CAM 16 Chamberwell 1912 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 the area comprised in the jurisdiction of the London County Council at the middle of the year 1912 is estimated by the Registrar-General to amount to 4,519,754. This is about 1,500 less than that given as the number for the corresponding period of 1911. As pointed out by the Registrar-General, the population of the Administrative County of London has declined from 4,536,267 in 1901. And, indeed, this is not surprising when one contemplates the enormous number of workers in London who, instead of living within it, now come in every day from the districts surrounding it, and which, not so very long ago, were rightly called " the country." The number of births registered in London during the 52 weeks ending December 28th was 110,353, while for the previous year it was 111,738, compared with 114,870 in 1910. The birth-rate, therefore, shows a diminution of ·3 for the present year, and the rate is said to be the lowest on record since civil registration was introduced. As is probably well known, each birth in London has to be notified to its local Sanitary Authority, and the Registrar-General gives 92.0 per cent. as the proportion of such notifications to registrations. The deaths registered for the same period and within the same limit were 61,473, but to give the number which will represent the deaths of Londoners, it is necessary to subtract 3,092 deaths of nonresidents which occurred within the County of London and to add 2,719, which, although they occurred outside the limit, are those of inhabitants. Of these, a substantial proportion are those that took place in the larger institutions, such as lunatic asylums, &c., many of which are situated outside the boundary. After this has been done, the correct total works out at 61,100 as the number of deaths actually to be assigned to the county for 1912. The population of Camberwell, which we calculated on the basis of so many persons per assessment, is estimated by us to amount to 263,536, and by the Registrar-General, who uses the more usual method of calculation, to be 261,591. Below is set out the population for the Borough and for the different registration sub-districts. Table I.—Population of Camberwell and Sub-Districts. South Camberwell. North Camberwell. South Peckham. North Peckham. St. George's. Borough. Dulwich. As enumerated at census 1896 7,519 88,242 90,286 67029 253,076 As enumerated at census 1901 259,339 65,589 90,465 93,038 10,247 As enumerated at census 1911 261,328 43,221 47,753 14,974 45,036 64,379 45,965 As estimated to middle of 1912 263,636 47,779 65,813 43,248 15,174 45,647 45,973 It will be seen that the greatest increase is in Dulwich, that of some of the other districts, and especially St. George's, being infinitesimal. The total number of births registered in the Borough was 6,281, but to this must be added those registrations of children who were born out of Camberwell but whose mothers were residents of the Borough. In this category come the children who are born in any of the large lying-in institutions, or even in the general hospitals. The Begistrar-General in his proof figures credits Camberwell with 6,422, the difference between this and 6,281 probably representing the addition of the births of Camberwell children outside its limits. and the subtraction of the registration of children born inside its boundaries but whose parents resided beyond the Borough. These births have been redistributed among the registration districts in proportion to those actually registered therein. Table II. -Births in Camberwell and its Sub-Districts. Borough. North Camberwell. South Peckham. South Camberwell. North Peckham. St. George's. Year. Dulwich. 1911 6,399 190 948 1,612 967 1,291 1,334 57 6,422 198 1912 938 1,588 962 1,307 1,288 141 Difference -10 -24 -5 +16 -46 +23 +8 +84 The excess in the number of births for the year over that of 1911 is 23. Taking the sub-districts, there was only an increase shown in Dulwich and North Peckham, while there was a not inconsiderable decrease in St. George's and in North Camberwell. Table III. — Birth-rates of Camberwell And its Sub-District's. Year. Borough. South Camberwell. North Camberwell. South peckham. North Peckham. St. George's. Dulwich. 12.8 21.2 25.2 22.5 29.2 1911 24.4 27.2 1912 24.3 13.0 24.1 22.2 27.3 28.0 20.5 There is thus a decrease in the birth-rate since last year of ·1. But, on making a reference to the Annual Report for 1901, I find that the birth-rate there is given as 29.75. That being a census year the rate is fairly certain to be accurate, and it shows a very great falling off when we come down to the 24.4 of 1912. At present the falling off is compensated for by the great diminution in infantile and other mortality. When this has attained its limit of decrease, and the birth-rate still shows a progressing diminution, the outlook for the material prosperity of the country, and even for the existence of the nation, will begin to assume an unfavourable aspect. The complete number of death registrations in the Borough was 3,874, but from this must be deducted the 823 non-residents who died in the district, and to it must be added 342, the number of residents who died outside. It thus happens that 3,393 represents the number of deaths to be actually assigned to the Borough for the purpose of calculating the death-rate. So far as possible, each of these outside deaths has been credited to the particular sub-district whence the patient was removed to the hospital or other institution where he died. But just as in the case of the registration of births it was not always possible to do this on account of the deficiency in the information as to the address, in 58 instances it was impossible to correctly allocate the deaths. They have therefore been redistributed among the various sub-districts proportionately to the deaths that we were aware of as having occurred in them. They were principally of people who had been moved from one of the Poor Law institutions to asylums outside, where they are registered as coming from Camberwell Borough, and this is usually the only address we are able to obtain. This number also includes the deaths of 33 persons who have been assigned to this Borough by the Registrar-General, as those considered by him to be properly described as residents of Camberwell, even although the death took place away from home. Some of these are of persons who obviously should be assigned to Camberwell, such as those who are found drowned, or who have met with a sudden death in other parts of London. There are, however, occasions in which, through the lack of ability to ascertain the last outside residence of a person who died in a Camberwell institution, we have had to accept the death as of a resident. A patient died from cancer of some standing in a nursing home in the Borough. She had been removed here from a similar institution in the West End, the exact situation of which it was impossible to ascertain, and in consequence the death was allocated as one of a local resident. The result is that, through the impossibility of finding out the address of the institution from which she was removed, we are credited with a death from a disease which commenced elsewhere. I—3 Table IV.—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 subdistricts. 180 3 Dulwich 183 7 Camberwell, South 451 444 16 Camberwell, North 866 882 9 532 Peckham, South 541 Peckham, North 688 12 700 St. George's 625 11 636 Total 3,335 58 3,393 The death-rate for the Borough is thus 12·8, calculated on our estimate of the population. The Registrar-General in his annual summary gives the crude death rate as 12.9, which when corrected for difference of sex and age constitution comes out at 12·7. Table V.—Death-rates in Camberwell and its Sub-Districts for the Past 10 Years. Borough. South Camberwell. North Camberwell. South Peckham. North Peckham. St. George's. Year. Dulwich. 