W0018 AC4372 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. 191 4. Woolwich: Pryoe & 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. 1914. Woolwich: Prycb & Son, Ltd., Printers (T.U. Federation), 31,33 & 35, Powis Street. 2 Public Health and Housing Committee: His Worship the Mayor. Councillor Richard Marsh William Allen (Chairman), 343, Eglinton Road, Plumstead. Alderman William Charles Martin (Vice-Chairman), 24, Herbert Road, Plumstead. Aldermen:— Joseph Pe.mberton Jackson, 2a, Wellington Street, Woolwich. Alfred John Walklin, 17, Beechhill Road, Eltham. Councillors:— Leon Charles Chastbauneuf, 224, Burrage Road, Plumstead. Walter John Enoch Clarke, 33, Westmount Road, Eltham. Thomas Davis, 2, Greening Street, Abbey Wood, Kent. William Haywood Dawson, 15, Wrottesley Road, Plumstead. Thomas Henry Hutchings, "Hamtnerwood," Shooters Hill. William Marlow, 123, Park Road, Plumstead. Edward Mayes, 20, Crookston Road, Eltham. James Newman, 92, Rochdale Road, Plumstead. Frederick Penny, 8, Blendon Terrace, Plumstead. Susanna Turnbull (Miss), 14, Plumstead Road, Plumstead. Gertrude Elizabeth Walters (Miss), 73, Federation Road, Abbey Wood. Chief Sanitary Inspector: Albert G. Duck, F.S.I.A. (Cert. San. Inst.). District Sanitary Inspectors: John W. Rance (Cert. Sant. Inst.) William Little (Cert. San. Inst.) William Wood (Cert. San. Inst.) 3 Alfred G. Potter (Cert. San. Inst.) William Tedham (Cert. San. Inst.) Thomas Powell (Cert. San. Inst.) Harry Shaw (Cert. San. Insp. Exam. Bd.) Women Sanitary Inspectors: Alice M. Middlebrooke (Cert. San. Inst, and San. Insp. Exam. Bd.) Marion FitzGerald (Cert. San. Insp. Exam. 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: Prank Lkason. Medical Officer of Health: Sidney Da vies, 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. 4 Summary of Statistics, 1914. Area of Borough 8,276.6 Acres Population—Census, 1911 121,376 do. estimated to middle of 1914 128,556 Inhabited Houses—Census, 1911 . 21,463 Persons to an acre 14.7 Persons to a House—Census, 1911 5.65 Marriages 1,145 Births 2,824 Birth Rate 22 0 Deaths 1,690 Death Rate 13.2 Infantile Mortality 84 per 1,000 births 5 TABLE OF CONTENTS. page Names of Members of Public Health Committee 2 Names of Members of Sanitary Staff 3 Summary of Statistics 4 Preface 10 Introduction 12 Part I.—Statistics. Population 23 Census Tables, Quinquennial Age Groups 26 Houses 27 Births 27 Marriages30 Deaths—Woolwich Death Rate compared with other Boroughs 30 Infant Mortality—Preventive Measures 35 Still-births 37 Mortality under five years 37 Zymotic Death Rate 38 Inquests and Uncertified Deaths 38 Deaths in Public Institutions 39 Notification of Diseases 39 Smallpox 41 Measles 41 Whooping-Cough 44 Scarlet Fever—Deaths—Hospital Isolation—Return Cases— Isolation at Home—Sources of Infection—Schools Incidence 45 Diphtheria—School Outbreaks and Precautions taken 48 Mistaken Diagnosis 50 Source of Infection 50 Bacteriological Examination 50 Enteric Fever—Source of Infection 51 Bacteriological Diagnosis 56 Diarrhoea or Zymotic Enteritis—Notification—Statistics — Tables 56 Erysipelas 63 Cerebro-Spinal Meningitis 63 Anterior Polio-Myelitis 63 Puerperal Fever 64 6 page Influenza, Bronchitis and Pneumonia 65 Tuberculosis—Deaths 65 Notification Regulations 68 Notification Statistics 69 Duration of Illness 69 Age and Sex Distribution—Table 70 Source of Infection—Occupation 72 Visiting 72 Bacteriological Diagnosis 73 Hospital and Sanatorium Treatment 74 Do. Condition after discharge 75 Nature of Cases 77 Shelters for Consumptives 77 Tuberculosis Dispensary 78 Scheme for Treatment of Tuberculosis 79 History of Woolwich Tuberculosis Administration 84 Cancer—Classification 85 Causes of 87 Alcoholism 93 Syphilis 94 Ophthalmia Neonatorum 95 Meteorology 95 Part II.—Administration. Water Supply—Plumstead Well—Houses with no Water Supply inside the house 97 Tenement Houses 97 Food and Drugs Act —Percentage Milk Adulteration 98 Public Health (Milk and Cream) Regulations, 1912 99 Informal Sampling 101 Food Reform 101 Food Inspection 101 Dairies, Cowsheds and Milk Shops 103 Tuberculosis in Cows—Order of the Board of Agriculture 104 Slaughterhouses 105 Nuisances—Complaints, Drains, Water-closets, Supervision of Drainage 105 Public-house Urinals 106 House Inspection 106 7 pagE Nuisances—Medical Officer's Inspections 107 Overcrowding 107 Smoke Nuisance 107 Defective Light 108 Verminous Rooms 108 Dust Removal—Collection, Cost of 108 Trade Refuse—Offensive and Inoffensive 110 Housing of the Working Classes— Houses represented as Unfit for Habitation 111 North Woolwich—Vital Statistics 113 High Street Flats Area 114 North Woolwich—Dock Extension—Demolition and Displacement 115 Council's Houses 117 Houses Registered under the By-laws—Existing By-laws and proposed new By-laws. 118 Inspections made 119 Inhabited House Duty 120 Common Lodging-houses 120 Underground Rooms 120 Factories and Workshops—Inspections—Outworkers 121 Bakehouses 121 Ice-cream Shops 121 By-laws—Fried Fish Vendors and Fish Curers 122 Disinfection, Disinfectants 125 Health Shelter 126 Mortuaries 126 Cemeteries 126 Cleansing of Verminous Persons—Cleansing School Children 127 Public Baths—Lavatories and Cleanliness 128 Tents, Vans and Sheds 129 Notices and Prosecutions under Public Health (London) Act 129 Bacteriological Examinations 129 Infant Consultation 130 Maternity and Child Welfare 130 Women Sanitary Inspectors' Work— Miss Middlebrooke's Report 133 Miss FitzGerald's Report 136 Public Ambulance 139 Public Health Staff 140 8 LIST OF TABLES. page Table I. Population. Births and Deaths for the whole Borough, from 1902 to 1914, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 143 No. of Inhabited Houses, the average number per house, and the acreage 144 „ Ia. Institutions inside and outside the district receiving sick and infirm persons from the district 145 „ II. Cases of Infectious Disease notified at all ages, at various age groups, and distributed according to Registration Districts during 1914 146 „ III. Deaths at all ages, at various age groups, from various causes, arranged by Registration Districts in 1914. Total Deaths in Public Institutions in District in 1914 147 „ IV. Infantile mortality during the year 1914 151 „ "V. Case and Death Rate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1914 153 „ VI. Vital Statistics for the various London Boroughs for 1914 155 „ VII. Birth and Death Rates do. do. 157 „ VIII. Meteorology and Registered Deaths from all causes and from certain prevalent diseases in each week of the year 1914 159 „ IX. Weekly Averages for Meteorology and Registered Deaths from all causes and from certain prevalent diseases 161 „ X. Summary of Statistics for the first Quarter of 1914 corrected for Public Institutions 162 „ XI. Summary of Statistics for the second Quarter of 1914, corrected for Public Institutions 163 „ XII. Summary of Statistics for the third Quarter of 1914, corrected for Public Institutions 165 9 page Table XIII. Summary of Statistics for the fourth Quarter of 1914, corrected for Public Institutions 166 „ XIV. Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 169 „ XVa. Summary of the General Work of the Public Health Department for 1914, the number of Nuisances abated, and Notices served in each Ward 171 ,, XVb. Summary of Work of Chief Inspector, and Miscellaneous 173 „ XVc. Inspection of Factories, Workshops, and Workplaces 174 „ XVd. Proceedings during 1914 re Milk Shops, Cowsheds, Slaughterhouses, etc. 177 „ XVI. List of Streets Inspected—House to House— and number of houses where defects were found 178 „ XVII. Prosecutions in 1914 under the Public Health (London) Act, Housing, Town Planning, etc., and L.C.C. (General Powers) Acts 183 „ XVIII. Summary of Articles Analysed under the Sale of Food and Drugs Act 184 „ XVIIIA. Proceedings in 1914 under the Sale of Food and Drugs Act 185 „ XIX. Food seized or surrendered by owners as unfit for consumption 187 „ XX. List of Level Bakehouses in the Borough, 1914 190 „ XXa. List of Certified Underground Bakehouses in the Borough, 1914 191 „ XXb. List of Factory Bakehouses in the Borough, 1914 192 „ XXI. List of Slaughterhouses in the Borough, 1914 93 „ XXII. List of Cow-houses in the Borough, 1914 194 „ XXIII. List of Milk-sellers 195 „ XXIV. List of Persons Registered as Purveyors of Milk during 1914 198 CHARTS:— Showing Death Rate, Birth Rate, and Infantile Death Rate, 18911914, facing Page 34. Phthisis—Death Rate and Temperature,1891-1914—England, London, Woolwich, Greenwich, and Lewisham, facing Page 68. 10 PREFACE. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies and Gentlemen, In presenting my Fourteenth Annual Report (which includes the 23rd Annual Report on the Health of Plumstead) I have to report that the markedly low death rate which characterised reoent years has reoeived a check. This is partly connected with conditions unfavourable to health which always follow on the outbreak of war. It must, however, be recognised that the death rate cannot continue to fall indefinitely. If the population were not increasing a death rate of 10 per thousand would mean an average life of 100 years. Death rates under 12 per thousand necessarily imply an increasing population containing an excess of young persons. Owing to fewer children born the rate of increase of the population has been steadily diminishing in reoent years and hence the death rate cannot oontinue to fall as it has done. Of course Woolwich, although it has made vast progress in sanitation 6inoe 1850 (see Introduction) has by no means reached a condition of sanitary perfection, and may still 11 confidently hope for further diminution of preventable diseases; but the progress in the future cannot be as great as in the past unless some elixir of life is discovered. In the last five years the infantile death rate has fallen more than the general death rate and there is ground for hoping that Infant Mortality can be much further reduced. In the Introduction to this Report will be found a summary of a most interesting report on the Health of Woolwich written more than 60 years ago by Mr. Rawlinson, a Government Commissioner. I have again to thank you for the careful attention you have given to my reoommendations, and also to the personal sympathy extended to me on the occasion of my anxious experiences as a Prisoner of War in Germany and my safe return from that unhappy country. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, SIDNEY DAVIES. 12 INTRODUCTION. The earliest account of the health and sanitary condition of Woolwich is contained in the report to the General Board of Health on an Enquiry into the sewerage, drainage, water supply, and sanitary condition of the inhabitants of the Parish of Woolwich, by Robert Rawlinson, Esq., Superintending Inspector, and printed by Messrs. Eyre & Spottiswoode in 1851. A copy of this report has come into my hands, and gives a very interesting account of the condition of Woolwich at that date. The General Board of Health was appointed under the Public Health Act of 1848, which gave power to establish local boards of health. In consequence of a petition signed by 441 inhabitants rated to the relief of the poor headed by William Greenlaw, Rector, Mr. Rawlinson was appointed to hold a Preliminary Enquiry. The following, among others, attended and gave evidence at the Enquiry:— William Greenlaw (Rector), James Conolly (Chaplain), Colonel W. B. Dundas, E.A., Captain J. Washington, R.N., Francis Bossey, M.D., Felix W. Richardson, John Butler, Peter Bossey, William Stuart, and Messrs. Rolls, Bland, Bayly, Ruegg, Pidcock, Sergeant, Samuel Watts, Robert Jolly, and Louis Chasteauneuf. Surgeons. 13 The Report describes the early history of Woolwich, the existing state of the town, the geology, meteorology, population, mortality, abstract of evidence taken at the Enquiry, Acts of Parliament in force, and the existing boundaries, the boundaries recommended for the purpose of the Act, the suggested drainage, water supply, lighting, burial grounds, etc. The following is a description of Woolwich as it then was:— "The more ancient portions of the town consist of narrow streets, imperfectly paved; the houses here stand upon a damp and undrained subsoil; they are badly built, and are unduly crowded. The newer streets in the higher portions of the town have been set out on a more liberal scale, but for want of some general and comprehensive plan they are neither so regular nor direct in their lines of communication as they might have been made, and for want of a proper system of drainage and sewerage throughout the whole town the sanitary condition of the older and lower portion of it is made worse, in consequenoe of the surface drainage from the higher portion being passed into it. The River in front of the town is one continued scene of activity and life; the bustling ferry boat paddles rapidly about; craft of various shapes and sizes ride upon the tide; merchant-men from every clime pass to and from the Metropolis of the world; and the mammoth steamers walk the water in majesty and pride. All that is required to make Woolwich and its neighbourhood one of the most desirable places of residence in the county is means of health and 14 comfort such as sanitary works and proper regulations can alone give." The population is stated as follows:— Year. Population. Remarks. 1801 9.826 Exclusive of Military 1821 17,008 1831 17,661 1841 25,785 1851 26,500 Dr. Bossey contributed a full report on the mortality of the district, from which the following are extracts: — "Bate of Mortality, I From irregular fluctuations in the population, and from the imperfect registration of the deaths, the rate of mortality in Woolwich cannot be very accurately ascertained." (From the number of buriajs it may be inferred that it was at least 25 per 1,000). "On the influence of the neighbouring marsh land on the health of Woolwich I will merely remark that it adds to the humidity of the air, and produces a malaria most injurious to the health of the town. From this malaria the ague, so extensively prevalent in Woolwich and its vicinity, has its origin, and many cases of fever, jaundice, enlargement of the liver and spleen, dropsy, neuralgia, and rheumatism are produced by the same cause." "The next circumstance to which I would direct attention as influencing the health of Woolwich is the immense quantity of animal and vegetable matter, 15 excrement, and other kinds of filth which is allowed to go through the process of decay and decomposition within the limits of the town. These matters may be buried in our graveyards, concealed in privies and cesspools, heaped up in dustmen's yards, or flowing in open ditches and gutters, but still in all these situations they pour forth volumes of deleterious gases into the air, and thus produce fevers, diarrhoea, dysentery, erysipelas, &c., and add malignity and fatality to many other diseases." "Another evil in Woolwich is the insufficient manner in which the town is supplied with water. From this circumstanoe results a want of cleanliness in the persons, in 'the clothing, and in the dwellings of the poor." "Apother circumstance prejudicial to the health of Woolwich is the overcrowded state of the dwellings of the poor, and the existence in the town of several common lodging-houses of the worst possible character. In these crowded residences the air becomes humid, heated, and in a high degree impure." "The first and most important improvement will be the thorough drainage of the marsh land between Woolwich and Erith." Mr. R. Ruegg stated as follows:— "The great cause of sickness was the presence of the marsh lands, which girded Woolwich, more particularly the Plunistead Marshes, which were the hotbed of malaria. In the spring of 1848 its ravages were frightful. About 4,000 persons were laid up at that 16 time, and including relapses there could not be less than 8,000 cases. Dysentery also was very common, and often fatal." Mr. Peter Bossey also gave evidence in which he referred as follows to overcrowding: — "The enlargement of the public establishments, and the addition to the garrison, have added to the density of the population, causing houses to be crowded into every vacant corner, and rooms to be filled with inmates to such a degree as to render them perfectly unwholesome. I will instance three cases. In one room at the top, of the house adjoining the Ordnance Arms, I 'last year attended two adult women in one bed, ill of fever; in the same room there lived and Slept three other adults, including one full-grown youth, and the father of the family." "I last year attended a child affected with water in the head and convulsions. In about two months a child in another room was similarly affected. On enquiry into the cause, I found no less than 26 persons living in that small house." "A child was brought to my surgery a few months since afflicted with gangrene of the mouth. Knowing that this was produced by bad air or by bad living, I inquired into the circumstances, and found it was brought from a small house at the entrance to Bullfields, in "which there resided 21 persons." The water supply is described by Dr. F. Bossey as follows:— 17 "The general supply of water is received from the Kent Water Company, but it is insufficient in quantity, not being under high pressure, and it is not pure." " The want of a sufficient supply of water is seen and felt in the uncleanliness Which prevails in the dwellings of the poor, and in the imperfect manner in which the sewers are cleansed.' "The water in itself was good; it contained a small quantity of carbonate and phosphaite of lime. It wat; rather as to the quantity than the quality of the water that he complained." Mr. Ruegg spoke of the water supply as follows:— "The water supply was very defective; and was turned on at irregular periods; i'n some parts of the town three times a Week, whilst in other parts it was on once a day. The quality is bad. I find it full of animaculse, and much deposit is precipitated. I consider the price high: 5s. each room per annum in the lower parts, and 6s. in the higher portions of the town, and 7s. 6d. if supplied to the highest levels. The tenant of a cottage with four rooms pays 20s. per year; the tenant of a house rated at £12 per annum pays 24s. per year. Very few of the houses in the town take the Company's water. Mr. Rawlinson severely condemned the Kent water as being one degree in excess of most, and two degrees harder than some, of the hard Metropolitan waters, and devotes several pages of the report to discussing the drawbacks of such hard water, and means of remedying it. 18 The principal burial ground was the yard attached to the church, in which 600 to 700 interments were made annually, with the result that the bones were repeatedly turned up. The construction of improved sewerage and drainage systems occupies a large part of the report, and the necessity of joint action by the civil and military authorities, and of an extension of the main drainage of London for the sake of Woolwich is pointed out:— " But however this may be settled, one thing is clearly requisite, namely, the complete drainage of Woolwich and the freedom of the river from any taint opposite to that town at any time of the tide; and this latter condition is only to be accomplished by continuing the proposed outlet sewer from the top of Woolwich Reach along Greenwich Marshes, beneath the town of Woolwich (as proposed to be accomplished for Greenwich), and through Plumstead Marshes, ' below Woolwich to some point near Erith,' as indicated by the Engineer to the Metropolitan Commissioner of Sewers. No scheme short of this ought to be satisfactory to the Government, as having so large an interest in Woolwich, or to the inhabitants of that town, as it is the only practical remedy to free them from a nuisance, which (if established) would place them in a more unhealthy condition than they are at present." As is now well known the construction of the. southern outfall sewer, which was doubtless to some extent the result of this report, had the efEect not only of improving the drainage of Woolwich, but of draining the marshes, and ultimately of ridding the neighbourhood of malaria. It is 19 generally thought that the latter result was unintended and unexpected, but Appendix E of the report indicates that Mr. Rawlinson at any rate was not unmindful of this desirable possibility: — Appendix E. "The following statement as to the condition of Woolwich Marshes, and the evil effects to health arising from their undrained condition, was laid before the General Board of Health in October, 1848. The subject is one deserving of serious consideration and' offers a powerful reason in favour of an extension of the Metropolitan drainage to some point below Woolwich, so that the Woolwich or Plumstead Marshes may be effectively drained by the same means." The statement referred to is one by Mr. Ruegg showing the very serious effects of malaria, not only on the health of Woolwich, but on the economical condition of the town. He calculates that the cost of medicines and loss of work in four months were equal to an absolute waste of £8,000. The Common Lodging-houses at that time were unregulated, and all the ordinary decencies of civilised life set at nought, "human beings in a Christian land living a more degraded life than savages." "Thousands of children are born in such places, and from their childhood to old age their only knowledge is of sensuality, vice, and crime." "Common lodging-houses are kept by a class of persons who pander to the vices of human nature for purposes of pecuniary gain. They charge from 1d. to 3d. per might for each adult person entering their house, and this demand complied with, they harbour the 20 known thief, the professional vagrant, or the unfortunate outcast. The housebreaker and pickpocket receive shelter, countenanoe, and advice; the vagrant and thief are frequently combined in the same person, so that the support supplied by so called charity is turned to the uses of immorality, fraud, and crimie, reaching occasionally to murder. There is in this kingdom a guild of vagrancy in which there are professors, masters, and apprentioes. The professor is he who can put on more shams than Mathews ever dreamt of; he will represent the country clergyman, the well-to-do [farmer, the day labourer out of work, the ruined artizan with a delicate wife and small family,' the shipwrecked sailor, or any of the thousand and one personal fictions daily receiving pay from those who give readily, and, as a consequence, give foolishly. But the professor can act in tragedy as well as in comedy, and cap use a p|ick-lock, a bracebit, a crow-bar, a life-preserver, a musket, or a pistol. The common lodging-house, the gaol, and the gallows are the scenes of three acts in one tragedy. Before a robbery the whining vagrant frequently reconnoitres the premises which the housebreaker enters, so that mistaken charity leads to retributive crime. In this guild of iniquity there is a sort of blackguards' literature, and the initiated understand each other by slang terms, by pantomimic signs, and by hieroglyphics. The vagrant's mark may be seen in Woolwich on corners of streets, on door posts, and on house steps. Simple as these chalk lines appear, they inform the succeeding vagrants of all they require to know; and a fiew white scratches may say 'be importunate' or ' pass on;' " 21 The following are the conclusions of the report: — That the town of Woolwich is not so healthy as by proper sanitary works and regulations it may be made; that disease is in excess; that cholera has prevailed; that fever is at all times present; and that many of the inhabitants suffer from ague, in consequence of the foul and stagnant condition of the marshes. That the health of the civil, as also the naval and military inhabitants, are likewise injuriously affected. That there are few sewers or drains, and that such as exist are either imperfect in their construction or inefficient in use. That there are many cesspools which have been most expensive in formation, and are most dangerous and even costly in use. That main streets are formed with defective material and are imperfectly cleansed, and that many back streets, lanes, courts, and yards have no form of pavement, and are allowed to continue in a filthy state. That houses are improperly constructed; that some rooms are without adequate ventilation, and are unduly overcrowded; that slaughter-houses are situated in improper places (in the midst of inhabited houses); and that common lodging-houses are unregulated. That privy accommodation is deficient; and that middens and cesspools are allowed to become nuisances dangerous to health. 22 That there is a deficiency of local power to grapple with all the evils which exist, and therefore that I sider the application of the Public Health Act necessary. The recommendation is:— That the Public Health Act, 1848, should be applied to the Parish of Woolwich, and that a Local Board of Health should he established consisting of 21 persons, 15 to be elected by the Parish, and 6 by the Government Authorities. There is still much room for improvement in the sanitary condition of Woolwich, but it is satisfactory to find how far it has advanced since 1851. 23 FOURTEENTH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1914. 