CAM I 1893-94. VESTRY OF CAMBERWELL. LONDON. THIRTY-EIGHTH ANNUAL REPORT OF THE VESTRY OF ITS Proceedings under the Metropolis Local Management Act, 18 and 19 Vic., Cap. 120. LONDON: FREDK. TARRANT & SON, PRINTERS 110, CAMBERWELL RD., S.E. 1894. THIRTY-EIGHTH ANNUAL REPORT OF THE VESTRY OF THE PARISH OF CAMBERWELL. In conformity with the provisions of the Metropolis Local Management Act, the Vestry of the said Parish submits to the Parishioners a Statement of its Proceedings in the execution of the various powers vested in it, and an Account of its Receipts and Expenditure for the year ending 25th March, 1894. 1893-94. MEDICAL OFFICER'S ANNUAL REPORT. Gentlemen, According to the Registrar General's Annual Summary, the population of London, estimated for the middle of the year, 1893 (the population, therefore, used in the determination of the metropolitan marriage-rate, birth-rate, and death-rate), was 4,306,411. The marriages numbered 36,971; the births 132,975; and the deaths 91,536. The marriage-rate was 17·2 per 1,000, being lower by 2 than that of the previous year. The birth-rate was2 per 1,000, being lower 31.0 per 1,000. This rate is identical with that of the previous year, which was the lowest rate recorded in London in any previous year, with the single exception of 1890, when the rate was 30·7. The death-rate was 21·3. This rate was 1·2 per 1,000 in excess of the average rate in the previous 5 years, having been raised considerably by the mortality from diphtheria and influenza. Table I. shews the populations of London and its five groups of districts, as ascertained at the censuses of 1881 and 1891 respectively. Table I—Populations of London and of its Groups of Districts at Censuses of 1881 and 1891. London. West D. North D. Central D. East D. South D. 1881 3,816,483 905,947 282,238 692,738 1,265,927 669,633 1891 740,725 994,207 705,012 1,523,692 4,211,056 247,140 Table II. sets forth the births and deaths, together with the birth-rates and death-rates of London and its five groups of districts for the year, 1893. It will be seen that the birth-rate of South London is higher than the birthrates of the Western, Northern and Central Districts, but considerably lower than the birth-rate of the Eastern District, and a trifle higher than that for London generally; and that the death-rate of South London is higher by 1·2 than that of the Western Districts, but lower than the rate of all the remaining districts, and of London. TABLE II.—Birth, Death, Birth-rates and Death-rates of London and its Groups of Districts for 1893. London. West D. North D. Central D. East D. South D. Births 132,975 19,919 29,591 50,227 6,953 26,285 91,536 20,391 6,154 17,555 Deaths 14,866 30,862 29·3 31.0 29·0 Birth-Rates 26·4 37·3 31·7 21·0 20·0 25·1 18·7 26·6 19·9 Death-Rates Table III. shews the Metropolitan deaths due to the so-called "zymotic" diseases for each of the last ten years; and, for the last year, their distribution among the groups of districts. In deaths from hooping cough there was a 464 465 falling-off of 117; in deaths from measles a falling-off of 1,732; and in influenza a falling-off of 738. While, on the other hand, in deaths from small-pox there was an increase of 165; in deaths from fever (mostly typhoid or enteric) an increase of 252, in deaths from scarlet fever an increase of 422; and in deaths from diphtheria an increase of 1380. Table III. —Mortality of chief Zymotic Diseases in London for 10 Years. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Fever. Small Pox. Influenza. 3,188 2,285 1,444 973 1,045 913 - 1884 2,479 896 - 2,928 707 695 899 1885 2,078 846 1886 2,834 688 701 24 - 2,928 2,894 1,467 961 672 9 1887 - - 2,987 2,401 1,209 1,301 9 1888 720 - 1,749 2,314 784 1,588 596 1 1889 3,285 861 636 3 652 1890 3,227 1,387 1,807 2,876 597 2,338 589 1,361 8 1891 2,447 1,885 467 3,393 1,174 41 2,264 1892 2,330 1,596 1,661 3,265 719 206 1893 1,526 366 102 223 366 118 1893 5 - West D. 385 1,043 - 553 437 185 11 North D. 170 35 192 Central D. 62 - 136 - 368 138 1 371 135 East D. 519 - 1,139 217 15 - 904 538 South D. 633 Metropolitan Hospitals outside London. - 175 6 2 174 - - Table IV. gives the populations of Camberwell and of its sub-districts, as enumerated at the censuses of 1881 and 1891, and also the populations calculated for the middle of 1893 on the hypothesis that the rates of increase which had ruled between these periods have been maintained since. It will probably be observed that according to this calculation, the estimated population for the parish does not correspond accurately with the estimated population of the sub-districts. This discrepancy is due to the fact that each sub-district has had its population deduced from its own special decennial increase between 1881 and 1891 —a mode of calculation which, though strictly correct, does not allow accurate correspondence. Table IV.—Populations of Camberwell and its Sub-Districts. Parish. Dulwich Camberwell. St. George's. 50,810 Peckh'm As enumerated at census, 1881 186,593 5,590 59,104 71,089 235,312 6,809 As enumerated at census, 1891 83,483 81,654 63,366 86,599 As calculated for middle of 1893 247,950 87,822 7,118 66,597 Table V. enumerates the births which were registered in the parish and its sub-districts during the years 1892 and 1893. It will be observed that in the latter year the births were 7 lower than those in the former year. In Camberwell there was an increase of 28, in Dulwich there was a falling-off of 9, in Peckham of 20, in St. George's of 6. Table V.—Births in Camberwell and its Sub-Districts. Parish. Dulwich. Camberwell. Peckham. St. George's. 7,478 7,471 73 64 2,377 2,405 2,741 2,724 1892 1893 2,284 2,278 -7 - 9 —20 +28 Difference —6 In Table VI. the birth-rates per 1,000 for the parish and its component parts are given both for the year 1892, and for the year 1893. The differences are on the whole only slight. For the parish there is a falling-off of only ·8, for Camberwell of only ·6, for Peckham of only ·7, for St. George's of ·9; but in Dulwich, where the birth-rate is always small, the fall is from 10·5 to 9. Table VI. —Birth-rates of Camberwell and its Sub-Districts. Parish. Dulwich. Camberwell. Peckham. St. George's. 1892 30.9 10.5 28.0 32.2 35.1 1893 30.1 9.0 34.2 31.5 27.4 The complete mortality returns are given in Tables IX. and X., to some of the facts set forth in which reference will be made further on. But meanwhile Table VII. has been constructed for the purpose of assisting to form as correct an estimate as possible of the death-rates of the parish and of its sub-districts. Table IX. gives the deaths due to the parish, which actually occurred and were registered within its limits. But a considerable number of deaths due to the parish took place in hospitals and other institutions placed outside the parish. These, with some approach to accuracy, are given in Table X. For the purposes of the death-rate the corresponding items in Tables IX. and X. have been added together, and the combined numbers (representing the total mortality of the parish and of its sub-districts) are set forth in the first column of Table VII. To Dulwich there are there attributed 77 deaths, to Camberwell 1,817, to Peckham 1,583, to St.George's 1,329, and consequently to the whole parish 4,806. But Camberwell proper contains the workhouse and infirmary, in which 397 deaths occurred, and two lunatic asylums, in which 71 deaths occurred; and Peckham contains two off-shoots of the workhouse, in which 81 deaths occurred. Now these deaths, though happening within these districts, no more properly belong to them than they do to the other districts of the parish, and if included in the mortality of these districts would unduly and unfairly swell their death-rates. I have, therefore, as I have always hitherto done, distributed them among the several subdistricts in proportion to the deaths (apart from these) due to each. The steps of this calculation are shewn in the 2nd, 3rd, and 4th columns of the Table, and the final result in the last column. It may be added that, even so, there is a little unfairness to the parish inasmuch as many of the deaths in the lunatic asylums are of persons who do not properly belong to the parish; and a little undue partiality to the sub-district of Camberwell and in a less degree to that of Peckham, inasmuch as in the former the populations in the workhouse, infirmary, lunatic asylums, and St. Saviour's informary, and in the latter the populations of the Gordon Road and Willowbrook Road infirmaries, are included in the populations as given in the census returns. I have, of course, excluded from consideration the deaths occurring in St. Saviour's infirmary, which amounted to 650. Table VII.—Re-distribution of Deaths among Sub-Districts of Camberwell. Deaths returned. Deaths in W.I.and L.A. Deaths in W.I. and L.A. subtracted. Deaths in W.I. and L.A. redistributed Estimates of Deaths due to Subdistricts. + 9 Dulwich ... 86 77 77 + 174 - 468 1,523 1,817 1,349 Camberwell 1,583 + 194 - 81 Peckham 1,502 1,696 ... 1,329 1,501 St. George's 1,329 + 172 + 349 4,806 Parish 4,806 - 549 4,257 The death-rates per 1,000, deduced from the estimated populations of the parish (as given in the lowest horizontal line of Table IV.), and from the re-distributed deaths (as given in the last column of Table VII.), are set forth in Table VIII.; in which Table are also given, for the purposes of comparison, the corresponding death-rates of the previous year. If we turn to Table II., which has already been explained, it will be seen that the southern group of districts have a lower mortality than London as a whole, and a lower mortality than all the other groups of districts excepting the west. But the mortality generally is a little higher than it was in the year immediately preceding. The mortality rate of the parish of Camberwell was 19.38, .32 higher than in the previous year; the mortality of Camberwell was 17.34, an increase of .66; the mortality of St. George's was 22.53, an increase of I.3; 469 while on the other hand the mortality of Peckham fell from 20.29 to 19·58, and that of Dulwich from 12.75 to 12.08. The results on the whole are not unsatisfactory. It will be observed, however, that the birth-rate and the death-rate of Dulwich continue, as they always have been, remarkably low; whilst that of St. George's shows a manifest increasestill it is considerably below the death-rates of the central and eastern group of districts. Table VIII.—Death-rates in Camberwell and its Sub-Districts. Parish. Dulwich. Camberwell. Peckham. St. George's. 1892 19.06 12.75 16.68 20.29 21.23 19.58 22.53 19.38 1893 12.08 17.34 Tables IX. and X. give between them the mortality returns for the year ending 1893, according to sex, to age, to disease, and also according to districts and to seasons. Table XI. shows the annual mortality for the most important of the so-called zymotic diseases from the origin of the Vestry until the end of the year 1893, no correction being made for increase of population. Table XII. displays the returns of the same diseases for the last 6 years quarter by quarter. One hundred and twenty-nine deaths were due to accidental or other violence, or 15 more than in the previous year. Deaths attributable to premature birth or defective vitality and to convulsions of infancy, collectively numbered 510, or 47 fewer than in 1892. To child-birth 45 deaths were attributed, 10 more than in the previous year; of which TABLE IX.— Returns of Births and Deaths for the Fifty-Two Weeks ending Saturday, December 31st, 1893. BIRTHS. DEATHS. ACCORDING TO AGE. ACCORDING TO DISEASES. Under 1 Year. Between 1 and 5. Between 5 and 10. Between 10 and 20. Between 20 and 30. Between 50 and 60. Between 60 and 70. Between 70 and 80. Between 80 and 90. 90 and upwards. Violence, Poison, and Accident. Premature Birth or Defective Vitality. Convulsions of Infancy. Child-birth. Erysipelas, Pyæmia, &c. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Typhoid Fever. Influenza. Small Pox. Tubercle. Cancer. Pneumonia, Bronchitis, &c. Diarrhœa, Dysentery, &c. Chronic Diseases. Between 30 and 40. Between 40 and 50. M F MF M F MF Non-febrile affections. Puerperal Fever. Under 5 years. Over 5 years. Under 5. Over 5. Dulwich 27 64 35 39 5 2 5 2 9 14 10 6 1 3 1 0 0 1 0 0 3 4 2 0 6 0 5 0 1 38 37 74 9 4 0 6 4 7 1207 1198 838 1671 342 160 35 55 85 135 159 160 211 220 100 9 112 41 7 9 17 23 8 34 1 90 97 28 531 Camberwell. 2405 833 28 28 11 21 262 277 54 Peckham 1415 1309 2724 440 86 130 121 119 136 144 8 7 15 7 0 181 177 12 423 57 36 10 28 28 697 741 1438 201 35 43 65 5 64 35 5 53 141 64 St. George's 1169 1109 23 67 5 40 5 23 5 180 161 50 595 17 22 153 2278 596 1191 383 244 37 30 48 72 81 105 86 80 24 1 110 9 2 49 0 6 264 1st Quarter. 943 1925 534 648 1182 73 52 8 7 6 29 15 7 173 43 139 241 104 982 263 157 31 22 54 88 104 136 66 5 25 9 4 16 0 12 4 319 152 2nd Quarter 936 1832 490 460 950 249 121 26 77 96 98 42 3 19 40 4 4 32 15 10 1 154 46 132 9 264 34 3 22 65 33 896 31 91 82 88 8 1 3rd Quarter. 969 859 531 508 353 156 37 58 87 80 73 30 2 31 105 4 1 28 40 19 5 140 52 100 318 79 1828 1039 26 52 83 36 5 9 4 0 40 23 0 906 26 114 119 15 5 16 162 42 160 23 4th Quarter. 980 1886 605 598 1203 305 175 55 79 58 6 15 104 45 10 7 10 39 11 38 143 3 355 40 99 127 Totals 3643 7471 2160 2214 4374 1170 609 109 133 192 302 379 400 426 442 171 399 612 39 1256 196 90 173 26 19 75 77 81 629 16 104 33 168 3828 370 29 22 1 TABLE X—Supplemental Return of the Deaths of Parishioners dying in Institutions outside the Parish. I ACCORDING TO AGE. ACCORDING TO DISEASE. M F MF Under 1 year. Between 1 and 5. Between 5 and 10. Between 20 and 30. Between 30 and 40. Between 40 and 50. Between 50 and 60. Between 60 and 70. Between 70 and 80. Between 80 and 90. 