1903 13.80 7.57 13.04 14.10 15.39 15.16 1904 6.66 12.07 16.11 22.97 13.8 9.87 15.60 1905 13.40 14.18 14.8 11.7 15.5 12.7 16.5 1906 9.5 15.6 14.0 16.1 16.1 1907 9.0 11.2 14.9 12.6 8.4 1908 13.1 11.1 14.2 12.1 15.6 13.4 1909 9.8 12.9 14.3 16.6 15.0 13.7 10.5 9.0 1910 12.2 9.5 12.8 11.0 14.4 14.5 14.2 10.1 11.4 15.1 15.7 15.2 1911 14.3 While it does not appear to reach the exceptionally low figure of 1910, the result for the year is not unsatisfactory, for, with the exception of that year, it is the lowest one for the past ten years. The low death-rate of 1910 was, it is true, owing partly to the smallness of the actual number of deaths, but it was also brought about by the over-estimation of the population in that year. The actual number of deaths at all ages in 1912 is the lowest recorded since the institution of the Council in 1901, and if the estimate of the population were corrected by the enumeration of 1911 the death-rate for 1910 would no longer hold pre-eminence, 1912 holding the position of the lowest recorded death-rate. No doubt the diminution in it of the infantile mortality had also important influence in bringing down the general rate, but, apart from that, there is a substantial reduction, which affects ail the districts except Dulwich, where, strange to say, there is an increase. Possibly this is due to the increasing number of young couples of a child-producing age going to live in the newer houses that are so rapidly appearing in that neighbourhood. An increased number of children born must of necessity increase the number of subjects more liable to fatal accidents and diseases. With regard to the other districts, all have shared in the decrease, especially South Peckham, while North Peckham seems to have benefited least. Camberwell takes the position of the tenth lowest among all the London Boroughs, there being below it on the south side of the Thames, Battersea, Wandsworth, Lewisham and Eltham, while it is seventh below the death rate for the whole County, which is computed at 136 per 1,000. When the weather of the summer of 1912 is considered it becomes a matter of no surprise to find that there is a considerable drop in the number of deaths under one year, these being 551, compared with 735 in the preceding year, and the proportion per 1,000 births falling from 109 to 83. Taking the report of the Registrar-General it appears that compared with other Sanitary Authorities it had the tenth lowest proportion of deaths under one year to the thousand births, and following the practice of recent years I again set out the table, going back to the year 1906, which shows how Camberwell stands when a comparison is made between it and other boroughs which have employed health visitors for some time past. I think it must be admitted that the comparative figures continue to show that without a health visitor the infantile mortality has not decreased in any less degree than in those sanitary districts where they are at work. Camberwell has throughout been third on this list during the period to which it refers, except in 1908 and 1910, when the rate was equal to that of Lambeth, while Hampstead and Woolwich always show a less infantile mortality than we do. From the reports of other medical officers I gather that the giving of advice without more substantial help is not always satisfactory, an opinion on which I have always insisted, and some health visitors point out that in their opinions their efforts for good are much hampered by their inability to assist in this way. In other words, lack of means to provide any extra or special form of nourishment is the factor that counts before all others. On making a detailed and comparative inspection of the certified causes of deaths, it would appear that there is a great decrease in those resulting from inflammatory intestinal diseases, the deaths being 56 compared with 226, and if we take the sub-heading Diarrhœa alone, we find that there were 116 fewer deaths. The low temperature not only means a condition unfavourable to the growth of the specific organisms, but it is accompanied usually by rain, which diminishes the amount of dust and flies, the two main sources of the probable contamination of food which induces diarrhœa in the epidemic form. Deaths under One Year from All Causes per 1,000 Births. 1906. 1908. 1910. 1911. Borough. 1907. 1909. 1912. Year in which Health Visitor was appointed. Camberwell 130 115 100 109 83 104 94 Bermondsey 153 123 144 138 126 156 111 1909 1906 Bethnal Green 155 138 132 129 123 151 96 138 117 146 90 Hammersmith 120 120 99 1905 Hampstead 77 69 69 75 60 78 62 1909 Kensington 132 128 119 113 106 133 91 1906 1907 Lambeth 131 120 104 109 94 123 86 94 97 Woolwich 109 112 82 85 73 1906 In the class of deaths attributed to premature birth we had less, but the deaths from infantile atrophy increased from 84 to 93. The deaths from the various forms of tuberculosis numbered 19, exactly the same as last year. Bronchitis and pneumonia were both a little more fatal, while congenital syphilis caused six more deaths than in 1911. It must be remembered that this only represents the fatal cases and is no criterion of the number who do not die, but who are maimed for life by its ravages. The question of notification has never been seriously taken up, although it seems certain that many of the worst effects of the congenital forms of venereal diseases would be robbed of much of their malignancy were the sufferers searched out and the parents forced to give them proper medical attention. A somewhat similar course is followed now with regard to the notification of ophthalmia neonatorum, and it is unaccompanied by difficulty in administration. There were 79 deaths from measles, compared with 107 in the previous year. As is usually the case, they all occurred among that age period under five of the population, 21 occurring in the first year of life, against 29 for the same age period in 1911. In practically all the fatal cases the immediate cause of deaths was some form of bronchitis or pneumonia. The policy of removing those suffering from this disease has been continued by the Metropolitan Asylums Board, and I have no doubt that this removal has in many cases resulted in the saving of life. Sometimes the pressure on the hospital has been too great, and to ensure the removal of the most suitable cases the Board issued a form which the officers of the sanitary authorities are required to fill in before a case can be removed. This has done much to ensure those children being taken away who are the least likely to be able to get proper attention at home, or where the house conditions are most unfavourable for proper isolation. The deaths from scarlet fever, which were 9 in all, showed a slight increase from the remarkably low number of 6 for last year; but when one comes to compare these figures with a total of 80 in 1893, it is hardly necessary to dwell on the enormous diminution in the mortality of the disease during the past twenty years. It is impossible to say whether this is due to the prevalence of a less virulent type of the disease than that which formerly existed, or whether a new race of children has developed, able to resist first the attacks of the disease, or who, if they should be so stricken, do not succumb. It is not unlikely that both these factors are at work. The notifications, although differing but little from the previous year, were 30 less than in 1903, and about 1,200 less than in 1893. It will be seen that the fatality of the disease has declined in the last twenty years, and for the last year the case mortality was only a little over 1 per cent. More notifications came from North Camberwell and St. George's than elsewhere, South Peckham showed a great diminution from last year, and, as usual, they were almost universally and entirely among children over 1 and under 15. There were a number of children notified from schools where they had been examined in the ordinary course of affairs by the school medical officers. They were all duly excluded from school, and were for the most part put under the care of private doctors; but in one case the mother point-blank refused to call a medical man, as she stated her child was perfectly well and she could not understand the reason of the exclusion. I visited the house, as there was a question of infection arising, but could not say that the child was suffering from scarlet fever, and therefore did not advise any action. There was no notification of any other attack in this house, nor were the great majority of excluded children mentioned above re-notified by their own doctors. Following the school notification, the parents in another instance called in a private practitioner, who asked me to see the child with him. We both agreed that there was not sufficient evidence to justify removal to hospital, which in the ordinary circumstances we should certainly have advised, and no other child was attacked in this house. The deaths from enteric fever, which were only four during 1911, increased by one the last year; the number of notifications rising from 29 to 33. Just the same as last year there were none notified from Dulwich, and the majority of the notifications came from North Camberwell, although there were two less than last year. Twenty of those attacked were removed to hospital, and we had no run of cases in any one locality which would suggest a common source of infection. Diphtheria showed a decrease of 35 in respect of notifications, and of live as regards deaths. There was increase in the amount of notifications from Dulwich and North Peckham, coupled with a very marked decrease in South Camberwell. Towards the end of September a child attending the boys' department of a school in East