LAM 16 L - 550 Report on the Vital and Sanitary Statistics of the Parish of Lambeth, During the Year 1899 (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. LAM 16 Public Health Department, 333, Kennington Road, London, S.E. February, 1900. To the Chairman and Members of the Vestry of the Parish of Lambeth. Gentlemen, I again have the honour of presenting to you a favourable Report dealing with the Vital and Sanitary Statistics of the Parish of Lambeth during the year 1801), and in doing so I may be allowed to express my appreciation of the way in which you have supported me in all matters relating to the Public Health. That good and satisfactory work has been accomplished must be admitted by everyone who will take the trouble to read the Report, and without focussing attention unduly, to the detriment of the other work, I feel it my duty to draw special attention to the following :— 1. The provision of a Bacteriological Laboratory at Wanless Road, which is for the sole use of Medical Men practising in Lambeth Parish, and which is now in full working order ; 2. The methods adopted in Lambeth for dealing with the Housing of the Working Classes, so as to prevent as far as possible displacement of tenants; 3. The conclusions arrived at in connection with the important question of Sewer Ventilation ; 4. The gratuitous distribution of Antitoxin (diphtheria) amongst medical men practising in Lambeth Parish. It is often stated that a Sanitary Authority and its Public Health Department rarely get credit for work done, but it will be admitted that this Report reflects sufficient honour on all concerned, not only upon the Vestry as the Sanitary Authority for supporting their Officers readily and willingly, but also upon the Inspectors and others who have at all tunes been ready to do their duty fearlessly and ungrudgingly. Under such circumstances, my own position as Medical Officer of Health is an enviable one. I am, Gentlemen, Your obedient Servant, JOSEPH PRIESTLEY, B.A., M.D., D.P.H., Medical Officer of Health. 4 T.—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 1899. The Parish of Lambeth contains 4,059 statute acres, inclusive of 79 tidal water and 39 foreshore, with an estimated population of 308,108 persons to the midllie of the year 1899, consisting of 145,531 males and 162,577 females, or an excess of 17,046 females. The total estimated increase of the population is 4,035, but the " natural increment," i.e., the excess of births over deaths, is 3,547, so that an entry of 488 in excess of those who went out of the Parish during; the year must be assumed. POPULATIONS. Censal (Enumerated). Estimated (From Censuses 1891 and 1896.) Sub-districts. 1891. 1896. 1899. Middle of Year. Waterloo Road First 14031 14186 14296 Waterloo Road Second 14644 14210 13936 Lambeth Church First 18075 18770 19234 Lambeth Church Second 39097 40994 42252 Kennington First 50536 52486 53753 Kennington Second 39708 43244 45570 Brixton 73405 81825 87350 Norwood 25657 29318 31717 275203 295033 308108 5 Registration Sub-districts. Males. Females. Total. The Lambeth estimated population to the middle of 1899, may be sub-divided as follows:— A. As to Registration Sub-districts. Waterloo Road First 7199 7097 14296 Waterloo Road Second 7137 6799 13936 Lambeth Church First 9700 9534 19234 Lambeth Church Second 21108 21144 42252 Kennington First 26358 27395 53753 Kennington Second 21074 24496 45570 Brixton 39110 48240 87350 Norwood 13845 17872 31717 Parish of Lambeth 145531 162577 308108 6 B As to Parliamentary Divisions and New Wards. Parliamentary Divisions and New Wards. Males. Females. Total. Marsh North Division 31051 30900 61951 Bishop's Prince's Kennington Division 40211 41270 81481 Vauxhall Stockwell Brixton Division 39204 46560 85764 Brixton Tulse Hill Norwood Division 35065 43847 78912 Norwood Parish of Lamteth 145531 162577 308108 N.B.—The 1896 Census takes no account of the Parliamentary and New Wards boundaries, so the distribution of the estimated population among the four Parliamentary Divisions, and the eight New Wards has been obtained from the Censuses 1881 and 1891, 7 C. As to Age-Periods. Age-Periods. Males. Females. Total. 0—1 3993 3975 7968 1—5 14376 14127 28503 Total under 5 18369 18102 36471 5—20 45307 48039 93346 20—40 48865 55061 103926 40-60 24749 28622 53371 60—80 7796 11761 19557 80 and upwards 445 992 1437 Total over 5 127162 144475 271637 8 The estimated number of inhabited houses to the middle of the year 1899 is 41,155, and the rateable value of the Parish on October 14th, 1899, was £1,737,298, an increase of £25,018 on the previous year, as the following Table shews:— Year. Rateable Value. 1899 1,737,298 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 1898 1,712,289 Yearly average for 10 years, 1889-1899, £1,583,114. The Registrar-General returns the estimated population of London for the middle of the year 1899 as 4,546,752, consisting of 2,154,265 males and 2,392,487 females, and states that there were registered during the year 41,853 marriages, 133,120 births (68,034 males and 65,086 females), and 89,689 deaths (46,134 males and 43,505 females). There were registered, too, 11,228 deaths from the seven chief zymotic diseases. The excess of registered births over deaths, i.e., the natural increment, is 43,431 and the estimated increase of population is 42,182. * 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 existence after such list is settled. 9 1899.—Sanitary Areas of the Metropolis. Enumerated Population, 1891 (Census). Enumerated Population, 1896 (Census). Estimated Population, 1899 (middle of year). Birth-Rate. Death-Rate. Zymotic DeathRate. Deaths under 1 year to 1000 Births. London 4211743 4411710 4546752 30.2 19.3 2.5 166 South Districts 1524472 1642796 1723800 30.4 18.8 2.6 164 West Districts 728418 766203 792739 24.9 18.0 1.9 173 North Districts 993884 1040694 1070782 27.2 17.8 2.2 154 Central Districts 259855 245683 236897 27.4 23.0 2.2 168 East Districts 705114 716334 722534 36.1 22.9 3.2 179 10 Table A. giving the number of Births and the Birth-Rates in each Registration Sub-District of Lambeth during 1899 (arranged quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1899. Rate per 1000 Inhabitants. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Waterloo Road 1st 136 119 107 104 466 32.6 „ 2nd 232 214 239 247 932 66.9* Lambeth Church 1st 159 165 133 170 627 32.6 „ 2nd 386 413 356 362 1517 35.9† Kennington 1st 492 485 455 439 1871 34.8 „ 2nd 283 277 288 241 1089 23.9 Brixton 557 519 537 536 2179 24.9 Norwood 200 180 188 184 752 23.7 Lambeth 2445 2402 2303 2283 9433 30.6 * Including Lying-in Hospital (514 cases, of which 341 belong to Lambeth). † Including Workhouse (183 cases, of which 156 belong to Lambeth). 11 Table B, shewing the Estimated Populations, Numbers of Inhabited Houses, Marriages, Births, and Corrected Deaths for the year 1899, and Ten Years preceding, in Lambeth Parish. The Year. Estimated Population. Estima'ed No. of 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 Yens. 1899 308108 41155 2523 9433 5886 1488 2198 782 1680 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 1891 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 1516 1898 304073 40840 2589 9256 5430 1426 2089 726 1543 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 1899 was 9433, as compared with 9256 for the year 1898. Of the total 9433 births, 4849 were males, and 4584 females, showing an excess of 265 males. The birth-rate for Lambeth is, therefore, 30.6 per 1,000 inhabitants (333 for males, and 28'2 for females), as compared with 29 4 for London (316 for males and 27 2 for females) ; 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 help 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 unsatisfactory and less healthy 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, the necessary corrections being given in a footnote (see p. 10). 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 1899 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 1 year, per 1000 Births. Deaths of Children under 1 year. per 1000 Deaths. Deaths of Children under 5 years, per 1,000 Deaths. Zymotic DeathRate, per 1000 Population. Deaths in Public Institutions per 1000 total uncorrected deaths. 1899 7.4 16.3 30.6 19.1 157.7 252.8 373.4 2.5 277.1 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 1898 17.0 30.4 17.9 154.1 262.6 38.7 2.4 277.1 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 1899 was 2523, as compared with 2589 for the year 1898. The marriage-rate for Lambeth is, therefore, 16.3 per 1,000 inhabitants, as compared with 18.4 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 1899 was 6,064, as compared with 5,567 for the year 1898. Of the total 6,064 deaths, 3,066 were males and 2,998 females, showing an excess of 68 males. The death-rate for Lambeth is, therefore, 19.7 per 1,000 inhabitants (21.1 for males and 18.4 for females), as compared with 19.8 for London (215 for males, and 18.2 for females). These rates are, however, uncorrected, and on analysing the 6,064 deaths registered in Lambeth Parish, it is found that 663 represent deaths occurring within the Parish amongst persons not belonging thereto. These are to be deducted, but, on the other hand, there are 485 deaths registered outside the Parish of persons belonging thereto and these must be added, giving a corrected number of deaths for Lambeth during 1899 of 5,886, and a corrected death-rate of 19 1 per 1,000 inhabitants, as compared with 19 3 for London (the total corrected number of London deaths being 87,530). 15 The Institutions, &c., where 485 Lambethians died during 1899 may be grouped as follows:— I. General Hospitals Charing Cross 17 French 3 Guy's 27 Hostel of God 8 King's 7 London 3 Middlesex 7 Royal Free 2 St. Bartholomew's 12 St. George's 8 University 8 Westminster 46 II. Special Hospitals Belgrave 12 Brompton 20 Cancer 3 Central London Sick 1 Cheyne House 1 Cottage Hospital 1 Evelina 27 Friedenheim 3 German 1 Gt. Ormond Street 7 Home for Women 1 Homœopathic 2 Home for Sick Children 2 Mildmay House 1 National 6 North London 1 Nursing Home, Clapham 1 Queen Charlotte 1 Royal Chest 4 St. Luke's 2 St. Mary's 1 St. Peter's House 2 Throat 2 Victoria 2 West London 2 Fever Fountain 29 Grove 24 South-Eastern 9 Western l9 Park Fever Hospital 3 III. Infirmaries and Workhouses St. Olave's Infirmary 1 St. Pancras Workhouse 1 St. Saviour's Infirmary 3 Westminster Workhouse 1 IV. Asylums Banstead 16 Bethnal Green 1 Camberwell House 4 Caterham 16 Cave Hill 33 Colney Hatch 4 Darenth 3 Dartford 4 Grove Hill 4 Hand-in-Hand 1 Hanwell 7 B. M. Prison, Wandsworth 3 H. M. Prison, Wormwood Scrubbs 1 Ilford 18 Leavesden 5 Licensed Victuallers 1 Peckham House 5 V. Unclassifiable Places L. & S. W. Railway 3 River Thames 6 Private Addresses 9 Streets 2 Brought dead to Hospital 1 Salvation Army Homes, Hackney 3 Total 485 16 Summary. I. General Hospitals 148 II. Special and Fever Hospitals 181 III. Infirmaries and Workhouses 6 IV. Asylums 126 V. Elsewhere (Unclassifiable) 24 485 Whether we take the corrected or uncorrected death-rates for Lambeth (as a whole), they are again satisfactory for the year 1899, 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 District, e.g., Waterloo 1st and 2nd, Lambeth Church 1st and 2nd, have again suffered more than the Outer Districts, e.g., Kennington 1st and 2nd, Brixton and Norwood. The corrected death-rate for the four Inner Districts is 24.7 and for the four Outer, 17.2 per 1000, with corresponding average birth-rates of 39.5 and 26.9 per 1000 respectively (remembering the fact that the Lying-inHospital and Workhouse are in the Inner Districts).* The Zymotic death-rate is, for the Inner Districts, 3.8, and for the Outer Districts, 2.03 per 1000, and the Zymotic incidence (cases notified), 10.6 and 7.9 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 corresponding smaller mortality in persons over 60 years of age. *There were 514 births in the Lying-in-Hospital, and 183 in the Workhouse, during 1899 (Vide footnote p. 10). 17 B COMPARISON BETWEEN STATISTICS FOR 1898 AND 1899. Death-Rates Birth-Rates Infantile Mortality (uncorrected) General. Zymotic 1899 1898 1899 1898 1899 1898 1899 1898 Inner Wards— Waterloo 1st 24.9 25.3 3.5 3.5 32.0 35.6 225.3 185.0 * Waterloo 2nd 27.0 25.4 2.9 2.2 66.9 62.3 90.1 113.4 Lambeth Church 1st 22.7 22.9 3.2 3.3 35.7 30.4 240.8 301.2 †Lambeth Church 2nd 24.8 20.1 4.4 2.9 35.9 38.5 207.6 164.3 Outer Wards— Kennington 1st 20.2 18.5 2.7 11 34.8 35.4 165.2 137.2 Kennington 2nd 17.8 16.2 2.1 0.8 23.9 22.5 141.4 139.7 Brixton 15.4 14.9 1.9 0.4 21.9 25.0 135.8 155.9 Norwood 13.5 14.0 1.3 0.2 23.7 20.7 150.3 124.8 Lambeth 19.1 17.9 2.5 2.4 30.6 30.4 161..9 156.3 * Excluding the 514 Lying-in Hospital Births, the birth-rate i 29.9, and the infantile mortality rate 200 9. † Excluding the 183 Workhouse Births, the birth-rate is 31.6, and the infantile mortality rate 236.1. 18 Norwood and Brixton have the lowest general deathrates, and Waterloo Road 1st and 2nd, the highest; whilst the lowest Zymotic rates are in Norwood, Brixton, Kennington 1st, and the highest in Lambeth Church 2nd, Waterloo Road 1st, and Lambeth Church 1st. Compared with last year the death-rate is higher, not only in Lambeth but in London as a whole—a difference chiefly accounted for by the increase in the numbers of deaths from (1) infantile Diarrhœa and other diseases of the gastro-intestinal tract (due to excessive summer heat), and (2) Influenza (directly or indirectly). Allowing for the general increase over the whole of London, the Lambeth statistics are pro rata satisfactory, and the slight improvement noticed during 1898 as compared with the previous year in connection with the separate mortality rates for the Inner and Outer Districts, has been again maintained during 1899 (vide Table on page 17). In other words, the Inner Districts do not suffer so severely as hitherto, though there is still a greater difference between the Inner and Outer Districts in regard to their mortality returns than is satisfactory. No efforts must be spared to lessen the difference, though it is practically impossible to obliterate it, considering the different status of the inhabitants; and the different conditions under which they live, e.g., area or house density. Given good sanitary conditions for the crowded Inner Districts, the difference will be reduced to a minimum, and a Sanitary Authority be doing all it can reasonably be expected to do. The 5,886 corrected deaths may be further analysed and tabulated according to age-periods, as follows :— 19 1488 i.e. 25.28 per cent, of the total deaths took place under 1 year of age. 710 i.e. 12.06 „ ,, ,, between 1 and 5 years. 