Borough of Camberwell. Town Hall, Camberwell, S.E. 5.12.01. With the Compliments of the Medical Officer of Health CAM 8 Appendix III. to Annual Report. Report of the Medical Officer of health. Gentlemen, During the 52 weeks ending December 29th, 1900, the number of births registered in London amounted to 130,868, and the deaths to 86,007. The Registrar-General estimates the population of London at the middle of that year to be 4,589,129, and the birth-rate, marriage-rate and death-rate are all calculated on these figures The birth-rate, which has been steadily declining since 1896, last year reached 28.6 per thousand, and is the lowest that has yet been recorded. The marriages numbered 40,499, and the rate per thousand was 17.6, thus being lower than in 1899, when the rate per thousand was 18.4. The deaths, as stated above, numbered 86,007, and therefore corresponded to an uncorrected rate of 18.8 per thousand, the average in the previous ten years having been 19.8. Included in this total are the deaths of Londoners who died in metropolitan institutions outside London, and also those of strangers who had been admitted into London hospitals and infirmaries from districts outside its boundaries. If these last be excluded the death-rate of London as a whole will be reduced to 18.3 per thousand. On next page in tabular form, are shown the births and the deaths, together with the birth-rate and death-rate for London taken as a whole, and also for the various groups of its sub-districts. TABLE I. —BIRTHS, DEATHS, AND CORRECTED BIRTH-RATES AND DEATHRATES OF LONDON AND ITS GROUPS OF DISTRICTS FOR 1900. London. West D. North D. Central D. East D. South D. Metropolitan Asylums and Hospitals outside London. Births 25,692 51,194 130,868 19,238 28,460 6,284 - 30,914 Deaths 86,007 14,259 18,220 4,762 15,962 1,890 - Birth-Rates 29.2 28.6 24.0 26.3 26.8 35.4 Death-Rates (corrected) 18.3 16.6 16.7 22.3 21.9 18.0 - Table II. shews the estimated population of Camberwell and its registration sub-districts at the middle of 1899, and also at the middle of 1900. These estimates are based on the assumption that the rate of increase in the population has continued in the same proportion as in the years 1891-6, but as I pointed out in my report last year, the figures are probably over estimated. The estimated population obtained by taking the average number of persons per assessment existing in previous years is 263,593. This method of calculation, however, is open to some objection, as in Camberwell there were formerly many single houses with large grounds which are now rapidly giving way to streets of smaller houses, each of which, although assessed as one house, is let out to two families. TABLE II. —POPULATION OF CAMBERWELL AND ITS SUB-DISTRICTS. Parish. Dulwich Camberwell. Peckham. St. George's As enumerated at census, 1896 253,076 90,286 67,029 88,242 7,519 As calculated for middle of 1899 265,385 96,379 91,476 69,520 8,018 As calculated for middle of 1900 92,495 269,276 98,335 70,305 8,178 ii Table III. gives the total number of births registered during the year in the Parish, showing a decrease of 232 contrasted with the increase of 16 that 1899 showed over 1898. The decrease is most marked in St. George's and Camberwell, and the increase in Peckham and Dulwich. The increase in the latter district is not a matter of surprise considering the number of new houses that are there being erected. TABLE III.-BIRTHS IN CAMBERWELL AND ITS SUB-DISTRICTS. Dulwich. Camberwell. St. George's. Parish. Peckham. 2,230 101 1899 7,443 2,669 2,443 1900 109 2,041 7,211 2,356 2,705 -189 -232 -87 Difference +36 +8 Table IV. shews the birth-rate of the whole Borough, together with its sub-districts. The decrease has been well marked except in Dulwich, where there has been an increase, and in Peckham which remains nearly as in 1899. TABLE IV.—BIRTHS-RATES OF CAMBERWELL AND ITS SUB-DISTRICTS. Camberwell. Peckham. St. George's. Parish. Dulwich. 28.04 12.59 32.07 1899 29.17 25.34 1900 26.77 13.32 29.24 29.03 23.95 The total number of deaths registered of inhabitants of the Borough, excluding 767 which occurred in St. Saviour's Infirmary, amounted to 4,455, compared with 4,693 in 1899, the deaths of parishioners occurring in institutions outside the Borough being of course included in these totals. The number of deaths is consequently 92 below the average number of deaths in the years 1890-1899. 1,107 deaths were those of infants under one year, compared with 1,181 in the last year, being 54 below the decennial average. iii. Since last year the population was smaller, and this diminution, both in the total deaths and also in those of infants, of course, is of greater import than it may seem at first sight. The deaths of those persons occurring in institutions outside the Borough have been distributed according to the sub-districts whence they were removed, in those instances where we have been able to get the requisite information; when this has been impossible they have been considered separately and have been re-distributed among the sub-districts in proportion to the recorded deaths in those localities. A similar plan has been followed out with regard to the Infirmary, Workhouses and Lunatic Asylums, but in the latter there are of course many persons who have perhaps been brought in many years ago from districts outside Camberwell; the deaths of such persons have accordingly been re-distributed according to the plan mentioned above. This