AC 4312 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH. 1915. Woolwich: Pioneer Press, Ltd. (T.U. Federatioc), 3, New Road. Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH. 1915. Woolwich: Pioneer Press, Ltd. (T.U. Federation), 3, New Road. 2 Chief Sanitary Inspector: Albert G. Duck, F.S.I.A. (Cert. San. Inst.). District Sanitary Inspectors: John W. Rance (Cert. San. Inst.). William Little (Cert. San. Inst.). WilliAm Wood (Cert. San. Inst.). 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: Amy as Britter (Cert. R. San. Inst.). Assistant Clerks: Harry S. Smith. H. M. Collyer. Boy Clerk: H. T. Prescott. Mortuary Keeper: Frank Leason. Medical Officer of Health: Sidney Davies, M.A., M.D., Oxon. ; D.P.H. Camb. Fellow of the Incorporated Society of Medical Officers of Health, and Fellow of the Royal Sanitary Institute. 3 Summary of Statistics, 1915. Area of Borough 8,276.6 Acres Population—Census, 1911 121,376 Do. estimated to middle of 1915 134,828 Inhabited Houses—Census, 1911 21,463 Persons to an Acre 14.7 Persons to a House—Census, 1911 5.65 Marriages 1,829 Births 2.815 Birth Rate 20.9 Deaths 1.841 Death Rate 13.7 Infantile Mortality 95 per 1,000 births 4 table of contents. page Names of Members of Sanitary Staff 2 Summary of Statistics 3 Preface 9 Part I.—Statistics. Population 11 Census Tables 13 Houses 14 Births 14 „ Illegitimate 17 Notification of Births 15 Birth Rate16 Marriages 17 Deaths—Woolwich Death Rate compared with other Boroughs 17 Effect of War Conditions on Death Rate 20 Infant Mortality—Preventive Measures 22 Mortality under five years 24 Zymotic Death Rate 24 Inquests and Uncertified Deaths 22 Notification of Diseases 25 Small-pox 25 Measles 25 Whooping-Cough 28 Scarlet Fever—Deaths—Hospital Isolation—Return Cases— Isolation at Home—Schools Incidence 29 Diphtheria—School Outbreaks and Precautions taken 31 Mistaken Diagnosis 32 Source of Infection 32 Bacteriological Examination 33 Enteric Fever—Source of Infection 34 Bacteriological Diagnosis 35 Diarrhoea or Zymotic Enteritis — Deaths—Notification — Statistics—Tables—Conveyance of Infection by flies 35 5 page. Erysipelas 42 Cerebro-Spinal Meningitis 42 Anterior Polio-Myelitis 43 Puerperal Fever 43 Influenza, Bronchitis and Pneumonia 44 Tuberculosis—Deaths 44 Notification Statistics 47 Duration of Illness 47 Age and Sex Distribution—Table 47 Visiting 49 Bacteriological Diagnosis 49 Disinfection 50 Hospital and Sanatoxium Treatment 50 Shelters for Consumptives 50 Tuberculosis Dispensary 51 Scheme for Treatment of Tuberculosis 52 Spitting Flasks 52 Tuberculosis Care Committee 52 Cancer—Classification 54 Causes of 56 Alcoholism 60 Syphilis 60 Ophthalmia Neonatorum 61 Part II.—Administration. Water Supply—Plumstead Well—Houses with no Water Supply inside the House 62 Tenement Houses 62 Food and Drugs Act—Percentage Milk Adulteration 63 Public Health (Milk and Cream) Regulations, 1912 63 Informal Sampling 65 Food and Patriotism 65 Food Inspection 65 „ Poisoning—Outbreak 65 Dairies, Cowsheds and Milk Shops 66 Slaughterhouses 67 Nuisances—Complaints, Drains, Water-closets 67 House Inspection 67 Medical Officer's Inspections 68 Overcrowding 68 6 page. Smoke Nuisance 69 Defective Light 69 Verminous Rooms 69 Dust Removal—Collection, Cost of 70 Trade Refuse—Offensive and Inoffensive 70 Housing of the Working Classes— Houses represented as Unfit for Habitation 71 Government Housing Scheme—Government Buildings occupied by Civilians 72 Housing in St. Nicholas Ward 73 Council's Houses 74 Houses Registered under the By-laws 74 Inspections made 75 Inhabited House Duty 76 Underground Rooms 76 Factories and Workshops—Inspections—Outworkers 76 Bakehouses 76 Ice-cream Shops 77 Fried Fish Shops 77 Disinfection, Disinfectants 77 Health Shelter 78 Mortuaries 78 Cemeteries 79 Cleansing of Verminous Persons—Cleansing School Children 79 Tents, Vans and Sheds 81 Notices and Prosecutions under Public Health (London) Act 81 Bacteriological Examinations 81 Infant Consultation 81 Maternity and Child Welfare 82 Women Sanitary Inspectors' Work— Miss Middlebrooke's Report 84 Miss FitzGerald's Report 86 Public Ambulance 88 Co-operation with Royal Army Medical Corps and Royal Arsenal Medical Officers. 89 Health Leaflets 90 Public Health Staff 90 7 LIST OF TABLES. page. Table I. Population. Births and Deaths for the whole Borough, from 1902 to 1915, including deaths of non-residents in the district, also deaths in Public Institutions in the district, and deaths of residents registered beyond the district 91 No. of Inhabited Houses, the average number per house, and the acreage 91 ,, II. Cases of Infectious Disease notified at all ages, at various age groups, and distributed according to Registration Districts during 1915 93 „ III. Deaths at all ages, at various age groups, from various causes, arranged by Registration Districts in 1915. Total Deaths in Public Institutions in District in 1915 95 „ IV. Infantile mortality during the year 1915 99 „ V. Case and Death Rate for various diseases per 1,000 population estimated to the middle of the year for the years 1891 to 1915 101 „ VI. Birth and Death Rates for the various London Boroughs for 1915 103 ,, VII. Deaths from various causes for the whole Borough in each week, corrected for Public Institutions 105 ,, VIII. Summary of the General Work of the Public Health Department for 1915, the number of Nuisances abated, and Notices served in each Ward 107 „ IX. Summary of Work of Chief Inspector, and Miscellaneous 109 „ X. Inspection of Factories, Workshops, and Workplaces 110 8 page. Table XI. Proceedings during 1915 re Milk Shops, Cowsheds, Slaughterhouses, etc 113 ,, XII. Prosecutions in 1915 under the Public Health (London) Act, Housing, Town Planning, etc., and L.C.C. (General Powers) Acts 114 ,, XIII. Summary of Articles Analysed under the Sale of Food and Drugs Acts 116 „ XIV. Proceedings in 1915 under the Sale of Food and Drugs Acts 117 „ XV. Summary of Food seized or surrendered by owners as unfit for consumption 120 „ XVIa. List of Persons Registered as Purveyors of Milk during 1915 120 „ XVI b. List of persons removed from Register during 1915 121 9 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies and Gentlemen, In presenting my Fifteenth Annual Report (which is the Twenty-fourth Annual Report on the Health of Plumstead), I have to state with regret that the steady fall in the deathrate which characterised successive years previous to the War was not maintained in 1915. It is satisfactory, however, to note that the rise in the death-rate last year was less than in London as a whole. This is as it should be, considering the great increase the population has received from young munition workers, who are housed in new buildings erected by the Government, and whose death-rate should be, and probably is, very low. War conditions have influenced the public health in different ways. Miss Middlebrooke, in her interesting comments on her work, describes one way in which the improved labour conditions in Woolwich, due to the War, have very favourably influenced the care of the children in the homes of the poorer classes; but on the whole it must be admitted that, in spite of abundance of money and food, war conditions have been unfavourable to health. The effect of war conditions on the death-rate is dealt with in paragraph 14. 10 Excessive emotions, especially grief and fear, unfavourably influence all, but especially women, and through the women their children. To these emotions must be added the resulting tendency to indulge in alcohol. This, no doubt, has been to a large extent counteracted by the wise regulations which have been adopted by the Government, but there is no doubt that it has unfavourably influenced the health of women and children. The effects of the Lighting Order, too, in addition to causing accidents, have been to interfere with ventilation, often unnecessarily, and this may be one reason of the greatly increased mortality from respiratory diseases. Then there has been the fear of Zeppelin raids. Many miscarriages and cases of loss of maternal milk have been attributed to this cause. Overwork by long hours has nodoubt been a contributory cause, shortening the life of those who were already feeble from disease or age. I have again to thank you for the careful attention you have given to my recommendations and the wise measures you have taken to carry them out. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, SIDNEY DAVIES. 11 Fifteenth Annual Report on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 3 J st December, 1915. PART I. STATISTICS. Population. 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 1915 is 134,828. The population of the four Registration Districts at the last three Censuses was as follows:— Census, 1891. Census, 1901. Census, 1911. Estimated to Middle of 1915. Woolwich Parish 40,848 41,625 36,710 39,055 Plumstead Parish West 52,436 38,569 40,328 43,124 East 29,758 30,888 34,233 Eltham Parish 5,7101 7,226 13,450 18,416 98,994 117,178 121,376 134,828 This population is estimated on the number of houses occupied in each Registration District, and the estimate has been checked by the result of the census taken for the National Register in August last. The population of the Borough has been rapidly increasing since the war began. The estimated population to the middle of 1915 is calculated as follows :— Census— Population, 1911. Unoccupied Houses at Census, 1911. Unoccupied Houses, May, 1915. New Houses from April, 1911, to June, 1915. Additional Houses Occupied June, 1915. Persons to a House. Estimated Increase in Population, Census to June, 1915. Addition Estimated on National Register. Estimated Population to June, 1915. Woolwich 36,710 432 53 26 Subs tract 119 houses demolished since Census 1911. 286 6.38 1,825 520 39,055 Flumstoad West 40,328 362 6 69 425 5.19 2,206 590 43,124 East 30,888 235 7 315 543 5.4 2,678 455 34,233 Eltham 13,450 204 40 802 966 4.77 4,720 246 18,416 121,376 1,233 106 1,212 -119 2,220 - 11,429 | 1,811 134,828 12 In East Plumstead 106 new houses and huts are calculated at 5 0 persons to a house, and in Eltham 490 new Government houses at the same rate. Note.—The number of persons to a house is that found at the Census, with the exception of Woolwich parish, for which the number in Dockyard and River Wards has been taken, omitting the Barracks. 13 The following figures show how the number of persons to a house in Woolwich and Plumstead has varied during the past four Censuses :— Woolwich. Plumstead. Census 1891 — 6.08 „ 1896 — 6.14 „ 1901 7.85 6.05 „ 1911 7.27 5.34 2. The population of soldiers in Barracks on July 15th was 8,695. The Registrar-General estimates the civil population to the middle of the year at 129,505, making the total population 138,200. The death returns include a considerable number of combatants, and the total population, including Army and Navy, has therefore been used as more satisfactory for comparing the health of the Borough in 1915 with previous years. For comparing Woolwich and other Boroughs the RegistrarGeneral's figures must be used. Though the population has rapidly increased since July, it was probably nearer 134,828 at that date than the figure taken by the Registrar-General, and the lower estimate is used in the succeeding birth and death rates. 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, and in the Report for 1914 the number to a house in each Ward. 14 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 „ July 1st, 1911, to June 30th, 1912 93 ,, July 1st, 1912, to June 30th, 1913 141 ,, July 1st, 1913, to June 30th, 1914 254 ,, July 1st, 1914, to June 30th, 1915 170 New Houses 1914-15:— Woolwich 1 West Plumstead 19 East Plumstead 86 Eltham 64 These figures do not include houses and huts erected by H.M. Government (see page 72). 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 May, 1915, the Rate Collectors found 106 houses unoccupied, viz.: 53 in Woolwich, 4 in West Plumstead, 9 in East Plumstead, and 40 in Eltham. It may be assumed that the majority of these houses were either unfit for occupation or were not to let. BIRTHS. 5. The number of births was 2,815, viz. : 874 in Woolwich parish, 866 in West Plumstead, 776 in East Plumstead, and 299 in Eltham (corrected for children born in the Infirmary, 15 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 20.9 compares with 22.0 in the previous year, and with 25.3, the average for the ten years 1905-14. The rate for the County of London was 22.6. Of the 2,815 births, 81 were illegitimate. Notification of Births. 2,445 live births were notified under the Notification of Births Act (1,240 males, 1,183 females, 22 not stated). This is at the rate of 87 per cent, of the registered births, compared with 93, 91, 94, 92 and 89 per cent, in the five preceding years. 1,407 births were notified by midwives, 203 by the Home for Mothers and Babies and Military Families Hospital, 435 by medical practitioners, and 400 by other persons. 75 still-births were notified (64, 79 and 59 in 1912, 1913 and 1914 respectively). Of the 75 stillborn, 36 were males, 35 females, and 4 not stated. The Notification of Births Act was adopted on March 1st, 1908. There were 351 births last year which were not notified. Five midwives were warned for neglect to notify. 774 live births, or 89 per cent., were notified in Woolwich parish, 1,422, or 87 per cent., in Plumstead parish, and 249 or 84 per cent., in Eltham. The proportion of still-births to live births was highest amongst those attended by midwives (4 per cent.) and lowest among those born at institutions (2 per cent.). 6. The following table gives the birth-rate of the Borough during the years 1901-5, 1906-10, 1911, 1912, 1913, 1914 and 1915, and for the purposes of comparison the corresponding rates of the neighbouring Boroughs, London, and England:— 16 BIRTH RATE. 1901-5. 1906-10. 1911. 1912. 1913. 1914. 1915. Greenwich Borough 27.6 26.5 24.9 25.0 26.0 25.1 24.5 Lewisham 25.7 23.3 21.2 20.4 20.5 19.8 19.2 West Ham 33.1 341. 29.9 29.6 310 29.8 28.2 East Ham 33.8 25.8 25.8 24.9 23.5 21.8 Erith 34.1 25.7 23.6 26.4 27.3 20.9 London 28.2 26.5 25.5 24.7 24.5 24.3 22.6 England and Wales 28.2 26.0 24.4 23.8 23.9 23.6 21.8 Woolwich Borough 29.2 25.3 23.2 22.3 22.5 22.0 20.9 7. The following table gives the birth-rate for the Borough and each Registration District for the four past Quinquennia and last five years. Correction has been made for births in the Infirmary, Female Hospital, the Wood Street Home for Mothers and Babies and outlying institutions, and the births distributed to the parishes to which they properly belong. West Plumstead and Eltham had the lowest birth-rate of the four Registration Districts. Although the birth-rate has again fallen, the apparent fall in Woolwich is less than the decrease in London. decrease in London. The greatest decrease since 1911 is in the parishes of Woolwich and Eltham. 1891-1895. 1896-1900. 1901-1905. 1906-1910. 1911. 1912. 1913. 1914. 1915. Woolwich Borough 32.5 30.2 29.2 25.3 23.2 22.3 22.5 22.0 20.9 Woolwich Parish 31.1 30.1 29.0 27.9 27.1 24.8 26.6 25.2 22.4 Plumstead— West 33.3 31.0 30.1 24.7 20.6 21.9 19.7 21.0 20.1 East 23.4 21.3 23.7 22.4 22.8 Eltham Parish 22.8 20.6 24.0 21.6 18.5 19.0 16.5 16.3 16.2 17 8. Illegitimate Births. 81 of the births registered were illegitimate, giving a rate of 29 per 1,000 births, compared with 19, 13, 17, 23 and 21 in the five preceding years. Although this is a marked increase, it is less than many expected and smaller than the rate in London in peace time. 9. There were 1,829 marriages. The marriage-rate was 27.1, compared with 16.0, 16.4 and 17.7 in the three preceding years. This is the highest marriage-rate recorded since the Borough was constituted. The chief increase was in Plum. stead. The marriage-rate in England and Wales was 19.2. 10. Table I. gives the gross and net deaths and death. rates in 1915, and each of the past eleven years, and shows how the net deaths are arrived at. 11. The net deaths were 1,841, and the net death-rate 13.7, compared with 12.3 and 13.2 in the two preceding years and 12.5, the average of the ten preceding years ; 13.7 is the highest rate recorded since 1904. 12. By multiplying by 1.0249, the factor for age distribution, we get the standard death-rate, viz., 14.0, which rate should be used in comparing Woolwich with other places in which the death-rate is similarly corrected. MARRIAGES. DEATHS. The following table shows the net and standard death-rates of Woolwich compared with London and the adjoining Boroughs :— Net. Standard. England and Wales 151 14.8 97 Great Towns 15.6 15.9 London 16.1 16.1 Greenwich 17.7 — Lewisham 12.3 — B 18  Net. Standard. West Ham 16.1 — East Ham 11.1 — Erith 10.5 — Woolwich 13.7 14.0 Three Metropolitan Boroughs had a lower death.rate than Woolwich, viz. : Hampstead, Lewisham and Wandsworth. 13. The following table gives the average death.rate in each Registration District of the Borough during the past six Quinquennial periods. Woolwich parish had the highest death. rate, and Eltham the lowest. 1886.1890. 1891.1895. 1896.1900. 1901.1905. 1906.1910. 1911. 1912. 1913. 1914. 