THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY, FOR THE YEAR 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. C x Lon THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY, FOR THE YEAR 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, I have the pleasure of submitting my Eleventh Annual Report on the state of the Public Health within your Sanitary District. The following statistics relate to a period of fifty-two weeks, that ended on Saturday, the first day of January, 1887. The mortality from all causes was low, being at the rate of 18.9 per thousand persons living. This rate exceeded that of the previous year by O.1, that year however, was an exceptionally favourable one, the total number of deaths recorded being fewer than in any year since 1867. The deaths from diseases of the zymotic class exceeded those of the previous year by 34, but were 70 below the decennial average. There were no deaths from Small-pox or Typhus, and only seven from Enteric and Simple fever. The fatal cases of Scarlet-fever fell from 23 to 16, being 48 below the average. Whooping cough was very prevalent during the first quarter of the year, and Measles during the first and last quarters. The deaths from Diarrhœal diseases were most numerous in the third quarter, when 70 deaths occurred out of 98 during the year. The birth rate, which had been continuously declining for several years, rose from 36.1 to 37.2. On a former occasion I called attention to the fact, that the lower birth rates which had prevailed during recent years must necessarily have led to a corresponding diminution in the proportion of infants and children under five years of age. The Registrar General is of opinion that the marked decline in the death rates of recent years has been in some part due to the decline in the birth rate, and had the birth rate in the successive five years 1882-86 been equal to the birth rate in the ten years 1871-80 there would have been, so nearly as can be estimated, some 50,000 more children under five living in 1886, and as the mortality in this first life-period is high, the general death rate would have been raised about 0 5. In some of the West End Districts which are remarkable for very low rates of mortality, it is observable that the birth rate is also very low, and has been so for several years. For Registration purposes the Parish of Bermondsey is unequally divided into three Districts; between these Districts there are considderable differences in density of population and general healthiness. iii. The Leather Market District comprises an area of 93 acres, and, at the census of 1881, had a population of 16,300, which was a decreasing one. The number of houses was 2282, or 24.5 per acre. The density of the population was 175 per acre. Many of the dwellings in this District are small and crowded together in courts and places. The people, for the most part, are of the poorer class. Under these circumstances we are not surprised to find that the rate of mortality (23.7) is higher than in any other part of the Parish. The zymotic death rate (4.3) is also higher, and so is the rate of infantile mortality (214). The St. Mary Magdalen District consists of an area of 142 acres, with 2014 inhabited houses, or 14 .2 per acre. In 1881 it had a population of 15,669, which may be regarded as stationary, or nearly so. The density of the population is 110 per acre. In this District the area is less crowded with houses, the population is less dense, and a larger proportion of the people are in better circumstances. After making a proportionate allowance for the deaths which occurred in the Workhouse, we find the rates of mortality are all much lower than in the adjoining District. The death rate was 19.5; the zymotic death rate 2.7; and the infantile death rate 143. The St. James's District contains 392 acres. In 1881 the population was 54,683; the number of inhabited houses 6787; the average number of houses per acre 17.3, and of persons 137. It would appear from these figures that the density of the population is greater than in the St. Mary Magdalen District. The houses are not really more crowded together, but a much smaller proportion of the entire area is occupied by extensive business premises. The death rate in this portion of the Parish was 17.3; the zymotic death rate 2.8, and the infantile death rate 138. Whatever increase takes place in the population of the Parish is almost exclusively confined to this division. The natural increase of the population, or the excess of births over deaths, was 1650, or 1.7 per cent, the estimated increase does not exceed 0.7 per cent, and therefore the number of inhabitants, calculated to the middle of the year, is computed to be 89,918. BIRTHS. The number of Births registered in the Parish during the year was 3348, being 122 more than in the previous year, and 171 less than the average of the preceding two years. The male children numbered 1706, and the female, 1642. The number of births in each week averaged 64. The annual birth rate was 37.2 per thousand of the estimated population being an advance of 1.1 above the birth rate in 1885. The birth rate in London was 32.3 being 0.3 lower than in 1885, and the lowest rate on record since 1850 when the rate was 32.0. In 1876 the birth rate in London was 35.9, and from that date it has fallen continuously. In the Leather Market District there were 633 births; in St Mary Magdalen District 626; and in the St. James's District 2089. Compared with the previous year there is an increase in the number of births in each of the three Districts. During the first quarter of the year, the births numbered 967; in the second quarter 817; in the third quarter 768; and in the fourth quarter 796. The number of births in the first half of the year usually exceeds the number in the latter half. The births registered during the first six months were more, and in the second six months fewer than in the corresponding periods of 1885. DEATHS. The total number of deaths from all causes was 1698, of which 874 were males and 824 