Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. 1911. Woolwich: H. Pryce & Son, Printers (T.U. Federation), 31, 33 & 35, Powis 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. Thomas Davis, 2, Greening Street, Abbey Wood. Alfred Halt., Ill, 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 Tailby, 89, Herbert Road, Plumstead. Charles Watkins, 10, Woolwich Common. Chief Sanitary Inspector: Albert G. Duck (Cert. San. Inst.) District Sanitary Inspectors: John W. Range (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 Sell. Hygiene (Univ. Coll.). Chief Clerk: Amyas Britteii (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., Camb. ; Fellow of the Incorporated Society of Medical Officers of Health (Vice-President, Metropolitan Branch), and Fellow of the Royal Sanitary Institute. a 2 4 Summary of Statistics, 1911. Area of Borough 8,276.6 Acres Population—Census, 1901 117,178 do. do. 1911 121,376 Inhabited Houses—Census, 1901 18,086 do. do. do. 1911 21,463 Persons to an acre 14.7 Persons to a House—Census, 1901 6.47 do. do. do. 1911 5.65 Marriages 997 Births 2,814 Birth Rate 23.2 Deaths 1558 Death Rate 12.8 Infantile Mortality 98 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 14 Marriages 17 Deaths—Woolwich Death Rate compared with other Boroughs 18 Lives and Illness Saved 22 Infant Mortality—Preventive Measures 22 Still-births 24 Mortality under five years 25 Zymotic Death Rate 25 Inquests and Uncertified Deaths 25 Deaths in Public Institutions 26 Poor Law Statistics 27 Notification of Diseases 27 Small-pox 28 Chicken-pox 28 Measles 28 Whooping Cough 31 Scarlet Fever—Expense of unnecessary Hospital IsolationReturn Cases—Isolation at Home—Sources of Infection— Schools Affected—Exclusion of Contacts 32 Diphtheria—School Outbreaks and Precautions Taken 37 Mistaken Diagnosis 40 Source of Infection 40 Bacteriological Examination 41 Enteric Fever—Source of Infection 42 Bacteriological Diagnosis 43 6 Page Diarrhoea or Zymotic Enteritis—Notification Statistics— Tables 43 Erysipelas 54 Cerebro-spinal Meningitis 54 Anterior Polio-Myelitis 54 Puerperal Fever 55 Influenza, Bronchitis, and Pneumonia 55 Tuberculosis—Notification 55 Duration of Illness 59 Source of Infection—Occupation 59 Bacteriological Diagnosis 61 Hospital and Sanatorium Treatment 61 Nature of Cases 64 Charge for Beds 67 Shelters for 67 do. do. —Photograph of 69 Tuberculosis Dispensary 70 Cancer—Classification 71 Alcoholism 75 Syphilis 75 Ophthalmia Neonatorum 76 Meteorology 76 Part II.—Administration. Water Supply—Plumstead Well 78 do. Tenement-houses 79 Food and Drugs Act—Percentage Milk Adulteration 80 Food Inspection 82 Dairies, Cow-sheds, and Milk-shops 83 Slaughter-houses 85 Nuisances —Complaints, Drains, Water-closets, Supervision of Drainage 85 Public House Urinals 86 House Inspection 86 Medical Officer's Inspections 87 Over-crowding 87 7 Page Nuisances—Smoke Nuisance 88 Defective Light 88 Verminous Rooms 88 Dust Removal—Collection, Cost of 89 Trade Refuse—Offensive and Inoffensive 89 Housing of the Working Classes- Houses represented as unfit for habitation 90 Council's Houses 92 Houses Registered under the By-laws 92 Inhabited House Duty 94 Common Lodging-houses 94 Underground Rooms 95 Factories and Workshops—Inspections—Outworkers 95 Bakehouses 95 Ice-cream Shops 96 Disinfection, Disinfectants 96 Health-Shelter 97 Mortuaries 97 Cemeteries 98 Cleansing of Verminous Persons—Cleansing School Children 98 Public Baths—Lavatories and Cleanliness 100 Tents, Vans and Sheds 101 Notices and Prosecutions under Public Health (London) Act 101 Bacteriological Examinations 101 Infant Consultation 101 Women Sanitary Inspectors' Work— Miss Middlebrooke's Report 103 Miss FitzGerald's Report 106 Public Ambulance 109 Public Health Staff 110 8 LIST OF TABLES. Page Table I.—Population. Births and Deaths for the whole Borough, from 1901 to 1911, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 1ll Number of Inhabited Houses, the average number per house, and the acreage 1ll „ Ia.—Institutions inside and outside the district receiving sick and infirm persons from the district 113 „ II.—Population, Births Registered, Deaths at all ages, and Deaths under One Year, for each Ward during 1901, 1902,1903, 1904, 1905, 1906, 1907, 1908,1909, and for each Parish during 1910 and 1911 115 „ III.— Cases of Infectious Disease notified at all ages, at various age groups, and distributed according to Wards during 1911 119 „ IV.—Deaths at all ages, at various age groups, from various causes, arranged by Parishes in 1911. Total Deaths in Public Institutions in district in 1911 121 „ IVa.—Infantile Mortality during the year 1911 125 „ V.—Case and Death Rate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1911 127 „ YI.—Vital Statistics of the various London Boroughs for 1911 129 „ VIa.—Birth and Death Rates do. do. do. 131 „ VII.—Death Rates and Infant Mortality of the various London Boroughs, 1906-10 and 1911 134 „VIII.—Meteorology and Registered Deaths from all causes and from certain prevalent diseases in each week of the year 1911 137 „ IX.—Weekly Averages for Meteorology and Registered Deaths from all causes and from certain prevalent diseases 139 „ X.—Summary of Statistics for the first Quarter of 1911, corrected for Public Institutions 140 „ XI.—Summary of Statistics for the second Quarter of 1911, corrected for Public Institutions 141 9 Page Table XII.—Summary of Statistics for the third Quarter of 1911, corrected for Public Institutions 143 „ XIII.—Summary of Statistics for the fourth Quarter of 1911, corrected for Public Institutions 144 „ XIV.—Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 147 „ XVa.-Summary of the General Work of the Public Health Department for 1911, the number of Nuisances abated, and Notices served in each Ward 149 „ XVb.—Summary of Work of Chief Inspector, and miscellaneous 151 „ XVc.—Inspection of Factories, Workshops and Workplaces 152 „ XVd.—Proceedings during 1911 re Milk-shops, Cowsheds, Slaughter-houses, &c 155 „ XVI.—List of Streets Inspected—House to House- and number of houses where defects were found 156 „ XVII.—Prosecutions in 1911 under the Public Health (London) Act and By-laws and Housing of the Working Classes Act. 162 „ XVIII.—Summary of Articles Analysed under the Sale of Food and Drugs Act 163 „ XVIIIa.—Proceedings in 1911 under the Sale of Food and Drugs Act 164 „ XIX.—Food seized or surrendered by Owners, as unfit for consumption 166 „ XX.—List of Level Bakehouses iii the Borough, 1911 169 „ XXa.—List of Certified Underground Bakehouses in the Borough, 1911 170 „ XXb.—List of Factory Bakehouses in the Borough, 1911 171 „ XXI.—List of Slaughter-houses in the Borough, 1911 172 „ XXII.—List of Cow-houses in the Borough, 1911 173 „ XXIII.—List of Milk Sellers 174 ,, XXIV.—List of Persons Registered as Purveyors of Milk during 1911 177 CHARTS :— Showing Death Rate, Birth Rate, and Infantile Death Rate, 1891-1911 Phthisis—Death Rate and Temperature, 1891-1911—England, London, Woolwich, Greenwich and Lewishain. 10 PREFACE. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Woohcich. Mr. Mayok and Gentlemen, I herewith present my eleventh Annual Report on the Health of the Borough, including the twentieth Annual Report on the health of Plumstead. Owing to a summer whose heat established a record, there was a higher mortality last year among infants than for several years past. Tables VI., VIa, and VII. shew, however, that Woolwich occupied a satisfactory position as compared with other London Boroughs ; four other Boroughs had a lower death-rate, but only one other had a lower infantile death-rate. The work of dealing with the epidemic of Diarrhoea in the summer overtaxed the powers of the two Women Inspectors and emphasised the need of additional health visitors. One of the two Women Inspectors usually devotes most of her time to health visiting re infants, but this had to be neglected for several weeks in August and September. The other Woman Inspector is now occupied mainly in dealing with verminous houses and children (see her report, par. 49), and can find no time for inspecting houses let in lodgings, and very little for visiting houses were infectious disease has occurred. 11 Last year was noteworthy for the establishment of a Tuberculosis Dispensary, under a Voluntary Committee, but in close co-operation with your council. By providing expert and early treatment for poor persons suffering from Consumption, this institution should greatly assist in the abolition of this disease. Satisfactory work has been done under the Housing, Town Planning, etc., Act (see par. 30). ' I would call your special attention to what is said in par. 49a re Public Baths, Lavatories, and Cleanliness. 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 DAWES. 12 ELEVENTH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1911. PART I. Statistics. 1. Population. The population of the Borough of Woolwich, as estimated at the Census of 1911, was 121,403. This is 7,045 less than was estimated for the year 1910. The increase since the previous Census was 4,225. The population of the four registration districts is as follows: — Census, 1901. Census, 1911. Woolwich Parish 41,625 36,710 Plumstead Parish (West) 38,569 40.328 do. (East) 29,758 30,888 Eltham Parish 7,226 13,450 117,178 121,376 Woolwich Parish has decreased by 4,915 persons, Plumstead has increased by 2,889, and Eltham by 6,224. 13 West Plumstead includes the Burrage, Herbert, Glyndon, and St. Margaret's Wards, and East Plumstead the Central and St. Nicholas Wards. 2. The following table gives the population, number of houses, and persons to a house, of each Ward as found at the Censuses of 1901 and 1911: — Census 1901. Census 1911. Wards. Population. No. of Inhabited Houses. Persons to a House. Population. No. of Inhabited Houses. Persons to a House. Dockyard 8712 1325 6.57 7199 1211 5.94 St. Mary's 7833 1126 9.27 6666 1003 6.64 River- North 2991 441 6.78 4409 585 7.54 „ —South 11405 1671 6.83 9353 1656 5.65 St. George's 10684 878 9.20 9083 860 10.56 Burrage 9837 1735 5.67 8887 1688 5.26 Glyndon 9810 1697 5.78 9501 1769 5.37 Herbert 9080 1612 5.63 8780 1739 5.05 St. Margaret's 9842 1638 6.00 13160 2578 5.10 Central 10118 1805 5.61 9083 1831 4.96 St. Nicholas 19640 2805 7.00 21805 3729 5.84 Eltham 7226 1353 5.34 13450 2814 4.77 The Census shows that in recent years too high a population has been estimated, and the birth and death rates given for those years were consequently somewhat too low. Probably the population estimated ms not far from the mark up till 1905. For the years 1906-10 an average population of the Wards and Parishes has been taken, based on the recent Census and the estimated population in 1905, viz.:— Woolwich Borough 123,644 Woolwich Parish 38,395 Plumstead Parish 72,714 Eltham Parish 12,535 14 The principal vital statistics given in this Report for the years 1906-10 have been re-calculated on these populations. *viz., Woolwich 19 West Plumstead 7 East Plumstead 3 Eltham 81 Most of the new houses certified in 1911 were in Eltham Parish. 4. At the 1911 Census there were 1,296 unoccupied houses in t^he Borough, viz., 450 in Woolwich, 387 in West Plumstead, 250 in East Plumstead, and 209 in Eltham. At tjhe 1901 Census there were 234 in the Borough, viz., 46 in Woolwich, 86 in Plumstead, and 102 in Eltham. 3. The following table shows the number of houses certified for water each year since 1901:— New houses to June 30th, 1901 257 ditto 1902 1,292 ditto 1903 743 ditto 1904 582 ditto 1905 483 1906 1906 390 ditto 1907 281 ditto 1908 191 ditto 1909 157 ditto 1910 123 ditto 1911 110* Births. 5. The number of births was 2,814, viz., 1,001 in Woolwich parish, 836 in West Plumstead, 726 in East Plumstead, and 15 251 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, 23.2, compared with 23 0 in tjhe previous year, and with 27.5, the average for the ten years 1901-10. The rate for the County of London was 25.0. Notification of Births. 2,543 births were notified under the Notification of Births Act. This is at the rate of 91 per cent, of the registered births, compared with 83, 88, and 93 per cent, in 1908, 1909, and 1910. 1,476 births were notified by midwives, 268 by the Home for Mothers and Babies and Military Families Hospitals, and 531 by medical practitioners. 68 still-births were notified. The Notification of Births Act was adopted on March 1st, 1908. There "were 253 births last year which were ,not notified. When any child is met with whose birth has not been notified, the doctor or midwife who attended is written to and warned. No cases have been found in which neglect to notify appeared to be due otherwise than to oversight. 88 per cent, of births "were notified in Woolwich, 91 per cent, in Plumstead Parish, and 93 per cent, in Eltham. 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. With very few exceptions the advice is welcomed. It was pointed out t,hat the code of instructions differed from one issued by the London County Council, and on further inquiry it was found that very considerable divergencies existed in tjie directions for infant feeding and management 16 used in the Metropolitan Boroughs. On the initiation of your Medical Officer of Health an effort is now being made to draw up a code which will commend itself to all London Authorities and Associations engaged in instructing mothers. 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 birth-rate of the Borough during the years 1901-5, 1906, 1907, 1908, 1909, 1910, and 1911, and for the purpose of comparison the corresponding rates of the neighbouring boroughs, London, and England: — Birth-Rate. 1901-5 1906 1907 1908 1909 1910 1911 Greenwich Borough 27.6 24.9 Lewisham 25.7 21.2 West Ham 33.1 29.9 East Ham 33.8 25.8 Erith 34.1 25.7 London 28.2 25.0 England and Wales 28.2 27.0 26.3 26.5 25.6 24.8 24.4 Woolwich Borough 29.2 28.5 26.5 24.9 23.8 23.0 23.2 7. The following table gives the birth-rate for the Borough, and each registration district, for the three past quinquennia, and last six 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. 17 West Plumstead and Eltham had the lowest birth-rate of the four registration districts. Average of 1891-1895. Average of 1896-1900. Average of 1901-1905. 1906 1907 1908 1909 1910 1911 Woolwich Borough 32.5 30.2 29.2 28.5 26.5 24.9 23.8 23.0 23.2 Woolwich Parish 31.1 30.1 29.0 3004 30.3 26.8 26.4 25.5 27.1 Plumstead— West 33.3 31.0 30.1 28.8 25.4 24.4 22.1 21.8 20.6 East 24.4 21.8 23.4 Eltham Parish 22.8 20.6 24.0 21.2 22.7 21.1 21.2 21.8 18.5 8. Illegitimate Births. 36 of the births registered were illegitimate, giving a rate of 13 per 1,000 births, compared with 22, 24, 20, 24, and 19, in the five preceding years. -The illegitimate birth-rate in London was 34 in 1910. Marriages. 9. There were 997 marriages. The marriage rate was 16-4, compared with 14 0 and 15 0 in the two preceding years. The increase in the marriage rate is an indication of improvement in local industrial conditions. In 1910, the marriage rate in London was 16'0, and in tEngland and Wales 14-8. deaths. 10. Table 1 gives the gross and net deaths and deathrates in 1911, and eacjh of the past ten years, and shows how the net deaths are arrived at. b 18 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 or inside the Borough. But, in order to institute a fair comparison between one district and another, it is necessary to further correct the death-rate for sex and age distribution, for it is obvious that a population containing a large number of young persons between the ages of five and thirty, when the death-rate is very low, Should have a lower death-rate than one containing an elxcess of aged persons. The factor for the correction of the Woolwich death-rate is 1.0690. 11. The net deaths were 1,558, and the net death-rate 12.8, compared with 12.8 and 11 4 in the two preceding years. 12. By multiplying by 1.0690, the factor for age distribution, we get the corrected death-rate, viz., 13.7, 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 14.6 14.6 77 Great Towns 15.5 16.4 London 15.8 16.6 Greenwich 14.7 15.0 Lewisham 11.3 11.8 West Ham 15.7 19 Net. Corrected. East Ham 12.1 Erith 7.7 Woolwich 12.8 13.7 In 1911 Woolwich had the highest death'rrate and Eltham Parish the lowest in the four districts. The greatest! decrease in the past ten years has occurred in Woolwich and Eltham Parishes. 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, 1910, and 1911. Average 1886-1890. Average 1891-1895. Average 1896-1900. Average 1901-1905. 1906. 1907. 1908. 1909. 1910. 1911. Woolwich Borough — 17.2 16.9 13.9 13.5 13.0 12.0 12.8 11.4 12.8 Woolwich Parish* 20.4 19.3 20.1 16.5 16.2 15.1 14.5 14.6 12.9 15.6 Plumstead West 16.4 16.0 15.1 12.9 12.7 12.5 11.4 3.8 12.0 13.4 East 10.6 10.4 11.4 Eltham Parish — 13.0 14.6 10.2 9.8 10.2 10.4 11.3 8.8 8.3 London 20.0 19.8 18.5 16.1 15.1 14.6 13.8 14.0 12'7 15.0 * Three years—1888, 1889 and 1890. 14. The following table gives the numbers dying at various ages in the past nine years from all causes, and the deaths at all ages from certain diseases not hereafter referred to:— b 2 Deaths—1901 to 1911. 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 75 & over 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 1911 273 136 37 27 24 36 85 132 168 211 214 218 20 Deaths from 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Apoplexy and all other diseases of the heart and blood vessels 221 212 215 227 216 217 243 268 248 265 Nephritis and Bright's disease 32 38 35 46 52 49 42 50 43 43 Respiratory diseases-all forms (except Phthisis) 308 269 285 264 277 209 234 250 236 206 Chart showing Death Rate, Birth Rate and Infantile Death Rate - 1891/1911. 21 Compared with the two previous years, there was in 1911 some excess of deaths at several age periods, but especially under five and over 55. The number of deaths from respiratory diseases (except phthisis) was the smallest recorded; deaths from influenza and scarlet fever also were fewer, but those from diarrhoea, tuberculosis, old age, diabetes, and cancer, were much increased. Comparing the years 1903-4 with 1910-11, it is seen that in the latter period there were fewer deaths at each of the nine age periods under 55, with two exceptions. At all the periods over 55 there were more deaths in 1910-11 than in 1903-4. Owing to the fall in the birth-rate the population under five years has probably slightly decreased, but not enough to invalidate the conclusion that there has been a repaarkable saving of life at ages under 55. It is also seen that whereas in 1910-11 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 the number of deaths in 1911, from 57 principal causes at various ages. Seveial alterations have been made in the table in order to include all the headings of the Table 3 required by the Local Government Board. Appendicitis caused 8 deaths iu 1911, compared with 3 in 1910. 15. The chart on the opposite page shows graphically how the birth and death rates have varied in the past 20 years. The death-rate and infantile death-rate usually rise and fall together, but the birth-rate follows quite a different 22 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. 16. Lives Saved, In the last two years, I have estimated that 383 and 568 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 1911 would have meant the death of 1874 persons instead of 1558 who actually died. There was thus a saving of 316 lives in 1911. It cannot be said that these were doubtless the lives of invalids whose prolongation would only be an infliction to themselves and their friends. Many strong and healthy children get infectious diseases and die of them. The whole evidence goes to show that the death-rate may be regarded as a health barometer of an inverse kind, i.e. a fall indicates a general improvement in the health of the population, and means that there are not only more persons who live to an advanced age, but that a much larger number of boys and girls, men and women, enjoy the highest form of wealth, namely health. Infant Mortality. 17. The deaths under one year were 273, compared with 241, in 1910. The infant mortality (deaths under one year per 1,000 births) was 98, compared with 84 last year, and with 82 in 1909. The chief cause of the rise in infant mortality last year was the warm summer, and consequent prevalence of diarrhoea. 23 The following table gives the infantile mortality in the Borough since 1901, compared with the neighbouring Boroughs, London, and England:— 1901-5. 1906. 1907. 1908. 1909. 1010. 1911. Lewisham 112 113 90 86 93 80 104 Greenwich 137 119 100 120 114 107 129 West Ham 158 149 131 128 123 101 141 East Ham 131 127 108 104 95 94 119 Erith 112 85 88 80 78 71 70 London 138 132 115 113 107 103 128 77 Great Towns — 146 127 128 118 115 140 England and Wales 135 133 118 121 109 96 130 Woolwich Borough 119 111 113 95 82 84 98 18. The following table gives the infantile mortality during 1906, 1907, 1908, 1909, 1910, and 1911, and four preceding quinquennia in the Borough, and each registration district:— It is seen that in East Plumstead the rate was lower than in 1910, and in Eltham the lowest on record. Thus the excessive infant mortality was confined to Woolwich Parish, and West Plumstead. 18861890 18911895 18961900 19011905 1906 1907 1908 1909 1010 1911 Woolwich Parish *151 157 170 134 139 114 111 91 89 110 Plumstead 121 120 132 113 97 108 88 W. 82 79 104 E. 75 90 82 Eltham .. 163 160 97 94 140 75 68 70 64 Woolwich Borough .. 140 146 119 111 113 95 82 84 98 1888, 1889, and 1890. 24 19. Table 4b gives full details as to the ages at death and causes of death of the 273 infants dying in 1911 under one year. It shows that 34 per cent. (43 in 1910) of those who died were under one month old, compared with 37 per cent. in the previous six years. 51 deaths were from premature birth, compared with 75, 61, 72, 41, and 51, in the five preceding years, and 31 (27 in 1910) were attributed to Atrophy, Debility and Marasmus, indefinite terms applied to deaths from immaturity, congential syphilis, and other causes. The number of deaths under one week in the past five years was 83, 76, 55, 72, and 62, respectively. It is satisfactory to note that in the past four years the deaths from suffocation in bed have averaged only 4 a year, whereas in the four years 1904-7 they averaged 7. The death-rate per 1,000 births from premature birth in Woolwich Borough was 18.1, compared with 14.0, and 17.9, in the two preceding years. In London it was 18.5 in 1910. There were 17 deaths of illegitimate infants. The deathrate of illegitimate infants under one year was 472 per 1,000 births, and that of legitimate children, 92. 