AC 432(3) ST GILES CAM 60 METROPOLIS LOCAL MANAGEMENT, 18 & 19, Vic., cap. 120. VESTRY OF THE PARISH SAINT GILES, CAMBER WELL. ANNUAL REPORT J. S. BRISTOWE, Jun. M.D., Lond. Licentiate of the Royal College of Physicians, &c , Medical Officer of Health, Assistant Physician to St. Thomas's Hospital. FEBRUARY 25th, 1857. LONDON; PRINTED BY ORDER OF THE VESTRY BY E. BILLING & SON, BERMONDSEY STREET. 1857. 50 Wellcome Library for the History and Understanding of Medicine MEDICAL OFFICER'S REPORT. Gentlemen, During the fifty-two weeks which ended on the 27th of December 1856, 1189 deaths were registered in the Parish of St. Giles, Camberwell. The returns which I have received from the registrars make the number of deaths -183, or less by six than the above amount. This difference depends on the fact that, during the first quarter, one or two of the registrars failed to transmit me correct returns of those deaths in connection with which coroner's inquests had been held. The difference is slight, and for all practical purposes may be disregarded; and, therefore, since all my tables have been arranged and calculated on the assumption of the correctness of the returns which I received, I shall, throughout this report, regard 1183 as a true record of the total mortality of the parish during the past year. This number was divided unequally between males and females; 561 deaths having occurred among the former, 622 among the latter. It was divided unequally also among the sub-districts; that of Dulwich having contributed 17, that of St. George 316, that of Peckham 416, and that of Camberwell 434. But the sub-district of Camberwell contains the workhouse, in which 73 deaths took place, and the Camberwell, and the Peckham-house lunatic asylums, in which 87 persons died; and if the deaths, 160 in all, which occurred in these institutions, be subtracted from the total returned for this sub-district, we obtain the number 274, as a more correct expression of its comparative mortality. 4 The deaths were distributed according to age as follows:— 427 deaths occurred in children under 5 years of age, 49 took place between 5 and 10, 20 between 10 and 15, 22 between 15 and 20, 67 between 20 and 30, 104 between 30 and 40, 92 between 40 and 50, 103 between 50 and 60, 116 between 60 and 70, and 182 in old persons of 70 years and upwards. Eighty-five deaths are placed under the head of " violence, privation, poison and premature birth;"19 under that of "fever;" 7 under that of " dysentery, and acute diarrhoea (not of infants;") 30 under that of "scarlet fever and cynanche maligna;" 5 under that of "small pox;" 26 under that of "erysipelas, pyœmia, and puerperal fever ' 104 under that of "diarrhoea, bronchitis, and pneumonia of infants under three years of age;" 100 under that of " measles, hooping cough, and croup;" 90 under that of "hydrophobia and convulsions of infancy;" 105 under that of " phthisis and other tubercular diseases and 552 under that of " other diseases, chiefly chronic," in which are included most of those chest complaints which proved so fatal during the late cold weather. (Tables I & II.) The mortality varied somewhat during the different quarters. 313 deaths were registered in the first quarter of the year; 296 in the second; 272 in the third; and 302 in the fourth. So that the highest mortality corresponded, as is usual, except in years when epidemics prevail, to the most inclement seasons. (Table III.) The fourth table has been framed to exhibit the total number of deaths due to what the registrar-general terms the zymotic class of diseases, the total number due to each disease comprised in that class, and the proportions in which they were distributed through the several sub-districts of the parish. From this table you will learn, that while no deaths from these causes occurred in Dulwich, 38 were ascribed to them in Camberwell, 44 in St. George's, and 81 in Peckham. Scarlet fever prevailed both in Camberwell, in Peckham, and in St. George's, but was most fatal in St. George's. Hooping cough and measles were epidemic in the same districts, but were far more fatal in Peckham than in the two other districts together. During the past year, 2313 houses, chiefly of the poorer class, were visited and reported on by the Inspectors of Nuisances under my superintendence. On the strength of the reports, 5 which were laid before the vestry, notices were served on the owners of such premises as were seriously defective in sanitary arrangements, requiring them to make such improvements and such alterations, or to construct such new works, as were deemed necessary in order to carry out the spirit of the Nuisances Removal and Metropolis Local Management Acts. In consequence of these proceedings 135 cesspools have been emptied and cleansed, and 531 have been filled up; 704 closets have been panned and trapped and connected with sewers; 895 sinks and drains have been trapped or otherwise amended ; 172 yards have been paved; 278 houses have been cleansed and. whitewashed, and 27 have been repaired; water has been laid on to premises in 15 instances, and in 34 water has been supplied to closets by means of cisterns. In addition to this 13 notices have been suspended for a time, by order of the committee, and 90 at the close of the year were still outstanding— each notice, be it remarked, as a rule applying to more than one house, and comprehending usually several suggested improvements. In 116 cases the first notice was disregarded, and a second was served: but in three instances only was it found necessary to appeal to the magistrate in order to enforce compliance with the orders of the vestry. All the slaughter-houses in the parish, 48 in number, have been inspected, with the view of ascertaining their cleanliness and their fitness for the purposes to which they are applied, in order that, according to their condition in these respects, their licenses might be opposed or not at the quarter sessions held last Michaelmas. I need not repeat the circumstances under which the efforts of the vestry in connexion with this subject became frustrated, but I can assure you that, in spite of these circumstances, a great deal of benefit accrued from the movement. Several manufactories yielding effluvia of an offensive character have been examined, and notices have been served; and in some instances these proceedings have been followed by a decided amelioration. Finally, I may add, that a considerable number of nuisances, arising from accumulations of dust, ashes, and other refuse, have been removed, without being entered in the notice book, through the instrumentality of the Inspectors of Nuisances, to whose activity and zeal I take this opportunity of testifying. The dry facts which I have laid before you, with regard to 6 the mortality of the population during the last year, convey of themselves but little instruction; but I propose to make some of them my text, and by comparing them with other data to educe information which will, I trust, prove not altogether valueless or devoid of interest. Death rate of Camberwell during 1856.