Metropolitan Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY. For the Year 1916, BY R. KING BROWN, B.A., M.d., D.P.H., Medical Officer of Health. TABLE OF CONTENTS. VITAL STATISTICS— Page Population 6 Births 7 Marriages 8 Deaths 8 Infantile Mortality 9 Zymotic Diseases 10 Small Pox 10 Senile Mortality 11 Death Certification 11 Measles 11 Whooping Cough 11 Typhus Fever 11 Enteric Fever 11 Tubercular Diseases 11 Phthisis 11 Alcoholism and Cirrhosis of Liver 12 Cancer 12 Heart Diseases 12 Suicides 12 Accidents 13 NOTIFICATION OF INFECTIOUS DISEASE— Small-pox 13 Typhus Fever 13 Diphtheria 13 Typhus 13 Diphtheria 15 Scarlet Fever 15 Measles 15 Enteric Fever 17 Puerperal Fever 17 2 Page Membranous Croup 18 Ophthalmia Neonatorum 18 Cerebro-Spinal-Meningitis 18 Acute Polio-myelitis 18 Bacteriological Laboratory 18 SANITARY ADMINISTRATION — Unsound Food 19 Milk Premises 20 Slaughterhouses 20 Ice Cream Premises 20 Unsound Food and Foreign Regulations 23 Food and Drugs 23 General Sanitar Work 26 Smoke Nuisances 26 House Refuse 26 Offensive Trades 27 Disinfection 27 District Inspector's Work 28 Cleansing of Persons Act, 1897 29 Proceedings during Year 29 Health Visitors 32 Tuberculosis Dispensary 34 Factories and Workshops 34 Outworkers 34 APPENDIX TABLES— Local Government Board Tables 36, 39, 41, 43, and 45 Marriages 40 Deaths from Zymotic Diseases 44 Prosecutions (Food and Drugs) 46 Food and Drugs 47 Factories and Workshops 48 Outworkers 50 Bakehouses 51 PUBLIC HEALTH DEPARTMENT. COMMITTEE, 1916. Chairman—Councillor OAKE. Councillor Brown, Councillor Mrs. Richmond, „ Delderfield, „ Roxbury, „ Gaunt, „ Shearring, W. H. „ Hooton, „ Siddle, „ Hunt, „ Taylor, „ Lunn, „ Vezey, „ B. A. Richmond. M.P., J.P. „ Wallsgrove. Ex-officio: J. H. HART, Esq., J.P. Mayor of Bermondsey. STAFF: Medical Officer of Health—R. KING BROWN, B.A., M.D., D.P.H. Sanitary Inspectors: No. 1 District Mr. M. Grice. No. 2 „ „ J- W. Wood. No. 3 „ „ A. H. Merryman No. 4 „ „ H. J. Toogood. No. 5 „ „ E. C. Freeman. No. 6 „ „ T. W. Golds. No. 7 „ J. Pitts. No. 8 „ H. M. Cockburn. Food Inspectors: Mr. T. Ashdown, Mr. G. A. Hoskins and Mr. G. L. Scott. Health Visitors —Miss B. Nuttall and Mrs. K. Croke. Clerical Staff: Mr. H. A. W. Bush, Sanitary Clerk, Mr. J. C. Watts, 4th Clerk. Mr. E. J. Pitts, Second Clerk. Mr. F. C. Shaw, Junior Clerk. Mr. J. G. Francksen, Third Clerk. H. E. Butcher, Office Lad. PUBLIC HEALTH DEPARTMENT. TOWN HALL, SPA ROAD, S.E. 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 Sixteenth Annual Report on the sanitary condition of the Borough of Bermondsey during the year 1916. The death-rate was 17.2, compared with 21.4 in 1915 and 17.6 in 1914. The death-rate is discussed in an early section. The sections of the report are, as usual, divided into: — I.—Vital Statistics. II.—Notification of Infectious Diseases. III.—Sanitary Administration. IV.—Factories and Workshops. In the Appendix will be found the Local Government Board Tables, including a special Table on Infantile Mortality. Partly owing to paper shortage and the difficulty of getting printing done, also too much of the time of the clercical staff being taken up with the Food Control and the Defence of the Realm Acts, I have found it necessary to cut down my Annual Report considerably. If reports of this kind are too long delayed, all interest vanishes, and as it is I am afraid that the happenings of 1916 will interest only a few. Still we hope to keep up the continuity of the statistical and other reports on our activities and rely on the leniency of our critics, should the reading and statistical matters owing to the difficulties abovementioned not come up to expectation. I wish specially to record that between the Chairman and Members of the Public Health Committee, and myself, the cooperation has been more than usually cordial during the year under report, and this, in spite of the fact that many members of the Council are tempted to lose interest in their muncipal work through the unprecedentedly long period of retention of office. The staff of the Department has also shown itself most willing to fall in with the various new and additional duties cast upon them, and have done their part loyally in the promotion of the Public Health of Bermondsey. I am, Gentlemen, Your obedient servant, R. KING BROWN. I.—VITAL STATISTICS. Population. The populations of the Borough of Bermondsey and its registration sub-districts, as enumerated in the Census of 1901 and 1911, and the estimate of the year under report are as follows:— 1901. 1911. Estimated to June 30th, 1916. Civil Population Total Population. Bermondsey 82,483 81,959 73,991 80,503 Rotberhithe 38,460 35,247 31,820 34,620 St. Olave 9,817 8,697 7,850 8,542 Borough 130.760 125,903 113,661 123,665 The total population of Bermondsey for 1916 has been esti mated by the Registrar-General as 123,665. This is approximately the number I would have estimated on the basis of the decrease shown by the census of 1901 and 1911 had there been no war, and this figure has been utilized in estimating the birthrate. The civil population has been estimated by the Registrar- General as 113,661, based on the National Register in conjunction with the two last census enumerations. He says: —" The figures of the total population are based on the assumption that the ratio between the total and the civilian population is the same in the borough as in England and Wales as a whole." If these figures are correct or even approximate it means that about 10,000 men from Bermondsey have joined the forces. Unfortunately we have no way of checking these figures, and if one may judge by the difficulty of getting house accommodation here, the replacement of the absent husbands and brothers by lodgers who have come to be near their work, and the enormous increase in personnell of factories doing war work, I fancy that the figures quoted above are, if anything, under the mark. They are, however, not only the best, but the only figures we have, so any statistics given in this report must be accepted with a certain amount of reserve, and will to some extent be corrected after the war when more reliable data are available. As stated above the total population has been used in calculating the births and marriage rates, since the men in the forces have participated in it, but the smaller figure of the civil population has been used for the death rates as no deaths in the forces. Births. The total number of births registered in the Borough for the 52 weeks ended December 30th, 1916, was 3,361, consisting of 1,708 males and 1,653 females. This is 534 below the average for the last 10 years, and 121 below the figure for 1915. In Table 11. of the Appendix will be seen the figures for the last 10 years in the three registration sub-districts, and in Table I. figures for the whole Borough. The birth-rate for 1916, calculated on the "total population." was 27.1 per thousand persons living, which is 2.5 below that for 1915 and 3.7. below the average for the last 10 years. The number of children born in Bermondsey is nearly 1,000 less than the number born in 1905, i.e., eleven years ago. This reduction is partly due to the decrease of the population which has been taking place since 1891, and partly due to the fall in the birth-rate, which is taking place in all civilised countries. The rate although a good deal lower is still high compared with the rest of the country. Marriages. The total number of marriages in the Borough in 1916 was 1,215, being 499 below the number for 1915, and 81 above the average for the last 10 years. Various more or less plausible reasons were given for the remarkable increase in the number of marriages in 1915, but why these should not be operative in 1916 is difficult to explain. War conditions are notoriously uncertain, so having stated the facts we had best leave the inferences for future investigation. In Table III. of Appendix will be found further particulars as to sub-districts. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 10 per 1,000 of the total population compared with a marriage rate calculated on the same population of 14 of last year, 1915. Deaths. In Table IV. of Appendix will be found the Local Government Board tables dealing with deaths in the Borough. The extended table of causes of death initiated in 1904 has been omitted this year from the Appendix. The total number of deaths registered in the Borough for the year ended December 30th, 1916, was 1,507, which is 546 less than in 1915, and 324 less than the average for the last 10 years. When this figure is corrected by exclusion of deaths of nonparishioners occurring in the district, and the inclusion of deaths of parshioners occurring outside the district, the number is raised to 1,960. This is 554 less than in 1915, and 370 less than the average for the last 10 years. The death-rate for the Borough in 1916 was 17.2 per thousand living inhabitants, being 4.2 below that recorded in 1915, and 1.4 below the average for the last 10 years. This is a highly satisfactory record, since it is the lowest death-rate recorded since the formation of the Borough in 1900. It is certainly also much lower than any rate previously recorded by the Vestries of Bermondsey and Rotherhithe before the amalgamation. In column 1, foot of Table I. of the Appendix will be found a list of places where deaths of non-parishioners occurred in the district. There were 155 such deaths in all, against 38 in 1915, and 26 in 1914. 145 such deaths occurred in the infirmary; 10 in the workhouse; 12 in River Thames; 9 in Surrey Commercial Docks. 453 persons belonging to this Borough died in outlying institutions, against 542 in 1915, and 516 in 1914. 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. Infantile Mortality. The figure for this is 108 deaths under one year to every 1,000 births, and when it is remembered that the average for the years 1905 - 1914 is 137, and that in 1915 it went up to 154, the drop is most remarkable and satisfactory. When examining the figures for last year I found that the increase was entirely in the period between 3 and 12 months old, but comparing Table V. for 1916 with the two previous years, I am unable to find any evidence that to one particular period under 12 months the fall is due for the reduction appears to be very evenly distributed. Neither am I sanguine enough to attribute the fall solely to increased activity on the part of Sanitary Authorities though some part is no doubt due to this cause. For one thing there was a tremendous drop in diarrhoeal diseases from 102 in 1915 to 36 in 1916. The real cause of this was the cold damp summer. The popular notion that such weather is unhealthy is not founded on fact, because with such weather one can with certainty predict a low infantile mortality. The fall in prematures from 63 to 41 and in atrophy from 75 to 57 gives much more cause to congratulation since such a drop can very well be attributed to improved hygiene measures in their broadest sense. Table A. -Infantile Mortality. Whole Borough London. Year. No. of Deaths. Rate per 1,000 Births. Rate per 1,000 Births. No. of Deaths. 1906 624 155 16,307 130 1907 501 125 14,114 116 610 13,943 1908 146 113 1909 573 141 12,582 108 1910 502 127 11,809 103 1911 611 159 14,440 129 1912 433 114 10,056 91 1913 505 131 11,869 105 1914 129 11,395 104 487 1915 537 154 11,369 104 138 Average for years} 1906-1915.} 538 12,788 110 364 108 8,819 1916 88 Deaths from Zymotic Diseases. There has been a decrease in the deaths from these diseases, the figures being 155, against 367 in the previous year, and 315 the average for the last ten years. This gives a zymotic deathrate of 1.36. The total number of deaths from notifiable diseases, viz., measles, scarlet fever, diphtheria, typhus fever and enteric fever, was 78, compared with 32 in 1915, and for the non-notifiable, viz., whooping cough and diarrhœa, 77 compared with 335 in the previous year. Small-pox. There were no deaths from this cause in 1916. Measles. There were 42 deaths due to this disease, which is 59 below the average for the last ten years, and 68 below the number for 1915. Whooping Cough. 16 deaths were due to this cause, against 79 in 1915. Typhus Fever. No deaths occurred from this disease. Enteric Fever. 2 deaths were due to this cause, 1 in Bermondsey and 1 in Rotherhithe. The corresponding figures for 1915 were 3 for the Borough, viz., 1 in Bermondsey and 2 in Rotherhithe. Senile Mortality. The number of deaths over 65 years of age in 1916 was 523, compared with 544 in 1915. Death Certification. There were no uncertified deaths in 1916. Tubercular Diseases. The number of deaths from all forms of tubercular disease in 1916 was 266, against 303 in 1915. This figure comprises 175 for Bermondsey, 70 for Rotherhithe, and 21 for St. Olave. Of these, 179 were due to phthisis and 87 to the other tubercular diseases. Phthisis. In Table B will be found particulars of deaths from phthisis since the year 1905. There were 184 deaths due to this cause, which is 49 less than the number recorded in the previous year. Table B—Phthisis. Sub. District. Whole Borough. Bermondsey. Rotherhithe. St. Olave. London. No. Rate. Year. No. Rate. No. Rate. No. Rate. No. Rate. 1.90 77 2.01 18 2.16 250 1.95 6775 1.44 1906 155 1907 150 1.84 68 1.78 19 2.36 237 1.85 6654 1.40 6419 1.32 1908 157 1.89 60 1.54 24 3.03 241 1.85 2.27 220 1.73 6337 1.31 1909 147 1.80 56 1.46 17 148 1.82 50 1.31 21 2.91 219 1.73 5555 1.14 1910 1911 141 1.72 52 1.48 18 2.08 211 1.68 6084 1.35 1.69 6069 1.35 1912 138 1.68 57 1.64 17 1.98 212 201 1.61 5981 1.30 1913 125 1.53 64 1.86 12 1.42 1.66 46 1.35 21 2.53 203 1.63 6281 1.39 1914 136 1915 156 1.76 57 1.77 20 2.42 233 1.97 6782 1.54 Averages for years 1906 - 1915 1.76 58 1.62 18 2.31 222 1.76 6293 1.35 145 1916 126 1.70 44 1.38 14 1.78 184 1.61 6288 1.45 Alcoholism and Cirrhosis of the Liver. 15 deaths were attributed to this cause in 1916, against 21 in 1915. This number gives a very small idea of the deaths caused by alcoholism, since it is often a remote cause of death, and not always mentioned on the certificate for various reasons. Cancer. 129 deaths were attributed to this cause. The Cancer Research Commission have not yet issued their final report on the subject. Heart Diseases. 217 deaths were due to this cause, which number is 12 above that for the previous year. This refers to organic or valvular disease of the heart. Suicides. 9 persons committed suicide in 1916, viz., 1 by poison, 1 by hanging or strangulation, 1 by asphyxia, 1 by firearms, 1 by crushing, 2 by drowning, 1 by cutting or piercing instruments and 1 by jumping from high place. Accidents. 84 deaths were due to accidents, against 108 in the previous year. II.—NOTIFICATION OF INFECTIOUS DISEASE. In Table VII. of Appendix will be found particulars of infectious diseases notified during the year under report. The number of cases notified, exclusive of notifications of tuberculosis, which numbered 345, was 935, compared with 930 in 1915 and 950 in 1914. All the diseases show a decrease on the number for the previous year, with the exception of poliomyelitis and opthalmia-neonatorum, which show an increase of 10 and 7 respectively. The attack per thousand inhabitants was 8.2, against 7.6 for 1915. 28 cases were returned from hospital as not suffering from the disease for which they were notified, but if allowance is made for mild unreported cases, the recorded notifications would, if anything, understate the actual number of cases. Small-pox. One case was notified as small-pox, but on examination by the Medical Officer of Health was found to be suffering from a form of eczema. Typhus Fever. No cases of typhus fever were notified during the year under report. Diptheria. There were 249 cases of diphtheria notified in 1916 as against 225 cases in 1915. There was therefore a slight recrudescence of the disease, the cause of which I was unable to discover. The attack-rate per thousand inhabitants was 2.19, against 1.98 in 1915. The case mortality was 11.6 per cent., against 8.8 per cent. in 1915 and 7.9 per cent. in 1914. 