BER 8 THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY For the Year 1882. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physicians of London, Member of the Roya College of Surgeons of England, & c. MEDICAL OFFICER of HEALTH for the PARISH C.x. Lon THE VESTRY OF BERMONDSEY REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY For the Year 1882. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physicians of London, Member of the Roya College of Surgeons of England, & c. MEDICAL OFFICER of HEALTH for the PARISH ANNUAL REPORT OF MEDICAL OFFICER. TO THE VESTRY OF BERMONDSEY, Mr. Chairman and Gentlemen, I have the honour of submitting my Seventh Annual Report, which comprises the Vital Statistics of the Parish for the 52 weeks of the registration year that ended on Saturday the 30th day of December, 1882. The general mortality exceeded that of the three previous years, but was just within the limit of the decennial average. Measles prevailed throughout the year, and Whooping Cough was very fatal during the first six months. The severity of these diseases is chiefly felt among children under five years of age, and as our population contains an excessive proportion of children at that age the occurrence of any two or more diseases of this kind in an epidemic form during the same year causes no inconsiderable addition to our deathrate. Last year the diseases I have mentioned caused 287 deaths, or rather more than one in every seven deaths from all causes, and no less than one-fourth of all the deaths which took place under five years of age. In the previous year there were only 91 deaths from the same causes, or less than one-third of the fatality. These diseases are not much under the control of Sanitary Authorities, but they would be far less fatal than they are if the importance of medical aid and careful nursing was better appreciated by many parents. They are infectious from a very early stage and probably are so before the symptoms have become sufficiently developed to remove all doubt about the nature of the complaint Hence, they are difficult to avoid. When two or three families are living in one house, and the house is crowded with children, anything like proper isolation of the cases is almost impossible, and indeed is rarely attempted. It is by no means an uncommon thing for mothers to desire that all the children in the family should have the disease at one time in order to " save trouble " as it is termed. This is a thoughtless and cruel proceeding, as the concentration of the poison arising from the simultaneous occurrence of several cases in one house or room can hardly fail to have an injurious effect on the little patients, and many of those who succumb to the disease in early infancy might have escaped with their lives if they had been more carefully shielded from contagion until after they had passed the age of five or six years. Bronchitis caused a larger number of deaths than usual, although the mean temperature of the air during the winter months was considerably above the average. Three or four dense fogs and a few cold nights cause inflammatory affections of the respiratory organs which continue to affect our mortality for several weeks. As the summer months were unusually cold we escaped with much less than the average amount of infantile Diarrhœa. POPULATION. The revised Census Tables show that the number of inhabited houses in the parish on the 4th day of April, 1881, was 11,083, an d the number of inhabitants 86,652. These figures are rather higher than those given in my last Reports but the difference is too small to affect the number of persons per acre (138) or the average number of persons per house (7.8). The density of the population is 88,500 persons per square mile. The population at the middle of the year is estimated at 87,430, which is 950 below the natural increase of the population by the excess of births over deaths. There is no doubt a margin of fluctuation, more or less, which is dependent on the state of trade and the prosperity of various industries, but we have no means of determining its extent. BIRTHS. The number of births registered was 3485, of which 1769 were males and 1716 were females. The births were 95 fewer than in the previous year. The annual birth-rate was 39.8 per 1000 of the estimated population. This is a lower birth-rate than any which has been recorded during the last eleven years. It is 5.5 above the London birth-rate, which was 34.3 per thousand. In the Leather Market District the births numbered 618; in St. Mary Magdalen, 610; and in St. James's, 2257. During the first quarter of the year 970 births were registered; in the second quarter, 827; in the third quarter, 803; and in the fourth quarter, 885. The excess of births over deaths was 1572 which is below the average of the previous three years. DEATHS. The total number of deaths recorded was 1913, of which 976 were males and 937 were females. In the previous year the deaths were 1735 and the average of the ten years, 1872- 81, was iB49. The annual rate mortality was 21.8 per thousand of the estimated population. The male death-rate was 22.3, and the female death-rate 21.4. In London the general death-rate was 21.4 per thousand. Males, 23.1; females, 19.8. Our death-rate among males is generally lower than that of London, and our female death-rate is higher. This may depend on a difference in the distribution of the population with regard to age. In a working-class neighbourhood there is a smaller proportion of female servants between 20 and 40 years of age, when the natural rate of mortality is considerably below the mean rate at all ages. Where there is not a sufficient demand for female labour, healthy young women are obliged to seek employment elsewhere. This is illustrated within the limits of our own parish. The Leather Market District contains 98 females to 100 males; St. Mary Magdalen District 99 to 100; and St. James's 101 females to 100 males. In England the proportion of females to males is 105 to 100; but in London it is 112 to 100. In the first quarter of the year 581 deaths were registered, in the second quarter 502, in the third quarter 410, and in the last quarter, 420. The number of persons who died in the Leather Market District was 362, in St. Mary Magdalen District 444, and in St. James's 1107. One hundred and twenty-four deaths occurred in the Workhouse, and if these deaths are distributed among the three registration districts in proportion to the relative population of each, the death-rates in the several districts would be :—Leather Market, 23.6; St. Mary Magdalen, 21.8; St. James's, 21.3. The infant death-rate, or the proportion of deaths under one year of age per thousand registered births was 158. In London this rate was 151, and the mean rate of 28 large towns was 162. In 20 of these towns this rate was higher than in Bermondsey. CAUSES OF DEATH. Classification. —The Registrar-General has made several changes in his classification of causes of death. The advance of medical science leads to greater precision in diagnosis, and this causes a constant increase in the number of deaths ascribed to definite causes at the expense of deaths of which the causes are indefinitely described. The latter class is still a large one. In order that deaths may be properly tabulated" by their causes, and that the results collected at the cost of much labour should be of any value, the certificates should state the primary disease as well as the immediate cause of death. A death may be assigned to "dropsy," but this may be dependent on very diverse diseases, as of the kidneys, lungs, liver, or heart. Deaths are sometimes attributed simply to " haemorrhage." Such deaths may have been caused by flooding in childbirth, by cut throat, by the rupture of an aneurism, by an ulcer of the stomach, by disease of the lungs, or other very different causes which may lead to fatal haemorrhage. The term " septicaemia," or blood poisoning, has in many cases a puerperal cause which is not stated on the certificates, and sometimes it is used to conceal the existence of infectious disease. Under the designation of " atrophy " are included some cases of death from congenital syphilis, and not a few which are really due to loss of breast milk and the improper hand feeding of infants. These observations are founded on those made by the Registrar- General in his 44th Annual Report, and must not be understood as having any special reference to our own district. Zymotic Diseases. —The mortality from the principal diseases of this class was high. The fatal cases numbered 420 in the year, against 290 in 1881, 411 in 1880, 344 in 1879, and 522 in 1878. The percentage of total deaths was 21.9. The deaths included 5 from Small Pox, all of which occurred during the first half of the year. A boy aged 14 years was certified to be unvaccinated, and a man aged 42 to have have been vaccinated. In the other cases—an infant aged 10 weeks, and two females aged 26 and 28 years—no statement was made with regard to vaccination. Measles caused 109 deaths, Scarlet Fever 47, Diphtheria 9, Whooping Cough 178, Typhus 2, Enteric Fever 9, and Simple Fever 2. The Diarrhœal class included 58 from Diarrhoea, 1 from Simple Cholera, and 1 from Dysentery. Diphtheria was less fatal, but 8 out of the 9 deaths occurred in St. James's District. All the deaths from Enteric Fever took place in the same district, which in other respects is the most healthy one in the parish. The zymotic deathrate was 4.79 per thousand persons living. The decennial average being 4.31. In London this rate was per thousand, the mean annual rate in the preceeding decade having been 3.59. In London the death-rate from Measles was 0.60, and from Whooping Cough 1.20. In Bermondsey the death-rate from Measles was 1.24, and from Whooping Cough 2.03. It will thus be seen that our excess in the general zymotic rate of 1.30 is fully accounted for by our excessive proportion of deaths from these two diseases, which amounted to a rate of 1.47 per thousand of the population. Septic Diseases. —Deaths from Diseases of this class are much less common in Bermondsey than they might be expected to be in a neighbourhood where skins of animals, etc., are daily passing through the hands of so many persons. One death was attributed to " blood poisoning caused by washing and cleaning foreign hides. ' Mr. John Spear, an Inspector of the Local Government Board, is of opinion that cases of this kind occasionally occur without the real source and exact nature of the disease being recognised. He has issued a communication on this subject to all the medical practitioners in the district. Constitutional Diseases.—In the first division of this class there were 9 deaths from Rheumatism and rheumatic disease of the heart, 3 from Gout, 3 from Rickets, and 24 from Cancer. The second or tubercular division included 30 deaths from Tabes Mesenterica, 64 from Tubercular Meningitis or acute Hydrocephalus, 165 from Phthisis or Consumption, and 8 from other forms of Tuberculosis or Scrofula. Three deaths were attributed to Purpura, and 5 to Diabetes. The total number of deaths from constitutional diseases was 314, or 16.4 per cent. of the deaths from all causes. Developmental Diseases. —In this class there were 155 deaths, or 8.1 per cent., viz.:—From old age, 106 ; from premature birth, 46; and from congenital malformations, 3. There were 82 deaths between 65 and 85 years of age, and 22 at upwards of 85. The aged women considerably outnumbered the aged men. Four women died between 90 and 92 years of age. One man attained the ripe age of 99 years. Local Diseases. —In this large division there were 824 deaths, or 43 per cent, of the whole number. Diseases of the brain and nervous system caused 158 deaths, or 8.26 per cent. There were 29 deaths from Apoplexy, 17 from Paralysis, 13 from Epilepsy, and 66 from Convulsions. From Diseases of the Heart and Circulatory System there were 66 deaths, or 345 per cent. One death was attributed to Syncope and one to Varicose Veins. Diseases of the respiratory system occupy the chief place in this class. They caused 481 deaths, or more than half the deaths from local diseases, and 25 per cent, of the deaths from all causes. There were 35 deaths from Croup, 346 from Bronchitis, and 89 from Pneumonia, or Inflammation of the Lungs. In the previous year the deaths from Bronchitis were 281, and from Pneumonia 98. These diseases are often combined. They cause a large number of deaths under five years of age —246 deaths were thus registered in the course of last year. Diseases of the Digestive System accounted for 77 deaths, or 4 per cent. There were 30 deaths from teething and 15 from "cirrhosis" of the liver. One death was registered as "constipation." Diseases of the Urinary System caused 20 deaths. From Childbirth there were 10 deaths; from diseases of the bones and joints 6; and from diseases of the skin 4. III-defined Causes.—These amounted to 7.3 per cent. The late Registrar-General considered "Atrophy and Debility" a sufficiently specified cause of death. The present Registrar-General does not. He thinks that a little more care not perhaps in the matter of diagnosis but in the writing of medical certificates would enable him to classify many of the deaths which are attributed to this cause, under some distinct and more appropriate head to which they properly belong, such as premature birth, want of breast milk, tabes mesenterica, phthisis, congenital syphilis, rickets, or the diseases of which the wasting or cachexia is a direct consequence. In cases of "tumour" and "abscess" there can be no difficulty and but little trouble in specifying the organ or part which is affected. Violence.—The deaths registered as due to violence numbered 35, or 1.8 per cent. Under the head of accident or negligence, 10 deaths were assigned to fractures and contusions, 3 to burns and scalds, 13 to asphyxia, 5 to drowning, and 1 to acute lead poisoning. A little boy, aged 4 years, was knocked down and run over by a two-horse van accidentally in the public street. Two children were burnt through accidents with benzoline spirit lamps. A girl, aged 10 years, died from concussion of the brain caused by the throwing of a stone. A child, aged one year, was suffocated by the impaction of a piece of potato in the throat. Another child of the same age was drowned by falling into a pail of water. A third child of the like age died from scalds caused by pulling down a cup of hot tea. There were three cases of suicide—all males—two by cut throat and one by strangulation. Inquests were held in 71 cases, or 3.7 per cent. In London the inquest cases were 6.8 per cent, of the total deaths. Thirty-five deaths were attributed to violence and 36 to natural causes. The latter included brain diseases 10, pulmonary diseases 8, heart diseases 8, and scarlet fever 1. An inquest was held on a man, aged 21 years, in which the verdict was "blood poisoning, inoculated by washing and cleaning foreign hides." Uncertified Deaths numbered 68, or 3.55 per cent. In London these deaths were 1.19 per cent, of all deaths registered; 37 were children under 1 year of age, 7 were between 1 and 5 years, and 10 were upwards of 60 years of age. The alleged causes of death included 13 from convulsions, 10 from premature birth, 5 from teething, and 5 from old age; 13 cases appear to have been referred to the Coroner, 10 were attended by students of Guy s Hospital, and 4 by unqualified medical assistants. STATISTICS OF LONDON. At the middle of the year the estimated population of London was 3,893,272 persons. The births numbered 133,200 and the deaths 82,905. The excess of registered births over deaths was 50,295, and the estimated increase of population during the year was 62,047. The marriages celebrated in London in 1882 numbered 35,414, giving a proportion