THE VESTRY OF BERJIONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY. FOR THE YEAR 1883. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physicians of London. Member of the Royal College of Surgeons of (England, &c. MEDICAL OFFICER of HEALTH foR the PARISH. BER 9 C x Lon THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH of BERMONDSEY FOR THE YEAR 1883. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physicians of London, Member of the Royal 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 pleasure of presenting my Eighth Annual Report. It is a summary of the vital statistics of the Parish for the year of 52 weeks, that ended on the 29th day of December, 1883. The year was a healthy one. The fatal cases of measles and whooping cough, which in the previous year, had reached the high number of 287, declined to 92. Summer Diarrhœa was more prevalent, but only to a slight extent, and the deaths from this cause were below the decennial average. Scarlet Fever was the epidemic disease of the year, the fatal cases being twice as numerous as in 1882, and exceeding the average by 34. No death from Small Pox was recorded. This is a gratifying circumstance, as we have not been entirely free from a few deaths from this disease in each year, since 1875. The deaths from Fever were comparatively few, being only slightly in excess of half the average number. During the summer, there were outbreaks of Cholera at several places in Egypt, and as it was possible that cases of this disease might be imported at any time, a further inspection was made of the courts and streets where it would be most likely to prevail. Public Notices were issued to the inhabitants, to remove existing nuisances, and 11,000 copies of " Sanitary Precautions" were distributed from house to house throughout the Parish. It is to be feared that advice of this kind is received with the greatest indifference when the enemy is known to be at a distance, but I have no doubt that much good resulted from the action of the Vestry. Several nuisances were brought to light and abated. The condition of many dwellings was improved. POPULATION. The population at the middle of the year is estimated at 88,052. In making this estimate we take credit for only about one-third of the natural increase which is shown by the annual excess of births over deaths. The proportion of the sexes is assumed to be the same as at the last census. This gives us: —Males 43962, Females 44090. This apparent equality in numbers does not exist throughout the several groups of ages under which the people are classed. Between 15 and 35 years of age, there is a greater preponderance of men; and after 55 years of age, the women considerably outnumber the opposite sex. The number of children living under 5 years of age is estimated at 13,648. This is an excess of 219 1 when compared with the number living at the same age in London. As the average mortality throughout the country, is 63 per thousand persons living at this age, the extra number in Bermondsey would make a constant addition to our general death rate, of 1.5 per thousand living at all ages, if it were not compensated for to a certain extent by differences in the numbers living at other ages. The actual or recorded death rate in any district serves the purpose of comparing one year with another, but when the comparative healthiness of different areas is estimated by their different death rates, it is necessary to consider also the differences which exist in the constitution of their respective populations with regard to sex and age. BIRTHS. The number of births registered in the Parish was 3435, being 50 less than in the previous year, and 164 below the decennial average. The number of male children born was 1723, and of females, 1712. The annual birth rate was 39.0 per thousand of the estimated population. In many districts this would be considered a high birth rate, but in Bermondsey it is the lowest which has occurred during the last twelve years. It has been decreasing for five years, and I anticipate a further decline. The London birth rate was 33.9 per thousand, which is the lowest recorded since 1860, when it was 33 .6. The number of births in the Leather Market District was 617; in the St. Mary Magdalen District, 610; and in St. James's, 2208. In the first quarter of the year there were 896 births; in the second quarter, 888; in the third quarter, 829; and in the fourth quarter, 822. The excess of births over deaths, was 1712. The natural increase of the population is 2.05 per cent. The estimated increase is 0.77 per cent. DEATHS. The total number of deaths registered was 1722, but as one death was twice registered, the actual number was 1721, of which 874 were males, and 847, females. In the previous year the deaths were 1913, and the average of the ten years, 1873-82, was 1874. The annual rate of mortality was 19.5 per thousand of the estimated population. Corrected for age and sex distribution, the death rate was 20.02. The male death rate was 19.9, and the female death rate, 19.2. In London the general death rate was 20.4 per thousand. Males 22.3; females 18.7. The number of persons who died in the Leather Market District was 343; in the St. Mary Magdalen District, 392 ; and in St. James's, 986. In the first quarter of the year, there were 489 deaths; in the second quarter, 392; in the third quarter, 392; and in the last quarter, 448. The number of deaths which occurred in the first year of life was 497, being nearly 29 per cent of the total deaths at all ages, and 145 per thousand registered births. The infant death rate in London was 146 per thousand registered births. The mean rate in 28 large towns, was 156 —only four of these towns having a lower rate than Bermondsey. Under 5 years of age the deaths numbered 894, or 52 per cent of the total deaths. In districts where the birth rate is low, and the proportion of children much below the average, this would be a high rate of mortality. In Bermondsey, the number living at this age, as shewn in the census tables, is 155 per thousand of the entire population, against 130 per thousand in London, and 135 per thousand in England and Wales. The rate of mortality was 65.5 per thousand living; the decennial average for England being 63.5. Our standard proportion of deaths at this age was exceeded by 26. This was probably due to the prevalence of scarlet fever. At all the other groups of ages the mortality was below the average. One hundred and thirty four deaths, or 7.7 per cent, took place in the workhouse. CAUSES OF DEATH. Zymotic Diseases. —The principal diseases of this class caused 292 deaths, or 17 per cent. In the previous year the fatal cases numbered 420, or 22 per cent. The decennial average is 373. Measles prevailed chiefly during the first three quarters of the year, and caused 67 deaths. The mortality from whooping cough was 25. In 1882, it was 178. The deaths from scarlet fever, which had been 5 in the first quarter and 9 in the second quarter, increased to 33 in the third, and to 54 in the fourth quarter, making a total of 101. Of this number, 73 were under 5 years of age. The deaths were equal to a rate of 1.15 per thousand living, and formed 5.8 per cent of the total deaths. In London, the scarlet fever death rate was 0.50, and the percentage of deaths, 2.47. There were 16 deaths from diphtheria, of which 14 occurred in the St. James's District. Last year, 8 out of 9 deaths took place in the same district; in 1881, 26 out of 31; and in 1880, 11 out of 13. In other respects, this district is the healthiest in the parish. The proportion of its population is 63 per cent. Its proportion of the deaths from diphtheria during the last five years has been 84 per cent. In my Report for 1881, I expressed the opinion "That the main sewers in this district are not sufficiently ventilated." I know of no other reason for the greater prevalence of this disease in this locality. 