CI AC 4372 WOO 17 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. 1913. Woolwich: Pryce & Son, Ltd., Printers (T.U. Federation), 31, 33 & 35, Powis Street. Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. 1913. Woolwich: I'ryok & Son, Ltd., Printers (T.U. Federation), 31, 33 & 35, Powis Street. 2 Public Health and Housing Committee: His Worship the Mayor. Councillor Frederick Penny (Chairman), 8, Blendon Terrace, Plumstead. Councillor William Marlow (Vice-Chairman), 123, Park Road. Plumstead. Aldermen:— Joseph Pehberton Jackson, 2a, Wellington Street, Woolwich. William Charles Martin, 24, Herbert Road, Plumstead. Alfred John Walklin, 17, Beechhill Road, Eltham. Councillors:— Richard Marsh William Allen, 343, Eglinton Road, Plumstead. William Williams Bullworthy, 255, Eglinton Road, Plumstead. Leon Charles Chasteauneuf, 224, Burrage Road, Plumstead. William Haywood Dawson, 15, Wrottesley Road, Plumstead. Henry Alfred Hart, 4, Chester Place, Plumstead. Thomas Henry Hutchings, "Hammerwood," Shooters Hill. Edward Mayes, 20, Crookston Road, Eltham. James Newman, 92, Rochdale Road, Plumstead. Susanna Turnbull (Miss), 14, Plumstead Road, Plumstead. Gertrude Elizabeth Walters (Miss), 73, Federation Road, Abbey Wood. 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. Women Sanitary Inspectors; Alice M. Middlebrooke, (Cert. San. Inst, and San. Insprs. Exmn. Board). Marion FitzGerald (Cert. San. Insprs. Exmn. Bd., and Sch. Hygiene (Univ. Coll.). Chief Clerk: Amyas Britter (Cert. R. San. Inst.) Assistant Clerks: Harry S. Smith. H. M. Collyer. Boy Clerk: H. T. Prescott. 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, and Fellow of the Royal Sanitary Institute. a 2 4 Summary of Statistics, 1913. Area of Borough 8,276.6 Acrcs Population—Census, 1911 121,376 do. estimated to middle of 1913 125,686 Inhabited Houses—Census, 1911 21,463 Persons to an acre 14.7 Persons to a House—Census, 1911 5.65 Marriages 1,051 Births 2,876 Birth Rate 22.5 Deaths 1,580 Death Rate 12.3 Infantile Mortality 80 per 1,000 births 5 TABLE OF CONTENTS. page Names of Members of Public Health Committee 2 Names of Members of Sanitary Staff 3 Summary of Statistics 4 Preface 10 Part I.—Statistics. Population 12 Census Tables, Quinquennial Age Groups 13 Houses 19 Births 20 Marriages 23 Deaths—Woolwich Death Rate compared with other Boroughs 23 Lives and Illness Saved 27 Infant Mortality—Preventive Measures 28 Still-births 29 Mortality under five years 30 Zymotic Death Rate 30 Inquests and Uncertified Deaths 31 Deaths in Public Institutions 32 Notification of Diseases 32 Small-pox 34 Chicken-pox 35 Measles 35 Whooping-Cough 38 Scarlet Fever—Deaths—Hospital Isolation—Return Cases— Isolation at Home—Sources of Infection—Schools Incidence 40 Diphtheria—School Outbreaks and Precautions taken 43 Mistaken Diagnosis 46 Source of Infection 46 Bacteriological Examination 46 Enteric Fever—Source of Infection 47 Bacteriological Diagnosis 48 Diarrhoea or Zymotic Enteritis—Notification—Statistics- Tables 49 Erysipelas 56 Cerebro-Spinal Meningitis 56 Anterior Polio-Myelitis 56 6 page Puerperal Fever 57 Influenza, Bronchitis and Pneumonia 57 Tuberculosis—Deaths 57 Notification Regulations 60 Notification Statistics 61 Duration of Illness 62 Age and Sex Distribution—Table 62 Source of Infection—Occupation 62 Yisiting 64 Bacteriological Diagnosis 65 Hospital and Sanatorium Treatment 66 Charge for Beds 66 Nature of Cases 69 Shelters for Consumptives 69 Tuberculosis Dispensary 71 History of Woolwich Tuberculosis Administration 72 Cancer—Classification 73 Causes of 76 Alcoholism 81 Syphilis 82 Ophthalmia Neonatorum 83 Meteorology 83 Part II.—Administration. Water Supply- -Plumstead Well—Houses with no Water Supply inside the house 85 Tenement Houses 86 Pood and Drugs Act—Percentage Milk Adulteration 86 Public Health (Milk and Cream) Regulations, 1912 88 Informal Sampling 90 Food Reform 90 Food Inspection 92 Dairies, Cowsheds, and Milk Shops 95 Tuberculosis in Cows—Order of the Board of Agriculture 96 Slaughterhouses 99 Nuisances—Complaints, Drains, Water-closets, Supervision of Drainage 99 Public-house Urinals 100 House Inspection 101 7 page Nuisances—Medical Officer's Inspections 101 Overcrowding 102 Smoke Nuisance 102 Defective Light 102 Verminous Rooms 103 Dust Removal—Collection, Cost of 103 Trade Refuse—Offensive and Inoffensive 103 Housing of the Working Classes— Houses represented as Unfit for Habitation 104 North Woolwich—Vital Statistics 107 High Street Flats Area 107 North Woolwich—Dock Extension—Demolition and Displacement 112 Council's Houses 113 Houses Registered under the By-laws —Existing By-laws and proposed new By-laws 113 Inspections made 114 Inhabited House Duty 115 Common Lodging-houses 115 Underground Rooms 116 Factories and Workshops—Inspections—Outworkers 116 Bakehouses 116 Ice cream Shops 117 Disinfection, Disinfectants 117 Health Shelter 118 Mortuaries 118 Cemeteries 119 Cleansing of Verminous Persons—Cleansing School Children 119 Public Baths—Lavatories and Cleanliness 120 Tents, Vans and Sheds 123 Notices and Prosecutions under Public Health (London) Act 123 Bacteriological Examinations 123 Infant Consultation 123 Women Sanitary Inspectors' Work— Miss Middlebrooke's Report 124 Miss FitzGerald's Report 128 Prevention of Caries and Preservation of Teeth 132 Public Ambulance 137 National Insurance Act 138 Public Health Staff 139 8 LIST OF TABLES. page Table I. Population. Births and Deaths for the whole Borough, from 1902 to 1913, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 141 Number of Inhabited Houses, the average number per house, and the acreage 142 „ IA. Institutions inside and outside the district receiving sick and infirm persons from the district 143 „ II. Cases of Infections Disease notified at all ages, at various age groups, and distributed according to Registration Districts during 1913 144 „ III. Deaths at all ages, at various age groups, from various causes, arranged by Registration Districts in 1913. Total Deaths in Public Institutions in District in 1913 145 „ IV. Infantile mortality during the year 1913 147 „ V. Case and Death Rate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1913 149 „ VI. Vital Statistics for the various London Boroughs for 1913 151 „ VII. Birth and Death Rates do. do. 153 „ VIII. Meteorology and Registered Deaths from all causes and from certain prevalent diseases in each week of the year 1913 155 „ IX. Weekly Averages for Meteorology and Registered Deaths from all causes and from certain prevalent diseases 157 „ X. Summary of Statistics for the first Quarter of 1913 corrected for Public Institutions 158 „ XI. Summary of Statistics for the second Quarter of 1913, corrected for Public Institutions 159 „ XII. Summary of Statistics for the third Quarter of 1913, corrected for Public Institutions 161 9 page Table XIII. Summary of Statistics for the fourth Quarter of 1913, corrected for Public Institutions 162 „ XIV. Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 165 „ XVA. Summary of the General "Work of the Public Health Department for 1913, the number of Nuisances abated, and Notices served in each Ward 167 „ XYb. Summary of Work of Chief Inspector, and Miscellaneous 169 „ XVc. Inspection of Factories, Workshops, and Workplaces 170 „ XVd. Proceedings during 1913 re Milk Shops, Cowsheds, Slaughterhouses, etc. 173 „ XVI. List of Streets Inspected—House to House—and number of houses where defects were found 174 „ XVII. Prosecutions in 1913 under the Public Health (London) Act and By-Laws and Housing of the Working Classes Act 180 „ XVIII. Summary of Articles Analysed under the Sale of Pood and Drugs Act 181 „ XVIIIa. Proceedings in 1913 under the Sale of Food and Drugs Act 182 „ XIX. Food seized or surrendered by owners as unfit for consumption 184 „ XX. List of Level Bakehouses in the Borough, 1913 187 „ XXa. List of Certified Underground Bakehouses in the Borough, 1913 188 „ XXb. List of Factory Bakehouses in the Borough, 1913 189 „ XXI. List of Slaughterhouses in the Borough, 1913 190 „ XXII. List of Cow-houses in the Borough, 1913 191 „ XXIII. List of Milk-sellers 192 „ XXIV. List of Persons Registered as Purveyors of Milk during 1913 195 CHARTS:- Showing Death Rate, Birth Rate, and Infantile Death Rate, 18911913, facing Page 27. Phthisis—Death Rate and Temperature, 1891-1913—England, London, Woolwich, Greenwich, and Lewisham, facing Page 60. 10 PREFACE. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor and Gentlemen, The Annual Report herewith, presented is the Thirteenth it has been my duty to make on the Health of the Borough and the Twenty-second on the Health of Plumstead. It contains full particulars of the population, numbers bom and dying, and numbers affected with certain diseases supposed to be more easily preventable, together with some account of the efforts made to diminish the number of the dying. Tuberculosis and Cancer—two specially fatal affections—have received particular attention, and I would ask your consideration of the special enquiry into the causes of Cancer, which points to the injurious effects of excessive smoking. 1912 had the lowest recorded infantile mortality, but last year had the lowest childhood mortality, i.e., death-rate of children between the ages of one and five. The continued increase of vitality of those commencing life is a matter for congratulation. 11 The Report must be read in order to realize the large amount of work done by the Health Department, but I may point to the fact that 23,442 inspections and re-inspections were made, 4,010 notices of nuisances found were served, and 4,062 letters were written during the year. Very good work was done under the Housing, Town Planning, &c., Act. Although it is difficult to make the Annual Report of a healthy town as interesting as a romance, I venture to think that this one, dealing with all the conditions which affect the health of yourselves, your friends, and the citizens, of whose welfare you are the trustees, will repay your careful perusal. Happy is the town which has no tragical epidemic to record. I congratulate you that such is the case with Woolwich, and thank you for the kind support you have given to the work of the Public Health staff and myself. I am, Mr. Mayor and Gentlemen, Your obedient Servant, SIDNEY DAVIES. 12 THIRTEENTH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1913. PART I. STATISTICS. 1. The population of the Borough of Woolwich, as estimated at the Census of 1911, was 121,376. The estimated population to the middle of 1913 is 125,686. The population of the four registration districts at the last three Censuses was as follows:— Census, Census, Census, 1891. 1901. 1911. Woolwich Parish 40,848 41,625 36,710 Plumstead Parish (West) 52,436 38,569 40,328 Do. (East) 29,758 30,888 Eltham Parish 5,710 7,226 13,450 98,994 117,178 121,376 13 The population to the middle of 1913 is estimated as follows:— Parish. Census 1911. Additional houses occupied between April, 1911, and June 30th, 1913. New houses, April 1st, 1911, to June 30th, 1913. Estimated number of persons to a house. Estimated increase of population. Estimated population to middle of 1913. Woolwich 36,710 214 14 5 1140 37,850 Plumstead (West) 40,328 221 9 5 1150 41,478 Do. (East) 30,888 129 77 5 1030 31,918 Eltham 13,450 44 154 5 990 14,440 Total 121,376 608 254 5 4310 125,686 The statistical year consists of 53 weeks ending January 3rd, 1914. West PI urns tead includes the Burr age, Herbert, Glyndon and St. Margaret's Wards, and East Plumstead the Central and St. Nicholas Wards. The Registrar-General estimates the population as 122,382 on the assumption of a uniform increase proportional to that between the two last Censuses. There can be no doubt that the above estimate which takes into account the number of ooeupied houses is neajer the truth; it is probably too small, as there is evidence that the number of persons to a house has increased sinoe the Census. The following figures show how the number of persons to 14 a house in Plumstead has varied during the past four Censuses:— Census 1891—6-08 persons to a house. 1896—6.14 ditto 1901—6.05 ditto 1911—5.34 ditto 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: — Wards. Census 1901. Census 1911. 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 6.93 6666 1003 6.64 River—North 2991 441 6.78 4409 585 7.54 Do. South 11405 1671 6.83 9353 1656 5.65 St. George's 10684 878 12.13 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 510 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 Borough 117178 18086 6.47 121376 21463 5.65 The following tables from Vol. 7 of the Census, 1911, give particulars of the age, distribution and conditions as to marriage of the popidation (Tables 8, p. 96; 9, p. 234; 18, p. 407; 19, p. 418). 15 Table 8. Ages of Persons, Males and Females, at each year of age under 21 and in Quinquennial Age Groups, in the. Borough of Woolwich:— Ages. Males. Females Ages. Males. Females All ages 61.271 60,105 Under 5 y6ars 6,465 6,396 Under 1 year 1,264 1,240 5 and under 10 6,561 6,624 1 1,209 1,241 10 ,, 15 6,106 5,917 2 1,298 1,341 15 ,, 20 6,485 5,264 3 1,319 1,272 20 ,, 25 5,139 5,002 4 1,375 1,302 25 ,, 30 4,886 4,859 5 1,329 1,306 30 ,, 35 4,817 4,877 6 1,337 1,302 35 ,, 40 4,740 4,526 7 1,367 1,335 40 ,, 45 4,091 4,021 8 1,254 1,315 45 ,, 50 3,334 3,309 9 1,274 1,366 50 ,, 55 2,731 2,676 10 1,258 1,233 55 ,, 60 2,103 1,987 11 1,248 1.230 60 ,, 65 1.502 1,614 12 1,190 1,184 65 ,, 70 1,002 1,234 13 1,211 1,165 70 ,, 75 698 874 14 1,199 1,105 75 ,, 80 383 537 15 1,138 1,148 80 ,, 85 162 276 16 1,100 1,028 85 ,, 90 51 89 17 1,262 1,006 90 ,, 95 14 20 18 1,540 1,000 95 ,, 100 1 3 19 1,445 1,082 100 years and upwards - - 20 1,187 1,013 Table 9. Condition as to Marriage and Ages of Males and Females' at each year of age 15-20, and in Quinquennial Age Groups over 15 in the Borough of Woolwich:— Ages. Unmarried. Married. Widowed. All ages Persons 68,890 46,361 6,125 Males 36,339 23,048 1,884 Females. 32,551 23,313 4,241 Under 15 years Males 19,132 - - Females 18,937 — — 16 Agea. Unmarried. Married. Widowed. 15 Males 1,138 - - Females 1,148 — — 16 Males 1,100 — — Females 1,028 — - 17 Males 1,261 1 Females 1,005 1 — 18 Males 1,539 1 — Females 987 13 - 19 Males 1,443 2 — Females 1,037 45 — 20 Males 1,172 15 - Females 931 82 - 15 and under 20 Males 6,481 4 - Females 5,205 59 - 20 „ 25 Males 4,624 512 3 Females 3.688 1,310 4 25 „ 30 Males 2.526 2,340 20 Females 1,744 3,075 40 30 „ 35 Males 1,312 3,468 37 Females 906 3,882 89 35 ,, 40 Males 801 3,856 80 Females 542 3,8i5 169 40 „ 45 Males 489 3,480 122 Females 424 3.356 241 45 ,, 50 Males 328 2,848 158 Females 315 2,652 342 50 „ 55 Males 240 2.276 215 Females 243 2,024 409 55 „ 60 Males 161 1,715 227 Females 184 1,334 469 60 „ 65 Males 108 1,137 257 Females 156 886 572 65 „ 70 Males 62 730 210 Females 95 517 622 70 „ 75 Males 44 410 244 Females 59 251 564 75 ,, 90 Males 16 194 173 Females 29 114 394 80 „ 85 Males 7 64 91 Females 16 33 227 85 „ 90 Males 5 11 35 Females 6 5 78 90 ,, 95 Males - 3 11 Females 2 — 18 95 „ 100 Males — — 1 Females — — 3 100 years and upwards Males — — — Females — — - 17 Table 18. Proportion of Males and Females at each age to 100,000 population as compared with London (Administrative County: — Males. Females. Ages. Metropolitan Borough of Woolwich. London. Ages. Metropolitan Borough of Woolwich. London. All ages 50,480 47,025 All ages 49,520 52,975 Under 5 years 5,326 5,187 Under 5 years 5,270 5,150 5 and under 10 5,405 4,774 5 and under 10 5,458 4,815 10 ,, 15 5,031 4,401 10 ,, 15 4,875 4,489 15 ,, 20 5,342 4,274 15 ,, 20 4,337 4,697 20 ,, 25 4,234 4,225 20 ,, 25 4,121 5,261 25 „ 30 4,026 4,194 25 „ 30 4,003 5,111 30 ,, 35 3,969 3,848 30 ,, 35 4,018 4,452 35 ,. 40 3,905 3,493 35 ,, 40 3,729 3,964 40 ,, 45 3,371 3,008 40 ,, 45 3,313 3,403 45 ,, 50 2,747 2,589 45 ,, 50 2,726 2,919 50 ,, 55 2,250 2,144 50 ,, 55 2,205 2,408 55 ,, 60 1,733 1,636 55 ,, 60 1,637 1,882 60 ,, 65 1,237 1,275 60 ,, 65 1,330 1,514 65 ,, 70 826 934 65 ,, 70 1,017 1,192 70 ,, 75 575 575 70 „ 75 720 856 75 „ 80 316 293 75 ,, 80 442 497 80 ,, 85. 133 125 80 ,, 85 227 243 85 ,, 90 42 40 85 ,, 90 73 94 90 and upwards 12 10 90 and upwards 19 28 B 18 Table 19. Proportion of Male and Female Population in Woolwich and in the Administrative County at each Quinquennial Age Groups compared with the corresponding proportions in England and Wales taken as 100:— Males. Females. Ages. Metropolitan Borough of Woolwich. London. Ages. Metropolitan Borough of Woolwich. London. All ages 104 97 All ages 96 103 Under 5 years 99 97 Under 5 years 99 97 5 and under 10 106 93 5 and under 10 106 94 10 ,, 15 104 91 10 ,, 15 100 92 15 ,, 20 116 93 15 ,, 20 93 101 20 „ 25 102 101 20 ,, 25 89 113 25 „ 30 100 104 25 ,, 30 89 114 30 ,, 35 104 101 30 ,, 35 97 107 35 „ 40 112 100 35 ,, 40 100 106 40 ,, 45 113 101 40 ,, 45 103 106 45 ,, 50 107 101 45 ,, 50 98 105 50 „ 55 106 101 50 „ 55 95 104 55 „ 60 103 97 55 ,, 60 88 101 60 „ 65 94 96 60 ,, 65 88 101 65 ,, 70 82 92 65 „ 70 83 98 70 ,, 75 88 88 70 „ 75 82 97 75 „ 80 90 83 75 ,, . 80 87 98 80 ,, 85 85 80 80 ,, 85 93 100 85 ,, 90 82 78 85 ,, 90 82 106 90 and upwards 100 83 90 and upwards 76 112 19 The following table from Vol. VI. of the Census shews the number of buildings of various kinds and the population in each kind :— WOOLWICH-CLASSIFICATION OF BUILDINGS. 1901. 1911. Total. Total Cols. 4—11. Buildings used as Dwellings. Separate Flats (included in Col. 5) Buildings not used as Dwellings. Ordinary Dwelling Houses. Blocks of Flats. Shops. Hotels, Inns, and Public Houses. Offices, Warehouses, Workshops, Factories. Institutions. Others. Vessels, Sheds, Vagrants, &c. Kind of Building. No. Columns 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Metropolitan Borough of Woolwich. Places of Worship 62 Government and Municipal Buildings 44 Shops 272 Number Inhabited 18,086 21,176 19,131 207 1,449 169 52 98 70 — 495 Offices 45 Separate Occupiers 24.585 26,504 23,906 498 1,560 171 54 121 93 101 498 Warehouses, Workshops, Factories 141 Population 117,178 121,376 102,052 2,057 6,761 1,040 224 8,303 414 525 2,057 Theatres and other places of Amusement 5 Uninhabited 410 1,211 1,009 12 175 2 5 4 4 — 34 Being Built 517 38 35 — 1 — — — 2 — — 20 3. The following table shows the number of new houses certified for water each year since the Census of 1911:— New houses, April 1st to June 30th, 1911 34 do. July 1st, 1911, to June 30th, 1912 93 do. July 1st, 1912, to June 30th, 1913 141 New houses, 1912-13:— Woolwich 14 West Plumstead 9 East Plumstead 63 Eltham 55 4. At the 1901 Census there were 234 unoccupied houses in the Borough, viz., 46 in Woolwich, 86 in Plumstead, and 102 in Eltham. At the 1911 Census there were 1,296 unoccupied houses in the Borough, viz., 450 in Woolwich, 387 in West Plumstead, 250 in East Plumstead, and 209 in Eltham. In May, 1913, the Bate Collectors found 468 houses empty, viz., 152 in Woolwich, 119 in West Plumstead, 111 in East Plumstead, and 86 in Eltham. The empty houses have still further filled up since that date, and at the present time (January) persons seeking a house have very considerable difficulty in finding one. BIRTHS. 5. The number of births was 2,876, viz., 1,029 in Woolwich parish, 831 in West Plumstead, 773 in Bast Plumstead, and 243 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 21 the Borough, and births in outlying institutions added on). The birth rate, 22.5, compared with 22.3 in the previous year, and with 25.8, the average for the ten years 190312. The rate for the County of London was 24.8. It is satisfactory to note an apparent arrest in the fall of the birth rate, but it may possibly be due to an underestimate of the population. Notification of Births. 2,637 live births were notified under the Notification of Births Act. This is at the rate of 92 per cent. of the registered births, compared with 83, 88, 93, 91, and 94 per cent. in the five preceding years. 1,588 births were notified by midwives, 298 by the Home for Mothers and Babies and Military Families Hospital, 500 by medical practitioners, and the remainder by other persons. 79 still-births were notified. The Notification of Births Act was adopted on March 1st, 1908. There were 239 births last year which were pot notified. Two midwives were warned for neglect to notify. 976 live births, or 95 per cent., were notified in Woolwich parish, 1,442, or 90 per cent., in Plumstead parish, and 219, or 90 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 two weeks those mothers who are considered to most need instruction. With very few exceptions the advice is welcomed. All mothers are invited to bring their infants for weighing and advice at the Town Hall, where an Infant Consultation 22 is held every Wednesday afternoon by the Lady Health Visitor and Medical Officer of Health. (See also Health Visitor's Report.) This consultation is becoming increasingly popular. The numbers attending averaged 30 last year. The results are most satisfactory. 6. The following table gives the birth-rate of the Borough during the years 1901-5, 1906-10, 1911, 1912, and 1913, and, for the purpose of comparison, the corresponding rates of the neighbouring Boroughs, London, and England:— BIRTH-RATE. 1901-5. 1906.10. 1911. 1912. 1913. Greenwich Borough 27.6 26.5 24.9 25.0 26.0 Lewisham 25.7 23.3 21.2 20.4 20.5 West Ham 33.1 31.4 29.9 29.6 31.0 East Ham 33.8 25.8 25.8 24.9 Erith 34.1 25.7 23.6 26.4 London 28.2 26.51 25.5 24.7 24.5 England and Wales 28.2 26.0 24.4 23.8 23.9 Woolwich Borough 29.2 25.3 23.2 22.3 22.5 7. The following table gives the birth-rate for the Borough and each registration 'district for the four past Quinquennia, and last three 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. West Plumstead and Eltham had the lowest birth-rate of the four registration districts, the rates being the lowest recorded for these parishes. 23  1891-1695. 1896-1900. 1901-1905. 1906-1910. 1911. 1912. 1913. Woolwich Borough 32.5 30.2 29.2 25.3 23.2 22.3 22.5 Woolwich Parish 31.1 30.1 29.0 27.9 27.1 24.8 26.6 Plumstead— West 33.3 31.0 30.1 24.7 20.6 21.9 19.7 East 23.4 21.3 23.7 Eltham Parish 22.8 20.6 24.0 21.6 18.5 19.0 16.5 8. Illegitimate Births. 65 of the births registered were illegitimate, giving a rate of 23 per 1,000 births, compared with 20, 24, 19, 13, and 17, in the five preceding years. The illegitimate birth-rate in London was 38 in 1912. MARRIAGES. 9. There were 1,051 marriages. The marriage-rate was 16.4, compared with 15.0, 16.4, and 16.0 in the three preceding years. In 1912 the marriage-rate in London was 18.6. DEATHS. 10. Table I. gives the gross and net deaths and deathrates in 1913, and each of the past ten years, and shows how the net deaths are arrived at. The net death-rates (which are the only ones referred to unless otherwise specified) are obtained by distribution of deaths in public institutions, deaths upon which inquests were held, and certain other deaths, to their proper locality, according as they occur outside or inside the Borough. But 24 in order to institute a fair comparison between one district and another, it is necessary to further correct the death-rate for sex and age distribution, for it is obvious that a population, containing a large number of young persons between the ages of five and thirty, when the death-rate is very low, should have a lower death-rate, than one containing an excess of aged persons. The population of London is taken as the standard, and factors are calculated which when multiplied by the death-rate of any Metropolitan Borough, give the death-rate that Borough would have if the age distribution of its population were the same as in the Metropolis. The, factor for the correction of the Woolwich death-rate is 1-0249. 11. The net deaths were 1,580, and the net death-rate 12.3, compared with 12.8 and 11 5 in the two preceding years, and 12.7 the average of the ten preceding years. 12. By multiplying by 1.0249, the factor for age distribution, we get the corrected death-rate, viz., 12.6, 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, oompared with London and the adjoining Boroughs:— Net. Standard. England and Wales 13.7 13.4 95 Great Towns 14.3 14.7 London 14.2 14.2 Greenwich 14.2 14.0 Lewisham 10.6 10.4 West Ham 14.5 - East Ham 10.0 - Erith 9.9 - Woolwich 12.3 12.6 25 Five Metropolitan Boroughs had a lower death-rate than Woolwich, viz., Lewisham, Wandsworth, Ilampstead, Stoke Newington, and Fulham. 13. The following table gives the average death-rate in each registration district of the Borough during the past five quinquennial periods and during 1911, 1912 and 1913. In 1913 Woolwich Parish had the highest death'-rate land Eltham Parish the lowest of the four districts. The greatest decrease has occurred in Woolwich and Eltham Parishes. 1886-1890. 1891-1895. 1896-1900. 1901-1905. 1906-1910. 1911. 1912. 1913. Woolwich Borough - 17.2 16.9 13.9 12.5 12.8 11.5 12.3 Woolwich Parish* 20.4 19.3 20.1 16.5 14.8 15.6 13.2 14.0 Plumstead— West 16.4 16.0 15.1 12.9 12.0 13.4 11.5 12.6 East 11.4 11.0 11.5 Eltham Parish - 13.0 14.6 10.2 10.1 8.3 8.4 8.8 London 20.0 19.8 18.5 16.1 14.9 15.0 13.6 14.2 * Three years—1888, 1889 and 1890. 14. The following table gives the numbers dying at various ages in the past eleven yeans from all causes, and the deaths at all ages from certain diseases not hereafter referred to:— 26 DEATHS-1903 TO 1913. Year. Age Period. Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-4 5 45-55 55-65 65-75 75 and over 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 1912 201 119 30 24 40 26 82 123 135 234 187 219 1913 229 93 34 25 44 48 109 134 177 208 240 239 Deaths from 1903 1904 1905 1906 1907 1908 1909 1911 3 191 1 1912 1913 Apoplexy and all other diseases of the heart and blood vessels 212 215 227 216 217 243 268 248 265 270 312 Nephritis and Bright's disease Respiratory diseases— all forms 38 35 46 52 49 42 50 43 43 57 57 (except Phthisis) 269 285 264 277 209 234 250 236 206 216 254 Chart showing Death Rate and Birth Rate per 1000 population, and infantile Death Rate per 1000 births 1891/1913. Bi r th rateDeath rate Jnfant death rate 27 i Compared with the average of the last ten years there was a diminution of deaths under 15, but an increase at ages between 15 and 55, and over 65. Over 75, the number of deaths was the highest recorded. The number of deaths also from nephritis (kidney diseases), apoplexy, and diseases of the heart and blood vessels, was the highest recorded, and those from respiratory diseases (bronchitis and pneumonia) reached the highest number since 1906. There has been a remarkable saving of life at ages under 15, and more people survive to die in old age of diseases resulting from the wear and tear of life. Table III. shows the number of deaths in 1913 from 57 principal causes at various ages. Appendicitis caused 9 deaths in 1913, compared with 3^ * 8, and 18, in the three preceding years. Of the 9 deaths,: 6 were males and 3 females; 6 were between 10 and 25 years of age and, 3 over 25. There is a gretat increase in the number of deaths attributed to this disease, but it would be a mistake to think that actually more persons die of appendicitis than formerly. Illnesses formerly called peritonitis, enteritis, etc., are now called appendicitis, and as a fact there has been a marked reduction in the total deaths from inflammatory affections of the abdomen. 15. The chart on the opposite page shows graphically how the birth and death rates have varied in the past 23 years. It is seen that Avhile the birth-rate has come down to 67 per cent. of what it formerly was, the death-rate has been reduced lower still, viz., to 65 per cent, of its figure in 1891. 