CAMIS Camberwell 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 for the middle of 1911, as estimated by the Registrar-General, is 4,521,301. The census being taken at the beginning of April, it is probable that this figure only exceeds by very little the actual number, and that for all practical purposes it may be considered as being accurate. The number of births actually registered was 111,738, as compared with 114,870 in 1910, when the birth-rate was estimated at 23.6. The birth-rate for 1911 is estimated at 24.8, an increase of 1.2, but this increase is more apparent than real, for the 1910 calculation was made on an estimated population of 4,872,702, that is, greater by some 250,000 than the actual enumeration in 1911. It will be further noticed that there is a recorded decrease of over 3,000 in the number of births registered in London in the year just past. When one comes to the death-rate of London as a whole an increase is again seen, and here there are two factors coming into action, for, on the one hand, we find the actual population has been found by enumeration to be considerably less than that which was estimated, and, on the other, an increase took place in the registrations of deaths of about 6,000, so it can be regarded as certain that the death-rate of London as a whole has gone up, while there has been an actual decrease in the birth-rate. Attention was drawn in last year's report to the fact that, owing to the long period which had elapsed since the enumeration of the population of the various London Boroughs, it was necessary to view the calculated rates for births and deaths with some considerable amount of reserve. The necessity for this caution shows itself when we come to compare the estimate of the population with the actual numbers obtained at the census. The Registrar - General for his purpose estimated that the population of Camberwell at the middle of 1910 would be 286,058. Our own estimate, which is calculated on a different basis, gave 279,566; but when, however, the actual enumeration was made in 1911, it was found to be but 261,238. It is therefore apparent that the birth and death rate as set out in 1910, and, indeed, in all others since 1901, are erroneous in being too low; but the nearer the year is to 1901, the more closely do they approach the correct figures. But there have also been changes in the boundaries of the sub- districts which have introduced still further difficulties in drawing comparisons between the various sub-districts of the Borough in 1911 and 1901. Table A.-Population of Camberwelland Sub-Districts. South Camberwell. North Camberwell. South Peckham. North Peckham. St. George's. Borough. Dulwich. 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 enumerated at census 1911 261,328 14,974 45,036 64,379 43,221 47,753 45,965 The number of births registered in Camberwell was 6,342, and to this we must add 57, representing infants whose mothers were inhabitants of the Borough, although the births themselves took place outside its boundaries. Owing to the impossibility in all cases of allocating these Births to the proper registration districts, as we are not always aware of the previous address of the mothers, it has been found that a certain proportion have to be treated as a class apart, and the various districts have to be credited with them in the same proportion as they are with the unclassified deaths. Table B.—Re-Disribution of Berths among the Sub-Districts of Camberwell. District. Received from Sub- Registrars. Sent in from Adjoining Boroughs. "Unattached" Registrar- General. Total number of Births due to Sub-Districts. 2 Dulwich 192 188 2 956 Camberwell, South 931 17 8 Camberwell, North 1,574 38 14 1,626 Peckham, South 976 956 11 9 Peckham, North 1,271 20 12 1,303 1,346 St. George's 1,314 20 12 Total 6,234 108 57 6,399 The total decrease in the actual number of births for the whole Borough is 258, North Camberwell being the only district to show an increase. The greatest decrease was in North Peckham, St.George's not being so very far behind. Table C. —Births in Camberwell and its SUB-Districts. Unattached. South Camberwell. North Camberwell. South peckham. North Peckham. Dulwich. St. George's. Year. Borough. 6,657 195 935 1,505 993 1,444 1,439 146 1910 1,334 1,291 1911 6,399 190 948 1,612 967 57 -258 —5 +13 +107 — 26 -153 —105 Difference -89 It will be seen that the birth rates have apparently increased in all districts except in St. George's and North Peckham. The decrease is really greater than it appears, for last year the estimate of the population in both these districts was considerably higher than that which was actually enumerated. TABLE D.­ BIRTH- RATES OF CAMBERWELL AND ITS SUB-DISTRICTS. Year. Borough. Dulwich. South Camberwell. North Camberwell. South Peckham. North Peckham. St.George's. 12.3 21.7 1910 23.8 19.9 22.0 29.1 30.3 22.5 12.8 1911 24.4 21.2 25.2 27.2 29.2 The actual number of the registrations received from the local registrars amounted to 4,097, but this included deaths which, although they were of persons who died in Camberwell, were of those who had been brought into this Borough for the purpose of treatment, and in the main were either denizens of the St. Saviour's Infirmary, which receives the sick from the poor law district of that name, and also of the two lunatic asylums where patients are treated from all parts of England. Such are therefore excluded from the Camberwell death returns, and are not reckoned with in the calculation of the Borough death rate. When it comes to the estimation of the death rate for the individual wards another difficulty of classification presents itself in the deaths taking place in outside institutions, and mainly in those which are devoted to the reception of diseases running a chronic course. Deaths occur therein of persons who have been removed from Camberwell, perhaps many years previously, but where no record exists of the exact locality in the Borough from which they were admitted. Dr. Bristowe instituted the plan of distributing these deaths, which can be described as unattached, among the various registration districts in proportion to the deaths recorded among them, and about which there could be no possibility of error on this score. The following table shows the method of this redistribution:— Table E.—RE-DISTRIBUTION OF DEATHS AMONG THE SUB-DISTRICTS OF CAMBERWELL. Deaths of persons removed from unknown addresses in the Borough re-distributed. District. Estimates of total deaths due to subdistricts. Deaths returned classified according to sub-districts. 152 Dulwich 147 5 517 South Camberwell 505 12 22 978 North Camberwell 956 14 620 South Peckham 606 17 754 North Peckham 737 701 St. George's 685 16 Total 3,722 3,636 86 After all these alterations have been carried out we have altogether 3,722 deaths recorded during the year of persons whose deaths can be properly ascribed to Camberwell, two less than those which have been 1assigned to us in the proof report of the Registrar General. This discrepancy is due to the difference of opinion as to whether deaths of persons dying outside who had been in Camberwell institutions, and who might conceivably have been moved from an address in that Borough to an outside institution, should be assigned to Camberwell or to any other district. Anyhow the difference will not appreciably affect the figures. Using this number of deaths, together with the calculation made of the population in July, that is, three months after its actual enumeration, we find that the death rate is 14.2, while if it be corrected as is done by the Registrar-General, so as to make it comparable with the other Boroughs of London, it becomes 14.8, having increased from 12.5 in 1910. The death rate for the whole county in these two years being 13.4 and 15.8 respectively. Table F. Death-rates in Camberwell and its Sub-Districts for the PAST 10 YEARS. South Camberwell. North Camberwell. South Peckham. North Peckham. Year. Borough. Dulwich. St. George's. 1902 16·34 8·07 19·13 14·53 17·01 7·57 13·80 1903 13·04 14·10 15·39 6·66 1904 15·16 12·07 16·11 22·97 1905 13·8 9·87 13·40 14·18 15·60 14·8 1906 11·7 15·5 9·5 12·7 16·5 15·6 14·0 1907 9·0 11·2 14·9 12·6 16·1 16·1 13·1 12·1 1908 8·4 11·1 14·2 15·6 13·4 13·7 1909 9·8 10·5 14·3 12·9 16·6 15·0 12·2 1910 9·0 9·0 12·8 11·0 14·4 14·5 1911 14·2 10·1 11·4 15·1 14·3 15·7 15·2 The rate thus on the surface appears to be one of the highest recorded since 1902, it being surpassed only in that year, in 1904 and in 1906. The real increase, however, is not so great, for although there has been an increase in the actual number of deaths in 1911 the enumerated population is less than the estimated one of 1910, therefore the death rate calculated upon it must of necessity be higher. If the census figures be disregarded, and the population were assumed to have increased in the same proportion as it did in 1901-1911, the death-rate for Camberwell would be 13.4, i.e. 0.9 more than last year. Coming down to the various registration sub-districts of the Borough there is an increased number of deaths to be put down to each of them with the exception of St. George's, where there is one less than last year. But allowance must again be made for the enumerated population being so much lower than the estimated for I find that in 1909 there were the same number of deaths recorded in North Camberwell as in 1911 but the death-rate in the former year is calculated at 14·3 and in the latter 15·1. It has been well said that owing to the heat and drought of 1911, the Sanitary Authorities of England were on their trial in that year. During the preceding four or five years there had been a succession of wet and cool summers which had its results in a low infantile mortality, the latter of which had declined in L ondon form 144 per thousand births in 1904 to 103 per thousand in 1910. Indeed, there were many who apparently looked for this to be a permanent reduction, due in great measure to the special methods adopted of late years, such as milk depots, consultations for mothers, and especially the appointment of health visitors, following on the Notification of Births Act These were each and all presumed to