BER 37 Metropolitan Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY, For the Year 1918. BY R. KING BROWN, B.A., M.D., D.P.H, Medical Officer of Health. TABLE OF CONTENTS. VITAL STATISTICS— Page Population 6 Births 6 Marriages 7 Deaths 7 Infantile Mortality 8 Zymotic Diseases 8 Measles 8 Whooping Cough 9 Enteric Fever 9 Tubercular Diseases 9 Phthisis 9 NOTIFICATION OF INFECTIOUS DISEASE— Diphtheria 10 Scarlet Fever 10 Measles 11 Enteric Fever 11 Puerperal Fever 11 Ophthalmia Neonatorum 11 Cerebro-Spinal-Meningitis 11 Polio-myelitis 11 Bacteriological Laboratory 12 Special Report on Influenza 12 SANITARY ADMINISTRATION— Page Unsound Food 21 Milk Premises 22 Slaughterhouses 22 Ice Cream Premises 22 Food and Drugs 22 Food Inspectors' Work 23 General Sanitary Work 24 Smoke Nuisances 24 House Refuse 24 Offensive Trades 24 Disinfection 25 Cleansing of Persons Act, 1897 25 Proceedings during Year 25 Mortuary 27 District Inspector's Work 28 Tuberculosis Dispensary 29 Factories and Workshops 29 Outworkers 29 Health Visitors 30 APPENDIX TABLES— Local Government Board Tables 32-39 Outworkers 40 Deaths from Zymotic Diseases 41 Prosecutions (Food and Drugs) 42 Food and Drugs 43,44 Marriages 45 Factories and Workshops 46 Bakehouses 47 Unsound Food and Foreign Meat Regulations 48,49 PUBLIC HEALTH DEPARTMENT. COMMITTEE, 1918. Chairman—Councillor OAKE. Alderman Morriss Councillor Hunt, „ Lunn, „ Squires, Councillor Braithwaite, „ Millson, „ Brown, „ Pocock, „ Gardiner, „ Roxbury, „ Gaunt, „ Siddle, „ Holton, „ Vezey, Ex-officio: W. SHEARRING, 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 Webber, Miss Bache, Miss Islip, Miss Carlton. Clerical Staff: Mr. H. A. W. Bush, Chief Clerk. Mr. E. J. Pitts, Second Clerk. Mr. F. C. Shaw, Fourth Clerk. Mr. J. G. Francksen, Third Clerk, Mr. H. E. Butcher, Junior Clerk. D. T. Carver, 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. MADAM AND GENTLEMEN, I have the honour to submit my Eightenth Annual Report on the sanitary condition of the Borough of Bermondsey during the year 1918. The death-rate was 22.0, compared with 18.8 in 1917, and 17.2 in 1916. 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. I wish once more to record that between the Chairman and Members of the Public Health Committee and myself, there has been the usual cordial co-operation during the year under report. 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: — Estimated to June 30th, 1918. 1901. 1911. Civil Population. Total Population. Bermondsey 81,959 70,583 79,083 82,483 34,005 Rotherhithe 38,460 35,247 30,343 8,377 9,817 8,697 7,480 St. Olave Borough 130,760 125,903 108,406 121,465 The total population of Bermondsey for 1918 has been estimated by the Registrar-General as 121,465, and this figure has been utilised in estimating the birth-rate. The civil population has been estimated by the Registrar-General as 108,406, based on the National Register in conjunction with the two last census enumerations. 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 have been included. Births. The total number of births registered in the Borough for the 52 weeks ended December 28th, 1918, was 2,323, consisting of 1,184 males and 1,139 females. This is 1,365 below the average for the last 10 years, and 290 below the figure for 1917. 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 1918 calculated on the "total population" was 19.1 per thousand persons living, which is 2.6 below that for 1917 and 10.4 below the average for the last 10 years. Marriages. The total number of marriages in the Borough in 1918 was 1,106, being 91 above the number for 1917, and 91 below the average for the last 10 years. In Table X. 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 18 per 1,000 of the total population, 121,465, compared with a marriage rate last year of 17 per 1,000 of the total population 119,983. Deaths. In Table III. and 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 28th, 1918, was 2,142 which is 335 more than in 1917 and 363 above 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 parishioners occurring outside the district, the number is raised to 2,390. This is 358 more than in 1917, and 147 more than the average for the last 10 years. The death-rate for the Borough in 1918 was 22.0 per thousand living inhabitants, being 3.2 above that recorded in 1917, and 3.7 above the average for the last 10 years. 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 districts. There were 191 such deaths in all, against 186 in 1917 and 155 in 1916. 148 such deaths occurred in the infirmary; 14 in the workhouse, 19 in the River Thames and the Surrey Commercial Docks, 2 at London Bridge Station, 4 in private houses, 1 in the street, 1 on the railway, 1 in a. railway carriage, and 1 in a factory. 439 persons belonging to this Borough died in outlying institutions, against 411 in 1917, and 453 in 1916. 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 139 deaths under one year to every 1,000 births. Table A.— Infantile Mortality. Whole Borough. London. Year. No. of Deaths. Rate per 1,000 Births. Rate per 1,000 Births. No. of Deaths. 1908 610 146 13,943 113 1909 573 141 12,582 108 502 127 1910 11,809 103 159 1911 611 129 14.440 1912 433 114 10,056 91 11,869 105 1913 505 131 487 1914 129 11,395 104 1915 537 154 11,369 104 1916 364 108 8,819 88 1917 335 125 8,273 103 Average for years 1908-1917. 496 11,456 105 133 322 139 7,965 107 1918 Deaths from Zymotic Diseases. There has been a slight increase in the deaths from these diseases, the figures being 229 against 218 in the previous year, and 290 the average for the last ten years. This gives a- zymotic death-rate of 2.11. The total number of deaths from notifiable diseases, viz., measles, scarlet fever, diphtheria, typhus fever and enteric fever, was 97, compared with 97 in 1917, and for the non-notifiable, viz., whooping cough and diarrhoea, 132, compared with 121 in the previous year. Measles. There were 71 deaths due to this disease, which is 28 below the average for the last ten years, and 1 below the number for 1917. Whooping Cough. 84 deaths were due to this cause, against 32 in 1917. Enteric Fever. No deaths were due to this cause. The figures for 1917 were 6 for the Borough, viz., 3 in Bermondsey, 2 in Rotherhithe, and 1 in St. Olave. Tubercular Diseases. The number of deaths from all forms of tubercular disease in 1918 was 233, against 274 in 1917. This figure comprises 160 for Bermondsey, 62 for Rotherhithe, and 11 for St. Olave. Of these, 169 were due to phthisis and 64 to the other tubercular diseases. Phthisis. In Table B will be found particulars of deaths from phthisis since the year 1908. There were 169 deaths due to this cause, which is 29 less than the number recorded in the previous year. Table B —Phthisis. Whole Borough. Sub. District. Bermondsey. Rotherhithe. St. Olave. London. No. Rate. No. Rate. No. Rate. Year. No. Rate. No. Rate. 1908 157 1.89 60 1.54 24 3.03 241 1.85 6419 1.32 1.73 1909 147 1.80 56 1.46 17 2.27 220 6337 1.31 1.73 148 1.82 50 1.31 2.91 219 1.14 1910 21 5555 1.48 141 1.72 52 18 2.08 211 1.68 6084 1.35 1911 1.68 1912 138 57 1.64 17 1.98 212 1.69 6069 1.35 125 1913 1.53 64 1.86 12 1.42 201 1.61 5981 1.30 1.35 1914 136 1.66 46 21 2.53 203 1.63 6281 1.39 156 1.76 57 1.77 2.42 1.78 233 1.97 6782 1.54 1915 20 1.70 44 1.38 1.6l 1916 126 14 184 6288 1.45 1917 123 1.75 61 2.02 14 1.88 198 1.83 6658 1.57 Averages for years 1908-1917 1.73 1.58 140 55 18 2.23 212 1.73 6245 1.37 1918 117 1.66 43 1.42 9 1.20 169 1.56 7048 1.78 9 II.