CAM 6 1898-9. VESTRY OF CAMBERWELL, LONDON. FORTY-THIRD ANNUAL REPORT OF THE VESTRY OF ITS Proceedings under the Metropolis Local Management Act, 18 and 19 Vic., Cap. 120. LONDON: G. MORRISH, PRINTER, 114, CAMBERWELL ROAD, S.E. 1899. FORTY-THIRD ANNUAL REPORT OF THE VESTRY OF THE PARISH OF CAMBERWELL. In conformity with the provisions of the Metropolis Local Management Act, the Yestry 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, 1899. Appendix I. to Annual Report. Report of the medical Officer of healh. Gentlemen, The Registrar-General in his Annual Summary for 1898 estimates the population of London at the middle of that year to be 4,504,766, and he further reports that during the fifty two weeks ending December 31st, 1898, the total number of births registered in London amounted to 132,432, and the total number of deaths to 83,936. Last year it was necessary to point out that the birth-rate for 1897 was the lowest on record; this is, however, no longer true, for the rate in 1898 was lower still, being 29.5 per thousand, instead of 30, as it was in the previous year. The marriages numbered 42,016, compared with 41,223 in 1897, the rate per thousand of the population being accordingly raised from 18.5 to 18.7. The deaths, as stated above, amounted to 83,936, and corresponded to a rate of 18.7 per thousand, comparing favourably with the average rate for the previous ten years, which is 19.7. This total just mentioned includes the deaths of those Londoners who died in institutions outside London, but it also includes the deaths of 1,899 strangers who had been admitted into London hospitals and infirmaries from districts outside Registration London. By excluding these deaths the death-rate of London is reduced to 18.3 per thousand. On page ii. are shown the births and deaths, together with the birth-rate and death-rate for the whole of London, arranged in tabular form, the deaths of Londoners who died in institutions outside its boundaries being included. Table I.—Births, Deaths, and corrected Birth-Rates and Death- Rates of London and its Groups of Districts for 1898. Births London. West D. North D. Central. D. East D. South D. Metropolitan Asylums and Hospitals outside London. 132,432 19,464 26,364 50,803 - 29,160 6,641 15,610 83,936 14,233 24.8 17.0 Deaths 18,118 4,984 29,456 1,535 29.4 36.5 Birth-Rates 27.4 27.7 29.9 - 18.3 Death-Rates (corrected) 16.9 22.1 21.7 - 17.7 Table II. shows the population of Camberwell and its sub-districts at the census of 1896, together with the estimated number of inhabitants at the middle of 1897, and also at a similar period in 1898. These figures naturally depend for their accuracy on the assumption that the annual rate of increase since 1896 has been equal to the rate of the years 1891-96. Table II.—Population of Camberwell and its Sub-Districts. Parish. Dulwich Camberwell. Peckham. St. George's 7,519 90,286 As enumerated at census, 1896 253,076 88,242 67,029 7,707 92,582 As calculated for middle of 1897 257,772 89,472 67,976 As calculated for middle of 1898 261,551 90,469 7,861 94,461 68,744 Table III. gives the total number of births registered during the year in the Parish, and it shows a decrease of 51 on the figures for 1897. The only registration sub-district that shows an increase is Camberwell, where 42 more births occurred than in 1897. ii. Table III.—Births in Camberwell and its Sub-Districts. Parish. Dulwich. Camberwell. Peckham. St. George's. 2,789 1897 7,478 94 2,385 2,210 91 2,427 2,172 7,427 2,737 1898 Difference - 51 — 3 + 42 — 52 — 38 Table IV. gives the birth-rate per thousand of the Parish and that of its sub-districts, calculated on the estimated populations, as set out in Table II. Table IV. —Birth-Rates of Camberwell and its Sub-Districts. Parish . Dulwich. Peckham. Camberwell. St. George's. 32.5 1897 29.01 12.19 31.17 25.76 28.39 11.57 30.25 25.69 31.59 1898 The total number of deaths registered in the Parish amounted to 4,639. From this number must be deducted the deaths which occurred in St. Saviour's Infirmary, which amounted to 643. But, on the other hand, there must be added 373 deaths of parishioners that occurred in institutions outside the Parish, so that the correct total from which the death-rate is to be calculated is 4,369. The deaths spoken of as those of persons belonging to the Parish, but dying in institutions outside, have been re-distributed among those parts of the Parish from which they were removed, and in those instances where it was impossible to ascertain from which registration sub-district they had been so removed, the deaths have been re-distributed, together with those that occurred in the Workhouses and Infirmary, among the four sub-districts of the Parish in proportion to the recorded deaths. I have, in a previous report, pointed out the necessity for this re-distribution of the Infirmary, &c., deaths, and to point the moral more strongly, I give in Table V., the death-rate iii. of the four sub-districts before such re-distribution. The steps by which the re-distribution is worked out are shown in Table VI. Table V. —Death-Rates previous to Re-distribution. Parish. Dulwich. Camberwell. Peckham. St. George's. 18.4 16.5 14.9 16.7 8.9 Table VI.-Re-distribution of Deaths among the Sub-Districts of Camberwell. Deaths returned. Deaths in I., W. H. and L. A. Deaths in I., W. H., &c. subtracted. Deaths in I., W. H., &c., re-distributed. Estimates of Deaths due to Sub- Districts. + 9 79 .. 70 70 Dulwich 1,746 —560 1,186 1,424 + 238 Camberwell - 10 + 208 1,695 1,497 1,487 Peckham + 142 .. 1,029 1,171 1,029 St. George's — 570 4,369 Parish 4,342 3,772 + 597 In addition to the deaths occurring in the Infirmary, Workhouses, &c., 27 deaths occurred in outside institutions, in regard to which the only information forthcoming was that they came from Camberwell Parish. I have, therefore, included them with the deaths taking place in the Infirmary, &c., and have re-distributed these in accordance with the deaths occurring in the four registration sub-districts. On completion of the above calculations we find that the death-rate for the year 1898 is 16.70, as compared with 16.98 in 1897. The greatest decrease is shown in the sub-district of St. George's, where the death-rate is 17.03, as compared with 18.91 in 1897, and 20.78 in 1896. Peckham shows but a slight decrease, while in both Camberwell and Dulwich there is an increase. As I have previously mentioned, the Registrar iv. General's estimate of the general corrected death-rate for London is 18.3, and that for South London taken as a whole is 17.7. But according to his calculations the death-rate for Camberwell is 16.4, instead of 16.7, as it is according to my figures. This difference can be explained to a small extent by the difference in our estimate of the population, but still more by the fact that I have included the deaths of all persons in outside Institutions, no matter how long they may have been away. Table VII.