Dulwich was notified; and at about the same time there was a communication from the teachers saying that certain children from the infants' section of the same school had been excluded on account of sore throat. The school was visited by the County Council authorities, and a number of swabs taken from the throats of children who showed suspicious symptoms. Seven children were subsequently reported as cases of diphtheria by the County Council ; out of these seven, three were placed under private doctors who did not notify them. On enquiry made at each house, the usual statement was that the child was quite well and the idea of any diphtheria was scouted. Advice as to the prevention of further attacks was given, but I fear that it fell on deaf ears, for it is difficult to persuade parents that a child is infectious unless it is so ill that it has to be confined to bed. There were also 69 names of children attending this same school which were sent to us from the teachers, and in each case the sanitary inspector visited the houses concerned. Four out of the 69 were subsequently notified by private doctors as suffering from diphtheria; one was notified as suffering from scarlet fever, and in two other cases scarlet fever broke out at the house, but the children so attacked were not pupils of the school first reporting. In 15 instances I visited the houses where children lived who were some of the 69 reported from the school as absent under suspicious circumstances, and took specimens from the throats, which on bacteriological examination were pronounced to be free from diphtheria bacilli. None of these children were subsequently notified, but a sister of one was notified some six weeks after as suffering from diphtheria. In four children there were positive results, only one being notified, but they all received medical attention, and in all alike there were no subsequent cases. So far as two children were concerned, positive results were obtained from the throat as long as two months after the initial swabbing. Ophthalmia neonatorum notifications were 29, being 5 less than last year. These cases were visited as soon as possible, but it was usually found that the patients were already under their own private doctors, or, more usually, had been taken to hospital. There were also a good many post cards received from the midwives inspector of the London County Council drawing attention to unhealthy conditions in the eyes of new-born children. Each of these was considered, and one visit made to see if the child was receiving all necessary attention. Owing to the great majority of the babies already being under treatment, including nursing, we have not had so much need to ask for the kindly assistance of the Ranyard nurses who helped us in the previous year. The notifications of polio-myelitis were six more and those of cerebro-spinal meningitis three more than last year. Two cases of the latter were notified from North Peckham and one each from Dulwich and North Camberwell. There was also a notification from South Peckham, but this after wards turned out to be tuberculous in its nature. The deaths and notifications from puerperal fever, although both higher than last year, seemed to indicate insolated attacks, and we had no series of cases which would infer a conveyance of infection from one woman to another. Whether the attendants were midwives or not, they were required to call at the Town Hall, and any necessary disinfection was there and then carried out. Erysipelas caused 5 fewer deaths than in 1911, and the notifictions were 218; but from the other forms of septic disease there were pleurisy showed a slight diminution over last year, but in the face of the prevailing opinion it is a moot point whether they should not be classified under the heading of tuberculosis. In so many of the cases of phthisis that I have enquired into, and especially among men, they have ascribed the beginning of their illness to an attack of pleurisy, often from which they have recovered more or less completely before the symptoms have appeared of the subsequent disease. The deaths from diarrhoea among persons of all ages are in line with those of infants under one year, there being a very great diminution at all the different age periods. The fatal forms of alcoholism certified as such are almost the same as last year, but as some of its effects are to be found in many other diseases it is not possible to draw any conclusions. One, however, of its frequent results, cirrhosis of the liver, certainly does show a diminution from 1911. Cancer, including the other forms of malignant disease, shows a very decided increase over the previous year, in which 262 deaths were reported compared with 220 in 1910. I—10 FACTORY AND WORKSHOPS ACT. In accordance with the provisions of the above Act, I submit a report setting out the work which has been carried out under its enactments. In all there were 3,848 inspections of factories, workshops, and workplaces, and in consequence of these visits it was necessary to serve 216 written notices. Both these numbers are in excess of last year, when there were 3,435 inspections. The Schedule No. 2 classifies the nature of the defects found under this section under certain headings, which in the main explain themselves. Under the division of "Other Nuisances" are included defects such as improper or insufficient ash-bins, dirty cisterns, &c. These, together with the specified nuisances, were all remedied without the necessity of police court proceedings. In 13 factories the women's conveniences were either dirty or not provided with an efficient water supply, or else the bolts and fastenings were defective. I.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Number of Premises. Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 398 38 - Workshops (including Workshop Laundries) 138 2,635 - Workplaces (other than Outworkers' Premises included in Part 3 of this Report) 40 - 815 Total 3,848 - 216 2.—Defects Found. Particulars. Number of Defects Number of Prosecutions. Remedied. Referred to H.M. Inspector. Found. Nuisances wider the Public Health Acts: — * Want of Cleanliness 54 54 - - Want of Ventilation 3 3 - - Overcrowding 3 3 - - Want of Drainage of Floors 4 - 4 60 - Other Nuisances 60 - - Sanitary Accommodation— Insufficient 1 1 - - Unsuitable or Defective 65 65 - - Not separate for Sexes - 4 4 - 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) - - - - Total 194 194 - - * Including those specified in Sections 2, 3, 7, and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. B.—Home Work. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109,110. Outworkers' Lists, Section 107. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made. (Sec. 110.) Prosecutions. Sees. 109,110.) Nature of Work. 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. - Wearing Apparel— - - - - - 37 144 60 1,740 23 7 - 11 (1) making, &c. 118 - - - - - - - - - - - (2) cleaning and washing - - - - - - - - - - - Household linen - - - - - - - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - - - - - - - - - Curtains and furniture hangings - - - - Furniture and upholstery - - - - - - - - - - - - - - - - - - - - Electro-plate - - - - - - - - - - - File making - - - - - - - - - - - - - - - - - - - - - - - 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 - - - - - - - - - - - Paper, &c., boxes, paper bags - 54 - - - - - - - - - 6 - - - 2 - 56 - - - - - - - - Brush making - - - - - - - - - - Pea picking - - - - - - - - - - Feather sorting - - - - - - - - - - - - - - - - - - - - - - - - - - Carding, &c., of buttons, &C. - - - - - - 12 - - Stuffed toys - 1 - - - - - - - - - - - Basket making - - - - - - - - - - - - Chocolates and sweetmeats - - - - - - - - - - - - - - 152 60 1,850 24 7 130 - - - Total - - - 37 11 - I—12 It will be seen that in the table relating to "Home Work " there were 37 instances of this class being carried on in unwholesome premises. They were for the most part of a trifling nature and remedied on verbal attention being called to them. Notices were served for those defects which were not so attended to and which might be taken into court with a reasonable chance of success in case of non-compliance with the notice. It will be seen that only in the cases of the making of wearing apparel and of paper bags were there any instances of unwholesome conditions. Several firms did not send in their lists of outworkers at the proper time, but a letter from the Committee calling attention to the default and pointing out its consequences had the desired effect, so that in no instance was it necessary to prosecute. There were no instances of outwork being carried on in infected premises during 1912. The list of notifications of infectious diseases is given each morning to Miss Bevan, who compares it with her list of outworkers to see if any names appear on both lists. In all there were 1,321 inspections of outworkers' premises, compared with 1,263 in 1911. As new workshops are continually being opened and old ones are being closed it is necessary to keep a careful watch over the streets so as to become aware of such changes. There is a diminution in the number of workshops compared with last year, the figures being 1,796 and 1,903 respectively. 