females. In the previous year the recorded deaths were 1583; the average of the three previous years 1694, and the decennial average 1809. The annual rate of mortality was 189 per thousand of the estimated population, or one death to every fifty-three persons living. The average weekly number of deaths was 32.6. The London death rate was 19.9 per thousand, with the exception of the immediately preceding year, when the rate was 19.8; the rate in 1886 was the lowest recorded since the present system of civil registration began. The number of deaths in the Leather Market District was 366; in the St. Mary Magdalen District 400; in the St. James's District 932. The deaths in the Workhouse, which is situated in St. Mary Magdalen District numbered 114. Distributing these deaths pro rata, the death rate in the first named District was 23.7; in the second 19.5; and in the third 17.3. During the first quarter of the year there were registered 558 deaths; in the second quarter 384; in the third quarter 362; and in the last quarter 394. The number of deaths in infants under one year of age was 514, of which 136 took place in the Leather Market District, 90 in St. Mary Magdalen's, and 288 in St. James's. The infantile death rate, or the proportion of deaths of infants in the first year of life to 1,000 registered births was 153, for the entire Parish; 214 in the Leather Market; 143 in St. Mary Magdalen; and 138 in the St. James's District. In London the infantile death rate was 159; in 28 great towns it averaged 169; in fifty large town Districts 164; and throughout England and Wales 150. The proportion reached 202 in Norwich, 209 in Blackburn, 211 in Leicester, and 233 in Preston. The number of deaths in persons of 60 years of age and upwards was 324, or 19 per cent. Of these deaths 129 took place in the first or coldest quarter of the year and only 40 in the third or warmest quarter. The widow of a tanner died at the extreme age of 100 years. CAUSES OF DEATH. The principal diseases of the zymotic class caused 279 deaths, or 16.4 per cent of the total deaths, and were equal to a rate of 3 .10 per thousand of the estimated population. The zymotic death rate in London was 2.88. In the previous year the zymotic deaths in Bermondsey numbered 245, or 15.5 per cent. The average of the preceding ten years, 1876-85, was 349 Small-pox, happily, does not appear in the mortality returns. The deaths from this disease in the entire Metropolitan area were only 24 in number, and fewer, not merely relatively to the population, but absolutely, than in any year since the present system of civil registration began; the years which most nearly approached this minimum being 1875, 1874, and 1883 From Measles there were 70 deaths against 61 in 1885, 57 of these deaths occurred in children between 1 and 5 years of age, 51 took place in the Ist and 4th, or coldest quarters, and only 19 during the warmer season. From Scarlet fever there were only 16 deaths against 23 in the previous fyear, and a decennial average of 64. Diphtheria caused 12 deaths against 15 in 1885, the decennial average is 13. One occurred in the Leather Market, 2 in St. Mary Magdalen, and 9 in St. James's District. From Whooping Cough there were 76 deaths. The number in 1885 was 61, and the average of ten years 94; 67 of these deaths occurred in the first six months of the year. Seven deaths were referred to fever, of which 6 were described as Enteric, and one as simple fever. The deaths from Diarrhœa numbered 96 against 61 in 1885, 97 in 1884, and a decennial average of 85. In addition to these, two deaths were described as Simple Cholera, both in young children. 70 of these 98 deaths occurred in the 3rd quarter and were mainly attributable to the hot weather. 25 took place in the Leather Market, 18 in St. Mary Magdalen, and 55 in St. James's District. The death rate from Diarrhœa in the Leather Market was 1.53, in St. Mary Magdalen I.l4, in St. James's 0.95, and in Bermondsey 1.07. In London this rate was 0.95. In the class of Septic diseases there were 6 deaths from Erysipelas, I from Pyæmia (attributed to vaccination), and 3 from Senile Gangrene. Intemperance was the certified cause of two deaths, but there can be no doubt that many of the deaths which are classed under diseases of the brain, heart, liver, and kidneys have been primarily induced by the abuse of alcoholic stimulants. In the class of constitutional diseases there were 10 deaths from Rheumatic affections, 4 from Rickets, and 27 from Cancer. The deaths from diseases of the Tubercular order numbered 254 or 14.9 per cent of the total deaths, and 2.8 per thousand living. From Tabes Mesenterica there were 33 deaths, from Meningites 71, from Phthisis 136, and from Tuberculosis 14. In the previous year the deaths from Phthisis were 144. Diseases of the Respiratory system caused 426 deaths, or 25.1 per cent of the total deaths, and 4.7 per thousand persons living. In this class 15 deaths were referred to Croup, 281 to Bronchitis, 103 to Pneumonia, 6 to Pleurisy, 6 to Asthma, and 15 to other diseases. From diseases of the Brain and Nervous systems there were 162 deaths, or 9.5 per cent, and 1.8 per thousand inhabitants. Apoplexy and Paralysis caused 46 deaths, chiefly among the aged, and Convulsions were said to be the cause of 79 deaths of children under 5 years of age Diseases of the Heart accounted for 75 deaths, or 4.4 per cent of the total deaths. Eighty-six deaths were referred to old age, 37 to Premature birth and 8 to Congenital Malformations. From various forms of diseases of the Digestive system there were 103 deaths, or 6.1 per cent of the whole. Thirty-eight deaths arose from teething, and 14 from diseases of the liver. The deaths from diseases of the Kidney numbered 34, which is a considerable increase over the number of deaths from this cause in previous years. Three deaths were recorded from Diabetes, 13 from child birth, and the large number of 98 from Atrophy, Debility, Inanition, Asthenia, Marasmus, and Exhaustion. This ill defined and unsatisfactory class is almost exclusively