—Death-Rates In Camberwell and its Sub-Districts. Parish. 18.88 Dulwich. Camberwell. Peckham. St. George's. 9.85 16.75 1895 21.28 20.78 20. 03 18.66 8.73 16.11 1896 20.35 16.98 14.31 18.91 1897 8.69 18.98 1898 10.05 15.07 18.74 17.03 16.70 Tables VIII. and IX. give the deaths occurring in the Parish, and Table X. those of inhabitants who have died in institutions outside the Parish, both arranged according to age, season, and disease, and also as to the registration sub-district of the Parish from which they were removed, whenever this information was given on the death certificate; in those cases where it was missing the deaths have been included under the head of unclassified. They were for the most part deaths of persons who had died in lunatic asylums, and the only information forthcoming was that they belonged to Camberwell. Table XI. gives much the same information only classified in a manner required by the Local Government Board, so that all the reports of Medical Officers shall be made on a uniform plan. The chief differences are that there are two separate classifications of rheumatic fever and heart disease, and one for phthisis considered by itself, and not under the general heading of tuberculous disease. The heading of "heart disease" is a little difficult in the way of classification, but under this term I have included all diseases, both of the heart muscle and of the valves. On making a comparison with the figures for 1897 it will be seen that accidental or other violence in which are included all cases of drowning, &c.) amounted to 124 in 1898, as compared with 133 in the previous year. The deaths ascribed to developmental diseases (premature birth, &c.), and to convulsions of infancy numbered 371 and 92, as contrasted with 345 and 124 in 1897. Seventeen deaths were certified as due to the immediate or remote effects of child-birth, and of that number seven were ascribed to "puerperal fever," under which heading I have, as heretofore, included septic diseases connected with child-birth. Tuberculous diseases caused 596 deaths in 1898, as compared with 551 in 1897 and 618 in 1896. There were 231 deaths from cancer, against 214 in 1897, and 234 in 1896. Under this heading I have included all the forms of fatal malignant new growths. Inflammatory affections of the lungs and pleura caused 735 deaths, as compared with 771 in 1897, and 834 in 1896. Of these, 355 were deaths of children under the age of five years. It is, however, possible that a certain number of these cases of pleurisy ought really to come under the head of tubercle, as modern opinion seems to incline to the belief that the majority of cases of pleurisy are tuberculous in origin. Among the "zymotic" diseases hooping cough caused 121 deaths, and measles 113 deaths, compared with 101 and 125 that were respectively ascribed to these two diseases in the previous year." The re-distributed figures considered in regard to the registration districts in respect of these two diseases were as follows:- In Camberwell, 47 and 33;in Peckham, 57 and 51; in St. George's, 17 and 28. Included in the Camberwell deaths are two deaths from measles that occurred in the Infirmary. The deaths from influenza amounted in all to 86, compared with 31 that occurred in 1897. This disease prevailed in the greatest intensity during the first quarter of the year, vi. and more cases occurred in Camberwell than in any of the other registration sub-districts. Of the 350 deaths due to diarrhoea and other inflammatory affections of the bowels, 14 took place in the first quarter, 17 in the second, 286 in the third, and 33 in the fourth. It will be seen by the Tables that 326 of the 350 deaths occurred in infants under the age of five years. Two occurred in Dulwich, 110 in Camberwell, 127 in Peckham and 86 in St. George's. I have prepared a little chart showing the influence of the temperature on the prevalence of this disease. It has been supposed that this disease is due to a specific micro-organism which is only able to grow and to manifest its power at a time when the temperature of the earth has attained a certain limit. In previous reports I have pointed out that it is probably due to infection from the milk, for the number of cases occurring are in a large proportion those of infants who are not fed from the breast. Scarlatina caused 18 deaths compared with 32 deaths in 1897 and 52 in 1896. Of these 18 there were only four that occurred at home, the remainder occurring in the isolation hospitals. Of these 18 deaths, 7 occurred in Camberwell, 7 in Peckham, and 4 in St. George's. Taken quarter by quarter the figures are 5 in the first, in the second 4, in the third 4, and 5 in the fourth . Diphtheria (including membranous croup) caused 86 deaths, compared with 167 that occurred in 1897. It is in fact the lowest recorded mortality since 1892. According to the Return of the Registrar-General, Camberwell has a death-rate of .33 per 1,000 for diphtheria, the death-rate for the whole of London being .39; while for scarlet fever the death-rate for London is .13, while that for Camberwell is only .07 per 1,000. I last year drew attention to the figures for diphtheria and scarlet fever, and I point out below in tabular form the mortality obtained by making a percentage calculation of the number of notifications received for the years 1895 to 1898. Table XII.— Case-Mortality of Scarlet Fever and Diphtheria. Diphtheria. Scarlet Fever. 1895 19.5 5.3 1896 18.4 4.2 2.7 14.3 1897 1898 12.4 1.9 Enteric fever caused 25 deaths, compared with 28 deaths that occurred in 1898. Twenty-one of these occurred at home, while four occurred in outside hospitals. Eight occurred in Camberwell, 12 in Peckham and five in St. George's. During the year there were five notifications of small-pox, two of these came from St. George's, two from Peckham, and one from Camberwell. Of these four were removed to hospital, but in all the four instances the cases were returned with a note written in the usual dogmatic style stating that the patients were not suffering from small-pox. With regard to two of these cases, namely those from St. George's, I should be thoroughly disposed to agree. The two from Peckham were both diagnosed after consultation with hospital physicians; one I feel myself, however, doubtful about, but the second I do think was a case of small-pox. The one from Camberwell was very doubtful from the beginning. The strictest precautions, however, were taken in these three cases, and I think it is probably due to this that there was no further