16 deaths were attributed to fever—13 to enteric fever, and 3 to Typhus. Diarrhœa caused 66 deaths, of which 46 took place in the third quarter. The zymotic death rate was 3.3 per thousand persons living. Constitutional Diseases caused 300 deaths, or 17.4 per cent. The first division included 5 deaths from rheumatism, 2 from gout, and 2 from rickets. Cancer caused 27 deaths—24 females and 3 males. The ages at death ranged from 25 to 85 years. Our death rate from cancer, was 0.30. The London rate was 0.64. In the tubercular division there were 272 deaths, viz.: from phthisis 164; from tubercular meningitis 70; from tabes mesenterica 29; and from scrofula and other forms of tuberculosis 9. The death rate from Phthisis was 1.86; the London rate being 2.25. On the other hand our death rate from tubercular meningitis (which is a disease of childhood) was 0.79, while the London rate was only 0.36. The different constitution of the population with respect to age affects the death rate from certain diseases, as well as the general death rate from all causes. Taking the tubercular class as a whole, the death rate in Bermondsey was 3.08 and in London 3.17. Developmental Diseases. —In this class there were 158 deaths, or 9.1 per cent. 38 deaths were attributed to premature birth and 112 to old age. Local Diseases. — In this important division 760 deaths were recorded, or 44 per cent of the total deaths. Diseases of the brain and nervous system caused 140 deaths, or 8.1 per cent. There were 22 deaths from apoplexy, 18 from paralysis, 9 from epilepsy, 61 from convulsions, and 30 from other diseases, including softening and congestion of the brain, etc. One death was caused by disease of the ear. From diseases of the heart and circulatory system there were 65 deaths, or 3.7 per cent. Diseases of the respiratory system caused 443 deaths, viz.: croup 36, bronchitis 268, pneumonia 99, pleurisy 4, and other diseases 36. Diseases of the digestive organs accounted for 67 deaths, or 3.8 per cent. There were 27 deaths from teething, and 15 from diseases of the liver. To diseases of the kidneys and urinary organs, only 14 deaths were referred. Under the head of childbirth, 4 deaths were registered. Violence. —The deaths attributed to this cause numbered 39. Under the head of accident or negligence, 6 deaths were assigned to fractures and contusions, 2 to burns, 5 to drowning, and 15 to suffocation. A little boy was "suffocated by impaction of food in the mouth. A girl aged 12 weeks, died from "Asphyxia, arising upon a distended stomach by food." A boy aged 4 years died from his night-dress taking fire, and a man was burnt to death from a house taking fire. Three bodies were found in the Thames without marks of violence, or any evidence how they came in the water. The number of suicides (11) was unusually high. Inquests were held in 86 cases, or 4.99 per cent of the total deaths. In London they were 7.2 per cent. Uncertified deaths numbered 43, or 2.49 per cent. In London they formed 1.22 per cent of all deaths registered. STATISTICS OF LONDON. The estimated population at the middle of the year was 3,955,814 persons. The births numbered 133,656, and the deaths 80,578. The excess of registered births over deaths was 53,078, and the estimated increase of population during the year, was 63,045. The number of marriages celebrated in London in 1883, was 35,297, giving a proportion of 17.8 persons married to 1000 inhabitants. This rate was lower than any previously recorded. It has gradually declined since 1865. The birth rate (33.9) was the lowest recorded since 1865, when it was 33.6. The death rate (20.4) was the lowest on record, the nearest approach to it being in 1850, when it was 21.0. Comparing the five groups of districts into which London is divided, the death rate was highest in the Eastern (24.1), and Central (23.2), and lowest in the Northern (19.1). In the South districts it was 19.4, and in the West districts 19.5. The mean temperature of the air was 49°.4 Fah.; that of the first quarter being 40°.0, of the second quarter, 53°0, of the third quarter, 59°5, and of the fourth quarter, 44°.9. The temperatures of the first and last quarters were 1°.2 above the average. The rainfall amounted to 21.9 inches. In the second quarter it exceeded the average by 1 inch, and in the fourth quarter by I.9 inches, The water drawn from the Thames was of better average quality than in any previous year, excepting 1870. The number of occasions when the water supplied by the Southwark Company was clear and transparent, was 7; when slightly turbid, 5; and when moving organisms were found 3. SANITARY WORK. During the year, 2948 houses and other premises were inspected and reported to the Vestry. The need for sanitary inspection is clearly shewn by the number of notices issued for the execution of the sanitary works required, amounting to no less than 2903, being 476 more than in the previous year. The owners of property appear to have paid less attention to these notices than in former years, as it was necessary to take out 170 summonses at the Police Court, to enforce compliance with the requirements of the Vestry. This is 116 more than in 1882. One or two heavy fines which have been recently inflicted will doubtless have a salutary effect on dilatory owners, and tend to convince those who perversely and obstinately refuse to do anything until they are "compelled," that the payment of a fine of ten pounds per house, makes the privilege of setting the law at defiance for a few weeks, a rather expensive luxury. The number of houses disinfected, cleansed and purified, was 142. Most of these were on account of cases of scarlet fever, and generally after fatal cases. Great activity has been shewn in dealing with houses of the worst class, 50 having been closed as unfit for human habitation. Some of these have been pulled down, and others have been more effectually repaired than would have been the case under the ordinary and milder course of proceeding. Another point in which the inspector has displayed commendable diligence is that of causing closets to be supplied with water, where that was not the case. 603 closets or "privies" have thus been converted into proper water closets, greatly to the convenience and health of the inhabitants. 251 waste water pipes were disconnected from a direct flow into the drains, and made to discharge in the open air, over trapped gulleys. Defective drains required much attention, 232 old brick drains were relaid with stoneware glazed pipes; 122 drains were repaired, 466 were cleared; and 294 untrapped sinks were trapped. 72 houses were supplied with water, 403 water receptacles were provided, and 195 were cleansed and repaired. 