THE VESTRY OF BERMONDSEY. REPORT ON THE Sanitary Condition OF THE Parish of Bermondsey FOR, THE YEAR 1392. 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. Fellow of the Incorporated Society of Medical Officers of Health. MEDICAL OFFICER OF HEALTH FOR THE PARISH. BERI 5 Cx.Lon THE VESTRY OF BERMONDSEY. REPORT ON THE Sanitary Condition OF THE Parish of Bermondsey FOR THE YEAR 1892. 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. Fellow of the Incorporated Society of Medical Officers of Health. MEDICAL OFFICER OF HEALTH FOR THE PARISH. London: Printed by Frederick Shaw & Co., Dockhead, S.E. 1893. ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH. TO THE VESTRY OF BERMONDSEY. Mr. Chairman and Gentlemen, My Seventeenth Annual Report on the state of the Public Health in the Parish of Bermondsey, includes the period of 52 weeks that ended on the 31st day of December, 1892. The general mortality was below that of the previous year, and was also below the average of the preceding ten years. Zymotic diseases upon the whole were less fatal, although a large number of cases of scarlet fever was notified. Influenza was more or less prevalent, and caused 39 deaths. Diseases of the respiratory organs caused 115 fewer deaths than in 1891. There was also an apparent reduction in the mortality from diseases of the tubercular order, but if we take into consideration the large number of deaths from phthisis, which takes place in outlying institutions, no important reduction is evident. The deaths from diarrhoea were the same in number as last year, and the mortality from this cause was much below the average, a circumstance which was probably due to the occurrence of a cool summer. Diphtheria, I regret to observe, exhibited a tendency to increased fatality. This was more marked in the deaths recorded in public institutions than in the number which took place within the boundaries of the Parish. The excess of births over deaths was 1,645, but notwithstanding this, we must regard the existing population as practically stationary, if not slowly declining. At the census which was taken in 1891, the population of the Leather Market District was 14,999; that of St. Mary Magdalen, 15,661, and that of St. James' District, 54,028 ; making a total for the whole Parish of 84,688. These figures are those which the Registrar General still uses. BIRTHS. The number of births recorded in the Parish was 3,177, being 23 fewer than in the previous year, and 96 below the decennial average. The annual birth-rate was 37.5 per thousand of the estimated population. The same rate in London was 30.9. The births in the Leather Market District numbered 601, corresponding to a birth-rate of 40.0; in St. Mary Magdalen District there were 645 births, being equal to a rate of 41.1, and in St. James' District 1,931, showing a rate of 35.7 per thousand inhabitants. iv The number of children born in the first quarter of the year was 805; in the second quarter, 793; in the third quarter, 780; and in the last quarter, 799. Compared with the previous year, there was a slight increase in the birth-rate of the two firstmentioned districts, and a decline of nearly two per thousand in St. James'. DEATHS. The total number of deaths from all causes registered in Bermondsey during the year was 1532, being 224 less than the number recorded in the previous year, and 152 below the decennial average. The death-rate calculated on the deaths which took place in the Parish, was 18.1 per thousand of the population, but when corrected for deaths in hospitals and outlying institutions, the rate of mortality is increased by 4.7. The number of parishioners ending their days in such institutions appears to be increasing year by year. On the other hand, there are fewer deaths in Bermondsey Workhouse. In the Leather Market District the deaths numbered 322, and the death-rate was 21.4; in St. Mary Magdalen District the deaths were 329, and the death-rate 21.0; and in St. James' District, 881 deaths occurred, being equal to a death-rate of 16.3. Compared with the previous year, there is a great reduction in the number of deaths in St. Mary Magdalen District, which may be due to the removal of aged persons from the workhouse. In St. James' District the death-rate was nearly two per thousand less than in 1891. The number of deaths registered in the first quarter of the year was 540 ; in the second quarter 350; in the third quarter 326, and in the last quarter 316. The mortality during the first quarter was exceptionally heavy, and during the last quarter unusually light. The number of deaths of children under one year of age in the Parish was 489, and in outlying institutions 27. The proportion of deaths of infants was 162 per thousand registered births. In the Leather Market District, this proportion was 216; in St. Mary Magdalen, 153; and in St. James', 134. For every ten infants born in St. James' District which do not survive their birth for a period of twelve months, there are under the same circumstances sixteen that perish in the Leather Market District. The number of persons who died in the workhouse was 17, against 132 in the previous year. The annual rate of mortality in London was 20.6 per thousand of the estimated population. The value of the death-rate as an index of the salubrity, or otherwise, of any particular district depends on the constitution of the population of that district with regard to age. It is obvious that vi where the birth-rate is high, there will be a larger proportion of children under five years of age, at which period of life the mortality is normally at a high figure. It may further be observed that where there is a constant migration of persons unable to find employment in their native parish, that migration generally occurs at a period of life when the natural mortality is comparatively low. Both these circumstances have some influence on the death-rate in Bermondsey. CAUSES OF DEATH. From the principal diseases of the zymotic class 177 deaths were registered in the Parish, being eight fewer than in the previous year, and 100 below the decennial average. This number corresponded to a rate of two per thousand of the population, and formed 11.5 per cent. of the deaths from all causes. The deaths from zymotic diseases in various outlying institutions numbered 46, being 29 more than in the previous year. Including these deaths, the annual zymotic death-rate is raised to 2.6. Influenzacaused 39 deaths against 47 in 1891. In the majority of these cases, there were complications of bronchitis or pneumonia. Whooping cough caused 49 deaths, or three per cent. of the total. The deaths from this disease were 18 below those of the previous year, and 27 below the decennial average. From measles there were 66 deaths, being 11 more than in 1891, and forming rather more than 4 per vii cent. of the total deaths. This disease was most prevalent during the second quarter of the year, causing 40 deaths. The deaths from diarrhoea numbered 39, and were 31 below the average. Scarlet fever caused seven deaths in the Parish and 23 in various hospitals. From diphtheria, including membranous croup, there were ten deaths in Bermondsey and ten in various hospitals. There was no death from small-pox. One death was attributed to typhus, but from my personal enquiries respecting the case I think there is room for doubt as to the accuracy of the diagnosis. From enteric fever there were five deaths in Bermondsey, and one in a hospital. The mortality from each of the diseases of this class was below the decennial average, but too much importance must not be attached to this, as the number of cases of infectious disease, which are removed to hospitals, increases year by year, and we have had no information of the deaths in these institutions for so long a period as ten years. In the class of septic diseases there were 28 deaths, or 1.8 per cent, of the total; 12 deaths of children under one year of age were attributed to syphilis, being more than double the number referred to this cause in the previous year. Erysipelas caused two deaths, which is a very small proportion to the large number of cases notified. Five persons were said to have died from the intemperate use of alcoholic stimulants, but that number probably represents a mere fraction of the truth. viii From constitutional diseases there were 41 deaths or 2.6 per cent. This division includes 27 deaths from cancer, 8 from rickets, 5 from rheumatism, and one from gout. The number of deaths from diseases of the tubercular order was 227, being equal to an annual rate of 2.6 per thousand of the population, and forming 4.8 per cent. of total deaths. This class included 124 deaths from phthisis, 56 from meningitis, and 27 from tabes mesenterica. There was a decrease in the number of persons dying from consumption in the Parish, but an increase in the number of deaths from this disease in public institutions. From diseases of the respiratory system there were 428 deaths, being 115 fewer than in the previous