1915. Woolwich Borough — 17.2 16.9 13.9 12.5 12.8 11.5 12.3 13.2 13.7 Woolwich Parish* 20.4 19.3 20.1 16.5 14.8 15.6 13.2 14.0 16.0 15.5 Plumstead— West 16.4 16.0 15.1 12.9 12.0 13.4 11.5 12.6 14.3 14.4 East 11.4 11.0 11.5 11.6 13.6 Eltham Parish — 130 14.6 10.2 10.1 8.3 8.4 8.8 8.8 10.1 London 20.0 19.8 18.5 16.1 14.9 15.0 13.6 14.2 14.4 16.1 * Three Years—1888, 1889 and 1890. This table shows that the increased death.rate affected each part of the Borough, and that there was a still greater increase in London. In both Woolwich and London the death.rate has increased each year since 1912. 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 :— 19 ANNUAL DEATHS— 1903 TO 1915. 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. 1903.7 (average) 402.4 102.8 43.4 27 31.4 44.8 104.2 138.4 155.6 174.8 201.4 171 1908.12 (average) 250.4 131 4 41.4 23.4 33.2 33.2 87.4 127 146.6 199.2 211.6 203.8 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 1915 268 136 62 28 47 41 93 170 210 246 269 263 Deaths From. Average, 1903.07 Average, 1908.12. 1913. 1914. 1915. Apoplexy and all other diseases of the heart and blood.vessels 217.4 258.8 312 332 351 Nephritis and Blight's disease 44 47 57 46 47 Respiratory diseases—all forms (except Phthisis ) 260.8 228.4 254 287 385 20 Compared with the last three years there was last year a marked increase of deaths under 1 and over 35. There was an increase also of deaths from apoplexy and diseases of the heart and blood.vessels, and a great increase from respiratory diseases (bronchitis and pneumonia). In order to estimate, so far as possible, the effect of war conditions on the death.rate, it is important to compare the deaths during 1915 (1,841) with those in 1913 (1,580), the last year before the war began. There was a total increase of 261 deaths, viz. : 104 males and 157 females. Of these, 36 represent an increase in measles, 19 tuberculosis of the lungs, 27 congenital debility and premature birth, 29 heart disease, 46 bronchitis, 55 broncho.pneumonia, 26 pneumonia, 22 cirrhosis of the liver, and 30 violence. The only disease showing a large diminution is diarrhoea (including enteritis). Taking the diseases which mainly affect adults and comparing males with females, it is found that the increase of deaths from tuberculosis was nearly equal in the two sexes. The increase of heart disease and violence was much greater in males than females, whereas the increase in bronchitis, pneumonia and cirrhosis of the liver was much greater in females than in males. It is interesting to find that while there was a total diminution of deaths from nephritis of 10, the diminution (15) was confined to males, there being an actual increase of deaths in females. If we assume that the chief cause affecting the health of males has been the increase of overwork on munitions, and in females anxiety and excitement causing increased indulgence in drink, this might offer an explanation of the above figures 21 so far as they affect heart disease, cirrhosis of the liver and, to some extent, tuberculosis and nephritis ; but there is no obvious reason which would explain the great increase of respiratory diseases, particularly in females. If we examine the figures of different age periods, we find that the increase of deaths between 15 and 35 is slight or nil, the increased death.rate in adults being confined to those over 35. When we refer to the figures for 1913, we find that already in that year it was noted that the number of deaths from apoplexy and diseases of the heart and blood.vessels, as well as those from respiratory diseases, reached the highest point recorded. Though there can be no doubt that overwork is causing much injury to health in the delicate and older men, there is not sufficient ground for associating the major part of the increased death.rate with overwork on munitions. War conditions have injuriously affected women more than men. Cirrhosis of the liver can be definitely attributed to the causes which give rise to intemperance, and with this is probably connected the increased mortality from congenital debility and premature birth. Woolwich is not alone in having a greatly increased death. rate from respiratory diseases, heart disease, phthisis and violence. There is a similar increase in the County of London. As regards cirrhosis of the liver, however, there was a diminution in London. 15. Owing to the steady fall of the birth.rate and the recent rise of the death.rate the natural increase of the population (i.e., the excess of births over deaths), 974, has reached the lowest point recorded since 1891. Though war conditions 22 must be held to a large extent responsible for this serious condition of things, it cannot but occasion grave anxiety. INFANT MORTALITY. 16. The deaths under 1 year were 268, compared with 239 in 1914. The infant mortality (deaths under 1 year per 1,000 births) was 95. This is the highest rate since 1911. The following table gives the infantile mortality in the Borough since 1901, compared with the neighbouring Boroughs, London and England :— 1901 to 1905. 1906 to 1910. 1911. 1912. 1913. 1914. 1915. Lewisham 112 92 104 70 78 74 80 Greenwich 107 112 129 84 103 98 101 West Ham 158 126 141 102 107 108 112 East Ham 131 106 119 71 64 63 82 Erith 112 80 70 69 81 91 73 London 138 114 128 90 105 104 112 97 Great Towns — 127 140 101 116 113 117 England & Wales 135 115 130 93 109 105 110 Woolwich Borough 119 97 98 73 80 84 95 Four Metropolitan Boroughs only had a lower infantile mortality than Woolwich, viz. : Hampstead, Lewisham, Wandsworth and Westminster. 17. The following table gives the infantile mortality during the past five years, and the five preceding Quinquennia in the Borough and each Registration District :— 23 1886.1890. 1891.1895. 1896.1900. 1901.1905. 1906.1910. 1911. 1912. 1913. 1914. 1915. Woolwich Parish *151 157 170 134 109 110 94 85 94 123 Plumstead— West 121 120 132 113 91 104 53 67 77 73 East 82 81 84 68 91 Eltham — 163 160 97 89 64 52 62 72 84 Woolwich Borough — 140 146 119 97 98 73 80 84 95 * 1888, 1889 and 1890. There was a marked increase in Woolwich parish, East Plumstead and Eltham, but most in the former. 18. Table IV. gives full details as to the ages at death and causes of death of the 268 infants dying in 1915 under 1 year. It shows that 30 per cent. of those who died under 1 year were under one month old, compared with 41 per cent, in 1914 and 38 per cent. in the previous ten years ; 50 deaths were from premature birth, compared with 51, 51, 52, 41 and 53 in the five preceding years. The number of deaths under one week in the past five years was 62, 61, 58, 68 and 55 respectively. The number of deaths from suffocation or overlying was 6, compared with 1 in 1913 and 2 in 1914. In the previous four years the deaths from suffocation in bed averaged 4 a year, and in the four years 1904.7 they averaged 7. This return to higher figures may be correlated with the increase of alcoholism among women. 24 The death.rate per 1,000 births from premature birth in Woolwich Borough was 19.5, compared with 17.9, 18.1, 18.9, 14.2 and 20.5 in the five preceding years. In London it was 17.6. There were 19 deaths of illegitimate infants. The death. rate of illegitimate infants under 1 year was 234 per 1,000 births, compared with 119 in 1914, and that of legitimate children 89. 19. Compared with 1914, the past year had among infants more deaths from measles, convulsions, wasting, bronchitis and pneumonia, and fewer from whooping.cough. 20. Deaths Between 1 and 5 Years. 80 deaths (67 in 1914) occurred between 1 and 2 years, and 56 (74 in 1914) between 2 and 5. The corresponding figures in 1913 were 55 and 38 respectively. The death.rate between 1 and 5 was 13.1 per 1,000 children of that age found at the Census (viz., 10,357), compared with 9 0 and 13.6 in the two previous years. 21. Zymotic Death Rate. The number of deaths from scarlet fever, diphtheria, measles, whooping.cough, enteric fever and from diarrhoea and enteritis (under 2 years of age as regards diarrhoea and enteritis) was 128, and the death. rate per 1,000 population 0.95, compared with 0.77, 0.74 and 0.98 in the three previous years. The zymotic death.rate has fallen greatly since 1901, when it was 1.51. 22. Inquests. There were 180 inquests, compared with 121, 128, 115, 105, 107, 123, 105, 123, and 146 in the nine preceding years. 25 The " Accidental Causes " were 42, 44, 35, 37 and 39 in the five preceding years. The " Homicidal Causes " were 6, 11, 11, 21 and 13 in the same years. SMALL.POX. 23. Not a single case of small.pox was notified. In London there were 11 notifications and 3 deaths. MEASLES. 24. There were 45 deaths from measles, giving a rate of 0.33, compared with 0.24, 0 07 and 0.19 in the three preceding years. The rate in London County was 0.50. 25. Of the 45 who died from measles, 40 were under five years of age ; 22 were males and 23 females. The following table gives particulars as to the cause of death 1. Natural Causes 100 2. Alcoholism 5 3. Accidental Causes— Burns and Scalds 5 Drowning 8 Vehicular Traffic : (a) By Road 13 (b) By Rail 2 Explosions 3 Suffocation—Overlying 7 Other Accidental Causes 25 — 63 4. Homicidal Cases— Suicide 11 Murder and Manslaughter 1 — 12 Total 180 26 26. 1,179 notifications were received from school teachers, compared with 396, 801, 775, 387 and 967 in the five preceding years. The mortality per cent, of notifications was 3.8, compared with 5.3, 3.5, 3.9, 2.3 and 2.6 in the five preceding years. Five cases were removed to the fever hospital on the certificate of the Medical Officer of Health that hospital isolation was necessary. 27. The following table gives the number of deaths and death.rates from measles for the past four years, and four preceding quinquennia in each parish and the death.rate in London :— Year. Woolwich. Plumstead. Eltham. The Borough. London Aver. No. Rate. Aver. No. Rate. Aver. No. Rate. Aver. No. Rate. Rate. 1891.5 20 0.49 29 0.51 Not re corded 49 0.51 0.59 1896. 1900 34 0.81 36 0.57 Not recorded 70 0.67 0.57 1901.5 9 0.22 15 0.22 1 0.13 26 0.21 0.44 1906.10 17 0.43 18 0.23 3 0.20 37 0.30 0.40 1911 7 019 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 3 008 3 0.04 3 0.21 9 007 0.34 1914 14 0.37 11 015 — . 25 019 0.31 1915 22 0.56 22 0.28 1 0.06 45 0.33 0.50 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. 27 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 1915 „ 45 16.0 It appears from these tables that whereas from 1891.1900 Woolwich had a somewhat higher measles mortality than London, since that date the measles death.rate has greatly diminished, and diminished much more in Woolwich than in London. 28. Owing to the prevalence of measles, the Medical Officer of the London County Council closed or excluded unprotected children from 40 classes. In many cases this was done immediately on the occurrence of one case. The period of exclusion or closure was usually for a few days only, in some cases for two weeks. Every effort was made to prevent children under five from attending school where measles was prevalent, and instructions as to sanitary measures for dealing with measles were left at the home of all notified cases and, where possible, the woman inspector paid a visit to enforce personally the directions. The reason of the high mortality last year is the fact that measles had prevailed very little in the two previous years, 28 and consequently a large number of children were unprotected. Compulsory Notification. By Order of the Local Government Board made under S. 130, P.H.A., 1875, Measles and German Measles were made compulsorily notifiable from January 1st, 1916 (see Council's Minutes, December 22nd, page 93). WHOOPING.COUGH. 29. There were 17 deaths from whooping.cough. The death.rate was 0.13, compared with 0.25, 0 08 and 0.19 in the three preceding years, and 0.25 in the County of London. Twelve 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 1915 17 0.13 . 0.25 The death.rate per 1,000 births was 5.3. 346 cases were notified by school teachers, compared with 41, 439, 265 and 321, in the four previous years. 84 were under five years of age, 253 between five and ten, and 9 over ten. The fatality or deaths per 100 notifications was 4.9. 29 In 1913 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. Two cases were admitted during the year. Instructions printed on cards are left at houses where cases are notified by school teachers. The instructions were printed in the Annual Report for 1910. 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. 30. There were 581 cases of scarlet fever notified (deducting 20 cases of mistaken diagnosis), equivalent to a rate of 4.31 per 1,000 population, compared with 5.46 in 1914. 31. The following table shows the case.rates of scarlet fever in the Borough and each Registration District during the past fifteen years, compared with London :— Average. 1901.5. 1906.10 1911. 1912. 1913. 1914. 1915. Borough 3.15 5.90 409 3.80 4.80 5.46 4.31 Woolwich Parish 2.99 5.66 2.89 2.41 5.44 6.11 4.48 Plumstead— West 3.24 6.33 3.77 4.96 4.68 5.45 4.0 East ) 7.51 4.88 511 4.18 6.55 Eltham Parish 3.21 4.94 2.09 2.64 4.36 7.45 3.85 London Count 3.57 4.22 2.32 1.76 3.89 5.53 3.94 32. Table III. gives the age distribution, the number in each parish, and the number removed to hospital. East Plumstead was most affected. 30 33. Deaths. There were 8 deaths, giving a death-rate of 0 06 per 1,000 population, compared with 0.07 in 1914, 0 06 in 1913, 0 08 in the five years 1908.12, and 019 in the ten years 1891.1900. The death.rate in London was 0 07 compared with 0.07 in 1909.13. The case mortality (or deaths per cent, of notifications) was 1.4, compared with 0.8, 1.3 and 1.3 in the three preceding years. One case died three days after confinement, and would have properly been said to have died of puerperal fever. One was in work at the Arsenal Canteen. 34. Hospital Isolation. Of the 601 cases notified, 511 (or 85 per cent.) were removed to one of the fever hospitals, compared with 90, 80, 88, 90 and 88 per cent. in the five preceding years. 20 cases were reported, after observation at hospital, not to be scarlet fever. 35. Return Cases. There were 40 cases (or 6.9 per cent. of notifications) in which infection was attributed to patients recently returned from hospital, compared with 27, 29, 37, 31 and 12 in the five preceding years. Of the infecting cases, 9 had some form of rhinitis on or after their return, 3 otorrhcea, 2 sores on face, and 3 catarrh. As a rule, the children returning from hospital are quite well at the moment of leaving, but in many cases develop some nasal discharge on arriving home, or within a few days. Illustrative cases of this were given in the 1908 Report. The parents of all children with any discharge are recommended to obtain medical 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. 31 The hospital superintendents forward the names of any children discharged while still suffering from rhinorrhoea. 36. Home Isolation. 15 certificates of efficient home isolation were given to enable men to continue their employment in the Arsenal, and so obviate unnecessary removal to hospital, compared with 25, 12 and 31 in the three preceding years. In the Annual Report for 1911 a comparison was made between home and hospital isolation, showing that, whereas there were only 1.6 per cent. of failures in home isolation, there were 4.6 per cent. in hospital isolation. Failure means the occurrence of secondary cases attributed to the primary case. 37. The Annual Report for 1905 contained a special report on a statistical investigation into school incidence of scarlet fever and diphtheria during the ten years 1896-1905. DIPHTHERIA. 38. 240 cases of diphtheria were notified (excluding 46 cases of mistaken diagnosis). The case-rate (number of cases per 1,000 population), corrected for cases of mistaken diagnosis was 1.77, compared with 3.09, 1.91 and 2.72, in the three preceding years, and 1.99, the average of the ten years 1901-10. 39. There were 20 deaths, compared with 20, 17 and 34 in the three preceding years. The death-rate was 0.15, compared with 0.26 in 1914, 0.13 in 1913, and 0.14, the average of the five preceding years. The London death-rate was 0.15, compared with 0.12 in the five preceding years. 40. 87 of the total cases notified were in Woolwich parish, 85 in West Plumstead, 98 in East Plumstead, and 16 in Eltham. The following table shows the case-rate in each 32 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. 1915. Borough 1.71 2.20 1.68 3.09 1.91 2.72 1.77 Woolwich Parish 1.63 2.34 2.40 4.38 4.43 4.92 2.23 Plumstead Parish 1.87 2.40 W.l.19 3.79 2.32 2.36 1.99 E. 2.33 2.81 1.02 2.39 2.87 Eltham Parish 1.62 2.22 2.30 1.71 1.29 3.33 0.88 London 1.90 1.63 1.64 1.57 1.70 2.02 2.01 The table shows that the rate in East Plumstead was the highest for several years past, but the other parts of the Borough had a much lower rate than any year since 1911. 41. 264 cases, or 92 per cent. of total notifications, were removed to hospital, compared with 92, 81, 93 and 94 per cent. in the four preceding years. A certificate of efficient home isolation was given in 10 cases, compared with 1, 3, 12, 1 and 7 in the five preceding years. The case.mortality was 8.3 per cent., compared with 3.4, 5.4, 5.2, 7 0 and 9.7 in the five preceding years. 