Camberwell CAM 13 advance proof. Report of the medical Officer of health. To The Worshipful the Mayor, Aldermen and Councillors of the Borough of Camberwell. Gentlemen, The population of London as used by the Registrar-General for the estimation of the birth, marriage, and death rates is estimated to be 4,795,757 in the middle of the year 1908, the previous calculation being 4,758,218. The actual number of births registered in the county totalled 122,898, being an excess of 693 on 1907, but as the year was reckoned as consisting of 53 weeks, it is obvious that the registration really showed a decrease in the second period. The birth-rate, which is calculated on an increased population, shows consequently a considerable decline. The number of deaths registered in London was 68,239, but these figures must be revised by the exclusion of the deaths of those who, although dying within the county boundary, could not be considered as Londoners. Further, the deaths of those inhabitants who live within the boundary, but who happened to die in institutions outside, must be included. The net result of the calculation gives 67,353 deaths to be reckoned with in the estimation of the death-rate. In 1907 the net deaths for this year, of 52 weeks only, reached 70,013, so that the reduction in the actual figures is really substantial. The death-rate of 13.8 shows a reduction of 0.8 on the previous year, and is 1.4 below the average rate for the five years 1903-7. The actual decrease in the number of deaths distinctly marks an improvement, but the apparently great reduction in the deathrate must be received with some little reserve. The Registrar-General, in making his calculation, assumes that the rate of increase which prevailed during the last intercensal period has been maintained; but he points out that the period under review being far removed from the census enumeration, the results must be accepted with great caution, and, further, that any method of estimating the population would be equally untrustworthy. Personally, I am not inclined to agree that our method is equally unreliable, for I believe that in Camberwell, at all events, the estimation by the assessment method will be found to be nearer the actual figures to be enumerated in 1911 than those which will be obtained by the estimate calculated on the continuance of the intercensal rate of increase. ii Table A.—Population of Camberwell and Sub-Districts. Dulwich. Borough. South Camberwell. North Camberwell. South Peckham. North Peckham. St. George's. As enumerated at census 1896 253,076 7,519 90,286 88,242 67,029 As enumerated at census 1901 259,339 10,247 90,465 93,038 65,589 As calculated for middle of 1903 262,968 11,214 92,079 94,286 65,283 As calculated for middle of 1904 265,139 14,259 108,028 94,323 47,449 As calculated for middle of 1905 267,594 14,677 110,648 94,856 47,420 As calculated for middle of 1906 270,153 15,130 45,125 66,598 45,585 49,682 48,033 As calculated for middle of 1907 272,479 15,600 45,915 67,195 45,831 49,872 48,066 As calculated for middle of 1908 273,856 16,170 46,400 67,440 45,943 49,769 48,134 The number of births registered in the Borough amounted to 6,885, an excess of 152 on the numbers recorded in the previous year. The increase was markedly shown in North and South Camberwell, the latter being a district which is now rapidly being built over. In St. George's and North Peckham there was a notable decrease in the numbers. Besides the births actually registered in the Borough, we have to reckon with the children of Camberwell mothers who are born outside its boundaries. In many instances among this class we have not been able to find out to which wards they belong, and have been compelled to re-distribute them in the method referred to (later on) in connection with the calculation of the death-rate. Table B.—Births in Cambebwell and its Sub-Distkicts. Borough. Dulwich. South Camberwell. North Camberwell. St. George's. Unattached, South Peckham. North Peckham. Year. 1907 6,733 205 969 1,575 1,029 1,439 1,386 130 6,885 217 1,064 1,080 1,370 1,352 156 1908 1,646 Difference + 152 + 12 + 95 + 71 + 51 - 69 - 34 + 26 It will be seen that the birth-rate has gone up, at all events, in this Borough. This can in part be ascribed to the building of new houses of a low rent, which are inhabited frequently by young or newly married couples, so that the neighbourhood contains a preponderance of persons at an age when child-bearing is usual. The change in character of Dulwich in this regard is very noticeable in recent years since the erection of new houses. Previously the population largely consisted of persons above the childbearing age, and who lived in large houses with many servants, so that there was of necessity a number of births small in proportion to the population and with the necessary sequence of a low birthrate. Table C.—Birth-rates of Camberwell and its Sub-Districts. Year. Borough. Dulwich. South Camberwell. North Camberwell. South Peckham. North Peckham. St. George's. 22.9 29.3 1907 24.7 13.1 23.9 21.5 29.3 13.7 26.7 24.0 28.1 25.1 23.4 28.7 1908 The total number of deaths properly referable to the Borough was 3,602, being 221 less than last year. A distinction has to be drawn between the deaths registered in the Borough and those which should be referred to it, and which alone must be used for the calculation of the death-rate. The former class in our case will include certain deaths in the two lunatic asylums of persons who, until they entered those institutions, were never inhabitants of Camberwell, and it will also include the mortality among those inmates of St. Saviour's Infirmary, who, while really inhabitants of Table D.—Re-distribution of Deaths among the Sub-Districts of Camberwell. District. Deaths returned classified according to sub-districts. Deaths of persons removed from unknown addresses in the Borough re-distributed. Estimates of total deaths due to sub-districts. 132 Dulwich 4 136 518 South Camberwell 506 12 19 North Camberwell 945 964 546 13 559 South Peckham North Peckham 764 634 14 778 13 647 St. George's 3,527 Total 75 3,602 iv and referable to Southwark, are sent into our Borough when sicknees lays hold of them with fatal results. Further, there are those who, often of nomadic habits, have had no fixed dwelling in Camberwell, but who have lived first in one lodging-house and then in another, and who, when admitted to any of the institutions, can only say they came from Camberwell. Further provision has to be made, and the only reasonable way seems to make a pro rata distribution of such deaths among the different districts in proportion to the mortality actually recorded therein, this re-allotment being shown in Table D. As a result of the calculations it will be seen that the death-rate stands at the remarkably low figure of 13.1 per 1,000 for the year. The Registrar-General's reckoning brings it out even less, but as this is due to his estimate of the population being higher than ours, I am inclined to think that our own calculation is the more accurate. As this is the age of records, it is perhaps interesting to note that the death-rate for this year comes within the purview of that definition, the nearest approach being 13.8 for 1903 and for 1905; it will also be seen that the decline referred to last year has continued its march. Whether we have reached the minimum can hardly be stated, but at the present low figure a further reduction becomes more and more improbable. The lessening is shown in all districts, but especially in North Camberwell, Dulwich, and St. George's. The decrease in the last districts being so much greater than any other would almost suggest the existence of some special factor. Death-rates in Camberwell and its Sub-Districts for the past 10 years. Dulwich. South Camberwell. North Camberwell. South Peckham. North Peckham. Borough. St. George's. Year. 1899 17.68 10.60 15.30 19.01 19.05 1900 16.54 10.14 14.24 17.96 18.59 