extension of the disease. The total number of certificates of notification received during last year amounted to 2,129, but the actual number of persons attacked was 2,002, the difference being due to duplicate notification, and to the fact that there were some notifications of cases outside the Parish. In Table XIII. the cases are shown arranged according to the locality in which they occuned, and the numbers are also given of the persons that were removed to hospital. The table is made up as follows:-Diphtheria (including 25 cases of membranous croup), 690, as compared with 1,161 in 1897 and 1,420 in 1896; scarlet fever, 937, viii. compared with 1,182 in 1897 and 1,225 in 1896; enteric fever, 116, compared with 143 in 1897 and 181 in 1896. There were five notifications of small-pox; 10 notifications of "puerperal fever," compared with 14 in 1897. There were also three cases notified of continued fever, and 251 of erysipelas. The subject of measles and its prevention was brought before your Sanitary Committee on account of a communication from the School Board for London recommending that power should be given to local authorities to proceed against persons who sent their children to school when they were suffering from measles. A letter was also received from the London County Council asking the opinion of the Vestry as to whether they would approve of the application practically of all the disease Sections of the Public Health (London) Act, except the one in which notification is required, to measles. The matter was referred to me for a report, of which the following is a copy:- Gentlemen, —Referring to the communications from the School Board and the London County Council with regard to the notification of measles, I think that if the Act be applied at all it ought to be applied in its entirety, and that if we take any action we should have the courage of our opinions and boldly put measles on the list of notifiable diseases. Whether this should be done is quite another matter, and one that I do not support. In all considerations regarding measles the fact should be ever present in our minds that the disease is infectious before the rash comes out, that is, a case which really presents the symptoms of an ordinary cold in the head may be a case of commencing measles, and have all the power to propagate that disease. The Sections the London County Council wish to have included in the Act are those which relate to the disinfection, the exposure of infected persons, and the letting of houses without disinfection. In these, proceedings must be taken before the Magistrate, and I do not see how the Vestry, in the absence of a proper notification certificate, can produce evidence that measles have existed. If disinfection and the prohibition of exposure are to check the disease, they ought to be done from the beginning and made universal in their action. I have before pointed out that the infection exists at a time when no medical man would feel justified in notifying measles. Opinion among Medical Officers of Health is very much divided as to the advisability of including measles as a notifiable disease, and the experience gained in those places where it has been adopted has not been such as to induce one to recommend its adoption. I, therefore, recommend that no support be given to this proposition of the London County Council, and that the School Board be requested to render universal the order requiring teachers to send information to the Medical Officer of Health relating to any children that they have excluded, either because they themselves are ix. suffering from measles or hooping cough, or because there are children in the same house suffering from those diseases. Your obedient Servant, FRANCIS STEVENS, Medical Officer of Health. The matter was considered by the Committee, and a recommendation made to the Vestry that this report be received and the recommendation adopted. The matter was, however, referred back for further consideration. An amended report of the Committee was brought up on October 5th with the recommendation that my report be received, and that the County Council be informed that this Vestry is not prepared to include measles under any of the Sections relating to dangerous infectious diseases, and that the School Board for London be requested to render universal the order requiring teachers to send information to the Medical Officer of Health relating to any children that they have excluded, either because they are suffering from measles or hooping cough, or because there are other children in the same house suffering from these diseases. The argument used in favour of the notification of measles rested mainly on the wide prevalence and heavy mortality from this disease. It will be seen on reference to the Tables for this year that measles, chiefly on account of the broncho-pneumonia that so frequently is a complication, is responsible for a large number of deaths, much larger indeed than any of the diseases which are properly notifiable. This of course in itself is a point which makes it incumbent on all those connected with the public health to carefully consider as to whether any means can be devised for preventing this mortality, and the readiest way that presents itself is the inclusion of measles under the category of dangerous infectious disease. As pointed out in my report, however, the advisability of so doing is a vexed question, and it is most instructive in this respect to consider a report made by the Medical Officer of Health for the city of Newcastle-on-Tyne with reference to an order of the Corporation made on August 26th, 1896, declaring that until August 26th, 1898, measles and hooping cough should be deemed infectious diseases within and subject to the provisions of the Newcastle-on-Tyne Improvement Act,. 