheria bacillus. In 73 (90 in 1909) the true Klebs Loffler bacillus was found (in 7 of these Hoffman's bacillus co-existed with the Klebs Loffler bacillus); 43 in 78 (189 in 1909) Hoffman's bacillus was found, and 368 were found free from either the Klebs Loffler bacillus or Hoffman's. Of the 526 swabs examined, 157 were taken from school children by myself. Of these, 21 contained the true Klebs Loffler bacillus, and 43 Hoffman's bacillus. Most of these were contacts seen about ten days after notification of the primary case, for the purpose of giving certificates to enable pupils to return to London County Council Schools. Others were examined with the object of finding possible sources of infection, e.g., where the first case notified in a house was a child not attending school. Of the 157 contacts swabbed by the Medical Officer of Health, 19 had symptoms, viz., some form of rhinitis. Of these, 5 gave a positive result, 2 showed Hoffman's bacillus, and 12 were negative. The contacts found positive on the first examination who had no symptoms were re-examined at intervals of ten days; 3 were found negative on the second examination; in 3 Hoffman's bacillus was found on the second examination, in 4 a positive result occurred twice. Two negative results are usually obtained before certifying the patient free from infection, and Hoffman's is treated as a negative unless in special circumstances, as after a positive result. In one case Diphtheria bacilli persisted for three examinations, and was succeeded by Hoffman's, and a recurrence of positive, viz., + + + H (+ H) -H. 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. 44 Diphtheria Anti-toxin. An order was issued by the Local Government Board authorising Sanitary Authorities to provide Diphtheria anti-toxin, and supply it free of charge for such poor patients as required it. I reported as follows on this order:— "A letter has been received from the Local Government Board enclosing an Order made under Section 77, Public Health (London) Act, with respect to the use of Diphtheria anti-toxin. Section 77 authorises the Sanitary Authority, with the sanction of the Local Government Board, to provide a temporary supply of medicine and medical assistance for the poorer inhabitants of their district. The Local Government Board, by their Order dated 16th August, sanction the provision of a temporary supply of Diphtheria anti-toxin and of medical assistance in connection with it, subject to the condition that the arrangements with respect to keeping, distribution, and use of the anti-toxin, shall be made in accordance with the advice of the Medical Officer of Health. As the duties of Medical Officers of Health did not previously include action taken in the execution of this circular, the Board has extended those duties to include such action. The Board also authorises the Sanitary Authority to pay in addition to his salary a reasonable compensation for all action by the Medical Officer of Health in the execution of this Order. In the covering letter from the Secretary of the Board, the Board suggest that the Borough Council should consider with their Medical Officer of Health what arrangements should be made for the provision 45 and use, both as a prophylactic and as a curative agent, of Diphtheria anti-toxin. Anti-toxin is used both for the cure of persons who have already contracted Diphtheria, and is also administered to persons who have been exposed to the infection of Diphtheria to prevent their taking the disease. Most of the cases of Diphtheria notified in this Borough are sent to the Fever Hospital forthwith on being notified. In many severe cases, however, it is desirable that no time should be lost in the administering of anti-toxin, and that the patient should have an injection immediately on the medical attendant detecting the disease. And the Board point out that the proper administration of anti-toxin before removal to hospital may go far towards preventing the attack of Diphtheria from being fatal. The Board state that it is desirable that the Poor Law Medical Officers should be able to obtain from the Council's store the anti-toxin they may require. Anti-toxin has heen kept in ithe Public Health Department of this Borough for many years for the use of medical practitioners, but hitherto has only been supplied on pre-payment. The consequence is that it has very seldom been used for the poorer classes, and its use has indeed been quite exceptional. If it could be obtained without payment no doubt it would be used very much more frequently. It will be necessary to keep a larger stock, and there should be facilities for medical men to obtain it after office hours. The great majority of the cases of Diphtheria which occur are among the poorer classes, and I take it 46 it will be the wish of the Committee that in the first instance the anti-toxin should be issued to all without waiting to enquire whether the patient or his friends are in a position to pay. It will be for the Committee to decide what steps, if any, should be taken to provide that patients who are in a position to pay shall do so. There do not appear to be any powers for enforcing payment. The Local Government Board state that the arrangements which may be made for the supply of antitoxin should be brought to the knowledge of all medical practitioners in the district, and that in any circular letter which is sent to such practitioners emphasis should be laid on the importance of prompt treatment by anti-toxin and to the saving of life which may thereby be effected. I recommend that the Committee defer the question of making any regulations on the subject, and that meanwhile the local medical practitioners be informed of the Order and asked what use they are likely to make of anti-toxin when provided free of charge." The Public Health Committee decided to take no action. Enteric fever. 55. There were 8 cases of Enteric Fever, not including two cases of mistaken diagnosis notified as Enteric. The case-rate was 0.06, compared with 0.16, 0.10, and 0.08, in the three preceding years; this is for the third successive year the lowest rate recorded in the Borough. For the ten years 1892-1901, the rate never fell below 0.41. The 47 rate in London was 0.26. Out of 10 cases notified, 5 went to hospital. 56. There was only 1 death, giving a death-rate of 0:01, which is again the lowest death-rate recorded. The deathrate in London was 0.04. At the present rate of diminution Enteric Fever will have disappeared in three years. 57. The following are the cases notified in each parish during the past six years:— Average, 1901-5 1906 1907 1908 1909 1910 Woolwich 12.6 16 6 4 9 3 Plumstead 21.2 21 16 12 W. 3 5 E. 0 0 Elthani 8.6 3 5 3 1 2 58. In three cases the disease was attributed to oysters, one was infected in a Yorkshire village, and one at Trouville on the coast of France. One may have caught the disease at a sewage farm in Essex. 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 fæces of the Enteric patients discharged from the Fever Hospitals and by request of the Board, I am assisting in this enquiry. All the Enteric cases discharged from the fever hospital in 1910 have been visited, and samples of urine and faces taken from those who were willing to supply them. Six persons were sampled each month for six months. Only one positive result was obtained and was followed by two negative ones. 48 59. Bacteriological Diagnosis. 18 samples of blood were sent to the Lister Institute to bo examined for Widal's reaction. A positive result was obtained in 6. Diarrhœa or Zymotic enteritis. 60. The deaths from Diarrhœa, Dysentery, and Epidemic or Zymotic Enteritis were 17, or 013 per 1,000 population, compared with 0.52, 0.81, 0.26, 0.36, and 0.15, in the five preceding' years. The rate for London was 0.28. There were in addition 13 deaths from Enteritis and Gastro-Enteritis, making a total of 30 deaths, or 11 per 1,000 births, due to diarrhœal diseases. 21 of the 30 were under one year of age, and 2 between one and five years. 61. The following table shows the death-rate from the above-mentioned diarrhœal 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 1910 Woolwich Parish 33 44 19 23 14 10 Plumstead Parish 27 31 16 16 6 W. 9 E. 15 Eltham Parish 19 19 11 12 26 4 The Borough (02-5) 28 34 18 18 11 11 Loudon County 35 48 21 31 22 — 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 of four years notifications were fully reported (see Council's Minutes, 11th February, 1909), and they were so satisfactory 49 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. 102 cases were notified in the past year. The subjoined tables give full particulars of these. The notifications were fewer than in any of the past six years excepting 1907. 2 cases were notified in June, 8 in July, 32 in August, 32 in September, and 28 in October. 4 deaths from Diarrhoea and Zymotic Enteritis occurred in August and September, 5 in October, 3 in November, and 3 in December. There were none in June or July. The fatality (deaths from June to October per 100 notified cases) was 8.8, compared with 6.7 in 1909, and 14.6 in the four preceding years. As pointed out in the report above referred to, the fatality has been highest when the prevalence was greatest, and vice versa. Vomiting. In 68 cases vomiting was noticed. Age Distribution. Table I. gives the age distribution of the cases, the largest number in any three-monthly period was between 9 and 12 months of age. 14 cases over five years were notified. Local Distribution (see Table II.). In proportion to population and births, the largest number of cases was notified in East Plumsteacl and Eltham. The largest number of deaths proportionally to population was in East Plumstead, and the smallest number in Eltham. Feeding of Infants. Table IV. shows the manner of feeding of all cases under one year of age. 5 had the breast d 50 only, 6 breast milk and other food; none had Depot milk. 14 had fresh cow's milk, and 13 Nestle's condensed milk. 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 Diarrhœa mortality than London, since notification commenced the Woolwich death-rate has decreased to a marked extent both absolutely and compared with London. In 1910 the Woolwich Diarrhoea mortality was only one-twentieth $he average mortality of 1901-4, and only one-fifth as much as in London in the same year. There were only 4 deaths in the summer quarter, giving a death-rate of 0.12, compared with 2.30, the average of the years 1901-4, and with 0.57, the London death-rate. There were, however, 11 deaths in the autumn quarter, when the death-rate was 0.34, compared with 0.35 in London. It is unusual for the deaths from Diarrhœa in the autumn quarter to exceed those in the summer quarter. The cool and rainy summer was favourable to a low diarrhoea death-rate, but the existence of notification has shown us that, even in the most favourable summers, a large number of children suffer from this disease, although usually in a mild form. In my last report I attributed the reduction of diarrhœa mortality to three causes, viz., notification, the Milk Depot, and the Health Visitor. The second of these ceased to exist in August. 51 NOTIFIED CASES OF ZYMOTIC ENTERITIS. Table I. Age and Sex. Notifications. Year. Total. M. F. Under 3 mths. 3to6 months. 6to9 months. 9to12 months Total under 1 year, 1to2 years. 2to5 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 1910 102 54 48 5 10 12 13 40 31 17 14 Total 1905-10 1095 576 519 83 157 157 161 558 299 114 124 d 2 52 Table II. DISTRIBUTION IN PARISHES. Notifications. Deaths of Notified Cases. Average Births in 1905-6-7. 1905 1906 1907 1908 Total Rate per 1000 Births 1909 1910 1905 1906 1907 1908 Total Rate per 1000 Births Rate per 1000 Population 1909 1910 Woolwich 1171 111 77 26 62 276 59.0 21 19 19 12 3 10 44 9.4 0.27 3 1 Plumstead 2004 76 242 57 93 468 58.3 122 W 17 12 33 7 12 64 8.0 0.21 3 W 1 E 49 E 4 Eltham 281 25 47 10 18 100 88.9 6 17 5 1 1 7 6.2 0.15 .. 1 3456 212 366 93 173 844 61.0 149 102 36 46 10 23 115 8.3 0.22 6 7 53 Table III. CLEANLINESS OP 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 1910 100 57 6 37 1059 705 162 192 Table IV. PRINCIPAL DIET OF CASES UNDER 1 YEAR OLD. 1905 1906 1907 1908 1909 1910 Totals 19051910 Breast only 15 12 4 9 4 5 49 Breast and other foods 10 28 9 10 15 6 78 Depot milk .. .. 4 2 6 .. 12 Depot milk and other food .. .. 1 .. .. .. 1 Fresh cows milk alone 54 59 10 12 10 5 240 Fresh cows milk with farinaceous food, etc. 139 11 21 10 9 Fresh Milk and Nestles .. .. .. 1 .. .. 1 Nestle's condensed 34 49 11 20 15 8 137 Nestle's with farinaceous food, etc. .. .. .. .. .. 5 5 Dried milk, Allenhury's, etc. 3 2 .. 1 1 1 8 Sterilised whole milk 1 1 .. 1 .. .. 3 Separated condensed .. .. .. 1 .. .. 1 Other foods, and "not stated" 5 4 l 13 2 1 26 122 194 51 91 63 40 561 54 Table CAUSE OF 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 1910 34 — 5 17 3 9 Total 494 5 79 295 22 93 55 Table VI. NUMBER OP 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 11th 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 1910 3 3 0 2 4 3 8 9 11 9 5 6 9 Total 14 18 18 28 58 116 143 162 128 114 100 72 66 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 5802 57.11 57.86 58.21 1909 57.21 57.59 59.39 59.49 59.68 61.25 62.79 61.48 60.19 58.70 57.87 57.60 57.11 1910 58.21 57.99 58.82 59.06 60.12 60.48 61.13 61.26 60.59 59.68 58.71 58.01 57.35 Average 58.88 59.40 60.35 61.14 61.66 61.88 62.07 61.51 60.73 60.11 59.33 58.58 57.92 57—58 Table VII. DEATHS PROM DIARRHŒA AND ZYMOTIC ENTERITIS, classified by Districts and Ages, during the Five Months ending 31st October, 1905, 1906, 1907, 1908, 1909, 1910. Under 1 Year. Over 1 Year. Total 1905 to 1910 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 1910 1905 1906 1907 1908 1909 1910 1905 1906 1907 1908 1909 1910 3905 1906 1907 1908 1909 1910 1905 1906 1907 1908 1909 1910 1905 1906 1907 1908 1909 1910 1905 9061 1907 1908 1909 1910 Woolwich 93 3 2 3 2 11 7 2 5 2 .. 8 9 3 4 .. .. 6 5 2 3 1 1 3 3 1 1 .. 1 1 .. .. .. .. .. .. 4 .. .. .. .. Plumstead— West 118 5 7 1 2 2 .. 5 8 7 4 .. 1 5 16 3 5 2 .. 4 8 •• 4 •• .. 2 6 3 5 1 .. 1 1 .. .. .. .. 2 2 .. 1 .. .. East 2 1 1 l Eltham 10 1 .. .. 1 .. .. .. 2 .. .. .. 1 2 .. .. .. .. .. 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1905-10 221 9 9 1 6 4 2 16 17 9 9 2 3 15 25 6 9 2 1 11 14 2 7 1 1 6 9 4 6 1 1 2 1 .. .. .. 1 2 6 .. 1 .. .. 31 56 58 36 27 4 9 59 Table VIII. DIARRHŒA, INFANTILE MORTALITY, AND TEMPERATURE OF SUMMER QUARTER IN LONDON AND WOOLWICH. 1901 1902 1903 1904 Average 1905 1906 1907 1908 1909 1910 Aver. 19051910 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 0.53 1.41 Woolwich 2.76 0.97 0.96 4.52 2.30 1.72 2.54 0.34 0.87 0.25 0.12 0.97 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 61.26 62.61 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 59.34 60.30 60 TABLE IX, ZYMOTIC ENTERITIS AND METEOROLOGY, Summer Quarter. 1902 1933 1904 1905 1906 1907 1908 1909 1910 Number of cases notified 212 366 93 173 149 102 Number of deaths, Diarrhœa (to October 31st) 40 37 139 56 93 22 38 10 9 Mean temperature of air 59.1 59.0 60.08 60.6 62.4 58.87 59.3 58.7 57.2 Mean temperature 3 ft. below ground 59.68 60.18 61.45 61.62 62.08 59.15 60.35 59.25 59.34 Mean humidity 75 77 72 75 70 74.6 77 80 80 Number of days on which rain fell — 46 34 33 26 32 38 46 37 Rainfall in inches 5.91 12.32 4.88 5.65 3.78 3.77 8.15 7.43 6.08 Number of hours bright sunshine 485 541 671 529 697 516 532 530 432 61 Erysipelas. 62. There were 89 cases of Erysipelas notified, compared with 110, 90, and 103, in the three preceding years. There were 3 deaths. The case-rate was 070, and the death-rate 0 02. The London case-rate was 082. The London deathrate was 0 04 in "1909. The Woolwich rates were the lowest since 1905, with one exception. Epidemic Cerebrospinal Meningitis. 63. 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. One case was notified in 1910 in Eltham. This was an infant who was moved to the Brook Hospital, and died there. Puerperal Fever. 64. There were 7 cases of Puerperal Fever notified, compared with 12, 8, 6, 6, and 9, in the five preceding years. There were 3 deaths. The case-rate was 0.06, and the death-rate 0.02. The London case-rate was 0.06, and the death-rate in 1909, 0.04. In the ten years 1891-1900, the case-rate was 0.07, and the death-rate 0.03. In 1901-5 the case-rate was 0.06, and the death-rate 0.03, and in 1906-10 the case-rate was 0.05and the death-rate 0.016. Thus in the past five years the death-rate has fallen To nearly one-half what it was in the previous quinquennium, and the case-rate has been reduced. The 62 Midwives Act was passed in 1902, and the Home for Mothers and Babies was established in Woolwich in 1905. Influenza, Bronchitis, Pneumonia. 65. Influenza caused 39 deaths, compared with 23, 33, 30, 29, and 36, in the five preceding years. Bronchitis and Pneumonia caused 232 deaths, compared with 255, 265, 298, 228, and 245, in the five preceding years. The deaths from these causes under five years were "66, compared with 140, 81, and 86, in the three preceding years. Tuberculosis. 66. Deaths. There were 176 deaths from Tuberculous disease, giving a death-rate of 1.40, compared with 1.83, 1.71, 1.60, 1.76, and 1.63, in the five preceding years. Last year had far the lowest rate yet recorded. 67. The following table gives the number of deaths from each of the various forms of Tuberculosis in the past ten years, and also the deaths from simple Meningitis:— Average, 1901-5 1906 1907 1908 1909 1910 Tuberculous Meningitis 20.0 22 19 27 27 19 Simple Meningitis 22.0 15 20 14 14 12 Tuberculosis of Intestines and Peritoneum 13.0 14 11 13 9 7 Tuberculosis, other forms 20.8 21 22 28 23 17 Phthisis 192.0 164 154 156 150 133 68. The deaths from Phthisis were 133, giving a deathrate of 1.04, compared with 1.47, 1.29, 1.19, 1.23, and 1.17, in the five preceding years. This is the lowest death-rate recorded. The reduction in the death-rate since 1901 represents a saving of 100 fives last year. The following 63 table gives the death-rate from Phthisis in each parish during the quinquenniums 1896-1900, and in 1901-5, and in 1906, 1907, 1908, 1909, and 1910, compared with London. The greatest reduction was in the Parish of Woolwich:— Average 1896-1900 Average 1901-5 1906 1907 1908 1909 1910 No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate Woolwich Parish 461 2.23 89 2.15 67 1.68 52 1.30 59 1.51 49 1.25 54 1.38 Plumstead West 458 1.42 97 1.34 90 1.20 92 1.20 90 1.19 w 56 1.37 44 1.08 East E 33 0.96 30 0.87 Eltham 44 1.28 6 0.63 7 0.58 10 0.78 7 0.54 12 0.91 5 0.36 The Borough 1926 1.74 192 1.56 164 1.29 154 1.19 156 1.23 150 1.17 133 1.04 London — — — 1.57 6969 1.47 6654 1.39 6419 1.32 — 1.31 — 1.14 64 69. The following table shows the death-rate from Phthisis in Woolwich and Plumstead parishes in each of the four past quinquennia:— 1891-5. 1896-1900. 1901-5. 