have had a special and beneficent influence towards the reduction, and quite apart from these general hygienic measures which have no doubt had a great effect in bringing down the all-ages death rate in recent years. It was no doubt owing to this impression that a recommendation of the Southwark Diocesan Conference that trained and qualified health visitors be appointed, was passed and sent to this Council. A rude shock is therefore experienced when we find that last year the infantile mortality rate rose in London from 103 to 129. In this Borough, with its total of 735 deaths, the proportion went from 94 to 109, and it becomes therefore a matter of interest and importance to see how far the measures already mentioned were able to withstand a condition of weather so favourable to a high infantile mortality, and to the prevalence of epidemics of diarrhœa. In July, 1910, when the recommendation of the South wark Diocesan Conference was under consideration, I drew up a table in a report showing the infantile mortality of certain other Boroughs (where such officials are at work) with which comparisons have been drawn in previous reports, and which is set out below, together with the inclusion of the 1911 figures. The Committee, having considered this report, after considerable discussion deci ded not to recommend any such appointments, a resolution whichw as endorsed by the Council on July 19th, 1910. This self-same question had already been before them on several occasions, and I have in previous annual reports made a comparison, going back to the year 1906, between Camberwell and five other Boroughs who had for some time employed health visitors. These figures do not produce any convincing evidence as to the influence of these appointments in reducing infantile mortality, and if the supporters of the appointment of these officials as a means for such reduction of can find much cause for self-congratulation in the figures, they are easily satisfied. Speaking for myself, however, I can see no reason to alter the view so frequently expressed that is it material help rather than advice that is needed, and that the intangible sympathy and assistance of the health visitor is not likely to be of advantage. Deaths under One Year from Ali Causes per 1,000 Births. Borough. 1906. 1907. 1908. 1909. 1910. 1911. Year in which Health Visitor was appointed. 104 100 Camberwell 130 94 109 115 153 144 138 126 156 1909 Bermondsey 123 138 123 151 1906 Bethnal Green 155 132 129 138 117 120 99 146 1905 Hammersmith 120 Hampstead 77 69 69 75 60 78 1909 106 1906 119 133 Kensington 132 128 113 1907 131 120 104 109 94 123 Lambeth 85 1906 109 112 94 82 97 Woolwich It has been urged that part of this increase has been due to the more rigorous exclusion of all births except those which are to be properly credited to particular districts, but it will be noted that there is an increase in the infantile mortality rate for the whole County of London where this process of exclusion and correction has gone on for some years. The subject was also considered at a meeting of sanitary authorities at the County Hall, where a resolution was carried that, in view of the passing of the Notification of Births Act, appointment of one or more sanitary inspectors or health visitors is eminently desirable, and the many speeches were almost unanimously in favour of this. The dissent, lam glad to say, came from the Chairman of your Committee, who pointed out that a larger number of deaths were of premature birth. It was, however, urged by some of the Medical Officers of Health present that many deaths in this class are often due to preventable causes, such as lead poisoning or neglect either on the part of the mother or of some hygienic precautions. If these views are correct, it will be shortly the duty of the Legislature to pass a Notification of Pregnancy Act, so that prospective mothers can be visited and inspected, and the holders of these opinions will no doubt be able to frame regulations for our guidance in enforcing and carrying out any remedial measures that may be considered necessary. There were exactly the same number of deaths from premature births as in the previous year, and in the class of the wasting diseases, such as atrophy, &c., there has been a decline from 101 to 84, thus being 32 below the 116 recorded in 1909. It is in these sub-divisions that food and feeding might be a factor of considerable importance, and it is a class which should indicate the effect of the visits of a health visitor in a reduction of the mortality; that is if the contention holds good that much of this is due to the fact that mothers do not know how to bring up their children, and that a health visitor is necessary to instruct them in this, it being assumed, of course, that the advice of this official will and can be carried out to its fullest extent. There were 29 deaths from measles in infants under 1 year, being 6 more than in 1910; on the other hand there were 8 fewer deaths from whooping cough. Three deaths from erysipelas were recorded, there being none in the previous year. Only 3 deaths were certified as due to syphilis, the number in the previous year being 13. The mortality from the respiratory diseases was also less than in 1910, there being 5 fewer deaths from bronchitis and 12 fewer from the various forms of pneumonia. The deaths from measles continued high in number, although a little below the 1909 figures. They gradually began to mount up in the early autumn of 1910, and in the latter months of that year had shown a great increase over the corresponding period of 1909, the epidemic continuing well into the spring of 1911. The heaviest incidence of the disease, judging from the number of deaths, was in the North Camberwell district, where they numbered 40, as compared with 29 last year. Next highest comes North Peckham, where there were 12 less than last year's total. South Camberwell had 14 deaths, 10 more than last year, while South Peckham with 5, and St. George's with 19, both show a decrease of 15. In nearly all the fatal cases the deaths were certified as being due to measles as the primary cause, with pneumonia or broncho-pneumonia as the secondary one. The subject was vigorously taken up by the daily press, and, as usual, all sorts of suggestions were made as to the course to be taken. The notification of the disease was the favourite measure to be recommended, but it must have been urged by those who are ignorant or not mindful of the fact that this disease is infectious before the rash appears, consequently the greater part of the mischief is done before any notification would be possible. There is again the fact that many, if not the majority of, cases of measles are not attended by a doctor, and this especially in the poorer districts, where overcrowding is at its greatest, and where from lack of power to afford any isolation the disease is most certain to spread. There is also the experience of those places where compulsory notification has been actively put into practice and has been a failure. Yet so firmly fixed is the idea of the value of notification that we find that a resolution calling for the compulsory notification of measles was passed even at the Conference held by the London County Council, not without dissent, it is true, some speakers wishing to limit it to epidemic periods and others to the first case appearing in a household. However, the Local Government Board have not yet put measles on the list of notifiable diseases, nor up to the present have the London County Council made it applicable to London, so that it would appear that they, at all events, are not yet convinced. If notification were to be made obligatory, and the section of the Act which renders it incumbent on the householder to notify were rigidly enforced, it might have some effect, especially if one or two were fined, for it might make the doubtful mother call in the parish or private doctor. The information received by the schools has also been suggested as forming a means whereby the existence of cases can be discovered, but for the purpose of minimising infection the information, on account of the channels through which at present it has to filter, cannot be very effective. It is unlikely that the Sanitary Inspectors will be able to visit on the same day that the authorities at the school are informed of the existence of measles, and even if they do, the rash of the disease is certain to have been out for one day at least, the pre-eruption stage of the disease having already occupied three days. Unless the teachers were to send down a list to the Sanitary Office twice a day, and we had a number of Inspectors ready to at once set out and deal with them, there must be a delay fatal to the prompt isolation and the removal where home segregation is impossible. I am aware also, of course, of the objections on financial grounds, and those that can be urged to the hurried provision of a staff ready to act in the early days of an epidemic, for it is no use waiting until it is well established to try and stop it. Expense, however, should not be allowed to stand in the way of a scheme which has a reasonable chance of success. A further difficulty will arise when the Inspectors may be called upon to visit cases reported from the schools, for they will in some instances have to distinguish between those cases which are measles and those which are not, a task which could only be discharged by a medical man. All these measures are, however, likely to be a costly experiment, and their chances of success, to my mind, are far from certain or even probable. The establishment of facilities for removal of the cases to the Metropolitan Asylums Board hospitals, whether Poor Law or not, seems to be a step very much in the right direction. Many of the bronchitis and pneumonia cases could be saved by attention better than that possible to be obtained in the homes, and so far the system seems to be working smoothly, fifteen cases in all having been removed in the latter half of 1911. At present nearly all of them, being attended by the Poor Law medical officers, have been removed through the agency of the relieving officer, and