90 and upwasds. Scarlet Fever. Small Pox. Chronic Diseases. Premature Birth or Defective Vitality. Convulsions of Infancy. Child-Birth. Erysipelas, Pysemia, &c. Influenza. Cancer. Between 10 and 20. Violence, Poison, and Accident. Measles. Diphtheria. Typhoid Fever. Tubercle. Pneumonia, Bronchitis, kc. Diarrhœa, Dysentery, &c. Hooping Cough. Non-febrile affections. Puerperal Fever. Under 5 years. Over 5 years. Over 5 years. Under 5 years. Dulwich ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 2 3 ... 1 ... ... ... ... ... ... 1 ... 9 ... 1 2 ... 18 1 1 17 5 1 1 57 Camberwell 72 146 7 15 12 4 ... 1 13 12 11 23 18 10 ... 12 19 4 4 74 13 1 17 4 ... 3 3 Peckham 145 10 13 16 9 8 ... ... 16 14 25 18 ... 14 5 20 7 5 ... 83 1 49 62 11 21 1 ... ... ... ... ... 15 4 1 5 ... 3 2 2 48 St. George's 138 10 31 14 7 1 1 13 ... 10 5 20 3 1 13 13 80 58 11 25 9 9 ... ... ... 1 ... 15 59 10 1 ... 5 3 3 51 12 9 17 10 7 6 ... ... ... ... 1 16 ... 5 5 2 8 ... 1 45 110 4 12 1st Quarter 22 1 7 1 ... 5 11 5 1 ... 13 10 ... 5 ... 8 44 9 16 13 2 2nd Quarter 109 5 4 ... 1 ... 3 56 12 20 7 2 11 2 53 9 3 91 6 17 7 13 14 11 8 2 ... ... ... ... 9 3 ... 1 2 2 3rd Quarter 6 7 8 3 28 59 ... 1 1 18 1 2 32 ... 4 1 1 17 4 2 6 ... 38 4th Quarter 8 24 14 10 7 12 11 9 2 ... 10 ... ... 14 16 9 3 ... ... 21 1 66 56 122 ... ... Totals 237 432 195 79 27 38 37 43 53 38 31 19 ... 39 11 ... 1 ... 8 ... 3 47 8 10 22 7 22 155 5 41 1 51 3 3 62 19 were due to various forms of so-called puerperal fever. These latter occurred chiefly in Camberwell and Peckham. 36 persons were stated to have died of erysipelas, carbuncle, or pyæmia, against 40 in 1892. Tubercular diseases, including pulmonary consumption, caused 680 deaths, and cancerous diseases 193, against 656 and 180 respectively in the previous year. Inflammatory affections of the lungs caused 1,040 deaths, or 47 more than in 1892, and diarrhæal affections 213, or 44 more than in the year before. The mortality due to the so-called zymotic diseases showed for the most part a decided increase on that of the previous year. For full details in reference to these affections I must refer not only to Tables IX. and X., but also to Table XI. which displays the annual mortality referred to these diseases ever since the constitution of the Vestry at the beginning of 1856, and to Table XII. in which the mortality of the same diseases is shown quarter by quarter for the last six years. Hooping cough caused 104 deaths against 128 in 1892 and 123 in 1891. It caused 1 death in Dulwich, 28 in Camberwell, 35 in Peckham, and 40 in St. George's. Measles caused 78 deaths, against 189 in 1892, and 67 in 1891. It caused 12 deaths in Camberwell, 16 in Peckham, and 50 in St. George's. The mortality from hooping cough was pretty uniform during the first 9 months of the year, and diminished considerably in the last 3. Measles was chiefly fatal during the third quarter, and almost died out in the fourth. Scarlet fever caused 80 deaths, against 63 in 1892 and 29 in 1891. It caused 39 deaths in Camberwell, 23 in Peckham, and 18 in St. George's. This disease was chiefly fatal in the last quarter; least so in the second. To diphtheria were attributed 118 deaths, against 85 in 1892 and 56 in 1891. This is considerably the heaviest mortality we have experienced from this disease, which has been making alarming progress in London during the last few years. Of these cases, 3 belong to Dulwich, 35 to Camberwell, 42 to Peckham, and 38 to St. George's; and more than half occurred in the last quarter. Typhoid fever caused 30 deaths, or 9 more than were due to the same disease both in 1892 and 1891. Of these 4 occurred in Dulwich, 12 in Camberwell, 8 in Peckham, and 6 in St.George's. 11 deaths were due to small-pox, against 1 severally in 1892 and 1891. Of these, 2 belong to Camberwell, 5 to Peckham, and 4 to St. George's. 3 occurred in the first quarter, 6 in the second, and 1 severally in the third and fourth. To diarrhœa were attributed 213 deaths, or 44 more than in the previous year. The great majority, as usual, happened in the third quarter, and in this quarter were only 6 in excess of the number registered in the third quarter of 1893. It is satisfactory to know that no case of even suspected Asiatic cholera was reported. The diarrhœal deaths were distributed (excepting Dulwich) pretty uniformly throughout the parish. Influenza was reported to have caused 82 deaths, of which 2 occurred in Dulwich, 34 in Camberwell, 28 in Peckham, and 17 in St. George's. Only 5 occurred during the third quarter of the year. Judged of by the death-rate alone the health of the parish was fairly good. Nevertheless, the mortality was, as is usual among young children, very heavy; there was serious cause for alarm with respect to an epidemic of smallpox, though, nevertheless, there was no large prevalence of the disease in the parish and only a small mortality; and there were threats of an invasion of Asiatic cholera, with a few small outbreaks here and there in the sea-port towns and one or two doubtful cases in London, but there were none in this parish. Probably the most serious fact revealed by the mortuary returns is the continuous increase in the prevalence and mortality from diphtheria. Table XIII. gives a summary of the sanitary work done by your sanitary inspectors. It is difficult, indeed impossible, to compare this year's work with that of former years; partly because up to the end of 1891 the returns were from the 26th March of one year to the 25th March of the next year (inclusive); but mainly because in my last report (acting under the directions of the Local Government Board) my returns included those of 3 months already given in the report of the previous year and those of the remaining 9 months of the year 1892. Moreover, owing to various circumstances during the last 2 or 3 years or more, important changes were being made in the sanitary staff. I am glad to say that during the year 1893 the completed changes have been in continuous operation. We have now, as I informed you in my last report, 14 sanitary inspectors. In addition to Mr. Griffiths, whose time is occupied mainly with notifications and matters connected therewith, a shorthand clerk has been appointed, and besides your chief disinfector (Yates) three men are engaged constantly in the work of disinfection which is now a serious part of our duty. It appears from Table XIII. A. that during the year 25,898 primary inspections were made, including 9,455 systematic house-to-house inspections, 2,762 inspections consequent on complaints, 3,166 inspections in respect of notified diseases, and 1,021 inspections of new buildings. It appears also that there were 52,746 re-inspections of works in progress, including the re-inspection of premises in which notifiable diseases were or had been prevailing. It further appears that in connection with the sanitary defects revealed by inspection, 6,116 intimations and 1,255 notices were served under the Public Health Act, and that in connection with all the above works only 66 summonses needed to be taken out Table XIII. B. shows the work which has been done in relation to the supervision and regulation of the drainage of houses newly built, and those relating to the total or partial reconstruction (under the Vestry's regulations) of the drainage of houses already built. Of partial reconstructions there were 702, and of drainage of new buildings and total reconstructions of drains, &c., of old houses 2,206. Table XIII. C. comprises a list of the ordinary sanitary works which have been carried out during the year and which have been carried out successfully. The table bears witness to the successful performance of a very large amount of sanitary work, but none of the items calls for special remark. Table XIII. D. sets forth the number of samples of food and drugs submitted by the inspectors to the Analyst, and the number of summonses which have been taken out under the provisions of the Food and Drugs Act. During the year (see Table XIV.) the following notifications of diseases were made:—140 of small pox against 17 in the previous year, 1,886 cases of scarlet fever against 1,571 in the previous year, 526 cases of diphtheria against 312 in the previous year, 440 of erysipelas against 282 in the previous year, 138 of typhoid fever against 108 in the previous year, 23 of puerperal fever against 15 in the previous year. Also 8 cases were notified as English cholera and 5 as relapsing and continued fever. To the above paragraph it may be added that 3,166 cases were notified to the Metropolitan Asylums Board, that 2,606 notifications of infectious diseases, and 1,770 of disinfection after infectious diseases, were made to schools, making in all the sending out of 5,195 notices. As respects other clerical work, 8,212 letters were received and 14,160 sent out. The total number of cases notified to us was 3,166 against 2,307 in 1892, and 1,212 in 1891. This increase has been general, but due mainly to considerable increase in the notifications of small-pox, scarlet fever and diphtheria. The total number of infectious cases removed to hospital was 725 against 723 in the previous year. These included 86 cases of small-pox, 506 cases of scarlet fever, 108 cases of diphtheria and 25 cases of typhoid fever. Table XV. gives a list of the number of houses or rooms disinfected by the vestry officials, and of the number of beds and other articles disinfected in the parish disinfector or destroyed. Without going into details 2,028 rooms or houses were disinfected and 2,623 lots of bedding and other articles. For articles destroyed only £1 5s. was paid. It is gratifying to know that all this work has been done systematically and satisfactorily by Yates and his assistants. 477 TABLE XI. ANNUAL MORTALITY RETURN OF ZYMOTIC DISEASES, FROM 1856 (inclusive). Year. Hooping Cough. Mealsles. Scarlet Fever. Diphtheria. Fever. Small Pox. Diarrhœa. 1856 32 30 5 29 48 19 1857 7 44 30 24 4 50 1858 51 14 26 129 7 28 20 12 1859 66 ? 82 31 5 ? 1860 36 40 34 11 26 72 8 13 25 2 ? 1861 25 101 40 0 ? 1862 53 32 64 124 41 14 1863 57 32 29 ? 1864 61 29 83 16 10 ? 51 52 55 14 12 118 1865 39 31 38 59 11 53 76 1866 72 35 64 20 1867 75 8 41 9 67 1868 58 67 71 17 45 13 146 134 43 164 133 1869 9 46 9 1870 24 57 49 192 10 23 160 29 40 1871 50 60 9 153 143 1872 132 46 124 86 1 38 41 1873 60 49 7 7 3 137 38 54 1874 76 24 9 57 2 93 1875 125 64 177 14 1 107 40 1876 93 78 16 33 31 32 126 72 38 27 1877 61 12 124 94 1878 206 88 59 29 41 81 176 1879 122 123 76 75 31 35 80 1880 59 223 206 126 32 36 33 1881 74 95 120 29 44 190 127 1882 168 76 66 180 60 44 100 1883 91 48 19 112 49 35 122 1884 173 171 82 78 31 40 240 1885 20 136 68 27 154 135 91 1886 156 97 18 30 2 215 48 1887 203 133 99 71 239 41 9 1888 130 31 101 105 65 1 115 1889 193 149 37 76 27 0 145 1890 163 51 60 0 144 191 26 1891 123 67 56 142 29 21 1 1892 128 63 21 169 189 85 1893 1 104 78 80 118 30 11 213 478 TABLE XII. MORTALITY RETURNS OF ZYMOTIC DISEASES QUARTERLY FOR THE LAST SIX YEARS. Year. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Fever. Small Pox. Diarrhœa. Influenza. 1888. 1st Quarter 71 5 40 23 12 1 9 - 7 - 2nd „ 46 22 8 5 0 20 3rd „ 23 9 6 12 5 0 71 - 80 37 22 8 0 4th „ 20 15 - 1889. 1st Quarter 126 13 14 3 0 8 - 41 13 2nd „ 44 38 7 12 10 0 - 21 21 3rd „ 5 26 112 - 5 0 4th „ 40 8 12 10 24 11 0 - 1890. 1st Quarter 100 3 20 2 9 2 14 0 2nd „ 40 19 11 7 6 11 25 0 4 3rd „ 31 16 13 97 6 29 0 112 27 8 4th „ 20 10 20 14 0 12 21 3 0 46 6 1891. 1st Quarter 10 13 11 2nd „ 43 7 9 11 129 5 0 3rd „ 25 1 4 98 5 15 1 9 7 21 4th „ 34 13 5 17 0 8 1892. 1st Quarter 69 18 3 14 122 10 12 0 2nd „ 30 65 12 20 7 18 4 1 20 63 7 121 3rd „ 24 19 0 4 43 9 4th „ 9 17 34 4 0 13 1893. 1st Quarter 16 14 7 3 17 16 29 23 2nd „ 32 16 9 4 43 22 17 6 7 28 41 18 27 1 127 5 3rd „ TABLE XIII. return of work performed in the sanitary department from the 1st January, 1893, TO THE 31st DECEMBER, 1893, BOTH INCLUSIVE. PUBLIC HEALTH (LONDON) ACT, 1891. TABLE A. Description of Work. Inspectors. Stevenson. Chadderton. Groom. Pointon. Dewey. Eagle. Shapley. Scudamore Collins. Heath. Kerslake. Morley. Farmer. Total. Homer. House to House Inspections 653 498 801 742 9455 683 790 728 635 758 531 677 557 820 582 Complaints 375 282 224 360 247 140 90 95 128 112 147 58 359 195 2762 6 17 39 4 38 71 23 Bakehouses 4 23 29 19 0 35 0 308 17 35 8 21 12 0 Cowhouses 4 4 11 5 5 17 21 0 160 Slaughterhouses 7 14 0 6 4 0 14 7 0 0 24 5 2 0 83 3 Laundries 19 17 37 4 14 9 5 1 8 13 0 0 1 131 363 320 184 245 Infectious Cases 384 300 213 234 277 176 196 0 274 0 3166 139 5 Schools 33 28 14 13 18 14 13 26 5 0 64 372 0 1 1 1 Workshops 0 1 8 2 26 3 1 2 2 0 10 58 Sanitary Conveniences, Urinals, &c. 105 28 129 76 72 81 34 79 45 0 100 0 65 78 892 116 242 0 42 27 37 0 New Buildings 188 21 41 95 103 85 24 1021 0 4 0 0 17 2 Stations inspected 0 24 6 0 0 0 0 0 53 Intimations served under the P.H. Act 479 435 424 278 624 495 401 333 373 712 301 363 6116 500 398 Notices served under the P.H. Act 67 85 24 27 81 105 121 103 78 249 69 27 101 118 1255 0 2 5 0 1 Summonses taken out under the P.H. Act 6 4 2 1 0 26 19 0 0 66 2455 2289 Total Primary Inspections 2122 1482 1724 2091 2221 1983 2024 1468 1670 1128 1931 25898 1307 4491 3564 3285 4854 4712 3284 3305 Re-Inspection of Works in hand 4537 4629 3293 3302 2897 2559 52065 3353 135 32 69 64 22 „ Infectious Diseases 55 52 53 35 51 55 0 53 5 681 4764 4661 2564 4989 4592 4544 3357 2897 3319 3633 3417 52746 Total Re-Inspections 3344 3307 3358 TABLE B. 199 39 20 48 169 27 10 27 4 63 12 702 Partial Re-construction of Old Drains under Vestry regulations 21 10 53 Drainage of New Buildings and total Re-construction of Drains, &c., of Old Houses 194 70 88 24 34 183 351 111 153 159 151 144 167 377 2206 TABLE XIII.