BER 13 THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY, FOR THE YEAR 1887. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physicians of London,Member of the Royal College of Surgeons of England, Licentiate of the Society of Apothecaries, Licentiate in Midwifery, etc., MEDICAL OFFICER OF HEALTH FOR THE PARISH Printed by lattimer, Laite & Kimber,73, Southwark Park Road, S.E. C.X.Lon THE VES.TRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY, FOR THE YEAR 1887. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physicians of London, Member of the Royal College of Surgeons of England, Licentiate of the Society of Apothecaries, Licentiate in Midwifery, etc., MEDICAL OFFICER OF HEALTH FOR THE PARISH. ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH. TO THE VESTRY OF BERMONDSEY. Mr. Chairman and Gentlemen, I have the honour of presenting my Twelfth Annual Report on the state of the Public Health in the Parish of Bermondsey. It embraces the period of 52 weeks that ended on the 31st day of December, 1887. Compared with the previous year, there was an increase of 33 in the total number of deaths from all causes. The mortality, however, was 67 below the average of the 10 preceding years. The deaths registered in the Parish showed an annual death rate of 19.1 per 1,000 of the estimated population. The deaths from the principal diseases of the Zymotic class numbered 341, being 62 more than occurred in 1886, and only two below the decennial average. They were equal to a rate of nearly 3.8 per 1,000 persons living. As in the previous year, there were no deaths from Small-pox or Typhus. Measles was generally prevalent, especially in the early part of the year, and caused 89 deaths. Whooping Cough was very fatal during the second and third quarters, and was the cause of 87 deaths. Diarrhoea caused 101 deaths, of which 89 took place in the third quarter, during a short season of hot weather. Scarlet Fever was almost absent in the spring, but excited much alarm in the autumn from the general public having been led to form an exaggerated idea of its prevalence. Our deaths from this cause were 45, being an advance of 29 on the previous year, but still 11 below the average. Diseases of the Inspiratory System were rather more fatal, and those of the Tubercular class less so. The birth rate, which had shown a small increase in the previous year, declined to 35.3. There were fewer births in each of the three registration districts. The natural increase of the population, or the excess of births over deaths, was 1,469, or 1.6 per cent., but the estimated increase is only 0.7 per cent, or 622 persons yearly. The number of inhabitants, calculated to the middle of the year, is computed to be 90,540. The sexes are nearly in equal proportions, the males being in a small majority in the Leather Market and St. Mary Magdalen Districts, and the females slightly outnumbering the males in St. James's District. For the three districts, the population, calculated on the basis adopted by the Registrar General, is as follows:—Leather Market, 16,000; St. Mary Magdalen, 15,640; St. James's, 58,900. BIRTHS. The number of births registered in the parish during the year was 3,200, being 148 less than in the previous year, and 197 below the decennial average. This is the lowest number of births recorded in any year since 1867, when it was 3,119 in a smaller population. The male children numbered 1,621, and the female 1,579, being in the proportion of 1,026 boys to 1,000 girls. The mean number of births per week was 61.5, against 64 in the previous year. One birth occurred among every 28 persons in the parish. The annual birth rate was 35.3 per thousand of the estimated population, and 1.9 below the same rate in 1886. The birth rate in London was 31.7 which is the lowest rate recorded since 1849, and probably the lowest since civil registration began. Since 1876 this rate has fallen continuously year by year. As is usually the case, the first quarter of the year was the most prolific. In that quarter the births numbered 889, while in the three remaining quarters they were respectively 751, 760 and 800. In the Leather Market district there were 613 births: being 19.1 per cent. of the whole, and showing a birth rate of 38.0 per 1,000 inhabitants. In St. Mary Magdalen District the births numbered 589, and the birth rate was 37.6. In St. James's district 1,998 children were born, or 62.4 per cent. of the total births. The birth rate in the last-named district was only 33.9 per 1,000 residents. In comparison with the previous year there was a decline in the number of births in each of the three districts. DEATHS. The total number of deaths from all causes registered in the Parish during the year was 1,731, of which 867 were males and 864 females. This number exceeds that of the previous year by 33, but falls short of the decennial average by 67. The annual rate of mortality was 19.1 per 1,000 of the estimated population, or in the proportion of one death to every 52 persons living. The average weekly number of deaths was 33.3. The ratio of deaths to births was 100 to 196. The London death rate was 19.6, being the lowest on record, although the rates of the two preceding years had been nearly equally low. The number of deaths recorded in the Leather Market District was 339, or 19.5 per cent. of the whole, and equal to a death rate of 21.2 per 1,000 living. The deaths in the St. Mary Magdalen District were 386, or 22.2 per cent., and equal to a death rate of 24.6. In the Workhouse, which is situated in this district, there were 69 deaths; exclusive of these, the death rate was 20.2. In the St. James' District there were 1,006 deaths, or a percentage of 58.1, corresponding to a yearly death rate of 17.1 per 1,000 inhabitants. During the first quarter of the year the registered deaths numbered 458, or 26.4 per cent.; in the second quarter, 386, or 22.3 per cent.; in the third quarter, 459, or 26.4 per cent. ; and in the fourth quarter, 428, or 24.7 per cent, of the total deaths of the entire year. The number of deaths of infants under one year of age was 544, of which 117 took place in the Leather Market District; 97 in St. Mary Magdalen's, and 330 in St. James's. The infantile death rate, or the proportion of the deaths of infants in the first year of life to 1,000 registered births, was 170 for the entire Parish : —l9O in the Leather Market; 164 in St. Mary Magdalen ; and 165 in St. James's District. Compared with the previous year, there is an increase in this rate in the two last-mentioned districts. In London the infantile death rate was 158 ; in 28 great towns it averaged 168; in 50 large town districts, 153; and