usually from the very poorest homes. During the year application was made to me to close a school in East Dulwich on account of the special prevalence of measles therein, but after carefully inquiring into the attendances in the course of the outbreak, I came to the conclusion that no good purpose would be served by then ordering its closure. During the year a number of inquiries at houses have been made by me where infants and very young children had been attacked by measles, and where, according to the rules of the London County Council, the elder children, if they are protected by a previous attack, had not been precluded from attending school in the boys' and girls' departments. I found that there was no evidence that this action, however much it might theoretically be condemned, had had the slightest effect in spreading the disease. At the same time, treating measles in such an obviously different way to scarlet fever must tend to confirm the popular mind in the prevailing idea that measles is a disease of little account. They see and know the stringent rules that are enforced on the first of these diseases, and as it is not so with the second, they are inclined to treat it as of less moment. The deaths from enteric showed a very welcome decrease of 5. In 1910 there were 9 deaths, there being one or more in each of the Registration Districts except Dulwich, which escaped altogether from death or notification, just as it did in 1911, when there was no death in South Camberwell, only one being assigned to each of the other Registration Districts. The notifications received were 33, of which 25 were removed to hospital or to the infirmary. They were reported from all the districts except Dulwich, the notifications being 3 from South Camberwell, 12 from North Camberwell, 7 and 9 from North and South Peckham respectively, and 2 from St. George's. In all a total of 33, rather less than half the number for the previous year. There were 24 deaths from diphtheria, being 3 more than in the previous year, when all the districts were credited with deaths. This year Dulwich escaped, but there were increases in South Camberwell, North Camberwell, and South Peckham, with decreases in North Peckham and St. George's. The figures were—South Camberwell 4, North Cambervvell 8, South Peckham and North Peckham 5 each, and 2 in St. George's. The notifications were 80 more than last year, and the increase, although specially marked in South Peckham, was apparent in all districts except North Peckham, where there was a decrease, and Dulwich, which remained about the same. We received information as to a good number of children who were excluded from school on account of sore throat. In all cases the Sanitary Inspectors visited the homes and made inquiries, and when I judged it necessary, I myself called to make inquiries and took a specimen for bacteriological analysis, the object being to ensure, so far as possible, that there was no unrecognised case of diphtheria residing in the house. The notifications of scarlet fever were 123 more than last year, the great increase being in South Peckham, where they were more than double the number of last year. There was no school which seemed to have any special influence in the spread. During the year there were several reports from the schools of cases of peeling, with or without a history of slight illness or rash among those actually in attendance. These were in each instance visited either by the Sanitary Inspector or myself and inquiries made. The information from the school also sometimes contained either a form of, or a request for, a certificate that the child was in a fit condition to resume attendance. This matter was always referred to the parents in order that they might call in medical advice. It seemed to me if the certificates were signed by an official of the Borough Council that that body was saddling itself with a responsibility that is not imposed on it; and, further, it seems just that the authority to exclude the children should also be the one to re-admit them. In consequence of the prevalence of small-pox, chicken-pox was made a notifiable disease in the early part of the year, and we received a total of 253 notifications. Ten of these I visited, either at the request of the medical man, or else on account of the age of the patient being over that usually found in those attacked by this disease, but in each case I came to the decision that the original diagnosis was correct. One small-pox notification was received from Dulwich. On visiting the patient the signs were by no means characteristic of the disease, and I advised that she be not removed. The other inmates of the house, however, were nervous, and in spite of their own doctor's concurrence in the course advised, they wished for her removal, which accordingly took place, the patient being returned from the Wharf next day with the diagnosis of not small-pox. The second report was that of a man who had visited a local doctor late on Saturday night, but on calling at his home on Sunday morning I found that he had gone out. Later on he seems to have become apprehensive of pains and penalties, if not of illness, and he presented himself for examination at the Wharf, where he was considered to be not suffering from small-pox. The third case was from the outskirts of the Borough, adjoining Bermondsey. In this case the patient was removed to hospital. No cases of cholera, relapsing fever, typhus fever, or plague were reported. There were 34 notifications of ophthalmia neonatorum. In each case the house was visited, and if the baby was not under medical attention this was advised to be at once secured; but in order to make sure that prompt measures were being taken a telephone message was sent to the Ranyard Nursing Association, with the result that a nurse was at once sent down and took in hand the necessary local treatment. For this the Association has made no charge whatever. Ten notifications were received of the various forms of disease classed under the heading of puerperal fever. In each case whether the nurses were under the control of the Sanitary Authority or whether they were merely neighbours who were summoned in the emergency, they were instructed to see me at the Town Hall, so that I could make sure that all possible disinfection had been carried out. Thirty-two more notifications of erysipelas were received than in 1910, the increased numbers being more noticeable in St. George's and the two Peckham districts than elsewhere. As compared with 1910 there were 6 more in 1911, and 4 of these were inmates of the infirmary. One of these, in Dulwich, was of a particularly malignant type, and at the request of the medical attendant we carried out a very thorough disinfection. The disease known as anterior polio-myelitis, which has sometimes appeared in epidemic form, has been added to the list. Each case has been visited and any action necessary has been taken. It will be seen that during the past year two more diseases have been added to the list of those to be notified under the Public Health Act, and pulmonary tuberculosis has also to be reported under an Order from the Local Government Board. The deaths from infantile diarrhœa began to assume formidable proportions about the last week in July, and continued well above the ordinary until the middle of September. The deaths occurred in the various Wards as follows: The greatest number of deaths, 20, both from diarrhœa and enteritis, were in No. 7 Ward. Nos. 1, 2, 4, 5 and 12 had each over 10 deaths from the former, the others, except in 19 and 20, ranging round five deaths from the same disease. Those from enteritis were most numerous in 1 and 7, and least so in 13, 18 and 20. As regards the diarrhœa deaths I made personal inquiry at the home as to the nature of the food supplied to the infants who died, and of about 106 deaths I was able to get exact information. Thirteen of these were alleged to have been breast-fed at the time of death. Fiftyeight had been bottle-fed for some time previous, while 30 had been brought up on artificial feeding from the time of birth, the material used being artificial food or cow's milk in a nearly equal number. Under ordinary circumstances the proportion of breastfed to bottle-fed babies must. I think, be certainly higher than this, so that once again is noted what has been so frequently shown before, namely, that there is a relatively severe incidence on this latter class. It is not usually a desire to avoid giving the natural food that leads to its non-supply, but the failure of milk supply in the mother. It may also happen that the mother has to supplement the natural food because she has to go out to work. This, however, works both ways, for the mother that goes out to work is able to provide better food for herself, and, indirectly, for her infant, and although she has to supplement natural means by those of artificial character the results are better, for want is a predominant factor in diarrhœa as it is in infantile mortality generally. It was in the week ending August 12th that the numbers reached their maximum both for diarrhœa and enteritis, 25 being certified as due to the former and 12 to the latter. Comparing these figures with the births recorded for the Wards we get a result pretty well what we should expect, the greater the number of births the more available material there is for the diarrhœa poison to work upon. The Local Government Board on August 18th sent down a letter calling attention to the greatly increased mortality from diarrhœa, containing recommendations on feeding children and avoiding contamination of foodstuffs, and suggesting a suitable leaflet to prevent the accumulation of decomposing matters and street and stable scavenging. The letter also called attention to the advisability of enlisting the help of the health visitor in obtaining early information of the cases of infantile diarrhœa, and the necessity for early treatment. At a meeting of the Emergency Committee, held on August 23rd, a Bill was ordered to be printed, and special instructions, as advised by the Board, were given to the Sanitary Inspectors the next day to temporarily devote their