12 carrier cases, with or without slight symptoms, were discovered by your Medical Officer of Health. The usual steps were taken. 42. Mistaken Diagnosis. 46 cases, or 15 per cent. of notifications, were, after removal to hospital, stated to be not diphtheria. The percentage of the four preceding years was 15, 11, 19 and 16 respectively. 43. Source of Infection. In 45 cases a probable source of infection was noted, viz. :—In 32 other inmates of the house were known or suspected to be the source ; in 1 school; 4 neighbours and friends ; 1 return case ; and in 7 the infection was due to the Fever or other Hospitals. 33 The return case well illustrates the difficulty in certain cases. A.D. returned from hospital after two months' isolation 24/12/14. Another case occurring at his home, he was swabbed and found negative. A third case occurring, he was again swabbed 1/3/15, and found positive. He had otorrhœa and rhinorrhœa, and was sent back to hospital, whence he was finally discharged in July, after 6½ months in hospital. 44. Bacteriological Diagnosis. Since January, 1913, the Council's bacteriological work has been done by the Bacteriological Department of the Seamen's Hospital, Greenwich. 776 (915 in 1914) swabs were examined for the presence of diphtheria bacilli. In 84 (95 in 1914) the true Klebs Loffler bacillus was found, in 54 (47 in 1914) Hoffman's bacillus was found, and 638 were found free from either the Klebs Loffler bacillus or Hoffman's. Of the 776 swabs examined, 168 were taken from school children by the Medical Officer of Health. Of these, 12 contained the true Klebs Loffler bacillus (so-called positive cases), and 16 Hoffman's bacillus. Most of the children were contacts seen about ten days after notification of a primary case for the purpose of preventing pupils returning to school in an infectious state. Others were examined with the object of finding possible sources of infection, e.g., where the first case notified in a house was a child not attending school; others, again, were children suspected to have diphtheria by the School Teacher, the Attendance Officer or Sanitary Inspector. Eight positive cases had some symptoms, viz. : running or sore nose, mild clinical diphtheria or follicular tonsilitis. These were notified and sent to Hospital or strictly isolated. Positive cases without any symptoms were excluded from C 34 school and from mixing with other children outside the house. Of the 168 cases, 47 had some symptoms. During 1915 it was for purposes of economy decided not to swab all the contacts coming for examination, but only those showing some abnormal condition, and those who, for any reason, were specially likely to be carriers ; but all were carefully examined as to the presence of any pharyngitis, rhinorrhœa or other symptoms. Unfortunately it has been found by experience that a negative bacteriological result is no guarantee that a contact will not within a few days or weeks develop diphtheria. One examination, too, is insufficient, and where rhinorrhcea or special suspicion exists, a second swab is taken if the first is negative or shows Hoffman's bacillus. In two cases last year this practice led to the discovery of carriers. One contact was brought to me with marked symptoms of clinical diphtheria, but the mother stated that she had made no complaint and she had observed nothing wrong with her. 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. Last year 18 quantities were supplied on payment and 7 gratis. ENTERIC FEVER. 45. There were 23 cases of enteric fever, not including 8 cases of mistaken diagnosis notified as enteric. The caserate was 0.17, compared with 0.15, 0 06 and 0 09 in the three preceding years. For the ten years 1892-1901 the rate never fell below 0.41. The case-rate in London was 014. 46. There were 5 deaths from this disease, giving a deathrate of 0.04. The death-rate in London was 0.03. 35 In the preceding five years the death-rate in Woolwich was 0 01 and in London 0.03. 47. The following are the cases notified in each parish during the past fifteen years :— Average. 1901-05. 1906-10 1911. 1912. 1913. 1914. 1915. Woolwich 12.6 7.6 10 10 7 6 11 Plumstead 21.2 11.4 W. 3 4 3 6 13 E. 2 2 2 4 5 Eltham 8.6 2.8 1 4 2 2 2 In my last Annual Report a full account was given of a mild outbreak of enteric occurring in December-January, 1914-15. 10 of the cases occurred before February 2nd. Of the 13 cases which have occurred since that date, 6 were soldiers, all of whom contracted the infection outside the Borough, either at the Front or at other Camps ; 3 were probably infected at the seaside, viz., at Bournemouth, Weymouth and Southend respectively (the latter had oysters at Southend) ; 1 in Hertfordshire ; 1 boy had partaken of cockles. The 2 remaining cases were a policeman and a boy for whom no source of infection was discovered. Of the 31 cases notified, 27 were removed to a Fever Hospital and 8 were reported as mistaken diagnosis. A report was made on the prevention of fly-carried infection of enteric fever (see Zymotic Enteritis). 48. Bacteriological Diagnosis. 20 samples of blood were sent to the Seamen's Hospital to be examined for Widal's reaction. A positive result was obtained in 11. DIARRHOEA OR ZYMOTIC ENTERITIS. 49. The deaths from diarrhoea and enteritis under two years of age were 30, or 10.7 per 1,000 births, compared with 36 3.65, 174 and 9 9 in the three preceding years. The rate for London was 25.0. The total number of deaths from these diseases at all ages was 33. Notification. Voluntary notification of zymotic enteritis during July, August and September, commenced in Woolwich in 1905. Compulsory notification commenced August 25th, 1913. 173 cases were notified in the past year, compared with 129, 338, and 199 in the three preceding years. 1 case was notified in January, 2 in March, 2 in April, 1 in May, 10 in June, 34 in July, 61 in August, 47 in September, 11 in October, and 4 in December. The fatality rate (deaths under two years per 100 notified cases under two) was 17. 3. Zymotic Enteritis. Many persons interested in the public health were afraid that owing to the exceptional conditions prevailing during the war, such as the large number of horses kept in the vicinity and the delay in removing manure, there would be heavy prevalence of Diarrhœal diseases during the past summer. Special efforts were made both by the Military Authorities and your own Public Health Department to obviate any such occurrence, and it is satisfactory to be able to report, whether owing to the success of these efforts, or to other factors that the amount of diarrhoea or zymotic enteritis during the summer has been less than for several years past. In view of the total number of deaths during the year being greater, but the number of notifications and of deaths during the summer quarter being less, one is led to the supposition that the infectious form of diarrhoea which specially prevails 37 in the summer was less prevalent this year and that certain other conditions which cause children to die of diarrhoea at all times were more prevalent than in previous years. A spot map was prepared showing the localities in which the cases occurred. This map shows a distinct grouping in certain districts. The chief groups occurred in the district between High Street, Plumstead, and Marmadon Road, and in Beresford Street, Ropeyard Rails and High Street, Woolwich. Smaller groups occurred in the neighbourhood of Princes Road, Ann Street, Joseph Street and Sand Street, and Elizabeth Street, North Woolwich. As compared with the County, Woolwich had a very low death.rate from diarrhoea and enteritis during the summer quarter. Per 1,000 births, the death.rate was 54.01 in London, and only 16.25 in Woolwich. Only the City and Stoke Newington had a lower rate. The death.rate from this disease in Woolwich is much less than in London, owing no doubt mainly to notification of cases ; but even the comparatively small number of deaths that occur could doubtless be much diminished if medical aid were summoned more quickly, notification made more promptly, and the mother properly advised as to feeding the patient. Most of the infants who died were found to be improperly fed. 50. The appended tables give 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. 38 TABLE A. DIET OF CASES UNDER 1 YEAR AT TIME OF NOTIFICATION. Totals 1905-10. 1911. 1912. 1913. 1914. 1915. Breast only 49 24 3 9 4 9 Breast and other foods 78 43 7 15 21 8 Hand.fed only 408 179 17 80 63 67 No information 16 3 11 7 3 561 262 30 115 95 87 N.B.—Of 30 children under 1 year having fresh cows' milk, 28 had it boiled, or were said to do so. Of the 67 hand.fed children, 28 had Nestlé's milk. 39 TABLE B. 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 10th Week 11th Week 12th Week 13th Week 1915 Average. 1905-14 9 9 9 5 5 8 21 22 7 10 9 17 12 2.7 3.6 8.0 7.6 13.0 23.2 35.8 42.6 35.1 24.3 25.7 12.7 12.6 Temperature. 1915 Average for 10 Years 65.3 59.2 61.5 61.5 63.6 66.4 61.5 62.5 56.0 58.2 64.5 60.4 49.0 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 40 TABLE C. DIARRHŒA MORTALITY and TEMPERATURE of SUMMER QUARTER in LONDON and WOOLWICH. Average 1901-4 Average 1905-10 1911 1912 1913 1914 1915 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 Diarrhœa and Enteritis under 2 years) per 1,000 births for whole year London 12.42 27.5 27.6 12.7 Woolwich 2.30 0.97 2.87† Woolwich 3.65 17.44 9.9 4.3 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 Air 66.4 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 Air 60.7 * In and after 1911 Deaths under 2 Years only are included. † If Deaths over 2 Years were included, this figure would be 3.64, and the figure for London would also bo increased. 41 TABLE D. ZYMOTIC ENTERITIS AND METEOROLOGY. (Summer Quarter.) Average, 1902-11. 1912. 1913. 1914. 1915. Number of Cases Notified 269.6 115 286 183 142 Number of Deaths* 18.9 2 49 21 12 Mean Temperature of Air 60.0 58.0 59.1 60.7 60.7 Mean Temperature 3 feet below ground 60.71 60.24 59.82 61.51 60.6 Mean Humidity 74.5 76 79 73 80 Number of Days on which which Rain fell 35.0 42 36 34 35 Rainfall in Inches 6.09 5.64 5.43 3..3 8.5 Number of Hours' Bright Sunshine 575.7 399 376 628 541 * Enteritis included in and from 1911. Up to 1911 all Deaths are given. After 1911, only Deaths under 2 Years. Conveyance of the Infection of Enteric and Zymotic Enteritis by Flies. A special report was made on this subject and by your instructions pictorial posters and handbills were printed and distributed in June. These notices called attention to the danger of accumulation of refuse of all kinds and the importance of cleanliness and the destruction of flies. Two cinematograph theatres, at the request of the Medical Officer of Health, exhibited films giving the life history of the fly, and showing his connection with dirt and refuse. Special efforts were made during the spring and summer to secure the regular removal of manure and business refuse. 42 ERYSIPELAS. 51. There were 138 cases of erysipelas notified, compared with 87, 70 and 107 in the three preceding years. There were 8 deaths, one under one year of age and the remainder over 45. The case-rate was l.02, and the death-rate 0.06, compared with 0.02, nil, and 0.05 in the three preceding years. The case-rate was the highest recorded, but the death-rate was higher in 1911. Three cases were removed to the Fever Hospital on the special recommendation of the Medical Officer of Health. The London case-rate was 0.89, and the London death-rate, 0 04. CEREBRO-SPINAL MENINGITIS. 52. Cerebro-spinal meningitis was made notifiable in 1907 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, nil in 1913, and one in 1914. 46 cases occurred in 1915, excluding 4 cases of mistaken diagnosis. There were 9 deaths, 2 of which were under two years of age. The case rate was 0.34 in Woolwich, compared with 0.06 in London. 31 cases occurred in Woolwich Parish and 9 in Eltham. 28 of the cases were soldiers in barracks and 12 were under 15 years of age. The large majority of the cases occurred in the first three months of the year. Of the 18 civilian cases, in only one instance did more than one case occur in the same house. This was the case of a girl aged 11, who began to be ill March 23rd. Apparently she was not acutely ill, but did not finally recover sufficiently for discharge from hospital for nearly five months. She was not notified until April 9th, when her mother too was severely ill. The mother's illness began April 6th and she died on the 10th. 43 Active steps were taken to deal with the outbreak. Notified cases (with one or two exceptions) were immediately removed to the fever hospital. Contacts were examined and those in close association were bacteriologically examined by a Medical Officer of the L.C.C. Several doubtful cases were seen by the Medical Officer of Health on request of the medical attendant and when the former had any doubt as to the diagnosis a bacteriological examination was made. The measures taken in the Garrison included steps to enforce the maintenance of thorough ventilation in barracks and huts and to this is attributed the rapid disappearance of the outbreak among soldiers. ANTERIOR POLIO.MYELITIS. 53. 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 (London) Act. 2 cases were notified in 1915. There were no deaths. 3 cases were notified in 1911, 3 in 1912, nil in 1913, and nil in 1914. It is interesting to note that the Woolwich Invalid Children's Association dealt with 52 cases of infantile paralysis last year. Evidently all the cases that occur are not notified. PUERPERAL FEVER. 54. There were 6 cases of puerperal fever notified, compared with 7, 16, 2, 8, and 7, in the five preceding years. There were 3 deaths. The case.rate per 1,000 births was 2.14, compared with 2.78 and 2.50 in the two preceding years. The death.rate was 1.07, compared with l.05, 0.36, and l.05 in the three foregoing years. The London case.rate and death.rate per 1,000 births were 3.57 and 1.67 respectively. 44 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 caserate 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 death-rate. Many cases are now notified which in former years would have been passed over. INFLUENZA, BRONCHITIS, PNEUMONIA. 55. Influenza caused 33 deaths, compared with 39, 19, 25, 35, and 25 in the five preceding years. Bronchitis and pneumonia caused 380 deaths, compared with 232, 200, 208, 253, and 285 in the five preceding years. There has been a remarkable increase of deaths from bronchitis and pneumonia during the past two years which is not easy to account for. The increase is less in males than females. The following table shows the figures for the past six years. The death-rate was 2.8, compared with 1.8 in 1912. 1912. The increase is as great in London as in Woolwich. 1909. 1910. 1911. 1912. 1913. 1914. 1915. Pneumonia over 5 63 67 61 54 63 78 99 Bronchitis over 5 101 50 84 84 120 113 160 Bronchitis and pneumonia under 5 81 66 55 70 70 94 121 Bronchitis and pneumonia over 5 164 166 145 138 183 191 259 Bronchitis and pneumonia M. 144 149 196 „ „ F. 109 136 184 TUBERCULOSIS. 56. Deaths. There were 232 deaths from tuberculous disease, giving a death-rate of 1.72, compared with 1.46, 1.65, 1.34, 1.69, and 1.68 in the five preceding years. 45 57. The following table gives the number of deaths from each of the various forms of tuberculosis in the past 10 years, and also the deaths from simple meningitis:— Average. Tuberculous Meningitis 1901.5. 1906.10. 1911. 1912. 1913. 1914. 1915. 20.0 22.8 20 23 14 29 18 Simple Meningitis 22.0 15.0 16 13 10 15 16 Tuberculosis of Intestines and Peritoneum 13.0 10.8 5 5 10 13 5 Tuberculosis (other forms) 20.8 22.2 29 16 10 11 8 Phthisis 192.0 151.4 146 124 182 163 201 58. The deaths from phthisis were 201, giving a death.rate of l.49, compared with 1.08, 1.20, 1.01, l.42, and 1.27 in the five preceding years. The rate of the last three years is higher than it has been since 1906, but is considerably below that of the quinquennia 1891.5, 1896.1900, and 1901.5, as is shown in the following table. The rise in the phthisis death.rate is parallel with that of bronchitis and pneumonia. In each case 1912 showed a minimum, and the three subsequent years a marked rise. Comparing 1915 with 1913 the increase in phthisis mortality is nearly equal in both sexes, but whereas there is an increase at ages over 35 of 29, at ages between 15 and 35 there is a decrease of 19. The rise is not confined to Woolwich—London also had the highest death.rate since 1905. 46 PHTHISIS (Tuberculosis, Lungs). 1891-5. 1890-1900. 1901-5. 1906-10. 1911. 1912. 1913. 1914. 1915. 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. 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 72 1.84 Plumstead . West — 1.78 92 1.42 97 1.34 87 1.20 W 41 1.02 31 0.76 66 1.56 51 1.21 67 1.55 East E 33 1.07 37 1.18 40 1.23 32 1.00 52 1.52 Eltham Parish — — 9 1.28 6 0.63 8 0.64 6 0.45 8 0.57 15 1.02 4 0.28 10 0.60 The Borough — — 193 1.74 192 1.56 151 1.22 146 1.20 124 1.01 182 1.42 163 1.27 201 1.49 London — 1.88 — 1.80 — 1.57 — 1.33 — 1.32 — 1.34 — 1.30 — 1.39 — 1.50 47 59. There was a marked decrease last year of deaths from tuberculosis other than pulmonary. 60. 