2198 i.e. 37.34 ,, ,, ,, under 5 years. 304 i.e. 5.17 ,, ,, ,, between 5 and 20 years. 691 i.e 31. 74 „ ,, ,, 20 and 40 years. 1103 i.e. 18.74 ,, ,, ,, 40 and 60 years. 1263 i.e. 2l.46 ,, ,, „ 60 and 80 years. 327 i.e. 5.55 ,, ,, ,, 80 years and over. 3688 i. e. 62.66 ,, ,, ,, over 5 years. These results must be compared with those for London given in Table F, which shows the estimated mortalities per 1000 persons at each age-period for London during 1899, and 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 18 other Districts (out of 43) with a less death-rate, 24 with a less Zymotic death-rate, and 16 with a less infantile mortality, i.e., deaths of infants under 1 year of age per 1000 births. Taking the 15 South Districts, the Lambeth statistics shew up even better, especially on comparing neighbouring Districts—Camberwell and Wandsworth alone having slightly lower death-rates. London, as a whole, has a birth-rate of 29 4, corrected death-rate of 19.3, and Zymotic (death) rate of 2.46, per 1,000 population, and an infantile mortality rate of 166, per 1000 births. B 2 20 21 TABLE D. Shewing the number of Birth and Deaths, with Birth- and Death-rates 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 chief Parish, and by re-distributing persons who die in Public Institutions in other Districts from which they have been removed during illness.Details for London (with corrected deaths) are added for comnarison. DISTRICTS. Persons per Acre. Estimated Population (middle 1899). Total Births. Birth-rate per 1000 of the Population. Total Deaths (corrected). General Death-rate per 1000 of the Population. Total Deaths from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population. Zymotic Death-rate per 1000 of the Total Death. Diarrhoea Death-rate per 1000 of the Population. Infantile Mortality per 1000 Births uncorrected. Small Pox. Measles. Scarlet Fever. 1 Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Diarrhœa. Waterloo Road 1st 213.3 14296 466 32.6 335 24.9 ... 14 1 6 9 ... 3 ... 16 49 3.5 138.5 1.1 225.3 „ 2nd 139.4 13936 932 66.9 354 27.0 ... 10 ... 9 8 ... 4 ... 10 41 2.9 110.3 0.8 90.1 Lambeth Church 1st 118.7 19234 627 32.6 414 22.7 ... 9 2 16 8 ... 5 ... 22 62 3.2 143.2 1.2 210.8 „ „ 2nd 226.6 42252 1517 35.9 1026 24.8 ... 35 5 30 43 ... 8 ... 64 185 4.4 176.9 1.5 207.6 Kennington 1st 109.7 53753 1871 34.8 1064 20.2 ... 37 2 20 27 ... 10 ... 50 146 2.7 134.9 0.9 165.2 „ 2nd 91.5 45570 1089 23.9 789 17.8 ... 16 2 29 10 ... 7 ... 29 93 2.1 115.2 0.6 141.4 Brixton 61.1 87350 2179 24.9 1319 15.4 ... 41 7 44 20 ... 11 ... 39 162 1.9 121.1 0.5 135.8 Norwood 31.4 31717 752 23.7 406 13.5 ... 7 6 5 5 ... 2 ... 15 40 1.3 94.6 0.5 150.3 District not stated ... ... ... ... 179 ... ... ... ... ... ... ... ... ... 4 4 ... ... ... ... Lambeth 78.2 308108 9433 30.6 5886 19.1 ... 169 25 159 130 ... 50 ... 249 782 25 132.9 0.8 161.6 N.B.- In the 179 cases 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 amd foreshore.) 22 TABLE E. Giving Death-rates, Zymotic Death-rates, and Zymotic Incidence-rates in the Parliamentary and New Wards, Division of Lambeth, during 1899. 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 of the population North Division Marsh 689 26.7 90 3.4 257 10.6 Bishop's 967 121 403 Kennington Division Prince's 849 20.9 150 3.2 406 8.5 Vauxhall 851 114 286 Brixton Division Stock-well. 474 14.2 82 1.9 332 7.5 Brixton 741 89 309 Norwood Division Tulse Hill 909 16.7 96 1.7 544 8.9 Norwood 406 40 156 Lambeth 5886 19.1 782 2.5 2693 8.7 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. 23 TABLE F. Showing Mortalities in Lambeth at different Age-Periods compared with (1) those for London 1899, and (2) the averages for London, for years 1881-90. Age Periods. LAMBETH. london. E timated Populations (middle 18P9). Mortality Rates per 1000 Population, 1399. Corrected. Uncorrected. Mortality Rates per 1000 Population, 1899, Uncorrected. Average of Ten Years 1881—90. per 1000. 0—5 36471 603 61.6 61.1 C8.4 5—20 93346 3.3 8.7 3.4 8.9 4.3 20—40 103926 6.6 7.2 7.7 40—60 53371 20.7 22.4 20.2 60—80 1P557 64.6 77.9 685 79.7 63.3 80 and upwards 1437 227.6 243.5 206.2 *Under 1 year 9433 157.7 161.9 167.4 152.0 All Ages 308108 19.1 19.7 19.8 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 i year are given in terms of 1000 births. 24 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 1899. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total No. of Deaths in each District. M. F. Tctal. M. F. Total. M. F- Total. M. F. Total. Waterloo Road 1 st 31 42 73 26 22 48 31 52 83 48 42 90 294 „ 2nd 37 27 64 25 23 48 33 36 69 34 31 65 246 Lambeth Church 1st 114 96 210 122 86 203 149 104 253 135 90 225 896 „ 2nd 182 198 380 177 149 326 237 180 417 202 170 372 1495 Kennington 1st 121 138 259 80 78 158 108 121 229 110 166 216 862 „ 2nd 73 81 157 69 65 134 89 80 169 71 98 169 629 Brixton 163 206 369 114 143 257 158 172 330 142 169 311 1267 Norwood 45 47 92 29 30 59 52 50 102 59 63 122 375 Totals 766 838 1604 642 596 1238 857 795 1652 801 769 1570 6064 25 TABLE H. Shewing the Uncorrected Mortality {i.e., including that of Strangers) at different Ages in each District of the Parish, 1899. Sub-Dist rict. Under I year. 1 to 5 years. 5 to 60 years. | 60 yrs. & 1 upwards. total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Waterloo Road 1st 58 47 105 23 32 55 37 57 94 17 23 40 294 „ 2nd 43 41 84 19 14 33 44 40 84 23 22 45 246 Lambeth Church ut 85 66 151 61 59 120 307 193 500 67 58 125 896 „ 2nd 184 131 315 71 73 144 313 222 535 230 271 501 1495 Kennington 1st 172 137 309 49 55 164 102 121 22 3 96 127 223 862 „ 2nd 84 70 154 31 30 61 9 6 98 194 91 129 220 629 Brixton 172 124 296 85 90 175 208 232 410 112 244 356 1267 Norwood 67 46 113 13 15 28 56 51 107 48 79 127 375 Totals 865 662 1527 352 368 720 1163 1017 2180 684 953 1637 6064 26 TABLE I. Shewing the Uncorrected Deaths (i.e., Parishioners and Strangers) at various Age-periods in each Quarter, 1899. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Under 1 year 170 138 808 157 114 271 531 292 623 107 118 325 1527 Between 1 and 5 years 86 93 179 88 96 181 96 116 212 82 63 145 720 Between 5 and 60 years 315 293 608 260 200 460 285 246 531 303 278 5bl 2180 60 years and upwards 195 314 509 135 188 323 145 141 286 209 310 519 1637 Totals 766 838 1604 640 593 1238 857 795 1652 801 769 1570 6064 27 INFANTILE MORTALITY, 1899. Of the 5886 deaths, 1488 were infants under one year of age, giving a proportion of 1577 (corrected) per 1,000 births, the uncorrected rate being 16L9—an increase over last year. The chief causes of these deaths were debility, atrophy and inanition, bronchitis and other diseases of the respiratory organs, diarrhoea 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 uncorrected infantile mortality varies from 240 8 per 1,000 births in Lambeth Church 1st to 1358 in Brixton (the rate of 901 in Waterloo Road 2nd and 207'6 in Lambeth Church 2nd being explainable by the fact that these Sub-Districts contain the General Lyiny-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 466 105 225.3 2nd 932 84 90.1* Lambeth Church 1st 627 151 240.8 „ 2nd 1517 315 207.6† Kennington 1st 1871 309 165.2 ,, 2nd 1089 154 141.4 Brixton 2179 296 135.8 Norwood 752 113 150.3 Lambeth. 9433 1527 161.9 N.B.—Waterloo Road 1st and 2nd have been amalgamated by the Registrar-General and now form one District called " Waterloo Road." * Excluding the Lying-in-Hospital births, the corrected rate becomes 200.9. t Excluding the Workhouse births, the corrected rate becomes 236.1. 28 TABLE J. Shewing the Infantile Mortalities in the Registrar-General's 33 Large Towns of England and Wales (including London), and in Lambeth Parish, duringl899. Deaths under one year per 10OO Births. Average Ten Years, 1889—98. England and Wales (33 Large Towns.) 181 170 Huddersfield 152 158 Croydon 154 133 Lambeth 1577 153 Bristol 158 148 Halifax 159 159 Derby 162 155 London 166 157 Swansea 166 163 Leeds 171 179 Brighton 173 151 Hull ... 175 177 Sunderland 175 176 Gateshead 177 172 Norwich 179 178 Bolton 181 179 Bradford 181 174 Cardiff 184 162 Wolverhampton 184 191 Birkenhead 186 169 Blackburn 189 202 Birmingham 191 184 Newcastle 193 172 Sheffield 194 183 Leicester 195 198 Plymouth 196 169 West Ham 197 157 Portsmouth 197 152 Liverpool 198 191 Oldham 198 181 Manchester 206 187 Salford 209 200 Nottingham 210 176 Preston 255 237 Burnley 269 208 *London Districts— North 154 South 164 East 179 West 173 Central 168 * The figures are corrected for the London Districts (including Lambeth). 29 CLASS I.—ZYMOTIC DISEASES. Principal Zymotic Diseases. The principal Zymotic diseases are seven in number, viz., smallpox, measles, scarlet fever, diphtheria (including membranous croup), whooping cough, " fevers " (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 1899 there were registered 796 deaths from the seven zymotic diseases, and of these 110 were strangers belonging to other parishes, and 686 parishioners who died within the Parish. 96 parishioners, however, died without the Parish. Subtracting the strangers and adding on the parishioners who died without the Parish, there is a corrccted total of 782, giving a zymotic corrected death-rate of 2 5 per 1,000 inhabitants, the corrected rate for London being 2.5, varying in the various Metropolitan Disticts, 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. Lambeth Church 2nd, Waterloo 1st and Lambeth Church 1st shew the highest, and Brixton, Norwood, and Kennington 2nd the lowest, zymotic death-rates. The zymotic deathrate (average) for the whole of the Inner Districts is 38, and for the Outer, 2 03—a difference explainable, as before, from the crowding and absence of proper means of home isolation and nursing in the former, as compared with the latter, Districts. During the year 1899 under the Notification Clauses of the Public Health (London) Act, 1891, 2693 cases of Infectious Diseases have been reported, and of this number 1649, i.e. 6.2% were removed to the Hospitals of the 30 Asylums Board, or to other Hospitals, and 1046, i.e. 38.8% remained under treatment at their own homes. These percentages are more satisfactory than during the last eight years, i.e., since the introduction of the Notification Act and the tabulation of cases removed to Hospital. In 1891, 366 % of the total Zymotic cases notified were removed; in 1892, 33.7% ; in 1893, 23% ; in 1894, 339% ; in 1895, 30 4% ; in 1836, 43% ; in 1897, 49 % ; in 1898, 55.97; whilst in 1899, the numbers removed form 612 % of the total cases. During 1899, 16.7 % puerperal fever, 6 4% erysipelas, 72 4% scarlet fever, 59.8 % typhoid, 70'5 % diphtheria, 14.3 % continued fever and 9T % membranous croup, were removed to Hospital respectively. Table L gives the averages of Notification Certificates received in Lambeth since 1890, and it will be seen that during 1899 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 1898 is .4 below the average incidence for the nine years 1890-98 (i.e., since the introduction of the Compulsory Notification Act). The three cholera cases were probably cholera nostras (English cholera), or infantile diarrhoea. The diphtheria increase is again a serious one—a total of 1081 notifications being received during the year 1899, i.e., 45.9 % above the average for the last nine years. The cases occurred in 964 infected houses, and in only 15.1% of these were the drains, on testing, found detective. For fuller details as to this increase in diphtheria, vide pp. 51-52. The enteric fever (or typhoid) notifications were also above the average, and represent only 209 infected houses, of which 14 4 % of the drains were shewn, on testing, to be defective. The notifications received during 1899 were 219, as compared with 163 during 1898. This increase in the amount of typhoid in Lambeth during 1898 is explained on pp. 56-56 (vide also Appendix). 31 TABLE K. Shewing the total cases notified under the Notification Clauses of the Public Health (London] Act in Lambeth during 1899 (arranged Quarterly). 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total for 189S Small Pox - 1 - - 1 Scarlet Fever 220 183 201 402 1006 Diphtheria 257 192 249 382 1080 Membranous Croup 10 2 6 4 22 Typhus 1 — — 1 Typhoid 37 21 48 113 219 Continued Fever 1 1 2 3 7 Erysipelas 80 80 70 100 330 Puerperal 4 4 11 24 Cholera - 3 — 3 611 484 583 1015 2693 cc IO 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 nine years, 1890-98, and in the year 1899. Disease. 1898 1891 1892 1893 1894 1895 1896 1897 1898 Annual average of 9 years 1890—'98 Notifications received during '99 Lambeth. Small-Pox 15 3 22 99 26 51 16 2 0 26.0 1 Cholera 7 4 26 23 10 16 6 18 7 13.0 3 Diphtheria 330 330 504 789 521 614 652 704 813 584.1 1080 Membranous Croup 46 29 47 49 26 23 27 17 16 31.1 22 Erysipelas 248 258 420 587 315 355 352 325 294 350.4 330 Scarlet Fever 1126 858 1832 2275 1198 1389 1550 1375 1009 1401.3 ICOtJ Typhus 0 1 8 3 2 0 1 0 0 1.1 1 Typhoid or Enteric 150 149 117 160 268 201 162 ] 85 163 172.8 219 Continued or Relapsing 41 33 34 58 48 20 16 ] 1 13 30.4 Puerperal 13 11 £0 27 19 16 19 26 14 18.3 24 Totals 1976 1676 3025 4070 2433 2685 2801 2663 2329 2628.6 2693 Average per 1000 of population 7.2 6.1 10.9 14.5 8.6 9-4 9.5 8.9 7.7 9.1 8-7 33 In the case of each infected house, an inspection was made, and the drains and sanitary fittings tested, with the results that of the 2435 infected houses:— (a) 384 (i.e., 15.8 %) were found to have defective drains. (b) 1163 (i.e, 47.8%) were found to have defective drains, or defective traps, fittings and appliances. (c) 1272 (i.e., 52.2%) gave no results with the tests. (d) 779 (i.e., 31.9%) were found to have defective traps, fitting's and aDuliances, 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 Delects. Percentage giving no Defects. Drains. Traps, Fitlings and Appliance. Total. Smallpox 1 ... ... ... ... ... Cholera* 3 ... ... ... ... ... Diphtheria 964 146 331 477 49.5 50.5 Membranous Croup 19 4 4 21.1 78.9 Erysipelas 319 39 120 159 49.8 50.2 Scarlet Fever 888 162 248 410 48.2 53.8 Typhus 1 1 1 2 l00.0 0.0 Typhoid 209 30 66 102 48.8 51.2 ( Continued or Relapsing 7 3 1 4 57.1 42.9 Puerperal 24 3 8 10 41.7 58.3 Totals 2435 384 779 1163 47.8 52.2 *These were in all probability cases of Diarrhoea or Cholera Nostras. It will be noted that only 15.8% of the total infected houses shewed, with the test, defective drains, no results being obtained from the test in the other cases, and 319% defective traps, fittings and appliances. Table M gives the average percentages for the last 8 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 1899 is 4.8% below the average in respect of defective drains, and 0 6% below the average in respect of defective traps, fittings, drains and appliances. These percentages are becoming less and less as time goes on, for each year sees many drains reconstructed, partly or wholly (vide pp. 76-78). C 34 TABLE M. Giving number of infected houses winch percentages of (1) General Defects, and (2) Defective Drains, during 1899 and the Seven preceding years. 