chief attention to the removal of insanitary accumulations, the clearing out of dust-bins, and the regular flushing of gullies and sewers. At a later date a communication was received from the Board containing a copy of a letter addressed to it by a member of this Council, of which the following is a copy 26, Camden Grove, Peckham. S.E., August 22nd, 1911. Dr. Newsholme, Local Government Board. Sir, —I was glad to read in the daily press that the Local Government Board has issued a circular to Sanitary Authorities suggesting certain lines of action in summer epidemics. Unfortunately, the circular in likely to be of little or no effect in Camberwell. The circular recommends leaflets and personal visits to mothers of babies under a year old. We cannot do that here, because we have no Health Visitor, and, if we had, over 1,000 births were not notified in Camberwell last year ! (My estimate is based on the fact that 213 births were not notified last year in my Registration Sub-District,which is less than one-fifth of Camberwell. Moreover, only one of the 3,000 fathers, nurses and doctors concerned was asked for an explanation, and that one parent was only asked at the direct request of the Registrar-General.) I forward herewith a copy of the report of our Medical Officer of Health (Dr. Stevens), which was discussed in July. Some of us pointed out that even from the limited statistics given there a good case could be made out for the appointment of a Health Visitor. For example (see figures in report):— (a) In 1910, the first year Hampstead had a Health Visitor at work the whole year, the death-rate dropped 15 per thousand births, whereas the death-rate in Camberwell only dropped 6 per thousand. Had Camberwell's death-rate dropped as much as Hampstead's (15 per thousand) sixty lives would have been saved in Camberwell that year (viz., 9 by 6.7, there being 6,700 births in Camberwell that year). (b) In 191 0, first year Bermon dsey had a Health Visitor at work the whole year, the death-rate dropped 12 per thousand, compared with Camberwell? s 6 per thousand. Had Camberwell's death-rate dropped as much as Bermondsey's (12 per thousand) forty lives would have been saved in Camberwell that year (viz., 6 by 6·7). (c) In the three years 1908, 1909 and 1910, when Lambeth had a Health Visitor at work, the death-rate dropped 26 per thousand, compared with Camberwell's 2l per thousand. It Camberwell's death-rate had dropped as much as Lambeth's, thirty-three lives would have been saved in Camberwell (viz., 5 by 6·7). We further quoted from your report 011 "Infant and Child Mortality," from the reports of London Medical Officers of Health, and from the portion of the Annual Report of the Registrar-General dealing with infantile mortality. It was all of no use. The public conscience had been aroused in other parts of England about infantile mortality, but not on Camberwell Public Health Committee. Here we are actually doing less than we did five years ago. Then we did distribute a few pamphlets to mothers. Now we do nothing direct. Earlier in this year, when the measles epidemic was over, we issued a placard telling the mothers of dead children how they might have saved their children's lives. Alter the summer epidemics we may repeat that ghastly proceeding. I see no prospect of anything being done before that. I write bitterly because it makes my blood boil to sit here daily registering the deaths of these infants (e.g., seven deaths yesterday in about two hours, ages varying from two to fourteen months). We have areas in Camberwell probably as bad as any in London for their exeessine infant death-rate, but the statistics for those parts are mixed up with the figures tor better parts, and, so far as I am aware, the Committee has made no effort to get separate statistics. We have no Health Visitor, no municipal milk depôt, no school for mothers, no infant consultations, no allied organisations, and, so far, no placard on summer epidemics has been issued. I am, Sir, (Signed) Alfred Lucas (Member of Camberwell Borough Council and Registrar of Births and Deaths). This letter was referred to me. In answer to it I prepared a report which was submitted, on September 18th, to the Committee, and which brought forward various figures opposed to the arguments adduced therein. An inspection of the mortality returns for the last year certainly does not appear to give any further reasons which would lead one to suppose that the views in the letter can be regarded as correct. Objection can be made that in the complaining letter no mention is made of the fact that in 1907 Hampstead's death rate was 69 per thousand births, compared with 115 for Camberwell. In 1908 the Hampstead rate remained the same, while Camberwell dropped to 104. In 1909 Hampstead rose to 75, whilst Camberwell declined to 100. From a return made by Hackney, based on replies received from Medical Officers of Health, I see that in 1907, at all events, the lady Sanitary Inspector at Hampstead did a certain amount of health visiting, so that although one was only officially appointed in 1910, a visitor had already been at work for a year or two. The rate for all times for Hampstead, while the conditions remain as they are, is certain to always be much lower; the births are fewer, and the district as a whole free from the poverty of which we have much. A point is also made in the letter that in the first year of that Borough's employment of an official health visitor the death rate dropped 15 per thousand, whereas in Camberwell's there was only a reduction of (i per thousand. If this be a valid argument, how will it be explained that in 1911, which Councillor Lucas would, I presume, say is the second year of employment of a health visitor, the rate in Hampstead went up 18 per thousand births (from 60 to 78), whereas in Camberwell it only went up 15 per thousand (from 94 to 109), while in Lambeth and Bermondsey—to both of which he refers—it went up from 94 to 123, and from 126 to 156 respectively, yet Lambeth has had a milk depot and health visitor since 1908, and in 1910 had a rate of 94, the same as ourselves? These three Boroughs mentioned in the letter as making out a good case for the appeal can hardly be said to have shown their great superiority to Camberwell in a trying year. There were in all eighteen Boroughs which had a higher rate in 1910 than we, Camberwell being equal to Islington and Lambeth. In 1911 there were 21 higher than we were, and Camberwell had then the sixth place, tying with Chelsea. We were third on the list of South London Boroughs, being excelled only by Lewisham and Woolwich, and for the rest of London, Westminster, St. Marylebone, Hampstead and Stoke Newington were the only districts to make a better showing, so that Camberwell, which in the terms of the letter has no health visitor, no municipal milk depot, no school for mothers, &c., has come fairly well through the ordeal of last year, and does not compare unfavourably with the Boroughs who have these agencies in their midst. Either, therefore, the appointment of a health visitor has not done much, or else in Camberwell there' must be alternative explanations of the actual statistical fact that we have come off as well as our neighbours. These may be that either the general sanitary condition of Camberwell is so much better that it makes up for the deficiency of a health visitor, that the children of Camberwell are of a more resistive order and better able to withstand disease, or lastly that the mixed organisms which give rise to the disease have here a diminished virulence. It will be remembered that this Council for some years past has been dealing with the children attending the County Council Schools who have been found to be verminous. Negotiations proceeded for some while both as to the payment for the past and that for the future. Both these have now been settled, and since the termination of the summer holiday of 1911 we have been carrying out the work. I give some idea of the plan and its magnitude which is carried out by our clerical staff in addition to the actual cleansing, and which is an altogether new duty thrown on this department since its re-organisation some ten years ago— (1) The school nurse reports to us day by day the number of children she has excluded from school by reason of their verminous condition, coupled with the request that we deal with the homes under the London County Council General Powers Act. Upon receipt of these names, of which we not uncommonly receive 20 per day, the cases are entered in a special register and indexed. As it repeatedly happens that certain cases are reported by the nurse over and over again with a few days' interval, it is obvious that this indexing is a long business, and necessitates constant cross reference to the previous inspection. When it is undoubtedly a fresh case a complaint sheet is made out and given to the inspector for the district. He visits the home, makes an inspection of the bedding and clothing, also of the general condition of the house, and in many instances, if thought desirable, has the whole of the bedding removed and disinfected. As soon as the inspection has been completed the sheet is returned to me, and the result of the inspection is copied into the register, and a form giving similar information is now sent at their own request to the County Council. (2) When each child has been cleansed at the station, the Superintendent brings the cards to the Town Hall, as they represent the basis for the account. They are all entered in the register of verminous cases, because it sometimes happens that a child has had a bath, but may not have been reported to us by the school nurse The importance, therefore, of the duplicate entering is obvious, because it ensures the inspection of every child's home. From January up to date of this year 1,661 entries have been made and indexed in the Verminous Register. (3) The account side of this work is also important, inasmuch that it represents an income to the department, and it is, in addition, the most complex part of the whole work, because according to our agreement a child can only be charged for once in one month, irrespective