SOU 22 Vestry of St. george the mertyr SOUTHWARK. annual report FOR 1894, of the MEDICAL OFFICER OF HEALTH, F. J. WALDO, M.A., M.D. (Cantab.) diplomate in public health of the royal colleges op physicians and surgeons (england); member of the royal college of surgeons (england); fellow of the society of medical officers of health; medical officer of health of the honourable societies of the inner and middle temples. tutor in public health to st. bartholomew's hospital medical school. PRINTED BY ORDER OF THE VESTRY. VESTRY HALL, BOROU3H ROAD, SOUTHWARK 1895 SOU 22 Vestry of St. George the Mertyr, SOUTHWARK. aNNUal report FOR 1894, . of the MEDICAL OFFICER OF HEALTH, F. J. WALDO, M.A., M.D. (Cantab.) diplomate in public health of the royal colleges of physicians and surgeons (england); member of the royal college of surgeons (england); fellow of the society of medical officers of health; medical officer of health of the honourable societies of the inner and middle temples. tutor in public health to st. bartholomew's hospital medical school. PRINTED BY ORDER OF THE VESTRY. VESTRY HALL, BOROUGH ROAD, SOUTHWARK. 1895. T. Cornell, Printer to the Vestry, 66, St. George's Road, Southwark, S.E. . SOU 22 ANNUAL REPORT on THE SANITARY CONDITION of the Parish of St. iBeorge the Sflartyr, Southward FOR THE YEAR 1894, by the MEDICAL OFFICEK OF HEALTH. To the Vestry of the Parish of St. George the Martyr. SECTION I— STATISTICAL. Ladies and Gentlemen, The Third Annual Report, which, as your Medical Officer of Health, I now, have the honour to submit to you, treats of the sanitary condition and environment, for the year 1894, of the most densely populated district in London, and, indeed for that matter, iri the United Kingdom. The following summary of facts will be found useful in approaching the various matters contained in this report. Area.—St. George's, Southwark, covers 2841/3 acres. The roads and streets as returned to the end of 1894, measure 19 miles, 5 furlongs, 14 poles. 4 Parish of St. George the Martyr, Southicark. Boundaries.—The parish, in shape somewhat like a hatchet, is surrounded by no less than six other Sanitary Districts. It is bounded on the north by St. Saviour and St. Olave, on the west by Lambeth, on the South by Newington and Camberwell, and on the east by Bermondsey. Geological Formation —The sub-soil of Southwark consists of porous "made" earth, sand, and gravel, of a depth of fifteen to twenty-five feet, overlying the London Clay. Saline Springs rise at times to the surface, and in certain excavated parts of the parish—e.g., Theatre and Music Hall, necessitate the constant use of pumps. Elevation.—The district is low-lying and flat, and is situate at an average of half a foot below the Trinity high water mark of the Thames, as against a mean elevation for London of 47.5 feet above the same mark. Houses.—At the Census of 1891, there were 6,946 inhabited houses, 732 uninhabited, and 44 buildings, containing an average of 8.5 persons to a house. According to the 1881 Census, the inhabited houses numbered 6,761—-i.e., 185 less than in 1891. The decrease in the number of inhabited houses in the London Road Sub-district may be traced to two chief causes—first, the exodus of population which is going on steadily from all the central metropolitan districts, and which is materially aided by the increasing facilities for cheap transit; secondly, the demolition and closing of many insanitary houses. Table I. Sub-District. Area in Acres. houses. Inhabited, Uninhabited, Building, 1881. Inhabited, Uninhabited Building, 1891. Borough Road 64 1,880 108 4 1,986 294 12 London Road 117 2,243 118 1 1,963 128 18 Kent Road 103 2,638 120 11 2,997 310 14 Whole Parish 284 6,761 346 16 6,946 732 44 St. George's has a population density of 211 to the acre—that is to say, about four times that of London, and four hundred times that of the United Kingdom. Its number of tenements is almost exactly double that of its inhabited houses. Of the tenement occupiers, one-third live in two rooms, and another third in a single room. In other words, about 1 in every 14 of your population is born, grows up, drinks, eats, sleeps, and often dies within the four walls of a one-roomed tenement. Population.—The number of inhabitants of the whole parish and of each subdistrict has not increased in the same proportion as in the rest of London. This fact was fully dealt with in my report of 1893. Births and Birth-Rate. Table II. gives the births and birth-rate per 1000 per annum for the years 1893 and 1894 in each sub-district of the parish, in London, and in the 33 large English towns. 5 Annual Report of the Medical Officer of Health—1894. Table II. Number of Births. Birth-rate per 1,000. 1893. 1894. 1893. 1894. Borough Road 604 629 36.1 37.3 London Road 689 804 32.4 37.6 Kent Road 828 638 37.6 28.5 Whole Parish 2,121 2,071 35.3 34.4 London 132,965 130,563 30.9 30.1 33 large English Towns 328,342 320,497 31.9 30.9 It will be seen that although the birth-rate is one lower than that of the preceding year, it is nevertheless considerably above that for the whole of London. The diminished rate of increase of population in the three sub-districts of the Parish of St. George's is, therefore, not attributable to a falling off in the number of persons born into the parish, but rather to a relatively high death-rate. A reference to the section on the mortality of infants and children will reveal the startling fact that more than one half of the total deaths in St. George's, Southwark, takes place under five years of age. The fact is notable that the birth-rate in St. George's is higher than in London and in the thirty-three large English towns. This may, I think, be explained by the fact that limitation of families is carried into effect by the better to do classes rather than by the poor. Deaths and Death-Rate for 1894. 1,398 deaths were registered in the parish during the fifty-two weeks ending December 31st, 1894, giving an average of 26 per week. Of this total 115 were deaths of non-parishioners in hospitals and asylums within the district; 152 of parishioners who died in outside public institutions and extra-metropolitan asylums. There were, therefore, 1,435 deaths among your parishioner*, equivalent to an average mortality of 23 9 per 1,030. The death-rate for all London in the same year was 17.7 per 1,000, which is in itself, according to many authorities 1. more per 1,000 than should occur from "the mortality incident to human nature." In St. George's, then, the "death-toll," as it has been aptly called, claims 6.32 persons out; of every 1,000 in excess of an already excessive rate. On the latter estimate there have been no less than 372 unnecessary deaths in St. George's, Southwark, during the year 1894. In the forty-three metropolitan sanitary areas the lowest death-rates were 9.8 in Stoke Newington, 10.6 in Hampstead, 12.4 in Wandsworth and in Lee, 12.5 in Plumstead, 138 in Lewisham (excluding Penge), and 14.5 in St. George's, Hanover Square; in the other districts the rates ranged upwards to 23.5 in St. Luke's, 23.9 in St. George's, Southwark, 24.7 in Limehouse, and 26.4 in St. George's in the Bast 6 Parish of St. Ocorne ti e Martyr, Southwark. The facts of your death-rate are briefly as follows:— Table III. Sub-District. No. of Deaths. Death-rate per 1,000. Deaths under 1 year to 1,000 Births. 1893. 1894. 1893. 1894. 1893. 1894. Borough Road 573 609 34.1 36.1 226 248 London Road 521 396 24.4 18.6 208 169 Kent Road 563 430 25.6 16.8 205 217 Whole Parish 1,657 1,435 27.6 23.9 213 211 London 91,536 77,051 21.3 17.7 157 143 33 Large Towns 222,178 189007 21.6 18.1 181 152 Prom the foregoing tables it is clear that the death-rate of St. George's, Southwark, is abnormally high. One is naturally led to enquire whether a further analysis of facts and figures will throw any fresh light upon this unenviable state of affairs. On comparing the average death-rate in the three sub-districts for the years 1892-3-If with that of 1894 we find :— Table IV. Death-rate per 1,000. 1892-3-4 1894 Borough Road 34.1 36.1 London Road 21.1 18.6 Kent Road 22.1 16.8 Hence we see that the heavy death-rate in the Borough Road Sub-district is still steadily increasing. In the other two sub-districts there is a considerable fall for 1894—namely, 5.8 in the London Road Sub-district and 8.8 in the Kent Road Subdistrict. It is a startling and suggestive fact that during the past year the mortality in the Borough Road has been in round numbers twice that of the London Road, and more than twice that of the Kent Road areas. The period over which these figures extend, three years, and the actual number of deaths, are both too small to allow of drawing any absolutely sound conclusions. Nevertheless, it may be noticed that— (1) The mortality of the Borough Road Sub-district 36.1 is 12.3 higher than that of Liverpool for the year, 1894. The latter place had the highest death-rate of the thirty-three large English towns. (2) That of the London Road Sub-district 18.6 is almost the same as that for the thirty-two large provincial towns, and only slightly higher than that of the whole of London. 7 Annual Report of the Medical Officer of Health—-1894. (3) That of the Kent Road Sub-district is nearly one below the figure for London, and only 3.6 higher than that of Croydon, the healthiest of the thirty-three great towns. This latter town showed a mortality of 13.2 per 1,000 in the year 1894. In looking over the returns of these three sub-districts one is struck by the fact that the general death-rate per 1000 in the Borough Road exceeds that of the Kent Road by 19.3 per 1000, and that of the London Road by 17.5 per 1000. This disproportion may, in my opinion, bo attributed to four causes, (1) Deaths in public institutions, which are unequally distributed among the various subdistricts; (2) Density of population, especially in the Borough Road Sub-district; (3) Poverty, which is conspicuous in each of the sub-districts, but most of all in the Borough Road; (4) Absence of open air spaces, of which there are none in the Borough Road. Wa will next proceed to discuss these points in detail. (1) Deaths in public institutions. The deaths which require notice under thie heading are those of parishioners of one sub-district who die in the hospitals of another sub-district. Correcting for those deaths of parishioners, drawn from the London Road and Kent Road Sub-districts—which took place in public institutions within the Borough Road Sub-district—the death-rate of the latter area still remains practically unchanged, the difference being merely fractional. (3) In my report for 1893 I showed that the south of London is the poorest part of the metropolis; that the central portion is worse off than other parts of that district; and that the particular sub-division which includes the Borough Road Subdistrict is the most poverty-stricken in the whole of London. (2 & 4) Further, the Borough Road, which has the highest death-rate of the three sub-districts, is conspicuous for its poverty, its density of population, and its absence of air spaces. Whereas, on the other hand, the London and the Kent Road Sub-districts, which have the lowest death-rate, are inhabited by a less-crowded and better-to-do class, and are better supplied with open-air spaces. The latter may be conveniently grouped under three headings:— (1) Public institutions occupying a large area. (2) Broad streets. (3) Areas, such as disused burial grounds, formally set apart as places of recreation. The death-rate of the 33 great towns of England and Wales, with a population of 34 4 personB to an acre, was 18.1 per 1,000, the lowest being:— TABLE V. Croydon 13.2 per 1000. Leicester 14.7 „ Derby 15.0 „ Portsmouth 15.2 „ Huddersfield 15.8 „ 8 Parish of St. George the Martyr, Southwark. The highest were:— Preston 20.8 per 1,000 Sunderland 20.8 „ Salford 21.0 Liverpool 23.8 ,, The death rate of Edinburgh was 17.4, that of Glasgow 19.7, and that of Dublin 24.8. The lowest rates in foreign and colonial cities were :— Brussels 14.3 per 1,000 The Hague 17.0 „ Berlin 17.7 „ Hamburg 18.0 ,, Copenhagen 18.7 ,, Stockholm 18.8 „ While the highest were:— Madras 37.9 „ Alexandria 40.6 ,, Bombay 44.3 „ Cairo 51.9 „ Although there is reason for alarm at the high and increasing death-rate of the Borough Road sub-district, yet one cannot help feeling a good deal of satisfaction with the figures for the whole parish during the past year. The annual death-rate for 1894 has dropped to 23.9 as against 27.6 in 1893. This fall of 3.7 brings the result within 6.2 of that of the whole of London. Moreover, if we take the recorded rate for the past 50 years we find that there has been a decrease from 30 in the decade 1841-50 to 23.9 in 1894. The last figures point to the encouraging fact that the death-rate of this parish touched the lowest point recorded for the last half century; in fact, since official returns of this kind have been systematically recorded. These results certainly appear, on the face of them,'to furnish proof of the value of sanitary progress to the community. At the same time it should be borne in mind that there is still room for large and permanent reduction in the death-rate of St. George the Martyr. Table VI. Years St. George, Southwark. London. Death-rate per 1,000. Death-rate per 1,000. 1841—50 inclusive 30 25 1851—60 „ 27 24 1861—70 „ 27 24 1871—80 „ 25.2 22.4 1881—90 „ 25.0 20.5 1892 25.2 20.3 1893 27.6 21.3 1894 23.9 17.7 Zymotic or Preventable Death Rate. It may be noted that the term "zymotic" applies to the following seven diseases : —Small-pox, measles, scarlet fever, diphtheria, whooping cough, "fever" (i.e., typhus, simple continued and typhoid), and diarrhoea. 9 Annual Report of the Medical Officer of Health—1894. I have called the above zymotic diseases "preventable," because I regard all communicable disease, broadly speaking, as coming under that heading. Diarrhoea is a symptom rather than a disease, and, although not usually communicated from one person to another, it may be regarded as the almost invariable result of bad environment. At the same time, it must be clearly understood that a vast amount of preventable disease, such as that due to alcoholism, is not zymotic in the ordinary sense of the term—that is to say, disease communicable from the sick to the healthy. The corrected death-rate in St. George's, Southwark, from the seven principal zymotic diseases was 4.0 per 1,000 in 1894, as against 2.6 per 1,000 in the whole of London for the same period, and 2.4 in the 33 great towns of England and Wales. As in the calculation of the general death-rate, so with the zymotic death-rate, the deaths of non-parishioners occurring within the district have been excluded, whilst on the other hand the deaths of parishioners in public institutions outside the parish have been included. Unless a proper distribution of these deaths be made, especially of those from zymotic diseases, no really trustworthy data can be secured upon which to calculate the rates of mortality. In the forty-three sanitary areas of the metropolis the zymotic death-rates ranged from 0.9 in Stoke Newington, 1.1 in the City of London, 1.4 in St. George's, Hanover Square, and in Hampstead, 1.7 in Lee, 1.8 in Wandsworth, and 1.9 in Lewisham, to 4.0 in St. George's, Southwark, 4.1 in Mile End Old Town, 4.3 in Limehouse, and 5.0 in St. George's in the East. Table VII.—For the Year 1894. Birth-rate per 1,000. Death-rate per 1,000. Zymotic death-rate. Influenza death-rate. Phthisis death-rate. Other Tubercular Diseases death-rate. Respiratory Diseases death-rate. Deaths under 1 year, to 1,000 births. Percentage of deaths under 5 to total deaths. St. George's, Southwark 34.4 23.9 4.0 0.9 1.7 1.5 6.8 211 53.2 London 30.1 17.7 2.6 – – – – 143 – Table VIII. Mortality in St. George's, Southwark, in 1894, from the Seven Principal Zymotic Diseases. Actual number of Deaths in St. George's, Southwark. St. George's, Southwark, proportion to total London deaths according to its population. Measles 100 44 Diarrhœa 72 24 Whooping Cough 64 28 Diphtheria 49 36 Scarlet Fever 15 13 Fever (chiefly Typhoid) 5 9 Small-pox 0 1 10 Parish of St. George the Martyr, Southwark. The mortality from measles, diarrhoea, whooping cough, and diphtheria, is thus seen from the foregoing table to be excessive in St. George's as compared with all London. Measles. The death-rate from measles is high, and, indeed, heads the table of mortality from zymotic diseases, both in St. George's, Southwark, and in the whole of London. In St. George's it has been more fatal than throughout London generally, in the proportion of 100 to 44. This waste of life, in my opinion, may be traced to the following causes :— (1) Measles, although highly infectious, is non-notifiable, and therefore outside the control of your Sanitary Authority. (2) It is generally looked upon as a mild disorder that wants little or no treatment, whereas it requires careful isolation and nursing, as it is liable to many grave accidents. (3) Bad environment: measles does little harm among the well-to-do, but among the poor it is estimated that twenty to thirty die out of every 100 attacked by the disease. The Notification of Measles. With regard to this important question, I think that the compulsory notification of cases of measles, with subsequent hospital treatment and disinfection, could not fail to result in a great saving of life. If compulsory notification be a fit and proper step in other zymotic disorders, such as scarlet fever or diphtheria, there is no reason, so far as one can see, why measles, which actually claims a greater number of victims, should not also be notifiable. During the year 1894 measles caused 100 deaths in vonr parish, whereas scarlet fever killed 15, diphtheria 49, typhoid 5, and small-pox 0. In London during the same period 3,291 deaths resulted from measles, as against 89 from small-pox. If measles were included under the list of notifiable diseases no doubt a large increase of hospital accommodation would be required, at any rate, for several years to come. Into that aspect of the case, however, it is not my duty to enter. As your medical officer I have only to point out that in measles we find an ever-increasing cause of avoidable death in this parish, and one which, in my opinion, would be materially reduced if dealt with in the same manner as most other infectious diseases. To some extent a precisely similar line of reasoning applies to whooping cough, which during the year 1894 was answerable for 64 deaths in St. George's, as against 2,094 in London. The affection is highly infectious, liable to lung complications, and is regarded by parents as a trifling disorder, requiring little or no treatment. The Salvation Army Shelter. This institution, as you are aware, was founded by Mr. Booth for the night shelter of poor persons. Although no doubt founded on philanthropic lines, a charge is made for accommodation, and there is no attempt to disguise the fact that enterprises of a similar kind are not only self-supporting, but are even carried on at a profit. Notwithstanding this commercial aspect of the case, in the Court of Appeal 11 Annual Report of the Medical Officer of Health—1894. Her Majesty's judges decided that these shelters did not fall within the regulations of the Common Lodging-House Acts. Another judicial decision showed that such institutions did not come under the Public Health (London) Act so far as disinfection was concerned. On that occasion Mr. .Justice Wills said that " the case was clearly one in which the Act ought to apply, but does not."* The need of an extension of the powers of your local authority in dealing with shelters of the kind may be judged from the following considerations:— (1) In 1893 thirty-one cases of small-pox were referred, directly or indirectly, to the Blackfriars Army Shelter. (2) The overcrowding, which is clearly shown in the following table:— TABLE IX. A comparison of the minimum cubic and superficial space allotted to each Adult in the Dormitories of various institutions. Cubic Space. Floor or Superficial Space. Cubic feet. Square feet. Blackfriars Penny Shelter 90 6 Common lodging houses in London 341 31 Workhouses 300 Military Barracks 600 Prison Cells 800 General Hospitals 1,200 100 As pointed out in my report for 1893, this list emphasises the utterly inadequate space allowance in the shelters, amounting to less than one-third of the minimum cubic space elsewhere, and little over one-thirteenth of the amount considered necessary in a good general hospital. Although the regulation of these philanthropic and semi-philanthropic—that is to say, free and paying—shelters has been widely discussed, there has been so far no practical outcome. The subject is presenting increasing difficulties to medical officers throughout the country, and sooner or later will have to be met by drastic action on the part of the Government. While everyone sympathises with the aims of the founders of such refuges for the poor and the needy, it is nevertheless extremely difficult to understand why they should insist on running counter to the local authorities, who must necessarily be the better judges as to what is or is not a danger to the public health. For my own part, as your responsible medical officer, so long ago as 1892 I felt it my duty to point out that the presence of a shelter in the midst of this crowded district constituted a real danger to the rest of the community—that is to say, in the absence of thorough and efficient control. One of the greatest evils that can affect a dense population arises from the spread of infectious diseases. In my opinion under present conditions these ill-regulated night refuges are apt at any time to become hot-beds of infection, and are a standing I menace to the public safety. * A full account of both these cases will be found in the Appendix. 12 Parish of St. George the Martyr, Southwark. Respiratory Diseases. Table X. Sub-District. No. of Deaths—1894. Total No. of Deaths—1893. Total Bronchitis Pneumonia Phthisis Bronchitis Pneumonia Phthisis Borough Road 43 30 28 101 48 41 25 114 London Road 74 35 22 131. 