28 16. The infantile death-rate has been reduced even more, viz., to 56 per cent., or roughly one-half, of what it was in 1891. These results have, it will be admitted, exceeded the expectations of the most sanguine sanitary reformers, and whatever objections may be made by the cautious and the economical in future, they cannot, in the face of such figures as the above, say that the deaths of the young are not to a large extent preventable. Fewer deaths mean less sickness; efficient sanitary administration causes the people to have life more abundantly. INFANT MORTALITY. ,17. The deaths under one year were 229, compared with 201 in 1912. The infant mortality (deaths under one year per 1,000 births) was 80, compared with 73 in 1912, and with 98 in 1911. With the exception of 1912 this is the lowest rate recorded. The following table gives the infantile mortality in the Borough since 1901, compared with the neighbouring Boroughs, London, and England:— 1901-5. 1906-10. 1911. 1912. 1913. Lewisham 112 92 104 70 78 Greenwich 107 112 129 84 103 West Ham 158 126 141 102 107 East Ham 131 106 119 71 64 Erith 112 80 70 69 81 London 138 114 128 90 105 95 Great Towns — 127 140 101 116 England and Wales 135 115 130 93 109 Woolwich Borough 119 97 98 73 80 29 Two Metropolitan Boroughs only had a lower infantile mortality than Woolwich, viz., Hampstead and Lewisham. 18. The following table gives the infantile mortality during 1911, 1912, and 1913, and the five preceding quinquennia in the Borough and each registration district:— 18861890 18911895 18961900 19011905 1906 1910 1911 1912 1913 Woolwich Parish *151 157 170 134 109 110 94 85 Plumstead — West 121 120 132 113 91 {104 53 67 East | 82 81 84 Eltham - 163 160 97 89 64 52 62 Woolwich Borough - 140 146 119 97 98 73 80 * 1888, 1889 and 1890. The Eltham rate has not exceeded 70 since 1908. In 1911 Erith had the lowest infantile death-rate of any English town, viz., 70. 19. Table IVA gives full details as to the ages at death and causes of death of the 229 infants dying in 1913 under one year. It shows that 42 per cent, of those who died under one year were under one month old, compared with 45 per oent. in 1912, and 37 per cent, in the previous eight years. 41 deaths were from premature birth, compared with 72, 41, 51, 51, and 52, in the five preceding years. The number of deaths under one week in the past five years was 55, 72, 62, 61, and 58 respectively. 30 The number of deaths from suffocation or overlying was only one. In the previous four years the deaths from suffocation in bed averaged 4 a year, and in the four years 1904-7 they averaged 7. This speedy diminution has no doubt been aided by the Children's Act. The death-rate per 1,000 births from premature birth in Woolwich Borough was 14'2, compared with 14.0, 17.9, 18.1, and 189 in the four preceding years. In London it was 18.8 in 1912. There were 14 deaths of illegitimate infants. The deathrate of illegitimate infants under one year was 215 per 1,000 births, and that of legitimate children 77. 20. Compared with 1912, the past year had among infants more deaths from diarrhoea and enteritis, gastritis, syphilis, convulsions, and pneumonia, and fewer from measles, whooping-cough, premature birth, suffocation, tuberculosis, and bronchitis. 21. 79 still-births were notified, compared with 54, 68, and 64, in the three previous years. 22. Deaths between One and Five Years. 55 deaths occurred between one and two years, and 38 between two and five. The corresponding figures in 1912 were 68 and 51 respectively. The death-rate between one and five was 9.0 per 1,000 children of that age found at the Census. 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 31 age, was 94, and the death-rate per 1,000 population 0.74, compared with 1.27 and 0 77 in the two previous years. The Zymotic death-rate has fallen steadily since 1901, and is now less than half what it was then. 24. Inquests. There were 123 inquests, compared with 121, 128, 115, 105, 107, 123, and 105, in the seven preceding years. The following table gives particulars as to the cause of death:— 1. Natural causes 64 2. Alcoholism 1 3. Accidental causes: Burns and Scalds 1 Drowning 8 Falls 12 Fractures 6 Run over 3 Suffocation, overlying 1 Poison 1 Other accidental causes 5 - 37 4. Homicidal cases: Suicide 20 Murder and Manslaughter 1 21 Total 123 The "Accidental Causes" were 49, 23, 42, 44, and 35, in the five preceding years. The "Homicidal Causes" were 15, 14, 6, 11, and 11, in the same years. 32 25. Deaths in Public Institutions. Table I. shows the actual number of deaths occurring in public institutions in the Borough, viz., 298, compared with 289, 276, 272, 326, and 292, in the five preceding years. These deaths nearly all occurred in the Poor Law Infirmary; they were 18.9 per cent. of total deaths, compared with 19.4, 18.8, and 20.6, in 1910-11-12. Table IA. shows the institutions, inside and outside the Borough, receiving sick and infirm persons belonging to the Borough, and Table IV. 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. 25a. Notification and Admission to Hospital of Infectious 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. Exposure of persons and articles infected with these diseases is penal, and disinfection can be enforced. 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-myelitjLs, cerebro-spinal fever, ophthalmia neonatorum, glanders, anthrax, and hydrophobia. 33 In 1911 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), and under a similar order all forms of tuberculosis were made notifiable on February 1st, 1913. In the case of all these latter diseases the notification is for the information of the Health Department only; exposure is not penal nor disinfection compulsory. The object is to get such measures carried out voluntarily as the circumstances of the case demand. The following notifiable diseases are admitted to the Asylums Board Hospitals:—Small-pox, scarlet fever, diphtheria, enteric fever, continued, typhus, and relapsing fevers, puerperal fever (under special conditions). The following non-notifiable diseases are also admissable under special conditions:—Measles and whooping-cough. The special conditions are that pauper oases have the priority, and that the case is specially recommended by the Medical Offioer of Health. In June I presented the following report:— "Compulsory Notification of Zymotic Enteritis. Voluntary notification of zymotic enteritis in Woolwich has been in force since 1905, and the usual fees paid by the Borough Council. When this was first introduced (no other Borough had commenced or proposed to institute notification of this disease, and the Local Government Board would not probably have approved of making the disease compulsorily notifiable in Woolwich alone, the policy then being not to allow the notification of disease 34 to be specially enforced in only one of the London Boroughs. That policy, however, has now been changed. Several diseases are notifiable in only one of the London Boroughs, e.g., measles in Stepney, and whooping cough and zymotic enteritis in Greenwich. The disease may be made notifiable under Section 56, Public Health (London) Act, by resolution passed at a meeting of the Council of which due notice has been given. The Order for compulsory notification must first receive the approval of the Local Government Board. The effect of the Order will make failure to notify on the part of a medical man or other person responsible an offence but will not entail any obligation on the patient notified. Probably making notification compulsory will cause a larger number of cases to be notified, and it will also enable the Borough Council to Teoover half the notification fees from the Metropolitan Asylums Board. I recommend that the necessary action be taken for making zymotic enteritis notifiable under the Public Health (London) Act." This was done, and zymotic enteritis is now compulsorily notifiable. 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, 19 diseases. SMALL-POX. 26. Not a single case of small-pox was notified. 27. The number of cases of small-pox notified in London was 3. There were no deaths. 35 CHICKEN-POX. 28. 157 oases of varicella were notified by school teachers, compared with 243, 327, 232, and 385, in the four preceding years. 28 were under five years, 115 between five and ten, and 14 over ten years. MEASLES. 29. There were 9 deaths from measles, giving a rate of 0.07, compared with 0.16, 0.23, and 0.24, in the three preceding years. This is the lowest rate yet recorded in the Borough. The rate in London County was 0.34, compared with 0 40 in 1912. 30. Of the 9 who died from measles, 7 were under five years of age; 5 were males and 4 females. 31. 387 notifications were received from school teachers, compared with 519, 768, 396, 801, and 775, in the five preceding years. The mortality per cent. of notifications was 2.3, compared with 1.9, 7.2, 5.3, 3.5, and 3.9 in the five preceding years. 12 cases were removed to the Fever Hospital on the certificate of the Medical Officer of Health that hospital isolation was necessary. 32. The following table gives the number of deaths and death-rates from measles for the past three years, and four preceding quinquennia in each parish, and the death-rate in London:— 36 Year. Woolwich. Plumstead. Eltham. The Borough. London Aver. No. Rate. Aver. No. Rate. Aver. No. Rate. Aver. No. Rate. Rate. 1891-5 20 0.49 29 0.51 Not recorded 49 0.51 0.59 1896-1900 34 0.91 36 0.57 Not recorded 70 0.67 0.57 1901-5 9 0.22 15 0.22 1 0.13 26 0.21 0.44 1906-10 17 0.43 18 0.23 3 0.20 37 0.30 0.40 1911 7 0.19 17 0.24 4 0.30 23 0.23 0.57 1912 12 0.32 17 0.24 1 0.07 30 0.24 0.40 1913 3 0.8 3 0.04 3 0.21 9 0.07 0.34 The actual reduction in measles mortality is not quite so large as appears from the above table, owing to the fact that the falling birth-rate has caused a diminution in the number of children living: under five years. The following table giving the deaths and death-rate per 1,000 births shows the reduction more accurately:— No. Rate. 1891-95 (average) 49 14.7 1896-1900 „ 70 20.9 1901-05 26 7.2 1906-10 „ 37 11.8 1911 28 10.0 1912 30 10.9 1913 9 3.1 It appears from these tables that whereas from 1891-1900 Woolwich had a somewhat higher measles mortality than London, since that date the measles death-rate in Woolwich 37 has greatly diminished, and was in the last two years less than half that of London, and that of Woolwich between 1891 and 1900. 33. Owing to the prevalence of measles, all unprotected children below the age of five were excluded from 15 London County Council schools in the Borough at various dates, and for periods varying from two to eight weeks (usually four weeks). The Medical Officer of the London County Council 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 five, occasions most often 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. 38 These measures have now been in force in Woolwich for more than 10 years, and have no doubt had a large share in the reduction of the measles death-rate. WHOOPING-COUGH. 34. There were 10 deaths from whooping-cough, compared with 15, 25, 6, and 28, in the four preceding years. The death-rate was 0.08, compared with 0.20, 0.05, and 0.25, in the three preceding years, and 0.17 in the County of London. 9 of the deaths were under two years of age. The following table gives the deaths and death-rates per 1,000 population since the Borough was formed, compared with London. Woolwich. London. No. Rate. Rate. 1901-05 (averages) 34 0.28 0.35 1906-10 26 0.21 0.29 1911 6 0.05 0.23 1912 28 0.23 0.22 1913 10 0.08 0.17 Owing to the fact that whooping-cough almost entirely falls on children under five, and that the diminution of birth-, rate since 1900 has caused a smaller population under five years, the rates calculated per 1,000 population show a larger diminution of mortality than has actually occurred. While the number of births has diminished 20 per cent. between the Census of 1901 and that of 1911, the population under five has only diminished 7 per cent. The rate should be given per 1,000 population under five, but the figures for each year are not available. In the following table the rates have been calculated per 1,000 births; there is still shown 39 a very marked reduction in the mortality of the disease. The real reduction lies between that shown by the two tables:— No. Rate. 1901-05 (averages) 34 9.4 1906-10 26 8.3 1911 6 2.1 1912 28 10.2 1913 10 3.5 265 cases were notified by school teachers, compared with 3)61, 377, 41, and 439, in the four previous years. 65 were under five yearn of age, 197 between five and ten, and 3 over ten. An order was issued by the Local Government Board giving permission to the Asylums Board to admit to their hospitals children under 14 suffering from whooping-cough, on the recommendation of the Medical Officer of Health. One case was admitted during the year. Whooping-cough being much more' serious and fatal in children under five it is important to protect them from infection as long as possible. For this purpose when thia disease is prevalent in a district it is desirable to exclude from school all children under the age of compulsory attendance. Last year on my advice children under five were excluded from seven County Council schools, for the prevention of whooping-cough, for periods not exceeding one month. Instructions printed on cards are left at houses where cases are notified by school teachers. The instructions were printed in the Annual Report for 1910. 40 It is satisfactory to note a further great reduction in the mortality of this disease in the four years during -which' this practice has been in force. SCARLET FEVER. 35. There were 614 cases of scarlet fever notified (deducting 12 cases of mistaken diagnosis), equivalent to a rate of 4 80 per 1,000 population, compared with 3'80 in 1912. 36. The following table shows the case-rates of scarlet fever in the Borough and each registration district during the past thirteen years, compared with London. Average. 1901-5. 1906-10. 1911. 1912. 1913. Borough 3.15 5.90 4.09 3.80 48.0 Woolwich Parish 2.99 5.66 2.89 2.41 5.44 Plumstead, West „ East 3.24 6.33 3.77 4.96 4.68 7.51 4.88 5.11 Eltham Parish 3.21 4.94 2.09 2.64 4.36 London County 3.57 4.22 2.32 1.76 3.89 37. Table 3 gives the age distribution, the number in each parish, and the number removed to hospital. Woolwich parish was most affected. 38. Deaths. There were 8 deaths, giving a death-rate of 0.06 per 1,000 population, compared with 0 03 in 1912, 0.02 in 1911, 0 09 in the five years 1906-10, and 019 in the ten years 1891-1900. The death-rate in London was 0 04, compared with 0.04 in 1911 and 1912 and 0.10 in 190610. It appears, then, that although proportionately more 41 cases are notified in Woolwich, the death-rate from this disease is usually lower than in London. The case mortality (or deaths per cent. of notifications) was 1.3, compared with 2.6, 0.6, and 0.8, in the three preceding years. 39. Hospital Isolation. Of the 626 cases notified, 561 (or 90 per cent.) were removed to one of the Fever Hospitals, compared with 86, 94, 90, 80, and 88, per cent, in the five preceding years. 12 cases were reported, after observation at hospital, not to be scarlet fever. The percentage of oases removed to hospital was again very high. A large proportion 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. 40. Return Cases. There were 31 cases (or 5 per cent, of notifications) in which infection was attributed to patients recently returned from hospital, compared with 38, 58, 27, 29, and 37, in the five preceding years. The interval between the return of the infecting case and commencement of! illness varied from three to 27 days. Of the 21 infecting cases, 5 had some form of rhinitis on or after their return. 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. The parents of all children with any discharge are recommended to obtain medical attendance, and the district nurse is 42 often requested to visit and syringe the ear or nose. Parents are always advised as to treatment, and children suspected to be infectious are kept at home and from association with other children. The hospital superintendents forward the names of any children discharged while still suffering from rhinorrhœa. 41. Home Isolation. 12 certificates of efficient home isolation were given to enable men to continue their employment in the Arsenal, and so obviate unnecessary removal to hospital, oompared with 13, 18, and 25, in the three preceding years. In the Annual Report for 1911 a comparison was made between home and hospital isolation, showing that, whereas there were only 1.6 per cent, of failures in home isolation, there were 4.6 per cent. in hospital isolation. Failure means the occurrence of secondary cases attributed to the primary case. 42. Other sources of Infection. In addition to return eases, a probable source of infection was found in 134 cases. In 63 cases infection was attributed to other inmates of the house. Some of these were never notified and had no distinct symptoms of scarlet fever, but a history of sore throats made it probable that they had had a slight attack of this disease. 43. In 17 cases infection was attributed to friends and neighbours, in 45 cases to school attendance, in 6 to the Fever Hospital, and in 3 to other hospitals. 43 44. The Annual Report for 1905 contained a special report on a statistical investigation into school incidence of scarlet fever and diphtheria during the ten years 18961905. 45. In the 1910 Annual Report 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 the. fifth after exposure are those in which most secondary cases occur. DIPHTHERIA. 46. 244 cases of diphtheria were notified (excluding 77 cases of mistaken diagnosis), compared with 147, 204, and 381, in the three preceding years. The case-rate (number of cases per 1,000 population), corrected for cases of mistaken diagnosis was 1.91, compared with 1.15, 1.68, and 3.09, in the three preceding years, and 2.13, the average of the ten preceding years. 4 of the cases were bacteriological, i.e., had no symptoms. 47. There were 17 deaths, compared with 5, 11, and 20, in the three preceding years. The death-rate was 0.13, compared with 0.16 in 1912, 0.09 in 1911, and with 0.14 the average of the five preceding years. The London deathrate was 0.09, compared with 0.10 in 1912, 0.14 in 1911, and 0.14 in the five preceding years. 44 48. 171 of the total cases notified were in Woolwich parish, 98 in West Plumstead, 33 in East Plumstead, and 19 in Eltham. The following table shows the case-rate, in each registration district (not corrected for mistaken diagnosis) in the past thirteen years, compared with London and the Borough:— 1901-05. 1906-10. 1911. 1912. 1913. Borough 1.71 2.20 1.68 3.09 1.91 Woolwich Parish 1.63 2.34 2.40 4.38 4.43 Plumstead Parish 1.87 2.40 W. 1.19 3.79 2.32 E. 2.33 2.81 1.02 Eltham Parish 1.62 2.22 2.30 1.71 1.29 London 1.90 1.63 1.64 1.57 1.70 The table shows that since 1910, diphtheria has prevailed more in Woolwich parish than in the rest of the Borough, and this was particularly so last year. Wood Street school, the largest school in this parish, was again affected in a special degree, so as to cause concern to several persons in its vicinity. Such persons are inclined to suspect that some special insanitary conditions must be present in the school or in its vicinity to cause such prevalence of infectious disease. It is quite a mistake to seek for such an explanation. The true explanation is in the habits of the disease. Diphtheria (like scarlet fever) is well known to haunt a particular locality persistently for several years. As shown in toy Annual Report for 1905, page 34, during the years 1901-5 Wood Street school had the lowest incidence of scarlet fever, and 'the lowest incidence but one of diphtheria among the provided schools in the Borough. Both these diseases were then haunting the neighbourhood of Elizabeth Street and Ancona Road schools, and leaving Wood Street school alone. Now the condition is reversed. 45 49. 370 cases, or 93 per cent. of total notifications, were removed to hospital, compared with 89, 81, 92, and 81, per cent, in the four preceding years. A certificate of efficient home isolation was given in one case, compared with 7, 1, 1, 3, and 12, in the five preceding years. The case mortality was 7.0 per cent., compared with 5 5, 10.4, 3.4, 5.4, and 5.2, in the five preceding years. Many of the cases were very mild, and 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. In addition to the notified cases (many of which never complained of illness), 5 (66 in 1912) cases were found to be carriers of the infection in their throat or nose without having any symptoms. 15 carrier cases, with or without slight symptoms, were discovered by your Medical Officer of Health. The usual steps were taken—school absentees were visited and medical attention obtained; children in affected classes were medically and bacteriologically examined, as were also a large number of contacts and suspected cases, and all cases found to be infectious strictly isolated. 50. A table giving details as to cases notified, cases bacteriologically examined, and deaths, was published in the Annual Report for 1912. The large number of cases with Klebs Loffler bacillus but no symptoms during that year was noteworthy. Last year the number of purely bacteriological cases was much lower, and the fatality of notified cases higher. 46 51. Mistaken Diagnosis. 77 cases, or 19 per cent, of notifications were, after removal to hospital, stated to be not diphtheria. The percentage of the four preceding years was 10, 10, 15, and 11, respectively. 52. Source of Infection. In 79 cases a probable source of infection was noted, viz.: In 31, other inmates of the house were known or suspected to be the source; in 22, schools; 14, neighbours and friends; 4, return cases; 1, general hospital; and in 6 the infection was due to the Fever Hospital. In two of the returned cases there were so to nares or rhinorrhoea on discharge, and a bacteriological examination showed the presence of diphtheria bacilli. In the other two the bacteriological examination was negative. 53. Bacteriological Diagnosis. In January, 1913, I recommended that the Council's bacteriological work should be given to the Bacteriological Department of the Seamen's Hospital, Greenwich, and this was done. That Hospital being much nearer than the Lister Institute, the results of examinations can be obtained more quickly. The Seamen's Hospital is fully equipped for this work, and the new arrangement has worked satisfactorily. 921 (1,231 in 1912) swabs were sent to the Seamen's Hospital and Lister Institutes to be examined in the presence of diphtheria bacilli. In 85 (320 in 1912) the true Klebs Loffler bacillus was found; in 67 (128 in 1912) Hoffman's bacillus was found, and 769 were found free from either the Klebs Loffler bacillus or Hoffman's. Of the 921 swabs examined, 327 were taken from school children by myself. Of these, 16 contained the true Klebs 47 Loffler bacillus (so-called positive cases). Most of the children 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 Attendance Officer, or Sanitary Inspector. In 6 cases without symptoms the bacillus disappeared within two or three weeks. 9 positive cases had symptoms of running or sore 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 8 cases of enteric fever, not including 6 cases of mistaken diagnosis notified as enteric. The caserate was 0.06, compared with 0 06, 0 10, and 0.15, (in the three preceding years. For the ten years 1892-1901, the rate never fell below 0.41. The case-rate in London was 0.17. Out of a total of 14 cases notified, 10 went to hospital. The case-rate is the lowest recorded in the Borough. 55. There was 1 death from this disease, giving a deathrate of 0 01. The death-rate in London was 0.02. In the preceding five years the death-rate in Woolwich was 0.02, and in London 0.03. 48 56. The following are the cases notified in each parish during the past thirteen years:— Average. 1901-05. 1906-10. 1911. 1912. 1913. Woolwich 126 7.6 10 10 7 Plumstead 21.2 11.4 W.3 4 3 E.2 2 2 Eltham 8.6 2.8 1 4 2 57. In my last Annual Report it was stated:—"6 cases occurred in one family. The first was the mother, who was treated in a general hospital for pneumonia. On her return home her four children sickened one after another with enteric. The mother was consequently examined bacteriologically, and the typhoid bacilli found. She was accordingly notified and sent to the Fever Hospital, but was, in spite of protest, discharged while still excreting the disease germs. A week later the husband began with enteric. This woman was therefore responsible for infecting the whole family. She has been specially warned as to steps she should take to avoid infecting other persons, and will be kept under observation. She is what is called a 'carrier case,' though fortunately discovered to be such at an early stage." Two of last year's cases were infected by this same woman, one being another daughter, and one a man who was boarding with her. Another was infected on board the S.S. "Balaclava" from South America. In not one case was the infection attributed to shell fish. 58. Bacteriological Diagnosis. 16 samples of blood were sent to the Lister Institute and Seamen's Hospital to be examined for Widal's reaction. A positive result was obtained in 1. 49 DIARRHOEA OR ZYMOTIC ENTERITIS. 59. The deaths from diarrhoea and enteritis (all forms) under two years of age were 46, or 17.4 per 1,000 births, compared with 3.65 in 1912. The rate for London was 27.50. The total number of deaths from these diseases at all ages was 49. Owing to the change in nomenclature, the diarrhoea death-rate cannot be strictly compared with that of years previous to 1912, but the rate was probably below the average of previous years. Notification. Voluntary notification of zymotic enteritis during July, August, and September, commenced in Woolwich in 1905. The results of four years' notifications were fully reported (see Council's Minutes, February 11th, 1909), and they were so satisfactory that it was resolved to continue voluntary notification, and, from and including 1909, to extend the period to June and October, thus making the disease notifiable during five months instead of three. In 1913 an Order was made under Section 55, Public Health (London) Act, making the disease compulsorily notifiable, and the Order was confirmed by the Local Government Board. Compulsory notification commenced 25th August, 1913. 338 cases were notified in the past year, compared with 866 and 129 in the two preceding years. 10 cases were notified in June, 13 in July, 110 in August, 163 in September, 38 in October, 4 in November, and none in December. The fatality (deaths under two years per 100 notified cases under two) was 23.1. 60. The following tables give full particulars of the oases notified each year since notification commenqed:— d 50 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 1912 129 61 68 4 4 16 6 30 26 22 51 1913 338 181 157 16 30 41 28 115 84 54 85 Total 1905-13 2428 1252 1176 131 260 293 284 968 649 361 450 51 TABLE B. CLEANLINESS OF HOUSES. Year. Total Houses of which information was obtained. Clean. Dirty. Indifferent. 1905 205 366 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 1912 104 83 2 19 1913 297 198 12 87 Tot. 1905-13 2157 1506 200 451 TABLE C. DIET OF CASES UNDER 1 YEAR AT TIME OF NOTIFICATION. 