—Continued. TABLE C. Description of Work. Inspectors. Stevenson. Groom. Pointon. Dewey. Eagle. Chadderton. Shapley. Scudamore Collins. Heath. Kerslake. Morley. Homer. Farmer. Total. Houses ventilated under Floors 445 119 395 417 162 67 166 92 159 348 454 210 267 101 3402 „ Cleansed 87 172 12 129 175 160 155 13 12 130 496 204 242 547 2534 „ Repaired 152 174 226 345 55 74 153 5 30 157 335 109 99 85 1999 Water Supplied 62 12 12 112 8 71 192 19 7 132 186 45 59 3 920 180 Drains Cleansed, Repaired and Trapped 536 554 420 369 537 364 242 248 155 325 13 131 332 4406 808 719 259 697 Sinks, Rain-water Pipes, &c., Disconnected 710 787 595 395 383 188 350 283 166 384 6724 Stable, Yards and Areas Paved and Drained 328 341 271 231 482 132 252 196 321 247 3688 318 360 106 103 Closets Provided, Cleansed or Removed 411 464 461 345 459 396 190 138 220 351 414 176 195 669 4889 Water laid on to Closets 526 404 501 383 256 409 143 77 214 189 242 70 205 91 3710 88 238 37 142 94 13 81 32 53 52 163 1127 Cisterns Provided or Re-constructed 28 20 86 Cisterns Repaired, Covered or Cleansed 29 221 367 16 192 74 173 1 55 132 29 144 21 1500 46 Provide, Repair, or Remove Dust Bin 249 219 463 423 288 241 289 106 171 229 376 142 243 336 3775 Cesspools Emptied and Abolished or Drained into Sewer 26 12 4 0 0 93 3 2 27 1 0 2 6 10 0 Remove Refuse or Manure 12 127 59 33 10 157 167 24 6 32 26 19 225 1 898 Keep Animals Clean or Remove them 2 19 0 1 3 1 12 4 7 1 1 3 3 2 59 0 3 9 5 0 72 Cleanse & Supply Water to Private Urinals 14 4 0 0 16 7 0 14 0 Abate Overcrowding 2 9 1 7 5 0 8 7 0 15 1 2 6 1 64 2 18 0 1 1 2 12 91 188 Abate Smoke Nuisances and raise Chimneys 0 3 17 31 10 0 Trade Nuisances Abated 0 2 0 0 3 0 0 0 0 2 0 0 3 0 10 Road Gullies Abated 0 4 0 0 0 0 8 16 0 1 0 1 0 0 30 Supply Manure Pits 10 14 0 6 13 8 15 6 4 3 18 2 0 1 100 27 Drains exposed for examination 137 121 118 115 117 37 10 82 13 108 56 99 38 1078 Interceptors and Chambers supplied 213 181 89 101 77 36 27 52 76 42 28 32 74 45 1073 TABLE D.—SALE OF FOOD AND DRUGS ACT. Samples submitted for Analysis 20 19 37 28 32 7 5 6 0 8 0 6 0 177 9 Summonses under the above Act 1 5 7 4 7 2 1 0 2 0 0 0 1 0 30 Inquests 195 Dead Bodies removed to Mortuary 228 Post Mortem Examinations 97 TABLE XIV. RETURN RELATING TO NOTIFICATION AND REMOVAL TO HOSPITAL OF PATIENTS SUFFERING FROM NOTIFIABLE INFECTIOUS DISEASES, ALL THE CLERICAL WORK CONNECTED THEREWITH HAVING BEEN PERFORMED BY GEORGE GRIFFITHS, FOR THE YEAR 1893, FROM 1ST JANUARY TO 31ST DECEMBER. Small Pox. Scarlet Fever. Typhoid Fever. Puerperal Fever. Relapsing and Continued Fever. Diphtheria. Erysipelas. English Cholera. Public Health (London) Act, 1891. 526 8 No. of Cases Notified. 140 1886 138 23 5 440 506 0 0 0 86 25 0 108 No. of Cases removed to Hospital. Total No. of Cases ... 3166 No. of Cases Notified to the Metropolitan Asylums Board 3166 No.of Schools Notified of Infection 2606 „ „ Disinfection 1770 No. of Infectious Notices Served 5195 OTHER CLERICAL WORK. No. of Letters received 8212 „ sent 14160 14160 TABLE XV. RETURN OP HOUSES AND ARTICLES OF BEDDING, CLOTHING, &C., WHICH HAVE BEEN DISINFECTED AFTER INFECTIOUS DISEASE BY ASHLEY YATES AND THE DISINFECTING STAFF, FROM IST JANUARY TO 31ST DECEMBER, 1893. Houses Disinfected. ARTICLES DISINFECTED. ARTICLES DESTROYED. Compensation allowed for the articles destroyed. Beds. Blankets Pillows and Cushion s Mattresses. Bolsters. Counterpanes. Palliasses. Wearing Apparel. Lots, including Beds. Blankets. Sheets. Pillows and Cushions. Palliasses. Counterpanes. Wearing Apparel. Sheets. Mattresses. Bolsters. There are several matters on which I propose to make some special remarks. (I.) PORK PIE POISONING. In May, 1893, there was an outbreak of illness in the Parish, which had all the characteristics of poisoning by some irritant matter. None of the patients had anything in common beyond their symptoms, and the fact that they had all partaken of pork pies bought at one particular place. The total number of persons attacked was forty, including one of your inspectors. The symptoms of the illness were severe diarrhœa, sickness, headache, and weakness, which last seemed out of all proportion to the severity of the other symptoms. In some cases there was an interval of as much as twenty-four hours between partaking of the pies and the onset of the illness ; and, in other cases, the patients were attacked early, got better, and then suffered a relapse which was more serious in character than the initial illness. Two of those who were attacked died : one was a little child who had eaten no pie but who occupied the same bed as its parents who had both eaten largely and were suffering severely. It is presumed that the child was infected by the parents' discharges being in some way conveyed into its system. The other case was that of an old lady of seventy-nine. In order to still further elucidate the outbreak a circular letter was sent to many of the doctors in the parish asking them if they had had any cases under their care of diarrhœa, and sickness accompanied by extreme prostration. In answer to these enquiries we received information which enabled us to discover fresh cases, thus making up the total of forty. At the instance of the Home Office, portions of the pies, which were supposed to have been the cause of the fatal termination in the two cases, were examined by Dr. Stevenson of Guy's Hospital, both chemically and bacteriologically. No trace, however, of any poison was found in them. Bacteriologically the result was practically negative. The true cause of the outbreak is consequently difficult to trace. The shop where the pies were bought is, as regards cleanliness and well-being, beyond reproach, and, speaking generally this remark also applies to the establishment in the country (which was visited by Dr. Stevens), where the pies were made, and from whence they were sent to the shop in this parish. There is nevertheless no doubt that the poisoning was due to the pies ; and there are grounds for suspecting that it was due to the poisonous influence of some as yet undiscovered living organism which had accidently infected them. As indicative of the virulence of the poison, it is interesting to note that two persons suffered who had not actually eaten of the pies : one, the child, already referred to, who slept with its parents : the other, a lady who used, in eating her own dinner, a knife and fork which had also been employed in cutting up a pork-pie, of which other members of the family, who were poisoned, partook. (II.) REPORT ON SMALL-POX By Dr. Stevens. "Between December 3rd, 1892, and October 10th, 1893, we received intimations of one hundred and fifty cases of small-pox. Of these one hundred and fifteen were removed to the hospital, the remaining thirty-five being treated at home. Of those removed to the hospital ten cases were returned immediately as not suffering from small-pox. In connection with five of these ten cases no fresh outbreaks were reported as occurring in the houses to which the patients were returned, so that we may assume that the diagnosis of the Metropolitan Asylums Board was in these instances correct. In the case of three we received subsequent notifications of small-pox from the houses of these patients, less than fourteen days having elapsed from the return of the first case ; and, of these three, one was sent to the hospital ships and detained there as suffering from undoubted small-pox. The other fresh cases occurring in the before-mentioned houses were seen by Dr. Bristowe or myself, and in each case we considered it true small-pox. One other case was returned after three days owing to its doubtful character, while the fifth was allowed, after he had recovered from his illness, for which he was treated at home, to go to the Metropolitan Asylums Board Convalescent Farm. "In ten cases out of the thirty-five that were not removed it is probable, judging from the history of the illness, the symptoms of the patients, and what happened subsequently, that they were not really cases of small-pox. "Regarding the remaining instances where patients were not removed, we would point out that two occurred where another inmate of the house was returned from the wharf as not having small-pox. "It was noticed in all but two instances that whereever an unremoved case of undoubted small-pox existed, other cases followed, mostly in the same house. Of these subsequent ones, some were removed, some were not. In one instance no small-pox broke out in the house, but a case occurred next door. In another the mother of the patient who lived in the same house with him, and his niece, who lived next door, were both attacked. "Of the total number of cases notified to us eighteen proved fatal. "Up to the end of January, 1893, about eighteen cases had been notified, all occurring in the eastern portion of the parish, six of which appeared to have been due to infection from patients previously attacked in the same house. "On the 23rd January we received notification of small-pox, in regard to six children, occurring in a family living in King's Road. It appeared that one of the girls had been ailing since the 12th, but was not sufficiently ill to cause her parents to seek medical aid, and she had subsequently returned to school. From the information I was able to procure there seems to be no doubt that she had suffered from small-pox, and that she had not only infected five of her sisters, but also several school-fellows by returning to school still in an infectious condition. These in their turn became fresh centres of infection, for no isolation was put into force, it not being known that they were suffering from any infectious disease. In all, no less than nineteen cases can be directly or indirectly put down to this child returning to school while still infected. Indeed, it seemed necessary to us that the school should be visited daily, and an enquiry made of the teachers as regards any of the children appearing to be out of sorts, also that the list of absentees should be examined, so that these could be visited at their houses, and the reason of their absence explained. Through these means we were able in one instance to secure the prompt removal of a case which otherwise would probably not have been isolated at all. "Henceforward up to the middle of April isolated cases occurred, the number of notifications having at this time reached fifty-four. On the 11th April we received information of the death of a child three months' old from small-pox. On visiting the house we found that there were two more members undoubtedly suffering from small-pox in a very slight form. On enquiry it was ascertained that some two weeks previously another child had complained of feeling out of sorts, and that she had some spots about her. No notice, however, was taken of it at the time, her illness being so slight as to call for no medical attendance. In all, five cases could be definitely ascribed to the infection from the first child, including the sweetheart of one of the patients who insisted on kissing him previous to his removal to the hospital ships. After this period until September there were apparently no series of cases depending one upon another, but cases occurred at intervals all over the parish. In September there were two cases notified in Barset Road, and as there was some reluctance on the part of one of these patients to be removed to the hospital we visited the house and desired to see her husband, and on seeing him he was at once discovered to be suffering from small-pox, although he had been at work up to the time of our visiting the house." I may make one or two supplemental remarks to the above report. In the first place both it and the table (especially the latter) are incomplete, mainly as regards facts as to vaccination. The fact is, in many instances the cases were removed to hospital before we had any opportunity of investigating this point. It is of the less importance however, because Dr. Luff was appointed by the Vaccination Commissioners to investigate and report on the small-pox epidemic in London, and before long such information as could be obtained from local sources in regard to small-pox, and the additional information derivable from the Asylums Board Hospitals will be collected in a comprehensive paper. In the next place, in the comments made as to the return of cases of suspected small-pox by the Asylums Board Officials, there is no intention of imputing blame. Small-pox, especially as modified by previous vaccination, is often exceedingly difficult, and even impossible, to recognise with any degree of certainty. I would certainly not pretend to be able to diagnose the disease in all cases. But it is important to mention the fact; the more especially as one of the returned cases formed the middle one of a series of three occurring at 48, Brymer Road. The first of these cases was removed at an early stage to the workhouse, whence it was removed in the course of a day or two to the Asylums Board Hospital. The second case was attacked twelve days later, and was the case sent to and returned from the hospital. The third case broke out twelve days later. The intervals between the attacks corresponded exactly to what should have happened had the first infected the second, and the second infected the third. In the third place it is mentioned that one of the notified cases was that of a medical student. I saw him professionally and learnt that a case or two of small-pox presented themselves as out-patients at the hospital at which he was a student. The cases were at once recognised; but pending their removal to the Asylums Board Hospital, they were naturally seen by several of the students, of whom some two or three (including my patient) contracted the disease. In the fourth place it is interesting to note that a young girl contracted small-pox from insisting on kissing her sweetheart previous to removal to hospital with the disease. In the fifth place to show how easily the disease may be spread, I may call attention to the fact that a man was notified in our parish and sent to hospital, who had travelled all the way from Newcastle to London with the rash upon him. The sixth case is of a somewhat similar character. The bare details of the cases are given under Nos. 142, 143, 144, 148 and 149 in the table. Dr. Stevens has mentioned that one case had occurred and not been recognised. Several other cases followed and were notified, and as they all refused to be removed to hospital Dr. Stevens and I made a point of visiting the premises. The house was occupied by two families, the mother of each family being the main sufferers. We endeavoured to persuade them to go to hospital, but fruitlessly. We heard, however, that the husband of one of them was in the house, and asked to see him. When he came down he had evidently just returned from work, for his face and hands were thickly grimed with coal-dust. I went up to speak to him, and found him covered with smallpox rash of some days' standing; and I learnt from him that he had been going to his work daily, ever since he was attacked. I explained the condition of things to him, and the result was that we soon got all who were ill to the hospital ships. In the last place i think it desirable to add a remark or two in regard to the cases referred to by Dr. Stevens as occurring in the King's Road, and attending at the Wood Street School. At first it might have seemed desirable to have the school closed; but I must confess I am slow to close schools, though in this matter I should not shrink from what I thought my duty. But after fully considering the matter with Dr. Stevens, and having made full enquiries, we determined to defer closing the school, and meanwhile, with the aid of the school officials, to keep a careful watch, especially with respect to those who remained away from school. The result was most satisfactory. There was practically no extension of the disease; and the school went on with its work.