Camberwell for 1899 Appendix I. to Annual Report. Report of the medical Officer of health. Mrs. Bracey-Wright and Gentlemen, In his annual summary for the year 1899 the Registrar- General estimates the population of London to consist of 4,546,752, and he further reports that during that year there were 133,120 births registered, while the deaths amounted to 89,689. The year that has just passed again breaks all previous records so far as the birth-rate is concerned, it being 29.4 per thousand, instead of as in 1898, 29.5. The marriages numbered 41,853, compared with 42,016 in 1898, the rate being accordingly lowered from 18.7 to 18.4. As stated above the deaths numbered 89,689, a number which does not shew to advantage when compared with 1898, in which year they were only 83,936 ; the death-rate is therefore 19.8, compared with 18.7 in 1898, being .2 above the average rate for London for the past ten years. The total number of deaths includes those Londoners who happen to have died in institutions outside its boundaries, but it also includes the deaths of 2,159 strangers who had been admitted into London hospitals and infirmaries from districts without its boundaries. By subtracting the latter number from the total the death-rate is reduced to the correct figure of 19.3 per annum, instead of 18.3 in 1898. I shew on next page the births and deaths in tabular form, together with the birth-rate and death-rate for the whole of London, the deaths of Londoners who died in institutions out-side its boundaries being included. Table I. —Births, Deaths, and corrected Birth-Rates and Death- Rates of London and its Groups of Districts for 1899. West D. North D. Central. D. South D. Metropolitan Asylums and Hospitals outside London. East D. London. 133,120 6,480 26,054 Births 19,717 29,095 51,774 - Deaths 5,042 89,689 15,219 19,348 16,600 31,831 1,790 Birth-Rates 29.4 24.8 27.3 36.0 30.0 - 27.0 Death-Rates (corrected) 18.0 17.8 23.0 22.9 - 19.3 18.8 Table II. shews the population of Camberwell and its sub-districts at the census of 1896, together with my estimate of the number of inhabitants at the middle of 1898, and at a similar period in 1899. I base my calculations on the assump-tion that the rate of increase since 1896 has been equal to the rate which prevailed during the years 1891-6, the interval between the last two censuses. I am rather inclined to think, however, that the real increase is somewhat less. Table II.—Population or Camberwell and its Sub-Districts. Parish. Dulwich Camberwell. Peckham. St. George's 90,286 67,029 253,076 7,519 88,242 As enumerated at census, 1896 As calculated for middle of 1898 261,551 7,861 94,461 68,744 90,469 As calculated for middle of 1899 96,379 265,385 8,018 91,476 69,520 Table III. gives the total number of births registered during the year in the Parish, and it shews an increase of 16 on the figures for 1898, which year shewed a decrease of 51 on 1897. There is an increase in all the districts except in Peckham, which has a decrease of 68. ii. Table III. —Births in Camberwell and its Sub-Districts. Parish. Dulwich. Camberwell. Peckham. St. George's. 2,737 7,427 91 1898 2,427 2,172 1899 7,443 101 2,669 2,443 2,230 Difference + 10 + 58 - 68 + 16 + 16 Table IV. gives the birth-rate for Camberwell and its sub-districts, shewing a decrease as regards the whole Parish. The decrease of births in Peckham has more than compensated for the higher birth-rate which has prevailed in Dulwich and in St. George's. Table IV. —Birth-Rates of Camberwell and its Sub-Districts. Parish. Dulwich. Camberwell. Peckham. St. George's. 28.39 31.59 11.57 25.69 30.25 1898 1899 25.34 29.17 32.07 28.04 12.59 The total number of deaths registered in the Parish amounted to 4,941. From this number must be deducted the deaths which occurred in St. Saviour's Infirmary which amounted to 732. On the other hand there are to be added 484 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 4,693. The deaths of those persons belonging to the Parish and who died in institutions outside its boundaries have been duly re-distributed among those parts of the Parish whence 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 the Infirmary, among the four sub-districts of the Parish in proportion to the recorded deaths. It has doubtless been noticed by the members of the iii. Vestry that in the weekly returns the death-rate for Camberwell is always higher than the rest of the Parish, and indeed very often approaches the death-rate for London. I have, for the sake of comparison, given death-rate of the Table V.—Death-Rates previous to Re-distribution. Parish. Dulwich. Camberwell. Peckham. St. George's. 17.6 8.9 20.3 16.2 16.9 Parish and its sub-districts as we receive them, and then following the death-rate in Camberwell redistributed according 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. 72 85 .. 72 Dulwich + 13 1,964 1,244 1,475 — 720 Camberwell + 231 — 16 1,739 1,466 + 273 Peckham 1,482 1,175 + 219 1,394 St. George's 1,175 .. Parish 4,693 —736 3,957 + 736 4,693 to Table VI. By referring to Table VI. it will be seen how the deaths in Camberwell have to be reduced by 736, which number must be again distributed according to the registered number of deaths among the four sub-districts of the Parish, iv. Table VII.—Death-Rates in Camberwell and its Sub-Districts. Parish. Dulwich. Camberwell. Peckham. St. George's. 1895 20.03 16.75 18.88 9.85 21.28 1896 18.66 8.73 16.11 20.35 20.78 1897 16.98 8.69 14.31 18.98 18.91 1898 16.70 10.05 15.07 18.74 17.03 1899 17.68 10.60 15.30 19.01 19.05 Coming to the consideration of the death-rate for 1899, it is not so satisfactory as it might be if we look at it from the point of comparison with previous years, but if we take the death-rate for the whole of London, we shall find that it has gone up more than ours, and that we still occupy a favourable position with neighbouring parishes, which are almost identical with our own in character, district and population. Death-rates of London and its Sanitary Areas during the Fiftytwo Weeks of 1898, after Distribution of Deaths in Public Institutions. Principal Zymotic Diseases. Sanitary Areas. All Causes. Registration London 2.77 18.3 West London 17.0 2.48 North London 16.9 2.48 Central London 22.1 2.79 East London 21.7 3.59 South London 17.7 2.74 14.4 Wandsworth 2.40 Lee 14.9 1.97 Lewisham (excluding Penge) 15.3 2.50 Plumstead 16.3 2.85 South London. CAMBERWELL 16.4 2.41 Battersea 16.9 2.93 Lambeth 17.9 2.50 Greenwich 18.5 3.08 Rotherhithe 19.0 2.24 Woolwich 20.4 4.23 Newington 20.5 3.17 St. Olave 20.6 2.31 Bermondsey 20.7 3.02 St. Saviour 23.6 3.09 St. George-the-Martyr 24.4 3.99 Death-rates of London and its Sanitary Areas during the Fiftytwo Weeks of 1899, after Distribution of Deaths in Public Institutions. Sanitary Areas. All Causes. Principal Zymotic Diseases. Registration London 19.3 2.46 West London 18.0 1.91 North London 17.8 2.16 Central London 23.0 2.21 East London 22.9 3.17 South London 18.8 2.62 Wandsworth 15.3 1.89 Plumstead 14.3 1.35 Lee 15.1 2.06 Lewisham (excluding Penge) 16.3 2.23 Battersea 16.7 2.22 CAMBERWELL 17.4 2.52 Greenwich 18.8 2.76 Lambeth 19.2 2.65 Rotherhithe 21.1 2.80 Woolwich 21.2 2.44 Newington 24.0 3.67 Bermondsey 24.1 3.46 St.Olave 24.9 2.61 St. Saviour 25.1 3.51 St. George-the-Martyr 27.7 4.53 The increase is present all over the Parish, but is most marked in St. George's, where, in contrast to last year when we had a decrease, there has been a considerable increase. It is worth while pointing out further that there was a higher number of births, although this increase is not large enough to account for the higher death-rate through there being a much larger number of infants under a year. The Registrar-General's estimate of the death-rate for Camberwell is 17.4. The difference, I think, can be explained to some extent by the variation in our estimates of the population, and 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 from this Parish. 