seems the fairest way, since otherwise the deathrate of Camberwell sub-district would be unfavourably affected by the extra number of deaths occurring in these institutions. RE-DISTRIBUTION OF DEATHS AMONG THE SUB-DISTRICTS OF CAMBERWELL. Deaths returned classified according to sub-districts. Deaths of persons removed from unknown addresses in Camberwell re-distributed. Estimates of deaths due to subdistricts. Dulwich +3 80 83 1,339 Camberwell +62 1,401 Peckham 1,591 +73 1,664 1,250 St. George's +57 1,307 4,455 Total 4,260 +195 iv. The number of deaths occurring in the Lunatic Asylums amounted to 68. After all these allowances and calculations have been made it is found that the death-rate for Camberwell is 16.54 per 1,000, a diminution of 1.l4 on the 1899 rate. There is a decrease in each of the sub-districts, especially in Camberwell and Peckham. The real decrease, however, both in this and in the birth-rate is not so great, because of the population being estimated on the basis of its conforming to the rate of increase in the years 1891-6. The Registrar- DEATH-RATES IN CAMBERWELL AND ITS SUB-DISTRICTS. Camberwell. Peckham. St. George's. Dulwich. Parish. 18.88 9.85 21.28 16.75 20.03 1895 1896 18.66 8.73 16.11 20.35 20.78 18.91 1897 16.98 8.69 14.31 18.98 15.07 18.74 17.03 1898 16.70 10.05 10.60 15.30 19.01 19.05 1899 17.68 1900 10.14 14.24 17.96 18.59 16.54 General's estimate of our death-rate is 16.3. As a rule his estimate is below mine, and this is probably due to the fact that he excludes some of the deaths of those who have occurred in outside institutions as deaths of inhabitants of Camberwell, and which are included in my report. As in last year, I give the death- rate of the South London parishes. It will be seen that Camberwell is now fourth on the list, whereas in 1899 it took the sixth place. V. vi. DEATH-RATES OF LONDON AND ITS SANITARY AREAS DURING THE FIFTYTWO WEEKS OF 1899, AFTER DISTRIBUTION OF DEATHS IN PUBLIC INSTITUTIONS. Principal Zymotic Diseases. All Causes. Sanitary Areas. Registration London 2.46 19.3 1.91 West London 18.0 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 South London. Battersea 16.7 2.22 CAMBERWELL 17.4 2.52 Greenwich 18.8 2.76 Lambeth 19.2 2.65 Rotherhithe 2.80 21.1 Woolwich 21.2 2.44 3.67 Newington 24.0 Bermondsey 24.1 3.46 St. Olave 24.9 2.61 25.1 St. Saviour 3.51 St. George-the-Martyr 27.7 4.53 vii. Death-rates of London and its Sanitary Areas during the Fifty-two Weeks of 1900, after Distribution of Deaths in Public Institutions. Principal Zymotic Diseases. Sanitary Areas. All Causes. Registration London 18.3 2.19 West London 16.6 1.84 North London 16.7 1.97 Central London 22.3 2.15 East London 21.9 2.89 South London 18.0 2.20 Wandsworth 14.8 1.65 Lee 15.1 1.40 Lewisham (excluding Penge) 15.7 2.14 CAMBERWELL 16.3 1.99 Plumstead 16.3 2.30 South London. Battersea 16.8 2.34 Lambeth 17.4 1.66 18.0 2.27 Greenwich St. Olave 21.2 1.85 Rotherhithe 22.5 3.40 Newington 21.9 2.85 Woolwich 22.1 2.79 Bermondsey 22.7 3.24 St. Saviour 25.2 2.93 St. George-the-Martyr 27.3 3.53 In comparing the death-rate of Camberwell with those of other districts in South London, I have given the Registrar- General's estimate of the rate, to bring it into uniformity with those of the other districts. As I noted above, these are all probably under estimated. It will be noticed that the forms of tables prepared this year are different to those in previous reports, the chief variation being the different classification of diseases by the Local Government Board. These now so closely approach the forms used for so many years in Camberwell that it is no longer necessary for me to give the latter as a comparison with the prevalence of disease in previous years, for this can be readily made from the classification adopted by the Local Government Board. There are, however, one or two points in the tables to which I shall presently draw attention. Coming to the causes of the deaths, there were 156 deaths in 1899 from the various forms of accidental or other violence, compared with 167 in 1900; of this total 22 were returned as suicide. The deaths from premature birth and defective vitality were 358, compared with 341 in 1899. Convulsion of infancy was the cause of 89 deaths, as against 105 in the previous year. Sixteen deaths were caused by child-birth, either directly or remotely, and of these eight were due to one or other of the septic diseases following on this condition, a slight improvement on 1899, when there were 11 deaths from this disease. I need hardly repeat what I have previously urged, namely, that of all the so-called preventible diseases this particular one has the best claim to the description. Among other new diseases, classified separately by the Local Government Board we have alcoholism, together with cirrhosis of the liver. I give the figures for these two diseases separately, for the reason that although cirrhosis of the liver is most frequently caused by alcohol, it is not so in every case. The figures for alcoholism are 13, and for cirrhosis of the liver 37. Venereal diseases accounted for 15 deaths, but, as in alcoholism, the fatal effects of the degenerative changes set up by the poisons of syphilis and alcohol are in part associated with the mental diseases, and also classified as changes in the arteries, kidneys and nervous system, which are grouped together among "other diseases." Two hundred and seventy-seven deaths were registered from heart diseases, as