—J.S.B. TABLE OF SMALL-POX CASES (Dr. Stevens). Commencement of Illness. Result. Vaccination and date. Re-Vaccination and date. Occupation. Address. Notified. Remarks. No 198 Sumner road 3-12-92 29-11-92 R Hammerman S.E.R. Bricklayers' Arms Infancy School boy, Cator street - 34 Sydney square 6-12-92 1-12-92 R Not vacc. 45 Pennethorne road 6-12-92 29-11-92 R Works at hat factory, Bermondsey Infancy No 34 Sydney square 19-12-92 R Infancy No Father of No. 2 - - 22-12-92 R School girl, Coburg road Not vacc. 48 Brymer road (at Infirmary, Havi street) 15-12-92 - 50 Hardcastle street 29-12-92 24-12-92 D Waiter Infancy - 871 Old Kent road 31-12-92 27-12-92 R Wife of publican Infancy - No vaccination marks 132 High street, Peck ham 31-12-92 R Infancy - - - 48 Brymer road 3-1-93 R 27-12-92 - Returned as not small-pox from M.A.B. hospital. - - - Sister of No. 5 Very doubtful case - 145 Camberwell grove 5-1-93 - - - - R No scars Casual ward, Gordon road 9-1-93 Tramp Works at a bedding factory No - 9 Nutt street R Yes 11-1-93 6-1-93 No Sweetheart of No. 13 12 Nutt street R Factory at Grimscott street Yes No 12-1-93 7-1-93 No. Age. Sex. Address. Commencement of Illness. Result. Occupation. Vaccination and Date. Re-Vaccination and Date. Remarks. Notified. 14 M 132 High street 13-1-93 9-1-93 Shop keeper Husband of No. 8 Yes 47 R Refused re-vacc. 15 1 F 48 Brymer road R - Yes 3-1-93 19-1-93 11-1-93 16 40 - M No Tramp ward, Gordon road R Tramp Yes - - 15 F 19 McKerrell road Yes 17 R - No A great friend of No. 22 Mother of 5, 9 and 15 30-1-93 21-1-93 18 F 48 Brymer road 3-2-93 R - Yes 32 No 19 - 14 F 3-2-93 R 27 Parkstone road 29-1-93 School girl, Wood's road Yes No 20 20 M - Yes No 1A Prince's terrace Shopman - - 21 6-2-93 11 School girl, Wood's road R - F 68 King's road Yes All sisters 25-1-93 14 R F „ „ 22 6-2-93 Yes 27-1-93 „ - 23 9 F 6-2-93 R - „ „ 24-1-93 „ Yes F 24 7 6-2-93 12-1-93 R No - 13 „ „ „ 25 F „ „ 6-2-93 27-1-93 R M „ Yes - Casual Ward 26 - 6-2-93 R Tramp Yes - - 27 7 F 43 Kimberley road 8-2-93 2-2-93 R School girl, Wood's road Not vacc. - 28 F 8 9-2-93 R 1 Sunwell street - Not vacc. - „ 29 8 M 10-2-93 5 Kirkwood road 1-2-93 R „ Not vacc. - 30 23 F 19 McKerrell road 15-2-93 7-2-93 Sister of No. 17 R Dressmaker Yes No 31 23 F 94 Shenley road 19-2-93 12-2-93 R - Yes - 32 F 29 43 Kimberley road 20-2-93 - R Yes No - 33 34 F 20 2-93 15-2-93 D Mother of No. 27 „ „ - No scars Yes, 9-2-93 Age. Sex. Address. Notified. Commencement of Illness. Result. Occupation. Vaccination and Date. Re-Vaccination and Date. Remarks. No. - R No 34 F 20-2-93 14-2-93 Yes - 5 Kirkwood road Mother of No. 29 Aunt of No. 29 Sister of No. 28 - 35 31 F 9 Burchell road 20-2-93 14-2-93 R Yes No School girl, Wood's road 12 22-2-93 R No 36 F 1 Sunwell street 20-2-93 - 23-2-93 - M R 37 25 Yes 5 Kirkwood road No - 38 24-2-93 23-2-93 R School boy, Wood's road Yes Yes, unsuccessfully, 2l-2-93 Brother to No. 29 12 M „ „ 5 26-2-93 39 F 24-2-93 R School girl, Wood's road 21-2-93 - 1 Sunwell street Sister of Nos. 36 and 28 Returned as not small-pox M - R 25 2 Champion terrace 25-2-93 40 - - - - M 9-3-93 R Medical student - - 41 24 93 Underhill road Death. Had only been confined 1 week Sister of No. 41 - - 42 M 2 Tindal street R Dustman Yes 40 - - F Grenard road - 43 27 - D - - F - 22 93 Underhill road - 44 23-3-93 R - - 45 - - Inserted by error. No M - Yes 46 29 99 Canterbury road 24-3-93 R Disinfector Yes, at wharf 24-3*93. unsuccessfully Returned not small pox 47 20 F 53 Tresco road R - - - - - 48 M 1 Cambridge terrace 34 2-4-93 R 29-3-93 Yes I - I - Yes, 25-3-93 49 12 F 53 Tresco road R Yes, no marks Sister to No. 47 - - - 50 - M Not in 11 Bishop's road Parish - - M R - Yes No 51 13 91 Ormside street 5-4-93 1-4-93 Not removed See No. 40. Very mild case - 26 M 3 Champion terrace 6-4-93 R Yes No 52 - No. Age. Sex. Address. Notified. Commencement of Illness. Result. Occupation. Vaccination and date. Re-vaccination and date. Remarks. 53 M St. Saviour's Infirmary, St. George's Workhouse - - - - 57 7-4-93 R 54 16 F 104 Camber well road Not removed. Very doubtful. 7-4-93 - R Dressmaker Yes No 3-12 F 68 Edmund street 55 10-4-93 - D - No - 56 11 F 68 Edmund street 10-4-93 6-4-93 R - Yes No Sister to No. 55 57 21 M 68 Edmund street 10-4-93 6-4-93 R Yes No Brother to No. 55 - 58 16 - 74 Bellenden road 10-4-93 8-4-93 R Assistant at hosiers, New Oxford street Extract of meat factory Yes - 59 M 22 14-4-93 - R Yes 7 Guildford place - 60 19 F Camb. Infirmary, 18 Branch buildings 14-4-93 - R - Yes - 61 19 F 36 Asylum road 15-4-93 9-4-93 - Yes - - 62 25 1 Rox villa, Underbill road 15-4-93 - R Yes Attacked two days after confinement F - - 63 23 M 56 Rosemary road 18-4-93 10-4-93 - Works at a laundry, Peckham Yes - 64 9 M 17-4-93 - - - - 18 Maxted road - 65 14 M 68 Edmund, street 17-4-93 14-4-93 R - - Yes F 66 17 6 Farndon row 22-4-93 17-4-93 R Works at a Yes - Sweetheart of 57 9 F 18 Maxted road 21-4-93 - - laundry - - 67 68 14 F 18 Maxted road 21-4-93 - - - - - 1 69 6 M 10 Hampton's avenue 18-4-93 R School boy No 22-4-93 - •- m 9 70 M 10 Hampton's avenue 22-4-93 17-4-93 R School boy Yes - 71 16 F 10 Hampton's avenue 22-4-93 22-4-93 R Laundry girl Yes - No. Age. Sex. Address. Notified. Commencement of Illness. Result. Occupation. Vaccination and date. Re-vaccination and date 21-4-93 91 Ormside street 26-4-93 Yes 14 F Yes unsuccessfully on 13-4-93 - - 72 21 M 2-5-93 28-4-93 Yes 73 304 Southampton street - - - No 74 41 F 258 Friern road 2-5-93 11-3-93? - Yes - 75 94 Ormside street 30-4-93 R Yes 19 M 2-5-93 - - 76 - No 8 F 65 Graylands road 4-5-93 29-4-93 R - 77 Yes 18 - 26 Clifton crescent 5-5-93 R Clerk - - M 78 3½ 12 Diamond street 6-5-93 1-5-93 R No - - No 79 9 Sandover Road 6-5-93 School girl 13 F 1-5-93 D - 80 - 15 Cooper's road 7-5-93 4-5-93 R Yes - - - Yes 81 - F 88 Grenard road 13-5-93 6-5-93 R School girl - 82 30 F 97 Ormside street Yes 15-5-93 - R - - Yes M 13-5-93 10-5-93 R 83 28 94 Ormside street - - 84 19 18 Camden Grove North R Plumber Yes - 15-5-93 9-5-93 - F Yes 85 22 112 Ormside street 15-6-93 12-5-93 D Servant - 86 45 M Tramp Ward, Albert road 16-5-93 - Tramp - - - 14 F R 87 65 Graylands road 24-5-93 Yes - Yes, 6-5-93 13-5-93 12 Diamond street - Yes, 6-5-93 88 2 F 18-5-93 15-5-93 R - - 89 8 M 97 Ormside street 18-5-93 - - - 90 - 16 39 Hill street 17-5-93 R Type setter Yes F 13-5-93 - 91 32 F 38 Barkworth road 19-5-93 R Yes - - - 92 2 1/3 F 44 Gordon road - 22-5-93 — - - 93 - Inf ant 38 Barkworth road - D - No - - 94 65 F 15 Cooper's road R Yes No 25-5-93 20-5-93 - 95 F - 25 93 Ormside street 25-5-93 R - Yes - 15 Bournemouth road Yes, no mark 96 35 F 28-5-93 23-5-93 D No - No. Age. Sex. Address. Notified. Commencement of Illness. Result. Occupation. Vaccination and date. Re-vaccination and date. Remarks. 97 47 F 46 St. George's road 29-5-93 R Yes - JgS 23-5-93 - 98 - Camberwell Workhouse 29-5-93 Tramp Yes M R - - 99 - - 10 F 17 Cooper's road 1-6-93 R - - I 25 2-6-93 - - 100 M 22 Dayton grove R Yes - 101 - 19 M 12 Diamond street 2-6-93 - Yes - R 102 28 38 Barkworth road - M 2-6-93 R Yes - - 103 F 47 Langton road - 5 2-6-93 - - Returned not small-pox - - 22 F 50 St. George's road 29-5-93 - Yes - 104 2-6-93 R - 105 25 F 6 Leyton square 3-6-93 - - Yes, no marks - D 39 M _ - 106 38 Barkworth road 5-6-93 - D - 37 15 Oglander road 107 F 15-6-93 14-6-93 R - Yes - 108 3 46 Graylands road 13-6-93 - - - Not removed. M 16-6-93 - 16 New Church road 16 6-93 109 12 F 16-6-93 R School girl, Green Coat School Yes - "Windsor Castle," Cooper's road 17-6-93 110 38 17-6-93 - F - - - 111 F 17-6-93 7 17-6-93 - - 283 Waterloo square, M Block No - M R 112 - Bargee 22 Yes No 17-6-93 Barge "Susan" Removed from a barge in Grand Surrey Canal Returned F 17-6-93 - 113 39 Rainbow street - R - - 8 2 Oak terrace, Bushey Hill road - 114 - M 19-6-93 - - - R 115 15 M 6 Surrey place, New Church rd. 21-6-93 Yes No - 11 - No. Age. Sex. Address. Notified. Commencement of Illness. Result. Occupation. Vaccination and date. Re-Vaccination and date. Remarks. 23 F 16 Great Orchard row 1-7-93 Yes - 117 R - 29-6-93 - 118 - M Camberwell Workhouse 5-7-93 R Tramp Yes - 17 M R Yes - 119 44 Verney road 4-7-93 - - R Yes - 120 14 F 44 Verney road 4-7-93 - - F R - 121 23 138 Kimberley road 5-7-93 Yes - - 25 M 5-7-93 R Yes - 122 "Windsor Castle" Barman - 16 Great Orchard row 10-7-93 - No - Returned not small-pox Died of inanition Not removed 123 9days - - - - R 124 8 M 29a Grenard road 10-7-93 - - - 7-12 R - 125 F „ „ 13-7-93 - - - - 126 36 M 1 Fenhum road 19-3-93 R Yes - - 127 20 M 17-7-93 R - 2 Mosedale street 11-7-93 Yes - 25-7-93 - 128 32 M 60 Ruby street - At Gas Works - - - 129 4 M 1 Blanche terrace 26-7-93 - - - - 30 M 116 Holmby street 28-7-93 24-7-93 R - 130 - Yes 25 31-7-93 - 131 M 22 Nutbrook Street R - - - 132 19 M 77 D'Eynsford Road 2-8-93 R - - - - - 133 8-12 F 26 Brymer road 7-8-93 - Very doubtful - - - 134 29 M 2 Castle street 18-8-93 Medical Practitioner Yes Yes - - 86 Lordship lane R 28 Yes - 135 F 18-8-93 - - Travelled from New- castle on board ship with rash out 136 27 F 39 Loncroft road R - 20-8-93 Yes - - 137 3 R 10 Grove cottages 4-9-93 - M - No - 30 4-9-93 R - 138 F 86 Lordship lane Yes - - - 139 25 37 Sansom street 10-9-93 R - - - - - 140 - F 86 Lordship lane 18-9-93 R - - M - No. Age. Sex. Address. Notified. Commence- ment of Illness. Result. Occupation. Vaccination and date. Re-vaccination and date. Remarks. - 51 Barset road 2-10-93 26-9-93 R Yes - 142 - F M - - 143 - 51 Baraet road 4-10-93 25-9-93 R Yes - 2-10-93 Coal heaver - 144 M 51 Barset road 28-9-93 R Yes - 145 - - - - - - - - - - 146 F 90 Bellenden road 3-10-93 - Returned R - - 17 M 50 Gowlett road - Not removed 147 4-10-93 R - - - Yes - 148 38 M 51 Barset road 6-10-93 R - - 16 - - 149 F 51 Barset road 9-10-93 R Yes - 150 - 54 Nutfield road 20-10-93 - D No - - - (III.) DIPHTHERIA. The increase of diphtheria during the last few years in London and many of the larger towns is very remarkable and disquieting, and all the more so that this increase in the towns has gone along with a subsidence in the country districts where formerly it prevailed largely. That diphtheria is highly infectious there is no doubt. There is also no doubt that it depends on a specific organism which as a rule attacks the throat and in the first instance grows there. Further, there can be no reasonable doubt that, like typhoid fever, it spreads largely by indirect contagion; but by what means this indirect contagion is conveyed is even now a matter of great doubt. It is generally attributed to imperfect drainage and the emanations from sewers; but as Dr. Thorne Thorne shows in his valuable lectures, embodying the information collected over many years by his inspectors (all able men), there is no clear evidence that it is connected with drains : and it is particularly noteworthy in this respect that its increase in London has taken place pari passu with the improvement of drainage. Moreover it occurs relatively as frequently among the well-to-do as among the poor. I have already mentioned that according to my estimate the deaths in Camberwell due to this disease were 118 this year against 85 in 1892. This is a large increase. But the Registrar-General makes it 130; doubtless by including in his computation cases I had good reason to regard as not being truly diphtheritic. It is important to note that while he attributes 130 deaths to Camberwell, he attributes 184 to Lambeth, 167 to Battersea, and 147 to Greenwich —parishes immediately adjoining our own. These statements are of serious omen, for they lead us to fear, indeed to be almost certain, that great as our increase is, we shall have in the ensuing anil probably subsequent years a still greater increase in the prevalence and fatality of this disease, for it is scarcely likely that surrounded as we are by parishes suffering even more severely than ourselves, we shall escape with the really severe, but relatively slight increase which has occurred this year. I think it right to state that, at his own suggestion and with my wish and sanction, Dr. Stevens has been endeavouring to discover the source of the aggravation of this disease. It is almost needless to say that the results of his enquiry are up to the present time of no great