limited to deaths of infants. "Sunstroke" is assigned as the cause of death in one case, and "Exhaustion from the effects of the hot weather," in another. Among the deaths arising from violent causes there were 7 cases of fractures and contusions, 2 of burns, 5 of drowning, and 11 of accidental asphyxia. Six deaths from Suicide were double the number in the previous year. They were Gun-shot 1, Cut-throat 2, Poison 2, and Drowning 1. The total number of inquests was 101, being rather more than 5 per cent of the total deaths. The uncertified deaths were 31 being in the proportion of 1.8 per cent. The proportion in London was 1.2 per cent. STATISTICS OF LONDON. The population at the middle of the year 1886 was 4,149,533 persons, of whom 1,954.346 were males, and 2,195,187 females. The Registrar General estimates that 66,132 persons were added to the number of the inhabitants of the Metropolis, 51,424 by excess of registered births over deaths, and 14,708 by immigration. The marriages celebrated in London during the year were 34,446, giving a proportion of 16 .6 persons married to each thousand of the population. This is the lowest marriage rate as yet recorded in London, the three next lowest being those recorded in the three immediately preceding years 1883-4-5, in which the rates were successively 17.9, 17.6, and 16.9. The registered births numbered 133,700, giving the proportion of 32.3 births in the year to 1000 inhabitants. This was the lowest rate on record since 1850, when the rate was 32 .0. The deaths registered in the year numbered 82,276, and corresponded to an annual rate of 19.9 per 1000. With the exception of the previous year when the rate was 19.8, this was the lowest rate recorded. The deaths from Diarrhœal diseases were 720 in excess of the year 1885. In all the other forms of zymotic disease there was a considerable diminution in the number of deaths. Tubercular diseases and those of the Respiratory system were less fatal, while there was an increase in the deaths from diseases of the heart and Circulatory organs and from diseases of the Urinary system. The deaths per 1000 persons living in the five great groups of Registration Districts, were: — West Districts 17.7; North, 18.0; Central, 25.9; East, 22.5; South, 19.2. The death rate in London during the first quarter of the year was 24.9; in the second quarter 17.2; in the third quarter 18.9; and in the fourth quarter 18.8. The mean rate of mortality in the 28 great towns of England and Wales was 20.9, the mean rate in the ten next preceding years having been 22.4. The mean temperature of the air was 48.7. The first quarter of the year was cold and damp, the mean temperature being 3.5 degrees below the average of 45 years. In the third quarter of the year the mean temperature was above the average. July was the hottest month, and February the coldest. May exhibited the greatest range in temperature and February the smallest. The hottest weeks in the year were those which ended July 10th and September 4th (mean tempt. 66.5°), and the coldest week that which ended March 13th (mean tempt. 31.9°) Rain fell on 163 days, the total amount registerea in the year being 24.21 inches, 1.85 less than the averages of 72 years. Most rain fell in May (4.23 inches) and least in June (0.44). The river water examined during the year was found, without exceptions, clear and bright. Thanking the vestry for the kind support which I have uniformly received at their hands, and my colleagues for their valuable assistance. I have the honour to be, Gentlemen, Your obedient Servant, JOHN DIXON, M.D., 133, Jamaica road, Bermondsey. Medical Officer of Heath. TABLE I. CAUSES OF DEATH. Registered in Bermondsey during the 52 weeks ending Saturday, January Ist, 1887. CAUSES OF DEATH. Total at all ages. DEATHS AT ALL AGES. 0—1 1-5 5—20 20-40 40—60 60—80 80-100 1698 All Causes ... ... ... 514 350 83 161 266 274 50 ... ... ... ... ... ... ... Small Pox ... ... ... ... 12 ... Measles ... ... ... ... 70 8 57 5 ... ... Scarlet Fever ... ... ... 3 ... 16 1 ... ... ... Diphtheria ... ... ... 12 2 ... 8 2 ... ... ... ... Whooping Cough ... ... 76 32 44 ... ... ... ... ... Typhus... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... 6 .. 1 2 ... 3 .. ... Simple Fever ... ... ... 1 1 ... ... ... ... ... ... Diarrhœa ... ... ... 96 63 18 2 6 1 ... 6 Simple Cholera ... ... 2 ... 1 1 ... ... ... ... Syphilis ... ... ... 4 4 ... ... .. ... ... ... Erysipelas ... ... ... 6 1 ... 1 2 2 ... ... Pyaemia ... ... ... 1 1 ... ... ... ... ... Puerpural Fever ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk ... ... 2 2 ... ... ... ... ... ... Alcoholism ... ... ... 2 ... ... 1 ... ... 1 Rheumatic Fever ... ... ... 5 2 1 ... 2 ... ... ... Rheumatism ... ... ... 5 ... 2 2 1 ... ... ... Rickets ... ... ... .. 4 ... 4 ... ... ... ... ... Cancer ... ... ... ... 27 2 15 9 1 ... ... .. Tabes Mesenterica ... ... 33 18 15 ... ... ... ... Meningitis ... ... ... 71 ... 20 36 13 1 1 ... ... Phthisis ... ... .. 136 4 3 17 58 49 5 ... Tuberculosis ... ... ... 14 7 3 1 2 1 ... ... TABLE I —Continued. Total at all ages. DEATHS AT ALL AGES. CAUSES OF DEATH. 0—1 1—5 5—20 20—40 40-60 60—80 80-100 Premature Birth ... ... 37 37 ... ... ... ... ... ... Congenital Malformations ... 8 7 1 ... ... ... ... ... 2 Old Age ... ... ... 86 ... 50 34 ... ... ... 11 19 1 Apoplexy ... ... ... 31 ... ... ... ... 3 11 1 Paralysis ... ... ... 15 ... ... ... ... 1 2 3 ... Epilepsy ... .. ... 8 ... ... 2 Other Brain Diseases ... 2 3 11 7 28 5 .. ... Convulsions ... ... ... 79 63 16 ... ... ... ... ... Tetanus ... ... ... 1 1 ... ... ... ... ... ... 25 Heart Disease ... ... .. 72 ... 1 8 15 22 1 Angina Pectoris ... .. 1 ... ... 1 ... ... ... ... 1 Syncope ... ... ... 2 ... ... ... 1 ... ... Croup ... ... ... ... 15 2 11 2 ... ... ... ... Bronchitis ... ... ... 281 72 43 5 10 53 90 8 15 11 Pneumonia ... ... ... 103 19 34 3 21 ... Pleurisy ... ... ... ... ... 2 4 ... 6 ... ... 4 Asthma ... ... ... 6 ... 2 ... ... ... ... 4 Other Lung Diseases ... 2 ... 15 3 2 ... 4 25 13 ... Dentition ... ... ... 38 ... ... ... ... 