of 18.2 persons married to 1000 inhabitants. This rate was far below the average. The birth rate (34.3) was the lowest recorded in 20 years, that is since 1862, in which year the rate was 34.2. The death-rate (21.4) was the lowest on record with the exceptions of 1881 and 1850. Comparing the five groups of districts into which London is divided the death rates were, as usual, highest in the eastern (25.3) and the central (23.9) groups, and lowest in the northern (19.7) an d western (19'9) groups, the Southern group (20.7) being intermediate in position. The mortality from Measles, Diphtheria, and Whooping Cough exceeded the average, while that from Typhus, Scarlet Fever and Diarrhœal affections was below it. London is one of the healthiest cities in Europe. The death-rate in Paris was 26.3, in Berlin 26.4, and in St. Petersburg 35.2. In New York it was 30.6. The Mean Temperature of the Air was 49°.7 Fah., that of the first quarter being 42°.7, of the second quarter 53°.0, of third quarter 58°.1, and of the fourth quarter 44°.8. The weather was unusually warm during the first five months, cool from June to September, and variable during the remainder of the year. The Rainfall amounted to 25.16 inches. It was below the average in the first and third quarters, and above it during the last quarter. The water drawn from the Thames contained rather more organic matter than 188 1, but was of better quality than in the three years 1878 to 1880. The number of occasions when the water supplied by the Southwark Company was clear and transparent was 7, when slightly turbid 5, and when turbid, or very turbid, or when moving organisms were found, 0. SANITARY WORK. The houses in which deaths from infectious diseases have occurred are promptly inspected with the view of discovering any sanitary defects in the dramage or water supply. In this way many unsuspected nuisances are brought to light. Twenty years ago it was supposed that every cesspool in the Parish had been done away with, and yet the Inspector succeeds in finding some every year; last year 20 were abolished. Many old and delapidated brick drains of an unnecessarily large size, and with no sufficient fall are nothing better than so many elongated cesspools; 135 drains of this kind have been taken up and relaid with stoneware glazed pipes. A large number of houses have been examined with regard to their water supply; 625 closets have been supplied with water; 332 water receptacles were supplied, and 182 were cleansed and purified; 61 houses were supplied with water which previously had none, or where the supply had been cut off; 30 houses in courts were provided with a constant supply by means of permanent stand pipes. This is really the cheapest and best way of supplying the very poor with a sufficiency of pure water, and of avoiding its contamination subsequent to its delivery. Two thousand four hundred and ninety-five houses and other premises have been inspected and reported on to the Vestry. This is an increase of 237 over the previous year. Two thousand four hundred and twenty-seven notices have been served for the execution of the necessary works, and these have generally been complied with without there being any necessity for taking further legal proceedings. Four hundred and six stopped drains had been cleared, and 192 defective ones repaired. One hundred and fifty-three offensive privies were cleared, 163 were repaired or ventilated, and 59 closets were panned and trapped. Two hundred and seventy-three untrapped sinks were trapped. Two hundred and ninety-eight dust-bins were provided. The condition of the urinals in the Parish has received the constant attention of your Sanitary Inspector; 53 have been cleansed and 22 new ones have been erected, 11 outside and 11 inside public-houses; 7 old urinals which had been closed have been re-opened. The bakehouses, cowhouses and slaughterhouses have been inspected under the Sanitary Acts. Two quarters of beef and a barrel of herrings were seized and destroyed, being unfit for human food. Seven dead bodies were removed from rooms in which persons were living to the Mortuary upon Magistrates' orders. Fifty-four summonses were taken out at the Southwark Police-court for non-compliance with the orders of the Vestry. The complaints respecting trade nuisances have not been of a serious character. In acknowledging the able assistance I have received from Mr. Thomas I am desirous of expressing my appreciation of the straightforward course he has pursued and the independent spirit in which he has always discharged his duties. Thanking the Vestry for the support which I have received, I am, Gentlemen, Your obedient Servant, JOHN DIXON, M.D., Medical Officer of Health. 133, Jamaica Road, Bermondsey. 13 TABLE I. CAUSES OF DEATH Registered in Bermondsey during the 52 weeks ending December 30th, 1882. AGES AT DEATH. CAUSES OF DEATH. ALL AGES. 0—1 1—5 5—15 15—25 25—45 45—65 65—85 85 & upwards. Female. Male. Total. All Causes 1913 976 937 552 525 86 63 201 263 196 27 5 2 Small Pox 3 1 ... 1 3 ... ... ... ... 109 57 52 7 Measles 31 71 ... .. ... ... 2 ... Scarlet Fever 47 29 18 35 10 ... ... ... ... ... Diphtheria 9 6 3 1 6 2 .. ... ... ... ... Whooping Cough 96 60 110 7 178 82 1 ... ... ... ... Typhus 2 1 1 ... 2 ... ... ... ... ... ... Enteric Fever 9 6 3 1 4 4 ... ... ... ... ... Simple Fever 2 2 ... ... ... 2 ... ... ... ... ... 57 29 Diarrhœa 28 40 12 ... 1 3 1 ... ... Simple Cholera ... 1 1 ... 1 ... ... ... ... ... ... Dysentery 1 1 1 ... ... ... ... ... ... ... ... 8 Syphilis 11 7 4 2 ... ... ... 1 ... ... ... Phagedena 1 1 ... ... ... ... ] ... ... Erysipelas 6 3 3 ... ... ... ... ... ... 5 1 ... 1 Septicæmia 3 2 1 1 ... 1 ... ... ... ... Puerperal Fever 3 3 .. .. ... 3 ... ... ... ... ... Alcoholism 1 ... 1 1 ... ... ... ... ... ... ... Rheumatism 1 7 6 1 ... 2 2 2 ... ... Rheumatism of the Heart 2 1 1 1 ... ... ... 1 ... ... ... Gout 3 2 1 ... ... ... 2 1 ... ... ... Rickets 2 1 3 3 ... ... ... ... ... ... 6 18 ... Cancer 24 5 13 6 ... ... ... ... Tabes Mesenterica 30 17 13 19 9 2 ... ... ... ... 165 89 76 ... .. Phthisis 6 1 4 30 84 39 1 ... Tuberculosis 8 6 2 1 5 ... 1 1 ... ... ... Tubercular Meningitis 64 30 34 21 36 7 ... ... ... ... ... 14 TABLE I.—Continued. CAUSES OF DEATH. ALL AGES. AGES AT DEATH. Total. Male. Female. 0—1 1—5 5—15 15—25 25—45 45—65 Purpura 3 . 3 1 1 1 ... ... ... Diabetes 5 4 1 3 1 ... ... ... ... 46 ... Premature Birth 46 24 22 ... ... ... ... Congenital Malformations 2 3 3 1 ... ... ... ... ... Old Age 106 41 65 ... 2 ... ... ... ... Inflammation of Brain 2 4 1 3 1 1 ... ... ... Apoplexy 29 12 17 ... 1 7 13 ... ... Paralysis 9 17 8 ... 1 8 ... ... ... Epilepsy 13 8 5 ... 4 4 5 ... ... Convulsions 37 29 66 50 15 1 ... ... ... Laryngismus Stridulus 5 3 2 3 2 ... ... ... ... 17 7 3 Other Diseases of Nervous System 7 5 24 1 5 1 2 2 ... Pericarditis ... ... ... ... ... 2 Heart Disease 62 43 1 3 19 6 4 12 25 Syncope 1 1 ... 1 ... ... ... ... ... 1 Varicose Veins 1 ... ... ... ... ... . ... 35 16 Croup 19 1 29 5 ... ... ... Bronchitis 346 189 157 91 103 9 3 16 72 Pneumonia 89 43 46 19 33 3 6 7 15 Pleurisy 3 1 2 ... 3 ... ... ... ... 8 Other Diseases of Respiratory System 4 4 1 4 ... 1 1 1 Dentition 20 10 30 17 13 ... ... ... ... Quinsy 1 1 ... 1 ... ... ... ... ... Dyspepsia 1 1 ... ... 1 ... ... ... ... Dis. of Stomach 9 3 6 1 ... 1 3 2 Enteritis ... 4 2 2 2 1 ... ... 1 Peritonitis 7 ... 3 1 4 2 ... 1 2 ... Hernia 1 ... 1 ... ... ... ... Gall stones ... ... 2 1 1 ... ... ... ... 1 Cirrhosis of Liver ... 15 6 9 ... ... ... 3 8 ... Other Diseases of Digestive System 7 1 ... 1 6 1 1 4 ... 15 TABLE I.— Continued. ALL AGES. AGES AT DEATH. CAUSES OF DEATH. Female. 85 & upwards Total. Male. 0—1 1—5 5—15 15—25 25—45 45—65 65—85 Nephritis 3 2 .. ... ... 4 1 1 1 ... ... 10 1 Bright's Disease 9 ... ... 4 6 ... ... ... ... Cystitis 2 2 2 ... ... ... ... ... ... ... ... Other Diseases of Urinary System 4 4 ... ... ... 1 ... ... 