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 1914 is 128,556. 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) 52436 38,569 40,328 Do. (East) ) 29.758 30,888 Eltham Parish 5,710 7,226 13,450 98,994 117,178 121,376 The estimated population to the middle of 1914 is calculated as follows:— 24 Census Population, 1911. Census. Unoccupied houses at Census, 1911. Unoccupied houses in April, 1914. New houses from April, 1911, to June, 1914. Additional houses occupied, June, 1914. Persons to a house. Est. increase in population from Census, 1911, to June, 1914. Estimated population to middle of 1914. Parish of Woolwich 36,710 432 131 26 236 6.38 1506 38,216 Subtract 91 houses demolished since Census, 1911 West Plumstead 40,328 362 80 40 322 5.19 1671 41,999 East Plumstead 30,888 235 32 193 396 5.4 2138 33,026 Eltham 13,450 204 62 249 391 4.77 1865 15,315 Borough of Woolwich 121,376 1233 305 508 1345 — 7180 128,556 25 Note.—The number of persons to a house is that found at the Census, with the exception of Woolwich Parish. In the case of Woolwich Parish, the number of persons to a house as given at the Census is greatly increased by the inclusion of such buildings as "Barracks, Academy, etc. I have consequently only taken 6.38 as the number of persons to a house for the additional houses occupied since the Census; this is the number to a house in Dockyard and River Wards. West Plumstead includes the Burrage, Herbert, Glyndon and St. Margaret's Wards, and East Plumstead the Central and St. Nicholas Wards. The Registrar-General estimates the population as 122,431 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 occupied houses, is nearer the truth. The population at the end of the year was certainly much in excess of this— probably not far short of 140,000—but a large number consisted of a floating population of soldiers, whose presence would not greatly affect the death rates. The following figures show how the number of persons to 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 26 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 9:!53 1656 5*65 St. George's ... 10684 878 12-13 9083 860 10-56 Barrage 9837 1735 5-67 8887 1688 5-26 Glyndon 9810 1697 5-78 9-")01 1769 5-37 Herbert 9080 1612 5-63 8780 1739 5*05 St. Margaret's 9842 1638 6-00 13160 2578 5-10 Central 10118 1805 5-61 9083 1831 4-96 St. Nicholas ... 19640 2805 7-00 21805 3729 5-84 Eltham 7226 1353 5-34 13450 2814 4-77 The Borough .. 117178 18086 6-47 121376 21463 5-65 In the Annual Report for 1913, on pages 15 to 19, tables were given showing the age distribution and condition as to marriage of the population, the proportion of males and females compared with London and England, and the classification of buildings. 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 do. July 1st, 1913, to June 30th, 1914 254 27 New houses, 1913.14:— Woolwich 12 West Plumstead 31 East Plumstead 116 Eltham 95 4. Unoccupied houses. 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, viz., 450 in Woolwich, 387 in West Plumstead, 250 in, East Plumstead, and 209 in Eltham. In April, 1914, the Rate Collectors found 305 houses unoccupied, viz., 131 in Woolwich, 80 in West Plumstead, 32 in. East Plumstead, and 62 in Eltham. The empty houses have still further filled up since that date, and in Deoember, 1914, there were only 128 houses to let in the Borough and most of these were shops and practically none were suitable for industrial dwellings. 5. The number of births was 2,824, viz., 956 in Woolwich parish, 879 in West Plumstead, 739 in East Plumstead, and 250 in Eltham (corrected for children born in the Infirmary, the Female Hospital, and the Wood Street Home for Mothers and Babies, whose parents reside outside the Borough, and births in outlying institutions added on). The birth.rate, 22.0, compares with 22.5 in the previous year, and with 25.1, the average for the ten years 1904.13. The rate for the County of London was 24.6. BIRTHS. Of the 2,824 births, 59 were illegitimate. 28 The fall of the birth-rate still continues and makes it more important to take all possible steps to diminish the death-rate at the earlier ages. Notification of Births. 2,506 live births were notified under the Notification of Births Act. This is at the rate of 89 per cent. of the registered births, compared with 88, 93, 91, 94, and 92 per cent. in the five preceding years. 1,460 births were notified by midwives, 274 by the Home for Mothers and Babies and Military Families Hospital, 394 by medical practitioners, and 378 by other persons. 59 stillbirths were notified (64 and 79 in 1912, 1913 respectively). The Notification, of Births Act was adopted on March 1st, 1908. There were 318 births last year which were not notified. Five midwives were warned for neglect to notify. 890 live births, or 93 per cent., were notified in Woolwich parish, 1,429, or 88 per cent., in Plumstead parish, and 187, or 75 per cent., in Eltharn. The principal decrease in notification was in Eltham parish. 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 is held every Wednesday afternoon by the Lady Health 6. The following table gives the birth.rate of the Borough during the years 1901.5, 1906.10, 1911, 1912, 1913, and 1914, and, for the purposes of comparison, the corresponding rates of the neighbouring Boroughs, London, and England: — BIRTH.RATE. 1901.5. 1906.10. 1911. 1912. 1913. 1914. Greenwich Borough 27.6 26.5 24.9 25.0 26.1 25.1 Lewisham 25.7 23.3 21.2 20.4 20.5 19.8 West Ham 33.1 31.4 29.9 29.6 31.0 29.8 East Ham 33.8 25.8 25.8 24.9 23.5 Erith 34.1 25.7 23.6 26.4 27.3 London 28.2 26.51 25.5 24.7 24.5 24.3 England and Wales 28.2 26.0 24.4 23.8 23.9 23.6 Woolwich Borough 29.2 25.3 23.2 22.3 22.5 22.0 7. The following table gives the birth.rale for the Borough and each reg.istration distriot 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 rate for Eltham was the lowest recorded. 30  1891.1895. 1896.1900. 1901.1905. 1906.1910. 1911. 1912. 1913. 1914. Woolwich Borough 32.5 30.2 29.2 25.3 23.2 22.3 2.2.5 22.0 Woolwich Parish 31.1 301 29.0 27.9 271 24.8 26.6 25 2 Plumstead— West 33.3 31 0 30.1 24.7 ( 20 6 21.9 19.7 21.0 East 23.4 21.3 23.7 22.4 Eltham Parish 22.8 20.6 24.0 21.6 18.5 19.0 16.5 16 3 8. Illegitimate Births. 59 of the births registered were illegitimate, giving a rate of 21 per 1,000 births, compared with 24, 19, 13, 17, and 23, in the five p.reoeding years. The illegitimate birth.rate in England and Wales was 43 in 1913. MARRIAGES. 9. There were 1,145 marriages. The marriage.rate was 17*7, compared with 16'4, 16'0, and 16 4, in the three preceding years. The marriage.rate in England and Wales was 15'9. DEATHS. 10. Table I. gives the gross and net deaths and death. rates in 1914, 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 31 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. This rate is called the standard death.rate. The factor for the correction of the Woolwich death.rate is 1.0219. 11. The net deaths were 1,690, and the net death.rate 13.2, compared with 11.5 and 12.3 in the two preceding years, and 12.6, the average of the ten preceding years. 12. By multiplying by 1.0249, the factor for age distribution, we get the standard death.rate, viz., 13.5, 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 standard death.rates of Woolwich, compared with London find the adjoining Boroughs:— Net. Standard. England and Wale6 13.9 13.6 97 Great Towns 14.6 14.9 London 14.4 14.4 Greenwich 14.7 14 5 Lewisham 10.9 10.7 West Ham 15.1 — East Ham 10.4 — Erith 9.8 — Woolwich 13.2 13.5 32 Thirteen Metropolitan Boroughs had a lower death.nate than Woolwich. 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, 1913, and 1914. In 1914 Woolwich parish had the highest death-rate, and 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 1914 Woolwich Borough — 17.2 16.9 13.9 12.5 12.8 11.5 12.3 13.2 Woolwich Parish* 20.4 19.3 20.1 16.5 14.8 15.6 13.2 14.0 16.0 Plumstead— West 16.4 16.0 15.1 12.9 120 13.4 11.5 12.6 14.3 East ll.4 11.0 11.5 11.6 Eltham Parish — 13.0 14.6 10.2 10.1 8.3 8.4 8..8 8.8 London 20.0 19.8 18.5 16.1 14.9 15.0 13.6 14.2 14.4 * Three years—1888, 1889 and 1890. 14. The following table gives the numbers dying at various ages in the past twelve years from all causes, and the deaths at all ages from certain diseases not hereafter referred to: — 33 DEATHS—1903 to 1914. Year. Age Period. Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75 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 1914 239 141 52 33 47 35 97 147 184 225 246 244 Deaths from 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Apoplexy and all other diseases of the heart and blood vessels 212 215 227 216 217 243 268 248 265 270 312 332 Nephritis and Bright's disease 38 35 46 52 49 42 50 43 43 57 57 46 Respiratory diseases - all forms (except Phthisis) 269 285 264 277 209 234 250 236 206 216 254 287 34 Compared with the average of the last ten years, there was last year an increase of deaths at nearly all age periods, but specially between 1 and 10 and over 65. Over 65 the number of deaths was the highest recorded. The number of deaths also from apoplexy and diseases of the heart and blood vessels and those from respiratory diseases (bronchitis and pneumonia) reached the highest point recorded. Table III. shows the number of deaths in 1913 from 57 principal causes at various ages. Comparing last year with 1913, there was considerably increased mortality from measles, whooping-cough, diphtheria, meningitis (tuberculous and nontuberculous), alcoholism and cirrhosis of the liver, cancer, premature birth, heart disease, and broncho-pneumonia. There were fewer deaths from influenza, enteritis, pulmonary tuberculosis, and diseases of the brain, nervous system, and kidney. Appendicitis caused 5 deaths in 1914, compared with 8, 18, and 9, in the three preceding years. Of the 5 deaths 2 were males and 3 females; all were between 20 and 55 years of age. It is a mistake to think that 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 while the birth-rate has come down to 67 per cent. of what it formerly was, the death-rate has been also reduced to 71 per cent. of its figure in 1891. 35 16. The infantile death-rate has been reduced even more, viz., to 59 per cent. of what it was in 1891. INFANT MORTALITY. 17. The deaths under one year were 239, compared with 229 in 1913. The infant mortality (deaths under one year per 1,000 births) was 84, compared with 73 in 1912., with 80 in 1913, and 97, the average of the ten preceding years. 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. 1914. Lewisham 112 92 104 70 78 74 Greenwich 107 112 129 84 103 98 West Ham 158 126 141 102 107 108 East Ham 131 106 119 71 64 — Erith 112 80 70 69 81 91 London 138 114 128 90 105 104 97 Great Towns — 127 140 101 116 113 England & Wales 135 115 130 93 109 105 Woolwich Borough 119 97 98 73 80 84 Five Metropolitan Boroughs only had a lower infantile mortality than Woolwich, viz., Hampstead, Lewisham, Stoke Newington, Westminster, and Chelsea. 18. The following table gives the infantile mortality 36 during 1911, 1912, 1913, and 1914, and the five preceding quinquennia in the Borough and each registration district: — 1886-1890. 1891-1895. 1896-1900. 1901-1905. 1906-1910. 1911 1912 1913 1914 Woolwich Parish *151 157 170 134 109 110 94 85 94 Plumstead — West 121 120 132 113 91 104 53 67 77 East 82 81 84 68 Eltham — 163 160 97 89 64 52 62 72 Woolwich Borough — 140 146 119 97 98 73 80 84 * 1888, 1889 and 1890. The rate was lower in East Plumstead, but higher in the other three divisions of the Borough than for the last two yiears. 19. Table IVa. gives full details as to the ages at death and causes of death of the 239 infants dying in 1914 under one year. It shows that 41 per cent. of those who died under one year were under one month old, compared with 42 per cent. in 1913, and 38 per cent. in the previous ten years. 53 deaths were from Tremature birth, compared with 41, 51, 51, 52, and 41, in the five preceding years. The number of deaths under one week in the past five years was 72, 62, 61, 58, and 68 respectively. The number of deaths from suffocation or overlying was two, compared with one in 1913. In the previous four years the deaths from suffocation in bed averaged 4 a year, and 37 in the four years 1904-7 they averaged 7. This speedy diminution has no doubt been aided by the Children's Act of 1908. The death-rate per 1,000 births from premature birth in Woolwich Borough was 20.5, compared with 14.0, 17 9, 18.1, 18 9, and 14.2, in the five preceding years. In London it was 18.8 in 1912. There were 7 deaths of illegitimate infante. The deathrate of illegitimate infants under one year was 119 per 1,000 births, and that of legitimate children 84. 20. Compared with 1913, the past year had among infants more deaths from measles, whooping-cough, premature birth, meningitis (tuberculous and non-tuberculous), and pneumonia; and fewer from convulsions and enteritis. 21. 59 still-births were notified, compared with 54, 68, €4, and 79, in the four previous years. The still-births are, like the deaths from premature births, the result of inherited disease or other conditions affecting the infant In the uterus and should be counted together with them. If we do this for the years 1913 and 1914 we see thait the total numbers for each year are 120 and 117 respectively; i.e., the decrease in still-births accompanied an increase in deaths from premature birth. A large proportion of these deaths is due to syphilis. 22. Deaths between One and Five Years. 67 deaths (55 in 1913), occurred between one and two years, and 74 (38 in 1913), between two and five. The corresponding figures in 1912 were 68 and 51 respectively. The death-rate 38 between one and five was 13.6 per 1,000 children of that age found at the Census, compared with 9.0 in 1913. 23. Zymotic Death-Hate. The number of deaths from scarlet fever, diphtheria, measles, whooping-cough, enteric fever, and from diarrhoea and enteritis (under two years of age as regards diarrhoea and enteritis) was 126, and the death-rate per 1,000 population 0.98, compared with 1.27, 0.77, and 0.74, in the three previous years. The zymotic death-rate has fallen greatly einoe 1901, when it was 1.51. 24. Inquests. There were 146 inquests, compared with 121, 128, 115, 105, 107, 123, 105, and 123, in the eight preceding years. The following table gives particulars as to the cause of death:— 1. Natural causes 90 2. Alcoholism 4 3. Accidental causes: Burns and Scalds 6 Drowning 3 Falls 4 Fractures 5 Suffocation, overlying 4 Other accidental causes 17 39 4. Homicidal cases: Suicide 12 Murder and Manslaughter 1 13 Total 146 39 The "Accidental Causes" were 23, 42, 44, 35, and 37, in the five preceding years. The "Homicidal Causes" were 14 6, 11, 11, and 21, in the same years. 25. Deaths in Public Institutions. Table I. shows the actual number of. deaths occurring in, public institutions in the Borough, viz., 367, compared with 276, 272, 326, 292, and 298, in the five preceding years. These deaths nearly all occurred in the Poor Law Infirmary; they were 21:7 per cent. of total deaths, compared with 19.4, 18.8, 20.6, and 18.9 in the four previous years. Table Ia. shows the institutions, inside and outside the Borough, receiving sick and infirm persons belonging to the Borough, and Table III. shows the number of deaths from each disease occurring in public institutions. Over one-third of the total deaths occurred in the Workhouse Infirmary or hospitals. 26. 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 40 Health (London) Act, the following diseases have since been added to the list:—Polio-myelitis, cerebro-spinal fever, ophthalmia neonatorum, glanders, anthrax, and hydrophobia. 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. By order of the Borough Council approved by the Local Government Board, zymotic enteritis was made compulsorily notifiable in 1913. This disease is only notifiable in Greenwich and Woolwich. 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 admissible under special conditions:—Measles and whooping-cough. The special conditions are that pauper cases have the priority, and that the case is specially recommended by the Medical Officer of Health. Children absent from school on account of measles and whooping-cough are notified by the school teacher or 41 dance officer. Thus some form of notification is in existence for, altogether, 19 diseases. SMALL-POX. 27. Not a single case of small-pox was notified. 28. The number of cases of small-pox notified in London was 3, but these were all found to be cases of mistaken diagnosis. MEASLES. 29. There were 25 deaths from measles, giving a rate of 0 19, compared with 0.23, 0.24, and 0.07, in the three preceding years. The rate in London County was 0.31, compared with 0.40 in 1912, and 0.34 in 1913. 30. Of the 25 who died from measles, 23 were under five years of age; 14 were males and 11 females. 31. 967 notifications were received from school teachers, compared with 768, 396, 801, 775, and 387, in the five preceding years. The mortality per cent. of notifications was 2 6, compared with 7.2, 5.3, 3.5, 3.9, and 2.3, in the five preceding years. 3 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:— 42 Year. Woolwich. Plumstead. Eltham. The Borough. London Aver. No. Bate. Aver. No. Rate. Aver. No. Rate. Aver. No. Rate. Rate. 1891.5 20 0.49 29 0.51 Not re corded 49 0.51 0.59 1896.1900 34 0.81 36 0.57 Not re corded 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 28 0.23 0.57 1912 12 0.32 17 0.24 1 0.07 30 0.24 0.40 1913 3 0.08 3 0.04 3 0.21 9 0.07 0.34 1914 14 0.37 11 0.15 — — 25 0.19 0.31 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 1914 25 8.8 It appears from these tables that whereas from 1891.1900 Woolwich had a somewhat higher measles mortality than 43 London, since that date the measles death-rate in Woolwich 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 prevaJennoe of measles, the Medical Officer of the London County Council closed or excluded unprotected children from numerous classes. In many oases 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. These measures have now been in force in Woolwich for more than 12 years, and have no doubt had a large share in the reduction of the measles death-rate. 44 WHOOPING.COUGH. 34. There were 25 deaths from whooping.cough. The death.rate was 0.19, compared with 0 05, 0 25, and 0 08, in the three preceding years, and 0.20 in the County of London. 22 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 1914 25 0.19 0.20 Owing to the fact that whooping.cough mortality almost entirely falls on children under five, and that the diminution of birth.rate since 1900 has caused the population under five years to be smaller, 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. The population under five at the 1901 Census was 13,823 and at the 1911 Census, 12,861. Estimated on these populations the death.rate in 1901.5 was 2.4 and in 1911.14 only 1.3 showing still a very marked reduction. 321 cases were notified by school teachers, compared with 377, 41, 439, and 265, in the four previous years. 103 were 45 under five years of age, 209 between five and ten, and 9 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. Four cases were admitted during the year. Instructions printed on cards are left at houses where cases are notified by school teachers. The instrutions were printed in the Annual Report for 1910. It is satisfactory to note a further great reduction in the mortality of this disease in the five years during which this practice has been in force. SCARLET FEVER. 35. There were 701 cases of scarlet fever notified (deducting 13 cases of mistaken diagnosis), equivalent to a rate of 5.46 per 1,000 population, compared with 4.80 in 1913. This is the highest rate recorded since 1909 when it was 8.04. 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. 1914. Borough 3.15 5.90 4.09 3.80 4.80 5.46 Woolwich Parish 2.99 5.66 2.89 2.41 5.44 6.11 Plumstead, West. 3.24 6.33 3.77 4.96 4.68 5.45 „ East 7.51 4.88 5.11 4.18 Eltham Parish 3.21 4.94 2.09 2.64 4.36 7.45 London County 3.57 4.22 2.32 1.76 3.89 5.53 46 37. Table 3 gives the age distribution, the number in each parish, and the number removed to hospital. Eltiham parish was most affected. 38. Deaths. There were 9 deaths, giving a death-rate of 0.07 per 1,000 population, compared with 0.06 in 1913, 0.08 in the five years 1908-12, and 0.19 in the ten years 18911900. The death-rate in London was 0.07, Compared with 0.07 in 1908-12. The case mortality (or deaths per cent. of notifications) was 1.3, compared with 0 6, 0 8, and 1.3, in the three preceding years. 39. Hospital Isolation. Of the 714 cases notified, 625 (or 88 per cent.) were removed to one of the Fever Hospitals, compared with 94, 90, 80, 88, and 90 per cent. in the five preceding years. 13 cases were reported, after observation at hospital, not to be scarlet fever. The accommodation at the Asylums Board's Hospitals was severely taxed in the latter part of the year, and many cases had to wait several days before they were removed. The Cases from the most crowded houses however were removed first and I saw no evidence that delay in removal led to the spread of infection. 40 Return Cases. There were 12 cases (or 1.7 per cent. of notifications) in which infection was attributed to patients recently returned from hospital, compared with 58, 27, 29, 37, and 31, in the five preceding years. Of the infecting' cases, 6 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. 47 The parents of all children with any discharge are recommended to obtain medical assistance, and the district nurse is 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 rhinorrhoea. 41. Home Isolation. 31 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 18, 25, and 12, in the three preceding years. One case of failure of home isolation was noted. 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 cases, a probable source of infection was found in 82 cases. In 40 cases infection was attributed to other inmates of the house. 43. In 8 cases infection was attributed to friends and neighbours, in 28 cases to school attendance, and in 6 to various hospitals. 44. The Annual Report for 1905 contained a special 48 report on a statistical investigation into school incidence of scarlet fever and diphtheria during the ten years 1896-1905. DIPHTHERIA. 45. 351 cases of diphtheria were notified (excluding 65 cases of mistaken diagnosis). The case-rate (number of cases per 1,000 population), corrected for cases of mistaken diagnosis was 2.72, compared with 1.68, 3 09, and 1.91, in the three preceding years, and 1.99, the average of the ten years, 1901-10. 46. There were 34 deaths, Compared with 11, 20, and 17, in the three preceding years. Thje death-rate was 0.26. compared with 0 13 in 1913, and with 0 14 the average of the five preceding years. The London death-rate was 0:16, compared with 0 09 in 1913, and 0:12 in the five preceding years. 47. 187 of the total oases notified were in Woolwich parish, 99 in We6t Plumstead, 79 in East Plumstead, and 51 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:— 1901-5. 1906-10 1911. 1912. 1913. 1914. Borough 1.71 2.20 1.68 3.09 1 .91 2.72 Woolwich Parish 1.63 2.34 2.40 4.38 4.43 4.92 Plumstead Parish 1.87 2.40 W. 1.19 3.79 2.32 2.36 E. 2 .33 2.81 1.02 2.39 Eltham Parish 1.62 2.22 2.30 1.71 1.29 3.33 London 1.90 1.63 1.64 1.57 1.70 2.02 49 The table shows that since 1910, diphtheria has prevailed more in Woolwich parish than in the rest of the Borough. Last year Eltham suffered more than it has done hitherto. Since the year 1908, diphtheria has been particulary prevalent in the south-east of London, specially in Greenwich, Lewisham, and Woolwich. This disease shows a tendency to be endemic in certain localities for a series of years. 48. 392 cases, or 94 per cent. of total notifications, were removed to hospital, oompared with 81, 92, 81, and 93, per cent. in the four preceding years. A certificate of efficient home isolation was given in 7 cases, oompared with 1, 1, 3, 12, and 1, in the five preoeding yeare. The case mortality was 9.7 per cent., compared with 10 4, 3.4, 5.4, 5.2, and 7.0 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 on 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. Nine 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 49. 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. Since that time the number of purely bacteriological cases has been much lower, and the fatality of notified cases higher. 50. Mistaken Diagnosis. 65 cases, or 16 per Cent. of notifications were, after removal to hospital, stated to be not diphtheria. The percentage of the four preceding years was 10, 15, 11, and 19, respectively. 51. Source of Infection. In 68 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 11, schools; 11, neighbours and friends; 6, return cases; and in 9 the infection was due to the Fever or other Hospitals. In one of the returned cases there was otorrhoea on discharge, and in one a bacteriological examination showed the presence of diphtheria bacilli. Two of the returned cases returned after scarlet fever. 52. Bacteriological Diagnosis. Since January, 1913, the Council's bacteriological work has been done by the Bacteriological Department of the Seamen's Hospital, Greenwich. 