1892 1893 1894 1895 1896 1897 1898 Average for last 8 years 1892-99 1899 Number of Infected Houses 2430 3179 2012 2111 2417 2374 2094 2374 2436 Number of Houses with defects found 1474 =60.7% 1641 =51.6% 1089 =54.1% 993 =47.04% 1177 =48.7% 1210 =50.9% 1044 =49.9% 1232 =52.9% 1156 =47.5% Number of Houses with defective drains found 720 =24.7% 658 =20.6% 464 =23.06% 392 =18.6% 423 =17.5% 390 =16.4% 351 =16.9% 464 =20.6% 384 15 % Number of Houses with no defects found 956 =39.3% 1538 =48.4% 923 =45.9% 1118 =52.96% 1240 =51.3% 1164 =49.1% 1050 =50.1% 1141 =47.1% 1280 =52.5% N.B.—Only 15 8 per cent, of the houses showed with the test defective drains, no results being obtained in the other cases. 35 The seasonal mortality from the different zymotic diseases is well shown by arranging the deaths quarterly, thus;— 1899. Smallpox. Measles. Whooping Cough. Scarlet Fever. Diphtheria. Membranous Croup. FEVER. Diarrhoea. Erysipelas. Puerperal Fever. Cholera. Influenza. Total. Typhus. Typhoid. Continued. 1st Qr. ... 4 49 11 36 3 ... 11 ... 2 4 3 ... 71 194 2nd Qr. ... 73 43 4 31 1 ... 7 ... 3 2 1 ... 36 201 3rd Qr. ... 67 24 5 40 1 ... 9 ... 230 2 2 24 6 410 4lh Qr. ... 25 14 5 46 1 ... 23 ... 14 9 6 1 38 182 Totals ... 169 130 25 153 6 ... 50 ... 249 17 12 25 151 987 Taking the zymotic diseases collectively, it is noticed that the 3rd quarter shewed the highest mortality, and the 4th quarter the lowest. Influenza, Scarlet Fever and Whooping Cough reached their maxima in tne 1st quarter; Measles in the 2nd quarter; Diarrhoea and Cholera in the 3rd ; and Diphtheria and Typhoid 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 1899, and for the ten previous years, not only in Lambeth Parish, but also (for cumparison) in London. C 2 36 TABLE N. Showi ig Zymotic seasonal variations (deaths) in Lambeth in the different Registration Sub-districts during 1899. Registration Sub-Districts. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. Year 1899. Zymotic Heath-rate per 1000 inhabitants. Waterloo Road 1st 7 5 23 14 49 3.5 Waterloo Road 2nd 5 7 21 8 41 2.9 Lambeth Church 1st 10 5 37 10 62 3.2 Lambeth Church 2nd 26 41 100 18 185 4.4 Kenningfton 1st 22 34 69 21 146 2.7 Kennington 2nd 13 21 41 15 93 2.1 Brixton 26 41 64 31 162 1.9 Norwood 7 5 18 10 40 1.3 District not stated ... ... 3 1 4 ... Lambeth 116 162 376 128 782 2.5 N.B.—In the case of the four zymotic deaths occurring in Districts which are not stated, they have bee a distrbuted equally amongst the eight sub-districts before working out percentages. 37 TABLE O. Deaths from Zymotic Diseases (Strangers deducted). For the 4 weeks ending January. Feb. March. April. i May. June. July. August. Sept. October. Nov. Dec. Total. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... 2 1 7 20 38 36 24 15 3 8 15 169 Scarlet Fever 2 4 3 1 2 2 1 2 2 1 3 2 25 Diphtheria 6 10 12 18 10 14 17 8 16 20 11 11 153 Membranous Croup 2 1 ... ... ... 1 ... ... 1 ... ... 1 6 Whooping Cough 6 18 22 21 10 13 10 8 5 6 2 9 130 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 6 1 4 1 0 1 4 2 5 6 8 10 50 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea ... 1 1 1 ... ... 34 123 77 8 2 2 249 22 37 43 49 44 69 102 167 121 44 34 50 782 Chief Zymotic Diseases Erysipelas 2 1 1 ... ... 1 1 1 3 4 3 17 Puerperal Fever 2 1 1 ... 1 1 1 2 1 2 12 F. Cholera and Choleraic Diarrhoea... ... ... ... 1 ... ... 7 13 3 1 ... ... 25 38 TABLE P. Shewing the number of Deaths from the principal Zymotic Disease. 1889 1890 1891 1892 1893 Smallpox 0 0 0 1 5 Diphtheria (and Membranous Croup) 155 74 78 127 172 Scarlet Fever 73 57 46 76 69 Fever Typhus 1 0 1 C 1 Typhoid or Enteric 31 31 28 22 36 Simple Continued 5 3 7 2 4 Measles 157 183 128 187 113 Whooping Cough 137 194 239 135 151 Diarrhoea 168 154 165 155 197 Lambeth 727 696 692 705 748 (London 9709 12270 9675 11983 13223 39 TABLE P. Diseases in the ten years 1889—98, and in the year 1899. 1894 1895 1896 1897 1898 Total Deaths in 1899. Proportion of Deaths to 1,000 total Deaths 1899. Annual Average of ten years 1988—98. Proportion of Deaths to 1000 total Deaths in 10 years. 1 2 2 — — - - 1.1 0.2 138 103 140 145 115 159 21.2 124.7 23.2 64 53 63 42 3D 25 5.5 57.3 11.7 0 0 1 - 0.4 0.08 46 26 24 26 35 50 6.4 30.5 5.7 0 2 1 — — — — 2.4 0.5 182 151 185 139 133 169 24.5 155.8 28.9 110 132 140 144 159 130 29.3 154.1 29.1 139 263 152 238 254 249 46.8 188.5 32.9 680 732 708 734 726 782 133.7 714.8 132.4 11544 11467 14009 11525 12482 11147 152.2 11788.7 137.4 40 SMALLPOX. Only one case of Smallpox has been notified during the year, and this, in all probability, was a case of ChickenPox. The usual precautions were, however, taken, and no further trouble resulted. In London during the year 1899, 29 cases of Smallpox were notified, and 3 deaths registered, giving a case mortality (uncorrected) of 10.4% . Tables Q and R give the vaccination statistics for the year 1898, and the first half of 1899—these for the second half of 1899 not being ready in time for the Report. It will be noticed that ruring 1898, only 7.9 % (as compared with 25.3 % for 1897) of the children born are unaccounted for as regards vaccination, and 57.1% were successfully vaccinated ; whilst during the first half of 1899, 8.1% are unaccounted for, and 57.9 % have been successfully vaccinated. The ''conscientious objectors" are not proving formidable in Lambeth—only 138 for the year 1898 and 61 for the first half of 1899, and the Vaccination Act of 1898 may be said to be working satisfactorily—the much-dreaded clause proving practically less harmful than was to be anticipated. This Clause (the conscientious objector's) is sufficient to prevent persons being compelled to have their children vaccinated, but failing their taking advantage of such Clause, vaccination is practically as compulsory as ever. Undoubtedly the use of glycerinated calf-lymph is causing the anti-vaccination movement to totter—the confidence of the outside public in such lymph growing, in view of the experiments of bacteriologists, which go to prove that glycerine, as an adjunct, has the power of purifying the lymph, and freeing it from all extraneous micro-organisms, even the tubercle bacilli, should such be present. Domiciliary vaccination is proving successful, and assisting in making the operation much more acceptable to the people. 41 TABLE Q.—VACCINATION RETURNS, 1898. Registration Sub-Districts. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Dead Vaccinated. Conscientious Objectors. Postponed on Medical Certificate. Removed to other Parishes Gone and not found. III or not otherwise accounted for. Waterloo Road 1380 757 2 180 8 10 232* 189* 2 Lambeth Church 1st 583 326 — 86 7 7 10 145 2 Lambeth Church 2nd 1613 959 3 203 22 15 67† 327† 17 Kennington 1st 1892 1106 8 236 30 33 170† 289† 20 Kennington 2nd 1011 652 3 102 22 — 18 124 90 Brixton 2152 1078 15 249 40 — 31 220 519 Norwood 641 421 6 50 9 - 17 53 88 Lambeth 9275 5299 37 1106 138 65 545 1347 738 * Hospital Cases (250; included. † Workhouse Cases (30) included. ‡ Maternity Cases (172) included. 42 TABLE R.—VACCINATION RETURNS FOR THE FIRST HALF-YEAR, 1899. 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 686 394 ... 70 3 19 112* 83* 5 Lambeth Church 1st 324 197 ... 39 1 11 6 64 6 Lambeth Church 2nd 799 471 l 101 9 38 18† 135† 26 Kennington 1 st 976 588 5 129 15 45 85‡ 95‡ 14 Kennington 2nd 565 383 8 37 13 8 17 56 43 Brixton 1099 541 13 106 16 2 37 128 256 Norwood 377 224 3 28 4 2 13 64 39 Lambeth 4826 2798 30 510 61 125 288 625 389 The Yearly Returns are not made up for the Local Government Board until the August in the following; year. * Hospital cases (165) included. † Workhouse cases (24) included. Maternity cases (110) included. 43 SCARLET FEVER. During 1899, 25 deaths were registered from Scarlet Fever, as compared with 30 during 1898, and an annual average of 57.3 for the last 10 years (1889-98). 1,006 cases were notified, as compared with an annual average of 1401.3 for the 9 years 1890-98; and of these 1,006 patients, 728 were treated in hospital, and 278 at their own homes. The case mortality is, therefore, 2.5%, varying in different Registration Sub-districts (an average of 2.3 for the Inner as compared with 2.6 for the Outer), and from 2.9 to 2.3 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 1899 are as follows:— Ages. Number of Cases Notified. Deaths. Death rate* per 100. M. F. Total. M. F. Total. Under 1 year 8 2 10 1 — 1 7.7 1 to 2 18 13 31 — 2 2 5.9 2 to 3 41 21 62 1 1 2 3.1 3 to 4 33 48 81 2 2 4 4.8 4 to 5 51 46 97 2 1 3 3.0 5 to 6 53 45 98 3 — 3 2.9 6 to 7 37 43 80 1 — 1 1.2 7 to 8 34 34 68 1 1 2 2.8 8 to 9 32 39 71 — 1 1 1.4 9 to 10 27 32 59 — 1 1 1.6 Over 10 years 142 174 316 3 2 5 1.6 Age not stated* 12 21 33 — — — — Total 488 518 1006 14 11 25 2.5 *In 33 cases the ages are not given, but in calculating percentages, these cases have been equally distributed amongst the different age-periods. 44 In London during 1899 there were registered 398 deaths out of a total of cases 18,112 of scarlet fever notified, giving a case mortality of 2.2% (uncorrected). As far as could be traced no scarlatinal milk outbreak occurred during 1899, and no school had to be closed on account of an outbreak of scarlet fever amongst the scholars. It is satisfactory to record that 72.4% of the cases were removed to the hospital—86.1% from the Inner, and 67.1% from the Outer, Districts. The number of deaths (25) is very small, giving a death-rate per cases notified of only 2.5%. Registration SubDistricts. Total No. of Cases notified. Cases treated at home Cases removed to Hospital. No. of Deaths. At Home. in Hospital. Total. Case mortality per 100. Rate of Persons notified per 1000 Inhabitants. Waterloo Road 40 2 38 ... 1 1 2.5 2.8 1st Waterloo Road 32 7 25 ... ... ... 0 0 2.3 2nd Lambeth Church 99 26 73 ... 2 2 2.02 5.2 1st Lambeth Church 109 4 105 ... 5 5 4.6 2.6 2nd Kennington 1st 160 27 133 2 ... 2 1.25 2.9 Kennington 2nd 168 71 97 2 ... 2 1.2 3.7 Brixton 290 91 199 ... 7 7 2.4 3.3 Norwood 108 50 58 4 2 6 5.5 3.4 Lambeth 1006 278 728 8 17 25 2.5 3.3 45 MEASLES AND WHOOPING COUGH. During 1899, 169 and 130 deaths were registered from Measles and Whooping Cough respectively, as compared with 133 and 159 during 1898, and annual averages of 155.8 and 154.1 for the last ten years (1889-98). In London, during 1899, there were registered 2,142 and 1,720 total deaths from Measles and Whooping Cough, giving corresponding death-rates (uncorrected) of 4.7 and 3.8 per 10,000 of the population living, respectively. Waterloo Road First suffered most, and Norwood least, from Measles; whilst Lambeth Church Second suffered most, and Norwood least, from Whooping Cough. Measles was epidemic in Lambeth during the second, third and fourth quarters, reaching a maximum during the second quarter. In the Annual Report for 1898 it was pointed out that the Vestry decided to distribute from house-to-house a leaflet pointing out the after-effects of Measles, if not properly attended to, and also the general dangerous and infectious nature of the disease. Posters (large and small) were also posted throughout the Parish, and every means taken to educate the public as to the serious nature of Measles and the urgent necessity for taking precautions to prevent its spread. The result has been that the amount of disinfection in connection with Measles-infected houses and clothes has been very considerably increased during 1899 (773 cases as compared with 129 during 1898). The question as to 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, without compulsory notification, still 46 remains unsettled by the Vestry, and I take this opportunity of again suggesting that the London County Council should be urged to do so forthwith by the Vestry.* As to the good that will accrue from so doing, there can, I think, be no two opinions, when it is remembered that Measles is a dangerous infectious disease in so far as it causes such a large number of deaths (chiefly amongst young children), though not yet so included under the Act. The whole subject is an important one from the point of view of Sanitary Administration; and it may be added that what applies to Measles, applies, too, to Whooping Cough. The importance of school or class-closure as a preventative against the spreading of a Measles epidemic has been well shewn during the year 1899 in the following cases:— Lollard Street Board School, Infants' Department.— Average number on roll 370, and of these 43.8% were absent on account of Measles. The Infants' Department was closed from July loth to August 28th, by order of the Medical Officer of Health, rooms disinfected and cleansed, and drains tested. Result of closure was the diminution of the epidemic. St. John's, Warham Street, Infants' Department.— Average number on roll 320, and of these 29.1% were absent on account of Measles. The Infants' Department was closed from July 19th to August 28th, by order of the Medical Officer of Health, rooms disinfected and cleansed, and drains tested. Result of closure was the dying-out of the epidemic. *Whilst this Report is passing through the Press, the Vestry at their meeting held on March 1st, 1900, decided that Measles should be included in the term "dangerous infectious diseases," and that the London County Council should be asked to take the necessary steps. 47 St. Mary-the-Less, Prince's Road, Infants' Department.—Average number on roll 260, and of these 19.3% were absent on account of Measles. The Infants' Department was closed from July 20th to August 28th, by order of the Medical Officer of Health, rooms disinfected and cleansed, and drains tested. Result of closure was the diminution of the epidemic. St. Saviour's, Salamanca, Infants' Department—Average number on roll 182, and of these 23.4% were absent on account of Measles. The Infants' Department was closed from July 20th to August 28th, by order of the Medical Officer of Health, rooms disinfected and cleansed, and drains tested. Result of closure was the diminution of the epidemic. In the above cases, disinfection was carried out, the drains tested, and the school-rooms cleansed. Outbreaks of Measles were investigated, but no action taken as to closing, in connection with the following schools:— Springfield Road School (Board). Infants 6.7% absentees ,, ,, ,, ,, Girls 3.2% ,, *Stockwell ,, ,, „ Infants 19.3% „ ,, ,, ,, ,, Girls 8.4% „ *Santley Street ,, ,, Infants 26.9% ,, Kennington Road „ ,, Infants 4.3% ,, Vauxhall Street ,, ,, Infants ll.7% „ *These were declining epidemics, as shewn by the fact that in the case of Stockwell Road School there were 30% absent during week ending May 23rd, ar,d only 19.3% during week ending May 30th; whilst at Santley Street School 62.1% were absent during week ending May 26th, and 26.9 during week ending June 2nd. It is not advisable to close in the case of a declining epidemic. 