5 cases were returned as not suffering from this disease. 195 specimens were sent in by medical practitioners for bacteriological examination, against 259 in 1915, and 327 in 1914. Of these 43 were found to contain diphtheria bacilli, all of which were notified. The following has appeared in various reports and gives a discription of the method adopted in this Borough to prevent the spread of this disease which will bear repetition:— "Diphtheria is a disease caused by a characteristic bacillus known as the Klebs-Loffler Bacillus, which occurs in the throats of persons attacked by the disease. It seems to be conveyed from person to person by direct contact, and there is no virulent disease which will spread more rapidly under certain circumstances than this will among school children. It is more or less directly conveyed from throat to throat by children passing sweets, slate pencils, and other articles which they are liable to put in their mouths, from one child to another. Kissing an affected person on the mouth will also frequently give rise to the disease, and an infected child coughing in the neighbourhood of non-infected ones will also often transmit the disease to them. Sometimes the bacilli will exist in the throat for a long time without producing any symptoms, but such children, while not suffering themselves, will be liable to convey the infection to others. "For this reason they have been called 'carrier' cases, and, as expressed in previous reports, my belief is that a large part of the spread of the disease is due to such cases. Since 1902 an endeavour has been made in this Borough to prevent any of these 'carrier' cases returning to school, and each Annual Report has contained some account of the working of the plan. This consists in getting the parents of a child which is notified as suffering from diphtheria to bring up the other members of the family within a week or so after the removal or recovery of the case to the municipal laboratory at the Town Hall for examination. If diphtheria bacilli are found in the throats they are excluded from school for a fortnight, and if then found to be free, are allowed to return to school." Scarlet Fever. The notifications of scarlet fever in 1916 were 252 against 365 in 1915. This is a decrease of 113, which is very satisfactory. The distribution of the disease in the various Wards, as shown in Table III. of Appendix, was fairly uniform. 23 cases were returned from hospital as not suffering from scarlet fever. There were 5 deaths, which gives the very low case mortality of 1.9 per cent., against 2.4 per cent. in 1915. The disease, as in recent years, was of a very mild type. The atack rate per thousand inhabitants was 2.2 against 3.1 in 1915. The sources of infection were mostly previous cases. There was no outbreak traceable to any common cause such as infected milk or school contagion. Measles. The number of deaths for 1916 was 42, against 110 in 1915, 79 in 1914 and 88 in 1913. Measles was made a notifiable disease in 1916, a distinction being drawn between Measles and German Measles. The notification consisted in first cases being notified by medical men— subsequent cases by the parents or guardians of the children attacked. This was not undertaken with the idea of action being taken similar to that in other infectious diseases, viz., removal, disinfection, etc., but with the idea of the house being visited by a Health Visitor or Sanitary Inspector, so that parents might be warned of the serious nature of the disease, and that in the case of the attack being a severe one, with complications, nursing assistance might be provided. By these means it was hoped that the mortality of the disease might be favourably affected, even if the prevalence continued as before. As no provision for nursing was made till 1916, one is not in a position to judge of the efficacy of the measure till a considerable period has elapsed. There was a considerable prevalence of measles in the Metropolis which was shared in by Bermondsey. The number of primary cases notified was 1,497, including 382 cases of German measles and 1,115 of meales. As there were only 42 deaths from measles this makes a case mortality of 3.7 per cent. on the first cases. If, however, we assume that there was at least one more case in each house this would make a case mortality of only 1.8 per cent., which figure, I imagine, is much nearer the truth than the large one. As regards inoculation, we know too little about the poison of measles to be able to make an effective vaccine. General hygiene is no doubt useful in helping to keep children from an attack, but the disease is very amenable to proper nursing and medical treatment. If one analyses the death returns it will be found that death is rarely due to uncomplicated measles, but is generally attributed to an intercurrent attack of pneumonia or bronchitis, both of which complications would probably have been prevented had the patient been put to bed on the first symptoms, and properly nursed. The prevention of measles is one of the hardy annuals of the Public Health world. All sorts of devices such as isolation, notification, disinfection, and school closure have been tried with a view to preventing or limiting its spread, and have eventually been given up, but while discussions on its prevention have been numerous, I have heard little said in favour of allowing every child to catch it, except occasionally among some benighted mothers, who, when a case occurred in the family immediately exposed the other members to infection with almost invariable success. At present the plan of modified notification mentioned above holds the field and of those suggested it certainly seems the most commonsense, for it aims not so much at preventing an attack as warding off a fatal issue. This is often all our aim in many infectious diseases, especially those prevalent in childhood, for the question of the incapacity produced by an attack is only important, where adults are concerned. It is well known that many regiments recruited from certain remote parts of the Empire suffered badly from measles caused by the want of protection afforded by an attack in childhood. We do not know the fatality of the attacks, but clinical experience shows that the disease may be very severe and even fatal when unprotected adults are attacked. The classical example of the Figi Islanders who were visited by measles in 1874 for the first time, and in which about a quarter of the total population perished, will always remain as a warning to those who could banish measles from the British Isles. I dread to think of the ravages of the disease were it introduced here after an absence of fifty years. Immunity from infectious disease may be natural or acquired, and the former is only gained by natural selection or survival of the fittest, a process which it takes untold ages to accomplish. Acquired immunity can only be got by passing successfully through an attack or by some form of vaccination or inoculation. Now applying these priciples to measles I believe that we have acquired a certain amount of racial immunity here, which shows itself by epidemics not proving so fatal among us as among races who have never had or have lost their immunity, but we are little immune to attacks of the disease till we have successfully passed through one, and this can take place if everyone becomes infected at some period and carefully nursed through the attack. There is no doubt some advantage in postponing an attack till later childhood, for the disease is more fatal in the first two years of life than later, and an endeavour has been made in London to bring this about by closing infant classes after the first case has occurred. It is doubtful, however, whether this measure has had much influence in this direction, for although this practice of exclusion has been in vogue now some years, it is found that practically all the children in the boys' and girls' departments are protected by previous attacks of measles. Enteric Fever. 