20. Compared with 1910 the past year had among infants more deaths from debility, meningitis, diarrhoea and enteritis, and fewer from measles, whooping-cough, congenital defects, syphilis, rickets, and bronchitis. Deaths from overlying were 5, compared with 2, 8, 5, 1, and 5, in the previous five years. 21. Still-Births. 74 still-born children were buried in 25 Woolwich and Plumstead Cemeteries, compared with 97, 93, 92, and 92, in the four preceding years. 68 still-births were notified, compared with 54 in 1910. 22. Deaths under five years. The total deaths under five years were 409 (345 in 1910). 23. Zymotic Death-rate. The number of deaths from scarlet fever, diphtheria, measles, whooping cough, enteric fever, and from diarrhoea and enteritis under two years of age were 154, and the death-rate per 1,000 population 1.27. Owing to the new tables required by the Local Government Board not distinguishing between different forms of EnteritiB it is impossible now to compare the Zymotic death-rate with that of former years. The following table gives the zymotic death-rate in each parish during the years 1901-10:— 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 Eltharn 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 123 inquests compared with 160, 141, 121, 128, 115, 105, and 107, in the seven preceding years. The following table gives particulars as to the cause of death:— 26 1. Natural causes 65 2. Alcoholism 3 3. Accidental causes:— Burns and Scalds 5 Drowning 7 Falls 11 Fractures 5 Run over 1 Suffocation, overlying 5 Poison 1 Anaesthetics 2 Other accidental causes 7 44 4. Homicidal causes:— Suicide 11 Murder and Manslaughter — 11 123 The " Accidental Causes " were 43, 35, 49, 23, and 42, in the five preceding- years. The " Homicidal Causes " were 15, 7, 15, 14, and 6, in the same years. 25. Deaths in Public Institutions. Table 1 shows the actual number of deaths occurring* in Public Institutions in the Boroug-h, viz., 311, compared with 293, 296, 289, 276, and 272, in the five preceding years. These deaths nearly all occurred in the Poor Law Infirmary; they were 18.8 per cent. of total deaths, compared with 19.4 in 1910. 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. Over one-third of the total deaths occurred in the Infirmary or hospitals. 27 25a. Poor Law Statistics. The following- figures from the "Abstract" published by the Guardians of the Woolwich Union, have an interesting bearing on death and sickness statistics. They comprise the half-year ending Lady Day, 1911: — Average daily number of inmates in the Workhouse (including: Receiving Home and Furze Lodge) 632 ditto patients in the Infirmary 274 ditto children in Cottage Homes 304 Number of vagrants relieved during the half-year 3,965 25b. Notification of Diseases. Information as to the occurrence of disease is obtained partly by death returns, and partly by notifications of illness. The former are received from the Registrars of Births and Deaths; the latter are made principally by medical practitioners, but also by school teachers, and very occasionally by other persons. The following diseases were made compulsorily notifiable by the Public Health (London) Act:—Small-pox, cholera, diphtheria, erysipelas, scarlet fever, typhus, typhoid or enteric fever, relapsing fever, continued fever, and puerperal fever. By order of the London County Council, approved by the Local Government Board, made under Section 56 of Public Health (London) Act, the following diseases have since been added to the list:—Polio-myelitis, cerebro-spinal fever, ophthalmia neonatorum, glanders, anthrax, aad hydrophobia. Last year the Local Government Board made pulmonary tuberculosis notifiable by an order under Section 130, Public Health Act, 1875, (treatment and prevention of spread of cholera, and any other epidemic, endemic, or infectious diseases). 28 Your Council has also encouraged the voluntary notification of zymotic enteritis or diarrhoea, by undertaking to pay the usual fees to medical men who notify such cases. Children absent from school on account of measles and whooping cough are notified by the school teacher or attendance officer. Thus some form of notification is in existence for altogether nineteen diseases. Smallpox and Vaccination. 26. No case of Small-pox was notified; up to 1912 only one case has occurred since 1905, viz:— in 1910. 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. 27. The number of cases of Small-pox notified in London was 63. Chicken-pox. 28. 232 cases of Varicella were notified by school teachers, compared with 286, 243, and 327, in the three preceding years. 65 were under five years, 153 between five and ten, and 14 over ten years. Owing to the outbreak of Small-pox in the East of London, Chicken-pox was made compulsorily notifiable for four months, March to June. 85 cases were notified in Woolwich. Enquiries made into these showed that none were Small-pox. Measles. 29. There were 28 deaths from Measles, giving a rate of 0:23, compared with 0.08, 0 43, and 0.16, in the three 29 preceding years. The rate in London County was 0.57 compared with 0.41 in 1910. 30. Of the 28 who died from Measles, 27 were under five years of age; 13 were males, and 15 females. 31. 801 notifications were received from school teachers, compared with 825, 1,453, 519, 768, and 396, in the five preceding years. The mortality per cent. of notifications was 3.5, compared with 3.8, 4 8, l.9, 7.2, and 5.3, in the five preceding years. In 1910, 205 of the 396 cases notified were found on visiting to be having medical attendance. 32. The following table gives the number of deaths and death-rates from Measles for the past six years and three preceding quinquennia in each parish, and the death-rate in London: — Year. Woolwich Plumstead Eltkam The Borough London No. Rate No. Rate No. Rate No. Rate Rate 1891-5 (average) 20 0.49 29 0.51 Not recorded 49 0.51 0.59 1896-1900 (average) 34 0.81 36 0.57 Not recorded 70 0.67 0.57 1901-5 (average) 9 0.22 15 0.22 1 013 26 0.21 0.44 1906 7 0.18 21 0.28 .. .. 28 0.24 0.40 1907 35 0.87 28 0.37 7 0.55 70 0.57 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 0.45 0.48 1910 11 0.28 7 0.09 3 0.22 21 0.17 0.41 1911 7 0.19 17 0.24 4 0.30 28 0.23 0.57 30 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. 33. Owing to the prevalence of Measles all unprotected children below the age of five were excluded from 12 London County Council Schools in the Borough at various dates, and for periods differing from two to four weeks. Dr. Kerr closed, or excluded unprotected children from numerous 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. Measles is usually a disease which runs its course in less than two weeks, and in children over 5 occasions only a moderate amount of discomfort. But it often leaves behind it tuberculosis, inflammation of the eyes, and other diseases, especially if there has been neglect in treatment. In children under five, Measles is much more serious, and has a higher death-rate than Scarlet Fever. It follows then, that Public Health Administration must aim at postponing the infection till after the age of five, and at securing, as far as possible, the hygienic treatment of those who are attacked. In order to postpone the infection every effort is made to prevent children under five from attending school when Measles is prevalent, and to secure the latter object instructions as to sanitary measures for dealing with Measles are left at the home of all notified cases, and where possible the Woman Inspector pays a visit to enforce personally the directions. 31 These measures have now been in force in Woolwich for over five years, and have no doubt had a large share in the reduction of the Measles death-rate, which in the last five years was only one half what it was in the period 1890 to 1900. Measles last year was much more prevalent in other parts of London than in Woolwich, and the President of the Local Government Board invited the Metropolitan Medical Officers of Health to meet him in conference on the subject. The outcome of the Conference was a decision that the steps above described should be generally carried out. There was a consensus of opinion that compulsory notification of Measles was inadvisable. The London County Council was asked to secure earlier notification of children absent for Measles, and the suggestion was made by the Local Government Board, in a memorandum, that the Borough Councils should increase their Medical Staff to visit notified cases. Lastly, it was arranged with the Metropolitan Asylums Board that, as far as accommodation allowed, children with Measles should be admitted to the Board's Hospitals if the Medical Officer of Health considered their removal necessary. Whooping-cough. 34. There were 6 deaths from Whooping-cough, compared with 32, 15, and 25, in the three preceding years. The death-rate was 0.05, compared with 0.20, in 1910, and 0.23 in the County of London. The Woolwich death-rate is the lowest on record. The following table gives the deaths and death-rates per 1,000 population since the Borough was formed, com- 32 pared with London. There has been a marked reduction in death-rate in recent years. Woolwich. Number. Rate. London. Rate. 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 1911 6 0.05 0.23 41 eases were notified by school teachers, compared with 598, 361, and 377, in the three previous years. 18 were under five years of age, 22 between five and ten, and one over ten. 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 precautions were printed in the Annual Report for 1910. It is satisfactory to notice a further great reduction in the mortality of this disease in the past two years during which this practice has been in force. The fatality of the disease in the last three years was 5.4 per cent. of notified cases, more than twice as great as that of Scarlet Fever. The majority of cases, however, are probably never notified. Scarlet-fever. 35. There were 496 cases of Scarlet Fever notified (deducting 22 cases of mistaken diagnosis), equivalent to a 33 rate of 4.09 per 1,000 population, compared with 4.18 in 1910. This rate is the lowest since 1905. 36. 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. 1911. Borough 3.15 4.27 8.27 4.82 8.04 4.09 4.09 Woolwich Parish 2.99 3.99 6.35 3.91 10.56 3.51 2.89 Plumstead West 3.24 4.37 9.02 5.41 8.50 3.40 3.77 East 7.22 6.63 7.51 Eltham Parish 3.21 4.54 9.81 4.15 4.38 1.84 2.09 London County 3.57 4.35 5.46 4.52 3.57 2.16 2.33 37. Table 3 gives the age distribution, the number in each parish, and the number removed to hospital. East Plumstead was most affected. 38. Deaths. There were three deaths, giving a death-rate of 0.02 per 1,000 population, compared with an average of 0 09 in the five preceding years, and 0.19 in the ten years 1891-1900. This is the lowest rate recorded in the Borough. The death-rate in London was 0.04. The case mortality (or deaths per cent of notifications) was 0.6, compared with 1.9 and 2.6 in the two preceding years. All these deaths were in West Plumstead. It appears from the Annual Report of the Medical Officer of Health to the London County Council that, in the five years 1905-9, only seven Metropolitan Boroughs had a lower death-rate from Scarlet Fever than Woolwich. 39. Hospital Isolation. Of the 518 cases, 411, or 80 per cent. were removed to one of the Fever Hospitals, c 34 compared with 78, 85, 86, 94, and 90 per cent. in the five preceding years. 22 cases, or 4.2-per cent. were reported, after observation at hospital, not to be Scarlet Fever. The percentage of cases removed to hospital was lower last year than for four years A large proportion, say one-third of notified cases, are removed to hospital, not because they cannot be sufficiently 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. The lower proportion of removals last year is no doubt due to less poverty in the Borough. 40. Return Cases. There were 29 cases in which infection was attributed to 20 patients recently returned from hospital, compared with 30, 38, 58, and 27, in the four preceding years. The interval between the return of the infecting case and commencement of illness varied from 3 to 27 days. Of the infecting cases 4 had some form of rhinitis on or after their return, 1 otorrhcea, and one was desquamating. One boy was apparently responsible for infecting four others, viz., mother, brother, sister, and a school fellow. After three return cases had been notified he was sent back to hospital; but, returning in a few weeks and resuming school, the boy sitting next to him at school was infected. He suffered from dry rhinitis. As a rule, the children returning from hospital are quite well at the moment of leaving, but in many cases develop some nasal discharge on arriving home, or within a few days. Illustrative cases of this were given in the 1908 Report. 35 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. 41. Home Isolation. 18 certificates of efficient home isolation were given to enable men to continue their employment in the Arsenal, compared with 16, 11, and 13, in the three preceding years. 107 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, land three secondary cases, making a total of six cases, 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 at home. 42. Other sources of Infection. In addition to return cases, a [probable source of infection was found in 91 cases. In 46 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 c 2 36 throats made it probable that they had had a slight attack of this disease. 43. In 12 cases infection was attributed to friends and neighbours, in 28 cases to school attendance, in 2 to the Fever Hospital, and in 2 to school excursions. Schools. Bostal Lane School was specially affected, and on my request medical examinations were made of children in certain classes. No improvement following, the school was closed in the summer term until the holidays. Exclusion of Contacts. Children living in the same house as a notified case are now excluded two weeks instead of one as previously. 44. The Annual Report for 1905 oontained a special Report on a Statistical Investigation into School Incidence of Scarlet Fever and Diphtheria during the ten years 1896-1905. 45. 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 deathrates of Scarlet Fever and Diphtheria in Woolwich. In the last Annual Reporjt I described an investigation into the incubation period of Scarlet Fever. The result was to show:—(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 incubation is under seven days; (3) That in a considerable proportion of cases it is over four weeks; and (4) That the days from the second to 37 the fifth after exposure are those in which most secondary cases occur. Diphtheria. 46. 204 cases of Diphtheria were notified (excluding 35 cases of mistaken diagnosis), compared with 362, 240, and 147, in the three preceding years. The case-rate (number of cases per 1,000 population) corrected for cases of mistaken diagnosis, was 1.68, compared with 1.15 in 1910, 188 in 1909, and 2-15, the average of the ten preceding years. 1 of the cases was bacteriological, i.e., had no symptoms. 47. There were 11 deaths, compared with 15, 25, and 5, in the three preceding years. The death-rate was 0 09, compared with 0.20 in 1909, 0.04 in 1910, and with 018, the average of the ten preceding years. The Woolwich death-rate is, with the exception of 1910, the lowest recorded since 1891. The London death-rate was 0.14. 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 11, the actual number. 48. 88 cases were in Woolwich Parish, 48 in West Plumstead, 72 in East Plumstead, and 31 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. 1906-10 1911. Borough 1.71 2.20 1.68 Woolwich Parish 1.63 2.34 2.40 38  1901-5. 1906-10. 1911. Plumstead Parish 1.87 2.40 W. 1.19 E. 2.33 Eltham Parish 1.62 2.22 2.30 London 1.90 1.54 1.64 49. 223 cases, or 92 per cent. of notifications, (were removed to hospital, compared with 83, 89, 89, and 81 per cent. in the four preceding years. A certificate of efficient home isolation was given in 3 cases (30 in 1907, 7 in 1908, 1 in 1909, and 1 in 1910). The case mortality was 5.4 per cent., compared with 5.7, 6.3, 5 5, 10.4, and 3.4, in the five preceding years, and 8.3 in London. In several cases there were no throat symptoms, but discharge or soreness of the nose. 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. The search for, and detection of, these nasal cases is one of the most important duties of the Public Health Department. 50. Outbreaks occurred in the Autumn among children attending St. Mary's, and Wood Street Schools. I reported fully on the former and attributed the outbreak partly to insufficient provision of windows in the Infants' Department, and failure to keep open the windows which existed. During both outbreaks, daily lists of absentees were otained from the School Mistress; these were visited, and, where any suspicious symptoms existed, parents were urged to obtain medical advice. When they were unable or unwilling to do so, your Medical Officer of Health examined the children. In this 39 way a number of mild oases were detected and isolated, and the outbreaks speedily ceased. But this work made large demands on the time and vigilance of the Department. Children in the affected classes were, by my request, swabbed by a Medical Officer of the London County Council. In order to awaken the public to the danger of these mild cases of diphtheria, a leaflet, as follows, was printed and circulated all over the Borough by the agency of school children:— METROPOLITAN BOROUGH OF WOOLWICH. Precautions against Diphtheria. Owing to the prevalence of Diphtheria in the neighbourhood you are requested to pay special atention to the health of your children, especially to any who have a "cold" or seem out of sorts. The following information may be of use to you. Diphtheria is a very dangerous disease if left to itself, but if proper treatment is applied at the commencement the patient is almost sure to recover. Children often have Diphtheria in a very mild form, and may be able to take their food and run about the whole time. But such cases sometimes get paralysis later on, with difficulty in swallowing, weakness of sight, and weakness of arms and legs, or they may die suddenly from paralysis of the heart. Mild cases are just as infectious as serious ones. 40 The chief symptoms of Diphtheria are sore throat, with white or yellow patches on the sides of the throat, swelling in the neck "below the ear and the side of the jaw, and weakness. Sometimes the disease affects the nose only, causing a discharge of matter from one or both nostrils; these cases are very infectious. All cases of sore throat should be looked upon with suspicion, and when the throat is very red, or there are white patches, a doctor should be sent for at once. It is very important that not an hour should be lost in Commencing the proper treatment, as delay of one day makes the chance of recovery much less. If removal to Hospital is required, application should be made at once to the Ambulance Station, Shooters Hill, or the Public Health Department, Town Hall. Sidney Davies, m.a., m.d., Town Hall, Medical Officer of Health. October, 1911. 51. Mistaken Diagnosis. 35 cases, or 15 per cent, of notifications, were, after removal to hospital, stated to be not Diphtheria. The percentage of the three preceding years was 8, 10, and 10 respectively. 52. Source of Infection. In 67 cases, a probable source of infection was noted, viz.:—in 29, other inmates of the house were known or suspected to be the source; in 18, school; 3, neighbours and friends; 1, a return ease; 4, general hospitals; and in 11 the infection was caught while in the Fever Hospital on account of measles, whooping 41 cough, or scarlet fever. One returned case went to hospital for measles; Diphtheria bacilli were found in her throat on notification of the brother 12 days after her return. Another child returned from Gore Farm after Diphtheria with a running nose. The discharge was found to contain Diphtheria bacilli, and the child was accordingly again sent to the Brook Hospital. 53. Bacteriological Diagnosis. 705 (526 in 1910) swabs were sent to the Lister Institute to be examined for the presence of Diphtheria bacillus. In 92 (73 in 1910) the true Klebs Loffler bacillus was found (in 2 of these Hoffman's bacillus co-existed with the Klebs Loffler bacillus). in 101 (78 in 1910) Hoffman's bacillus was found, and 512 were found free from either the Klebs Loffler bacillus or Hoffman's. Of the 705 swabs examined, 255 were taken from school children by myself. Of these, 27 contained the true Klebs Loffler bacillus. Most of these were contacts seen about ten days after notification of a primary case for the purpose of preventing pupils returning to school in an infectious state. 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; others again were children suspected to have diphtheria by the school teacher. The contacts found positive on the first examination who had no symptoms were re-examined at intervals of ten days, or two weeks; 3 were found negative on the second examination; in 2 Hoffman's bacillus was found on the second examination, and in 2 a positive result occurred 42 twice. The results expressed by signs were as follows: — -+—, +— —, + + —H., +— — , + H. H., + +— + H. 19 positive eases had symptoms of running at nose or sore throat; these 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. Enteric Fever. 54. There were 12 eases of Enteric Fever, not including 4 cases of mistaken diagnosis notified as Enteric. The case-rate was 0.10, compared with 0.10, 0.08, and 0.06, in the three preceding years; this rate, though higher than in the past two years was exceeded in every previous year. For the ten years 1892-1901, the rate never fell below 0:41. The case-rate in London was 0.23. Out of 16 cases notified, 15 went to hospital. 