4.—Registered Workshops. Workshops and Workplaces on the Register (s.131) at the end of the year. Number. Laundries 49 Clothing (wholesale and private) 346 Preparation of food 180 Building trades 59 Bakehouses 162 Miscellaneous 1,000 1,796 Total number of workshops on Register 5.—Other Matters. Class. Number. Mattel's notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 16 Action taken in matters referred by H.M. Inspector as remediable under the Public Notified by H .M.Inspector 10 Reports (of action taken) sent to H.M. Inspector Health Acts, but not under the Factory and Workshop Act (s. 5) 3 Other 1 Underground Bakehouses (s. 101): — Certificates granted during the year - In use at the end of the year 65 With the onset of the compulsory notification of all persons suffering from pulmonary tuberculosis, which came into force on January 1st, 1912, it is but natural that there would be a great increase in the total number reported for the year, for previously to this, notification was only obligatory in the case of persons attending hospital or those under the care of the Poor Law medical officers, while before May 1st, 1911, it referred to those only in the second category. It will be noticed that there is a very great difference between the number of persons notified and the notifications received in respect to such, which is explained by the fact that the same person has been seen by several doctors. For instance: a man attended by a private doctor reaches such a condition either of illness or means that it is advisable for him to be removed to the infirmary. As a preliminary to this, he would have been seen by one of the Poor Law doctors, who would have to report the case, and a third notification would have also been received from the doctor at the infirmary. At the end of 1911 a small Sub-Committee was appointed to consider what changes and additions might be called for in the staff on account of the extra amount of work involved in the addition of phthisis to the list of notifiable diseases. The question of assistance resolved itself into two parts, the first that of professional help to me, which was considered, but adjourned and re-adjourned during the year, and the second the necessity for increasing the clerical staff. The idea of the Committee was rather to allow the lapse of a sufficient period to form some idea as to the scope of necessary alterations rather than immediately to decide on action which must have been more or less permanent in its character. But I was allowed to engage extra clerical assistance. Since January, 1912, Mr. Wooldridge has been temporarily employed, and the help has been of considerable use. In fact, without it we would have been in a hopeless muddle; even as it is, the work was only got through with difficulty and with the occasional working beyond the ordinary hours. Following the report of the Departmental Committee, much attention has been drawn to the general provision of tuberculosis dispensaries. Not content with the mere treatment of the patients, the idea of these institutions is one of searching out the disease in the homes of the persons notified, and by means of what is technically termed a "march past" to discover any unsuspected cases in the families, the object being to get these mild and early cases under medical care, and to keep them under the best possible conditions for recovery. The Departmental Committee expressed themselves very strongly in favour of the provision of a dispensary, and in this they were no doubt influenced by reports they had received from authorities and medical officers of health. In opposition, however, to the view of the indispensable character of the tuberculosis dispensary, it has been urged that in towns where no dispensaries have been established a decline has occurred in the death-rate from tuberculosis not less than in those where they have been in force. If such an institution be associated with a band of voluntary helpers who realise that there is a more important side to the question than the bacteriological, much good must result, for its benefit will be proportionate to its dealing with the circumstances and surroundings of patients apart from their ailment. Such helpers will find out suitable employment both for those who have been discharged from sanatoria and also for those who for some reason or other are not considered fit for a residence at such an institution. They will also, so far as they can, see that those who are left at home, while the breadwinner is undergoing treatment, get their proper needs, and alleviate the anxiety which must be a constant menace to the man or woman who realises his or her duty to those who are deprived of their main support. The prevention of consumption will, I am convinced, lie in general improvement of the housing and feeding conditions of the population, rather than to the destruction of the germ of a disease, to the infection of which we are all more or less exposed. Compared with past years, I notice in other reports an increasing amount of attention being devoted to this aspect of the struggle against tuberculosis, and it will be a matter of no surprise if eventually it comes to be recognised as the only factor that counts. A dispensary has been established in Camberwell for some time under the auspices of Cambridge House, who wrote offering their services to form part of the scheme in this .Borough. The letter was referred to me for report, of which the following is a copy:— Gentlemen,—The point that the Public Health Committee have to consider is how far such an institution as a tuberculosis dispensary should be affiliated to the Public Health Department. To bring it under the sole control of the Council would be to probably lose us many voluntary workers who would render valuable service in the way of material help, of searching out cases where this help was necessary, and who would set themselves to try and obtain suitable occupations for those sufferers to whom a change in this respect is necessary for a cure. It would also probably diminish the substantial interest that many would like to take who could not actively participate in its working. On the other hand, measures for the prevention of tuberculosis are just as much under this authortity as are the cases of diphtheria, &c., and any delegation of the duties should only be done, if indeed they are done at all, after anxious consideration. It seems, therefore, necessary that the Council should recognise that if such a dispensary were established the Council must be in some way directly interested in its management. Whether this should be done by appointment of members, or, on the other hand, of officers of the Council, is a point which needs careful consideration by the Committee. Personally, I think both should be represented. For instance; questions will arise as to the locality of the dispensary, how far the sanitary inspectors are to be charged with the supervision of the patients, &c., and it is necessary that these points should be carried out in a manner agreeable to the supporters of the dispensary, and in accord with the responsibilities of the Council. The advantages that the dispensary would provide, apart from the treatment of cases unable to afford to pay a medical man, would be that of a nurse, who would be of great assistance in visiting and tending patients; tuberculin treatment could be given where desirable, ami that, further, the early cases, which are the most hopeful from the point of view of cure, would be detected in the examination that would be made at the patient's home. As a word of warning, I feel bound to point out that disappointment with the results is likely to occur unless the dispensary is able to help, either directly or indirectly, in the way of provision of nourishment in suitable cases, in that of finding occupations for those suffering, and also for those who have returned from a sanatorium, and who if they resume their previous occupation are almost ceitain to go under. (Signed) FRANCIS STEVENS, Medical Officer of Health. The matter was again considered by the Committee in April and adjourned for three months to see how the institution was working at the end of that time. As it was understood that some scheme was in course of preparation by the London County Council it was again adjourned. In consequence, however, of a wish expressed by the Medical Officer of Health to the Local Government