THE VESTRY OF BERMONDSEY. REPORT ON THE SANITARY CONDITION OF THE PARISH OF BERMONDSEY, FOR THE YEAR 1890. BY JOHN DIXON, M.D., Licentiate of the Royal College of Physicians of London, Member of the Royal college of Surgeans of England. Licentiate of the Socitty of Apatholigies,Licentiate in midwifery, etc. 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 1 890. 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. London: Printed by Frederick Shaw & Co., Dockhead, London, S.E. 1891. ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH. TO THE VESTRY OF BERMONDSEY— Mr. Chairman and Gentlemen, My Fifteenth Annual Report on the State of the Public Health in the Parish of Bermondsey embraces the period of 53 weeks that ended on the third day of January, 1891. The general mortality exceeded that of the year 1889, which was an exceptionally favourable year. Diseases of the organs of respiration, especially bronchitis and pneumonia, were much more fatal than usual. This may, in a great measure, be attributed to prolonged periods of cold weather which occurred in the spring months and at the close of the year. In addition to these ordinary causes of lung disease, the presence of influenza appears to have exercised considerable influence in increasing the mortality from the above-named inflammatory affections of the chest, and also from phthisis. There were fewer cases of diarrhoea during the summer, but the mortality from this cause was not much below the average. Whooping cough and measles were the most prevalent zymotic diseases. The deaths from scarlet fever and enteric fever, —including the deaths in hospitals,—were below the mean decennial rate. Three cases of typhus occurred: one in Vauban Street and two in Gedling Street, which were promptly removed to the hospital. The premises were disinfected and cleansed, and, fortunately, the disease did not spread. The Census, which was taken in April, 1891, showed a decrease in the population. I have, therefore, estimated the number of inhabitants on the decrease which took place during the ten years 1881-1891, instead of on the small increase which was shown at the Census of 1881. The excess of births over the deaths during the last ten years exceeded 16,000. Notwithstanding this natural increment, the population has declined 1964, as appears from the Preliminary Report of the Census. It is evident that in the course of ten years upwards of 18,000 inhabitants have migrated to seek their fortunes elsewhere. There are no means of ascertaining whether an increase or decrease of the population occurred chiefly at the beginning, the middle, or the end of the period between one Census and the next, or whether the change was progressive and uniform. The latter is generally assumed to have been the case in framing estimates of the population. At the middle of the year 1890 the estimated population was 84,835. BIRTHS. The number of births registered in the parish was 3,120, being 50 less than in the previous year and 230 below the average of the last ten years. The annual birth rate was 36.7 per thousand of the estimated population The birth rate in London was 29.1 per thousand. In the Leather Market District there were 555 births, and the birth rate was 36.7; in St. Mary Magdalen District, 651 births, corresponding to a rate of 41.5; and in St. James's District 1,914 births, equalling a rate of 35.4. The children born in the first quarter of the year numbered 867; in the second quarter, 718; in the third quarter, 737; and in the last quarter, 798. The excess of births over deaths was 1,460, but we are unable to consider this as indicating an increasing population. DEATHS. The total number of deaths from all causes recorded in Bermondsey during the year (53 weeks) was I,660—851 males and 809 females. The deaths were 36 below the decennial average, and 180 above the number registered during the 52 weeks of 1889. The annual rate of mortality, calculated on the deaths which took place in the parish was 19.6 per thousand of the estimated population The deaths in hospitals and asylums which are credited to our parish were 386. This number is equal to a further rate of 4.5. The death rate in London was 20.3. The number of deaths registered in the first quarter of the year was 443; in the second quarter, 357; in the third quarter, 386; and in the last quarter, 474. In the Leather Market District the deaths numbered 299, and the annual death rate was 19.8; in St. Mary Magdalen District, the deaths were 417, and the death rate, 26.6; and in St. James's district the number of deaths was 944, and the corresponding death rate, 17.4. The number of deaths of children under one year of age in the parish was 450, being in the proportion of 144 per thousand registered births. When the deaths in hospitals are included this rate is raised to 152. In London the infantile death rate was 163, and the mean rate in 28 great towns was 172. This rate varied very considerably in the different Registration districts, being 191 in the Leather Market, 154 in St. Mary Magdalen, and 127 in St. James's. The number of deaths of children under 5 years of age was 810, being 48.8 per cent, of the total deaths, against 52.0 per cent. in the previous year. At ages above 60 years 298 deaths were registered, being 17.9 per cent. of the whole. These figures by no means represent the deaths of aged persons belonging to the parish, as 78 of these died in Rotherhithe Infirmary, 25 in Parish Street Workhouse, and 18 in various hospitals and asylums. The number of deaths in Bermondsey Workhouse was 84. CAUSES OF DEATH. From the chief diseases of the zymotic class 239 deaths were registered in the parish, and 41 in various public institutions outside its boundaries. These numbers indicate an annual zymotic death rate of 2.8 per thousand of the population on the deaths which happened in Bermondsey, and a further rate of 0.5 on the deaths in hospitals. Measles caused 75 deaths, being 17 fewer than in the previous year. Fifty-five of these deaths occurred in the St. James's District. From whooping cough there were 76 deaths, against 50 in 1889. Scarlet fever caused 30 deaths, 18 of which took place in hospitals and 12 in Bermondsey. The deaths from diphtheria were 8 within the parish and 11 outside. In 1889, the number of deaths from this cause, inclusive of hospital cases, was 23. Three deaths from typhus, and 3 from enteric fever took place in hospitals, and 7 deaths from the latter disease occurred in the parish. From diarrhœa there were 65 deaths, and from simple cholera, 2. Only 3 deaths were attributed to influenza, but there can be no doubt that the presence of this epidemic tended to increase the mortality from lung diseases. In the class of septic diseases there were 7 deaths of infants from congenital syphilis, 7 deaths from erysipelas, and 3 from puerperal fever. The deaths of 5 persons were attributed to chronic intemperance and 2 to delirium tremens. These figures are only a very small fraction of the deaths caused by alcoholic poisoning. In the class of constitutional diseases there were 9 deaths from rheumatism, 2 from gout, 6 from rickets, and 42 from various forms of cancer. The latter disease has been steadily