Metropolitan Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY. For the Year 1904. BY R. K. BROWN, B.A., M.D., B.Ch., B.A.O. (R.U.I.), D.P.H. (Lond.) (Fellow of the Royal Institute of Public Health.) (Fellow of the Incorporated Society of Medical Officers of Health.) Medical Officer of Health for the Metropolitan Borough of Bermondsey. London: Frederick Shaw & Co., Printers, Dockhead, S.E. 1905. TABLE OF CONTENTS. Page. Page. VITAL STATISTICS- SANITARY ADMINISTRATION- Population 3 Offensive Trades 26 Births 4 Offensive Matter 26 Marriages 4 Milk Premises 26 Deaths 5 Cowsheds 26 Infantile Mortality 7 Slaughterhouses 26 Senile Mortality 9 Ice Cream Premises 26 Death Certification 9 Houses Let in Lodgings 26 Zymotic Diseases 9 Sec. 48 Public Health (London) Act, 1891 29 Small-pox 10 Measles 10 Disinfection 29 Whooping Cough 10 Food Inspection 29 Typhus Fever 10 Food Premises 30 Enteric Fever 10 Unsound Food Seizures 30 Simple Continued Fever 10 Food Destroyed 30 Diarrhœa 10 Bacteriological Laboratory 30 Tubercular Diseases 11 Overcrowding 31 Phthisis 11 Food and Drugs 32 Alcoholism and Cirrhosis of Liver 12 Housing of Working Classes 32 Cancer and Malignant Disease 12 Back-to-back Houses 36 Heart Disease 12 House Refuse 37 Suicides 13 Smoke Nuisances 38 Accidents 13 Other Violent Deaths 13 Customs and Inland Revenue Act 38 Public Health Legislation 38 FACTORIES AND WORKSHOPS— NOTIFICATION OF INFECTIOUS DISEASE— HomeWork 41 Bakehouses 41 Small-pox 13 Typhus Fever 14 APPENDIX—TABLES— Diphtheria 14 Scarlet Fever 15 Local Government Board Tables 43-45 Meteorology 46 Enteric Fever 16 Continued Fever 18 Marriages 46 Puerperal Fever 18 Proceedings during Year 47 Factories and Workshops 46-48 Measles 18 Chicken-pox 22 Sanitary Work 49 Notification of Phthisis 22 Food and Drugs 50-51 List of Bakehouses 52 Anthrax 24 Children excluded from School 25 Extended Table of Deaths 53 Metropolitan Borough of Bermondsey. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Bermondsey. Gentlemen, I have the honour to submit my fourth Annual Report on the Sanitary Condition of the Metropolitan Borough of Bermondsey during the year 1904. This report deals with the 52 weeks which commence on the 3rd January, and end on the 31st December, 1904. The death rate was 20.1, compared with 18.4 in 1903, the causes for this increase being explained on page 5. There have been no serious outbreaks of notifiable infectious diseases during the year, but measles was very prevalent. The subject matter will be found under the following heads, viz., I. —Vital Statistics; II.—Notification of Infectious Disease; III. —Sanitary Administration; IV. —Factories and Workshops. In the Appendix will be found the various Tables required by the Local Government. Board, along with other Tables relating to matters dealt with in the Report. A new and extended Table of the causes of death will also be found here. I wish to express my thanks to the Chairman and members of the Public Health Committee for the interest they have displayed in all sanitary matters during the year, and also to the Chief Inspector and other members of the department for the ready assistance and support they have given me on all occasions. I am, gentlemen, Your obedient servant, R. K. BROWN. I.—VITAL STATISTICS. Population. The populations of the Borough of Bermondsey and its registration sub-districts, as enumerated in the Census of 1891, 1896 and 1901, were as follow:— 1891. 1896. Estimate, 1904. 1901. Bermondsey 84,682 85,475 82,483 81,986 Rotherhithe 39,255 40,379 38,460 38,304 St. Olave's 12,723 11,731 9,817 8,897 Borough 136,660 137,585 129,187 130,760 In commenti on l ar g e changes which took place in the population between the census periods m the above table, these were attributed to the pulling down of houses in various districts for railway widening, improvement schemes and the formation of the Thames Tunnel in Rotherhithe. Buildings have been provided for the greater part of the displaced population in Abbey Street (now occupied), in Fulford Street area (partly occupied), in Swan Lane (nearly all occupied), to these have now to be added 64 tenements with a population of 344, built by the South eastern Railway in Rotherhithe New Road. For this reason I do not think that the London County Council Census for 1906 will show any marked change from that of 1901, and it is quite possible that it may show a slight increase. As, however, there is no accurate method except actual enumeration of finding out the changes m the population, we must fall back on that adopted in previous reports, viz., an estimate. This year it has been based on the Registrar General's figures for 1891 and 1901, the population being assumed to increase or decrease at the same rate as it did in the last intersensal period. In Bermondsey this works out as a slight decrease. It is on this estimated figure that the various rates m this report are calculated except where otherwise stated. To give some idea of the density of population, i.e., the number of inhabitants per acre, the following table has been prepared. The areas of each ward were kindly worked out by the borough Surveyor. It will be noticed that in calculating the density the area of the river has not been taken into account. Wards. Areas measured to centre of river. Population at Census, 1901. No. of persons per acre computed on land area. Land areas. Acres. Acres. 82,483 132 624 Bermondsey 681 14,323 181 79 Ward 1 79 14,405 137 105 Ward 2 105 15,633 101 155 Ward 3 155 16,336 116 141 Ward 4 141 11,804 137 86 Ward 5 124 9,982 172 58 Ward 6 77 38,460 51 751 Rotherhithe 899 15,508 118 131 Ward 1 164 15,046 90 167 167 Ward 2 7,906 17 453 Ward 3 568 9,817 81 162 121 St. Olave 2,250 64 35 St. Olave Ward 61 5,986 122 49 St. John's Ward 64 1,581 43 37 St. Thomas' Ward 37 130,760 87 1496 1742 Whole Borough Births. The total number of births registered in the Borough for the 52 weeks ending December the 31st, 1904, was 4,193, consisting of 2,169 males and 2,024 females. This is 463 below the average for the last ten years and 7 below the figure for 1903. This total includes 2,748 for Bermondsey, being 53 below that for 1903, and 276 below the average for the last ten years; 1,083 for Rotherhithe, being 33 below the number for 1903, and 168 below the average for the last ten years; 362 for St. Olave's, being 79 above the number for 1903 and 18 below the average for the last ten years. In Table II. of the Appendix will be seen particulars of these numbers for the last 10 years in the three registration sub-districts, and in Table I. figures for the whole Borough. The birth rate for 1904 was 32.4 per thousand persons living, which is the same rate to one decimal place as that for 1903 and 2.4 below the average for the last ten years. Particulars of the birth rate will be found in the annexed Table A. The birth rate for London is included for purposes of comparison. Table A—Birth Rates. A. Year. Rotherhithe. St. Olave's. Whole Borough. Bermondsey. London. 30.1 39.77 35.9 36.31 33.83 1894 30.5 32.43 36.04 35.9 37.63 1895 30.2 36.03 36.2 37.53 33.41 1896 30.0 38.68 35.8 37.48 31.53 1897 29.5 32.97 35.3 36.73 32.85 1898 29.4 34.55 35.2 36.67 32.38 1899 28.6 39.67 33.5 34.07 30.56 1900 29.0 32.73 34.1 35.42 31.73 1901 28.5 33.92 33.4 34.70 30.47 1902 28.4 30.83 32.4 31.12 29.10 1903 Average for years 1894-1903 36.07 31.83 35.52 34.8 29.4 27.8 40.69 32.4 33.52 28.27 1904 Taken as a whole there is no decline this year in the birth rate for the Borough, but taking the registration sub-districts Bermondsey and Rotherhithe, they show a fall of 1.7 and 2.8 per cent respectively, while St. Olave shows a rise of 30 per cent. The high birth occurred in 1904 and 53 in 1903. Were these allocated to their proper addresses the former two sub-districts would probably show the same rate as 1903. Marriages. The total number of marriages in the Borough for 1904 was 1,105, bring 4 above that for 1903 and 7 above the average for the last ten years. In Table VI. of the Appendix will be found the figures for the three registration subdistricts. These have been supplied by the Superintendent Registrar. Deaths. In Table IV. of Appendix will be found the Local Government Board tables dealing with the deaths in the Borough. Table XIV. is an extended one inserted here for the first time, giving particulars aS to age and sex distribution, and diseases. This in future years will be found very useful to anyone who wishes to obtain in a convenient form for reference, details as to any particular disease. The total number of deaths registered in the Borough during the 52 weeks ending December 31st, 1904, was 2,142, which is 169 more than in 1903, and 337 less than the average for the last 10 years. When this figure is corrected by exclusion of deaths of non-parishioners occurring in the district and the inclusion of deaths of parishioners occurring outside the district, the number is raised to 2,593. This is 211 more than in 1903 and 257 less than the average for the last ten years. The annexed table shows the distribution of deaths in quarters, together with the corresponding ponding quarters of 1903. The largest number of deaths occurred as usual in the first and fourth quarters. Comparing 1904 with the previous year it will be seen that there is a substantial increase in all the quarters except the last. The greatest increase, which is 74, appears in the third quarter, and is entirely due to summer diarrhœa. This subject will be discussed later. Table B. Quarter. Bermondsey. Rotherhithe. St. Olave's. Whole Borough. 1903. 1904. 1903. 1904. 1903. 1904. 1903. 1904. 423 48 70 689 400 179 627 First 196 Second 330 401 160 548 161 58 53 615 362 389 67 Third 182 163 51 545 619 431 Fourth 421 134 193 47 56 662 670 1523 1634 655 246 2382 Total Deaths 713 204 2593 The death rate of the Borough during 1904 was 20.1 per 1,000 living inhabitants, being 1.7 above that recorded for 1903 and 1.2 below the average for the last ten years. This is a slight increase on 1903, and an examination of Table D will show that the three registration sub-districts of Bermondsey, Rotherhithe and St. Olave's all participated in this increase. Table C.- Increase or Decrease of Diseases in 1904 Compared with 1903. Increase. Decrease. Amount. Amount. Amount. Amount. Measles 86 Bronchitis 6 Scarlet Fever 7 Cancer 6 Whooping Cough 27 Pneumonia 30 Diphtheria 1 Pleurisy 3 Enteric 5 Alcoholism and Cirrhosis of Liver 11 Typhus 4 Other Respiratory Diseases 7 Continued Fever 3 Influenza 5 Diarrhœa 86 Enteritis 8 Diseases of Parturition 9 Erysipelas 6 Venereal 1 Premature Birth 10 All other causes 9 Puerperal Fever 2 Accidents 5 Other Tubercular Diseases 49 Heart Diseases 5 Suicides 4 Phthisis 36 By adding the above figures it will be seen that the increases amount to 336 and the decreases to 125, making a balance of 211 in favour of 1903. The smaller figures are naturally accounted for by the variations which must occur in the number of deaths from year to year, but taking three diseases, viz., measles, whooping cough and diarrhœa, they make a total of 199, which practically accounts for the increase, leaving the question of bronchitis and pneumonia out of account. Against the increase of phthisis one can balance the decrease in other tubercular diseases. In column 1, at the foot of Table I. of the Appendix, will be found a list of places where the deaths of non-parishioners occurred in the district. 14 such deaths occurred in the St. Olave's Infirmary, 9 in the River Thames, 5 in the Surrey Commercial Docks, 2 in the St. Olave's Workhouse, Parish Street, 4 at South Wharf, and 1 at each of the following Globe Wharf, Rotherhithe; South BermondseyStation; S. E. & C. Ry., Rotherhithe L. B. & S. C. Ry., London Bridge; a granary in St. Marychurch Street; ss. "Grattan," River Thames; 7, Duke Street; 203, Lower Road; 91, Silwood Street; 63, Leroy Street. There were 44 such deaths registered as occurring in the Borough in 1904, against 40 in 1903. This is practically the average number. 495 persons belonging to this Borough died in outlying institutions, against 449 in 1903. The names of the various places where the deaths occurred will be found in columns 2 and 3 at foot of Table I. of Appendix. As remarked in last year's Report, these numbers show a tendency to increase owing to the greater advantages now taken of treatment in hospitals, the average for the last ten years being 427, showing an increase of 68 in 1904. Table D. —Death Rate. Rotherhithe. St. Olave's. Whole Borough. London. Year. Bermondsey. 20.35 20.1 17.4 19.10 22.20 1894 21.89 19.47 26.44 21.6 19.4 1895 20.70 22.44 21.6 18.2 1896 21.95 19.20 21.4 17.7 1897 22.22 22.54 1898 21.05 19.56 21.42 20.6 18.3 24.70 22.11 26.42 24.1 19.3 1899 23.49 22.79 22.91 23.2 18.3 1900 21.44 19.43 20.93 20.8 17.1 1901 21.66 19.30 24.62 21.2 17.2 1902 17.08 18.4 15.1 1903 18.54 22.23 21.3 17.8 Average for years 1894-1903 19.87 21.73 23.21 1904— On estimated population. 19.91 20.1 16.0 27.65 18.59 19.83 On Census population. 19.77 18.51 25.06 The following extract from the Annual Report for 1903 explains Table E. below "Since the mortality per thousand living is much greater among children under 5 and old people, and is higher at practically all ages among men, it follows that a community which has a preponderance of these elements will have ceteris paribus a higher death rate than one which has not. "The age and sex distribution of the population of England and wales being taken as a standard to all communities within their borders, the death rates of different localities can be calculated on the assumption that they have the same proportions of children under 5, old people and women, as have the population of England and Wales. By thus eliminating this disturbing factor of age and sex distribution different communities can be brought into strict comparison with one another. "In 1883 the Registrar-General commenced a method of correcting the death rates of the great towns of England and Wales. Taking account of the differences of age and sex distribution between and the latter, he has calculated a factor for each great town by which the recorded death rate must be multiplied so as to allow for the differences of age and sex, and thus places them as regards these matters on an equal footing. You thus get death rates, the differences in which can be put down to general sanitary conditions alone. In illustration of this I have taken the following rates for a table calculated on the Registrar's method by the Medical Officer of the London County Council, published in his Annual Report for 1902. "It will be seen from this that in London and the Boroughs the correction raises the death rate, showing that there is in them a preponderance of people living at ages when the death rate is low (viz., between 5 and 50), and also of women, sufficient to keep the recorded death rate down, notwithstanding the great number of children under 5." Table E.-Death Rates corrected for Age and Sex Constitution of the various Populations. Year. Factor for Correction of Age and Sex Distribution. Corrected Death Rate. Crude Death Rate. District. 18.1 1.05107 17.2 1902 London 1.03788 16.3 16.9 1902 Camberwell 1.05107 17.3 1902 16.5 21.4 Deptford 22.4 1.04684 Southwark 1902 1902 1.03375 21.2 21.9 BERMONDSEY 1.03375 18.4 19.0 1903 „ 1.0244 20.1 20.6 1904 „ Infantile Mortality. This is calculated as usual, as the number of children dying under one year of age to every 1,000 births of the same year, the reasons previously assigned for this method being the difficulty of getting the infantile population at the census. The high infantile mortality in Bermondsey and its causes have been the subject of comment in the last three Annual Report, and I am happy to be able to report this year that the Council of this Borough has at laśt taken a serious step in its endeavour to check the sppalling loss of child life here. The total number of infantile deaths in the Borough in 1904 was 723, viz., 477, 187 and 59 for the sub-divisions of Bermondsey, Rotherhithe and St. Olave's, the corresponding figures for 1903 being 657 for the whole Borough, and 453, 168 and 36 for its divisions. This gives an infantile mortality for 1904 of 172 for the Borough, the other figures being 173 Bermondsey, 173 Rotherhithe, and 163 St. Olave's. This is a very high mortality, for which the hot summer with its attendant diarrhœa is largely responsible. TABLE F. —INFANTILE MORTALITY. Bermondsey. Rotherhithe. St. Olave. Whole Borough. London. Year. Rate per 1000 Births. No. of Deaths. Rate per 1000 Births. No. of Deaths. Rate per 1000 Births. No. of Deaths. Rate per 1000 Births. No. of Deaths. No. of Deaths. Rate per 1000 Births. 147 18,604 143 451 146 161 55 114 218 724 1894 88 165 162 148 205 801 162 22,013 1895 520 193 513 160 214 159 64 153 791 159 21,695 160 1896 605 190 174 67 154 891 183 21,106 158 1897 219 485 157 169 47 132 752 158 21,931 166 1898 220 147 574 169 53 842 180 22,129 1899 187 215 166 120 526 186 205 48 817 185 158 1900 243 20,730 176 42 754 169 148 1901 497 170 215 132 19,412 149 49 153 455 678 156 18,478 139 1902 159 174 176 657. 428 179 160 156 16,978 130 1903 153 50 505 167 167 209 56 165 153 Average for years 1894 to 1903. 771 20,308 149 477 18,600 173 1904 187 59 163 723 143 172 173 On October 20th, 1904, I presented the following report on the subject to the Public Health Committee, together with a draft of suggested instructions on infant feeding. After several adjournments and reconsiderations my suggestions were finally adopted in February, 1905, with the alteration that instead of giving the leaflets, etc., to the Registrars to distribute on the registration of the birth they should be invited to send the names and addresses of infants to me, which would serve the double purpose of enabling us to send a copy of the instructions by post, and also allocate the births along with deaths to the various wards for statistical purposes. REPORT. "In commenting on the subject of infantile mortality, I pointed out in the last Annual Report, that while the general death rate showed a steady decline, the figures of infantile mortality both in Bermondsey and the country generally, unfortunately, did not point to a similar conclusion with regard to it. "In this report as well as previous ones I showed that the majority of deaths at this age could be attributed more or less directly to gastro-intestinal disorders, largely if not solely traceable to improper feeding. "As one remedy for this state of matters, it was recommended that mothers should have systematic instructions on infant feeding. "I have therefore drawn up a series of these for your consideration, and suggest that if they are adopted they should be printed on stiff cardboard so as to last. "The question of the best method of having them distributed to mothers has been under my consideration, and the first one which occurs is distribution by the Registrar of Births or by making an arrangement whereby they would supply us with the names and addresses of infants registered, by which method we would be responsible for each mother receiving a copy. From enquiries made it seems that children are generally registered within about five weeks of birth, which delay it seems to me is a drawback, because in this period a good deal of mischief may be done." "The cost would be about £18 per annum. By this method one would be assured that each mother had a copy a few weeks after the birth of the child. "Another way, either alone or in conjunction with the above, would be to supply each midwife and doctor practising in the Borough with a certain number of these cards. It would be advisable for the midwives to give these cards in all cases in which they attend, since their practice would be amongst the poorest classes, and those in which the mothers are most in need of instruction. The doctors might be asked to give them in those cases in which they think such instructions would be useful. The addresses of the midwives practising in the Borough are now or will be shortly available, since the London County Council, owing to the new Midwives Act, will have to keep a register. I am afraid, however, that this method would not prove reliable in actual practice. "Organisations in the Borough which employ district visitors, nurses, etc., might also be pressed into service for the distribution of these instructions, and in many of these could be accompanied by further verbal recommendations. This is pre-eminently a work in which the services of one or two female sanitary inspectors would prove most useful. "In order, however, that the present children in the Borough may benefit by these instructions, each family in the Borough should be supplied with one of these cards immediately they are ready." Instructions on the Feeding and Care of Infants and Young Children. Food. The natural food for children for the first seven or eight months of life is breast milk. It is BY FAR THE BEST FOOD, and NO form of artificial food is equal to it. For the first week or two the child should be fed every two hours during the day, and less frequently at night, so as to give about ten feedings in the twenty-four hours. From this period up to two months the intervals should be extended to 2½ hours during the day and longer at night, so as to give in all eight feedings in the twenty-four hours. From the end of the second month onwards the intervals should be three hours in the daytime, and the number of feeds six or seven in the twenty-four hours. About the eighth month the child should be gradually weaned, but this should not be done during the months of July, August and September, when diarrhoea is prevalent. The child should not be put on the breast every time it cries, but a little water or thin barley water, sweetened, may be given with a teaspoon. The nipples should be washed with warm water immediately before and after feeding. While nursing, the mother should live on plain diet, largely vegetable. Stout or any alcoholic drink is not only unnecessary, but frequently harmful. The best drinks for the mother during this period are milk or barley water taken about an hour before feeding time. If the mother from any cause is unable to feed the child for the whole period above mentioned she should attempt it for a shorter period, and if she has insufficient milk she should try to feed the child twice or three times a day, and supplement this by artificial feeding as directed below. If the mother is unable to nurse the child at all, some form of artificial feeding should be resorted to. This should consist of milk for the first seven or eight months, and the best for this purpose is COWS'MILK (NOT SKIMMED OR SEPARATED). This should be given warm, diluted with water, or barley water, in the proportions as mentioned in the table. A lump of white sugar or a teaspoonful of sugar of milk, and a teaspoonful or two of limewater should be added to each feed. Feeding Table. Age of Child. Barley Water. Total Amount each feed. Milk. No. of Feeds in 24 hours. Tablespoonfuls. 3 During first fortnight 1 2 10 2 3 5 9 „ second „ 2½ 6 8 „ second month 3½ „ third „ 4 4 8 7 5 4 9 7 „ fourth „ 7 4 11 „ fifth „ 6 „ sixth „ 8 12 6 4 9 13 6 „ seventh „ 4 „ eighth „ 10 4 14 6 12 4 16 6 „ ninth „ Pure milk 16 and upwards Over twelve months The above quantities are suited to .the size and capacity of the stomach of a child of average size, and SHOULD NOT BE EXCEEDED except in the case of exceptionally big children. The feeding bottle with the long tube should on no account be used, since it is impossible to keep the inside of this tube clean and with it children are liable to be given too much. The best bottle is the boat-shaped pattern with nothing but a teat. This should be scalded, immediately after feeding, with water to which a little washing soda has been added, and kept when not in use along with the teat lying in plain water which has been boiled. After the eighth month the child may begin to have its milk thickened with a little oatmeal once or twice a day made so that it can pass easily through the teat of the bottle. Foods which contain starch, such as arrowroot, rice, bread and oatmeal, should not be given before this period as the child's stomach cannot possibly digest them earlier. At ten months a litle bread and milk, bread and butter, or milk pudding may be given. At twelve months a little mutton broth, gravy mixed with mashed potatoes, porridge and milk, a lightly boiled egg and milk to drink, and at eighteen months a little fish, fowl or meat, may be added to the diet. During the summer months the milk should be boiled immediately it is received from the milkman. If cows' milk is found to disagree, condensed milk may be tried for a short time, but should not be continued. A whole milk brand should always be chosen, and the cheap forms of "separated" or "skimmed" milk should NEVER BE USED for feeding children, as there is little or no nourishment in them. Once a tin is opened it should be carefully recovered and kept in a cool place until it is used again. Children should have their meals regularly and at not too long intervals. They should not be allowed to eat between meal times. WINES, SPIRITS, BEER, TEA, COFFEE, CAKES, OR SWEETMEATS SHOULD NEVER BE GIVEN TO INFANTS. They must not have the ordinary food of parents, and condiments such as mustard, pepper, etc., should be avoided. Clothing. Children should wear flannel next to the skin, and all clothing should be warm and light. The legs and arms should not be exposed. Stiff binders put on with the idea of "supporting" the child should not be used. Anything which injures the free movements of the body, and especially of the lungs, should be avoided. PARENTS ARE SPECIALLY REMINDED OF THE GREAT DANGER OF FLANNELETTE CLOTHING COMING IN CONTACT WITH FIRE. Air. Children should be trained to sleep in a room with the window open, and the sleeping room should be well flushed by opening wide all the windows and doors two or three times a day. Sleep. Babies and young children require at least twelve hours' sleep, and should be put to bed early. They should never sleep in the same bed as their parents, BUT FROM BIRTH SHOULD HAVE A SEPARATE COT. If this cannot be afforded, an orange box or clothes basket will do just as well. In this way only can so many deaths from suffocation due to overlaying be avoided. Washing. The child should be washed all over every day with soap and warm water. Plain yellow soap is the best. How to prepare Barley Water. Take a teaspoonful of pearl barley and scald it. Then place it in a pint and a half of clean water and simmer gently down to a pint—strain. It should be made twice a day. How to prepare Lime Water. Take a piece of quicklime about the size of an orange and slake it by pouring a little water on it. Then place it in a gallon jar, fill up with water, and cork. Shake it and allow it to settle for twenty-four hours. Pour off the top what is required, and fill up again with water. The jar must be kept tightly corked as the lime water soon becomes spoiled by exposure to the air. Senile Mortality. The number of deaths over 65 years of age in 1904 was 478, against 396 in 1903. The increase here is principally due to bronchitis and pneumonia. Death Certification. There were five deaths uncertified in 1904, the corresponding figure for 1903 being also five. Zymotic Diseases The following table gives the death rates for the principal zymotic diseases. Corresponding figures are given for London for comparison. Table G. Simple Continued Fever. Diarrhœa. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Year. All Causes. Principal Zymotic Liseases. Small-Pox. Measles. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. 71 18 .13 - 77 .31 100 .73 .52 .00 1894 2766 449 139 42 1 20.1 - .56 3.27 1 .00 1.01 .27 - .16 - 127 .92 21.6 .17 .46 37 - 22 1895 2966 2.99 .00 136 .99 24 64 - 411 1 100 .73 - .17 - .94 35 .79 1.06 24 1896 2968 21.6 542 3.95 - 129 .25 108 146 - - - .62 .12 - 188 1.38 .76 .43 .64 16 1897 2902 21.4 537 3.95 - - 103 58 85 87 - - - .79 .08 106 20.6 375 97 .72 30 .43 73 .54 - 11 - 1898 2776 2.79 - .22 58 - - - 120 .90 92 .69 23 .17 .97 43 .32 2 .01 31 .23 - 1899 3204 440 3.31 - - 129 - 24.1 .28 117 .89 .11 .67 - 37 - 1900 3062 23.2 437 3.32 - 87 .66 14 88 94 .71 - - - .27 .16 133 1.0 .42 - - 22 5 .03 2719 20.8 387 2.96 14 .10 76 .58 45 .34 36 56 1901 .49 .09 88 .68 1.19 .14 .22 64 - - 12 - 21.2 396 .24 154 18 29 - 1902 3.06 31 2756 .32 103 .80 .14 41 4 .03 11 .09 - 251 1.96 - 50 .39 25 .19 18 - 1903 2382 18.4 - 422 3.16 .03 106 31 71 .7 .00 20 .5 0.00 .53 .86 Average for years 1894-1903. 2850 21.3 4.7 .79 .23 71 .53 .15 116 1.46 3.46 .13 .02 189 2593 447 - - 16 3 20.1 136 17 .13 1904 - 1.05 18 .14 68 - .53 - .00 74556 286 .06 6 4751 London 1904 9907 365 723 - 1.02 16.0 2.13 25 2256 .48 .08 .15 .00 1495 .32 Taking the figures for small-pox, scarlet fever, diphtheria, enteric fever, and simple continued fever, they amount to 54 deaths in 1904 compared with 58 in 1903. These are diseases which are much more under control than any other. The increase is solely to be found in measles, whooping cough, and diarrhœa, the number of deaths for these being 393 in 1904 and 194 in 1903 The subject of the control of these will be discussed under the head of Notification of Infectious Disease. Small-pox. There were no deaths from this disease in Bermondsey in 1904. Measles. There were 136 deaths due to this disease, which is 30 above the average for the last 10 years, and 86 above the number in 1903. The deaths occurred in quarters as follow:-viz., 22, 68, 15 and 31. In contrast to 1903, in which the majority of the deaths occurred in the first quarter, the largest number occurred in the second quarter. Whooping Cough. 68 deaths were attributed to this cause against 41 in 1903; of these 35 occurred in the first quarter, and 21, 4 and 8 in the other quarters respectively. Typhus Fever There were no deaths from this cause in 1904. Enteric Fever. 16 deaths were due to this cause, viz., 8 in Bermondsey and 8 in Rotherhithe. This is 5 more than occurred in 1903. Simple Continued Fever. 3 deaths were attributed to this cause. This heading is kept in the notification form and death returns, so that the possibility of overlooking enteric fever may be obviated and preventive measures not be neglected. Diarrhœa. Under this head are included: — Epidemic enteritis. Zymotic „ Epidemic or summer diarrhœa. Dysentery or dysenteric diarrhœa. Choleraic diarrhœa, cholera, and cholera nostras (in absence of Asiatic cholera). 189 deaths were due to this cause in 1904, 122 for Bermondsey, 49 for Rotherhithe, and 18 for St Olave's. This is a very high figure, the highest in fact during the past eleven years. There were 188 deaths in 1897, which is the nearest approach to this. Taken in age periods the deaths under one year were 148, between one and five 35, and over five b. It is thus evident that it is practically confined to infants and those of tender years. As mentioned in previous reports it is a disease due to contamination of food, more especially milk, by a special microbe or microbes (because the special cause in each case may not be exactly identical, but undoubtedly all belong to similar species), and the view is finding general acceptance that it is contagious in the same sense as typhoid fever, cholera and other diseases connected with the intestines, i.e., that if a case occurs in a family that the infection of the excreta gets on to the hands of those attending the patient, soils various articles in the house, possibly gets dried and thrown about 11 or carried by flies, and thus contaminates food, leading to other cases in the same house and neighbourhood. It has been long known that there is a close connection between the heat and dryness of the summer, the height to which the temperature of the earth attains 3 or 4 feet below the surface, and the occurrence of diarrhoea. These conditions, as one time supposed, are not the direct cause, but act as factors favouring the growth and propagation of the specific cause above-mentioned. An examination of appended Table H. illustrates this point very well. The temperature and rainfall here are the mean of each week during the diarrhoea period. Taking the air temperature first it is evident that the summer of 1904 was much hotter than 1903, and this contrast is much more marked in the 3-foot thermometer. A glance at the rainfall is also sufficient to show the difference between the two years in that respect. Wet acts in a double way, firstly, by flushing and keeping the streets more or less damp ; and secondly, by keeping down the temperature. The former is probably the more important function. TABLE H. Weeks. Deaths from Diarrhoea. Temperature of the Air. Temperature of ground 3 feet below surface. Rainfall. 1903. 1903. 1904. 1904. 1903. 1904. 1903. 1904. July 0 0 0 0 ins. ins. 67.1 61.39 0.04 10 60.5 63.58 3.18 3 61.07 1.52 1.83 10 58.6 65.4 64.23 6 August 0.35 0.08 61.2 68.1 60.70 64.53 3 25 59.5 60.87 2.11 0.06 61.0 64.62 2 20 58.3 0.47 59.5 60.49 63.26 1.11 8 29 1.23 0.22 58.1 57.6 59.83 61.58 5 23 September 62.9 61.0 60.69 61.37 0.86 1.01 6 17 53.7 57.0 60.53 60.57 0.55 0.36 9 8 57.98 0.01 51.7 56.4 59.29 0.24 4 5 0.20 59.3 53.6 57.87 58.13 0.22 7 9 59.3 52.1 58.72 56.72 0.81 0.14 6 5 October 54.9 50.3 58.33 56.03 1.05 0.86 9 1 1.39 52.0 47.8 56.44 54.46 0.02 6 6 54.9 0.43 2 49.3 54.80 53.74 0.60 3 Weekly average 57.1 58.0 59.26 60.15 0.42 5 1.06 12 In Table I. confirmation of these views can be seen in that breast-fed children are much less frequently attacked than those artificially so. The reason is obviously that the milk in the former is not open to contamination to anything like the same extent as in the case of the latter. I hope in the future to see some improvement in the diarrhoea mortality from the instructions on infant feeding, but education in these matters is slow, and too much must not be expected at first. TABLE I.—DEATHS FROM DIARRHCEA. Year. Cases Inquired into. State of Premises. Family. Method of Feeding. Overcrowding. Good. Fair. Clean and Careful. Dirty and Improvident. Breast. Artificially. Partialy by Both Methods. Defective. 1901 74 49 23 2 4 59 - 70 13 2 1902 40 21 18 1 1 37 3 6 33 1 1903 40 15 22 3 38 8 29 2 3 - 1904 115 55 54 6 101 14 16 82 17 - 23 43 203 23 1 Total 269 140 117 12 246 Tubercular Diseases. The number of deaths due to all forms of tubercular diseases in 1904 was 350, against 363 in 1903. This figure comprises 226 for Bermondsey, 89 for Rotherhithe, and 35 for St. Olave's., Of the 350, 257 were due to phthisis, and 93 to other tubercular diseases, that is, there was an excess of 36 deaths from the former over those in 1903, but 7 less than the average during the last ten years, and a decrease of 49 in tubercular diseases other than phthisis, compared with the number in 1903. Phthisis. In Table J will be found particulars of deaths of phthisis since the year 1894; 257 deaths occurred from this cause, which is an excess of 36 over 1903. 12 Judging from the increase in bronchitis and pneumonia in 1904, as compared with 1903, it was seen that the former was more fatal to persons with lung complaints, and that as a consequence a certain number of patients with phthisis were carried off who might have survived longer had the winter been milder. The subject of phthisis is again reverted to under Notification:— TABLE J. PHTHISIS. BERMONDSEY. ST. OLAVE'S. WHOLE BOROUGH. LONDON. SUB-DIST. ROTHERHITHE. Year. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. 1894 2.21 66 1.65 32 2.65 286 2.08 7334 1.69 188 1895 190 2.22 76 1.89 32 2.69 298 2.16 7742 1.77 176 2.06 90 2.23 26 2.24 292 2.13 7567 1.68 1896 1897 174 2.05 64 1.60 33 294 271 1.99 7629 1.71 1898 184 2.19 74 1.87 25 2.31 283 2.10 7746 1.72 1899 183 2.19 75 1.92 28 2.68 286 2.15 8275 1.82 169 2.04 47 1900 1.21 29 2.88 235 1.78 7809 1.71 1901 150 1.82 57 1.48 19 1.95 226 1.73 7514 1.66 163 1.98 55 1.43 21 2.22 239 1.83 7424 1.62 1902 1903 1.47 1.79 56 1.46 18 1.96 221 1.70 7124 1.54 Averages for years 1894-1903. 172 66 1.67 26 2.45 264 1.96 7616 1.69 2.05 165 2.02 60 1.57 31 3.48 257 7526 1.62 1904 1.99 Alcoholism and Cirrhosis of the Liver. Thirty-nine deaths were attributed to these causes against 28 in 1903. In these the death could be directly traced to alcoholic beverages, but were all those deaths in which such beverages are an indirect cause enumerated, the figures above-mentioned would require to be very largely increased. Cancer and Malignant Disease. There were 92 deaths from this cause, 86 of which were due to carcinoma, or cancer as it is ordinarily understood, and six of which were due to sarcoma, an equally malignant form of tumour, but one which attacks bones and connective tissue as distinguished from skin, and usually occurs in younger people. The corresponding figures for last year were 108, including 104 carcinoma and 4 sarcoma. TABLE K. CANCER. DEATHS DURING 1903 AND 1904. Forms of the disease. Sex. All ages. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards Male. Female. Male. Female. Male. Female. Male. Female. Male. Female. Male. Female. Male. Female. Male. Female. Male. Female. Cancer of rectum 21 ... ... ... ... ... ... ... 1 4 6 3 2 1 2 ... 1 1 ... Cancer of stomach 33 ... ... ... ... ... ... 2 2 5 ... 8 4 4 6 1 1 ... ... Cancer of bowel 10 ... ... ... ... 2 1 ... ... 2 3 ... 1 ... ... 1 ... ... ... Cancer of liver 20 ... ... ... ... ... ... ... ... 1 1 2 5 2 4 1 3 1 ... Cancer of breast 18 ... ... ... ... ... 1 ... 5 ... 6 ... 4 ... 1 ... 1 ... ... Cancer of female pelvis and uterus, etc. 40 ... ... ... ... ... 4 7 ... 10 ... 15 ... ... 1 ... ... 3 ... Cancer of oesophagus 11 ... ... ... ... ... ... 2 1 3 ... 3 1 ... 1 ... ... ... ... Cancer of mouth, tongue and pharynx, cheek and lower jaw 17 ... ... ... ... ... 3 4 ... 5 2 2 ... ... 1 ... ... ... ... Cancer of peritoneum 3 ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... 2 ... Cancer of other parts 14 ... ... ... ... ... ... 1 1 2 ... 4 3 3 ... ... ... ... ... Malignant disease, kind not stated. 3 ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... Sarcoma 10 2 1 1 ... ... ... 2 1 1 ... ... 1 1 ... ... ... ... ... TOTALS 2 1 1 ... 2 8 18 19 28 29 37 17 2 11 1 1 200 6 17 In this table the two years 1903 and 1904 are taken together. It will be seen from this that there are 190 deaths due to carcinoma, of which 116 were females and 74 were males. The preponderance of females is due to their tendency to cancer of the breast and uterine appendages. Of the 10 deaths from sarcoma 7 were male and 3 female. Heart Diseases. 154 deaths were due to this cause, which is 5 deaths below that for 1903, and 3 below that for 1901 and 1902. These numbers refer only to organic or valvular diseases of the heart. Suicides. 11 persons belonging to the Borough committed suicide in 1904, viz., 1 by poison, 6 by hanging, 1 by drowning, 1 by firearms, 1 by knife, and 1 by jumping from height. Accidents. 103 deaths were due to this cause against 98 in 1903, and 108 in 1902. Particulars will be found in the large table of deaths in the appendix. Other violent deaths. There was one death from homicide by stabbing in the neck. II—NOTIFICATION OF INFECTIOUS DISEASE. In Table III. of Appendix will be found full particulars of the diseases notified in Bermondsey during the 52 weeks ending December 31st, 1904. This year I have to report a slight increase in the notification of infectious disease. the increase, however, is not sufficiently large to invalidate the statement that the diminution which was reported in 1903 is still maintained, and is probably to be explained by the ordinary variations which occur from year to year. The number of cases notified in 1904 (exclusive of chicken-pox) was 926, and including this was 1,220. The corresponding total for 1903 was 867 (chicken-pox not being notifiable), showing an increase of 59. The diseases which showed an increase were small-pox (12), diphtheria (19), erysipelas (5), scarlet fever (51), continued fever (1) ; and those which showed a decrease were membranous croup (2), typhus (18), enteric (3), relapsing fever (1), puerperal fever (5). The numbers in the registration sub-districts (exclusive of chicken-pox) were Bermondsey 569 against 575 in 1903, Rotherhithe 308 against 186 in 1903, St. Olave's 49 against 106 in 1903. It would thus appear that there has been a slight diminution of infectious disease in Bermondsey, a large diminution in St. Olave's, and a considerable increase in Rotherhithe. In this latter scarlet fever accounts for practically all the increase, the numbers for 1904 being 163, and for 1903, 71 —less than half. The attack rate of these diseases per 1,000 inhabitants, excluding chicken-pox, is 7'2 for the whole Borough, the rate for the sub-districts being 6.9 Bermondsey, 8.0 Rotherhithe, and 5.5 St. Olave's. The corresponding figures for 1903 were 6.7 whole Borough, 7.o Bermondsey, 4.8 Rotherhithe, and 11.5 St. Olave's. Forty-one cases of the above were returned from hospital as not suffering from the diseases for which they were notified. Although strictly speaking these should be deducted to give a net result, for the reasons mentioned in previous reports they probably more nearly represent the true number of cases occurring. Small-pox. There were 19 notifications of small-pox during the year, of which 18 were genuine cases, and one was returned as not being small-pox. This small percentage of wrong diagnosis was largely due to the appointment by the London County Council of two experts, Messrs. Wanklyn and Bingham, both of whom had a large and recent experience of small-pox. There were no deaths. The following are particulars of the individual cases: — (1) February 3rd.—C.W., 25, male, Temeraire Street.vaccinatined infancy. Convalescent when notified. (2) February 3rd. —A. S. W., 23, female, wife of above. Vaccinated in infancy. (3) February 3rd. —C. J. W., 5 weeks, male, son of above. Unvaccinated. The history of infection in this family is very interesting, and illustrates the value of intercommunication between Medical Officers of Health where " contacts " are concerned. The following is the report transmitted to the Public Health Committee : — " On February 2nd I received a letter from the Medical Officer of Health, Wandsworth, confirming a telephone message on the previous day, that C. R., 27 years (m), had been removed from a house in Wandsworth suffering from small-pox. It appears he had been a resident at Albion Street, Rotherhithe, until January 19th, when he went to a situation in Wandsworth. He fell ill on January 28th, and the rash appeared on the 30th. On January 31st he visited Albion Street, and remained there all day. He went back to Wandsworth on February 1t, on which day he was removed to hospital. " I ascertained that this patient's sister lived in Temeraire Street, and that there had been cases of chicken-pox in her family. I visited this house and found that C. W., her husband, fell ill on January 7th, and was attended by a medical man for chickenpox. On January 18th, the baby, 4 weeks old, fell ill with what was diagnosed by the same medical man as chicken-pox. On January 21st the mother seems to have taken ill, and had a few spots on her face. I may say the history of the illness in none of these cases was suggestive of small-pox, but, on examining the child, I found there were abundant scars on the hands, feet, body and face, and on the face and head and parts of the body there were numerous scabs. " From these appearances I diagnosed that the case was one of small - pox and after consultation with the medical attendant, agreed to send the mother and child to hospital, where they have been detained. The father and mother have been vaccinated, but the baby has not. Since writing above I have examined the husband, C. W., and from the appearance and distribution of the scars am of opinion he has recently recovered from small-pox. (4) March 27th.—G. W., 17 years, male, Southwark Chambers, Tooley Street. Unvaecinated Fell ill March 21st, rash appeared March 26th. His length of residence on the day of notification was four days. Source of infection probably a lodging house in East Smithfield, where several cases had occurred previously. (5) April 9th— P. D., 33, male, Southwark Chambers. Fell ill April 7th, rash April 9th. Vaccinated in infancy. Source of infection previous case. (6) April 18th.—C. O'L., 21, male, Southwark Chambers. Fell ill April 7th, rash April 10th. Vaccinated in infancy. Source of infection case (4). (7) April 12th.—W. J., 19, male, Eugenia Road, Rotherhithe. Vaccinated in infancy. Fell ill April 7th, rash April 10th. Source of infection unknown. (8) April 25th.—S. J., 46, female, mother of (7). Vaccinated in infancy. Fell ill April 22nd, rash April 23rd. Source of infection case (7). (9) April 26th.—J. M., male, Southwark Chambers. Vaccinated 6or 7 years previously. Returned not smallpox. (10) April 29th — E. D., 9 years, female, Raymouth Road. Vaccinated in infancy (stated unsuccessfully) Fell ill April 23rd, rash April 25th. Source of infection unknown. (11) May 9th —W. J. W., 46, male, Southwark Chambers. Vaccinated in infancy. Fell ill May Ist, rash May 6th, Source of infection unknown. Had been i months resident here. (12) May 21st. —H. E., 28, male, Abbey Street. Vaccinated in infancy. Fell ill May 18th, rash May 19th. Sonrce of infection unknown. (13) May 22nd. — E. R., 39, male, Southwark Chambers. Vaccinated in infancy. Fell ill May 20th, rash May 23rd. Source of infection case (11). (14) May 24th.- J. G., 34, male, Alscot Road. Vaccinated in infancy. Fell ill May 19th, rash May 21st. Source of infection doubtful, was acquaintance of (12.). (15) May 24th. —J. M., 31, male, Southwark Chambers. Vaccinated in infancy. Fell ill May 23rd, rash May 24th. Source of infection (11). (16) June 6th.- G. G., 16 years, male, Lockyer Street. _ Vaccinated in infancy. Fell ill June 4th, rash june 6th. Source of infection: This patient's sister was in contact with a girl who was removed to hospital with small-pox from an address in Southwark. (17) June 17th.- R. G., 26, female, Abbey Street. Vaccinated in infancy. Fell ill June 6th, rash June 8th. Source infection unknown. (18) June 17th.- E. G., 27, male, Abbey Street. Vaccinated in infancy. Source of infection (17). (19) June 17th.- R. H. G., 1½ years, female, Abbey Street. Unvaccinated. Fell June 16th, rash not developed when sent to hospital on 17th, but did so the following day. Source of infection (17)." All the above cases were removed to hospital on the date of notification, i.e., the first date mentioned. Disinfection was carried out immediately on removal and vaccination recommended. Exclusive of the cases which occurred in Southwark Chambers, which is a common lodging house, there were 31 contacts kept under close observation till the incubation period was passed, 4 of these were stated to be unvaccinated, 15 were vaccinated, 1 had had small-pox, and about 11 there was no information. Of these 3 developed small-pox, viz., cases (8), (18) and (19). Two belonged to Camberwell but did not develop the disease. The London County Council kept a very close watch on the Southwark Chambers, which are capable of accommodating upwards of 500 lodgers. The average number of lodgers on the night previous to the notification of the various cases was 395. 349 contacts were vaccinated and none of these showed any symptoms of smallpox. The premises were visited every morning by the special inspector of the L.C.C., and during the day by our inspector and all suspicious cases were immediately sent to bed and isolated till one of the London County Council small-pox experts pronounced an opinion on them. Judging from the small number of contacts who developed attacks the poison does not appear to have been as virulent as that in 1901 and 1902, but this is what one may expect from the history of previous epidemics of small-pox and other infectious diseases which goes to show that towards the end of an epidemic the cases are usually of a much milder type since the poison appears to " wear itself " out. Typhus Fever. There were no notifications of this disease during 1904. Diphtheria. There were 191 cases of diphtheria notified in 1904, of which 123 occurred in Bermondsey, 60 in Rotherhithe and 8 in St. Olave's. This shows a slight increase on 1903 when the figures were 172 for the Borough, and 115, 38 and 19 for Bermondsey, Rotherhithe and St. Olave s respectively. The increase is so small that one may practically state that the decrease for 1903 is still maintained when the figures were 329 for the Borough. DIPHTHERIA SCARLET FEVER There were 17 deaths, making a case mortality of 8.9 per cent. in 1904, against 10.5 per -cent, in 1903. This is a strikingly low mortality and this is principally due to the introduction of antitoxin. Previous to its introduction the mortality was about 20 per cent. The accompanying chart shows that the notifications were pretty evenly distributed throughout the year, and that there was an absence of special outbreaks. 