Board as to the provision of a dispensary, I reported on November 20th:— Gentlemen, —The opinion of the Local Government Board is that arrangements for the provision of dispensaries, which are to be centres of diagnosis and treatment as well as receiving houses, should be made by Borough Councils either singly or in groups where small districts are concerned; they also express a wish that I should report to you on the subject. The Camberwell Dispensary for the Prevention of Tuberculosis has been started by voluntary effort, aided by a Central Fund, and is managed by a local Committee. It consists of a house in Brunswick Square which lias been properly fitted up for the purpose of a dispensary, with a staff of a medical officer, nurse, and caretaker, and is in actual work. Patients are seen there, and treatment at home of those who have been attending there is also undertaken. This dispensary has been provision lly approved by the Local Government Board, subject to certain conditions they have imposed, for a period of six months from July loth, 1912. The point lor this Committee's present consideration is whether they will themselves provide a dispensary or make use of the one already in their midst. Any measures dealing with tuberculosis must be considered as a part of the general health administration of the Borough, and must consequently be a duty and responsibility of the sanitary authority and its officers. It seems, therefore, that any recognition of the existing dispensary as fulfilling the duty imposed by the Local Government Board must be accompanied by some means which will ensure that this authority is the principal controlling force in its management. Whether this should be achieved by appointment of members of this Public Health Committee who would be in a majority on that of the dispensary, or whether a definite bargain should be struck setting out that in return for financial help from this authority the governing body of the latter will agree to carry out our requirements, is now to be decided. This bargain in the main would relate to their undertaking an agreement for their medical officer to examine any person of the family of the patient notified to me, the notification of any insanitary condition, to keeping under observation the members of the household, in other ways to answer any question on which they are in a position to give us information, and to agree to and to carry out the arrangements we should make in the way of elimination of overlapping and over-inspection. This second plan seems to be the better, for there will be fixed principles governing the relations between the two bodies, and subsequent friction in working is most likely to be obviated. If, on the other hand, the Council should decide not to recognise the dispensary, and themselves inaugurate an undertaking on similar lines, the initial cost of fitting up an establishment, roughly, would be about £250, and with an expenditure of at least £800 annually. The financial assistance received by the Borough Council if they themselves start a dispensary will take the form of payment for those insured persons who are treated there in accord with the conditions imposed by the Local Government Board, and certain other assistance would be likely to be given for the non-insured if the dispensary should form part of a scheme approved by the Local Government Board. My reason for saying this is that at; a conference between the Local Government Board and National Insurance Commission and the Metropolitan Medical Officers of Health it was asked whether any legal obligation or order in which a grant for a dispensary may be made. The Local Government Board representative answered: "That the Chancellor of the Exchequer, in answer to a deputation, said .... that so far as insured persons are concerned, it may be assumed that the authority running the scheme of institutional treatment would receive the actual expenditure on the insured. Then there are the non-insured twothirds of the population. So far as they are concerned, he is willing to pay half the cost if the local authorities will pay the other half." This probably relates to any scheme elaborated by a local authority, and which would probably be essentially one including all the requirements of the Departmental Committee set out above. It is obvious that the inspection of contracts of the notified people who are of the non-insured section will reveal cases of incipient trouble which may very well be treated in institutions. But it is little use going to the expense of diagnosing such early cases unless it is possible to carry out the idea of home or institution treatment as recommended by the Committee, and it will be necessary to make some arrangements with sanatoria or kindred institutions for a certain number of beds which can be used by this authority to send cases to ; and this may also mean a certain number of beds for observation at a dispensary. I think it is the better plan to make use of the existing dispensary, provided that a satisfactory arrangement can be come to with its authorities. It will save time and trouble with regard to the finding and equipping of suitable premises ; it will probably be less expensive than our own undertaking of the whole of the cost; and further —and this is. perhaps, one of the most important things—we shall gain voluntary helpers who, besides taking what I may call a local interest in its success, will interest themselves in the way of helping persons attending there to find employment more suitable to them, will to some extent be able to arrange for material help, and by whom this had best be supplied, and also for assisting those who are in need of removal to convalescent homes or institutions. None of these would, I think, be so well done by a purely municipal dispensary, yet without them the results of the work of a dispensary itself would be, I fear, a grievous disappointment. (Signed) FRANCIS STEVENS, Medical Officer of Health. An answer was duly received from the Board in which they stated they were inclined to agree that this was a case in which this Council should not themselves provide a dispensary, but should make the necessary arrangements with a view to the existing organisation serving as the main tuberculosis dispensary for the Borough, and any branch dispensary that might be found necessary to be worked in association with it. Many meetings were arranged between the representatives of the dispensary and ourselves since December, 1912, but at the time of writing nothing final has been arranged. The following table sets out the number of instances in which sanitary defects were found at the houses about which we received notifications :— TUBERCULOSIS. 1912. Inspector. Green Malins Dewey Nash Jones Eagle Morley Scudamore Farmer Pointon Overcrowding. Intimations. 2 5 - - - 1 - 1 - - 9 Notices. - - - - - - - 1 - - 1 Ordinary. Intimations. 80 50 28 23 21 21 23 21 5 4 276 Notices. 12 10 - 1 6 4 6 4 3 1 47 The accompanying table gives some idea of the additional work thrown upon the Public Health Department, and which has now still further been increased by the inclusion since 1913 of all forms of tuberculosis other than that of the lungs. It is necessary also, besides arranging for the regular visits to the greater proportion of those notified, to see that any advisable disinfection of premises when patients have removed is carried out, to keep and check the accounts (no light matter), and to see to numberless other details. This has been well done, and in the main by Messrs. Wright and Wooldridge, but all the other clerks have occasionally been compelled to lend a hand. If the work should increase, as it shows every likelihood of doing, we shall require more assistance. The number of which all trace has been lost may appear large, but it refers not only to cases notified in 1912, but to those of previous years who were still to be visited last year. It is not improbable that the ignorance of the whereabouts is pretended and not real, although in not a few instances enquiries elicited the fact that there were others who were anxious to know the address, but for reasons altogether different from ours. As set out in Table III. there were 339 deaths in the Borough, and of these 16 had not been notified. The subject of non-notification was reported to the Committee, and they have decided that in each case where a death has been registered as due to tuberculosis and where a notification has not been received that I should write to the medical attendant and ask for an explanation. This is now done, and the explanations duly given to the Committee, No one has as yet been prosecuted in this Borough for omitting to notify. The amount of segregation of the advanced cases which is not compulsory has been attracting much attention, and part of the diminution in the