LAM 15 Report on the Vital and Sanitary Statistics of the Parish of Lambeth, During the Year 1898 (With an Account of the work done by the Inspectors, and of the Proceedings taken under the Food and Drugs, Margarine, and Public Health Acts), by JOSEPH PRIESTLEY, B.A., M.D., D.P.H., Medical Officer of Health. Printed by order of the Vestry by MERSER & SONS, Printing Contractors, 270, Kennington Road, London, S.E. Public Health Department, 333, Kennington Road, London, S.E. February, 1899. To the Chairman and Members of the Vestry of the Parish of Lambeth. Gentlemen, Again I have the pleasure of congratulating you on the good sanitary work that has been done in Lambeth during another year (1898), and of thanking you for the ready way in which you have carried out my suggestions, and taken my advice. Details will be found in the pages of the Report, but I would specially note the action which you, as a Sanitary Authority, have taken with respect to— 1. Tuberculosis and its prevention. 2. Bacteriological Examination in Infectious Diseases. There can be no question but that Lambeth is getting rapidly to the front in all matters appertaining to the Public Health, and such a condition of affairs can only be brought about when a Sanitary Authority is ready and willing to support its advisers. It gives me great pleasure to speak well of the work that has been done by the Public Health Department, and to offer my thanks for the way in which I have been supported by my officers, and my praise for the satisfactory manner in which they have, one and all, carried out their duties. To the head officials of the various other departments of the Vestry, I beg to offer my thanks also. I am, Gentlemen, Your obedient Servant, JOSEPH PRIESTLEY, B.A., M.D., D.P.H., Medical Officer of Health. 4 I.—VITAL STATISTICS. All the estimated populations are calculated upon the enumerated populations of the Censuses of 1891 and 1896, and made up to the middle of the year 1898. The Parish of Lambeth contains 4,059 statute acres, inclusive of 79 tidal water and 39 foreshore, with an estimated population of 304,073 persons to the middle of the year 1898, consisting of 143,625 males and 160,448 females, or an excess of 16,823 females. The total estimated increase of the population is 4,025, but the " natural increment," i.e., the excess of births over deaths, is 3,826, so that an exodus of 199 in excess of those who came into the Parish during the year must be assumed. POPULATIONS. Censal (Enumerated). Estimated (From Censuses 1891 and 1896.) Sub-districts. 1891. 1896. 1898. Middle of Year. Waterloo Road First 14031 14186 14262 Waterloo Road Second 14644 14210 14020 Lambeth Church First 18075 18770 19090 Lambeth Church Second 39097 40994 41864 Kennington First 50586 52486 53361 Kennington Second 39708 43244 44852 Brixton 73405 81825 85647 Norwood 25657 29318 30977 275203 295033 304073 5 The Lambeth estimated population to the middle of 1898, may be sub-divided as follows:—- Registration Sub-districts. Males. Females. Total. A. As to Registration Sub-districts. Waterloo Road First 7179 7083 14262 Waterloo Road Second 7177 6843 14020 Lambeth Church First 9623 9467 19090 Lambeth Church Second 20907 20957 41864 Kennington First 26156 27205 53361 Kennington Second 20733 24119 44852 Brixton 38334 47313 85647 Norwood 13516 17461 30977 Parish of Lambeth 143625 160448 304073 6 B. As to Parliamentary Divisions and New Wards. Parliamentary Divisions and New Wards. Males. Females. Total. Marsh Bishop's North Division 31095 30964 62059 Prince's Vauxhall Kennington Division 39738 40811 80549 Stockwell Brixton Brixton Division 38315 45534 83849 Tulse Hill Norwood Norwood Division 34477 43139 77616 Parish of Lambeth 13625 160448 304073 N.B.— The 1896 Census takes no account of the Parliamentaiy and New Wards boundaries, so the distribution of the estimated population among the four Parliamentary Divisions has been obtained from the Censuses 1881 and 1891. 7 C. As to Age-Periods. Age-Periods. Males. Females. Total. 0—1 3941 3923 7864 1—5 14189 13941 28130 Total under 5 18130 17864 35994 5—20 44714 47410 92124 20—40 48224 54341 102565 40—60 24424 28247 52671 60—80 7694 11607 19301 80 and upwards 439 979 1418 Total over 5 125495 142584 268079 8 The estimated number of inhabited houses to the middle of the year 1898 is 40,840, and the rateable value of the Parish on October 27th, 1898, was £1,712,289, an increase of £19,473 on the previous year, as the following Table shews:— Year. Rateable Value. 1898 1,712,289 1888 1.491,518 1889 1,491,851 1890 1,498,535 1891 1,526,176 1892 1,540,047 1893 1,551,023 1894 1,562,868 1895 1,575,253 1896 1,680,283 1897 1,692,816 Yearly average for 10 years, 1887-1896, £1,561,037. The Registrar-General returns the estimated population of London for the middle of the year 1898 as 4,504,766, consisting of 2,129,250 males and 2,375,516 females, and states that there were registered during the year 42,016 marriages, 132,432 births (67,212 males and 65,220 females), and 83,936 deaths (43,366 males and 40,570 females). There were registered, too, 12,565 deaths from the seven chief zymotic diseases. The excess of registered births over deaths, i.e., the natural increment, is 48,496 and the estimated increase of population is 41,791. * These rateable values are the figures as settled by the Assessment Committee in the last Supplementary Valuation List, and do not include, therefore, any new properties that may come into txiatence after such list is settled. 9 1898.—Sanitary Areas of the Metropolis. Enumerated Population, 1891 (Census). Enumerated Population, 1896 (Census). Estimated Population, 1898 (middle of year). Birth-Rate. Death-Rate. Zymotic DeathRate. Deaths under 1 yearto 1000 Births London 4211743 4411710 4504766 29.5 18.3 2.77 166 South Districts 1524472 1642796 1698524 29.9 17.7 2.74 163 West Districts 728418 766203 784394 24.5 17.0 2.48 170 North Districts 993884 1040694 1061560 27.5 16.9 2.48 153 Central Districts 259855 245683 239567 28.9 22.1 2.79 170 East Districts 705114 716334 720721 36.6 21.7 3.59 181 10 Table A, giving the number of Births and the Birth-Rates in each Registration Sub-District of Lambeth during 1898 (arranged quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1898. Rate per 1000 Inhabitants. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Waterloo Road 1st 143 119 126 120 508 35.6 „ 2nd 213 205 230 225 873 62.3* Lambeth Church 1st 157 142 141 141 581 30.4 2nd 410 409 410 384 1613 38.5† Kennington 1st 482 449 494 463 1888 35.4 „ 2nd 267 259 248 235 1009 22.5 Brixton 530 563 559 491 2143 25.0 Norwood 191 143 153 154 641 20.7 Lambeth 2393 2289 2361 2213 9256 30.4 * Including Lying-in Hospital, † Including Workhouse, 11 Table B, shewing the Estimated Populations, Numbers of Inhabited Houses, Marriages, Births, and Corrected Deaths for the year 1898, and Ten Years preceding, in Lambeth Parish. The Year. Estimated Population. Estima'ed No. ot Inhabited Houses. Marriages. Registered Births. Corrected Number of Deaths, Deaths from 7 Chief Zymotic Diseases. Deaths in Public Institutions. Total Ages. Under 1 Year. Under 5 Years. 1898 304073 40840 2589 9256 5430 1426 2089 726 1543 1888 269114 37689 1985 9017 5095 1196 1990 634 1533 1889 271312 38004 1997 8906 5057 1259 2071 727 1460 1890 273529 38319 2060 9017 5842 1369 2228 696 1320 1891 276162 38634 2140 9097 5886 1387 2251 692 1438 1892 280032 38950 2107 9226 5457 1250 2091 705 1578 1893 283956 39265 2233 9222 5219 1325 1925 748 1741 1894 287935 39580 2224 9232 4837 1223 1936 680 1484 1895 291970 39895 2220 9341 5559 1420 2187 732 1511 1896 296061 40210 2445 9592 5098 1313 2045 708 1588 1897 300048 40525 2445 9388 5251 1425 2096 734 1546 Note.—(a) Enumerated Population at Census 1896 was 295,033. (b) Actual number of inhabited houses at Census 1891 was 38,556. 12 THE BIRTH-RATE. The number of Births registered in Lambeth during the year 1898 was 9256, as compared with 9388 for the year 1897. Of the total 9256 births, 4739 were males, and 4517 females, showing an excess of 222 males. The birth-rate for Lambeth is, therefore, 30.4 per 1,000 inhabitants (32.9 for males and 28.2 for females), as compared with 29.5 for London (31.6 for males and 27.5 for temales) ; whilst in the various Registration Sub-Districts the birth-rates work out as shown in Table A. Tables B and C shew the number of births, and the birth-rates for the last 10 years in Lambeth. It must again be pointed out that the death-rate and birth-rate must be taken together, as the death-rate per se gives no reliable information as to the relative healthiness or otherwise of a particular district, For this reason, in considering the statistics of the various Registration SubDistricts of Lambeth, the birth-rates and death-rates are given side by side, and any deductions drawn must be on the understanding of the importance of this interrelationship. In the Inner Wards (where the birth-rates are high) is this to be again especially noted, as the high birth-rates there cause the high death-rates, owing to the great numbers of deaths amongst infants and children between 1 and 5 years of age. Density of population in the Inner Wards leads to this high infantile mortality, and a persistently high birth-rate, instead of leading to a lower, causes a higher, death-rate, and points to the insanitary and unhealthy conditions under which the inhabitants in the Inner Wards of Lambeth exist, as compared with those in the Outer Wards. It must be remembered, too, that the Lying-in Hospital and the Workhouse tend to abnormally increase the birth-rates in Waterloo Second and Lambeth Church Second Districts. 13 Table C, shewing the number of persons per house, the Marriage-, Birth-, and Death-Rates, and proportion of Deaths in Public Institutions, for the Year 1898 and ten years preceding. The Year. Estimated No. of Persons per house. Marriage-Rate per 1,000 Population. Birth-Rate per 1,000 Population. Death-Rate per 1,000 Population. Deaths of Children under I year, per 1000 Births. Deaths of Children undei 1 year, per 1000 Deaths. Deaths of Children 1 under 5 years, per iooo Deaths. Zymotic DeathRate, per 1000 Population. Deaths in Public Institutions per 1000 total uncorrected deaths. 1898 7.4 17.0 30.4 17.9 154.1 262.6 384.7 2.4 277.1 1888 14.8 33.5 18.9 132.6 234.7 390.6 2.4 297.3 1889 14.7 32.8 18.6 141.4 248.9 409.5 2.7 284.5 1890 15.1 32.9 21.4 151.8 234.3 381.4 2.5 222.1 1891 15.5 32.9 21.3 152.5 235.6 382.4 2.5 236.6 1892 15.0 32.9 19.5 135.5 229.1 383.2 2.5 272.4 1893 15.7 32.5 18.4 143.7 253.9 368.8 2.6 305.9 1894 15.4 32.1 16.8 132.5 252.8 400.3 2.4 284.7 1895 15.2 31.9 19.0 152.0 255.4 393.4 2.5 257.9 1896 16.5 32.4 17.2 136.9 257.6 401.1 2.4 295.7 1897 16.3 31.3 17.5 151.8 271.4 400.1 2.4 281.8 Note.—(a) Enumerated number of Inhabited Houses at Census 1891 was 38,556. (b) Enumerated number of Inhabited Houses at Census 1881 was 35,404. 14 THE MARRIAGE-RATE. The number of marriages registered in Lambeth during the year 1898 was 2589, as compared with 2445 for the year 1897. The marriage-rate for Lambeth is, therefore, 17.0 per 1,000 inhabitants, as compared with 185 for London. Tables B and C shew the number of marriages and the marriage-rates for the last ten years in Lambeth, and it will again be noticed that the marriage-rate has been gradually, but persistently, falling during that period, as also during the previous decennium. Marriage statistics are of little value. THE DEATH-RATE. The total number of deaths registered in Lambeth during the year 1898 was 5,567 as compared with 5,486 for the year 1897. Of the total 5,567 deaths, 2,869 were males and 2,698 females, showing an excess of 171 males. The death-rate for Lambeth is, therefore, 18.3 per 1,000 inhabitants (16.8 for males and 19.9 for females), as compared with 18.7 for London (20.4 for males, and 17.1 for females). These rates are, however, uncorrected, and on analysing the 5,567 deaths registered in Lambeth Parish, it is found that 592 represent deaths occurring within the Parish amongst persons not belonging thereto. These are to be deducted, but, on the other hand, there are 455 deaths registered ontside the Parish of persons belonging thereto, and these must be added, giving a corrected number of deaths for Lambeth during 1898 of 5,430, and a corrected death-rate of 17.9 per 1,000 inhabitants, as compared with 18.3 for London (the total corrected number of London deaths being 82,037). 15 The Institutions, &c., where the 455 Lambethians died during 1898, may be grouped as follows:— I. General Hospitals South-Eastern 14 Charing Cross 12 Western 8 French 1 Park Fever Hospital 4 Guy's 16 III. Infirmaries and Workhouses Hostel of God 4 King's College 19 Bethnal House Asylum 1 London 4 Camberwell Workhouse 2 Middlesex 9 Central London Sick Asylum 1 Royal Free 1 St. Bartholomew's 12 Girdler's Almshouses 1 St. George's 7 Kensington Infirmary 1 University 3 Newington Workhouse 1 Westminster 49 St. George's Union Infy. 1 II. Special Hospitals St. Saviour's Infirmary 6 Bethlehem 2 St. Saviour's Workhouse 1 Belgrave 13 IV. Asylums Brompton 11 Banstead 20 Brcok House, Hackney 1 Bethnal House Asylum 1 Cancer Camberwell House 4 Children's Hosp., Pdgtn. 1 Caterham 16 City of London Asylum 3 Cave Hill 25 Convent Hospital 1 Colney Hatch 3 Evelina 36 Darenth 3 Friedenheim 7 Grove Hill 5 German 1 Hanwell 4 Gt. Ormond Street H. M. Prison, Wandsw'rth 1 Gt. Northern Central 1 llford 13 Heart Hospital, Soho 1 Leavesden 6 Homoeopathic 1 Licensed Victuallers 1 Home for Sick Children Middlesex Asylum 1 Invalid House, Highbury 1 Peckham House 7 London Temperance 1 Hoxion House 1 Mildmay House 1 V. Unclassifiable Places National 1 River Thames 4 North London 1 Private Addresses 7 Nursing Home, Clapham Mount Pond, Claph'm Con 1 Royal Chest Hospital 1 Streets 3 Samaritan Free 1 Chelsea Barracks' Parade 1 St. Elizabeth's Home 3 Brought dead to Hospital 2 St. Peligras Creche 1 Found drowned in Victoria 5 voir 1 West London 2 Found drowned in Dock 1 Fever Total 455 Fountain 33 Northern 1 16 Summary. I. General Hospitals 137 II. Special and Fever Hospitals 172 III. Infirmaries and Workhouses 15 IV. Asylums 111 V. Elsewhere (Unclassifiable) 20 455 Whether we take the corrected or uncorrected death-rates for Lambeth (as a whole), they are again satisfactory for the year 1898, whilst on examining the death-rates more closely, e.g., as to age-periods, and special diseases, we still find cause for even greater satisfaction and congratulation. If, however, we sub-divide the death-rate into the several Registration Sub-Districts, we find that the Inner Districts, e.g., Waterloo 1st and 2nd, Lambeth Church 1st and 2nd, have again suffered out of all proportion as compared with the Outer Districts, e.g., Kennington 1st and 2nd, Brixton and Norwood. The mean average death-rate for the four Inner Districts is 22.51 and for the four Outer, 1593 per 1000, with corresponding average birth-rates of 401 and 26.4 per 1000 respectively (allowing for the fact that the Lying-in Hospital and Workhouse are in the Inner Districts). The Zymotic death-rate is, for the Inner Districts, 3.03, and for the Outer Districts, 2.12 per 1000, and the Zymotic incidence (cases notified), 9.3 and 6.9 per 1000 of the population respectively. The Inner Wards have a larger comparative mortality amongst children under five years of age, and amongst infants one year of age (per 1000 births), and a correspondingly smaller mortality in persons over 60 years of age. 17 COMPARISON BETWEEN STATISTICS FOR 1897 AND 1898. Death.Rates. Birth-Rates. Infantile Mortality, uncorrected General. Zymotic. 1897 1898 1897 1898 1897 1898 1897 1898 Inner Wards— Waterloo 1st 32.9 25.3 4.6 3.5 35.9 35.6 251.9 185.0 Waterloo 2nd 15.2 25.4 2.3 2.2 62.7 62.3 82.9 113.4 Lambeth Church 1st 23.3 22.9 4.4 3.3 31.6 30.4 314.9 301.2 Lambeth Church 2nd 22.5 20.4 4.5 2.9 38.5 38.5 188.7 164.3 Outer Wards— Kennington 1st 17 .9 18.5 2.6 1.1 35.1 35.4 133.9 137.2 Kennington 2nd 16.3 16.2 1.5 0.8 25.1 22.5 118.9 139.7 Brixton 13.5 14.9 1.5 0.4 25.4 25.0 134.2 155.9 Norwood 12.8 14.0 1.2 0.2 23.1 20.7 143.1 124.8 Lambeth 17.5 17.9 2.4 2.4 31.3 30.4 155.4 156.3 18 It will be noted (vide Table on page 17) that there is a slight improvement during the year 1898 over the year 1897, in connection with the separate mortality rates for the Inner as compared with the Outer Districts; but the great difference in the returns of the Inner and Outer Districts still remains, unfortunately, such that no efforts must be spared in continuing to carry out the suggestions contained in the Special Report on High Death-rates presented to the Vestry last year (vide Annual Report, 1897). It will be remembered that in this Special Report, a series of recommendations were made, and these recommendations the Vestry,* at their meeting held on April 28th, 1898, decided to carry out as follows:— I. " Municipal cleanliness in its widest sense—scavenging to be carried out as often as possible to ensure efficiency, together with the sweeping and flushing of all side roads, courts and alleys (even though quasi public properties), not less than once a week in the winter, and oftener in the summer; roads to be repaired when the water collects and stagnates in holes, e.g.:—Prince's—Cory—Square (Commercial Road), Commercial Buildings, Brad Street, Mepham Street, Little Windmill Street, Cornwall Mews (entrance), Felix Street, Lanfranc Street, Mary's Buildings (Tanswell Street), Johanna Street, Whitgift Street, &c., &c." " With the view of carrying out these principles, the Vestry also recommend that the streets and *The Report was considered by the Sanitary Committee on February 2ist, March 7th and 21st, and April 18th; by the Sewers Committee on April 4th; by the General Purposes Committee on April 5th; and by the Wharf Committee on April 6th. 19 courts of the Inner Wards be swept and cleansed frequently; that immediate steps be taken to channel the streets which are not now channelled; and that additional gullies be placed where required." (N.B.—All the above suggestions are being carried out, and the special roads mentioned have been repaired, with the exception of Prince's (Cory) Square, which is being left over until the completion of the Broadwall Sewer).* II. "Periodic inspection, with examination of drains, of the houses in the Inner Districts (at frequent intervals), with systematic house-to-house visitations, including schools—but that the question of appointing a Female Inspector be deferred for six months." (N.B.—The Inner Wards or Districts have been better and more systematically inspected during the past year than ever before—the Inspectors, having smaller districts, being better able to keep up their house-to-house inspections). III. " Cleansing, flushing, repairing, relaying (as required) of those sewers or combined systems of drainage, for the condition of which the Vestry, in the present state of the law, is liable, together with attention to the gullies, and the closing of those ventilating grids (with or without compensatory ventilation as may be necessary) in narrow streets which are complained of, and shewn to be real and persistent nuisances." (N.B.—These suggestions are being systematically carried out from time to time). *This work is now approaching completion. b2 20 IV. "The securing of open spaces or playgrounds in the densest portions of the Inner Districts." (N.B.—The Vestry are at present considering this matter in connection with several sites). V. " The rigid and systematic enforcement of the laws as to Houses Let in Lodings, or Occupied by Members of more than one Family—a duty which might with advantage engage the whole time of an extra permanent Inspector. The Inspector, in his dealing wilh overcrowding, would have under observation the sanitary conditions of the lodgings, and be able to enforce the Bye-laws to secure systematic cleansing and general sanitation." (N.B.—The Vestry have appointed permanently an extra male Sanitary Inspector). VI. "The application of the Housing of the Working Classes Act to secure houses being rendered fit for human habitation, without resorting to the extreme measure of closing them—a line of action which is apt to increase the evil which the Vestry is endeavouring to remedy; and the consequent obtaining for the working classes of better house accommodation—a sanitary improvement much required and much to be desired in connection with the Inner Districts." (N.B.—Much good has been derived from applying the Housing of the Working Classes Act to some of the worst property in Lambeth during the past year (vide pp. 113—117). Credit is due to the Vestry for the ready way in which they adopted the recommendations of the Medical Officer, 21 and it must be noted with satisfaction that as a consequence better attention is being given to the following important matters:— 1. Provision of additional gullies in the Inner Wards together with channelling and repairing of roads as may be found necessary from time to time. 2. More frequent sweeping of side roads and courts in addition to the main thoroughfares. 3. Flushing and cleansing of sewers. 4. Greater attention to scavenging and periodical cleansing of gullies. In connection with No. 4, the Sanitary Committee consulted with the Wharf Committee and suggested the following series of recommendations, which were presented to, and adopted by, the Vestry:— Ordinary Trade Refuse. 1. That all descriptions of Trade Refuse be removed (offal, builder's refuse and manure, only excepted). 2. That the present price of 5s. 6d. per load of 36 baskets, be altered to 2d. per basket, for any number of baskets. 3. That a circular be sent to grocers, provision chants, etc., informing them that their refuse will be removed by the Vestry, on the terms abovementioned. 4. That the carmen should be supplied with a small book and counterfoil, on which they should enter the number of baskets of refuse removed, and should give a ticket to those firms who avail themselves of these facilities for the removal of 22 their refuse, in order that they may have a check as to the quantity for which they are charged. 5. That a notice be sent to such persons, cautioning them against putting their trade refuse in the dust-bin, and informing them that a request that such refuse should be removed, addressed to the Surveyor at the Vestry Hall, will receive prompt attention. Trade Refuse left in the streets by Costermongers. 1. That it is advisable that the Vestry continue to remove the trade refuse left in the streets by costermongers. 2. That a van be sent round the market thoroughfares (New Cut, Lower Marsh, Lambeth Walk, Wandsworth Road and Atlantic Road) once a day on ordinary days at 11 o'clock in the morning, and thrice a day on market days (Wednesdays and Saturdays) to collect the trade refuse from the costermongers' stalls. 3. That a printed notice be circulated among the costermongers, that they will be required to deposit their refuse in this van when it comes round; and that any costermonger who deposits his refuse on the roadway, after the receipt of such notice, will be proceeded against under the Vestry's Bye-laws. The above regulations will simplify matters very much, and will assist considerably the Vestry in keeping cleaner the roadways in the market thoroughfares which have given such trouble in the past. The garbage, etc., thrown down on market days ought, especially, to be removed as soon as possible. 23 The 5430 corrected deaths may be further analysed and tabulated according to age-periods as follows:— 1426, i.e., 26.3 per cent. of the total deaths took place under 1 year of age. 663 „ 12.2 „ „ between 1 and 5 years. 2089 „ 38.5 „ „ under 5 years. 261 „ 48.1 „ „ between 5 and 20 years. 610 „ 11.2 „ „ 20 and 40 years. 1020 „ 18.8 „ „ 40 and 60 years. 1199 „ 22.1 „ „ 60 and 80 years. 251 „ 4.6 „ „ 80 years and over. 3341 „ 61.5 „ „ over 5 years. These results must be compared with those for London given in Table E, which shews the estimated mortalities per 1000 persons at each age-period for London during 1898, and for the London averages for the 10 years 1881-90. Tables G, H and I shew the uncorrected returns (male and female) arranged as to Registration Sub-districts, ageperiods, and quarters respectively, for comparison with similar tables in former Lambeth Reports. The place that Lambeth takes amongst the Metropolitan Sanitary Districts is worthy of note, there being only 15 other Districts (out of 43) with a less death-rate, and 18 with a less zymotic death-rate—a condition of things satisfactory in so far as general death-rates are a guage of the health, or otherwise, of a Community. The sanitary conditions under which the people live are important, and, as far as Lambeth is concerned, are improving year by year owing to the good work that is being done by the Sanitary Department. [See Report as to Work done by Sanitary Inspectors—pp. 85 and onwards.] 24 25 TABLE D. Shewing the number of Births and Deaths, with Birth- and 1898. Ttie Deaths are from all causes, and from the chief outside the Parish, by omitting strangers who die within the other Districts from which they have been removed during illness. TABLE D. Death-rates in each of the Registration Sub-Districts of the Parish during Zymotic Diseases, and are corrected by adding Lambethians who die Parish, and by re-distributing persons who die in Public Institutions in Details for London (with corrected deaths) are added for comparison. DISTRICTS. Fersons per Acre. Estimated Population fmiddle 1898). Total Births. Birth-rate per rooo of the Population. Total Deaths (corrected). General Death-rate per 1000 of the Population. Total Deaths from Total Zymotic Deaths. Zymotic Death-rate per icoo cf the Population. Zymotic Death-rate per 1000 of the Total Deaths. Diarrhcea Death-rate per 1000 of the Population. Infantile Mortality per 1000 Births uncorrected. Small Fox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whocping Cough. Typhus. Typhoid or Enteric. Continued Fever. Diarrhcea. Waterloo Road, 1st 212.8 14262 508 35.6 340 25.3 ... 7 2 7 17 ... 3 ... 14 50 3.5 134.6 0.9 185.04 „ „ 2nd 140.0 14020 873 62.3 335 25.4 ... 3 2 4 8 ... 3 ... 11 31 2.2 88.2 0.8 113.4 Lambeth Church, 1st 111.6 19090 581 30.4 418 22.9 ... 7 7 4 11 ... 4 ... 30 63 3.3 144.4 1.6 301.2 „ „ 2nd 225.1 41864 1613 38.5 833 20.4 ... 16 7 14 17 ... 7 ... 64 125 2.9 146.9 1.5 164.3 Kennington, 1st 108.8 53361 1888 35.4 967 18.5 ... 55 1 31 32 ... 8 ... 56 183 1.1 185.6 1.1 137.2 „ 2nd 90.1 44852 1009 22.5 705 16.2 ... 6 5 11 16 ... 4 ... 34 76 0.8 105.2 0.8 139.7 Brixton 60.6 85647 2143 25.02 1253 14.9 ... 17 5 34 47 ... 4 ... 37 144 0.4 113.4 0.4 155.9 Norwood 30.5 30977 641 20.7 413 14.0 ... 22 1 9 10 ... 2 ... 7 51 0.2 118.4 0.2 124.8 District not stated ... ... ... ... 166 ... ... ... ... 1 1 ... ... ... 1 3 ... ... ... ... Lambeth 77.2 304,073 9256 30.4 5430 17.9 ... 133 30 115 159 ... 35 ... 254 726 2.4 133.7 0.8 1563 London 60.3 4504766 132432 29.5 82037 18.3 1 3069 581 1756 2157 3 554 9 4352 12482 2.8 152.2 0.9 167 N.B.—In the 166 case where the District is not stated the death-rate has been calculated on the assumption that these deaths were sub-divided equally in the eight Districts. Census 1891, Return gives the area of Lambeth as 3,941 statute acres (exclusive of tidal water and foreshore). 26 TABLE E. Giving Death-rates, Zymotic Death-rates, and Zymotic Incidence-rates in the Parliamentary and New Wards, Division of Lambeth, during 1898. Parliamentary Divisions. New Wards. Total Deaths. DeathRate per 1,000 Zymotic Diseases. Zymotic Incidence. Total Deaths. DeathRate per 1,000 population Total Zymotic Cases Incidence per 1,000 e population North Division Marsh 673 24.5 77 2.7 213 9.9 Bishop's ... 845 90 351 Kennington Division Prince's 731 18.8 139 3.6 326 8.2 Vauxhall 780 152 336 Brixton Dvision Stockwell ... 400 13.0 52 1.6 242 6.1 Brixton 692 78 269 Norwood Division Tulse Hill 887 16.9 95 1.8 396 7.6 Norwood 422 43 196 Lambeth ... 5430 17.9 726 2.4 2329 7.7 N.B—The above Rates are estimated from the Censuses 1881 and 1891—the 1896 Census taking no account of the Parliamentary and New Wards boundaries. 27 TABLE F. Showing Mortalities in Lambeth at different Age-Periods compared with (1) those for London 1898, and (2) the averages for London, for years 1881-90. Age-Periods. LAMBETH. LONDON. Estimated Populations (middle 1898). Mortality Rates per 1000 Population, 1898. Corrected. Uncorrected. Mortality Rates per 1000 Population, 1898, Uncorrected. Average of Ten Years 1881—90. per 1000. 0—5 35994 58.0 59.6 78.3 68.4 5—20 92124 2.8 7.9 3.9 8.1 4.3 20—40 102565 5.9 6.5 7.7 40—60 52671 19.4 19.9 20.2 60—80 19301 62.1 70.3 60.6 69.6 63.3 80 and upwards 1418 177.0 201.2 206.2 *Under 1 year 7864 154.1 156.3 167.0 152.0 All Ages 304073 17.9 18.3 18.7 20.5 I have used the Age-periods adopted in previous Lambeth Reports, though it is considered more accurate to sub-divide as follows:—1-5, 5-15, 15-25, 25-35, 35-45, 45-55, 55-65, 65-75, 75-85, 85 and over. * N.B.—The Rates under 1 year are given in terms of 1000 births. 28 TABLE G. Shewing the Uncorrected Mortality (Male and Female) in the different Districts, and a comparison of the number of Deaths in each Quarter during the year 1898. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total No. of Deaths in each District. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Waterloo Road 1st 44 27 71 33 27 60 43 46 89 30 33 63 283 2nd 23 36 59 35 24 59 36 45 81 30 24 54 265 Lambeth Church 1st 139 93 232 107 78 185 141 84 225 123 68 196 838 2nd 192 198 390 159 122 281 173 151 324 161 135 296 1292 Kennington 1st 128 125 253 80 78 158 93 106 199 80 88 168 778 2nd 68 94 162 54 63 117 74 69 143 52 69 121 543 Brixton 166 189 355 137 119 256 173 160 333 129 132 261 1205 Norwood 52 66 118 25 39 64 51 59 110 33 51 84 376 Totals 812 828 1640 630 550 1180 784 720 1504 643 600 1243 5567 29 TABLE H. Shewing the Uncorrected Mortality (i.e., including that of Strangers) at different Ages in each District of the Parish, 1898. Sub-District. Under 1 year. 1 to 5 years. 5 to 60 years. 60 yrs. & upwards. . M. F. Total. M. F. Total. M. F. Total. M. F. Total. Waterloo Road 1st 52 43 95 29 26 55 51 44 95 18 20 38 283 2nd 55 43 98 18 18 36 34 44 78 18 23 41 253 Lambeth Church 1st 93 82 175 71 51 122 293 151 444 57 40 97 838 2nd 154 110 264 58 48 106 264 192 456 204 261 465 1291 Kennington 1st 143 117 260 59 68 127 90 94 184 88 119 207 778 „ 2nd 73 68 141 22 24 46 90 98 188 63 105 168 543 Brixton 190 144 334 32 80 162 194 198 392 135 182 317 1205 Norwood 44 36 80 23 22 45 55 73 128 39 84 123 376 Totals 804 643 1447 362 337 699 1071 894 1965 622 834 1456 5567 co o TABLE I. Shewing the Uncorrected Deaths (i.e., Parishioners and Strangers) at various Age-periods in each Quarter, 1898. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Under 1 year 166 130 296 167 110 277 414 279 593 157 124 281 1447 Between 1 and 5 years 133 112 245 76 80 156 90 81 171 64 63 127 699 Between 5 and 60 years 297 271 568 247 206 453 241 203 444 295 205 500 1965 60 years and upwards 216 315 531 140 154 294 139 157 296 127 208 335 1456 Totals 812 828 1640 630 550 1180 784 720 1504 643 600 1243 5567 31 INFANTILE MORTALITY, 1898. Of the 5430 deaths, 1426 were infants under one year of age, giving a proportion of 1541 (corrected) per 1,000 births, the uncorrected rate being 156 3—an increase over last year. The chief causes of these deaths were debility, atrophy and inanition, bronchitis and other diseases of the respiratory organs, diarrhcea and enteritis, premature birth, whooping cough, suffocation and convulsions. Table J gives the infantile mortality in different towns in England and Wales, and in the London Districts. In the Registration Sub-Districts of Lambeth the un corrected infantile mortality varies from 3012 per 1,000 births in Lambeth Church First to 124 8 in Norwood (the low rate of 113-4 in Waterloo Road Second and 164 3 in Lambeth Church Second being explainable by the fact that these Sub-Districts contain the General Lying-in Hospital and the Workhouse respectively), thus :— Total No. of Births. Total Deaths under 1 year (uncorrected). Infantile Mortality per 1,000 births (uncorrected) Waterloo Road 1st 508 94 1850 873 99 113.4* Lambeth Church 1st 581 175 301.2 ,, ,, 2nd 1613 265 164.3† Kennington 1st 1888 259 137.2 „ 2nd 1009 141 139.7 Brixton 2143 334 155.9 Norwood 641 80 124.8 Lambeth 9256 1447 156.3 N.B.—Waterloo Road 1st and 2nd have been amalgamated by the Registrar-General and now form one District called " Waterloo Road." * Including the Lying-in Hospital. f Including the Workhouse. 32 TABLE J. Shewing the Infantile Mortalities in the Registrar-General's 33 Large Towns of England and Wales (including London), and in Lambeth Parish, during 1898. Deaths under one year per 1000 Births. Average Ten Years. 1888—97. England and Wales (33 Large Towns.) 178 167 Croydon 150 128 Huddersfield 153 158 Lambeth 154 143 Portsmouth 156 150 Cardiff 158 160 Halifax 163 158 Bristol 164 144 London 166 155 Bolton 168 179 Derby 169 152 West Ham 170 154 Plymouth 170 168 Oldham 175 178 Nottingham 178 174 Brighton 181 148 Leeds 182 178 Hull 182 173 Liverpool 184 189 Swansea 184 157 Bradford 185 171 Birkenhead 186 166 Newcastle 190 167 Leicester 191 199 Birmingham 191 180 Norwich 192 175 Sheffield 195 180 Burnley 195 209 Manchester 197 185 Wolverhampton 200 188 Sunderland 202 169 Blackburn 206 201 Gateshead 208 166 Salford 212 198 Preston 225 234 *London Districts— North 153 141 South 163 151 East 181 164 West 170 158 Central 170 167 * The figures are corrected for the London Districts (including Lambeth). 33 CLASS I.—ZYMOTIC DISEASES. Principal Zymotic Diseases. The principal Zymotic diseases are seven in number, viz., smallpox, measles, scarlet fever, diphtheria (including membranous coup), whooping cough, "feves" (including typhus, typhoid or enteric, and simple or continued), and diarrhoea; and the zymotic death-rate is made up from the total deaths from these diseases. As a test of the sanitary condition of a Community, the zymotic death-rate is of approximate value, and the statistics for Lambeth are satisfactory. In Lambeth during 1898 there were registered 746 deaths from the seven zymotic diseases, and of these 103 were strangers belonging to other parishes, and 643 parishioners who died within the Parish. 