1882. Dr. Armstrong considers that an experience of two years has been amply sufficient to form a decided opinion on the working of the system. The measures taken appear, so far as I can make out, to be practically the same that we take after an outbreak of disease such as scarlet fever, and in addition that in December, 1896, all the elementary schools in the city were closed for four weeks, that all other day schools and Sunday schools in the city were also closed in the same manner, and that a large number of schools were disinfected, after November 13th, 1897, but not closed. The practical result of the notification seem, in the opinion of the Medical Officer, to be disappointing, although he says some good has undoubtedly followed the notification of measles, and he particularly points out that the most important point seems to be to promptly close every school in which the disease appears. In his concluding remarks he points out that "whatever conclusion the sanitary authority may come to as to the advisability of renewing the notification of this disease with the object of dealing with it more thoroughly, if more heroically, than heretofore, through the agency of school closure, there can scarcely be two opinions as to the undesirability of continuing it on the old lines." In the face of this report it is indeed difficult to say how the proposals of the London County Council and of the London School Board would be of service, for if the whole machinery of notification has been powerless to do much good, how much less will the partial application of certain provisions of the Act have any effect. This report of Dr. Armstrong, which is based on experimental evidence bears out the expression of opinion that I have made that if the Act is applied at all it should be applied in its entirety, but at the same time I still must express my opinion that measles is not a disease in which notification would be advantageous. It has also been urged that the inclusion of measles under the Notification Section would tend to raise the estimation xi of the danger of this disease, and to thus make people more careful as to its treatment. This, of course, is a good argument, but it cuts both ways, because it will not have the effect on the mild cases, which in measles, as in all cases of infectious disease, are the chief agencies of the spread of infection. I have, for instance, frequently been told by friends of patients who have undoubtedly had scarlet fever, that they do not think it could have been really scarlet fever, because the child was not ill. So long as people insist on judging the amount of infectivity possessed by a disease according to the severity of the symptoms the same opinion will inevitably apply to measles, should it be attempted to bring it under the same conditions. If the mortality from measles be used in favour of its notification, the more it must follow that a disease like syphilis, so eminently contagious, and so fatal in its consequences to life and health, ought to be included in the same way. This Vestry on June 15th joined with St. Marylebone Vestry in an application to the London County Council to add to Section 55 of the Public Health (London) Act the names of all diseases included under the heading of "puerperal fever" in the Registrar-General's report. In December we heard from the County Council that all acute septic inflammations in the pelvis occurring as a direct result of child-birth are covered by the term "puerperal fever." This does not make any difference to our statistics, for ever since 1895 I have considered the notification of one of these diseases to come under the heading of " puerperal fever," and in the same way a death arising from similar causes has always been attributed in the returns to that disease. The subject of tuberculosis, especially that form of it which is known as consumption of the lungs, has been prominently before the public of late, and an association has recently been formed under the presidency of the Prince of Wales, to enter on an active crusade against this disease, which has come under the head of infectious disorders ever since the discovery of the tubercle bacillus some 15 or 16 years ago. In considering the subject of tuberculosis there are two factors to be dealt with, namely, the bacillus, which may be considered as analogous xii. to the seed, and the resisting power of the individual, which may be considered as the soil. It is thus apparent that there may be many people who are exposed to the action of the bacillus who come to no harm owing to the resisting power of their tissues. The absence or presence of this resisting power may be described as the predisposition, or otherwise, to the disease, and it is on account of this predisposition that the popular belief in the hereditary nature of consumption is due. It is, however, certain that however much predisposed a person may be, he will never develop tuberculosis unless he is exposed to the bacillus, or in other words, the soil however suitable and well prepared will not produce any growth unless the proper seed be sown in it. The consideration of these facts leads up to the remedies. In the first place it is of the utmost importance that the general sanitary condition of houses should be made as healthy as possible. Sunlight and fresh air are powerful antiseptics, and within the reach of all. Sir William Broadbent stated that he was so often surprised to find cases of consumption prevalent among the rich who lived in well-ordered houses, and had every care and attention in the way of proper food, that he was impelled to the belief that one of the chief causes was the dark and ill-ventilated state of their houses. I would point out to this Vestry, and it is a matter of congratulation for them, that they have taken a very active part, more, I believe, than any other parish in London, in enforcing the proper lighting and ventilating of staircases, a sanitary provision too much neglected, and although we have been obliged to take some cases before the Courts, we have in almost every instance gained our point, and more gratifying still is it to find that the landlords, who at first bitterly opposed the requirement, now that it has been carried out, express their satisfaction and their opinion that it is an improvement to their" property. Another way in which the Vestry can act is by disinfection, that is, rendering the bacillus powerless, or in other words by destruction of the seed. This, of course, is a more difficult task since the bacillus is probably ubiquitous; it is coughed up in enormous numbers by phthisical patients, and xiii. unfortunately by those persons who although they have phthisis, a diagnosis of this disease has not been made. The disease also is spread, in the case of young children, by the specific organism in cow's milk: it has been proved over and over again that in tuberculosis of the udder of a cow there are tubercle bacilli in the milk, and it is to this fact that the extensive prevalence of tuberculosis of the intestinal tract, otherwise known as consumption of the bowels, is due in young children. Another means of dissemination but secondary in importance, is the consumption of tuberculous meat. This, of course, acts to a much less extent, because it is the custom to cook meat, although perhaps imperfectly, whereas milk is taken raw. The Vestry has already adopted a circular letter setting forth the causes of consumption, and the means that should be adopted for its prevention, and it is only necessary for me to point out again and to urge the paramount importance of the following rules:—All houses to be as light and as well