value. The subject is exceedingly difficult, and especially difficult for any one who wishes rather to ascertain the actual truths, than to support popular theories or to write a sensational report. (IV.) ASIATIC CHOLERA. With respect to this disease I have little to add to what I said in the appendix to my last report. It prevailed here and there on the continent during the year; a few cases were brought on board ship to some of our seaport towns; and there appear to have been a few local outbreaks in England due to some of these cases. Indeed there is reason to believe that a case or two occurred in London. All this is very interesting and satisfactory: first, as showing that cholera was on the whole very satisfactorily dealt with by the port sanitary authorities acting under the directions of the Local Government Board; and second, as indicating that even if cholera finds its way into our country the sanitary conditions are now for the most part hostile to its epidemic spread and prevalence among us. As I have often stated before I have personally little fear of its ever again assuming an epidemic character in London. At the same time having regard to the heavy mortality of the disease, and to the terror which its prevalence inspires, I think it is right that precautionary measures against it should in no degree be relaxed. Your Cholera Committee, in accordance with the instructions of the Local Government Board, took all reasonable precautions in view of the possible occurrence of an outbreak; but no case of the disease occurred in the parish. It may be added that infantile diarrhœa was widely prevalent and fatal throughout the country (as also in our own parish) during the autumnal months. This however, had no relation to Asiatic cholera, and was doubtless due largely to the hot and dry weather which prevailed in the summer and autumn. (V.) ON THE CAUSES OF THE DIFFERENT MORTUARY RATES IN THE DIFFERENT SUB-DISTRICTS OF THE PARISH. Some months ago a very important question on the above subject was put to me in the Vestry Hall, and I promised that I would make some observations on the subject in my forthcoming annual report. The question of the causation of such differences has always been of very great interest, because it has naturally been assumed that such differences are a measure of the healthiness or otherwise of the districts in which they occur; and the question is one that has always been of special interest in Camberwell, owing to the striking differences which have been observed in the mortuary rates of the several sub-districts, and especially in Dulwich as compared with Peckham and St. George's. There is no doubt that, other tilings being equal, mortuary rates should be a fair and trustworthy measure of the relative sanitary states of localities. But unfortunately "other things" are very rarely equal, and the inequality is sometimes enormous. In the first place we ought to have an accurate enumeration of the population. But this is practically impossible excepting at the time of the taking of the census; and even then it must be recollected that in a population like our own, where the rise and fall probably depends more on immigration and emigration than on births and deaths, each item of the estimated population represents not a single individual but portions of the annual duration of two or three lives. Further it must be borne in mind, as has been shown in the course of our own parochial progress, that the rate of increase in different sub-districts is liable to irregular and considerable variations; so that our estimates of population made in accordance with wellrecognised rules often lead us widely astray. In the next place we ought to have an accurate enumeration of the deaths due to the several sub-districts, inasmuch as a correct death-rate depends fundamentally on a correct estimate of the population amongst which the deaths occur, and on a correct return of the number of deaths. But our death returns, although they have improved much of late years, are still not absolutely correct. It may be reasonably assumed that the actual returns of persons dying in the parish are fairly accurate; and these were the only returns on which for many years we had to rely. But during all that time deaths occurring in Hospitals and Institutions were returned as occurring in the parishes in which these places were located, thereby aggravating the apparent unhealthiness of such parishes, and by so much improving the apparent healthiness of other parishes whose sick and injured died therein. For some years now such deaths have been referred to the several parishes from whence the patients came, and have been included in their mortuary returns. This has of course been a great improvement. But even so, there are many persons who die, not in hospitals or institutions, but when on visits, or at friends' or employers' houses, and away from home; and are naturally returned for the parishes in which they die. Then again the relative numbers of persons living at different ages in different localities exert a very remarkable influence over the respective mortalities of these localities. It might be assumed at first sight that all districts were equal in this respect, and that hence such a suggested difficulty had no real existence and was of no practical importance. This however is not so. As a general rule marriages take place much earlier, and the birth-rate is much larger, in poor than in well-to-do districts. Thus in Dulwich the birth-rate this year was 9 per 1,000 of the population, in Peckham it was 31.5, and in St. George's 34.2 So it has been substantially from time immemorial. Hence it is obvious that the proportion of young children in Dulwich is far smaller than that in other districts named, and I may add in Camberwell. Now the mortality among children under five is always far heavier than that among persons above five, indeed it constitutes from one-third to one-half of the total mortality. Again, persons in the prime of life die in far less proportion, not only than young children but also than persons advancing in years. And consequently the presence or absence of a disproportionate number of young and middle-aged adults must largely affect the death rate. Again, it has been proved over and over again that different trades and businesses exert a marked influence over those who are engaged in them, and that the disproportionate presence or absence of certain employments has no inconsiderable influence over the mortality of places in which such disproportion exists. I have not at hand at the present time any authoritative evidence on this matter. But putting aside, as having no special influence in Camberwell, workers in lead and cotton and various other manufactures, I may mention that publicans and butchers are both as a rule relatively short lived. So important is the influence on mortality of age and trade, that (in order to arrive at approximate truth as regards the death-rate) it has even been suggested, that the numbers of persons of different ages, and of persons engaged in different businesses should be accurately ascertained and (in calculating the death-rates) due allowance should be made. Another very important point is the mutual relation of the birth-rate and death-rate. Thus (quite apart from the fact that the mortality among young children is very heavy), it appears that, if in any locality the annual number of the population is wholly independent of emigration and immigration, and depends only on the actual relation between the annual births and deaths, the birth-rate would largely modify the meaning of the death- rate; that the average duration of life (assuming the same birth-rate and death-rate to be maintained from year to year) could be accurately determined by comparing these two rates ; and that the death-rate, taken by itself, would be of little value in determining the healthiness or unhealthiness of the locality. The subject is so important that I shall venture to quote a paper on this subject which I read some 20 years ago, before the Society of Medical Officers of Health, and the more so because in that same paper I quote from my annual report for the year 1863 some remarks on the question I am now endeavouring to answer. (See appendix). I now proceed to answer the question put to me to the best of my ability, and guided in no small degree by the above considerations. In the first place, how is it that Dulwich has, and always has had, such a remarkably low mortality? and does that low mortality constitute a fair measure of its healthiness? The low mortality of Dulwich is no doubt very largely due to its remarkably low birthrate, and to the comparatively small share which infantile mortality takes in the estimation of its death-rate. It is largely due," also, to another fact, and that is the relatively great excess of inhabitants in the prime of life. Dulwich contains, relatively to its population, the largest number of well-to-do persons in the parish ; whilst, on the other hand, St. George's and Peckham contain, relatively to their populations, the largest number of poor people. A well-to-do household comprises, as a rule, father and mother, children and servants. Now these last are for the most part in the prime of life. It is easy to see, therefore, that Dulwich possesses from this cause a much larger proportion of healthy adults than any other part of the parish; and that these not only go to swell the population of the entire district as ascertained at the census, but also largely augment the area (so to speak) over which the Dulwich deaths are spread, and so largely reduce the death-rate. Moreover, it is to be noted, that not only do servants, as a rule, die away from the houses in which they have been living, and that their deaths are hence more likely to be referred to the localities in which their families reside than to those in which they have lived as servants, but also that places such as the poor parts of St. George's and Peckham are just the localities which are most likely to provide servants for their richer neighbours, and that thus such localities are specially apt to be robbed of their healthy adults, and consequently to have an augmented death-rate. It might naturally be assumed that the deaths due to zymotic diseases would be far fewer in Dulwich than in St. George's and in Peckham ; and, on the whole, I am inclined to believe that it is so. Put on the other hand, it must be recollected that most persons suffer in the course of their lives from scarlet fever, and especially from measles and hooping cough; and that if they fail to take them when they are young, they are likely to take them at some later period of life. It is a curious fact, however, that on comparing the numbers of deaths due to zymotic diseases in the different sub-districts of the parish with the numbers of births, the proportion of such deaths to births is larger in Dulwich than anywhere else. I may here add that I have no doubt that Dulwich is a healthy place, and that its healthiness is in no small degree due to the comparative sparseness of the population, and absence of overcrowding, and to the comparative affluence of the population, and the comfort and pleasant surroundings in which they live. There is no doubt, however, that the Dulwich death-rate is, mainly for reasons given above, largely misleading as a mere proof of healthiness. Next as to St. George's. I select this sub-district because, according to my report, it shows the highest birthrate and the highest death-rate of all the sub-districts of the parish. There is no doubt that it is in proportion to its area the most populous sub-district, and therefore the most overcrowded. This is due mainly to the facts, that it is largely occupied by a poor working population; that many of its houses are small, and that, moreover, it is studded much more largely than any other sub-district with lodging-houses and tenement-houses —which latter (whatever advantages they may present) largely promote overcrowding. A crowded population is generally a poor population, and the children mingle freely with one another both in schools and in the streets, and hence infectious diseases are more difficult to isolate, and more likely to spread than under other conditions. Again, as I have pointed out, the birth-rate is relatively very large. The only explanation that can be given of this fact is that the poor are, to a large extent, improvident ; they marry as a rule early, and they have families and often large families, while they are unable to support them in comfort, or even to look after them as young children need to be looked after. It is mainly due to these causes that the infantile mortality is so enormous in these localities; and that so many deaths are referred to premature birth, defective vitality, to pulmonary affections (including pneumonia), and to summer or autumnal diarrhœa, and that zymotic diseases are so largely fatal. No doubt, too, the occupations of the residents in many cases exert an adverse influence over their health; not in all cases because their occupations are in themselves insalubrious, but often because persons in order to obtain a livelihood persist in going on with their work at times when they are ill and unfit to do it. Again, it must be borne in mind that, conversely to what occurs in places like Dulwich, adults in the prime of life remove largely to other districts, and thus tend to diminish the area Over which the annual deaths are distributed. No doubt unhealthy conditions, such as (not only overcrowding and its consequences, but also) too close packing in rooms, bad ventilation, imperfect drainage, and the like, are more likely to prevail and bear fruit in such districts as St. George's. Further, I must point out that lam very doubtful of the correctness of my estimate of the population of St. George's. Assuming the population