16.49 7.51 13.91 18.41 18.81 1901 1902 16.34 8.07 14.53 17.01 19.13 13.80 7.57 13.04 14.10 15.39 1903 1904 15.16 6.66 12.07 16.11 22.97 13.8 9.87 15.60 1905 13.40 14.18 1906 14.8 9.5 11.7 15.5 12.7 16.5 15.6 14.0 9.0 11.2 14.9 12.6 16.1 16.1 1907 1908 13.1 8.4 11.1 14.2 12.1 15.6 13.4 It is possible that the population has been under estimated for this sub-district, whose boundaries have been altered since the census, with the coincident release of some of the poorer districts, and errors are thus likely to obtain. But at the same time the comparatively small number of deaths registered has often been a matter of speculation, and I am inclined to think that the decrease is due not so much to a special factor, as to the healthier conditions of housing and prosperity which prevail in the district as now defined. Infantile mortality again shows a decrease, amounting to 65 on the previous year, of which decline whooping-cough and measles are responsible for 41. As the Council are aware, no action has been taken in the way of the adoption of the Notification of Births Act, so the reduction cannot, therefore, be ascribed to any special efforts in the way of health visiting that have been made in this regard. The effects of such efforts, if they were really of use, would be shown chiefly in the reduction of deaths from atrophy, &c., which is intimately bound up with improper feeding; to a less degree in diarrhoea, which is also associated with such a cause; in bronchitis and pneumonia, which often occur through the neglect of some simple precaution. In the case of diarrhoea and bronchitis, however, the influence of the weather is so much more powerful than anything else that all other factors, whether in raising or lowering the mortality, become relatively almost insignificant in effect. Twenty-three more infants under one week old died in the past year. The increase appears under the following headings : 17 from premature birth, 2 from congenital defects, 3 to injury at birth, and 1 from want of breast milk; and there was some shifting about of the numbers in the other causes. The total number of deaths due to the classification atrophy, debility, &c., is 12 less than in 1907, and there is also a decrease of 14 in the tuberculous diseases. There were 13 fewer deaths from scarlet fever, with a decrease of 500 in the notifications. The recorded case mortality is thus practically the same as last year, but the notifications I think do not nearly represent the prevalence of the disease. Several times during the year I have received notice from the school authorities that children have been discovered attending school while they were peeling. On enquiry, it was found that they had been suffering from slight indisposition, hardly worthy to be entitled illness, and certainly not to demand medical treatment, the child attending school the whole time and mixing unrestrainedly with all the other young people in the neighbourhood. Added to these are the instances where the parents on their own initiative keep the children at home and subsequently discover evidence of peeling. The deaths showed a great decrease in St George's and North Peckham, while there was an increase of 9 in South Peckham. The deaths from diphtheria are practically equal to those of last year, but considering the number of cases notified, the case mortality is low, a result which can almost certainly be attributed to the increased use of antitoxin in cases of the disease as well as a measure of prevention. Of recent years another very potent agent in the reduction has been the calling into aid of bacteriological methods, whereby the throats of children who have suffered from the disease and who have been nursed at home can be examined in this way before being allowed to return to school. I believe that if the rule requiring such a certificate before return to school were more widely applied, there would be a still further reduction of the disease. The rule of the Council to supply antitoxin free to the medical practitioners who require it is still being carried out, and during last year 60 bottles were distributed. The incidence so far as relates to fatal cases showed a considerable increase in South Peckham, the other districts remaining nearly the same, with the exception of a very marked decrease in St. George's. In the number of notifications there was a decline in the two Peckham divisions. Seven deaths were put down to enteric fever, a reduction of 2 from 1907. There were, however, less than half the number of notifications received during the past year, St. George's alone showing any increase. In 7 instances there was a history of the patient having eaten some form of shell-fish, while one man obviously contracted the disease away from Camberwell. Considerable interest has recently been aroused on the subject of this disease by the fact that persons may apparently have recovered from it and yet be passing virulent bacilli from the kidneys and bowels. The subject is of great importance, as it explains single cases which were previously difficult to account for, and it has been the means of giving an explanation of epidemics in isolated districts. The Government is at present making an investigation into such cases, and has invited the co-operation of the various medical officers of health to take specimens from patients who at the time of their discharge from the hospital were passing these bacilli. Next year I hope to give some account of the investigation. Measles and whooping cough both showed a very large decrease on the two previous years, and in the case of the former there being 50, and in the latter 57 less than the previous year. Too much must not be set on this, for the years always show considerable variation, and it is probable that in 1909 the deaths will again reach, if not exceed, the number of former years. There was a diminution specially noticeable in the case of the poorer districts. As is usual, all deaths, except 7, occurred in persons under the age of 5 years. During the year a careful watch has been kept in all instances where there have been children of tender years attacked, and where, in conformity with the rules of the Education Department, any older children who had previously, perhaps even in infancy, suffered from measles were allowed to continue attendance at school. This course has always seemed to me as theoretically a wrong one, but I am bound to repeat what I said two years ago, viz., that I have no evidence that this procedure has been instrumental in spreading the disease. Up to 1907 it was the practice of the Public Health Committee to have disinfection carried out at all houses where we had received information, no matter how belated, of the existence of measles. Since that year, however, the practice has been discontinued, with apparently no untoward results, your Officers only attending on a special request being made. The deaths from erysipelas were the same in number as last year, but of the 7 cases, 3 occurred between fifteen and sixty-five, and the other 4 within the first week of life. In the previous year 3 of the fatal issues were in those over sixty-five. Of puerperal fever and the septic diseases of childbirth which are classified with it there were 5 fatal instances, 2 more than last year. In each case the midwife in attendance, as well as any other person who might have been in attendance, on the woman, have been required to see me in order that I might be certain that they had taken all the necessary precautions to avoid spreading the disease to others. There were 2 notifications of epidemic cerebro-spinal meningitis, both of which were fatal, both in infants under one year. Enquiries were in all instances made as to contact with any other persons who had been suffering from either this disease or from such symptoms, such as nasal catarrh, and which are occasionally associated with its development, but in each case without any result. No