1 ... 1 ... Tonsillitis ... ... ... ... ... .. ... 12 2 ... 1 5 ... Stomach Diseases ... .. 2 2 Enteritis ... ... ... 17 7 3 1 3 3 ... ... Peritonitis ... ... ... 3 ... 1 ... 2 ... ... ... Vomitus ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 .. Hernia ... ... ... ... 1 ... ... ... ... ... ... ... ... Intussusception ... ... 1 2 1 xiv. TABLE I.— Continued. CAUSES OF DEATH. Total at all Ages. DEATHS AT ALL AGES. 0-1 1-5 5—20 20—40 40—60 60—80 80-100 Intestinal Obstruction ... 5 1 ... ... 1 ... 1 2 Infantile Jaundice ... ... 2 2 ... ... ... ... ... ... Diseases of Liver ... ... 14 ... 1 3 7 3 ... Other Diseases of the Digestive Organs ... ... ... ... 1 ... 1 1 ... 1 7 3 34 Diseases of Kidney ... ... 2 1 4 18 8 1 ... Diabetes ... ... ... 3 ... ... 1 ... 2 ... ... 8 Uterine Diseases ... ... ... ... 2 4 2 ... ... Ovarian Tumour ... ... 1 ... 1 ... ... .. ... ... Child Birth ... ... ... 7 13 ... ... 6 ... ... ... Diseases of Bone and Joints 5 1 2 2 ... ... ... ... Skin Diseases ... ... ... 1 1 ... 2 ... ... ... ... Inanition ... .. ... 12 ... ... 12 ... ... ... ... Debility ... ... ... 28 28 ... ... ... ... ... ... ... Atrophy ... ... ... ... 14 14 ... ... ... ... ... Asthenia ... ... ... 5 5 ... ... ... ... ... Marasmus ... ... ... 39 36 3 ... ... ... ... ... ... Exhaustion ... ... ... 4 ... 3 .. ... ... 1 ... Sunstroke ... ... .. 1 1 ... ... ... ... ... Dropsy ... ... ... ... 2 ... 1 1 Gangrine ... ... ... ... ... ... ... ... 3 ... 1 2 ... Violence — (Accident.) ... ... 3 1 Fractures and Contusions ... ... 2 ... 7 1 Burns ... ... ... ... 2 5 ... ... 1 1 ... ... ... ... ... 3 ... ... Drowning ... ... ... ... 2 ... TABLE I.— Continued. CAUSES OF DEATH. Total at all Ages DEATHS AT ALL AGES. 5—1 5—20 20—40 40-60 60—80 80-100 0-1 1 ... ... ... 10 ... ... Asphyxia ... ... ... 11 3 ... 1 1 1 Otherwise ... ... ... (Suicide) ... ... .. 1 ... 1 ... ... ... ... ... Gun Shot ... ... ... 2 2 ... ... ... ... Cut Throat ... ... ... ... ... Poison ... ... ... ... 2 ... ... ... 2 ... .. ... ... Drowning ... ... ... 1 ... ... ... 1 ... ... NOTES. Area of Parish. — 652 Acres, (Land, 626; Tidal Water, 26.) Population at Census, 1881. —86,652. Inhabited Houses, 1881.—11,083. No. of Houses per Acre, 1881. —17.6. No. of Persons per Acre, 1881.—l38. No. of Persons per House, 1881.—7.8. TABLE II. DEATHS FROM ZYMOTIC DISEASES IN 1886. ZYMOTIC DISEASES. 1886. Total for the Year 1886. Rate per 1000 living, Percentage of Total Deaths. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. ... Small Pox ... ... ... ... .. ... ... ... ... 4 Measles ... ... ... 15 70 0.78 4.12 23 28 ... Scarlet Fever ... ... 9 0.18 0.94 1 6 16 Diphtheria ... ... ... 2 4 0.70 12 0.13 2 4 17 4.47 6 0.84 Whooping Cough ... ... 50 3 76 1 2 Fever ... ... ... 0.07 4 0.41 7 ... 69 1.07 Diarrhœa ... ... ... 7 12 96 5.65 8 1 95 0.22 0.11 Simple Cholera ... ... 1 2 ... ... 3.10 Total ... ... ... 43 279 88 53 16.4 TABLE III. DEATHS FROM ZYMOTIC DISEASES IN 10 YEARS, 1876—85. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Average of 10 Years. 9 Small Pox ... ... 39 8 3 8 5 0 5 14 10.9 18 Measles ... ... ... 46 46 46 56 109 67 81 61 63.9 75 52 47 23 Scarlet Fever ... ... 97 21 102 102 101 48 64.0 43 56 5 19 13 9 13.0 Diphtheria ... ... 31 15 3 9 16 10 94.0 75 225 98 39 178 61 Whooping Cough ... 94 25 82 63 21 12 18 25 16 21 20 13 16 Fever ... ... ... 10 16.2 113 137 45 126 74 97 Diarrhœa and Cholera 80 67 59 85.9 61 351 420 411 287 344 335 292 245 Total ... ... ... 522 290 349.7 TABLE IV. BIRTHS AND DEATHS IN 16 YEARS 1871-86. Year. Estimated Population Total Births. Total Deaths. Excess of Births over Deaths. Birth Rate. Death Rate. Deaths from Zymotic Diseases. London Death Rate. Total. Rate per 100 living. 1871 80,585 3327 1994 1333 41-2 24-7 564 6 - 1 26-6 45-4 2 81,198 2024 20-4 4 - 2 21 1 3687 1663 344 81,811 1584 43-8 3 3587 2003 24-4 392 4 - 7 22-4 3656 1642 44-3 3 - 2 22 4 4 82,424 2014 19-8 268 23-5 3587 2094 43-1 5 - 4 5 83,038 1497 25-2 452 43-9 3571 1804 21-5 21-9 6 83,615 1867 351 287 4 - 2 7 1665 84,264 3620 1955 42-9 19-7 3 - 4 21-5 42-9 23-1 8 84,877 3597 2110 1487 24-8 522 6 - 1 9 3715 1983 1732 43-4 4 - 0 22-1 85,490 23-1 344 3532 1736 41-0 411 4 - 6 1880 86,104 1796 20-8 21-7 Ten Years' Average. 3598 1875 1722 43-1 22-4 393 4 - 6 22-4 1881 86,808 3550 1735 1815 40-9 20-0 290 3 - 3 21-2 1882 87,430 1572 39-8 3485 1913 21-8 420 4 - 7 21-2 1712 3 - 3 1883 3435 1722 39-0 19-5 20-4 88,052 292 88,674 1777 20-3 1884 3469 1692 39-1 20-0 3 - 7 335 1885 3221 1638 36-1 17-7 245 279 19-7 80,296 89,918 1583 2 - 7 1886 37-2 18-9 3348 1098 1650 3 - 1 19-9 FORTNIGHTLY REPORTS. January 18th, 1886. In the fortnight that ended on the 9th day of January, 171 births and 103 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 49.7, and an annual rate of mortality of 29.9 per thousand of the estimated population. The corresponding death rate in London was 24 4, and the mean rate of 28 great towns 24.0. These unusually high rates are partly due to delayed registration at Christmas, and partly to increased fatality from diseases of the respiratory organs, and greater mortality among aged persons, arising from cold, fog, and north-easterly winds which had prevailed during the preceding week. The number of deaths from diseases of the zymotic class was 6, viz., 5 from whooping cough and 1 from diarrhœa. Diseases of the respiratory organs caused 41 deaths,—viz., bronchitis 27. pneumonia 10, and other diseases 4. From consumption there were 10 deaths ; from old age 11 ; and from heart disease 9. Five inquests were held. One death was attributed to accidental asphyxia. The deaths under 1 year of age numbered 17, and above 60 years of age, 36. Cold is more fatal to the aged than to the young, especially sudden and sharp, although short, periods of cold. Fifteen deaths occurred in the workhouse—10 males and 5 females. The ages at death averaged 75 years for the women, and 67½ the men. The latter included 2 deaths from phthisis, and 1 from acutebronchitis at the comparatively early ages of 38 and 53. These reduce the mean age at death among the