to have progressed at the same rate since 1891, as was its progress between 1881 and 1891, the figures are no doubt fairly correct; but I am inclined to think that the increase has been a good deal greater than I have assumed ; and I am led to form this opinion not only by the increase of the birth-rate and deathrate relatively to those of Peckham, but also by the increase during late years of blocks of tenement houses. If this be so, it is very probable that the actual death-rate of St. George's is no greater than that of Peckham. I have no doubt, for the foregoing reasons, that St. George's relatively to Dulwich is an unhealthy district. But I have also no doubt that its relatively high death-rate is not a fair measure of its unhealthiness, and that the true death-rate of St. George's is not larger than that of other similarly circumstanced localities, and a little less than that of London as a whole. I do not think that on the whole St. George's suffers more from infectious diseases than other parts of the parish; although of course the incidence of such diseases varies from time to time in various districts. In this connection it is important to point out, that diseases distinctly referrible to bad drainage have diminished largely in London of late years, as also in our own parish; and that but few cases of typhoid fever occur in any parts of our parish, and not more in St. George's than elsewhere ; that during the cholera epidemic of 1866, which prevailed (owing to local causes) at the east end of London, there were but few cases in the rest of London, and but few in Cambers ell, and that again it did not prevail more in St. George's than elsewhere; and that during the not infrequent subsequent prevalences of the disease on the continent it has never appeared in London except in isolated cases; and lastly that during the last epidemic of small-pox, as also during its threat of recurrence during the last year or two, St. George's has not suffered so much as some other parts of the parish. I refer to this fact, because (owing to the existence of a good deal of small property in St. George's, which many people think should be demolished) I have for some years paid particular attention to the occurrence of certain infectious diseases, with the object of satisfying myself whether the property referred to was specially unhealthy or not, and I have come to the conclusion it is not. Diphtheria prevails in all parts of the parish, and by no means specially in St. George's. At present (as I have already stated) we know that diphtheria is highly con-tagious, but we have no certain knowledge with respect to the conditions which permit its spread, and which have determined its recent growth in London. It will be observed from what I have said above that some of the conditions which cause ill-health and death in the poorer parts of the parish, and which help, therefore, to swell their death-rate are conditions over which we, as sanitary authorities, have little or no direct control. In concluding my report I should like to be permitted, to express my high opinion of Dr. Stevens's work during the last twelve months, and my thanks to him for much personal assistance of value; to say that I think your large staff of inspectors have shewn great interest in their work, and devotion to it, and have done it in a highly satisfactory manner, and yet so as to cause but little friction; to speak in praise of the excellent way in which disinfection has been carried out by your disinfecting staff; and to pay a warm tribute to the trustworthy and untiring zeal with which Mr. Griffiths and the clerk have performed their respective onerous and important duties. I should like also to give my heart-felt thanks both to the Vestry and to the Sanitary Committee for the great kindness they have shewn me during my unfortunate illness —a kindness in fact which has never failed since I became connected with the vestry. I remain, gentlemen, your obedient servant, J.S.BRISTOWE. APPENDIX. ON THE MUTUAL RELATIONS OF THE BIRTH-RATE AND DEATH-RATE. BY J.S.Bristowe, M.D., F.R.C.P. It will probably be recollected that Dr. Richardson claimed as one of the benefits to be anticipated for those living in his visionary city "Hygeiopolis," that their annual death-rate should be reduced to .5 per cent. It will probably also be recollected that immediately after the reading of Dr. Richardson's celebrated paper an anonymous correspondent of the "Times" asserted, with some show of argument, that a mortality of ·5 per cent, implied an average duration of life of 200 years, and that, a fortiori, Dr. Richardson's anticipations were impossible of realization and absurd. There is no doubt that under one special condition (and that the condition which, on account of its simplicity, would probably present itself most readily for computation) the result arrived at by the "Times" correspondent is correct. If an annual mortality of .5 per cent. be maintained in a population which neither diminishes nor increases, and in which the removals by death are exactly balanced by the additions by birth, it is certain that the average duration of life would be exactly 200 years. Thus, if in a population of 1000 persons five deaths and five births occur annually, and it be assumed for simplicity's sake that every individual of the population lives to the same (namely,the mean) age, it is obvious that exactly 200 years will elapse before the whole of the original 1000 will have died out, and that the turn of each annual litter to die will arrive exactly 200 years from the date of birth. But 200 years would still be the mean duration of life, even if the population were to die as they do now at different ages; only in this case while many would die below the mean age, many would exceed it, and some might easily attain to the years of Methuselah. The author of this calculation might have added that if a mortality of .5 per cent, were to be maintained in a population uniformly diminishing by that amount, the population would never die out; and that if it commenced with 1,000 individuals the last whole man would live for somewhat over 1,379 years, and would then perish only bit by bit in a diminishing geometrical series throughout all eternity. On the other hand, an annual death-rate of .5 per cent, with an annual birth-rate of 20,000,000 per cent, (a condition of things conceivable in the case of certain intestinal worms) would imply an average duration of life of little more than a year. It is obvious that if with a uniform annual mortality of only ·5 in the 100 the mean duration of life may vary, with variations of the birth-rate, from zero to infinity, even a low death-rate means per se neither healthiness nor unhealthiness, neither a long nor a short span of life, and that in order to determine its significance in these respects its relation to the birth-rate must be taken into account. It is because as an officer of health I have hitherto practically overlooked this important relation, and because, as I believe, the great majority of my colleagues have been equally neglectful—often, indeed, falsely boasting that while the birth-rates of our districts have been higher, and their death- rates only a little lower, than those of our less prolific neighbours, they were therefore in a twofold sense healthier than theirs —that I determined to investigate it. The results at which I have arrived form the more important part of the present paper. The death-rate implies healthiness or unhealthiness only in so far as it implies long or short average duration of life ; for example, there can he no difference in the healthiness of two localities in one of which the death-rate is twice or even thrice as high as that of the other, provided other conditions are such that in both cases the inhabitants attain the same mean age; or conversely, supposing different populations to enjoy the same mean duration of life, any differences which may be presented by their respective death-rates are due to other circumstances than differences of health. From the death-rate alone, however, it is impossible to arrive at any definite conclusion in regard to the average duration of life. But the birth-rate and the death-rate together supply us with the necessary data. The primary object, therefore, which I set before myself was the determination of the mean duration of life under various conditions of the birth-rate and death-rate. For the purposes of my calculations I have assumed the simplest possible condition of things; namely, Ist, that in each case the death-rate and birth-rate continue uniform from year to year; 2nd, that no immigration or emigration takes place, and that, consequently, any annual differences there may be in the number of the population are due simply to the excess of births over deaths or conversely; and 3rd, that every individual born into the population attains the mean age, or, in other words, that all the inhabitants die at the same age. Under these conditions there are three different cases for investigation; namely, Ist, that in which the births exceed the deaths and the population consequently increases; 2nd, that in which the births and deaths are equal, and the population consequently undergoes no change of number; and 3rd, that in which the deaths exceed the births, and the population therefore progressively diminishes. In the first case (that in which the births exceed the deaths), the population, the births and the deaths, all increase from year to year in the same ratio by geometrical progression. And if the number of the population from which we start be represented as a unit, and the letters b and d represent respectively the birth-rate and death-rate of this unit, and r its increase for one year, or what is the same thing, the difference between b and d, the following three series will represent the annual growth of the population, of the births and of the deaths respectively : Population, Births. Deaths. 1st year 1 b d 2nd year (1+r) b(1+ r ) d(1+r) 3rd year (1+ r)2 - b(l+r) 2 - d(1+r)* 4th year (1+ r)3 b(1+r) 3 d (1+r) 3 5th year (1+ r ) 4 (1+ r ) 4 (1+r)4 * * * * nthyear (1+r)n-i b(1+r)n-i d(1+r)n-i Now, according to the hypothesis with which we started, all the persons born in any one year, attaining as they do exactly the same age, will die together in the coarse of some future year. Thus, the births represented by the letter b, occurring in the first year of the series, will die in a lump, so to speak, at the end of some definite period, and those of the next year represented by b(1+r) will die similarly in the course of the year next following, and so on continuously; and it is obvious, therefore, that if we can ascertain the number of terms of the series which intervene between these respective epochs of birth and death, we shall thereby ascertain the mean duration of life. Now, since the index of (1+r) is 1 at the expiration of one year from the t ime at which the births, b, occurred, 2 at the expiration of two years,3 at the expiration of three years, and n at the expiration of n years, it follows that the index of that term of the third of the above series which equals b represents the mean duration of life in years. Let x be that unknown index the value of which it is required to ascertain. Then it is obvious that, 1:(1+r)x::d::d(1+r)x but by the hypothesis d(1+r)x=b; so that the proportion becomes 1:(1+r)x::d:b; and, consequently, log.b/d (1 +r)x=b/d, or x=/. log. (1+r) a formula from which the value of x can be readily deduced. For the second case (that in which the birth-rates and death-rates are exactly equal) the above formula is useless; for here b and d being equal to one another,b/d-=1, r=0, and the equation consequently becomes x=log.1/log.1=o-,o the value of which is indeterminate. The mean duration of life, however, is readily ascertainable by another process. In this case the whole number of persons supposed to be living at any one time is made up of a series of successive annual increments, which are due to the successive annual births and are equal to one another; and it is obvious that the term of the last added of these increments to die will arrive only after all the other increments have been successively removed. And hence the mean duration of life will be the quotient obtained by dividing the population, by the annual increment of births. In the third case (that, namely, in which the annual deaths exceed the annual births, and the population has a consequent tendency to die out) the formula which was made use of for the first case is again applicable; only since b is now less than d, b—d or r becomes a minus quantity, and the ratio less than unity, so that the series (whether of population, births or deaths) which is a diminishing one is infinite, and the population, though constantly decreasing, never comes to an end. In Table 1., I have arranged the calculations which I have made (in accordance with the principles above enunciated) in regard to the combined relation of the death-rate and birth-rate to the duration of life. I have in eight successive vertical columns, in which it is assumed that the mortality is .5, 1, 1.5, 2, 2.5, 3, 3.5 and 4 respectively per cent., arranged the mean durations of life which result from a combination of these several mortuary rates and of birth-rates varying from a little over 100 per cent. to zero. The series of birth-rates which corresponds to each death-rate is placed in a vertical column to the left-hand side of the death-rate column; and all the birth-rates are so arranged that the differences between the birth-rates and death-rates on the same horizontal line of the general table are in all cases identical. These differences, which represent the annual differences in the population per cent. and range from 100 to zero (at which latter point the births and deaths balance each other), and from zero to —3.95, occupy a special