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 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 under its control shall be made on a uniform plan. It will be seen that in the latter there are two separate classifications for rheumatic fever and heart disease, while that for cancer is included under the head of "other diseases." There is also a heading for phthisis considered by itself and not included with other tuberculous diseases. I confess that I am unable to understand why this should be, since the disease in all cases has a common origin and differs clinically only on account of the different organs in the body that may be attacked. It is true that in the present stage of our knowledge the infection is considered more likely to arise in cases of phthisis owing to the expectoration of material which contains organisms required for the propagation of the disease. I have in previous years referred to the difficulty of classifying heart disease, which is a somewhat wide term, but as heretofore I have included all diseases both of the heart muscle and its valves. On comparing the figures for 1899 with those of 1898 it will be seen that deaths from accidental or other violence (in which are comprised cases of drowning) amounted to 156, compared with 124 in 1898. The deaths ascribed to developmental diseases (premature birth, etc.) and to convulsions of infancy numbered 341 and 105 as contrasted with 371 and 92 in 1898. Twenty-four deaths were ascribed to the immediate or remote effects of child-birth, and of that number 11 were ascribed to puerperal fever. This vii. is a matter for regret, as of all the diseases which are wrongly described as preventible puerperal fever most nearly deserves this adjective. Anyone can see this for himself by the records of the General Lying-in Hospital, where the death-rate from this disease has so markedly declined since the introduction of aseptic midwifery, yet this is a hospital where difficult cases are especially sent, and where operation, with its increased chances of septic infection, is so much more frequently needed. Among the "zymotic" diseases hooping cough caused 76 deaths, and measles 127 deaths, compared with 121 and 113 that were respectively ascribed to these two diseases in the previous year. The re-distributed figures considered in respect of these two diseases, as to the registration district in which they occurred, were as follows: — Camberwell, 22 and 34 ; Peckham, 28 and 43 ; and St. George's, 26 and 50. The deaths from influenza amounted in all to 97, as compared with 86 in 1898, and 31 in 1897. The disease was fairly equally prevalent in all the quarters except the summer when there was a marked diminution. There were in all 371 deaths due to diarrhœa and other inflammatory affections of the intestines, compared with 358 that occurred in 1898. Of these 18 occurred in the first quarter, 14 in the second, 322 in the third, and 17 in the fourth. In coming now to the age incidence of this disease, it will be seen that out of a total of 371 deaths, 339 occurred in children under the age of five years, and also that of the total number of the fatal cases 302 took place in the summer quarter. It is thus evident that many of these deaths were dependent on climatic conditions which prevailed during the summer months. Nineteen deaths occurred from scarlet fever, compared with 18 in 1898, and 32 in 1897. Three of these were of persons who had remained at home, while the remainder were of those who had been removed to hospital. The total number of notifications for this disease amounted to 1,175, including two that occurred in St. Saviour's Infirmary, among those who had been removed from places outside this Parish. This total compares with 937 certificates received during 1898. Of these viii. 19 deaths, 5 were of inhabitants of Camberwell, 7 of St. George's and a similar number of Peckham. Enteric fever caused 32 deaths, 19 of which were of those who had been removed to outside institutions. Camberwell is credited with 11 deaths, Peckham with 12, and St. George's with 9. The number of notification certificates and also the number of deaths from diphtheria has undergone a striking increase as compared with the previous year, in fact it is nearly the same as in 1898, although it is a good way behind 1897, when we were nearly at the top of the tree. Diphtheria and measles are the only instances in which Camberwell is above the average in the death-rates calculated by the Registrar-General so far as the "zymotic" diseases are concerned. The death-rate for the whole of London (which must be carefully distinguished from the attack rate) was .43 per thousand living in 1899, compared with .39 in 1898, the most marked decrease being in the central and west districts, but to compensate and more than compensate there is an increased number in the east and south. To illustrate this, especially in our own part of the world, I put below the figures for some of the Sanitary Authorities south of the Thames, which in most instances shew a greatly increased death-rate for the past year. Sanitary Areas. 1898. 1899. 