R E P O R T TO The Board of Works for the Lewisham District TO THE END OF THE YEAR 1893, BY Dr. S. BLAKE JOLLY, Medical Officer of Health for the District. Gentlemen, The number of deaths registered in this District during the year 1893 was 1468, being 8 less than the number registered during the previous year, making the death rate 15.1 per 1000, as compared with 15.6 per 1000 in 1892.* The year 1893 has been one of many dangers from a sanitary point of view. (1.) Diphtheria and scarlet fever have been even more prevalent in London than in 1892, and in a worse form. (2 ) There has been a most serious outbreak of smallpox throughout the country, and more especially in London. (3.) There has been another epidemic of influenza, though fortunately of a milder type. (4) The country has again been threatened with cholera, and has only escaped owing to the great care and promptness displayed in the means taken to prevent its introduction amongst us In spite of these dangers the Lewisham District has been in a satisfactory condition, though they have not been *This is the first year in which the corrected death rate is given for this District, i.e., in which the deaths of residents in this District, occurring in public institutions situated beyond the District, have been included in the total number of deaths. According to the old reckoning the death rate for this District for 1893, would be 14.2 per 1000. 2 without their effect. Thus, though there has been no serious outbreak of small. pox, 25 cases of this disease were notified, with 5 deaths, this being the first year for 8 years in which a death from this disease has occurred in the district. There has also been a considerable increase in the number of deaths from diphtheria and scarlet fever, though our statistics compare very favourably with other London Districts in this respect. Every effort has been made to immediately isolate all cases, and, whenever possible, to remove them to hospital. Influenza was registered as the cause of death in 58 cases. Population. The population of the Lewisham District, at the Census of 1891, was found to be 92,647, occupying 15,643 houses, giving an average of 5.9 inmates to each inhabited house. The number of inhabited houses at Midsummer, 1893, was 16,658, and the population estimated at 97,160. Births. The registered births in the District in the year 1893 amounted to 2,469, or 33 more than in the previous year; of these 74, or 3 per cent., were illegitimate. Males 1,271 Females 1,198 The birth rate to population was 25.4 per 1,000. Deaths. The number of deaths registered in the Lewisham District for the year 1893 was 1,468. Males 714 Females 754 The death rate was 15.1 per 1000. The deaths of residents occurring in public institutions situated beyond the District amounted to 82, as compared with 79 last year. The number of deaths in public institutions in the District amounted to 150, a decrease of 11 on the previous year. 3 Lewisham Workhouse 124 deaths. Lower Sydenham Home for Sick Children 10 „ St. John's Hospital, Blackheath 8 „ North Surrey District Schools 5 „ Watermans' Asylum, Penge 3 „ During the same period the death rate in England and Wales, which in the preceding four years had been successively 18.2, 19 5, 20.2, and 19.0 per 1000, rose to 19.17. The death rate in London for 1893 was 21.3, per 1000. The death rate of the "Outer Ring" of suburban districts, with a population of close on a million and a-half was 15.4 per 1,000. The death rate of the thirty-three great towns of England and Wales, with a population of over ten millions, averaged 21.6 per 1,000, ranging from 15.0 per 1000 for Croydon to 26.7 per 1000 for Preston. Zymotic Disease. The number of deaths from Zymotic Disease was 153 as compared with 145 in 1892. There was a marked decrease in the number of deaths from whooping cough, there being only 10 deaths as against 67 in 1892 ; but in all other zymotic disease there was an increase in the number of deaths. Scarlet Fever 14 deaths as compared with 4 in 1892. Diphtheria 53 „ „ 17 „ Small-pox 5 „ „ 0 „ Typhoid Fever 10 „ „ 2 „ Measles 19 „ „ 15 „ Whooping Cough 10 „ „ 67 „ Diarrhoea 42 „ „ 40 „ Scarlet Fever. There were 524 notifications of this disease received during the year 1893, with 14 deaths. The type of disease was in most cases mild, and there was no epidemic ; the cases being scattered over the whole district. 