83 41 29 153 Kent Road 64 48 19 131 95 56 1 152 Total 181 113 69 363 226 138 55 419 In 1892 the total mortality under this heading was 539, which fell to 419 in 1893, and to 363 in 1894. This rate is above that of the whole of London. The excess may, I think, be traced to the overcrowded state of the parish, both as to tenements and to workshops, and to the number of indoor occupations which predispose to respiratory diseases. A good deal of the mortality among young children is due to lung troubles, which often follow measles and whooping cough. The returns of deaths from consumption are not so heavy as one would expect in so densely crowded and poverty-stricken a district. At the same time it should be noted that the registrars have to depend for these figures on the death certificates, and there can be no doubt that a certain number of cases are not correctly described. This applies especially to alcoholism, and to such hereditary and constitutional disorders as syphilis or consumption. Mortality of Infants and Children. The death-rates of infants under one year, and of children under five years, are worthy of careful attention, as they afford valuable indirect evidence of the sanitary condition of a community. By this I do not mean that all preventable infant and child mortality is to be attributed to defective sanitation. Other factors—to be mentioned further on— doubtless play a considerable part in either destroying or crippling the lives of these slum-bred children. The fact remains, however, that the most sensitive test of the sanitary condition of a district lies in the death-rate prevailing among its young population. During 1894 the number of infants who died within the first year of life in St. George's was 437. These figures give the high rate of 211 deaths to every 1,000 births in St. George's, as compared with 143 deaths per 1,000 births for London. The average rate for the three years 1892-3-4, for St. George's was 204, and for the Borough Eoad sub-district, 231, as against 151 for London. The highest rate in the metropolis for 1894, was 211 in St. George's; Southwark, and the lowest in Stoke Newington, where it was 86. Of a total of 1398 deaths at all ages in St. George's, 810 occurred under five years, which gives the large percentage of 53.2 to the total number of deaths. It is wellknown to specialists in children's disuses that "wasting" constitutes one of the commonest causes of death in infants' Thousands of children die every year in London simply because they are fed on food which they cannot digest. 13 Annual Report of the Medical Officer of Health—1694. TABLE XI. The following are the most prominent Diseases causing the Infant Mortality under One Year of Age :— Deaths 1892. Deaths 1893. Deaths 1894. Diarrhoea 23 43 54 Tabes Mesenterica (bowel phthisis) 22 58 16 37 10 38 Tubercular Meningitis, Hydrocephalus 20 10 12 Other Tubercular and Scrofulous Diseases 16 11 16 Premature Birth 24 36 44 Convulsions 35 41 63 Bronchitis 45 50 44 Pneumonia 32 24 16 Dentition 21 14 22 Whooping Cough 11 20 29 Suffocation in bed 11 12 20 Debility, Atrophy, and Inanition 42 84 88 Other cases not specified or ill-defined 34 6 8 Total 336 367 426 From the foregoing list it is seen that " debility, atrophy, and inanition," is the chief cause of infantile death in St. George's. This ill-defined group refers mainly to chronic wasting disease, produced by malnutrition, which is again a consequence of improper feeding. Infants fed on mother's milk for the most part escape these fatal consequences, which chiefly affect children brought up by hand. In this connection I must again emphasise the fact that infants during the first six months of life are as little fitted to digest bread, arrowroot, cornflour, biscuits, tops and bottoms, or any of the so-called infant foods as they would be to live on sawdust, shavings, or other foreign matter. Another feature of the list is the high death-rate shown from chest complaints, largely due to over-crowding and breathing of foul air. Another cause of diseases of this class is due to the fact that children have relatively a much larger body surface than adults, so that with their quicker circulation children lose heat rapidly and chills are contracted. Hence it follows that they should be more warmly clothed than grown-up people. Certain practical rules dealing with the problem of " how to bring up children " are given in the Appendix. Their free distribution among parishioners would, I believe, be a step in the right direction towards improving the condition of infant life in Southwark. Diarrhoea killed more infants during 1893 than in 1892, This may be explained explained by the hot and dry summer of 1893, as compared with the comparatively cold and wet weather of 1892. A similar explanation, however, does not apply to 1894, when the death-rate from this cause, for some reason that is not clear, was higher than in 1893. It is an established fact that epidemic and autumnal diarrhoea always becomes prevalent as soon as the earth thermometer reaches a temperature of 56 degrees F. at a depth of four feet from the earth's surface. Given this temperature and a polluted soil or environment the air becomes germladen and poisons the milk with which the children are fed. I have little doubt that the greater part of infantile summer diarrhoea may be explained in some such way. With a view to lessening the high death and higher sick-rate from this disease I would advise a serious consideration of the following causes of autumnal Fever:— 14 Parish of St. George the Martyr, Soiithivark. 1.—The presence of foul sewers in which the solids stagnate, while the liquids percolate through the walls and joints into the surrounding soil. 2.—The constant danger of sewage-flooding in basements—in many of which food and drinks are prepared and stored—due to the inadequacy of main sewers under the control of the London County Council. 3.—The failure to put into practice the pail-system of dust removal throughout the parish, advised in my Annual Reports for 1892 and 1893. 4.—The absence of a sufficiently prompt and systematic method of house-refuse removal in and about dwellings. 5.—The need of a more frequent and thorough flushing of the sewers and watering of the streets. 6.—The want of adequate attention to the cleanliness of hye-streets, courts, and alleys, situated in the poorer quarters of the parish. The deaths from tubercular diseases, which include tabes mesenterica, popularly known as " consumption of the bowels," tubercular meningitis, hydrocephalus, (water on the brain) and scrofula, are probably due largely to the use of unboiled milk, derived from cows suffering with tubercle in the glands of the udder. As mentioned in my Report for 1893, this fact points to the need of an increased supervision of dairies. The many causes leading to loss of infant life in St. George's may be thus summarised:— (1) Bad environment, such as insanitary conditions, overcrowding and absence of parks and open spaces. (2) Improper and insufficient food. (3) Mismanagement by mothers through ignorance. (4) Early marriages. (5) Debility of mothers. (6) Maternal neglect, due to mothers being more or less employed away from home in factories and workshops. (7) Use of opiates : usually in the form of patent medicines. The mortality of children between the ages of two and five years is recorded as due chiefly to bronchitis and pneumonia, and to such preventable diseases as measles, whooping cough, diarrhoea, diphtheria, and scarlet fever. Apart from general moral and sanitary measures, I have no special remedies to suggest for counteracting the excessive infantile mortality, other than those urged in my Annual Repor^for 1892-3. They are the provision of :— (1) Open breathing spaces. (2) Creches or day nurseries for the better protection of infants during the hours they are deprived of maternal care. It would be idle for me again to enlarge on the advantages resulting from open spaces—since my advice on this matter has been so often proffered, hitherto, I regret to say, without, any practical result. In my Reports for 1892 and 1893, I advised the establishment of creches in your parish. These are wanted owing to the large number of mothers resident in this district, who are engaged in factories and workshops, and are therefore unable to attend to ^heir domestic duties during the greater part of the day. It goes without saying that creches should know nothing of creeds and religions; and it seems to me that their best chances of success would be secured by co-operation between employers and workpeople. 15 Annual Report of the Medical Officer of Health—1894. TABLE XII. Sanitary Area. Estimated Population middle of 1894. Persons to an Acre. Annual rate per 1,000 living. Deaths of Infants under 1 year of age to 1,000 Births. Deaths from all Causes. Deaths fr'm principal Zymotic Diseases St. George, southwark 60,030 211 23.9 4.0 214 St. saviour, southwark 26,712 132 21.0 3.3 145 St.Olave southwark 12,984 103 20.7 2.8 126 Bermondsey 84,053 135 20.7 3.3 146 Newington 118,512 185 20.0 2.8 158 Rotherhithe 40,365 53 19.0 3.3 161 Woolwich 42,309 37 17.8 2.6 136 Lambeth 282.574 71 17.2 2.4 133 Greenwich 173,128 49 17.2 3.1 138 Camberwall 248,893 54 16.3 2.8 148 Battersea 161,558 71 16.0 3.1 146 Lewisham 79,903 15 13.8 1.9 128 Plumstead 59,233 9 12.5 2.1 94 Wandsworth 179,516 18 12.4 1.8 144 Lee 38,172 23 12.4 1.7 94 London 4,349,166 57 17.4 2.6 143 " The foregoing table shows that St. George's—the most densely-populated district in the United Kingdom—had among the South London Sanitary areas in 1893 :— (1) The highest general death rate. (2) The highest zymotic or preventable deathrate. (3) The largest number of deaths of infants under one year of age. " The above quotation from my 1893 Report need not be altered. As it stands for that year it also describes exactly the unenviable position in these vital points of St. George's, Southwark, for 1894. This fact speaks for itself and no words of mine are needed to emphasise the strikiug testimony afforded by these figures. Customs and Inland Revenue Acts. 1890, s. 26 (2), and 1891, S. 4. Eighty-six tenements, occupied by about 430 persons, have been examined by me during 1894. This duty has been performed at the request of the respective owners, with a view to the granting of certificates by your Medical Officer, by virtue of which exemption from inhabited house duty may be claimed under the provisions of the Acts. Much time was taken up in the inspection of the dwellings before certificates could either be given or refused. The Act of 1890 provides that, "before exemption from duty can be claimed the house be so constructed as to afford suitable accomodation for each of the families or persons inhabiting it, and that due provision be made for their sanitary requirements." The Act of 1891 stipulates that the annual value of each separate dwelling within the house " shall not amount to £20." The standard of sanitary requirements fixed by me was reached in the case of five houses (the same number as in 1893). Certificates were given in each of these eases. 16 Parish of St. George the Martyr, Southwark. It is noteworthy that the Inland Revenue Acts throw the burden and responsibility of making a thorough inspection of houses, with a view to the levying of imperial taxes, upon the Local Authorities. No definition, moreover, is given, of what is meant by the somewhat vague and elastic expressions "suitable accommodation" and "sanitary requirements," the interpretation of these phrases being left to the judgment of the individual Medical Officer of Health. Housing- of the Working Classes Act, 1890. Summary of Representations, under Part II., made by the Medical Officer of Health during the year 1894. TABLE XIII. Premises. Date of Official Representation. Result. 4, 5, 6, and 7, Green Street January 18th. Closed with costs. 1, 2, 3, 4, Chadwell Court January 18th. Closed with costs. 116, Blackfriars Road January 23rd. Closed with costs. 1 and 2, Maypole Alley Februay 4th. Closed with costs. 2, Green Street February 6th. Closed with costs. Block II.—Nos. 1 to 28, Artizans' Buildings, Gun Street February 7th. Works completed. 1,2, 3, 4. 6, and 7, Pontypool Place, Valentine Place July 10th. Closed. 25, 26, and 27, Gerridge Street August 1st. Closed with a view to demolition, the Summonses being adjourned. 8, Willmott's Buildings October 16th. Closed with costs. 1, 2, and 3, Taylor's Buildings Nov. 20th. Closed with costs. 7, Willmott's Buildings Dec. 11th. Closed with costs. Summary. Houses and tenements, respecting which representations were made to the Vestry that they were in a state so dangerous or injurious to health as to be unfit for human habitation. Houses and tenements 69 Inhabitants 345 During the years 1892, 1893, and 1894, applications have been made for closing orders in the case of 210 houses and tenements unfit for human habitation. These dwellings have sheltered upwards of a thousand persons, and I think some steps should be taken to re-house those whose occupations necessitate their living in or near the district. I would respectfully commend the serious attention of your Sanitary Authority towards the equitable solution of this pressing problem. 17 Annual Report of the Medical Officer of Health—1894. Section 30, of the Act states that, "It shall be the duty of the Medical Officer of Health of every district to represent to the Local Authority of that district any dwelling-house which appears to him to be in a state so dangerous or injurious to health as to be unfit for human habitation," In compliance with this direction I have from time to time advised your Vestry (the authority under the Act), to apply for closing orders with respect to some of the worst class of slum-property in Southwark. Moreover after closure for a term of certain of these houses, your Vestry have passed resolutions ordering their demolition. Certain unwholesome dwellings which can be put into an habitable condition, have been reported to your Health Committee. Such houses have been closed pending alterations—under the provisions of the Public Health Act. It should, however, be clearly understood that those dwelling-houses which can be dealt with only by demolition, if a due regard be paid to health considerations, are usually taken under the Housing Act. If closed by virtue of the less stringent Health Act, there is nothing to prevent their being a standing danger, for an indefinite period, to the health of the public or of the inhabitants of neighbouring dwellings. 18 Parish of St. George the Martyr, Southwark. Table XIV. TABLE OF DEATHS during the Year 1894, in the Metropolitan Sanitary District of St. George, Southwark; Classified According to Diseases, Ages, and Localities. (Prepared in accordance with the instructions of the Local Government Board.) Names of Localities adopted for the purpose of these Statis tics; Public Institutions being shown as separate localities. MORTALITY FROM ALL CAUSES AT SUBJOINED AGES. MORTALITY FROM SUBJOINED CAUSES, DISTINGUISHING DEATHS OF CHILDREN UNDER FIVE YEARS OF AGE. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65 65 and upwards Small-pox. 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. ! Boro' Road 542 156 155 61 28 114 28 Under 5 ... 1 6 ... ... 1 ... ... ... ... ... 25 25 24 ... ... ... 28 1 10 190 311 5 upwds. ... 2 5 1 ... 1 1 ... ... ... 1 13 5 1 4 ... 28 45 14 8 103 231 London Road 332 102 72 13 5 134 6 Under 5 ... ... 5 ... ... ... ... ... ... ... ... 21 12 18 ... ... ... 40 2 4 72 174 5 upwds. ... 2 1 1 ... 1 ... ... ... ... 3 8 4 ... 3 ... 22 69 18 9 17 158 Kent Road 370 138 50 30 10 116 16 Under 5 ... ... 5 ... ... ... ... ... ... ... ... 29 11 6 ... ... ... 44 5 6 92 198 5 upwds. ... 2 3 ... ... 2 ... ... ... ... 1 2 5 ... 2 ... 19 68 30 4 34 172 Evelina Hospital 145 40 96 9 ... 4 ... Under 5 ... ... 7 ... ... ... ... ... ... ... ... 3 14 5 ... ... ... 22 ... 4 81 136 5 upwds. ... ... 2 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 9 St. George's Workhouse 9 1 ... ... ... 8 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 6 8 Totals 1398 437 373 113 43 372 50 Under 5 ... 1 23 ... ... 1 ... ... ... ... ... 78 62 43 ... ... ... 134 8 24 456 820 5 upwds. ... 6 11 2 ... 7 ... ... ... ... 5 23 14 1 9 ... 69 190 62 21 162 578 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- 152 30 7 12 3 98 2 Under ... 8 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 3 7 37 5 upwds ... ... 7 ... ... ... ... ... ... ... ... 1 ... ... ... ... 34 37 15 11 10 115 Deaths occurring within the district among persons not belonging thereto 115 41 60 1 4 9 ... Under ... ... 5 ... ... ... ... ... ... ... ... 2 12 4 ... ... ... 17 ... 3 36 106 5 upwds ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 9 Table XV. TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year, 1894, in the Metropolitan Sanitary District of St. George, Southwark; classified according to Diseases, Ages, and Localities. (Prepared in accordance with the instructions of the Local Government Board.) Annual Report of the Medical Officer of Health—1894. Names of Localities adopted for the purpose of these Statistics ; Public Institutions being shown as separate localities. Population at all ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality coming to the knowledge of the medical officer of health Number of such Cases Removed from thkir homes in the several localities for treatment in Isolation Hospital. Small-pox. Scarlatina. Diphtheria Membranous. Croup Typhus Fevers. Puerperal. Cholera. Erysipelas. Small-pox. Scarlatina. Diphtheria. Membranous Croup Fevers. Choleraic Erysipelas. Census 1891. Estimatedto middle of 1894. Enteric or Typhoid. Continued. Relapsing. Typhus Enteric or Typhoid. Continued. Relapsing. Puerperal Boro' Road 16,624 16,825 629 f Under 5 ... 27 31 4 ... ... ... ... ... ... 7 ... ... ... 14 20 ... ... ... ... ... ... ... ... ... ... 5 upwds. 1 75 67 2 ... 12 ... ... ... ... 41 ... ... ... 31 38 ... ... 4 ... ... ... ... 2 ... ... London Road 21,221 21.194 804 | Under 5 1 29 8 1 ... ... ... ... ... ... 1 ... ... ... 17 5 ... ... ... ... ... ... ... ... ... ... 5 upwds 3 58 23 1 ... 13 ... ... ... ... 29 ... ... ... ... 13 1 ... 5 ... ... ... ... 4 ... ... Kent Road 21,867 22,011 638 | Under 5 ... 28 14 1 ... 2 ... ... ... ... ... ... ... ... 16 5 ... ... ... ... ... ... ... ... ... ... 5 upwds ... 64 28 3 ... 9 ... ... ... ... 31 ... ... ... ... 12 1 ... 3 ... ... ... ... 5 ... ... Evelina Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. George's Workhouse ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Bethlem Hospital and King Edward School ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Eye Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 59,712 60,030 2071 f Under 5 1 84 S3 6 ... 2 ... ... ... ... 8 ... ... ... 47 30 2 ... ... ... ... ... ... ... ... ... 5 upwds 4 199 118 6 ... 34 1 ... ... ... 101 ... ... 2 88 63 ... ... 12 ... ... ... ... 11 ... ... 19 20 Parish of St. George the Martyr, Southwark. SECTION II.—GENERAL. The Factory and Workshop Act, 1891. 164 Workshops have been registered by your Authority since January, 1892, when the Act first came into operation. Of this number 43 have been added during the past year. In many of these cases I am glad to say that registration has led to either the abatement or the removal of nuisances such as filth, overcrowding, and bad ventilation. Special attention has been given to the water-closets both as to sufficiency and to a separate accommodation for the sexes. The Home Secretary's order under Section 27.—(1) of the Act first took effect on the 20th November, 1892. It was made in the interests of the public and of those employed in " domestic workshops." All information under this order supplied me by Mr. Lakeman, H.M. Superintending Inspector of Workshops, regarding outworkers engaged in the manufacture of wearing apparel, upholstery, and furniture has been acted upon. Beyond this the order remains only partially enforced in this parish, and will continue so unless some means be devised to lighten the more pressing duties of the Sanitary Inspectors. In my Report for 1893, I said that in my opinion a special inspector would be required to carry the order out thoroughly in your district. This view of the question I would again uesoectively urge upon the attention of your Vestry Mortuary and Coroner's Court. One hundred and ninety bodies were removed to the parish mortuary during the year 1894, as against 236 in 1893, and 181 in 1892. This number includes bodies brought from the St. George's Workhouse. Post-mortem examinations and inquests were held in 78 cases, and inquests alone in 33 cases. During 1894 twenty young children were suffocated whilst lying in bed with their parents as against 13 in 1893. This lamentable loss of life might have been prevented had these unfortunate children slept in cots. As pointed out in my Report for 1893 a separate chamber is needed in which to deposit infectious bodies. This might, I think, be best arranged by partitioning off a small portion of the existing mortuary. The provision also of a tressel and of a separate entrance with increased ventilation would remedy the present objectionable condition of the mortuary. The Notification of Infectious "Diseases. Certain infectious diseases have been made notifiable in London since the passing of the Infectious Disease (Notification) Act, 1889. They comprise:—small-pox, cholera, diphtheria, membranous croup, erysipelas, the disease known as scarlatina or scarlet fever, and the fevers known by any of the following names:—typhus, typhoid, enteric, relapsing, continued, or puerperal. 