THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE Parish of Bermondsey, FOR THE YEAR, 1885. 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 ENDED LADY-DAY, 1886. 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, The following Report embraces a period of fifty-two weeks, which ended on the Second day of January, 1886. It is the Tenth Annual Statement of the vital statistics of the Parish of Bermondsey, which it has been my duty to submit to the Vestry. The low rate of mortality from all causes which prevailed in 1884, shewed a further decline in 1885. This is especially remarkable in the number of deaths from diseases of the zymotic class which fell during the past year to a point which is without parallel in the records of the last quarter of a century. The low birth-rates of recent years have led to a corresponding reduction in the proportion of infants and young children existing in the population. This may account for some part of the diminished mortality. The improved isolation effected by the removal of patients to hospitals specially designed for the treatment of infectious diseases, has doubtless been productive of the best results. Let us also hope that the steady and persistent efforts which have been made to improve the sanitary condition of the dwellings of the poor, have contributed their share towards a progressive and general improvement in the state of the public health. Small-pox prevailed during the first half of the year, and caused 14 deaths. The deaths from Scarlet-fever fell from 48 to 23, the decennial average being 74. The fatal cases of Measles, Whooping-cough, and Diarrhœa were below the number in the previous year, and considerably under the average. The deaths from Diphtheria increased from 10 to 15. No death from Typhusfever was recorded. Enteric-fever caused 10 deaths, or 0.11 per thousand living. The death-rate from fever in London was 0.17, and the mean rate of 28 great towns was 0.20. A slight increase occurred in the number of deaths from diseases of Respiratory System, but this was more than counter-balanced by a reduction in the mortality from those of the Tubercular class. POPULATION. The number of inhabitants, calculated to the middle of the year, is estimated at 89,296. The proportion of males is estimated at 44,560, and that of females at 44,736. The natural increase of the population, or the excess of births over deaths, averages 1,696 per year, but of this number not more than 622 can be claimed as the legitimate and probable increase in the number of residents. It is quite possible, that even this small addition may ultimately be found to be slightly in excess of the actual increase, but the difference will be too small to materially affect the various calculations which form a part of my periodical reports. Assuming the population to be stationary, or to have remained precisely the same as it was found to be at the last census, it is satisfactory to observe that the annual rate of mortality during the past year would be only 18.3. BIRTHS. The number of births registered in the Parish was 3,221, being 248 less than in the previous year, and 335 less than the average of the preceding ten years. The male children numbered 1,634, an d the female 1,587. The annual birth-rate was 36.1 per thousand of the estimated population. The above is the lowest number of births recorded in the Parish in any year since 1867. The birth-rate in London was 32.6 per thousand, being the lowest on record since 1850. In the Leather Market District there were 570 births; in St. Mary Magdalen District 591; and in the St. James' District 2,060. Compared with the previous year, there is a decrease in the number of births in each of the three districts. During the first quarter of the year, the births numbered 889; in the second quarter 726; in the third quarter 771; and in the fourth quarter 885. Each of the quarters shews a decrease in the number of children born, compared with the corresponding quarter of 1884. The excess of births over deaths was 1,638. The natural increase of the population was 1.84 per cent. DEATHS. The total number of deaths from all causes was 1,583, of which 803 were males, and 780 females. In the previous year the recorded deaths were 1,777, and the average of the three previous years 1,796. The above is the lowest number of deaths registered in Bermondsey in any year since 1867. The annual rate of mortality was 17.7 per thousand of the estimated population. The male death-rate was 18. 