1906-10. Woolwich 2.80 2.23 2.15 1.42 Plumstead 1.78 1.42 1.35 1.17 70. To judge of the decrease of Tuberculosis it is necessary to consider carefully the figures given above for the various forms of disease. It is seen that the number of cases of simple Meningitis has considerably diminished, while that of Tuberculous Meningitis has tended to increase. The number of the two together diminished but little until 1910. There can be little doubt that cases which were formerly called simple Meningitis are now certified as Tuberculous Meningitis, and that the latter has really decreased. Again, it has become increasingly the practice to certify deaths from such diseases as hip and spinal disease as Tuberculous. The real diminution of Tuberculosis other than Phthisis is no doubt greater than appears on the surface. The reduction of Phthisis is very marked and satisfactory. 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 65 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 fifteen 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, anct to this fact is probably due That Woolwich has so small a death-rate from consumption of the bowels. The following table shows the variation of the death-rate from Phthisis since 1896:— 1896 1897 1898 1899 1900 1901 1902 1903 Deaths 177 185 189 204 208 215 183 171 Death-rate 1.66 1.70 1.71 1.80 1.80 1.80 1.47 1.39 1904 1905 1906 1907 1908 1909 1910 Deaths 206 185 164 154 156 150 133 Death-rate 1.64 1.47 1.29 1.19 1.23 1.17 1.04 71. 73 of those who died from Phthisis were males, and GO females. In 1906 there were 97 males and 67 females; in 1907, 82 males and 72 females; in 1908, 101 males and 55 females; and in 1909, 88 males and 62 females. 72. The source of infection was attributed in 61 deaths from Tuberculosis, with more or loss probability, as follows: Family or personal:— Father 7 Husband 3 Carried forward 10 66 Brought forward 10 Mother 7 Brother 2 Sister 3 Wife 1 Other relatives 1 Other inmates of house and friends 6 Workplace 6 Public house or licensed restaurant 15 Milk 6 Army 2 Hospital 1 Nurse 1 61 Two who died were engaged in the liquor traffic. 73. Notifications. Voluntary notification of Phthisis has low been in force in the Borough for nine years. In 1909, notification of cases attended by Poor Law Medical Officers was made compulsory. 196 cases were notified last year, compared with 176, 150, 154, and 206, in the four preceding years. 59 of these were in the Poor Law Infirmary. 43 others were notified by the District Medical Officers of the Poor Law Unions, 20 by the Medical Officers of the Royal Arsenal, and the remainder by various social workers, applicants for admission to Peppard Common Sanatorium, and by private medical practitioners. £14 13s. 0d. was paid during the year for the notification of Phthisis. 67 Duration. Of the 196 cases notified during 1910, at least 57 have since died, and of 206 notified during 1909, at least 65 have since died (March 1st, 1910). 74. The source of infection of the notified cases was probably as follows:— Family or personal—Father, 6; mother, 11 brother, 4; sister, 5; husband, 2; other members of family, 1; friends, lodgers, etc., 4 33 Workshop and Office 9 Public House 23 Navy and Army 6 Milk 1 Undetermined 124 75. Of the 27 adults about whom information was obtained, 3 were stated to "be teetotalers, 16 temperate, and 8 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 2 9 29 112 43 1 Sex, 130 males, 66 females. 76. Occupation. Of the 130 notified males, 36 were Arsenal employees. The Department and Workshops affected are as follows:— Royal Laboratory ll Danger Buildings 2 e 68 Royal Carriage Department 4 Royal Gun Factory 3 Army Ordnance Department 3 Building Works Department 2 Torpedo Factory 3 Central Office 1 Naval Ordnance 'Department 1 Royal Dockyard 2 Other Departments and unknown 4 77. Bacteriological Diagnosis. Sputum from 210 cases of suspected Phthisis was examined at the Lister Institute, and tubercle bacilli were found in 64 cases. The number of examinations for the five previous years was 130, 130, 171, 175, and 179, respectively. It appears that medical practitioners are availing themselves to a greater extent of this valuable means of diagnosis. 78. In my Annual Report for 1904 some figures were given as to the "Public House as a source of Infection," and "Chronic Tuberculosis in Children" (see page 50 of that Report). 79. Disinfection was performed by the Public Health Department at 166 premises, compared with 165, 157, and 146, in the three preceding years. Of these 77 were disinfected after the death of the patient, and 89 after removal to hospital, sanatorium, or other opportunity. 79a. Sanatorium Treatment. Since the year 1904, the Council has had an arrangement with Dr. Carling, the 69 Superintendent and late Proprietor of the Maitland Cottage Sanatorium, Peppard, by which the Council maintains beds at the Sanatorium, paying a fixed charge (raised from 28s. to 30s. a week in 1910) for each bed when occupied, and 20s. a week when unoccupied. Dr. Carling during the year 1909 made arrangements to vest the Sanatorium in trustees, and put it under control of a Management Committee appointed by the Governors. For further particulars, see page 842 of the Council's Minutes, 1909. 80. Numbers treated. The Council now maintain seven beds, five for men and two for women. All the beds were kept occupied throughout the year. There were generally more patients anxious to go than could be accommodated. The male applicants numbered 40, and the female 17. 35 patients were admitted, compared with 41 in 1909. Of these, 9 stayed for one month, and the remainder for longer periods. None stay at the Council's expense for more than six months. One died from pneumonia following a severe haemorrhage. 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. 80a. Nature of Cases. It would be a mistake to suppose that the majority of the cases sent were very early ones; the contrary is nearer the truth. No case of course is sent e 2 70 which is likely to die at the Sanatorium, and acute cases, i.e., those with temperatures over 100° are not sent until the temperature has come down. But of the 35 patients admitted last year the disease affected both lungs in 17, and one lung in an advanced stage (consolidation) in 7 cases. 18 cases had an evening temperature of over 99°. Tubercle bacilli were found in 21 cases, and were very numerous in 9. No examination of sputa was made in the other cases. As patients are only received for one month in the first instance, there is no objection to sending somewhat advanced or chronic cases, who, though their lives may not be prolonged very much, will learn the open-air treatment, and thus lessen the danger to others on return. 81. The following table recommended by the Local G-overnment Board, shows the condition in each subsequent year of the survivors from the cases treated in each year. The difference between the sum of the numbers dead and the survivors, and the number discharged, in any year, shows the cases lost sight of. 71 Number of patients discharged in each year who were (a)alive, but not well enough to work; (&) at work, seeking work, or performing their ordinary duties, in January of each of the undermentioned years:— Year. Number Discharged. Dead. Jan. 1911 1904 1905 1906 1907 1908 1909 1910 1911 a b a b a b a b a b a b a b a b 1903 1 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1904 11 6 .. .. 2 6 1 5 1 5 1 5 2 4 1 4 1 4 1905 16 10 .. .. .. .. 1 12 2 10 2 4 2 2 .. 3 .. 5 1906 29 11 .. .. .. .. .. .. 5 24 2 20 5 15 1 14 .. 14 1907 38 19 .. .. .. .. .. .. .. .. 9 24 2 22 7 15 2 13 1908 30 9 .. .. .. .. .. .. .. .. .. .. 7 18 6 16 2 12 1909 36 9 .. .. .. .. .. .. .. .. .. .. .. .. 3 24 2 20 161 65 1 .. 3 6 2 17 8 39 14 53 18 61 18 76 7 68 Some half-dozen of those recorded as at work are employed at the Sanatorium in various capacities, receiving 72 board and a small wage. Of the 21 patients not accounted for, the majority are believed to be well and at work in Canada, Australia, South Africa, etc. The above table accounts for all patients who left the Sanatorium up to December 31st, 1909. Out of 161 who have left over one year, 68 are now well and at work, 7 are unwell, 65 have died, and 21 have been lost sight of. 82. 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 on return. Unfortunately the latter condition can seldom be fulfilled, and hence the large number of recurrences after work has been resumed. Some too, have suffered from not being able to find any occupation, others 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 kept at their employment too long under the same fear. Consumption is largely a question of poverty. The chart on the opposite page shows the decline of Phthisis in Woolwich compared with England, London, Lewisham and Greenwich, and the average temperature of the summer quarter in each year since 1891. It is seen that since 1900 the decline has been very great in London and in "Woolwich, but in England, Lewisham and Greenwich, the death-rate has only fallen to a small extent. It is noteworthy that in the years 1896-1900 which were noted for their high summer temperature, there was no fall in the Phthisis mortality. Average Temperature of Summer Quarter (The figure on the Chart multiplied by 10, gives the temperature in degrees Fahr.) 73 83. The Economy of Sanitorium Treatment. This subject was fully dealt with in my Anuual Report for 1909. 83a. Charge for Sanatorium Beds. A slight increase was made in the charge per bed according to the following resolutions:— (1) That from the 1st January, 1911, the charge per bed per week for occupied beds for Woolwich patients at Peppard Sanatorium shall be 30s., to include all exceptional liabilities for the removal of patients, special nursing, etc. (2) That the charge for unoccupied beds shall continue as at present, 20s. per week, and the charge for children under 12 as heretofore, 25s. per week. 84. The names of 57 applicants were entered on the register during the year for admission to the Sanatorium, compared with 65, 59, 70, and 71, in the previous four years. Of these, 35 have been admitted, 9 were too far advanced to be accepted, and 5 were found not to be tuberculous. One was unable to pay travelling expenses. Others were admitted to Consumption Hospitals, other Sanatoriums, or the Workhouse Infirmary, but all received instructions as to means to be taken to promote Their own health and avoid infecting others. 84a. Shelters for Consumption. Although open-air treatment for consumption can best be carried out in the first instance at a Sanatorium, there are many cases for which it is desirable such treatment should be tried who cannot be admitted to any Sanatorium. These are sometimes too ad- 74 vanced for it to be wise to send them to a distance, but openair treatment would certainly prolong their life, diminish infection, and in some cases sufficiently restore them as to enable a resumption of ordinary duties. Many cases too who have had temporary treatment at a Sanatorium find it difficult or impossible to continue the open-air treatment at home as is desirable. For such cases the plan of using an open-air shelter, erected in the garden, has been tried with success in Edinburgh, Paddington, and other places. The use of such shelters also prevents infection in the home. In July, the Public Health Committee decided to obtain two shelters of a type used in Edinburgh and Paddington, to be lent to needy consumptives for use in their garden or back-yard. These shelters were closed on three sides, and entirely open on the fourth, which was provided with a canvas curtain which could be let down like a shop blind in wet weather. They, however, did not exclude the rain and cold winds, and were accordingly altered, after inspecting shelters used by Dr. Lyster of Great Baddow at that village with great success. The new shelters can be closed by canvas or wooden shutters (see illustration) on each side, or can be entirely open above 2 ft. 6 in. from the ground all round. Four shelters of this type are now in use by three women and one man, all patients who have been to Peppard Sanatorium and had not entirely recovered or had relapsed after their return. The results have been completely satisfactory. The patients use them mainly for sleeping at night, while they perform their duties as far as possible during the day. One patient had been given up by her medical man as a hopeless case, but is now again looking after her house and family, 75 and to outward appearances restored to health. These shelters can be used in all weathers. They can be taken to pieces and transferred from place to place. A photograph of one is reproduced on this page. 76 85. 25 spitting flasks were supplied at cost price, 6d.,, compared with 14, 22, 32, 23, and 19, in the previous five years. Cancer. 86. There were 106 cases of cancer (malignant tumour), giving a death-rate of 0.82, compared with 0.70, 0.90, 0.83, 0.75 and 0 93, in the five preceding years. 47 of the deaths were in males and 59 in females. 89 of the deaths were in persons over 45. The highest mortality was in Woolwich Parish and West Plumstead. The London deathrate was 0.96 in 1909. 42 of the deaths occurred in public institutions. 87. The following table shows the sex and region affected in all cases of malignant disease:— Carcinoma. Seat of primary disease:— Male. Female. Head and face — - Mouth, jaw and tongue 7 1 Pharynx, œsophagus, larynx, and neck 6 2 Pleura, lung, mediastinum — — Stomach and pylorus 10 7 Intestines (excluding rectum) 2 2 Rectum 8 3 Liver 7 10 Kidney and bladder 1 3 Female genital organs 14 Female breasts 10 Male genital organs - — Carried forward 41 52 77  Male. Female. Brought forward 41 52 Pancreas 1 1 Arm — 1 Undefined 2 2 44 56 Sarcoma. — — Jaw 1 1 Pelvis 2 — Foot — 1 Undefined — 1 3 3 87a. 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 have been classified under the organs affected since 1903, and the following table shows the result for males and females separately:— Carcinoma. Males. Seat of Primary Disease. 1903 1904 1905 1906 1907 1908 1909 1910 Total Head and face 1 .. 4 1 1 .. 4 .. 11 Mouth, jaw, and tongue 3 5 4 7 1 6 3 7 36 Pharynx, oesophagus, larynx, and neck 5 3 7 18 8 2 9 6 58 Pleura, lung, mediastinum 1 .. .. 1 1 .. .. .. 3 Stomach and pylorus 6 5 5 9 9 12 12 10 68 Intestines (excluding rectum) 2 3 3 5 3 2 4 2 24 Rectum and anus 6 4 2 3 3 5 5 8 36 Peritoneum and omentum 2 .. .. .. .. .. .. 2 Liver 9 3 12 7 7 6 5 7 56 Kidney and bladder .. .. .. 1 3 1 2 1 8 Genital and external urinary organs 3 5 .. .. 2 2 .. .. 12 Pancreas 1 .. .. 3 1 1 1 1 8 Pelvis and groin 1 .. .. .. .. .. .. .. 1 Undefined .. 1 .. 1 1 2 5 2 12 38 31 37 56 40 39 50 44 335 78 Females. Seat of Primary Disease. 1903 1904 1905 1906 1907 1908 1909 1910 Total Head and face .. 1 1 2 2 1 2 .. 9 Mouth and tongue 2 3 .. 1 .. .. 1 1 8 Pharynx, oesophagus, larynx, and neck 1 1 3 2 1 1 1 2 12 Pleura, lung, mediastinum 1 .. 1 .. 1 2 .. .. 5 Stomach and pylorus 8 8 1 7 5 7 12 7 55 Intestines (excluding rectum) 1 1 .. 5 2 5 7 2 23 Rectum and anus 2 4 3 5 7 10 9 3 43 Liver 6 7 9 6 10 12 5 10 65 Peritoneum and omentum .. .. 1 1 1 .. .. .. 3 Kidney and bladder .. .. .. .. 2 1 .. 3 6 Genital organs 20 17 11 11 19 11 13 14 116 Breasts 8 11 10 11 11 3 8 10 72 Limbs .. .. .. l .. .. 1 .. 2 Pancreas .. .. .. .. .. .. .. 1 1 Pelvis and groin 1 1 .. .. .. .. .. .. 2 Undefined .. 1 1 2 .. .. 3 3 10 50 55 41 54 61 53 62 56 132 Sarcoma. Male. 1903 1904 1905 1906 1907 1908 1909 1910 Ttl. Jaw .. .. .. .. .. .. .. 1 1 Pelvis .. .. .. .. .. .. .. 2 2 Mouth .. 1 .. .. .. .. .. .. 1 Liver .. 1 .. .. .. .. .. .. 1 Pancreas .. 1 .. .. .. .. .. .. 2 Bones .. .. 1 .. .. .. .. .. 1 Humerus .. .. 1 .. .. .. .. .. 1 Femur .. .. 1 .. .. .. .. .. 1 Skin .. .. 1 .. .. .. .. .. 1 Genital and urinary organs .. .. .. 1 .. .. .. .. 1 Diffused .. .. .. 1 .. .. .. .. 1 Tonsil .. .. .. .. 1 .. .. .. 1 Leg .. .. .. .. 1 .. .. .. 1 Neck .. .. .. .. .. .. 1 .. 1 Testicle .. .. .. .. .. .. 1 .. 1 Vetebræ .. .. .. .. .. .. 1 .. 1 Undefined .. .. 1 1 l .. .. .. 3 .. 3 5 3 4 .. 3 3 21 79 Female. 1903 1904 1905 1906 1907 1908 1909 1910 Ttl. Jaw .. .. .. .. .. .. .. 1 1 Foot .. .. .. .. .. .. .. 1 1 Intestines .. 1 .. .. .. .. .. .. 1 Genital and urinary organs .. 1 .. .. .. .. .. .. 1 Tibia .. 1 .. .. .. .. .. .. 1 Multiple Osteo Sarcomata .. 1 .. .. .. 1 .. .. 2 Femur .. .. 1 .. .. .. .. .. 1 Kidney .. .. 1 .. .. 1 .. .. 2 Orbit .. .. .. .. .. .. .. .. 1 Leg .. .. .. .. .. .. .. .. 1 Cerebellum .. .. .. .. .. 1 .. .. 1 Hip .. .. .. .. .. .. 1 .. 1 Thigh .. .. .. .. .. .. 1 .. 1 Suprarenals .. .. .. .. .. .. 1 .. 1 Ovary .. .. .. .. .. .. 1 .. 1 Undefined .. .. 1 1 1 .. .. 1 4 .. 4 3 2 2 3 4 3 21 Comparing 1910 with. 1903, there has been an increase of 6 deaths from Carcinoma in both males and females, or 12 deaths in all. In males the most notable increase is in cancer of the stomach and pylorus, and in females of the digestive organs. 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 1909-10. 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. 80 It is seen from the two tables that Cancer affects the mouth, tongue, pharynx, oesophagus, 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. The increase of Cancer in recent years has been attributed to the excessive use of various articles of diet, e.g., alcohol, tea, coffee, and meat. That alcohol is a predisposing cause of Cancer, acting probably as an irritant to the digestive organs, seems to be well established. With a view to seeing if diet greatly influences the mortality from Cancer, I have compared the deaths from Cancer of persons over 25 years dying in the Infirmary, with those dying from this disease of similar age outside, with the result that there is no evidence that the restricted diet of the Workhouse and Infirmary greatly affects the Cancer death-rate. Alcoholism. 88. There were 7 deaths from Alcoholism, and 16 from Cirrhosis of the Liver, making a total of 23 deaths probably due to alcohol, compared with 24, 17, 18, 21, and 20, in the five preceding years. In addition to these there were 343 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 336, 347, 327, 346, and 335, respectively. 89. The death-rate from alcoholism and Cirrhosis of the Liver was 0.18 in the Borough, and 0.16 in the County of London. There is one licensed house per 658 population 81 in the Borough, and one per 266 in River Ward. Ten licensed houses in River, Dockyard and St. Mary's Wards have been closed under the Licensing Act, 1904, and two have been closed since 1904 for offences against other Acts. Syphilis. 90. There were 7 deaths from Syphilis, compared with 14, 10, 9, 7, and 10, in the five preceding years. Five of these occurred in Public Institutions. Six were males and one female. Five were infants under one year. There were in addition 18 deaths from General Paralysis, Tabes Dorsalis (Locomotor-ataxy) and Aneurism, diseases which are considered to be usually due to Syphilis. These figures are far from representing the total mortality caused by this disease. ophthalmia neonatorum. 