—NOTIFICATION OF INFECTIOUS DISEASE. In Table V. 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 444 was 2,659 compared with 1,885 in 1917 and 935 in 1916. The diseases showing a decrease on the number for the previous year are diphtheria, erysipelas and scarlet fever. Those showing an increase are poliomyelitis, ophthalmia neonatorum, measles and German measles. The attack rate per thousand inhabitants was 24.5 against 17.5 for 1917. 13 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. Diphtheria. There were 375 cases of diphtheria notified in 1918 as against 408 cases in 1917. The attack-rate per thousand inhabitants was 3.46, against 3.78 in 1917. The case mortality was 6.1 per cent., against 4.4 per cent, in 1917 and 11.6 per cent, in 1916. 8 cases were returned as not suffering from this disease. Scarlet Fever. The notifications of scarlet fever in 1918 were 231 against 300 in 1917. This is a decrease of 69. The distribution of the disease in the various Wards, as shown in Table V. of Appendix was fairly uniform. 4 cases were returned from hospital as not suffering from scarlet fever. There were 3 deaths, which gives the very low case mortality of 1.3 per cent., against 0.3 per cent, in 1917. The disease, as in recent years, was of a very mild type. The attack rate per thousand inhabitants was 2.13 against 2.7 in 1917. 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 1918 was 71, against 72 in 1917, 42 in 1916 and 110 in 1915. There was a considerable prevalence of measles in the Metropolis which was shared in by Bermondsey. The number of primary cases notified was 1,524, including 220 cases of German measles and 1,304 of measles. Enteric Fever. 6 cases of enteric fever were notified, being 3 for Bermondsey, 2 for Rotherhithe, and 1 for St. Olave. 1 case was returned as not suffering, making an actual total of 5. The total number of cases notified in the previous year was 7. Puerperal Fever. 2 eases of puerperal fever were notified. Death resulted in both eases. Ophthalmia Neonatorum. There were 13 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 Visitors who instructed the mother in each case to immediately seek medical advice. Cerebrospinal Meningitis. 6 cases were notified in 1918, no cases were returned as not suffering. Most of them consisted of the sporadic form known as posterior-basic meningitis. Two of them occurred in children under one year of age. Polio-Myelitis. 8 cases were notified in 1918, against nil in 1917. Bacteriological Laboratory. The total number of specimens examined in 1918 was 1,055, as compared with 1,212 in 1917, and 689 in 1916. Table C . Results of Examination. Total Examinations. Nature of Specimen. Positive. Negative. 1917 1918 1917 1918 1917 1918 Diphtheria (specimens taken by Medical Officer of Health) Ditto (taken by general practitioners) 57 663 524 74 589 467 210 242 80 58 130 184 Diphtheria (total specimens taken) 873 766 154 115 719 651 Phthisis 333 281 77 51 256 230 Enteric 1 7 - 1 1 6 Various 5 1 1 1 4 - Total specimens taken 1,055 1,212 232 168 980 887 SPECIAL REPORT ON INFLUENZA. I beg to submit the following report on the epidemic of Influenza during 1918:— the deaths from influenza during 1918 (184 males and 244 females), thus giving a death-rate for this disease of 3.95 per thousand living of the civil population. Deaths from the ordinary infectious diseases were 1.13 per thousand of the civil population, and for tuberculosis 2.15, and for these two combined 3.26. It is thus evident that influenza was more deadly than all the infectious diseases including tuberculosis put together. In order to compare the two, something must, however, be deducted from the figures for influenza, because in the figures 428 is included every death in which the word influenza was mentioned, so that it is quite possible that many who are recorded as having died from influenza were already suffering from some more or less deadly disease. This will be apparent from the figures of the complications, namely:— Lobar pneumonia 92 Broncho-pneumonia 100 Pneumonia 126 Influenza 18 Heart Diseases 19 Pulmonary Tuberculosis 8 Bronchitis 41 Other Complications 24 428 Take, for instance, the question of heart diseases, pulmonary tuberculosis, and a certain number under the designation of "other complications," which include a few cases of cancer, and it is evident that many patients'were suffering from these diseases before they were attacked by influenza, and that many of those diseases would have ended their lives, the end merely being hastened by influenza. A look at the accompanying charts will give a very good idea of the behaviour of influenza in Bermondsey during 1918. On chart No. 1 the weekly number of deaths is shown, and you will see that we were practically free from the disease until the first week in July, when the deaths ran up to 11 in one week. By the second week in August we were quite free from influenza deaths until the second week in October, when one death was reported, and during the following weeks the epidemic spread in the most extraordinary manner, so that by the third week in November the deaths from this disease totalled 79. It died down practically as rapidly as it rose, so that it had completely disappeared by the fourth week in December. It is difficult to say why the deaths of females number so many more than the males, but it is probably due to the fact that a good deal of the nursing was done by the women of the household, so that in this way they were more exposed to infection. This is confirmed when we note the occupations of the victims. Out of the total of 428 deaths, the occupation is only definitely stated in 166, and these were so evenly distributed that one could not say that any occupation was specially effected. It was somewhat different regarding the remaining 262 who are registered as of "no occupation," which means that they were either school children or engaged in domestic work. AGE PERIOD. On table 2 is shown graphically the age periods which were most attacked, and those appeared to have been from 2 to 5 and from 15 to 35. Again this table shows that in the majority of the age periods women contributed a much higher proportion of deaths. The question is often asked as to why people of the most- vigorous period of life mostly succumbed to this disease, and I think the probable explanation is that being vigorous and in many cases previously exempt from disease of any sort they did not "lie up" when the attack came, but tried to "shake it off," the result being that they contracted pneumonia with, in many cases, a fatal result. Another reason has been suggested—and I am making inquiries on these lines—for the apparent immunity of delicate people from a fatal ending, and that is that those who are suffering from certain chronic lung disease, such as bronchitis and pulmonary tuberculosis, are already inoculated against the many organisms which cause fatal complications in influenza, so that when the disease comes on they are already immune to a certain extent against, the organisms which cause broncho-pneumonia. This, however, on general grounds, seems very improbable, and would lay a premium on ill-health, which I think future invesitgations will scarcely support . I think it much more probable that when they are attacked they give in promptly and go to bed. MODE