Vestry of St. George the Martyr, SOUTHWARK. Annual Report FOR 1900 of the Medical Officer of Health, F. J. WALDO, M.A., M.D. (Cantab.), Barrister-at-Law. 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 and of the sanitary institute ; 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. milroy lecturer to the royal college of physicians of london. VESTRY HALL, BOROUGH ROAD, SOUTHWARK. 1901. T. Cornell & Sons, Printers, 63, Borough Road, S.E. LIST OF OFFICERS of the PUBLIC HEALTH DEPARTMENT of the Parish of St. George the Martyr, SOUTHWARK. Medical Officee of Health : FREDERICK J. WALDO, M.D., D.P.H. Vestry Hall Public Analyst : Dr. J. MUTER, F.R.S., Edin., F.I.C., F.C.S. 325, Kennington Road Chief Sanitary Inspector : JAMES WEATHERITT Vestry Hall District Inspectors : JOSHUA OWNER, Ward I. Vestry Hall ROBERT SIMPSON, Ward II. Vestry Hall PHILIP DAVID, Ward III. Vestry Hall Miss ANNIE ELLIOTT (Insp. Houses Let in Lodgings, &c.) Vestry Hall Miss EMILY WILKIN „ „ Vestry Hall Miss S. E. MOFFATT (Health Insp. and Sanitary Officer) Vestry Hall Sanitary Clerk : ERNEST OWEN JONES Vestry Hall Caretakers of Reception House : W. R. AYLMER and Wife Superintending Disinfector : W. R. AYLMER Disinfector : WILLIAM THOMAS Vestry Hall Mortuary Attendant and Assistant Disinfector : HENRY LYNCH Vestry Hall ANNUAL REPORT ON THE SANITARY CONDITION OF THE PARISH OF ST. GEORGE THE MARTYR, SOUTHWARK, FOR THE YEAR, 1900, BY THE MEDICAL OFFICER OF HEALTH. To the Mayor and Council of the Borough of Southwark. SECTION I— STATISTICAL. Mr. Mayor and Gentlemen, The ninth Annual Report, which I now submit, treats of the sanitary condition and environment, for the year 1900, of one of the most densely populated districts in London, and indeed for that matter, in the United Kingdom.* The circumstances under which this Report is presented are peculiar, inasmuch as under the New London Government Act, 1899, this is the last Annual Report of the Parish of St. George the Martyr, now merged in the new Borough of Southwark, that I shall have the honour of submitting. 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 acres. The roads and streets, as returned to the end of 1900, measure 19 miles 5 furlongs 14 poles. •According to the 1896 census Whitechapel heads the list with 220 per acre, and St. George the Martyr stands next with 212. 4 Boundaries.—The parish, in shape somewhat like a hatchet, merges upon 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 subsoil of Southwark consists of porous "made" earth, sand, and gravel, of a depth of 15 to 25 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 lies 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—I am indebted to the Medical Officer of the Administrative County for a copy of the Superintendent-Registrar's Summary, giving the number resident in the district on 29th March, 1896. This summary— given under Table I.—shows also there were 5,512 inhabited and 657 uninhabited houses, which makes an average of 10 9 persons to a house. TABLE I. London Census, 1896. Name of Registration Sub-District. HOUSES. POPULATION. Area in Acres. No. of Schedules. Inhabited. Uninhabited. Males. Females. Total. Empty. Occupied in Daytime but not at Night. Building. Borough Road 64 3,769 1,351 88 79 6 8,328 7,755 16,083 London Road 117 5,337 1,790 134 85 10 10,487 10,829 21,316 Kent Road 103 5,243 2,371 80 128 47 11,426 11,453 22,879 Whole Parish 284 14,349 5,512 302 292 63 30,241 30,037 60,278 Wards. S. George the Martyr: — No. 1—S. Michael's ... 5,765 1,895 150 130 10 12,604 11,589 24.193 No. 2 —S. Paul's ... 3,727 1,417 78 61 6 7,011 7,878 14,889 No. 3—S. George's ... 4,857 2,200 74 101 47 10,626 10,570 21,196 Whole Parish ... 14,349 5,512 302 292 63 30,241 30,037 60,278 5 In 1900 St. George's had a population density of rather over 213 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. There is no reason to alter the statement advanced for several years past that about one in every fourteen of your population is born, grows up, lives, works, and often dies within the four walls of a one-roomed tenement. From Table I. it will be seen that the number of males in the parish is some 200 in excess of the females. This uuusual feature may, I think, be explained by the following facts:—(a) The presence of a number of factories where men are employed either exclusively or mainly ; (b) the comparatively small number of domestic servants employed in the parish ; (c) and the presence of the Salvation Army Shelter, which attracts in the parish a daily average of several hundred men—(in 1895 the Senior District Magistrate estimated the Salvation Army accommodation at 500 per night. Another point brought strongly into relief by Table I. is the fact that the division of the parish into sub-districts affords a more equal grouping of inhabitants than a division by wards. Thus the greatest difference between the individual sub-district population is 6,796, whereas in the Wards the extreme difference is 9,304. This disproportion has a somewhat important bearing on various matters of administration. Population.—The number of inhabitants for the whole parish, according to the census of 29th March, 1896, was 60,278, as against 59,712 in the census of 1891. In the middle of 1900, the figures, estimated on the foregoing census, reached 60,883. The rate of increase was extrrmely low compared with that of London generally. Births and Birth-rate. Table II. gives the birth-rate per 1,000 per annum for the years 1896, 1897, 1898, 1899, and 1900 in each sub-district of the parish, in London, and in the 33 large English towns. 6 TABLE II. Sub-District. Birth-rate per 1,000. 1896 1897 1898 1899 1900 Borough Boad 39.4 37.5 39.6 38.7 36.2 London Boad 32.6 31.4 32.1 33.5 31.3 Kent Boad 37.8 36.6 35.5 34.3 36.1 Whole Parish 36.6 35.0 35.4 35.2 34.4 London 30.4 29.9 29.5 29.4 28.6 The fact is notable that the birth-rate in St George's is persistently higher than in London. This may, I think, be partly explained by the fact that the limitation of families is carried into effect by the better-to-do classes rather than by the poor. The figures 28.6 record the lowest birthrate hitherto known in London. Deaths and Death-rate for 1900. 1,275 deaths were registered in the parish during the fifty-two weeks ending 30th December, 1900, giving an average of 24.5 per week. Of this total 169 were deaths of non-parishioners in hospitals and asylums within the district. In addition 546 parishioners died in outside public institutions and extra metropolitan asylums. There were, therefore, 1,652 deaths amongst your parishioners, equivalent to an average mortality of 27.1 per 1,000. The death-rate for all London in the same year, excluding strangers, was 18.3 per 1,000, which is in itself, according to many authorities, 2.3 more per 1,000 than should occur from " the mortality incident to human nature." In St. George's, then, the deathtoll, as it has been aptly called, claims 8.8 persons out of every 1,000 in excess of an already excessive rate. On the latter estimate, that of the whole of London there have been some 534 unnecessary deaths in St. George's, Southwark, during the year 1900, and, comparing it with the ideal estimate, the unnecessary deaths number no less than 668. 7 In the forty-three metropolitan sanitary areas the lowest death-rates were 11.3 in Hampstead, 12.6 in Stoke Newington, 13.8 in St. George's, Hanover Square, 14.8 in Wandsworth, and 15.1 in Lee; the highest death-rates, on the other hand, were 25.2 in St. Saviour's, Southwark, 261 in Limehouse, 26 5 in Holborn, 26.8 in St. Luke's, and 271 in St. George's, 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. 1899. 1900. 1899. 1900. 1899. 