91. The question of the notification of this disease was considered by the Public Health Committee. I reported that the obtaining of immediate medical treatment was of much more importance than notification, and recommended that with this object the London County Council should have power to pay medical fees under the Midwives Bill. meteorology. (See Table VIII.) 92. The temperature in the winter quarter of the year was rather high; it had eight weeks with an average temperature above the normal, and five below. The spring quarter had an average temperature. The summer quarter was exceptionally cool; it had two weeks above the average 82 and eleven below; its average temperature was 57.2, which is 2.9 degrees below the average. In the autumn quarter the temperature was above the average in six weeks, below in six, and equal to the average in one. The lowest temperature, 20.3° F., occurred in the fourth week of January, and the highest, 82.2° F., occurred in the fourth week of June. The rainfall, 28.06 in., was above the average; the excess being specially in the spring and autumn quarters. The largest weekly number of deaths, 46, took place in the week ending December 17th ; the smallest number of deaths was in the week ending August 6th. (See also under Diarrhœa). 83 PART II. Administration. Water Supply. 1. The supply is now constant throughout the Borough. A water tower has been constructed which has enabled all houses on Shooters Hill to have a constant supply from April 1st, 1911. Plumstead Well. In previous years I have repeatedly called attention to the unsatisfactory condition of the water supplied by the Plumstead Well. From the December report of the Water Examiner on the Metropolitan Water Supply, page 76, it appears that in 1910 there were 68 samples taken of the Plumstead Well for chemical analysis. The ammoniacal nitrogen averaged •0001, the albuminoid nitrogen .0016, the chlorine 5.68, the total hardness 38.29, and the temporary hardness 15.25, In all these particulars the Plumstead Well compared unfavourably with the other Kent Wells. The chlorine found last year was slightly lower than the amount reported in 1907 when it was 6.07, but the hardness was higher last year than ever, and much in excess of all the other Kent Wells. For bacteriological examination 89 samples were taken, and an average of 6.4 microbes per cent. were found present. F 84 This was slightly below the average for the whole of the Kent Wells, and compares favourably with the number of microbes present in 1907, viz., 14.3. The excess of chlorine and of hardness are the worst features of the Plumstead water, and call for further investigation and explanation on the part of the Water Board. Apart from the liability to dangerous pollution suggested by the high percentage of chlorine, the excess of hardness is a tax on the consumers in the respect of necessitating the use of an extra amount of soap and labour for washing purposes, and extra expense and labour from the furring of kettles, boilers, etc. Dr. Houston, Director of Water Examination, has also favoured me with the results of the chemical and bacteriological examinations of the Plumstead Well up to the 31st March. Dr. Houston considers that there is no evidence of any undesirable pollution. 2. Water Supply in Tenement-houses. An additional tap and sink were supplied on at least one upper floor of 18 tenement-houses, under the Public Health (London) Act, Sec. 48, previously to the coining into force of the London County Council (General Powers) Act, 1907, by which a suitable water supply can be required on each separately occupied floor of a tenement-house. Under this Act an additional supply was required and provided at 25 houses in 1908, 30 houses in 1909, and 3 in 1910. 18 of these houses were in the Dockyard and St. Mary's Wards, 13 in River Ward, and 22 in St. George's Ward. There were three prosecutions in 1909, which were recorded in full in my last Annual Report. 85 3. Defective and foul storage cisterns were found and remedied at 51 houses, compared with 77, 67 and 35, in the three preceding years. At 59 houses the supply was found insufficient or temporarily cut off, and the necessary steps taken for obtaining a proper supply. Food and Drugs Act. 4. 477 samples were submitted to the Public Analyst, and 16, or 3.3 per cent were found to be adulterated, compared with 7.4, 9.3, 4.3, 2.5, and 3.4, in the five preceding years, and 10.0 in the Metropolis in 1907 and 1908. The very small percentage of adulterations in the past four years is noteworthy. 5. Proceedings were taken in 15 cases. 10 convictions were obtained. 3 cases were dismissed on proof of warranties, and 2 on payment of costs. 6. A total of £14 5s. Od. was imposed in fines, and £10 17s. 6d. in costs. 7. 315 of the samples were fresh milk. 15 of these, or 4.8 per cent. were adulterated, compared with 6.5, 8.7, 4.8, 1.7, and 3.7, in the five preceding years. 51 samples were bought as butter, and one was found to be adulterated. Table XVIII. shows the other 111 articles analysed. Not one of these was found to be adulterated. 8. Of the 12 adulterated milk samples for which proceedings were taken, 5 were for abstraction of fat, 5 for addition of water, and 2 for both. f 2 86 9. Of the 315 milk samples, 86 were taken on Sunday or Bank Holidays; 4 of these were found adulterated. In former years 5 per cent. of samples taken on Sunday were found adulterated. 60 samples were taken on arrival at railway stations, of of which two were found adulterated. 10. A record is kept of all analyses of milk made by the Public Analyst. The average percentage of fat in all unadulterated samples taken last year was 3.6, and of nonfatty solids 8 8. This average percentage has now been been found constant for four years. Out of 301 unadulterated samples, 136 had less than 3.5 per cent. fat, 128 had from 3.5 to 4.0 per cent., and 37 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 1 seizure and 46 surrenders. The seizure was of 16 fowls, which were unfit for food. These were condemned by a Magistrate and destroyed. The vendor was fined £10 and £3 3s. Od. costs. Of the surrenders, 3 were tuberculous, 17 unsound, and 26 livers or other organs affected with parasitic disease or otherwise diseased. The meat affected with tuberculosis was pork in two cases, and cow's lights in the third. The food surrendered as unsound consisted principally of fish. A full list is given in Table XIX. 87 Dairies, cowsheds, and Milkshops. 12. On January 1st, 1910, there were 128 milkshops on the register; 24 were added, and 15 removed during the year, leaving a total of 137 on the register at the close of 1910. There were 205 inspections made, and 10 notices served. Owing to the steps taken by the Health Department requiring persons not to sell milk in unsuitable general shops, the number of milkshops was reduced from 196 to 128 in the five years 1905-9. As it was found that several persons were selling milk without being registered, an advertisement was issued in the local newspapers in April, 1909, calling attention to the illegality of selling milk without being registered. The following abstract of regulations was drawn up; this is left at every milkshop:— Abstract of Regulations as to Milk sold by Retail. (1) Every purveyor of milk carrying on his trade in the Metropolitan Borough of Woolwich, must be registered by the Council of the said Borough. Application for registration must be upon the form provided for the purpose, which can be obtained from the Public Health Department, Town Hall, Woolwich. (2) The Council may remove from the register, or may refuse to enter therein, the name of any person carrying on, or proposing to carry on, the trade of a dairyman or purveyor of milk upon premises which are in their opinion for any reason unsuitable for the sale of milk. 88 Every person selling milk without being registered is liable to a penalty of £5. (3) A person following the trade of a cowkeeper or dairyman or purveyor of milk, or being the occupier of a milk store or milkshop, must not use a milk store or milkshop in his occupation or permit the same to be used, as a sleeping apartment, or for any purpose incompatible with the proper preservation of the cleanliness of the milk store or milkshop and of the milk vessels and milk therein, or in any manner likely to cause contamination of the milk therein. (4) Every purveyor of milk, or person selling milk by retail, must immediately on any outbreak of infectious or contagious disease within the building or upon the premises in which he keeps milk, or amongst the persons employed in his business, give notice of such outbreak to the Medical Officer of Health, Town Hall, Woolwich. (5) Every purveyor of milk, or person selling milk by retail, must immediately on such outbreak coming to his knowledge, remove all milk for sale, and all utensils for containing milk for sale, from such building ; and must cease to keep milk for sale or to sell milk in such building until the same has been disinfected and declared by the Borough Medical Officer of Health to be free from infection. (6) A purveyor of milk, or person selling milk by retail, must not keep milk for sale in any place where it would be liable to become infected or contaminated by gases or effluvia arising from any sewers, drains, gullies, cesspools, or closets, or by any offensive effluvia from putrid or offensive substances, or 89 by impure air, or by any offensive or deleterious gases or substances. (7) Every purveyor of milk, or person selling milk by retail, shall keep milk for sale only in clean receptacles ; and all utensils used in connection with the keeping or sale of such milk shall be thoroughly cleansed with steam or scalding water as frequently as may be necessary, and shall be at all times kept clean. (8) Every purveyor of milk, or person selling milk by retail, shall at all times employ such means, and adopt such precautions, as may be necessary for keeping the utensils and vessels used by him for containing milk in a clean and wholesome condition, and for preserving the purity of the milk, and for protecting it against infection and contamination. (9) Due cleanliness must be observed by persons gaged in any room, shop, or other part 6f the building in which milk is sold. Note.—Any person who contravenes any of the above Regulations is liable to a penalty of Five Pounds. 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 1910 several applications were refused. The usual requirements of the Health Department for securing the purity of the milk are roughly as follows:— The premises must be either (a) Used solely for the sale of milk and dairy produce 90 (b) Confectioners' shops or restaurants. (c) General shops which are of exceptional cleanliness, and in which the variety of articles sold is strictly limited, and no objectionable articles, as oil, coal, greengrocery, etc., are kept. These are only allowed to sell milk when a milk business has already been previously carried on, or where there is no other milk shop near. Where the premises are not confined to the sale of dairy produce, it is usual to require the milk bowl to be kept in a glass case covered in on all sides with a swinging door. In other cases a permanent cover to the milk bowl alone is required. 14. The number of cowsheds remained as before, 17. There were 68 inspections, and 7 notices were served for dirty conditions, etc. There were no prosecutions. Slaughter-houses. 15. There are 11 slaughterhouses on the register. 44 inspections were made, and 3 notices served and complied with. Nuisances (See Table XVa). 16. 398 complaints of sanitary defects were received and investigated, compared with 366, 399, and 497, in the three preceding years. 26 complaints of non-removal of dust were made and attended to, compared with 43, 18, and 28, in the three preceding years. 7 of the dust complaints came from Woolwich parish, 13 from Plumstead, and 6 from Eltham. 91 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 7 defective combined drains were investigated and reported on by the Chief Sanitary Inspector, compared with 29, 16, and 22, in the three preceding years. These drains affected 39 houses. 411 private drains, found choked and defective, were examined, cleared and re-laid, compared with 451, 371, and 440, in the three preceding years. The largest number was found in River Ward. 963 water-closets and w.c. cisterns were repaired, compared with 1,131, 944, and 992, in the three preceding years. 312 foul w.c. pans were cleansed by tenants, compared with 175, 193, and 197, in the three preceding years. Rats. Six complaints of rats were received. These were dealt with by examining the drains which were all found to be defective. When the drain was made good the rats disappeared. Chief Inspector Duck thus describes two instances:— Complaints were made of rats in a chicken-run. On investigation, a drain was found underneath, which had a broken pipe. This was repaired and no further complaint has been received. Complaints were received from the occupiers of a small cottage at the end of a row, that the house was infested with rats, several having been seen during the daytime and much mischief having been done during the night. 92 The smoke test revealed three separate rat-runs connected with a drain outside the house running parallel with the side wall. The drainage system has been completely relaid and there has been no further trouble from rats. 18. Ventilation of Outfall Sewers. There were no complaints during the year as to nuisance 'from the new outfall sewers, but complaints were received as to bad smells from shafts ventilating the outfall sewer in Plumstead Road. These were referred to the London County Council. 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, 528 inspections being made. Regular cleansing has been required. 21. House Inspection. 6,626 houses were inspected, house to house, compared with 6,092, 5,384, and 5,512, in the three preceding years; 6,026 were inspected re infectious diseases and complaints, compared with 7,573, 7,600 and 7,377. In addition to these, 669 inspections of registered houses were made. 22. Table XVI. shows the streets inspected and the number of houses found defective in each. At 2,064 houses, interiors were cleansed, or defective roofs repaired, compared with 2,193, 2,026, and 1,957, in 93 the three preceding years. 523 houses with damp walls were remedied, compared with 369, 368 and 450, in the three preceding years. Improved ventilation was provided in 101 houses, compared with 117, 187 and 120. in the three preceding years. 585 new dust-pails were supplied, compared with 675, 612 and 681, in the three preceding years. 23. Medical Officer's Inspections. These amounted to a total of 770. Special inspections were made at the powsheds, 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. 19 visits were made by request of the medical attendants for the purpose of diagnosing doubtful cases of infectious disease. 15 of these were suspected cases of Scarlet Fever, and two supposed cases of Small-pox which proved to be Varicella, one an actual Small-pox case, and one Enteric Fever. Many other visits re infectious disease were made at the request of school teachers and others. Special house-to-house inspections were made of Hylton Street, Globe Lane, Howick Mansions, Down's Place, Kate's Place, Jackson Street, and Artillery Mansions. 24. Overcrowding. 78 cases of overcrowding were found and remedied (compared with 85, 72, and 97, in the three preceding years) or 1.2 per cent. of house-to-house inspections. Most of the cases of overcrowding are found in house-to-house inspection. 25. Smoke Nuisance. 29 observations re smoke nuisance 94 were made, and 2 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 as practicable, consume the smoke." The nuisanoe 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 22 houses new windows were supplied or existing ones enlarged, or other work done to improve the lighting by daylight. 26a. In my last report particulars were given as to "Dark rooms in houses and failure of the Building Act," and the steps taken by the Borough Council and London County Council in the matter. 27. Verminous Rooms. 143 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, 183, and 159, in the four preceding years. Dust Removal. 28. In Woolwich parish 6,912 loads of house and 145 loads of trade refuse were removed by direct labour, and 95 destroyed at the Woolwich Destructor. "In the three preceding years 7,517, 6,477, and 5,951 loads, respectively, were removed. In Plumstead, 16,941 loads, weighing 13,894 tons, were removed by the contractors, Messrs. Tuff & Hoar, and destroyed by the Plumstead Destructor. £2,805 17s. 7d. was paid for collection, compared with £2,801 in 1909. In Eltham the sum of £840 9s. 10d., compared with £812 19s. 7d. in 1909, was paid to the Contractor, Mr. Tucker, for removal of dust. The contractor on the whole complied with the requirements of the contract. The shoot was kept in a very satisfactory state, in some fields well away from any houses. Trade Refuse. 29. During the past year there have been 7,461 (7,321 in 1909) receptacles of offensive trade refuse removed. The weight of refuse was 362 tons. There are now 53 (57 in 1909) tradesmen on the books from whom offensive trade refuse is removed. There was no complaint of nuisance arising from collection. Chloride of lime is used as a deodorant. 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. Last year was notable for the coming into force of the Housing and Town Planning Act, which replaces the 96 previously existing Housing Acts. Among other important amendments it transfers the power of making closing orders from the Magistrate to the Borough Council. The new provisions have been found to work satisfactorily. Owners have always been given an opportunity of stating their case to the Public Health Committee before an order has been made. The following table shows the action taken:— Number of houses inspected re Housing and Town Planning Act 62 Dwelling houses considered on inspection in a state so dangerous or injurious to health as to be unfit for human habitation 10 Number of representations made to Borough Council with a view to the making of closing orders 10 Number of closing orders made 9 Number of dwelling houses remedied without making closing order 1 Number of dwelling houses put into fit state for human habitation after making closing order Nil The following are the houses referred to in the above table:— 1, Connor's Cottages, Harrow Manorway. House completed and ready for re-occupation. 1, Albert House, High Street, Woolwich. 9, ditto ditto 10, ditto ditto 1. Elizabeth Place, High Street, Woolwich. 