25 cases were returned from hospital not suffering from the disease. This number of cases returned is largely due to the general practitioners not taking advantage of the facilities afforded for free bacteriological examination of swabs, etc. Of the 20 specimens sent in by medical practitioners and examined with positive results before being sent to hospital, 2 cases were returned. One of these cases occurred in Guy's Hospital where it was bacteriologically examined, and the other was examined here. I examined the Guy's specimen which was a very typical example of diphtheria bacilli. In my opinion these were both cases of genuine diphtheria, and the hospital made a mistaken diagnosis because they did not find the bacilli. In such cases one positive result is more valuable than two or three negatives. During the year the plan of examining school contacts, inaugurated the year previously, was continued with useful results. This was outlined in my last annual report and I reproduce it for the information of the Council. " On the notification of a case of diphtheria the Inspector visits the house and sees that the necessary precautions of removal, disinfection, etc., are duly carried out. He then requests the parents to send up those .children attending school to the Town Hall during the second week after the removal of the case, to have their throats examined by the Medical Officer. If no diphtheria bacilli are found the headmaster and parents are notified that the children may return to school at once, but if they are found a request is sent to the headmaster to exclude them till further examination. The parents are at the same time notified of this and asked to bring the children to their medical attendant for an antiseptic gargle and requested to bring them up for a second bacteriological examination in 14 days. " If, of course, any of these ' contacts ' at the time the inspector calls or during the subsequent period develop sore throats the parents are advised to call in their medical attendant at once." The only alteration in this was sending an additional notification of the result of the examination to the Divisional Superintendent of the schools so that the school visitors should know the result at the same time as headmasters. The method here described has worked very satisfactorily during the year, and no difficulty has been experienced in getting parents to have their children examined, especially when the advantages of early knowledge of the commencement of an attack was explained to them. The number of contacts examined for school attendance was 145, belonging to 60 families. Out of this number 11 had diphtheria bacilli in their throats, and of these 4 subsequently showed symptoms of diphtheria and were removed to hospital. This is a smaller number than 1903, when the number of infected children was 20, 16 of whom developed the disease. One contact was examined for bacilli with a negative result, but he was removed subsequently to hospital with laryngeal diphtheria. The bacilli were evidently confined at the time of the examination to the larynx, which cannot be reached by an ordinary throat swab. Those contacts which had the bacilli in their throats but no clinical symptoms of diphtheria were advised to have an antiseptic gargle, and were not allowed to attend school till a subsequent examination of the throat, at an interval of 14 days, showed them to be free from infection. Many experts consider that there ought to be at least three examinations of the throats of convalescents and "contacts " before they can be considered free from diphtheria bacilli, but that is not practicable in a district of this kind where the children come to the laboratory. I am still of opinion that this method is a very valuable safeguard against the introduction of the disease in question into public elementary schools. Scarlet Fever. There were 451 notifications of scarlet fever, 268 for Bermondsey, 163 for Rotherhithe and 20 for St. Olave's. This is an increase of 51 for the Borough on the figure for 1903, the only decrease in the sub-districts being St. Olave's, which had 70 cases in 1903, owing to the outbreak in Parish Street Workhouse. Eight cases were returned from hospital as not suffering from scarlet fever. Looking at the chart of the notifications, it will be seen that they remained fairly constantly between 5 and 10 per week with two exceptions, viz., the middle of June, when there were 18 cases in one week, and during October and the first week in November, when the cases went above 20. This is a normal scarlet fever curve for London, since a curve taken on the mean of 40 years shows a seasonal maximum during the months of October and November and a minimum in March and April. In 1903 the maximum was in March. Out of the 451 cases notified there were 18 deaths, making a case mortality of 3.9 per cent. This is much lower than 1903, when it was 6.25 per cent., and slightly above that for 1902, which was 3.7 per cent. This indicates that the cases were of a milder type than 1903. From a good many cases which I had the opportunity of visiting in consultations I can confirm this. The attack rate per 1,000 living was 3.49, compared with 3.08 in 1903. In 53 cases the source of infection was attributed as follows: — Previous cases in house or family 31 From friends (visiting) 5 " Return " cases 15 Playmates 2 In addition to the above, in 10 cases there was history of sore throats in the family previous to the case of scarlet fever, but there was no proof that these originated the scarlet fever or, in other words, that they were mild cases of that disease, and in 8 cases there was a history of a patient having returned from hospital recently in the same building or street. In these cases the connection between the returned case and the fresh case was too indefinite to draw any conclusion. By " return " case referred to in above table is meant a case caused by a return into a family of a case recently convalescent from scarlet fever. These cases have been the subject of a great deal of investigation. The first investigation on a large scale was by Professor Simpson on behalf of the Metropolitan Asylums Board. This was followed by another by Dr. Cameron in the same connection, the results of which for some reason or other have not been yet published by the Board. More recently, the matter has been investigated by Dr. Newsholme, of Brighton, who has the advantage of being both Medical Officer of Health and Medical Superintendent of the fever hospital of Brighton. When this source of infection was first brought into prominence, it was thought to be a hospital phenomenon, and it was surmised that on cases being sent to hospital they returned home in a more infectious condition than if they had been nursed at home, i.e., that if a mild case, which would soon get rid of the infection, is put into a ward along with severe cases it harbours the infection of the severe case in its throat or nose; this aggravates the inflammation in these parts, so that when the case is sent home it immediately infects others. Different plans have been tried from time to time to obviate this, such as keeping the convalescent children in wards by themselves for some time before sending them out, sending them away to convalescent homes and treating mild and severe cases in separate wards. Notwithstanding all these efforts " return " cases still occur and will probably continue to occur until the infective microbe of scarlet fever has been discovered and a ready method of proving its presence or absence has been found. Unfortunately there are at present no reliable statistics on "return" cases in private practice, though such do undoubtedly occur. The whole matter, is still sub judice, and at the present time the opinion seems to be that the source of infection in these cases is not the peeling, but that the poison lingers in the throat, the crypts of the tonsils and other hollows or sinuses of the nasal passages and that under certain conditions, as the occurence of sore throat, cold, nasal catarrh, in the patient, it again becomes active and liable to infect others. In the cases which occurred in Bermondsey this is borne out by the fact that in no case did the parents state definitely that they found a discharge from the nose or ears when they went to the hospital for the child, and that in those cases in which a discharge occurred it came on after the child had been home some time. In one case infection appeared to be caused by a small abscess in the tear duct, which burst a couple of days after the return of the patient. In some cases no discharge of nose or ears was visible at any time in the case which was supposed to cause the infection. The percentage of these "return" cases to the total notifications is small in any case, the numbers being, 1901, 3 per cent.; 1902, 2.2 per cent.; 1903, 1.5 per cent., and 1904, 3.3 per cent. Whatever will be found to be the ultimate explanation, I am quite convinced that it is not due to carelessness or premature discharge from the Board's hospitals, and that the Medical Superintendents are doing everything in their power to prevent their occurrence. Extra precautions were taken by me during 1903 to prevent the occurrence of these cases. The Board, at the request of the Society of Medical Officers of Health, furnish us with the names and addresses of patients about to be discharged from their hospitals, a day or two before they are sent out, and I am in the habit of sending by post a letter, advising that the patient should not be sent to school for 14 days after return, that he should sleep alone, and during the day be in the open air as much as possible. Enteric Fever. 73 cases of this disease were notified in 1904, being 42 for Bermondsey, 29 for Rotherhithe, and 2 for St. Olave's. This is a slight diminution on 1903 when the number notified was 76. of the 73 cases notified, 7 were returned from hospital as not suffering from that disease, making the actual number of cases 66, which is one more than the actual number in 1903. On inquiries being made by the inspectors the sources of inspection attributed mostly by the patients were as follow : — (a) 1 patient had eaten oysters recently. (b) 1 „ mussels and whelks. (c) 2 „ cockles. (d) 3 „ fried fish. (e) 1 " tinned salmon. (f) 1 " frequently went to Borough Market, where he obained quantities of unwholesome fruit. (g) 1 „ complained that at Whitechapel Station where he is employed the platform became foul with the liquid from fish trunks. (h) 8 attributed to previous cases. (i) 3 „ a doubtful illness occurring in the house before, which may have been a mild form of enteric. ENTERIC FEVER With regard to the majority of the cases a source of origin could not be suggested, and even in the above table one can only speak with any certainty in those marked (b), (h) and (i). In (b) W. G. S., of St. James' Road, was taken ill June 21st, 1904. Three weeks previously he had eaten some mussels and whelks from a stall at New Cross Gate. Within an hour of eating these he was taken ill with what was evidently ptomaine poisoning, and had some difficulty getting home. He, however, did not completely recover from this before symptoms of enteric developed. There is no doubt in my mind that these shellfish were contaminated with the bacteria which produced these symptoms as well as those of enteric later. In the case of (h) the following is the Report to the Public Health Committee in October :- "In one house in St. Helena Road, 9 cases have occurred. The following are the names, ages, and dates on which they fell ill :— Date Notified, 1904. Name. Age. Fell ill. Sept. 6 John J. Bernell 51 Aug. 20 „ 12 Phoebe „ 19 Sept. 9 „ 12 Lily „ 6 „ 9 „ 12 Rose „ 4 1/1 ½ „ 12 Oct. 4 George „ 10 „ 30 „ 6 John Rabjohns 4 Oct. 4 „ 6 Alice Bernell 43 „ 3 „ 12 Lottie „ 12 „ 8 „ 12 John J. „ 12 „ 8 "This is evidently an outbreak in which there was no common source of infection for all the cases, but in which one case became infected from another. The father, John James Bernell, was a week in the Infirmary before the nature of his disease was discovered, and the three cases on September 12th evidently acquired their infection from him. On October 4th another case occurred, at which time I visited the house and discovered that the mother and another child were ill with the disease. they were removed to the hospital, and the three smallest children taken into the Council's shelter, the other two members of the family and the lodgers refusing to come in. In the shelter two further cases occurred, viz., Lottie and John Bernell. They evidently received their infection from the mother, who had been ill some little time before removal. The father is the only death which has occurred so far. " The house has been thoroughly cleansed and disinfected, and the drains are in good order. The origin of the first case is obscure. He was in the habit of getting fish from a shop in Derrick Street, but there is no reason for suspecting that this was the source of infection." The next report refers to (i) : — " There have been three cases of enteric fever recently in connection with a house in Pages Walk. They are as follow January 19th, A. T., 7 years (F) ; January 23rd, T. S., 6 years (m); January 29th, F. T., 2 years (m). There is a history in connection with these cases which suggests a common origin for the first two, the third one having arisen direct from the first. The first two cases belong to separate families, who were in the habit of frequently visiting one another. In the family of the second case there has been some indefinite form of illness, which affected three members of the family besides the one removed with enteric. Edith, 4 years, took ill at the end of November with what appeared to be a cold, and was attended by a medical man, who described the illness as bronchitis and pneumonia. She is slowly convalescing at present. Frederick, 14 years, took ill with symptoms resembling influenza a week before Christmas ; he is now recovered, but does not look very well. George, 12 years, had a similar illness before Christmas, and has now recovered. The father, mother and baby seem to be the only ones that escaped. " If these should have been anomalous cases of enteric it would account for the first two cases. I purpose making further investigations and will report at the next meeting." The further investigation consisted in an endeavour to get specimens of the blood from the un-notified cases with what result appears in the next report to the Committee : — " The following is the full investigation into the three cases of typhoid fever which occurred at 21, Pages Walk. The notifications occurred as follows: — January 19th, 1904 A. T. 17 years, female. „ 23rd, „ T. E. S. 6 „ male. 29th, „ F. T. 12 „ "E. S., 3 years (f), took ill at the end of November, 1903, with cold and bad cough, later with diarrhœa and vomiting, and was diagnosed to be suffering from pneumonia and bronchitis. She was ill when I saw her on February 3rd, and did not recover until at least a fortnight later. "F. S., 14 years (M), brother of above, took ill a week before Christmas He was described as " sleepy and lying about," with pains and headache, loss of appetite, but no bowel symptoms. He was ill about four weeks. " G. S., 12 years (M), another brother, took ill about the new year, and had not quite recovered when I saw him on February 3rd. He had similar symptoms to F. S., but had abdominal pains. "As the laboratory was not fixed up, I did not examine the blood until February 26th, and was then only able to examine two of these, viz : E. S. and G. S.; the third case was at business. The result was negative in both. I found, on communication with the hospital where the notified cases were sent, that they were suffering from genuine typhoid, and notwithstanding the result of the examination of the blood, I still think there is good ground for believing that these illnesses were of similar if less severe type to the three that were notified. "If this is so, then the first case notified on January 19th arose from them, and that in turn gave rise to the next two notified, as the families were on frequent visiting terms with one another." The fixing of the laboratory here referred to, was its removal from our old quarters in Rotherhithe Town Hall, up to the Town Hall. Spa Road. Some doubt occurred later as to the purity of the typhoid culture used here, so that the result of the inquiry does not preclude the possibility mentioned in these reports. Of the seven cases returned as not suffering from enteric, the diseases which were mistaken for it were tubercular meningitis (2), diarrhoea ('2), lobar pneumonia (1) ; about 2 there was no diagnosis recorded. There were 16 deaths, which makes a case mortality of 24.2 per cent. This is unusually high, since the average mortality in London is between 16 and 17 per cent., and shows that the type of disease must have been very severe. In the latter part of the year 1903 Dr. .J. King Warry, Medical Officer of Health for Hackney, traced a number of cases of enteric fever to the eating of watercress. A copy of this report was sent to this Council, with the request that we would support the suggestion that the London County Council should make an extended enquiry on the supply of watercress of the metropolis. This suggestion was supported by this Council. As far as this district is concerned no cases have been traced to this source. Continued Fever. 1 case was reported under this heading and the patient died. As she was not removed to hospital, and there was no post-mortem, it is impossible to say precisely what the fever was. It is probable it was a case of enteric, in which some of the usual symptoms were absent. As far as preventive measures were concerned it was treated as enteric. Puerperal Fever. 4 cases of puerperal fever were notified in 1904, and 2of these died. This is a considerable diminution on 1903, in which there were 9 notifications and 4 deaths. Only one of these cases was in connection with Guy's Hospital. Measles. As stated in last report the London County Council applied the sections of the Public Health Act dealing with infectious disease, to measles, with the exception of those dealing with notification and removal to hospital. Taking advantage of this we have endeavoured to control the disease by disinfecting in every case which came to our knowledge and excluding contacts for a period of three weeks and until disinfection is completed. The plan was not fully adopted in the early months of the year, but as the numbers of cases and deaths began to increase, an effort was made to have measures against the disease thorough and systematic. The following is the first report on the subject presented to the Public Health Committee on May 9th :— " When reports of measles are received from the head masters of board schools, my custom is to send on a notice to the master of the house similar to that which is sent in cases of dangerous infectious diseases under the Public Health (London) Act, 1891, and also a postcard to be signed by the medical attendant and the master of the house, when, in the opinion of the former, the patient is well and the house ready for disinfection. " I have written to several schools requesting them not to receive these children back until they produce certificates that their houses have been disinfected. " I am informed however, by the district Inspectors, that the School Board visitor in connection with Alexis Street, Farncombe Street, and Keeton's Road Schools, has been urging the parents to send the "contacts" back to school when he thinks it is time for them to return, which is a fortnight from the beginning of the illness, and telling them not to mind the question of disinfection. " In this respect he would seem to be acting in conformity with the regulations of the late School Board for London, in which it is stated that " children suffering from measles must be excluded for at least one month. Children coming from houses where measles exists, but who themselves are not suffering from the disease, must be excluded from school for two weeks." " This regulation was framed before the London County Council made the Order extending certain sections of the Public Health (London) Act, 1891, relating to infectious diseases, to measles. I do not see the use of enforcing these sections, especially as regards disinfection, if children are allowed to go backward and forward to school while a member of the family is lying ill with measles. " This disease being so infectious and prevalent at certain times of the year no doubt interferes greatly with school attendance. " I should therefore advise the Committee under article 88 of the Education Code, to exclude children suffering from measles for a period of one month, and "contacts" for three weeks, and then only to readmit them after the rooms, etc., have been disinfected. " The reason I have chosen this period is that in the majority of measles disinfection could take place at the end of three weeks, immediately after which the " contacts " would return, the patient remaining away for another week. In addition these three weeks would cover the incubation period, when those " contacts " who had not previously had measles would have an opportunity of contracting the disease. " Arrangements have been made to inform the head master of the school by postcard immediately disinfection has taken place in any particular case, so that unnecessary delay may be avoided." As the epidemic seemed to proceed unchecked, and my recommendations were not being strictly carried out, I made a Special Report to the Committee pointing out the difficulties of our position and suggesting, if we were to continue disinfection, etc., that we should have compulsory notification so as to have a legal basis on which to act. As I did not specifically recommend notification, the report was simply sent on to the Council and nothing particular was done. The following is a copy of the Special Report:— " September 13th, 1904. " Gentlemen,—The necessity of making some effort to control measles being now admitted by all those interested in sanitary matters, it is unnecessary to refer to this part of the subject further than to state that the average death rate for this disease for the ten years ending 1902 was "79 per 1,000, which is the highest rate for any single zymotic disease, diarrhoea excepted, which was '86. The usual preventive measures, viz., notification, isolation, disinfection, school closure, and the application of those sections of the Public Health Acts dealing with disease prevention have all been tried with varying success. It is the object of the present report to show the anomalous position in which the recent Order of the London County Council has placed us by applying those sections of the Public Health (London) Act, 1891, which ostensibly give us powers to deal with measles, but which we cannot effectively enforce. It is similar to supplying an army with guns, powder, etc., but leaving out the means of igniting the latter. The two sections which the London County Council left out are notification and removal to hospital. " Taking removal to hospital first, I do not think it is advisable or practicable to provide hospital accommodation for measles. The disease is very widespread and comes in epidemics, which would strain whatever hospital accommodation we could provide to the utmost. Practically all deaths in this disease are due to complications and occur in the first five years of life. Out of 90 deaths which occurred during the first six months of the present year in Bermondsey, 86 were of children under five years. " There is no doubt that many of the deaths are due to ignorance and carelessness on the part of the parents, and anything which teaches the parents to look upon the disease as a serious one will do a great deal of good. " We have just passed through a rather severe epidemic in Bermondsey, and the experience gained by it has emphasised the difficulties of our present position. "In dealing with any infectious disease the first thing is to know where it is. Granted this, the three essentials of the information are that it must be (1) early, (2) accurate, and (3) complete. Practically the only information we receive at present of the existence of measles is from the school notifications, and our recent experience shows that these notifications are wanting in the essentials just mentioned. "In the first place these notifications are not early. The information in them is very rarely less than a week old, and not infrequently is four weeks old. This arises as a natural consequence of the way the information is obtained. A child is absent, and as soon as the teacher can find out the cause of the absence, either through brothers or sisters of the absentee, neighbours' children, or, on the return to school of the child, she reports to the Medical Officer of Health. The longest delay is generally when the cause of the absence is ascertained from the patient on his or her return. These absentees are at the same time reported to the school visitor about twice a week, or as often as he may call at the school. "In the second place the information is not accurate. Between February 28th and July 2nd (18 weeks), which practically covers the epidemic period of measles referred to above, 687 cases were reported from the schools. In 55 the addresses were wrong, in 142 the disease was not measles but some totally different complaint or some other excuse for absence, such as want of boots, etc. Thus nearly 200 or about 29 per cent, of the notifications were incorrect, necessitating a very large amount of unnecessary work on the part of your Inspectors. " In the case St. Paul's School most of the eases were discovered by the enquiries of the Inspector and not through the school notifications. " In Grange Walk School I only learned of the existence of an epidemic by the head teacher sending to me for a certificate for the epidemic grant which she was unaware had been abolished. On visiting this school the number of notifications I got one morning were 57, of these 36 turned out to be genuine cases, in 18 there were no measles in the house, and in three wrong addresses had been given. "In the third case the information is not complete. Many cases occur which are never heard of unless someone in the house happens to attend a school, and all our information practically ceases during school vacation. "In connection with these school returns it will be convenient to examine the probable influence of the abolition of the Epidemic Grant. Under Article 88 of the Education Code the local sanitary authority, acting on the advice of the Medical Officer of Health, have power to exclude children from school on account of infectious disease. In times of prevalence the exercise of the power given by this Article may cause a very serious diminution of the school attendance and a consequent reduction of the Government grant. In order that schools might not suffer by the exclusions made by the sanitary authority a special grant under Article 101, known as the Epidemic Grant, was provided. It reads as follows : — "Where the Board are satisfied that by reason of a notice of the sanitary authority under Article 88 or any provision of an Act of Parliament requiring the exclusion of certain children, or by reason of the exclusion under medical advice of children from infected houses, the average attendance has been seriously diminished, and that consequently a loss of the annual grant would, but for this Article, be incurred, the Board have power to make a special grant not exceeding the amount of such loss in addition to the ordinary grant. " In the provisional Code for 1903 this Article is abrogated, and in the Prefatory Memorandum Mr. R. L. Morant states that ' After March 31st, 1903, the Board will discontinue the special Epidemic Grant which has hitherto been allowed to schools in compensation for loss of income in any particular year owing to the grant being payable on a diminished attendance, while the expenditure on staff and maintenance remain unreduced. The amounts payable under "this Article to individual schools have, as a rule, been inconsiderable as compared with the total income and expenditure of the year. Many difficulties, too, have been found incident to the administration of the Article, and it is believed that the money spent under its provisions might better be devoted to the improvement of the instruction given to pupil teachers. Arrangements are accordingly being made to effect this.' "By Article 101* it is obvious that it was not to the interest of school teachers or