125 of those who died from phthisis were males, and 76 females. The increase of deaths has been greater among males than among females. Notification Statistics. 489 cases were notified (excluding second notifications), viz.:—Tubercle of lung, 420; tuberculous meningitis, 11; tuberculosis of the intestines and peritoneum, 3; other forms, 55. The 420 cases of phthisis compare with 375, 689, 532, and 400 in the four preceding years. 28 of these were in the Woolwich and Eltham Poor Law Infirmaries; 2 others were notified by the District Medical Officers of the Poor Law Union, 79 by the Medical Officers of the Royal Arsenal and Army, 169 from hospitals and dispensaries, including 143 from the Woolwich Tuberculosis Dispensary, 8 from School Medical Officers, and the remainder by private medical practitioners. £28 19s. 0d. was paid during the year for the notification of tuberculosis. Duration. Of the 489 cases notified during 1915, at least 114 have since died, and of 498 cases notified during 1914 at least 145 have since died (February, 1915). 61. The source of infection of the notified cases was probably as follows:— Family or Personal:—Father, 10 ; Mother, 12 ; brother, 7; sister, 9; husband, 5; members of family (not defined), 40 83 Workshop and Office 9 Navy and Army 67 Undetermined 330 62. 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:— 48 Metropolitan Borough of Woolwich. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the year 1915. 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. 5 to 10 10 to 15 Total. Pulmonary Males 2 2 26 9 25 31 52 63 28 16 4 258 280 — 1 2 3 3 35 66 „ Females 2 5 17 20 13 14 27 30 18 9 — 155 168 1 — 3 4 5 18 51 Non-Pulmonary Males 4 8 11 6 2 3 1 1 — — — 36 38 1 1 2 4 6 3 6 „ Females — 7 10 4 2 1 2 1 — — — 27 27 — — 2 2 2 5 7 Total 8 22 64 39 42 49 82 95 46 25 4 476 513 2 2 9 13 16 61 130 49 63. 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 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 sanatoria 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 sanatoria are practised as much as possible at home, and that the patient is not discouraged by initial difficulties. 64. Bacteriological Diagnosis. Sputum from 254 cases of suspected phthisis was examined at the Seamen's Hospital and tubercle bacilli were found in 50 cases. The number of examinations for the five preceding years was 210, 191, 151, 231, and 273 respectively. In addition, the Medical Officer examined 515 specimens of sputum at the Tuberculosis Dispensary, 73 being found positive. 65. In my Annual Report for 1904 some figures were given as to the "Public.house as a Source of Infection "and "Chronic Tuberculosis in Children" (see page 50 of the Report). D 50 66. Disinfection was performed by the Public Health Department at 243 premises, compared with 194, 247 and 166 in the three preceding years. Disinfection was performed after the death of the patient, and also after removal to hospital, sanatorium, or other occasion of the house or bedroom being vacated. 67. Sanatorium Treatment. Altogether 281 notified persons were admitted to some sanatorium or hospital for the treatment of tuberculosis, most of them being sent by the London Insurance Committee. The following table shows the number sent to the chief institutions:— Cases Admitted as In-Patients to Sanatoria, Hospitals, etc., 1915. Male. Female. Total. Infirmary 43 24 67 Downs Sanatorium 41 — 41 Northern Hospital (Winchmore Hill) 1 27 28 Harpenden Sanatorium 3 7 10 Nayland Sanatorium 5 6 11 Treloar's Home, Alton 1 4 5 Herbert Hospital 56 — 56 East Anglian Sanatorium — 5 5 Brompton Hospital 4 11 15 Carshalton Children's Hospital 3 3 6 All others 22 15 37 Total 179 102 281 68. Shelters for Consumptives. The use and provision of these shelters has been described in previous Reports. There are 13 shelters available. All were in use during the summer and autumn; 9 have been in use all through the winter. The use of 1 was discontinued on account of air raids. 5 are occupied by men and 4 by women. 51 They are lent at a small rent varying from 1s. 6d. to 3d. per week, according to means. Only those who have no source of income are now exempted from payment. The weekly call to collect the rent insures that the shelter is being used. Shelters were lent to 24 persons last year, 18 men, 4 women, 1 boy and 1 girl. 4 of these had the shelter free', 1 paid 3d., 16 paid 6d., 1 paid 9d., and 2, 1s. a week. Two have been occupied by married women for nearly four years. Most of the patients using shelters are now under the supervision of the Tuberculosis Dispensary. 3 bedsteads with bedding are also being lent to needy cases too poor to provide such. 69. 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, 1915:— Insured persons treated 444 Uninsured ,, 2,065 In attendance on January 1st, 1915:— Treatment. Observation. Insured. Uninsured. Insured. Uninsured. 163 424 29 407 Total attendances year ending Dec. 31st 13,086 Number of new patients examined 1,486 ,, with definite pulmonary tuberculosis 235 „ with surgical tuberculosis 24 ,, of suspect and observation cases 555 ,, found non.tuberculous 672 „ of home visits of medical officers 2,739 „ ,, ,, nurses 2.543 „ of sputum examinations 515 ,, found positive 73 ,, of children in 1,486 new cases 866 „ of contacts examined 719 52 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. The Borough Council's scheme for the Treatment of Tuberculosis—particularly for the provision of a Tuberculosis Dispensary—was set out in the last Annual Report. Some difficulties arose as to the proposed agreements with the Tuberculosis Dispensary and the Dreadnought Hospital, and these have undergone some modification. It is hoped that a complete understanding has now been arrived at and that the scheme will shortly receive the approval of the Local Government Board and the London County Council. 70. 4 spitting flasks were supplied at cost price (6d.), compared with 25, 20, 21, 20 and 9 in the previous five years. TUBERCULOSIS CARE COMMITTEE. 70a. Poor persons suffering from tuberculosis now receive attention from several bodies and officials. The number of these and the number of steps which are taken and inquiries made render the routine somewhat complicated. Care Committees were originally started specially to help consumptive persons after returning from a sanatorium to continue to carry out the healthy life which had been inculcated at the sanatorium and to assist, if necessary, in providing necessary means of subsistence. When the London County Council undertook the provision of sanatorium treatment for uninsured persons and decided 53 to assess those who were able to pay for such assistance it was found convenient to make the Care Committees the bodies responsible for such assessment and collection of contributions. The Care Committee was constitued by the Tuberculosis Dispensary Committee in 1914, and now meets at the Dispensary every fortnight. It consists of members of the Tuberculosis Dispensary Committee, along with representatives of the County Council, Children's Care Committees, Invalid Children's Aid Association, and Borough Council. All cases treated at the Tuberculosis Dispensary which are recommended for sanatorium, or for other reasons require any material assistance, are considered by the Committee. It is interesting to give a summary of the various steps in the way of assistance which accompany the provision of sanatorium treatment for the poor consumptive : (а) Notification to the Medical Officer of Health. (b) The Sanitary Inspector visits and obtains particulars as to institution treatment required or received, the home and sanitary conditions, cause of illness, and isolation. (c) The home contacts are referred to the Tuberculosis Dispensary, or their private doctor, for examination, with a view to discovering undetected cases of tuberculosis. (d) Occasional visit by the Medical Officer of Health and Woman Sanitary Inspector to see that open. air treatment and other necessary steps are being taken. (e) The Dispensary Medical Officer recommends the case to the L.C.C., through the Medical Officer of Health, for sanatorium treatment. 54 (f) Form A (medical certificate) is filled up by the Dispensary Medical Officer and sent to the Medical Officer of Health. Form B (general environmental conditions) is filled up by a Sanitary Inspector, and both forms, together with a consent form in the case of children, are sent to the London County Council by the Medical Officer of Health. (g) The case is brought before the Care Committee, and a visitor is sent to obtain particulars of the financial circumstances and the special aid required. (h) The Care Committee considers the visitor's report, and assesses the contributions of the patient or friends towards the cost of treatment. (i) The case is sent to a sanatorium and returns. (j) Notice of discharge of patient from sanatorium is sent to the Medical Officer of Health by L.C.C., together with report of progress while at sanatorium and condition on discharge. A copy of this report is sent to the Tuberculosis Medical Officer or private doctor by the Medical Officer of Health, together with a request for a report on progress at intervals of three months, for transmission to the London County Council. (k) The case is again considered by the Care Committee as to after.care. CANCER. 71. There were 121 deaths from cancer (malignant tumour), giving a death.rate of 0.90, compared with 0.88, 1.02, 0.97, 1.01 and 1.06 in the five preceding years. 50 of the deaths were in males and 71 in females; 58, or nearly 65 one-half, of the deaths were in persons over 65. The highest mortality was in West Plumstead. The London death.rate was 1.16. One.third of the deaths occurred in public institutions. Of the 121 deaths, 5 were from sarcoma and 116 from carcinoma. 72. The following table shows the sex and region affected in all cases of sarcoma for males and females:— Sarcoma. Male. Female. Orbit 2 — Lung 1 — Colon — 1 Ovary — 1 3 2 73. The deaths from carcinoma have been classified under the organs affected, since 1903, and the following table shows the result for males and females respectively:— Carcinoma. Males. Seat of Primary Disease. Aver. 1903-5 Aver. 1906-10 1911 1912 1913 1914 1915 Head and face 1.7 1.2 3 1 1 1 - Mouth, jaw and tongue 40 4.8 5 6 7 11 7 Pharynx, oesophagus, larynx and neck 5.0 8.6 11 13 11 13 4 Pleura, lung, mediastinum 0.3 0.4 — 1 — 1 — Stomach and Pylorus 5.3 10.4 8 10 6 4 18 Intestines (excluding rectum) 2.7 3.2 5 2 4 9 3 Rectum and anus 4 0 4.8 5 10 7 4 3 Peritoneum and omentum 0.7 — — — — — — Liver 80 6.4 8 7 6 9 5 Kidney and Bladder — 1.6 2 1 2 1 3 Genital organs - - - 1 - - 2 Prostate and external urinary 2.7 0.8 2 1 3 4 1 Pancreas 0.3 1.4 4 2 1 1 1 Pelvis and groin 0.3 — — — — — — Undefined 0.3 2.2 6 3 2 — — 35.3 45.8 59 58 50 58 47 56 Females. Seat of Primary Disease. Aver. 1903-5 Aver. 1906-10 1911 1912 1913 1914 1915 Head and face 0.7 1.4 1 1 1 - - Mouth and tongue 1.7 0.6 — 1 — 2 — Pharynx, œsophagus, larynx, and neck 1.7 1.4 2 1 5 1 1 Pleura, lung, mediastinum 0.7 0.6 1 1 — 1 — Stomach and Pylorus 5.7 7.6 7 5 9 10 14 Intestines (excluding rectum) 0.7 4.2 6 5 4 3 3 Rectum and anus 30 6.8 5 6 5 11 7 Liver 7.3 8.0 6 8 12 7 7 Peritoneum and omentum 0.3 0.4 1 1 — — Kidney and bladder 1.2 2 1 2 — — Genital organs 16.0 13.6 15 11 16 16 12 Breasts 9.7 8.6 9 11 11 18 19 Limbs — 0.4 — — — 1 Pancreas — 0.2 1 1 — 2 — Pelvis and groin 0.7 — — — — 1 — Undefined 0.7 1.6 1 3 3 — 5 48.9 57.2 57 56 68 72 69 Last year had the lowest cancer death-rate for five years, but the reduction was mainly confined to men. As compared with 1913, in men there was a decrease under carcinoma of the throat and intestines; and in both men and women an increase of cancer of the stomach. Causes of Cancer. The special inquiry into the habits of persons suffering and dying from cancer since 1912 was continued. For the scope of this and the standards taken, see previous Annual Reports. The following table shows the sex and age distribution of the cases investigated :— Under 50. 50-60. 60-70. Over 70. Total. Males 24 42 46 23 135 Females 11 28 24 14 77 212 57 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 31 7 38 Pharynx. (Esophagus, Larynx and Neck 32 4 36 Stomach and Pylorus 26 21 47 Intestines (excluding Rectum) 13 12 25 Rectum and Anus 16 16 32 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 — 1 135 77 212 Cancer Cases. 65 of the patients were stated to be excessive users of alcohol, 19 took the standard quantity, and 116 below the standard. There were thus 32 per cent. of excessive alcohol drinkers. 82 smoked excessively, 16 consumed an average quantity of tobacco, and 101 below the average, giving 41 per cent. of excessive smokers. 58 were excessive tea drinkers, 81 moderate, and 46 small tea drinkers, giving 31 per cento. of excessive tea drinkers. 88 were large eaters, 71 moderate, and 39 small eaters, giving 44 per cent. large eaters. 59 were large meat. eaters, 85 moderate, and 48 small meat eaters, giving 31 per cent. of large meat eaters. 58 117 had a daily action of the bowels, and 38 suffered from constipation, giving 75 per cent. 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. (For details of these, see Annual Report, 1915.) 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 users, 41 per cent. excessive smokers, and 25 per cent. of constipation. Non-cancerous persons living to a greater age had 14 per cent. of excessive alcohol users, 16 per cent. excessive smokers, and 17 per cent. 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 marked with respect to alcohol and smoking if only those who died from cancer of the mouth and throat are considered. Of 68 persons dying from cancer of the lips, tongue, jaws, fauces, larynx, oesophagus and cervical glands, 31 (or 46 per cent.) took alcohol excessively, while 51 (or 75 per cent.) smoked excessively. 23 of these smoked chiefly a clay pipe, 16 a briar or other form of pipe, and 10 sometimes a clay and sometimes a briar, 2 cigarettes, and 2 cigars. There were only 4 out of the 21 cases of cancer of the mouth or tongue who did not smoke; 2 of these had bad teeth. Among the 59 non-cancer cases all the smokers smoked pipes (29 clay and 19 briar, and 3 both), except one, who smoked cigarettes. Of 134 cases with cancer of other parts than the mouth and throat, 34 (or 24 per cent.) took alcohol excessively, and 31 (or 22 per cent.) smoked excessively. It would appear, then, that both alcohol and smoking (especially alcohol) have some general effect in promoting cancer, but chiefly exert their injurious influence locally. Of the 64 cases of cancer of the mouth and throat, 18 (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. The following table gives the above results in tabular form: All Cancer Cases. Cancer of Mouth and Throat. Cancer of other Parts. Control Cases (NonCancer). Per cent. Per cent. Per cent. Per cent. Excessive alcohol drinkers 32 46 24 14 ,, smokers 41 75 22 16 ,, tea drinkers 31 28 34 31 Large eaters 44 — — 49 ,, meat eaters 31 — — 29 Constipation 25 — — 17 42 cases had cancer of the stomach. Of these, 15 (or 35 per cent.) drank excessively, 16 (or 38 per cent.) were large eaters, and 11 (or 26 per cent.) were large meat eaters. As regards cancer of the bowels, out of 46 persons dying from cancer of the intestines, 25 had a regular daily action, 20 had constipation, and 1 was not quite regular—i.e., 43 per cent had constipation. Thus constipation seems to preispose to cancer of the bowels. 60 ALCOHOLISM. 74. There were 7 deaths from alcoholism, 3 from peripheral neuritis, and 33 from cirrhosis of the liver, making a total of 43 deaths probably due to alcohol, compared with 23, 31, 23, 18 and 31 in the five preceding years. Of the 43 deaths, 17 were males and 26 females. As compared with 1913, the deaths show an increase of 6 males and 19 females. Excessive drinking among women, especially among wives receiving separation allowance, was noted by many observers. It is no doubt one cause of the increased infant mortality 11 deaths occurred in the first quarter of the year, 6 in the second, 12 in the third, and 14 in the fourth. 75. The death-rate from alcoholism, peripheral neuritis and cirrhosis of the liver was 0.32. Though higher than for 14 years, this rate is lower than it was from 1899-1901, during the South African War. SYPHILIS. 76. There were 3 deaths from syphilis, compared with 7, 6, 3, 9 and 9 in the five preceding years. All of these occurred in public institutions. All were infants under one year. There were, in addition, 27 deaths from general paralysis, tabes dorsalis (locomotor-ataxy), and aneurism, diseases which are considered to be due to syphilis, compared with 25, 30, 29 and 23 in the four preceding years. These figures are far from representing the total mortality caused by venereal disease. Many of the deaths from epilepsy, premature birth, congenital debility, and diseases of the brain, heart, blood-vessels and other organs are due to this cause. Private practitioners—for obvious reasons—rarely certify a death as due to venereal disease, so that the total amount of mortality from this cause can only be guessed at. 61 For the purpose of instructing patients and the public generally as to the prevention of venereal disease, 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 on the request of medical practitioners. No request was received during the year. OPHTHALMIA NEONATORUM (Inflammation of the Eyes of the New-born. The bad cases are usually due to Venereal Disease in a Parent). 