915 (921 in 1913) swabs were examined for the presence of diphtheria bacilli. In 95 (85 in 1913) the true Klebs Loffler bacillus was found; in 47 (67 in 1913) Hoffman's bacillus was found, and 773 were found free from either the Klebs Loffler bacillus or Hoffman's. 51 Of the 915 swabs examined, 279 were taken from school children by the Medical Officer of Health. Of these, 14 contained the true Klebs Loffer bacillus (so-called positive cases), 15 Hoffman's bacillus, and 2, both kinds. 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 Attendanoe Officer or Sanitary Inspector. In 4 cases without symptoms the bacillus disappeared within two or three weeks. Seven positive cases has some symptoms, viz., 4 running or sore nose, 1 mild clinical diphtheria, 1 follicular tonsilitis, and 1 ottorhcea (discharge from ear). 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. Of the 15 cases with Hoffman's bacillus, 3 had slight pharyngitis. These were excluded from school till well. Diphtheria antitoxin is kept at the Town Hall and the Plumstead and Eltham Free Libraries and supplied to medical practitioners on application at cost price, or free where there is inability to pay. ENTERIC FEVER. 53. There were 12 cases of enteric fever, not including 6 cases of mistaken diagnosis notified as enteric. The caserate was 0 09, compared with 0.10, 0.15, and 0.06, in the three preceding years. For the ten years 1892-1901, 52 the rate never fell below 0 41. The case-rate in London was 0.17. Out of a total of 18 cases notified, 14 went to hospital. 54. There were 4 deaths from this disease, giving a death-rate of 0.03. The death-rate in London was 0 03. In the preceding five years the death-rate in Woolwich was 0.01, and in London 0 03. 55. The following are the cases notified in each parish during the past thirteen years:— Average, 1901-05. 1906-10. 1911. 1912. 1913. 1914. Woolwich 126 7.6 10 10 7 6 Plumstead 21.2 11.41 W. 3 4 3 6 E. 2 2 2 4 Eltham 8.6 2.8 1 4 2 2 The following is a list of the castes:— Initials. Age. Sex. Date of commencement. Date of Notification. Source. I.H. 39 F. Dec. 12,1913 Jan. 4, 1914 T.R.J 45 M. Jan. 29, 1914 Feb. 19 „ F.E. 16 F. Feb. 27, „ Mar. 8, „ Mussels M.L 25 F. Mar. 14, „ Mar. 24, „ F.L 15 M. - Aug. 24, „ L.W 2 F. Nov. 30,1914 Dec. 16, 1914 Milk M.W 25 F. Nov. 27, „ Dec. 16, „ Milk S.M. 10 M. Nov. 25, „ Dec. 18, „ Milk W.B 49 M. Dec. 5, ,. Dec. 18, „ Milk M.C. 19 F. Dec. 1, „ Died Dec. 11 Milk A.R. 40 F. Nov. 26, „ Dec. 23,1914 Milk T.M. 41 M. Dec. 5, „ Dec. 26, „ Milk- Died Dec. 26 53 Cases occurring in January, 1915:— Initials. Age. Sex. Date of commencement. Date of Notification. Source. L.C. 9 M. Dec. 6, 1914 Jan. 4,1915 Milk G.M. 16 F. Jan. 2, 1915 Jan. 8, „ Milk W.H. 12 M. Dec. 15, 1914 Jan. 8, „ Milk A.M. 24 F. Dec. 23, „ Jan. 11, „ Friend, M.W. C.A. 2 M. Jan. 5,1915 Jan. 14, „ Milk J.A. 27 M. Jan. 2, „ Jan. 14, Milk J.R. 7 M. Jan. 18, „ Jan. 25, „ Mother or Sister, A.R. Died Jan. 31 B.C. 26 F. Jan. 10, „ Jan. 30, „ Milk M.M. 40 F. Jan. 15, „ Jan. 29, „ Daughter, E.M. E.M. 14 F. Dec. 28, 1914 or Jan.20,1915 Feb. 2 „ Milk It is seen that up till the end of the year the case-rate was extremely low, only 5 cases occurring up till the middle of December. At the end of December, however, a series of 17 cases began connected with one dairy. The series went on till February, 1915. 7 cases were notified in December and 10 cases since. 8 of these were bacteriologically examined and gave a positive Widal reaction and in only one case was there reason to suspect the accuracy of the diagnosis. It was quickly seen that the milk supply was implicated and full particulars were obtained. The occupier of the dairy (who will be referred to as M) has only a small business; he purchases three churns a day from a wholesale dairy company in Essex. This company derives their supply from farms in the Counties of Norfolk, Suffolk, and Essex, whence milk is sent to the North Woolwich Station and from the station fetched by M. M purchases his milk in association with another dairyman, N. who takes 30 churns a day and sells it both wholesale and 54 retail. No special churns were consigned to M, so it was a matter of chance whether milk from any particular farm went to M ot N. A list of the farms was obtained and the Medical Officers of Health of the three counties communicated with. No cases of enteric were found in connection with any of the farms nor was there any prevalence of the disease in the other districts supplied by the wholesale company. No cases of enteric fever were notified among any persons supplied by N. It thus becomes obvious that if the milk was infected it must be after it came into the, hands of M. M's premisses consist of a small shop with kitchen and scullery behind and a very small yard in which is situated the w.c. and can shied. These premises were found to be kept scrupulously clpan, and the drainage and water satisfactory. Very littlie milk was kept at the shop; it was brought therp to be emptied into M's own churns and then taken away foT sale by cart or barrow. M, his wife, female servant, and boy, were the only persons engaged in the business. No illness was known to have occurred in any of these persons. The boy (employed at the time the first ease was notified has only been in M's service a few days, and could not have been the source of the infection. He had succeeded another lad who had left on the 12th December after three months' service. Neither the address nor name of the latter was known, but after some difficulty he was discovered working for a dairyman in an adjoining Borough. By the assistance of the Medical Officer of Health of that Borough, samples of his urine and faeces were taken and submitted for bacteriological examination. He was thus found to be a carrier of paratyphoid B. bacilli. Further bacteriological examinations of the milk and the patients 55 were carried out with a view to learn if these bacilli were actually the cause of the infection. A paratyphoid bacillus was found in the milk, but the blood sera of several patients, though giving a positive Widal reaction, did not agglutinate the paratyphoid bacilli found in the boy and in the milk. The investigation was therefore inconclusive, though leaving a suspicion that the boy was the source of infection. No history of illness could be obtained with regard to this boy. Steps were taken to prevent him continuing in the milk business. The dairyman and his wife and servant were also examined bacteriologically with a negative result, except that Gartner's bacillus was found in the faeces of the servant. The dairyman's wife and servant were stated not to have anything to do with the milk that went on the round, but as a precaution the dairyman was advised not to bring this milk to the shop, and arrangements were made to take it to other premises occupied as a dairy by a friend. A list of his customers was obtained from M, comprising 242 addresses, and a circular letter was sent to all the occupiers warning them as to the advisability of boiling the milk before using it. It is true that at three patients' houses out of the 12 affected the milk was stated to be always boiled. The suspected boy left the business on the 12th December. The dates of commencement of illness of the 13 primary cases were within three weeks of the 12th December with two exceptions, viz., the 5th and 10th January. In the course of observations made by the Chief Sanitary Inspector at the Station as to how the milk was dealt with, a porter was observed to dip a mug into one of the churns and help himself to a pint of milk. When challenged he 56 stated that this was a standing privilege allowed him in return for assistance rendered to the dairyman. The dairyman denied having given any such authorisation. To exclude the possibility of the milk having been infected by this porter, his faeces and urine were bacteriologically examined, but the result was negative. The cases for the most part exhibited symptoms characteristic of enteric fever of a moderately severe type; three out of the 17 died (viz., two in 1914, and one in 1915), giving a death-rate of 18 per cent. Several, if not all, commenced gradually, and some were at the outset of an ambulant character. They thus did not exhibit the sudden onset said to be peculiar to paratyphoid. 56. Bacteriological Diagnosis. 26 samples of blood were sent to the Lister Institute and Seamen's Hospital to be examined for Widal's reaction. A positive result was ob-, tained in four. DIARRHœA OR ZYMOTIC ENTERITIS. 57. The deaths from diarrhoea and enteritis under two years of age were 28, or 9 9 per 1,000 births, compared with 3.65 and 17.4 in the two preceding years. The rate for London was 27.64. The total number of deaths from these diseases at all ages was 33. Owing to the change in nomenclature, the diarrhoea death-rate cannot be strictly compared with that of years previous to 1912, but the rate in 1914 was below the average of previous years. Notification. Voluntary notification of zymotic enteritis during July, August, and September, commenced in Woolwich 57 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 continuel 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. 199 cases were notified in the past year, oompared with 866, 129, and 338, in the three preceding years. One case was notified in February, one in March, one in May, 4 in June, 22 in July, 51 in August, 109 in September, 9 in October, and one in December. Thus only four cases were notified except in the months June to October. The fatality (deaths under two years per 100 notified cases under two) was 14.1. 58. The appended tables give full particulars of the cases notified each year since notification commenced. The rainfall was much below and the average temperature of the summer quarter was above the average of the five preceding years. In spite of these unfavourable conditions the number of deaths and notified cases was below the average. 58 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 1914 199 102 97 9 29 24 33 95 56 32 16 Total 1905-14 2627 1354 1273 140 289 317 317 1063 705 393 466 59 TABLE B. CLEANLINESS OF HOUSES. Year, Total Houses of which information was obtained. Clean. Dirty. Indifferent. 1905 205 166 39 - 1906 360 289 71 — 1907 93 53 13 27 1908 156 51 22 83 1909 145 89 11 45 1910 100 57 6 37 1911 697 520 24 153 1912 104 83 2 19 1913 297 198 12 87 1914 178 116 16 46 Tot. 1905-14 2335 1622 216 497 TABLE C. DIET OF CASES UNDER 1 YEAR AT TIME OF NOTIFICATION. Totals 1905-10 1911. 1912. 1913. 1914. Breast only 49 24 3 9 4 Breast and other foods 78 43 7 15 21 Hand-fed only 408 179 17 80 63 No information 26 16 3 11 7 561 262 30 115 95 N.B.—Of 35 children under 1 year having fresh cow's milk, 33 had it boiled, or were said to do so. 60 TABLE D. NUMBER OP CASES NOTIFIED EACH WEEK, with MEAN TEMPERATURE of 3 Feet Ground Thermometer during Week, Summer Quarter. Cases. Year 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 3 1 2 7 16 15 32 43 48 52 25 40 1914 7 5 6 9 4 7 8 19 19 31 46 13 9 Totals, 1905-1914 27 36 80 76 130 232 358 426 351 243 257 127 126 Temperature. 1914 60.65 61.45 62.65 63.24 61.80 61.78 61.80 62.19 62.48 62.48 62.40 61.14 58.87 Average for 10 years 59.41 60.13 61.19 61.54 62.07 62.13 62.22 61.87 61.25 60.73 59.92 58.85 57.94 TABLE E. DEATHS PROM DIARRHOEA 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 1914 4 5 2 4 5 20 61 TABLE F. DIARRHœA MORTALITY, AND TEMPERATURE OP SUMMER QUARTER IN LONDON AND WOOLWICH. Average 1901-4 Average 1905-10 1911 1912 1913 1914 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 2 years) per 1,000 births for whole year London 12.42 27.5 27.6 Woolwich 2.30 0.97 2.87† Woolwich 3.65 17.44 9.9 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 63.24 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 61.51 *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. 62 TABLE G. ZYMOTIC ENTERITIS AND METEOROLOGY. Summer Quarter. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Number of cases notified - - - 212 366 93 173 123 72 848 115 286 183 Number of Deaths (Diarrhoea)* 27 29 136 56 81 11 28 8 4 109 2 49 21 Mean Temperature of Air 59.1 59.0 60.08 60.6 62.4 58.87 59.3 58.7 57.2 65.1 58.0 59.1 60.7 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 61.51 Mean Humidity 75 77 72 75 70 74.6 77 80 80 65 76 79 73 Number of days on which rain fell - 46 34 33 26 32 38 46 37 22 42 36 34 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 3.3 Number of hours bright sunshine 485 541 671 529 697 516 532 530 432 824 399 376 628 * Enteritis included in and from 1911. Up to 1911 all deaths are given. After 1911 only deaths under two years. 63 ERYSIPELAS. 59. There were 107 cases of erysipelas notified, compared with 82, 87, and 70, in the three preceding years. There were 7 deaths. The case-rate was 0.83, and the death-rate 0.05, compared with 0.07, 0.02, and nil, in the three preceding years. These rates were higher than they have been since 1900 with the exception of one year. The London case-rate was 1.10 and the London death-rate 0 05. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 60. In consequence of the serious epidemic of this disease in certain towns in Ireland and Scotland, cerebrospinal meningitis was made in 1907 a notifiable disease, under the Public Health (London) Act, by the London County Council. One case was notified in the Borough in each of the two years 1907-8. One case was notified in 1911, one in 1912, and nil in 1913. One case was notified in 1914. This was a soldier in the Garrison; he was notified at the end of the year and died, but the death was transferred to the district he came from. It is to be noted that though no deaths were registered as from cerebro-spinal meningitis the deaths from tuberculous and simple meningitis were more numerous in 1914 than since 1905. ANTERIOR POLIO-MYELITIS. 61. This disease, commonly known as infantile paralysis, was made compulsorily notifiable in 1911, by an Order of the London County Council under Section 55, Public Health 64 (London) Act. Not a single case was notified last year and 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. It is interesting to note that the Woolwich Invalid Children's Association dealt with 52 cases of infantile paralysis last year. It hardly seems as though all the cases were notified. PUERPERAL FEVER. 62. There were 7 cases of puerperal fever notified, compared with 9, 7, 16, 2, and 8, in the five preceding years. There were 3 deaths. The case-rate per 1,000 births was 2.50, compared with 0.73 and 2.78 in the two preœding years. The death-rate was l.05, compared with 1.05 and 0.36 in the two foregoing years. The London case-rate and death-rate per 1,000 births were 3.57 and 1.67 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 in 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. 65 INFLUENZA, BRONCHITIS, PNEUMONIA. 63. Influenza caused 25 deaths, compared with 36, 39, 19, 25, and 35, in the five preceding years. Bronchitis and pneumonia caused 285 deaths, compared with 245, 232, 200, 208, and 253, in the five preceding years. The deaths from these causes under five yeaTS were 90, compared with 86, 66, 55, 70, and 70, in the five preceding years. There were more deaths of persons under five from bronchitis and broncho-pneumonia than for several years past. Many of these deaths were probably really due to whoopingcough and some to measles. There has, however, been an excess of deaths from bronchitis and pneumonia during the past two years which is not easy to account for. TUBERCULOSIS. 64. Deaths. There were 216 deaths from tuberculous disease, giving a death-rate of 1.68, oompared with 1.68, 1.46, 1.65, 1.34, and 1.69, in the five preceding years. 65. 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. 1914. Tuberculous Meningitis 20.0 22.8 20 23 14 29 Simple Meningitis 22.0 15.0 16 13 10 15 Tuberculosis of Intestines and Peritoneum 130 10.8 5 5 10 13 Tuberculosis (other forms) 20.8 22.2 29 16 10 11 Phthisis 192.0 1514 146 124 182 163 66 66. The deaths from phthisis were 163, giving a deathrate of 1.27, compared with 1.22, 1.08, l.20, 1.01, and 1.42, in the five preceding years. The rate of the last two years is higher than it has been since 1906, but is considerably below that of the quinquennia 1891.5, 18961900, and 1901.5, as is shown in the following table. The table shows also that the rate last year in East Plumstead and Eltham was the lowest recorded, but in Woolwich parish it was higher than it has been since 1905. 67 PHTHISIS (Tuberculosis, Lungs). 1891-5. 1896-1900. 1901-5. 1906-10. 1911. 1912. 1913. 1914. No. Rate. Aver, No. per year. Rate. Aver. No. per year. Rate. Aver. No. ; per year. Rate. No. 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 76 1.99 Plumstead West — 1.78 92 1.42 97 1.34 87 1.20 w41 102 31 0.76 66 1.56 51 1.21 East e 33 1.07 37 1.18 40 1.23 32 1.00 Eltham Parish — — 9 1.28 6 0.63 8 0.64 6 0.45 8 0.57 15 1.02 4 0.28 The Borough — — 193 1.74 192 1.56 151 1.22 146 1.20 124 1.01 182 1.42 163 1.27 London — 1.98 — 1.80 — 1.57 — 1.33 — 1.32 — 1.34 — 1.30 — 1.39 68 67. There was a considerable increase last year of deaths from both tuberculous and simple meningitis. There was also an increase of abdominal tuberculosis. 68. The chart on the opposite page shows the course of the phthisis death-rate in Woolwich in the past 24 years, compared with Greenwich, Lewisham, London, and England. It shows that in London, Greenwich, and Lewisham, as in Woolwich, there has been a rise or arrested fall of the phthisis death-rate in the past three or four years. 69. 97 of those who died from phthisis were males, and 66 females. The diminution of deaths has been greater among females than among males. 70. Notification Regulations. Voluntary notification of phthisis has now been in foroe 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. 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 Chart showing Phthisis Death Rate 1891/1914. 69 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. 498 cases were notified (excluding second notifications), viz.:—Tubercle of Lung, 400; tuberculous meningitis, 16; tuberculosis of the intestines and peritoneum, 6; other forms, 76. 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 communica'ted with. The 400 cases of phthisis compare with 196, 375, 689, and 532, in the four preceding years. 28 of these were in the Woolwich and Eltham Poor Law Infirmaries; 3 others were notified by the District Medical Officers of the Poor Law Union, 41 by the Medical Officers of the Royal Arsenal, Army, &c., 188 from hospitals and dispensaries, including 154 from the Woolwich Tuberculosis Dispensary, and the remainder by private medical practitioners. £31 18s. 3d. was paid during the year for the notification of tuberculosis. Turation. Of the 498 cases notified during 1914, at least 108 have since died, and of 675 cases notified during 1913, at least 135 have since died (February, 1915). 71. The source of infection of the notified cases was probably as follows:— 70 Family or Personal—Father, 30; mother, 24; brother, 20; si6ter, 10; husband, 6; wife, 1; other members of family, 14; friends, lodgers, &c., 2 107 Workshop and Office 16 Public House 10 Navy and Army 3 Milk 3 Undetermined 359 72. 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 source of notification:— 71 Metropolitan Borugh of Woolwich. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the year 1914. Number of Notifications on Form A. from Private Medical Practitioners. Number of Notifications on Form B. from School Medical Officers. Number of Notifications Form C. Age periods. 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 10 to 5 10 to 15 Total. Pulmonary Males 1 2 16 24 23 26 47 46 28 9 4 226 246 - - - - - 17 65 ,, Females 7 22 23 23 21 31 26 11 7 3 174 190 -- — — — 1 11 35 Non-Pulmonary Males 2 7 12 15 — 2 4 2 — 2 — 46 47 — 2 1 3 3 3 7 „ Females 3 7 4 11 5 2 6 5 — — — 43 43 — 3 3 6 6 1 — Total 6 23 54 73 51 51 88 79 39 18 7 489 526 — 5 4 9 10 32 107 72 73. Occupation. Of the 424 cases from which information was obtained, the occupations were as follows:— Outdoor— Official, Soldiers, &c. 39 Mechanical 5 Carmen and Costers 11 Labourers, Porters—Docks and all others 24 — 79 Indoor— Clerks 22 Mechanical 33 Printers 5 Bakehouses 1 Laundry 4 Domestic—Private 23 Public House 3 — 26 Labourers 26 School Children and Teachers 114 Housewives 65 All Others 44 345 424 74. 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 73 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. Cases returning from sanatoriums are notified to the medical practitioners under whose care they were before going to the sanatorium. If it -was a private practitioner he is asked if he proposes to keep the patient under observation for after care; if not the case is referred to the Tuberculosis Dispensary. In this way it is attempted to secure that all cases shall have after care, that the advantage of sanatorium treatment is not lost, 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. 75. Bacteriological Diagnosis. Sputum from 273 cases of suspected phthisis was examined at the Seamen's Hospital and Lister Institute, and tubercle bacilli were found in 71 cases. The number of examinations for the five preceding years was 179, 210, 191, 151, and 231, respectively. In addition the Medical Officer examined 338 specimens of sputum at the Tuberculosis Dispensary, 46 being found! positive. 76. 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 Rejport). 77. Disinfection was performed by the Public Health Department at 166 premises, compared with 152, 194, and 247 in the three preceding years. Disinfection was performed after the death of the patient, and also after removal 74 to hospital, sanatorium, or other occasion of the house or bedroom being vacated. 78. Sanatorium Treatment. Altogether 181 notified persons were admitted to some sanatorium or hospital for the treatment of tuberculosis, most of them being 6ent 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., 1914. Male Female. Total Downs Sanatorium 43 — 43 Northern Hospital — 24 24 Peppard Sanatorium 4 9 13 Harpenden Sanatorium 1 1 2 Treloar's Home, Alton 7 1 8 Herbert Hospital 22 — 22 Alexandra Hospital 2 1 3 East Anglian Sanatorium 2 7 9 Brompton Hospital 5 4 9 Carshalton Children's Hospital 2 2 4 Sea Bathing Hospital, Margate 1 — 1 All others 36 7 43 Total 125 56 181 79. Peppard Sanatorium. Owing to this Sanatorium being taken over by the Berks and Bucks County Councils, and owing also to the London County Council making provision for sanatorium treatment, the Borough Council ceased in October to maintain beds at Peppard. All uninsured cases 75 requiring such treatment are now referred to the Medical Officer, London County Council, and by him sent to one of several sanatoriums, principally East Anglian (children), Essex, and Northern (women). The former is directed by Dr. Jane Walker; the latter is under the control of the London Insuranoe Commtitee. The Public Health Department makes full reports to the London County Council on the home conditions of cases recommended and each case is medically examined previously to acceptance by the Medical Officer of the Tuberculosis Dispensary. Insured persons are referred to the Insurance Committee, which sends most of the men to the Downs Sanatorium. 80. The following table, recommended by the Local Government BoaTd, 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:— 76 Year. Number Discharged. Dead, Jan., 1915. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. 1915. a b 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 11 - - 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 — 1 1906 29 15 - - - - - - 5 24 2 20 5 15 1 14 — 14 1 12 — 9 — 8 — 8 1907 38 22 - - - - - - - - 9 24 2 22 7 15 2 13 1 13 2 9 2 10 - 7 1908 31 16 - - - - - - — — — - 6 21 6 17 4 12 2 10 1 10 1 7 2 5 1909 39 17 - - - - - - - - - - - - 3 25 2 25 6 18 3 15 1 13 — 9 1910 32 15 - - - - - - - - - - - - - - 4 25 7 18 4 16 3 9 2 9 1911 39 20 - - - - - - - - - - - - - - - - 14 17 4 14 4 12 1 7 1912 46 14 - - - - - - - - - - - - - - - - — — 4 33 6 26 2 22 1913 33 5 - - - - - - - - - - - - - - - - - - - - - - 3 23 316 148 1 — 3 6 2 18 8 38 14 54 15 66 18 79 14 94 33 91 19 108 18 87 10 91 77 The above table accounts for all the patients who left the Sanatorium up to December 3st, 1913. Out of the 316 who have left over one year, 91 are now well and at work, 10 are unwell, 148 have died, and 67 have been lost sight of. At least 37 per cent. of those treated are well and at work. 81. Of the 67 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 more healthy occupations and conditions of life are required on return home. More after care, suitable work, a guaranteed income, and the provision of a garden shelter, would probably improve the sanatorium results 50 per cent. 82. Shelters for Consumptives. The use and provision of these shelters has been described in previous Reports. Two additional ones were constructed in 1914, and there are now 13 shelters available. Four are at present (30th April) disepgaged. 4 are occupied by men, 2 by women, 2 by boys, and 1 by a girl. These shelters are lent at a small rent varying from is. 6d. to 3d. per week, according to means. Only those who have no source of inoome are now exempted from payment. The weekly call to collect the rent insures that the shelter 78 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, Is. 