attendance officers to hurry back to school children who were either suffering from infectious disease, or came from houses in which such existed. They knew that allowance would be made for these cases, and that the average attendance would not be diminished from this cause. " The result was that fairly accurate records of disease were kept both in the voluntary schools and under the late School Board for London. There was then no hampering of the sanitary authority through the desire to keep up the attendance. " Previous to the abolition of the Epidemic Grant, if a teacher saw a child suffering from a severe cough, suggesting whooping cough, or others suffering from similar symptoms to the well known symptoms of measles, it was to their interest to exclude such children until the existence or non-existence of the disease was confirmed. " Now, however, it is clear that such cases are likely to be kept at schools during the stage before mentioned, unless, as is frequently the case, the parents take the matter in hand and keep the children at home. This is, of course, only a single safeguard against the double one which existed previously. " Under the present conditions, it is the interest of the school authority on the one hand to keep up their average attendance when diminution is threatened from whatever cause, and of the sanitary authority to keep down infectious disease, and though in the schools controlled by the late School Board and now by the London County Council there are various rules about re-admission of "contacts" and those who have recovered from infectious disease, I have found that there is a tendency on the part of the attendance officers to hurry the children back to school when insufficient time has elapsed either for recovery or disinfection, and that this is fostered by the rivalry which exists between the attendance officers of different districts to keep their averages as high as possible. I have also reason to believe that the records of infectious disease, notwithstanding statements to the contrary, are not so accurately or well kept as they were previous to March, 1903, when this grant .was done away with. Of course the answer to this is that a body like the London County Council would not countenance a relaxation of the regulations regarding infectious diseases as I have mentioned. That I quite believe, but at the same time it does not prevent over-zealous officers of the Council acting in the way I have mentioned. "In the case of one disease, viz., measles, I received so many complaints from our District Inspectors about children being hurried back to school regardless of disinfection, or the time they had been away, that I found it necessary to recommend your Council to exercise powers under Article 88 and exclude all patients suffering from measles for a month, "contacts" for three weeks, and none of them to be readmitted until disinfection had taken place. It is therefore quite evident that the loss of the epidemic grant has produced as regards measles tangible and far-reaching results, and no doubt the same applies to many other diseases, and although the trouble regarding measles has been stopped to a large extent, the tendency still remains to hurry the children back and has to be constantly guarded against. The Article in question was of great assistance to Medical Officers of Health and did away with all friction between the sanitary and the school authorities as regards infectious disease, and I think that the Board of Education were badly advised in doing away with it. " These school notifications are useless if legal proceedings should become necessary to enforce disinfection or any other section applicable to this disease. For such proceedings a medical certificate is absolutely necessary. Of course one might say that the Medical Officer could visit, but that is out of the question because by the time legal proceedings become necessary in any particular case all symptoms of the disease have gone, and even if be visited every case, which would be impossible, the rash would have gone in the majority by the time he arrived. " From these considerations it would appear that if these sections continue to be applied to measles by the London County Council, and if they wish the sanitary authorities to enforce them, it follows as a logical consequence that cases ought to be notified in the same way as any other infectious disease. Proceedings can always be taken on a notification certificate, and in fact it is the only basis for proceedings in the notifiable diseases. In many cases we have had refusals to disinfect and great difficulty has not infrequently been experienced in enforcing it. The result in many cases has been arrived at by a compromise on our part. " There are difficulties of course attending the notification of measles, one being that it has apparently done no good in some of the districts where it has been tried. This is probably due to its not having been tried for a sufficiently long period, or to imperfections of diagnosis. It is generally stated in measles that the mischief is done before the rash appears, but I cannot think that this will prove an insurmountable difficulty in the future, because with a little patience it is now possible to diagnose measles a day or two before the rash appears, and when bacteriology comes to our aid, as no doubt it will, we shall have full means of early diagnosis. " Another difficulty is that a great many medical men do not at present draw a sharp distinction between ' epidemic roseola,' often known as German measles, and ordinary measles. German measles is a comparatively trivial affection, and is rarely a cause of death, either alone or through complication. If it was pointed out, however, that it would not be notifiable, but that notification would be strictly confined to measles, I have no doubt that in time this difficulty would be done away with. If the principle of notification were adopted, the matter of the amount of the fee and other details could be settled later, but the present requisite is a medical certificate on which action can be taken. " There are other points which might be mentioned in dealing with measles epidemics. Since the disease, as shown above, is most fatal under five years, if infant classes were done away with, and the children not sent to school during this period, there is no doubt that measles epidemics would be greatly curtailed, and those which did occur would be postponed to a later age period. The abolition of these would also save about 14 per cent, of the present school rate, so that it would have both hygienic and economic advantages. " Another practical and useful check to measles would be the printing and distribution of a leaflet giving general instructions on the importance of careful nursing, etc., in cases of that disease. I should be glad if the Committee would give me instructions to have such a leaflet drawn up and printed. " Your obedient Servant, " R.K. Brown, " Medical Officer of Health." The annexed table gives the number of notifications received from the schools, the number of " contacts" included and the number of deaths in fortnightly intervals. Patients. Fortnight ending " Contacts." Deaths. January 16th 12 17 - January 30th 14 11 3 February 13th 6 14 4 February 27th 34 64 2 March 12th 23 19 4 March 26th 96 4 48 April 9th 38 37 10 April 23rd 64 155 10 May 7th 81 148 11 May 21st 142 172 19 June 4th 177 159 6 June 18th 57 125 9 July 2nd 8 57 129 July 16th 16 63 4 July 30th 5 10 54 August 13th Schools closed - August 27th 25 38 3 September 10th 19 24 2 September 24th 37 110 - 68 October 8th 24 1 October 22nd 58 92 5 74 November 5th 23 6 November 19th 20 35 6 79 December 3rd 4 49 57 December 17th 42 5 December 31st 8 7 5 1089 1842 136 The figures in the first column do not give an idea of the number of cases which occurred in the Borough, probably not more than half, or at most two-thirds, of the cases which occur come to our knowledge. The number of rooms disinfected were 917, in addition to portions of 9 schools which were closed on account of measles. Several schools or portions of schools were temporarily closed by the Medical Officer of the Education Department of the London County Council for measles, during which time they were disinfected viz.: Fair Street, Infant's Classroom "A"; Midway Place, Classroom "G" Magdalen Street, St. Paul's, Pages Walk, Grange Walk, Infants; Farncombe Street, Infants; Southwark Park, Classroom "A," Infants; and Rotherhithe New Road, Classroom "VII., Infants. The total cost of disinfecting measles during the year was £247 8s. 7d., the cost of disinfecting other infectious diseases being £270 18s. 11d. In addition to the precaution of disinfection, the following leaflet is sent per post to each house where a case of measles is known to occur along with the copy of the section of the Public Health Act dealing with infectious diseases. METROPOLITAN BOROUGH OF BERMONDSEY. PRECAUTIONS IN MEASLES. The Council of the Metropolitan Borough of Bermondsey desire to draw the attention of parents and guardians to the serious nature of measles. During 1903 it caused more deaths than any other infectious disease. In the first six months of 1904 it caused 90 deaths, 86 of which were in children under five years of age. It is therefore MOST FATAL IN YOUNG CHILDREN. Death in measles is nearly always caused by complications, and those which occur most frequently are PNEUMONIA and BRONCHITIS. It is therefore MOST IMPORTANT that on the first symptoms the patient should be isolated and KEPT IN BED, IN A WARM, WELL-VENTILATED ROOM, so as not to "catch cold." As the eyes are very sensitive to light it is advisable that the patient should be so placed that it should not shine directly into them. It takes ten or eleven days after the child has become infected before the first symptoms appear. These come on somewhat SUDDENLY, and consist of sneezing, coughing, running and redness of the eyes and nose, loss of appetite, the symptoms generally being those of a bad cold. On the fourth day the rash appears, usually first about the roots of the hair, forehead, sides of the head, and neck, and rapidly invades the remainder of the trunk and limbs. . MEDICAL ADVICE should ALWAYS be sought at this stage and STRICTLY FOLLOWED. The patient, if attending school, should be excluded on the first suspicious symptoms, and as soon as they are confirmed by the beginning of the rash, the other members of the family attending school should also be excluded. Complications are most liable to appear during the height of the rash, but a patient is NEVER SAFE from them until recovery is complete. This generally takes three or four weeks. In order to prevent the patient and members of the family carrying infection back to school it is MOST IMPORTANT that their clothes should be DISINFECTED before return there. This will be done on receipt of enclosed post card duly filled up. R. K. BROWN, M.D., Medical Officer of Health. Town Hall. The results of all these precautions have been somewhat disappointing, considering that it is the first year during which disinfection has been systematically carried out; for in this year we have the highest mortality from measles of any year during the past eleven years with the one exception of 1902. The question whether it is worth spending this amount on disinfection considering the small return is at present under consideration. Chicken-pox. This disease was made notifiable by an Order of the London County Council from April 7th till November 7th, 1904. There were 294 notifications during this period. None of these turned out subsequently to be small-pox. As mentioned in the section of this report dealing with small-pox, some cases in Hatteraick Street were treated as chicken-pox and turned out to be small-pox, but the former was not notifiable at this period. Membranous Croup. There were no notifications from this disease, against 2 in 1903. Notification of Phthisis. 128 cases of phthisis were voluntarily notified in 1905. The leaflet with precautions was posted at once to the patient, and this was followed in the course of a week or two by a visit from myself. I then amplified the recommendations and pointed out the value of disinfection, which was accepted in some cases. Prom these visits, besides the benefit of the advice to the patients, I learned that the knowledge of the infectious nature of consumption is becoming much more common, and that the people are more anxious to do everything in their power not to be a danger to others. Those patients who have been to sanatoria, convalescent homes and hospitals for this disease, are much the most careful, and sanatoria for the poor, if they did nothing else than train people in the hygiene of phthisis, would be doing an excellent work. I hope to see phthisis compulsorily notifiable before very long, and the principal work which the voluntary notification is doing at present is preparing public opinion for this extension, The fear in the public mind is that if phthisis is classed with the other infectious diseases there will be too much interference with the liberty of the patient, especially in relation to his occupation. It should, however, be made clear that this will not be the case, but disinfection at stated intervals, as advised by the medical attendant, should be insisted on. Every case also should have a period of treatment at an open-air sanatorium, but until the Metropolitan Asylums Board take up the provision of these seriously I fear we will remain a long way behind-hand in London. Disinfection was carried out in 77 cases, but this was mostly after death from this disease. The annexed table gives the ages and occupation of all the cases notified up to December 31st, 1904. Of the 128 cases notified in 1904, in 40 there was a family history of phthisis in near relatives, in 20 there was a similar history in distant relatives, in 4 the patients' husbands were phthisical, in 14 no information was obtainable, and in 70 the family history as regards phthisis seemed to be good. I certainly see no reason to give up the voluntary notification, but on the contrary hope it will be extended at no distant date. OCCUPATION. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards ALL AGES. ... ... ... ... 1 ... ... ... ... 1 Barmaid Book Keeper ... ... ... ... 1 ... ... ... ... 1 B0uilder's Labourer ... ... ... ... ... ... 1 ... ... 1 Book Folder ... ... ... 1 ... ... ... ... ... 1 Boot Repairer ... ... ... 1 ... ... ... ... 1 ... Buttonhole Maker ... ... ... 1 1 ... ... 2 ... ... Card Maker ... ... ... 1 ... 1 ... ... ... 1 Cashier ... ... ... ... ... 1 ... ... ... 1 Charwoman ... ... ... ... ... ... 1 ... ... 1 Clerk ... ... ... 4 ... ... ... ... ... 4 Collar Turner ... ... ... ... ... ... ... 1 1 ... Compositor ... ... ... ... 1 ... 1 ... 2 ... 1 COOK ... ... ... ... ... ... 1 ... ... 1 1 Cork Cutter ... ... ... ... ... ... ... ... Domestic Servant and General Work ... ... 1 1 ... ... 1 1 4 ... Dressmaker ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... Engine Driver 1 ... ... ... Engineer's Labourer ... ... ... 1 ... ... ... ... ... 1 Envelope Maker ... ... ... 1 ... ... ... ... ... 1 Fitter ... ... ... ... 1 ... ... ... ... 1 Forewoman (wholesale grocers) ... ... ... ... ... 1 ... ... ... 1 Fur Dresser ... ... ... ... ... ... 1 ... ... 1 Fur Puller ... ... ... ... ... ... ... ... 1 1 Grocer's Assistant ... ... ... 1 ... ... ... ... ... 1 Hatter ... ... ... 1 ... ... ... ... ... 1 Housewife ... ... ... 4 16 18 8 3 2 51 Indoor Porter ... ... ... ... ... ... ... 1 ... 1 In Cold Store ... ... ... 1 - ... ... ... ... 1 In Confectioner's Shop ... ... ... ... ... ... ... ... 1 1 Jam Factory hand ... ... ... ... ... 1 ... ... ... 1 Lambswool Cutter ... ... ... ... ... 1 ... ... ... 1 Lace Tagger ... ... ... ... ... 1 ... ... ... 1 Laundry ... ... ... 1 ... ... 2 ... ... 3 Labourer (waterside) ... ... ... ... 1 2 4 1 ... 8 Labourer (iron work) ... ... ... ... ... ... 1 ... ... 1 Labourer (general) ... ... ... 2 2 1 ... ... ... 5 1 lighterman ... ... ... ... ... 1 ... ... ... 1 Lead Worker ... ... ... ... ... 1 ... ... ... Leather Dresser ... ... ... 1 1 ... 1 ... ... 3 Lath Maker ... ... ... 1 ... ... ... ... ... 1 Machinist ... ... ... 1 2 ... 1 ... ... 4 Mat Weaver .. ... ... ... ... ... 1 ... ... 1 Mantle Maker ... ... ... ... 1 ... ... ... ... 1 Messenger ... ... ... ... 1 ... ... ... ... 1 Night Watchman ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... 1 Office Cleaner Paper Bag Maker ... ... ... ... 1 ... ... ... ... 1 Park Labourer ... ... ... ... 1 ... ... ... ... 1 Printers ... ... ... 1 ... 1 1 ... ... 3 Printing Machine Minder ... ... ... 1 ... ... ... ... ... 1 Printer's Warehouseman ... ... ... ... ... 1 ... ... ... 1 Spring Blind Maker ... ... ... ... ... 1 ... ... ... 1 smelter ... ... ... ... ... 1 ... ... ... 1 Stevedore ... ... ... ... ... 1 1 ... ... 2 Sackmaker ... ... ... ... ... ... 1 ... ... 1 seamstress ... ... ... ... 1 1 ... ... ... 2 Ship's steward ... ... ... 1 ... ... ... ... 1 Sailor (H.M. Navy) ... ... ... 1 ... ... ... ... ... 1 Sawyer ... ... ... ... ... ... ... 1 ... 1 Scholar ... ... 15 ... ... ... ... ... ... 15 Tin Work ... ... ... ... 1 ... 1 ... ... 2 Telegraphist ... ... ... 2 ... ... ... ... ... 2 Tobacco Hand ... ... ... ... ... 1 ... ... 1 ... Watcher (Customs) ... ... ... ... ... 1 ... ... ... 1 Whitesmith ... ... ... ... ... ... 1 ... ... 1 Warehouseman ... ... ... ... 1 1 ... 1 ... 3 Waitress ... ... ... ... 1 ... ... ... ... 1 Woodchopper ... ... ... ... ... ... 1 ... ... 1 No occupation ... 9 ... ... ... ... ... ... ... 9 No information ... ... ... 5 3 9 3 ... ... 20 ... 9 15 32 43 46 34 11 5 Anthrax. The following is a complete list of all the cases of anthrax which occurred in connection with Bermondsey in 1904. Date notified 1904. Name and Address of Patient. Occupation. Part Affected. Source of Infection. Result of Illness. Jan. 22 C. S., Poppins Court, Fleet Street, E.C. Warehouseman, Topping's Wharf, Tooley Street Left side of neck Firm import large quantities of hides, but patient only had finished hides to deal with Recovered P.K., 502, Hanover Buildings Employed at Nesbitt's Hide and Skin Warehouse, Pickle Herring Street Left side of neck „ April 5 Worked last on March 31st on dry Columbian ox and cow hides F.P., 146, Guinness Buildings, Snowsfields April 5 Left side of nose „ Carman at Neal's, 8, Tooley Street, Contractors, who deal principally in provisions Patient had not been working with any hides as far as could be ascertained Sept. 27 E. B., Rowton House, Newington Butts Left side of neck „ Patient had been employed on Cape goat skins three or four days previous to notification Employed at Tower Bridge Wharf Dec. 5 „ R. B., 1, Curlew Street Waterside Labourer, General Steam Navigation Co. Near left ear Engaged in unloading foreign hides Dec. 8 W. H. D., 61, Riley Street Right side of nose Died Lime Jobber, Wichelow's, Tidal Place Been working at Cape goat skins Dec. 8 P. B., 42, Crosby Row Front of ear Waterside Labourer, Pickle Herring Wharf Recovered Engaged in unloading foreign hides Dec. 9 W. H., Maybrow Bldngs., Redcross Street, Borough „ Works at Voss & Son, 75, Weston Street Right side of neck Been working at foreign hides Dec. 10 Works at Voss & Sons, 75, Weston Street Been working at foreign hides E. W. S., 101, Percival Road, Enfield Town Left side of neck „ Every precaution is taken by the above firms to prevent the occurrence of the disease, and to ensure its early recognition, hand basins, nail brushes, etc., being supplied. In addition the following recommendations in the form of a bill drawn up by me at the request of the Public Health Committee is exhibited in different parts of the premises:— "Anthrax is a fatal disease affecting certain animals, which may be conveyed from them to man especially to those handling hides, wool, or horsehair of animals which have died of this disease. The minute germs or spores remain for a very long time in the hair and hides of animals which have died of, or have been slaughtered while suffering from the disease. "It is communicated to man sometimes by swallowing the dust from an infected hide, but more usually by the poison lodging in some place where the skin is broken, such as a fresh scratch or cut, or a scratched pimple or even chapped hands. This happens most frequently on the neck, but also on the hands, arms, face, or any uncovered part. Infection may also be brought about by rubbing or scratching a pimple with hand or nail carrying anthrax poison. "The first symptom of anthrax is a small inflamed swelling like a pimple or boil, often quite painless, which extends, and in a few days becomes black in the centre and surrounded by other pimples. The poison spreads from this over the whole body. The disease can be cured by prompt treatment in the early stages and before it has spread beyond the boil or pimple. It is of the utmost importance therefore to consult a medical man early. "In working among hides avoid breathing dust from them, and before working among wet or dry hides be sure that all scratches and cuts are carefully covered. Do not take any food or allow the hands to touch the face or neck unless the hands are thoroughly cleansed and disinfected. In doing this a nail brush should be used, particular attention being paid to cleaning the nails. It is advisable to keep these short so that there will be less room for dirt collecting underneath." Children excluded from School on account of Infectious Diseases. Scarlet Fever. Diptheria. Enteric Fever. Erysipelas. Smallpox. Continured Fever. Measles. Whooping Cough. Chickenpox. Mumps. Schools. Total. Patients, "Contacts." Patients. "Contacts." Patients, "Contacts." Patients. "Contacts." Patients. "Contacts." Patients. "Contacts." Patients. "Contacts." Patients. "Contacts." Patients. "Contacts." Patients. "Contacts." 217 6 3 6 ... ... ... ... ... ... 41 95 39 1 ... 1 1 Alma, Suiithwark Park Road 10 14 ... ... Alexis street 314 6 5 6 11 ... ... ... ... ... ... ... 80 181 9 3 4 8 1 ... ... Amicable, Adams Gardens 19 ... ... ... 2 ... ... ... ... ... ... 13 ... ... ... 1 ... ... ... ... Albion street 471 7 17 12 22 2 ... 1 ... ... ... ... ... 99 205 14 5 33 51 3 ... Alscot Road (Miss Jennings) 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bacon, Grange Road 1 6 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Boutcher, Grange Road 33 12 14 ... 1 ... ... ... ... ... ... ... ... 4 5 1 2 ... ... ... ... Clarence street 149 12 24 1 ... ... ... ... ... ... ... 13 14 ... ... 4 7 45 29 ... ... Credon Road 103 4 7 2 3 ... ... ... ... ... ... 13 57 4 8 ... ... ... 5 ... ... Chaucer, Tabard Street 1 ... 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Christ Church, Paradise Street 112 1 9 4 ... 32 56 1 6 1 1 ... ... ... ... ... ... ... 23 ... ... ... DocKhead Catholic 163 8 32 1 5 65 10 1 7 7 1 ... ... ... ... ... ... ... ... ... East Lane 312 18 55 3 34 5 3 142 12 13 4 18 3 2 ... ... ... ... ... ... ... Fair street 266 6 9 6 1 51 88 25 12 33 27 3 4 ... ... ... ... ... ... ... ... 144 6 21 1 Farncom be Street 5 1 1 27 61 11 3 2 5 ... ... ... ... ... ... ... ... ... Galley Wall Road 221 17 33 2 10 33 72 27 2 8 14 1 ... ... ... ... ... 2 ... ... 32 Gomm Schools, Plough Road 10 14 1 2 1 ... 2 2 ... ... ... 139 ... ... ... ... ... ... ... ... ... Grange Walk 20 ... 1 13 3 4 ... 47 43 6 1 1 ... ... ... ... ... ... ... ... 2 Holy Trinity, Rotherhithe 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Keetons Road 336 15 28 9 10 1 78 122 12 6 8 11 18 18 ... ... ... ... ... ... ... Laxon Street 115 3 47 6 5 7 2 43 ... 1 1 ... ... ... ... ... ... ... ... ... ... Mawbey Road 24 3 1 1 2 2 ... ... 12 ... 3 ... ... ... ... ... ... ... ... ... ... Magdalen Street 2 17 93 2 1 ... 24 29 3 4 8 3 ... ... ... ... ... ... ... ... ... Mina Road, Old Kent Road 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Melior Street 7 1 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Midway Place ... ... 76 7 2 7 6 ... 21 2 16 8 5 2 ... ... ... ... ... ... ... ... 85 7 ... Monnow Road 281 15 20 2 6 1 1 ... 70 71 2 1 ... ... ... ... ... ... ... NecKinger 261 11 26 2 8 5 ... 9 90 93 10 2 3 ... ... ... ... ... ... ... Newcomen Street 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Page's Walk 101 2 5 5 5 1 1 ... 12 63 2 3 1 1 ... ... ... ... Riley Street ... ... ... 84 2 11 1 4 1 ... 6 53 4 2 ... ... ... ... ... ... Rotherhithe New Road ... ... ... ... 178 20 28 7 9 1 ... 42 63 5 2 1 ... ... ... ... ... Rolls Road ... ... ... ... 34 3 5 19 ... 1 1 ... 5 1 ... ... ... ... ... ... ... ... ... ... ... St. Mary Magdalen, Purbrook Street 12 2 9 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St.Paul's Lane 18 6 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. James', Spa Road 132 8 25 1 49 36 7 1 4 ... ... ... ... ... ... ... ... ... ... ... ... 48 3 3 23 Sil wood Street 1 12 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Stephen the Yeoman, Marigold Street 9 1 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 2 St. Joseph's Paradise Street 35 1 3 ... ... 6 15 1 ... ... ... ... ... ... ... ... ... ... ... 12 St. Mary's,Rotherhithe 47 12 3 3 6 ... ... 8 1 ... ... ... ... ... ... ... ... ... ... 23 ... Southwark Park 122 16 7 1 33 24 ... ... 3 6 9 ... ... ... ... ... ... ... ... ... Snowsfields 49 3 6 6 8 1 10 ... 6 5 4 ... ... ... ... ... ... ... ... ... 3 18 ... Webb street 134 3 8 1 77 5 4 10 5 ... ... ... ... ... ... ... ... ... ... Weston street 66 ... 1 1 6 ... ... ... 10 47 ... 1 ... ... ... ... ... ... ... ... ... 4965 Totals 260 522 91 179 22 6 6 1 1 2 ... 2 1093 1838 334 92 156 181 107 58 III.