48 Christ Church Schools (Church) Boys & Girls 5% absentees Salter's Hill School (Board), Infants 9.7% ,, St. John the Apostle (Church) Junior mixed 5.7% ,, St. Mary's, Prince's Road ,, Girls 10.7% ,, Sancroft Street School ( ,, ) Boys 10% „ St. Saviour's, Salamanca (Church) Girls 13.9% ,, Stockwell Road School (Board) Boys 11.4% „ Santley Street ,, ,, Girls 3.5% ,, ,, ,, ,, Boys 7.7% „ Two of the above schools (infants' departments) were disinfected, whilst in many cases the houses of the absentees were visited, and necessary disinfection carried out, increasing the work of the disinfecting staff considerably. In no single case was a school or class closed on account of Whooping Cough, though this disease was, undoubtedly, epidemic in Lambeth during 1899, and many children must have been absent from school in consequence of suffering from this disease themselves, or living in houses wherein other children were so suffering. Disinfection was carried out during the year in 58 cases, a satisfactory statement to be able to make considering that hitherto in Lambeth practically no such action has been taken. Much yet remains to be done, as Whooping Cough (like Measles) is an infectious disease, which causes much damage—130 deaths from this disease being registered in Lambeth during 1899, as compared with an annual average during the last ten years, 1889-98, of 154. Even when death does not occur, the amount of ill-health left as a result of Whooping Cough is considerable, calling for every effort on behalf of a Sanitary Authority to prevent the extension of the disease. Whooping Cough (like Measles) is a disease that is apt to spread by means of schools. 49 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 9 14 6.3 9.8 Waterloo Road 2nd 8 10 5.8 7.2 Lambeth Church 1st 8 9 4.2 4.7 Lambeth Church 2nd 4.3 35 10.2 8.3 Kennington 1st 27 37 5.0 6.9 Kennington 2nd 10 16 2.2 3.5 Brixton 20 41 2.3 4.7 Norwood 5 7 1.6 2.2 District not stated* ... ... ... ... Lambeth 130 169 4.2 53 Of the 169 deaths registered from Measles, 43 were in infants under 1 year of age, 118 in children between 1 and 5, making a total of 161 in children under 5 years of age—78 males and 83 females. Of the 130 deaths registered from Whooping Cough,???59 were in infants under 1 year of age, 69 in children between 1 and 5, making a total of 128 in children under 5 years of age—51 males and 77 females. Both diseases are distinctly diseases of childhood. D 50 DIPHTHERIA. During 1899, 153 deaths were registered in Lambeth from Diphtheria, as compared with 108 during 1898, and an annual average of 124'7 for the last ten years (1889 to 1898). 1081 cases were notified during 1899, as compared with 813 in 1898, and an annual average of 5841 for the nine years, 1890 to 1898. Of the 1081 cases notified, 761 were removed to hospital and 320 were treated at their homes. The case mortality per cent, for the year is, therefore, 14 2, varying from 14 2 to 14T, 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, especially when it is remembered that the antitoxin treatment in hospital is beginning to have a favourable effect, by lowering the Diphtheria death-rate amongst the patients treated there. The case mortality rate, as a whole, for Lambeth is low, pointing in part to the mildness of the majority of the cases, more especially in Lambeth Church 1st and Norwood, where the case mortality was 10 4 % and 9 4 % respectively. In many instances outbreaks of mild throat trouble were again noted, showing that in all probability, many cases of unsuspected Diphtheria were the means of spreading the disease. In the 216 cases that were submitted to bacteriological examination, true diphtheria bacilli were found in 46 8 °L . The age and sex incidence and mortality from Diphtheria cases notified in Lambeth during 1899 are as follow:— 51 Ages. N umber of cases Notified. Deaths. Death-Rate per 100. M. F. Total. M. F. Total Under 1 year 8 4 12 4 5 9 56.3 1 to 5 181 166 347 45 38 83 23.6 5 to 10 179 224 403 25 21 46 11.3 10 to 20 62 108 170 6 4 10 5.8 20 to 40 38 64 102 2 1 3 2.8 40 to 60 4 11 15 ... 1 1 5.3 60 and over 1 3 4 ... 1 1 14.3 Age not stated* 14 13 27 ... ... ... — Total 487 593 1080 82 71 153 14.2 *In making percentages, these cases have been distributed equally amongst the different age periods. The Diphtheria statistics for Lambeth are as follow:— 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 1899 308108 153 496 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 D 2 52 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. The 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. The Vestry is to be congratulated upon having decided to supply, free of charge, antitoxin to all the medical practitioners attending patients in Lambeth Parish—a decision come to at the Meeting of the Vestry, held on August 3rd, 1899. The antitoxin is made up in glass bottles, each containing 1,500 units (Behring) and being wrapped round with full directions as to use, etc. Up to the end of the year (i.e., during a period of 4 months). 69 bottles have been gratuitously distributed in Lambeth, with the following results:— No. of vials given out, 69 No. of cases treated with antitoxin, 53 Results Successful, 52 Unsuccessful, 1 There was one serious outbreak of Diphtheria in connection with a school in Ferndale Road, necessitating closure, and the thorough overhauling of the sanitary arrangements, and drains. Full details of this outbreak are to be found on pp. 127-128. 53 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 Persors Notified per 1000 Inhabitants. At Home. In Hospital. Waterloo Road 1st 43 4 39 — 6 6 13.9 3.01 Waterloo Road 2nd 75 5 70 2 7 9 12.0 5.4 Lambeth Church 1st 154 17 137 — 16 16 10.4 8.01 Lambeth Church 2nd 161 51 110 13 15 28 17.4 3.8 Kennington 1st 124 28 96 8 11 19 15.3 2.3 Kennington 2nd 201 76 125 8 19 27 13.4 4.4 Brixton 270 107 163 11 32 43 15. 3.1 Norwood 53 32 21 3 2 5 9.4 1.7 Lambeth 1081 320 761 45 108 153 14.2 3.5 During 1899, in Lambeth, 22 cases were notified from Membranous Croup, and 6 deaths were registered, giving a case mortality of 27.3, as compared with 16 cases notified, and 7 deaths registered during 1898. Two of the 22 Lambeth cases were removed to Hospital. In London, during 1899, there were registered 1,963 deaths out of a total of 13,701 cases of Diphtheria and Membranous Croup notified, giving a mortality of 14.3%* (uncorrected). *In London Statistics, Diphtheria and Membranous Croup are now grouped together by the Registrar-General. 54 TYPHOID FEVER. During 1899, 50 deaths were registered in Lambeth from Typhoid (or Enteric) Fever, as compared with 35 during 1898, and an annual average of 30.5 for the last ten years (1889 to 1898). 219 cases were notified during 1899, as compared with 163 during 1898, and an annual average of 172.8 for the nine years, 1890 to 1898. Of the 219 cases notified, 131 were removed to hospital, and 88 were treated at home. The case mortality for the year is, therefore, 22.8, varying from 26.7 to 17.1, 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. Number of cases Notified. Deaths. Death-rate per 100. M. F. Total. M. F. Total. Under 1 year 1 1 2 — 1 1 30.3 5 to 10 13 9 22 — 2 2 8.6 10 to 20 42 15 57 7 7 14 24.0 20 to 40 55 39 94 14 8 22 23.1 40 to 60 11 11 22 4 5 9 38.6 60 and over — — — — — — — Age not stated* 6 3 9 — — — — Total 136 83 219 27 23 50 22.8 *When the age is not stated, in calculating percentages, these cases are divided equally amongst the different age-periods. 1 to 5 8 5 13 2 — 2 13.9 55 In London during 1899 there were registered 800 deaths out of a total of 4,460 cases of Typhoid notified, giving an uncorrected case mortality of 17.9%. 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. Kate of persons Notified per 10,000 Inhabitants. In Hospital Waterloo Rd. 1st 9 2 7 33.3 — 3 3 6.3 Waterloo ,, 2nd 11 4 7 36.4 2 2 4 7.9 Lambeth Ch. 1st 21 5 16 23.8 — 5 5 10.9 Lambeth Ch. 2nd 32 2 30 25.0 1 7 8 7.6 Kennington 1st 50 21 29 20.0 3 7 10 9.3 Kennington 2nd 33 15 18 21.2 2 5 7 7.2 Brixton 53 33 20 20.8 6 5 11 6.1 Norwood 10 6 4 20.0 1 1 2 3.2 Lambeth 219 88 131 22.8 15 35 50 7.1 The case mortality was slightly higher in the Inner than the Outer Districts, viz., 27,4% as compared with 20.6%. It is satisfactory to note that 59.8% of the cases were removed to hospital. The increase in the number of Typhoid notifications for the year 1898 is explained by three localised epidemics or outbreaks (over 20 cases in all) that occurred towards the latter end of the year, and which were specially reported upon to the Vestry (see Appendix). Personal contact, as a factor in the spread of Typhoid, is not 56 sufficiently admitted, and the three special outbreaks investigated in connection with Lambeth—fortunately, small outbreaks, on account of the severe and prompt measures taken—will rank as important evidence in shewing that the disease is apt to spread from person to person oftener than is generally supposed—the fœces and urine of patients being sources of infection, well-proved by bacteriological methods. The natural corollary to the above statement is the importance of strict isolation of all cases (preferably in hospital), whilst the absolute necessity of diagnosing the disease as early as possible, must come to be more and more realised. Bacteriological examination of the blood of suspected persons is a ready means at hand for assisting medical practitioners in their diagnosis of doubtful Typhoid cases, and such examination (offered gratuitously in Lambeth) is much appreciated, and coming to be more and more used (81 blood samples having been examined during the last year). 25 cases were introduced into Lambeth from outside, and in 6 cases there appears to have been a causal relationship between the attacks and the previous ingestion (within the incubation period) of infected shellfish, in three cases oysters, in two cases mussels, and in one case cockles, being the suspected medium. 35 cases were due to personal contact, other likely sources being excluded. CONTINUED AND TYPHUS FEVERS. During 1899, 7 cases were notified in Lambeth, but no deaths were registered, from Continued Fever, as compared with 69 cases notified and 1 death registered (i.e., 1.5% uncorrected case mortality) in London. One case of Typhus was notified in Lambeth, but in all probability this was a case of Typhoid fever. 14 cases were notified in London, and 3 deaths registered, from Typhus during 1899, giving a case mortality of 21.4% (uncorrected).* *One case of Relapsing fever was notified in London during 1899. 57 PUERPERAL FEVER. During 1899 in Lambeth 12 deaths were registered from Puerperal Fever (a disease of child-bed), as compared with 4 during 1898, and an annual average of 12.6 during the last 10 years (1889—98). 24 cases were notified, as compared with 14 during 1898, and an annual average of 18.3 for the 9 years 1890-98. The case mortality for 1899 is 50 %. In London, during 1899, there were registered 209 deaths out of a total of 329 cases notified, giving a case mortality of 62.9% (uncorrected). Registration Sub-Districts. Number of Cases Notified. Number of Deaths. Case Mortality per 100. Waterloo Road 1st 2 1 50.0 Waterloo Road 2nd 1 0 0.0 Lambeth Church 1st 4 2 50.0 Lambeth Church 2nd 4 2 50.0 Kennington 1st 3 2 66.6 Kennington 2nd 4 1 25.0 Brixton 5 3 50.0 Norwood 1 1 100.0 Lambeth 24 12 50.0 58 ERYSIPELAS. During 1899, in Lambeth 17 deaths were registered from Erysipelas, as compared with 12 for 1898, and an annual average of 17.5 during the last 10 years (1889—1898). 330 cases were notified, giving a case mortality of 5.2%. In London, during 1899, there were registered 213 deaths out of a total of 5,615 cases notified, giving a case mortality of 3.8% (uncorrected). Registration Sub-Districts. Number of cases Notified. Number of Deaths. Case Mortality per 100. Waterloo Road 1st 25 0 0.0 Waterloo Road 2nd 18 2 11.1 Lambeth Church 1st 35 2 5.7 Lambeth Church 2nd 70 3 4.3 Kennington 1st 46 5 10.9 Kennington 2nd 44 3 6.9 Brixton 76 1 1.3 Norwood 16 1 6.3 Lambeth 330 17 5.2 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. 59 DIARRHŒA. During the year 1899 there were registered in Lambeth 249 deaths from Diarrhœa, as compared with 254 during 1898, and an average of 188.3 for the last 10 years. Of these 249 deaths, 228 (i.e., 91.6 per cent.), were in children under five years, and 198 (i.e., 79.5 per cent.) in infants under one year of age. August and September were the most fatal months (see Table S), though the disease was prevalent also during July and October. In this connection, it is again interesting to note that the mean monthly air temperature was in June, 60.7°; July, 65.7°; August, 65.7°; September, 57.7°; and October, 49.1°; whilst the 4-ft. earth thermometer registered 56°F. on June 13th, rising to a maximum 65°F. on August 13th, and sinking to 56°F. again on October 9th. 56°F. is the so-called "critical" earth temperature for Diarrhœa, i.e., the temperature at which the germs of this particular disease begin to multiply and prove themselves dangerous.* Age mortalities from Diarrhœa were as follows:— Age Total Deaths. Percentage of Total Deaths from Diarrhœa M. F. Total. Under 1 year 90 108 198 79.5 1 to 5 19 11 30 12.1 5 to 20 — 3 3 1.2 20 to 40 1 — 1 0.4 40 to 60 1 2 3 1.2 Over 60 6 8 14 5.6 Total 117 132 249 100.0 *The 4-ft. earth temperatures were taken in Regents Park, and I beg to acknowledge my indebtedness to Mr. Wm. Marriott, of the Royal Meteorological Society, for the information in connection therewith. 