compared with 251 in 1899. These include all those cases in which heart mischief itself appeared to be the primary cause of death, but do not include those cases of congenital heart diseases, which are classified under other causes. Two hundred and seventeen deaths were ascribed to cancer, including all the forms of malignant disease, compared with 199 in 1899. It is often stated that cancer is on the increase, but this point is by no means proved; the increased registration of such disease is, I think, chiefly due to the fact that new growths are now diagnosed as cancer which were formerly certified as tumours of various kinds. viii. Among the "zymotic" diseases, hooping-cough caused 110 deaths, and measles 38, a contrast to the records of 1899, when there were 76 from hooping-cough, and 127 from measles. The above deaths, classified according to the locality in which they occurred, were, so far as hooping-cough is concerned, 32 in Camberwell, 38 in Peckham, and 40 in St. George's, while as regards measles, 1 was in Dulwich, 8 in Camberwell, 14 in Peckham, and 12 in St. George's. In three instances the address from which the patient had been removed to the Infirmary, &c., could not be ascertained. As usual in these maladies the fatal effects were almost entirely shewn in children under the age of 5. The deaths from measles were fewer than in any year since 1876. Sixty-one deaths from hooping-cough, and 6 from measles took place in one or other of the public institutions, chiefly the Infirmary and Workhouse. There were 126 deaths from influenza, 29 more than in 1899. I have included under this heading all cases where this appeared to be the primary cause of death, although bronchitis or some other inflammatory affection of the lungs was the disease which carried the patient off. There were 204 deaths from diarrhœa, and 78 from other forms of inflammatory diseases of the intestines, such as enteritis, compared with a total of 371 in the previous year. The classification of the Local Government Board shews the mortality from the epidemic form of the disease, to which most of the deaths of infants are due, and which is probably caused by certain micro organisms. It is, however, decided that in future under this head should be included not only deaths from diarrhœa alone, but also from cholera and dysentery. The causation of the summer diarrhœa of children has been brought prominently before the profession during the past year by the Milroy Lectures at the College of Physicians. From the incidence of the disease, both as regards locality and age, the opinion was enunciated in these lectures that the milk in the various shops was infected by the dust blowing in from the streets, and that contamination largely arises through the agency of horse dung. I have before pointed out the result of the observations made in Liverpool some years ago, showing that the mortality among breast-fed children even ix. under the most insanitary conditions of residence was less than that of hand-fed children under good circumstances. It might, perhaps, be urged that the children of those mothers who were unable to nurse their offspring were not probably of the most robust kind, and therefore more liable to disease and death, but the difference appears to me to be too great to be explained in this way, and it would therefore seem evident that the cause of diarrhœa is in great measure associated with contamination of the milk which is the chief article of diet among infants. Anyhow, last year I recommended that a still further use should be made in what had been inaugurated in previous years—the practice of watering the streets and washing out the gullies with a weak solution of permanganate of potash. I was strengthened in this recommendation by a report from the Bacteriologist on the same subject. Enteric fever caused 33 deaths, compared with 32 in 1899; of these 19 were of persons who had been removed to hospital. One death occurred in a resident of Dulwich. Camberwell, Peckham and St. George's have been respectively credited with 9, 10 and 11, while in two instances the deaths were of persons whose previous address we have been unable to ascertain. The notifications amounted to 186, of which the majority came from Camberwell. Inquiries were made into the history of each of these cases, but so far as we were able to ascertain there was no one factor especially at work. It was supposed in some parts of London that the disease had been spread by means of infected linen through the agency of mangling. In only one case in Camberwell were we able to Snd that linen from a house attacked by this disease was washed it a laundry where another case of enteric subsequently occurred. The death rate per 1000 from this disease is below that of London as a whole, and considerably under the rate of most of the South London parishes, a matter of congratulation, as this disease may be considered as "everywhere an index of the sanitary intelligence of a community." (Osler.) Scarlet fever caused 19 deaths in 1899, and 11 in 1900; all these last occurred in persons who had been removed from their homes for treatment in one or other of the infectious disease hospitals. Six deaths were of inhabitants of Camberwell, 4 came from Peckham, and 1 from St. George's. The total number of notifications of this disease was 784, compared with 1,175 in 1899. I may here remark that the death-rate from this disease in Camberwell is among the lowest of the London