increasing for several years. In 1889 it caused 35 deaths. The number of deaths from diseases of the tubercular order was 231, being 32 more than in the previous year. This class formed 13.9 per cent. of the deaths, and equalled a death rate of 2.7. There were 16 deaths from tabes mesenterica, 52 from meningitis, 145 from phthisis, and 18 from general tuberculosis. The fatality from phthisis considerably exceeded that of the previous year and the decennial average. viii Diseases of the respiratory system caused 513 deaths, against 414 in 1889. They were 39.9 per cent, of the total deaths, and equalled a rate of 6.0 per thousand persons living. From bronchitis there were 293 deaths, and from pneumonia 173. Thirteen deaths were referred to croup, of which 4 were classed as "membranous." From diseases of the brain and nervous system there were 145 deaths, against 138 in the preceding year. They formed 8.7 per cent, of the deaths and 1.6 of the general death race. Apoplexy and paralysis caused 53 deaths, epilepsy 1, convulsions 66, tetanus 1, and other diseases 23. Two persons died from disease of the ear leading to disease of the brain. To diseases of the heart and organs of circulation 86 deaths were referred. This is an increase of 16. They were 5.2 per cent. of the deaths from all causes, and equalled a death rate of 0.99. Diseases of the stomach, liver, and digestive organs contributed 86 deaths to the general mortality. This is an increase of 20 on the previous year. From diseases of the kidney and urinary organs there were 23 deaths. Two fatal cases of diabetes were recorded. Seventy-seven persons died from old age, 29 children from immaturity at birth, and 3 from congenital imperfections. Four women died from accidents of child-birth in addition to the 3 recorded as dying from puerperal fever. In the large class of ill-defined diseases, or those of uncertain seat, there were 30 deaths ascribed to marasmus, 20 to debility, and 19 to inanition. All these were children under 5 years of age. Six deaths were registered as due to "natural causes." In the class of deaths arising from violence there were 12 from accidental fractures and contusions, 18 to accidental suffocation of infants in bed, 2 to suffocation by impaction of food in the throat, and 7 cases of suicide. Of the latter, 4 were by hanging, 1 by gunshot, 1 by drowning, and 1 by cut wound. All were males; one was a youth of 19 years of age. The inquest cases numbered 98, being 5.9 per cent. of the deaths. They included 41 deaths from violence, 47 from diseases of the brain, 15 from those of the heart, 9 from diseases of the respiratory organs, and 6 from those of the digestive system. The number of deaths not certified by any registered medical practitioner, or by the coroner, was 22, being in the proportion of 1.3 per cent. of the deaths, against 3.1 per cent. in the previous year. The proportion in London was 0.9 per cent. NOTIFICATION OF INFECTIOUS DISEASES. During the year 922 certificates have been received under the Notification of Infectious Diseases Act. There were for scarlet fever or scarlatina 612, typhus 3, enteric fever 57, continued fever 2, puerperal fever 6, diphtheria 67, membranous croup 21, erysipelas 152, and cholera 1. It is interesting to note that the 612 cases of scarlet fever did not cause more than 30 deaths, of which 12 only took place in the parish. From the 57 cases of enteric fever there were 10 deaths, of which 7 occurred in Bermondsey and 3 in the hospitals. Of the 67 cases reported as diphtheria 8 of the patients died in Bermondsey and 11 in hospitals. From the 21 cases of membranous croup there were only 4 deaths, and from 152 reported as erysipelas only 7 deaths appear in the returns of mortality. Whether these figures indicate that diseases of this kind have occurred in an Unusually mild form, or whether they point to remarkable skill in the treatment of diseases which were formerly believed to be of a dangerous character, I am unable to determine. The receipt of these notices has led to the more prompt and general disinfection of premises where infectious diseases prevailed, and has also led to the discovery of sanitary defects which might not otherwise have been discovered. DEATHS IN OUTLYING INSTITUTIONS. Until the present year we have had no information concerning the deaths of parishioners outside the limits of the parish. The number, variety, and wide distribution of the institutions in which persons belonging to Bermondsey Parish have died during the last year is astonishing. From the weekly returns I have abstracted the deaths in each institution, which are as follows: —In Rotherhithe Infirmary, 153; in Parish Street Workhouse, 41; in Guy's Hospital, 94; in the Metropolitan Asylums Hospitals, 31; in lunatic asylums, 13; in 16 different hospitals, situated in various parts of London, 50; in other parish infirmaries, 5; and found drowned in the Thames, 5. A large number of aged people are sent to Rotherhithe Infirmary and die there. Many cases of accidents in the streets, burns and scalds, etc., are sent to Guy's Hospital. The majority of the deaths from zymotic diseases, outside the parish, occur in the South Eastern Fever Hospital. Nine persons died in St. Thomas's, and 9 children in Evelina Hospital, 5 at King's College, 4 at Brompton, 4 at the London Hospital, 3 in St. Bartholomew's, and 2 at University College Hospital, and at several other hospitals a single patient in each. The asylums included in this list are Wandsworth, Cane Hill, Darenth, Colney Hatch, Banstead, Hanwell, and Camberwell. Some of the patients in these asylums have probably not been residents of Bermondsey for many years. Comparatively few children die outside the boundaries of the parish. xii A child, aged one day, which was born and died in the General Lying-in Hospital, was credited to us as being a parishioner of Bermondsey. SANITARY WORK. Details of sanitary work are given in Table IV. Houses in Turner's Court, Jacob Street, Metcalfe Court, and London Street, after inspection by the Medical Officer, have been closed under the Housing of the Working Classes Act, 1890, as being "so dangerous or injurious to health as to be unfit for human habitation." Various trade nuisances have been abated; one which seriously affected the Rolls Road Board School was caused by the South Eastern Railway Company. The managers of that school having endeavoured to obtain some abatement of the nuisance without success, applied to your Medical Officer, who had an interview with the parties concerned, and succeeded in obtaining its removal without litigation. Several Board Schools have been visited, and any defects that were met with were reported. Under the Customs and Inland Revenue Act, 1890, nearly 600 houses were examined and certified as being so constructed as to afford suitable accommodation for the families inhabiting them, and that due provision was made for their sanitary requirements. In several instances these inspections by the Medical Officer led to an improved condition of the premises. xiii STATISTICS OF LONDON. The population of Registration London, in the middle of the year 1890, was estimated by the Registrar General at 4,421,661 