year. These represented a death-rate of five per thousand and a percentage of 27.9. The deaths referred to bronchitis numbered 235, and those attributed to pneumonia 165. In this class there were 213 deaths of children under 5 years of age, being nearly one-half of the whole, and 155 deaths of persons over 45 years of age. Asthma, pleurisy, and other diseases of the lungs, accounted for 22 deaths, and inflammatory diseases of the larynx for six. From diseases of the brain and nervous system 130 deaths were registered, being 19 fewer than in the previous year. They formed 8.5 per cent. of ix the total deaths, and 1.5 of the general death-rate. From apoplexy and paralysis there were 53 deaths, and from convulsions 59. Diseases of the heart and circulatory organs caused 75 deaths, being the same number as in 1891. They were 4.9 per cent. of the deaths from all causes, and equal to a death-rate of 0.88. To diseases of the stomach, liver and digestive organs 78 deaths were referred, being 5 per cent. of all deaths. From diseases of kidney and urinary organs there were 28 deaths. Six women died in child-birth, but to this number must be added four deaths ascribed to puerperal fever. In the large class of ill-defined diseases or those of uncertain seat, 25 were attributed to marasmus, six to atrophy, 25 to debility, and 17 to inanition. Premature birth was assigned as the cause of 46 deaths, and old age of 59. From violent causes there were 53 deaths in the Parish, including 30 from accidental suffocation of x infants under one year of age. One death, that of a man 90 years of age, was attributed to starvation. In the outlying institutions there were 31 deaths of parishioners from accidents, drowning and other violent causes. The number of inquests held in the Parish was 97, and of the bodies of parishioners in hospitals 31. Sixty-five deaths, or 4 per cent., were not certified by any registered medical practitioner or by the coroner. These were chiefly deaths of infants where a midwife or a hospital student had been in attendance. SANITARY WORK. Inspection of houses and other premises has been vigorously carried on by your Sanitary Officers, the number of such inspections during the year ended Lady-day, 1893, having exceeded 10,500 ; the number of notices to execute works being 8,349. Unfortunately it has happened that in many cases where the lease-holders had only a small interest in the property, or the leases had nearly expired, the owners have preferred to close the houses to undertaking expensive repairs, for which they would not be reimbursed during the limited period of their possession of the houses. Inconvenience to many poor families may thus arise, while the loss of rating to the Parish is not inconsiderable. xi The number of houses found to be in a dirty and dilapidated condition, requiring cleansing and repair was 770. Through information derived from notification of infectious diseases, 1,001 houses were inspected, 896 were disinfected by your officers, and 86 others were disinfected to the satisfaction of the medical attendants on the cases; 781 defective drains were repaired, and notices were served for ventilating 591. Underground floors were provided with more adequate means of ventilation in 513 cases, and 826 houses were benefited by separating the water used for flushing water-closets from that used for ordinary purposes. The number of persons suffering from infectious diseases who were removed to hospital was 349. 118 notices for the abatement of smoke nuisance were served. Great use was made of the mortuary, where 301 bodies were received and 52 post-mortem examinations made. Fifteen dead bodies were removed to the mortuary from rooms in which persons were living, and nine cases were deaths from infectious disease. A large number of articles of food, which were unfit for human consumption, were seized and destroyed. The disinfecting chamber of the vestry was used to disinfect 4,890 articles, and 38 lots of bedding were destroyed in the furnace employed for that purpose. A large number of factories and workshops were inspected, and the owners served with notices to provide improved sanitary accommodation for the use of the work-people xii Thanking my fellow officers for their able assistance, and the vestry for the support given me in the exercise of my duties, I have the honour to be, Gentlemen, Your obedient servant, JOHN DIXON, M.D., L.R.C P. Lond. Medical Officer of Health. 133, Jamaica Road, Bermondsey. xii TABLE I. CAUSES OF DEATH. Registered in Bermondsey during the 52 weeks ending December 31st, 1892. CAUSES OF DEATH. 1892. Ages at Death. Total. Male. Female. 0 —1 1—5 5 —15 15 —25 25—45 45— 6 5 1532 4 8 9 311 761 77 1 38 47 186 260 All Causes Small Pox ... ... ... ... ... ... ... ... ... 66 37 20 46 ... ... ... Measles 29 ... 2 ... 1 ... Scarlet Fever 7 3 4 4 ... 1 Diphtheria 10 7 3 3 6 ... ... ... 49 Whooping Cough 26 23 21 27 1 ... ... ... 1 ... ... ... ... Typhus 1 ... ... ... 1 ... 1 1 2 ... Enteric Fever 5 4 1 25 ... 1 Diarrhœa 39 14 25 13 ... ... 18 21 5 1 8 11 Influenza 39 4 1 .. Syphilis 12 9 3 12 ... ... ... ... 1 1 Erysipelas 2 2 ... ... ... ... ... 4 3 Puerperal Fever 4 ... 1 ... ... ... ... 2 1 ... ... ... Purpura 1 1 1 ... 1 1 Thrush ... 1 ... ... ... ... ... 5 4 ... 2 Alcoholism 1 ... 3 ... ... ... 1 2 1 ... 1 Septicæmia 1 ... ... 2 3 ... ... Rheumatism 4 2 ... ... ... 1 ... 1 Rheumatic Fever 1 ... ... ... ... ... ... 1 1 ... ... ... Gout ... ... ... 8 4 ... ... Rickets 4 4 4 ... ... TABLE I . —continued. CAUSES OF DEATH. 1892. Ages at Death. Total. Male. Female. 0—1 1—5 5—15 15—25 25—45 45—65 Cancer 27 6 ... 21 ... ... ... 2 20 Tabes Mesenterica ... 18 1 ... 27 9 17 9 ... Meningitis 56 33 23 19 29 6 ... 1 1 Phthisis 124 58 6 66 3 5 18 62 27 Tuberculosis 18 9 9 3 2 2 3 1 7 2 Hæmoptysis 2 1 ... ... ... ... ... ... 46 46 Premature Birth 32 14 ... ... ... ... ... ... Atelectasis 1 ... 1 1 ... ... ... ... Congenital Malformation 4 4 2 2 ... ... ... ... ... 59 32 Old Age 27 ... ... ... 3 ... ... Apoplexy 36 23 13 1 ... ... ... 5 13 17 8 ... Paralysis 9 1 ... ... ... 7 Epilepsy 2 2 ... 1 1 1 ... ... ... Convulsions 59 40 19 47 12 ... ... ... .. 1 Other Brain Diseases 7 7 2 1 16 9 ... 5 Heart Disease 70 28 ... 4 15 32 42 2 5 Aortic Disease 1 1 ... ... ... ... ... ... ... Aneurism 1 ... ... 1 ... ... ... 1 ... Angina Pectoris 1 ... 1 ... ... ... ... 1 ... TABLE I.— continued. CAUSES OF DEATH. 1892. Ages at Death 0—1 1—5 5—15 15—25 25—45 45—65 Total. Male. Female. 1 1 ... ... 1 ... ... Croup ... ... 4 3 1 2 1 Laryngitis 1 ... ... ... Spasm of Glottis ... 1 1 ... 1 ... ... ... ... Bronchitis 235 109 126 66 54 2 ... 15 56 5 32 Pneumonia 165 74 38 40 18 91 13 1 1 Pleurisy 1 ... ... ... ... ... ... 2 Asthma 3 2 1 ... ... ... ... ... Congestion of Lungs 6 2 ... 7 1 3 1 ... 1 Other Lung Diseases 6 5 4 1 1 ... 3 2 11 ... 11 8 6 5 ... ... Dentition 3 ... 6 Gastritis 9 4 5 ... ... ... 1 ... 1 Enteritis 4 8 9 2 ... ... 12 ... 3 Peritonitis ... 3 ... 2 ... 1 ... ... Intestinal Obstruction 1 1 ... 2 ... ... ... 1 ... 13 Other Stomach Diseases 8 10 ... 9 1 ... 21 1 16 5 11 ... 1 2 9 Liver Disease ... ... 2 Jaundice 4 1 3 ... ... ... 1 1 27 ... Kidney Disease 14 13 3 ... ... 9 13 Bladder Disease 1 ... 1 ... ... .. ... ... ... ... Child Birth 6 ... 6 ... ... 1 5 ... 1 Puerperal Convulsions 1 ... ... ... ... .. 1 ... Rupture of Uterus ... 1 ... 1 1 ... ... ... .. 1 ... Ovarian Disease 1 ... ... ... ... ... .. Diseases of Joints ... 1 ... 1 ... ... 1 ... ... Diseases of Skin 2 2 1 ... 1 ... ... ... ... TABLE I. —continued. CAUSES OF DEATH. 1892. Ages at Death. Total. Male. Female. O—1 1—5 5—15 15—25 25—45 45—65 1 ... Circumcision 1 1 Nævus 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 25 ... Marasmus 10 21 4 ... ... 15 ... Atrophy 6 2 4 6 ... ... Debility ... ... ... 25 16 9 23 2 ... ... Inanition ... ... 17 9 8 17 ... ... Malnutrition ... ... ... 2 2 ... 2 ... Want of Breast Milk ... ... ... ... 2 2 ... 2 ... Non Vitality ... ... ... 5 3 ... 2 5 ... ... ... Anæmia ... ... 1 1 ... ... ... 1 ... ... Abscess 3 ... ... 3 2 1 Bed-sores ... ... ... ... ... 1 ... 1 ... Ulcer ... ... 2 1 ... ... 1 ... ... ... ... ... 1 Gangrene 2 ... 2 ... ... ... 1 Ill deined ... ... 13 6 7 ... 1 1 ... 3 4 9 Fractures and Contusions 5 4 1 ... ... 1 3 2 Suffocation 30 11 19 30 ... Drowning ... ... ... ... 6 6 ... 1 Burns and Scalds ... ... ... 2 2 3 1 2 1 1 .. ... ... ... Poison 1 2 1 1 ... ... 1 Cut Throat ... ... 1 1 ... ... ... 1 Starvation 1 ... ... ... 1 ... ... ... ... ... ... ... Found Dead 1 ... 1 ... ... ... 1 ... Notes. Area of Parish. —652 Acres (Land, 626 ; Tidal Water, 26) 1881 1891 Population at Census 86,652 84,688 Inhabited Houses 11,083 11,450 No. of Houses per Acre 17.6 18.2 No. of Persons per Acre 138 135 No. of Persons per House 7.8 7.4 xviii TABLE 11. DEATHS FROM ZYMOTIC DISEASES REGISTERED IN BERMONDSEY IN 1892, AND IN EACH QUARTER OF THE YEAR. 1892. Per centage of Total Deaths. ZYMOTIC DISEASES. Total for the Year 1892. Rate per 1000 living. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. ... ... ... ... ... ... Small Pox ... Measles 66 0.78 4.30 10 40 14 2 0.08 Scarlet Fever 1 3 2 1 7 0.45 Diphtheria 2 1 3 10 0.11 0.65 4 Whooping Cough 26 6 0.58 3.19 17 0 49 0.38 Fever 1 2 1 2 0.07 Diarrhoea 26 0.46 2.55 4 4 5 39 11.56 Total 44 67 53 13 177 2.08 TABLE 111. DEATHS FROM ZYMOTIC DISEASES REGISTERED IN BERMONDSEY IN THE TEN YEARS, 1882—1891. 1882 1883 1884 1885 1886 1887 1888 1889 1890 1891 Average of 10 Years. Small Pox 5 ... 5 14 ... ... ... ... ... ... 2.4 89 Measles 109 67 81 70 95 74 71.9 61 51 22 47 101 48 23 16 19 11 12 8 11 33.3 scarlet Fever 45 Diphtheria 9 15 10 9 14 7 11.0 16 10 12 75.9 25 61 76 87 60 73 67 82 50 Whooping Cough 178 18 10 11.8 13 13 16 12 10 7 7 Fever 9 39 Diarrhœa and Cholera 61 67 97 98 101 64 65 70.1 49 59 239 244 185 420 245 177 Total 292 335 279 341 277.1 TABLE IV. Sanitary Work, &c., during the Year, Lady-day, 1892, to Lady-day, 1893. Houses, &c., inspected and reported to the Vestry by the Medical Officer of Health, and the Sanitary Inspector. Houses and other premises inspected 10584 Notices served to execute works, &c. 8349 Houses in a dirty and dilapidated condition, cleansed and repaired, etc. 770 Houses disinfected, cleansed and purified 896 Houses disinfected, to satisfaction of Medical Attendant 86 Cases of overcrowding abated 7 Houses closed as unfit for habitation 55 W.C.'s repaired, ventilated, and whitewashed 271 Closets panned and trapped or old pans cleansed 308 Closets supplied with water 224 Defective drains repaired 781 Stopped drains cleared 251 Untrapped sinks trapped 301 Cesspools abolished 13 Badly paved yards repaired 402 Water receptacles cleansed and repaired 93 Houses supplied with water 14 Defective roofs repaired 109 Defective rain-shoots and gutters repaired 193 Offensive accumulations removed 32 Houses drained direct into the public sewer 136 Defective water apparatus in w.c.'s repaired 186 TABLE IV. —Continued. Lots of fowls which were a nuisance, removed 18 Animals kept so as to be a nuisance, removed 16 Urinals and other offensive places cleansed 39 Slaughter-houses inspected and licensed 8 Cow-houses inspected and licensed 7 Bakehouses inspected 82 Cellar flaps repaired 15 Stables and other premises drained 29 Old brick drains relaid with stoneware glazed pipes 83 Waste water pipes disconnected from drains and made to discharge in the open air 16o For providing the requisite means of ventilation by means of excavating underground floors and inserting air bricks 513 For separating the water used for flushing w.c.'s. from that used for ordinary purposes 826 Houses inspected where infectious diseases occurred 1001 Letters written to owners, agents, and others ... 897 Persons suffering from infectious diseases removed to Hospital 349 Dead bodies removed from rooms to mortuary 15 99 Summonses taken out before Police Magistrates for not complying with orders of the Vestry. (Fines inflicted £161 ios. and £6 7s. costs) Food destroyed—1 basket apples; 6 boxes oranges; 8 pieces beef; 500 cocoanuts; 3 baskets cherries; 1 bag mussels; 13 barrels of grapes; 1 bag whelks Window Sashes made to open 79 Windows made to open for ventilation 591 For ventilating drains 591 Notices served for abatement of smoke 118 Summonses for abatement of smoke (Fines £15, cost 125.) ... 7 HENRY THOMAS, Sanitary Inspector. 84,6,88 844,94 843,00 .23 .23 .23 25404 253482 252900 1493464 168988 2148600 194326 1947824 193,8900 TABLE V. POPULATION AT EACH CENSUS, 1801 to 1891. 841- .23 Census Year. Population Enumerated. Increase in 10 Years. Decennial Increase per cent. 2523 1682 1801 17,169 ... ... ... ... 19343 1811 2,361 19,530 13.7 5,705 29.2 25,235 1821 29,741 4,486 1831 17.7 5,206 17.7 1841 34,947 47,836 12,889 36.9 1851 58,212 10,376 1861 21.6 22,217 80,429 38.3 1871 7.7 1881 86,652 6,223 DECREASE. 1,964 84,688 DECREASE. 2.3 1891 TABLE VI. MIGRATION IN FOUR DECENNIAL PERIODS. Decennial Period. Total Increase of Population. Excess of Births over Deaths Migration in 10 Years. Influx. Efflux. 1851-61 10,376 7,903 2,473 ... ... 1861—71 22,177 8,896 13,221 ... ... 1871—81 6,223 17,227 11,004 ... ... 1881-91 DECREASE. 1,964 16,543 ... ... 18,507 xxiii TABLE VII. BIRTHS AND DEATHS IN TWENTY-TWO YEARS, 1871—92. Excess of Births over Deaths. Total Births. Total Deaths. Birth Rate. Death Rate. Year. Deaths from Zymotic Diseases London Death Rate. Rate per 1000 living. Total. 26.6 1871 3327 1994 1333 41.2 24.7 564 6.1 1872 3687 1663 2024 45.4 20.4 344 4.2 21.1 1 873 3587 1584 43.8 22.4 2003 24.4 392 4.7 18 74 3656 1642 2014 44 3 19.8 268 3.2 22.4 1875 3587 2094 1497 43.1 25.2 452 54 23.5 1876 1804 1867 21.9 3571 43.9 21.5 351 4.2 1877 3620 1665 1955 287 3.4 21.5 42.9 19.7 1878 3597 2110 1487 42.9 24.8 522 6.1 23.1 1879 1983 22.1 3715 1732 43.4 23.1 344 4.0 1880 1796 1736 20.8 411 4.6 21.7 3532 41.0 1881 3550 1735 1815 40.9 20.0 290 3.3 21.2 39.8 21.8 1882 34 8 5 1913 1572 420 4.7 21.2 1883 292 3.3 20.4 3435 1722 1712 39.0 19.5 1884 3469 1777 1692 39 .1 20.0 335 3.7 20.3 188 5 3221 158 3 1638 36.1 17.7 245 2.7 19.7 1886 334 8 1698 1650 18.9 3.1 37.2 279 19.9 1887 3200 1 73 1 1469 35.3 19.1 34 1 3.8 19.9 18. 5 1888 3085 1527 1558 33.8 16.8 177 1.9 1889 1480 1690 16.1 2.6 3170 34.5 247 17.4 1890 1660 1460 36.7 196 239 2.8 20.3 3120 1891 3200 1756 1444 37.7 20.7 185 2.2 21.4 1892 1645 18.1 20.6 3177 1532 37.5 177 2.1 Sanitary Works carried out under the "Factory and Workshops Act." THE PATENT FIREWOOD CO., The Grange.—One new water-closet provided for workpeople. 11, CROSBY ROW, Laundry.—Premises drained direct into public sewer, new water-closet provided for women, surface of yard and workroom concreted. MESSRS. BEDFORD & STEER, Wireworkers, Long Lane.— Water-closet reconstructed, urinal accommodation, and one extra water-closet provided. MESSRS. FISHER, Leather Manufacturers, Tanner Street. — Drains reconstructed, workshops paved, drained, cleansed, and whitewashed, water-closets reconstructed and furnished with water and apparatus for flushing. MESSRS. SALING, Leather Manufacturers, Tyer's Gateway.— Workshops paved, drained, cleansed, and whitewashed ; two new water-closets provided for use of men, old privies in workshops abolished. MESSRS. BROOKS, Tarpaulin Makers, Mellick's Place.— Drains and water-closet reconstructed, yard repaved, water supply and apparatus provided to water-closet. MR. C. ALLDEN, Wood Turner, 181, Drummond Road.— Workshops and water-closets cleansed and whitewashed, skylights made to open for ventilation. MESSRS. HARRIS & SMITHERS, Leather Manufacturers, Blue Anchor Lane. —Workshops cleansed and whitewashed, waterclosets reconstructed and furnished with water and apparatus for flushing. MESSRS. MARSHALL & CLARK, Leather Manufacturers, Grange Walk. —Drains and water-closets reconstructed, waterclosets furnished with water and apparatus for flushing, yard repaved, workshops cleansed and whitewashed, foul and disused tanpits emptied and filled up with dry rubbish. xxv MR. SMITH, Leather Merchant, Maltby Street. —Drains trapped, water-closets reconstructed and furnished with water and apparatus for flushing, suitable urinal accommodation provided, workshops repaved, cleansed and whitewashed. MR. BRAY'S LAUNDRY, Providence Place, Crosby Row.— Drains and water-closet reconstructed, water-closet furnished with water supply and apparatus for flushing. MESSRS. POTTER, Picklers, Hyson Road.—Additional watercloset provided for women. MESSRS. BOWRON BROS., Leather Manufacturers, Purbrook Street.—Separate water-closet accommodation provided for women (one), men's, water-closets reconstructed, urinal acoommodation provided. MESSRS. ARMFIELD, Leather Manufacturers, Bombay Street. —Workshops drained direct into the public sewer, with intercepting trap and ventilation, new water-closets erected with stoneware glazed troughs and automatic flushing apparatus. LONDON GALVANISED IRON CO., Druid Street.—Foul and defective brick drains under workshops taken up, new stoneware pipe drain laid connected direct with the public sewer, with intercepting trap, inspection chamber, and means of ventilation, old water-closets in workshops abolished, two new closets erected furnished with pedestal washout pans and syphonic flushing apparatus. MESSRS. B. NOAKES & CO., Galvanised Iron Works, 142, Spa Road. —Closed chamber constructed, coppers covered, effluvia carried through and consumed in furnace, old water-closets abolished and four new ones constructed, fitted with stoneware troughs, automatic flushing apparatus, and partitions of stone glazed bricks and efficiently ventilated. MESSRS. MILES, DRUCE & CO., Galvanised Iron Works, Long Lane. —Closed chamber constructed, coppers covered, effluvia carried through and consumed in furnace. xxvi MR. CARTER, Cocoa-nut Matting Manufacturer, 108, Spa Road.—Water-closets reconstructed, urinal accommodation provided and furnished with water and apparatus for flushing, workshops cleansed and whitewashed. MESSRS. E. KIPPS & CO., Leather Manufacturers, 94, Bermondsey Street.