ventilated as possible, and means taken to have an abundant supply of fresh air in every room; all milk to be boiled; and all meat to be thoroughly cooked. Besides these there are other measures which may with good results be adopted, the disinfection of the sputum, and the disinfection of the rooms after death or removal. This is now offered in all cases of consumption directly we get to know of a death having taken place. At the same time, I think it will be some time before we get people to adopt this universally; public opinion has to be educated, and all that can be done is to keep pegging away at the measures designed for its prevention indicated above, and also in the circular sent out by the Vestry. The registration of lodging houses has been again before the Vestry, with, I regret to say, no more satisfactory result than before. I have before pointed out that the limit of exemption in Camberwell is too low, particularly in regard to unfurnished apartments. The Sanitary Committee surveyed some of the houses which are above the present limit, and agreed with me that these houses were eminently suitable for registration, and they recommended the raising of the exemption clause, with a proviso that before a house is registered it must first of all be inspected by myself, then brought before a SubCommittee, who would also inspect the premises and report to the main Committee, and they in their turn to the Vestry. The Vestry declined to pass the recommendation. A resolution was, however, passed, which I trust will be successful, namely, that the Vestry approach the Local Government Board and ask that a fresh interpretation regarding the word " landlord " be inserted in the existing by-laws, so as to get rid of the difficulty alluded to in my report for 1897. As to the beneficial effects of registration, I can only repeat what I said last year, and to ask the members of the Vestry to go and look at the houses that are on the register and compare them with those that are not. I feel certain that they will not fail to notice the difference and the improvement. It will be remembered that in 1897 the Vestry passed a recommendation that a certain number of cases of diphtheria that had been notified should be examined bacteriologically. A report was presented to the Committee and came before the Vestry on November 16th. It runs as follows:— To the Sewers and Sanitary Committee, Gentlemen, —I have received a report of the examination of the cases of diphtheria made by Dr. Bousfield in pursuance of the resolution of the Vestry. I found it impossible to examine the next fifty cases occurring, as some of them had been removed to hospital before I was aware of them. I, therefore, took those cases where from the age of the patient I felt tolerably certain of being able to procure a satisfactory specimen, and where the circumstances of the case rendered it particularly desirable that a diagnosis should be rapidly and surely made. As regards the treatment of the cases from the point of view of the spread of infection, all those which either seemed to be diphtheria or in which the specific bacilli were found, although there were no signs visible in the throat, we considered as true cases of diphtheria, and all the ordinary measures for the prevention of the spread of infection were carried out, and only in those cases where diphtheria was absent clinically and bacteriologically were these precautions dispensed with. The points brought out in the bacteriological examination are:— (a.) That bacilli were present in cases where clinically diphtheria was absent. (b.) That bacilli were absent in cases where clinically diphtheria was present. (c.) That a certain number of cases, amounting in this inquiry to 24 per cent., were notified as diphtheria when diphtheria in my opinion was absent clinically and bacteriologically. on was absent clinically and bacteriologically. (d.) That a certain number of cases (14 per cent.) were doubtful, considered either from a clinical or bacteriological point of view, and sometimes from both these standpoints. As regards (c) there were no further cases notified from any of the houses except one; in this case the second notification was of a lad in the same house, and as the second patient was not removed to hospital there was no confirmation of the diagnosis. Concerning the seven cases in which either or both of us were in doubt, there was only one case notified again, and it was a supposed second attack. This time, however, there was no doubt either in the mind of Dr. Bousfield or in my own that it was not a case of diphtheria. This inquiry has again brought out the fact, noticed previously in America, that the bacilli may be present in a throat which appears perfectly healthy, and a large field for investigation is therefore opened up as to the date when persons who have suffered from diphtheria can be pronounced free from infective power, for it is well known that the bacilli are present in the throat of a person who has suffered from this illness after all its signs have long since disappeared. The advantages of calling in the aid of bacteriological examination are that in cases which are doubtful on clinical examination, the doubt is confirmed or dispelled by the further investigation, and I am enabled either to allow children to re-attend school at a much earlier date than I otherwise should have felt justified in doing, or on the other hand to insist on strict precautions against the spread of infection. We have also been able to render disinfection and the possible stripping of rooms unnecessary. If the Committee should consider the results commensurate with the cost, I recommend that the following course of action be adopted:- That the Vestry arrange for the bacteriological examination of specimens taken from the throats of persons supposed to have diphtheria, either by myself or by the doctors in attendance and to be forwarded by me for examination. The medical practitioner, if a wish has been expressed by him, has been informed of the result of the case. In no case have we requested the notification to be withdrawn. —Yours faithfully, FRANCIS STEVENS, Medical Officer of Health. On account of this report and a letter at the same time from Dr. Bousfield, they decided to appoint him Bacteriologist to the Vestry. It is unnecessary for me to point out the advantages that may be obtained from this appointment, not only in the way of diphtheria, but also many other diseases in which a bacteriological confirmation of the diagnosis is occasionally of great advantage to the public health. xvi. Table XIV. gives the work carried out by your inspectors during the past year arranged in tabular form. The house-to-house inspections numbered 6,902, as