55. There were no deaths from this disease, an occurrence without parallel in previous years. The death-rate in London was 0-03. At the present rate of diminution, iEnterie Fever will soon have disappeared. 56. The following are the cases notified in each parish during the past six years: — Average, Woolwich 1901-5 1906. 1907. 1908 . 1909. 1910. 1911. 12.6 16 6 4 9 3 10 Plumstead 21.2 21 16 12 W. 3 5 3 E. 0 0 2 Eltham 8.6 3 5 3 1 2 1 43 57. In five cases the disease was attributed to shell fish (mussels, periwinkles, etc.), and one to fried fish. Four cases had milk from one dairy, where a girl was employed who had Enteric a year and a half ago, and was found to be still infectious. It has been found that some cases of Enteric continue to be infectious for years after they are apparently well, and occasionally prove sources of infection to others. The Local Government Board made an enquiry as to the duration of infectiousness of the urine and faeces of the Enteric patients discharged from the Fever Hospitals, and, by request of the Board, I assisted in this enquiry. The girl in question was one of those found in this enquiry to have been intermittently infectious for many months after leaving Hospital. On her leaving the shop no further cases occurred. 58. Bacteriological Diagnosis. 20 samples of blood were sent to the Lister Institute to be examined for Widal's reaction. A positive result was obtained in 8. diarrhœa or zymotic enteritis. 59. The deaths from Diarrhœa, Dysentry, and Enteritis, (all forms) under two years of age were 101, or 0 83 per 1,000 population. The rate for London was 1.18. The total deaths from these diseases at all ages were 130. Although the diarrhoea death-rate was higher last year than for several years past, there was a much higher rate in previous years of warm summers, viz., in 1900 (1.31) 44 and in 1904 (1.19). Per 1,000 births the death-rate was 46. 87 of the 130 were under one year of. age, and 20 between one and five years. 60. The following table shows the death-rate from the above-mentioned diarrhoeal 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. 1911 Woolwich Parish 33 44 19 23 14 10 44 Plumstead Parish 27 31 16 16 6 W. 9 55 E. 15 43 Eltham Parish 19 19 11 12 26 4 36 The Borough ('02-5) 28 34 18 18 11 11 46 London County 35 48 21 31 22 12 — Notification. Voluntary notification of Zymotic Enteritis commenced in Woolwich in 1905. The Council ordered its trial 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 that it was resolved to continue the voluntary notification indefinitely, and from and including 1909 to extend the period of notification to June and October, thus making the disease notifiable during five months instead of three. 866 cases were notified in the past year, nearly as many as the total number notified in the five preceding years. The subjoined tables give full particulars of these. 8 cases were notified in June, 42 in July, 658 in August, 148 in September, and 10 in October. 8 deaths from Diarrhœa and 45 Enteritis occurred in July, 51 in August, 51 in September, 9 in October, 2 in November, and 1 in December. There were none in June. The fatality (deaths from June to October per 100 notified cases was 13.8, compared with 6.7 in 1909, 8.8 in 1910, 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. Age Distribution. Table A. (page 47), gives the age distribution of the cases; the largest number in any three- monthly period was between 9 and 12 months of age. 190 cases, or about one-fifth of the total were over five years. 265 cases under one year were notified, and 240 between one and two years. Previously the number of cases under one year has been nearly double that between one and two years. Feeding of Infants. Table D. shows the manner of feeding of all cases under nine months of age. 18 had the breast only, 27 breast milk and other food, and 120 were hand fed. Deaths Table H. 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 compared with London. 46 60a. In the Summer Quarter of 1911, there were 110 deaths from Diarrhoea and Enteritis, 81 of these being under two years of age. If the deaths at all ages are taken, the Diarrhœa death-rate was 3.64. This is a higher rate than any year since 1904, when it was 4.52. Considering that the average temperature of the 3 ft. ground thermometer in the summer quarter of 1904 only exceeded the average of the past ten years by 2°, while last year it exceeded this average by over 4°, it was to be expected that the Diarrhœa death-rate would have been much higher in the latter year. In London as a whole this was the case. If the death-rate in Woolwich last year had been in the same proportion to the London rate as in 1904, it would have been nearly twice as high as it actually was. The only known factor which can account for the low deathrate in Woolwich compared with London is the notification of Zymotic Enteritis; this notification and the steps which it enabled to be taken may be said to be mainly instrumental in saving the lives of some 100 persons. But probably both in Woolwich and the County, last summer, far the hottest summer on record, would have experienced a much higher Diarrhœa mortality but for the employment of Health Visitors, and other measures for instructing the poor and ignorant in the care and feeding of infants. Such measures are now carried out in most Metropolitan Boroughs. They have been perhaps longer employed and more effective in Woolwich than in most other parts of London, and thus have had a considerable share in producing the comparative exemption from Diarrhœa mortality of our Borough. 47 NOTIFIED CASES OF ZYMOTIC ENTERITIS. TABLE A. Age and Sex. Notifications, Year. Total. M. F. Under 3 months. 3 to 6 months. 6 to 9 months, 9 to 12 months. Total under 1 year. 1 to 2 years. 2 to 5 years. Over 5 years. 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 15 1909 149 79 70 12 10 20 22 64 35 18 32 1910 102 54 48 5 10 12 13 40 31 17 14 1911 866 434 432 28 69 79 89 265 240 171 190 Total 1905-11 1961 1010 951 111 226 236 250 823 539 285 314 48 TABLE B. DEATHS OF NOTIFIED CASES FOR THE BOROUGH OF WOOLWICH. Notifications. Deaths of Notified Cases. Average Births, 1905-1910. 1905 1906 1907 1908 1909 1910 Total. Rate per 1000 Births. 1911 1905 1906 1907 1908 1909 1910 Total. Rate per 1000 Births. Rate per 1000 Population. 1911 3205 212 366 93 173 149 102 1095 57 866 36 46 10 23 6 7 128 6.7 0.18 55 49 TABLE C. 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 1911 697 520 24 153 1756 1225 186 345 TABLE D. DIET OF CASES UNDER 1 YEAR AT TIME OF NOTIFICATION. 1905 1906 1907 1908 1909 1910 Totals 19051910 1911 Breast only 15 12 4 9 4 5 49 24 Breast and other foods 10 28 9 10 15 6 78 43 Hand-fed only 92 150 37 59 42 28 408 179 No information 5 4 1 13 2 1 26 16 122 194 51 91 63 40 561 262 TABLE E. CAUSES 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 1911 205 2 32 137 5 29 Total 699 7 111 432 27 122 d 50 TABLE F. NUMBER OF CASES NOTIFIED EACH WEEK, with MEAN TEMPERATURE of 3 Feet Ground Thermometer during Week, July to September Quarter, Cases. Year, 1st Week 2nd Week 3rd Week 4 th Week 5th Week 6th Week 7th Week 8th Week 9th Week 10th Week 11th Week 12 th 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 1911 – – 7 18 57 82 189 207 156 48 57 17 10 Total 14 18 25 46 115 198 332 369 384 162 157 89 76 Temperature. 1905 60.68 62.17 63.59 64.21 64.19 63.04 62.62 62.37 61.33 60.97 59.96 58.47 57.43 1906 59.16 60.68 61.29 62.26 63.25 64.00 63.80 62.80 63.08 63.83 62.89 60.80 59.24 1907 56.71 57.00 58.53 59.67 60.10 60.34 60.84 60.26 59.67 59.45 59.43 58.77 58.18 1908 61.34 60.97 60.47 62.15 62.65 62.18 61.26 60.88 59.51 58.02 57.11 57.86 58.21 1909 57.21 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 1911 59.80 62.16 63.31 65.17 66.11 66.43 67.06 66.39 65.36 64.63 64.19 61.74 59.94 Average 58.99 59.79 60.77 61.72 62.30 62.53 62.79 62.20 61.39 60.75 60.02 59.04 58.21 51 Table G. DEATHS FROM DIARRHŒA AND ZYMOTIC ENTERITIS classified by Ages during the five months ending 31st October, 1905, 1906, 1907, 1908, 1909, 1910, 1911. Under 1 year. Over 1 year. Year. 1-3 months. 3-6 months. 6-9 months. 9-12 months. 1-5 years. 5-60 years. Over 60 years. Total for each year. 1905 9 16 15 11 6 2 2 61 1906 9 17 25 14 9 1 6 81 1907 1 9 6 2 4 .. .. 22 1908 6 9 9 7 6 .. 1 38 1909 4 2 2 1 1 .. .. 10 1910 2 3 1 1 1 1 .. 9 1911 19 27 21 15 18 5 11 116 Total 1905-11 337 Note:—In the above figures "enteritis" and "gastro-enteritis " are excluded up to, and including 1910. For 1910 they are included. d 2 52 TABLE H. DIARRHŒA, INFANTILE MORTALITY, AND TEMPERATURE OF SUMMER QUARTER IN LONDON AND WOOLWICH. 1901 1902 1903 1904 Average 1905 1906 1907 1908 1909 1910 1911 Aver. 19051911 Annual death rate from Diarrhœa and Enteritis 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 3.82 1.75 Woolwich 2.76 0.97 0.96 4.52 2.30 1.72 2.54 0.34 0.87 0.25 0.12 2.87† 1.28 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 67.06 63.24 Average Temperature of 3 ft. ground theremometer 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 64.01 60.83 * In 1911 deaths under two years only are included. † If deaths over two years were included this figure would be 3 64 and the figures for London would also be increased. 53 TABLE I. ZYMOTIC ENTERITIS AND METEOROLOGY. Summer Quarter. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Number of cases notified – – – 212 366 93 173 120 72 848 Number of deaths, Diarrhœa* 27 29 136 56 81 11 28 8 4 109 Mean Temperature of air 59.1 59.0 60.08 60.6 62.4 58.87 59.3 58.7 57.2 65.1 Mean temperature 3 ft. below ground 59.68 60.18 61.45 61.62 62.08 59.15 60.35 59.25 59.34 64.01 Mean Humidity 75 77 72 75 70 74.6 77 80 80 65 Number of days on which rain fell – 46 34 33 26 32 38 46 37 22 Rainfall in inches 5.91 12.32 4.88 5.65 3.78 3.77 8.15 7.43 6.08 2.94 Number of hours bright sunshine 485 541 671 529 697 516 532 530 432 824 * Enteritis is included in 1911. 54 Erysipelas. 61. There were 82 cases of Erysipelas notified, compared with 90, 103, and 89, in the three preceding years. There were 8 deaths. The case-rate was 0.68, and the death-rate 0.07. The London case-rate was 1.09. The London deathrate in 1910 was 0.03. The Woolwich death-rate was the highest since 1892. Epidemic Cerebrospinal Meningitis. 62. 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. Only one case was notified in 1911, which recovered. It was in West Plumstead. anterior polio-myelitis. 63. This disease, commonly known as infantile paralysis, was made compulsorily notifiable by an order of the London County Council, under S. 55, Public Health (London) Act. The order came into force in September, 1911. Three cases were notified. The disease is believed to be due to the presence of a germ, and to be conveyed from one person to another by the nasal secretion. Treatment is important to prevent the contraction and wasting of the limbs which frequently ensues. 55 Disinfection and isolation have not been made compulsory, though probably both will be desirable when more knowledge has been obtained of the infection. Puerperal Fever. 64. There were 16 cases of Puerperal Fever notified, compared with 8, 6, 6, 9, and 7, in the five preceding years. There were 3 deaths. The case-rate was 0.13, and the death-rate 0.02. The London case-rate was 0.07, and the death-rate in 1910, 0.03. 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 0.05 and 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 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 19 deaths, compared with 33, 30, 29, 36, and 39, in the five preceding years. Bronchitis and Pneumonia caused 200 deaths, compared with 265, 298, 228, 245, and 232, in the five preceding years. The deaths from these causes under five years were 55, compared with 81, 86, and 66, in the three preceding years. Tuberculosis. 66. Deaths. There were 200 deaths from Tuberculous disease, giving a death-rate of 1 65, compared with 1.71, 1.65, 1.80, 1.68, and 1.46, in the five preceding years. 56 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, Tuberculous Meningitis 1901-5 1906 1907 1908 1909 1910 1911 20.0 22 19 27 27 19 20 Simple Meningitis 22.0 15 20 14 14 12 16 Tuberculosis of Intestines and Peritoneum 13.0 14 11 13 9 7 5 Tuberculosis, other forms 20.8 21 22 28 23 17 29 Phthisis 192.0 164 154 156 150 133 146 68. The deaths from Phthisis were 146, giving a deathrate of 120, compared with 1.33, 1.25, 1.27, 1.22, and 1.08, in the five preceding years. Though higher than in 1910, this rate is lower than in any previous year. The reduction in the death-rate since 1901-5 represents a saving of 46 lives last year from Consumption. The following table gives the death-rate from Phthisis in each parish during the quinquenniums 1891-5, 1896-1900, 1901-5, and in 190610, and 1911, compared with London. The greatest reduction was in the Parish of Woolwich. 1891-5. 1896-1900 1901-5 Average 1906-10 1911 No. Rate Aver No. per year Rate Aver. No. per year Rate Aver. No. per year Rate No. Rate Woolwich Parish – 2.80 92 2.23 89 2.15 56 1.46 66 1.80 Plumstead West East – 1.78 92 1.12 97 1.34 87 1.20 w 41 E 33 1.02 1.07 Eltham Parish – – 9 1.28 6 0.63 8 0.64 6 0.45 The Borough – – 193 1.74 192 1.56 151 1.22 146 1.20 London – 1.88 – 1.80 – 1.57 – 1.33 – 1.32 57 69. 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 comparing the past six years with the previous five, the number of cases of simple Meningitis has considerably diminished, while that of Tuberculous Meningitis has increased. 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. This accounts for the increase of deaths under Tuberculous—other forms. The real diminution of Tuberculosis other than Phthisis is no doubt greater than appears on the surface. The reduction of Phthisis in recent years is very marked and satisfactory. The slight increase in 1911 is probably due to the hot summer. The fourth quarter had most deaths from Tuberculosis. 70. Until 1909, there was but very slight reduction in Tuberculosis of intestines and peritoneum. If this disease, as Dr. Koch and others think, is mainly contracted from other persons in the home suffering from Phthisis, the reduction should have been greater. If, on the other hand, it is mainly due to the consumption of tuberculous milk, little diminution could be expected until some radical step was taken for preventing the importation into the Borough of such milk. Such a step was taken when the London County Council (General Powers) Act, 1907, came into operation in 1908, and the great decrease of deaths from 58 tuberculosis of the abdomen in the past three years may be the direct result of this action. 71. 81 of those who died from Phthisis were males,, and 65 females. 72. Notifications. Voluntary notification of Phthisis has now been in force in the Borough for nine years. In 1909, notification of cases attended by Poor Law Medical Officers was made compulsory by an order of the Local Government Board, made under Section 130, Public Health Act, 1875. This section authorises the Local Government Board to make such regulations as they may see fit with the view to the treatment of persons affected with Cholera or any other epidemic, endemic, or infectious disease, and preventing the spread of such diseases. The penalty for neglecting or refusing to obey any regulation made under this Section is £50. Under the same Section, the Board, in the Spring of the year, made it compulsory on the Medical Officers of all Public Hospitals and Public Dispensaries to notify cases of Pulmonary Tuberculosis attending such Institutions, and in November, by further regulations, made the notification of this disease compulsory on all Medical Practitioners. The regulations also authorise local authorities to supply all such medical or other assistance, and all such facilities and articles as may reasonably be required for the detection of the disease, and for preventing the spread of infection, and removing conditions favourable to infection, and they may appoint such officers as may be necessary. 375 cases were notified last year, compared with 150, 154, 206, and 196, in the four preceding years. 78 of these were 59 in the Woolwich and Eltham Poor Law Infirmaries. 39 others were notified by the District Medical Officers of the Poor Law Union, 13 by the Medical Officers of the -Royal Arsenal, 184 from Hospitals and Dispensaries, including 119 from the Woolwich Tuberculosis Dispensary, and the remainder by various social workers, applicants for .admission to Peppard Sanatorium, and by private medical practitioners. £26 lis. 3d. was paid during the year for the notification of Phthisis. Duration. Of the 375 cases notified during 1911, at least 75 have since died, and of 196 notified during 1910, at least 87 have since died (February 1911). 73. The source of infection of the notifiedcaseswas probably as follows:— Family or personal—Father, 29; mother, 32; brother, 14; sister, 15; husband, 8; wife, 6; other members of family, 9; friends, lodgers, etc., 6 119 Workshop and office 22 Public house 10 Navy and Army 3 Milk 2 Club 1 School 2 Undetermined 216 74. Age Distribution. The following table gives the age of notified cases:— 60 Under 1 1-2 2-3 3-4 4-5 5-15 15-25 S 25-45 15-65 65 & over 1 1 0 1 2 83 65 166 51 5 Sex—212 males, 163 females. Duration of Illness before Notification. Under 1 year. 1-2. 2-3. 3-4. 4-5 5 and over. 104 40 28 17 17 56 75. Occupation. Of the 278 cases from which information was obtained, the occupations were as follows:— Outdoor— Official, Soldiers, &c.14 Mechanical 3 Carmen and Costers 7 Labourers, Porters—Dock and all others 26 — 50 Indoor— Clerks 8 Mechanical 27 Printers — Bakehouses — Laundry 1 Domestic—Private 13 Public House 6—19 Labourers 15 School children and teachers 71 Housewives 62 All others 25 — 228 278 61 76. Bacteriological Diagnosis. Sputum from 191 cases of suspected Phthisis was examined at the Lister Institute, and tubercle bacilli were found in 53 cases. The number of examinations for the five preceding years was 130, 171, 175, 179, and 210, respectively. In addition, Dr. Short examined a large number of cases at the Tuberculosis Dispensary. 77. 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 the Report). 78. Disinfection was performed by the Public Health Department at 152 premises, compared with 157, 146, and 166, in the three preceding years. Of these 66 were disinfected after the death of the patient, and 86 after removal to hospital, sanatorium, or other opportunity. 79. Hospital and Sanatorium Treatment. The following table, prepared by the directions of the Local Government Board, shows the provision made for sanatorium and hospital treatment of cases of consumption in the Borough of Woolwich:— 62 PHTHISIS : SANATORIUM AND HOSPITAL ACCOMMODATION. Classes for which accommodation is provided. By whom provided. Where situated. Total Number of Beds. How are Patients selected ? Are Patients under the care of a Resident Medical Officer ? What charge, if any is made for the use of Beds ? Do the Sanitary Authority use—(1) their Isolation Hospital, or (2) their Small-pox Hospital for cases of Phthisis ? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium ; if so, how many, and in what Sanatorium ? Do the Sanitary Authority provide poitable openair Shelters or Tents ? (a) Early cases Maitland Cottage Sana t o ri u m Committee, paid for by Borough Council Peppard, Oxon. 6 or 7 By the Medical Officer of Health Yes 25/- children and 30/- adults weekly (b) Intermediate cases. Poor Law Guardians (many go to the London Consumptive Hospitals & various charitable sanatoriums Infirmary 23 Beds on open air balconies Guardians Yes According to means There is none Yes —see under early cases Yes—9 provided all in use (c) Advanced cases. Poor Law Guardians. A few go to the two or three London Homes for the Dying Plumstead Average 35-40 None in this Borough Do. No organised selection Yes Do. Have the Council, or any Private Body, provided a Dispensary. If so, give particulars ? Yes—Central Fund for London. One Doctor and one Nurse employed. Commenced Sept., 1911. 236 patients now under treatment. 63 Sanatorium Treatment. Since the year 1904, the Council has had an arrangement with Dr. Carling, the Superintendent and late Proprietor of the Maitland Cottjage Sanatorium, Peppard, by "which the Council maintains beds at the Sanatorium, paying a fixed charge (raised from 28s. to 30s. a rtveek in 1910) for each bed when occupied, and 20s. a week when occupied. 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 six or seven beds, five for men, and one or two for women. It being found that there "were frequently no female applicants, it was resolved that only six beds should be maintained permanently, and when necessary, a seventh bed should be taken either at Peppard or some other sanatorium. Since the establishment of the Tuberculosis Dispensary, however, there has been a much greater demand for female beds, and at present four female beds are required. Six beds were kept occupied throughout the year, and a seventh for a large part of it. The male applicants numbered 47, and the female 27, or 17 more than in 1910. 40 patients were admitted, compared with 41 and 35 in 1909 and 1910. Of those who left in 1911,9 stayed for one month, 14 for two months, 14 for three, and 2 for five. None stay at the Council's expense for more than six months. Four shewed no distinct improvement, but all the others returned home in improved general health, and with a decided 64 increase in weight. Most shewed 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 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 oome down. But, of the 40 patients admitted last year, the disease affected both lungs in 22, and one lung in an advanced stage (consolidation) in 4 cases. Tubercle bacilli were found in 29 cases. As patients are only received for one month in the first instance there is advantage in 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 Government Board, shows the condition in each subsequent year of the survivors from the cases treated in each year. The difference between the sum of the numbers dead and the survivors, and the number discharged, in any year, shows the cases lost sight of. Number of patients discharged in each year who were (rt) alive, but not well enough to work; (b) at work, seeking work, or performing their ordinary duties, in January of each of the undermentioned years:— 65 Year. Number Discharged. Dead, Jan. 1912. 