throughout England and Wales, 145. The proportion reached 209 in Leicester and 214 in Preston. The number of deaths in persons of 60 years of age and upwards was 282, or 16.3 per cent, of the total deaths. The first quarter of the year, being the coldest, is most fatal to the aged, and the third, or hottest quarter, to young children. The deaths of two centenarians were recorded — one at the age of 100, and the other at the age of 102 years. Both were widows. Twenty-one per cent of the deaths registered in London in 1887 occurred in some or other public institution. About one in nine of the deceased persons died in a workhouse, and one in 133 in a Metropolitan Asylum Hospital; while one in 12 died in other hospitals, and one in 6O in an asylum for lunatics or imbeciles. To include all these cases the number of deaths of Bermondsey parishioners should be raised to 2,000, of which 1,731 took place within the Parish and 269 beyond its boundaries. These deaths in public institutions included— Scarlet Fever, 17; Diphtheria, six; Whooping Cough, three; Enteric Fever, two; and Diarrhoea, five. I have no information as to the residences or ages of these patients, nor any account of the causes of death in the remaining cases. CAUSES OF DEATH. The chief diseases of the Zymotic class caused 341 deaths against 279 in the previous year, and a decennial average of 342. These deaths were 19.7 per cent., or nearly one-fifth, of the deaths from all causes, and were in the proportion of 3.76 to 1,000 of the population. The Zymotic death rate in London was 3.02. Measles prevailed throughout the year, and caused 89 deaths, exceeding the average by 23. No less than 83 of these deaths occurred in children under five years of age. Scarlet Fever was more fatal than in the previous year, there being 45 deaths from this disease, against only 16 in 1886. The average of the 10 preceding years, however, is 56, and during that period there were three years when the number of deaths from this cause exceeded 100. Whooping Cough accounted for 87 deaths, of which 84 took place in children under five years of age. From Diarrhoea there were 101 deaths, 89 of which happened in the third or summer quarter, and 80 in infants under one year. 10 deaths were attributed to Diphtheria :—one in the Leather Market District; two in St. Mary Magdalen's; and seven in St. James's. This number is below the average, which is 14. The deaths from Fever included eight of the enteric and one of the simple continued form. In 1863 the deaths from Fever were 64, and the average for five years was 48. The completion of the main drainage scheme, the covering of the tidal ditches, and the abolition of cesspools, were promptly followed by a great reduction in the number of deaths from fever. Including two deaths from Enteric Fever which occurred in the hospitals, our fever death rate is 0.12 per 1,000. The same rate in London is 0.16, and the mean rate in 28 great towns is 0.22. There are 10 towns in which this rate exceeds 0.30, and one—Preston—where it amounts to 0.63. In the class of Septic Diseases there were seven deaths from Erysipelas, one from Pyaemia, one from Gangrene, two from Anthrax, and eight from Puerperal Septicaemia. The deaths of three children were referred to want of breast-milk. It is probable that many of the deaths attributed to Atrophy and other " wasting diseases" are really due to improper hand-feeding. Alcoholism was the certified cause of six deaths—a number which by no means fully represents the fatal consequences resulting from the abuse of alcoholic stimulants. In the class of Constitutional Diseases there were eight deaths from Rheumatic Affections, one from Gout, four from Rickets, and 25 from Cancer. The number of deaths from diseases of the Tubercular order was 225 being 12.9 per cent. of the total deaths, and at the rate of 2.48 per 1,000 persons living. From Tabes Mesenterica there were 22 deaths, from Meningitis 72, from Phthisis, or Consumption, 115, and from other Scrofulous Diseases, 16. In the previous year the deaths from Phthisis were 136, and in 1885, 144. Diseases of the Respiratory System caused 459 deaths, against 426 in the previous year. They were 26.5 per cent, of the total deaths, and equalled a rate of 5.1 per 1,000. They included Croup, 14 ; Bronchitis, 271; Pneumonia, 143 ; and other diseases, 31. From Diseases of the Brain and Nervous System there were 163 deaths, or 9.4 per cent., and 1.8 per 1,000 inhabitants. Apoplexy and Paralysis caused 55 deaths, and Convulsions 80. Diseases of the Heart and Organs of Circulation accounted for 84 deaths, or 4.8 per cent, of the total deaths. Seventy-five deaths were referred to Old Age, 39 to Premature Birth, and seven to Congenital Malformations. From various forms of Diseases of the Digestive System there were 65 deaths, or 3.8 per cent. Teething caused 18 deaths, and Diseases of the Liver, 12. Thirty-two persons died from Diseases of the Kidneys, and four from Diabetes. Five women died from accidents of Child-birth. To this number should be added the eight deaths from Puerperal Septicaemia. The inquest cases were 97, or 5.6 per cent, of the deaths. The Natural Causes of death included: Convulsive Fits, 20; Heart Diseases and Syncope, 16; Pulmonary Diseases, seven; Brain Diseases, four; Excessive Drinking, two. The deaths arising from Violence were 33, or 1.96 per cent, of the deaths. Ten infants were accidentally suffocated. Six persons died from injuries received from "Falls." Four were "Found Drowned," and two were "Accidentally Drowned." A woman died through "Misadventure by drinking a quantity of ammonia in tea." There were four cases of Suicide —two by cut throat, and two by hanging. There were two cases of Murder (both children), and one of Manslaughter (a man aged 46 years). The uncertified deaths were 32, or 1.8 per cent, —eight in the Leather Market, 11 in St. Mary Magdalen, and 13 in St. James' District. In London the uncertified deaths were 1.1 per cent, of the registered deaths. NOTIFICATION OF INFECTIOUS DISEASES. In order to prevent the spread of Infectious diseases and the possibility of one or two cases developing into a widespread and fatal epidemic, it is essential that the occurrence of the first cases should be brought within the knowledge of the Sanitary Authorities. The first persons attacked do not always die, and an infectious disease may have been diffused extensively and in various directions before any certificate of death, announcing the first fatal cause comes into the hands of the Medical Officer of Health. The longer the delay the greater is the difficulty of tracing the source of importation, or the local origin of the