4 Diphtheria. There were 219 notifications of this disease received during the year. The disease was in many cases of a very malignant type, and there were 53 deaths. They were for the most part scattered over the district, with the exception of one portion of Forest hill, known as the Freehold. In this part of the District diphtheria has been perpetually in evidence. The houses are for the most part badly drained, and the same cistern supplies the drinking water of the house and the water-closet. A house to house inspection is being made in this locality, and a great many of the houses have been redrained and separate water cisterns supplied. I trust that when the whole work is completed we shall get rid of diphtheria from this part of the District. Its close proximity to one of the large Board Schools in the Brockleyroad makes diphtheria in this locality a special danger. In many cases a child attending school with a diphtheric throat, which has not been noticed by its parents, may give the disease in a more severe form to large numbers of children with whom it may come in contact. All children are excluded from school who come from a house in which zymotic disease is known to exist. I think that in many cases they are allowed to return before the house is thoroughly free from infection. I have been asked lately by the Medical Officer of Health for the School Board to give certificates in all cases when the disinfection of the house has been completed, certifying that the rest of the children in the house are free from infection, and can therefore return to school. This I have not at present agreed to, as I consider that such certificates should be given by the medical man in attendance, and that it might throw any onus on to Sanitary Authorities, and possibly in some cases lead to legal proceedings. I think that special provision should be made in the Public Health Act for this matter, as no child should be allowed to resume attendance at School till a medical certificate is given that the other children in the house are free from infection, and the house itself has been properly dis- 5 infected. The Medical Officer of Health cannot be expected to examine all the children to see whether they are free from infection, and therefore his certificate in regard to disinfection of premises might lead to misunderstanding. Small-pox. There were 28 notifications of this disease received during the year, with 5 deaths. This is the first year for 8 successive years in which there has been a death from this disease in the District. Most of the cases were of the modified form and isolated cases. It is worthy of mention that every case which had not been vaccinated died. Of the 5 deaths, 3 had never been vaccinated, one had been vaccinated only in infancy, and the remaining case was believed to have been vaccinated only in infancy, but there was no reliable history. At the beginning of March we were threatened with a serious outbreak in Lower Sydenham. The case occurred in a densely populated district, near the Gas Works, and there were 5 other members of the household. The case was that of an old nurse who had only come to live in the house a few days when she developed a confluent small-pox rash, and was sent to hospital at once, where she died in three days. All the other members of the household were immediately vaccinated and completely isolated. Three granddaughters of the patient contracted the disease, and it is interesting to note that the vaccination took in all three cases, and so thoroughly mitigated the disease, that although they had contracted small-pox before the vaccination, the rash appeared in a very mild form and their illness was comparatively slight. The severity of the type of the disease was shown by the confluent rash of the first patient, and the fact that she died on the third day of the rash, and also from the fact that a child, aged 6, who had seen her unknown to us, also contracted confluent small-pox and died. This visit was kept from the Sanitary Authorities till too late, and the child was consequently not vaccinated. Both its mother 6 and father, however, were at once vaccinated and isolated, and though both contracted the disease they had it in a modified form. I think therefore this outbreak is worthy of mention as so plainly showing the enormous value of vaccination. There were 11 cases in all from this first case; but by vaccination and isolating, not only the patients themselves, but all those who had been in contact with them, the outbreak was arrested, and no fresh cases appeared. Small-pox has never disappeared in London, and is again at the present time increasing. Last year I wrote to all the medical men in this District asking them to urge their patients, who had not been vaccinated for some years, to be revaccinated at once, and I cannot too strongly urge every one who can, to use their influence in persuading all persons to be revaccinated who have not been vaccinated for the last seven years. Diseases of the Respiratory Organs. There was an increase of 4 in the number of deaths from Phthisis