THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE Parish of Bermondsey, FOR THE YEAR 1884. 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. C.x Lon THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH of BERMONDSEY FOR THE YEAR 1884. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physician 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 honour of submitting my Ninth Annual Statement of the general mortality and sanitary condition of the parish during the preceding twelve months. My present Report embraces a period of fifty-three weeks, ending on the third day of January, 1885. The year 1884 exhibited a comparatively low rate of mortality notwithstanding a slight increase in the number of fatal cases of certain diseases. Smallpox, which had been absent for a year and a half, again made its appearance. The deaths however, were only five, or half the decennial average. The deaths from Scarlet-fever amounted to but half of the number which occurred in the previous year. Measles, Whooping-cough, and Diarrhæa showed an increase in the number of deaths. The last mentioned disease invariably tends to raise the general mortality whenever the summer is hotter than usual, as was the case last year. The continued prevalence of Cholera on the Continent of Europe rendered it advisable for your sanitary officers to exercise increased vigilance in getting the closets of the poorer class of houses supplied with water. As a preparatory step to placing houses, which are let in lodgings, or occupied by members of more than one family, under a system of sanitary bye-laws and constant supervision, I organized a special inspection of every court, and of all the smaller houses throughout the parish. The immediate result of this, was the discovery of numerous sanitary defects to which our attention might not otherwise have been called. The Special Sanitary Inspections included 198 streets, courts and places, containing a total of 3465 houses, of these, 3234 were reported on. The number of houses occupied by a single family was 1701, and by more than one family, 1533. The number of houses occupied by two families was 1130; by three families, 305; by four families 66; by five families, 17; by six families, 11; and by seven families, 4. The higher numbers included one or more single men lodgers. There were no houses consisting of a single room. The number consisting of two rooms was 437; of three rooms 305; of four rooms, 1425; of five rooms, 419; of six rooms, 540; of seven rooms, 32; of eight rooms, 23; of nine rooms, 10; of ten rooms, 3; of eleven rooms, 3; of 12, 13, 15, and 21 rooms, each 1. In a few cases the Inspector's returns were only partially completed. In 12,266 rooms, there were 4,880 families, consisting of 21,072 persnos, of whom 13,760 were adults, and 7,312 were children under 12 years of age. In 3,005 houses the number of w.c.'s was 2878. No water was laid on in 1012; the apparatus was out of order, in 249, and 34 were stopped. The number of houses provided with dustbins was 2606; and the houses without dustbins, 399. As a general rule the latter were near some public dust bin. The number of cisterns was 2,266; and of water butts, 610. Several of these were in a defective condition. The number of drains found untrapped was 167; defective, 381; and stopped, 39. Badly paved yards were frequently met with, and they were also commonly found in a very dirty state where fowls, ducks, geese, rabbits and pigeons were kept. On comparing the sanitary work or Last year with that which was done ten years ago, I find that the number of houses inspected in 1874 was 11 6, while in 1884 the number of such inspections had increased to 6146. During the same period the number of notices served for the execution of sanitary works has risen from 112 to 5992. Previous to 1876, there is no record of any attempt having been made to compel landlords to provide the closets of small houses with a proper supply of water. Since that day no less than 3872 houses have obtained the benefit of this essential improvement in their sanitary condition. We have every reason to hope that measures of this kind will place the parish in a better position to resist a possible invasion of cholera, and we are confident, that they will not be without their effect in checking the spread of other preventible diseases. POPULATION. For statistical purposes the mean population of the year is calculated from the rate of increase which prevailed during the ten years preceding the last Census. On this basis, the number of inhabitants is estimated at 88,674. About 1,000 persons annually leave the Parish to obtain their livelihood elsewhere. BIRTHS. The number of births registered in the Parish was 3,469, being 34 more than in the previous year, and 106 less than the average of the preceding ten years. The male children numbered 1,728, and the female 1,741. The annual birth-rate was 39.1 per thousand of the estimated population. The London birth-rate was 33.7 per thousand. In the Leather Market District there were 662 births; in St. Mary Magdalen District 606; and in the St James's District 2201. During the first quarter of the year, the births numbered 934; in the second quarter 832; in the third quarter 807; and in the fourth quarter, 896. The excess of births over deaths was 1,692. The natural increase of the population was 1.9 per cent. DEATHS. The total number of deaths registered, was 1777, of which 897 were males, and 880 females. In the previous year, the recorded deaths were 1722, but as the present year includes an additional week, and also a larger population, the mortality may be considered the same as last year. The deaths were sixteen below the average of three years, and sixty nine below that of ten years. The annual rate of mortality, was 20.0 per thousand of the estimated population. The London death-rate was 20.3 per per thousand. The number of persons who died in the Leather market district was 364; in the St. Mary Magdalen district, 410; and in the St. James's district, 1003. In the first quarter of the year, there were 408 deaths; in the second quarter, 452; in the third quarter, 486; and in the last quarter, 431. The numbers of deaths which occurred in the first year of life was 536, showing an infantile rate of mortality of 154 per thousand registered births. The infantile death rate in London was 155 per thousand registered births. Above sixty years of age, there were 356 deaths. The number of deaths in the Workhouse was 151, or eight and a half per cent, of the total deaths. CAUSES OF DEATH. The chief diseases of the Zymotic class, caused 335 deaths, or 18.7 per cent, of the total deaths from all causes, and 3.7 per thousand of the estimated population. The Zymotic death rate in London was 3.3 per thousand. In the previous year, the Zymotic deaths numbered 292, or 17 per cent. ; the decennial average being 374. Small Pox caused 5 deaths; 3 being males and 2 females. Two were under one year of age; one was between 1 and 5 years; one between 5 and 15 years; and one between 15 and 25 years. One case occurred in the Leather market district; two in St. Mary Magdalen, and two in St. James's district. From Measles there were 81 deaths, against 67 in the