compared with 5,944 in 1897. The complaints numbered 1,138, and the inspections that were made in consequence of such complaints amounted to 2,019. The complaints are exclusive of notices received from the London County Council, that in 1,077 instances houses were either without dust-bins or were provided with insufficient dust receptacles. In 1897 there were 1,209 complaints, so that there is a slight reduction, which it is to be hoped may continue, but as the sanitary condition of the Parish improves the standard of requirements will also tend to be raised. There was a considerable increase in number of inspections of new buildings for the year, these numbered 2,102 as compared with 1,453 in 1897. In Sub-section C. is shown the description of work that has been carried out by your Inspectors, which calls for no detailed comment on my part except that the work in connection with an alleged smoke nuisance is considerable, it being often necessary to watch a suspected chimney for many minutes at a time. As a result of the house-to-house inspections and the complaints that have been referred to above, 5,231 intimations were served, followed up in 1,237 instances by statutory notices. Of these 200 referred to houses let in lodgings. Furthermore in 135 instances it was necessary to issue summonses to enforce the requirements of t0he Committee. There were 337 inspections of cow-houses and dairies and 143 of slaughterhouses. Prior to the annual licensing by the London County Council I myself visited the whole number of slaughter-houses and cow-houses. In several instances it was necessary to call the attention of the owners to various defects. As these, however, were all remedied before the day for lodging objections, I was able to withdraw opposition in each case. There were 360 inspections of bakehouses, excluding 75 by myself. xvii. The work of the Sanitary Department has been interfered with by the suspension of two Inspectors for a period of about a month, and also by the illness of the Notification Clerk. In January, 1898, in consequence of a report that I made to the Committee, it was decided to appoint two additional Shorthand Clerks in the Sanitary Department. On the report being presented to the Vestry, however," the previous question " was carried. The Vestry decided that in future the work of stripping and washing rooms where cases of infectious disease have occurred should be carried out by a contractor instead of as heretofore by our own men. The matter was fully discussed in the Sub-Committee and Committee. I think, however, that the work could be done as expeditiously and as cheaply by our own men, and we should have the additional advantage that it would be our own staff who would be engaged in this duty, and who would be more directly under the control of the Medical Officer of Health. In conclusion, I have to express my thanks to the Inspectors and Clerks for the help that they have cheerfully afforded me during the past year. I am, Gentlemen, Your obedient Servant, FRANCIS STEVENS. xviii. TABLE XIV.-RETURN OF WORK PERFORMED IN THE SANITARY DEPARTMENT DURING THE 52 WEEKS ENDING DECEMBER 31st, 1898. PUBLIC HEALTH (LONDON) ACT, 1891. TABLE A. Description of Work. Inspectors. Totals. Heath. Kerslake. Morley. Homer. Stevenson. Groom. Pointon. Eagle. Chadderton. Scudamore Collins. Farmer. Complaints 112 132 59 93 100 92 1138 57 135 61 138 69 90 2019 141 210 122 224 159 161 330 76 226 76 184 110 Inspections arising from Complaints 226 537 655 628 950 768 274 551 391 410 6902 House-to-House Inspections 753 759 63 33 43 63 31 12 7 24 360 10 13 48 13 No. of inspections of Bakehouses 4 111 7 0 19 54 58 337 Do. do. Cow-houses and Dairies 0 24 6 53 1 7 0 20 41 143 17 1 14 0 0 36 4 3 Do. do. Slaughter-houses 17 15 41 12 11 33 20 6 7 21 24 220 Do. do. Laundries 13 191 207 103 150 53 195 139 113 113 1808 Do. do. Infectious Cases 187 116 241 13 8 68 53 21 452 Do. do. Schools, Board 51 32 112 17 53 17 7 0 154 20 4 0 14 25 3 3 19 5 Do. do. do. Private 17 44 19 7 16 9 6 23 21 25 11 187 Do. do. Workshops 15 18 17 Do. do. Sanitary Conveniences, Public Urinals, &c. 60 0 0 21 19 0 89 428 65 106 0 29 39 155 No. of inspection of Sanitary Conveniences, Private Urinals, &c. 93 106 199 145 108 308 136 99 1817 187 194 87 2 0 8 0 0 233 No. of inspections of Railway Stations 0 0 52 30 0 97 44 0 298 0 0 3 0 0 0 0 0 295 0 0 Houses Let in Lodgings Inspected 168 18 91 15 20 324 30 0 128 0 800 Tenement Houses Inspected 0 6 10 0 67 1 67 10 5 0 170 Miscellaneous Inspections 0 9 0 1 620 390 5231 548 490 297 525 424 246 161 634 384 512 Intimations served under the P.H. Act 19 10 4 8 1 6 2 17 27 8 16 17 135 Summonses taken out under the P.H. Act Notices served under the P.H. Act 19 66 50 27 77 176 139 72 56 79 1037 84 192 0 200 0 0 200 Do. do. Houses Let in Lodgings 0 0 0 0 0 0 0 0 4005 4037 4166 46801 Re-Inspections of Works in hand 3443 3657 4519 3990 3667 3060 3747 4187 4323 28 95 52 128 63 132 53 126 97 1199 „ Infectious Diseases 233 154 38 105 308 596 102 263 42 90 144 2102 New Buildings Inspected and Re-Inspected 124 140 90 98 TABLE B. 64 82 104 135 117 116 132 Reconstruction of Old Drains Completed 102 96 73 125 183 1329 TABLE XIV.—continued. TABLE C. Description of Work. Totals. Houses Ventilated on Staircase 412 „ „ under Floors 762 „ Cleansed 1420 „ Repaired 765 Water Supplied to Premises 283 Drains Cleansed, Repaired and Trapped 1908 Sinks, Rainwater Pipes, &c., Disconnected 614 Stables, Yards and Areas Paved, Levelled, and Drained 1345 Closets Provided, Repaired, Cleansed or Removed 1543 Water Laid on to Closets 1049 142 Cisterns Provided or Reconstructed „ Repaired, Covered or Cleansed 246 Provide, Repair, or Remove Dustbins 1549 Cesspools Emptied, Abolished, or Drained into Sewer 56 Remove Refuse or Manure 655 Keep Animals Clean or Remove them 58 Cleanse & Supply Water to Private Urinals 55 „ „ Public „ 26 Abate Overcrowding 144 Abate Smoke Nuisances and raise Chimneys 80 Trade Nuisances Abated 20 Supply Manure Pits 94 Interceptors and Chambers Supplied 349 TABLE D. —SALE OF FOOD AND DRUGS ACT. Samples Submitted for Analysis 485 Summonses under the above Act 69 Seizure of Unwholesome Meat 6 Inquests 240 Bodies Removed to Mortuary 300 Post-Mortem Examinations 144 TABLE XV. MORTALITY RETURNS OF ZYMOTIC DISEASES QUARTERLY FOR THE LAST SIX YEARS. Year. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Fever. Small Pox. Diarrhœa. Influenza. 29 14 1893. 1st Quarter 16 23 7 3 17 16 3 2 2nd „ 16 9 17 4 6 43 22 3rd „ 28 41 18 27 7 1 127 5 4th „ 15 5 30 60 12 1 26 39 1894. 1st Quarter 29 16 14 31 5 0 17 22 2nd „ 47 96 13 41 1 2 8 6 3rd „ 41 45 13 54 2 0 71 1 4th „ 9 7 5 67 13 0 19 8 1895. 1st Quarter 13 3 8 43 9 0 22 98 2nd „ 22 3 9 41 3 0 20 17 3rd „ 7 23 10 50 12 6 174 8 4th „ 19 71 20 47 6 1 38 10 1896. 