0, and the female death-rate 17.4. The London death-rate was 19.7 per thousand, being the lowest on record, The number of persons who died in the Leather Market District was 281; in the St. Mary Magdalen District 424; and in the St. James' District 878. The death-rate in the first named District being 17.5; in the second 26.0; and in the third 15.25. The apparently high death rate in St. Mary Magdalen District is due to 162 deaths in the Workhouse. The low death-rate in St. James' District —which contains a population of 57,500 persons—will bear comparison with that of many country districts. In the first quarter of the year there were 447 deaths; in the second quarter 339; in the third quarter 356; and in the last quarter 441. The number of deaths which occurred in the first year of life was 434, shewing an infantile rate of mortality of 135 per thousand registered births. In the Leather Market District, which is comparatively a poor and a crowded one, the rate was 180, while in the St. James' District it was only 128. v. In London the infantile death-rate was 148; in the fifty large town districts 150; and in the twenty-eight great towns 155. The proportion reached 189 in Cardiff; 193 in Leicester; and 218 in Preston. CAUSES OF DEATH. The chief diseases of the Zymotic class, caused 245 deaths, or 15.5 per cent. of the total deaths from all causes, and 2.7 per thousand of the estimated population. The Zymotic death-rate in London was 2.7 per thousand. In the previous year, the Zymotic deaths in Bermondsey numbered 335, or 18.7 per cent. The average of ten years, 1875-84, was 370. Small-pox caused 14 deaths; 4 were under 1 year of age, 2 between 1 and 5 years, 4 between 5 and 20 years, and 4 above 20 years of age; 4 were certified to be unvaccinated, and in the remaining 10 there was no statement with respect to vaccination. Four of the deaths occurred in the Leather Market District, one in St. Mary Magdalen, and nine in St. James' District. From Measles there were 61 deaths, against 81 in the previous year. 58 of these deaths took place in children under 5 years of age. There was one death from German Measles. From Scarlet Fever there were 23 deaths, against 48 in the previous year, and a decennial average of 75. Of the 15 deaths from Diphtheria, 14 took place in St. James' and 1 in the Leather Market District. Whooping Cough caused 61 deaths, against 82 in the previous year, and a decennial average of 99. The 10 deaths from Fever were all certified as Enteric, —one was vi. an infant. From Diarrhœa there were 61 deaths, against 97 in the previous year, and a decennial average of 87. 51 of these deaths occurred under 1 year of age, and 5 between 1 and 5 years. There were 15 in the Leather Market District, 14 in St. Mary Magdalen, and 32 in St. James' District. In proportion to the population, there was an excess of deaths from this cause in the two first named districts. In the class of Septic diseases, there were 8 deaths from Erysipelas, 1 from Anthrax or Carbuncle, 2 from Septicæmia, or Blood poisoning, 2 from Puerperal Fever, and 2 from Gangrene. In the class of Constitutional affections, there were 6 deaths from Rheumatism, 2 from Gout, and 23 from Cancer. The deaths from the diseases of the Tubercular class, numbered 239, or 15 per cent. of the tota l deaths, and 2.6 per thousand living. From Tabes Mesenterica, there were 18 deaths, from Meningites 71, from Phthisis 144, and from Tuberculosis 6. In the previous year the deaths from Phthisis numbered 166. Diseases of the Respiratory System caused 432 deaths, or 27.3 per cent of the total deaths, and 4.8 per thousand living. In this class 15 deaths were referred to Croup, 294 to Bronchitis, 84 to Pneumonia, and 39 to other diseases, including Pleurisy, Asthma, Congestion of the Lungs, &c. Diseases of the Heart and Circulatory organs accounted for 83 deaths, or rather more than 5 per cent, of the whole. From diseases of the Brain and Nervous System, there were 140 deaths, or nearly 9 per cent. In this class Apoplexy is the most fatal disease in the vii. aged, and Convulsions in young children. The latter disease caused 63 deaths, all of which occurred in children under 5 years of age. The deaths certified as due to old age numbered 103, and those attributed to premature birth 42. The other causes of death included 72 from diseases of the Digestive Organs, 19 from Renal Diseases, and 9 from Diseases of the Bones and Joints. Eighty inquests were held, being in the proportion of 5 per cent. Twenty-six deaths were attributed to violent causes; thirty-one deaths, or nearly 2 per cent, were uncertified. STATISTICS OF LONDON. The estimated population at the middle of the year was 4,083,928 persons, of whom 1,923,447 were males, and 2,160,481 females. The marriages celebrated in London in 1885 numbered 34,573 giving a proportion of 16.9 persons married, to one thousand inhabitants. This was the lowest marriage-rate as yet recorded in London. The registered births numbered 132,506, and corresponded to an annual rate of per thousand inhabitants. This was the lowest rate on record since 1850, when the rate was 32.0. The excess of births over deaths was 52,506, or about 1,000 a week. The deaths were exactly 80,000, shewing an annual rate of 19.7 per thousand living. This is the lowest rate on record in London. The outbreak of small-pox that commenced towards the end of the first quarter of 1884, lasted to the middle of the third quarter of 1885. viii. With the exception of Small-pox, Measles, and Diphtheria, there was a considerable diminution in the mortality from all forms of Zymotic disease. The mean temperature of the air 48.6°, being slightly below the average. The first quarter of the year was warmer than usual, and the last quarter cooler. The rain-fall amounted to 24.0 inches, being 5.4 inches more than in the previous year, but 1.3 below the average of a long series of years. The Water supply of London maintained the satisfactory quality which has characterised it during the last three years. That supplied by the Southwark Company was sometimes better and sometimes worse than that supplied by the other companies, whose common source is the river Thames. It was clear and transparent throughout the year. SANITARY WORK. The inspections of houses, and other premises, which demanded the attention of your sanitary officers during the year numbered 8,772, being an increase of 2,626. The notices served for the execution of necessary sanitary works amounted to 5,411. 