—SANITARY ADMINISTRATION. In Table X. of Appendix will be found particulars of the general sanitary work for 1904 by the different inspectors, and in Table VII. the number of premises on the register to which special attention has been paid, such as milkshops, etc. The house-to-house inspections, which number 5,073, are fewer than in 1903, but this is no doubt due to two of the districts being some time without an inspector, one between January 14th, when Mr. Davies left the Council's service, and March 7th, when Mr. Harris commenced duties, and the other between September 2nd, when Mr. Williams left, and October 3rd, when Mr. Jones commenced duties. The number of re-inspections was 24,707, against 24,409 in 1903. The number of intimations served was 3,670, against 4,251 in 1903. Part of the reduction is no doubt due to the cause above mentioned. The number of statutories was 899, against 1,314 in 1903. This reduction appears to me satisfactory, since it shows that the work was largely done on the first notice. Offensive Trades. The same number of offensive trades, viz., 13, are on the register as during 1903. They consist of the following:— Tripe boiler 1 Glue and size makers 4 Fat melters 4 Fellmongers 3 Manure manufacturers 1 118 inspections were made, against 58 in 1903, and 3 notices were served. Several minor defects were remedied without notice being served. I have so far found the occupiers of these premises ready and willing to carry out any reasonable suggestion for the prevention of nuisances. There were two prosecutions in connection with these trades in 1904, both against the manure manufacturer J. A. Smith (later known as Freeland, Smith & Co.). In the first case he was fined £1 and 2s. costs for having the door of the closed chamber in which the offensive process is carried on, open at an improper time, and in the second the firm were fined £5 and 2s. costs for allowing the fire which consumes the offensive vapours of this chamber to go out, in both these cases causing an offensive smell in the neighbourhood. Offensive Matter. Five summonses were taken out under the London County Council bye-laws for carrying offensive matter through the streets at improper hours or in improper receptacles : — Offence. Result. Date. Name and Address. Carriage of fish offal in unsuitable receptacle £5 and 2s. costs Jan. 5, 1904 Dennis Sheehan, 208, Rotherhithe New Road T. Maule, The Grange Carriage of offensive matter in unsuitable receptacle £2 & 2s. costs, summonsagst. carman dismissed Sept. 21, 1904 Carriage of offensive matter during prohibited hours £1 & 2s. costs, summonsagst. carman dismissed Sept. 30, 1904 A. Stannard, 16, Sudlow Road, Wandsworth Milk Premises. There were 286 milk premises on the register at the end of 1903, 18 were added and 3 removed in 1904, making a total of 301 on the register at the end of the year under report. The number of inspections was 444 and 15 notices were served. Cowsheds. There are seven cowsheds in the Borough, these were regularly inspected. Unfortunately in the table from which the inspections are taken the cowsheds and slaughterhouses are put under one head, the total inspections being 170. They will be separated in future reports. Slaughterhouses. There are three at present in the Borough. A small number of the inspections under the latter head should be included here. Ice Cream Premises. There were 68 premises, where ice cream was manufactured, on the register at the end of 1903, one was added making the total 99 in 1904. There were 285 inspections of these premises and 14 notices served. We are still without any power to make regulations regarding the actual process of manufacture, and I hope that some legislation will be brought in enabling Sanitary Authorities to deal with this subject. Houses let in Lodgings. In 1903 there were 207 "houses let in lodgings or occupied by members of more than one family" on the register, and during 1904, 11 more were added bringing the total up to 218. These, according to the instructions of the Public Health Committee, were visited quarterly, the total number of inspections being 462. 95 notices were served and 2 of these were for overcrowding. No further proceedings were required. 5, Aberdour Street 11, „ 13, „ 14, „ 17, „ 56, Arnolds Place 82, Abbey Street 86, „ 95, „ 98, „ 100, „ 10, Alice Street 26, Bermondsey Street 84, „ 117, „ 131, „ 136, „ 50, Bermondsey Wall 52, „ 6, Bell Court 8, „ 9, „ 12, „ 15, „ 18, „ 24, Bermondsey New Road 7, Cloyne Row 1, Curlew Street 2, „ 10, Crosby Row 19, Debnam's Road 21, „ 23, „ 13, Decima Street 42, „ 28, Enid Street 2, Emba Street 4, „ 28, East Lane 29, „ 3, Elim Street 7, „ 9, „ 18, „ 19, „ 21, „ 40, „ 41, „ 45, „ 24, Freda Street 1A, Flockton Street 5, Foxlow Street 7, „ 8, „ 15, „ 16, „ 17, „ 19, „ 20, „ 21, „ 22, „ 23, „ 25, „ 23, Faustin Place 31, „ 35, „ 4, Fendall Street 30, Ferrand Street 31, „ 16, Fulford Street 18, „ 12, Gedling Street 14, „ The following is a list of the houses let in lodgings:-- 60, Gainsford Street 9, Grange Walk 76, „ 81, „ 87, „ 91, „ 5A, Green Walk 6, Hatteraick Street 9, Kenning Street 10, „ 11, „ 19, Kipling Street 31, „ 6, Lamb Alley 7, „ 8, „ 46, Larnaca Street 47, „ 54, Leroy Street 58, „ 62, „ 72, „ 74, „ 76, „ 78, „ 82, „ 86, „ 22, Littlington Street 11, London Street 12, „ 13, „ 14, „ 15, „ 16, „ 17, „ 18, „ 19, „ 20, „ 31, Lafone Street 230, Long Lane 201, Lower Road 35, Mellicks Place 39, „ 41, „ 43, „ 63, „ 4, Maze Pond 6, „ 8, „ 10, „ 12, „ 14, „ 16, „ 18, „ 7, Morris Court 8, „ 9, „ 10, „ 11, „ 12, „ 19, Manor Lane 6, Marigold Street 10, „ 12, „ 1, Marshall's Place 21, „ 9, Maynard Road 9, Marcia Road 13, „ 2, Oldfield Road 3, „ 1A, Osborne Buildings 10, Pages Walk 9, Porlock Place 19, „ 21, „ 21, Paulin Street 2, Parkers Buildings 4, „ 6, „ 10, „ 13, „ 20, „ 28, „ 11, Read Street 9, Riley Street 350, Rotherhithe Street. 352, „ 556, „ 1, Suffolk Street 42, „ 1, Salisbury Place 4, „ 10, „ 14, „ 16, „ 20, „ 8, Salisbury Street 24, „ 27, „ 29, „ 55, „ 57, „ 58, „ 59, „ 66, „ 14, Snowsfields 43, „ 16, St. Helena Road 78, St. Marychurch Street 80, „ 19, The Grange 21, „ 51, „ 86, Tanner Street 23, Trident Street 26, „ 13, Turners Retreat 40, Vauban Street 41, „ 3, Warford Place 4, „ 14, Wilds Rents 1, William Square 29, West Lane 40, „ 43, „ 45, „ 48, „ 50, „ 62, „ 20, Westlake Road 22, „ 52, Weston Street 54, „ 199, „ 247, „ 253, „ 4, Woods Place 11, „ 14, „ 15, „ 16, „ 1, Woolf Street 2, „ 27 During the year two very important decisions were given in the High Court affecting the validity of certain of the bye-laws, made by the London County Council and this Council, for the above as well as other matters. The following is a short report of the cases: — "In the first case, Stiles v Galinski, the appellant was a sanitary inspector of the Stepney Borough Council, and the respondent a landlord within the meaning of the bye-laws in force in Stepney as to houses let in lodgings. At the Thames Police Court, on 23rd June, 1903, an information was preferred by the appellant against the respondent that he being the landlord of a lodging house did not in the first week of April last cause every part of the premises to be cleansed as required by the bye-laws in such case made and provided. In this case the magistrates dismissed the summons as no notice had been sent to the landlord." "In the second case, Nokes and Nokes v the Mayor, Aldermen, and Councillors of Islington, the appellants were the landlords within the meaning of the bye-laws, the information preferred was similar to that in the first case, and the magistrate sitting at the Clerkenwell Police Court convicted the appellants and fined them 10s. and costs." The appeal here was dismissed on the same grounds as the last, viz., that the bye-laws were invalid as there was no provision for notice being given. Bye-laws. As a consequence of the above decision, the London County Council amended their bye-laws in the beginning of the year, and the Borough Council in April. The following are the recommendations of the Public Health Committee which were adopted by the Council. For the prevention of nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. Insert at the end of bye-law 2 : — "Provided that the person receiving the rent either on his own account or as the agent of another person and not residing upon the premises shall not be deemed to have offended against this bye-law until the sanitary authority shall have caused notice to be served upon such person requiring him forthwith or within such reasonable time as may be specified in the notice to comply with the requirements of such bye-law and he shall have failed to do so." For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. Insert at the end of bye-law 9 : — "10. Provided that with the exception of the provisions contained in the third paragraph of No. 9, no person shall be deemed to have offended against the two previous bye-laws until the sanitary authority shall have caused notice to be served upon such person requiring him forthwith or within such reasonable time as may be specified in the notice to comply with any of the requirements of the said two bye-laws and he shall have failed to do so." As to the paving of yards and open spaces in connection with dwelling houses. Insert at the end of bye-law 10 : — "Provided that an owner of a dwelling-house shall not be deemed to have offended against this bye-law until the sanitary authority shall have caused notice to be served upon such owner, requiring him forthwith or within such reasonable time as may be specified in the notice to comply with the requirements of such bye-law, and he shall have failed to do so." For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing of water used, or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. Insert at the end of bye-law 4 : — "4a. Provided that neither the owner nor the person receiving the rent, either on his own account or as the agent of another person and not residing upon the premises, shall be deemed to have offended against bye-laws 2, 3 and 4, until the sanitary authority shall have caused notice to be served upon either of such persons respectively, requiring compliance with the requirements of such bye-laws forthwith or within such reasonable time as may be specified in the notice, and they shall have respectively failed to do so." With respect to the keeping of water-closets supplied with sufficient water for their effective action. Insert at the end of bye-law 2: — "Provided that no person shall be deemed to have offended against this bye-law until the sanitary authority shall have caused notice to be served upon such person, requiring him forthwith or within such reasonable time as may be specified in the notice to comply with the requirements of such bye-law, and he shall have failed to do so." Bye-laws made by the Borough Council with respect to houses let in lodgings, or occupied by members of more than one family in the Metropolitan Borough of Bermondsey. Insert at the end of bye-law 21:- "21a. Provided that the landlord of any lodging-house who does not reside upon the premises shall not be deemed to have offended against these bye-laws until the sanitary authority shall have caused notice to be served upon him requiring him forthwith or within such reasonable time as may be specified in the notice to comply with the requirements of such bye-laws, and he shall have failed to do so." Sec. 48, Public Health (London) Act, 1891. Certificates were granted to the following premises for a proper and sufficient water supply:— South Eastern Railway Flats, Rotherhithe New Road. Hythe Buildings, Swan Lane (1 to 70). 21, 23, 25, 27, 29, 33, Leroy Street. 9, 11, 13, 15, 17, 19, Bush Road. 21, 22, Silver Street. Barnaby Buildings, Swan Lane (1 to 20). Winchelsea Buildings, „ (41 to 65). Seaford Buildings, „ (1 to 40.) Abbey Street Buildings. Police Station, Tooley Street. Four houses in Gomm Road. 8, St. Helena Road. Summons taken out for permitting 33, Leroy Street to be occupied without a certificate under Sec. 48, Public Health Act. Fined 20s. and 2s costs. Disinfection. The following table shows the number of articles passed through the steam disinfector during the year : — Beds 1338 Pillows 2182 Blankets 1407 Quilts 1012 Bolsters 672 Sheets 1978 Carpets 253 Wearing apparel, etc. 7092 Cushions 349 Mattresses 1322 Total 17665 Palliasses 60 The corresponding number in 1903 was 17,046, and the increase is mostly due to the prevalence of measles. Food Inspection. This has been systematically carried on during the year. All places where food is manufactured in the Borough and imported by road, rail or river were regularly inspected. The markets are inspected every Sunday morning by the district Inspectors in rotation, and regularly, in addition, by the Chief Inspector. The inspection of fruit is principally done by the Chief Inspector, who visits the various jam factories about twice a day each during the season, and at other irregular times. He is assisted by the district Inspectors. Each Inspector is responsible for the food places in his own district and is required to hand in before every Public Health Committee meeting a record of his work in this department during the time elapsed since the last meeting. At the beginning of the year great difficulty was experienced in settling on a common basis whereby records could be kept by each inspector which could be compared. Some of them used to state their inspections in lots of various sorts and sizes, such as trunks of fish, pipes, parcels, etc., and after various changes the following table was commenced on July 6th, and is completed up to January 3rd, 1905. Partly with the help of the various tradesmen, etc., whose premises are inspected, rough estimates of the weight of the articles inspected are made. The number of inspections are accurate, but according to the bulk and nature of the article some inspections are larger than others. The number of these, therefore, must be taken in conjunction with the articles mentioned in the next column in endeavouring to form an idea of the work done. Food Examined from July 6th, 1904, to January 3rd, 1905. Meat. Fish. Fruit. Vegetables. Tinned Goods. Dairy Produce. Cereals. Inspectors. Inspections. Tons. Inspections. Tons. Inspections. Tons. Inspections. Tons. Inspections. Tons. Inspections. Tons. Inspections. Tons. 1031 683½ 861 2075¼ 40 26 114½ 63¼ 3 Mr. Thomas 467 74 158 32 60½ 13¾ „ Ashdown 139 382½ 29½ 402 27 1398½ 464 3282¼ 163 224¼ 637 2997 4 10¾ „ Cockburn 42 71 25 18 32¼ 146 5 27 2 1½ 23¼ - - „ Bartlett 18 8 9 1½ 7 - 2½ 2 2 - - - - 27 - „ Toogood 75 53½ 511 116 47¼ 91 31 14 50 - - 1 10 „ Scott 170 60½ 72 23 7 68 10¼ - - 8 10½ 12 26½ - - „ Hoskins 32 50½ 15 6¼ 202½ 19 17¾ - - 2 4½ - - 27¼ 83 „ Harris 37 25 3¾ 1½ 5 - - - 7 10 1½ - 19 „ Jones 31 39¾ 4 6 11 12 4 3½ 2 10 5 - - 1575 1376½ 291¼ 1409 3823¼ 4027¾ 233 814 694 3172¾ 27 589 348¾ 117½ Mr. Jones commenced duties on October 3rd. The total number of inspections of wharves, factories and shops where food stuffs are stored or made, was 2,942 during the year 1904. Register of places where Food is Prepared for Sale. The following table gives the number and kind of the various places where food is prepared (exclusive of the warehouses and wharves on the riverside) at present on our register. A special register was started towards the end of 1903 for such places, and a considerable number were added during 1904. Butchers 10 Pork butchers 4 Picklers 2 Confectioners (wholesale) 2 Restaurants 9 Coffee and eating houses 93 Tinned provision merchants 4 Eel pie shops 6 Tea rooms 2 Fried fish shops 22 Pish shops 10 Various 9 Fish curers 7 Total 185 Ham and beef shops 3 Oyster rooms 2 Unsound Food Seizures. The following are particulars of unsound food seized during the year 1904: — 20th March 4 tins unwholesome salmon Fined £5 and 5s. costs 19th 48 tins bloater paste „ £5 and 5s. „ 4th July 84 sacks gooseberries „ £5 and £1 11s. 10d. costs „ £5 and £1 costs 56 half sieves red currants *Dismissed 19th Fined £1 10s. and 5s. costs 14th „ 2 baskets of black currants 14th Aug. 5 pigs' heads, 4 half pigs' heads, Committed to prison for three months 1 piece of bacon 3 trunks of fish „ „ 28 days 25th Oct. 7th Dec. 13 pairs soles „ „ „ * Magistrate held that the goods were sold subject to sorting. Food Destroyed. The following articles were brought to the notice of the Department, found to be unfit for human food, and destroyed as trade refuse: — 12,478 tins various tinned foods 336 lbs. of meat 25 cwt. „ „ 1,168 boxes (about) of tomatoes 29 cases ,, ,, 2 cwt. „ „ 3½ barrels of fish 601 bags of carrots 3 boxes ,, 3 cases of eggs 1 case ,, 3¼ cwt. of liquid eggs 3 trunks ,, 19 cwt. of cheese 6 cwt. 1 qr. 14 lbs. of fish 7 bags of Brussels sprouts 484 bags of potatoes 36½ pipes of orange peel 76 tons 2 qrs. 11 lbs. potatoes 278 half sieves of fruit 910 bags of onions 1 case of oranges 70 crates of bananas 15 casks of apples 22 cases ,, 5 cases of pears Bacteriological Laboratory. The total number of specimens examined was 432, against 485 in 1903. The most noticeable thing is the decrease in the diphtheria swabs, but this is due largely to the comparative freedom of the Borough from suspicious throats in 1904. The number of specimens of tubercle is steadily increasing and was 172, compared with 134 in 1903 and 67 in 1902 Nature of Specimen. Number Examined. Result of Examination. Positive Result. Negative Result. Diphtheria (specimens taken by the Medical Officer of Health) Ditto (taken by private practitioners) 149 91 11 20 138 71 Diphtheria (total specimens taken) Tubercle Enteric Various 240 172 17 3 31 69 6 1 209 103 11 2 Total Specimens taken 432 107 325 Occupants of overcrowded part of house. Space Required. Rooms occupied and cubic feet space. Deficiency. State of Premises and Family. Address. :i cubco ft. The following casas of overcrowding were visited by the Medical Officer of Health during 1904:- Weston St. Man, wife and 2 children, 18 (F) and 14 (F) Sleeping, 1200 cubic feet Front room, first floor, 816 cubic feet 384 The occupants of this house are all Italians, and considerable difficulty was experienced in making them understand. Do. 332 Three men, lodgers Sleeping, 900 cubic feet Second room,first floor, 568 cubic feet Man, wife and 3 children, 8 (M), 2 (F) and baby 2 months Sards Rents Living and Bleeping, 1400 cubic feet Front room, top floor, 708 cubic feet 692 The husband is a hawker and sells fruit and flowers. He earns about 15s. per week. Rent 3s. per week. Light and ventilation bad. The room is clean and the people very poor. 1246 Risdon Street Man, wife and six children, 9, 7, 5, 3 (M), and 11, 5 months (F) Living and sleeping, 2200 cubic feet Front room, first floor, 954 cubic feet The ventilation was bad and the light indifferent when I called. Husband a -waterside labourer, who met with an accident some 18 months ago, and his wife stated he has done little work since. They were evidently in very straitened circumstances. This is a very bad case of overcrowding. The wife stated she was unable to obtain room anywhere owing to the children. 232 Parkers Buildings (Registered house) Man, wife and 2 children, 2 (M) and 1 (F) Living and sleeping, 1200 cubic feet Front room, first floor, 968 cubic feet Husband a casual labourer, earning 12s. to 15s. a week. His wife takes in needlework and earns 5s. a week. Walls and ceilings fairly clean, but bedclothes scanty and dirty. The room generally untidy. Light and ventilation fairly good. Marshalls Place 2 adults and 2 children Living and sleeping, 1200 cubic feet Front room, first floor, 811 cubic feet 387 Husband a waterside labourer, earning 15s. to 20s. a week, but his work very uncertain. Room and bedclothes fairly clean, but floor dirty at time of visit. Light and ventilation fairly good. Overcrowding. Maltby Street 31 192 3 adults, mother, son 18 and daughter 13 Living and sleeping, 1200 cubic feet Front room, first floor, 1008 cubic feet I was informed that at the time of visit another brother, a soldier, aged about 20, was sleeping here also. This would bring the deficiency up to 392 cubic ft. Mother a widow, making a living by nursing and washing. The son, aged 18, earns 12s. per week in a leather warehouse. Light and ventilation not very good.Room fairly clean but bedclothes scanty and dirty. This is not only a case of overcrowding but of indecent occupation. Living and sleeping, 1200 cubic feet 605 Ground floor, room on right, 595 cubic feet Hick mans Folly Man, wife and 2 boys (9 months and 3 years) Husband is a leather dresser but had done no work at his trade for two years. He at the time of visit earned a precarious living by selling fish (about 10s. per week). Boom dirty and bedclothes scanty and dirty. Light and ventilation bad. The husband stated he was recovering from an illness. Living and sleeping (1 adult) 400 Sleeping (3 adults and 1 child) 1050 Attic, 780 cubic feet 670 Gillhams Court 4 adults and 1 child, 7 years I was informed at the time of visit that there were only three adults, viz., an old lady, aged 75, in receipt of parish relief, a girl 20, a girl 15 and a child occasionally. Whichever figure is correct the place is overcrowded and very unhealthy, as the light and ventilation are very bad. Total (cubic ft.) 1450 Living and sleeping, 1200 cubic feet Dunlop Place Mother and 3 children, 12 (M), 4 and 6 (F) First floor, front room, 752 cubic feet 448 The tenant of this room is a widow, who is stated to earn 9s. or 10s. per week at Messrs. E. &T. Pink's. The room is dirty and the bedclothes scanty and dirty. Light and ventilation somewhat deficient. Food and Drugs. In Tables XI. and XII. of Appendix will be found a list of samples taken during the year and the action taken. There were 844 samples taken, compared with 721 in 1903. Of these 8.2 per cent. were found adulterated, against 7.6 in 1903. No special Inspector for food and drugs has yet been appointed by the Council, but I hope before long the matter will be considered by them. The following remarks, reprinted from last year's report, fully expresses my opinion on the subject: — "The administration of the Food and Drugs Acts is extremely important and owing to the constant influx of new articles of food into the market and the rapid increase of new and more refined methods of adulteration, there has grown up recently a large amount of literature on the subject which renders it very difficult for the ordinary Inspector to keep up to date with the question of adulteration, while performing the multifarious duties which he is called upon to undertake. " In my opinion, therefore, it would be well for the Public Health Committee to consider the advisability of appointing an Inspector whose sole duty would be to administer the Food and Drugs Acts. " Specialising in this, as in many other branches, leads to a man taking an interest in the particular subject he has to deal with, and makes him much more efficient in carrying it out. " Another advantage is that the Act could be more uniformly administered by the single Inspector. Under the present regime, there is a considerable and unavoidable difference in the methods by which the various Inspectors take samples, and the discovery of adulteration depends very largely on the way this is done. "About half the Sanitary Authorities in the Administrative County of London have Special Inspectors for this purpose, and, from enquiries made, in those cases in which experience has been had of both plans, opinion is greatly in favour of having a Special Inspector. "I think that there would be quite sufficient work to keep one man occupied in the administration of this Act for the whole Borough. If this were not so he could perform other special duties, such as smoke, food inspection, etc." Particulars of prosecutions and fines will be found on Table .... Milk and butter are the articles to which most attention was paid as they are in every day use as staple articles of food. Drugs were not neglected as three prosecutions in cod liver oil will show. Samples of cod liver oil were taken from all the chemists in the Borough, and the three which were adulterated came from those calling themselves " herbalists." Milk.