13 cases of enteric fever were notified, being 8 for Bermondsey, 2 for Rotherhithe, and 3 for St. Olave. 2 cases were returned as not suffering, making an actual total of 11. The total number of cases notified in the previous year was 21. Puerperal Fever. 2 cases of puerperal fever were notified. There were no deaths from this disease during the year. B Membranous Croup. No notification of this disease was received during the year under report. Ophthalmia Neonatorum. There were 19 cases of this disease notified during the year. Under this heading is included every kind of "sore eyes" occurring in the newly born. They were all visited by the Health Visitor, who instructed the mother to immediately seek medical advice. Cerebrospinal Meningitis. 15 cases were notified in 1916, but very few of them were genuine cases of the epidemic form. Most of them consisted of the sporadic form known as posterior-basic meningitis. Ten of them, as is usual, occurred in children under one year of age. Polio-Myelitis. 12 cases were notified in 1916, against 2 in 1915. None of the cases were of the epidemic form as no secondary cases occurred in any of the houses attacked. Bacteriological Laboratory. The total number of specimens examined in 1916 was 689, as compared with 919 in 1915, and 1,087 in 1914. Table C. Results of Examination. Total Examinations. Nature of Specimen. Positive. Negative. 1915 1916 1915 1915 1916 1916 Diphtheria (specimens taken by Medical Officer of Health) 326 311 308 321 15 13 Ditto (taken by general practitioners) 259 195 41 43 218 152 Diphtheria (total specimens taken) 585 516 56 56 529 460 Phthisis 321 282 92 61 229 221 Enteric 9 4 6 1 3 3 Various 4 4 5 5 - - 919 807 118 Total specimens taken 154 765 689 There was some decrease in the number of specimens. This laboratory is most convenient for the medical practitioners in the Borough. In most of the London Boroughs this work is done by an outside laboratory at a cost of £100 to £200 per annum, which is saved in Bermondsey by the work being done by the Medical Officer of Health. SANITARY ADMINISTRATION. UNSOUND FOOD. The following were brought to the notice of the Department found to be unfit for human food and destroyed as trade refuse:— Table D. 4½ 3 7 12 0 0 17 6 21 3 9 45 7 1 11 1 20 1 16 8 0 2 11 5 3 15 14 7 2 13 22 24 1 0 85 11 3 13 67 6½ 13¼ 2 1 1 22 1 19 34 0 2 14 1 24 0 2 14 0¾ 0 4 73 23 1 10 17 Lbs. Qrs. Cwts. Tons. Canned (surrendered) Pickled Canned Fresh VEGETABLES: Dried (surrendered) Peel in brine (surrendered) Preserved and canned (surrendered) Dried Preserved and canned Fresh FRUIT: Tinned fish (surrendered) Pickled FISH: Canned meat (surrendered) Sausage casings Rabbits Canned meat Fresh, salted or refrigerated MEAT: B2 Milk Premises. There were 253 milk premises on the Register at the end of 1915. 32 were added and 1 removed during 1916, making a total of 284 on the Register at the end of the year under report. 683 inspections were made and 20 notices served. Slaughterhouses. There is one slaughterhouse in the Borough. 56 inspections were made. No notices were served. Ice Cream Premises. There were 95 premises where ice cream is manufactured on the Register at the end of 1915. 7 were added during the year under report, making a total of 102. 80 inspections were made and 11 notices served. 16 3 18 1610 1½ 1 16 57 13 3 3 11½ 3 15 73 15 2 14 5 11 2 14 314 27 0 17 10 0 0 19 18 0 2 7 720 Various canned goods (surrendered) Coffee Various canned goods VARIOUS: Tinned goods (surrendered) Eggs (surrendered) Various Eggs in brine Eggs DAIRY PRODUCE: Table E. UNSOUND FOOD AND FOREIGN MEAT REGULATIONS. The following articles of food were dealt with under the above regulations during the period under report. Quantity Unsound. Article. Disposed of for other Purposes than Human Food. Removed for Sorting under S.A. Destroyed. Weight. Quantity. Quantity. Weight. Quantity. Weight. Tons. cwt. qr. lbs. qr. lbs. Tons. cwt. qr. lbs. Tons. cwt. Apples and Pears 24 11 2 - - - - - - 3 - - - - - Almond Substitute - 5 - - - - - - - - - - - - - Bananas - 361 crates 1 - - - - 12 19 - - - - - - Bacon and Hams 31 19 1 21 - 5 11 3 8 3 18 1 8 - - Butter 1 18 1 - - - - - - - - 3 boxes - 2 - Butter Beans 12 - - - - - - - - - - - - - - Cereals 5064 16 11 - - - - - - - - - - - - Cheese - 17 - 4 18 0 9½ - 5 4 9 - - - - Chestnuts 2 - 19 3 - - - - - - - - - - - Coffee - - 3 3 13 - 44 15 - - - - - - - Chocolate - 18 19 - - - - - - - - - - - - Cocoa Beans - 1 2 - - - - - - - - - - - - Condensed Milk 12 121 - - - - - - - 0 14 - 1 - 4 Concentrated Milk - - 1 6 3 4 - - - - - - - - - Cocoa Nuts 50 bags 2 2 - 2000 bags 125 15 - - - - - - - - Cauliflowers in brine 6 17 - - - - - - - - - - - - - Eggs - 7 68 8 33 14 - - - 720 2 - - - - Eggs in brine - 5 2 - - - - - - - - - - - - Egg yolk 37 3 16 - - - - - - - - - - - - Fish in pickle 51 barrels 5 2 1 1 2 13¼ - - - - - - - - 106 7 3 - 22 15 Dried Fruit - - 2 7 - - - - - Gherkins - 1 cask 3 2 - - - - - - - - - - - Lemons - - - - - - 6 13 - - - - - - - Lard - - - 2 2 0 3 - - - - - - - - Maize 562 5 2 24 - - - - - - - - - - - Macaroni - - - 2 - - - - - - - - - - - Milk Powder 3 6 - - - - - - - - - - - - - UNSOUND FOOD AND FOREIGN MEAT REGULATIONS—continued. Quantity Unsound. Article. Disposed of for other Purposes than Human Food. Destroyed. Removed for Sorting under S.A. Quantity. Quantity. Weight. Quantity. Weight. Weight. Tons. cwt. qr. lbs. qr. lbs. cwt. qr. lbs. Tons. cwt. Tons. Margarine 95 cases 1 3 3 - - - - - - - - - - - Meat Offal 2 bags 1 - - - - - - - - - - - - - Onions - 3 1 7 - - - - - - - - - - - Oranges 229 cases 7 3 110 cases - - - - - 21 - 23 4 - - Ox Tongues - - - - - - - - - - - - - - - Plums 1 10 - - - - - - - - - - - - - 2 Pineapple - - 6 - - - - - - - - - - Papain 1 2 - - - - - - - - - - - - - 17 Peel in brine - - - - - - - - - - - - - Potatoes 9 - - - - - - - - - - - - - 15 2 Poultry - - - 4 8 - - - - - - - - Rabbits 14 2 0 24 86 18 2 - - - - - - - - Sardines - - - - - - - - - - - 15 17 2 6 Sausage Casings 2 1 2 7 16 - - - - - - - - - - Tinned Goods, Fruits 1 - - - - - - 85 - 24 - 109 12 1 - Fish 20 5 1 17 - - - - - - - - - - - „ Meat 22 2 73 -¾ - 18 14½ - 4 - - 60 - - 2 9 „ Vegetables 2 12 45 3 21 15 - - - - - - - - „ Various 73 15 3 11½ - - - - - - - - - - - Tea - - - - - - - - - - - - - - - Tomatoes 38 crates 19 - - - - - - - - - - - - - 17 Vegetables, Pickled - 2 casks - - - - - - - - - - - - Vegetole 1 2 8 - - - - - - - - - - - - The following remarks on the year's work which are here submitted were drawn up by the Wharves Inspector, Mr. T. Ashdown. Unsound Food and Foreign Meat Regulations. Reviewing the operations under the regulations in this district during the year ending 31st December, 1916, a comparison with past years would be useless and brevity is a necessity. There has been no new legislation directly dealing with these matters, and no new orders have come into operation. We have adhered to the same methods as in the past in all initial inspections, but in the enleavour to prevent unnecessary waste of food stuffs a very large amount of work has been done in actually sorting and supervising the sorting of goods found by the initial inspections to be unsound in various degrees, and with the results as indicated in the tabulated statements. I might point out that this extra work has greatly reduced the average annual number of visits, but by reference to the tables mentioned it will be seen that the quantities of food stuffs dealt with about 6,465 tons were utilised for purposes other than the food of man (principally cattle food), and this, to a small extent, supports the contentions I have expressed in previous reports with regard to the costly waste of what should be a valuable material. With regard to the disposal of that portion actually destroyed we have adhered to the same methods as in the past; although the cost of destruction has become more expensive, but in spite of this a good deal of material which might be utilised is completely lost. Beyond the above there has