—During the last year 1183 persons died in Camberwell. According to the census which was taken in 1851, this parish contained on the 31st of March of that year 54,667 inhabitants ; and therefore supposing the population to have remained stationary, the mortality during the year 1856 was at the rate of 2-16 per cent., or, in other words, out of every 1000 individuals 22 died. But the number of parishioners, instead of being stationary during the lustrum which has passed since the census was taken, has in all probability fluctuated ; and that fluctuation which has not been taken into account in the above calculation, would no doubt, if its amount could be accurately ascertained, be found to exert a considerable, or at least a very appreciable, influence over the apparent proportion of deaths. It is necessary, therefore, to estimate what the propable change in the amount of population has been, before we can venture to establish the correct death rate for the year. During the five consecutive decennial periods which constitute the half century between 1801 and 1851, London has exhibited an increase, on the number of the population living at each census, of 18, 21, 20, 17, and 21 per cent. respectively, so that the increase has been tolerably uniform, at the rate of about 20 per cent. per decennium at compound interest. And, as there is every reason to believe, that the rate of increase which has been going on for the last fifty years, is still the rate at which the population of London is augmenting, it is not difficult to estimate the probable population of this large city for any given time, subsequent to the last census. But, as might have been surmised, what holds good of the entire metropolis does not hold good of its constituent parts ; for the various parishes and districts of which it is composed, are found to differ remarkably, not only in their rate of increase as compared with one another, but also as regards the fluctuations in the amount of their own population at different periods. Disturbing influences are great in individual parishes, but correct and neutralize one another in the aggregate, so as not to affect materially the 7 constant and uniform growth of this giant city. Now it is clear that to determine the relative mortality for the whole of London in any year subsequent to the last census a correction for increase of population must be made, otherwise the annual increase in the number of deaths due to increase of population would be unjustly ascribed to deterioration in the sanitary condition of the metropolis ; and it is equally clear, that this correction may be made with a reasonable assurance of its accuracy. But how unfairly superior healthiness would be ascribed to several of the central districts of London—in some of which the population has remained stationary, in some of which it has even diminished—were their mortality during the last five years calculated on the inference that the number of their inhabitants had increased at the same rate as the population of London; and, on the other hand, how unjustly the stigma of unhealthiness would cling to several of the peripheral parishes, in which the growth of the population is extremely vigorous, were their mortality during the same period estimated according to the same rule. Now Camberwell is one of the most rapidly growing of the metropolitan parishes, and the remarks just made apply therefore with peculiar force to it, and demonstrate the importance, for our own sakes, of making an independent calculation of its rate of increase. During the fifty years, between 1801 and 1851, this parish progressed, as regards population, far more rapidly than the whole of London—its increase per cent. at the end of the first decenniad being 60-1, at the end of the second 58-1, at the end of the third 58, at the end of the fourth 41-2, and at the end of the fifth 37-1. And although the rate of increase (calculated according to the rules of compound interest), would appear gradually to have diminished, it was still during the last ten years considerably (16 per cent.) higher than that for the whole of London during the same period; and higher also than that of every other district except Islington, Kensington, Poplar, Lewisham, Chelsea, Hackney, and Bermondsey. But, in truth, though the rate of increase for Camberwell would appear to have decreased, the actual increase has been greater and greater during each successive ten years, the increment in the first decenniad being 4250, that in the second 6567, that in the third 10,355, that in the fourth 11,637, and that in the last 14,799. And hence, it may very fairly be 8 sumed that, since 1851, its population has gone on augmenting at a rate not less than that which obtained during the ten years immediately preceding. And we shall probably be within the mark, if we calculate that in the ten years which will terminate in 1861, 15,000 individuals will have been added to the 54,667 existing at the last census; and that in the five years which ended on the 31st of March 1856, the population received an addition of half that number, or 7500. Should this estimate be correct, the number of human beings dwelling in the Parish in the spring of last year was about 62,167; and the mortality of the year, estimated for this amount of population, becomes 1-9 per cent. only, instead of 2-16 per cent., which indicates that 19 only in every 1000 died, instead of 22 in every thousand, which, as I have shown, would have been the rate had no increase of population taken place. Comparison of death rate with that of previous years.—By the same method of computation, the population which was 54,667 in 1851, was 56,167 in 1852, 57,667 in 1853, 59,167 in 1854 and 60,667 in 1855. The deaths in the respective years were 1203, 1125, 1367, 1980, and 1361, and these, when calculated according to the estimated population of the years to which they belong, yield the following series of death rates per cent., 2-20, 2-00, 2-37, 3-35, and 2-24, every one of which is higher than the death rate for the year 1856. And hence, it will be observed, that the past year has been peculiarly healthy, indeed healthier than any one of the five years immediately preceding it. Comparison of death rate with that of other parts of London.