males, which, exclusive of these cases, was 78 years. The causes of death were old age, or chronic diseases of the lungs and he art, which are ordinarily attendant on advanced periods if life. February Ist, 1886. During the fortnight that' ended on the 23rd day of January, 149 births and 79 deaths were registered in the parish. These numbers show an annual birth rate of 43.0, and an annual rate of mortality of 22.8 per thousand of the estimated population. The corresponding death rate in London was 22.9. Zymotic diseases caused 13 deaths, viz., measles 2, scarlet fever 1, whooping cough 10. From diseases of the respiratory system there were 24 deaths, viz. : —from bronchitis 17, from pnuemonia 4, and other diseases 3. Diseases of the tubercular class caused 9 deaths, of which 7 were referred to phthisis. There were 3 deaths from old age, 3 from heart disease, and 3 from cancer. Eighteen children died under one year of age, and twenty persons at and above 60 years of age. Four inquests were held ; all the deaths were referred to natural causes. The Dairies', Cowsheds', and Milkshops' Order of 1885, [Reg. 28 to 32] contains important provisions respecting the sale of milk by retail, which cannot be too generally known. [Read 28 to 32.] February 15th, 1886. During the fortnight that ended on the 6th day of February. 141 births and 82 deaths were registered in the parish. These numbers are equal to an annual birth rate of 40.7, and an annual rate of mortality of 23.7 per thousand of the estimated population. The corresponding death rate in London was 22.3. The number of deaths from zymotic diseases was 16, there being recorded 2 deaths from measles, 11 from whooping cough and 3 from diarrhœa. Diseases of the respiratory organs caused 19 deaths, viz :— bronchitis 12, pneumonia 4, and other diseases 3. Fourteen deaths were attributed to diseases of the tubercular order, of which 10 were from consumption. The deaths under one year of age numbered 21, and above 60 years of age, 14. One inquest was held ; the cause of death being fractured ribs from a fall downstairs. There is reason to fear another epidemic of whooping cough. This disease is very fatal to young children. It requires early, careful, and constant medical treatment and domestic care, and yet —strange to say—it is often disregarded by parents, until the condition of the little patient has become critical and dangerous. March 1st, 1886. During the fortnight that ended on the 20th day of February, 145 births and 105 deaths were registered in the parish. These numbers shew an annual birth rate of 41.9, and an annual late of mortality of 30.3 per thousand of the estimated population. The corresponding death rate in London was 25.2 per thousand. The chief diseases of the zymotic class caused 13 deaths, viz : —measles 4, whooping cough 7, and diarrhœa 2. Diseases of the respiratory organs caused 34 deaths, or one-third of the entire mortality from all causes. There were 29 fatal cases of bronchitis, and 5 of pneumonia. From tubercular diseases 13 deaths were recorded, there being 11 from phthisis, and 2 from meningitis. The other causes of death included 4 from old age, 4 from heart disease, 3 from childbirth, and 6 from premature birth. Six inquests were held : 3 deaths were referred to violence. The deaths under one year of age numbered 30, and those above 60 years of age, 22. The water supplied by the Southwark Company was clear and bright and of average quality for the season of the year. March 15th, 1886. During the fortnight that ended on the 6th day of March, 142 births and 79 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 22.8 per thousand of the estimated population. The corresponding death rate in London was 25.9. From the chief diseases of the zymotic class there were 12 deaths, viz:— 3 from measles, 6 from whooping cough, 2 from enteric fever, and 1 from diarrhœa. Diseases of the respiratory organs caused 28 deaths, viz :—bronchitis 19, pneumonia 7, and other diseases 2. There were 7 deaths from phthisis, 4 from meningitis, 4 from old age, and 6 from heart disease. Under one year of age the deaths numbered 16, and above 60 years of age 18. One inquest was held; the cause of death being accidental asphyxia. Eleven persons died in the Workhouse. Two deaths were not certified. April 5th, 1886. During the three weeks that ended on the 27th day of March, 223 births and 135 deaths were registered in the parish. These numbers shew an annual birth rate of 43.9, and an annual rate of mortality of 26.0 per thousand of the estimated population. The corresponding death rate in London was 28.6 per thousand. The chief diseases of the zymotic class caused 22 deaths, viz. :—measles 9, diphtheria 1. whooping cough 9, enteric fever 1, simple fever 1, diarrhœa 1. From diseases of the respiratory system there were 47 deaths, of which 40 were due to bronchitis, and 7 to pneumonia. In the tubercular class there were 7 deaths from phthisis, and 5 from meningitis. Ten persons died from diseases of the brain and nervous system, and 9 from old age. Thirty-five children died under one year of age, and 34 persons at 60 years of age and upwards. Eight inquests were held; in 7 cases the deaths were referred to natural causes, and in 1 to accidental asphyxia. The water supplied by the Southwark Company was efficiently filtered and the proportion of organic matter was not excessive for the season of the year. April 19th, 1886. During the fortnight that ended on the 10th day of April, 148 births and 61 deaths were registered in the parish. These numbers are equal to an annnal birth rate of 42.7, and an annual rate of mortality of 17.6 per thousand of the estimated population. The corresponding death rate in London was 20.9 per thousand. The number of deaths from the principal diseases of the zymotic class was 11, viz.:—from measles 6, whooping cough 3, diphtheria 1, and diarrhœa 1. From tubercular diseases there were 11 deaths, of which 6 were referred to phthisis, 2 to meningitis, 1 to tabes mesenterica, and 2 to tuberculosis. Diseases of the respiratory