disease. It is by no means an easy task to follow up every case and endeavour to prevent the establishment of an epidemic by the enforcement of isolation and disinfection. The people in general do not appreciate the importance of these measures. However, they are becoming more and more sensible of the advantages of the prompt removal of patients to the hospitals, and there can be no doubt that this will have considerable effect in limiting the prevalence and the fatality of an epidemic. Voluntary notification of the occurrence of infectious disease in a house is incomplete, and fails to secure those public benefits which a well organised system of compulsory notification is calculated to effect. Thirty-eight towns in Great Britain have adopted, under their Local Acts, some plan of compulsory notification. In practice the system has been found to work satisfactorily and to be free from many of the objections which were formerly urged against it. The Society of Medical Officers of Health, the Sanitary Institute of Great Britain, and the Metropolitan Asylums Board are in favour of the principle of this measure, and concur in the opinion that its adoption throughout the Metropolitan area would be an additional security to the public against the spread of a fatal class of diseases. NUISANCES. The most important trade nuisance which has been abated during the year, and, I hope entirely abolished, is the Fish Offal Depot in Little Abbey Street, which from time to time, was peculiarly offensive to the residents in that locality. Complaints have been made of nuisances arising from the careless conduct of the business in certain trades peculiar to the parish, but only in one instance was it necessary to institute any legal proceedings. Several houses in a dilapidated and insanitary condition, and in some instances unfit for human habitation, have received the attention of your officers. STATISTICS OF LONDON. The population at the middle of the year 1887 was 4,215,192 persons, of whom 1,985,270 were males, and 2,229,922 females. The estimated increase during the year was 67,194, of which 50,867 arose from the excess of births over the deaths, and 16,327 from the influx of persons from the country and from abroad. The marriages celebrated in London were 34,193 in number, giving a proportion of 16.2 persons married to each 1,000 of the population. This is the lowest marriage rate yet recorded in London. The same statement has been made year by year during the last five years. The registered births numbered 133,075: males, 67,481; females, 65,594. The births were in the proportion of 31.7 to 1,000 inhabitants. This is the lowest rate since civil registration began. The deaths registered in the year numbered 82,208, of which 42,105 were males, and 40,103 females. The annual rate of mortality was 19.6 per 1,000 The male death rate being 21.3, and the female death rate 18.0. The deaths from Measles, Diarrhoea and Diphtheria exceeded the average, while those from Scarlet Fever, Whooping Cough and Fever were below it. The death rates in the groups of districts were: West, 19.0; North, 17.8; Central, 26.0; East, 22.5; South, 18.6. The death rate during the first quarter of the year was 20.7; in the second quarter, 18.0; in the third quarter, 19.6; and in the fourth quarter, 20.0. The mean temperature of the air was 47.8, being 1.4 below the average of 45 years. The temperature of the summer quarter was above the average. Rain fell on 141 days. The amount registered was 19.86 inches, being 5.36 inches below the mean rainfall of the previous 72 years. The remarkable small rainfall occasioned, in many parts of the country, great difficulties in maintaining an abundant supply of water. The absence of floods affecting the river Thames enabled the companies deriving their supply from that source to distribute water containing but little impurity, either in solution or suspension. With the exception of a slight turbidity which occured in the month of January, and arose from the flooded state of the river, the water supplied by the Southwark Company was reported to be clear and bright. At the end of April there were two or three days when the water supplied to some parts of this Parish was very turbid. I attributed it to accidental local contamination during the laying down of new pipes. Thanking the Vestry for the kind support which I have received in the exercise 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 year ending December 31st, 1887. Total at all ages DEATHS AT AGES. CAUSES OF DEATH. 0 — 1 1 — 5 5 — 20 20 — 40 40 — 60 60 — 80 80 — 100 All Causes 1731 544 418 98 153 236 208 74 ... ... ... ... ... ... ... Small Pox ... Measles 14 69 5 ... 89 1 ... ... 15 Scarlet Fever 45 1 29 ... ... ... ... 4 Diphtheria 10 3 3 ... ... ... ... 38 46 3 Whooping Cough 87 ... ... ... ... Typhus ... ... ... ... ... ... ... ... Enteric Fever 8 2 5 1 ... ... ... 1 ... ... ... Simple Fever ... 1 ... 101 ... ... Diarrhœea 80 19 ... 2 ... ... ... 2 1 Dysentery 1 ... ... ... ... ... Simple Cholera ... ... ... ... ... ... ... ... Syphilis 6 6 ... ... ... ... ... ... Erysipelas 7 4 1 1 1 ... ... ... Pyæmia 1 ... 1 ... ... ... ... ... Puerperal Septicaemia 8 8 ... ... Want of Breast Milk ... ... ... ... ... 3 3 ... ... ... 6 ... ... Alcoholism ... 2 2 2 ... ... ... Rheumatic Fever 2 1 ... ... 1 ... ... ... Rheumatism 6 1 3 2 ... ... ... ... 1 ... Gout ... ... 1 ... 4 ... ... 2 ... Rickets 1 1 ... ... ... Cancer 25 ... 2 15 8 ... ... ... ... Tabes Mesenterica 22 15 5 2 ... ... ... 37 Meningitis 72 25 10 ... ... ... ... TABLE I.—continued. CAUSES OF DEATH. Total at all Ages. DEATHS AT AGES. 0 - l 5 — 20 20 — 40 40 — 60 60 — 80 80 — 100 1 — 5 Phthisis 115 7 5 9 59 34 1 ... 6 Tuberculosis, Scrofula, &c 16 7 2 1 ... ... ... Premature Birth 39 39 ... ... ... ... ... ... Atelectasis 3 3 ... ... ... ... ... ... Congenital Malformations 7 7 ... ... ... ... ... ... Old Age 75 ... ... ... ... ... 26 49 Apoplexy 42 2 19 18 3 ... ... ... 9 Paralysis 13 1 2 1 ... ... ... Epilepsy 4 ... ... 2 1 1 ... Other Diseases of Brain ... 24 4 5 1 4 6 4 ... Convulsions 80 65 15 ... ... ... ... 12 ... Heart Disease 84 4 2 11 25 29 1 Croup 14 2 11 1 ... ... ... 10 ... Bronchitis 271 57 67 2 45 71 19 Pneumonia 143 34 54 11 12 24 8 ... Pleurisy 2 ... ... 1 1 ... ... ... Asthma 5 ... 4 ... 1 ... ... ... 24 6 9 1 Other Diseases of Respiratory Organs 3 4 1 ... 18 8 Dentition 10 ... ... ... ... ... Tonsillitis 1 1 ... ... ... ... ... ... Stomach Diseases 7 1 ... 4 2 ... ... ... Enteritis 11 4 3 ... ... 1 3 ... Peritonitis 7 1 ... 2 1 3 ... ... Hernia 2 1 1 ... ... ... ... ... Intestinal Obstruction 3 ... 1 2 ... ... ... ... TABLE I.