— According to the annual abstract just published by the Registrar General, it appears that the year 1856 has been unusually healthy for the whole of London ; and in the superior healthiness which it manifested, Camberwell would seem to have shared in a general blessing, and from all that has been yet shown to have been by no means peculiarly favored. But let us compare the mortality of other sections of the metropolis, for the past year, with that of Camberwell. (Table Y.) London is divided into five groups of districts; the western, the northern, the central, the eastern, and the southern. Of these the northern and western enjoy the reputation of being the most salubrious, the southern and eastern labour under the imputation of being the least salubrious, while the central 9 approximate in their standard of health to the average which is deduced for the whole of London. In the western districts the mortality was 2-097 per cent., in the northern 2-069, in the central 2-193, in the whole of London 2-178, in the eastern districts 2-286, in the southern districts 2-211. The lowest death rate was in the northern districts, where it was only 2-069 per cent,; and the death rate of Camberwell, not allowing for increase of population, was but little in excess of that, namely 2-16 per cent.—a rate about equal to that of the whole of London, and superior to that of the group of eastern and the group of southern districts. But in deducing these rates, the Registrar General has allowed for increase of population, and he has calculated the rate of increase of the several groups of districts, and of London, according to their respective rates of increase between the last two censuses. Calculated on this principle, I have shown that the death rate of Camberwell during the last year was 1-9 only, less therefore than the healthiest of the groups with which I have compared it. In the northern districts 20 persons died in a 1000, in Camberwell 19 died in a 1000. Again, let us compare the Camberwell death rates, which I have deduced for the years 1851, 1852, 1853, 1854, and 1855, with the death rates for the whole of London, and for the five groups of districts, during the corresponding years. An examination of table Y demonstrates that thrice during the Jive years, namely in 1851, 1852, and 1855, the mortality of Camberwell was lower than the mortality of all London, and of all its groups of districts, including the northern and western which usually rank the healthiest. And the probability that this is no fallacious estimate is enhanced by the fact that the year 1851, in which the number of inhabitants comprised in the several districts was accurately determined, and in which, therefore, the death rate could be accurately calculated, was itself a year in which the comparative healthiness of Camberwell was manifest. In 1853, Camberwell appears to have been comparatively healthy also, but in that year the death rate was higher than those of the northern and western districts, and in 1854, it rose to such a height as to exceed the death rates of all the districts except the south. How was this ? In the latter part of the year 1853, cholera had appeared in London, 10 and in 1854 a serious epidemic of that disease broke out. Camberwell suffered on both occasions, but more especially on the latter, and the deaths due to that cause alone, swelled the mortality of the former year, and gave a terrible magnitude to that of the latter year. In order to complete the comparisons I have instituted, I have calculated the death rates, both for the year 1851 and for the year 1852, of several of the neighbouring parishes, namely, Lambeth, Bermondsey, St. George's Southwark, Newington, Rotherhithe, and Wandsworth; and I find that in 1852 the death rate of Camberwell was more favorable than that of either of these parishes, and that in 1851, while the mortality of Botherhithe and Wandsworth was proportionately less than that of Camberwell, the mortality of the other parishes was as before proportionately greater. (Table VII.) I think then, Gentlemen, that it may fairly be taken for granted, from the concurrent testimony of all the calculations and comparisons which I have laid, somewhat tediously I fear, before you, that the death rate of Camberwell is naturally not high ; and further, that Camberwell is in ordinary years, one of the healthiest parishes in the metropolis. Nevertheless it is one of the favorite strongholds of cholera, and the reason of this I will ere long endeavour to explain. Comparison of death rate of sub-districts of Camberwell.— Camberwell is not only one of the most rapidly increasing parishes as regards population, but it is one of the most extensive, the only parishes which are larger than it, being Lewisham, Wandsworth, Kensington, and Greenwich. And as a consequence, partly of its great extent and partly of its eccentric position, in density of population and in other matters which exert an influence over its sanitary condition, it presents greater varieties than are found between separate parishes in the more central districts, and therefore affords opportunities for studying the hygienic peculiarities of different localities, and the influence which these peculiarities exert upon health, which ought not to be neglected. The area of Camberwell is 4342 statute acres, and these are distributed among the four sub-districts into which it is divided, in the following proportions:—Dulwich comprises 1423, Camberwell 1339, Peckham 1146, and St. George 434. At the last census, Dulwich, which is the largest of the sub-districts, contained only 11 1632 inhabitants, Camberwell 17,742, Peckham 19,445, and St. George's, which has an area considerably smaller than either of the others, 15,849. The population, therefore, of the several districts displays great differences in point of number, and naturally the number of deaths in each district exhibits a like disproportion. Thus, in Dulwich, 17 persons died, in Camberwell 434, in Peckham, 416, and in St. George's 316—that is, without allowing for increase of population, there died in Dulwich 10-4 in a 1000, in Camberwell 24-5 in a 1000, in Peckham 21-4 in a 1000, and in St. George's 19-9 in a 1000. The difference here indicated is something remarkable; in one locality 10 persons died in a 1000, in the other localities from 19 to 24 persons died in a 1000. Can this be true ? Is it certain that no deception exists ? Let us examine into the matter rigorously. I need scarcely remind you that the smaller the numbers we have to deal with, the more liable we are to be misled by fallacies. Thus, in calculating the mortality of the whole of London, though fever may be concentrated in the Fever Hospital, and consumption in the Hospital at Brompton, the places in which the deaths occur are still in London, and therefore the general mortality is in no wise affected by the localization of the diseases. In calculating the mortality of districts however, the formation of foci of disease in the way indicated, must frequently prove productive of serious error, inasmuch as it causes certain localities in which hospitals and infirmaries are situated to appear disproportionately unhealthy, and those localities in which these institutions do not exist to seemingly enjoy a comparative immunity from disease. And in estimating the death rate of a still smaller portion, as that of a sub-district, the liability to error becomes yet more increased by the fact that the poor, the aged, and the insane of several districts are frequently accumulated into one. Thus the sub-district of Camberwell contains the Workhouse, in which 