4 persons suffering from infectious diseases, were removed to Hospitals, and 7 dead bodies were removed to the mortuary, from rooms occupied as dwelling rooms. The articles seized and destroyed as being unfit for human food were:—139 rabbits, 4 hundred-weight of beef, and two boxes of fish. The bake-houses, slaughter-houses, and cow-houses were inspected, and the regular cleansing of 44 urinals duly superintended. Public attention having been called to the state of the dwellings occupied by the poor, I visited several of the courts and streets where the houses are of small size and let at moderate rents, and I am happy to say that I found very few that were not in a fairly clean and satisfactory condition. On the other hand the larger houses, which are let to several tenants, were, not unfrequently, in a filthy state, equally discreditable to the owners or agents, and to the occupiers. Mr. Thomas has rendered me every assistance with his usual readiness and courtesy. Thanking the Vestry for the support I have received in t exercise of my duties, I am, Gentlemen, Your obedient Servant, JOHN DIXON, M.D., Medical Officer of Health. 133 Jamaica Road, Bermondsey. 12 TABLE I. CAUSES OF DEATH. Registered in Bermondsey during the 52 weeks ending December 29th, 1883. ALL AGES. AGES AT DEATH. CAUSES OF DEATH. Total. Male. Female. 0—1 1—5 5—15 15—25 25—45 45—65 65—85 85 & upwards. All Causes 1721 847 497 397 98 55 189 225 234 26 874 Small Pox ... ... ... ... ... ... ... ... ... ... ... Measles 67 39 28 15 43 8 1 ... ... ... ... Scarlet Fever 101 55 46 10 63 2 ... 26 ... ... ... 16 7 9 Diphtheria ... 12 3 ... 1 ... ... ... 25 14 10 14 Whooping Cough 11 1 ... ... ... ... ... 1 Typhus 3 2 ... ... 2 1 ... ... ... ... Enteric Fever 13 4 9 6 5 1 1 ... ... ... ... Simple Fever ... ... ... ... ... ... ... ... ... ... ... Rotheln 1 ... 1 1 ... ... ... ... ... ... ... Diarrhœa 66 34 32 46 8 1 1 4 3 3 ... Simple Cholera 1 1 1 ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... Remittent Fever 1 ... 1 ... 1 ... ... ... ... ... ... Syphilis 11 ... ... ... 12 5 1 ... ... 7 ... Erysipelas 3 2 1 2 ... ... ... ... 1 ... ... Pyaemia 1 1 ... ... ... 1 ... ... ... ... ... Septicæmia 1 ... 1 ... ... ... ... 1 ... ... ... Puerperal Fever 3 3 ... 2 ... ... ... 1 ... ... ... Thrush 5 4 1 5 ... ... ... ... ... ... ... Want of Breast Milk 6 2 3 3 ... ... ... ... ... ... 4 Alcoholism 2 2 2 ... ... ... ... ... ... ... ... 13 TABLE I. — Continued. ALL AGES. AGES AT DEATH. CAUSES OF DEATH. Total. Male. Female. 0—1 1-5 5—15 15—25 25—45 45—65 65—85 85 & upwards. Rheumatic Fever 1 ... 1 ... ... ... ... ... ... ... 1 Rheumatism 4 2 2 ... ... 1 1 1 1 ... ... Gout 2 ... 2 ... ... ... ... ... 1 1 ... 2 2 Rickets ... ... 2 ... ... ... ... ... ... Cancer 27 24 ... ... ... ... 4 12 9 2 3 83 81 1 6 9 19 85 42 2 ... Phthisis 164 Meningitis 70 47 23 25 39 6 ... ... ... ... ... Tabes Mesenterica 29 14 15 23 5 1 ... ... ... ... ... Tuberculosis 9 5 4 2 5 2 ... ... ... ... ... Purpura 1 ... 1 ... 1 ... ... ... ... ... ... Diabetes 1 1 ... ... ... ... 1 ... ... ... ... Premature Birth 38 23 38 ... ... ... ... ... ... 15 ... Atelectasis 2 1 1 2 ... ... ... ... ... ... ... Congenital Malformations 6 3 3 6 ... ... ... ... ... ... ... Old Age 112 46 66 ... ... ... ... ... 5 92 15 Apoplexy 22 10 12 ... ... ... ... 5 7 10 ... Paralysis 18 ... 8 10 ... 5 1 ... ... ... 12 Epilepsy 9 6 ... ... 2 2 3 ... 3 2 ... Convulsions 61 31 30 37 20 3 ... 1 ... ... ... Brain Disease 20 14 6 ... ... 2 3 3 9 3 ... Other Diseases of Nervous System 10 5 5 5 1 ... 1 1 2 ... ... Diseases of Ear 1 ... 1 ... ... ... ... 1 ... ... ... Pericarditis 1 ... 1 ... ... ... ... 1 ... ... ... Heart Disease 64 34 30 ... ... ... 3 15 30 14 ... 14 TABLE I.- Continued. ALL AGES. CAUSES OF DEATH. Total. Males. Females. 0-1 1-5 5—15 Croup 36 15 21 5 26 5 Bronchitis 268 130 138 84 61 3 33 99 55 44 24 4 Pneumonia 4 3 1 Pleurisy 1 ... ... Other Diseases of Respiratory System 36 21 3 5 15 17 Teething 27 12 15 15 12 ... 3 1 Quinsy 4 2 2 ... 2 Dis. of Esophagus ... 2 ... ... ... Dis. of Stomach 4 2 2 ... ... ... Enteritis 2 2 1 ... ... ... 3 Peritonitis 3 ... ... ... ... Diseases of Liver 15 9 6 ... ... ... 1 1 Fistula ... ... ... ... Other Dis. of Digestive System 11 7 ... 4 2 1 Nephritis 5 3 2 ... ... ... 4 Bright's Disease 6 2 ... ... ... Other Diseases of Urinary System 3 3 ... ... ... ... Diseases of Uterus 3 ... 3 ... ... ... Haemorrhage 1 1 ... ... ... ... 4 Child birth ... 4 ... ... ... Dis. of Bonesand Joints 5 2 3 1 ... 2 Abscess 11 6 5 3 2 5 4 1 3 1 1 ... Gangrene 15 TABLE I.— Continued. ALL AGES. AGES AT DEATH. CAUSES OF DEATH. Total. Females. 1—5 5—15 25—45 45—65 Males. 15-25 0-1 Violence—(Accident.) Fractures & Contusions 6 2 4 ... ... ... 1 ... 3 Burns and Scalds 2 2 ... ... 1 ... ... 1 ... Drowning 5 5 ... ... ... 3 2 ... ... Suffocation 15 5 10 13 1 ... ... ... 1 (Suicide.) Gunshot 1 1 ... ... ... ... ... 1 ... Cut Throat 1 ... 1 ... ... ... ... ... ... Drowning 5 4 1 ... ... ... 3 1 ... Hanging 3 1 2 ... ... ... ... 1 1 Otherwise 1 1 ... ... ... ... ... ... ... Atrophy and Debility, Marasmus, Inanition, &c. 107 59 48 94 13 ... ... ... ... Dropsy 4 1 3 ... 1 ... ... ... 2 Debility 3 ... 3 ... 1 ... ... 1 ... Anaemia 1 ... 1 1 ... ... ... ... ... Leucocythœmia 1 1 ... ... ... ... ... ... 1 Abdominal Diseases 4 ... 4 ... ... ... 1 3 ... Constipation 1 ... 1 ... ... ... ... 1 ... Vomiting 2 ... 2 1 ... ... ... 1 ... "Natural" 1 1 ... ... ... ... ... ... 1 TABLE II. DEATHS FROM ZYMOTIC DISEASES IN 1883. ZYMOTIC DISEASES. 1882. Total for the Year. Rate per 1000 living. Percentage of Total Deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Small Pox ... ... ... ... ... ... ... 3.89 5.86 0.93 1.45 0.93 3.89 Measles 14 31 4 0.76 18 67 54 Scarlet Fever 5 9 101 33 1.15 7 3 Diptheria 2 4 0.18 16 5 Whooping Cough 4 5 11 25 0.28 5 5 0.18 Fever 16 4 2 7 Diarrhœa 5 0.76 8 47 67 39 42 76 Total 115 292 3.31 16.95 TABLE III. DEATHS FROM ZYMOTIC DISEASES IN THE 10 YEARS, 1873-82. 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 Average of 10 Yrs. Small Pox 2 0 0 9 39 8 3 8 18 9.2 5 109 46 45 101 56 68.5 Measles 46 75 46 52 109 25 130 21 43 102 Scarlet Fever 51 56 67.4 102 97 47 Diphtheria 3 5 9 19 13 7 3 31 16 11.5 9 18 TABLE IV. MORTALITY FROM CLASSIFIED CAUSES OF DEATH IN 1883. DISEASES. Total Deaths. Rate per 1000 living. Percentage of Total Deaths. 18.2 I.—Zymotic 314 3.56 Miasmatic 226 2.55 13.1 Diarrhœal 67 0.75 3.8 Venereal 12 0.14 0.7 8 Septic 0.09 0.5 5 II.—Parasitic 0.05 0.3 8 0.09 III.—Dietic 0.5 3.41 300 17.4 IV.—Constitutional Cancer 27 1.6 0.30 272 Tubercular 15.8 3.08 164 Phthisis 9.5 1.86 70 Meningitis 0.79 4.1 1.7 Tabes Mesenterica 29 0.32 Scrofula 9 0.10 0.5 V.—Developmental 1.79 158 9.1 2.2 Premature Birth 38 0.43 Old Age 112 1.27 6.5 760 8.63 VI.—Local 44.1 140 1.59 Nervous System 8.1 65 0.73 Circulatory 3.7 Respiratory 443 5.05 25.7 Digestive 67 3.8 0.75 14 Urinary 0.15 6.8 Reproductive System 8 0.09 0.5 5 Locomotive 0.05 0.3 39 Violence 0.44 2.3 28 1.6 Accident 0.31 11 0.7 0.12 4 82,424 83,038 5 6 83,615 7 84,264 8 84,877 9 85,490 1880 86,104 Ten Years' Average. 86,808 87,430 88,052 1881 1882 1883 3656 3587 3571 3620 3597 3715 3532 3597 3550 3485 3435 1642 2094 1804 1665 2110 1983 1796 1875 1735 1913 1722 2014 1497 1867 1955 1487 1732 1736 1722 1815 1572 1712 44.3 43.1 43.9 42.9 42.9 43.4 41.0 43.1 40.9 39.8 39.0 19.8 25.2 21.5 19.7 24.8 23.1 20.8 22.4 20.0 21.8 19.5 268 452 351 287 522 344 411 393 290 420 392 3.2 5.4 4.2 3.4 6.1 4.0 4.6 4.6 3.3 4.7 3.3 22.4 23.5 21.9 21.5 23.1 22.1 21.7 22.4 21.2 21.2 20.4 TABLE VI. NUISANCES. &c., DURING THE YEAR 1883. Inspected and reported to the Vestry by the Medical Officer of Health and the Inspector of Nuisances. TABULAR STATEMENT OF SANITARY WORK. 2948 Houses and other premises inspected and reported on. 2903 Notices served to execute works, etc. 106 Houses in a dirty and dilapidated condition, cleansed and repaired, etc. 142 Houses disinfected, cleansed and purified. 