21 Annual Report of the Medical Officer of Health—1894. In 1894 the sum in fees paid to medical practitioners for notifying infectious cases in St. George's amounted to £61 Os. Od. This amount, paid in the first instance by your Vestry, is recouped by the Asylums Board and charged to the Metropolitan Common Poor Fund. 44 per cent, of the total number of cases notified in the parish during 1894 were removed to the Asylums Board and other hospitals. During 1892, 67 per cent., and in 1893, 34 per cent, of such cases were treated in these institutions. The decrease of admissions during 1893 and 1894 was due to the overcrowded state of the hospitals. My experience of the past year shows that there is urgent need for further hospital accommodation for infectious cases. It is important to bear in mind that prompt isolation alone can obviate the danger resulting from the detention of infectious patients in so poor and densely packed a district as St. George's. List of Slaughter-houses licensed by the London County Council, in October, 1894. Name. Situation. Farmer, John 264, Old Kent Road Kedman, Frederick 146, High Street, Borough Rowe, John 73, London Road Trask, William S. 11, Bermondsey New Road Waters, Arthur William 59, Old Kent Road Waters, Frederick S. 79, Old Kent Road The Slaughter-houses regularly inspected have been found to be conducted in a satisfactory manner. In the interests of the public, however, private slaughter-houses should be speedily replaced by "Abattoirs." This change would alone enable a systematic and thorough inspection of meat to be made as at present practised in the large towns of Germany, France, and Belgium. List of Horse Knackert' Yards licensed by the London County Council in October, 1894. Name. Situation. Harrison, Barber & Co., Limited 23, Green Street Harrison, Barber & Co., Limited Wescott Street, Tabard Street During 1894, 6,537 horses were received at the above-mentioned knackers' yards and disposed of as cat's meat. 22 Parish of St. George the Martyr, Southwark. List of Cow-houses licensed by the London County Council, in October, 1894. Name. Situation. Evans, John 89, Redcross Street Owens, John 143, Tabard Street Park, Isabella S. 30, Wellington Place Jones, David 10, & 11, Sturge Street The cow-houses have been regularly inspected. They are situated in populous bye-streets. The following table gives the number of cows and cow-houses in 1882, 1892, 1893 and 1894, within the parish, and it is a matter for congratulation that they are still steadily on the decrease. TABLE XVI. Year No. of Cows. No. of Cowhouses. 1882 101 9 1892 46 5 1893 37 4 1894 25 4 List of Bakehouses under Inspection in St. George the Martyr, 1894. 128, Southwark Bridge Road 16, Borough Road 90, Cross Street 111, Great Suffolk Street 7, Westminster Bridge Road 168, Borough High Street 102, Lancaster Street 119, Waterloo Road 67, Long Lane 70, London Road 28, Tower Street 44, „ 7, Great Suffolk Street 5, ,, 1, Tabard Street 17, „ „ 32, Earl Street 255, „ „ 126^ „ „ 10-4. Hayles Street 285, „ ,, H9, „ ,, 60, St. George's Road 28, Clarendon Street 237, Scovell Road 17, „ 15, Old Kent Road 26, Friar Street 21, Ontario Street 69, „ „ 161, Blackfriars Road 57 & 58, London Road 85, ,, ,, 45, Pocock Street 48, London Road 80, „ „ 14, Friar Street 233, Old Kent Road 146, „ „ Valentine Place 269, ,, ,, 168, ,, ,, 43, Webber Street 70, Red-cross Street 272, ,, 242, Borough High Street 151, Borough High Street 304, „ ,, 216, „ „ 108, „ „ 37, Warner Street 26, Lant Street 1, Cross Street 23 Annual Report of the Medical Officer of Health—1894. Return of Registered Common Lodging Houses in the Parish of St. George's, Southward, within the Jurisdiction of the London County Council. (C.h.) signifies Coffee House. Beg. No. Date when registered. Name. Street or Place. Authorized No. of Lodgers Date of Approval. 5463 16th Dec., 1882 James Hogan 61, Borough-road 68 24th Nov., 1882 5492 16th June, 1883 Demo Constantine 14, Great Suffolk-street (c.h.) 15 5th June, 1883 5363 30th Nov., 1889 Harriet Childes 2, Marcia-road 7 21st Oct., 1889 5366 1st Oct., 1881 Henry Levy 12, Lombard-street 76 20th Dee., 1881 5376 5th Nov., 1881 Henry Levy 13, Lombard-street 16 25th Oct., 1881 5222 21st Feb., 1880 William Wade 115, Tabard-street 20 14th Feb., 1880 243 27th July, 1872 Arthur Ford 7, Dorritt-street (late Duke street 15 12th July, 1872 261 20th Nov., 1888 William Longdon 15, Falcon-court 45 12th Nov., 1888 264 27th July, 1872 Arthur Ford 8, Dorritt-street (late Dukestreet) 36 12th July, 1872 297 27th July, 1872 Arthur Ford 83, Mint-street 31 5th June, 1872 3094 30th Sept., 186? Lewis Levy 1, 2, & 3, Disney-street 86 25th Aug., 1863 4386 31st May, 1872 Lewis Levy 12, Marshalsea-road (late 14, Mint-street) (house in yard) 119 8th May, 1872 4900 25th Nov., 1876 George Morley 112, Southwark-bridge-road 161 20th Nov., 1876 152 21st Nov., 1874 Ann Elizabeth Willis 2, Quilp-street (late 2, Queen-street) (house in rear) 92 13th Nov., 1874 26 1st Jan., 1887 Thomas Hunter Farmhouse, Harrow-street, Mint (house in yard) 81 . - 5572 29th Nov., 1893 James Hogan 64, Borough-road 36 2nd Nov., 1883 5657 12th Aug., 1884 Henry Levy 56, Newington-causeway (house in rear) 44 17th July, 1884 5680 22nd Dec., 1884 Henry Levy 14, Lombard-street 6 24th Nov., 1884 5762 30th Jan., 1886 Henry Levy 95, Mint-street 10 22nd Jan., 1886 5763 30th Jan., 1886 Henry Levy 97, Mint-street 12 22nd Jan., 1886 6171 27th Oct., 1894 Dennis Lineham 20, Falcon-court 16 24th Oct., 1894 5182 20th Oct., 1894 R. L. F. Brettingham Red Cross Chambers, Red Cross-square 70 15th Oct., 1894 5238 5th Sept., 1885 Frederick Allen 12, Gray-street & 14 95 28th Aug., 1885 5938 19th July, 1888 Thomas Moore 1, Surrey-buildings, Eaststreet 30 11th July, 1888 5993 26th March 1889 Robert Levy 131, Great Suffolk-street 87 22nd March, 1889 5952 14th March, 1890 James Cavender 210, High-street, Borough 33 22nd Feb., 1890 5897 9th April, 1888 Henry Levy 99, Mint-street 49 2nd March, 1888 5896 3rd March, 1888 Henry Levy 101, Mint-street 12 2nd March, 1888 5879 4th Feb., 1888 William Wade 113, Tabard-street 17 30th Jan., 1888 5843 14th March, 1890 James Cavender 212, High-street, Borough (house in rear) 142 22nd Feb., 1890 Houses Let in Lodgings. The Bye-laws made in compliance with the Public Health Act, with respect to houses let in lodgings or occupied by members of more than one family, have received the approval of the Local Government Board. A copy of these Bye-laws will be found in the Appendix. Register Books have been provided for use in each sub-district together with notices of requirements and blank requisition forms for service upon landlords. It now remains for your Authority to enforce the Bye-laws, which will, I believe, if thoroughly carried out, prove a sanitary reform of the utmost importance. In this parish, houses built on the so-called "model" or block system and accommodating upwards of 12,800 inmates, escape the salutary provisions of the byelaws. These dwellings, which are chiefly inhabited by the poorest classes, are for the most part badly supervised. In the interests of the public health such "models" should be included, by means of an amendment of the Health Act, within the purview of the New Tenement Bye-laws. 24 Parish of St. George the Martyr, Southwark. Bakehouses. During the year 1894 a circular letter was addressed by the Local Government Board to the Metropolitan Vestries and District Boards as to the enforcement of bakehouse law. They point out that action may be taken against insanitary bakehouses under certain sections of the Factory and Workshop Acts. They draw attention more especially to Section 16 of the 1883 Act, under which an occupier may be fined up to £5 for repetition of offences. A copy of the circular letter is appended. Bakehouses, London. Local Government Board, Whitehall, S,W., 22nd May, 1894. Sir, I am directed by the Local Government Board to state that questions have been raised in Parliament as to the sanitary condition of bakehouses in London and as to the steps taken by the Sanitary Authorities to enforce the law on this subject, and that the Board deem it desirable to draw the special attention of Sanitary Authorities to their powers and duties in this matter. The Board direct me to point out that under section 26 of the Public Health (London)-Act, 1891, it devolves on the Sanitary Authority to enforce the provisions of sections 34, 35 and 81 of the Factory and Workshop Act, 1878. and 15 and 16 of the Factory and Workshops Act Amendment Act, 1883, with regard to cleanliness, ventilation and other sanitary conditions, with respect to every bakehouse which is a workshop within their District. The Board attach much importance to a strict enforcement of these provisions, and they desire me specially to refer to section 16 of the Factory and Workshop Act, 1883, which provides that where a court of summary jurisdiction is satisfied on the prosecution of a local authority that any bakehouse is in such a state as to be on sanitary grounds unfit for use or occupation as a bakehouse, the occupier is liable on summary conviction to a fine not exceeding five pounds. The court, in addition to or instead of inflicting such fine, may order means to be adopted by the occupier within the time named in the order for the purpose of removing the ground of complaint. If after the expiration of the time as originally named or enlarged by subsequent order the order is not complied with the occupier is liable to a fine not exceeding one pound for every day that such non-compliance continues. It will be been from section 141 of the Act of 1891 that the term "bakehouse " is defined as meaning " any place in which are baked bread, biscuits, or confectionery, from the baking or selling of which a profit is derived." The Board trust that the Sanitary Authority will give such instructions to their officers as will ensure that the bakehouses in their district to which the Act applies will be systematically inspected by them, and that when the statutory provisions are not complied with the facts will be reported to the Sanitary Authority, and that they will cause to be instituted such proceedings as may be necessary for a due enforcement of the law. I am, Sir, Your obedient Servant, HUGH OWEN, The Clerk to the Sanitary Authority. Secretary. At the end of 1894 there were 54 retail bakehouses in your parish, or nine less than in 1893. 25 Annual Report of the Medical Officer of Health—1894. Official proceedings have been taken against the occupiers of 8, out of a total of 23, cellar bakehouses in St. George's. Efficient ventilation and natural lighting of these underground workshops seems to be out of the question owing to defects of structure. Of the eight cases proceeded against, only three remain closed at the time of making this report. In the absence of any official standard of requirements, by which the local authority may be guided, I may state that, in my opinion, none of the eight bakehouses alluded to are in a fit condition to be used for the making of bread. Those who are interested in the subject of bakehouse construction will find the matter entered into very fully in the Appendix. Falcon Court and Neighbourhood. Falcon Court and the adjacent courts and alleys constitute, as the Vestry is aware, an insanitary area. Their chief defects have been set forth in a special report which will be found in the Appendix. Some of the houses in Brent's Court, in Adam's (now Eve) Place, in Redcross Court, and in Maypole Alley have been closed by magistrate's order, under part 2 of the Housing of the Working Classes Act. Of these houses 7 have been re-opened in Brent's Court, and 11 in Adam's Place, after certain structural alterations had been carried out to the satisfaction of the Vestry. With these exceptions the whole of the buildings in the Falcon Court neighbourhood, as above defined, remain in much the same insanitary condition as they were when reported upon by my predecessor. This state of affairs cannot be regarded with complacency. Indeed, in my opinion, there is need for urgent action in dealing with these crowded rookeries. The plan which I suggested to the London County Council was, briefly, to demolish the whole area and to convert it into a modern recreation ground, of which a portion would be set aside for the use of children. So far nothing has been done in the matter by the London County Council. It may perhaps be assumed that the Council was unwilling to take any decisive step until the passing of the new London Building Act. That excellent measure, however, was placed on the statute book towards the end of 1894. In my opinion, therefore, your Vestry will do well to urge upon the Council once more the necessity of ridding not only St. George's but the metropolis as well of this most unwholesome area. Proposed Reception House. The following Table gives a return of tenements in which efficient fumigation has been impracticable owing to the tenants having no rooms to go to during the process, rhyingi thr year 1894:— No. of Infected Tenements. No of Persons occupying Infected Tenements. 1 room 2 rooms 3 rooms Total. 1 room 2 rooms 3 rooms Total. 99 120 49 368 342 699 290 1331 This Table tells its own tale. 26 Parish of St. George the Martyr, Southwark. During the year 1893, 268 infected tenements, occupied by 1,331 infected persons, were not efficiently disinfected. In other words, 1,331 centres of infection over and above the 268 infected tenements continue their liability to spread fevers, diphtheria, and erysipelas broad-cast by means of the clothes and persons of the families of the infected. During the period reported upon I have noted many examples of widowers, whose children have been confined to their beds with dangerous catching diseases. The care and nursing of these motherless children devolving upon the fathers, the latter have been obliged against their own will to throw up their work and seek relief at the hands of the guardians, thus swelling the numbers of the unemployed. My opinion is that had your Vestry acted upon the advice tendered by me in a Special Report on a proposed Reception House, presented on the 20th December, 1892, much money in Poor and Metropolitan Asylum Board Rates would have been saved to the ratepayers of this poor Parish. Moreover, many deaths and more sickness, misery, and broken health would have been avoided among those stricken with infectious disease. Section 60, sub-section 4 of the Public Health (London) Act, 1891, is perfectly explicit. The law is not merely permissive, but it says the authority shall provide shelter free of cost for the families of infected patients pending the disinfection of their houses or tenements. This important matter has been considered by your Public Health Committee, but no action has been resolved upon. Uniform Death Rates. In accordance with the instruction of your Health Committee, I beg, herewith, to report on the results obtained by the despatch of the following circular letter:— " Vestry of St. George the Martyr, Southwark, Vestry Hall, Borough Road, Southwark, S.E., November 20th, 1893. Dear Sir, I am directed by the Public Health Committee of this Parish to inquire if your Medical Officer of Health in calculating the General and Zymotic Death Rates of your sanitary area is in the habit of excluding the deaths of non-parishioners occurring within the district, and of including the deaths of parishioners dying in public institutions outside the district. If this method is not adopted will you kindly state how the rates of mortality are determined. An early answer will oblige. Yours very truly, (Signed) A. Millar, Vestry Clerk." This letter was sent to the clerks of the various Metropolitan Vestries and District Boards of Works, which together number forty. Replies have been received and handed me by your Vestry Clerk from twenty-nine of these authorities, each of these twenty-nine bodies, with the exception of two, state that their Medical Officers of Health adopt the Registrar-General's method in the computation of the Death Rates—i.e., they exclude the deaths of non-parishioners dying in public institutions within the district. In the Vestry of St. James and St. John, Clerkenwell, there being no public institutions within the district, correction, therefore, is made only for those parishioners dying in public institutions outside the district. 27 Annual Report of the Medical Officer of Health—1894. In the Vestry of St. Margaret, Westminster, the clerk states that the Medical Officer in calculating the death rate excludes the deaths of non-parishioners dying within the Parish. Nothing is said about the inclusion of parishioners dying in outlying institutions. No answer to your clerk's letter has been received from the Vestries of Lambeth, Camberwell, Bermondsey, and Woolwich, or from the District Board of Works of Whitechapel, Greenwich, Wandsworth, Hackney, St. Giles, and Limehouse. It goes, I thick, without saying that the introduction of a uniform system of computing the death rates in the various metropolitan areas would constitute a useful reform. This could be brought about by the Local Government Board adding the rule to those duties already defined for the guidance and. observance of the Medical Officers of Health that all general and zymotic death rates shall, in future, be corrected according to the method practised by the Registrar-General. House to House Inspection. In order to arrive at a proper knowledge of the sanitary wants of the district it is clear that inspection must be systematic and thorough. This fact has been recognised in the first section of the Public Health (London) Act, 1891, which directs that a house to house inspection shall be made by the Local Authority. For the first time in the history of this parish a visitation such as that intended by the framers of the Act has been commenced. This important step has been rendered possible by last year's increase of the staff of inspectors. The method which I have adopted is as follows:— Under the direction of Mr. Edwards, Chief Inspector, each sub-district inspector visits a particular street in his own ward; he then calls at each house in turn and makes an entry of all its chief sanitary features in the following form, which is contained in a book supplied for that purpose. INSPECTED. Date 189 . Premises No. Basement Ground Floor First Floor Second Floor Third Floor Families Adults Children General Condition Ventilation Exterior W.C. Water Supply 28 Parish of St. George the Martyr, Southwark. Dram Yard Dustbin Owner or Agent Remarks I For the block or so-called " model " buildings a special book is used.'' Date 189 . Place Inspected Owner Occupier No. of Booms.—Living Sleeping No. of Inmates Adults Children W.C. Accomodation Drainage Water Supply General Remarks In this way during the last quarter of the year 1894, 20 streets, and 353 houses were examined and reported upon. No. of tenements ... ... ... ... 516 No. of persons affected ... ... ... ... 2737 No. of Sanitary defects. ... ... ... ... 708 No. found to be in fair condition ... ... ... 59 It should be added that the worst class of Ute- streets has been dealt with first, but at the same time these facts and figures, I think, more than justify the adoption of the system. The routine work of the inspectors is undertaken in the following order oi precedence:— 1. Infectious cases. 2. Complaints. 3. Works in progress. 4. House to house visitation. 5. Miscellaneous. Court Work, as it arises. I may perhaps be allowed to add my opinion that this system of house to house inspection is likely to do more towards raising the general health standard of your district than any single step yet taken by your Vestry. 29 Annual Report of the Medical Officer of Health—1894. Common Lodging-houses. The accommodation afforded by the common lodging-houses of the parish (for a list of which see page 23) is materially the same as in the preceding year. From information courteously furnished by the Metropolitan Commissioner of Police, I was enabled to publish the following figures for 1893:—Common lodging-houses, 39 in number, mostly situated in the Borough Road sub-district, registered to accommodate 1,297 males and 316 females, in all 1,613 persons. In November, 1894, an important change was effected with regard to the regulation of common lodging-houses. On that date the control of the police over the licensed places in question was transferred to the London County Council. The last named body, therefore, has now full powers of making and enforcing special regulations and bye-laws. The magnitude of this trust may be inferred from the fact that at the end of 1891 the total number of registered common lodginghouses under the control of the police was 863, with accommodation for 33,086 lodgers. Sanitary Inspectors. Up to the year 1894 the whole of the sanitary inspection of this poor and denselycrowded district was carried on by two sanitary inspectors. It is clear that the supervision of such a parish, containing as it does 60,000 inhabitants, could not be properly performed by so small a staff. Moreover, the development of sanitary knowledge has of late years added many new laws to the Statute Book, and has multiplied the administrative duties of public health authorities. A glance through the vast mass of details included within the provisions of the Public Health Act will show how multifarious are the matters to be dealt with under present conditions. It is not surprising, then, that all over the country there has been a constant demand for an increase in the number of sanitary inspectors. Early in 1894 your Vestry, in "my opinion most wisely, determined to double the number of sanitary inspectors. This proceeding, by drawing from the Exchequer contribution account, has resulted in an actual decrease of £57 10s. in salaries during the year 1894. That is to say, the two inspectors have been increased to four, with a saving of money out of pocket. In the rearrangement of staff the chief place has been granted to your old and faithful officer, Mr. Edwards. That honourable position he has earned by a loyal discharge of responsible duties now extending over thirty years. During the time of my connection with your Vestry I can testify to the capable and thorough way in which he has performed his work, which has often been of a delicate and highly technical nature. It may perhaps sound somewhat like a truism to remark that the practical value of any law depends on the machinery that can be used for its administration. This principle, however, appears to be often lost sight of by those who oppose the appointment of adequate staffs of inspectors. The Medical Officer of Health is responsible to the Vestry for the sanitary state of his parish. From the nature of things it is impossible that he can be personally acquainted wtih the enormous mass of details connected with his official work. He can only be kept in touch with the particular sanitary wants and needs of his district by means of his subordinate inspectors. Hence, it follows, that to discharge his duties in a thorough manner he must possess a sufficient staff of skilled and trustworthy men. 30 Parish of St. George the Martyr, Southwark. Disinfection. During the year the efficiency of the disinfection carried out by your Sanitary Authority has been greatly increased. A house has been specially erected for the purpose in the stoneyard; it is provided with a room for infected goods, which are then passed through the disinfecting apparatus and taken out in another or disinfected room. Two hand-carts are also provided, one of them for the infected and the other for the purified articles. A new disinfector has replaced the old one, which was worked by hot air, and erected so long ago as 1867. The pattern chosen by your Committee is the very excellent one invented by Mr. Lyon. It may be described as a large iron cylinder tilled with steam, which is super-heated by means of a steam jacket. It is further supplied with a vacuum apparatus, by means of which the disinfection of such things as thick mattresses is rendered certain and thorough. The boiler is separated from the disinfector, and can therefore be readily cleansed or renewed. Your Sanitary Authority is still in want of a properly constructed incinerator, in which to burn infected articles that require destruction. In bringing this report to a conclusion I may congratulate your Vestry on the steady progress that has been made in health matters in St. George's, Southwark. There has been a marked fall in the death-rate, which has reached a lower point than that recorded at any period during the last half century. At the same time the sanitary staff has been strengthened by the addition of new inspectors, and the disinfecting appliances have been brought up to a modern standard. It now remains for me to thank all who during the past year have helped to advance the public health work of this parish. I have the honour to be, Your obedient Servant, F. J. WALDO, 1, Plowden Buildings, Temple, Medical Officer of Health. March, 1895. 