83 parishioners, however, died without the Parish. Subtracting the strangers and adding on the parishioners who died without the Parish, there is a corrected total of 726, giving a zymotic corrected death-rate of 2 4 per 1,000 inhabitants, the corrected rate for London being 2 8, varying in the various Metropolitan Districts, as shown on page 9. The zymotic death-rates (corrected) for the different Registration Sub-Districts of Lambeth vary also, as shown in Table D, which in addition gives the death-rates and birth-rates for comparison. Waterloo 1st and Lambeth Church 1st shew the highest, and Brixton and Norwood the lowest, zymotic death-rates. The zymotic death-rate (average) for the whole of the Inner Districts is 3'03, and for the Outer, 2T2—a difference explainable (as before) from the overcrowding and absence of proper means of home isolation and nursing in the former, as compared with the latter, Districts. During the year 1898, under the Notification Clauses of the Public Health (London) Act, 1891, 2329 cases of Infectious Diseases have been reported, and of this number c 34 1302, i.e., 55.9% were removed to the Hospitals of the Asylums Board, or to other Hospitals, and 1027 i.e., 441% remained under treatment at their own homes. These percentages are more satisfactory than during the last seven years, i.e., since the introduction of the Notification Act and the tabulation of cases removed to Hospital. In 1891, 86.6% of the total zymotic cases notified were removed; in 1892,337%; in 1893, 23%; in 1894, 33.9%; in 1895,30 4%; in 1896, 43%; in 1897, 49%; whilst in 1898, the Inumbers removed form 55 9% of the total cases. During 1898, 21% puerperal fever, 4.4% erysipelas, 66% scarlet fever, 49.7% typhoid, 65.8% diphtheria, 7 7% continued fever, and 18.8% membranous croup, were removed to Hospital respectively. Table L gives the averages of Notification Certificates received in Lambeth since 1889, and it will be seen that during 1898 the total number is practically the average— the greatest number of Notifications being received in 1893—though the incidence per 1000 of the population during 1897 is only .1 above the average incidence for the eight years 1890-97 (i.e., since the introduction of the Compulsory Notification Act). The seven cholera cases were probably cholera nostras (English cholera), or infantile diarrhoea. The diphtheria increase is a serious one—a total of 813 notifications being received during the year 1898, i.e., 47.3% above the average for the last seven years. The 813 cases occured in 724 infected houses, and in only 16.3% of these were the drains, on testing, found defective. For fuller details as to this increase in diphtheria, vide pp. 54—57. The enteric fever (or typhoid) notifications were below the average, and represent only 159 infected houses, of which 25.8% of the drains were shewn, on testing, to be defective. The notifications received during 1898 were 163, as compared with 185 during 1897. This decrease in the amount of typhoid in Lambeth is satisfactory. 35 TABLE K. Shewing the total cases notified under the Notification Clauses of the Public Health (London) Act in Lambeth during 1898 (arrange 1 Quarterly). 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total for 1898 Small Pox Scarlet Fever 225 272 221 291 1009 Diphtheria 136 144 209 324 813 Membranous Croup 4 4 5 3 16 Typhus — — — — — Typhoid 26 26 29 82 163 Continued Fever 4 4 3 2 13 Erysipelas 65 60 61 108 294 Puerperal 3 2 2 7 14 Cholera – — 7 — 7 463 512 537 817 2329 C 2 36 TABLE L. Shewing the number of Certificates for the Notifiable Zymotic Diseases received in Lambeth since the introduction of the Notification Act, i.e., in the eight years, 1890-97, and in the year 1898. Disease. 1890 1891 1892 1893 1894 1895 1896 1897 Annual average of 8 years 1890—'97 Notifications received during '98 Lambeth. Small-Pox 15 3 22 99 26 51 16 2 29.2 0 Cholera 7 4 26 23 10 16 6 18 13.7 7 Diphtheria 330 330 504 789 521 614 652 704 555.5 813 Membranous Croup 46 29 47 49 26 23 27 17 33.0 16 Erysipelas 248 258 420 587 315 355 352 325 357.5 291 Scarlet Fever 1126 858 1832 2275 1198 1389 1550 1375 1450.3 1009 Typhus 0 1 3 3 2 0 1 0 1.25 0 Typhoid or Enteric 150 149 117 100 268 201 162 185 174.0 163 ( Continued or Relapsing 41 33 34 58 48 20 16 11 32.6 13 Puerperal 13 11 20 27 19 16 19 26 l8.8 14 Totals 1976 1676 3025 4070 2433 2685 2801 26(3 26661 2329 Average per l000 of population 7.2 6.1 10.9 14.5 8.6 9.4 9.5 8.9 9.4 7.7 37 In the case of each infected house, an inspection was made, and the drains and sanitary fittings tested, with the results that of the 2094 infected houses:— (a) 351 (i.e., 16.8 %) were found to have defective drains. (b) 1044 (i.e, 49.9%) were found to have defective drains, or defective traps, fittings and appliances. (c) 1058 (i.e., 50.1%) gave no results with the tests. (d) 693 (i.e., 33.1%) were found to have defective traps, fittings and appliances, but not defective drains. Sub-divided according to the different notifiable diseases, the results are as follows:— Diesase. No. of Infected Houses. Numbers shewing Defects as to Percentage shewing Total Defects. Percentage giving no Defects. Drains. Traps, Fittings and Appliances. Total. Smallpox ... ... ... ... ... ... Cholera* 7 ... 3 3 42.9 57.1 Diphtheria 724 118 273 391 52.7 47.3 Membranous Croup 15 1 3 4 26.7 73.3 Erysipelas 280 40 104 144 51.4 48.6 Scarlet Fever 882 141 251 395 44.8 55.2 Typhus ... ... ... ... ... ... Typhoid 159 41 49 90 56.6 43.4 Continued or Relapsing 13 5 7 12 92.3 7.7 Puerperal 14 2 6 8 57.1 42.9 Totals 2094 351 693 1044 499 50.1 *These were in all probability cases of Diarrhœa or Cholera Nostras. It will be noted that only 16.8% of the total infected houses shewed, with the test, defective drains, no results being obtained from the test in the other cases, and 33T% defective traps, fittings and appliances. Table M gives the average percentages for the last 7 years (i.e., practically from the introduction of the Notification Act), and it will be noted with satisfaction, in regard to infected houses in Lambeth, that the year 1898 is 4.2% below the average in respect of defective drains, and 3.3% below the average in respect of defective traps, fittings, drains and appliances. These percentages will become less and less as time goes on, for each year sees many drains reconstructed, partly or wholly (vide pp. 86-88). 38 TABLE M. Giving number of infected houses with percentages of (1) General Defects, and (2) Defective Drains, during 1898 and the Seven preceding years. 1891 1892 1893 1894 1895 1896 1897 Average for last 7 years 1891-97 1898 Number of Infected Houses 1417 2430 3179 2012 2111 2417 2374 2277 2094 Number of Houses with defects found 903 =63.7% 1474 =60.7% 1641 =51.6% 1089 =54.1% 993 =4704% 1177 =487% 1210 =50.9% 1212 4 =53.2% 1044 =49.9% Number of Houses with defective drains found 316 =22.3% 720 =24.7% 658 =20 6% 464 =23.06% 392 =18.6% 423 =17.5% 390 =16.4% 480.4 = 21.1% 351 =16.9% Number of Houses with no defects found 514 =36.3% 956 =39.3% 1538 =48.4% 923 =45.9% 1118 =52.96% 1240 =51.3% 1164 =49.1% 1064.7 =46.8% 1050 =50.1% N.B.—Only 16.9 per cent. of the houses showed with the test detective drains, no results being obtained in the other cases. 39 The seasonal mortality from the different zymotic diseases is well shown by arranging the deaths quarterly, thus:— 1898. Smallpox. Measles. Whooping Cough. Scarlet Fever. Diphtheria. Membranous Croup. FEVER. Diarrhoea. Erysipelas. Puerperal Fever. Cholera. Influenza. Total. Typhus. Typhoid. Continued. 1st Qr. ... 84 34 8 18 2 ... 8 ... 6 2 2 ... 75 239 2nd Qr. ... 36 52 10 14 2 ... 7 ... 10 1 1 ... 26 159 3rd Qr. ... 11 54 1 33 1 ... 5 ... 211 2 ... 7 10 335 4th Qr. ... 2 19 11 43 2 ... 15 ... 27 7 1 ... 15 142 Totals 133 159 30 108 7 ... 35 ... 254 12 4 7 126 875 Taking the zymotic diseases collectively, it is noticed that the 3rd quarter shewed the highest mortality, and the 4th quarter the lowest. Measles and Influenza reached their maxima in the 1st quarter; Whooping Cough, Diarrhoea, and Cholera in the 3rd; and Diphtheria and Scarlet Fever in the 4th. Table N shews the zymotic seasonal variations in the different Registration Sub-districts, while Table O gives the monthly mortalities from the zymotic diseases. Table O gives the deaths from the seven principal zymotic diseases during 1898, and for the ten previous years, not only in Lambeth Parish, but also (for comparison) in London. 40 TABLE N. Showing Zymotic seasonal variations (deaths) in Lambeth in the different Registration Sub-districts during 1898. Registration Sub-Districts. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. Year 1898. Zymotic Death-rate per 1000 inhabitants. Waterloo Road 1st 4 11 24 11 50 3.5 Waterloo Road 2nd 4 9 14 4 31 2.2 Lambeth Church 1st 10 13 28 12 63 3.3 Lambeth Church 2nd 19 22 66 18 125 2.9 Kennington 1st 66 32 56 29 183 1.1 Kennington 2nd 7 18 44 7 76 0.8 Brixton ... 23 22 75 24 144 0.4 Norwood 26 4 9 12 51 0.2 District not stated 1 ... ... 2 3 ... Lambath 160 131 316 119 726 2.4 N.B.—In the case of the three zymotic deaths occurring in Districts which are not stated, they have been distributed equally amongst the eight sub-districts before working out percentages. 41 TABLE O. Deaths from Zymotic Diseases (Strangers deducted). For the 4 weeks ending January. Feb. March. April. May. June. July. August. Sept. October. Nov. Dec. Total. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 31 18 31 21 13 3 9 4 1 1 ... 1 133 Scarlet Fever 5 2 5 1 3 2 1 ... ... 3 8 30 Diphtheria 6 4 5 9 3 5 13 6 13 10 13 21 108 Whooping Cough 13 11 9 13 22 14 22 21 12 11 3 8 159 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 2 3 4 1 1 2 3 2 4 6 4 35 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 3 1 1 3 1 4 24 86 90 32 4 5 254 Chief Zymotic Diseases 61 36 51 55 41 30 72 121 118 58 29 47 719 Membranous Croup ... ... ... 2 1 ... ... 1 1 ... 1 1 7 Erysipelas 1 1 ... ... ... 1 ... 2 ... 4 1 2 12 Puerperal Fever ... ... 2 ... 1 ... ... ... ... ... ... 1 4 Chicken Pox ... 1 ... ... ... ... 1 ... ... ... ... ... 2 Malarial Fever ... ... ... ... 1 ... ... ... ... ... ... ... 1 E. Cholera ... ... ... ... ... ... ... 3 4 ... ... ... 7 42 43 TABLE P. TABLE P. Shewing the number of Deaths from the principal Zymotic Diseases in the ten years 1888—97, and in the year 1898. Disease. 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 Total Deaths in 1898. Proportion of Deaths to 1,000 total Deaths 1898. Annual Average of ten years 1888—97. Proportion of Deaths to 1000 total Deaths in 10 years. Smallpox 0 0 0 0 1 5 1 2 2 — — — 1.1 0.2 Diphtheria (and Membranous Croup) 103 155 74 78 127 1 172 138 103 140 145 115 21.2 123.5 23.2 Scarlet Fever 82 73 57 46 76 69 64 53 63 42 30 55 62.5 11.7 Fever. Typhus 0 1 0 1 0 1 0 0 1 — 0.4 0.08 Typhoid or Enteric 36 31 31 28 22 36 46 26 24 26 35 6.4 30.6 5.7 Simple Continued 3 5 3 7 2 4 0 2 1 — 2.7 0.5 Measles 119 157 183 128 187 113 182 151 185 139 133 24.5 154.4 28.9 Whooping Cough 171 137 194 239 135 151 110 132 140 144 159 29.3 155.3 29.1 Diarrhœa 120 168 154 165 155 197 139 263 152 238 254 46.8 175.1 32.9 Lambeth 634 727 696 692 705 748 680 732 708 734 726 133.7 705.6 132.4 London 10503 9709 12270 9675 11983 13223 11544 11467 14009 11525 12482 152.2 11590.8 137.4 44 SMALLPOX. No case of Smallpox has been registered during the year in Lambeth, though one or two cases of a doubtful nature were reported to the Medical Officer of Health, but proved afterwards to be chicken-pox. No death from Smallpox has been registered in Lambeth during the year. In London 35 cases of Smallpox were notified, and 1 death was registered, giving an uncorrected case mortality of 29 per cent. Tables Q and R give the Vaccination Statistics for the year 1897, and the first half of 1898—those for the second half of 1898 not being ready in time for this Report. It will be noticed that during 1897, 253 per cent. of the children born are unaccounted for as regards vaccination, and 60.6 per cent. were successfully vaccinated; whilst during the first half of 1898, 33 9 per cent. are unaccounted for, and only 48 04 per cent. have been successfully vaccinated. The figures for 1898 (first half of the year) are ominous, and future ones will probably prove more so when the "conscientious objectors" have made their influence statistically more felt!!! This serious experiment, which the Government has decided to try, may have far reaching results, and all Health Authorities are much concerned at what may happen should Smallpox, unfortunately, become epidemic amongst an unvaccinated child population, and should the isolation means of stamping out the disease break down from any cause. So long as an Authority has the necessary machinery ready, and in working order, for (1) the notification of all cases of smallpox; (2) the immediate isolation of cases in hospital; (3) the disinfection of houses, bedding, etc.; and (4) the quarantining of suspected persons, all will go well; but it will go hard with an Authority not so prepared ! 45 TABLE Q—VACCINATION RETURNS, 1897. Registration Sub-Districts. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinated. Conscientious Objectors. Postponed on Medical Certificate. Removed to other Parishes Gone and not found. 111 or not otherwise accounted for. Waterloo Road 1383 810 l 170 5 9 198* 185* 5 Lambeth Church 1st 601 356 — 81 1 10 3 140 10 Lambeth Church 2nd 1602 988 9 213 1 28 56† 27 7† 30 Kennington 1st 1868 1103 3 219 2 42 117‡ 323‡ 59 Kennington 2nd 1117 649 — 98 3 44 16 146 161 Brixton 2145 1391 7 198 9 61 14 212 253 Norwood 697 406 7 65 2 36 8 54 119 Lambeth 9413 5703 27 1044 23 230 412 1337 637 * Hospital Cases (242) included. † Workhouse Cases (70) included. ‡ Maternity Cases (120) included. 46 TABLE R.—VACCINATION RETURNS FOR THE FIRST HALF-YEAR, 1898. Registration Sub-districts. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinated. Conscientious Objectors. Postponed on Medical Certificate. Removed to other Parishes. Gone and not found. 111 or not otherwise accounted for. Waterloo Road 671 337 1 84 4 17 116* 99* 13 Lambeth Church 1st 297 136 ... 48 1 9 2 69 32 Lambeth Church 2nd 811 389 ... 99 7 26 l0† 87† 193 Kennington 1st 927 427 3 92 6 42 73‡ 102‡ 182 Kennington 2nd 521 261 ... 49 6 55 8 71 74 Brixton 1083 501 3 134 12 71 13 99 250 Norwood 335 182 2 26 5 38 7 24 51 Lambeth 4648 2233 9 532 41 258 229 551 795 The Yearly Returns are not made up for the Local Government Board until the August in the following year. * Hospital cases (138) included. † Workhouse cases (10) included. ‡ Maternity cases (87) included. 47 SCARLET FEVER. During 1898, 30 deaths were registered from Scarlet Fever, as compared with 42 daring 1897, and an annual average of 62.5 for the last 10 years (1888-97). 1,009 cases were notified, as compared with an annual average of 1450.3 for the 8 years 1890-97; and of these 1,009 patients, 666 were treated in hospital and 343 at their own homes. The case mortality is, therefore, 2.9%, varying in different Registration Sub-districts (an average of 5 2 for the Inner as compared with 18 for the Outer), and from 12 to 3.9 according as the cases were treated at home or in hospital respectively. The age and sex incidence and mortality for scarlet fever cases notified in Lambeth during 1898 are as follows: — Ages. Number of Cases Notified. Deaths. Death rate* per 100. Under 1 year M. 4 F. 6 Total. 10 M. i F. 2 Total. 3 21.4 1 to 2 16 9 25 3 1 4 13.8 2 to 3 25 34 59 3 3 4.8 3 to 4 40 46 86 4 1 5 5.6 4 to 5 54 65 119 3 7 10 8.1 5 to 6 57 69 126 1 1 2 1.6 6 to 7 44 57 101 – – – – 7 to 8 29 34 63 – – – – 8 to 9 21 27 48 – – – – 9 to 10 35 44 79 – – – – Over 10 years 128 122 250 2 1 3 1.2 Age not stated* 20 23 43 – – – – Total 473 536 1009 14 16 30 2.9 *In 43 cases the ages are not given, but in calculating percentages, these cases have been equally distributed amongst the different age-periods. 48 In London during 1898 there were registered 588 deaths out of a total of 16,917 cases of scarlet fever notified, giving a case mortality of 3 4 % (uncorrected). As far as could be traced no scarlatinal milk outbreak occurred during 1898, but one school—small, private school, with average attendance of 25 children—had to be closed on account of an outbreak of scarlet fever amongst the scholars, 16% of whom were absent suffering from the Registration SubDistricts. Total No. of Cases notified. Cases treated at home Cases removed to Ho pital. No. of Deaths. Case mortality per 100. Rate of Persons notified per 1000 Inhabitants. At Home. In Hospital. Total. Waterloo Road 1st 61 9 52 ... 2 2 3.3 4.3 Waterloo Road 2nd 50 7 43 ... 2 2 4.0 3.5 Lambeth Church 1st 94 7 87 1 6 7 7.5 4.9 LambethChurch 2nd 138 54 84 ... 7 7 5.1 3.3 Kennington 1st 127 27 100 ... 1 1 0.8 2.4 Kennington2nd 195 123 72 1 4 5 2.6 4.3 Brixton 213 50 163 1 4 5 2.3 2.5 Norwood 131 66 65 1 1 0.8 4.2 Lambeth 1009 343 666 4 26 30 2.9 3.3 49 disease. The school was closed from May 20th to June 10th, rooms disinfected and cleansed, and ceilings whitewashed, and the drains tested, with the result that they were found to be defective (the sanitary fittings also being bad). The drains were partly relaid, new w.c.'s provided, the sink waste disconnected and under-trapped, and the soil pipe reconstructed and placed outside the building. The case mortality is very low—especially in the Outer Wards, whilst the difference of hospital versus home treatment is noteworthy (3 9 as compared with 1.2), and explainable from the greater severity of the cases treated in hospital as compared with those treated at home. The large number of cases removed to Hospital, more especially in connection with the Inner Wards, are highly satisfactory, and there is no doubt but that prompt isolation has prevented the spread of the disease and lowered considerably the mortality. Indeed, the small number of total deaths from Scarlet Fever [viz. 30) during 1898 is remarkable, being £0 % below the average for the last 10 years; whilst the incidence of the disease is for the whole of the Parish, 3 3 per 1000 of the population at all ages. There is little or no difference between the Outer and Inner Districts (taken as a whole) as regards numbers of Scarlet Fever deaths—a fact, as already stated, to be explained (in part at least) by the higher percentage of cases removed in the latter (77'6 %) as compared with the former (60T %). Prompt isolation, followed by efficient disinfection of rooms and their contents, is the keystone of the preventive methods in battling with infectious and contagious diseases, and preventing their spread. d 50 WHOOPING COUGH AND MEASLES. During 1898, 159 and 133 deaths were registered from Whooping Cough and Measles respectively, as compared with 144 and 139 during 1897, and annual averages of 155.3 and 154.4 for the last ten years (1888-97). In London, during 1898, there were registered 2,160 and 3,075 total deaths from Whooping Cough and Measles, giving corresponding death-rates (uncorrected) of 4.8 and 6 8 per 10,000 of the population living, respectively. Waterloo Road First suffered most and Norwood least from Whooping Cough, and Kennington First the most and Kennington Second the least from Measles. Measles was epidemic in Lambeth at the beginning of the year, and the epidemic gradually lessened through the second and third quarters, with the result that only two deaths were registered during the fourth quarter. Whooping Cough was epidemic during the first three quarters of the year, and the epidemic lessened during the fourth quarter. In connection with the Measles epidemic, 129 infected houses were disinfected by the Vestry's officials, who, however, were not asked in one single instance to disinfect after Whooping Cough. A Special Report on the subject of Measles and its Prevention (vide Appendix, p. 18), was presented to the Vestry on June 23, 1898. In the Report the Medical Officer pointed out the highly infectious nature of the disease, which is chiefly met with in children under 5 years of age (amongst whom it is extremely fatal)—the disease in Lambeth during the last 10 years having claimed more than half as many victims as the whole of the Notifiable Infectious Diseases together. The need for preventative 51 measures being taken as in the case of the notifiable diseases is apparent, and the Medical Officer suggested to the Vestry the advisability of including Measles amongst the dangerous and infectious diseases for the purposes set forth in certain sections of the Public Health (London) Act. 1891*—compulsory notification not being advised for the present for the reasons given in the 1896 Annual Report {vide p. 48). The Vestry decided to distribute from house to house a leaflet pointing out the after-effects of Measles if not properly attended to. The leaflet was drawn up by the Medical Officer, and 51,175 copies were distributed to the different (separate) families in the houses throughout the Parishf (taking 134 days), at a total cost of^30 14s. 2d. for printing, and £30 0s. lOd. for distribution. From the numbers of enquiries made, the distributing of these leaflets has done much good in preparing the way for the future adoption of the necessary precautions advised by the Medical Officer, and contained in the sections of the Public Health (London) Act, 1891, referring to dangerous, infectious diseases. A copy of the leaflet is printed in the Appendix to this Report (vide p. 21). The part played by schools in disseminating Measles, and the value of school—(or, at least class—) closure, in checking such spread, have been again shewn during 1898, by the following cases :— Wesley an Day Schools, Eden Road, West Norwood.— Number on roll, 238, and of these 22 °/Q were absent on account of Measles. School was closed from April 6th to •Sections 60-66, 68-70, 72-74, dealing with exposing infected persons or clothing in the public streets, disinfection of infected houses and bedding, etc., letting of infected houses or rooms, removal of infected persons to hospital, etc., etc. fTwo men were engaged in distributing, and received 26s. per week each, or 4s. 6d. per odd days. d 2 52 April 25th, by order of the Medical Officer of Health, rooms disinfected, cleansed, and ceilings lime-whited, and drains tested (but without any result). Result of closure was a diminution of the epidemic. Priory Grove Board School, Infants' Department.— Number on roll, 402, and of these 19 4 °\Q were absent on account of Measles. The Infants' Department was closed from April 5th to April 19th, by order of the Medical Officer of Health, rooms disinfected, cleansed, and ceilings lime-washed, and drains tested (but without any result). Result of closure was a diminution of the epidemic. Woodland Road Board School, Upper Norwood, Infants' Department.—Number on roll, 286, and of these 24 5 °/Q were absent on account of Measles. The Infants' Department was closed from June 14th to July 4th, by order of the Medical Officer of Health, rooms disinfected, cleansed, and ceilings lime-whited, and drains tested (but without any result). Result of closure was a diminution of the epidemic. It is important that schools or classes, when closed for Measles, should remain so a sufficiently long time, so that the disease (as it then exists) may have time to burn itself out. No shorter period than three weeks should be allowed, owing to the average incubation, and duration, of this particular disease being ten days and three weeks respectively. In no instance was a school or class closed on account of Whooping Cough, though this disease was undoubtedly epidemic in Lambeth during the year, and many children must have been absent from schools in consequence of suffering from the disease themselves, or living in houses wherein other children were so suffering. It seems unfortunate that the School Board Authorities do not insist upon a systematic notification to the Medical Officer of 53 Health of all absentees suffering from infectious diseases which are not notifiable in the ordinary way by medical men. It is part of their duty, as laid down by the Legislature {vide Regulation 148 of the Code drawn up by the School Board of London, for the guidance of Managers, Correspondents and Teachers). Registration Sub-Districts. Number of Deaths from Whooping Cough. Number of Deaths from Measles. Whooping Cough. Deaths per 10,000 Inhabitants. Measles. Deaths per 10,000 Inhabitants. Waterloo Road 1st 17 7 12.01 4-9 Waterloo Road 2nd 8 3 5-8 21 Lambeth Church 1st 11 7 5-8 3-7 Lambeth Church 2nd 17 16 41 3.8 Kennington 1st .32 55 602 10.3 Kennington 2nd 16 6 3-6 1.8 Brixton 47 17 5-5 1.9 Norwood 10 22 3-3 7.1 District not stated* 1 Lambeth 159 133 *2 4.4 * Where the District is not stated, the deaths (or death) are divided equally amongst the other Districts before calculating percentages. 54 DIPHTHERIA. During 1898, 108 deaths were registered in Lambeth from Diphtheria, as compared with 138 during 1897, and an annual average of 122'8 for the last ten years (1888 to 1897). 813 cases were notified during 1898, as compared with 704 in 1897, and an annual average of 5555 for the eight years, 1890 to 1897. Of the 813 cases notified, 278 were removed to hospital and 535 were treated at their homes. The case mortality per cent, for the year is, therefore, 13 3, varying from 20 9 to 8'04, according as the cases were treated at hospital or at home respectively, a difference, in all probability, to be explained, as usual, by the greater severity of the cases sent to hospital. The case mortality rate, as a whole, for Lambeth is low, pointing to the mildness of the majority of the cases, more especially in Lambeth Church 1st and Kennington 2nd, where the case mortality was only 3'5 % and 7 8% respectively ! In these two districts outbreaks of throat trouble were noted, but it is doubtful whether or not the cases were true Diphtheria, with the result that, in all probability, many cases of unsuspected Diphtheria were the means of spreading the disease. No means for bacteriological diagnosis were then provided by the Vestry, unfortunately. The age and sex incidence and mortality from Diphtheria cases notified in Lambeth during 1898 are as follows:— 55 Ages. Number of cases Notified. Deaths. Death -Rate per ioo. M. F. Total. M. F. Total. Under 1 year 4 6 10 3 3 6 40-0 1 to 5 143 122 265 28 29 57 211 5 to 10 141 164 305 17 21 38 12-2 10 to 20 48 67 115 3 3 6 50 20 to 40 26 43 69 1 ... 1 1.4 40 to 60 5 5 10 ... ... ... ... 60 and over 1 1 2 ... ... ... ... Age not stated 23 14 37 ... ... ... ... Total 391 422 813 52 56 108 13.3 The steady yearly increase in Diphtheria in Lambeth (as in London generally) is again noticeable during 1898, but still difficult to explain satisfactorily. Undoubtedly mild and unrecognized cases have been again to blame, as also the mixing together of children in schools. It is satisfactory to be able to report that the Vestry has decided (and has already made the necessary arrangements) to supply the medical practitioners who practice in Lambeth with means for the bacteriological examination, free of cost, of all membranes and discharges from doubtful Diphtheria cases, so that more efficient isolation may be carried out in those patients who are proved to be suffering from true (but mild) Diphtheria. The good that will arise will depend upon the use that the medical profession make of the means of bacteriological diagnosis offered to them, free of cost, by the Vestry. The following statistics for Lambeth show that the increase in Diphtheria is persistent:— 5r» Quinquennial Period. Population. Number of Deaths. Death-Rate per million living. 1863—1867 902119 148 164 1868—1872 1021165 96 94 1873—1877 1132106 184 163 1878—1882 1245913 255 205 1883—1887 1313211 365 278 1888—1892 1367734 537 393 1893—1897 1443857 683 483 1898 304073 108 355 The increase in London, generally, has also been marked during the same quinquennia, but a satisfactory and complete explanation for the increase remains yet to be given. The large numbers of cases to be isolated, in London, have, at times, baffled the officials of the Asylums Board Hospitals, and rendered it necessary to refuse removal except in the very worst and most urgent cases, with the result that many cases have had to be treated at home. 1 he beneficial effect of the antitoxin treatment in Hospital is beginning to be felt, as shewn by the lessened death rate, or case mortality in Hospital-treated patients ; whilst those Experts who are best able to form an opinion, speak in decided terms as to the value of the antitoxic serum as a prophyllactic, or preventative—a most important conclusion to have come to. 57 DIPHTHERIA. Registration SubDistricts. No. of cases Notified. Cases treated at Home. Cases removed to Hospital. No. of Deaths. Total. Case Mortality per 100. Rate of Persons Notified per iOOO Inhabitants. At l Home. In Hospital. Waterloo Road 1st 39 31 8 1 5 6 15.7 2-7 Waterloo Road 2nd 28 17 11 1 2 3 11.2 1-9 Lambeth Church 1st 117 87 30 ... 4 4 3.5 61 Lambeth Church 2nd 98 71 27 5 8 13 13.4 2-3 Kennington 1st 163 132 31 12 17 29 17.9 31 Kennington 2nd 130 44 86 4 6 10 7.8 2-9 Brixton... 187 120 67 17 17 34 18.3 2-2 Norwood 51 33 18 3 6 8 16.1 1-6 Lambeth 813 535 278 43 65 108 13.3 27 During 1898, in Lambeth, 16 cases were notified from Membranous Croup, and 7 deaths were registered, giving a case mortality of 43-8, as compared with 17 cases notified, and 7 deaths registered during 1897. Three of the 16 Lambeth cases were removed to Hospital. In London, during 1898, there were registered 1772 deaths out of a total of 11,871 cases of Diphtheria and Membranous Croup notified, giving a mortality of 15.2 %* (uncorrected). * In London Statistics, Diphtheria and Membranous Croup are now grouped together by the Registrar-General. 58 TYPHOID FEVER. During 1898, 35 deaths were registered in Lambeth from Typhoid (or Enteric) Fever, as compared with 26 during 1897, and an annual average of 30 6 for the last ten years (1888 to 1897). 163 cases were notified during 1898, as compared with 185 during 1897, and an annual average of 174 for the eight years, 1890 to 1897. Of the 163 cases notified, 81 were removed to hospital and 82 were treated at home. The case mortality for the year is, therefore, 215, varying from 24-7 to 18-3, according as the cases were treated at hospital or at home respectively. The age and sex incidence and mortality for Typhoid cases notified in Lambeth during the year are as follows :— Ages. Nu-nber of cases Notified. Deaths. Death-rate per ioo. Under 1 year M. F. Total. M. f. Total. ... ... ... ... ... ... ... 1 to 5 3 6 9 ... 2 2 20.6 5 to 10 11 10 21 ... 1 1 4.6 10 to 20 20 22 42 5 6 11 25.8 20 to 40 46 20 66 13 3 16 23.9 40 to 60 10 7 17 2 2 4 22.6 60 and over 3 1 4 1 ... 1 22-2 Age not stated* 3 1 4 ... ... ... ... Total 96 67 163 21 14 35 21.5 * When the age is not stated, in calculating percentages, these cases are divided equally amongst the other age-periods. 59 In London during 1898 there were registered 585 deaths out of a total ot 3,032 cases of Typhoid notified, giving an uncorrected case mortality of 18 3 °/0. Registration Sub-Districts. Total No. of Cases notified. Cases treated at Home. Cases removed to Hospital. Case Mortality per 100. At Home. No. of Deaths Total. Rate of persons Notified per 10,000 Inhabitants. In Hospital Waterloo Rd. 1st 13 6 7 23.1 1 2 3 91 Waterloo „ 2nd 7 1 6 42.9 1 2 3 50 Lambeth Ch. 1st 20 9 11 20.0 1 3 4 105 Lambeth Ch. 2nd 27 17 10 25.9 2 5 7 6-5 Kennington 1st 21 7 14 38.J 4 4 8 3-9 Kennington 2nd 32 24 8 12.5 3 1 4 71 Brixton 28 12 16 14.3 3 1 4 3-3 Norwood 15 6 9 13-3 ... 2 2 4-9 Lambeth 163 82 81 21-5 15 20 35 53 The case mortality was higher in the Inner than the Outer Districts, viz., 25"4°/0as compared with 18-8 %—a fact to be explained by the better sanitary conditions of the latter, and the consequent better resisting powers of the inhabitants. It is satisfactory to note that 50 % of the cases were removed to hospital. In so far as Typhoid Fever in a district is a sanitary index, Lambeth is to be congratulated on the number of cases notified during 1898—ll'9°/0 below last year, and 60 6'3°/0 below the annual average for the last 8 years. The Typhoid incidence is gradually decreasing, due to improved sanitation, and a better condition of drainage. Nine cases were introduced into Lanbeth from outside, and in no single instance could a satisfactory causal relationship be made out between a typhoid attack and a previous ingestion of infected shellfish. In three instances the disease was contracted from person to person during nursing—a means of contagion not always sufficiently acknowledged, but none the less certain. CONTINUED AND TYPHUS FEVERS. During 1898, 13 cases were notified in Lambeth, but no deaths registered, from Continued Fever, as compared with 55 cases notified and 9 deaths registered (i.e., 16-4% uncorrected case mortality) in London; whilst there were no cases of Typhus notified, and no deaths from this disease registered, either in 1898 or 1897 in Lambeth, though the cases notified in London in 1898 were 17, and there were four deaths registered, making a case mortality of 23 5% Typhus and Continued Fever are generally bracketted with Typhoid under the heading " Fever.1' Typhus is a disease to be found in overcrowded and insanitary districts, and its absence in Lambeth is a matter for congratulation, and a guarantee that great improvements have taken place, and are still taking place, in regard to such overcrowding and insanitation. Much, however, still remains to be done. 61 PUERPERAL FEVER. During 1898 in Lambeth 4 deaths were registered from Puerperal Fever (a disease of child-bed), as compared with 16 during 1897, and an annual average of 13 7 during the last 10 years (1888—97). 