from the previous year. The total number of deaths from diseases of the respiratory organs was 335, or 10 less than last year. Of this number 58 deaths were attributed directly to Influenza, as compared with 74 in the previous year. Inquests. Coroner's inquests were held in 81 cases of death under peculiar circumstances The causes of death were returned as follows:— Natural causes 35 Violent deaths 46 Of these latter 37 were accidental, 8 suicidal, and 1 homicidal. Twenty-five deaths were registered as "Not Certified." Marriages. During the year 1893 there were 521 Marriages in the 7 Parish of Lewisham, of which 370 were solemnised in the various Churches, 52 in Dissenting Chapels, and 99 at the Registrar's Office. During the same period there were 130 marriages in the Hamlet of Penge, of which 104 were solemnised in Churches, 10 in Dissenting Chapels, and 5 at the Registrar's Office. Total 651, as compared with 597 in 1892. The marriage rate was equal to 13.4 persons married per 1,000 of estimated population. In London the proportion of persons married to the total population was 17 2 per 1,000. Meteorology. The mean temperature of the air at Greenwich in 1893 was 51.1. The highest reading by day, 95.1, was registered in August, and the lowest reading by night, 13.9, in January. Rain fell on 154 days. The total amount of rainfall was 20.13 inches. I am, Gentlemen, Faithfully yours, S. BLAKE JOLLY, Medical Officer of Health to the Lewisham District. 8 TABLE I.—Shewing the Population, Inhabited Houses, Marriages, Births, and Deaths, for the Year 1893 and 10 years preceding. (gross numbers). The Year.* Estimated Population. No. of Inhabited Houses. Marriages. Registered Births. Corrected No. of Deaths. Deaths in Public Institutions. Total All Ages. Under One Year. Under Five Years 1893 97160 16468 651 2469 1468 308 459 232 1892 94210 15968 597 2436 1476 345 502 240 1891 92647 15643 581 2521 1355 ... ... ... 1890 90564 15094 576 2259 1320 ... ... ... 1889 90812 14503 538 2319 1126 ... ... ... 1888 88845 14188 510 2287 1226 ... ... ... 1887 86423 13800 566 2354 1191 ... ... ... 1886 85300 13613 473 2324 1150 ... ... ... 1885 82000 13090 531 2451 1128 ... ... ... 1884 79730 12716 503 2316 1110 ... ... ... 1883 77572 12361 504 2340 1052 ... ... ... Average of 10 years, 1883—1892 86810 13997 587 2360 1213 ... ... ... NOTES. 1. Population according to Census, 1891,92,647. 2. Average No. of Persons in each House at Census 1891, 5.9. 3. Area of District in acres, 6544. *For statistical purposes the Registrar-General estimates the population to the middle of the year on the basis of the rate of increase ruling between the two preceding Census periods. The estimate of population may be checked by the known number of inhabited houses, and by the average number of inmates per house, as ascertained at the preceding Census. 9 TABLE 11.—Showing the Annual Birth and Death Rates, Death Rates of Children, and Proportion of Deaths in Public Institutions in a Thousand Deaths for the Year 1893 and 10 years preceding. ]In the Year Birth Rate per 1000 of the Population. Corrected Death Rate per 1000 of the Population. Deaths of Children under 1 year; per 1000 of Registered Births. Deaths of Children under 1 year; per 1000 of Total Deaths. Deaths of Children under 5 years: per 1000 of Total Deaths. Deaths in Public Institutions; per 1000 of Total Deaths. 1893 25.4 15.10 124.7 209.8 312.6 158.0 1892 25.8 15.6O 140.0 245.0 351.4 162.6 1891 27.2 14.62 117.4 218.0 332.1 121.7 1890 24.9 13.97 139.8 239.3 364.3 109.8 1889 25.5 12.39 126.7 261.1 370.3 123.4 1888 25.6 13.43 126.6 240.6 385.8 92.1 1887 27.2 13.66 121.0 240.1 381.2 115.0 1886 27.2 13.36 124.3 251.3 363.4 87.8 1885 29.8 13.75 120.3 261.5 390.9 89.9 1884 29.0 13.92 125.2 261.2 409.0 64.8 1883 301 13.56 131.2 291.8 398.3 87.9 Average of 10 years, 1883—1892 27.2 13.82 127.2 250.9 374.6 105.5 10 TABLE III. Deaths registered from all causes during the year 1893. Note.—The Deaths of Non-residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District, are included. AGES. Totals. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & upwards. I. Specific Febrile, or Zymotic Diseases 53 54 30 6 8 7 9 4 3 2 ... 176 II. Parasitic Diseases 3 ••• ... ... ... ... ... ... ... ... ... 3 III. Dietic Diseases 1 ... ... 1 1 1 2 1 ... ... 7 IV. Constitutional Disease 28 26 15 26 33 37 43 42 31 9 ... 290 V. Developmental Diseases 59 ... ... ... ... ... ... ... 15 43 19 136 YI. Local Diseases 100 67 36 23 51 55 65 119 129 95 12 752 VII. Deaths from Violence 13 3 6 1 4 5 5 3 2 ... ... 42 VIII. Deaths from Ill-defined and Not Specified Causes 51 1 ... ... 2 2 2 3 1 ... ... 62 Totals 308 151 87 56 99 107 125 173 182 149 31 1468 I. Specific Febrile, or Zymotic Diseases. 1.