73 deaths occurred, and two Lunatic Asylums from which 87 deaths were returned ; so that there is collected in that sub-district, a population amounting to about 1200 persons, who are for the most part diseased or aged, and in whom therefore an excessive mortality takes place, which swells most unfairly the mortuary tables of that locality. In order then to arrive as nearly as possible at the truth with regard to the actual and relative 12 mortality of the several divisions of Camberwell, it will be necessary, on the one hand to determine what the probable increase of population in each division since the last census has been, and on the other hand to divide the mortality of the Workhouse and of the Asylums proportionately between them. The whole of Camberwell, as before stated, increased between the two last censuses, at the rate of 37-1 per cent., or in other words 14,799 persons were added to it in that time. But the increase in the several sub-districts was not at all proportionate to the general increase. Dulwich remained stationary. The sub-district of Camberwell augmented at the rate of 25 per cent.; that of St. George's at 41 per cent.; and that of Peckham at 54 per cent. On the assumption that these rates of increase have continued, calculations, conducted on the same principles as those which I employed in estimating the present population of the entire parish, indicate that in the spring of 1856, the probable population of Dulwich was 1632, that of Camberwell 19,525, that of St. George 18,163, and that of Peckham 22,884. And calculating the mortality according to these estimates of the population, and incorporating the necessary corrections as regards the mortality of the Workhouse and Asylums, the more correct death rate in each subdistrict will become, lor Dulwich 1.29 per cent., for Camberwell 1.73 per cent., for St. George 1.97 per cent., and for Peckham 2.04 per cent.; or, to adopt a different form of expression, in Dulwich 13 persons died out of every 1000, in Camberwell 17 out of every 1000, in St. George rather less, and in Peckham rather more than 20 out of the same number. So that although the mortality of Camberwell generally, and that of three of its sub-districts, are not unfavorable when compared with the mortality of other districts, their mortality contrasted with that of the Hamlet of Dulwich is exceeding high and sufficiently alarming. Mortality among Children.—On casting our eyes over the columns which show the number of deaths due to different ages, the great preponderance of mortality among young children arrests the attention. No fewer than 427 deaths, out of 1183, occurred among children under five years of age, which is equivalent to 36.1 per cent. Of this number Dulwich contributed 3, Camberwell 119, St. George's 136, and Peckham 169. Table VI. shows the proportions which the deaths of children, under five years of age, bear to the total mortality, 13 and to the population in each of the sub-districts. This table demonstrates a remarkable correspondence between the amount of mortality among children, and the death rates deduced from the deaths at all ages; that is to say, it demonstrates that whenever the death rate is high, the death rate of young children is high also, thus in Dulwich the death rate of young children was .18 per cent., in Camberwell it was .61, in Peckham .74, and in St. George .75. But there is another fact which appears from the table, and one of greater interest than that just pointed out: it is that the mortality per cent. among persons upwards of five years of age is very nearly the same in each of the subdistricts, and that the excess of mortality in Peckham, St. George's, and Camberwell, over that in Dulwich is almost wholly due to infantile mortality. A fact that is strongly corroborative of what I have on previous occasions endeavoured to show, namely, that infant life succumbs more readily than adult life to unfavorable hygienic conditions, and that the degree of mortality prevalent among children, may be taken as a fair measure of the sanitarv state of a population. The following table, which 1 quote from a Report of Mr. Rendle's, shows that though our infantile mortality is large, other parishes surpass us in that respect:— Total Deaths. Deaths under 5. Proportion of Deaths under 5, to total Deaths. 1850 All London 48,950 18,847 One in 2½ Camberwell 1,066 368 One in 3 Newington 1,486 648 One in 21/3 Bermondsey 983 506 More than half St. George, Southk. 1,169 565 One half St. Giles 1,204 512 One in 21/3 Mortality from Fever.—There are but few among the diseases, which have been fatal during the last year, which call for comment. None of them has been peculiarly virulent. Yet I should wish to say a few words with regard to those affections which are included in the term "Fever;" for the amount of fever which occurs in a locality is not unfairly taken as a 14 measure, in some degree, of the sanitary condition of that locality; inasmuch as its constant presence in any neighbourhood, is a tolerably sure indication that there is some local cause, such as overcrowding, bad drainage, want of ventilation, or accumulations of filth, which encourages its presence. In the last year 19 deaths were ascribed to fever in this parish, 4 in Camberwell, 4 in St. George's and 11 in Peckham. This, supposing the population has not increased, is at the rate of .035 per cent. I have already shown that, although four or five individual districts have grown more rapidly than Camberwell during the last ten years, all London has increased much less rapidly, and so also have each of the five groups of districts; and hence, if their mortality be compared with that of Camberwell for any year subsequent to the last census, without in either case allowing for increase of population, it is clear that the disadvantage will be on the side of Camberwell. I have calculated their fever death rate on the assumption that no increase of population has taken place, and I find that while the fever mortality in Camberwell was only 3.5 in 10,000, that of all London was at the rate of 11.1 in 10,000, that of the southern districts was 8.2, that of the western 8.7, that of the central 9.8, and that of the eastern 16.5 in 10,000. For the northern districts the rate was 12.5 in 10,000, but since the Fever Hospital is situated in one of them, the mortality for this group is fallaciously high, and therefore I have not included it in my comparison. The above extracts prove that fever is not one of the scourges of the southern districts, and that Camberwell by comparison is peculiarly exempt (See Table VIII) from its ravages. There is then, Gentlemen, cause for congratulation; we have been blessed with a year of unusual healthiness; our Parish is not only more salubrious than most of the parishes which are our immediate neighbours, but during ordinary seasons is undoubtedly, I believe, one of the healthiest in London; our infantile mortality is not high compared with that of other districts, and