288 houses were disinfected, cleansed, and purified; and 170 in a dirty and dilapidated condition, were cleansed and repaired. The attention which has been given during recent years to the supplying of water to closets was continued, and 1,050 were thus supplied. Defective and stopped drains, and untrapped sinks have required the superintendence of the Inspector in ix. 1,230 cases. Waste water pipes have been disconnected from drains and made to discharge in the open air in 883 instances. Nineteen persons suffering from infectious diseases were removed to hospitals, and 16 dead bodies were removed to the mortuary, from houses which were occupied by more than one family, or from rooms which were used as living and sleeping rooms. Among the articles of food which were seized and destroyed, on account of their being in a putrid state, were 40 baskets of cherries; 8 cases of fish; and 10 pieces of beef and pork. Ten cases of overcrowding and various nuisances of a minor character were abated. In all these matters I am much indebted to the active and zealous assistance of the sanitary inspector. Thanking the Vestry for the support I have at all times received in carrying out the duties of my office, 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 52 weeks ending Saturday, January 2nd, 1886. DEATHS AT AGES. Total at all ages. CAUSES OF DEATH. 0-1 1—5 5—20 20—40 40—60 60—80 80—100 All Causes ... ... ... 333 100 150 213 276 77 1583 434 Small Pox ... ... ... 14 2 4 4 4 ... ... ... 61 18 40 3 Measles... ... ... ... ... ... ... ... Scarlet Fever ... ... ... 23 ... 14 7 2 ... ... ... 24 Whooping Cough ... ... 61 34 3 ... ... ... ... 2 15 10 3 ... Diphtheria ... ... ... ... ... ... 1 Enteric Fever ... ... ... 10 ... 1 6 2 ... ... 49 6 2 2 2 ... Diarrhœa ... ... ... 61 ... 3 ... 1 Syphilis ... ... ... 4 ... ... ... ... Erysipelas ... ... ... 8 2 3 2 1 ... ... ... Septicæmia ... ... ... 2 ... 1 1 ... ... ... ... Puerpural Fever ... ... 2 ... 2 ... ... ... ... ... 1 ... ... 1 Carbuncle ... ... ... ... ... ... ... 1 1 Gangrene ... ... ... 2 ... ... ... ... ... Intemperance ... ... ... 1 1 ... ... ... ... ... ... 1 1 Delirium Tremens ... ... 2 ... ... ... ... ... 3 1 1 1 ... Rheumatic Fever ... ... ... ... ... 3 3 ... Rheumatism ... ... ... ... ... ... ... ... Gout ... ... ... ... 2 ... ... 2 ... ... ... ... Sciatica ... ... ... 1 ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... 2 1 ... ... ... ... ... ... 2 8 ... Cancer ... ... ... ... 23 13 ... ... 10 7 1 ... Tabes Mesenterica ... ... 18 ... ... ... 71 23 39 9 ... ... Tub. Meningitis ... ... ... ... 144 2 12 26 57 41 6 ... Phthisis ... ... ... ... 6 1 3 1 1 ... Tuberculosis ... ... ... ... ... TABLE I. — Continued. Total at all ages. DEATHS AT AGES. CAUSES OF DEATH. 5—20 20—40 40—60 60—80 80—100 1—5 0—1 Premature Birth ... ... 42 42 ... ... ... ... ... ... Atelectasis ... ... ... 1 1 ... ... ... ... ... ... Congenital Malformations ... 5 5 ... ... ... ... ... ... Old Age ... ... ... 103 ... ... ... ... 1 56 46 Apoplexy ... ... ... 31 ... ... 9 16 4 ... 2 Paralysis ... ... ... 17 1 ... ... 1 4 10 1 Epilepsy ... ... ... 6 ... 1 1 2 1 1 ... Convulsions ... ... ... 63 53 10 ... ... ... ... ... Other Diseases of Brain ... 3 3 1 3 4 8 1 23 Heart Disease ... ... ... 80 1 1 8 13 23 31 3 Angina Pectoris ... ... 1 ... ... ... ... ... 1 ... Aneurism ... ... ... 1 ... ... ... ... 1 ... ... Syncope ... ... ... 1 ... ... ... 1 ... ... ... Croup ... ... ... 15 4 11 ... ... ... ... ... Bronchitis ... ... ... 294 55 68 7 6 55 87 16 Pneumonia ... ... ... 84 10 28 5 14 13 11 3 Pleurisy ... ... ... 5 2 ... ... ... ... 3 ... Other Diseases of Respiratory Organs ... ... ... 9 1 2 8 5 ... 9 34 Dentition ... ... ... 27 12 15 ... ... ... ... ... Thrush ... ... ... ... 1 1 ... ... ... ... ... ... Cancrumoris ... ... ... 1 ... ... ... ... ... ... 1 Tonsillitis ... ... ... 1 1 ... ... ... ... ... ... Diseased Stomach ... ... 5 ... 1 ... ... 2 2 ... Enteritis ... ... ... 6 2 2 ... ... 1 1 ... Peritonitis ... ... ... 8 1 ... 1 2 2 2 ... TABLE I. —Continued. DEATHS AT AGES. CAUSES OF DEATH. Total at all ages. 80—100 5—20 20—40 40—60 60-80 0-1 1-5 19 1 1 4 10 Diseased Liver ... ... 3 ... ... Other Diseases of Digestive Organs ... ... ... 4 4 ... ... ... ... ... ... Diseased Kidney ... ... 15 3 2 5 7 1 ... ... ... Diseased Bladder ... ... 1 2 ... ... ... ... ... Diabetes ... ... ... 1 1 ... ... ... ... ... ... Diseased Utirus ... ... 3 2 1 ... ... ... ... ... Child-birth ... ... ... 9 9 ... ... ... ... ... ... 2 1 Diseased Bones and Joints ... 8 2 3 ... ... ... Skin Disease ... ... ... 1 1 ... ... ... ... ... ... (Accident) Fractures and Contusions ... 9 1 3 2 2 1 ... ... Wounds ... ... ... 