3 ... ... Diseases of Uterus 2 2 ... ... ... 1 ... ... 1 ... ... 10 9 1 Childbirth ... 10 ... ... ... ... ... ... Diseases of Bones and Joints 4 ... 2 3 6 1 2 ... ... ... ... Pemphigus 2 ... ... 1 1 ... ... 1 1 ... ... 1 1 1 Cellulitis ... ... .. ... ... ... ... ... Gangrene 1 ... 1 ... 1 ... ... ... ... ... ... Violence—(Accident.) Fractures and Contusions 10 7 1 3 2 1 3 1 1 1 Burns and Scalds 1 1 ... 3 2 2 ... ... ... ... ... ... Asphyxia 13 7 6 13 ... ... ... ... ... ... ... Drowning 5 5 ... ... ... 1 1 1 2 ... 1 ... 1 1 Poison ... ... ... ... ... ... ... ... (Suicide.) . . Cut Throat 2 2 ... 1 1 ... Strangulation ... ... ... ... ... 1 1 .. ... ... 1 ... ... ... ... ... (Ill-defined.) Atrophy, Debility, Marasmus, Inanition, &c. 63 47 1 ... 110 99 9 1 ... ... ... Dropsy 1 7 8 1 ... ... 5 2 ... ... Abscess ... 8 3 5 2 3 2 1 ... Asthenia ... ... ... 4 ... 4 2 ... 1 ... 1 ... ... ... Mortification 1 1 ... ... 1 ... ... ... ... 1 1 ... ... Constipation ... ... ... 1 ... ... ... ... .. Tumour 3 3 1 1 ... ... ... ... 1 ... ... 1 1 1 ... ... ... ... ... TABLE II. DEATHS FROM ZYMOTIC DISEASES IN 1882. 1882. ZYMOTIC DISEASES. Total for the Year. Rate per 1000 living. Percentage of Total Deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Small Pox ... ... 0.26 2 5 0.05 3 Measles 48 109 18 21 22 1.25 5.69 Scarlet Fever 5 18 47 10 14 0.54 2.45 Diphtheria 1 3 9 0.47 2 3 0.10 74 178 3 Whooping Cough 84 17 2.03 9.30 3 Fever 1 13 5 4 0.15 0.67 5 8 59 Diarrhœa 6 40 0.67 3.08 99 420 Total 136 57 128 4.79 21.92 TABLE III. DEATHS FROM ZYMOTIC DISEASES IN THE 10 YEARS, 1872-81. Average of 10 Yrs. 1872 1880 1881 1873 1874 1875 1876 1877 1878 1879 11.0 Small Pox 0 9 8 3 18 23 2 0 39 8 20 46 52 Measles 109 45 101 46 46 75 56 59.6 65.7 30 102 Scarlet Fever 51 130 97 21 43 102 56 25 11.3 7 13 31 Diphtheria 16 3 5 9 19 7 3 98.2 94 128 111 63 75 225 98 39 Whooping Cough 92 57 24.8 Fever 21 18 21 25 16 21 20 29 48 29 94.7 107 73 80 137 45 126 74 Diarrhœa and Cholera 109 83 113 290 351 287 522 411 344 392 268 452 344 365.3 Total 18 TABLE IV. MORTALITY FROM CLASSIFIED CAUSES OF DEATHS IN 1882. DISEASES. Total Deaths. Rate per 1000 living. Percentage of Total Deaths. I Specific Febrile, or Zymotic 444 23.21 5.07 1. Miasmatic 361 18.87 4.12 2. Diarrhœal 59 3.08 0.67 3. Malarial ... ... ... 4 Zoogenous 0.05 1 0.01 5. Venereal 11 0.12 20.5 6. Septic 12 0.62 0.13 II.— Parasitic ... ... ... III.—Dietic 1 0.01 005 IV.—Constitutional 3.59 16.41 314 1. Cancer .. ... ... 027 1.25 24 2. Tabes Mesenterica 0.34 1.56 30 3. Phthisis 8.63 165 1.88 4. Scrofula, etc. 0.09 0.41 8 5. Meningitis 0.72 3.35 64 v.—Developmental 155 8.10 1.77 1. Premature Birth 46 0.53 2.40 2. Old Age 106 5.41 1.21 824 43.07 VI.—Local 9.42 1 Nervous System 158 8.26 1.81 2. Circulatory „ 66 0.74 3.45 3. Respiratory „ 481 5.50 25.06 4. Digestive „ 402 77 0.88 5. Urinary „ 1.04 20 0.23 6. Reproductive „ 0.62 12 0.13 7. Locomotary „ 0.31 6 0.07 8. Integumentary System 0.21 4 0.04 1.82 VII.—Violence 35 0.40 TABLE V. BIRTHS AND DEATHS IN 12 YEARS, 1871-82. Deaths from Zymotic Diseases. Excess of Births over Deaths. London Death Rate. Estimated Population. Total Births. Total Deaths. Birth Rate. Death Rate. Year. Rate per 1000 living. Total. 1871 80,585 3327 1994 1333 41.2 24.7 564 6.1 24.6 2 81,198 3687 1663 2024 45.4 20.4 344 4.2 21.4 3 81,811 3587 2003 1584 43.8 24.4 392 4.7 22.4 4 82,424 3656 1642 2014 44.3 19.8 268 3.2 22.4 5 83,038 3587 2094 1497 43.1 25.2 452 5.4 23.5 6 83,615 3671 1804 1867 43.9 21.5 351 4.2 21.9 7 84,264 3620 1665 1955 42.9 19.7 287 3.4 21.5 8 84,877 3597 2110 1487 42.3 24.8 522 6.1 23.1 9 85,490 3715 1983 1732 43.4 23.1 344 4.0 22.1 1880 86,104 3532 1796 1736 41.0 20.8 411 4.6 21.7 Ten Years' Average. 3597 1875 1722 43.1 22.4 393 4.6 22.4 1881 86,808 3550 1735 1815 40.9 20.0 290 3.3 21.2 1882 87,430 3485 1913 1572 39.8 21.8 420 4.7 21.4 TABLE VI. NUISANCES, &c., DURING THE YEAR 1882. Inspected and reported to the Vestry, by the Medical Officer of Health and the Inspector of Nuisances. TABULAR STATEMENT OF SANITARY WORK. 2495 Houses and other premises inspected and reported on. 2427 Notices served to execute works, etc. 201 Houses in a dirty and dilapidated condition, cleansed and repaired, etc. 219 Houses disinfected, cleansed and purified. 2 Cases of overcrowding abated. 5 Houses closed, being unfit for human habitation. 30 Houses in courts provided with a constant supply of water by means of stand pipes. 163 Privies repaired or ventilated. 153 Offensive privies cleared. 59 Closets panned and trapped. 625 Closets supplied with water. 192 Defective drains repaired. 406 Stopped drains cleared. 273 Untrapped sinks trapped. 20 Cesspools abolished. 103 Badly paved yards repaired. 332 Water receptacles supplied. 182 Water receptacles cleansed and repaired. 61 Houses supplied with water. 298 Dust bins provided. 13 Defective roofs repaired. 34 Defective rain-shoots and gutters repaired. 51 Offensive accumulations removed. 19 Animals kept so as to be a nuisance removed. 53 Urinals and other offensive places cleansed. 22 New urinals erected (11 outside and 11 inside). 7 Old urinals re-opened. 15 Slaughterhouses inspected and licensed. 15 Cowhouses inspected and licensed. 90 Bakehouses inspected. 5 Cellar flaps repaired. 1 Street re-numbered. 19 Stables and other premises drained. 135 Old brick drains relaid with stoneware glazed pipes. 7 Articles of infected bedding destroyed. 1 Barrel of herrings 2 Quarters of Beef Seized and destroyed, being unfit for human food. 2 Persons suffering from infectious diseases removed to Hospital. 7 Dead bodies removied from rooms to mortuary, upon Magistrates' orders. pital. 54 Summonses taken out before Police Magistrates for not complying with orders of the Vestry. Various attendances at the Police Courts, etc. H. THOMAS, Inspector. SALE OF FOOD AND DRUGS' ACT. List of Articles submitted to the Public Analyst, from April 11th, 1882, to April 3rd, 1883. Number of Samples. Costs. Adulterated. Amount of Fines. Article Genuine. £ s. d. £ s. d. Milk 29 18 11 11 9 0 7 7 6 Coffee 4 1 3 3 10 0 1 17 6 Butter 15 13 2 1 3 0 1 5 0 Bread 5 5 ... ... ... ... ... ... ... Flour 4 4 ... ... ... ... ... ... ... Mustard 7 6 1 0 10 0 0 12 6 Pepper 2 2 ... ... ... ... ... ... ... Lard 1 1 ... ... ... ... ... ... ... Arrowroot 1 1 ... ... ... ... ... ... ... Condensed Milk 1 1 ... ... ... ... ... ... ... 69 52 17 16 12 0 11 2 6 The fines and costs recovered under the Sale of Food and Drugs' Act, are paid to the Vestry's account. H. THOMAS, Inspector. FORTNIGHTLY REPORTS. From, January 16th, 1882, to January 1st, 1883, Inclusive. January 16th, 1882. During the fortnight that ended on the 7th day of January, 155 births and 75 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 46.5 and an annual rate of mortality of 22.5 per 1000 of the population. The corresponding death rate in London was 26.5. The chief zymotic diseases caused 11 deaths, viz.: smallpox 2, measles 4, diphtheria 1, whooping cough 3, and enteric fever 1. From diseases of the respiratory organs there were 21 deaths, of which 18 were referred to bronchitis and 3 to pneumonia. There were 7 deaths from consumption and 3 from meningitis. The deaths which occurred at various periods of life were 16 under one year; 16 between 1 and 5 years; 25 between 5 and 60 years; 7 between 60 and 70 years; 3 between 70 and 80 years; and 8 above 80 years. Three Inquests were held, and three deaths were not certified by any registered medical man. On the 3rd inst. I met the Inspector of the Metropolitan Board at the size factory of Messrs. Cripps. That gentleman fully concurred in my opinion that the appliances for drawing off and consuming the vapour are rot effective, and do not communicate with the furnace, although they are so constructed as to have the appearance of doing so. My attention has been called to a nuisance at 70, Tanner Street. It arose from some "soaks" which were inside the building, and too near