1900. Borough Road 546 575 34.8 34.3 188 191 London Road 501 497 23.5 22.5 188 194 Kent Road 626 580 26.6 26.3 234 235 Whole Parish 1,673 1,652 27.7 27.1 205 209 London 89.689 86,007 19.3 18.3 167 160 33 Large Towns 229,777 226,287 20.2 19.5 181 172 It is clear, then, 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 light upon this state of affairs. On comparing the average death-rate in the three sub-districts for the years 1892-3-4-5-6-7-8-9 with that of 1900, we find :— TABLE IV. Sub-district. Death-rate per 1,000. 1892 to 1899. 1900. Borough Road 33.1 34.3 London Road 22.0 22.5 Kent Road 24.4 26.3 During the past year the mortality in the Borough Road has been 11.8 over that of the London Road, and 8.0 over that pf the Kent Road 8 areas. The period over which these figures extend (eight 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 the mortality of the Borough Sub-district is 14.8 higher than that of the 33 large English towns. Further, the figures, so far as they extend, show that the excessive mortality of the Borough Road Sub-district is maintained from year to year, so that it appears to be due to inherent and not to accidental causes. The annual death rate for 1900 has fallen slightly, being 271 as against 27.7 in 1899, thereby showing a decrease of 0.6 per 1,000. During the same period the returns for the whole of London showed a fall of 1, and for the 33 great towns of 0.7. The phthisis and diarrhoea rates of the Parish of St. George-the-Martyr are the highest in London. There has been a decrease in the deaths from diphtheria. The infantile death-rate is still very high and is exceeded only in two other Metropolitan districts. As all, or nearly all, of the mortality arises from preventable causes, it follows, as pointed out in former years, that there is still room for large and permanent reduction in the death-rate of St. George-the-Martyr. Were it possible to eliminate the Borough Road Sub-district, or to reduce its mortality to a level with that of other sub-districts, the condition of St. George-the-Martyr, as a whole, would compare favourably with many districts much more happily situated, both as regards density of population and general healthiness of surroundings. TABLE V. 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 1895 23.7 19.7 1896 22.9 18.2 1897 23.6 18.1 1898 24.3 18.7 1899 27.7 19.3 1900 27.1 18.3 9 If it be permissible to offer any observation upon the foregoing figures, and bearing in mind that comparisons of the kind are open to fallacies, it may be said that St. George-the-Martyr, Southwark, stands in a worse position with regard to its death-rate than London has stood in any ten-yearly period since 1840. 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, relapsing, puerperal, simple, continued and typhoid), and diarrhoea. I have called the above zymotic diseases ''preventable," because I regard all communicable diseases, broadly speaking, as coming under that heading. Diarrhoea is a sympton as well as a specific 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 diseases, such as that due to alcoholism, is not zymotic. In other words, while all zymotic diseases are preventable, not all preventable diseases are zymotic. The corrected death-rate in St. George's, Southwark, from the seven principal zymotic diseases was 3 33 per 1,000 in 1900 as against 2.19 per 1,000 in the whole of London for the same period, and 2.5 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 ; 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 trustworthy data can be secured upon which to calculate the rates of mortality. Among the 43 sanitary areas the zymotic death-rate ranged from 0.78 in St. George's, Hanover Square, 0.84 in St. Martin's in the Fields, 0.89 in the City of London, 1.08 in St. James, Westminster, and 1.14 in the Strand, to 3.02 in Shoreditch, 3.25 in St. Luke, 3.33 in St. George the Martyr, Southwark, 3.34 in Shoreditch, and 4.10 in Limehouse. 10 TABLE VI.—For the Year 1900. Birth-rate per l,000. Death-rate per 1,000. Zymotic death-rate. Phthsis death-rate. Other Tubercular Diseases death-rate. Respiratory Diseases death-rate. Deaths under 1 year, to 1,000 births. St George's, Southwark 34.4 27.1 33.3 3.63 1.22 7.11 209 London 28.6 18.3 2.19 1.71 — — 160 TABLE VII. Mortality in St. George's from the seven principal Zymotic Diseases. Disease. Deaths. 1900. 1899. Diarrhoea 88 102 Whooping Cough 43 32 Measles 36 63 Diphtheria 23 63 Fever (Typhoid, etc.) 12 8 Scarlet Fever 11 6 Small-pox 0 0 The total absence of deaths from small-pox in two successive years is in itself a valuable evdience as to the efficiency of vaccination, together with notification and prompt isolation. How long this immunity will continue under the new Vaccination Act remains to be seen. Diarrhoea. Amongst children diarrhoea is the most deadly preventable complaint in your parish. With the high figure of 88, it heads the table of mortality from zymotic diseases. Of this number 63 deaths occurred under the age of one year, 19 between 1 and 5, and 6 at the age of 5 and upwards. In addition to the 88 deaths from diarrhoea coming under the general heading of "Specific Febrile or Zymotic Diseases," there were 51 deaths from gastro-enteritis placed under the class " Local Diseases." 11 During the nine years 1892 to 1900 more deaths were due to diarrhoea than to any other of the principal zymotic diseases. This is seen in the following table :— TABLE VIII. Mortality in St. George's, from the seven principal Zymotic Diseases. Deaths. 1892 1893 1894 1895 1896 1897 1898 1899 1900 Total. Diarrhœa 53 63 72 61 64 111 99 102 88 713 Measles 66 22 100 71 85 67 43 63 36 553 Whooping Cough 46 59 64 56 55 32 34 32 43 421 Diphtheria 26 41 49 19 26 28 36 63 23 311 Scarlet Fever 15 41 15 14 10 14 20 6 11 146 Fever, chiefly Typhoid 8 12 5 9 7 11 9 8 12 81 Small pox 0 7 0 0 0 0 1 0 0 8 214 245 305 230 247 263 242 274 213 2233 It has been proved that the temperature of the earth is one of the most important factors concerned in the development of summer diarrhoea, and that the summer rise of diarrhceal mortality does not commence until the mean temperature recorded by the four-foot earth thermometer has attained somewhere about 56 degrees Fahrenheit. This subject of summer diarrhoea has been dealt with by me in the Milroy Lectures, delivered before the Royal College of Physicians of London. The main facts of the disease are that— 1.—It is for the most part a disease of towns. 2.—It chiefly affects children. 3.—It prevails in the third quarter of the year. 4.—It is spread only rarely by infection from the sick to the healthy. 5.— It increases in hot and dry, and lessens in wet summers. These strongly marked features would have to be accounted for by any theory capable of serious consideration. After a careful investigation of the matter, I have come to the conclusion that epidemic diarrhoea is due to the organic pollution of street dust by horse-dung. Many bacteria are common inhabitants of the intestine both of the horse and of man ; they are deposited in the streets in enormous numbers, and when dry are blown about in the form of dust. In this way town houses and larders, milk shops, restaurants, and other places where food is stored or consumed are exposed to contamination by numerous kinds of microbes, 12 some of which are known to bo harmful to man. The same street dust is blown into milk shops, whore milk is usually kept for sale in open vessels. Milk forms an excellent brooding ground for bacteria, and it is therefore easy to see why town infants who are fod mainly on milk should suffer from diarrhoea, that is to say, if wo accopt the origin of diarrhoea as a dust disease. Road dust is practically free from horsedung in country districts, where summer diarrhœa is hardly known. The influence of hot summers most likely lies in furnishing the amount of warmth requisite to the growth and multiplication of the microbes. Rain washes the microbes