fever appears to touch us but lightly. Tet, if we look with a scrutinizing glance, at certain facts, which the mortuary tables disclose, we find ample matter for deep and anxious consideration. In Dulwich 13 persons died in 1000, in Peckham and in St. George's 20 ; in Dulwich two children died in 1000, in Peckham and St. George's between 15 7 and 8; in Dulwich not one death was due to zymotic causes, in Peckham and St. George's though deaths from these causes were not excessive, still they were numerous. Now the healthiness of Dulwich is not merely apparent, it is real, for the returns from it for years past have proved it to he pre-eminently healthy among the districts of the metropolis. How is this ? How is it that Dulwich should be so favored above the other sections of this large Parish ? Again, Camberwell, in common with the other southern districts, suffers so severely from cholera during epidemic outbreaks of that disease, and has in cousequence obtained such an unenviable reputation for general unhealthiness, that a recent writer in "The Times," expressing no doubt the prevailing sentiment, suggests that, because the Registrar General in his last annual abstract did not allude to them, it might, therefore, be taken for granted that they maintained their pre-eminence as the seats of fever and cholera. How is this ? The solution of these queries, momentous though they be, is easy and lies on the surface. Dulwich is more healthy than the other portions of the parish, because it stands on higher ground, because, in consequence of this, it enjoys a natural drainage and a purer air, because it is more thinly peopled, and because its inhabitants are for the most part wealthy or well to do, and able to surround themselves with comforts which promote health and soften the severity of disease. Cholera has proved so peculiarly fatal, partly because of the foul water which the water companies forced us to imbibe, but chiefly on account of the want of drainage, under which the greater part of the parish labours. On each of the conditions, which I have just pointed out as combining to produce comparative unhealthiness in our low lying districts, and to intensify the attacks of cholera, I would wish before concluding to offer a few remarks. Density of population.—The degree of crowding to which a population is subject must clearly, other things being equal, exercise great influence over the health of that population. In all Camberwell there are 12.6 persons to an acre. In three parishes only, Lewisham, Wandsworth and Hampstead, is there a thinner population than is indicated by these figures. In all the other parishes of London, the population is more 16 dense than in Camberwell, and in the majority of them much more dense. In many of the more central ones, the inhabitants are accumulated at the rate of 200 or 300 to an acre, and in certain sub-districts, of which Berwick-street St. James's is a notable example, there are more than 400 individuals in the same space. You see, therefore, that in the comparative rarity of its population, Camberwell enjoys one element of health in a superior degree to almost all of the other London parishes; and I have no doubt that it is to this element chiefly that the comparative healthiness, which I have shown to prevail usually, is mainly attributable. But if we look to our subdistricts, we find that they differ greatly among themselves, that in Dulwich the population is at the rate of one person to an acre, in Camberwell at the rate of 13, in Peckham at that of 17, and in St. George's at that of 36. And it is worthy of remark, that though none of these numbers indicate a crowded population, nevertheless the relative density corresponds pretty exactly with the relative mortality. Yet, though even the most crowded district of Camberwell as a whole is thinly peopled, there is no doubt that in certain streets and courts an excessive degree of overcrowding really does take place, which arises mainly from the vicious practice of allowing each room in a house to be occupied by one, aye, and even by more than one family, and of admitting, as is too frequently the practice among the poorer Irish, an indefinite number of nightly tenants into a single apartment. Water supply.—I have already in a special report directed your attention to the subject of water supply. I have pointed out by arguments, which I need not now repeat, how important it is for cleanliness, comfort and health, that a plentiful and constant supply should be within the reach of every one. I have shown you how important it is that that which is destined for our daily beverage should be reasonably pure, how great a loss the use of hard water brings upon the poor, how many evils the use of water contaminated by sewage or decomposing organic matters entails upon all. I pointed out that the water, as at present supplied by the Lambeth, the Southwark and Vauxhall and the Kent Companies, is a fair and palatable water, a water that may be drunk in perfect safety, though it is yet scarcely so pure as the inhabitants of a metropolis like that of England ought to be provided with; and 17 I explained that the chief evil at present attending its use is the necessity for storage—a necessity which brings with it all the complicated apparatus of cisterns, water-butts, &c., in which, especially among the poorer classes, the water is allowed to become stagnant and to putrify, and to absorb every poisonous gas, and to imbibe every noxious living thing. I look forward hopefully to the day when there shall be a constant supply of water to each house, and when the expensive and inefficient plan of storage shall be discontinued. Those who have been, as I have during the last year, accustomed to visit the lowly habitations of the poor, will feel the force of what I say; and those who have seen the water-butts, and substitutes for water-butts, that are in daily use,—broken, rotting, and filthy things,—will understand how desirable it is that the need for their use should cease to exist. For, great as is the boon to our poorer neighbours of having water laid on to the premises, a boon too of which they are almost without exception fully sensible, many of its advantages are neutralized by the system at present in operation. I explained to you then, and I repeat it now, that water containing organic impurities is a dangerous and a poisonous beverage; and that on that account the water from the superficial wells of the metropolis, liable, nay almost certain, as it is to become impregnated with the leakage of cesspools and sewers, and with all the other abominations that sink into the soil, can rarely be a wholesome even though it be a palateable drink. The danger that may follow the use of sewage-contaminated water has been frequently illustrated by the occurrence of dysentery, diarrhoea, and cholera, the origin of which has been clearly traced to this cause. Indeed, the influence of impure water over the production of cholera has been