—Workshops paved, cleansed, and whitewashed, drains trapped, manhole provided with air-tight cover, old privies abolished, three new water-closets erected, furnished with washout soil pans and water supply and apparatus for flushing. MR. BROOKS, Wood Turner, 71½,Storks Road. —Water- closet provided with water supply and apparatus for flushing, workshops cleansed and whitewashed. MESSRS. PROCTOR & BEVINGTON, Glue and Size Manufacturers, Grange Road. —Soil pans cleansed and flushing apparatus repaired in women's water-closets ; men's water-closets furnished with soil pans, seats, and water supply, and apparatus for flushing, old privy for use of office abolished and new water-closet erected, furnished with pedestal washout soil pan and apparatus for flushing. MESSRS. BEVINGTON, Leather Manufacturers, Neckinger. — Old privies abolished, two new blocks of water-closets (with 18 openings) erected for men, four additional for women, furnished with stoneware glazed troughs, automatic flushing apparatus, drained direct into the public sewers with intercepting traps, inspection chambers, and requisite means of ventilation. MESSRS. YOUNG & CO., Glue and Size Manufacturers, Dunlop Place. —Water-closets furnished with water supply and apparatus for flushing. MESSRS. SHADE & CASTLE, Leather Manufacturers, Dunlop Place. —Water-closets reconstructed, furnished with water supply and apparatus for flushing. xxvii MESSES. BOLANACHI, Chocolate Works, Spa Road. —New pans provided in water-closets, flushing apparatus repaired, walls of water-closets whitewashed. MESSES. PERKINS, Japanners, Bermondsey Street.—Old water-closets repaired and cleansed, two additional water-closets provided. MR. MARTIN, Comb Manufacturer, Rouel Road.—Drains reconstructed, workshops cleansed and whitewashed, water-closet furnished with water and apparatus for flushing. MR. MARTIN, Leather Merchant, 1, Dockley Road.—Drains reconstructed, provided with intercepting trap, inspection chamber, and requisite means of ventilation, flushing apparatus in watercloset repaired, floors cemented and walls whitewashed, workshops cleansed and whitewashed. MR. JEFFREYS .Leather Manufacturer, 34, Crimscott Street.— Drains reconstructed with intercepting trap, inspection chamber, and requisite means of ventilation, old privy abolished and new water-closet erected, furnished with water supply and apparatus for flushing. MESSRS. NICKERSON, Leather Merchants, Alscot Road.— Pans and traps in water-closets reset, drains in workshops trapped. MESSRS. BRACKNELL, Sauce Makers, Alscot Road.— Flushing apparatus in water-closet repaired. MR. GROVE, Leather Manufacturer, Alscot Road.—Pans and traps in water-closets reset, drains repaired, workshops cleansed and whitewashed. MESSRS. SUTTON, Orchil Works, Grange Road.—Watercloset cleansed and furnished with water apparatus for flushing. xxviii 60, SNOWSFIELDS.—Workshop cleansed and whitewashed. MESSRS. CHEVERTON, Leather Manufacturers, Tyer's Gateway.—Soil pans cleansed, flushing apparatus repaired, one additional water-closet provided for women. MESSRS. E. & T. PINK, Jam Manufacturers, Staple Street.— Workshops repaved, cleansed and whitewashed, water-closets and urinals cleansed, flushing apparatus repaired, drains trapped, the old iron troughs removed, and stone glazed substituted, furnished with automatic flushing apparatus. MESSRS. GRIFFITHS, Paint Manufacturers, Macks Road.— Flushing apparatus in water-closets repaired. MESSRS. SPENCER, Leather and Bag Manufacturers, Crimscott Street.—Drains trapped, workshops cleansed and whitewashed, separate water-closet accommodation allocated for women. MESSRS. BLOOR & HEAL, Curriers, Kintore Street, Workshops drained, paved, cleansed and whitewashed. SCOTT'S COOPERAGE, Cherry Garden Street. —Drains reconstructed with intercepting trap, inspection chamber and requisite means of ventilation, one new water-closet and urinal erected for workmen. WILSONS' COOPERAGE, Tanner Street.—Water-closets reconstructed and furnished with water supply and apparatus for flushing. MR. VALE, Glass Blower, Flockton Street.—Water-closet reconstructed and furnished with water supply and apparatus for flushing. MESSRS. GIBB, Leather Manufacturers, Long Lane.—Waterclosets reconstructed and furnished with water supply and apparatus for flushing, interceptor fixed in drains to prevent sewer gas entering workshops, with inspection chamber and requisite means of Ventilation. xxix MR. HARTEL, Wholesale Tailor, 154, Long Lane.—One additional water-closet provided for use of women. C. MANGOLD, Fur Dresser, 11, Grange Walk.—Water-closet removed outside the workshops, new water-closet provided, workshops cleansed and whitewashed, drinking water altered so as to be drawn direct from the main instead of from foul cistern. MR.NORTON, Accoutrement Manufacturer, 25, Leroy Street.— Water-closets reconstructed, ventilated and furnished with water supply and apparatus for flushing. MESSRS. ROSS & CO., Trunk and Bag Makers, Wright's Buildings —Water-closets removed outside workshops, two additional water-closets provided for use of women and two for men, furnished with syphonic and automatic flushing apparatus, suitable urinal accommodation provided for men. MESSRS. SAMUEL & ROSENFIELD, Furriers, Homey Lane.—Old water-closets (two) removed outside workshops, and two additional water-closets erected with washout soil pans, syphonic flushing apparatus, and ventilated by means of louver boards in the roof, the drains reconstructed with intercepting trap, inspection chambers and ventilation. The workshops ventilated through the roof by means of louver boards and other openings ; the overcrowding abated. MR. JAS. BARROW, Leather Merchant, Weston Street.— Drains reconstructed with intercepting trap, inspection chamber, and requisite means of ventilation. Flushing apparatus in watercloset repaired. MESSRS. BEACH, Leather Manufacturers, Willow Walk.— Old privies abolished. Four water-closets constructed with water supply and apparatus for flushing, and means of ventilation. xxx MR. SMITH, Fellmonger, Horney Lane.—Water-closets reconstructed, one additional erected with water supply and apparatus for flushing, walls and floor cemented. S. E. RAILWAY COMPANY, Goods Station, Bricklayers' Arms.—Old privies abolished, new water-closets constructed, furnished with stoneware glazed troughs, automatic flushing apparatus. Urinals furnished with flushing apparatus. Drains trapped. Privies attached to signal and shunting boxes drained, provided with pan, water supply and apparatus for flushing. L. B. & S. C. RAILWAY COMPANY, Goods Station, Willow Walk.—Old privies abolished, new and additional water-closets provided, furnished with stoneware glazed troughs and automatic flushing apparatus, water laid on to urinals. Waterclosets attached to signal boxes reconstructed and furnished with water supply and flushing apparatus. MESSRS. BAILEY & WILKINS, Leather Merchants, Long Lane.—Drains, water-closets and urinals reconstructed. One additional water-closet provided for women. HENRY THOMAS, Chief Sanitary Inspector. xxxi REPORT OF INSPECTOR OF HOUSES LET IN LODGINGS. Mr. Chairman and Gentlemen, I again submit for your consideration my Annual statement in regard to Houses Let in lodgings, or occupied by members of more than one family, this being the Eighth Annual Report I have been privileged to bring under your notice. During the year ending June 19th, 1893, 4667 houses have been inspected ; of these 28 were in my opinion in such a state and condition as to justify me in recommending them for registration, and 16 were by special resolution of the Board placed under the regulations ; the owners of the other 12 took the necessary steps to comply with the requirements. The 28 houses recommended for registration contained 127 rooms, and were occupied by 81 families, consisting of 358 persons; 75 rooms were overcrowded and deficient in the prescribed air space to the extent of 47745 cubic feet, showing an average deficiency of air space of 636 cubic feet each. Some of the houses were not overcrowded, but the floors were in such a dirty condition, and the proper cleansing of the houses altogether neglected, that the Board decided to place them under the regulations, thus rendering the landlords and lodgers liable to penalties if they failed to keep their houses clean and wholesome. xxxiii During the year 79 notices have been served for the abatement of overcrowding, and 175 for the cleansing of passages, floors, wash-houses, water-closets, and the remedying of other sanitary defects. Nearly the whole of these houses have a good supply of water direct from the main without the intervention of a cistern The yards are well paved. The total number of houses now on the Register is 294, the same as last year. Sixteen houses have been registered, and 16 registered houses have been pulled down as unfit for human habitation. I remain, Gentlemen, Your obedient Servant, HENRY THOMAS, Inspector of Houses let in Lodgings or occupied by members of more than one family. xxxiv The number of Registered