not, in my opinion, been any case of sufficiently special interest to warrant comment by me in these strenuous times. Customs Authorities. The most amicable feeling exists with these officers, and the ever ready and valuable assistance rendered by them is deserving of the warmest thanks. FOOD AND DRUGS. In Tables VIII. and IX. of Appendix will be found a list of the samples taken in 1916, and the action taken; 1,001 samples 23 were taken, compared with 1,198 in 1915 and 1,186 in 1914. Of these 11.1 per cent. were found adulterated, compared with 7.4 per cent, in the previous year and 11.6 per cent. in 1914. As the Government had expressed a desire that Local Authorities should exercise strict economy, we decided, in view of this, and the fact that the percentage of adulteration had fallen so much during 1915, to reduce the number of samples analysed from 1,200 per annum to 1,000. Unfortunately, however, the low percentage of adulteration shown in 1915 was not maintained in 1916, so it was thought desirable to return to our original figure when the estimates came to be revised in January, 1917. For instance, the percentage of adulteration went from 9.8 in 1915 to 15.8 in 1916. The same happened with the butter. It is difficult to explain the difference, but it is probably due to the higher food price ruling in 1916 than in 1915, which make the temptation to adulterate greater. Food Inspectors. The figures recording the work of the food inspectors are not so high as last year, but the decrease is owing to the supervision of large Government contracts and shortage of clerical labour, necessitating them doing rather more office work than usual, etc. Food Inspectors. Particulars of Work, 1916. 1 2 3 4 5 6 8 9 10 7 11 12 13 14 15 Food Factories. Butchers Fishmongers, Friers and Curers Food Stores. Food Wharves and Depots Ice Cream Destruction of Food. Nuisances Reported. Markets. Restaurants and Eating Houses Slaughterhouses. Fruiterers and Greengrocers. Milk Sellers. Butter and Margarine. Visits. Bakehouses. Cowsheds. Other. Jam. ... ... ... ... ... 6 ... 841 6 Re-visits ... 630 2471 ... ... ... ... Re-visits 340 475 1 158 26 71 1 12 94 112 178 ... 115 83 8 287 156 New occupiers or Premises ... ... ... ... 2 1 24 21 3 ... 2 3 ... ... ... ... ... Re-visits 108 1 105 610 161 110 72 284 527 161 2 74 9 39 116 1 105 New occupiers or Premisns ... 2 1 7 ... 4 3 22 5 ... 11 8 ... ... ... ... ... Re-visits 448 133 228 283 1 1745 2612 193 80 577 683 319 1026 13 220 28 16 New occupiers or Premises ... 2 4 1 7 32 ... 7 4 ... 11 ... ... ... 46 5 ... ... GENERAL SANITARY WORK. Inspections. In Tables G and H. (pages 28 and 29) will be found particulars of the general sanitary work by the District Inspectors during 1916. The house-to-house inspections numbered 490. This is 3,884 below the total for the previous year. 1,643 intimation notices were served, compared with 4,356 in the previous year. Owing to the depletion of the staff of Inspectors and the difficulty of replacing them, it was decided to try and manage with four instead of eight district inspectors. This entailed the suspension of the house-to-house inspection which seemed the less urgent part of the work, especially as in many parts of the borough it consisted in examining houses which had nothing whatever the matter with them. This policy at this time had a good deal to recommend it as it was not only a temporary measure till the end of the war, which it was thought might not last much longer, but an economic measure. Later, however, when the agitation for better housing for the working classes became greater, and the end of the war appeared further off, the Committee deemed it advisable to try and replace the inspectors who had gone, by appointing temporary men in their place. The first attempt was not very successful as the salary offered, £125 per annum, did not atract any suitable candidates, but later on temporary inspectors were found when the maximum salary of the permenant inspectors, viz., £180, was offered. They did not commence work till 1917. Smoke Nuisances. 26 observation were kept on chimneys and 16 notices served. House Refuse. The following table shows the amount of house and traderefuse disposed of during the year ended December, 1916:— House Refuse- Tons. Cwts. Qrs. Bermondsey Destructor 10,524 loads. 16,311 18 0 Taken to shoot 364 „ 564 4 0 Total 10,888 „ 16,876 2 0 Trade Refuse — Bermondsey Destructor 1,587 loads. 963 6 2 Taken to shoot 3,297 „ 3,626 14 0 Total 4,884 „ 4,590 0 2 Offensive Trades. The offensive trades on the Register are us follows:— Tripe boiler 1 Fellmongers 3 Glue and size makers 4 Fatmeltere 4 Manure Manufacturer 1 DISINFECTION. The following table shows the number of articles passed through the steam disinfector during the year under report: — Beds 524 Sheets 830 Blankets 2,306 Books 539 Bolsters 349 Miscellaneous 3,493 Carpets 2 Verminous Clothing 3,456 Cushions 192 Hair (bundles) 107,064 Mattresses 143 „ (cases) 324 Overlays 261 - Pillows 1,254 Total 121,302 Quilts 565 2,667 new tabs were used to replace those taken off mattresses, palliases, and cushions before disinfection. Table G. Work of District Inspectors 1916. 1 2 3 4 5 6 7 8 9 10 11 Underground Conveniences. Drains Tested. Other Calls and Visits. Outworkers' Bi-Annual Inspection. Special Inspections. Infectious Diseases. Factories and Workshops specially Inspected. House to House. Offensive Trades. Re-inspections. Complaints. No. Ints. No. Ints. No. Ints. No. Ints. No. Ints. No. No. Ints. No. Ints. No. No. No. - 45 463 474 135 Mr. Grice 106 53 254 107 272 270 44 5 - 1 5 193 2120 Mr. Wood 111 71 62 16 57 27 24 4 22 8 1 - 12 114 - - - 554 Mr. Merryman 99 54 236 91 264 156 650 54 9 4 18 170 10 145 40 1818 405 - Mr. Toogood 89 38 102 5 59 38 62 4 - 5 8 5 505 101 - - - - - 20 - 7 - 220 - 188 - 27 - 3 - 91 - 98 Mr. Golds - 24 - 111 - 448 - 39 - 3 - 69 - 73 - 1084 - 175 - - Mr. Pitts 15 11 41 2 12 4 3 1 1 - - 5 - 76 - - - 5 Mr. Coekburn 50 33 89 8 236 176 510 129 5 3 189 27 182 106 1870 97 - - Totals 490 267 1004 253 1290 784 1967 275 69 19 115 3 592 42 602 281 8027 1360 Cleansing of Persons Act, 1897. During the year under report 17 male adults, 292 male and 572 female children used the Verminous Baths and had their clothing disinfected. The total number of articles disinfected for this purpose was 3,456. These figures are very low compared with 1915, since the station was closed early in April, 1916, as the County Council decided to do the cleansing of school children at their own station at Chaucer Street School. Table H. —Proceedings during 1916. Number of Places. Number of Prosecutions, 1916. Number of Inspections, 1916. On Register at end of 1915. Added in 1916. Removed in 1916. On Register at end of 1916. Number of Notices,1916. Premises. Milk Premises 32 1 683 ... 284 ... 253 Cowsheds ... ... ... ... ... ... ... 1 Slaughter-houses ... ... 1 56 ... ... Other offensive trade premises 13 ... 13 115 3 ... ... 95 7 102 80 11 ... Ice-cream premises ... Registered houses let in lodgiings 223 ... 223 446 ... ... ... Total number of Intimation Notices served for all purposes 1659 Overcrowding, 1916 — Number of dwelling rooms overcrowded 8 Number remedied 8 Number of prosecutions Underground, rooms — Illegal occupation dealt with during year — Number of rooms closed insanitary houses— Number closed under the Public Health (London) Act, 1891 Number closed under the Housing of the Working Classes Act Number of premises cleansed under Section 20 of the L.C.C. (General Powers) Act, 1904 Number closed under the Housing, Town Planning, etc., Act, 1909 Shelters -provided under Sec. 60 (4) of the Public Health Act, 1891 — Number of persons accommodated Revenue Acts — Number of houses for which applications were received during the year Number of tenements for which certificates were granted Number of tenements for which certificates were deferred Housing Town Planning, etc., Act, 1909, Sec. 35— Number of houses for which applications were received during the year Number of houses for which certificates were granted — Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. - (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health - (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. - (f) As to cesspools and privies, removal and disposal of refuse, etc. - (g) For securing the cleanliness of tanks, cisterns, etc. - (h) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) - (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) — Mortuaries— Total number of bodies removed 160 Total number of infectious bodies removed 21 Health Visitors. The following table shows the work done by the Health Visitors during the period under report:— Bermondsey Wards. Rotherhithe Wards. St. Olave Ward. Whole Borough. St. John. St. Thomas St. Olave. 