the adjoining inhabited houses Notice has been given for the abatement of this nuisance. February 6th, 1882. During the three weeks that ended on the 28th day of January, 212 births and 109 deaths were registered in Bermondsey. These numbers are equal to an annual birth rate of 42.4, and an annual rate of mortality of 21.8 per 1000 of the population. The corresponding death rate in London was 24.2. From the principal diseases of the zymotic class there were 18 deaths, viz.: from small-pox 3, measles 4, scarlet fever 4, and whooping cough 7. Diseases of the organs of respiration caused 36 deaths, of which 24 were referred to bronchitis, 5 to pneumonia, and 7 to other diseases. Fourteen deaths were attributed to diseases of the tubercular class, viz.: Phthisis 5, meningitis 5, tabes 3, tuberculosis 1. Old age was assigned as the cause of 7 deaths. In infants under one year of age there were 26 deaths, and in persons aged 60 years and upwards 23 deaths were recorded. The Inquest cases included one death from accidental asphyxia and one from accidental drowning. Four deaths were not certified. During the past year the deaths in the parish numbered 1 735, an d the births 3549. The natural increase of the population, or the excess of births over deaths, was 1814. The birth rate was 40.8, and the death rate 20.0. Zymotic diseases caused 289 deaths, of which 17 were referred to small-pox, 52 to measles, 56 to scarlet fever, 31 to diphtheria, 39 to whooping cough, 20 to fever, 71 to diarrhoea, and 3 to simple cholera. February 20th, 1882. During the fortnight that ended on the 11th day of February, 174 births and 97 deaths were registered in Bermondsey. These numbers are equal to an annual birth rate of 52.2, and an annual rate of mortality of 29.1 per 1000 of the estimated population. The corresponding death rate in London was 31.2 per 1000. The high rate of mortality was due to the combined effects of low temperature and a succession of dense fogs causing an increased number of deaths from diseases of the respiratory organs. There were 30 deaths from bronchitis, 7 from pneumonia, one from asthma, and one from congestion of the lungs, making a total of 39 in this class. Zymotic diseases caused 11 deaths, of which one was referred to measles, 8 to whooping cough, one to typhus, and one to diarrhœa. Tubercular diseases caused 14 deaths, including 11 from consumption. There were 5 deaths from heart disease, and 8 from old age. Twenty-four children died during the first year of life, and 21 persons at upwards of 60 years of age. Twelve people died in the Workhouse ; one Inquest was held, and 2 deaths were not certified. March 6th, 1882. During the fortnight that ended on the 25th day of February, 159 births and 107 deaths were registered in the parish. These numbers are equal to an annual birth rate of 47.2, and an annual rate of mortality of 31.8 per 1000 of the population. The corresponding death rate in London was 27.7. There were 29 deaths from zymotic diseases, viz. : Measles 4, scarlet fever 3, diphtheria 1, whooping cough 19, and diarrhoea 2. Diseases of the respiratory organs caused 43 deaths, viz. : Bronchitis 37, pneumonia 4, and other diseases 2. From tubercular diseases there were 13 deaths, of which 8 were referred to phthisis, 3 to meningitis, 1 to tuberculosis, and 1 to tabes. Whooping cough is unusually prevalent. Deaths from bronchitis, caused by cold and fog, continue to affect the registration returns for two or three weeks after the disappearance of the exciting cause. The deaths included 27 children under one year of age and 19 persons aged 60 years and upwards. One Inquest was held. The cause of death was "accidental asphyxia." Three deaths were not certified. March 20th, 1882. During the fortnight that ended on the 11th day of March, 140 births and 80 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 41.6, and an annual rate of mortality of 23.8 per 1000 of the population. The corresponding death rate in London was 24.0. From the chief diseases of the zymotic class there were 28 deaths, of which 4 were referred to measles, 2 to diarrhœa, and the large proportion of 22 to whooping cough. The number of deaths from diseases of the respiratory organs, which had been 43 in the previous fortnight, declined to 15. Tubercular diseases caused 12 deaths, viz.: Phthisis 8, meningitis 3, and tuberculosis 1. Twenty-six deaths were recorded in children under one year of age, and 8 in persons aged 60 years and upwards. Three Inquests were held. Two of the deaths were attributed to natural causes, and one to blood poisoning caused by Washing and cleansing foreign hides. Three deaths were uncertified. The water supplied by the Southwark Company during last month, was clear and efficiently filtered before delivery. April 3rd, 1882. During the fortnight that ended on the 25th day of March, 124 births and 100 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 36.8, and an annual rate of mortality of 29.7 per 1000 of the population. The death rate in London was 23.6. The chief diseases of the zymotic class caused 19 deaths, viz.: Measles 2, diphtheria 1, whooping cough 13, typhus 1, and enteric fever 2. From diseases of the organs of respiration there were 30 deaths, of which 27 were referred to bronchitis, 2 to pneumonia, and 1 to croup. Thirteen deaths were attributed to tubercular diseases, viz.: 9 to phthisis, 3 to meningitis, and 1 to tabes. The other registered causes of death include 7 from old age, 5 from heart disease, and 9 from diseases of the brain and nervous system. One death was certified as due to "purpura haemorrhagica—duration five days." This is a frequent symptom of malignant small-pox. I am informed that a case of small-pox had occurred in the same house. The three Inquest cases included one of suicide by cutthroat, one of accidental asphyxia, and one from "a fit." Twenty-five children died during the first year of life, and 12 persons at the age of 60 years and upwards. Two deaths were uncertified. April 17th, 1882. During the fortnight that ended on the 8th day of April, 128 births and 81 deaths were registered in the parish. These numbers are equal to an annual birth rate of 38.0 and an annual death rate of 24.0 per 1000 of the population. The corresponding death rate in London was 21.8. Of the deaths 20 occurred during the first year of life, and 13 in persons of 60 years of age and upwards. The number of deaths from diseases of the zymotic class was 30, viz.: Small-pox 1, measles 7, scarlet fever 1, whooping cough 18, enteric fever 1, and diarrhoea 1. Diseases of the respiratory organs caused 19 deaths, of which 12 were referred to bronchitis, 5 to pneumonia, and 2 to other diseases. The actual number of deaths ultimately due to these diseases is much larger than here appears, as they are frequently the fatal complications of measles, whooping cough, and other primary diseases under which the deaths are finally classed. There were 6 deaths from tubercular diseases, viz.: from phthisis, 1 from meningitis, and 1 from tabes mesenterica. The Inquest cases included 2 deaths from violence, one of a child accidentally drowned in a pail of water, and one case of suicide by cut-throat, while mentally deranged. Five deaths were uncertified as to their cause by any registered practitioner. May 1st, 1882. During the fortnight that ended on the 22nd day of April, 141 births and 85 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 42.0, and an annual rate of mortality of 25.1 per 1000 of the estimated population. The corresponding death rate in London was 22.1. The deaths included 25 children under one year of age, and 10 persons aged 60 years and upwards From the chief diseases of the zymotic class there were 29 deaths, of which 22 were referred to whooping cough, 5 to measles, 1 to scarlet fever, and 1 to small-pox, an infant aged 10 weeks. Diseases of the respiratory organs caused 18 deaths, viz.: Bronchitis 