14 cases were notified, as compared with 26 during 1897, and an annual average of 18 8 for the 8 years 1890-97. The case mortality for 1898 is 28'6 °/Q. In London, during 1898, there were registered 184 deaths out of a total of 250 cases notified, giving a case mortality of 73-6 °/Q (uncorrected). Registration Sub-Districts. Number of Cases Notified. Number of Deaths. Case Mortality per ioo. Waterloo Road 1st ... ... ... Waterloo Road 2nd ... ... ... Lambeth Church 1st 2 ... ... Lambeth Church 2nd 4 2 500 Kennington 1st 1 ... ... Kennington 2nd 2 ... ... Brixton 5 2 400 Norwood ... ... ... Lambeth 14 4 28.6 62 "Puerperal Fever" is a somewhat lax term, and may include many different diseases occurring in lying-in women, e.g., peritonitis, metritis, pycemia,septiccemia,and saproemia. A proper definition as to what ought to be included in the term is much needed, and with a view to this being arranged the Vestry at their meeting on December 22nd decided to include within the term "puerperal fever" the following diseases:—Septicoemia, pycemia, septic peritonitis, septic metritis, and other acute septic inflammations of the pelvis, occurring as the direct result of child-bed. The few cases of puerperal fever (as notified) reflect credit upon the treatment of puerperal women in Lambeth, whether by medical men or by midwives, for it is a disease entirely preventible—care and cleanliness alone being required. The Medical Officer has only had occasion to caution three midwives during the year, and in no single instance has found it necessary to stop a midwife carrying on her vocation, even for a limited period of time. The old fashioned routine plan of stopping a midwife's work for a period of six or eight weeks after a case of Puerperal Fever is now discarded—it being considered sufficient for thorough disinfection of clothes and person to be carried out, and the ordinary precautions as to cleanliness taken. There is no doubt but that a midwife (or medical man) who neglects these simple precautionary measures is criminally responsible for any deaths that may arise from such neglect. 63 ERYSIPELAS. During 1898 in Lambeth 12 deaths were registered from Erysipelas, as compared with 16 for 1897, and an annual average of 18'0 during the last 10 years (1888—1897). 294 cases were notified, giving a case mortality of 41°/0. In London, during 1898, there were registered 165 deaths out of a total of 5,180 cases notified, giving a case mortality of 3-2 °/0 (uncorrected). Registration Sub-Districts. Number of Cases Notified. N umber of Deaths. Case Mortality per ioo. Waterloo Road 1st 10 ... ... Waterloo Road 2nd 10 ... ... Lambeth Church 1st 25 2 8.0 Lambeth Church 2nd 69 8 11.6 Kennington 1st 51 ... ... Kennington 2nd 57 ... ... Brixton 55 2 3.6 Norwood 17 ... ... Lambeth 294 12 41 The advantages from the notification of Erysipelas are few, and the majority of cases notified as Erysipelas are not such as were contemplated by the framers of the Notification Act. 64 DIARRHCEA. During the year 1898 there were registered in Lambeth 254 deaths from Diarrhoea, as compared with 238 during 1897, and an average of 1751 for the last 10 years. Of these 254 deaths, 242 (i.e., 91-3 per cent.), were in children under five years, and 209 (i.e., 82-3 per cent.) in infants under one year of age. July and August were the most fatal months (s?e Table Q), though the disease was prevalent also during June, September and October, In this connection, it is again interesting to note that the mean monthly air temperature was in June, 57 6°; July, 61-5° ; August, 64'6°; September, 621° ; and October, 53 8° ; whilst the 4-ft. earth thermometer registered 56° F. on June 26th, rising to a maximum 63 ° F. on August 28th, and sinking to 56° F. again on OctobeT 29th. 56° F. is the so-called "critical " earth temperature for Diarrhcea, i.e., the temperature at which the germs of this particular disease begin to multiply and prove themselves dangerous.* Age mortalities from Diarrhoea were as follows:— Age. Total Deaths. Percentage o Total Death fromDiarrhce, M. F. Total. Under 1 year 111 98 209 82.3 1 to 5 21 12 33 12.9 5 to 20 ... ... ... ... 20 to 40 ... 1 1 0.4 40 to 60 1 3 4 1.6 Oyer 60 1 6 7 2.8 Total 134 120 254 1000 # The 4-ft. earth temperatures were taken in Regent s Park, and I beg to acknowledge my indebtedness to Mr. Wm. Marriott, of the Royal Meteorological Society, for the information in connection therewith. 65 In London there were registered during 1898, 4376 deaths from Diarrhoea, giving an uncorrected rate of 9 7 per 10,000 living, and 5 2 % of total deaths. Registration Sub-Districts. Number of Deaths. Diarrhoea Death-r«ite per 10,000 Inhabitants. Waterloo Road 1st 14 9.9 Waterloo Road 2nd 11 7.9 Lambeth Church 1st 30 5.7 Lambeth Church 2nd 64 15.3 Kennington 1st 56 10.5 Kennington 2nd 34 7.6 Brixton 37 4.3 Norwood 7 2.3 District not stated 1 — Lambeth 254 8.3 In the Inner Wards the average Diarrhoea death-rate per 10,000 inhabitants was 13'4, as compared with 6-3 for the Outer Wards, i.e., 2 to 1. Under the heading of Diarrhoea may be classed the 7 cases of cholera* notified, together with the 7 deaths registered, in Lambeth during the year, as there is no reason to regard any one case as "Asiatic Cholera" ; and also the 144 deaths registered from "Enteritis." * 23 cases of Cholera were notified in London. E 66 TABLE S. Shewing the Diarrhoea Mortality in Lambeth in each month during the year 1898. Sub-Districts. Jan. Feb. Mar. Apr. May jUne July Aug. | Sept. Oct. Nov. Dec. Total Waterloo 1st ... ... ... ... ... ... 2 3 9 2 I ... 17 Waterloo 2nd. ... ... ... ... ... ... ... 4 4 1 ... ... 9 Lambeth 1st ... ... ... 2 ... ... 5 8 12 2 ... 3 32 Lambeth 2nd 1 ... l ... ... 1 8 27 18 7 ... 1 64 Kennington 1st l ... ... 1 1 1 6 22 10 8 3 1 54 Kennington 2nd ... ... ... ... ... 1 3 11 16 3 ... ... 34 Brixton ... 1 ... ... ... 1 1 8 17 9 ... ... 37 Norwood l ... ... ... ... ... ... 1 4 1 ... ... 7 Total 3 1 1 3 1 4 25 84 90 33 4 5 254 67 In connection with Diarrhoea, it may be noted that there are many contributory causes, e.g., maternal neglect, want of proper feeding, insanitary surroundings, etc., but that density of population is a most potent excitant, as shewn by the difference in the rate per 10,000 in the Inner, as compared with the Outer, Districts. Meteorological conditions (especially the earth 4' temperature) played, as usual, an important role in connection with the statistics for Lambeth during 1898. On the whole, the Lambeth rate is satisfactory, and must be considered in connection with the Infantile Mortality Rate which, for the year 1898, works out for Lambeth at 1541 per 1000 births—a lower rate than is shown by any of the Registrar-General's 33 large towns of England and Wales, with the exception of Croydon and Huddersfield (see p. 32.) The rate for London, as a whole, is 167. As insanitary conditions lessen, the infantile mortality lessens also, and may be taken as a fair and trustworthy gauge of sanitary improvement in Lambeth—the inner, more congested, districts sharing also in the lessened mortality, but not to the same extent as the outer, less congested, ones. 68 INFLUENZA. During 1898,126 deaths were registered from Influenza in Lambeth, as compared with 45 during 1897, and an average of 65 3 for the last ten years. Of these 126 deaths, 75 were registered during the first, 26 during the second, and the rest during the third and fourth quarters of the year. In London there were registered 1283 deaths (uncorrected) from Influenza during 1898. Reviewing the past history of Lambeth in relation to Epidemic Influenza, it will be seen that the disease has been practically epidemic since 1890, rising to a maximum in 1892 and again in 1895. The disease during 1898 was double the average for the last 10 years. Table shewing the number of deaths from Epidemic Influenza during the last 10 years in Lambeth and London. 1888 1889 1890 1891 1892 '893 1894 1895 1896 1897 1 Average for 10 years (1888—97). 1898 Lambeth 0 0 47 131 142 85 44 148 S' 45 65'3 126 London (including Lambeth). 3 S 652 2336 2264 1526 75° 2156 496 671 1085-9 1283 69 BACTERIOLOGICAL DIAGNOSIS. In connection with Infectious or Zymotic Diseases, mention may be made of the fact that the Vestry have decided to have fitted up for the use (free of cost) of the medical men of Lambeth, a Bacteriological Laboratory where the bacteriological diagnosis of doubtful cases of typhoid, diphtheria, tuberculosis, &c., may be carried out. The Medical Officer presented a Special Report on the subject (copy of which is to be found at p. 14 of the Appendix), and this Report, with its recommendations, was adopted by the Vestry on December 8th, 1898. The importance and value of bacteriological examinations in doubtful cases of cholera, diphtheria, typhoid, and tuberculosis, are now universally acknowledged, and much good is, consequently, expected to accrue from the work to be carried out in Lambeth Parish. The laboratory is to be fitted up for the present at the Wanless Road Disinfecting Station (where a suitable room is unoccupied); and being in the centre of the Parish will be equally convenient for all the medical practitioners. It is clear that a local laboratory for Lambeth alone will give much better, cheaper, and quicker results than a central laboratory for the whole of London, as suggested by the London County Council. Indeed, past experience of the difficulties that at times arise in connection with the Asylums Board and the removal of infectious cases to hospital, owing to Lambeth having to take turn with other Parishes, more than warrants the Vestry in having taken the step they have in establishing a laboratory which shall be purely local. 70 The amount of work that will be done in the laboratory will depend upon the use the medical practitioners of Lambeth make of the opportunities offered, free of cost, by the Vestry—separate diphtheria and typhoid "outfits" having been forwarded to each; and it rests with them, therefore, to make the experiment a huge success, and the laboratory a permanent institution for Lambeth, under the care of a specially appointed bacteriologist—the Medical Officer's time being too much engaged with other duties to enable him permanently to carry out this extra work in connection with bacteriological diagnosis. It is clearly advisable that the Medical Officer should be directly responsible to the Vestry for the management and efficiency of the bacteriological laboratory, as any irregularity in its management might prove serious, and cause endless trouble and inconvenience to the members of the medical profession (practising in Lambeth Parish), for whom, alone, the Vestry has gone to the expense of providing this gratuitous bacteriological diagnosis, with a view to lessening the amount of infectious diseases in the Parish by securing greater precision and rapidity in diagnosis. In connection with bacteriological diagnosis in diphtheria, the Metropolitan Asylums Board have made arrangements for the gratuitous distribution of antitoxic serum by Medical Officers of Health to the medical attendants of patients who are suffering from diphtheria, but who cannot be removed to Hospital owing to want (in times of extra pressure) of sufficient accommodation. This use of antitoxic serum may be (1) curative, and (2) prophyllactic or preventative. 71 TUBERCULOSIS. The question of Tuberculosis (including consumption or phthisis) has engaged the special attention of the Vestry during the year 1898. A Report was presented by the Medical Officer (copy of which will be found in the Appendix, page 4), who pointed out that 2680 deaths from Tuberculosis (1913 being due to phthisis or consumption) were registered in Lambeth during the four years 1894—1897, the Inner Wards again suffering more severely than the Outer Wards. As Tuberculosis is now a recognised infectious disease, due to the entrance into the body from without of the tubercle bacillus, and is acquired either directly from man to man, or indirectly through food (milk and meat), the Medical Officer felt that the Vestry ought (1) to systematically disinfect rooms (and contents) that had been previously occupied by tuberculous-infected invalids (more especially those suffering from the pulmonary form of the disease known as consumption or phthisis) ; (2) to afford opportunities to medical men and others, of having the sputa from infected persons examined bacteriologically, so as to demonstrate the presence of the bacilli, and so put all doubt as to the diagnosis out of question; and (3) to disseminate knowledge as to the nature and dangers of the disease, amongst clergymen, district visitors, school teachers, etc., and through them amongst the Lambeth ratepayers generally. With these objects in view, the following suggestions were made by the Medical Officer, and adopted in toto by the Vestry on the 8th December, 1898:— i. That a circular letter (A) be sent round to all the Medical men in Lambeth, pointing out that the Vestry is prepared to disinfect (free of cost) all rooms (and contents) recently occupied by patients 72 ing from Tuberculosis, and which have become unoccupied, owing to the deaths or removals of such patients, when requested to do so by the Medical men or others in attendance; 2. That a circular letter (B) be sent to the person, or persons, in charge of Public Institutions in Lambeth, pointing out the nature of this disease, and the importance of having disinfection carried out, and other means adopted, for the prevention of this disease spreading to others, and offering disinfection (free of cost) by the Yestry's Officers, where it may be necessary; 3. That a circular letter (C) be sent to the occupiers of those houses in which deaths from Tubercular Disease are reported week by week to the Medical Officer by the Registrar-General, offering disinfection (free of cost) by the Vestry; 4. The issuing of leaflets (D) pointing out in simple language the danger of the diseaie and the ready means at hand for its prevention, to Clergymen, District Visitors, School Teachers, etc., as may be necessary. Copies of the above-mentioned circular letters and leaflet* are to be found in the Appendix on pages 7-13. Over 2,000 of the leaflets have already been distributed, and the Vestry have ordered 20,000 more copies in pamphlet form for distribution. Much good is expected to accrue from the action of the Vestry in battling with Tuberculosis—a disease which causes much permanent ill-health, and kills more than all the other infectious diseases put together. •These letters and leaflets were circulated on the ist January, 1899, and have been much appreciated by medical men and others. Many applications have been made for additional copies, for distribution, and many samples of spu a already sent to the Medical Officer for bacteriological examination. 73 The 21 deaths from venereal affections (Syphilis, etc.) are the only other point calling for note in the class of Zymotic Diseases. Classes II. and III.—Parasitic and Dietetic Diseases. 36 deaths were registered in Lambeth in these classes from Alcoholism and Delirium Tremens. Class IV.—Constitutional Diseases. Of the total 1043 deaths under this class 270 were due to Cancer, 490 to Phthisis, and 184 to Tubercular Meningitis and other forms of Tuberculosis. Class V.—Developmental Diseases. The total number of deaths in this class was 389, consisting of 154 from Premature Birth, 180 from Old Age, and 55 from Atelectasis and Congenital Malformations. Class VI.—Local Diseases. 1. Diseases of the Nervous System caused 518 deaths, including 68 from Convulsions, 230 from Apoplexy, and 27 from Epilepsy. 2. 402 deaths were due to diseases of the Circulatory System. 3. The diseases of the Respiratory Organs caused 975 deaths (551 from Bronchitis, and 203 from Pneumonia). 4. Diseases of the Digestive Organs caused 432 deaths, of which 144 were due to Enteritis and Peritonitis, 101 to diseases of the Liver, and 44 to Dentition. 5. Diseases of the Urinary System caused 153 deaths. 74 6. Diseases of the Reproductive System, Integumentary System, Locomotive System, Lymphatics, Organs of Special Senses, etc., caused together 89 deaths. Class VII.—Deaths from Violence. 219 deaths in all, including 178 from Accidents, 19 from Burns and Scalds, 12 from Drowning, 57 from Suffocation in bed (53 being infants under 1 year) 33 from Suicide, and 8 from Homicide. Class VIII.—Other Causes. 258 deaths were registered in this class, consisting of deaths from Dropsy, Tumours, Haemorrhages, or other ill-defined or non-specified causes. Different rates of mortality from different diseases or groups of diseases (also sub-divided as to Districts) are given in terms of the total deaths in Tables T and W ; whilst Table T gives also the deaths from the chief Infantile Diseases, expressed in terms of the infantile population (or number of births). Allowing for the slight differences between corrected and uncorrected death returns, it will be noted that, in regard to both infantile and other diseases, Lambeth again compares favourably with London. Deaths amongst infants under one year are a sensitive index (amongst others) of the sanitary state of a Community, and in this respect the Lambeth statistics, as a whole, are satisfactory. Table F is important, too, in this connection, as comparing the Lambeth Statistics with those for London as a whole, taken in different age-periods. 75 TABLE T. Shewing Classification of Causes of Deaths in Lambeth during 1898, compared with 1897. A.—Total Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected). Class of Disease. Lambeth Parish. 1898. 1897. No. of Deaths (corrected). Percentage of Total Deaths. No. of Deaths (corrected). Percentage of Total Deaths. I.—Zymotic Diseases 908 16.7 853 16.2 Seven Principal 726 13.4 734 13.9 Influenza 126 2.3 45 0.9 II.—Parasitic 1 0.02 3 0.1 III.—Dietetic 43 0.8 42 0.8 IV.—Constitutional 1043 19.2 1021 19.4 Cancer 270 4.9 239 4.6 Phthisis 490 9.0 483 9.2 Tubercular Diseases, excluding Phthisis 184 3.4 188 3.6 Rheumatism (Acute and Chronic) and Gout 34 0.6 51 0.9 V.—Developmental 389 7.2 421 8.0 Old Age 180 3.3 188 3.6 VI.—Local Diseases 2569 47.3 2442 46.5 Circulatory System 402 7.4 388 7.4 Bronchitis 551 10.2 446 8.5 Pneumonia and Broncho-Pneumonia 305 5.6 272 5.2 Pleurisy and Pleuropneumonia 25 0.5 21 0.4 Respiratory System, excluding Phthisis 975 17.9 819 17.5 VII.—Violence 219 4.0 207 3.9 Suicide 33 0.6 29 0.6 VIII.—Other Causes 258 4.8 271 5.2 76 TABLE T (Continued). B.—Deaths (corrected) of Infants under One Year of age from the chief infantile diseases, and from all causes, expressed in terms of 1,000 births. Lambeth Parish. 1898. 1897. Total Deaths under One Year (Corrected). Percentage to 1000 Births. Total Deaths under One Year {Corrected,'. Percentage to 1000 Births. From all causes 1426 154.1 1425 151.8 Diarrhoea 209 22.6 197 20.9 Convulsions 60 6.5 44 4.7 Respiratory Diseases 212 22.9 201 21.4 Premature Births 154 16.6 196 20.9 Tubercular Diseases (including Phthisis) 81 8.5 83 8.9 Measles 27 2.9 23 2.5 Whooping Cough 71 7.7 66 7.0 Suffocation in Bed 53 5.9 29 3.1 Enteritis 103 11.1 89 9.5 Dentition 24 2.6 29 3.1 77 TABLE U. Shewing Classification of certain Causes of Deaths (uncorrected) in Lambeth, compared with London, during 1897 and 1898. A.—Deaths at all /1ges. Lambeth. London. Percentage of total Deaths (uncorrected). 1897. 1898. Percentage of total Deaths (uncorrected). 1897. 1858. I. Principal Zymotics 14.8 13.4 14.2 14.9 Influenza 0.8 2.4 0.8 1.5 Measles 2.5 2.4 2.4 3.7 Whooping Cough 2.6 2.8 2.3 2.6 Diarrhoea and Dysentery 4.3 4.5 5.1 5.2 II. Rheumatic Fever and Heart Rheumatism 0.5 0.4 0.5 0.4 III, Diseases of Circulatory System 7.2 7.2 8.6 8.1 IV. Bronchitis, Pneumonia, and Pleurisy 13.9 15.9 15.7 16.1 Phthisis 8.3 8.5 9.7 9.5 V. Injuries ... 4.4 4.6 4.3 4.2 B.—Deaths under 1 Year of Ace (per 1000 Births). I. All Causes 155-4 156-3 159-2 167 78 79 TABLE V. TABLE V. Local Government Board Table A.] Table of DEATHS during the Year 1898, in the Lambeth District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all causes, at subjoined Ages. (i) Mortality from subioined causes, distinguishing deaths of children under flve yaars of age. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox, Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysiptlas. Measles. w hooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. uroncnitis. Pneumonia and Pleurisy. Heart Disease. Influenza. Irjuries. All other Diseases. . Typhus. hnteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) Royal Infirmary (Women and Children) 63 26 22 7 4 4 ...... Under 5 ...... ...... 1 ...... ...... 1 ...... ...... ...... ...... ...... ...... 2 3 ...... 2 8 1 ...... 1 29 48 5 upwds. ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 2 1 ...... 2 ...... ...... 10 15 Remainder of Waterloo Road First 219 6- 33 3 6 84 25 Under 5 ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... 7 14 11 ...... ...... 17 ...... 5 46 101 5 upwds. ...... ...... ...... 1 ...... 1 ...... ...... ...... ...... ...... ...... 1 1 ...... 25 30 17 6 3 33 118 General Lying-in-Hospital, York Road 14 9 ...... ...... 1 4 ...... Under 5 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 7 ...... 5 upwds ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 5 5 Remainder of Waterloo Road 240 90 36 3 7 71 33 Under 5 ...... 1 ...... 1 ...... ...... ...... ...... ...... ...... ...... 8 8 9 ...... ...... 21 ...... ...... 4 76 126 5 upwds. ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 2 16 24 17 14 41 114 St. Thomas's Hospital 546 59 75 50 51 280 31 Under 5 ...... ...... 8 ...... ...... ...... ...... ...... ...... ...... 2 3 ...... 8 ...... 2 17 ...... ...... 26 58 131 5 upwds. ...... ...... 4 ...... ...... 9 1 ...... ...... ...... 2 1 ...... 1 25 24 36 2 56 251 412 Remainder of Lambeth Church First 292 116 47 4 9 87 29 Under 5 ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 9 31 2 15 72 163 5 upwds. ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 3 23 21 14 5 20 40 129 Lambeth Infirmary 715 41 21 5 17 343 285 Under 5 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 2 2 16 45 65 5 upwds ...... ...... ...... ...... ...... 3 ...... ...... 2 ...... 3 ...... ...... 3 123 130 77 5 2 292 650 Lambeth Workhouse 33 8 1 ...... ...... 9 15 Under 5 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 9 ...... 5 upwds ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 3 6 6 2 7 21 Remainder of Lambeth Church 543 212 84 11 17 158 60 Under 5 ...... ...... 3 1 ...... ...... ...... ...... ...... 3 1 16 16 51 ...... ...... 57 1 10 135 297 5 upwds ...... ...... 1 ...... ...... 1 ...... ...... ...... ...... 5 ...... ...... 3 3 47 56 31 12 7 78 246 Clapham Maternity 12 11 ...... ...... ...... 1 ...... Under 5 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... 2 8 11 5 upwds ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 1 St. Peter's House 29 ...... ...... ...... ...... 6 23 Under 5 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 5 upwds ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 9 2 1 17 29 Remainder of Kenninglon First 737 248 127 19 19 177 147 Under 5 ...... ...... 8 1 ...... ...... ...... ...... ...... 2 ...... 52 32 51 ...... ...... 53 ...... 4 18 150 375 5 upwds. ...... ...... 4 1 ...... 5 ...... ...... ...... ...... 1 1 ...... 3 3 37 65 28 16 8 190 362 Kennington Second 543 141 46 17 11 193 135 Under 5 ...... ...... 3 ...... ...... ...... ...... ...... ...... ...... ...... 5 12 31 ...... 5 28 3 ...... 5 95 187 5 upwds ...... ...... 1 ...... ...... 3 ...... ...... ...... ...... ...... ...... 2 ...... ...... 52 52 52 18 15 158 356 80 81 TABLE V—continued., T.DIt, -r ,. , TABLE V—continued. Local Government Board Table A—continued. Table of DEATHS during the Year 1898, in the Lambeth District, classified acccording to diseases, Ages and localities. of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all causes, at subjoined ages. Mortality from subjoined causes, distinguishing deaths of children under flve years of age At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. I 2 3 4 5 6 7 8 1 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. | Diphtheria. Membranous Croup. Fevers. Choi ra. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) South Western Hospital 116 5 51 39 9 12 ...... Under 5 ...... 12 40 ...... ...... ...... ...... ...... ...... ...... ...... 2 ...... ...... ...... ...... 1 ...... ...... ...... 1 56 5 upwds. ...... 6 30 ...... ...... 14 ...... ...... ...... ...... ...... ...... ...... ...... ...... 3 ...... ...... ...... 7 60 .Remainder of Brixton 1089 329 111 25 30 331 263 | Under 5 ...... ...... 9 ...... ...... ...... ...... ...... ...... ...... ...... 14 43 36 ...... 7 55 ...... 6 10 260 440 5 upwds ...... 1 10 ...... ...... ...... ...... ...... 1 ...... ...... 4 2 1 4 75 111 78 4ti 13 300 649 Lambeth Old Workhouse Schools 7 ...... 4 3 ...... ...... ...... Under 5 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... 3 ...... ...... ...... ...... 4 5 upwds. ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... 2 3 British Home for Incurables 8 ...... ...... ...... ...... 6 21 Under 5 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 5 upwds. ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 7 8 Remainder of Norwood 361 80 41 14 8 125 93 Under 5 ...... 1 1 ...... ...... ...... ...... ...... ...... ...... ...... 19 9 7 ...... ...... 12 ...... ...... 3 69 121 5 upwds. ...... ...... 1 i ...... ...... ...... ...... ...... 1 ...... 3 1 i 21 3i 30 9 6 131 240 Totals 5567 14}7 699 200 189 1891 1141 | Under 5 ...... 15 84 3 ...... 1 ...... ...... ...... 5 3 128 148 236 20 324 9 10 iro 1060 2146 5 upwds. ...... 7 51 3 ...... 41 1 ...... 5 2 11 8 8 12 20 451 564 390 121 156 1570 3421 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occuring outside the district among persons beonging thereto 455 45 66 43 30 217 54 Under 5. ...... 14 3 22 19 ...... ...... 1 ...... ...... ...... ...... ...... 2 4 10 4 15 39 111 5 upwds ...... 1 ...... 6 ...... ...... ...... ...... ...... ...... ...... 1 2 40 19 39 20 191 344 Deaths occurring within the district among persous not belonging thereto 592 G6 102 68 45 256 55 Under 5 ...... 4 5 43 25 ...... ...... ...... ...... ...... ...... ...... o 4 1 4 i 19 ] 19 69 168 5 upwds ...... ...... ...... ...... 14 i 1 ...... ...... 1 1 i 23 22 35 5 38 251 424 K 82 83 TABLE W. TABLE W. Table of Population, Births, and of New Cases of Infectious , Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1898, in the Metropolitan Sanitary District of Lambeth, classified according to Diseases ' and Localities. Local Government Board Table B.~\ Registration Sub-Districts. Population at all Ages. Registered Births. New Cases of Sickness in each Locality, coming to the knowledge of the Medical 0fficer of Health" Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census 1896. Estimated to middle of 1898. 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Fevers. English Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. 1 y phoid or Enteric Typhus. Continued, Relapsing. Puerpera'. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) Waterloo Road,lst 14186 14262 508 ... 61 39 3 13 ... ... ... ... ... 10 ... 52 31 1 ... 7 ... ... ... ... 2 Waterloo Road, 2nd 14210 14020 873 ... 50 28 ... 7 ... ... ... ... ... 10 ... 43 17 ... ... 6 ... ... ... ... 1 Lambeth Church, 1st 18770 19090 581 ... 94 117 ... 20 ... ... ... 2 4 25 ... 87 87 ... ... 11 ... ... ... ... 3 Lambeth Church, 2nd 40994 41864 1613 ... 138 98 4 27 ... 5 ... 4 2 69 ... 84 71 ... ... 10 ... ... ... ... 2 Kennington, 1st. 52486 53361 1888 ... 127 163 5 21 ... 2 ... 1 ... 51 ... 100 132 1 ... 14 1 ... ... ... 1 Kennington, 2nd. 43244 44852 1009 ... 195 130 3 32 ... 3 ... 2 ... 57 ... 72 44 1 ... 8 ... ... ... ... 1 Brixton 81825 85617 2143 ... 213 187 1 28 ... 3 ... 5 ... 55 ... 163 120 ... ... 16 ... ... 3 ... 3 Norwood 29318 80977 641 ... 131 51 1 15 ... ... ... ... 1 17 ... 65 33 ... ... 9 ... ... ... ... ... Totals 295,033 304,073 9256 ... 1009 813 16 163 ... 13 ... 14 7 291 ... 656 535 13 ... ... 1 ... 3 ... 13 F 2 84 LAMBETH PARISH. SUMMARY OF VITAL AND MORTAL STATISTICS, &c., FOR 189S. Area of Parish—3,941 statute acres (exclusive of tidal water 79, and foreshore 39, statute acres respectively), divided into 8 Registration Sub-Districts, 4 Parliamentary Divisions and 8 New Wards. The Parliamentary Divisions and New Wards are co-extensive. Population (estimated middle of 1898)—304,073 (males, 143,625; females, 160,448). Density—77T personsjper acre. Inhabited Houses—38,556 at Census, 1891. Rateable Value—£1,712,289. Marriages—2589, being 17 0 per 1000. Births—9256, being 30'4 per 1000. Deaths (corrected)—5430, being 17"9 per 1000. Infantile Mortality—1426 under 1 year, or 154T per 1000 births. Zymotic—Death-Rate, 2'4 per 1000. Increase of population 4025; but the natural increase or increment (i.e., excess of Births over Deaths) was 3826. 85 Return showing the Number of Nuisances removed or abated in the Parish of Lambeth, from the 1st January to the 31st December, 1898. Number of Notices ... ... 10469* NOTIFIABLE INFECTIOUS DISEASE. (Public Health, London, Act.) No. of Infected Houses (Notices served) 209-4 Smallpox — Scarlet Fever 882 Typhoid 159 Typhus — Continued Fever 13 Diphtheria 724 Membranous Croup 15 Puerperal Fever 14 Erysipelas ... 280 English Cholera 7 Total 2094 * Excluding 44 Notices under the Housing of the Working Classes Act, 1890 {vide pp. 87, 113—117). 86 PARTICULARS OF SANITARY WORK Carried out in Lambeth Parish during 1898, and for 21 years previously. Year. Total Number of N otices(excluding those under Housing of the Working Classes Act). Sanitary Works, Structural and Permanent. Sanitary Work net Structural. 1898 10469 9905 2224 1897 11088 9058 1884 1896 7475 6702 982 1895 7645 8581 1104 1894 6975 7672 1911 1893 8769 9207 2046 1892 7173 6931 2190 1891 5557 7232 3173 1890 5588 5053 3251 1889 6854 4192 2662 1888 4891 2969 1922 1887 4565 2430 2135 1886 4504 2433 2071 1885 3567 1459 2108 1884 3727 1621 2106 1883 3000 1294 1766 1882 3239 1267 1972 1881 3730 1293 2437 1880 3259 1106 2153 1879 3075 960 2115 1878 3310 1169 2211 1877 3563 1299 2264 87 A. Public Health (London) Act and Metropolis Local Management Act. Notices served (Preliminary and Statutory) 8375 Works Structural :— Drainage defective 1598 lntercepting Traps with Fresh Air Inlets requ'red 763 Ventilating Pipes required 911 Indoor Sinks connected with the Drain 563 Rain Water Stack Pipes connected with the Drain 416 Bath Waste connected with the Drain 27 Traps Defective, or of Obsolete Pattern 56 Closet Pan and Connections Defective 968 Water Supply to Closet Defective 541 Closet Dilapidated 319 Draw-Off from Main for Drinking Purposes required ... 501 Dust Bins Defective 815 Premises Dilapidated 98 Ventilation under the Floors required 176 Roofs Dilapidated 145 Soil Pipes Defective 76 Paving Defective 941 Damp and Unwholesome Houses 76 Dung Receptacles required 185 Works not Structural:— Cisterns Dirty 85 Manure Accumulations 71 Underground Rooms occupied 91 Animals improperly kept 39 Stopped Drains 141 Overcrowding 274 Foul Urinals 14 Through Ventilation provided 9 Refuse Accumulations 49 No Water Supply or Defective Water Supply 456 Dirty Premises 995 12129 B. Infectious Diseases Notification. Notices served , ... ... 2094 Nature of Work.—To disinfect infected rooms (with stripping off of wall papers and general cleansing as may be necessary), bedding, clothes, etc. C. Housing; of the Working Classes Act, 1890. Notices served 44 Nature of Work.—To put premises into proper order and condition, or to close and demolish them. 88 SUMMARY OF WORK DONE BY THE SANITARY INSPECTORS DURING THE YEAR 1898. Inspections 8886 Re-Inspections 52858 Infectious Houses visited 2094. Complaints attended to 5620 Cases of Infectious Disease notified 2329 a. Cases under treatment at home 1027 b. Cases removed to Hospital 1302 Cases of Non-Notifiable Diseases dealt with ... 144 Houses disinfected 2019 Rooms disinfected 2556 Bedding, etc., disinfected 21597 Bedding, etc., destroyed 126 Dust Yards, Manure Depots and Brickfields, inspections of 260 Drains tested (with chemical, water, or both) 9135 Sanitary Works completed 6349 Plans of Drainage received and approved 559 New Buildings the drains of which have been completed 151 Premises the drains of which have been totally or partly reconstructed 555 Articles procured for the Analyst— (a.) Food and Drugs 602 (6.) Water 16 Summonses and Orders issued 86 Workshops inspected and registered 133 Special Smoke observations and enquiries 113 Cowhouses inspected and registered 27 Slaughter-houses inspected and registered 45 Notices served— Sanitary Work (Preliminary and Statutory) 8375 Infectious Diseases (Public Health Act, 1891) 2094 Housing of Working Classes Act 44 Sanitary nuisances abated 12129 (a.) Structural y905 (b.) Non-structural 2224 Persons received in Shelter at Wharf 7 Convictions obtiined— Public Health Act 40 Food and Drugs and Margarine Acts 54 89 INSPECTORIAL STAFF. On January 20th, 1898, Mr. William James Perrin* was appointed Sanitary Inspector in place of Mr. J. T. Wiggs, deceased, and commenced his duties on February 21st. Inspector Perrin has charge of a small district—part of Stockwell Ward, and in addition is special Smoke Inspector and Food and Drugs Inspector for the whole of the Parish. On July 21st, 1898, Mr. William Winder Howesf was appointed an extra Sanitary Inspector, and commenced his duties on August 29th. Inspector Howes has charge of a district, consisting of the N.E. portion of Prince's Ward and N. portion of Brixton, with an area of 350 acres, 2054 inhabited houses, and 15248 persons (estimated). The boundaries of the District are Brook Street on the North, Vassall Road on the South, Kennington Park and Farmer's Road on the East, and Kennington and Brixton Roads on the West. Inspector Howes keeps, in addition, the register of houses-let-in-lodgings, and in that connection is doing good work in inspecting the houses and measuring up the different rooms. On the 28th April, 1893, the Vestry decided to place the senior Inspectors under the Local Government Board in accordance with the provisions of the Sanitary Officers (London) Order, 1891—the six recently appointed Inspectors being already under the same conditions by virtue of their appointments having been made subsequently to January 1st, 1892. *W. J. Perrin formerly Sanitary Inspector to Newington Parish. +W. W. Howes formerly Assistant Inspector of Nuisances to the West Ham Corporation. 