—The total number of milk samples taken in 1904 was 451 against 374 in 1903. This is an improvement, but I think if the milk standard is to be raised the number might still be increased. For instance, the total number of milk premises in the Borough on the register is 301, and each of them ought to be sampled at least, say, once a year, the remaining number being taken in the streets, railway stations, etc. It is a curious coincidence that with the increase of the number of samples taken during the year 1904 there should be an improvement in the quality of the genuine samples taken, as the following table shows:- Of samples taken in 1904 — Under 3 per cent. 5 1.2 per cent, of total 3 per cent, and under 3.5 per cent. 147 35.1 3.5 „ 4 „ 164 39.1 4 per cent. and over 103 24.6 419 100.0 1903— Under 3 per cent. 32 8.63 per cent. of total 3 per cent, and under 3.5 per cent. 134 36.12 3.5 „ 4 „ 135 36.38 4 per cent, and over 70 18.87 The adulterations this year were also 7.1 per cent. compared with 7.5 per cent. in 1903. It would therefore be worth while increasing these to see if a corresponding improvement occurs. Housing of the Working Classes. In the latter end of 1902 an old pond known as the Mill Pond was filled up. It consisted of a stretch of water 300 ft. long with a width varying from 15 ft. at the Paradise Street end to 40 ft. at the Rotherhithe Street end. The houses of cne side of Gilham's Court backed on to it on the east and those on one side of West Lane on the west side. A considerable strip of vacant land was thus formed belonging to the flour mill at 16, Rotherhithe Street. This mill became empty in 1903, and the freeholders offered to sell it and the Mill Pond to the Borough Council for building purposes. As it was scarcely worth negotiating for without the surrounding property, I was requested by the Public Health Committee to inspect and report on this, so as to assist the Housing Committee to come to a decision. The following is the report submitted in the beginning of 1904 :- "Report on condition of property adjacent to and surrounding the piece of vacant land originally occupied by the Mill Pond, and buildings in the same curtilage. " The buildings and property at present for sale comprise a flour mill, offices and a piece of vacant land-the site of the old Mill Pond. This extends in a narrow strip from the river Thames, near 14, Rotherhithe Street, on the north, to Paradise Street on the south. It is bounded on the west by the following houses:(lst) 10 to 14 (even numbers) Rotherhithe Street, (2nd) 22 to 62 (even numbers West Lane, (3rd) Iphegenia Cottages, and on the east by (1st) Candlish's Warehouse, (2nd) the houses on both sides of Gilham's Court, and (3rd) 1 to 9 (odd numbers) Paradise Street. "For convenience of description the various houses and properties can be divided into certain groups and divisions, which I will take in the above order. "Taking the west boundary, the first group comprises three large three-storied houses, Nos. 10 to 14, Rotherhithe Street. No. 10 is occupied below as an office the remainder being let out. No. 12 is a public-house, and No. 14 is sub-let to the employees of Messrs. Tidy, Farrand's Wharf, and has a large stable attached in the occupation of the same firm. "The brickwork of these houses is good, as is also the general sanitary condition. Nos. 10 and 14 were redrained within the last 3 years, and during this process the drains of No. 12, which discharge into the same system, were subjected to examination and found to be in sound condition. " Rotherhithe Street here is 22 feet wide, and partly owing to this and the height of the opposing warehouses, the front rooms of these houses are somewhat dark. "Between 10, Rotherhithe Street and 62, West Lane are the stables already mentioned. " The second group of houses extends from 46 to 62 (even numbers), West Lane. This consists of seven large three-storied houses. The third story in 48, 50 and 60 is an attic with dormer window. These houses are all very old but the brickwork is in fairly good condition. In Nos. 48, 50 and 52 the back of the house is weatherboard and in fair condition, and the fronts of 56 and 58 are plastered; these houses have all been redrained within the last three years. They are sub-let, most of the occupants being very poor. The houses are clean for this class of tenant. The ventilation generally is fairly good. The yards at rear of Nos. 48, 50, 52, 54, 60 and 62 range from 20 to 22 ft. in depth, those of 46, 56 and 58 being not less than 9 ft. The yard paving in one or two was defective, and other sanitary faults, such as defective w.c. flushes, were found. The main defects from a sanitary point of view are : (1) The roofs are old, and if not at present leaking seem to have been recently in that state; they are tiled. (2) The staircases are mostly in the centre of the houses and very dark. (3) The whole of the front rooms are dark, owing to the narrowness of West Lane (13 ft.) in this portion, and the height of the opposite building, which is a warehouse. " The third group of houses comprises the numbers 22 to 44, West Lane. They are all three-storied houses. In Nos. 28 to 36 the third storey consists of a small attic with dormer window. They are sub-let like the last. The walls of No. 36 are weatherboard, front and rear, in good condition. In the remainder the brickwork though old is in very good repair. They are fairly clean and in good condition generally, and any nuisances found were of a minor character, such as defective yard paving and, in one or two cases, defective w.c. flushes. The main defects from a sanitary point of view are: (1) Old tiled roofs and (2) dark staircases. The ventilation is good, and the air space ample in front and rear, since though the back yards of Nos. 22 to 26 are somewhat narrow they abut on the Mill Pond, and West Lane in the front varies in width from about 20 ft. opposite No. 44 to 38 ft. opposite No. 22, so that the front is both well lighted and ventilated. " The fourth group of houses is known as Iphigenia Cottages, and comprises three houses numbered 1, 2 and 3. They are entered from West Lane by a narrow passage consisting of two parts, the first being covered, 23 ft. 6 in. long, 2 ft. 11 in. wide, and about 10 ft. high; and the second open and 22 ft. long by 4 ft. 2 in. wide. These cottages are two storey. They are old but in fairly good condition sanitarily, since they were redrained about six years ago. The yards are rather small, but in Nos. 2 and 3 this is compensated for by the backs of the yards abutting on an open space belonging to the flour mill. No. 1 is rather confined in the front owing to the proximity of the wall of the back addition of 44, West Lane. Nos. 2 and 3 abut on an open space in front, and the side wall of No. 3 forms part of the boundary of the Mill Pond. The roofs here have the same defects as those in West Lane, but otherwise the sanitary condition is good. No. 3 was flooded three months ago, when the sluice valve of the Mill Pond was open." " The fifth group of houses includes 1 to 9 (odd numbers), Paradise Street. The houses in this group differ considerably from one another as regards their apparent age, state of repairs and general structure. They are all four-storied houses, the lowest storey being a basement, and, in Nos. 7 and 9, the top storey an attic with dormer window. "1 to 5, Paradise Street have been redrained within the last three years. No. 1 is a large house in the occupation of a builder and his family, two rooms being sub-let, and is in good repair and sanitary condition. No. 3 is sub-let. The brickwork of the back wall is in bad condition and requires pointing. The roof is leaky, but otherwise the house is in fair condition. The light and ventilation and air space are good. No. 5 is a very old and peculiarly built house. It consists of a basement used as a coal and wood store, and wash-house, first floor (three rooms), second floor (three rooms), and top floor (three rooms). One room on the top floor is registered as a common lodging house. The house is clean and in passable repair. There are no serious sanitary defects except that the staircase is dark and ill-ventilated owing to it being in the centre of the house. No. 7 has a basement used as a bakehouse. It is a very old house, curiously constructed. The first floor back is made of wood. The house is in fairly good repair, and there are no serious sanitary defects. No. 9is sub-let. The house is very old, the staircase dark and the roof leaky, but otherwise clean and in good repair. " Since the houses in this group all possess large back yards and the street in front is very open, they are, with the exceptions mentioned above, well off as regards light, ventilation and air space back and front. " The sixth group of houses is Gilham's Court. This consists of a long, narrow passage running from Paradise Street (between Nos. 5 and 7) north to Rotherhithe Street. It is about 130 yards long, and at its widest part is 8 ft. 9 in. wide. The entrance is narrower than the court itself, varying from 4 ft. to 5 ft. wide by 52 ft. long, and partly covered. For convenience in description, the houses naturally fall into four groups which have similarities of structure and condition. Group 1is situated at the north end of the court and on the east side. It consists of four rather large three-storied houses. They are all very old and are generally badly constructed, the staircases being especially dark and ill-ventilated through being situated in the middle of the house. The brickwork is in fair repair. The top storey is an attic with dormer window. It is deficient in cubic space and light. The tenants which occupy these houses are very poor and not very clean ; but the houses are, for this class, fairly clean and the general condition good. The roofs are tiled, and one was leaky, while the rest showed signs of having recently been so. The ventilation, with the exception of the staircase, is good, since these houses possess large yards varying from 15 to 20 feet in depth. They were redrained about six months ago. The whole of the front rooms are very dark, sinca the court here is only 8 feet wide, and the flour mill opposite is very high. " The second group comprises three two-storied houses, Nos. 5, 6 and 7. Judging from their appearance these houses are much newer than the last. The brick-work is fresh-looking, and in very good condition. Structurally they are better than the last, but the staircases are somewhat dark, They are sub-let, and occupied by poor people. The houses are clean. The only sanitary defects were the yard paving and condition of the top room at No. 7, which required stripping and cleansing. The light of the front rooms is fairly good, although the court here is only 8 feet wide, since the wall of the mill opposite is comparatively low ; but both light and ventilation in the rear are good since the back yards have a depth of 16 feet. " The third group comprises twelve houses, viz., 7A to 18. It bounds the court on the east side from the group just described to the rear of Paradise Street. Judging from appearance, these, and the group opposite, next to be described, would appear to be some of the oldest property adjacent to the Mill Pond. They are three-storied houses with four rooms, viz., two ground, one first floor and one attic. The attics are deficient in light, ventilation, and cubic space, since though the floor space is sufficient, the tapering of the roof makes it impossible to stand up except in the centre of the floor. " As the court between these and the opposite houses is only 8 feet 9 inches wide they are all deficient in light in the front rooms, ground, floor. They have proper through ventilation. The first floors are better lighted because they have a window overlooking the yard as well as one in front. The back yards of these houses have each an area of 182 square feet with the exception of Nos. 7A, 17 and 18, which are somewhat less. The only structure in these is a small w.c. and occasionally a shed. The depth, with the exception of those above mentioned, is 16 feet 4 inches from front to rear, and in the exceptions mentioned, not less than 12 feet. In addition the yards of Nos. 11 to 18 abut on the yards of Donne Place which are 8 feet in depth, so that all these houses are well provided with air space and light behind. On the whole the brickwork of these houses shows signs of age and is in want of re-pointing. This has been done in the case of the front walls of Nos. 7A, 14, 15 and 16, and No. 17 has been re-pointed back and front. The back portion of No. 18 is weatherboard, in dilapidated condition. The roofs are tiled and old and were mostly watertight, though those which were not actually leaky showed signs of having recently been so. In the interior of these houses the lower part of the staircase is very dark. The houses are tolerably clean and in a passable state of repair. They are all sub-let, and the tenants are very poor and none too clean. " The fourth and last group comprises eight houses on the opposite side of the Court, viz., Nos. 19 to 26. They are similar in structure and condition to the last, with the exception of the back yards. The attics are dark and ill-ventilated. The lower front rooms are dark, as also the bottom part of the staircase. The roofs are in similar condition to the previous group, and the brickwork shows signs of decay and requires pointing. The back wall of No. 26 is weatherboard in good condition. The back walls of the remainder are brick. those from 22 to 25 being more dilapidated than in any other part of the Court, while 19 to 21 are in fair condition. Nos. 19 to 24 have extra 35 long back yards, that at No. 26 being the smallest. As they abut on the old Mill Pond, all these dwellings are practically well off for light, ventilation, and air space in the rear. " Looking at the property under report, it may be described as old and in Some parts might be in better repair. The light, ventilation and air space in the front and rear of the houses, with the exceptions above-mentioned, are on the whole fairly good, and with regular inspection they could be kept in a sanitary condition for a good while to come. They are all ventilated under the floors, and, though many show no evidence of a damp course, the walls are dry. The roofs, where possible to ascertain, were tiled and liable to leak at any moment." The attics in those houses which possess them have very similar defects to those described in the attics of 7 to 26, Gilham's Court. " The following table gives particulars as to population, number of rooms, and ownership of the various houses : — Premises. Rooms. Families. Adults. Children Owner or Agent. under 10 under 1 3 2 5 0 0 Mr. Lugg 1, Gillhams Court 2, „ 5 1 2 4 0 „ 3, 5 3 12 3 0 „ 4, 4 2 4 1 0 „ 5, 5 2 3 3 0 Mr.Rye 5 6, „ 1 3 2 0 „ 7, 5 1 5 3 0 „ 7a, „ 4 1 4 1 0 Mr. Cripps 8, 4 2 5 1 0 Mr. Efford 9, „ 4 2 8 1 1 Mrs. Holding 10, 2 5 2 0 „ 4 11, 4 1 6 1 0 Mrs. Edwards 12, 4 1 6 1 0 „ 13, 4 5 0 0 1 „ „ 4 1 4 2 0 „ 15, 4 2 6 1 0 Mr. Lugg 16, 4 1 4 0 0 „ 17, 5 2 6 0 1 Mr. Osman 18, 4 2 4 1 1 Messrs. Bisley 19, 5 2 5 4 1 Mr. Osman 20, 5 2 10 1 0 Mrs. Holding 21, 5 2 7 4 1 Mrs. Brown 22, 4 1 5 0 0 Mr. Efford 23, 4 2 6 0 0 „ 24, 4 2 4 1 0 „ 25, 4 2 4 1 0 „ 26, 5 1 5 1 0 Mr. Back 1, Paradise Street 7 2 9 0 0 Mr. Harris 7 2 3, „ 5 3 0 Mr. O'Connor 5 5, „ 8 11 0 0 „ 1 2 0 7, 5 0 „ 3 9, „ 6 5 5 0 „ 22, West Lane 5 2 5 2 Mr. Robertson 0 6 2 24, 11 2 0 „ 26, „ 6 2 6 0 0 i 5 28, 2 8 1 0 Mr. D. Farmer 30, „ 5 2 4 3 0 „ 5 32, 1 3 0 0 „ 5 34, 2 9 2 0 Mr. Crip 36, „ 7 2 10 2 0 Mr. Cripps 38, 11 6 3 1 Mr. Gardiner 11 40, 11 5 1 20 4 Mr. Watts 42, 11 3 11 1 „ 7 44, 11 3 11 4 1 „ 46, 6 2 6 1 0 Mr. Boswell 5 2 9 48, 1 0 Mr. Chandler 1 50, „ 5 1 5 4 „ 52, 6 2 7 5 0 „ 54, 6 7 6 1 Mr. Cripps 3 7 6 4 56, „ 4 1 Mrs. Nutbeern 7 58, „ 6 3 1 0 „ 60, 2 9 7 0 6 Mr. Cripps 62, 6 3 9 0 0 (Regd.) „ (Regd.) 1, Iphigenia Cottages 4 1 6 0 0 „ 2, 4 1 3 0 0 „ 3, „ 7 1 0 4 1 10, Rotherhithe Street 6 2 0 Mr. Tidy 5 2 12, „ 5 1 3 0 0 Messrs. Burneys 14, 5 1 3 3 1 Mr. Tidy 317 374 116 13 y 118 36 " The total deaths during the last three years in this area number 42, which gives an annual death rate of 27*8, as compared with an average for the whole Borough for the last ten years of 21*8. The deaths of children under one year, during the same period, are 11, and the number living at present are 18, which gives an infantile mortality of 282' per thousand, compared with an infantile mortality of 167 for the whole Borough during the last ten years. I would point out that the basis on which the infantile mortality is calculated is different from that of the whole Borcugh, the latter being on the number of births, and not on the population under one year old living at the time. Notknowing the births in this area, it is impossible to say how far the actual rates differ. The number of persons per room is I*6, but Mr. Hoskins, the Inspector for the district, is of opinion that the actual population is more than that stated here. If this is so, the rates should be lowered. " Too much stress should not, however, be laid upon the death rate from so small an area, unless the difference between it and the rest of the Borough were very much greater. "The infectious diseases notified during the last three years consist of:-Scarlet fever, 1 case; diphtheria, 3 cases; enteric fever, 3 cases; erysipelas, 3 cases, and small pox, 1 case. This makes an attack rate of 7 per thousand, compared with 10 for the Borough in 1902. "Taking all the facts into consideration the area is not, in my opinion, a suitable one to form the subject of an official representation as an ' Insanitary Area under the Housing of the Working Classes Acts, though it would be a suitable site for a housing scheme, could the property be purchased along with the Mill Pond area, at a reasonable cost." Back-to-Back Houses. The following is a list of the back-to-back houses in the Borough. It is complete as far as groups of houses are concerned. There are two types in the Borough, 1st, the genuine, i.e., where two dwelling-houses back on to one another or on to a warehouse or other building, with no through ventilation in either case; 2nd, houses which have no back yard, but back on to an open space. Some of these have a very small window, generally high up in the staircase, but the ventilation is deficient. The difference is indicated in the following list. There may be a few odd houses of the second type not included here :- Persons. No. Address. Rooms. Remarks. Adults. Ch'n. 1 Medley Place 3 4 2 2 „ 3 4 1 3 „ 3 3 4 " 3 2 3 1 room on each floor. Back on a largewarehouse. No yards. Small windows opening on to top of staircase. These form one type of back-to-back houses. 5 ” 3 4 1 6 „ 3 5 0 7 „ 3 6 1 8 „ 3 3 5 9 „ 3 4 3 10 „ 3 3 3 Small yard at side in this case. 1 Mariners Buildings 3 2 8 2 „ 3 2 2 3 „ 5 3 2 Nos. 1, 2 and 3 back on Nos. 4, 5 and 6. These and next are typical back-to-back. 4 „ 5 1 — (Empty) 5 „ 8 2 4 6 „ 3 2 3 7 „ 3 2 - Nos. 7 and 8 Mariners Buildings back on to Nos. 31 and 32, Trinity Road. 8 „ 3 2 4 30A Trinity Road 3 2 — This is a type of back-to-back. 30 „ 5 2 5 31 „ 3 2 3 See above. 30, Trinity Road sides on to-30A, Trinity Road. 32 „ 3 2 4 1 Bryants Court 3 1 3 2 3 3 2 2, Bryants Court backs on No. 4 Genuine back-toback. 3 „ 3 2 3 4 „ „ „ 1 4 „ 3 2 2 1 „ „ „ 3 9 Silver Street 4 — — 9 Silver Street sides on to No. 10. 10 „ 4 1 3 1 Little Morris Court 3 5 — Type of back-to-back (unoccupied) Back on to New Lane without windows in back wall except small window in staircase. 2 „ 3 2 3 3 „ 3 - - 9 Nolan Place 3 2 3 Nos. 9 and 10 back on stables Nos. 11 and 12 back on Adam Street 10 „ 3 3 1 11 „ 3 2 - 12 „ 3 — — (unoccupied) 15 Bethel Place 2 5 Back on to public court but only have small ventilator in each through back wall top room 16 „ 2 2 - 37 Persons. No. Address. Rooms. Remarks. Adults. Ch'D. —— - - , I I j Both have yards. Door leading thereto 17 Bethel I'lace 2 2 — ( from ground floor room. Small ventila- 2g 2 4 — ( tor through back wall from first floor ) room. 19 2 1 1 ) These are acua]ly back-to-back premises. 20 " 2 2 5. ( Back on a shed. Neither have any through " V 1 . /Xrt 1 11 oi 2 5 — i ventilation, but 22 has a small ventilator * " „ I , 1 1 c Ul„ —A 99 2 2 1 ) at extreme back portion of gable end. " _ > -l — i i 1 .fir !. 4 Little Morris Court I 3 6 — ) Nob. 4 and 5 back on to yards of Morris 5 ~ ! 3 4 3 Courfc. 6 ! „ 3 4 4 1 No. 6 backs end of house, 7, Morris Court. 55 Tanner Street 4 5 3 Backs on to end wall of 1, Bermondsey PI. 57 i „ 4 5 — Backs on to end wall of 7, Bermondsey PI. 1 1 Bermondsey Place 3 3 2 }No vent, back wall. Small louvre in roof 2 | „ 3 7 — ( over staircase in back. 3 | „ 3 5 4 / Back on to tanyard. 4 „ 3 6 — ) (small windows on staircase) 5 „ " 3 2 1 j Back on yards of Finnimore Place, but 6 I „ 3 3 2 ' have no light or vent, in back wall except 7 | „ 3 3 1 I ' small window on each staircase. 1 I Llama Place 2 3 3 \ 2 ! „ 2 3 1 I 3„24 ; - ! 4 | „ 2 4 - 5 v 2 2 2 6 „ 2 j 2 2 v These are typical back-to-back bouses. 7 „2 2 2 j 8 „ 2 1 2 , I 9„2, 2 i 3 10 „ 2 2 1 | 11 „ 2 3 2 j 12 ~ „ , ? . T \ 1 j Gutteridge Court 3 i 3 2 2 „ 3 2 2 L. u i_ , . , , , . g " o 3 J (These houses have no back yards and might . ~ / be classed as one type of back-to-back ► i ao uuc vj ui uava-iu-uav/iv w I hniifipe Tlipv liavp lioTOovor amnio ano^o 5 2 4 nouses, l ney nave, However, ample space 6 ;; z 2 i 2:) in front - 7 ;; i 2 , 2 4 1 | Caroline Court 2 2 1 } These houses back on to a large warehouse 2 „ 2 2 — and have no through ventilation what- 3 j „ 2 2 — > ever. 4 „ 2 2 1 I They might be classed as genuine back-to- 5 i „ | 2 2 3 I ) hack houses. , Insanitary Area. I made an official representation to the London County Council of an area near Crosby Row, but, as the matter is still under consideration, I do not propose to enter into any details until next Annual Report. House llejuse. The following table gives the amount of house and trade refuse disposed of during the year ended March 31st, 1905. There is a slight increase in both totals. During the year two fresh cells were added to the Bermondsey Destructor, making the number in use now eight. In addition, the Rotherhithe Destructor was closed down, since it was found more economical to deal with the refuse at one place, especially as the Rotherhithe one was so out of the way. This accounts for the small amount burnt in Rotherhithe. Loads. Tone. cwts. qrs. Bermondsey Destructor 8,847 17,892 0 1 Rotherhithe „ 686 1,284 16 0 Bermondsey "Wharf 21 37 17 0 Rotherhithe „ 304 582 16 0 9,858 19,797 9 1 Trade Refuse — Bermondsey Destructor 447 349 9 2 Wharf 804 1,567 16 0 Eotherhithe Destructor 11 19 16 0 1,262 1,937 1 2 Smoke Nuisances. 148 observations were made and 48 nuisances were reported to the Committee. No procèdings were taken. Customs and Inland Revenue Act. Certificates under section 26 of the above Act were granted to the following premises:— Hythe Buildings, Swan Lane 70 tenements Barnaby Buildings, Leroy Street 80 „ Winchelsea Buildings, Swan Lane 65 „ 17, 19, 21, 23, Cherry Garden Street 12 „ Public Health Legislature. VACCINATION.THE EXPIRING LAWS CONTINUATION ACT, 1904, extended the period of the Vaccination Act, 1898, to December 1st, 1905. THE LOLDON COUNTY COUNCIL (GENERAL POWERS) ACT came into force on August 15th. The provisions concerning the public health are dealt with under Part IV. Sec. 19 (1). Enables the Sanitary Authority, on the certificate of the Medical Officer of Health, to disinfect any articles in any house which are in such a filthy, dangerous or unwhole-some condition, that health is affected or in danger. Sec. 19 (2). Enables them to compensate the owner for unnecessary damage. Sec. 20 (1). Enables the Sanitary Authority, on the certificate of their Medical Officer of Health that any house is infected with vermin, to give notice to the owner or occupier to have it disinfected. Sec. 20 (2). If the person fails in the above the Sanitary Authority have power to do the disinfection and recover the cost. Sec. 20 (3). Deals with the apportionment of the cost. Sec. 21. Extends the provisions of Sec. 59 of the Public Health (London) Act, 1891, to the last two sections. Sec. 22. Enables the Sanitary Authority to deal with any sanitary convenience now or hereafter erected, which is a nuisance or offensive to public decency. Sec. 23. Enables them to require that fixed ashpits be removed where movable ashpits have been provided. Sec. 24. Deals with power of entry for the aforesaid purposes. Sec. 25. Deals with the enforcing of the provisions of this Act. Sec. 26. Deals with the interpretation of the terms used. Part. V. Deals with tuberculosis of the udder in cows, and enables the veterinary surgeon appointed by the Council for the purpose of the Dairies, Cowsheds and Milkshops Order of 1899, if he suspects any cow to be suffering from tuberculosis of the udder, to have this cow removed and slaughtered, due provision being made for compensation. An important Conference was held during the year on the Administration of the Public Health Act, 1891, convened by the London County Council, and in which all the Metropolitan Boroughs were asked to participate. The following resolutions were passed:— HOUSING. Houses Let in Lodgings. (6) That the efficient administration of Section 94 of the Public Health (London) Act, 1891, relating to the registration and regulation of houses let in lodgings is a matter of extreme importance to the public health of London. (7) That it is advisable that in bye-laws made in respect of houses let in lodgings there should be no rental limit of exemption, but that they should be so framed as to apply only to such houses as are registered by the sanitary authority. (8) That the efficient enforcement of bye-laws relating to houses let in lodgings is the most effective method of dealing with overcrowding, but that inspection should from time to time be made during the early hours of the morning at other houses where overcrowding within the meaning of Section (2), (1), (e) of the Public Health (London) Act, 1891, is suspected. Underground Rooms. (9) That a single angle of light and air to underground dwelling rooms should be adopted in the enforcing of Section 96 of the Public Health (London) Act, 1891. (10) That this Conference is of opinion that no underground room not complying with the conditions laid down by Section 96 of the Public Health (London) Act, 1891, should be used for sleeping. Water Supply. (11) That a draw-off tap from the rising main and a sink should be provided on every floor of a tenement house. Factories and Workshops. (12) That it is desirable that the sanitary authorities in enforcing Section 38 of the Public Health (London) Act. 1891, should adopt the following standards :— I. In factories and workshops where females are employed or in attendance there shall be one sanitary convenience for every 25 females, provided that in factories or workshops where the number of females employed or in attendance does not exceed 75, the following shall be the standard:- One sanitary convenience where no more than 15 females are employed or in attendance. Two sanitary conveniences where from 15 to 40 females are employed or in attendance. Three sanitary conveniences where from 40 to 75 females are employed or in attendance. II. In factories or workshops where males are employed or in attendance there shall be one sanitary convenience for every 25 males ; provided that— (a) in factories or workshops where the number of males employed or in attendance does not exceed 50, and sufficient urinal accommodation is also provided there shall be one sanitary convenience where no more than 20 males are employed or in attendance, and two sanitary conveniences where from 20 to 50 males are employed or in attendance. (b) in factories or workshops where the number of males employed or in attendance exceeds 100, and