7 Cases of overcrowding abated 50 Houses closed, being unfit for human habitation. 84 Houses in courts provided with a constant supply of water by means of stand pipes. 121 Privies repaired or ventilated. 144 Offensive privies cleared. 83 Closets panned and trapped. 603 Closets supplied with water. 122 Defective drains repaired. 466 Stopped drains cleared. 294 Untrapped sinks trapped. 8 Cesspools abolished. 156 Badly paved yards repaired. 403 Water receptacles supplied. 195 Water receptacles cleansed and repaired. 72 Houses supplied with water. 317 Dust bins provided. 21 Defective roofs repaired. 16 Defective rain-shoots and gutters repaired. 78 Offensive accumulations removed. 3 Animals kept so as to be a nuisance removed. 44 Urinals and other offensive places cleansed. 12 Slaughter-houses inspected and licensed. 15 Cowhouses inspected and licensed. 86 Bakehouses inspected. 3 Cellar flaps repaired. 30 Stables and other premises drained. 232 Old brick drains relaid with stoneware glazed pipes. 251 Waste water pipes disconnected from drains and made to discharge in the open air. 139 Rabbits. 4 Cwt. Beef. Seized and destroyed, being unfit for human food. 2 Boxes of Fish 4 Persons suffering from infectious diseases removed to Hospital. 7 Dead bodies removed from rooms to mortuary, upon Magistrates orders. 170 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 3rd, 1882, to April 3rd 1883. Number of Samples. Amount of Fines Costs. Article. Genuine. Adulterated. 33 23 I Milk £ s. d. 11 13 6 10 2 0 0 4 £ s. d. 6 7 6 1 5 0 Coffee 2 2 1 3 0 1 5 0 Butter 15 12 3 ... ... ... 5 ... ... ... ... Bread 5 Flour 4 4 ... ... ... ... ... ... ... Mustard 8 ... ... ... ... 8 ... ... ... Pepper 2 ... 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... Lard 1 ... ... ... Arrowroot 1 ... ... ... Cond. Milk 1 ... ... ... ... 1 ... ... ... 74 8 17 6 15 14 16 6 59 The fines and costs recovered under the Sale of Food and Drugs' Act, are paid to the Vestry's account. H. THOMAS, Inspector. BERMONDSEY VESTRY. SANITARY PRECAUTIONS TO BE OBSERVED AGAINST DIARRAŒA, CHOLERA, AND INFECTIOUS DISEASES GENERALLY. The Vestry, as the Local Sanitary Authority, and on the advice of their Medical Officer of Health, desire to call the attention of all owners and occupiers of property within the Parish to those Sanitary Measures which experience has proved to be of service in avoiding diseases of various kinds, and especially in preventing the spread of those which are infectious. AREAS, &c —All areas, basements, cellars, kitchens, yards, and other damp and dark places, should be cleared of all rubbish, well lime-whited, and kept in a clean state. DUSTBINS, &c.—All dustbins should be regularly emptied; be kept covered and protected from rain or wet. Vegetable refuse should not be placed in the dustbin, but, after slight drying behind the fire, be burned—small quantities being placed on the fire at one time. REFUSE, &c.—All offensive accumulations should be removed. No stable or other manure should remain near a dwelling house. All places where fowls, pigeons, rabbits, dogs, or other animals are kept, should be kept scrupulously clean. DRAINS, &c.—All closets, sinks and drains should be kept clear, and be properly trapped from the sewer. They should be flushed daily during the summer. Whenever there is any infectious disease, or even a case of diarrhœa, in the house, some chloride of lime, or green copperas, or carbolic acid, should be added to the flushing water as a disinfectant. Care should be taken that all traps are properly fixed, covered and supplied with water—otherwise the drain is not trapped. Rats inside a house generally show defective drains close at hand. CISTERNS, &c.—All cisterns and water-butts should be kept clean and covered over, Wooden butts should be pitched inside. If the waste pipe is connected with the drain or soil pipe, it should be disconnected, and converted into an overflow or warning pipe; otherwise the water may become polluted by foul air, to the danger of health and life. WASTE PIPES, &c.—Bath or sink wastes, and rainwater pipes should be disconnected from the drain, and made to discharge in the open air, over a trapped stoneware gulley. FRESH AIR, &c.—Houses should be kept clean. Plenty of fresh air should be admitted by opening windows. Overcrowding should be avoided, especially in sleeping rooms. DIET, &c.—Every person should live regularly and temperately. Stimulants are injurious. Intemperance is dangerous. There is no objection to vegetables, if gocd, or to ripe fruit, if sound and eaten in moderation. All stale, or over-kept fruit, fish, meat, and vegetables, should be shunned. Great care should be taken to give no sour or stale food to children. The greatest pains should be taken to ensure pure water for drinking purposes. DIARRHŒA, &c.—Every person attacked by diarrhœa, especially if without pain, should attend to himself, and obtain proper medicine. When young children suffer from watery purging in summer, medical aid should be sought without delay. DISINFECTION, &c.—ln all infectious diseases, and especially in enteric or Typhoid fever, and in Cholera, every-thing that passes from the sick person should be received into vessels containg half-a-pint of a solution of green copperas, made by dissolving one pound of the copperas in a gallon of water. In ordinary Diarrhœa the same course is recommended as a prudent precaution. All infected body and bed-linen should be first put into a solution of carbolic acid—in the proportion of a wine glassfull of the acid to a gallon of hot water —and after remaining therein for at least an hour, be afterwards boiled in water. All rooms infected with small pox, typhus, or scarlet fever, should be disinfected with burning brimstone. INTERMENTS.—The dead should be buried without delay. No dead body should be kept in a room where persons are living, but should be removed to the mortuary. NOTIFICATION, &c—Cases of infectious disease; defective water supply; stopped drains; offensive closets; over-crowding; unemptied dustbins, etc., may be reported to the inspector at the Town Hall, any week day morning at 10 o'clock. All communications are regarded as private, but they should be authenticated by the proper name and address of the person giving the information. By Order of the Vestry, JOHN DIXON, M.D., Medical Officer of Health. 