previous year, and a decennial average of 64. Half of the deaths [42) occurred during the second quarter of the year; 56 took place between the ages of 1 and 5 years—one was an adult. Two deaths were recorded from what is called "German Measles." From Scarlet Fever, there were 48 deaths, against 101 in the previous year, and a decennial average of 75. From Diphtheria, there were 10 deaths, all of which occurred in the St. James's district. Whooping Cough caused 82 deaths, or 57 more than in 1883, but 15 fewer than the decennial average. The second quarter of the year was the most fatal. As is the case with both Measles and Scarlet Fever, a very large proportion of deaths from this disease takes place under 5 years of age. It is satisfactory to record the fact, that not a single death from Typhus was registered in the Parish during the year. From Enteric Fever there were 10 deaths, and from simple continued Fever, 2. The death rate from Fever in Bermondsey (o.13), was exactly half that of London (0.26); the latter was below the decennial rate which is 0.33. From Diarrhoeal diseases, there were 97 deaths, of which 3 were stated to be Choleraic Diarrhæa, or English Cholera. 83 of these deaths occurred in children under 5 years of age, and 42 in the summer quarter. Two deaths were attributed to Chicken-pox. This is rarely a fatal disease. There may have been complications which of themselves were sufficient to account for death. In the tubercular class, there were recorded 166 death from Phthisis; 64 from Menengitis; 26 from Tabes Mesenterica; and 18 from other less clearly defined forms of tubercular disease. In the large class of local diseases, the first place is occupied by those of the respiratory organs from which there were no less than 415 deaths, the chief causes being Bronchitis 279, and Pneumonia 86. 136 deaths were referred to diseases of the Nervous System; 67 to those of the Heart and Circulatory Organs; 83 to those of the Stomach and Digestive Organs; 26 to affections of the Kidney and Urinary system, and 8 to diseases of the Bones and Joints. From old age there were 121 deaths, and from premature birth 43. A large proportion of the deaths in infants is attributed to Atrophy, Debility, Marasmus, Asthenia, and other causes which are well understood, but not easily classified with that accuracy and precision which would render them available for scientific data. Inquests were held in 89 cases, or 5 per cent, of the total deaths; 38 deaths were due to violent causes; 12 children died from accidental Asphyxia; 3 persons from burns and scalds; 2 from drowning; 5 from fractures and contusions of various kinds. A woman aged 62 was killed by the impaction of a piece of meat in the throat. A man aged 27 was decapitated by being run over by a railway carriage. A woman aged 72 died from the effects of drinking accidentally Carbolic Acid, carelessly placed in a beer bottle. Four persons died suddenly from the effects of intemperance. There were 3 cases of suicide, 2 by hanging (one of which was a lad aged 15 years, and the other an old man, aged 65,) and a woman by cutting her left arm. Two children were wilfully murdered. PREVENTION OF CHOLERA. Epidemic cholera is a disease, which is so mysterious in its origin and progress, so sudden in its attack, so appalling in its symptoms, so great in its fatality, that its approach within a few days' sail of our shores, can hardly fail to excite a certain amount of apprehension and alarm. It is satisfactory, however, to know that the most effective means against its spread are precisely those sanitary measures which are steadily adopted year by year and have been found efficacious in lessening the fatality of Enteric fever and other kindred diseases. They include whatever tends to promote the health of individuals viz., cleanliness, exercise, moderation in food and drink, warm clothing and regularity of habits. They include also, whatever tends to promote the healthiness of our dwellings, such as free ventilation by means of open windows; the removal of all vegetable and animal refuse; the avoidance of damp, by properly concreted or paved basements, cellars, yards and areas; the cleansing and lime-whiting of everv dark or dirty nook or corner; the maintenance of an efficient system of drainage by well constructed drains, and effectivelytrapped sinks and gulleys; the avoidance of all offensive closets by constant cleanliness and frequent flushing. The obtaining an abundant supply of pure water, and preventing its subsequent contamination, by regularly cleansing the cisterns, keeping them covered as a protection from impurities floating in the air, and above all, by preventing any possible pollution of the water which is used for drinking purposes, through the absorption of sewer gas. All waste pipes should be severed from any direct communication with the drain, and be made to open in the air over a trapped gulley. A separate cistern should be used for drinking water. When there is only one cistern, a water waste preventer should be used to break the connection between the cistern and the W.C. When epidemic cholera is prevalent in any locality. it is important that no case of diarrhæa should be neglected. The diarrhoeal discharges should be disinfected as if they were certainly known to be those of cholera. The closets and drains of the house should be daily flushed with chloride of lime and water. The present state of knowledge concerning the mode in which epidemics of cholera (at least in this country) are produced is ably and concisely expressed by Dr. Buchanan, the Medical Officer of the Local Government Board, as follows: — "Cholera in England shows itself so little contagious, in the sense in which Small Pox and Scarlatina are commonly called contagious, that, if reasonable care be taken where it is present, there is almost no risk that the disease will spread to persons who nurse and otherwise closely attend upon the sick. But Cholera has a certain peculiar infectiveness of its own, which, where local conditions assist, can operate with terrible force, and at considerable distances from the sick. It is characteristic of Cholera (and as much so of the slight cases where Diarrhœa is the only symptom as of the disease in its more developed and alarming forms) that all matters which the patient discharges from his stomach and bowels are, or can become, infective. Probably, under ordinary circumstances, the patient has no power of infecting other persons except by means of these discharges; nor any power of infecting even by them except in so far as particles of them are enabled to taint the food, water, or air, which people consume. Thus, when a case of Cholera is imported into any place, the disease is not likely to spread, unless in proportion as it finds, locally open to it, certain facilities for spreading by indirect infection. In order rightly to appreciate what these facilities must be, the following considerations have to be borne in mind —first, that any choleraic discharge, cast without previous thorough disinfection into any cesspool or drain, or other depository or conduit of filth, has a faculty of infecting the excremental matters with which it there mingles, and probably, more