sufficient urinal accommodation is also provided, it shall be sufficient if there is one sanitary convenience for every 25 males up to the first 100, and one for every 40 after ; (c) in factories or workshops where the number of males employed or in attendance exceeds 500, and the district inspector of factories certifies in writing that, by means of a check system, or otherwise, proper supervision and control in regard to the use of the conveniences are exercised by officers specially appointed for that purpose, it shall be sufficient if one sanitary convenience is provided for every 60 males, in addition to sufficient urinal accommodation. Any certificate given by an inspector shall be kept attached to the general register, and shall be liable at any time to be revoked by notice in writing from the inspector. (In calculating the number of conveniences required, any odd number of persons less than 15, 20, 25, 40 or 60, as the case may be, shall be reckoned as 15, 20, 25, 40 or 60.) Shops. (13) That it is desirable that power should be given to local authorities to inspect the sleeping accommodation in shops where the assistants are boarded in. FOOD. Premises where food is prepared for sale. (14) That the London County Council be requested to insert in their General Powers Bill for the Session of 1905 a clause enabling them to make bye-laws for the regulation of the structure of premises where food is prepared for sale and that no such premises should be used unless certified by the Borough Council to be suitable for the purpose. (15) That the London County Council be requested to insert in their General Powers Bill for the Session of 1905 a clause enabling them to make bye-laws for the regulation of the conduct of the business carried on in premises where food is prepared for sale, such bye-laws to be enforced by the Borough Councils. Abolition of private Slaughter-houses. (16) That the time has arrived when private slaughter-houses should cease to exist in London. Inspection of meat killed in private Slaughter-houses. (17) That it is desirable that Borough Councils should endeavour to have all meat that is killed inspected. Inspection of Slaughter-houses, Cowhouses, Dairies, Milkshops, and Milkstores. (18) That slaughter-houses, cowhouses, dairies, milkshops and milkstores should be frequently inspected. Registration of Milk Shops. (19) That the London County Council be requested to take powers to enable the Metropolitan Borough Councils to refuse registration of premises as milkshops where, in their opinion, the premises are unfit for the purpose." Sale of Milk. (20) That the London County Council be requested to introduce legislation providing for the penalising of persons selling filthy milk in London. Municipal Milk Depots. (21) That, having regard to the declining birth rate and the large infantile mortality rate of the Metropolis, it is desirable that the Metropolitan Borough Councils should be empowered at their discretion, to provide in their respective districts depots for the preparation and sale of sterilised and humanised milk for the food of infants, and that the London County Council be requested to insert a clause in its General Powers Bill for the session of 1905 to confer such power upon the said Borough Councils. Sale of Food and Drugs Acts. (22) (a) That, in the opinion of this Conference, the provisions of section 25 of the Food and Drugs Act, 1875, and of section 20 of the Food and Drugs Act, 1899, operate to the prejudice of the purchaser and of public health, and should be repealed. (b) That the London County Council be requested to make a communication, conveying the resolution of the Conference, to the President of the Local Government Board, with a view of his promoting legislation for this purpose. (23) That the Local Government Board and the Board of Agriculture be asked to take such steps as may be necessary in order that a limit may be fixed as to the amount of boracic acid—that is free or combined boracic acid-or other preservatives which may be mixed with food other than milk. (24) That every registered milk seller in a borough shall have his milk tested frequently. Cisterns. (25) That, in cases where there is a constant water supply, cisterns should only be used in connection with hot water services and sanitary conveniences. PREVENTION OF DISEASE. Disinfection. (26) That this Conference is of opinion that disinfection should be carried out by the responsible officers of the sanitary authority without the intervention of a contractor. (27) That the London County Council be asked to take measures to amend the law with regard to disinfection, so that disinfection should be carried out by the responsible officers of the sanitary authority, without the intervention of a contractor, and that in ail cases the disinfection should be to the satisfaction of the Medical Officer of Health. Provision of Laundry. (28) That the provision of a laundry for use in connection with the disinfection of infected articles is essential. Provision of Permanent Shelter Accommodation. (29) That at least one permanent shelter for temporary use should be provided in each borough for the accommodation of persons during the disinfection of their homes. (30) That the word " accommodation " mentioned in Section 60, sub-section 4, of the Public Health (London) Act, 1891, should, if and when necessary, include the expense of the supply of food. Precautionary Measures against Phthisis. (31) That the system of voluntary notification of phthisis is desirable, and should be made general throughout London. (32) That the sanitary authorities should disinfect the premises in which a person suffering from phthisis has died, .or from which such a pàtient his removed or lias been removed. Hospital Accommodation. (33) That it is desirable to make provision of sanatoria for the isolation and treatment of persons suffering from consumption, for the Metropolis as a whole, and under one authority ; and that, in the opinion of this Conference, the Metropolitan Asylums Board should be such authority. (34) That the foregoing resolution be sent to the Local Government Board with the request that they give the matter their immediate consideration. Offensive Trades. (35) That the business of a marine store dealer should be added to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891. (36) That the business of a fried fish shop keeper should be added to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891. (37) That the London County Council be requested to make an Order to carry out these resolutions. House Refuse. (38) That this Conference is of opinion that dust collection should be carried out by the responsible officers of the sanitary authority, without the intervention of the contractor. (39) That the daily removal of house refuse in suitable districts is advisable. (40) That improved dust carts should be adopted, so covered as to minimise annoyance caused to passers-by during collection of house refuse, especially in crowded thoroughfares. (41) That the method of destruction of house refuse by tire should be universally adopted in London. Collection of Fish Offal and other Offensive Trade Refuse. (42) That the collection of fish offal and other offensive trade refuse should be undertaken by the sanitary authorities at the expense of the producers. SANITARY INSPECTION. (43) That female inspectors should be employed in each borough. MISCELLANEOUS. Municipal Creches. (44) That, having regard to the declining birth rate and the large infantile mortality rate of the Metropolis, it is desirable that the Metropolitan Borough Councils should be empowered at their discretion to establish creches for the reception of young children during the hours their mothers are employed in work away from home, and to make reasonable charges for the accommodation so provided and for the food of the children, and that the London County Council be requested to insert in their General Powers Bill for the session of 1905 a clause to confer such power upon the said Borough Councils. Smoke Nuisances. (45) That in the opinion of this Conference it is desirable that the provisions of the Public Health (London) Act, 1891, as to nuisances arising from the emission of smoke, should be applied to property in the possession of the Crown. Metropolitan Ambulance Service. (46) That the Conference, taking note that the Metropolitan Asylums Board are prepared to extend the operations of their ambulance service so as to include the transport of medical, surgical and mental cases, respectfully requests the Local Government Board to obtain for the Managers the requisite legal authority to enable them to do so. (47) That the Conference desires to express the opinion that should the London County Council not be able to provide for a street ambulance service the duty should be undertaken by the Metropolitan Asylums Board. Application of Acts to Government Property. (48) That all provisions of the Public Health and Sanitary Acts should apply to Government property. On these resolutions being presented to the Bermondsey Borough Council, they expressed the following views and recommendations : — " With some few exceptions we concur in and thoroughly endorse the views expressed and proposals made in the various resolutions. With reference to resolution No. 28, " that the provision of a laundry for use in connection with the disinfection of infected articles is essential," we have directed the Medical Officer to make inquiries and report fully to us upon the matter. With reference to resolutions Nos. 33 and 34 (Hospital accommodation for Consumption), 43 (Female Sanitary Inspector), 44 (Municipal Creches), we do not submit any recommendation. We recommend — That the London County Council be informed— (a) That this Council approves of the views and proposals contained in the resolutions numbered 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 23, 24, 25, 26, 27, 29, 30, 31, 32, 35, 40, 41, 42, 45, 46, 47, 48. (b) That with reference to resolution 22 this Council adheres to the views expressed in the report forwarded to the County Council on the 19th September, 1904, dealing with the question of warranties under the Sale of Food and Drugs Acts. (c) That as regards resolution 22 the views of this Council will be forwarded at a later date. (d) That this Council disagrees with the proposal in resolutions 36 and 37 to add the business of a fried fish shop keeper to the list of offensive businesses under Sec. 19 of the Public Health (London) Act, 1891. (e) That with reference to resolution 39, the Council is further of opinion— (1) That bye-law No. 9 made by the London County Council should be amended so as to provide for the removal of house refuse at least twice every week instead of once a week as at present. (2) That the daily removal of house refuse is advisable in all districts during the months of June, July, August and September." A Conference on the spread of infectious disease among vagrants was also convened by the London County Council, and attended by representatives of the County Councils of England and Wales, the Corporation of the City of London, and the Councils of County and Metropolitan Boroughs. Various resolutions were adopted for dealing with this evil, and to give effect to these a Special Committee was appointed to wait on the Local Government Board and take such measures as might be deemed advisable to support the resolutions of the Conference. IV.—FACTORIES AND WORKSHOPS. In Table VIII. of the Appendix will be found particulars of inspection of factories and workshops and the action taken, and in annexed table some particulars regarding the number of workshops on the register with the number of persons employed. In 1904 there were 476 workshops on the register against 322 in 1903. Including bakehouses, of which there are 105, the total is 581. The number is being gradually increased, but I do not think we have got more than two-thirds of those that exist in Bermondsey on the books. I have urged in each report the advisability of employing a female inspector for this branch of the administration, but the Council (when I brought the matter up this spring) decided against it. Home Work. There were 477 outworkers' premises on the register in 1904, against 345 in 1903. Several of these are on the workshops' register. 24 lists were sent in by firms in Bermondsey which give out work, and those names which received work outside the Borough were duly forwarded to their respective boroughs. There is some difficulty getting firms to forward these lists regularly, but there are some signs of improvement in this respect. They were written to two or three times during the year. Very often the inspectors in the course of their house-to-house visitation come across an outworker whose name has not been received. Occasionally they refuse to tell the name of the firm for which they work; this happened at least once last year. Unfortunately, there does not appear to be any provision in the Act to compel the outworker in such case to give correct information. One case of enteric fever occurred in the home of an outworker in St. James' Road during the year. The firm giving the work was immediately notified of it, and no more work was given out until the house and articles in it likely to retain infection were disinfected after the death of the patient on September 6th, 1904. Bakehouses. There are at present 105 retail bakehouses in the Borough, viz., 41 underground and 64 above. Of the underground 33 are in use and 8 not. Six of these were not in use at the time the Factory and Workshop Act came into force and two were not granted certificates as the owners did not comply with the requirements of the Council. Of the 64 overground bakehouses 56 are in use and 8 not. The bakehouses were all visited twice during the year, and the usual requirements as to limewashing were complied with. The improvements in connection with the underground bakehouses were fully dealt with in last year's report. APPENDIX. 43 APPENDIX. Table I. —Vital Statistics of Whole District during 1904 and Previous Years-. Year. 1 Population estimated to Middle of each Year. 2 Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. 10 Deaths of Residents registered in Pnblic Institutions beyond the District. 11 Net Deaths at all Ages belonging to the District. Births. Total Deaths Registered in the District. Number. 3 Rate. 4 Under 1 Year of Age. At all Ages. Rate* 13 Number. 12 Rate. ☼ 8 Number. 7 Rate per 1000 Births registered. 6 Number. 5 1894 137,249 35·9 745 151 2417 336 2766 17·6 392 20.1 4928 43 1895 137,438 4944 35·9 818 165 2650 19·3 387 41 357 2966 21.6 1896 36·2 807 162 2646 19·3 385 2968 21·6 137,231 4968 57 379 135,827 4868 903 185 2540 404 21.4 1897 35·8 18·7 35 397 2902 1898 134,446 4745 35·3 779 164 2422 18.0 438 81 435 2776 20.6 133,085 35·2 855 182 3204 24·1 1899 4690 2817 21·2 515 48 435 131,748 837 190 2684 20·4 23·3 1900 4410 33·5 540 99 477 3062 1901 130,633 4459 34·1 711 159 2320 17·8 423 52 451 2719 20·8 1902 130,137 4346 33·4 636 146 2323 17·8 460 63 496 2756 21·2 1903 129,654 4200 32·4 596 142 1973 15·2 414 40 449 2382 18·4 Averages for years 1804-1903 133,745 4656 34.8 769 165 2479 18·5 430 56 427 21·3 2850 1904 129,187 4193 32·4 654 156 2142 440 44 495 2593 20·1 16.6 Rates in columns 4, 8, and 13 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 1336.1. At Census of 1901 —Total population of all ages, 130,760. Number of inhabited houses, 15,817. Average number of persons per house, 8.26. II. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the District. I. Institutions within the District receiving sick and infirm persons from outside the District. No.of Deaths Bermondsey Workhouse, Ladywell-51 deaths Column No. 10 includes deaths of non-residents which occurred in the following :— Guy's Hospital 233 Bermondsey Workhouse, Ladywell 51 „ Children's Home, Peckham Rye 3 1. Bermondsey Infirmary, Rotherhithe Brook Hospital 32 Park „ 5 South Western Hospital 2 2. Bermondsey Workhouse, Tanner Street St. Bartholomew's Hospital 11 Evelina Hospital 10 Seamen's Hospital, Greenwich 3 8. Bermondsey Workhouse, Parish Street King's College Hospital 3 London Hospital 5 St. Thomas' Hospital 8 i. Metropolitan Asylums Board Wharf and Shelter, Rotherhithe East London Hospital 10 Chest Hospital, Victoria Park 1 Royal Face Hospital 1 Westminster Hospital 1 5. Surrey Commercial Docks, River Thames, etc. London Temperance Hospital 1 General Lying-in Hospital, York Road 2 Friedenheim Hospital 2 Charing Cross Hospital 8 West London Hospital 1 Homoeopathic Hospital, Great Ormond Street 2 Miller Hospital 1 New Hospital for Women, Euston Rd. 1 Cancer Hospital 1 Clapham Maternity Hospital 1 Cane Hill Asylum 12 Dartford Asylum 8 Caterham Asylum 14 Leavesden Asylum 2 Banstead Asylum 5 44 Institutions within the District receiving sick and infirm persons from outside the District 11. Institutions outside the District receiving sick ami infirm persons from the District. 111. Other Institutions, the deaths in which have been distribute i among the several localities in the District. 1 . No. of Deaths Tooting Bee Asylum 15 Norwood Asylum 1 Claybury Asylum 4 Dareuth Asylum 1 Horton Asylum 5 Manor Asylum, Epsom 1 City Infirmary, Bromley 1 Shoreditch Intirmary 2 Southwark Infirmary 1 Lewisham Infirmary 1 Wkitechapel Infirmary 1 Greenwich Workhouse 2 St. Peter's House, Kennington 1 Licensed Victuallers' Asylum, Peckham 1 Wandsworth Prison 1 River Thames 5 Grand Surrey Canal 2 Miscellaneous 10 Total 495 Table ll.—Vital Statistics of separate Localities in 1904 and previous Years. BERMONDSEY. ROTHBBHITHE. ST. OLAVE'S. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Births registered. Death at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Year. 1734 451 39,983 1353 764 12,069 268 1894 85,197 3095 218 480 55 1895 85,356 3212 1869 520 40,208 1304 783 193 11,874 428 314 88 1896 85,323 3203 1873 513 40,281 1346 834 214 11,627 419 261 64 1897 84,717 3176 1883 605 39,890 1258 766 219 11,220 434 253 67 1898 84,116 3090 1771 485 39,504 1298 773 220 10,826 357 232 47 1899 83,518 3063 2063 574 89,121 1266 865 215 10,446 361 276 53 1900 82,925 2826 1948 526 38,742 1184 883 243 10,081 400 231 48 1901 82,441 2920 1768 497 38,446 1220 747 215 9,746 319 204 42 1902 82,281 2855 1782 455 38,394 1170 741 174 9,462 321 233 49 2801 1903 I 82,129 1523 453 38,347 1116 655 168 9,178 283 204 36 Averages of years 1894 to 1903. 1821 508 781 208 10,053 380 248 55 3024 39,292 1251 83,800 1904 81,986 2748 477 38,304 1083 187 8,897 BG2 246 1634 713 59 Table lll.—Cases of Infectious Disease Notified During the Year 1904. Notifiable Disease. Cases Notified in Whole District: Total Cases Notified in Bach Locality. No. of Cases Removed to Hospital from Each Locality. Rotherith At all Ages. Bermondsey. Bermondsey. Rotherhithe. St. Olave. St. Olave. At ages— Years. Under I 1. 5 to 15. 15 to 25. 25 to 65. 65 and Upward 1 to 5. ' 19 1 6 - 6 6 7 6 5 7 1 10 Small-pox 1 Cholera - - - - - i - - - - vuuiuin 191 12 69 1)2 92 5 - 123 60 8 118 48 8 Membranous croup - - - - - - - - - - - - Erysipelas 187 1 11 22 21 100 29 126 50 11 - - - scarlet5 451 8 165 247 20 11 - 2GB 163 20 242 137 20 Typhus fever - - - - - I - I - - - - - 32 22 Enteric fever 73 - 4 26 21 22 - 42 29 2 2 Relapsing fever - - - - - - - - - - - - - 1 Continued fever - - - - 1 - 1 - 1 - - - Puerperal fever 4 - - 3 1 - 3 - 1 - - - - Plague - - - - - - - - - - - - - 38 157 99 chicken-pox (From Apiil 7th to Nov. 7th) 294 35 136 121 2 - - - - - 212 37 87 398 407 Totals 1220 60 368 509 86 150 29 726 Table IV.—Births and Corrected Deaths, for the Year 1904. Cause of Death. All Ages. Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upward Corrected deaths all ages. Outling Institutions Indtitutions in Borought Deaths of Non-Parisioners i Boro., Bermoudsey. Rotherhithe. St.Olave's. Small-pox - - - - - - - - - - - - 1 Measles 136 33 99 4 - - - 87 42 7 7 3 - Scarlet Fever 18 2 9 7 - - 12 6 17 - - - - Whooping Cough 68 22 45 1 - — - 43 19 6 4 2 - Diphtheria and Membranous Croup 17 4 10 2 - - - 6 1 10 15 - - - <Jroup [ I -I 1 - - - - - - - - - fe (lyplius - - - - - - -- - - - - - - Enteric 16 4 5 4 4 7 1 8 8 - 12 1 - other Continued 3 1 1 - - 1 - 3 - -- - - - 4 - 5 - Epidemic Influenza. 19 - 1 1 - 12 5 13 2 Cholera - - - - - - - - - - - - - Plague - - - - - - - - - - - Diarrhoea 189 148 35 - 3 » 122 49 18 2 2 25 - Enteritis 13 8 1 - 3 - 11 2 - 2 - 1 - Puerperal Fever 2 - 1 1 - 1 - 1 2 - - - - - 4 Erysipelas 8 2 1 - 2 3 4 2 2 2 - 3 Other Septic Diseases 23 3 6 1 2 8 6 17 * 3 14 - Phthisis 257 3 6 12 34 197 5 166 60 I 31 19 112 8 17 1 7 22 Other Tubercular diseases 93 33 3535 60 29 4 22 1 - Cancer and Malignant disease 92 - - - 63 26 23 7 19 30 81 62 4 Bronchitis 256 55 - 112 72 13 53 1 14 75 171 20 - Pneumonia 273 84 88 3 7 58 88 164 81 ! 28 47 23 2 Pleurisy 2 1 - - - 1 - 1 1 - 1 - - Other diseases of Respiratory Organs 11 2 1 1 1 3 3 5 2 4 6 - 1 Alcoholism and Cirrhosis of Liver 39 - - - 25 4 21 11 7 7 8 1 - Venereal diseases 7 6 - -- 1 - 6 1 - - - - - Premature birth 91 11 - - - -- 32 8 8 1 91 53 - Diseases and accidents of Parturition 1 - - - 1 - 1 - 1- - - Heart diseases 154 > 2 7 9 84 51 90 46 18» 35 3500 2 3333 Accidents 30 103 10 8 8 ! 37 10 sfl 2! 15 46 2 1+ Suicides ill ,1 /~i 11 - - 2 9 - 8 3 - 3 A t 3 All other Causes— 691 191 32 16 16 11 222 216 4:17 183437 71 164 134 9 All Causes 2593 396 85 81 829 479 1034 718 246 495 440 44 723 ST. OLAVE'S. WHOLE BOBOOGH, Bermonfatrs. ROTHERHITHE. BERJIONDSEY. M. * F. M. , I M. & F. If. F. I M. i F. ! M. F. M. M. & F. F. 1429 1319 2748 542 541 108:3 198 164 362 2169 2024 4193 46 Table V.— Meteorology of the Year, 1904 (Greenwich Record). 1904. MONTH. Mean Reading of the Barometer. TEMPERATURE OF THE AIR. RAIN. A Minimum. B Maximum. Mean of A and B. Number of days it fell. Amount collected. 0 0 ins. ins. 0 29·778 33·8 38·7 16 2.51 43·7 January ... ... 44·4 29·417 39·4 19 2·55 .. ... 34·5 February 47·3 40·5 12 1·36 29·800 33·7 March ... ... 57·7 49·2 13 1·01 29.771 40·7 April ... ... 29·781 62·0 53·7 14 1·92 45·4 May ... ... 29·875 68·4 58·5 8 0·87 48·6 June ... ... 77·3 66·2 14 2·23 29·859 55·2 July ... ... 73·0 62·4 8 1·24 29·845 51·8 August ... ... 64·7 55·8 11 1·34 29·893 46·9 September ... ... 57·5 50·6 16 1·74 29·932 43·6 October ... ... 11 47·5 42·1 1·65 29·892 36·7 November ... ... 40·3 23 2·25 35·6 44·9 December ... 29·762 49·8 20·67 Sum. 29·800 57·4 Means ... ... 42·2 165 Sum. Table VI.—Marriages. ROTHERHITHE. ST. OLAVE'S. WHOLE BOROUGH. BERMONDSEY. No. Rate. Year. No. Rate. No. Rate. No. Rate. 105 877 547 12·84 225 11·26 1894 17·40 12·78 72 12·12 917 13.34 605 14·18 240 11·94 1895 73 12·56 1027 14·9 16·08 268 13·30 1896 686 280 14·04 86 15·32 1197 17·62 19·62 1897 831 15·28 81 14·96 1216 18·08 833 19·80 302 1898 68 13·02 1182 17·76 826 19·78 288 14·72 1899 69 13·68 1186 18·00 18·88 334 17·24 1900 783 58 11·92 1154 17·70 19·44 296 15·42 1901 800 54 11·50 1123 17·39 19·55 270 14·22 1902 799 69 15·23 1101 17·22 19·56 238 12·65 1993 794 73 13·77 1098 16·48 750 Average for years 1894-1903 14·01 17·97 274 17·11 280 14·62 58 13·04 767 1105 1904 18·71 Table VII. —Proceedings during 1904. NUMBER OP PLACES. Number of prosecution-1904. Number of notice, 1904. Number of inspection-, 1904. Removed in 1904. On register at end of 1904. PREMISES. On register at end of l903. Added in 1904. 444 15 - 3 286 Milk premises 301 18 - - 7 {170 2 7 Cowsheds - 1 - 3 2 Slaughter-bouses - 2 13 118 3 Other offensive trade premises 13 - - - 285 14 1 - 69 Ice cream premises 68 - 218 462 93 Registered houses let in lodgings 207 11 - 2 for overcrowding Table Vlll.—Factories, Workshops, Laundries, Workplaces and Homework. (1) Inspection. Number of Premises. Prosecutions. Inspections. Written Notices. 13 - Factories (including Factory Laundries) 47 72 264 Workshops (including "Workshop Laundries) - 138 376 - Workplaces 32 Homeworkers' Premises 274 - - 961 255 Total 47 Table VIII. —continued. (2) Defects Found. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Particulars. Nuisances under the Public Health Acts : — Want of Cleanliness 180 180 - - 11 Want of Ventilation 11 - - Overcrowding 3 3 3 - Want of Drainage of Floors 23 23 Other Nuisances - 213 206 - I Insufficient 15 15 - - Sanitary Accommodations -! Unsuitable or Defective 81 81 (Not Separate for Sexes 10 10 - - O-fenee» under tin- Factory and Workshop Act: — - - Illegal Occupation of Underground Bakehouse (s. 101) - - - - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) i Failure as regard Lists of Outworkers (s. 107) - - - - G=iving out work to be done I Unwholesome (s. 108) = = in premises which are (Infected (s. 110) Allowing Wearing Apparel to be made in Premises infected by Scarlet Fever or Small Pox (s. 109) - Other Offences 536 529 - Total - (3) Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories : — Failure to affix Abstract of the Factory and Workshop Act (s. 133) 2 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (s. 5) {Notified by H.M. Inspector 1 {Reports (of action taken) sent {to H.M. Inspectors 1 Other ... Underground Bakehouses (a. 101) : — In use during 1903 33 {in 1903 33 Certificates granted {in 1904 ... In use at the end of 1904 33 Number of Homework:— Hat of Outworkers (s. 107) :— Lists. outworkers. Lists received 24 363 {forwarded to other Authorities 54 169 Addresses of outworkers {received from other Authorities 283 86 Wearing Apparel. Other. Homework in unwholesome or injected premises : — Notices prohibiting homework in unwholesome premises (s. 108) Cases of infectious disease notified in homeworkers' premises 1 Orders prohibiting homework in infected premises (s. 110) 1 Workshops on the Register (s. 131) at the end of 1904 476 Bakehouses 105 Total number of workshops on Register 48 Table IX.