persons. The Census, which was taken on the 6th day of April, 1891, showed the number of inhabitants was then 4,211,056, being an increase of 395,51 2 on the population of 1881, but falling short of the estimated number by upwards of 210,000. The marriages registered in London in the year 1890, numbered 36,753, and were in the proportion of 8.3 marriages, or 16.6 persons married, per 1000 of the estimated population. The registered births in the year numbered 130,690, being in the proportion of 29.1 annually to 1,000 inhabitants. This is by far the lowest birth rate as yet recorded in London, the rate having fallen continuously year by year since 1879, when it was 35.5 per 1000. The deaths registered in London during the year numbered 91,243, and corresponded to an annual rate of 20.3 per 1000 of the estimated population. This rate was higher than the rate in any of the five next preceding years. The principal diseases of the zymotic class caused 12,229 deaths, and the corresponding death rate was 2.73 per 1,000. The proportion of the deaths of children under one year of age per 1,000 registered births was 163. The returns of general mortality show a large increase in the number of deaths from diseases of the lungs and heart. The deaths from measles, whooping cough, diphtheria, and cancer, exceeded the average numbers. There were fewer deaths from scarlet fever, enteric fever, and diarrhœal diseases. Small-pox was almost absent, there being only four deaths from this cause during the year. All were adults, of whom one had been vaccinated. Among the accidental deaths, nearly one-fourth of the whole were infants under one year of age, suffocated in bed. Twice as many of these deaths took place on Saturday night as in any other night in the week. About 1 in 8 of the persons dying in London died in a workhouse; 1 in 90 in a Metropolitan Asylum Hospital; 1 in 12 in some other hospital; and 1 in 48 in an asylum for lunatics or imbeciles. The mean temperature of the air was 48°.6 F., which is only o ° .7 below the average. Some very cold weather was experienced. On the first day of January the temperature was below the average 9°7; during the first five days of March, 14.0 below it; on the 28th of November, 21°.4 below it; and during the whole month of December the cold was remarkable for its severity and persistency. It was the coldest December in this century. Rain fell on 162 days, the total amount during the year being 21.88 inches, and 2.99 inches below the average of 75 years. During the first nine months of the year the rainfall slightly exceeded the average, but in the last three months it was 3.6 inches below it. The water supplied by the Southward Company was clear and transparent throughout the year. Thanking the Vestry for the support which I have received in the discharge of my duties. I have the honour to be, Gentlemen Your obedient Servant, JOHN DIXON, M.D., Medical Officer of Health. 133, Jamaica Road, Bermondsey. TABLE I. CAUSES OF DEATH. Registered in Bermondsey during the 53 weeks ending January 3rd, 1891. 1890. Ages at Death. CAUSES OF DEATH. Total. Male. Female. 0 —1 1—5 5—20 20—40 4 0—60 60—80 80—100 851 809 360 8 9 163 57 All Causes 1660 300 241 450 Small Pox ... ... ... ... ... Measles ... ... ... ... ... 72 43 29 15 54 3 Scarlet Fever ... ... ... 12 4 8 8 ... ... 3 1 Diphtheria ... ... ... 8 3 5 ... 4 3 1 ... ... Whooping Cough ... 73 32 4 1 32 40 1 ... Typhus ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... 7 4 3 ... 3 4 ... Simple Fever ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 63 ... ... 39 24 35 21 1 2 1 3 Choleraic ditto ... 2 1 1 ... 1 1 Influenza ... ... ... ... 3 1 2 ... 1 2 ... ... ... ... Syphilis 6 7 6 1 1 Erysipelas ... ... ... ... ... 7 3 4 1 1 2 2 1 Puerperal Fever ... ... 3 3 ... 3 Purpura ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... Alcoholism ... 5 4 1 ... ... ... 1 3 1 Delirium Tremens ... 2 1 1 ... 2 Rheumatism ... ... ... ... ... 5 4 1 1 3 1 Rheumatism of Heart ... ... ... ... 4 1 3 1 1 1 1 Gout ... ... ... 2 2 ... ... ... ... 2 Rickets 6 ... ... ... 3 3 5 1 Cancer ... ... ... ... ... 42 12 30 1 2 27 12 ... ... ... TABLE I.—co ntinued. 1890. Ages at Death. CAUSES OF DEATH. Total. Male. Female. 1 —5 5-20 20—40 40-60 60—80 80—100 0—1 16 7 9 8 8 Tabes Mesenterica ... ... ... ... ... 19 17 22 13 Meningitis 52 33 ... ... ... ... 55 6 14 7 1 49 Phthisis 145 90 3 2 ... 1 Tuberculosis 18 8 10 4 10 3 ... 1 ... Premature Birth 12 17 29 29 ... ... ... ... ... ... Atelectasis 2 2 2 ... ... ... ... ... ... ... Congenital Malformation 3 1 2 3 ... ... ... ... ... ... 36 77 26 51 4 1 Old Age ... ... ... ... ... 1 4 13 20 2 Apoplexy 40 16 24 ... ... 6 4 7 Paralysis 11 5 ... ... ... ... ... Epilepsy 1 1 1 ... ... ... ... ... ... ... Convulsions 66 46 20 55 10 1 ... ... ... ... Paraplegia 2 2 2 ... ... ... ... ... ... ... 1 Tetanus 1 1 ... ... ... ... ... ... ... Locomotor Ataxy 1 1 1 ... ... ... ... ... ... ... Other Diseases of Brain, &c. 21 9 12 4 3 5 5 4 ... ... Disease of Ear 2 1 1 2 ... ... ... 1 ... ... 16 12 Heart Disease 7 1 24 47 1 4 35 3 ... Pericarditis 1 1 1 ... ... ... ... ... ... ... Aortic Disease 2 3 2 2 1 5 ... ... ... ... Aneurism ... 1 1 1 ... ... ... ... ... ... Angina Pectoris 1 ... 1 1 ... ... ... ... ... ... 3 Syncope, &c. 7 4 3 1 3 ... ... ... ... TABLE I. —continued. 1890 Ages at Death CAUSES OF DEATH. Total. Male. Female. 1-5 5—20 0—1 20 —40 40-60 6 0—80 Croup 6 6 9 3 1 2 ... ... ... „ Membranous 4 2 2 1 1 2 ... ... ... Laryngitis 6 4 2 1 4 ... ... 1 ... Laryngismus Stridulus 2 2 2 ... ... ... ... ... ... Spasm of Glottis 1 1 1 ... ... ... ... ... ... Bronchitis 6 7 293 152 141 52 4 10 77 73 Pneumonia 173 100 73 42 62 6 16 28 18 Pleurisy 1 3 4 1 2 1 ... ... ... Asthma 4 3 1 3 1 ... ... ... ... Other Diseases of Lungs 8 17 9 3 7 1 1 2 3 Dentition 20 6 11 9 14 Pharyngitis ... ... ... ... 1 1 1 ... ... ... ... ... Gastritis 6 ... 3 3 1 1 4 ... ... Enteritis ... 15 6 9 6 5 3 1 Peritonitis ... ... 6 3 3 1 2 2 1 Diseases of Stomach ... ... 4 2 2 1 3 ... ... ... ... Acute Indigestion 1 1 ... ... ... ... ... 1 Hernia ... 3 1 2 ... ... ... 1 2 Intestinal Obstruction ... 3 2 1 1 1 Diseases of Liver ... ... ... ... 5 3 2 1 2 2 ... ... ... Cirrhosis 14 7 7 2 11 ... ... ... 1 Hepatitis 3 2 1 ... ... 1 2 Icterus ... ... 2 1 1 1 1 ... ... ... ... Nephritis 4 1 3 ... ... ... ... ... 4 Kidney Disease 16 9 7 1 ... 2 4 9 Diseases of Bladder ... 2 1 1 1 1 ... ... ... ... Stricture of Urethra 1 1 1 ... ... ... ... ... ... Diabetes 2 ... 2 ... 1 1 ... ... ... TABLE I. —continued. 1890. Ages at Death. CAUSES OF DEATH. Male. Female. 1—5 5— 20 20—40 4 0—60 Total. 0—1 Child Birth 4 ... 4 ... ... ... 3 1 Diseases of Bones 1 1 1 ... ... ... ... ... „ Joints 2 2 2 ... ... ... ... ... „ Skin 1 1 ... ... 1 ... ... ... Marasmus 30 14 16 23 7 ... ... ... Atrophy 2 3 3 1 ... ... ... ... 20 Debility 20 7 13 ... ... ... ... Inanition 19 10 9 19 ... ... ... ... 4 Malnutrition 4 1 3 ... ... ... ... Want of Breast Milk 1 1 1 ... ... ... ... ... Asthenia 2 2 1 1 ... ... ... ... Non Vitality 4 3 1 4 ... ... ... ... Abscess 1 1 1 ... ... ... ... ... Dropsy 3 2 1 1 ... ... ... ... Natural Causes 6 3 1 1 2 4 ... ... Violence— 6 Fractures and Contusions 12 6 3 5 1 ... ... Accidental Asphyxia 6 15 21 21 ... ... ... ... 