mortality from phthisis has been ascribed to it. Of the deaths which occurred in infirmaries and other public institutions, which were 172 in number, 28 had been inmates less than a week, 27 had been there more than one week and less than a month, 51 had been there more than one month, and in 32 other instances the patient had been in some institution but had come out before his death. A temporary Committee was appointed after the coming into force of the National Insurance Act in July to make provision for the domiciliary treatment of insured persons suffering from consumption. A difficulty arose in the case of a man who was unable to provide for his own lodging, and at one time it seemed necessary, despite his own wish, that he would be compelled to go into the infirmary. Up to the formation of the permanent Committee arrangements were made by the Public Health Department of this Council, naturally entailing additions to the work already increased by the notifications. In addition to this, I was asked to draw up a scheme of fees and charges to be defrayed by the Committee in cases where treatment in a sanatorium was considered undesirable for the patient, and he is recommended for domiciliary treatment, that is, for him to be attended at home by his own doctor. Those PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS. Particulars of Notifications received from January 1st to December 31st, 1912. District No. Ward. Sanitary Inspector. Number of Persons Notified. Number of Notifications received. Age Distribution. Inspections and Re-visits made by Sanitary Inspector. Patients left Address, since Notification, for other Address in Borough. Patients who have left Borough since Notification. Patients of whom all trace has been lust since Notification. 1 year to 5. 15 to 25. 25 to 65. 65 and upwards. 5 to 15. 3 8 15 Part of Ward 1 96 51 34 ... 333 6 4 6 1 M. Malins 394 Part of Ward 1 and the whole of Ward 2 H. Jones 80 181 2 17 16 44 1 6 6 16 2 65 338 2 15 25 3 4 20 3 Wards 3 and 14 G. Dewey 110 166 2 27 94 702 6 4 „ 4 and 8 H. Green 159 275 3 32 3 20 26 „ 5 and 6 R. Nash 230 2 27 18 85 2 648 20 5 28 5 134 8 14 71 4 553 6 8 42 6 „ 7 and 9 G. Scudamore 99 205 2 1 7 „ 10 and 11 W. Eagle 63 120 5 16 42 397 4 15 ... ... 5 „ 12 and 13 70 116 1 6 16 44 3 381 3 9 8 J. Pointon 5 38 2 235 5 5 9 „ 15 and 16 W. Farmer 61 96 1 15 ... 34 10 „ 17 and 18 G. Morley 56 90 4 17 1 220 7 7 9 ... „ 19 and 20 22 31 1 4 17 39 1 1 11 E. Collins ... ... ... Total 45 177 568 905 1,606 16 138 164 19 4,240 90 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. There were also 49 Notifications forwarded to neighbouring Boroughs. This brings the total of number of Notifications dealt with for the year 1912 up to 1,793. who have been recommended for treatment in a sanatorium seem to have been so chosen on the ground of their own condition. But in view of the stress which is laid on the danger of infecting others, it would seem logical that the home conditions and circumstances should be taken into account, and a report on these should be considered by the Committee simultaneously with that of the medical referee. It is true that the hard pressure of privation may drive many of those refused for a sanatorium to the workhouse, even those who were at first altogether unwilling to avail themselves of such an asylum. But if they are so dangerous to those surrounding them, surely much harm must have previously been done to these, for admission is often only sought when they are completely at the end of their resources, and where the home conditions have been at their worst for some time. The necessity for some drastic alteration at the Cleansing Station for verminous children at Peckham Park Road was reported to the Committee, who surveyed the premises and who were convinced of the necessity of improving the conditions under which the work was carried out. A sub-committee was appointed to visit and to confer with the Borough Engineer and myself, with the result of a scheme being prepared which would have been thoroughly satisfactory. The cost, however, was great, and the matter was referred back to the Sub-Committee to see if economies could be effected. A modified estimate was submitted which, although by no means so thorough or so lasting as the original, was a considerably less expense. This was approved, and the work subsequently put in hand, and at the time of write is complete. Owing to the expense of the alterations, it was decided to ask the London County Council to extend their agreement to ten years, but they did not accede to this request, and the period of our contract with them remains at five years as originally arranged. A proposal to treat scabies there was before the Committee. It was, however, pointed out that this disease would have required many more baths than the usual run of cases dealt with, and as the London County Council did not agree to any increase on the sum allowed for the ordinary verminous children, the matter dropped. The smell from a factory near the Old Kent Road was alleged to continue and to cause a nuisance to the neighbourhood. The complaint was of the formal nature required by the Public Health Act, i.e., signed by ten ratepayers. On this complaint the Committee took action, and the matter was taken before the magistrate in July. The business was that of cleansing oily and greasy cloths, and the nuisance arose from the escape of steam from the drying chamber, where effectual means for obviating the smell did not exist. The evidence was conflicting, and in the end the case was adjourned, a sum of £3 3s. being allowed as the costs to the Council. Housing and Town Planning Act. Number of houses inspected under Section 17 20 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 19 One of the houses which was inspected under the Act was demolished. Last year I referred to a block of houses between Peckham Park Road and Levant Street where the conditions are practically those of back-to-back houses, but where certain improvements have been made in the way of air shafts to the basement. Nothing further has been done, but the occupiers tell me that the basement rooms are not so stuffy as they were. A block of cottages in Ormside Street was brought up as one in which proceedings might be taken under this Act, on account of the damp and generally insanitary condition of houses. They were accordingly surveyed by the Committee, who decided that the owners should be pressed to deal with the matter, but no closing order was made. Notices of as comprehensive a nature as possible under the Public Health Act were served in February, and the work was subsequently carried out. Complaints were received as to the nuisance caused by ashes and smoke discharged from railway engines, which were said to have blocked up some gullies. It was resolved to write to the railway company on the subject. As no further complaints have been received, the nuisance has probably abated. The report of the Departmental Committee on the use of interceptors will be very gratifying to a Council like Camberwell, which has always discountenanced insistence on their routine provision. In the beginning of 1898 when the Sewers and Sanitary Committee of the Vestry had the proposed drainage by-laws under consideration, Mr. Brown (your then Surveyor) and I both desired a provision to be incorporated in the draft which would allow us to dispense with the interceptor where such a course was desirable. The Committee, however, decided to make no recommendation to the Council. In my report for that year are pointed out some of the disadvantages of the interceptor, which have been suggested by experience, and the objections to its use. The Committee at that time made no stand against the prevailing idea of its advantages, and left it to Willesden, who, at the instigation of their Medical Officer, brought things to a climax in later years and were instrumental in the appointment of the Departmental Committee. With the coming into existence of this Council, steps were taken in the right direction by the non-insistence of the disconnection of rainwater pipes in all cases. The Borough Council of Lewisham, in 1905, sent out a circular letter which was reported on by your Engineer and myself. We stated that " as regards the non-insistence on the provision of interceptors we are both agreed that it is a wise step to take, not only on account of the better ventilation of sewers, but also, as we have often before insisted, on other grounds. Indeed, we have previously advised that rain-water pipes going direct to the drain and not opening near a window should be left connected direct with the sewer, even in houses where no interceptor is provided, and the step proposed by Lewisham is only a little in advance of this." Among other things the report finishes up with the following "It is not necessary