31 Annual Report of the Medical Officer of Health—1894. APPENDIX A. Booth v. Ferrett * This case raised the question whether a Salvation Army " refuge " is a common lodging-house within the Common Lodging-houses Act of 1851, requiring to be registered and approved by the inspector appointed by the local authority. Mr. Booth had opened a refuge at '272, Whitechapel Eoad, which had not been inspected or registered under the Act, and an information was laid against him under the Act, on the ground that it was a common lodging-house. The magistrate held that it was so, and convicted; but stated a case to raise the question, on which Mr. Booth appealed. It was proved and not contested that Mr. Booth in and from October, 1889, opened and kept open the house for the reception of male lodgers to sleep in one common room for one or more nights, and to be supplied with food in it and another common room at an inclusive charge of 4d. per night for bed, supper, and breakfast. There was accomodation for 100 men, and as many as 69 were on one night found sleeping in the room. Notice to register the house under the Act was given by the Commissioners of Police, and in spite of such notice and after the expiration of a month Mr. Booth continued to receive male lodgers in the house (in the manner already stated), the house not having been registered or approved. It was not disputed by him that if the house was a common lodging-house within the Act the conviction was right. The lodgers so sleeping in separate beds on the floor in one common room were strangers to each other, and were of the class of poor persons who frequent the registered common lodging-houses. A notice was posted that 4d. a night was charged for supper, bed, and breakfast, and frequently a notice that the house was full. The sum of 4d. was paid for such accomodation by such as had 4d. to pay, or a smaller sum if they had less, while free tickets were given to persons with no means at the discretion of the person in charge, such free tickets being paid for by charitable friends of the institution. The person in charge also exercised his discretion in refusing to admit persons who were, in his opinion, able to pay more than 4d. for their night's accomodation. The rooms were opened for lodgers at 5 o'clock each evening. Supper was given at 7 and a Salvation meeting held at 8. Up to 11 o'clock the lodgers were admitted and given supper. It was contended on the part of Mr. Booth that this was not a common lodging-house within the Act, on the grounds that the house was kept partly for charity and not as a common inn, which is common to the sexes ; and that the owner elected to refuse whom he chose, and that it was partly maintained by charitable contributions and not for the purpose of profit or gain ; and the question whether the facts constituted a common lodging-house within the Act was a question of law. The magistrate found that this was a lodging-house established and maintained not for any pecuniary pupose of gain, but for the accomodation of the poorest class of persons only, partly with a charitable and partly with a religious object; and he found that it was a common lodging-house as the appellant received therein such poor persons for short periods upon the terms of inhabiting one common room, although strangers to each other; and he found that it was a common lodging-house within the Act upon the facts proved before him as above set forth, and having regard to the provisions of the Act and the Public Health Acts, and to the need of sanitary protection of the successive relays of such poor persons so lodged by the appellant and, through them, of the public at large, and he therefore convicted the appellant, but submitted to the Court whether he was right in holding that the house was a a common lodging-house. *Beprinted from Times Law Reports, Vol. 6, p. 337. (By permission of Editor.) 32 Parish of St. George the Martyr, Southwark. Mr. Willis, Q.C., (with Mr. Colam), appeared for the appellant, Mr. Booth, to contend that the magistrate was wrong, and said the inmates were admitted at the discretion of the manager, some without payment of the usual charge or at a less rate. The institution was not carried on for any profit, but its object was partly charitable and partly religious, the object being to meet special emergencies and pressing distress; and while there was no objection to the entrance of the police for police purposes, it would be seriously fettered if the regulations of common lodginghouses were to be applied and enforced to such institutions as this. Mr. R. S. Wright, instructed by the Solicitor to the Treasury, argued in support of the conviction, contending that this was a case of a common lodging-house. It was said to be a question of fact; and it was found by the magistrate that this was a common lodging-house. The phrase appeared to distinguish between a lodginghouse where all were admitted and private lodging-house where all were admitted and private lodging-house Upon sanitary grounds it did not matter whether the object was profitable or charitable. The Court, however, came to the conclusion that the conviction was wrong. Lord Coleridge, in giving judment, said, as the Act contained no definition of "common lodging-houses,'' it was necessary to see what are "common lodginghouses." It is clear that it is not all lodging-houses, but only "common lodginghouses." It should seem, looking at the scope and intention of the Acts, that such an institution as this—a charitable institution, not carried on for purpose of profit or gain, not open to all comers, but only on such terms and conditions as the managers may direct—is not within these Acts of Parliament, which contain extremely stringent regulations, highly proper for the purposes of the institutions, which appear to be intended where all persons are received for purposes of gain. Such lodging-houses being kept for the purpose of profit, it is reasonable to assume that the keepers, so that they do not violate any law, will endeavour to make as much money as possible, and that, therefore, injury or danger to the public may result from the houses being overcrowded or kept without regard to sanitary conditions ; and therefore Parliament established certain regulations, highly proper for such houses, which appear to have been intended by the Act. He could not therefore say that this institution came within the Act or within the notion any one would entertain of a 'common lodging-house." According to common understanding, a lodging-house open to all comers, and kept for the purpose of profit, would seem to be the kind of lodging-house intended. A magistrate of intelligence had already held, in the case of a female lodging-house, that it did not come within the Act, and there had been no attempt to reverse that decision. It was for those who desired to bring such institutions as these within the Act to show that they came within it. But such an institution as this certainly did not come within his idea of a " common lodging-house." On the whole, therefore, he came to the conclusion that the Act was not intended to apply to such institutions as this, and, therefore, that the conviction was wrong and must be set aside. Mr. Justice Matthew was of the same opinion. Appeal allowed, with costs. Colclough v. Edwards.* This case raised, on appeal from a decision of one of the metropolitan police magistrates, a question of some interest as to the refuges or shelters of the Salvation Army. The appellant, one of the officers of the Army, was summoned by the sanitary inspector of the parish of St. George the Martyr, Southwark, for that on the 25th and 26th of May last he unlawfully let for hire a part of a house, No. 115a, Blackfriars *Reprinted from Times Law Reports, Vol. 10, p. 118. (By permission of Editor.) 33 Annual Report of the Medical Officer of Health—1894. Road, in which one Edwin Henderson had been suffering from a dangerous infectious disease, without having it disinfected to the satisfaction of a medical practitioner duly qualified, contrary to the provision in the Public Health Act for London, 1891, 54 and 55 Vict., cap. 76, sec. 63. The magistrate convicted and inflicted a fine of £20, but stated a case for the opinion of the Court. It was proved that the premises were in the occupation of William Booth—commonly called General Booth—and were used by him in connection with the social scheme of the Salvation Army for the purpose of sheltering at night persons of the homeless and poorest class. The part of the premises in question, known as "The Penny Shelter" consisting of a large hall or room having six ventilators. The appellant is the person placed in charge of the shelter by Mr. Booth, and the charge for admission is a penny. Persons are admitted to the shelter at and after 5 p.m. each evening, and are permitted to remain there till half-past 7 next morning, and that after 6 p.m. persons so admitted are at liberty to lie down upon the forms or seats therein that may happen to be unoccupied, but no particular part of the shelter is appropriated or alloted to any of those so admitted, and the forms or seats are not numbered or railed off. On the evening of the 24th of May last, between 10 and 11 o'clock, one Henderson was admitted to the shelter on payment of a penny, and remained there until the morning of the 25th of May, when he went to the parish infirmary, and on the same morning the appellant was informed that Henderson was suffering from small-pox. Regulations have been made on behalf of Mr. Booth for the daily cleansing and disinfecting of the shelter, and pursuant thereto, immediately the men have vacated it each morning, all windows and doors were closed and the shelter fumigated with sulphur, and all the drains cleansed and disinfected; the floor scrubbed and washed with soap and soda, and afterwards disinfectant was sprinkled on the floor. The regulations were, in the opinion of the magistrate, sufficient for ordinary purposes of cleanliness, bat not for disinfection in connection with dangerous infectious diseases. When Henderson was taken ill special instructions were given to the foreman-cleaner of the shelter by the appellant, and in consequence more sulphur was burnt and for an hour longer than usual, and the disinfectant used was much stronger and more was used, and on Tuesday, the 26th, these additional and extra precautions were repeated. On the 25th and 26th, however, the premises were opened and persons admitted on the usual terms. On the 27th a registered medical practitioner acting on behalf of Mr. Booth, visited the premises and signed two certificates testifying that the premises had on the 25th and 26th of May been disinfected to his satisfaction, but he did not on either of those days visit the shelter or take any part in the usual daily cleansing and disinfecting. It was contended for the appellant that there was no letting, and that the certificates given were sufficient under the act. The Magistrate, however, thought otherwise and convicted, but stated the case to raise the questions, (a) whether there was a letting for hire of part of a house, and (b) whether the certificates were sufficient to satisfy the statute. Mr. Willis, Q.C. (with Mr. Munroe) appeared for the appellant, and contended that there was no "letting" of any part of the house. (Mr. Justice Wills—surely there was not. It was a mere license), Just so, No particular part was allotted to any man. (Mr. Justice Wills.—It is clearly a case in which the Act ought to apply but does not. Mr. Justice Wright.—Besides which certificates were given by a qualified medical practitioner.) That is so, and there is a daily disinfectant process. The case is not one within the enactment. Mr., Disturnal, who appeared for the inspector, the respondent, urged that there was 4&t letting; but the Court was clearly of the opposite opinion and said the case was hardly arguable. Appeal allowed and conviction set aside. 34 Parish of St. George the Martyr, Southwark. Report on Bakehouse Conference. In accordance with the instructions of your Health Committee, I have the honour to report on a Conference convened by your Vestry, and held on the 15th of October, 1894. Two delegates, together with the Medical Officer of Health, from each of the metropolitan Vestries and District Boards, were invited to discuss the present law regulating bakehouses. Your committee consulted me with regard to (a) the propositions to be brought before the notice of the conference ; (b) other suggestions of a general character. The following propositions, were submitted by me:— I. That the present state of the law relating to bakehouses requires amendment by the addition of the following clauses to the Public Heath (London) Act, 1891 (а) That uniform metropolitan bye-laws regulating the conduct of the retail bakeries be made by the London County Council, and be confirmed by the Local Government Board, and that the duty of enforcing these byelaws shall devolve upon the various Local Sanitary Authorities. (b) That such bye-laws shall cover the regulation of (1) The conduct of the business ; (2) the structure of the premises; (3) the mode in which application is to be made for the sanction to establish anew the business of a baker in the county of London. (c) That the portions of the bye-laws regulating the structure of bakehouses do not apply to existing bakeries until after the lapse of a certain number of years. (d) That it should be rendered an offence to occupy as a bakehouse any cellar or place almost or altogether below the level of the street, unless it had been so occupied before and up to a certain fixed date. (e)—(1) That all metropolitan bakehouses be compulsorily licensed, and that such license be renewable annually ; (2) that the granting of licenses be vested in the London County Council. II. That a clause be inserted in the bill, to amend and extend the law relating to factories and workshops now before Parliament, limiting the maximum number of hours of labour of adult bakers to 12 daily, i.e., 72 weekly. III. That a deputation consisting of delegates of this conference wait upon (a) the Secretary of State for the Home Department, and (b) the President of the Local Government Board and of the Board of Trade, to urge upon them the appointment of a Select Committee of the House of Commons to inquire into the sufficiency of the existing law relating to bakehouses. IV. That the question of compensation for disturbance of existing right in retail bakeries be taken into consideration by the Parliamentary Committee, and that the inquiry into the regulation of bakehouses should include the relations between the millers and the retail bakers. Your committee resolved to adopt these propositions verbatim with the two following exceptions:— (a) Clause 1, sub-section e. After recommending that all metropolitan bakehouses be compulsorily licensed it was decided to omit the words " and that such license be renewable annually." 35 Annual Report of the Medical Officer of Health—1894. (b) Proposition IV., touching the question of compensation for disturbance of existing right to be considered by a Parliamentary Committee, was rejected in toto. The remaining suggestions made by me to your committee were: (1) That if any lasting practical outcome of the conference was intended, and was of opinion that it was of paramount importance to invite as chairman a man such as Mr. R. K. Causton, M.P. for West Southwark, or Mr. John Burns, M.P., L.C.C.; (2) an offer was made by me to write during my holiday a short and as lucid a report as possible on the present state of the law relating to bakehouses, copies of which I suggested might be advantageously distributed to the nonmedical and non-legal delegates. Neither of these suggestions was adopted. Of the thirty-nine local authorities invited to attend the conference twenty-six accepted. These bodies, according to the signatures inscribed in a book provided for the purposes, were represented by fifty-one delegates. In addition to this number your Vestry sent Messrs. Neville and Loeber and your Medical Officer of Health. Amongst those present were fourteen medical officers, and a sanitary inspector sent by Bermondsey in lieu of their medical adviser. I was also able to identify twelve master bakers, but this number I have reason to believe did not include all the master bakers present, to say nothing of other delegates interested in the trade. The following authorities neither returned any answer nor sent any delegates in response to your Vestry's invitation:—Shoreditch, Mile End, Woolwich, Greenwich, Hackney, Limehouse, St. Saviour's Southwark, and Plumstead. Kensington and Paddington refused to take part in the conference on the plea that the L.C.C, was already dealing with the question. The former Vestry, I understand, addressed a circular letter to the Local Authorities of London informing them that Kensington intended keeping away from your conference. St. James's, Westminster, and Wandsworth also refused to attend on the ground that in their opinion the present law was sufficient to secure the proper regulation of bakehouses. The Vestry of St. George's, Hanover Square, acknowledged your letter, but was unrepresented at the conference. The presence and ripe experience of their medical officer, Professor Corfield, one of the highest authorities on house sanitation, was thus lost to the meeting. The Lancet, in an article which appeared on April 7th, 1894, in reference to statements made by Dr. Corfield, as well as by myself, says:— "The Medical Officer of Health of St. George's, Hanover Square, one of the richest quarters of London, stated before his Vestry that most of the bakehouses of his district were underground. They were insufficiently ventilated, and though the sanitary convenience did not actually open into the bakehouses, as was the case formerly, still the latter were affected by the foul air. We have visited bakehouses in both these districts (the two St. George's), and can confirm the accuracy of these statements." In the unavoidable absence from the conference of Dr. Bate, the medical officer of St. Matthew, Bethnal Green, the chairman of the Sanitary Committee gave a favourable account of the condition and conduct of the business of baking as he and his committee judged it to be within Bethnal Green. Dr. Bate, however, in his annual report for 1893 says:— "The total number of bakehouses under inspection is 106; about a dozen others were temporarily unoccupied at the time of my visit, and were therefore not inspected 36 Parish of St. George the Martyr, Southwark. by me. Forty-four of the bakehouses are underground, the remainder are situated in yards behind the shops. In the whole of the Parish I found only thirteen (a baker's dozen) in a fairly clean and satisfactory condition, the remainder were either dirty or badly ventilated. In twenty-eight the filthy custom of sweeping the refuse under the troughs has been continued, notwithstanding my strong remonstrances. Two of these were in such a state as to be absolutely unfit for use." With regard to the conference, I have to report to your Vestry the satisfactory result that the important resolution, No. 1 on the Agenda Paper, was passed by the delegates sent, by twenty-seven of the metropolitan sanitary authorities, and this with only three dissentient voices. The resolution was to the effect: "That the present state of the law relating to bakehouses requires amendment by the addition of the following clause to the Public Health (London) Act, 1891: 'That uniform metropolitan bye-laws regulating bakehouses be made by the L.C.C., and be confirmed by the Local Government Board, and that the duty of enforcing these bye-laws shall devolve upon the various local sanitary authorities.' " Other amendments and amendments of amendments of a minor character, which I was unable to follow, were also passed. Your Vestry clerk will doubtless furnish you in due course with a copy of these latter resolutions. In conclusion, I would advise that a copy of the resolutions passed be forwarded to—(a) The Local Government Board; (b) the Home Office; (c) the Board of Trade; (d) the London County Council; (e) the Metropolitan Vestries and District Board of Works, as well as to their Medical Officers of Health ; (/) Members of Parliament interested in the bakehouse question. The following paper sums up shortly the chief points that require attention in the construction of a wholesome bakehouse. It is quoted here in order that parishioners may form a clear idea of the needs and necessities of modern sanitation in this important matter. An Ideal Bakehouse.