11 and pneumonia 7. There were 8 deaths from diseases of the tubercular class, 6 from phthisis, 1 from tubercular meningitis, and 1 from tabes mesenterica. A woman, 36 years of age, were certified to have died from "acute alcoholism." The high rate of mortality is due to the prevalence of whooping cough. Our death rate exceeds that of London by 3 per 1000. The difference caused by whooping cough alone is no less than 6 per 1000, or one-fourth of the death rate from all causes. During the present year 109 deaths of children have been referred to this disease. I have no doubt many deaths result from neglect of proper treatment in the early stages of the complaint. May 15th, 1882. During the fortnight that ended on the 6th day of May 117 births and 93 deaths were registered in the parish. These numbers are equal to an annual birth rate of 34.7, an d an annual rate of mortality of 27.6 per 1000 of the estimated population. The corresponding death rate in London was 20.2. The deaths included 30 children under one year of age, and 14 persons aged 60 years and upwards. The chief diseases of the zymotic class caused 29 deaths, of which 22 were from whooping cough, 5 from measles, one from scarlet fever, and one from continued fever. From diseases of the respiratory organs there were 23 deaths, of which 15 were attributed to bronchitis, 3 to pneumonia, 2 to croup, and 3 to other diseases. Tubercular diseases caused 7 deaths, viz.: Phthisis 6 and abes mesenterica 1. The other causes of death included 5 from apoplexy, 4 from old age, 3 from heart disease, and 5 from wasting diseases of infants. Nine Inquests were held. In 5 the deaths were referred to natural causes, and in 4 to violence. On the 6th instant I accompanied the Inspector to a butcher's shop in the occupation of George Godbolt, at Bermondsey New Road. In the back yard we found half the carcase of an old cow which appeared to be unfit for human food. This was removed, and, on the following Monday, it was condemned by the magistrate, and ordered to be destroyed. In the shop there were several sheep said to be "Australian." The outsides of the bodies were spotted all over with mould. The insides were lined with a thick coat of green mould, and in many parts they were sodden with a dark brown offensive looking fluid. The flesh, when cut into and exposed to the air, rapidly became offensive to the smell. These sheep appeared to me to be unfit for human food, but as the question was a new and an important one, I directed a sample only to be seized and submitted to the magistrate. On the evidence of the City Inspector, who had passed this mutton, "that it was very peculiar, and required a great deal of trimming,"but (in his opinion) it was fit for food, the magistrate declined to condemn it. I mention these facts to show that Mr. Thomas and myself are not responsible for the exposure and sale of mutton of this description within the parish. June 5th, 1882. In the three weeks that ended on the 27th day of May the number of births registered in the parish was 185 (males 89, females 96). The number of deaths was 116 (males 58, females 58). The annual birth rate was 36.6, and the annual rate of mortality 23.0 per 1000 of the estimated population. The death rate in London was 19.1. The principal diseases of the zymotic class caused 25 deaths, viz.: Measles 12, whooping cough 11, scarlet fever 1, and diarrhoea 1. All these occurred in children under 5 years of age. From diseases of the respiratory organs there were 25 deaths, viz.: From bronchitis 17, from pneumonia 4, and from croup 4. Thirteen of these were deaths of children. Seventeen deaths were referred to tubercular diseases, viz.: 12 to phthisis, 2 to tabes, and 2 to meningitis. The other causes of death included diseases of the brain 11, of the liver 4, of the heart 2, old age 7, and wasting diseases of children 9. The Inquest cases comprised 4 deaths from accident, one by machinery, one by a locomotive engine, one by accidental asphyxia, and one by drowning. The deaths which occurred at various periods of life were 29 under one year, 36 between 1 and 5 years, 34 between 5 and 60 years, and 17 above 60 years. The mortality is high for the season of the year. The excess is due to the number of deaths of children from measles, whooping cough, and bronchitis. The importance of early medical treatment in these diseases is not sufficiently estimated by many parents. Isolation of the patient is generally neglected in the case of measles, and is a matter of extreme difficulty in cases of whooping cough. The latter disease is so excessively fatal to infants, that too much care cannot be taken in excluding them from sources of infection. Where isolation cannot be effected by the removal of the sick, or allowing them the exclusive use of a separate room, the same object may be gained by the prompt removal of the other children. Wherever it is practicable this is advisable, whether the other children have had the disease or not, as, if they do not take it themselves, they are active carriers of the infection to others. June 19 th, 1882. During the fortnight that ended on the 10th day of June, 131 birth and 74 deaths were registered in Bermondsey. These numbers are equivalent to an annual birth rate of 39.0, and an annual rate of mortality of 22.0 per 1000 persons living. The death rate in London was 17.9. The chief zymotic diseases caused 17 deaths, viz.: Measles 12, whooping cough 4, and diarrhœa 1. From tubercular diseases there were 12 deaths, of which 7 were due to phthisis, 4 to meningitis, and 1 to tabes. The number of deaths from diseases of the respiratory system declined to 13. They were—8 from bronchitis, 4 from pneumonia, and 1 from croup. The deaths which occurred at various periods of life were 23 under one year, 22 between 1 and 5 years, 20 between 5 and 60 years, and 9 above 60 years. Two Inquests were held, and two deaths were not certified. The water supplied by the Southwark and other Companies during the month of May was of inferior quality to that sent out during the previous month. The fatal cases of whooping cough have declined, but those of measles have increased. The latter disease has caused 58 deaths within the last six months, being 6 in excess of the number which occurred during the previous twelve months. July 3rd, 1882. During the fortnight that ended on the 24th day of June, 135 births and 61 deaths were registered in the parish. These numbers are equivalent to an annual birth-rate of 40.1, and an annual rate of mortality of 181 per 1000 of the estimated population. The death-rate in London was 18.2. The chief zymotic diseases caused 13 deaths, viz.:— measles 4, scarlet fever 1, whooping cough 6, and diarrhœa 2. There were 13 deaths from diseases of the tubercular class, of which 7 were referred to phthisis, 1 to tabes, and 5 to meningitis. Thirteen deaths were attributed to diseases of the respiratory system. The deaths which occurred at various periods of life were 14 under 1 year of age, 22 between 1 and 5 years, 19 between 5 and 60, and 6 above 60 years. Two Inquests were held. In one case a child aged one year was accidentally suffocated by a piece of potato. On Saturday last I received a complaint about the Vestry Wharf. On visiting the wharf I found that a very offensive smell arose from a heap of manure and other refuse which which was then being removed. I think the manure should be removed more speedily, and (if this cannot be done) it should not be mixed with greengrocers' refuse, as I am satisfied that the mixture is far more offensive than a much larger collection of stable dung alone would be. All vegetable refuse should be burnt instead of being thrown into the dustbin. Complaint has been made of a nuisance at Mr. Maules' yard, in Southwark Park Road. It arose from a heap of horns which were undergoing the process of putrefaction. I have advised greater care to be observed in this business. July 