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. Three bedsteads with bedding are also being lent to needy cases too poor to provide such. 83. 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 January to 31st December, 1914:— Insured persons treated 320 Uninsured do. 1,754 Total attendances and home visits of doctors and nurses:— Insured 2,984 Uninsured 10,264 In attendance on March 31st, 1914:— Treatment. Observation. Insured. Uninsured. Insured. Uninsured. 113 535 57 265 Total attendances year ending March 31st 9,732 Number of new patients examined 1,210 „ "with definite pulmonary tuberculosis 218 „ with surgical tuberculosis 41 ,, of suspect and observation cases 475 ,, found non-tuberculous 476 79 Number of home visits of medical officers 2,079 „ „ „ nurses 2,701 ,, of sputum examinations 338 „ found positive 64 „ of children in 1,210 new cases 564 „ of contacts examined 364 The Medical Officer of Health acts as Administrative Tuberculosis Officer, and is a member of the Tuberculosis Dispensary Committee. Scheme for the Treatment of Tuberculosis. Under the Finance Act, 1911, and National Insurance Act, a Parliamentary grapt was made for sanatorium treatment of consumption. The grant is made through the Local Government Board, who require, before distribution, the presentation of satisfactory schemes for the treatment, of tuberculosis. The London County Council was constituted the authority for providing hospital and sanatorium treatment for London, and the provision of tuberculosis dispensaries was allotted to ,the Borough Councils. The Woolwich Borough Council, in 1913, resolved on a scheme which involved the taking over of the existing tuberculosis dispensary as a going concern. The Local Dispensary Committee was favourable to such an arrangement, but it was found that the Central Fund, on which the Local Committee was dependent, was opposed to the proposal. The scheme consequently had to be altered, and after prolonged consideration, the following scheme was prepared and submitted in October to the Local Government Board, London County Council, and London Insurance Committee, and is awaiting the approval of these bodies:— 80 Scheme for the Dispensary Treatment of Tuberculosis, as amended by the Sub-Committee of the Public Health Committee, and the Tuberculosis Dispensary Committee, 29th September, 1914. Medical Officer of Health.—The Medical Officer of Health will act as administrative officer, and will keep records of the work of the Dispensary, and supply the London County Council with information required by them. He will also supervise the visitation of patients as regards home conditions, and the examination of contacts and suspects. Agreement.—The Borough Council will enter into an agreement with the Administrative Committee of the Woolwich Tuberculosis Dispensary, for a period of twelve months in the first instance, to treat cases of Tuberculosis in the Borough in accordance with the requirements of the Local Government Board, London County Council, and the London Insurance Committee, and the provisions of the agreement; the Borough Council making a grant of threeeighths of the total expenditure on uninsured persons. The oost to the Borough Council will be roughly as follows:— Three-eighths of total expenditure on uninsured persons, viz., £1,120 420 Repayment— Local Government Board (one-half) 210 London County Council (one-quarter) 105 315 Balance payable by Borough Council £105 81 The Proposed Agreement is as follows: — (1) The Medical Officer of Health for the Borough for the time being shall be the Chief Executive and Organising Officer in the execution of this scheme. (2) The Council shall agree with the Committee of the Woolwich Tuberculosis Dispensary for the treatment at the Dispensary, Maxey Road, Plumstead, of cases of Tuberculosis on the following terms and conditions: — (a) The Dispensary Committee shall provide for the diagnosis and treatment as may be neoessary of persons suffering or suspected to be suffering from Tuberculosis who are resident in the Borough of Woolwich, and who apply voluntarily to the Dispensary, or who are referred thereto by any qualified medical practitioner or by any officer of the London lnsurance Committee. (b) The Dispensary Committee shall comply with the requirements of the Local Government Board, the London County Council, and the London Insurance Committee. (c) The Dispensary Committee shall provide an adequate staff and maintain the Dispensary in an efficient condition so as to ensure the continued approval of the Local Government Board under Section 16 (1) (a) of the National Insurance Act, 1911. (d) The Dispensary Committee shall arrange that the place of residence of each patient shall be visited within such period after notification to them, and as often as may be reasonably neoessary in the opinion of the Medical Practitioner in charge of the said 82 Dispensary, (hereinafter called the "Tuberculosis Officer") by one of the Medical Practitioners attached to the said Dispensary, and also by one of the nurses appointed by the Dispensary Committee, and also that the Tuberculosis Officer shall furnish as soon as possible full information together with all reports in duplicate to the said Medical Officer of Health regarding any resident patient and the sanitary conditions existing at the place of residence of such resident patient. (e) The Tuberculosis Officer shall be independent of any control by the said Medical Officer of Health or other Medical Practitioner in all matters relating to diagnosis and treatment. The clinical reports of the Tuberculosis Officer shall be transmitted to the London County Council, without alteration, by the Medical Officer of Health, in those cases which are recommended for residential treatment, or in such other cases as the County Council may require. (f) The Tuberculosis Officer shall act as Consultative Officer under the Local Government Board's Tuberculosis Order of the 26th July, 1912, relating to domiciliary treatment of insured persons suffering from Tuberculosis, and he will be available to examine insured persons resident within the Borough of Woolwich applying for sanatorium benefit, and report thereon to the Insurance Committee, and attend the meetings of such Committee when required. (g) The Tuberculosis Officer shall be available to act in consultation with the practitioner in charge of a case of a non-insured person resident in the 83 Borough suffering from Tuberculosis, and shall, at the discretion of the Dispensary Committee, be entitled to a fee. (h) 'The Tuberculosis Officer shall refer any specially difficult cases to the Dreadnought or other agreed Hospital for consultative purposes, when necessary, in accordance with any agreement entered into with the Committee of such Hospital. (f) The management of the Dispensary is vested in an Executive Committee of whom two are representatives appointed by the Borough Council, and one is the Medical Officer of the Borough as an exofficio member. (j) Subject to the observance by the Dispensary Committee of the conditions of the agreement, the Borough Council will pay to the Dispensary Committee at the rate of three-eighths of the total expenditure of the Dispensary Committee on uninsured persons. (k) The agreement between the Woolwich Borough Council and the Dispensary Committee shall remain in operation for a period of twelve calendar months. (3) Summary of proposed agreement with the Dreadnought or other Hospital:— (a) The Tuberculosis Officer shall, when necessary, refer non-pulmonary cases of Tuberculosis to the Hospital for consultation, operation, or radiography, including cases of Glandular, Bone, Joint, or Skin cases, Tabes Mesenterica, Tuberculosis of the internal organs (such as Liver, Spleen, Kidneys, and Testicle), Tuberculous Meningitis, Hydrothorax, and 84 Empyema, and such other cases, whether pulmonary or non-pulmonary, as he may deem desirable, and the Hospital Committee agree that any cases so referred shall be treated as may be necessary as special out-patient cases for consultative purposes. That no charge shall be made for out-patients. (b) The agreement to be determined by six calendar months' notice. 84. 9 Spitting Flasks were supplied at cost price, 6d., compared with 19, 25, 20, 21, and 20, 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 Borough Council and other bodies 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 6pittoons supplied cost price (6d.) 85 1903. Borough Council oommenced to maintain beds at Peppard Sanatorium. Letters 6ent 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. 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. 85. There were 137 deaths from cancer (malignant tumour), giving a death-rate of 1.06, compared with 0.93, 0.88, 1 02, 0 97, and 101, in the five preceding years. 62 of the deaths were in males, and 75 in females. 16 only of the deaths were in persons under 45. The highest mortality was in West Plumstead and Eltham. The London death-rate was 1.12 in 1913. One-third of the deaths occurred in public institutions. Of the 137 deaths, 7 were from sarcoma and 130 from carcinoma. 86. The following table shows the sex and region affected in all cases of sarcoma for males and females:— 86 Sarcoma. Male. Female Jaw 1 — L. tonsil 1 — Thigh 1 — Lung — 1 Rib — 1 Intestine — 1 Pelvis 1 — 4 3 87. The deaths from carcinoma have been classified tinder the organs affected, since 1903, and the following table shows the result for males and females respectively: — CARCINOMA. Males. Seat of Primary Disease. Aver. 1903-5 Aver. 1906-10 1911 1912 1913 1914 Head and face 1.7 1.2 3 1 1 1 Mouth, jaw, and tongue 4.0 4.8 5 6 7 11 Pharynx, oesophagus, larynx, and neck 5.0 8.6 11 13 11 13 Pleura, lung, mediastinum 0.3 0.4 — 1 — 1 Stomach and Pylorus 5.3 10.4 8 10 6 4 Intestines, excluding rectum 2.7 3.2 5 2 4 9 Rectum and anus 4.0 4.8 5 10 7 4 Peritoneum and omentum 0.7 — — — — — Liver 8.0 6.4 8 7 6 9 Kidney and bladder — 1.6 2 1 2 1 Genital organs — — — 1 — — Prostate and external urinary 2.7 08 2 1 3 4 Pancreas 03 1.4 4 2 1 1 Pelvis and groin 0.3 — — — — — Undefined 0.3 2.2 6 3 2 — 35.3 45.8 59 58 50 58 87 Females. Seat of Primary Disease. Aver. 1903-5 Aver. 1906-10 1911 1912 1913 1914 Head and face 0.7 1.4 1 1 1 - Mouth and tongue 1.7 0.6 — 1 — 2 Pharynx, oesophagus, larynx, and neck 1.7 1.4 2 1 5 1 Pleura, lung, mediastinum 0.7 0.6 1 1 - 1 Stomach and Pylorus 5.7 7.6 7 5 9 10 Intestines, excluding rectum 0.7 4.2 6 5 4 3 Rectum and anus 3.0 6.8 5 6 5 11 Liver 7.3 8.6 6 8 12 7 Peritoneum and omentum 0.3 0.4 1 1 — — Kidney and bladder — 1.2 2 1 2 — Genital organs 160 136 15 11 16 16 Breasts 9.7 8.6 9 11 11 18 Limbs - 0.4 - - - - Pancreas - 0.2 1 1 - 2 Pelvis and groin 0.7 - - - - 1 Undefined 0.7 1.6 1 3 3 — 48.9 57.2 57 56 68 72 Last year had the highest recorded cancer death-rate. As compared with the three years 1903-5 the chief increase was in males. In men there was a great increase under carcinoma of the mouth, throat, and intestines; and in women under the stomach, rectum, and breast. Increase of cancer of the stomach, intestines, and rectum, may be due to improved diagnosis. The greater incidence of cancer on the mouth or 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, though in the past two years the contrary has been the case in Woolwich. Causes of Cancer. The special enquiry into the habits of 88 persons suffering and dying from cancer was continued. It was sought to elicit habits of five to ten years' duration before death, so as to ensure that they had not been caused or modified by the illness which was the cause of death. Cases affecting the alimentary tract were preferred for investigation, as being more probably affected by the habits tinder review. The enquiries were all made by myself of the nearest relative or friend discoverable. Altogether 178 cases have been tabulated during the three years. The following table shows the sex and age distribution of the cases investigated: — Under 50. 50-60. 60-70. Over 70. Total. Males 19 33 41 20 113 Females 9 21 21 14 65 178 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 26 7 33 Pharynx, (Esophagus, Larynx and Neck 29 4 33 Stomach and Pylorus 15 15 30 Intestines (excluding Rectum) 12 8 20 Rectum and Anus 14 14 28 Peritoneum and Omentum — 1 1 Liver 8 4 12 Breasts — 6 6 Uterus — 4 4 Limbs 2 — 2 Kidney and Bladder 1 1 2 Prostate and External Urinary Organs 2 — 2 Pancreas 3 1 4 Lung 1 — 1 113 65 178 89 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 consumption of If 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 adopted for the enquiry does not affect its value, since the standard was 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 on the United Kingdom was 2.6 lbs., and allowing one-third otf 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 1.7 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 form a general opinion based on the information given as to whether the patient used these articles in excess or otherwise. The figures as to tea drinking were probably a little more reliable than those relating to food consumption. The control cases were mainly old persons and there is a tendency to exaggerate the appetites of those advanced in life. 90 As regards the action of the bowels, the cases were divided into those who had a daily action and those whose bo.wels did not act as often as once in a day. Cancer Cases. 53 of the patients were stated to be excessive users of alcohol, 15 took the standard quantity, and 100 below the standard. There were thus 32 per cent. of exoessive alcohol drinkers. 69 smoked excessively, 15 consumed an average quantity, and 87 below the average, giving 40 per cent. of excessive smokers. 50 were excessive tea drinkers, 70 moderate, and 36 small tea drinkers, giving 32 per cent. of exoessive tea drinkers. 75 were large eaters, 61 moderate, and 31 small eaters, giving 45 per cent. large eaters. 49 were large meat eaters, 74 moderate, and 39 small meat eaters, giving 30 per cent. of large meat eaters. 98 had a daily action of the bowels, and 32 suffered from constipation, giving 75 per oent. of persons with a regular action. Non-Cancer Cases. These figures may be compared with those obtained for 155 persons under similar circumstances who did not die of cancer. They were persons dying fromt other causes than ca,ncer at ages over 50, or still alive at advanced ages. The following table gives the age and sex distribution of these controls: — Under 60. 60-70. Over 70. Total. Males 6 27 68 101 Females — 4 50 54 155 91 21 took alcohol excessively, 17 took the standard quantity, and 116 below the standard, giving 14 per cent. of excessive drinkers. 25 smoked excessively, 13 in moderation, and 118 were non-smokers or smoked very little, giving 16 per cent. of excessive smokers. 46 took tea excessively, 78 were moderate tea drinkers, and 26 were small tea drinkers, giving 31 per cent, excessive tea drinkers. 75 were large eaters, 49 moderate, and 28 small eaters, giving 49 per cent. of large eaters. 43 were large meat eaters, 78 moderate, and 28 small meat eaters, giving 29 per cent. large meat eaters. 112 had a regular daily actios of the bowels, and 23 suffered from constipation, giving 83 per oent. persons with a regular action. Comparison. It will be seen that comparing persons who suffer from cancer with those living at advanced ages or who died at advanced ages through other causes, the great differences are as to habits with respect to alcohol, smoke.', and the action of the bowels, viz.:— Cancerous persons had 32 per cent. of excessive alcohol usere, 40 per cent. excessive smokers, and 25 per cent. of oonstipation. Non-cancerous persons living to a greater age had 14 per oent. of exoessive alcohol users, 16 per cent. excessive smokers, and 17 per oent. of constipation. The percentage of excessive alcohol drinkers and large smokers among those dying from cancer is more than twice as high as among other persons. Mouth and Throat. These differences are still more 92 marked with respect to alcohol and smoking if only those who died from cancer of the mouth and throat are considered. Of 60 persons dying from cancer of the lips, tongue, jaws, fauces, larynx, oesophagus, and cervical glands, 28 or 47 per cent, took alcohol excessively, while 44 or 73 per cent. smoked excessively. 21 of these smoked chiefly a clay pipe, 14 a briar or other form of pipe, and 9 sometimes a clay, and sometimes a briar, 2 cigarettes, and 1 cigars. There were only four out of the 21 cases of cancer of the mouth or tongue who did not smoke; two of these had bad teeth. Among the non-cancer cases all the smokers smoked pipes (29 clay and 19 briar and 3 both), except one who smoked cigarettes. Of 108 cases with cancer of other parts than the mouth and throat, 23 per cent. took alcohol excessively, and ,22 per oent. smoked excessively. It would appear then that both alcohol and smoking (especially aloohol) have some little general effect in promoting cancer, but chiefly exert the.r injurious influence locally. The following case is interesting: A stoker in the navy died of enlarged prostate at the age of 78. He was stated to have been formerly a large smoker, and consumed 3½ ozs. a week of tobacco. He got cancer of the tongue and was operated on at the age of 62. After this he gave up smoking and the cancer did not return. He was always an abstainer from alcohol. Of the 60 cases of cancer of the mouth and throat, 17, or 28 per cent., were excessive tea drinkers. Tea drinking does not seem to be specially injurious locally or generally as far as cancer is concerned. If the injurious effect of smoking were chiefly due to the local effect of heat one would have expected excessive drinking of hot tea to have had a similar bad result. 93 The following table gives the above results in tabular form:— All Cancer cases. Per cent. Cancer of mouth and throat. Per cent. Cancer of other parts. Per cent. Control cases (noncancer). Per cent. Excessive alcohol drinkers 32 47 23 14 Do. smokers 40 73 22 16 Do. tea drinkers 32 28 — 31 Large eaters 45 — — 49 Do. meat eaters 30 — — 29 Constipation 25 — — 17 27 cases had cancer of the stomach. Of these 8, or 29 per cent., drank excessively, 10, or 37 per cent., were large eaters, and 7, or 26 per cent., were large meat eaters. As regards cancer of the bowels, out of 39 persons dying from cancer of the intestines, 19 had a regular daily action, 19 had constipation, and 1 was not quite regular, i.e., 49 per cent. had constipation. Thus constipation seems to predispose to cancer of the bowels. ALCOHOLISM. 88. There were 9 deaths from alcoholism, nil from peripheral neuritis, and 22 from cirrhosis of the liver, making a total of 31 deaths probably due to alcohol, compared with 23, 23, 31, 23, and 18, in the five preceding years. In addition to these, there were 423 deaths from diseases of the brain and nervous system (excluding meningitis), heart, blood vessels, and kidneys, of which a large proportion was certainly caused directly or indirectly by alcohol. The deaths from these causes in the five preceding years were 335, 343, 377, 395, and 429, respectively. The increase last year was chiefly in deaths from heart disease. 94 Of the 31 deaths, 15, or one half, took place in the months of August, September, and October, i.e., between the declaration of war and the reduction in the hours of the sale of drink. 89. The death-rate from alcoholism and cirrhosis of the liver was 0.24 in the Borough, and in 1912, 016 in London. SYPHILIS. 90. There were 9 deaths from syphilis, compared with 10, 7, 6, 3, and 9, in the five preceding years. All but one of these occurred in public institutions. Five were infants under two years. There were, in addition, 23 deaths from general paralysis, tabes dorsalis (locomotor-ataxy), and aneurism, diseases which are considered to be due to syphilis, compared with 25, 30, and 29, in the three 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 orders a card of instruction 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. Arrangements have also been made with the Pathological Department of the Seamen's Hospital to make bacteriological examination at the public expense for the diagnosis of syphilis. 95 OPHTHALMIA NEONATORUM (Inflammation of the Eyes of the New-born). 91. This disease was made compulsorily notifiable by an Order of the London County Council, dated March, 1911. In February, 1914, the Local Government Board issued an Order imposing the duty of notification on certified midwives who are to be paid 1s. for each notification. 5s. was paid under the Order last year. There is no requirement to disinfect or penalty for exposure, the 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 steps are being taken 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 Guardians have indicated their willingness to facilitate immediate removal to the Infirmary when satisfactory home treatment is impracticable. 18 cases were notified, compared with 14 in 1913. One was removed with the mother to the Infirmary, and 3 were treated as hospital out-patients. The others were all reported to be reoeiving effectual treatment at home. The district nurses visited 4. METEOROLOGY (See Table 8). 92. The average temperature in the winter quarter of the year was 42.7; 9 weeks had an average temperature above the normal, and 4 below. The spring quarter had a temperature somewhat above the average; the summer quarter was very dry; its average temperature was 60.7° F., which 96 is 0.6° above the average. The rainfall was only 3.22 in this quarter. In the autumn quarter the temperature was above the average in 8 weeks. The lowest temperature, 19.9° F., occurred in the week ending January 24th, and the highest, 92.1° F., occurred in week ending July 4th. The rainfall was 23.9 inches, which is one inch below the average; most rain, 5.96 inches, fell in December. (See also under Diarrhœa.) 97 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 situate within the Borough, viz., the Plumstead Well. Plumstead Well. In previous years I have repeatedly called attention to the unsatisfactory condition of the water supplied by this well. It is being kept under observation, and there was no great change in its condition during the year. 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 one house last year, making a total of 71 houses in the seven years 1908-1914. 30 of these houses were in the Dockyard and St. Mary's Wards, 13 in River Ward, 26 in St. George's 98 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 93 houses, compared with 34, 55, and 33, in the three preceding years. At 10 houses the supply was found insufficient or temporarily cut off, and the necessary steps taken for obtaining a proper supply. FOOD AND DRUGS ACT. 4. 491 samples were submitted to the Public Analyst, and 36, or 7.3 per cent., were found to be adulterated, compared with 3.4, 3.3, 4.6, 2.7, and 5.6, in the five preceding years, and 8.4 in the Metropolis in 1912. The percentage of adulteration in the previous five years averaged 3.9. The average of the five years 1904-08 was 6.3. 88 of the samples taken were informal. 4 of these were found to be adulterated. 5. Proceedings were taken in 20 cases; fines were inflicted in 12. In 3 there was proof of warranty; one was adjourned sine die; in 2 costs were given against the defendant; and 2 were dismissed. 6. A total of £20 7s. 6d. was imposed in fines, and £11 18s. 0d. in costs. 7. 309 of the samples were fresh milk. 30 of these, or 9.7 per cent. were adulterated, compared with 3.7, 4.8, 7.2, 3.5, and 7.9, in the five preceding years. 99 58 samples were bought as butter, and one was found to be adulterated. Table 18 shows the other 124 articles analysed. Five of these were found to be adulterated, viz., 3 samples of Easton's syrup and 2 of camphorated oil. During the past seven years, 7 samples of coffee out of 105 taken have been found to be adulterated, one of cocoa out of 77, and 5 of drug3 out of 156. But no adulteration was discovered in 37 samples of vinegar, 33 of flour, 13 of sugar and sweets, 75 tea, 56 mustard, 46 jams, and 17 condensed milk, nor in any one of the smaller number of several other articles, other 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 pier 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. 8. 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 309 0 100 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 0 (ii.) Statements incorrect 0 (b) Determinations made of milk fat in cream sold as preserved cream:— (i.) Above 35 per cent. 0 (ii.) Below 35 per cent. 0 (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. 3. Thickening Substances. No evidence of their dition to cream or to preserved cream. 4. No other observations. 9. Of the 18 adulterated milk samples for which proceedings were taken the adulteration varied from 5.41 to 34.1 per cent. of added water, and from 8.0 to 25.66 per cent., deficiency in fat. The fines varied from 2s. 6d. to £4. Adulteration in Woolwich compared with London. In March I reported on the Sale of Food and Drugs Acts. It appeared from the Local Government Board's Report that the proportion of samples reported against in 1912 was 8.8 in London and 2 7 in Woolwich. In the latter half of the past year there was a very marked increase in the percentage of articles reported as adulterated. 101 15 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. 