1905 1906 1907 1908 1909 1910 Ttls. 19051910 1911 1912 1913 Breast only 15 12 4 9 4 5 49 24 3 9 Breast and other foods 10 28 9 10 15 6 78 43 7 15 Hand-fed only 92 150 37 59 42 28 408 179 17 80 No information 5 4 1 13 2 1 26 16 3 11 122 194 51 91 63 40 561 262 30 115 N.B.— Of 35 children under 1 year having fresh cow's milk, 33 had it boiled, or were said to do so. d 2 52 TABLE D. NUMBER OF CASES NOTIFIED EACH WEEK, with MEAN TEMPERATURE of 3 Feet Ground Thermometer during Week, September Quarter. Year Cases. 1st Week 2nd Week 3rd Week 4th Week 5th Week 6th Week 7th Week 8th Week 9th Week 10 th 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 1912 4 10 48 19 4 11 3 6 5 2 2 1 1913 2 1 2 7 16 15 32 43 48 52 25 40 Total 20 31 74 67 126 225 350 407 332 212 211 114 117 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 68.80 62.80 6308 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 6.2.79 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 1912 59.73 60.75 63 65 62.22 63.09 61.57 60.48 60.22 59.74 59.08 58.01 57.38 56.20 1913 59.82 59.40 59.61 59.45 59.73 60.24 60.10 60.58 60.62 60.63 59.96 59.03 58.46 Average 59.18 59.66 60.96 60.52 62.11 62.17 62.23 61.60 61.12 60.55 59.71 59.96 58.01 53 TABLE E. DEATHS FROM DIARRHOEA AND ZYMOTIC ENTERITIS classified by Ages during the five months ending 31st October, 1905-12. Year. Under 1 Year. Over 1 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 1912 — 2 1 — — — — 3 Total for 1905-12 50 85 80 51 45 9 20 340 Note.—In the above figures, "Enteritis" and "Gastro-Enteritis" are excluded up to and including 1910; after 1910 they are included. DEATHS FROM DIARRHG3A AND ZYMOTIC ENTERITIS under two years of age, for three months, July, August and September. Year. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. 1-2 Years. Total. 1913. 9 8 8 3 7 35 54 TABLE F. DIARRHOEA, INFANTILE MORTALITY, AND TEMPERATURE OF SUMMER QUARTER IN LONDON AND WOOLWICH. Average 1901-4 Average 1905-10 1911 1912 1913 Annual Death Rate from Diarrhoea and Enteritis in summer quarter per 1,000 living.* London 2.27 1.40 3.82 Annual Death Rate from Diarrhoea and Enteritis (under two years) per 1,000 births for whole year London 12.42 27.5 Woolwich 2.30 0.97 2.87† J Woolwich 3.65 17.44 Max. weekly average Temperature of 3ft. ground thermometer in 13 weeks of summer quarter 62.72 62.61 67.06 Max. weekly average Temperature of 3ft ground thermometer in 13 weeks of summer quarter - 63.65 60.63 Average Temperature of 3ft. ground thermometer in summer quarter 60.84 60.30 64.01 Average Temperature of 3ft. ground thermometer in summer quarter - 60.24 59.82 * In and after 1911 deaths under two years only are included. † If deaths over two years were included, this figure would be 3 64, and the figure for London would also be increased. 55 TABLE G. ZYMOTIC ENTERITIS AND METEOROLOGY. Summer Quarter. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 Number of cases notified — — — 212 366 93 173 123 72 848 115 286 Number of Deaths (Diarrhoea)* at all ages 27 29 136 56 81 11 28 8 4 109 2 49 Mean Temperature of Air 591 59.0 60.08 60.6 62.4 58.87 59.3 58.7 57.2 65.1 58.0 59.1 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 60.24 59.82 Mean Humidity 75 77 72 75 70 74.6 77 80 80 65 76 79 Number of days on which rain fell — 46 34 33 26 32 38 46 37 22 39 36 Rainfall in inches 5.91 12.32 4.88 5.65 3.78 3.77 8.15 7.43 6.08 2.94 5.64 5.43 Number of hours bright sunshine 485 541 671 529 697 516 532 530 432 824 399 376 * Enteritis included in and from 1911. 56 ERYSIPELAS. 61. There were 70 cases of erysipelas notified, compared with 89, 82, and 87, in the three preceding- years. There were no deaths. The case-rate was 0.55, and the death-rate nil, compared with 0.02, 0.07, and 0.02 in the three preoeding years. The London case-rate was 0.92. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 62. In consequence of the serious epidemic of this disease in certain towns of Ireland and Scotland, cerebrospinal meningitis was made in 1907 a notifiable disease, under the Public Health (London) Act, by the London County Council. 1 case was notified in the Borough in each of the two years 1907-8, but none in 1909. 1 case was notified in 1910, 1 in 1911, and 1 in 1912. No case was notified last year. ANTERIOR POLIO-MYELITIS. 63. This disease, commonly known as infantile paralysis, was made oompulsorily notifiable in 1911, by an Order of the London County Council under Section 55, Public Health (London) Act. One ease was notified last year which was treated at the London Hospital; very slight paralysis now remains. There were no deaths. 3 cases were notified in 1911 and 3 in 1912 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. 57 PUERPERAL FEVER. 64. There were 8 cases of puerperal fever notified, compared with 6, 9, 7, 16, and 2, in the five peceding years. There were 3 deaths. The case-rate per 1,000 births was 2.78, and the death-rate 1.05, compared with 0 73 and 0 36 in 1912. The London case-rate and death-rate per 1,000 births were 3 16 and 124 respectively. In the ten years 1891-1900, the case-rate per 1,000 population 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 1906-10 the case rate was 0.05, and the death rate 0.016. There has been a decided fall in the death-rate from this disease. Although the apparent fall in the case-rate appears to be but slight, it is probably just as great as that of the deathrate. Many cases are now notified which in former years would have been passed over. INFLUENZA, BRONCHITIS, PNEUMONIA. 65. Influenza caused 35 deaths, oompared with 29, 36, 39, 19, and 25, in the five preceding years. Bronchitis and pneumonia caused 253 deaths, compared with 228, 245, 232, 200, and 208, in the five preceding years. The deaths from these causes under five years were 70, compared with 86, 66, 55, and 70, in the four preceding years. There were more deaths of persons over five from bronchitis than for several years past. TUBERCULOSIS. 66. Deaths. There were 216 deaths from tuberculous 58 disease, giving a death-rate of 1.69, compared with 1.80, 1.68, 1.46, 1.65, and 1.34, in the five preceding years. 67. The following table gives the number of deaths from each of the various forms of tuberculosis in the past ten years, and also the deaths from simple meningitis:— Average. 1901-5. 1906-10. 1911. 1912. 1913. Tuberculous Meningitis 20.0 22.8 20 23 14 Simple Meningitis 22.0 15.0 16 13 10 Tuberculosis of Intestines and Peritoneum 130 10.8 5 5 10 Tuberculosis (other forms) 20.8 22.2 29 16 10 Phthisis 1920 151.4 146 124 182 68. The deaths from phthisis were 182, giving a death. rate of 1.42, compared with l.27, 1.22, 1 08, 1.20, and 1.01, in the five preceding years. The rate is higher than it has been since 1905, but is considerably below that of the quinquennia 1891.5, 1896-1900, and 1901-5, as is shown in the following table. The table shows that the increased rate of last year was chiefly in West Plumstead and Eltham, and most of the deaths occurred in the fourth quarter of the year. 59 ] 1891-5. 1896-1900. 1901-5. 1906-10. 1911. 1912. 1913. No. Rate. Aver. No. per year. Rate. Aver. No. per year. Rate. Aver. No: per year. Rate. No. Rate. No. Rate. No. Rate. Woolwich Parish — 2.80 92 2.23 89 2.15 56 1.46 66 1.80 48 1.30 61 1.58 Plumstead West — 1.78 92 1.42 97 1.34 87 1.20.J W41 1.02 31 0.76 66 1.56 East E33 1.07 37 1.18 40 1.23 Eltham Parish — .- 9 1.28 6 0.63 8 0.64 6 0.45 8 0.57 15 1.02 The Borough — — 193 1.74 192 1.56 151 1.22 146 1.20 124 1.01 182 1.42 London — 1.88 — 1.80 — 1.57 — 1.33 — 1.32 — 1.34 — 1.30 60 69 While there was an increase last year of deaths from phthisis, there was a great decrease of other forms of tuberculosis. The number of cases of both tuberculous and simple meningitis considerably diminished. There was a slight increase of abdominal tuberculosis, but the decrease of deaths from meningitis is very marked. The death-rate from tuberculous diseases in the past two years was less than in any two preceding consecutive years. 70. The chart on the opposite page shows the course of the phthisis death-rate in Woolwich in the past 23 years, compared with Greenwich, Lewisham, London, and England. 71. 115 of those who died from phthisis were males, and 67 females. The diminution of deaths has been greater among females than among males. 72. Notification Regulations. Voluntary notification of phithisis 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 of 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. Chart showing Phthisis Death Rate 1891/1913. 61 Under the same Section, the Board, by Regulations issued in 1912, 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 and 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. Under a further order all forms of tuberculosis were made notifiable in January, 1913. Notification Statistics. 675 cases were notified, viz.:— Tubercle of Lung, 532; tuberculosis meningitis, 3; tuberculosis of the intestines and peritoneum, 8; other forms, 132. It is seen that the deaths from tuberculosis of the meninges and the abdomen exceeded the notifications. "When deaths occurred in cases not already notified the medical man certifying was communicated with. The 532 cases of phthisis compare with 206, 196, 375, and 689, in the four preceding years. 17 of these were in the Woolwich and Eltham Poor Law Infirmaries; 9 others were notified by the District Medical Officers of the Poor Law Union, 21 by the Medical Officers of the Royal Arsenal, Army, &c., 396 from hospitals and dispensaries, including 313 from the Woolwich Tuberculosis Dispensary, 33 by school doctors, and the remainder by private medical practitioners. 62 £33 7s. 9d. was paid during the year for the notification of tuberculosis. Duration. Of the 675 eases notified during 1913, at least 96 have since died, and of 689 cases notified during 1912, at least 110 have since died (February, 1914). 73. The source of infection of the notified cases was probably as follows:— Family or Personal—Father, 49; mother, 61; brother, 39; sister, 27; husband, 14; wife, 3; other members of family, 23; friends, lodgers, etc., 4 220 Workshop and Office 22 Public House 11 Navy and Army 2 Milk 4 School 2 Undetermined 414 74. Age and Sex Distribution. The following table, required by the Local Government Board, gives the age and sex distribution of pulmonary and non-pulmonary cases, and shows also the sources of notification:— 63 Metropolitan Borough of Woolwich. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the year 1913. Age periods. Number of Notifications on Form A. from Private Medical Practitioners. Number of Notifications on Form B. from School Medical Officers. Number of Notifications Form 0. Primary Notifications. Total Notifications, i.e., including cases previously notified by other doctors. Primary Notifications. Total Notifications, i.e., including cases previously notified by other doctors. Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Under 5 5 to 10 10 to 15 Total. Pulmonary Males - 6 27 29 25 31 58 48 31 7 2 264 264 — 3 6 9 9 22 60 ,, Females — 10 40 25 28 35 46 40 19 5 1 249 249 4 6 10 10 10 44 Non-Pulmonary Males 4 11 27 15 6 — 4 4 1 — — 72 72 — 4 4 8 8 — 14 ,, Females — 5 17 16 9 4 1 2 3 — — 57 57 — 4 2 6 6 1 4 Total 4 32 111 85 68 70 109 94 54 12 3 642 642 — 15 18 33 33 33 122 64 75. Occupation. Of the 602 cases from which information was obtained, the occupations were as follows:— Outdoor— Official, Soldiers, etc. 20 Mechanical 7 Carmen and Costers 8 Labourers, Porters—Dock and all others 28 63 Indoor— Clerks 24 Mechanical 52 Printers 2 Bakehouses 2 Laundry 4 Domestic—Private 30 Public House 7 37 Labourers 30 School Children and Teachers 219 Housewives 105 All Others 64 539 602 75a. Visiting. Cases notified by the Tuberculosis Dispensary are visited by the Dispensary Medical Officers and Nurses, and full particulars provided to the Public Health Department, which follows up any sanitary defects reported. Other cases (except where the social conditions are exceptionally favourable) are visited by the Medical Officer of Health, or one of the Sanitary Inspectors, instructions as to precautions and open-air treatment given, and examination of contacts advised. Printed instructions are sent to every 65 notified case. Advice and assistance is (given as to sanatorium treatment. Revisits of such cases as most need it are made by the Health Visitor. The Health Visitor also visits, as far as time allows, cases returning from Sanatoriums, in order to see that the lessons learnt at the Sanatoriums are practised as much as possible at home, and that the patient is not discouraged by initial difficulties. But it is impossible with the present staff to follow up tuberculous cases as far as desirable. It is not enough, e.g., to simply advise that contacts in the family should go to the Dispensary to be examined. The house should be revisited to see that the advice has been taken. Similarly with regard to the advice given to occupy a separate bed and keep the window freely open; it is often necessary to make repeated visits before this is satisfactorily done. 76. Bacteriological Diagnosis. Sputum from 231 cases of suspected phthisis was examined at the Seamen's Hospital and Lister Institute, and tubercle bacilli were found in 57 cases. The number of examinations for the five preceding years was 175, 179, 210, 191, and 151, respectively. In addition the Medical Officers examined 439 specimens pf sputum at the Tuberculosis Dispensary, 94 being found postiive. 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 247 premises, compared with 166, 152, and 66 194, in the three preceding years. Disinfection was performed after the death of the patient, and also after removal to hospital, sanatorium, or other occasion of the house or bedroom being vacated. 79. Sanatorium Treatment. Altogether 144 notified persons were admitted to some sanatorium or hospital for the treatment of tuberculosis, most of them being sent by the London Insurance Committee. The following table shows the number sent to the chief institutions:— Cases admitted as In-Patients to Sanatoria, Hospitals, etc., 1913. Male. Female. Total. Downs Sanatorium 24 — 24 Northern Hospital 5 13 18 Peppard Sanatorium 7 21 28 Ipswich Sanatorium 3 — 3 Treloar's Home, Alton 4 4 8 Mount Vernon Hospital 5 1 6 Alexandra Hospital 3 — 3 Brompton Hospital 4 — 4 Carshalton Children's Hospital .. 2 1 3 Sea Bathing Hospital, Margate.. 2 1 3 All others ... ... .. 24 20 44 Total 83 61 144 79a. Peppard Sanatorium. Since the year 1904 the Council has had an arrangement with Dr. Carling, the Superintendent and late proprietor of the Maitland Cottage Sanatorium, Peppard, by which the Council maintains beds at the Sanatorium, paying a fixed inclusive charge of 30s. 67 a week for each bed when occupied by an adult, 25s. for children, and 20s. a week when unoccupied. For further particulars as to the constitution and regulations see page 842 of the Council's Minutes, 1909. 80. Numbers Treated. The Council now maintains 7 beds. At present 5 are occupied by women, 1 by a man, and 1 by a child. Since the provision of sanatorium treatment by the London Insurance Committee there has been less need to provide for insured men, who are now generally referred to the Insurance Committee. The 7 beds were kept occupied with very little intermission throughout the year. The male applicants numbered 26 (45 in 1912), and the female 52 (31 in 1912). 33 patients were admitted, and 35 discharged. Of the 35 patients discharged, 10 were males over 14, 22 women, and 3 children. 6 stayed for one month, 7 for two months, 17 for three, and 3 for four or five months; 1 died and 1 discharged herself. 31 returned home in improved general health and with a decided increase in weight, and 29 showed very great improvement and were able to resume their ordinary duties. 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 since patients were sent to Peppard. The difference between the sum of the numbers dead and the survivors, and the [number discharged, in any year, shows the cases lost sight of. Number of patients discharged in each year who were (a) alive but not well enough to work; (b) at work, seeking work, or performing their ordinary duties, in January of each of the undermentioned years:— e 2 Number of patients discharged in each year who were (a) alive but not well enough to work; (b) at work, seeking work or performing their ordinary duties, in January of each of the undermetioned years:- Year. Number Discharged. Dead, Jan., 1914. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. a b a b a b a b a b a b a b a b a b a b a b 1903 1 1 1 — 1 - - - - - - - - - - - - - - - - - - - 1904 11 10 — — 2 6 1 5 1 5 1 5 2 4 1 4 2 2 2 — 1 — 1 — 1905 17 12 — — — — 1 13 2 9 2 5 — 4 — 4 — 3 - 3 — 2 — 2 1906 29 14 - - - - - - 5 24 2 20 5 15 1 14 — 14 1 12 — 9 — 8 1907 38 20 - - - - - - - - 9 24 2 22 7 15 2 13 1 13 2 9 2 10 1908 31 16 - - - - - - - - - - 6 21 6 17 4 12 2 10 1 10 1 7 1909 39 15 - - - - - - - - - - - - 3 25 2 25 6 18 3 15 1 13 1910 32 14 - - - - - - - - - - - - - - 4 25 7 18 4 16 3 9 1911 39 17 - - - - - - - - - - - - - - - - 14 17 4 14 4 12 1912 46 11 - - - - - - - - - - - - - - - - - - 4 33 6 26 283 130 1 — 3 6 2 18 8 38 14 54 15 66 18 79 14 94 33 91 19 108 18 87 68 69 The above table accounts for all the patients who left the Sanatorium up to December 31st, 1912. Out of the 283 who have left over one year, 87 are now well and at work, 18 are unwell, 130 have died, and 48 have been lost sight of. 82. Four of those recorded as at work are employed at the Sanatorium in various capacities, receiving board and a small wage. Of the 48 patients not accounted for, a large proportion have emigrated, and are believed to be well and at work in Canada, Australia, South Africa, etc. Many cases have now been in regular work for five, six, and even seven years, after spending only two or three 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 years go on indicates that sanatorium treatment is desirable earlier, and that more healthy occupations and conditions of life are required on return home. Suitable work, a guaranteed income, and the provision of a garden shelter, would probably improve the sanatorium results 50 per cent. 83. The Economy of Sanatorium Treatment. This subject was fully dealt with in my Annual Report for 1909. 84. Shelters for Consumptives. Although open-air treatment for consumption can best be carried out in the first instance at a Sanatorium, there are many cases for which it is desirable such treatment should be tried who cannot be 70 admitted to any Sanatorium. These are sometimes too advanced for it to be wise to send them away. Many cases, too, who have had temporary treatment at a Sanatorium find it difficult or impossible to continue the open-air treatment at home as is desirable. For such cases, and to prevent infection in the home, the Public Health Committee decided in 1910 to provide shelters for loan to needy consumptives for use in their garden or back yard. After inspecting shelters used by Dr. Lyster, of Great Baddow, a simple construction was devised by the Chief. Sanitary Inspector which is easily transportable, will exclude wind and rain, is durable, and at the same time enables the patient to be always virtually in the open air. These shelters can be closed by canvas or wooden shutters on each side, or can be entirely open above 2 feet 6 inches from the ground all round. Nine shelters of this type have been, provided, and two cheaper ones made in Street (Somerset). One Lyster (all canvas) shelter was purchased last year. These have been in almost continual use. Not one is at present (April 24th) disengaged. 7 are occupied by men, 3 by women, and 1 by a boy. The oost of the Woolwich shelter is about £9, and the cost of the Street shelter £4. These shelters are lent at a small rent varying from 1s. 6d. to 3d. per week, according to means. Only those who have no source of income are now exempted from payment. The weekly call to collect the rent insures that the shelter is being used. Shelters were lent to 22 persons last year, 17 men, 4 women, and 1 boy. 4 of these had the shelter free, 1 paid 3d., 15 paid 6d., and 2, 1s. a week. Two have been occupied by married women for nearly three years. Most of the patients using shelters are now under the supervision of the Tuberculosis Dispensary. 71 The results have been eminently satisfactory. In many cases the shelters have been of the greatest value in enabling an advanced and infectious case to be isolated from other members of the family; without the shelter the patient would have had to occupy the same bedroom, if not the same bed, as other persons. Three bedsteads with bedding are also being lent to needy cases too poor to provide such. 84a. Tuberculosis Dispensary. A Dispensary for the treatment of tuberculosis was opened in September, 1911. The following is the summary of the work referring' to the period 1st October, 1912, to 31st December, 1913:— New patients examined 1,892 Number found tuberculous or "suspect" 933 Total of attendances at Dispensary 12,335 Home visits by Medical Officers 3,752 do. Nurses 5,414 Sputum examinations in Laboratory 542 SOURCES FROM WHICH DRAWN, AND NUMBERS ACCEPTED FOR TREATMENT. Source. Total, Tuberculous. Private Doctors 182 161 Public Health Department 62 28 Hospital or Societies 57 40 School 89 56 Previous Patients 418 202 Contacts 666 243 Unrecommended 414 199 Insurance Committee 4 4 The Medical Officer of Health acts generally as Executive 72 Tuberculosis Officer, and is a member of the Tuberculosis Dispensary Committee. 85. 20 Spitting Flasks were supplied at cost price, 6d., compared with 23, 19, 25, 20, and 21, in the previous five years. HISTORY OF WOOLWICH TUBERCULOSIS ADMINISTRATION. (1894-1913.) The following table gives the dates of the chief steps taken by the Public Health Department in combating Tuberculosis:— 1894. Disinfectants supplied gratis by Plumstead Vestry for use in Consumption. 1896. Leaflet of Precautions printed by Plumstead Vestry and circulated through medical men, nurses, clergy, and district visitors. 1898. The Medical Officer of Health, Plumstead, recommended Notification of Consumption. 1900. Notices printed and distributed at public-houses, workshops, etc., warning people against spitting. 1901. Voluntary Notification of Consumption and infection of infected rooms begun. 1902. Pocket spittoons supplied cost price (6d.). 1903. Borough Council commenced to maintain beds at Peppard Sanatorium. Letters sent to public-house managers asking them to arrange for wet cleansing of floors, and avoid dry sweeping, which helps to cause the excessive mortality from Phthisis among public-house servants. 73 1906. Guardians commenced Open-air Treatment of Phthisis at Woolwich Infirmary. 1910. Open-air Shelters for night use of Consumptives in their own gardens, furnished on loan by the Borough Council. 1911. Woolwich Tuberculosis Dispensary started. 1912. Notification of Pulmonary Tuberculosis made pulsory. 1913. Notification of all forms of Tuberculosis made pulsory. CANCER. 86. There were 127 deaths from cancer (malignant tumour), giving a death-rate of 0.99, compared with 0.75, 0.93, 0.88, 1 02, and 0.97, in the five preceding years, 55 of the deaths were in males, and 72 in females. 17 only of the deaths were in persons under 45. The highest mortality was in West Plumstead. The London death-rate was I'll in 1912. 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:— Carcinoma. Seat of Primary Disease: Male. Female. Head and face 1 1 Mouth, jaw, and tongue 7 — Pharynx, oesophagus, larynx, and neck 11 5 Pleura, lung, mediastinum — — Stomach and pylorus 6 9 Intestines (excluding rectum) 4 4 74 Seat of Primary Disease: Male. Female. Peritoneum and omentum — — Rectum and anus 7 5 Liver 6 12 Kidney and bladder 2 2 Genital organs — 16 Breasts — 11 Prostate and external urinary organs 3 — Pancreas 1 — All other 2 3 50 68 87a. The deaths from carcinoma have been classified under the organs affected, since 1903, and the following table shows the result for males and females respectively:— Sarcoma. Male. Female. Brain 1 — Jaw 1 1 Glands of neck 1 — Breast — 1 R. Axilla — 1 Prostate 1 — Testicle 1 — Thigh — 1 5 4 75 CARCINOMA. Males. Seat of Primary Disease. Aver. 1903-5 Aver. 1906-10 1911 1912 1913 Head and face 1.7 1.2 3 1 1 Mouth, jaw, and tongue 4.0 4.8 5 6 7 Pharynx, oesophagus, larynx, and neck 5.0 8.6 11 13 11 Pleura, lung, mediastinum 0.3 0.4 1 — Stomach and pylorus 5.3 10.4 8 10 6 Intestines excluding rectum 2.7 3.2 5 2 4 Rectum and anus 4.0 4.8 5 10 7 Peritoneum and omentum 0.7 - — - — Liver 8.0 6-4 8 7 6 Kidney and bladder - 1-6 2 1 2 Genital organs — — — 1 — Prostate and external urinary 2.7 0-8 2 1 3 Pancreas 0.3 1-4 4 2 1 Pelvis and groin 0.3 — — — — Undefined 0.3 2-2 6 3 2 35.3 45-8 59 58 50 Females. Seat of Primary Disease. Aver. 1903-5 Aver. 1906-10 1911 1912 1913 Head and face 0.7 14 1 1 1 Mouth and tongue 1.7 06 — 1 -- Pharynx, oesophagus, larynx, and neck 1.7 1.4 2 1 5 Pleura, lung, mediastinum 0.7 0.6 1 1 — Stomach and pylorus 5.7 7.6 7 5 9 Intestines (excluding rectum) 0.7 4.2 6 5 4 Rectum and anus. 3.0 6.8 5 6 5 Liver 7.3 8.6 6 8 12 Peritoneum and omentum 0.3 0.4 1 1 — Kidney and bladder — 1.2 2 1 2 Genital organs 16.0 13.6 15 11 16 Breasts 9.7 8.6 9 11 11 Limbs — 0.4 — - - Pancreas — 0.2 1 1 - Pelvis and groin 0.7 — —. — — Undefined 0.7 1.6 1 3 3 48.9 57.2 57 56 68 76 Last year had, with the exception of 1911, the highest recorded cancer death-rate; there was an increase in females, but a decrease in males. There was an increase under carcinoma of the throat, stomach, liver, genital organs, in women, and of the mouth in men. On the whole since 1903, the most notable increase has been in canoer of the mouth and throat in men, and of the digestive organs in women. The latter increase may be due to improved diagnosis. The greater incidence of canoer on the mouth and throat can hardly be accounted for in this way. 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. Causes of Cancer—Special Enquiry. Owing to the apparent increase of this painful disease, much interest has been aroused in the attempts to discover its cause. So fax no great addition to our knowledge on the subject has been made. It has been long known that the disease is frequently a result of local irritation, as in the case of irritated sores producing cancer of the skin, chimney sweeps' cancer, and smokers' canoer of the lip and tongue. Apart from the irritation of a pipe, smoking has been alleged to be the cause of cancer, as also alcoholic liquors, tea, excessive food and meat, and septic teeth, and constipation has been suggested as a cause of cancer of the bowels. I have personally investigated the habits of persons suffering and dying from cancer during the past two years, with a view of seeing what amount of truth is contained in these allegations. The inquiries sought to elicit habits of five to ten years' duration. 77 before death, so as to ensure that they had not been caused or modified bv the illness which was the cause of death. The following table shows the sex and age distribution of the cases specially investigated:— Under 50. 50-60. 