from the air and from exposed surfaces, hence the smaller amount of diarrhœa in wet summers. According to my theory, epidemic diarrhoea is duo to a surface pollution derived from street dust. Tho practical lessons to be gathered from the application of the theory are plain and simple. First of all the necessity of unremitting activity in the scavenging of streets and of houses is emphasized, especially does this apply to courts and alleys and passages which should, in my opinion, be systematically flushed with hose, at any rate during the third quarter of the year, when the disease is rampant. In this way the purifying influences of an abundant rainfall may be obtained by artificial means. It is necessary, however, that the road and other paving should be washable—that is to say, it must be hard, smooth, and impermeable. The best roadways are those of hard asphalte or concrete, while all passages, courts, yards, alleys, and byways, should be smoothly and evenly paved with bricks, flags, or one of the hard, smooth paving surfaces. The need of daily scavenging of house refuse need only to be mentioned. Perhaps one of the most important of all points is that relating to milk. Milk should be sterilized and kept in closed vessels ; if exposed to the air of towns, either in shops or in the larder, it cannot fail to become, sooner or latter, infected with unwholesome germs. There can be no doubt whatever that the infection of summer diarrhoea is conveyed in the vast majority of cases, to town children, through the agency of milk. This fact explains why the disease is so much less common among children fed at the breast than among those brought up on the bottle. The question arises, how is this milk to be purified of the poison of summer diarrhoea ? The answer lies in the sterilization of milk. The milk should be sterilized at the farm and kept in sterilized bottles until opened for use. So far as one can see under the modern complex conditions of milk collection and milk storage there is no other path of 13 safety. In this connection I would suggest that all dairy farms and dairies should be under stringent sanitary control by a combined rural and urban authority. As to the supply of sterilized milk to the poor, I would suggest the establishment of a public service of sterilized milk, where poor people could obtain a daily supply at a cost that although small, could bo made to cover expenses. This experiment has been carried out successfully at St. Helen's, Lancashire, and in several American towns. Diarrhoea is one of the epidemic diseases that has shown no tendency to decrease with the advance of public sanitation in this country. That it is preventable cannot be doubted, although hitherto it has eluded our grasp. As our special knowledge of the subject becomes greater we may hope to remove this scourge from our town populations. Whether the theory of the origin of the malady be true or not, there can be, I think, no question as to the practical value of the sterilization of milk, which in a poor district like that of St. George the Martyr, can be made generally available only by the efforts of the local sanitary authorities. Measles. Measles is the next most deadly complaint in your parish, and leads to a lamentable waste of life. As frequently pointed out by me before, I think that the compulsory notification of capes of measles throughout London, with subsequent hospital treatment and disinfection, could not fail, in a poor parish like St. George's, to result in a great saving of life. Diphtheria Mortality. There has been a decrease in deaths from diphtheria, a fact that is in accordance with the the general fall in the whole of London, and is probably to a great extent due to the modern treatment by anti-toxin. There can be no doubt that the density of population and the modern system of Board School education have a considerable influence upon the prevalence of this highly preventable disease. As I have said in previous reports, it would be prudent, I think, to consider the desirability of the frequent and systematic inspection of all schools. It is in such places that early and undetected cases of diphtheria, in the sore throat stage, are to be found under circumstances that afford every opportunity for the spread of infection. 14 In March, 1898, in compliance with a resolution of the late St. George's Vestry I drew up a special report upon the bacteriological diagnosis of doubtful cases of diphtheria and of typhoid fever. This communication will be found under Section III. of my Annual Report for 1898. It dealt fully and systematically with the whole matter of the detection of the two diseases named in early and doubtful cases. There is no doubt, in my own mind, that a public bacteriological service such as that suggested therein would materially add to the powers of your Council in the control of infectious diseases, which is one of the most important duties of a sanitary authority. A free bacteriological examination has been established in at least eight metropolitan parishes, and their legal position has not been questioned by the Local Government Board. Respiratory Diseases. TABLE IX. Sub Districts. No. of of deaths. 1898. 1899. 1900. Borough Road 150 193 147 London Road 145 106 116 Kent Road 158 204 170 Total 462 563 433 These figures represent a rate of 7.11 per 1,000 living. Mortality of Infants and Children. The death-rates of infants under one year, and of children under five years, afford valuable indirect evidence of the sanitary well-being of a community. During 1900 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 209 deaths to every 1,000 births in St. George's, as compared with 160 deaths per 1,000 births for London. Of a total of 1,652 deaths at all ages in St. George's, 684 occurred under five years, which gives the large percentage of 41.4 of the total 15 number of deaths. It is well known to specialists in children's diseases that " wasting " constitutes one of the commonest causes of death among infants. Thousands of children die every year in London simply because they are fed on indigestible food which acts as an irritant to the stomach and intestines. The many causes leading to the 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 through maternal ignorance. (4) Early marriages. (5) Debility, disease, and dissipation of parents. (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. Diarrhoea causes the greatest loss of life amongst children, and I have already pointed out how, in my opinion, the use of sterilised milk would vastly lessen the incidence of that disease. The lamentable number of deaths from measles could be to a great extent avoided by a proper isolation and nursing of those attacked. Indeed, the more one looks into the matter the more one is convinced that the excessive death-rate amongst children is in the main avoidable and unnecessary. 16 TABLE X. PARISH OF ST. GEORGE THE MARTYR, SOUTHWARK. For Whole District. Year. Population estimated to middle of each year. Births. Deaths under one year of age. Deaths at all Ages.—Total. Deaths in Public Institutions. Deaths of Non-Residents registered in District. Deaths of Residents registered beyond District. Deaths at all Ages.—Nett. Number. Rate. Number. Rate per 1,000 Births registered. Number. Bate. Number. Rate. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 11. 12. 13. 1900 00,883 2,093 34.4 437 209 1,275 20.9 590 169 546 1,652 27.1 Area of District in acres (exclusive of area covered by water) 284½ Total population at all ages 59,712 Number of Inhabited Houses 6,946 Average number of persons per house 8.5 At Census of 1891. TABLE XI. PARISH OP ST. GEORGE THE MARTYR, SOUTHWARK. Names of Localities. 1. Borough Road. 2. London Road. 3. Kent Road. Year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. 