90 The question of appointing a female Sanitary Inspector was adjourned for six months by the Vestry at their meeting held on April 28th, 1898 (Vide Minutes, 1898, p. 819). The Vestry is now equipped with a good Inspectorial Staff of 13 Sanitary Inspectors (one of whom is engaged indoors), and the good work that they are carrying out is beginning to tell on the sanitary state of the Parish generally, and more especially of the Inner Wards, the courts and alleys and houses of which are in a much better state, owing to more constant supervision and inspection. In connection with the poorer disticts, it is found that inspections, to be of use, must be made as frequently as possible—the majority of the tenants being careless in the matter of domestic cleanliness, whether as regards themselves or their surroundings. In this connection much good is accruing, and will further accrue, from the smallness of the districts allotted now to the different Inspectors who take charge of the so-called Inner Wards. Many house-to-house inspections have taken place during the year 1898, in those parts of the Parish where such inspections have been thought to be necessary, eg., more especially these courts and alleys of the Inner Wards. Drains are tested in all cases, and it is satisfactory to note the comparatively small percentage (under 20) of houses in which the test gives a result. It must be remembered, however, that the method of testing with chemical, though satisfactory, is not infallible, and consequently, when a result is obtained, the drains are certainly defective, but when a result is not obtained, it would be unwise to conclude that therefore the drains are perfect. Local conditions, state of atmosphere, wind, etc., play an important part at times, interfering with proper 91 and true results. The question arises, " Is there any better general test ? " and the answer is '' No, not in the light of our present knowledge.'' The water test is too severe to apply indiscriminately in cases of old drains, though it is, of course, used entirely in cases of new drains—being applied to them both in sections (in course of construction) and as a whole (when completed). Since the Vestry transferred the drainage of new buildings to the Inspectors (who already had charge of reconstructions), much extra work has been thrown upon them, as it must be remembered that many visits are necessary in connection with each house, visits being requisite for testing the drainage—whether new or reconstructed— in sections and as a whole. These extra duties become serious in the case of large buildings, or block of buildings, e.g., the South-Western Fever Hospital, where recently the drainage has been reconstructed, necessitating an average of not less than two visits a week by the Inspector—each visit occupying an average of two or three hours. This work has been going on during the last twelve months. The South-Western Hospital is mentioned as the work is in process at the present time, but many other examples might be given, e.g., Lambeth Palace, Stockwell Orphanage, Board Schools, etc., whilst ordinary dwelling-houses necessitate a great amount of supervision in connection with alterations, improvements, or additions either of drainage or sanitary fittings and appliances. There is a large amount of detail in connection with the supervising of drainage, in addition to the actual testing of new work with water, e.g., examination of depth and quality of concrete bed for pipes, amount of fall, true alignment of pipes, inspection of each joint, so as to see 92 that there has been no "faking," etc. 'Ihis work might in great part be carried out by special drain layers who would act as Assistants to the Inspectors, and thereby save a large amount of their (the Inspectors') time. With the present arrangement, hours and hours of the Inspectors' time are practically wasted, which might be profitably devoted to the carrying out of other duties. During 1898, 559 plans (representing 892 houses) have been received and approved, and the drainage work, as shewn, carried out under the personal supervision of the Inspectors, and water-tested. 8375 Preliminary and Statutory Notices have been served by the Inspectors during the year 1898, under the Public Health (London) Act, and the Metropolis Local Management Acts, and in connection with infected houses (for disinfection, stripping off wall papers, and general cleansing), whilst 44 Notices have been served by the Vestry under the Housing of the Working Classes Act, 1890. The special work in connection with Disinfection, Smoke Abatement, Houses Let in Lodgings, and the carrying out of the Focd and Drugs and Margarine Acts, is dealt with on pp. 94—111. Several important seizures of unsound food were made by the Inspectors during the year, and in connection with most of these exemplary fines were inflicted by the Magistrate as follows:— 1. 88 cases of condensed milk consisting of over 5000 tins were seized in a stable in connection with 5, Little Windmill Street, New Cut, condemned and ordered to be destroyed by the Magistrate, who inflicted a penalty of £50 and £5 5s. Od. costs, or three months' imprisonment, The tins 93 were destroyed at the Vestry Wharf—each tin being pierced and its contents emptied out. 2. Three cases of oranges were seized in the New Cut, condemned (and ordered to be destroyed) by the Magistrate, who inflicted a penalty of £5 and 2/- costs, or one month's imprisonment. 3. 22 pieces of bacon (114 lbs.) were seized on a stall in front of 66, Lower Marsh, condemned (and ordered to be destroyed) by the Magistrate, who inflicted a penalty of £25 and £2 2s. Od. costs, or three months' imprisonment, on the wholesale dealer, and a penalty of £10 and £1 Is. Od. costs or one month's imprisonment, on the retail dealer—making a total of £35 and £3 3s. Od. costs. 4. 39 pieces (112 lbs.) of beef and mutton were seized at 222 and 225, Wandsworth Road, condemned (and ordered to be destroyed) by the Magistrate, who inflicted a penalty of £4 and 8/- costs, or one month's imprisonment. 5. 21 rabbits and 29 pieces of rabbit, were seized at 120, Lower Marsh, condemned (and ordered to be destroyed) by the Magistrate, who inflicted a penalty of £2 and 4/- costs, or a month's imprisonment. The market thoroughfares have been under bi-weekly inspection by the Inspectors (four being on duty at a time), and much good has arisen therefrom, more especially during the summer months, when there is much bad and unsound fruit, vegetables, fish and meat about; and the food would undoubtedly be sold to the poorer inhabitants were such inspections stopped. The inspections are made on Saturday nights (9 to 12), and Sunday mcrnings (9 to 12). 94 DISINFECTING DEPARTMENT. The statistics of this Department show the amount of work done, with particulars. The new Equifex disinfecting machine has proved of great value during the year—the automatic record of disinfections being especially useful as checking the work of the man in charge. In connection with the machine several slight alterations and improvements have been made, including the covering of the boiler-feeder with a galvanised iron cover, fitting of a condenser on to the steam exhaust chimney, and the inserting of two steam traps between the coils and the drain—improvements which have reduced the noise in connection with the working of the machine to a minimum, and economised the steam. The boiler and furnace have also been lagged with magnesia and wood, thereby saving heat, and making it more convenient for the attendant to work in close proximity thereto. The Vestry has decided to have the house (Arlington Lodge) put into proper repair and the top rooms fitted up for use as living rooms for the chief disinfecting officer, who will have charge of, and be responsible for, the safe keeping of the plant; whilst the lower part of the house is to be fitted up and used as a refuge for families from houses that are undergoing disinfection—a bath, etc., being supplied. In addition, the Vestry has decided to fit up a bacteriological laboratory in one of the rooms of the house, which is being fitted up accordingly. A 10-inch wall has been built round the garden at a cost of £121, completely shutting off the disinfecting station from the surrounding houses. The Lambeth Vestry is now well equipped as regards its disinfecting department, and the work carried out during the last year has been satisfactory and compares favourably 95 with that of former years. The staff have given every satisfaction during the year. No repairs have been necessary in connection with the old disinfecting machine at the Wharf, Belvedere Road. During 1898, 14 certificates were received in respect of rooms, 2 of bedding and clothing, and 146 of both rooms and bedding, making a total of 162 as compared with 169 last year. Medical Certificates accepted in lieu of disinfection being carried out by the Vestry :— Nature of Certificates. 1st Q. 2nd Q. 3rd 0. 4th Q. Total. For Rooms only 2 6 3 3 14 For Bedding only — — 2 — 2 For Rooms and Bedding 36 46 34 30 146 38 52 39 33 162 In addition to the 2,329 cases of notifiable infectious diseases (see page 33), each one of which has been attended to by the disinfecting staff, there have also been during the year the following non-notifiable diseases, etc., dealt with:— 96  1st Q. 2nd Q. 3rd Q. 4th Q. Total. 'Measles 76 52 1 — 129 Chicken pox — 2 1 1 4 Cancer — 2 2 3 7 Consumption — 2 1 1 4 C Infected Cabs 2 4 3 — 9 ^ Dirty Premises, etc. 15 11 10 13 49 113 73 18 18 202 The work in connection with Measles-infected premises is satisfactory, and is due to the action taken by the Vestry in distributing leaflets, etc. {see p. 51). The Vestry would do well to petition the London County Council to take steps to have Measles included as a dangerous infectious disease, so that the various important sections of the Public Health (London) Act, 1891, as to disinfecting, etc., might be put into force, and more stringent measures taken for the prevention of this disease. 97 Particulars as to Disinfection carried out ill Lambeth Parish during 1898. Total No. of rooms disinfected by Vestry . 2556 Cases in which bedding has been disinfected at home... 132 ,, ,, „ at Chamber 2424 ,, „ ,, destroyed 27 Replaced by the Vestry Premises disinfected and disinfectants 2 supplied 8441 No. of Cleansing Notices served in connection with infected houses 1821 Certificates of Medical Practitioners received in lieu of disinfection by the Vestry ... 162 Articles of Bedding, etc., disinfected. Beds 1763 Bolsters 2260 Pillows 4858 Mattresses 1069 Palliasses 114 Chair Cushions 1557 Clothing 3641 Blankets 3079 Rugs 212 Counterpanes and Eiderdown Quilts 1652 Carpets 182 Extras (not mentioned in above) 1210 Total 21,597 G 98 Articles of Bedding destroyed. Beds 17 Bolsters 2 Pillows 14 Mattresses 9 Palliasses 26 Chair Cushions 6 Clothing 16 Sundries 36 Total 126 The Refuge provided at the Wharf has only been used once during the year—a family consisting of a mother and 6 children under 12 years of age, and coming from an erysipelas-infected house (8, Surrey Lodge) being accommodated during the disinfection of their house. The situation of the present Refuge prevents its use becoming popular, as there have been many instances of families expressing their willingness to go to such a place until they are told where it is situated. The new Refuge at Wanless Road will doubtless be more popular and consequently more used, the experience of other Authorities being that these Refuges should be made as attractive and inviting as possible, for those poorer ratepayers who may have to use them. The provision of these Refuges is rendered compulsory by sect. 60 of the Public Health (London) Act, 1891, 99 DISINFECTION STATISTICS. For eight years prior, and eight years subsequent, to the passing of the Notification of Infectious Diseases Act; and for the year 1898. 1832 1883 1881 1885 1886 1887 18S8 1889 Yearly average for 8 years preceding the Notification Act 1890 1891 1892 1893 1894 1895 1896 1897 Yearly average for 8 years succeeding the Notification Act 1898 No. of Cases in which Bedding etc., has been disinfected. At Home 332 258 278 16 62 52 7 144 143 6 179 246 593 343 177 251 368 217 296-7 132 At Chamber 85 56 162 569 236 722 902 951 4604 1391 1570 2546 3042 2286 2462 2447 2126 2233-7 2424 No. of Cases in which Bedding etc., has been destroyed. ... ... 37 23 62 52 8 57 48 79 457 185 275 314 224 119 67 49 39 1590 27 No. of articles of Bedding, etc., disinfected. ... ... 1526 1437 1895 2275 916 3078 3121 3778 2253 2 3013 6747 9909 11513 8022 13516 20349 21487 118195 21597 No. of articles of Bedding, etc destroyed. ... ... 63 101 1!4 144 59 92 61 267 113 0 333 467 605 674 544 186 178 162 3936 126 Premises Disinfected and Disinfectants Supplied. ... ... 727 680 657 727 73g 1276 1255 1277 9169 1722 1816 3157 5896 5742 7146 7210 8715 51755 8441 G 2 100 ANALYSIS OF FOOD AND DRUGS, WATER, Etc. During the year 1898, 602 samples have been purchased and submitted to the Public Analyst for analysis. Taking the last ten years (1888-97), the annual average as to number of samples taken is 411, of which 66 (i.e., 15-9 %} were found, on analysis., to be adulterated. The average annual number of summonses issued is 44, with an average of 44 convictions and 18 cautions, and an average of £90 0s. 6d. in penalties, and £29 lis. lid. in costs during the same decennium. Of the 602 samples purchased during 1898, 74 (i.e., 12-3 °/0) were reported by the Analyst to be adulterated ; 57 summonses were issued, with the result that 54 convictions were obtained, together with £69 in penalties, and £34 9s. Od. in costs; and in six cases the Vendors were cautioned. Full details are given as to the various foods and drugs purchased and analysed, with the percentages of adulterations in each case, not only during the year 1898 but also for each of the previous ten years (1888-97). The results for the year are satisfactory, and a credit to the newly-appointed Inspector (Mr. W. J. Perrin), who has had sole charge of the carrying out of the Foods and Drugs and Margarine Acts in Lambeth. It will be noted that more samples have been taken during the year 1898 than ever before in one year in Lambeth Parish, whilst the average of adulterated samples is higher than during last year (1897). The Inspector, in most cases, employs a deputy to purchase the samples. The results of the monthly examinations of the Water supplied to the Parish by the Southwark and Vauxhall and Lambeth Companies were satisfactory during 1898. 101 SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of Analyses, during the year 1898. Samples. Number Procured. Number Adulterated. Milk 235 32 Butter 193 28 Coffee 58 6 Mustard 19 — Pepper 22 — Gin 9 — Rum 2 1 Whisky 17 1 Potassium Iodide 2 — Sugar 3 — Cocoa 2 — Olive Oil 6 — Arrowroot 1 — Lard 6 — Gregory's Powder 3 3 Sweet Spirit of Nitre 1 — Cream of Tartar 1 — Prescription 9 — Margarine (not labelled) 3 3 Oatmeal 3 — Ground Rice 7 — Totals 602 74 102 TABLE Shewing percentage of different adulterated Samples during 1898 and in the previous ten years. Year. Milk. Butter. Coffee. Bread and Flour. Cocoa and Chocolate. Cheese and Lard. Other Groceries. Sundries. Spirits. Brandy. Gin. Rum. Whisky. Ale and Porter. Wines. Crated Waters. Drugs. 1898 136 145 103 — 0.0 00 00 00 Ill — 00 500 59 — — — 18.8 1897 10.5 7.3 3.03 0.0 0.0 0.0 20 111 17 7 — 25.0 18.2 0.0 — — 14.3 1896 11.06 17.7 15.1 0.0 0.0 — 0.0 0.0 0.0 0.0 0.0 0.0 0.0 — — 0.0 0'9 1895 21.05 14.7 26.4 — 0.0 o.o 0.0 16.6 16 0 — 12.5 25.0 — — 0.0 0.0 12.5 1894 27.6 22.4 30.0 — 0.0 0.0 5.3 0.0 0.0 0.0 0.0 0.0 0.0 — — — 0.0 1893 30.4 35.04 11.1 0.0 18.2 0.0 3.3 0.0 8.7 20.0 0.0 0.0 11.1 — — — 0.0 1892 31.3 36.4 18.4 — 66.7 0.0 2.1 0.0 0.0 0.0 0.0 0.0 — 0.0 — — 0.0 1891 47.8 5.0 3.8 0.0 — — 2.6 0.0 0.0 0.0 0.0 — 0.0 0.0 — 0.0 0.0 1890 19.3 12.1 23.3 0.0 0.0 — 5.0 0.0 57.1 100.0 66.7 — 50.0 0.0 — — — 1889 28.1 22.2 12.9 — — 0.0 3.9 0.0 — — — — — 0.0 — 0.0 — 1888 20.7 9.3 8.6 0.0 — 0.0 5.08 0.0 11.1 — 0.0 33.3 0.0 0.0 — 0.0 0 0 means that all Samples were reported to be genuine and unadulterated, — means that no Samples were taken during the year. 103 Year. No. of Samples Analysed. No. of Samples adulterated Percentage of Samplts adulterated. No. of Summonses issued. No. of Convictions. No. of Cautions. Penalties. Costs. I898 602 74 12-3 57* 54 6 £ s. d. £ s. d. 69 0 0 34 9 0 1897 546 41 7-5 7 21 2 48 0 0 24 5 0 1896 549 66 1202 66 60 2 93 0 0 35 11 6 1895 500 87 17-4 64 62 23 149 15 0 41 18 0 1894 495 107 216 81 79 26 199 0 0 45 11 0 1893 498 120 2409 79 79 41 207 17 0 48 19 0 1892 332 65 19-5 43 43 22 66 8 6 32 9 0 1891 292 48 164 25 24 23 28 13 6 15 1 0 1890 300 40 13-3 30 28 10 39 1 0 19 6 0 1889 300 47 15 6 29 29 18 46 0 6 18 2 6 1888 300 35 116 22 22 13 22 9 6 14 16 0 Average of 10 years 1888-97 411 2 65 6 15-9 44 6 44-8 180 90 0 6 29 11 11 Inspector Perrin commenced his duties on February 21st, 1898. #Two Summonses we e dismissed, and one could not be served owing; to the defendant having absconded 104 SMOKE ABATEMENT. Considerable emphasis has been given during the past year to the question of Smoke Nuisance in Lambeth by the action of the London County Council, who, at the time of the Coal Strike, took the opportunity of exercising the power contained in Section 100 of the Public Health (London) Act, 1891, and summoning two firms for creating a nuisance under the Smoke Section of the Act, alleging that the Vestry were in default. A Special Report* on the subject was presented by the Medical Officer to the Vestry on July 21st, 1898, and unanimously adopted by the Vestry, who, consequently, decided to take no further action against offenders, pending the settlement of the Coal Strike— it being shown that the firms in question (and others) were doing all they reasonably could be expected to do to minimise, as far as practicable, any nuisance. The County Council were not satisfied with the Vestry's action, took out summonses against Messrs. Walker, Parker & Co. and Messrs. Seth Taylor, and obtained a conviction in each case—penalties of £10 (with £2 2s. Od. costs) and £5 5s. Od. (with £2 2s. Od. costs) being respectively imposed. The Magistrate held that a chimney, not being the chimney of a dwelling-house, sending forth black smoke was a nuisance per se, and that no evidence could be taken as to existence of smoke-prevention appliances, kind of fuel used, &c. This action of the London County Council is open to criticism—whether in respect of Lambeth or other Metropolitan Districts, and to show the invidious position in which a Local Sanitary Authority may be placed, it may be stated here that the Si. Giles' Board of Works were * Vide Appendix, p. 23. 105 forced by the London County Council, under threat of neglect of duty, to take out a Summons in connection with Smoke Nuisance in their District, and the case was heard before Sir James Vaughan, who made an Order for the Nuisance to be abated within seven days. As the Nuisance was not so abated, the St. Giles' Board of Works applied to the Magistrate for Penalties, taking out for this purpose fifty Summonses for the non-compliance with the Magistrate's Order, and the Magistrate then marked the whole of these Summonses, in each case, " No Conviction ! " The Summonses were withdrawn by the Solicitor of the St. Giles' Board of Works, who mentioned to the Magistrate that " the action had been forced upon them by the London County Council, and that otherwise they would not have taken the action they did, at any rate, at that time when the Coal Strike was on." Sir James Vaughan, in summing up, stated that it was proved to his satisfaction that Welsh coal could not at the time of the Strike be supplied in sufficient quantity to admit of the smoke from the Defendant's chimney being of a clear character. The Nuisance remained unabated, and the County Council took no further action. Before the same Magistrate, on the same day, several Summonses were on for hearing, by the Strand District Board, and, as the result of the Magistrate's decision in the case of the St. Giles' Board of Works, these Summonses by the Strand District Board of Works were withdrawn. The Vestry of Paddington took out a Summons against the Metropolitan Electrical Supply Co., Ltd., and, on the first hearing of the case, the Summons was adjourned sine die, the Company undertaking to abate the Nuisance. On the further hearing of the case, however, the Nuisance 106 in the meantime being no better, but rather worse, the Magistrate (Mr. Lane, Q.C.) dismissed the Summons, the Company pleading lack of Welsh coal. Under the circumstances the Vestry of Lambeth was justified in holding its hand in connection with Smoke Nuisances until the Coal Strike was over. A leading article in a paper called "Public Health," dealing with the Smoke Nuisances in London, stated in its August number that " the outcome of the Magistrate's decision is that Local Authorities have, with few exceptions, practically decided to let Smoke Nuisance alone, and to allow the Council to give effect to the announced intention to take action against Defendants in default of the Local Authorities." The Chelsea Vestry, on the recommendation of their Medical Officer, decided to send written notices to the owners of chimneys emitting black smoke, calling upon them to alter the construction of their furnaces so as to allow complete combustion of the softer coal, and allowing three months for these necessary alterations to be carried out, but to take no action in respect to taking out Summonses at that particular time (the time of the Coal Strike). With the end of the Coal Strike, matters were simplified, and the Lambeth Vestry then took action, and is still taking action, against offending Firms. Penalties are now easily obtained under the Magistrate's ruling (Mr. Slade in the case of the L.C.C. versus Messrs. Seth Taylor and Walker, Parker & Co.), as shewn by the convictions obtained by the Vestry at the end of the year against Messrs. Maudslay & Sons, and against the Strand Electricity Supply Corporation (total of .£20 in penalties and £7 7s. in costs). In dealing with the Smoke Nuisance in connection with 107 the Steam Boats plying on the Thames, the Vestry decided to act (in conjunction with other Sanitary Authorities affected) by petitioning the London Port Authority (i.e., the Corporation of the City) who alone have jurisdiction over the Thames navigation. The London County Council have drawn the Vestry's attention to smoke nuisances observed by their own officers on 69 different occasions, as follows:— Laundry, 31, Thornton Street Sussex Road Board School Charing Cross and Strand Electricity Supply Company, 85, Commercial Road (9 occasions) Messrs. Stiff & Sons, Albert Embankment (5 occasions) Messrs. Doulton & Co , Albert Embankment (3 occasions) Bakery, 66, Brixton Road (2 occasions) Messrs. Clowes & Son, Duke Street (7 occasions) Messrs. Walkers, Parkers & Co., 63, Belvedere Road (5 occasions) New London Brewery, Durham Street (2 occasions) Laundry, 274, South Lambeth Road (2 occasions) Vine Lodge, Bonnington Square Waterloo and City Electricity Generating Station, Launcelot Street South Metropolitan Gas Co., Vauxhall (2 occasions) Messrs. Barry & Sons, 1, Thorparch Road Sunny Bank Laundry, Vauxhall (2 occasions) Mr. Peter Brotherhood, Belvedere Road (3 occasions) St. Thomas's Hospital, Lambeth Palace Road Messrs. Brand & Co., 86, South Lambeth Road Messrs. Maudslay, Son & Field, 110, Westminster Bridge Road (2 occasions) Messrs. Seth Taylor, Commercial Road (5 occasions) Messrs. Barrett & Co., Bond Street, Vauxhall (3 occasions) L. & S. Western Railway Co., Nine Elms Messrs. Daun & Valentin, 107 -109, Lambeth Road 108 Messrs. Drew, Bear, Perks & Co., Commercial Road Sir Joseph Causton, Clapham Road (5 occasions) Licensed Victuallers' Schools, Upper Kennington Lane Marble Laundry, Clapham Road. In addition to the above, most of which were under special observation by the Vestry's officers at the time of the County Council's communications being received, special observations have also been made during the year and reported to the Sanitary Committee, in respect of the following:— L.C.C. Works Department, Belvedere Road Darfield Wharf, 57, Belvedere Road Laundry, Workhouse Baths, Kennington Road Laundry Messrs. C. & J. Denny Messrs. Aland & Co., 46, Commercial Road Messrs. Selway & Sons, 45, Upper Kennington Lane Messrs. Williamsons, 201, Lyham Road Messrs. Oppenheimer Bros., 51 and 53, Handforth Road. The above lists will give an idea of the extra work thrown upon the Sanitary Department, as each case had to be kept under practically constant observation with a view to proceedings being taken before the Magistrate as might be required. The close of the year 1898 has seen a distinct improvement in connection with black smoke emitted from Factories, etc., especially in the neighbourhood of Belvedere and Commercial Roads. 109 The question as to fumes from the Potteries of Messrs. Stiff and Doulton being a nuisance and injurious to health has been raised during the past year by Earl Stanhope, one of the Ecclesiastical Commissioners, who states that the fumes are destroying the exterior of Lambeth Palace, which is situated close to the Potteries. The fumes (such as they are) arise from the salt-glazing, but the best-known means for preventing or minimising the Nuisance from such manufacturing processes are undoubtedly adopted. Further, the Medical Officer of Lambeth has no reason for supposing that the fumes are injurious to the health of the inhabitants of that particular part of Lambeth. Two important effluvium nuisances in connection with petroleum engines were dealt with by the Vestry during the year under Section 21 of the Public Health (London) Act, 1891—a Section which makes it compulsory upon a Sanitary Authority to take action on receipt of a complaint of nuisance from effluvia arising in any manufactory, building, or premises used for any trade, process, or manufacture causing effluvia and signed by more than ten inhabitants of the neighbourhood. In the one case (100, Westminster Bridge Road), the nuisance was effectually abated by the petroleum engine being replaced by a gas engine, and the Magistrate consequently inflicted no penalty, but ordered the summons to be withdrawn, the defendant paying the costs. In the other case (251, Clapham Road), the nuisance was effectually abated by intercepting the fumes and treating them in a kind of scrubber or purifier containing chemicals and asbestos, so that no action had to be taken by the Vestry before the Magistrate. 110 REFUSE AND MANURE DEPOTS. The various depots have been under frequent inspection throughout the year, and during the summer months these inspections have been not less frequent than tri-weekly. The City of London and Clerkenwell Vestry depots, which, at the end of 1897, were anything but satisfactory, have much improved, so that there has been no occasion to take any further legal action against either of them. Two Railway sidings,* which are used as outlets for offensive matters, chiefly manure, have been carefully watched during the year, and have at no time been found sufficiently bad to warrant legal action being taken against the owners in either case. The condition generally of the different refuse and manure depots in the Parish has been, throughout the year, satisfactory. The mews throughout the Parish have been inspected also, from time to time, and any insanitary condition, when found, remedied. During the summer months frequent inspections had to be made to prevent accumulations of manure being left in mews so as to be a nuisance, and notices had to be served. In connection with the stables belonging to the South London Tramways Company, and located in arches belonging to the L. & S. W. Railway Company, in Westminster Bridge Road, action was taken owing to their dark, unventilated, and generally insanitary condition, rendering the stables unfit and even dangerous for men (and animals) to live in. It was finally decided by the Company to * One belongs to L. & C. D. Railway Company at Herne Hill, and the other to the L. & S. W. Railway Company at Nine Elms. 1ll remove the stables elsewhere, and pending the building of the new stables, temporary arrangements were made for (i) the paving of the outside yard; (2) daily flushing and cleansing of the inside of the stables. Complaints were received with respect to the depositing of road-slop at the rear of 70, etc., Loughborough Park, but road-slop per se not being a source of danger to health, in the opinion of the Medical Officer, no further action was taken by the Vestry. In connection, too, with temporary collections of manure in the course of work carried on in Nurseries at Shakespeare Road, complaints were received but no action taken by the Vestry—the Medical Officer being of opinion that there was no nuisance. The dust destructor in connection with the City and South London Electric Supply Corporation is approaching completion, and will be ready for use during the year 1899. It is situated in Bengeworth Road (centre of the Parish), and has been built, with all modern improvements, by Messrs. Manlove, Alliott & Co., of Nottingham. Several complaints have been received as to the offensive odours given off from peat moss, which is now largely used as litter in place of straw, with the results that arrangements have been made for this litter (when used) to be placed in a cart or wagon, which is removed when full— thus avoiding the necessity of disturbing (during removal) the fermenting peat. HOUSES LET IN LODGINGS. The following houses have been selected by the Vestry during 1898, for registration under the bye-laws as to houses let in lodgings or occupied by more than one family:— 112 1—62, Tanswell Street.—55 houses containing 324 rooms, in which are housed 475 persons, of whom 328 are over 10 years of age, and at rents varying from 1s. 6d. to 9s. per week respectively; 1—32, Finck Street.—34 houses containing 224 rooms, in which are housed 285 persons, of whom 192 are over 10 years of age, and at rents varying from 2s. 6d. to 15s. pe r week respectively; 1—26, Waxwell Terrace.—22 houses containing 201 rooms, in which are housed 379 persons, of whom 205 are over 1C years of age, and at rents varying from 4s. 6d. to lis. per week respectively; 1—6, Beadman Street, West Norwood, and 1—10, Langmead Square, West Norwood.—16 houses containing 107 rooms, in which are housed 209 persons, of whom 140 are over 10 years of age, and at rents varying from 1s, 6d. to 7s. per week respectively; 2, 3, 4, 5, 11, 16, Frazier Street.—6 houses containing 24 rooms, in which are housed 52 persons, of whom 28 are over 10 years of age, and at rents varying from 3s. 9d. to 6s. 6d. per week respectively; 8—52, Pitman Street.—23 houses containing 116 rooms, in which are housed families consisting of 221 persons, of whom 141 are over 10 years of age, and at rents varying from 2s. 6d. to 10s. per week respectively; 113 12—14, 16—22, 25—38, Murphy Street.—24 houses containing 88 rooms, in which are housed 189 persons, of whom 117 are over 10 years of age, and at rents varying from 2s. 6d. to 5s. 6d. per week respectively; 2—6, 10, 18—22, 86—108, 112—134, 152—172,176— 200, 206—208, 214—218, 107—109, 115—139, 143—147, Farmer's Road.—78 houses containing 429 rooms, in which are housed 685 persons, of whom 472 are 10 years of age and over, and at rents varying from 2s. to 8s. per week respectively. The Vestry have, therefore, during the year 1898, selected for registration a total of 258 houses containing 1513 rooms, in which are housed 2495 persons, of whom 1623 are over 10 years of age. During 1897, there were selected 93 houses containing 566 rooms, with 992 persons. The amount of work involved in measuring up and cubing all the different 1513 rooms and making a detailed sanitary inspection (with testing of drains) of each separate house will readily be admitted, and much good will accrue from registering these houses. The Vestry, in having appointed an extra Inspector, are enabling this extra work to be carried out more systematically and satisfactorily, and good results are expected to accrue—there being no doubt but that houses which are registered, and therefore more frequently and regularly inspected, are in much better condition than are those which are not so registered, at least in respect of cleanliness and overcrowding. II 114 HOUSING OF THE WORKING CLASSES ACT, 1890. 45 houses were represented to the Vestry by the Medical Officer of Health, under Part II. of the Housing of the Working Classes Act, during the year 1898, as being unfit for human habitation, on account of the premises being dirty, damp, dilapidated, defective in drains and sanitary appliances, deficient in light and ventilation, generally worn out, etc. Details are to be found on pp. 116-137. Records of action taken under this Act in Lambeth Parish shew that:— 6 houses were condemned in 1893. 39 „ „ „ „ 1894. 16 „ „ „ „ 1895. 96 „ „ „ „ 1896. 40 „ „ „ „ 1897. 45 „ „ „ „ 1898. The policy adopted has been the same as in previous years, viz. : only to represent under this particular Act premises which are too insanitary or dilapidated to be dealt with by the service of ordinary Notices under the Public Health (London) Act, 1891. In very many instances this latter Act has accomplished all that was required, so that only in comparatively few cases (45) has it been, fortunately, found necessary to take proceedings under the former and most stringent Act. To realise fully the work that has been accomplished during the year in bringing up to a better state of sanitation and more habitable condition the houses of the working classes and of others, reference must also be made to the Tables given on pp. 85—88, which are to be read in conjunction with the details given under the present heading. 