1.04 St. George-the-Martyr 0.60 St. Olave 0.27 0.81 Bermondsey 0.51 1.03 Battersea 0.70 0.86 Rotherhithe 0.27 0.78 Lambeth 0.38 0.51 Camberwell 0.33 0.61 Lewisham (excluding Penge) 0.29 0.75 There has been an increased amount of notification in all the registration sub-districts; the increase, however, is more marked in Camberwell than in any other district, both for persons under and over the age of 5 years. In my report ix. for last year I mentioned that 24 persons were notified as suffering from diphtheria, when, in my opinion, diphtheria was absent both clinically and bacteriologically, and I am bound to confess that at the time of that report I considered that the adoption by the Vestry of means of offering bacteriological diagnosis would result in a diminution of the notifications from diphtheria; instead of that the exact opposite has occurred, and I think this can be explained by the fact that there are certain cases which have been notified during the past year as diphtheria, which in the absence of a bacteriological examination would be considered as non-specific. At the beginning of November the Heber Road Board School was closed. During the whole of October I had kept a careful look-out on this school, as it seemed to be having more than its fair share of diphtheria, especially as the other schools in the neighbourhood were at this time pretty free from the disease. The report, which was presented to the Vestry on November Ist, and on which they decided to close not only the Infants' Department, but the whole school is appended below. The school was closed for three weeks. [Copy.] November 1st, 1899. Dear Sir, —I have to report that since October 2nd there have been 27 primary cases of diphtheria at the Heber Road Board School and that the incidence of the disease has been especially on the infants' department and to a lesser degree on the girls' department. The total number of primary cases notified in the Parish for the similar period was 159, the aggregate of both primary and secondary cases being 179. From the inquiries I have made at the houses and at the school I find that the first one in a household to be attacked was in the infants' department in 20 instances, while in the remaining seven the illness started from one who was attending the girls' school. In no instance was anyone in the boys' department the first to be attacked. The average attendance for the infants' school for the week ending October 27th was 599, and the infants in two classes were especially affected, and to a lesser degree was a third division involved. The disease being decidedly on the increase I made arrangements on October 27th to take some cultivations from the throats of five children taken at random from two classes where the disease, judging from the notifications received, was most prevalent at the time. This was accordingly done on October 30th, and the result of the examination by Dr. Bousfield shewed that in one case diphtheria bacilli were present; in another X. specimen their presence was doubtful; while in three the specific microorganisms were not discovered. To my mind, however, the one positive result is worth more than the four negative, for it points absolutely to the fact that there is one child at least attending the school with the throat containing the organisms which are considered to be the cause of the disease, although the characteristic clinical signs were absent. It is difficult to contend that this child happened to be the only one affected out of 55 who were attending these two classes on October 30th. I am quite alive to the factors which render school-closing in a crowded locality a much less satisfactory measure than it would be in the country, but so far as I can make out after a consideration of the milk supply and of the various other places of meeting where infection might be conveyed I have come to the conclusion that attendance at the infants' department of Heber Road Board School, and to a lesser degree at the girls' section, is the principal factor common to all the cases I have mentioned. The number of primary cases occurring at the other schools in the neighbourhood is exceedingly instructive. For the same period the maximum at any one school was three at St. John's School, while Goodrich Road Board School, which is situated near Heber Road and draws very much the same class of children, had no primary cases of diphtheria during the month. I therefore, as Medical Officer of Health, advise that the infants' department be closed for a period of three weeks, and my strongest reason is the discovery of the diphtheria bacillus in a child actually attending school. Will you therefore kindly put this report before the Sanitary Authority so that they may consider whether my advice is to be carried out and the infants' department of Heber Road Board School accordingly closed? —Your obedient Servant, (Signed) FRANCIS STEVENS, Medical Officer of Health. The Chairman, Sewers and Sanitary Committee. Taking a period of three weeks, after the closure of the school, I find that there were 7 primary cases of diphtheria notified among children who were pupils of that school. Of these, I came from the Boys' Department, 2 from the Girls', and 4 from the Infants'. In three of the cases I should say that the illness had started when the School was closed. The decline of the disease as shewn, especially in the number of first persons attacked being of school age, is so marked that I do not think it can be explained by the theory of the disease having, as it were, burnt itself out by all those who were susceptible to diphtheria having been attacked and excluded, but rather to the destruction of the focus of infection by the closure of the school. xi. About the same time there was a rather undue incidence of the disease on St. Mary's School, Albert Road, and also on George Street Board School and some other schools in the neighbourhood of Nunhead. Closure of the schools was not called for, as there was nothing in the progress of the series of cases that would lead one to believe that there was an undiscovered focus of infection still attending the school, and in the case of St. Mary's School there was not the fact present of that school being especially attacked while the remaining schools in the immediate vicinity practically entirely escaped. In my report for last year I mentioned the fact first described in a report to the International Congress of Hygiene in 1894, by Professor Welch, of Baltimore, that virulent diphtheria bacilli had been found after the lapse of so long a period as seven weeks from the disappearance of the membrane from the throat; and subsequent experiments by various observers have placed the correctness of this assertion beyond dispute. This has such an important bearing on the time which should elapse before the return of children to school after they had had diphtheria, that I sent out a circular letter to all the public and private schools whose existence I was aware of, stating that occasionally children had returned to school without a certificate of disinfection having been sent by us, pointing out that we often intentionally delayed the issue of this certificate, and also drawing attention to the necessity of having a bacteriological examination made of the throats before the children return to school. We now also send a letter to the head of the house where a child is attacked, saying that it will not be possible for the children to attend school again until a notice of disinfection has been sent by us to the school. I should withhold a certificate of disinfection in cases where children had remained at home until I had had an opportunity of taking a specimen for bacteriological examination, but not in the case of those removed to the Metropolitan Asylum Board's Hospitals as I understand that bacteriological examinations are made as a matter of course before the child is returned to its home. The heads of the school can therefore co-operate with xii. me by refusing to accept any certificate of disinfection except my own, and not from any medical man unless he has made a bacteriological examination. In many cases I have had this co-operation; those teachers who have followed my advice by only accepting my certificate, I have to thank, and to express the hope that those who have not done so will see the advantage that must accrue to the school in which they are interested from the adoption of such a system of preventing the resumption of school attendance by children who may still be infectious, although apparently quite recovered. I append below the percentage of fatal cases in relation to the number of persons attacked by diphtheria and scarlet fever since the year 1895. Case Mortality op Diphtheria and Scarlet Fever. Diphtheria. Scarlet Fever. 