1900 16,762 607 575 116 22,075 690 497 134 22,046 796 580 187 TABLE XII. PARISH OF ST. GEORGE THE MARTYR, SOUTHWARK. Cases of Infectious Disease notified during the Year 1900. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. 65 and upwards. St. Michael's Ward. St. Jude's ' Ward. St. George's Ward. Evelina Hospital. Royal Bethlem Hospital. St. George's Workhouse. St. Michael's Ward. St. Jude's Ward. St. George's Ward. Evelina Hospital. Royal Bethlem Hospital. St. George's Workhouse. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 210 1 89 87 23 10 ... 101 28 79 2 ... ... 93 27 72 ... ... ... Membranous Croup 4 3 1 ... ... ... 3 ... 1 ... 2 12 1 ... ... ... ... ... Erysipelas 75 4 4 1 5 51 10 27 16 18 ... ... 1 ... ... ... ... ... 12 Scarlet Fever 252 1 85 146 12 8 108 56 86 1 ... ... 100 50 78 ... ... 1 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... Enteric Fever 175 1 21 89 38 25 1 136 13 24 ... ... ... 121 12 17 ... ... 2 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... Puerperal Fever 3 ... ... ... ... 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 720 8 202 324 78 97 11 378 114 208 3 2 15 315 90 167 ... ... 15 18 TABLE 13. Causes of, and Ages at, Death during Year 1900. Deaths in whole District at Subjoined ages. Deaths in Localities (at all Ages). Deaths in Public Institutions. Causes op Death. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Borough Road. London Road. Kent Road. Small-pox ... ... ... ... ... ... ... ... ... ... ... Measles 36 6 26 4 ... ... ... 20 11 5 2 Scarlet fever 11 8 3 ... ... ... 2 4 5 10 Whooping-cough 43 17 25 1 ... ... ... 12 15 16 7 Diphtheria and membranous croup 23 1 15 7 ... ... ... 6 7 10 20 Croup 2 ... 2 ... ... ... ... ... 1 1 ... Typhus ... ... ... ... ... ... ... ... ... ... ... Fever Enteric 12 ... 3 3 3 3 ... 1 1 3 10 Other continued ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 18 1 ... ... 2 7 8 4 6 8 1 Cholera ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... Diarrhoea (See notes on next page) 88 63 19 1 ... 3 2 16 18 54 7 Enteric. (See notes on next page) 51 33 12 2 ... 4 ... 17 14 20 7 Puerperal fever 4 ... ... ... 1 3 ... 3 1 ... 2 Erysipelas 2 2 ... ... ... ... ... 1 1 ... 1 Other septic diseases 2 ... ... ... ... 2 ... 1 1 ... 1 Phthisis 221 1 5 3 22 182 8 105 59 57 132 Other tubercular diseases 74 29 32 5 2 5 1 23 30 21 25 Cancer, malignant disease 40 ... ... ... ... 26 14 16 15 9 25 Bronchitis 203 47 11 3 ... 67 75 63 56 84 52 Pneumonia 210 41 54 3 7 84 21 79 53 78 78 Pleurisy 4 1 ... ... ... 3 ... 1 ... 3 2 Other diseases of Respiratory organs 16 1 1 1 ... 10 3 4 7 5 4 Alcoholism 15 ... ... ... 1 13 1 7 7 1 7 Cirrhosis of liver Venereal diseases 12 7 1 ... ... 4 ... 6 4 2 8 Premature Birth 21 21 ... ... ... ... ... 6 6 9 2 Diseases and accidents of parturition 5 ... ... ... 1 4 ... 1 2 2 2 Heart diseases 111 2 1 5 9 76 18 40 39 32 46 Accidents 75 31 10 6 4 21 3 20 33 22 33 Suicides 2 ... ... ... 1 1 ... 1 ... 1 ... All other causes 351 133 22 10 11 112 63 113 106 132 106 All causes 1652 437 247 57 64 630 217 575 497 580 590 19 Notes.—(a) The deaths of residents occurring beyond the limits of the district are to be included in this table, and deaths of nonresidents occurring in the district are to be excluded. See note on Table I. as to meaning of " Residents " and " Non-residents.'' (b) Deaths of residents occurring in public institutions are to be allotted to the respective localities according to the addresses of the deceased as given by the Registrars, and, in addition, to be classified under " Public Institutions." (c) Under the heading of " Diarrhoea " are to be included deaths certified as from diarrhoea, alone or in combination with some other cause of ill-defined nature; and also deaths certified as from Epidemic enteritis; Zymotic enteritis ; Epidemic diarrhoea. Summer diarrhoea ; Dysentry and dysenteric diarrhoea ; Choleraic diarrhoea, cholera, cholera nostras (in the absence of Asiatic cholera). Under the heading of " Enteritis " are to be included those certified as from Gastro-enteritis, Muco-enteritis and Gastric catarrh, unless from information obtained by enquiry from the certifying practitioner or otherwise, the Medical Officer of Health should have reason for including such deaths, especially those of infants, under the specific term " Diarrhoea." Deaths from diarrhoea secondary to some other well-defined disease should be included under the latter. In recording the facts under the various headings of Tables I., II., III. and IV., attention has been given to the notes on the Tables. P. J. WALDO, [Late) Medical Officer of Health. May, 1901. 20 SECTION II.—GENERAL. Housing of the Working Glasses Act. Under Part I. of the above Act I have already officially represented three unhealthy areas of Ward I. of your parish, namely, Webber Row, King's Bench Walk, and Grotto Place. Of these areas two, namely, Webber Eow and King's Bench Walk, have been dealt with by the London County Council, which is the local authority under Part I. of the Act. The Grotto Place remains untouched, although in my opinion it is structurally worse in many respects than the other two. The London Council Housing Committee reported with regard to the three sites, (1) Webber Eow, (2) King's Bench Walk, (3) Grotto Place, as follows :— " After careful consideration we are of opinion that 1 and 2 should be dealt with by scheme, but we are not prepared at present to recommend the Council to deal with Grotto Place area in this manner. It will be noticed that the death-rate is lower than that of the rest of the district, and although the condition of the houses generally is such as to make their re-arrangement a matter for consideration, we think the fact of the deathrate being low is sufficient justification for its exclusion." With regard to the foregoing statements the obvious criticism suggests itself that the death-rate for so small an area affords no just basis for drawing sound conclusions. As the result of a close acquaintance with the structural and social conditions of the Grotto Place area, I feel convinced in my own mind that it is unwise to allow this unwholesome group of dwellings to exist in the parish. In my opinion the best way of utilising the site would be to convert it into a recreation ground, in view of the fact that Southwark is badly off by way of open spaces. A special Report on the three unhealthy areas above referred to was published in my Annual Report for the year 1898 (pages 32-34). During the year 1900 I had under consideration in Ward III. a further area to be investigated under Part I. of the Housing Act. The area in question comprises a triangular space of ground, bounded by Rephidem Street, Weston Street, and Potier Street. The owners have 21 closed the houses, presumably with a view of demolition. Here, again, I would venture to suggest that an excellent opportunity is afforded to the present Borough Council of acquiring a desirable site for an open space. Other areas to which the future attention of the London County Council might with advantage be directed are :— I. The group of streets in Ward III. around Sterry Street, Providence Place, Fisher's Buildings, and Fox's Buildings, with about 20 houses in Tabard Street. II. An area in Ward II. comprising more or less of St. George's Market, Butcher Row, Dantzic Street, and Parliament Street. 