—continued. DEATHS AT AGES. CAUSES OF DEATH. Total at all Ages. 0 — 1 1 - 5 5 — 20 20 — 40 40 — 60 60 — 80 80 — 100 2 2 ... ... ... ... ... ... Infantile Jaundice 12 Diseases of Liver ... ... 1 2 5 4 ... Diseases of Spleen 2 ... 1 ... 1 ... ... ... Diseases of Kidney 32 ... 2 3 5 14 7 1 Diseases of Prostrate 1 ... ... ... ... 1 ... ... Diabetes 4 ... ... 2 2 ... ... ... Child Birth 5 ... ... ... 5 ... ... ... Diseases of Bone and Joints Skin Disease 3 ... ... 1 ... 1 1 ... 1 ... ... ... 1 ... ... ... 32 32 ... ... ... ... ... Inanition ... Debility 18 17 1 ... ... ... ... ... 13 Atrophy 12 1 ... ... ... ... ... Asthenia 5 5 ... ... ... ... ... ... Marasmus 27 26 1 ... ... ... ... ... 1 Anæmia ... ... 1 ... ... ... ... 1 ... ... ... ... 1 Purpura ... ... Dropsy 1 ... ... ... 1 ... ... ... Carbuncle 2 ... ... ... ... 1 1 ... 1 1 ... ... ... ... ... Ulcer ... 2 1 1 ... ... ... ... ... Abscess 8 2 4 3 ... I11-defined 17 ... ... 4 8 ... ... 4 ... Violence—Fractures and Contusions ... ... Wounds 3 ... ... ... ... 2 1 ... 1 ... ... Poison ... 1 ... ... 6 ... ... 1 2 3 ... ... Drowning ... TABLE I.—continued. Total at all Ages. DEATHS AT AGES. CAUSES OF DEATH. 0 — 1 1 - 5 5 — 20 20 — 40 40 — 60 60 — 80 80 — 100 Accidental Asphyxia 10 5 5 ... ... ... ... ... 2 ... ... 1 Hanging ... 1 ... ... Manslaughter 1 ... ... ... ... 1 ... ... Murder 2 ... 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.-138. No. of Persons per Houses, 1881.-7.8. DEATHS FROM ZYMOTIC DISEASES IN 1887, AND IN EACH QUARTER OF THE YEAR. 1887. Total for the Year 1887. Rate per 1000 living. Per centage of Total Deaths. ZYMOTIC DISEASES. 1st. Quarter. 2nd. Quarter. 3rd. Quarter. 4th. Quarter. ... ... ... ... Small Pox ... ... ... Measles 31 20 19 19 89 0.98 5.14 2.60 Scarlet Fever 8 1 18 18 45 0.49 Diphtheria 2 4 3 1 10 0.11 0.58 25 87 0.96 5.02 Whooping Cough 12 38 12 0.52 Fever 2 ... 4 3 9 0.09 Diarrhœa 5 1 89 6 101 1.11 5.84 ... ... ... ... Simple Cholera ... ... ... Total 60 64 158 49 341 3.76 19.70 TABLE III. DEATHS FROM ZYMOTIC DISEASES IN THE TEN YEARS, 1877 — 86. 1883 1877 1878 1879 1880 1881 1882 1884 1885 1886 Average of 10 Years. 39 8 8 5 0 5 14 18 Small Pox 3 ... 46 46 56 52 109 67 81 61 70 Measles 75 Scarlet Fever 21 43 102 102 56 47 101 23 16 55.9 48 Diphtheria 5 9 19 13 31 9 16 10 15 12 Whooping Congh 75 225 98 39 25 76 94 178 82 61 Fever 21 25 16 21 20 13 16 12 10 7 Diarrhoea and Cholera 80 137 45 126 74 59 67 97 61 84.4 98 Total 287 522 344 411 420 292 335 245 279 342.5 290 BIRTHS AND DEATHS IN SEVENTEEN YEARS, 1871 — 87. Deaths from Zymotic Diseases. Excess of Births over Deaths. London Death Rate. Total Deaths. Birth Rate. Death Rate. Estimated Population. Total Births. Year. Rate per 100 living. Total. 1871 80,585 3327 1994 1333 41 - 2 24 - 7 564 6 - 1 26 - 6 1872 81,198 3687 1663 2024 45 - 4 20 - 4 344 4 - 2 21 - 1 81,811 392 4 - 7 22 - 4 1873 3587 2003 1584 43 - 8 24 - 4 1874 82,424 3656 1642 2014 44 - 3 19 - 8 268 3 - 2 22 - 4 1875 83,038 3587 2094 1497 43 - 1 25 - 2 452 5 - 4 23 - 5 21 - 9 1876 83,615 3571 1804 1867 43 - 9 21 - 5 351 4 - 2 84,264 1665 1955 42 - 9 19 - 7 287 3 - 4 21 - 5 1877 3620 1878 84,877 3597 2110 1487 42 - 9 24 - 8 522 6 - 1 23 - 1 85,490 22 - 1 1879 3715 1983 1732 43 - 4 23 - 1 344 4 - 0 86,104 1736 20 - 8 411 4 - 6 21 - 7 1880 3532 1796 41 - 0 Ten Years' Average. 3598 1875 1722 43 - 1 22 - 4 393 4 - 6 22 - 4 3 - 3 21 - 2 1881 86,808 3550 1735 1815 40 - 9 20 - 0 290 87,430 1572 39 - 8 21 - 8 420 4 - 7 21 - 2 1882 3485 1913 1883 88,052 3435 1722 1712 39 - 0 19 - 5 292 3 - 3 20 - 4 20 - 3 1884 88,674 3469 1777 1692 39 - 1 20 - 0 335 3 - 7 36 - 1 17 - 7 245 2 - 7 19 - 7 1885 89,296 3221 1583 1638 89,918 3348 1698 1650 37 - 2 18 - 9 279 3 - 1 19 - 9 1886 1887 90,540 3200 1731 1469 35 - 3 19 - 1 341 3 - 8 19 - 6 TABLE V. SANITARY WORK, &c., DURING THE YEAR 1887. Houses, &c., inspected and reported to the Vestry by the Medical Officer of Health, and the Inspector of Nuisances. Houses and other premises inspected 5221 Notices served to execute works, &c. 3292 Houses in a dirty and dilapidated condition, cleansed and repaired, etc. 225 Houses disinfected, cleansed and purified 125 Cases of overcrowding abated 9 Houses closed as unfit for habitation 22 Privies repaired or ventilated 111 Closets panned and trapped or old pans cleansed 153 Closets supplied with water 279 Defective drains repaired 143 Stopped drains cleared 350 Untrapped sinks trapped 201 Cesspools abolished 4 Badly paved yards repaired 197 Water receptacles supplied 19 Water receptacles cleansed and repaired 48 Houses supplied with water 17 Dustbins provided 219 Defective roofs repaired 91 Defective rain-shoots and gutters repaired 84 Offensive accumulations removed 34 Houses drained direct into the public sewer . 75 Defective water apparatus in w.c. repaired 97 Lots of fowls which were a nuisance, removed 7 Animals kept so as to be a nuisance, removed 6 Urinals and other offensive places cleansed 26 Slaughter-houses inspected and licensed 10 Cow-houses inspected and licensed 13 Bakehouses inspected 93 Cellar flaps repaired 9 Stables and other promises drained 51 Old brick drains relaid with stoneware glazed pipes 58 Waste water pipes disconnected from drains and made to discharge in the open air 140 Persons suffering from infectious diseases removed to Hospital 36 Dead bodies removed from rooms to mortuary upon Magistrates orders 8 Summonses taken out before Police Magistrates for not complying with orders of the Vestry 41 Food destroyed— Trunks of Fish,4; baskets of ditto,3 7 Pieces Beef 10 Various attendances at the Police Courts, etc. H. THOMAS, Inspector. FORTNIGHTLY REPORTS. January 17th, 1887. During the fortnight that ended on the 8th day of January the number of births registered in the parish was 128, and the number of deaths 97. The annual birth rate was 37.0, and the annual rate of mortality 28.0 per 1000 of the estimated population. The corresponding death rate in London during the same period was 25.1. Zymotic Diseases caused 13 deaths, viz.:—Measles, 11; Scarlet Fever, one; and Diarrhœa, one. From Diseases of the Respiratory Organs there were 21 deaths, viz.: —from Bronchitis, 16; Pneumonia, two; and other Diseases, three. To Tubercular Diseases 19 deaths were referred, viz.:—to and other Diseases of the same class, four. Heart Disease accounted for seven deaths, and Old Age for five. Six inquests were held. In one case, that of a woman, aged 45 years, death was attributed to "Excessive Drinking and Exposure to Cold." The deaths in children under one year of age numbered 32, and those in persons of 60 years of age and upwards, 19. Among the latter, three had attained the ages of 83, 85 and 88 years. The water supplied during the previous month contained