60-70. Over 70. Total. Males 12 22 22 15 71 Females 5 19 12 13 49 120 The following gives the parts affected for males and females:— Carcinoma. Cases specially investigated and parts affected. Seat of Primary Disease. Male. Female. Total. Face, Mouth, Jaw and Tongue 14 5 19 Pharynx, (Esophagus, Larynx and Neck 17 3 20 Stomach and Pylorus 12 11 28 Intestines (excluding Rectum) 4 6 10 Rectum and Anus 12 9 21 Peritoneum and Omentum — 1 1 Liver 7 3 10 Breasts — 6 6 Uterus — 4 4 Limbs 2 — 2 Kidney and Bladder — 1 1 Prostate and External Urinary Organs 1 — 1 Pancreas 2 — 2 71 49 120 As regards alcohol and smoke, it was possible in most cases to learn to some extent the amount consumed by the patient, and an arbitrary standard was taken as to the limit of moderation consistent with health, viz.: the daily 78 consumption of 1½ pints of beer or its equivalent, an ounce of spirits being considered equivalent to ½ pint of beer; wine was never but an occasional luxury. The standard for smoke was taken as 2 ozs. of tobacco per week. Persons consuming: more than these quantities have been classed as excessive drinkers or smokers. The correctness of the standard of consumption of alcohol and tobacco taken for the enquiry does not affect its value, since the standard is the same for cancer and non-cancer cases. But it is interesting to find from the recently published statistical abstract for 1912, that as regards tobacco the amount consumed in 1911 per head of population of the United Kingdom was 2.6 lbs., and. allowing one-third of the population to be adult males, we get an average weekly consumption by men of 2.4 ozs. in 1911. In 1901 the weekly consumption was 17 ozs., so that in ten years the amount of tobacco used by each smoker has increased more than 25 per cent., and cancer of the mouth has increased by at least as much. With regard to tea, food and meat, it was only possible to accept the opinion of the person giving the information as to whether the patient used these articles in excess or otherwise. As regards the action of the bowels, the cases were divided into those who had a daily action and those whose bowels did not act as often as once in a day. 31 of the patients were stated to be exoessive users of alcohol, 10 took the standard quantity, and 74 below the standard. There were thus 27 per cent. of exoessive alcohol drinkers. 79 45 smoked excessively, 5 consumed an average quantity, and 66 below the average, giving 39 per cent. of excessive smokers. 34 were excessive tea drinkers, 48 moderate, and 21 small tea drinkers, giving 32 per cent. of excessive tea drinkers. 51 were large eaters, 43 moderate, and 20 small eaters, giving 45 per cent. large eaters. 33 were large meat eaters, 50 moderate, and 27 small meat eaters, giving 30 per cent. of large meat eaters. 68 had a daily action of the bowels, 4 were doubtful, and 20 suffered from constipation, giving 74 per cent. of persons with a regular action. These figures may be compared with those obtained for 108 persons under similar circumstances who did not die of cancer. They were persons dying from other causes than cancer at ages over 50, or still alive at advanced ages. 19 took alcohol excessively, 7 took the standard quantity, and 81 below the standard, giving 18 per cent of excessive drinkers. 19 smoked excessively, 7 in moderation, and 83 were nonsmokers or smoked very little, giving 17 per cent. of excessive smokers. The following table gives their age and sex distribution:— Under 60. 60-70. Over 70. Total. Males 5 26 45 76 Females — 4 28 32 108 80 34 took tea excessively, 49 were moderate tea drinkers, and 23 were small tea drinkers, giving 32 per cent. excessive tea drinkers. 53 were large eaters, 35 moderate, and 18 small eaters, giving 50 per cent. of large eaters. 30 were large meat eaters, 56 moderate, and 18 small meat eaters, giving 29 per cent. large meat eaters. 83 had a regular daily action of the bowels, 4 were doubtful, and 14 suffered from constipation, giving 82 per oent. persons with a regular action. It will be seen that comparing persons who suffer from cancer with those living at advanced ages or who died at equally advanced ages from other causes, the great differences are as to habits with respect to alcohol, smoke, and the action of the bowels, viz.:— Cancerous persons had 27 per cent. of excessive alcohol users, 39 per cent. excessive smokers, and 26 per cent. of constipation. Non-cancerous persons living to a greater age had 18 per cent. of excessive alcohol users, 17 per cent. excessive smokers, and 18 per cent. of constipation. The percentage of large smokers among those dying from cancer is more than twice as high as among other persons. These differences are still more marked with respect to alcohol and smoking if only those who died from cancer of! the mouth and throat are considered. Of 33 persons dying from cancer of the lips, tongue, jaws, fauces, larynx, oesophagus, and cervical glands, 14 or 45 per cent. took alcohol excessively, while 25 or 76 per cent. smoked excessively. 15 of these smoked chiefly a clay pipe, 8 a briar or other form of pipe, 2 cigarettes, and 1 cigars. There 81 were only two cases of cancer of the mouth or tongue who did not smoke; one of these had bad teeth. There were 5 cases of cancer of the larynx and oesophagus who did not smoke, but one chewed. Among the non-cancer cases all the smokers smoked pipes (23 clay and 16 briar), except one who smoked cigarettes. Of cases with cancer of other parts than the mouth and throat, 20 per cent. took alcohol excessively, and 23 per cent. smoked excessively. It would appear then that both alcohol and smoking have some little general effect in promoting canoer, but chiefly exert their injurious influence locally. 20 cases had cancer of the stomach. Of these 4, or 20 per cent., drank excessively, 8, or 40 per cent., were large eaters, and 5, or 25 per cent., were large meat eaterts. Comparing these figures with the non-cancer cases, it is seen that, though the percentage of large eaters is no greater in canoer of the stomach, the percentage of small eaters is much smaller, the large number of moderate eaters accounting for this somewhat anomalous result. As regards cancer of the bowels, out of 25 persons dyingfrom cancer of the intestines (viz., colon, 6; rectum, 17; and undefined, 2), 14 had a regular daily action, 10 had constipation, and 1 was not quite regular. Thus constipation seems to predispose to canoer of the bowels. ALCOHOLISM. 88. There were 4 deaths from alcoholism, 3 from peripheral neuritis, and 11 from cirrhosis of the liver, making a total of 18 deaths probably due to alcohol, compared with 24, 23, 23, 31, and 23, in the five preceding years. In addition to these, there were 429 deaths from diseases of f 82 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 346, 335, 343, 377, and 395, respectively. The increase last year was chiefly in deaths from cerebral haemorrhage. It is Satisfactory to find that the deaths due to alcoholism have shown a steady diminution in England and Wales from 113 per million in 1900 to 45 in 1911. Cirrhosis of the liver has diminished from 144 to 91. 89. The death-rate from alcoholism and cirrhosis of the liver was 014 in the Borough, and in 1911, 0'14 in England and Wales. SYPHILIS. 90. There were 9 deaths from syphilis, compared with 7, 10, 7, 6, and 3, in the five preceding years. All but one of these occurred in public institutions. Five were infants under two years. There were, in addition, 29 deaths from general paralysis, tabes dorsalis (locomotor-ataxy), and aneurism, diseases which are considered to be usually due to syphilis, compared with 25 and 30 in the two preceding years. These figures are far from representing the total mortality caused by venereal disease. Many of the deaths from epilepsy, congenital debility, and other diseases of the brain, heart, blood vessels, and other organs, are doubtless due to this cause. The question of instructing patients and the public generally as to the prevention of venereal disease has been under the consideration of the Public Health Committee, and by their 83 orders a card of instructions has been issued to the local medical men for distribution to their patients. The instructions are similar to those used in the Army, and by Dr. Mott, Pathologist to the London County Council Asylums. OPHTHALMIA NEONATORUM (Inflammation of the Eyes of the New-Bom). 91. This disease was made compulsorily notifiable (by an Order of the London County Council, dated March, 1911. 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. The Borough Council Health Visitor inspects in all cases, and reports where proper treatment is 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 where proper treatment is being carried out. The Guardians have indicated their willingness to facilitate immediate removal to the Infirmary when satisfactory home treatment was impracticable. 14 cases were notified, of which 2 were removed with the mother to the Infirmary, and 3 were treated as hospital out-patients. The others were all reported to be receiving effectual treatment at home. The district nurses visited 1. METEOROLOGY (See Table 8). 92. The average temperature in the winter quarter of f 2 84 the year was 42.3; 12 weeks had an average temperature above the normal, and 1 below. The spring quarter had a temperature about the average, but the summer quarter was exceptionally cool, though rather dry; it had 11 weeks below the average, and only 2 above; its average temperature was 59.1° F., which is 1.0° below the average. In the autumn quarter the temperature was above the average in every week. The lowest temperature, 26.2° F., occurred in the week ending January 18th, and the highest 80° F., occurred in the week ending 23rd August. The rainfall was 22.37 inches, which is nearly 3 inches below the average; most rain, 6.89 inches, fell in the autumn quarter. The summer quarter had 5 43 inches of rain, most of which fell in July and September. (See also under Diarrhœa.) 85 PART II. ADMINISTRATION. WATER SUPPLY. 1. The water supply is constant throughout the Borough. It is derived from deep chalk wells, one of which is situated within the Borough, viz., the Plumsted Well. Plumstead Well. In previous years I have repeatedly called attention to the unsatisfactory condition of the water supplied by this Well. From the Annual Report of the Water Examiner on the Metropolitan Water Supply for the year ending March 31st, 1913, it appears that 88 samples were taken of the Plumstead Well in the year for chemical analysis. The ammoniacal nitrogen averaged .0000, the albumenoid nitrogen .0014, the chlorine 5.62, the total hardness 38.03, and the temporary hardness 15.02. In all these particulars the Plumstead Well compared unfavourably with the other Kent wells, the chlorine and hardness far exceeding that of all but one of the other deep wells. The results of last year differ little from those of preceding recent years. The chlorine found in 1913 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 but one. 86 For bacteriological examination 127 samples were taken, and an average of 8.8 microbes per cub. centim. 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. Houses with Water Supply outside the House. A report on this subject was contained in the Annual Report for 1912. 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, 2 in 1911, 6 in 1912, and 4 in 1913. 29 of these houses were in the Dockyard and St. Mary's Wards, 13 in River Ward, 26 in St. George's Ward, and 2 in Eltham. 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 33 houses, compared with 51, 34, and 55, in the three preoeding years. At 24 houses the supply was found insufficient br temporarily cut off, and the necessary steps taken for obtaining a proper supply. FOOD AND DRUGS ACT. 4. 513 (samples were submitted to the Public Analyst, and 29, or 5 6 per cent., were found to be adulterated, 87 compared with 2.5, 3.4, 3.3, 4.6, and 2.7, in the five preceding years, and 8.4 in the Metropolis in 1912. The percentage of adulteration in the past five years averages 3 9. The average of the five previous years was 6.3. 84 of the samples taken were informal. 3 of these were found to be adulterated. 5. Proceedings were taken in 17 cases; convictions were obtained in 11, and 6 were dismissed, 3 on proof of warranty. 6. A total of £15 16s. 0d. was imposed in fines, and £10 15s. 0d. in costs. 7. 303 of the samples were fresh milk. 24 of these, or 7.9 per cent. were adulterated, compared with 1.7, 3.7, 4.8, 7 2, and 3.5, in the five preceding years. 73 samples were bought as butter, and two were found to be adulterated. 14 samples of cream were taken and two were found not to be labelled in accordance with the Milk and Cream Regulations. Table 18 shows the other 123 articles analysed. Not one of these was found to be adulterated. During the past six years, 7 samples of coffee out of 78 taken have been found to be adulterated, and one of cocoa out of 69. But no adulteration was discovered in 30 samples of vinegar, 33 of flour, 13 of sugar and sweets, 70 tea, 49 mustard, 46 jams, 17 condensed milk, and 117 drugs, nor in any one of the smaller number of several other articles, other 88 than milk or butter, taken for analysis. From the Local Government Board Annual Report for 1912 it appears that in that year the adulteration of samples taken in England and 'Wales was nil for tea, 5 per cent. for coffee, 3 per cent. for cocoa, 2 per cent. for mustard, 2 per cent. for flour, 5 per cent. for confectionery and jams, and 9 per cent. for drugs. As regards all the above articles except coffee,, Woolwich shows less adulteration than the rest of London. Public Health (Milk and Cream) Regulations, 1912. 7a. The following tabular statement shows the work done under these regulations which forbid the adding of preservatives to milk and require the amount in cream to be declared on a label. 1. Milk; and Cream not sold as Preserved Cream:— (a) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 303 0 Cream 5 2 Boric acid was present in both samples, viz., 0.32 per cent. and 0 08 per cent. No action taken under Regulations; both samples taken informally. Further samples were taken from the same vendors and found satisfactory. 2. Cream sold as Preserved Cream:— (a) Instances in which samples were submitted for analysis to ascertain if the statements on the label as to preservatives were correct:— (i.) Correct statements made 8 (ii.) Statements incorrect 1 9 89 (b) Determinations made of milk fat in cream sold as preserved cream:— (i.) Above 35 per cent. 9 (ii.) Below 35 per cent. 0 9 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations are not observed—Nil. (d) In one case the Regulations wore not complied with. This sample was labelled as "preserved cream," but not exactly in accordance with the Regulations. The sample having been purchased informally the vendor was cautioned. 3. Thickening substances. No evidence of their addition to cream or to preserved cream. 4. No other observations. 8. Of the 13 adulterated milk samples for which proceedings were taken the adulteration varied from 2.7 to 12.9 per cent. of added water, and from 8.3 to 64.0 per cent. deficiency in fat. The fines varied from 2s. to £5. 9. Sampling. Of the 303 milk samples, 81 were taken on Sundays or Bank Holidays; 2 of these were found adulterated. In recent years fewer samples taken on Sunday were found to be adulterated than samples taken on week days. 90 17 samples were taken on arrival at railway stations, one of which was found adulterated. Informal Samples. The reasons for taking informal samples were detailed in my last Annual Report. 84 such samples were taken in 1913, and 3 were found adulterated; one of these was butter which proved to be three-fourths margarine, and the other two were cream containing preservatives not declared on the label. Two formal samples of cream taken subsequently from the same vendors were found to contain no preservatives. A sample of butter taken subsequently formally from the vendor of the three-fourths margarine butter was found to be similarly composed, and he was fined 40s. and 23s. costs. 10. A record is kept of all analyses of milk made by the Public Analyst. The average percentage of fat in unadulterated samples have been found to be the same each year, viz., 3.6, and of non-fatty solids from 8.8 to 8.7 per cent. 10a. Food Reform. It is desirable in the interests of health that a sufficient amount of pure food should be consumed and it is also specially important that those with limited incomes should know what articles of food are most nutritious in proportion to their cost. Efforts have been made in recent years to give instruction in this matter, particularly in the value of oatmeal, whole-meal and standard breads, and of the pulses—peas, beans, and lentils, which contain a larger amount of proteid than other vegetable foods. The following particulars, kindly supplied by the Secretary of the largest trading society in the Borough, are interesting in showing 91 the proportion of the above vegetable foods consumed by the public as compared with the amount of animal food:—• One week, " Bread. Quarterns. Produced March, 1904 White and Brown 44,180 (No separate record of white and brown kept) Produoed July, 1906 White 38,862 Brown 1,167 Produced March, 1914 White 74,814 Brown 2,300 Dr. Allinson's 1,570 Hovis 354 Standard 798 The baking of Standard Bread was commenced in February, 1911, when to meet the demand 1,696 quarterns were produced. This produce has fallen to the figure given above for March, 1914. I am unable to give you the separate figures for white and whole-meal bread ten years ago, the records at that time having been made in the aggregate. Comparisons of the years 1906 and 1913: — 1906. 1913. Oatmeals 24 tons 37 tons Peas. 83 qrs. 120 qrs. Lentils 140 bags 200 bags Beans 275 bags 500 bags There were also large quantities of oatmeals, peas, etc., sold in packet form during 1913 of which we have no complete reoord. Meat sold. 1906—Membership, 25,800; Butchery Trade, £54,010. 1913—Membership, 34,300; Butchery Trade, £80,627." 92 It appears from the above statement that while the membership has increased over 30 per cent., the sale of meat has increased about 50 per cent., white bread 90 per cent., other bread has quadrupled, and the sale of oatmeal, peas, beans and lentils have increased about 50 per cent. These figures are of course capable of various interpretations. They no doubt indicate increased prosperity of the population, but are not very encouraging to the food reformer. FOOD INSPECTION. 11. The inspection of meat and other food received the usual attention. Inspector Tedhaim made special inspections of the slaughter-houses. There was one seizure and 87 surrenders. The seizure was of unsound plums, the details being as follows: — On Saturday, the 30th August, Chief Sanitary Inspector Duck seized 52 crates of plums, the total weight of plums being 8 cwt. 1 qr. 12 lbs. These were exposed for sale and were offered to the Inspector at one shilling per crate. They were laid out on the forecourt of No. 92, Plumstead Road. During the examination and seizure there was considerable obstruction and abuse on the part of the men in charge, and police protection had to be threatened. At the conclusion of the seizure application was made by Inspector Duck to inspect the interior premises, but this was refused. The plums were taken before the Magistrate, sitting at the Woolwich Police Court the same afternoon, who made the order for the destruction of the whole of the 52 crates, and at the same time Inspector Duck laid information, with 93 regard to the refusal to enter, and was granted an order to enter if needs be by force. This was executed in the afternoon with assistance and under police protection. The Chief Sanitary Inspector with Inspector Tedham found large quantities of plums in various parts of the building and in the back yard, but all the heaps had notice boards with a chalked notice "All these plums are condemned and all plume on the premises." There were in all about four tons and, but for these notices being affixed, the Inspector would have seized them, as they were obviously unsound and worse than those seized during the morning. In order to prevent, if possible, these being carted away and used for human food, (as suggestions had been made that they might be useful for jam making), arrangements were made to keep the premises under observation the whole of Saturday night, Sunday, and Sunday night. On Monday, the 1st September, the whole of the four tons were surrendered and taken to the Council's Destructor. Information was received on the 3rd September that a, further consignjment of 16 tons of similar plums had been released for delivery at 92, Plumstead Road. The occupiers on delivery commenced sorting them and the premises were continually inspected during the days that this was in progress, but none of the sorted plums were approved by the Sanitary Inspectors a,nd the owners were threatened with seizure if they attempted to expose any of them for sale. Ultimately the whole of the 16 tons were surrendered and destroyed. The whole of these plums, including those seized, were found to have come from Germany, but considerable difficulty was experienced in finding who was the actual owner of them. 94 The freightage account from Germany was paid by a Joseph Blake with a cheque signed Robert Pearce, but on enquiry of Robert Pearce he denied responsibility and put it on to Blake. Proceedings were therefore taken against Joseph Blake, otherwise known as Thomas Carter, on 2nd October, 1913 before Mr. Hutton at the Woolwich Police Court, the Council being represented by the Town Clerk and the defendant by Mr. Bickmore. The case against Blake was that he was the person to whom the plums did belong at the time they were exposed for sale. At the hearing Pearce was called for the prosecution when he denied what he had previously said and swore that the plums were his and that Blake was acting as his manager. The Magistrate, after several adjournments, dismissed the case against Blake on the grounds that he was not satisfied! on the evidence that Blake was the owner. Fresh proceedings were then instituted against (1) Joseph Blake, otherwise Thomas Carter, for being in possession of plums that were unsound and unfit for the food of man;j (2) Robert Pearoe, being the person to whom the said plums did belong at the time; and (3) Richard Carter for having the plums on his premises. Richard Carter, who was said to be Blake's father, had recently entered into an agreement for the premises, 92, Plumstead Road. The case against these three defendants came before Mr. Simmons, sitting at the Woolwich Police Court, oil 28th November and 18th December, 1913. The defendants were all represented by Mr. Bickmore, who made application to 95 the Magistrate for each defendant to be separately tried. This was conoeded and the Magistrate in giving judgment expressed the opinion that Pearce and Richard Carter appeared to be dummies in the hands of Blake. Blake, against whom there were several previous convictions in connection with unsound food, was sentenced to four months' hard labour; Pearce was fined £40 and 10 guineas costs or one month's hard labour; pnd Richard Carter was fined £5 or 14 days. Blake lodged an appeal against his conviction which came before the Chairman of the Clerkenwell Sessions on 9th' January, 1914, the Borough Council being represented by Mr. Bodkin and Blake by Mr. Cecil Walsh, K.C., and Mr. Bickmore. The appeal was dismissed with costs. Blake lodged a further appeal on a point of law as to the true construction of the word "possession." This further appeal has not yet been heard. 11a. Of the surrenders 8 were tuberculous pigs, 36 livers or other organs affected with parasitic disease, 225 lbs. unsound mutton, 206 unsound kidneys, and 384 tins of unsound condensed milk. A full list is given in Table 19. DAIRIES, COWSHEDS, AND MILKSHOPS. 12. On January 1st, 1913, there were 117 milkshops on the register; 11 were added, and 12 removed, during the year, leaving a total of 116 on the register at the close of 1913. There were 192 inspections made, and 25 notices served. There were no prosecutions. 96 Owing to the steps taken by the Health Department requiring persons not to sell milk in unsuitable general shops the number of milkshops has been reduced from 196 to 116' in the nine years 1905-13. An abstract of regulations was drawn up and printed in the Annual Report 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 1913 one application was refused. The requirements of the Health Department for securing the purity of milk were detailed in the 1912 Annual Report. 14. One cowshed was closed and one opened, leaving 16 on the register. There were 32 inspections, and 9 notices were served for dirty conditions, etc. There has certainly been an advance in the condition of cowsheds and methods of milking in the Borough, but until more up-to-date legislation takes effect, dirty milk will continue to be sold, involving risk of various infectious diseases unless the milk is boiled. Tuberculosis in Cows—Order of the Board of Agriculture. The Board of Agriculture have made an Order under the Diseases of Animals Act requiring the notification of any cow suffering from tuberculosis of the udder, indurated udder, or other chronic disease of the udder, or any bovine animal suffering from tuberculosis with emaciation. The notification has to be made to a constable of the police force or to an inspector of the Local Authority. The constable must 97 transmit the information to the Local Authority, who, if not themselves the Sanitary Authority, shall inform that authority. I take it the Local Authority in London is the County Council. The Order further requires a similar notification from a Veterinary Surgeon who is employed to examine any cow or bovine animal. The Local Authority must cause any cow or bovine animal supposed to be giving tuberculous milk, or suffering from disease of the udder, to be examined by a Veterinary Inspector, and the Inspector may, with the consent of the owner, apply the tuberculin test. A Veterinary Inspector for the purposes of the examination may at all reasonable hours enter the premises where animals are kept and require any cow to be milked in his presence and samples of the milk taken. He may also take samples of the faeces or urine of any bovine animal. Where the Local Authority is satisfied that a cow is suffering from tuberculosis of the udder or giving tuberculous milk, or a bovine animal is suffering from tuberculosis with emaciation, they shall with all practicable speed give notioe to the owner and cause the animal to be slaughtered. Before the slaughter of the animal the Local (Authority must agree with the owner as to the value of the animal. The value is to be ascertained both on the supposition that it is suffering from tuberculosis and also on the supposition that it is not so suffering. If the animal is found after slaughtering to have suffered from tuberculosis not advanced, the Local Authority shall pay compensation of a sum equal to three-quarters of the value of the animal as valued for compensation, after deducting one-half the cost of the valuation. If the animal is found to have suffered from advanced tuberculosis the Local Authority must pay a sum equal to one-quarter of the value or the sum of 98 30s., whichever is greater. If the animal is found not to have suffered from tuberculosis the Local Authority must pay the full amount at which the animal was valued and a further sum of 20s. The Order requires that any milk produced by a cow which is suffering from disease of the udder, or tuberculosis with emaciation, shall not be mixed with other milk until the cow has been examined by a veterinary inspector. The Board, in a coveripg letter, states that— "The Order aims at securing the destruction of every cow found to be suffering from tuberculosis of the udder, or to be giving tuberculous milk, as well as of all bovine animals which are suffering from tuberculosis with emaciation, since these are known to disseminate freely the germs of the disease. In connection with the cost of administering the Order, the Board have obtained from the Lords Commissioners of His Majesty's Treasury authority to refund to Local Authorities from moneys provided by Parliament one-half of the net amount payable by way of compensation for slaughtered animals during a period of five years from the coming into operation of the Order. The Board believe that public opinion is favourable to the adoption of concerted measures designed to check the spread of tuberculosis throughout the country, and no such action can be satisfactory which fails to make provision for dealing with the disease in the animal, but it should, the Board feel, carry with it a full measure of public sympathy and 'support. The payment to agriculturists of reasonable compensation for animals slaughtered in the public interest 99 must, in the opinion of the Board, be an essential feature of any well-devised scheme for gradually reducing the prevalence of tuberculosis in animals. On the other hand the liability of the Treasury and of the Local Authority to provide such compensation on the present basis from public funds is a serious one, and cannot be continued unless events show that a return commensurate with the burden imposed is being obtained. It behoves agriculturists, therefore, to second the efforts of the public authority by the segregation of all bovine animals which respond ,to the tuberculin test, so as to prevent tuberculosis from being spread within the herd, and the Board will be prepared to advise how this can best be done in particular cases." 