parishes. Among the deaths registered during the year we have 7 from heat-stroke. These occurred in July and were among those who were either young, or exposed to the sun in the course of their work. The report I have to present on diphtheria is almost the exact contrary to last year. Now I find myself in the pleasant position of being able to point out a decrease in the notifications, which amounted to 886, compared with 1,251 in 1899, while the deaths amounted to 131, as compared with 153 in the previous year. The notifications were diminished in all the districts, especially in Camberwell and St. George's. The death-rate for the whole of London was .34 per thousand, while that of Camberwell was .49, so that we are still above the average both for London and its south districts, but we are below most of the parishes bordering on our eastern and northern boundaries. I give the figures for 1899 and 1900 for the neighbouring Sanitary Authorities: — Sanitary Areas. 1899. 1900. 0.38 1.04 St. George-the-Martyr 0.81 St. Olave 0.28 Bermondsey 1.03 0.69 0.86 Battersea 0.19 Rotherhithe 0.78 0.63 Lambeth 0.32 0.51 Camberwell 0.61 0.49 0.34 Lewisham (excluding Penge) 0.75 It was not found that there were any special schools affected, so that there was no need for the closure of any of these institutions. I have again to call the attention, not only of the Council, but of the public, to the fact that virulent diphtheria bacilli have been found after seven weeks from the disappearance of all naked-eye signs of the disease from the throat, and again to emphasise the importance of having a bacteriological xi. examination made of every case which has been notified as diphtheria. In the case of the Metropolitan Asylums Board's hospitals I understand that these examinations are made as a matter of routine before the child is returned to its home as cured, but in the case of those children who have been kept at home the whole time, this precautionary measure is not so systematically carried out by the medical men in attendance. We invariably send a letter to the head of the house where a child is attacked by this disease, pointing out that it will not be possible for the children to attend school until notice has been sent by the Council to the head teacher. Some of the authorities of the Board Schools have been most careful in refusing to allow such children to attend school until they have communicated with me, but I cannot by any means pay the same compliment to all, for I have found in many cases that children have been taken back without any certificate of disinfection from us, and without a bacteriological examination having been made of the throat. Now that there are facilities for the absolutely gratuitous examination of such cases, there can be no reason why the opportunities so provided should not be used by all the medical men in the Parish, and it would save many fresh cases if all the teachers were to satisfy themselves that this had been done before re-admitting the children who have either been notified as suffering from this disease, or have come from an infected house. I give below the percentage of fatal cases in relation to the number of persons attacked by diphtheria and scarlet fever since 1895. Case Mortality of Diphtheria and Scarlet Fever. Diphtheria. Scarlet Fever. 1895 19.5 5.3 1896 18.4 4.2 1897 14.3 2.7 1898 12.4 1.9 1899 12.7 1.6 1900 14.6 1.4 xii. Altogether in the past year three eases of small-pox were notified. Of these, two were returned by the authorities of the Metropolitan Asylums Board as not being small-pox. This opinion I have no doubt was a correct one, for the persons who were sent back immediately mixed with others in the house as if they were non-infectious, and no further outbreak occurred. The third case was of a young man who had clearly contracted the disease on board ship. In this case we carried out the necessary precautionary measures, with the fortunate result that no further case occurred in the house. He was removed from Commercial Road to the Hospital Ship. The Bacteriological Department instituted by the late Vestry has enabled me to give a more definite opinion as regards cases where people had been exposed to diphtheria, and where it was essential that they should not return to work if there were any chance of their being in an infected state. This has been particularly useful when cases occurred among school teachers and servants, who were kept away from their duties until it was certain that they were non-infective. As the Council are aware, we systematically examine houses as regards their sanitary condition when a case of infectious disease has occurred. It may be of interest to supply the following table showing the defects usually met with, and the proportion in which they occur in the infected houses:— Number of Infectious Cases Notified from January 1st, 1900, to December 31st, 1900=2,285. Drains Intercepted. Defects. Defective w.c. Water Supply. Yes. ? Cistern. Defective. Main. No. House Drain. 