1 1 ... ... ... ... ... ... Burns ... ... ... ... 1 1 ... ... ... ... ... ... Drowning ... ... ... 4 1 2 1 ... ... ... ... Suffocation ... ... ... 5 5 ... ... ... ... ... ... (Suicide) Wounds ... ... ... 1 1 2 ... ... ... ... ... Hanging ... ... ... 1 1 ... ... ... ... ... ... Marasmus 46 38 8 ... ... ... ... ... Atrophy and Debility ... ... 30 29 1 ... ... ... ... ... Inanition ... ... ... 15 14 ... 1 ... ... ... ... ... Ill defined ... ... ... 11 3 4 4 ... ... ... TABLE II. DEATHS FROM ZYMOTIC DISEASES IN 1885. 1885. ZYMOTIC DISEASES. Total for the Year 1885. Rate per 1000 living. Percentage of Total Deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. 3 Small Pox ... ... ... ... 11 14 0.16 0.88 ... ... 20 Measles ... ... ... ... 1 16 7 61 0.68 3.85 Scarlet Fever ... ... ... 3 4 12 4 23 0.26 1.45 Diphtheria ... ... ... ... 3 5 3 4 15 0.17 0.95 Whooping Cough ... ... 22 8 13 18 61 0.68 3.85 Fever ... ... ... ... ... 2 2 2 4 10 0.11 0.63 Diarrhœa ... ... ... ... 5 49 ... 7 61 0.68 3.85 53 Total ... ... ... ... 52 95 44 245 2.74 15.47 xiv. FORTNIGHTLY REPORTS. Jan. 19th, 1885. During the fortnight that ended on the 10th day of January, 154 births and 77 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 45, and an annual rate of mortality of 22.5 per thousand of the estimated population. The corresponding death rate in London was 24.9. From the chief diseases of the zymotic class, there were 5 deaths, viz:—From measles 1, scarlet fever 1, diphtheria 1, and whooping cough 2. One death was certified as "chicken pox." Diseases of the respiratory system caused 23 deaths, of which 17 were referred to bronchitis. From diseases of the tubercular class there were 17 deaths, including 12 from phthisis. Ten inquests were held. Three deaths were attributed to violence. Several cases of small-pox have occurred in the parish during the last fortnight. Feb. 2nd, 1885. During the fortnight that ended on the 24th day of January, 137 births and 79 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 39.9, and an annual rate of mortality of 23.0 per thousand of the estimated population. The corresponding death rate in London was 23.4, and the mean rate of 28 great towns was 24.1. The population of Bermondsey, estimated to the middle of the present year, is 89,296. The deaths included 18 children under 1 year of age, and 23 persons above 60 years. Zymotic diseases caused 10 deaths, viz:—small-pox 2, measles 3, scarlet fever 2, whooping cough 2, and enteric fever 1. Diseases of the respiratory organs caused 29 deaths, of which no less than 23 were attributed to bronchitis. From diseases of the tubercular class there were 11 deaths, and from old age 5. Six inquests were held, 3 deaths being referred to natural causes, and 3 to accident. The number of patients suffering from small-pox in the hospitals of the Metropolitan Asylums Board on January 24th, was 1092, and in the Highgate hospital 99. The new cases admitted during the week, were 287 in the former and 25 in the latter. The fatal cases which occurred in the Metropolitan Asylum Hospitals during the fortnight ending January 24th, distributed according to the districts from whence they came, were from Camberwell 17, Newington 12, Islington 12, Hackney 9, Greenwich and Deptford 9, Poplar 8, Bermondsey 4, Whitchapel 4, Bethnal Green, St. Giles, and Mile End Old Town, each 3. Feb. 16th, 1885, During the fortnight that ended on the 7th day of February, 165 births and 73 deaths were registered in the parish. These numbers shew an annual birth rate of 48.0, and an annual rate of mortality of 21.2 per thousand of the estimated population. The corresponding death rate in London was 22.2. Diseases of the zymotic class caused 9 deaths, viz:— Measles 3, diphtheria 1, and whooping cough 5. From diseases of the respiratory organs there were 22 deaths; from those of the tubercular class 14, and from old age 9. Four inquests were held, two deaths being attributed to concussion of the brain from accidental falls. During the last week 5 cases of small-pox and 2 cases of scarlet fever, have been removed to hospitals. The water supplied by the Southwark Company during January was "clear and bright." On Saturday last, I inspected the vaults of the Parish Church. I noticed 70 coffins, which appeared to be in a fair state of preservation. The dates, so far as they could be ascertained, ranged from 1812 to 1853, but many were obviously much older than the first mentioned year. Coffins which have been there for 40 years, are perfectly sound. Those which have been deposited there 60 years ago are beginning to decay. When I inspected these vaults in 1876, I observed several coffins at the east end of the North Vault which were in a bad state. At present these coffins are not accessible for examination. I am not able to report that these vaults are in a satisfactory condition, or one which is a credit to the parish. I think the time has arrived when the coffins should be placed on the ground and covered with concrete, leaving an air space above the floor. The entrance should then be partially bricked up, with an iron grating for ventilation. The remains would then rest in peace, free from all risk of molestation or desecration, while