77. Notification of this disease is compulsory on medical men under the Public Health (London) Act, and on midwives under an L.G.B. Order. Midwives are paid 1s. for each case notified. 19 cases were notified, compared with 14 and 18 in the two preceding years. The case rate was 0.14 in Woolwich and 0.12 in London. One case was removed to hospital and two were treated as hospital out-patients. The others were all reported to be receiving effectual treatment at home. The district nurses attended seven. 62 PART II. ADMINISTRATION. WATER SUPPLY. 1. Plumstead Well. Dr. Houston reports that on February 22nd this water contained no typical bacillus coli in 100 c.c. The chemical sample collected on the same date showed:— Albuminoid Nitrogen .0017 Oxidised Nitrogen .78 Chlorine 5.40 Oxygen abs. from Perm. .0082 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. Under London County Council (General Powers) Act an additional supply was required and provided at seven houses last year, making a total of 78 houses in the eight years, 1908-1915. 34 of these houses were in the Dockyard and St. Mary's Wards, 16 in River Ward, 26 in St. George's Ward, and 2 in Eltham. There were three prosecutions in 1909, which were recorded in full in the Annual Report for that year. 3. Defective and foul storage cisterns were found and remedied at 40 houses, compared with 55, 33, and 93, in the three preceding years. At 24 houses the supply was found insufficient or temporarily cut off, and the necessary steps taken for obtaining a proper supply. 63 FOOD AND DRUGS ACT. 4. 495 samples were submitted to the Public Analyst, and 39, or 7.9 per cent., were found to be adulterated, compared with 3.3, 4.6, 2.7, 5.6 and 7.3 in the five preceding years, and 8.4 in the Metropolis in 1912. The average of the five years 1904-08 was 6.3. 107 of the samples taken were informal. 6 of these were found to be adulterated. 5. Proceedings were taken in 33 cases; fines were inflicted in 22. In 7 there was proof of warranty; in one, costs were given against the defendant; and 2 were dismissed. One of the cases was dismissed because the place of delivery was held not to be in the Borough. 6. A total of £24 13s. Od. was imposed in fines, and £19 12s. 6d. in costs. 7. 330 of the samples were fresh milk. 33 of these, or 10 per cent., were adulterated, compared with 4 8, 7.2, 3.5, 7.9 and 9.7 in the five preceding years. 55 samples were bought as butter, and 2 were found to be adulterated. Table XIII. shows the other 110 articles analysed. 4 of these were found to be adulterated, viz., 2 samples of preserved cream, 1 of condensed milk and 1 of vinegar. 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. 64 1. Milk ; and Cream not sold as Preserved Cream:— (a) (b) Number of samples Number in which a examined for the presence preservative was reported of a preservative. to be present. Milk 330 0 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 5 (ii.) Statements incorrect 2 (b) Determinations made of milk fat in cream sold as preserved cream:— (i.) Above 35 per cent. 7 (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—2. (N.B.—The label was not fixed on the jar containing the cream.) 3. Thickening substances. No evidence of their addition to cream or to preserved cream. 4. No other observations. 9. Of the 33 adulterated milk samples for which proceedings were taken the adulteration varied from 4.36 to 22.23 per cent. of added water, and from 3.33 to 29.33 per cent. deficiency in fat. The fines varied from 2s. 6d. to £4. 65 The higher percentage of adulteration found in the last two years is no doubt evidence not of lower trade morality but of more successful sampling and enforcement of the Pood and Drugs Acts. 21 samples were taken in course of delivery of which 18 were taken on arrival at Railway Stations ; 3 of the latter were found adulterated. Informal Samples. The reasons for taking informal samples were detailed in my 1913 Annual Report. 107 such samples were taken in 1914 and 6 were found adulterated. 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., 3.68, and of non-fatty solids, 8.79 per cent. FOOD AND PATRIOTISM. 11. A leaflet with this title was printed and circulated with the object of showing how a hygienic and nourishing diet could be supplied at a low cost. 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 61 surrenders of unsound food, including 320 lbs. of tuberculous beef and 2,281 lbs. of black spotted lamb. A full list is given in Table XV. FOOD POISONING. Five persons were taken ill in August after eating sausages. The symptoms were pain, diarrhoea and vomiting, and commenced from 12 to 24 hours after taking the sausages. The sausages were cooked directly they e 66 were purchased, none were left over, so that no analysis could be made. The source was traced and the place of preparation inspected. It was in a dirty condition and swarming with flies. Inquiries were made, but no other cases were discovered. It seems probable that small portions of the sausages made were contaminated at the butchers by some carrier, perhaps flies. The cases were notified as zymotic enteritis. The sanitary conditions of the butcher's premises have since been much improved. DAIRIES, COWSHEDS AND MILKSHOPS. 13. On January 1st, 1915, there were 109 milkshops on the register; 6 were added, and 10 removed, during the year, leaving a total of 105 on the register at the close of 1915. There Were 171 inspections made, and 16 notices served. There were no prosecutions. Three purveyors gave up selling milk on getting work in the Arsenal and 2 because, having been convicted of retailing adulterated milk, they came to the conclusion that the risks of the business were greater than its profits. Owing to the steps taken by the Health Department requiring persons not to sell milk in unsuitable general shops the number of milkshops has been reduced from 196 to 105 in the eleven years 1905-15. During 1915, 2 applications for registration were refused. The requirements of the Health Department for securing the purity of milk were detailed in the 1912 Annual Report. 14. No cowshed was closed and none opened, leaving 16 on the register. There were 54 inspections, and 6 notices were served for dirty conditions, etc. 67 SLAUGHTER-HOUSES. 15. The number of slaughter-houses on the register remained the same, viz., 10. 40 inspections were made, and 5 notices served and complied with. NUISANCES (see Table VIII.). 16. 614 complaints of sanitary defects were received and investigated, compared with 361, 441, and 454 in the three preceding years. 43 complaints of non-removal of dust were made and attended to, compared with 29, 38, and 55 in the three preceding years. 11 of the dust complaints came from Woolwich Parish, 21 from Plumstead, and 11 from Eltham. The dust in Woolwich is collected by your Council's employees, but that in Plumstead and Eltham by contractors, Messrs. Tuff & Hoar. 17. Drains and Water-Closets. 26 defective combined drains were investigated and reported upon by the Chief Sanitary Inspector, compared with 16, 7, and 12, in the three preceding years. These drains affected 143 houses. 475 private drains, found choked and defective, were examined, cleared, and relaid, compared with 399, 448, and 450 in the three preceding years. The largest number, 107, was found in St. Nicholas Ward. 843 water-closets and w.c. cisterns were repaired, compared with 890, 785, and 782, in the three preceding years. 255 foul w.c. pans were cleansed by tenants, compared with 238, 209, and 181 in the three preceding years. 18. House Inspection. 4,707 houses were inspected, house to house, compared with 5,830, 5,489, and 4,538, in the 68 three preceding years; 7,707 were inspected re infectious diseases and complaints, compared with 6,678, 6,516, and 7,267. In addition to these, 576 inspections of registered houses were made. 19. At 2,703 houses, interiors were cleansed, or defective roofs repaired, compared with 2,206, 2,620, and 2,337 in the three preceding years. 646 houses with damp walls were remedied, compared with 571, 629 and 393 in the three preceding years. Improved ventilation was provided in 55 houses, compared with 62, 41, and 55 in the three preceding years. 561 new dust pails were supplied, compared with 525, 545, and 474 in the three preceding years. 20. Medical Officer's Special Inspections. These amounted to a total of 547. 31 inspections were made of cowsheds and milkshops, 42 of bakehouses, 28 of factories and workshops, 61 inspections were on account of tuberculosis, 66 cancer, 7 diphtheria, 21 scarlet fever, 21 cerebro-spinal meningitis, and 14 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. 150 premises were inspected re housing conditions. Special inspections were made of Ann Street, Palmerston Road, Francis Street and Ogilby Street, and of all the houses reported as unfit for human habitation. 21. Overcrowding. 97 cases of overcrowding were found and remedied, compared with 91, 101, and 93, in the three preceding years. The overcrowding was 2.1 per cent. of house-to-house inspections, compared with 1.6, 1.8 and 2.0 69 per cent. in the three preceding years. Three persons were convicted of allowing overcrowding and fines of 10s. and 5s. inflicted, with costs of £2 2s. Od. in one case. The overcrowding is less than might have been expected, but it must be remembered that overcrowding depends on two factors, lack of housing accommodation and inability to pay rent. While the former is acute the latter is almost absent and consequently the majority of occupiers keep their rooms to themselves and do not sub-let. 22. Smoke Nuisance. 44 observations re smoke nuisance were made, and 6 nuisances of black smoke observed. The nuisances were abated on service of notices. There was no prosecution. Considerable nuisance occurred from smoke at one of the Dockyard chimneys. An undertaking was given by the officer responsible to abate it. 5 complaints of smoke nuisance were received from the London County Council. These related to the Electric Light Works, Globe Lane and White Hart Lane, Woolwich and Plumstead Baths. 23. Defective Light. At 62 houses new windows were supplied or existing ones enlarged, or other work done to improve the lighting by daylight, compared with 38 in 1914. 24. Verminous Rooms. 198 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 248, 214, 220, and 122, in the four preceding years. 70 DUST REMOVAL. 25. The collection of dust is weekly throughout the Borough, with the following exceptions; in Plumstead there is a collection twice a week from houses in Plumstead Road and High Street; in Woolwich Parish there is a collection twice a week at High Street flats (40 houses) and Ropeyard Rails (8 houses), and a collection two or three times a week at several large business premises and public buildings (about 57). In Woolwich Parish, 7,322 loads of house refuse, and 416 loads of inoffensive trade refuse were removed by direct labour, and destroyed at the Woolwich Destructor. In the three preceding years, 5,866, 6,058, and 5,160 loads of house refuse respectively were removed. In Plumstead, 18,344 loads of house refuse, weighing 16,142 tons were removed by the Contractors, Messrs Tuff and Hoar, and destroyed at the Plumstead Destructor. In addition, 1,080 loads of trade refuse weighing 648 tons were removed to the Plumstead Destructor and destroyed (the contractors removed 300 loads and were paid for the removal by the tradesmen at the rate of 1s. 6d. per load). £3,043 14s. 4d. was paid for collection in Plumstead, compared with £2,929 5s. 8d. in 1914. In Eltham, the sum of £953 4s. Od. (£860 in 1914) was paid to the contractors for removal of dust. 71 loads of trade refuse were removed at the tradesmen's cost. TRADE REFUSE. 26. During the past year there have been 2,076 (1,709 in 1914) receptacles of offensive trade refuse removed. There are now 24 (12 in 1914) tradesmen on the books from whom 71 offensive trade refuse is removed. Certain manure manufacturers recently collected offensive trade refuse free of charge, but this collection has now ceased. The charge made for inoffensive refuse is 2s. per load (raised from 1s. 6d. in April, 1916), and for offensive refuse at the rate of 3d. per receptacle, charged per quarter in advance on the amount collected in the previous quarter. HOUSING OF THE WORKING CLASSES ACTS. 27. 16 houses were dealt with under the Housing Act, compared with 18, 52, and 18, in the three previous years. Two notices were served under Section 15 ; Closing Orders were served for 9 houses and 4 underground rooms, and 1 house was closed by the owners without notice. The work required was done at 7 houses and demolition orders have been made for 4. The procedure usually adopted and the requirements made of the owners before allowing a house to be re-occupied were detailed in the 1914 report. The following table summarises the action taken:— Number of houses inspected re Housing and Town Planning Act 4,707 Dwelling-houses considered on inspection to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 Number of representations made to Borough Council under Section 17 (2) with a view to making of Closing Orders 11 Number of Closing Orders made 9 Number of dwelling-houses remedied without making Closing Order 1 72 Number of dwelling-houses put into fit state for human habitation after making Closing Order 6 Number of dwelling-houses closed in 1914, demolished by Orders made in 1915 The following are the 11 houses represented:— 33 and 35, Barnfield Road. 5, 6 and 7, Globe Lane. 37, 39, 41 and 43, Abbey Grove. 33, Red Lion Lane. 3, Scott's Place. HOUSES—INSUFFICIENCY. Government Housing Scheme. 28. In October, 1913, I reported that there was a very great demand for working-class houses in the Borough, and that the demand was not being met by the supply. In response to the request of a deputation of the Borough Council following that report, the Government has erected 1,200 new houses at Well Hall. This was done with unexampled celerity, and on a plan which in variety, beauty and convenience probably constitutes a record in State housing, and will compare favourably with any garden suburb yet built. The report on the house famine was made in December, the deputation was received in January, and in February the ground was laid out and the houses were going up. Not half of them were finished, however, by July, so that the increase of population in the second half of the year was much greater than in the first half. The houses comprise:— 212 flats of 3 rooms at rents of 7s. Od. to 7s. 6d. per week. 613 houses „ 4 „ „ 10s. Od. to 11s. 6d. „ 358 „ „ 5 „ „ 12s. Od. to 14s. Od. „ 113 „ „6 „ „ 14s. 6d. to 16s. 6d. „ 73 Number of houses to the acre—13. The houses are arranged in a great variety of design, including semi-detached blocks and blocks up to groups of 15. The blocks are variously grouped so as to afford a maximum of light and air. In addition to the Well Hall houses the Government has erected or are erecting 1,904 temporary four-roomed huts which constitute self-contained houses for one family. These are situated in East Plumstead and at Eltham adjoining the Corbett Estate. Six hostels are also erected or in course of construction. 1,460 of the huts are in Eltham. Comparatively few new houses have been supplied by private enterprise, but in spite of the excessive cost of materials there has been some increase of building in East Plumstead. The houses built are all for sale, so that they only appeal to the more affluent of the workers. Government Buildings occupied by Civilians. In addition to the new houses in Eltham, and the newly erected huts in Eltham and Plumstead, the married quarters in Artillery Place and some huts erected for soldiers on Bostall Heath are or have been occupied by civilian munition workers. It was arranged with the Chief Superintendent of the Royal Arsenal and the Assistant Director of Medical Service that these should be under the sanitary supervision of the Public Health Department. Notices of sanitary defects are sent to the Chief Superintendent and attended to by the Building Works Department. HOUSING IN ST. NICHOLAS WARD. 29. Mr. Little inspected 3,029 houses in St. Nicholas Ward during the last two years and has tabulated the results 74 according to number of rooms occupied. The figures work out out at 5.46 persons to a house and slightly over one person to a room. The following are the total figures. No. of houses No. of rooms Number of Persons living in Tenements of :— More than 7 rooms Total 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6 rooms 7 rooms 3,029 15, 653 63 759 4,005 3,862 5,124 1,763 678 107 16,361 30. Council's Houses. All the Council's 25 houses in North Woolwich were occupied throughout the year with the exception of two 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. HOUSES REGISTERED UNDER THE BY-LAWS. 31. At the commencement of the year, 418 houses were on the register, 5 were newly registered, and 3 taken off the register, leaving 420 on the register at the close of the year, compared with 409, 429, 432, 432, and 432, in each of the five preceding years. 