column on the extreme left of the table. The first series of results (and these I shall quote at length) are those which are deduced from a death-rate of .5 per cent. With a birth-rate of 100.5 par cent. and an annual increase, therefore, of 100 per cent., the mean duration of life is 7.6 years; with a birth-rate of 10.5 and an increase-rate of 10 the mean duration of life is 31.9; with a birth-rate of 8.5 and an increase-rate of 8 the mean duration of life is 36.81; with a birth-rate of 5.5 and an increase-rate of 5 the mean duration of life is 49.15; with a birth-rate of 5 and an increase-rate of 4.5 the mean duration of life is 52.31; with a birth-rate of 4.5 and an increase-rate of 4 the mean duration of life is 56.02; with a birth-rate of 4 and an increase-rate of 3.5 the mean duration of life (60.4; with a birth-rate of 3.5 and an increase-rate of 3 the mean duration of life is 65.8 ; with a birth-rate of 3 and an increase-rate of 2.5 the mean duration of life is 72.56 ; with a birth-rate of 2.5 and an increase-rate of 2 the mean duration of life is 81.27 ; with a birth-rate of 2 and an increase-rate of 1.5 the mean duration of life is 93.1; with a birth-rate of 1.5 and an increase rate of 1 the mean duration of life is 110.4; with a birth-rate of 1 and an increase rate of .5 the mean duration of life is 138.98; and with a birth-rate of .5 and a consequent stationary condition of the population the mean duration of life is 200. Lastly, with a birth-rate of .05 per cent., or of only 5 in 10,000, and a consequent annual diminution of the population by .45 per cent., or by 45 in 10,000, the mean duration of life is 510.54 years. Now, it will be readily perceived from the above figures that under the same death-rate, namely .5 per cent., the average duration of life progressively diminishes as the birth-rate increases, and conversely progressively increases as the birth-rate diminishes. And it is obvious as well from an inspection of the table as from a consideration of the principles on which it has been constructed, that if the annual increase of the population be conceived to increase to infinity, the mean duration of life would sink to zero; and that, on the other hand, if the birth-rate sink to nil, the mean duration of life becomes infinite. The second series of results are those which are obtained with a death rate of 1 per cent. In this case the mean duration of life varies from 6 2/3 years with a birth-rate of 101 and an annual increase of 100, to 100 years when the birth-rate is 1 per cent. and the population consequently neither increases nor diminishes; but when the birth-rate sinks to .5 per cent., and the population decreases at the same rate, the duration of lite becomes 138.28 years; and when the birth-rate sinks to .05 per cent., and the population decreases by .95 the duration of life becomes 313.84. In the third series of results, which are derived under a death-rate of 1.5 per cent., the duration of life appears to be 6.08 years when the birth-rate is 101.5 and the increaserate 100, and 66 2/3 years when the death-rate and birth-rate are equal and the population is stationary. With a birth-rate of - 5 per cent. and an annual diminution of 1 per cent., the duration of life mounts to 109.31, and with a birth-rate of .05 per cent, and an annual diminution of 1.45 per cent, the duration of life mounts to 232.86. The fourth series of results are connected with a deathrate of 2 per cent. Here the mean duration of life ranges from 5.67 years with a birth-rate of 102 and an increase-rate of 100, to 50 years with a birth-rate of 2 and a stationary population. With a birth-rate of .5 per cent, and an annual diminution of l.5 the mean duration of life becomes 91.72; with a birth-rate of .05 and a diminution of 1.95, 187.32 years. In the fifth series the death-rate is 2.5 per cent., and the mean duration of life rises from 5.35 years when the birth-rate is 102.5 and the increase-rate 100, to 40 when the birth-rate and death-rate are equal. With a birth-rate of .5 per cent, and an annual diminution of the population by 2 per cent, the duration of life becomes 79 2/3; and with a birth-rate of .05 and an annual diminution of 2.45, 157.71. In the sixth series, with a death-rate of 3 per cent., the mean duration of life is 5.10 years with a birth-rate of 103 and an increase-rate of 100, and 33 1/3 when the birth-rate and death-rate are equal. When the birth-rate is .5 per cent., and the annual decrease of the population is 2.5 per cent., the duration of life is 70.77 years; and when the birth-rate is .05 and the decrease is 2.95 the duration of life is 136.73. The seventh series is dependent on a death-rate of 3.5 per cent. In this case the mean length of life ranges from 4.89 years when the birth-rate is 103.5 per cent. and the increase-rate 100, to 28.57 years when the birth-rate and death-rate are equal to one another. The duration of life increases to 63.89 years when the birth-rate is only .5 percent, and the population diminishes by 3 per cent, per annum, and to 121.01 when the birth-rate becomes .05 and the annual diminution per cent. 3.45. In the last series it is assumed that the death-rate is 4 per cent. Here with a birth-rate of 104, and an increaserate of 100, the mean duration of life is 4.70 years; and with a birth-rate of 4 per cent. and a stationary population 25 years. With a birth-rate of .5 per cent, and an annual loss of 3.5 per cent, of the population the duration of life mounts up to 58.37 years; while with a birth-rate of .05 and an annual loss of 3.95 it rises to 108.73. It may be added that in all cases, as well as in the first, the increase of the birth-rate to infinity reduces the mean duration of life to zero, and the reduction of the birthrate to zero raises the mean duration of life to infinity. The table shows further the degree in which, under the same rates of increase, the mean duration of life varies as the death-rate varies. Thus, with an increase of 100 per cent. the mean duration of life, which is 7.6 when the deathrate is .5 per cent., becomes successively 6.66, 6.08, 5.67, 5.35, 5.10, 4.89, and 4.7, as the death-rate increases by increments of .5 up to 4 per cent.; and with a stationary population, under similar conditions of the death-rate, the duration of life is 200, 100, 66 2/3, 50, 40, 33 1/3, 28.57, and 25. The table shows also the degree in which, under the same birth-rates, the mean duration of life becomes shorter as the death-rate increases. Thus, assuming the birth-rate to be 4 per cent., the average duration of life becomes, with a death-rate of .5 per cent. 60.4 years; with a death-rate of 1 per cent. 46.9; with a death-rate of 1.5, 39.74; with a death-rate of 2, 35 ; with a death-rate of 2.5, 31.56; with a death-rate of 3, 28.91; with a death-rate of 3.5, 26.77; and with a death-rate of 4, 25, and assuming a birth rate of .05 per cent., or of 5 in 10,000 the mean length of life becomes for the same death-rates, taken in the same order, 510.54 years, 313.84, 232.86, 187.32, 157.71, 136.73, 121.01, and 108.73. But the tables further demonstrate clearly, and this is the point of chief importance, that the health of a population as measured by the duration of life may under certain conditions of the birth-rate be as good when the mortality is high as when the mortality is low. Thus, the mean duration of life is the same, namely 81 years, with a death-rate of .5 per cent, and a birth-rate of 2.5 per cent., as it is with a death-rate of 1 per cent, and a birth-rate of 1.5 per cent., or with a death-rate of 1.5 per cent, and a birth-rate of 1 per cent.; it is the same, namely 37 years, with a death-rate of 1.5 per cent, and a birth-rate of 4.5 per cent., as it is with a death-rate of 2 per cent, and a birth-rate of 3.5 per cent., or a death-rate of 3.5 per cent, and a birth-rate of 2 per cent.; it is the same, namely 31 years, with a death-rate of 1.5 and a birth-rate of 6, as it is with a death-rate of 2 and a birthrate of 5, or with a death-rate of 3 and a birth-rate of 3.5, or with a death-rate of 3.5 and a birth-rate of 3, or with a death-rate of 4 and a birth-rate of 2.5 ; it is the same, namely 58 years, with a death-rate of .5 and a birth-rate of between 4 and 4.5 per cent., as it is with a death-rate of 4 and a birth-rate of .5. Other examples might be adduced from the table, but it is unnecessary, inasmuch as a little consideration will render it apparent that by interpolating other birth-rates and mean durations of life between those given in the table we may readily find exactly corresponding terms under each death-rate column. It may be objected to my table that it comprises amongst conditions which are quite possible other conditions which are impossible and absurd: that, for example, a birth-rate of 100 per cent. could only he maintained in a population of which every female bore annual twins from the time of her birth to that of her death, while even a birth-rate of 10 per cent. is scarcely compatible with any possible conditions of a population; and that, on the other hand, not only is it absolutely certain that the age of 200 will never be reached by human beings, but that the attainment of a mean duration of life of even 70 years is entirely beyond the anticipations of sober-minded sanitarians. The answer to these objections is, of course, that the table has been constructed primarily with the object of showing clearly the mutual relations of the birth and death-rates, and that these are most strikingly exhibited by adducing extreme cases. Yet what holds good of extreme cases holds good in principle of all other cases ; and to render the table practically useful it is only necessary to disregard the former, and to limit our attention to the latter. The highest birth-rate which I see recorded in the Registrar-General's annual summary, for 1875, is that of Gateshead, which was 4.76 per cent. The lowest is 2.42 and occurred at Cheltenham. Now there is no physical impossibility in the reduction of the birth-rate considerably below that recorded of Cheltenham; it is conceivable indeed, that under special conditions it might fall to zero. But, on the other hand, though the birth-rate might easily rise above that of Gateshead, the number of children capable of being born per annum must be limited by the reproductive capacity of those members of the female population who are of child-bearing age. This age extends from puberty to 45, or in a well-ordered population may be taken to extend practically from 20 to 45. With the object of arriving at some kind of notion of the possible reproductive capacities of populations existing under the several conditions which I have assumed for the purposes of Table 1., I have calculated the percentage number of persons between 20 and 45 years of age living under each several combination of the birth and death-rates. Now, if males and females existed in equal numbers, and every woman gave birth to a child once in two years, the fourth part of each number arrived at should give the highest possible number of births per cent, per annum attainable in the case to which it relates. Hence it w T ill be readily seen that a birth-rate of 6 per cent, might be maintained in such a population with a death-rate of either .5 or 1 per cent. ; a birth-rate of 5.5 per cent, in a population dying at the rate of 1 5 or 2 per cent. ; a birth-rate of 5 per cent, in a population dying at the rate of 2.5 per cent.; a birth-rate of 4.5 per cent, in a population dying at the rate of 3 per cent.; and a birth-rate of 4 per cent, in populations dying at the rate of 3.5 and 4 per cent. It is obvious, of course, that these calculations do not represent anything that would actually obtain under the continuance of the combined birth and death-rates to which they severally relate; for we know that females and males do not exist in equal proportion; that not all women marry; and that of those who marry some marry early, some late, some have no children, some but few, others large families; and we know further that the mean age, the attainment of which was an essential element in my calculations, does not represent the actual age which all persons reach, but that in contributing to maintain it many persons live beyond it, many fall short of it. While, however, the former consideration would tend to reduce the possible increase of populations by births below my estimates, the last demonstrates that even in those cases in which the mean duration of life is under 20, and in which, therefore, on my original assumption there is little or no reproductive material, there would be actually living a considerable number of women above the age of 20, and that generally in the series of cases which I have just quoted there would certainly be a considerably larger percentage of adult population than my figures show. At any rate, the practical conditions which tend to reduce the possible birth-rates under the assumed relations of the birth and death-rates, and those which tend to increase them, balance one another to some extent, and thus tend to confirm the possibility of the conclusions to which my calculations lead. I have drawn in each column of Table I. a horizontal line immediately above the highest birth-rate which, on the grounds above given, seems to be reasonably attainable in connection with the death-rate belonging to that column. The mean duration of life in England has been calculated to be nearly 41 years. It is impossible to predict to what extent sanitary science will ultimately succeed in raising it. It is, certain, however, that its rise must depend, less on increasing the duration of life beyond what is commonly regarded as the normal span, namely 70 or 80 years, than on the prevention of deaths in the earlier periods of life, and especially in early infancy. If we assume that, in consequence of the prevention of premature mortality, the mean duration of life is