the fabric of the Church itself shall last. March 2nd, 1885. During the fortnight that ended on the 21st day of February, 122 births and 57 deaths were registered in the parish. These numbers are equal to an annual birth rate of 35.5, and an annual rate of mortality of 16.6 per thousand of the estimated population. The corresponding death rate in London was 19.3, being lower than any previous week of this year. The number of deaths which occurred in the first year of life was 22, and above 60 years of age 12. The deaths from zymotic diseases were 9, viz:—Measles 4 and whooping cough 5. Diseases of the respiratory organs caused 14 deaths, and those of the tubercular class 7. Three inquests were held, and 2 deaths—from convulsions —were not certified. The number of births recorded in the parish during last year was 3469, and of deaths 1777, being an excess of births over deaths of 1692. The annual birth rate was 39.1, and the death rate 20. The number of deaths from zymotic diseases was 335, shewing a rate of 3.7 per thousand of the population. The causes of death included small-pox 5, measles 81, scarler fever 48, diphtheria 10, whooping-cough 82, fever 12, diarrhœa 94, and cholera 3. I have no information of the number of our parishioners who have died in the public institutions of the Metropolis, with the exception of deaths in the workhouse. I believe the particulars can be obtained from the office of the Registrar General at a moderate cost, and I shall be glad to have the authority of the Vestry to procure them. March 16th, 1885. During the fortnight that ended on the 7th day of March, 132 births and 59 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 thousand of the estimated population. The corresponding death rate in London was 19.5. The chief diseases of the zymotic class caused 7 deaths, viz:—small-pox 1. (an infant aged one week), scarlet fever 1, and whooping cough 5. From diseases of the respiratory organs there were 17 deaths; from phthisis 5, and from old age 4. Three inquests were held. One death was referred to "deprivation and want of cleanliness." One death arose from the accidental breakage of a paraffin lamp. March 30th, 1885. During the fortnight that ended on the 21st day of March, 119 births and 69 deaths were registered in the parish. These numbers are equal to an annual birth rate of 34.6, and an annual rate of mortality of 20.0 per thousand of the estimated population. The corresponding death rate in London was 21.4. The principal diseases of the zymotic class caused 9 deaths, viz:—Measles 5, diphtheria 1, whooping cough 2, and enteric fever 1. Diseases of the respiratory organs caused 23 deaths, including 16 from bronchitis and 6 from pneumonia. From diseases of the tubercular class there were 10 deaths. Four inquests were held. Two deaths were referred to violence. Three deaths were not certified. April 20th, 1885. During the three weeks that ended on the 11th day of April, 172 births and 111 deaths were registered in the parish. These numbers are equal to an annual birth rate of 33.4, and an annual rate of mortality of 21.5 per thousand of the estimated population. The corresponding death rate in London was 22.6. The number of deaths referred to diseases of the zymotic class was 11, viz:—Small-pox 1, measles 6, diphtheria 1, whooping cough 2, and enteric fever 1. Two of the deaths registered as "measles" were uncertified. It is probable that they were caused by small-pox, as two children suffering from this disease were removed from the same house to the small-pox hospital only two days after. Diseases of the respiratory organs caused 28 deaths, of which 19 were from bronchitis. Three inquests were held. One death was caused by a stab wound. The water supplied by the Southwark Company during March, was clear, and contained only a small proportion of organic matter for the season. I regret to observe that during the last three weeks, there has been a considerable increase in the number of cases of small-pox removed to the hospitals. May 4th, 1885. During the fortnight that ended on the 25th day of April, the number of births registered in the parish was 117, and the number of deaths 63. The annual birth rate was 34.0, and the annual rate of mortality 18.3 per thousand of the estimated population. The corresponding death rate in London was 22. The chief diseases of the zymotic class caused 10 deaths, viz:—Small-pox 1, measles 6, scarlet fever 1, and whooping cough 2. From diseases of the respiratory organs there were 18 deaths, viz: —from bronchitis 9, pneumonia 5, pleurisy 3, and congestion of the lungs 1. Tubercular diseases caused 7 deaths, viz: —phthisis 4, meningitis 2, tabes 1. Three inquests were held. Two deaths were attributed to violence. Ten infants died in the first year of life, and 20 persons at upwards of 60 years of age. May 18th, 1885. During the fortnight that ended on the 9th day of May, 120 births and 38 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 34.9, and an annual rate of mortality of 11.1 per thousand of the estimated population. The corresponding death rate in London was 19.2. From the chief diseases of the zymotic class there were 7 deaths, viz:—from small-pox 4, measles, diphtheria, and