Houses are as follows :— Abbey Street 9 Alderminster Road 5 Arnold's Place 1 Albion Place 2 Alice Street 3 Aldred Street 5 Ambrose Street 2 Anchor Street 1 Bermondsey New Road 2 Bermondsey Square 1 Bermondsey Street (2 closed) 5 Bermondsey Wall 2 Brandon Street 1 Camperdown Place 4 Castles Buildings 1 Canal Row 1 Catlin Street 1 Chapel Place 3 Cherry Garden Street 3 Crosby Row 4 Crucifix Lane 1 Druid Street 3 East Lane 2 Edward Street 2 Elim Street 13 Fendall Street 1 Ferrand Street 4 Flockton Street 1 Foxlow Street 14 George's Court 1 The Grange 3 Grange Road 2 Grange Walk 5 Gedling Street 4 George Row 1 Green Walk 1 Jacob Street (closed) 2 St. James' Road 1 Javen's Buildings, Leroy Street, 3 blocks, 20 suites of rooms 3 Wood's Place 8 King's Arms Place 1 Kirby Street (1 closed) 6 Leroy Street 12 Lamb Alley 3 Long Lane 3 Long Walk 3 Lucey Road 1 Lockyer Street 2 Lynton Road 1 Marigold Court 5 Marigold Place 1 Marigold Street 4 Marshalls Place 4 Matilda Place 2 Medley's Place 2 Mellick's Place 6 Millstream Road 1 Minto Street 2 Napoleon Passage 2 Neckinger Street 2 Nelson Street 4 Osborne Buildings l Pages Walk 2 Parker's Buildings 4 Pleasant Place l Porlock Place 5 Paulin Street 1 Riley Street 1 Rouel Road 1 Russell Place 1 Salisbury Street 19 Sarah Place 1 Salisbury Place 10 xxxv Ship and Mermaid Row 2 Snowsfields 3 Spa Road 3 Staple Street 5 Stevenson's Court 2 Suffolk Place 3 Tanner Street 2 Turner's Retreat 1 Vauban Street ... Victoria Place 1 West Lane 5 West Grove 2 Weston Street 4 Wilderness Street 2 Williams Square 1 Wolseley's Buildings (8 8 Blocks) Wells Street 2 Woolf Street 2 Wylds Rents 1 xxxvi xxxvii SALE OF FOOD AND DRUGS' ACT. List of Articles submitted to the Public Analyst, from Lady-day, 1892. to Lady-day, 1893. Articles. Number of Samples. Genuine. Adulterated. Amount of Fines. Costs. £ s. d. 4 £ s. d. 4 ... Arrowroot ...... 18 Milk 68 35 103 153 10 0 10 0 5 Coffee 14 9 12 10 0 4 6 7 Butter 24 5 29 15 0 0 3 2 6 Bread 3 3 ... ...... ...... Flour 3 3 ... ...... ...... Mustard 10 ... ...... 10 ...... Pepper 4 4 ... ...... ...... Lard 1 1 ... ...... ...... Rum 3 3 ... ...... ...... Gin 13 3 5 0 6 10 0 0 12 Ice Cream 3 3 ... ...... ...... Whiskey 10 10 12 2 0 0 0 12 6 8 Margarine ... 8 9 15 o 5 0 2 Brandy 7 ... 7 ...... ...... Acetic Acid 1 1 ... ...... ...... Tincture Rhubarb 2 2 ... ...... ...... Seidlitz Powder 1 1 ...... ... ...... Beef Sausage 1 ... 1 ...... ...... German „ ...... 1 1 ... ...... 2 Cheese 2 ... ...... ...... 1 Cloves 1 ... ...... ...... Hop Bitters 1 1 ... ...... ...... ... Liquorice 2 2 1 0 0 0 12 6 1 ... Tartaric Acid 1 ...... ...... 1 1 Linseed ... ...... ...... 6 Sugar 6 ... ...... ...... 237 173 64 206 15 0 32 6 19 Several samples of Coffee and Milk were declared to be a mixture when purchased. The fines and costs recovered under the Sale of Food and Drugs' Act are paid to the Vestry account, except in the case of Margarine, when half the fines go to the Vestry if applied for at the time, and half to the Treasury. In some of the spirits the adulteration was so small that legal proceedings were not taken, and in others Notices were fixed on bar: "All spirits sold here are diluted." One sample of Liquorice was adulterated with 10 per cent. of Starch which the Analyst considered insufficient for a prosecution. HENRY THOMAS, Inspector. Public Analyst—Mr. R. BODMER. 12. Southwark Street. FORTNIGHTLY REPORTS o OF MEDICAL OFFICER OF HEALTH. January 18th, 1892. During the fortnight that ended on the 9th day of January, 166 births and 151 deaths were registered in the parish. These numbers indicate an annual birth-rate of 51 and an annual rate of mortality of 48.1 per thousand of the population. The corresponding death-rate in London was 37.4. From the chief diseases of the zymotic class there were 17 deaths, viz.: from measles 7, scarlet fever 2, diphtheria 1, whooping cough 6, and diarrhoea 1. Diseases of the tubercular class caused 13 deaths, viz.: phthisis 11, meningitis 1, and tuberculosis 1. Diseases of the respiratory organs caused the unusually large number of 65 deaths, viz. : bronchitis 42, pneumonia 19, asthma 2, pulmonary congestion 1, and pleurisy 1. These deaths form 43 per cent, of the deaths from all causes, and equal a death-rate of 19.9. The excessive mortality is due to the cold and foggy weather which prevailed three weeks ago. One death was referred to influenza complicated with pneumonia. Old age caused 8 deaths, and heart diseases, 3. The number of deaths of children under one year of age was 34, and of persons aged 60 years and upwards, 36. The water supplied by the Southwark Company was opalescent from finely suspended clay, which was not removed by subsidence or filtration. The excessive floods in the Thames rendered it very difficult for the Water Companies who have but small storage at their command to send out water fit for dietetic use. The number of certificates received under the Infectious Diseases Notification Act from the 4th to the 16th instant, was 21, viz.: for scarlet fever 13, erysipelas 5, diphtheria 1, and typhoid fever 2. The deaths primarily attributed to influenza in London were 37 in the week ending January 2nd, and 95 in the week ending January 9th. February Ist, 1892. During the fortnight that ended on the 23rd day of January, 137 births and 131 deaths were registered in the parish. These numbers indicate an annual birth-rate of 42.0, and an annual rate of mortality of 40.2 per thousand of the population. The corresponding death-rate in London was 43.0 per thousand. The chief diseases of the zymotic class caused 13 deaths, viz. : measles 3, whooping cough 9, and diarrhoea 1. From tubercular diseases there were 13 deaths, including 8 from phthisis. Diseases of the respiratory organs caused 42 deaths, viz. : bronchitis 24, pneumonia 17, and pulmonary congestion 1. Tendeaths were attributed to influenza and pneumonia, 8 to influenza and bronchitis, and 1 simply to influenza, making a total of 19. Five of these were children, 4 months, 10 months, 1 year, 1½ years, and 3 years of age. xl Seven persons died from old age, 5 from brain disease, and 3 from liver disease. The number of deaths of children under one year of age was 32, and of persons aged 60 years and upwards, 37. Seven inquests were held. Five deaths were due to violent causes ; 4 of these were cases of accidental suffocation of infants. The Notification of Infectious Diseases under the Public Health Act, 1891, included 13 certificates for scarlet fever; 1 typhoid fever, 1 membranous croup, and 1 erysipelas. The deaths primarily attributed to influenza in London during the week ending January 16th were 271, and 63 in which influenza was a secondary cause. In the week ending January 23rd, the deaths from influenza were 506, and 86 cases in which influenza was a secondary cause. February 15th, 1892. During the fortnight that ended on the 6th day of February, 131 births and 108 deaths were registered in the parish. These numbers indicate an annual birth-rate of 40.2, and an annual rate of mortality of 33.1 per thousand of the population. The corresponding death-rate in London was 35.8 per thousand. The chief diseases of the zymotic class caused 6 deaths, viz.: measles 3, scarlet fever 1, and whooping cough, 2. Two deaths were referred to influenza alone, and 11 to influenza associated with other diseases. Diseases of the respiratory organs caused 41 deaths, viz.: bronchitis 26, pneumonia 13, and pulmonary congestion, 2. From diseases of the tubercular order there were 10 deaths, including 7 from phthisis. Seven persons died of old age. The number of deaths of children under one year of age was 33, and of persons aged 60 years and upwards, 27. xli Five inquests were held. Three deaths were due to accidental suffocation in bed. The water supplied by the Southwark Company in January showed a great improvement on that sent out in December. The deaths primarily attributed to influenza in London during the week ending January 30th were 436 in which that disease was a primary, and 71 in which it was a secondary cause. In the following week the deaths from influenza declined to 314 as a primary, and 62 as a secondary cause. The diseases notified under the Public Health Act from February Ist to 13th, were scarlet fever 8, diphtheria 1, erysipelas 4, and enteric fever, 1. March 7th, 1892. During the three weeks that ended on the 27th day of February, 189 births and 98 deaths were registered in the parish. These numbers indicate an annual birth-rate of 39.2, and an annual rate of mortality of 20.0 per thousand of the population. The corresponding death-rate in London was 22.5. Diseases of the zymotic class caused 6 deaths, viz. : measles 1, whooping cough 3, and diarrhoea 2. Seven deaths were referred to influenza as a primary cause of death, and 2 to the same disease as a secondary cause. From diseases of the respiratory system there were 28 deaths, of which 17 were from bronchitis and 9 from pneumonia. Eleven persons died from tubercular diseases, 9 from heart disease, and 