22 SECTION III—SPECIAL REPORT. Special Report on an Outbreak of Enteric Fever in the Parish. In accordance with the resolution of the Vestry of the 2nd inst., I beg herewith to submit a brief report upon an outbreak of enteric or typhoid fever within your parish. In making such report I propose as nearly as possible to follow the lines set forth in the letter from the Local Government Board to the Vestry dated the 1st October, 1900, and to furnish in the words of the Board— " Such information as can be given with regard to the number of non-fatal as well as of fatal cases, and to the circumstances in which they have occurred with reference particularly to the purity of the water used for drinking, to the drainage, and to the method of disposal of excrement in the localities where the disease has been prevalent." Also to state—" the measures taken by the County Council or the Medical Officer of Health for checking the spread of the disease." One-hundred-and-two cases of enteric fever have occurred in St. George's Parish between the 14th of September last and the 8th day of present month. From among this number there have been—so far as I can ascertain from the weekly returns of the Sub-Registrars as well as from information afforded me by the Metropolitan Asylums Board—two deaths. Of the total of 102 cases 60 are males and 42 females. Ninety-seven of the cases have occurred in Ward I. (St. Michael's), 3 in Ward II. (St. Paul's), and 2 in Ward III. (St. George's). The infected area from which 97 of the cases have been notified lies in the north-east part of Ward I., and is bounded roughly on the north by Pocock Street, Suffolk Grove (in St. Saviour's), and the Southwark Bridge Road, on the south by the Borough Road, on the east by the Marshalsea Road and Borough High Street, and on the west by the Blackfriars Road. The inhabitants of this area who have been attacked by the fever are mostly of the poorer and labouring classes, and are drawn from densely-crowded blocks—such as Queen's Building's (housing upwards of 3,000 persons on about 3 acres of ground). Many, also, come from thickly populated tenement houses situated in Bittern Street, Toulmin Street, Little Suffolk Street, Borough Road, Friar 23 Street, Gun and and other neighbouring streets. Several of the patients, too, live in houses in Lant Place, Goldsmith Place, King's Court, Sturge Street, and Great Suffolk Street, officially represented by me in 1899 under part I. of the Housing of the Working Classes Act, 1890, as constituting an unhealthy area, but not yet taken by the London County Council. Of the 102 cases of enteric fever notified it is a noteworthy fact that a large proportion are those of children of school age. Thus of this number 24 are under 10 years of age, 63 are between the ages of 10 and 20, and 15 are 20 years of age and upwards. The following table gives the daily incidence of cases forming the outbreak up to date:— Date of Notification. Number of Attacks. Sept. 14 1 „ 15 2 „ 16 3 17 6 „ 18 3 „ 19 3 „ 20 4 „ 21 11 „ 22 9 „ 23 4 „ 24 4 „ 25 8 „ 26 5 „ 27 6 „ 28 5 „ 29 5 „ 30 1 Oct. 1 7 „ 2 5 „ 3 3 „ 4 1 „ 5 1 „ 6 1 „ 7 1 „ 8 3 Total 102 24 As far as one can judge from recent notifications shown in the above table the outbreak appears to be on the decrease. With reference to the water used for drinking I may say it is supplied on the constant system to the infected houses in about equal proportions by the Southwark and Vauxhall and by the Lambeth Water Companies. In some instances the water is drawn direct from the main, and in others it is supplied through the intervention of cisterns. Samples of water from both companies drawn from the supplies to various of the infected houses are being examined both chemically and bacteriologically. So far I have not been able to find any evidence of pollution of the water by the specific poison of enteric fever. The possibility of the milk being the medium of the dissemination of the fever is still under investigation. The milk supply is—I may add—taken from various sources, and samples both of cow's milk and of condensed milk are being examined chemically and bacteriologically. As regards " the drainage and method of disposal of excrement in the localities where the disease has been prevalent." The w c.'s are mostly of modern type. Several of the house drains—which are both separate and combined—are only imperfectly ventilated, and are apparently not disconnected by any trap from the sewers. In 17 instances the house-drain was found on examination with the chemical test ,'an imperfect one) in use by your Sanitary Authority to be defective. Steps have been taken to remedy the defects. The sewers into which the sewage drains are mostly either imperfectly ventilated or not ventilated at all, and some of them, e.g., those in Bittern Street, Toulmin Street, and Marcia Road, have been condemned by your Surveyor (Mr. Harrison). In conclusion I have personally visited every house in which a case or cases of enteric fever has been notified to me, and have as fully as possible enquired into the origin and circumstances of the outbreak. I may add that the investigation of the possible cause or causes of the outbreak is still engaging my attention. The chief preventive measures which have already been adopted by your Sanitary Authority are :— 1. Isolation of 89 of the cases in Hospital—13 patients only remaining under treatment at home. 2. Disinfection of clothing and other articles that have been exposed to risk of contamination, and of infected rooms and premises. 25 3. Removal and accommodation of 25 persons from infected houses during a minimum period of 24 hours in Parish Reception House during disinfection and cleausing of premises and of all infected goods. 4. Free flushing of the street gullies weekly within the infected area by your Surveyor (Mr. Harrison). 5. Bacteriological examination of samples of ice-cream, water-ice, and shell-fish in addition to those of water and milk already alluded to. 6. Distribution throughout parish of a leaflet (a copy of which will be found appended) containing printed instructions to Heads of Families, Householders, and others for preventing the spread of typhoid fever. At the time of distribution of this leaflet the Sanitary Inspectors have made enquiries with respect to possible cases of illness of a diarrhœal nature in their house to house visitation, and on such cases being discovered, and found to be unattended, the inspectors have advised the calling in of a medical practitioner with a view to the removal of the patient to Hospital if found to be suffering from enteric fever. Other suggested measures, not yet carried out, aimed at the checking of the spread of the disease in connection with surface, soil, air, and food pollution, and will be found duly recorded in my official diary. I have the honour to be, Your obedient servant, F. J. WALDO, Medical Officer of Health. Health Department, Vestry Hall, St. George the Martyr, Southwark. Submitted to Public Health Committee 8th October, 1900, and presented to Vestry on 16th October, 1900. (Copy of Leaflet Issued by Vestry.) the vestry of the PARISH OF ST. GEORGE THE MARTYR, SOUTHWARK. public health department. Instructions to Heads of Families, Householders, and others, for Preventing the Spread of TYPHOID FEVER. N.B—You are requested to read the following statement and preserve it for future use. As there have been several cases of Typhoid Fever in the Parish 26 during the past few days, it is advisable for inhabitants to take the following precautions:— 1. Boil all water and milk before drinking the same. 2. Avoid eating all unsound fruit and vegetables, ice cream and uncooked shell fish. 3. Particularly observe a strict regard for cleanliness and a free circulation of fresh air in the home. 4. Freely flush and disinfect all W.C.'s and drains. 5. Report immediately all nuisances such as bad smells, nonremoval of dust, choked drains, Ac., to the Vestry Hall, 81, Borough Boad. Vestry Hall, Borough Road, Southwark. September, 1900. In concluding my Ninth Annual Report, I may perhaps be permitted to express my regret in recording the fact that it represents the last year of my official connection with the Parish of St. George the Martyr. During the nine years it has been my pleasure and privilege to act as your Medical Officer of Health, my constant endeavour has been to carry out the duties of my important office without fear and without favour. On the whole, I think, the Parish may be congratulated on having made substantial sanitary progress during the period in question. I have the honour to be. Your obedient Servant, F. J. WALDO, Medical Officer of Health. 