88 such samples were taken in 1913, and 3 were found adulterated; one of these was camphorated oil, and the other two were Easton's syrup. Two formal samples were taken subsequently from the same vendors and found to be adulterated and successful proceedings were instituted. 10. A record is kept of all analyses of milk made by the. Public Analyst. The average percentage of fat in unadulterated samples has been found to be the same each year, viz., 3.6, and of non-fatty solids from 8.8 to 8.7 per cent. 11. Food Reform. A leaflet has been printed on the management of children from one to five years of age for distribution at the Infants' Consultation. This is largely occupied with the feeding of young children and shows the importance of the use of hard food from the earliest eruption of the teeth. FOOD INSPECTION. 12. The inspection of meat and other food received the usual attention. Inspector Shaw made special inspection of the slaughter-houses. There were 76 surrenders. A large seizure of unsound turkeys is described as follows by the Chief Sanitary Inspector:— 102 On the 22nd December, 1914, a representative of the Royal Arsenal Co-operative Society, Ltd., called at the Town Hall and stated that the Society had received a delivery of doubtful turkeys at all their branches in the Borough. The Chief Sanitary Inspector, accompanied by Inspector Wood, at once visited the various branch shops. In several of the shops they found some of the doubtful turkeys exposed for sale in the front shop, but the majority of them had been put at the backs of the various shops by the respective managers. The turkeys at the various shops were examined and the Inspectors decided they were unfit for food, seized them, and arranged to take them away on the following day. Those deposited at the backs were seized in consequence of suggestions that they were going to be returned to the wholesale firm. On the following day, 23rd December, 376 turkeys were collected from different branches and taken before the Magistrate at the Woolwich Police Court, who made the order for their destruction, and on the next day, 24th December, a further 246 were surrendered by the Society for destruction. A total of 622 turkeys, weighing 2 tons 19 cwt. 27 lbs. were seized and surrendered. The Public Health Committee, after consideration of the fact that in spite of the information volunteered by the Society, some of the turkeys oontinued to be exposed for sale, resolved to take proceedings. The case came before the Magistrate on 25th February, 1915, when he granted £6. 6s. 0d. costs against the Society, 103 but inflicted no fine on the ground that the turkeys were taken possession of at the instance of the Society. In the Report for 1913, a full account was given of the seizure of 52 crates of unsound plums and the prosecution of Joseph Blake for being in possession; of Robert Pearce, to whom the plums belonged; and Richard Carter, on whose premises they were found. 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; and Richard Carter was fined £5 or 14 days. Blake lodged an appeal against his conviction which was dismissed with costs. He lodged a further appeal on a point of law as to the true construction of the word "possession," and then disappeared and the further appeal has not been heard. 13. Of the surrenders in 1914, 2 were tuberculous ox lungs, 35 livers or other organs affected with parasitic disease, 88 lbs. bruised pork, 2,477 lbs. unsound beef, and 300 oysters. A full list is given in Table 19. DAIRIES, COWSHEDS, AND MILKSHOPS. 14. On January 1st, 1914, there were 116 milkshops on the register; 6 were added, and 13 removed, during the year, leaving a total of 109 on the register at the close of 1914. There were 174 inspections made, and 21 notices served. There were no prosecutions. Owing to the steps taken by the Health Department requiring persons not to sell milk in unsuitable general shops, 104 the number of milkshops has been reduced from 196 to 109 in the ten years 1905-14. An abstract of regulations was drawn up and printed in the Annual Report for 1910. This is left at every milkshop. 15. 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 1914 two applications were refused. The requirements of the Health Department for securing the purity of milk were detailed in the 1912 Annual Report. 16. No cowshed was closed and none opened, leaving 16 on the register. There were 35 inspections, and 7 notices were served for dirty conditions, etc. Milk and Dairies Act, 1914. This Act to make better provision for the sale of milk, and the regulation of dairies, was passed on the 10th August last, and comes into operation on the 1st October, 1915, or such later date as the Local Government Board may order. The Act prohibits the sale of tuberculous milk, extends the power of the Local Government Board to make orders with respect to milk and dairies, gives special powers to stop a supply of milk likely to cause tuberculosis, and gives various other powers to local authorities with regard to milk. It is to be hoped that the powers given by this Act and the regulations to be made under it by the Local Government Board will enable much progress to be made in the hygiene of cowsheds and milk shops. Tuberculosis in Cows—Order of the Board of Agriculture. The Board of Agriculture made an Order in 1913 under the 105 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 (see Annual Report, 1913). SLAUGHTER-HOUSES. 17. Two slaughter-houses were removed from the register, leaving 10. 40 inspections were made, and 3 notices served and complied with. NUISANCES (see Table 15a). 18. 454 complaints of sanitary defects were received and investigated, compared with 400, 361, and 441, in the three preceding years. 55 complaints of non-removal of dust were made and attended to, compared with 20, 29, and 38, in the three preceding years. 11 of the dust complaints came from Woolwich parish, 32 from Plumstead, and 12 from Eltham. The dust in Woolwich is collected by your Council's employees, but that in Plumstead and Eltham by contractors, Messrs. Tuff & Hoar. The dust collection in Eltham was taken over by Messrs. Tuff & Hoar from Mr. Tucker in 1913. 19. Drains and Water-Closets. 12 defective combined drains were investigated and reported upon by the Chief Sanitary Inspector, compared with 27, 16, and 7, in the three preceding years.. These drains affected 74 houses. 450 private drains, found choked and defective, were examined, cleared, and relaid, compared with 319, 399, and 106 448, in the three preceding years. The largest number, 84, was found in River Ward. 782 water-closets and w.c. cisterns were repaired, compared with 734, 890, and 785, in the three preceding years. 181 foul w.c. pans were cleansed by tenants, compared with 279, 238, and 209, in the three preceding years. 20. 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. 21. Public Urinals. The urinals attached to public houses, and others accessible to the public, have been regularly inspected during the year, 361 inspections being made. Regular cleansing has been required. 22. House Inspection. 4,538 houses were inspected, house to house, compared with 5,892, 5,830, and 5,489 in the three preceding years; 7,267 were inspected re infectious diseases and complaints, compared with 6,546, 6,678, and 6,516. In addition to these 612 inspections of registered houses were made. 23. Table 16 shows the streets inspected, and the number of houses found defective in each. At 2,337 houses, interiors were cleansed, or defective roofs repaired, compared with 2,137, 2,206, and 2,620, in the three preceding years. 393 houses with damp walls were remedied, compared with 600, 571, and 629, in the three preceding years. 107 Improved ventilation was provided in 44 houses, compared with 94, 62, and 41, in the three preceding years. 474 new dust pails were supplied, compared with 516, 525, and 545, in the three preceding years. 24. Medical Officer's Special Inspections. These amounted to a total of 433. 16 inspections were made of oowsheds and milkshops, 28 of bakehouses, 9 of factories and workshops, 80 inspections were on account of tuberculosis, 57 cancer, 6 diphtheria, 7 scarlet fever, and 13 other infectious diseases. 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. 110 premises were inspected re housing conditions. Special inpections were made of Morris Street, New Street, High Street Flats, St. Thomas' Cottages, and of all the houses reported as unfit for human habitation. 25. Overcrowding. 93 cases of overcrowding were found and remedied, compared with 97, 91, and 101, in the three preceding years. The overcrowding was 2.5 per cent. of house-to-house inspections, compared with 1.6 and 1.8 per cent. in 1912 and 1913 respectively. Overcrowding has increased with the impossibility of finding unoccupied houses. These figures do not include 45 oases of overcrowding found by Miss Middlebrooke and abated without serving notice. 26. Smoke Nuisance. 54 observations re smoke nuisance were made, and 4 nuisances of black smoke observed. The nuisances were abated on service of notices. There was no prosecution. Considerable nuisance occurred from smoke at 108 the Public Baths, and the Woolwich Electric Light Station. The notice of the Baths and Electricity Committees was called to it. Seven complaints of smoke nuisance were received from the London County Council. These related to the Electric Light Works, Globe Lane and Whitehart Lane, Siemens Electrical Works, and Woolwich Baths. 27. Defective Light. At 38 houses new windows were supplied or existing ones enlarged, or other work done to improve the lighting by daylight. 28. 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. 29. Verminous Booms. 122 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 143, 248, 214, and 220, in the four preceding years. DUST REMOVAL. 30. In Woolwich parish 5,160 loads of house refuse, and 207 loads of inoffensive trade refuse were removed by direct labour, and destroyed at the Woolwich Destructor. In the three preceding years 5,769, 5,866, and 6,058, loads respectively, were removed. In Plumstead 17,547 loads of house refuse, weighing 15,415 tons were removed by the contractors, Messrs. Tuff & Hoar, and destroyed at the Plumstead Destructor. 109 In addition, 756 loads of trade refuse weighing 462 tons were removed to the Plumstead Destructor and destroyed; the contractors removed 105 loads and were paid for the removal by the tradesmen at the rate of 1s. 6d. per load. £2,929 5s. 8d. was paid for collection, compared with £2,864 10s. Od. in 1913. In Eltham the sum of £860 (£894 in 1913) was paid to the contractors for removal of dust. The following report on dust collection was made in April:— "Enquiries as to mode of dust collection have been made of all the Metropolitan Boroughs and of 8 suburban Boroughs, and replies have been received from all except Lambeth and Westminster. It appears that in all the Boroughs the dust is directly collected by the Council with the exception of Stoke Newington, St. Marylebone, Willesden, and Woolwich. Four wheel vans are used in all the Boroughs, though, in three, two wheel carts are used as well. In only four Boroughs is motor traction employed, and in two of these—Kensington and Acton—it is only employed for special work, as for conveying the dust to the destructor after house-to-house collection has been made. Hampstead apparently employed motor traction for a time and gave it up as not being economical. There is a concensus of opinion that motor traction is not economical for ordinary houseto-house collection. Information as to the mode of covering the vans is not as clear as is desirable. 19 Boroughs state that tarpaulins or sheets are used, and 13 that wooden or iron 110 coverings are employed which 6lide or work on hinges. It appears, however, that in many cases where tarpaulin sheets are used, these are not loose and detachable as in Woolwich, but are fixed on to a frame work so that the cart can be partially covered during the process of collection. This is the case in the Borough of Greenwich. It is very desirable that some more effectual steps should be taken for preventing the dust being scattered by the wind and spilt in collection and removal, and I recommend that in future contracts a condition should be made that suitable vans should be used with fixed covering, which would allow the carts to be partly covered in collection; and that similar vans and coverings should be purchased for use in the Parish of Woolwich, wherever it is necessary to replace the present dust-vans. Dust Inspectors are employed in all Boroughs but Bermondsey, Bethnal Green, Camberwell, Deptford, Hampstead, Stepney, Woolwich, Acton, and Croydon." The consideration of this report was deferred. TRADE REFUSE. 31. During the past year there have been 1,709 (5,271 in 1913) receptacles of offensive trade refuse removed. There are now 12 (45 in 1913) tradesmen on the books from whom offensive trade refuse is removed. Certain manure manufacturers 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 1s. 6d. per load, and 2d. per bushel, and for offensive refuse at the rate 111 of 3d. per receptacle, charged per quarter in advance on the amount collected in the previous quarter. HOUSING OF THE WORKING CLASSES ACTS. 32. Active steps were again taken in 1914 under the Housing and Town Planning Act. 18 houses were represented under Section 17 as unfit for human habitation, compared with 9, 18, and 52, in the three previous years. 9 Closing Orders were made, compared with 5, 14, and 14, in the three preceding years. 9 houses were remedied to the satisfaction of the Medical Officer of Health without Closing Orders being made, compared with 4, 4, and 26, in 1911-1913. In some of the 9, the houses were temporarily closed while the work was done. The following was the procedure 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 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:— 112 Remedying dampness, concreting sites, providing dampproof courses and dry areas. Providing sub-soil drainage, re-roofing, improving sanitary arrangements, providing adequate water supplies, remedying dilapidated conditions of structure. Seven houses were 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 4,538 Dwelling houses considered on inspection to be in a state so dangerous or injurious to health as to be unfit for human habitation 18 Number of representations made to Borough Council under Section 17 (2) with a view to making of closing orders 18 Number of closing orders made 9 Number of dwelling houses remedied without making closing order 9 Number of dwelling houses put into fit state for human habitation after making closing order 4 Number of dwelling houses demolished (by War Office) 2 Number of dwelling houses closed in 1913 demolished by orders made in 1914 5 The following are the 18 houses represented:— 1, Walpole Place; 11, 13, Meetinghouse Lane; 6, 7, Rodney Street; 23, Barnfield Road; 113 6, 8, Stanley House; 3, 4, 5, 6, 7, 8, 9, Kate's Place; 2, 3, 4, New Street. With regard to Nos. 1, Walpole Place, and 23, Barnfield Road, the necessary works were done by the owners to render these houses fit for human habitation without Closing Orders being made. Nos. 11 and 13, Meetinghouse Lane, have been demolished by the Government for the extension of the Royal Arsenal. Nos. 6 and 7, Rodney Street, and 6 and 8, Stanley House.— The Closing Orders became operative and the necessary works were carried out and the Closing Orders withdrawn. The Closing Orders have become operative with respect to Nos. 2, 3 and 4, New Street. Nothing has been done by the owners, and there has been considerable trouble in getting the tenants to comply with the Closing Orders. Some persons are still occupying these houses. The question of demolition will shortly be considered by the Council. In the following cases Closing Orders were made in 1913, and, nothing having been done to render the houses fit for human habitation, the houses were demolished:—Nos. 7 and 8, New Street, 1 and 2, Globe Lane, and 2, Prospect House. The Closing Order on No. 83, Church Street, Was withdrawn, the work necessary having been completed. The seven houses dealt with under Section 15 were Nos. 3 to 9, Kate's Place; the work was put in hand and completed by the owner. NORTH WOOLWICH—VITAL STATISTICS. 33. A report on the greatly improved health of this 114 district was contained in the Annual Report for 1912. The Vital Statistics of 1911 and 1912 were compared with those of 1902-3. HIGH STREET FLATS AREA. 34. This area was fully reported on in 1913 (see Annual Report, 1913). On the 16th January, 1914, the Medical Officer of Health made a representation to the London County Council, under Part I. of the Housing of the Working Classes Act, that the most satisfactory way of dealing with the insanitary conditions existing at the High Street Flats Area was an improvement scheme for the rearrangement and reconstruction of the streets within the area. The London County Council replied stating that there is nothing in the arrangement or condition of the area generally which would justify an improvement or reconstruction scheme, and that the houses can be properly dealt with either by means of closing orders or by the service of sanitary notices under the Public Health or the Housing Acts. The Highways Committee of the London County Council has had the matter of widening High Street at this point, for the purposes of the trams, under consideration, but has failed to come to any decision. The Council resolved to serve notices under the Public Health (London) Act on the owner of Sydney, Albert, Fore, and Stanley Houses, to abate the nuisances and execute prescribed works. This was done; the walls of the dark recesses caused by the back additions, were whitened to the top; additional windows were provided and other works for 115 improving the lighting carried out. The common yard was also made inaccessible to the public so as to prevent depredations by hooligans. But it was not found possible to do anything as regards providing caretakers, washhouses, drying and play grounds, and other matters referred to in my original report. The demolition of Nos. 7 and 8, New Street, and 1 and 2, Globe Lane, has also permitted the access of more air and light to the backs of some of the flats. Nos. 6 and 8, Stanley Houses, have been reconstructed. It was arranged that the house refuse from these flats should be collected thrice a week. NORTH WOOLWICH DOCK EXTENSIONDEMOLITION AND DISPLACEMENT. 35. My last Annual Report described the intended demolition for the new docks and steps taken for' a re-housing scheme by the Council. The Local Government Board decided that it was not practicable to re-house within the Borough and a site was accordingly chosen at West Ham. HOUSES—INSUFFICIENCY. 36. The following report was made in November:— "In October, 1913, I reported on the supply of new houses in the Borough, and stated that there was a Very great demand for working class houses in the Borough at that time, and that the demand was not being met by the supply. The Committee decided on January 9th, 1914, to reconsider the matter in six months' time. Since that report was written, 227 new houses have been built, but on the other hand a large number have been demolished or closed for various 116 reasons. Even before the War the number of empty houses was rapidly diminishing. In April this year there were only 305 unoccupied houses in the Borough, showing a diminution of 163 during the twelve months. With the outbreak of war, the consequent increase of work in the Arsenal, the number of army recruits quartered in the Borough, and the removal of families from married quarters into private houses, the demand for housing accommodation became acute, and it is a matter of common knowledge that it is practically impossible now for a working class family to find suitable housing accommodation vacant in Woolwich. This matter is not only seriously detrimental to national and municipal interests, but greatly interferes with sanitary administration and abatement of nuisances. Cases of overcrowding due to the same cause are frequently reported. There is no doubt there is a permanent demand for additional houses, quite apart from (he temporary and acute demand caused by the War. There is a diminution in the provision of new houses owing to the increased cost of building material. As regards the temporary demand occasioned by the War, and the increased work in the Arsenal, this should be met by H.M. Government. It would be easy to erect in a few weeks temporary housing accommodation to provide for the additional number working in the Arsenal and unable to obtain suitable accommodation." In consequence, the Council resolved:— (a) That the attention of the Government be drawn to the deficiency of housing accommodation in the 117 Borough of Woolwich, due to the abnormal conditions of work in the Royal Arsenal, and the they be asked what steps they are prepared to take in the matter. (b) That the Member of Parliament for the Borough be informed that it is the intention of this Council to approach the Government on the above matter, and to request him to arrange if possible for the Heads of the Government Departments concerned to receive a Deputation from the Council, and that in the event of a deputation being received it consist of Councillors R. M. Allen, W. Barefoot, and W. H. Dawson, the Town Clerk, and the Medical Officer of Health. Mr. Samuel, President of the Local Government Board, received the deputation on the 30th December. A full statement of the housing conditions of the Borough and the variations of employment in the Arsenal was presented. The Government was apparently convinced as to the urgent need of houses and with extraordinary expedition decided to build a garden suburb at Well Hall. So rapidly was the scheme planned and carried out that within three months of presenting the report and two months of the deputation being received, the new houses were rising from the ground. 37. Council's Rouses. All the Council's 25 houses in North Woolwich were occupied throughout the year with the exception of three which were vacant for one week. 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. 118 On June 5th, 1911, Nos. 15, 17, and 19, Gossage Road, were taken over by the Libraries Committee. HOUSES REGISTERED UNDER THE BY-LAWS. 38. The existing By-Laws and the history of proposed new By-Laws were commented on in the Annual Report for 1913. At the commencement of the year, 432 houses were on the register; 8 were newly registered, and 22 taken off the register, leaving 418 on the register at the close of the year, compared with 395, 409, 429, 432, and 432, in each of the five preceding years. The large number taken off the register is mainly due to houses demolished under the Housing, Town Planning, &c., Act, and for the new docks. 39. These houses were inspected, some quarterly, others half-yearly or yearly. 612 inspections were made in all, and 308 notices were served. One occupier was summoned for failing to keep the rooms he occupied clean; the case was adjourned to see if an improvement took place, and as on re-hearing the conditions were reported as satisfactory, the defendant was discharged on payment of costs. The registered houses were under the care of Inspector Shaw. The duties consist largely in educating housewives 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 22 do. South 104 119 St. Mary's 35 Dockyard 67 St. George's 56 Herbert 4 Burrage 25 St. Margaret's 16 Central 3 Glyndon 18 St. Nicholas 68 The following are the particulars of the inspections made: Houses Let in Lodgings. Total number on register 418 Number of houses inspected (one or more times) 612 „ found unsatisfactory 314 „ found satisfactory 298 ,, of notices served 308 ,, of nuisances, defects and offences against the by-laws, dealt with and remedied 471 „ of cases of overcrowding remedied by redistribution without notice 8 ,, of houses measured 8 Notices. On Owners for Cleansing (under P.H.L. Act) 149 On Tenants for Cleansing (under By-laws) 47 On Landlords for Overcrowding 12 On Tenants for Overcrowding 14 On Landlords and Tenants for other defects 127 On Landlords and Tenants for Verminous Rooms 39 Verbal Notices on Tenants for Cleansing—carried out 90 120 INHABITED HOUSE DUTY. 40. A certificate under the Inland Revenue Act was granted for the 8 houses, 1-8 Kendal Terrace, Blanmerle Road. COMMON LODGING HOUSES. 41. 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 Houses. 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 UNDERGROUND ROOMS. 42. No underground rooms were found not in accordance with the regulations made under Section 17, Housing, Town Planning, &c., Act. 121 FACTORIES, WORKSHOPS, AND WORKPLACES. 43. There were, at the close of the year, 201 (200 in 1913), workshops and workplaces on the register. 402 inspections were made, and 63 notices served and complied with. 96 inspections of factories were made regarding sanitary accommodation, and 15 notices served and complied with. 490 inspections of homeworkers' premises were made and 14 notices sent and attended to. Table XVc. gives full particulars of the work done under Sec. 107, Factory Act. 