1 3 2 4 5 6 1 2 3 Births Notified:— r~ I i — — By Guy's Hospital 7 1,078 2 8 41 16 265 305 203 176 52 2 1 By Midwives 107 782 39 40 45 86 85 150 By Doctors 115 54 47 7 7 891 17 51 96 192 98 32 By Parents 28 123 157 101 21 5 2 167 21 5 12 44 15 5 17 33 4 9 1 4 TOTAL 2,918 326 413 406 200 249 298 307 350 165 124 54 26 Visits—Miss Nuttall:— ~n — ! i —- — — — — Births (first) 1,190 230 46 10 209 4 11 ... 284 271 69 „ (subsequent) 36 20 362 59 173 37 Ophthalmia Neonatorum 4 68 1 17 ... ... ... 3 4 ... ... 1 1 1 ... Phthisis (first) ... ... 1 239 ... ... ... ... 48 54 51 13 26 „ (subsequent) 1 4 2 13 17 10 29 ... 10 8 5 2 3 ... Pupereral Fever ... ... ... ... 1 1 ... 1 Poliomyelitis ... ... ... ... ... ... ... ... ... ... 4 ... 3 1 ... ... ... ... Various 206 ... ... ... ... ... 45 52 42 ... 4 39 ... 2 1 1 11 5 4 2,025 382 575 409 TOTAL 70 346 11 11 14 1 110 62 34 Visits—Mrs. Croke: — | i r f I I Births (first) 174 18 37 18 25 48 28 ... ... ... ... ... ... „ (subsequent) 116 11 20 11 17 48 9 ... ... ... ... ... ... Ophthalmia Neonatorum 6 ... ... ... ... 4 1 1 ... ... ... ... ... Phthisis (first) 61 5 19 5 5 19 8 ... ... ... ... ... ... „ (subsequent 24 1 8 1 6 6 2 ... ... ... ... ... ... Pupereral Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... Various 46 5 14 2 9 13 3 ... ... ... ... ... ... TOTAL 427 40 102 37 63 134 51 ... ... ... ... ... ... Visits—Miss Webber: — T . I I i 33 Births (first) 772 44 150 133 153 178 114 ... ... ... ... ... ... „ (subsequent 36 3 7 3 3 19 1 ... ... ... ... ... ... Ophthalmia Neonatorum 7 1 1 1 2 2 ... ... ... ... ... ... ... Phthisis (first) 142 17 23 29 28 32 13 ... ... ... ... ... ... „ (subsequent) 19 3 3 4 5 ... ... 4 ... ... ... ... ... Cerebro-Spinal-Meningitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... Poliomyelitis 8 1 1 6 ... ... ... ... ... ... ... ... ... Various 146 21 27 30 31 27 10 ... ... ... ... ... ... TOTAL 1,131 89 212 240 180 270 140 ... ... ... ... ... ... Health Visitors. The work of the Health Visitors is set out on accompanying table. Mrs. Croke resigned in March, and her place was taken by Miss Webber in June. Towards the end of the year the Council finally decided to appoint two more Health Visitors, making a total staff of four, but the additional members did not take up their duties till January, 1917. Tuberculosis Dispensary. I continued to assist on Monday nights at the dispensary in the early part of the year, but discontinued later as I found that owing to the air-raids the attendance at night was very small. From the Annual Report of the Dispensary there were 486 new patients examined; of these 342 were definitely suffering from or suspected to be suffering from tuberculosis in some form. The number of visits paid by patients to the dispensary was 8,755, and the number of visits paid to the homes of patients was 643 by the Medical Officer, and 1,134 by the Nurse. IV.—FACTORIES AND WORKSHOPS. In Table X of the Appendix will be found particulars of the inspections of factories and workshops, and in the following table particulars regarding the trades and persons employed in connection with workshops. There were 328 workshops on the Register in 1916. Including bakehouses, of which there were 10 in use, the total is 338. OUTWORKERS. There were 791 outworkers on the Register at the end of 1916. 70 lists were sent in by firms in this Borough employing outworkers. Table XI. of the Appendix shows the various trades followed by outworkers in this district. APPENDIX. c 2 APPENDIX. Table I. —Vital Statistics of Whole District during 1916 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non- Residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Net Deaths at all Ages belonging to the District. Rate.* No. Under 1 Year of Age. No. Rate.* At all Ages. No. Rate per 1,000 Births registered No. Rate.* 1 2 3 4 5 7 8 9 10 6 11 12 13 1906 128,288 4,031 31.4 533 132 1,979 15.4 456 20 570 2,529 19.7 1907 127,856 31.4 1.856 14.5 460 25 507 4,013 441 110 2,338 18.3 1908 127,438 4,172 32.1 534 128 1,951 15.0 591 37 530 2,444 18.8 1909 15.3 2,387 127,030 4,055 31.9 480 118 1,947 562 26 466 18.8 126,634 3,957 1910 31.2 403 102 1,717 13.5 550 30 542 2,229 17.6 1911 125,840 3,842 30.5 497 130 1,782 14.2 515 22 560 2,320 18.4 1912 125,388 30.3 1,601 483 2,119 16.9 3,799 433 114 12.8 20 538 124,739 3,842 505 529 1913 30.8 131 1,730 13.9 21 534 2,243 17.9 1914 3,757 30.2 487 129 13.6 615 26 516 2,184 124,213 1,694 17.6 123,665 3,482 29.6 537 17.5 654 38 542 21.4 1915 154 2,053 2,514 Averages for years 1906-1915 126,111 30.8 1,831 14.5 2,330 18.5 3,895 485 124 530 541 26 1916 123,665 3,361 27.1 364 108 1,507 13.2 608 155 453 1,960 17.2 * 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 1911—Total population of all ages, 125,903. Do. Number of inhabited houses, 14,967. Do Average number of persons per house, 8.41. TABLE I: —continued. I. Institutions within the District receiving sick and infirm persons from outside the District. No of Deaths. Bermondsey Infirmary, 145 Bermondsey Workhouse, 10 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc. 23 Total 178 11. Institutions outside the District receiving sick and infirm persons from the District. Bormondsey Workhouse, Ladywell-35 deaths III. Other institutions, the deaths in which have been distributed among tile several localities in the District. No. of Deaths. Bermondsey Workhouse, Ladywell 35 Banstead Asylum 2 Cane Hill Asylum 15 Caterham Asylum 23 Children's Hospital, Great Ormond Street 1 Claybury Asylum 1 Colney Hatch Asylum 1 Children's Infirmary, Cleveland Street 2 Chest Hospital, City Road 2 Charing Cross Hospital 2 Derenth Industrial Colony 1 Dartford Heath Asylum 10 Downs Sanatorium 3 East London Hospital 4 Evelina Hospital 10 Epileptic Colony 1 Grove Hospital 1 Grand Surrey Canal 2 Greenwich Infirmary 1 Guy's Hospital 178 German Hospital 2 General Lying-in Hospital 1 Hanwell Asylum 1 Hostel of God 1 Infants' Hospital, Vincent Square 3 Italian Hospital 1 Infirmary, Plumstead 1 Joyce Green Hospital 1 London Hospital 7 Lambeth Infirmary 5 Leavesden Asylum 1 Long Grove Asylum 6 Lambeth Schools Infirmary 11 Manor Asylum 2 Marylebone Infirmary 1 Middlesex Hospital 3 Millers Hospital 3 New Hospital for Women 2 Park Hospital 6 Queen Mary's Hospital, Carshalton 2 Railways 3 TABLE I.—continued. I Institutions within the District receiving sick and infirm persons from outside the District. No. of Deaths. 11. 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. No. of Deaths. River Thames 12 Royal Waterloo Hospital 5 St. Bartholomew's Hospital 1 St. Annis Home, Streatham Hill 9 St. George's Home, Chelsea 1 St. Thomas's Hospital 1 South Eastern Hospital 17 South Western Hospital 3 Southwark Workhouse 1 Street 19 Surrey Commercial Docks 9 Tooting Bee Asylum 15 Throat Hospital, Golden Square 1 The Green, Esher 1 Westminster Infirmary 1 Total 453 Table II.—Vital Statistics of Separate Localities in 1916 and Previous Years. Bermondsey. Rotherhithe. ST. Olave. Births registered. Deaths 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. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. 