or less, the effluvia which those matters evolve; secondly, that the infective power of choleraic discharges attaches to whatever bedding, clothing, towels and like things, have been imbued with them, and renders these things, if not thoroughly disinfected, as capable of spreading the disease in places to which they are sent (for washing or other purposes) as, in like circumstances, the patient himself would be; thirdly, that if, by leakage or soakage from cesspools or drains, or through reckless casting out of slops and washwater, any taint (however small) of the infective material gets access to wells or other sources of drinking water, it imparts to enormous volumes of water the power of propagating the disease. When due regard is had to these possibilities of indirect infection, there will be no difficulty in understanding that even a single case of Cholera, perhaps of the slightest degree, and perhaps quite unsuspected in its neighbourhood, may, if local circumstances co- operate, exert a terribly infective power on considerable masses of population. "The dangers which have to be guarded against as favouring the spread of Cholera-infection are, particularly, two. First, and above all, there is the danger of water-supplies which are in any (even the slightest) degree tainted by house refuse or other like kinds of filth; as where there is outflow, leakage, or filtration, from sewers, house-drains, privies, cesspools, foul ditches, or the like, into springs, streams, wells, or reservoirs from which the supply of water is drawn, or into the soil in which the wells are situate; a danger which may exist on a small scale (but, perhaps, often repeated in the same district) at the pump or dip-well of a private house, or, on a large or even vast scale, in the source of public water-works. And secondly, there is the danger of breathing AIR which is foul with effluvia from the same sort of impurity. "It may fairly be believed, that, in considerable parts of the country, conditions favourable to the spread of Cholera are now less abundant than at any former time; and in this connexion, the gratifying fact deserves to be recorded, that during recent years, enteric fever, the disease which in its methods of extension bears the nearest resemblance to Cholera, has continuously and notably declined in England. But it is certain that in many places such conditions are present as would, if Cholera were introduced, assist in the spread of that disease. It is to be hoped that in all these cases, the local sanitary authorities will at once do everything that can be done to put their districts into a wholesome state. Measures of cleanliness, taken beforehand, are of far more importance for the protection of a district against Cholera, than removal or disinfection of filth after the disease has actually made its appearance." "It is important for the public very distinctly to remember that pains taken and costs incurred for the purposes to which this Memorandum refers cannot in any event be regarded as wasted. The local conditions which would enable Cholera, if imported, to spread its infection in this country, are conditions which day by day, in the absence of Cholera, create and spread other diseases; diseases, which as being never absent from the country, are in the long run, far more destructive than Cholera; and the sanitary improvements which would justify a sense of security against any apprehended importation of Cholera, would, to their extent, though Cholera should never re-appear in England, give amply remunerative results in the prevention of those other diseases." STATISTICS OF LONDON. The estimated population at the middle of the year was 4,019,361 persons The births numbered 137,495, and the deaths 83,050. The excess of registered births over deaths was 54, 445, and the estimated increase of population during the year 64,057. The number of marriages celebrated in 1884 was, 35,367, giving a proportion of 17 .6 persons married to 1,000 inhabitants. This is the lowest rate yet recorded in London. The birth rate (33.7) was the lowest recorded in any year since 1860. when it was 33.6. The death rate (20.3) was the lowest on record, the next lowest being theprevious year when it was 20.4. There has been no rate approaching these rates since 1850, when it was 21.0. Comparing the five groups of districts into which London is divided, the death rate was highest in the Central (23'8), and Eastern (23.0) and lowest in the Northern (19.1); in the South district it was (19.8), and in the West district (19.2). The mean temperature of the air was 50°.7; that of the first quarter being 43°.4; of the second quarter 52 ° .5 ; of the third quarter 62°.7; of the fourth quarter 44.1. The mean temperature of the first quarter was 4.7, and of the third quarter was 3.o above the average of 113 years. The rain-fall amounted to 18.0 inches, being 7*3 below the average. The deficiency occurred in each quarter, but was most marked in the last two quarters. The water supply of London, was of better average quality than in any of the previous sixteen years, The water of the Southwark Company contained both greater maximum, and average amounts of organic matter, than any of the other waters. This unfavourable position is doubtless due to the inadequate storage capacity, which it at present possesses, whereby the exclusion of flood-water from the reservoirs cannot be secured. This Company is at present engaged in carrying out works similar to those of the Lambeth and Grand Junction Companies for collecting subterranean water from the gravel beds adjoining the river, so as to avoid being dependent upon the river itself when the latter is in flood. SANITARY WORK. The number of houses and other premises inspected and report to the Vestry during the year was 6,146, being 3,198 more than in the previous year. The notices served for the execution of the sanitary works required were 5,992, being 3,089 above the number issued in 1883, and fifty-three times as many as were given ten years ago. 378 houses were repaired and cleansed and 141 houses where infectious diseases had been were disinfected cleansed and purified. This includes all cases of the kind that were brought under the notice of your sanitary officers, which was almost exclusively done through the returns of the Registrars of Deaths. 2,029 houses had water supplied to the closets. In 1883 the number of houses so supplied was 603. 464 stopped drains were cleared, 187 defective ones repaired and 285 relaid or new made. In 407 cases the water supply apparatus was repaired, and in 646 the waste pipes were severed from direct communication with the sewers. The number of complaints respecting trade nuisances has much abated during recent years. There can be no doubt that various trades, which are almost peculiar to this parish, and which in certain process are offensive to the senses, are much more carefully conducted than was formerly thought to be necessary. Various nuisances of a minor character have been abated. In all these and other matters, Mr. Thomas has rendered me every assistance with his usual courtesy. Thanking the Vestry for the support I have received in the discharge of my duties. I have the honour to be, Gentlemen, Your obedient Servant, JOHN DIXON, M.D., Medical Officer of Health. 