1895 19.5 5.3 18.4 1896 4.2 2.7 1897 14.3 1.9 1898 12.4 1.6 12.7 1899 In May measles was very prevalent all over the Parish, but specially in the neighbourhood of Gloucester Road Board School, and at one time it seemed as if that school were an agent in the propagation of the disease, and it was accordingly disinfected by your officials under my superintendence. From a careful consideration of the circumstances I have come to the conclusion that attendance here was not the sole agent, because I found on making inquiries where the cases had been notified to me from the school that the disease seemed to select particular streets, and houses adjoining those where there had been outbreaks of the disease seemed very likely to be attacked, although the children may have attended quite different schools. xiii. The disease among the school children was not of a fatal type. In January of this year we started sending out a circular letter relating to consumption, and offering disinfection to all private houses where a death had occurred. In a certain number of cases our offer has been accepted, a much larger number, I regret to say, took no notice of our letter, while a not inconsiderable proportion in their reply stated that precaution had been taken throughout the disease with regard to the avoidance of any spread of the infection. In consequence of representations made to the Sewers and Sanitary Committee by myself regarding the necessity for more extended registration of houses let in lodgings it was decided by that body to appoint a Sub-Committee to inspect these premises after I had recommended them for registration, and before any resolution to that effect was submitted by the Committee. The Vestry, however, passed "the previous question." The By-laws, therefore, relating to Houses let in Lodgings are practically only in force in the district round Hollington Street, although it is my opinion that other parts of the Parish are equally suitable for registration in this way, and it was my intention that the houses on which the discussion arose should be the starting-point of a much wider registration than has heretofore existed. In regard to the notification of infectious diseases, we have been requested several times during the year to withdraw certificates by the Metropolitan Asylums Board, on the ground that although the illness had occurred in our Parish, the person attacked had been removed to an institution in Camberwell from an outside district, therefore according to law the Medical Officer of Health of this outside district was the one to be notified, notwithstanding the fact that judging from the time of removal to the onset of the disease this must have been contracted in Camberwell. As we were bound by law so to do their wishes were duly carried out. It, however, seems to me to be a most serious disadvantage of the law that the Medical Officer from whose district the patient has been removed is the only one to be xiv. notified. Under the head of hospitals are reckoned such institutions as the infirmaries, it consequently amounts to this, that an epidemic of diphtheria might be very prevalent in the St. Saviour's Infirmary which would be officially absolutely unknown to me, the notification of such persons as they relate to, having been removed from St. Saviour's, would be sent to the Medical Officer for that district; similarly if a number of persons who came from the country are removed to the Infirmary the cases would have to be reported to the Medical Officer for that district whence they came, and not to me. In consequence of this, I have made arrangements that such cases should be notified to me, and that the Vestry should themselves defray the expense of such notification without asking for the amount to be returned by the Metropolitan Asylums Board, as would be done in the case of any other certificate. List of Houses, Bedding, Clothing and Miscellaneous Articles Disinfected by A. Yates and Staff, from January 1st, 1899, to January 1st, 1900. Houses. Lots including Beds. Blankets. Sheets. Pillows. Cushions. Mattresses. Palliasses. Quilts. Clothing. Carpets. Sundries. Bolsters. 3294 11890 7640 13850 6313 3675 5240 2456 8315 30000 2620 60000 17580 16070 Articles destroyed in Cremator by Owner's Orders—lnnumerable. The work of the Bacteriological Department started in real earnest on January Ist, 1899, it being carried on as an independent department over which I have no control. The material is sent direct from the medical men to the Bacteriologist, and I am entirely dependent on the courtesy of Dr. Bousfield for letting me know of any specimens which have been so sent. To my mind it would be much better to have a counterfoil which should be sent to me by the medical man at the same time as the material is sent to the Bacteriologist. This would keep me in touch with the suspicious cases of sore XV. throat, and would avoid any delay which might be caused by the material being sent to me in the first place before transmission to the Bacteriologist. Table XIV. gives the work carried out by your Inspectors during the past year arranged in tabular form under the head of each Inspector. The total number of house to house inspections amounted to 6,206, as compared with 6,902 in 1898. The complaints numbered 1,155, while the inspections made in consequence of such complaints amounted to 1,381. The diminution in the house to house inspections is accounted for by the fact that Inspector Stevenson was superannuated at the end of June, and in consequence of Inspector Groom being appointed Inspector under the Food and Drugs Act before his successor was appointed, I took him off house to house work so that he only attended to complaints and fevers, in addition to carrying out his new duties. The complaints, as nearly as possible, amount to the same number as last year. There was an increase of over 1,000 in the number of inspections of new buildings, and as I have before pointed out their supervision takes up much time, which is only to be realised by those who have to do