2, ditto ditto 3, ditto ditto 4, ditto ditto 97 5, Elizabeth Place, High Street, Woolwich 6, ditto ditto No. 1 Connor's Cottages, was in an exceedingly damp state, and the drainage was unsatisfactory. A damp-course was put in all round and the house was redrained into a new cesspool in accordance with the by-laws. The other houses were in a dirty and dilapidated condition, and No. 1 Albert House, was very dark. Nos. 1, 9, and 10, are separate flats of a block dwelling, and could not therefore be demolished without levelling the whole block to the ground. No. 1 is unfit for human habitation according to the regulations made under Section 17, Housing and Town Planning Act, but Nos. 9 and 10 only require renovation and repairs. The entry to Eliazbeth Place has been boarded up, so these cottages do not appear likely to become a nuisance to the neighbourhood. The following regulations under Section 17 (7), Housing and Town Planning Act, were passed by your Council in July, 1910, and have been approved by the Local Government Board:— Regulations prescribed by the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Woolwich, under Section 17 (7) of the Housing, Town Planning, &c., Act, 1909, with which a room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface pf the part of the street adjoining or nearest to the room shall comply:— (1) Such room shall have in every part thereof at least three feet of its height above the surface of 98 the street or ground adjoining or nearest to the room; provided that, if the width of the area hereinafter mentioned is not less than the height of the room from the floor to the said surface of the street or ground or is not less than six feet, the height of the room above such surface may be fess than three feet, but it shall not in any case be less than one foot. (2) Every wall of such room shall be constructed with a proper damp-proof course, and if in contact with the soil, shall be effectually protected against dampness from that soil by means of a vertical damp-proof course or otherwise. (3) There shall be outside of and adjoining the room, and extending along the entire frontage thereof, and open upwards from six inches below the level of the floor thereof, an area properly paved and effectually drained at least three feet wide in every part, and of a mean width not less than four feet. Provided that in the area there may be placed steps necessary for access to the room, and over and across such area there may be steps necessary for access to any building above the room, if the steps in each case be so placed as not to be over or across any external window of the room. (4) The space, if any, beneath the floor of such room shall be provided with adequate means of ventilation. (5) Any drain passing under the room shall be properly constructed of a gas-tight pipe. (6) The room shall be effectually protected against the rising of any effluvia or exhalation by means of 99 a layer of good cement concrete, at least six inches thick, laid upon the soil of the site of the entire room, or in some equally effectual manner. (7) If the room is without a fireplace, and a flue properly constructed and properly connected with such fireplace, it shall be provided with special and adequate means of ventilation by a sufficient aperture or air shaft which shall provide an unobstructed sectional area of one hundred square inches at the least. (8) The room shall be sufficiently lighted by one or more windows opening directly into the external air. Provided that such window or windows shall have a total area clear of the sash frames equal to at least one-tenth of the floor area of the room. Every such window shall be so constructed that one half at least can be opened, and that the opening may, in every case, extend to the top of the window. In the 1909 report statistics were given as to the health of persons living in new and old houses in North Woolwich, and reasons were adduced for believing that the better health of the inhabitants of the newer houses was due to these having concreted sites, instead of being unprotected from earth damp like the older houses. 31. 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 11, 9, 6, and 2 weeks respectively. The number of persons housed is about 130, or 5 to a house. For particulars as to rent and cubic space of these houses, see Annual Eeport, 1904, page 70. G 100 Of the Council's 12 houses in Gossage, Park, and Parkdale Roads, 10 were occupied throughout the year; Nos. 3 and 7, Gossage Road, were empty for periods of 46 and 21 weeks respectively. No.. 3 had been empty for many months on account of dampness. No. 5, which suffered in the same way, was dealt with in 1909, and the steps taken having been found satisfactory, No. 3 was similarly treated by the Borough Engineer at a cost of £110. No. 7, a four roomed house, was rented at 12s. and did not easily find a (tenant ; on the rent being reduced to 11s., and £40 being spent in providing a dry area and damp course, and in general repairs, it was again let to a satisfactory householder. 32. Houses Registered under the By-Laws. At the commencement of the year 395 houses were on the register; 22 were newly registered, and 8 taken off the register, leaving 409 on the register at the close of the year, compared with 265, 307, 332, 359, and 395, in each of the five preceding years. 33. These houses were inspected, some quarterly, others half-yearly or yearly. 669 inspections were made in all, and 220 notices were served. The registered houses were under the care of Miss Middlebrooke, and Inspector Shaw ; further particulars will be found in Miss Middlebrooke's report given further on. In October the houses were situated as follows:— River "Ward, North 27 River Ward, South 101 St. Mary's 33 Dockyard 69 101 St. George's 53 Herbert 3 Burrage 19 St. Margaret's 16 Central 3 Glyndon 16 St. Nicholas 63 Inhabited House Duty. 34. Application was received for a certificate under the Revenue Act for a block of superior flats No. 9, Artillery Mansions. The top flat occupied by the caretaker was found very damp, and the w.c. dark and insufficiently ventilated. These defects having been remedied the certificates were granted. Certificates were also requested for Howick Mansions, two blocks of 11 workmen's dwellings, including two shops. Certificates were given for Nos. 3, 4, 9, 10 and 11. Nos. 1 and 2, do not comply with the regulations under Section 17 (7) Housing and Town Planning Act, and Nos. 7 and 8 are basements with insufficient light and perflation. Certain sanitary defects were found at Nos. 5 arid 6, which have not yet been remedied. Certificates were therefore refused for Nos. 1, 2, 5, 6, 7, and 8. Certificates were also given for Nos. 6, 6a, 7, 7a, 8, 8a, 9, 9a, Mount Pleasant. Common Lodging-houses. 35. There are 19 common lodging-houses in the Borough, 17 for men and 2 for women. Total accommodation (for 585 persons is available. The following is the list: — G 2 102 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 .. 30 102 do 22 .. 22 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 541 44 585 Underground Rooms. 36. Three underground rooms, separately occupied, in Burrage Ward, were found not in accordance with the Public Health (London) Act. The service of notices led to cessation of occupation. Factories, Workshops, and Workplaces. 37. There were, at the close of the year 203 (227 in 1909) workshops and workplaces on the register. 639 inspections were made, and 81 notices served and complied with. 75 inspections of factories were made regarding sanitary accommodation and 21 notices served and complied 103 with. 266 inspections of home workers' premises were made and 15 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; 23 new workrooms were measured up and put on the register. 38. A special report on Home-work was presented to your Council on October 31st, 1906, and printed in the Annual Report of that year. Bakehouses. 39. The number of factory bakehouses is 9, and of workshop bakehouses in use is 44, 16 of the latter being underground. One underground was certified during the year, and 9 bakehouses (2 underground) were discontinued. They were all inspected twice. I inspected most of them personally, and found them generally satisfactory. Ten (Certified underground bakehouses are not in use. Ice-cream Shops. 40. Eighty-six ice-cream shops were on the register at the close of the year, compared with 76, 108 md 98, in the three previous years. Four were added and 16 removed during the year. There were 198 inspections made, and 5 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. The shops are inspected in April, June and August, by Inspector Powell. 104 disinfection. 41. The mode of disinfection, cost of appliances, staff, etc., were fully described in my Annual Report, 1903, pages 73-76. Rooms at 964 houses were disinfected, compared with 1,392, 1,333, and 987, in the three preceding years. The disinfecting apparatus was used 939 times for 18,200 articles. 375 books from the Free Libraries and Public Schools were disinfected. The sum of £4 8s. Od. 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 infections disease, and for use by the contractor in dust receptacles. They are dispensed at the Maxey Road Depot the Sun Street Mortuary (73 persons were supplied in 1908, 110 in 1909 and 71 in 1910), 14, Barge House Road, North Woolwich (18 persons supplied), and at the Eltham Office, 144a, High Street (24 persons supplied). The cost of disinfectants used by the department in 1910 was £41 8s. l0d. 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.). Health Shelter. 42. The Health Shelter was not used during the year. 105 It was used twice in 1906, once in 1908, and not at all in 1903, 1904, 1905, 1907 and 1909. 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. 43. The Sun Street Mortuary was used for 136 bodies, compared with 171, 151 and 146, in the three preceding years. 123 were deposited for inquest, and 13 for custody. 7(8 post-mortem examinations were made. One body was deposited in the infectious mortuary, compared with two in 1907, none in 1908, and one in 1909. The Eltham Mortuary was used for three bodies, two for inquest and one for custody, compared with one in each of the 'two preceding years. cemeteries. 44. The two Borough Cemeteries were well maintained as usual. 669 bodies were buried in the Woolwich Cemetery, compared with 670, 609, and 613, in the three previous years. There were 696 interments in the Plumstead Cemetery, compared with 753, 656, and 732, in the three previous years. 51 burials took place in Plumstead Churchyard, compared with 40, 22 and 59, in the three preceding years. There has been an increase in burials in the Churchyard during the past two years. It is much to be desired (in the interests of public health and social amenity that interments in this burial ground, which is now surrounded by houses, should cease. Cemetery Accommodation for Eltham. I reported that 106 there was burial accommodation for Eltham parish for five years only, and recommended the provision of a small Cemetery with a Crematorium. I also recommend that the Council should endeavour to further any project by which the means of communication with the Woolwich Cemetery might be improved. Cleansing of Verminous Persons. 45. The station for cleansing verminous persons was opened in November, 1906. During 1910 it was used by 590 persons, compared with 19, 257, 262 and 408, in the four previous years. The users were 139 adults, viz:— 1 female, and 138 males; and 451 children, viz.:—210 females and 241 males. The increased use has been both among men and children. 3,714 articles were disinfected, and the disinfector was used 456 times. The adults came mainly from common lodging-houses, and the children were mainly sent from County Council Schools. There has been a greatly increased use of the station by school children, who all come now for verminous bodies. Verminous heads are dealt with at home under the direction of the school nurse. The increase of children bathing is due to the greater stringency of the Education Authority in requiring cleanliness of scholars. No female attendant has yet been provided, but, under a proposed agreement with the London County Council, this great deficiency will be removed. The construction and modus operandi of the station were fully described in the 1906 report. A box of white precipitate or stavesacre ointment is supplied to each bather with instructions for its use. The 107 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 verminous bedding and rooms. Tents, Vans, and Sheds. 46. During the year, 48 tents, vans, and sheds, were inspected (27 in 1909) and the bye-laws enforced. notices and prosecutions. 47. 3089 written intimation notices, and 541 statutory notices were served. 56 of the latter, not having been complied with in the time specified, were referred to the Town Clerk, who, before taking proceedings, wrote a warningletter in each case. Finally 5 defaulters were summoned at the Police Court. The results are given in Table XVII. Bacteriological Examination. 48. 751 bacteriological examinations were made for the Public Health Department by the Lister Institute, viz 525 for Diphtheria, 210 for Phthisis, and 18 for (Enteric Fever. The total cost was £120 5s. Od. compared with £1/48 18s. l0d. in 1909. Infants' Milk Depot. 49. Full particulars as to the establishment, objects, mode of working, and apparatus, of the Infants' Milk Depot, have been given in four previous Reports, the first one being separately printed in 1906, and the others forming part of the Annual Reports of 1907, 1908 and 1909. 108 The Depot was closed July 31st, 1909, according to the following resolutions:— "That, having regard to the demand upon the rates of between £400 and £500 per annum, caused by the maintenance of the Infants' Milk Depot, it be an instruction to the Public Health Committee to take the necessary steps to discontinue at the earliest possible date the use of the Depot as a Council undertaking, either by transferring it to a private firm, or by closing the Depot and selling the apparatus."—Council's Minutes, 20th April, 1910, page 426. "We considered the instruction passed by the Council at their last meeting to discontinue the use of the Milk Depot as a Council undertaking at the earliest possible date, and Resolved— (a) That advertisements be issued in the 'Kentish Independent" and one trade paper, inviting tenders for the acquisition of the Milk Depot business, including apparatus and utensils used in connection therewith. (b) That the Female Health Visitor be instructed, through the Medical Officer of Health, to continue to visit the homes of infants and advise mothers, where necessary, as to the proper care and food of the children. (c) That the Medical Officer of Health be instructed to fix a monthly advisory centre, with a view to meeting parents who desire advice respecting the up-bringing of their infants. 109 (d) That notice be given to Mr. H. J. Chard to terminate on July 30th, 1910, his contract with the Council for supply of Milk to the Depot. (e) That the manageress, female assistants, carman and boy employed at the Milk Depot, be notified that their duties under the Council in connection with the Milk Depot will cease on July 30th, 1910. (/) That the mothers of infants who are at present using Depot milk be informed that the supply by the Council will cease about July 30th, 1910.—Council's Minutes, 23rd May, 1910, page 475. By order of the Council I made a report as to the value of the Depot and the results likely to follow its closure, which was printed in the Council's Minutes for 29th June, 1910, page 576. Infant Consultation. 49a. As long as the Milk Depot existed, mothers whose infants had Depot Milk were easily induced to bring their babies to the Depot for weighing and advice as to feeding. Many of these brought friends with babies fed at the breast or by hand. Consequently the weekly consultations were well attended. When the Depot was closed, the Health Committee decided that the consultations should be continued at the Town Hall, which, though less centrally situated geographically than the Milk Depot, is nearer to the business centre of the town, and seemed therefore likely to be as good a centre. The Health Visitor and Medical 110 Officer of Health attend here every "Wednesday from 2.30 to 4.0 for this purpose. But the attendance immediately fell off to about one-third of the previous numbers, and so far Miss FitzGerald has not succeeded in persuading mothers to come to a larger extent. No doubt more would come if there were three or four centres in different parts of the Borough, but this could hardly be managed with the present staff. Further information on this subject is given below in Miss FitzGerald's report. The following tables show the numbers weighed, and the results of weighing:— Infants Weighed—Hand and Depot Fed. Number of infants weighed 84 Number of infants weighed three times or more 62 Number of weighings 524 Of those weighed three times or more:— Number who gained more than average amount 35 Number who gained average amount 8 Number who gained less than the average amount or lost 19 Breast Fed. Number of infante weighed 73 Number of infants weighed three times or more 43 Number of weighings 194 Of those weighed three times or more:— Number who gained more than average amount 11 Number who gained average amount 16 Number who gained less than the average amount or lost 16 Ill 111 Women Sanitary Inspectors' Work. 50. There are two Women Sanitary Inspectors, one of whom is specially a Health Visitor. I have repeatedly urged the desirability of appointing more women to do this important work, and the closure of the Milk Depot makes the need greater than ever. The Health Committee authorised me to obtain the services of an unpaid Assistant Health Visitor, and Miss Chappie was engaged in November. The following is a summary of Miss Middlebrooke's work for the twelve months:— Houses Let in Lodgings. Total number on register 409 Number of Inspections 570 „ Re-inspections (estimated) 1,364 „ Found satisfactory 182 „ Notices served 220 „ Nuisances, defects and offences against the By-laws dealt with and remedied 829 „ Cases of overcrowding remedied by redistribution without notice 8 „ Houses measured 15 Notices. On Landlords for Cleansing 178 „ Tenants for Cleansing 208 „ Landlords for Overcrowding 3 „ Tenants for Overcrowding 20 „ Landlords and Tenants for other defects 412 „ Landlords and Tenants for Verminous Rooms 35 Women's Lavatories at Railway Stations, &c. Number of inspections 63 „ Found defective and dirty 6 112 Restaurants and Eating-Houses. Number of inspections 102 „ Defects and dirty conditions found and remedied 35 Factories and Workshops. Number of inspections of Factories and Workshops 161 „ Notices served 18 „ New workrooms measured 23 Homeworkers' Premises. Number of inspections 266 „ cases referred to district inspectors 16 Miscellaneous. Total number of houses visited re Phthisis, Measles, and Zymotic Enteritis 425 „ Visits paid