133, Jamaica Road, Bermondsey. TABLE I CAUSES OF DEATH. Registered in Bermondsey during the 53 weeks ending January 3rd, 1885. AGES AT DEATH. ALL AGES. CAUSES OF DEATH. Total. Male. Female. 0—1 1-5 5—15 15—25 25—35 35—45 45—65 65—85 85—100 253 24 235 69 67 88 107 1777 897 536 398 All Causes 880 ... ... ... ... ... 2 2 1 1 1 Small pox 5 3 58 3 ... 1 ... ... ... 81 44 37 19 ... Measles 26 22 5 32 10 1 ... ... ... Scarlet Fever 48 ... ... 2 2 ... 4 6 6 ... ... ... ... ... Diphtheria 10 82 37 45 36 44 2 ... .. ... ... ... Whooping Cough ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... 4 Enteric Fever 10 6 3 2 1 2 1 1 ... ... ... 2 1 1 1 ... 1 ... ... Simple Fever ... ... ... ... 2 92 41 32 1 1 2 3 Diarrhœa 51 51 ... ... ... 1 1 Simple Cholera 3 2 1 1 ... ... ... ... ... 1 Dysentery 2 1 ... ... ... ... 2 ... ... ... ... 2 1 1 1 ... ... ... Varicella 1 ... ... ... ... 9 4 Syphilis 5 7 2 ... ... ... ... ... ... ... 3 1 1 Erysipelas 5 2 2 ... 1 ... ... ... ... 1 Septicæmia 2 ... 2 1 ... ... ... ... ... ... ... Puerpural Fever 5 5 1 1 ... ... ... 3 ... ... ... ... 1 Want of Breast Milk ... 1 1 ... ... ... ... ... ... ... ... 1 Alcoholism 3 3 ... 3 ... ... ... ... ... ... ... 1 2 Rheumatism 10 6 4 3 2 2 ... ... ... ... 3 2 2 1 Gout 1 ... ... ... 3 ... ... ... 3 ... Rickets 6 3 3 3 ... ... ... ... ... ... 10 8 Cancer 26 9 17 ... ... ... 2 6 ... ... 1 1 1 ... .. Ephithelioma ... .. ... ... ... ... ... 166 7 31 48 35 38 1 Phthisis 85 81 1 5 ... 30 34 6 1 2 ... 64 34 21 ... ... Meningitis ... ... Tabes Mesenterica 26 13 13 19 4 3 ... ... ... ... ... 6 3 Tuberculosis 17 10 7 7 1 ... ... ... ... 1 ... 1 ... ... ... Tubercular Peritonitis 2 ... 2 ... ... ... ... 2 ... ... 1 ... Diabetes 2 ... ... ... 1 ... ... 43 ... 25 18 43 ... ... ... ... Premature Birth ... ... ... TABLE I.-Continued. CAUSES OF DEATH. ALL AGES. AGES AT DEATH. 1-5 5—15 15-25 25—35 35—45 45—65 65—85 Total. Male. Female. 0-1 85—100 Atelectasis 2 1 1 2 ... ... ... ... ... ... ... ... Congenital Malformation 3 2 ... ... ... 5 ... ... ... ... 5 ... 121 Old Age 53 68 ... 10 ... ... ... ... 92 19 15 ... Apoplexy 34 19 13 l5 ... 1 ... 1 4 ... ... Paralysis 27 17 10 ... 8 ... 1 2 15 1 ... ... Epilepsy 5 3 2 1 2 1 1 ... ... ... .. ... 53 25 28 ... ... Convulsions 40 13 ... ... ... ... ... 3 Brain Disease 6 3 3 1 ... ... ... 2 ... ... ... Other Diseases of Nervous System 11 6 3 5 ... ... 2 1 ... 5 ... ... Pericarditis 1 1 ... 2 ... 2 1 1 ... ... ... ... 58 29 1 Heart Disease 29 ... 3 2 9 26 16 1 ... Aneurism 2 2 ... 1 ... 1 ... ... ... ... ... ... 4 2 ... 2 1 Angina Pectories 2 ... ... 1 ... ... ... 1 Syncope 1 1 ... ... ... ... ... ... ... ... 1 ... 6 5 2 ... ... ... ... Laryngitus 4 ... ... 26 ... Croup 18 8 2 24 ... ... ... ... ... ... ... 143 136 74 279 66 3 4 Bronchitis 4 11 60 56 1 86 42 6 4 8 2 Pneumonia 44 30 20 4 6 6 1 2 Pleurisy 6 5 ... ... 1 1 1 1 ... .. Asthma 3 3 ... ... ... 1 ... 1 1 ... ... ... 9 4 5 4 ... 1 1 ... ... Congestion of Lungs 3 ... ... 24 15 9 6 Teething 18 ... ... ... ... ... ... ... Tonsillitis 3 2 1 2 1 ... ... ... ... ... ... ... 1 2 Gastritis 3 1 ... 1 1 ... ... ... ... ... 3 1 2 ... Peritonitis ... 2 ... ... 1 ... ... 5 ... Enteritis 3 2 ... 2 ... ... 1 ... 2 ... ... 1 ... Hernia 1 ... ... ... 1 ... ... ... ... ... Dis. of Stomach & Intestines 12 6 ... 6 5 1 ... 4 ... 2 ... ... Hepatitis 4 1 3 ... 3 ... ... ... ... 1 ... ... Jaundice 5 1 4 2 2 ... ... 1 ... ... ... ... 16 7 9 Cirrhosis ... ... ... 10 3 ... 3 xix TABLE I.-Continued. CAUSE OF DEATH. ALL AGES. AGES AT DEATH. 1-5 0-1 5—15 15—25 25—35 Total. Male. Female. Dis. of Liver 2 4 ... 1 ... ... 6 ... 1 ... ... Spleen Disease 1 ... ... ... ... 1 1 Nephritis 5 4 1 1 ... ... Bright's Disease 12 8 4 ... 1 ... ... 3 2 ... 1 Renal Dropsy 5 ... ... ... Other Disease of Urinary System 4 3 ... ... ... ... 1 4 Child birth ... ... 2 4 ... ... ... 8 3 1 Diseases of Bones and Joints 4 2 1 1 4 1 1 1 ... Eczema 1 ... ... 1 ... ... 1 ... 1 ... Abscess ... ... 1 ... 1 ... Bronchocele 1 ... ... ... 4 1 3 ... 1 1 Tumor ... ... 33 23 ... ... Marasmus 56 47 8 1 Asthenia 8 4 4 7 ... ... .. ... Debility 51 28 49 2 ... ... ... 23 Chronic Lead Poisoning (Accident) ... 1 1 ... ... ... ... ... 2 5 1 ... ... Fall &c. 3 ... ... Fractures and Contusions 5 1 ... 1 1 4 ... 1 Burns & Scalds 3 2 ... 1 ... ... ... 12 5 12 ... Asphyxia 7 ... ... ... 2 ... Drowning 2 ... ... ... ... ... 1 ... Poison (Suicide) 1 ... ... ... ... ... ... Cut Arm 1 1 ... ... 1 ... ... 2 ... Hanging (Murder) 2 ... ... ... 1 .. Cut Throat ... TABLE II. DEATHS FROM ZYMOTIC DISEASES IN 1884. ZYMOTIC DISEASES. 1884. Total for the Year. Rate per 1000 living. Percentage of Total Deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. 0.28 5 Small Pox 3 ... 1 0.06 1 18 13 81 0.91 4.55 Measles 8 42 2.70 17 8 19 4 48 0.54 Scarlet Fever 0.56 4 1 3 2 10 0.11 Diphtheria 6 21 14 4.61 41 82 0.32 Whooping Cough 3 0.67 4 3 2 0.13 12 Fever 5.45 4 6 77 10 97 1.09 Diarrhœa 335 3.78 Total 110 125 41 18.82 59 xx TABLE III. DEATHS FROM ZYMOTIC DISEASES IN THE 10 YEAR. 1874-83. 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Average of 10 Yrs. 3 0 Small Pox 9.0 8 0 39 5 9 8 18 0 46 46 46 67 64.3 Measles 75 109 45 101 56 52 130 21 43 102 101 75.0 97 Scarlet Fever 51 102 56 47 3 19 16 5 Diphtheria 9 12.4 3 16 13 31 9 63 111 75 225 25 96.5 Whooping Cough 57 94 39 98 178 18 20.0 Fever 21 29 21 25 16 21 20 13 16 Diarrhœa and Cholera 73 113 85.7 67 83 80 137 45 126 74 59 452 351 Total 362.9 292 268 287 522 344 411 290 420 xxi TABLE IV. BIRTHS AND DEATHS IN 14 YEARS 1871-84. Year. Estimated Population. Total Births. Total Deaths. Excess of Births over Deaths. Births Rate. Death Rate. Deaths from Zymotic Diseases. Total. Rate per 100 living. London Death Rate 1871 80,585 3327 1994 1333 41-2 24-7 564 6-1 26-6 2 81,198 3687 344 4-2 1663 2024 45-4 20-4 21-1 3 81,811 3587 2003 1584 43-8 24-4 392 4-7 22-4 82,424 4 3656 1642 44-3 19-8 268 3-2 2014 22-4 25-2 5 83,038 3587 2094 43-1 452 5-4 1497 23-5 3571 6 83,615 1804 43-9 21-5 351 4-2 1867 21-9 7 84,264 3620 42-9 19-7 287 3-4 1665 1955 21-5 8 84,877 359 2110 42-9 24-8 6-1 1487 522 23-1 9 85,490 3715 344 1983 1732 43-4 23-1 4-0 22-1 21-7 1880 86,104 3532 20-8 411 4-6 1796 1736 41-0 Ten Years Average. 3598 393 1875 43-1 1722 22-4 4-6 22-4 1881 86,808 3550 1815 290 3-3 21-2 1735 20-0 40-9 1882 3485 87,430 1913 1572 21-8 420 4-7 39-8 39-0 21-2 1883 3435 292 88,052 1722 1712 3-3 19-5 20-4 1884 1692 88,674 3469 1777 39-1 20-0 335 3-7 20-3 xxiii TABLE V. SANITARY WORK, &c, DURING THE YEAR 1884. Houses, &c., inspected and reported to the Vestry by the Medical Officer of Health, and the Inspector of Nuisances. 6146 Houses and other premises inspected and reported on. 5992 Notices served to execute works, etc. 578 Houses in a dirty and dilapidated condition, cleansed and repaired, etc. 141 Houses disinfected, cleansed and purified. 2 Cases of overcrowding abated. 41 Houses closed, being unfit for human habitation. 32 Houses in courts provided with a constant supply of water by means of stand pipes. 373 Privies repaired or ventilated. Offensive privies cleared. 536 Closets panned and trapped, or old pans cleansed. 2029 Closets supplied with water. 187 Defective drains repaired. .. 