1st Quarter 73 146 15 52 13 0 14 8 2nd „ 67 34 11 55 6 0 24 9 3rd „ 31 8 11 71 11 0 183 3 4th „ 9 4 15 84 4 0 17 5 1897. 1st Quarter 34 2 6 51 6 5 17 10 2nd „ 30 4 6 27 4 0 16 10 3rd „ 20 34 8 46 4 0 288 5 4th „ 17 85 12 43 14 0 18 6 1898. 1st Quarter 35 65 5 20 5 0 18 57 2nd „ 40 40 4 26 6 0 16 14 3rd „ 31 4 4 14 4 0 292 4 4th „ 15 4 5 26 10 0 18 11 TABLE XVI. ANNUAL MORTALITY RETURN OF ZYMOTIC DISEASES, FROM 1856 (inclusive). Year. Hooping Cough. Scarlet Fever. Diphtheria. Fever. Small Pox. Measles. Diarrhœa. 1856 48 32 30 19 5 29 1857 30 7 44 24 4 50 1858 51 28 129 14 20 7 26 1859 66 82 31 12 ? 1860 36 40 26 5 ? 34 11 1861 72 8 13 25 25 2 ? 1862 53 32 101 40 64 0 ? 1863 57 32 124 29 41 14 ? 1864 61 29 83 16 51 10 ? 1865 52 39 55 14 31 12 118 1866 72 38 59 11 53 35 76 1867 64 20 75 8 41 9 67 1868 58 67 71 17 45 13 146 1869 134 4 3 164 9 46 9 133 1870 49 24 192 10 57 23 160 1871 50 29 60 9 40 153 143 132 1872 46 86 1 38 41 124 1873 60 49 7 38 2 137 7 1874 76 24 9 57 2 93 54 1875 125 64 177 14 40 1 107 1876 93 33 78 16 31 32 126 1877 61 72 38 12 27 124 94 1878 206 88 59 29 41 81 176 1879 122 123 76 31 35 80 75 1880 206 59 126 32 36 33 223 1881 74 95 120 29 44 190 127 1882 180 168 76 60 44 66 100 1883 91 112 48 49 35 19 122 1884 173 171 82 78 40 240 34 1885 136 91 20 68 27 154 135 1886 156 97 18 48 30 2 215 1887 203 133 99 71 41 239 0 1888 130 101 105 65 31 1 115 1889 149 193 37 76 27 0 145 1890 191 163 51 60 26 0 144 1891 123 67 29 56 21 1 142 1892 128 189 63 85 21 1 169 1893 104 78 80 118 30 11 213 1894 126 164 45 193 21 2 115 1895 61 100 47 181 30 7 254 1896 180 192 52 262 34 0 238 1897 101 125 32 167 28 5 339 1898 121 113 18 86 25 0 350 Under the head of fever I have only included the deaths from enteric fever. TABLE VIII. —Returns of Births and Deaths for the Years 1897 and 1898. DEATHS. BIRTHS. ACCORDING TO AGE. DEATHS. ACCORDING TO DISEASES. Under 1 Year. Between 80 and 90. 90 and upwards. Violence, Poison, and Accident. Premature Birth or Defective Vitality. Convulsions of Infancy. Child-birth. Erysipelas, Pyæmia, &c. Scarlet Fever. Enteric Fever. Small Pox. Pneumonia, Bronchitis, &c. Diarrhœa, Dysentery, &c. Alcoholism. F MF MF Between 1 and 5. Between 5 and 10. Between 10 and 20. Between 20 and 30. Between 30 and 40. Between 40 and 50. Between 50 and 60. Between 60 and 70. Between 70 and 80. Hooping Cough. Measles. Diphtheria. Influenza. Tubercle. Cancer. Chronic Diseases. F M M Non-febrile Affections. Puerperal Fever, &c. Under 5. Under 5 years. Over 5 years Over 5. 1897. Dulwich - 48 46 94 33 25 58 5 2 0 6 2 3 5 5 6 9 2 0 1 0 0 0 2 0 1 1 0 4 4 2 1 0 0 40 1 0 13 0 1 Camberwell 1201 1184 2385 795 793 1588 364 161 33 35 80 104 164 160 213 70 7 40 106 5 3 26 42 6 17 7 18 0 212 102 100 77 16 15 560 197 7 45 184 Peckham - 1417 1372 2789 671 621 1292 432 198 26 18 55 60 92 120 128 103 48 12 26 137 43 6 2 6 38 25 4 30 5 5 0 159 54 124 123 127 5 3 370 45 St. George's 1108 1102 2210 469 498 967 364 200 28 27 29 50 58 77 66 20 3 40 97 35 2 0 3 35 53 4 20 4 7 0 116 20 137 74 101 8 0 211 Totals - 3774 3704 7478 1968 1937 3905 1165 561 87 86 166 217 319 362 383 388 147 24 106 341 123 14 5 16 101 120 68 17 31 0 491 180 361 383 306 29 18 1181 14 1898. Dulwich - 53 38 91 33 33 66 7 4 0 4 4 4 8 9 1 0 1 0 0 0 0 2 8 1 3 1 1 37 1 16 4 0 0 0 4 2 5 3 2 Camberwell 1202 1225 2427 840 800 1640 378 170 19 34 79 114 154 160 191 217 114 10 33 13 4 19 2 3 7 45 33 2 10 8 39 0 223 103 102 148 109 13 7 600 Peckham - 1387 1350 2737 675 694 1369 436 215 24 35 51 65 96 122 133 129 59 4 29 135 36 4 1 3 57 51 1 16 8 26 0 163 65 130 124 125 4 4 387 1101 1071 2172 464 457 921 340 139 26 26 37 63 78 74 60 29 2 33 95 36 3 3 6 17 28 1 13 5 17 0 142 34 111 90 84 3 3 197 St. George's 47 Totals - 3743 3684 7427 2012 1984 3996 1161 528 69 99 171 227 317 414 414 211 20 98 366 91 10 7 16 120 112 4 39 21 0 536 206 344 365 320 21 15 1221 365 84 TABLE IX.—Returns of Births and Deaths for the Years 1897 and 1898. DEATHS. BIRTHS. ACCORDING TO AGE. ACCORDING TO DISEASES. M M 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. Enteric Fever. Influenza. Small Pox. Tubercle. Cancer. Pneumonia, Bronchitis, &c. Diarrhœa, Dysentery, &c. F MF Between 5 and 10. Between 10 and 20. 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. F MF Under 1 year. Between 1 and 5. Non-febrile affections. Puerperal Fever, &c. Under 5 years. Over 5 years. Under 5 years. Over 5 years. 1897. 1st Quarter 957 970 1927 474 486 960 231 122 21 23 94 39 8 21 93 23 5 0 3 34 1 21 3 10 0 118 46 96 136 14 3 73 114 2 32 88 115 2nd Quarter 911 877 1788 376 366 742 178 90 17 20 33 41 74 88 94 71 28 8 33 66 4 3 30 3 5 12 10 0 104 46 52 72 10 5 20 2 3 47 3rd Quarter 1008 943 1951 571 541 1112 484 154 21 23 53 52 63 74 69 84 32 3 33 105 5 1 5 20 32 3 20 4 5 0 127 54 43 43 270 16 2 5 17 5 15 7 6 0 142 34 170 132 12 5 4th Quarter 898 914 1812 547 544 1091 28 20 48 51 94 106 106 118 48 5 19 77 33 0 83 272 195 3774 3704 1968 1937 3905 1165 561 87 86 166 217 319 362 383 388 147 24 106 341 14 5 101 14 68 31 0 491 180 361 306 29 Totals 123 120 17 383 7478 16 1898. 1st Quarter 982 960 576 1182 247 23 56 68 98 110 138 141 81 10 26 32 2 1 35 64 0 11 4 56 0 156 50 166 13 0 19 82 3 122 1942 606 191 2nd Quarter 886 1763 414 832 184 19 19 35 61 71 81 105 85 39 4 27 66 20 2 0 3 40 40 2 12 5 14 0 118 33 65 85 10 6 877 418 129 969 923 1892 575 1066 474 120 22 40 43 71 75 65 99 39 1 23 120 22 3 1 3 31 4 2 2 4 4 0 137 58 62 32 268 12 491 17 3rd Quarter 915 1830 443 473 916 256 88 35 40 55 77 99 106 89 52 5 22 98 17 3 5 7 14 4 0 14 8 10 0 125 65 95 82 29 3 915 14 4th Quarter 317 365 414 414 211 20 98 366 10 7 16 120 112 4 39 21 84 0 536 344 365 320 Totals 3743 7427 2012 3996 1161 528 69 171 227 91 206 99 21 3684 1984 TABLE X.—Supplemental Return of the Deaths of Parishioners dying in Institutions outside the Parish. ACCORDING TO AGE. ACCORDING TO DISEASES. 1898. M F MF Under 1 Year Between 1 and 5. Between 5 and 10. Between 10 and 20. 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. Violence, Poison, and Accident Premature Birth or Defective Vitality. Convulsions of Infancy. Child-birth Erysipelas, Pyæmia, &c. Hooping Cough Measles Scarlet Fever Diphtheria Enteric Fever Influenza Small Pox Tubercle Cancer Pneumonia, Bronchitis, &c. Diarrhœa, Dysentery &c. 90 and upwards. Under 5 Over 5 Under 5 Over 5 Non-febrile affections Puerperal Fever, &c. Dulwich 1 3 4 1 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 Camberwell 65 41 106 6 9 7 9 11 16 13 12 7 0 5 1 0 0 0 2 0 5 5 0 0 0 10 3 5 1 0 15 1 1 18 Peckham 72 56 128 11 29 9 16 10 7 3 2 0 1 0 0 0 2 0 6 18 4 2 26 8 4 5 2 17 13 11 11 0 0 St. George's 59 108 11 29 19 12 8 3 10 6 2 1 10 2 0 0 0 2 0 3 24 0 0 11 7 4 4 2 49 7 0 0 0 Unclassified 13 27 1 1 0 1 5 3 2 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 4 1 14 3 4 6 0 0 1st Quarter 47 93 5 21 9 8 7 12 11 8 6 0 0 6 2 0 0 5 9 1 1 0 15 8 4 3 1 0 1 46 6 1 0 2nd Quarter 44 89 8 8 7 11 7 11 8 3 2 0 4 0 0 0 2 0 2 14 1 0 18 6 1 6 0 16 45 8 0 0 0 3rd Quarter 52 90 12 16 6 9 9 9 5 2 0 9 2 0 0 2 0 2 12 0 0 0 16 5 2 0 4 38 10 11 1 0 0 4th Quarter 34 101 5 15 12 10 13 10 12 9 6 7 2 7 0 0 0 2 0 5 2 1 0 11 6 4 6 0 67 0 1 1 12 1 Totals 210 163 373 30 68 39 31 40 40 38 37 27 18 5 0 26 5 0 0 0 7 14 47 4 2 0 60 11 15 6 3 1 1 25 Table XI.