—Miasmatic Diseases. Small pox Vaccinated ... ... ... ... ... 1 1 ... ... ... ... 2 Unvaccinated ... 1 ... ... ... ... 1 1 ... ... ... 3 No Statement ... ... ... ... ... ... ... ... ... ... ... 0 Measles 7 12 ... ... ... ... ... ... ... ... ... 19 Scarlet Fever ... 3 6 2 1 ... ... ... ... ... ... 12 Typhus ... ... ... ... ... ... ... ... ... ... ... 0 11 Whooping Cough 4 6 ... ... ... ... ... ... ... ... ... 10 Diphtheria 3 20 21 ... 2 ... ... ... ... ... ... 53 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 1 1 ... 1 ... 4 ... ... ... ... 10 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... 2—Diarrheal Diseases. Simple Cholera ... ... .,. ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 34 3 1 1 ... ... 1 1 1 42 3. -Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia,Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... 5.— Venereal Diseases. Syphilis 3 1 ... ... ... 1 ... ... ... ... ... 5 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... 6.—Septic Diseases. Erysipelas 2 ... ... ... ... ... 3 2 2 1 ... 10 Pyaemia, Septicaemia ... 1 1 ... ... 1 ... ... ... ... ... 3 Puerperal Fever ... ... 2 3 2 ... ... ... ... ... 7 Totals 53 54 30 6 8 7 9 4 3 2 ... 176 12 TABLE III. (Continued.) Deaths registered from all causes during the year 1893. AGES. Total. 0 to 1 1 to 6 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & upwards. II. Parasitic Diseases. Thrush, and other Vegetable Parasitic Diseases 3 ... ... ... ... ... ... ... ... ... ... 3 Worms, Hydatids, and other Animal Para- sitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Totals 3 ... ... ... ... ... ... ... ... ... | ... 3 III. Dietic Diseases. Want of Breast Milk, Starvation 1 ... ... ... ... ... ... ... ... ... ... 1 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 1 1 ... 1 1 ... ... 4 Delirium Tremens ... ... ... ... 1 ... 1 1 ... ... ... 2 Totals 3 ... ... ... 2 1 1 2 1 ... ... 7 IV. Constitutional Diseases. Rheumatic Fever, Rheumatism of the Heart ... 2 3 2 2 2 1 ... ... ... ... 12 Rheumatism ... ... ... ... ... ... 2 1 1 ... ... 4 13 Gout ... . . . ... ... ... ... 1 1 ... ... ... 2 Rickets ... 3 ... ... ... ... ... ... ... ... ... 3 Cancer, Malignant Disease ... ... 1 1 3 5 21 22 26 8 ... 87 Tabes Mesenterica 18 2 2 ... ... ... ... ... ... ... ... 22 Tubercular Meningitis, Hydrocephalus 3 14 1 1 ... ... ... ... ... ... ... 19 Phthisis 1 1 3 20 25 26 11 13 2 ... ... 102 Other forms of Tuberculosis, Scrofula 5 4 4 2 2 2 1 1 ... ... ... 21 Purpura, Haemorrhagic Diathesis ... ... ... ... ... ... 1 ... ... ... ... 2 Anaemia, Chlorosis, Leucocythaemia 1 ... 1 ... 1 ... 1 ... 1 •.. ... 5 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... 4 4 1 ... ... 11 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... Totals 28 26 15 26 33 37 43 42 31 9 ... 290 V. Developmental Diseases. Premature Birth 45 ... ... ... ... ... ... ... ... ... ... 45 Atelectasis 9 ... ... ... ... ... ... ... ... ... 9 Congenital Malformations 5 ... ... ... ... ... ... ... ... ... ... 5 Old Age ... ... ... ... ... ... ... ... 15 43 19 77 Totals 59 ... ... ... ... ... ... ... 15 43 19 136 VI. Local Diseases. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 6 3 4 1 1 ... ... ... ... ... ... 15 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 1 ... 1 ... 5 5 9 15 28 19 1 84 14 TABLE III. (CONTINUED) Deaths registered from all causes during the year 1893. AGES. Total. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & uPwards. Insanity, General Paralysis of tlie Insane ... ... ... ... 1 ... 5 2 4 1 ... 13 Epilepsy ... ... ... ... 2 2 1 ... 2 ... ... 7 Convulsions 23 6 . . . ... ... ... ... ... ... • •• ... 29 Laryngismus Stridulus (Spasm of Glottis) 1 ... ... ... ... ... ... ... ... ... ... 1 Diseases of Spinal Cord, Paraplegia, Paralysis Agitans 1 ... 1 2 1 ... 1 3 3 3 ... 15 Other Diseases of the Nervous System ... ... 1 ... 1 ... 1 ... 1 ... ... 4 Total 32 9 7 3 11 7 17 20 38 23 l 168 2.— Diseases of Organs of Special Sense, (e.q., of Ear, Eye, Nose ... ... ... ... ... ... ... ... ... ... ... ... 3.—Diseases of Circulatory System. Pericarditis ... ... 1 1 1 ... ... ••• . . . . . . ... 2 Acute Endocarditis ... ... ... 1 2 ... ... ... ... ... ... 2 "Valvular Disease of the Heart ... ... 2 4 1 6 c 8 14 9 ... 51 Other Diseases of Heart ... ... 1 ... ... ... fi 9 13 13 44 Aninrism ... ... ... ... 1 1 1 ... ... 9, ... 4 Embolism, Thrombosis ... ... ... ... ... ... ... 1 ... ... ... 2 Other Diseases of Blood Vessels ... ... ... ... ... ... 1 1 2 1 l 6 Total ... ... 4 6 5 7 14 19 29 25 2 111 15 4.—Diseases of Respiratory System. Laryngitis ... 2 3 ... ... ... 1 ... ... ... ... 6 Croup ... 3 1 ... ... ... ... ... ... ... ... 4 Emphysem, Asthma ... ... ... ... 1 1 ... 3 1 ... ... 6 Bronchitis 29 26 2 1 ... 