OF SPREAD. Many investigators have endeavoured to connect the spread with climate and weather, but the universality of the disease seems to negative these factors, and I do not think it is necessary to resort to any but the ordinary explanation that it is passed from the sick to the healthy by more or less close contact. In this, connection it has been shown that it is transferred along lines of communication between various countries. Of course, if it occurs in the summer, it is obvious that the patients will be less liable to pulmonary complications, but that does not mean that the disease is less prevalent, because I think there is no doubt that in the summer epidemic of 1918 the disease was very prevalent, but the fatal cases were much less numerous than they were in the autumn. The causes of the epidemic can be divided into (1) predisposing, and (2) exciting. The Predisposing Causes are in my opinion, everything that interferes with health and vitality, and this will apply not only to defective sanitation and overcrowding, but also to matters of food; so if one must have a theory of the predisposing cause of the world-wide prevalence it must be one which will apply to every nation of the globe. Now the great European War would seem to provide the basis of a theory which will comply with the conditions here stated, for by putting a stop to building operations not only have the existing homes in practically every country got into a very insanitary condition, but the absence of fresh building has led to more or less overcrowding in large centres of population. The result is that the health of the inhabitants has deteriorated, and the overcrowding has facilitated the spread of infection. The withdrawal of men from agricultural pursuits has further led to a decreased production of the staple foods, and an enormous increase in the price of those available. The general result is that most of the civil populations have suffered from a general deficiency of food, together with greatly diminished quantities or the absence of certain staple foods, such as fats, to which they were previously accustomed. In the British Isles, too, the practical disappearance of fresh fruit has resulted in a great dimution of "vitamines" or "accessory food substances" in our daily diet. It is well known that the spread of infectious diseases require two factors, the seed and the soil. The seed may be ever present, such as in the case of tubercle bacillus, but it does not succeed in growing unless there is a suitable soil in the nature of a lowered constitution. Now all the factors enumerated above have prepared the soil for this pandemic with the grave results of which we are already familiar. Exciting Cause. In Influenza we are dealing unquestionably with an infection which is very virulent, though the virulence seems to vary from time to time. Many years ago Pfeiffer discovered a bacillus which is frequently associated with influenza, and which he looked upon as the cause of the malady, but many investigations have been recently undertaken, the effect of which has been to cast doubt upon his conclusion. Recently, however, the late Major Graeme Gibson discovered by special methods an extremely small organism which experiments seem to prove is the cause of influenza. Its extreme minuteness may be judged by the fact that it will pass through a fine porcelain filter, and in this respect it resembles the virus of typhus fever, measles, rose measles and trench fever, and possibly very many other infectious diseases, such organisms being known as " filter passers." These organisms or viruses are undoubtedly present in the secretion of the nose and throat, and are passed from one person to another during the act of speaking, sneezing and coughing, for it has been proved that in the act of speaking small droplets are projected from the mouth to a distance of about four feet, and in coughing and sneezing they may be projected as far as ten feet. It is thus evident that if the virus is in these droplets, a person suffering from the disease may infect a great many persons, especially during conditions of overcrowding or close contact between the the healthy and sick. Prevention. As the organism has only been very recently discovered, and its method of spread is still under discussion, it has been difficult to formulate any systematic method of prevention. After careful consideration it became evident to the Local Government Board that the difficulties of preventing the disease were enormous, but that a great deal could be done to render it less fatal, and these were the lines on which our preventive efforts were concentrated. Some attempt was made to prevent its spread by the printing and distribution of posters and handbills, giving an account of the general methods which experience has shown are useful in preventing infection from similar diseases. The handbills were distributed among the principal firms in the Borough, and the posters were exhibited in conspicuous places. To prevent a fatal issue, the Council gave instructions to call in the assistance of the district nurses in severe cases of pneumonia. Notwithstanding these efforts the mortality was very high. On the chief question of prevention innumerable disinfectants and prophylactics have been suggested in the daily press and elsewhere, but the fact that they were so numerous shows that none of them are of any great value. Two, however, found a little more prominence than the rest, namely the employment of a vaccine, and the question of face masks. It seems to me that now that the organism has been discovered that the manufacture of a vaccine is only a matter of time, and beyond such measures as keeping fit, the greatest hope of prevention lies, in my opinion, in the provision of a suitable vaccine. The question of the advisability or otherwise of wearing masks has been largely canvassed in the public press, the agitation in their favour being led by the medical correspondent of 'The Times,' who seems to think that there is no difficulty in completely abolishing influenza by suitable measures, among which is the wearing of masks during an epidemic by the general public. I think, however, that medical authorities are more or less agreed that for general use the mask is very little of a preventative. If the virus is so fine that it can pass through a porcelain filter, there seems very little use putting on a gauze mask; besides the mask itself is liable to become infected with the virus, and if it is taken off there is very little guarantee that it won't be put on again with the wrong side out. It seems to me that for a mask to be of any use, one should carry a dozen or two sterilized in their pockets, and every time they take a mask off for speaking and eating, put on a fresh one. This, of course, is possible in a hospital, but it is not possible outside. lam afraid the British public are little likely to adopt this measure, and I am sure that their natural instincts against "coddling" and "wrapping up" are correct, for it seems to me that the proper lines to adopt are to raise our natural immunity by plenty of open air and the avoidance of crowded places during an epidemic. It may be argued, however, as I have said in the earlier part of the report that there is no use trying to keep fit since the healthy suffered most, but even they mostly acquired the infection in crowded places, such as barracks and