* " My Lords and Gentlemen, ' Of late the subject of unwholesome bakeries has attracted a good deal of public attention, but so far there has been little practical outcome to the agitation. Your Honorary Secretary, Mr. Lawrence, has asked us to read a short paper on sanitary bakehouses, a request to which we gladly accede, as we believe that anything which is likely to educate people generally in these matters cannot fail to be a step in the direction of reform. First of all we will give an outline sketch of an ideal bakehouse. "By the term 'ideal bakehouse' we mean a place for the making of bread, so constructed that it may be healthy for the workmen and be devoid of sources of contamination to the bread. It should, wherever possible, be above ground. Its walls should be furnished with a damp-proof course below the floor level, and by a 'dry area' or hollow space, so arranged as to prevent the soil coming into contact with the main building. Without these precautions it would be impossible to prevent dampness , especially where porous bricks are used in the construction. The inner surface of the walls should be smooth, non-absorbont, and made of some material that can be easily washed. These conditions may be fulfilled by using glazed bricks or tiles, or by a good lining plaster, such as the best Portland or Parian cement. * A paper read before the Church Sanitary Association at the Church House, Westminster, Nov. 13, 1894. Quoted in Chap. V. of "Bread, Bakehouses, and Bacteria," by Drs. Waldo and Walsh. 37 Annual Report of the Medical Officer of Health—1894. Whitewash over brick or plaster is undesirable, as it soon gets dirty, has a rough surface, and cannot be properly cleansed. "The floor should be of good concrete. Its surface should be made smooth and even with a layer of cement or with brick tiles, and there should be on no account a gulley-opening or sink in the floor. Any drain-pipe passing beneath the floor should be a foot or more below the concrete. The drain-pipes must be surrounded by at least six inches of concrete and all the joints made gastight with Portland cement. Better still, the pipes may be of iron, prepared by the Barff process or lined with Angus Smith's solution ; such pipes should be laid on concrete and cemented at the joints. "The roof should be ceiled with plaster, or witli tongued match-boarding, or with a smooth glazed material that can be periodically cleansed. "All the rooms in our ideal bakehouse should be light, airy, and lofty. Natural light should be obtained in the daytime from windows of good size reaching to the ceiling, and having an area not less than one-tenth of the floor-space Artificial light can be obtained from gas, preferably from incandescent lamps with ventilating outlets, or, best of all, from electric lamps. Airiness is secured by a proper system of ventilation. Where there is no ' cross ' ventilation—that is to say, where there is not a through current of air between windows in opposite external walls—some of the following means must be adopted. Inlets may be provided by the use of windows, Tobin's tubes, perforated bricks, Sherringham valves, Mc Kinnell's roof-ventilators, and other methods, but in all cases it is absolutely essential that they should be beyond the control of the workmen. Outlets must be through exit tubes or exhaust shafts, the draught of which may be created by waste heat from the furnace flue, by gas-burners, by a steam jet, or by a mechanically driven fan. In dusty situations the inlets may be furnished with filters of wire, gauze or other suitable material. Whatever the scheme of ventilation, it must be so arranged that the air of the bakery is renewed without draft at least three times in an hour. Loftiness is a point which must be to some extent regulated by the special circumstances of the case. It may, however, be stated generally, that in no case should the height between floor and ceiling be less than eight feet in every part. "The furnace, fire, and fuel should be outside the bakehouse, while the oven can be easily arranged to open inside. This plan of construction could be adopted only in in cases where there is a good system of ventilation. If found to be structurally impossible, so that there is a inside fire, the oven damper should be so made that the workman cannot cut off the whole of the flue, unless there be an alternative or " sulphur " flue to carry off the pent-up furnace fumes. The object of this precaution is to prevent the place being charged with poisonous products from the furnace when the baker closes the damper in order to save fuel as soon as his oven is hot. It has been remarked elsewhere that this effect may be rehearsed by any person curious on this point if he gets up a good fire in his sitting-room grate and then suddenly blocks the chimney by pulling down the register. In all cases coal and other fuel should be stored away from the bakehouse. "The water-supply should come from a tap connected directly with the rising main, and should not be drawn from a cistern, as such receptacles are often dirty and liable to pollution from sewer-gases. Filters are worse than useless. "Flour should be kept in a cool, dry place, away from the bakehouse. All empty sacks should be systematically cleansed, and not' be allowed to lie about in the bakehouse. "The dough-troughs should be of glazed iron, and movable. If made of wood, the inner surface must be perfectly smooth and free from cracks, so as to prevent the lodgment of dough and other putrescible matter. The best lining for a wooden trough is one made of zinc. " The loaves should be taken as soon as baked to a special bread or cooling room. 38 Parish of St. George the Martyr, Southwark. "Lavatory arrangements should be ample, including every facility for washing. At the same time this department should be cut off from direct communication with the bakehouse. "As to the breathing-space for workmen, we consider that, in view of the nature of the trade, there should be an allowance of at least 500 cubic feet for each adult. "The foregoing points embrace the main essentials of our ideal bakehouse. It will be noted that their adoption does not necessarily mean either that retail bakeries must be replaced by factories, or hand labour by machinery. Nor does it say that a properly constructed basement should not be used as a bakehouse. "With regard to underground bakeries, however, one absolutely indispensable feature is the presence of a clear and open area on at least two sides, preferably back and front. ■ If the other conditions as to lighting, ventilation, height, structure of walls, floor and roof, water-supply, construction of furnace, and drainage, be fulfilled, together with a proper provision of cubic space for workmen, there is no reason why a basement may not be used for making bread. At the same time it would be always better to place such workshops above ground wherever possible. Nor should the adaptation of an ordinary cellar to the purposes of a bakery be allowed under any conceivable circumstances. "As regards the areas, we would suggest that every bakehouse altogether below the general surface of the adjoining ground should have an outside area along its entire frontage; that the said area be properly drained and paved, be at least four feet in width in all parts, and extend to six inches below the level of the bakehouse floor. The second area, whether at back or side of the house, to be of similar construction, except that it may be three feet in width in all parts. In the case of basement bakehouses having two feet af their height above the general adjoining surface level, the width of the front area might also be reduced to three feet. The windows opening into these areas should reach to the top of the walls, and cover a superficies equal to one-tenth or more of floor space of the bakehouse, At the same time each window should be made to open in its upper half. "In dealing with the bakehouse question, beside the need of fixing structural and sanitary standards, there are other important points which call for consideration, such as, for example, the limitation of the hours of labour and the abolition of night work. "In this short paper the question has been considered mainly from the point of view of the bread producer. The importance of the matter to the bread consumer, on the other hand, has been advanced in a joint paper read at the last meeting of the British Medical Association, in which we showed that baking does not necessarily destroy the germs that may be contained in the dough. If the microbes, for instance, of typhoid fever and of tubercle were to gain admission to dough in a foul bakery, it is quite possible that they might be distributed to consumers in a condition capable of setting up disease. The regulation of bakeries, therefore, is a matter in which the well-being of the community may be far more closely involved than the master bakers would have us imagine. "In concluding, we would suggest that bakeries proved to be injurious to workmen and dangerous to consumers should be forthwith closed. The bakery must either (a) be reconstructed; (b) be removed to a back yard or to the top of the house ; or (c) the baker must find other quarters. The journeymen and the public must not go on suffering because a certain number of bakers have been permitted in the past to carry on their trade upon too scanty a capital. To allow such evils to continue would be to run counter to the accepted canon that it is a first duty of Government to look after the health of its citizens, In the enforcing of structural reforms we would throw the burden upon the ground landlord and on the house owners, unless, perhaps, where the occupier is in possession of a long lease, say of fourteen to twenly-one years, not less than ten of which are unexpired. 39 Annual Report of the Medical Officer of Health—1894. "We would offer the following practical conclusions-:— "1. In future all bakehouses, if underground, should be provided with back and front areas of good size, with concrete floors, damp-proof walls, full provision for light and ventilation, a height of at least eight feet, proper allowance of cubic space for workmen, separate water supply from the main, impermeable drains, and entire separation of lavatory arrangements. In short, that the sanitary conditions should reach a high modern standard. "2. That in future no building be allowed to be used as a bakery unless above ground or in a properly constructed basement, as above outlined. "3. That provision be made whereby the present cellar bakeries, which cannot be made to answer the above requirments, shall be abolished within a certain fixed time." * * * * * * (The following points are not purely sanitary, but are so closely connected with the bakehouse question as to merit careful consideration):— "4. That the present hours of labour are excessive and require limitation. "5. That night-work should, if possible, be done away with. "6. That the retail bakehouse industry, as at present conducted, might with advantage be included within the schedule of the dangerous trades." Note.—In cases where the front of the house abuts on the pavement and there is consequently no room for a basement area, we suggest the construction of a ' borrowed area,' full particulars of which will be shortly published. Report on the Falcon Court Area, with some Account of its Surroundings. In accordance with instructions, I, along with your delegates, have attended the conference invited by the Housing Committee of the London County Council. The object of the meeting was to discuss the advisability of a scheme to embrace the improvement, not only of the insanitary Falcon Court Area, but also of the neighbouring slum property. At this meeting, in answer to the Council's chairman, I stated that within a few weeks of my appointment as Medical Officer of Health to this Parish, my attention was directed by the Sanitary Committee to the Falcon Court Area, which is approached from the Borough Street by a couple of covered passages. One of these entries, measuring 2ft. 3in. in its widest part, will admit only one person at a time. The Falcon Court Area—as you are all probably aware—comprises Bird Cage Alley (also known as Mason's Building) and Falcon Court, a portion of the latter forming a block of back-to-back houses continuous with those situated on one side of the adjacent Brent's Court. Certain other of the houses in Falcon Court, forming the second row (none of which are "through" houses), abut directly upon those in Bird Cage Alley. This faulty structural arrangement effectually precludes any possibility of a through ventilation. The cellars of these houses contain the w.c.'s, ash-pails, and other sanitary conveniences. Thev are also used for washing and drying clothes. In addition to the 40 Parish of St. George the Martyr, Southwark. foregoing there are minor defects into which it is not necessary to enter. Suffice it to say that, after full consideration, I gave it as my opinion to the Sanitary Authority that the needs of the district would be best consulted by clearing the space and converting it into a modern recreation ground for children. This site could, of course, be fitted with simple gymnastic appliances, and reserved for the use of children. Other courts and alleys run parallel with those in the Falcon Court Area. They include Brent's Court, Adam's (now Eve) Place, Redcross Court, and Maypole Alley, and are composed of similar slum property. They are entered from the Borough High Street by means of covered passages, which are narrow and funnel-shaped. Here, again, the construction and grouping of houses in most cases effectually prevents a due admission of light and air. As might be expected, this neighbourhood forms a close refuge and theatre for the illicit occupations of thieves and prostitutes, as well as a nursery for the rearing of a race of children who are sickly and stunted, not less in mind than in body. The children who survive the blighting effect of this portion of slumland existence too often reproduce a similar progeny. In this way a number of helpless individuals have ultimately to depend. for their support upon the ratepayers. One outcome of this inquiry has been the certification by me from time to time to the Sanitary Authority of certain buildings as unfit for human habitation, under Part 2 of the Housing of the Working Classes Act, 1890. Of these dwelling-houses the magistrates have already granted closing orders for all except three, situate in Brent's Court, the backs of which have a party wall in common with a row in Falcon Court. These back-to-back houses still remain closed, it being impossible, in my opinion, to render them habitable. Closing orders have also been made in the case of two of the largest back-to back houses in Red Cross Court, housing thirteen families in as many rooms, and against two wooden shanties, situated in the same court, which latter have since been partially demolished. I have in addition certified, and the Vestry have applied for closing orders against the owners of aft the houses on the west side, including two of the worst on the opposite side of Adam's Place, as well as against certain houses at present standing in the narrow and winding cul de sac known as Maypole Alley. These cases are still sub judice. My opinion was asked at the last meeting of the Vestry regarding your recentlywritten letter, and also regarding a resolution of the Public Health Committee, both of which communications related to the "Falcon Court Area." My answer was as follows:— "I do not think the Home Secretary is at all likely to revoke his predecessor's decision as to preparing a scheme for dealing with the Falcon Court Area. "The Act of Parliament gives power to the County Council to proceed with the scheme at the cost (as to two-thirds) of the Vestry. My predecessor, Dr. Waterworth, initiated the dealing with this area, and I am personally of opinion that a larger scheme, to be carried out by the Council at the cost of the metropolis, would be preferable to a scheme dealing simply with Falcon Court. "In my opinion the best course would be for the Vestry to refer it to their officers to consider a scheme, or rather, in the words of the 39th Section of the Act, to direct them to prepare a scheme. My opinion is that instead of bringing up a scheme they would find it necessary to report that a reconstruction is not advisable for this area, and that a larger scheme of metropolitan importance, to be carried out by the London 41 Annual Report of the Medical Officer of Health—1894. County Council at the expense of the metropolis, would be appropriate. This would, I think, strengthen the Vestry's hands in approaching the County Council with a view to a more beneficial arrangement for our parish." So far I have received no instructions to assist in the preparation of any plans. I would venture to suggest, however, that a larger scheme, embracing the following courts, alleys, and buildings, in order running from west to east, and opening into the Borough High Street, might comprise:— (a) The Falcon Court Area, i.e., Maypole Alley and Falcon Court, including in the latter the obstructive common lodging-house, which is not officially included in the unhealthy area. (b) Sundry rod warehouses. (c) Brent's Court. (d) Adam's Place. (e) The Midland Railway Receiving Depot. (f) Messrs. Smith's Medicated Lozenge Manufactory. (g) Redcross Court, including a common lodging-house, in which upwards of 100 men and women are housed nightly. (h) Maypole Alley. This area is irregularly oblong in shape and borders upon the neighbouring district of St. Saviour and Christchurch Board of Works. Its two longer sides are bounded by the Borough High Street on the south, and by Redcross Street on the north, its shorter sides by Union Street on the east, and by the Marshalsea Road on the west. If this provisional scheme, after deliberation, were considered too ambitious in scope, or too costly in outlay, the alternative one of leaving Messrs. Smith's Manufactory and the Depot intact, so as to divide the area into two portions, might be adopted. Abundant dwelling accommodation for displaced persons of the working class from the Falcon Court or larger area could easily be provided in the vicinity. At the present time various building plots of ground are lying idle in the limits of this district. Two of these are in the Borough Road, within a distance of a quarter of a mile, and between forty and fifty empty tenements in the Queen's Model Buildings, Borough Road, which would be obtainable at low rentals. A reconstruction scheme for the larger area would, I believe, be in practice difficult of execution. Amongst other objections it would entail the purchase of expensive business houses facing the Borough High Street in order to open up existing approaches, and also at the same time to satisfy sanitary demands. Moreover, comparatively few healthy dwellings could be raised on the space that would be available, and I am doubtful, if hop or other warehouses were contructed, whether they would let at a remunerative rental. In conclusion, Gentlemen, my opinion is that the public health, not only of this small, poor, and heavily-rated Parish, but also that of the whole metropolis, would be distinctly improved and safe-guarded were the larger area converted into an open breathing space. The Parish, be it remembered, is bounded by no less than six important South London Districts, which are poorly provided with parks and open spaces as compared with other parts of the metropolis. At present the only open spaces within this district which are free to all comers are the small disused burial grounds of the 42 Parish of St. George the Martyr, Southwark. Parish Church of St. George the Martyr, and that of the "Lock," the latter of which is situated in the Old Kent Road, close to the ancient site of the leper-house, which existed in the thirteenth century. The pressing need of more opportunity for the gutter children of Southwark to enjoy healthy physical exercise and recreation in the open air is, I think, conclusively proved by the following facts:— (a.) This Parish is the most densely inhabited area in the whole of London, with over 210 persons living on every acre, and with an increasing population. (b) The general and zymotic death-rates are excessively high and partially preventable. (c) The significant and extreme rate of 188 deaths before the completion of the first year of life to every 1,000 births, and the percentage of 44.3 deaths under five years to the total number of deaths. (d) If any additional proof be needed in favour of the metropolitan nature of the proposed improvement, I have only to call attention to the fact that during the years 1863-4, 1864-5, 113 and 128 deaths occurred respectively within this Parish from typhus fever alone, and this without the inclusion of deaths of parishioners from the same complaint which took place in extra-parochial hospitals. Several of these deaths occurred, and much of the fever originated in the courts and alleys under report, the construction of which was materially the same thirty years ago as it is to-day. Typhus fever, a highly communicable and deadly affection, is often spread by means of infected clothes, and is mainly fostered by inefficient ventilation, overcrowding, bad feeding and, intemperance. These are the very factors most noticeable in the area under consideration. What applies to typhus fever refers with almost equal force to other preventable and catching diseases, the germs of which, whenever and wherever they find suitable soil, are liable to spread with disastrous effect throughout London in the houses of the rich as well as in those of the poor. It is a significant fact that the last death from Asiatic cholera which occurred in this Parish, during the epidemic of 1866, took place in Redcross Court, then known under the name of Redcross Place. F. J. WALDO, Medical Officer of Health. Vestry Hall, St, George the Martyr, Southwark. January, 1894. Metropolitan Ambulance Service. Stations within or near the parish, containing litters and stretchers, and provided by the Street Ambulance Branch of the Hospitals Association, for the transfer of sick and injured persons (infectious cases excepted) are situated as follows:— Marshalsea Road, at the junction of Mint Street. Fire Brigade Head Quarters, Southwark Bridge Road. Fire Brigade Station, Waterloo Road. St. Thomas's Hospital. Guy's Hospital, Southwark. All metropolitan patients suffering from small-pox, fevers, and diphtheria, may, on application, be conveyed to and fro, and treated free, within the isolation hospitals of the Asylums Board. 