1, Plowden Buildings, Temple, E.C. May, 1901. 27 APPENDIX. Report of the Chief Sanitary Inspector, For the Year ending December 31st, 1900. SALE OF FOOD AND DRUGS ACTS, 1875-1899. The number of samples of food and drugs procured for analysis during the year is 135, being a considerable increase on the numbers purchased for analysis in any preceding year of which we have a record. 21 samples or 15.55 per cent, of the total were not genuine. Milk, as usual, forms the chief subject of analysis and adulteration. Of the 14 samples (see table) certified to be not genuine, eight contained extraneous water, five were deficient in cream, while one contained extraneous water and was also deficient in cream. Thus 20.90 per cent, of the samples purchased were to the prejudice of the purchaser, as against 19 29 for last year. This percentage is high compared with the Metropolis, which was 15.4 per cent, in 1899. However, when we consider that in 1894 the very high percentage of 38.46, more than a third of the samples bought for test purposes in St. George's Parish were adulterated, we may look upon this year's figures with less apprehension. At the same time it is almost needless for me to say there is ample room for improvement in the milk supply, and for a vigorous application of the Food and Drugs Acts. Of the 34 samples of butter, or what was sold as butter, 3 or 8.80 per cent, were condemned. This per centage is 4.33 lower than last year, when it was 13.13 per cent. The number of samples of butter adulterated vary considerably each year. In 1895 the percentage was 28 70; in 1896, 7.70; in 1897, 25.00, and in 1898, 00.00. The percentage for the whole of London in 1899 was 12.9. Of the five samples of Drugs procured for analysis 2, or 40 per cent, were adulterated. This percentage is high, but may be to some extent due to the small number of samples taken. Twenty-five summonses have been taken out against offenders. The fines and costs amounting to £60 14s. 28 The details of the articles bought for analysis are set out in the following table:— 1900. 1899. No. of Samples Examined. Certified to be No. of Samples Examined. Certified to be Genuine. Not Genuine. Genuine. Not Genuine. Milk 66 52 14 55 44 11 ,, (Separated) 1 1 — — — — „ (Skimmed) — — — 2 2 — ,, (Condensed) 1 1 — — — — Butter 34 31 3 30 26 4 Lard - — — 2 2 — Margarine 1 1 — 5 5 — Cheese 5 5 — — — — Bread 1 1 — 1 1 — Flour 2 2 — 1 1 — Cornflour 1 1 - — — — Coffee 6 6 — 2 1 1 Cocoa 2 2 — — - — Demerara Sugar 1 1 — 1 1 — Golden Syrup — — — 1 1 — Ice Cream - — — 2 2 — Pepper 2 1 1 — — — Jam 1 1 - — — — Sago 1 — 1 — — - Whisky 2 2 — — — — Rum 2 2 — — - — Gin 1 1 — — - — Olive Oil 1 1 — - - — Sweet Spirits of Nitre 1 1 — — — — Calcined Magnesia 1 — 1 - — — Fluid Magnesia 1 1 — — — — Gregory's Powder — — — 1 1 — Milk of Sulphur 1 — 1 — — — 135 114 21 103 87 16 29 UNWHOLESOME FOOD DESTROYED. 2 Casks of Apples. 7 Baskets of Cherries. 10 Shoulders of Bacon. 1 Ham. 13 Rib Pieces. 2 Pieces of Ham. 1 Piece of Flitch. 220 Boxes of Greengages. ½ Case of Eggs. 1 Box of Cat Fish. 2 Boxes of Haddocks. FACTORY AND WORKSHOPS ACT. During the year 50 workshops have been added to the register, which brings the number of workshops registered up to 252. The principal industries are :—Laundries, tailors, brush, box, boot, sack, tie, and artificial flower makers. There are no fur pullers' domestic workshops registered. The workshops have been under the supervision of the Female Sanitary Inspectors and myself. 232 inspections have been made and 280 revisits, 27 workshops measured, 33 cleansed, 7 new w.c.'s provided, and 34 miscellaneous repairs executed. The following table gives some particulars as to the number of men, women, young persons, and children employed, and the number of workrooms:— No. of Workshops. No. of Workrooms. Men. Women. Young Persons. Children. Domestic workshops 94 101 48 106 6 — Other „ 158 337 385 1027 174 2 Total 252 438 433 1133 180 2 RECEPTION HOUSE. The number of families admitted to the Reception House during the year was 108, numbering altogether 406 persons, being an increase of 7 and 48, respectively, on the numbers admitted in 1899. 30 The following table shows the number of cases of infectious disease notified from one, two, and three roomed tenements, and the number and percentage of such cases admitted to the Reception House. Ward. One-roomed dwellings. Two-roomed dwellings. Three-roomed dwellings. Cases notified. Admitted to Reception House. Percentage of cases admitted. Cases notified. Admitted to Reception House. Percentage of cases admitted. Cases notified. Admitted to Reception House. Percentage of cases admitted. I 35 13 37.14 160 46 28.75 137 16 11.60 II ,, 16 4 25.00 37 14 37.83 37 3 8.10 III 16 6 37.50 49 4 8.16 108 2 1.85 67 23 34.33 246 64 26.01 282 21 7.44 DISINFECTION. Lots of Bedding, &c., disinfected 634 Articles destroyed 91 Apartments disinfected 602 The following is a summary of premises infected by the different zymotic diseases :— Diphtheria 203 Scarlet Fever 221 Typhoid Fever 158 Miscellaneous 20 602 CERTIFICATES ISSUED BY THE SANITARY AUTHORITIES AS TO THE SUFFICIENCY OF THE WATER SUPPLY. Certificates under Sec. 48 of the Public Health (London) Act have been granted by the Local Authority in respect to 261 dwellings, 168 being in No. I. Ward, 31 in No. II. Ward, and 62 in No. III. Ward 31 SUMMONSES ISSUED. Public Health Act 61 Bye-Laws 25 Food and Drugs Acts 25 The General Paving (Metropolis) Act, 1817 7 118 327 complaints have been entered in the Complaints Book, as against 165 for the preceding twelve months. JAMES WEATHERITT, P.A.S.I., Assoc. San. Inst., Chief Sanitary Inspector. Vestry Hall, Borough Road, Southwabk, S.E. March 25th, 1901. REPORT OF SANITARY DEFECTS REMEDIED IN WARD No. 1 (St. Michael's Ward), St. George the Martyr, Southwabk. During the twelve months ending December 31st, 1900. House to house inspection 499 Other inspections 1203 Re-inspections 4516 Visits—Infectious diseases 453 Intimations served 352 Statutory notices served 577 8000 Drains reconstructed 132 ,, repaired 41 „ ventilated only 2 ,. unstopped and cleansed 64 ., tested with chemicals 296 „ „ water 97 ,, smoke 2 Inspection chambers tested with water 2 Waterclosets entirely reconstructed, including new pans, lamps, seats, flushing apparatus, &c. 167 32 Waterclosets, new pans and traps 119 ,, repaired 151 „ cleansed 69 ,, unchoked 35 ., supplied with water apparatus 29 Sink wastes unchoked and repaired 12 New sink waste pipes 3 Gullies provided 31 „ repaired 11 Flushing apparatus repaired 61 Sink wastes disconnected from drain 9 Dwelling houses entirely cleansed 60 „ „ partially „ 117 Other rooms, &c., cleansed 808 Roofs repaired 126 „ renewed 1 Ceilings repaired 73 Floors repaired, renewed or ventilated 60 Walls repaired 50 Rain water gutters renewed 3 „ repaired 10 Nuisance in overcrowded premises abated 45 Houses supplied with water 76 Water fittings (drinking) repaired 15 Yard pavings repaired 61 „ ,. entirely relaid 28 Dust shoot repaired 50 Rain water fittings repaired 29 Damp walls remedied 47 Cisterns cleansed 119 ,. repaired 10 ,. abolished 1 Cellar dwellings 3 Dust bins provided 58 Offensive accumulations removed 29 Ventilation provided to fish frying hood 2 Animals improperly kept removed 6 Dung receptacles provided 2 Workshops cleansed 3 33 Dead bodies removed to mortuary 3 Dust shoot tested with smoke 1 „ cleared 7 Stairs repaired 1 Knackers yard boiling apparatus repaired 1 „ „ renewed 1 Dung pits covered 3 Bakehouses cleansed 17 Offensive and soiled bedding destroyed 5 Water supplied to public urinal 1 Miscellaneous 45 Pamphlets delivered 490 Grand Total 3761 (Signed) JOSHUA OWNER. Sanitary Inspector. REPORT OF WORK DONE IN WARD No. II., For the year ending 31st December, 1900. House to house inspections 820 Other inspections 561 Re-visits 5424 Intimations served 932 Official Notices served 662 Inquiries made respecting cases of infectious disease 160 8559 Results. Drains, new ... ... ... ... ... 