5 from old age. The number of deaths of children under one year of age was 36, and of persons aged 60 years and upwards 19. Eight inquests were held. Four deaths were attributed to violence, and 4 to natural causes. Five deaths were not certified. xlii The notices of Infectious Diseases were for scarlet fever 15, erysipelas 5, typhoid fever 4, diphtheria 3, and typhus 1, making a total of 28. The deaths primarily attributed to influenza in London have fallen in the course of six weeks from 506 to 61. The cases in which influenza was noted as a secondary cause have fallen from 86 to 20. March 21st, 1892. During the fortnight that ended on the 17th day of March, 106 births and 56 deaths were registered in the parish. These numbers indicate an annual birth-rate of 31.5, and an annual rate of mortality of 17.2 per thousand of the population. The corresponding death rate in London was 20.5. From the diseases of the zymotic class there were 5 deaths, viz.: 4 from whooping cough and 1 from typhus. I have made enquiries about the latter case without being able to trace any source of contagion. Diseases of the respiratory system caused 18 deaths, viz.: bronchitis 10, and pneumonia, 8. From diseases of the tubercular order there were 9 deaths, and from old age, 2. The number of deaths of children under one year of age was 20, and of persons aged 60 years and upwards, 13. Three inquests were held. All the deaths were attributed to violence. The water supplied by the Southwark Company was of better average quality than that delivered in the previous month. The deaths from influenza in London have fallen to 30 in the week. No deaths from this disease were registered in Bermondsey. Under the Public Health Act, 30 notices of Infectious Diseases have been received, viz. : for scarlet fever 20, erysipelas 6, typhoid fever 1, diphtheria 2, and membranous croup 1. xliii April 4th, 1892. During the fortnight that ended on the 26th day of March, 102 births and 53 deaths were registered in the parish. These numbers indicate an annual birth-rate of 31.3, and an annual rate of mortality of 16.2 per thousand of the population. The corresponding death-rate in London was 22.8. From the chief diseases of the zymotic class there were 5 deaths, viz.: from measles 1, diphtheria 1, and whooping cough 3. Diseases of the respiratory organs caused 13 deaths, of which 9 were from bronchitis and 3 from pneumonia. From tubercular diseases there were 6 deaths, from kidney diseases 3, old age 2, and influenza 1. The number of deaths of children under one year of age was 16, and of persons aged 60 years and upwards, 8. Three inquests were held. Two deaths were due to violent causes. Three deaths were uncertified. The certificates of Infectious Diseases received from 21st March to 2nd April, included 8 cases of scarlet fever, 2 of typhoid, 2 of diphtheria, and 5 of erysipelas. The present state of the public health in Bermondsey compares favourably with that of the corresponding period in the previous three years. April 25th, 1892. During the three weeks that ended on the 16th day of April, 162 births and 83 deaths were registered in the parish. These numbers indicate an annual birth-rate of 33.1 and an annual rate of mortality of 16.9 per thousand of the population. The corresponding death-rate in London was 21*0 per thousand. The principal diseases of the zymotic class caused 11 deaths, viz. : measles 2, scarlet fever 2, whooping cough 6, and enteric fever 1. xliv From diseases of the respiratory organs there were 13 deaths, from those of the tubercular order 15, from old age 5, and from heart disease, 3. The number of deaths of children under one year of age was 35, and of persons aged 60 years and upwards, 11. Eleven inquests were held. In four cases the deaths were referred to violent causes. The water supplied was efficiently filtered, and maintained the improved quality which it obtained in the previous month. The certificates of Infectious Diseases received from the 4th to the 23rd of April were 31, viz. : for diphtheria 7, smallpox 1, erysipelas 7, scarlet fever 15, and enteric fever 1. During the three weeks 34 deaths were attributed to influenza in London. There were none in Bermondsey. May 2nd, 1892. During the week that ended on the 23rd day of April, 52 births and 29 deaths were registered in the parish. These numbers indicate an annual birth-rate of 31.9 and an annual rate of mortality of 17.8 per thousand of the population. The death-rate in London was 21.0 per thousand. Diseases of the zymotic class caused 4 deaths, viz. : measles, diphtheria, whooping cough, and diarrhoea, each 1. From diseases of the respiratory organs there were 6 deaths from those of the tubercular order 5, from heart disease 2, and from old age 1. The number of deaths of children under one year of age was 9, and of persons aged 60 years and upwards, 5. Four inquests were held. Three deaths arose from violence ; two of them were infants accidentally suffocated in bed. xlv The certificates of Infectious Diseases received from the 25th to the 30th April numbered 15 ; they were for scarlet fever 10, erysipelas 3, diphtheria 1, and membranous laryngitis 1. Eight deaths in London were primarily attributed to influenza. May 16th, 1892. During the fortnight that ended on the 7th day of May, 137 births and 66 deaths were registered in the parish. These numbers indicate an annual birth-rate of 42.0, and an annual rate of mortality of 20.2 per thousand of the population. The corresponding death-rate in London was 19.3 per thousand inhabitants. Diseases of the zymotic class caused 14 deaths, viz.: measles 11 and whooping cough 3. The deaths from measles in London exceed double the average number of the corresponding period of the last ten years. From the diseases of the respiratory organs there were 15 deaths, of which 9 were from bronchitis and 6 from pneumonia. Diseases of the tubercular order caused 8 deaths, brain diseases 6, and heart diseases 5. The number of deaths of children under one year of age was 19, and of persons aged 60 years and upwards 11. Four inquests were held. Three deaths were due to violent causes. Four deaths were uncertified. From the 2nd to the 14th of May, 23 notices of Infectious Diseases were received. These were for erysipelas 1, for diphtheria, 7, for scarlet fever 14, and for enteric fever 1. I have personally inquired into some of the cases of diphtheria, and found the patients were never confined to bed, and were well in the course of a few days. xlvi May 30th, 1892. Daring the fortnight that ended on the 2lst day of May, 128 births and 43 deaths were registered in the parish. These numbers indicate an annual birth-rate of 39.2, and an annual rate of mortality of 13.2 per thousand of the estimated population. The corresponding death-rate in London was 19.4. From the principal diseases of the zymotic class 8 deaths were registered, viz.: 4 from measles and 4 from whooping cough. Diseases of the respiratory system caused 13 deaths ; those of the tubercular order 8, heart diseases 3, and cancer 2. In outlying institutions 11 deaths were recorded. The number of deaths of children under one year of age was 11, and of persons aged 60 years and upwards 6. One inquest was held, and 5 deaths were uncertified. The water supplied was of a high degree of organic purity for river water, and was efficiently filtered. The certificates of Infectious Diseases received from the 16th to the 28th of May, numbered 25, there being 23 for scarlet fever, 1 for enteric fever, and 1 for diphtheria. During the fortnight 7 deaths from small-pox have occurred in London. There are 84 cases of this disease in the Metropolitan Asylums Hospitals and 17 in the Highgate Small-pox Hospital. June 20th, 1892. During the three weeks that ended on the 11th day of June, 168 births and 72 deaths were registered in the parish. These numbers indicate an annual birth-race of 34.4 and an annual rate of mortality of 14.7 per thousand of the population. The corresponding death-rate in London was 17.9. From the principal zymotic diseases there were 18 deaths, viz. : from measles 12, scarlet fever 1, whooping cough 3, enteric fever 1, and diarrhoea 2. xlvii Diseases of the tubercular order caused 16 deaths, viz.: phthisis 10, meningitis 5, and tabes mesenterica 1. From diseases of the respiratory organs there were 18 deaths, viz. : 9 from bronchitis and 9 from pneumonia. The number of deaths of children under one year of age was 20, and of persons aged 60 years and upwards 11. Five inquests were held. Two deaths arose from accidental suffocation in bed, and 1 from drinking carbolic acid in mistake for ginger beer. The water supplied during the last month was of superior quality and efficiently filtered. Thirty-nine Notifications of Infectious Diseases have been received, viz. : 38 of scarlet fever, 5 of erysipelas, and 1 of diphtheria. July 4th, 1892. During the fortnight that ended on the 25th day of June, 128 births and 50 deaths were registered in the parish. These numbers indicate an annual birth-rate of 39.2, and an annual rate of mortality of 15.3 per thousand inhabitants. The corresponding death-rate in London was 17.2. Diseases of the zymotic class caused 7 deaths, viz. : measles 6 and diarrhoea 1. From diseases of the tubercular order there were 13 deaths, of which 7 were referred to phthisis. The deaths from diseases of the respiratory organs numbered 8, from heart diseases 3, and from old age 3. The number of deaths of children under one year of age was 17, and of persons aged 60 years and upwards 6. Two inquests were held, and 6 deaths were uncertified. xlviii The certificates of Infectious Diseases received from June 20th to July 2nd, were 32 for scarlet fever, 4 for diphtheria, 1 for membranous croup. 