marked increase in the quantity of organic matter, owing to the flooded state of the river, but all the samples were clear and bright. In the 13 weeks that ended on the 1st of January, the number of deaths in Bermondsey, including the deaths in Hospitals and in other Public Institutions of persons admitted from this Parish, was 468. The annual rate of mortality was 20.4. The number of deaths from Zymotic Diseases was 60, shewing an annual Zymotic death rate of 2.7 per 1,000 persons living. February 7th, 1887. During the three weeks that ended on the 29th day of January, 227 births and 105 deaths were registered in the Parish. These numbers shew an annual birth rate of 43.4 and an annual rate of mortality of 20.1 per 1,000 of the estimated population. The corresponding death rate in London was 21.5. The chief Zymotic Diseases caused 10 deaths, being at the rate of 1.9 per 1,000. There were five deaths from Measles, two from Scarlet Fever, and one each from Diphtheria, Whooping Cough, and Enteric Fever. The last named case is registered as " Erysipelas, Typhoid Fever, and Pneumonia." Its Enteric character may be considered doubtful. The fatality of diseases of the Respiratory Organs was considerable. There were 42 deaths, of which 32 were referred to Bronchitis, six to Pneumonia, and four to other diseases. Diseases of the Tubercular Class caused eight deaths, and Old Age, five. Under one year and above 60 years of age, there were 25 deaths in each case. Eight Inquests were held. Five deaths were referred to Natural Causes, and three to violence. Five deaths were uncertified. February 21st, 1887. During the fortnight that ended on the 12th day of February 120 births and 56 deaths were registered in the Parish. These numbers shew an annual birth rate of 34.4, and an annual rate of mortality of 15.1 per 1,000 of the estimated population. The corresponding death rate in London was 18.0 per 1,000. Only four deaths were recorded from Zymotic Disease, viz.:— one from Measles, two from Whooping Cough, and one from Enteric Fever. From Diseases of the Respiratory System there were 15 deaths, of which 11 were referred to Bronchitis. Tubercular Diseases caused six deaths, and those of the Brain and Nervous System, eight. The deaths which occurred in the first year of life numbered 24, and those in persons of upwards of 60 years of age, nine. Five Inquests were held. Four deaths arose from Violence, including two cases of murder, and one of suicide. The water supplied by the Southwark Company during the previous month was of inferior quality, the deterioration being attributed to excessive floods. The general state of the public health is satisfactory. March 7th, 1887. During the fortnight that ended on the 26th day of February, 157 births and 62 deaths were registered in the Parish. These numbers shew an annual birth rate of 45.0, and an annual rate of mortality of 17.8 per 1,000 of the estimated population. The corresponding death rate in London was 20.1. Zymotic Diseases caused eight deaths, viz: —Measles, three; Scarlet Fever, one; Whooping Cough, three; and Diarrhoea, one. From Diseases of the Respiratory Organs there were 20 deaths, of which 12 were referred to Bronchitis, and five to Pneumonia. Tubercular diseases caused eight deaths, viz:—Phthisis, four; Meningitis, three; and Tabes Mesenterica, one. Four deaths occurred from Old Age, and six from Infantile Convulsions. Under one year of age there were 22 deaths, and in persons of 60 years of age and upwards, 13. Two Inquests were held, and three deaths were uncertified. March 21st, 1887. During the fortnight that ended on the 21st day of March, the number of births registered in the Parish was 133, and the number of deaths 66. These numbers shew an annual birth rate of 38.2, and an annual rate of mortality of 18.9 per 1,000 of the estimated population. The corresponding death rate in London was 20.3 per 1,000 The chief diseases of the Zymotic class caused 11 deaths, viz.: —Measles, Scarlet Fever and Whooping Cough, each three, and Diarrhoea, two. From Diseases of the Tubercular order there were 10 deaths, viz:—from Phthisis, seven; from Meningitis, two; and from Tuberculosis, one. Diseases of the Respiratory Organs caused 18 deaths, viz:— Bronchitis, 12; Pneumonia, five; and Croup, one. Four deaths were attributed to Old Age. The number of deaths which occurred in children under one year of age was 18, and in persons of upwards of 60 years of age, 13. Two Inquests were held, the death in both cases appeared to be due to Natural Causes. The water supplied by the Southwark Company during the previous month showed a marked improvement in quality. April 4th, 1887. During the fortnight that ended on the 26th day of March 120 births and 83 deaths were registered in the Parish. These numbers shew an annual birth rate of 34.4, and an annual rate of mortality of 23.7 per 1,000 of the estimated population. The corresponding death rate in London was 20.8. Diseases of the Respiratory Organs exhibited an increased fatality. Nineteen persons died from Bronchitis, and 12 from Pneumonia. The chief Diseases of the Zymotic class caused 13 deaths, viz. :—Measles, eight; Scarlet Fever, two; Diphtheria, Whooping Cough, and Diarrhœa, each one. Measles were unusually prevalent in London. From Diseases of the Tubercular class there were nine deaths. The deaths of children under one year of age numbered 21, and those in persons of 60 years of age and upwards, 13. Nine inquests were held. In five the deaths were referred to Natural Causes, and in two to Accident. April 18th, 1887. During the fortnight that ended on the 9th day of April, 113 births and 74 deaths were registered in the Parish. These numbers shew an annual birth rate of 32.4, and an annual rate of mortality of 21.2 per 1,000 of the estimated population. The corresponding death rate in London was 18.7. The fatality from Diseases of the Respiratory System remains high. There were 18 deaths from Bronchitis, and six from Pneumonia. From Zymotic Diseases there were eight deaths, of which five were referred to Measles, two to Whooping Cough, and one to Diarrhoea. Diseases of the Tubercular class caused eight deaths, Old Age, four, and Heart Diseases, five. The deaths under one year of age numbrred 15, and those above 60 years of age, 13. Six inquests were held. Three deaths were attributed to Violence. One was caused by " Excessive Drinking." The water supplied by the Southwark Company during the last month was clear and bright. May 2nd, 1887. During the fortnight that ended on the 23rd day of April, 131 births and 62 deaths were registered in the Parish. These numbers shew an annual birth rate of 37.6, and an