3 „ re-constructed ... ... ... 43 „ cleansed and repaired ... ... ... 101 ,, trapped... ... ... ... ... 12 „ ventilated ... ... ... ... 1 „ tested with water ... ... ... ... 46 „ „ chemicals ... ... ... 129 „ „ smoke ... ... ... ... 6 Water-closets cleansed and repaired ... ... ... 207 „ supplied with water ... ... ... 84 ,, provided with new fittings ... ... 26 ,. lighted and ventilated .., .,. J 34 Water-closets new pans and traps fixed 125 „ limewashed 249 New water-closets erected 33 New soil pipes erected 13 Soil pipes ventilated full diameter 4 New sinks erected 5 Sink waste pipes and rain water pipes disconnected from drain 31 Sink waste pipes repaired 12 Interior of premises cleansed and whitewashed 44 Rooms of houses ,, ,, 454 Staircases and passages „ ,, 106 Workshops and bakehouses., ,, 32 Walls of yard ,, 241 Washhouses ,, ,, 133 Damp walls of houses remedied 12 Ceilings and floors of rooms repaired 107 Light and ventilation provided to staircases 4 Occupation of "Underground " rooms discontinued 2 Nuisances from overcrowding abated 11 Ventilation to floors provided 2 Yards repaired and repaved 109 New rain-water pipes and rain-water guttering fixed 51 Roofs of houses, guttering and stack-pipes repaired 147 Water supply provided to dwelling houses 5 Water supply for drinking purposes put on direct from main 2 Water storage cisterns cleansed 15 ,, „ covered 8 New dustbins (galvanised) provided 174 Dust shoots abolished 2 Foul accumulations removed 44 Animals improperly kept removed 12 Manure receptacles provided 2 Smoke nuisances abated 2 Miscellaneous defects remedied 77 Bakehouses inspected 8 Slaughter-house inspected 1 Total 2238 (Signed) ROBERT SIMPSON, Sanitary Inspector. 35 REPORT OF WORK DONE IN WARD No. III., For the year ending 31st December, 1900. House to house inspections 453 Other inspections 1290 Re-visits 5379 Inquiries as to infectious diseases 213 Intimations served 1180 Notices served 821 9336 Results. Drains reconstructed 68 „ repaired 194 ,, unstopped and cleansed 135 „ trapped and intercepted 26 „ tested with chemicals 297 „ ,, water 67 „ ,, smoke 4 Water-closets cleansed and repaired 118 „ provided with new seats 85 ., supplied with water 56 „ fittings repaired 215 ,, provided with new fittings 53 ., ,, „ ,, pans and traps 263 ., pans cleansed 53 ,, ventilated 13 New water-closets provided 11 New soil pipes provided 12 Soil pipes repaired and ventilated 40 New Mica valves provided and fixed 5 New dust bins provided 148 Dust bins repaired 29 Dust shoots unchoked and repaired 24 „ abolished 18 Dust pits abolished 8 New dust pails provided 60 Rooms cleansed 863 36 Passages and staircases cleansed 200 Bakehouses inspected and cleansed 38 Workshops cleansed 8 Dairies and cowsheds inspected and cleansed 13 Water supply provided to dwelling-houses 15 Water fittings repaired 6 Water cisterns cleansed and repaired 30 Water cisterns abolished 7 Water supply put on from main 7 Urinals provided with water fittings 4 Urinals cleansed 13 New urinals provided 2 Urinal abolished 1 Roofs repaired 128 New roof provided to dwelling house 1 Ceilings repaired 51 New ceilings provided 2 Windows repaired 10 Floors repaired and ventilated 97 New floor provided 1 Staircases repaired 7 Gutters and down pipes repaired 68 Rain water pipes disconnected from drains 10 Stack pipes unchoked and repaired 10 Sink wastes repaired 20 „ disconnected from drain 6 New sink wastes provided 4 Yardg paved and drained 26 Yard pavements repaired 230 „ walls limewashed 103 Yards cleansed 13 Overcrowding nuisances abated 15 Occupation of underground rooms discontinued 5 Smoke nuisances abated 1 Stables and stable yards repaired and drained 27 Manure receptacles provided 6 ,, ,, repaired 6 Animals improperly kept removed 8 Walls of dwelling bouses rendered and repaired 26 37 Foul accumulations removed 55 Miscellaneous 123 4277 PHILIP DAVID, Sanitary Inspector. REPORT OF INSPECTOR OF HOUSES LET IN LODGINGS. For the year ending 31st December, 1000. Tenemement houses inspected and visited 6287 Other houses 1973 Workshops inspected 109 „ revisited 60 Workrooms cleansed 11 „ measured 1 Miscellaneous 14 Notices served 314 Intimations served 473 Number of rooms, &c., cleansed 1155 „ overcrowding cases abated 201 Defective w.c.'s repaired 187 Roofs, gutters, &c., repaired 100 Dustbins provided 25 ANNIE ELLIOTT. REPORT OF INSPECTOR OF HOUSES LET IN LODGINGS, For the year ending 31 st December, 1900. Tenement Houses on the Register 309 Inspections and visits in tenement houses 5549 Inspections and visits in other houses 2792 Intimations served 451 Notices served 228 Overcrowding cases abated 96 Walls cleansed 1496 Notices re workshops complied with 20 Other notices complied with 484 EMILY WILKIN. 38 REPORT OF FEMALE HEALTH INSPECTOR AND SANITARY OFFICER, From 16th October to 31st December, 1900. Tenements visited for purpose of giving instruction on health... 757 Nuisances discovered and reported to the Chief Sanitary Inspector 42 Re-visits 311 Calls made at tenements where the occupants were out 150 Houses visited to recommend disinfection and other means of prevention after phthisis 15 At all the above tenements leaflets by the Medical Officers of Health, relating to the care of children, and the prevention of consumption and other diseases have been distributed, and have been found in the majority of cases where revisits have been made, to have been read, and to have aroused interest in health and disease. A great deal of tuberculosis has been met with. Amongst infants, chiefly those which have been bottle fed. Phthisis being largely found in proportion to the absence of ventilation, even where otherwise cleanly and sanitary conditions prevail. S. E. MOFFAT, Health Inspector and Sanitary Officer. List of Slaughter-houses Licensed by the London County Council in October, 1900. Name. Situation. Redman, Frederick 146, High Street, Borough. Rowe, John 73, London Road. The slaughter-houses regularly inspected have been found to be conducted in a satisfactory manner. In the interest of the public, however, private slaughter-houses should be 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. 39 List of Horse Knackers' Yards Licensed by the London County Council in October, 1900. Name. Situation. Messrs. Harrison, Barber & Co.. Ltd. 23, Green Street. List of Cow-houses Licensed by the London County Council in October, 1900. Name. Situation. No. of Cows. Evans, John 89, Redcross Street 1 Owens. John 143, Tabard Street 4 Jones, David 10 & 11, Sturge Street 17 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, 1894, 1895. 1896. 1897, 1898, 1899, and 1900, within the parish. TABLE XIV. Year. No. of Cows. No. of Cow-houses. 1882 101 10 1892 46 5 1893 37 4 1894 25 4 1895 25 4 1896 22 3 1897 22 3 1898 22 3 1899 22 3 1900 22 3 40 List of Bakehouses under Inspection in St. George The Martyr, 1900. No. 1 Ward. No. 2 Ward. No. 3 Ward. 5, Tower Street. 7, Westminster Bridge Road. 151, Borough High Street. 28 „ „ 21, Ontario Street. 46, Long Lane. 195, Waterloo Road. 32, Earl Street. 1, Tabard Street. 43, Webber Street. 70, London Road. 49, „ 161, Blackfriars Road. 17, St. George's Road. 155, „ Valentine Place. 57 & 58, London Road. 255, „ 26, Friar Street. 104, London Road. 285, „ 27, Little Surrey Street. 