429 626 378 274 366 543 934 1,687 270 The percentage of houses disinfected by the Council's officers after consumption rose from 15.4 to 18.2, but this year in a notably larger number of cases in answer to our circular offering disinfection we were informed that all necessary precautionary measures had been enjoined by the doctor during the illness, and had been fully carried out, so that there was no need for the assistance of the Council. xiii. The By-laws for Houses Let in Lodgings were again considered by the Sewers and Sanitary Committee, especially with regard to the definition of the word "landlord," that is, the person upon whom the duty would devolve of carrying out the annual cleansing of the premises. As I have before pointed out, it is a matter of great importance that we should be able to look to some person of a more responsible holding than that of a weekly tenancy of the whole house, to carry out this work, and it was with this idea that I suggested that the Local Government Board should be asked to make some alteration. The matter was, however, deferred until after the election of the new Council. At the request of the Committee, on October 9th I brought up a report for the re-organisation of the Sanitary Department. In view of the change of administration to the Borough Council this was adjourned, and at the end of the year 1900 was still under consideration. SANITARY STAFF. Local Government Board, Whitehall, S.W., September 3rd, 1900. Sir,-I am directed by the Local Government Board to acknowledge the receipt of your letter of the 4th ultimo forwarding a statement showing the area and estimated population of each of the eleven districts into which the Vestry of the Parish of Camberwell propose to divide the Parish for sanitary purposes. The proposed arrangement involves a reduction in the number of Sanitary Inspectors, and on comparing the staff employed by the Vestry with that in the service of the various Sanitary Authorities in the Metropolis, it will be seen that the population proposed to be assigned to the Sanitary Inspectors of all except the first and eleventh districts is considerably above the average population of a Sanitary Inspectors' district in the Metropolis generally, and this is especially so in the fourth, fifth and sixth districts. Calculated on the basis of the Metropolitan average (which is about 17,000 population to each Inspector) the number of Sanitary Inspectors' districts in the Parish of Camberwell should be fifteen. Having regard to the above facts, the Board have considered whether in the interests of the Parish the Vestry are doing well to reduce the number of their Sanitary Inspectors. The Board are not aware of the reasons which have induced the Vestry to make the proposed reduction, and in asking them to reconsider the matter I am to suggest whether xiv. instead of reducing the number of Sanitary Inspectors the Vestry should not rather add to their number.—I am, Sir, your obedient Servant, (Signed) JOHN LITHIBY, Assistant Secretary. C. W. Tagg, Esq., Vestry Clerk, Parish op Camberwell. REPORT OF MEDICAL OFFICER OF HEALTH. To the Chairman and Members of the Sewers and Sanitary Committee. Gentlemen, —On January 18th, 1898,I reported to the Committee on the subject of the supervision and working of the Public Health Department, and the recommendation of the Committee to the Vestry was that in future I should be the absolute head of my Department, responsible for myself and the Sanitary Staff direct to the Committee, and that I be responsible for all the correspondence of the Department, and that all complaints relating to the Sanitary Department at once be referred to me for report to the Committee direct. This was shelved by the Vestry with the exception of the question of the appointment of two additional clerks, to which the "previous question" was moved as an amendment and carried. To the recommendations then put forward in the main I still adhere to, but certain modifications are necessary, first of all in consequence of the increased duties which will be imposed on the Sanitary Authority by the new Act, and also to effect some necessary improvement in the administration of the Sanitary Department. First of all as regards the number of Inspectors. The Local Government Board imply that fifteen would be the proper number for a district the size of Camberwell, while your Committee apparently consider that eleven are sufficient. In my opinion, however, I think that twelve, excluding the Inspector in charge of the Food and Drugs Acts, is the minimum, but I think that if the clerical staff be increased to the number that I propose, with this number we shall be able to carry out the Public Health Act in a proper manner, but not otherwise. If, however, the Vestry should decide to carry out those sections of the Public Health Act which relate to Houses Let in Lodgings as they should be carried out, a further increase in the number of Inspectors will become necessary. Now as regards the clerical staff. I think that in the future much should be done by the clerks that is at present done by the Inspectors, work which necessitates them being much longer in the Vestry Hall than is advisable. The latter should simply have as their clerical work their pocket books (of which they should have a double set), which they use as memoranda of their visits, &c., their time sheets and their books in which they ask power from the Committee to serve statutory notices and to make out the same. The clerks would fill up the complaint sheets and make out intimations. They should also keep the register of inspections of schools and cowhouses. XV. All the clerks should be able to write shorthand, further I think that one of them should be a sufficiently skilled draughtsman to draw plans of the reconstruction of drains when we have no chance of getting the same from those whose duty it is to carry out the work. At present there is