proved, beyond all dispute, by the grand experiment, which the inhabitants of the southern districts of London, allowed unwittingly to be performed upon themselves during the cholera epidemics of 1849 and 1854. During the outbreak of 1849, the greater part of the districts south of the Thames was supplied with water by the Lambeth, and the Southwark and Vauxhall companies; the former drawing its supply from the foot of Hungerford Bridge, the latter from the neighbourhood of Battersea Fields. If there was any difference between the waters supplied by the respective companies at that period, that furnished by the Lambeth Company, and derived from B 18 the vicinity of Hungerford Bridge, must have been the worse; and from a careful analysis of the districts supplied by these Companies, it was found that of the population drinking Southwark and Vauxhall water, 11.8 in a 1000 died of cholera, and of that drinking Lambeth water, 12.5 in a 1000 died of the same disease. The difference here is small, and may have been accidental, yet it is worthy of remark that it is in favour of the population drinking the purer water. Between 1849 and 1854, the Lambeth Company removed their Works to Thames Ditton, and the water furnished by them became consequently infinitely more pure than it had been previously. The Southwark and Vauxhall Company, however, still continued to derive their supply from Battersea, "purveying," to use the words of Mr. Simon, "perhaps the filthiest stuff ever drunk by a civilized community;" for by that time it was worse than in 1849, "because the larger population and more extended drainage of London had given it a denser infusion of sewage and a more revolting unfitness for drink."' In 1854, a comparison was again instituted between the relative number of deaths from cholera, among those who derived their water supply from the two companies; and what were the results?—16.0 in a 1000 died of those who imbibed the disgusting stuff furnished by the Southwark Company, and 2.7 only in a 1000 of those who drank the now pure water supplied by the Lambeth Company. The Lambeth Company, which between the two epidemics had changed its source of supply, showed a diminution of cholera, deaths among those who used its water, from 12.5 in a 1000 to 2.3; the Southwark and Vauxhall, which continued to derive its water in 1854 from the same source whence it had derived it in 1849, showed an increase from 11.8 to 16 in a 1000. It might be suggested that the social condition of the persons supplied by the two companies varied, that the Lambeth supplied a superior class of people to the Southwark and Vauxhall, or that the condition of those supplied by the former was better in respect of drainage, density of population, or some other matters affecting health. But no—the investigation clearly showed that such was not the case, for in many instances the two companies' mains run side by side, and numerous streets exist in which one side is supplied by one company, and the other side by the other company; and in all such cases, cases in which there was no room for deception, separate comparisons 19 were instituted, and the law enunciated above was found to prevail universally.* Before leaving this subject, I will point out the results arrived at as regards Camberwell. 352 deaths occurred in this parish among those who drank the water of the Southwark Company, and 33 among those who drank the Lambeth water, 115 died of those who derived their supply from pumps and other sources, and 49 persons died whose source of supply was not ascertained. On calculating the rate of death among those who drank the water furnished by the Southwark and Vauxhall, and the Lambeth Companies, according to the number supplied by the two companies respectively, it appears that 3 in a 1000 died of those who drank the Lambeth water, and 15 in a 1000 of those who drank the Southwark water. These facts speak for themselves, and prove incontestably the great importance of that which all who devote themselves to sanitary investigations inculcate—the unspeakable importance of being supplied for drinking purposes with pure water. The Southwark and Vauxhall Company now obtains its water from Hampton; the water distributed by it is now equally good with that furnished by the Lambeth Company, and it will be a subject of intense interest to learn, in the event of any future outbreak of cholera, how far its mortality will be affected by the change. I may add that the Kent Water Works supply a small portion of the parish, and that the water which they purvey seems about equal in quality to that of the other two companies. Drainage.—The importance of efficient drainage I need scarcely dwell upon, for it is a subject to which your Board has paid much and enlightened attention. I crave your indulgence, however, while I make some remarks on a matter which especially interests all who dwell on the south side of the river. Cesspools, though unobjectionable perhaps in the country, where they can be placed at long distances from the houses, and where they cannot injuriously affect either the owners or their neighbours, in a crowded metropolis, like that of London, are most injurious and reprehensible. Owing to the proximity of dwelling-houses they have to be made in confined situations ; they are formed frequently close * See Dr. Snow's and Mr. Simon's reports. 20 to the houses, and sometimes even beneath them; and not only do their abominable contents sink into the soil around, and contaminate the water of the surface wells, but they even saturate the walls of adjoining houses, and not unfrequently their overflow accumulates under the very floors. Not only, however, are they injurious individually, but how vast must their influence for evil be in the aggregate! Think of the millions of inhabitants that at present crowd London, and think how foul must be the exhalations from the open mouths of the thousands of cesspools by which its surface is riddled, and how foul the soil which has become saturated by their constant soakage during many many years past, and surely the necessity of banishing them will be apparent to every one, and the importance of providing the only efficient substitute, namely good drainage, must be acknowledged! But, gentlemen, there is yet another reason why it is important that that matter, which the Board of Works has had under consideration, should be speedily and well carried out ; for not only is it essential that the excreta of the population should be carried away, but it is equally essential for health that the drainage of the ground on which we dwell, as regards the removal of its surface water and of that which saturates the soil, should be complete. No localities probably are so unhealthy as marshy localities—localities which lie low, which possess no natural drainage, in which water accumulates and becomes stagnant, and in which, even when the surface becomes dry, the soil immediately below the surface is still saturated with moisture. What