1 for puerperal fever, and 4 for erysipelas making a total of 41. July 18th, 1892. During the fortnight that ended on the 9th day of July, 114 births and 59 deaths were registered in the parish. These numbers indicate an annual birth-rate of 34.9, and an annual rate of mortality of 18.1 per thousand of the population. The corresponding death-rate in London was 18.1. Diseases of the zymotic class caused 12 deaths, viz. : measles 8, whooping cough 2, and diarrhoea 2. From diseases of the respiratory organs there were 14 deaths, including 9 from bronchitis and 4 from pneumonia. Diseases of the tubercular order caused 10 deaths, viz.: phthisis 4, meningitis 3, and tabes mesenterica 3. Two inquests were held ; both cases were infants accidentally suffocated in bed. The number of deaths of children under one year of age was 16, and of persons aged 6O years and upwards 7. The water supplied during the month of June is reported to have been of a high degree of organic purity for river water. Some specimens delivered in this parish during the present month were not efficiently filtered, or had become contaminated in course of transmission. The certificates of Infectious Diseases received from the 4th to the 16th July numbered 38, being for scarlet fever 25, erysipelas 8, diphtheria 4 and enteric fever 1. Measles is not included in Section 55 (8) of the Public Health Act 1891, but under Section 56 the Sanitary Authority may order that the section with respect to the Notification of Infectious Diseases shall apply in their district to any infectious xlix diseases other than a disease specifically mentioned in that section. The School Board for London have informed the London County Council that the Board are of opinion that measles should be included in the list of notifiable diseases, and request the Council to exercise the power conferred by Section 56 (6) of the Act with a view to measles, so far as London is concerned, being deemed a notifiable infectious disease. August 8th, 1892. During the three weeks that ended on the 30th day of July, 186 births and 82 deaths were registered in the parish. These numbers indicate an annual birth-rate of 37.9 and an annual rate of mortality of 16.7 per thousand of the population. The corresponding death-rate in London was 18.4. The chief diseases of the zymotic class caused 19 deaths, viz. : measles 7, diarrhoea 9, scarlet fever, diphtheria, and whooping cough, each one. From diseases of the respiratory organs there were 13 deaths, viz. : 8 from bronchitis and 5 from pneumonia. Diseases of the tubercular order caused 17 deaths, of which 6 were referred to phthisis. The number of deaths of children under one year of age was 30, and of persons aged 60 years and upwards 5. Eight inquests were held. Four deaths were due to violence. Three children were accidentally suffocated in bed. The certificates received under the Public Health Act from July 18th to August 6th, were for scarlet fever 55, diphtheria 4, membranous croup 1, erysipelas 8, typhoid fever 4, making a total of 72. September 5th, 1892. During the five weeks that ended on Saturday last only 9 deaths from diarrhoea were registered in the parish, which is much below the average of the corresponding period in the previous three years. 1 One case has been notified as " Cholera." I visited this case without delay, and am quite satisfied that it was not one of the epidemic form of the disease. However, the usual steps for disinfection were directed to be carried out. A telegram from the Port of London Sanitary Authority, received at 8.30 on Thursday evening, informed us of the names and addresses of two persons who had landed from the ship " Peregrine," and had come into this parish. One of these persons had removed from the address given at 6 p.m., that is, two hours before the telegram came to hand, and had left no address. I found there were three men, all seamen belonging to the " Peregrine." I succeeded in seeing all of them on Saturday, and ascertained that they were in good health. I have obtained a supply of the disinfectants on which most reliance is to be placed in cases of genuine malignant cholera. These are supplementary to the usual stock of carbolic acid which is available for general purposes. I propose to keep at the Town Hall a mixture for diarrhoea, a dose of which can be given to anyone employed about the premises, or passers by who may be taken suddenly ill. I recommend that the name and address of each such person should be taken, and that he be required, if necessary, to obtain proper medical aid. I wish it to be distinctly understood that this medicine is not to be taken by persons who are not suffering from diarrhoea, under the impression that it is a preventive of an attack of cholera. I have issued a placard on the Sanitary Measures which are calculated to lessen the prevalence of summer diarrhoea, and to enable the parish to resist a possible invasion of cholera. It may be necessary or advisable to supplement this with directions for the use of disinfectants in a house where a case of Asiatic cholera has occurred. I have visited the wards provided for the reception of cases of cholera in St. Olave's Union Infirmary, and report that they are suitable for the purpose and ready for immediate use in case of need. li If, unfortunately, cholera should prevail to any serious extent I have no doubt the Managers of the Metropolitan Asylum Hospitals would be able to cope with the difficulty by making other provision for existing convalescent patients. The proposal to provide a Marquee requires further consideration by the Committee. Not only must drainage and water supply be attended to, but the ground should be concreted or asphalted. In a large tent it would be difficult to maintain a suitable temperature during the cold nights of autumn. In a large Marquee no provision is made for the separation of the sexes; no living or sleeping rooms are provided for the nurses and medical staff; there is no place for the temporary reception of the dead, and no facilities for the prompt disinfection of articles of clothing. On Friday last a number of the leading medical men in the parish favoured me with their presence at the Town Hall. I am under the impression that they are prepared to aid the efforts of the Vestry. It appeared to be the general opinion that every case of cholera, when practicable, should be promptly removed to the hospital provided by the sanitary authorities. I believe the sanitary condition of the parish is far better than ever it has been, but this will not protect us from the possible importation of an infected person, and I would urge on all medical practitioners the importance of giving us the earliest possible notice of every case of cholera, of stating on the certificate whether the patient is or is not in a fit state to be removed to a hospital, the hour and minutes at which the certificate was signed, and the necessity of disinfection of all cholera-infected excreta, utensils and clothing. September 19th, 1892. During the six weeks that ended on the 10th day of September, 360 births and 138 deaths were registered in the parish. These numbers indicate an annual birth-rate of 36.8, and an annual rate lii of mortality of 14.1 per thousand of the population. The corresponding death-rate in London was 17.0. Zymotic diseases caused 19 deaths, viz.: measles 3, diphtheria 2, whooping cough 3, and diarrhoea 11. From diseases of the respiratory organs there were 21 deaths, from those of the tubercular order 28, from heart disease, 6, from liver diseases 5, from old age 5, and from cancer 3. The number of deaths of children under one year of age was 51, and of persons aged 60 years and upwards 18. Six inquests were held. Three deaths were due to violent causes. The Notifications of Infectious Diseases from August 6th to September 17th, were for scarlet fever 92, enteric fever 3, erysipelas 35, diphtheria 16, puerperal fever 1, typhoid fever 1, and cholera 1. The latter was not a case of Asiatic cholera. October 3rd, 1892. During the two weeks that ended on the 24th day of September, 124 births and 49 deaths were registered in the parish. These numbers indicate an annual birth-rate of 38, and an annual rate of mortality of 15 per thousand of