no such record kept, and I think it is highly desirable that this procedure should be adopted. I should put one of the clerks on to the special duty of keeping a biography, so to speak, of each house, noting everything which occurs there. All these additional clerks and the work that they will have to carry out will need much closer and more detailed supervision than it is possible for me to give, and I therefore recommend that provision should be made for an officer, who should be a qualified Sanitary Inspector, to be appointed, whose duty chiefly would be to see that all the clerical work of the office is carried out. (a) He would see that all complaints are duly entered and that they are attended to and remedied without unnecessary delay. (b) He would see that the insanitary conditions which may be discovered on the inspection of a house where infectious disease has occurred should be remedied as soon as possible. (c) He would see that all places, such as schools, &c., have the regular inspection that they need. (d) He would see that all letters are duly attended to and answered, and arrange for the drawing of plans of drainage works carried out when no plans are submitted by the builders. He would see that all registers and diaries are properly kept. (e) He would act as an additional Inspector where my presence is not necessary. (f) He would countersign all certificates relating to drainage works, except when I judged that I should give these personally. (g) He would receive instructions from me relating to any matters I wished attended to and give out these instructions to the Inspectors. In other matters not set out here he would act under my guidance. In case of difficulty or doubt on any point the Inspectors as heretofore are to consult me. Under this scheme it will therefore still remain with me to decide what house-to-house inspections are to be made, and ratepayers and owners must look to me for appeal unless they should choose rather to apply to the Committee for redress. I recommend, therefore, that the following appointments be made:— 1. A Superintendent or Chief Clerk. 2. Another Sanitary Inspector. 3. Three Clerks all able to write shorthand, and one of these able to draw out plans. I also recommend that the other recommendations with regard xvi. to the opening of letters, &c., contained in my report of 1898 be still carried out. In conclusion I would mention that I have been in communication with some of the other Vestries, and have tried to introduce some of their good regulations. I can only repeat that in my opinion it is, as in 1898, that our weakness is in the clerical part of the work and not in outdoor inspections.—I am, Gentlemen, your obedient Servant, (Signed) FRANCIS STEVENS, Medical Officer of Health. Below is shown a table giving details of the work of the Disinfecting Department showing the enormous number of articles dealt with. lam glad to say that we had practically no well-founded complaints with regard to the work of disinfection, while loss and wrong delivery of articles collected by your staff were practically unknown. As the Council are aware, we only have one disinfecting machine, and in the course of the year owing to necessary repairs having to be carried out we were compelled to make use of the station at Lambeth, by the kind permission of their Medical Officer of Health, but on another occasion when Lambeth were not able to assist us we were helped by Bermondsey, who made a charge of 10s. per lot. It appears to me now, however, that it would be wise in view of the extension of the Borough, and also to provide for cases of extra stress, that another machine should be provided, and that it might be well considered as to whether this second machine should not be placed in a different part of the Borough so as to avoid the long journeys from Dulwich, which is so rapidly being covered with houses, down to Peckham Park Road. Return of Houses, Clothing and Miscellaneous Articles Disinfected during the Year 1900. No. of Houses. Beds. Blankets. Sheets. Pillows. Bolsters. Cushions. Mattresses. Palliasses. Quilts. Clothing. Carpets. Curtains. Rugs. Sundries. 8345 1767 2308 1742 375 4037 483 1417 1758 5865 7384 927 721 15783 12006 xvii. Tables V. and VI. give the work carried out by your Inspectors during the past year, arranged in tabular form under the head of each Inspector and also the nature of the work. The total number of house to house inspections amounted to 7,116, instead of 6,206 in 1899. The complaints numbered 957, while the inspections made in consequence of such complaints amounted to 1,131. There is thus a considerable increase even on the figures of 1898. As a result of the house-to-house inspections and the complaints referred to above, and the occurrence of infectious disease, 5,061 intimations were served under the Public Health (London) Act, followed up in 1,217 cases by statutory notices, 220 of which related to houses let in lodgings. Further, in 116 instances it was necessary to issue summonses to enforce the requirements of the Committee. There were 722 inspections of Cowhouses and Dairies, the former number, together with that for the Slaughterhouses, excluding the inspections made by myself of each of these premises previous to the licensing day. This is an increase of over 200 on the figures for the previous year. All our requirements were satisfactorily carried out before the meeting of the Licensing Committee of the London County Council, so