32. These houses were inspected, some quarterly, others half-yearly or yearly. 576 inspections were made in all, and 259 notices served. Two occupiers were summoned for overcrowding. Fines of 5s. and 10s. respectively were inflicted. The registered houses were under the care of Inspector Shaw. 75 The houses were situated as follows:- River Ward, North 22 do. South 105 St. Mary's 35 Dockyard 67 St. George's 57 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 420 Number of inspections 576 ,, found unsatisfactory 365 ,, found satisfactory 211 „ of notices served 259 ,, of nuisances, defects and offences against the by-laws, dealt with and remedied 347 ,, of cases of overcrowding remedied by redistribution without notice 14 ,, of houses measured 5 Notices. On Owners for Cleansing (under P.H.L. Act) 140 On Tenants for Cleansing (under By-laws) 55 On Landlords for Overcrowding 11 On Tenants for Overcrowding 14 On Landlords and Tenants for other defects 95 On Landlords and Tenants for Verminous Rooms 24 Verbal Notices on Tenants for Cleansing—carried out 81 76 INHABITED HOUSE DUTY. 33. A certificate under the Inland Revenue Act was granted for the house, 6, Ripon Road, Plumstead, containing four separate flats on two floors. UNDERGROUND ROOMS. 34. Nine underground rooms occupied for sleeping were found not in accordance with the regulations made under Section 17, Housing, Town Planning, etc., Act. Four Closing Orders were made and the occupation of five rooms for sleeping was stopped on service of notice. FACTORIES, WORKSHOPS, AND WORKPLACES. 35. There were, at the close of the year, 197 (201 in 1914) workshops on the register. 390 inspections were made and 22 notices served and complied with. 149 (96 in 1914) inspections of factories were made regarding sanitary accommodation, and 37 (15 in 1914) notices served and complied with. 369 (490 in 1914) inspections of homeworkers' premises were made and 9 (14 in 1914) notices sent and attended to. Table X. gives full particulars of the work done under Section 107, Factory Act. Miss Middlebrooke devoted a large amount of her time to the inspection of workshops, factories, and houses where women are employed; 17 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. 36. The number of factory bakehouses is 9, and of workshop bakehouses in use is 36, 11 of the latter being underground. They were all inspected twice. I inspected most of them personally, and found them generally satisfactory. 14 certified underground bakehouses are not in use. 77 ICE-CREAM SHOPS. 37. 87 Ice-cream shops were on the register at the close of the year, compared with 89, 82, and 83, in the three previous years. 5 were added and one removed during the year. There were 124 inspections made and 6 notices served. Regulations, embodying the provisions for premises where food is sold, contained in the London County Council (General Powers) Act, are distributed at every shop on the register. The shops are inspected in April, June, and August, by Inspector Potter. FRIED FISH SHOPS. 38. There are 39 fried fish shops in the Borough. These were all inspected one or more times. 34 were found to comply with the L.C.C. regulations (see Annual Report, 1914). 5 notices were served. DISINFECTION. 39. The mode of disinfection, cost of appliances, staff, etc., were fully described in my Annual Report, 1903, pages 73-76. Rooms at 1,252 houses were disinfected in 1915, compared with 1,195, 1,278, and 1,344 in the three preceding years. The disinfecting apparatus was used 1,252 times for 27,544 articles after infectious disease and 76 times for special disinfection. Books from the Free Libraries and Public Schools were disinfected. The sum of £63 13s. 6d. was received for disinfection in special cases on request of the occupier. A large quantity of horsehair was disinfected for the Army Ordnance Store Department, for the sum of £8 6s. 6d. 78 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 (145 persons supplied in 1915), the Sun Street Mortuary (31 persons supplied), 14, Barge House Road, North Woolwich (31 persons supplied), and at 144a, High Street, Eltham (25 persons supplied). The cost of disinfectants used by the Department in 1915 was £42 8s. 6d. The disinfectants used were Corrosive Sublimate; Sulphur and Formalin (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. The use of disinfecting powder for dust pails has now been discontinued, and the practice of cleansing the receptacles recommended; nearly £50 was saved last year in this way without any prejudice to the public health. HEALTH SHELTER. 40. The Health Shelter was not used during 1915. It was used once in 1914 and 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, 1914, on a weekly tenancy. The flat from that date was kept empty until October, 1915, in view of the possibility of an outbreak of small-pox or other epidemic during the war. The flat was re-let on October 11th, 1915, at a weekly rental of 8s. THE MORTUARIES. 41. The Sun Street Mortuary was used for 277 bodies, compared with 143, 179, and 189, in the three preceding years. 255 were deposited for inquest, and 22 for custody. 148 79 post-mortem examinations were made. 1 body was deposited in the infectious mortuary, compared with 4, 3, and 2 in the three preceding years. The Eltham Mortuary was used for three bodies compared with 5 in 1912, 2 in 1913, and 1 in 1914. CEMETERIES. 42. The two Borough Cemeteries were well maintained and no complaint was received. 720 bodies were buried in Woolwich Cemetery, compared with 540, 627, and 667 in the three previous years. There were, 834 interments in the Plumstead Cemetery, compared with 602, 764, and 842 in the three previous years. 46 burials took place in Plumstead Churchyard, compared with 47, 60, 34, and 51 in the four preceding years. CLEANSING OF VERMINOUS PERSONS. 43. The station for cleansing verminous persons was opened in November, 1906. During 1915 it was used by 954 persons, compared with 590, 509, 430, 651, and 811 in the five preceding years. The users were 88 adults (viz., 16 females and 72 males) and 866 children (viz., 551 females and 315 males). 6,654 articles were disinfected. The adults came mainly from common lodging-houses, and the children from County Council Schools. An agreement was entered into with the London County Council, dated August 21st, 1911, to allow the London County Council to use the Borough Council Cleansing Station for cleansing school children. The Station is reserved for school children on Tuesday, Wednesday, and Friday, between 9 a.m. and 4.30 p.m., girls being cleansed between 9 and 1, 80 and boys in the afternoon. The Borough Council must properly cleanse the children and their clothes to the reasonable satisfaction of the London County Council, the children cleansed not to exceed 10 in one day or 20 in one week. The Borough Council for this purpose employs a female attendant for the three days, Tuesday, Wednesday, and Friday, at a cost of 4s. per day. £37 4s. Od. 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 2 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. The County Council, until this year, paid the Borough Council at the rate of 2s. for each child cleansed, such payment to cover any number of cleansings during one month. Experience has shown that the number of re-cleansings required is greater than was expected, and the payment was found to be inadequate, besides involving complicated accounts for the children who needed repeated cleansings. On the representation of the Borough Council the County Council has now agreed to make payment at the rate of 1s. for every cleansing, with a minimum payment during the year of £63, which will be much simpler and more satisfactory. 81 TEXTS, VANS, AND SHEDS. 44. During the year 48 tents, vans, and sheds were inspected (6 in 1914), and one notice served under the By-laws for this class of dwelling. 41 were in Eltham and 5 in St. Margaret's Ward. NOTICES AND PROSECUTIONS. 45. 3,386 written intimation notices and 773 statutory notices were served. 106 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, 28 defaulters were summoned at the Police Court. This is the largest number of prosecutions instituted in one year. The results are given in TableXII. Convictions were obtained and orders made in every case. BACTERIOLOGICAL EXAMINATION. 46. The Council's bacteriological work is done by the Bacteriological Department of the Seamen's Hospital. 1,050 bacteriological examinations were made for the Public Health Department, viz., 776 for diphtheria, 254 for phthisis, and 20 for enteric fever. The total cost was £156 13s. 0d., compared with £186 7s. 6d. in 1914. INFANT CONSULTATION. 47. The consultation for mothers and infants continued to be 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 attended and were assisted by a voluntary worker. Infants under one year and children from one to five are received as far as the Medical Officer of Health can find time. The Consultation was attended last f 82 year by 946 infants, compared with 460, 863, 1,408, and 1,196 in the three previous years. For particulars see Miss FitzGerald's report. 48. Maternity and Child Welfare. In 1914 the Local Government Board suggested that local authorities should carry out a complete scheme for maternity and child welfare embracing:— (1) The local supervision of midwives. (2) An ante-natal clinic for expectant mothers with home visiting and the provision of a maternity hospital. (3) By assistance to ensure skilled and prompt attendance at birth. (4) By an infant consultation for infants and children up to school age. Numbers 1 and 3 are in the province of the London County Council which is the supervisory authority for midwives. As regards (2), at the suggestion of the Local Government Board arrangements were made by the Borough Council with the British Hospital for Mothers and Babies to establish an ante-natal clinic, the Hospital providing the services of a medical woman together with an experienced member of its nursing staff and the Borough Council supplying the rooms and the necessary appliances. An ante-natal clinic on these lines was commenced in the rooms used by the infant consultation at the end of November and it has continued to work satisfactorily. The midwives and doctors of the district were circularised inviting them to send their patients to the clinic. The numbers so far attending have not been very large, but 83 are slowly increasing. A detailed account of the work will be given in the Annual Report for 1916. The Acting Medical Officer is Dr. Agnes M. Swanson. Miss FitzGerald attends the clinic and does the home visiting which is necessary and the British Hospital provides hospital treatment where requisite. One half of all expenses is repaid by the Treasury. In order to carry out a proper child-welfare scheme I recommended that an assistant Medical Officer should be appointed to conduct the infant consultation at the existing centre and at an additional one to be instituted in East Plumstead, and that an additional woman inspector and health visitor should be appointed. In view of the necessity of economy during the war no action has been taken as to the Medical Officer, but steps are now being taken to appoint an additional woman Inspector and Health Visitor. Two-thirds of the new officer's salary will be allotted for health visiting and one-third as Sanitary Inspector, and the Local Government Board have made themselves responsible for repaying one-half the amount allotted for health visiting. WOMEN SANITARY INSPECTORS' WORK. 49. There are two Women Sanitary Inspectors, one of whom, Miss FitzGerald, is also a Health Visitor. Miss Middlebrooke inspects 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. Special efforts are made to deal with verminous children, and for these efforts 84 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. Infested bedding at the homes is destroyed or disinfected. 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, measles, and ophthalmia neonatorum. During part of the year the services of an unpaid Health Visitor were obtained. Miss Middlebrooke's report gives striking testimony to the improvement in the condition of homes resulting from increased wages. Her report is as follows:— Women's Lavatories at Railway Stations, etc. Number of Inspections 99 „ found dirty and defective 8 Restaurants and Eating-houses. Number of Inspections 95 ,, Defects and dirty conditions found and remedied 15 Factories and Workshops. Number of Inspections of Factories and Workshops 261 ,, Notices served 11 ,, new workrooms measured 17 Homeworkers Premises. Number of Inspections 369 „ Cases referred to District Inspectors 9 Miscellaneous. Total number of houses visited re Phthisis, Measles, Scabies, Whooping-Cough, and Zymotic Enteritis 49 85 Visits paid for various causes, complaints, etc. 443 ,, verminous and dirty houses and bedding 878 Re-visits—estimated 1000 Cases where bedding was found to be in a dirty and verminous condition, and cleansed or destroyed 390 Total number of cases referred to District Inspectors 171 „ Early-morning Inspections 5 ,, Overcrowding—cases found and abated 41 Notices served on tenants re dirty conditions 150 ,, „ landlords and tenants—various 131 In reviewing the general aspect of the work during 1915, one comes to the conclusion that it has been of a most unusual nature. The frequent crowding together into one room of all the children, caused by the exceptional circumstances and expected air raids, could not be dealt with harshly. Reasoning with the parents as to the danger to health of this practice has generally induced an abatement of this special kind of overcrowding. I have spent a good deal of time in connection with the Cleansing Station. It may be owing to war conditions that Scabies and Impetigo cases have been numerous. The explanation as to how school children are affected is not far to seek. Very often the mothers of the children take in soldiers' washing. The children fetch and return it, and so easily become infected. Verminous conditions are also produced in this way. When a definite case of the kind has come to our notice, the regimental Medical Officer has been communicated with, and the soldiers' clothes and bedding have been disinfected. With our great increase of population the disinfecting officers and machinery have been kept extremely busy. It has therefore been expedient to reduce the number of beds 86 disinfected for verminous conditions. It is much more practical to get new bedding substituted where possible. Very little difficulty is experienced in getting parents to accomplish this instead of having to submit to the disgrace of the visit of the disinfecting van at the house for all the neighbourhood to see and comment upon. With better financial conditions, many of the homes I almost despaired of have become improved almost beyond belief, which goes to prove very emphatically that if we want to eliminate the slum type of human being and the slum type of home, the surest and quickest way is to give the workman a good living wage. It is only natural that wives and mothers get tired of struggling against a tide of difficulties which every day threatens to engulf them. One endless struggle of bootbuying and repairing, clothes wanted, rent and coal to be paid for, the pawnbroker in possession of the bedding and spare clothing. With more wages coming in, all these difficulties disappear as if by magic, and the housewife begins to buy comforts for her family and home which never could have been afforded before. She gradually improves in health and spirits and is anxious to make her surroundings correspond with her own improvement. 