1 SLAUGHTER-HOUSES. 15. There are 12 slaughter-houses on the register, as in 1912. 46 inspections were made, and 4 notices served and complied with. NUISANCES (see Table 15a). 16. 441 complaints of sanitary defects were received and investigated, compared with 398, 400, and 361, in the three preceding years. 38 complaints of non-removal of dust were made and attended to, compared with 26, 20, and 29, in the three preceding years. 1 of the dust complaints came from Woolwich parish, 12 from Plumstead, and 25 from Eltham. The dust in Woolwich is collected by your Council's employees, but that in Plumstead and Eltham by contractors, Messrs. Tuff & Hoar. 100 Complaints were received against Mr. A. J. Tucker, the Eltham contractor, for breach of oontract as regards nonpayment of the proper rates of wages and the working of excessive hours of labour. After investigation, notice was served on Mr. Tucker to determine his contract. Tenders were invited, and after considerable delay owing to the discovery that the lowest tenderer had not paid wages in accordance 'with the terms of his contract for another job, the contract was given to Messrs. ,Tuff & Hoar, the Plumstead contractors. There have been no complaints from Eltham since the change of contractors. 17. Drains and Water-Closets. 7 defective combined drains were investigated and reported upon by the Chief Sanitary Inspector, compared with 7, 27, and 16, in the three preceding years. These drains affected 57 houses. 448 private drains, found choked and defective, were examined, cleared, and relaid, compared with 411, 319, anc( 399, in the three preceding years. The largest number, 99, was found in River Ward. 785 water-closets and w.c. cisterns were repaired, compared with 963, 734, and 890, in the three preceding years. 209 foul w.c. pans were cleansed by tenants, compared with 312, 279, and 238, 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 public 101 houses, and accessible to the public, have been regularly) inspected during the year, 545 inspections being made. Regular cleansing has been required. 20. House Inspection. 5,489 houses were inspected, house to house, compared with 6,626, 5,892, and 5,830, in the three preceding years; 6,516 were inspected re infectious diseases and complaints, compared with 6,026, 6,546, and 6,678. In addition to these 531 inspections of registered houses were made. 21. Table 16 shows the streets inspected, and the number of houses found defective in each. At 2,620 houses, interiors were cleansed, or defective roofs rapaired, compared with 2,064, 2,137, and 2,206, in the three preceding years. 629 houses with damp walls were remedied, compared with 523, 600, and 571, in the three preceding years. The increase of these figures is probably not unconnected with the diminution of empty houses. When tenants have no choice and must take any house they can get, a certain class of landlords do not, decorate and repair until required to do so by the Sanitary Authority. Improved ventilation was provided in 41 houses, compared with 101, 94, and 62, in the three preceding years. 545 new dust pails were supplied, compared with 585, 516, and 525, in the three preceding years. 22. Medical Officer's Special Inspections. These amounted to a total of 623. 12 inspections were made of cowsheds and 102 milkshops, 37 of bakehouses, 21 of factories and workshops, and 9 of houses registered under the by-laws. 187 inspections were on account of tuberculosis, 119 cancer, 12 diphtheria, 23 scarlet fever, 4 enteric, and 1 small-pox. Many of these visits were made by request of the medical attendants for the purpose of diagnosing doubtful cases of infectious disease. Other visits re infectious disease were made at the request of school teachers and others. 114 premises were inspected re housing conditions. Special inspections were made of Horn Park sheds, Thomas Cottages, Avenue Cottages, Railway Cottages, High Street Flats, New Street, the Swimming Baths, Dust Destructors, etc. 23. Overcrowding. 101 cases of overcrowding were found and remedied, compared with 78, 97, and 91, in the three preceding years. The overcrowding was 1.8 per cent. of house-to-house inspections, compared with 1.6 per oent. in 1912. Overcrowding is increasing with the demand for houses. 24. Smoke Nuisance. 42 observations re smoke nuisance were made, and 17 nuisances of black smoke observed. The nuisances were abated on service of notices. There was no prosecution. Considerable nuisance occurred from smoke at the Plumstead Baths. The notice of the Baths Committee was called to i,t. Two complaints of smoke nuisance were received from the London County Council, and one from the Coal Smoke Abatement Society. These related to the Electric Light Works, Globe Lane, and to Siemens Electrical Works. 25. Defective Light. At 73 houses new windows were 103 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 referred to. 27. Verminous Booms. 220 verminous rooms were cleansed under the London County Council (General Powers) Act, 1904, or were dealt with as dirty rooms under the! Nuisance Section of the Public Health (London) Act, compared with 159, 143, 248, and 214, in the four preceding years. DUST REMOVAL. 28. In Woolwich Parish 6,058 loads of house and inoffensive trade refuse, and 185 loads of offensive trade refuse were removed by direct labour, and destroyed at the Woolwich Destructor. In the three preceding years 6,912, 5,769, and 5,866, loads respectively, were removed. In Plumstead 14,880 loads, weighing 12,359 tons were removed by the contractors, Messrs. Tuff & Hoar, and destroyed at the Plumstead Destructor. £2,864 10s. Od. was paid for collection, oompared with £2,826 15s. Od. in 1912. In Eltham the sum of £89,4 0s. 0d. (£891 14s. 3d. in 1912) was paid to the contractors for removal of dust. TRADE REFUSE. 29. During the past year there have been 5,271 (6,337 in 1912) receptacles of offensive trade refuse removed. There 104 are now 45 (47 in 1912) tradesmen on the books from whom offensive trade refuse is removed. Certain soap firms collect offensive trade refuse free of charge, and hence the fall in numbers collected by the Borough Council. The charge made for inoffensive refuse is Is. 6d. per load, and 2d. per bushel, and for offensive refuse at the rate of 3d. per receptacle, charged per quarter in advance on the amount collected in the previous quarter, HOUSING OF THE WORKING CLASSES ACTS. 30. More active steps were taken in 1913 under the Housing Acts than in any recent year. 52 houses were represented under Section 17, Housing, Town Planning, &c., Act, as unfit for human habitation, compared with 9 and 18 in the two previous years. 14 Closing Orders were made, compared with 5 and 14 in the two preceding years. 26 houses were remedied to the satisfaction of the Medical Officer of Health without Closing Orders being made, compared with 4 and 4 in 1911 and 1912. In many of the 26 the houses were temporarily closed while the work was done. The following was the prooedure adopted: — The Public Health and Housing Committee, after considering the Medical Officer's representation, gave notice to all persons interested that the question of making a Closing Order would be considered at the following meeting. When the owner attended the meeting, admitted the existence of the defects, and gave an undertaking to carry out the works required to make the house fit for human habitation, the Committee usually accepted his undertaking. In several cases where the owner disputed the 105 existence of the defects the Committee visited and inspected the house in question. In such cases, if convinced of the serious condition of the premises, a Closing Order was usually made. The following were the chief requirements demanded of the owner for putting premises into sanitary condition:— Remedying dampness, concreting sites, providing damp- proof courses and dry areas. Providing sub-soil drainage, re-roofing, improving sanitary arrangements, providing adequate water-supplies, remedying dilapidated conditions of structure. One house was dealt with under Section 15 which requires a house of a certain rental to be kept by the owner in all respects reasonably fit for human habitation. The following table summarises the action taken: — Number of houses inspected re Housing and Town Planning Act 5489 Dwelling houses considered on inspection to be in a state so dangerous or injurious to health as to be unfit for human habitation 52 Number of representations made to Borough Council under Section 17 (2) with a view to making of closing orders 52 Number of closing orders made 14 Number of dwelling houses remedied without making closing order 26 Number of dwelling houses put into fit state for human habitation after making closing order 4 The following are the houses referred to in the above table:— 106 1, 2, 3, 4, 5, 6, 7, 8, Cooper's! Place, Eltham. 2, Thrift Cottages, Henry Street; 5 and 6, Limbrey's Buildings; 8, St. Thomas Cottages; 20, 21, and 22, The Avenue, Sandy Hill Road; 35, Timbercroft Lane; 83 and 83a, Timbercroft Lane; 112, Sandy Hill Road; Nell Gwynn's Cottage, Well Hall Road; 83, Church Street; 45a, Brewer Street; 53 and 54, Charles Street, Woolwich; 55, St. Mary Street; 2, 3, 4, 6, 7, and 8, Railway Cottages; 7 and 8, New Street; 1 and 2, Globe Lane; 10, Rodney Street; 2, Prospect House, Plumstead Common. 33 and 35, Barnfield Road; 3, 5, 11, 13, 19, 21, 27, 29, 35, 37, 43, 45, Barge House Road; 4, Dingley Cottages. With ;regard to Nos. 1 to 8, Cooper's Place, 2, Thrift Cottages, 5 and 6, Limbrey's Buildings, 8, St. Thomas Cottages, 35, Timbercroft Lane, 45a, Brewer Street, 53 and 54, Charles Street, 2, 3, 6, and 7, Railway Cottages, 33 and 35, Barnfield Road, and 4, Dingley Cottages, the necessary work was done by the owners to render these houses fit for human habitation without Closing Orders being made, and in the following the work is still in progress:—Nos. 4 and 8, Railway Cottages, and 3, 5, 11, 13, 19, 21, 27, 29, 35, 43, 45, Barge House Road. 107 Closing Orders were made in the following oases and determined on the satisfactory completion of the work necessary to render the houses fit for human habitation:—Nos. 20, 21, and 22, The Avenue, 83 and 83a, Timbercroft Lane, and 112, Sandy Hill Road. In the following cases Closing Orders were made, and, nothing having been done to render the houses fit for human habitation, the Council has under consideration the question of making Demolition Orders:—Nos. 7 and 8, New Street, 1 and 2, Globe Lane, 10, Rodney Street, and 2, Prospect House. A Closing Order was made with respect to No. 55, St. Mary Street, and this house was voluntarily demolished by the owners-. A Closing Order was made for No. 83, Church Street, and the work necessary has been commenced. In addition to the above one house was dealt with under Section 15, viz., 4, Godfrey Street, and the work put in hand and completed by the owner. NORTH WOOLWICH—VITAL STATISTICS. A report on the greatly improved health of this district was contained in the Annual Report for 1912. The Vital Statistics of 1911 and 1912 were compared with those for 1902-3. HIGH STREET FLATS AREA. The following report was presented on this area:— This area comprises Stanley, Sidney, Albert, and Fore 108 Houses, in High Street, Woolwich, 1, 2, 3, 4, 5, 6, 7, Globe Lane, 1, 2, 3, 4, 5, 6, 7, 8, New Street, and 8, 9', 10, and 11, Market Hill. Stanley House contains 9 separate and self-oontained fiats, and Sidney, Albert, and Fore Houses 10 flats, all of three rooms each. The other houses contain from three to six rooms. Altogether there are 58 houses containing 198 rooms. These form a square area which is bounded on the south by High Street, west by Market Hill and "Anchor and Hope" P.H., north by the Electricity Station, and east by Globe Lane. The population at the Census was 242, but the Sanitary Inspector found, on recent inspection, the population to be 273 persons. I have calculated some vital statistics for the years 1910-11-12, taking an average population of 257 5 persons. Total births notified (1910-11-12) 21 Total deaths do. do. 20 „ „ under one year (1910-11-12) 4 „ „ 1 to 5 years do. 5 ,, „ infectious diseases do. 4 „ „ tuberculosis do. 3 „ „ alcoholism and cirrhosis of liver 3 Special area. Borough. Birth-rate 27.1 22 8 Death-rate 25 . 9 11 . 9 Infantile death-rate (per 1,000 births) 190 85 Zymotic death-rate 5.2 0.89 109 Tuberculosis ,, ... ... 3-9 1'48 Alcoholism ,, ... ... 3-9 0-18 Phthisis notifications (1912) ... 3 689 „ „ rate (per 1,000 population) ... ... 11'7 5-6 Death-rate of Stanley, Sidney, Albert, and Fore Houses (19001902) ... ... 20:8 do. Alcoholism ... 3 4 It will be seen that the health of this area compares very badly with that of the Borough. The birth-ratei is but very slightly in excess of the deathrate. Both the death-rate and the infantile death-rate are more than twice as high as that of the Borough. The zymotic death-rate is six times as high; Tuberculosis death-rate more than twice as high; Death-rate from alcoholism twenty times as high. Ten years ago I calculated the death-rate of Stanley, Sidney, Albert, and Fore Houses, for 1900-1-2, and found it to be 20-8. There appears, then, to have been rather a deterioration than an improvement in the health of the area. The area is inhabited by a poor class of persons, and' although it does not contain a public house there are two public houses immediately adjoining, and two others within one minute's walk, and it is obvious that too frequent resort to these houses by the women as well as the men is one cause of the unhealthy conditions. 110 The wage-earners occupying the houses are employed at the neighbouring coal wharves, docks, river, the Arsenal, and other places. The chief part of the area forms a square which is Continuously built round on three sides in Market Hill, High Street, and Globe Lane, but open to some extent in New Street. The High Street flats were built about 1890, but the other houses are all old and to a large extent dilapidated. The flats are very badly arranged. They have very long back additions causing the back rooms to be exceedingly, dark. Exoept the basement flats, none of them have proper provision of back yards, the back yard provided being about six feet square and so arranged as to make the kitchen and w.e. dark. There is thus no satisfactory provision for drying grounds or playgrounds for these houses. The houses are provided with dust-shoots which open into receptacles in the basement yards. All the internal passages of the flats are dark owing to the arrangement of the houses. The back rooms are all dark for the reasons above given. In the front the rooms of the two lower flats are dark owing to the narrowness of High Street, but the upper rooms are well lighted. Owing to the square above described being enclosed on three sides, there is no proper access of air to several of the houses. Most of the houses have basements, the occupation of 1ll which has been prohibited by the Public Health Department on your instructions. Although this has been an advantage in one way, it has had the disadvantage of making it more difficult to prevent the accumulation of refuse in the back yards in the square referred to. This square is accessible to the public, and hooligans continually gain access and injure the property, pulling down doors, removing pipes and coppers, and doing general destruction; frequently they have caused blockages in the drains. They have also destroyed the dust receptacles and left the house refuse exposed. In addition to this the occupants of the upper flats throw their refuse down on the waste ground, and there is no caretaker, or other person to interfere with their doing so. Nuisances also frequently take place on the public staircases of the flats owing to these being under no control by a caretaker. The area has been under the continual systematic inpection of the Health Department, so that to a large extent overcrowding and other gross nuisances have been kept under. A special sub-committee was appointed to consider this matter, consisting of Councillor F. Penny (Chairman), Councillors W. Marlow, It. M. W. Allen, W. H. Dawson, and J. Newman. They held several meetings and made repeated inspections of the area, and also interviewed the owners and endeavoured to get them to take joint action for improving the condition of the block dwellings, but without success. Finally the Medical Officer of Health represented the area as unhealthy under the Housing of the Working Classes Act, Part II., to the London County Council. The London County Council has refused to take action. 112 NORTH WOOLWICH DOCK EXTENSIONDEMOLITION AND DISPLACEMENT. In the last Annual Report particulars were given of the intended demolition of houses in North Woolwich, the sites of which are required by the Port of London Authority for the extension of the South Albert Dock. 55 houses were scheduled. 12 of these were situated in Drew Road, 17 in Rhea Street, 15 in Winifred Street, and 11 in Auberon Street. They were occupied by 380 persons of the workingclass. Under the Housing of the Working Classes Act, 1903, where, under powers given by any Local Act or Provisional Order, land is acquired by any authority or persons on which are Situated working-men's dwellings, such dwellings shall not be entered on until the Local Government Board have either approved of a housing scheme or have decided that such scheme is not necessary. The housing scheme must make provision for the accommodation of such number of persons as is in the opinion of the Local Government Board required, but "hot exceeding the aggregate number of persons displaced. The Local Government Board may require that the mew dwellings shall be completed and fit for occupation before possession is taken of the dwellings it is proposed ta (Demolish. The Committee decided to ask the Local Government Board to require a re-housing scheme, but did not press for the new houses to be completed before demolition of the old. The Local G pvernment Board, however, insisted that po occupants should be displaced until suitable housing provision had been found for them to the satisfaction of the Medical Officer of Health of the district in which the new 113 residence was situated. The tenants have experienced great difficulty in finding new provision. The question of the site of the new houses to be built by the Port of London Authority has been a difficulty, as no satisfactory site could be found in the Borough to the north of the river. A site in Wickham Lane is now under consideration. 31. Council's Houses. All the Council's 25 houses in North Woolwich were occupied throughout the year with the exception of four; of these four, one was vacant for four weeks, two for two weeks, and one for one weekv The loss of rent was due to the necessity of repairs and not to lack of tenants. All of the Council's 9 houses in Gossage, Park, and Parkdale Roads, which are under the care of the Health Committee, were occupied throughout the year. On June 5th, 1911, Nos. 15, 17, and 19, Gossage Road, were taken over by the Libraries Committee. HOUSES REGISTERED UNDER THE BY-LAWS. 32. The existing By-laws and the history of proposed new By-laws were commented on in my last Annual Report. At the commencement of the year, 432 houses were on the register; 10 were newly registered, and 10 taken off the register, leaving 432 on the register at the close of the year, compared with 359, 395, 409, 429, and 432, in each of the five preceding years. These figures seem to indicate that the limit of houses considered by the Committee as likely to be improved by registration has been arrived at. h 114 33. These houses were inspected, some quarterly, others half-yearly, or yearly. S31 inspections were made in all, and 360 notices were served. The registered houses were under the care of Inspector Shaw. The duties consist largely in educating house wive6 in keeping their homes clean, and can therefore be best performed by a woman inspector, but unfortunately there is none available. The houses were situated as follows:— River Ward, North 34 do. South 106 St. Mary's 37 Dockyard 69 St. George'6 56 Herbert 4 Burrage 24 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 432 Number of houses inspected 531 „ found unsatisfactory 433 ,, found satisfactory 98 ,, of notices served 360 ,, of nuisances, defects and offences against the by-laws, dealt with and remedied 561 ,, of cases of overcrowding remedied by tribution without notice 9 ,, of houses measured 10 115 Notices. On Owners for Cleansing (under P.H.L. Act) 133 On Tenants for Cleansing (under By-laws) 64 On Landlords for Overcrowding 10 On Tenants for Overcrowding 14 On Landlords and Tenants for other defects 134 On Landlords and Tenants for Verminous Rooms 34 Verbal Notices on Tenants for Cleansing—carried out 92 INHABITED HOUSE DUTY. 34. No application was received for a certificate under the Inland Revenue Act. COMMON LODGING HOUSES. 35. There are 18 common lodging-houses in the Borough, 16 for men and 2 for women. Total accommodation for 516 persons is available. The following is the list: — Common Lodging-House. Accommodation. Men. Women. Total. 60 Beresford Street 58 - 58 50 High Street 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. 27 — 27 10 do. 45 — 45 10a & 11 do. 62 - 62 21 & 21a do. 42 - 42 "Ship House," Rodney Street — 32 32 4 Warren Lane 31 — 31 Totals 465 51 516 h 2 116 UNDERGROUND ROOMS. 36. Three underground rooms, separately occupied, were found not in accordance with the Public Health (London) Act. 2 were in St. Mary's and Dockyard Wards, and 1 in Burrage Ward. The service of notices led to cessation of occupation. FACTORIES, WORKSHOPS, AND WORKPLACES. '37. There 'were, at the close of the year, 200 (191 in 1912) workshops and workplaces on the register. 391 inspections were made, and 46 notices served and complied with. 120 inspections of factories were made regarding sanitary accommodation, and 18 notices served and complied with. 364 inspections of home workers' premises were made and 18 notices sent and attended to. Miss Middlebrooke devoted a large amount of her time to the inspection of workshops, factories, and houses where women are employed; 25 new workrooms were measured up and put on the register. 38. A special report on Homework was presented to your Council on October 31st, 1906, and printed in the Annual Report of that year. BAKEHOUSES. 39. The number of factory bakehouses is 9, and of workshop bakehouses in use is 40, 14 of the latter being underground. '2 bakehouses were discontinued. They were all inspected twice. I inspected most of them personally, and found them generally satisfactory. 11 certified underground bakehouses are not in use. 117 ICE-CREAM SHOPS. 40. 82 ice-cream shops were on the register at the close of the year, compared with 86, 89, and 89, in the three previous years. 7 were added and 14 removed during the year. There were 164 inspections made, and 8 notices served. Regulations, embodying the provisions for premises where food is sold, 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, oost of appliances, staff, etc., were fully described in my Annual Report, 1903, pages 73-76. Rooms at 1,278 houses were disinfected, compared iwith 964, 1,093, and 1,195, in the three preceding years. The disinfecting apparatus was used 1,278 times for 28,116 articles. 464 books from the Free Libraries and Public Schools were disinfected. The sum of £5 2s. 6d. was received for disinfection of rooms in special cases, on request of the occupier. A large quantity of horsehair was disinfected for the Army Ordnance Store Department, for the sum of £28 7s. 5d. 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 (306 persons supplied), the Sun Street Mortuary (67 persons supplied), 14, Barge House Road, 118 North Woolwich (20 persons supplied), and at 144a, High Street, Eltham (78 persons supplied). The cost of disinfectants used by the Department in J913 was £48 Is. 5d. The disinfectants used were Corrosive Sublimate; Sulphur and Formalin tablets (for fumigation); Formaldehyde (for praying and disinfecting' books, and for use in the Mortuary); Cyllin (for summer diarrhoea, and sputa, in phthisis); Permanganate of Potash; Jeyes' Corporation Fluid (for dust-pails); and Chloride of Lime (for offal tins). 41a. The Local Government Board called attention to the importance of issuing disinfectants in poison bottles, and accordingly it was decided to discontinue the practice of using' applicants' own bottles, and to purchase dark and ribbed bottles. Applicants are required to leave a deposit on the bottles. HEALTH SHELTER. 42. The Health Shelter was not used during the year nor since 1908. It was used twice in 1906, and once in 1908. 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 179 bodies, compared with 136, 189, and 143, in the three preceding years. 140 were deposited for inquest, and 36 for custody. 92 post-mortem examinations were made. 3 bodies were deposited in the infectious mortuary, compared with 1, 1, and 4, in the three preceding years. 119 The Eltham Mortuary was used for 2 bodies, both for custody, compared with 3 in 1910, 3 in 1911, and 5 in 1912. CEMETERIES. 44. The two Borough Cemeteries were well maintained and no complaint was received. 627 bodies were buried in Woolwich Cemetery, compared with 669, 679, and 540, in the three previous years. There were 764 interments in the Plumstead Cemetery, compared with 696, 690, and 602, in the three previous years. 