464 Stopped drains cleared. 940 Untrapped sinks trapped. 5 Cesspools abolished. 787 Badly paved yards repaired. 64 Water receptacles supplied. 91 Water receptacles cleansed and repaired. 8 Houses supplied with water. 1095 Dust bins provided. Defective roofs repaired. 54 91 Defective rain-shoots and gutters repaired. 29 Offensive accumulations removed. 74 Houses drained direct into the public sewer. 407 Defective water apparatus in w.c. repaired. 13 Lots of fowls which were a nuisance, removed. 5 Animals kept so as to be a nuisance removed. 76 Urinals and other offensive places cleansed. 12 Slaughter-houses inspected and licensed. 14 Cow-houses inspected and licensed. 88 Bakehouses inspected. 10 Cellar flaps repaired. 27 Stables and other premises drained. 285 Old brick drains relaid with stoneware glazed pipes. 646 Waste water pipes disconnected from drains and made to discharge in the open air. 23 Persons suffering from infectious diseases removed to Hospital. 6 Dead bodies removed from rooms to mortuary, upon Magistrates' orders. Summonses taken out before Police Magistrates for not complying with orders of the Vestry. 160 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 17th, 1884, to April 17th 1885. Article. Number of Samples. Genuine. Adulterated. Amount of Fines Cost. Milk 36 25 11 £ s. d. 13 15 0 £ s. d. 6 7 0 3 5 0 1 5 0 5 2 Coffee 7 2 10 0 1 5 0 6 Butter 2 8 ... ... ... ... ... ... ... 10 Bread 10 ... ... ... Flour 8 ... ... ... ... 8 ... ... ... Mustard 4 ... ... ... 4 .. ... ... ... ... ... ... Pepper 2 ... 2 1 Lard ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... Cond. Milk ... 2 2 ... ... ... Sugar .. ... ... ... 2 Whisky 2 ... ... ... ... ... ... .. 2 0 2 6 Rum 1 0 12 6 2 ... ... ... ... ... ... Gin .. 3 Brandy 1 ... ... ... ... ... ... ... 1 19 12 6 88 72 16 9 9 6 The fines and costs recovered under the Sale of Food and Drugs' Act, are paid to the Vestry account. H. THOMAS, Inspector. FORTNIGHTLY REPORTS. Jan. 21st, 1884. During the fortnight that ended on the 12th day of January, 130 births and 69 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 38.3, and an annual rate of mortality of 20-2 per thousand of the estimated population. The corresponding death rate in London was 20.5. Zymotic diseases caused 10 deaths, viz. : —Measles 2, scarlet fever 5, diphtheria 1, and enteric fever 2. From diseases of the respiratory system there were 16 deaths, and from tubercular diseases 9. Eight inquests were held. Three deaths were attributed to accidental causes. The water supplied by the Southwark Company during last month was delivered in a clear and bright condition. This morning I received three letters from different persons complaining of a very offensive smell in the neighbourhood of Weston Street. I found this to be caused by the emptying of old soaks at the tannery in Long Lane which was lately in the occupation of Mr. Siegfrid Simon. These soaks are being converted into lime-pits by their present occupier, Mr. Delay. Eight or ten pits have been dealt with, and 18 have still to be cleaned out. The nuisance is a serious one. I have directed that the solid refuse matter at the bottom of the pits should be deodorised by the addition of a sufficient quantity of green copperas before it is removed. February 4th, 1884. During the fortnight that ended on the 26th day of January, 128 births and 62 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 38-1, and an annual rate of mortality of 18.5 per 1000 of the estimated population. The corresponding death rate in London was 20.2. Zymotic diseases caused 8 deaths, viz. :—measles 1, scarlet fever 1, diphtheria 3, whooping cough 3, and enteric fever 1. Diseases of the respiratory system caused 15 deaths, and those of the tubercular class 9. Two deaths were attributed to violence. I inspected the reservoir of the tidal culvert in Horney Lane. It had been cleared out a few days previous to the last meeting of the Vestry. The water was about eight inches deep, and tinged of a brown colour. This was caused by the surface drainage from Mr. Ellis's yard, where a heap of tan was deposited. There was no mud or sediment, and no nuisance. I was informed that lime grounds are occasionally admitted into this reservoir from Mr. Garnar's yard. If that is the case, it is a matter which chiefly concerns Messrs. Barrow who makes most use of the water. [The statement made to me that the inlet which 1 observed showing marks of lime belonged to Mr. Garnar's yard, proved to be incorrect.] February 18th, 1884. During the fortnight that ended on the 9th day of February, 147 births and 62 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 43.1, and an annual rate of mortality of 18.2 per thousand of the estimated population. The death rate in London was 20.1. Zymotic diseases caused 10 deaths, viz. :—measles 1, scarlet fever 3, diptheria 1, and whooping cough 5. Diseases of the respiratory system caused 19 deaths. Six persons died from phthisis. Three inquests were held. Two deaths were referred to violence. One death was not certified. The water supplied by the Southwark Company during January, was clear and transparent and contained less than the usual amount of organic matter. The Vestry Wharf has lately displayed more than the usual accumulation of dust and manure. I have inspected the following houses:- 1. Alfred Place consists of 12 houses of 2 rooms each, let at 4s. per house. The cubic space of each room is 800 cubic feet. There is one family in each house. These houses have lately been whitewashed and repapered. New cisterns are being erected which will afford a supply of 75 gallons of water to each house, independent of the supply for the closets, which are provided with a separate cistern. When the repairs are completed these houses will be in a satisfactory conditon. 2. Wells Street, Nos. 1 and 2. These houses are old, dirty and dilapidated. At No 1 the closet is in the washhouse, and not properly ventilated. Water has been laid on but the apparatus appears to have been unused for some time. The necessary steps have been taken to get the se houses put into a habitable condition. They are now closed. 3. Elizabeth Cottages, New Church Street. These five houses are in a very fair condition. Some of the closets are not kept in a wholesome state. There is one cistern holding about 100 gallons for 5 closets and 25 persons. Water should be laid on to the closets. 4. Turner's Court consists of 3 small houses occupied by 20 persons. They are in a dirty state. 5. Jacob Street, Nos. 2, 4, 6. These houses are old, dirty and dilapidated. No. 6 is occupied by 15 persons, chiefly adults. 6. Metcalf Court, Nos. 1 to 6. Occupied by 54 persons. These houses are old, but the rooms are above the average size. 7. Staple Street. At No. 15, the lower room is used for a coal and wood store. The upper room is clean and decent. At No. 17 there are 2 rooms on the ground floor let at 3/6d. per week. The ceiling is old. There is no through ventilation. The rooms are in a fair state and not overcrowded. 8. Victoria Place, at the rear of the "Ship," Long Lane. These 15 houses are in good condition. 