50. The following is Miss FitzGerald's report:— Summary of Inspections. Visits to houses after notification of births 1300 Re-visits 225 Visits re infant deaths 37 Domiciliary visits to children attending Consultation 304 Zymotic Enteritis cases investigated, including re-visits 201 Tuberculous cases 103 Ophthalmia Neonatorum 31 Ophthalmia (reported by schools) 12 37 Infants weighed at Consultation 946 Health Lectures given 4 Unsuccessful visits (occupiers absent from home) 750 Visits re dirty conditions 23 Visits not otherwise classified 96 Ante-Natal Clinic—attendances 5 Reported to District Inspectors:— Contraventions of Housing Acts 3 Dirty interior walls 12 Other defects 28 Visits paid by pupils who did temporary health visiting under my supervision 547 The forecast that I ventured to make in my last Annual Report, that some rise in the infant death-rate might be expected as the result of the disturbed conditions through which the country is passing, has unhappily been fulfilled. As a result of the increased prosperity in the Borough, the homes are better furnished, the provision of bedding is more satisfactory, and the children are better clothed. The infant death-rate, however, seems to be influenced more by the subtle factors of environment which are included in the term "good mother-craft." The marked drop in the attendances at the Infant Consultation which occurred directly the war broke out has continued through 1915. The number of attendances had been steadily rising year by year as the mothers learnt to value the opportunity of coming for advice and having their infants weighed regularly, and medically supervised. In 1913 the total attendances were 1,408, in 1914 only 1,196, with a very marked drop in the last five months of the year (war began on August 4th), and in 1915 they had fallen as low as 946. It seems as if distractions of some sort are preventing the mothers from taking the same 88 interest in the progress of their babies. Industrial occupation has not so far been a factor, but there are now indications that married women are going into the munitions factories in considerable numbers, and the effect of this on the welfare of their children has yet to be reckoned with. The excitements and alarms incidental to the country being in a state of war have, without doubt, acted prejudicially on the well-being of both mothers and children. I have not been able to obtain direct evidence as to the results of alcoholism of the mothers on the children, but there is little doubt that an increase in alcoholism amongst women has to some extent influenced the death-rate amongst infants. In view of the foregoing it is well to be able to comment on the starting of the ante-natal clinic at the Town Hall on November 26th. We have now at last an opportunity of advising the mothers and supervising their health during pregnancy. PUBLIC AMBULANCE. 51. The Woolwich Public Ambulance, for accidents and non-infectious illness, was used 97 times, compared with 147, 127, 150, and 120 in the four preceding years. The ing were the journeys made:— To Guy's Hospital 15 Cottage Hospitals 17 Seamen's and Miller Hospitals 17 King's Hospital 1 St. Thomas's 2 Union Infirmary 19 Other hospitals 7 Private houses 13 Asylums 6 89 There are now in the Borough three separate means of provision of ambulance service for accidents and non-infectious cases, viz.: (1) The London County Council ambulance, which is free for all places in the County, but only available for accident (anywhere) and for sudden illness in public places. (2) The Metropolitan Asylums Board ambulance, which is available for accidents and all cases of non-infectious illness. The charge is 10s. to a place within the Metropolis including the services of a male attendant. Outside the Metropolis,an additional charge of 1s. per mile is made. (3) The Woolwich Ambulance, Mr. Chick, Herbert Road. This can be used for all non-infectious cases and the charge is the same as cab fare except that a minimum charge is made of 2s. 6d. It would thus appear that for accidents and sudden illness in the street the London County Council service offers both the cheapest and best means of conveyance to a hospital or other place. For illness occurring at home or in private places if the patient is to be conveyed a distance of ten miles, the Metropolitan Asylums Board ambulance would probably be the best means of conveyance. If, however, the distance is shorter than that, the Woolwich ambulance offers the cheapest mode of removal. 52. Co-operation with the Royal Army Medical Corps and Royal Arsenal Medical Officers. 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. Information has been given and received with respect to billeting. All possible assistance has been given in disinfection of articles and premises. I have been repeatedly consulted by the Medical Officers of the Army and Royal Arsenal on sanitary matters and infectious diseases. 90 53. Health Leaflets. The following leaflets were issued by the Public Health Department during the year:— Food and Patriotism, about 3,000 distributed. Teeth and Diet, about 250 distributed. Advice to Mothers (Ante-Natal), about 200 distributed. How to Bring up a Baby, about 3,000 distributed. Kill that Fly, about 1,000 distributed. And 3,500 copies of "How to be Healthy," and instructions re infectious diseases. STAFF. 54. The following changes were made in the duties of the staff :— Mr. Collyer, clerk, joined the Army and a temporary female clerk was appointed to take his place. Miss Wheeler stayed only 12 weeks and was succeeded by Miss Saunders. My sincere thanks are due to the Chief Sanitary Inspector and the Staff of the Department for their loyal co-operation. Three members of the clerical staff, Messrs. Britter, Collyer, and Prescott, have joined the Army (Mr. Britter obtaining a commission). The Sanitary Inspectors are all over the age for military service. 91—92 TABLE I. Borough of Woolwich. Vital Statistics of the whole District during 1915 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 Non-Residents Registered in the District. Deaths of Residents Registered Beyond the District. Net Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Ago. At All Ages. Number. Rate per 1,000 Births Registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1902 122505 3730 29.9 466 124 1678 13.7 278 43 208 1843 14.7 1903 123172 3691 30.0 399 106 1511 12.3 272 41 175 1637 13.3 1904 125791 3531 28.1 479 132 1636 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 1179 .. 296 50 184 1613 13.0 1908 123644 3082 24.9 298 95 1374 .. 333 60 170 1487 12.0 1909 123644 2937 23.8 240 82 1415 .. 323 51 223 1585 12.8 1910 123644 2844 23.0 241 84 1296 .. 314 42 156 1410 11.4 1911 121376 2814 23.2 273 98 1402 .. 327 53 212 1561 12.8 1912 123311 2747 22.3 201 73 1249 .. 297 42 196 1420 11.5 1913 125686 2876 22.5 229 80 1378 .. 298 50 252 1580 12.3 1914 128556 2824 22.0 239 84 1505 .. 369 61 246 1690 13.2 Average for Years 1902-14 124192 3188 25.6 323 99 1455 .. 306 49 197 1605 12.9 1915 134828 2815 20.9 268 95 1725 .. 390 117 233 1841 13.7 *Rates in Columns 4, 8 and 13 calculated per 1,000 of Estimated Population. Note.—The deaths included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-Residents" is meant persons brought into the district on account of sickness or infirmity and dying in Public Institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity and have died in Public Institutions elsewhere. The "Public Institutions" taken into account for the purposes of these Tables are these into which persons are habitually received on account of sickness or infirmity, such as Hospitals, Workhouses and Lunatic Asylums. Area of District in Total Population at all Ages 121,376 acres (exclusive Number of Inhabited Houses 21,463 of area covered 8239-7 Average Number of Persons per House 5.6 At Census of 1911. by water) TABLE II. Cases of Infectious Diseases notified under S. 55, P.H.L.A., during the Year 1915. 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. W oolwich. Plumstead. Eltham Under 1 1—5 5—15 15—25 25—65 05 and Upwards. West East Small-pox Scarlet Fever 601 3 111 357 98 32 — 175 172 202 52 20 511 Diphtheria 286 4 72 153 35 22 — 87 85 98 16 40 264 Membranous Croup — — — — — — — — — — — — — Typhoid or Enteric Fever. 31 — 1 7 10 12 1 11 13 5 2 8 27 Erysipelas 138 2 1 8 21 91 15 48 41 38 11 — 3 Puerperal Fever 6 — — — 1 5 — 2 1 2 1 — 2 Cerebro-Spinal Fever 50 2 3 7 21 17 — 31 5 5 9 4 45 Ant. Polio Myelitis 2 — — 2 — — — — 2 — — — 1 Ophthalmia Neonatorum 19 19 — — — — — 9 4 5 1 — — Zymotic Enteritis 173 85 73 6 4 5 — 40 55 67 11 — — Total 1306 115 261 540 190 184 16 403 378 422 103 78 853 93 95—98 TABLE III. Causes of, and Ages at Death during the year 1915. Disease. Deaths in or Belonging to Whole District at Subjoined Ages. Woolwich. Plumst'd Eltham. Residents in Outlying Institutions. Public Institutions in Borough. Residents and 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. j West. East. Small-pox — — — — — — — — — — — — — — — — — — — — — — — — Measles 45 22 23 11 17 12 5 — — — — — — — — — — 22 17 5 1 — — — Scarlet Fever 8 4 4 — 1 1 2 1 1 2 — — — — — — — 4 — 3 1 8 — — Epidemic Influenza 33 25 8 2 — — 1 — 1 1 4 5 4 4 4 4 3 10 11 7 5 1 10 Whooping Cough 17 4 13 7 5 5 — — — — — — — — — — — 7 4 5 1 — — 1 Diphtheria and Membranous Croup 20 5 15 1 4 8 4 2 1 — — — — — — — — 5 8 0 1 18 — — Enteric Fever 5 1 4 — — — 1 1 — — 1 1 1 — — — — — 3 2 — 5 — — Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — — Diarrhœa 6 4 2 — — — — — — — — — — — — — — 5 1 — — 1 — 1 Enteritis 27 15 12 21 3 1 — — — — — — 1 — 1 — — 11 3 11 2 4 3 Acute Anterior Polio myelitis — — — — — — — — — — — — — — — — — — — — — — — — Cerebro spinal Fever 9 5 4 1 1 — — 2 — — 2 1 2 — — — — 5 1 1 2 5 — — Other Continued Fevers — — — — — — — — — — — — — — — — — — — — — — — — Erysipelas 8 4 4 1 — — — — — — — — 3 — 1 1 2 3 4 — 1 — 4 — Puerperal Fever 3 — 3 — — — — — — 1 9 — — — — — — — — 3 — 2 — — Other Septic Diseases 12 7 5 1 — — 1 — — 1 2 2 2 1 1 1 — 5 4 1 2 2 5 1 Syphilis 3 1 2 3 — — — — — — — — — — — — — 2 — 1 — — 3 — Rheumatic Fever 5 2 3 — — — — 1 1 — 1 — 1 — — 1 — 2 1 2 — — — — Gout 1 1 — — — — — — — — — — — — — — 1 — — — — 1 — — — Intermittent Fever and Malarial Cachexia — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of Meninges 18 9 9 3 3 2 0 1 — — — — — — — — — 6 8 2 2 3 2 — Tuberculosis of Lungs (Phthisis) 201 125 76 3 2 1 6 6 24 15 — 55 33 19 4 — — 72 67 52 10 18 36 5 Tuberculosis of Intestines & Peritoneum 5 4 — 1 — 1 1 — 1 — — 1 — — — — — 2 — 2 1 — — 1 Other forms of Tuberculosis 8 5 — 1 — 1 1 1 2 — — 1 — — 1 — — 2 3 1 2 1 2 1 Alcoholism 7 3 — — — — — — — — — 4 1 2 — — — — 5 2 — 1 4 1 Cancer 121 50 — — — — — 1 — — 3 7 23 29 38 15 5 31 45 31 14 19 18 3 Diabetes 17 6 11 — — — — — — 2 — 2 2 2 6 3 — 2 4 5 6 5 3 1 Congenital Debility and Malformation, including Premature Birth 110 66 44 107 1 — 2 — — — — — — — — — — 44 30 22 14 4 5 2 Old Age 88 46 42 — — — — — — — — — — 2 15 47 24 21 39 13 15 12 35 1 Meningitis 16 8 8 1 1 3 3 1 3 1 2 — — 1 — — — 4 7 3 2 3 3 — Inflammation and Softening of Brain 2 1 1 — — — — — — — — — — 1 1 — — — 1 1 — 1 1 Epilepsy 6 2 4 — — — — — — 1 2 — 2 — 1 — — 2 1 3 — 3 1 — General Paralysis 8 6 2 — — — — — — — 1 5 2 — — — — 2 4 1 1 8 — — Tabes Dorsalis and Locomotor Ataxia 5 4 1 — — — — — — — 1 — — 4 — — — 2 2 1 — — 1 — Peripheral Neuritis 3 — 3 — — — — — — — — — 1 1 1 — — — 3 — — — — — Other Diseases of Brain and Nervous System 19 8 11 7 — — 1 — — 2 2 1 4 1 — 1 — 8 4 4 3 2 1 — Organic Diseases of the Heart 178 107 71 — 1 — 4 4 6 1 11 20 28 35 47 20 1 55 54 40 20 11 35 10 Cerebral Hemorrhage, Embolism and Thrombosis 81 36 45 — — — — — — — — 4 10 22 27 15 3 27 25 18 11 4 16 3 Apoplexy and Hemiplegia 19 7 12 — — — — — — — — 1 2 4 6 4 2 3 10 4 2 — 3 Aneurism 14 7 7 — — — — — — — 1 — 4 7 1 1 — 5 4 3 2 3 2 — Other Diseases of Blood Vessels & Heart 63 31 32 — — — — 1 3 1 1 2 9 7 24 9 6 16 25 13 9 14 8 — Bronchitis 191 96 95 27 1 3 1 — — 2 2 7 13 33 49 42 11 62 67 48 14 9 32 2 Lobular (Broncho) Pneumonia 96 51 45 40 25 9 3 1 — 2 — 1 1 3 3 7 1 44 25 24 3 7 1 Pneumonia 93 49 44 9 5 2 5 1 1 1 12 12 12 14 8 9 2 24 37 20 12 10 17 3 Other Diseases of Respiratory System 5 3 2 — 1 — — — — — — 2 — 1 1 — — 3 — 2 — — 1 — Diseases of Stomach 13 4 9 2 — — — — — 1 — 1 4 4 — — 1 2 5 5 1 2 1 — Appendicitis and Typhlitis 8 6 2 — — — 3 1 1 — 1 1 1 — — — — 3 3 1 1 4 3 — Obstruction of Intestines 13 6 7 2 — 1 — — — — — 2 — 4 1 3 — 3 4 5 1 5 5 — Cirrhosis of Liver 33 14 19 — — — — — — — 1 3 12 14 3 — — 12 13 6 2 6 13 1 Other Diseases of the Digestive System 13 7 6 2 — — — — — 2 — 2 1 2 2 2 — 3 4 3 3 3 4 — Nephritis and Bright's Disease 47 23 24 — — 2 1 — — 1 1 8 15 9 8 1 1 16 17 11 3 2 8 — Tumours and other Affections of Female Genital Organs — — — — — — — — — — — — — — — — — — — — — — — — Accidents and Diseases of Pregnancy, Parturition 5 5 — — — — — — — 2 3 — — — — — 3 1 — 1 1 — 1 Violence 66 46 20 7 4 3 5 1 1 2 4 6 11 8 7 3 4 29 22 10 5 12 32 20 Suicide 11 6 5 — — — — — — — 1 4 2 2 2 — — 3 5 1 2 1 — — Ill-defined Diseases or Unknown 8 5 3 1 — 1 — — — — — 2 — 1 — 3 — 2 1 2 3 — 1 1 Other Defined Diseases 48 25 23 4 2 — 3 2 1 2 2 5 5 10 8 3 1 11 22 9 6 13 11 1 Total 1841 972 869 268 80 56 62 28 47 41 95 171 212 247 271 196 67 605 624 424 188 233 330 60 99—100 TABLE IV. Infant Mortality During the Year 1915. Net Deaths from Stated Causes at Various Ages Under 1 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. Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — 1 3 7 11 Scarlet Fever — — — — — — — — — — Whooping-Cough — — — — — — — 4 3 7 Diphtheria and Croup — — — — — — 1 — — 1 Erysipelas — — — — — — — 1 — 1 Tuberculous Meningitis — — — — — — — 1 2 3 Abdominal Tuberculosis — — — — — — — — — 1 Other Tuberculous Diseases — — — — — — — 2 2 4 Meningitis (not Tuberculous) — — — — — — 2 — — 2 Convulsions — 1 — 1 2 1 — — 4 7 Laryngitis — — — — — — — — — — Bronchitis — — 1 1 2 6 8 7 4 27 Pneumonia (all forms) — — — 1 1 6 14 10 18 49 Diarrhœa — — — — — — 1 2 — 3 Enteritis — — — — — 5 9 3 4 21 Gastritis — — — — — 1 1 — 1 3 Syphilis — 1 — — 1 — 2 — — 3 Rickets — — — — — 1 — — 1 2 Suffocation—Overlying 3 — — — 3 2 1 — — 6 Injury at Birth — — — — — — — — — — Atelectasis 6 — — — 6 — — — — 6 Congenital Malformations 3 — — 1 4 — 2 1 2 9 Premature Birth 38 8 3 1 50 4 1 — — 55 Atrophy, Debility and Marasmus 4 3 2 1 10 17 7 2 1 37 Other Causes 1 — — 1 2 3 2 — 3 10 Totals 55 13 6 7 81 47 52 36 52 268 Not Births registered in the Year Legitimate, 2734. Illegitimate, 81. Not Deaths registered in the Year Legitimate Infants, 245. Illegitimate Infants, 23. 101 TABLE V. Rates per 1,000 Population, estimated to the middle of the Year. Year. Small-pox. Erysipelas. Diphtheria and Membranous Croup. Scarlet Fever. Enteric and Continued Fevers. Puerperal Fever Per 1,000 Population. Puerperal Fever Per 1,000 Births. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Average. 1891-5 0.15 0.01 0.87 0.05 1.38 0.38 6.05 0.25 0.94 0.17 0.09 0.03 — — 1896-1900 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 — — 19011-10 — — 0.76 0.03 2.28 0.14 5.90 0.09 0.12 0.03 0.05 0.02 — — 1911 — — 0.68 0.07 1.68 0.09 4.09 0.02 0.10 Nil 0.13 0.02 5.71 1.07 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 0.73 0.36 1913 — — 0.55 Nil 1.91 0.13 4.80 0.06 0.06 0.01 0.06 0.02 2.78 1.05 1914 — — 0.83 0.05 2.72 0.26 5.46 0.07 0.09 0.03 0.05 0.02 2.50 1.05 1915 — — 1.02 0.06 1.77 0.15 4.31 0.06 0.17 0.04 0.04 0.02 2.14 1.07 103—104 TABLE VI. London and the Metropolitan Boroughs—Births and Deaths of Persons belonging to London and the Metro politan Boroughs during the 52 Weeks ended 1st January, 1916.* Boroughs Population estimated to the Middle of 1914. Births. Birth Rats. Deaths From. Deaths under 1 Year of Age. Rate per 1,000 Births. All Causes. Rate. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 Years). Pulmonary Tuberculosis. County or London 4,516,612 101,649 22-5 72,399 1603 120 3 2272 332 1146 699 2542 6782 11,369 112 West. Paddington 142,055 2746 19.3 2266 15.9 6 — 93 11 31 20 91 169 316 115 Kensington 170,817 3118 18.2 2607 15.3 2 — 111 11 21 16 69 193 367 118 Hammersmith 124,750 2707 21.7 1932 15.5 2 — 47 13 27 14 45 197 275 101 Fulham 158,849 3870 24.4 2349 14.7 5 3 122 20 50 27 75 197 445 115 Chelsea 63,791 1099 17.2 1116 17.5 — — 40 5 8 6 17 110 106 96 City of Westminster 152,346 1969 12.9 2229 14.6 4 — 38 11 11 12 39 205 182 92 North. St. Marylebone 112,892 1823 16.1 1700 15.0 2 — 53 9 16 8 46 134 181 99 Hampstead 86,731 1317 15.2 1014 11.7 1 — 22 2 6 10 17 55 103 78 "St. Pancras 212,497 4755 22.3 3527 16.6 8 — 64 22 51 24 102 415 496 104 Islington 324,764 7544 23.2 5555 17.1 5 — 152 40 105 58 164 525 812 107 Stoke Newington 50,454 916 18.1 778 15.4 2 — 24 7 7 9 7 55 94 103 Hackney 223,724 4844 21.6 3259 14.6 6 — 67 7 43 29 122 309 526 108 Central. Holborn 45,861 672 14.6 759 16.5 1 — 19 1 12 11 13 80 68 101 Finsbury 83,212 2198 26.4 1643 19.7 1 — 54 10 45 9 83 169 281 128 City of London 17,129 150 8.7 308 17.9 — 4 — 1 3 3 20 18 120 East. Shoreditch 108,869 3114 28.6 2052 18.8 3 — 68 11 36 22 130 260 450 144 Bothnal Green 127,662 3514 27.5 2110 16.5 4 — 101 11 41 39 135 199 430 122 Stopney 273,265 7512 27.5 4603 16.8 3 — 111 29 53 72 236 520 867 115 Poplar 160,222 4742 29.6 3046 19.0 5 — 118 9 72 34 173 252 628 132 South. Southwark 186,941 5239 28.0 3727 19.9 3 — 131 12 46 37 148 389 693 132 Bermondsey 124,213 3547 28.5 2504 20.1 3 — 110 9 79 21 134 239 527 148 Lambeth 296,724 6571 22.1 4944 16.6 13 — 102 19 49 45 139 460 693 105 Battersea 167,338 3824 22.8 2648 15.8 6 — 164 9 77 29 79 240 428 112 Wandsworth 338,998 6278 18.5 4195 12.4 9 — 165 22 66 54 117 335 589 94 Camberwell 262,020 6149 23.4 3918 14.9 6 — 95 8 40 30 146 360 635 103 Deptford 109,182 27.0 1948 17.8 4 — 55 9 65 10 96 173 390 132 Greenwich 96,037 2335 24.3 1710 17.8 8 — 46 3 43 14 46 165 237 101 Lewisham 172,433 3317 19.2 2124 12.3 3 — 51 5 29 16 39 155 267 80 Woolwich 122,836 2823 22.9 1828 14.8 5 — 45 7 16 20 31 196 265 94 * 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 1,592 cases the residence was outside the County of London, and these cases have been excluded. On the other hand, 53 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 3,529 cases, while, on the other hand, the deaths of 3,507 London residents occurred in the Outer Ring or in Metropolitan Institutions outside Greater London. 