organs caused 15 deaths, viz :— bronchitis 12, and pneumonia 3. There were 5 deaths from old age, 3 from brain diseases, and 3 from stomach diseases. Fifteen children died under one year of age, and 13 persons at 60 years of age and upwards. Seven inquests were held: 3 deaths were due to violent causes ; only one death was not certified, The water supplied was clear and bright, being efficiently filtered. May 3rd, 1886. In the fortnight that ended on the 24th day of April, 139 births and 63 deaths were registered in the parish. These numbers show an annual birth rate of 40.1, and an annual rate of mortality of 18.2 per thousand of the estimated population. The corresponding death rate in London was 19.2 xxiv. The mortality from diseases of the zymotic class was unusually low, there being only 2 deaths from measles, and 4 from whooping cough. Diseases of the respiratory organs also show a considerable diminution, the number of deaths having fallen to 13 in the fortnight. From tubercular diseases there were 10 deaths, from old age 9, from brain diseases 5, and heart disease 3. The deaths which occurred in the first year of life numbered 18, and those above 60 years of age, 17, One inquest was held, the cause of death being epilepsy. The general health of the parish is good. May 17th, 1886. During the fortnight that ended on the 8th day of May, 151 births and 71 deaths were registered in the parish, shewing an annual birth rate of 43.6, and an annual rate of mortality of 20.5 per thousand of the estimated population. The corresponding death rate in London was 18.6. From the chief diseases of the zymotic class there were 11 deaths, viz.:— 4 from measles and 7 from whooping cough. Diseases of the respiratory organs caused 17 deaths, viz.:— bronchitis 12, and pneumonia 5. From tubercular diseases there were 10 deaths, of which 3 were referred to phthisis, 4 to meningitis, and 3 to tabes mesenterica. Diseases of the brain caused 8 deaths, and old age, 3. Six inquests were held ; 4 deaths were due to violence. The number of deaths in children under one year of age was 20, and in persons of 60 years of age and upwards, 17. June 7th, 1886. During the three weeks that ended on the 29th day of May, 160 births and 91 deaths were registered in the parish. These numbers are equivalent to an annual birth rate of 30.8, and an annual rate of mortality of 17.5 per thousand of the estimated population. The corresponding death rate in London was 16.8. The chief diseases of the zymotic class caused 10 deaths, viz. : —measles 4, whooping cough 5, and enteric fever 1. From diseases of the respiratory organs there were 21 deaths, of which 10 were referred to pneumonia, and 9 to bronchitis. In the tubercular class of diseases there were 10 deaths from phthisis, 6 from meningitis, and 1 from tabes mesenterica. Nine persons were certified to have died from old age. The number of deaths under one year of age was 23, and above 60 years of age, 15. Eight inquests were held ; 1 death was referred to violence, and one death was not certified. June 21st, 1886. During the fortnight that ended on the 12th day of June, 132 births and 69 deaths were registered in the parish. These numbers shew an annual birth rate of 38.1, and an annual rate of mortality of 19.9 per thousand of the estimated population. The corresponding death rate in London was 15.8. The number of deaths frym zymotic diseases was 2, viz. :—from measles 1, and from diphtheria 1. From diseases of the respiratory organs there were 10 deaths, viz.:—from bronchitis 6, pneumonia 3, and asthma I. Tubercular diseases caused 13 deaths, including phthisis 6, meningitis 5, and tabes mesenterica 2. The other causes of death included 6 from convulsions, 5 from brain disease, and 4 from old age. Five inquests were held; 3 deaths were referred to violence. The number of deaths in children under 1 year of age was 16, and of persons above 60 years of age, 15. The water supplied by the Southwark Company was clear and bright. July 5th, 1886. In the fortnight that ended on the 26th day of June, 117 births and 34 deaths were registered in the parish. These numbers shew an annual birth rate of 33.8, and an annual rate of mortality of 9.8 per thousand of the estimated population. The corresponding death rate in London was 15.3. All these rates are much below the average. xxvi. Zymotic diseases caused 8 deaths, viz.:—diphtheria 1, and diarrhœa 7. In the tubercular class there was one death from mesenteric disease. From diseases of the respiratory organs there were 7 deaths, viz. :—6 from bronchitis, and 1 from pneumonia. Three inquests were held; 2 deaths were from violent causes—l accidental and 1 suicide. Six children died under 1 year of age, and two persons at upwards of 60 years of age. July 19th, 1886. During the fortnight that ended on the 10th day of July, the number of births registered in the parish was 115, and the number of deaths 68. These numbers are equal to an annual birth rate of 33.2, and an annual rate of mortality of 19.6 per thousand of the estimated population. The corresponding death rate in London was 17.6 The chief diseases of the zymotic class caused 8 deaths, viz. : —measles 2, whooping cough 2, diarrhœa 3, and simple cholera 1. From diseases of the respiratory organs there were 18 deaths, of which 8 were referred to bronchitis, and 8 to pneumonia. Eleven deaths were attributed to diseases of the tubercular order. A boy aged 15 years was certified to have died from " sunstroke." [July 2nd ; ill 3 days]. Five inquests were held ; Four deaths were due to violence. The number of deaths of children under 1 year of age was 19, and of persons above 60 years of age, 8. The water supplied by the Southwark Company was clear and bright. Complaint has been made of a nuisance at Mr. Bowron's, 11, The Grange, Some pelts said to have been imported from New Zealand and to have been fellmongered with Sulphide of Sodium and Lime, were in a decidedly offensive condition. I have reason to think the nuisance will be abated. August 9th, 1886. During the three weeks that ended