2 6 22 23 29 7 147 Pneumonia 15 11 4 4 13 9 11 16 11 4 ... 98 Pleurisy ... ... 1 ... 2 ... ... ... 1 ... ... 4 Influenza 4 4 8 3 6 6 4 10 4 10 2 56 Other Diseases of Respiratory System 2 ... ... ... ... ... ... ... 2 1 ... 5 50 46 14 8 22 18 22 51 42 44 9 326 5.— Diseases of Digestive System— Dentition 7 5 ... ... ... ... ... ... ... ... ... 12 Sore Throat, Quinsy ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Stomach ... 1 ... ... ... . . . 1 2 1 1 ... 6 Enteritis 8 3 1 ... ... ... ... ... 1 ... ... 13 Obstructive Diseases of Intestine 1 ... ... 1 ... 4 1 3 1 ... ... 11 Peritonitis ... ... 4 2 2 4 ... ... ... ... ... 12 Ascites ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... 1 1 5 4 1 ... 14 Jaundice and other Diseases of Liver ... ... ... ... 2 2 2 4 4 ... ... 14 Other Diseases of Digestive System ... 1 1 ... ... ... ... 1 2 ... ... 5 16 10 6 3 6 11 5 15 13 2 ... 87 6.— Diseases of Lymphatic System. (eg. of Lymphatics and of Spleen) ... ... 2 ... ... 1 ... ... ... ... ... 3 16 TABLE III. (Continued.) Deaths registered from all causes during the year 1893. ages. Total. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 ie upwards. 7.—Diseases of Gland-like Organs of Uncertain Use. • (e.g., Bronchocele, Addison's Disease) ... ... ... 1 ... 1 ... ... ... ... ... 2 8.— Diseases of Urinary System. Nephritis ... 1 2 2 ... ... ... 3 ... ... ... 8 Bright's Disease, Albuminuria ... ... ... ... 2 7 3 6 2 ... 20 Disease of Bladder or of Prostate ... ... 1 ... ... ... ... 1 4 1 ... 7 Other Diseases of the Urinary System ... 1 ... ... ... ... 1 1 1 ... ... 4 ... 2 8 2 2 7 4 11 7 1 ... 39 9.—Diseases of Reproductive Si/stein. a. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... 2 2 ... ... ... 4 B. Of Parturition. Abortion, Miscarriage ... ... ... ... ... 1 ... ... ... ... ... 1 Puerperal Convulsions ... ... ... ... 1 . . . ... ... ... ... ... 1 Placenta praevia, Flooding ... ... ••• ... ... 1 ... ... ... ... ... 1 Other Accidents of Child Birth ... ... ... ... 2 1 ... ... ... ... ... 8 ... ... ... ... 8 3 2 2 ... ... ... 10 17 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... 2 ... ... ... ... ... ... 2 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Integumentary System 2 ... ... ... ... ... 1 1 ... ... ... 4 100 67 36 23 51 55 65 119 129 95 12 752 VII. Deaths from Violence. 1.—Accident or Negligence. Fracture and Contusions 1 ... 2 1 3 1 2 ... 1 ... ... 14 Gunshot and Contusions ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 2 2 ... 1 1 ... ... ... ... ... 6 Poison ... ... ... ... ... ... ... ... ... ... ... ... Drowning ... 1 ... ... ... ... ... 1 ... ... ... 2 Suffocation 9 ... ... ... ... ... ... ... ... ... ... 9 Otherwise 2 ... 2 ... ... ... ... 1 ... ... ... 5 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... Murder 1 ... ... ... ... ... ... ... ... ... ... l 3.—Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... 1 ... ... 1 Cut, Stab ... ... ... ... ... ... 1 ... ... ... ... l Poison ... ... ... ... ... 1 ... ... ... ... ... l TABLE III. (Continued.) Deaths registered from all causes during the year 1893. AGES. Total. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & upwards. Drowning ... ... ... ... ... 2 1 1 ... ... ... 4 Hanging ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... ... ... 1 ... ... ... ... 1 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... 13 3 6 1 4 5 5 3 2 ... ... 42 VIII. Deaths from Ill-defined and not Specified Causes. . Dropsy ... ... ... ... ... ... ... 1 ... ... ... 1 Debility, Atrophy, Inanition 46 1 ... ... ... ... ... ... ... ... ... 47 Mortification .. ... ... ... . . . ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... 1 ... 1 ... ... 2 Abscess 1 ... ... ... 1 ... ... ... ... ... ... 2 Hæmorrage ... ... ... ... ... 1 ... ... ... ... ... 1 Sudden Death (cause not ascertained) 1 ... ... ... ... ... 1 1 ... ... ... 3 Causes not Specified or Ill-defined 3 ... ... ... 1 1 ... 1 ... ... ... 6 51 1 ... ... 2 2 2 3 1 ... ... 62 18 19 Note—The Deaths of non-residents occurring in Public Institutions situated in the District are excluded, and the Deaths of residents occurring in Public Institutions situated beyond the limits of the District are included. SUMMARY OF TABLE III. No. of Deaths. I.—Specific Febrile, or Zymotic Diseases— 1. Miasmatic Diseases 109 2. Diarrhœal „ 42 3. Malarial „ - 4. Zoogenous „ - 5. Venereal „ 5 6. Septic „ 20 II.—Parasitic Disease 3 III.—Dietic Disease 7 IV.—Constitutional Diseases 290 V.—Developmental Diseases 136 VI.