workshops, etc., and although they might be considered healthy they did not acquire the disease in healthy circumstances. It is a curious thing that general practitioners on the whole escaped very well, and this might be attributed to their being so much in the open air. I think the suggestion that the nose and throat should be douched by a weak solution of common salt, is an excellent one, for, as Professor Leonard Hill has pomted out, people who bathe at the seaside are very little liable to take cold or infection, largely because the nose and throat are constantly washed out, and there is no reason why, when one is washing the face and hands and mouth, that the throat and nose should be left out. The following notes on the admissions into the Infirmary for influenza have been kindly written by Dr. Alexander Robertson, Acting Superintendent, and I think they throw a great deal of light on the clinical aspects of the two epidemics of 1918. I am reprducing them in full:— Statistical. Influenza. Summer Epidemic:—End of June to beginning of August, 1918. lotal number of cases admitted O > 94 „ „ „ Males „ 52 „ „ „ Females „ 42 Developed lobar pneumonia 36 „ broncho pneumonia 38 Cases showing epistaxis Ni l. >> ~ albuminuria 6 ~ developing meningitis 3 i> >. empyema 7 Cases with serious effusia in pleura 2 Number of deaths 24 Males 14 Females 10 Autumn Epidemic:—End of October to December, 1918. Total number of cases admitted 554 »» if ft M&l&s fy 230 ~ ~ ~ -Females ~ 324 Developed lobar pneumonia 149 ~ broncho pneumonia 269 Cases showing epistaxis 28 „ „ albuminuria 111 „ developing empyema 9 ~ with serious effusion 9 ~ developed hyperpyrexia 3 ~ showing haemoptysis a Number of deaths 171 Males 86 Females 85 In both epidemics the case incidence fell chiefly on males and females between the ages of 20 and 40, who were well developed, strong and healthy. There were also a good many cases amongst children between 1—5 years of age. In the summer epidemic the cases who developed pneumonia did not with some exceptions show the same severity as those in the Autumn epidemic. In only a few was there any marked cyanosis and delirium, and those cases generally ended fatally. Pneumonia. —In the autumn epidemic a large number of the cases who had Pneumonia showed a peculiar bluish grey appearance of the face and other parts of the body, and the prognosis in all these was bad. With this was always associated extreme dyspnoea, due to the fact that both lungs were almost invariably affected, and such cases were always fatal. Albuminuria. In the autumn epidemic a high percentage of the cases, had albuminuria varying in amount from 1/6 in some urines, to others, which on boiling became practically solid, while in the summer epidemic the cases of albuminuria were much less in proportion and the quantity of albumen also. Delirium. The delirium in the autumn epidemic was very well marked, often of a rather violent nature and very persistent; only a few cases in the summer epidemic were thus affected. Tremors. Well marked tremors of face, lips, hands and arms occurred in the autumn epidemic in much higher proportion than in the summer. Epistaxis. The male eases in the autumn epidemic frequently showed epistaxis (bleeding of the nose) and the epistaxis was very often recurrent. Uterine haemorrhage and abortion were of frequent occurrence. Sore Throat. This was a common symptom; usually an ordinary catarrhal condition of the fauces though some had well marked follicular tonsillitis. Diarrhoea. Some cases showed this, but it was not a common feature. Empyema and Ordinary Pleural Effusia. This was common throughout the whole of the summer epidemic, but such complications only arose towards the end of the epidemic in the autumn. All these cases invariably recovered after aspiration or operation. A large number of cases who had been in the wards for various periods prior to each epidemic, and were still inpatients, developed the disease. The incidence was greatest amongst the younger patients, and the death rate was higher. The old patients, who developed the disease, had it less severely, and showed a high percentage of recoveries. Incubation Period. This was short as far as I could judge about 2—3 days, or even less in some cases. Duration of the Infectivity. Unknown. Secondary Attacks. Only two nurses who had influenza in the summer developed it again in the autumn. In the autumn epidemic 54 nurses were attacked, of which 18 developed pneumonia, and one died. None of the cases that were treated in the summer epidemic developed the disease in the autumn, with the exception of the two nurses. INFLUENZA EPIDEMIC 1918. INFLUENZA EPIDEMIC 1918. (MORTALITY AT VARIOUS AGES.) The disease was particularly severe in some families, the infection being very virulent, and several deaths occurred in the same families, who were treated in the Infirmary. A large proportion of the cases, and more particularly the fatal cases, appeared to have the disease as a virulent Septicaemia with the lung signs predominant, and in these cases the disease showed a strong resemblance to pneumonic and septicaemic plague, of which I have seen a large number of cases in British East Africa. A curious coincidence was that no cases occurred in the consumptive wards. Whether this was due to exclusion of cases of influenza from these wards or, as has been suggested in the medical paper, to the natural resistance of consumptives to influenza, I am unable to state. 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. MEAT— Tons. cwts. qrs. lbs. Fresh 5 0 0 3 Canned 5 16 3 0 FISH— Fresh 2 5 1 26 Canned 0 16 3 22 VEGETABLES— Fresh 85 0 0 0 Canned 1 17 2 0 In Brine 9 2 0 0 FRUIT— Fresh 25 6 0 20 Canned 59 15 0 7 DAIRY PRODUCE 5 1 1 2 VARIOUS 0 9 3 13 200 11 0 9 Milk Premises. There were 305 milk premises on the Register at the end of 1917. Ten were added and 14 removed during 1918, making a total of 301 at end of the year under report. Slaughterhouses. There is one slaughterhouse in the Borough. 16 inspections were made. No notices were served. Ice Cream Premises. There were 95 premises where ice cream is manufacturd on the Register at the end of 1917. Four were added and 2 removed during the year under report, making a total of 97. 28 inspections were made. FOOD AND DRUGS. In Table IX. of Appendix will be found a list of the samples taken in 1918, and the action taken; 1,186 samples were taken, compared with 1,070 in 1917, and 1,001 in 1916. Of these 9.1 per cent, were found adulterated, compared with 13.2 per cent, in the previous year, and 11.1 per cent, in 1916. Food Inspectors. TABLE E. Particulars of Work, 1918. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Visits. Fishmongers, Friers and Curers Food Factories. Destruction of Food. Nuisances Reported. Number of Samples taken Food Wharves and Depots Fruiterers and Greengrocers. Restaurants and Eating Houses Slaughterhouses. Bakehouses. Food Stores. Milk Sellers. Butter and Margarine. Cowsheds. Ice Cream Markets. Butchers Various. Jam. Other. Mr. Ashdown Re-visits 9 8 471 2520 593 1 1 9 ... ... ... ... ... ... ... ... ... ... ... D.O.R.A. 3 116 38 82 22 524 23 ... ... ... ... ... ... ... ... ... ... ... ... ... New occupiers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ Premises ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Closed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mr. Scott Re-visits 303 3 62 56 223 54 581 1 40 1 301 290 87 15 142 188 547 ... ... D.O.R.A. 4 30 220 47 463 36 38 79 103 ... ... ... ... ... ... ... ... ... New occupiers ... 