on the 31st day of July, 162 births and 98 deaths were registered in the parish. These numbers shew an annual birth rate of 31.2, and an annual rate of mortality of 18.8 per thousand of the estimated population. The corresponding death rate in London was 21.6. Diseases of the zymotic class caused 28 deaths, viz. :— measles 1, scarlet fever 1, whooping cough 2, and diarrhœa 24. The fatal cases of diarrhœa were almost exclusively confined to children under 1 year of age. From diseases of the respiratory organs there were 11 deaths, and from those of the tubercular class, 21. Three inquests were held ; in all these cases the deaths were referred to natural causes. The number of deaths in children during the first year of life was 52, and in persons of 60 years of age and upwards, 13. The memorial from residents in Cadbury Road is not dated. On the day after the last Vestry meeting, I visited Messrs. Young & Co.'s Glue Yard, and found an offensive effluvium pervaded the whole of the premises. I attributed this to an unusually large collection of animal matter and the hot weather. I have visited the premises again to-day, and found the collection considerably reduced. I have inspected St. Saviour's Dock, and report that there is a thick deposit of offensive black mud, which is a nuisance and injurious to health. The houses in Ship and Mermaid Court are without through ventilation, damp, and in a dilapidated state. I consider them unfit for human habitation. With reference to the letter of Mr. Taylor, I beg to observe that notice had been served on Mr. Bowron, and that I had done all that the law enables me to do under the circumstances, previous to the receipt of that letter. In accordance with the resolution of the Vestry, Public Notices of the Precautions to be observed against Diarrhœa, have been posted throughout the Parish. September 20th, 1886. During the six weeks that ended on the 11th day of September, 365 births and 157 deaths were registered in the parish. These numbers shew an annual birth rate of 34.5, and an annual rate of mortality of 15.0 per thousand of the estimated population. The corresponding death rate in London was 18.1. From the chief diseases of the zymotic class there were 50 deaths, viz. :—from measles 1, scarlet fever 6, diphtheria 3, whooping cough 3, enteric fever 2. and diarrhœa 35. Diseases of the tubercular class caused 21 deaths, of which 6 were referred to phthisis, 6 to meningitis, 7 to tabes mesenterica, and 2 to tuberculosis. From diseases of the respiratory organs there were 22 deaths, including 9 from bronchitis, and 10 from pneumonia. The deaths in children under one year of age numbered 68, and those in persons above 60 years of age, 15. Thirteen inquests were held ; four deaths were attributed to violence. One death was caused by a blow from a cricket ball. Five deaths were uncertified. The water supplied by the Southwark Company during July and August was clear and bright. October 4th, 1886. During the fortnight that ended on the 25th day of September, 117 births and 45 deaths were registered in the parish. These numbers shew an annual birth rate of 33.8, and an annual rate of mortality of 13.0 per thousand of the estimated population. The death rate in London was 16.8 per thousand. These rates are unusually low. In the class of zymotic diseases there was 1 death from scarlet fever, and 5 deaths occurred from diarrhœa. Diseases of the respiratory organs caused 10 deaths, and those of the tubercular class, 7. Two inquests were held, one death was referred to violence, a boy run over by a horse and cart. One death was uncertified. From the above figures it is evident that the parish is in a very healthy condition. October 18th, 1886. In the fortnight that ended on the 9th day of October, 131 births and 47 deaths were registered in the parish. These numbers shew an annual birth rate of 34.8, and an annual rate of mortality of 13.5 per thousand of the estimated population. The death rate in London was 17.1. Diseases of the zymotic class caused 7 deaths, viz.:— measles 1, scarlet fever 2, diphtheria 2, and diarrhœa 2. One of the cases of diphtheria is that of a woman, aged 44 years, whose death is certified to have been caused by " diphtheritic sore throat, erysipelas of head, and pyæmia." This death might fairly be attributed to " erysipelas." From diseases of the respiratory organs there were 12 deaths, of which 5 were referred to bronchitis, 5 to pneumonia, and 2 to other diseases. To tubercular diseases 9 deaths were attributed, there being 3 from phthisis, 3 from meningitis, and 3 from tabes mesenterica. Heart diseases caused 4 deaths, and kidney diseases 4. Two inquests were held, the deaths in both cases arising from heart disease. The water supplied during the last month was clear and bright, the quantity of organic matter being exceptionally small, This, no doubt, is attributable to the fine and dry weather. November 1st, 1886. During the fortnight that ended on the 23rd day of October, the number of births registered in the parish was 118, and the number of deaths 54. These figures shew an annual birth rate of 34.1, and an annual rate of mortality of 16.6 per thousand of the estimated population. The corresponding death rate in London was 16.8. There were only 5 deaths from diseases of the zymotic class, viz. : —1 from measles, 2 from scarlet fever, 1 from diphtheria, and 1 from whooping cough. From diseases of the respiratory organs there were 14 deaths, and from those of the tubercular class 11. Five inquests were held; two deaths were referred to violence: I to accidental asphyxia, and I to suicidal poisoning by carbolic acid. The number of deaths from diphtheria in London during the year 1885, was 896, of which 202 occurred in the first quarter, 213 in the second quarter, 238 in the third quarter, and 243 in the fourth quarter. The total exceeded the average of the previous 10 years, which was 690. It was, however, less than in the two preceding years, —the deaths in 1884 being 973, and in 1883, 951. During the present year the number of