60, St. George's Road. 15, Old Kent Road. 16, Borough Road. 48, London Road. 69, „ „ 126, Southwark Bridge Road. 102, Lancaster Street. 80, „ „ lll, Great Suffolk Street. 85 „ „ 7, ,, ,, „ 146, „ „ 17 ,, ,, „ 168, „ „ 119, ,, ,, „ 233, „ „ 70, Red Cross Street, Marshal sea Road. 269, „ „ 272, „ „ 90, Borough High Street. 304, „ „ 108, ,, ,, 28, Law Street. 168 ,, ,, 37, Warner Street. 216, ,, ,, 1, Crosslet Street. 242, ,, ,, 22, Darwin Street, Little Suffolk Street. 237, Scovell Road. Of the foregoing 86 are above ground and 16 are under ground. The following is a copy of a memorandum forwarded me by the Local Government Board :— Memorandum as to Annual Reports of Medical Officers of Health. Every Medical Officer of Health appointed under Order of the Local Government Board is required to make an Annual Report with regard to the sanitary district which is under his superintendence. The report is to be for the year ending the 31st December, or, if the officer at that date had not been in office for a whole year, then for so much of the year as has elapsed since bis appointment,. The report is to be made to the Sanitary Authority, and the Medical Officer of Health himself should send a copy of it to the Local Government Board and to the London County Council. It should be made to the Sanitary Authority as soon as practicable after the expiration of the year to which it relates, and should be in the hands both of the Sanitary Authority and of the Local Government Board within at most five months from the end of the year. The Board's copy of the report should be forwarded to them when the original is sent to the 41 Sanitary Authority, except where the report is likely to be printed by order of the Authority. In such cases the Board need only be supplied with a printed copy. Article 18 (Section 15) of the Board's Order of the 8th December, 1891, specifies the information to be contained in the Annual Report, and is printed below. The report should be chiefly concerned with the conditions affecting health in the district and with the means of improving these conditions. It should consider these subjects with reference to the past and future, as well as to the particular year ; and the account of the sanitary state of his district generally should, while marking the point that has been reached in the sanitary state and administration of the district, indicate directions for further consideration and action. The sanitary history of the year under review should include a record alike of the proceedings of the Medical Officer himself and of the proceedings taken under his direction or advice. The Medical Officer of Health, in reporting his proceedings and advice, may find it convenient to follow in the main the order in which the subject matters of his duty appear in the several paragraphs of Article 18. Special care should be taken to report fully and explicitly in reporting on the influences affecting or threatening to affect injuriously the public health within the district; and the causes, origin, and distribution of disease within the district may usefully be the subjects of annual record. An account should also be given both of the actual circumstances of the district up to the end of the past year and of any improvement or deterioration that has occurred during the year in conditions conducive to health or to disease. For example, a vigilant health officer has in his annual report an opportunity of pointing out any facts as to water supplies, house construction, conditions of storage and of removal of refuse customary in the district, together with any facts as to the adequacy or inadequacy of means of isolation and disinfection and the like; and such a health officer, reporting on the diseases and their causes within the district, will generally have some instructive details to give, either of conditions newly productive of disease or of matters that have been remedied with advantage to the public health. In reporting upon Section 3, not only should the fact of having made systematic inspections, but the outcome from those inspections should be duly put on record. The report should contain a full account of 42 inspections, whether systematic or occasional, of the judgment which the Medical Officer of Health has formed thereon as to the sanitary state of his district, and of the advice he has in consequence given to the Sanitary Authority, and the action taken by the authority thereon. By " systematic " inspections are meant inspections independent of such enquiries as, under other Article of the Order, the Medical Officer of Health has to make into particular outbreaks of disease, or into unwholesome complaints to which his attention may have been specially called by complaints or otherwise, and such inspections will include the house-to-house inspections which may be necessary in particular localities. In making systematic inspections, as in much of his other action, the Medical Officer of Health will usually have required the assistance of the Inspector of Nuisances, and it will be for the Medical Officer to include in his report an account of the action which at his instance the Inspector may have taken for the removal of nuisances injurious to health. The tabular statements of sickness and mortality in the district during the year to be made on the forms supplied for the purpose, should be the subject of comment in the text of the report, in so far as deductions from them may assist the Sanitary Authority to an appreciation of the lines of action needful in the future. As regards these statements of sickness and mortality, only one other observation appears to be needful. The district under the superintendence of a Medical Officer of Health will often contain several parts evidently differing in their circumstances, or having very different rates of mortality, either from all causes or of mortality from some particular disease or class of diseases. The observation of these differences can scarcely fail to lead to valuable information, and it is in view of such differences that the tabular statements are required in Section 15 to be classified according to localities, and that provision for such classification is made in the forms supplied for returns of deaths. In the absence of any ascertained differences of the above sort, it will still be desirable to classify the deaths of the district according to the part of the district in which they occur ; and for this purpose any areas of known population may be taken as representing " localities " for the purposes of the Order. Classification on this basis will be likely to lead to the discovery of real differences when the returns of several years can be compared together. The same considerations apply to the records of sickness (Table B). These records should be tabulated for every sanitary district, and it will be well before proceeding 43 to fill the columns and the blank spaces to note carefully the headings and the foot notes. What has been said above with regard to the information which an annual report should contain must bo understood not as suggesting that the report should be limited to these subjects, or that more detailed or differently arranged tabular statements may not be added, but as indicating the sort of information required by the Board's Order. Many Medical Officers of Health will doubtless with great advantage to the administration of their districts furnish much more detailed information respecting particular questions to which they have been led by the circumstances of the foregoing years to devote attention, or in the investigation of which they may have arrived at valuable conclusions. Any information of this, kind will be appreciated by the Local Government Board. (Signed) R. THORNE THORNE, Medical Officer. Local Government Office, December, 1896.