115 The Vestry has, during the year, emphasised the importance of displaced tenants being re-housed—more especially in connection with improvement and extension schemes of Railway Companies, by endeavouring to insist upon the insertion of clauses in Private Bills, requiring the said Companies to give definite agreements to provide dwellings for the full number of persons displaced. The Act allows the Secretary of State for the Home Department the right to waive or enforce the condition with respect to providing accommodation for working classes before the occupants are displaced—an unwise provision, as it has proved, hitherto, in Lambeth and elsewhere. It is agreed that these improvement and extension schemes are needed from time to time, and prove highly beneficial from a sanitary and health point of view—old property being removed, but it is a most serious consideration as to whether a Local Authority is justified in allowing such displacements of tenants, without supplying an equal amount of accommodation, of a class into which the displaced tenants will move, to live under much better sanitary conditions. It is customary, when accommodation is supplied, for such buildings to be in the form of Artizans' Dwellings, in which are to be found, as the name implies, artizans in regular work, but never the poor, who are chiefly displaced by improvement schemes. The open space in Lambeth Walk* has not yet been taken over by the Vestry, who have, however, rescinded on March 10th, 1898, a previous resolution (passed on Nov. 11th, 1897) in which they declined to entertain its purchase as an open space. The matter still remains in statu * Consisting of Fountain, Francis, and Paved Courts, and covering about a quarter of an acre. H 2 116 117 Housing of the Working Classes Act. DETAILS OF 45 HOUSES CONDEMNED IN LAMBETH DURING 1898. Date of representation of M.O.H. to, and of resolution of, Sanitary Authority. Address of Premises. No. of Houses. Date of Service of Notices. Result. Remarks. 1898. Jan 20th. Rose Cottage Laundry, 71, Gipsy Road 1 1898. jan. 24th. Closed voluntarily. Dirty, damp, dilapidated, and drains defective. Jan. 20th. 83, Walcot Square 1 No notice served. Rendered fit. Jan. 20th. i½a, Sail Street 1 Jan. 24th. Rendered fit. Feb. 3rd. 6, Webber Street 1 March 8th Closed voluntarily. Dirty, damp, dilapidated, and drains and sanitary appliances defective, and generally worn out. Feb. 3rd. 8, Webber Street 1 March 8th Closed voluntarily. Feb. 3rd. 10, Webber Street 1 March 8th Rendered fit. Feb. 3rd. 12, Webber Street 1 March 8th Rendered fit. March 3rd. 14, Webber Street 1 March 8th Rendered fit. March 3rd. 16, Webber Street 1 March 8th Rendered fit. March 3rd. 18, Webber Street 1 March 8th Rendered fit. Feb. 3rd. 133, Waterloo Road 1 March 8th Rendered fit. Feb. 3rd. 135, Waterloo Road 1 March 8th Rendered fit. Dirty, damp, dilapidated, and sanitary appliances and drains defective. Feb. 3rd. 137, Waterloo Road 1 March 8th Rendered fit. Feb. 3rd. 139, Waterloo Road 1 March 8th Rendered fit. March 3rd 19, Caffyn Street 1 March 8th Closed voluntarily. Premises without light or through ventilation, dirty,and with defective sanitary appliances and arrangements. March 3rd. 20, Caffyn Street 1 March 8th Closed voluntarily. Dec. 8th. 1—35, Pascal Street, Wandsworth Road 18 1899. Jan. 2nd. Dirty, damp, dilapidated, and generally worn out. Dec. 8th. 1—11, Portland Cottages, Hemans Street, Wandsworth Road ii Jan. 2nd. Rendered fit (in progress). 118 quo (vide Annual Report, 1897, p. 102), and it is to be hoped that during the coming year a satisfactory arrangement may be come to with the London County Council, by which the site (small though it be) may be secured for the inhabitants of that congested and poor area of the Parish for all time as an open space or playground for children who would, thereby, be drawn from the crowded streets of that particularly congested district. In the case of the 45 houses in connection with which action was taken under the Housing of the Working Classes Act, voluntary arrangements were come to with the owners concerned, and it is satisfactory to mention that in no single instance was there any necessity to resort to the Magistrate. CUSTOMS AND INLAND REVENUE ACTS. During 1898, Certificates in connection with 131 tenements have been applied for, and of these 113 have been granted unconditionally; 18 have been granted conditionally; and none have been refused. A. Certificates granted unconditionally. Blocks or Houses. Tenements. 1. Russell Gardens, Stangate Street, t—96 2 96 2. Belvedere Road, 64, 66 2 9 3. St. James' Mansions, Kennington Road 1 8 B Certificates granted conditionally. 1. Heyford Avenue, 4, 6, 33, 35, 37, 39 6 18 119 MORTUARIES AND CORONERS' COURTS. The total number of bodies received at the two Mortuaries (High Street and Wanless Road) during 1898, was 495, as compared with 400 during 1897, and 373 during 1896. Of the 495 bodies, 365 were received at High Street and 130 at Wanless Road, shewing the need of this second Mortuary for the Parish. 31 bodies were brought in by the Police (19 to High Street and 12 to Wanless Road), and the rest by Undertakers. 275 Post-Mortems were conducted (194 at High Street and 81 at Wanless Road) as compared with 281 during 1897, and 253 during 1896. The Coroners' Court sat 127 times at Wanless Road, and 116 times at High Street. Bodies, dead from infectious disease (diphtheria), were received at both Mortuaries—one at High Street, and four at Wanless Road. The latter Mortuary is provided with a separate infectious room, but the former is, unfortunately, not so provided. 120 Registered Ages of Bodies. 1898. High Street. Wanless Road. Total 1898. Total 1897. Total 1896. 0-l 108 52 160 101 121 1-5 43 7 50 39 22 5-10 15 2 17 9 12 10-20 5 3 8 18 9 20-30 21 5 26 26 24 30-40 38 7 45 35 35 40-50 49 15 64 48 37 50-60 24 18 42 59 46 60-70 29 10 39 30 35 70-80 25 7 32 20 22 80-90 1 4 5 9 7 90-upwards 1 — 1 — 3 Age not stated 6 — 6 6 — Totals 365 130 495 400 373 121 Particulars as to bodies received at the Lambeth Mortuaries during 1896-98. 1898 January. February. March. April. May. | June. July. August. September. October. November. December. Total 1898. Total 1897. Total 1896. High Street. Males 16 19 21 19 18 15 24 18 15 18 18 21 222 218 221 Females 9 14 9 12 12 11 14 11 11 6 10 21 143 109 152 Wanless Road. Males 6 8 6 7 6 4 3 6 9 7 7 3 72 41 — Females 6 3 8 3 3 2 1 8 6 5 9 4 58 32 — Totals 37 44 44 41 39 32 42 43 44 36 44 49 495 400 373 N.B.—Wanless Road Mortuary was opened on April 12th, 1897, and is under the control of Mr. Joshua Fazey—High Street Mortuary being under Mr. T.angston. Mr. Morris is Deputy Mortuary Keeper. 122 Particulars as to cases of Drowning, accidental death, and Suicide, during 1896-98 High Street. Wanless Road. Total 1898. Total 1897. Total 1896. M. F. M. F. M F. M" F. M. F. Drowning 1 — 1 — — — 1 — 10 3 14 2 Suicides 7 3 10 — — — 7 3 6 1 12 1 Poisoning 1 — 1 1 1 2 2 1 2 2 3 1 Hanging 3 2 5 3 1 4 6 3 — — 2 — Throat cutting 2 1 3 1 1 2 3 2 1 — 2 — Jumping off heights — — — — — — — — — — 2 — Shooting 1 — 1 3 — 3 4 — 1 — 3 — Railway Accidents 1 — 1 — — — 1 — 1 — 3 — Accidental death 4 1 5 4 3 7 8 4 — — — — Street Accidents 5 — 5 1 1 2 6 1 1 — 3 — Murder (Shooting) 1 1 — 2 Burning — 1 1 — 2 2 — 3 1 — — — Falling from heights 3 3 1 — 1 4 — 4 — — — Bicycle Accidents — — — 1 — 1 1 — — — — — Strangulation and Suffocation — — — 1 1 2 1 1 — — — — 4 bodies dead from diphtheria (1 male and 3 females), were admitted into the infectious Mortuary at Wanless Road, and 1 (diphtheria) was taken to High Street (where, unfortunately, no separate infectious Mortuary exists,) 123 INQUESTS. During the year 1898, 586 cases were submitted to the Coroner who, in 84 instances, decided that no further inquiries were necessary; but, in the other 502 cases, held inquests with the following results:— I. Natural Causes 213 II. Accidental Causes 244 Burns and Scalds 36 Drowning 13 Run over 29 Falls, &c. 43 Suffocation 65 Alcoholism 16 Knocked down by Engine 1 Improper Feeding 1 Gunshot Wounds or Fractures 12 Rupture — Exposure 3 Misadventure 6 Kicked by Horse 1 Injury to Head — Self Neglect — Blood Poisoning 5 Crushed 12 Executed Sucking Phosphorous Matches 1 III. Homicidal Causes 42 Suicide 33 Murder 4 Manslaughter 5 IV. Open Verdicts 3 Found Drowned 3 Found Dead — Total 502 124 UNDERGROUND CONVENIENCES. A new Underground Convenience (for Men only) has been built at Kennington Cross, at a total cost of £1425 12s. 8d., and was opened to the Public on September 5th, 1898. Two new permanent male attendants and a temporary relief male attendant (for Brixton Convenience) have been appointed, making a total of 15 employes, who are now engaged as follows:— Vauxhall. Males (only) A. Becke & W. Holbrook. Hercules. Males W. Lockyer & J. Moody. Females Miss E. Davis & Mrs. E. Luckett. Kennington Cross. Males (only) F. Rodda & W. H. Bennett. Brixton Oval. Males C. Lester & F. Parsons. Females Mrs. C. Carrett & Mrs. C. Carter. The Relief woman for Brixton and Hercules (females) is Mrs. C. Kimber, whilst G. Cooper is permanent relief man for Vauxhall, Hercules, and Kennington Cross—William Baker acting as temporary relief man for Brixton (twice a week and every third Sunday). The permanent attendants work 6 days a week. W. Holbrook and G. Taylor were appointed permanent attendants, and G. Cooper the temporary relief attendant for Brixton. Taylor left after a few weeks, and his place was taken by G. Cooper, William Baker being elected as temporary relief attendant in Cooper's place. 125 UNDERGROUND CONVENIENCES. The following is a Statement of the Receipts and Expenditure in respect of the four Underground Conveniences, for the year ending 31st December, 1898:— Receipts. Expenditure. Wages. Gas. Water. Rates, Cleaning Materials, Toilet Papers and Repairs. Uniforms. First Cost (propn.) Alterations, (propn.) Total. £ s. d. £ s. d. £ s. d. £ d. e s. c d. e s. d. £ s. d. e s. d. £ s d. Vauxhall. Men only—3 paying, 1 free closet 176 19 4 172 7 711 9 8 31 18 10 23 5 8 7 17 6 49 0 5 ... 297 19 8 Hercules. Male side—4 paying, I free closet £241 10 0 Female side—3 paying, 1 free closet 180 0 7 421 10 7 301 3 6 38 5 2 66 16 7 30 16 9 15 7 6 120 19 9 573 9 3 Male side—3 paying, 1 free closet 341 0 7 Female side—3 paying 1 free closet 159 15 4 400 15 11 301 3 53 4 1 8 165 2 6 36 19 10 15 7 6 152 7 111 2 8 2 717 11 0 *kenningon cross. Men only—3 paying, 1 free closet 35 7 7 52 8 10 5 li 6 5 8 10 12 19 9 5 5 3 101 6 8 183 0 10 103 4 13 5 827 3 49 1 8 0 269 6 9 04 2 0 43 17 9 423 14 91 2 8 21 772 0 9 * Opened 5th September, 1898. 126 SLAUGHTER-HOUSES. There were, at the end of 1897, 46 registered Slaughterhouses, but during the past year one (109, Dorset Road) has been closed, leaving 45 which came up for Registration before the London County Council, on October 24th and November 28th, 1898. A new application was received during the year in respect of 65, Brixton Road, but the premises being unfit,* the application was opposed by the Vestry, and refused by the Council. LIST OF REGISTERED SLAUGHTER-HOUSES IN LAMBETH. Marsh Ward 113, Lower Marsh. „ 106, „ „ 124, „ „ 99 „ Bishop's Ward 38, Walnut Tree Walk. „ 172, Lambeth Walk. „ 151, „ „ 7, „ „ 165, „ Prince's Ward 406, Kennington Road. „ 6o, Kennington Park Road. „ 171, Lower Kennington Lane. „ 158, Newington Butts. „ 4, Clapham Road. 36, „ Vauxhall, Ward 53, South Island Place. „ 369, Wandsworth Road. „ 302, Clapham Road. 152, „ „ 18, Paradise Road (rear of). „ 1, Lansdowne Road. Stockwell Ward 97, Stockwell Road. „ +74, „ „ 27, Bedford Road. Brixton Ward 58, Coldharbour Lane. „ Near Railway Hotel Brewery (Electric Lane) * Premises are of wood, paving is bad, and drains are defective. There is no pound. + Opposed by the Council and the license refused. 127 Brixton Ward 12, Vassall Road. „ 263, Brixton Road. „ 136, Wyndham Road. „ 10, Foxley Road. „ Industry Terrace (yard leading to) Tulse Hill Ward 45, New Park Road. „ 16, „ (rear of). „ 12, Lower Tulse Hill. „ 309, Coldharbour Lane. „ 207, ,, „ 77, Dulwich Road. Norwood Ward 120, High Street. „ 121, „ (rear of). „ 66, Knight's Hill Road. „ 125, Hamilton Road. „ 32, Chapel Road. „ 116, High Street. „ 107, Hamilton Road (east side of). „ Ernest Street and High Street (rear of). The above 45 Slaughter-houses have been inspected during the year and defects (when found) remedied—the test being applied in each case to the drains. The necessity for frequent inspection of these Slaughter-houses is shewn by the following list of defects that were found:— Defective Drains 7 Defective Traps 1 Defective Paving 5 Defective w.c. 1 Defective Ventilation to w.c. 1 Defective Cement Plinth 1 Drains Stopped 1 No proper Manure Pit or Cage 8 No Blood or Offal Receptacles 2 Pigs kept so as to be a nuisance on premises adjoining 1 All the Slaughter-houses are retail, with the exception of two (which are both retail and wholesale), and the estimated weekly number of animals killed in Lambeth private Slauphter-houses are as follows :— Cattle 53 Sheep 768 Pigs 68 Total 889 Calves occasionally. 128 The private Slaughter-houses of Lambeth Parish are in a satisfactory condition, and under constant supervision by the Officers, not only of the Vestry, but also of the London County Council. It is unquestionable that meat inspection would be much more easily and more efficiently carried out by the institution of Public Abattoirs (and the subsequent closure of all private Slaughter-houses), but it is another question as to whether such an expensive change would be warranted. It would be possible to keep the private Slaughter-houses (which are in Lambeth in a fairly sanitary condition) under proper supervision by the appointment of a large number of meat inspectors—an alternative much less costly than the wholesale abolition of all the private Slaughter-houses,and requiring, therefore,careful consideration at the hands of the Vestry, who would do well to attempt to deal for the present with more pressing reforms—whether in connection with the spread of tuberculosis, e.g., through other channels (milk), or in connection with other matters. A complete register has been made during the year of the Slaughter-houses, with full particulars under the subjoined headings :— PARISH OF LAMBETH. Slaughter-house No Ward Date of Inspection for this Registration Name of Inspector Address of Slaughter-house Name and Address of Occupier Name and Address of Owner Wholesale or Retail Slaughter-house What kind and number (average) of Animals killed weekly Cattle Sheep Pigs If Pigs, is there a Scalding Pot or Copper with Flue and Fireplace 129 Slaughter-house: — Material (e.g., brick, wood, iron, etc.) Inner Walls:— Hard, smooth, impervious to what height Material of which made How often per year cleansed and whitewashed How often per week washed Roof:— Shape and height Floor:— Material of which made How drained Is there trapped gully or drain inlet inside Is the gully grating fixed Position:— In crowded locality Near to dwellings Distance from nearest dwelling-house Can Slaughtering be seen from street or houses Paving outside Slaughter-house:— Material Impervious or not Is it levelled to properly trapped gully Is gully grating fixed Size of meshes of grating Drainage:— Outside or Inside Intercepted or not Are there manholes Well ventilated or not Result of test Have drains been re-constructed (with date)— Totally Partially Gully Gratings or Drain Inlets—Inside or outside Fixed or loose Distance apart of bars or holes Sanitary Conveniences:— Nature and position Is there separate flushing tank to each w.c. or urinal Is any w.c., urinal, etc., beside, or in direct or indirect communication with, Slaughterhouse I 130 Manure Pit or Cage:— Material (impervious or not) and position Distance from Slaughter-house Is it covered, drained, and ventilated How often is manure removed Is pit below level of ground Vessels for Offal, Blood, etc.:— Nature of vessels used State as to cleanliness How often cleansed Covered or not Are there duplicate sets Water Supply:— Kind (constant or intermittent) and position Cisterns or other receptacles—Materials Capacities Are overflow pipes disconnected Are they properly constructed, covered, get-at-able Heights above ground floor How often cleansed Ventilation:— General condition Cross, or roof and side, louvred openings Lighting:— General condition Are there windows or other openings in Slaughter-house Openings or Windows— Numbers and positions Whether or not made to open and shut Is there a separate blood house Is there a separate fasting pen or pound If so, Size Material of floors and walls Ventilation Drainage Means of watering animals Is room or loft over Slaughter-house Are dogs, fowls, swine, etc., kept on premises If so, how near to Slaughter-house. Were premises originally constructed for Slaughter-house How far is Slaughter-house separate from stables Is Slaughter-house approached through shop or dwelling-house Is Slaughter-house below ground level Are any offensive accumulations near to Slaughter-house I 2 131 How often are offensive matters removed General condition as to cleanliness 1. Of premises How often cleansed 2. Of utensils How often cleansed COWHOUSES. There were in 1897, 29 registered Cowhouses in Lambeth Parish, and of these two have since become empty, viz., 167, Railway Arch, Sail Street, and Clayland's Dairy, Ashmore Place. During 1898, 27 applications have been received for renewal of licenses, and granted by the London County Council on October 24th and November 28th, 1898, as follows:— LIST OF REGISTERED COWHOUSES IN LAMBETH. Ward. No. of Sheds. No. of Cows kept. Marsh 6, Coral Street, Lower Marsh 1 10 Bishop's Cambria Cottage, Tracey Street 1 13 „ 71, Ethelred Street 1 7 „ 24, Distin Street 2 9 Prince's 30, Upper Kennington Lane 1 7 Vauxhall 38, Hartington Road 1 22 „ 9, Dawlish Street 1 12 Stockwell 8, Moat Place 1 7 „ 34, Ingleton Street 1 5 Brixton 324, Camberwell New Rd. (rear of) I 3 „ Vassall Mews 1 8 „ 1, Elliot Road 2 9 Tulse Hill 7, Mill Lane, Brixton 1 2 „ 67, Coldharbour Lane 1 7 „ 1, Lutheran Place, Upper Tulse 2 34 Hill „ 56, Railton Road 1 5 „ 329, Coldharbour Lane 1 8 „ 26, Somers Road 1 18 Carried forward 21 186 132 Brought forward 21 186 Norwood 156, Hamilton Road 3 26 „ 76 and 78, Gipsy Hill 3 27 „ 67, Rosendale Road 1 10 „ 93, Clive Road 1 4 „ 196, Norwood Road 1 20 „ 40, Gipsy Road 1 5 „ Elder Road, West Norwood 3 35 „ Railway Arch, East Street 1 13 „ 1, Change Alley, West Norwood 1 11 36 337 The above 27 Cowhouses have been inspected carefully during the year, and the following sanitary defects discovered, and since remedied:— Defective Paving 3 Dirty Premises 5 Foul Accumulation 1 Defective Drain 1 Defective W.C. 1 Blocked Drain 1 Rain-water Pipe direct 1 Overcrowding 1 Blocked Drain 1 Defective Water Supply to W.C. 1 Defective Gullies 2 Defective Grain Pit 2 Defective Ventilating Pipe 1 Deficient Ventilation of Drain 1 In 13 of the Cowhouses no sanitary defects were discovered, whilst the general condition of the premises in all the Cowsheds was found to be satisfactory. It will be noted that, though the drains were tested in each case, in only one was there a result, which was due to defective connection between the gully and drain. BAKEHOUSES. One new Bakehouse has been registered during the year, making a total of 248 known Bakehouses in the Parish of Lambeth These Bakehouses have all been inspected and found to be in a satisfactory condition. 133 The newly-registered Bakehouse (28, Barnfield Road) is above ground, and, on inspection, shewed the following sanitary defects:—premises dirty, defective soil pipe, defective w.c. pan, defective drain (which is unventilated and not disconnected from the sewer), water cistern dirty and uncovered, and no tap from rising main (there being no constant service, however, in the District). LIST OF BAKEHOUSES IN LAMBETH. MARSH WARD:— Cornwall road, 14, 64, 73, 78 Doon street, 22 Duke street, 14 Lower Marsh, 14, 20, 43, 49, 139 New Cut, 44, 81 Oakley street, 26, 70 Roupell street, 62 Westminster Bridge road, 120 Waterloo road, 59, 102 York road, 102 BISHOP'S WARD:— Broad street, 13 Brook street, 106 China walk, 16 Crozier street, 12 Ethelred street, 107 Hercules road, 4, 66 Lambeth road, 81 Lambeth walk, 17, 71, 82, 115, 121, 126, 148, 154, 191, 204 Lollard street, 124 Monckton street, 2 North street, 27 Prince's road, 101, 152 Saville place, 19 Stangate street, 32 Tracey street, 22 Upper Marsh, 18 Walcot Square, 85 (late 28) Walnut Tree walk, 43 Westminster Bridge road, 189, 219 PRINCE'S WARD:- Auckland street, 1 Bonnington square, 13 Church street, 10, 25 Clapham road, 24 Cleaver street, 12 Glasshouse street, 60 Goding street, 1 Hurley road, 17 Kennington Park road, 40, 98, 202 Kennington road, 334 Lower Kennington lane, 32, 84, 122, 177 Newburn street, 20 Newington butts, 150 Prince's road, 19 Stannary street, 39 Trigon road, 46 Tyer's street, 49 Upper Kennington lane, 19,70,107, 159, 199 Vauxhall street, 36, 86, 115, 126 Vauxhall walk, 184, 79, 123 White Hart street, 24, 58 Windmill row, 10 VAUXHALL WARD:- Clapham road, 226, 264, 324, 360 Dorset road, 55, 129 Hartington road, 42, 58, 88, 129 Larkhall lane, 63, 98 Lansdowne road, 74 Portland place south, 20 Paradise road, 30 South Lambeth road, 28, 108, 158, 175, 184 Wandsworth road, 51,181,227,230, 259, 283 Wilcox road, 29, 44, 3 134 STOCKWELL WARD:- Acre lane, 120, 144 Bedford road, 29 Brixton road, 56, 66a (late 78), 274, 468 Clapham road, 93, 247 Dalyell road, 46 Dorrell place, 11 Ferndale road, 118, 185 (late 1, Shepherd's lane) Holland street, 22 Kepler road, 14 Lingham street, 76, 39 Landor road, 80, 99, 147 Russell street, 17 Santley street, 13 Stockwell road, 63, 143, 150, 170 Sydney road, 26 Tasman road, 52 BRIXTON WARD:- Akerman road, 45 Atlantic road, 40 Beresford street, 271 Brixton road, 37, 231, 267, 407, 447 Camberwell New road, 167 Coldharbour lane, 76, 240, 326, 386 Cumberland place, 6 Denmark street, 25 Farmer's road, 127 Frederick terrace, 7 Garden grove, 9 Holland road, 1 Langton road, 30 Lothian road, 100 Loughborough road, 73, 76 Normandy place, 8 St. Mark's road, 1 Treherne road, 12 Vassall road, 54, 75 Warham street (late Thomas street), 44, 81 Wyndham road, 140 TULSE HILL WARD:- Acre lane, 115 Atlantic road, 65, 74 Barnwell road, 91 Brixton hill, 72, 154, 232 Coldharbour lane, 203, 223, 307, 319, 439 Cornwall road, 32, 76, 146 Denmark hill, 120 Dulwich road, 67 Effra parade, 11 Elm park, 58 Hinton road, 51 Hurst street, 28 Kemerton road, 7 Lyham road, 159 Milkwood road, 6, 69 New Park road, 59 Probert road, 1 Railton road, 13,45,64, 78, 111, 205, 311 Shakespeare road, 84 Somer's road, 27 Sussex road, 75 Tulse hill, 5, 25, 182 UpperTulsehill (TheExchange),3 Water lane, 25, 87 NORWOOD WARD:- Approach road, 6 Barnfield road, 28 Chapel road, 2 Eden road, 7 Elder road, 1a Gipsy bill, 53, 130, 190 Gipsy road, 105, 193, 253 Hamilton road, 134 High street,34, (rear of)87,94,63 Knight's hill, 26, 49, 58, 190 Norwood road, 90, 202, 222, 427 Rommany road, 191 Westow hill, 33 Wood street, 5 135 WORKSHOPS. 134 Workshops have been added to the Register during the year 1898, consisting of the following:- Nature of Trade Nature of Trade or Business. No. of Workshops. or Business. No. of Workshops. Dress Making 33 Brought forward 109 Tailor and Clothiers 7 Clothing Contractor 1 Laundries 40 Brush Makers 2 Milliners 3 Tie Makers 3 Boot Makers 5 Paper Bag Makers 2 Builders 2 Leather Bag Maker 1 Mantle Maker 1 Gunsmith 1 Blacksmith 1 Sculptor 1 Cycle Maker 4 Wood Turner 1 Wheelwrights 3 Photo Engravers 2 Harness Maker 1 Picture Frame Makers 2 Carriage Builder 1 Ironmonger 1 Cooper 1 Surgical Instrument Make 1 Costumiers 4 Automatic Machine Maker 1 Wire Maker 1 Sundry other Trades 6 Hook and Eye Makers 1 Blind Manufacturer 1 Total 134 Carried forward 109 The total number of known Workshops within the Parish of Lambeth is 634, all of which have now been inspected, and the different work-rooms measured up and plans drawn in connection therewith, shewing cubic capacity (width, height and length) and general shape. A card (as required) has been hung up in each separate workroom, stating the exact number of persons to be employed therein at any one time in (a) ordinary work and (b) overtime. The results have been tabulated of the inspections of these 134 new workshops (inspected during 1898) containing 265 rooms, in which were working at the time of inspection 736 persons, 253 males and 483 females (females alone being employed in 81 workshops). Further, 1 was 136 a child under 14 years of age (male), 64 were young persons, i.e., between 14 and 18 years of age (19 males and 45 females), and the rest adults (233 males and 438 females); and of the so-called "protected persons" (i.e., children, young persons, and women), the Medical Officer of Health has given written notice to the Factory Inspectors as required by Section 27 of the Public Health (London) Act, 1891, and Section 3 of the Factory and Workshops Act, 1891, from time to time, as he became aware of such being employed. The Vestry of Lambeth, as the Sanitary Authority, has received 60 notices of occupation of Workshops from the Factory Inspectors, during 1898, as compared with 31 during 1897, and 29 during 1896. Twenty-seven written notices have been received from the Factory Inspectors with reference to contravention of the Public Health Acts in connection with Factories or Workshops (vide Section 4, Factory and Workshops Act, 1878), and all such nuisances have been abated, and due notice sent to the Factory Inspectors within one month as to action taken in each case. In 1897, 25, and in 1896, 66 such notices were received. In connection with the 134 new Workshops, the following insanitary conditions were met with at the time of the Inspections:— 1. As to Ventilation, and Warming and Lighting. In 7 out of 134 workshops (i.e., 5.2 per cent. was the ventilation unsatisfactory, and in 6 (4.4 per cent.) were the workrooms, at the time of the inspections, found to be not reasonably warmed. Cross or roof ventilation (or both) was in use, and the methods of warming were by open fire-places, open or closed stoves, gas jets, etc. 137 2. As to Cleanliness. In 24 workshops (i.e., 179 per cent.) the workrooms were dirty and had to be cleansed. 3. As to Drainage and Sanitary Appliances. The drains were in each case tested with chemical, and in 32 (i.e., 23.9 per cent.) were shown to be defective, requiring partial or total reconstruction, whilst in 31 (i.e., 23.1 per cent.) the sanitary fittings and appliances were bad. The W.C.s were outside in 44.8 percent., inside in 28.3 per cent., outside and inside in 24.6 per cent., whilst in 3 cases (i.e., 2.2 per cent.) there were no W.C.s provided at all. Separate closet accommodation for the sexes was wanting in 7 cases (i.e., 5.2 per cent.). The soil pipes were found to be unventilated in 29 cases (i.e., 2.6 per cent.), a condition of things which may, or may not, be a nuisance; and in 8 cases (i.e., 6 per cent.) there was found to be direct communication between the W.C.s and workrooms. 4. As to Dampness. In 6 Workshops (i.e., 4.5 per cent.), the workrooms were found on inspection to be damp, and to such an extent as to call for attention by the Inspector. 5. As to Overcrowding. The cubic capacities of the different workrooms were found to vary considerably, and in 13 out of 265 workrooms (i.e., 4.9 per cent.) overcrowding was found to exist, though the overcrowding was limited to 1, 2 or 3 persons in excess per workroom, as will be found on reference to the accompanying Table III. 138 6. As to special Lavatory and Urinal Accommodation. In very few instances was this special sanitary accommodation found to exist, though its absence can hardly be described as a nuisance, calling for the attention of the Inspector. The above defects have been or are being put right, and in no case was it necessary to resort to Magisterial proceedings. The question as to the advisability of appointing a Female Sanitary Inspector was adjourned for six months by the Vestry at their Meeting, held on April 28th, 1898. Nothing further is to be added to the arguments in favour of such an appointment for Lambeth (vide Annual Report, 1897, pp. 141—142), with the exception that the 134 new workshops shew 483 additional women and girls employed, and of these 360 are employed alone in workshops. 139 I.—WORKSHOPS:—Number of Rooms and Persons employed. Districts, and Inspectors in charge thereof. No. of Workshops No. of Workrooms Children. Young Persons. Adults. TOTALS. M. F. M. F. M. F. M. F. Total. Marsh Jackson 3 7 ... ... 1 ... 2 25 3 25 28 Wallis 9 15 ... ... ... 2 30 24 30 26 56 Bishop's Hooper 13 15 ... ... 1 3 47 16 48 19 67 Prince's Jones 7 19 ... ... 1 8 8 38 9 46 55 Vauxhall Stockwell Eowden 5 9 ... ... ... 1 10 1 10 2 12 Baxter 16 19 ... ... 1 5 11 25 12 30 42 Perrin 11 26 1 ... l 3 23 43 25 46 71 Brixton Gavin 20 45 ... ... ... 5 9 81 9 86 95 Bott 8 10 ... ... ... 13 7 20 7 33 40 Tulse Hill Smith 10 16 ... ... l 3 2 38 3 41 44 Norwood Barfoot 32 84 ... ... 13 2 84 127 97 129 226 134 265 1 ... 19 45 233 438 253 483 736 140 141 II.—WORKSHOPS:—Details as to Sanitary Conditions and Defects found. Details as to Sanitary Conditions and Defects found. Districts, and the Inspectors in charge thereof. Totals. Marsh. Bishop's Hooper. Prince's. Jones. Vauxhall and Stockwell. Brixton. Tulse Hill. Smith. Norwood. Barfoot Jackson. Wallis. Bowden. Baxter. Perrin. Gavin. Bott. Ventilation satisfactory 3 8 12 7 5 16 11 19 8 10 28 127 not ... 1 1 ... ... ... ... 1 ... ... 4 7 Cleanliness satisfactory 2 8 10 7 5 14 11 15 7 7 24 110 not 1 1 3 ... ... 2 ... 5 1 3 8 24 Workrooms damp ... ... 1 ... ... ... ... ... ... ... 5 6 not 3 9 12 7 5 16 11 20 8 10 27 128 Workrooms warm 3 9 13 7 5 16 11 20 8 10 29 131 not ... ... ... ... ... ... ... ... ... ... 3 3 Result of testing of drains no result 3 8 11 6 5 11 9 20 6 5 18 102 defects found ... 1 2 1 ... 5 2 ... 2 5 14 32 State of sanitary fittings, &c. good 3 7 10 6 4 11 9 18 5 9 21 103 bad ... 2 3 1 1 5 2 2 3 1 11 31 Soil pipe ventilated 1 2 4 ... 1 7 7 6 4 1 9 42 not ventilated 2 1 2 2 3 6 2 1 3 5 2 29 no soil pipe ... 6 7 5 1 3 2 13 1 4 21 63 Position of W.C. outside 2 5 7 4 3 3 7 9 3 4 13 60 inside ... 3 3 3 1 6 1 5 1 3 12 38 outside & inside 1 1 2 ... ... 7 3 5 4 3 7 33 No W.C. ... ... 1 ... 1 ... ... 1 ... ... ... 3 Separate W.C. accommodation (where required) Yes 3 9 13 6 4 16 11 20 6 10 29 127 No ... ... ... 1 1 ... ... ... 2 ... 3 7 Communication (direct) between W.C.'s & rooms Yes ... ... 2 ... ... ... 1 ... ... 1 4 8 No 3 9 11 7 5 16 10 20 8 9 28 126 142 III.—WORKSHOPS.—Full details as to overcrowding found. Nature of Workshop. No. of Workrooms overcrowded. No. of Employes at time of Inspection. No. of Employes allowed. Extent of Overcrowding (in persons). Male. Female. Total. Bootmakers 2 7 ... 7 4 1, 2. Dressmakers 3 ... 15 15 12 1, 1, 1, Tailors 1 2 6 8 7 1 Costumier 1 ... 7 7 4 3 Laundry 4 3 20 23 18 1, 2, 1, 1. Seltzogene Bottle Makers 1 ... 4 4 3 1 Photo Engravers 1 8 ... 8 7 1 72 persons (20 males and 52 females) were found to be working in a state of overcrowding—in a cubic space enough for only 55. 143 COMBINED DRAINAGE. The question of combined drainage has engaged the attention of the Vestry during the year, and a definite decision has been arrived at in connection therewith. The Medical Officer brought up on August 4th, 1898, the following report:— A well-established theoretical principle in sanitation, is to keep the drains of houses, as far as possible, outside; and, carrying out this principle in practice, it is clear that combined drainage may, with advantage, be allowed in the case of several houses adjoining, and built together in a terrace or row, under which conditions a main combined drain would be laid at the rear, and into this main combined drain any number of houses separately taken, the drain of each individual house being, where necessary, disconnected by means of a separate intercepting trap and chamber, and separately ventilated. The main combined drain at the rear would discharge into a branch sewer in a side roadway, or be turned into the sewer in the roadway in front of the houses in question, either through an open passage-way between two houses, or at the side of one house—but not through and under one of the houses, unless absolutely necessary, in which rare case the combined main drain must be laid under proper conditions, e.g., with a manhole at the back and front of the house, and the drain itself embedded in concrete, and its joints made absolutely air- and water-tight. When combined drainage is necessary, as in the abovementioned case, the simplest form is for six (or less) houses to be drained together, the main combined drain being intercepted with intercepting chamber, and 144 sufficient means of access (e.g., chambers, inspection pipes, &c.) supplied to every portion of the drainage system, which must be thoroughly ventilated. With more than six houses on the combined system, the main combined drain must be treated as a sewer, and dealt with (as to ventilation, fall, means of access, &c.), accordingly. Finally, where a single house can be drained separately, with the drains outside, a combined system is neither necessary nor advisable; but rather than have a drain under and through each house, it is better to have a combined system, with a main combined drain passing through and under one house (provided no open passage-way is available), thereby minimising in proportion the danger, or chance of accident, from leaky drains and joints due to settlements, &c. To sum up, it is impossible to lay down any hard and fast rule; each plan must be taken and considered on its own merits and approved:— 1. As a Combined System.