notifications were received of plague, cholera, or typhus fever. The various forms of tuberculosis caused 411 deaths, as compared with 465 in 1907, a number which is calculated to well bring home to us the extent of the disease and the imperative necessity of seriously examining any and every plan for its lessening. Out of the 411, 297 were due to phthisis, as compared with 333 in 1907. The view which ascribes to pulmonary tuberculosis a person-to-person infectivity of great power, is very generally held among Public Health administrators, perhaps, indeed, to a greater extent than among practising physicians, but this theory seems hardly warranted by the observed facts. On this supposition the occurrence of secondary cases in houses where lives a person attacked by phthisis should be a matter of common observation; but it has not been so, at all events so far as inquiries in this Borough go to prove. It might be urged that this non-occurrence is due in recent years to the precautions taken by sufferers to avoid the chance of infection to others, but if disinfection, &c., have been so powerful in the abolition of such secondary cases, it seems reasonable to ask why they have not been equally successful in bringing about a greater fall in the death-rate than has actually occurred. It must be apparent to all that the practice of regarding the disease as infectious has very largely prevailed in Great Britain, and the precautionary measures generally adopted, while not being allowed to run riot as they are in certain parts of Europe, have certainly been of such a character to lessen the channels of such hypothetical infection ever since 1899, and we should consequently expect a much more rapid decline since that date, especially in those places where special measures have been devised, such as Sheffield, &c., compared with previous years, in which there was only an improvement in general sanitary conditions. Further, it will be seen that last year there was a decline in the deaths from other forms of tuberculosis, a decline which again is simply a continuation of one started long ago, and which occurs in those manifestations of the disease in which any direct measures against theoretical infection are out of the question. This would lead one to infer that the personal resistive power to infection is the factor of importance in the prevalence and fatality of the disease. Perhaps experience gained from the notification of Poor Law cases now in vogue may lead to a different conclusion, although it has not done so up to the moment of writing. The prevailing opinion was almost unanimous that infection occurred through breathing air containing tubercle bacilli. The view has recently been gaining ground that the infection first passes into the stomach, subsequently attacking the lungs; and it has also been suggested that cases of phthisis in the adult are merely the starting into activity of a focus of the disease, the cause of which was taken in long previously. On this view it will be seen how important are the recent enactments with regard to the milk supply in relation to infection by tubercle, and I feel convinced that it is to this side of the question that we must look for the further and more rapid diminution in the mortality from phthisis. I quite agree with some of the pronounced advocates of notification in their opinion that phthisis will disappear ; but not so much on the grounds of treating it as an infectious disease as to the establishment of a pure milk supply, improved conditions of housing, abolition of overcrowding, and last, but not by any means the least, to improved economic conditions, whereby undeserved want, one of the most frequent of causes, will disappear. The situation is admirably summed up by Sir Shirley Murphy in his Annual Report to the London County Council. When speaking of the decrease of phthisis and the improvement in the dwellings, the workshops, and the food of the people, he says : "Whether this improvement has resulted in making the population more resistent to a contagium of constant virulence, or whether the virulence of the phthisis contagium has itself declined, must be matter for speculation. The relative strength of each of the two opposing forces must finally determine the death-rate, but there is much reason for thinking that the power of resistance is the all-important factor in determining the liability to attack from a widely distributed infection." The direct means, if they are to be successful, should bring about a very great improvement within the next five years, whereas the agencies I have mentioned above will work more slowly but more surely, but they will have done much within the fifty years that have been suggested as the period for the disappearance of phthisis. At the present rate of progress it will be for a future generation to pronounce judgment on our efforts, and the advocates of either side are not unlikely to be beyond the reach of criticism. The deaths from cancer and the other forms of malignant disease were 257, compared with 226 in 1907. There is, of course, an extra week to be reckoned with in 1908, but at the same time there is a decided increase. As mentioned in my previous report, the decrease that occurred in 1907 could not be considered as anything more than any accidental variation. Bronchitis and pneumonia are both less. The decrease is shown where the normal incidence is heaviest, namely, in the first year of life. Pleurisy, which ought, perhaps, to go under the classification of a tubercular disease, caused 8 fewer deaths than in 1907. The deaths from premature birth, injury at birth, and convulsions remain at pretty nearly the same figures as they were in 1907. There is a decided increase in the deaths from congenital venereal disease, and also among those from overlaying, two unpleasant reminders that perfection of conduct seems to be no nearer. A decline is shown in the various non-specific wasting diseases of children, which has come down from 113 to 101. The deaths from the inflammatory affections of the intestines, coming under the head of diarrœa,&c.,showed a considerable increase. As is usual, the incidence was especially seen in children under five, the infants of twelve months being markedly in excess. From the infective form of this complaint 119 deaths took place, as contrasting with 55 in 1907, a rise of over 50 per cent. The rise cannot be ascribed to causes which existed in Camberwell especially, for the deaths all over London showed an increase. Forty deaths were ascribed to the combined group of alcoholism and cirrhosis of the liver. Complaints have been received intermittently in 1908, as they were in 1907, of the effluvium caused by grain drying in the neighbourhood of the Old Kent Road. The owners were summoned at the end of 1907, but the case was adjourned for improvements to be carried out under my direction. As a matter of fact, the yard was seen to, and although this, no doubt, is a sanitary improvement, I do not think it would have been sufficient to have destroyed the nuisance. Many inspections have been made both by myself and the Sanitary Inspector at all times and on all days, and the Committee have also paid a surprise visit, when they decided that they found everything in a satisfactory condition at the time of such visit. I have myself noticed the smell on one or two occasions, but, judging from the evidence given at the police court, it was then never anything like so bad as it occasionally appears to have been. The owners were summoned in November, 1908, and were fined. In my opinion the nuisance comes in great measure from the state of the grain at the time of drying, and if care were taken not to allow any grain which had gone sour to be dealt with, I think the cause of complaint would be minimised. We also received a complaint of the grinding of mica, which, was carried out practically in the open air, and which led to a deposit of fine powder