for various causes, viz., complaints, and verminous and dirty houses and bedding 701 „ Intimation Notices served 226 „ Statutory „ „ 61 „ Cases referred to District Inspectors 121 „ Dustbins supplied 63 „ Accumulations of refuse removed 21 „ Cases where animals were kept in such a state as to be a nuisance 4 „ Re-inspections (excluding registered houses) estimated 1,200 „ Early morning inspections 5 51. Miss Middlebrooke gives details of her work as follows:— 113 Verminous and Dirty Homes. In last year's report I described a few of the difficulties encountered in the work of visiting verminous and dirty homes. The number of children who have been sent to the Cleansing Station during this year has again much increased, probably owing to the continued vigilance of the school authorities, the working of the Children Act, and the frequent infliction of fines for non-attendance at school. When vermin is found on a child's body or clothing, the child is excluded from school until a certificate is produced signed by the Cleansing Station Officer to the effect that the child has had a bath fend has had his or her clothing disinfected. It must not be thought that the increased number of children using the station and the increased number of visits paid to the homes indicate that matters instead of improving are getting worse. The truth is that the standard of cleanliness required is gradually getting higher. Of course in some cases one finds it very difficult to effect an improvement, especially where the sense of decency and self-respect is lacking, but in spite of many disappointments we are, I feel assured, gaining ground rapidly. Owing to the great difficulty experienced in some cases of getting verminous bedding and articles delivered up for disinfection, a Statutory Notice form was drafted requiring the owner of the verminous articles to allow the Disinfecting Officer to enter and remove the articles for disinfection. To each notice is appended a certificate of the Medical Officer of Health. The notice is used with good 114 results. There are many reasons why occupiers object to the disinfection of their bedding, but the principal reason is the dread of adverse criticism from neighbours and friends; this dread of their neighbours' opinion is a useful factor and prevents many women from reverting to their negligent, dirty habits. Restaurants and Eating-Rouses. The chief offenders against the laws of cleanliness in this branch of the work are the fried fish vendors. Premises where the frying of fish is carried on are sometimes found to be in a very dirty condition. The cleansing of the frying vats having been neglected, they become coated with a substance which is very offensive and must be harmful to the consumer of the fish fried in them. The floor too round the frying apparatus soon gets covered with black grease, which it is difficult to remove if left for any period. It is necessary that scrupulous cleanliness should be observed in this trade, otherwise the shop might become a source of danger to many. To give an instance of the careless attitude assumed by some of the proprietors of the fish frying establishments:—A notice was served on Mrs. S. to cleanse the floor of her shop which was used jointly for frying purposes and dining room. She came to remonstrate with me in great disgust, stating that she coul!d not see the slightest necessity for the cleansing of the floor, seeing that it was well swept daily, and a layer of nice clean sand sprinkled over it; and that, should I insist on the removal of 115 all the grease, it would necessitate the provision of a new floor, the old one not being strong enough to stand the strain of the cleansing process. It was found, however, that her fears were groundless, and the floor was brought into a satisfactory state by means of scraping and chipping the grease away. In all kitchens where cooking is carried on on an extensive scale the walls get permeated with grease from the steam and require frequent cleansing. Where possible persuasion is used to get a smooth impervious painted surface for the walls, which can easily be washed down. The cleanliness of the sculleries, sinks, and outside premises, of the utensils used in cooking, and the disposal of offal and refuse in covered receptacles prior to its frequent removal, is specially insisted upon. 52. The following is Miss FitzGerald's report:— Summary of Inspections. Visits to houses after notifications of births 1811 Re-visits 401 Visits after infant deaths 68 Visits re Zymotic Enteritis 94 Re-visits 37 Visits to Depot-fed infants 478 Visits re Phthisis 101 Special visits 78 Infants weighed at Consultation 803 Health lectures given 4 Eeported to District Inspectors: — Structural defects 15 H 116 Dirty interior walls 10 Overcrowding 5 Other matters 13 In spite of a slight increase in the infant death-rate for the year under review, there are encouraging signs that the general level of knowledge on the subject of infant rearing is rising. There are fewer long-tube feeding bottles met with; and there is less tendency to resort to the use of patent foods for those infants under nine months of age who are unfortunately obliged to be hand fed. A card of instruction on infant feeding and rearing is sent out to every home on the notification of a birth. In the drawing up of this card no pains have been spared to make it as full of information and as simple as possible, and it seems to be generally appreciated. In the majority of cases it is hung up, and the mothers frequently say, in reply to a question as to how the baby is fed, that they feed him "by the Borough Council Card." It is to be regretted that, with the closing of the Milk Depot, the weekly attendance at the Infant Consultation and weighing has fallen in numbers very considerably. I make every effort to persuade as many mothers as possible to avail themselves of the opportunities which the Consultation offers of testing their babies' progress by weighing and of getting advice in the matters of feeding and rearing as the child grows and develops. A great number promise readily to come, but only a few of those who promise actually do come. The numbers would doubtless be higher if we had mora 117 Consultation centres; the Town Hall is not in the centre of the Borough, and it is a long way for the mothers to come from the more distant parts of Plumstead, to say nothing of Abbey Wood and North Woolwich. Only one Eltham mother has ever come to the weighing. With the present staff it is not possible to have more than one weighing centre as it would take too much time from the domiciliary visiting. The Consultation is, however, a most useful adjunct to the home visiting. I find more and more, in visiting the homes after the notification of births, that a good deal more than the condition of the particular baby, which is the occasion of one's visit, needs to be enquired into. Particularly is this true of the feeding and condition generally of the children above the age of infancy and under school age. We have, up to the present, concentrated somewhat exclusively on the infant, and I think that, as a result of this, the infant is now on the whole more hygienically fed than his brothers of two years and upwards. I have witnessed the preparation of most unwholesome kinds of food destined for quite young children. One mother informed me that her little girl was so delicate that she could only fancy such things as sausages for her dinner! I have seen very small children eating pickles and bread for their mid-day meal. Apart from such gross errors as these, children often suffer from the lack of knowledge on their mother's part qf food values and how best to expend money on food. In visiting the homes of Consumptives I 118 deavour, whenever possible, to give some simple advice on the choice and preparation of food, not only with a view to the patient's own welfare, but that of his or her family. I should like to express my appreciation of the valuable aid to my work rendered by the Assistant Health Visitor. The work, which has for its object the improvement of the health of the children in their homes, tends to increase and multiply in many ways, especially with the growth of agencies both voluntary and official, aiming at the welfare of child-life. It is before all things essential that the Health Visitor, going as she does, day by day, into the homes of the people, should keep her work in touch with these agencies. For want of this co-operation a great deal of valuable time and effort is wanted in social work. But it takes up time and necessitates much letter-writing. It is, however, one of the characteristics of health visiting that the more work one does the more work one creates to do. One visit paid may reveal conditions which necessitates five or six or even ten or twenty future visits. I found Miss Chappie's assistance of great value with the re-visits, and with some of the routine visiting after births; her help on Consultation days in weighing the babies was of great service. She began work here on November 28th, 1910, and between that time and April 11th, when she resigned her temporary appointment on having obtained an appointment at Taunton, she paid 448 visits. 119 Public Ambulance. 53. The Public Ambulance, for accidents and non-infectious illness, was used 86 times, compared with 110, 104, 122, 143, and 123, in the five preceding years. The following were the journeys made:— To Guy's Hospital 22 Cottage Hospitals 22 Seamen's and Miller Hospitals 5 King's Hospital 1 London Hospital 7 Charing Cross Hospital 8 Union Infirmary 2 Other hospitals 1 Private houses 18 Particulars of this ambulance were given in my Annual Report, 1903, page 78. The ambulance is kept in good repair. An ambulance for non-infectious illness can now be obtained from the ambulance station of the Asylums Board on payment of 5s. This may explain the diminished use of the Woolwich ambulance. 54. Conference of Metropolitan Borough Councils re Sanatorium Accommodation for the Metropolis. In company with Councillor Colonel Leslie I attended this Conference on the 25th May. The Conference arose out of a drawing-room meeting held at Elackheath, at which Dr. Carling of Peppard Sanatorium, and Dr. Newsholme, Medical Officer, Local Government Board, spoke, advocating sanatorium treatment for 120 sumption. The meeting appointed a deputation to wait on the Councils of Lewisham and Greenwich, inviting them to take the same steps as have been taken in Woolwich to provide beds for sanatorium treatment at some existing sanatorium. The Borough Council of Greenwich received the deputation and gave careful consideration to 'the suggestion made. They decided, however, that the matter was one for joint action on the part of the London Sanitary Authorities, and consequently called a Conference. The Conference met at the Caxton Hall, Westminster, and the chair was taken in the first place by the Mayor of Westminster, and in the second by Canon Horsley, the Mayor of Southwark. The following resolutions were moved on behalf of the Greenwich Borough Council by Dr. Gordon Parker, and after a long discussion were carried:— (a) That in the opinion of this Conference it is able that a sanatorium should be established for the accommodation of persons of the working class of the Metropolis suffering from Tuberculosis, and that such institution should be maintained by a charge upon "the several Metropolitan Boroughs in accordance with their respective rateable values. (b) That in the opinion of this Conference the proposed sanatorium should be under the direct control of the Metropolitan Asylums Board, and that such Authority be asked to seek the necessary Parliamentary powers for that purpose (if necessary). (c) That copies of the above resolutions be forwarded to the Metropolitan Asylums Board and to the Local Government Board. 121 The following resolutions were moved by your Medical Officer of Health and seconded by Colonel Leslie:— (a) That further provision for sanatorium treatment of poor patients suffering from Phthisis is required in London, for educational and curative purposes, and also for isolation of advanced cases. (b) That the education and cure of persons suffering from Phthisis may be best and most economically secured by each Metropolitan Borough maintaining, at some existing sanatorium, a certain number of beds according to their requirements. (c) That the Metropolitan Asylums Board should make provision for the isolation of advanced cases of consumption, and that such Board be asked to again approach the Local Government Board to this end, and to take such further steps as may be necessary. In speaking on this motion I pointed out the great benefits Woolwich had derived from sanatorium treatment at Peppard, and the importance of provision by the Metropolitan Asylums Board for advanced cases of consumption. Such Board, however, is not one to which, in my opinion, should be entrusted the provision of additional buildings suitable for educational treatment, and treatment of early and curable cases of consumption. If the Metropolitan Asylums Board undertakes this latter work it will be done at much greater expense, and not so well as if it were done at small existing sanatoria. It is, however, satisfactory that London is being roused to the importance of sanatorium provision, and, even if the Metropolitan Asylums Board again decide to take no action 122 in the matter, the Conference will undoubtedly be productive of good. Already I have received enquiries from three other Boroughs as to the provision of beds at Peppard Sanatorium. School Attendance Medals—Proposed Abolition. I have frequently had to call attention to the fact that children attend school when they are suffering from some form of illness, and that these attendances were to a large extent the result of the encouragement of the School Authority by giving medals for regular attendance. The Borough Council recommended the abolition of this system in 1907. The Education Committee of the London County Council has now issued the following report:— On the 23rd July, 1907, we submitted a report stating that we had considered on the one hand the abolition of the system of the award of medals for regular and punctual attendance of children attending the Council's schools, and on the other its retention and extension to non-provided schools, and had decided to recommend the abolition of the scheme. The Council on 8th October, 1907, after considerable discussion, referred back our recommendation with instructions to report as to amending the rules, and as to the possibility of extending the medal system to the non-provided schools. Subsequently on 2nd March, 1909, we again reported on the subject, pointing out the absurdity of the regulations as they affected absences for infectious illness and again recommended the abolition of the medal scheme. The Council on 16th March, 1907, however, a second time referred our recommendation 123 back, with instructions to report as to returning to the medal system prevailing up to 4th February, 1908. The medal regulations now in force permit only four absences or late attendances during the year without loss of medal. Cases, however, frequently occur in which, in the interests of the health of the individual child and of the school, it is important that a child should, through no fault of its own, be absent from school for a short period. It will, therefore, be seen that the administration of the medal scheme is becoming increasingly difficult. Many absences of a wholly unavoidable nature occur, and the Council is being seriously hampered in the discharge of its duties in respect of caring for the health of the children by the existence of regulations which we regard as antiquated. In all the circumstances we are strongly of opinion that the medal scheme should now be abolished. We have informed the Finance Committee of our proposals, and we recommend That, as from 1st August, 1910, the award of attendance medals be discontinued; and that the scheme governing such award be abolished." I regret to say that the recommendation was not carried by the Council, and the matter was referred back to the Education Committee. On my recommendation a letter was sent to the London County Council supporting the recommendation of the Education Committee; asking the other Metropolitan Borough Councils to take simitar action; and the members of the 124 London County Council for the Borough to support the action taken. 56. There was no change in the staff of the department during the year. I have gratefully to acknowledge the devoted and able assistance of Chief Inspector Duck and other members of the Public Health Staff, who have conscientiously worked for the improvement of the public health and the diminution of sickness and physical inefficiency. 125—126 TABLE I. Borough of Woolwich. Vital Statistics of the whole District during 1910 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 Instiiutions 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 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 1909 127993 2937 22.9 240 82 1415 ... 323 51 223 1585 12.4 Average for years 1900 to l909 124291 3418 27.5 395 113 ... ... ... ... ... 1698 13.7 1910 128448 2844 22.1 241 84 1296 314 42 156 1410 11.0 * 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 asylumns. 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. 127 TABLE 1a. I. II. Institutions within the District receiving Sick and Infirm Persons from outside the District. Institutions outside the District receiving Sick and Infirm Persons from the District. Woolwich Union Infirmary Lewisham Infirmary Royal Arsenal Hospital Herbert Hospital Auxiliary Hospital Blackheath Cottage Hospital Woolwich and Plumstead Cottage Hospital Seamen's Hospital Brook do. Eltham Cottage Hospital Park do. Home for Mothers and Babies Gore Farm do. Guy's do. King's College Hospital London do. St. Bartholomew's do. Charing Cross do. Westminster do. St. Thomas's do. East London do. Poplar do. St. Peter's do. St. John's, Lewisham, Hospital Children's Hospital West London do. Fulham Road Consumption Hospital Ear and Nose Hospital Brompton do. Bethnal Green do. Cane Hill Asylum Dartford Heath Asylum Colney Hatch clo. Clay bury do. Tooting Bee do Darenth do. Caterham do. Stone do. Banstead do. Horton do. Hostel of God do. 129—132 TABLE II. Vital Statistics of Separate Localities, 1901-2-3-4-5-6-7-8-9-10. Increase of Population since 1901 Census, estimated by number of new houses occupied, and number of persons to a house in the Parish. Wards. 