whooping cough, each 1. Diseases of the respiratory organs were less fatal, and the general mortality was much below the average. The water supplied by the Southwark Company during the month of April was clear and bright, and contained less than the usual proportion of organic matter. June 1st, 1885. During the fortnight that ended on the 23rd day of May, 121 births and 43 deaths were registered in the parish. These numbers shew an annual birth rate of 35.2, and an annual rate of mortality of 13.7 per thousand of the estimated population. The corresponding death rate in London was 19.5. Under the head of zymotic diseases, only 4 deaths were recorded, viz:—from small-pox, scarlet fever, whooping cough, and enteric fever, each 1. Diseases of the respiratory system caused 13 deaths, and those of the tubercular class 14. Four inquests were held, including one death from suicide by drowning. Small-pox is still very prevalent, but many of the cases are of a comparatively mild form. It is quite a mistake to suppose that this disease is caused by, or is mainly dependant on, insanitary conditions. A large number of cases have occurred in some of the best streets in the parish, and there has been no unusual prevalence of this disease in the poorest localities. At no previous period has the general condition of the dwellings of the working classes, with regard to water supply and efficient drainage, been so satisfactory as it is at present. June 15th, 1885. During the fortnight that ended on the 6th day of June, the number of births registered in the parish was 82, and the number of deaths 55. The annual birth rate was unusually low, being only 25 per thousand of the estimated population. The annual rate of mortality was also low, it being only 16 per thousand. The death rate in London for the same period, was 19.5 per thousand. From diseases of the zymotic class there were 5 deaths, viz:—from small-pox 3, and from measles and diphtheria each 1. Diseases of the respiratory organs caused 14 deaths, those of the tubercular class 12, and old age 8. Under 1 year of age there were 13 deaths, and above 60 years of age 15. Three inquests were held, and in all these cases the deaths were referred to violence. One was a child, aged one year and nine months, run over by a van in the public street. A little boy, aged 5 years, died from the consequences of being struck on the head by a stone. July 6th, 1885. In the three weeks that ended on the 27th day of June, the number of births registered in the parish was 161, and the number of deaths 69, shewing an annual birth rate of 30.7, and an annual rate of mortality of 13.4 per thousand of the estimated population. The corresponding death rate in London was 16.5. The deaths from the chief diseases of the zymotic class numbered 14, there being from measles 5, scarlet fever 2, diphtheria 1, whooping cough 3, and diarrhœa 3. From diseases of the respiratory system there were 8 deaths, and from diseases of the tubercular class 4. Four inquests were held. All the deaths were attributed to natural causes. Under one year of age there were 19 deaths, and above 60 years of age 11. The state of the public health is highly satisfactory. July 20th, 1885. During the fortnight that ended on the 11th day of July, 136 births and 65 deaths were registered in the parish. These numbers shew an annual birth rate of 39.7 and an annual rate of mortality of 18.9 per thousand of the estimated population. The death rate in London was 17.8 per thousand. The chief diseases of the zymotic class caused 15 deaths, viz:—Small-pox 1, measles 3, diphtheria 2, whooping cough 1, and diarrhœa 8. The fatal case of small-pox was a girl, aged 14 years, not vaccinated. The deaths from diphtheria occurred in Balaclava road and Lynton road. From diseases of the respiratory system there were 9 deaths, and from those of the tubercular class 8. The inquest cases numbered 3. All the deaths were referred to natural causes. There were 28 deaths in children under 1 year of age, and 10 in persons aged 60 years and upwards. All the deaths from diarrhœa occurred in infants. The summer diarrhœa of young children, which often forms an important element in the general mortality of London, is mainly due to hot weather. August 10th, 1885. During the three weeks that ended on the 1st day of August, 164 births and 85 deaths were registered in the parish. These numbers shew an annual birth rate of 31.8, and an annual rate of mortality of 16.5 per thousand of the estimated population. The corresponding death rate in London was 21.3. A sudden and large increase has occurred in the number of deaths from diarrhœa, there being about 26 deaths attributed to this cause. The deaths from the other diseases of the zymotic class were: —from measles 2, scarlet fever 4, diphtheria 1, and whooping cough 3. Diseases of the pulmonary organs, caused only 5 deaths, and those of the tubercular class 4. During the first year of life there were 53 deaths, the increase being solely due to diarrhœa. Above 60 years of age there were 9 deaths. Five inquests were held. Three of the deaths were referred to fits, and 2 to diarrhœa. No deaths have occurred from small-pox and the cases removed have been very