of this substance in the gardens of houses in the neighbourhood. A prosecution was ordered and successfully taken. The question of the adoption of the Notification of Births Act was discussed by the Public Health Committee, who also received a deputation from the Lambeth Division of the British Medical Association urging them not to adopt the Act. Reports were submitted by the Town Clerk setting out the provisions of the Act, and also by myself, of which the following is a copy; but I have brought up to date the statistics relating to the comparison between Camberwell and those districts in London where health visitors have been appointed. January 17 th, 1908. GENTLEMEN, —Granted that ignorance on the part of the mothers is one of the chief factors in determining infant mortality, it would appear logically to follow that the appointment of health visitors, who would visit mothers soon after their confinement and advise them as to the feeding and general caring for their infants, must be of advantage. Since the greatest mortality occurs in the first week of life, even if we exclude premature births and congenital defects, it is obvious that the first visit must be paid as early as possible. The first would be paid when either the doctor or a midwife is in attendance and still in charge of the mother, and it is possible that friction and difficulty may arise in this regard. With many Boroughs the appointment of health visitors has been of recent date, and those who advocate the appointment of such officials say that it must be many years before the advantages are manifest. But for myself I cannot agree with this view. It is not easy to see why, ten years hence, provided the machinery is the same now as it will be then, a good result should be then seen that cannot equally well appear at the present. The good effect of the advice should begin as soon as it is given and followed, and if experience should lead to efficacious methods other than health visitors, we cannot appeal to those functionaries as being of great value. There can be no doubt that a very large number of medical officers of health who have had experience of the subject have pronounced strongly in favour of their doing useful work, and from the names given of those who hold these views the opinions themselves become of weight. But before embarking in a scheme of this sort it is necessary to have some figures either in support of or against it, for this should and will be the ultimate criterion by which the success is judged, rather than by the mere expression of opinion. We therefore take Huddersfield, a town which has especially laid itself out for the prevention of infantile mortality ; also Oldham, a typical manufacturing town, which has given some figures in support of the appointment of health visitors. The health visitors, who are both qualified medical women, were appointed in October, 1905. Infantile Mortality. Annual rate per 1,000 Births for the years 1903-4-5 and 6. Huddersfield. Rate. Year. Camberwell Rate. 120 1903 123 1904 144 136 119 1905 124 130 135 1906 1st three quarters of 1907. 154 101 1st Quarter 2nd Quarter 101 93 62 3rd Quarter 83 The figures for Oldham, a manufacturing town of 140,969 inhabitants, taken by themselves, support the view that much good has been done by health visitors. The average mortality rate for infants for ten years previous to their appointment was 180 per thousand births, while the average rate for the five years ended 1906 was 152. There is, however, another side to this picture, for I find that in Camberwell for the same ten years our rate was 155.7 per 1,000, while the average rate for the second period ended 1906 was 134.1. Had we gone down in the same ratio as Oldham our figures would have been a little under 132. The strong support which was, apparently, given by Oldham's figures is much discounted, for in Camberwell, with no visitors, we did very nearly as well. Of the London Boroughs, the following had appointed health visitors in 1906:- Bethnal Green. Hampstead. Woolwich. Hammersmith. Kensington. I will therefore give the death-rate per 1,000 births for 1905-8 for these Boroughs and for our own. 1905 1906 1907 1908 Borough. 115 104 130 124 Camberwell 120 Hammersmith 135 138 117 69 77 69 Hampstead 94 128 119 132 Kensington 144 109 102 112 94 Woolwich 155 132 Bethnal Green 151 138 The London Medical Officers of Health, where health visitors have been appointed, speak highly of the work they are doing, with the exception of Hammersmith, where the Medical Officer finds that instead of a decrease following their appointment an actual increase was registered. It frequently happens that children are left for a greater part of the day to the care of a foster-mother, while the proper parents go out to work. Hence it will be necessary for the health visitors not to confine their duties to the proper mother, but also to instruct the foster-mother. I mention this point as an example to show that the visiting is not such a straightforward business as might be imagined. It seems to be fully recognised that permission to adopt the Act will be made conditionally of the appointment of health visitors, otherwise we should gain some advantage by its adoption, inasmuch as we should then obtain information of the locality of births without any expense. It will be remembered that it was agreed that I should try and obtain particulars among the employers of women shortly before and after childbirth ; this enquiry was to have begun in January, but I have delayed making a start in order to ascertain whether there is any chance of the Act being adopted, and thereby saving the borough the expense of twopence for the particulars of each birth. In conclusion, taking the actual results which have been obtained by those Boroughs who have appointed health visitors and those who have not, I am bound to come to the opinion that the advantage of their appointment is not proven, tor in Camberwell, where we confined our attention to sending out a pamphlet on Infant Feeding," using some discretion as to where they were to go, we make by no means a discreditable appearance. (Signed) FRANCIS STEVENS, Medical Officer of Health. A complaint was received from the Works calling attention to the nuisance caused by the sorting of dust at Nunhead Station. I visited the premises, and was of opinion that, taking into consideration the distance from the houses, and even from the station platform nearest to where the sorting was going on, no nuisance could possibly arise. A discussion has taken place with the London County Council as regards the cleansing of verminous children. It will be remembered that this Council decided to allow the children whose heads had been found by the school nurse to be in a verminous condition to use our disinfection station under the superintendence of our own officers. An amount has been expended on this work which really should be borne by the London County Council. If the work is to grow at the rate at which it has been doing during the last year, the present arrangements at the Peckham Park Road Depot, which were originally intended for the voluntary cleansing of adults, will be found to be totally inadequate. As it is, it is worked with a certain amount of difficulty, owing to the structural conditions, and to the lack of sufficient means for the heating of the bath water. At present the supply of this commodity has to be supplemented by one of the staff being employed to carry it over from the disinfecting machine, a procedure inadvisable and wasteful of time. Complaints were received of the nuisance caused by the defective urinal accommodation in the neighbourhood of the Joiners' Arms Yard in Denmark Hill. It was pointed out that there are two music halls and several public-houses in the immediate neighbourhood. The Committee made a midnight visit to the locality and concluded that the matter is mainly one for the police, for it is the public who