the estimated population. The corresponding death-rate in London was 16 per thousand inhabitants. From diseases of the zymotic class there were only 3 deaths, viz. : 1 from enteric fever, and 2 from diarrhoea. Diseases of the respiratory organs caused 10 deaths, of which 6 were from bronchitis and 3 from pneumonia. In the order of tubercular diseases, phthisis caused 4 deaths and tabes mesenterica 3. The other causes of death included premature birth 4, and old age 2. liii The number of deaths of children under one year of age was 19, and of persons aged 60 years and upwards 7. Two inquests were held. One death was registered as due to " natural causes." The number of Notifications of Infectious diseases received was 92, there being for scarlet fever 59, erysipelas 22, diphtheria 8, and enteric fever 3. October 17th, 1892. During the fortnight that ended on the 8th day of October, 123 births and 58 deaths were registered in the parish. These numbers indicate an annual birth-rate of 37.7, and an annual rate of mortality of 17.8 per thousand of the estimated population. The corresponding death-rate in London was 15.8. Diseases of the zymotic class caused 9 deaths, viz. : measles 2, scarlet fever 1, diphtheria 1, and diarrhoea 5. From diseases of the respiratory system there were 9 deaths, of which 7 were due to bronchitis. Diseases of the tubercular order accounted for 5 deaths, and premature birth for 5. The number of deaths of children under one year of age was 22, and of persons aged 60 years and upwards 8. Three inquests were held. All the deaths were due to natural causes. The Notifications of cases of Infectious Diseases received from the 2nd to the 14th instant, numbered 73, being for scarlet fever 60, erysipelas 10, and diphtheria 3. The results of Analyses of the Metropolitan Water Supply undertaken by Dr. Frankland, on behalf of the Local Government Board, show that the water delivered by the five companies drawing their supply from the Thames was of good quality, considering the time of the year, and in every case, efficiently filtered. liv November 7th, 1892. Daring the three weeks that ended on the 29th day of October, 177 births and 66 deaths were registered in the parish. These numbers indicate an annual birth-rate of 36, and an annual rate of mortality of 13.5 per thousand of the estimated population. The corresponding death-rate in London was 17.8. From the chief diseases of the zymotic class only 1 death —a case of enteric fever—was registered during the three weeks. Prom diseases of the respiratory organs there were 22 deaths, viz.: 14 from bronchitis and 8 from pneumonia. Tubercular diseases caused 10 deaths, viz.: phthisis 8, tabes mesenterica and tubercular meningitis each one. There were 6 deaths from heart disease, 4 from cancer, and 2 from old age. The number of deaths of children under one year of age was 17, and of persons aged 60 years and upwards 9. Four inquests were held. Two deaths were referred to violence; one was an infant which died from suffocation, but how caused, there was not sufficient evidence to show. A fatal case of influenza with pneumonia occurred on the 16th October. The Notifications of Infectious Diseases numbered 67, viz. : scarlet fever 45, diphtheria 9, membranous croup 1, erysipelas 9, and typhoid fever 3. November 21st, 1892. During the fortnight that ended on the 12th day of November, 116 births and 53 deaths were registered in the parish. These numbers indicate an annual birth-rate of 35.6, and an annual rate of mortality of 16.2 per thousand of the estimated population. The corresponding death-rate in London was 18.5. lv The chief diseases of the zymotic class caused 5 deaths, viz.: scarlet fever 1, diphtheria 1, enteric fever 1, and diarrhoea 2. From diseases of the respiratory system there were 15 deaths, of which 7 were referred to bronchitis, and 6 to pneumonia. The other causes of death included 6 from phthisis, 3 from old age, and 2 from cancer. The number of deaths of children under one year of age was 21, and of persons aged 60 years and upwards 8. Two inquests were held. One child was accidentally suffocated in bed. The certificates relating to cases of Infectious Diseases received from the 30th of October to the 19th of November, inclusive, numbered 78, viz. : for scarlet fever 59, erysipelas 11, puerperal fever 2, diphtheria 2, membranous croup 1, and enteric fever 3. December 5th, 1892. During the fortnight that ended on the 26th day of November, 130 births and 45 deaths were registered in the parish. These numbers indicate an annual birth-rate of 39.9, and an annual rate of mortality of 13.8 per thousand of the estimated population. The birth-rate is much above, and the death-rate below the average. The corresponding death-rate in London was 18.5. No death from any of the principal diseases of the zymotic class was registered in the parish during the fortnight. Diseases of the respiratory organs caused 10 deaths, of which 7 were from bronchitis and 3 from pneumonia. From diseases of the tubercular order there were 3 deaths, from heart disease 3, and from kidney disease 4. The number of deaths of children under one year of age was 18, and of persons aged 60 years and upwards 10. Three inquests were held. One person was found drowned, lvi The Notifications of Infections Diseases received from the 20th November to the 2nd December, numbered 43. There were for scarlet fever 21, erysipelas 11, diphtheria 7, and enteric or typhoid fever 4. On the 20th October, 1890, I reported on the Laxon Street Board School that the walls of the school rooms were dirty and required cleansing, and that the closet accommodation for the boys was, in my opinion, inadequate. A copy of that report was sent to the School Board. A letter dated February 3rd, 1891, was received in reply, stating that Laxon Street School would be cleaned during the year. This was done during the summer vacation. Plans were prepared for providing an additional number of closets, and I am informed the contracts respecting the same are to be sent in to-day. The drains have lately been stopped, and when they were uncovered it was found that they had originally been constructed in a very imperfect manner. Complaint has been made by Messrs. Peek, Frean & Co. of unpleasant smells arising from the sewer gulley in Storks Road, at the side of their factory, and opposite the end of Keetons Road, and several cases of sore throat among their employes are thought to be due to this cause. When I inspected it, there was no smell arising from the gulley, and it appeared to be properly trapped. A permanent remedy would be found by carrying a ventilating pipe above the roof of the adjoining building. December 19th, 1892. During the fortnight that ended on the 10th December, 120 births and 39 deaths were registered in the parish. These numbers indicate an annual birth-rate of 36.8, and an annual rate of mortality of 12 per thousand of the estimated population. The corresponding death-rate in London was 17.7. I have again the satisfaction of reporting that no death from any of the chief diseases of the zymotic class was registered in the parish during the fortnight. lvii From diseases of the respiratory system there were 15 deaths, of which 7 were referred to bronchitis and 8 to pneumonia. In the order of tubercular diseases there was only 1 death, which was from phthisis. Two deaths were due to old age. The number of deaths of children under one year of age was 10, and of persons aged 60 years and upwards 9. Eight inquests were held. Two deaths arose from violence. Three deaths were uncertified. The Notifications of Infectious Diseases were scarlet fever 26, erysipelas 9, enteric fever 3, diphtheria 3, puerperal fever 1, and small-pox 1. The latter was removed to hospital on the same day that the notice was received. The water supplied by the Southwark Company was not efficiently filtered before delivery, being slightly turbid, and yellow when seen through a stratum two feet deep. January 2nd, 1893. During the fortnight that ended on the 24th day of December, 138 births and 53 deaths were registered in the parish. These numbers indicate an annual birth-rate of 42.3, and an annual rate of mortality of 16.2 per thousand of the estimated population. The corresponding death-rate in London was 19.5. No deaths were registered from any of the principal diseases of the zymotic class. One death was referred to influenza associated with pleurisy and pneumonia. From diseases of the respiratory system there were 14 deaths, from those of the tubercular order 10, from heart diseases 3, and from cancer 2. lviii The number of deaths of children under one year of age was 17, and of persons aged 60 years and upwards 9. Three inquests were held. Two deaths were from accidental asphyxia and one from burn. Four deaths were uncertified. Under the Public Health Act 37 certificates have been received, viz. : for scarlet fever 19, erysipelas 7, typhoid and enteric fever 4, diphtheria 6, and membranous croup 1. lix BER 15