2 Hanging 4 4 ... ... 1 ... ... 1 Gun Shot 1 1 ... ... ... ... ... Cut Wounds 1 1 ... 1 ... ... ... ... Drowing 1 1 ... ... ... ... ... ... Found dead 1 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 House, 1881 —7.8. TABLE II. DEATHS FROM ZYMOTIC DISEASES IN 1890, AND IN EACH QUARTER OF THE YEAR. Total for the Year 1890. Rate per 1000 living. Per centage of Total Deaths. ZYMOTIC DISEASES. 1st Quarter. 2nd Quarter. 3 rd Quarter. 4th Quarter. Small Pox 4.46 Measles 17 23 22 12 74 0.87 3 3 12 0.72 Scarlet Fever 2 4 0.14 3 2 8 0.09 0.48 Diphtheria 1 2 22 Whooping Cough 16 18 17 73 0.86 4.40 4 Fever 1 1 1 7 0.08 0.42 Diarrhœa 1 2 50 63 0.74 3.79 10 ... 0.02 Simple Cholera 1 1 2 ... 0.12 96 38 51 54 239 2.81 14.4 Total ... .. ... ... ... .. ... 1890. TABLE III. DEATHS FROM ZYMOTIC DISEASES IN THE TEN YEARS, 1880—1889. Smal Pox 1880 1881 1883 1884 1885 1886 1887 1888 1889 Average of 10 Years. ... 5.0 8 18 5 ... ... 5 ... 56 52 109 67 81 70.2 Measles 61 70 22 95 89 11 Scarlet Fever 102 56 47 101 4 8 23 46.8 16 19 45 Diphtheria 13 31 9 16 10 15 12 14 13.9 10 9 Whooping Cough 94 39 178 25 82 76 75.2 61 60 50 87 13 12 13 Fever 21 20 16 10 7 18 13.9 9 Diarrhœa and Cholera 126 74 98 59 67 97 61 49 64 79.8 101 4 20 245 4 11 290 304.8 Total 335 177 244 279 14 1882 341 292 ... TABLE IV. SANITARY WORK, &c., DURING THE YEAR 1890. Houses, &c., inspected and reported to the Vestry by the Medical Officer of Health, and the Inspector of Nuisances. Houses and other premises inspected 5970 4622 Notices served to execute works, &c. Houses in a dirty and dilapidated condition, cleansed and repaired, etc. 409 309 Houses disinfected, cleansed and purified 7 Cases of overcrowding abated 5 0 Houses closed as unfit for habitation W.C.'s repaired, ventilated, and whitewashed 197 217 Closets panned and trapped or old pans cleansed Closets supplied with water 204 210 Defective drains repaired 246 Slopped drains cleared 166 Untrapped sinks trapped 9 Cesspools abolished 228 Badly paved yards repaired 66 Water receptacles cleansed and repaired 17 Houses supplied with water 34 Defective roofs repaired 59 Defective rain-shoots and gutters repaired 42 Offensive accumulations removed 78 Houses drained direct into the public sewer Defective water apparatus in w.c.'s repaired 336 12 Lots of fowls which were a nuisance, removed 4 Animals kept so as to be a nuisance, removed 75 Urinals and other offensive places cleansed Slaughter-houses inspected and licensed 7 12 Cow-houses inspected and licensed 76 Bakehouses inspected 13 Cellar flaps repaired 24 Stables and other premises drained 51 Old brick drains relaid with stoneware glazed pipes Waste water pipes disconnected from drains and made to discharge in the open air 163 For providing the requisite means of ventilation by means of excavating underground floors and inserting air bricks 578 For separating the water used for flushing w.c.'s. from that used for ordinary purposes 472 103 Persons suffering from infectious diseases removed to Hospital Dead bodies removed from rooms to mortuary upon Magistrates Orders 8 81 Summonses taken out before Police Magistrates for not complying with orders of the Vestry. (Finesinflicted £627s. 6d.) Food destroyed—Trunks of Fish, 2; Bacon pieces, 62lbs.; Rabbits, 500 Baskets of Cherries, 15; I Leg of Pork; 1 Pig's head; 56 tins Pineapple; 71 Cocoanuts; 9 pieces of Beef and Mutton. Window Sashes made to open, 185; Window openings made for light and ventilation, 346. HENRY THOMAS, Sanitary Inspector. POPULATION AT EACH CENSUS, 1801 to 1891. Census Year. Population Enumerated. Increase in 10 Years. Decennial Increase per cent. ... ... 1801 17, 16 9 ... ... 1811 13.7 19,530 2,361 1821 25 ,235 5,705 29.2 17.7 1831 29,741 4,486 1841 5,206 17.7 34,947 12,889 36.9 21.6 1851 47,836 1861 58,212 10,376 38.3 1871 22,217 80,429 1881 86,652 6,223 7.7 1891 84,688 DECREASE. 1,964 DECREASE. 2.3 TABLE VI. MIGRATION IN FOUR DECENNIAL PERIODS. Decennial Period. Total Increase of Population. Excess of Births over Death. Efflux. 7,903 2,473 1851-61 10,376 13, 221 8,896 ... ... 1861-71 22,177 1871-81 6,223 17,227 ... ... 11,004 ... ... 16,543 1881-91 DECREASE. 1,964 18,507 ... ... Influx. Migration in 10 Years. TABLE V. TABLE VII. BIRTHS AND DEATHS IN TWENTY YEARS, 1871—90. Year. Total Births. Total Deaths. Excess of Births over Deaths. Birth Rate. Death Rate. Deaths from Zymotic Diseases London Death Rate. Total. Rate per 1000 living. 3327 1994 1333 2024 1584 2014 1497 1867 1955 1487 1732 41.2 24.7 20.4 24.4 19.8 25.2 21.5 19.7 24.8 23.1 20.8 6.1 26.6 3687 1663 45.4 4.2 21.1 4.7 3587 2003 43.8 22.4 3656 1642 44.3 3.2 22.4 3587 43.1 5.4 23.5 2094 4.2 21.9 3571 1804 43.9 3620 1665 42.9 3.4 21.5 2110 42.9 6.1 23.1 1983 4.0 22.1 3715 43.4 1796 4.6 21.7 3532 4 1.0 43.1 393 4.6 22.4 3598 1875 22.4 20.0 21.8 19.5 20.0 17.7 18.9 19.1 16.8 16 .1 19.6 290 420 292 335 245 279 34 1 177 247 239 3550 1735 3485 4 0.9 39.8 39.0 39.1 36.1 37.2 35.3 33.8 34.5 36.7 1913 3435 1722 3469 1777 3221 1583 334 8 1698 3200 1731 3085 1527 21.2 21.2 20.4 20.3 19.7 19.9 19.9 18. 5 17.4 20.3 3170 1480 1660 3120 1736 411 344 522 287 351 452 268 392 344 564 2.8 2.6 1.9 3.8 3.1 2.7 3.7 3.3 4.7 3.3 1460 1690 1558 1469 1650 1638 16 9 2 1712 1572 1815 1722 1890 1889 1888 1887 1886 1885 1884 1883 1882 1881 3597 Ten Years Average. 1880 1879 1878 1877 1876 18 7 5 1874 1873 1872 1871 FORTNIGHTLY REPORTS. January 20th, 1890. During the fortnight that ended on the 11th day of January, 148 births and 77 deaths were registered in the parish. These numbers indicate an annual birth-rate of 42.4, and an annual rate of mortality of 22.1 per thousand of the estimated population. The corresponding death-rate in London was 30.2. The only deaths referred to zymotic disease were 2 from whooping cough. Diseases from the respiratory organs caused 35 deaths, of which 30 were referred to bronchitis and 4 to pneumonia. From diseases of the tubercular order there were 4 deaths, and from old age 5. The number of deaths of children under one year of age was 14, and of persons aged 60 years and upwards 23. Two inquests were held, and two deaths were uncertified. The water supplied by the Southwark Company was of better quality than that delivered in November. The local registrars' returns of deaths do not include any from influenza. The deaths primarily attributed to influenza in London were 4 in the first week, and 67 in the second week included in this report. The higher death-rate in the metropolis is partly due to delayed registration at Christmas, but mainly to a considerable increase in the number of deaths from diseases of the respiratory organs. February 3rd, 1890. During the fortnight that ended on the 25th day of January, 131 births and 95 deaths were registered in the parish. These numbers indicate an annual birth-rate of 37.6, and an annual rate of mortality of 27.2 per thousand of the estimated population. The corresponding death-rate in London was 29.6. The chief diseases of the zymotic class caused 4 deaths, viz.