cause the nuisance by their impatience. An additional light, which, however, was not considered necessary by the Geneval Purposes Committee, would probably do something to deter persons from using the outside instead of the inside of the urinal already provided. Complaint has been made of a factory at Camberwell Green. In consequence of complaints made the owners called in a firm of sanitary surveyors, who made various suggestions as regards the sanitary fittings of the place. As a consequence of this action I was requested to report on the nuisance and the proposed remedies. On May 5th it was ordered that a summons be issued, but a letter was received from the owners stating that the factory was to be shut down temporarily, and that they would then carry out my recommendtions. Certain works have, I believe, been carried out by them, but which were not in any way supervised by me, nor were my suggestions asked for. Complaints still continue, and the matter at the end of the year was still under consideration by your Committee. The question of the colour of the water from the well at the Old Kent Road Baths was referred to the Bacteriologist and myself, and on the following report the Committee decided that no action be taken:— "The precipitation of the iron in the water from the artesian well at the Old Kent Road Baths occurs on exposure of the water to the air, and the greater rapidity with which it can be exposed in this way the speedier will be the formation of the precipitate. Hence, if the Committee desire to make any alteration the present large tank will have to be altered so as to admit of the provision of means for agitating the water and bring it as quickly as possible into contact with the atmospheric air. This will ensure the rapid conversion of the iron into the form in which it is precipitated. As this must be done before passing the water into the bath another tank of a size equal to the first must be provided in which the precipitate may settle, and there should be the provision of yet another tank to act as a reservoir. This, to our minds, is the only practical way out of the difficulty, and if we may offer a suggestion, we should say: ' Leave matters as they are, and avoid the expense of alteration and possible disappointment with its results." ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901, IN CONNECTION WITH FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. In accordance with the above Act, I have to submit a report of the work carried out under its enactments. The figures shown under 1.—Inspection show an increase of over twelve hundred on the figures for 1907. This is apparent in all the three classifications of premises which are set out in the table. It might be expected the written notices would also be in excess, but they show a decline, especially remarkable as regards workplaces. Turning to the defects which were found as the result of these inspections, there were twenty-four less. They were all remedied without recourse to legal proceedings, except in one instance of insufficient w.c. accommodation. This was the only instance in which we had to take out a summons under this Act. It will be observed that there were twenty-four instances of home work being carried out in unwholesome premises. From the Inspector's report it appears that these related chiefly to such things as " carelessly kept rooms, the work lying about on the bed, rooms in a dirty condition," and it was not even necessary to go to the form of serving a notice, for the conditions were remedied forthwith. The registered workshops in the Borough show a diminution, except so far as laundries and those that are used for the making of clothing. 1.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Number of Premises. Inspections. Written Notices. Prosecutions. 478 Factories (including Factory Laundries) 31 - Workshops (including Workshop Laundries) 75 3,456 1 Workplaces (other than Outworkers' Premises included in Part 3 of this Report) 1,017 23 - Total 4,937 129 1 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referredto H.M. Inspector. Nuisances under the Public Health Acts:—* 28 28 - Want of Cleanliness - 2 Want of Ventilation 2 - - Overcrowding - - - - 4 4 - - Want of Drainage of Floors Other Nuisances Sanitary Accommodation— 103 103 X\JO - - 4 4 - Insufficient 1 Unsuitable or Defective 51 51 - - 2 Not separate for Sexes 2 - - Offences under the Factory and Workshop Act:— - - Illegal Occupation of Underground Bakehouse (s. 101) - - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) - - - - Other Offences (excluding Offences relating to Outwork which are include in Part 3 of this Report) - - - - Total 194 194 - 1 * Including those specified in Sections 2, 3, 7, and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 3.—Home Work. Nature of Work. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 103. Outwork in Infected Premises, Sections 109,110. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Instances. Orders made (Sec. 110.) Prosecutions (Secs. 109,110.) Prosecutions. Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Lists. Outworkers. Lists. Contractors Workmen. Workmen. Contraetors Wearing Apparel— (1) making, &c. 156 94 1,615 3 13 1,511 565 1,100 21 - - - - - - - - (2) cleaning and washing 12 - - - - - - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - - - - - - - Artificial Flowers 6 3 - - - - - - - - - - - - - - - Nets, other than Wire Nets - - - - - - - - - - - - - - - - - Tents - - - - - - - - - - - - - - - - - Sacks - - - - - - - - - - - - - - - - - Furniture and Upholstery 1 1 - - - - - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - - - - Feather sorting - - - - - - - - - - - - - - - - - Umbrellas, &c. 7 3 - - - - - - - - - - - - - - - Carding, &c., of Buttons, &c. 3 3 - - - - - - - - - - - - - - - Paper Bags and Boxes 4 48 13 48 3 40 - - - - - - - - - - - Basket making - - - - - - - - - - - - - - - - - Brush making 2 42 18 35 - - - - - - - - - - - - - Racquet and Tennis Balls 1 - - - - - - 1 - - - - - - - - - Stuffed Toys - - - - - - - - - - - - - - - - - File making - - - - - - - - - - - - - - - - - Electro plate - - - - - - - - - - - - - - - - - Cables and Chains - - - - - - - - - - - - - - - - - Anchors and Grapnels - - - - - - - - - - - - - - - - - Cart Gear - - - - - - - - - - - - - - - - - Locks, Latches and Keys - - - - - - - - - - - - - - - - - Pea picking - - - - - - - - - - - - - - - - - Total 162 13 - 94 1,705 3 1,599 579 - 1,194 24 - - - - - - FACTORY AND WORKSHOP ACT, 1901. Miss G. D. BEVAN. REPORT OF WORK DONE DURING 1908. Defective Roof, Dampness, &c. Defective Yards and Flooring. Sanitary Accommodation. Miscellaneous Defects. Intimation Notices. Statutory Notices. Summons. No. of Visits. Want of Cleanliness. Overcrowding and Want of Ventilation. Dirty or Uncovered Cisterns. Insufficient Defective Dust-bins. Dirty or Defective. Not Separate. Other Defects. I I I I I Factories and Workshops Report:— Complaints and Visits re ditto 3 1 1 - - - - - - - - - - - Workshops (new) 78 2 2 5 1 6 15 1 438 - Do. (old) - - - - - Laundries (new) 5 2 2 1 - - - - - - - - - - Do. (old) 99 4 Factories (new) 3 3 112 - - Do. (old) - - - - - - - - - Outworkers (new) 568 20 1 1 1 1 4 1 Do (old) - - - - - - 626 Visits re Infectious Disease on Outworkers' Premises 24 - - - - - - - - - - - - - Re-inspections re Work in Hand 72 - - - - - - - - - - - - - Eating Houses 2 3 1 2 11 1 100 2 4 - - - - - Miscellaneous 1,241 - - - - - - - - - - - - - 13 5 3,370 8 4 1 - - Totals 25 - 3 35 4 2 xvii There were no instances where it was necessary to take any steps in outwork being carried on in places where infectious disease had occurred. The lists of outworkers are now sent in with greater regularity, and in cases of default an intimation to that effect usually brings the information by return of post. 4.