1904 1905 1906 1907 1908 1909 1910 1911 1912 a b a b a 6 a b a b a b a b a 6 a b 1903 1 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1904 11 6 .. .. 2 6 1 5 1 5 1 5 2 4 1 4 2 2 2 .. 1905 17 11 .. .. .. .. 1 13 2 9 2 5 .. 4 .. 4 .. 3 .. 3 1906 29 13 .. .. .. .. .. .. 5 24 2 20 5 15 1 14 .. 14 1 12 1907 38 20 .. .. .. .. .. .. .. .. 9 24 2 22 7 15 2 13 1 13 1908 31 12 .. .. .. .. .. .. .. .. .. .. 6 21 6 17 4 12 2 10 1909 39 9 .. .. .. .. .. .. .. .. .. .. .. .. 3 24 2 25 6 18 1910 32 6 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 25 7 18 198 78 1 .. 3 6 2 18 8 38 14 54 15 66 18 78 14 94 19 74 66 Some half-dozen of those recorded as at work are employed at the Sanatorium in various capjacities, receiving' board and a Small wage. Of the 27 patients not accounted for, the majority have emigrated and are believed to be well and at work in Canada, Australia, South Africa, &c. The above table accounts for all patients who left the Sanatorium up to December 31st, 1910. Out of 198 who have left over one year, 74 are now well and at work, 19 are unwell, 78 have died, and 27 have been lost sight of. 82. Prolonged experience only confirms my confidence in the benefit of sanatorium treatment. Many cases have now been in regular work for five, six, and even seven years, after spending a few months at Peppard: several mothers of families have continued for similar periods to look after their families, and perform their household duties. The fact that so many relapse as the ye§.rs go on only shows that sanatorium treatment is required earlier, and needs in some cases to be repeated and prolonged, and that more healthy occupations and conditions of life axe required than commonly obtain. Suitable work, a guaranteed income, and the provision of a shelter, would probably improve the sanatorium results 50 per cent. 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, 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 67 high summer temperature, there was no fall in the Phthisis mortality. The rise in the Phthisis death-rate in 1911, oorresponding to a record hot summer, again indicates that heat is prejudicial to consumptives. 83. The Economy of San torium Treatment. This subject was fully dealt with in my Annual Report for 1909. 83a. Charge for Sanatorium Beds. The following resolutions were passed in 1910: — (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 gtll exceptional liabilities for the removal of patients, special nursing, &c. (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 weak. 84. .The names of 74 applicants were entered on the register during the year for admission to the Sanatorium, compared with 65, 59, 70, 71, and 57, in the previous five years. Of these some were too far advanced to be accepted, and some were found not to be tuberculous. Others were admittted 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 Consumptives. Although open-air treatment for consumption can best be carried out in the firsit instance at a Sanatorium, there are many cases for which it is e 2 68 desirable such treatment should be tried who cannot be admitted to any Sanatorium. These are sometimes too advanced for it to be wise to send them 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 eases, too, who have had temporary treatment at a Sanatorium find it difficult or imposible 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, 1910, 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, 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. Five additional shelters of this type were provided in 1911, and two cheaper shelters made in Street, Somerset, making a total of nine now in use, seven by men and two by women. 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. 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 the opposite page. 69 Altogether 20 persons have used the shelters since July, 1910. Since June, 1911, a weekly charge not less than 6d. and not more than Is. 6d. has been made to all in a position to pay. At present one patient is paying 6d., and three Is., five not being- charged; of the latter four are now out 70 of work. Eight persons discontinued the use of shelters in 1911, viz:—2 died, 2 went to hospital, 1 left the district, 1 was much improved and was unwilling to' pay anything, and 2 for other reasons. All who have had shelters have experienced great benefit from them; cough has diminished, sleep, appetite, and strength have improved. Several have slept out in the shelter during the severest weather of winter, during frost, snow, and cold wind. The "Street" shelters are supplied with light canvas and wooden bedsteads; this is a great advantage as many people have not a bedstead small enough for the shelter. One man was also provided with a mattress, two blankets, and a hot water bottle; his improvement subsequently was so marked that although he was discharged from the Arsenal as medically unfit some 18 months ago, he now says he could do a good day's work if he could get it. 84k. Tuberculosis Dispensary. A Dispensary for the treatment of Tuberculosis was founded during the year. The Public Health Committee invited a Representative Conference. The Members formed themselves into a General Committee, with Councillor Dawson as President. The General Committee appointed an Executive Committee, with your Medical Officer of Health a Chairman. The Borough Council has granted the use of the Council's rooms at Maxey Road, formerly used by the Milk Depot, at a nominal rent of £10 a year. These have been altered and adapted so as to provide a consulting room, undressing room, nurse's room and office, dispensary, and waiting-room. Dr. Short was appointed as Medical Officer, and the services of an experienced nurse and dispenser obtained. The Dispensary has been a complete success from the outset, and the staff already have more cases to treat than they cun well deal 71 with. The Dispensary works under the regulations of the Central Fund for the promotion of Tuberculosis Dispensaries, who provide three-quarters of the working expenses. Only persons who cannot afford to pay for medical attendance are received for treatment. The Medical Officer works in cordial co-operation with the Medical Officer of Health, and with the general medical practitioners in the District. As mentioned above, 119 cases of Phthisis have been notified by Dr. Short, the Medical Officer. A large number of eases returning from Peppard Sanatorium place themselves under the supervision of Dr. Short, but perhaps the chief item in his work is examining all the members of the family of every consumptive case dealt with. In this way a large number of cases of incipient phthisis are discovered and treated before the disease has gone too far. 85. 20 spitting-flasks were supplied at cost price, 6d., compared with 22, 32, 23, 19, and 25, in the previous five years. Cancer. 86. There were 124 deaths from Cancer (Malignant Tumour), giving a death-rate of 1.02, compared with 0.90, 0.83, 0.75, 0.93, and 0.88, in the five preceding years. 62 of the deaths were in males, and 62 in females. 12 only of the deaths were in persons under 45. The highest mortality was in West Plumstead. The London death-rate was 1.01 in 1910. More than one-third of the deaths occurred in public institutions. 87. The following table shows the sex and region affected in all cases of malignant disease :— 72 Carcinoma. Seat of Primary Disease: — Male Female Head and face 3 1 Mouth, jaw, and tongue 5 — Pharynx, oesophagus, larynx, and neck 11 2 Pleura, lung, mediastinum — 1 Stomach and pylorus 8 7 Intestines (excluding rectum) 5 6 Peritoneum and omentum — 1 Rectum 5 5 Liver 8 6 Kidney and bladder 2 2 Genital organs — 15 Breasts — 9 Prostate and external urinary organs 2 — Pancreas 4 1 Undefined 6 1 59 57 Sarcoma. Male. Female Mouth and jaw 1 — Limbs — 2 Intestines — 1 Genital organs — 2 Kidney and urinary organs 1 — Undefined 1 — 3 5 87a. The apparent increase of Carcinoma in recent years makes it desirable to give special attention to the statistics of this disease. The deaths from Carcinoma have been 73 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|l910 1911 Total Yearly Av'ge. Head and face 1 .. 4 1 1 .. 4 .. 3 14 1.6 Mouth, Jaw, and Tongue 3 5 4 7 1 6 3 7 5 41 4.6 Pharynx oesophagus, larynx, and neck 5 3 7 18 8 2 9 6 11 69 7.7 Pleura, lung, mediastinum 1 .. .. 1 1 .. .. .. .. 3 0.33 Stomach and pylorus 6 5 5 9 9 12 12 10 8 76 8.4 Intestines (excluding rectum) 2 3 3 5 3 2 4 2 5 29 3.2 Rectum and anus 6 4 2 3 8 5 5 8 5 41 4.6 Peritoneum and omentum .. 2 .. .. .. .. .. .. .. 2 0.22 Liver 9 3 12 7 7 6 5 7 8 64 7.1 Kidney and bladder .. .. .. 1 3 1 2 1 2 10 1.1 Genital organs .. .. .. .. .. .. .. .. .. .. .. Prostate and externa) urinary 3 5 .. .. 2 2 .. .. 2 14 1.6 Pancreas 1 .. .. 3 1 1 1 1 4 12 1.3 Pelvis ahd groin 1 .. .. .. .. .. .. .. .. 1 .. Undefined .. 1 .. 1 1 2 5 2 6 18 2.0 38 31 37 56 40 39 50 44 59 394 43.8 Females. Seat of Primary Disease. 1903 1904 1905 1906 1907 1908 1909 1910 1911 Total Yearly Av'ge. Head and face .. 1 1 2 2 1 2 .. 1 10 1.1 Mouth and tongue 2 3 .. 1 .. .. 1 1 .. 8 0.89 Pharynx oesophagus, larynx, and neck 1 1 3 2 1 1 1 2 2 14 1.6 Pleura, lung, mediastinum 1 .. 1 .. 1 2 .. .. 1 6 0.67 Stomach and pylorus 8 8 1 7 5 7 12 7 7 62 6.9 Intestines (excluding rectum) 1 1 .. 5 2 5 7 2 6 29 3.2 Rectum and anus 2 4 3 5 7 10 9 3 5 43 5.3 Liver 6 7 9 6 10 12 5 10 6 71 7.9 Peritoneum and omentum .. .. 1 1 1 .. .. .. 1 4 0.44 Kidney and bladder .. .. .. .. 2 1 .. 3 2 8 0.89 Genital organs 20 17 11 11 19 11 13 14 15 131 14.6 Breasts 8 11 10 11 11 3 8 10 9 81 9.0 L/imbs .. .. .. 1 .. .. 1 .. .. 2 0.22 Pancreas .. .. .. .. .. .. .. 1 1 2 0.22 Pelvis and groin 1 1 .. .. .. .. .. .. .. 2 0.22 Undefined .. 1 1 2 .. •• 3 3 1 11 1.2 50 55 41 54 61 53 62 56 57 489 54.3 74 Last year had the highest recorded Cancer death-iate, the increase being confined to males. There was some slight increase under most of the organs tabulated, but chiefly from carcinoma of the throat, pancreas, and undefined regions. On the whole, since 1903, the most notable increase has been in cancer 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 decrease of Cancer in the female genital organs and 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 tl at the former appear to have decreased, and the latter increased, strengthens the opinion that the apparent increase of Cancer is largely due to improved diagnosis. It is seen from these 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, ancl meat, and to smoking. That alcohol is a predisposing cause of Cancer, acting probably as an irritant to the digestive organs, seems to be well established. The local irritation of the mouth by the use of pipes is certainly conducive to the disease. 75 Alcoholism. 88. There were 8 deaths from Alcoholism, and 18 from 'Cirrhosis of the Liver, making' a total of 26 deaths probably due to alcohol, compared with 17, 18, 21, 20, and 23, in the five preceding years. In addition to these there were 377 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 347, 327, 346, 335, and 343 respectively. It is unsatisfactory to find that the deaths due to alcoholism are steadily increasing in Woolwich. 89. The death-rate from Alcoholism and Cirrhosis of the Liver was 0'21 in the Borough, and in 1910, 0.18 in the County of London. There is one licensed house per 658 population in the Borough, and one per 266 in River Ward. Syphilis. 90. There were 6 deaths from Syphilis, compared with 10, 9, 7, 10, and 7, in the five preceding years. Five oi these occurred in Public Institutions. All were males. Three were infants under one year. There were in addition 25 deaths from General Paralysis, Tabes Dorcalis (Locomotor-ataxy) and Aneurism, diseases which are considered to be usually due to Syphilis. These figures are far from rgpresenting the total mortality caused by this disease. 76 Ophthalmia Neonatorum. (Inflammation of the eyes of the new-born). 91. This disease was made compuLsorily notifiable by ail order of the London County Council, dated March, 1911, which came into force on the 13th March. The order is under Section 55, Public Health (London) Act. No other Section of the Act is applied, so there is no requirement to disinfect, or penalty for exposure, the main object of notification being to secure effective treatment of the infant affected. Most cases notified are the infants of women attended in their confinement by midwives, who are inspected by the County Council. The Borough Council Health Visitor also inspects in all cases, and reports whether proper treatment is being carried out. The Guardians were asked to facilitate immediate removal to the Infirmajy, where satisfactory home treatment was impracticable, and gave a favourable response. Eight cases were notified, of which one was removed with the mother to the Infirmary. The others were all reported to be receiving effectual treatment at home. In most cases the Ophthalmia was clearly due to venereal disease in the parents. meteorology. (See Table VIE;). 92. The temperature in the Winter quarter of the year was about normal; it had six weeks with an average temperature above the normal, and seven below. The Spring quarter had a temperature somewhat above the average, and the Summer quarter was exceptionally warm; it lad eleven weeks above the average, and only one below; its 77 average temperature was 65.1, which is 5.0 degrees above the average. In the Autumn quarter the temperature was above the average in nine weeks, below in four. The lowest temperature. 21.6°F., occurred in the week ending February 4th, and the highest 100.0°F., occurred in the second week in August. The rainfall was 23.65 in., a little below the average, 10.79 in. of which fell in the Autumn quarter. The Summer quarter was specially dry, with only 2.94 in. of rain. The largest weekly number of deaths, 48, took place in the week ending September 2nd; the smallest number of deaths, 15, was in the week ending July 8th. (See also under Diarrhœa). 78 PART II. Administration. Water Supply. 1. The supply is now constant throughout the Borough. A water tower has been constructed which 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. Prom the December report of the Water Examiner on the Metropolitan Water Supply, page 76, it apears 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 in 1910 was slightly lower than the amount reported in 1907 when it was 6.07, but the hardness was higher 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. 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. 79 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 Wa er 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 coming into force of the London County Council (General Powers) Act, 1907, by which a suitable water supply can be required on each separately occupied floor of a tenement-house. Under this Act an additional supply was required and provided at 25 houses in 1908, 30 houses in 1909, 3 in 1910, and 2 in 1911. 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 the Annual Report for that year. 3. Defective and foul storage cisterns were found and remedied at 34 houses, compared with 67, 35, and 51, in the three preceding years. At 23 houses the supply was 80 found insufficient or temporarily cut off. and the necessary steps taken for obtaining a proper supply. Food and drugs Act. 4. 500 samples were submitted to the Public Analyst, and 23, or 4.6 per cent. were found to be adulterated, compared with 9.3, 4.3, 2.5, 3.4, and 3.3, in the five preceding years, and 8.5 in the Metropolis in 1910. The very small percentage of adulterations in the past five years is noteworthy. Ten of the samples taken were informal. All these were found to be genuine. 5. Proceedings were taken in 20 cases. 14 convictions were obtained. 5 cases were withdrawn or dismissed on proof of warranties, and one withdrawn on conviction for another offence. 6. A total of £16 0s. 0d. was imposed in fines, and £15 12s. 0d. in costs. 7. 289 of the samples were fresh milk. 21 of these, or 7.2 per cent. were adulterated, compared with 8.7, 4.8, 1.7, 3.7, and 4.8, in the five preceding years. 52 samples were bought as butter, and one was found to be adulterated. A sample of lemon squash contained 7 grains per pint of salicylic acid; no proceedings were taken in this case. Table XVIII. shows the other 158 articles analysed. Not one of these was found to be adulterated. . 81 During the past four years 5 samples of coffee out of 59 taken have been found adulterated, and one of cocoa out of 48. But no adulteration was discovered in 16 samples of vinegar, 19 of flour, 10 sugar and sweets, 62 tea, 35 mustard, 29 jam, 17 condensed milk, and 70 drugs, nor in any one of the smaller number of several other articles, other than milk and butter, taken for analysis. From the Local Government Board Annual Report for 1910 it appears that in that year the adulteration of samples taken in the Metropolis was about 9 per cent. for tea, 7 per cent. for coffee, 19 per cent. for cocoa, 13 per cent. for mustard, nil for flour, 10 per cent, for confectionery and jams, and 4 per cent. for drugs. As regards all the above articles except coffee, Woolwich shows less adulteration than the rest of London. One difficulty in detecting adulteration is the necessity of dividing each sample into three parts; this necessitates taking so large an amount of the article purchased that the suspicion of the vendor is aroused. This applies especially to drugs. 8. Of the 19 adulterated milk samples for which proceedings were taken the adulteration varied from 6.6 to 25.4 per cent. of added water, and from 4.6 to 21.6 deficiency in fat. The adulterated sample of butter contained 2.13 per cent. excess of water. Proceedings were taken and a fine of £2 inflicted. % The fines varied from 10s. to £4. In one case which was dismissed on proof of warranty, there was 15 per cent. deficiency in fat. F 82 9. Sampling. Of the 289 milk samples, 72 were taken on Sunday or Bank Holidays; 2 of these were found adulterated. In the past three years 3.3 per cent. of samples taken on Sunday were found adulterated, and in the preceding four years 5 per cent. 31 samples were taken on arrival at railway stations, of which five were found adulterated. One informal milk sample was taken. The police notified two cases of selling from cans pr vehicles not giving the name and address of the vendor. The offenders were cautioned but there was no evidence to justify a prosecution. 10. A record is kept of all analyses of milk made by the Public Analyst. The average percentage of fat in adulterated samples has been found to be the same each year, viz., 3.6, and of non-fatty solids 8 8. Last year seven samples contained as much as 5 per cent. fat, and three of these 6 or more per cent. Food Inspection. 11. The inspection of meat and other food received the usual attention. Inspectors Little, Tedham and Powell, made special inspections in rotation. There was one seizure and 105 surrenders. The seizure was of 145 lbs. of bacon which was unsound and unfit for food. This was condemned by a magistrate and destroyed. The vendor was fined £64 and £8 '8s. 0d. costs. He was a man named Blake who, besides the shop in Plumstead High Street, "where the bacon was seized, had shops in other parts 83 of London, and had been previously convicted of a similar offence. Of the surrenders, 17 were tuberculous meat; 75 livers or other organs affected with parasitic disease; 9 unsound fish; one unsound rabbits; and one a quantity of 301 blown tins of condensed milk. A full list is given in Table XIX. Dairies, Cowsheds, and Milkshops, 12. On January 1st, 1911. there were 137 milkshops on the register; 14 were added and 22 removed during the year, leaving a total of 129 on the register at the close of 1911. There were 193 inspections made, and 30 notices served. There were no prosecutions. 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 129 in the seven years 1905-11. 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. An abstract of regulations Was drawn up and printed in the Annual Eeport for 1910. This is left at every milkshop. 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 1911 no applications were refused. The visual requirements of the Health Department for securing the purity of milk are roughly as follows:— The premises must be either:— 84 (a) Used solely for the sale of milk and dairy produce. (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, and 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 64 inspections, and 8 notices were served for dirty conditions, etc. Mr. — of — Farm, was prosecuted under Regulation 17, made under the Dairies and Cowsheds Order. This regulation requires cowkeepers to adopt necessary precautions for keeping cowsheds and cows in a clean and wholesome condition. The circumstances were as follows: — On the 2nd inst., in company with Chief Inspector Duck. I visited the cowsheds at — Farm. One shed was found in a very dirty and dilapidated condition. There was a large pool of liquid manure on the floor, the walls were very much splashed with manure, and several of the cows were in a filthy state. One cow was observed being milked by a boy with dirty hands; the cow's udder was thickly coated with manure; and some milk in a phurn (about 4 gallons) 85 standing in a shed was found to be in a filthy condition. It was consequently seized and taken before a Magistrate and condemned. Some of the milk was sent to Professor Smith for analysis, and a sample was also sent to the Lister Institute for bacteriological examination. The case was tried at Woolwich on 1st November, and defended by Mr. Ricketts, Junior. It was maintained by defendant that the regulation was ultra vires, and the case was adjourned to see the decision in a similar case pending at Wandsworth. As this decision was favourable to the contention that the regulation was ultra vires the case was not proceeded with. Slaughter-houses. 15. One additional slaughter-house was licensed during the year, leaving 12 on the register. 