—measles 1, scarlet fever 2, and whooping cough 1. Diseases of the respiratory organs caused 46 deaths, of which 31 were referred to bronchitis, and 14 to pneumonia. From diseases of the tubercular order there were 14 deaths, from old age 5, and from heart disease 5. The number of deaths of children under one year of age was 12, and of persons aged 60 years and upwards, 18. Three inquests were held, and 2 deaths were uncertified. The deaths primarily attributed to influenza in London which had been 4, and 67 in the two preceding weeks, rose in the week ending January 18th to 127, and in the week ending January 25th declined to 105. No deaths attributed to this cause were registered in Bermondsey. February 17th, 1890. During the fortnight that ended on the 8th day of February, 127 births and 64 deaths were registered in the parish. These numbers indicate an annual birth-rate of 36.5, and an annual rate of mortality of 18.4 per thousand of the estimated population. The corresponding death-rate in London was 21.2. Only two deaths were recorded in the class of zymotic diseases, both being from whooping cough. Diseases of the respiratory organs caused 24 deaths, of which 16 were referred to bronchitis and 6 to pneumonia. From diseases of the tubercular order there were 16 deaths, viz. —9 from phthisis and 7 from meningitis. From heart disease there were 6 deaths, and from old age 2. xxviii The number of deaths of children under one year of age was 14, and of persons aged 60 years and upwards, 11. Four inquests were held. One death was from violence. The deaths primarily attributed to influenza in London declined to 75 in the week ending February Ist, and to 38 in the week ending February 8th. Two of the latter occurred in Bermondsey. March 3rd, 1890. During the fortnight that ended on the 22nd day of February, 150 births and 57 deaths were registered in the parish. These numbers indicate an annual birth-rate of 43.0, and an annual rate of mortality of 16.3 per thousand of the estimated population. The corresponding death-rate in London was 21.5. The chief diseases of the zymotic class caused 7 deaths, viz.—measles 1, diphtheria 1, whooping cough 3, enteric fever 1, and diarrhcea 1. From diseases of the respiratory organs there were 20 deaths, of which 12 were referred to bronchitis, 6 to pneumonia, and 2 to croup. From diseases of the tubercular order there were 9 deaths, and from old age 3. The number of deaths of children under one year of age was 12, and of persons aged 60 years and upwards, 14. Three inquests were held. Two deaths were attributed to accidental suffocation in bed. The water was of inferior quality to that delivered at the close of last year, owing to the heavy rain having washed much organic matter into the river. It was delivered clear and efficiently filtered. The deaths primarily attributed to influenza in London further declined to 30 and 24. No deaths from this cause were registered in the parish. xxix March 17th, 1890. During the fortnight that ended on the 8th day of March, 126 births and 61 deaths were registered in the parish. These numbers indicate an annual birth-rate of 36.2, and an annual rate of mortality or 17.5 per thousand of the estimated population. The corresponding death-rate in London was 21.8. Only 5 deaths were recorded from zymotic diseases, viz.— 3 from measles and 2 from whooping cough. Diseases of the respiratory organs caused 18 deaths; those of the tubercular order 9, heart disease 3, brain diseases 5, cancer 2, and old age 2. The number of deaths of children under one year of age was 15, and of persons aged 60 years and upwards, 13. Three inquests were held. Two deaths were attributed to violence. Two deaths were uncertified. The water supplied during the last month was of much better quality than that delivered in January. Influenza has not entirely disappeared from London, the deaths primarily attributed to this disease during the two weeks being 23 and 24. Although scarlatina does not appear in the mortality returns, it is generally prevalent, the number of cases reported during the last fortnight being 28, and from the Ist of January, 88. The fatality of this disease is very much less than it was 30 years ago. March 31st, 1890. During the fortnight that ended on the 22nd day of March, 129 births and 49 deaths were registered in the parish. These numbers indicate an annual birth-rate of 37.0, and an annual rate of mortality of 14.0 per thousand of the estimated population. The corresponding death-rate in London was 20.1. Diseases of the zymotic class caused 8 deaths, viz.— measles 6, and whooping cough 2. xxx From diseases of the respiratory organs there were 16 deaths, of which 8 were referred to bronchitis and 5 to pneumonia. Diseases of the tubercular order caused 5 deaths, and cancer 2. The number of deaths of children under one year of age was 16, and of persons aged 60 years and upwards, 6. Two inquests were held. One was on a child accidentally suffocated in bed, and the other, a child aged 6 months, whose death was ascribed to an " apoplectic fit." The deaths primarily attributed to influenza in London were 11 and 17 in the last two weeks. The number of cases reported under the Infectious Diseases Notification Act during the quarter was 148. April 21st, 1890. During the three weeks that ended on the 12th day of April, 168 births and 97 deaths were registered in the parish. These numbers indicate an annual birth-rate of 32.1, and an annual rate of mortality of 18.5 per thousand of the estimated population. The corresponding death-rate in London was 18.1. Zymotic diseases caused 16 deaths, viz.—measles 10, and whooping cough 6. From diseases of the respiratory system there were 28 deaths, which were equally divided between bronchitis and pneumonia. Tubercular diseases caused 14 deaths, of which 10 were referred to phthisis, 3 to meningitis and 1 to tabes mesenterica. There were 6 deaths from old age, and 5 from heart disease. The deaths of children under one year of age numbered 33, and those of persons aged 60 years and upwards, 13. Six inquests were held. Four deaths were attributed to natural causes, and 2 to accidental asphyxia. The water supplied by the Southwark Company exhibited a further reduction in the proportion of organic matter. The deaths primarily attributed to influenza in London during the last three weeks were 13, 10, and 7. Complaint has again been made of a nuisance arising from smoking fish at No. 232, Southwark Park Road. I have visited the premises and cautioned the occupier (Mr. Clark). May 5th, 1890. During the fortnight that ended on the 26th day of April, 118 births and 61 deaths were registered in the parish. These numbers indicate an annual birth-rate of 33.7. and an annual rate of mortality of 175 per thousand of the estimated population. The corresponding death-rate in London was 18.7. Zymotic diseases caused 8 deaths, of which 4 were due to measles and 4 to whooping cough. From diseases of the respiratory organs there were 19 deaths, of which, 11 were referred to bronchitis and 8 to pneumonia. Tubercular diseases caused 7 deaths, old age 3, heart disease 2, and cancer 2. The number of deaths of children under one year of age was 20, and of persons aged 60 years and upwards, 9. Six inquests were held. Three deaths were due to violent causes. The deaths primarily attributed to influenza in London were 9 and 6 during the last two weeks. May 19th, 1890. During the fortnight that ended on the 10th day of May, 115 births and 66 deaths were registered in the parish. These numbers indicate an annual birth-rate of 33.0, and an annual rate of mortality of 18.9 per thousand of the estimated population. The corresponding death-rate in London was 17.7. xxxii The chief zymotic diseases caused 7 deaths, viz.