1 1 6 ... 3 1 ... ... ... ... ... ... ... ... ... ... ... ... „ Premises 3 3 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Closed 1 12 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mr. Hoskins Re-visits 125 ... 30 109 116 46 670 101 119 18 296 362 100 1 96 8 175 601 ... D.O.R.A. 1 5 29 124 27 556 4 114 8 3 190 247 ... 5 ... ... ... ... ... New occupiers 7 25 ... ... 1 3 3 13 5 ... ... ... ... ... ... ... ... ... ... „ Premises 1 3 2 5 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Closed 3 2 11 4 2 3 ... ... ... 9 ... ... ... ... ... ... ... ... ... Mr. Golds Re-visits ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... D.O.R.A. 771 ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... GENERAL SANITARY WORK. Inspections. In Tables F. and G. (pages 25 and 28) will be found particulars of the general sanitary work by the District Inspectors during 1918. The house-to-house inspections numbered 2,146. This is 407 above the total for the previous year. 4,327 intimation notices were served, compared with 3,645 in the previous year. Smoke Nuisances. 33 observations were kept on chimneys and 7 notices served. House Refuse. The following table shows the amount of house and trade refuse disposal during the year ended December, 1918: — House Refuse — Tons. Cwts. Qrs. Bermondsey Destructor 9,321 loads, 15,923 0 3 Taken to shoot 373 „ 684 2 0 Total 9,694 „ 16,557 2 3 Trade Eefuse— Bermondsey Destructor 1,129 loads 666 19 3 Taken to shoot 1,913 „ 2,104 6 0 Total 3,042 „ 2,771 5 3 Offensive Trades. The offensive trades on the Register are as follows:— Tripe boiler 1 Glue and size makers 4 Fellmongers 3 Fatmelters 4 Manure Manufacturer 1 24 DISINFECTION. The following table shows the number of articles passed through the steam disinfector during the year under report: — Beds 612 Sheets 683 Blankets 839 Books 360 Bolsters 405 Miscellaneous 1,816 Carpets 10 Verminous Clothing 227 Cushions 175 Hair (bundles) 39,195 Mattresses 115 „ (cases) 110 Overlays 167 Pillows 1,380 Total 46,651 Quilts 557 3,044 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Cleansing of Persons Act, 1897. During the year under report 52 male adults used the Verminous Baths and had their clothing disinfected. The total number of. articles disinfected for this purpose was 227. Table F.— Proceedings during 1918. Number of Places. Number of Prosecutions, 1918. Number of Inspections, 1918. On Register at end of 1917. Added in 1918. Removed in 1918. On Register at end of 1918. Number of Notices, 1918. Premises. 305 28 Milk Premises 14 10 301 693 ... Cowsheds ... ... ... ... ... ... ... Slaughter-houses 1 1 ... ... 16 ... ... Other offensive trade premises 13 ... ... 13 ... 5 110 Ice-cream premises 95 4 2 97 28 ... ... ... 223 223 446 Registered houses let in lodgings ... ... ... Total number of Intimation Notices served for all purposes 4327 Overcrowding, 1918 — Number of dwelling rooms overcrowded 23 Number remedied 23 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 11 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 Bye-laws under Public Health Act, 1891 — (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. - (b) For prevention of nuisanace 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 (Bye-laws) Act, 1899) - Mortuary— Total number of bodies removed 179 Total number of infectious bodies removed 80 Work of District Inspectors 1918. Table G. 11 7 8 9 10 12 1 2 3 4 5 6 Infectious Diseases. Outworkers' Bi-Annual Inspection. Special Inspections. Chimneys Watched. House to House. Factories and Workshops specially Inspected. Drains Tested. Offensive Trades. Other Calls and Visits. Re-inspections. Complaints. Underground Conveniences. lnts. No. No. No. Ints. No. Ints. No. Ints. No. Ints. No. Ints. No. No. Ints. No. Ints. No. No. - - 263 25 157 108 75 15 5 1 1 - 37 6 113 17 1719 398 Mr. Grice 139 103 158 40 14 4 15 114 5 69 31 2518 425 4 2 Mr. Merryman 185 81 202 113 293 223 - 2119 Mr. Toogood 215 102 211 21 354 266 231 38 1 15 1 37 5 14 740 - - - - Mr. Freeman 9 19 16 30 26 5 2 1 20 1 114 32 - 26 - - - - - - 373 194 171 43 106 3 60 234 9 58 65 1800 93 13 2 Mr. Golds 22 6 308 103 - 152 10 178 37 2680 38 Mr. Cockburn 424 263 99 18 156 130 172 55 2 - - - - - 2174 408 Mr. Taverner 143 116 337 55 209 172 187 74 29 24 24 5 65 4 26 - - - 72 6 317 180 78 1 74 15 171 29 3028 349 5 1 Mr. Davis 404 269 300 - - - 29 20 8 2 71 18 14 3900 767 11 2 Mr. Baker 464 279 229 175 648 576 139 41 - 519 57 - - Mr. Carter 44 80 60 61 16 36 1 5 - - - - - - - - 400 189 53 123 8 820 73 609 239 20571 3307 33 7 Totals 2146 1264 1624 532 2517 1990 1444 Tuberculosis Dispensary. From the Annual Report of the Dispensary there were 597 new patients examined; of these 406 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 6,345, and the number of visits paid to the homes of patients was 1,447 by the Medical Officer, and the Nurse. FACTORIES AND WORKSHOPS. In Table XI. 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 1918, including bakehouses, of which there were 10 in use the total is 338. OUTWORKERS. There were 373 outworkers on the Register at the end of 1918. 68 lists were sent in by firms in this Borough employing outworkers. Table VI. of the Appendix shows the various trades followed by outworkers in this district. Table H. Health Visitors. The following table shows the work done by the Health Visitors during the period under report:— Whole Borough. Bermondsey Wards. Rotherhithe Wards. St. Olave Ward. St. Thomas St. Olave. St. John. 3 3 1 2 4 5 6 1 2 Births Notified By Guy's Hospital 869 205 235 105 ... 2 169 1 3 ... 44 25 20 16 „ Mid wives 617 16 68. 78 95 35 140 74 49 34 9 3 „ Doctors 403 9 16 34 59 49 16 106 66 41 5 1 1 25 „ Parents 263 10 11 17 47 29 6 33 78 4 1 2 TOTAL 2,152 240 278 284 184 175 226 280 221 115 87 36 26 30 DISTRICTS. Attendances at Classes for Mothers. Whole Borough. VISITS :- 1 2 3 4 Town Hall. Abbeyfield Road. Trinity Road. Ante-natal 284 86 120 75 3 1,197 1,006 514 Births (first) 2,219 697 548 545 429 „ (subsequent) 3,024 606 806 627 985 Measles (first) 1,350 365 364 396 225 „ (subsequent) 356 104 139 80 33 Ophthalmia Neonatorum (first) 38 2 1 12 23 „ „ (subsequent) 10 4 6 ... ... District No. 1 ... Miss Islip. Puerperal Fever 2 2 ... ... ... ~ ~ 2 ... Miss Webber. 2 Diarrhœa 2 ... ... ... 268 ~ ~ 3 ... Miss Bache. Various 1,523 432 375 448 ~ „ 4 ... Miss Carlton. TOTAL 8,808 2,143 2,291 2,175 2,199 APPENDIX. APPENDIX. Table I.—Vital Statistics of Whole District during 1918 and Previous Years. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths registered in the District. Net Deaths at all Ages belonging to the District. Deaths of Non-Resi-dents registered in Public Institutions in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 No. 3 Rate.* 4 Total Deaths in Public Institutions in the District. 9 Under 1 Year of Age. Rate.* 13 At all Ages. No. 12 Rate per 1,000 Births, registered. 6 No. 5 No. 7 Rate.