annual rate of mortality of 17.8 per 1,000 of the estimated population. The corresponding death rate in London was 19.1 per 1,000 persons living. There were only seven deaths from Diseases of the Zymotic class, viz.: —Four from Measles, one from Scarlet Fever, and two from Whooping Cough. Diseases of the Respiratory Organs caused 18 deaths, of which 12 were referred to Bronchitis, four to Pneumonia, and two to other diseases. Tubercular Diseases caused nine deaths, and Old Age, four. Four inquests were held. All the deaths were attributed to Infantile Convulsive Fits. The number of deaths under one year of age were 23, and above 60 years of age, 14. On Friday and Saturday last the water supplied by the Southwark Company was very turbid—sufficiently so to indicate a break-down in the filtering arrangements, or some accidental contamination of the supply. May 16th, 1887. During the fortnight that ended on the 7th day of May, 120 births and 59 deaths were registered in the Parish. These numbers shew an annual birth rate of 34.4, and an annual rate of mortality of 15.9 per 1,000 of the estimated population. The corresponding death rate in the whole of London was 18.6. From the chief Diseases of the Zymotic class 12 deaths were recorded, viz: —four from Measles, and eight from Whooping Cough. Diseases of the Respiratory Organs caused 18 deaths, viz:— Bronchitis, nine; and Pneumonia, nine. Three deaths were attributed to diseases the Tubercular class, and four to Old Age. A man, aged 29, died from "Alcoholism." Three inquests were held. One death arose from Accidental Asphyxia. The number of deaths under one year of age was 17, and above 60 years of age, 13. With the exception of Whooping Cough, the general state of the public health in the Parish is very satisfactory. June 8th, 1887. During the three weeks that ended on the 28th day of May, the number of births registered in the Parish was 159, and the number of deaths, 111, shewing an annual birth rate of 30.4, and an annual rate of mortality of 21.0 per 1,000 of the estimated population. The corresponding death rate in London was 19 per 1,000 persons living. The chief Diseases of the Zymotic class caused 18 deaths, viz.:—Measles, six; Diphtheria, three; Whooping Cough, eight; and Diarrhœa, one. From Diseases of the Respiratory Organs there were 32 deaths, viz. :—From Bronchitis, 17; and from Pneumonia, 16. Eleven deaths were referred to Diseases of the Tubercular class—six to Phthisis; four to Meningitis; and one to Tabes Mesenterica. Eight persons died from Old Age. Two inquests were held. The number of deaths in children under one year of age was 25, and in persons of 60 years of age and upwards, 20. Eight persons died in the workhouse. I have prepared a Report on the Bill for the Sanitary Registration of Buildings. June 20th, 1887. During the fortnight that ended on the 11th day of June, 132 births and 55 deaths were registered in the Parish. These numbers are equal to an annual birth rate of 37.9, and an annual rate of mortality of 14.7 per 1,000 of the estimated population. The corresponding death rate in London was 17.7. From Diseases of the Zymotic class there were eight deaths, viz.:—two from Measles, and six from Whooping Cough. Diseases of the Respiratory Organs caused 17 deaths, and those of the Tubercular order, 12. Three inquests were held. One death was attributed to an Injury to the Lungs from a fall in the street. The number of deaths in children under one year of age was 26, and in persons of 60 years of age and upwards, five. There were no deaths from Diarrhœa, and with the single exception of Whooping Cough being still prevalent, the general mortality returns are very satisfactory. July 4th, 1887. During the fortnight that ended on the 25th day of June, 92 births and 46 deaths were registered in the Parish. These numbers shew an annual birth rate of 26.4, and an annual rate of mortality of 13.2 per 1,000 of the estimated population. The corresponding death rate in London was 16.5, a lower than has been recorded since the last week of June, 1886. The chief Zymotic Diseases caused 13 deaths, of which two were referred to Measles; one to Diphtheria; and 10 to Whooping Cough. From Diseases of the Respiratory Organs there were only seven deaths. In the class of Tubercular Diseases there were five deaths from Phthisis, five from Meningitis, and one from Tuberculosis. The number of deaths in children under one year of age was ten; in persons of 60 years and upwards, eight. July 18th, 1887. During the fortnight that ended on the 9th day of July, 112 births and 55 deaths were registered in the Parish. These numbers shew an annual birth rate of 32.1, and an annual rate of mortality of 15.7 per 1,000 of the estimated population. The corresponding death rate in London was 18.2. This rate, which had been 16.6 in the first week, rose to 19.9 in the last week. The rise is due to an increase in the number of deaths from Measles, Whooping Cough, Scarlet Fever, Enteric Fever, and Diarrhœa —the latter being the principal cause. The number of deaths from Zymotic Diseases in the Parish was 17, viz.:—From Measles, five; Whooping Cough, six; Enteric Fever, one; and Diarrhœa, five. The fatality from Diseases of the Respiratory Organs was small, there being only six deaths from Pulmonary Diseases exclusive of Phthisis, BER 13 Tubercular Diseases caused nine deaths, viz,:—Consumption, four; Meningitis, four; and Tabes Mesenterica, one. The deaths in children under one year of age numbered 18, and those in persons of 60 years of age and upwards, four. Two inquests were held. The deaths were referred to Natural Causes. I have directed that the usual public notices concerning Diarrhœa should be re-printed and published throughout the Parish. August 8th, 1887. During the three weeks that ended on the 30th day of July, 186 births and 143 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 27.2 per 1,000 of the estimated population. The corresponding death rate in London was 23.8. In the deaths from Diseases of the Zymotic class there were six from Measles, one from Scarlet Fever, nine from Whooping Cough, and 49 from Diarrhœa. Of these fatal cases of Diarrhœa 14 occurred in the Leather Market District and 31 in St. James's. The number under one year of age was 42. Exclusive of deaths from Diarrhœa the general death rate would have been 18.1. From Diseases of the Respiratory Organs there were 10 deaths, and from those of the Tubercular order, 26. The latter included 11 deaths from Phthisis, and the large number of 13 from Meningitis. The number of deaths under one year of age was 79, and above 60 years of age, 13. Four inquests were held. One death was