to enter into the desirability of interceptors, for when there has been any possible means of getting out of the by-law we are not ashamed to say that we have aided and abetted any plan by which the rule for their enforcement can be evaded." In an exhaustive enquiry, in the course of which evidence was given by many Engineers and Medical Officers of Health, and for which many experiments were carried out, the conclusion was come to that " the disadvantages involved by the use of the interceptor are substantial and of serious practical importance." They condemn the fresh-air inlet and suggest its discontinuance. Furthermore, they go on to say " that the association of the incidence of certain specific diseases, such as enteric fever and diphtheria, with drain defects which allow of the entry of sewer air as well as of drain air into houses, is almost identically the same as the association of similar defects with the absence of disease, and that the experience of districts without intercepting traps does not show that their absence has been harmful." And, further, " that human beings deliberately exposed to sewer air do not appear to be affected in health." This conclusion bears out views which I arrived at, which I set out in a paper read in 1894, " that the occupation of these men (i.e. sewer men) is by no means unhealthy; indeed, if we were to compare them, say, with clerks in City offices, I am strongly inclined to the opinion that they would show a much better record than the latter." There were 200 less inspections of complaints than in 1911, but there were 500 more house-to-house inspections. In addition to this there were 600 more visits to verminous premises, which are included in the total of 1,811 such inspections which are made as a matter of course at the address of every child who is treated at the cleansing station. The house-to-house inspections have thus not suffered ,although the additional work in consequence of tuberculosis has meant an excess of about 1,500 more visits and inquiries over those which were carried out last year. A feature of the last year was the large number of applications for my certificate to obtain exemption from Inhabited House Duty. This necessitated my personally inspecting 272 tenements, and, as shown in the tables, it was possible to grant certificates for 233 of these. Owing to the superannuation of Mr. Heath at the end of 1911 a vacancy occurred in the Sanitary Department. It was filled by the appointment of Mr. R P. Nash, to whom was allotted the district formerly under the care of Mr. Heath. In conclusion, I have to thank the Public Health Committee for many acts of kindness, and the Staff for their invaluable help. 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:— TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1912 AND PREVIOUS YEARS. Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Under 1 Year of Age. At all Ages. Uncorrected Number. 3 Nett. of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Rate. 7 Number. 6 Number. 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate. 13 Number. 4 Rate. 5 6,733 24.7 15.4 479 3,823 272,479 6,603 4,217 873 805 119.5 14.0 740 273,836 6,729 6,885 25.1 3,922 14.3 839 519 107.4 3,602 13.1 275,275 6,547 6,689 24.3 4,098 14.8 814 494 687 102.7 3,778 13.7 279,566 6,511 6,657 23.8 13.8 455 3,435 12.2 3,871 891 654 98.2 114.8 261,328 6,342 6,399 24.4 4,053 15.6 847 516 735 3,722 14.2 TABLE II. -CASE OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1912. Number of Cases Notified. Total Case Notified in Each Locality (e.g., Parish or Ward) of the District. Notifiable Disease. At all Ages. At Ages—Years. Dulwich. South Cambenwell. North Camberwell. South Peckham. St. George's. North Peckham. Under 1. 65 and upwards. 1 to 5. 15 to 25. 25 to 45. 45 to 65. 5 to 15. ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 319 165 23 17 2 25 46 77 37 76 58 ... 8 104 ... 23 Erysipelas 218 2 13 26 52 75 27 5 17 80 16 46 54 ... 638 7 176 409 25 20 1 40 85 126 113 106 168 Scarlet Fever ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 7 Enteric Fever 29 4 12 1 ... ... 3 10 2 7 ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... Puerperal Fever 10 17 ... ... 7 ... ... ... 3 5 4 3 2 ... ... Cerebro-spinal Meninigitis ... 1 1 2 ... 5 ... 4 ... ... 1 1 ... ... ... 11 7 3 ... Polio-myelitis 1 ... ... ... ... 2 3 1 2 3 ... 13 179 224 Pulmonary Tuberculosis 905 3 138 164 389 19 22 93 265 133 168 ... Ophthalmia Neonatorum 29 3 5 9 7 ... 29 ... ... ... ... ... 1 4 ... 50 314 746 257 500 253 311 2,172 259 46 94 572 419 523 Totals ... TABLE III.—CAUSES OF. AND AGES AT, DEATH DURING YEAR 1912. Nett Deaths at subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of "Residents" or "non-Residents" in Institutions in the District. Causes of Death. All Ages. Under 1 year. 1 and under 2. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 2 and under 5. 5 and under 15 1 2 3 4 5 6 8 10 7 9 11 I—24 All causes Certified 3,004 508 117 131 103 115 402 667 961 785 Uncertified 389 7 28 60 94 43 114 13 19 105 1. Enteric Fever 5 ... ... ... 2 3 1 ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... 3. Measles ... ... 79 21 24 30 3 1 ... ... 3 4. Scarlet Fever ... 9 1 2 2 4 ... ... ... 5. Whooping Cough ... ... 49 23 12 12 2 ... ... ... 2 19 2 ... 6. Diphtheria and Croup 5 3 8 ... 1 ... 1 ... 7. Influenza 34 ... 1 1 1 6 ... 12 13 2 8. Erysipelas 4 1 1 ... 1 ... ... 1 9. Phthisis (Pulmonary Tuberculosis) ... 1 339 3 1 3 13 61 150 90 136 18 14 1 10. Tuberculous Meningitis 11 1 ... 1 ... ... 1 11. Other Tuberculous Diseases ... 75 6 9 17 16 9 7 8 3 7 12. Cancer, malignant disease 1 1 311 ... ... 2 31 139 137 100 13. Rheumatic Fever 9 7 1 1 ... ... ... ... ... ... 14. Meningitis 5 3 2 ... 1 ... ... ... ... ... 15. Organic Heart Disease 348 1 2 20 58 108 142 85 17 ... 16 16. Bronchitis 10 3 89 164 88 326 42 2 ... 32 17. Pneumonia (all forms) 245 77 33 7 3 28 38 27 26 18. Other Diseases of Respiratory Organs ... ... 13 2 1 5 5 5 ... ... 19. Diarrhœa and Enteritis 75 56 4 3 2 2 4 4 7 ... 20. Appendicitis and Typhlitis ... 1 ... 1 ... ... ... ... ... ... 21. Cirrhosis of Liver 23 6 17 5 ... ... ... ... ... ... 21a Alcoholism 11 2 7 2 8 ... ... ... ... ... 22. Nephritis and Bright's Disease 129 1 2 2 55 43 76 2 24 ... 3 ... ... 23. Puerperal Fever 9 ... ... 6 ... ... ... 12 24. Other accidents and diseases of Pregnancy and Parturition ... ... ... ... 5 7 6 ... ... 25. Congenital Debility and Malformation, including Premature Birth ... 216 ... ... ... 216 23 ... ... ... 26. Violent Deaths, excluding Suicide 16 4 9 10 18 18 23 26 42 124 27. Suicide 23 ... ... 11 9 3 6 ... ... ... 81 I—25 28. Other Defined Diseases 884 62 18 24 21 23 176 479 243 3,393 124 144 122 143 1,066 879 462 551 781 1 1 ... ... 14(a). Cerebrospinal Meningitis Sub- ( Entries included in above figures. ... ... ... ... ... ... ... ... 28 (a). Poliomyelitis ... ... ... ... ... ... ... ... 6 6 12 Other Septic Diseases 50 2 4 4 12 4 17 7 ... Pleurisy 2 1 1 2 1 ... ... ... Mental Diseases 31 2 1 10 16 2 2 ... ... ... Old Age 293 6 287 ... ... 99 ... ... ... ... TABLE IV.—INFANTILE MORTALITY DURING THE YEAR 1912. Next Deaths from stated Causes at Various Ages 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 3 months. 3 to 6 months. 6 to 9 months. 99 33 21 17 170 79 96 81 All causes Certified Uncertified 9 1 1 15 10 13 2 4 Small-pox ... ... ... ... ... ... ... .. Chicken-pox ... ... ... ... ... ... ... ... 1 5 Measles ... 1 ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... Whooping Cough 4 4 8 ... ... ... ... ... ... Diphtheria and Croup ... ... 1 ... 1 ... ... Erysipelas ... ... ... 1 ... ... ... ... Tuberculous Meningitis ... ... 5 4 ... ... ... ... ... 3 1 Abdominal Tuberculosis ... ... ... ... ... Other Tuberculous Diseases 1 ... ... ... ... ... ... ... 2 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... Convulsions ... 3 5 1 ... 2 1 Laryngitis ... ... ... ... ... ... ... ... ... 10 8 8 Bronchitis ... 4 4 ... 15 21 Pneumonia (all forms) 1 1 3 5 11 ... 13 Diarrhœa ... 1 1 2 6 7 ... Enteritis 1 10 8 2 ... 1 ... 3 ... 1 Gastritis ... 1 1 ... 2 ... Syphilis ... ... ... ... ... 6 ... ... Rickets ... ... ... ... ... ... ... ... 3 3 4 ... Suffocation, overlying ... ... ... 4 ... Injury at Birth 4 ... ... ... 4 ... ... 3 ... Atelectasis 1 ... 1 6 1 ... 5 Congenital Malformations 11 ... 3 4 17 5 3 Premature Birth 61 9 2 82 8 3 10 ... Atrophy, Debility, and Marasmus 18 12 5 18 27 7 3 39 5 10 8 Other Causes 8 1 13 9 ... 