of the number of baths. It is very important that no mistakes are made with the account (which has to be worked by a system of one month in arrear, so that the duplicates can be weeded out), because the London County Council have all the account cards, which are checked by the returns forwarded to them by their own nurse. Up to the present no complaint has been received from the London County Council with regard to our charges. I might incidentally mention that before definite arrangements were made with regard to payment for cleansing of verminous children, this Council had carried on the work for upwards of two years without any question of payment. But, after the agreement was finally settled with regard to the payment in future, the London County Council promised to pay the Council for the past work, and suggested that we submit an account. The work of making out this account, the major part of which was done by Messrs. Harman and Sawyer, meant that each separate entry in the latter's register had to be examined, and each child charged up separately. The work was long and tedious, and it necessitated their attendance at the Town Hall many nights for several hours at a time to complete the work. It was, however, so well and accurately done that the account, which amounted to £271 16s., was, according to the intention of the London County Council, to be checked by our register, but when they found what a huge task they had in hand, they apparently were so satisfied with the way in which the account had been prepared that they decided to pay the amount without any question of checking. The number of deaths registered in London from phthisis amounted to 6,084, an increase of more than 500 over 1910. Those in Camber well have increased from 300 to 338. The death rate in Camberwell was 1.34, which is only 1 below that for the whole of the County of London, whereas in 1910 we were .6 below. The increase in the death rate being calculated differently for the whole of the County in the two years, the one being an estimate and the other the census enumeration, is not quite available for the purpose of comparison. The rate for 1910 is too low, both for the County and the Boroughs, so that the increase is not so great as appears. Nevertheless, the hard fact remains that instead of there being a decrease in the mortality due to the greater attention paid to the prevention of presumed infection with all its attendant circumstances, there has been an actual increase. Various reasons have been assigned for this, one being that from the increased interest taken in consumption and the greater facilities for diagnosis, we must expect many more cases to be diagnosed, with a consequent swelling of the death returns. But whatever might be one's opinion as regards now and ten years ago, it is difficult to think that between 1910 and 1911 there has been such an enormous improvement in the means of diagnosis to account for the rise. It has also been pointed out that while improved diagnosis may lead to the inclusion of cases of phthisis which would formerly not be so included, it may also lead to the exclusion of those cases which in previous and less accurate years would have been so considered, so that this is obviously an argument which cuts both ways. Judging from the number of cases that are sent for examination, it is certain that in many instances it is suspected and that bac- teriology is called in as ail aid, but it is impossible to say how many of these cases in pre-bacteriological times would have been put down to phthisis or not. It is again pointed out that it is highly improbable that the cases of phthisis discovered by the better diagnostic means now obtainable are so large as to swamp those which have been prevented by the measures now taken and which are based on the infectivity of phthisis being the paramount consideration. 839 notifications were received of Poor Law cases, and under the order in respect to the reporting of hospital cases, which came into effect on May 10th, there were 385 notifications ; of these 12 had been previously reported by the Poor Law Authorities, and 42 of them ultimately were again notified by the same Authority. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS. Particulars of Notifications received from January 1st to December 30th, 1911. Patients left Address since Notification for other Addresses in the Borough. Age Distribution. Patients who have left Borough, and also those of whom all trace has been lost since Notification. Number of Persons Notified. Number of Notifications received. Inspections and Re-visits made by Sanitary Inspector. 5 to 15. 15 to 25. 25 to 65. 1 year to 5. 65 and upwards. District No. Sanitary Inspector, Part of Ward 1 1 M. Malins 31 66 1 2 59 4 309 3 14 ... Part of Ward 1 and the whole of Ward 2 2 37 87 69 H. Jones ... 17 332 1 3 21 ... 34 1 3 28 45 G. Dewey 5 6 6 273 Wards 3 and 14 3 19 150 7 4 and 8 H. Green 68 109 4 4 6 24 675 15 41 „ 5 and 6 5 H. Heath 41 76 1 ... 64 ... 11 452 2 10 „ 7 and 9 64 155 1 6 23 118 7 6 G. Scudamore 563 5 40 7 24 43 ... 6 35 2 „ 10 and 11 W. Eagle 255 2 20 ... „ 12 and 13 67 4 12 42 ... 8 J. Pointon 35 9 414 7 21 15 and 16 9 19 1 16 W. Farmer 12 ... 2 ... 168 1 4 ... 17 and 18 10 G. Morley 2 10 21 ... 4 16 1 142 17 „ 19 and 20 E. Collins ... 11 2 2 2 17 2 ... ... ... ... Total 352 32 107 564 16 3,600 43 209 731 12 In addition to the above, 138 Notifications were received relating to inmates of common lodging-houses and of persons described as "homeless " being at the time of Notification inmates of Poor Law institutions situated in the Borough. This number brings the total of Notifications received up to 839 for the year. The chief incidence of the disease on the different ages and districts is set out above in tabular form, and the ward numbers comprising these districts are also shown. A form is also set out which shows the result of the inspection of the address of the notified, this being carried out on the first receipt of any notification. As in previous years we have offered disinfection in all cases of death, and now, when we either have information that the patient has been received into the infirmary or other institution, or, on the other hand, the inspector discovers on his two monthly visits that removal has taken place, disinfection is offered, and we are usually able to get it carried out. III. Intimations and Notices served during 1911 in consequence of Consumption Notifications. Inspector's District. Overcrowding. Other Defects. Notices. Intimations. Notices. Intimations. 42 5 1 - - 22 7 2 - - 2 3 18 - - 4 19 52 - - 5 13 3 - - 6 28 3 - - 7 25 12 - - 7 2 8 - - 9 9 4 - - 10 4 1 1 14 11 - - - - 1 61 1 230 An example of the usual combination of phthisis and want was brought to the notice of the Committee in respect to one of these overcrowding cases. The father, the phthisical mother, and two children were sleeping in a small room which formed part of a onestorey two-roomed house off the Old Kent Road, the other room being used for living and also for the sleeping of two other children. The family were unable to move owing to the inability to pay a higher rent, but as there was a piece of garden ground belonging to the house I advised that the case was a suitable one in which to try the effect of an open-air shelter. This apparently was used with good result during last summer, but the patient has now gone back into the Infirmary, and is not improving. There can be no doubt that the action of the Committee did abate the insanitary condition which otherwise it would have been impossible to do, and I should certainly say it prolonged the life of the patient. We had hoped to use the shelter in many other cases, but a very serious difficulty arises in the fact that where it would be most useful, the persons affected have often only one room of a manyroomed house, and the only place available for the shelter to be put is in a yard which is used in common by the other inmates of the household. With the beginning of 1912 the new system of compulsory notification (but not under penalty) of all cases of pulmonary tuberculosis came into force. With, this it will be my duty to deal next year, and it will then be possible to estimate how far the Insurance Act will be able to supplement this order in the way of providing the relief in kind rather than that in advice, that is so essential in tuberculosis. In the meantime, the notified persons have been visited, and, according to whether I thought it necessary or not, arrangements have been made for the subsequent visits of the inspectors. The amount of new work this lias thrown on the office has been very great, the phthisis clerical work practically monopolizing Mr. Wright's attention, and although the work is well done, to keep it up entails his staying overtime, and extra help has had to be imported to enable him to keep abreast of it. Indeed, the increase of clerical work has been so considerable that I anticipate a reorganization and revision of the whole clerical staff in the Public Health Department becoming a question of pressing necessity. The deaths from cancer were 262, compared with 220 in 1910, and 254 in 1909. There was an increase of 7 in Dulwich, 19 in North Camberwell, 7 in South Peckham, 19 in North Peckham, and a decrease of 11 in St. George's. Thirty-four deaths took place in South Camberwell, being the same as in 1910. This increase on a comparatively small population is hardly enough to lay down any statement that the disease is increasing generally, but from other reports it seems as if there were some reason for such an opinion, and also that younger persons are more frequently attacked. One theory for this increase is that which has already been referred to under the heading of phthisis, namely, the more accurate diagnosis, but this, although great as compared with twenty-five years ago, hardly acts as a factor in present times. It is also possible that cancer, being a disease of later life, finds more potential victims owing to the fact that the average length of life has increased, and there is therefore a greater amount of material available for the disease. Some two or three years ago inquiries