60 In London there were registered during 1899, 4,196 deaths from Diarrhoea, giving an uncorrected rate of 9.2 per 10,000 living, and 4.7% of total deaths. Registration Sub-Districts. Number of Deaths. Diarrhœa Death-rate per 10,000 Inhabitants. Waterloo Road 1st 16 11.5 Waterloo Road 2nd 10 7.5 Lambeth Church 1st 22 11.2 Lambeth Church 2nd 64 15.3 Kennington 1st 50 9.4 Kennington 2nd 29 6.5 Brixton 39 4.5 Norwood 15 4.9 District not stated 4 — Lambeth 249 8.1 In the Inner Wards the average Diarrhœa death-rate per 10,000 inhabitants was 12.7 as compared with 6.2 for the Outer Wards, i.e., 2 to 1. The Inner Wards during 1899 have suffered less pro rata from Diarrhoea than during last year. Under the heading of Diarrhœa may be classed the 3 cases of cholera* notified, together with the 25 deaths registered, in Lambeth during the year, as there is no reason to regard any one case as "Asiatic Cholera"; and also the 166 deaths registered from "Enteritis." Diarrhœa and other diseases of the gastro-intestinal tract (including Typhoid Fever) have increased the death-rate both in Lambeth and in London generally. *15 cases of Cholera were notified in London. 61 TABLE S. Shewing the Diarrhoea Mortality in Lambeth in each month during the year 1899. Sub-Districts. Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Waterloo 1st ... ... ... ... ... ... 5 4 6 1 ... ... 16 Waterloo 2nd ... ... ... ... ... ... 2 3 5 ... ... ... 10 Lambeth 1st ... ... ... ... ... ... 4 11 7 ... ... ... 22 Lambeth 2nd ... ... ... ... ... ... 11 31 20 1 ... 1 04 Kennington 1st ... ... l ... ... ... 4 28 13 4 ... ... 50 Kennington 2nd ... ... ... l ... ... 3 17 7 1 ... ... 29 Brixton ... 1 ... ... ... ... 4 19 14 1 ... ... 39 Norwood ... ... ... ... ... ... ... 10 5 ... ... ... 15 District not stated ... ... ... ... ... ... 1 2 1 ... ... ... 4 Total ... 1 1 I ... ... 34 125 78 8 ... 1 249 62 INFLUENZA. During 1899,151 deaths were registered from Influenza in Lambeth, as compared with 126 during 1898, and an average of 81.9 for the last ten years. Of these 151 deaths, 71 were registered during the first, 36 during the second, 6 during the third, and 38 during the fourth quarter of the year. In London there were registered 1817 deaths (uncorrected) from Influenza during 1899. 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, 1895, and 1899. The disease during 1899 was almost 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. 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 Average for 10 years (1889-98.) 1899 Lambeth 0 47 131 142 85 44 148 51 45 126 81.9 151 London (including Lambeth). 5 652 2336 2264 1526 750 2156 496 671 1283 1213.9 l8l7 63 The 37 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. 38 deaths were registered in Lambeth in these classes from Alcoholism and Delirium Tremens. Class 1V.—Constitutional Diseases. Of the total 1082 deaths under this class 261 were due to Cancer, 525 to Phthisis, and 205 to Tubercular Meningitis and other forms of Tuberculosis. Class V.—Developmental Diseases. The total number of deaths in this class was 396, consisting of 184 from Premature Birth, 166 from Old Age, and 46 from Atelectasis and Congenital Malformations. Class VI.—Local Diseases. 1. Diseases of the Nervous System caused 504 deaths, including 59 from Convulsions, 237 from Apoplexy, and 19 from Epilepsy. 2. 451 deaths were due to diseases of the Circulatory System. 3. The diseases of the Respiratory Organs caused 1172 deaths (661 from Bronchitis, and 235 from Pneumonia). 4. Diseases of the Digestive Organs caused 520 deaths, of which 185 were due to Enteritis and Peritonitis, 138 to diseases of the Liver, and 45 to Dentition. 5. Diseases of the Urinary System caused 187 deaths. 64 6. Diseases of the Reproductive System, Integumentary System, Locomotive System, Lymphatics, Organs of Special Senses, etc., caused together 85 deaths. C lass VII.—Deaths from Violence. 182 deaths in all, including 151 from Accidents, 15 from Burns and Scalds, 14 from Drowning, 40 from Suffocation in bed (33 being infants under 1 year), 24 from Suicide, 6 from Homicide, and 1 from Execution. Class VIII.—Other Causes. 231 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 favourbly 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. 65 TABLE T. Shewing Classification of Causes of Deaths in Lambeth during 1899, compared with 1898. A.—Total Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected). Class of Disease. Lambeth Parish. 1898. 1899. No. of Deaths (corrected). Percentage of Total Deaths. No. of Deaths (corrected). Percentage of Total Deaths. I.—Zymotic Diseases 908 16.7 1033 17.6 Seven Principal 726 13.4 782 13.3 Influenza 126 2.3 151 2.6 II.— Parasitic 1 0.02 2 0.03 III.—Dietetic 43 0.8 41 0.7 IV.—Constitutional 1043 19.2 1082 18.4 Cancer 270 4.9 261 4.4 Phthisis 490 9.0 525 8.1 Tubercular Diseases, excluding Phthisis 184 3.4 205 Rheumatism (Acute and Chronic) and Gout 34 0.6 41 0.7 V.—Developmental 389 7.2 396 6.7 Old Age 180 3.3 166 2.8 VI.—Local Diseases 2569 47.3 2919 49.6 Circulatory System 402 7.4 451 7.7 Bronchitis 551 10.2 661 11.2 Pneumonia and Broncho-Pneumonia 305 5.6 372 6.3 Pleurisy and Pleuropneumonia 25 0.5 34 0.6 Respiratory System, excluding Phthisis 975 17.9 1172 19.9 VII.—Violence 219 4.0 182 3.1 Suicide 33 0.6 24 0.4 VIII.—Other Causes 258 4.8 231 3.9 E 66 • 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 1000 births. Lambeth Parish. 1898 1899 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 1488 157.7 Diarrhoea 209 22.6 198 20.9 Convulsions 60 6.5 49 5.2 Respiratory Diseases 212 22.9 229 24.3 Premature Births 154 16.6 184 19.5 Tubercular Diseases (including Phthisis) 81 8.5 98 10.4 Measles 27 2.9 43 4.6 Whooping Cough 71 7.7 59 6.3 Suffocation in Bed 53 5.9 33 3.5 Enteritis 103 11.1 114 12.1 Dentition 24 2.6 30 3.2 67 TABLE U. Shewing Classification of certain Causes of Deaths (uncorrected in Lambeth, compared with London, during 1897 and 1898. A.—Deaths at all Ages. Lambeth. London. Percentage of total Deaths (uncorrected). Percentage of total Deaths (uncorrected). 1899. 1898. 1899. 1898. I. Principal Zymotics 12.9 13.4 12.5 14.9 Influenza 2.5 2.4 2.0 1.5 Measles 2.8 2.4 2.4 3.7 Whooping Cough 2.1 2.8 1.9 2.6 Diarrhœa and Dysentery 4.1 4.5 4.7 5.2 II. Rheumatic Fever and Heart Rheumatism 0.3 0.4 0.4 0.4 III. Diseases of Circulatory System. 7.6 7.2 8.6 8.1 IV. Bronchitis, Pneumonia, and Pleurisy 17.8 15.9 18.0 16.1 Phthisis 8.2 8.5 9.5 9.5 V. Injuries 3-.8 4.6 4.2 4.2 B.— Deaths under 1 Year of Age (per 1000 Births). I. All Causes 161.9 156.3 167 167 e 2 68 69 TABLE V. TABLE V. Local Government Board Table A.] District, classified according to diseases, ages, and localities. Table of DEATHS during the Year 1899, in the Lambeth 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 subjoined causes, distinguishing deaths of children under five years of age. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 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. Mem'r. nous Croup. Fevers Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Smallpox. Scarlatina. Diphtheria.| Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) ... ... 1 ... ... ... ... ... 1 ... 4 ... 4 2 ... ... ... 45 57 Royal Infirmary (Women and Children) 77 35 22 6 4 10 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 3 ... 14 20 5 upwds. ... ... ... ... ... ... ... ... ... ... ... 13 5 15 ... 1 24 ... ... 5 40 103 Remainder of Waterloo Road First 217 70 33 9 7 67 31 Under 5 ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 ... 16 36 12 ... 5 38 114 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 16 17 General Lying-in-Hospital, York Road 20 17 ... ... 1 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 3 5 upwds ... ... ... ... ... 1 ... ... ... ... ... 8 8 9 ... ... 14 2 ... 5 52 100 Remainder of Waterloo Road Second 226 67 33 5 5 82 34 Under 5 ... ... 1 ... ... 2 ... ... ... ... ... 1 ... ... ... 22 34 9 4 7 46 126 5 upwds. ... ... 1 ... ... ... ... ... ... ... 2 1 ... ... 2 1 0 3 ... 25 51 114 St. Thomas's Hospital 578 38 76 59 51 318 33 Under 5 ... ... 19 ... ... 13 ... ... 2 ... 5 1 1 ... 1 22 42 45 2 64 262 464 5 upwds. ... ... 4 ... ... ... ... ... ... 1 ... 8 7 20 ... 1 31 ... ... 4 84 157 Remainder of Lambeth Church First 318 113 44 11 12 91 47 Under 5 ... ... 1 ... ... ... ... ... ... ... 2 1 ... 1 ... 17 38 23 2 20 55 161 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 9 10 Lambeth Workhouse 43 10 ... ... ... 10 23 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 21 4 ... ... 6 33 5 upwds. ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 ... 3 9 ... ... ... 18 36 Lambeth Infirmary 756 24 12 1 26 392 301 Under 5 ... ... ... ... ... 2 ... ... ... ... 5 ... ... 3 1 150 158 83 8 19 291 720 5 upwds. ... ... ... 2 ... ... ... ... ... 10 ... 35 41 60 ... 2 78 1 ... 7 166 413 Remainder of Lambeth Church Second 696 281 132 10 21 165 81 Under 5 ... ... 11 ... ... 1 ... ... 1 ... 1 ... ... ... ... 54 71 40 8 6 95 283 5 upwds. ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 10 ... Clapham Maternity 12 11 ... ... ... 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Peter's House 32 ... ... ... ... 4 28 U nder5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 8 ... ... 14 32 5 upwds. ... ... ... 1 ... ... ... ... ... 7 ... 34 26 43 ... ... 72 1 2 8 204 402 Remainder of Kennington First 818 298 104 25 20 219 152| Under 5 ... 2 2 ... ... 3 ... ... 2 1 2 1 ... 7 ... 38 91 52 29 17 166 416 5 upwds. ... ... 6 1 ... ... ... ... ... 2 ... 16 10 25 ... 3 37 3 1 7 104 215 Kennington Second 629 154 61 9 20 209 176 Under 5 ... 1 5 1 ... 2 ... ... 1 ... 2 ... ... 2 3 52 76 61 16 2 194 414 5 upwds ... 1 1 70 71 TABLE V—continued. TABLE V—continued. Local Government Board Table A —continued. Table of DEATHS during the Year 1899, in the Lambeth District, classified acccording 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. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 an 1 under 25. 25 and under 66. 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. Whooping Cough. Dirrhoea and Dyse ntery. Rheumat.c Fever. Phthisis. Bionchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal Cholera. Erysipelas. Measles. (a) (b) (c) (d) (e) (f) (g) (h) (i) South Western Hospital 149 8 59 44 13 21 4 Under 5 ... 17 44 ... ... ... ... ... ... ... ... 3 ... ... ... ... 2 ... ... ... 1 67 5 upwds. ... 11 34 ... ... 2 ... ... ... ... ... ... ... ... ... 1 1 1 1 ... 7 82 Remainder of Brixton 1118 288 116 32 46 335 201 Undf r 5 ... ... 1 1 ... 1 ... ... ... 4 ... 38 18 32 1 5 50 3 11 6 233 404 5 upwds ... ... 11 ... ... 6 ... ... 3 ... 1 3 ... 7 7 77 124 74 51 12 338 714 Lambeth Old Workhouse Schools 7 2 3 2 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 4 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 British Home for Incurables 6 ... ... ... 1 2 3 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 5 6 Remainder of Norwood 362 111 25 16 7 9!2 104| Under 5 ... ... 2 ... ... ... ... ... ... ... ... 6 5 14 ... ... 16 ... 1 2 90 136 5 upwds ... 4 1 ... ... 1 ... ... 1 ... 1 1 ... ... 4 22 27 31 12 8 113 226 Totals 6064 1527 720 235 237 2027 1318 Under 5 ... 20 86 5 ... 3 ... ... ... 24 2 164 121 230 1 20 317 13 15 260 1127 2247 5 upwd. ... 16 61 1 ... 56 ... ... 13 1 19 9 2 22 17 475 730 447 136 168 1652 3817 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto 485 37 82 45 38 211 42 Under 5 ... 4 37 ... ... 1 ... ... ... ... ... ... 7 5 ... 4 18 1 ... ... 40 119 5 upwds. ... 4 19 ... ... 19 ... ... ... ... ... ... ... ... ... 57 20 49 2 21 169 366 Deaths occurring within the district among persons not belonging thereto 663 76 92 66 55 299 75 Under 5 ... 12 31 ... ... 1 ... ... ... ... ... 3 ... ... ... 3 11 2 ... 11 84 168 5 upwds. ... 7 19 ... ... 28 ... ... 1 ... 4 1 ... 1 1 28 37 57 2 62 247 495 72 73 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 1899, 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 the knowledge of the Medical Locality, coming to Officer 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 1899. 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. Fevers. Typhoid or Enteric Typhus. Continued. Relapsing, PuerperaL English Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Cholera. Erysipelas. (a) (b) (c) (d) Waterloo Road 1st 14186 14296 466 ... 40 43 ... 9 ... 1 ... 2 ... 25 ... 38 39 ... ... 7 ... ... ... ... 3 Waterloo Road 2nd 14210 13936 932 ... 32 75 ... 11 ... ... ... 1 ... 18 ... 25 70 ... ... 7 ... ... ... ... 4 Lambeth Church 1st 18770 19234 627 ... 99 154 ... 21 ... ... ... 4 1 35 ... 73 137 ... ... 16 ... ... ... ... 3 Lambeth Church 2nd 40994 42252 1517 ... 109 161 4 32 ... 1 ... 4 1 70 ... 105 110 1 ... 30 1 ... 2 ... 3 Kennington 1st 52486 53753 1871 1 160 121 4 50 ... 1 ... 3 ... 46 ... 133 96 ... ... 29 ... ... ... ... 3 Kennington 2nd 43244 45570 1089 ... 168 201 11 33 ... ... ... 4 1 44 ... 97 125 ... ... 18 ... ... 1 ... 3 Brixton 81825 87310 2179 ... 290 270 3 53 1 4 ... 6 ... 76 ... 199 163 ... 1 20 ... ... 1 ... 2 Norwood 29318 31717 753 ... 108 53 ... 10 ... ... ... ... ... 16 ... 58 21 ... ... 4 ... ... ... ... ... Totals 295,033 308,108 9433 1 1006 1081 22 219 1 7 ... 24 3 330 1 728 761 2 1 131 1 ... 4 ... 21 74 LAMBETH PARISH. SUMMARY OF VITAL AND MORTAL STATISTICS, &c., FOR 1899. 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 1899—308,108 (males, 145,531; females, 162,577). Density—78.2 persons per acre. Inhabited Houses—38,556 at Census, 1891. Rateable Value—£1,737,298. Marriages—2,523, being 16'3 per 1,000. Births—9,433, being 30 6 per 1,000. Deaths (corrected)—5,886, being 191 per 1,000. Infantile Mortality—1,488 under 1 year, or 157.7 per 1,000 births. Zymotic—Death-Rate, 2 5 per 1,000. Increase of Population 4,035; but the natural increase or increment {i.e., excess of Births over Deaths) was 3,547. 75 II.—SANITARY WORK. Return showing the Number of Nuisances removed or abated in the Parish of Lambeth, from the 1st January to the 31st December, 1899. Number of Notices 10583* NOTIFIABLE INFECTIOUS DISEASE. (Public Health, London, Act.) No. of Infected Houses (Notices served) 2435 Smallpox 1 Scarlet Fever 888 Typhoid 209 Typhus 1 Continued Fever 7 Diphtheria 964 Membranous Croup 19 Puerperal Fever 24 Erysipelas 319 English Cholera 3 Total 2435 * Excluding 42 Notices under the Housing of the Working Classes Act, 1890 (vide p. 100). 76 PARTICULARS OF SANITARY WORK Carried out in Lambeth Parish during 1899, and for 22 years previously. Year. Total Number of Notice-(excluding those under Housing of the Working Classes Act). Sanitary Works, Structural and Permanent. Sanitary Work not Structural. 1899 10583 10042 2273 1898 10459 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 1 621 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 77 A. Public Health (London) Act and Metropolis Local Management Act. Notices served (Preliminary and Statutory) 8 48 Works Structural:— Drainage defective 1574 Intercepting Traps with Fresh Air Inlets required 643 Ventilating Pipes required 801 Indoor Sinks connected with the Drain 472 Rain Water Stack Pipes connected with the Drain 468 Bath Waste connected with the Drain 51 Traps Delective, or of Obsolete Pattern 1006 Closet Pan and Connections Defective 849 Water Supply to Closet Defective ... 