43 Annual Report of the Medical Officer of Health—1894. The Ambulance Station nearest the parish is the South-Eastern one, situate at the New Cross Road (near Old Kent Road Railway Station), S.E. Telephonic communication can be made from the Health Department (within office hours), to the chief office of the Asylums Board, and within a few minutes an ambulance will be on its way, for the conveyance of the patient to the South-Eastern Hospital (adjoining the South-Eastern Ambulance Station), if suffering from fever or diphtheria; or to the South Wharf, at Rotherhithe, if it be a case of small-pox. In the latter case, the patient will embark in one of the ambulance steamers for the hospital ships at Long Reach. . The Convalescent Hospitals, belonging to the Asylums Board, are two in number. That for fevers and diphtheria is sitated at Winchmore Hill, in the North-East of London; that for small-pox at Gore Farm, Darenth, distant about four miles from the hospital ships. Patients in a position to bear the expense of their support, and suffering from fevers and diphtheria, or small-pox, can be accommodated at the London Fever Hospital, Liverpool Road, Islington, and at the Highgate Small-pox Hospital, respectively. HOW TO BRING UP CHILDREN The following Rules are copied from the Pharmacopœia of the Hospital for Sick Children:— 1. Keep them warm. Let the clothing be warm (i.e., flannel or woollen), but not tight. Children should wear stockings nearly up to the knees, and frocks well up to the neck, with long sleeves. Give them plenty of fresh air ; take them out when the weather is fine. Wash the Child all over with warm water daily. If possible let the child sleep in a cot by itself. Open the windows at least twice a day. FOOD. 2. If the mother has plenty of breast-milk, the child should not have any other food whatever, until it is seven months old. It must be suckled every two hours during the first month, and the interval gradually increased, so that at the end of three months the child is suckled every three hours. Too frequent suckling is a common cause of the sickness of infants. 4. If the mother has only a little milk, let the child have it; and in addition milk mixed as directed in Rule 4. Except when ordered by a doctor, do not on any account give the child any baked flour, arrowroot, corn flour, biscuits, tops and bottoms, or any so-called "infant's food," before it is seven months old. It is a good plan, if the mother has only a little breast-milk, that she should drink a cupful of cow's milk half-an-hour before suckling. 4. If the child must be brought up entirely by hand, it should be fed out of a bottle with cow's milk warmed and diluted. Fresh cow's milk must be used : during the first month it must be diluted with at least twice as much water or, better still, with lime water* in the same proportion, if the milk be of good quality ; the addition of a table-spoonful of cream to each bottle when it can be obtained would render the mixture more nutritious. A small quantity of white sugar must be added to each bottle. As the child gets older, the proportion of milk must be gradually increased. The milk should always be boiled before being used. This is especially important in the case of infants under three months old, and in the summer. 5. If cow's milk cannot be digested after a fair trial, condensed milk may be given —one teaspoonful to four or five tablespoousful of water which has been boiled, but after a month another attempt should be made with fresh cow's milk. The best kind of bottle is the old-fashioned straight one, with an india-rubber teat, and without any * Barley Water is prepared as follows :—Two teaspoonsful of pearl barley to a pint of cold water, boiled down to two-thirds of a pint, and then strained through muslin. A fresh quantity must be prepared at least twice a day. 44 Parish of St. George the Martyr, Southwark. tube at all. It is quite impossible to prevent corks and tubes from becoming foul and turning the milk sour. When the child has finished its meal the bottle must be rinsed, and placed in clean water until again required. Once a day it should be carefully cleansed with hot water in which a little soda has been dissolved, and then rinsed with water and a few tea leaves. On no account must the milk that remains, after the child has finished, be used again. A fresh quantity must be prepared for each time of feeding. 6. When the child has reached the age of seven months it may have one or two meals a day of milk thickened with one or other of the following malted foods, viz., Allen & Hanbury's, Mellin's, Savory & Moore's, and Squire's. Or Chapman's entire wheaten flour may be used: to prepare this, make a teaspoonful of the flour into a paste with cold water, pour half a pint of boiling water on it, and let it simmer for twenty minutes, constantly stirring ; then add it to the milk, which must be warmed. The other meals should be of milk only. The amount of these foods used may be increased as the child grows older. As a rule the child should be gradually weaned at ten months old. At eight months the child may have broth or beef tea, in addition to the milk. At twelve months give the yolk of an egg lightly boiled or beaten up, or a little milk pudding. At eighteen months, give a little meat every day, scraped or pounded into soft pulp ; or a little mashed potato with gravy. Cheese, beer, or spirits should never be given to children. It is a great mistake to give children under two years old "just what the parents have." It is a great mistake to give them tea instead of milk. On no account give babies teething powders and soothing syrups. 45 Annual Report of the Medical Officer of Health—1894. APPENDIX B. Public Health (London) Act, 1891. BYE-LAWS, with respect to Houses let in Lodgings or occupied by Members of more than One Family, made by the above-named Vestry wider and in pursuance of the Public Health (London) Act, 1891. Interpretation of Teems. 1. In these bye-laws, unless the context otherwise requires, the following words and expressions have the meanings hereinafter respectively assigned to them; that is to say :— "Sanitary Authority" means the Vestry of the Parish of St. George the Martyr, Southwark. "Lodging-house" means a house or part of a house which is let in lodgings, or occupied by members of more than one family. "Landlord," in relation to a house or part of a house which is let in lodgings or occupied by members of more than one family, means the person (whatever may be the nature or extent of his interest in the premises) by whom, or on whose behalf, such house or part of a house is let in lodgings, or for occupation by members of more than one family, or who for the time being receives, or is entitled to receive, the profits arising from such letting. "Lodger," in relation to a house or part of a house which is let in lodgings or occupied by members of more than one family, means a person to whom any room or rooms in such house or part of a house may have been let as a lodging or for his use and occupation. Exempted Houses. 2. In either of the following cases a lodging-house shall be exempt from the Operation of these bye-laws; that is to say:— (a) Where the rent or charge payable by each lodger, and exclusive of any charge for use by such lodger of any furniture, is at a rate of seven shillings and sixpence (7s. 6d.) per week or upwards. (b) Where the rent or charge payable by each lodger, and inclusive of any charge for use by such lodger of any furniture is at a rate exceeding ten shillings and sixpence (10s. 6d.) per week. (a) For fixing the number of persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family. (b) For the registration of houses so let or occupied. (c) For the inspection of such houses. (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses. (e)For the cleansing and lime-washing at stated times of the premises. (f) For the taking of precautions in the case of any infectious disease. 46 Parish of St. George the Martyr, Southwark. 3. The landlord of a lodging-house, or a lodger therein, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of three hundred cubic feet of free air space for each person of an age exceeding ten years and of one hundred and fifty cubic feet of free air s ace for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is used exclusively for that purpose, and which is under the control of such landlord, or which has been let to such lodger, respectively, as the case may be. 4. The landlord of a lodging-house, or a lodger therein, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of four hundred cubic feet of free air space for each person of an age exceeding ten years, and of two hundred cubic fece of free air space for each person of an age not exceeding ten years to occupy at any one time, as a sleeping apartment, a room which is not used exclusively for that purpose, and which is under the control of such landlord, or which has been let to such lodger, respectively, as the case may be. 5. The landlord of a lodging-house within a period of fourteen days after he shall have been required by a notice in writing, signed by the Clerk to the Sanitary Authority, and duly served upon or delivered to such landlord, to supply information necessary for the registration of such house by the Sanitary Authority, shall himself, or by his agent duly authorised in that behalf, sign and furnish to the Sanitary Authority a true statement of the following particulars with respect to such house; that is to say:— (a) The total number of rooms in the house. (b) The total number of rooms let in lodgings or occupied by members of more than one family. (c) The manner of use of each room. (d) The number, age, and sex of the occupants of each room used for sleeping. (e) The christian name and the surname of the lessee of each room ; and (f) The amount of rent or charge per week payable by each lessee. 6. In any case where the landlord of a lodging-house occupies or resides in any part of the premises, such landlord, and in any case where the landlord of a lodging-house does not occupy or reside in any part of the premises, or retain a general possession or control of the premises, every lodger who is entitled to have or to exercise the control of the outer door of the premises shall at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Sanitary Authority in that behalf, afford any such officer free access to the interior of the premises for the purpose of inspection. 7. Every lodger in a lodging-house shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Sanitary Authority in that behalf, afford any such officer free access, for the purpose of inspection, to the interior of any room or rooms which may have been let to such lodger. 8. Where the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Sanitary Authority in that behalf, has, for the purpose of inspection, obtained access to the interior of a lodging-house, or to the interior of any room or rooms in such house, a person shall not wilfully obstruct any such officer in the inspection of any part of the premises, or, without reasonable excuse, neglect or refuse when required by any such officer, to render him such assistance as may be reasonably necessary for the purpose of such inspection. 9. In any case where a lodger in a lodging-house is entitled to the exclusive use of any court, court-yard, area, or other open space within the curtilage of the 47 Annual Report of the Medical Officer of Health—-1894. premises, such lodger and in any case where two or more lodgers in a lodging-house are entitled to the use in common of any court, court-yard, area, or other open space within the curtilage of the premises, the landlord shall cause such court, court-yard, area, or other open space to be thoroughly cleansed from time to time as often as may be requisite for the purpose of keeping the same in a cleanly condition. 10. The landlord of a lodging-house shall cause every drain or means of drainage with which any water-closet belonging to such house may communicate, to be maintained at all times in good order and efficient action. He shall also cause all such means of ventilation as may be provided in or in connection therewith, to be maintained at all times in good order. 11. Every lodger in a lodging-house shall cause all solid or liquid filth or refuse to be removed once at least in eyery day from every room which has been let to him, and shall once at least in every day cause every vessel, utensil, or other receptacle for such filth or refuse to be thoroughly cleansed. 12. In every case where a lodger in a lodging-house is entitled to the exclusive use of any staircase, landing, or passage in such house such lodger shall cause every part of such staircase, landing, or passage to be thoroughly cleansed from time to time as often as may be requisite. 13. A lodger in a lodging-house shall not cause or suffer any animal to be kept in any room which has been let to such lodger or elsewhere upon the premises in such a manner as to render the condition of such room or premises filthy. 14. The landlord of a lodging-house shall cause every common passage or staircase in such house to be thoroughly cleansed from time to time as often as may be requisite. 15. The landlord of a lodging-house shall in the first week of the month of April in every year cause every part of the premises to be cleansed. He shall at the same time, except in such cases as are hereinafter specified, cause every area, the interior surface of every ceiling, and the wall of every water-closet belonging to the premises, and the interior surface of every ceiling and the wall of every room, staircase, and prssage in the house to be thoroughly lime-washed. Provided that the foregoing requirements with respect to the lime-washing of the internal surface of the walls of rooms, staircases, and passages, shall not apply in any case where the internal surface of any wall is painted, or where the material of or with which such surface is constructed or covered is such as to render the limewashing thereof unsuitable or inexpedient, and where such surface is thoroughly cleansed, and the paint or other covering is renewed, if the renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition. 16. The landlord of a lodging-house shall provide adequate means of ventilation in or in connection with every common passage or staircase in such house, and shall cause such means of ventilation to be maintained at all times in good order. 17. The landlord of a lodging-house shall cause all such means of ventilation as may be provided in or in connection with any room in such house to be maintained at all times in good order. 18. In every case where, in pursuance of any statutory provision in that behalf, an order of a justice has been obtained for the removal from the lodging-house to a hospital of a person who is suffering from any dangerous infectious disease and is without proper lodging or accommodation, the landlord of such house, and the lodger to whom any room whereof such person may be an occupant has been let shall, on being informed of such order, forthwith take all such steps as may be requisite on the part of such landlord, and of such lodger, respectively, to secure the safe and prompt removal of such person in compliance with such order, and shall, in and about such removal, adopt all such precautions as, in accordance with any instructions which such landlord and such lodger, respectively may receive from the Medical Officer of Health of the Sanitary Authority, may be most suitable for the circumstances of the case. 48 Parish of St. George the Martyr, Southwark. Penalties. 19. Every person who shall offend against any of the foregoing bye-laws shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notioe of the offence from the Sanitary Authority. Provided, nevertheless, that the justices or Court before whom any complaint may be made or any proceedings may be taken in respect of any such offence, may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this bye-law. Regulations as to Furnishing Information Relative to the Condition of Patients, and as to the Visiting of Patients. Information as to Conditions of Patients:— 2. Upon the admission of a patient, a letter will be sent to the nearest known relative or friend, setting forth the state of the patient. Should any serious change for the worst take place, a letter will be sent daily to the relative or friend, stating how the patient is progressing; which letter will be continued until the patient is in such a condition as to render further comnications unnecessary. But should the patient become dangerously ill notice will be sent to the nearest known relative or intimate friend, with an intimation that the patient may be visited; and, at the discretion of the Medical Superintendent, arrangements may be made for the conveyance of the visitor to and from the hospital. 3. Enquires as to the conditions of patients must be made in writing to the Medical Superintendent, who will reply by return of post. It is very undesirable that friends of patients should personally make enquiries at the hospital. Visiting:— 4. The visiting of patients is limited to the nearest relatives and intimate friends of patients dangerously ill. One visit only will be allowed daily to each patient. Visits, which will not be allowed without the permission of the Medical Superintendent, are, as a rule, to be limited in duration to a quarter of an hour. In urgent and special cases, however, the Medical Superintendent is empowered to increase the number of visitors to two, and to extend the duration of the visit. 5. Visitors are warned that they run great risk in entering the hospitals. They are advised not to go into the wards of the small-pox hospitals without having been properly re-vaccinated, and if they reside where the case visited occurred, are earnestly requested to urge the remainder of the occupiers of such house to call at once on the Public Vaccinator (whose address can be obtained from any of the parish officers) for the purpose of being vaccinated. 6. Visitors are further advised not to enter the wards in any of the hospitals when in a weak state of health or in an exhausted condition, but to partake of a good meal before entering the hospital. They will be required when in the wards to carefully avoid touching the patient, or exposing themselves to his breath, or to the emanations from his skin; and will not be permitted to sit on the bed or handle the bed-clothes, but will be allowed to sit on a chair at the bedside at some little distance from the patient. 7. Visitors will also be required to wear a wrapper (to be provided by the Board) to cover their dress when in the wards, and to wash their hands and faces with carbolic soap and water before leaving the hospital, or to use such other mode of disinfection as may be directed by the Medical Superintendent. 8. Visitors are strongly urged not to enter any omnibus, tramcar, or other publio conveyance, immediately after leaving the hospital. 49 Annual Report of the Medical Officer of Health—1694. Regulations as to the Removal of Persons suffering from Infectious Diseases, &c. The Metropolitan Asylums Board has published the following set of regulations as to the removal of persons suffering from infectious diseases:— 1. Apply on week days between 9 a.m. and 8 p.m. to the chief offices. Postal address: Norfolk House, Norfolk Street, Strand, W.C. Telegraphic address: Asylums Board, London. Telephone number: 2587. (N.B.— Applications in the latter part of the day must be dispatched in time to reach the of/ices before 8. p.m.). At night, between 8 p.m. and 9 a.m., and on Sundays, Christmas Day and Good Friday, to the Ambulance Stations; Eastern Ambulance Station, Brooksby's Walk, Homerton, N.E.; SouthEastern Ambulance Station, New Cross-road (near Old Kent-road Railway Station) S.E.; Western Ambulance Station, Seagrave-road, Fulham, S.W. 2. Removal to the Board's Hospitals:— (а) Only persons suffering from small-pox, fevers, or diphtheria are admitted into the Board's Hospitals. (b) Every application must state the name, age, and full address of the patient, from what disease suffering, and, in cases of fever, the particular kind of fever; and also the name of the person making the application. (e) Unless a medical certificate be handed to the ambulance nurse, the patient will not be moved. (d) Patients should leave all valuables, money, &c., and all outside clothing at home; should wear body linen only, and be wrapped in the blankets provided for the purpose. (e) The ambulance nurse will leave at the house from which the patient is removed a notice stating the hospital to which the patient is to be taken, and a copy of the regulations as to visiting, &c. 3. Conveyance to other places:— (a) Persons suffering from any dangerous infectious disease may be conveyed by ambulance to places other than the Board's Hospitals. N.B.