48 inspections were made, and 4 notices served and complied with. Nuisances (See Table XVa). 16. 400 complaints of sanitary defects were received and investigated, compared with 399, 497, and 398, in the three preceding years. 20 complaints of non-removal of dust were made and attended to, compared with 18, 28, and 26, in the three preceding years. 6 of the dust complaints came from the Woolwich Parish, 12 from Plumstead, and 2 from Eltham. The dust in Woolwich is collected by your Council's employees, but that in Plumstead and Eltham by two different contractors. 86 17. Drains and Water-closets. 27 defective combined drains were investigated and reported on by the Chief Sanitary Inspector, compared with 16, 22, and 7, in the three preceding years. These drains affected 236 houses. 319 private drains, found choked and defective, were examined, cleared, and re-laid, compared with 371, 440, and 411, in the three preceding years. The largest number was found in River Ward. 734 water-closets and w.c. cisterns were repaired, compared with 944, 992 and 963, in the three preceding years. 279 foul w.c. pans were cleansed by tenants, compared with 193, 197, and 312, in the three preceding years. 18. 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. 19. Public-house Urinals. The urinals attached to publichouses, and accessible to the public, have been regularly inspected during the year, 488 inspections being made. Regular cleansing has been required. 20. House Inspection. 5,892 houses were inspected, house to house, compared with 5,384, 5,512, and 6,626, in the three preceding years; 6,546 were inspected re infectious diseases and complaints, compared with 7,600, 7,377, and 6,026. In addition to these, 539 inspections of registered houses were made. 21. Table XVI, shows the streets inspected, and he number of houses found defective in each. 87 At 2,137 houses, interiors were cleansed, or defective roofs repaired, compared with 2,026, 1,957, and 2,064, in the three preceding years. 600 houses with damp walls were remedied, compared with 368, 450, and 523, in the three preceding years. Improved ventilation was provided in 94 houses, compared with 187, 120, and 101, in the .three preceding years. 516 new dust-pails were supplied, compared with 612, 681, and 585, in the three preceding years. 22. Medical Officer's Inspections. These amounted to a total of 605. Special inspections were made at the cowsheds, milksliops, bakehouses, workshops, many of the houses registered under the By-laws, and other tenement-houses The other inspections were chiefly on account of Tuberculosis, Diphtheria, and Scarlet Fever. 18 visits were made by request of the medical attendants for the purpose of diagnosing doubtful cases of infectious disease. Twelve of these were suspected cases of Scarlet Fever, two supposed cases of Small-pox, one Enteric Fever, two Diphtheria, and one Cerebro-Spinal 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 Globe Lane, Market Hill, Prospect Cottages, Cordwainers' School, Down's Place, Ogilby Street, Orchard Place, New Street, and Horn Park sheds. 23. Overcrowding. 97 cases of overcrowding were found and remedied, compared with 72, 97, and 78, in the three preceding years, or 1.3 per cent. of house-to-house inspections. 88 24. Smoke Nuisance. 48 observations re smoke nuisance were made, and 4 nuisances of black smoke observed. The nuisances were abated on service of notices. There was no prosecution. Seven complaints of smoke nuisance were received from outside bodies, viz:—one from the L.C.C., and 6 from the Coal Smoke Abatement Society. These related to three firms in North Woolwich, and one in West Woolwich. In 1901, eig-ht 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 nuisance has been decidedly less since the prosecutions. 25. Defective Light. At 56 houses new windows were supplied or existing ones enlarged, or other work done to improve the lighting by daylight. 26. In my 1909 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. 248 verminous rooms were cleaned under the London County Council (General Powers) Act, 1904, or were dealt with as dirty rooms under the Nuisance Section, compared with 148, 183, 159, and 143, in the four preceding years. 89 Dust Removal. 28. In Woolwich Parish 5,769 loads of house, and 157 loads of trade refuse were removed by direct labour, and destroyed at the Woolwich destructor. In the three preceding years 6,477, 5,951, and 6,912, loads, respectively, were removed. In Plumstead, 16,597 loads, weighing 13,059 tons were removed by the Contractor, Messrs. Tuff & Hoar, and destroyed at the Plumstead destructor. £2,847 14s. 1d. was paid for collection, compared with £2,805 17s. 7d. in 1910. In Eltham, the sum of £866 18s. 8d., compared with £840 9s. 10d. in 1910, 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 satisfactory state, in some frields well away from any houses. Trade Refuse. 29. During the past year there have been 7,094 (7,461 in 1910) receptacles of offensive trade refuse removed. The weight of refuse was 354 tons. There are now 48, (53 in 1910) 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. 90 Housing of the Working classes act. 30. The Housing and Town Planning Act was found to work satisfactorily. Owners have always been given an opportunity of stating their case to the Public Health Committee before a closing orded has been made. The following table shows the action taken:— Number of houses inspected re Housing and Town Planning Act 340 Dwelling houses considered on inspection in a state so dangerous or injurious to health as to be unfit for human habitation 18 Number of representations made to Borough Council with a view to the making of closing orders 18 Number of closing orders made 14 Number of dwelling houses remedied without making closing order 4 Number of dwelling houses put into fit state for human habitation after making closing order 7 The following are the houses referred to in the above table:— 6, Market Hill, Woolwich. 5, Cock Yard, Woolwich. 6 ditto ditto 1, Stanley House, High Street, Woolwich. 5, Godfrey Street, Woolwich. 9, ditto ditto 10, Kate's Place, North Woolwich. 11 ditto ditto 12, ditto ditto 13, ditto ditto 14, ditto ditto 91 15, Kate's Place, North Woolwich. 16, ditto ditto 18, Anglesea Road, Woolwich. 19, Barnfield Road, Plumstead. 73, St. Mary Street, Woolwich. 21, Beresford Street, Woolwich. 5, Walpole Place, Woolwich. No. 1, Stanley House, 18, Anglesea Road, and 19, Barnfield Road, were underground rooms, and were dealt with under Section 17 (7), Housing, Town Planning, &c., Act, the rest being dealt with under Section 17 (2). The houses in Kate's Place have been thoroughly renovated, and new floors provided. The following premises were demolished under the Housing, Town Planning, &c., Act, 1909, during the year 1911:— 1, Elizabeth Place, High Street, Woolwich. 2, ditto ditto 3, ditto ditto 4, ditto ditto 5, ditto ditto 6, ditto ditto 5, Cock Yard, Woolwich. 6, ditto ditto 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. 92 31. Council's Houses. All the Council's 25 houses in North Woolwich were occupied throughout the year, with the exception of one which was vacant two weeks. 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 Report, 1904, page 70. Of the Council's 12 houses in Gossage, Park, and Parkdale Roads, 10 Were occupied throughout the year; Nos. 3 and 19, Gossage Road, were empty for periods of six and four 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. On June 5th Nos. 15, 17, and 19, Gossage Road, were taken over by the Libraries Committee. 32. Houses Registered under the By-Laws. At the commencement of the year 409 houses were on the register; 30 were newly registered, and 10 taken off the register, leaving 429 on the register at the close of the year, compared with 307, 332, 359, 395, and 409, in each of the five preceding years. 33. These houses were inspected, some quarterly, others half-yearly or yearly. 539 inspections were made in all, and 257 notices were served. The registered houses were under the care of Inspector Shaw. On December 31st the houses were situated as follows: — River Ward, North 34 93 River Ward, South 111 St. Mary's 35 Dockyard 68 St. George's 56 Herbert 3 Burrage 20 St. Margaret's 16 Central 3 Glyndon 18 St. Nicholas 65 The following are the particulars of the inspections made:— Houses Let in Lodgings. Total number on Register 429 Number of Inspections 539 „ Re-inspections (estimated) 1,364 „ Defaults found 401 „ Found satisfactory 138 „ Notioes served 257 ,, Nuisances, defects and offences against the By-laws dealt with and remedied 732 ,, Cases of overcrowding remedied by redistribution without notice 14 ,, Houses measured 30 Notices. On Landlords for Cleansing 118 „ Tenants for Cleansing 86 „ Landlords for Overcrowding 4 ,, Tenants for Overcrowding 16 ,, Landlords and Tenants for other defects 157 ,, Landlord and Tenants for Verminous Rooms 33 ,, Verbal Notices on Tenants for Cleansing—carried out 74 94 Inhabited House duty. 34. Application was received for a certificate under the Revenue Act, for a number of houses in Mineral Street. These houses, however, were not self-contained, having only one w.c. for the two families occupying them. The certificates were therefore refused. 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: — 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 95 Underground rooms. 36. Fourteen underground rooms, separately occupied, were found not in accordance with the Public Health (London) Act. Five were in St. Mary's and Dockyard Wards, four in River, three in Burrage, and two in St. Nicholas Wards. The service of notices led to cessation of occupation. Factories, Workshops, and Workplaces. 37. There were, at the close of the year, 199 (203 in 1910) workshops and workplaces on the register. 890 inspections were made, and 84 notices served and complied with. 80 inspections of factories were made regarding sanitary accommodation, and 5 notices served and complied with. 405 inspections of homeworkers' premises were made and 24 notices sent and attended to. Miss Middlebrook devoted a large amount of her time to the inspection of workshops, factories, and houses, where women are employed; 41 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 10, and of workshop bakehouses in use is 43, 15 of the latter being underground. 2 bakehouses (1 underground) were discontinued. They were all inspected twice. I inspected most 96 of them personally, and found them generally satisfactory. Ten certified underground bakehouses are not in use. Ice-cream Shops. 40. Eighty-nine ice-cream shops were on the register at the close of the year, compared with 108, 98, and 86, in the three previous years. Nine were added and 6 removed during the year. There were 178 inspections made, and 9 notices served. Regulations, embodying the provision-; 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. Disinfection. 41. The mode of disinfection, cost of appliances, staff, etc., were fully described in my Annual Export, 1903, pages 73-76. Rooms at 1,093 houses were disinfected, compared with 1,333, 987, and 964, in the three preceding years. The disinfecting apparatus was used 1,093 times for 21,860 articles. 347 books from the Free Libraries and Public Schools were disinfected. The sum of £4 12s. 6d. was received for disinfection of rooms in special cases on request of the occupier. Disinfectants are supplied by the Department for disinfecting infected soiled linen, infected stools, sputa in phthisis, for personal use in infectious disease, and for use by the Contractor in dust receptacles. They are dispensed at the Maxey Road Depot, the Sun Street Mortuary 97 (73 persons were supplied in 1908, 110 in 1909, and 71 in 1910), 14 Barge House Road, North Woolwich (18 persons supplied), and at 144a High Street, Eltham (53 persona supplied). The cost of disinfectants used by the department in 1911 was £36 7s. 9d. The disinfectants used were Corrosive Sublimate; Sulphur and Formalin tablets (for fumigation); Formaldehyde (for spraying and disinfecting books, and for use in the Mortuary); Cyllin (for sputa in phthisis); Permanganate ,of Potash; Jeyes' Corporation Fluid (for dust-pails); and Chloride of Lime (for offal tins). Health Shelter. 42. The Health Shelter was not used during the year. It was used twice in 1906, once in 1908, and not at all in 1903, 1904, 1905, 1907, 1909, and 1910. 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 189 bodies, compared with 151, 146, and 136, in the three preceding years. 157 were deposited for inquest, and 32 for custody. 98 post-mortem examinations were made. One body was deposited in the infectious mortuary, compared with two in 1907, none in 1908, one in 1909, and one in 1910. The Eltham Mortuary was used for three bodies, two for inquest and one for custody, compared with one in 1908, one in 1909, and three in 1910. G 98 Cemeteries. 44. The two Borough Cemeteries were well maintained as usual. 679 bodies were buried in the Woolwich Cemetery, compared with 609, 613, and 669, in the three previous years. There were 690 interments in the Plumstead Cemetery, compared with 656, 732, and 696, in the three previous years. 47 burials took place in Plumstead Churchyard, compared with 22, 59, and 51, in the three preceding years. There has been an increase in burials in the Churchyard during the past three 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. In 1910 I reported that there was burial accommodation for Eltham parish for five years only, and recommended the provision of a small Cemetery with a Crematorium. I also recommended 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 1911 it was used by 509 persons, compared with 257, 262, 408, and 590, in the four previous years. The users were 123 adults (viz., 1 female and 122 males) and 386 children (viz., 210 females and 176 males). 3,123 articles were disinfected, and the disinfector was used 361 times. The adults came mainly from common 99 lodging-houses, and the children were mostly sent from County Council Schools. An agreement was entered into with the London County Council, dated 21st August, 1911, to allow the London County Council to use the Borough Council Cleansing Station for cleansing school children. The Station is reserved for school children on Tuesday and Friday between 9 a.m. and 4 p.m., girls being cleansed between 9 and 1, and boys in the afternoon. The Borough Council must properly cleanse the children and their clothes to the reasonable satisfaction of the London County Council, the children cleansed not to exceed 10 in one day or 20 in one week. The London County Council pays to the Borough Council 2s. for each child cleansed, such sum to include all attendances made by the child in one month when repeated baths are necessary. The Borough Council for this purpose has engaged a female attendant (Mrs. Lewis) for the two days, Tuesday and Friday, at a payment of 3s. 6d. per day. The cleansing of children is supervised by a school nurse. The Station has been found inadequate for its purpose, especially as regards water-closet accommodation. It is now being extended by the provision of another bath, and two closets, according to plans prepared by the Borough Engineer. A box of white precipitate or stavesacre ointment is supplied to each bather with instructions for its use. The names and addresses of bathers are entered in a book, and the Lady Inspector calls at the houses and arranges for necessary disinfection and cleansing of verminous bedding and rooms. G 2 100 45a. Public Baths, Lavatories, and Cleanliness. During the year ending March 31st, 1911, there were 96,257 private baths taken at the Borough Council's Public Establishments in Woolwich and Plumstead. It is satisfactory to find that the number for 1911 showed a considerable increase on that for previous years. The figures, however, are equivalent to less than one bath a year per head of poplution, or to one bath per "week for less than 2,000 persons. No doubt a large proportion of the population have a weekly bath at home, but, considering that there are no baths fixed in at least three-fourths of the houses, it seems probable that the majority of persons in the Borough do not have a bath as often as is desirable for health. Second class private baths can be obtained for 2d. This is not a high price, but, in view of the fact that it is to the interest of the public that every member of the community should be personally clean, it seems desirable that the prices should be still further reduced. Private spray baths could probably be supplied at ½d. per head without involving any considerable charge on the rates. It cannot be too much insisted on that a dirty person is a danger to the public health. This is especially the case with respect to dirty hands. A person who has had enteric fever may, through failure to wash his hands when decency requires, infect the public food supply. The greatest cleanliness should be practised by all persons engaged in selling milk, meat, bread, fruit, &c. For this purpose public lavatories are important, but the charge made is prohibitive to the persons who it is of prime importance should make use of the lavatories. The public lavatories in the Borough were used last year for washing hands 7,946 times. If only those 101 employed in Beresford Square "washed their hands once a day while employed, this figure would be more than doubled. If paper towels were used in place of ordinary towels, the lavatory 'would no doubt pay at the charge of ¼d., and the advantage to public health would be great. Tents, Vans, and Sheds. 46. During the year, 35 tents, vans, and sheds, were inspected (48 in 1910), and three notices served. Notices and Prosecutions, 47. 3,200 written intimation notices, and 535 statutory notices were served. 73 of the latter, not having been complied with in the time specified, were referred to the Town Clerk, who, before taking proceedings, wrote a warning letter in each case. Finally three defaulters were summoned at the Police Court. The results are given in Table XVII. Bacteriological Examination. 48. 916 bacteriological examinations were made for the Public Health Department by the Lister Institute, viz.:— 705 for Diphtheria, 191 for Phthisis, and 20 for Enteric Fever. The total cost was £142 9s. 0d., compared with £120 5s. Od. in 1910. Infant Consultation. 49. Since the closure of the Milk Depot, a Consultation for mothers and infants has been held every Wednesday afternoon in a room at the Town Hall. Mothers bring their infants for advice and weighing between 2.30 and 102 4.0 p.m. Miss FitzGerald, and the Medical Officer of Health, are in attendance during that time. The Consultation has not been as well attended as could be desired probably on account of the long distances which most mothers are required to come. 460 infants attended last year. Further particulars are given in Miss FitzGerald's Report. 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, but so far you have not seen fit to comply with my request. Owing to the demand on Miss Middlebrooke's time by visiting verminous houses, I was obliged to transfer the inspection of registered houses to a male inspector, viz:—Mr. Shaw. The following is a summary of Miss Middlebrooke's work for the twelve months:— Women's Lavatories at Railway Stations, &c. Number of Inspections 49 „ Found defective and dirty 5 Restaurants and Eating-Rouses. Number of Inspections 83 ,, Defects and dirty conditions found and remedied 25 Factories and Workshops. Number of Inspections of Factories and Workshops 264 „ Notices served 20 „ New workrooms measured 41 103 Homeworkers' Premises. Number of Inspections 405 „ Cases referred to District Inspectors 24 Miscellaneous. Total number of houses visited re Phthisis, Measles, Whooping-cough, and Zymotic Enteritis 346 Visits paid for various causes, complaints, etc. 379 „ ,, Verminous and dirty houses and bedding 755 Re-visits—estimated 1000 Cases where bedding was found to be in a dirty and verminous condition, and cleansed 222 Total number of cases referred to District Inspectors 114 „ Dustbins—notices served 35 „ Accumulations of refuse removed 12 „ Early morning inspections 11 „ Overcrowding—cases found and abated 39 Notices served on tenants re dirty conditions 270 Notices served on Landlords to cleanse 69 „ ,, ,, and tenants—various 127 51. Miss Middlebrooke gives details of her work as follows:— The work connected with the cleansing of verminous children and their homes is still on the increase, but is easier to cope with owing to the fact that the London County Council Education Department, during the latter part of the year, organized their new cleansing scheme and placed their part of the work on a more definite and businesslike basis, instead of the rather informal methods which had been in use hitherto. A Special Nurse was 104 pointed whose duty it is to inspect all children at the schools who are reported by the District School Nurses to be in a verminous condition, to send their names and addresses to the Medical Officer of Health. to convey them where necessary to the Cleansing Station, and inspect them after the cleansing. In order to meet the requirements of the London County Council Cleansing Scheme, the Borough Council appointed a woman attendant for the Cleansing Station; it is one of my duties to supervise her work and the appliances used. It is the attendants duty to bath the children, assist in their dressing and undressing, to cut off the hair when the head is verminous or when the scalp is in an unhealthy condition to see that the children's clothing is given to the disinfecting officer for disinfection, and all articles returned to them. Every child is thoroughly cleansed, and where possible the bedding is disinfected on the same day. Every endeavour is made to cause as little friction as possible with the parents, but as may be imagined the inspector is not always a welcome visitor, especially as the School Authority's notice has invariably been served on the parents prior to my visit. A good deal of patience has to be exercised sometimes before the mothers can be induced to talk in anything approaching a reasonable frame of mind. One can quite understand this attitude in some instances; the poor women lead drab, monotonous lives, struggling with big families against heavy odds, with very few facilities for cleansing purposes, old and worn-out bedding and furniture, the discouragement of houses or rooms which are 105 the reverse of satisfactory from the housewife's point of view, and frequently a small mountain of debt incurred through the recent unemployment of the breadwinner, which has to be paid off bit by bit before anything new can be bought for the house or children. Where it appeal's that the father is in fault, a special visit is paid to see him, even if it means an evening visit after office hours, and an effort made (which is usually successful) to bring him to a sense of his responsibilities, in the shape of getting him to provide sufficient and clean bedding and better clothing for the children. I find old flock beds a great source of nuisance; they are happy hunting grounds for vermin and have a knack of retaining offensive smells; as a rule they are highly treasured and it requires a lot of persuasion to get the mothers to substitute clean straw for the old flocks; where this can be managed they express satisfaction afterwards at the improvement and the freedom from vermin. It is to be regretted that Sanitary Authorities have not been given more power to take summary proceedings in persistent cases of neglect to provide proper and wholesome bedding for children; as the law stands at present, the Sanitary Authority may disinfect the bedding, &c., time after time, and, as long as there is no refusal to allow them to carry out the disinfection, it is most difficult to obtain a conviction. The parents are often in such a verminous and dirty state themselves, that the bedding and children quickly become re-infested; there is unfortunately no law or regulation to compel the parents to cleanse their own persons. 