601 Closet Dilapidated 421 Draw-Off from Main for Drinking Purposes required 621 Dust Bins Defective 763 Premises Dilapidated 105 Ventilation under Floors required 184 Roofs Dilapidated 176 Soil Pipes Defective 89 Paving Defective 1009 Damp and Unwholesome Houses 64 Dung Receptacles required 145 Works not Structural — Cis???erns Dirty 76 Manure Accumulations 94 Underground Rooms occupied 71 Animals Improperly Kept 6 Stopped Drains 158 Overcrowding 148 Foul Urinals 17 Through Ventilation provided 7 Refuse Accumulations 76 No Water Supply or Defective Water Supply 521 Dirty Premises 1049 12315 B. Infectious Diseases Notification. Notices served 2435 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 42 Nature of Work.-—To put premises into proper order and condition, or to close and demolish them. 73 SUMMARY OF WORK DONE BV THE SANITARY INSPECTORS DURING THE YEAR 1899. Inspections 8797 Re-inspections 58280 Infectious Houses visited 2435 Complaints entered in complaint book 4137 Cases of Infectious Disease notified 2693 a. Cases under treatment at home 1043 b. Cases removed to Hospital 1650 Cases of Non-Notifiable Diseases dealt with 1339 Houses disinfected 2406 Rooms disinfected 3132 Bedding, etc., disinfected 27923 Bedding, etc., destroyed 326 Dust Yards, Manure Depots and Brickfields, inspections of 344 Drains tested (with chemical, water, or both) 9571 Sanitary Works completed 5910 Plans of Drainage received and approved 413 New Buildings, the drains of which have been completed 206 Premises, the drains of which have been totally or partly reconstructed 399 Articles procured for the Analyst— 648 (a.) Food and Drugs 600 (b.) Water 48 Summonses and Orders issued 87 New Workshops inspected and registered 87 Special Smoke Observations and enquiries 461 Cowhouses inspected 26 Slaughter-houses inspected 42 Notices served— 10625 Sanitary Work (Preliminary and Statutory) 8148 Infectious Diseases (Public Health Act, 1891) 2435 Housing of Working Classes Act 42 Sanitary Nuisances abated 12315 (a.) Structural 2273 (b.) Non-structural 10012 Persons received in Shelter at Wharf 19 Convictions obtained — 77 Public Health Act 28 Food and Drugs and Margarine Acts 49 79 INSPECTORIAL STAFF. Much good work has been done by the Inspectors during the year, and the noticeable change in the condition of the Inner Wards calls for comment. House-to-house inspections, and a careful and constant supervision (more especially of the courts and small cottage property in the Inner Wards) are giving very satisfactory results. Further, the work that is being carried out in connection with the drainages of new and old buildings, is giving equal satisfactory results, bye-laws and regulations being rigorously enforced, and in the case of old buildings, old and defective drainages gradually being replaced by new and improved. The supervision by the Inspectors of the drainages of new, as well as of old, buildings, increases considerably their duties, but the results accomplished are most satisfactory, whilst the difficulties hitherto experienced from dual control are gone. In connection with drain testings, the small (comparative) percentage (15.8) of houses in which the test gives a result is noteworthy. It must be remembered, however, that the smell or chemical test (as applied) is not wholly satisfactory. When a result is obtained, the drains may definitely be stated to be defective; but when no result is obtained, it would be misleading to assume that, therefore, the drains are perfect. The water test is the only trustworthy one, but it is somewhat severe, more especially for old drainages, and on that account, is not used indiscriminately except in the case of the drains of new houses. During 1893, 413 plans (representing 712 houses) have been received and approved, and the work as shewn on plan, carried out under the personal supervision of the 80 Inspectors, and water-tested. 8148 Preliminary and Statutory Notices have been served by the Inspectors during the year under the Public Health (London) Act, 1891, and the Metropolis Local Management Acts, and 2273 in connection with infected houses (for disinfection, stripping of wall papers, and general cleansing), whilst 42 have been served under Part II. of the Housing of the Working Classes Act, 1890. These last notices were served by the Vestry Clerk as required by the Act. Of the total 10,625 Notices served, only 25 (i.e., 0.2%) led to summonses before a Magistrate, a highly satisfactory statement, shewing that practically the whole of the work is carried out without having to resort to extreme measures. It may be added that owners generally do what is necessary upon receipt of the preliminary, or intimation, notices, and do not wait even for the Statutory Notices which are issued by the Sanitary Committee, who are empowered by the Vestry to act as the Sanitary Authority in connection with the carrying out of the Public Health Acts. Many cases of combined drainages have received attention during 1899, the majority being carried out by the owners. The Vestry, by reason of the liability incurred in the present state of the law has, in a comparatively fewcases, had to carry out the necessary work, and thus private properties have been improved at the cost of the general rate, a condition of affairs that is unfortunate, and one that was clearly never contemplated by the Legislature, when the Metropolis Management Acts were drafted. Until the law is altered, this liability must be met by the Vestry; and the more inspections carried out by the Inspectors, the more combined drainages (more or less defective) will have to be dealt with. Fresh legislation is much needed, but until such is passed, the Vestry cannot 81 scientiously hold their hands by examining and testing as few drains as possible, but must accept their responsibility. In this connection, there is a growing feeling that in regard to new buildings, each house should be required to have a separate drain so as to avoid any future difficulty. This feeling, on behalf of a Sanitary Authority, is readily understood, but it must also be remembered that, in certain conditions, a combined system of drainage is the best sanitarily, as by such means no drains are allowed to pass under buildings—a sanitary desideratum. As regards Lambeth, both the Surveyor and the Medical Officer reported in favour of combined drainage under certain conditions (i.e., drains outside), and their opinions were endorsed by a majority of the Vestry, the Clerk pointing out the legal conditions under which such combined drainages could be carried out without any future trouble necessarily arising for the Vestry. The majority of Metropolitan Districts allow, and approve of, combined drainage under certain conditions. The special work in connection with disinfection, smoke abatement, houses let in lodgings, and the carrying out of the Food and Drugs and Margarine Acts, is dealt with on pp. 82-99. Several important seizures of unsound food were made by the Inspectors during the year as follow:— 1. 74 sheep's plucks, 376 kidneys, and 7 pieces of pork were seized on a stall in the roadway outside 66, Lower Marsh, and 33 sheep's plucks under the same stall, condemned by the Magistrate as being unfit for the food of man, and ordered to be destroyed; the Vendor did not appear to the Summons and a warrant was issued for his arrest. F 82 2. 23 tins of lobster, which was unfit for human food, were seized at 119, Flaxman Road, condemned by the Magistrate, and ordered to be destroyed; the Vendor being fined £10 and 4s. costs, or in default one month's imprisonment. 3. 114 pieces of pork and 16 pieces of beef were seized on a stall outside 66, Lower Marsh, condemned, and ordered to be destroyed; the Vendor being fined £20 and 2s. costs, or in default two months' imprisonment. The market thoroughfares have been under bi-weekly inspection by the Inspectors, such duties being included by the Vestry (by special resolution) in the routine work of the Inspectorial Staff. These inspections are made on Saturday nights (9 to 12), and Sunday mornings (9 to 12), and are proving of value. DISINFECTING DEPARTMENT. A large amount of important work has been carried out during the year in connection with disinfection, as the accompanying statistics shew. The increase in the work of this Department is due to the more systematic disinfection which is now being carried out in regard to tuberculosis-, measles and whooping cough-infected premises. Much good must accrue from following up the cases of tuberculosis measles and whooping cough, as doubtlessly will be seen in the mortality statistics in years to come. The two disinfecting machines have been at work during the year, the Equifex machine at Wanless Road giving the most satisfaction as regards efficiency of disinfection. Indeed, the old machine (Neville's patent, of small highpressure tubes) is year by year becoming less and less satisfactory, and will have to be replaced soon by a more 83 modern one on the high-pressure saturated steam principle —£500 having already been placed in the Estimates for this purpose. The disinfecting staff has given every satisfaction during the year, both collectively and individually. Mr. Norris (the Superintendent) is now provided with rooms at Arlington Lodge, Wanless Road, having charge of, and being responsible for, the plant of the Equifex machine, etc., the newly-fitted Refuge, and the Bacteriological Laboratory, the apparatus of which requires constant supervision. During 1899, 3 Certificates were received in respect of rooms, 3 of bedding and clothing, and 178 of both rooms and bedding, making a total of 184, as compared with 162 last year. The fewer of these Certificates received the better, as it is more satisfactory for all disinfection work to be carried out by the Vestry's own appointed officers. Medical Certificates accepted in lieu of disinfection being carried out by the Vestry:— Nature of Certificates. 1st Q. 2nd Q. 3rd Q. 4th Q. Total. For Rooms only — — — 3 3 For Bedding only — — — 3 3 For Rooms and Bedding 45 34 47 52 178 45 34 47 53 184 In addition to the 2693 cases of notifiable infectious diseases (see page 32), each one of which has been attended F 2 84 to by the disinfecting staff, there have also been during the year the following non-notifiable diseases, etc., dealt with, the large amount of work that has been carried out in connection with consumption, measles and whooping cough, being specially noteworthy and gratifying. In each case, after disinfection, a Certificate is left at the house, and during the year 1899, 2,689 such Certificates have been given out. 1st Q. 2nd Q. 3rd Q. 4th Q. Total. Measles 39 394 174 166 773 Whooping Cough — 8 34 16 58 Chicken-pox 4 10 5 2 21 Cancer 5 3 4 1 13 Consumption 118 112 123 121 474 Infected Cabs 6 5 7 3 21 Dirty Premises, etc. 7 1 5 4 17 Schools* — 1 4 2 7 185 541 368 332 1426 The work in connection with tuberculosis-infected premises is new, being due to the action taken by the Vestry in connection with a Special Report presented by the Medical Officer on December 8th, 1898. The seven schools have been disinfected during the year 1899, in connection with outbreaks of Measles. (See also pp. 46-48.) * Two Board Schools, four Church Schools, and one Private School. 85 Particulars as to Disinfection carried out in Lambeth Parish during 1899. Total No. of rooms disinfected by Vestry 3132 Cases in which bedding has been disinfected at home 81 „ ,, ,, at Chamber 2998 „ „ „ destroyed 44 Replaced by the Vestry (cases)* 3 Premises disinfected and disinfectants supplied 9146 No. of Cleansing Notices served in connection with infected houses 2488 Certificates of Medical Practitioners received in lieu of disinfection by the Vestry 184 Articles of Bedding, etc., disinfected. Beds 2081 Bolsters 2086 Pillows 3632 Mattresses 1782 Palliasses 224 Chair Cushions 1650 Clothing 8014 Blankets 3818 Rugs 377 Counterpanes and Eiderdown Quilts 2356 Carpets 246 Extras (not mentioned in above) 1657 Total 27,923 * 3 palliasses, 3 flock beds, 5 flock pillows, and 2 flock bolsters. 86 Articles of Bidding destroyed. Beds 27 Bolsters 4 Pillows 36 Mattresses 17 Palliasses 44 Chair Cushions 19 Clothing 37 Sundries 142 Total 326 The Refuge provided at the Wharf has been used four times during the year—9 adults, and 10 children under 10 years of age, being accommodated during the disinfection of their scarlet fever- and diphtheria-infected houses respectively. The new additional Refuge at Arlington Lodge, Wanless Road, has been completed* and furnished during the year, and is now ready for use when required. There appears, however, to be in Lambeth, as elsewhere, a prejudice against the use of such Refuges by those inhabitants who ought to make the greatest use of them. The Public Health (London) Act, 1891, makes it compulsory upon all Metropolitan Sanitary Authorities to provide such Refuges. *The total cost of the alterations in connection with Arlington Lodge (including drainage work), was £541 12s. 6d., whilst the Vestry voted sums of (not to exceed) £30 and £50 for furnishing the refuge rooms and the bacteriological laboratory respectively. 87 DISINFECTION STATISTICS. For eight years prior, and nine years subsequent, to the passing of the Notification of Infectious Diseases Act; and for the year 1899. 1882 1883 1881 1885 1886 1887 1858 1889 Yearly average for 8 years preceding the Notification Act 1890 1891 1892 1893 1894 1895 1896 1897 1898 Yearly average for 9 years succeeding the Notification Act 1899 No. of Cases in which Bedding etc., has been disinfected. At Home 332 258 278 11 62 52 7 144 143.6 179 246 593 343 177 251 361 217 132 278.4 81 At Chamber 85 50 162 56??? 236 722 902 951 460.4 1391 1570 2546 3042 2286 2462 2447 2126 2424 2254-. 2098 No. of Cases in which Bedding etc., has been destroyed. ) 37 23 62 5. 8 57 48 79 45.7 185 275 314 224 119 67 49 39 27 144.3 44 No. of articles of ) Bedding, etc., disinfected. 1526 1437 1895 2275 916 3078 3121 3778 2253.2 3013 6747 909 11513 8022 13516 20349 21487 21597 12905.9 27923 No. of articles of Bedding, etc, destroyed. 63 10l 114 144 59 92 61 267 113.0 333 4???7 605 674 544 186 178 162 126 363.9 326 Premises Disinfected and Dis-infectants Supplied. 727 080 657 7???7 736 1276 1255 1277 916.9 1722 1816 3157 5896 5742 7146 7210 8715 8411 5538.3 9140 88 PARTICULARS AS TO REFUGE OR SHELTER AT THE WHARF. District or Ward. Address. Nature of Disease. Date of Admission. Date of Discharge. Adults. Children under year M. F. 1896. Marsh 25, Royal Street Scarlet Fever Nov. 12 Nov. 12 1 2 1 Princes' 20, Anderson's Walk ,, ,, Nov. 21 Nov. 21 1 1 1 1897. Marsh 6, P Block, Peabody Buildings ,, ,, April 1 Apr. 1 1 3 3 Marsh 42, Royal Street ,, ,, June 25 June 25 1 1 ... Prince's 2, Abernethy Cottages, Little Clayton street ,, ,, Nov. 3 Nov. 3 1 2 2 1898. Prince's 8A, Surrey Lodge Erysipelas Dec. 29 Dec. 29 ... 