—Dangerous infectious diseases include the following: Smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlatina or scarlet fever, typhus, typhoid, enteric, relapsing, continued, and puerperal fevers, and measles. (b) Every application for an ambulance must state:— (i.) Name, sex, and age of patient. (ii.) Description of disease, and in the case of fever, the particular kind of fever. (iii.) Full address from which the patient is to be conveyed. (iv.) Full address to which the patient is to be conveyed. (c) The patient must be provided with a medical certificate of the nature of the disease, to be handed to the driver of the ambulance. (d) The charge for the hire of the ambulance, including (when the patient is over ten years of age) the services of a male attendant, is 5s. This amount must be paid to the driver, who will give an official receipt for the same. 50 Parish of St. George the Martyr, Southwark. (e) One person only will be allowed to accompany the patient, and such person may be conveyed back to the place from which the patient was conveyed. If desired, a nurse will be supplied at an additional charge 2s. 6d. for her services. (f) The ambulances may be sent outside the Metropolitan District only by special sanction of the Ambulance Committee, or of the Clerk to the Board, and in such cases an extra charge will be made of 1s. for every mile outside the metropolitan area. 4. The drivers of the Board's ambulances are not allowed to loiter on their journeys or to stop for refreshments on pain of instant dismissal. It is particularly requested that any breach of this regulation, or any neglect or incivility on the part of drivers, nurses, or attendants may be immediately reported. The servants of the Board are forbidden to accept any gratuities or refreshments. N.B.—PENALTY.—By Section 70 of the "Public Health (London) Act, 1891,'' it is enacted that- "It shall not be lawful for any owner or driver of a public "conveyance knowingly to convey, or for any other person knowingly to place "in any public conveyance, a person suffering from any dangerous infectious "disease, or for a person suffering from any such disease to enter any public "conveyance, and if he does so he shall be liable to a fine not exceeding TEN " POUNDS .'' 51 Annual Report of the Medical Officer of Health—1894. Copy of Placard Distributed Within the Parish on Small-pox and its Prevention. The best means of Preventing the Attack of the Disease, and of Stopping it when it has Broken Out. It is required by Law that every child be vaccinated within three months of its birth ; parents or persons in charge of infants are liable to prosecution and fines for omission. It cannot be too widely known that Vaccination is one of the best means of preventing an attack of Small-pox. All persons above twelve years of age should be Re-vaccinated. When Small-pox prevails in a family or neighbourhood, every person should be immediately Re-vaccinated. When an individual has Small-pox, everything should be done to separate the person attacked from those around. Since Small-pox is pre-eminently contagious in all stages of the disease every case should be at once removed to a Small-pox Hospital. If the patient be treated at home the sick-room should be cleared of all needless furniture, including woollen or other draperies, which serve to harbour the contagion. No person should be allowed to enter the room, except those who are attending upon the sick. Where persons have had Small-pox, whether they get well or die, the room in which they have been ill, and all articles therein should be disinfected. The inhabitants of the Parish who may at any time have any bedding or clothing which requires to be disinfected, are requested to give notice thereof, without delay, at the Vestry Hall, Borough Road; such articles will then be removed by the Officers of the Vestry, disinfected and returned without any charge whatever. F. J. WALDO, M.D., D.P.H., Medical Officer of Health. PUBLIC VACCINATORS. Dr. MATCHAM, 9, St. George's Circus. Every Monday at 2 o'clock. Dr. WILLS, 216, New Kent Road. Every Wednesday at 2 o'clock. Dr. JONES, 61, Nelson Square, Blackfriars Road. Every Friday at 2 o'clock. 52 Parish of St. George the Martyr, Southwark. Regulations for Bakehouses, Factory and Workshop Act, 1878 and Factory and Workshop Amendment Act, 1883. 1st.—All the inside walls of the rooms of such Bakehouse, and all the ceilings or tops of such rooms (whether such walls, ceilings, or tops be plastered or not) and all the passages and staircases of such Bakehouse shall either be painted with oil or varnished, or be limewashed, or be partly painted or varnished, and partly limewashed; where painted with oil or varnished, there shall be three coats of paint or varnish, and the paint or varnish shall be renewed once at least in every seven years, and shall be washed with hot water and soap once at least in every six months ; where limewashed, the limewashing shall be renewed once at least in every six months. A Bakehouse in which there is any contravention of this Section shall be deemed not to be kept in conformity with this Act. 2nd.—A place on the same level with a Bakehouse, and forming part of the same building, shall not be used as a sleeping place unless it is constructed as follows:— that is to say, unless it is effectually separated from an external glazed window of at least nine superficial feet in area, of which at least four and a half superficial feet are made to open for ventilation. Any person who lets or occupies, or continues to let or knowingly suffers to be occupied, any place contrary to this Section, shall be liable to a fine not exceeding for the first offence, twenty shillings, and for every subsequent offence five pounds. The Factory 3rd.—It shall not be lawful to let or suffer to be occupied as a Bakeand Work- shop Act,1883 house, or to occupy as a Bakehouse, any room or place which was not so let or occupied before the 1st June, 1883, unless the following Regulations are complied with :— (a) No water closet, earth closet, privy or ashpit shall be within or communicate directly with the Bakehouse. (b) Any cistern for supplying water to the Bakehouse shall be separate and distinct from any cistern for supplying water to a watercloset. (c) No drain or pipe for carrying off faecal or sewage matter shall have an opening within the Bakehouse. 4th.—Any room or place used as a Bakehouse (whether the same was or was not so used before the passing of this Act) is in such a state as to be, on sanitary grounds, unfit for use or occupation as a Bakehouse, the occupier of the Bakehouse shall be liable to a fine of forty shillings, and on a second or any subsequent conviction, five pounds. 5th.—Every person refusing or failing to allow the Sanitary Authority or their Officer to enter any premises in pursuance of those provisions, for the purpose of this Section, shall be subject to a fine of five pounds. FREDK. J. WALDO, M.D., D.P.H., Medical Officer of Health. N.B.—The Medical Officer of Health requests that the cleansing shall take ulace in April and October of each year. 53 Annual Report of the Medical Officer of Health—1894. Report of the Chief Sanitary Inspector. During the year 296 complaints of nuisances have been entered in the official register kept for that purpose. 31 notices have been served in respect to houses, and 36 notices in respect to tenements under "the Housing of the Working Classes Act, 1891" 86 inspections have been made relating to tenement houses under the Customs and Inland Revenue Acts. 38 inspections of houses newly erected or pulled down to or below the ground floor, and rebuilt during the year, and 38 water supply certificates granted, under Section 48 Public Health (London) Act, 1891. ADULTERATION ACTS, 1875—1887 and MARGARINE ACT, 1887. SAMPLES SUBMITTED TO THE PUBLIC ANALYST. Name of Sample. Margarine Adulterated. Unadulterated. Total. Milk - 15 21 36 Skimmed Milk - - 3 3 Butter — 4 23 27 Bread — — 3 3 Pepper — — 2 2 Coffee — — 3 3 Scotch Oatmeal — — 3 3 Irish Whiskey — — 2 2 Lard — — 1 1 Lucca Oil — — 1 1 Chocolate Candy — — 1 1 Margarine 3 - 3 Total 3 19 03 85 The above Table shows 21.1 per cent. of the samples to be to the prejudice of the Purchaser. 54 Parish of St. George the Martyr, Southwark. The samples purchased in the preceding year showed 25.6 per cent. Fines imposed for adulteration and contravention of the Margarine Acts, for the year amount to £106 0 0 Costs ordered to be paid 15 13 0 Total £121 13 0 Unsound Food Seized and Destroyed. 10 boxes of plaice, 281bs. of plaice, 2½ cases containing 197 rabbits, 16 baskets of cherries, 1 box of mackerel, 2 bushels of whelks, 23 pieces of pork, 99 pieces of mutton, and 1 turkey. Workshops. 41 workshops have been registered during the year, and 32 notices served in relation thereto. Summonses Issued During the Year. Adulteration 18 Contravention of Margarine Act 5 Factory and Workshops Act 6 Unsound food 6 Houses unfit for human habitation, H.W.C. Act 22 Nuisances, various 37 Unlawfully permitting houses to be occupied without water certificates 4 Not obeying magistrates orders 3 Contravention of County Council by-laws 1 Total 102 N.B.—A systematic bouse to house inspection is now being made throughout the parish. Bedding, &c., Disinfected. 432 lots of bedding have been disinfected during the year, viz.:— Scarlet Fever 243 Diphtheria 156 Typhoid Fever 27 Small-pox 6 Total 432 The infected apartments have also been fumigated with sulphur. 417 notices have been given to masters of infected dwellings,under Sections 62 and 65 Public Health (London) Act, 1891, and 311 notices, under Section 55, sub-Section 4 Public Health (London) Act, have been sent to head teachers of schools attended by any patient suffering from infectious diseases, or by any child who being an inmate of the same house as the patient is attending school. 55 Annual Report of the Medical Officer of Health—1894. APPENDIX C. Table I. Corrected Return of Cause of Death in the Registration Sub-Districts during the 52 Weeks ending December 31st, 1894. CAUSE OF DEATH. borough road london road Kent Road. I.—Specific, Febrile, or Zymotic Diseases. 1.—Miasmatic Diseases. Small-pox ... • • • ... Measles 41 29 31 Scarlet Fever (Scarlatina) 3 2 2 Diphtheria 20 6 8 Whooping-Cough 44 16 16 Typhus Fever ... ... ... Enteric or Typhoid Fever 5 1 2 Simple Continued and Ill-defined Fever 1 ... ... Influenza 3 2 ... Other Miasmatic Diseases ... ... ... 2.—Diarrhœal Diseases. Simple Cholera ... ... ... Diarrhœa, Dysentery 29 18 6 3.—Malarial Diseases. e. g., Remittent Fever, Ague) ... ... ... 4.—Zoogenous Diseases. Cowpox and effects of Vaccination ... ... • •• Other Diseases (e.g., Hydrophobia, Glanders, and Splenic Fever) ... ... ... 5.—Venereal Diseases. Syphilis 1 ... 2 Gonorrhœa, Stricture of Urethra ... ... ... 6.—Septic Diseases. Erysipelas 11 3 1 Pyæmia, Septicæmia ... ... ... Puerperal Fever ... ... ... II.—Parasitic Diseases. Thrush ... ... ... Hydatids and other Animal Parasitic Diseases ... ... ... III.—Dietic Diseases. Starvation and Want of Breast Milk 1 ... • • . Scurvy • •• • « • . . . Chronic Alcoholism, Delirium Tremens 3 ... 3 IV.— Constitutional Diseases. Rheumatic Fever and Rheumatism of the Heart. 4 3 2 Rheumatism 14 ... ... Gout ... ... ... Rickets 1 • • • 1 Cancer, Malignant Disease 3 2 6 Tabes Mesenterica 10 5 8 Tubercular Meningitis, Hydrocephalus 6 4 6 Phthisis 28 22 19 Other Tubercular and Scrofulous Diseases 14 8 14 Purpura, Hemorrhagic Diathesis ... • •• ... Anænna, Chlorosis, Leucocythæmia 12 ... ... Glycosuria, Diabetes, Mellitus • •• ... ... Other Constitutional Diseases 14 ... ... Carried forward 268 121 128 56 Parish of St. George the Martyr, Southwark Table I.—(Continued.) Corrected Return of Cause of Death in the Registration Sub-Districts during the 52 Weeks ending December 31st, 1894. CAUSE OF DEATH. Borough Road. London Road. Kent Road. Brought forward 268 121 128 V.—Developmental Diseases. Premature Birth 14 6 14 Atelectasis ... ... ... Congenital Malformations 4 ... 7 Old Age 9 8 12 VI.—Local Diseases. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes ... ... ... Apoplexy, Softening of Brain, Hemiplegia Brain Paralysis 8 9 2 Insanity, General Paralysis of the Insane ... ... 1 Epilepsy ... ... ... Convulsions 34 10 10 Laryngismus Stridulus (Spasm of Glottis) ... ... ... Paralysis Agitans. Paraplegia, Disease of Spinal Cord 1 ... ... Other Diseases of Nervous System 10 ... 3 2.—Diseases of Organs of Special Sense. (e.g., Ear, Eyes, and Nose) ... ... ... 3.—Diseases of Circulatory System. Endocarditis, Valvular Diseases of Heart 2 6 4 Pericarditis 12 12 19 Other Diseases of Heart 1 2 12 Aneurism ... ... ... Embolism, Thrombosis 1 ... 4 Other Diseases of Blood Vessels 14 ... 3 4.—Diseases of Respiratory System. Croup 2 1 1 Laryngitis 3 3 1 Bronchitis 60 71 81 Pneumonia 30 27 30 Pleurisy 5 1 2 Emphysema, Asthma 10 ... ... Other Diseases of Respiratory System 4 ... 1 5.—Diseases of Digestive System. Dentition 8 7 7 Tonsillitis, &c. 1 1 1 Diseases of Stomach 12 ... ... Enteritis 1 2 3 Peritonitis 4 ... 1 Obstructive Diseases of Intestines 1 ... ... Ascites ... ... ... Cirrhosis of Liver 6 ... 1 Jaundice and other Diseases of Liver 4 ... ... Other Diseases of Digestive System 3 ... ... 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... ... ... 7.—Diseases or Glandlike Organs of Uncertain Use. (e.g Bronchocele, Addison's Disease ... ... ... Carried forward 535 287 338 57 Annual Report of the Medical Officer of Health—1894. Table I.—(Continued). Corrected Return of Cause of Death in the Registration Sub-Districts during the 52 Weeks ending December 31st, 1894. CAUSE OF DEATH. Borough road. London road. Kent road. Brought forward 535 287 338 8.—Diseases of Urinaby System. Nephritis 1 1 2 Bright's Disease, Albuminuria ... ... ... Disease of Bladder and of Prostrate 4 ... ... Other Diseases of Urinary System 11 ... 2 9.—Diseases of reproductive System. (a) Of Organs of Generation). Male Organs ... ... ... Female Organs ... ... ... (B) Of Parturition. Abortion, Miscarriage 2 ... ... Puerperal Convulsions ... ... ... Placenta Prævia, Flooding ... ... ... Other Accidents of Child-birth 3 ... 5 10.—Diseases of Locomotive System. Caries, Necrosis 4 ... ... Arthritis, Ostitis, Periostitis 4 ... ... Other Diseases of Locomotive System 10 ... ... 11.—Diseases of Integumentary System. (e.g., Carbuncle, Phlegmon, Cellulitis) ... ... ... Other Diseases of Integumentary System VII.—Violence. 1.—Accident, Negligence, &c. Fracture and Contusion 6 4 3 Gunshot Wound 1 ... ... Cut, Stab ... ... ... Burn and Scald 4 3 2 Poison ... ... ... Drowning ... ... ... Suffocation 9 6 5 Hernia ... ... ... Deaths consequent on Surgical Operation 2 ... ... Otherwise ... ... ... 2.—Homicide. Murder and Manslaughter ... ... ... 3.—Suicide. Gunshot Wound 1 ... ... Cut, Stab ... ... ... Poison ... ... ... Drowning ... ... ... Hanging ... ... ... Otherwise ... ... ... 4.—Execution. Hanging ... ... ... Carried forward 597 301 856 58 Parish of St. George the Martyr, Southwark. Table I.—(Continued). Corrected Return of Cause of Death in the Registration Sub-Districts during the 52 Weeks ending December 31st, 1894. CAUSE OF DEATH. Borough road. London road. Kent road. Brought forward 697 301 356 YIII. — Deaths from Ill-defined and not Specified Causes. Dropsy 14 15 1 Debility, Atrophy, Inanition 44 2 8 Mortification 2 ... ... Tumour 3 3 ... Abscess 4 ... ... Hæmorrhage 4 ... 1 Sudden Death (cause not ascertained) 2 ... ... Found Dead (cause not stated) 1 ... ... Other Causes not Specified or Ill-defined 25 12 4 Totals 696 332 370 TABLE II. Summary of Return of Cause of Death (Corrected.) Cause of Death. Total. I.—Specific Febrile, or Zymotic Diseases:— 1. Miasmatic Diseases 232 2. Diarrhœal Diseases 63 5. Venereal Diseases 3 6. Septic Diseases 15 II.—Parasitic Diseases ... - III.-Dietic Diseases 7 IV.—Constitutional Diseases 106 V.—Developmental Diseases 134 VI.—Local Diseases:— 1. Diseases of Nervous System 88 2. Diseases of Organs of Special Sense ... 3. Diseases of Circulatory System 92 4. Diseases of Respiratory System 433 5. Diseases of Digestive System 115 8. Diseases of Urinary System 21 9. Diseases of Reproductive System:— Parturition 10 10. Diseases of Locomotive System 18 VII. —Violence:- Suicide, Accident, Negligence, &c. 45 VIII.—Deaths from ill-defined and not specified causes 116 Total 1,398 59 Annual Report of the Medical Officer of Health—1894. Table III. Corrected Return of Cause of Death of Infants under One Year in the Registration Sub-Districts during the 52 Weeks ending December 31st, 1894. CAUSE OP DEATH. borough road london road Kent Road. I.-Specific. Febrile, or Zymotic Diseases. 1.—Miasmatic Diseases. Small-pox - - - Measles 1 1 - Scarlet Fever (Scarlatina) - - - Diphtheria - - - Whooping-Cough 12 7 10 Typhus Fever - - - Enteric or Typhoid Fever - - - Simple Continued and Ill-defined Fever - - - Other Miasmatic Diseases - - - 2.—Diarrheal Diseases. Simple Cholera - - - Diarrhcea, Dysentery 28 10 l6 3.—Malarial Diseases. e.g., RemittentTever, Agu'eJ - - - 4.—Zoogenous Diseases. Cowpox and effects of Vaccination - - - Other Diseases (e.g., Hydrophobia, Glanders, and Splenic Fever) - - - 5.—Venereal Diseases. Syphilis - - - Gonorrhoea, Stricture of Urethra - - - 6.—Septic Diseases. Erysipelas - - - Pyaemia, Septicaemia - - - Puerperal Fever - - - II.—Parasitic Diseases. Thrush - - - Hydatids and other Animal Parasitic Diseases - - - III.—Dietic Diseases. Starvation and Want of Breast Milk - - - Scurvy - - - Chronic Alcoholism, Delirium Tremens - - - IV.—Constitutional Diseases. - - - Rheumatic Fevel- and Rheumatism of the Heart. - - - Rheumatism - - - Gout - - - Rickets - 1 - Cancer, Malignant Disease - - - Tabes Mesenterica 5 2 3 Tubercular Meningitis, Hydrocephalus 6 4 2 Phthisis - - - Other Tubercular and Scrofulous Diseases 5 "6 5 Purpura, Hemorrhagic Diathesis - - - Ansemia, Chlorosis, Leucoeythtemia - - - Glycosuria, Diabetes, Mellitus - - - Other Constitutional Diseases - - - Carried forward 57 31 36 60 Parish of St. George the Martyr, Southwark Table III.—(Continued.) Corrected Return of Cause of Death of Infants under One Yewr in the Registration Sub-Districts during the 52 Weeks ending Deceviber 31st, 1894. CAUSE OF DEATH. Borough Road. LONDON Road. Kent Road. Brought forward 57 31 36 V.—Developmental Diseases. Premature Birth 16 8 20 Atelectasis ... ... ... Congenital Malformations 2 ... ... Old Age ... ... ... VI.—Local Diseases. 1.—Diseases of Nervous System. ... ... ... Inflammation of Brain or Membranes ... ... ... Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... Insanity, General Paralysis of the Insane ... ... ... Epilepsy ... ... ... Convulsions 28 14 21 Laryngismus Stridulus (Spasm of Glottis) ... ... ... Paralysis Agitans. Paraplegia, Disease of Spinal Cord ... ... ... Other Diseases of Nervous System ... ... ... 2.—Diseases of Organs of Special Sense. {e.g., Ear, Eyes, and Nose) ... ... ... 3.—Diseases of Circulatory System. Endocarditis, Valvular Diseases of Heart ... ... ... Pericarditis ... ... ... Other Diseases of Heart ... ... ... Aneurism ... ... Embolism, Thrombosis ... ... ... Other Diseases of Blood Vessels ... ... ... 4.—Diseases of Respiratory System. Croup ... ... ... Laryngitis ... ... ... Bronchitis 16 15 13 Pneumonia 5 4 7 Pleurisy ... ... ... Emphysema, Asthma ... ... ... Other Diseases of Respiratory System ... ... ... 5—Diseases of Digestive System. Dentition 9 6 7 Tonsillitis, &c ... ... ... Diseases of Stomach ... ... ... Enteritis ... ... ... Peritonitis ... ... ... Obstructive Diseases of Intestines ... ... ... Ascites ... ... ... Cirrhosis of Liver ... ... ... Jaundice and other Diseases of Liver ... ... ... Other Diseases of Digestive System ... ... ... 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... ... ... 7—Diseases of Glandlike Organs of UNcertain Use. (e.g Bronchocele, Addison's Disease ... ... ... Carried forward 133 78 104 61 Annual Report of the Medical Officer of Health—1894. Table III.—(Continued). Corrected Return of Cause of Death of Infants under One Year in the Registration Sub-Districts during the 52 Weeks ending Deecmber 31st, 1894. CAUSE OF DEATH. Borough Road. London Road. Kent Road. Brought foirward 133 78 104 8.—Diseases of Urinary System. Nephritis ... ... ... Bright's Disease, Albuminuria ... ... ... Disease of Bladder and of Prostrate ... ... ... Other Diseases of Urinary System ... ... ... 9.—Diseases of Reproductive System. (A) Of Organs of Generation). Male Organs ... ... ... Female Organs ... ... ... (B) Of Parturition. Abortion, Miscarriage ... ... ... Puerperal Convulsions ... ... ... Placenta Previa, Flooding ... ... ... Other Accidents of Child-birth ... ... ... 10.—Diseases of Locomotive System. Caries, Necrosis ... ... ... Arthritis, Ostitis, Periostitis ... ... ... Other Diseases of Locomotive System ... ... ... 11.—Diseases of Integumentary System. [e.g., Carbuncle, Phlegmon, Cellulitis) ... ... ... Other Diseases of Integumentary System ... ... ... VII.—Violence. 1.—Accident, Negligence, &c. Fracture and Contusion ... ... ... Gunshot Wound ... ... ... Cut, Stab ... ... ... Burn and Scald ... ... ... Poison ... ... ... Drowning ... ... ... Suffocation ... ... ... Hernia ... ... ... Deaths consequent on Surgical Operation ... ... ... Otherwise ... ... ... 2.—Homicide. Murder and Manslaughter ... ... ... 3.—Suicide. Gunshot Wound ... ... ... Cut, Stab ... ... ... Poison ... ... ... Drowning ... ... ... Hanging ... ... ... Otherwise ... ... ... 4.—execution. Hanging ... ... ... Carried forward 143 82 110 62 Pariah of St. George the Martyr, Southwark. Table III.—(Continued). Corrected Return of Cause of Death of Infants under One Year in the Registration Sub-Districts during the 52 Weeks ending December 31st, 1894. CAUSE OF DEATH. Bobouqh Bo ad. London Bo/il). Kent Boad. Brought forward 143 82 110 VIII.—Deaths from Ill-defined and not Specified Causes. Dropsy - - - Debility, Atrophy, Inanition 41 16 31 Mortification - - - Tumour - - - Abscess - - - Hemorrhage - - - Sudden Death (cause not ascertained) - - - Found Dead (cause not stated) - - - Other Causes not Specified or Ill-defined 2 1 - Totals 186 99 141 63 Annual Report of the Medical Officer of Health—1894. TABLE V.