—measles 3, diphtheria 1, and whooping cough 3. From diseases of the tubercular order there were 11 deaths, viz.—6 from phthisis, 2 from meningitis, and 3 from tabes mesenterica. To diseases of the respiratory organs 15 deaths were referred, viz.—10 to bronchitis, 4 to pneumonia, and 1 to membranous croup. Four deaths were attributed to old age, and 4 to heart disease. The number of deaths of children under one year of age was 18, and of persons aged 60 years and upwards, 13. Four inquests were held. One death was caused by being run over by a van. The deaths primarily attributed to influenza in London have declined to 2 in the week. The water supplied by the Southwark Company was efficiently filtered, and for river water exhibited a high degree of organic purity. During the fortnight 18 cases have been reported under the Infectious Diseases Notification Act, viz.—15 of scarlet fever, 2 of erysipelas, and 1 of typhoid fever. Complaint has been made of a nuisance from the presence of decaying matter in railway trucks, lying just outside the Rolls Road Board School. I have seen Mr. George Wallis, the Station Superintendent at Bricklayers' Arms Station with reference to this matter, and he has undertaken not to receive fish manure from this week ; to direct careful examination of all manure which may be brought to the station, and the refusal of what is objectionable, and to load all manure as far away from the school as is practicable. I am informed that all manure which is loaded during the day is removed the same night without a single exception. June 2nd, 1890. During the fortnight that ended on the 24th day of May, 108 births and 57 deaths were registered in the parish These numbers indicate an annual birth-rate of 31.0, and xxxiii an annual rate of mortality of 16.3 per thousand of the estimated population. The corresponding death-rate in London was 17.2. Diseases of the zymotic class caused 10 deaths, viz.— measles 6, scarlet fever 2, whooping cough 1, and diarrhoea 1. From diseases of the respiratory organs there were 13 deaths; from those of the tubercular order 8; from heart disease 4, and from old age 2. The number of deaths of children under one year of age was 12, and of persons aged 60 years and upwards, 10. Two inquests were held. In both cases the deaths were referred to natural causes. The deaths primarily attributed to influenza in the two previous weeks were 3 and 2. The number of cases reported under the Infectious Diseases Notification Act, between May 20th and May 29th, was 39; of these 25 were reported as scarlet fever, 2 as diphtheria, 2 as puerperal fever, 7 as erysipelas, and 3 as typhoid fever. I regret to add that two of the latter, after removal to the hospital, were regarded as cases of "typhus." June, 16th, 1890. During the fortnight that ended on the 7th day of June, 100 births and 50 deaths were registered in the parish. These numbers indicate an annual birth-rate of 28.6, and an annual rate of mortality of 14.3 per thousand of the estimated population. The corresponding death-rate in London was 16.2. The number of deaths from diseases of the zymotic class was 11, viz.— 5 from measles, 4 from whooping cough, 1 from scarlet fever, and 1 from diphtheria. From diseases of the respiratory organs there were 15 deaths, of which 6 were due to bronchitis, 8 to pneumonia, and 1 to croup. Diseases of the tubercular order caused 6 deaths, and old age 4. xxxiv The number of deaths of children under one year of age was 1o, and of persons aged 60 years and upwards, 10. Two inquests were held. One death was attributed to accident. The water supplied by the Southwark Company was efficiently filtered, and remarkably free from organic matter. During the last fortnight, 27 cases of infectious disease have been reported ; 19 of scarlet fever, 4 of diphtheria, 2 of membranous croup, and 2 of erysipelas. Complaint has been made of fumes from a furnace at Messrs. Donkin & Co's. Factory. I have visited the premises and enquired into the process, and at present have no reason to suppose that any fumes are likely to be evolved which are injurious to health. I shall visit them again when the process is in full work. July 7th, 1890. During the three weeks that ended on the 28th day of June, 143 births and 87 deaths were registered in the parish. These numbers indicate an annual birth-rate of 44.8, and an annual rate of mortality of 16.6 per thousand of the estimated population. The corresponding death-rate in London was 16.2, the rate for the last week (15.9) being the lowest rate recorded in any week of this year. The chief diseases of the zymotic class caused 8 deaths, viz.—measles 1, diphtheria 1, whooping cough 4, enteric fever 1, and diarrhoea 1. From diseases of the respiratory organs there were 10 deaths; from those of the tubercular order 10, from old age 5, and from heart disease 6. The number of deaths of children under one year of age was 14, and of persons aged 60 years and upwards, 14. Nine inquests were held. Five deaths were attributed to accident or violence. Only one death was uncertified. Under the Infectious Diseases Notification Act, 47 cases have been reported. They were : scarlet fever 31, erysipelas xxxv 7, diphtheria 4, membranous croup 1, enteric or typhoid fever 3, and typhus 1. The case of typhus is one of a series of cases which have occurred in Gedling Street. So far these cases have been confined to two families, who are not only friends and neighbours, but, at'the outbreak of the disease, resided in the same house. July 21st, 1890. During the fortnight that ended on the 12th day of July, 112 births and 57 deaths were registered in the parish. These numbers indicate an annual birth-rate of 32.1, and an annual rate of mortality of 16.3 per thousand of the estimated population. The corresponding death-rate in London was 17.4. The chief diseases of the zymotic class caused 9 deaths, viz.—measles 2, diphtheria 1, whooping cough 3, enteric fever 1, and diarrhoea 2. From diseases of the respiratory organs there were 19 deaths, of which 6 were referred to bronchitis, 11 to pneumonia, and 2 to congestion of the lungs. Diseases of the tubercular order caused 4 deaths, heart disease 3, and old age 1. The number of deaths of children under one year of age was 16, and of persons aged 60 years and upwards, 6. Four inquests were held. One death was referred to apoplexy caused by excessive drinking. The water supplied by the Southwark Company was efficiently filtered, and the improved quality which it has of late exhibited has been fully maintained. Since the last meeting of the Vestry, notices have been received of 28 cases of scarlet fever, 9 of erysipelas, 6 of diphtheria, and 2 of membranous croup—total 45. August 11th, 1890. During the three weeks that ended on the 2nd day of August, 166 births and 81 deaths were registered in the arish. These numbers indicate an annual birth-rate of xxxvi 31.8, and an annual rate of mortality of 15.5 per thousand of the estimated population. The corresponding death-rate in London was 18.1. Diseases of the zymotic class caused 15 deaths, viz.