it is that impresses on the emanations from such a soil the deleterious and often deadly qualities they are known to possess, may be a matter for speculation, but the fact itself is authentic and too notorious. Bat, it is equally certain that, when these marshy lands become artificially drained, agues and fevers and dysenteries and other affections, which were rife, become remarkably lessened or wholly disappear. This has been illustrated in the History of London itself; a large segment of its area—some part of the north, and a large portion of the south—was once marshy ground, and ague and dysentery were once common diseases. London however has been drained more or less efficiently, and those diseases once so common are now rare. But all parts have not been equally well drained; the southern districts are no longer a marsh it is true, but the level is so 21 low, and the soil so thoroughly sodden, that the evils of their marshy condition are far from being eradicated. Dulwich is situated high, and consequently enjoys a natural drainage, in virtue of which it escapes those evils which fall on the lower districts, and in which the other subdistricts of this parish unfortunately for them partake. The truth is, that the greater part of the southern districts is situated nearly on the same level as high water mark, varying from two or three feet above that line, to two or three feet below; and there is ever hanging over this level, clinging as it were to the soil and rising but little above it, stopping short along the margin of the hills, but sometimes probably sweeping over them, a cloud of unhealthy moisture, which is constantly steaming from the sodden earth, and bears in it not merely a portion of the poison due to a marshy soil, but a considerable portion also of poison due to the sewage with which the soil is so thoroughly impregnated. It is in marshy character, in their low level, and in the want of proper drainage dependent on that low level, that the southern districts differ from the other districts of London; and, I have no hesitation in saying, that it is from this cause mainly, that cholera seizes with such frightful virulence on these localities in preference to others, of which many are more densely populated, many are poorer, and many with the exception of enjoying a superior drainage, are in all other sanitary arrangements far worse than these. Can I bring any stronger argument to show how vastly important it is to these districts, above all others, that some scheme for the effectual drainage of the Metropolis should be carried into execution ? Ventilation—is a sanitary requirement of the utmost importance ; and indeed when it is recollected that about twenty times in a minute, night and day, we are drawing in a fresh supply of air, the value of pure air cannot be over estimated; and when it is further borne in mind, that every inspiration is succeeded by an expiration of poisonous gas, the necessity of having this gas removed must become strikingly apparent. It is astonishing how often we find persons, even in the higher grades of society, who habitually neglect to avail themselves of that ventilation which their houses are constructed to allow of, and who seem to delight in close, sickly and unhealthy rooms. The same want of appreciation of the value of fresh air is still more frequent among the poor, whose apartments are often 22 actually fetid with the long pent up exhalations from the bodies of their crowded inmates. But too often among the poor, the want of ventilation depends in great measure on faulty construction of the houses, occasionally the windows of one of their apartments do not open, or they only open below, frequently there is no means of ventilating the stair-case, and not uncommonly houses are built back to back. Defects of this sort are serious enough, and when complicated as they frequently are with cesspools, which open directly into the houses, or communicate with their interior through the medium of saturated walls, they constitute evils of the most dangerous kind, and call for immediate remedy. But house ventilation is not the only kind of ventilation that is needed, the air of districts and of streets requires constant renovation, and especially the air of districts, which like these lie low, aud are constantly yielding unwholesome exhalations. The construction of narrow streets, aud of courts ending in blind extremities, is therefore to be deprecated, and I am glad to say that as yet not much sin lies at the door of this Parish on that score. In connection with this subject, I may allude to a matter with regard to which there has been some discussion lately in the Vestry, namely vegetation.—I beg to assure you that I regard trees as a most important sanitary provision. It is a fact well known to physiologists, that those gases which the animal body exhales, and which are poisonous to it, are the appropriate food of vegetables, and are greedily absorbed by them ; and that, on the other hand, vegetables having appropriated to their own nourishment that which is inimical to us, yield up to the air again those constituents of which we are in need; so that vegetables and animals play as it were into each others hands, each abstracts from the atmosphere that which is either hurtful or useless to the other, and each restores to the atmosphere that which the other requires. Among the evils which tend to increase the mortality of a district, poverty must take a high rank. Hard work and insufficient food rapidly break down the strongest constitutions; over-crowded and ill ventilated rooms breed fevers; foul water and defective drainage prepare the way for epidemic cholera; the wretchedness of home finds a glaring and alluring contrast in the gin palace; and the indecencies which promiscuously crowded sleeping apartments give rise to, lay the foundation of vices which an early death so often expiates. It 23 is towards the extremes of life, however, that the fatal effects of poverty become most apparent; when the poor labouring man is sinking into the vale of years, hard work is still too often his daily portion; that work which was comparative play to him in his early life, now overtaxes his enfeebled frame, and sows the seeds of diseases which the continuing necessity of work hurries to a fatal issue ; and he, who in a higher station of life, might have lived to an honoured old age, sinks into a comparatively early grave. The poor man's child, too often comes into the world to share a portion all too scanty, and he, whose very existence depends on the watchful care and anxious solicitude of a parent, is too often left in the ruder guardianship of children or of strangers, while his mother is earning a precarious subsistance. What wonder that this frail vessel should founder on the stormy sea of infancy ! What wonder that the mortality among the children of the poor should be so great ! I am aware, gentlemen, that there are many other matters which influence the sanitary condition of localities, and the health of individuals. I am aware too that there are many facts in relation to this Parish that you may wish I had alluded to, but on which I have been silent; and many whereon I have simply touched, with regard to which you may regret that I have not been more explicit. But in the limit of a Report I did not deem it necessary to write a complete Essay. Nevertheless I am conscious of many imperfections and of many short-comings in the carrying out even of that plan which I proposed to myself; but, in the estimate you may form of them, I look to you with some degree of confidence to exercise a portion of that consideration and kindly feeling which you have invariably manifested towards me, and which have been so great an encouragement to me in the performance of the duties of the important office, to which twelvemonths ago I had the honour of being elected. I remain, Gentlemen, Your obedient Servant, Jan. 28th, 1857. JOHN SYER BRISTOWE. Table I.