* 8 534 1908 127,438 4,172 32.1 128 1,951 15.0 591 37 530 2,444 18.8 4,055 480 1909 127,030 31.9 118 1,947 15.3 562 26 466 2,387 18.8 1910 126,634 3,957 31.2 403 102 1,717 13.5 30 542 550 2,229 17.6 125,840 3,842 30.5 497 130 1,782 14.2 1911 515 22 560 2,320 18.4 433 1912 125,388 3,799 30.3 114 1,601 12.8 483 20 538 2,119 16.9 1913 124,739 3,842 30.8 505 131 1,730 13.9 529 534 21 2,243 17.9 1914 124,213 3,757 30.2 129 1,694 13.6 26 516 2,184 487 615 17.6 29.6 537 154 1915 123,665 3,482 2,053 17.5 654 38 542 2,514 21.4 608 1916 123,665 3,361 27.1 364 108 1,507 13.2 155 453 1,960 17.2 119,983 2,613 21.7 329 125 1,807 840 1917 18.8 186 411 2,032 18.8 Averages for years 1908-1917 29.5 124,860 3,688 457 124 1,779 14.8 595 56 509 2,243 18.3 139 1918 121,465 2,323 19.1 322 2,142 19.8 1007 191 439 2,390 22.0 * 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. 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. No of Deaths. Bermondsey Infirmary, 148 Bermondsey Workhouse, 14 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc. 19 Private Houses, 4 Street, 1 London Bridge Station, 2 Railway, 1 Railway Carriage, 1 Factory, 1 Total 191 No. of Deaths. Banstead Asylum 12 Bethlehem Hospital 1 British Home and House for Incurables 1 Bromley House Institution 2 Camberwell House 1 Cane Hill Asylum 20 Caterham Asylum 26 Charing Cross Hospital 1 Cheyne Hospital 1 Children's Hospital, Great Ormond Street 1 Checkendon Hospital 1 Cancer Hospital, Chelsea 1 Claybury Asylum 5 Colney Hatch Asylum 3 C.O. Lunatic Asylum 1 Croydon Mental Asylum 1 Chest Hospital, Bethnal Green 1 Convalescent Home for Children, Grosvenor Place 1 Darenth Industrial Colony 6 Dart-ford Heath Asylum 21 East Anglican Sanatorium 1 East London Hospital 7 Evelina Hospital 13 Eden Cottage Hospital 1 Fountain Temporary Asylum 2 Forest Gate Sick Home 1 Grand Surrey Canal 3 Greenwich Infirmary 2 Guy's Hospital 160 Gravesend Workhouse Infirmary 1 Hanwell Asylum 4 Infants' Hospital. Vincent Square 6 King's College Hospital 1 London Lock Hospital 1 London Hospital 6 Lambeth Infirmary 4 Leavesden Asylum 13 Long Grove Asylum 8 Marylebone Infirmary 1 Middlesex Hospital 2 Newington Temporary Hospital 1 Newport Corporation Asylum 1 TABLE I. —continued. I. Institutions within the District receiving sick and infirm persons from outside the District. No. of Deaths. II. Institutions outside the District receiving sick and infirm persons from the District. Park Hospital 5 Peckham House 1 Private Houses 5 Queen's Hospital 1 Queen Mary's Hospital, Carshalton 4 River Thames 2 River Medway 1 Royal Waterloo Hospital 2 Royal Alexandra. Hospital 1 Royal Arsenal Surgery 1 Royal Hospital, Richmond 1 Royal Naval Barracks, Portsea 1 St. Bartholomew's Hospital 3 St. Luke's House, Kensington 3 St. George's Home Chelsea 1 St. Ann's Home, Herne Bay 1 St. Annis Home, Streatham Hill 3 St. Thomas's Hospital 5 Seamen's Hospital 2 South Eastern Hospital 17 South Western Hospital 1 Southwark Workhouse 3 Street 9 Tooting Bec Asylum 18 Westminster Infirmary 1 Whitechapel Infirmary 1 Total 439 III. Other institutions, the deaths in which have been distributed among the several localities in the District. No of Deaths. Table II. —Vjtal Statistics of Separate Localities in 1918 and Previous Years. Bermondsey. Rotherhithe. St. Olave. Population estimated to middle of each year. Population estimated to middle of each year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Births registered. Deaths at all Ages. Deaths under 1 year. Births registered. Deaths at all Ages. Deaths under 1 year. Year. 1908 81,500 2,785 1,613 411 38,169 1,129 611 151 7,769 258 220 48 1909 81,398 2,739 1,563 396 38,145 1,069 654 143 7,487 247 170 34 1,441 341 38,125 1,040 603 134 7,205 256 185 27 1910 81,304 2,661 184 41 1911 82,110 2,528 1,470 403 35,059 1,067 666 167 8,671 247 1912 82,073 2,502 1,439 290 34,747 1,065 511 113 8,568 232 169 30 81,833 2,548 1,501 357 34,477 1,074 584 118 8,429 220 158 30 1913 1,023 554 1914 81,781 2,502 1,409 333 34,134 116 8,298 232 173 36 1915 77,155 2,306 1,665 349 32,194 991 642 153 7,839 185 207 35 80,503 1.341 233 34,620 950 479 102 8,542 140 29 1916 2,200 211 568 1917 78,118 1.716 1,328 215 33,590 762 89 8,275 135 136 25 Averages of years 1908-1917 35,325 1,017 587 8,108 80,778 2,449 1,477 333 129 222 174 34 640 7,480 - 1918 Civil Total 70,583 1,589 209 30,343 91 161 22 - - 34,005 79,083 1,487 694 - 8,377 142 - - - - - Table III.—Abbreviated Tables or Causes of Death Total under 1 mth. Total Deaths under 1 year. 1918. Total Deaths under 1 year. 1917. Causes of Death. Under 1 week 1-2 weeks. 2-3 weeks. 3-4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. All Causes Certified 47 9 13 11 80 43 64 70 65 322 335 Uncertified ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... 5 Measles 1 6 12 18 ... ... ... ... ... ... Scarlet Fever 1 1 ... ... ... ... ... ... ... ... ... Whooping-Cough 1 1 1 8 8 8 26 9 ... ... ... Diphtheria and Croup 1 2 1 1 ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis 3 2 5 8 ... ... ... ... ... ... ... Abdominal Tuberculosis ... 3 ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 1 1 2 2 5 2 ... ... ... ... ... Meningitis (not Tuberculous) ... ... 5 ... ... ... ... ... ... ... ... Convulsions 1 1 1 3 1 2 6 8 36 ... ... ... Laryngitis 1 1 2 ... ... ... ... ... ... ... Bronchitis 7 ... 2 2 4 5 8 5 29 ... ... 18 19 Pneumonia (all forms) 1 1 2 10 9 22 62 65 Diarrhœa ... ... 1 1 13 ... ... ... ... ... ... ... Enteritis ... 6 8 4 3 21 30 ... ... ... ... ... 2 Gastritis ... ... 2 17 ... ... ... ... ... ... Syphilis 1 1 1 3 8 ... ... ... ... ... ... Rickets 1 1 1 ... ... ... ... ... ... ... ... Injury at birth 3 3 3 ... ... 1 ... ... ... 1 ... Atelectesis 3 3 1 1 1 6 8 ... ... ... ... 6 1 1 10 1 Congenital Malformations 2 11 9 ... ... ... Premature birth 23 2 4 3 32 1 2 35 39 ... ... Atrophy, Debility and Marasmus 7 3 1 12 13 1 17 7 9 58 44 Other Causes 4 1 2 2 9 3 4 6 9 31 28 11 47 Totals 9 13 80 43 64 70 65 322 335 Nett births in the year—Legitimate, 2,274; Illegitimate, 49. Table IV.—Causes of and Ages at Deaths during the year 1918. Total Deaths whether of "Residents" or "Nonresidents" in Public Institutions in the District. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Causes of Death. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. All Ages. Under 1. All Causes Certified 2390 322 181 210 131 148 371 479 548 1007 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... 37 ... ... Small Pox ... ... ... ... ... ... ... ... ... ... 29 Measles 71 12 33 24 2 ... ... ... ... Scarlet Fever 3 1 1 1 ... ... ... ... ... ... Whooping Cough 84 26 31 25 2 25 ... ... ... ... 23 2 3 15 3 1 Diphtheria and Croup ... ... ... ... Influenza 428 9 17 44 47 65 136 69 41 156 Erysipelas ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 169 6 7 34 76 41 5 59 ... ... Tuberculous Meningitis 37 5 8 8 12 2 1 1 16 ... Other Tuberculous Diseases 27 5 1 8 4 4 2 2 1 14 Cancer, Malignant Disease 141 1 14 75 51 92 ... ... ... ... Rheumatic Fever 5 1 2 1 1 2 ... ... ... ... Meningitis 7 2 2 2 1 ... ... ... ... ... Organic Heart Disease 229 1 1 6 14 33 64 110 151 ... 2 Bronchitis 242 29 14 2 3 8 67 117 129 70 42 53 10 5 31 41 33 83 Pneumonia 285 ... Other Diseases of Respiratory Organs 24 2 3 1 5 11 10 2 1 7 10 3 2 6 Diarrhœa and Enteritis 48 24 6 ... ... 1 3 1 1 ... ... Appendicitis and Typhlitis ... ... ... ... 1 1 ... ... Cirrhosis of Liver ... ... ... ... ... ... 1 ... 1 ... ... ... Alcoholism ... ... ... ... 14 2 1 6 9 9 30 1 ... 2 Nephritis and Bright's Disease 1 2 1 ... Puerperal Fever ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 5 1 ... 2 3 ... ... ... ... ... 38 Congenital Debility and Malformation, including Premature Birth 53 ... ... ... 115 108 7 ... ... ... 3 Violent Deaths, excluding Suicide 19 14 15 3 11 14 75 6 5 ... ... ... 2 2 1 ... 