were made by myself on a small scale in Camberwell, but the results were eminently unsatisfactory, for there were no facts elicited which would give any indication for action. As mentioned last year, proceedings were taken under the Housing and Town Planning Act with respect to the closure of four houses in Whateley Road. The inspection was made at the beginning of March, 1910, and the closing order made by this Borough Council on April 15th. The owners of the houses in question were invited to attend before the Public Health Committee. The one of them who did so promised to carry out certain work. The owner of the other three subsequently appealed against the order, and the appeal was duly heard in June, before the Inspector of the Local Government Board. In August we received an intimation that the Local Government Board had quashed the order, and they directed the Council to pay the costs of the inquiry, amounting to about £6; but the Board did not make any order, as they were entitled to do under the Act, as to the costs of the appellant. The grounds on which I considered the closing orders should be made were the generally dilapidated condition of the premises, and also the dark and ill-ventilated condition of the basements. By the time of the hearing of the appeal all the work, apart from the basements, had been carried out. The interval between the making of the order and the hearing of the appeal under this Act compared with the possibility of almost immediate action under the Public Health (London) Act, 1891, constitute a very great advantage in proceding under the latter statute. Had we proceeded under this the summons would probably have been beard when the work had not been done, or at all events only in progress, instead of, as in the present case, after it was finished. It seems to me impossible for an Inspector to judge of what the condition of things was when everything has been put to rights and made to look fairly spick and span, whereas had a visit been made by the magistrate, it would have been when the condition was at its worst. In January, 1911, I prepared a list of certain houses, set out on the table below, which I thought should be inspected under the Housing and Town Planning Act. The Committee considered the list of such importance that it was referred by them to a small Sub-Committee who issued instructions to the Inspectors concerned to make an inspection with regard to the conditions set out in Article 2 of the Board's order. This was accordingly done and the reports were subsequently considered by the Main Committee. It was recognised that while defects of all the other properties could be remedied in great part under the Public Health Act, in Levant Street and Lower Park Road we had a block of 16 houses practically back-to-back, and that short of a re-arrangement little could be done. A Sub-Committee paid a visit to the property and recommended the matter to be adjourned, in the first place, for a conference with the owners as to their willingness to do anything, and in the second, to consider whether in the event of a closing order being made this would be upheld in the event of an appeal. Up to the present, in order to increase the air movement in the basements, shafts have been erected with some amount of good effect, but the evils of the absence of thorough ventilation still remain. The fact that the inhabitants usually keep their front doors open may explain the fact of our rarely getting any extra amount of sickness in this little area. In tabular form is set out the results of the working of this Act. Number of houses inspected under Section 17 30 Number of houses in respect of which closing orders were made Nil Number of houses where defects (such as could be remedied under the Public Health Act) were remedied 14 The other houses inspected were Mayhew's Buildings, where the main defects were absence of fireplaces and lack of proper through ventilation. These are old houses with narrow, winding staircases, and are built almost entirely of wood. There were also some houses off High Street, Peckham, in the Orchard, some of which were of wood, were badly lighted and ventilated, and were also damp. There is a note also made of the stairs being defective. The Committee had also under their consideration the question of making by-laws relating to the occupation of underground rooms. The Town Clerk and myself were instructed to draw up a draft set of by-laws that could be submitted to the Local Government Board for informal approval before the statutory publication. These were drawn up and duly forwarded, but were returned with the deletion of several sections to which the Committee attached importance. On this it was resolved that the Board be asked to make such bylaws as they thought just themselves, leaving the duty of carrying them out to this Council; but in consequence of a further letter from the Board it was resolved to refer the matter to me to try and arrange a form with Whitehall which would incorporate the views of both parties. The chief points at issue between the Board and the Council are the insistence of the latter on the provision of a fireplace and chimney to each underground room, and also the necessity of making provisions for the proper lighting and ventilation of all staircases and passages leading to such rooms. The Board, however, did not see their way to accept these enactments, so the consideration of making any by-laws by this Council has been adjourned. With the coming into force of this Act it was necessary to remodel the by-laws with regard to houses let in lodgings. This was done after consultation with the Board, and an agreement was come to between myself and them as to a proviso which they advised, differing somewhat in detail from my own suggestion but which will secure the object I aimed at. FACTORY AND WORKSHOPS ACT. In accordance with the provisions of the above Act, I submit a report of the work carried out under its statutory enactments. There were 3,435 inspections of factories, workshops, and workplaces,and there were 157 notices served. These, as they did last year, related chiefly to the lack of cleanliness or to unsuitable or defective sanitary accommodation. In the majority these were remedied when the occupiers' attention was called to them, and in no case was it necessary to prosecute; but there are certain cases of insufficient accommodation where the one demand for entire provision is still outstanding. 1.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Written Notices. Inspections. Prosecutions. 321 Factories (including Factory Laundries) 25 - Workshops (including Workshop Laundries) 2,414 86 - Workplaces (other than Outworkers' Premises included in Part 3 of this Report) 700 46 - 3,435 - Total 157 2.—Defects Found. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Particulars. Nuisances under the Public Health Acts:— * 46 I 46 — - ' - Want of Cleanliness Want of Ventilation - - - - 5 5 Overcrowding - - 5 Want of Drainage of Floors 5 - 47 - Other Nuisances 47 - - Sanitary Accommodation — Insufficient 5 5 - 25 - Unsuitable or Defective 35 - - Not separate for Sexes 1 1 - - 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 included in Part 3 of this Report) - - - - 144 144 - Total - *Including those specified in Sections 2, 3, 7, and 8 of the Factory and Work shop Act as remediable under the Public Health Acts. 3.—Home Work, Nature of Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109,110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Orders made (Sec. 110.) Instances. Notices served. Prosecutions. Prosecutions (Secs. 109, 110.) Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. contractors Workmen. I I I ' I I I" Wearing Apparel— I I I I I I I I I I I I I I I I I I I I 62 - 12 142 1,629 19 8 9 1 167 - 38 - - - (1) making, &c. - - - - (2) cleaning and washing - - - - - - - - - - - - Household linen - - - - - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - - - - - - - - Curtains and furniture hangings - - - - - - - - - - - - Furniture and Upholstery - - - - - - - - - - - - - - - - Electro plate - - - - - - - - - - - - - - - - - - - - File making - - - - - - - I-24 - - Brass and brass articles - - - - - - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - Cables and chains - - - - - - - - - - - - - - - Anchors and grapnels - - - - - - - - - - - - - - - - - - - Cart gear - - - - - - - - - - - Locks, latches and keys - - - - - - - - - - - - - - - Umbrellas, &c. - - - - - - - - - - - - - - - Artificial flowers - - - - - - - - - - - - - - - - - Nets, other than wire nets - - - - - - - - - - - - - - - Tents - - - - - - - - - - - - Sacks - - - - - - - - - - - - - - - - - - - - - - Racquet and tennis balls - - - - - - - - - - 56 - 4 3 1 - - Paper bags and boxes 4 2 - - - - - - Brush making 2 - 54 - - - - - - - - - - - Pea picking - - - - - - - - - - - - - - - Feather sorting - - - - - - - - - - - - - - - - - - Carding, &c., of buttons, &c. - - - - - - - - - - - - - - Stuffed toys - - - - - - - - - - - - Basket making - - - - - - - - - - - - - - - 13 Total 148 62 1,739 21 8 95 - - 41 - - - 167 - I—25 Compared with last year, Table No. 3, relating to home work, has been enlarged in its scope by the addition of other trades, but none of these are carried on in Camberwell. There were no instances during the year where outwork was going on in infected premises. There was, however, a notification in a house where the occupier had a child who was attacked by scarlet fever, and from her disposition the parents were afraid of serious risk if she were removed to a hospital. As the trade carried on at the bottom of the house was that of a furrier, I pointed out to the people that it meant stopping the trade carried on there or having the child removed to hospital. The latter course was eventually decided upon; and, not without some trepidation, I undertook the disinfection of the furs, which amounted in value to several hundreds of pounds, as they had been in the house some days. The work, however, was successfully carried out, the furs returned to their owner, and after the house had been disinfected work was resumed. There were 1,202 inspections of outworkers' premises, compared with 1,263 in 1910. 