9. Ship and Mermaid Court contains 12 houses of 2 rooms each. The cubic space of each room is about 700 cubic feet. All the walls are damp. Several cases of bronchitis have occurred in these houses. At Nos. 6 and 12 the ceilings and walls are very dirty. I think the opinion of the Surveyor should be taken on the houses referred to in Turner's Court, Jacob Street, Metcalf Court and Ship and Mermaid Court, as to whether these houses are capable of being put in a proper state of repair. March 3rd, 1884. During the fortnight that ended on the 23rd day of February, 143 births and 52 deaths were registered in the parish. These numbers are equal to an annual birth rate of 41.9 and an annual rate of mortality of 15.2 per thousand of the estimated population. The corresponding death rate in London was 20.0. Zymotic diseases caused 8 deaths, viz. :—scarlet fever 2, whooping cough 4, and diarrhœa 2. Diseases of the respiratory organs caused 18 deaths, and those of the tubercular class 6. I have inspected the four houses in Halfpenny Alley which were referred to me at the last meeting. For old houses of this class, they are in a fair condition. The ground in Major Road was in a dirty and sloppy state when I visited it. The occupants of the caravan are not provided with sanitary accomodation or water supply, but make use of adjoining premises. I informed the owner of the unsatisfactory state of the place and he has promised to see to its being remedied. March 17th, 1884. During the fortnight that ended on the 8th day of March, 164 births and 66 deaths were registered in the parish. These numbers correspond to an annual birth rate of 48, and an annual rate of mortality of 19.3 per thousand of the estimated population. The death rate in London for the same period was 20.3. There were only 5 deaths from zymotic diseases, of which 2 were referred to scarlet fever, 2 to whooping cough, and 1 to diarrhœa. Diseases of the respiratory organs caused 21 deaths, and those of the tubercular class 10. One death was recorded from peurperal fever. Three inquests were held, and one death was not certified. There were 18 deaths in children under one year of age, and the same number in persons of 60 years of age and upwards. The present state of the public health must be regarded as satisfactory. April 7th, 1884. During the three weeks that ended on the 29th day of March, 223 births and 89 deaths were registered in the parish. These numbers shew an annual birth rate of 43.5 and an annual rate of mortality of 17.3 per thousand of the estimated population. The corresponding death rate in London was 20.9. The chief diseases of the zymotic class caused 17 deaths, viz :—measles 4, scarlet fever 6, and whooping cough 7. Twenty-one deaths were referred to diseases of the respiratory organs, and the like number to those of the tubercular class. Four inquests were held. A boy age 15, committed suicide by hanging. Several inhabitants of St. James's Road have complained of a nuisance at Mr. Francis's Metallic Cask Factory in Tranton Road. When I visited the premises there was no offensive smell at that time, but I have no doubt that very disagreeable vapours are likely to be evolved in certain processes of the business. April 21st, 1884. During the fortnight that ended on the 12th day of April, 153 births and 66 deaths were registered in the parish. These numbers are equal to an annual birth rate of 44.8 and an annual rate of mortality of 19.3 per thousand of the estimated population. The corresponding death rate in London was 20.5. The chief diseases of the zymotic class caused 16 deaths, viz. :—measles 5, scarlet fever 2, diphtheria 1, whooping cough 6, and diarrhœa 2. Five inquests were held. Two deaths were referred to violence. Twenty one deaths occured in the first year of life, and 11 in pessons upwards of 60 years. There is a large accumulation of manure at the Vestry Wharf. May 5th, 1884. During the fortnight that ended on the 16th day of April, the number of birth registered in the parish was no and the number of deaths 83. These numbers are equal to an annual birth rate of 32.2 and an annual rate of mortality of 24.3 per thousand of the estimated population. The corresponding death rate in London was 21.5. The deaths from the chief diseases of the zymotic class numbered 24, and included 13 from measles, 1 from diphtheria, and 10 from whooping cough. Diseases of the respiratory organs caused 21 deaths, viz. : bronchitis 15, pneumonia 3 and croup 3. Twelve deaths were attributed to diseases of the tubercular class. The advance in the rate of mortality is mainly due to the prevalence of measles and whooping cough. May 19th, 1884. During the fortnight that ended on the 10th day of May, 127 births and 84 deaths were registered in the parish. These numbers correspond to an annual birth rate of 37.2 and an annual rate of mortality of 24.5 per thousand of the estimated population. The death rate for all London was 21.3. Eighteen deaths occurred in children under one year, and 17 in persons of upwards of 60 years of age. The chief diseases of the zymotic class caused 16 deaths, viz.measles 9, scarlet fever 3, whooping cough 2, and diarrhoea 2. From diseases of the respiratory system 23 deaths occurred, viz. :—18 from bronchitis, 4 from pneumonia, and 1 from croup. Eight deaths were referred to diseases of the tubercular class. In 7 cases death was attributed simply to natural decay. The water supplied by the Southwark Company during the month of April was slightly turbid, but contained less than the usual proportion of organic matter. The mortality, which has been unusually low for 4 months, has lately exceeded the average. The excess appears to be caused by measles and bronchitis. June 9th, 1884. During the three weeks that ended on the 31st day of May, 201 births and 102 deaths were registered in the parish. These numbers represent an annual birth rate of 39.1, and an annual rate of mortality of 19.9 per thousand of the estimated population. The corresponding death rate in London was 19.2. The chief diseases of the zymotic class caused 23 deaths, viz. :-measles 8, scarlet fever 5, whooping cough 8, enteric fever 1, and diarrhœa 1. From diseases of the respiratory organs there were 25 deaths, of which 12 were referred to bronchitis and 10 to pneumonia. Thirteen deaths were attributed to tubercular diseases, including 9 from consumption. Nine persons died from old age. Of the deaths which occurred at various periods of life, there were 24 under 1 year, 30 between 1 and 5 years, 23 between 5 and 60 years, 20 between 60 and 80, and 5 above 80 years. Five inquests were held. Four deaths were caused by violence. One death was uncertified. Smallpox is prevalent in London. Either the cases are numerous, or they are more generally removed to the hospitals, as the hospitals of the Metropolitan Asylums Board are nearly full. The epidemic appears to be of a mild character. The fatal cases are not numerous. When vaccination has been postponed—excepting for very urgent cases—it should be delayed no longer. Last year the deaths from smallpox in London, in children under 5 years of age, were as follows:—vaccinated 1; unvaccinated 24; no statement 9. The population of vaccinated children is 20 times that of the unvaccinated, and yet in a non epidemic year, it furnished less than