2,683 259 1906 81,727 1,618 408 38,229 1,089 702 170 8,332 209 46 81,610 2,674 1,506 335 1,110 669 144 8,049 163 22 1907 38,197 229 2,785 7,769 258 48 1908 81,500 1,613 411 38,169 1,129 611 151 220 1909 81,398 2,739 1,563 396 38,145 1,069 654 143 7,487 247 170 34 1910 81,304 2,661 341 603 134 7,205 256 185 27 1,441 38,125 1,040 167 247 184 41 1911 82,110 2,528 1,470 403 35,059 1,067 666 8,671 1912 82,073 2,502 1,439 290 34,747 1,065 511 113 8,568 232 169 30 1913 81,833 2,548 1,501 357 34,477 584 118 8,429 220 158 30 1,074 232 36 1914 81,781 2,502 1,409 333 34,134 1,023 554 116 8,298 173 1915 77,155 2,306 1,665 349 32,194 991 642 153 7,839 185 207 35 Averages of years 1906-1915 81,249 1,065 619 2,592 1,522 362 36,147 140 8,064 236 183 34 1916 Civil 73,991 - 1,341 233 30,820 - 479 102 - 140 29 7,850 Bermondsey. Rotherhithe St. Olave. Whole Borough. Year. No. Rate. No. Rate. No. Rate. No. Rate. 719 17.59 310 16.22 70 16.80 1,099 17.13 1906 1907 736 18.69 315 16.49 69 17.14 1.147 17.4 1908 750 18.05 250 12.85 84 21.21 1,084 16.69 723 15.76 1,038 16.34 1909 17.76 256 13.42 59 754 18.55 315 16.52 80 22.21 1,149 18.14 1910 1911 757 18.44 284 16.20 89 20.53 1,130 17.96 1912 722 17.59 325 18.71 135 31.51 1,182 18.81 1913 748 18.28 323 18.74 132 31.32 1.203 19.21 759 18.56 378 22.15 99 23.86 1,236 19.90 1914 1915 1066 26.16 450 26.18 198 150.50 1,714 28.12 320 Average for years 1906-1915 773 18.96 17.74 101 25.08 1,198 18.93 13.46 1.215 9.82 1916 326 9.41 774 9.61 115 Table IV.—Causes of and Ages at Deaths during the year 1916. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Total Deaths whether of "Residents" or "Nonresidents" in Public Institutions in the District. 65 and upwards. All Ages. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. Under 1. ... All Causes {Certified 1,960 364 128 82 453 523 86 86 238 Uncertified ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 2 1 ... 1 ... ... ... ... 41 ... Small Pox ... ... ... ... ... ... ... ... ... ... Measles 42 11 54 7 6 ... ... ... ... ... Scarlet Fever 5 2 1 ... 2 ... ... ... ... Whooping Cough ... 16 7 5 4 ... ... ... 2 ... ... Diphtheria and Croup 29 1 9 12 5 1 1 ... ... ... Influenza 17 1 1 1 1 9 5 ... ... ... Erysipelas 4 1 1 2 ... ... ... ... 4 ... Phthisis (Pulmonary Tuberculosis) 160 1 2 11 30 61 52 3 93 ... Tuberculosis Meningitis 44 12 15 6 10 1 18 ... ... ... Other Tuberculous Diseases 3 1 1 ... 1 16 ... ... ... ... Cancer, Malignant Disease 129 ... ... 1 10 69 49 63 ... ... Rheumatic Fever 8 ... ... 1 4 1 1 1 2 ... Meningitis 19 10 1 2 3 1 1 1 ... ... Organic Heart Disease 216 ... 1 6 9 26 85 89 ... 107 Bronchitis 292 35 7 3 2 4 17 63 161 154 Pneumonia 193 73 30 9 8 4 19 25 25 55 Other Diseases of Respiratory Organs 16 2 4 1 1 3 5 1 ... ... Diarrhœa and Enteritis 61 36 10 3 2 ... 7 3 19 Appendicitis and Typhlitis ... 7 ... 2 ... 2 1 1 1 ... ... Cirrhosis of Liver 14 1 1 ... 8 ... ... ... 3 9 ... Alcoholism 1 ... ... 1 Nephritis and Bright's Disease ... ... ... ... ... 37 2 11 ... ... ... 1 17 6 21 Puerperal Fever ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition ... 4 ... 6 ... 1 1 1 ... ... ... Congenital Debility and Malformation, including Premature Birth 117 4 42 4 ... 185 ... 45 ... ... ... Violent Deaths, excluding Suicide 8 6 85 10 13 16 6 10 16 15 Suicide 9 ... 1 3 ... 3 2 1 ... ... Other Defined Diseases 48 9 17 11 417 24 61 92 155 71 Diseases ill-defined or unknown 3 ... ... 1 2 ... ... ... ... ... All Causes 86 523 1,960 364 82 453 704 128 86 238 Table V.—Abbreviated Tables of Causes of Death. Causes of Death. 2-3 weeks. Total under 1 mth. 1-3 months. 6-9 months. Total Deaths under 1 year. 1916. Total Deaths under 1 year. 1915. Under 1 week 1-2 weeks. 3-4 weeks. 3-6 months. 9-12 months. 59 17 21 5 102 64 85 45 68 364 537 {Certified All causes {Uncertified ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... Chicken-pox 1 ... ... ... ... ... ... ... ... ... ... Measles 1 2 8 11 26 ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Whooping-Cough 3 2 1 1 7 29 ... ... ... ... ... Diphtheria and Croup 1 1 2 ... ... ... ... ... ... ... ... Erysipelas ... ... 1 ... ... ... ... ... ... ... ... Tuberculous Meningitis 2 3 4 3 12 6 ... ... ... ... ... Abdominal Tuberculosis 1 1 2 4 ... ... ... ... ... ... ... Other Tuberculous Diseases ... 3 ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) 2 2 1 3 1 3 10 8 43 ... ... ... Convulsions 2 1 1 4 1 3 8 12 ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... Bronchitis 4 1 1 6 3 9 7 10 35 45 ... Pneumonia (all forms) 1 1 2 12 19 16 24 73 82 ... ... Diarrhœa 4 7 ... ... 1 2 24 ... ... ... ... Enteritis 1 1 6 14 3 5 29 78 ... ... ... Gastritis 1 ... ... ... 1 ... ... ... ... ... ... Syphilis 2 2 ... 2 ... ... ... ... ... ... ... Rickets 1 ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 2 1 2 5 4 9 10 ... ... ... ... 2 2 Injury at birth ... ... ... 2 7 ... ... ... ... Atelectesis 7 7 2 9 20 ... ... ... ... ... ... Congenital Malformations 4 5 2 1 12 4 2 1 19 14 ... Premature birth 23 37 3 1 6 6 2 41 63 ... ... Atrophy, Debility and 11 3 3 17 15 14 6 57 75 Marasmus ... 5 3 3 7 5 8 1 29 Other Causes 1 8 24 ... Totals 59 17 21 5 102 64 85 45 68 364 537 Nett births in the year—Legitimate, 3,310; Illegitimate, 51. Table VI.—Deaths from Zymotic Diseases, 1916. Pyrexia (origin uncertain) Principal Zymotic Diseases. Smallpox. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Year. All Causes. Measles. Diarrhœa No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. 1.46 1906 2529 19.7 400 3.12 - - 94 .73 30 .23 34 .27 50 .39 - - 4 .03 - - 188 1907 2338 18.3 223 1.74 51 .40 36 .28 22 .17 52 .41 - - 7 .05 - 55 .43 - - - 1908 2444 18.8 300 2.31 - 105 .81 26 .20 26 .20 18 .14 - 12 - - .09 - 113 .87 - 1909 2387 18.8 368 2.89 - 196 1.54 17 .13 12 .09 54 .42 1 .00 2 .01 - - 86 .68 - 1910 2229 17.6 310 2.44 - - 143 1.12 14 .11 18 .14 44 .34 - 4 .03 - - 87 .68 - 1911 2320 18.4 352 2.79 51 .41 6 05 15 12 48 38 6 05 - - 226 1.80 - - - - 04 67 1912 2119 16.9 252 1.21 - - 101 81 8 06 17 14 36 29 1 00 5 - - 84 1913 2243 17.9 320 2.56 - 88 70 5 .04 16 .13 47 .38 - - 2 .02 - 162 1.30 - - 1914 2184 17.6 262 2.11 79 64 9 .07 17 14 14 .11 2 .02 - 141 1.14 - - - - - 1915 2514 21.4 367 3.13 110 .93 9 .07 20 .17 79 .67 - 3 .03 - 146 1.24 - - - - Average for years 1906 to 1915 2330 18.5 315 2.43 - - 101 .80 16 .12 19 .15 44 .35 - - 3 .03 - - 128 1.2 42 5 1916 17.2 155 1.36 - .36 .04 29 1960 - .25 16 .14 - - 2 .01 - 61 .53 - London 1916 61373 4031 .93 815 146 .03 604 .18 - 75 .01 - 1598 - 14.2 .18 .14 793 - - - - TABLE VII.—CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1916. Notifiable Disease NUMBER OF CASES NOTIFIED. Bermondsey. Rotherhithe. St. Olave. At all ages. At Ages Years. 1 2 3 4 5 6 Total. 1 2 3 Total. St. John. St. Thomns. St. Olave. Under 1 65 and upwards. 1 and under 5 years. 5 an under 15 years. 15 and under 25 years. 25 and uncle 45 years. 45 and under 65 years. 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Small-pox 1 Diphtheria (including Membranous Croup) 249 13 157 4 24 75 4 9 ... 7 116 109 11 2 33 43 31 18 19 26 25 4 88 22 28 8 10 8 62 7 20 2 1 Erysipelas 12 7 2 5 11 12 18 7 11 2 3 252 23 19 160 Scarlet Fever 36 80 6 3 98 134 11 6 ... ... 46 38 16 18 27 17 5 1 Relapsing Fever—Continued Fever 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... ... ... 1 ... Puerperal Fever ... ... ... ... ... ... 1 1 1 ... ... ... 1 15 Cerebro-Spinal Meningitis 4 5 5 1 ... ... 4 2 1 ... 1 2 10 2 1 ... 1 ... 1 ... 3 ... ... 1 1 6 1 5 1 ... Polio Myelitis 12 2 10 ... ... ... 1 1 2 4 ... ... 19 ... ... ... 1 8 5 Ophthalmia Neonatorum 19 ... ... 2 ... 3 3 3 11 ... ... 2 ... ... ... ... Anthrax 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 8 ... 2 2 ... Enteric Fever 13 ... ... ... 2 ... 1 4 6 2 1 2 2 ... 2 1115 Measles 111 6 ... 185 135 131 51 789 64 181 29 7 9 528 358 11 1 211 76 75 42 382 ... 16 30 41 11 3 Measles (German) 183 26 282 80 6 18 140 29 11 1 67 80 63 32 7 345 60 3 37 24 234 35 Pulmonary Tuberculosis 8 39 78 19 4 52 87 101 53 54 27 27 16 7 7 Other forms of Tuberculosis 161 17 28 113 21 36 5 2 9 36 5 1 20 3 82 18 10 17 15 16 12 5 179 939 186 98 12 309 317 442 1832 237 573 67 51 33 Totals 196 362 219 46 Table VIII. — Prosecutions in connection with Samples taken during 1916. No. Sample. Adulteration or Infringment. Remarks. ! ~ FIRST QUARTER. 