— measles 6, diphtheria 1, whooping cough 4, and diarrhoea 4. From diseases of the respiratory organs there were 19 deaths, and from those of the tubercular order 15. The number of deaths of children under one year of age was 27, and of persons aged 60 years and upwards, 10. Seven inquests were held. One death of an infant was referred to accidental suffocation in a cab. Under the Diseases Notification Act, 57 cases have been reported since the last meeting of the Vestry. They were : scarlet fever 43, erysipelas 8, diphtheria 4, typhoid fever 1, and membranous croup 1. September 15th, 1890. During the five weeks that ended on the 6th day of September, 281 births and 163 deaths were registered in Bermondsey. These numbers indicate an annual birth-rate of 32.3, and an annua] rate of mortality of 18.7 per thousand of the estimated population. The like death-rate in London was 19.2. Diseases of the zymotic class caused 52 deaths, of which 10 were referred to measles, 3 to scarlet fever, 7 to whooping cough, and 33 to diarrhoea. One death was attributed to cholera. I made enquiries about this case, and found the symptoms were those of choleraic diarrhoea, and not of malignant cholera. From diseases of the respiratory organs there were. 32 deaths, from those of the tubercular order 20, from heart disease 7, and from enteritis 5. The number of deaths from children under one year of age was 62, and of persons aged 60 years and upwards, 21. Six inquests were held. Two deaths were due to violence. xxxvii The water supplied during the month of August was affected by the heavy rains, and consequent floods, but was efficiently filtered, and delivered in a clear and bright condition. Since the last meeting of the Vestry, 113 certificates have been received under the Infectious Diseases Notification Act, and copies thereof duly forwarded to the Metropolitan Asylums Board. They were : diphtheria 14, scarlet fever 74, erysipelas 14, membranous croup 2, cholera 1, enteric fever 6, and typhoid fever 2. Complaint has been made by inhabitants of Yalding Road, of noise, smoke, and dust from Donkin's factory. I have visited the premises, and consider there is a nuisance arising from the dust, but at present am doubtful whether this case can be dealt with under the Sanitary Acts. October 6th, 1890. During the three weeks that ended on the 27th day of September, 194 births and 85 deaths were registered in the parish. These numbers indicate an annual birth-rate of 37.0, and an annual rate of mortality of 16.2 per thousand of the estimated population. The corresponding death-rate in London was 16.6. The number of deaths from diseases of the zymotic class was 19, viz.—4 from measles!, 1 from scarlet fever, 3 from whooping cough and 11 from diarrhoea. There were 14 deaths from diseases of the tubercular order, 16 from diseases of the respiratory organs, 8 from cancer and 2 from old age. The number of deaths of children under one year of age was 31, and of persons aged 60 years and upwards, 11. Three inquests were held. Two deaths were referred to alcoholic poisoning from excessive drinking, and 1 to accidental suffocation in bed. From September 15th to October 4th, 64 cases were reported under the Diseases Notification Act. They were: xxxviii scarlet fever 39, erysipelas 14, typhoid fever 3, enteric fever 2, diphtheria 5, and puerperal fever 1. October 20th, 1890. During the fortnight that ended on the 11th day of October, 129 births and 52 deaths were registered in the parish. These numbers indicate an annual birth-rate of 37.0, and an annual rate of mortality of 15.0 per thousand of the estimated population. The corresponding death-rate in London was 17.0. Diseases of the zymotic class caused 9 deaths, viz.— measles 1, whooping cough 4 and diarrhoea 4. From diseases of the respiratory organs there were 12 deaths, and from those of the tubercular order 9. The number of deaths of children under one year of age was 19, and of persons aged 60 years and upwards, 5. Five inquests were held, and in four of the cases the deaths were referred to violence. The water supplied by the Southwark Company was of its normal summer quality and efficiently filtered. The number of certificates received under the Infectious Diseases Notification Act was 58, there being for scarlet fever 43, erysipelas 10, typhoid fever 2, diphtheria 2 and membranous croup 1. I have inspected the Board Schools in No. 1 Ward. At the Laxon Street School the walls of the schoolrooms are dirty and require cleansing. The accommodation of 5 closets for 450 boys is, in my opinion, inadequate. The master complains of the filthy state of the passage leading from Crosby Row to the Infants' School. The existence of this passage may be unknown to the street sweepers, but their attention should be called to its disgusting condition, especially on Monday mornings. At Riley Street School serious complaints were made of offensive exhalations from the gullies in the street. If these gullies are not trapped, they should be trapped. And if they xxxix are trapped they should be regularly supplied with water during long periods of dry weather. The existence of several tanyards, &c, in the immediate neighbourhood, which probably empty their old soaks into the main sewer, necessitates special attention being paid to the gullies in this locality. November 3rd, 1890. During the three weeks that ended on the 25th day of October, 127 births and 62 deaths were registered in the parish. These numbers indicate an annual birth-rate of 36.5, and an annual rate of mortality of 17.8 per thousand of the estimated population. The corresponding death-rate in London was 20. Diseases of the zymotic class caused 12 deaths, viz.— Measles 3, scarlet fever 3, whooping cough 3, enteric fever 1 and diarrhoea 2. From diseases of the respiratory organs there were 21 deaths, of which 15 were referred to bronchitis, 4 to pneumonia and 2 to pulmonary congestion. From diseases of the tubercular order there were 9 deaths; from heart disease 7, and from old age 2. The number of deaths of children under one year of age was 22, and of persons aged 60 years and upwards, 9. Three inquests were held. In all these cases the deaths were attributed to violent causes. Under the Notification of Infectious Diseases Act 48 certificates have been received, including scarlet fever 32, erysipelas 10, diphtheria 3, typhoid fever 1, enteric fever 2. I have inspected Webb Street, Kirby Street, Alma, and Monnow Road Board Schools, and found them in a satisfactory condition. The Customs and Inland Revenue Act, 1890, under section 26, provides that the assessment to Inhabited House Duty of any house originally built or adapted by additions or altera- xl tions and used for the sole purpose of providing separatedwellings for persons at rents not exceeding for each dwelling the rate of seven shillings and sixpence a week, and occupied only by persons paying such rents, is to be discharged by the Commissioners