with work of this sort. As a result of the house to house inspections, the complaints referred to above and the occurrence of infectious disease, 4,678 intimations were served, followed up in 987 instances by statutory notices, 36 of which referred to houses let in lodgings. Furthermore, in 142 cases it was necessary to issue summonses to enforce the requirements of the Committee. There were 508 inspections of cowhouses and dairies and slaughter houses, excluding the inspection made by myself of each of these premises. All our requirements were satisfactorily complied with before the meeting of the Licensing Committee of the London County Council, so that in no case had we to offer any opposition to the renewal of the license. There were 311 inspections of bakehouses. The superannuation of Inspector Stevenson left his district at our disposal, and I have partitioned it between xvi. Messrs. Eagle, Heath and Homer. I cannot, however, look upon this plan with approval, as I still think another Inspector should be appointed, but it seemed the best way to secure some sort of supervision for the division formerly under the inspection of Mr. Stevenson. The Committee in December, 1898, owing to the illness of Mr. Griffiths, the then Notification Clerk, authorised me to appoint a temporary assistant, and Mr. H. K. Wright was accordingly so appointed, and has remained in the service of the Vestry ever since, as the illness of the Notification Clerk practically lasted all the year and terminated in his death in the beginning of 1900. While he could, Mr. Griffiths did his work with all his old care and intelligence. The house to house register has been kept up to the best of his ability by Mr. Wright, but I do not think we can ever deal with this task satisfactorily until we have a clerk especially devoted to this work, who would practically keep up a biography of each house, setting forth any occurrence of death, fever, &c. In conclusion, I have to express my thanks to the Inspectors and Clerks for the assistance they have always cheerfully rendered me, and in an especial measure to the Senior Clerk, Mr. Gower, for help in prepartion of this report and in many other ways. I am, Gentlemen, Your obedient Servant, FRANCIS STEVENS. xvii. TABLE XIII. RETURN OF WORK PERFORMED IN THE SANITARY DEPARTMENT DURING THE 52 WEEKS ENDING DECEMBER 30TH, 1899. PUBLIC HEALTH (LONDON) ACT, 1891. TABLE A. Description of Work. Inspectors. Totals. Stevenson. Groom. Pointon. Eagle. Chadderton. Scudamore Collins. Heath. Kerslake. Morley. Homer. Farmer. Dewey. Complaints 36 106 67 118 64 117 42 1 41 111 83 160 99 11 1155 Inspections arising from Complaints 55 107 67 113 65 173 68 139 133 92 224 129 16 1381 House-to-House Inspections 159 220 525 747 814 280 202 649 628 632 655 619 76 6206 No. of inspections of Bakehouses 5 2 38 13 19 41 35 4 14 47 33 45 15 311 0 Do. do. Cow-houses and Dairies 6 1 15 5 9 0 26 2 26 54 5 0 149 Do. do. Slaughter-houses 0 0 25 5 0 41 93 6 4 90 41 53 1 359 Do. do. Laundries 2 1 49 9 9 27 12 8 8 16 21 32 1 195 187 Do. do. Infectious Cases 64 180 253 229 169 322 144 299 202 191 200 63 2503 Do. do. Schools, Board 30 26 110 5 12 43 43 6 1 19 53 28 7 383 Do. do. do. Private 9 0 48 2 9 13 16 3 8 26 0 1 0 135 Do. do. Workshops 2 2 19 37 28 12 21 17 37 25 25 16 3 244 Do. do. Sanitary Conveniences, Public Urinals, &c. 11 22 50 4 26 41 0 8 417 47 61 91 0 56 No. of inspection of Sanitary Conveniences, Private Urinals, &c. 81 104 111 187 151 175 70 263 155 171 7 1894 215 204 No. of inspections of Railway Stations 0 0 54 28 8 0 87 0 3 0 0 27 0 207 Houses Let in Lodgings Inspected 0 0 3 0 0 18 0 0 27 3 0 0 0 51 Tenement Houses Inspected 0 88 0 52 107 22 17 247 99 10 0 0 17 659 Miscellaneous Inspections 0 6 1 5 28 0 50 3 54 24 10 1 9 191 Intimations served under the P.H. Act 135 238 293 580 292 335 176 627 581 473 384 465 99 4678 Summonses taken out under the P.H. Act 0 5 2 3 15 7 22 33 14 8 29 0 142 4 Notices served under the P.H. Act 10 77 26 108 38 81 55 155 125 77 72 145 18 987 Do. do. Houses Let in Lodgings 0 0 0 0 0 0 16 0 20 0 0 0 0 36 Re-Inspections of Works in hand 1048 3103 4275 4148 3639 3113 2936 3870 5008 4074 4323 4442 309 44288 Infectious Diseases 94 87 77 117 65 379 200 234 59 122 28 67 66 1595 New Buildings Inspected and Re-Inspected 21 60 132 4 136 818 1127 238 194 67 42 285 1 3145 TABLE B. Reconstruction of Old Drains Completed 123 100 188 56 77 123 107 79 137 6 1267 TABLE XIII.—continued. TABLE C. Description of Work. Totals. Houses Ventilated on Staircase 605 „ „ under Floors 611 „ Cleansed 1185 „ Repaired (Gutters, &c.) 185 Water Supplied to Premises 262 Drains Cleansed, Repaired and Trapped 2170 Sinks, Rainwater Pipes, &c., Disconnected 665 Stables, Yards and Areas Paved, Levelled, and Drained 1122 Closets Provided, Repaired, Cleansed or Removed 1648 Water Laid on to Closets 1503 Cisterns Provided or Reconstructed 173 „ Repaired, Covered or Cleansed 278 Dustbins Provided, Repaired, or Removed 748 Cesspools Emptied, Abolished, or Drained into Sewer 6 Refuse or Manure Removed 589 Animals, &c., Removed, or to be Kept Clean 34 Private Urinals, Cleansed and Supplied with Water 70 Public „ „ „ 6 Overcrowding Abated 107 Smoke Nuisances Abated 38 Trade Nuisances Abated 17 Manure Pits Supplied 126 Interceptors and Chambers Supplied 400 TABLE D. —SALE OF FOOD AND DRUGS ACT. - Samples Submitted for Analysis 549 Summonses under the above Act Seizure of Unwholesome Meat Inquests 286 Bodies Removed to Mortuary 286 Post-Mortem Examinations 104 XX. TABLE XIV. MORTALITY RETURNS Of ZYMOTIC DISEASES QUARTERLY FOR THE LAST SIX YEARS. Year. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Fever. Small Pox. Diarrhœa. Influenza. 1894. Ist 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. Ist 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. Ist Quarter 73 15 52 0 14 8 146 13 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 2 6 51 6 5 17 34 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 14 4 0 292 4 4 4 4th „ 15 4 5 26 10 0 18 11 1899. Ist Quarter 18 6 23 4 0 36 44 18 2nd „ 23 49 2 25 0 0 14 29 3rd „ 8 39 5 42 11 0 322 4 XXI. TABLE XV. ANNUAL MORTALITY RETURN OF ZYMOTIC DISEASES, FROM 1856 (inclusive). Year. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Fever. Small Pox. Diarrhœa. 1856 32 48 30 19 5 29 1857 30 7 44 24 4 50 1858 129 14 26 51 28 20 7 1859 66 82 ? 31 12 1860 36 40 34 11 26 5 ? 1861 25 2 ? 72 8 13 25 1862 53 32 101 40 64 0 ? 1863 57 32 124 29 41 14 ? 61 29 83 16 51 10 ? 1864 1865 118 52 39 55 14 31 12 1866 72 38 59 11 53 35 76 1867 64 20 75 8 41 9 67 58 71 45 13 146 1868 67 17 9 1869 134 43 164 9 46 133 1870 49 24 192 10 57 23 160 1871 50 29 60 9 40 153 143 1872 41 124 132 46 86 1 38 1873 60 49 7 7 38 2 137 1874 76 54 24 9 57 2 93 125 64 177 14 40 1 107 1875 1876 93 78 16 31 32 126 33 1877 61 72 38 12 27 124 94 1878 206 88 59 29 41 81 176 1879 122 76 35 80 75 123 31 223 1880 206 59 126 32 36 33 1881 74 95 120 29 44 190 127 1882 180 168 76 60 44 66 100 91 112 48 49 19 122 1883 35 1884 173 171 82 78 40 34 240 1885 136 91 20 68 27 154 135 1886 156 97 18 48 30 2 215 203 133 99 41 0 239 1887 71 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 21 142 67 29 56 1 1892 128 189 63 85 21 1 169 1893 104 78 80 118 30 11 213 126 164 45 193 21 2 115 1894 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 1899 162 0 76 127 19 32 371 Under the head of fever I have only included the deaths from enteric fever. TABLE VIII.