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 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 Registered Deaths at all ages Deaths under 1 year Population estimated to middle of year Births Registered Deaths at all ages Deaths under 1 year Dockyard 8712 282 137 40 8712 286 146 28 8712 275 141 28 8712 286 159 39 8712 326 140 33 8712 244 146 37 7800 268 122 23 7800 120 28 7800 227 116 12 Woolwich, 38,991 979 494 87 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 Burrage 9837 253 133 24 9837 228 154 28 9837 235 133 17 9726 219 123 23 9726 217 119 17 9726 201 140 27 9726 202 109 16 9184 142 15 9184 206 143 19 West Plumstead 40,907 881 486 70 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 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 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 East Plumstead 34,500 711 320 t 64 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 14050 273 111 i 19 N.B.—The births in 1909 are the notified births increased in the proportion of Registered to notified births in the whole borough. 133 TABLE III. Cases of Infectious Disease notified during the Year 1910. Notifiable Diseases. Cases Notified in whole District. Total Cases Notified in each Locality. Cases of Mistaken Diagnosis included in the preceding figures. Cases removed to Hospital. All Ages. Age— Periods. Woolwich. Plumstead. Eltham. Under 1 1-5 5—15 15-25 25—65 65 and upwards East West Small-pox 1 ... ... • • • ... 1 ... 1 ... ... ... ... 1 Cholera • • • ... • • • • • • ... ... ... ... • • • ... ... ... ... Diphtheria 171 2 50 93 10 16 ... 41 55 68 7 24 139 Membranous Croup • • • • • • ... • • • • • • ... • • • • • • ... ... • • • ... Scarlet Fever 524 4 137 330 32 21 ... 135 205 161 23 18 470 Typhus Fever ... ... ... ... ... • • • ... ... ... ... ... ... ... Enteric Fever 10 ... ... 2 3 5 ... 3 ... 5 2 2 5 Relapsing Fever • • • • • • ... • • • ... ... ... ... • •. ... ... ... ... Continued Fever • • • • • • • • • ... ... ... ... ... ... ... ... ... Puerperal Fever 7 • • • ... ... 1 6 ... 3 3 1 ... ... ... Erysipelas 89 4 5 7 8 55 10 17 44 24 4 ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis 1 1 ... ... ... ... ... ... ... ... 1 • • • 1 Total 803 11 192 432 54 104 10 200 307 259 37 44 616 135—136 TABLE IV.—Causes of, and Ages at Death during the Year 1910. Disease. Deaths in or belonging to whole District at subjoined ages. Woolwich. Plumst'd Eltham. Public Institutions in the Borough. Outlying Institutions. 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. West. East. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 21 12 9 5 13 3 ... ... ... ... ... ... ... ... ... ... 11 3 4 3 ... ... Scarlet Fever 13 9 4 1 4 6 1 ... ... 1 ... ... ... ... ... ... 2 7 4 ... ... 10 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 39 17 22 1 3 ... ... ... ... 5 2 4 9 7 0 2 7 14 14 4 5 ... Whooping Cough 25 9 16 15 10 ... ... ... ... ... ... ... ... ... ... ... 10 9 4 2 ... 1 Diphtheria and Membranous Croup 5 3 2 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... 3 2 ... ... 4 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa and Dysentery 4 ... 4 4 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 2 1 Epidemic or Zymotic Enteritis 13 10 3 9 2 1 ... ... ... ... ... ... ... ... 1 ... 2 2 8 1 1 ... Enteritis 13 9 4 8 ... ... ... ... ... 1 1 ... ... ... 2 ... 5 5 3 ... ... ... Other Continued Fevers 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Erysipelas 3 2 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 1 ... ... ... Puerperal Fever 3 ... 3 ... ... ... ... ... ... 3 ... ... ... ... ... ... 2 1 ... ... ... 1 Other Septic Diseases 12 11 1 1 ... 1 ... ... ... 3 2 ... ... 1 1 ... 5 2 3 2 3 5 Syphilis 7 6 1 5 ... ... ... ... ... ... ... 2 ... ... ... ... 3 2 2 ... 3 2 Rheumatism 4 3 1 ... 1 1 ... ... ... ... 1 ... 1 ... ... ... ... 1 3 ... ... ... Gout 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Meninges 19 6 13 2 12 3 2 ... ... ... ... ... ... ... ... ... 6 5 6 2 1 1 Tuberculosis of Lungs (Phthisis) 133 73 60 ... 1 ... 2 10 ... 24 41 18 15 8 ... ... 54 44 30 5 38 11 Tuberculosis of Intestines and Peritoneum 7 3 4 3 1 2 ... ... ... ... ... ... 1 ... ... ... 2 1 3 1 ... 2 Other forms of Tuberculosis 17 13 4 3 1 3 3 1 ... 2 2 ... 2 ... ... ... 6 4 7 ... 4 3 Alcoholism 7 3 4 ... ... ... ... ... ... ... 3 2 2 ... ... ... 3 3 1 ... 5 ... Cancer 100 47 59 ... ... 1 ... ... ... 3 13 24 31 25 9 ... 40 40 19 7 24 18 Diabetes 8 4 4 ... ... ... ... ... ... ... 2 1 1 3 1 ... 1 2 1 4 1 ... Premature Birth 51 32 19 51 ... ... ... ... ... ... ... ... ... ... ... ... 21 16 8 6 7 1 Developmental Diseases 60 33 27 57 2 ... 1 ... ... ... ... ... ... ... ... ... 20 21 13 6 6 6 Old Age 89 40 49 ... ... ... ... ... ... ... ... ... ... 21 45 23 27 33 21 8 31 6 Meningitis 12 6 6 4 3 ... ... 1 ... ... 2 1 ... ... 1 ... 3 5 4 ... 2 1 Inflammation and Softening of Brain 6 2 4 ... ... ... ... ... ... 1 ... ... ... 3 2 ... 2 4 ... ... 2 ... Epilepsy 6 3 3 ... ... ... ... ... 1 2 1 1 ... ... ... 3 1 2 ... 1 2 General Paralysis 8 6 2 ... ... ... ... ... ... 1 ... 3 3 ... 1 ... 5 2 ... 1 ... 5 Tabes Dorsalis and Locomotor Ataxia 3 3 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 2 ... 1 ... 1 ... Peripheral Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Brain and Nervous System 29 15 14 13 4 1 ... ... 1 2 l 1 2 1 3 ... 11 5 11 2 3 4 Organic Diseases of the Heart 132 67 65 ... ... 2 5 7 3 9 9 20 36 28 13 ... 45 50 27 10 26 11 Cerebral Haemorrhage, Embolism and Thrombosis 72 28 44 ... ... ... ... ... ... 3 2 4 22 23 15 3 15 26 22 9 17 2 Apoplexy and Hemiplegia 20 7 13 ... ... ... ... ... ... 1 1 3 3 5 6 1 9 6 3 2 5 1 Other Diseases of Blood Vessels and Heart 24 18 6 ... ... ... ... ... ... 2 2 3 2 19 5 ... 7 9 4 4 3 4 Acute Bronchitis 60 20 34 22 11 ... 1 ... ... ... 2 2 4 7 8 3 19 25 <4 2 3 3 Chronic Bronchitis 72 38 34 ... ... ... ... 1 1 ... 3 4 13 28 19 3 20 28 18 6 20 3 Lobar (Croupous) Pneumonia 11 8 3 1 ... ... ... 1 1 1 1 1 3 2 ... ... 4 5 1 1 ... 4 Lobular (Broncho) Pneumonia 40 19 21 11 10 ... 2 ... 1 1 1 1 7 3 2 1 19 13 7 1 2 2 Pneumonia 49 25 24 2 9 2 2 2 1 3 4 8 9 2 4 1 23 13 9 4 9 3 Other Diseases of Respiratory System 4 2 2 ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 1 3 ... ... ... 1 Diseases of Stomach 8 2 6 1 1 1 ... ... ... ... 1 2 2 ... ... ... 2 4 2 ... ... 2 Obstruction of Intestines 14 3 11 4 ... ... ... ... 1 ... 1 1 1 3 2 1 7 3 2 2 4 3 Cirrhosis of Liver 10 6 10 ... ... ... ... ... ... ... 4 5 5 2 ... ... 9 1 6 ... 7 ... Other Diseases of the Digestive System 10 7 3 ... ... ... ... 1 1 1 ... 3 1 2 1 ... 2 6 ... 2 ... 3 Nephritis and Bright's Disease 43 18 25 ... 1 1 ... ... ... 1 7 4 14 9 6 ... 13 14 11 5 10 6 Tumours and other Affections of Female Genital Organs 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... l ... ... ... Accidents and Diseases of Parturition 6 ... 6 ... ... ... ... ... ... 4 2 ... ... ... ... ... 1 5 ... ... 1 ... Deaths by Accidents or Negligence 37 21 10 6 7 2 4 ... 2 2 6 2 2 2 1 1 19 9 ... 4 9 6 Deaths by Suicide or Homicide 8 7 1 ... 1 ... ... ... 2 1 ... 3 ... 1 ... ... 9 3 2 1 2 2 Deaths from ill-defined causes 9 4 5 8 ... ... ... ... ... ... ... ... 1 ... ... ... 5 1 2 1 1 ... Aneurism 7 6 1 ... ... ... ... ... ... 1 4 ... 1 1 ... ... 4 2 1 ... 2 ... Appendicitis 3 3 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... 3 ... ... ... 2 1 All other Diseases 37 27 10 3 2 4 1 2 1 ... 4 5 5 4 5 1 11 18 6 2 9 12 Totals 1410 724 686 241 104 35 25 26 34 81 127 131 207 201 162 41 496 484 319 111 272 154 137—138 TABLE IVa. Infantile Mortality during the Year 1910. 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 Common Infectious Diseases— Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... 12 2 ... ... ... ... ... 1 1 ... ... ... 1 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Diphtheria (including Membranous Croup) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... 2 ... 2 3 ... 1 ... 3 2 ... 1 2 ... 1 15 Diarrhceal Diseases— Diarrhoea, all forms ... ... ... ... ... 1 ... 3 1 1 2 2 1 1 1 ... 13 Enteritis, Muco-enteritis, Gastro-enteritis ... ... ... ... ... 1 2 2 ... ... ... 1 1 1 ... ... 8 Gastritis, Gastro-intestinal Catarrh ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Wasting Diseases— Premature Birth 40 2 6 1 49 1 1 ... ... ... ... ... ... ... ... ... 51 Congenital Defects 15 2 ... 1 18 4 1 ... ... ... 1 ... ... ... ... ... 24 Injury at Birth 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 Want of Breast-milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 4 1 2 2 9 4 4 3 2 1 ... 1 ... 1 2 ... 27 Tuberculous Diseases— Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 Tuberculous Peritonitis, Tabes Mesenterica ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 4 Other Causes— Erysipelas ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 Syphilis 1 ... ... 1 2 2 1 ... ... ... ... ... ... ... ... ... 5 Rickets ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 2 ... 4 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 ... 5 Convulsions 3 2 1 1 7 1 l ... ... ... ... ... ... ... 1 1 11 Bronchitis ... 1 1 ... 2 3 2 ... 3 1 2 1 2 ... 3 2 21 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 3 ... 2 3 1 1 ... 1 1 1 1 14 Suffocation, overlying ... ... ... ... • • • 2 1 ... 1 1 ... ... ... ... ... ... 5 Other causes 6 2 ... 1 9 3 l ... 1 ... 1 1 1 1 ... ... 18 72 10 12 10 104 29 16 12 11 8 12 9 10 11 11 8 241 Six years, 1905-10 426 111 83 86 706 212 136 122 99 94 102 95 86 93 74 79 1898 Population estimated to middle of 1910, 128,448. Births in the year Legitmate, 2781 Illegitimate, 53 Deaths in the year Legitmate, 225 Illegitimate, 16 Deaths from all Causes at all Ages, 1410. 139 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 1.30 0.41 9.40 0.33 ... ... 0.41 0.13 ... ... 0.09 0.02 1893 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1894 0.35 0.03 ... ... 0.96 0.04 1.70 0.56 7.80 0.42 ... ... 0.47 0.11 ... ... 0.04 0.03 1895 0.19 0.01 ... ... 0.93 0.02 2.00 0.47 5.50 0.20 ... ... 2.50 0.38 ... ... 0.08 0.03 1896 0.03 ... ... ... 1.03 0.04 2.80 0.87 5.00 0.24 ... ... 0.62 0.07 ... ... 0.03 0.01 1897 0.01 ... 0.03 ... 0.83 0.04 2.60 0.58 6.00 0.12 ... ... 0.45 0.05 ... ... 0.04 0.02 1898 ... ... 0.02 ... 0.86 0.02 2.20 0.31 5.70 0.16 ... ... 0.52 0.11 ... ... 0.09 0.08 1899 ... ... ... ... 0.83 0.06 3.00 0.36 6.80 0.09 ... ... 0.52 0.09 ... ... 0.09 0.07 1900 0.01 ... ... ... 0.91 0.05 3.10 0.27 3.90 0.09 ... ... 0.59 0.10 ... ... 0.06 0.01 1901 0.18 ... ... ... 0.61 ... 1.80 0.16 2.00 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 1910 ... ... ... ... 0.70 0.02 1.15 0.02 3.94 0.10 ... ... 0.08 0.00 ... ... 0.06 0.02 Note.—Data for 1893 could not be obtained. 141—142 TABLE VI. London and the Metropolitan Boroughs.—Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 52 Weeks of 1910.* Boroughs. Population estimated to the middle of 1910. Births. Deaths from Deaths under 1 year of Age. All Causes. Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Typhus. Enteric Fever. Pyrexiaf (Origin uncertain. Diarrhoea. Phthisis. County of London 4,872,702 114,870 61,756 5559 — 1980 214 434 1363 - 196 4 1368 5555 11809 West. Paddington 153,004 3084 1796 164 - 69 7 9 32 - 4 - 43 128 296 Kensington 184,635 3217 2190 141 - 53 1 16 32 - 5 - 34 142 340 Hammersmith 127,413 3045 1549 170 - 70 7 22 26 - 4 - 41 132 302 Fulham 181,282 4303 1907 204 - 65 7 14 60 - 2 - 56 170 462 Chelsea 75,457 1382 950 49 - 19 4 12 - 2 - 12 87 140 City of Westminster 167,233 2554 1893 78 - 21 4 10 18 - 6 - 19 186 215 North. St. Marylebone 125,195 2331 1600 116 - 28 7 9 44 - 6 - 22 137 252 Hampstead 95,729 1340 822 44 — 15 2 5 11 - 3 - 8 56 80 St. Pancras 237,792 5720 3261 330 — 140 17 21 96 - 4 - 52 304 582 Islington 353,356 8289 4529 432 — 168 11 33 124 - 17 1 78 397 777 Stoke Newington 54,838 984 600 31 - 11 1 2 7 - 2 - 8 50 63 Hackney 239,979 5298 2797 202 — 66 5 8 61 — 10 — 52 259 520 Central. Holborn 53,142 1022 792 49 - 14 - 4 16 - 5 - 10 105 105 Finsbury 94,578 2824 1656 182 - 66 4 21 36 - 4 1 50 160 347 City of London 17,132 227 264 8 — — 1 — 2 — 2 — 3 29 15 East. Shoreditch 114,387 3613 1905 217 - 84 4 14 46 - 8 - 61 170 526 Bethnal Green 131,579 4208 2010 192 — 59 9 20 35 — 18 - 51 188 517 Stepney 314,379 9258 4303 414 — 103 12 29 114 - 15 - 141 410 1037 Poplar 172,432 5111 2609 259 -- 42 12 21 84 — 13 — 87 234 605 South. Southwark 211,832 5873 3360 427 — 226 9 35 60 - 7 - 90 368 682 Bermondsey 127,238 4006 2240 310 — 145 14 19 43 — 4 — 85 223 503 Lambeth 327,074 7344 4091 322 — 122 22 26 54 — 18 — 80 382 691 Battersea 188,222 4483 2120 2C9 — 74 7 12 51 — 7 1 57 194 434 Wandsworth 305,838 6980 3102 185 — 43 11 13 70 — 9 — 39 261 545 Camberwell 286,058 6657 3439 308 — 136 10 22 70 — 9 — 61 309 629 Deptford 119,642 3004 1667 176 — 59 3 11 48 — 5 — 50 142 367 Greenwich 112,935 2432 1306 158 — 48 3 10 57 — 3 — 37 106 261 Lewisham 164,899 3439 1585 100 — 12 12 20 29 — 3 — 24 90 274 Woolwich .. 135,422 2842 1413 82 — 22 12 4 25 — 1 1 17 136 242 * The births in this table have been corrected by distributing those which occurred away from home to the boroughs in which the mothers had resided. In 1357 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 2331 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 3184 cases, and these have been excluded from the tables. † Called Simple Continued Fever previous to 1901. 143—144 TABLE VIa. London and the Metropolitan Boroughs.—Birth-rates and Death-rates of Persons belonging to London and the Metropolitan Boroughs during the 52 weeks of 1910. Boroughs. Per 1,000 Persons Living. Deaths under 1 year to 1000 Births. Births. Deaths from All Causes. Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Typhus. Enteric Fever. Pyrexiaf (Origin uncertain). Diarrhoea. Phthisis. County of London 23.6 Crude 12.7 Corrected., 13.4 1.14 .. 0.41 0.04 0.09 0.28 .. 0.04 0.00 0.28 1.14 103 West. Paddington 20.2 11.8| 12.6 1.08 .. 0.45 0.05 0.06 0.21 .. 0.03 .. 0.28 0.84 96 Kensington 17.5 11.9 12.8 0.77 ... 0.29 0.01 0.09 0.17 .. 0.03 .. 0.18 0.77 106 Hammersmith 24.0 12.2 12.7 1.33 .. 0.55 0.06 0.17 0.20 .. 0.03 .. 0.32 1.04 99 Fulham 23.8 10.5 11.0 1.13 .. 0.36 0.04 0.08 0.33 .. 0.01 .. 0.31 0.94 107 Chelsea 18.4 12.6 13.1 0.65 .. 0.25 .. 0.05 0.16 .. 0.03 .. 0.16 1.16 101 City of Westminster 15.3 11.4 12.7 0.47 .. 0.13 0.02 0.06 0.11 .. 0.04 .. 0.11 1.12 84 North. St. Marylebone 18.7 12.8 13.7 0.93 0.22 0.06 0.07 0.35 .. 0.05 .. 0.18 1.10 108 Hampstead 14.0 8.6 9.7 0.46 0.16 0.02 0.05 0.12 .. 0.03 .. 0.08 0.59 60 St. Pancras 24.1 13.8 14.4 1.39 0.59 0.07 0.09 0.40 .. 0.02 .. 0.22 1.28 102 Islington 23.5 12.9 13.4 1.22 0.48 0.03 0.09 0.35 .. 0.05 0.00 0.22 1.13 94 Stoke Newington 18.0 11.0 11.5 0.58 0.20 0.02 0.04 0.13 .. 0.04 .. 0.15 0.91 64 Hackney 22.1 11.7 12.2 0.84 0.28 0.02 0.03 0.25 .. 0.04 .. 0.32 1.08 98 Central. Holborn 19.3 14.9 16.1 0.91 .. 0.26 .. 0.07 0.30 .. 0.09 .. 0.19 1.98 103 Finsbury 29.9 17.6 18.2 1.92 .. 0.70 0.04 0.22 0.38 .. 0.04 0.01 0.53 1.70 123 City of London 13.3 15.5 17.0 0.48 •• •• 0.06 •• 0.12 •• 0.12 • • 0.18 1.70 66 East. Shoreditch 31.7 16.7 17.5 1.90 .. 0.74 0.04 0.12 0.40 .. 0.07 .. 0.53 1.49 146 Bethnal Green 32.1 15.3 15.5 1.47 .. 0.45 0.07 0.15 0.27 .. 0.14 .. 0.39 1.43 123 Stepney 29.5 13.7 14.3 1.32 .. 0.33 0.04 0.09 0.36 .. 0.05 .. 0.45 1.31 112 Poplar 29.7 15.2 15.6 1.51 •• 0.24 0.07 0.12 0.49 •• 0.08 • • 0.51 1.36 118 South. Southwark 27.8 15.9 16.6 2.02 .. 1.07 0.04 0.17 0.28 .. 0.03 .. 0.43 1.74 116 Bermondsey 31.6 17.7 18.1 2.44 .. 1.14 0.11 0.15 0.34 .. 0.03 .. 0.67 1.76 126 Lambeth 22.5 12.5 12.9 0.99 .. 0.37 0.07 0.08 0.17 .. 0.05 .. 0.25 1.17 94 Battersea 23.9 11.3 12.1 1.11 .. 0.39 0.04 0.06 0.27 .. 0.04 0.01 0.30 1.03 97 Wandsworth 22.9 10.2 10.7 0.61 .. 0.14 0.04 0.04 0.23 .. 0.03 .. 0.13 0.86 78 Camberwell 23.3 12.1 12.5 1.09 .. 0.48 0. 04 0.08 0.25 .. 0.03 .. 0.21 1.08 94 Deptford 25.2 14.0 14.7 1.47 .. 0.49 0.03 0.09 0.40 .. 0.04 .. 0.42 1.19 122 Greenwich 21.6 11.6 11.8 1.42 .. 0.43 0.03 0.09 0.51 .. 0.03 .. 0.33 0.94 107 Lewisham 20.9 9.6 ! 10.0 0.61 .. 0.07 0.07 0.12 0.18 .. 0.02 .. 0.15 0.55 80 Woolwich 21.0 10.5 11.2 0.62 .. 0.16 0.09 0.03 0.19 .. 0.01 0-01 0.13 1.01 85 In this Table 0.00 indicates that the deaths were too few to give a rate of 0.005; where no death occurred, is inserted. * The Corrected Death-rates represent the Crude Death-rates multiplied by the respective Factors for Correction for differences of sex and age constitution of population. † Called Simple Continued Fever previous to 1901. 145—146 TABLE VII. London and the Metropolitan Boroughs.—Death-rates per 1000 persons living, and Infantile Mortality, after Distribution of Births in the chief Institutions treating Maternity cases, and of Deaths in all Public Institutions, &c., in the Five Years 1905-9, aod in 1910. Boroughs. All Causes. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Diarrhoea. Phthisis. Deaths Under One Year to 1000 Births. 19051909. 1910. 19051909. 1910 19051909. 1910. 19051909. 1910. 19051909. 1910. 19051909. 1910. 19051909 1910. 19051909. 1910. 19051909. 1910. 19051909. 1910. 19051909. 1910. 19051909. 1910. County of London 14.5 12.7 0.00 .. 0.39 0.41 0.11 0.04 0.14 0.09 0.28 0.28 .. • • 0.05 0.04 0.00 0.00 0.57 0.28 1.38 1.14 120 103 Paddington 12.9 11.8 .. .. 0.25 0.45 0.09 0.05 0.08 0.06 0.22 0.21 .. .. 0.03 0.03 .. .. 0.45 0.28 1.05 0.84 107 96 Kensington 13.6 11.9 .. .. 0.28 0.29 0.07 0.01 0.11 0.09 0.23 0.17 .. .. 0.04 0.03 .. .. 0.45 0.18 1.08 0.77 126 106 Hammersmith 14.2 12.2 .. .. 0.38 0.55 0.09 0.06 0.17 0.17 0.29 0.20 .. .. 0.05 0.03 . . . . 0.57 0.32 1.19 1.04 125 99 Fulham 13.3 10.5 .. .. 0.42 0.36 0.10 0.04 0.20 0.08 0.33 0.33 .. .. 0.05 0.01 .. . . 0.90 0.31 1.17 0.94 125 107 Chelsea 14.9 12.6 ... .. 0.38 0.25 0.09 .. 0.14 0.05 0.25 0.16 .. .. 0.04 0.03 . . .. 0.44 0.16 1.46 1.16 116 101 City of Westminster 13.0 11.4 0.00 .. 0.14 0.13 0.08 0.02 0.08 0.06 0.12 0.11 .. .. 0.03 0.04 0.00 •• 0.25 0.11 1.37 1.12 103 84 St. Marylebone 14.8 12.8 .. .. 0.25 0.22 0.11 0.06 0.09 0.07 0.19 0.35 .. .. 0.03 0.05 0.00 ... 0.35 0.18 1.40 1.10 109 108 Hampstead 9.0 8.6 .. .. 0.11 0.16 0.06 0.02 0.06 0.05 0.12 0.12 .. .. 0.03 0.03 . . .. 0.13 0.08 0.72 0.59 76 60 St. Pancras 15.2 13.8 .. .. 0.35 0.59 0.10 0.07 0.11 0.09 0.28 0.40 .. .. 0.04 0.02 0.00 . . 0.40 0.22 1.62 1.28 113 102 Islington 14.2 12.9 0.00 .. 0.42 0.48 0.09 0.03 0.11 0.09 0.26 0.35 .. .. 0.5 0.05 0.00 0.00 0.38 0.22 1.26 1.13 113 94 Stoke Newington 11.9 11.0 .. .. 0.19 0.20 0.08 0.02 0.07 0.04 0.25 0.13 .. .. 0.3 0.04 .. ... 0.32 0.15 1.04 0.91 98 64 Hackney 13.4 11.7 0.00 .. 0.29 0.28 0.11 0.02 0.13 0.03 0.23 0.25 .. .. 0.7 0.04 •• .. 0.65 0.22 1.21 1.08 116 98 Holborn 17.0 14.9 .. .. 0.27 0.26 0.07 .. 0.10 0.07 0.28 0.30 .. .. 0.5 0.09 .. .. 0.38 0.19 2.39 1.98 117 103 Finsbury 19.3 17.6 .. .. 0.71 0.70 0.16 0.04 0.17 0.22 0.45 0.38 .. .. 0.8 0.04 . . 0.01 0.85 0.53 2.18 1.70 118 123 City of London 17.9 15.5 •.. .. 0.14 •• 0.08 0.06 0.11 •• 0.18 0.12 .. .. 0.04 0.12 •. •• 0.17 0.18 1.81 1.70 109 66 Shoreditch 19.3 16.7 0.00 .. 0.76 0.74 0.19 0.04 0.15 0.12 0.60 0.40 .. .. 0.05 0.07 .. .. 1.05 0.53 1.96 1.49 152 146 Bethnal Green 17.8 15.3 .. .. 0.55 0.45 0.24 0.07 0.17 0.15 0.40 0.27 .. .. 0.07 0.14 o.oo . . 0.82 0.39 1.87 1.43 140 123 Stepney 16.6 13.7 o.oo .. 0.64 0.33 0.17 0.04 0.22 0.09 0.35 0.36 .. .. 0.06 0.05 o.oo .. 0.87 0.45 1.65 1.31 129 112 Poplar 16.8 15.2 .. .. 