—Mortality of the Parish of Camberwell during the year 1856, (shewing Mortality of each District.) At what Ages ? Prom what Causes ? M. F. Total. Total Mortality due to each District, after a proportionate division among them of the Deaths occurring in Workhouse and Asylums. 0 to 5 5 to 10 10 to 15 15 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 and over. Violence, Privation, Poison and Premature Birth. Fever. Dysentery and Acute Diarrhoea (not of Infants) and Cholera. Scarlet Fever and Cynanche Maligna. Small Pox. Erysipelas, Pyœmia and Puerperal Fever. Diarrhœa, Bronchitis, & Pneumonia of Infants under three. Measles, Hooping Cough and Croup. Hydrophobia, and Convulsions of Infancy. Phthisis and other tubercular diseases. Other diseases, chiefly Chronic. Dulwich 7 10 17 21 3 ... ... ... 2 1 5 1 3 1 1 ... ... ... ... ... 1 ... ... 6 9 *Camberwell 214 220 434 338 119 13 5 9 26 52 43 46 48 73 26 4 1 7 1 8 33 16 28 65 245 Peckham 186 230 416 467 169 22 9 6 19 30 21 34 42 67 25 10 3 10 1 9 42 57 30 47 182 St. George 154 162 316 357 136 14 6 7 20 21 23 22 23 41 33 5 3 13 3 9 28 27 32 47 116 General Total 561 622 1183 1183 427 49 21 22 67 104 92 103 116 182 85 19 7 30 5 26 104 100 90 165 552 Table II. M. F. Total. Workhouse M. F. Total. 39 34 73 *Camberwell 214 220 434 Lunatic Asylums 44 43 87 Sub-district exclusive of above 131 143 274 Table III.—Mortality of the Parish of Camberwell during the Tear 1856, (shewing Mortality of each Quarter.) At what Ages. From what Causes ? M. F. Total. 0 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 30. 30 to 40. 40 to 50. 50 to 60. 60 to 70. 70 and over. Violence, Privation, Poison and Premature Birth. Fever. Dysentery and Acute Diarrhœa (not of Infants) and Cholera. Scarlet Fever and Cynanche Maligna. Small Pox. Erysipelas, Pycemia, and Puerperal Fever. Diarrhoea, Bronchitis, & Pneumonia of Infants under three. Measles, Hooping Cough and Croup. Hydrophobia, and Convulsions of Infancy. Phthisis, and other tubercular diseases. Other Diseasese6, chiefly Chronic. First Quarter 153 160 313 110 15 2 3 19 25 25 29 32 53 11 3 ... 9 2 13 22 23 33 38 159 Second Quarter 133 163 296 106 11 7 6 15 29 27 27 31 37 18 8 ... 12 1 8 19 30 27 38 135 Third Quarter 126 146 272 116 13 8 6 15 24 15 16 23 36 38 5 4 3 1 5 33 27 11 48 97 Fourth Quarter 149 153 302 95 10 4 7 18 26 25 31 30 56 18 3 3 6 1 ... 30 20 19 41 161 General Total 561 622 1183 427 49 21 22 67 104 92 103 116 182 85 19 7 30 5 26 104 100 90 165 552 Table IV.—Mortality due to Zymotic Diseases in 1856. Fever. Scarlet Fever. Small Pox. Hooping Cough. Measles. Diarrhæa. Total. Dulwich ... ... ... ... 0 ... ... Camberwell 4 7 1 4 11 11 38 Peckham 11 10 1 21 27 11 81 St. George 4 13 3 7 10 7 44 Total 19 30 5 32 48 29 163 27 TABLE V. Average Mortality of London, its five groups of Districts and Camberwell for six years; allowance has been made in every year since 1851, for increase of population. Taken chiefly from the Registrar General's Abstract for 1856. Districts. 1851 1852 1853 1854 1855 1856 West 2.206 2.144 2.212 2.829 2.252 2.097 North 2.208 2.113 2.236 2.422 2.295 2.069 Central 2.415 2.365 2.497 2.703 2.441 2.193 East 2.429 2.309 2.655 2.994 2.519 2.286 South 2.410 2.296 2.542 3.516 2.469 2.211 London 2.340 2.247 2.441 2.938 2.406 2.178 Camberwell 2.20 2.0 2.37 3.35 2.24 1.9 West Districts—Kensington, Chelsea, St. George Hanover Square, Westminster, St. Martin's, St. James Westminster. North Ditto—Marylebone, Hampstead, Pancras, Islington, Hackney. Central Ditto—St. Giles, Strand, Holborn, Clerkenwell, St. Luke, East London, West London, City. East Ditto—Shoreditch, Bethnal Green, Whitechapel, St. George's in the East, Stepney, Poplar. South Ditto—St. Saviour, St. Olave, Bermondsey, St. George, Newington, Lambeth, Wandsworth, Camberwell, Rotherhithe, Greenwich, Lewisham. TABLE VI. Exhibiting the relative number of Deaths per Cent. between Children under five years of age, and persons upwards of five years of age. Total Deaths per Cent. Deaths oyer 5 per Cent. Deaths under 5 per Cent. Per centage of Deaths under 5 to total Deaths. Dulwich 1.29 1.11 .18 14. Camberwell 1.73 1.12 .61 35. Peckham 2.04 1.30 .74 36. St, George's 1.97 1.22 .75 38. 28 TABLE VII. Table showing relative mortality of Camberwell and neighbouring districts in 1851 and 1852. Districts. Mortality per cent Increase of population not allowed for in 1852. 1851. 1852. Camberwell 2.20 2.06 Lambeth 2 26 2.22 Bermondsey 2.48 2.40 St. George's Southwark 2,61 2.51 Newington 2.29 2.21 Wandsworth 2.00 2.19 Rotherhithe 2.16 2.26 TABLE VIII. Table showing Mortality due to Fever, increase of population not allowed for, (1856). Population in 1851. Fever Deaths. No. in 10,000 London 2,362,236 2645 11.1 West Districts 576,427 326 8.7 North ditto 490,396 634 12.5 Central ditto 393,256 384 9.8 East ditto 455,522 793 16.5 South ditto 616,635 508 8.2 Camberwell 54,667 19 3.5 | Sub-districts. Dulwich 1632 0 Camberwell 17,742 4 Peckham 19,444 11 St. George 15,849 4 29 TABLE IX. Table showing increase and density of population, &c. Area in Statute Acres. Population in 1841. Population in 1851. Increase of Population per cent. between 1841 & 1851 Number of Persons to an Acre in 1851. London 78,029 1,948,417 2,362,236 21. 30.3 West District 10,786 300,711 376,427 25. 34.9 North ditto 13,533 375,971 490,396 30. 36.2 Central ditto 1,938 373,653 393,256 5.2 202.9 East ditto 6,230 392,444 485,522 23.7 77.9 South ditto 45,542 502,548 616,635 22.7 13.5 Camberwell 4,342 39,868 54,667 37.1 12.6 Sub-Districts. Dulwich 1,423 1,904 1,632 0* 1.1 Camberwell 1,339 14,178 17,742 25.2 13.3 Peckham 1,146 12,563 19,444 54.8 16.9 St. George 434 11,225 15,849 41.2 36.5 * The population of Dulwich may really be considered to have been stationary between 1841 and 1851, the apparent decrease being due to the presence, during the time the census was taken in 1841, of a considerable number of Haymakers and to the existence of one or two Schools which were subsequently discontinued. BILLING AND SON, PRINTERS, BERMONDSEY STREET.