106 The average number of visits paid to verminous and dirty homes per week is 20. This does not include re-visits which average about 40. There are fresh addresses to be traced, and many visits paid where there is wilful evasion of inspection until a compulsory letter is sent. It will thus be seen that this branch of work alone is almost sufficient for one inspector. More re-visits ought to be paid which it is impossible to find time for. It will be noted that out of a total of 1,152 homeworkers' addresses sent in by employers only 405 inspections were made. Most of the lists are sent in twice yearly; they differ very slightly, numbers of the same names and addresses appearing in each list. A number of addresses sent are those of workshops on the register. These are inspected and included in the number of workshop inspections. The majority of outworkers are tennis and racket ball workers. The necessity for extreme care and cleanliness in this class of work demands that the workers should be selected with every possible discrimination by the employer. It is found with few exceptions that the houses where the ball work is done are kept scrupulously clean and tidy, and it is quite unnecessary to pay repeated inspections except at distant intervals. 52. The following is Miss FitzGerald's report:— Summary of Inspections. Visits to houses after notifications of births 1307 Re-visits 261 107 Visits re infant death 52 Zymotic Enteritis cases investigated 384 Re-visits 53 Visits to cases of Phthisis 247 Ophthalmia Neonatorum 10 Ophthalmia (reported by Schools) 36 Special visits 101 Infants weighed at Consultation 460 Health Lectures given 7 Reported to District Inspectors:— Structural defects 14 Dirty interior walls 12 Other defects 19 Overcrowding 5 The outstanding feature in the year under review was the exceptionally large number of cases of Zymotic Enteritis notified, as a result of the phenomenally hot summer. For several weeks during the height of the hot weather, the notifications poured in in such numbers that not only was all the available time taken up with this work to the exclusion of other things, but it was often necessary to work overtime, and cease visiting only when daylight failed. It is to be regretted that it was not possible to make any special investigations into the causes and incidence of epidemic diarrhoea with so much material at one's disposal, and when so much remains to be done in this direction. But to have made minute and detailed enquiries, necessitating much clerical work and elaborate statistics, would have taken up time, which, as it was, was devoted to visiting 108 promptly after notification, and giving clear and definite instructions as to disinfection, the protection of food from flies and dust, and precautions against the spread of infection generally. The majority of people are still surprisingly ignorant of the infectious nature of diarrhoea. In clean and well-kept houses it was very common to find soiled clothing exposed in such a manner that flies could easily carry infection. Owing to the large number of cases of epidemic diarrhoea the number of visits paid in respect of births is lower during 1911 than in previous years. The work tends, too, to increase in variety and so to absorb time which would otherwise be given to infant-visiting. Ophthalmia Neonatorum is now a notifiable disease. Ophthalmia occurring in school children and reported by teachers necessitated a good many visits during the year. I have given more time in the past year to the re-visiting of cases of Consumption, where the conditions as regards cleanliness of the premises and isolation of the patient were unsatisfactory. 247 visits were paid in 1911, as compared with 101 in 1910. The work of the Infant Consultation, held on Wednesday afternoons at the Town Hall, still goes on and plays a useful part in furthering the welfare of infants in the Borough. The average attendance is not large, but on the whole those who do come attend regularly and take a keen interest in the growth and development of their children, and appreciate the benefits of having them under regular scientific supervision. General hygienic and dietetic advice only is given at the Consultation. If a 109 baby needs treatment, the mother is advised to consult her own medical attendant. "There has been a slight increase in the number of requests received for Health Lectures. Seven were given in 1911, as against 4 in 1910. They were mostly given to small gatherings of women; but in two instances the audience numbered 50 and 70 respectively; and in one the audience was a mixed one of men and women. I should be glad to have more requests for simple talks on health at Mothers' Meetings, Temperance Societies, and similar gatherings. It is possible to do some useful work in that way, provided the addresses are very simple and quite short. A series of three short lectures of about 20 minutes each is better than one lasting an hour, for the kind of audience one gets at these meetings, who are not used to mental concentration. Public Ambulance. 53. The Public Ambulance, for accidents and non-infectious illness, was use'd 147 times, compared with 104, 122, 143, 123, and 86, in the five preceding years. The following were the journeys made:— To Guy's Hospital 33 Cottage Hospitals 26 Seamen's and Miller Hospitals 10 King's Hospital 12 London Hospital 8 Charing Cross Hospital 8 Union Infirmary 6 Other hospitals 9 Private houses 30 Asylums 5 110 Particulars of this ambulance were given in my Annual Report, 1903, page 78. The ambulance is kept in good repair. C. E. S. Phillips, Esq., F.R.S.E., of Castle House, has kindly provided a mattress to lie on the stretcher. Sutton Messent, Esq., 234, Burrage Road, is acting as Hon. Secretary for the Ambulance. An ambulance for non-infectious illness can now be obtained from the ambulance station of the Asylums Board on payment of 5s. 54. In May, Mr. Ellis, Chief Clerk, retired on pension, and was succeeded by Mr. Britter. The vacancy so caused was not filled up. Mr. Ellis had been a most faithful and devoted officer of the Department for 20 years, and will be much missed. I have gratefully to acknowledge the devoted and able assistance of Chief Inspector Duck, and the 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. 111—112 TABLE I. Borough of Woolwich. Vital Statistics of the whole District during 1911 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of NonResidents Registered in Public Institutions in the District. Deaths of Residents Registered in Public Institutions beyond the District. Net Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1000 Births Registd. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 123644 3524 28.5 396 111 1530 ... 293 48 183 1666 13.5 1907 123644 3295 26.5 372 111 1479 ... 296 50 184 1613 13.0 1908 123644 3082 24.9 298 95 1374 ... 333 60 170 1487 12.0 1909 123644 2937 23.8 240 82 1415 ... 323 51 223 1585 12.8 1910 123644 2844 23.0 241 84 1296 ... 314 42 156 1410 11.4 Average for years 1901 to l910 123331 3371 27.3 372 107 1498 ... 311 46 182 1633 13.2 1911 121376 2814 23.2 273 98 1402 ... 327 53 212 1561 12.8 * Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-Residents" is meant persons brought into the district on account of sickness or infirmity and dying in Public Institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity and have died in Public Institutions elsewhere. The "Public Institutions" taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic Asylums. Area of District in acres (exclusive of area covered by water) 8239.7 Total Population at all Ages 121,376 Number of Inhabited Houses 21,463 Average Number of Persons per House 5.6 At Census of 1911. 113 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 Victoria Park do. do. Ear and Nose Hospital Brompton do. Bethnal Green do. City Road Chest do. Mount Vernon do. Miller do. Cane Hill Asylum Dartford Heath Asylum Colney Hatch do. Claybury do. Tooting Bec do. Darenth do. Caterham do. Stone do. Banstead do. Horton do. Hostel of God do. 115—118 TABLE H. Vital Statistics of Separate Localities, 1901-2-3-4-5-6-7-8-9-10-11. 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 1911 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 Population Census 1911 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 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 9 979 494 87 36710 994 581 110 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 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 15 881 486 70 40328 831 533 86 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 64 30888 722 335 59 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 19 13450 249 112 16 N.B.—The births in 1909 are the notified births increased in the proportion of Registered to notified births in the whole borough. 119 TABLE III. Cases of Infectious Disease notified during the Year 1911. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 518 6 142 314 45 11 ... 106 232 152 28 22 411 Diphtheria 239 1 53 153 17 15 ... 88 48 72 31 35 223 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Typhoid or Enteric Fever 16 4 5 7 ... 10 2 3 1 4 15 Erysipelas 82 3 3 5 9 53 9 20 33 28 1 ... ... Puerperal Fever 16 ... ... ... 6 10 ... 7 8 1 ... ... ... Cerebro-Spinal Fever 1 1 ... ... ... ... ... ... ... 1 ... ... ... Ant. Polio Myelitis 3 ... 3 ... ... ... ... ... 2 1 ... ... ... Ophthalmia Neonatorum 8 8 ... ... ... ... ... ... 5 2 1 ... 1 Chicken-pox (March to June) 85 3 30 49 3 ... ... 13 38 30 4 ... ... Total 968 22 231 525 85 96 9 244 368 290 66 61 650 121—124. TABLE IV.—Causes of, and Ages at Death during the Year 1911. Disease. Deaths in or belonging to whole District at subjoined ages. Woolwich. Plumst'd Eltham. Residents in Outlying Institutions. Public Institution in Borough. Residents & nonresidents. All Ages. Male. Female. Under 1. 1 to 2. 2 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 28 13 15 2 15 10 1 .. .. .. .. .. .. .. .. .. .. 7 11 6 4 3 2 Scarlet Fever 3 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. 3 .. Epidemic Influenza 19 8 11 1 .. .. .. .. .. .. 2 1 1 8 3 3 .. 3 6 9 1 .. .. Whooping Cough 6 1 5 2 3 1 .. .. .. .. .. .. .. .. .. .. .. 4 2 .. .. .. 1 Diphtheria and Membranous Croup 11 6 5 .. 1 6 4 .. .. .. .. .. .. .. .. .. .. 5 4 1 1 9 .. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 34 16 18 23 6 1 1 .. .. .. .. .. .. .. 1 2 .. 15 12 5 2 2 6 Enteritis 96 48 48 64 8 5 2 .. 1 .. 2 .. 3 4 4 3 .. 29 34 26 7 8 .. Acute Anterior Polio Myelitis 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 Cerebro-spinal fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Continued Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 8 6 2 .. 1 .. .. .. .. 1 .. 2 2 1 1 .. .. 2 4 2 .. .. 3 Puerperal Fever 3 .. 3 .. .. .. .. .. .. 1 2 .. .. .. .. .. .. 2 1 .. .. 1 2 Other Septic Diseases 19 11 8 1 1 .. .. 2 .. .. 3 2 2 5 2 1 .. 7 7 4 1 7 5 Syphilis 6 6 .. 3 .. .. .. .. .. .. 2 1 .. .. .. .. .. 1 3 2 .. .. 5 Rheumatic Fever 7 2 5 .. .. 1 .. 2 .. .. 1 1 2 .. .. .. .. 5 2 .. .. 1 1 Gout 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. Intermittent Fever and Malarial Cachexia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Meninges 20 11 9 3 7 5 4 .. .. 1 .. .. .. .. .. .. .. 8 5 7 .. 1 .. Tuberculosis of Lungs (Phthisis) 146 81 65 2 .. 1 2 2 9 19 32 31 25 15 7 1 .. 66 41 33 6 20 51 Tuberculosis of Intestines and Peritoneum 5 2 3 1 1 .. 2 1 .. .. .. .. .. .. .. .. .. 2 2 1 .. 2 .. Other forms of Tuberculosis 29 19 10 3 2 3 1 2 3 1 2 2 2 7 1 .. .. 17 8 4 .. 6 10 Alcoholism 8 6 2 .. .. .. .. .. .. .. .. 1 2 5 .. .. .. 4 3 1 .. .. 6 Cancer 124 62 62 .. 1 .. .. .. 1 .. 1 10 28 33 36 13 1 31 56 24 13 31 22 Diabetes 19 13 6 .. .. .. 2 1 .. 1 1 2 1 7 4 .. .. 3 10 5 1 5 5 Congenital debility and malformation, including premature birth 99 50 49 95 3 .. .. .. .. 1 .. .. .. .. .. .. .. 40 28 22 9 5 16 Old Age 100 38 62 .. .. .. .. .. .. .. .. .. .. 1 18 61 20 27 42 22 9 5 34 Meningitis 16 8 8 7 4 2 2 1 .. .. .. .. .. .. .. .. .. 6 6 4 .. .. 3 Inflammation and Softening of Brain 5 3 2 .. .. .. .. .. .. .. .. .. .. 1 1 3 .. 3 2 .. .. 1 2 Epilepsy 6 2 4 .. 1 1 .. .. .. .. 1 .. 3 .. .. .. .. 2 3 1 .. 2 .. General Paralysis 12 12 .. .. .. .. .. .. 1 .. 2 4 2 2 .. 1 .. 6 3 2 1 8 1 Tabes Dorsalis and Locomotor Ataxia 2 2 .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 1 .. 1 .. .. .. Peripheral Neuritis 5 3 2 .. .. .. .. .. .. .. 1 .. 1 1 2 .. .. 3 1 .. 1 1 1 Other Diseases of Brain and Nervous System 37 26 11 9 2 1 .. 2 .. 2 3 3 6 4 2 3 .. 14 13 7 3 8 4 Organic Diseases of the Heart 143 67 76 .. .. 1 3 6 2 3 2 13 25 41 36 9 2 57 43 31 12 10 34 Cerebral Hæmorrhage, Embolism and Thrombosis 64 34 30 .. .. .. .. .. .. .. .. 2 13 16 19 11 3 17 28 16 3 .. 16 Apoplexy and Hemiplegia 14 6 8 .. .. .. .. .. .. .. 1 2 1 5 3 2 .. 5 5 3 1 1 1 Aneurism 11 8 3 .. .. .. .. .. .. .. 1 5 2 .. 3 .. .. 6 3 2 .. 4 1 Other diseases of blood vessels and heart 35 36 19 .. .. .. 1 .. 1 .. 1 3 3 6 9 10 1 14 8 8 5 13 5 Bronchitis 99 46 53 12 3 .. 1 .. 1 .. .. 2 9 12 19 31 9 34 34 23 8 3 15 Lobular (Broncho) Pneumonia 46 27 19 12 10 6 3 .. .. .. 2 2 1 4 3 2 1 25 12 8 1 5 3 Pneumonia .. 55 38 17 3 6 3 .. 1 .. 2 3 13 4 6 9 5 .. 25 15 12 3 9 8 Other Diseases of Respiratory System 6 3 3 .. 2 .. .. .. 2 .. 1 .. .. 1 .. .. .. .. 4 2 .. 2 .. Diseases of Stomach 13 4 9 2 .. .. .. .. 1 .. 2 3 2 1 .. 2 .. 7 2 4 .. 2 3 Appendicitis and Typhlitis 8 5 3 .. .. .. .. 2 1 .. 2 2 .. .. 1 .. .. 4 3 1 .. 5 2 Obstruction of Intestines 16 7 9 2 .. .. .. .. .. .. .. 1 4 3 5 1 .. 8 6 1 1 5 3 Cirrhosis of Liver 18 6 12 .. .. .. .. .. .. .. 1 3 6 6 2 .. .. 9 7 2 .. 2 6 Other Diseases of the Digestive System 7 4 3 1 .. .. .. 1 .. .. 1 2 .. .. 1 1 .. 4 2 1 .. 1 2 Nephritis and Bright's Disease 43 22 21 .. .. .. 2 .. .. 2 3 5 5 8 12 6 .. 16 14 7 6 5 15 Tumours and other Affections of Female Genital Organs 6 .. 6 .. .. .. .. .. .. 1 2 1 1 .. .. 1 .. 1 2 .. 3 3 .. Accidents and Diseases of Pregnancy Parturition 4 .. 4 .. .. .. .. .. .. .. 2 2 .. .. .. .. .. 3 .. 1 .. .. 1 Violence 43 31 12 7 2 2 6 4 1 .. 3 5 4 1 3 3 2 18 12 9 4 7 15 Suicide 9 9 .. .. .. .. .. .. .. .. 2 3 3 1 .. .. .. 2 3 4 .. 1 5 Ill defined diseases or unknown 4 2 2 1 .. 1 .. .. .. .. .. .. .. .. 1 1 .. 1 2 1 .. 1 1 Other defined diseases 42 23 19 17 2 1 .. .. .. 1 1 2 4 5 6 2 1 10 16 10 6 4 7 Total 1561 815 746 273 81 55 37 27 24 36 85 132 168 211 214 178 40 581 533 335 112 212 327 125—126 TABLE IVa. Infantile Mortality during the Year 1911. Net Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. All Causes Certified Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 2 .. 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. .. .. 2 2 Diarrhœa .. .. .. .. .. 4 8 8 4 24 Enteritis .. .. .. .. .. 15 20 16 11 63 Tuberculous Meningitis .. .. .. .. .. .. .. 1 2 3 Abdominal Tuberculosis .. .. .. .. .. .. .. .. 1 1 Other Tuberculous Diseases .. .. .. .. .. 1 1 1 2 5 Congenital Malformations 5 4 .. 2 11 1 .. 1 .. 13 Premature Birth 41 3 1 4 49 2 .. .. .. 51 Atrophy, Debility, and Marasmus 5 .. 1 4 10 6 9 3 3 31 Atelectasis 5 1 1 .. 7 1 .. .. .. 8 Injury at Birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. 1 1 2 .. .. .. 3 Rickets .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. 2 4 1 7 Convulsions 3 2 .. .. 5 1 .. 3 1 10 Gastritis .. .. .. .. .. 2 .. .. .. 2 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 .. 1 4 2 2 3 12 Pneumonia (all Forms) .. .. 1 .. 1 2 4 6 2 15 Suffocation, overlying 1 .. .. .. 1 2 2 .. .. 5 Other causes 2 .. 2 1 5 .. 5 3 1 14 62 10 7 13 92 43 53 51 34 273 Nett Births in the year Legitimate, 2778. Illegitimate, 36. Nett Deaths in the Year of Legitimate Infants, 256. Illegitimate Infants, 17. 127 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 Nil 1.80 0.16 2.60 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 Nil 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 3.13 0.17 4.27 0.04 ... ... 0.22 0.06 ... ... 0.06 0.02 1907 ... ... ... ... 0.85 0.04 2.22 0.12 8.27 0.11 ... ... 0.16 0.03 ... ... 0.04 0.01 1908 ... ... ... ... 0.70 0.05 2.93 0.16 4.82 0.07 ... ... 0.10 0.02 ... ... 0.04 0.02 1909 ... ... ... ... 0.80 0.01 1.94 0.20 8.04 0.15 ... ... 0.08 0.02 ... ... 0.07 0.01 1910 ... ... ... ... 0.70 0.02 1.19 0.04 4.09 0.10 ... ... 0.08 0.01 ... ... 0.06 0.02 1911 ... ... ... ... 0.68 0.07 1.68 0.09 4.09 0.02 ... ... 0.10 Nil ... ... 0.13 0.02 Note.—Data for 1893 could not be obtained. 129—130 TABLE VI. London and the Metropolitan Boroughs.—Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 52 weeks of 1911* Boroughs. Population estimated to the middle of 1911. Births. Deaths from Deaths under 1 year of Age. All Causes, Enteric Fever. Small-pox. Measles. Scarlet Fever. W hooping-cough. Diphtheria. Diarrhoea and Enteritis (under 2 years). Phthisis. County of London 4,521,301 111,738 67,826 144 9 2570 172 1038 612 5313 6084 14,440 West. Paddington 142,513 3038 1897 5 — 48 3 44 11 134 173 387 Kensington 172,203 3252 2349 4 — 94 2 54 18 146 159 432 Hammersmith 121,766 2927 1891 7 — 36 5 35 28 178 153 428 Fulham 153,705 4121 2203 8 — 64 7 28 27 213 224 517 Chelsea 66,189 1269 1020 — — 30 1 10 5 55 96 138 City of Westminster 159,662 2358 1983 4 — 23 3 26 14 63 193 244 North. St. Marylebone 117,761 2376 1772 2 — 66 7 28 5 83 172 257 Hampstead 85,589 1276 823 2 — 14 — 3 17 22 52 99 St. Pancras 217,941 5559 3371 7 — 108 12 55 37 201 342 624 Islington 327,203 8108 4853 12 — 130 21 70 51 365 405 1032 Stoke Newington 50,644 1045 658 1 — 28 3 18 3 28 55 107 Hackney 222,623 5226 3185 8 — 148 11 58 20 195 311 621 Central. Holborn 49,092 945 768 3 — 15 3 3 3 34 102 109 Finsbury 87,566 2674 1728 8 — 79 6 24 17 142 163 418 City of London 19,466 226 293 — — 1 1 1 1 10 31 28 East. Shoreditch 111,199 3533 2226 1 128 6 32 24 222 204 601 Bethnal Green 128,144 4029 2320 3 — 130 5 49 21 248 208 610 Stepney 279,309 8743 4833 6 7 303 7 49 32 468 493 1261 Poplar 162,274 5015 3054 14 2 225 10 44 44 316 213 787 South. Southwark 191,531 5693 3509 5 — 120 6 64 30 298 326 818 Bermondsey 125,775 3908 2311 5 — 55 6 50 13 212 223 609 Lambeth 297,957 7292 4430 12 — 112 8 67 43 336 419 897 Battersea 167,712 4372 2391 3 — 112 4 36 20 222 223 540 Wandsworth 313,453 6747 3743 9 — 230 10 70 33 293 277 823 Camberwell 261,380 6399 3724 5 — 112 7 45 25 276 350 696 Deptford 109,472 3000 1706 2 — 69 7 37 15 171 139 425 Greenwich 95,973 2376 1409 3 — 41 3 14 16 152 112 305 Lewisham 161,712 3420 1821 5 — 21 5 18 28 128 104 354 Woolwich 121,487 2811 1555 — — 28 3 6 11 102 162 273 * For the purpose of this table the Births registered in London have been corrected by distributing those which occurred in the principal institutions treating maternity cases to the boroughs in which the mothers resided. In 1088 oases the residence was outside the County of London, and these cases have been excluded. On the other hand 31 births that occurred outside the County have been included. With regard to the deaths of London residents, all transferable deaths (i.e., those of persons who, having a fixed or usual residence in England and Wales, die in a district other than that in which they resided) occurring in Greater London and in certain Metropolitan Institutions outside Greater London have been distributed to the Metropolitan Borough to which the deceased belonged. Of the deaths registered in London the previous residence was outside the county in 3299 cases, while on the other hand the deaths of 2826 London residents occurred in the Outer Ring or in Metropolitan Institutions outside Greater London. 131—133 TABLE VIa. London and the Metropolitan Boroughs.—Birtii-rater and Death-rates of Persons belonging to London and the Metropolitan Boroughs during the 52 weeks of 1911. Boroughs. Per 1,000 Persons Living. Deaths under 1 year to 1000 Births. Births. Deaths from All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping-cough. Diphtheria. Diarrhoea and Enteritis (under 2 years). Phthisis. Crude. Cor-* rected. County of London 24.8 15.0 15.8 0.03 0.00 0.57 004 0.23 0.14 1.18 1.35 129 West. Paddington 21.4 13.3 14.3 0.04 .. 0.34 0.02 0.31 0.08 0.94 1.22 127 Kensington 18.9 13.7 14.7 0.02 .. 0.55 0.01 0.31 0.10 0.85 0.93 133 Hammersmith 24.1 15.6 16.2 0.06 .. 0.30 0.04 0.29 0.23 1.47 1.26 146 Fulham 26.9 14.4 15.0 0.05 .. 0.42 0.05 0.18 0.18 1.39 1.46 125 Chelsea 19.2 15.5 16.0 — .. 0.45 0.02 0.15 0.08 0.83 1.45 109 City of Westminster 14.8 12.5 14.0 0.03 .. 