108 37 18 185 89 109 22 83 FACTORY AND WORKSHOP ACT, 1912. No. of Visits. Want of Cleanliness. Overcrowding and Defective Ventilation. Defective Root and Dampness. Sanitary Accommodation. Defective Yard and Paving. Defective Dust-bins. Other Defects. Intimation Notices. Statutory Notices. Summonses. Insufficient. Not Separate for the Sexes. Dirty and Defective. Complaints 7 - - - - - - - - - - - - 105 3 Workshops (new) 6 - 3 8 - - 7 3 - 4 28 Do. (old) 533 Laundries (new) 3 3 - 1 - - 1 - - - 5 1 - Do. (old) 91 5 - - - 1 - - Factories (new) - 13 - 14 1 - Do. (old) 115 - Outworkers (new) 615 - - 1 1 - 11 3 29 - 6 - Do (old) 710 Eating Houses 99 5 - 2 - - 1 2 - 9 2 - - Schools 44 - - - - - - - - - - - - 181 - - - Re Work in Hand - - - - - - - - - 1,085 - Miscellaneous - - - - - - - - - - - 3 Total 3,593 40 6 16 1 3 22 5 - 67 11 - G. D. B AN. RETURN OF WORK CARRIED OUT AT THE DISINFECTING STATION DURING THE YEAR 1912. Articles Disinfected. January. February. March. April. May. June. July. August. September. October. November. December. Total. 104 120 98 123 1,055 55 58 64 Beds 72 110 66 84 101 Blankets 99 152 144 104 91 235 88 82 80 131 131 209 1,546 Bolsters 39 37 76 46 48 42 57 88 75 78 66 83 735 Books—Public Library 15 20 - 4 - 7 9 14 13 107 3 10 12 Cushions 20 24 48 14 26 22 38 25 33 46 37 48 381 Curtains (pairs) 3 5 1 - - 1 2 2 7 6 3 5 35 8 Carpets 11 17 37 17 13 10 15 13 21 12 194 20 Mattresses 32 35 80 35 25 49 67 58 54 44 I—28 40 72 591 Palliasses - 12 4 4 - 3 8 2 4 8 2 2 49 Pillows 112 241 128 130 148 200 213 193 128 119 209 247 2,068 Quilts 61 84 112 56 38 62 70 99 103 120 91 122 1,018 Sheets 54 82 104 69 55 68 78 129 118 141 88 99 1,085 Wearing Apparel 548 986 1,951 730 996 1,378 2,257 890 2,578 1,755 1,497 1,991 17,557 Miscellaneous 4 2 7 9 - 35 - 2 - - 59 - - Total 1,046 1,585 1,253 2,876 1,773 3,030 1,509 1,916 2,387 3,517 2,548 3,040 26,480 Mattresses Retabbed 80 40 49 67 58 53 44 72 590 32 35 35 25 Palliasses do. - - - - - - - 2 - 2 - - - Cushions do. 20 24 14 26 43 48 22 25 33 38 37 48 378 52 59 128 49 51 62 74 102 81 120 970 Total 96 96 Return of Work carried out at the Disinfecting Station during the Year 1912 (continued). January. June. September. November. December. Total. May. August. February. April. October. March. July. Articles Disinfected. Verminous Cases — Persons Cleansed 53 109 202 84 128 184 289 92 179 345 266 229 2,160 Rooms Disinfected 1 5 27 26 11 208 1 10 13 27 28 32 8 10 174 Bedding do. 2 25 15 4 13 23 27 16 13 7 12 18 56 159 221 281 251 Total 223 340 151 369 2,542 144 233 114 183 127 244 178 2,268 142 Articles Destroyed— Palliasses and Mattresses 168 221 116 144 269 335 141 I—29 Miscellaneous - - - - - - 70 - - - 130 200 - 144 269 168 221 183 127 405 244 178 142 271 2,468 116 Total 233 260 458 388 Houses Visited 177 243 246 264 319 396 358 464 3,806 Rooms Disinfected 68 83 90 98 107 97 121 173 164 147 162 127 1,437 Total 316 350 341 440 485 245 353 631 552 543 62 6 5,243 361 UNSOUND FOOD, &c., DESTROYED AT DEPOT. Fish. Fruit. Meat. Tinned Food. Rabbits. Wood Chips. Miscellaneous. cwt. qrs. lbs. cwt. qr. lbs. lbs. 45 tins of Trade Refuse. Loads. No. Loads. cwt. qr. 1 1 1 Milk 17 9 0 16 1 5 4 28 29 SUMMARY OF SANITARY WORK FOR THE YEAR ENDING DECEMBER, 1912. Eagle. Scudamore. Collins. Morley. Farmer. Dewey. Malins. Green. Pointon. Description of Work. 161 226 130 74 143 165 587 253 Cleanse and limewash 17 96 86 Repair guttering, &c. 132 63 36 93 124 248 102 17 Ventilate under floors, &c. 100 10 6 108 144 74 24 81 Abate overcrowding 5 18 17 - 3 12 41 10 - 1 12 2 3 8 46 Abate smoke nuisance 1 2 15 - 1 6 10 Light and ventilate staircase 50 17 4 35 - 47 46 Provide, repair, or remove dustbin 73 18 31 48 45 130 67 Remove refuse or manure 11 7 6 15 7 12 12 62 11 112 94 16 50 59 56 87 Pave, level, or drain yard, &c. 67 111 Provide manure pit - 1 8 5 2 1 3 4 4 Provide sufficient water supply 2 1 5 24 10 - 6 - 15 Provide or reconstruct receptacle (render accessible) 3 4 1 3 2 - - 5 6 Repair, cover, or cleanse receptacles 1 11 15 1 13 7 20 21 6 Provide, repair, or remove closets, pans, &c. 75 32 107 135 33 66 27 65 61 Proper water supply to closet and apparatus 52 95 137 41 32 125 36 21 35 Ventilate and remove to outside soil pipes, cleanse, repair, and trap drains or sinks 55 140 81 50 37 39 90 69 56 Disconnect rainwater pipes, sinks, and other wastes 2 6 18 71 8 45 4 6 13 Empty and cleanse cesspools, or drain into sewer - 1 1 - - - - - - Totally reconstruct drains 8 3 15 30 31 4 17 8 11 Partially reconstruct drains 17 16 5 7 37 4 - 35 11 2 Animals to be kept clean or removed 3 4 2 8 - - 7 4 Public conveniences—cleanse, supply with water, &c. - - - - - 1 - - - Private conveniences -cleanse, supply with water, &c. - 3 10 2 1 19 2 3 14 Abate nuisance from offensive trades - - - - - - - - - Abate nuisance from road gullies - - - 2 - - - - - Miscellaneous Return of work performed in the sanitary department during the 52 weeks ending December, 1912. Inspectors. Pointon. Eagle. Scudamore. Collins. Morley. Farmer. Dewey. Malins. Green. Jones. Nash. Miss Bevan. Totals. Description of Work. 132 214 102 88 220 121 79 140 176 65 7 1,517 173 Visits to complaints 222 81 121 44 981 House inspections following on complaints 124 9 8 203 17 34 118 - 323 602 397 346 437 425 578 331 201 192 434 - 4,266 House-to-house inspections Tenement inspections 41 - 15 76 45 2 349 - - 528 - - - - - 414 42 - - Houses let in lodgings inspections 1 - 24 481 - - - - 46 4 - - 23 14 - - 87 Housing a nd town planning inspections - - - 64 1 1 2 6 10 14 55 4 10 6 - New buildings completed 173 156 63 110 1,279 272 36 86 - 126 - 2,160 Visits to new buildings 32 - 119 1 85 6 60 No. of inspections re overcrowding 12 - 4 - 287 - - - - 7 - 15 13 8 50 4 - 24 9 130 Do. of slaughterhouses - 78 35 50 19 73 118 46 28 56 18 14 - 535 Do. do. bakehouses Do. do. cowhouses 5 54 6 40 13 6 - 4 2 - - - 130 115 112 59 - Do. do. milk shops and dairies 210 103 186 40 107 96 228 97 1,353 90 Do. do. eating houses 130 22 28 2 16 12 25 18 34 20 22 419 I—31 Do. do. ice cream shops 70 39 44 23 59 35 38 18 59 45 30 - 469 2 13 70 15 - - - 11 - Do. do. railway stations 25 - 136 - 100 21 80 727 Do. do. workshops 148 289 48 141 68 127 153 104 2,006 45 121 Do. do. factories 77 - - 3 - 32 33 48 39 398 - Do. do. urinals, public 90 45 - 8 12 41 45 76 19 53 7 - 396 Do. do. do. private 225 203 263 128 355 220 356 326 148 3,223 729 266 4 26 21 19 Do. do. schools, public 44 20 37 24 65 29 27 20 - 332 Do. do. do. private 32 7 11 23 56 64 7 5 - 1 47 253 - 2,501 3,336 4,036 3,055 2,553 3,680 4,029 2,859 2,664 2 ,132 1,271 183 32,299 Re-inspections 236 165 273 738 1,191 Miscellaneous 75 83 82 410 465 8 56 155 4,729 68 87 Infectious cases visited and houses inspected 97 58 175 107 82 58 163 65 139 - 1,099 144 20 117 89 31 85 29 61 90 16 - 750 Do. do. or inquiries 68 93 53 27 34 69 55 145 92 - Tuberculosis cases visited and houses inspected 99 46 60 773 375 7 11 47 267 Do. do. or inquiries 441 322 346 282 794 406 383 - 4,434 135 25 605 2 25 70 69 127 589 111 53 Visits to verminous premises - 1,811 Intimations 480 372 247 352 324 384 598 541 292 66 547 522 4,725 72 155 94 57 60 200 11 Statutory notices 107 112 127 162 7 1,164 - Notices, houses let in lodgings — - - - 337 28 9 - - 374 - - Summonses under P.H. Act - 1 2 3 4 4 4 6 - - 3 - 27 12 24 6 19 12 32 31 - Infectious disease contacts 7 14 23 - 180 1 1 Seizures of unwholesome food - - 1 1 2 - - 1 - 7 - Outworkers 2 - - - - - - - - - 1,319 1,321 - Drainage plans, total reconstructions 6 16 43 7 31 22 35 7 26 8 9 - 210 17 30 23 15 32 5 Do. partial do. 11 23 12 29 18 - 215 PROCEEDINGS DURING 1912 (as asked for by the London County Council). Number of Places. Premises. Number of Inspections, 1912. Number of Notices, 1912. Number of Prosecutions, 1912. Added in 1912. Removed in 1912. On Register at end of 1911. On Register at end of 1912. Milk Premises 614 22 612 1,353 22 22 - Cowsheds 10 130 - 10 - - - Slaughterhouses 13 - 1 12 130 2 - 6 - Other Offensive Trade Premises 5 1 6 - - Ice Cream Premisesl 219 17 73 163 460 6 - Registered Houses Let in Lodgings 262 481 254 - - 8 (a) 34 (b) 418 - (a) For overcrowding. (b) For other conditions. Total Number of Intimation Notices served for all purposes 4,725 Overcrowding, 1912: — Number of dwelling rooms overcrowded 115 Number remedied 115 Number of prosecutions 3 Underground Rooms:- Illegal occupation dealt with during year Number of rooms closed 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, 1004 172 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 55 Number of tenements comprised therein 272 Number of tenements for which certificates were— (a) Granted 233 (b) Refused 2 (c) Deferred 37 Number of Prosecutions under By-laws under Public Health Act, 1891:- (a) For prevention of nuisance arising from snow, ice, salt, tilth, &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 5 {e) In connection with the removal of offensive matter, &c. Nil (f) As to cesspools and privies, removal and disposal of refuse, &c. 6 (g) For securing the cleanliness of tanks, cisterns, &c. 2 (A) With respect to water closets, earth closets, etc. 3 (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) 1 Mortuaries:— Total number of bodies removed 330 Total number of infectious bodies removed Nil