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. Seven matters under the Factory Act were reported to H.M. Inspector, including three failures to affix abstracts of the Factory Act. BAKEHOUSES. '44. The number of factory bakehouses is 9, and of workshop bakehouses in use is 40, 14 of the latter being underground. They were all inspected twice. I inspected most of them personally, and found them generally satisfactory. 11 certified underground bakehouses are not in use. ICE-CREAM SHOPS. 45. 83 Ice-cream shops were on the register at the close of the year, compared with 89, 89, and 82, in the three previous years. 5 were added and 4 removed during the year. There were 132 inspections made, and 9 notices served. Regulations, embodying the provisions for premises where food is sold, contained in the London County Council 122 (General Powers) Act, axe distributed at every shop on the register. The shops axe inspected in April, June, and August, by Inspector Potter. 46. By-Laws for vendors of Fried Fish and Fish Curers have been approved by the Local Government Board and! are now in force. (a) Fried Fish Vendors. No. 1 forbids persons suffering from infectious disease to take part in the business. A place where fish is cleansed or stored must have a rainproof ceiling or roof; must be adequately lighted and ventilated; the window must be one-tenth of the floor area with one-twentieth capable of opening; there must foe permanent openings for ventilation; the surface of the walls and floor must be constructed of smooth, impervious material, and the floor must be such as to provide for the removal of liquid matter; proper steps must be taken to prevent effluvium arising from the gutting, cleansing, or storing; the gutting,, cleansing, or Istoring, must not he carried out in any place in which poultry or other animals are kept, or in a place communicating with a place in which animals are kept unless it be through the open air or an intervening Ventilated space. No vendor of fried fish may keep, upon his premises more than 24 hours any hamper, box, or barrel, which has contained wet fish, and which may be offensive. Adequate provision must be made for securing the personal cleanliness of any person taking part in the business. 123 All fish must be thoroughly gutted and cleansed before being fried. By-law 8 requires the provision of sufficient receptacles, of galvanised iron or other suitable material, with close fitting covers, for receiving and conveying away from the premises all fish skins, garbage, and other refuse produced in the business. Such refuse must be placed in the receptacles immediately upon its production, and must be removed from the premises at least once every 24 hours. The receptacles must be thoroughly cleansed at least once in every 24 hours, and the external surfaces must be at all times maintained in a cleanly condition. A vendor of fried fish must maintain the floor, wall surfaces, and ceiling of the business premises, and all apparatus and utensils, in proper order and repair. He must also wash with hot lime, at least four times every year, the surfaces of every wall and ceiling or inner surfaces of the roof of the premises. The cleansing must be carried out between the 1st and 10th days of the months of March, June, September, and December. Such cleansing, however, is not required if the surfaces axe painted or varnished or oovered with hard, smooth, impervious material. By-law 11 prescribes the mode of construction of the furnace. The exterior surface must be of hard, smooth,, fireproof material, with side screens and a suitable hood. The hood must be connected with a flue having a good draught. The gas or vapour must either be discharged into the external air at such a height as to be diffused without injurious effect, or pass through a fire, or condensing apparatus so as to consume the gas or deprive it of its injurious qualities. 124 For the purpose of gutting, an adequate surface of slate, glazed earthenware, or other suitable material, must be provided. The yard must be properly paved and have adequate drainage. (b) Fish Curers. The By-laws for fish curers are similar to those for vendors of fried fish, with certain differences applicable to the trade. By-law 10 requires every smoking or drying kiln used for the business to be constructed of hard and smooth brick, stone, or other suitable fireproof material, and so constructed and used that all vapour or smoke discharged shall be effectively conveyed away in such a manner as to admit of its diffusion without injurious effects. All tanks or receptacles used for salting or brining must be constructed with internal surfaces of smooth and impervious material. The penalty for breach of the By-laws is £5, and in case of a continuing offence a further penalty of 40s. a day. The By-laws are made by the County Council under the London County Council (General Powers) Act, 1908, and Under Section 10 of that Act it is the duty of each Sanitary Authority to enforce them in their district. The London County Council gave notice of the By-laws by public advertisement, and every vendor of fried fish and every fish curer in the Borough was provided with a copy. The Inspector subsequently visited each shop, and when it was found that the By-laws were not complied with, 125 notice was served and complied with. Very little difficulty was found in getting the vendors to do the necessary work and the result has been a great improvement in the condition of these shops. DISINFECTION. 47. The mode of disinfection, cost of appliances, staff, etc., were fully described in my Annual Report, 1903, pages 73-76. Rooms at 1,344 houses were disinfected in 1914, compared with 1,093, 1,195, and 1,278, in the three preceding years. The disinfecting apparatus was used 1,344 times for 29,568 articles. 411 books from the Free Libraries and Public Schools were disinfected. The sum of £18 9s. 2d. was received for disinfection inspecial cases on request of the occupier. A large quantity of horsehair was disinfected for the Army Ordnance Store Department, for the sum of £52 12s. 6d. 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 (224 persons supplied in 1914), the Sun Street Mortuary (53 persons supplied), 14, Barge House Road, North Woolwich (43 persons supplied), and at 144a, High Street, Eltham (114 persons supplied). The cost of disinfectants used by the Department in 1914 was £37 9s. 2d. The disinfectants used were Corrosive Sublimate; Sulphur 126 and Formalin tablets (for fumigation); Formaldehyde (for spraying and disinfecting books, and for use in the Mortuary); Cyllin (for summer diarrhœa, and sputa in phthisis); Permanganate of Potash; Jeyes' Corporation Fluid (for dustpails); and Chloride of Lim,e (for offal tins). HEALTH SHELTER. 48. The Health Shelter was used during the year for 6ix soldiers sleeping in a tent where a case of scarlet fever had occurred. It had not been used before this since 1908. It was used twice in 1906. In view of the small demand for it, the upper of the two flats was let in 1908, and was occupied until September last on a weekly tenancy. The flat has been empty since October 1st in consequence of an order from the Local Government Board requiring local authorities to make provision for isolation in the event of an outbreak of small-pox or other epidemic during the War. THE MORTUARIES. 49. The Sun Street Mortuary was used for 189 bodies, compared with 189, 143, and 179, in the three preceding years. 174 were deposited for inquest, and 15 for custody. 114 post-mortem (examinations were made. 2 bodies were deposited in the infectious mortuary, compared with 1, 4, and 3, in the three preceding years. The Eltham Mortuary was usied for one body, compared with 3 in 1910, 3 in 1911, 5 in 1912, and 2 in 1913. CEMETERIES. 50. The two Borough Cemeteries were well maintained 127 and no complaint was received. 667 bodies were buried in Woolwich Cemetery, compared with 679, 540, and 627, in the three previous years. There were 842 interments in the Plumstead Cemetery, compared with 690, 602, and 764, in the three previous years. 51 burials took place in Plumstead Churchyard, compared with 51, 47, 60, and 34, in the four preceding years. CLEANSING OF VERMINOUS PERSONS. 51. The station for cleansing verminous persons was opened in November, 1906. During 191(4 it was used by 811 persons, compared with 408, 590, 509, 430, and 651, in the five preceding years. The users were 116 adults (viz., 9 females and 107 males) and 695 children (viz., 388 females and 307 males). 5,677 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 21st August, 1911, to allow the London County Council to use the Borough Council Cleansing Station for cleansing school children. The Station is reserved for school children on Tuesday, Wednesday, and Friday, between 9 a.m. and 4.30 p.m., girls being cleansed between 9 and 1, and boys in the aft,ernoon. The Borough Council must properly cleanse the children and their clothes to the reasonable satisfaction of the London County Council, the children cleansed not to exceed 10 in one day or 20 in one week. The London Coujnty Council pays to the Borough Council 2s. for each child cleansed, such sum to. include all attendances made by the child in one month when repeated baths 128 are necessary. The Borough Council for this purpose pays a female attendant (Mrs. Hicken) for the three days, Tuesday, Wednesday, and Friday, at a payment of 3s. 6d. per day. £40 12s. 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. 52. 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. Second class hot baths can be obtained for 2d. and school children can get them for 1d.; for these terms towel and soap are not supplied. Temporary spray or shower baths for soldiers were arranged on a rough hut effective scale, as a result of the great demand for further washing provision for the soldiers of Kitchener's Army. 129 Workmen's Baths. In the Annual Report for 1913, I described the neglect of the men at the Plumstead Destructor to use the slipper baths provided for them and pointed out the advantage of spray baths which are more economical, and allow a bath to be taken in much less time. Spray baths should be of the most approved type; those sometimes supplied are not satisfactory. TENTS, VANS, AND SHEDS. 53. During the year 6 tents, vans, and sheds were inspected (42 in 1913), and one notice served under the Bylaws for this class of dwelling. NOTICES AND PROSECUTIONS. 54. 3,131 written intimation notices, and 578 statutory notices were served. 90 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 3 defaulters were summoned at the Police Court. The results are given in Table XVII., together with the results of 9 other prosecutions under the Public Health and Housing Acts. BACTERIOLOGICAL EXAMINATION. 55. The Council's bacteriological work is done by Dr. A. Davies, the Pathologist of the Seamen's Hospital. 1,214 bacteriological examinations were made for the Public Health Department, viz.: 915 for diphtheria, 273 for thisis, and 23 for enteric fever. The total cost wast £186 7s. 6d., compared with £183 3s. 2d. in 1913. 130 INFANT CONSULTATION. 56. A Consultation for mothers and infants is held every Wednesday afternoon in two rooms at the Town Hall. Mothers bring their 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. At first it was limited to infants under one year, but in accordance with the wish of the Local Government Board, children from one to five are now received as far as the Medical Officer of Health can find time. The Consultation was attended last year by 1,196 infants, compared with 460, 863, and 1408, in the three previous years. For particulars see Miss FitzGerald's report. 57. Maternity and Child Welfare. The Local Government Board in July, 1914, approached Sanitary Authorities stating that they were prepared to give grants in aid of expenditure for Maternity and Child welfare and inviting the Sanitary Authorities to initiate complete schemes for this purpose and to apply for grants towards carrying them out. The Board particularly urged that the infant welfare work undertaken by Sanitary Authorities, and which has been specially concerned with the child in its first year of life, should be dealt with on, a more comprehensive basis It was pointed out that there should be a continuity in dealing with the whole period from before birth until the time when the ohild is entered upon a school register. The Local Government Board memorandum contemplates that medical advice and where necessary treatment should be continuously and systematically available for expectant mothers and for children until they are entered on a school register, and that arrangements should be made for home 131 visitation throughout this period. The work of home visitation is one to which the Board attach very great importance and in promoting schemes for maternity and child welfare Local Authorities are urged as a first step to appoint an adequate staff of Health Visitors. So far as the recommendations of the Local Government Board concern children between the years of 1 and 5, the Infant Consultation is not now restricted to infants under one year, and the mothers are invited to continue coming once a quarter until the children reach school age. No medical treatment is given and the advice given is mainly hygienic and dietetic. Children needing medical and surgical treatment are referred to local doctors, hospitals, the Invalid Children's Aid Association, or the Tuberculosis Dispensary. The staff, however, is not sufficient to continue the supervision of all children up to school age. One Consultation too, is insufficient, and one or two more are required in other parts of the town. An outline scheme has been submitted by the Borongh Council to the Local Government Board and approved by them, which includes provision for an antenatal clinic. The scheme embraces:— 1. An ante-natal clinic for expectant mothers. This (might be carried out at the new premises of the Home for Mothers and Babies, if some means were discovered of gaining the goodwill of the local doctors and midwives. Such goodwill too would facilitate the use of the Maternity Hospital by oases requiring to be attended at a hospital for operations or other1 serious reasons. 2. An Assistant Medical Officer to conduct the Infant Consultations under the Medical Officer of Health. 132 Payment to be £1 1s. 0d. for each half-day's attendance. 3. An additional Woman Inspector and Health Visitor (Salary, £120 to £140). 4. Premises in East Plumstead for a Consultation., Rent, £20; furniture, £50; lighting, cleaning, printing, &c., £10. Half of all expenses will be repaid by the Treasury, so that the annual cost to the Borough Council will be £112 10s. 0d. for salaries, £15 for premises, and £25 capital expenditure. It is greatly to be hoped that before long it will be possible by means of hygienic advice to expectant mothers and also by means of medical treatment where necessary, to avert the number of still births and deaths from immaturity. (Further reference is made to the subject in Miss FitzGerald's report.) WOMEN SANITARY INSPECTORS' WORK. 58. There are two Women Sanitary 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 lavatories for women, 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 eases, 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. Miss FitzGerald's duties comprise advising mothers as to the care of infants, and the prevention of infant mortality, visiting homes 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 Miss Middlebrooke's Report: — Women's Lavotaries at Railway Stations, etc. Number of Inspections 95 „ Found dirty and defective 7 134 Restaurants and Eating Houses. Number of Inspections 85 „ Defects and dirty conditions found and remedied 22 Factories and Workshops. Number of Inspections of Factories and Workshops 313 ,, Notices served 12 „ New workrooms measured 25 Homeworkers' Premises. Number of Inspections 490 ,, Oases referred to District Inspectors 14 Miscellaneous. Total number of houses visited re. Phthisis, Measles, Scabies, Whooping-Cough, and Zymotic Enteritis 53 Visits paid for various causes, complaints, etc. 360 „ „ Verminous and dirty houses and bedding 1060 Re-visits—estimated 1000 Cases where bedding was found to be in a dirty and verminous condition, and cleansed 385 Total number of cases referred to District Inspectors 160 „ Early morning inspections. 5 „ Overcrowding—cases found and abated 45 Notices served on tenants re dirty conditions 150 Notices served on landlords and tenants—various 195 There are some details of work which cannot be represented in figures, but which take up a tremendous amount of time—mostly in connection with troublesome complaints, where the ordinary mode of procedure, that of serving the stereotyped notice, followed up by prosecution would not 135 gain the desired result. For instance, it is of no use serving a notice on old and infirm persons to make and keep their rooms clean. Instead it is best to find an obliging relative or friend to do it, or else, failing this expedient, get the machinery of the Poor Law into motion, and get the old person removed to the Infirmary. It can quite well be understood that many visits which are not strictly official have to be made before matters are cleared up satisfactorily. Or, take a further instance—a child appears to require medical treatment, and the mother is provided with information and instruction as to how best to obtain it (if too poor to afford medical advice). The shiftless mothers require numerous visits before they finally summon sufficient energy to take the child and act on the advice given. During the year there were several attendances at the Police Court. The National Society for Prevention of Cruelty to Children often requires assistance in giving evidence before the Magistrate. The welfare of children usually makes it advisable to do this. During the latter months of the year we received numerous complaints of overcrowding, owing to conditions caused by the War and the scarcity of housing accommodation; this overcrowding tending to increase immorality, alcoholism, and consequent neglect of home and children. It is very difficult to deal with the overcrowding owing to the lack of rooms to be had, but sometimes readjustment of sleeping arrange ments will modify the nuisance somewhat. I also noticed an increase in the number of Scabies cases. At the Cleansing Station we dealt with numerous cases (of which some were adults living in affected houses). They 136 were given three hot baths, the affected places dressed with sulphur ointment, and their clothing and bedding disinfected. Alice M. Middle.ebrooke. 59. The following is Miss FitzGerald's Report:— Summary of Inspections. Visits to houses after notification of births 1205 Re-visits. 237 Visits re infant death 57 Domiciliary visits to children attending Consultation 250 Zymotic Enteritis cases investigated, including re-visits 238 Tuberculous cases 86 Ophthalmia Neonatorum 28 Ophthalmia (reported by Schools). 10 Puerperal Fever 6 Complaints investigated 5 Infants weighed at Consultation 1196 Health Lectures given 9 Evening visits 6 Unsuccessful visits (occupiers absent from home) 750 Visit6 re dirty conditions 26 Visits not otherwise classified 100 Reported to District Inspectors:— Contraventions of Housing Acts 4 Dirty interior walls 7 Other defects 20 Overcrowding 2 Visits paid by pupils who did temporary health visiting under my supervision:— Miss Hurst 53 Mis6 Durrant 349 137 The War has made infant welfare work of greater importance than before. Infant life has risen in value owing to the immense wastage of life that is going on at the Front. Moreover, social conditions at home resulting from the War are not favourable to the preservation of infant life. During the time of the South African War the infant deathrate in Woolwich reached the highest point of the last 25 years; and this at a time of great local material prosperity. The infant death-rate declined steadily in the years that followed while Woolwich went through a period of distress and poverty caused by unemployment. The death-rate fell, not as the result of poverty but in spite of it, and largely as the result of the steady work, educational and otherwise, done to further infant welfare by the Public Health Department. There is no fear that the infant mortality rate, which stands at 84 per 1,000 for the year under review, will return to 150, the average for the years of the South African War, because the work which has been done will tell, and there is to-day a m,uch higher standard of mother-craft than there was 15 years ago. But some rise in the infant death-rate may be expected as the result of the disturbed conditions through which we are passing. It is to be regretted that the attendance at the Infant Consultation showed a marked diminution directly War broke out, and it has remained considerably below the average of the previous year in spite of persistent efforts on my part to get the attendance back to the standard of the time previous to the War. One can readily understand that the mothers axe more inclined to visit neighbours and discuss war news, which in many cases has some personal interest to them, than to come to the Town Hall to get advice a,bout the babies. 138 A very large proportion of the mothers of Woolwich have husbands at the Front, and the consequent anxiety and mental distress have in many oases an adverse effect upon the infants. A nursing mother should be guarded from emotional strain, but it is impossible in the case of women with husbands at the Front; many of them can get no reliable information as to whether the men are alive 013 dead, and a great many are already widows. It is abundantly clear that no effort to safeguard the health of the mothers and babies can be relaxed at this time. On the contrary there is need for new enterprise in this direction. One new departure has been started in the Borough since the War began. A school for mothers under the name of the River Ward Babies Welcome, has been initiated by voluntary effort. It works in oc-operation with the Public Health Department, and aims to reach a class of mothers who will not come to the Municipal Infant Consultatson and amongst whom the infant death-rate is high. Its present premises are at 103, High Street, Woolwich, formerly the Pier Tavern, Dust-hole." An Infant Consultation is held there weekly conducted by Dr. Helen Saxgeant, of Camberwell, and there are sewing classes and health talks by the Superintendent (a trained and salaried worker). So much for the post-natal work. It still remains to deal with the ante-natal period and to safeguard the health of pregnant women. In such way only can we prevent the loss of infant life before and immediately after birth. We have no statistics of the number of miscarriages and still-births which take place annually; but Dr. Armaund Routh, a recognised authority, estimates the number at 100,000 for England and Wales. That is to 139 say, more deaths of infants occur in the nine months of ante-natal life than the total English losses from the War up to date. One effect of the War will be a diminution of the birthrate to an extent which cannot at present be estimated. It becomes increasingly necessary therefore to preserve all the nation's babies. So far our efforts have been directed towards teaching the mothers how to care for the infants after they are born. The satisfactory results of this instruction in mother-craft are shown in the steady decline in the number of deaths which take place in the 3 to 12 months age-periods. But in the deaths which take place in the earliest weeks of life (a period chiefly influenced by ante-natal conditions) there has been no continuous decrease. It has for some time been evident to experts that the next step must be to make provision for supervising the health of expectant mothers. PUBLIC AMBULANCE. 60. The Public Ambulance, for accidents and non-infectious illness, was used 120 times, compared with 123, 147, 127, and 150, in the four preceding years. The following were the journeys made:— To Guy's Hospital 19 Cottage Hospitals. 48 Seamen's and Miller Hospitals 20 King's Hospital 3 London Hospital 3 St. Thomas' 2 Union Infirmary — Other hospitals. 5 140 Private houses 17 Asylums 3 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. 61. Co-operation with the Royal Army Medical Corps. The co-operation with the Army Medical Officers of Medical Officers of Health was requested by the Local Government Board and willingly offered by your Medical Officer of Health. The sanitary condition of Woolwich Common was very Unsatisfactory in the early months after war was declared. Certain suggestions were made and an improvement resulted. Information has been given and received with respect to billeting. All possible assistance has been given in disinfection of articles and premises. 