0.14 0.02 0.16 0.09 0.40 1.21 103 North. St. Marylebone 20.2 15.1 16.1 0.02 .. 0.56 0.06 0.24 0.04 0.71 1.46 108 Hampstead 14.9 9.6 10.9 0.02 .. 0.16 — 0.04 0.20 0.26 0.61 78 St. Pancras 25.6 15.5 16.2 0.03 .. 0.50 0.06 0.25 0.17 0.92 1.57 112 Islington 24.8 14.9 15.5 0.04 .. 0.40 0.06 0.21 0.16 1.12 1.24 127 Stoke Newington 20.7 13.0 13.6 0.02 .. 0.55 0.06 0.36 0.06 0.55 1.09 102 Hackney 23.5 14.3 15.0 0.04 .. 0.67 0.05 0.26 0.09 0.88 1.40 119 Central. Holborn 19.3 15.7 16.9 0.06 .. 0.31 0.06 0.06 0.06 0.69 2.08 115 Finsbury 30.6 19.8 20.5 0.09 .. 0.90 0.07 0.27 0.19 1.63 1.87 156 City of London 11.6 15.1 16.6 .. .. 0.05 0.05 0.05 0.05 0.52 1.60 124 East. Shoreditch 31.9 20.1 21.1 0.01 .. 1.15 0.05 0.29 0.22 2.00 1.84 170 Bethnal Green 31.5 18.2 18.3 0.02 .. 1.02 0.04 0.38 0.16 1.94 1.63 151 Stepney 31.4 17.4 18.1 0.02 0.03 1.09 0.03 0.18 0.11 1.68 1.77 144 Poplar 31.0 18.9 19.5 0.09 0.01 1.39 0.06 0.27 0.27 1.95 1.32 157 South. Southwark 29.8 18.4 19.2 0.03 .. 0.63 0.03 0.34 0.16 1.56 1.71 144 Bermondsey 31.2 18.4 18.9 0.04 .. 0.44 0.05 0.40 0.10 1.69 1.78 156 Lambeth 24.5 14.9 15.4 0.04 .. 0.38 0.03 0.23 0.14 1.13 1.41 123 Battersea 26.1 14.3 15.3 0.02 .. 0.67 0.02 0.22 0.12 1.33 1.33 124 Wandsworth 21.6 12.0 12.6 0.03 .. 0.74 0.03 0.22 0.11 0.94 0.89 122 Camberwell 24.5 14.3 14.8 0.02 .. 0.43 0.03 0.17 o.io 1.06 1.34 109 Deptford 27.5 15.6 16.4 0.02 .. 0.63 0.06 0.34 0.14 1.57 1.27 142 Greenwich 24.8 14.7 15.0 0.03 .. 0.43 0.03 0.15 0.17 1.59 1.17 128 Lewisham 21.2 11.3 11.8 0.03 .. 0.13 3.03 0.11 0.17 0.79 0.64 104 Woolwich 23.2 12 8 13.7 .. .. 0.23 0.02 0.05 0.09 0.84 1.34 97 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 as in 1901. 134—136 TABLE VII. London and the Metropolitan Boroughs.—Death Rates per 1000 persons living and Infantile Mortality of persons belonging to London and the Metropolitan Boroughs in the Five Years 1906-10, and 1911. Boroughs. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea & Enteritis (under 2 years). Phthisis. Deaths Under One Year to 1000 Births. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. County of London 14.9 15.0 0.04 0.03 0.00 0.00 0.42 0.57 0.10 0.04 0.29 0.23 0.14 0.14 The average mortality under this heading cannot be stated. 1.18 1.40 1.35 114 129 Paddington 13.3 13.3 0.04 0.04 .. .. 0.27 0.34 0.09 0.02 0.20 0.31 0.10 0.08 0.94 1.09 1.22 103 127 Kensington 13.8 13.7 0.03 0.02 .. .. 0.30 0.55 0.04 0.01 0.21 0.31 0.12 0.10 0.85 1.05 0.93 120 133 Hammersmith 14.5 15.6 0.05 0.06 .. .. 0.46 0.30 0.09 0.04 0.24 0.29 0.17 0.23 1.47 1.22 1.26 118 146 Fulham 14.3 14.4 0.05 0.05 .. .. 0.45 0.42 0.09 0.05 0.33 0.18 0.21 0.18 1.39 1.28 1.46 118 125 Chelsea 15.8 15.5 0.03 .. .. 0.45 0.45 0.07 0.02 0.24 0.15 0.15 0.08 0.83 1.52 1.45 114 109 City of Westminster 12.9 12.5 0.04 0.03 0.00 .. 0.13 0.14 0.06 0.02 0.11 0.16 0.09 0.09 0.40 1.32 1.21 99 103 St. Marylebone 14.8 15.1 0.03 0.02 .. .. 0.25 0.56 0.10 0.06 0.23 0.24 0.10 0.04 0.71 1.38 1.46 105 108 Hampstead 9.8 9.6 0.04 0.02 .. .. 0.13 0.16 0.05 0.11 0.04 0.07 0.20 0.26 0.73 0.61 70 78 St. Pancras 15.8 15.5 0.04 0.03 .. .. 0.43 0.50 0.10 0.06 0.31 0.25 0.11 0.17 0.92 1.67 1.57 108 112 Islington 14.7 14.9 0.05 0.04 .. .. 0.47 0.40 0.08 0.06 0.28 0.21 0.11 0.16 1.12 1.30 1.24 107 127 Stoke Newington 12.2 13.0 0.04 0.02 .. .. 0.19 0.55 0.08 0.06 0.25 0.36 0.06 0.06 0.55 1.02 1.09 87 102 Hackney 13.7 14.3 0.05 0.04 .. .. 0.29 0.67 0.10 0.05 0.24 0.26 0.13 0.09 0.88 1.27 1.40 109 119 Holborn 17.2 15.7 0.05 0.06 .. .. 0.29 0.31 0.06 0.06 0.29 0.06 0.11 0.06 0.69 2.31 2.08 114 115 Finsbury 19.9 19.8 0.08 0.09 .. .. 0.80 0.90 0.13 0.07 0.48 0.27 0.20 0.19 1.63 2.21 1.87 134 156 City of London 15.5 15.1 0.06 .. .. .. 0.12 0.05 0.08 0.05 0.16 0.05 0.08 0.05 0.52 1.66 1.60 93 124 Shoreditch 18.9 20.1 0.06 0.01 .. .. 0.81 1.15 0.16 0.05 0.54 0.29 0.15 0.22 2.00 1.90 1.84 149 170 Bethnal Green 17.5 18.2 0.09 0.02 .. .. 0.58 1.02 0.22 0.04 0.37 0.38 0.16 0.16 1.94 1.78 1.63 135 151 Stepney 17.2 17.4 0.06 0.02 0.00 0.03 0.65 1.09 0.15 0.03 0.36 0.18 0.21 0.11 1.68 1.70 1.77 123 144 Poplar 17.1 18.9 0.08 0.09 .. 0.01 0.59 1.39 0.16 0.06 0.46 0.27 0.18 0.27 1.95 1.43 1.32 129 157 Southwark 18.3 18.4 0.05 0.03 .. .. 0.65 0.63 0.13 0.03 0.33 0.34 0.17 0.16 1.56 2.04 1.71 130 144 Bermondsey 18.7 18.4 0.04 0.04 .. .. 0.94 0.44 0.19 0.05 0.35 0.40 0.17 0.10 1.69 1.88 1.78 137 156 Lambeth 14.9 14.9 0.04 0.04 .. .. 0.34 0.38 0.10 0.03 0.25 0.23 0.15 0.14 1.13 1.49 1.41 112 123 Battersea 13.8 14.3 0.04 0.02 .. .. 0.38 0.67 0.10 0.02 0.36 0.22 0.13 0.12 1.33 1.31 1.33 109 124 Wandsworth 11.8 12.0 0.03 0.03 .. .. 0.23 0.74 0.06 0.03 0.26 0.22 0.12 0.11 0.94 0.94 0.89 97 122 Camberwell 14.3 14.3 0.03 0.02 .. .. 0.40 0.43 0.09 0.03 0.28 0.17 0.14 0.10 1.06 1.28 1.34 109 109 Deptford 15.3 15.6 0.05 0.02 .. .. 0.51 0.63 0.09 0.06 0.40 0.34 0.15 0.14 1.57 1.33 1.27 119 142 Greenwich 14.2 14.7 0.05 0.03 .. .. 0.40 0.43 0.09 0.03 0.37 0.15 0.17 0.17 1 59 1.21 1.17 110 128 Lewisham 11.2 11.3 0.02 0.03 .. .. 0.14 0.13 0.09 0.03 0.21 0.11 0.16 0.17 0.79 0.82 0.64 89 104 Woolwich 13.0 12.8 0.03 .. .. .. 0.31 0.23 0.10 0.02 0.22 0.05 0.15 0.09 0.84 1.31 1.34 96 97 137—138 TABLE VIII. Meteorology and Registered Deaths from all Causes and from certain Prevalent Diseases for the Year 1911. 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 and Enteritis. Bronchitis and Pneumonia. All causes. 1911. January 7 45.6 31.9 37.5— 43.66 86 6 0.43 — 2 21 „ 14 50.0 25.6 38.7+ 43.23 88 4 0.73 — 9 30 „ 21 44.0 24.1 37.3— 41.98 91 2 0.02 1 12 46 „ 28 51.7 29.5 41.5+ 42.19 87 1 0.04 1 8 45 February 4 43.0 21.6 34.2— 41.93 84 2 0.03 — 7 36 „ 11 44.9 25.1 37.0— 41.02 80 3 0.11 — 10 35 „ 18 55.2 26.3 42.8+ 40.87 79 3 0.12 — 9 43 „ 25 55.0 33.1 45.1+ 42.59 77 6 9.60 — 6 35 March 4 59.3 34.3 46.3+ 43.53 80 4 0.62 — 6 33 „ 11 51.0 29.1 40.4— 43.90 83 4 0.42 — 4 35 „ 18 47.1 29.1 38.1— 42.87 83 7 0.77 — 6 32 „ 25 61.8 33.2 42.8+ 42.74 84 1 0.13 — 5 34 April 1 56.0 33.1 42.8— 42.96 87 2 0.31 — 3 32 1st Quarter 61.8 21.6 40.3 42.57 84 45 4.33 2 87 457 April 8 50.6 26.7 36.3— 43.26 77 4 0.91 — 6 29 „ 15 66.9 30.3 45.0— 42.66 73 2 0.04 — 4 28 „ 22 67.3 37.4 51.2+ 45.10 65 — 0.00 1 1 35 „ 29 66.0 42.0 51.3+ 47.50 72 4 0.60 — 5 28 May 6 62.2 39.8 50.1+ 48.36 73 3 0.35 — — 28 „ 13 75.6 36.7 56.9+ 49.96 74 1 0.18 1 3 24 „ 20 72.2 45.3 54.7+ 52.47 82 2 0.36 — 2 20 „ 27 78.0 35.0 57.8+ 53.20 76 1 0.04 2 2 27 June 3 81.7 47.8 646+ 56.00 68 2 1.01 — 1 20 „ 10 83.9 42.1 62.3+ 58.73 67 — 0.00 — 3 25 „ 17 74.5 40.6 57.0— 58.76 64 4 0.66 — 4 24 „ 24 73.6 50.7 59.2— 58.98 75 4 0.94 — 3 21 July 1 75.7 48.2 57.5— 53.72 76 4 0.50 — 4 20 2nd Quarter 83.9 26.7 54.1 51.82 72 31 5.59 4 38 329 July 8 88.0 48.2 65.6+ 59.80 59 — 0.00 1 2 15 „ 15 85.0 49.1 65.2+ 62.16 78 — o.oo 2 1 20 „ 22 95.6 45.8 69.5+ 63.31 54 — o.oo 2 1 24 „ 29 91.9 54.7 71.0+ 65.17 64 4 0.26 3 3 35 August 5 86.2 53.7 68.0+ 66.02 66 1 0.06 1 1 17 „ 12 100.0 54.6 72.5+ 66.43 58 — o.oo 6 1 27 „ 19 90.9 51.3 69.44. 67.06 59 1 0.58 18 1 36 „ 26 82.2 52.7 63.9+ 66.39 78 4 0.29 25 — 39 September 2 89.1 48.1 653+ 65.36 67 2 0.41 16 2 48 „ 9 94.1 50.1 66.9+ 64.63 59 1 0.01 7 — 27 „ 16 88.5 45.4 60.3+ 64.19 66 2 0.41 10 1 31 „ 23 69.4 37.7 54.3— 61.74 71 4 0.48 9 1 25 „ 30 71.7 40.3 55.0+ 59.94 69 3 0.44 9 2 42 3rd Quarter 100.0 37.7 65.1 64.01 65 22 2.94 109 16 386 October 7 59.5 34.4 48.2— 57.63 81 3 0.27 4 4 27 „ 14 60.0 39.7 51.9+ 55.99 87 2 0.29 2 3 38 „ 21 64.1 45.1 54.5+ 55.92 91 5 0.37 1 — 27 „ 28 61.5 35.6 48.5+ 55.42 82 5 1.98 2 5 33 November 4 59.2 28.1 48.4+ 52.78 79 5 0.63 2 3 29 „ 11 59.0 34.1 44.5— 51.75 80 6 1.16 — 1 16 „ 18 58.0 38.2 49.0+ 50.15 83 6 1.70 — 3 25 „ 25 47.0 28.3 39.3— 49.04 80 3 0.25 — 5 26 December 2 49.0 30.1 40.8— 46.99 92 4 0.10 — 5 27 „ 9 49.2 28.9 41.3+ 46.94 86 6 1.07 — 10 29 „ 16 51.7 34.1 44.6+ 45.78 88 5 1.02 — 7 28 „ 23 53.8 35.1 46.0+ 46.57 91 7 1.31 — 7 35 „ 30 52.8 38.1 45.7+ 46.01 89 5 0.64 — 5 28 4th Quarter 64.1 28.1 46.4 50.84 85 62 1079 11 58 368 Year 100.0 21.6 51.5 52.31 76 160 23.65 126 199 1540 139 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 51.1 28.9 40.3 42.57 84 3.5 0.33 0.15 7 35 2nd Quarter 71.4 40.2 54.1 51.82 72 2.4 0.43 0.31 3 25 3rd Quarter 87.1 48.5 65.1 64.01 65 1.7 0.23 8.4 1 30 4th Quarter 55.7 34.6 46.4 50.84 85 4.1 0.83 0.80 4 28 140 TABLE X. Summary of Statistics for the First Quarter, ending April 1st, 1911, 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 InstitutioDS. 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. 128,448 727 22.6 66 90 427 102 13 43 457 14.2 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 27.4 17.4 112 West 40,907 21.1 16.1 74 14,050 17.9 9.4 48 East 34,500 21.0 10.3 94 141 C. Deaths from Certain Causes in whole Borough. Cause of Death. Total. Average for last 5 years. Cause of Death. Total. Average for last 5 years. Smallpox Rheumatic Fever 1 2.6 Measles 17 18.2 Tubercle of Lung 43 55.2 Scarlet Fever — 3.2 Other Tubercular Diseases 19 Influenza 6 16.2 Alcoholism and Cirrhosis of Liver 6 4.6 Whooping Cough 3 8.0 Diphtheria & Mem. Croup 2 6.6 Cancer and Sarcoma 33 26.4 Enteric — 1.2 Bronchitis 45 68.0 Diarrhœa and Enteritis 2 2.6 Broncho-Pneumonia 24 44.2 Erysipelas 3 1.2 Pneumonia 18 Puerperal Fever — 0.4 Violence 3 13.6 TABLE XI. Summary of Statistics for the Second Quarter, ending July 1st, 1911, 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 Census, 1911. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 121,376 699 230 39 56 281 71 12 60 329 10.8 142 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population Census, 1911. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. Population Census, 1911. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. Population Census, 1911. Birth Kate. 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 36,710 27.0 13.4 56 West 40,328 19.7 11.1 85 13,450 20.5 6.8 29 Bast 30,888 23.7 92 33 C. Deaths from Certain Causes in whole Borough. Cause of Death. Total. Average for last 5 years. Cause of Death. Total. Average for last 5 years. Smallpox — — Rheumatic Fever 2 2.0 Measles 7 9.8 Tubercle of Lung 28 56.6 Scarlet Fever 2 3.2 Other Tuberculous Dis. .. 11 Influenza 5 7 Alcoholism and Cirrhosis 6 5.6 Whooping Cough 2 6.6 Cancer and Sarcoma 22 22.2 Diphtheria and Mem. Croup 4 4.4 Bronchitis 14 21.4 Enteric — 0.4 Broncho-Pneumonia 9 Diarrhœa and Enteritis 4 — Pneumonia 15 26.8 Erysipelas 1 1.2 Violence 10 8.6 Puerperal Fever 1 0.4 Suicide 6 3.4 143 TABLE XII. Summary of Statistics for the Third Quarter, ended Sept. 30th, 1931, corrected for Public Institutions:. A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population. Population Census, 1911. Births. Deaths under one year. Deaths at all ages.Gross. Deaths in Public Institutions. Deaths of Non. Residents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Number. Bate. Number. Bate per 1,000 Births Registered Number. Number. Bate. 121,376 676 22.3 117 167 364 70 16 38 392 12.7 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population, Census, 1911. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 births. Population, Census, 1911. Birth Bate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population, Census, 1911. Birth Bate. Death Bate at all ages. Deaths under 1 year, per 1000 Births. A B C D A B c D A B C D 36,710 26.7 15.4 192 West 40,328 19.2 12.4 149 13,450 16.7 11.3 179 East 30,888 23.4 10.6 149 144 C. Deaths from certain causes in the whole Borough. Cause of Death Total. Average for last 5 years. Cause of Death. Total. Average for last 5 years. Smallpox — — Rheumatic Fever 1 1.8 Measles 4 30 Tubercle of Lung 24 47.2 Scarlet Fever 1 2.4 Other Tuberculous Dis 11 Influenza — 1.4 Alcoholism and Cirrhosis 6 4.6 Whooping Cough — 5.6 Cancer and Sarcoma 33 28.6 Diphtheria and Mem. Croup — 1 2 Bronchitis 6 12.4 Enteric 0.8 Broncho. Pneumonia 2 Diarrhoea and Enteritis 109 26.4 Pneumonia 8 11.8 Erysipelas — 0.8 Violence 11 8.4 Puerperal Fever 1 0.4 Suicide 2 4.2 TABLE XIII. Summary of Statistics for the Fourth Quarter, ending December 30th, 1911, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population Births, Deaths under one year of age. Deaths at all ages — Gross. Deaths in Public Institutions. Deaths of Non. Residents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Population, Census, 1911. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 121,376 694 22.9 49 71 325 84 12 55 368 12.1 145 B. Birth and Death Rates for each Parish. Woolwich. Plumstedad Eltham. Population, Census, 1911. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 Births. Population, Census, 1911. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 Births. Population, Census, 1911. 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 36,710 25.5 14.5 73 West 40,328 East 30,888 22.0 22.9 13.3 11.0 99 51 13,450 18.1 4.8 16 C. Deaths from certain causes in whole Borough. Cause of Death, Total. Average for last 5 years. Cause of Death. Total. Average for last 5 years. Smallpox — — Rheumatic Pever 3 2.2 Measles — 6.6 Tubercle of Lung 50 49.2 Scarlet Pever — 8 Other Tuberculous Dis 12 Influenza 6 8.2 Alcoholism and Cirrhosis 13 7 Whooping Cough 1 5.8 Cancer and Sarcoma 35 30.6 Diphtheria and Mem. Croup 5 4.6 Bronchitis 33 40.2 Enteric Fever — 1 Broncho.Pneumonia 13 Diarrhoea and Enteritis .. 11 10.6 Pneumonia 12 26.6 Erysipelas 4 1 Violence 14 7 Puerperal Pever — 0.6 Suicide 2 1.8 147—148 TABLE XIV. Deaths from various causes for the whole Borough, 1911, corrected for Public Institutions. Week ending Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Mem. Croup. Enteric. Diarrhoea. Enteritis. Erysipelas. Puerperal Fever. Rheumatic Fever. Tubercle of Lung. Other Tuberculous diseases. Alcoholism and Cirrhosis of Liver, and Per. Neuritis. Cancer and Sarcoma. Bronchitis. BronchoPneumonia. Pneumonia. Violence Suicide January 7 .. 1 .. .. .. .. .. .. .. .. .. .. .. 2 .. 4 1 1 .. .. .. „ 14 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 4 5 3 1 .. .. „ 21 .. .. .. 1 1 .. .. 1 .. .. .. .. 2 3 .. 4 9 1 2 .. .. „ 28 .. 1 .. 2 .. .. .. 1 .. .. .. .. 3 1 .. 5 4 3 1 .. .. February 4 .. .. .. .. 1 .. .. .. .. .. .. .. 4 1 .. 1 5 .. 2 .. .. „ 11 .. .. .. .. .. .. .. .. .. .. .. .. 4 2 .. .. V 1 2 .. .. „ 18 .. 1 .. .. .. .. .. .. .. .. 6 1 3 b 3 1 . . . . „ 25 .. 2 .. 1 •• .. .. .. .. .. .. .. 5 • • 3 3 2 1 . . . . March 4 .. 3 .. 1 .. .. .. .. .. .. .. .. 3 1 2 1 2 2 2 . . . . „ 11 .. 2 .. .. ., .. .. .. .. .. .. .. 5 1 2 2 1 1 . . . . „ 18 .. 2 .. .. .. .. .. .. .. .. 6 2 1 1 1 3 2 . . . . „ 25 .. 2 .. 1 .. .. .. .. .. .. 1 3 2 4 1 3 1 . . . . April 1 .. 3 .. •• 1 .. .. .. .. .. .. •• 2 3 •• 3 •• 1 2 . . . . 1st Quarter .. 17 .. 6 3 2 .. 2 .. 3 .. 1 45 19 6 33 45 24 18 . . . . April 8 .. 1 .. 1 .. .. .. .. .. . . .. 1 3 1 1 1 3 1 2 . . . . „ 15 .. .. .. .. .. .. .. . . .. 8 1 .. .. 3 • • 1 •• . . „ 22 .. 1 .. .. 1 .. .. .. . . 1 2 1 1 . . . . „ 29 .. 1 .. 1 1 .. .. .. . . . . . . 1 1 3 1 1 . . . . May 6 .. 1 1 .. 1 .. .. .. . . . . . . 4 • • • • 3 •• . . . . „ 13 .. 1 .. .. .. .. .. .. . . . . . . 3 1 2 1 . . 2 „ 20 .. 1 .. .. .. .. .. .. . . . . . . 2 . . 2 2 . . 2 „ 27 .. .. .. 1 .. .. .. .. . . . . . . • • 3 •• 1 1 3 . . June 3 .. .. .. .. .. .. .. . . . . . . 1 1 . . 5 1 1 . . „ 10 .. .. .. .. .. .. .. . . . . . . 4 . . 3 2 1 3 . . „ 17 .. 1 .. . . . . . . ... . . . . . . . . . . . 1 . . 1 3 . . . . „ 24 . . 1 . . . . . . . . . . . . . . . . . . . . 2 2 1 1 1 1 1 1 . . July 1 . . . . . . . . . . 1 . . . . . . . . 1 . . 2 •• 2 1 •• 2 2 1 . . 2nd Quarter . . 7 2 5 2 4 1 3 1 1 . . 28 11 6 22 14 9 15 10 6 July 8 . . . . . . . . . . . . 1 . . . . . . 2 .. .. 1 1 . . 1 1 . . „ 15 . . 1 . . . . . . . . . . .. 2 . . . . . . 1 1 1 1 . . 1 . . „ 22 . . . . . . . . . . . . 1 1 . . . . . . 4 .. 1 3 .. . . 1 1 . . „ 29 . . 1 . . . . . . . . . . 3 .. . . . . . . 2 2 . . 3 1 . . 2 1 . . August 5 . . . . . . . . . . . . 1 . . . . . . 1 • • . . 3 . . 1 0 . . „ 12 . . 1 . . . . . . . . . . 2 4 . . . . . . 1 1 . . 3 . . 1 2 . . „ 19 . . . . . . . . . . . . . . 5 13 . . . . . . 1 1 . . 2 1 . . •• • • . . 26 . . 1 . . . . . . . . . . 6 20 . . . . . . . . . . 1 5 . . . . . . 2 . . September 2 5 11 6 1 5 1 1 A . . „ 9 . . . . . . . . . . . . . . 1 6 . . . . . . '2 1 . . 3 . . . . . . 1 . . „ 16 . . . . . . . . . . . . . . 1 9 . . . . . . 2 1 • • 2 1 •• 1 . . „ 23 . . . . . . . . . . . . . . 1 8 . . . . . . 1 2 1 . . 1 . . 1 . . „ 30 . . . . . . . . . . . . . . 2 7 . . . . . . 2 3 •• 1 1 1 . . 1 . . 3rd Quarter . . 4 1 . . . . .. . . 29 81 •• 1 1 24 11 6 33 6 2 8 13 2 October 7 . . . . . . . . . . 1 . . 4 1 3 1 .. 1 3 1 5 . . „ 14 . . . . . . . . . . . . . . 1 1 1 . . 10 1 4 3 1 . . „ 21 . . . . . . . . . . 2 . . 1 1 . . . . 7 1 1 4 . . . . . . 1 . . „ 28 . . . . . . . . . . 1 . . 1 1 . . . . . . 5 4 2 1 4 1 1 . . November 4 . . . . . . . . . . . . . . . . 2 . . . . . . 6 2 1 1 1 1 1 1 . . „ 11 . . . . . . . . . . . . . . . . . . . . . . . . 1 . . 3 . . . . 1 . . . . . . „ 18 . . . . . . . . . . . . . . . . . . . . . . . . 3 . . 3 4 2 1 •• •• . . „ 25 . . . . . . 1 . . . . . . . . . . . . . . . . 3 . . . . 3 2 3 . . . . December 2 . . . . . . 1 . . . . . . . . . . . . . . . . 4 . . 2 3 2 1 2 1 . . „ 9 . . . . . . . . . . . . . . . . . . . . . . . . 2 1 . . 3 6 3 1 . . . . „ 16 . . . . . . 1 . . . . . . . . . . . . . . . . 2 2 . . 4 2 4 1 2 . . „ 23 . . . . . . . . . . . . . . . . . . . . . . 2 2 . . 1 6 5 1 1 . . . . „ 30 . . . . . . 1 . . 1 . . . . . . . . . . . . 2 •• •• 1 3 1 1 2 . . 4th Quarter . . . . . . 6 1 5 .. 6 5 4 .. 3 50 12 13 35 33 13 12 14 2 Whole Year •• 28 3 17 6 11 •• 38 89 8 2 7 147 53 31 123 98 48 53 40 10 149—150 TABLE XVa. Summary of Nuisances Abated, Notices served, and General Work of Public Health Department, 1911. 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 787 1215 803 1153 802 666 242 224 5892 ,, Re-inspections after service of Notice (estimated) 1665 1840 1839 1900 1896 1206 964 526 11836 ,, Houses and premises specially inspected, including infectious diseases and complaints 978 625 1139 1146 1094 540 722 302 6546 ,, Houses where drains have been tested by smoke test 34 32 48 14 12 24 15 8 187 ,, Houses where drains have been tested by water test 22 8 27 2 2 12 24 12 109 ,, New Houses inspected for Water Certificates •• •• •• 5 6 •• 84 •• 95 NUISANCES ABATED—DRAINS. Waste-pipe from baths, lavatories, and wash-house sinks, repaired or disconnected 36 39 19 8 29 6 5 14 156 Choked and defective drains 68 95 91 17 52 38 26 27 414 Defective traps 14 95 11 2 3 10 11 7 153 Defective and unventilated soil pipes •• 4 5 5 1 5 3 23 W.C.'s. W.C.'s repaired, new traps or pans provided 36 65 49 18 39 47 28 35 317 Water supply apparatus repaired or renewed 89 59 48 46 77 41 21 30 411 Foul pans cleansed 67 31 35 68 30 11 20 17 279 Additional w.c.'s provided to Factories & Workshops, &c. •• •• •• •• •• •• •• 1 1 Do. do. dwelling houses •• •• •• •• •• •• 2 •• 2 PREMISES. Underground rooms not in accordance with Act 5 4 3 2 •• •• •• 14 Interiors cleansed and defective roofs repaired 420 560 419 140 182 195 86 135 2137 Damp walls remedied 103 241 72 25 87 30 19 23 600 Paving in yards and wash-houses repaired 64 84 48 11 45 40 29 19 340 Improved ventilation provided 5 44 5 •• 7 23 7 3 94 Wash-houses without sink and outlets for waste water •• •• .. 1 • • •• •• 1 2 Defective guttering and rain-water pipes 69 29 37 40 40 36 20 13 284 Dustbins supplied 113 109 75 62 61 32 22 42 516 Dung pits provided •• •• 4 1 2 1 •• •• 8 Cases of overcrowding remedied 26 18 14 11 19 2 3 4 97 Deficient light—windows supplied, or enlarged, or other works 9 18 18 •• 8 •• •• 3 56 Dampness in premises from defective water pipes 25 4 9 19 7 •• 4 3 71 ANIMALS. •• •• •• •• •• •• •• •• •• Animals (including pigs) kept in such a state as to be a nuisance 3 •• 5 4 8 •• 4 •• 24 Accumulations of manure removed 21 31 8 8 4 11 15 5 103 WATER. Defective and foul cisterns used for dietary purposes •• 5 4 3 16 .. 5 1 34 Defective and foul rain-water tanks remedied 4 •• 7 •• 1 •• •• •• 12 Insufficient supply, and water cut off by Water Board •• 1 9 3 4 6 23 Additional water supply for two or more families •• 1 •• •• •• •• •• 1 2 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 12 14 4 11 5 •• •• 2 48 No. of smoke nuisances observed •• •• •• •• 4 •• •• •• 4 Tents, Vans, &c., inspected •• •• .. 3 1 •• 31 •• 35 Notices served with respect to tents and vans •• •• •• •• •• •• 3 •• 3 Inspection of Urinals accessible to the public 90 40 63 126 42 60 42 25 488 Verminous rooms cleansed 54 103 36 17 20 8 5 5 248 Intimation notices served 775 709 541 238 391 251 136 159 3200 Statutory „ ,, 130 41 101 27 124 59 17 36 535 151 TABLE XVB. SUMMARY OP WORK OF CHIEF INSPECTOR. Premises Inspected 1260 New Buildings Inspected 21 Defective Combined Drains Investigated and Reported on 27 Number of Houses referred to in such Combined Drains 236 Cow-houses and Slaughter-houses Inspections 35 Complaints Investigated 135 Attendances at Police Courts 29 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for proceedings 73 Summonses at Police Courts 27 Bake-houses Inspected and Cleansed twice during the year 50 Number of Houses Disinfected after Infectious Disease 1093 Letters written 3954 Notifications received 3050 Certificates issued after Disinfection 1002 ,, of Infectious Disease forwarded to Schools 1514 Complaints of Sanitary Defects 400 ,, of Non-removal of Dust, viz:— Woolwich 6 Plumstead 12 Eltham 2 152 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) 80 5 Workshops (Including Workshop Laundries) 322 30 Workplaces 83 25 Homeworkers' Premises 405 24 Total 890 84 2.—Defects found. Description. Number of Defects, Found. Remedied. Nuisances under Public Health Act: — — Want of Cleanliness 65 65 Want of Ventilation 18 18 Overcrowding 10 10 Want of Drainage of floors — — Other nuisances 41 41 Sanitary Accommodation insufficient- 0 0 unsuitable or defective 17 17 not separate for sexes 3 3 Total 154 154 153 TABLE XVc.—continued. 3.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act. (S. 133) 1 Action taken in matters remediable under the Public Health Acts, but not under the Factory Act (S. 5). Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspectors 1 Underground Bakehouses (S. 101):— In use during 1903 24 Certificates granted in 1903 24 in 1904 1905 0 in 1906 1 in 1907-1908-1909 0 in 1910 1 in 1911 0 In use during 1911 15 Workshops on the Register (S. 131) at end of 1910:— Workshop Laundries 14 ,, Bakehouses 36 Other Workshops 149 Total number of Workshops on Register 199 154 TABLE XVc.