—If by so doing the drainage scheme is simplified as much as possible, and the drains kept outside, or (a rare necessity) even taken through and under one house, instead of through and under several. 2. With separate drain to each house.—Provided that this can be effected with drains outside. Out of 35 Metropolitan Districts communicated with, only five do not allow or approve of combined drainage—two in connection with new, and three in connection with new or old, buildings. The other 30 Districts allow and approve of combined drainage— (a) Where there is no obvious disadvantage (2 Districts). (b) In certain cases (12 Districts). 145 (c) Under exceptional circumstances (8 Districts). (d) Unconditionally (8 Districts). I have dealt with the subject of combined drainage entirely from a practical sanitation point of view, and without regard to the legal bearings of the question. The Surveyor and Clerk also reported on the subject, and the Vestry decided (on the lines of the Medical Officer's report) as follows: — 1. That combined drainage, where advantageous, shall be approved. 2. That combined drainage shall not be approved where the plan shows that separate drains can be laid outside each house. 3. That combined drainage shall be limited to a maximum of six houses, to drain into one drain, with one interceptor from the main sewer. 4. That in no case where combined drainage is sanctioned shall any part of the combined drain pass under any house, without the special consent of the Vestry. 5. That the passage-way under which the main portion of the combined drain is laid shall be of the minimum width of four feet, such passage-way being open to the sky. 6. That, where the passage-way is more that seven feet wide, such passage-way shall be considered as open to the air, if open at both ends to a minimum height of ten feet. 7. That the owner shall sign an agreement, to the satisfaction of the Clerk to the Vestry, that the passage-way shall never be built upon. 8. That, when it is proposed to drain more than six houses by a combined system, for the maintenance and repair of which the owner or owners are to be liable for all time, a main combined drain shall be placed at the rear K 146 of the houses and treated separately as to ventilation, means of access, &c , and into this back line of drainage each house shall be drained separately (with drains outside), and separately intercepted and ventilated. 9. That in the case of tenement blocks, each self-contained block of flats or tenement dwellings shall be drained separately. Combined drainage in Lambeth in respect of new buildings is now much simplified, and the rules laid down above are working smoothly and well. 147 The Clerical work in connection with the Department during 1898 deserves recognition, and will best be realised in the form of the following statement:— 1898. 1897. 1896. Letters, etc., received (entered in letter book) 8974 8309 7625 *Letters, etc., sent out (entered in postal book) 25892 24821 25980 Notices served Infectious Diseases 2094 2374 2327 Public Health Acts Preliminary 8375 8714 6222 Statutory 2004 2018 1985 Housing of Working Classes Act 44 33 55 Cases entered in Inspector's Report Books 8725 8337 6767 Complaints entered in book 5620 4915 3768 Copies of Infectious Diseases Notifications— (a) Entered in Notification Book 2329 2633 3202 (4) Sent off to Asylums Board ... 2329 2f63 3202 Notices of Infectious Diseases sent to Schools 2094 2663 2576 Workshops (with full particulars) entered up in Register 134 245 255 Cowsheds (with full particulars) entered up in Register - 8 32 Slaughter-houses (with full particulars) entered up in Register 46 - - Bakehouses (with full particulars) entered up in Register 1 247 - Water Certificates for New Dwellings given out 131 215 89 Disinfection Certificates given out 2094 159 109 Stamps used 19151 20141 20925 Reports to Committee (Fortnightly) 21 20 20 Reports to Vestry (Monthly and Quarterly) 17 17 Special Reports 6 12 6 There are 3 clerks—a chief (W. R. Lawrence), a second (A. L. Baxter), and a junior (VV. J. Lawrence)—two of whom are able to type and shorthand write; whilst Inspector Emblin assists also in the clerical work, being engaged chiefly indoors. The telephone placed in the Sanitary Offices has proved of great benefit in saving letters and telegrams in many instances. * 5,052 letters were typed during the year 1898, as compared with 5,538 during 1897, and 4,350 during 1896 (8 months). APPENDIX. 2 3 Death-rates (General and Zymotic) for London and the Metropolitan Distriots during 1898. Metropolitan Districts. Death-rate (corrected). Zymotic Deathrate (corrected). Infantile Mortality Rate. Diarrhoea Rate. Typhoid Fever Rate. Diphtheria Rate. Scarlet Fever Rate. Phthisis Rate. Metropolitan Districts. Death-rate (corrected). Zymotic Deathrate (corrected). Infantile Mortality Rate. Diarrhoea Rate. Typhoid Fever Rate. Diphtheria Rate. Scarlet Fever Rate. Phthisis Rate. Registration London 18.3 2.77 1.66 0.97 0.12 0.39 0.13 1.72 East. Shoreditch 22.3 3.95 196 1.58 0.14 0.36 0.17 2.02 West. Bethnal Green 22.3 3.90 184 1.10 0.13 0.48 0.09 2.17 Whitechapel 20.2 2.10 144 0.78 0 .11 0.25 0.10 2.60 Paddington 16.1 2.41 161 0.65 0.13 0.48 0.06 1.38 St. George-in-the-East 24.8 3.31 195 1.25 0.15 0.29 0.12 2.70 Limehouse 23.8 4.26 208 1.54 0.14 0.44 0.09 2.39 Kensington 16.4 2.02 181 0.64 0.08 0.15 0.14 1.26 Mile End Old Town 19.9 3.51 155 1.27 0.12 0.56 0.07 1.46 Hammersmith 18.3 3.19 183 1.12 0.11 0.21 0.21 1.48 Poplar 21.2 3.72 191 1.40 0.18 0.52 0.13 1.83 Fulham 17.2 3.16 168 1.44 0.14 0.49 0.28 1.47 Chelsea 18.2 2.73 176 0.77 0.15 0.43 0.16 1.74 South. » St. George's, Hanover Square 13.2 1.29 120 0.36 0.11 0.12 0.05 1.31 St. Saviour's 23.6 3.09 211 1.02 0.16 0.61 0.01 3.06 St. Margaret and St. John, Westminster 20.8 3.00 182 0.61 0.06 0.42 0.10 2.63 St. George-the-Martyr, Southwark 24.4 3.99 188 1.64 0.15 0.60 0.33 3.18 St. James', Westminster 18.o 1.51 177 0.41 0.05 0.23 0.09 1.90 Newington 20.5 3.17 173 1.48 0.08 0.59 0.20 2.43 North. St. Olave 20.6 2.31 132 0.44 0.09 0.27 0.09 2.22 Bermondsey 20.7 3.02 157 0.94 0.11 0.51 0.22 2.15 Rotherhithe 19.0 2.24 169 0.52 0.02 0.27 0.25 1.82 St. Marylebone 18.3 2.36 132 0.56 0.16 0.32 0.09 1.79 Lambeth I7'9 2.50 154 0.93 0.12 0.38 0.10 1.67 Hampstead 11.7 1.40 125 0.31 0.13 0.24 0.04 0.74 Battersea 16.9 2.93 166 0.92 0.08 0.70 0.16 1.50 St. Pancras 19.2 2.49 170 0.88 0.17 0.40 0.22 1.99 Wandsworth 14.4 2.40 144 0.82 0.08 0.44 0.08 1.13 Islington 16.6 2.78 159 0.85 0.10 0.26 0.08 1.46 Camberwell 16.4 2.41 160 0.97 0.10 0.33 0.07 1.53 Stoke Newington 13.7 1.56 108 0.78 0.06 0.14 0.03 1.04 Greenwich 18.5 3.08 176 1.23 0.21 0.24 0.12 1.51 Hackney 16.4 2.64 152 0.82 0.19 0.55 0.14 1.39 Lee 14.9 1.97 160 0.76 0.18 0.35 0.18 1.16 Central. Lewisham (excluding Penge) 15.3 2.50 161 1.27 0.07 0.29 0.11 0.88 Woolwich 20.4 4.13 173 1.31 0.19 0.46 0.12 2.08 St. Giles 20.2 1.88 137 0.61 0.13 0.16 0.05 3.34 Plumstead 16.3 2.85 155 0.91 0.05 0.24 0.19 1.48 St. Marlin's-in-theFields 15.5 0.88 156 0.32 0.08 0.24 0.08 1.78 Strand 22.9 1.76 171 0.60 0.17 0.17 0.09 3.32 N.B.—These Returns are taken from the Registrar-General's Annual Summary. A* 2 Holborn 24.9 3.37 221 0.93 0.07 0.73 0.07 3.17 Clerkernwell 21.7 3.75 196 1.43 0.11 0.55 0.20 2.35 St. Luke 25.7 4.04 150 1.54 0.05 0.59 0.37 2.64 City of London 19.1 1.17 128 0.17 0.21 0.34 0.07 1.86 4 Report on TUBERCULOSIS AND ITS PREVENTION. (Adopted by the Vestry, December 8th, 1898.) Tuberculosis (including consumption) is now a recognised infectious disease, due to the entrance into the body from without of a germ (the Tubercle Bacillus), and is acquired either directly from man to man, or indirectly through food (milk and meat). It causes more deaths and more permanent ill-health than all the other infectious diseases put together—over 70,000 persons dying annually in Great Britain alone (and over 600 in Lambeth Parish); whilst very many more are permanently maimed or injured, and their healths ruined thereby. The corrected death-rate from Phthisis in London is 2 per 1,000 of the population; whilst in Lambeth the deathrate from Phthisis is 1.9 per 1,000, and the death-rate from Tubercular diseases generally 2.7 per 1,000, as compared with 3T from the whole of the principal zymotic diseases together. The above rates refer to the decennium 18811890 (the last corrected rates issued by the RegistrarGeneral). To make the matter clearer, I may mention that during the last four years, 1894-1897, there have been registered in Lambeth 2,680 deaths from Tuberculosis, and of these 1,913 were certified as being due to Phthisis or Consumption. Separated into Districts, it appears that the four Inner Wards have suffered more severely than the four Outer Wards (i.e., half as much again), whilst of the four Inner Wards, Waterloo 1st and Waterloo 2nd are the worst—the death-rate from Tuberculosis being 14.8 and 12.9 respectively. The Workhouse helps to increase the rate in Lambeth Church 2nd, whilst Norwood and Brixton suffer the least of all Districts in Lambeth, viz., 5.3 and 7.5 per 1000 respectively, as the following table shows:— 5 Deaths from Phthisis, 1894.7. Deaths from other forms of Tuber., 1894-7. Total. Death-rate per 1000 of Population. Waterloo 1st 54 57 211 14.8 Waterloo 2nd 135 49 184 12.9 Lbth. Church 1st 15 457 211 14.8 Lbth. Church 2nd 321 154 475 11.6 Kennington 1st 334 124 458 8.7 Kennington 2nd 272 105 377 8.7 Brixton 437 175 612 7.5 Norwood 121 32 153 5.3 1913 767 2680 9.1 Tuberculosis in Lambeth causes far more deaths than all the notifiable infectious diseases put together; and, as strict precautions are taken in connection with these latter diseases, why not also in connection with the former disease ? The disease being proved to be infectious and due to a germ, it is of the highest importance that disinfection should be thoroughly carried out, not only in connection with the room, or rooms, recently occupied, but also in connection with their contents (e.g., bedding, curtains, etc.). I am of opinion that such precautions as to disinfection would tend to minimise the dangers associated with this disease, and prevent it spreading to other members of the same family, or to members of another family who might happen to move into the recently infected house or rooms; whilst the educational value of such measures, together with that to be obtained from the issuing of leaflets, must not be forgotten. I beg to offer the following suggestions:—(1) That a circular letter (A) be sent round to all the Medical men in Lambeth, pointing out that the Vestry is prepared to disinfect (free of cost) all rooms (and contents) recently occupied by patients suffering from Tuberculosis, and which have become unoccupied owing to the deaths or removals of such patients, when requested to do so by the Medical men or others in attendance; (2) That a circular letter (B) be sent to the person, or persons, in charge of Public Institutions in Lambeth, pointing out the nature of this disease, and the importance of having disinfection carried 6 out, and other means adopted, for the prevention of this disease spreading to others, and offering disinfection (free of cost) by the Vestry's Officers, where it may be necessary; (3) That a circular letter (C) be sent to the occupiers of those houses in which deaths from Tubercular Disease are reported week by week to the Medical Officer by the Registrar-General, offering disinfection (free of cost) by the Vestry; (4) The issuing of leaflets (pointing out in simple language the danger of the disease and the ready means at hand for its prevention), to Clergymen, District Visitors, School Teachers, etc., as may be necessary (circular letter D). I may add that it is at present the custom of the Sanitary Department to carry out (free of cost) disinfection in connection with Tuberculosis where Medical attendants apply, but the little use that has hitherto been made of such disinfection shows that Medical Attendants and others are unaware either of such methods being at their disposal for that particular disease, or, indeed, of their necessity at all in connection with Tuberculosis. In addition, Tuberculosis has been recently shown to be spread by infected milk and meat (especially by infected milk), but preventive measures in respect of these two sources of infection must be left to Parliament, to legislate for the whole of London and the rest of the Country generally. It is clear that Lambeth could not take action singly, except in the way of looking carefully after the sanitary condition of the cowsheds and slaughter-houses in the Parish—a duty which is at present being systematically carried out by the Vestry, Measures for the more stringent examination of animals before and after slaughter, for the establishment of public abattoirs in place of private slaughter-houses, for the protection of all milk supplies by a systematic bacteriological examination of doubtful samples, etc., belong clearly to a Central Authority, acting for the whole of London. 7 Circular Letter A. Dear Sir, Re Tuberculosis and its Prevention. In a report which has been presented by me to the Sanitary Committee, and adopted by the Vestry, I have pointed out the infectious nature of Tuberculosis (more especially Phthisis or Consumption), and the necessity that exists for the thorough disinfection and cleansing of all rooms (and contents) recently occupied by patients so suffering, and which have been rendered vacant by the deaths or removals of such patients—there being evidence in Lambeth (and elsewhere) of Tuberculosis being spread from person to person by means of such rooms. The Vestry has, accordingly, decided to disinfect, free of cost, all tuberculosis-infected rooms, beddings, carpets, curtains, &c., and I shall be glad if you will kindly inform me, from time to time, of any such rooms or articles that you think require disinfection. I am further instructed by the Vestry to send a letter, pointing out the benefits of disinfection and cleansing, and offering disinfection, free of cost, to the occupiers of houses or rooms in which deaths from Tuberculosis have taken place, as shown by the Registrar's weekly returns; and in this connection I shall be glad of your co-operation in persuading the occupiers to have such disinfection and cleansing carried out. The cleansing with soap and water of all floors and woodwork, the white-washing of ceilings, the stripping off (and burning) of the papers from the walls of infected rooms, the thorough ventilation of all premises, &c., are, I need not remind you, measures of as great importance as disinfection; but such measures must be carried out afterwards by the occupiers or owners. I may add that the Vestry is now in possession of means whereby the sputa of patients may be examined bacteriologically for the presence of the bacilli tuberculosis ; and such examinations will be made by the Vestry for Medical men free of cost, on receiving samples at the Public Health Department, and must prove of the utmost importance and 8 value (whether with a view of curative or preventative measures being taken), by enabling a certain diagnosis to be come to at the earliest possible date. I enclose you a leaflet, which I have drawn up for circulation, pointing out simple preventive measures to be taken with a view of preventing the spread of the disease. These preventive measures are well known to you, and are, doubtlessly, taken already by patients under your care ; but I shall be glad to furnish you with printed copies of the leaflet, if you are of opinion that such would be of use to you, and will kindly let me know. Circular Letter B. Sir or Madam, I am directed by the Vestry of the Parish of Lambeth to inform you that it is now acknowledged by most, if not all, medical men that Tuberculosis (including Consumption or Phthisis) is a disease that is communicable either directly from person to person, or indirectly through infected food (milk and meat). The disease is due to the entrance into the body from without of a germ or microbe (called the tubercle bacillus), and it becomes of the greatest importance that preventive measures should be taken in all cases, including the systematic disinfection and cleansing of all rooms (and contents) recently occupied by invalids suffering from tuberculosis, and which have been rendered vacant by the deaths or removals of such invalids. With this object in view, I am sending you enclosed a copy of the leaflet that I have drawn up for circulation, and I take the liberty of asking you kindly to peruse the same, extra copies of which will be sent to you on application to me, and to note that the Vestry will disinfect, free of cost, all tuberculosis-infected rooms, bedding, carpets, curtains, etc., if you will kindly inform me of any such rooms or articles that you think require, from time to time, disintection. Further, alter disinfection by the Vestry, 1 advise the 9 following extra precautions:—the cleansing with soap and water of all floors and woodwork, the white-washing of ceilings, the stripping-off (and burning) of the papers from the walls, of infected rooms, which must be also thoroughly ventilated. I need not add how important it is to prevent the disease from spreading amongst the inmates of a Public Institution, by the carrying out of the precautions which are mentioned in the leaflet, and which are well known to your medical advisers. I shall be glad to give you such further advice as is in my power, if you wish it, and will kindly let me know. Circular Letter C- Sir or Madam, In connection with the death from Consumption (Phthisis) registered as having occurred at No. I beg to draw your attention to the now-recognised fact that Consumption is a disease communicable from person to person, and is due to the entrance into the body of a germ or microbe, which may be inhaled with the dust of the room or rooms previously occupied by the deceased invalid. These rooms should, therefore, be thoroughly disinfected, and afterwards cleansed, so that all traces of infection (dust or otherwise) may be removed. 1 here will then be no danger either to members of the same family or to others from again occupying the rooms. The Vestry will, free of cost, disinfect the infected room or rooms and their contents (bedding, carpets, curtains, &c.), and afterwards you should have the wall-papers stripped off and burnt in the fireplace of the rooms, the ceilings white-washed, the floors and woodwork scrubbed with soap and water, and the whole house thoroughly ventilated by leaving windows open, and allowing the fresh air to blow freely through. Further, all bed linen 10 (that has been used by the deceased) should be thoroughly washed, and the mattresses, pillows, &c., exposed to the fresh air and sunlight (or ordinary daylight) for several hours. Kindly advise me, on the enclosed post card, when it will be convenient for the Vestry's Officers to call and carry out the necessary disinfection. Circular Letter d. Dear Sir, I am directed by the Vestry of Lambeth to forward you copies of a leaflet which I have drawn up, pointing out the danger of Tuberculosis (more especially Phthisis or Consumption), and the ready means at hand for its prevention. The Vestry is of opinion that you, by virtue of your position, have many opportunities of distributing such leaflets, in the course of your parochial work, and I am taking the liberty of enclosing you half-a-dozen copies, and shall be glad to furnish you with such extra ones as you may require, either for your own use, or for the use of others who may be working with you in connection with district visiting, etc. It is now acknowledged by practically all medical men that the disease is one that is communicable, either directly from person to person, or indirectly through infected food (milk and meat), and is due to the entrance into the body, from without, of a germ or microbe, called the tubercle bacillus. I would add that the Vestry is in possession of means whereby the expectoration of patients may be examined bacteriologically for the presence of the tubercle bacillus, and that such examinations will be made free of cost, on receiving at the Public Health Department (333, Kennington Road) samples from suspected cases of Consumption— the samples to be taken by the medical men in attendance, or where there are no such medical men, by the relatives or friends of the patients. 11 Copy of Leaflet. Consumption and its Prevention. Tuberculosis (including Consumption or Phthisis) causes annually over 70,000 deaths in Great Britain, and over 600 in Lambeth Parish, whilst very many more persons are permanently maimed or injured and their healths ruined. Most, if not all, of these deaths, and of this ill-health, are preventable, and ought to be prevented. The disease is due to the entrance from without of a germ or microbe, and is acquired either directly from person to person, or indirectly through infected food (milk and meat). These germs or microbes thrive in damp, dark and dirty places, under insanitary conditions, and in ill-ventilated, stuffy, or over-crowded rooms, but are killed by sunlight, or ordinary daylight, and fresh air. They readily take root and grow in persons weakened or debilitated by infectious disease or other illness, poverty, alcoholic excess, etc., or in a low state of health, such as may be inherited, or induced by overcrowding and other insanitary conditions; but not in those in robust health, and living in good, clean, sanitary surroundings. The disease spreads chiefly through the phlegm, spit or expectoration (in which are found vast quantities of germs) of a consumptive person, and in a moist state this expectoration does little or no harm in the way of infecting the air, but in a dried condition, as dust, becomes exceedingly dangerous, and is then a ready means by which the disease passes from person to person. The disease is little (if at all) catching through the breath or perspiration, so that consumptive invalids may be closely attended upon by healthy persons, provided care is taken about the expectoration. Consumption is not necessarily fatal, but can often be cured if its nature is recognised early and proper means taken for its treatment. SPECIAL PREVENTIVE MEASURES. 1. A consumptive person must not expectorate or spit about the house, in cabs, omnibuses, tramcars, 12 and railway carriages, or in public places (e.g., theatres, concerts, churches, schools, etc.), as by so doing the disease may be spread to others. 2. A consumptive person must expectorate or spit into a special cup or vessel provided for the purpose, and containing a little water, or into small pieces of rag or paper, but not into handkerchiefs; whilst a small wide-mouthed bottle with a well-fitting cork, or a pocket spittoon (which may be obtained from any Chemist), may be used for out of doors. 3. The collected expectoration or spit must be burnt at the back of the fire—the quickest, simplest, and safest way, or mixed with an equal quantity of strong disinfectant and then placed into the drain or W.C., the cup, vessel, bottle, or spittoon being afterwards immediately washed with boiling water; or, where small pieces of rag or paper are used, they must be treated in the same way. 4. All cups, spoons, knives and forks, etc., used by consumptive persons must be carefully washed before being used by others. 5. A consumptive person must not swallow the expectoration or spit, as by so doing the disease may be conveyed to other organs or parts of the body. 6. A consumptive person must sleep in a separate bed, but not necessarily in a separate room. 7. A consumptive person must not kiss or be kissed on the mouth. GENERAL PREVENTIVE MEASURES. All sleeping and living rooms (the latter including schools, workshops, &c.) used by consumptive persons, should be as well lighted and ventilated, and as free from dirt and damp, as possible. There should be no overcrowding, with the consequent breathing again and again of vitiated, and may be infected, air. 13 Chimneys should not be blocked up, and in the case of living rooms, the windows should be kept open as much as possible, and even in the case of sleeping rooms, should be left wide open during the day, and slightly so during the night, unless otherwise ordered by the Medical Attendant. All rooms, passages, and staircases should be kept free from dust, and whenever dusting is done, damp dusters should be used so as to prevent any danger from infected dust flying about and being inhaled, and the dusters afterwards boiled. When floors are swept, tea leaves and damp saw-dust may be used, and burnt afterwards. When a room or rooms become disused owing to the removal or death of a consumptive invalid such rooms (and their contents) should be first thoroughly disinfected by the Vestry's officers, who will carry out the disinfection free of cost. The walls, afterwards, should be stripped of paper, and the paper burnt; the ceilings white-washed; all floors and woodwork cleansed with soap and water; and all soiled linen and clothing boiled. All milk should be boiled, and meat well cooked, as tuberculosis may be spread by such foods (especially milk), if infected. Sunlight and fresh air are very valuable preventatives against Consumption, as are also good, clean, sanitary surroundings. By Order of the Vestry, MEDICAL OFFICER OF HEALTH. N.B.—The Disinfection carried out, free of cost, by the Vestry consists of— (a) Fumigation of rooms or houses. (b) Disinfection with Saturated Steam (under pressure) of all bedding, carpets, curtains, bedhangings, etc. Application to be made to the Medical Officer of Health, Public Health Department, 333, Kennington Road, S.E. 14 Report on BACTERIOLOGICAL DIAGNOSIS in INFECTIOUS DISEASES. (Adopted by the Vestry, December 8th, 1898.) Taking the local Reports for Lambeth during the last 35 years, and expressing the Diphtheria rate as deaths per million living, we find as follows (sub-dividing into quinquennia):— Quinquennial Period. Population. Number of Deaths. Death-rate per Million living. 1863-1867 902,119 148 164 1868-1872 1,021,165 96 94 1873-1877 1,132,106 184 163 1878-1882 1,245,913 255 205 1883-1887 1,313,211 365 278 1888-1892 1,367,734 537 393 1893-1897 1,443,857 683 483 London, too, as a whole, shows a similar and practically pro rata increase in Diphtheria. During last year, 1897, the London rate per million living was 500, as compared with an average 595 during the five years 1893-1897, 356 during 1888-1892, 228 during 1883-1887, 166 during 18781882, and 116 during 1873-1877. The above statistics prove that there has been during recent years a steady and persistent increase of Diphtheria in Lambeth, as well as in London generally, and in the opinion of those best able to judge, this increase is due in part to the mild and unrecognised cases that occur, and which, owing to them not being properly and efficiently insolated, give rise to the spread of the disease to others; more especially is this true of schools (Board, Private, and Sunday), and crowded assemblages of children, who are most prone to develop Diphtheria. The Vestry, as the Sanitary Authority, ought to leave no stone unturned in dealing with this Disease, and preventing. 15 -as far as possible, its spread, and I am satisfied that the extra means of prevention offered by bacteriological examination and diagnosis will, if tried, be found satisfactory. I suggest, therefore, that facilities should be given to the Medical men of Lambeth for the Bacteriological Examinations (free of cost) of discharges, or membranes, from the throats of patients presumably suffering from Diphtheria, or suffering from doubtful forms of throat disease, which may prove of an infectious nature. Much will, of course, depend upon the Medical Practitioners of Lambeth, and the good results that will accrue from the above-mentioned extra preventive measures, will be in proportion to the use they (the Medical Practitioners) make of them. The matter should be left entirely in the hands of the Medical profession, and there should, of course, be no interference on behalf of the Vestry or its advisers, between patients and Medical Attendants, except in the cases where the Medical Officer is called in in consultation. In addition to Diphtheria cases, doubtful Typhoid Fever, Cholera, and Tuberculosis cases could also be examined bacteriologically in the same way, should the Medical Attendants or others so desire; and such examinations would prove of great value in deciding definitely the nature of the illness. It is admitted by all that Typhoid Fever and Tuberculosis present, at times, very great difficulties in diagnosis, more especially in the early stages, so that it is of importance to lessen errors of diagnosis and at the same time to ensure (as may be required) earlier isolation. Cholera, fortunateiy, is a rare disease in London, but it is necessary at times to decide whether a case of severe Diarrhoea is due to Asiatic Cholera or to ordinary English Cholera. The plan suggested is a simple and inexpensive one:— Each Medical man in Lambeth should be supplied with a small box—"Diagnosis Outfit" as it is called—containing sterilised tubes, some furnished with swabs of cotton wool, and others with pipettes. The Medical Attendant, in the case of a patient about whose throat disease there is doubt, would collect, under suitable precautions, a sample, or samples, of the discharge or membrane, or, in a doubtful Typhoid patient, a drop or two of blood, place them in the 16 tubes mentioned above, and transmit to the Medical Officer of Health, who would be able, in the majority of cases, to furnish the Medical Attendant with the result of the bacteriological examination within forty-eight hours. The cost of each "Outfit" complete is (in quantity) Sixpence or less. The value of these bacteriological examinations, more especially in connection with Diphtheria and Typhoid, has been practically proved by Authorities who have already adopted the method mentioned above (e.g., State of New York, Bristol, Croydon, Leeds, Liverpool, Glasgow, Manchester, Newcastle, Sheffield, and several Metropolitan Districts, e.g., St. Pancras, St. Marylebone, Islington, Clerkenwell, Fulham, Stoke Newington, Lee, Strand, Holborn, St. Olave's, etc.) in the following cases: (1) Suspected Diphtheria throats or other doubtful cases of throat diseases, and doubtful Typhoid cases, which are proved, by bacteriology, to be true infectious diseases; (2) Diphtheria cases about which it is desirable to know when the patients may return (with safety to others) to school, work, etc.: (3) Cases of doubtful Diphtheria or Typhoid which are at present sent to hospital, and prove afterwards to be ordinary, or non-infectious, sore throats or non-typhoid (with subsequent danger of the real diseases being contracted); (4) Doubtful cases of Diphtheria and Typhoid, which are notified at present and for which the notification fees are paid, though the disease may not be a notifiable one, and the expenses in connection with disinfection and isolation consequently needlessly incurred. In short, errors of diagnosis are lessened in quantity, and earlier and more exact diagnosis ensured. The bacteriological examinations could be carried out for the Vestry at some well-known Laboratory, several of which are to be found in London, at a cost of 2s. 6d. (about) each case; but, as an alternative course, I would suggest that, for the present, they might be made by your own Medical Officer of Health—in which latter case it would be necessary to fit up bacteriological apparatus (microscopes, incubators, etc.), complete at an initial cost of £50, A room at the Wanless Road Disinfecting Station might, with advantage, be used, and can readily be spared, for 17 such a purpose—at least for the present. This latter plan would be the cheaper in the end. The annual averages of Notification Certificates received in Lambeth since the Notification Act came into force in 1889, and the greatest numbers received in any one year, are as follows:— Annual Average. Greatest Yearly Number. Diphtheria 534 789 Membranous Croup 35 49 Typhoid Fever 172 268 Totals 741 1106 Allowing 2/6 each examination and 6d. each outfit, and taking the maximum number of certificates ever received in one year, the yearly cost works out at £165 18s 0d., i.e., sending the samples to a Public Laboratory; whereas, with a Private Laboratory for Lambeth Parish, the annual expenses would amount to the cost of the outfits (i.e., £27 13s. 0d.), and the cost of the Laboratory spread over a number of years (initial estimated cost, £50). As a matter of fact I only anticipate one-fourth (or less) of notified cases being examined bacteriologically, at least at first, and it must be remembered that the estimated cost is based on the largest number of notifications that have ever been received in one year in Lambeth. Experience shows that the money invested gives a good return in the earlier diagnosis of the diseases mentioned (Diphtheria, Typhoid, Tuberculosis), and the good results that accrue therefrom. In the cases of Diphtheria and Typhoid Fever, there would be a probable saving in Notification Fees and in the cost of isolation and disinfection— more exact and earlier diagnosis being amongst the practical results of the bacteriological examinations. I repeat my recommendations:— 1. Each Medical Practitioner in Lambeth to be provided with "diagnosis outfit" at a cost of 6d. or less each " outfit." 