few. September 21st, 1885. During the six weeks that ended on the 12th day of September, 355 births and 162 deaths were registered in the parish. These numbers shew an annual birth rate of 34.3, and an annual rate of mortality of 15.7 per thousand of the estimated population. The corresponding death rate in London was 18.0. From the chief diseases of the zymotic class there were 40 deaths viz:—from measles 12, scarlet fever 6, diphtheria I, whooping cough 8, enteric fever 1, and diarrhœa 12. Diseases of the respiratory organs caused 20 deaths, and those of the tubercular class 33. Twelve persons died from diseases of the brain, and 11 from heart disease. Six inquests were held. Two deaths were referred to accident. The number of deaths which occurred under the age of one year was 53, and above 60 years of age 21. Complaints have been received of offensive smells on the premises of Mr. Warren, in Tanner Street. The nuisance was a serious one, and of frequent occurrence. It arose from the business not being conducted in a proper manner. It can be prevented by increasing the number and size of the tanks, and by exercising greater care. If this is not done I should advise the Vestry to take the necessary steps to prevent a recurrence of the nuisance. October 5th, 1885. During the fortnight that ended on the 26th day of September, 141 births and 43 deaths were registered in the parish. These numbers are equal to an annual birth rate of 41.0, and an annual rate of mortality of 12.5 per thousand of the estimated population. The corresponding death rate in London was 14.7, and the mean death-rate in 28 great towns was 16.5. In the last week of this period, the London death rate declined to 13.8, which was considerably lower than the rate recorded in any week since the first publication of the Registrar General's Weekly Returns. The Bermondsey death rate for the same week was 10.5. Only 5 deaths were recorded from zymotic diseases during the fortnight, and these were very equitably distributed, there being one death from each of the following causes.:— Measles, scarlet fever, whooping cough, enteric fever, and diarrhœa. Diseases of the respiratory organs caused 8 deaths, and those of the tubercular class the same number. The letter from the Metropolitan Asylums Board of the 16th of September, incloses a report of the General Purposes Committee of that Board, dated the 29th of August, and also a copy of Mr. Shirley Murphy's Report to the Sub-Committee re Cholera, bearing date August 18th, 1885. The object of the communication is to inform the Vestry of the extent of hospital accommodation, which the managers, in the event of the Local Government Board issuing an order under the Diseases Prevention Act of 1885, will be enabled to provide in the Metropolis for persons suffering from cholera. The managers are able to provide, in round numbers, hospital accommodation to the extent of some 1700 or 1800 beds. This is by no means evenly distributed throughout the Metropolis, and large areas, particularly in the south of London, are absolutely devoid of any accommodation whatever. The premises and number of beds probably available for the treatment of Cholera patients which are situate within a mile of our parish, are:—Guy's Hospital 50 beds, St. Olave's Workhouse 50, Rotherhithe Workhouse 50; total 150. In the list of open spaces, the use of which can be obtained for Cholera Hospitals, and upon which accommodation for cases could be provided within about 14 days, includes for Bermondsey, ground at the South Eastern Railway layer's Arms); and for Rotherhithe, land at the Manager's Wharf; the former having an estimated space for 40, and the latter for 30 beds. The area for which this provision of hospital accommodation is intended to be available, is a large and populous one, extending far beyond the limits of our own sanitary district. October 19th, 1885. During the fortnight that ended on the 10th day of October, 103 births and 56 deaths were registered in the parish. These numbers represent an annual birth rate of 29.9, and an annual rate of mortality of 16.3 per thousand of the estimated population. The corresponding death rate in London was also 16.3 per thousand. Zymotic diseases caused 7 deaths, of which 1 was referred to measles, 1 to scarlet fever, 2 to whooping cough, and 3 to diarrhœa. Diseases of the respiratory system caused 12 deaths, viz: —bronchitis 10, and croup 2. From diseases of the tubercular class there were 9 deaths, 5 of which were attributed to phthisis. Five persons died from old age. Under 1 year of age there were 19 deaths, and above 60 years of age 13 deaths. The water delivered by the Southwark Company during September was clear and bright. All the Thames waters shew an increase in the quantity of organic matter as a necessary consequence of the late abundant rain. On the letter and form of agreement received from the Metropolitan Asylums Board, I beg to report that the Vestry, as the Local Sanitary Authority, is empowered, if not required, to make some provision for the removal and proper isolation of non pauper cases of infectious diseases under certain circumstances, and that unless some such provision has been made by the Vestry, it