4.—Registered Workshops. Workshops and Workplaces on the Register (s. 131) at the end of the year. Number. Laundries 57 Clothing (wholesale and private) 370 182 Preparation of food 66 Building trades 167 Bakehouses Miscellaneous 1,057 4 Florists Total number of workshops on Register 1,903 The number of workshops on the Register at the end of the year was 1,903, compared with 1,914. 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) 24 Action taken in matters referred by H.M. ( Notified by H.M. Inspector Inspector as remediable under the Public 10 Health Acts, but not under the Factory Reports (of action taken) and Workshop Act (s. 5) sent to H.M. Inspector 3 Other 11 Underground Bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 66 We continue to keep a careful watch on the roads in the Borough to discover any new premises which would come within the purview of the Act. The visits to complaints in 1911 are nearly 600 more than last year, but the inspections of neighbouring houses that they led up to show a diminution of about 300, while the house to house inspection shows a considerable falling off, partly accounted for by the number of visits and re-visits that have had to be made in consequence of tuberculosis notification, there being nearly 2,000 more of these than in 1910. There is also a slight increase in the number of buildings that have taken place, especially in the districts of Messrs. Collins and Morley. The new item of visits to verminous houses appears on the return for this year. Each house is now visited, whence any children may have been sent down to the cleansing station. An inspection is made of the house and furniture, and if necessary, an intimation is served on the person responsible; a subsequent visit being made if this has been done so as to see that any work ordered has been properly carried out. Under the head of miscellaneous inspections is included a general one of all the underground rooms in the Borough, whether occupied as sleeping rooms or not. The work in the districts of Messrs. Scudamore and Green has suffered on account of the amount of work they had to do in No. 5 District, whose proper Inspector was in bad health. Mr. Heath was superannuated at the end of 1911. In conclusion I have to thank the Council for their never-failing consideration and the officers of the Public Health Department for ready and willing help whenever I have required it. I am, Mr. Mayor and Gentlemen, Your obedient servant, FRANCIS STEVENS. The following four Tables of Statistics are for the use of the Local Government Board:— VITAL STATISTICS OF WHOLE DISTRICT DURING 1911 AND PREVIOUS YEARS. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Next Deaths belonging to the District. Under 1 Year of Age. At all Ages. Of Nonresidents registered in the District. Of Residents not registered in the District. Uncorrected Number. Nett. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Number. Rate. Rate. 2 3 6 7 9 10 12 4 5 8 11 13 6,909 25.9 4,312 808 495 942 134.1 3,999 14.8 270,153 7,020 15.9 6,603 272,479 6,733 24.7 4,217 15.4 873 479 805 119.5 3,823 14.0 273,836 6,729 6,885 25.1 3,922 14.3 839 519 740 107.4 3,602 13.1 275,275 6,547 6,689 4,098 14.8 814 494 687 102.7 3,778 13.7 24.3 279,566 6,511 6,657 23.8 3,871 13.8 891 455 654 98.2 3,435 12.2 261,328 6,342 6,399 24.4 15.6 847 516 735 3,722 114.8 14.2 4,053 TABLE 11.-CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1911. Notifiable Disease. Number op Cases Notified. Total Cases Notified in each Locality (e.g., Parish or Ward) of the District. Total Cases Removed To Hospital At Ages —Years. Dulwich. Unattached. At all Ages. Sonth Camberwell. North Camberwell. Sonth Peckham. North Peckham. St, George's. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox 3 ... ... 1 ... 2 ... ... 1 ... ... ... 1 1 ... 3 Cholera ... ... ... ... ... .. ... ... ... . ... ... ... ... ... ... 354 62 Diphtheria (including Membranous Croup) 5 157 14 4 41 ... 131 ... 12 84 78 315 43 77 9 62 Erysipelas 251 10 19 27 82 76 28 5 23 63 36 62 ... 46 392 Scarlet Fever 7 170 38 23 29 124 90 115 ... 630 ... ... 80 192 533 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... 1 6 33 9 7 3 12 9 7 2 ... 25 9 1 ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 2 ... ... 1 ... 1 ... 1 ... ... ... 1 ... ... ... 1 Puerperal Fever 10 ... ... 2 8 ... ... ... 3 ... 4 3 ... 8 ... ... ... I ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum ... 34 34 6 8 15 ... ... 2 3 ... ... ... ... ... ... 2 Cerebro-spinal Meniningitis 2 ... ... ... ... ... 2 ... ... ... 1 1 ... ... ... Polio-myelitis 5 1 3 1 1 ... 2 1 1 ... 2 ... ... ... ... ... 112 65 253 28 99 11 3 10 33 34 5 Chicken pox ... ... 60 51 ... Under Tuberculosis Regulations, 1908 phthisis. 35 417 839 230 4 34 121 12 123 22 230 240 142 68 ... ... Under Tuberculosis Regulations, 1911 385 43 73 . 3 201 45 9 38 113 69 82 1 88 4 ... Others ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 Totals 2,801 88 441 753 342 862 255 705 612 760 71 551 538 69 940 I—29 TABLE III.—CAUSES OF, AND AGES AT, DEATH DURING YEAR 1911. Causes of Death. 1 Nett Deaths at sub-joined Ages or "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "non-Residents" in Institutions in the District. 11 1 and under 2. 4 2 and under 5. 5 5 and under 15. 6 15 and under 25. 7 25 and under 45. 8 45 and under 65. 9 Under 1. 3 65 and upwards. 10 All Ages. 2 3362 699 224 136 95 122 446 646 994 (Certified . All causes (Uncertified 360 36 17 19 18 14 73 115 68 Enteric Fever 4 ... ... ... ... 1 2 1 ... ... ... ... ... Small-pox ... ... ... ... ... ... ... 107 29 39 31 14 Mcasles 8 ... ... ... ... ... 3 2 Scarlet Fever 6 1 ... ... ... ... ... 20 11 1 Whooping-cough 43 10 1 ... ... ... ... Diphtheria and Croup 24 2 11 7 ... ... 4 ... ... ... 24 1 ... 1 4 12 3 1 1 4 Influenza 9 3 ... ... 2 1 3 4 Erysipelas ... ... Cerebro-Spinal Fever ... 4 ... ... ... ... 9 ... ... ... 1 4 9 15 Other Septic 45 4 3 9 10 5 291 ... ... 3 78 Old Age ... ... ... ... 288 117 Heart Disease 329 1 1 2 4 19 46 139 74 Phthisis (Pulmonary Tuberculosis) 338 1 89 1 3 9 58 154 23 154 31 10 9 8 Tuberculous Meningitis Other Tuberculous 4 ... ... ... ... 4 11 8 5 12 3 13 6 2 59 10 Diseases 13 ... ... ... 4 2 5 Rheumatic Fever 2 ... 1 Cancer, malignant disease 262 ... 106 ... ... 3 3 26 124 92 314 51 29 64 150 Bronchitis 6 4 1 9 56 Broucho-Pneumonia 142 55 30 22 3 ... 7 10 15 13 Pneumonia (all other forms) 18 23 41 41 12 9 29 35 177 4 Other Diseases of Respiratory Organs 29 7 1 1 2 ... 5 5 8 5 Diarrhœa and Enteritis 309 224 51 10 1 3 7 13 37 ... Appendicitis and Typhlitis 4 ... ... ... ... ... 3 1 ... ... Alcholism 13 ... ... ... ... ... 5 7 1 5 Cirrhosis of Liver 35 ... 8 5 8 ... ... ... ... 22 Nephritis and Bright's Disease ... ... 74 122 ... 1 21 48 52 ... Puerperal Fever 8 8 4 ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition 17 3 ... ... ... ... 1 13 6 ... Congenital Debility and Malformation, including Premature Birth 226 226 ... ... ... ... ... ... 8 ... Violent Deaths, excluding Suicide 40 16 61 10 1 2 25 106 17 15 27 2 11 2 Suicides ... ... ... 1 11 3 Pleurisy 10 ... ... ... 2 5 3 1 ... ... Mental Diseases 39 1 23 12 3 1 ... ... ... ... Other Defined Diseases 546 56 20 26 153 176 137 21 17 77 Diseases ill-defined or unknown 13 2 2 ... 1 4 3 ... ... 4 ... ... 3722 735 241 155 519 1062 113 136 761 886 TABLE IV.—INFANTILE MORTALITY DURING THE YEAR 1911. Nett Deaths from stated Causes at Various Ages under One Year op 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 3 months. 6 to 9 months. 3 to 6 months. All causes Certified 106 40 23 24 193 104 149 111 11 Uncertified. 4 2 1 18 7 9 7 ... ... ... ... .. ... Small-pox ... ... Chicken-pox ... ... ... ... ... ... ... ... Measles ... ... ... ... 3 5 ... ... ... Scarlet Fever ... ... ... ... ... ... Diphtheria and Croup ... ... ... .. ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 5 5 Diarrhœa ... ... ... 4 4 25 54 39 Enteritis 1 ... 1 2 4 13 28 20 (Tuberculous Meningitis ... ... ... 2 ... ... ... 6 Abdominal Tuberculosis ... ... ... 1 ... ... 1 ... Other Tuberculous Diseases ... ... 1 18 ... ... ... 2 Congenital Malformations 4 3 18 1 1 24 1 3 Premature Birth 13 68 7 7 95 14 2 Atrophy, Debility and Marasmus 15 ... 18 11 7 8 44 20 3 Atelectasis 2 ... 8 3 3 ... ... ... Injury at Birth 3 ... ... ... 3 ... ... Erysipelas ... ... 1 ... 1 2 ... ... ... Syphilis 3 ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 2 ... ... Convulsions 3 2 3 ... 8 4 8 2 Gastritis ... ... 2 ... ... ... 3 1 Laryngitis 1 1 ... ... 2 ... ... ... Bronchitis 1 1 2 ... 4 9 13 10 Pneumonia (all forms) ... 3 ... 1 4 12 21 8 Suffocation, overlying ... 1 1 2 ... 4 4 Other Causes ... 