473H Milk Added water 6.6 per cent Dismissed. Warranty proved 465H Vinegar Added water 50 per cent. Dismissed. Warranty proved 494H Milk Added water 5.4 per cent Dismissed. Warranty proved 505H Vinegar Added water 26.5 per cent. Dismissed. Warranty proved 4 23s Vinegar Added water 10 per cent. Ordered to pay costs, 17/6 SECOND QUARTER. 500s SECOND QUARTER. Added water 17.8 per cent. Dismissed. Warranty proved Butter 532s Milk Added water 8.7 per cent Fined 10/-; costs, 13/6 4s Milk Deficient in milk fat 9 per cent. Fined 10/-; costs, 13/6 Added water 6.7 per cent. Fined 10/-; costs, 13/6 526s Milk 29s Dripp;ng Added water 13.9 per cent. Fined and costs, 15/6 Deficient in milk fat 7.30 per cent. Fined 40/-; costs included 29s Milk 43s Milk Deficient in Milk fat 4.7 Fined 40/-; costs included 37s Milk Added water 50 per cent. Dismissed. Warranty proved Dismissed. Warranty proved. 4 0s Milk Added water 3.9 per cent. 74H Milk Added water 2.3 per cent. Ordered to pay costs, 13/6 Fined 20/-; costs, 13/6 52s Milk Deficient in milk fat 23 per cent. Deficient in milk fat 7.7 per cent, Fined the costs, 15/6 68s Milk 62H Margarine Wrapper not marked Fined 40/-; costs. 13/6 Butter Added water 17.9 per cent, Fined the costs, 15/6 62s 97H Milk Added water 1.9 per cent, deficient in fat 9.3 per cent. Dismissed. Warranty proved THIRD QUARTER. s 69s Butter Added water 1.7 per cent. Dismissed Warranty proved 92s Milk Deficient in milk fat 8 per cent. Dismissed. Warranty proved 93s Milk Deficient in milk fat 12 percent. Dismissed. Warranty proved 94s Butter Added water 3.9 per cent. Dismissed. Warranty proved 97s Vinegar Added water 11.5 per cent. Fined 5/-; costs, 13/6 111s Milk Added water 4.5 per cent. Dismissed. Warranty proved 121 Milk added water 3 per cent deficient 121s Milk in fat 15.7 per cent. Ordered to pay costs, 10/6 126 Margarine Wrapper not marked Ordered to pay costs, 2/- 153s Vinegar Added water 17.5 per cent. Ordered to pay costs, 10/- 119s Milk Added water 3.8 per cent. deficient 119s Milk in fat 7.3 per cent. Dismissed. Warranty proved 136H Butter Added water 17.6 per cent. Ordered to pay costs 157H Milk Added water 12.2 per cent. Dismissed. Warranty proved. 103s Milk Added water 2 per cent. Fined 10/-; costs, 12/- 88s Milk Added water 2 Per cent. Fined £10; costs, 15/6 190H Milk Deficient in milk fat 11.3 percent. Dismissed. Warranty proved 191H Milk Deficient in milk fat 26.7 Per cent. Dismissed. Warranty proved. 146s Milk Deficient in milk fat 7.3 per cent. Ordered to pay costs, 15/- FOURTH QUARTER. 183s Milk Added water 3.9 P er cent. Fined 20/-; and costs 17/6 207s Milk Added water 12.5 P er cent. Fined 20/-; and costs, 15/6 233H Milk Deficient in milk fat 20 per cent. Dismissed. Warranty proved. 22 4 S Vinegar Added water 17.5 per cent. Fined 20/-; and costs, 15/6 197s Milk Deficient in milk fat 16.7 P er cent Fined 10/-; and costs, 15/6 239s Milk Added water 10.9 per cent. Ordered to pay costs. 15/6 281H Egg Powder 0.11 grs. per lb. in excess of arsenic Fined 40/-; and costs, 13/6 I Added water 38 per cent. Fined 20/-; and costs, 13/6 316H Vinegar Fined 10/-; and costs, 13/6 316H Milk Added water 15.9 per cent. Summary. £ s. d. Fines 26 5 0 Costs 19 16 0 TOTAL £46 1 0 47 TABLE IX,—FOOD AND DRUGS. Total Samples Taken. Percentage of Articles Adulterated. Articles submitted for Analysis. Number Genuine Number Adulterated. Acid Phosphate 4 3 1 25.0 Ammoniated Tincture Quinine 2 2 - - Black Currant Jam 1 1 100.0 - Brawn 1 1 - - Butter 112 118 6 5.1 Baking Powder 8 7 1 12.5 Bun Flour 1 1 - - Camphorated Oil 1 1 - - Cocoa 16 16 - - Coffee 5 5 - - 1 Cream 1 - - Crystal Syrup 1 1 - - Cakeoma 2 2 - - 3 Cheese 3 - - Dripping 54 52 2 3.7 Egg Powder 2 1 1 50.0 1 Fine Oatmeal 1 - - Fish Paste 2 2 - - 9 8 1 11.1 Freah Butter Granulated Effervescent . I Citrate 1 1 - - Ground Ginger 1 1 - - Gorgonzola Cheese 1 1 - - Lard 19 19 - - 1 1 Lemonade Powder - - 11 Malt Vinegar 11 - - Margarine 31 29 2 6.4 544 457 87 15.9 Milk 1 Mincemeat 1 - - Mustard 4 4 - - 1 1 Oatmeal Stout - - Olive Oil 3 3 - - 1 1 Paisley Flour - - 15 Pepper 15 - - Raspberry Syrup 1 - 1 100.0 Raspberry Jam 4 3 1 25.0 4 4 Salmon and Shrimp Paste - - 3 Salt Butter 3 - - 1 Sausage (Breakfast) 1 - - 22 Self Raising Flour 22 - - 1 Special Mild Ale 1 - - 2 1 1 50.0 Strawberry Jam 4 4 Tapioca - - 1 Temperance Wine 1 - - 90 84 6 6.6 Vinegar 1 1 Viola Mixture - - 1 White Pepper 1 - - 890 1001 111 11.1 Table X.-Factories, Workshops, Laundries, Workplaces and Homework. Inspection. Number of Premises. Written Notices. Inspections. Prosecutions Factories (including Factory Laundries) ... 26 6 Workshops (including Workshop Laundries.) ... 13 5 Workplaces (other than outworkers' Premises) 30 8 ... Total 19 ... 69 Defects found. Number of Defects. Number of Prosecutions. Particulars. Referred to H.M. Inspector. Remedied Found. Nuisances under the Public Health Want of Cleanliness 2 2 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of Drainage of Floors ... ... ... ... Other Nuisances 44 44 ... ... Sanitary Insufficient ... ... ... ... Unsuitable or Defective 6 6 ... ... Not separate for Sexes 1 1 ... ... Offences under the Factory and Workshop Act— Illegal Occupation of Underground Bakehouse (s. 101) ... ... ... ... Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) ... ... ... ... Other Offences ... ... ... ... Total 53 ... ... 53 Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) ... Action taken in matters referred} by H.M. Inspectors as } remediable under the Public } Health Acts. but not under } the Factories Act (s. 7) } Notified by H.M. Inspectors Reports (of action taken sent to H.M. Inspectors) 11 ... Other Underground Bakehouses (s. 101) Certificates granted during 1916 ... In use at end of 1912 32 Workshops on the Register (s. 131) at the end of 1916 328 Workshop Bakehouses 10 Toal Number of Workshops on Register 388 Table XI.—Factories, Workshops, Laundries; Workplaces, and Homework (continued). Home Work. Nature of Work. a) 1 Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section, 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. (8) Prosecutions. Instances. (11) Notices served. (12) Prosecutions. (13) Instances. (14) Order made (S. 110). (15) Prosecutions (Sections 109,110). (16) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) Lists. (2) Outworkers. Outworkers Lists. (5) Contractors. (3) Workmen. (4) Contractors. (6) Workmen. (7) Wearing Apparel:— m 14 O.IO 1 i ! •; '! .. !' — .. (1) Making, &c. 22 14 248 ... ... 14 ... ... 15 ... ... ... ... ... 21 (2) Cleansing and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace,lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture ings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro-plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, latches and keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents 2 ... 6 ... 2 ... ... ... ... ... ... ... ... ... ... Sacks and cotton bags 4 ... 61 ... 5 ... ... 3 2 ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper „ oa . 3 ... 1 1 ... Bags 2 ... 28 ... ... ... ... 1 ... ... Brush making ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Pea Picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather Sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of Buttons, &c. ... ... 7 ... ... ... ... ... ... ... ... ... ... ... ... Surgical Instruments 1 ... 7 ... ... ... ... ... ... ... ... ... ... ... ... Basket making 1 ... 6 ... ... ... ... ... ... 3 2 ... ... ... ... Chocolates and Sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas I Crackers, Christmas Stockings, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Leather Goods 1 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... Total 34 14 361 1 ... 1 24 ... ... 28 20 ... ... ... ... Table XII.—No. of Bakehouses in the Borough. In Use. Not in Uue. Inspentor. Underground. Above Ground. Underground. Above Ground. Mr. Scott 10 20 2 2 23 Mr. Hoskins 13 4 7 10 of these are Factory Bakehouses.