62. The following changes were made in the duties of the staff:— In June, Inspector Tedham was appointed to take over the duties of Food and Drugs Inspector; in addition he takes the Glyndon Ward and makes enquiries as to infectious disease in Glyndon, Central, and St. Margaret's Ward. STAFF. Inspector Ranee takes Central and St. Margaret's Wards 141 for general inspection and inspects workshops and factories (re sanitary provision) where women are not employed:— Inspector Potter was nominated to Burrage and Herbert Wards, and Inspector Powell to Eltham, including Food and Drugs sampling. On the outbreak of War your Medical Officer of Health was taking his holiday in Germany and was detained as a prisoner of war for seven weeks beyond the date when he should have returned. Colonel Moore, M.D., his locum tenems, was called up for active service and it became necessary to appoint another medical man. After some difficulty in finding one qualified and willing to serve, Dr. Mair was nominated, and I have to acknowledge the able and conscientious way in which he filled the gap. My sincere thanks are also due to the Chief Sanitary Inspector and the staff of the Department for the way in which they laboured to prevent the public health of the Borough from suffering through my absence. Two members of the clerical staff, Messrs. Britter and Prescott, joined the Army (Mr. Britter obtaining a commission). Although temporary clerks were appointed in their place, their absence greatly increased the work and responsibility of the remaining clerks, Messrs. Smith and Collyer, and I cannot speak too highly of the work performed by Mr. Smith as acting chief clerk. 143—144 TABLE I. Borough of Woolwich. Vital Statistics of the whole District during 1914 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 125701 3531 28.1 479 132 1636 13.0 261 40 169 1765 14.0 1905 125885 3549 28.2 366 103 1463 ... 313 50 192 1605 12.7 1906 123644 3524 28.5 396 111 1530 ... 293 48 183 1666 13.5 1907 123644 3295 26.5 372 111 1479 ... 296 50 184 1613 13.0 1908 123644 3082 24.9 208 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 1913 125686 2876 22.5 229 80 1378 ... 298 50 252 1580 12.3 Average for years 1902 to l913 123829 3218 25.9 330 100 1451 ... 300 47 193 1597 12.8 1914 128556 2824 22.0 239 84 1505 ... 369 61 246 1690 13.2 * 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 arc those into which persons are habitually received on account of sickness or infirmity, such as Hospitals, Workhouses and Lunatic Asylums. Area of District in acres (exclusive of area covered by water) 8230.7 Total Population at all Ages 121,376 Number of Inhabited Houses 21,463 Average Number of Persons per House 5.6 ) At Census of 1911. 145 TABLE IA. I. II. Institutions within the District receiving Sick and Infirm Persons from outside the District. Institutions outside the District receiving Sick and Infirm Persons from the District. "Woolwich Union Infirmary Lewisham Infirmary Royal Arsenal Hospital Herbert Hospital Auxiliary Hospital Blackheath Cottage Hospital Woolwich and Plumstead Cottage Hospital Seamen's Hospital Brook do. Eltharn 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 East Anglian Sanatoria, Harpenden Ear and Nose Hospital Brompton do. Bethnal Green do. City Road Chest do. Mount Vernon do. Miller do. Hostel of God Cane Hill Asylum Dartford Heath Asylum Colney Hatch do. Claybury do. Tooting Bec do. Darenth do. Caterham do. Stone do. Banstead do. Horton do. 146 TABLE II. Cases of Infectious Diseases notified under S. 55, P.H.L.A., during the Year 1914. 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 714 ... 134 449 105 26 ... 233 229 138 114 13 625 Diphtheria 416 4 111 233 38 30 ... 187 99 79 51 65 392 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Typhoid or Enteric Fever 18 ... 2 3 4 9 ... 6 6 4 9 6 14 Erysipelas 107 5 4 7 13 66 12 29 40 32 6 ... ... Puerperal Fever 7 ... ... ... ... 7 ... 4 1 1 1 ... 1 Cerebro-Spinal Fever 1 ... ... ... ... 1 ... 1 ... ... ... ... ... Ant. Polio Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 18 18 ... ... ... ... ... ... 7 5 1 ... ... Zymotic Enteritis 199 95 88 8 1 7 ... 83 54 44 18 ... ... Total 1480 122 339 700 161 146 12 548 436 303 193 84 1032 147—150 TABLE III.—Causes of, and Ages at Death during the Year 1914. 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. 75 to 85. Over 85. West. East. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 25 14 11 4 14 5 2 .. .. .. .. .. .. .. .. .. .. 14 8 3 .. 1 2 Scarlet Fever 9 4 5 .. .. 6 2 .. 1 .. .. .. .. .. .. .. .. 4 5 .. .. 8 .. Epidemic Influenza 25 15 10 5 .. 1 .. 1 2 .. .. 3 2 4 6 1 .. 5 10 5 5 1 .. Whooping Cough 25 12 13 16 6 2 1 .. .. .. .. .. .. .. .. .. .. 9 6 6 4 1 .. Diphtheria and Membranous Croup 34 15 19 1 1 10 16 5 1 .. .. .. .. .. .. .. .. 15 7 10 2 32 .. Enteric Fever 4 1 3 .. .. .. .. .. 2 .. 1 1 .. .. .. .. .. 2 .. 2 .. 3 .. Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 10 6 4 8 .. .. .. .. .. .. .. .. .. .. 1 1 .. 5 4 1 .. 2 .. Enteritis 23 8 15 15 6 1 1 .. .. .. .. .. .. .. .. .. .. 7 5 7 4 6 .. Acute Anterior Polio Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Continued Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 7 4 3 1 .. .. 2 .. 1 .. .. 1 .. 1 .. .. 1 1 2 2 2 2 2 Puerperal Fever 3 .. 3 .. .. .. .. .. .. 1 2 .. .. .. .. .. .. 1 .. 2 .. 1 1 Other Septic Diseases 17 8 9 3 .. 1 3 .. .. .. .. 1 2 3 2 1 1 7 3 6 1 6 7 Syphilis 9 6 3 5 .. .. .. .. .. .. .. 2 1 1 .. .. .. 3 4 2 .. 4 2 Rheumatic Fever 10 6 4 .. .. .. 1 1 1 .. 1 1 3 2 .. .. .. 3 3 3 1 1 1 Gout 2 2 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 1 .. 1 .. .. .. Intermittent Fever and Malarial Cachexia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Meninges 29 14 15 5 1 12 4 6 1 .. .. .. .. .. .. .. .. 10 10 6 3 3 7 Tuberculosis of Lungs (Phthisis) 163 97 66 2 .. 2 3 2 12 19 35 43 26 15 4 .. .. 76 51 32 4 22 55 Tuberculosis of Intestines and Peritoneum 13 7 6 2 2 2 .. .. 3 1 3 .. .. .. .. .. .. 3 4 5 1 4 3 Other forms of Tuberculosis 11 8 3 .. 1 2 1 2 1 1 1 1 1 .. .. .. .. 4 2 4 1 9 1 Alcoholism 9 4 5 .. .. .. .. .. .. .. 2 3 4 .. .. .. .. 4 3 2 .. .. 2 Cancer 137 62 75 .. .. .. .. .. .. .. 3 13 25 42 36 15 3 42 49 29 17 19 31 Diabetes 13 5 8 .. .. .. .. .. 1 1 1 2 4 1 3 .. .. 1 2 4 3 1 1 Congenital debility and malformation, including premature birth 104 58 46 101 1 .. .. 1 .. .. 1 .. .. .. .. .. .. 41 37 18 8 5 13 Old Age 103 48 55 .. .. .. .. .. .. .. .. .. .. 1 27 49 26 34 33 24 12 6 48 Meningitis 15 8 7 3 2 1 3 3 1 .. 1 .. .. 1 .. .. .. 6 6 2 1 1 2 Inflammation and Softening of Brain 2 .. 2 .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. .. 1 .. 1 Epilepsy 2 1 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. General Paralysis 12 11 1 .. .. .. .. .. 1 .. 3 4 2 2 .. .. .. 5 4 2 1 12 .. Tabes Dorsalis and Locomotor Ataxia 6 5 1 .. .. .. .. .. .. .. .. 2 2 1 .. 1 .. 2 2 1 1 1 2 Peripheral Neuritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Brain and Nervous System 23 10 13 4 2 1 .. .. .. 1 3 .. 3 3 4 .. 2 10 10 3 .. 5 4 Organic Diseases of the Heart 172 90 82 .. 1 .. 1 3 6 2 8 18 26 43 43 19 2 63 54 41 14 10 25 Cerebral Hsemorrhago, Embolism and Thrombosis 83 36 47 .. .. .. .. .. .. .. 2 2 13 20 17 19 10 25 36 17 5 1 26 Apoplexy and Hemiplegia 22 10 12 .. .. .. .. .. .. .. .. 1 4 5 7 5 .. 6 8 7 1 1 8 Aneurism 5 4 1 .. .. .. .. .. .. .. 1 .. 3 .. 1 .. .. 1 4 .. .. 1 2 Other diseases of blood vessels and heart 50 22 28 .. .. .. .. .. .. 1 2 7 8 6 13 10 3 15 9 14 12 9 5 Bronchitis 142 73 69 17 11 1 1 .. .. .. .. 4 7 21 41 34 5 47 52 34 9 6 26 Lobular (Broncho) Pneumonia 68 31 37 27 13 14 3 2 1 1 .. .. .. 3 .. 3 1 29 17 19 .. 4 6 Pneumonia 75 45 30 4 3 4 2 .. 3 1 6 11 .. 8 14 8 .. 32 28 12 .. 6 13 Other Diseases of Respiratory System 2 1 1 .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 .. .. 1 Diseases of Stomach 18 12 6 3 .. 1 .. .. .. 1 1 3 5 1 2 1 .. 7 6 5 .. 5 2 Appendicitis and Typhlitis 5 2 3 .. .. .. .. .. .. 2 1 1 1 .. .. .. .. 2 2 1 .. 4 1 Obstruction of Intestines 14 .. 7 4 .. 1 .. .. 1 .. 1 1 1 1 3 1 .. 3 7 4 .. 5 5 Cirrhosis of Liver 22 13 9 .. .. .. 2 .. .. .. 1 3 10 5 .. 1 .. 10 6 6 .. 2 9 Other Diseases of the Digestive System 10 5 5 .. 1 .. .. .. 1 .. .. 1 1 3 2 1 .. 3 4 2 1 1 4 Nephritis and Bright's Disease 46 21 25 .. .. .. .. 1 3 1 3 4 7 11 10 4 2 10 15 14 7 8 10 Tumours and other Affections of Female Genital Organs 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. Accidents and Diseases of Pregnancy, Parturition 6 .. 6 .. .. .. .. .. .. .. 2 4 .. .. .. .. .. 2 3 .. 1 1 2 Violence 43 27 16 2 .. 3 3 4 3 2 5 4 2 5 4 4 2 17 18 8 .. 11 23 Suicide 11 6 5 .. .. .. .. .. .. .. 4 2 4 1 .. .. .. 4 5 1 1 1 2 Ill defined diseases or unknown 6 6 .. 1 .. 2 .. .. .. .. .. 1 .. .. .. 2 .. 1 1 2 .. 2 1 Other defined diseases 44 31 13 5 2 1 .. 2 1 .. 3 3 5 13 4 3 2 14 14 13 3 12 6 Total 1690 881 809 239 67 74 52 33 47 35 97 147 184 225 246 181 60 612 559 384 135 246 367 151—152 TABLE IV. Infant Mortality. 1914. 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 .. .. .. .. .. .. .. 2 2 4 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. 1 1 8 3 4 .. 16 Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. 1 1 .. .. .. .. 1 Tuberculous Meningitis .. .. .. .. .. 1 2 1 1 5 Abdominal Tuberculosis .. .. .. .. .. .. 1 .. 1 2 Other Tuberculous Diseases .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. 1 1 .. 1 3 Convulsions .. .. .. .. .. .. 1 2 .. 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. 1 1 2 4 6 4 17 Pneumonia (all Forms) .. .. .. 1 1 7 8 5 10 31 Diarrhœa .. .. .. .. .. 2 4 .. 2 8 Enteritis .. .. .. .. .. 4 3 4 4 15 Gastritis .. .. .. 1 1 1 .. .. .. 2 Syphilis .. .. .. .. .. 1 2 .. 2 5 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. 2 .. .. .. 2 Injury at Birth 1 1 .. .. 2 .. .. .. .. 2 Atelectasis 9 .. .. .. 9 .. .. .. .. 9 Congenital Malformations 3 1 .. 1 5 2 1 .. .. 8 Premature Birth 40 5 3 5 53 4 1 .. .. 58 Atrophy, Debility, and Marasmus 12 1 2 1 16 4 1 2 .. 23 Other causes 3 1 1 2 7 4 5 3 3 22 68 9 6 14 97 43 37 31 31 239 Nett Births in the year Nett Deaths in the Year of Legitimate, 2765. Illegitimate, 59. Legitimate Infants, 232. Illegitimate Infants, 7. 153 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 0.17 4.27 0.04 ... ... 0.22 0.06 ... ... 0.06 0.02 1907 ... ... ... ... 0.85 0.04 2.22 0.12 8.27 0.11 ... ... 0.16 0.03 ... ... 0.04 0.01 1908 ... ... ... ... 0.70 0.05 2.93 0.16 4.82 0.07 ... ... 0.10 0.02 ... ... 0.04 0.02 1909 ... ... ... ... 0.80 0.01 1.94 0.20 8.04 0.15 ... ... 0.08 0.02 ... ... 0.07 0.01 1910 ... ... ... ... 0.70 0.02 1.19 0.04 4.09 0.10 ... ... 0.06 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 ... ... 0.06 0.02 1914 ... ... ... ... 0.83 0.05 2.72 0.26 5.46 0.07 ... ... 0.09 0.03 ... ... 0.05 0.02 TABLE VI. London and the Metropolitan Boroughs.—Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 52 weeks ended 2nd January, 1915.* 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 op London 4,518,021 109,667 64,994 147 — 1385 316 918 706 3031 6281 11,395 West. Paddington 142,193 2965 1846 3 — 4 8 25 20 79 145 281 Kensington 171,234 3210 2242 1 — 15 17 7 13 63 187 302 Hammersmith 123,853 2935 1717 5 — 41 5 21 16 67 170 275 Fulham 157,303 4154 2101 9 — 31 21 42 22 126 205 468 Chelsea 64,511 1299 870 3 — 3 5 6 8 21 87 87 City of Westminster 154,544 2155 1936 9 — 6 10 21 15 35 205 173 North. St. Marylebone 114,355 2132 1577 6 — 2 9 20 18 59 146 208 Hampstead 86,388 1273 893 4 — 2 2 16 10 11 55 102 St. Pancras 214,133 5223 3334 4 — 56 18 51 30 121 379 481 Islington 325,496 8171 4923 15 — 97 24 84 43 228 470 857 Stoke Newington 50,511 1045 661 — — 1 3 6 4 16 58 81 Hackney 223,393 5460 3099 8 — 106 9 53 39 127 303 502 Central. Holborn 46,832 764 754 6 — 11 2 9 4 13 92 69 Finsbury 84,521 2541 1652 2 — 76 6 45 9 88 167 312 City of London 17,831 181 239 1 — 1 1 3 2 1 20 17 East. Shoreditch 109,569 3511 2075 2 — 112 5 55 20 148 234 496 Bethnal Green 127,807 3786 2034 4 — 68 7 48 28 174 210 518 Stepney 275,081 8058 4539 8 — 182 28 72 70 268 465 997 Poplar 160,839 5073 2743 6 — 66 10 31 34 195 268 590 South. Southwark 188,321 5604 3350 2 — 95 22 59 37 207 330 693 Bermondsey 124,683 3849 2165 3 — 81 8 14 18 140 203 482 Lambeth 297,094 7022 4319 16 — 58 16 40 50 202 422 728 Battersea 167,451 4303 2220 3 — 50 11 26 17 122 210 402 Wandsworth 331,321 6675 3617 5 — 26 13 56 41 148 298 591 Camberwell 261,828 6580 3589 5 — 65 23 47 39 143 373 653 Deptford 109,269 3115 1572 3 — 51 9 9 25 91 150 308 Greenwich 96,018 2408 1412 5 — 47 7 6 16 53 132 235 Lewisham 169,211 3336 1836 6 — 7 8 19 24 55 126 247 Woolwich 122,431 2839 1679 3 — 25 9 27 34 30 171 240 * 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 1370 oases the residence was outside the County of London, and these cases have been excluded. On the other hand 55 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 3433 cases, while on the other hand the deaths of 3082 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. 157—158 TABLE VII. London and the Metropolitan Boroughs.—Birth-rates and Death-rates of Persons belonging to London and the Metropolitan Boroughs during the 52 weeks ended 2nd January, of 1915. 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. Counts of London 24.3 14.4 14.4 0.03 0.31 0.07 0.20 0.16 1.39 27.64 104 West. Paddington 20.9 13.0 12.9 0.02 .. 0.03 0.06 0.18 0.14 1.02 26.64 95 Kensington 18.8 13.1 13.1 0.01 .. 0.09 0.10 0.04 0.08 1.10 19.63 94 Hammersmith 23.8 13.9 13.7 0.04 .. 0.33 0.04 0.17 0.13 1.38 22.83 94 Fulham 26.5 13.4 13.8 0.06 .. 0.20 0.13 0.27 0.14 1.31 30.33 113 Chelsea 20.2 13.5 12.9 0.05 .. 0.05 0.08 0.09 0.12 1.35 16.17 67 City of Westminster 14.0 12.6 13.2 0.06 .. 0.04 0.06 0.14 0.10 1.33 16.24 80 North. St. Marylebone 18.7 13.8 14.1 0.05 .. 0.02 0.08 0.18 0.16 1.28 27.67 98 Hampstead 14.8 10.4 11.0 0.05 .. 0.02 0.02 0.19 0.12 0.64 8.64 80 St. Pancras 24.5 15.6 15.6 0.02 .. 0.26 0.08 0.24 0.14 1.77 23.17 92 Islington 25.2 15.2 14.8 0.05 .. 0.30 0.07 0.26 0.13 1.45 27.90 105 Stoke Newington 20.7 13.1 12.5 .. .. 0.02 0.06 0.12 0.08 1.15 15.31 78 Hackney 24.5 13.9 14.0 0.04 .. 0.48 0.04 0.24 0.18 1.36 23.26 92 Central. Holborn 16.4 16.1 16.2 0.13 .. 0.24 004 0.19 009 1.97 17.02 90 Pinsbury 30.1 19.6 19.4 0.02 .. 0.90 0 07 0.53 0.11 1.98 34.63 123 City of London 10.2 13.4 14.0 0.06 .. 0.06 006 017 011 1.12 5.52 94 East. Shoreditch 32.1 19.0 19.6 0.02 .. 1.02 0.05 0.50 0.18 2.14 42.15 141 Bethnal Green 29.7 16.0 16.6 0.03 .. 0.53 0.05 0.38 0.22 1.65 45.96 137 Stepney 29.4 16.5 17.3 0.03 .. 0.66 0.10 0.26 0.26 1.70 33.26 124 Poplar 31.6 17.1 16.9 0.04 .. 0.41 0.06 0.19 0.21 1.67 38.44 116 South. Southwark 29.8 17.8 17.9 0.01 .. 0.51 0.12 0.31 0.20 1.76 36.94 124 Bermondsey 31.0 17.4 17.4 0.02 .. 0.65 0.06 0.11 0.14 1.63 36.37 125 Lambeth 23.7 14.6 14.3 0.05 .. 0.20 0.05 0.14 0.17 1.42 28.77 104 Battersea 25.8 13.3 13.4 0.02 .. 0.30 0.07 0.16 0.10 1.26 28.35 93 Wandsworth 20.2 10.9 11.0 0.02 .. 0.08 0.04 0.17 0.12 0.90 22.17 89 Camberwell 25.2 13.7 13.6 0.02 .. 0.25 0.09 0.18 0.15 1.43 21.73 99 Deptford 28.6 14.4 14.3 0.03 .. 0.47 0.08 0.08 0.23 1.38 29.21 99 Greenwich 25.1 14.7 14.5 0.05 .. 0.49 0.07 0.06 0.17 1.38 22.01 98 Lewisham 19.8 10.9 10.7 0.04 .. 0.04 0.05 0.11 0.14 0.75 16.49 74 Woolwich 23.3 13.8 14.1 0.02 .. 0.20 0.07 0.22 0.28 1.40 10.57 85 "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. 159—160 TABLE VIII. Meteorology and Registered Deaths from all Causes and from certain Prevalent Diseases for the Year 1914. 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. 1914. January 10 55.4 29.1 43.7+ 43.41 86 4 0.39 — 16 49 „ 17 42.1 29.3 34.8— 43.60 80 3 0.03 — 12 35 „ 24 38.1 19.9 32.2— 42.10 77 1 0.01 — 9 46 „ 31 52.5 33.0 43.6+ 41.24 88 4 0.07 — 7 41 February 7 56.6 36.6 46.4+ 43.23 82 2 0.16 — 9 39 „ 14 59.0 38.6 47.9+ 44.07 85 5 1.10 1 9 33 „ 21 55.6 33.1 43.0+ 44.87 84 6 0.74 — 2 29 „ 28 55.7 29.2 41.8+ 43.99 80 1 0.44 — 7 30 March 7 57.0 33.6 45.8+ 43.59 79 4 0.35 — 2 28 „ 14 57 5 29.3 43.9+ 44.39 84 7 2.21 — 6 23 „ 21 51.0 31.9 40.5— 44.36 82 7 0.96 1 8 41 „ 28 56.8 27.8 42.3— 43.19 78 6 0.31 — 8 33 April 4 66.8 38.2 50.0+ 44.45 77 4 0.18 1 7 53 1st Quarter 66.8 19.9 42.7 43.57 92 54 6.95 3 102 480 April 11 60.8 36.0 48.2+ 46.12 76 7 1.02 — 8 39 „ 18 66.3 33.9 49.1+ 46.90 68 — 0.00 — 5 35 „ 25 73.6 37.1 53.4+ 48.14 63 3 0.03 — 1 31 May 2 69.6 31.7 49.1+ 49.48 71 — 0.00 — 8 33 „ 9 66.9 40.2 52.0+ 50.26 74 5 0.97 — 7 41 „ 16 70.2 39.4 51.4— 50.62 74 1 0.05 — 1 22 „ 23 83.4 42.3 60.7+ 52.66 67 2 0.35 — 7 26 „ 30 66.3 46.3 50.4— 53.94 72 2 0.26 — 2 30 June 6 73.3 44.7 55.4— 54.34 74 2 0.26 — 3 28 „13 77.6 40.3 55.7— 54.70 74 4 0.65 1 3 23 „ 20 83.4 45.5 62.2+ 56.78 75 2 0.34 — 4 24 „ 27 80.8 45.7 60.6— 58.60 67 2 0.28 — 3 30 July 4 92.1 48.2 67.7+ 60.65 64 2 0.09 1 4 33 2nd Quarter 92.1 31.7 55.0 52.55 71 32 4.30 2 56 395 July 11 81.8 45.2 62.3— 61.45 76 3 0.64 — 3 24 „ 18 83.8 53.0 65.8 + 62.65 70 3 0.33 — 5 29 „25 78.0 61.2 62.5 63.24 72 6 0.31 — 4 26 August 1 81.6 48.1 59.8— 61.80 70 4 0.13 1 2 28 „8 73.2 46.3 59.5— 61.78 84 5 0.88 — 3 25 „15 79.4 48.8 64.0+ 61.80 73 2 0.02 — 3 31 „ 22 77.8 47.1 62.1+ 62.19 67 1 0.01 2 1 23 „ 29 83.7 52.1 64.4+ 62.43 77 2 0.17 3 4 30 September 5 82.0 45.9 63.4+ 62.48 75 — 0.00 1 5 30 „ 12 81.0 58.6 62.4+ 62.40 73 3 0.47 3 6 28 „ 19 72.5 47.6 57.1— 61.14 69 2 0.14 5 4 37 „ 26 73.9 35.3 52.5— 58.87 73 1 0.12 2 5 36 October 3 68.6 33.8 53.8— 57.34 75 — 0.00 3 9 35 3rd Quarter 83.8 33.8 60.7 61.51 73 32 3.22 20 54 382 October 10 63.4 36.0 52.9— 56.62 74 — 0.00 1 5 22 „ 17 61.0 35.2 51.3— 55.82 88 3 0.19 — 7 25 „ 24 62.7 42.2 51.6+ 55.19 86 3 0.13 — 3 34 „ 31 62.0 35.0 50.6+ — — — 0.64 — — 30 November 7 62.0 41.0 51.8+ — — — 0.43 — 4 32 „ 14 59.0 39.0 49.1+ — — — 0.43 — 6 31 „ 21 54.0 29.0 38.7— — — — 0.70 — 5 20 „ 28 52.0 34.0 42.1— — — — 0.66 1 4 30 December 5 56.0 36.0 48.3+ — — — 0.97 — 1 35 „ 12 56.0 33.0 43.5+ — — — 2.06 — 3 28 „ 19 51.0 35.0 44.0+ — — — 1.31 — 8 34 „ 26 48.0 27.0 36.4— — — — 0.56 — 3 31 January 2 53.0 30.0 41.5+ — — — 1.83 — 20 70 4th Quarter 63.4 27.0 46.3 — — — 9.91 2 69 422 Year 92.1 19.9 51.18 — — — 24.38 27 281 1679 161 TABLE IX. Weekly Averages, 1914. 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 54.2 31.5 42.7 43.57 82 4.1 0.53 0.23 8 37 2nd Quarter 74.2 40.9 55.0 52.55 71 2.46 0.15 0.15 4 30 3rd Quarter 78.2 47.9 60.7 61.51 73 2.46 0.25 1.38 4 29 4th Quarter 56.9 34.8 46.3 — — — 0.76 0.15 5 32 162 TABLE X. Summary of Statistics for the 1st Quarter ending 4th April, 1914, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 Population. Births. Deaths under one year. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions Population to middle of 1913 Number. Rate. Number. Bate per 1,000 Births Registered. Number. Number. Rate. 125,686 721 22.3 64 89 433 102 13 60 480 15.3 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population to middle of 1913 Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 births. Population Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1000 Births. Population 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 37,850 27.2 18.2 124 West 41,478 21.3 16.2 104 14,440 183 14.2 45 East 31,918 221 11.9 34 163 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. Rheumatic Fever 1 2.2 Smallpox - 0.2 Tubercle of Lung 50 55.2 Measles 2 9.8 Other Tuberculous Dis. 13 Scarlet Fever 1 2.8 Alcoholism and Cirrhosis of Liver 4 5.4 Influenza 12 13.4 Whooping Cough 9 4.4 Cancer and Sarcoma 31 26.8 Diphtheria & Mem. Croup.. 8 5.0 Bronchitis 59 68.4 Enteric Fever 1 0.4 Broncho-Pneumonia 21 Diarrhœa and Enteritis 3 2.8 Pneumonia 22 25.4 Erysipelas 1 0.8 Violence 11 8.0 Puerperal Fever 1 0.4 Suicide 4 3.2 TABLE XI. Summary of Statistics for the Second Quarter, ending July 4th, 1914, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Rates calculated per 1,000 population. Births. Deaths under 1 year. Deaths at all ages— Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Population estimated to middle of 1914. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 128,230 702 21.9 62 88 357 83 17 55 395 12.3 164 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population estimated to middle of 1914. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 Births. Population estimated to middle of 1914. Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 Births. Population estimated to middle of 1914. 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 37,890 23.6 16.5 125 West 41,999 212 11.8 90 15,315 16.7 7.1 31 East 33,026 23.1 10.7 63 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 6 11.8 Tubercle of Lung 33 44.6 Scarlet Fever 3 3.2 Other Tuberculous Dis. 17 Influenza 7 6.8 Alcoholism and Cirrhosis of Liver 8 5.6 Whooping Cough 11 6.8 Diphtheria and Mem. Croup 7 4.2 Cancer and Sarcoma 37 25.6 Enteric — 0.4 Bronchitis 24 19.2 Diarrhœa and Enteritis 2 1.8 Broncho-Pneumonia 16 26.2 Erysipelas — 0.8 Pneumonia 16 Puerperal Fever — 0.6 Violence 6 8.0 Suicide 3 4.2 165 TABLE XII. Summary of Statistics for the 3rd Quarter ending October 3rd, 1914, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Bates calculated per 1,000 Population Births, Deaths under one year. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District. Deaths at all ages corrected for Public Institutions. Population middle of 1914. Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 128,230 729 22.4 55 75 338 100 8 52 382 11.9 B. Birth and Death Bates for each Parish. Woolwich. Plumstead. Eltham. Population middle of 1914. Birth Rate. Death Rate at all ages. Deaths under 1 year per 1,000 Births. Population estimated to middle of 1914. Birth Rate. Death Rate at all ages. Deaths under 1 year per 1,000 Births. Population estimated to middle of 1914. 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 37,890 26.1 14.2 73 West 41,999 22.4 11.5 43 15,315 16.5 6.3 79 East 33,026 22.3 11.0 120 166 C. Deaths from certain causes in whole Borough. Cause of Death, Total. Average for last 5 years. Cause of Death. Total. Average for last 5 years. Smallpox Rheumatic Fever 2 0.8 Measles 5 3.4 Tubercle of Lung 33 37.2 Scarlet Fever 3 2.0 Other Tuberculous Dis. 8 Influenza — 1.4 Alcoholism and Cirrhosis of Liver 12 5.4 Whooping Cough 3 2.8 Diphtheria and Mem. Croup 4 2.2 Cancer and Sarcoma 35 32.8 Enteric Fever 1 0.4 Bronchitis 28 10.0 Diarrhoea and Enteritis 21 31.6 Broncho-Pneumonia 12 11.6 Erysipelas 2 0.2 Pneumonia 14 Puerperal Fever — 0.4 Violence 10 8.8 Suicide 3 3.0 TABLE XIII. Summary of Statistics for the Fourth Quarter, ending January 2nd, 1915, corrected for Public Institutions:— A. Birth and Death Statistics for the Borough of Woolwich. Bates calculated per 1,000 population. Births. Deaths under 1 year. Deaths at all ages—Gross. Deaths in Public Institutions. Deaths of NonResidents in District. Deaths of Residents Registered beyond District Deaths at all ages corrected for Public Institutions. Population middle of 1914 Number. Rate. Number. Rate per 1,000 Births Registered. Number. Number. Rate. 128,230 672 21.0 45 67 379 84 23 66 422 13.2 167 B. Birth and Death Rates for each Parish. Woolwich. Plumstead. Eltham. Population, middle of 1914 Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. Population, middle of 1914 Birth Rate. Death Rate at all ages. Deaths under 1 year, per 1,000 births. Population, middle of 1914 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 37,890 23.9 149 53 West 41,999 19.0 13.0 75 15,315 14.9 9.9 140 East 33,026 22.8 12.7 53 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 4 2.2 Measles 9 1.8 Tubercle of Lung 43 54.2 Scarlet Fever 3 1.2 Other Tuberculous Dis. 11 Influenza 4 8.8 Alcoholism and Cirrhosis of Liver 6 7.4 Whooping Cough 3 2.8 Diphtheria and Mem. Croup 16 3.8 Cancer and Sarcoma 29 33.2 Enteric Fever 2 0.2 Bronchitis 33 38.2 Diarrhœa and Enteritis 2 7.8 Broncho-Pneumonia 16 26.8 Erysipelas 4 1.2 Pneumonia 20 Puerperal Fever 2 0.6 Violence 10 8.2 Suicide 1 1.2 169—170 TABLE XIV. Weekly Deaths from various causes for the whole Borough, 1914, corrected for Public Institutions. Week ending Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Mem. Croup. Enteric Fever. Diarrhœa (under 2 years). Enteritis (under 2 years). Erysipelas. Puerperal Fever. Rheumatic Fever. Tubercle of Dung and acute Tuberculosis. Other Tuberculous diseases. Alcoholism and Cirrhosis of Liver, and Per. Neuritis. Cancer and Sarcoma. Bronchitis. BronchoPneumonia. Pneumonia. Violence. Suicide. January 10 .. .. .. 2 1 .. .. .. .. .. .. .. 3 1 .. 4 6 7 3 1 .. „17 .. .. .. .. .. 1 .. .. .. .. .. .. 4 1 1 1 8 2 2 .. 1 „ 24 .. .. .. 2 1 .. .. .. .. .. .. .. 6 1 1 4 4 3 2 1 .. „ 81 .. .. 1 1 .. 3 .. .. .. .. .. .. 8 1 .. 3 4 2 1 1 .. February 7 .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. 3 6 .. 3 2 .. „ 14 .. .. .. 1 2 .. .. .. .. .. .. .. 2 .. .. 2 7 1 1 2 1 „ 21 .. .. .. .. 2 1 .. .. .. .. .. .. 3 2 .. 1 1 .. 1 2 .. „ 28 .. .. .. 1 1 .. .. .. .. .. .. .. 4 1 .. .. 4 .. 3 1 1 March 7 .. .. .. 1 .. .. .. .. .. .. .. .. 9 1 .. 2 2 .. .. .. .. „ 14 .. .. .. 1 1 .. .. .. .. .. .. .. 1 1 .. 2 2 3 1 1 .. „ 21 .. 2 .. 1 .. 1 .. .. .. .. .. .. 2 2 .. 2 5 1 2 .. .. „ 28 .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. 2 5 1 2 .. 1 April 4 .. .. .. 2 1 2 .. .. 1 .. .. .. 3 1 .. 5 5 1 1 .. .. 1st Quarter .. 2 1 12 9 8 1 1 2 1 1 1 50 13 4 31 59 21 22 11 4 April 11 .. .. .. 1 1 1 .. .. .. .. .. 1 1 4 2 1 4 2 2 .. .. „ 18 .. .. .. 2 .. .. .. .. .. .. .. .. 2 3 1 5 1 2 2 .. .. „ 25 .. 1 .. .. 3 1 .. .. .. .. .. .. 3 1 1 1 .. 1 .. .. .. Slay 2 .. 1 .. .. 1 .. .. .. .. .. .. .. 3 2 1 3 1 2 5 .. .. „ 9 .. 2 .. .. .. 1 .. .. .. .. .. .. 4 1 2 7 6 .. 1 1 .. „ 16 .. .. .. .. 1 1 .. .. .. .. .. .. 1 .. 1 3 .. .. 1 .. .. „ 23 .. .. 1 .. 1 1 .. .. .. .. .. .. .. 1 .. 2 3 3 1 .. .. „ 30 .. 1 .. 2 1 1 .. .. .. .. .. .. 1 .. .. 3 1 .. 1 .. 1 June 6 .. .. 1 .. 2 .. .. .. .. .. .. .. 4 .. .. 2 2 1 .. .. .. „ 13 .. 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. 3 1 1 1 .. .. „ 20 .. .. 1 1 .. .. .. .. .. .. .. .. 4 1 .. .. 2 1 1 1 .. „ 27 .. .. .. 1 .. .. .. .. .. .. .. .. 