133, Jamaica Road, August, 1883. FORTNIGHTLY REPORTS From January 15th, 1883, to January 7th, 1884. January 15th, 1883. During the fortnight that ended on the 6th day of January, 132 births and 66 deaths were registered in Bermondsey. These numbers correspond to an annual birth rate of 39.4, and an annual rate of mortality of 19.7 per 1000 of the estimated population. The death rate in London was 21.7. Zymotic diseases caused 5 deaths, viz.:—Measles 2, scarlet fever 1, and diarrhœa 2. From diseases of the respiratory system, there were 20 deaths, of which 12 were referred to bronchitis, 6 to pneumonia, and 2 to croup. In the tubercular class there were 5 deaths, all from Phthisis. Two inquests were held. The deaths were assigned to natural causes. Three deaths were not certified. February 5th, 1883. During the three weeks that ended on the 27th day of January, the number of births registered in the parish was 213, and the deaths numbered 102. The annual birth rate was 43.3, and the annual rate of mortality was 20.3 per 1000 of the estimated population. The corresponding death rate in London, was 21.0 per 1000. The mortality from the principal divisions of the zymotic class was low, there being only 10 deaths, viz.:—from measles 5, scarlet fever 2, whooping cough 1, and diarrhœa 2, Diseases of of the respiratory system caused 24 deaths, of which 19 were referred to bronchitis, 2 to pneumonia, 2 to croup, and 1 to congestion of the lungs. Fifteen deaths were attributed to tubercular diseases, of which 9 were due to phthisis. There were 7 deaths from old age, and 9 from premature birth. The latter included three pairs of twins. I regret to observe that three women died of childbirth within the space of 15 days. Two of the deaths were registered as "puerpural fever." All these cases were attended by the same medical student. One inquest was held. Four deaths were not certified. The accumulation of Manure and Dust at the Vestry Wharf is excessive, and the former is becoming offensive. During the past year, the registered births in Bermondsey, numbered 3485, and the deaths 1913. The annual birth rate was 40.0, and the death rate 22.9 per 1000. The death rate in London, was 21.4, and the mean rate of 27 provincial towns, 23.0. February 19th, 1883. During the fortnight that ended on the 10th day of February, 137 births and 90 deaths were registered in the parish. The deaths included 23 under 1 year of age, and 25 above 60 years. The annual birth rate was 40.6, and the annual rate of mortality was 26.6 per 1000 of the estimated population. The death rate in London was 21.6, and the mean rate of large provincial towns 23.6. The mortality from diseases of the zymotic class was low, the deaths numbering 7, of which 3 were from measles, 2 from scarlet fever, 1 from diphtheria, and 1 from typhus and pneumonia. Diseases of the respiratory system caused no less than 37 deaths, viz.:—bronchitis 26, pneumonia 6, and croup 5. From tubercular diseases there were 17 deaths, viz.:- phthisis 11, meningitis 4, and tabes 2. Seven deaths were attributed to natural decay. Six inquests were held, 3 deaths being referred to natural causes, and 3 to accident. Two deaths were not certified. The water supplied by the Southwark Company during the month of January, was of inferior quality. The Vestries of the parishes of St. Pancras, Islington, Clerkenwell, Kensington, and the Lewisham Board of Works, have passed resolutions expressive of their opinion, " That the power formerly vested in the Vestries and District Boards, under the "Bakehouses Regulation Act," 1863, should be restored to those bodies; and further, that the Vestries and District Boards should be empowered to make bye-laws for the regulation of all bakehouses within their respective Districts." Copies of these resolutions have been forwarded to the Secretary of State, the Metropolitan Board of Works, and the several Vestries and District Boards in the Metropolis. In this parish, the Sanitary Inspector has continued to inspect bakehouses under the provisions of the "Nuisances Removal, and Sanitary Acts," notwithstanding the repeal by the "Factory and Workshops Act, 1878," of the "Bakehouses Regulation Act, 1863." In my opinion, the present state of the Law is unsatisfactory. I think full powers of inspection and supervision should be restored to the Local Sanitary Authorities. I consider it desirable that all bakehouses in the Metropolis, should be regulated by an uniform set of bye-laws, framed by the Metropolitan Board, and that they should be licensed or registered the same as cowsheds or dairies. March 5th, 1883. During the fortnight that ended on the 24th day of February, 133 births and 72 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 30.3, and an annual rate of mortality of 20.2 per 1000 of the estimated population. The corresponding death rate in London was 20.3. Only 4 deaths were referred to diseases of the zymotic class, measles, diphtheria, whooping cough, and diarrhœa, each being the cause of 1 death. The deaths from diseases of the respiratory system, numbered 23, viz.: —bronchitis, 17, pneumonia 4, croup 2. Tubercular diseases caused 12 deaths, 9 being attributed to consumption, 1, to meningitis, and 2 to tabes mesenterica. There were 5 deaths from old age, and one from intemperance. Four inquests were held. Three deaths were assigned to violence, and 1 to natural causes. March 19, 1883. During the fortnight that ended on the 10th day of March, 140 births and 64 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 41.3, and an annual rate of mortality of 18.9 per 1,000 of the estimated population. The corresponding death rate in London, was 21.3, and the mean rate in the large provincial towns was 23.0 The chief diseases of the zymotic class caused 5 deaths, viz:—Enteric fever 2, scarlet fever, whooping cough, and diarrhœa, each 1. From diseases of the respiratory system there were 20 deaths, of which 13 were attributed to bronchitis, 4 to pneumonia, 2 to croup, and 1 to congestion of the lungs. Sixteen deaths were due to tubercular diseases, viz.:— Phthisis 9, meningitis 4, tabes mesenterica 1, tuberculosis 2. Six deaths were referred to old age. Four inquests were held. Two cases of suicide occured; one by hanging and one by drowning. Five deaths were not certified. The present fortnightly return is a very favourable one, but the effect of the late change in the weather will probably appear in my future reports. April 2nd, 1883. During the fortnight that ended on the 24th day of March, 127 births and 85 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 37.5, and an annnal rate of mortality of 24.9 per 1000 of the estimated population. The corresponding death rate in London, was 24.7. From diseases of the zymotic class only 6 deaths were recorded, viz.:—from measles 2, diphtheria 1, whooping cough 1, and diarrhœa 2. Diseases of the respiratory system were more fatal than in the previous fortnight; 29 persons died from disorders of this class, viz.:—20 from bronchitis, 5 from pneumonia, 3 from croup, and 1 from pulmonary congestion. The deaths from tubercular diseases included 10 from consumption, 3 from meningitis, 1 from tabes mesenterica, and 1 from tuberculosis. Twelve deaths were referred to old age, 6 to heart disease and 7 to convulsions. One inquest was held. The cause of death was "burn, from the child's night dress accidentally taking fire." Four deaths were not certified. Three of these were registered as due to bronchitis, and 1 to convulsions. The increased mortality is caused by the greater number of deaths from pulmonary diseases and old age. April 16th, 1883. In the fortnight that ended on the 7th day of April 145 births and 70 deaths were registered in the parish. These numbers were equal to an annual birth rate of 44.2, and an annual rate of mortality of 20.6 per 1000 of trie estimated population. The corresponding death rate in London was 26.9. The chief diseases of the zymotic class caused 5 deaths, viz.:—measles 3, typhus 1, and diarrhœa 1. From diseases of the respiratory system, 24 deaths were recorded, viz.:— 14 from bronchitis, 6 from pneumonia, and 4 from other diseases. In the tubercular class, there were 11 deaths, of which 6 were referred to phthisis, 4, to meningitis, and 1 to tabes. Five persons died of natural decay. Under 1 year of age, there were 19 deaths, and at 60 years of age and upwards, 15. Five inquests were held, in 4 of these the deaths were caused by violence. Six deaths were not certified. The mortality from affections of the chest is still high, while that which