—Local Diseases— 1. Diseases of Nervous System 168 2. Diseases of Organs of Special Sense — 3. Diseases of Circulatory System 111 4. Diseases of Respiratory System 326 5. Diseases of Digestive System 87 6. Diseases of Lymphatic System 3 7. Diseases of Gland-like Organs of Uncertain Use 2 8. Diseases of Urinary System 39 9. Diseases of Reproductive System— (a) Diseases of Organs of Generation 4 (b) Diseases of Parturition 6 10 10. Diseases of Bones and Joints 2 11. Diseases of Integumentary System 4 VII.—Violence— 1. Accident or Negligence 33 2. Homicide 1 3. Suicide 8 4. Execution - VIII.—Ill-defined and not Specified Causes 62 Total 1468 NOTICE. 1. Includes Smallpox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid), and Simple Continued Fevers, and Diarrhoea, 23 of the deaths occurred in Hospitals situated beyond the limits of the District. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, want of Breast Milk, and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. TABLE IV. Showing the Number of Deaths at all ages in 1893, from certain groups of Diseases, and proportions to 1000 of Population, and to 1000 Deaths from all causes; also the Number of Deaths of Infants under one gear of age from other groups of Diseases, and proportions to 1000 Births and to 1000 Deaths from all causes under one year. Division I. (Adults). Total Deaths. Deaths per 1000 of Population, at all ages. Deaths per 1000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 151 1.55 102.8 2. Pulmonary Diseases 326 3.35 222.0 3. Principal Tubercular Diseases 148 1.52 100.8 Division II. (Infants under One Year). Total Deaths. Deaths per 1000 of Births. Deaths per 1000 of Total Deaths under 1 Year. 4. Wasting Diseases 92 37.2 298.7 5. Convulsive Diseases 36 14.6 116.8 20 21 TABLE V. Showing the number of Deaths from the seven principal Zymotic Diseases in the 10 years, 1883 to 1893, and in the Year 1893. Disease. 1883. 1884. 1885. 1886. 1887. 1888. 1889. 1890. 1891. 1892. Annual Average of 10 yours, 1883—1892. Proportion of Deaths to 1000 Deaths in 10 years, 1883—1892. 1893. Proportion of Deaths to 1000 Deaths in 1893. Smallpox 0 1 5 0 0 0 0 0 0 0 0.6 0.5 5 3.4 Measles 24 41 38 5 40 18 21 34 30 15 23 .0 18.8 19 12.9 Scarlet Fever 18 8 0 4 6 7 9 4 3 4 6.3 5.1 12 8.8 Diphtheria 16 12 13 25 10 37 5 11 10 17 15.6 12.9 53 36.1 Whooping Cough 24 52 39 32 28 76 23 53 29 67 41.8 34 .4 10 6.8 Fever- Typhus ....... ...... ...... ..... ...... ...... ...... ...... ...... ....... ..... ..... ...... ...... Enteric 10 12 16 6 6 11 6 5 2 4 7.8 6.4 10 6 .8 Simple continued ..... ...... ..... ..... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Diarrhœa 26 31 37 60 31 25 34 29 24 40 33.7 27.7 42 28.6 Totals 118 157 148 132 116 174 98 136 98 147 132. 4 254.5 151 102.8 Totals—London 10905 13982 11861 11212 12720 10896 9785 12090 9675 11983 11410 138.4 12851 140.5 Totals—England and Wales 58972 71762 57726 62859 64686 50684 61027 59698 53221 56032 59666 110.8 73496 128.0 22 TABLE VI.—Inspectors' Reports of the Sanitary Work completed in the year 1893. Total. Penge. Sydenham and Foreat-hill Blackheath and Lewisham Sanitary Districts.      411 25C 105 56 Number of Complaints received during the year. 2474 1021 720 733 Number of Houses, Premises, &c., inspected. 2624 660 994 970 No. of Re-inspections of Houses, Premises, &c. 1080 65 458 557 Orders issued for Sanitary Amendments of Houses, Premises &c. Results of Inspection. 673 112 360 201 Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. 921 62 478 381 Houses Disinfected after illness of an Infectious character. 902 408 359 135 Repaired, Cleansed, Trapped, &c. House Drains. 618 203 354 61 Ventilated. 444 60 142 212 Repaired, &c. Privies and Waterclosets. 250 83 149 18 Supplied with Water 99 83 5 11 New provided. 168 36 75 57 New provided. Dust Bins. 118 13 38 67 Repaired, Covered, &c. 27 11 16 Cioterns (new) erected. Water Supply. 273 15 166 92 Cisterns Cleansed, Repaired, and Covered. 411 89 258 64 Waste Pipes connected with Drains, &c., abolished. ... ... ... ... No. of Lodging Houses registered under 35th sec. of the "Sanitary Act, 1866," or 90th of " Public Health Act, 1875." Miscellaneous. 232 5 135 92 Dust Removal—No. of Communications received and attended to. 46 8 23 15 Removal of accumulations of Dung, Stagnant Water, Animal and other Refuse. 29 3 9 17 Animals Removed, being improperly kept. 80 21 37 22 Bakehouses. Regularly Inspected. 31 5 11 15 Licensed Cowsheds. 21 3 8 9 Licensed Slaughter-houses. 24 ... 13 11 Legal proceedings: i.e., Summonses. 