one-twentieth of the deaths from smallpox. June 23rd, 1884. During the fortnight that ended on the 14th day of June, 113 births and 67 deaths were registered in the parish, These numbers are equal to an annual birth rate of 33.1 and an annual rate of mortality of 19.6 per thousand of the estimated population. The corresponding death rate in London was 18.9. The chief diseases of the zymotic class caused 18 deaths, viz. :—smallpox 1, measles 6, scarlet fever 3, whooping cough 7, and enteric fever 1. From diseases of the respiratory organs there were 14 deaths, and from those of the tubercular class, 5 deaths. Two inquests were held. In both cases the deaths were attributed to accident. The water supplied by the Southwark Company during May, was above the average quality, being clear and bright, and containing an unusually small proportion of organic matter. In the week ending June 14th, the fatal cases of smallpox in London had declined from 40 to 30. The number of smallpox patients in the Metropolitan Asylums Hospitals had risen from 1096 to 1238. There is a large heap of manure at the Vestry's Wharf, and about two barge loads of ashes. The accumulation is more than should be allowed at this season of the year. July 7th, 1884. In the fortnight that ended on the 28th day of June, 128 births and 51 deaths were registered in the parish. These numbers are equal to an annual birth rate of 37.5, an annual rate of mortality of 14.9 per thousand of the estimated population. The corresponding death rate in London was 18.4. Erom diseases of the zymotic class, 9 deaths were recorded, viz. :-from measles 1, scarlet fever 1, and whooping cough 7. Diseases of the respiratory organs caused 12 deaths, and those of the tubercular class 9. There have been no deaths from smallpox or diarrhoea. The state of the public health is very satisfactory. July 21st, 1884. During the fortnight that ended on the 12th day of July, the number of births registered in the parish was 108, and the number ot deaths 79. The annual birth rate was 31.6, and the annual rate of mortality was 23.1 per thousand of the estimated population, The death rate in London was 21.8. The chief diseases of the zymotic class caused 18 deaths, vi z . :— measles 3, scarlet fever 1, whooping cough 4, continued fever 1, and diarrhoea 9. Of the deaths from diarrhoea, there were 7 under 1 year of age, 1 aged 1 year, and 1 aged 7 years. Diseases of the respiratory organs caused 17 deaths, viz. bronchitis 10, pneumonia 7. From tubercular diseases there were 12 deaths, including 5 from consumption. Three inquests were held. Two deaths were referred to natural causes, and 1 to drowning, accidentally. At this season of the year there is generally a sudden and considerable rise in the number of fatal cases of diarrhoea. A high temperature of the air continuing for several days, is undoubtedly a strong predisposing cause, and seems sufficient to excite the disease in young infants. Errors of diet are generally the exciting cause. My experience of English Cholera in adults, is, that it is frequently caused by overindulgence in eating, and especially of pork and green peas. In children it is likely to arise from milk, or other food, just "turning sour." August 11th, 1884. During the three weeks that ended on the 2nd day of August, 187 births and 127 deaths were registered in the parish. These numbers are equal to an annual birth rate of 36-5, and an annual rate of mortality of 24.8 per thousand of the estimated population. The corresponding death rate in London was 24.9. The chief diseases of the zymotic class caused 34 deaths, viz.measles 2, scarlet fever 1. whooping cough 2, enteric lever 1, and diarrhoea 28. The last named disease was particularly fatal to young children. Diseases of the respiratory organs caused 15 deaths, and those of the tubercular class 17. Six inquests were held. Three deaths were referred to violence and one to intemperance. Two deaths—both infants—were not certified. 1 have visited Mr. H. Higgins's premises at Nos. 25 and 26, Abbey Street South. The part of the premises used by him as a leather dresser is in a dirty and untidy condition, with heaps of shumac and refuse lying about. but neither these nor the puer give rise to any smell which can be perceived outside the premises. In a letter received from the Metropolitan Board of Works (dated 18th July, 1884), it is stated that "a special investigation was made into the source of the nuisance complained of, and it was ascertained that the stench did not arise from manure-making, which was being conducted in accordance with the Board's Bye-laws, regulating that business." I do not agree with this opinion. The close chamber is in a very offensive state. It is supposed to be ventilated by the air from this chamber, being drawn through a fire in the upper room. In this fire-place I found a very small fire, amere handful of hot cinders, but this was totally useless lor the purpose of consuming the vapours from the lower room, as the iron frame fronting the furnace is detached from the brickwork for about 5 inches in width and nearly 2 feet in length. The chimney is too low, and the firing is not properly attended to. The carts used for collecting fish refuse and removing the mixture are without covers, and are very offensive even when empty. I have just received a complaint about the nuisance arising from these premises, signed by 64 persons residing in the neighbourhood. I have no doubt the nuisance arose from an accumulation of putrid fish offal which was detained on the premises for a longer period than usual. This is a common occurrence every Bank Holiday. September 15th, 1884. During the five weeks that ended on the 6th day of September, 329 births and 166 deaths were registered in the parish. These numbers are equal to an annual birth rate of 38.6, and an annual rate of mortality of 19.0 per thousand of the estimated population. The corresponding death rate in London was 20.5, and the mean rate of 28 large towns was 24.2. The chief diseases of the zymotic class caused 48 deaths, viz.:—smallpox 1, measles 8, scarlet fever 2, diphtheria 3, whooping cough 4, enteric fever 2, diarrhoea 27, and English Cholera 1. From diseases of the respiratory organs there were 18 deaths, and from tubercular diseases 22. Eleven persons died from heart disease and 9 from old age. Six inquests were held. Three deaths were referred to natural causes and 3 to violence. A female aged 72 years, died from the effects of drinking accidently, carbolic acid, carelessly placed in a beer bottle. The water supplied by the Southwark Company during July and August was of good quality. On August 20th, I met Mr. Spencer at Higgin's Manure Factory. The place was cleared and cleansed, the stove repaired, a fair fire was burning, the yard was recently washed, there were no filthy carts standing about, and altogether, the premises were fit—if not fitted—for inspection. Notwithstanding, the ventilation of the close chamber was defective. In my opinion the nuisance complained of by the inhabitants does not so much arise from the condition of the mixing-room as from the conveyance through the streets of putrid fish in open and filthy vans. I believe Mr. Higgins has promised