is due to zymotic diseases is particularly low. The general state of the public health is satisfactory. May 7th, 1883. During the three weeks that ended on the 28th day of April, 210 births and 106 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 41.3 and an annual rate of mortality of 20.8 per 1000 of the estimated population. The corresponding death rate in London was 22.9. Diseases of the zymotic class caused 10 deaths viz.:— measles and scarlet fever, each 2, whooping cough 3, typhus fever, enteric fever and diarrhœa, each 1. From diseases of the respiratory system there were 36 deaths, of which 22 were referred to bronchitis and 12 to pneumonia. Fourteen persons died from tubercular diseases viz., 9 from phthsis, 4 from meningitis, and 1 from tabes mesenterica. Thirteen deaths were attributed to old age, and 5 to heart disease. Two inquests were held:—both cases were suicide by drowning. One death was not certified. Fatal cases of pulmonary diseases continue numerous for the season of the year. The zymotic death rate is very low. May 21st, 1883. During the fortnight that ended in the 12th day of May, 123 births and 59 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 36.3, and an annual rate of mortality of 17.4 per 1000 of the estimated population. The corresponding death rate in London was 20.8 and the mean rate of all the large towns was 22.2. The chief zymotic diseases caused 12 deaths, viz.:—measles 6, diphtheria 1, whooping cough 1, and diarrhœa 3. The number of deaths from diseases of the respiratory system declined to 15. There were 9 deaths from bronchitis, 4 from pneumonia, 1 from croup, and 1 from congestion of the lungs. Eleven deaths were referred to diseases of the tubercular class: —7 to phthsis, 2 to meningitis, 1 to tabes mesenterica, and 1 to tubercular peritonitis. There were 4 deaths from old age, and 3 from heart disease. One inquest was held, and 3 deaths were uncertified. The mortality returns shew a healthy state of the parish. The water supplied by the Southwark Company during last month was unusually free from organic matter, and delivered in an efficiently filtered condition. On the letter received from the Coroner's Officer, which was referred to me, I beg to report that the first part of the letter, which relates to the conduct of the parish undertaker and one of the relieving officers, should have been sent to the Board of Guardians, rather than to the Vestry. On the second part of the letter, which suggests that one of the mortuaries should be set apart for the exclusive use of the Coroner's Officer, I beg to observe that both mortuaries (one for contagious and one for non-contagious diseases,) are intended for the convenience and advantage of the parishioners generally, and I do not think the parishioners should be restricted to the use of the one for contagious diseases. A mistake like the one referred to in the letter would be obviated by having a separate and distinctive shell for cases which were awaiting an inquest. It is desirable that a record should be kept of all bodies which are brought to the mortuary, with the dates of their removal therefrom. At present, the mortuary may be made use of for the convenience of undertakers in any part of London, and bodies may be kept there for an indefinite period, without the Vestry or its officers having any knowledge of the facts. June 4th, 1883. During the fortnight that ended on the 26th day of May, 135 births and 63 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 39.8 and an annual rate of mortality of 18.6 per 1000 of the estimated population. The corresponding death rate in the Metropolis was 20.1, and the mean rate in 28 large towns was 21.3. The chief diseases of the zymotic class caused 10 deaths, viz.:-measles 7, scarlet fever, whooping cough, and diarrhœa each 1. From diseases of the tubercular class there were 17 deaths, of which 9 were referred to phthisis. Fifteen deaths were attributed to diseases of the respiratory system. Five inquests were held :-3 of the deaths were due to violence, and 2 to natural causes. Two deaths were not certified. Sixteen ehildren died under one year of age, and ten persons aged 60 years and upwards. The present rate of mortality is much below that which prevailed at the corresponding period of last year. June 18th, 1883. During the fortnight that ended on the 9th day of June, 131 births and 54 deaths were registered in the parish. These numbers are equal to an annual birth rate of 38.7, and an annual rate of mortality of 15.9 per 1000 of the estimated population. The corresponding death rate in London was 18.5, and the mean rate in the 28 cities and large boroughs, was 19.5. The deaths from the principal diseases of the zymotic class numbered 13, viz.:-measles 8, whooping cough 2, scarlet fever, diphtheria, and enteric fever, each 1. Diseases of the respiratory oagans caused 15 deaths, and tubercular diseases 11. Twelve children died in the first year of life, and 8 persons at upwards of 60 years. Two inquests were held, and one death was not certified. The water supplied by the Southwark Company during May, was unusually free from organic matter, but was not efficiently filtered. The general health of the parish is remarkably good, but the season of the year is approaching when the inhabitants should take especial care that their cisterns are kept clean; and all persons having the care of young children should scrupulously avoid giving them milk or other food which is even beginning to turn sour. July 2nd, 1883. During the fortnight that ended on the 23rd day of June, 133 births and 55 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 39.3, and an annual death rate of 16.2 per 1000 of the estimated population. The corresponding death rate in London, was 17.2. The chief diseases of the zymotic class caused 9 deaths, viz.:—measles 5, scarlet fever 1, and whooping cough 3. There were 8 deaths from diseases of the respiratory organs, 8 from tubercular diseases, and 5 from heart disease. Five inquests were held and 1 death was uncertified. My attention has been called to a building in Riley Street, at the end of the Grange, where the skins of fish are cleaned and dried. The business is a small one, but sufficient to create a nuisance which is complained of by the occupiers of the adjoining premises. The place is a stable, and not a suitable place for any such business. July 16th, 1883. During the fortnight that ended on the 7th day of July, 149 births and 58 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 43.9, and an annual rate of mortality of 17.1 per 1000 of the estimated population. The corresponding death rate in London was 19.5. The principal diseases of the zymotic class caused 14 deaths, viz. :—measles 1, scarlet fever 5, diphtheria I, enteric fever 2, and diarrhcea 5. From diseases of the respiratory system there were 8 deaths, and from tubercular diseases, n. Fourteen children died in the first year of life, and 7 persons at upwards of 60 years of age. A child, aged 1 month, died from suffocation, caused by impaction of food in the throat. Two deaths were not certified. The general state of the public health is satisfactory. The death rate is below that of the corresponding period in 1882, and 1881. Very offensive smells have been complained of in the neighbourhood of the workhouse. I have no doubt they arose from animal matter in a state of decomposition on the premises of Mr. Warren. I have cautioned him to be more careful in conducting his