that in no case was it necessary for us to offer any opposition to the renewal of the licenses. There were 504 inspections of Bakehouses by the inspectors, including those made by myself. The Department sustained the loss of an able and zealous servant in the case of Mr. Griffiths, who died in February of this year. He had been ailing for some time past, and this necessitated the employment of Mr. H. K. Wright, who was temporarily appointed the notification clerk. In conclusion I have to thank all the members of the Public Health Staff for the assistance they have rendered me during the past year. I am, Gentlemen, Your obedient servant, FRANCIS STEVENS. xviii. TABLE V. —RETURN OF WORK PERFORMED IN THE SANITARY DEPARTMENT DURING THE 52 WEEKS ENDING DECEMBER 29th, 1900. XX. TABLE VI. TABLE C. Description of Work. Totals. Houses Ventilated on Staircase 634 „ „ under Floors 406 „ Cleansed „ Repaired (Gutters, &c.) Water Supplied to Premises Drains Cleansed, Repaired and Trapped Sinks, Rainwater Pipes, &c., Disconnected Stables, Yards and Areas Paved, Levelled, and Drained Closets Provided, Repaired, Cleansed or Removed Water Laid on to Closets Cisterns Provided or Reconstructed „ Repaired, Covered or Cleansed Dustbins Provided, Repaired, or Removed Cesspools Emptied, Abolished, or Drained into Sewer Refuse or Manure Removed Animals, &c., Removed, or to be Kept Clean Private Urinals, Cleansed and Supplied with Water Public „ „ „ Overcrowding Abated Smoke Nuisances Abated Trade Nuisances Abated Manure Pits Supplied Interceptors and Chambers Supplied 11 Seizures of Unwholesome Meat TABLE D.—SALE OF FOOD AND DRUGS ACT, &C. Samples Submitted for Analysis Summonses under the above Act Inquests Bodies Removed to Mortuary xxi. TABLE VII. MORTALITY RETURNS OF ZYMOTIC DISEASES QUARTERLY FOR THE LAST SIX YEARS. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Fever. Small Pox. Diarrhœa. Influenza. Year. 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 31 8 11 71 11 0 183 3 3rd „ 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 20 8 3rd „ 34 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 1899. 1st Quarter 44 18 6 23 4 0 18 36 2nd „ 23 49 2 25 0 0 14 29 3rd „ 8 39 5 42 11 0 322 4 1 21 6 72 0 4th „ 17 17 28 1900. 1st Quarter 5 21 3 54 6 0 19 99 2nd „ 25 9 1 20 6 0 13 18 62 1 1 18 7 0 219 3rd „ 1 18 7 6 39 14 0 31 8 4th „ xxii. TABLE VIII. ANNUAL MORTALITY RETURN OF ZYMOTIC DISEASES, FROM 1856 (inclusive). Year. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Fever. Small Pox. Diarrhœa. 1856 32 48 30 5 19 29 1857 30 7 44 24 4 50 1858 51 28 129 14 20 7 26 1859 66 82 31 12 ? 1860 36 40 34 11 26 5 ? 1861 72 8 13 25 25 2 ? 1862 53 32 101 40 64 0 ? 1863 57 124 14 32 29 41 ? 1864 61 29 83 16 51 10 ? 1865 52 39 55 14 31 12 118 1866 72 38 59 11 53 35 76 64 20 1867 75 8 41 9 67 1868 58 67 71 17 45 13 146 1869 134 43 164 9 46 9 133 1870 49 24 192 10 57 23 160 1871 50 29 60 9 40 153 143 1872 132 46 86 1 38 41 124 1873 60 49 7 7 38 2 137 1874 76 54 24 9 57 2 93 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 44 100 66 1883 91 112 49 48 35 19 122 1884 173 171 82 78 40 34 240 1885 136 91 20 68 27 154 135 1886 156 97 18 48 30 2 215 1887 203 133 99 71 41 0 239 1888 130 101 105 65 31 1 115 1889 149 193 37 76 27 0 145 1890 191 163 51 60 0 26 144 123 29 1891 67 56 21 1 142 1892 128 189 63 85 21 1 169 1893 104 78 80 118 30 11 213 1894 126 164 193 21 2 45 115 61 100 1895 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 76 127 19 162 32 0 371 1900 110 38 11 131 33 0 282 Under the head of fever I have only included the deaths from enteric fever. TABLE A. Deaths under One Year of Age. Deaths at all Ages. Nett. Deaths at all Ages. Total. Births. Deaths of Nonresidents registered in District. 10 Deaths of Residents registered beyond District. 11 Deaths in Public Institutions. Rate per 1,000 Births registered. 6 Population estimated to Middle of each Year. 2 Number. 3 Rate.* 4 Year. 1 Number. 5 Rate.* 18 Number 7 Rate.* 8 Number. 12 1891 236,693 7,338 31.0 1,051 143.2 4,861 20.5 1,224 650 282 4,493 18.9 1892 242,264 7,478 30.9 1,155 154.2 4,942 20.3 1,194 663 339 4,618 19.0 30.1 650 4.806 19.3 1893 247,950 7.471 1,197 160.2 5,024 20.2 999 432 1894 253,770 7,384 29.1 1,105 149.6 4,288 16.8 1 ,114 574 431 4,145 16.3 1895 259,725 7,531 28.9 1,238 164.3 4,879 18.7 1,192 610 458 4,727 18.2 1896 253,998 7,665 30.2 1,197 156.1 4,856 19.1 613 483 4,726 18.6 1,271 7,478 1897 257,772 29.0 1,187 158.7 4,525 17.5 1,222 620 472 4,377 16.9 7,427 4,639 1,213 1898 261,551 28.3 1,191 160.3 17.7 643 373 4,369 16.7 1899 265,385 7,443 28.0 1,181 158.6 4,941 18.6 1,468 732 484 4,693 17.6 Averages for years 1891-9. 253,234 7,468 29.5 1,167 156.1 4,772 18.8 1,210 639 417 4,550 17.9 1900 269,276 7,211 26.7 1,107 153.5 4,748 17.6 1,421 767 474 4,455 16.5 Rates calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water Total population at all ages, 235,344 4,342 Number of inhabited houses, 33,849} At census of 1891. Average number of persons per house, 6.9 TABLE B. Names of Localities. 1. Borough. 2. Dulwich. 3. Camberwell. 4. Peckham. 