—continued 4.—Home Work. Nature of Work. Out Workers' Lists, Section 107. Prosecutions. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Number of Addresses of Outworkers received from Other Councils. Number of Addresses of Outworkers forwarded to Other Councils. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 103). Prosecutions (Sees. 109, 110) Twice in the year. Once in the year. Failing to keep or permit in spection 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 42 167 .. .. .. 23 .. .. 35 7 7 .. .. .. .. Shirt makers 4 83 3 86 .. 20 .. .. 76 8 8 .. .. .. Corset makers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Gold braid makers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tennis Balls, etc. 6 816 .. .. .. 128 .. .. 294 9 9 •• .. •• .. 52 1066 3 86 67 171 .. .. 405 24 24 .. .. .. .. 155 TABLE XVD. Proceedings during 1911. Premises. Number of Places. Number of Inspections, 1911' Number of Notices, 1911. Number of Prosecutions, 1911. On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end of 1911. Milk Premises 137 14 22 129 193 30 0 Cowsheds 17 0 1 16 64 8 0 Slaughter-houses 11 1 0 12 48 4 0 Ice Cream Premises 86 9 6 89 178 9 0 Registered houses let in Lodgings 409 30 10 429 539 257 0 Overcrowding, 1911— Number of Dwelling Rooms overcrowded 97 Number remedied 97 Underground Booms— Illegal occupation dealt with during year 14 Number of rooms closed 14 Insanitary Houses— Number closed under the Housing Town Planning, &c. Act 11 Number of Prosecutions under By-laws under Public Health Act, 1891— With respect to water closets, earth closets, etc 0 With respect to sufficiency of water supply to water closets 0 With respect to drainage, etc. (Metropolis Management Act, Sec. 202) 0 Mortuaries— Total number of Bodies removed 192 Total number of Infectious Bodies removed 1 Inspections of premises where food is p)~epared for sale 178 Number of Public Sanitary Conveniences removed or altered 0 Number of fixed ashpits removed 1 156 TABLE XVI. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. I RIVER WARD. Beresford Street 79 49 Creton Street 30 14 Brewer Street 42 6 Myrtle Street 8 2 Gough Street 29 8 Union Street 13 2 Sandy Hill Road 14 11 Bellwater Gate 4 1 Salutation Alley 7 6 Howard's Place 5 5 Clara Place 11 8 Monk Street 10 8 Eleanor Road 40 19 Kingsman Street 16 5 Charles Street 42 23 Powis Street 44 19 Rodney Street 13 8 Meeting House Lane 9 7 Collingwood Street 10 10 New Street 6 6 High Street 68 37 Rope Yard Rails 23 14 Nelson Street 14 8 Glass Yard 11 7 Warren Lane 15 6 Brookhill Road 20 9 KateB Place 16 12 Anglesea Avenue 9 4 Taylors Buildings 5 4 Taylor Street 19 4 Helen Street 9 2 Wilmount Street 37 20 Masons Avenue 5 4 Walpole Place 28 16 Anglesea Road 21 6 Red Lion Street 24 8 Parsons Hill 5 1 Nile Street 10 4 Mulgrave Place 21 10 Upper Market Street 12 4 Albert Road 143 73 157 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVEK WARD—cont. Winifred Street 78 42 Dock Street 19 14 Auberon Street 38 22 Rhea Street 80 36 Barge House Road 36 24 Mary Ann Street 15 9 1213 616 DOCKYARD AND ST. MARY'S WARDS. 50.7 % Defects. Ogilby Street 17 5 Robert Street 21 14 Limbreys Buildings 10 9 Eustace Place 11 6 Sims Buildings 9 4 Henry Street 85 33 Pellipar Road 26 14 Pellipar Place 4 2 Samuel Street 115 45 Siemens Road 28 28 Mary Place 9 9 Elgin Terrace 7 5 Paradise Place 24 16 Glenalvon Street 10 8 North Kent Grove 20 12 North Kent Place 4 3 Lyford Street 18 10 Martyrs Passage 8 8 Prospect Row Cottages 5 3 Parson9 Hill 16 9 Bowling Green Row 9 6 Chapel Street 47 24 Warwick Street 69 48 Marshalls Grove 29 8 Acorn Street 25 12 Oak Street 17 5 Sand Street 76 42 158 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. DOCKYARD AND St. MARY'S WARDS—eont. Orchard Place 36 34 Orchard Street 32 24 787 446 St. GEORGE'S WARD. 55'4 % Defects. Belmont Place 5 2 Campbell and Montague Cott 8 1 Dicey Street 39 21 Eglinton Road, part of 14 7 James Street 54 39 Manor Street 38 20 Nightingale Vale 33 13 Ritter Street 33 15 224 118 ELTHAM WARD. 52-6% Defects. Coopers Place 8 8 Court Yard—Part of 13 7 Dairsie Road 58 12 Jubilee Cottages 30 12 Ladysmith Road 23 8 Meadow-court Road, Lee 37 5 Mottingham Lane and New Cottages 10 6 Reventlow Road 36 19 Sherard Road 10 6 The Grove, Court Yard 17 7 242 90 37.1 % Defects. 159 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. BURRAGE AND HERBERT WARDS. Frederick Place 62 32 Burrage Road 147 70 East Street 29 15 Mount Pleasant 27 13 Parry Place 35 15 Spray Street 43 29 Ripon Road 37 9 Burrage Grove 35 19 Raglan Road 37 27 Armstrong Street 32 12 „ Place 29 14 Whitworth Place 21 12 Charles Street 16 9 Chester Place 12 5 Arthur Street 37 23 Sandy Hill Road 130 72 The Avenue 19 14 Bignell Road 14 6 Bloomfield Road 21 12 803 408 GLYNDON WARD. 50 8 % Defects. Griffin Road 80 7 Maxey Road 66 24 Majendie Road 43 20 Down Street 12 8 Glyndon Road 79 26 Inverness Place 14 5 Vicarage Road 23 5 Pattison Road 7 4 Charlotte Street 38 19 Dawson Street 23 10 Sandbach Place 16 3 Swetenham Place 21 5 Robert Street 118 48 609 223 36.6% Defects. 160 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. Elm Grove 15 7 Upper Garland Street 9 5 The Slade 38 15 Sutcliffe Road 38 12 Durham Road 51 7 Bramblebury Road 66 18 Old Mill Road 26 0 Parkdale Road 110 40 Wernbrook Street 74 12 Vicarage Park 12 7 Lee Street 40 10 St. Margaret's Terrace 18 3 Goldsmid Street 10 1 Rowton Tioad 5 0 Admaston Road 48 21 Congo Road 38 7 Tilce Road 9 2 Gal losson Road 24 6 Bebbington Road 12 6 Lakeview Terrace 6 1 Swingate Lane 58 11 Waverley Road 43 6 Ennis Road 53 8 Heavitree Road 78 11 Blendon Road 10 1 Plum Lane 48 14 Tuam Road 119 9 Winus Cottages 6 4 Inverary Place 10 4 Palmerston Road 63 30 Kirkham Street 16 3 1153 287 St. NICHOLAS WARD. 24-89% defects. Rippolson Road 24 17 Bassant Road 32 17 High Street (south aide) 111 51 Gatling lioad 32 9 161 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. Wickham Lane 151 41 Glenside Road 26 18 Hartville Road 36 14 Mabyn Road 26 12 Abbey Grove 47 28 Benares Road 132 44 Rockmount Road 14 8 Scotch Plats 13 6 Gavin Street 12 3 Garibaldi Street 20 10 Abery Street 25 15 Gunning Str et 29 15 Heverham Road 25 7 Reidbaven Road 47 22 802 337 42-2 % Defects. 162 TABLE XVII. Prosecutions under the Public Health and London County Council (General Powers) Acts. No. Date of Hearing. Offence. Situation. Result. 1 1911 Feb. 15 Dirty and Dilapidated Conditions 143 High Street, Woolwich Costs, 8/6 2 April 19 Dirty Conditions and Defective Roof 74 Plumstead Road Fine, £2/2/0 and 3/- costs Order to abate in 14 days 3 Oct. 26 Contravention of Shop Hours Act 240 High Street, Plumstead Costs, 12/6 4 26 74 lbs. Unsound Bacon and Pigs Heads 30 High Street,Plumstead... Fine £28 and £4/4/0 costs 5 26 70 lbs. Unsound Bacon 30 High Street, Plumstead... Fine £36 and £4/4/0 costs 6 26 Non-provision of Dust-Bin 61 Lakedale Road Costs, 12/6 7 Nov. 1 Breach of Regulations for Purveyors of Milk Lyme Farm, Elthain Adjourned sine die 163 TABLE XVIII. Summary of Articles Analysed, under the Sale of Pood and Drugs Act, during the year ended 31st December, 1911. Article. Number Analysed. Number Adulterated. Milk 289 21 Butter 52 1 Margarine 7 .. Tea 23 .. Cocoa 16 .. Jam 17 .. Mustard 11 .. Flour 6 .. Condensed Milk 8 .. Olive Oil 4 .. Spirits of Nitre 1 .. Tartaric Acid 1 .. Iron Pills 1 .. Liniment of Ammonia 1 .. Magnesia Carbonate 1 .. Blue Pills 1 .. Mercury Ointment 1 .. Mercury and Chalk Powder 1 .. Lime Water 1 .. Ammoniated Tincture of Quinine 4 .. Coffee 6 .. Cheese 4 . Quinine Wine 3 .. Cod Liver Oil 3 .. Pepper 8 .. Lemon Squash 1 1 Rice 6 .. Honey 2 .. Lard 2 .. Bread 4 .. Tincture of Opium 2 .. Essential Oil of Camphor 2 .. Camphorated Oil 2 .. Malt Vinegar 3 .. Seidlitz Powder 3 .. Canned Cray-fish 1 .. Canned Roast Beef 1 .. Canned Smoked Herring 1 .. 500 23 164 TABLE XVIIIA. Prosecutions under Food & Drugs Act during year 1911. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 15 % deficient in fat Butter & Son, 49 Woolwich Common, Woolwich Dismissed, Warranty proved 2 Milk 9.76 % added water T. Hellier, Manor Farm, Winsham, Chard Pined £4 and 42/- costs 3 Milk 8.82 % added water Ditto Costs 10/6 4 Milk 12.4 % added water Ditto Costs 10/6 5 Milk 6 % added water and 4.66 % deficient in fat C. March, " Ashurst," Shrewsbury Lane, Plumstead Dismissed, Warranty proved 6 Milk 8.5 % added water and 8.66 % deficient in fat D. Palmer, 46 Church Street, Woolwich Pined 20/- and 12/6 costs 7 Milk 25.4 % added water and 14.6 % deficient in fat E. A. Leaver, 25 Garland Street, Plumstead Fined 10/- and 12/6 costs 8 Milk 18.9 % added water and 21.6 % deficient in fat J. H. Whiffen, 108 Burrage Road, Plumstead Fined 30/- and 12/6 costs 9 Milk 12.5 % added water and 12 % deficient in fat Williamsons, Ltd., Trinity Warehouse, Savage Gardens, E.C. Fined 20/- and 23/- costs 10 Milk 6.6 % added water and 6.6 % deficient in fat W. J. Corp, 98c High Street, Etham Fined 20/- and 23/- costs 165 TABLE XVIIIa.—continued. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 11 Milk 8 % deficient in fat Handsley, Ltd., 22 Ingleton Street, Brixton, S.W. Dismissed, Warranty proved 12 Milk 8.24 % added water and 4.66 % deficient in fat Butter & Son, 49 Woolwich Common, Woolwich Withdrawn, Warranty proved 13 Milk 6.66 % deficient in fat . C. Marsh, " Ashurst," Shrewsbury Lane, Plumstead Withdrawn, Warranty proved 14 Milk 8.82 % added water E. Poynter, " Maplehurst," Staplehurst, Kent Pined 20/- and 42/- costs 15 Milk- 7.64 % added water Ditto Withdrawn 16 Milk 13.5 % addod water Handsley, Ltd., 22 Ingleton Street Brixton, S.W. Pined 20/- and 42/- costs 17 Milk 16.6 % deficient in fat .. Mackintosh Bros., 16 Warwick Terrace, Plumstead Pined 40/- and 23/- costs 18 Milk 14.5 % added water P. Greatorex, Lydwin Cottage, The Slade, Plumstead Fined 30/- and 23/- costs . 19 Milk .066 % of boric acid (Equivalent to 46.2 grains per gall.) P. Bunton, 10 Birkbeck Road, Sidcup, Kent Costs 23/- 20 Butter 2.13 % excess water W. H Dark, 1 The Slade, Plumstead Pined 40/- and costs 12/6 166 TABLE XIX. Food Seized, or Surrendered by Owners, as unfit for Consumption. Articles. Quantity. Date. Remarks. Reason. Ox Liver 1 Jan. 2 Surrendered Flukey Cow's Udder 1 2 „ Actinomycosis Pig's Lungs 1 12 „ Strongyli Ox Liver 1 ,, 16 „ Flukey Sheep's Liver 1 „ 25 „ Cirrhosis Ox Liver 1 „ 25 „ Flukey Ox Liver 1 „ 27 „ Flukey Pig's Liver and Lungs 1 Feb. 8 „ Strongyli Ox Liver 1 „ 8 „ Flukey Pig's Liver 1 „ 9 „ Strongyli Fish Roes 1 Box „9 „ Unsound Skate 1 Box Mar. 2 „ Do. Ox Liver 1 „ 6 „ Flukey Ox Lungs 1 „ 7 „ Tuberculous Ox Livers „ 7 „ Flukey Ox Liver 1. „ 10 „ Fatty Degeneration Ox Liver 1 „ 11 „ Flukey Ox Lungs 1 ,, 14 „ Tuberculous Ox Liver 1 „ 14 „ Flukey Ox Livers 2 „ 20 „ Do. Ox Liver 1 „ 20 „ Do. Ox Liver 1 „ 25 „ Do. Ox Livers 2 „ 27 „ Do. Ox Liver 1 ,, 28 „ Do. Ox Liver 1 ,, 31 „ Do. Ox Liver 1 April 3 „ Do. Ox Livers 2 ,, 3 „ Do. Skate 1 Kit „ 5 „ Unsound Ox Liver 1 „ 5 „ Flukey Ox Liver 1 6 „ Do. Sheep's Pluck 1 „ 10 „ Strongyli Ox Liver 1 „ 12 „ Abscesses Calf's Pluck 1 ,, 12 „ Tuberculous Ox Liver 1 12 „ Flukey Ox Livers 2 „ 24 „ Do. Ox Lungs 1 „ 24 „ Echinococcus Pig's Pluck 1 „ 27 „ Strongyli Pig's Pluck 1 ., 28 „ Tuberculous Ox Liver 1 May 3 „ Flukey Ox Lungs 1 „6 „ Tuberculous Ox Livers 2 „ 6 „ Flukey Sheep's Liver 1 „ 9 „ Tumor Skimmed Milk 273 tins „ 10 „ Unsound Parts of 2 hind-quarters of Ox including flanks. skirt, and offal 16 Tuberculous 167 TABLE XIX.—continued. Articles. Quantity. Date. Remarks. Reason. Ox Liver 1 May 20 Surrendered Plukey Ox Lungs 2 sets „ 20 ” Echinococcus Ox Liver 1 „ 24 ” Plukey Ox Lung 1 „ 24 ” Tuberculous Ox Liver 1 „ 29 ” Plukey Ox Lungs 1 „ 29 ” Abscesses Ox Lung 1 ” 30 ” Tuberculous Mackerel 2 boxes ” 31 ” Unsound Pig's Liver 1 June 1 ” Cirrhosis Pork—fore quarters and offal „ 12 ” Tuberculous Monk Fish 1 box „ 13 ” Unsound Ox Livers 2 ” 14 ” Plukey Sheep's Pluck 1 ” 14 ” Cysts Ox Livers 2 ,, 19 ” Flukey Ox Lungs 1 pair „ 19 ” Echinococci Sheep's Livers 2 „ 19 ” Cysts Ox Liver 1 ” 21 ” Flukey Ox Liver 1 „ 28 ” Do. Monk Pish 1 box July 4 ” Unsound Ox Liver 1 ” 5 ” Flukey Condensed Milk.. 28 tins ” 7 ” Unsound Ox Livers 2 ” 12 ” Flukey Pish (various) 1 box „ 15 ” Unsound Ox Lungs 1 ,, 19 ” Tuberculous Pig's Liver 1 „ 20 ” Cirrhosis Beef 5 flanks Aug. 2 ” Unsound Pig's Liver 1 „ 17 ” Cirrhosis Soles 1 box ,, 23 ” Unsound Ox Lungs 1 „ 28 ” Echinococcus Ox Liver 1 ,, 28 ” Flukey Ox Livers 2 ” 31 ” Do. Pig's Liver 1 Sept. 4 ” Cirrhosis Sheep's Lungs 1 ,, 13 ” Strongyli Ox Liver 1 „ 20 ” Flukey Walnuts ” 20 ” Unsound Ox Liver 1 „ 27 ” Flukey Sheep's Cauls 3 (parts of) ” 27 ” Cysts Bacon 70 lbs. (18 pieces) „ 30 Seized Unsound Bacon and parcel of cuttings 75 lbs. (13 pieces) „ 30 Seized Do. Ox Livers 4 Oct. 4 Surrendered Flukey Pig 1 carcase and offal ”4 ” Tuberculous Ox Liver 1 ” 4 ” Flukey Ox Livers 3 ”9 ” Do. Pig's Liver 1 „ 9 ” Cirrhosis 168 TABLE XIX.—continued. Articles. Quantity. Date. Remarks. Reason. Ox Liver 1 Oct. 18 Surrendered Flukey Pig's Liver 1 „ 23 Cirrhosis Pig's Lungs 1 23 Tuberculous Ostend Rabbits 1 hamper „ 25 Unsound Ox Liver 1 „ 25 Abscesses Ox Lungs 1 „ 25 Tuberculous Ox Liver 1 „ 25 Flukey Sheep 1 carcase and offal 26 Found dead Ox Liver 1 Nov. 1 Flukey Haddocks 4 trunks 4 Unsound Ox Lungs 1 „ 7 Tuberculous Ox Liver 1 „ 8 Flukey Ox Lung 1 „ 9 Echinococcus Pig's Liver 1 „ 16 Degenerated Pigs 2 „ 20 Tuberculous Tomatoes 21 bundles Dec. 19 Unsound Ox Liver 1 „ 30 Tuberculous Summary— Beef 2 lots 1 75 Parasitic worms 17 Tuberculous 5 Cirrhosis 3 Abscesses 1 Tamour 1 Actinomycosis 1 Fatty . degeneration 1 Found dead 1 Degenerated Ox Livers 62 Ox Lungs 16 Sheep' s Carcase 1 Sheep's Liver 3 Sheep's Pluck 2 Sheep's Lungs 1 Sheep's Cauls 1 Pork 4 lots Pigs' Livers.. 9 Pigs' Plucks 2 Cow's Udder 1 Calf's Pluck 1 Pish 9 lots Unsound Rabbits 1 hamper Condensed Milk 301 tins Walnuts 1 lot Tomatoes 21 bundles Bacon 145 lbs. 169 TABLE XX. List of Level Bakehouses. Name. Address. (Unoccupied) 48 Princes Road, Plumstead Chadwell Bros. 60 Plumstead Common Road C. Pullen 105 do. C. Uheesman 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. C. Letchford 109 Plumstead Road, do. J. Clark 152 do. do. (Unoccupied) 82 Bannoekburn Road, Plumstead (Unoccupied) 2 Stratton Terrace, Bostall Lane, Plumstead (Unoccupied) 123 Burrage Road, Plumstead V. 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. Fyson 94 High Street, Eltham H. Westbrook 114 do. do. P. Cook 142 do. do.' F J. Cook 5 The Parade, New Eltham P. A, Pinch 13 do. do, W. Millar 6 Well Hall Parade, Eltham R. Moakes 53 Cordite Street, Plumstead W. Steed 53 Lakedale Road, do. G. H. Porter 29 Charles Street, Woolwich E. Dalton and 4 Plumstead Road P. Mendham R. Tsinn 100 High Street, Woolwich 170 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. (unoccupied) 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. G. Scott 16, Armstrong Place, do. Virgoe & Sons 13, Eton Road, do. J. Colver 57, Plumstead Road, do. R. C. Davis 2, Crescent Road, do, A. E. Sims 24, St. James's Place, do. (unoccupied) 165, Sandy Hill Road, do. (unoccupied) 57 Burrage Road, do. (unoccupied) 16, Woolwich Common, Woolwich H. Adams 81, Beresford Street, do. F. Wilkening 72, Henry Street, do. W. C. Clothier 51, Albion Road, do. (unoccupied) 23, George Street, do. (unoccupied) 21, Albion Road, do. (unoccupied) 32, Church Street, do. Mrs. Attenborough 60, Sand Street, do. T. Tuoker 81 & 82, Brookhill Road, do. (unoccupied) 8, Hill Street, do. J.Fletcher 15, New Road do. 171 TABLE XXB. List of Factory Bakehouses. Name. Address. J. Fletcher 57, Burrage Road, Plumstead (Unoccupied) 92, Plumstead Road, Plumstead T.Newman 94, Wellington Street, Woolwich Royal Ar6enal Co-operative Society 127 to 153, Powis Street, Woolwich Alderton, Ltd. Malton Street, Plumstead Mackintosh Bros. Warwick Terrace, Plumstead Common J.Werner 1, Park Road, Plumstead A. Chapman 2, High Street, Plumstead Virgoe & Sons 13, Eton Road, Plumstead Alderton, Ltd. 81, Park Road, Plumstead 172 TABLE XXI. List of Slaughterhouses. No. Name of Owner. Situation l A. E. & E. 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 Hedley Vicars 41, Church Street, Woolwich 6 William Franois 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 12 Royal Arsenal Co-operative Sooiety Bostal Farm, Plumstead 173 TABLE XXII. List of Cowhouses. No. Name and Address of Owner. Situation. 1 John B. Stocker Cold Harbour Farm, Chislehurst 2 Alfred Low Park Farm, Eltham 3 W. F. Corp Lyme Farm, Eltham 4 Charles Unfreville Fisher and William F. Fisher, Crescent Farm, Sidcup Belmont Park Farm, Eltham 5 John Grace Pippinhall Farm, Eltham 6 William Ridewood Chapel Farm, Eltham 7 George Keen Clay Farm, New Eltham 8 Maurice Bay ley Middle Park Farm, Eltham 9 Harry Furber Southend Farm, Eltham 10 Charles William Killick 52, St. James' Place, Plumstead 11 Charles William Killick 13, Princes Road, Plumstead 12 Henry Woolsey 50, Francis Street, Plumstead 13 William Ridewood 3, Ripon Road, Plumstead 14 F. G. Cock 13, Raglan Road, Plumstead 15 Ethelbert Hiscock 1, Griffin Road, Plumstead 16 Jas. Buckingham Rear of 14, 15 & 16, Pellipar Road, Woolwich 174 TABLE XXIII. List of Milk Sellers. No. Name. Address. 1 Perrett, H. N. 2 The Parade, New Eltham 2 James, J. R. W. 26 Parry Place 3 Webb, P. W. 58 Brewery Road 4 Balster, H. 97 Plumstead Common Road 5 Carr, E. 46 Kingsman Street 6 Finnimore, J. A. 83 Park Road 7 Palmer, M. A 127 Plumstead Road 8 Digby. W. J. 82 Plumstead Road 9 Squirrell, J. 57 Church Street 10 Jeal, W. H. 139 Plumstead Road 11 Cook, G. 13 Raglan Road 12 Royal Arsenal Co-op. Society. Lakedale Road 13 Do. 15 Brewery Road 14 Do. 143 Powis Street 15 Do. Herbert Road 16 Do. 147 & 151 Powis Street 17 Fletcher, J. 92 Plumstead Road 18 Brooks, H. 2 Richmond Place 19 Woolsey, H. 50 Francis Street 20 Howe, J. R. 82 High Street, Eltham 21 Hawkins, Ellen M. 2 St. Nicholas Road 22 Furber, Harry Southend Farm, Eltham 23 Large, Daniel J. 6 Herbert Road 24 Hiscock, C. T. & E. 14 Blenheim Terrace 25 Dalton, R. G. 55 Eglinton Road 26 Green, R. 13 Saunders Road 27 Butter & Sons 49 Woolwich Common 28 Do. 10 Jackson Street 29 Ward, Samuel 1 Nightingale Vale 30 Mack, P. h. 111 High Street, Woolwich 31 Webb, Younger 10 Beresford Square 32 Dennis, Ellen 90 Brookhill Road 33 Prowett, J. 25 Plum Lane 34 Bayley, M. Middle Park Farm Eltham 35 Godden, A. A. 229. High Street, Plumstead 36 Wilton, M. M. 77 Powis Street 37 Corp, W. F. Lyme Farm, Eltham 38 Pearce, R. A. 175 Plumstead Common Road 39 Christmas, Hannah 18 Well Hall Parade, Eltham 40 Dodson, W. 138 Plumstead Common Road 41 Dowsett, W. 105 Crescent Road 42 Dolphin, T. G. 89 Maxey Road 43 Tyler, C. W. 142 High Street, Woolwich 44 Clements, E. J. 2 Cross Street 45 Bohmer, H. 307 High Street, Plumstead 175 TABLE XXIII.—continued. No. Name. Artiole. 46 Couzens, Jessie 10 Chapel Street 47 Stevens, P. 100 Roydene Road 48 Ridewood, W. 116 High Street, Eltham 49 Rose, J. .. 64 Hargor Road 50 Stevens, H. 27 Church Street 51 Needham, Elizabeth. 94 High Street, Woolwich 52 Webb, P. W. & Co. 16 Lakedale Road 53 Finch, G. A. Davis, D. H. 13 The Parade, New Eltham 54 170 Albert Road 55 West, W. H. J. Rear of 49 Lakedale Road 56 Phipps, H. 15a Sand Street 57 Smith, Elizabeth 12 The Broadway, Eltham 58 Bennett, Rose 22 Glyndon Road 59 Williams, Ellen 12 Thomas Street, Woolwich 60 Bartrum, Abner 167 Kingsman Street 61 Jones, David 65 Maxey Road 62 Jaques, Herbert 56 Anglesea Road 63 Killick, C. W. 52 St. James's Place 64 Hawkins, Emily 77 Powis Street 65 Parkes, J. Fountain Stores, The Slade 66 Lamb, Annie 29 Admaston Road 67 Jones, E. C. 6 Samuel Street 68 Harrington, James 26 Prospect Row 69 Greatrex, F. Lydwin Cottage, Plumstead Common 70 Cole, E. J. 18 Camrose Street 71 Finnimore, W.J. 21 Walpole Place 72 Lyons, J. & Co., Ltd. 99 Powis Street 73 McGee, Jane 42 Mulgrave Place 74 Attenborough, Caroline 18 Prospect Place 75 Marsh, C... Ashurst, Shrewsbury Lane 76 Palmer, Annie 127 Plumstead Road 77 Mumford, Kate P. 22 Cross Street 78 Holmes, Blanche 43 Bostall Hill 79 Wainwright 36a Mulgrave Place 80 Gill, Emily A. 398 High Street, Plumstead 81 Brinlrworth, W. J. 82 Purrett Road 82 Palmer, P. 82 Purrett Road 83 Elliott, W. G. 289 High Street, Plumstead 84 Espline, G. 48 High Street, Woolwich 85 R.A. Co-operative Society The Links, Plumstead Common Road 86 Jones, W. H. 39 Beresford Street 87 Holdway, Georgina H. 45 Bostall Hill 88 Buck, E. V. 52 Raglan Road 89 Challis, P. W. 4 High Street, Woolwich 90 Frost, W. D. 44 Powis Street 176 TABLE XXIII.—continued. No. Name. Address. 91 Gee, A. J 147 Plumstead Road 92 Joy, W. G. 36 Thomas Street 93 Crayfourd, J. E. 40 Orchard Road 94 Leaver, E. A. 25 Garland Street 95 Buckingham, J. 16 Pellipar Road 96 Corp, W. F. 3 Wellington Street 97 Flint, Emma 124 Maxey Road 98 Gittings, W. J. " Cold Blow," Plumstead Common 99 Poulter, G. E. 52 Whitworth Road 100 Brown, H.J. 92 Kingsman Street 101 Phillips, J. H. 77 Kingsman Street 102 Curtis, Stephen 181 Abbey Wood Road 103 Grace, James 18 The Broadway, Eltham 104 Cornwall, J. 14 Frances Street 105 Sheldon, W. 101 Sand Street 106 King, E. A. L. 4 Spray Street 107 Richardson, M. 182 Elizabeth Street 108 Adams, H. 31 Beresford Street 109 Hadley, H. W. 3 Wellington Street 110 Lovell, E.J. 3 Wellington Street 111 Higgins, E. M. 136 Macoma Road 112 Muir, W. C. 28 Conway Road 113 Handsley, Ltd. 68½ Bloomfield Road 114 Townsend, Rose E. 104 Brookhill Road 115 Fuller, R. E. & Co. Southwood Road, Eltham 177 TABLE XXIV. List of Applicants Registered as Purveyors of Milk During 1911. No. Name. Address. 116 Hurst, Minnie 113a, High Street, Woolwich 117 Voice, Charles 102, Ann Street, Plumstead 118 Trodd, W. J. 19, Green's End, Woolwich 119 Bunn, W. C. 13, Hinstock Road, Plumstead 120 Collins, George 2b, New Road, Woolwich 121 122 Williamsons, Ltd. (J. Bird, Secretary) Smith, Josiah 66, Powis Street, Woolwich 289, High Street, Plumstead 123 Willis, Jessie 2, Ritter Street, Woolwich 124 125 Fairbrother & Co. (T. Newman) Hill, G. M. 94, Wellington Street, Woolwich 30, High Street, Eltham 126 Hilder, Edward 102, Ann Street, Plumstead 127 Gouzens, Jesse 46, Church Street, Woolwich 128 Phillips, Sophia 141, Albert Road, North Woolwich 129 Warhaft, Violet 107, Pattison Road, Plumstead