raised to 70 years, we shall find that in the first column of Table I. the conditions become impossible when the birth-rate falls below 3.5 per cent.; in the second column, when the birth-rate falls below 2 per cent.; in the third column, when the birth-rate falls below 1.5 per cent.; in the fourth, fifth, and sixth columns, when the birth-rate falls below 1 per cent.; and in the seventh and eighth columns, when the birth-rate falls below .5 per cent. Beneath these several birth-rates and their associated estimates of the duration of life I have again drawn horizontal lines ; so that the conditions which may be regarded as possible conditions are in each column included between the upper and lower horizontal lines. It may be added that the apparent irregularities in the table presented by the upper and lower limits of the assumed possible conditions are due simply to the small number of birth-rates which have been employed; and that it would be easy, if it were worth while, to ascertain for each column, on the one hand, the exact birth-rate which would allow of a mean duration of life of 70 years, and, on the other hand, the exact birth-rate which in accordance with my assumptions is compatible with the lowest possible mean duration of life. It may also be added (what is, however, sufficiently obvious) that a population in which there are no births must gradually die out, and that it is impossible in such a case that a uniform annual death-rate can be maintained. Indeed, however healthy and long-lived such a population might be, and however low its initial death-rate, the death-rate must of necessity increase year by year until it becomes with the extinction of the population cent, per cent. In calculating the mean duration of life given in Table 1., I assumed (as will be recollected) that every person born into a population attains the same age, and further that the children born in a group (so to speak) in one year, die in a group in the course of some subsequent year. But the truth of the table is not dependent on these assumptions. The results as regards the duration of life in relation to uniformly maintained birth-rates and death-rates are in fact identical, whether the same length of life be attained by every one of the inhabitants, or whether as occurs in nature the mean duration be the resultant of lives varying widely among themselves in length. And again, in order to determine the mean duration of life, it is not really necessary to assume that persons are born in groups and die in groups. For if we take as the basis of our calculation just so much of a population as yields one birth and take d to be the mortality due to the same fragment of the population, the duration of life will be determined by that index of (1+r) which makes d (1+r)x =1; and the log- i/d equation becomes x = log. (1+r). * * * In conclusion, and as hearing upon the questions which have just been discussed, I venture to quote some remarks which I addressed to the Vestry of Camberwell in my report for the year 1863. They are subject, of course, to correction in reference to the influence of the birth-rate on the significance of the death-rate, which at that time I overlooked. "But supposing a death-rate to have been ascertained with perfect accuracy; what does it teach? what do we learn from it ? The prime fact, of course, is that out of so many persons living, so many persons have died in a given time. Experience has shown that in ordinary years deathrates vary within comparatively narrow limits; that in the presence of severe outbreaks of epidemic diseases deathrates become augmented, and often very seriously augmented; that in certain localities (such as large towns) which are generally assumed to be of inferior healthiness the deathrates are mostly higher than they are in certain other localities (such as country districts) which enjoy the reputation of comparative salubrity. And on these and other "rounds it has been assumed that the death-rate is a measure of the health of a population, and that the fluctuations of the death-rate imply corresponding fluctuations of health. To a certain extent this is true ; but it is true only of the margin which remains after necessary deaths (if I may use the expression) have been eliminated (and these constitute the great bulk of a mortality) ; and after the effects of all influences tending to disturb the due proportion between the young, the middle-aged, and the old, the healthy, the sick, and the dying have been investigated and allowed for. On the effects of those deaths which I have termed necessary upon death-rates I need not now enlarge. "On the effects of the second class of causes, however, I have something to say, especially as I believe that they have a very important influence, and that this influence has been very generally overlooked. The influence of hospitals, of asylums, and of workhouses, and of any institution receiving the aged and sick is well illustrated in the present report, by the excessive mortality which the presence of the workhouse and of two lunatic asylums gives to the sub-district of Camberwell. But it may happen in another way, that, by a kind of process of natural selection, the young and able-bodied tend to accumulate in certain localities, while the infants and the aged, and it may be the sickly, remain in undue proportion in other localities. To illustrate this: the death-rate of Dulwich has always been remarkably low ; the death-rate of Peckham. without being really remarkably high, has always been by contrast remarkably high, and it has been assumed that, therefore, Dulwich is far more healthy than Peckham. I believe Dulwich to be very healthy ; I know that Peckham, in its low-lying parts, has many elements of unhealthiness; but I do not for one moment believe that the difference of their death-rates indicates a corresponding difference in their healthiness, still less, of course, that the excess of its deathrate is a measure of the degree in which diseases, preventable by the action of the Vestry, prevail in Peckham. I have said on former occasions, and I repeat it now, that there is in many parts of Peckham a large poor population ; that amongst such a population children get neglected and die of illnesses, from which under other conditions they would doubtless have recovered ; that from their habits of life contagious diseases spread anions: them with far greater virulence than they do among the so-called better classes, and that illnesses are manufactured amongst them which those who live in different circumstances rarely see. I have said formerly, and I say again, that (although important improvements have been made) there are many localities in Peckham which, in great measure from want of sewerage, are still in a condition to make them (in the presence of epidemics of cholera or of fever) hotbeds of these diseases. Fortunately we have escaped such disasters. Doubtless some of these conditions have influenced injuriously the death-rate of Peckham. But Dulwich comprises mainly the houses of the rich, Peckham mainly the houses of the poor. A typical Dulwich household consists of the father, mother and children, and of a considerable number of other persons —domestic servants —in the prime of life, and for the most part in the prime of health, draughted, so to speak, from the poorer households, and therefore from the poorer localities. Now, the mortality in such a household is as a rule the mortality of the family, and not the mortality of the servants of the family. If the latter become ill and die, their deaths rarely, if ever, occur in the houses to which they are attached; their own homes or the hospital become their final refuge. So that in such a household there is, in varying but often large proportion, a population which can add nothing to the deaths of the household, and the presence of which, in a statistical sense, must necessarily therefore produce a fallacious appearance of healthiness —a condition the exact converse of that which obtains at a workhouse or a hospital. Obviously, Dulwich, which comprises such households in large proportion, owes no inconsiderable proportion of its apparent healthiness to this cause. Peckham, on the other hand, comprises in large measure the houses of the poor. Their inmates consist of the parents and a family of children, but of no domestic servants. In fact, the elder and adult children are just the material of which domestic servants are made, and have probably quitted home for service elsewhere. So that in such a household not only are the numbers not swelled by the influx of a (so to speak) non-dying population, but on the contrary are diminished by the efflux of a certain number of those who, in a statistical sense, are the very vitality of the family. There remains, therefore, a population somewhat below the normal average in health and strength, which of itself would naturally yield a comparatively high death-rate, and in which the death-rate is liable to be still further increased, from the fact that many of those who have left the parent roof return thither to die when fatal illness overtakes them. lam not, of course, asserting that all the households of Peckham are of one class, or that all the households of Dulwich are of another class ; I am not asserting that all the elder children of the poor go out to service, or that of those that die all die at their own homes and none in the house of their master. But I assert that the one class of household prevails in Peckham, the other class prevails in Dulwich ; that the differences in regard to them which I have pointed out are real differences, which must necessarily affect the respective death-rates of Peckham and of Dulwich; and that differences of death-rate due to these conditions are totally unconnected with local salubrity or insalubrity. "The fact is that the sanitary condition of a locality is much more truly measured by the comparative prevalence in it of certain forms of disease than by mere variations of death-rate; although no doubt a large, and especially an increasing, death-rate is a matter to arrest attention and to demand inquiry. Thus if, in a certain place, ague prevails, we know it to be unhealthy from the presence of marsh miasm; if cholera or typhoid fever prevails in a locality, we have good reason to believe that in that locality the atmosphere or the water is unduly impregnated with the poison of cess- pools or of sewers; if typhus fever breaks out, there is ground to suspect that the population among whom it appears are overcrowded, their houses filthy and insufficiently ventilated. But it does not necessarily follow that the presence or the spread of such diseases proves local insalubrity: many of them are infectious, and if introduced into a crowded neighbourhood will spread in it however otherwise healthy that neighbourhood may be. The prevalence of any of them, however, in a markedly aggravated form, or for an unusually long period, renders the presence of local causes of insalubrity exceedingly probable." Table—Showing Mean duration of Life under different conditions of the Birth-rate and Death-rate. Annual variation of population per cent. Death-rate 5 per cent. Death-rate 1 per cent. Death-rate 1.5 per cent. Death-rate 2 per cent. Death-rate 2.5 per cent. Death-rate 3 per cent. Death-rate 3.5 per cent. Death-rate 4 per cent. Birth-rate per cent. Mean duration of life. Birth-rate per cent. Mean duration of life. Mean duration of life. Birth-rate per cent. Mean duration of life. Birth-rate per cent. Mean duration of life. Birth-rate per cent. Mean duration of life. Birth-rate per cent. Mean duration of life. Birth-:ate per cent. Birth rate per cent. Mean duration of life. 7.6 101 6.66 101.5 6.08 102 5.67 103 5.10 103.5 4.89 104 4.70 Increasing 100 100.5 102.5 5.35 10.5 11 11.5 13 14 21.37 12 12.5 13.5 „ 10 31.9 25.16 18.80 16.88 15.38 14.16 13.14 8.5 11.5 12 14.28 36.81 28.55 9.5 23.98 10 20.91 10.5 11 „ 8 9 18.65 16.88 15.46 36.72 7.5 8 5.5 6 6.5 30.05 25.67 8.5 16.62 7 22.52 20.10 18.19 9 „ 5 49.15 38.73 7.5 8 52.31 5.5 6 31.49 6.5 26.78 7 8.5 17.12 5 23.39 20.82 18.78 4.5 24.36 7 56.02 41.03 6 28.02 6.5 21.60 7.5 „ 4 4.5 5.5 33.14 19.43 8 17.67 5 43.72 29.41 6.5 7 4 4.5 5 34.91 6 7.5 18.27 „ 3.5 60.4 5.5 25.45 22.47 20.15 65.8 6.5 46.90 37.16 30.99 5.5 6 7 18.93 „ 3 4 4.5 5 20.67 23.45 20.94 3.5 4 3 72.56 3.5 50.73 39.74 28.07 6 6.5 19.66 „ 2.5 4.5 32.85 5 5.5 24.54 21.83 81.27 3 55.48 3.5 4 4.5 5 5.5 6 20.47 2 2.5 42.78 35.00 29.68 22.82 25.80 2.5 61.54 3 4 93-1 3.5 4.5 27.23 5 5.5 21.39 „ 1.5 2 46.55 37.28 31.56 23.96 110.4 2 69.66 51.34 3 40.75 4.5 5 „ 1 1.5 2.5 3.5 33.82 28.91 25.26 22.43 4 2.5 3 4.5 „ 0.5 138.98 2 44.75 3.5 23.61 1.5 81.30 57.67 36.55 4 26.77 1 30.91 1.5 66.66 200 100 50 2.5 40 3 Stationary 0 1 2 33.33 3.5 4 25 0.5 28.57 ... ... Diminishing — 0.45 510.54 ... ... ... ... ... ... ... ... ... ... 0.05 ... ... 2 „ -0.5 1 80.89 1.5 2.5 0 138.28 57.39 44.52 36.37 3 30.75 3.5 26.64 8 0.5 ... ... „ -0.95 0.05 ... ... ... ... ... ... 313.84 ... ... ... ... ... ... 68.97 40.34 „ - 1 0 0.5 1 1.5 2 3 28.62 ... 8 109.31 50.93 2.5 33.48 ... ... ... „ - 1.45 ... ... ... ... ... ... 0.05 232.86 ... ... ... ... ... 2 ... ... 0.5 1 60.63 45.86 „ -1.5 ... ... 0 91.72 1.5 2.5 8 37.03 31.10 ... ... „ -195 ... 0.05 187.32 ... ... ... b=birth-rate of one unit for one year ... ... ... ... ... 0 54.38 1.5 2 34.31 d=death-rate „ „ 0.5 79.66 1 41.94 „ -2 8 1.5 ... ... ... ... -2.45 r=inerease „ „ =b—a ... 0.05 157.71 ... ... ... 0.5 1 x=number of years, or mean duration of life 0 38.74 „ - 2.5 ... ... 8 70.77 49.47 1.5 ... ... 0.05 136.73 ... ... „ -2.95 (1+r)x=b/d log. b/d x= log.(1+r) ... ... ... ... 0 ... ... 0.5 45.52 „ -3 ... 63.89 1 ... 8 ... ... ... ... ... ... „ — 3.45 ... ... ... 0.05 ... 121.01 ... ... „ —3.5 ... ... ... 0 0.5 58.37 8 ... ... ... ... ... „ —3.95 ... ... ... ... 0.05 108.73 - ... ... ... ... ... ... ... ... 0 ...