—Workshops. Trade. No. of Workshops on Register. No. of Workrooms. Persons Employed. Young Persons. Males. Females. Brashmakers - 17 25 11 21 Bottle Washers 2 12 7 4 - Boot Makers and Repairers 34 63 1 36 - Buttonhole Makers 4 5 6 3 - Collar Workers 13 15 - 16 - Chair Making 4 3 3 - - Cycle Makers 4 5 6 2 - Curriers 2 4 7 - - Coopers 6 21 6 - - Cork Cutters 2 2 4 - - Carmen, Stables 5 6 68 - - Carpenters' Shops (builders) 9 9 19 - - Dressmakers, etc. 86 33 42 1 10 - Engineers and Smiths 7 7 13 2 1 Farriers 3 11 3 - Harness Makers and Strap Workers Hairdressers 2 7 8 21 - 88 88 158 1 4 Leather Workers 9 9 34 5 - Laundries 170 23 56 5 - Mantle Makers 11 12 2 31 - Paper Bag Makers 3 3 3 - - Picture Frame Makers 12 2 6 - - Rag Sorters 2 2 1 2 - Sack Makers 4 4 3 4 2 Shirt and Blouse Makers 5 5 6 - 2 Shirt Makers 19 19 26 - - Tailors 10 10 17 26 - Tobacco Pipe Makers 2 4 - - - Tie Makers 9 9 23 - - Tin Workers 2 5 8 2 - Underclothing 11 22 9 - - Undertakers 2 2 3 - - Wheelwrights 6 8 28 - - Waistcoat Work 8 4 4 - - Wood Choppers 9 9 10 2 17 Various 107 123 340 54 21 476 509 Totals 565 901 61 Table X.— Sanitary Work, 1904. Mr. Thomas. Mr. Ashdown Mr. Cockburn Mr. Bartlett. Mr. Toogood. Mr. Scott. Mr. Williams Mr. Hoskins. Mr. Harris. Mr. Jones. Mr. Davies. Totals. Houses and other places inspected:— 466 534 383 450 House to house 509 822 565 689 547 105 3 5073 Various 655 527 359 662 681 832 771 893 428 210 4 6031 3188 2022 Re-inspections 2714 2595 2790 2929 2321 1940 3466 764 28 24707 Notices and intimations served: — I Intimations 541 618 415 247 356 318 829 452 281 108 5 3670 147 83 Statutories 224 84 33 100 30 53 129 16 899 - 113 Houses or parts of houses cleansed or repaired 273 229 821 70 152 87 195 97 131 1669 1 W.C. accommodation provided or reconstructed 1 4 11 4 6 1 11 5 46 - 3 - W.C.s repaired, ventilated, and whitewashed 31 110 103 50 9 27 14 59 2 29 1 435 7 Closets panned and trapped, or old pans cleansed or new ones fixed 56 91 289 14 23 16 39 67 23 - 625 Closets supplied with water or defective water Supplies remedied 40 88 37 9 96 25 48 93 21 30 - 487 Defective drains reconstructed, repaired, ventilated or trapped 43 49 107 32 15 39 36 95 14 5 1 436 43 83 Stopped drains and W.C.s cleared 49 86 24 45 32 10 1 48 27 448 75 76 Yards and forecourts paved or paving repaired 25 84 42 34 130 95 25 29 1 616 6 Houses supplied with water 2 13 5 3 2 2 5 - 2 40 - Defective roofs repaired 89 144 83 30 37 39 92 55 - 55 31 655 Defective rainshoots and gutters repaired, unstopped, or disconnected from drain 144 32 21 40 33 55 151 22 - 85 20 603 Offensive accumulations removed 3 1 8 13 5 - 4 57 6 8 4 109 Defective water apparatus in W.C.s repaired 2 22 38 40 48 35 - 99 68 23 375 - Animals kept so as to be a nuisance removed 11 1 3 - 49 6 - 1 - - - 22 - Urinals cleansed, supplied with water and doors 22 29 6 9 39 2 4 8 13 11 - 143 Stables and other premises drained and paved 10 2 12 1 1 7 4 1 38 - - - Waste water pipes disconnected from drains and made to discharge in open air, and new waste pipes provided 30 33 37 5 2 22 2 7 10 3 - 151 10 6 4 Providing means of ventilation beneath ground floor 25 7 4 2 1 21 4 - 84 7 8 Dung receptacles provided or repaired 12 3 3 3 1 6 4 47 - - 3 4 Accumulations of manure removed 4 7 8 2 3 3 - 40 - 6 4 2 Separating W.C. and domestic water supplies 2 1 - - 9 - - - - - 12 21 42 5 Effective means taken to prevent dampness 7 7 7 10 14 12 137 - Yards cleansed 6 13 46 - 11 16 5 4 - 101 - - Means of ventilation provided or improved 58 15 10 13 17 2 45 3 163 - - - Cisterns cleansed or covers provided 1 - 6 1 20 8 - 11 5 - 88 36 - - Cowsheds cleansed - 2 - - 2 - - - - - 60 Miscellaneous 21 2 55 34 21 114 129 - - 436 - 48 162 24 - Drains tested 364 81 247 40 12 99 85 1162 Note. —Mr. Davies left the Council's service on January 14th. Rooms disinfected 1769 Mr. Williams left the Council's service on September 2nd. Articles disinfected 17665 Mr. Harris commenced duties on March 7th. Bodies removed to Mortuary 178 Mr. Jones commenced duties on October 3rd. Post-mortem examinations 77 Houses disinfected to satisfaction of Medical Attendant 72 50 Table XI.—Food and Drugs. Articles submitted for analysis. Total samples taken. Number genuine. Number adulterated. Percentage of articles adulterated. Milk 32 7.1 451 419 Skimmed Milk nil 1 1 ... Separated Milk 13 4 30 8 9 Milk and Water nil 1 1 ... Condensed Milk (machine skimmed) 1 nil 1 ... Condensed Milk nil 1 1 ... Butter 180 19 10.6 161 Margarine 12 nil 12 ... Ginger Wine 28 21 7* 25.0 nil Pepper 18 18 ... nil White Pepper 1 1 ... Vinegar (Malt) 1 10.0 10 9 Vinegar nil 9 9 ... nil Lard 8 8 ... 1 7.7 Coffee 13 12 18 nil Cheese 18 ... nil Cheese (Dutch) 1 1 ... nil Arrowroot 8 8 ... 2 nil Glycerine 2 ... 28 3 10.7 Cod Liver Oil 25 11 nil Mustard 11 ... 5 nil IceCream 5 ... 2 nil Green Peas 2 ... 2 nil Fluid Beef 2 ... nil Extract of Beef 1 1 ... 2 2 Demerara Sugar 4 50.0 3 nil Beef Sausage 3 ... 2 nil Jam (Raspberry) 2 ... 2 nil Baking Powder 2 ... 2 nil Gin 2 ... nil Whisky 1 1 ... nil Cream of Tartar 1 1 ... 1 nil Liquorice Powder 1 ... Assorted Chocolates 1 nil 1 ... nil Marmalade 1 1 ... 1 nil Cocoa 1 ... 844 775 69 8.2 Totals * Ginger Wine containing more than 1 grain per pint of Salicylic Acid is considered adulterated in the above Table. 51 Table XII. —Prosecutions in connection with Samples taken during 1904. Sample. Adulteration. Result. No. 117h Milk Added water 12 per cent. Fined £1 and 12/6 costs 164w Separated Milk Said sample not a separated milk but a whole milk containing 5 per cent. of added water Dismissed; magistrate held no prejudice to purchaser 211a Milk Deficient in milk fat 20 per cent. Fined £1 and 12/6 costs Milk 124h Deficient in milk fat 10 per cent. Dismissed; warranty proved 333c Butter Margarine 100 per cent. Fined £2 and 12/6 costs 386b Cod Liver Oil Consisted of at least 90 per cent. of oil other than Cod Liver Oil Fined £1 and £2 2s. costs 174w Cod Liver Oil Consisted of at least 90 per cent. of oil other than Cod Liver Oil Fined £1 and £5 5s. costs 139h Fined £1 and £5 5s. costs Cod Liver Oil Consisted of at least 90 per cent. of oil other than Cod Liver Oil 135h Milk Deficient in milk fat 16 per cent. Dismissed; warranty proved Fined £10 and 14/6 costs 147h Butter Margarine containing 9 per cent. of butter fat 149h Margarine containing 8 per cent. of butter fat Fined £5 and 14/6 costs Butter 220a Milk Deficient in milk fat 15 per cent. Fined £1 and 12/6 costs 222a Margarine Bulk not marked Fined the costs, 12/6 Fined £1 and 12/6 costs 256t Malt Vinegar Malt Vinegar about 20 per cent., Wood Vinegar about 80 per cent. Deficient in milk fat 15 per cent. 229a Milk Fined £1 and 12/6 costs Milk Added water 8 per cent. Fined £2, and 12/6 costs 268t Milk Fined £2 and 18/6 costs 419b Deficient in milk fat 10 per cent. Fined and 12/6 costs 421b Milk Deficient in milk fat 10 per cent. Milk Fined £2 and 12/6 costs 424b Deficient in milk fat 13 per cent. Fined £l and 12/6 costs 174h Milk Deficient in milk fat 17 per cent. Dismissed; warranty proved 240 a Milk Deficient in milk fat 30 per cent. 276t Milk Deficient in milk fat 22 per cent. Fined £3 and 12/6 costs 280t Milk Deficient in milk fat 18 per cent. Fined £1 and 12/6 costs *229s Separated Milk Boracic acid preservatives equivalent to 17.5 grains per pint Fined £5 and 12/6 costs Butter 32d Margarine 100 per cent. Fined £2 and 12/6 costs 33d Butter Margarine 100 per cent. and wrapper not marked Fined £3 and 12/6 costs for wrapper not marked. Summons for "Margarine sold as Butter" withdrawn, 2/- costs 34d Butter Margarine 100 per cent. Fined £3 and 12/6 costs 288t Butter Margarine 100 per cent. Fined £1 and 12/6 costs 185h Batter Margarine 100 per cent, and wrapper not marked Fined £2 and 12/6 costs. Summons for "Wrapper not marked" withdrawn, 2/-costs 239s Milk Separated milk containing 0.10 per cent, of boracic acid (8¾ grains per pint) Fined £5 and 12/6 costs Butter 193h Margarine 100 per cent. Fined £3 and 12/6 costs Milk Added water 15 per cent Fined £3 and 12/6 costs 374c 198h Milk Vehicle not marked Costs 12/6 211j Margarine Wrapper not marked Fined £3 and 12/6 costs 461b Butter Fats other than butter fat 20 per cent., water, salt and curd, and traces of boracic acid 16.8 per cent., and wrapper not marked Fined £1 and 12/6 costs. Summons for "Wrapper not marked" withdrawn Milk 206h Added water 10 per cent., deficient in milk fat 14 per cent. Fined and 14/6 costs 208h Milk Added water 12 per cent. Fined £1 and 12/6 costs 213j Butter Margarine 100 per cent.; wrapper not marked Fined £2 and 12/6 costs. Summons for "Wrapper not marked" withdrawn, 2/- costs Ginger Wine Dismissed. 463b 13 grains per pint of salicylic acid 223j Butter Fined £2 and 14/6 costs Margarine 100 per cent 331t Coffee Chicory 45 per cent. Fined £1 and 12/6 costs Milk Water beyond that in standard milk 5 per cent. 272s Dismissed; warranty proved 239j Demerara Sugar Consisted of white sugar crystals coloured with a yellow aniline dye Withdrawn, 12/6 costs Demerara Sugar 245j Consisted of white sugar crystals coloured with a vellow aniline dye Withdrawn, 12/6 costs SUMMARY. Fines £76 0 0 Costs 35 9 6 £93 9 6 *In this case the defendant went to prison for 1 month in lieu of paying fine. 52 Table XIII. —List of Bakehouses in the Borough. Address Situation of Bakehouse. Address Situation of Bakebouse. 49, Abbey Street Underground 91, Old Kent Road Above ground 157, „ 69, „ „ „ 20, Alice Street (closed) 7, Paradise Street Underground „ 2, Alscot Road 246, Rotherhithe New Road „ „ 126, „ (closed) „ 186, Abbey Street Above ground 365, „ „ 66, Abbey field Road 173, „ „ „ 218, Bermondsey Street Underground 25, Parkers Row Above ground 88, Bermondsey Wall „ 49, „ „ 20, Bracton Road (not in use) 25, Paradise Street „ „ 3, Plough Road „ 209, Bermondsey Street (not in use) „ 1, Rosebery Street „ 79, Rouel Road „ 270, RotherhitheStreet 101, Bermondsey Street Above ground „ 111, „ 34, Rotherhithe New Road „ „ 31, Charlotte Street „ 48, Cherry Garden Street 37, Rolls Road (not in use) „ „ 574, Rotherhithe Street (not in use) 31, Crimscott Street (not in use) „ „ 39, St. James' Road 145, Drummond Road Underground Underground 239, Southwark Park Road 51, Dockhead Above ground „ 27, Derrick Street „ 20, Dockhead (not in use) 351, Southwark Park Road „ „ 415, Southwark Park Road (not in use) 51, Esmeralda Road „ „ 49, Frean Street (not in use) „ 479, Southwark Park Road „ 77, Grange Road Underground 31, George Row 3, Spa Mansions (never been used) „ „ 68, Galley wall Road „ 163, Grange Road (not in use) 49, South wark Park Road Above ground „ „ 55, „ (not in use) 119, Southwark Park Road „ Above ground 158, Southwark Park Road 33, „ „ 125, „ „ 2, Galley wall Road 198, South wark Park Road „ „ 36, Gedling Street „ (not in use) 319, Southwark Park Road „ Underground 1a, Ilderton Road 16, „ 855, Southwark Park Road „ „ 170, Jamaica Road „ 53, „ 208, Southwark Park Road „ „ 140, „ „ 92, Snowsfields 75, „ Above ground „ 203, „ 92, Spa Road „ „ 227, „ 61, Salisbury Street „ „ 29, Kipling Street 5, St. Marychurch Street „ „ Underground 82, Keetons Road Underground 142, Long Lane 96, Tooley Street „ 157, „ 2, Lucey Road „ „ 167, „ 97, Lynton Road „ „ 132, Lower Road 95, Tower Bridge Road „ „ 93b, 87, „ Above ground „ 184, Long Lane 43, Tanner Street Above ground „ 49, Lucey Road „ 144, „ „ 25, Lower Road 245, Tooley Street „ „ 160, „ „ 58, Tower Bridge Road „ 182, „ 26, „ „ „ 204, „ „ „ „ „ 47, Maltby Street Underground 22, The Grange „ Above ground 106, Union Road (not used) 17, Neckinger Street „ 16, Neptune Street „ 69, New Church Street (not in use) 22, Union Road „ „ 94 „ 333, Old Kent Road Table XlV.—Causes of Death, 1904. Corrected for deaths of non-residents within the Borough and deaths of residents without the Borough. Disease. Whole Boro.' All ages. 10 and under 15 15 and under 20 20 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and under 85 85 and upwards Under 1 1 and under 5 5 and under 10 Sub-Districts. Bermondsey. Rotherhithe. St. Olave. Males. Females. Totals. Males. Females. Males, Females. Males. Females. Males. Females. Males. Females. Females. Males. Females. Males. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. Totals. Males Females. Males. Females. Totals. Females. Totals. Males. 73 63 136 17 16 53 46 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 43 44 87 27 15 42 3 4 7 Measles ... ... 10 8 1 1 5 4 3 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 3 12 1 5 6 ... ... Scarlet Fever 18 ... ... ... ... 12 7 19 ... ... ... 1 ... ... ... 1 ... ... ... 1 ... 3 ... 1 1 4 2 3 2 ... ... ... 9 4 13 2 ... 2 1 3 4 Epidemic Influenza ... ... 19 11 24 48 8 11 19 2 4 6 Whooping-Cough 29 39 68 11 18 27 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 10 4 ... 7 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 6 4 10 1 5 6 ... 1 1 17 3 Diphtheria, Membraneous Croup ... 9 7 16 ... ... ... ... 2 2 ... ... 1 1 2 2 1 1 ... 3 ... ... ... ... ... ... 1 ... ... 6 2 8 3 5 8 ... ... ... Enteric Fever ... 1 1 1 20 19 39 18 23 41 1 2 3 Diarrhoea, Dysentery 39 44 83 30 35 6 7 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 54 52 106 46 37 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 43 40 83 1 7 8 10 5 15 Epidemic or Zymotic Enteritis 8 41 ... ... ... ... ... 2 1 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 3 ... ... ... ... ... Other allied diseases 1 ... ... ... ... 2 1 3 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 2 ... ... 1 1 Tetanus ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... Anthrax, Splenic Fever ... ... 3 4 7 3 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 6 1 1 ... ... ... Syphilis ... ... ... 4 4 8 1 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 ... 1 ... 2 2 4 1 1 2 1 1 2 Erysipelas ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 Puerperal Fever ... ... Pyæmia, Septicaemia 4 1 5 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 3 1 4 1 ... 1 ... ... ... ... 1 6 7 ... ... ... ... ... ... ... ... ... 1 3 1 1 2 ... 1 ... ... ... ... ... ... 1 4 5 ... 1 1 1 1 Septic, Ulcerative or Infective Endocarditis ... ... ... ... ... Other allied diseases 5 6 11 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 1 1 ... ... ... 4 4 8 1 ... 1 ... 2 2 ... ... ... Rheumatic Fever 5 6 11 ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 1 2 1 2 ... 1 ... ... ... ... 4 4 8 1 1 2 ... 1 1 ... 14 11 25 3 4 7 4 2 2 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 8 18 4 2 6 ... 1 1 Tuberculosis of Brain or Meninges, Acute Hydrocephalus ... ... 161 96 257 1 2 5 1 2 4 6 13 6 8 7 31 18 40 26 31 18 23 10 3 2 ... ... 100 66 166 35 25 60 26 5 31 Tuberculosis of Lungs, Phthisis Pulmonalis ... ... ... 13 16 29 6 8 4 3 ... 2 3 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 4 14 18 8 1 9 1 1 2 Tuberculosis of Intestines, Tabes Mesenterica ... General Tuberculosis, tubercular disease of undefined position 14 39 8 4 10 7 3 1 ... 1 ... ... ... ... 1 ... 1 1 2 ... ... ... ... ... ... ... ... 15 9 24 9 5 14 1 ... 1 25 ... Other forms of Tuberculosis, Scrofula 3 8 ... ... 1 1 1 ... 1 2 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 5 3 8 ... ... ... ... ... ... 5 ... ... ... 1 Hydatid Diseases 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 Other diseases due to altered food 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 1 3 Acute Alcobolism, Delirium Tremens 4 ... Chronic Alcoholism 3 3 ... ... ... 1 ... 1 1 3 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 3 1 4 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 1 ... ... 2 1 3 ... ... 1 ... 1 Osteo-arthritis, Rheumatoid Arthritis ... ... ... 1 Gout 4 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 ... ... ... ... 3 4 1 ... 1 ... ... ... ... ... ... ... 36 50 86 ... ... ... ... ... ... ... ... ... ... ... 2 3 9 6 13 14 13 10 7 2 6 1 ... 23 34 57 9 13 22 4 3 7 Cancer (Carcinoma) ... ... 3 6 ... ... 2 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 3 2 5 ... 1 1 ... 3 ... 1 ... ... „ (Sarcoma) ... Diabetes Mellitus 6 8 14 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 3 1 ... 4 1 1 ... 1 ... 3 4 7 3 3 6 ... 1 1 ... ... Purpura Hemorrhagica 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... Hemophilia 1 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 1 2 Anæmia, Leucocythæmia 1 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... ... ... ... ... 1 ... 1 ... ... 3 1 4 ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 3 1 ... 1 ... ... ... Lymphadenoma, Hodgkin's Disease 1 ... Premature birth 60 31 91 60 31 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 17 53 20 12 32 4 2 1 6 ... ... ... ... 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... Injury at birth ... ... 28 18 46 28 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 10 33 4 4 8 1 4 5 Debility at birth ... ... 4 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... ... ... 1 ... 1 Atelectasis ... ... ... ... ... ... Congenital defects 9 7 16 9 6 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 3 9 2 2 4 1 2 3 ... ... Want of breast milk 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus 21 59 36 20 2 1 26 16 42 10 5 15 2 ... 2 38 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dentition 6 10 3 4 1 2 5 1 1 1 1 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 7 ... ... ... ... ... ... Rickets 4 1 5 1 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 1 ... 1 1 ... 1 ... ... Old Age, Senile decay 42 87 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 15 12 25 19 3 10 28 28 56 14 9 23 3 5 8 45 16 13 29 14 12 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 12 9 21 3 4 7 1 ... 1 Convulsions ... ... 9 25 9 5 4 3 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 16 3 4 7 1 1 2 Meningitis 16 ... ... ... ... Encephalitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Apoplexy 8 8 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 4 3 3 2 ... ... 7 7 14 1 1 2 ... ... ... 5 6 11 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 1 3 1 2 ... ... ... ... 3 4 7 2 ... 2 2 2 Softening of brain ... ... Hemiplegia, Brain Paralysis 3 3 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 1 1 ... ... 2 3 5 1 2 1 ... ... ... ... ... ... General Paralysis of Insane 7 4 11 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 2 1 2 2 ... ... ... ... ... ... ... 2 1 3 2 2 4 3 1 4 ... Other forms of Insanity ... 6 6 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 1 1 ... ... ... 4 4 ... 1 1 ... 1 1 ... ... ... Cerebral Tumour ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... Epilepsy 6 6 12 1 ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 2 ... 3 ... 1 1 ... ... ... 3 3 6 1 1 2 2 2 4 ... ... Locomotor Ataxy 9 ... 9 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 ... ... ... 3 ... 1 ... ... ... ... ... 7 ... 7 1 ... 1 1 ... 1 Paraplegia, Disease of Spinal Cord 8 5 13 1 ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 3 2 1 1 ... 6 2 8 2 2 4 ... 1 1 ... ... ... ... Other and ill-defined diseases of Brain or Nervous System 10 9 19 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 2 2 3 3 1 2 2 1 ... ... ... 6 5 11 2 4 6 2 2 ... ... Otitis, Otorrhœa 1 2 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 ... ... ... ... ... ... ... Pericarditis 1 2 2 1 ... 1 1 ... 4 ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... Endocarditis, valvular disease of Heart 72 75 147 1 ... 1 ... 1 ... 1 2 2 8 8 1 ... 6 10 4 13 18 16 15 17 18 7 7 ... 1 42 46 88 20 22 42 10 7 17 Hypertrophy of Heart 2 1 3 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... 1 1 1 2 ... ... ... ... ... ... ... ... Angina Pectoris 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... .. . 1 ... 1 ... ... ... ... ... ... ... ... Aneurism 5 1 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... ... ... ... 1 ... ... ... ... 3 1 4 2 ... 2 ... ... ... ... ... Senile Gangrene ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 2 2 ... 1 1 ... ... ... ... ... Embolism Thrombosis 5 4 9 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 3 1 ... ... ... 3 2 5 1 ... 1 1 2 3 ... ... ... Phlebitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... Other and ill-defined diseases of Heart and Circulatory System 42 53 95 ... ... ... ... ... ... 1 ... ... ... ... ... 8 ... 2 9 6 12 10 11 20 6 9 1 1 23 29 52 15 20 35 4 4 8 ... Laryngitis 1 ... 3 3 ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 ... 1 ... ... Acute Bronchitis 59 61 120 30 24 7 7 ... ... ... ... ... ... ... 1 1 3 2 4 2 5 7 5 12 4 6 ... 44 41 85 13 19 32 2 1 3 ... ... Chronic Bronchitis 61 75 136 1 ... ... ... ... ... ... ... ... ... ... 1 ... 4 2 10 6 13 14 25 32 5 19 2 2 40 46 86 18 22 40 3 7 10 ... Lobar, Croupous, Acute Pleuro-Pneumonia 26 10 36 1 ... ... 1 ... ... ... ... 1 ... 1 ... 2 1 4 3 6 3 5 1 3 ... 2 1 ... ... 16 7 23 8 3 11 2 ... 2 Lobular, Catarrhal, Broncho-Pneumonia 90 88 178 39 39 38 41 ... 2 ... ... ... ... ... ... ... ... 1 2 2 1 1 ... 3 2 5 5 ... ... 57 47 104 24 30I 54 9 11 20 Pneumonia, form not stated 37 22 59 8 2 5 3 ... ... ... ... 2 2 ... ... 1 2 3 ... 8 2 6 3 3 7 1 1 ... 23 14 37 ... ... 16 3 3 6 ... Emphysema, Asthma 4 ... 4 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... 1 ... 1 1 ... 1 2 2 ... ... Pleurisy 1 1 2 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... Other and ill-defined diseases of the respiratory system 4 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 3 ... 3 ... ... 1 1 ... 1 4 Diseases of mouth and annexa 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... Diseases of Œsophagus 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Ulcer of Stomach and Duodenum 1 5 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... 2 ... ... ... ... ... ... 1 2 3 ... 2 2 ... 1 1 ... ... 5 4 9 ... 2 2 ... ... ... ... ... Other diseases of Stomach ... ... ... ... 1 1 ... ... 3 ... ... 1 1 ... ... ... ... 4 1 5 1 2 3 ... 1 1 ... Enteritis 6 7 13 4 4 ... 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... 6 11 1 1 2 ... ... ... Appendicitis 4 3 7 ... ... ... ... ... ... 1 ... 2 1 ... ... ... 2 ... 1 ... ... ... ... ... ... 3 ... 3 1 2 3 ... 1 1 ... ... ... ... Obstruction of Intestine 10 5 15 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 1 ... 3 2 1 ... ... 5 4 9 4 1 5 1 ... 1 Other diseases of Intestine ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... Cirrhosis of Liver 11 19 30 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 7 5 4 3 4 1 1 ... 2 ... ... 7 11 18 3 6 9 1 2 3 Other diseases of Liver 3 1 4 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... 3 ... 3 ... 1 1 ... ... ... ... Peritonitis 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... Other and ill-defined diseases of Digestive System 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 Acute Nephritis ... 2 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... 25 28 53 ... Brights Disease ... ... ... ... 1 2 1 ... 1 1 ... 1 ... 2 4 6 10 7 5 5 6 1 ... ... 12 17 29 9 11 20 4 ... ... ... Calculus 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 7 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 ... 2 ... ... ... 4 ... 4 1 ... 1 2 ... 2 Diseases of Bladder and Prostate ... Other and ill-defined diseases of Urinary System 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... Diseases of Vagina and External Genital Organs ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Other and ill-defined accidents and diseases of Pregnancy and Childbirth ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... Arthritis, Ostitis, Periostitis ... ... 2 2 4 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 1 3 ... 1 1 ... ... ... ... Eczema ... 3 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 ... 1 1 ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... Deaths from External Causes. ... ... 4 5 ... ... ... 1 2 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 2 1 3 2 ... 2 ... ... In Vehicular Traffic 1 ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 3 1 ... 1 ... ... ... On Railways 4 ... ... On Ships, Boats and Docks, excluding Drowning 3 ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 1 ... 1 1 ... 1 ... ... ... By Machinery 1 4 ... 4 ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... 1 ... ... ... Burns or Scalds 5 12 17 ... 1 3 4 ... 2 ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... 3 ... ... 1 ... 3 8 11 2 3 5 ... 1 1 ... Poisons and Poisonous Vapours 2 1 3 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 ... 1 ... 1 1 ... ... ... Surgical Narcosis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... Corrosion by Chemicals ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Drowning 21 2 23 ... ... ... ... 2 ... 1 ... 2 ... 2 ... 2 ... 4 1 3 ... 4 1 1 ... ... ... ... ... 8 ... 8 8 10 5 ... 5 2 Suffocation, overlaid in bed 13 10 23 13 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 8 16 3 2 5 2 ... 2 ... ... Suffocation, otherwise 1 6 7 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 5 6 ... ... ... ... 1 1 ... ... Falls, not specified 5 5 10 ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 ... 1 ... ... 1 ... 1 1 2 ... ... 1 4 5 3 1 4 1 ... 1 ... Weather Agencies 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... Otherwise and nob stated 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... Homicide ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... Suicides, all forms. By Poison 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... By Hanging and Strangulation ... ... 5 1 6 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 ... ... ... 1 ... ... ... ... ... ... ... 4 1 5 1 ... 1 ... ... ... By Drowning ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... By Shooting 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... By Cab or Stab 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... By Precipitation from Elevated Places 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... Other ill-defined and not specified causes 2 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 2 ... 1 1395 1198 2593 409 314 200 26 21 18 20 23 20 24 14 70 49 113 79 145 107 145 121 142 158 172 85 8 14 888 746 1634 369 344 713 138 108 246 196