from Accidental Drowning while bathing. On the 26th of July I visited the premises of Mr. Higgins in Little Abbey Street, and found there deposited several tons of fish offal and other refuse matters. The mixture was highly offensive, a decided nuisance, and injurious to health. Proceedings were taken, and on the 4th of August the Magistrate at the Southwark Police Court made an order for the abatement of the nuisance, and an order prohibiting its recurrence. xxxiii. September 19th, 1887. In the six weeks that ended on the tenth day of September, the number of births registered in the Parish was 355, and the number of deaths, 200. These numbers are equal to an annual birth rate of 33.9, and an annual rate of mortality of 19.1 per 1,000 of the estimated population. In London the death rate ranged from 16.6 to 23.3 during this short period, the mean rate being 19.8. From Diseases of the Zymotic class there were 62 deaths, viz. : —From Measles, eight; Scarlet Fever, 13; Diphtheria, one ; Whooping Cough, eight; and Diarrhœa, 32. Of the 13 deaths from Scarlet Fever, nine occurred in the Leather Market District, two in St. Mary Magdalen, and two in St. James's. All the deaths from "Whooping Cough were in St. James's District. Of the 32 deaths from Diarrhœa, two occurred in aged persons, seven in children aged one to five years, and 23 in infants under one year of age. Diseases of the Respiratory Organs caused 23 deaths, and those of the Tubercular class, 28. The number of deaths in children under one year of age was 32, and in persons of 60 years of age and upwards, eight. Seventeen inquests were held. The cases included eight deaths from Violence. There were two cases of Suicide, five of Accidental Suffocation in bed, and one of Concussion arising from a fall down stairs. Five deaths were uncertified. The water supplied by the Southwark Company was exceptionally free from organic matter, and efficiently filtered. Mr. Higgins having failed to comply with the order of the Magistrate, the usual and necessary steps in such cases have been taken. I attended at the Police Court on the 7th and 14th iNst., when the case was further adjourned for the convenience of counsel. Complaint having been received of offensive smells from the premises of Mr. Warren in Tanner Street, I visited them and found an accumulation of animal matter, of which a large portion was in a putrid and semi-putrid state. Notwithstanding repeated cautions every year for seven years, Mr. Warren has not used proper and available means for preventing the occurrence of a nuisance. On the 14th inst. an order was obtained for the abatement of the nuisance. This is not intended to interfere with the business so long as care is taken to prevent it from being a nuisance and injurious to health. October 3rd, 1887. During the fortnight that ended on the 24th day of September, 109 births and 51 deaths were registered in Bermondsey. These numbers shew an annual birth rate of 31.3, and an animal rate of mortality of 14.6 per 1,000 of the estimated population. The corresponding death rate in Lonbon was 15.0. The chief Diseases of the Zymotic class caused 12 deaths, viz. :—Scarlet Fever, two ; Whooping Cough, four; Enteric Fever, three ; and Diarrhoea, three. From Diseases of the Respiratory Organs there were only six deaths. Tubercular Diseases caused 14 deaths, including 10 from Consumption. The number of deaths in children under one year of age was 13, and of persons aged 60 years and upwards, eight. One death was referred to Violence, and two were uncertified. The deaths from Scarlet Fever in London, which had increased in the six preceding weeks from 21 to 57, declined in the week ending September 24th, to 38 (including 12 in hospital) and were three below the corrected average. October 17th, 1887. During the fortnight that ended on the 8th day of October, 129 births and 49 deaths were registered in the Parish. These numbers are equal to an annual birth rate of 37.0, and an annual rate of mortality of 14.0 per 1.000 of the estimated population. The corresponding death rate in London was 15.5. From Diseases of the Zymotic class there were only five deaths, viz:—From Measles, one; from Scarlet Fever, three; and from Whooping Cough, one. From Diseases of the Respiratory Organs there were 13 deaths, and from those of the Tubercular class, 10. The number of deaths in children under one year of age was nine, and in persons of 60 years of age and upwards, 12. Four inquests were held. One death was referred to Violence—a verdict of " Manslaughter" being returned by the coroner's jury. The water supplied by the Southwark Company was clear and bright, and (for river water) remarkably free from organic matter. The number of deaths from Scarlet Fever in London during the fortnight was slightly below the corrected decennial average. I have inspected the house, No. 14, Cross Street, and report that it is in such a dirty and dilapidated state as to be unfit for human habitation. November 7th, 1888. During the three weeks that, ended on the 29th day of October, 185 births and 89 deaths were registered in the Parish. These numbers shew an annual birth rate of 35.4, and an annual rate of mortality of 17.0 per 1,000 of the estimated population. The corresponding death rate in London was 19.2 per 1,000, this rate having risen from 16.7 to 21.5. The number of deaths from Diseases of the Zymotic class was nine, viz.:—From Measles, four; Scarlet Fever, two; Whooping Cough, one ; and Diarrhoea, one. Diseases of the Respiratory Organs caused 23 deaths, of which 16 were referred to Bronchitis, and six to Pneumonia. From Diseases of the Tubercular class there were 12 deaths, of which eight were attributed to Phthisis. Nine persons died from Heart Disease, and two from Old Age. Six inquests were held. Three deaths were due to Violence. At 48, Parker's Row the roof at the rear of the premises is very defective, and the drainage is so bad as to cause a nuisance injurious to health. There is a letter from the Metropolitan Asylums Board inviting a Report from your Medical Officer as to the extent, as compared with previous years, to which Scarlet Fever has been prevalent during the present year in your Sanitary District. I beg to report that during the last ten years the deaths from Scarlet Fever in Bermondsey have been as follows :—ln 1877, 21; 1878, 42; 1879, 102; 1880, 102; 1881, 56; 1882, 47; 1883, 101; 1884, 48; 1885, 23; 1886, 16, the mean yearly number being 56. The number of deaths during the present year, registered up to Saturday last, has been 35. If the same proportion prevails to the end of the year the number will be 42. In the absence of any general notification