0.61 0.24 0.17 0.07 0.20 0.12 0.43 0.49 .. .. 0.07 0.08 • • •• 0.99 0.51 1.41 1.36 136 118 Southwark 17.5 15.9 .. .. 0.54 1.07 0.14 0.04 0.17 0.17 0.33 0.28 .. .. 0.04 0.03 .. .. 0.77 0.43 1.98 1.74 135 116 Bermondsey 18.9 17.7 .. .. 0.80 1.14 0.19 0.11 0.16 0.15 0.34 0.34 .. .. 0.05 0.03 0.00 . . 0.83 0.67 1.87 1.76 141 126 Lambeth 14.4 12.5 .. .. 0.30 0.37 0.11 0.07 0.15 0.08 0.25 .017 .. .. 0.03 0.05 o.oo .. 0.52 0.25 1.43 1.17 118 94 Battersea 13.3 11.3 .. .. 0.41 0.39 0.11 0.04 0.12 0.06 0.33 0.27 .. .. 0.03 0.04 .. 0.01 0.52 0.30 1.26 1.03 115 97 Wandsworth 12.2 10.2 .. .. 0.27 0.14 0.08 0.04 0.13 0.04 0.27 0.23 .. .. 0.04 0.03 o.oo .. 0.44 0.13 0.97 0.86 105 78 Camberwell 13.6 12.1 .. .. 0.34 0.48 0.09 0.01 0.13 0.08 0.27 0.25 .. .. 0.03 0.03 .. .. 0.49 0.21 1.22 1.08 114 94 Deptford 14.4 14.0 .. .. 0.41 0.49 0.10 0.03 0.14 0.09 0.33 0.40 .. .. 0.05 0.04 o.oo .. 0.61 0.42 1.25 1.19 118 122 Greenwich 12.9 11.6 .. .. 0.30 0.43 0.09 0.03 0.17 0.09 0.25 0.51 .. .. 0.05 0.03 . . .. 0.53 0.33 1.12 0.94 113 107 Lewisham 11.3 9.6 0.01 .. 0.17 0.07 0.07 0.07 0.14 0.12 0.20 0.18 .... .. 0.02 0.02 0.00 .. 0.40 0.15 0.85 0.55 91 80 Woolwich 12.4 10.5 .. .. 0.28 0.16 0.09 0.09 0.16 0.03 0.19 0.19 .. .. 0.04 0.01 0.00 0.01 0.42 0.13 1.30 1.01 100 85 147—148 TABLE VIIa. Death Rates during 1910 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. Boroughs. Death-rates per 1000 living. 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 12.9 12.7 0.04 0.04 0.08 0.09 0.4 0.04 1.12 1.14 West. Paddington 13.1 11.8 — 0.05 0.04 0.06 0.03 0.03 0.79 0.84 Kensington 13.7 11.9 — 0.01 0.02 0.09 0.02 0.03 1.37 0.77 Hammersmith 12.4 12.2 — 0.06 0.08 0.17 0.02 0.03 0.90 1.04 Fulham 9.4 10.5 0.10 0.04 0.25 0.08 0.08 0.01 0.82 0.94 Chelsea 19.0 12.6 — — 0.01 0.05 0.03 0.03 2.29 1.16 City of Westminster 13.0 11.4 — 0.02 0.04 0.06 0.06 0.04 0.62 1.12 North. St. Marylebone 12.5 12.8 0.01 0.06 0.06 0.07 0.04 0.05 0.62 1.10 Hampstead 11.2 8.6 0.28 0.02 0.27 0.05 0.04 0.03 1.37 0.59 St. Pancras 14.4 13.8 0.00 0.07 0.03 0.09 0.02 0.02 1.36 1.28 Islington 12.4 12.9 0.01 0.03 0.02 0.09 0.03 0.05 1.26 1.13 Stoke Newington 8.4 11.0 — 0.02 — 0.04 — 0.04 0.66 0.91 Hackney 12.2 11.7 0.07 0.02 0.08 0.03 0.12 0.04 1.20 1.08 Central. Holborn 17.8 14.9 — — 0.17 0.07 0.08 0.09 1.25 1.98 Finsbury 8.7 17.6 — 0.04 0.12 0.22 — 0.04 0.67 1.70 City of London 47.5 15.5 — 0.06 1.11 — 0.06 0.12 2.17 1.70 East. Shoreditch 15.6 16.7 — 0.04 0.04 0.12 0.02 0.07 1.62 1.49 Bethnal Green 15.6 15.3 — 0.07 0.06 0.15 0.05 0.14 1.50 1.43 Stepney 15.3 13.7 — 0.04 0.10 0.09 0.04 0.05 1.11 1.31 Poplar 14.8 15.2 0.01 0.07 0.05 0.12 0.04 0.08 1.43 1.36 South. Southwark 13.6 15.9 - 0.04 0.08 0.17 0.00 0.03 0.94 1.74 Bermondsey 13.6 17.7 001 0.11 — 0.15 0.02 0.03 1.57 1.76 Lambeth 13.3 12.5 0-07 0.07 0.15 0.08 0.06 0.05 1.14 1.17 Battersea 11.5 11.3 0.04 - 0.06 0.01 0.04 1.17 1.03 Wandsworth 9.4 10.2 0-06 0.04 0.09 0.04 0.02 0.03 0.72 0.86 Camberwell 13.6 12.1 o-oi 0.04 0.02 0.08 0.02 0.03 1.52 1.08 Deptford 10.4 14.0 0-35 0.03 0.40 0.09 0.13 0.04 0.68 1.19 Greenwich 15.4 11.6 022 0.03 0.22 0.09 0.04 0.03 1.45 0.94 Lewisham 9.5 9.6 004 0.07 0.07 0.12 0.02 0.02 0.52 0.55 Woolwich 9.6 10.5 001 0.09 0.10 0.03 — 0.01 0.94 1.01 * The deaths " before Distribution" are those actually registered in the several Boroughs without any correction whatever. 149.150 TABLE VIII. Meteorology and Registered Deaths from all Causes and from Certain Prevalent Diseases of the Year, 1910. Week. Date of ending. Temperature of the Air. Average temperature 3 feet below ground. Mean Humidity complete Saturation= 100 No. of days on which rain fell. Rainfall in inches. Deaths Corrected for Public Institutions. Highest during week. Lowest during week. Mean temperature. Diarrhoea. 1 Bronchitis and Pneumonia. All causes. 1910. January 8 55.3 36.7 43.2 + 44.48 94 2 0.05 .. 6 31 15 53.1 31.0 43.9+ 44.47 82 5 0.30 .. 7 41 22 53.0 26.9 39.6 + 44.15 78 3 0.16 .. 8 26 29 44.9 20.3 34.2— 41.76 75 4 1.15 .. 12 42 February 5 50.7 27.5 37.4— 40.33 88 4 0.09 .. 10 39 12 54.0 28.6 42.0 + 41.43 86 6 0.38 .. 6 29 19 56.0 32.1 44.7 + 41.79 80 7 0.69 .. 8 32 26 50.6 31.3 42.5 + 42.94 83 7 1.40 .. 9 35 March 5 57.0 30.1 41.8+ 42.38 83 3 0.15 1 6 24 12 57.7 38.1 46.0 + 43.12 87 7 0.95 1 5 32 19 54.2 27.9 40.1— 43.27 75 3 0.13 .. 11 34 26 54.0 25.5 42.0 — 42.69 80 .. .. .. 4 22 April 2 57.3 29.5 41.9— 43.50 74 •• .. .. 4 28 1st Quarter 57.7 20.3 41.5 42.79 82 51 5.45 2 98 415 April 9 56.0 25.5 42.8 43.48 79 3 0.11 .. 6 31 16 63.8 39.1 48.8 + 44.87 79 6 1.86 .. 1 23 23 65.5 30.9 49.3 + 46.59 82 2 0.23 .. 3 25 30 60.0 34.9 45.4— 47.18 73 5 0.43 .. 3 21 May 7 58.3 36.6 46.3— 47.34 77 6 0.74 .. 2 28 14 67.0 30.4 47.5— 47.29 76 5 0.42 .. 3 23 21 76.0 48.2 58.9+. 49.93 84 5 0.89 .. 1 23 28 78.0 45.6 57.8 + 53.20 75 1 0.08 .. 4 32 June 4 74.9 45.1 56.9— 54.43 77 4 0.27 .. .. 20 11 79.9 50.9 62.2 + 55.73 88 2 0.44 .. 3 26 18 74.2 43.6 58.8 + 57.79 77 1 0.01 .. 2 26 25 82.2 50.1 62.3 + 59.28 75 3 1.11 .. 2 27 July 2 69.0 45.1 56.5— 59.10 76 7 1.00 .. 4 24 2nd Quarter 82.2 25.5 53.3 51.25 78 50 7.59 .. 34 329 July 9 67.0 48.1 55.2— 58.21 84 5 1.29 .. 4 27 16 71.0 50.1 57.9— 57.99 84 1 0.01 .. 1 19 23 73.2 47.9 59.2— 58.82 85 5 1.22 .. 22 30 75.7 47.4 58.8— 59.06 77 4 0.35 .. 4 21 August 6 74.0 49.2 60.2— 60.12 77 5 0.85 .. 2 15 13 77.4 49.1 60.7— 60.48 85 4 0.18 .. 1 19 20 75.8 51.4 62.7 + 61.13 75 3 0.19 1 2 21 27 75.0 49.1 59.9. 61.26* 77 3 0.80 .. 2 19 September 3 69.5 48.9 58.3— 60.59 77 3 0.41 .. 2 21 10 65.6 39.1 54.7— 59.68 79 1 0.02 1 2 22 17 67.0 45.7 56.1— 58.71 81 1 0.66 .. 2 18 24 65.7 39.3 53.8— 58.01 76 .. 0.00 1 2 20 October 1 71*2 43.7 58.6 + 57.35 88 2 0.10 1 2 25 3rd Quarter 77.4 39.1 57.2 59.34 80 37 6.08 4 26 269 October 8 73.2 47.2 57.4 + 57.61 79 2 0.08 1 7 23 15 69.2 43.2 53.1 + 57.23 85 3 0.61 .. .. 16 22 60.6 42.3 51.4 + 55.69 86 3 0.63 2 .. 24 29 61.4 39.6 51.2 + 54.44 89 3 0.30 2 1 24 November 5 54.9 27.6 42.7— 53.12 83 6 1.03 0 2 29 12 51.6 28.4 40.8— 49.85 83 5 0.31 1 3 34 19 51.6 23.4 400— 48.16 79 3 0.53 2 9 38 26 42.0 24.1 34.1— 45.60 89 4 0.62 .. 8 30 December 3 520 28.8 392 — 44.03 93 6 2.52 .. 8 35 10 53.9 40.1 47.8 + 45.05 87 5 0.71 1 11 44 17 55.0 42.1 48.6 + 46.60 86 7 1.38 1 11 45 24 53.0 33.1 44.8 + 46.68 90 4 0.09 1 5 22 31 46.0 27.1 38.8— 45.55 83 1 0.13 •• 6 34 4th Quarter 73.2 23.4 45.4 49.97 85 52 8.94 11 71 398 Whole Year 82.2 20.3 49.3 50.84 81 190 28.06 17 227 1411 * Highest in week 61.36. TABLE IX. Weekly Averages. Period. Temperature of the Air. Temperature 3 feet below ground. Mean Humidity Complete Saturation = 100. Number of days on which rain fell in each week. Average Weekly Rainfall in inches. Deaths Corrected for Public Institutions. Average of Weekly Maxima. Average of Weekly Minima. Average of Weekly Means. Diarrhoea. Bronchitis and Pneumonia. All Causes. 1st Quarter 53.7 29.7 41.5 42.79 82 3.9 0.42 .15 7 32 2nd Quarter 69.6 40.5 53.3 51.25 78 3.8 0.58 - 3 25 3rd Quarter 71.4 46.6 57.2 59.34 80 2.8 0.47 .31 2 21 4th Quarter 55.7 34.4 45.4 49.97 85 4.0 0.69 .85 5 31 151 TABLE X. Summary of Statistics for the First Quarter, ending 2nd April, 1910, 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 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. 127,993 725 22.7 67 92 387 104 12 40 415 13.0 B. Birth and Death Bates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Bate. Death Rate at all ages. Deaths under 1 year per 1,000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under year per 1,000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under year per 1,000 Births. A B C D A B C D A B C D 38.991 26.1 15.4 90 West 40,907 East 34,500 20.1 23.2 13.7 11.8 112 80 13.595 18.8 8.0 78 152 C. Notifications of Infectious Disease. Disease. Woolwich. Plumstead. Elthaam. Total. Average for 1st Quarters of 1905/6/7/8/9. West. East. Smallpox - - - - - .4 Scarlet Fever 30 36 23 9 98 190.6 Diphtheria 4 30 16 — 50 102.6 Enteric Fever - 2 — — 2 6.6 Erysipelas 3 3 17 1 24 27.8 Puerperal Fever — — — — — 1.8 Phthisis 23 11 10 5 49 40.6 Measles (Notified by School Teachers) - 1 12 - 13 393.6 153 TABLE XL Summary of Statistics for the Second Quarter, ending 2nd July, 1910, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates 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. 128,448 769 23.9 60 78 293 67 9 45 329 10.2 B. Birth and Death Rate for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 Births. Population estimated to middle of year. Birth Rate. Death Rate at all ageB. Deaths under 1 year, per 1,000 Births. A B C D A B C D A B C D 38,991 26.0 12.4 94 West 40,907 East 34,500 24.2 21.7 11.3 8.0 69 91 14,050 22.8 6.5 25 C. Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Average for 2nd Quarters of 19C5/6/7/8/9. West. East. Small-pox - - - - - 06 Scarlet Fever 30 34 43 3 110 181.2 Diphtheria 10 17 22 4 53 61.2 Enteric Fever 1 - - - 1 3.4 Erysipelas 2 10 11 - 23 19.0 Puerperal Fever 1 1 2 - 4 1.4 Phthisis (Voluntary and Poor Law) 19 17 18 3 57 42.3 Measles (Notified by School Teachers) 162 33 37 3 235 205.8 154 TABLE XII. Summary of Statistics for the Third Quarter, ended 1st October, 1910, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population Population estimated to middle of Year. Births. Deaths under one year. 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. 128,448 715 22.3 40 56 236 51 4 37 269 8.4 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 24.3 8.5 42 West 40,907 22.9 8.8 60 14,050 20.5 8.0 83 East 34,500 199 7.9 58 155 C. Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Average for 3rd Quarters 1905/6/7/8/9. West. East. Small-pox 1 - - - 1 - Scarlet Fever 20 43 55 8 126 171.6 Diphtheria 9 13 5 2 29 53.0 Enteric Fever - 3 1 - 4 4.8 Erysipelas 7 5 9 1 22 22.2 Puerperal Fever 1 - 1 - 2 2.6 Phthisis (Voluntary and Poor Law) 18 18 13 2 51 380 Measles (Notified by School Teachers) 27 39 24 1 91 42.4 Zymotic Enteritis 10 11 37 14 72 - TABLE XIII. Summary of Statistics for the Fourth Quarter, ending December 31st, 1910, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population. Population estimated to middle of Year. Births, Deaths under one year of age. Deaths at all ages— Gross. Deaths in Publio 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. 128,448 635 19.8 73 115 381 90 17 34 398 12.4 156 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. Population estimated to middle of year. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. A B C D A B C D A B C D 38,991 23.9 144 129 West 40,907 18.9 13.7 83 14,050 16.2 9.4 105 East 34,500 17.6 9.8 138 c. Notifications of Infectious Disease. Woolwich. Plumstead. Eltham. Total. Average for 4th Quarters, 1905/6/7/8/9. West East Smallpox - - - - - - Scarlet Fever 38 51 69 3 161 185.0 Diphtheria 10 7 5 1 23 84.2 Enteric Fever 1 — — — 1 8.8 Erysipelas 4 5 8 1 18 26.2 Puerperal Fever 1 — — — 1 2.8 Phthisis 16 9 10 2 37 47.2 Measles (Notified by School Teachers) 3 23 27 1 54 174.8 157 159—160 TABLE XIV. Deaths from various causes for the whole Borough, 1910, corrected for Public Institutions. Week ending Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Mem. Croup. Enteric. Diarrhoea and Dysentery. Erysipelas. Puerperal Fever. Rheumatism. Tubercle. Alcoholism. Cancer. Bronchitis. Pneumonia. Accidents. Homicide and Suicide. January 8 .. .. .. .. .. .. .. .. .. .. .. 4 1 1 3 3 .. 1 15 .. .. .. 1 3 .. .. .. .. .. .. 4 .. 4 4 3 2 .. 22 .. .. .. 2 1 .. .. .. .. .. .. 3 .. .. 4 4 .. .. 29 .. .. 1 .. 2 .. .. .. .. .. .. 4 2 2 10 2 3 .. February 5 .. .. .. 4 .. .. .. .. .. .. .. 7 .. 1 6 4 1 .. 12 .. .. .. 3 1 .. .. .. .. .. 1 2 1 4 4 2 1 .. 19 .. .. .. 2 2 .. .. .. .. .. .. 4 .. 2 5 3 1 .. 26 .. .. .. 1 1 2 .. .. .. .. .. 3 .. 1 6 3 .. .. March 5 .. .. 1 1 .. .. .. 1 .. .. .. 4 ., 2 4 2 .. .. 12 .. .. 1 1 2 .. .. 1 .. .. .. 3 .. 1 2 3 .. .. 19 .. .. .. 2 .. .. .. .. .. .. .. 3 .. 2 9 2 • • .. 26 .. .. 2 .. 1 1 .. .. .. .. .. 3 9, .. 4 .. .. .. April 2 .. .. 1 1 .. .. .. .. .. .. .. 1 2 2 1 3 1 .. 1st Quarter •• •• 6 18 11 3 •• 2 • • 1 45 8 22 62 34 9 2 April 9 .. .. .. 2 2 1 .. .. .. .. .. 5 .. 2 3 3 1 .. 16 .. .. 1 2 1 .. .. .. .. .. .. 4 1 2 1 .. .. .. 23 .. .. .. .. .. .. .. .. .. .. .. 3 .. 3 1 2 1 .. 30 .. .. .. 1 1 .. .. .. .. .. .. 5 .. 1 1 2 .. .. May 7 .. .. .. .. 2 .. .. .. .. .. 1 1 .. 2 .. 2 3 1 14 .. .. .. .. .. .. .. .. .. .. .. 5 .. .. 1 2 1 .. 21 .. .. .. .. 1 .. .. .. .. .. .. 4 .. 3 1 .. 1 .. 28 .. 1 .. .. 1 .. .. .. .. .. .. 3 2 1 .. 4 1 .. June 4 .. 1 .. .. 1 .. .. .. .. .. .. 6 .. 1 .. .. 1 .. 11 .. 3 .. .. 1 .. .. .. .. .. .. 2 1 1 1 2 .. .. 18 .. 2 .. .. 1 1 .. .. .. .. .. 4 .. 2 1 i 1 .. 25 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. July 2 .. 1 .. 1 •• .. .. .. .. .. .. •• •• 1 1 3 1 .. 2nd Quarter •• 9 2 6 11 2 •• •• 2 1 1 42 4 19 11 23 12 3 July 9 .. 1 .. .. .. .. .. .. .. .. .. 3 .. 2 3 1 1 1 16 .. 1 .. .. .. .. .. .. .. .. .. 2 .. 1 .. 1 2 .. 23 .. 2 1 .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. 30 .. 1 .. .. .. .. .. .. .. .. .. 3 .. 1 1 3 .. .. August 6 .. .. .. .. .. .. .. .. .. .. .. 2 .. 2 2 .. .. .. 13 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 .. 20 .. .. .. .. .. .. .. 1 .. .. .. 1 3 4 .. 2 .. .. 27 .. .. 1 .. .. .. .. .. .. .. .. 2 .. 7 .. 2 .. .. September 3 .. .. 2 .. .. .. .. .. .. .. .. 5 .. 5 2 .. .. .. 10 .. .. .. .. .. .. .. 1 .. .. .. 3 2 1 .. 2 1 .. 17 .. 1 .. .. .. .. .. .. .. .. .. 5 .. 1 1 1 .. .. 24 .. .. .. .. .. .. .. 1 .. .. .. 6 1 4 2 .. 1 .. October 1 .. .. .. 2 .. .. .. 1 .. .. .. 5 •• 3 1 1 •• .. 3rd Quarter •• 6 4 2 1 .. 1 4 .. 1 1 38 6 32 13 13 6 2 October 8 .. .. .. .. .. .. .. 1 .. .. .. 3 .. 4 3 4 1 .. 15 .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. 1 .. 22 .. 1 .. .. .. .. .. 2 .. .. .. 2 .. 3 .. .. 1 .. 29 .. .. .. .. .. .. .. 2 .. .. .. 2 .. 2 1 .. 1 .. November 5 .. 1 .. .. 1 .. .. .. .. .. .. 6 1 3 2 .. .. .. 12 .. 1 .. 1 1 .. .. 1 .. .. .. 5 .. 3 3 .. 1 .. 19 .. 1 .. 2 .. .. .. 2 .. .. .. 5 1 2 7 2 1 .. 26 .. .. .. 1 .. .. .. .. .. .. .. 7 2 .. 4 4 .. .. December 3 .. .. .. 2 .. .. .. .. .. .. .. 2 .. 2 3 5 .. 10 .. 1 .. .. .. .. .. 1 .. .. .. 3 .. 2 7 4 2 .. 17 .. .. .. 2 .. .. .. 1 .. .. .. 6 1 2 7 4 .. .. 24 .. 1 .. 3 .. .. .. 1 .. .. .. 2 .. 3 3 2 .. .. 31 .. •• .. 3 .. .. .. •• .. .. .. 6 1 5 2 4 2 .. 4th Quarter .. 6 1 14 2 .. .. 11 1 1 1 51 6 32 42 29 10 •• Whole Year. .. 21 13 40 25 5 1 17 3 3 4 176 24 105 128 99 37 7 161—162 TABLE XVA. Summary of Nuisances Abated, Notices served, and General Work of Public Health Department, 1910. 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 883 1021 986 1232 935 920 465 184 6626 ,, Re-inspections after service of Notice (estimated) 1881 1769 1938 1895 1610 1394 1090 368 11947 ,, Houses and premises specially inspected, including infectious diseasss and complaints 998 748 1152 1171 675 474 625 183 6026 ,, Houses where drains have been tested by smoke test 33 19 42 10 6 14 12 6 144 ,, Houses where drains have been tested by water test 13 23 33 2 6 12 18 5 112 ,, New Houses inspected for Water Certificates 2 15 6 6 •• 1 79 •• 109 NUISANCES ABATED—DRAINS. Waste-pipes from baths, lavatories, and wash-house sinks, repaired or disconnected 27 28 22 7 52 16 12 6 170 Choked and defective drains 52 97 64 24 76 32 45 21 411 Defective traps 12 8 18 2 3 8 10 2 63 Defective and unventilated soil pipes 2 6 2 5 1 .. 4 1 21 W.C.'s. W.C.'s repaired, new traps or pans provided 44 99 70 14 56 75 81 25 464 Water supply apparatus repaired or renewed.. 90 82 52 67 102 40 46 20 499 Foul pans cleansed Additional w.c.'s provided to Factories & Workshops &c. 78 38 38 61 35 12 35 15 312 Do. do. dwelling houses •• •• •• •• •• •• •• •• PREMISES. Underground rooms not in accordance with Act .. .. 3 .. .. .. .. .. 3 Interiors cleansed and defective roofs repaired 407 358 401 181 225 212 193 90 2064 Damp walls remedied 76 177 62 34 106 35 17 16 523 Paving in yards and wash-houses repaired 84 58 80 25 74 52 57 17 447 Improved ventilation provided 4 7 14 1 41 22 9 3 101 Wash-houses without sink and outlets for waste water .. 2 .. .. .. 1 .. 1 .. 4 Defective guttering and rain-water pipes 65 34 49 43 66 33 44 12 346 Dustbins supplied 102 105 109 62 75 46 59 27 585 Dung pits provided .. .. 7 .. 1 2 1 .. 11 Cases of overcrowding remedied 13 14 11 15 15 4 3 3 78 Deficient light—windows supplied, or enlarged, or other works 4 1 9 6 1 1 22 Dampness in premises from defective water pipes 41 9 7 20 5 •• 16 6 104 ANIMALS. Animals (including pigs) kept in such a state as to be a nuisance 5 4 6 3 9 • • 3 2 32 Accumulations of manure removed 20 22 6 2 19 5 20 3 97 WATER. Defective and foul cisterns used for dietary purposes 5 1 5 33 # # 7 ,. 51 Defective and foul rain-water tanks remedied Insufficient supply, and water cut off by Water Board .. 17 7 1 12 5 4 2 7 5 1 59 Additional water supply for two or more families 2 •• •• •• •• •• 1 •• 3 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 11 10 2 .. .. .. 3 3 29 No. of smoke nuisances observed .. .. .. .. .. .. 1 1 2 Tents, Vans, &c.t inspected .. .. 5 18 .. 25 .. 48 Notices served with respect to tents and vans .. .. .. 1 8 .. 3 .. 12 Inspection of Urinals accessible to the public 91 49 72 147 20 57 42 50 528 Verminous rooms cleansed 19 58 18 28 6 6 3 5 143 Intimation notices served 534 505 534 260 490 394 254 118 3089 Statutory ,, ,, 100 21 93 22 162 86 46 11 541 163 TABLE XVB. SUMMARY OF WORK OF CHIEF INSPECTOR. Premises Inspected 1363 New Buildings Inspected 25 Defective Combined Drains Investigated and Reported on 7 Number of Houses referred to in such Combined Drains 39 Cow-houses and Slaughter-houses Inspections 38 Complaints Investigated 167 Attendances at Police Courts .. 14 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTOR, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for proceedings 56 Summonses at Police Court 18 Bake-houses Inspected and Cleansed twice during the year .. Number of Houses Disinfected after Infectious Disease 964 Letters written 3411 Notifications received 1115 Certificates issued after Disinfection 1210 ,, of Infectious Disease forwarded to Schools 1251 Complaints of Sanitary Defects 398 ,, of Non-removal of Dust, viz :— Woolwich 7 Plumstead 13 Eltham 6 164 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) 75 21 Workshops (Including Workshop Laundries) 196 24 Workplaces 102 21 Homeworkers' Premises 266 15 Total 639 81 2.—Defects found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Acts : Want of Cleanliness 42 42 Want of Ventilation.. 10 10 Overcrowding 2 2 Want of Drainage of floors 1 1 Other nuisances 28 28 Sanitary accommodation. insufficient, unsuitable, or defective 9 9 not separate for sexes 3 3 Total 95 95 165 TABLE XVC.— continued. 3.— Other Matters. Class. Number. Hatters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act. (S. 1331 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 Bakehouses (S. 101) :—■ In use during 1903 .. 24 in 1903 24 in 1904 — in 1905 — Certificates granted - in 1906in 1907 .. 1 in 1908 — in 1909 — in 1910 1 In use during 1910 16 Workshops on the Register (S. 131) at end of 1910 :— Workshop Laundries 19 „ Bakehouses 44 Other Workshops 140 Total number of Workshops on Register 203 TABLE XVc.