business, so as to avoid a nuisance. July 30th, 1883. During the fortnight that ended on the 21st day of July, 131 births and 78 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 38-7 and to an annual rate of mortality of 23-0 per 1000 of the estimated population. The corresponding death rate in London was 23'2. The number of deaths under one year of age was 27, and above 60 years, 7. Zymotic diseases caused 26 deaths, of which 17 were due to diarrhcea, 5 to measles, 2 to scarlet fever, 1 to diphtheria, and 1 to whooping cough. Of the deaths which occurred from diarrhcea, 14 were under one year of age, 2 were between I and 2 years, and 1 was a person aged 73 years. Constitutional diseases caused 15 deaths, of which 10 were referred to meningitis. Nine deaths were caused by diseases of the respiratory system. Six inquests were held. In two cases the deaths were assigned to " natural causes " and in four to " violence." Three deaths were not certified. During the last fortnight diarrhcea has been three times as fatal in London as in the provincial towns. The largest proportion of fatal cases occurred in East London. Of 325 deaths, there were 247 infants under 1 year, and 56 children between 1 and 5 years of age. A few years ago the Vestry issued some public notices on the subject of the prevention of infectious and diarrhceal diseases. With the sanction of the Vestry I purpose to do something of the same kind this year. I also think that notices should be issued for the removal of dust, stable dung, and other accumulations of refuse or offensive matters at short intervals. August 13th 1883. During the fortnight that ended on the 4th day of August, 115 births and 72 deaths were registered in the Parish. These numbers are equivalent to an annual birth rate of 33-9, and an annual rate of mortality of 21-2 per 1000 of the estimated population. The death rate in London for the same period was 20-2. The number of deaths under 1 year of age was 26, and above 60 years of age, 13. Zymotic diseases caused 17 deaths, viz ;—measles 2, scarlet fever 4, whooping cough 1, enteric fever 1, and diarrhcea 9. There were 9 deaths, from diseases of the respiratory system, 7 from tubercular diseases, 8 from affections of the brain, and 7 from old age. There were 3 deaths from violence. 1 of these was the case of a child, aged 12 weeks, which died from " asphyxia, arising from over distention of the stomach by food." The mortality from diarrhcea is below the average for the season of the year. In accordance with the resolution of the Vestry I have prepared a concise summary of the sanitary precautions which ought to be adopted by every householder to avoid diarrhœa, cholera, and infectious diseases generally. The constant observance of these precautions would enable the inhabitants to avoid many other diseases which are not included in the term "infectious." September 17th, 1883. During the 5 weeks that ended on the 8th day of September the number of births registered in the Parish was 313, and the number of deaths was 129. The annual birth rate was 36.9, and the annual rate of mortality 15.2 per 1000 of the estimated population. The death rate in London was 17.5 per 1000. Of the deaths which occurred in Bermondsey, 40 were children under one year, and 12 were persons of upwards of 60 years of age. The principal diseases of the zymotic class caused 40 deaths, viz:- measles 8, scarlet fever 15, diphtheria 3, whooping cough 1, enteric fever 2, and diarrhœa 11. The deaths from diphtheria occurred in the St. James's district. I am very doubtful about one of the deaths which was registered as "enteric fever," being due to that disease. Upwards of 11,000 copies of Sanitary Precautions have been distributed from house to house throughout the parish, and 300 large sheets have been posted in courts, and factories, as well as on the walls. The immediate result was that a plentiful crop of nuisances was brought under my notice, all of which were promptly attended to. I have inspected houses in Long Lone, Queen's Gardens, Snowsfields, Crucifix Lane, Bermondsey Street, Riley Street, Paulin Street, Nelson Street, Alscot Road, Willow Street, Alderminster Road, Lynton Road, Drummond Road, Lucey Road, and Marine Street. The nuisances comprised dirty houses, stopped drains, defective water supply, overcrowding, and accumulations of manure. Complaint has been made of a nuisance at Channel Row, which arises from burning shavings, &c., from old anchovy casks. At No. 72, Long Lane, an undertaker's shop, the police found 11 bodies of infants, of which 10 were stillborn. They were conducted there at midnight, by the manager of the branch establishment, who had had a dispute with his employer about 3s. due for wages. The police removed the bodies out of the parish and then communicated with me, but I did not see that there would be any advantage to the parish in my fetching the nuisance back. That the man Camden was guilty of an outrage against public decency, as well as of gross breach of faith with his customers, admits of no doubt. That a nuisance existed when the coffins were opened is equally evident. If he has committed a criminal offence the matter is already in the hands of the police. Whether any further proceedings can be taken under the Sanitary Acts for the prolonged detention of the bodies on the premises, I am unable to say, but suggest that the Vestry should take the opinion of the Law Clerk on that point. The accumulation of dust and manure at the Vestry Wharf is much larger than should be allowed. October 1st, 1883. During the fortnight that ended on the 22nd day of September, 136 births and 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 15.9, per 1000 of the estimated population. The corresponding death rate in London was 16.8. The fatal cases of diarrhœa in the Metropolis are considerably below the average of the corresponding period in the previous ten years. Our deaths from the chief diseases of the zymotic class numbered 16, of which 2 were referred to measles, 7 to scarlet fever, 1 to diphtheria, 2 to whooping cough, and 4 to diarrhœa. Diseases of the respiratory organs caused 12 deaths, and tubercular diseases, 6. One death arose from accident. The accumulation at the Vestry wharf has been reduced. Seven barge loads were removed last week. About 6 barge loads are remaining. October 15th, 1883. During the fortnight that ended on the 6th day of October 130 births and 56 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 38.4, and an annual rate of mortality of 16.5 per 1000 of the estimated population. The death rate in London was 16.5. Zymotic diseases caused 12 deaths, viz.:—measles 1, scarlet fever 9, diphtheria 1, and enterie fever 1. Scarlet fever is prevalent. There were no deaths from diarrhœa or cholera. Diseases of the respiratory system caused 12 deaths, and those of the tubercular class 9. Fourteen children died under 1 year of age, and 8 persons at upwards of 60 years. There were 3 inquests, and 2 deaths were attributed to violence. The water supplied by the Southwark Company, during September, was clear and bright and unusually free from organic matter. At the Vestry wharf there are about 4 barge loads of dust, &c., It is distributed in several heaps and a large portion is deposited close to the wall next the street, which I think should be avoided as much as possible. The Committee of the Metropolitan Board for carrying out the Artizans' Dwellings Acts have expressed their intention of visiting the Kirby Street