1 4 2 1 8 8 5 1 1 —- _^ 117 44 25 25 211 111 158 118 FACTORY AM) WORKSHOP ACT, 1910. Sanitary Accommodation. Statutory Notices. Defective Yard and Paving. No. of Visits. Overcrowding and Defective Ventilation. Defective Roof and Dampness. Other Defects. Summonses. Want of Cleanliness. Intimation Notices. Defective Dust-bins. Defective or Dirty. Not Separate for the Sexes. Insufficient. - - - - Complaints 10 - - - - - - - - 5 Workshops (new) 93 2 1 - - 5 6 1 - 4 Do. (old) 499 - - I-31 Laundries (new) 4 2 - - 1 - - - - 1 - 1 - Do. (old) 91 Factories (new) 3 - - - 6 1 - - 2 - - - - 120 Do. (old) Outworkers (new) 578 35 - 1 5 - - 1 - - - - - Do (old) 711 32 1 Schools - - - - - - - - - - - 198 - - - - Re Work in Hand - - - - - - - - 2 4 - Eating Houses 107 4 - - - 1 3 - - - 1,148 - - - - - - - - Miscellaneous - - - - 3,594 43 5 - 9 59 13 - Total 13 17 2 3 3 G. D. BEVAN. RETURN OF WORK CARRIED OUT AT THE DISINFECTING STATION DURING THE YEAR 1911. November. December. Articles Disinfected. January. February. March. April. May. June. July. August. September. October. Total. Beds 59 44 79 49 42 73 102 85 122 129 95 85 964 Blankets 129 50 77 59 62 61 102 89 108 162 166 165 1,230 Bolsters 27 33 31 40 73 69 644 41 50 72 81 69 58 - 105 Books—Public Library 11 - 1 6 5 10 - 16 18 22 16 19 32 17 Cushions 20 21 17 38 34 28 43 30 45 344 2 1 10 Curtains (pairs) 3 - 2 - - - - 1 - 1 Carpets 20 41 28 19 15 20 35 24 278 3 13 24 36 37 36 27 38 67 53 61 73 Mattresses 21 31 53 42 551 8 3 7 7 10 2 6 - 22 2 4 4 75 Palliasses 76 187 124 94 125 87 127 204 198 215 212 138 1,787 Pillows 48 59 60 55 54 80 96 123 117 971 Quilts 80 108 91 54 46 69 55 148 108 Sheets 81 63 119 139 125 80 1,087 3,236 1,639 1,363 19,142 Wearing Apparel (Suits, Dresses, &c.) 441 1,959 1,194 2,492 1,552 941 319 2,311 695 Miscellaneous 7 8 3 5 29 2 22 9 22 9 4 120 - Total 2,059 2,324 2,085 1,815 1,091 2,495 27,308 2,884 3,342 2,321 1,448 3,820 1,624 Mattresses Retabbed 37 21 36 31 27 38 65 67 53 64 73 42 554 Palliasses do. - - - - 5 8 4 2 - 2 - 21 - 17 17 32 28 20 19 32 18 34 43 34 45 339 Cushions do. Total 62 48 72 51 44 55 97 101 83 107 107 87 914 Return of Work carried out at the Disinfecting Station during the year 1911 (continued). Articles Disinfected. January. February. March. April. May. June. July. August. September. October. November. December. Total. Verminous CasesPersons Cleansed 154 275 94 262 69 2,338 200 424 158 342 19 186 155 Rooms Disinfected 7 4 4 1 7 8 3 15 13 3 60 - - Bedding do. 11 19 1 6 19 4 21 5 - 123 3 34 - 447 290 160 222 105 25 296 69 2,521 Total 355 154 235 163 Articles Destroyed— Palliasses and Mattresses 2,077 77 165 163 132 527 379 97 110 82 91 179 75 I- 33 Miscellaneous - 24 - - 24 - - - — - - - - Total 82 132 527 403 97 110 2,101 91 77 179 75 165 163 Houses Visited 189 260 201 184 193 336 279 339 383 356 3,234 249 265 Rooms Disinfected 89 74 72 119 146 144 97 1,282 108 64 64 133 172 Total 338 263 368 265 265 469 398 485 555 500 4,516 362 248 UNSOUND Food &c., DESTROYED AT DEPOT. Fish. Peas. Bread. Meat. cwt. lbs. lb. lbs. cwt. qrs. tons. cwt. qr. qr. cwt. lbs. qrs. 17 0 6¾ 2 16 2 3 1 24 1 1 4 - SUMMARY OF SANITARY WORK FOR THE YEAR ENDING DECEMBER, 1911. Description of work. Pointon. Eagle. Scudamore. Collins. Heath. Morley. Farmer. Dewey. Malins. Green. Cleanse and limewash 192 234 134 38 143 70 84 180 463 245 57 111 188 124 Repair guttering, &c. 62 136 69 31 68 64 63 Ventilate under floors, &c. 34 94 38 12 6 61 87 43 29 9 13 10 - 5 Abate overcrowding 4 3 14 27 6 5 4 7 Abate smoke nuisance 2 11 5 6 4 3 24 - - 75 Light and ventilate staircase 6 59 - 7 16 5 17 49 Provide, repair, or remove dustbin 52 70 44 29 29 22 34 53 128 Remove refuse or manure 14 23 14 9 15 16 65 12 10 13 83 47 Pave, level, or drain yard, &c. 97 34 41 2 2 50 66 67 111 1 Provide manure pit - 8 2 1 5 2 1 2 12 3 Provide sufficient water supply 11 - 4 12 4 3 4 4 4 Provide or reconstruct receptacle (render accessible) - 7 1 - 3 2 1 1 1 4 Repair, cover, or cleanse receptacles 8 2 16 22 14 13 - 7 17 9 Provide, repair, or remove closets, pans, &c. 91 35 86 93 26 40 51 39 70 52 Proper water supply to closet and apparatus 70 24 94 26 26 29 37 72 98 19 Ventilate and remove to outside soil pipes, cleanse, repair, and trap drains or sinks 20 43 55 133 83 78 60 49 49 133 19 Disconnect rain-water pipes, sinks, and other wastes 5 9 2 64 - 9 42 1 10 Empty and cleanse cesspools, or drain into sewer - - - - 7 - - 6 - - 4 5 13 9 Totally reconstruct drains 31 21 8 - 25 22 25 21 Partially reconstruct drains 9 7 1 43 3 - 19 5 15 Animals to be kept clean or removed 4 3 5 6 - - 2 4 6 Public conveniences—cleanse, supply with water, &c. - 1 - - - - - 2 - - Private conveniences—cleanse, supply with water, &c. 3 5 - - 1 12 - 1 2 26 Abate nuisance from offensive trades - - - - - - - - - - Abate nuisance from road gullies - - - - - - 3 2 19 - RETURN OF WORK PERFORMED,IN THE SANITARY DEPARTMENT DURING THE 52 WEEKS ENDING DECEMBER, 1911. Description of Work. Inspectors. Pointon. Eagle Scudamore. Collins. Heath. Morley. Farmer. Dewey. Malins. Green. Jones. Miss Bevan. Totals. Visits to complaints 134 153 173 113 303 76 214 126 73 126 215 6 1,712 71 House inspections following on complaints 94 38 214 109 103 96 168 13 37 104 1,047 354 - House-to-house inspections 541 374 232 328 126 296 344 418 447 293 3,753 - Tenement inspections - 3 367 48 10 37 183 5 268 921 - - - Houses let in lodgings inspections - 5 427 34 24 490 - - - - - - - Housing and town planning inspections - 15 6 7 10 - - - - - - 38 - 3 5 53 New buildings completed 5 5 80 37 188 1 10 387 - - Visits to new buildings 138 39 1,379 3,099 38 55 534 476 294 1 11 134 - No. of inspections re overcrowding 2 70 5 1 5 6 1 28 3 42 163 - 5 - Do. of slaughterhouses 18 12 42 5 3 7 4 96 - - - - Do. do. bakehouses 37 34 18 28 79 91 67 48 19 48 24 494 - Do. do. cowhouses 7 28 6 52 21 5 2 4 97 - - - - Do. do. milk shops and dairies 174 175 93 49 123 109 79 137 101 186 105 1,331 - Do. do. eating houses 93 30 21 3 25 17 18 9 32 13 27 107 395 I-35 Do. do. ice cream shops 77 32 28 32 30 75 35 38 11 46 40 444 - Do. do. railway stations 26 1 14 54 12 5 112 - - - - - Do. do. workshops 141 94 129 - 229 32 51 93 90 110 112 101 681 1,863 Do. do. factories 5 56 8 39 17 - 1 29 25 18 123 321 - Do. do. urinals, public 81 29 - 2 15 42 52 60 7 56 344 - - Do. do. do. private 171 221 203 251 149 199 333 593 326 366 365 3,177 - Do. do. schools, public 44 18 35 23 18 19 41 26 288 22 25 18 4 Do. do. do. private 3 38 35 6 3 60 57 9 2 9 2 28 261 Re-inspections 4,241 2,546 2,871 2,205 1,453 3,286 3,837 2,185 3,129 2,492 2,266 190 30,701 Miscellaneous 532 565 515 917 538 313 630 900 477 724 1,134 1,026 8,271 120 Infectious cases visited and houses inspected 175 138 57 52 98 191 111 58 157 74 - 1,231 Do. do. or inquiries 237 127 105 216 42 88 163 107 101 189 112 1 1,488 Tuberculosis cases visited and houses inspected 83 67 60 118 27 82 45 38 12 114 65 771 - 245 Do. do. or inquiries 374 618 28 317 116 164 248 278 224 740 - 3,352 Visits to verminous premises 69 5 439 18 142 2 26 48 57 374 56 - 1,236 Intimations 416 586 319 239 282 238 279 375 453 506 459 58 4,210 Statutory notices 93 209 88 43 63 94 86 58 100 187 13 1,193 159 - Notices, houses let in lodgings 18 375 - - - 325 32 - - - - - Summonses under P.H. Act 1 2 4 4 1 1 5 5 2 1 - 26 - 13 Infectious disease contacts 16 27 11 29 30 10 8 12 23 15 194 - 1 Seizures of unwholesome food 1 1 - - - - - 1 - 4 - - Outworkers - - - 1,202 - - - — 1,202 39 - - - - Drainage plans, total reconstructions 11 36 20 49 25 60 13 14 12 17 - 296 26 Do. partial do. 16 9 26 24 21 26 35 13 24 14 - 234 PROCEEDINGS DURING 1911 (as asked for by the London County Council). Number of Places. Number of Inspections, 1911. Number of Notices, 1911. Number of Prosecutions, 1911. Premises. Added in 1911. Removed in 1911. On Register at end of 1910. On Register at end of 1911. Milk Premises 610 29 22 - 25 614 1,331 Cowsheds 11 - 1 97 - 10 - Slaughterhouses 13 - 13 96 - - - - 6 6 Other Offensive Trade Premises 1 - - 12 - 219 219 6 Ice Cream Premises 12 444 - 254 254 490 - Registered Houses Let in Lodgings - - (a) 18 (b) 411 - (a) For overcrowding. (b) For other conditions. Total Number of Intimation Notices served for all purposes ... 4,210 Overcrowding, 1909 :— Number of dwelling rooms overcrowded 102 Number remedied 102 Number of prosecutions Nil Underground Rooms: — Illegal occupation dealt with during year 2 Number of rooms closed 2 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 87 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 63 Number of tenements comprised therein 289 Number of tenements for which certificates were— (a) Granted 3 (4) Refused 8 (e) Deferred 278 Number of Prosecutions under By-laws under Public Health Act, 1891:— (a) For prevention of nuisance arising from snow, ice, salt, tilth, &c. Nil (6) 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 (cl) As to paving of yards, &c., of dwelling houses Nil (e) In connection with the removal of offensive matter, &c. 2 (f) As to cesspools and privies, removal and disposal of refuse, &c. Nil (g) For securing the cleanliness of tanks, cisterns, &c. Nil (h) With respect to water closets, earth closets, etc. 1 (i) With respect to sufficiency of water supply to water closets 11 (J) With respect to drainage, &c. (Metropolis Management Act, Section 202) 4 (k) With respect to deposit of plans as to drainage, &c. (Metro-polis Management Acts Amendment (By-laws) Act, 1899) Nil Mortuaries:— Total number of bodies removed 346 Total number of infectious bodies removed Nil I. Institutions within the District receiving sick and infirm persons from outside the District. Southwark Infirmary. Peckham House Lunatic Asylum. Camberwell Infirmary. Camberwell House Lunatic Asylum. Camberwell Workhouse. Gordon Road Workhouse. 93, Grove Lane, Maternity Home. Guy's Hospital. St. Thomas's Hospital. Long Grove Asylum. Banstead Asylum. Cane Hill Asylum. Lambeth Infirmary. South-Eastern Hospital. Caterham Asylum. Cancer Hospital, Chelsea. Evelina Hospital. Tooting Bec Asylum. Royal Hospital for Incurables. Children's Infirmary, Carshalton. Claybury Asylum. Bermondsey Infirmary. South-Western Hospital. Belgrave Hospital. Dartford Heath Asylum. General Lying-in Hospital, York Rd. University College Hospital. Shoreditch Infirmary. Grove Hospital. King's College Hospital. London Throat Hospital. Horton Asylum. Homoeopathic Hospital, Great Ormond Street. London Hospital. Royal Free Hospital. Catholic Nursing Institute. nvuviiv 1,1 t") GO, Lambeth Boarf. Brook Hospital. St. Mary's Hospital. Westminster Hospital. II. Institutions outside the District receiving sick and infirni persons from the District. London Temperance Hospital. Friedenheim Hospital. Manor Asylum, Epsom. Home for Sick Children, Sydenham. Royal Waterloo Hospital. Colney Hatch Asylum. Children's Hospital, Great Ormond St. St. George's Workhouse, Southwark. St. Peter's Hospital. St. George's in-the-East Infirmary. Park Hospital. Hanwell Asylum. Seamen's Hospital. Infants' Hospital, Vincent Square. Leavesden Asylum. Darenth Asylum. Miller General Hospital, Greenwich. St. Bartholomew's Hospital. National Hospital, Charing Cross Hospital. Wandsworth Infirmary. Brompton Hospital, Chelsea. St. Marylebone Infirmiary. St. Joseph's Hospital, Hackney. City of London Asylum, Stone. Middlesex Hospital. St. John's Hospital, Blackheath, East London Hospital. Epileptic Colony, Epsom. Bethnall House. Workhouse, Renfrew Rd., Kennington. Hampstead General Hospital. St. George's Hospital. Gordon Hospital. 111. Other Institutions, the deaths in which have been distributed among the several localities in the District Camberwell infirmary. Camberwell Workhouse. Nursing Home. " Inglewood," Grove Park. Gordon Road workhouse. I—38