-Returns of Births and Deaths for the Years 1898 and 1899. BIRTHS. DEATHS. ACCORDING TO AGE. ACCORDING TO DISEASES. Pneumonia, Bronchitis, &c. Diarrhœa, Dysentery, &c. Between 10 and 20. Between 50 and 60. Between 60 and 70. Between 70 and 80. Between 80 and 90. Premature Birth or Defective Vitality. Between 20 and 30. Between 30 and 40. Between 40 and 50. Child-birth. Chronic Diseases. Between 5 and 10. Violence, Poison, and Accident. Hooping Cough. Between 1 and 5. Convulsions of Infancy. Scarlet Fever. Enteric Fever. 90 and upwards. Erysipelas, Pyæsmia, &c. Alcoholism. Diphtheria Influenza. Small Pox. Tubercle. Under 1 Year. Cancer. Measles Non-febrile Affections. Puerperal Fever, &c. M F MF M F MF Under 5. Under 5 years. Over 5 years. Over 5. 1898. I I 66 Dulwich 5 16 8 0 4 1 2 1 1 53 38 91 33 33 7 4 0 4 4 1 4 9 4 3 2 0 1 0 0 1 0 0 0 2 0 8 3 37 170 191 102 184 109 13 Camberwell 1202 1225 2427 840 800 1640 378 19 34 79 114 154 160 217 114 10 33 134 19 2 3 7 45 33 2 10 8 39 0 223 103 7 600 Peckham 125 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 4 4 387 St. George's 84 1101 1071 2172 464 457 921 340 139 26 26 37 47 63 78 74 60 29 2 33 95 36 3 3 6 17 28 1 13 5 17 0 142 34 111 90 3 3 197 Totals 3743 3684 7427 2012 1984 3996 528 69 227 317 365 414 414 211 98 366 91 10 4 39 84 0 536 206 344 365 320 21 15 1221 1161 99 171 20 7 16 120 112 21 1899. I I i i I i I I I [ I Dulwich 4 0 1 37 54 47 101 27 43 70 9 1 1 3 6 6 4 5 14 10 10 1 2 1 2 0 0 0 0 0 0 0 0 2 0 12 5 3 1 Camberwell 1250 1193 2443 927 868 1795 361 169 22 45 79 123 177 192 249 231 139 8 48 112 32 5 5 12 21 33 0 21 5 39 0 240 94 106 217 102 9 19 677 Peckham 1398 1271 2669 692 637 1329 420 165 32 39 61 74 86 109 135 139 64 5 31 128 40 3 5 2 26 43 1 14 6 34 0 173 48 94 150 123 8 9 391 St. George's 1147 1083 2230 532 483 1015 356 180 38 26 33 58 57 92 83 71 16 5 33 94 31 4 1 2 23 50 2 18 2 22 0 134 17 119 114 109 10 3 227 3594 261 324 398 481 114 335 53 322 485 335 27 32 1330 3849 7443 2178 2031 4209 1146 515 93 113 179 451 229 19 105 12 11 16 70 126 3 13 97 0 559 164 TABLE IX.—Returns of Births and Deaths for the Years 1898 and 1899. DEATHS. BIRTHS. ACCORDING TO AGE. ACCORDING TO DISEASES. Between 50 and 60. Between 60 and 70. Between 70 and 80. Premature Birth or Defective Vitality. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Enteric Fever. Influenza. Small Pox. Tubercle. Cancer. Pneumonia, Bronchitis, &c. Diarrhœa, Dysentery, &c. Between 5 and 10. Between 10 and 20. Between 20 and 30. Between 30 and 40. Between 40 and 50. Between 80 and 90. 90 and upwards. Violence, Poison, and Accident. F MF F MF Under 1 year. Between 1 and 5. Convulsions of Infancy. Child-birth. M M Under 5 years. Over 5 years. Under 5 years. Puerperal Fever, &c. Erysipelas, Pyæmia, &c. Non-febrile affections. Over 5 years. 1898. I I I I i 1st Quarter 98 110 138 141 81 10 26 82 32 2 1 3 35 64 0 11 4 56 0 156 50 122 166 13 0 247 191 19 23 56 68 982 960 1942 576 606 1182 2nd Quarter 105 85 39 4 27 66 20 2 0 3 40 40 2 12 5 14 0 118 33 65 85 10 6 129 19 19 35 61 71 81 877 886 1763 418 414 832 184 65 99 23 120 22 3 1 3 31 4 2 2 4 4 0 137 58 62 32 268 12 3rd Quarter 474 120 17 22 40 43 71 75 39 1 969 923 1892 575 491 1066 4th Quarter 106 89 98 17 14 4 0 14 8 10 0 125 65 95 82 29 3 88 14 35 40 55 77 99 52 5 22 3 5 7 915 915 1830 443 473 916 256 Totals 171 227 317 365 414 414 211 20 98 366 91 10 7 16 120 112 4 39 21 84 0 536 206 344 365 320 21 3743 3684 7427 2012 1984 3996 1161 528 69 99 1899. I I I I I I I I I i i I 141 104 65 73 144 149 56 8 28 77 33 2 0 1 42 18 1 14 1 36 0 36 168 11 5 924 1936 1060 203 161 27 28 45 101 1st Quarter 1012 523 537 58 85 52 72 24 3 21 49 0 8 0 29 0 122 44 65 86 7 5 884 1828 203 115 19 29 43 62 79 108 3 34 3 5 2nd Quarter 944 414 442 856 62 45 86 24 4 7 38 0 13 4 4 0 144 36 32 46 302 16 888 123 27 25 33 70 105 88 81 2 29 2 3 3rd Quarter 966 1854 634 514 1148 487 76 100 5 6 21 2 8 28 0 152 48 185 15 1 20 31 58 76 119 113 141 136 6 23 24 5 0 18 121 4th Quarter 927 898 1825 607 538 1145 253 116 Totals 3849 3594 7443 2178 4209 1146 515 93 113 179 261 324 398 481 451 229 19 114 335 105 12 11 16 70 126 3 53 13 97 0 559 164 322 485 335 27 2031 TABLE X.—Supplemental Return of the Deaths of Parishioners dying in Institutions outside the Parish. ACCORDING TO DISEASES. ACCORDING TO AGE. 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. 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. Alcoholism. Chronic Diseases. 1899. Non-febrile affections Puerperal Fever, &c. Under 5 Over 5 Under 5 Over 5 Dulwich 1 1 2 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 Camberwell 75 66 141 10 35 16 7 16 14 13 14 12 4 0 0 8 1 0 0 0 3 1 1 5 42 6 0 0 13 9 3 5 1 2 0 41 Peckham 77 76 153 9 40 16 9 13 20 15 14 13 2 2 0 22 2 0 0 0 3 2 0 6 31 6 0 0 21 9 2 4 1 0 0 44 St. George's 83 77 160 16 34 17 13 14 18 26 12 7 2 1 0 12 3 0 1 0 3 3 0 5 35 7 0 0 22 14 1 3 2 2 1 46 Unclassified 12 16 28 0 0 0 0 2 5 1 1 6 12 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 2 0 2 0 1 0 18 1st Quarter 51 48 99 9 17 5 8 9 16 9 9 11 4 2 0 6 1 0 0 0 2 2 0 5 9 3 0 0 15 5 1 4 0 2 0 44 2nd Quarter 2 56 55 111 8 24 12 5 13 12 14 8 7 8 0 0 14 2 0 0 0 2 0 2 17 0 0 0 16 9 1 1 0 2 0 43 1 3rd Quarter 62 69 131 13 28 5 12 14 17 19 8 12 3 0 0 12 2 0 0 0 3 1 5 29 7 0 0 15 12 0 2 3 1 0 38 4th Quarter 1 79 64 143 5 41 11 11 18 12 14 16 8 5 2 0 10 1 0 1 0 2 0 4 54 9 0 0 15 9 4 7 1 0 1 24 248 236 484 35 110 49 45 56 41 38 20 4 6 0 1 0 16 109 19 0 0 35 6 4 5 1 149 29 6 57 42 0 9 1 61 14 Totals Table XI.—RETURN REQUIRED BY THE LOCAL GOVERNMENT BOARD. Deaths during the Year 1899, 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 20 21 14 15 1.6 17 18 19 22 At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Small Pox. Diphtheria. Membranous Croup. Cholera. Erysipelas. Measles. Hooping Cough. Diarrhoea and Dysentery. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Fevers. Rheumatic Fever. Scarlatina. Typhus. Puerperal Enteric or Typhoid. Continued Relaps in g. Dulwich Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 ... ... 2 4 10 ... 30 70 9 1 2 6 22 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... 1 10 4 3 2 40 60 ... ... Camberwell Under 5 ... ... 10 1 ... ... ... ... ... ... 1 21 19 94 ... 99 2 9 8 194 458 ... 314 1103 144 32 37 325 251 5 upwards ... 8 1 ... 3 ... 3 3 3 9 4 83 127 67 27 10 297 ... ... ... ... 645 Peckham Under 5 ... 7 3 ... ... ... ... ... 38 25 123 ... 93 1 ... ... ... 4 4 16 268 582 359 269 1313 418 164 53 50 5 upwards ... 77 ... 1 4 ... 6 ... ... 5 ... ... 4 1 8 7 93 149 27 15 334 731 St. George's Under 5 ... ... 