area on Saturday next. An official representation concerning this area was made by your Medical Officer in October, 1875. November 5th, 1883. During the 3 weeks that ended on the 27th day of October, 195 births and 95 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 38.4, and an annual rate of mortality of 18.8 per 1000 of the estimated population. The corresponding death rate in London was 18.9. The deaths under 1 year of age numbered 26, and those above 60 years of age, 17. From the chief diseases, of the zymotic class, there were 22 deaths, of which 15 were from scarlet fever, 2 from diphtheria, 2 from whooping cough, 2 from enteric fever, and 1 from diarrhœa. Diseases of the respiratory system caused 15 deaths, and those of the tubercular class 14. Five inquests were held. Two deaths were not certified. On the 27th ult., I seized 87 rabbits, and 2 boxes of fish— the latter weighing about 10 stone—which were unfit for human food. These articles had been delivered to the local tradesmen in an unsound condition. A very fair clearance of dust has been effected at the Vestry Wharf. On the 20th ult., I met the Sub-Committee of the Metropolitan Board on Artizans Dwellings, to inspect the unhealthy area near Snowsfields, which was the subject of an official representation by Dr. Parker, dated 29th October, 1875. The Committee directed my attention to a broken flag in the pavement of Suffolk Place, and requested that I would report the same to the Vestry. There was also a broken flag in lor 2 of the adjoining Courts. Since then I have received the following letter, dated 31st October. [Read.] During the 8 years that this area has been under the consideration of the Metropolitan Board, about 20 houses have been pulled down in Kirby Street, for the erection of a Board School, and the various courts have been kept in as clean and healthy a condition as possible, through receiving the constant weekly supervision of the Sanitary Inspector, but the close and badly ventilated condition of Suffolk Place, Webb's Court, Palmer's Rents, Ship and Mermaid Court and Row remain as before. I do not know under what clause of the Artizans Dwelling Act the Board require me to submit an amended representation. The Board is of opinion that "some parts of the area appear to be within the scope of the Act," and as Section 5 of the Act, (1875), provides that the local authority "may exclude any part of the area in respect of which an official representation is made." I do not know why the Board declines to deal with those parts which, in their opinion, do come within the scope of the Act. At the meeting of the Metropolitan Board on the 26th, October, 19 areas, concerning which official representations had been made by the Medical Officers of Health of 10 different parishes, were considered. Twelve of these were rejected on the ground of not coming within the scope of the Act. Two were said to be too limited in size. Three were said to be less urgent than others. One was adjourned till next year, and in one an amended representation was required. It is much to be regretted that so much time and labour have been wasted in making these official representations concerning unhealthy areas, in consequence of the medical officers not knowing what amount of ill construction of houses, want of ventilation, density of population, sickness, and deaths, will entitle such area to be considered "within the scope of the Act." I have also received the following letter respecting the Foxlow Street area. [Read.] Time and other means have already dealt with this area. The nuisance complained of, at Mr. Waring's premises, in Willow Street, has been abated. November 19th, 1883. During the fortnight that ended on the 10th day of November, 127 births and 67 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 37.5, and an annual rate of mortality of 19.7 per 1000, of the estimated population. The corresponding death rate in London was also 19.7. Zymotic diseases caused 10 deaths, of which 8 were referred to scarlet fever, and 2 to diarrhœa. Diseases of the respiratory system caused 17 deaths, and those of the tubercular class 11. The water supplied by the Southwark Company during the month of October was of inferior quality. On Thursday last Sir Charles Dilke inspected the unhealthy areas in the neighbourhood of Snowsfields and Foxlow Street, concerning which official representations, under the Artizans' Dwelling Act, 1875, had been made to the Metropolitan Board, in December, 1875, and September, 1878. I have visited Mr. Salmons' artificial manure works, and report that the nuisance which occurred on the 22nd of October, and which was complained of by Messrs. Peek & Co., arose from the opening of a door communicating with the closed chamber. It is said that this was done by one of the workmen, without the knowledge or authority of the manager. In order to prevent a recurrence of the nuisance, the doorway in question has been bricked up. One of the houses in Foxlow Street appears to me to be in a dangerous condition, as the front wall bulges out considerably. December 3rd, 1883. In the fortnight that ended on the 24th day of November, the number of births registered in the parish was 143, and the number of deaths 75. The annual birth rate, per 1000, of the estimated population, was 42.2, and the annual rate of mortality 22.1. The corresponding death rate in London was also 22.1. In the zymotic class of diseases there were only 5 deaths, all of which were from scarlatina. Diseases of the respiratory system are showing an increased fatality. They caused 26 deaths, of which 20 were attributed to bronchitis. Tubercular diseases caused 6 deaths, and old age 7. Two deaths occurred at upwards of 90 years of age. Five inquests were held, and one death was not certified. At the Vestry Wharf there is very little dust and less than the usual amount of hard core. There is a much larger accumulation of manure and slop, but it is not in an offensive condition at present. December 17th, 1883. In the fortnight that ended on the 8th day of December, the number of births registered in the parish was 121, and the number of deaths 75. These numbers are equivalent to an annual birth rate of 35.7, and an annual rate of mortality of 21.1, per 1000, of the estimated population. The corresponding death rate in London was 21.6. The chief diseases of the zymotic class caused 15 deaths, viz :—measles 1, scarlet fever 10, diphtheria 2, whooping cough 1, and diarrhœa 1. From diseases of the respiratory organs there were 26 deaths, of which 18 were referred to bronchitis, and 6 to pneumonia. Nine deaths were attributed to phthisis. Three inquests were held, 1 death was caused by "accidental asphyxia. Two deaths were not certified. Twenty-three deaths occurred during the first year of life, and 9 at upwards of 60 years of age. January 7th, 1884. During the 3 weeks that ended on the 29th day of December, 171 births and 111 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 33.6, and an annual rate of mortality of 21.8, per 1000, of the estimated population. The corresponding death rate in London was 21.2. The deaths under one year of age numbered 29, and these above 60 years, 20. Zymotic diseases caused 20 deaths, viz. : —measles 3, scarlet fever 11, diphtheria 1, whooping cough 2, and diarrhœa 3. Nine inquests were held. Two deaths were the result of "violence." Two deaths were not certified. The present accumulation of refuse at the Vestry Wharf is between 250 and 300 tons.