—Registered Workshops. Workshops and Workplaces on the Register (s. 131) at the end of the year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Laundries 80 Clothing (wholesale and private) 388 Preparation of food 198 Building trades 54 Bakehouses 174 Miscellaneous 461 Total number of workshops on Register 1,355 5. —Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Act (s. 133) 17 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s.5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 1 Other - Underground Bakehouses (s. 101): — - Certificates granted during the year In use at the end of the year 66 The tables set forth the details of the work which has been carried out under the supervision of your Inspectors. The item of New Buildings shows a decrease on the previous year, and, as might be expected, the figures are the highest in the Dulwich and Herne Hill districts. They also show the character and number of the inspections carried out by your Inspectors, but beyond testifying to the energy and zeal of your Officers they call for no special remark. Those which were made as the result of complaints were 1,326, compared with 1,827 in 1907, while those which were systematic or house-to-house in character numbered 5,238. The latter were chiefly those in the poorer neighbourhoods, and in many instances were of premises which had recently been overhauled, but which, owing to the character and habits of the tenants, were found to be in as bad a condition as they were a year ago. The Department sustained a serious loss through the death in July of Mr. A. G. Fitch, who had been with us since 1902. In conclusion, I beg to thank the Council and the Committee for the consideration they have never failed to show me, and the Officers of the Public Health Department for the assistance that they have never grudged. I am, Gentlemen, Your obedient servant, FRANCIS STEVENS. TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1908 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each Year. 2 Births. Deaths under One Year of Age. Deaths Ages. AT ALL Total. Deaths IN Public Institutions. tions. 9 Deaths of Nonresidents registered in District. 10 Deaths of Residents registered beyond District. 11 Deaths at all Ages. Nett. Rate per 1,000 Births registered. 6 Number. 3 Rate. * 4 Number. 5 Number. 7 Rate. * 8 Number. 12 Rate.* 13 261,551 7,427 28.3 1,191 160.3 4,639 17.7 4,369 1898 1,856 643 373 16.7 7,443 28.0 1899 265,385 1,181 158.6 4,941 18.6 2,200 732 484 4,693 17.6 1900 269,276 7,211 26.7 1,107 153.5 4,748 17.6 2,188 767 474 4,455 16.5 1901 259,660 7,260 27.9 1,033 142.2 4,576 17.6 2,224 802 509 4,283 16.4 1902 261,309 7,333 28.06 1,035 141.1 5,474 17.5 818 516 4,272 16.3 2,304 122.5 1903 262,968 7,286 27.7 893 4,004 15.2 1,768 741 366 3,629 13.8 1904 265,139 7,242 27.3 1,084 148.3 4,352 16.4 1,475 776 445 4,021 15.1 1905 267,601 6,939 25.9 865 124.7 4,067 15.2 849 495 3,713 13.8 1,468 1906 270,153 25.9 942 134.1 15.9 7,020 4,312 1,524 808 495 3,999 14.8 24.7 1907 272,479 6,733 805 119.5 4,217 15.4 1,508 873 479 3,823 14.0 Averages for years 1898 to 1907. 265,552 7,189 27.1 1,013 16.7 140.4 4,533 1,851 780 463 4,125 15.5 25.1 740 107.4 1908. 273,856 6,885 3,922 14.3 1,553 839 3,602 519 13.1 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. TABLE II. VITAL STATISTICS OF SEPARATE LOCALITIES IN 1908 AND PREVIOUS YEARS. 3. South Camberwell. Names of Localities. 1. Borough. 2. Dulwich. 4. North Camberwell. Deaths at all Ages. 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. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Deaths at all Ages. Deaths at all Ages. Births Registered. Births registered. Births registered. Births registered. Year. Camberwell. b d b d a c a c a b c d 261,551 7,861 91 79 1898 7,427 4,369 1,191 8 94,461 2,427 1,424 384 1899 265,385 7,443 4,693 1,181 8,018 101 85 9 96,379 2,443 1,475 371 1900 269,276 7,211 4,455 1,107 8,178 109 83 8 98,335 2,356 1,401 315 1901 259,660 7,260 10,247 125 77 15 4,283 1,033 90,465 2,295 1,259 284 32 1902 261,309 7,333 4,272 1,035 11,275 117 91 90,510 2,401 1,316 290 1903 262,968 7,286 3,629 901 11,214 140 85 9 92,079 2,341 1,209 279 1904 265,139 7,242 4,021 1,084 14,295 181 92 13 109,028 2,735 1,275 306 267,601 6,939 3,713 865 14,677 208 145 22 322 1905 110,648 2,731 1,483 b c d a b c d I I - —I a 1,036 531 138 66,598 1,703 1906 270,153 7,020 3,999 942 15,130 232 144 17 45,125 1,034 194 272,479 6,733 3,823 15,600 212 141 12 45,915 991 516 82 67,195 1,607 1,002 209 1907 805 265,552 Averages of Years 1898 to 1907 4,125 1,392 100,673 2,506 317 151 102 7,189 1,014 11,649 14 46,400 1,089 518 79 67,440 1,684 964 221 1908 3,602 740 16,170 222 136 17 273,856 6,885 TABLE II.—Continued. Names of Localities. 6. North Peckham. 7. St. George's. 5. South Peckham. Population estimated to middle of each Year. Deaths under 1 year. Deaths under 1 year. Population estimated to middle of each Year. Deaths at all Ages. Deaths under 1 year. Deaths at all Ages. Population estimated to middle of each Year. Deaths at all Ages. Births Registered. Births registered. Births registered. Year. Peckham. b d d a c a b c 68,744 2,172 1,171 352 447 1898 90,469 2,737 1,695 372 69,520 2,230 1,394 91,476 2,669 1,735 429 1899 354 70,305 2,041 1,307 430 1900 92,495 2,705 1,664 65,589 1,234 336 2,098 1901 93,038 2,742 1,713 398 1,256 333 65,640 2,062 1902 94,548 2,753 1,609 380 65,283 2,041 1,005 284 94,286 2,764 1,330 329 1903 47,449 1,713 1,056 326 94,323 2,613 439 1904 1,474 740 198 323 47,420 1,386 1905 94,849 2,611 1,345 b d I ... I „„ a b d a c c 1,492 824 224 48,033 1,493 751 211 715 158 49,682 1906 45,585 1,064 1,409 778 167 118 49,872 1,463 804 217 48,066 1907 45,831 1,051 582 Averages of Years 1898 to 1907 59,604 1,864 1,069 293 93,645 2,666 1,549 389 647 156 49,769 1,402 778 150 48,134 1,383 1908 45,943 1,105 559 117 It has not been possible to correctly allot the deaths of persons removed to public Institutions and of whose previous address we were unaware. See also report respecting the alteration in boundaries of the sub-districts. A pro rata distribution has been made in respect to the "unattached" births. TABLE III.-CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1908. Notifiable Disease. Cases Notified in Whole District. No. of Cases Removed to Hospital from each Locality. Total Cases Notified in each Locality. At Ages—Years. South Camberwell. North Camberwell. St. George's. South Camberwell. North Camberwell. St. George's. Total cases removed to Hospital. South Peckham. North Peckham. South Peckham. North Peckham. Dulwich. Dulwich. 65 and upwards. At all Ages. Under 1. 15 to 25. 25 to 65. 1 to 5. 5 to 15. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria(including) Membranous Croup 156 186 32 16 16 83 66 105 75 59 91 72 399 9 54 11 42 69 344 ... 21 146 17 Erysipelas 226 6 13 24 16 4 81 34 52 38 5 17 8 7 7 44 159 ... Scarlet Fever 1,032 8 274 626 88 36 49 163 230 248 183 33 128 205 207 175 148 896 ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 7 2 20 3 2 7 6 12 24 Enteric Fever 35 1 16 1 2 4 1 4 ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 10 3 4 1 2 2 3 1 1 7 Puerperal Fever ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Cerebro-Spinal Meningitis 2 2 1 1 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 228 349 289 240 449 840 350 47 298 1,317 1,704 25 146 16 75 236 177 276 279 405 xxiii TABLE IV.—CAUSES OF, AND AGES AT, DEATH DURING YEAR 1908. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages). 9 Dulwich. 10 South Camberwell. 11 North Camberwell. 12 South Peckham. 13 North Peckham. 14 St. George's. 15 Locality unknown. 16 Deaths in Public Institutions. 3 Under 1. 4 1 and under 5. 5 5 and under 15. 6 15 and under 25. 8 65 and upwards. 7 25 and under 65. 2 All Ages. Causes of Death. 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 10 5 7 17 Measles 49 9 37 3 2 ... ... ... ... ... 1 8 Scarlet Fever 24 12 5 2 2 11 2 2 3 ... ... ... ... Hooping-cough 4 9 8 13 16 50 23 27 ... ... ... ... ... ... ... Diphtheria and Membranous Croup 2 6 7 13 9 4 2 27 12 ... ... 41 ... ... ... Croup 2 1 1 ... 