2 9 2 .. .. .. ... ... ... 45 23 109 2 119 1 5 18 201 536 ... 1015 356 180 47 34 266 132 52 5 upwards ... 7 ... 2 ... ... 1 .. 1 5 ... 10 5 75 114 17 15 175 ... ... 479 ... Workhouse (Constance Rd.) Under 5 ... ... ... ... ... 1 1 ... ... 6 ... ... ... ... ... ... ... ... ... 8 .. ... 146 110 7 1 28 ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 24 5 1 101 138 ... 1 Workhouse (Gordon Road) ... ... ... ... ... . Under 5 ... ... .. ... ... ... 1 ... ... ... ... 1 ... 3 ... ... ... 16 2 1 5 8 ... 5 upwards ... ... ... ... .. ... ... ... ... .. .. ... ... 1 2 3 7 ... ... ... 13 ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... Lunatic Asylums 80 ... ... 55 22 ... 3 5 upwards ... ... ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... ... 6 4 66 80 Camberwell Infirmary Under 5 ... ... ... 7 ... ... ... ... ... ... .. ... 8 2 ... 1 6 ... ... 1 39 64 466 40 24 5 22 250 125 5 upwards ... 1 1 .. ... 1 ... 2 ... 2 ... 1 71 62 39 2 27 193 402 ... ... ... St. Saviour's Union Infirmary ... Under 5 ... ... ... ... 1 1 3 12 ... 2 ... 1 ... ... ... ... ... ... ... 24 44 13 417 240 732 31 5 26 5 upwards ... ... ... 2 ... ... 3 ... ... 58 ... ... .. 1 2 1 224 100 ... 8 289 688 Under 5 ... . ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TOTALS Under 5 2 26 6 ... ... 2 114 72 347 ... 7 322 6 18 46 737 1705 ... ... .. .. ... 1727 1187 4941 1177 528 144 178 5 upwards 1 20 1 15 ... 8 1 29 569 585 305 79 ... ... .. ... 12 13 19 77 1502 3236 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto Under 5 ... 70 ... ... ... ... ... 9 ... ... ... ... 1 6 4 ... 2 6 11 35 144 .. 110 201 40 484 35 64 34 ... ... 5 upwards 7 39 ... ... 19 ... ... ... ... 1 .. ... 5 ... 38 14 33 31 153 340 ... ... ... 44 Deaths occurring within the district among persons not belonging thereto Under 5 ... ... ... ... ... 1 1 3 12 ... 2 .. ... .. ... ... 1 24 240 732 31 13 5 26 417 5 upwards ... ... ... 2 ... 1 ... ... ... ... ... 3 2 1 224 100 58 ... 8 289 688 Table XII .—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 1899, in the Parish of Camberwel l; 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. 6 12 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 7 8 9 10 11 13 Census 1896. Estimated to middle of 1899. Small Pox. Scarlatina. Diphtheria. Cholera. Scarlatina. Diphtheria. Membranous Croup. Fevers. " I Membranous Croup. Fevers. Small Pox. Erysipelas. Erysipelas. Cholera. Continued Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. Enteric or Typhoid. Typhus. 7519 8018 101 Under 5 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... .. ... ... Dulwich 5 upwards ... 19 9 ... 4 ... ... 8 5 ... ... 4 ... ... ... ... ... 6 .. ... ... ... ... ... ... ... Camberwell 90286 Under 5 112 168 ... 1 ... ... ... ... ... 70 127 1 ... ... ... ... ... ... 3 7 ... ... ... ... ... ... 96379 2443 5 upwards ... 313 350 2 ... 176 210 27 1 ... 2 ... 6 ... ... ... 60 3 6 ... 79 ... ... ... ... ... 1 Peckham 88242 91476 2669 Under 5 1 162 113 7 ... ... ... ... ... ... 4 ... ... 1 116 84 2 ... ... ... ... ... ... ... ... 356 235 2 1 62 ... 8 35 ... ... 2 ... 6 ... 2 73 1 150 153 1 1 5 upwards 1 ... ... .. ... 1 67029 69520 2230 ... 61 141 10 ... ... ... ... 3 ... 39 105 2 ... ... ... ... Under 5 ... ... ... ... ... ... ... ... St. George's 5 upwards 1 48 1 117 150 34 1 ... 1 6 ... ... 143 ... 1 ... 5 76 ... ... ... ... 218 ... ... ... ... ... ... Under 5 ... ... ... ... .. ... ... .. ... ... ... ... ... ... ... ... ... ... .. ... ... ... .. Workhouse (Constance Road) ... . ... 5 upwards ... .. ... ... ... ... ... ... 8 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... Under 5 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... Workhouse (Gordon Road) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 5 ... ... ... ... 1 ... ... ... 5 ... ... 5 upwards 1 ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lunatic Asylums ... ... 1 .. ... ... 5 upwards ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Camberwell Infirmary ... ... .. Under 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... 1 ... ... ... ... 4 ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... St. Saviour's Union Infirmary ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... 5 upwards ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 11 Cases reported from St. Saviour's Infirmary as being removed thither from places within the St. Saviour's Union. Under 5 ... ... ... ... ... ... ... ... ... 5 upwards ... 1 1 ... 6 ... ... ... ... 42 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... .. ... Under 5 ... ... ... ... ... ... ... .. ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... .. ... ... ... ... ... ... ... ... ... ... 253076 265393 7443 Under 5 1 339 20 ... 1 ... 1 ... ... ... ... 2 .. 437 ... 15 1 226 316 4 ... ... ... ... ... ... 102 2 ... 5 ... 25 ... ... TOTALS 5 upwards 2 836 814 4 1 183 6 ... 19 ... 294 ... ... 2 451 519 1 1 Camberwell, London. Report of the Bacteriologist. (DR. E. C. BOUSFIELD.) ORDERED TO BE PRINTED BY THE SEWERS AND SANITARY COMMITTEE. LONDON: G. MORRISH, PRINTER, 114, CAMBERWELL ROAD, S.E. Report of the Bacteriologist. BACTERIOLOGICAL DEPARTMENT. The chief business of the Department has naturally been the examination of material from suspected cases of diphtheria. Of these, 426 have been received. The specific bacillus was found in 207, whilst 192 gave a negative result, and in 27 it was found impossible to decide with certainty. A large experience of specimens examined on behalf of the Lords of the Admiralty having shown that the negative or doubtful result of a first examination was not absolutely reliable, the practice has for some time past been adopted of making a second examination in all such cases, with the result that in several the specific organism has been detected. The reason is, that when only very few diphtheria bacilli are present, the colonies which spring from them may easily be missed at the first search, but, when the progeny of the original bacilli are spread over the surface of the medium, the preferential growth which they show upon the latter enables them to be far more easily detected. Having tried several media, I now invariably use Kanthack's. Its transparency is a great advantage, and it certainly gives the diphtheria organisms a start over nearly all others. It has frequently been found possible to report positively within nine hours of the receipt of the material, a matter of the greatest consequence. Appended to this report will be found a chart showing the number of notifications of diphtheria and membranous croup (which must be regarded as identical), the number of specimens received, and the number of deaths, in each fourweek period during the year. The total number of notifications was 1,338, and of deaths 193, a case mortality of 14.42 per cent. I would remind the Vestry that the total case mortality shown by the Chicago returns, which I had the honour to bring under its notice some time ago, was about 6 per cent. This was on