4 3 .. 3 1 2 .. 3 1 July 4 .. .. .. .. .. 1 .. 1 .. .. .. .. 5 1 .. 4 2 1 1 1 1 2nd Quarter .. 6 3 7 11 7 .. 1 1 .. .. 3 33 17 8 37 24 16 16 6 3 July 11 .. 2 .. .. 1 .. .. .. .. .. .. .. 2 1 .. .. .. 1 2 .. 1 „ 18 .. .. .. .. 1 .. .. .. .. .. .. 1 2 .. 1 5 2 1 2 1 .. „ 25 .. 2 .. .. .. .. .. .. .. .. .. .. 3 .. .. 2 1 2 1 .. .. August 1 .. .. .. .. .. .. .. .. 1 .. .. .. 2 2 .. 3 2 .. .. 1 .. „ 8 .. .. .. .. .. .. .. .. 1 .. .. .. 2 1 3 1 3 .. .. .. .. „ 15 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 3 1 .. 2 .. 1 „ 22 .. .. 1 .. .. .. .. .. 2 .. .. .. 1 .. .. 5 1 .. .. 1 .. „ 29 .. .. 1 .. .. .. .. .. 2 .. .. .. 3 .. .. 5 2 9 .. 2 .. September 5 .. .. .. .. .. .. .. .. 1 .. .. .. 5 1 4 3 4 .. 1 .. .. „ 12 .. .. 1 .. .. 1 .. 1 2 .. .. .. 1 .. 1 .. 2 3 1 1 1 „ 19 .. .. .. .. .. 1 .. 3 3 .. .. .. 3 1 1 4 2 2 .. .. .. „ 26 .. .. .. .. .. 1 .. .. 2 .. .. .. 9 1 1 2 3 1 1 4 .. October 3 .. 1 .. .. .. 1 .. .. 3 .. .. .. 1 .. 2 5 .. 4 .. .. 3rd Quarter .. 5 3 .. .. 4 1 4 17 .. .. 2 33 8 12 35 28 12 14 10 3 October 10 .. .. .. 1 1 .. .. .. 1 .. 1 .. 1 .. .. .. 3 .. 2 1 .. „ 17 .. .. .. .. .. .. .. .. .. 2 .. 1 3 .. .. 1 2 1 4 .. .. „ 24 .. .. .. .. .. 4 .. .. .. 1 .. 1 6 1 .. 4 1 .. 2 .. .. „ 31 .. .. .. .. .. 2 .. .. .. .. .. .. 4 .. 4 1 .. .. .. 1 .. November 7 .. .. .. .. .. .. .. .. .. .. .. .. 6 2 .. 4 2 1 1 1 .. „ 14 .. 1 .. .. .. 1 .. .. .. .. .. .. 2 .. 1 4 3 1 2 1 .. „ 21 .. 1 .. .. .. .. .. .. .. .. .. .. 2 .. .. 2 4 1 .. 1 .. „ 28 .. .. .. .. .. .. .. .. .. .. .. .. 4 2 .. 3 3 1 .. 1 .. December 5 .. .. .. .. .. 4 .. .. .. .. .. .. 1 .. 1 .. .. .. 1 .. .. „ 12 .. 1 .. .. .. 1 .. .. .. .. .. .. 4 .. .. 3 1 2 .. .. .. „19 .. 1 .. .. .. 1 1 .. .. .. .. .. 3 1 .. .. 4 3 1 1 .. „ 26 .. 3 .. 1 .. 2 .. .. .. .. .. .. 2 1 .. 3 1 1 1 January 2 1915 .. 2 .. .. .. 1 1 .. .. 1 .. .. 5 4 .. 4 9 5 6 3 .. 4th Quarter .. 9 3 4 3 16 2 1 1 4 2 4 43 11 6 29 33 16 20 10 1 Whole Year .. 22 10 23 26 35 4 7 21 7 3 10 159 49 30 132 144 65 72 37 11 171—172 TABLE XVa.. Summary of Nuisances Abated, Notices served, and General Work of Public Health Department, 1914. St. Mary's and Dockyard. River. Burrage and Herbert. Central and St. Margaret's. St. Nicholas. Glyndon. Eltham. St. George's. Total. PREMISES INSPECTED. No. of Houses inspected, house to house 433 883 660 975 723 489 94 271 4538 „ Re-inspections after service of Notice (estimated).. 1168 1721 1650 1625 1724 1149 1100 561 10700 ,, Houses and premises specially inspected, including infectious diseases and complaints 835 1033 1143 750 1101 760 1150 490 7267 ,, Houses where drains have been tested by smoke test 20 9 29 20 16 16 14 13 137 ,, Houses where drains have been tested by water test 4 4 28 8 4 15 22 4 89 ,, New Houses inspected for Water Certificates .. .. 19 12 107 .. 98 .. 236 NUISANCES ABATED—DRAINS. Waste-pipe from baths, lavatories, and wash-house sinks, repaired or disconnected 38 13 80 40 44 8 10 18 251 Choked and defective drains 77 84 76 33 81 18 57 24 450 Defective traps 12 5 24 15 2 8 8 4 78 Defective and unventilated soil pipes 2 .. 9 7 .. .. 1 .. 19 W.C.'s. W.C.'s repaired, new traps or pans provided 37 35 116 71 41 27 24 28 379 Water supply apparatus repaired or renewed 88 52 58 30 100 35 16 24 403 Foul pans cleansed 39 19 28 25 24 21 9 17 181 Additional w.c.'s provided to Factories & Workshops, &c. .. .. .. .. .. .. .. .. .. Do. do. dwelling houses .. .. .. .. .. .. .. .. .. PREMISES. Underground rooms not in accordance with Act .. .. .. .. .. .. .. .. .. Interiors cleansed and defective roofs repaired 480 523 375 226 301 145 105 182 2337 Damp walls remedied 53 73 73 55 64 18 27 30 393 Paving in yards and wash-houses repaired 75 63 95 50 87 24 28 47 469 Improved ventilation provided 2 17 6 5 14 .. .. .. 44 Wash-houses provided with sinks and outlets for waste water 12 .. .. 2 .. .. .. .. 14 Defective guttering and rain-water pipes 74 26 65 53 51 35 26 18 348 Dustbins supplied 75 82 95 23 97 26 26 50 474 Dung pits provided .. 1 2 2 1 .. .. 2 8 Cases of overcrowding remedied 25 14 8 5 22 5 9 5 93 Deficient light—windows supplied, or enlarged, or other works 3 9 1 2 1 4 7 11 38 Dampness in premises from defective water pipes 27 10 21 7 15 4 7 3 94 ANIMALS. Animals (including pigs) kept in such a state as to be a nuisance 7 .. 10 4 3 1 5 1 31 Accumulations of manure removed 11 10 25 7 10 3 14 3 83 WATER. Defective and foul cisterns used for dietary purposes 2 54 3 .. 33 .. 1 .. 93 Defective and foul rain-water tanks remedied .. .. 2 .. .. .. .. .. 2 Insufficient supply, and water cut off by Water Board .. 3 1 .. 2 .. 3 1 10 Additional water supply for two or more families 1 .. .. .. .. .. .. .. 1 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 28 22 .. 1 .. .. 1 2 54 No. of smoke nuisances observed 1 2 .. 1 .. .. .. .. 4 Tents, Vans, &c., inspected .. .. .. .. 1 .. 5 .. 6 Notices served with respect to tents and vans .. .. .. .. .. .. 1 .. 1 Inspection of Urinals accessible to the public 70 73 42 53 43 19 35 26 361 Verminous rooms cleansed 30 43 7 8 9 3 9 13 122 Intimation notices served 603 588 393 305 531 306 165 240 3131 Statutory „ ,, 110 40 91 37 187 34 39 50 578 173 TABLE XVB. SUMMARY OF WORK OP CHIEF INSPECTOR. Premises Inspected 1135 New Buildings Inspected 37 Defective Combined Drains Investigated and Reported on 12 Number of Houses referred to in such Combined Drains 74 Cow-houses and Slaughter-houses Inspections 27 Complaints Investigated 121 Attendances at Police Courts 47 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Number of Cases of Inattention to Notices reported to Town Clerk for proceedings 90 Summonses at Police Courts under P.H.L.A. and H.T.P.A. 12 Bake-houses Inspected and Cleansed twice during the year 40 Number of Houses Disinfected after Infectious Disease 1344 Letters written 4189 Notifications received 3507 Certificates issued after Disinfection 1390 „ of Infectious Disease forwarded to Schools 1993 Complaints of Sanitary Defects 454 ,, of Non-removal of Dust, viz:— Woolwich 11 Plumstead 32 Eltham 12 174 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) 96 15 Workshops (Including Workshop Laundries) 317 41 Workplaces 85 22 Homeworkers' Premises 490 14 Total 708 92 2.—Defects found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Act: Want of Cleanliness 25 25 Want of Ventilation 8 8 Overcrowding 5 5 Want of Drainage of floors — — Other nuisances 14 14 Sanitary Accommodation insufficient— unsuitable or defective not separate for sexes 4 4 2 2 Total 58 58 175 TABLE XVc.—continued. 3.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act. (S. 133) 3 Action taken in matters remediable under the Public Health Acts, but not under the Factory Act (S. 5). Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspectors 0 Underground Bakehouses (S. 101):— In use during 1903 24 in 1903 24 Certificates granted in 1906 1 in 1910 1 In use during 1914 14 Workshops on the Register (S. 131) at end of 1914:— Workshop Laundries 10 ,, Bakehouses 40 Other Workshops 151 Total number of Workshops on Register 201 176 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 inspection of Lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 48 175 3 6 36 15 .. .. 90 11 11 .. .. .. .. Tennis Balls, etc. 6 555 .. .. 53 87 .. .. 398 3 3 .. .. .. .. Furriers .. .. .. .. 2 .. .. .. 2 .. .. .. .. .. .. Lace Making .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. 54 730 3 6 93 102 .. .. 490 14 14 .. .. .. .. 177 TABLE XVD. Proceedings during 1914. Premises. Number of Places. Number of Inspections. Number of Notices. Number of Prosecutions. On Register at end of 1913. Added in 1914. Removed in 1914. On Register at end of 1914. Milk Premises 116 6 13 109 174 21 0 Cowsheds 16 0 0 16 35 7 0 Slaughter-houses 12 0 2 10 40 3 0 Ice Cream Premises 82 5 4 83 132 9 0 Registered houses let in Lodgings 432 8 22 418 612 308 1 Overcrowding— Number of Dwelling Rooms overcrowded 93 Number remedied.93 Underground Booms— Illegal occupation dealt with during year 0 Number of rooms closed 0 Insanitary Houses— Number closed under the Housing Town Planning, &c. Act 9 Number of Prosecutions under By-laws under Public Health Act, 1891 0 Mortuaries— Total number of Bodies removed 190 Total number of Infectious Bodies removed 2 Inspections of premises where food is prepared for sale 150 Number of Public Sanitary Conveniences removed or altered 0 Number of fixed ashpits removed 0 178 TABLE XVI. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD. Beresford Street 49 15 Creton Street 23 11 Gough Street 31 12 Myrtle Street 11 2 Sandy Hill Road 15 14 Meeting House Lane 10 10 High Street 9 9 Rope Yard Rails 26 18 Rodney Street 8 6 New Street 5 5 Globe Lane 5 5 Collingwood Street 12 9 Monk Street 14 9 Clara Place 13 6 Salutation Alley 5 4 Nelson Street 14 9 Walpole Place 27 15 Brookhill Road 20 3 Anglesea Avenue 7 4 Wilmount Street 31 11 Warren Lane 26 6 Fore House 9 2 Albert House 9 7 Sidney House 7 6 St. Mary's Street 5 4 Charles Street 41 18 Eleanor Road 39 20 Glass Yard 6 6 Union Street 13 13 Upper Market Street 9 4 Powis Street 29 16 Kingsman Street 14 5 Surgeon Street 3 3 Anglesea Road 25 8 Taylor Street 16 4 Albert Road 137 64 Davey's Square 10 4 Ann's Place 4 3 Woodman's Cottages 4 4 179 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD—cont. Winifred Street 67 47 Rhea Street 71 34 879 455 51.8 % Defects. DOCKYARD AND ST. MARY'S WARDS. Morris Street 29 22 Morris Place 6 2 Trinity Street 36 26 Harrington Road 1 Prospect Row Cottages 6 6 Siemens Road 30 19 Bowater Road 10 6 Warwick Street 14 14 Elgin Terrace 10 2 Lyford Street 20 8 Henry Street 78 27 Thrift Cottages 6 2 Orchard Place 38 35 Orchard Street 34 24 St. Mary Street 74 38 Parsons Hill 17 6 Paradise Place 24 10 433 247 57.0% Defects. ST. GEORGE'S WARD. Fenwick Street 59 30 Ordnance Road 65 43 Eglinton Road 13 13 Delvan Street 13 11 Sandy Hill Road 10 7 Brookhill Road 79 43 180 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. St. GEORGE'S WARD—cont. Hanover Terrace 9 7 Engineer Road 23 22 271 176 64.9% Defects ELTHAM WARD. Jubilee Cottages 29 8 Merchland Road 19 9 Southwood Road 7 — Lannoy Road 25 13 Bercta Road 14 1 94 31 32.9% Defects. BURRAGE AND HERBERT WARDS. Barnfield Road 68 36 Brookhill Row 6 4 Cantwell Road 39 12 Frederick Place 49 25 Graydon Street 16 11 Kirk Lane 26 8 Llanover Road 60 31 May Place Lane 8 5 Paget Road 46 15 Paget Terrace 13 4 Portland Place 17 13 Post Office Cottages 5 3 Parry Place 36 20 Princes Road 87 44 Red Lion Terrace and Place 8 4 Sandy Hill Road 125 75 Shooters Hill 6 3 181 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-cont The Avenue 15 7 Thomas's Cottages 8 2 Whitworth Place 22 10 660 332 50.3% Defects. GLYNDON WARD. Ann Street 67 24 Glyndon Road 80 25 Robert Street 114 53 Durham Road 14 9 Vicarage Road 60 26 Villas Road 124 53 Pattison Road 30 8 489 193 40.49% Defects. St. MARGARET'S AN D CENTRAL WARDS. Roydene Road 17 4 Palmerston Road 74 36 Alabama Street 105 32 Ravine Grove 47 25 Sutcliffe Road 41 14 Nyanza Street 15 8 The Slade 39 14 Flaxton Road 108 19 Fairlight Terrace 16 8 Alexandra Terrace 8 1 Manthorpe Road 34 11 Plumstead Common Road 112 32 Durham Road 51 24 182 TABLE XVI.—continued. Details of House to House Inspections. Name of Street. Number of Houses Inspected. Number where Defects were found. St. MARGARET'S AND CENTRAL WARDS—cont. Gallosson Road 26 13 Gossage Road 13 5 Inverary Place 9 3 Pendrell Street 35 12 Old Mill Road 21 10 Chesnut Road 110 26 Griffin Road 76 20 Bramblebury Road 18 12 975 329 33.7% defects. St. NICHOLAS WARD. Basildon Road 70 18 Rippolson Road 55 31 Kingsdale Road 52 27 Station Road, A.W 14 11 Harrow Manorway 11 6 Bostall Lane 120 32 Glenside Road 24 17 Mabyn Road 30 18 Hartville Road 46 23 Gunning Street 30 14 Abery Street 28 12 Bateson Street 13 5 Garibaldi Street 21 5 Gavin Street 13 5 Heverham Road 29 13 Brookdene Road 37 29 Balgowan Street 37 24 Hylton Street 38 31 Barth Road 55 29 723 350 48.4% Defects. 183 TABLE XVII. Prosecutions under the Public Health, Housing, Town Planning, &c., and London County Council (General Powers) Acts. No. Date of Hearing. Offence. Situation. Result. 1 1914 January22 Disobeying Closing Order and refusing to quit premises 1 Globe Lane Order to quit in 14 days 2 „ 22 Do. do. 2 Globe Lane Order to quit in 14 days 3 „ 9 Seizure of unsound Plums. (Appeal to Sessions) 92 Plumstead Road Appeal dismissed with costs 4 Sept. 10 Failure to keep room in a registered house in a cleanly condition 31 Princes Road Condition improved. 2/costs 5 „ 10 Disobeying Closing Order and refusing to quit premises 6 Rodney Street Order to quit in 14 days 6 „ 10 Do. do. 7 Rodney Street Order to quit in 14 days 7 Nov. 14 Do. do. 6 Stanley House Order to quit in 14 days 8 „ 14 Do. do. 8 Stanley House Order to quit in 14 days 9 Dec. 3 Dilapidations and dirty conditions ... 3 Sand Street Costs 2/-. Work done date of hearing 10 „ 3 Do. do. 9 Sand Street Costs 2/-. Work done date of hearing 11 „ 3 Dampness and dilapidations 15 Sand Street Order to abate in 21 days. 5/- costs 12 „ 3 Dampness 9 Gunning Street Order to abate in 21 days. 5/- costs 184 TABLE XVIII. Summary of Articles Analysed, under the Sale of Food and Drugs Act, during the year ended 31st December, 1914. Article. Number Analysed. Number Adulterated. Milk 309 30 Separated Milk 15 .. Butter 58 1 Vinegar 7 .. Coffee 27 .. Mustard 7 .. Drugs 39 5 Cocoa 8 .. Lard 8 .. Pepper 6 .. Tea 5 .. Treacle 2 .. 491 36 185 TABLE XVIIIa. Prosecutions under Food & Drugs Act during year 1914. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 8.59% added water Handsley, Ltd., 22 Ingleton Rd., Brixton Fined £1 and 12/6 costs 2 Milk 10.59% „ „ H. Panter, 1 Church Lane, Charlton Warranty defence: adjourned sine die 3 Butter Without label: 100 % margarine: Exposed F. Roberts, 71 New Read Fined 15/- and 12/6 costs 4 Milk for sale as butter 34.1% added water A. E. Jaques, 16 Frederick Place Pined £2 and 12/6 costs 5 Easton's Syrup 97.0% deficient in iron W. H. Clarke, 51 Plumstead Road Dismissed: £2 2s. costs 6 Milk 6.83% added water H. Jaques, 85 Frederick Place Fined £1 and 12/6 costs 7 Milk 12.33% deficient in fat S. Phillips, 141 Albert Road, N. Woolwich Fined 2/6 and 12/6 costs 8 Milk 17.33% „ „ E. Williams, 12 Thomas Street Fined 2/6 and 12/6 costs 9 Milk 16.2% added water Handsley, Ltd., 22 Ingleton Rd., Brixton Dismissed 10 Milk 18.3% deficient in fat W. F. Corp, 3 Wellington Street Dismissed 186 TABLE XVIIIa.—continued. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 11 Milk 25.0 deficient in fat J. W. Martin, 9 Station Road, Abbey Wood Fined 17/6 and 12/6 costs 12 Milk 25.66% „ „ D. Jones, 65 Maxey Road Dismissed: Warranty proved 13 Milk 5.41% added water J. W. Hearn, 61 Bannockburn Road Dismissed: Warranty proved 14 Milk 29.1% „ „ H. Jaques, 85 Frederick Place Fined £2 10s. and 12/6 costs 15 Milk 5.53% „ „ G. A. Pinch, 13 The Parade, Eltham Fined £2 and 12/6 costs 16 Camphorated Oil 10.0% deficient in camphor D. U. Still, 39 Artillery Place Costs 12/6 17 Milk 7.4% added water W. G. Joy, 90 High Street, Woolwich . Fined £4 and 23/- costs 18 Milk Preservative added E. A. Gill & Son, 398 High St., Plumstead Fined £1 and 12/6 costs 19 Milk 6.8% added water T. Lambeth, East Wickham, Welling Dismissed; Warranty proved 20 Milk 8.0% deficient in fat G Espline, 46 High Street, Woolwich Fined £1 and 12/6 costs 187 TABLE XIX. Food Seized, or Surrendered by Owners, as uufit for Consumption. Articles. Quantity. Date. Remarks. Reason. 1914. Ox Liver 1 Jan. 14 Surrendered Flukey Ox Liver 1 „ 21 „ Flukey Oysters 100 Feb. 3 „ Unsound Beef 57 lbs. „ 14 „ Unsound Ox Livers 2 „ 16 „ Flukey Ox Livers 2 „ 25 „ Flukey Ox Livers 2 „ 25 „ Flukey Ox Livers 2 Mar. 6 „ Flukey Apples ½ barrel „ 9 „ Unsound Beef 55 lbs. „ 10 „ Unsound Beef 80 lbs. „ 13 „ Unsound Beef 82 lbs. „ 14 „ Unsound Sheep's Pluck 1 „ 19 „ Strongyli Ox Liver 1 „ 25 „ Flukey Ox Livers 2 „ 27 „ Flukey Ox Tongue 1 „ 27 „ Actinomycosis Beef 2079 lbs. April 6 „ Unsound Ox Liver 1 „ 15 „ Flukey Ox Livers 2 „ 23 „ Flukey Beef 84 lbs. „ 24 „ Unsound Mackerel 3 barrels „ 28 „ Unsound Reef 21 lbs. May 12 „ Unsound Herrings 1 box „ 19 „ Unsound Tomatoes 1 box „ 20 „ Unsound Mutton 63 lbs. „ 20 „ Unsound Mutton 86 lbs. „ 21 „ Unsound Ox Lungs 1 set „ 27 „ Tuberculous Reef 63 lbs, June 6 „ Unsound Ox Liver 1 „ 10 „ Flukey Sheep's Liver 1 „ 10 „ Ternicolis cysts Mutton 51 lbs. „ 18 „ Unsound black spotted Mutton 49 lbs. „ 24 „ Unsound black spotted Sheep's Lungs 1 set „ 24 „ Strongyli Mutton 16 lbs. „ 25 „ Unsound Ox Livers 2 „ 30 „ Flukey Cod 1 box July 4 „ Unsound Beef 398 lbs. „ 18 „ Unsound Bream 1 box „ 21 „ Unsound Ox Livers 2 „ 22 „ Abscesses Sheep's Plucks 2 „ 22 „ Strongyli Mackerel 32 lbs. „ 23 „ Unsound Haddock 32 lbs. „ 23 „ Unsound 189 TABLE XIX.—continued. Articles. Quantity. Date. Remarks. Reason. Sheep's Pluck 1 Aug. 13 Surrendered Ternicolis cysts Ox Liver 1 „ 13 „ Flukey Pork 88 lbs. „ 17 „ Bruises Pig's Pluck 1 „ 17 „ Cirrhosis Bananas 1 crate „ 17 „ Unsound Ox Liver 1 „ 26 „ Cirrhosis and Flukey Ox Liver 1 „ 26 „ Abscesses Kippers 3 boxes „ 26 „ Unsound Ox Tongue 1 Sept. 3 „ Actinomycosis Ox Liver 1 „ 3 „ Echinococcus cysts Cole Fish 1 barrel „ 3 „ Unsound Haddocks 1 barrel „ 10 „ Unsound Sheep's caul fat 1 „ 17 „ Ternicolis cysts Sheeps' Plucks 2 „ 17 „ Ternicolis cysts Ox Liver 1 „ 17 „ Flukey Sheep's Liver 1 „ 17 „ Flukey Dole Fish 1 box „ 21 „ Unsound Sheep's caul fat 1 „ 24 „ Ternicolis cysts Ox Tongue 1 „ 24 „ Actinomycosis Ox Tongues 2 „ 30 „ Actinomycosis Ox Livers 2 „ 30 „ Flukey Haddocks 1 trunk Oct. 12 „ Unsound Ox Liver 1 „ 14 „ Flukey Ox Liver 1 „ 27 „ Flukey Ox Liver 1 „ 27 „ Abscesses Ox Tongue 1 „ 27 „ Actinomycosis Ox Liver 1 Nov. 11 „ Abscesses Ox Liver 1 „ 11 „ Flukey Ox Liver 1 „ 18 „ Ulcers Ox Tongue 1 „ 18 „ Actinomycosis Ox Liver 1 „ 23 „ Flukey Oysters 200 „ 23 „ Unsound 421 Turkeys 38cwt. 27 lbs. Dec. 23 Seizure Unsound 201 Turkeys 21 cwt. 0 lbs. „ 24 Surrendered Unsound 189 TABLE XIX.—continued. Articles. Quantity. Reason. Summary— Beef 2919 lbs. Unsound Mutton 265 „ Unsound Pork 88„ Bruises Sheep's Plucks 6 Strongyli and Ternicolis cysts Sheep's Livers 2 Ternicolis cysts and Flukey Ox Tongues 7 Antinomycosis Ox Livers 35 Flukey, Abscesses, Ulcers, Cirrhosis, and Echinococcus Ox Lungs 1 Tuberculous Sheep's Lungs 1 Strongyli ,, Caul Fat 2 Ternicolis cysts Pig's Pluck 1 Cirrhosis Fish 14½ boxes Unsound Oysters 300 Unsound Turkeys 59 cwt. 27 lbs. Unsound Apples ½ barrel Unsound Tomatoes 1 box Unsound Bananas 1 crate Unsound 190 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 Riverdale Road, do. S. C. Margetts 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. E. Cook 5 The Parade, New Eltham G. A, Finch 13 do. do, W.Millar 6 Well Hall Parade, Eltham B. Moakes 53 Cordite Street, Plumstead C. Tucker 53 Lakedale Road, do. E. Dalton and F. Mendham 4 Plumstead Road R. Tsinn 100 High Street, Woolwioh 191 TABLE XXa. List of Certified Underground Bakehouses. Name. Address. Alderton, Ltd. 50, Herbert Road, Plumstead A. B. Adams 223, High Street, do. J. Werner 1, Park Road, do. F. Cox 46, Hudson Road, do. G. Scott 16, Armstrong Place, do. Virgoe & Sons 13, Eton Road, do. J. Colver 57, Plumstead Road, do. F. Hissey 2, Crescent Road, do. A. E. Sims 24, St. James's Place, do. H. Adams 31, Beresford Street, Woolwich F. Wilkening 72, Henry Street, do. W. C. Clothier 51, Albion Road, do. Mrs. Attenborough 60, Sand Street, do. J. Fletcher 15, New Road do. — (unoccupied) 33, Eglinton Road, Plumstead — (unoccupied) 14, Westdale Road, do. — (unoccupied) 58, Pattison Road, do. — (unoccupied) 14, Conway Road, do. — (unoccupied) 30, Burrage Road, do. — (unoccupied) 165, Sandy Hill Road, do. — (unoccupied) 57 Burrage Road, do. — (unoccupied) 16, Woolwich Common, Woolwich — (unoccupied) 23, George Street, do. — (unoccupied) 21, Albion R ad, do. — (unoccupied) 32, Church Street, do. — (unoccupied) 81 & 82, Brookhill Road, do. — (unoccupied) 8, Hill Street, do. 192 TABLE XXB. List of Factory Bakehouses. Name. Address. J. Fletcher 57, Burrage Road, Plumstead T.Newman 94, Wellington Street, Woolwich 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 & Sons 13, Eton Road, Plumstead Alderton, Ltd. 81, Park Road, Plumstead 193 TABLE XXI. List of Slaughterhouses. No. Name of Owner. Situation. 1 Frederick Hedges 168, High Street, Eltham 2 H. Reed & Co., Ltd. 6, High Street, Plumstead 3 Hedley Vicars 41, Church Street, Woolwich 4 William Francis Bartlett Rear of 14, Church Street, Woolwich 5 H. Reed & Co., Ltd. Love Lane (rear of Wellington Street), Woolwich 6 James & George Mitchell 25, Hare Street, Woolwich 7 Hedley Vicars 30, Hare Street, Woolwich 8 H. Reed & Co., Ltd. 38, Plumstead Common Road, Plumstead 9 Henry Fretter 33, Herbert Road, Plumstead 10 Royal Arsenal Co-operative Society Bostal Farm. Plumstead 194 TABLE XXII. List of Cowhouses. No. Name of Owner. Situation. 1 John B. Stocker Cold Harbour Farm, Chislehurst 2 Alfred Low Park Farm, Eltham 3 W. F. Corp Lyme Farm, Eltham 4 Charles 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 Honry 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 195 TABLE XXIII. List of Milk Sellers. No. Name. Address. 1 Perratt, H. N. 2 The Parade, New Eltham 2 Webb, F. W. 58 Brewery Road 3 Carr, E. 46 Kingsman Street 4 Finnimore, J. A. 83 Park Road 5 Squirrell, J. 57 Church Street 6 Jeal, W. H. 139 Plumstead Road 7 Cock, G. 13 Raglan Road 8 Royal Arsenal Co-op. Society Lakedale Road 9 Do. 15 Brewery Road 10 Do. 143 Powis Street 11 Do. 147 & 151 Powis Street 12 Woolsey, H. 50 Francis Street 13 Howe, J.R. 82 High Street, Eltham 14 Hawkins, Ellen M. 2 St. Nicholas Road 15 Furber, Harry Southend Farm, Eltham 16 Large, Daniel J. 6 Herbert Road 17 Hiscock, E. 14 Blenheim Terrace 18 Dalton, R. G. 55 Eglinton Road 19 Butter Bros. 49 Woolwich Common 20 Do. 10 Jackson Street 21 Webb, Y. 10 Beresford Square 22 Dennis, Ellen 90 Brookhill Road 23 Bayley, M. Middle Park Farm Eltham 24 Godden, A. A. 229, High Street, Plumstead 25 Corp, W. F. Lyme Farm, Eltham 26 Pearce, R. A. 175 Plumstead Common Road 27 Christmas, Hannah 18 Well Hall Parade, Eltham 28 Dodson, W. 138 Plumstead Common Road 29 Dolphin, T. G. 89 Maxey Road 30 Corp, C. 142 High Street, Woolwich 31 Stevens, F. 100 Roydene Road 32 Ridewood, F. 116 High Street, Eltham 33 Rose, J. 64 Hargor Road 34 Stevens, H. 27 Church Street 35 Needham, Elizabeth 94 High Street, Woolwich 36 Webb, F. W. & Co. 16 Lakedale Road 37 Davis, D. H. 170 Albert Road 38 Smith, Elizabeth 12 The Broadway, Eltham 39 Bennett, Rose 22 Glyndon Road 40 Williams, Ellen 12 Thomas Street, Woolwich 41 Bartrum, A. 167 Kingsman Street 42 Jones, D. 65 Maxey Road 43 Jaques, H. 56 Anglesea Road 44 Killick, C. W. 52 St. James's Place 45 Parkes, J. Fountain Stores, The Slade 196 TABLE XXIII.—continued. No. Name. Address. 46 Lamb, Annie 29 Admaston Road 47 Jones, E. C. 6 Samuel Street 48 Harrington, J. 26 Prospect Row 49 Cole, E. J. 18 Camrose Street 50 Finnimore, W. J. 21 Walpole Place 51 Lyons, J. & Co., Ltd. 99 Powis Street 52 McGee, Jane 42 Mulgrave Place 53 Attenborough, Caroline 18 Prospect Place 54 Marsh, C. Ashurst, Shrewsbury Lane 55 Mumford, Kate F. 22 Cross Street 56 Holmes, Blanche 43 Bostall Hill 57 Gill, Emily A. 398 High Street, Plumstead 58 Brinkworth, W. J. 40 Garibaldi Street 59 Palmer, P. 40 Saunders Road 60 Espline, G. 48 High Street, Woolwich 61 R.A. Co-operative Society The Links, Plumstead Common Road 62 Jones, W. H. 39 Beresford Street 63 Holdway, Georgina H. 45 Bostall Hill 64 Challis, P. W. 4 High Street, Woolwich 65 Gee, A. J. 147 Plumstead Road 66 Joy, W. G. 90 High Street, Woolwich 67 Crayfourd, J. E. 40 Orchard Road 68 Buckingham, J. 16 Pellipar Road 69 Corp, W. P. 3 Wellington Street 70 Flint, Emma 124 Maxey Road 71 Gittings, W. J. " Cold Blow," Plumstead Common 72 Curtis, Stephen 181 Abbey Wood Road 73 Grace, James 18 The Broadway, Eltham 74 Cornwall, J. 14 Frances Street 75 Sheldon, W. 101 Sand Street 76 Adams, H. 31 Beresford Street 77 Muir.W. C. 28 Conway Road 78 Handsley, Ltd. 68½ Bloomfield Road 79 Townsend, Rose E. 104 Brookhill Road 80 Voice, C. 102 Ann Street, Plumstead 81 Trodd, W. J. 19 Green's End, Woolwich 82 Bunn, W. C. 13 Hinstock Road, Plumstead 83 Williamsons, Ltd. 66 Powis Street, Woolwich 84 Willis, Jessie 2 Ritter Street, Woolwich 85 Fairbrother & Co. 94 Wellington Street, Woolwich 86 Slater, E. T. 30 High Street, Eltham 67 Couzens, J. 46 Church Street, Woolwich 88 Phillips, Sophia 141 Albert Road, North Woolwich 197 TABLE XXIII.—continued. No. Name. Address. 89 Virgoe & Sons 13 Eton Road, Plumstead 90 Adams, E. J. 1 Shooters Hill Gardens. Eltham 91 Adams, H. 56 Artillery Place, Woolwich 92 Look, Albert G. Southwood Road, New Eltham 93 Cook, Margaret 25 Plum Lane, Plumstead 94 Brown, T. N. 18 Oliver Street, Plumstead 95 Wilkinson, A.J. 52 Whitworth Road, Plumstead 96 Hoar, J. (Junr.) 40 Saunders Road 97 Grove, J. R. 1 The Broadway, Abbey Wood 98 Wilkening, A. E. G. 63 Grffin Road 99 Hearn, J. W. 61 Bannockburn Road 100 Naylor, L. 82 Plumstead Road 101 Grayson, J. 41 Hylton Street 102 Balster, W. H. 147 Burrage Road 103 Cheesman, C. 126 High Street, Plumstead 198 TABLE XXIV. List of Applicants Registered as Purveyors of Milk During 1914. No. Name. Address. 104 Sanders, J. D. 4 Garland Street, Plumstead 105 Jaques, A. E. Martin's Yard, Woolwich 106 Wilkening, H. C. 40 Garibaldi Street, Plumstead 107 Burchell, H.J. 40 Saunders Road, Plumstead 108 Barley. A. R. 40 Saunders Road, Plumstead 109 Dinmore, H. E. 2b New Road, Woolwich