34 burials took place in Plumstead Churchyard, compared with 59, 51, 47, and 60, in the four preceding years. CLEANSING OF VERMINOUS PERSONS. 45. The station for cleansing verminous persons was opened in November, 1906. During 1913 it was used by 651 persons, compared with 262, 408, 590, 509, and 430, in the five preceding years. The users were 132 adults (viz., 5 females and 127 males) and 519 children (viz., 297 females and 222 males). 4,557 articles were disinfected. The adults came mainly from common lodging-houses, and the children from County Council Schools. An agreement was entered into with the London County Council, dated August 21st, 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 120 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 hy 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. £28 2s. 0d. was paid by the London County Council' for the school children cleansed last year. The cleansing of children is supervised by a school nurse. The Station was found inadequate for its purpose, especially as regards water-closet accommodation. It was extended during 1912 by the provision of another bath, and two closets, according to plans prepared by the Borough Engineer. A box of 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 homes and arranges for necessary disinfection and cleansing of verminous bedding and rooms. PUBLIC BATHS, LAVATORIES, AND CLEANLINESS. 45a. During the year ended March 31st, 1912, there were 100,005 private baths taken at the Borough Council's Public Establishments in Woolwich and Plumstead. The Annual Report for 1912 pointed out the desirability of making baths and lavatory accommodation cheaper in order to encourage cleanliness. 121 Workmen's Baths. A letter has been received from the National Women's Labour League with reference to Industrial Dirt, and asking that the Municipality should set an example in relation to its employees of making provision for personal cleanliness. A pamphlet has also been forwarded showing what is done both in England and abroad in this matter. Everyone appreciates the desirability of personal cleanliness and a daily bath is specially important for men engaged in dirty occupations such as scavenging, dust destructors, etc. Public baths have been a great boon to a large number of people but in the ease of the great majority of workmen the distance from the home, the cost and the time occupied, prevent their frequent use. At certain industrial works in England, and to a much larger extent in certain continental cities, and the United States, employers of labour have either in their own interests or in that of their employees made very elaborate provision for the workmen to wash themselves before leaving their "work. The pamphlet referred to says:— "In the better towns in the United States and Canada the democratic self-respect of the people makes the use of working overalls, and the provision of full cleansing opportunities at the works, all but universal. Citizens of New York over in this country express amazement at our national toleration of the grimy condition of many of the passengers on our tramcars and trains. Their own dustmen, road sweepers, etc., are provided daily with a clean white suit of overalls, and look their part of servants of the Public Health as attractively as our hospital nurses. By all accounts too, the increased self-respect engendered by the uniform reacts most beneficially upon the standard of the cleansing work performed." 122 In 1910 I reported as to the provision for washing at Beckton Gas Works. At these works large lavatory basins are provided supplied with hot and cold water, and also spray baths, and the baths are used very freely in summer, and to. an increasing extent every year. I [was informed that the Gas Company found it to their interest to make such provision. The Borough Council has provided baths at the dust destructors for the workmen but these it appears are being little used. At the Plumstead Destructor there are two slipper baths for about 16 men, but I understand that only three men make use of them and that only about once a week. There are two lavatory basins attached to each bath. These are more used. It appears that the men are mostly in the habit of washing themselves over down to the waist every day before leaving work. Ten minutes or a quarter of an hour is allowed out of every daily shift for th'is purpose. Apparently the men think it necessary to be clean as to the upper half of their bodies, but disregard the lower half. It seems difficult to understand why some of them at any rate should not use the bath every day as it would be easy to take a bath during the quarter of an hour allowed. The provision of spray baths, however, in the place of slipper baths, as at Beckton and many places abroad, is of great advantage. The first cost of spray baths is small compared with that of slipper baths, hence more can be provided, and they can be used much more quickly. With a spray bath a man can wash himself all over in three minutes. There is no doubt than in future when any provision of washing facilities is made for workmen it will be desirable to provide spray baths rather than slipper baths. 123 TENTS, VANS, AND SHEDS. 46 During the year, 42 tents, vans, and sheds were inspected (34 in 1912), and three notices served under the) by-laws for this class of dwelling. NOTICES AND PROSECUTIONS. 47. 3,285 written intimation notices, and 725 statutory notices were served. 79 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 5 defaulters were summoned at the Police Court. The results are given in Table XVII. BACTERIOLOGICAL EXAMINATION. 48. In the early part of last year the Public Health' Committee decided to send its bacteriological work to the Seamen's Hospital. This is situated much nearer than the Lister Institute and there is less delay in obtaining reports. The results have been decidedly satisfactory. 1,168 bacteriological examinations were made for the Public Health Department by the Bacteriological Department of the Seamen'6 Hospital and the Lister Institute, viz.: 921 for diphtheria, 231 for phthisis, and 16 for enterio fever. The total cost was £183 3s. 2d., compared with £205 19s. 8d. in 1912. 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 124 infants for advice and weighing between 2.30 and 4 p.m. Miss FitzGerald and the Medical Officer of Health are in attendance during that time. The Consultation was much better attended last year than ever before, 1,408 infants being seen, compared with 460 and 863 in the two previous years. Further particulars are given in Miss FitzGerahl's Report. WOMEN SANITARY INSPECTORS' WORK. 50. There were two Women Sajnitary Inspectors, one of whom, Miss FitzGerald, is also a Health Visitor. Miss Middlebrooke originally inspected houses registered under the by-laws, workshops where women are employed, restaurants, and eating-houses, re kitchens, etc., public laivatories, houses where certain infectious diseases (e.g., measles) occurred, and houses reported as being verminous or in a dirty condition. During recent years special efforts have been made by the school authority to deal with verminous children, and for these efforts to be successful it has been necessary to inspect the homes of such children, and arrange for the cleansing of those found to be verminous.. This work naturally fell on Miss Middlebrooke, and has grown to such an extent as to take up the greater part of her time. Consequently she has been for some years unable to attend to houses registered under the by-laws nor to measles cases, and it is necessary to leave this work to a male inspector. The by-laws deal mainly with the habits of tenants, especially the housewife's habits, and can consequently be more effectively enforced by a woman who understands women's work and difficulties. 125 Miss Fitz Gerald's duties comprise advising' mothers as to the care of infants, and the prevention of infant mortality, visiting houses where phthisis exists, and notified cases of certain infectious diseases, as enteritis and ophthalmia neonatorum. Miss FitzGerald has never been able to do as much of this work as was desirable, and has been obliged especially to neglect the visiting of cases of infectious disease. The visiting of such cases necessarily nursed at home, as phthisis, measles, enteritis, etc., is work which cannot be properly performed by male inspectors. During the year the Committee sanctioned the employment of an unpaid Health Visitor, who, while gaining experience to fit her for a paid post, gives useful assistance in health visiting and the, infants' consultation. There is still, however, great and increasing need of an additional woman inspector. The following is a summary of Miss Middlebrooke's work for the twelve months:— Women's Lavatories at Railway Stations, etc. Number of Inspections 91 „ Found dirty and defective 5 Restaurants and Eating-Rouses. Number of Inspections 120 „ Defects and dirty conditions found and remedied 31 Factories and Workshops. Number of Inspections of Factories and Workshops 253 „ Notices served 15 ,, New workrooms measured 25 126 Homeworlcers' Premises. Number of Inspections 364 ,, Cases referred to District Inspectors 18 Miscellaneous. Total number of houses visited re Phthisis, Measles, Scabies, Whooping-cough, and Zymotic Enteritis 63 Visits paid for various causes, complaints, etc. 356 „ „ Verminous and dirty houses and bedding 836 Re-visits—estimated 1000 Cases where bedding was found to be in a dirty and verminous condition, and cleansed 250 Total number of cases referred to District Inspectors 157 „ Accumulations of refuse removed 15 „ Early morning inspections 7 ,, Overcrowding—cases found and abated 33 Notices served on tenants re dirty conditions 119 Notices served on landlords and tenants—various 154 51. Miss Middlebrooke refers as follows as to her work re verminous children:— "We hear a great deal nowadays about the welfare of the child as a national asset and its relation to the welfare of the State. This is the day of the child; the air is thick with theories regarding the child's education and health; but how many people outside the Public Health service are aware of the constant and daily warfare being waged at London's Cleansing Stations with dirt and vermin infecting the human body, where children whose parents fail to cleanse their little bodies are taken in hand by public officials, bathed, their hair cut, heads and bodies dressed' 127 where sores are found (sores which are the result of dirth and vermin), and their clothing disinfested, besides being supplied with a box of vermicide ointment. Poor little victims of incapable parents ! their skin disfigured and tortured by thousands of bites. As a matter of fact the parents themselves have verminous bodies in many instances, and constantly re-infest the children after treatment at the Cleansing Station. There is at present no power to compel adults to cleanse themselves, so that the fathers, mothers, adult brothers and sisters of the children can be as verminous as they like,, and, not only can they infest the school children in the same house, but they can jostle shoulders with clean people in the street or in any public conveyance at their own sweet will. The Public Health Department of the London County Council are now considering this question and it is to be hoped we shall soon have power to compel these dirtty< people to cleanse themselves and so be less of a menace to clean people. Those who take part in the working of the present law ask themselves very seriously and very often, "What is the good of such a high and expensive system of education for those poor children who have such bad homes and such parents ?" Parents who allow them to sleep in flea-ridden beds, huddled together for warmth under some old coats, irritated all night, heavy eyed and unrested in the morning, too utterly tired to use their brains during school hours. The provisions of the Children's Act for punishing parents who neglect their children and home is not enforced effectively; the Sanitary Authority should be responsible for taking proceedings under the Act. 128 A few remarks made by the children at the CleansingStation might illustrate the conditions under which they live: One little mite told the attendant that since she had her last bath at the Station and the bedding had been disinfected she had had a good night's rest, whereas before she could not sleep for the "jumping fleas." Another looking up pathetically into the attendant's face said " I do wish you were my mother, you are so kind and gentle." One child protested against her clothes being removed as mother had "stitched her up for the winter," and not even at night did she have them taken off. A little girl asked if she could come every week and bring her sister. These few remarks speak volumes as to the value of the work done. It is wonderful to see the homes gradually improving, the standard of cleanliness getting higher and higher, and the intense desire to please the Inspector that a good many of the women visited display. With the cleaner home comes greater self-respect land respect from the husband and family for the wife and mother. One man informed me that since the home had become bright and clean he had not wanted to go out in the evening at all." 52. The following is Miss FitzGerald's report:— Summary of Inspections. Visits to houses after notification of births 1105 Re-visits 437 Visits re infant deaths 47 129 Zymotic Enteritis cases investigated 348 Re-visits 50 Tuberculous cases 119 Ophthalmia Neonatorum 27 Ophthalmia (reported by Schools) 10 Special visits 88 Infants weighed at Consultation 1408 Health Lectures given 4 Unsuccessful visits (occupiers absent from home) 500 Reported to District Inspectors:— Structural defects 10 Dirty interior walls 17 Other defects 25 Overcrowding 6 "During 1913 I had the assistance in succession of three fully qualified pupil assistants who did temporary health visiting under my supervision. Miss Allnutt (April 2nd to June 30th) paid 308 visits. Miss Lewin (July 2nd to August 29th) paid 242 visits. Miss Evans (September 26th, 1913, to January 29th, 1914) paid 763 visits. As the result of the experience gained in practical work they were all successful in obtaining very satisfactory appointments. The assistance they were able to give me was chiefly (a) In connection with the work of the infant consultations; assisting in weighing babies and entering up case-papers, also in visiting mothers who were irregular in their attendance; 1 130 (b) In following up my visits and reporting as to whether recommendations were being carried out, or any improvement taking place in condition of delicate infante, results of visits to doctors or hospitals, and so on; (c) Assistance with routine clerical work. I frequently visited after them and found they had all been very tactful in their manner and that their visits were very well received. As the result of their assistance I was able to devote more time to difficult cases. I am convinced that it is the intensive work which we are able to do that oounts—the frequent visiting at home and the regular attendance at the consultation. It is gratifying in this connection! to note the increasing use that is being made of the infant consultation. The total number of attendances for 1913 was 1,408, as compared with 863 in 1912 and 460 in 1911. In the Second Report on Infant and Child Mortality issued by the Local Government Board in 1913 the following statement occurs:— "The visitation of infants and young children, and the instruction of mothers as to the details of feeding and of general hygiene form a most important branch of child welfare work. The experience of many countries shows that the maximum of efficiency of such visiting is reached when the children can be referred to an infant consultation." On the whole infant welfare work in Woolwich is carried on under relatively favourable conditions compared with some London Boroughs. There is but a small slum area and there are many open spaces. One great advantage is that most of the houses have gardens, and the people are 131 learning to use them. A baby that sleeps all day in a garden thrives very much better than one which is kept all day in the one or two-roomed tenement used for both living and sleeping by the rest of the family. The great advance made in the open-air treatment of infants is illustrated in an amusing way by the following) reminiscence: Some 15 years ago the wife of a late Mayor of Woolwich received a visit from the Inspector of the Society for Prevention of Cruelty to Children. The Inspector explained that he had received a complaint that Mrs. was exposing her child in an injurious manner. She somewhat indignantly pointed out to him that she was only carrying out the instructions of her medical attendant, Dr. S. Davies, who was then in general medical practice, and had advised that the baby should sleep out of doors in the day time. The salutary practice which is now common was then so unusual as to have excited the horror of the neighbours. There is, however, one hindrance which is constantly; met with even in the better class houses and that is the lack of provision for storing food. It is part of a Health Visitor's duty to advise mothers in the feeding of infants and young children and this involves instruction in (i.) the choice, (ii.) the preparation, and (iii.) the storing of food. To some extent (i.) and (ii.) will depend upon what provision there is for (iii.) In 202 routine investigations made in respect of zymotic enteritis in houses of all classes in the Borough, special note was taken of the accommodation provided for food storing. In 111 cases food was stored in unventilated cupboards. These were usually in the kitchen and were unduly warm owing to proximity to the fireplace. In 61 cases 12 2 132 there was no provision at all and food was kept on open shelves. In 20 cases food was kept in a safe provided by the tenant; and in only 10 cases was there any efficient larder accommodation." PREVENTION OF CARIES AND PRESERVATION OF TEETH. 53. The Inter-Departmental Committee on Physical Deterioration reported in 1904:— " There is no question that the teeth of the people have become much worse of late years, and in many parts of the country may now be described as very bad. Professor Cunningham assigned the real cause of dental degeneration to the change that has taken place in the character of the food in common use. Sir Lauder Brunton laid great stress on the fact that dental caries is due to the cessation of the use of food which requires good mastication, and added that the soft foods are more apt to leave particles behind which cause decay. This view, and the aggravation that lack of cleanliness lends to the conditions of the mouth so produced, were emphasised by a succession of witnesses, lay and professional. Mr. W. H. Dolamore on behalf of the British Dental Association ' had no doubt that bad teeth were a condition of the feeding that accompanies high civilisation. The cruder and coarser sorts of food at one time in use not only kept the jaw in action during the plastic period of its development, but had the effect of a tooth-brush in keeping the teeth free from the settlement of toxic agents.' " 133 The Committee found that it was not poverty or the physical deterioration accompanying poverty or town life which in itself caused decay of teeth, and that the poorer children had better teeth than those of the well-to-do working people. Worse teeth were found in better class schools, no doubt because the poorer children ate coarser foods. An Admiralty and War Office Inter-Departmental Conference on the subject found that:— "Mai-nutrition plays but a very small part in the production of dental caries, as compared with the more; common use of articles of food which readily undergo acid fermentation, and that it is neglect to keep the mouth1 clean that is chiefly responsible for the decay of the teeth." The Committee recommended as remedies for this state of things the teaching of hygiene and the care of the teeth in schools, daily cleansing of the teeth, and systematic examination and treatment of children's teeth by dentists employed by School Authorities. The Committee also expressed the belief that by instructing mothers, through the medium of Health Visitors, as to the proper food for infants, much might be done towards removing dental caries and the evil results to the general health which it produced. The recommendations of the Committee as regards teaching cleanliness and examination of teeth have been taken much to heart by thie nation. The reports of School Medical Officers every year call attention to the large number of defective; teeth found, and some effort has been made to provide treatment for decayed teeth, but the great cost of this seriously 134 interferes with its being carried out. The upper classes are on the whole able to ensure the preservation of the teeth by frequent resort to the dentist. This, however, is much too expensive for the working classes as a whole, and the fact that there is another simpler, cheaper, and better way, viz., regulation of the diet, has not yet received the attention which it deserves. Dr. Sim Wallace has systematised, in a recent work on the prevention of dental caries, the, means of prevention suggested in the evidence given by: Professor Cunningham, Sir Lauder Brunton, Mr. Dolamore, and the Admiralty and War Office Conference. These means are based on the relation between diet and decay of teeth, and Dr. Wallace shows the practicability of adopting such a diet as will prevent decay. He has proved, both theoretically and by practical experience, that it is perfectly possible to so arrange the diet as to prevent the teeth decaying. He gives lists of articles of diet such as new white bread, cake, milk puddings, jam, chocolate and sweets, which are found to cause decay, and of others such as fish, meat, fresh vegetables, stale bread with crust, toast, and baked bread, cheese., and fruits, which not only do not cause decay, but when, eatien after other foods act as natural cleansers of the teeth, and if therefore taken at the end of a meal leave the mouth clean until the next meal. In order to teach the public how by diet the teeth may be preserved, by the Committee's direction, I drew up a short leaflet on the subject for distribution, as .follows:— "TEETH AND DIET.—How to avoid Toothache, and get a good set of teeth. Children will not get strong and regular teeth unless their, jaws have plenty of exercise by eating hard, coarse food 135 which requires chewing. Coarse food, like brown bread and salad, promotes hpalth by increasing the action of the bowels. Decay of teeth is caused by particles of sweet and starchy foods sticking to the teeth between meals; these particles ferment and form acids which eat away at a tooth until the nerve is exposed. Sucking sweete (or eating chocolates) is one of the chief causes of decay. When teeth begin to ache it is often too late to save them. Decayed teeth not only cause toothache but prevent the food being masticated, and produce indigestion and blood poisoning. Enlarged glands, earache and deafness are often due to this cause. Clean teeth do not decay. After eating hard and stringy foods like crusts, lettuce, meat and apples, the mouth is left clean. Such foods are called cleansing foods. How to avoid Decay. 1. As soon an infant has got any teeth it should have stale crusty bread or hard crisp toast with butter, in addition to milk. Don't soak the bread in milk. As the child takes more solid food, the milk should be mixed with water which will prevent it from sticking to the teeth. 2. Strong children over two years, and healthy adults, should only take three or four meals a day, and no food oil any kind between meals. 2a. Children should be taught from infancy to chew their food well before swallowing it. 136 3. Drinking while eating prevents proper chewing; liquids should be taken before or after a meal. 4. Sweets and chooolates should never be taken between meals or the last thing at night. Acid drops are the least injurious form of sweets. A piece of ripe apple or other fruit, which requires chewing, is much better than sweets. 5. A meal should always be finished with a cleansing food (see over), and jam or marmalade should never be taken to finish up with. A slice of apple or other fruit, or a hard crust with butter, is the best thing at the end of a meal. 6. Mouth breathing in children is injurious to the teeth and the general health; as soon as it is noticed a doctor should be consulted. 7. If the above rules are strictly followed the teeth will always keep clean, but as an additional precaution the teeth and gums should be thoroughly cleansed before going to bed and again after breakfast, and the mouth should be rinsed out with water after each meal. A little soap, or precipitated chalk (whiting) is a good thing to clean the teeth with. A match cut to a point and used as a toothpick makes a good toothbrush. Decayed Teeth. As soon as there are any signs of decay, don't wait for the teeth to ache but go to the dentist. The first permanent teeth are big double ones which come at the back, about the age of six or seven years. It is important to watch and see that they do not decay. Examples of Food. The following foods stick to the teeth 137 and cause decay unless cleansing foods are taken after them; they should be followed by a cleansing food:—White bread, sweet biscuits, cake, marmalade, jam, honey, most sweets, chocolate, sweet puddings, patent foods, potatoes. The following are cleansing foods and prevent decay:— Fish, meat, bacon, uncooked vegetables, lettuce, celery, radishes, watercress, cooked greens, and some other cooked vegetables, stale wholemeal bread with crust, crisp toast,, twice baked bread, cheese, butter, margarine, fruits (especially apples and nuts). (N.B.—Some of these, as nuts, celery, and radishes, are not recommended for persons with weak digestion.) Sidney Davies, M.D., Medical Officer of Health. Town Hall, Woolwich." PUBLIC AMBULANCE. 54. The Public Ambulance, for accidents and non-infecr tious illness, was used 150 times, compared with 143, 123, 147, and 127, in the four preceding years. The following were the journeys made:— To Guy's Hospital 30 Cottage Hospitals 48 Seamen's and Miller Hospitals 13 King's Hospital 8 London Hospital 10 St. Thomas' 4 Union Infirmary 4 Other hospitals 11 Private houses 15 Asylums 7 138 Particulars of this ambulance were given in my Annual Report, 1903, page 78. 