acting in the execution of the Acts relating to the Inhabited House Duty from the payment of house duty on such houses, provided that a certificate is produced to them to the effect that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements. This certificate is to be obtained from the Medical Officer of Health for the district in which the house is situate, or from some other medical practitioner having the qualifications required for a Medical Officer of Health and specially appointed for this purpose. In cases where the remuneration of the Medical Officer of Health is subject to the approval of the Local Government Board, the Board will be prepared to assent to a reasonable increase of such remuneration if the Local Authority deem the officer entitled to such increase. In any case where payment is made it is to be paid by the Local Authority, and not by the person who is benefited by the certificate. November 17th, 1890. During the fortnight that ended on the Bth day of November, 105 births and 68 deaths were registered in the parish. These numbers indicate an annual birth-rate of 30.1, and an annual rate of mortality of 19.7 per thousand of the estimated population. The corresponding death-rate in London was 20.9. Diseases of the zymotic class caused 6 deaths, viz.— measles 3, enteric fever 1 and diarrhoea 2. From diseases of the respiratory organs there were 21 deaths, of which 13 were referred to bronchitis, 7 to pneumonia and 1 to pleurisy. Diseases of the tubercular order caused 11 deaths and cancer 6. xli The number of deaths of children under one year of age was 19, and of persons aged 60 years and upwards, 14. Seven inquests were held. One death was attributed to accident. The water supplied was of remarkable organic purity and efficiently filtered before delivery. The number of certificates received under the Diseases Notification Act since the last meeting of the Vestry is 55, exclusive of 16 received this day. The number of houses I have been required to inspect and certify under the Inland Revenue Act is 42. These are from two owners only. I have every reason to believe that applications of this kind will be largely increased at the beginning of the year, when the tax papers are delivered. December Ist, 1890. During the fortnight that ended on the 22nd day of November, 117 births and 62 deaths were registered in the parish. These numbers indicate an annual birth-rate of 33.6, and an annual rate of mortality of 17.8 per thousand of the estimated population. The corresponding death-rate in London was 20.2. Five deaths were attributed to zymotic diseases, viz.— 1 to measles, 1 to scarlet fever, 2 to whooping cough and 1 to diarrhoea. Diseases of the respiratory organs caused 21 deaths, viz.— bronchitis 11, pneumonia 8, and croup 2. From tubercular diseases there were 12 deaths, including 9 from phthisis and 3 from meningitis. The number of deaths of children under one year of age was 14, and of persons aged 60 years and upwards,11. Five inquests were held. Two deaths were referred to violence. Under the Diseases Notification Act, 72 certificates have been received during the fortnight. These were classed as scarlet fever 51, erysipelas 10, diphtheria 7, enteric fever 1, typhoid fever 2, membranous croup 1. I have continued my inspection of the Board Schools, and report that the Keeton's Road School requires the ceilings to be whitewashed, and the walls of the rooms and passages to be cleaned throughout. At the Southwark Park School the w.c. accommodation at the girls' school is inadequate. There are six female teachers, and no separate w.c. has been provided for their use. December 15th, 1890. During the fortnight that ended on the 6th day of December, 98 births and 57 deaths were registered in the parish. These numbers indicate an annual birth-rate of 28.1, and an annual rate of mortality of 16.4 per thousand of the estimated population. The corresponding death-rate in London was 19.2. Only four deaths were recorded from diseases of the zymotic class, viz.—l from measles and 3 from whooping cough. From diseases of the respiratory organs there were 18 deaths, from those of the tubercular order 6, and from old age 4. The number of deaths under one year of age was 17, and of persons aged 60 years and upwards, 14. Three inquests were held. These were two cases of suicide and one death from excessive drinking. The water supplied during the last month was more highly charged with organic matter from access of decaying vegetation, which is usual at this season of the year, but was efficiently filtered before delivery. The number of cases of infectious diseases reported was 31, viz.—scarlet fever 18, erysipelas 8, diphtheria 4, and enteric fever 1. The number of houses requiring inspection under the House Duty Relief Act was 72. In Javen's Buildings, King Street, there are 20 tenements, occupied by 102 persons. Only one or two of these houses are fairly clean, and fully half of them (viz. —numbers 3, 4, 5, 6, 13, 16, 17, 18, 19 and 20) are in a dirty and unsanitary condition. In some of these houses the ceilings were whitewashed five months ago, and the walls have been left dirty and unpapered. Broken panes in the windows abound. The stairs and passages are dirty. There are four w.c.'s, each of which is a double one. The doors have no fastenings. On the 5th inst. I attended a conference of a Committee of the London County Council and of representatives of the Metropolitan Vestries on the proceedings to be taken under the Housing of the Poor Act, 1890. It was resolved that the Medical Officer of the County Council should convene a meeting of the Medical Officers of Health to endeavour to arrive at some common understanding as to what conditions rendered a house unfit for human habitation, and to report thereon to a future meeting of the Committee and Delegates. January 5th, 1891. During the three weeks that ended on the 27th day of December, 144 births and 122 deaths were registered in the parish. These numbers indicate an annual birth-rate of 27.6, and an annual rate of mortality of 22.5 per thousand of the estimated population. The corresponding death-rate in London was 24.5. The low birth-rate is probably due to delayed registration, and the higher death-rate is attributable to cold and foggy weather. The number of deaths from the chief diseases of the zymotic class was 12, viz.—from measles 1, diphtheria 1, whooping cough 7, enteric fever 2, and diarrhoea 1. Diseases of the respiratory organs caused 46 deaths, viz.— bronchitis 27, pneumonia 14, laryngitis 3, and pulmonary congestion 2. In the class of tubercular diseases there were 10 deaths from phthisis, 3 from meningitis, 2 from tabes mesenterica, and 2 from tuberculosis. xliv Old age caused 6 deaths, heart disease 5, and cancer 3. The number of deaths of children under one year of age was 22, and of persons aged 60 years and upwards, 33. Four inquests were held. Three deaths were due to violent causes. Eight persons died in the Workhouse. Three deaths were uncertified. Under the Infectious Diseases Notification Act, 35 cases have been reported. Although the list is a smaller one, the proportion of serious and important cases is higher than usual.