1 1 ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever 1 1 1 2 3 Enteric 7 1 2 3 ... ... ... ... ... ... Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 63 2 2 2 35 22 1 15 22 9 8 7 1 7 ... Cholera ... ... .. ... ... ... ... ... .. ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 48 Diarrhœa 132 97 29 1 5 2 22 22 28 ... ... ... ... Enteritis 1 1 1 5 11 3 7 2 4 29 21 4 2 ... ... 2 2 1 2 Puerperal Fever 5 1 4 ... ... ... ... ... ... ... ... 2 4 1 2 Erysipelas 7 4 1 2 ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 5 49 11 6 42 77 32 76 57 7 102 297 3 9 220 Other Tubercular Diseases 15 40 16 28 22 18 2 113 29 15 11 3 4 23 12 Cancer, Malignant Disease 2 163 91 17 44 69 28 49 40 10 59 257 ... 1 ... Bronchitis 7 36 105 54 91 62 4 69 359 59 33 1 1 99 166 Pneumonia 305 75 84 13 12 82 39 6 34 82 33 66 75 9 53 Pleurisy 2 3 4 1 2 2 3 1 9 ... ... ... ... ... ... Other Diseases of Respiratory Organs 3 5 5 5 1 5 23 6 3 1 4 9 4 ... ... Alcoholism 2 4 13 6 10 1 8 40 31 9 4 ... ... ... ... Cirrhosis of Liver 1 1 3 2 1 3 Venereal Diseases 14 13 1 4 2 ... ... ... ... 16 18 Premature Birth 111 111 4 23 27 23 7 ... ... ... ... ... ... Diseases and Accidents of Parturition 1 2 1 5 4 5 4 4 20 5 ... 13 ... ... ... Heart Diseases 15 47 63 50 68 4 48 287 3 2 16 14 142 110 40 Accidents 110 24 8 9 24 38 2 9 30 17 30 21 1 35 7 Suicides 2 17 1 1 6 3 1 4 5 4 20 ... ... ... ... Convulsions 3 9 20 10 14 70 64 5 1 14 1 ... ... ... ... 19 21 4 Defective Vitality 130 123 4 2 1 4 31 25 26 20 ... ... Granular Kidney 94 62 32 6 14 25 11 23 14 1 38 ... ... ... ... Mental Diseases 21 7 2 8 6 1 4 3 4 4 28 ... ... ... ... Old Age 11 48 74 45 61 45 8 85 292 ... 9 283 ... ... ... Cerebro-spinal Meningitis 2 2 1 1 ... ... ... ... .. ... ... ... ... ... ... All other causes 612 61 34 37 34 261 185 31 98 168 100 110 90 15 121 546 75 All causes 740 123 144 1215 1018 132 506 945 764 634 695* 3602 362 * This number refers to the deaths of parishioners, and excludes the deaths of non-residents who were inmates of Southwark Infirmary. TABLE V.—INFANTILE MORTALITY DURING THE YEAR 1908. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total Under 1 month. 1 to 2 months. 2 to 3 months. 3 to 4 months. 4 to 5 months. 5 to 6 months. 6 to 7 months. 7 to 8 months. 8 to 9 months. 9 to 10 months. 10 to 11 months. 11 to 12 months. Total Deaths under 1 year. ... ... ... ... ... ... ... ... ... All Causes Certified ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... 2 2 ... ... ... ... ... ... 1 ... ... ... 4 9 ... ... Scarlet Fever ... 1 ... ... ... ... ... ... ... ... ... 1 1 3 ... ... ... Diphtheria (including Membranous Croup) ... ... ... ... 2 2 ... ... ... ... ... ... ... Hooping Cough ... ... ... ... ... ... 3 3 3 1 1 4 23 ... ... ... ... 1 7 ... ... Diarrhœal Diseases :— Diarrhœa, all forms 2 1 3 4 5 14 7 - ... ... 14 11 11 5 6 4 90 Enteritis, Muco-enteritis, Gastro-enteritis 1 1 1 5 1 1 3 1 1 4 1 1 2 4 24 ... ... Gastritis, Gastro-intestinal Catarrh 2 1 3 ... 1 ... xxvi ... ... ... ... ... ... ... 4 ... ... ... Wasting Diseases :— Premature Birth 82 11 9 4 106 4 2 2 ... ... ... ... 114 ... ... ... ... Congenital Defects 13 2 1 1 17 2 ... ... 1 1 1 22 ... ... ... ... Injury at Birth .. 8 ... 8 ... ... ... ... ... 8 ... ... ... ... ... ... ... ... Want of Breast-milk, Starvation 1 1 1 3 1 ... ... 4 ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 22 6 9 3 40 18 11 11 3 8 1 3 2 3 1 101 Tuberculous Diseases:— ... Tuberculous Meningitis ... 1 ... ... ... 2 ... 1 1 3 8 ... ... ... .. Do. Peritonitis : Tabes Mesenterica ... ... ... ... ... 2 1 1 1 ... 6 ... ... ... ... 1 ... ... ... Other Tuberculous Diseases 1 1 3 2 3 2 17 ... ... ... ... ... 1 4 ... ... ... Erysipelas ... 1 1 ... ... 1 1 1 ... ... 4 ... ... ... ... ... ... Syphilis 4 3 1 1 1 1 4 1 1 ... 13 ... ... ... ... ... ... Rickets ... 1 ... 1 ... ... ... ... ... ... ... ... .. ... ... - ... Meningitis (not Tuberculous) 1 1 1 3 2 6 2 ... ... 4 1 1 1 2 3 2 27 Convulsions 2 11 8 5 26 12 4 ... 3 3 5 2 3 1 1 4 64 Bronchitis 1 1 2 4 7 3 6 3 7 5 6 7 3 8 59 ... Laryngitis ... 1 1 2 ... ... ... ... .. ... ... ... ... 2 Pneumonia ... ... ... ... 2 3 5 10 5 ... 6 5 1 7 ... 9 8 8 8 9 76 Suffocation, overlying 3 1 3 5 2 ... ... 4 1 1 1 1 2 ... 20 .. ... Other Causes 7 1 1 3 12 2 3 4 2 2 3 2 1 4 2 2 39 47 62 69 45 40 37 32 31 740 Other Causes 158 39 28 24 249 45 31 I 52 XXV MORTALITY RETURNS OF ZYMOTIC DISEASES QUARTERLY FOR THE LAST SIX YEARS. Year. Hooping Cough. Measles. Scarlet Fever. Diphtheria. Small-pox. Diarrhœa. Influenza. Fever. 1903. 1st Quarter 40 14 26 3 19 8 0 12 2nd „ 24 8 0 9 2 0 6 7 4 2 3rd „ 11 6 5 0 62 11 4th „ 7 2 3 4 0 30 7 16 34 1904. 1st Quarter 35 1 6 4 8 9 0 3 6 2nd „ 36 53 3 4 0 0 3rd „ 12 13 5 5 5 0 200 1 4th „ 0 11 7 8 4 0 15 16 1905. 1st Quarter 36 3 5 9 12 10 0 1 28 2nd „ 19 10 0 6 15 5 2 7 3rd „ 4 4 4 3 0 140 1 9 4th „ 11 37 5 2 0 11 6 1906. 1st Quarter 22 4 3 5 10 72 15 0 2nd „ 22 26 7 5 0 0 9 15 4 3rd „ 10 1 6 5 0 194 2 10 4th „ 17 2 14 3 0 16 11 1907. 1st Quarter 40 10 9 7 21 50 3 0 2nd „ 51 33 8 5 0 0 6 10 9 15 21 8 24 0 4 3rd „ 2 4th „ 10 11 27 8 2 4 0 4 1908. 1st Quarter 18 16 5 43 10 11 1 0 2nd „ 21 17 2 1 0 5 8 7 3rd „ 11 7 0 14 4 0 99 6 4th „ 8 2 16 5 0 23 6 - ANNUAL MORTALITY RETURN OF ZYMOTIC DISEASES, FROM 1856 (inclusive). Hooping Cough. Measles. Scarlet Fever- Fever. Small-pox. Diarrhœa. Diphtheria. Year. 30 5 29 1856 19 32 48 1857 30 7 44 24 4 50 20 7 26 1858 51 28 129 14 82 66 31 12 ? 1859 11 1860 36 40 34 26 5 ? 2 13 25 25 ? 1861 72 8 1862 40 64 0 ? 53 32 101 41 1863 57 32 124 29 14 ? 1864 61 29 83 16 51 10 ? 52 39 55 14 31 12 118 1865 53 35 76 1866 72 38 59 11 9 67 1867 64 20 75 8 41 17 1868 58 67 71 45 13 146 1869 134 43 164 9 46 9 133 23 49 24 192 10 57 160 1870 153 1871 50 29 60 9 40 143 1872 132 46 86 1 38 41 124 1873 60 49 7 7 38 2 137 76 24 9 57 2 93 1874 54 40 1 107 1875 125 64 177 14 1876 93 33 78 16 31 32 126 1877 61 72 12 27 124 94 38 1878 206 88 29 41 81 176 59 1879 76 35 75 122 123 31 80 1880 206 59 126 32 36 33 223 74 95 120 29 44 190 127 1881 180 76 44 66 100 1882 168 60 49 35 19 122 1883 91 112 48 78 240 1884 173 171 82 40 34 136 91 20 68 27 154 135 1885 156 97 48 30 2 215 1886 18 71 41 0 239 1887 203 133 99 115 1888 130 101 105 65 31 1 1889 149 193 37 76 27 0 145 1890 191 163 51 60 26 0 144 29 56 21 1 142 1891 123 67 21 1 169 1892 128 189 63 85 1893 104 78 80 118 30 11 213 126 164 45 193 21 2 115 1894 100 47 181 30 7 254 1895 61 34 0 238 1896 180 192 52 262 1897 101 125 32 167 28 5 339 1898 121 113 18 86 25 0 350 76 127 19 162 32 0 371 1899 131 33 0 282 1900 110 38 11 186 1901 77 149 47 110 22 7 96 1902 105 40 88 29 62 131 68 75 11 36 18 0 110 1903 100 16 23 16 0 229 1904 94 9 166 1905 70 79 29 18 0 1906 71 101 25 40 11 0 224 1907 107 109 37 40 9 0 61 50 49 24 41 7 0 132 1908 Under the head of fever I have only included the deaths from enteric fever. RETURN OF WORK CARRIED OUT AT THE DISINFECTING STATION DURING THE YEAR 1908. April. May. June. July. August. September. October. November. December. Total. January. February. March. Articles Disinfected. 