appears to me, that there is no power to compel the removal of a non pauper patient. The charge of £4 4s. od. for each case, which includes maintenance, medical treatment, and conveyance to and from the hospital, is a very moderate and reasonable charge, and I recommend the Vestry to accept the offer of the Metropolitan Asylums Board. November 2nd, 1885. During the fortnight that ended on the 24th day of October, 136 births and 49 deaths were registered in the parish. These numbers shew an annual birth rate of 39.6, and an annual rate of mortality of 15.3 per thousand of the estimated population. The corresponding death rate in London was 17.9. There were only five deaths from zymotic diseases, viz:— 1 from measles, 2 from scarlet fever, and 2 from whooping cough. From diseases of the respiratory organs there were 11 deaths, viz:—10 from bronchitis and 1 from pneumonia. Diseases of the tubercular class caused 7 deaths, viz:— phthisis 5 and meningitis 2. During the first year of life the deaths numbered 13, and above 60 years of age 7. The state of the public health is very satisfactory. November 16th, 1885. During the fortnight that ended on the 7th day of November, 155 births and 71 deaths were registered in the parish. These numbers shew an annual birth rate of 45.1, and an annual rate of mortality of 20.6 per thousand of the estimated population. The corresponding death rate in London was 18.2. From the chief diseases of the zymotic class there were 5 deaths, of which 2 were referred to whooping cough, 2 to enteric fever and 1 to diarrhœa. The fatal cases of diseases of the respiratory system considerably increased in number. There were 16 deaths from bronchitis and 6 from pneumonia. The deaths from phthisis numbered 7, and those from old age also 7. Under 1 year of age there were 22 deaths, and above 60 years of age 20 deaths. Eight inquests were held. Seven deaths were attributed to natural causes and one to suicide. December 7th, 1885. During the three weeks that ended on the 28th day of November, the number of births registered in the parish was 174, and the number of deaths 109. The annual birth rate was 33.7, and the annual rate of mortality was 21.1 per thousand of the estimated population. The corresponding death rate in London was 20. The chief diseases of the zymotic class caused 15 deaths, viz:—Scarlet fever 1, diphtheria 3, whooping cough 7, enteric fever 2 and diarrhœa 2. All the deaths from diphtheria occurred in the St. James' District. From diseases of the respiratory organs there were 29 deaths, of which 15 were referred to bronchitis, 8 to pneumonia, and 6 to other diseases. Sixteen deaths were attributed to diseases of the tubercular order, of which 8 were from phthisis and 6 from meningitis. Eleven persons died from old age. One death - of a drysalter-was referred to chronic alcoholism. Under 1 year of age there were 21 deaths, and above 60 years of age 37. Three inquests were held. Two deaths were caused by violence. December 21st, 1885. In the fortnight that ended on the 12th day of December, 124 births and 71 deaths were registered in the parish. The annual birth rate was 36, and the annual rate of mortality was 20.6 per thousand of the estimated population. The death rate in London was 19.2 per thousand. The chief diseases of the zymotic class caused 9 deaths, viz:—Measles 5, Scarlet fever 1, whooping cough 2, and diarrhœa 1. From diseases of the respiratory organs there were 27 deaths, viz:—from bronchitis 17, from pneumonia 9, and from congestion of the lungs 1. There were 6 deaths from phthisis, 1 from meningitis, 3 from heart disease and 4 from old age. Three inquests were held on deaths from convulsions in children, and one on a case of accidental asphyxia. The deaths under 1 year of age numbered 22, and above 60 years of age 16. The water supplied from the Thames during the month of November, contained a larger proportion of organic matter than in any previous month of the last 3 years; this result being due to the flooded condition of the river. January 4th, 1886. During the fortnight that ended on the 26th day of December, the number of births registered in Bermondsey was 107, and the number of deaths 59. The annual birth rate was 31.1, and the annual rate of mortality 17.1 per thousand of the estimated population. The corresponding death rate in London was 20.0. The parish is remarkably free from zymotic diseases, there having been only 1 death from measles, 3 from whooping cough and 2 from diarrhœa. Diseases of the respiratory organs usually occupy a prominent position at this season of the year. The deaths from bronchitis were 21, and from pneumonia 4. This mortality is below the average. From tubercular diseases there were 7 deaths, viz:— from consumption 6, and from meningitis 1. Three inquests were held. All the deaths were referred to natural causes. The deaths under one year of age numbered 13, and those above 60 years of age 18. A few days are required to complete the year, but I am able to report that during the last 12 months, the general rate of mortality and the death rate from zymotic diseases, in the parish, have been unusually low. The birth rate also will be found to be considerably below the average.