to use covered iron carts. The inspection of the older streets, courts and places in the parish is being satisfactorily carried out. October 6th, 1884. During the three weeks that ended on the 27th day of September, 179 births and 105 deaths were registered in the parish. These numbers are equal to an annual birth rate of 34.7, and an annual rate of mortality of 20.5 per thousand of the estimated population. The corresponding death rate in London was 17.0. From the chief diseases of the zymotic class there were 18 deaths, viz:—from measles 1, scarlet fever 4, diphtheria 1, whooping cough 3, and diarrhœa 9. Diseases of the respiratory system coused 18 deaths, and those of the tubercular class 14. Brain diseases caused 10 deaths; heart diseases 8, and old age 6. Five inquests were held. Four deaths were not certified. Thirty-six deaths occurred in the first year of life, and 23 in persons aged upwards of 60 years. October 23th, 1884. During the fortnight that ended on the 11th day of October, 123 births and 57 deaths were registered in the parish, These numbers are equal to an annual birth rate of 36.0, and an annual rate of mortality of 16.0 per thousand of the estimated population. The corresponding death rate in London was 17.3. With the exception of three deaths from diarrhœa, there was no death from any important zymotic disease registered during the fortnight. Diseases of the respiratory organs caused 10 deaths, and tubercular diseases 13. The deaths under one year of age numbered 22, and those above 60 years of age 14. Three inquests were held. Two deaths were referred to violence. For a large and densely populated parish like Bermondsey, the late mortality returns show an exceptionally healthy condition. November 3rd, 1884. During the fortnight that ended on the 25th day of October, 147 births and 70 deaths were registered in the parish. These numbers are equal to an birth rate of 43, and an annual rate of mortality of 20.5 per thousand of the estimated population. The corresponding death rate in London was 19.3. From the chief diseases of the zymotic class there were 7 deaths viz.:—from measles 2, whooping cough 1, enteric fever 2, and diarrhœa 2. Diseases of the respiratory organs begin to shew an increased fatality. There were 18 deaths from bronchitis, 7 from pneumonia, and 2 from other diseases. Ten deaths were caused by tubercular diseases, viz.:— phthisis 6, meningitis 1, and tabes mesenterica 3. The period for which an assistant inspector of dwellings was engaged, expires on Wednesday next. He has visited the worst conditioned houses in 139 streets and courts. The total number of houses reported on is 2137, of rooms 8938, and of families 3532. The statistics collected relate to the dwellings of upwards of 15,000 persons. As might be expected, a number of stopped drains, foul closets and other nuisances were discovered. These were referred to the Sanitary Inspector and the proper notices were served for abating them. The number of rooms in a house ranged from 2 to 21, but the average was under 5. The number of families in a house varied from 1 to 7. The higher numbers were not often met with, and the mean was below 2 families. The number of persons in a house were from 1 to 29, but the mean of all the houses did not exceed 8 persons. These low averages are accounted for by the number of small two-roomed houses in No. 1 Ward, in the Leather Market District. November 17th, 1884. During the fortnight that ended on the 8th day of November, 129 births and 58 deaths were registered in the parish. These numbers are equal to an annual birth rate of 37.8 and an annual rate of mortality of 17.0 per thousand of the estimated population. The corresponding death rate in London was 19.6. There were only 4 deaths from zymotic diseases, viz.:— 1 from measles, 1 from whooping cough, and 2 from diarrhoea. Diseases of the respiratory organs caused 16 deaths, and those of the tubercular classs 10. There were 3 inquest cases, including 2 deaths from accidental aspluyscia. The number of deaths which occurred during the first year of life was 23, and above 60 years of age, 11. The water supplied by the Southwark Company during October was efficiently filtered and contained only a small proportion of organic matter. December 1st, 1884. During the fortnight that ended on the 22nd day of November, 112 births and 56 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 32.8, and an annual rate of mortality of 16.4 per thousand of the estimated population. The corresponding death rate in London was 19.6. These rates are unusually low. Zymotic diseases caused 4 deaths, viz.: —from measles, scarlet fever, whooping cough, and diarrhsaea—each 1. From diseases of the respiratory organs there were 14 deaths, viz.:—bronchitis 9, pneumonia 3, and croup 2. There were 5 deaths from diseases of the tubercular class; 4 from phthisis, and 1 from meningitis. The deaths in the first year of life, numbered 11, and above 60 years of age 15. Five deaths were referred to old age, Five inquests were held. One death was attributed to a fall in the street. December 15th, 1884. During the fortnight that ended on the 6th day of December, 138 births and 62 deaths were registered in Bermondsey. These numbers represent an annual birth rate of 40.4, and an annual rate of mortality of 18.2 per thousand of the estimated population. The corresponding death rate in London was 22.6. From the chief diseases of the zymotic class there were 8 deaths, viz.:—smallpox 1, measles 4, and whooping cough 3. Diseases of the respiratory organs caused 20 deaths tubercular diseases 9, and old age 7. There were three inquest cases, and 4 deaths not certified. The extra sanitary inspection carried out in addition to the regular inspections of Mr. Thomas, has been as follows— 198 streets, with a total of houses 3,465. Number of Houses inspected 3,005 „ Rooms „ 12,266 „ Families „ 4,880 „ Persons „ 21,072 „ Adults „ 13,760 „ Children „ 7,3 12 No. of W.C.'s 2,878 Dirty conditions 1,002 No water laid on 1,012 Cisterns 2,266 Apparatus out of order 249 Water butts 610 No covers 137 W.C.'s stopped 34 Rotten butts 90 Houses with Dustbins 2,606 Houses without 399 D. B., no covers 5 2 3 D. B., rotten and bad 201 Drains found untrapped 167 „ „ defective 381 „ „ stopped 39 These extra inspections have been exceedingly useful, as they have not only collected a large amount of statistical information, but have brought to light the existence of many nuisances. January 5th, 1885. During the three weeks that ended on the 27th day of December, 175 births and 91 deaths were registered in the parish. These numbers are equal to an annual birth rate of 34.2, and an annual rate of mortality of 17.8 per thousand of the estimated population. The corresponding death rate for the whole of London was 20.3. The chief diseases of the zymotic class caused 14 deathe, viz.:—smallpox 2, (both infants, not vaccinated,) measles 5, scarlet fever 2, diphtheria 2, and enteric fever 1. From diseases of the respiratory organs there were 21 deaths; from those of the tubercular class 15; and from old a g e 7. Six inquests were held, one death was due to intemperance. All the courts and places in the parish have been thoroughly inspected.