of cases of infectious disease, it is not possible to form a trustworthy estimate of the total number of cases, as the rate of mortality varies in different years and at different seasons. On the subject of Compulsory Notification of Infectious Diseases I am fully in accord with the resolution unanimously adopted by the Society of Medical Officers of Health at their Annual Meeting on the 21st of October, at which I was present. Without this the Sanitary Laws are imperfect and partial in their application, and are deprived of more than half the power which they would otherwise possess in protecting the public against the spread of infectious diseases. November 21st, 1887. During the fortnight that ended on the 12th day of November the number of births registered in the Parish was 115, and the number of deaths, 82. These figures shew an annual birth rate of 33, and an annual rate of mortality of 23.5 per 1,000 of the estimated population. The corresponding death rate in London was 20.4. From Diseases of the Zymotic class there were 11 deaths, viz.:—Two from Measles; eight from Scarlet Fever; and one from Diphtheria. The deaths from Diseases of the Respiratory Organs were 28, of which 22 were referred to Bronchitis, and six to Pneumonia. Tubercular Diseases caused 13 deaths, viz.: —Phthisis, eight; Meningitis, three; and Tabes Mesenterica, two. Four persons died from Heart Disease, and six from Old Age. There were two Inquest cases. One death arose from Accident. Twenty children died under one year of age, and 17 persons at upwards of 60 years of age. Among the latter there were five between 70 and 80, and six between 80 and 90 years of age, the oldest being 89. The increased mortality is mainly due to a sudden fall in the temperature of the air. I have inspected the house, No. 79, East Lane, and find the roof is very defective, and the state of dampness is injurious to health. A girl aged 15 years was removed on Saturday last from 72, Wolseley Buildings to the Rotherhithe Infirmary, and found to be suffering from Scarlet Fever. Yesterday morning she was sent to the South Eastern Hospital. There has lately been a death from this disease at 58, Wolseley Buildings. December 5th, 1887. During the fortnight that ended on the 26th day of November, 136 births and 76 deaths were registered in Bermondsey. These numbers shew an annual birth rate of 39, and an annual rate of mortality of 21.8 per 1,000 of the estimated population. The corresponding death rate in London was 21.6 per 1,000. Zymotic Diseases of all kinds caused 10 deaths, which is equal to an annual rate of 2.8 per 1,000 living. There were four deaths from Measles, two from Scarlet Fever, one from "Whooping Cough, one from Enteric Fever, and two from Diarrhoea. From Diseases of the Respiratory Organs there were 29 deaths, of which 18 were referred to Bronchitis, 10 to Pneumonia, and one to Congestion of the Lungs. Tubercular Diseases caused eight deaths, Heart Disease, four, and Old Age, four. Nineteen children died under one year of age, and 15 persons at upwards of 60 years of age. Four inquests were held. Two deaths were due to Violence. The water supplied during the previous month contained only a small proportion of organic matter for the season of the year. The deaths from Scarlet Fever in London are slightly below the average. December 19th, 1887. During the fortnight that ended on the 10th day of December, 108 births and 73 deaths were registered in the Parish. These numbers shew an annual birth rate of 31.0, and an annual rate of mortality of 20.9 per 1,000 of the estimated population. The corresponding death rate in London was 20.3 per 1,000. The number of deaths from Zymotic Diseases was 13, viz.: — From Measles, four; Scarlet Fever, four; Whooping Cough, three; Enteric Fever, one; and Diarrhoea, one. In the hospitals there were seven deaths from Scarlet Fever in patients who had been removed from Bermondsey. There was one death from Scarlet Fever in Flockton Street on the 21st of November, and one death from Whooping Cough in the same street, but not in the same house, on December the 2nd. Diseases of the Respiratory Organs caused 23 deaths, and those of the Tubercular class, 13. Sixteen children died under one year of age, and nine persons at upwards. of 60 years of age. Four inquests were held. Three deaths were referred to Natural Causes, and one was that of a person unknown, " Found Drowned; no marks of violence, no proof how he came into the water." The letters from the Society of Medical Officers of Health, the Sanitary Institute of Great Britain, the Metropolitan Asylums Board, and the Kensington Vestry, on the subject of the Notification of Infectious Diseases, which were referred to the General Purposes Committee on the 7th of November, have been again referred to me. I think it is desirable that the Vestry should pass a resolution in favour of the principle of the compulsory notification of infectious diseases throughout the Metropolis. The best way of carrying this out may be left to the Local Government Board and the Legislature. It is obvious that, in order to prevent the spread of disease and the possibility of one or two cases developing into a widespread and fatal epidemic, a knowledge of the existence of first cases is indispensable. The first cases are not necessarily fatal, and the information derived from certificates of death usually come too late to be of much use in the prevention of epidemics. Voluntary notification is incomplete, and therefore a failure. Thirty-eight towns in Great Britain have availed themselves—under Local Acts—of compulsory notification, and in practice it has been found to work satisfactorily. This subject is perfectly distinct from that of the compulsory removal of the sick to Hospital. January 2nd, 1888. During the fortnight that ended on the 24th day of December, 124 births and 53 deaths were registered in the Parish. These numbers shew an annual birth rate of 35.5, and an annual rate of mortality of 15.2 per 1,000 of the estimated population. The corresponding death rate in London was 19.3. Zymotic Diseases caused 14 deaths, viz.:—Measles, five; Scarlet Fever, one; Whooping Cough, six; Simple Fever, one; and Diarrhoea, one. From Diseases of the Respiratory Organs there were 12 deaths, viz.:—From Bronchitis, seven; from Pneumonia, four; and from Asthma, one. Diseases of the Tubercular class caused six deaths. Six inquests were held. All the deaths were referred to Natural Causes. The number of deaths in children under one year of age was 11, and in persons of 60 years of age and upwards, nine. A female died in the Workhouse, at the age of 100 years, on the 24th of December. BER 13