more than 3,000 cases, all of which had been proved to be true diphtheria by bacteriological examination, and the same can by no means be said of the cases notified in Camberwell. Allowing 25 per cent. deduction (only half that justified by the figures of this department, and by the result of similar examinations in the cases notified in Chicago and elsewhere) the case mortality in Camberwell rises to very nearly 20 per cent. In other words, had the same results been obtained here as in Chicago, 120 persons who have died of diphtheria during the year would now have been alive. Furthermore, not a single death occurred among more than 300 cases treated with anti-toxin in Chicago on the first day of the disease. The reason for the terrible discrepancy in the two places is probably due to two factors. The most important is clearly the failure of two-thirds of the medical men of the Parish to make any use whatever of the means of early diagnosis, and treatment with the only remedy known to be effectual, which have been freely provided by the Vestry. Upon this side of the question there is nothing more to be said. The Vestry has done all that lies in its power, and lam unable to suggest any other provision which it can make. With the other factor, the ignorance or apathy of the general population, it may be possible to deal to some extent, and I would suggest that a circular should be widely distributed throughout the Parish pointing out the importance of neglecting no cases of sore throat among children, and the fact that there is a cure available which is practically certain if used at once, and which is in itself sufficient to cure when properly administered. It is highly desirable to educate the population, if possible, up to the point of making them demand the use of the remedy. It would also be very desirable to make clear to the minds of the profession and the public alike the fact that patients who have had diphtheria may remain in an infectious state for three months. A great step in advance would be gained if medical men would send swabs from convalescent cases at weekly intervals until the bacilli had disappeared. The new series of examinations, those of tubercular material and of the blood in suspected cases of typhoid fever, have not been made use of to any great extent. Fourteen specimens of tubercular sputum have been received, in seven of which a positive result was obtained. Eight specimens of blood have been examined, in four of which the typhoid reaction was obtained. It is to be regretted that these means of diagnosis, both of which are almost absolutely certain in their results, have not been more largely used, especially as the medical men of a neighbouring Parish appear to do so to a much greater extent. The method of collecting the blood is very simple. It is only necessary to prick the lobe of a clean ear with a surgical needle, and receive the blood in a lymph tube, which is then sealed at both ends. Care need only be taken not to burn the blood in the sealing. Two of the photographs appended to this report shew the very characteristic appearances obtained by the Widal method in typhoid fever. I place a drop of the blood-serum and a drop of the dilution of a young culture of typhoid bacilli side by side upon a cover glass, and join the edges by a narrow line of fluid. This allows of a slow mixture of the two drops, and the whole process can be clearly seen, the typhoid culture being pure at one end, and the diluted serum at the other, whilst at the junction the process of " clumping " can be seen going on. The difficulty of obtaining a rapid positive or negative result of a reliable character in the examination of the milk supply of the Parish, as regards the presence or absence of tubercle bacilli, has not yet been satisfactorily overcome, but I have now caused an apparatus to be constructed capable of dealing with much larger quantities of the milk than have hitherto been treated, and hope to be in a position to make reports upon the subject very shortly. The water supply from the three companies, Kent, Lambeth, and Southwark and Vauxhall, upon whom the Parish depends, has been several times examined, with results, upon the whole, satisfactory, though it has at times been found that all three have given evidence of temporary contamination. In view of the fact, proved almost to demonstration by Dr. Waldo in his recent Milroy Lectures before the Royal College of Physicians, that summer diarrhoea, so fatal in urban districts, is due to the distribution of germs through the air by dried and powdered horse dung, I would venture to urge upon the Vestry the advisability of watering the streets during the summer months with a weak solution of permanganate of potash. Some time ago I made an extensive series of experiments upon the power of this disinfectant, from which it appeared that a solution of the strength of one pound in 500 gallons of water was capable of immediately destroying the germs in question, or most of them. The cost of such an agent would be about fivepence beyond the cost of plain water for the quantity mentioned, and whilst the aggregate cost would no doubt be considerable, there is reason to believe that the reduction in infant mortality would go far to compensate it. Finally, I would draw attention to the fact that during the year two severe cases of blood poisoning have occurred among the men employed in emptying the sanitary dust bins. It would be a simple and not at all an expensive matter to supply them with a disinfectant, such, for example, as a solution of Jeyes' Fluid, in the proportion of one tablespoonful to a quart, in which they might dip their hands from time to time. The whole cost would, at any rate, be less than that which has been incurred in paying the wages of these men during their protracted illnesses. EDWD. C. BOUSFIELD. Illustrations. Diphtheria Chart, showing number of (a) Notifications, ( b) Bacteriological Examinations, (c) Deaths, in each four-week period during the year. The thin continuous line shews the notifications. The dotted line shews the examinations. The heavy continuous line shews the deaths. The numbers are shewn at the side of the column. Fig. 1. Case 387. Pure typical diphtheria. X 1,000. Fig. 2. Case 368. Various bacilli, cocci, etc., with a very small number of diphtheria bacilli, x 1,000. Fig. 3. Case 392. Organisms much resembling the last, but with only a single doubtful diphtheria bacillus, x 1,000. Fig. 4. Case 34. Cladothrix. A very rare throat organism. I have met with it only twice in nearly three thousand examinations, x 1,000. Fig. 5. Typhoid bacilli at the " culture " end of a Widal preparation, made as described. The bacilli are seen to be fairly evenly distributed, x 500. Fig. 6. Typhoid bacilli at the point of mixture in the same preparation. The bacilli are seen to be " clumped" together, and there are very few in the surrounding portion of the preparation. The picture is quite characteristic, x 500.