5. St. George's. Deaths under 1 year. Population estimated to middle of each Year. Deaths under 1 year. Population estimated to middle of each Year. Deaths under 1 Year. Population estimated to middle of each Year. Dirths Registered. Population estimated to middle of each Year. Deaths under 1 year. Population estimated to middle of each Year. Deaths at all Ages. Births Registered. Births Registered. Deaths at all Ages. Deaths at all Ages. Births Registered. Deaths at all Ages. Births Registered. Deaths under 1 year. Deaths at all Ages. Year. b d b d b d b d b d a c a c a c a c a c 1890 231658 7298 4521 1112 6718 74 80 13 79963 2291 1375 329 82553 2657 1758 421 62424 2276 1298 349 1891 236693 7338 4493 1051 6843 65 79 8 82325 2360 293 83821 2685 1583 406 1400 1431 63720 2228 344 242264 7478 4618 1155 85179 2744 471 1892 6979 73 89 10 85028 2377 1418 305 1728 65142 2284 1383 369 7471 2405 1893 247950 4806 1197 7118 64 86 5 87822 1523 349 86599 2724 1696 450 66597 2278 1501 393 1894 253770 7384 4145 1105 7260 78 57 4 90706 2397 1350 324 87961 2667 1559 425 68084 2242 1179 352 1895 259725 7531 4727 1238 7404 76 73 6 93685 367 89386 2742 1753 468 2405 1490 69604 2308 1411 397 1896 253998 7665 1197 7556 12 2487 369 4726 75 66 90740 1462 88486 2784 1801 423 67217 2319 1397 393 1897 257772 7478 4377 1187 7707 94 67 5 92582 2385 1325 367 89472 2789 1699 442 67976 2210 1286 373 1898 261551 7427 4369 1191 7861 91 79 8 94461 2427 1424 384 90469 2737 1695 447 68744 2172 1171 352 1899 265385 7443 4693 1181 8018 101 85 9 96379 2443 1475 371 91476 2669 429 2230 1739 69520 1394 372 Averages of Years 1890 to 1899. 438 251076 7451 4547 1161 7346 79 76 8 89369 2397 1427 345 87540 2719 1701 66902 2254 1342 369 1664 1900 269276 7211 4455 1107 315 430 8178 109 83 8 98335 2356 1401 92495 2705 70305 2041 1307 354 TABLE C.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1900. No. of Cases Removed to Hospital from each Locality. Total Cases Notified in each Locality. Cases Notified in Whole District. Notifiable Disease. Peckham. At Ages—Years. Dulwich. Camberwell. Peckham. St. George's. St. George's. Dulwich. Camberwell. 15 to 25. 65 and upwards. At all Ages. Under 1. 5 to 15. 25 to 65. 1 to 5. 1 Small-pox 3 1 1 1 1 1 1 1 .. .. .. .. 1 .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 211 886 13 310 426 78 59 7 342 326 2 230 244 .. 153 Membranous Croup 1 10 1 9 .. .. 3 6 .. .. 1 2 .. .. .. 70 215 Erysipelas 5 6 14 29 145 16 2 73 70 11 4 7 .. 784 178 Scarlet Fever 6 223 462 69 24 17 286 303 2 174 217 137 .. Typhus Fever .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 56 186 1 3 49 59 72 2 3 69 58 1 35 38 34 .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 3 6 1 2 3 1 2 1 2 .. .. .. .. .. .. Puerperal Fever 11 2 9 6 3 2 1 .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 2101 26 552 953 240 312 18 29 781 769 522 5 454 506 334 TABLE D. —Causes of, and ages at, Death during Year 1900. Deaths in whole District at subjoined ages. Deaths in Localities (at all Ages.) Cause of Death. Deaths in Public Institutions. 1 and under 5. 25 and under 65. St. George's. 5 and under 15. 15 and under 25. 65 and upwards. Camberwell. Peckham. Locality unknown. Dulwich. All Ages. Under 1. .. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. 38 31 2 .. .. 1 8 14 12 6 Measles 5 3 .. .. 6 4 1 .. 11 Scarlet Fever 11 .. 7 3 1 .. .. Hooping-cough 110 52 53 5 .. .. 32 38 40 .. 6 .. .. Diphtheria and Membranous Croup .. 3 4 6 .. 45 52 131 85 .. 39 1 94 .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. Typhus .. .. .. .. .. .. .. .. .. .. .. .. Fever Enteric 33 2 14 15 2 1 9 10 11 2 19 .. .. Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. 61 1 48 32 7 18 Epidemic Influenza 126 .. 2 2 61 38 .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 5 37 89 78 2 Diarrhœa 204 165 32 .. .. .. Enteritis 1 8 4 1 30 16 3 17 78 55 10 28 .. 8 3 1 1 1 Puerperal Fever 3 5 .. 3 .. .. .. .. Erysipelas 12 3 8 1 1 4 7 .. 2 .. .. .. .. 2 Other Septic Diseases 43 10 3 4 5 16 5 8 16 17 24 .. Phthisis 356 2 8 280 15 5 108 121 100 22 105 11 40 Other Tubercular Diseases 51 28 2 48 68 53 2 40 173 62 8 22 2 74 86 7 Cancer, Malignant Disease 217 .. .. 1 2 140 7 78 39 77 Bronchitis 585 187 96 4 1 128 169 8 154 224 183 16 77 212 27 26 5 15 92 47 8 64 65 67 8 42 Pneumonia Pleurisy 18 1 5 1 5 12 1 .. .. 1 11 .. .. Other Diseases of Respiratory Organs 39 9 11 2 1 15 1 1 13 17 8 5 .. I J 1 I Alcoholism .J . .. 50 1 42 7 21 15 14 7 .. Cirrhosis of Liver .. .. .. 3 2 7 Venereal Diseases 15 9 4 8 3 1 .. .. .. .. Premature Birth 124 124 .. .. 2 43 35 44 4 .. .. .. .. Diseases and Accidents of Parturition 2 1 8 6 .. .. 2 5 .. .. .. .. .. 6 58 Heart Diseases 277 3 19 20 157 78 4 101 91 75 .. 1 Accidents 145 32 10 10 8 56 29 6 52 49 37 54 Suicides 22 .. 1 1 19 1 .. 2 11 8 1 8 .. Mental Disease 69 2 54 13 9 13 8 37 63 .. .. 2 .. .. 306 97 63 34 118 Old Age 314 .. .. 8 7 113 .. 314 All other causes 1037 367 66 15 31 336 222 24 381 276 42 262 Male, 2,313. 1339 151 80 195 1128 All causes 4455 1107 508 158 1484 1047 1591 1250 Female, 2,142. vH Borough of Camberwell. Public Health Department. TELEPHONE HOP, 1207 & 1443. Town Hall, Camberwell, S. E. 4th July, 1901. Dear Sir, My report for the year 1900 will be out of the printer's hands in the course of a few weeks, when I will forward you a copy. Yours faithfully. francis stevens Medical Officer of Health. The Librarian, Library of the British Medical Association, 429, Strand, W.C. Borough of Camberwell. Public Health Department. TELEPHONE HOP, 1207 & 1443. Town Hall, Camberwell, S.E. 11th September, 1901. Dear Sir, The annual report of the Council, which includes my report, has not yet been issued. Directly it is out of the printer's hands I will forward you a copy. Yours faithfully, francis stevens Medical Officer of Health. The Librarian, library of the British Medical Association, 429, Strand, W.C.