5 ... ... Suicide 10 9 37 74 155 146 25 8 9 Other Defined Diseases 327 1 2 3 ... ... Diseases ill-defined or unknown ... ... ... ... ... 1,007 131 148 371 479 548 2,390 322 181 210 All Causes TABLE V.—CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1918. Total Cases removed to Hospital. Notifiable Disease NUMBER OF CASES NOTIFIED. Bermondsey. Rotherhithe. St. Olave. 2 1 3 4 6 Total. 1 2 5 Total. At all ages. At Ages—Years. 3 St. Thomas. St. John. St. Olave. Total. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Under 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 9 234 34 49 13 96 25 18 2 45 370 375 137 198 22 9 ... 51 46 33 40 33 31 ... 34 4 6 10 2 1 3 7 Erysipelas 47 4 5 9 5 8 14 2 6 6 8 6 1 7 ... 154 43 15 68 6 1 2 9 219 Scarlet Fever 231 2 84 136 9 ... ... 27 20 41 21 26 19 10 ... Relapsing Fever—Continued Fever 39 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Puerperal Fever 2 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... 4 1 1 2 3 Cerebro-Spinal Meningitis 6 2 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 4 1 1 2 4 ... 1 Polio Myelitis 8 ... 2 5 1 ... ... ... ... ... ... ... ... 1 3 2 1 7 4 1 5 1 1 3 Ophthalmia Neonatorum 13 13 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 Anthrax 2 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 3 2 2 1 1 6 Enteric Fever 6 ... ... 5 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Typhus 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 154 164 153 192 91 170 924 192 94 34 320 23 23 14 60 ... Measles 1304 83 792 416 9 3 1 ... 14 26 28 38 28 36 170 18 17 4 39 3 5 3 11 Measles (German) 220 12 102 99 5 2 ... ... ... 6 34 50 28 21 24 204 38 39 17 94 13 5 3 21 Pulmonary Tuberculosis 319 ... 10 45 71 123 64 47 ... Other forms of Tuberculosis 4 2 ... 7 23 66 14 10 5 ... 7 13 20 15 8 19 82 15 15 7 37 ... ... 125 313 338 316 210 319 1825 352 238 87 677 78 55 24 157 612 Totals 2659 132 1157 974 138 163 87 8 309 Table VI.— Factories, Workshops, Laundries, Workplaces, and Homework (continued). Home Work. Nature of Work. (1) Outwork in Unwholesome Premises, Section, 108. Outwork in Infected Premises, Sections 109, 110. Outworkers' Lists, Section 107. Prosecutions. Prosecutions (Sections 109,110). (16) Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. (8) Prosecutions. (13) Instances. (14) Order made (S. 110). (15) Instances. (11) Notices served. (12) 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) Lists. (5) Outworkers. Outworkers. Contractors. (3) Workmen. (4) Contractors. (6) Workmen. (7) Wearing Apparel:— I I — — ... (1) Making, &c. 34 26 496 2 79 17 ... ... ... ... ... 86 ... ... (2) Cleansing and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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. 2 2 1 ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... 4 1 ... ... ... ... ... ... 6 ... ... ... ... ... ... ... Sacks and cotton bags 10 1 ... ... ... ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper Bags 6 ... 43 4 ... ... ... ... ... ... ... ... ... ... ... Brush making 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Pea Picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather Sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of Buttons, &c. ... ... ... ... ... ... Surgical Instruments ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and Sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas Crackers, Christmas Stockings, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Leather Goods 4 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... Total 66 26 496 2 125 86 33 ... ... ... Table VII. —Deaths from Zymotic Diseases, 1918. Pyrexia (origin uncertain) Principal Zymotic Diseases. All Causes. Diphtheria. Whooping Cough. Typhus Fever. Year. Smallpox. Scarlet Fever. Enteric Fever. Measles. Diarrhœa No. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Rate. No. Rate. Rate. No. 1908 − − − 12 .09 113 .87 2444 18.8 300 2.31 105 .81 26 .20 26 .20 18 .14 − − − 2.89 .01 .68 1909 2387 18.8 368 196 1.54 17 .13 12 .09 54 .42 1 .00 2 86 − − − − 14 1910 2229 17.6 310 2.44 143 1.12 .11 18 .14 44 .34 − 4 .03 87 .68 − − − − − 51 6 .05 15 .12 48 .38 6 .05 226 1.80 1911 2320 18.4 352 2.79 .41 − − − − − − 5 .04 .67 1912 2119 16.9 252 1.21 101 .81 8 .06 17 .14 36 .29 1 .00 84 − − − − 1913 2243 17.9 320 2.56 88 .70 5 .04 16 .13 47 .38 2 .02 162 1.30 − − − − − − 262 79 9 .07 17 .14 14 .11 − 2 .02 141 1.14 1914 2184 17.6 2.11 − .64 − − − − 3.13 3 .03 1.24 1915 2514 21.4 367 110 .93 9 .07 20 .17 79 .67 146 − − − − − − .01 1916 1960 17.2 1.36 42 .36 5 .04 29 .25 16 .14 2 61 .53 155 − − − − − − 2032 218 2.02 72 1 .01 18 32 .29 − 6 .05 − − 89 .82 1917 18.8 .66 .16 − − − Average for years 1908 to 1917 10 .15 120 2.28 − − 99 .80 .08 19 39 .32 − 4 .04 − − .97 2243 18.3 290 − 1918 2390 22.0 229 2.11 − − 71 .66 3 .03 23 .21 84 .78 − − − − − − 48 .44 London 1918 76193 18.9 5319 1.32 − − 1618 .42 123 .03 659 .17 1671 .43 − − 56 .02 − − 1192 − 42 Table VIII. —Prosecutions in connection with Samples taken during 1918. Remarks. No. Sample. Adulteration or Infringement. FIRST QUARTER. 359H Milk Added water 2.5 per cent. Adjourned sine die Vinegar Added water 10.75 per cent. Ordered to pay costs, 15/6 352S 413H Vinegar Added water 24.5 per cent. Adjourned sine die Milk Added water 14.8 per cent. Dismissed 29H 32H Milk Added water 3.5 per cent. Withdrawn 15H Vinegar Added water 22.75 per cent. Adjourned sine die 401S Butter False warranty Dismissed. Milk Deficient in fat 16 per cent. Fined £10 and 15/6 costs 401S 440S Milk Added water 2.6 per cent. Dismissed. Milk Added water 37.4 per cent. Dismissed. 430S Dismissed. Warranty proved. 52H Milk Added water 18.3 P er cent. Vinegar Added water 35.7 per cent. Ordered to pay costs, 15/6 73H Ordered to pay costs, 15/6 97H Vinegar Added water 25.0 per cent. Margarine Added water 2.75 per cent. Ordered to pay costs, 15/6 110H Ordered to pay costs, 15/6 557S Milk Deficient in fat 8.0 Per cent. Milk Deficient in fat 9.7 per cent. Ordered to pay costs, 15/6 558S Added water 1.8 per cent. Dismissed. Warranty proved 529S Margarine Milk Deficient in fat 13.0 percent. Ordered to pay costs, 15/6 564S Dismissed. 538 Margarine Added water 2.6 per cent. SECOND QUARTER. Added water 2.2 per cent. and deficient in milk fat 30.3 per cent. Dismissed. Warranty proved 8S Milk 157H Fined 10/- and 15/6 costs Vinegar Added water 8.25 per cent. Bound over under Probation of Offenders Act Milk Added water 2.0 per cent. 528S Dismissed. Warranty proved 21S Margarine Added water 2.1 per cent. Deficient in fat 5.0 per cent. Dismissed. Warranty proved 25S Milk Milk Deficient in fat 9.0 per cent. Ordered to pay costs, 15/6 42S Milk Added water 10.5 per cent. Ordered to pay costs, 15/6 49S 51S Milk Added water 10 per cent. Ordered to pay costs, 15/6 Milk Deficient in fat 6.0 per cent. Fined 4/6 and 15/6 costs 563S THIRD QUARTER. 