17 th, 1882. During the fortnight that ended on the 8th day of July, 123 births and 71 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 36.5, and an annual death rate of 21.1 per 1000 of the estimated population. The corresponding death rate in London was 17.4. The chief zymotic diseases caused 23 deaths, viz.:- Measles 8, scarlet fever 4, whooping cough 5, and diarrhœa 6. Ten deaths were referred to pulmonary diseases, and 13 to tubercular affections. Three Inquests were held. Two deaths were caused by accidents, and two were uncertified. The deaths which occurred in the first year of life num bered 22, and between one and five years 18. Above 60 years of age there were 13 deaths. At the Vestry Wharf there are about 150 tons of manure and slop, and 200 tons of dust. A barge is being loaded with ashes, and I am informed that the manure will be removed to-morrow and on Wednesday. As the season for summer diarrhoea is close at hand, I beg to call attention to the necessity of cleansing cisterns, dustbins, and back yards; the proper trapping of sinks and drains, and the great importance of never giving to infants and young children any milk or other food which is beginning to turn sour. All milk should be boiled as soon as it is received, and be kept covered in a clean and cool place. July 31st, 1882. During the fortnight that ended on the 22nd day of J uly, 121 births and 64 deaths were registered in the parish. These numbers are equivalent to an annual birth rate 36.0 and an annual rate of mortality of 19.0 per 1000 of the estimated population. The corresponding death rate in London was 17.9. The number of deaths which occurred during the first year of life was 17; between one and five years, 25; and at all other ages 22. From the principal diseases of the zymotic class there were 20 deaths, of which 6 were from measles, 4 from whooping cough, 8 from diarrhœa, and 2 from fever. Tubercular diseases caused 10 deaths, and pulmonary diseases 8. Two Inquests were held, and 4 deaths were not certified. All the latter were attributed to "convulsions." Complaint has been made of frequent and offensive smells arising from a ventilator in a sewer in St. James's Road. It is situated in front of the house No. 54. l am informed that there is a case of typhoid fever at No. 54, and that several cases of sore throat, diphtheria, low fever, gastric fever, typhoid fever, and other disorders which are generally caused by emanations of sewer gas, have occurred in the immediate locality, I do not know the course of the sewer, but have been told that it is one which belongs to the Metropolitan Board, and that it crosses Southwark Park in a diagonal direction towards China Hall. I presume there is a long length of sewer which is not sufficiently ventilated. I am under the impression that this is the case in other parts of St. James's District, as diphtheria and similar complaints are much more prevalent in that district than in other parts of the parish, where the houses are, generally speaking, of an inferior class. At the Vestry Wharf, 483 loads of dust and 172 loads of slop have been received during the last fortnight. All the manure has been removed. There are about three barge loads of dust remaining to be sifted. Efforts have been made to clear the place, and I hope they will not be relaxed until that work has been accomplished. As a wharf for the removal of refuse these premises are indispensable, and it is not unreasonable that a moderate time should be allowed for the sifting of materials, without which they are valueless ; but I believe it was never intended that the wharf should be used as a depôt for an indefinite period, and I do not think it is a suitable place for such a purpose. August 14th, 1882. During the fortnight that ended on the 5th day of August, 111 births and 80 deaths were registered in Bermondsey. These numbers correspond to an annual birth rate of 32.1, and an annual rate of mortality of 23.8 per 1000 of the estimated population. The death rate in London was 18.6. Of the deaths, 32 were aged under one year, 15 between one and five years, and 10 above 60 years. Zymotic diseases caused 20 deaths, of which 6 were referred to measles, 1 to scarlet fever, 4 to whooping cough, 1 to enteric fever, and 8 to diarrhœa. All the fatal cases of diarrhoea were under one year of age. Tubercular diseases caused 14 deaths, viz.: Phthisis 8, meningitis 3, and tabes 3. The number of deaths from diseases of the respiratory system was considerable for the season of the year. There were 13 from bronchitis, 6 from pneumonia, 1 from croup, and 1 from pleurisy; making a total of 21. Three Inquests were held. All the deaths were attributed to natural causes. Four deaths were not certified. Since my last report on the Vestry Wharf, 364 loads of dust and 92 loads of slop have been received. Six barges of ashes, one of mixture, one of hard core, and 11 loads of core have been removed. An extra number of hands are at work. About two-thirds of the accumulation has been cleared away, and if the activity which has lately been displayed be continued, and advantage be taken of the present dry weather, the remainder may be removed in a short time without causing any nuisance. In the second quarter of the year the number of births was 827, and of deaths 522. The mortality was unusually high in consequence of the prevalence of measles and whooping cough. The chief zymotic diseases caused no less than 136 deaths, of which 2 were attributed to small-pox, 48 to measles, 5 to scarlet fever, 1 to diphtheria, 74 to whooping cough, 1 to fever, and 5 to diarrhoea. The birth rate was 37.9, and the death rate 23.8. September 18th, 1882. During the five weeks that ended on the 9th day of September, 339 births and 157 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 40.4, and an annual rate of mortality of 18 .7 per 1000 of the population. The corresponding death rate in London was 19.1. The numher of deaths which occurred in the first year of life was 71, and above 60 years of age 19. Zymotic diseases caused 34 deaths, viz. : —Measles 7, scarlet fever 6, diphtheria 1, whooping cough 5, and diarrhœa 15. From diseases of the respiratory system there were 20 deaths, and from diseases of the tubercular class 26. One death was attributed to acute lead poisoning. Eight Inquests were held. In four cases the deaths arose from violence. One of these was a child, 4 years of age, whose night dress caught fire from a spirit lamp. Another was a girl, 10 years old, who died from "concussion of the brain caused by the throwing of a stone." Eleven deaths were not certified by any registered medical practitioner. Six of these cases appear to have been attended by students of Guy's Hospital. The water supplied by the Southwark Company in July and August was slightly turbid from imperfect filtration, but did not contain any excessive proportion of organic impurity. During the last five weeks, 1166 loads of dust and 480 loads of slop and mixture have been received at the Vestry Wharf, and 16 barge loads of ashes, 7 of mixture, and one of hard core have been removed. The old accumulation has been cleared away, and the walls have been whitewashed. October 2nd, 1882. During the fortnight that ended on the 23rd day of September, 120 births and 55 deaths were registered in Bermondsey. One death was registered in duplicate. The annual birth rate was 35.8, and the annual rate of mortality 161 per 1000 of the population. The corresponding death rate in London was 18.2, and the mean rate of 28 of the largest English towns was 20.4. From the chief zymotic diseases there were 8 deaths, viz.: From scarlet fever 4, diarrhœa 3, and whooping cough 1. Thirteen deaths were referred to diseases of the respiratory system, and 14 to tubercular diseases. Two Inquests were held, and three deaths were not certified. The general state of the public health is satisfactory. No further complaints