23 TABLE VII. The number of Inhabited Houses, the Estimated Population, 1893, with the Birth and Death Rale in the different Registrars' Sub-districts in Lewisham Parish and the Hamlet of Penge, together comprising "The Lewisham District." Registrars' Sub-districts. Number of Inhabited Houses, Midsummer, 1893. Estimated Population. Number of Births, 1893. Birth Rate per 1000. Number of Deaths 1893. Death Rate per 1000. Blackheath, the part of Lewisham Parish in the Sub-district of Lee 1174 6925 129 18.6 79 11.40 Lewisham, the part of Lewisham Parish in the Sub-district of Lewisham Village 5804 36028 968 26.8 553 16.10 Sydenham Chapelry 6106 34212 930 27.1 539 14.97 Parish of Lewisham 13084 77195 2027 26.2 1171 15.16 Hamlet of Penge 3384 19965 442 22.1 297 14.87 The Lewisham District 16468 97160 2469 25.4 1468 15.10 TABLE VIII. Register of Licensed Cow-houses. LEWISHAM. Name Address. Allen, W. J. Bellingham Farm, Southend. Attwater, J. Loampit Hill (Angel Public House.) Cawston, Saml Bromley Hill. Clarke, S Court Hill Road. Covell, E Beckenham Place. Covell, E, White House Farm, Southend. Ive, S. George Lane. Slagrove Farm, Ladywell. Kirby, James Rushey Green. Phillips and Dutton. Bridge House Farm, Ladywell. Phillips and Dutton Holloway Farm, Southend. Ridewood, William Shroffields Farm, Hither Green. Umfreville, W Joy Farm, Brockley. Umfreville, W Court Hill Road. Williamson, W Court Hill Road. SYDENHAM. Alliance Dairy Company 195, Stanstead Road. Blundell, Henry Wells Road. Blundell, Thomas Russell Street. Duffin, James (Executors) Dartmouth Road. Morgan, T. D. Lower Sydenham. Nevill, Mrs. M. A. S Dalmain Road. Roberts, Alfred George Wells Road. Stimpson, William High Street. Tick, W. E Porthcawe Road. Webb, Henry Kent House Terrace. PENGE. Apps,W Hartfield Grove. Clarke,T Challin Street. Norman,M.A Maple Road. Ironside,Ed Madeline Road. Rogers,Geo Oakfield Road. 24 25 TABLE VIII.—Continued. List of Milksellers who hare no Cowhouse Licenses, and of the Dairies, Milkstores, and Milkshops in the Lewisham District. LEWISHAM. Name. Address. Ade,Mary 1, Railway Terrace. Aldridge, Charles 19, Rushey Green, Catford. 3, The Parade, Perry Vale. Alliance Dairy Company Woodcote Terrace, Stanstead Road. Barrett, Matthew 1, Ely Place, Sydenham Road. Belgravia Dairy Company Station Parade, Sydenham. Bennett, Arthur Wells Road, Sydenham. Blundell, Thomas Russell Street, Sydenham. Brann,John 3, Grote's Place, Blackheath. Cansdale, — London Road. Convell,E. 16, Royal Parade. Delahoy, Michael 61/2, Wastdale Road. | Bank Buildings, Sydenham. Express Dairy Co 22, Montpelier Vale, Blackheath. 1 196, High Street, Lewisham. Finch,Thomas 138, Rushey Green, Catford. Ford, Robert 13, Springfield Park Crescent, Catford. Friern Manor Dairy Company 86, Loampit Vale. Greenhill, Sydney 141, High Street. Harnett, — Sydenham Road. Harris, Robert 146, Loampit Hill. Harris,Wm 15, Porson Street. Hillman, George 4, Alfred Terrace, Lower Sydenham. Homersham, Charles 198, Lewisham Road. Leppard, Frederick 1a, Holly Tree Terrace. Martin, Albert 6, Devonshire Road. Martin,Luther Ewart Road, Forest Hill. Milton, Edward 116, Rushey Green, Catford. Noakes,Bros 20, Rushey Green. Parks, F. J 51, Lewisham Road. Ridgewell, Albert G 5, Royal Terrace, Bell Green. Ringwell ,A.G 83, Catford Hill. Robinson, R Berlin Road. Smith, Arthur 2, Loampit Vale. Stevens, Charles 122, High Street. Steer, Henry 61, Stanstead Road. Sullivan, Charles 43, Lethbridge Road. Thorn,Isaas 6, Beadnell Road. Tick, W. E Bell Green. Vingo, Richard 20, High Street, Lewisham. Wade, Samuel 10, Wastdale Road. Waters, James Charles 268, Brockley Road. Waters, James Charles 226, Brockley Road. 26 TABLE VIII.— Continued. Milksellers and Milkstores— Continued. PENGE. Name. Address. Apps, Wm 66, Hawthorne Grove Belgravia Dairy Co 124, Anerley Road. Bird, Wm 76, Woodbine Grove. Bloomfield,Mr 173, Beckenham Road Clarke, Thos Challin Street, Crampton, Thos Hawthorne Grove. Denning, Frank 76, Anerley Road. Emes, Bros 80, Oakfield Road. Green, Geo 2, Crampton Road. Hampden, Viscount 2, Belvedere Road. Hook, M 14, Clarina Road. Howell, Jas 55, Maple Road. Huggins,Wm.A 39, Baeckenham Road. Ironside, Ed Madeline Road. Kellam, Fredk 102, Woodbine Grove. Morris, Thomas 20, Evelina Road. Norman, M. A 131, Maple Road. Ridewood, William 111, Beckenham Road. Rogers, Geo 18, Oakfield Road. Wilds, J. 52, Station Road. Wilds, J. 9, Ridsdale Road Wilds, J. 123, Anerley Road. Table of DEATHS during the year 1893, in the Sanitary District of Lewisham, classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causes, at subjoned Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Tears of Age. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 60. 60 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Typhus Enteric or Typhoid Continued Relapsing Puerperal Lewisham 430 105 49 25 23 136 92 Under 5 1 2 5 ... ... 1 ... .. ... 2 7 5 10 1 ... ... 25 ... 6 89 154 5 upwds. 1 3 6 ... ... 4 ... ... 2 ... 3 ... ... 2 3 ... 30 49 18 6 149 276 Do. Workhouse 123 8 2 3 3 60 47 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 9 10 5 upwds. ... ... ... ... ••• ... ... ... ... 4 ... ... ... 2 ... 11 27 6 8 55 113 Penge 290 58 20 10 7 112 83 Under 5 ... ... 