2. Necessary apparatus (at an initial cost of £50) to be supplied in a room to be fitted up at (for the present) the Wanless Road Disinfecting Station. B* 18 It must not be supposed that the Laboratory would enable important bacteriological examinations of milk and water to be carried out, as in these cases inoculation experiments are required, and the Vestry would not be likely to obtain the necessary vivisecting licence from the Home Office. In connection with Diphtheria, Typhoid Fever, and Tuberculosis, however, I am of opinion that much good would accrue from such a Laboratory being provided at the Wanless Road Disinfecting Station, or elsewhere in the Parish. It is clear that such a Laboratory would be most useful for Lambeth if situated in Lambeth Parish, and under the immediate control of your Officer of Health, provided too much of such Officer's time was not taken up therewith, and such an arrangement would be certainly much cheaper than the method suggested by the London County Council in their letter of 30th July, "of establishing a Laboratory or making such other arrangements as would enable Medical Officers of Health and Medical Practitioners in London to obtain the examination of pathological matter at the expense of the County; and of applying to Parliament for such powers." Report on MEASLES PREVENTION. (Presented to the Vestry June 23rd, 1898). Measles is a highly infectious disease, which attacks chiefly young children under the age of 5 years, amongst whom it causes a high rate of mortality. In Lambeth during the last 10 years, there have been registered 1541 deaths from Measles, i.e., more than half of the total deaths from all the notifiable infectious diseases taken together, as the following table shows:— 19 DEATHS FROM DIFFERENT INFECTIOUS DISEASES IN THE PARISH OF LAMBETH DURING THE LAST TEN YEARS. Year. Measles. Whooping Cough. Scarlet Fever. Diphtheria. Total Notifiable Infectious Diseases. 1888 119 171 82 103 256 1889 157 137 73 155 287 1890 183 194 57 74 199 1891 128 239 46 78 185 1892 187 135 76 127 276 1893 113 151 69 172 338 1894 182 110 64 138 269 1895 151 132 53 103 259 1896 185 140 63 140 261 1897 139 144 42 145 245 10 Yrs. 1544 1553 625 1235 2575 These figures prove that Measles is a dangerous infectious disease, though not so included in the Public Health (London) Act, 1891, and requires to be stringently dealt with by a Sanitary Authority, with a view to preventing its extension. By including Measles in the term "Dangerous and Infectious Diseases," the prevention clauses or sections of the Public Health (London) Act, 1891, will apply, and will be the means of impressing upon people the dangerous nature of this disease and the importance of stringent measures being taken in connection therewith. If preventive measures are made to apply to Scarlet Fever, Diphtheria, and Smallpox, they are much more needed in the case of Measles, which causes 147 per cent. more deaths than Scarlet Fever, 25 per cent, more than Diphtheria, and only 33 per cent. less than all the notifiable infectious diseases combined, and which are at present included in the term "Dangerous and Infectious Diseases " (mentioned in the Public Health Act) As a further argument in favour of these preventive measures being made applicable to Measles, I may mention B* 2 20 hat during the present month 61 cases of Measles have been visited in Norwood Ward, and in 16 cases the 'Measles-infected children were found to be out in the street, instead of being kept indoors to prevent the spread of the disease, and the after-consequences that arise from too early exposure to the cold ; whilst out of these 61 cases, only 34 were being attended by medical men, shewing that at present parents regard the disease as a trifling one, and are, unfortunately, ignorant of the dangers to health and life that may arise from want of care. The preventive Sections of the Act do not include the notification of the disease, whilst it must be remembered that the Vestry, at their Meeting on February 18th, 1897, confirmed and adopted the Report of the Medical Officer of Health, in which it was pointed out that notification was not advisable at present, the expense being out of all proportion to the benefits to be gained, owing to the want of proper isolation (Hospital) accommodation, the infectious nature of the disease in its early stages, the very young ages of the patients, etc. (p. 239, Minutes, Vestry, 1897). The Vestry's Officers, therefore, will not, by virtue of these Sections, necessarily hear of more Measles cases, but will have authority to prevent children suffering from Measles from exposing themselves or being exposed in the public streets, omnibuses, and tramcars, at schools, etc., and the power to fumigate with sulphur infected rooms (stripping in very few cases being necessary after Measles, the contagion of which appears to be, outside the body, evanescent), and steam disinfect infected bedding and clothes. Another important point is that it is expected that by including Measles as a dangerous and infectious disease, people will become educated to look upon Measles as requiring proper isolation and care to prevent its spread, and the development of the serious after-effects, if not death, which are apt to ensue; and it is manifest that any means that can be devised to so educate parents should be adopted by a Sanitary Authority. I am of opinion that the adoption of the Sections and their application to Measles (as suggested by the London County Council in connection with a letter received by them from the London School Board) will do much good, but with little (if any) additional cost to the Ratepayers. 21 Copy of Leaflet. Lambeth Vestry. PRECAUTIONS TO BE OBSERVED during MEASLES. The Sanitary Committee of the Lambeth Vestry desire to direct the attention of parents and others, having the care of young children, to the importance of treating Measles properly and checking its spread. In Lambeth during the last ten years, 1544 deaths have been registered from Measles, but it would be necessary to increase this number three- or four-fold, if we were to include also the deaths from bronchitis, inflammation of the lungs, etc., which are often the after-consequences of Measles; indeed, Measles kills, directly and indirectly, more persons (chiefly children) than all the notifiable infectious diseases put together, and very many more than Scarlet Fever. Whenever Measles breaks out in a household, it is of the greatest importance to at once isolate the patient or patients from the other inmates of the house, and especially to prevent all children from the infected house mixing with other children in the street or garden, at day or Sunday schools, or elsewhere, as the disease is readily transmitted both from person to person and through the medium of clothes. 22 Measles is a highly infectious disease, even in the early stages, and several days before the appearance of the rash, so that, whenever MEASLES is about, a child who shows symptoms of being poorly and feverish (or shivering), with running at the eyes or nose, sneezing and coughing, as though suffering from a cold, should at once be kept from school, and as far as practicable from associating with other children for a few days. If the child is sickening for Measles, the rash, which is generally raised and red or purplish in colour, will appear during that time. MEASLES is also infectious after the rash is gone, and children convalescent from this disease should not be allowed to return to school or mix with other children until at least three weeks after the disappearance of the rash in the last patient affected in a household. The treatment required in MEASLES is to keep the patient isolated in a warm room with plenty of fresh air, and in bed until the rash has disappeared; and, above all things, to avoid draughts, as the after-consequences of Measles arising from chill or exposure are most serious, and may kill or cripple for life. A medical practitioner, if not already in attendance, should be called in at once whenever the slightest difficulty of breathing is observed, as any neglect in promptly attending to lung or other complications may be followed by death. All handkerchiefs, clothes, beds, towels, plates, cups, spoons, etc., used by the patient, are highly infectious, and must be disinfected (by washing or otherwise) as early as possible after the patient is convalescent and the sick room or house thoroughly cleansed and aired; whilst disinfectants in a dilute form should be freely used during the course of the disease, both in the infected room and in the water used for bathing and washing. Disinfection of rooms, bedding, and clothes will be carried out by the Officers of the Vestry, free of cost, on application to the Medical Officer of Health, at the Health Department, 333, Kennington Road, S.E., where disinfectants are also to be gratuitously obtained. 23 It is wrong for parents to regard Measles as of trifling importance, and as a disease of childhood "to be got over, and the sooner the better," as many a child has lost its life in consequence of such foolish reasoning. N.B.—Please circulate this Notice amongst all the Occupiers of the house. (By Order) MEDICAL OFFICER OF HEALTH. Report by Medical Officer of Health on SMOKE NUISANCE IN LAMBETH. (Adopted by the Vestry July 21st, 1898). I have to report that I have had the question of smoke nuisance in Lambeth Parish under special consideration since the beginning of the year, and have had during that time many careful observations taken in connection with most of (if not all) the large and important Firms. Observations have been taken both by myself and regularly by the Smoke Inspector, and also, as corroborative evidence, by other Inspectors; whilst many letters of complaint have been received, from time to time, from the Officers of the London County Council. I have further to report that I have myself recently visited the following premises for the purpose of inspecting the boilers, furnaces, and kilns, together with the appliances for the consumption of smoke connected therewith:— 24 Nature Name. Address. of Business. Maudslay & Son Westminster Bridge Engineers Road Seth Taylor Commercial Road Flour Mills Charing Cross & Strand Commercial Road Electrical Electricity Supply Co. Engineers Peter Walker Belvedere Road Lead Works Brotherhood Belvedere Road Engineers Clowes Stamford Street Printers Sunny Bank Laundry Vauxhall Laundry Doulton & Co. Albert Embankment Potteries Stiff & Sons Albert Embankment Potteries In the course of my inspections, I found that in all cases patent appliances were in use in connection with the different boilers and furnaces, e.g., Ellis & Eaves' forced or induced draughts, rocking bars, patent grids (opening and shutting automatically or otherwise), steam jets, mechanical stokers, split bridges, etc., so that every reasonable precaution appears to have been taken in connection with the construction of the furnaces and boilers themselves. The stokers and kiln-burners in all cases are supervised, and warned that carelessness or laziness in stoking may be followed by fine or even dismissal of the servant or servants concerned; whilst in the case of Messrs. Doulton and Stiff, special Smoke Inspectors are appointed, whose duties are to watch daily and hourly the various chimneys and to report at once to their respective Firms any negligence observed and any nuisance arising therefrom from the emission of black smoke for a longer period than is reasonable and necessary for the purpose of stoking, e.g., three to five minutes. There is no question but that much depends upon the firemen or stokers, despite the patent appliances used—light and frequent firings being, in the ooinion of those most experienced and therefore best able to judge, most satisfactory 25 economically, and least likely to cause a nuisance from black smoke. In the Potteries belonging to Messrs. Doulton and Stiff, there are 74 kilns (averaging 10 fires a kiln), and of these, 67 are on the down-draught principle, 6 on the modified and improved double crown up-draught principle, and only one (belonging to Messrs. Stiff & Sons) on the old-fashioned and simple up-draught principle, discharging directly into the air without the intervention of an upper chamber or crown, and a high chimney, giving rise, therefore, at times, to a great amount of black smoke. Arrangements are, however, in hand by Messrs. Stiff & Sons for the building of a new modern kiln, on the down-draught principle, together with the erection of an extra chimney shaft of sufficient height to secure an efficient draught in place of the old-fashioned kiln on the up-draught principle. Large amounts of money have been and are still being spent on improvements by Messrs. Doulton and Stiff in connection with their kilns, whilst both Firms are willing to carry out any further practical suggestions that the Vestry or others have to offer, and that regardless of the cost connected therewith. The only other point is the question of coal or fuel. In all cases the excuse offered is the inability of the various Firms to obtain the best Welsh steam or smokeless coal, owing to the South Wales Strike, and there is no doubt but that the use of second class (and inferior) coal has recently increased the smoke nuisance in Lambeth as elsewhere. It is a matter for the Vestry to decide as to whether this excuse shall be considered a valid one in the future, or whether written notice should not be sent to the various Lambeth Firms mentioned above (and others) to the effect that after a certain period (say three months) this excuse will not be accepted by the Vestry. Under the terms of the Public Health (London) Act, 1891, a chimney (not of a private dwelling) discharging black smoke in such a quantity as to be a nuisance, is a Nuisance liable to be dealt with summarily, and by Sections 23 and 24 furnaces must consume their own smoke, or, if provided with patent smoke-consuming apparatuses, must not be negligently used by the stokers or others concerned. There is in the Act, however, an important proviso, 26 whereby proceedings before a Magistrate may be quashed, "where a fire-place or furnace is constructed in such a manner as to consume, as far as practicable, having regard to the nature of the manufacture or trade, all smoke arising therefrom, and that such fire-place or furnace has been carefully attended to by the person in charge thereof, and the Court, if satisfied of this, shall hold that no nuisance is created and dismiss the complaint." The Vestry is now the Sanitary Authority to deal with Smoke Nuisance under the Act, but it must be remembered that the Act of Parliament definitely and specifically states black (and no other) smoke as a nuisance, under the conditions as stated above. Considering all the above circumstances, I am of opinion, as Medical Officer, that the Vestry would not, for the present, be justified in taking action in connection with any of the above-mentioned Firms—certainly not with any prospect of success, as in each case special appliances have been provided in connection with the furnaces, kilns, and boilers to prevent a nuisance arising from any unconsumed smoke, and reasonable precautions taken to minimise, as far as possible, carelessness or laziness on the part of the stokers and kiln-burners concerned. As a corollary it follows that the London County Council would be ill-advised to take proceedings over the head of the Vestry of Lambeth, as threatened in their letter dated July 6th. Joseph Priestley. July 11th, 1898. 27 OFFENCES UNDER THE PUBLIC HEALTH, AND FOOD AND DRUGS AND MARGARINE, ACTS DURING 1898. ADDRESSES OF OFFENDERS, WITH NATURe OF OFFENCE, AND AMOUNT OF PENALTIES AND COSTS IN EACH CASE. 28 29 Public Health (London) Act, 1891. Date. Address. Offence. Penalty. Costs. 1898. Jan. 14th 3, Alderswick Terrace, London Road, Hounslow Non-compliance with Notice of Vestry to cleanse the dirty premises at 20, Broad Street (Order made for the work to be done within 7 days and Owner to pay 4/0 costs.) £ s. d. £ s. d. ... 0 4 0 Jan. 14th 3, Alderswick Terrace, London Road, Hounslow Non-compliance with Notice of Vestry to put the water closet into proper order and condition at No. 20, Broad Street (Order made as above.) ... 0 4 0 Jan. 27th 44, Charing Cross For non-compliance with Notice of Vestry to cleanse and whitewash all dirty walls and ceilings and repair paving of yard at No. 19, Bird Street (Order made for work to de done within 14 days, and Owner to pay 4/0 costs.) ... 0 4 0 Jan. 27th 44, Charing Cross For non-compliance with Notice of Vestry to properly pave the yard at No. 27, Bird Street (Order made as above ) ... 0 4 0 Jan. 27th 44, Charing Cross For non-compliance with Notice of Vestry to cleanse, whitewash, &c., dirty walls and ceilings of rooms at No. 5, Hope Place, Bird Street ... (Order made as above.) ... 0 4 0 Jan. 27th 44, Charing Cross For non-compliance with Notice of Vestry to repair roof, cleanse and whitewash, etc., the whole of the interior of the premises at No. 35, Bird Street (Order made as above.) 0 4 Mar. 4th 3, Alderswick Terrace, London Road, Hounslow Non-compliance with Magistrate's Order to cleanse and purify the premises at No. 20, Broad Street ... (Work being completed, Owner to pay costs.) ... 0 2 0 Mar. 11th 74, Cornwall Road, S.W. Non-compliance with Notice of Vestry to abate the overcrowding in back room (Second Floor), at No. 74, Cornwall Road, S.E. (Order made to abate overcrowding within 7 days, and to pay costs.) ... 0 2 0 Mar. 17th Stable, rear of 171, Camberwell New Road Failing to provide a receptacle for dung at No. 171, Camberwell New Road, in accordance with Byelaws of L.C.C. (Order made to do work in 7 days, and Defendant to pay costs.) ... 0 4 0 Mar. 17th 176, Queen's Road, Battersea Non-compliance with Notice of Vestry to provide a metal ash-bin at 207, Camberwell New Road (Order made to do work in 7 days, and to pay costs.) 0 4 0 Mar. 17th 143, Waterloo Road Non-compliance with Notice of Vestry to provide a new pan, trap and water supply to the outer W.C. at No. 28, Crawshay Road (Order made to do work in 7 days, and to pay 4/0 costs.) 0 4 0 Carried forward ... 2 0 0 30 31 Date. Address. Offence. Penalty. Costs. Brought forward £ s. d. £ s. d. ... 2 0 0 War. 24th 38, Murphy Street Non-compliance with Notice of Vestry to cease occupying the basement as a separate dwelling, at No. 38, Murphy Street (Defendant fined 20/0 and 2/0 costs, or 14 days' imprisonment.) 1 0 0 0 2 0 May 5th 57, Brixton Hill For non-compliance with Notice of Vestry to put the drainage and water-closets into proper order and condition at No. 16, St. James' Road (Order made to do the work within 14 days.) ... 0 4 0 May 2;th 59, Kennington Road For non-compliance with Notice of Vestry to abate a nuisance, arising from the foul and defective condition of paving of the stables and yard, in Brad Street, Cornwall Road, S.E. 5 0 0 0 2 0 May 27th 59, Kennington Road Neglecting to provide a proper dung receptacle, in accordance with the Bye-laws of L.C.C., at the stables, Brad Street, Cornwall Road, S.E. 2 0 0 0 2 0 May 27th 59, Kennington Road For non-compliance with Notice of Vestry to abate a nuisance, arising from" the closet being without a proper water supply, at 33, Brad Street 1 0 0 0 2 0 May 27th 59, Kennington Road For non-compliance with Notice of Vestry to put a drain under W.C. into proper order and condition, repair the flushing tank and provide a dust-bin at No. 36, Brad Street 1 0 0 0 2 0 May 27th 59, Kennington Road For non-compliance with Notice of Vestry to abate a nuisance, arising from the wash-house floor being defective, at No. 37, Brad Street 1 0 0 0 2 0 May 27th 59, Kennington Road For non-compliance with Notice of Vestry to abate a nuisance arising from the drain under closet being defective,broken pan, and wash-house paving being defective at No. 38, Brad Street 1 0 0 0 2 0 May 27th 59, Kennington Road For non-compliance with Notice of Vestry to abate a nuisance, arising from the drain under closet being defective at No. 39, Brad Street (The work having been completed, the defendant was ordered to pay the costs, 2/-). ... 0 2 0 May 27th 59, Kennington Road For non-compliance with Notice of Vestry to abate a nuisance arising from the drain under closet being defective at No. 40, Brad Street (The work having been completed, the defendant was ordered to pay the costs, 2/-). ... 0 2 0 May 27th 59, Kennington Road For non-compliance with Notice of Vestry to abate a nuisance arising from the wash-house paving being defective, also the drain under closet, and there being no dust bin at No. 43, Brad Street 1 0 0 0 2 0 Carried forward 13 0 0 3 4 0 32 33 Date. Address. Offence. Penalty. Costs. Brought forward £ s. d. £ s. d. 13 0 0 3 4 0 June 2nd Tinworth Street, Vauxhall Removing offal from poultry in an improperly constructed van, from No. 401, Brixton Road, contrary to the Bye-laws of the L.C.C. 1 0 0 0 2 0 June 2nd 9, Springfield Place, Wandsworth Road Removing offal from poultry in an improperly constructed van from No. 401, Brixton Road, contrary to the Bye-laws of the L.C.C. 0 5 0 0 2 0 June 9th 1, Branksome Road For non-compliance with Notice of Vestry to alter and amend the water closet and drainage at No. 126, Branksome Road (Order made for work to be done within 7 days and Owner to pay 4/0 costs). ... 0 4 0 July 21st Sutton, Surrey Non-compliance with Notice of Vestry to provide a drain for the yard, and put paving into proper order and condition at No. 142, Warham Street (Order made to do the work in 7 days). ... 0 4 0 Aug. 2nd 349, Coldharbour Lane Non-compliance with Notice of Vestry to re-construct the drains and water closet at No. 33, Villa Road (Order made to do work in 7 days, and pay 4/- costs.) ... 0 4 0 Aug 12th 48 Hercules Read Non-compliance with Notice of Vestry to provide a proper water supply at No. 46 & 48, Hercules Road (Order made to close premises, and to pay 4/- costs in each case.) ... 0 8 0 Aug. 12th 99, The Grove, Camberwell Non-compliance with Notice of Vestry to provide external ventilation to the W.C., properly pave the yard and front area, and provide sanitary dust bin at No. 85, Lambeth Palace Road ... (Order made to do work in 7 days, and pay 4/-costs.) ... 0 4 0 Aug. 12th 99, The Grove, Camberwell Non-compliance with Notice of Vestry to reconstruct the whole of the drain at No. 85, Lambeth Palace Rd (Order made to do work in 7 days and pay 4/- costs.) ... 0 4 0 Sept. 8th 289, Coldharbour Lane Non-compliance with Notice of Vestry to put into proper order and condition the ventilating and soil pipe from the drain at No. 1, Canterbury Road (Order made to do work in 7 days, and to pay 4/costs). ... 0 4 0 Sept. 9th 3, Friar's Place, Blackfriars Road Exposing for sale in the New Cut certain articles of food, viz.:—3 cases of oranges intended for the food of man wh'ch were unsound and unfit for food (Or 1 month's imprisonment). 5 0 0 0 2 0 Oct. 5th 225, Wandsworth Road Depositing, for the preparation for sale, certain articles of food, to wit:—three pieces of meat which were unsound and unfit for the food of man, at No. 225, Wandsworth Road (Or 1 month's imprisonment). 2 0 0 0 4 0 Carried forward 21 5 0 5 6 0 c* 34 35 Date. Address. Offence. Penalty. Costs. Brought forward £ s. d. £ s. d. 21 6 0 5 6 0 Oct. 5th 222, Wandsworth Road Exposing for sale certain articles of food, to wit:-36 pieces of meat which were unsound and unfit to food (Or 1 month's imprisonment). 2 0 0 0 4 0 Oct. 7th 68, New Cut Deposited for the purpose of sale, and intended for the food of man, at the Stables, 5 Little Windmill Street, New Cut, 88 cases of Condensed Milk which were unsound, unwholesome, and unfit to the food of man (Or in default of payment of fine, 3 months' imprisonment). 50 0 0 5 5 0 Nov. 9th 42, Lambeth Road Depositing for sale on a stall in Lower Marsh, 21 pieces of bacon which were u sound and unfit to the food of man (Or 1 month's imprisonment). 10 0 0 1 1 0 Nov. 9th 5, Talbot Mews, Talbot Grove, Notting Hill Selling certain articles of food, i.e., 22 pieces of bacon which were unsound and unfit for the food of man (Or 2 months' imprisonment). 25 0 0 2 2 0 Nov. 24th 120, Lower Marsh Exposing for sale at 120, Lower Marsh, 21 rabbits and 29 pieces of rabbit, and that such articles were unsound, unwholesome, and unfit for the food of man 2 0 0 0 4 Q Dec. 1st 110, Westminster Bridge Road For a Nuisance caused from circular iron chimney at rear of Gloucester Street sending forth black smoke in such quantity as to be a nuisance 10 0 0 2 2 0 Dec. 1st 15, Maiden Lane, Strand, W.C. For creating black smoke at No. 85, Commercial Road, 10 0 0 5 5 0 Dec. 21 st 100, Westminster Bridge Road For a nuisance caused by offensive effluvia emitted from a manufactory at 100, Westminster Bridge Road (Adjourned for purpose of fitting new plant). ... ... Dec. 21st 07, Graham Road, Dalston. N.E. Non-compliance with Notice of Vestry to provide a dust bin, and to put the yard paving into proper order and condition, at No. 32, Hartington Road (Summons dismissed). ... ... Totals £ 130 5 0 £21 9 0 36 37 Food and Drugs and Margarine Acts. Date. Address. Offence. Penalty. Costs. £ s. d. £ s. d. Jan.12th 24 Lower Marsh Selling Gin being 7 degrees below the standard allowed by Act of Parliament 5 0 0 0 12 6 Feb. 24th Hurst Farm, Winchfield, Hants. Selling Milk containing added water to the extent of 10 per cent. 2 0 0 0 13 6 Feb. 24th Hurst Farm, Winchfield, Hants. Selling Milk containing added water to the extent of 8 per cent. 2 0 0 0 13 6 Mar. 4th 40, Bolton Street Selling Coffee containing added Chicory to the extent of 40 per cent. 5 0 0 0 17 6 April 5th 39, Akerman Road Selling Milk from which the Cream had been abstracted to the extent of 15 per cent. 1 0 0 0 12 6 April 15th 3, Windmill Row, Kennington. Selling Milk deficient in Cream to the extent of 10 per cent. 2 0 0 0 12 6 May 5th 291, Camberwell Road Selling Milk containing added water to the extent of 33 per cent. (Case dismissed, the Magistrate saying it was " Pudding Milk ") ... ... May 5th 135, Cornwall Road, S.W. Selling Milk from which the Cream had been abstracted to the extent of 18 per cent. 1 0 0 0 12 6 May 5th 61, Cornwall Road, S.W. Selling Milk from which the Cream had been abstracted to the extent of 37 per cent. 1 0 0 0 12 6 May 5th 10, Renfrew Road Selling Milk from which the Cream had been abstracted to the extent of 18 per cent. 1 0 0 0 14 6 May 5th 61, Cornwall Road, S.W. Selling Milk from which the Cream had been abstracted to the extent of 41 per cent. 1 0 0 0 12 6 May 20th 12, Walcot Square Selling Butter containing added Margarine to the extent of 65 per cent. 2 0 0 0 12 6 June 1st 96, Laikhall Lane Selling Butter containing added Margarine to the extent of 37 per cent. 0 10 0 0 12 6 June 1st 95, Larkhall Lane Selling Butter containing added Margarine to the extent of 75 per cent. 0 10 0 0 12 6 June 24th 131, Lambeth Walk Selling Butter containing Margarine (not Butter) 90 per cent. 1 0 0 0 12 6 June 24th 80, Prince's Road Selling Butter containing Margarine (not Butter) 84 per cent. 1 5 0 0 12 6 July 24th 91, Lyham Road Selling Butter containing Margarine (not Butter) 80 per cent. 1 0 0 0 12 6 July 15th 2a7, Kennington Road Selling Butter containing Margarine (not Butter) 90 per cent. 1 0 0 0 12 6 Carried forward 28 5 0 11 1 6 38 39 Date. Address. Offence. Penalty. Costs. Brought forward £ s. d. £ s. di 28 5 0 11 1 6 July 19th 59, Bond Street, Vauxhall Selling Butter containing Margarine (not Butter) 90 per cent. 1 0 0 0 12 6 Aug. 3rd 290, Clapham Road Selling Gregory's Powder which contained 70 per cent. of Official Carbonate of Magnesia 0 10 0 0 12 Aug. 3rd 1, Beaufoy Terrace Selling Milk containing added water to the extent of 10 per cent. 1 0 0 0 12 6 Aug. 3rd 9, Dawlish Street Selling Milk containing 8 per cent. of added water 0 10 0 0 12 6 Aug. 3rd 5, Wilcox Road Selling Butter containing Margarine (not Butter) 88 per cent. 1 0 0 0 12 6 Aug. 3rd 193, Wandsworth Road Selling Butter containing Margarine (not Butter) 72 per cent. 1 0 0 0 12 6 Aug. 4th 180, Upper Kennington Lane Selling Gregory's Powder which contained 66 per cent. of Official Carbonate of Magnesia 2 0 0 0 12 Aug. 19th 1, Harleyford Road Selling Gregory's Powder which contained 32 per cent. of Official Carbonate of Magnesia 2 0 0 0 12 6 Sept. 8th 9, Wyvil Road Selling Butter containing Margarine (not Butter) 90 per cent. 0 10 0 12 6 Oct. 20th 23, Glynn Street Selling Coffee containing added Chicory to the extent of 80 per cent. 2 0 0 0 12 0 Oct. 20th 149, Prince's Road Selling butter containing Margarine (not Butter) 85 per cent. 3 0 0 0 12 0 Oct. 20th 149, Prince's Road Selling Butter containing added Water to the extent of 10 per cent. 0 10 0 0 12 0 Oct. 20th 37, Tyers Street Selling butter containing Margarine (not Butter), 95 per cent. 3 0 0 0 12 6 Oct. 20th 45, Lowden Road Selling Milk containing added Water, 7 per cent. 2 0 0 0 12 6 Oct. 20th 447, Coldharbour Lane Selling Milk containing added Water, 8 per cent. ... 0 12 6 Oct. 27th 58, Bird Street Selling Butter containing Margarine (not Butter), 35 per cent. 0 10 0 0 12 6 Oct. 27th 191, Westminster Bridge Rd. Selling Butter containing Margarine (not Butter), 85 per cent. " 1 0 0 0 17 0 Oct. 27th 14, Vassall Road Selling Butter containing Margarine (not Butter) 80 per cent. 1 0 0 0 12 6 Nov. 11th 256a, Brixton Hill Selling Milk containing added Water to the extent of 10 per cent. 1 0 0 0 12 6 Nov. 11th 186, South Lambeth Road Selling Butter containing Margarine (not Butter), 85 per cent. 1 0 0 0 12 6 Nov. 11th 11, Victoria House, South Lambeth Road Selling Butter, containing Margarine (not Butter), 88 per cent. 1 0 0 0 12 6 Carried forward 53 15 0 24 9 0 40 41 Date. Address. Offence. Penalty. Costs. Brought forward £ s. d. £ s. d. 53 15 0 24 9 0 Nov. 11th 11, Victoria House, South Lambeth Road Selling Milk from which the Cream had been abstracted to the extent of 16 per cent. 1 0 0 0 12 6 Dec. 2nd 403, Brixton Road Selling Butter containing Margarine (not Butter), 67 per cent. 1 0 0 0 12 6 Dec. 2nd 331, Coldharbour Lane Selling Butter containing Margarine (not Butter), 70 per cent. 1 0 0 0 12 6 Dec. 2nd 2, Coldharbour Lane Selling Butter containing Margarine (not Butter), 72 per cent. 0 5 0 0 12 6 Dec. 2nd 94, Landor Road Selling Butter containing Margarine (not Butter), 68 per cent. 1 0 0 0 12 6 Dec. 22nd 91, Milkwood Road Selling Butter containing Margarine (not Butter), 38 per cent. 0 10 0 0 12 6 Dec. 22nd 194, Coldharbour Lane Selling Butter containing Margarine (not Butter), 72 per cent. 1 0 0 0 12 6 Dec. 22nd 135, Cornwall Road, S.W. Selling Butter containing Margarine (not Butter), 85 per cent. 1 0 0 0 12 6 Dec. 22nd 76, Milkwood Road Selling Coffee containing Chicory, 72 per cent. 1 0 0 0 12 6 Dec. 22nd 96, Acre Lane Selling Butter containing Margarine (not Butter), 25 per cent. (Summons not served; Defendant absconded.) ... ... Dec. 22nd 5, Milkwood Road Selling Butter containing Margarine (not Butter), 92 per cent. 1 0 0 0 12 6 Dec. 22nd 76, Railton Road Exposing for sale a parcel of Margarine without having a label attached or the wrapper stamped or printed with the word " Margarine " 1 0 0 0 12 6 Dec. 22nd 76, Railton Road Exposing for sale a parcel of Margarine without having a label attached or the wrapper stamped or printed with the word " Margarine " 1 0 0 0 12 6 1899. Jan. 5th 97, Milkwood Road Selling Coffee containing Chicory, 50 per cent. 2 0 0 0 12 6 Jan. 17th 39, Electric Avenue Selling Butler containing Margarine (not Butter), 72 per cent. (Dismissed owing to wrong man being summoned inadvertently.) ... ... Jan. 19th 29, High Street, West Norwood Selling Coffee containing Chicory, 37 per cent. 1 0 0 0 12 6 Jan. 19th 93, High Street, West Nor- Selling Milk containing added Water, 24 per cent. 1 0 0 0 12 6 Feb. 7th 30, Upper Kennington Lane Exposing for sale a parcel of Margarine without having a label attached or the wrapper stamped or printed with the word " Margarine" 0 10 0 0 12 6 Totals £ 69 0 0 34 9 0 42 43 Lambrth Parish.—Deaths Registered from all Causes during the Year 1898. AGES. AGES. Total. Under 1 Year. 1-5 Under 5 Years. 5-10 1015 15-20 20-25 25-40 40-60 60-65 65-80 80 and over Over 5 Years. All Ages. i. Specific Febrile, or Zymotic Diseases M. F. M. F. M. F. M. F. M. f. M F M F m F m f m F M F M F M F M F. 167 170 152 157 319 327 32 31 2 6 12 6 5 2 24 9 36 23 8 11 19 25 6 5 144 118 463 445 908 II. Parasitic Diseases 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 III. Dietic Diseases 3 4 ... ... 3 4 ... ... ... ... ... ... ... ... 7 6 5 15 ... 3 ... ... ... ... 12 24 15 28 43 IV. Constitutional Diseases 49 36 47 39 96 75 11 8 7 6 12 21 21 16 128 101 186 158 40 22 54 70 3 8 462 410 558 485 1043 V. Developmental diseases 112 94 2 ... 114 94 ... ... ... ... ... ... ... ... ... 1 ... ... 2 9 30 44 30 72 62 119 176 213 389 VI. Local Diseases 298 206 124 109 422 315 24 18 7 9 21 9 15 21 107 111 284 260 105 105 259 357 43 77 865 967 1287 1282 2569 Vll. Deaths from Violence 33 30 11 7 44 37 9 3 1 ... 3 2 6 2 19 7 33 15 11 ... 7 l6 2 2 91 47 135 84 219 Vlll. Deaths from Ill-defined and not Specified Causes 133 90 10 5 143 95 ... 1 ... ... ... ... ... ... ... 2 3 2 ... 1 3 5 1 2 7 13 150 108 258 Totals 796 630 346 317 1142 947 76 61 17 21 48 38 47 41 285 237 547 473 166 144 371 517 85 166 1643 1698 2785 2645 5130 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... [ Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 16 11 56 43 72 54 4 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 4 3 76 57 133 Whooping Cough 25 4b 33 47 58 93 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 62 97 159 Scarlet Fever 1 2 10 12 11 14 1 1 ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... 3 2 14 16 30 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... 2 ... 2 ... 1 ... 3 9 1 11 9 1 21 1 2 21 14 35 Diphtheria 3 3 28 29 31 32 17 21 1 3 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... 21 24 52 50 108 Membranous Croup 1 ... ... 2 1 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 5 2 7 Influenza 2 2 2 4 4 6 1 1 1 ... 3 1 3 ... 8 3 20 14 5 7 19 22. 5 3 65 51 69 57 126 Other Miasmatic Diseases ... ... 1 3 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 4 Cholera, Nostras 3 2 ... ... 3 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... 5 2 7 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 111 98 21 12 132 110 ... ... ... ... ... ... ... ... ... 1 1 3 1 2 ... 2 ... 2 2 10 134 120 254 Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 5 5 1 3 6 8 ... ... ... ... 1 ... ... 1 1 ... 2 ... ... ... ... ... ... ... 4 1 10 9 19 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... 2 ... 