have been received respecting the Vestry Wharf. There is no undue accumulation, excepting of hard core, which I believe is removed by the officers of the Vestry. This mixture of broken crockery, glass and tin ware, is not free from organic matter of an offensive kind adhering to it. It presents a very large surface exposed to the air, and from the porous nature of the mass, the actual surface greatly exceeds the apparent surface. I think it should be removed. I have considered the communication from the Vestry of St. Pancras on the Regulation of Bakehouses, which was referred to me at the last meeting. I believe no advantage whatever has resulted from taking away the duty of enforcing certain special requirements of bakehouses from the Vestry's officers, and placing that duty upon the Inspectors of Factories and Workshops. I am also of opinion that bakehouses, as well as slaughterhouses and dairies, should be registered and regulated by special bye-laws. October 16 th, 1882. During the fortnight that ended on the 7th day of October, 105 births and 33 deaths were registered in the parish. These numbers correspond to an annual birth rate of 31.3, and an annual rate of mortality of 9.8 per 1000 of the estimated population. The death rate in London was 19.2, and the mean rate of 28 large English towns 20.2; the several rates ranging from 12.6 to 32.6. In the first week of the above period there were 21 deaths, and the death rate was 12.5, In the second week there were 12 deaths, showing a death rate of 7.1 per 1000 during the year, or less than one death in every 7000 of the population during the week. I have never been in the habit of attaching any undue importance to the death rate being exceptionally high or low for short periods, but I think the fact of the occurrence of such a low rate of mortality, even for one week, in a population of 87,000 persons, is evidence of the absence of any permanent local influences of an insanitary character. The registered causes of death included 3 from zymotic diseases, viz.: 2 from diphtheria and 1 from enteric fever. Pulmonary diseases caused 9 deaths, and consumption 3. Two Inquests were held, and in both instances the deaths were attributed to natural causes. The quality of the water supplied by the Southwark Company during month of September was good. A portion of the hard core at the Vestry Wharf, which was referred to in my last report, has been removed. November 6th, 1882. During the three weeks that ended on the 28th day of October, 190 births and 89 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 37 .7 and annual rate of mortality of 17.7 per 1000 of the estimated population. The corresponding death rate in London was 19.9, and the mean rate of 28 large towns was 21.1. The principal zymotic diseases caused 14 deaths, of which 3 were referred to measles, 6 to scarlet fever, 2 to diphtheria, 1 to whooping cough, and 2 to diarrhoea. From diseases of the respiratory organs there were 20 deaths, from bronchitis 14, and pneumonia 6. Fourteen deaths were attributed to tubercular diseases, viz.: Phthisis 9, meningitis 3, and tabes 2 Four Inquests were held, and two deaths were not certified. The Vestry Wharf presents its usual appearance during wet weather. Last Monday I was shown the body of an animal which had been purchased as an Ostend rabbit. The head and feet had been removed. At first sight it had the general appearance of a large rabbit, but on closer inspection, the dark colour of the flesh, the depth of chest, the strong muscular fore-legs, and the character of the internal organs, proved very conclusively that it was not a rabbit; while the thickness of the stump which represented the tail, the presence of a few hairs on a small piece of skin which had been left attached to the body, and other points, convinced me that it was a cat. In the quarter that ended on the 30th day of September, the registered births numbered 803 and the deaths 410. The annual birth rate was 36.8, and the death rate 18.8. November 20th, 1882. During the fortnight that ended on the 11th day of November, 156 births and 61 deaths were registered in the parish. These numbers correspond to an annual birth rate of 46.5, and an annual rate of mortality of 18.2 per 1000 of the estimated population. The death rate in London for the same period was 20.0 per 1000. The principal diseases of the zymotic class caused 7 deaths, viz.: Scarlet fever 3, whooping cough 1, enteric fever 1, and diarrhoea 2. From diseases of the respiratory organs there were 17 deaths, viz.: from bronchitis 10, pneumonia 6, asthma 1. There were 5 deaths from phthisis and 2 from tabes. Five Inquests were held. Three deaths were not certified. The general state of the public health is satisfactory. December 4th, 1882. During the fortnight that ended on the 25th day of November, 126 births and 46 deaths were registered in the parish. These numbers correspond to an annual birth rate of 37.6, and an annual rate of mortality of 13.7 per 1000 of the estimated population. The death rate in London was 21.8, and the mean death rate of 28 large towns was 23.4; the lowest being 13.9 and the highest 47.8. The principal diseases of the zymotic class caused 9 deaths, viz.: Measles 1, scarlet fever 5, whooping cough 1, enteric fever 1, and dysentery 1. There were 13 deaths from diseases of the respiratory system, viz. : 11 from bronchitis and 2 from pneumonia Seven deaths were attributed to tubercular diseases. Two Inquests were held. The deaths were referred to spasm of the heart and accidental asphyxia. Twelve deaths occurred in infants under one year of age, and 10 deaths in persons aged 60 years and upwards. The general mortality is much below the average for the season of the year. December 18th, 1882. During the fortnight that ended on the 9th day of December, 141 births and 85 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 42.0, and an annual rate of mortality of 25.3 per 1000 of the estimated population. The corresponding death rate in London was 21.9. The deaths under one year of age numbered 22, and above 60 years of age 14. The deaths from zymotic diseases show a sudden increase in the fatal cases of measles. The total was 15, of which 10 were referred to measles, 2 to scarlet fever, 1 to diphtheria, and 2 to diarrhœa. Deaths from diseases of the respiratory system also show an increase. There were 20 deaths from bronchitis, 3 from pneumonia, and 3 from croup. Tubercular diseases caused 14 deaths, viz.: Phthisis 12 and meningitis 2. The Inquest cases included one death from heart disease and one from accidental asphyxia. Two deaths were not certified. One was registered as due to bronchitis and the other to convulsions. The water supplied by the Southwark Company during November was inferior to the average quality. This was due to the heavy rain and consequent floods. January 1st, 1883. During the fortnight that ended on the 23rd day of December, 162 births and 91 deaths were registered in the parish. These numbers are equal to an annual birth rate of 41.3, and an annual rate of mortality of 26.9 per 1000 of the estimated poputation. The corresponding death rate in London was 26.9. Twenty-two deaths occurred in the first year of life, and 16 at the age of 60 years and upwards. The principal diseases of the zymotic class caused 10 deaths, of which 8 were referred to measles, 1 to scarlet fever, and 1 to enteric fever. Twenty-eight deaths were attributed to diseases of the respiratory system. Of these 22 arose from bronchitis, 3 from croup, 2 from pneumonia, and 1 from asthma. Tubercular diseases caused 16 deaths, viz.: Phthisis 9, meningitis 5, and tabes 2. The other registered causes of death included 9 from brain diseases, 7 from old age, and 4 from premature birth. Four Inquests were held. Three deaths were attributed to violence, and one to natural causes. Five deaths were not certified. JOHN DIXON, M.D., Medical Officer of Health.