1 ... ... •. . .. ... ... ... ... ... ... 7 ... ... ... 15 ... 2 53 78 5 upwds. ... 1 ... ... 1 ... ... 2 ... 1 ... ... ... 3 ... 26 41 21 5 111 212 Lee 71 12 4 3 4 30 18 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... ... ... 1 ... 1 9 16 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 12 4 1 35 55 Under 5 1 22 1 12 I 5 1 1 40 ... 7 103 194 Sydenham 530 124 71 39 19 158 119 5 upwds. 3 5 17 ... ... 4 ... ... 3 ... ... ... ... 3 1 ... 27 40 36 5 192 336 St. John's Hospital 8 ... ... 2 ... 4 2 Under 5 ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... 2 ... ... ... 6 8 Under 5 . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... North Surrey District Schools. 4 ... ... 3 ... ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 4 Home for Sick Children 9 ... 3 5 1 ... ... Under 5 . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... •• ... 1 2 3 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... 1 ... 5 6 Waterman's Asylum 3 ... ... ... ... ... 3 Under 5 ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Totals 1468 307 149 90 57 400 365 Under 5 1 3 28 1 ... 1 ... ... ...✓ ... 2 19 10 23 2 ... 1 82 ... 17 265 1468 5 upwds. 4 9 24 ... ... 9 ... 7 8 5 9 ... 98 169 85 25 559 } The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the District among persons be- llonging thereto 82 5 12 10 5 37 13 Under 5 ... 2 8 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 4 17 5 upwds. 3 2 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... 5 3 7 5 34 65 Deaths occurring within the District among persons not belonging thereto 19 3 7 1 3 4 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 7 10 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 6 9 K2 3. Lewisham District Boards of Works. . K2 11. Lewisham District Board of Works 3(B) Table of POPULATION, and of NEW CASES of INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health during the year 1893, in the Sanitary District of Lewisham, classified according to Diseases and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Aged unde0r 5 or over 5. New Casks of Sickness in each Locality, coming to the knowledge or The Medical Officer of Health. Number of such Cases Removed from their Humes in the several Localities for Treatment in Isolation Hospital. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 18 ' Smallpox. J Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus Enteric or Typhoid 1 Continued | Relapsing j Puerperal Typhus. Enteric or Typhoid Continued Relapsing Puerperal Under 5 ... 55 5 1 ... 1 ... ... ... ... 2 ... ... ... 15 ... ... ... ... ... ... ... ... ... ... ... Lewisham 5 upwds. 6 87 29 2 ... 15 ... ... ... ... 68 ... ... 3 53 ... ... ... 3 ... ... ... ... ... ... ... Under 5 •.. • • • ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... Lewisham Workhouse 5 upwds. 5 ... ... ... ... ... ... ... ... ... 36 ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... 8 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Penge 5 upwds. 2 43 17 17 3 12 ... .... ... ... ... ... ... ... ... Under 5 ... 1 1 ... ... ... ... ... ... ... ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... Blackheath 5 upwds. 1 8 4 ... ... 1 ... ... ... ... S ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... Under 5 ... 73 42 ... ... ... ... ... ... ... 8 ... ... ... 12 8 ... ... ... ... ... ... ... ... ... ... Sydenham 5 upwds. 14 246 119 ... ... 22 ... ... ... ... 67 ... ... 8 61 28 ... ... 3 ... ... ... ... ... ... ... % Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. John's Hospital 5 upwds. ... ... 1 ... ... 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Under 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... 1 ... ... ... ... ... ... ... North Surrey District Schools 5 upwds. ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... .... .... .... ... ... Home for Sick Children 5 npwds. ... 1 ... ... ... 2 ... .... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... .. ... Totals Under 5 ... 138 49 3 ... 2 ... ... ... ... 13 ... ... ... 27 8 ... .... 1 ... ... ... ... ... ... ... 5 upwds. 28 386 170 2 ... 61 ... ... 12 ... 187 ... ... 16 115 29 ... ... 6 ... ... ... ... ... ... ...      27 TABLE IX. Register of Licensed Slaughter-houses. LEWISHAM. Name. Address. Y,G. High Street. Hon, John. High Street dstone, F. Rushey Green. ons, Wm. Blackheath. ell, William Rennell Street. lers, Mrs Loampit Hill or, W Rushey Green ker, G Blackheath. g, H. King Street SYDENHAM. k, Frederick Havelock Mews. 3, William Kirkdale. finch,H Sydenham Road on, James High Street enden, Henry High Street. es, Chas Wastdale Road kins, Edmund J. High Street. kins, Herbert . Dean Terrace. PENGE. w m Woodbine Grove. w m Maple-road den, Geo Beckenham Road.