—RETURN REQUIRED BY THE LOCAL GOVERNMENT BOARD. Deaths during the Year 1898, in the Parish of Camberwell, classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 At all ages. 1 and under 5 5 and under 15. 15 and under 25. 65 and upwards. Under 1 year. 25 and under 65. Fevers. Small Pox. Diphtheria. Membranous Croup. Erysipelas. Measles. Hooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Total. Influenza. Scarlatina. Cholera. Injuries. All other Diseases. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal Under 5 ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 1 ... 1 6 ... 11 ... .. 66 7 4 ... 5 20 30 5 upwards Dulwich .. .. ... .. ... ... ... ... ... ... ... ... .. 1 ... 5 3 8 2 2 34 55 Under 5 1 8 ... ... 1 ... ... ... ... .. 30 45 105 ... ... 88 .. 1 6 183 468 ... Camberwell 1080 319 26 36 297 253 149 ... 1 1 ... ... 7 ... ... 2 ... ... 1 ... 8 5 80 96 68 34 12 297 6 upwards 612 3 130 2 2 15 255 Under 5 ... 1 6 ... 1 ... ... ... ... ... 48 55 125 ... 649 6 Peckham 1359 434 215 35 50 377 248 5 upwards ... 4 ... ... 7 ... 1 3 3 4 106 123 80 24 14 336 710 2 3 ... ... ... Under 5 ... 1 2 .. ... .. ... ... ... 27 16 84 ... 3 111 4 1 207 6 .. 17 479 St. George's 921 340 139 37 34 248 123 5upwards ... ... 5 ... 5 ... 3 .. 3 1 1 3 3 83 90 31 16 16 182 442 ... ... Under 5 ... ... ... ... ... 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. Workhouse (Constance Rd.) 135 4 ... .. 30 99 5 upwards 2 ... ... ... ... ... ... ... ... ... ... ... 4 1 25 3 1 2 87 131 8 ... ... Under 5 ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... 2 2 Worlhouse (Gordon Road) 10 2 ... ... ... 5 3 5 upwards ... ... ... ... ... .. ... ... ... ... ... .. .. ... ... 2 1 1 ... ... 4 8 Under 5 .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lunatic Asylums 84 ... ... ... 2 60 22 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... .. 10 2 2 1 1 68 84 ... Under 5 ... ... 1 ... ... ... ... ... ... .. ... 2 ... 4 ... ... 14 ... ... 1 54 76 Camberwell Infirmary 341 55 21 5 14 173 73 5 upwards ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... 64 25 39 2 11 121 265 .. St. Saviour's Union Infirmary Under 5 ... ... ... ... ... ... ... ... ... 1 ... ... ... 12 ... 1 4 ... ... 23 41 643 32 9 5 24 357 216 5 upwards ... ... ... ... ... 4 ... .. ... ... 3 ... 5 1 181 102 43 1 10 252 602 ... Under 5 ... ... ... ... ... ... ... .. ... ... ... ... .. ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1193 537 108 167 1567 1067 Under 5 ... 3 17 12 ... 2 ... .. .. ... ... 117 332 ... 7 348 6 4 40 734 1730 4639 108 TOTALS 5 upwards ... 1 10 ... ... 23 .. ... 7 ... 10 5 3 26 13 539 467 275 81 68 1381 2909 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Under 5 ... 8 27 ... ... ... ... ... ... ... 1 6 ... 2 11 1 ... 34 98 Deaths occurring outside the district among persons belonging thereto 373 30 68 52 32 ... 1 7 159 32 5 upwards ... 6 20 ... ... 4 ... ... ... ... .. 3 1 36 15 24 2 19 145 275 ... ... Deaths occurring within the district among persons not belonging thereto 643 32 9 5 24 357 216 Under 5 ... ... ... ... ... ... ... .. ... ... 1 ... 12 ... 1 4 .. .. 23 41 .. ... 5 upwards ... ... ... ... 4 ... ... ... 3 ... 5 1 181 102 43 1 10 252 602 ... ... ... Table XIII.—RETURN REQUIRED BY THE LOCAL GOVERNMENT BOARD. Population, Births, and New Cases of Infectious Sickness coming to the knowledge of the Medical Officer of Health during the year 1898, in the Parish of Camberwell; Classified according to diseases, ages, and localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. 12 13 1 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 2 3 4 5 6 7 8 9 Census 1896. Estimated to middle of 1898. Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Cholera. Erysipelas. Small Pox. Scarlatina. Diphtheria. Fevers. Membranous Croup. Typhus. Continued Relapsing. Puerperal. Enteric or Typhoid. Continued Relapsing. Puerperal. Enteric or Typhoid. Typhus. Under 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Dulwich 7519 7861 91 ... 3 .. ... ... ... ... ... ... ... ... 5 upwards ... 7 7 ... ... 2 ... ... ... ... 1 ... ... ... .. Under 5 ... 96 42 ... ... 2 ... ... ... ... 5 ... ... 59 19 ... ... ... ... ... ... ... ... ... ... ... Camberwell 90286 94461 2427 ... 120 54 ... ... 9 ... ... ... ... 9 ... ... 5 upwards 1 224 138 ... ... 35 1 ... 4 ... 79 ... ... ... 71 51 3 ... ... ... ... ... ... ... Under 5 ... 94 73 13 ... 5 ... ... ... ... 3 ... ... ... ... Peckham 88242 90469 2737 5 upwards 2 248 151 3 ... 39 2 ... 3 ... 71 .. ... 1 174 82 2 ... 25 ... ... 2 ... 8 ... ... ... 86 83 7 ... 1 ... ... ... ... 3 ... ... 59 60 3 ... ... ... ... ... ... ... ... ... Under 5 ... St. George's 67029 68744 2172 2 114 ... ... 11 ... ... 2 ... 4 ... 5 upwards 2 167 148 2 ... 29 ... ... 3 ... 60 ... 92 ... ... Under 5 ... ... ... ... .. ... .. ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Workhouse Constance Road) ... . ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... .. ... ... ... ... ... ... 3 ... ... Under 5 ... 2 ... ... ... ... ... .. ... 1 ... ... ... 4 1 ... ... ... ... ... ... ... 1 ... ... 4 Workhouse (Gordon Road) ... ... ... 5 upwards ... 5 1 ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lunatic Asylums ... ... ... 5 upwards ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... Under 5 ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... Camberwell Infirmary ... ... .. 5 upwards ... 1 2 ... ... ... ... ... ... ... 4 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... St. Saviour's Union Infirmary .. ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... 2 ... ... 1 ... ... ... ... 1 ... ... Cases reported from St. Saviour's Infirmary as being removed thither from places within the St. Saviour's Union. ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... 2 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... 2 1 ... ... 2 ... ... ... ... 17 ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... .. Under 5 ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... 193 133 6 ... ... ... ... ... .. 1 ... .. Under 5 ... 283 214 20 ... 8 ... ... ... ... 12 ... ... 253076 261535 7427 TOTALS 3 414 230 2 ... 45 ... ... 4 ... 22 ... ... 5 654 451 5 ... 108 3 ... 10 ... 239 ... ... 5 upwards Diarrhœa—lnfants under 5 years of age.