105—106 TABLE VII. Weekly Deaths from various causes for the whole Borough, 1915, corrected for Public Institutions. Week Ending. Small-pox. Measles. Scarlet Fever. Epidemic Influenza. Whooping Cough. Diphtheria and Mem. Croup. Enteric Fever. Diarrhoea (under 2 years). Enteritis (under 2 years). Erysipelas. Puerperal Fever. Rheumatic Fever. Tubercle of Lung & Acute Tuberculosis. Other Tuberculous Diseases. Alcoholism and Cirrhosis of Liver, and Per. Neuritis. Cancer and Sarcoma. Bronchitis. BronchoPneumonia. Pneumonia. Violence. Suicide. Cerebro-Spinal Meningitis. Post-Basal Meningitis. Simple Meningitis. 1915. Jan. 9 — — — — — — — — 1 — — — 6 1 2 — 9 5 — 1 1 — 1 — 16 — — 1 1 — 2 — — — — — — 6 — — 4 9 4 3 2 1 1 — — 23 — 1 — — — 1 — — — — — — 5 — 1 2 6 4 1 1 — — — 1 30 — 1 — 1 — — — — 1 — — — 8 — 1 3 4 5 2 3 — — — 1 Feb. 6 — 2 — — 1 1 1 — — — — — 6 — 2 4 7 3 3 1 — — — 1 13 — — — — — — — — — — — — 5 1 — — 8 6 4 — 1 — — 1 20 — 1 — 2 — — — — — — — — 2 — — 1 12 5 6 — — — — — 27 — 2 — 3 1 3 — — 1 — — — 2 — — 6 9 5 3 — — — — — Mar. 6 — 1 — 1 — — — — — — — — 3 1 — — 6 4 — 1 1 — — — 13 — 3 1 1 1 — — 1 1 — — — 1 1 3 — 12 4 2 1 — — 1 — 20 — 5 — 2 — 1 1 — — — — — 7 — — 2 5 2 2 2 — 1 1 1 27 — 3 — 1 — — — — 1 — — — 8 1 1 1 3 2 1 1 — — — — April 3 — 4 1 1 — — — — 1 — — — 1 1 1 1 4 1 2 2 — — — — 1st Qtr. — 23 3 14 3 8 2 1 6 — — — 60 6 11 24 94 50 29 15 4 2 3 5 April 10 — 1 — 2 1 1 — — — — — — 5 — 1 2 8 1 1 — — 1 — — 17 — 4 — 2 — — — — — — — — 2 — 3 4 4 5 2 1 — 2 — — 24 — 4 — 1 1 2 — — — — — — 2 1 1 1 4 — 8 4 — — — — May 1 — 5 — 3 1 — — — — — — — 3 2 — 1 2 — 3 1 — — — — 8 — 2 — 1 1 1 — — — — — — 5 — — 1 4 1 4 — — — — — 15 — — — — — — — — — — — — 2 1 — 1 3 — 2 — — 1 — — 22 — 1 — — 1 1 — — 1 — — — 5 — — 1 — — 2 1 — 1 — — 29 — 1 1 — — — — — — 2 — — — — — 2 2 — 3 1 — 1 — — June 5 — 3 — — — — — — — 1 1 — 2 1 — 3 1 — 1 3 — — — — 12 — 1 — — — — — — 2 — — — — 1 — 3 2 — 1 — 1 — — — 19 — — — — 1 — — — — — — 1 3 2 1 — 2 1 — 3 — — — 1 26 — — — — — — — — — — — — 7 3 — 6 1 — 2 2 — — — — July 3 — — — — — — — — — — — — 1 2 — 1 — — 2 1 — — — — 2nd Qtr. — 22 1 9 6 5 — — 3 3 1 1 37 13 6 26 33 8 31 17 1 6 — 1 July 10 — — — — — — — — 1 — — — 7 — — 3 1 — 3 — — — — — 17 — — — — — — — — — 1 — — 3 1 2 4 2 — 1 1 — — — — 24 — — — — — — 1 — — — — — — — 1 2 1 3 5 3 — — — — 31 — — — — — — — — 1 — — — 1 2 3 3 1 — 1 1 — — — — Aug. 7 — — — 1 — 2 — — — — — — 2 1 1 2 1 1 1 1 — — — 1 14 — — — — — — — — — — — — 3 1 1 I — 1 2 — — — — 21 — — — — — 1 — — 3 — 1 — 1 — 2 1 — 1 — — 1 — 1 — 28 — — — — 1 1 — — 1 — — — 3 — — 4 1 — — 1 — — — — Sept. 4 — — — — — — — — — — — — — — — 4 2 1 — 1 1 — — — 11 — — — — 1 — — — 1 — — — — — — 6 1 — 1 — — — — — 18 — — — — — — — 1 1 1 — — 4 — — 3 1 — 1 1 — — — — 25 — — — 1 — — — — — — — — 10 — 1 1 — 1 — 2 — — — — Oct. 2 — — — 1 1 1 — 1 — — — 1 4 1 1 2 — 2 1 2 — — — — 3rd Qtr. — — — 3 4 5 1 2 10 2 1 1 42 6 12 36 11 10 16 13 2 — 1 1 Oct. 9 — — 1 — 1 — — — 2 — — — 3 3 — 1 1 — — — — — — — 16 — — — — — 1 — 1 3 — — — 3 — — 1 1 1 1 2 1 — — 1 23 — — — — — — — — — — — — 3 1 4 5 3 1 2 1 — — — — 30 — — — — — — — — — — — — 1 1 1 2 3 1 1 2 1 — — — Nov. 6 — — — — — — — — — — 1 — 3 2 1 2 2 — — — — — — 1 13 — — — — — — — — — — — — 5 — 3 5 3 1 2 2 1 — — 1 20 — — — — — — — — — — — 1 8 — 1 2 3 — — 4 — — — — 27 — — — — — — — — — — — — 5 — 1 2 5 1 3 — — — — — Doe. 4 — — — — 1 — 1 — — 1 — 1 2 — — 1 7 4 3 — — — — — 11 — — — — — — — — — — — — 4 1 2 6 5 3 4 4 1 — — — 18 — — — — — — — — — — — — 6 1 1 3 11 2 3 2 — — — — 25 — — 1 2 — — — — — 1 — — 4 — — 1 5 2 1 — — — — 1 1916. Jan. 1 — — — — — — — — — — — — 5 1 — 3 4 — 4 2 — — — — 4th Qtr. — — 3 6 3 2 1 2 6 3 1 2 52 10 14 33 53 16 24 19 4 — — 4 Total for Year — 45 7 32 16 20 4 5 25 8 3 4 191 35 43 119 191 84 100 64 11 8 4 11 107—108 TABLE VIII. Summary of Nuisances Abated, Notices Served, and General Work of Public Health Department, 1915. 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 560 1099 806 925 629 236 278 168 4707 „ Re-inspections after service of Notice (estimated) 1591 1373 1565 1713 1388 987 655 407 9669 „ Houses and premises specially inspected, including infectious diseases and complaints 1331 874 1259 657 1359 1051 821 375 7707 „ Houses where drains have been tested by smoke test 19 10 25 16 15 10 8 9 112 „ Houses where drains have been tested by water test 9 11 18 9 4 8 10 3 72 „ Now Houses inspected for Water Certificates — — 6 18 64 — 25 — 113 NUISANCES ABATED—DRAINS. Waste-pipe from baths, lavatories and washhouse sinks repaired or disconnected 24 24 65 44 45 9 14 16 241 Choked and defective drains 91 98 67 52 107 14 19 27 475 Defective traps 10 1 19 14 — 7 5 10 66 Defective and unventilated soil pipes 4 — 7 3 — 1 3 4 22 W.C.'s. W.C.'s repaired, new traps or pans provided 56 43 82 79 31 28 22 15 356 Water supply apparatus repaired or renewed 89 64 64 57 125 38 24 26 487 Foul pans cleansed 91 32 26 30 19 19 20 18 255 Additional W.C.'s provided to Factories and Workshops, etc. — — 1 — — — — — 1 Do. do. dwelling-houses — 1 — — — — — — 1 PREMISES. Underground rooms not in accordance with Act 1 4 — — 1 — — 3 9 Interiors cleansed and defective roofs repaired 410 725 398 251 346 196 167 220 2703 Damp walls remedied 83 128 69 143 86 52 42 43 646 Paving in yards and wash-houses repaired 41 59 41 63 48 8 35 45 340 Improved ventilation provided 1 25 10 3 10 6 — — 55 Wash-houses provided with sinks and outlets for waste water 3 2 — 12 — 1 — — 18 Defective guttering and rain-water pipes 77 35 113 65 90 33 20 40 473 Dustbins supplied 108 139 53 49 81 36 41 54 561 Dung-pits provided — — 1 2 — 1 3 1 8 Cases of overcrowding remedied 25 17 12 — 15 9 7 12 97 Deficient light—windows supplied or enlarged, or other works 1 3 — 35 8 — 9 6 62 Dampness in premises from defective water pipes 36 9 25 10 17 14 7 8 126 ANIMALS. Animals (including pigs) kept in such a state as to be a nuisance 6 8 6 6 5 2 5 3 41 Accumulations of manure removed 66 51 52 27 17 8 16 15 252 WATER. Detective and foul cisterns used for dietary purposes 1 16 1 — 11 — 12 — 40 Defective and foul rain-water tanks remedied 6 — 1 — — — — — 7 Insufficient supply and water cut off by Water Board 5 5 2 — 4 1 5 2 24 Additional water supply for two or more families 4 3 — — — — — — 7 MISCELLANEOUS. No. of observations made of chimneys in connection with smoke nuisances 39 — — — — — 2 3 44 No. of smoke nuisances observed 6 — — — — — — — 6 Tents, Vans, etc., inspected 1 — — 5 1 — 41 — 48 Notices served with respect to tents and vans — — — — — — 3 — 3 Inspection of Urinals accessible to the public 73 76 62 45 45 22 40 21 384 Verminous rooms cleansed 29 92 4 32 13 6 10 12 198 Intimation notices served 529 752 474 571 517 240 132 171 3386 Statutory „ ,, 154 62 71 70 227 57 65 67 773 109 TABLE IX. SUMMARY OF WORK OF CHIEF INSPECTOR. Premises Inspected 1215 New Buildings Inspected 47 Defective Combined Drains Investigated and reported on 20 Number of Houses referred to in such Combined Drains 143 Cow-houses and Slaughter-houses Inspections 33 Complaints Investigated 153 Attendances at Police Courts 51 MISCELLANEOUS, INCLUDING WORK OF CHIEF INSPECTOR, DISTRICT INSPECTORS, AND CLERKS. Plans submitted for Repairs to Drains 42 Number of Cases of Inattention to Notices reported to Town Clerk for Proceedings 106 Summonses at Police Courts under P.H.L.A. and H.T.P.A. 28 Bakehouses Inspected and Cleansed twice during the Year 72 Number of Houses Disinfected after Infectious Disease 1252 Letters Written 5859 Notifications received 3464 Certificates Issued after Disinfection 1771 „ of Infectious Disease forwarded to Schools 1162 Complaints of Sanitary Defects 614 „ of Non-removal of Dust, viz. :— Woolwich 11 Plumstead 21 Eltham 11 43 110 TABLE X. Factories, Workshops, Laundries, Workplaces, and Homeworkers' Premises. 1.—Inspection. Premises. Number of Inspections. Written Notices. Factories (Including Factory Laundries) 149 37 Workshops (Including Workshop Laundries) 241 15 Workplaces 149 7 Homeworkers' Premises 369 9 Total 908 68 2.—Defects Found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Act: Want of Cleanliness 35 35 Want of Ventilation 18 18 Overcrowding 3 3 Want of Drainage of floors — — Other nuisances 18 18 Sanitary Accommodation insufficient— unsuitable or defective not separate for sexes 13 13 2 2 89 89 111 TABLE X.—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 2 Reports (of action taken) sent to H.M. Inspectors 2 Underground Bakehouses (S. 101):— In use during 1903 24 Certificates granted in 1903 24 in 1906 1 in 1910 1 In use during 1015 11 Workshops on the Register (S. 131) at end of 1914:— Workshop Laundries 14 „ Bakehouses 36 Other Workshops 147 Total number of Workshops on Register 197 G 112 TABLE X.—continued. 4.—Home Work. Nature of Work. Outworkers' Lists (Section 107). Number of Inspections of Outworkers' Premises Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addresses of Outworkers forwarded to Other Councils. Prosecutions. Instances. Notices Served. Prosecutions. Instances. Orders Made (Sect, 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 40 175 7 29 26 21 — — 53 5 5 — — — — Tennis Balls, etc. 6 375 — — — 79 — — 315 4 4 — — — — Furriers — — — — 2 — — — — — — — — — — Lace Making 2 5 — — 5 3 — — — — — — — — — Artificial Flowers — — — — 1 — — — 1 — — — — — — 113 TABLE XI. Proceedings during 1915. Premises. Number of Places. Number of Inspections. Number of Notices. Number of Prosecutions. On Register at end of 1914. Added in 1915. Removed in 1915. On Register at end of 1915. Milk Premises 109 6 10 105 171 16 — Cowsheds 10 — — 16 54 6 — Slaughter-houses 10 — — 10 40 5 — Ice Cream Premises 83 5 1 87 124 6 — Registered Houses let in Lodgings 418 5 3 420 576 259 2 Overcrowding— Number of Dwelling Rooms overcrowded 97 Number remedied 97 Underground Rooms— Illegal occupation dealt with during year 9 Number of rooms closed 5 Insanitary Houses— Number closed under the Housing-Town Planning, etc., Act 9 Number of Prosecutions under By-Laws under Public Health Act, 1891 2 Mortuaries— Total number of Bodies received 280 Total number of Infectious Bodies received 1 Inspections of Premises where Food is Prepared for Sale 131 Number of Public Sanitary Conveniences Removed or Altered. — Number of Fixed Ashpits Removed — 114 TABLE XII Prosecutions under Public Health, Housing, Town Planning, etc., and London County Council (General Powers) Acts. No. Date of Hearing. Offence. Situation. Result. 1915. 1 Jan. 7 An accumulation of foul and offensive slops 128 Ann Street Order to abate in 24 hours. Fine £5 or 1 month. 2 Feb. 4 Dilapidations and dirty conditions 117, Elm Street Fine 40s. and order to abate in 7 days. 3 Feb. 25 Unsound Turkeys Lakedale Road Stores Costs £6 6s. 4 Do. do. Herbert Road Stores 5 Do. Disobedience of Closing Order 2, New Street Order to quit in 14 days and 4s. costs. 6 Do. do. 3, do. do. do. 7 Do. do. 3, do. do. do. 8 Do. do. 4, do. do. do. 9 Do. do. 4, do. do. do. 10 Do. do 4, do. do. do. 11 April 15 do. 5, do. do. do. 12 Do. do 6, do. do. do. 13 Do. do. 7, do. do. do. 115 TABLE XII.—continued. No. Date of Hearing. Offence. Situation. Result. 1915. 14 May 4 Dilapidations and dirty conditions 18, Samuel Street Order to abate in 14 days ; 4s. costs. 15 Do. Non-provision of dustbin 18, do. 2s. costs. 16 Do. Dilapidations and dirty conditions 5, Acorn Street 2s. costs. 17 June 1 Dilapidations and dampness 63, Sand Street 2s. costs. 18 June 22 Overcrowding 1, Tewson Road (Tenant.) Order to abate in 14 days. Fine 10s. 19 July 6 do. 1, do. (Occupier.) Order to abate in 10 days. Fine 10s. and £2 2s. costs. 20 June 1 Dilapidations and dirty conditions 4, Acorn Street Fine 10s. 21 Do. Dampness 14, Samuel Street Fine 10s. 22 July 6 Non-compliance with Nuisance Order 18, do. Fine 6d. per day for 26 days 13s. and £1 1s. costs. 23 Aug. 20 Defective flushing apparatus in w.c. 169, Ann Street Fine 20s. 24 Do. Dilapidations and duty conditions 169, Ann Street Order to abate in 14 days; 4s. costs. 25 Do. do. 171, do. Order to abate in 14 days; 4s. costs. 26 Nov. 10 Carrying on the trade of a purveyor of milk without being registered 82, Brookhill Road Fined £5 and 21s. costs. 27 Dec. 7 Permitting basement room of house registered under the By-Laws to be overcrowded 25, Dicey Street Fine 5s. 28 Do. Overcrowding basement room 25, do. Fine 10s. 116 TABLE XIII. Summary of Articles Analysed, under the Sale of Food and Drugs Acts, during the Year ended 31st December, 1915. Article. Number Analysed. Number Adulterated. Milk 330 33 Separated Milk 6 — Condensed Milk 5 1 Butter 55 2 Coffee 13 — Vinegar 10 1 Lard 14 — Preserved Cream 7 2 Drugs 22 — Flour 12 — Rice 4 — Pepper 3 — Ground Ginger 4 — Cheese 4 — 495 39 117 TABLE XIV. Prosecutions under Food and Drugs Acts during Year 1915. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 7.88% added water W. J. Gittings, Cold Blow, Grosmont Road Fined £4 and 23s. costs 2 Milk 13.0 % added water S. Curtis, 181, Abbey Wood Road Fined £1 17s. and 23s. costs 3 Milk 25.3% deficient in fat S. A. Smith, 4, High Street, Eltham Fined £1 and 12s. 6d. costs 4 Milk 7.0% added water R. G. Dalton, 55, Eglinton Road Costs 12s. 6d. 5 Milk 3.33% deficient in fat J. W. Hearn, 61, Bannockburn Road Warranty proved. Dismissed 6 Milk 13.33% deficient in fat F. J. Sansom, 24, Ingledew Street, Brixton Fined £2 and £2 2s. costs 7 Milk 6.94% added water Eastern Counties Dairy Farmers' Co-operative Society, Ltd., 106, Windmill Lane, Stratford Warranty proved. Dismissed 8 Milk 10.66% deficient in fat C. Voice, 102, Ann Street Fined £2 9s. 6d. and 10s. 6d. costs 9 Milk 5.0% deficient in fat S. Cornwell, 14, Frances Street Fined 10s. 6d. and 10s. 6d. costs 10 Milk 9.41% added water W. F. Corp, 3, Wellington Street Warranty proved. Dismissed 11 Milk 4.36% added water F. W. Webb & Co., 16, Lakedale Road Warranty proved. Dismissed 118 TABLE XIV.—continued. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 12 Milk 6.0% deficient in fat E. A. Smith, 12, The Broadway, Eltham Fined 2s. 6d. and 12s. 6d. costs 13 Milk 11.41% added Water H. Woolsey, 50, Francis Street Warranty adjourned sine die 14 Vinegar 40.0% deficient in acetic acid H. Hoadley, 25, Ascot Street, Canning Town Fined 40s., including costs 15 Milk 29.33% deficient in fat K. F. Mumford, 22, Cross Street Fined 9s. 6d. and 10s. 6d. costs 16 Milk 4.33% deficient in fat and 1.76% added water E. Hiscock, 27, Wickham Lane Warranty proved. Dismissed 17 Milk 14.66% deficient in fat G. Corp, 142, High Street, Woolwich Fined 3s. and £2 7s. costs 18 Milk 10.0% deficient in fat W. M. Forward, Huntingdon Farm, Mere, Wilts Dismissed 19 Milk 5.0% deficient in fat G. Jones, 6, Samuel Street Fined 2s. 6d.and 12s. 6d. costs 20 Milk 10.0% deficient in fat C. Attenborough & Son, 60, Sand St. Fined 10s. and 12s. 6d. costs 21 Milk 7.0% deficient in fat Lord Hollenden, Hall Place, Leigh, Kent Dismissed. Place of delivery was Hildenborough Station, not Woolwich Dockyard 22 Milk 22.23% added water and 24.66% deficient in fat G. Corp, 142, High Street, Woolwich Fined £2 and 21s. costs. 119 TABLE XIV.—continued. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 23 Milk 8.66% deficient in fat H. D. Virgoe, 13, Eton Road Fined 10s. and 12s. 6d. costs 24 Milk 17.53% added water and 13.67% deficient in fat J. Willis, 2, Ritter Street Fined £1 10s. and 21s. costs 25 Milk 11.66% deficient in fat J. Buckingham, 74. Little Heath, Old Charlton Warranty proved. Dismissed 20 Milk 9.66% deficient in fat A. G. Look, Keightley House, Southwood Road, New Eltham Fined 20s. and 10s. 6d. costs 27 Margarine Sold in package not marked R. A. Pearce, 175, Plumstead Common Road Fined 20s. and l1s. 6d. costs 28 Butter Wholly Margarine do. do. Fined 2s. and l1s. 6d. costs 29 Milk 9.0% deficient in fat J. McGee, 42, Mulgrave Place Fined 2s. 6d. and 10s. 6d. costs 30 Milk 10.35% added water E. Godden, 276, High Street, Plumstead Fined £1 and 21s. costs 31 Milk 12.3% added water H. Melville, 120a, Plumstead Road Fined 4s. and 21s. costs 32 Milk 11.2% added water W. J. Gittings, Cold Blow, Grosmont Road Fined 40s. and 23s. costs 33 Milk 4.94% added water and 4.67% deficient in fat W. F. Corp, 3, Wellington Street Warranty proved. Dismissed 120 TABLE XV. Summary of Food Seized, or Surrendered by Owners, as Unfit for Consumption, 1915. Articles. Quantity. Reason. Beef 320 lbs. Tuberculous Lambs (59) and 1 sack pieces 2,281 lbs. Black spotted ; all unsound Ox Livers 37 Flukey, Abscesses, Cirrhosis Ox Kidney 1 Cysts Ox Lungs 2 Tuberculous Sheep's Pluck 21 Strongyli Sheeps' Livers 3 Ternicolis Cysts Sheep's Caul 5 do. Pig's Liver 1 Cirrhosis Haddocks 4 boxes Unsound Whelks 6 bags do. Mackerel (smoked) 12 boxes do. Codfish 10 stone do. Coalfish 1 box do. Rabbits 1 case do. (Green) Black Currants ½ bushel do. Condensed Milk 36 boxes do. TABLE XVIa. List of Applicants Registered as Purveyors of Milk during 1915. No. Name. Address. 110 Couzens, J. H. 10, Chapel Street, Woolwich 111 Margetts, S. C. 307, High Street, Plumstead 112 Wallace, J. M. 107, Pattison Road, Plumstead 113 Smith, S. A 4, High Street, Eltham 114 Pitcher, A. M. 87, Plumstead Road, Plumstead 115 Godden, E. 276, High Street, Plumstead 121 TABLE XVIb. List of Applicants Removed from Milk Register during 1915. Name. Address. Dalton, R. G. 55, Eglinton Road, Plumstead Godden, A.A. 276, High Street, Plumstead Stevens, H 27, Church Street, Woolwich Finnimore, W. J. 21, Walpole Place, Woolwich Challis, P. W. 4, High Street, North Woolwich Hoar, J. (Jun.) 40, Saunders Road, Plumstead Hearn, J. W. 61, Bannockburn Road, Plumstead Cheesman, C. 126, High Street, Plumstead Burley, A. R. 40, Saunders Road, Plumstead Adams, E. J. 1, Shooters Hill Gardens, Eltham