deaths from diphtheria, in London was 220 in the first quarter, and 188 in the second quarter. In the last six weeks, the weekly numbers have been 13, 15, 20, 28, 18, 25. The last number is 7 above the average, which is 18 for the corresponding week in the previous 10 years. I am unable to suggest any course by which the Sanitary authorities could prevent the occurrence of this disease, but have no doubt that the number of fatal cases might be reduced by prompt medical aid. It is a complaint in which the early symptoms are not strongly marked, and, consequently, it often happens that a doctor is not called in until the condition of the patient has become dangerous or even hopeless. The death rate from diphtheria in London last year was 0.22, or 22 deaths from this cause in one hundred thousand of the population. This disease has a distinct maximum period in the last quarter of the year. The highest point is generally reached about the end of November, when it gradually declines till about the first week in May. It is frequently more prevalent in the extra-metropolitan parts of Surrey and Middlesex, and in some of the country districts, than it is in London. The Registrar-General remarks that, " So much uncertainty attaches to the use of the term " diphtheria" by medical men, and there is such confusion in their certificates between diphtheric and simple spasmodic croup, that the returns under this heading are extremely untrustworthy." Diphtheria is as prevalent just now in the healthy districts of the West End as it is in the less healthy parts of East London. November 15th, 1886. During the fortnight that ended on the 6th day of November, 114 births and 48 deaths were registered in the parish. These numbers show an annual birth rate of 32.9, and an annual rate of mortality of 13.8 per thousand of the estimated population. The corresponding death rate in London was 17.0. This was the average death rate of the first five weeks of the current quarter, which was 2.6 below the mean rate in the corresponding periods of the ten years 1876-85. There were only 3 deaths from zymotic diseases, viz. :— 2 from diarrhœa, and 1 from measles. Diseases of the respiratory organs caused 6 deaths, and those of the tubercular class, 9. Five inquests were held ; three deaths were due to violence. The number of deaths which occurred under one year of age was 17, and above 60 years of age, 11. Among the latter is recorded the death of the widow of a tanner at the age of 100 years. December 6th, 1886. During the three weeks that ended on the 27th day of November, 207 births and 95 deaths were registered in the parish, shewing an annual birth rate of 39.9, an d an annual rate of mortality of 18.2 per thousand of the estimated population. The corresponding death rate in London was also 18.2 per thousand. The number of deaths from diseases of the zymotic class was 9, viz. :—from measles 3, scarlet fever 1, diphtheria 1, whooping cough 1, and diarrhœa, 3. The number of deaths from diseases of the respiratory organs was 32, being a considerable increase, caused by fogs and cold. The fatal cases were bronchitis 20, pneumonia 8, croup 3, and pluerisy 1. From diseases of the tubercular class there were 16 deaths. Three inquests were held; one death was referred to "excessive drinking of spirits," and one to accidental asphyxia. Three deaths were uncertified. The deaths in childern under one year of age numbered 29, and those in persons of 60 years of age and upwards, 16, The water supplied by the Southwark Company was clear and bright, and although it contained a larger proportion of organic matter than in the previous month, this was not excessive for the period of the year. December 20th, 1886. During the fortnight that ended on the 11th day of December, 130 births and 69 deaths were registered in the parish. These numbers shew an annual birth rate of 34.5, and an annual rate of mortality of 19.9 per thousand of the estimated population. The corresponding death rate in London was 21.1 per thousand. The number of deaths from diseases of the zymotic class was 10 ; there were 8 deaths from measles and 2 from diarrhœa. Diseases of the respiratory organs caused 19 deaths, all being attributed to bronchitis In the tubercular order there were 10 deaths, viz.:—from phthisis 5, from meningitis 4, and from tabes mesenterica, 1. Seven deaths were referred to heart disease, and 2 to old age. Seven inquests were held; one death was attributed to "mortal burns, but how caused there was no legal evidence to show." The number of deaths in children under 1 year 01 age was 22, and in persons of 60 years of age and upwards, 12. During the last two weeks the deaths from diphtheria in London have fallen befow the corrected decennial average. The metropolis is unusually free from smallpox. The most prevalent zymotic disease is measles. The general mortality during the last quarter has been remarkably low. January 3rd, 1887. In the fortnight that ended on the 25th day of December, the number of births registered in the parish was 95, and the number of deaths, 54. These numbers shew an annual birth-rate of 27.5, and an annual rate of mortality of 15.6 per thousand of the estimated population. The birth rate is exceptionally low, probably on account of delayed registration. The death rate in the Metropolis was 19.2 per thousand. The chief zymotic diseases caused 13 deaths, viz. : — measles 10, and scarlet fever, diphtheria, and whooping cough, each 1. From diseases of the respiratory organs there were 14 deaths, viz.:—from bronchitis 9, and from pneumonia 5. Diseases of the tubercular order caused 10 deaths, viz. :— phthisis 8, and meningitis 2. Two inquests were held, and 2 deaths were uncertified. The number of deaths in children under one year of age was 10, and in persons of 60 years of age and upwards, 8. Up to this period the parish has been very healthy, but we may expect a considerable increase in the mortality arising from the inclement weather, the effects of which will continue to affect the death rate for some weeks to come. BER 12