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., but in spite of this there seems little diminution in the use of the Woolwich Ambulance. NATIONAL INSURANCE ACT. 55. Last year was the first during the whole of whichl the Insurance Act was in force. This Act was intended to be a great measure for promoting the Public Health. It attempted to do this in various ways:—(1) By providing! medical treatment for all insured persons, and so promoting1 their early recovery; (2) By giving a maternity grant which enables mothers to obtain skilled attendance in their confinements; (3) By making special provision for treating! tuberculosis; (4) By allowing the cost of excessive sickness to be surcharged on the person or Municipal Authority] responsible. Your Medical Officer of Health was nominated as a member of the District Insurance Committee, and has attended all the meetings of that Committee, and advised the Chairman on many matters affecting the public health. The part of the Act dealing with tuberculosis has very greatly added to the work of the Public Health Department. The Medical Officer of Health is Chairman of the Tuberculosis Dispensary Executive Committee. His assistance is continually sought for obtaining sanatorium benefit. Records of all cases going to and returning from sanatoria are kept in the Department, and cases returning are visited by the Health Visitor with a view to after care. 139 One complaint was received from a Friendly Society of exoessive sickness alleged to be caused by work at the, Plumstead Destructor. On examination of the Electrical Engineer's returns I was able to show that there was no exoessive sickness, but on the contrary, the average sickness of the employees of the Electricity Works is much below the average. I reported as follows:— "As regards the general question as to the healthiness of the work at the Dust Destructor, I have received no complaints as to the work being injurious or unhealthy, nor has the Secretary of the Society who calls attention, to the excessive sickness. There is no reason to think that such work is directly injurious to health, though it may possibly be so indirectly by exciting a thirst which is not satisfied in a wise manner. The Registrar General gives no statistics in his mortalities of occupations for mien employed at destructors or similar work, but it does not appear from the report on occupational mortality that offensive occupations have a high mortality. Thus tallow, soap, glue, and manure workers have a very low mortality, viz., 689, compared with 1,000 for all males. It is, too, generally stated that workers in sewers and at sewer outfalls have a low mortality, though I am not aware of any reliable statistics on the subject." STAFF. 56. Owing to the great increase in the work of the Department caused by the Insurance Act and the notification of all forms of tuberculosis, the Public Health Committee! decided to replace the deficiency in the staff which hadl existed since the retirment of Mr. Ellis, and Herbert Prescott was appointed Boy Clerk. 140 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 public health and the diminution of sickness and physical inefficiency. 141—142 TABLE I. Borough of Woolwich. Vital Statistics of the whole District during 1913 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 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 130 261 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 1911 121376 2814 23.2 273 98 1402 ... 327 53 212 1561 12.8 1912 123311 2747 22.3 201 73 1249 ... 297 42 196 1420 11.5 Average for years 1902tol912 123660 3249 26.2 339 102 1458 ... 301 47 188 1599 12.9 1913 125686 2876 22.5 229 80 1378 ... 298 50 252 1580 12.3 * 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 Total Population at all Ages 121,376 of acres (exclusive of area covered [ 8239-7 Number of Inhabited Houses 21,463 by water) J Average Number of Persons per House 5.6 At Census of 1911 143 TABLE IA. I. II. Institutions within the District receiving Sick and Infirm Persons from outside the District. Institutions outside the District receiving Sick and Infirm Persons from the District. Woolwich Union Infirmary Royal Arsenal Hospital Auxiliary Hospital Lewisham Infirmary Herbert Hospital Blackheath Cottage Hospital Woolwich andPlumstead Cottage Hospital Seamen's Hospital Brook do. Eltham Cottage Hospital Park do. Home for Mothers and Babies Southern 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 Hospital, Lewisham Children's Hospital West London do. Northern Consumption Hospital Victoria Park Consumption Hospital Downs Sanatorium Maitland and other Sanatoria 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 Bee do. Darenth do. Caterham do. Cii- A Stone do. Ban stead do. H or ton do. Hostel of God do. 144 TABLE II. Cases of Infectious Diseases notified under S. 55, P.H.L.A., during the Year 1913. Notifiable Diseases. Total Cases Notified in whole District. 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 West East Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 626 4 136 429 36 21 ... 206 194 163 63 12 561 Diphtheria 321 3 62 216 24 15 1 171 98 33 19 77 370 Membranous Croup ... ... ... • • • ... • • • ... • • • • • • • • • ... • • • ... Typhoid or Enteric Fever 14 ... 1 5 3 5 ... 7 2 3 2 6 10 Erysipelas 70 1 3 6 8 42 10 21 21 21 7 ... 1 Puerperal Fever 8 • • • • • • ... 3 5 • • • 2 2 4 ... ... 1 Cerebro-Spinal Fever • • • • • • • • • ... ... • • • ... ... ... • • • ... ... ... Ant. Polio Myelitis 1 ... 1 ... ... ... ... 1 ... ... ... ... ... Ophthalmia Neonatorum 14 14 ... ... ... ... ... 5 6 3 ... ... ... Zymotic Enteritis 338 115 138 25 23 33 4 128 86 119 5 ... ... Total 1392 137 341 681 97 121 15 541 409 346 96 95 943 145—146. TABLE III.—Causes of, and Ages at Death during the Year 1913. Disease. Deaths in or belonging to whole District at subjoined ages. Woolwich. Plumst'd Eltham. Residents in Outlying Institutions. Public Institutions 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. 1 75 to 85. Over 85. West. East. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 9 4 5 2 i 4 2 .. .. .. .. .. .. .. .. .. .. 3 3 .. 3 .. 1 Scarlet Fever 8 2 6 1 2 3 2 .. .. .. .. .. .. .. .. .. .. 6 1 1 .. 7 .. Epidemic Influenza 35 21 14 .. 3 .. .. 1 .. .. 1 2 5 11 5 7 .. 6 13 13 3 2 .. Whooping Cough 10 3 7 5 4 1 .. .. .. .. .. .. .. .. .... .. .. 3 4 3 .. 1 .. Diphtheria and Membranous Croup 17 6 11 .. .. 7 8 2 .. .. .. .. .. .. .. .. 12 3 2 14 2 Enteric Fever 1 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. Asiatic Cholera .. .. .... .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea 9 8 1 7 1 .. .. .... .. .. .. .. .. .. 1 .. .. 6 2 1 .. 1 1 Enteritis 40 24 16 32 6 1 .. .. .. .. .. .. .. .. 1 .. .. 16 7 16 1 2 4 Acute Anterior Polio Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Continued Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 3 .. 3 .. .. .. .. .. .. 1 2 .. .. .. .. .. 1 1 1 .. 1 .. Other Septic Diseases 10 3 7 .. 1 .. 2 1 2 1 1 1 1 .. .. .. .. 5 2 2 1 5 1 Syphilis 9 5 4 4 1 .. .. .. .. 1 1 .. 2 .. .. .. .. 3 4 2 .. 3 5 Rheumatic Fever 8 1 7 .. .. .. .. 2 .. 1 2 2 .. 1 .. .. .. 3 1 2 2 .. 2 Gout .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. Intermittent Fever and Malarial Cachexia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Meninges 14 7 7 1 2 2 4 4 1 .. .. .. .. .. .. .. .. 5 4 5 .. 7 .. Tuberculosis of Lungs (Phthisis) 182 115 67 .. 1 4 4 18 26 47 32 31 14 5 .. .. 61 66 40 15 31 35 Tuberculosis of Intestines and Peritoneum 10 7 3 2 1 1 .. .. 1 2 1 2 .. .. .. .. .. 3 3 2 2 5 1 Other forms of Tuberculosis 10 6 4 .. 1 2 .. 1 1 1 2 2 .. .. .. .. .. 5 4 1 .. 5 .. Alcoholism 4 2 2 .. .. .. .. .... .. .. 1 2 1 .. .. .. 2 1 1 .. .. 3 Cancer 127 55 72 .. .. .. .. .. 1 .. 3 13 27 33 3b 12 2 34 55 26 12 19 25 Diabetes 16 9 7 .. .. 1 .. .. .. .. 1 1 1 4 4 1 3 8 2 3 6 4 Congenital debility and malformation, including 83 48 35 81 2 .. .. .. .... .. .. .. .. .. .. .. .. 32 26 20 5 6 15 Old Age 96 42 54 .. .. .... .. .. .. .. .. .. .. .. 16 63 17 27 36 25 8 10 24 Meningitis 10 5 5 1 5 2 .. .. 1 1 .. .. .. .. .. .. .. 4 3 3 .. 1 .. Inflammation and Softening of Brain 7 6 1 .. .. .. .. .... .. .. .. .. .... 3 1 3 .. 5 1 .. 1 1 3 Epilepsy 5 5 .. 1 .. 1 .. 1 .. 2 .. .. .. .... .. .. 1 3 1 .. 1 1 General Paralysis 14 9 5 .. .. .. .. .. .. 1 1 4 5 1 2 .. .. 4 5 5 .. 12 1 Tabes Dorsalis and Locomotor Ataxia 1 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. Peripheral Neuritis 3 1 2 .. .. .. .... .. .. .. .. 1 2 .. .. .. .. 2 .. 1 .. 2 Other Diseases of Brain and Nervous System 33 13 20 12 2 .. .. .. 1 1 1 4 3 2 5 2 .. 8 8 12 5 5 7 Organic Diseases of the Heart 149 80 69 1 .. .. .. 4 4 5 8 14 20 39 39 14 1 50 52 36 11 14 29 Cerebral Haemorrhage, Embolism and Thrombosis 82 37 45 .. .. .. .. .. .. .. 2 2 11 22 20 25 .. 23 32 17 10 5 22 Apoplexy and Hemiplegia 17 6 11 .. .. .. .. .. .. 1 .. 3 1 7 4 l 6 8 2 1 .. 6 Aneurism 14 14 .. .. .. .. .. .... .. .. .. 3 8 3 .. .. .. 4 6 3 1 1 2 Other diseases of blood vessels and heart 50 27 23 .. .. .. .. .. 1 .. 1 6 6 10 16 8 2 19 11 14 6 9 6 Bronchitis 145 80 65 18 6 1 1 .. .. .. 2 3 7 20 37 41 9 49 48 37 11 2 28 Lobular (Broncho) Pneumonia 41 19 22 23 9 3 1 .. .. .. 2 .. .. 2 .. 1 .. l6 11 10 4 5 6 Pneumonia 67 45 22 5 2 3 2 1 6 2 3 9 11 6 12 8 .. 27 19 13 8 10 9 Other Diseases of Respiratory System 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. Diseases of Stomach 15 9 6 3 .. .. 1 .. 1 .. 1 .. 3 1 1 1 .. 5 2 7 1 3 .. Appendicitis and Typhlitis 9 6 3 .. .. .. 2 2 1 1 .. .. 2 1 .. .. .. 4 4 1 .. 6 2 Obstruction of Intestines 13 6 7 1 2 .. .. .. 1 .. 2 1 2 2 2 .. .. 5 5 3 .. 4 5 Cirrhosis of Liver 11 8 3 .. .. .. .. .. .. .. .. l 4 4 2 .. .. 3 3 .. .. .. Other Diseases of the Digestive System 17 11 6 8 1 1 .. .. .. .. .. .... .. .. .... .. .. 18 18 .. .. .. Nephritis and Bright's Disease 57 38 19 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 8 .. .. .. .. Tumours and other Affections of Female Genital Organs 4 .. 4 .. .. .. .. .. .. .. .. 2 .. .. 1 1 .. .. .. .. .. .. .. Accidents and Diseases of Pregnancy, Parturition 3 .. 3 .. .. .. .. .. 1 .. 2 .. .. .. .. .. .. .. .. ..c .. .. .. Violence 36 25 11 6 2 3 1 2 1 2 3 4 1 4 3 4 .. 16 10 6 4 11 6 Suicide 20 17 8 .. .. .. .. .. 1 .. .. .. 1 1 .. .. 1 6 7 5 2 1 3 I11 defined diseases or unknown 13 5 8 8 .. .. .. .. .. .. .. .. .. .. .. .. 8 3 2 .. 1 8 Other defined diseases 42 25 17 12 1 2 2 .. 2 1 3 4 4 5 4 2 .. 15 16 8 3 8 8 Total 1580 868 712 229 55 38 | 34 25 44 48 109 134 177 208 240 206 33 543 532 374 131 252 298 147—148 TABLE IV. Infant Mortality. 1913. Nett 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 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total Deaths under 1 year. All Causes Certified No uncertified Deaths .. •• .. •• •• Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .... .. .. .. 1 1 2 Scarlet Fever .. .. .. .. .. .. .. 1 .. 1 Whooping-cough .. .. .. .. .. .. .. 2 1 5 Diphtheria and Croup .. .. .. .. .... .. .. .. .. •• Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .... .. .. .. .. 1 .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. 2 2 Other Tuberculous Diseases .. .. .. .... .. .... .. .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. 1 Convulsions 2 2 2 .. 6 2 2 2 1 13 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. 1 6 3 6 2 18 Pneumonia (all Forms) .. .. .. .. 3 6 6 6 7 28 Diarrhoea .. .. .. .. .. 3 3 .. 1 7 Enteritis .. .. .. 1 1 8 7 14 2 32 Gastritis .. .. .. 1 1 1 1 .. .. 3 Syphilis .. .. .. .. 1 2 1 .. .. 4 Rickets .. .. .. .. .. .. .. 1 .. 1 Suffocation, overlying .. .. .. .. .. 1 .. .. .. 3 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis 8 .. .. .. 8 .. .. .. .. 8 Congenital Malformations 3 1 .. .. 4 2 .. .. 3 9 Premature Birth 26 3 1 4 34 6 1 .. .. 41 Atrophy, Debility, and Marasmus 9 3 5 4 21 5 3 2 .. 31 Other causes 8 .. 2 .. 10 3 2 1 3 19 58 12 11 11 92 47 29 37 24 229 Nett Births in the year{Legitimate,2811. {Illlegimate, 65. Nett Deaths in the year of {Legitimate Infants, 215. {Illegitimate Infants, 14. * . 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. Avge. _ 1891-5 0.15 0.01 ... ... 0.87 0.05 1.38 0.38 6.05 0.25 0.00 ... 0.94 0.17 ... ... 0.09 0.03 18961900 0.01 ... 0.01 ... 0.89 0.04 2.74 0.48 5.48 1.34 ... ... 0.54 0.08 ... ... 0.06 0.04 1901-5 0.43 0.06 ... ... 0.62 0.02 1.71 0.16 3.14 0.07 ... ... 0.34 0.07 ... ... 0.06 0.03 1906 ... • • • ... ... 0.76 0.02 3.13 0.1/ 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 ... ... 0.06 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 1912 0.02 0.01 ... ... 0.71 0.02 3.09 0.16 3.80 0.03 ... ... 0.15 0.02 ... ... 0.02 0.01 1913 ... ... ... ... 0.55 Nil 1.91 0.13 4.80 0.06 ... ... 0.06 0.01 ... ... 0.0.6 0.02 149 101—102 TABLE VI. London and the Metropolitan Boroughs.—Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 53 weeks ended 3rd January, 1914.* Boroughs. Population estimated to the middle of 1913.† Births. Deaths from Deaths under 1 year of Age. All Causes, Enteric Fever. - Small-pox. Measles. Scarlet Fever. Whooping-cough. Diphtheria. Diarrhoea and Enteritis (under 2 years). Pulmonary Tuberculosis. County of London 4,518,191 112,637 65,030 114 — 1570 188 800 431 3098 5981 11,869 West. Paddington 142,210 3055 1941 6 — 55 7 37 12 71 157 305 Kensington 171,284 3357 2377 4 — 84 3 29 6 80 188 375 Hammersmith 123,745 3043 1754 — — 47 7 47 12 64 151 314 Fulham 157,117 4302 1992 8 — 50 3 27 14 98 209 414 Chelsea 64,598 1257 911 1 — 18 3 5 1 24 81 113 City of Westminster 154,810 2227 1992 3 — 22 7 7 8 52 206 213 North. St. Marylebone 114,532 2221 1633 5 — 33 10 10 6 37 158 202 Hampstead 86,346 1326 938 1 — 21 4 11 3 18 50 97 St. Pancras 214,330 5512 3321 6 — 41 6 31 16 114 327 508 Islington 325,585 8357 5009 5 — 107 17 61 34 221 441 894 Stoke Newington 50,518 1144 698 2 — 11 1 6 6 16 48 94 Hackney 223,353 5522 3037 4 — 68 11 23 11 141 261 549 Central. Holborn 46,949 798 698 — — 10 — 6 4 15 89 83 Finsbury 84,679 2547 1576 — — 30 4 31 9 97 173 352 City of London 17,916 167 276 2 — — 1 2 1 2 27 16 East. Shoreditch 109,654 3513 2068 1 52 3 29 14 207 200 546 Bethnal Green 127,824 3998 2006 4 — 62 3 34 10 151 201 470 Stepney 275,300 8187 4172 11 — 95 8 26 22 287 471 916 Poplar 160,913 5230 2668 5 — 69 12 38 34 159 239 586 South. Southwark 188,487 5936 3343 6 105 11 38 19 182 354 682 Bermondsey 124,739 3896 2266 3 — 90 4 47 17 165 204 513 Lambeth 297,139 7233 4314 8 — 99 14 47 37 202 389 736 Battersea 167,464 4s39 2361 6 — 93 7 28 20 125 192 469 Wandsworth 330,395 6840 3550 5 — 116 11 23 16 148 288 603 Camberwell 261,805 6671 3653 5 — 68 13 54 18 179 306 708 Deptford 109,280 3103 1704 2 — 50 3 46 17 93 144 347 Greenwich 96,015 2541 1385 2 — 40 2 24 12 52 114 262 Lewisham 168,822 3522 1814 8 — 25 5 23 35 50 127 273 Woolwich 122,382 2893 1573 1 — 9 8 10 17 48 186 229 * For the purpose of this table the Births registered in London have been corrected by distributing those which occurred in the principal institutions receiving maternity cases to the boroughs in which the mothers resided. In 1253 oases the residence was outside the County of London, and these cases have been excluded. On the other hand 44 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 3412 cases, while on the other hand the deaths of 2973 London residents occurred in the Outer Ring or in Metropolitan Institutions outside Greater London, †Based on the results of the Censuses of 1901 and 1911. 153—154 TABLE VII. London and the Metropolitan Boroughs.—Birth.rates and Death.rates of Persons belonging to London and the Metropolitan Boroughs during the 53 weeks ended 3rd January, of 1914. Boroughs. Per 1,000 Persons Living. Rate per 1000 Births. Births. Deaths from All Causes. Enteric Fever. Small.pox. Measles. Scarlet Fever. Whooping.cough. Diphtheria. Pulmonary Tuberculosis Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. Crude. . Standar dized. County of London 24.5 14.2 14.2 0.02 .. 0.34. 0.04 0.17 0.09 1.30 27.50 105 West. Paddington 21.1 13.4 13.4 0.04 .. 0 38 0.05 0.26 0.08 1.09 23 24 100 Kensington 193 13.7 13'6 002 .. 0.48 0.02 0.17 0.03 1.08 23.83 112 Hammersmith 24.2 13.9 13.8 .. 0.37 006 0.37 0.10 1.20 21.03 103 Fulham 26.9 12.5 12.9 0.05 .. 0 31 002 0.17 0.09 1.31 22.78 96 Chelsea 19.1 13 9 13.2 0.02 .. 0.27 005 008 002 1.23 19 09 90 City of Westminster 14.2 12.7 13 3 002 .. 0.14 0.04 0.04 005 1.31 23.35 96 North. St. Marylebone 19.1 14.0 14.3 0.04 .. 0.28 0.09 0.09 005 1.36 16.66 91 Hampstead 15.1 10.7 11.3 001 .. 0.24 005 0.13 003 0.57 13.57 73 St. Pancras 25.3 15.2 15.2 0.03 .. 0.19 003 014 0.07 1.50 20.68 92 Islington 25.3 15.1 14.8 002 .. 0.32 005 0.18 0.10 1.33 26.44 107 Stoke Newington 22.3 >3.6 12.9 0.04 .. 0.21 0.02 0.12 0.12 0.93 13.99 82 Hackney 24.3 13.4 13.5 0.02 .. 0.30 0.05 0.10 0.05 1.15 25.53 99 Central. Holborn 16.7 14.6 14.7 .. .. 0.21 013 008 1.87 18.80 104 Finsbury 29.6 18.3 18.1 .. .. 0.35 0 05 0.36 0.10 2.01 38 08 138 City of London 9.2 15.2 15'8 0.11 •• •• 005 0.11 005 1.48 11.98 96 East. Shoreditch 31.5 18.6 19.2 001 .. 0.47 0.03 0.26 0.13 1.79 58 92 155 Bethnal Green 30.8 15.4 161 0.03 .. 0.48 0.02 0.26 0.08 1.55 37.77 118 Stepney 29.3 14.9 15.6 0.04 .. 0.34 0.03 009 0.08 1.68 35.06 112 Poplar 320 16.3 16.1 0.03 •• 0.42 007 0.23 0.21 1.46 30.40 112 South. Southwark 31.0 17.4 17.6 003 .. 0.55 0.06 0.20 0.10 1.85 30.66 115 Bermondsey 30.7 179 17.8 002 .. 0.71 0.03 0.37 0.13 1.61 42.35 132 Lambeth 23.9 14.3 14.0 0.03 .. 0.33 005 0.16 012 1.29 27.93 102 Battersea 24.9 13.9 14.0 0.04 .. 0.55 004 0.16 0.12 1.13 29.49 111 Wandsworth 20.4 10.6 106 0.01 .. 0.35 003 0.07 0.05 0.86 21.64 88 Camberwell 25.1 13.7 13.6 0.02 .. 0.26 0.05 0.20 0.07 1.15 26.83 106 Deptford 27.9 15.3 15.2 0.02 .. 0.45 0.03 0.41 015 1.30 29.97 112 Greenwich 26.0 14.2 14.0 0.02 .. 0.41 002 0.25 012 1.17 20 46 103 Lewisham 20.5 10.6 10.4 0 05 .. 0.15 0.03 0 13 0.20 0.74 14.20 78 Woolwich 23 3 12 6 130 001 .. 0 07 006 0 08 0 14 1 50 16 59 79 The Standardized Death.rates represent the Crude Death.rates multiplied by the respective Standardizing Factors in order to make Correction for differences of sex and age constitution of the several populations in 1911 as compared with that of England and Wales in 1901. 155—156 TABLE VIII. Meteorology and Registered Deaths from all Causes and from certain Prevalent Diseases for the Year 1913. Week 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. Under 2, Diarrhoea and Enteritis. Bronchitis and Pneumonia. All causes. 1913. January 4 51.2 32.1 44.6 + 46.80 86 4 0.15 1 8 38 ,, 11 51.4 33.1 42.1 + 46.18 93 3 0 66 - - 24. ,, 18 48.1 26.2 38.5 + 44.49 88 5 0.66 1 9 36 ,,25 52.1 32.0 42.3 + 43.63 89 6 0.70 - 6 29 February 1 50.2 28.1 39 6+ 43.63 90 5 0.78 1 8 42 ,, 8 55.0 33.3 46.7 + 43.78 81 3 0.26 - - 42 ,, 15 53 5 30.2 40.6 + 44.51 92 3 0.19 - 4 29 ,, 22 46.0 27.8 36.0— 42.87 75 2 0.04 - 12 4.1 March 1 530 24 2 41.3 + 41.92 75 2 0.08 - 6 32 ,, 8 59 0 33.4 46.7 + 43 35 78 4 0.24 - 9 43 ,, 15 56.2 29.0 45.4 + 44.33 82 2 0.28 - 11 39 ,, 22 56.8 28.2 43 .0+ 44.16 77 6 1.42 - 7 38 ,, 29 56.7 29.0 43.4 + 44.13 85 6 0.49 — 6 37 1st Quarter 59.0 24.2 42.3 44.14 84 51 5.95 3 103 466 April 5 57.0 330 45.5— 44. 73 81 4 0.33 - 6 24. ,, 12 55.0 33.2 42.0— 45.19 75 3 0.53 - 5 32 ,, 19 57.9 290 44.4— 44.89 75 5 0.50 - 5 28 ,,26 67.2 33.1 50.6+ 46.47 75 4 0 32 - 5 43 May 3 64.9 39.6 52.0 + 48.57 78 6 0.60 - 6 25 ,, 10 63.2 36.3 49. 9+ 49.40 80 7 0.62 - 6 33 ,, 17 70.6 39.4 53.7 + 50.51 73 2 0.05 - 2 19 ,, 24 74.9 37.1 54.4 + 51.70 71 2 0 .02 - 5 30 ,, 31 83.5 45.2 64 9 + 55.07 67 2 0.40 - 1 26 June 7 79.1 42.2 58.0— 57.18 74 2 0.12 - 6 26 ,, 14 70.7 43.1 56.9— 57 08 73 1 0.14 - 2 26 ,, 21 871 43.8 62.3 + 58.47 68 1 0.41 - - 18 ,, 28 78.3 47.1 59.2— 59.29 69 3 0.06 1 2 23 2nd Quarter 87.1 29.0 53.4 51.43 74 42 4.10 1 51 345 July 5 79.5 49.1 59 9— 59.82 75 4 0.21 - 3 14 ,, 12 75.8 46.2 57 2— 59 40 78 3 1 .33 - 2 25 ,, 19 73.8 51.2 60 0— 59.61 85 5 0.52 1 3 22 ,, 26 71.3 48.7 57.5— 5945 78 1 0.05 1 1 30 August 2 75.0 50 1 59.5— 59.73 81 - 0.00 1 - 13 ,, 9 75.2 45.4 571— 60 24 73 1 0.09 1 3 26 ,, 16 750 49.3 60.7— 60.10 75 4 0.14 1 2 30 ,, 23 80 0 49.2 60.9— 60.58 74 1 0.36 3 2 25 ,, 30 79.2 45.0 62 8 + 60.62 76 4 0.51 9 2 25 September 6 680 53.5 59.1— 60.63 91 4 1.43 7 1 24 ,, 13 71.6 45.3 58.0— 59 96 79 1 0.06 3 1 ,, 20 70 9 421 549— 59 03 82 6 0.60 6 1 29 ,, 27 77.4 46.0 60.2 + 58.46 82 2 0.13 2 2 20 3rd Quarter 800 42.1 59.1 59.82 79 36 543 35 23 310 October 4 70.9 48 1 585 + 58.75 84 1 0.22 3 3 27 ,, 11 63.2 42 1 52 9 + 57.84 85 4 1 .28 1 3 29 ,, 18 64.2 389 52.8 + 56 30 85 1 0.12 1 3 40 ,, 25 61.9 36.1 49.3 + 55.31 90 2 0.57 - 5 37 November 1 64.2 43.6 54.1 + 54 25 84 6 0.57 - 6 37 ,, 8 59 2 36.1 48.3 + 53.53 81 6 1.27 - 5 28 ,, 15 59.1 36.0 49.0+ 51.92 86 5 1 .50 2 6 33 ,,22 59.5 31.7 48.9 + 5115 80 3 0.63 - 4 28 ,, 29 57 0 276 46.3 + 50 01 89 1 0.03 - 4 24 December 6 54.0 350 46.8 + 49.93 83 6 0.31 - 7 31 ,, 13 54.6 36.9 462 + 48.80 82 1 0.02 1 3 28 ,, 20 50.5 32.1 42.8 + 48.12 81 0.01 — 6 26 ,,27 51 0 30 2 39.2 + 46.24 83 4 0.53 — 9 5 34 31 4th Quarter 70.9 276 48.8 52.47 84 41 6 89 8 66 396 Year 87.1 24.2 509 51.96 80 170 22.37 47 243 1517 ■ 157 TABLE IX. Weekly Averages. Period. Temperature of the Air. Temperature 3 feet below ground. Mean Humidity Complete Saturation = 100. Number of days on which rain fell in each week. Average Weekly Rainfall in inches. Deaths corrected for Public Institutions. Average of Weekly Maxima. Average of Weekly Minima. Average of Weekly Means. Diarrhoea and Enteritis (under 2 years). Bronchitis and Pneumonia. All Causes. 1st Quarter 53.0 29 7 42.3 44.14 84 3.9 0.46 0.23 7 33 2nd Quarter 69.9 38'6 53.4 51.43 74 3.2 0.32 0.08 4 27 3rd Quarter 74.8 47.8 59.1 59.82 79 2.8 0.42 2.69 2 24 4th Quarter 59.2 36.5 48.8 52.47 84 3.2 0.53 0.61 5 30 158 TABLE X. Summary of Statistics for the 1st Quarter ending March 29th, 1913, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Bates calculated per 1,000 Population. Population estimated to middle of 1912 Births. Deaths under one year. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 123,311 714 23.2 68 95 411 84 14 69 466 15.1 B. Birth and Death Hates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of 1912 Birth Rate. Death Bate at all ages. Deaths under 1 year, per 1000 births. Population estimated to middle of 1912 . Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population estimated to middle of 1912. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. A B c D A B c D A B c D 37,030 27.4 16.7 118 West 40,943 19.8 17.1 98 14,050 15.1 10.5 113 East 31,288 261 12.7 59 159 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 0.2 Rheumatic Fever 2 1.8 Tubercle of Lung 45 ]. 55.6 Measles 3 9.6 Other Tuberculous Dis 10 Scarlet Fever 2 2.8 Alcoholism and Cirrhosis 5 5.4 Influenza 17 13.4 of Liver Cancer and Sarcoma 31 25.4 Whooping Cough 2 7'6 Diphtheria & Mem. Croup Enteric Fever 3 5.6 Bronchitis 65 57 — 0.4 Broncho.Pneumonia 14 | 36.6 Diarrhœa and Enteritis 3 2.8 Pneumonia 24 Erysipelas — 1.2 Violence 8 8.0 Puerperal Fever 1 0.6 Suicide 5 2.8 TABLE XI. Summary of Statistics for the Second Quarter, ending June 28tb, 1913, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 population. Population estimated to middle of 1913. Births. Deaths under 1 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. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 125,846 730 23.2 38 52 300 74 14 59 345 110 K 2 160 B. Birth and Death Bates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of 1913. Birth Rate. Death Rate at all ages. Deaths under 1 year p. r l,000 Births. Population estimated to middle of 1913. Birth Rate. Death Rate at all ages. Deaths under 1 year per 1,000 Births. Population estimated to middle of 1913. 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 38,070 24.2 12.2 70 West 41,458 East 31,878 21.0 261 11.5 110 23 68 14,440 20.5 6.1 41 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 3 1.8 Measles 5 13.2 Tubercle of Lung 35 50.6 Scarlet Fever 4 2..8 Other Tuberculous Dis. 6 Influenza 11 6.2 Alcoholism and Cirrhosis of Liver 3 6.8 Whooping Cough 3 7.8 Diphtheria and Mem. Croup 7 3.8 Cancer 27 23.2 Enteric — 0.4 Bronchitis 26 18.8 Diarrhoea and Enteritis 1 2. 0 Broncho-Pneumonia 4 25.0 Erysipelas — 0.8 Pneumonia 21 Puerperal Fever - 0.6 ViolenCe Suicide 10 5 8.8 4.0 161 TABLE XII. Summary of Statistics for the Third Quarter, ending September 27th, 1913, corrected for Public Institutions :— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population. Population estimated to middle of 1913. Births. Deaths under one year. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Number. Rate. Number. Rate per 1,000 Births Registered. Number Number. Rate. 125,846 729 23-2 59 81 274 66 12 48 310 9.9 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of 1913. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 Births. Population estimated to middle of 1913. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 , Births. Population estimated to middle of 1913. 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 38,070 28.6 11.8 81 West 41,458 21.0 9.2 64 14,440 14.7 8.3 38 East 31,878 23.3 9.7 113 162 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 0.8 Measles 1 3.4 Tubercle of Lung 34 39.8 Scarlet Fever 2 2.0 Other Tuberculous Dis. 6 Influenza 1 1.2 Alcoholism and Cirrhosis of Liver 4 5.4 Whooping Cough 3 2.8 Diphtheria and Mem. Croup 3 1.6 Cancer and Sarcoma 33 32.0 Enteric Fever 1 0.6 Bronchitis 10 10.4 Diarrhoea and Enteritis 35 802 Broncho.Pneumonia 8 11.0 Erysipelas - 0.8 Pneumonia 5 Puerperal Fever — 04 Violence 8 8.6 Suicide 3 3.4 TABLE XIII. Summary of Statistics for the Fourth Quarter, ending January 3rd, 1914 (14 weeks), corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 population. Population Estimated to middle of 1913 Births. Deaths under 1 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. Rate. Number.| Rate per 1,000 Births Registered. Number. Number. Rate. 125,686 703 20.8 58 82 393 73 9 60 444 13.1 163 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population, Estimated to middle of 1913 Birth Rate. Death Rate Deaths under 1 year, per 1,000 births. Population, Estimated to middle of 1913 Birth Rate. Death Rate Deaths under I year, per 1,000 births. Population, Estimated to middle of 1913 Birth Rate. Death Rate Deaths under 1 year, per 1,000 births. A B C D A B c D A B . c D 37,850 26.8 14.8 70 West 41,478 17.2 12.6 89 14,440 16.2 111 63 East 31.918 20.4 12.6 103 C. Deaths from Certain Causes in whole Borough. Cause of Death. Total. Average for 4th Quarters of the last 5 years. Cause of Death. Total. Average for 4th Quarters of the last 5 years. Smallpox Rheumatic Fever 2 7.4 Measles — 2.8 Tubercle of Lung 62 48.8 Scarlet Fever — 1.8 Other Tuberculous Dis. 9 Influenza 6 8.4 Alcoholism and Cirrhosis of Liver 7 7.2 Whooping Cough 3 2.8 Diphtheria and Mem. Croup 4 4.4 Cancer and Sarcoma 37 30.8 Enteric Fever — 0.4 Bronchitis 43 394 Diarrhoea and Enteritis 8 8.6 Broncho.Pneumonia 13 Erysipelas — 1.6 Pneumonia 19 21 6 Puerperal Fever 2 0.2 Violence 6 8.4 Suicide 3 1.2 165—166 TABLE XIV. Weekly Deaths from various causes for the whole Borough, 1913, corrected for Public Institutions. Week ending Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Mem. Croup. Enteric Fever. Diarrhoea (under 2 years). ' Enteritis (under 2 years). Erysipelas. Puerperal Fever. Rheumatic Fever. Tubercle of Lung and acute Tuberculosis. Other Tuberculous diseases. Alcoholism and Cirrhosis of Liver, and Per. Neuritis. Cancer and Sarcoma. Bronchitis. BronchoPneumonia. Pneumonia. Violence. Suicide. January 4 .. .. .. .. .. .. .. .. 1 .. .. .. 2 1 .. 3 7 .. 1 1 1 ,, 11 .. .. .. 1 .. .. .... .. .. .. .. .. 1 1 .. 3 3 3 .. 1 .. ,, 18 .. .. .. .. .... .. .. .. 1 .. .. .. 5 1 1 3 3 3 3 1 •• 25.. .. .. .. .. .. .. .. .. .. .. .. •• 4 .. 1 .. 6 .. .. .. .. February 1 .. .. .. 2 .. 1 .. .. .. .. .. .. 5 1 1 i 0 .. 3 .. .. ,, 8 .. .. .. 1 .. .. .. .... .. .. .. .. 5 1 .. 5 3 1 .. .. .. ,, 15 .. .. 1 2 .. .. .. .. .. .. .. .. 3 .. .. 3 8 1 2 1 1 ,, 22 .. .. .. 3 .. .. .. .. .. .... .. .. 1 .. .. 3 .. .. .. .. .. March 1 .. .. .. 1 .. .. .. .. .. .. .. 1 2 3 .. 2 5 .. l .. 1 ,, 8 .. 2 .. 2 .. 2 .. .. .. .. .. .. 2 3 .. 1 7 .. 2 1 1 ,, 15 .. .. 1 .. 1 .. .. .. .. .. .. 1 4 2 .. 2 4 1 6 .. 1 ,, 22 .. .. .. 2 .. .. .. .. .. .. .. .. 7 .. .. 3 5 .. 2 1 1 ,, 29 •• 1 •• 3 1 .. .. .. .. .. .. .. 4 .. 2 2 3 1 2 1 •• 1st Quarter .. 3 2 17 2 3 1 2 1 2 45 10 5 31 65 14 24 8 5 April 5 .. .. .. 2 ,. .. .. .. .. .. .. .. 2 .. .. .. 4 .. 2 1 1 ,, 12 1 1 1 .. 1 .. .. .. .. .. 1 5 1 .. 1 3 .. 2 .. 1 ,, 19 .. .. .. 3 .. .. .. .. .. .. .. 1 3 .. 