2 Erysipelas ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 4 2 ... ... ... 1 1 ... 6 5 6 6 12 Pyæmia, Septicaemia ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 3 ... ... ... ... ... ... ... 5 2 5 2 7 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 1 ... ... ... ... ... ... ... 4 ... ... 4 Thrush, and other Vegetable Parasitic Diseases 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk, Starvation 3 4 ... ... 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 7 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 3 15 ... 3 ... ... ... ... 8 21 8 24 32 Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... 4 ... 4 ... 4 Rheumatic Fever ... ... ... ... ... ... 2 ... 1 ... ... 2 ... 3 3 1 4| 4 ... ... ... ... ... ... 10 10 10 10 20 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 45 Lambeth Parish.—Deaths Registered from all Causes during the Year ages. ages. Under 1 Year. 1-5 Under 5 Years. 5-10 10-15 15-20 20-25 25-40 40-60 60-65 65-80 80 and over. Over 5 Years. All Ages Total. m. f. m. f. m. f. m. f. m. f. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 ... ... 2 5 1 ... 5 9 5 9 14 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 1 ... 3 2 ... 2 7 6 7 9 13 Rickets ... 2 6 1 6 3 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 7 4 11 Cancer, Malignant Disease ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 2 14 54 77 16 16 29 54 2 4 104 165 105 165 270 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 17 9 3 7 20 16 1 3 ... 1 ... ... 1 ... ... 1 2 ... ... ... ... 1 ... ... 4 6 24 22 46 Tuberc-Meningitis, Hydrocephalus 18 13 21 17 39 30 3 3 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 5 4 44 34 7846 Phthisis 3 6 6 7 9 13 1 ... 2 2 9 17 17 10 113 78 112 62 20 6 15 3 ... 1 289 179 298 192 490 Scrofula 4 2 1 1 5 3 1 ... ... ... 1 ... 1 1 ... ... ... 1 ... ... ... ... ... ... 3 2 8 5 13 Other forms of Tuberculosis 6 3 7 6 13 9 2 1 2 2 2 1 1 1 5 4 1 1 1 ... ... 1 ... ... 14 11 27 20 47 Purpura, Hemorrhagic Diathesis ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 Anaemia, Chlorosis, Leucocythæmia 1 ... 2 ... 3 ... ... ... ... ... ... 1 ... ... ... 1 2 2 ... ... ... ... ... ... 2 4 5 4 9 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 3 1 5 4 1 ... 3 ... ... ... 13 5 13 5 18 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 1 ... 2 4 ... 1 5 7 5 7 12 Premature Birth 84 70 ... ... 84 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 70 154 Atelectasis 13 14 ... ... 13 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 14 27 Congenital Malformations 15 10 2 ... 17 10 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 14 11 28 Old Age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 30 44 ... 72 62 118 62 118 180 Inflammation of Brain or Membranes 8 9 12 5 20 14 2 1 ... ... 1 1 1 1 ... ... ... 1 ... ... ... ... 30 ... 4 4 21 18 42 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 3 30 36 16 16 44 63 ... 8 103 127 103 127 230 Insanity, General Paralysis of Insane ... ... ... ... ... ... ... ... ... ... ... ... 1 1 13 4 17 10 6 1 7 15 7 5 46 36 46 36 82 Epilepsy ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 5 4 6 1 2 1 3 2 1 8 19 8 19 27 Convulsions 39 21 3 1 42 22 ... 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 2 2 44 24 68 Laryngismus Stridulus (Spasm of Glottis) 4 2 1 1 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 3 8 Disease of Spinal Cord, Paraplegia, Paralysis Agitans 2 1 ... ... 2 1 ... 1 ... ... ... ... 1 ... 2 2 8 2 ... ... ... 2 ... ... 12 7 14 8 22 Other Diseases of Nervous System 1 2 1 3 2 5 ... 1 ... 1 1 ... 1 2 3 2 4 9 1 2 1 3 1 1 11 21 13 26 39 Diseases of Ear, Eye, Nose 4 1 1 ... 5 1 3 ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... 4 2 9 3 12 Pericarditis ... ... ... ... ... ... 1 2 ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 4 2 4 6 Acute Endocarditis ... ... ... ... ... ... ... ... ... ... 2 1 1 1 1 2 1 1 ... 1 ... ... ... ... 5 6 5 6 11 Valvular Diseases of Heart 2 1 ... ... 2 1 ... ... ... 2 4 ... ... 5 6 8 15 19 6 12 11 22 ... 3 44 71 46 72 118 Other Diseases of Heart 3 2 ... ... 3 2 2 ... 1 2 3 1 1 1 15 6 39 34 14 24 38 49 2 11 115 12 118 130 248 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 1 2 ... 2 ... 8 1 8 1 9 Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 1 1 4 1 4 5 Other Diseases of Blood Vessels ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 2 3 2 3 5 Laryngitis 3 ... 1 3 4 3 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... 2 ... 6 3 9 Croup 2 ... 6 ... 8 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 8 2 10 Emphysema, Asthma ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 8 5 1 1 7 2 ... ... 16 8 16 9 25 Bronchitis 62 43 26 26 88 69 2 ... ... ... ... ... 1 ... 7 6 49 47 24 23 81 115 ... 25 178 216 266 285 551 Pneumonia 24 15 22 18 46 33 1 3 1 ... 1 ... 4 1 17 5 29 10 10 4 14 14 14 6 81 43 127 76 203 Pleurisy 2 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... 4 3 1 1 1 1 ... 4 ... 6 6 8 7 15 Bronchopneumonia 26 14 18 17 44 31 3 2 ... 1 ... ... ... ... 2 3 5 2 1 ... 3 3 1 1 15 12 59 43 102 Pleuropneumonia 1 2 3 ... 4 2 ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... ... 1 ... 1 3 5 5 10 Other Dis. of Respiratory System 14 3 6 4 20 7 1 ... ... ... 1 ... ... ... 3 2 6 2 1 ... 2 3 ... 1 15 8 35 15 50 Dentition 12 12 11 9 23 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 23 21 44 Sore Throat, Quinsy 1 ... 2 3 3 3 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 5 8 Diseases of Stomach 6 6 ... 2 6 8 ... ... ... ... ... 1 ... 1 3 9 3 3 1 ... 4 2 ... 2 11 18 17 26 43 Enteritis 54 49 7 10 61 59 2 ... 2 1 1 1 ... ... 1 2 1 4 1 ... 4 2 ... 2 12 12 73 71 43144 46 47 Lambeth Parish.- Deaths Registered from all Causes during the Year 1898. ages. ages. Totals. Under 1 Year. 1-5 Under 5 Years. 5-10 10-15 15-20 20-25 25-40 40-60 60-65 65-80 80 and over. Over 5 Years. All Ages M. F. M. F. m. F. M. F. M. F. M F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Obstructive Diseases of Intestine 5 1 1 ... 6 1 ... 1 ... ... 2 1 ... 1 1 3 4 6 1 1 2 3 1 1 11 17 17 18 35 Peritonitis ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 2 ... 1 ... ... ... 1 ... ... 3 4 3 4 7 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 5 3 12 16 2 3 4 9 ... ... 24 31 24 31 55 Jaundice and other Diseases of Liver 4 4 ... 1 4 5 1 ... ... ... ... 1 ... 1 1 4 6 9 ... 1 5 5 ... 3 13 24 17 29 46 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 Other Diseases of Digestive System 15 15 1 2 16 17 ... ... ... ... ... ... ... ... 3 ... 7 2 2 ... 1 1 ... ... 13 3 29 20 49 Diseases of Lymphatics andof Spleen ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... 1 1 ... 1 ... ... 1 ... ... ... 3 2 3 3 6 Bronchocele, Addison's Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 3 ... 3 3 Nephritis ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... 1 2 4 4 3 ... 2 2 ... ... 14 8 14 8 22 Bright's Disease, Albuminuria ... ... ... ... ... ... 1 ... ... ... ... ... 2 ... 3 6 15 12 7 7 16 23 1 5 45 53 45 53 98 Disease of Bladder or of Prostate 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 l 3 ... 3 ... 4 ... 11 1 12 1 13 Calculus (Stone) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... 2 1 2 1 3 Other Dis. of the Urinary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 2 3 1 ... 1 4 ... ... 9 8 9 8 17 Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... ... ... ... ... ... ...i t ... ... ... ... 6 ... 2 ... 1 ... 5 ... ... ... 14 ... 14 14 Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... 3 3 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta praevia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 1 ... ... ... ... ... ... ... 5 ... 5 5 Other Accidents of Child Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 ... 2 ... ... ... ... ... ... ... 11 ... 11 11 Caries, Necrosis ... ... 1 1 1 1 1 1 ... ... ... 2 ... 1 1 ... 5 1 ... ... ... ... ... ... 7 5 8 6 14 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... 2 2 Carbuncle, Phlegmon 3 ... ... 1 3 1 ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... 1 2 1 ... 5 2 8 3 11 Other Dis. of Integumentary System ... 1 1 1 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 1 ... 4 1 6 7 Fractures and Contusions ... ... 4 2 4 2 2 1 1 ... 1 ... 2 ... 1 1 9 4 3 ... 4 9 ... 1 23 16 27 18 45 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald 2 1 5 3 7 4 2 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... 1 1 ... 4 4 11 8 19 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 4 ... ... ... ... ... ... ... 5 3 5 3 8 Drowning ... ... ... ... ... ... 2 ... ... ... 1 ... 1 ... 5 ... 1 1 1 ... ... ... ... ... 11 1 11 1 12 Suffocation 27 26 ... 1 27 27 ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 2 28 29 57 Otherwise 2 2 2 ... 4 2 3 1 ... ... ... 2 1 ... 4 1 8 2 3 ... 2 3 ... 1 21 10 25 12 37 Manslaughter ... ... ... 1 ... 1 ... ... ... ... ... ... 2 ... 1 ... 1 ... ... ... ... ... ... ... 4 ... 4 1 5 Murder 2 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... ... ... ... ... ... ... 5 ... 5 ... 5 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... ... ... ... 2 2 2 2 4 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 1 ... ... ... 4 1 4 1 5 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... 2 ... ... ... ... ... 4 2 4 2 6 Hanging ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 2 2 ... ... 1 1 ... 7 3 7 3 10 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... 3 ... 3 3 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 ... 2 2 Debility, Atrophy, Inanition 125 88 9 4 134 92 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 1 ... 2 3 4 137 96 233 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Tumour 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 1 ... 2 3 3 3 6 Abscess ... 2 ... 1 ... 3 ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... 1 2 1 5 6 Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined 7 ... 1 ... 8 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 9 1 10 48. 49 Lambeth Parish.-Death registered from all causes the year 1898. Sub-Districts Waterloo Road 1st. Waterloo Road 2nd Lambeth Church 1st. Lambeth Church 2nd. Kennington 1st. Kennington 2nd. Brixton. Norwood Ward not stated. All Ages. Total. I. Specific Febrile, or Zymotic Diseases M. F. M. F. M. F. M. F. m. F m F m f m F m F m f 31 28 17 17 40 31 86 72 103 107 52 46 97 112 33 31 4 1 463 445 908 II. Parasitic Diseases ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 III. Dietic Diseases 2 1 1 2 1 2 1 7 2 6 1 5 6 3 1 1 ... 1 15 28 43 IV Constitutional Diseases 38 28 34 33 54 38 87 57 99 79 68 82 127 115 34 42 17 11 558 485 1043 V. Developmental Diseases 8 3 14 11 10 18 29 26 29 38 16 36 55 51 14 28 1 2 176 213 389 VI Local Diseases 93 78 83 83 82 81 203 190 228 207 160 181 292 289 86 113 60 60 1287 1282 2569 VII. Deaths from Violence 8 3 7 12 27 11 19 12 29 15 16 13 22 12 3 6 4 ... 135 84 219 VIII. Deaths from Ill-defined and not Specified causes 6 13 15 6 13 10 28 16 16 8 19 10 40 32 10 11 3 2 150 108 258 Totals 186 154 171 164 227 191 453 380 507 460 332 373 639 614 181 232 89 77 2785 2645 5430 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 6 1 1 2 4 3 8 8 30 25 3 3 8 9 16 6 ... ... 76 57 133 Whooping Cough 5 12 4 4 6 5 8 9 13 19 8 10 17 30 2 8 1 ... 62 97 159 Scarlet Fever ... 2 1 1 2 5 6 1 1 ... 3 2 1 4 ... 1 ... ... 14 16 30 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever 3 ... 1 2 4 ... 4 3 5 3 2 2 2 2 4 4 1 ... 21 14 35 Diphtheria 2 4 1 2 2 2 5 8 12 17 7 3 18 16 1 ... ... ... 52 56 108 Membranous Croup 1 ... 1 ... ... ... ... 1 1 1 1 ... ... ... 5 4 ... ... 5 2 7 Influenza 6 ... ... ... 2 4 11 3 11 10 10 8 24 28 ... ... ... ... 69 57 126 Other Miasmatic Diseases ... ... ... ... ... ... ... 1 1 ... ... 1 ... 1 1 ... ... ... 1 3 4 Cholera, Nostras ... ... ... ... ... ... 3 ... ... 2 1 ... ... ... ... ... ... ... 5 2 7 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 ... 1 ... ... ... Diarrhœa, Dysentery 7 7 6 5 18 12 36 28 28 28 18 16 18 19 ... ... ... ... 134 120 254 Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Ague ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia glanders,splenic fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 2 2 1 ... ... 2 1 1 1 ... 1 2 1 1 2 1 ... 10 9 19 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 ... 2 Erysipelas ... ... ... ... 1 ... 2 5 ... 1 1 ... 1 ... ... ... 1 ... 6 6 12 Pyæmia, Septicæmia ... ... ... ... 1 ... ... 2 ... ... ... ... 4 2 ... ... ... ... 5 2 7 Puerperal Fever ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 4 4 Thrush, and other Vegetable sitic diseases ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk, Starvation ... ... ... ... 1 ... ... ... 1 3 ... ... 2 ... ... ... ... ... 3 4 7 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism 1 1 1 1 1 2 ... 7 1 3 ... 5 4 3 ... 1 ... 1 8 24 32 Delirium Tremens 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... 4 ... 4 Rheumatic fever ... ... ... 2 1 2 3 ... 2 3 1 1 2 2 1 ... ... ... 10 10 20 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... D* 50 51 Lambeth Parish.- Deaths registered from all causes the year 1898. Sub-Districts Waterloo Road 1st. Waterloo Road 2nd Lambeth Church 1st. Lambeth Church 2nd. Kennington 1st. Kennington 2nd. Brixton. Norwooc Ward not started. All Ages. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Rheumatism ... 1 ... ... ... 2 ... 1 2 1 ... 1 2 3 ... ... 1 ... 5 9 14 Gout ... ... ... ... 1 ... 1 ... 1 ... 1 3 2 2 1 1 ... ... 7 6 13 Rickets ... ... ... ... ... ... ... ... ... ... 1 1 6 2 ... 1 ... ... 7 4 11 Cancer, Malignant Disease 3 4 4 11 6 8 15 7 18 34 18 32 28 46 6 19 7 4 105 165 270 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica ... 2 1 4 2 3 4 4 7 3 ... 1 9 5 1 ... ... ... 24 22 46 Tuberc-Meningitis, Hydrocephalus 2 4 7 1 8 2 4 5 9 6 4 4 8 10 2 2 ... ... 44 34 78 Phthisis 30 17 18 12 28 19 52 34 49 20 38 34 63 35 14 15 8 6 298 192 490 Scrofula ... ... ... ... ... 1 3 3 3 ... 1 ... 1 1 ... ... ... ... 8 5 13 Other forms of Tuberculosis 1 ... 3 2 3 1 3 2 5 5 5 2 1 6 5 2 1 ... 27 20 47 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 2 Anæmia, Chlorosis, Leucocythæmia 2 ... 1 ... 1 ... ... 1 ... ... ... 1 1 2 ... ... ... ... 5 4 9 Glycosuria, Diabetes Mellitus ... ... ... 1 3 ... 1 ... 2 2 ... 1 3 ... 4 1 ... ... 13 5 18 Other Constitutional Diseases ... ... ... ... 1 ... 1 ... 1 4 1 1 1 1 ... ... ... 1 5 7 12 Premature Birth 3 3 9 5 5 8 17 11 15 12 5 8 25 17 5 6 ... ... 84 154 Atelectasis 1 ... 1 2 2 1 4 5 1 1 1 2 2 2 1 1 ... ... 13 70 27 Congenital Malformations 1 ... 1 1 ... 4 2 ... 1 1 3 2 8 2 1 1 ... ... 17 14 28 Old Age 3 ... 3 3 3 5 6 10 12 24 7 24 20 30 7 20 1 2 62 11 180 Inflammation of Brain or Membranes 1 1 ... 1 1 2 3 5 7 5 5 ... 6 4 1 ... ... ... 21 118 42 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 6 3 8 9 3 10 19 18 19 25 16 20 22 24 6 10 4 8 103 18 230 Insanity, General Paralysis of Insane 2 2 2 1 1 2 14 7 4 8 6 3 10 7 1 ... 6 6 46 127 82 Epilepsy ... 2 ... 3 ... ... ... 3 1 3 3 1 2 1 ... 1 2 5 8 36 27 Convulsions 3 2 5 5 4 1 7 3 3 3 8 2 10 6 2 2 2 ... 44 19 68 Laryngismus Stridulus (Spasm of Glottis) ... ... 1 ... ... ... ... ... ... ... ... 1 2 2 2 ... ... ... 5 24 8 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... 1 ... 1 1 2 ... 4 ... ... 2 4 3 1 2 1 ... 14 8 22 Other Diseases of Nervous System ... 2 ... 3 1 2 2 3 1 4 3 4 3 7 2 1 1 ... 13 26 39 Diseases of Ear, Eye, Nose 1 1 ... ... 1 1 2 ... 3 ... 1 1 1 ... ... ... ... ... 9 3 12 Pericarditis ... ... ... ... ... ... ... 1 2 ... 2 1 ... ... ... ... ... 2 4 6 Acute Endocarditis 1 ... ... ... ... 2 1 1 ... ... 1 1 1 2 1 ... ... ... 5 6 11 Valvular Diseases of Heart 3 8 4 5 5 3 7 9 3 8 10 11 11 15 1 11 2 2 46 72 118 Other Diseases of Heart 9 6 3 9 3 7 14 16 20 15 19 26 32 27 9 13 9 11 118 130 248 Aneurism 1 ... ... ... 2 ... 1 1 1 ... 1 ... 2 ... ... ... ... ... 8 1 9 Embolism, Thrombosis ... ... ... 1 ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... 1 4 5 Other Diseases of Blood Vessels ... 1 ... 1 ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... 2 3 5 Laryngitis 1 ... ... ... ... ... 1 ... ... 2 1 ... 3 1 ... ... ... ... 6 3 9 Croup 2 ... ... ... 2 ... ... ... 1 ... 1 ... ... 1 2 1 ... ... 8 2 10 Emphysema, Asthma 1 ... 1 ... ... ... 3 ... 2 3 2 3 5 2 2 1 ... ... 16 9 25 Bronchitis 21 22 21 15 15 21 53 42 53 46 25 42 53 64 9 18 16 15 266 285 551 Pneumonia 12 4 13 8 16 5 20 14 19 9 12 12 24 18 8 6 3 ... 127 76 203 Pleurisy 1 1 ... ... ... ... ... ... 3 3 1 ... 1 2 2 1 ... ... 8 7 15 Bronchopneumonia 7 3 6 3 4 5 14 10 10 5 2 3 9 11 5 2 2 1 59 43 102 Pleuropneumonia ... ... ... ... 1 ... ... ... 4 4 ... ... ... ... ... 1 ... ... 5 5 10 Other Dis. of Respiratory System 1 1 2 ... 2 1 3 6 10 4 5 1 7 2 5 ... ... ... 35 15 50 Dentition 3 ... 3 3 ... 4 2 3 3 3 3 5 6 1 3 2 ... ... 23 21 44 Sore Throat, Quinsy ... ... ... ... ... ... 1 1 ... 1 1 ... ... 3 1 ... ... ... 3 5 8 Diseases of Stomach ... 3 1 ... ... ... ... 5 3 4 4 4 7 7 ... 3 ... ... 17 26 43 Enteritis 7 2 2 4 ... 3 10 11 10 12 4 6 30 27 3 6 4 ... 73 71 144 D* 2 52 53 LAMBETH PARISH.— Deaths Registered from all Causes during the year 1898. Sub-Dirtricts Waterloo Road 1st. Waterloo Road 2nd Lambeth Church 1st. Lambeth Church 2nd. Kennington 1st. Kennington 2nd. Brixton. Norwood Ward not stated. All Ages Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Obstructive Diseases of Intestine ... 1 ... 2 1 1 4 2 3 4 3 2 4 3 1 3 1 ... 17 18 35 Peritonitis ... ... ... ... ... ... ... 1 1 1 ... ... 1 1 1 1 ... ... 3 4 7 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver 1 3 3 2 1 ... 5 ... 2 5 4 7 5 6 3 7 ... 1 24 31 55 Jaundice and other Diseases of Liver 1 2 1 1 2 ... 1 2 7 5 1 5 4 10 ... 4 ... ... 17 29 46 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Diseases of Digestive System 1 1 3 ... 2 2 2 ... 9 8 2 2 5 4 5 3 ... ... 29 20 49 Diseases of Lymphatics and of Spleen ... ... ... ... ... 2 2 ... ... ... ... 1 ... ... 1 ... ... ... 3 3 6 Bronchocele. Addison's Dis. ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 3 3 Nephritis 1 1 1 ... 1 ... 2 3 6 ... 2 ... ... 1 ... 1 1 2 14 8 22 Bright's Disease, Albuminuria 4 6 2 3 4 2 1 14 7 7 6 1 14 6 3 7 4 7 45 53 98 Disease of Bladder or of Prostate 1 ... ... ... ... 1 ... ... 1 ... 4 ... 2 ... 3 ... 1 ... 12 1 13 Calculus (Stone) ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... 2 1 3 Other Dis. of the Urinary System.. ... ... ... 1 1 ... ... 3 3 1 2 1 1 1 1 ... 1 1 9 8 17 Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... ... ... 2 ... 3 ... 1 ... 5 ... 2 ... 1 ... 14 14 Abortion, Miscarriage ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 3 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta prævia, Flooding ... ... ... 1 ... ... ... 1 ... ... ... 1 ... 2 ... ... ... ... ... 5 5 Other Accidents of Child Birth ... ... ... ... ... 1 ... 2 ... 2 ... 2 ... 3 ... 1 ... ... ... 11 11 Caries, Necrosis ... ... ... 1 1 1 3 ... 1 ... 1 1 ... 2 2 1 ... ... 8 6 14 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Other Diseases of Bones and Joints ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 2 Carbuncle, Phlegmon 1 ... ... ... 1 ... 2 ... 1 ... ... ... 3 3 ... ... ... ... 8 3 11 Other Dis. of Integumentary System ... ... ... ... 1 ... ... 1 ... 1 ... 4 ... ... ... ... ... ... 1 6 7 Fractures and Contusions 3 1 2 4 3 ... 3 3 6 ... 2 5 4 4 2 1 2 ... 27 18 45 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn. Scald 1 ... 1 1 1 3 2 1 5 1 1 ... ... 1 ... 1 ... ... 11 8 19 Poison ... ... ... ... 1 1 1 ... 1 ... ... 2 1 ... ... ... 1 ... 5 3 8 Drowning 1 ... 1 ... 2 ... 3 ... 2 ... 2 ... ... ... ... ... ... ... 11 1 12 Suffocation 2 2 1 3 8 2 4 4 8 10 1 2 4 4 ... 2 ... ... 28 29 57 Otherwise ... ... ... 1 5 2 3 2 3 2 5 2 8 2 1 1 ... ... 25 12 37 Manslaughter ... ... ... ... 1 1 ... ... 1 ... 1 ... 1 ... ... ... ... ... 4 1 5 Murder ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 Gunshot Wounds ... ... 1 ... ... ... ... ... 1 ... 2 ... 1 ... ... ... ... ... 5 ... 5 Cut, Stab ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... 1 ... ... 2 2 4 Poison ... ... ... ... 3 ... ... ... 1 ... ... 1 ... ... ... ... ... ... 4 1 5 Drowning 1 ... ... 1 1 1 ... ... ... ... ... 1 1 ... ... ... 1 ... 4 2 6 Hanging ... ... ... ... 1 ... 2 2 1 ... 2 ... 1 1 ... ... ... ... 7 3 10 Otherwise ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 3 Dropsy ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 2 Debility, Atrophy, Inanition 6 12 15 5 12 9 25 16 15 6 17 6 38 30 7 10 2 2 137 96 233 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Tumour ... ... ... ... ... 1 ... ... ... ... 1 1 1 1 ... ... 1 ... 3 3 6 Abscess ... 1 ... 1 ... ... 1 ... ... ... ... 2 ... ... ... 1 ... ... 1 5 6 Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined ...... ... ... ... 1 ... 2 ... 1 1 1 ... 1 ... 3 ... ... ... 9 1 10 54 SUMMARY OF DEATH RETURNS (arranged quarterly). Quarters. | Whole Year. Quarters. Whole Year.]/###] 1st 2nd 3rd 4th 1st 2nd 3rd 4th I.— Specific Febrile, or Zymotic Diseases. VI.— Local Diseases—continued 1. Miasmatic Diseases 231 147 117 107 602 6. Diseases of Lymphatic System ... 1 1 4 6 2. Diarrhœal „ 6 10 218 27 261 3. Malarial „ ... ... 1 ... ... 1 7. Diseases of Gland-like Organs of Uncertain Use ... 1 1 1 3 4. Zoogenous „ 5. Venereal „ 10 2 5 4 21 8. Diseases of Urinary System 38 51 31 33 153 6. Septic „ 5 6 2 10 23 9. Diseases of Reproductive System— II.—Parasitic Diseases 1 ... ... ... 1 (a) Diseases of Organs of Generation 6 1 3 4 14 III.—Dietic Diseases 16 8 11 8 43 (b) Diseases of Parturition 4 4 3 8 19 10. Diseases of Bones and Joints 4 7 2 4 17 IV.—Constitutional Diseases 288 250 253 252 1043 11. Diseases of Integumentary System 7 4 3 4 18 V.—Developmental Diseases 117 95 87 90 389 VII.— Violence. VI.—Local Diseases. 133 129 136 121 519 1. Accident or Negligence 39 48 45 44 176 1. Diseases of Nervous System 2. Homicide ... 3 5 ... 8 2. Diseases of Organs of Special Sense 3 4 2 3 12 3. Suicide 9 9 9 7 34 4. Execution 3. Diseases of Circulatory System 118 88 93 103 402 VIII.— Ill-Defined and not Specified Causes. 56 48 99 55 258 4. Diseases of Respiratory „ 415 194 141 225 975 5. Diseases of Digestive System 69 74 197 92 432 Total 1575 1185 1464 1206 5130 INDEX. iii. INDEX OF TABLES. Page A. The number of Births and the Birth-Rates in each tion Sub-District of Lambeth during 1898 (arranged quarterly)10 B. The estimated Populations, numbers of Inhabited Houses, Marriages, Births, and corrected Deaths for the year 1898 and the ten years preceding, in Lambeth Parish 11 C. The number of Persons per House, the Marriage-, Birth- and Death-Rates, and the proportion of Deaths in Public Institutions per 1,000 persons, for the year 1898, and ten years preceding 13 D. The number of Births and Deaths, with Birth- and DeathRates in each of the Registration Sub-Districts of the Parish during 1898. [The Deaths are from all causes and from the chief Zymotic Diseases, and are corrected by adding Lambethians who die outside the Parish, by omitting strangers who die within the Parish, and by redistributing persons who die in Public Institutions into the Districts from which they have been removed during illness.] 24—25 E. Death-Rates, Zymotic Death-Rates and Zymotic IncidenceRates in the Parliamentary and New Wards, Divisions of Lambeth during 1898 26 F. Mortalities in Lambeth at different age-periods compared with (1) those for London, 1898, and (2) the averages for London for the years 1881-90 27 G. The uncorrected mortality, Male and Female, in the different Districts, and a comparison of the number of Deaths in each Quarter during the year 1898 28 H. The uncorrected mortality (i.e., including that of strangers) at different ages in each District of the Parish during 1898 - 29 I. The uncorrected Deaths (i.e., Parishioners and strangers) at various age-periods in each Quarter of the year 1898 30 J. The Infantile mortalities in the Registrar-General's thirtythree large Towns of England and Wales (including London), and in Lambeth Parish during 1898 32 K. Total cases notified under the Notification Clauses of the Public Health (London) Act, in Lambeth during 1898 (arranged quarterly) 35 L. The number of Certificates for the notifiable Zymotic Diseases received since the introduction of the Notification Act (i.e., in the eight years 1890-97, and in the year 1898) 36 iv. Page M. The number of infected houses, with percentages of (1) General Defects, and (2) Defective Drains, during the years 1898 and the seven preceding years 38 N. Zymotic seasonal variations in the different Registration SubDistricts of Lambeth during 1898, with the Zymotic Death-Rate per 1,000 inhabitants40 O. Deaths from Zymotic Disease (strangers deducted), 1898 41 P. The number of deaths from the principal Zymotic Diseases in the ten years, 1888-97, and in the year 1898 42—43 Q. Vaccination Returns, 1897 45 R. Vaccination Returns for the first half-year, 1898 46 S. The Diarrhcea Mortality in Lambeth in each month during the year 1898 65 T. The classification of causes of Deaths in Lambeth during 1898, compared with 1897— (a.) Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected) 75 (b.) Deaths of infants under one year of age from the chief infantile diseases and from all causes, expressed in terms of 1,000 births 76 U. Table of Uncorrected Deaths during the years 1897 and 1898 classified according to Diseases, in Lambeth and London 77 V. Table of Deaths during the year 1898 in the Lambeth District, classified according to Diseases, Ages and Localities. (Local Government Board Table A.) 78—81 w. Table of Population, Births, and of new cases of Infectious Sickness coming to the knowledge of the Medical Officer of Health during the year 1898, in the Metropolitan Sanitary District of Lambeth, classified according to Diseases and Localities. (Local Government Board. Table B.)82—83 Table showing General and Zymotic Death-Rates, and Scarlet Fever, Diphtheria, Enteric, Diarrhœa, Phthisis, DeathRates for the forty-three different Metropolitan Sanitary Areas, for Registration London, and for Lambeth, 1898 Appendix 2—3 Mortality Tables showing Deaths (corrected) from all causes in Lambeth during 1898, sub-divided— (a.) As to different Age-Periods Appendix 42—47 (b.) As to Registration Sub-Districts Appendix 48—54 V GENERAL INDEX. Page Abatement of Nuisances 85—88 Accidental Deaths 74 Adulteration of Food and Drugs 100—103 Age Distribution of Diarrhœa 64 „ „ Diphtheria 55 „ Scarlet Fever 47 „ „Typhoid 58 „ „ Deaths 11,23,27,29,30 „ „ Population (Lambeth) 7 Air Temperature 64 Alcoholism—Deaths from 73 Analysis of Food and Drugs 100—103 Antitoxin in Diphtheria 56,70 Apoplexy—Deaths from 73 Area of Parish of Lambeth 4,84 Atelectasis 73 Bacteriological Diagnosis 3,69—70 „ Laboratory 69, 94 Bakehouses 133—135 „ List of 134, 135 Bedding, &c., Disinfected 97 „ Destroyed 97 Births and Birth Rates 10—13, 24 Birth Rates in Sub-Districts 10, 16—17, 24 Bodies received into Mortuary 117—119 Bronchitis, Deaths from 73 Cancer, Deaths from 73 Cautions (Food and Drugs) 100, 103 Censal Populations (Lambeth) 4 „ „ (London) 9 Cholera 34,37, 65 Circulatory System, Diseases of 73, 75 77 Clerical Work 148 Closure of Schools 48, 49, 51—53 Combined Drainage 144—147 vi. Page Congenital Malformations 73 Conscientious Objectors 44 Constitutional Diseases 73 Continued Fever 6o Convictions under Public Health Acts 88, Appendix 27—35 „ „ Food and Drugs and Margarine Acts . 88, Appendix 36—41 Convulsions, Deaths from 73 Coroners' Courts 117 Costers and Trade Refuse 22 Costs, Food and Drugs 100, 103 Cowhouses 132—133 „ List of 132—133 „ Defects found in 133 Critical Temperature (Earth) 64 Customs and Inland Revenue Acts 119 Deaths and Death Rates 11,13—32 „ Inner v. Outer Wards 16 Deaths (arranged quarterly) 28,30 Death Rates and Birth Rates—Inter-relationship 12 Deaths—corrected 11,23,24,78—79 „ uncorrected 28—30, 74—77 Deaths in Public Institutions 11,13,15,16 „ Zymotics 11,25,33—84 „ under 1 year 11,23,27,29,30 ,, 5 years 11,23,27,29,30 Deaths from Violence 74 Deaths from Ill-defined and Non-specified Causes 74 Delirium Tremens, Deaths from 73 Density, per acre (Lambeth) 24,84 „ „ (London) 24 Dentition, Diseases of 73 Depots (Refuse and Manure) 108—109 Developmental Diseases 73 Diagnosis (bacteriological) 69—70 Diarrhœa 25, 37, 64—67 „ Age Distribution of 64 „ Monthly Mortality 66 „ Inner v. Outer Wards 65 vii. Page Diarrhœa and Inases 73 Digestive System, Diseases of 73 Diphtheria 54—57 „ Age Distribution of cases 55 „ Increase of 34, 55—56 „ and Bacteriological Examinations 55, 69—70 Disinfection, Details of 94—99 „ Statistics 99 „ Certificates 95 Disinfecting Department 94—99 „ Machines 94, 95 „ Refuge 94, 98 „ Stations 94,95 Drainage 90—91 Drain Testing 90—92 Drainage, Combined 131—134 Drainage Defects 37,38,86, 87 Drowning, Deaths from 74 Dust Depots 108—109 Earth Temperature 64 Effluvium Nuisances 109—111 Enteric Fever (see Typhoid) 34, 58—60 Enteritis 65, 73 Epilepsy, deaths from 73 Equifex Disinfecting Machine 94 Erysipelas 63 Female Inspector 142 Food and Drugs—Adulteration of 100—103 Food Seizures 92—93 Houses condemned 114—118 Houses let in Lodgings 111—113 House-to-House Inspections 93 Housing of the Working Classes Act 87,114—118 Increase of Population (Lambeth) 4,84 „ „ (London) 8 Infantile Mortality 25,31, 32 „ „ (London and 33 large towns of England and Wales) 32 viii. Page Infected Houses 37,38 „ „ and Drains 37,38 Infectious cases removed 34,88 Infectious Diseases Inspection 37, 85, 88 Influenza 68 Inhabited Houses of Lambeth, 1898 8, 11 Inner Districts— Mortalities and Birth Rates 17 Inquests 124 Inspections, House-to-House 90, 93 Inspectors—Increase of Staff 89 „ Under Local Government Board 89 Inspector—Female 90, 139 „ Food and Drugs 89, 100 „ Smoke 89 „ Houses Let in Lodgings 89 Institution Deaths 11, 13, 15, 16 Introductory Letter 3 Lambeth Statistics 4—80 Lavatories 122—123 Liver, Diseases of 73 Local Diseases—Nervous System, Heart, Respiratory Organs, Digestive and Urinary Organs, Reproductive System 73 Local Government Board and Inspectors 89 „ „ „ Tables A and B 78—83 London (County of), Vital Statistics, 1898 8—9 „ Number of Births, Deaths and Marriages, 1898 8 „ Birth, Death and Marriage Rates, 1898 24—25 „ Zymotic Deaths 42—43 „ Zymotic Diseases 44, 48, 50, 57, 59, 60, 61, 63, 65, 68 Manure Depots 110—111 Market Thoroughfares 93 Marriage and Marriage Rates (Lambeth) 11, 13, 14 Measles 50—53, 96 „ Special Report on Appendix 18—23 Measles and School Closure 51—53 Membranous Croup 57 Mortality Rates— Different Age Periods (Lambeth and London) 13,27 ix. Page Mortality Rates (continued)— Different Diseases 75—77 „ „ (Lambeth, quarterly) 28,30,39 Under 1 year of age (London and Lambeth) 27 Mortality Tables Appendix 42—54 Mortuaries 120—123 „ Keepers of 122 Natural Increment of Population (Lambeth) 4, 84 „ „ „ (London) 8 Nervous System (Diseases of) 73 No. of Persons per House (Lambeth) 13 Acre „ 24,84 „ „ „ „ (London) 24 Notices Served 85—88, 92 Non-Notifiable Infectious Diseases 96 Notifiable Infectious Diseases 33—36, 95 Notification Certificates received, 1890-8 33—36 Old Age, Deaths from 73 Outer Districts— Mortalities and Birth-Rates 17 Parliamentary and New Wards (Lambeth)— General Diseases, Deaths 26 Population 6 Zymotic Diseases 26 Zymotic Incidence 26 Parasitic Diseases 73 Peat Moss 111 Penalties— Public Health Acts Appendix 27—35 Food, Drugs and Margarine Acts 100, 103, Appendix 36—41 Housing of the Working Classes Act Peritonitis 73 Persons per House 13 „ Acre 24 Phthisis 73 Plans of Drainage 88, 92 Pneumonia, Deaths from 73 Population of Lambeth, 1898 4—7, 11, 24 „ „ „ Sut-Dis ricts 4, 5, 24 X. Page Population of Lambeth, 1898, Parliamentary and New Wards 6 „ „ „Age Periods 7, 27 Population of London, 1898 8 „ „ „ Sub-Districts 6 Post Mortems 120 Premature Births 73 Premises Disinfected 97 Prosecutions— Public Health Acts Appendix 27—35 Food, Drugs and Margarine Acts Appendix 36—41 Public Institution Deaths 11,13,15,16 Puerperal Fever 61—62 „ „ and Midwives 62 Quarterly Returns (Lambeth)— Births 10 Deaths (Zymotic and General) 28—30, 39, 40 Notifiable Infectious Diseases 35 Disinfection Certificates 95 Railway Sidings and Manure 108—109 Rateable Value of Lambeth, 1898 8 Refuge for Infected Households 94, 98 Refuse Depots 110—111 Register— Slaughter-houses 129—132 Registration Sub-Districts (Lambeth)— General Diseases, Deaths 17,24—25,28—29 Zymotic Diseases, Deaths 17, 24—25 Births and Birth-rates 10, 17 Relapsing Fevers (London) 60 Removal of Infectious Diseases 34. 48, 49 Reproductive System, Diseases of 74 Respiratory Diseases 73 Samples, Food and Drugs 101 Sanitary Defects 87 Sanitary Work 85—143 „ Structural 86—88 „ Non-Structural 86—88 xi. Page Scarlet Fever 47—46 „ Age Distribution of cases 47 „ and School Attendance 48—49 School Closure and Measles 51—53 Simple or Continued Fever 60 Slaughter-houses127—132 „ List of 127—128 „ Defects found in 128 „ Register 129—132 Small Pox 44—46 Smoke Nuisance and Abatement 104—108 Special Report on Death Rates 18—22 Staff— Clerks Inspectors 89—92 Mortuary Attendants 119 Underground Lavatory Attendants 122—123 Suffocation in bed 74 Suicide and Homicide 74 Summary of Vital Statistics (Lambeth) 1898 84 Summary (Vital Statistics) 84 „ (Sanitary Work) 88 Summonses Syphilis 73 Temperature (Air and Earth) 64 Testing of Drains 90—92 Trade Refuse, removal of 21—22 „ and Costers 22 Tuberculosis, Deaths from 73 „ and its Prevention 3, 71—72, Appendix 4— 13 Typhoid (see Enteric) 58—60 „ Age Distribution of 58 „ and Shellfish 60 Typhus60 Underground Conveniences 125, 126 „ „ Receipts, 1898 126 Unsound Food 92—93 Urinary Diseases, Deaths from 73 Vaccination Returns 45,46 xii. Page Venereal Diseases 73 Violent Deaths 74 Vital Statistics, London 8, 9 „ Lambeth 4—84 „ Summary (Lambeth) 84 Water Supply 100 Whooping Cough 50—53 Work of Sanitary Staff 85—93 Workshops 136—143 Defects found 137—141 Female Inspector in 139 Overcrowding in. 138, 143 Trades, &c. 136 Zymotic Diseases 33—84 „ Deaths, Arranged Quarterly 39—40 „ Deaths, Arranged Monthly 41 „ Incidence in Parliamentary and New Wards 26 „ Principal deaths 11,33—67