98 82 100 1,240 80 49 110 125 Beds 172 135 103 60 126 349 162 127 139 208 Blankets 186 208 67 83 117 93 230 1,969 144 71 78 93 58 39 50 70 34 62 77 83 859 Bolsters Books—Public Library 50 29 10 20 27 21 33 55 411 61 51 34 20 - Books— Sunday School Library - - - - - - - - - - - - - - Books—Day School Library 3 - - - - - - - 3 - - 70 44 45 23 13 41 26 36 21 70 33 459 Cushions 37 Curtains (pairs) 4 4 1 4 1 2 2 4 5 2 9 1 39 18 27 Carpets 35 13 19 12 3 9 12 7 15 14 184 100 Mattresses 55 79 45 44 29 34 43 27 52 58 58 624 2 6 Palliasses 12 - 4 4 - 3 4 133 98 - - 218 177 154 45 149 196 230 260 Pillows 364 271 133 181 2,378 Quilts 116 98 75 64 225 132 55 97 60 108 130 141 1,301 Sheets 203 131 132 94 94 960 92 123 114 139 161 2,320 77 Wearing Apparel (Suits, Dresses, &c.) 961 733 1,090 373 472 286 1,276 1,266 11,483 1,116 8 1,360 2,542 Miscellaneous 96 14 42 140 13 42 19 7 17 24 13 24 451 1,825 1,132 Total 2,945 1,953 1,110 1,403 1,104 1,928 2,234 3,647 2,472 23,854 2,101 Mattresses Retabbed 95 31 79 45 44 14 34 43 25 52 58 58 578 4 Palliasses do. 3 5 2 18 - - 4 - - - - - Cushions do. 76 17 45 37 23 5 70 41 26 36 21 18 415 Total 171 48 82 67 73 128 128 61 78 78 19 78 1,011 Return of Work carried out at the Disinfecting Station during the Year 1908 (continued). January. February. March. April. May. July. August. September. October. November. December. Total. June. Articles Disinfected. Verminous Cases— L. Persons Cleansed 55 36 43 79 25 35 173 142 303 106 1,124 28 99 Rooms Disinfected 1 1 6 3 1 1 13 - - - - - - Bedding do. 1 6 - - - - - - 5 - - - - 28 38 173 xxviii Total 56 36 43 79 100 36 144 304 106 1,143 Articles Destroyed— Palliasses and Mattresses 56 55 67 111 143 151 210 396 90 158 116 46 1,599 227 Miscellaneous 13 28 53 9 30 67 27 - - - - - 56 143 Total 55 80 111 171 204 219 426 90 225 46 1,826 Houses Visited 491 196 310 307 251 199 232 352 178 307 406 387 3,616 Rooms Disinfected 228 78 158 131 100 70 101 139 85 129 174 166 1,559 5,175 Total 719 274 468 438 351 269 333 491 263 436 580 553 SUMMARY OF SANITARY WORK FOR THE YEAR ENDING JANUARY 2nd, 1909. Scudamore. Kerslake. Pointon. Totals. Collins. Morley. Homer. Farmer. Malins. Description of Work. Heath. Dewey. Eagle. 133 Cleanse and limewash 108 150 206 187 57 117 238 1,719 92 21 410 Repair guttering, &c. 84 85 41 21 125 111 59 100 74 155 123 978 15 Ventilate under floors, &c. 31 161 7 144 46 46 82 52 8 596 4 8 8 8 10 6 4 7 1 16 23 91 Abate overcrowding - Abate smoke nuisance 1 15 6 5 11 5 4 20 15 82 - - 6 Light and ventilate staircase 9 27 1 1 10 6 5 3 3 1 72 50 81 51 54 96 46 49 55 54 82 87 705 Provide, repair, or remove dustbin 24 25 31 26 Remove refuse or manure 38 28 14 30 5 20 19 260 Pave, level, or drain yard, &c. 90 73 47 72 36 98 45 123 68 84 133 869 Provide manure pit 10 1 7 1 2 5 12 12 2 52 - - 8 11 22 5 9 6 4 1 1 Provide sufficient water supply 2 - 69 Provide or reconstruct receptacle (render accessible) 17 1 3 12 2 1 5 5 1 2 49 - Repair, cover, or cleanse receptacles 21 19 2 25 5 52 17 2 10 20 17 190 102 48 152 126 36 85 65 90 84 81 48 917 Provide, repair, or remove closets, pans, &c. 137 87 36 71 66 51 75 Proper water supply to closet and apparatus 79 122 56 92 872 Ventilate and remove to outside soil pipes, cleanse, repair, and trap drains or sinks 114 179 121 100 53 96 56 123 94 49 60 1,045 Disconnect rain-water pipes, sinks, and other wastes 7 38 21 94 11 22 15 55 2 26 291 - Empty and cleanse cesspools, or drain into sewer 2 2 4 - - - - - - - - - Totally reconstruct drains 21 55 39 38 8 21 42 10 1 24 2 261 Partially reconstruct drains 78 40 32 80 29 46 20 31 28 49 40 473 11 2 4 6 11 Animals to be kept clean or removed 9 2 4 4 53 - - Public conveniences—cleanse, supply with water, &c. - - - - - - - - - - - - Private conveniences—cleanse, supply with water, &c. 1 11 5 6 1 2 1 5 4 15 51 - Abate nuisance from offensive trades 1 5 1 3 - - - - - - - - Abate nuisance from road gullies 6 1 1 4 2 5 2 21 - - - - 4 Miscellaneous 1 46 55 46 5 17 13 47 107 341 - 10,066 873 1,202 912 767 1,076 589 859 794 1,029 1,232 733 Totals RETURN OF WORK PERFORMED IN THE SANITARY DEPARTMENT DURING THE 53 WEEKS ENDING JANUARY 2nd, 1909. Inspectors. Pointon. Kerslake. Totals. Description of Work. Scudamore. Farmer. Collins. Morley. Homer. Dewey. Malins. Miss Bevan. Eagle. Heath. 86 127 50 109 106 110 105 78 81 44 4 968 68 Complaints 220 100 81 165 107 58 1,326 Inspections arising from complaints 112 126 179 55 121 2 189 5,238 House to house inspections 512 619 379 637 403 635 349 346 484 685 - Tenement houses inspected 6 9 17 238 54 85 18 17 198 66 708 - - 1 18 15 1,422 1,456 Houses let in lodgings inspected - - - - - - - - 67 142 11 1 76 15 19 341 New buildings inspected 2 8 - - - Visits to new buildings 172 40 11 1,728 82 17 769 6 694 5 8 3,532 - - No. of inspections of slaughterhouses 24 29 5 46 4 15 6 3 132 - - - 75 41 57 64 32 57 56 99 112 32 658 Do do. bakehouses 33 - 3 52 6 7 26 1 Do. do. cowhouses and dairies 32 58 7 12 8 212 - Do. do. milk shops 187 74 209 36 127 193 114 229 68 94 112 1,443 - 81 31 60 30 41 33 48 53 54 31 32 494 Do. do. ice cream shops - 29 1 10 48 27 6 126 Do. do. railway stations - - 1 4 - 110 - 133 117 39 Do. do. workshops 63 241 60 231 80 114 129 523 1,840 XXX 4 57 Do. do. urinals, public 93 39 4 49 14 35 49 57 48 449 - 303 177 387 205 120 235 466 359 478 126 3,117 Do. do. do. private 261 - 26 Do. do. schools, L.C.C. 69 78 38 30 17 27 84 25 15 90 499 - 7 49 37 57 257 Do. do. do. private 45 6 1 12 23 14 6 - Do. do. laundries 57 12 1 5 5 22 4 31 2 103 242 - - Do. do. re overcrowding 78 2 7 7 3 8 27 6 4 41 183 - - 75 20 6 25 29 17 64 11 18 49 447 Do. do. eating houses 20 113 1 27 Do. do. factories 49 72 - 96 117 362 - - - - - 6 Do. do. re outworkers 2 4 - 3 1,154 - - - - - - 1,169 Miscellaneous 138 21 69 80 18 275 39 208 18 594 625 1,245 3,330 3,091 4,158 3,721 3,198 2,723 3,621 4,191 3,003 3,926 2,181 2,609 71 36,493 Re-inspections No. of infected houses 154 83 139 386 219 179 132 124 174 131 83 25 1,829 Do. do. re-visited 133 21 116 64 15 30 47 197 60 50 46 779 - Measles 7 1 6 363 15 29 - - - - - 512 37 Intimations served under P.H. Act 431 501 304 271 462 339 228 511 4,405 446 363 512 37 Statutory notices under P.H. Act 137 83 164 74 67 85 84 29 81 84 104 4 996 6 16 - Notices re houses let in lodgings 1 3 - 81 107 - - - - - 9 Summonses under the P.H. Act 1 2 3 2 5 5 4 1 15 47 - - 6 10 7 12 5 2 52 Small-pox contacts - 10 - - - - Cholera do. 18 4 3 6 31 - - - - - - - - 6,886 6,381 6,746 6,099 6,665 5,320 7,425 5,798 5,085 3,446 73,297 Totals 6,202 7,244 PROCEEDINGS DURING 1908 (as asked for by the London County Council). Premises. Number of Places. Number of Inspections, 1908. Number of Notices, 1908. Number of Prosecutions, 1908. On Register at end of 1907. Removed in 1908. On Register at end of 1908. Added in 1908. 41 1,443 Milk Premises 599 24 616 - - Cowsheds 17 1 17 212 - - - 15 1 15 132 Slaughterhouses - - - Other Offensive Trade Premises 2 6 6 - - - - 216 Ice Cream Premises 238 13 35 494 17 - Registered Houses Let in Lodgings (a) Nil (a) 12 217 1,456 217 - - (b) 254 (b) 4 * (a) For overcrowding. (b) For other conditions. Total Number of Intimation Notices served for all purposes 4,40 Overcrowding, 1908:— Number of dwelling rooms overcrowded 91 Number remedied 91 Number of prosecutions 1 Underground Rooms: — Illegal occupation dealt with during year Nil Number of rooms closed Nil Insanitary Houses:— Number closed under the Public Health (London) Act, 1891 Nil Number closed under the Housing of the Working Classes Act Nil Number of Verminous Premises cleansed under Section 20 of the L.C.C. (General Powers) Act, 1904 13 Shelters provided under Section 60 (4) of the Public Health (London) Act, 1891:- Number of persons accommodated during the year Nil Revenue Acts:— Number of houses for which applications were received during year 25 Number of tenements comprised therein 105 Number of tenements for which certificates were— (a) Granted 15 (b) Refused 10 (c) Deferred Nil Number of Prosecutions under By-laws under Public Health Act, 1891:- (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. Nil (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c. Nil (c) For the prevention of keeping of animals in such a manner as to be injurious to health Nil (d) As to paving of yards, &c., of dwelling houses 12 (e) In connection with the removal of offensive matter, &c. 5 (f) As to cesspools and privies, removal and disposal of refuse, &c. 8 (g) For securing the cleanliness of tanks, cisterns, &c. Nil (h) With respect to water closets, earth closets, etc. 4 (i) With respect to sufficiency of water supply to water closets 2 (j) With respect to drainage, &c. (Metropolis Management Act, Section 202) 6 (k) With respect to deposit of plans as to drainage, &c.(Metropolis Management Acts Amendment (By-laws) Act, 1899) 2 Mortuaries:- Total number of bodies removed 321 Total number of infectious bodies removed 4