— continued 4.— Home Work. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Nature of Work. Lists received from Employers. Number of Addresses of Outworkers received from Other Councils. Number 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, Onoe 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 42 170 4 16 20 .. .. .. .. .. .. .. .. .. Shirt makers 8 193 1 4 .. 18 .. .. .. .. .. .. .. .. .. Corset makers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Gold braid makers , . .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tennis Balls, etc. 6 407 .. •• .. 64 .. .. .. .. .. .. .. .. .. 56 770 5 20 38 102 •• •• 266 16 16 .. .. .. .. 166 167 TABLE XVD. Proceedings during 1910. Premises. Number of Places. Number of Inspections, 1910. Number of Notices, 1910. Number of Prosecutions, 1910 On Register at end of 1909. Added at 1910. Removed in 1910. On Register at end of 1910. Milk Premises 128 24 15 137 205 10 0 Cowsheds 17 0 0 17 68 7 0 Slaughter-houses 11 0 0 11 52 4 0 Ice Cream Premises 98 4 16 86 198 5 0 Registered houses let in Lodgings 395 22 8 409 669 269 0 Overcrowding, 1910— Number of Dwelling Rooms overcrowded 78 Number remedied 78 Underground Rooms— Illegal occupation dealt with during year 3 Number of rooms closed 3 Insanitary Houses— Number closed under the Housing Town Planning, &c. Act 9 Number of Prosecutions under By-lav)s under Public Health Act, 1891— With respect to water closets, earth closets, etc. 0 With respect to sufficiency of water supply to water closets 0 With respect to drainage, etc. (Metropolis Management Act, Sec. 202) 0 Mortuaries— Total number of Bodies removed 136 Total number of Infectious Bodies removed 1 Inspections of premises where food is prepared for sale 102 Number of Public Sanitary Conveniences removed or altered 0 Number of fixed ashpits removed 0 168 TABLE XVI. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. DOCKYARD AND ST. MARY'S WARDS. Morris Street 10 8 Morris Place 6 6 Orchard Street 32 23 Orchard Place 37 28 Prospect Row 38 26 Prospect Row Cottages 4 4 Prospect Place 58 26 Eustace Place 14 4 Railway Cottages 5 5 Joseph Street 22 11 Upper Harden Street 13 7 Lower Harden Street 19 7 Trinity Street 31 17 Warwick Street 64 31 Kingsman Street 141 52 St. Mary's Street 71 39 Rectory Grove 49 22 Sun Street 24 11 Bowater Road 10 5 Station Road 32 8 Lower Wood Street 30 10 Ann Street 21 8 Wick Cottages, West Street 9 4 Godfrey Street 25 12 Woodville Street 8 3 Godfrey Hill 19 2 Lower Pellipar Road 21 11 Back Lane 5 2 St. James Place 13 7 Ogilby Street 46 18 883 417 47.2 % defects. RIVER WARD. Elizabeth Street 78 25 Beresford Street 64 27 High Street 58 16 Gough Street 28 5 169 TABLE XVI.— continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD-cont. Creton Street 21 9 Myrtle Street 12 5 Sandy Hill Road 16 12 Brookhill Road 25 14 Parsons Hill 6 2 Union Street 15 4 Eleanor Road 40 11 Helen Street 9 3 Taylor Street 20 6 Taylor Buildings 5 2 Walpole Place 24 10 Masons Avenue 6 1 Wilmount Street 39 17 Anglesea Road 23 7 Anglesea Avenue 9 5 Globe Lane 14 10 Nelson Street 13 7 Collingwood Street 12 7 Rodney Street 12 7 Meeting House Lane 7 3 New Street 6 2 Sidney House 25 15 Stanley House Albert House Fore House Glass Yard 6 2 Warren Lane 17 8 Rope Yard Rails 14 8 Wellington Street 40 19 Albert Road 137 53 Rhea Street 75 21 Dock Street 21 5 Auberou Street 53 15 Barge House Road 47 16 Mary Ann Street 8 5 Fernhill Street 8 3 Wiseman Street 8 1 1021 388 ■ 37 % defects. 170 TABLE XVI.— continued. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. ST. GEORGE'S WARD. Engineer Road 32 16 Gildersome Street 59 26 Jackson Street 56 34 Keemor Street 37 11 184 87 ELTHAM WARD. 47.2% defects. Blanmerle Road 48 20 Blunts Road 34 14 Elizabeth Terrace 22 11 Elm Terrace 23 10 Foots Cray Road 23 13 Friths Buildings 15 11 Green Lane 27 19 Hainault Street 6 5 High Street 111 51 Kirks Yard 7 3 Messiter Place and Back Lane 11 4 Merchland Road 16 8 Novar Road 16 7 Osborne Terrace, Lee 10 4 Pelham Terrace 26 21 Pottery and Farm Cottages 9 7 Pound Place 22 10 Roper Street 22 14 Southwood Road 10 4 Theobalds Cottages 7 6 465 242 BURRAGE AND HERBERT WARDS. 52% defects. Princes Road 71 33 Portland Place 16 7 Brookhill Row 5 5 Thomas' Cottages 8 7 Cumberland Cottages 4 3 May Place 4 3 171 TABLE XVI.— continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. BURRAGE AND HERBERT WARD S—cont. Barnfield Road 68 36 Barnfield Place 8 7 Conduit Road 34 13 Gray don Street 14 10 Church Terrace 3 — Plumstead Road 58 15 Kirk Lane 26 5 Helen Street 11 4 Maxey Road 99 53 Eglinton Road 122 55 Whitworth Road 77 29 Llanover Road 60 26 Paget Road 46 9 Paget Terrace 12 2 Genesta Road 51 13 Westdale Road 55 35 Red Lion Lane 62 32 Red Lion Terrace Hillside Cottages 3 — Albion Cottages 2 — Post Office Cottages 5 2 Eton Street 37 19 Frederick Place 19 5 980 428 St. MARGARET'S AND C ENTRAL WARDS. 43.7% defects. Orchard Road 127 41 Maxey Road 43 16 St. John's Road 35 8 Raglan Road 38 lt> Plumstead Common Road 86 18 Francis Street 79 21 Upton Road 6 0 Hinstock Road 24 5 Manthorp Road 51 6 Flaxton Road 106 13 Sladedale Road 73 26 OlvenRoad 21 4 Hargor Road 53 22 172 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 WARDS- cont. Roydene Road 98 21 Tormount Road 73 13 Albatross Street 48 18 Alabama Street 102 34 Nyanza Street 14 9 Timbercroft Lane 73 28 Garland Street 40 27 Pendrell Street 35 22 Elm Grove 27 4 1232 371 GLYNDON WARD. 22 % defects. Brewery Road 26 6 Raglan Road 22 7 Hudson Road 27 5 Station Road 102 35 Vicarage Road 56 32 Richmond Place 40 16 Pattison Road 83 35 Villas Road 114 46 Oliver Street 22 7 Park Road 49 16 Durham Road 9 2 (East of Park Road) Ann Street 164 80 Earl Street 96 37 Elm Street 100 33 910 357 St. NICHOLAS WARD. 39.2% defects. Bannockburn Road 13 5 Bleak Hill 10 3 17 Kings Highway 35 Cemetery Cottages 9 7 Southland Road 9 3 Bostall Hill 37 19 173 TABLE XVI.— continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. St. NICHOLAS WARD— cont. Bastion Road 24 12 Kentmere Road 38 19 Heathfield Terrace 18 9 Scotch Flats 13 8 Swingate Lane (East side) 21 6 Lakedale Road (East side) 34 21 Station Road, Abbey Wood 14 10 Abbey Wood Road 81 37 Harrow Manorway 8 7 Bostal Lane 122 32 Brookdene Road 35 29 Cordite Street 48 17 Hull Place 7 4 High Steet (North side) 176 67 Basildon Road 36 4 Heath Villas 6 1 Tewson Road 113 61 Rippolson Road 28 10 935 408 43.6% defects. 174 TABLE XVII. Prosecutions under the Public Health, London County Council (General Powers), and Housing, Town Planning, etc., Acts. No. Date of Hearing. Offence. Situation. Result. 1 1910 10th Feb. Sixteen fowls unfit for the food of man deposited for the purpose of sale Beresford Square Market Fine £10 and £3 3s. costs 2 4th Aug. Bedroom overcrowded 120a, Plumstead road Order to abate in 48 hours 17/6 costs. 3 26th Oct. Dirty conditions 4, Stratton Terrace Costs 3/- 4 26th „ Damp conditions 7, Stratton Terrace Costs 7/6 5 26th „ Defective yard paving 13, Stratton Terrace Costs 6/6 175 TABLE XVIII. Summary of Articles Analysed, under the Sale of Food and Drugs Act, during the year ended olst December, 1910. Article. Number Analysed. Number Adulterated. Milk 315 .15 Butter 51 1 Coffee 11 0 Tea 27 0 Jam 3 0 Lard 5 0 Vinegar 3 0 Mustard 10 0 Ammoniated Tincture Quinine 4 0 Cheese 4 0 Condensed Milk 3 0 Dried Milk 2 0 Cocoa 7 0 Margarine 4 0 Canned Salmon 3 0 Sardines 2 0 Preserved Peas 1 0 Camphorated Oil 5 0 Orange Quinine Wine 2 0 Compound Liquorice Powder 1 0 Chicken and Ham Paste 1 0 Potted Lobster Paste 1 0 Potted Bloater Paste 1 0 Potted Salmon and Shrimp Paste 1 0 Turkey and Tongue Paste 1 0 Horlick's Malted Milk 1 0 Raisin Wine 1 0 Ginger Wine 1 0 Elder Wine 1 0 Peppermint 1 0 Cloves 1 0 Paregoric 3 0 Totals 477 16 176 TABLE XVIIIA. Prosecutions under Food and Drugs Act during year 1910. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 10 % fat abstracted H. M. Everard, Rayleigh Farm, Essex .. Costs 21/- 2 Milk 12 % added water George Espline, 46 High Street, Woolwich Fine 40/- and 23/- costs 3 Butter 65 % foreign fat Emma Morris, 6 Brentwood Cottages, Eltham Fine 40/- and 23/- costs 4 Milk 35 % fat abstracted Henry Willis, 2 Ritter Street, Woolwich.. Dismissed, Warranty provec 5 Milk 10 % added water Ellen Dennis, Brookhill Road, Woolwich Fine 40/- and 12/6 costs 6 Milk 10 % added water and 11 % fat abstracted Ellen Williams, 12 Thomas St., Woolwich Fine 30/- and 12/6 costs 7 Milk 10 66 % fat abstracted and -047 % boric acid John Grace, Pippen Hall Farm, Eltham.. Fine £3 and 23/- costs 8 Milk 7 % added water Thomas Hellier, Chard, Somerset Costs 25/- 9 Milk 4-7 % added water and 4 % fat abstracted Royal Arsenal Co-operative Society, Woolwich Dismissed, Warranty provec 10 Milk 8-6 % added water and 4 % fat abstracted Walter Dodson,, 138 Plumstead Common Road Fine 20/- and 23/- costs 11 Milk 18'8 % added water and 6-67 % deficient in fat A. E. Paine, 14 Gunning Street Fine 40/- and 23/- costs 12 Milk 5 % added water Harry Furber, Southend Farm, Eltham.. Fine £4 and £2 2s. costs 13 Milk 6'67 % fat abstracted Henry J. Burgess, 14 St. Mary Axe, E C. Dismissed, warranty proved 14 Milk 14 5 % added water Robert Green, 13 Saunders Rd., Plumstead Fine 15/- and 12/6 costs 15 Milk 14-3 % added water H. Brown, 92 Kingsman St., Woolwich Fine 10/- and 12/6 costs 16 Milk 3-33 % fat abstracted T. Penryn, Cheshunt Dairy, Cheshunt No proceedings taken 177 TABLE XIX. Food Seized, or Surrendered by Owners, as unfit for consumption. Articles. Quantity. Date. Remarks. Reason. 1910 Fowls 16 Jan. 1 Seized Unsound Ox Liver 1 Feb. 8 Surrendered Flukes Sheep's Cauls (parts of) „ 8 ,, Cystic Codlings 4 boxes ... ,, 16 ,, Unsound Sheep's Liver Mar. 8 ,, Cirrhosis Ox Liver ,, 10 ,, Flukes Ox Liver ,, 16 ,, Do. Skate, Cod and Haddocks 1 kit ,, 18 ,, Unsound Ox Liver April 6 „ Flukes Pig's Liver ,, 7 ,, Cirrhosis Sheep's Cauls (parts of,) 4 ,, 12 ,, Cystic Ox Liver ,, 18 ,, Flukes Sheep's Cauls (part of) 3 ,, 19 ,, Cystic Cod Pish 5 ,, 19 ,, Unsound Ox Liver ,, 25 ,, Flukes Kippers 1 box May 21 ,, Unsound Ox Liver ,, 30 ,, Flukes Ox Liver June 1 ,, Haddocks 1 turn ,, 6 ,, Unsound Ox Liver Aug. 3 ,, Abscesses Lemon Soles 1 box ,, 5 ,, Unsound Mackerel 1 box ,, 18 ,, Do. Monk 1 box ,, 20 ,, Do. Haddocks 4 boxes ,, 23 ,, Do. Ox Liver ,, 31 ,, Flukes Haddocks 1 box Sept. 7 ,, Unsound Sheep's Caul ,, 8 ,, Cystic Ox Liver ,, 14 ,, Flukes Ox Liver ,, 21 ,, Do. Ox Liver ,, 28 ,, Do. Haddocks 1 box Oct. 7 ,, Unsound Herrings 1 box ,, 12 ,, Do. Dabs 1 box ,, 13 ,, Do. Codlings 1 box ,, 14 ,, Do. Pig's Head and Spare Rib ,, 14 ,, Tuberculosis Haddocks 1 box Nov. 15 ,, Unsound Cow's Liver 2 ,, Flukes Lights 2 ,, 2 ,, Tuberculosis Pig's Carcase with Liver, etc. ,, 3 ,, Tuberculosis Sheep's Cauls (parts of) ,, 7 ,, Cystic Pigs Liver Pig's Pluck ,, 17 ,, Cirrhosis ,, 17 ,, Strongyli Apples 1 barrel Dec. 1 ,, Unsound Ox Liver ,, 7 ,, Flukes Apples 1 barrel ,, 13 ,, Unsound Ox Liver ,, 14 ,, Flukes Ox Liver ,, 15 ,, Do. Ox Liver ,, 16 ,, Do. Ox Liver ,, 19 ,, Do. 178 TABLE XX. List of Level Bakehouses. Name. Address. (Unoccupied) 48 Princes Road, Plumstead Chadwell Bros. 60 Plumstead Common Road 0. Pullen 105 do C. Cheesman 126 High Street, Plumstead J. E. Porter 1 Riverdale Road, do P. Bohmer ., 307 High Street, do A. E. Paine 14 Gunning Street, do A. Jewiss 68 Glyndon Road do (Unoccupied) 102 Ann Street, do 0. Letchford 109 Plumstead Road, do J. Clark 152 do do (Unoccupied) 82 Bannockburn Road, Plumstead (Unoccupied) 2 Stratton Terrace, Bostall Lane, Plumstead W. Jeffery 123 Burrage Road, Plumstead P. H. Mack 111 High Street, Woolwich A. Bradshaw 3 Green's End, do (Unoccupied) 184 Elizabeth Street, North Woolwich C. Haas 122 Albert Road, do H. Meyer 33 Samuel Street, Woolwich Mrs. Dennis 90 Brookhill Road, do W. Jones 36 Chapel Street, do A. Adams 168 Kingsman Street, do J. B. Pyson 94 High Street, Eltham H. Westbrook 114 do do P. Cook 142 do do F. J. Cook 5 The Parade, New Eltham P. 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 4 Plumstead Road F. Mendham R. Tsinn 100 High Street, Woolwich 179 TABLE XXa. List of Certified Underground Bakehouses. Name. Address. (unoccupied) 33, Eglinton Road, Plumstead Merritt & Co. 50, Herbert Road, do. (unoccupied) 14, Westdale Road, do. H. Percival 223, High Street, do. J. Werner 1, Park Road, do. (unoccupied) 58, Pattison Road, do. F. Cox 46, Hudson Road, do. (unoccupied) 14, Conway Road, do. J. Fletcher 30, Burrage Road, do. W. T. Akers 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. (unoccupiedl 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. 180 TABLE XXb. List of Factory Bakehouses. Name. Address. J. Fletcher 57, Barrage Road, Plumstead J.Fletcher 92, Plumstead Road, Plumstead T. Newman 94, Wellington Street, Woolwich Royal Arsenal Co-operative Society 127 to 153, Powis Street, Woolwich J. Alderton Malton Street, Plumstead G. Mackintosh Warwick Terrace, Plumstead Common J.Werner 1, Park Road, Plumstead A. Chapman 2, High Street, Plumstead 6. Paterson 13, Eton Road, Plumstead 181 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 H. Reed & Co., Ltd. 25, Parry Place, Plumstead 4 Do. 6, High Street, Plumstead 5 Hed ley 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 H. Reed & Co., Ltd. 38, Plumstead Common Road, Plumstead 11 Henry Fretter 33, Herbert Road, Plumstead 182 TABLE XXII. List of Cowhouses. No. Name and Address of Owner. Situation. 1 Robert E. Puller KeightleyHouse Farm, Southwood Road, Eltham 2 Richard and James Higgs Cold Harbour Farm, Chislehurst 3 John and Alfred Low, Avery Hill Farm, Bltham Park Farm, Eltham 4 W. F. Corp Lyme Farm, Eltham 5 Charles UnfrevilleFisherand William F. Fisher, Crescent Farm, Sidcup Belmont Park Farm, Eltham c 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 13 Charles William Killick, 52, St. James' Place Henry Woolsey 13, Princes Road, Plumstead 50, Francis Street, Plumstead 14 William Ridewood, Chapel Farm, Eltham 3, Ripon Road, Plumstead 15 F. G. Cock 13, Raglan Road, Plumstead 16 Charles George Lambeth, Frank Seymour Lambeth, Frederick Lambeth, and George Pannell Lambeth 1, Griffin Road, Plumstead 17 Jas. Buckingham, 16, Pellipar Road Rear of 14, 15 & 16, Pellipar Road, Woolwich 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 Balster, h. 97 Plumstead Common Road 5 Carr, E. 46 Kingsman Street 6 Finnimore, J. A. 83 Park Road 1 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. 68J 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 Woolsey, H. 50 Francis Street 21 Howe, J. R. 82 High Street, Eltham 22 Hawkins, Ellen M. 2 St. Nicholas Road 23 Purber, Harry Southend Farm, Eltham 24 Large, Daniel J. 6 Herbert, Road 25 Hiscock, C. T. & E. 14 Blenheim Terrace 26 Dalton, R. G. 55 Eglinton Road 27 Green, R. 13 Saunders Road 28 Butter & Sons 49 Woolwich Common 29 Do. 10 Jackson Street 30 Ward, Samuel 1 Nightingale Vale 31 Mack, P. H. 111 High Street, Woolwich 32 Webb, Younger 10 Beresford Square 33 Dennis, Ellen 90 Brookhill Road 34 Prowett, J. 25 Plum Lane 35 Bayley, M. Middle Park Farm, Eltham 36 Godden, A. A. 229 High Street, Plumstead 37 Palmer, D. 46 Church Street 38 Wilton, M. M. 77 Powis Street 39 Corp, W. P. Lyme Farm,. Eltham 40 Pearce, R. A. 175 Plumstead Common Road 41 Christmas, Hannali . 18 Well Hall Parade, Eltham 42 Dodson, W. 138 Plumstead Common Road 43 Dowsett, J. 105 Crescent Road 44 Wyatt, J. 141 Albert Road 45 1 Nelson, J. 9 Parson's Hill 183 TABLE XXIII.—continued. No. Name. Address. 46 Dolphin T. G. 89 Maxey Road 47 Rumsey, E. 186 Powis Street 48 Tyler. C. W. 142 High Street, Woolwich 49 Clements, E. J. 2 Cross Street 50 Bohmer, H. 307 High Street, Plumstead 51 Couzens, Jesse 10 Chapel Street 52 Bollen, W. 1 Warwick Terrace 53 Stevens, P. 100 Roydene Road 54 Ridewood, W. 116 High Street, Eltham 55 Rose, J. .. 64 Hargor Road 56 Trodd, W. J. 113a High Street, Woolwich 57 Stevens, H. 27 Church Street 58 Needham, Elizabeth.. 94 High Street, Woolwich 59 Webb, F. W. & Co. 16 Lakedale Road 60 Pinch, G. A. 13 The Parade, New Eltham 61 Davis, D. H. 170 Albert Road 62 Willis, H. 2 Ritter Street 63 West, W. H. J. Rear of 49 Lakedale Road 64 Phipps, H. 15a Sand Street 65 Reynolds 21b & 26b Glyndon Road 66 Smith, Elizabeth 12 The Broadway, Eltham 67 Bennett, Rose 22 Glyndon Road 68 Williams, Ellen 12 Thomas Street, Woolwich 69 Bartrum, Abner 167 Kingsman Street 70 Jones, David 65 Maxey Road 71 Mackintosh, G. H. 16 Warwick Terrace 72 Jaques, Herbert 56 Anglesea Road 73 Killick, 0. W. 52 St. James's Place 74 Hawkins, Emily 77 Powis Street 75 ' j Campion, H. E. 105 Pattison Road 76 Parkes, J... Fountain Stores, The Slado 77 Lamb, Annie 29 Admaston Road 78 Townsend, J. 21 Wilmount Street 79 Jones, E. C. 6 Samuel Street 80 Harrington, James 26 Prospect Row 81 Greatrex, P. Lydwin Cottage, Plumstead Common 82 Cole, E.J. 18 Camrose Street 83 Finnimore, W. J. 21 Walpole Place 84 Smith, S. R. 6 Bloomfield Road 85 Lyons, J. & Co., Ltd. 99 Powis Street 86 McGee, Jane 42 Mulgrave Place 87 Attenborough, Caroline 18 Prospect Place 88 Whiffin J. H. 108 Burrage Road 89 Marsh, C. Ashurst, Shrewsbury Lane 90 Palmer, Annie 127 Plumstead Road 91 Mumford, Kate P. 22 Cross Street 184 185 TABLE XXIII.—continued. No. Name. Address. 92 Holmes, Blanche 43 Bostall Hill 93 Wain wright 36a Mulgrave Place 94 Gill, Emily A. 398 High Street, Plumstead 95 Morley, Ernest 31 Craigton Road 96 Brinkworth, W. J. 82 Purrett Road 97 Palmer, P. 82 Purrett Road 98 Elliott, W. G. 289 High Street, Plumstead 99 Espline, G. 48 High Street, Woolwich 100 Crawford, F. 13 Hinstock Road 101 Bassett, T. 69 Bannockburn Road 102 R.A. Co-operative Society The Links, Plumstead Common Road 103 Jones, W. H, 39 Beresford Street 104 Holdway, Georgina H. 45 Bostall Hill 105 Buck, E. Y. 52 Raglan Road 106 Challis, P. W. 4 High Street, Woolwich 107 Frost, W. D. 44 Powis Street 108 Gee, A. J. 147 Plumstead Road 109 Dick, J. 107 Pattison Road 110 Joy, W. G. 36 Thomas Street 111 Corp, W. J. 98c High Street, Eltham 112 Crayfourd, J. E. 40 Orchard Road 113 Leaver, E. A. 25 Garland Street 186 TABLE XXIV. List of Applicants Eegisteeed during 1910. No. Name. Address. 114 Buckingham, J. 16 Pelliper Road 115 Burgess, H.J. 3 Wellington Street 116 Paterson, G. 13 Eton Road 117 Flint, Emma 124 Maxey Road 118 Gittings, W. J. " Cold Blow," Plumstead Common 119 Poulter, G. E. 52 Whitworth Road 120 Brown, H. J. Phillips, J. H. 92 Kingsman Street 121 77 Kingsman Street 122 Curtis, Stephen 181 Abbey Wood Road 123 Paine, A. E. 14 Gunning Street 124 Grace, James 18 The Broadway, Eltham 125 Kerry, P. L. 30 H igh Street, Eltham 126 Cornwall, J. 14 Frances Street 127 Sheldon, W. 101 Sand Street 128 King, E. A. L. 4 Spray Street 129 Richardson, M. 182 Elizabeth Street 130 Adams, H. 31 Beresford Street 131 Hadley, H. W. 3 Wellington Street 132 Lovell, E.J. 3 Wellington Street 133 Higgins, E. M. 136 Macoma Road 134 Muir, W. C. 28 Conway Boad 135 Handsley, Ltd. 68J Bloomfield Road 136 Townsend, Rose E. 104 Brookhill Road 137 Fuller, R. E. & Co. Southwood Road, Eltham