2 5 1899. Prince's 16, St. Olave's House Scarlet Fever Jan. 7 Jan. 7 1 2 1 ,, 40, Stangale Street Diphtheria Jan. 17 Jan. 17 1 1 2 ,, 24, Cornwall Place Scarlet Fever July 3 July 3 ... 1 3 ,, 58, Oakley Street Diphtheria Sept. 26 Sept. 26 1 2 4 N.B.—Refuge or Shelter at the Wharf first used November 12th, 1896. 89 ANALYSIS OF FOOD AND DRUGS, WATER, Etc. During the year 1899, 600 samples have been purchased and submitted to the Public Analyst for analysis. Taking the average of the last ten years (1889-98), the annual number of samples taken is 441, of which 69 (i.e., 15.7%) were found, on analysis, to be adulterated. The annual number of summonses issued is 48, with 48 convictions (together with 17 cautions), and .£94 13s. 6d. in penalties) and £31 11s. 3d. in costs, during the same decennium. Of the 600 samples taken during 1899, 65 (i.e., 10.8%) were reported by the Analyst to be adulterated; 52 summonses were issued, with the result that 49 convictions were obtained, together with £76 10s. Od. in penalties, and £29 12s. 6d. in costs ; and in 6 cases the vendors were cautioned. Full details are to be found on pp. 90-92. The Inspector (Mr. W. J. Perrin), who has charge of this department, is to be congratulated, his samples being purchased by deputy, as a rule. The new Food and Drugs Act gives greater powers to the Inspectors, and alters the procedure in one or two instances, as will be seen by reference to pp. 93-94. The results of the monthly examinations of the Water supplied to the Parish of Lambeth by the Southwark and Vauxhall and the Lambeth Companies were satisfactory during 1899. 90 SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of Analyses, during the year 1899. Samples. Number Procured. Number Adulterated. Milk 202 22 Butter 235 34 Coffee 72 5 Mustard 16 — Pepper 15 — Brandy 3 1 Rum 1 — Whisky 10 2 Sugar, Demerara 6 1 Ginger Ale 2 — Soda 1 — Grey Powder 1 — Lard 14 — Cream of Tartar 2 — Margarine (not labelled) 1 — Oatmeal 5 — Ground Rice 4 — Linseed 4 — Eucal. Oil 3 — White Precipitate 1 — Milk of Sulphur 2 — Totals 600 65 91 TABLE . Shewing percentage of different adulterated Samples during 1899 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. Ærated Waters. Drugs. 1899 10.9 14.5 6.9 — — 00 27 00 21.4 33.3 - 00 20.0 — — 00 00 1898 13.6 14.5 10.3 — 0.0 0.0 0.0 0.0 11.1 — 0.0 50.0 5.9 — — — 18.8 1897 10.5 7.3 3.03 0.0 0.0 0.0 2.0 11.1 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 2105 14.7 26.4 — 0.0 0.0 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 304 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 478 50 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 — — — — — 00 — 0.0 — 0.0 means that all Samples were reported to be genuine and unadulterated. —means that no Samples were taken during the year. 92 Year. No. of Samples Analysed. No. of Samples adulterated. Percentage of Samples adulterated. No. of Summonses issued. No. of Convictions. No. of Cautions. Penalties. Costs. 1899 600 65 10.8 52 49 6 £ s. d. £ s. d. 76 10 0 29 12 6 1898 602 74 12.3 57 54 6 69 0 0 34 9 0 1897 546 41 7.5 7 21 2 48 0 0 24 5 0 1896 549 66 12.02 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 24.09 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 16.4 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 Average of 10 years 1889-98 441.4 69.5 15.7 48 1 48.0 17.3 94 13 6 31 11 3 Inspector Perrin commerced his duties on February 21st, 1898, vice Inspector Wiggs, who did the work from August, 1892, to November, 1897. 93 The new Sale of Food and Drugs Act, 1899, came into operation on January 1st, 1900, and is an important measure, amending and enlarging the scopes of the Food and Drugs Acts of 1875 and 1879, and the Margarine Act, 1887; the controlling and supervisory powers of the Local Government Board being considerably increased, and similar powers given to the Board of Agriculture in respect of milk, cream, butter, cheese, margarine, &c., when these goods are of home production. In the case of imported goods such as mentioned above, the Commissioners of Customs take the necessary samples, as directed by the Treasury. The term "food" is made to include any article which ordinarily enters into or is used in the composition or preparation of human food, amongst which are to be reckoned flavouring matter and condiments. The Margarine Act is extended to Margarine-cheese, which means any substance, whether compound or otherwise, which is prepared in imitation of cheese, and which contains fat not derived from milk; and to cheese, which means the substance known as cheese, containing no fat derived otherwise than from milk. Wholesale dealers in Margarine (as well as manufactories) require to be regisfered. Slight alterations as to the procuring of samples (in transit, course of delivery, or otherwise) are made, as also in connection with the labelling of margarine, or margarinecheese, which labelling must now be on the package itself. Any vehicle or receptacle from which milk (or cream) is sold, must have conspicuously inscribed thereon the name and address of the person so selling in any public place; while notice must be given (by means of a clearly visible label) whether condensed milk on sale in tins or other 94 receptacles, is separated or skimmed, i.e., machine-skimmed or not. All mixtures must be clearly labelled, and the labels must not be obscured by other matter printed thereon; whilst tinned articles need not be sold to an Inspector except in unopened tins. All articles of food (in addition to milk) may be sampled in course of delivery, but only upon the request or with the consent of the purchasers or consignees. Increases of penalties are allowed on second or any subsequent convictions, viz., maximum penalties of £50 and £100 respectively. There are several slight alterations as to prosecutions, e.g., time limit of 28 days for proceedings; minimum limit of 14 days for summons to be returnable; name of prosecutor and particulars as to offences alleged, to be given, together with a copy of the analyst's certificate. Finally, important provisions as to warranties are introduced; whilst the appointment of a Public Analyst and the due carrying out of the Sale of Food and Drugs and Margarine Acts, become compulsory upon all Sanitary Authorities. SMOKE ABATEMENT. The Smoke Inspector (Mr. W. J. Perrin*) has been energetic during the year—404 special observations and enquiries having been made. There being no coal strike, the Vestry felt justified in taking stringent measures to minimise, as far as possible, the smoke nuisance in Lam- *Inspector Perrin is also Food and Drugs Inspector, and in addition has charge of a small sanitary area. 95 beth; and in this particular work they have been well supported by the Magistrates, who have inflicted exemplary fines in two cases, as follow: Charing Cross & Strand Electrical Supply Co., £45; Messrs. Clowes & Sons, £70; with £4 10s. and 14/0 in costs respectively. The Electricity Supply Co. (South London), Bengeworth Road, were fined £2, with £1 costs; and Messrs. Clowes, on a former conviction, £5 and 2s. costs. Speaking generally, a decided improvement has taken place in connection with nuisances from smoke in Lambeth Parish, and the improvement is likely to continue, as Firms are beginning to realise that they will no longer be allowed, as hitherto, to pollute the atmosphere with dense volumes of black smoke, which are a nuisance and injurious and dangerous to health. The following Firms have been under special observation by the Inspector during the year:— Charing Cross and Strand Electricity Supply Company, 85, Commercial Road Messrs. Causton & Co., Clapham Road Messrs. Clowes & Sons, Duke Street City & Waterloo Railway Generating Station, Launcelot Street Messrs. Walkers, Parker & Co., Belvedere Road Messrs. Seth Taylor, Commercial Road Nelson's Wharf, Commercial Road Messrs. Meredith, Belvedere Road Messrs. Rendell, Little Duke Street London County Council,Works Department, Belvedere Road Messrs. Cooper, 8z, New Cut Messrs. McGaw, York Road India Store Depot, Belvedere Road Messrs. Jonas Smith & Co., Belvedere Road Phoenix Wharf, Commercial Road New London Brewery, Durham Street 96 Licensed Victuallers' Schools, Upper Kennington Lane Beulah Laundry. South Lambeth Road Sunnybank Laundry, South Lambetn Road Messrs. Doulton & Co., Albert Embankment Messrs. Stiff & Sons, Albert Embankment Thames Mining Machinery Co., Commercial Road Messrs. Maudslay, Sons and Field, Westminster Bridge Road Arlington Laundry, Cambria Road Lambeth Water Company Works, Brixton Hill Messrs. Barrett, Wandsworth Road, Vauxhall Electric Light Works, Electric Avenue Mr. Slocombe (Baker), Akerman Road Messrs. F. & H. Higgs, Loughborough Junction Mr. Lock (Baker), Loughborough Junction Messrs. Mumford, Albert Embankment Messrs. Nightingale, Albert Embankment Messrs. Webb & Son, Albert Embankment Messrs. Higgs & Hill, Vauxhall Gardens Marble Laundry, Clapham Road Stockwell Brewery, Stockwell Park Crescent Bon Marche, Brixton Metropolitan Gas Company, Works, Vauxhall Messrs. Francis & Son, Brixton Bonanza, Lyham Road Messrs. Riley, Norwood Road Messrs. Oppenheimer & Co., Handforth Road South London Electricity Supply Co., Bengeworth Road Victoria Date Co.. Belvedere Road Messrs. Gulliver & Co., Commercial Road Lambeth Baths and Wash-houses, Kennington Road Army and Navy Stores, Lambeth Palace Road Messrs. Baker & Co., Lambeth Palace Road Vauxhall Iron Works, Wandsworth Road Messrs. J. W. Clarke, Brixton Road Mr. Cookson's Destructor, Tinworth Street Mr. Clarkson's Destructor, Tinworth Street 97 The above list will give an idea of the amount of work involved in carrying out the Nuisance Clauses of the Public Health Act which have reference to the emission of black smoke from a chimney (other than the chimney of a private dwelling-house) in such quantity as to be a nuisance. Special fortnightly reports were presented to the Sanitary Committee (who reported to the Vestry) throughout the year. The London County Council has drawn the Vestry's attention to smoke nuisances observed by their own officers on 34 different occasions, as follow: Sir Joseph Causton, Clapham Road Messrs. Doulton & Co., Albert Embankment (5 occasions) Messrs. Stiff & Sons, Albert Embankment (6 occasions) Mr. Schmidt, 78, Brixton Road (Baker) Messrs. Rogers & Cook, Beulah Laundry, South Lambeth Road, (4 occasions) Sunnybank Laundry, South Lambeth Road (3 occasions) Messrs. Williamson, 201, Lyham Road (Bakery), (2 occasions) Messrs. Higgs & Hill, Crown Works, Vauxhall Park Messrs. Waliham Bros., Stockwell Road Waterloo and City Railway Co., Generating Station, Launcelot Street (2 occasions) Messrs. Oppenheimer, Son & Co., 51 Handforth Road 113, Oakley Street (private chimney) Messrs. Barrett & Co., Bond Street, Vauxhall Mr. Whelch, 81, New Cut (Baker) Mr. J. Petry, 22, Tracey Street (Baker) Electric Lighting Station, Electric Avenue (2 occasions) South London Electric Lighting Destructor, Bengeworth Road. With one or two exceptions, the whole of the above were already under observation at the time of the receipts of the G 98 Council's communications, and no further action had, consequently, to be taken in connection therewith. The Potteries (of Messrs. Doulton and Stiff) have been under constant observation during the year, but no nuisance has been found to justify the Vestry in taking action before a Magistrate. The Firms take more than reasonable precautions to minimise, as far as possible, any nuisance that may arise in connection with the legitimate carrying out of their important businesses, and there is no sufficient ground for supposing that the fumes issuing from the kilns are a source of danger to the health of the inhabitants in the neighbourhood, or even cause the crumbling away of the brick- and stone- work of several large buildings in the vicinity to a greater extent than, or even as much as, the ordinary smoke from chimneys of factories and dwellinghouses. REFUSE AND MANURE DEPOTS. A great improvement has been noticed during the year in the condition of the various refuse and manure depots. During the summer months, daily inspections were made in connection with the Heme Hill and Nine Elms sidings (used for manure traffic, and specially brought before the notice of the Vestry on several occasions during the year 1898), with the result that there have been practically no complaints during the year 1899. The dust yards in the Parish have been under frequent inspection during the year, as also the dust destructors belonging to the City, Clerkenwell, Mr. Cookson and Mr. Clarkson (the two last-mentioned being private contractors). With regard to the dust destructor belonging to the Clerkenwell Vestry, and situated at the Phoenix Wharf, Commercial Road, the nuisance became so great during the summer that special action had to be taken, with the result that the following improvements were carried out by the Clerkenwell Vestry:— 99 1. Provision of an extra flue (communicating with main flue) above each furnace door to prevent escape of noxious fumes whilst the furnaces are being fed; 2. Chimney increased in height; 3. Galvanized iron screen erected, at north side of destructor, to minimise escape of fumes. HOUSES LET IN LODGINGS. By the Vestry's Bye-laws as to houses let in lodgings or occupied by more than one family, each house has to be brought before the Vestry for consideration before registration—an arrangement that is found to work well, and to be a great improvement upon the usual method of fixing a rent limit and only registering those houses that are let at a rent at or below such limit. The following houses have been selected by the Vestry during 1899:— 1 to 12, Victoria Place, Broaduiall.—12 houses, containing 46 rooms, in which were housed 97 persons, of whom 60 were over 10 year of age, and at rents varying from 2/- to 4/- per room per week respectively. 1 to 8, Coad Place, Fitzalan Street.—8 houses, containing 32 rooms, in which were housed 65 persons, of whom 42 are over 10 years of age, and at rents of 2/6. 1 to 14, Milton Place, Belmont Street, Wandsworth Road.