—Zymotic Diseases, 1894. Street List of Gases and Deaths from the undermentioned Diseases. Locality. Small Pox. Erysipelas. Scarlet Fever. Diphtheria. Puerperal. Fever (Mostly Enteric or Typhoid.) Locality. Small Pox. Erysipelas.' Scarlet Fever. Diphtheria. Puerperal. Fever (Mostly Enteric or Typhoid.) Amicable ... ... ... ... ... ... Grotto-place ... ... ... ... ... ... Ann's Place ... ... 1 1 ... - Goldsmitli's-place ... ... ... ... ... ... Angel's Place ... ... ... ... ... ... Goodwin Buildings ... ... ... 1 ... Aldams Place ... ... 1 ... ... ... ... ... ...- ... ... Alfred Place ... ... ... ... ... ... Henshaw Street ... ... ... ... ... ... Afreton Street ... ... ... 2 ... ... Hayle's Street ... ... 3 5** ... ... Austral Street ... ... 2 2* ... ... Hender Road ... ... 2 ... ... ... Bangor Court ... 1 ... ... ... ... Hunters-Place ... ... ... ... Blackfriars Road ... ... 4* 4** ... 1 High Street ... 2 4 4** 1 Bath Street ... ... ... ... ... ... Herberts-place ... ... ... ... ... ... Barron's Place ... ... 1 ... ... ... Hill Street ... ... ... ... ... ... Bermondsey New Road ... ... 2 1 ... ... Harrow Street ... ... 1 ... ... ... Borough Road ... 1* 3 3* ... ... ... ... ... ... ... ... Buckenham Street ... ... 3 2 ... ... Ilfracombe Buildings ... ... ... ... ... ... Bront's Court ... ... 1 ... ... ... ... Brown's Building ... ... ... ... ... ... John's-place ... ... 2 ... ... ... Bean street ... ... ... ... ... ... Joiner Street ... ... ... ... ... ... Buckenham Square ... ... 2 2 ... ... John Street ... ... 1 ... ... ... Belvedere Place ... ... ... 1 ... ... Jubilee Buildings ... ... ... ... ... ... Brook Cottages ... ... ... ... ... ... James Street ... ... ... ... ... ... Boutcher's Place ... ... - - - - ... ... ... ... ... ... Burman Street ... ... 1 - - - Kell Street ... ... 3* 2* ... ... Blackhorse Yard ... ... ... ... ... ... King's Bench Walk ... ... ... ... ... ... Bethl'em Hospital ... ... ... ... ... ... King Street ... ... 2* ... ... ... Collinson Street ... 2 3* 2 ... ... King's Court ... ... ... ... ... ... Collier's Rents ... ... ... ... ... ... Kingslake Street ... ... ... ... ... ... CastleStreet ... ... ... ... ... ... ... ... ... ... ... ... Chatham Street ... ... 1 1 ... ... Lant Street ... ... - ... ... 1 Cornbury Street ... ... ... ... ... ... Lancaster- Street ... ... 3* 2 ... ... Clarendon Street ... ... ... 1 ... ... Lambeth Road ... ... 4 1 ... ... Charles Street ... ... ... ... ... ... Long Lane ... 1 4* 2 ... ... Cleghorn Cottages ... ... ... ... ... ... London Street ... ... 2 3 ... ... Crespin Street ... ... ... ... ... ... Lansdowne Place ... ... ... ... ... ... Chapel Court ... ... 2* ... ... ... Little Frederick Place ... ... ... ... ... ... Cook's Cottages ... ... ... ... ... ... Lant-place ... ... 1 1 ... ... Cross' Street \... ... ... ... ... ... Leyton Grove ... ... ... ... ... ... Cavendish Street ... ... ... ... ... ... Lant Street ... 1 2 1 ... ... Clifton Buildings ... 1 5** i ... ... London Road ... ... ... ... ... ... Chester Street ... ... ... ... ... ... Lombard Street ... ... ... ... ... ... Clarence Street ... ... ... ... ... ... Little Surrey Street ... ... ... ... ... ... Darwin Street ... 1 5** 3 ... ... Mardyke Street ... ... ... ... ... ... Duke Street ... ... ... ... ... ...- Montague Street ... ... ... ... ... ... Delph Street ... ... ... ... ... ... Mansfield Street ... ... ... 1 ... ... Dover Buildings ... 1 8*** 1 ... ... Marshall Street ... ... ... ... ... ... Dobb's Cross ... .... ... ... ... ... Market Street ...... ... ... ... ... ... Douglas Buildings ... ... 2* ... ... ... Mason Street ... 1 2 2* ... ... Disney Street ... ... ... ... ... ... Mai sball Buildings ... ... 1 ... ... ... Draper's Almhouses ... ... ... ... ... ... ... ... 1 ... ... ... East Street ... ... 1 ... ... ... Martin Street ... 2* 1 ... ... ... Earl Street ... ... ... 1 ... ... Marcia Road ... ... 2* ... ... ... Elliott's Row ... ... ... ... ... ... Mina Court ... ... ... ... ... ... Evelina Hospital ... ... 14 8 ... 1 Maypole Alley ... ... ... ... ... ... Etbam Street ... 1 5 ... ... ... Mina Road ... ... ... ... ... ... Elizabeth Cottages ... ... ... ... ... ... Madron Street ... ... 1 ... ... ... Fox's Buildings ... ... 2* ... Marshalsea Road ... ... ... ... ... ... Falstafl: Yard ... ... ... ... ... ... Milton T'rrae ... ... ... ... ... ... Falcon Court ... 1 2* ... ... ... 1 1 Francis-place ... ... ... 1 ... ... Newingtou Causeway - - 6** 4** - 1 Friar Street ... ... 3* ... ... ... New Kent Road ... ... ... ... ... ... Flint Street ... ... ... ... ... ... North Street ... ... ... ... ... ... Friar's-place ... ... ... 1 ... ... New Street ... ... ... ... ... ... Gable Cottages ... ... ... ... ... ... Nelson-piace Northampton Street ... ... ... ... ... 1 Gilbert Street ... ... ... ... ... ... Noel Street ... ... ... ... ... ... Gladstone Street ... ... 1 ... ... ... Garden Row ... ... 2 3* ... ... Old Kent Road ... ... 12** 4** ... ... Bray Street ... ... ... ... ... ... Orient Street ... ... 2 1 ... ... preen Street ... ... 1 ... ... ... Oswin Street ... 1 ... 1 ... ... Gun Street ... ... ... ... ... George Street ... ... ... ... ... ... Gaywood Street ... ... 1 1 ... 1 Providence-place ... ... ... ... ... Gilbert Court ... ... ... ... ... ... Peter Street ... ... ... ... ... ... The asterisks represent deatns ana tne numerals me raiai cases w eaun siresi. 64 Parish of St. George the Martyr, Southwark. TABLE V.—Zymotic Diseases, 1893.—(Continued.) Street List of Gases and Deaths from the undermentioned Diseases. Locality. Small Pox. Erysipelas. Scarlet Fever. Diphtheria. Puerperal. Fever (Mostly Enteric or Typhoid). Locality. Small Pox. Erysipelas. Scarlet Fever. Diphtheria. Puerperal. Fever (Mostly En teric or Typhoid) Peabody Square ... 1 9 4* ... ... Tennis Court ... ... ... ... ... ... Pocock Street ... ... 1 ... ... ... Tabard Street ... 1 4 2 ... ... Princess Street ... ... 3 ... ... 1 Tower Street ... ... ... ... ... ... Parliament Street ... ... ... ... ... ... Townsend Street ... ... ... ... ... ... Pitt Street ... ... ... ... ... ... Temple Street ... ... 2 1 ... ... Pleasanfc-place ... ... ... ... ... ... Toulmin Street ... ... ... ... ... ... Potier Street ... ... 3 ... ... ... Trinity Building ... ... 3 1 ... ... Paragon ... ... ... ... ... ... Thomas Place ... ... ... ... ... ... Quinn Square ... 8* 3* ... ... Quinn's Buildings ... 1 16** 7* 1 Upper Green Street ... ... ... ... ... ... Quinn Street ... ... 1 ... ... ... Union Street ... ... ... ... ... ... Quinn Court ... 1 1 ... ... Upper Mill Street ... ... ... ... ... ... Red Cow Alley ... ... ... ... ... Upper Grange Road ... ... ... ... ... ... Red Course Square ... ... ... ... ... ... Regent Street ... ... 1 ... ... ... Vine Yard ... ... ... ... ... ... Rephidim Street ... ... 1 1 ... ... Valentine-row ... ... 1 ... ... ... Rodney Street ... ... ... ... ... ... Victoria-place ... ... ... ... ... ... Red Cross-place ... ... ... ... ... ... ... ... ... ... ... ... Russell-place ... ... 1 ... ... ... Waleran Bullding ... 1 12** 3* ... ... Richmond Street ... ... ... ... ... ... Westminstoer Bridge-road ... 1 14** ... ... ... ... ... ... ... ... ... Warwick Street ... ... ... ... ... ... St. George's place ... ... ... ... ... ... Weston Street ... ... 6** 4* ... ... Spiller's Court ... ... ... ... ... ... Webber Street ... 1 2 1 ... ... Stephen place ... ... ... ... ... ... Warner Street ... ... ... 1 ... 1 Stephen's Square ... ... 2 1 ... ... William Street ... 1 2 ... ... ... Suffolk Street 1 8* 3 ... ... Warwick Square ... ... ... ... ... ... St. George's place ... ... ... ... ... ... Waterloo Road ... ... ... ... ... ... Southwark Bridge Road ... ... ... 1 ... ... Wellington-place ... ... ... ... ... ... Smyrk's Road ... ... 10* 2* ... Westcott Street ... ... ... ... ... ... Streey Road ... ... ... ... ... ... Wickliam-place ... ... ... ... ... ... Streey Street ... ... 1 ... ... ... Wilmott's Buildings ... ... ... ... ... ... Staple Street ... ... 1 ... ... ... Walker Street ... ... ... ... ... ... Surrey Street ... ... ... ... ... ... West Square ... ... 6** 3* ... ... St. George's Market ... ... ... ... ... ... West-place ... ... ... ... ... ... Stamford place ... ... ... ... ... ... Webber-row ... ... ... ... ... ... Sturge Street ... ... ... ... ... ... Whitecross Street ... ... ... ... ... ... Swan place ... ... 8* ... ... ... Wickham Place ... ... ... ... ... ... St. George's Buildings ... ... 1 ... ... ... Surrey Buildings ... ... 1 ... ... ... ... ... 10** ... ... ... Young's Buildings ... ... ... ... ... ... Surrey Square ... ... 1 ... ... ... York Street ... ... ... ... ... ... St. Mary's Place ... ... ... ... ... ... Sussex House ... ... ... ... ... ... The asterisks represent deaths and the numerals the total cases in each street. 65 Annual Report of the Medical Officer of Health—1894. Report of Work done in WARD No. I. Mr. J. WEATHEEITT, Assoc. San. Inst., Sanitary Inspector. House Drains reconstructed and ventilated 77 Drains amended Drains freed 33 Rainwater Stack-pipes and Sink-pipes disconnected or repaired 166 Water-closets supplied with water, or repaired 375 Dust Bins provided or repaired 192 Dust Shoots removed from the inside of living rooms 52 Yards paved or repaired 135 Ventilation provided to the floors of ground floor rooms 162 Floors renewed or repaired 107 Houses cleaned throughout 150 Houses partly cleansed 146 Washhouse floors paved or repaired 20 Eoofs repaired 24 Water provided to dwelling houses 89 Water fittings repaired 16 Water Tanks covered or repaired 6 Houses closed 28 Overcrowding nuisance abated 6 Animals improperly kept 2 Dung receptacles provided 11 Offensive accumulations removed 5 Slaughter-house inspected 1 Cat gut premises inspected 1 Cowsheds inspected 2 Bakehouses inspected 22 Miscellaneous cases 148 Total 2111 House to house inspection 303 Other inspections 589 Re-Visits 1990 Intimations served 540 Official Notices served 438 66 Parish of St. George the Martyr, Southwark. Report of Work done in WARD No. II. Mr. J. A. ANSCOMBE, Sanitary Inspector. Interior of houses cleaned throughout 211 Do. do. partly 280 Exteriors of houses repaired 167 Water-closets and Drains cleansed 66 Water-closets repaired and put into proper order 26 Water-closets supplied with water 71 WTater-closets—New Structures 25 Water-closets and Drains ventilated 68 Through Ventilation under floors 65 Drains neWto houses 17 Drains amended 56 Gulley Traps to Drains fixed 293 Sink and Stack-pipes disconnected from Drains 188 Rain-water pipes and gutters put into proper order 36 Paving to yards put into.proper order 253 Water service pipes repaired 71 Water Cisterns cleaned out and repaired 103 Water Cisterns—new supplied 5 Water laid on from main for drinking purposes 48 Overcrowding in rooms abated 31 Unlawful occupation of underground rooms discontinued 2 Cesspools abolished 6 Boundary walls aud,premises lime-washed 258 Animals improperly kept (discontinued) 50 Bemoval of offensive matter 50 Slaughter-house inspected l Bake-hoageS inspected 10 Smoke abatements discontinued 6 Receptacles supplied for manure 6 Miscellaneous cases abated 82 Total 2508 House to house inspection 536 Other inspections 302 Re-visits (of works in progress) 1463 Intimations served 523 Official notices served 373 Annual Report of the Medical Officer of Health—1894. Report of Work done in WARD No. III. Mr. F. H. MITCHENEE, Sanitary Inspector. House drains reconstructed 81 Drains amended 121 Drains freed 17 Drains ventilated 69 Cesspools abolished 3 Rain water pipes disconnected from the drain 28 Waste pipes of sinks disconnected from the drain 21 Closet pan and traps fixed 34 Closets supplied with water 107 New closets constructed 28 Yards and washhouses paved and repaired 226 Water supply for domestic purposes provided 16 Water receptacles repaired and cleansed 22 Houses cleansed and whitewashed 196 Tenements cleansed and whitewashed 207 Dust-bins provided 142 Dust-bins repaired 5 Roofs repaired 39 Boundary walls limewashed 21 Floor spaces ventilated 39 Overcrowding abated 24 Manure receptacles provided 4 Smoke nuisances abated 3 Animals improperly kept 12 Offensive accumulations removed 39 Horse slaughterers premises inspected 1 Slaughter-houses inspected 4 Cowhouse inspected 1 Bakehouses inspected 26 Houses closed as unfit for human habitation 11 Miscellaneous improvements 120 Total 1667 House to house inspections 493 Other inspections 421 Re visits 1934 Intimations served 701 Official notices issued 321 JOHN EDWARDS, Assoc. San. Inst., Chief Sanitary Inspector. 67 58 Parish of St. George the Martyr, Sduthwark. PUBLIC HEALTH DEPARTMENT. The Streets and Houses therein, on the Parish Boundary. Alfreton Street 1 to 31 odd Nos.; 2 to 32 even Nos. Ann's Place (now Falka Place) To-wer-st. 17 and 18.- Austral Street 1 to 15 and Orphan's Home. Bermondsey New Boad 1 to 19 odd Nos.; 2 to 14 even Nos. Blackfriars Boad 96 to 172. Bland Street No. 46. Boro' High Street 151 to 221 odd Nos.; 74 to 302 even Nos. Bowling Green Lane 1, 3 to 6. Chatham Street 113 to 159 odd Nos.; 94 to 118 even Nos. Darwin Street 1 to 71 odd Nos.; 22 to 42 even Nos. "Bee Hive" Cottages, Deverill Street 1, 2, and 3. East Street 301 to 323 odd Nos.; 334 to 354 eves Nos. Elliott's Bow 7 to 67. Gloucester Street 29 and 30. Great Guildford. Street 4$, 50, 53, and 55. Great Suffolk Street 1 to 141, odd Nos.; 2 to 142a even Nos. Great Dover Street 107 to 110. Henshaw Street, Chatham Place 79, 80, 81, and 82. Hayles Street 1 to 52. John Street (now Leroy Street) 4 to 20. Kinglake Street 1 to 21 odd Nos.; 2 to 8 even Nos. Lamlash Street 1, 2, 3, 4, 10, 9, 8, 11, 12. Lambeth Boad 2.to 92 & Blind School & Bethlem Hospital. Long Lane 1 to 67 odd Nos.; 16 to 54 even Nos. Mason Street 1 to 31. Mina Road 1 to 17 odd Nos.; 2 to 28 even Nos. Newcomen Street No. 70. New Kent Boad 2.11 to 597 odd Nos.; 182 to 246 even Nos. Newington Butts 2 to 22 even Nos, Newington Causeway 2 to 140 even Nos. Old Kent Boad 1 to 279 odd Nos.; 2 to 308 even Nos. Oswip Street 2 to 52 even Nos.; 1 to 43 odd Nos. Peter Street 1 and 2, and 8 to 29- Potier Street 9 to 19. Bedcross Street 79 to 103 odd Nos.; 64| to 80 even Nos. Short Street (now Emery Street) 1 and 2. Smyrks Boad 1 to 21 odd Nos.; 2 to 26 even Nos. 2, Staple Street 70 to 28. 1, Southwark Bridge Boad 115, 131 to 157, 191 to 197, 201, 205 to 223 231 to 273 odd Nos.; 68 to 94, 98 to 130, 134 to 140, 144 to 162a, 164 to 228 even Nos. Orient Street 2 to 16 even Nos.; 1 to 47 odd Nos. Surrey Square 1a, 2, and 3|. Tabard Street All odd Nos. and 302. Temple Street 3 to 41, and 1 to 34. Townsend Street 1 to 34. Union Street 1 to 25 odd Nos.; 2 to 18 even Nos. Upper Grange Boad 94 to 106 even Nos. only. Waterloo Boad 169 to 275 odd Nos.; 226 to 300 even Noa. Westminster Bridge Boad 4 and 6,10 to 82 even Nos.; 1 to 59 odd Nos. Weston Street 219 to 235,263 to 293 odd; 174 to 210even. White Cross Street 1 and 2. Annual Report of tlie Medical Officer of Health—1894. 69 CONTENTS. SECTION I.—STATISTICAL Births and Birth Bate for 1894 4 Deaths and Death Bate for 1894 5 Death Bate per 1000 for 1894 6 Deaths in Public Institutions 7 Death Bate of Sub-Districts 7 Density of Population 7 Zymotic or Preventable Death Bate 8 » Zymotic Disease Mortality 9 Measles 10 Notification of Measles 10 Salvation Army Shelter 10 Mortality of Infants and Children 12 Diseases Causing Infant Mortality. 13 Comparative Analysis of Deaths in South London District 15 Customs and Inland Bevenue Acts, 1890 15 Housing of the Working Classes Act . 16 Table of Deaths during 1894 18 Table of Population, Births, and New Cases 19 SECTION II.—GENEBAL:— Factory and Workshops Act, 1891 20 Mortuary and Coroner's Court 20 Notification of Infectious Diseases 20 Slaughter Houses ftttd Knacbtr's Yards 21 The Cowhouses 22 List of Bakehouses 22 Beturn of Begistered Common Lodging Houses 23 Houses Lfet in Lodgings 23 Bakehouses 24 Falcon Court and Neighbourhood 25 Proposed Beception House 25 Uniform Death Bates 26 House to House Inspection 27 -Common Lodging Houses 29 70 Parish of St. George the Martyr, Southwark. CONTENTS—(Continued.) Sanitary Inspectors ... ... 29 Disinfection ... ... 30 APPENDIX A :— Booth v. Ferritt 31 Colclough v. Edwards 32 Report on Bakehouse Conference 34 An Ideal Bakehouses 36 Report on the Falcon Court Area, with some Account of its surroundings 39 Metropolitan Ambulance Service 42 How to bring up Children 43 APPENDIX B:- Bye-Laws under the Public Health (London Act, 1891) 45 Regulations as to Furnishing information Relative to the Condition of Patients, and as to the Visiting of Patients 48 Regulations for the Removal of Persons suffering from Infectious Diseases 49 Small-Pox and its Prevention 51 Regulations for Bakehouses 52 Report of the Chief Sanitary Inspector 53 Unsound Food Seized and Destroyed 54 Workshops 54 Summonses Issued during the year 54 Bedding, Ac Disinfected 54 APPENDIX C:— Return of Cause of Death in the Registration Sub-Districts 55- Summary of Return of Cause of Death 58 Return of Cause of Death of Infants in the Registration Sub-Districts 59 Zymotic Diseases—Street List of Cases and Deaths 63 Report of Work done in Ward 1 65 „ „ Ward 2 66 „ Ward 3 67 Street Boundaries 68 Return of' Pulled-Down, Closed & Uninhabitable Property IN THE PARISH OF ST. GEORGE THE MARTYR, SOUTHWARK. WARD 1. Situation of Property. dumber of Houses. People Displaced. Year. Rateable Value. Total Rateable Value. @ in the £. Yearly loss to Parish. 1 ?; 3 Three Years loss to the Parish. 222 to 224, Borough High Street 2 8 1892 £. 147 £. £ s. d. £ s. d. 87, Webber Row 1 4 26 205 to 222, Southwark Bridge Road (Basements) 9 36 117 46, Tower Street 1 4 20 2 to 6, Redcross Place 3 12 46 Artizan's Dwellings 221 Ground Hill Street 25 1 to 7, Pontypool Place 7 28 44 56, Lant Street 1 4 17 18, Tower Street 1 4 27 6a to 12, Borough Road 7 28 235 8 and 9, New Street 2 8 84 48, Dodson Street 1 4 26 15 to 27, Silex Street, 15 to 43, Gun Street, 41 to 56, Miniver Street, 10 to 14, and 14i King's Bench Walk, 1 to 4, Reddin's Court, 38 to 45, Green Street, 1 to 10, Mason's Buildings, and 1 to 4, Back Court 91 364 1893 693 1728 6/8 576 0 0 1728 0 0 42, Warwick Street, 42a, Little Surrey Street, 2, Friar Street, 12 and 13, Green Street, 1 to 3, Pocock Street, 170 to 172, Blackfriars Road, and 35 and 37, Tower Street 13 52 434 10, Redcross Place, 7 to 11, and 2 to 10, King James Street, 38, Warwick Street, and 47, Little Surrey Street 11 44 1894 125 559 6/4 177 0 4 354 0 8 51 to 61, Friar Street, 41 to 32, Hill Street, 2 to 4, an<l SI, Green Street, and 1 to 7, Chadwell Court 31 124 371 6 to 9, Green Street, 1 to 15, Friar Street, 154 to 155, Blackfriars Road, 29a, Green 'Street, ■1 ~ • ^uEb'ei' "Row, and 49, 50, 51, 54 to 58, and 65, to 67»)Dodson Street 41 164 562 25 to 29, Gerridge Street, 20, King's Bench Walk, 256, Waterloo Road, 1, Little Surrey Street, 53, Webber Row, and Alms Houses, Hill Street (Rowland Hill's) 8 32 211 44, 44a,. 45 to ,50a, and 46. Webber Row, 130 to 1,32. "Rla.ckfria.rs Road. 25 and 26, Warwick Street. T7 to S"?. and 25a to 31, New Street, 10, 11, ancl 29, T-Treen Street, 43 to 45, Friar Street, 4 to 13, Valentine Place, 1 to 4, John's Place, 1, Jonathan Place, 1 to 4, Emmett's Buildings, and 1 to 13, Spiller's Court, 276 to 282, Waterloo Road, 2 and 4, Boucher Place, and 45, Tower Street 71 284 981 99 to 103, Redcross Street and Disney Street, 74, Webber Street, and 34, Tower Street 6 24 153 86, Webber Row, 60 to 70 Lancaster Street, 21 to 29, Borough Road 16 64 407 2685 6/6 872 12 6 872 12 6 323 1292 4972 £1625 12 10 £2954 13 2 Return of Pulled-Down, Closed and Uninhabitable Property—Continued. WARD 2. 1 Situation of Property. Number ol Houses. People Displaced. Year. Rateable Value. Total Rateable Value @ in the £. Yearly loss to Parish. Three Years loss to the Parish. 1, Parliament Street, 33 to 47, Garden Row 9 36 1892 £ 199 £ £ s. d. £ s. d. House and Shed, Market Eow 2 8 17 2 to 18, Burman Street, 1 to 6, Edmond's Court, 7 to 13, Union Court, 14 to 19, Bird-in-Hand Court, 1 to 20, Alfred's Place, 1 to 4, James Court, and 1, Smith's Court 53 212 568 3 and 4, Providence Place, School, Westminster Bridge Eoad, and 17, Dantzic Street 4 16 142 7 to 15, and 19 to 23, Garden Row 8 32 198 18 to 30, Kell Street, and 45 to 55, Ontario Street 19 76 255 1379 6/8 459 13 4 1379 0 0 1 to 11, Kell Street 11 44 1893 130 130 6/4 41 3 4 82 6 8 13 to 19, Elliott's Row, 82 to 90, St. George's Road, 38, and 44 to 50, Earl Street 10 40 1894 427 427 6/6 138 15 6 138 15 6 116 464 1936 £639 12 2 £1600 2 2 WARD 3. Situation of Property. Number of Houses. People Displaced. Year. Rateable Value. Total Rateable Value. @ in the £. Yearly loss I,, Parish. Three Years loss tc the Parish. 10 to 12, and 18 to 20, Pardoner Street, 9 to 11 and 223 to 227, Tabard Street 11 44 1892 159 159 6/8 £ s. d. 53 0 0 £ s. d. 159 0 0 1 to 45, Trinity Buildings 45 180 1893 304 304 6/4 96 5 4 192 10 8 Queen's Buildings—Basements 50 200 1894 388 1 to 12, Victoria Place, 174 to 176, Weston Street, (Hatch Cottage) 14 56 115 4 to 20, Leroy Street, 1 to 14, Jane Place, 47 to 49, (Jamelot Street, and Vtl to 173, Tabard Street 29 116 390 893 6/6 290 4 6 290 4 6 149 596 1356 439 9 10 641 15 2 SUMMARY OF WARDS. Situation of Property. Number of Houses. People Displaced Year. Rateable Value. Total Rateable Value. @ in the £. Yearly loss to Parish. Three Years loss to the Parish. WARD 1 323 1292 4972 £ 3. d. 1625 12 10 £ s. d. 2954 13 2 „ 2 116 464 1936 639 12 2 1600 2 2 „ 3 149 596 1356 439 9 10 641 15 2 588 2352 8264 £2704 14 10 £5196 10 6 TOTALS FOR THE PARISH. Houses pulled down, closed and uninhabitable 588 People displaced (average 4 persons per house) 2352 Loss in Rates, 1894-5 2704 14 10 Loss in Rates in three years, 1892-5 £5196 10 6 Last year's loss to the Parish was £2704 14s. 10d., but as the rates will be much higher this financial year—the loss will be greater in proportion. The above list does not include the large number of houses and places of business that are now unoccupied and to let. May 7th, 1895, A. MILLAR, Vestry Clerk. PARISH OP ST. GEORGE THE MARTYR SOUTHWARK. RETURN OF Cioseti AND fBitiirijabttafcle $ri)pertp» A. MILLAR, Vestry Clerk. May, 1895. 100/2/5/95.