218H Orange Quinine Wine Deficient in Quinine Hydrochloride 14.0 per cent. Dismissed. Warranty proved Dismissed. Warranty proved 297H Milk Added water 6.1 per cent. Added water 14.1 per cent. Dismissed. Warranty proved 136S Milk Ordered to pay costs, 15/6 Milk Deficient in fat 9.0 per cent. 357H 94S Added water 9.7 per cent. Dismissed. Vinegar Ordered to pay costs 2/- 87S Milk Deficient in fat 7.0 per cent. Deficient in fat 6.7 per cent. Dismissed. Warranty proved 106S Milk Ordered to pay costs, 15/6 170S Milk Deficient in fat 10.0 per cent. Added water 24.5 per cent. Ordered to pay costs, 15/6 391H Vinegar Dismissed under Probation of Offenders Act, on payment of costs, 15/6 Milk Deficient in fat 24.0 per cent. 416H 441H Added water 9.4 per cent. Dismissed. Warranty proved Vinegar FOURTH QUARTER. Milk Deficient in fat 5.3 per cent. Dismissed. Warranty proved 487H Dismissed 450H Milk Deficient in fat 9.0 per cent. Malt Vinegar Added water 75.0 per cent. Dismissed. Warranty proved 471H Dismissed. Warranty proved 468H Vinegar Added water 10.9 per cent. Deficient in fat 23.0 per cent. Ordered to pay costs, 15/6 262S Milk Dismissed. Warranty proved 226S Milk Deficient in fat 6.7 per cent. Added water 6.5 per cent. Ordered to pay costs, 15/6 525H Milk Ordered to pay costs, 15/6 542S Vinegar Added water 50.0 p er cent. 552H Milk Added water 8.2 per cent. Dismissed. Warranty proved Added water 25.8 per cent. Ordered to pay costs, 15/6 572H Milk Ordered to pay costs, 15/6 391S Milk Added water 7.8 per cent. Summary. £ s. d. Fines 10 14 6 Costs 17 3 0 Total £27 17 6 43 TABLE IX.—FOOD AND DRUGS. Total Samples Taken. Percentages of Articles Adulterated. Articles submitted for Analysis. Number Genuine Number Adulterated. Ammoniated Tincture of Quinine 2 1 1 50.0 Arrowroot 2 2 - - Baking Powder 7 7 - - Barley Kernels 1 1 - - Blanc Mange Powder 1 1 - - Boracic Acid Powder 2 2 - - Brawn 1 1 - - Bread 2 2 - - Butter 131 130 1 .7 Camphorated Oil 1 1 - - Carbonate of Soda 2 2 - - Castor Oil 1 1 - - 1 Cheese 1 - - Chocolate 1 1 - - Citrate of Magnesia 1 1 - - Cocoa 53 53 - - Cocoa Butter 4 4 - - Cocoa Shell 1 1 - - Cocoa and Milk 1 1 - - Cod Liver Oil 1 1 - - Coffee 36 36 - - Corned Beef 1 1 - - Corn Flour 3 3 - - Curry Powder 1 1 - - Custard Powder 6 - 6 - Digestive Relish 1 1 - - Dripping 25 21 4 16.0 Dripping Substitute 1 1 - - Edwards' Desiccated Soup 1 1 - - Eggs (Dried) 2 2 - - Egg Substitute 1 1 - - Epsom Salts 1 1 - - Eucalyptus Oil 1 1 - - Farina 1 1 - - Fish Paste 7 7 - - Flour 5 5 - - Flour (Bun) 1 1 - - Flour (Maize) 1 1 - - Flour (Self-raising) 32 32 - - Frostine 1 1 - - Frying Fat 1 1 - - Galath Powder 1 1 - - Gin 1 1 - - Ginger Wine 2 2 - - Glauber Salts 1 1 - - Gravy (Thick) 1 1 - - Ground Ginger 2 2 - - Jam 13 12 1 7.7 Jelly 2 2 - - Lactic Cheese 1 1 - - Lard 22 22 - - Lard Substitute 1 1 - - Lemonade (Concentrated) 1 1 - - 44 TABLE IX.—FOOD AND DRUGS.—continued. Total Samples Taken. Percentages of Articles Adulterated. Articles submitted for Analysis. Number Genuine. Number Adulterated. Lime Juice 3 3 - - Linseed Liquorice and Chlorodyne Guma 1 1 - - Liquid Egg 1 1 - - 1 Liquorice Powder 1 - - Luncheon Sausage 1 1 - - Margarine 137 132 5 37 1 Maize Flour 1 - - Malt Extract 1 1 - - Marmalade (Lemon) 4 4 - - Milk 351 79 18.4 430 Milk (Skimmed) 1 1 - - Milk (Sterilized) 2 2 - - Mustard 10 10 - - Oatmeal 7 7 - - Olive Oil 1 - 1 - Orange Quinine Wine 3 1 2 66.6 Orange Wine 1 100.0 1 - Paste (Goose) 1 1 - - Pea Flour 2 2 - - Pearl Barley 4 4 - - 33 Pepper 33 - - Peppermint Cordial 1 1 - - Rice 13 13 - - Rice Flour 1 1 - - Rolled Oats 1 1 - - Sago 1 1 - - 1 Salmon and Shrimp Paste 1 - - Sauce (Worcester) 2 2 - - Sausage 2 2 - - 1 Semolina 1 - - Soup Powder 2 2 - - Sucron 1 1 - - Suet (Beef) 1 1 - - Suet (Shredded) 2 66.6 3 1 Sugar 1 1 - - Sweetenors 1 1 - - Syrup (Golden) 2 2 - - Tapioca 1 1 - - Valento 1 1 - - Vinegar 57 10 14.9 67 3 6.8 Vinegar (Malt) 41 44 Yorkshire Pudding Powder 1 1 - - 1186 1077 109 9.2 18.44 16.20 17.59 18.71 325 284 31.51 20.53 135 89 1,182 1,130 722 757 1912 1911 18.81 17.96 Table XI. —Factories, Workshops, Laundries, Workplaces and Homework. Inspection. Number of Premises. Written Notices. Inspections. Prosecutions Factories (including Factory Laundries) ... 48 11 Workshops (including Workshop Laundries.) 43 6 ... Workplaces (other than Outworkers' Premises) 5 ... 26 117 22 ... Total Defects found. Number of Defects. Number of Prosecutions. Referred to H.M. Inspector. Particulars. Found. Remedied Nuisances under the Public Health Acts— ... 5 5 Want of Cleanliness ... ... Want of Ventilation ... ... ... 1 1 Overcrowding ... ... Want of Drainage of Floors 1 1 ... ... 22 22 ... ... Other Nuisances Sanitary Accommodation— I 2 ... Insufficient 2 ... Unsuitable or Defective 2 2 ... ... Not separate for Sexes ... 2 2 ... 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 ... ... ... ... 35 35 ... ... Total 46 Table XII. —No. of Bakehouses in the Borough. In Use. Not in Use. Inspector. Above Ground. Underground. Above Ground. Underground. 10 2 20 2 Mr. Scott 11 23 5 3 Mr. Hoskins 10 of these are Factory Bakehouses. 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 7 Reports (of action taken sent to H.M. Inspectors) ... Other Underground Bakehouses (s. 101) Certificates granted during 1917 ... In use at end of 1917 21 Workshops on the Register (s. 131) at the end of 1917 328 Workshop Bakehouses 10 Total Number of Workshops on Register 338 47 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. Disposed of for other Purposes than Human Food. Article. Destroyed. Removed for Sorting under S.A. Weight. Quantity. Weight. Quantity. Weight Quantity. Tons. cwt. lbs. Tons. cwt. qr. lbs. Tons. cwt. qr. lbs qr. Meat 2 9 13 - - - - - - - - - - - - Beef - - 16 9 - - - - - - - - - - - Tripe 1890 boxes 41 9 - - - - - - - - - - - - Shoulders 1 box 2 3 5 - - - - - - - - - - - Hearts 3 casks 8 3 6 - - - - - - - - - - - 1 25 Bacon - 39 3 1 24 - - - - - - 182 13 Ham - 1 1 - - - - - - - - - - - - 1 Pork 10 barrels 1 17 - - - - - - - - - - - Tongues in Brine 1 cask - 2 2 - - - - - - - - - - - 1 van load, 5118 cases 6920 tins Tinned Meat 180 5 3 15 11 19 1 26 - - - - - - 22 „ Fish - - 1 van, 12 boxes 15 cs. & 177 tins 7 13 - - - - - - - - - 1 „ Fruit - - - - - 9 - 23 - - - - - - 82 1 3 2 „ Vegetables - - - - - - - - - - - 7150 cs. 153 4 1 4 „ Milk 10882 cases 43 tins 235 19 3 27 - - - - - - - - - - „ Goods (various) 1302 tins - 18 3 - 2 vans 28787 tins 50 12 3 1 - - - - - 7 2 7 91 boxes 2 2 15 529 packages 5 18 1 7 Fruit (dried) 35 cases - 9 1 6 - Apples - - - - - - - - - - - - 8381 cases 143 Oranges and Lemons 2047 cases 91 7 2 20 - 1 9 - - - - - - - 60 2 - 20 Onions - - - - - - - - - 238 bushels 1 Cucumbers - - - - - 2 9 - - - - - - Cauliflowers 4 casks 16 2 - - - - - - - - - - - - UNSOUND FOOD AND FOREIGN MEAT REGULATIONS—continued. Quantity Unsound. Disposed of for other Purposes than Human Food. Destroyed. Removed for Sorting under S.A. Article. Quantity. Weight. Quantity Weight. Quantity. Weight. Gherkins 1 14 casks and 306 baskets 8 - - - - - - - - - - - - Vegetables - - - - - 11 casks, 1 pipe 1 12 1 - - - - - - Gherkins and Vegetables - 12 packages 3 10 - - - - - - - - - - - 2 Tomato and Cucumber - - - - - 2 - - - - - - - - Vegetables in Pickle 50 kegs 38 casks 12 17 - - - - - - - - - - - - 4 1 18 Eggs - - - - - - 147 - 170 cases 4 - - Egg Yolk 4 cases 4 - - - - - - - - - - - - - 6 2 2 Butter 13 boxes - - 5 boxes - - - 35900 packages 898 - - - Cheese 428 packages 34 11 2 7 3 2405 packages 171 15 2 24 - pieces - - Wheat 8 20 330 - - - - - - - - - - - - Oats 515 5 2 6 - - - - - - - - - - - Maize 3 2 8 - 18 - - - - - - - - - - Barley 380 6 - - - - - - - - - - - - - 1 21 Flour - 686 16 - - - - - - - - - - Sago Flour 383 bags 20 - - - - - - - - - - - - - 1 Tapioca 1 bag - - - - - - - - - - - - - Rice 30 16 1 - - - - - - - - - - - - 2 10 Beans - - - - - - - - - - - - - Haricot Beans 9 10 - - - - - - - - - - - - - Peas 17 - 5 - - - - - - - - - - - - Cocoa 32 bags 2 16 - - - - - - - - - - - - Jam 16 483 packages 6 9 2 - - - - - 542 packages 6 14 3 10