1 3 3 1 1 .. .. ,, 26 .. 1 .. 2 .. .. .. .. .. .. .. .. 4 2 1 3 4 .. 1 •• •• May 3 .. .. .. 1 .. .. .. .. .. .. .. .. 4 2 .. 1 2 1 3 1 2 ,, 10 .. .. .. .. 1 .. .. .. .. .. .. .. 5 .. .. 3 2 .. 4 2 •• ,, 17 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 1 .. .. 2 .. .. ,, 24 .. 1 1 2 .. 1 .. .. .. .. .. .. 3 1 .. 1 3 .. 2 .. .. ,, 31 .. 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. 1 .. 1 .. 1 1 June 7 .. .. 1 .. .. 3 .. .. .. .. .. .. 1 .. .. 4 l 1 3 2 .. ,,14 .. .. 1 .. .. 1 .. .. .. .. .. .. 2 .. .. 2 2 .. .. 1 .. ,, 21 .. 1 .. .. .. 1 .. .. .. .. .. .. 3 .. .. 2 .. .. .. 1 •• ,, 28 .. .. .... .. •• .. .. .. 1 .. .. .. 1 .. .. 5 1 1 1 .. 2nd Quarter .. 5 4 11 3 7 .. .. 1 .. .. 3 35 6 3 27 26 4 21 10 5 July 5 .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. .. 1 2 1 ., . . .. ,, 12 .. .. .. .. .. 1 .. .. .. .. .. 1 2 1 1 1 .. 1 1 2 1 ,, 19 .. .. 1 .. .. .. .. .. 1 .. .. .. 2 .. 1 1 2 1 .. 2 1 ,, 26 .. .. .. .. .... .. .. .. 1 .. .. .. 7 .. .. 3 .. .. 1 .. .. August 2. .. .. 1 .. .. .. .. .. .. .. .. .. 2 .. .. 2 .. .. .. .. .. ,, 9 .. .. .. .. .. .. .. .. 1 .. .. .. 3 l .. 3 1 .. 2 2 .. ,, 16 .. .. .. .. .. .. .. 1 .. .. .. 3 1 .. 2 .. 1 1 • • .. ,, 23 .. .. .. .. .. .. .. .. 3 .. .. .. 1 1 .. 6 1 1 .. 1 .. ,, 30 .. .. .. 1 .. .. .. 3 6 .. .. .. 2 .. .. 2 .. 2 .. .. .. September 6 .. .. .. .. .. .. .. 2 5 .. .. .. 3 1 .. 1 1 .. .. .. .. ,, 13.. .. .. .. .. .. .. .. 1 2 .. .. .. 4 1 .. 3 .. 1 .. •• 1 ,, 20 .. .. .. .. .. .. .. .. 6 .. .. .. 3 .. .. 4 i .. .. .. .. ,, 27 .. .. .. .. .. .. .. •• 2 .. .. .. 1 •• .. 4 2 •• .. 1 .. 3rd Quarter .. 1 2 1 .. 3 1 7 28 .. .. 1 34 6 4 33 10 8 5 8 3 October 4 .. .. .. 1 .. .. .. .. 3 .. .. .. 2 .. .. 1 1 2 .. .. 1 ,, 11 .. .. .. .. .. .. .. .. 1 .. .. .. 6 .. 1 1 1 .. 2 1 1 ,, 18 .. .. .. 1 .. 2 .. .. 1 .. .. .. 5 1 .. 4 3 .. 2 1 .. ,, 25 .. .. .. .... .. .. .. .. .. .... .. .. 7 2 .. 5 3 1 2 .. .. November 1. .. .. .. .. .. .. .. .. .. .. .. .. 7 .. .. 1 3 1 1 .. .. ,, 8 .. .. .. .. .. .. .. .. .. .. .. .. 4 1 1 3 1 3 2 .. .. ,, 15 .. .. .. .. .. .. .. .. .. .. .. .. 4 .. .. 3 1 .. 3 1 .. ,, 22 .. .. .. .. .. 1 .. .. .. .. .. .. 5 .. 1 4 3 .. 1 .. .. ,, 29 .. .. .. .. .. .. .. .. .. .. .. .. 3 1 .. 5 5 .. 2 1 .. December 6 .. .. .. .. .. 1 .. .. .. .. .. .. 3 .. 2 4 2 1 .. 2 .. ,, 13 .. .. .. .. .. .. .. .. .. .. .. .. 4 .. .. 1 3 1 2 .. .. ,, 20 .. .. .. 1 2 .. .. .. .. .. .. 1 3 2 .. 1 6 2 1 .. .. ,, 27 .. .. .. 2 .. .. .. .. .. .. .. .. 3 2 1 .. 3 1 1 .. .. January 3 .. .. .. 1 .. .. .. .. .. .. 1 1 6 .. 1 4 8 1 .. .. .. 1914 4th Quarter .. .. .. 6 3 4 .. .. 8 .. 2 2 62 9 7 37 43 13 19 6 3 Whole Year (53 weeks) •• 9 8 35 11 17 1 8 39 •• 3 8 176 31 19 128 44 39 69 32 16 167—168 TABLE XVA. Summary of Nuisances Abated, Notices served, and General Work of Public Health Department, 1913. 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, nouse to house 630 1157 655 1013 894 626 256 258 5489 ,, Re-inspections after service of Notice (estimated) 1560 1680 1737 1870 1830 1120 1150 490 11437 ,, Houses and premises specially inspected, including infectious diseases and complaints 1039 628 1182 1086 939 496 901 245 6516 ,, Houses where drains have been tested by smoke test 30 28 32 49 15 12 8 4 178 ,, Houses where drains have been tested by water test 10 15 22 5 10 16 17 2 97 ,, New Houses inspected for Water Certificates •• .. .. 12 97 •• 66 •• 175 NUISANCES ABATED—DItAINS. Waste-pipe from baths, lavatories, and wash-house sinks, repaired or disconnected 60 26 40 12 49 7 16 22 232 Choked and defective drains 72 99 84 28 89 24 24 28 448 Defective traps 19 7 12 6 1 9 5 4 63 Defective and unventilated soil pipes 1 1 9 4 •• •• 3 1 19 W.C.'s. W.C.'s repaired, new traps or pans provided 35 33 61 14 46 76 36 33 334 Water supply apparatus repaired or renewed 110 63 36 63 90 50 17 22 451 Foul pans cleansed 42 27 22 52 18 17 17 14 209 Additional w.c.'s provided to Factories & Workshops, &c. .. .. .. .. .. 2 .. .. 2 Do. do. dwelling houses 4 .. •• •• •• •• .. .. 4 PREMISES. Underground rooms not in accordance with Act 2 .. 1 .. .. .. .. .. 3 Interiors cleansed and defective roofs repaired 697 643 324 143 258 240 161 154 2620 Damp walls remedied 158 154 91 33 116 30 21 26 629 Paving in yards and wash-houses repaired 82 59 89 17 93 26 25 40 431 Improved ventilation provided 2 8 16 .. .. 10 4 1 41 Wash-houses without sink and outlets for waste water .. .. 17 .. .. .. .. .. 17 Defective guttering and rain-water pipes 86 35 36 43 64 81 36 35 416 Dustbins supplied 130 94 64 47 105 27 40 38 545 Dung pits provided 1 .. 8 .. .. .. 1 1 11 Cases of overcrowding remedied 19 16 14 12 26 1 8 7 101 Deficient light—windows supplied, or enlarged, or other works 16 .. 19 .. 13 11 8 6 73 Dampness in premises from defective water pipes 36 10 9 17 15 •• 5 6 98 ANIMALS. Animals (including pigs) kept in such a state as to be a nuisance 8 .. 8 .. 5 1 3 2 27 Accumulations of manure removed.. 13 14 10 10 17 2 21 10 97 WATER. Defective and foul cisterns used for dietary purposes .. .. .. 2 26 .. 5 .. 33 Defective and foul rain-water tanks remedied 3 .. 4 1 .. .. .. .. 8 Insufficient supply, and water cut off by Water Board .. 5 2 .. 5 .. 7 5 24 Additional water supply for two or more families 2 •• .. •• •• •• •• 2 4 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 16 7 2 1 13 .. 3 .. 42 No. of smoke nuisances observed .. 4 .. .. 13 .. .. .. 17 Tents, Vans, &c., inspected .. .. .. 4 1 .. 37 .. 42 Notices served with respect to tents and vans .. .. .. 1 .. .. 5 .. 6 Inspection of Urinals accessible to the public 90 32 62 83 35 75 45 23 545 Verminous rooms cleansed 54 82 14 5 20 28 8 9 220 Intimation notices served 840 552 437 217 557 317 206 159 3285 Statutory ,, ,, 187 49 155 37 153 65 43 36 725 169 TABLE XVB. SUMMARY OF WORK OF CHIEF INSPECTOR. Premises Inspected 1240 New Buildings Inspected 27 Defective Combined Drains Investigated and Reported on 7 Number of Houses referred to in such Combined Drains 57 Cow-houses and Slaughter-houses Inspections 29 Complaints Investigated 143 Attendances at Police Courts 27 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for proceedings 79 Summonses at Police Courts 5 Bake-houses Inspected and Cleansed twice during the year 40 Number of Houses Disinfected after Infectious Disease 1278 Letters written 4062 Notifications received 3008 Certificates issued after Disinfection 1268 ,, of Infectious Disease forwarded to Schools 1831 Complaints of Sanitary Defects 441 ,, of Non-removal of Dust, viz:— Woolwich 1 Plumstead 12 Eltham 25 170 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) 120 18 Workshops (Including Workshop Laundries) 271 15 Workplaces 120 31 Homeworkers' Premises 364 18 Total 875 82 2.—Defects found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Act: Want of Cleanliness 36 21 Want of Ventilation 11 11 Overcrowding 1 1 Want of Drainage of floors — — Other nuisances 12 12 Sanitary Accommodation C insufficient— unsuitable or defective 12 11 not separate for sexes 2 2 Total 74 58 171 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) 4 Action taken in matters remediable under the Public Health Acts, but not under the Factory Act (S. 5). Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspectors 0 Underground Bakehouses (S. 101):— In use during 3903 24 Certificates granted in 1903 24 in 1904-1905 0 in 1906 1 in 1907-1908-1909 0 in 1910 1 in 1911-1913 0 In use during 1913 14 Workshops on the Register (S. 131) at end of 1913:— Workshop Laundries 12 „ Bakehouses 40 Other Workshops 148 Total number of Workshops on Register 200 172 TABLE XVc.—continued 4.—Home Work. Out Workers' Lists, Section 107. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Nature of Work. Lists received from Employers. Number of Addresses of Outworkers received from Other Councils. Number of Addresses of Outworkers forwarded to Other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Sees. 109, 110). Twice in the year. 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 Wearing Apparel 42 158 4 12 68 16 .. .. 129 12 12 .. .. .. .. Lace .. .. .. .. 4 .. .. .. .. .. .. .. .. .. .. Artificial Flowers .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Tennis Balls, etc. 6 586 .. .. 18 103 .. .. 232 6 6 .. .. .. .. Furriers .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. Brushes .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Upholstery 2 3 .. .. .. .. .. .. 2 .. .. .. .. .. .. 50 747 4 12 94 119 .. .. 363 18 18 .. .. .. .. 173 TABLE XVD. Proceedings during 1913. Premises. Number of Places Number of Inspections. Number of Notices. Number of Prosecutions. On Register at end of 1912. Added in 1913. Removed in 1913. On Register at end of 1913. Milk Premises 117 11 12 116 192 25 0 Cowsheds 16 1 1 16 32 9 0 Slaughter-houses 12 0 0 12 46 4 0 Ice Cream Premises 89 7 14 82 164 8 0 Registered houses let in Lodgings 432 10 10 432 631 360 0 Overcrowding— Number of Dwelling Rooms overcrowded 101 Number remedied 101 Underground. Booms— Illegal occupation dealt with during year 3 Number of rooms closed 0 Insanitary Souses— Number closed under the Housing Town Planning, &c. Act. 13 Number of Prosecutions under By-laws under Public Health Act, 1891— With respect to water closets, earch closets, etc. 0 With respect to insufficiency of water supply to water closets 0 With respect to drainage, etc. (Metropolis Management Act, Sec. 202) 0 Mortuaries— Total number of Bodies removed 179 Total number of Infectious Bodies removed 3 Inspections of premises where food is prepared for sale 130 Number of Public Sanitary Conveniences removed or altered 0 Number of fixed ashpits removed 0 174 TABLE XVI. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD. Beresford Street 66 34 Bellwater Gate 6 3 Creton Street 23 8 Myrtle Street 8 2 Anglesea Road 23 4 The Plats, High Street 22 9 Sandy Hill Road 17 11 Brookhill Road 24 10 Nelson Street 11 4 Mulgrave Place 23 7 Red Lion Street 20 5 Brewer Street 28 6 Meeting House Lane 9 6 Collingwood Street 11 8 Rodney Street 10 4 Clara Place 12 9 Monk Street 12 5 Upper Market Street 11 6 Rope Yard Rails 13 2 Wellington Street 77 20 Rectory Place 11 2 Kingsm an Street 19 6 New Street 7 2 Globe Lane 12 10 Charles Street 58 16 St. Mary's Street 8 3 Gough Street 25 14 Parsons Hill 6 2 Eleanor Road 42 12 Warren Lane 19 7 Union Street 13 — Powis Street 28 8 Taylors Buildings 5 3 Kates Place 13 9 Elizabeth Street 85 18 Glass Yard 6 — Nile Street 7 4 Albert Road 129 62 Winifred Street 66 29 175 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD—cont. Rhea Street 62 17 Auberon Street 34 16 Davey's Square 10 3 Dock Street 27 11 Barge House Road 39 28 1157 445 38.0 % Defects. DOCKYARD AND ST. MARY'S WARDS. Thrift Cottages 6 5 Warwick Street 60 30 Glenalvon Street 11 5 Joseph Street 27 16 Limbreys Buildings 11 11 Lower Wood Street 42 30 Sun Street 29 23 Frances Street 26 11 Hill Street 56 19 Rectory Grove 58 18 Trinity Street 8 6 Station Road 35 8 Waverley Cottages 7 1 Ogilby Street 48 37 Back Lane 9 6 Rideout Street 36 22 Eustace Place 14 7 Sims Buildings 10 7 Railway Cottages 8 8 Martyrs Passage s 7 Godfrey Street 31 15 Lower Pellipar Road 20 10 Pellipar Place 4 2 Pellipar Road 28 13 Woodville Street 9 1 Mary Place 10 9 Sarah Place 6 5 North Kent Grove 22 10 North Kent Place 5 — 176 TABLE XVI.—continued. Detail of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. DOCKYARD AND St. MARY'S WARDS—cont. Morris Street 5 3 649 345 53.0% Defects. St. GEORGE'S WARD. Belmont Place 5 3 Dicey Street 42 30 Eglinton Road, part of 16 10 Gildersome Street 61 25 James Street 41 23 ICeemor Street 28 13 Montague Cottages 4 2 Nightingale Vale 30 14 Ritter Street 31 20 258 140 54.2 % Defects ELTHAM WARD. Back Lane 4 1 Bowness Terrace, Blanmerle Rd. 8 4 Kendal House „ 8 7 Deansfield Road 40 4 Elizabeth Terrace, High Street 24 12 Elm Terrace ,, 23 12 Grangehill Road 31 10 High Street 18 7 Messeter Place 7 4 Osborne Terrace, Lee Green 8 3 Pound Place 24 15 Reventlow Road 34 19 Roper Street 20 5 Theobalds Cotts., Southwood Rd. 7 3 256 106 41.2 % Defects. 177 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. Plumstead Common Road 24 13 Conduit Road 33 13 Hanover Road 59 19 Maxey Road 107 48 Red Lion Lane 58 41 East Street 28 14 Edge Hill 22 6 Eglinton Road 92 50 Plum Lane 39 7 Westdale Road 53 41 Herbert Road 53 17 Brent Road 5 2 Frederick Place 44 29 Eton Street 36 17 Barnfield Road 2 2 655 319 48 7 % D fects. GLYNDON WARD. Richmond Place 42 18 Oliver Street 25 11 Earl Street 103 35 Elm Street 106 40 Park Road 51 18 Plumstead Road 97 30 Down Street 17 9 ,, Place 7 4 Dawson Street 26 11 Swetenham Place 22 7 Sandbacb Place 15 6 Ann Street 71 36 582 225 38.7% Defects. L 178 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 CE NTRAL WARDS. Orchard Road 107 28 Albatross Street 46 20 Timbercroft Road 81 30 Francis Street 86 20 Maxey Road 44 13 High Street 58 14 Vicarage Road 24 3 Coxwell Road 59 13 Ingledew Road 57 13 Liffler Road 59 15 Miriam Road 55 33 Orissa Road 22 6 Conway Road 118 19 Sladedale Road 74 26 Lee Street .. 38 5 Roydene Road 85 24 1013 262 25.8% defects. St. NICHOLAS WARD, Kashgar Road 18 5 Bannockburn Road 89 48 Bastion Boad 25 IS Bostall Hill 40 12 Swingate Lane (east side) 23 7 Scotch Flats, Bassant Boad 11 4 King's Highway 35 17 Cemetery Cottages 7 5 Southland Boad 9 2 Bleak Hll 11 5 Biyerdale Boad .. 111 54 Viewland Road 35 14 Hull Place 10 5 Heath Villas 5 0 Bostall Lane 6 6 Grove Road 19 13 Abbey Grove 101 49 179 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. Abbey Wood Road 81 23 Bassant Road 29 17 Heathfield Terrace 20 8 Tewson Road 118 65 Dingley Cottages, A.W. 4 4 Lakedale Road (east side) 33 15 Cordite Street 54 22 894 418 47.2% Defects. 180 TABLE XVII. Prosecutions under the Public Health and London County Council (General Powers) Acts. No. Date of Hearing. Offence. Situation. Result. 1 1913 April 2 Failure to keep rooms in a cleanly and wholesome condition (By-laws, Houses let in Lodgings). 23 Balgowan Street Summons withdrawn, conditions improved. 2 June 25 Dirty condition 43 Elm Street Costs, 3/-. Work done date of hearing. 3 25 No dust bin 43 Elm Street Costs, 2/-. Supplied date of hearing. 4 July 24 Damp walls of house 9 Radnor Terrace Costs, 3/-. Work done date of hearing. 5 Nov. 27 Dampness and dilapidations 38 Albion Road Costs 23/-. Order to abate in 14 days. 6 3 Joseph Blake did expose for sale (as owner) 8 cwt. 1 qr. 12 lbs. of plums that were unsound and unfit for the food of man 92 Plumstead Road Dismissed. 7 Dec. 18 Joseph Blake had in his possession 8 cwt. 1 qr. 12 lbs. of plums that were unsound and unfit for the food of man 92 Plumstead Road Pour months hard labour 8 18 Robert Pearce owner of above 92 Plumstead Road Fine £40 & £10 10s. Od. costs, or 1 month. 9 18 Richard Carter had above on his premises 92 Plumstead Road Fine £5, or 14 days. 181 TABLE XVIII. Summary of Articles Analysed, under the Sale of Pood and Drugs Act, during the year ended 31sfc December, 1913. Article. Number Analysed. Number Adulterated. Milk 303 24 Separated Milk 10 .. Butter 73 2 Vinegar 4 .. Coffee 9 .. Jams 10 .. Potted Fish 9 .. Iron Pills 1 .. Mustard 5 .. Drugs 21 .. Whisky 6 .. Rice 4 .. Coooa 8 .. Potted Meat 6 .. Cheese 1 .. Flour 8 .. Lard 5 .. Pepper 4 .. Sausages 12 .. Cream 14 3 513 29 182 TABLE XVIIIa. Prosecutions under Food & Drugs Act during year 1913. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 12.94 % added water J. R. Grove, 1 The Broadway, Abbey Wood Fined 2/- and 12/6 costs 2 Milk 76.5 % „ „ G H. Holdway, 45 Bostall Hill Fined 2/- and 12/6 costs 3 Milk 11.7 % „ „ E. Hiscock, 14 Blenheim Terrace, Wickham Lane Dismissed on proof of Warranty i Milk 2.71 % ,, ,, W. M. Forward, Huntingford Farm, Mere, Wilts Dismissed 5 Milk 9.66% ,, ,, W. C. Bunn, 13 Hinstock Road Fined 2/- and 5/- costs 6 Milk 36.6 % deficient in fat A. P. Godden, 229 High Street, Plumstead Dismissed on proof of Warranty 7 Milk 15.6 %,, ,, J. Couzens, 10 Chapel Street Dismissed on proof of Warranty 8 Milk 18.0 % ,, ,, R. Pollock, Jersey Farm Dairy, High Road, Mottiugham Costs 12/6 9 Milk 16.6 % „ „ E. A. & L. King, 4 Spray Street Fined 40/- and 23/- costs 183 TABLE XVIIIa.—continued. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 10 Milk 15.3 % deficient in fat.. H. N. Perrett, 2 The Parade, New Eltham Pined £5 and 23/- costs 11 Milk 8.33 % ,, ,, Attenborough Bros., 60 Sand Street .. Fined 20/- and 22/- costs 12 Milk 64.0 % „ „ W. Joy, 90 High Street, Woolwich Fined 60/- and 23/- costs 13 Milk 12.66;% „ „ T. Clark, 33 Butterfield Road, Lee Dismissed 14 Butter Upwards of 75 % Foreign fat E. Gray, 36 High Street, Eltham Fined 40/- and 23/- costs 15 Milk 15.3 % deficient in fat. W. H. Jones, 39 Beresford Street Fined 40/- and 23/- costs 16 Milk 6.0 % „ „ J. W. Hearn, 61 Bannockburn Road Fined 10/- and 12/6 costs 17 Milk 8.5 % added water W. J. Gittings, Grosmount Road Dismissed, 23/- costs 184 TABLE XIX. Food Seized, or Surrendered by Owners, as unfit for Consumption. Articles. Quantity. Date. Remarks, Reason. Pork 2 pieces Jan 1 Surrendered Abscesses Ox Liver 1 ,, 9 ,, Flukey Pig's Liver 1 „ 23 ,, Cirrhosis Ox Livers 2 ,, 31 ,, Flukey Ox Lungs 1 ,, 31 ,, Tuberculous Sheep's Pluck 1 Feb. 4 ,, Strongyli Beef 2 pieces „ 18 ,, Tuberculous Pig, carcase and offal 128 lbs. ,, 19 ,, Tuberculous Beef 108 lbs, „ 22 ,, Unsound Beef 129 lbs. „ 24 ,, Unsound Ox Liver 1 „ 28 ,, Echinococci Beef 128 lbs. ,, 27 ,, Unsound Ox Lungs 1 Mar. 7 ,, Tuberculous Ox Liver 1 11 ,, Abscesses Beef 26 lbs. 11 ,, Unsound Beef 132 lbs. „ 13 ,, Unsound Pie and offal 112 lbs. ., 13 ,, Tuberculous Pork 28 lbs. ,, 18 ,, Wounds and abscesses Apples 1 box ,. 22 ,, Unsound Ox Lungs 1 „ 25 ,, Tuberculous Ox Livers 2 April 4 ,, Flukey Dabs 1 box ,, Unsound Condensed Milk 384 tins „ 14 ,, Unsound Ox Liver 1 „ 18 ,, Abscesses Sheep's Liver 1 21 ,, Cavernous angioma Apples 1 box „ 23 ,, Unsound Ox Liver 1 „ 23 ,, Echinococci Ox Liver 1 ,, 29 ,, Abscesses Herrings 4 boxes May 1 ,, Unsound Herrings 4 boxes ,, 6 ,, Do. Beef 40 lbs. ,, 15 ,, Do. Herrings 1 box „ 27 ,, Do. Ox Livers 2 June 18 ,, Flukey Ox Liver and Lungs 1 „ 23 ,, Tuberculous Ox Livers 2 July 22 ,, Echinococci Ox Lungs 1 ,, 22 ,, Echinococci Plums 15 baskets ,, 29 ,, Unsnund Potatoes 25 bags Aug. 1 ,, Do. Mackerel 5 barrels ,, 1 ,, Do. Ox Liver 1 ,, 20 ,, Flukey Pollock 1 box „ 23 ,, Unsound Ox Livers 3 „ 25 ,, Flukey Plums 936 lbs. ,, 30 Seized Unsound 195 TABLE XIX.—continued. Articles. Quantity. Date. Remarks. Reason. Plums 8960 lbs. Sept. 1 Surrendered Unsound Plums 6720 lbs. 5 ,, Do. Plums 6720 lbs. 6 ,, Do. Plums 11200 lbs. 8 ,, Do. Plums 6720 lbs 9 ,, Do. Plums 4480 lbs. .. 11 ,, Do. Haddocks 1 trunk 3 ,, Flukey Skate 1 box s ,, Unsound Coalie 1 box „ 10 ,, Do. Beef 294 lbs. 15 ,, Do. Beef 1 piece 17 ,, Do. Ox Liver 1 „ 18 ,, Flukey Ox Livers 2 ., 18 ,, Echinococci Haddocks 1 trunk 17 ,, Unsound Winkles 1 bag 22 ,, Unsound Ox Tongues 2 .. 23 ,, Actinomycosis Whiting 1 trunk ,. 29 ,, Unsound Ox Liver 1 Oct. 1 ,, Flukey Haddocks 1 trunk 2 ,, Unsound Bloaters 3 boxes 2 ,, Unsound Ox Livers 3 13 ,, Flukey Mackerel 2 boxes „ 15 ,, Unsound Kidneys 206 ,, 22 ,, Do. Herrings 1 barrel ,, 23 ,, Do. Haddocks 1 box .. 24 ,, Do. Pig's Liver 1 „ 30 ,, Cirrhosis Dabs 1 box Nov. 5 ,, Unsound Dabs 1 box 5 ,, Do. Skate 32 lbs. 7 ,, Do. Pig's Plucks 2 10 ,, Strongyli Ox Livers 2 11 ,, Flukey Ox Livers 2 20 ,, Flukey Sheeps' Pluck 2 24 ,, Strongyli Pig and offal 1 ,, 25 ,, Tuberculous Dog Fish 1 trunk Dec. 3 ,, Unsound Ox Tongue 1 8 ,, Antinomycosis Mutton 99 lbs. Nov. 24 ,, Unsound Mutton 18 lbs. Dec.* 13 ,, Do. Mutton 138 lbs. 15 ,, Do. Beef .. 29 lbs. „ 16 ,, Do. Ox Livers 2 .. 17 ,, Flukey Pork 80 lbs. 21 ,, Badly bled and discoloured Apples 4 boxes „ 22 ,, Unsound Beef 132 lbs. ,, 23 ,, Unsound 186 TABLE XIX.—continued. Articles. Quantity. Reason. Summary— Pigs, carcases of 3 Tuberculous Pork 4 lots Abscesses and unsound Pig's Liver 2 Cirrhosis Pig's Pluck 2 Strongyli Mutton 255 lbs. Unsound Sheep's Pluck Sheep's Liver 3 Strongyli 1 Cavernous angioma Ox Tongues 3 Antinomycosis Ox Livers 31 Abscesses, Plukey, Tuberculous, and Echinococcus Ox Lungs 5 Tuberoulous and Echinococcus Beef 11 lots Unsound and Tuberculous Kidneys 206 Unsound Condensed Milk 384 tins Unsound Pish 34 boxes Unsound Apples 6 boxes Unsound Potatoes 25 bags Unsound Plums 46006 lbs. Unsound 187 TABLE XX. List of Level Bakehouses. Name. Address. Chadwell Bros. 60 Plumstead Common Road C. Pullen 105 do. C. Cheesman 126 High Street, Plumstead J. E. Porter 1 Riveidale Road, do. F. Bohmer 307 High Street do. A, E. Paine 14 Gunning Street. do. A. Jewiss 68 Glyndon Road, do. C. Letchford 109 Plumstead Road, do J. Clark 152 do. do. P. H. Mack 111 High Street, Woolwich A. Bradshaw 3 Green's End, do. E. Erdman 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. J. B. Fyson 94 High Street, Eltham W. Redler 114 do. do. F. Cook 142 do. do. F. J. Cook 5 The Parade, New Eltham G. A, Pinch 13 do. do, W. Millar 6 Well Hall Parade, Eltham R. Moakes 53 Cordite Street, Plumstead C. Tucker 53 Lakedale Road, do. E. Dalton and F. Mendham 4 Plumstead Road R. Tsinn 100 High Street, Woolwich 188 TABLE XXA. List of Certified Underground Bakehouses. Name. Address. -(unoccupied) 33, Eglinton Road, Plumstead Alderton, Ltd. 50, Herbert Road, do. -(unoccupied) 14, Westdale Road, do. A. B. Adams '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. -(unoccupied) 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 31, Beresford Street, do. F. Wilkening 72, Henry Street, do. W. C. Clothier 51, Albion Road, do. -(unoccupied) 23, George Street, do. -(unoccupied) 21, Albion Ri ad, do. -(unoccupied) 32, Church Street, do. Mrs. Attenborough .. 60, Sand Street, do. -(unoccupied) 81 & 82, Brookhill Road, do. -(unoccupied) 8, Hill Street, do. J. Fletcher 15, New Road do. 189 TABLE XXB. List of Factory Bakehouses. Name. Address. J. Fletcher 57, Burrage Road, Plumstead T. Newman 94, Wellington Street, Woolwioh Royal Arsenal 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 <fc Sons 13, Eton Road, Plumstead r Alderton, Ltd. 81, Park Road, Plumstead 190 TABLE XXI. List of Slaughtisrhouses. No. Name of Owner. Situation 1 Frederick Hedges 168. High Street, Eltham 2 William Francis Bartlett 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 Francis Bartlett 14, Church Street, Woolwich 7 H. Reed & Co., Ltd. Love Lane (rear of Wellington Street), Woolwich 8 James & George Mitchell 25, Hare Street, Woolwich 9 Hedley Vicars 30, Hare Street, Woolwich 10 H. Eeed & Co., Ltd. 38, Plumstead Common Road, Plumstead 11 Henry Fretter 33, Herbert Road, Plumstead 12 Royal Arsenal Co-operative Society Bostal Farm, Plumstead 191 TABLE XXII. List of Cowhouses. No. Name of Owner. Situation. l John B. Stocker Cold Harbour Farm, Chislehurst 2 Alfred Low Park Farm, Eltham 3 W. P. Corp Lyme Farm, Eltham 4 Charles Umfreville 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 Bayley 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 Jas. Buckingham Rear of 14, 15 & 16, Pellipar Road, Woolwich 16 Albert George Look Keightley House, Southwood Road 192 TABLE XXIII. List of Milk Sellers. No. Name. Address. 1 Perrett, H. N. 2 The Parade, New Eltham 2 Webb, F. W. 58 Brewery Road 3 Carr, E. 46 Kingsman Street 4 Fiunimore, J. A. 83 Park Road 5 Squirrell, J. 57 Church Street 6 Jeal, W. H. 139 Plumstead Road 7 Cook. G. .. 13 Raglan Road 8 Royal Arsenal Co-op. Society. Lakedale Road 9 Do. 15 Brewery Road 10 Do. 143 Powis Street 11 Do. Herbert Road 12 Do. 147 & 151 Powis Street 13 Woolsey, H. 50 Francis Street 14 Howe, J. R. 82 High Street, Eltham 15 Hawkins. Ellen M. 2 St. Nicholas Road 16 Furber, Harry Southend Farm, Eltham 17 Large, Daniel J. 6 Herbert Road 18 Hisoook, E. 14 Blenheim Terrace 19 Dalton, R. G. 55 Eglinton Road 20 Butter Bros. 49 Woolwich Common 21 Do 10 Jackson Street 22 Ward, S, 1 Nightingale Vale 23 Webb, Y. 10 Beresford Square 24 Dennis, Ellen 90 Brookhill Road 25 Bayley, M. Middle Park Farm Eltham 26 Godden, A. A. 229. High Street, Plumstead 27 Corp, W. F. Lyme Farm, Eltham 28 Pearce, R A. 175 Plumstead Common Road 29 Christmas, Hannah 18 Well Hall Parade, Eltham 30 Dodson, W 138 Plumstead Common Road 31 Dolphin, T. G. 89 Maxey Road 32 Corp, C. 142 High Street, Woolwich 33 Clements, E. J. 2 Cross Street 34 Bohmer, H. 307 High Street, Plumstead 35 Couzens, Jessie 10 Chapel Street 36 Stevens, F. 100 Roydene Road 37 Ridewood, F. 116 High Street, Eltham 38 Rose, J. 64 Hargor Road 39 Stevens, H. 27 Church Street 40 Needham, Elizabeth 94 High Street, Woolwich 41 Webb, F W. & Co. 16 Lakedale Road 42 Finch, G. A. 13 The Parade, New Eltham 43 Davis, D. H. 170 Albert Road 44 Smith, Elizabeth 12 The Broadway, Eltham 45 Bennett, Rose 22 Glyndon Road 193 TABLE XXIII.—continued. No. Name. Address. 46 Williams, Ellen 12 Thomas Street, Woolwich 47 Bartrum, A. 167 Kingsman Street 48 Jones, D. 65 Maxey Road 49 Jaques, H. 56 Anglesea Road 50 Killick, C. W. 52 St. James's Place 51 Parkes, J.., Fountain Stores, The Slade 52 Lamb, Annie 29 Admaston Road 53 Jones, E. C. 6 Samuel Street 54 Harrington, J. 26 Prospect Row 55 Cole, E.J. 18 Camrose Street 56 Pinnimore, W. J. 21 Walpole Place 57 Lyons, J. & Co., Ltd. 99 Powis Street 58 McGee, Jane 42 Mulgrave Place 59 Attenborough, Caroline 18 Prospect Place 60 Marsh, C. Ashurst, Shrewsbury Lane 61 Mumford, Kate F. 22 Cross Street 62 Holmes, Blanche 43 Bostall Hilt 63 Gill, Emily A. 398 High Street, Plum stead 64 Brinkworth, W. J. 82 Purrett Road 65 Palmer, P. 82 Purrett Road 66 Espline, G. 48 High Street, Woolwich 67 R.A. Co-operative Society The Links, Plumstead Common Road 68 Jones, W. H. 39 Beresford Street 69 Holdway, Georgina H. 45 Bostall Hill 70 Buck, E. V. 52 Raglan Road 71 Challis, P. W. 4 High Street, Woolwich 72 Gee, A.J. 147 Plumstead Road 73 Joy, W. G. 36 Thomas Street 74 Crayfourd, J. E. 40 Orchard Road 75 Leaver, E. A. 25 Garland Street 76 Buckingham, J. 16 Pellipar Road 77 Corp, W. P. 3 Wellington Street 78 Flint, Emma 124 Maxey Road 79 Gittings, W. J. "Cold Blow," Plumstead Common 80 Curtis, Stephen 181 Abbey Wood Road 81 Grace, James 18 The Broadway, Eltham 82 Cornwall, J. 14 Frances Street 83 Sheldon, W. 101 Sand Street 84 Adams, H. 31 Beresford Street 85 Muir, W. C. 28 Conway Road 86 Handsley, Ltd. 68½ Bloomfield Road 87 88 Townsend, Rose E. 104 Brookhill Road Voice, C. 102 Ann Street, Plumstead 89 Trodd, W. J. 19 Green's End, Woolwich 194 TABLE XXm.—continued. No. Name. Address. 90 Bunn, W. C. 13 Hinstook Road, Plumstead 91 Collins, G. 2B New Road, Woolwich 92 Williamsons, Ltd. 66 Powis Street, Woolwich 93 Willis, Jessie 2 Ritter Street, Woolwich 94 Fairbrother & Co. 94 Wellington Street, Woolwich 95 Slater, E. T. 30 High Street, Eltham 96 Hilder, E. 102 Ann Street, Plumstead 97 Couzens, J. 46 Church Street, Woolwich 98 Phillips, Sophia 141 Albert Road, North Woolwich 99 Warhaft, Violet 107 Pattison Road, Plumstead 100 Virgoe & Sons 13 Eton Road, Plumstead 101 Adams, E. J. 1 Shooters Hill Gardens. Eltham 102 Adams, H. 56 Artillery Place, Woolwich 103 Charles, Herbert 35 Sand Street, Woolwich 104 Look, Albert G. Southwood Road, New Eltham 105 Cook, Margaret 25 Plum Lane, Plumstead 106 Brown, T. N. 18 Oliver Street, Plumstead 107 Wilkinson, A. J. 52 Whitworth Road, Plumstead 195 TABLE XXIV. List of Applicants Registered as Purveyors of Milk During 1913. No. Name. Address. 108 Hoar, J. (Junr.) 40 Saunders Road 109 Grove, J. R. 1 The Broadway, Abbey Wood 110 Wilkening, A. E. G. .. 63 Grffin Road 111 Hearn, J. W. 61 Bannockburn Road 112 Naylor, L. 82 Plumstead Road 113 Grayson, J. 41 Hylton Street 114 Balster, W. H. 147 Burrage Road 115 Cheesman, C. 126 High Street, Plumstead 116 Campbell, W. W. 22 George Street