—14 houses, containing 56 rooms, in which were housed 132 persons, of whom 73 are over 10 years of age, and at rents fro 1/- to 8/6 per room per week. The Vestry have, therefore, during the year 1899, selected for registration a total of 34 houses, containing 134 rooms, in which are housed 294 persons, of whom 175 are over 10 years of age. During 1898, there were selected 258 houses, containing 1513 rooms, with 2495 persons ; and during 1897, 93 houses, containing 566 rooms, with 992 persons. A total of 385 houses, containing 2,213 rooms, have been registered in Lambeth Parish, up to the end of 1899. G 2 100 HOUSING OF THE WORKING CLASSES ACT, 1890. 42 houses have been represented to the Vestry by the Medical Officer of Health under Part II. of the Housing of the Working Classes Act, during the year 1899, as being unfit for human habitation, on account of the premises being dirty, damp, dilapidated, insufficiently provided with water, or w.c. accommodation, generally worn out, &c. Details are as follows:— Date of representation of M.O H. to, and of Resolution of Vestry Addre's of No of Prenrses. Houses. Date of service of Notices. Result. Remarks. 1899. March 2 1-12, Auckland Place. West Norwood 12 1899 Mar. 2 Rendered fit Dirty, damp, dilapidated, generally worn out and insufficiently provided with water and w.c. accommodation April 27 12-21, Portland 10 July 6 Work in hand Dirty, dilapidated and generally worn out. April 27 Cottages, Hemans Street, Wandsworth Road 4-24, Pascal Street, Wands 11 July 6 Rendered fit April 27 worth Road 37-53, Pascal Street, Wandsworth Road 9 J uly 6 Work in hand 101 In connection with the Housing of the Working Classes Act, the Vestry has adopted during 1899 an important principle, laid down in a Special Report presented by the Medical Officer of Health, on "Insanitary Areas and the Housing of the Working Classes."* This principle is that, as far as the Lambeth experience goes, condemnation under Part I. is unnecessary, better results being obtained from systematic house-to-house inspections of houses with the carrying out of Notices, served (as may be found necessary) under Part II. of the Housing Act, or under the Public Health Act. It cannot be denied but that in Lambeth Parish, more especially in the Inner Wards, a marked improvement is noticeable in connection with the small houses (courts, etc.) The work is slow, but sure, and more than repays (financially and otherwise) the trouble and extra work involved. Further, there is the additional advantage that there is practically no displacement of tenants, a most important consideration. Displacements (wholesale) lead to great trouble for a Sanitary Authority, the displaced tenants move into neighbouring houses, which they consequently crowd and overcrowd, and so a Sanitary Authority may create, by means of one Act of Parliament (the Housing Act), serious nuisances, which it. then becomes the duty of the same, or a neighbouring Sanitary Authority, to abate by powers invested in them under another Act (the Public Health Act). The neighbouring houses become rookeries, and so the difficulty is not overcome, but simply transferred from one district, or part of a district, to another, and from one house to another. Action under Part I. is costly and dilatory, leading to Inspectorial neglect. with the result that dilapidated and * Vide Appendix. 102 insanitary houses become more and more dilapidated and insanitary. Not so with the method adopted in Lambeth, where displacement is reduced to a minimum, and the conditions of the houses are improving. Displacements under condemnation or closing schemes (large or small) are not the only ones, for unfortunately there are what may be described as unavoidable displacements connected with railway extensions, improvement schemes, increase of business premises (factories, workshops, etc.) In these latter cases, all that a Sanitary Authority can do is to insist upon a pro rata amount of suitable accommodation (in the neighbourhood) being provided before any displacement of persons is allowed to take place, and that the displaced tenants should have the first refusal of the new rooms which are to be let at (or about) the same rents as the old ones— conditions that are being rigorously enforced, in all cases, by the Vestry of Lambeth. The Vestry has not yet taken any further action in respect of the Open Space (partly cleared) in Lambeth Walk. 103 CUSTOMS AND INLAND HE VENUE ACTS. During 1899, Certificates (carrying exemption from or abatement of Inhabited House Duty) have been applied for in connection with 207 tenements, and of these 53 have been granted unconditionally, 85 have been granted conditionally, whilst in 69 the Certificates have been refused. A.—Certificates granted unconditionally:— Houses or Blocks. Tenements. Ethelred Street, 15 and 15A 2 12 Somerleyton Road, 57 and 59 2 4 Lower Kennington Lane (Longreign House) 1 7 Auckland Terrace, 15—24 10 30 E.—Certificates granted conditionally:— Connaught Mansions, 1—35 2 35 Dorset Road, South Lambeth, 15—25 6 18 Comrie Road, Strathleven Road, 18—24 4 8 „ „ 26—48 12 24 C—.Certificates refused:— Rattray Road, 60—66 4 11 Comrie Road, 29—53 13 26 Thorparch Road, 45—55 6 12 Cowthorpe Road, 2—12 6 12 „ „ 5—11 4 8 Totals 72 207 104 SLAUGHTER-HOUSES. There were, at the end of 1898, 44 registered slaughterhouses, but during the year three (172, Lambeth Walk, 53, South Island Place, and 369, Wandsworth Road), have been closed, and one (74, Stockwell Road) the licence of of which was refused last year, has been re-opened, leaving 42 which came up for registration before the London County Council, who granted the necessary licences in all the cases. LIST OF REGISTERED SLAUGHTER-HOUSES IN LAMBETH. Marsh Ward 113, Lower Marsh. ,, 106, ,, ,, 124, ,, ,, 99, ,, Bishop's Ward 38, Walnut Tree Walk (rear of) „ 151, Lambeth Walk. ,, 7, ,, ,, 165, ,, Prince's Ward 406, Kennington Road. „ 60, Kennington Park Road. „ 171, Lower Kennington Lane. ,, 158, Newington Butts. „. 4, Clapham Road. ,, 36, ,, Vauxhall Ward 302, Clapham Road. ,, 152, ,, „ 18, Paradise Road (rear of). „ 1, Lansdowne Road. Stockwell Ward 97, Stockwell Road. ,, 74, ,, „ 27, Bedford Road. 105 Brixton Ward 58, Coldharbour Lane. „ Near Railway Hotel Brewery (Electric Lane). ,, 12, Vassall Road. „ 263, Brixton Road. ,, 136, Wyndham Road. „ 10, Foxlev 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 42 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:— Dirty and Uncovered Cistern 1 Defective Drains 2 Dirty Premises 7 Broken Manhole Cover 1 Defective Door 1 Defective Roof 1 Defective Gutters 1 106 Defective Gully 1 Uncemented Walls 1 Defective Walls 1 Pen used as Stable 1 Defective Paving 4 Defective W.C. 2 Pigs kept so as to be a nuisance in Stable 1 In 28 of the Slaughter-houses no sanitary defects were discovered, whilst the general condition of the premises in all was found to be satisfactory. In only two cases was a result obtained from the drain test. 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 Slaughter-houses are (roughly) as follow:— Cattle 53 Sheep 768 Total 889 Pigs 68 Calves occasionally. COWHOUSES. There were in 1898, 27 registered Cowhouses in Lambeth Parish, and of these one (26, Somers Road) has since become empty. During 1899, 26 applications have been received for renewal of licenses, but only 24 were granted by the London County Council, as follows—the 2 licenses in connection with 324, Camberwell New Road and 40, Gipsy Road, being refused by the Council, the Vestry objecting in each case on account of defective paving, which the licensees refused to make good:— 107 IST 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 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 Vassall Mews 1 8 „ 1, Elliot Read 9 Tulse Hill 7, Mill Lane, Brixton 1 2 „ 67, Coldharbour Lane 1 !!. 7 „ 1, Lutheran Place, Upper Tulse 34 Hill „ 56, Railton Road 1 r> „ 329, Coldharbour Lane 1 8 Norwood 156, Hamilton Road 26 „ 76 and 78, Gipsy Hill 3 27 „ 67, Rosendale Road 1 10 „ 93, Clive Road 1 .. 4 196, Norwood Road 1 20 „ Elder Road, West Norwood 3 35 „ Railway Arch, East Street 1 13 1, Change Alley, West Norwood 1 11 33 311 The above 24 Cowhouses have been inspected carefully during the year, and the following sanitary defects discovered, and since remedied:— Defective Paving 2 Dirty Premises 6 Defective W.C. 1 Dirty W.C. Pan 1 Rain-water Pipe Defective 1 Defective Gully 1 Defective Roof 1 Defective Cover to Cistern 1 Defective Ventilating Pipe 1 108 In 14 of the 24 Cowhouses 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 no instance was there a result obtained. WORKSHOPS. 87 Workshops have been added to the Register during the year 1899, consisting of the following:— Nature of Trade or Business. No. of Workshops. Nature of Trade or Business. No. of Workshops. Dressmaking 27 Brought forward 67 Tailors and Clothiers 5 Bedding Manufacturer 1 Laundries 17 Cardboard Box Maker 1 Boot Maker 1 Cycle Manufacturers and Repairers 4 Builder 1 Brush Maker 1 Incubator Maker 1 Tie Makers 3 Stone Mason 1 Waistcoat Maker 1 Copying Apparatus Maker 1 Shoemaking or Mending 2 Upholsterer 1 Perfume Manufacturer 1 Confectioner 1 Fancy Goods Manufacturer 1 File Cutter 1 Baby Cap Maker 1 Furniture Restorer 1 Stay Maker 1 Advertisement Fainter 1 Underclothiers 2 Art Needleworkers 3 Turner in Wood 1 Wheelwright 1 Blacksmith 1 Surgical Box Maker 1 Sundry other Trades 2 Carried forward 67 Total 87 109 The total number of known Workshops within the Parish of Lambeth is 721, all of which have been inspected, and the different workrooms measured up and plans drawn in connection therewith, showing 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 lb) overtime. All the Workshops (with full particulars) have been entered up in the Register which the Vestry now possesses. In connection with the 87 new Workshops (inspected and registered during 1899), it is found that there are 138 rooms, in which were working, at the time of inspection, 391 persons, 92 males and 299 females (females alone being employed in 53 Workshops). Further, no children were found employed, but there were 64 young persons, i.e., between 14 and 18 years of age (12 males and 52 females), and the rest were adults (80 males and 247 females) ; whilst 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, 189 L, 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 32 notices of occupation of Workshops from the Factory Inspectors during 1899, as compared with 60, 31 and 29 respectively in the previous 3 years. 8 written notices have been received from the Factory Inspectors with reference to contraventions of the Public Health Acts in connection with Factories or Workshops 110 (vide Section 4 Factories 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. During the three previous years, 27, 25 and 66 written notices respectively have been received. In connection with the 87 new Workshops, the following insanitary conditions were met with at the time of the inspections :— 1. As to Ventilation and Warming and Lighting. In 3 out of 87 Workshops (i.e., 34%) was the ventilation unsatisfactory, though in all cases the workrooms, at the time of inspection, were found to be reasonably warmed by open fireplaces, open or closed stoves, gas jets, etc. 2. As to Cleanliness. In 27 Workshops (i.e., 3103%), the workrooms were dirty and required cleansing. 3. As to Drainage and Sanitary Appliances. The drains were in each case tested with chemical, and in 16 (i.e., 18.4%) were shown to be defective, requiring partial or total reconstruction; whilst in 20 (i.e., 22.9% ) the sanitary fittings and appliances were bad. The w.c.s were outside in 43.7% , inside in 26.4% , outside and inside in 25.3%; whilst in 4 cases (i.e., 46%) there were no w.c s provided at all. Separate closet accommodation for the sexes was wanting in 6 cases (i.e., 6'.9% ). The soil pipes were found to be unventilated, or insufficiently ventilated, in 11 cases (i.e., 12.6), a. condition of things which may, or may not, be a 111 ance; and in 2 cases (i.e., 2.3%) there was found to be direct communication between w.c.s and workrooms. 4. As to Dampness. In 1 workshop (i.e., 1.2%) a workroom was 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 4 of the 133 workrooms {i.e. 301%) overcrowding was found to exist, though the overcrowding was limited to 1, 2 or 3 persons in excess per workroom, as will be seen on reference to the accompanying Table III. During the year the Vestry decided by resolution to take no further action in regard to appointing a Female Sanitary Inspector—a decision to be regretted, as Lambeth Parish contains 721 Workshops, in which are employed 3,157 persons, and of these 2,472 (i.e., 78.3%) are women and girls (44 6 per cent. of the Workshops employing only female labour).* These statistics help to make out a strong case for the appointment of a Female Inspector, who would also be of great use in (1) constantly supervising the female underground conveniences in the Parish—a supervision that cannot be efficiently done, for obvious reasons, by a male Inspector; (2) inspecting shops where girls and women * The question had been adjourned for six months by the Vestry at their Meeting held on April 28th, 1898. 112 only are employed ; (3) visiting infants' and girls' schools and colleges in connection with outbreaks of infectious disease ; (4) working among the poor, especially in the Inner Wards of the Parish, and assisting in the educating of mothers as to the feeding and caring of infants, and as to domestic sanitation generally. The Vestry will doubtless see its way to reconsider the question at some future time. 113 I.—W ORKSHOPS:—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 10 13 ... ... 1 4 20 5 21 9 30 Wallis 8 9 ... ... 1 7 4 19 5 26 31 Bishop's Prince's Hooper 9 17 ... ... 3 ... 17 30 20 30 50 Howes 2 4 ... ... 3 ... 1 1 4 1 5 Jones 2 6 ... ... ... ... 7 21 7 21 28 Vauxhall Stockwell Eowden 5 5 ... ... ... ... ... 18 ... 13 13 Baxter 3 4 ... ... ... 5 ... 8 ... 13 13 Perrin 4 4 ... ... 1 2 1 5 2 7 9 Brixton Gavin 10 17 ... ... 1 7 2 24 3 31 34 Bott 6 6 ... ... ... 5 ... 16 ... 21 21 Tulse Hill Smith 6 7 ... ... ... 15 6 7 6 22 28 Norwood Barfoot 22 41 ... ... 2 7 22 96 24 103 127 87 133 ... ... 12 52 80 245 92 297 389 H 114 115 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. Marsh. Bishop's and Prince's. Jackson.. Wallis. Hooper. Jones. Howes. Vauxhall and Scockwd . brixton. Tulse Hill. Smith. Norwood. Barfoot Totals Bowden. Baxter, Perrin. Gavin. Bott. Ventilation satisfactory 10 7 9 2 2 5 3 4 8 6 6 22 84 not ... 1 ... ... ... ... ... ... 2 ... ... ... 3 Cleanliness satisfactory 7 8 1 2 2 5 1 4 7 5 6 12 60 not 3 ... 8 ... ... ... 2 ... 8 1 ... 10 27 Workrooms damp 1 o 1 ... ... 1 not 10 7 9 2 2 5 3 4 10 6 6 22 86 Workrooms warm 10 8 9 2 2 5 3 4 10 6 6 22 87 not ... ... ... ... ... ... ... ... ... ... ... ... ... Result of testing of drains no result defects found 8 8 5 1 2 4 3 4 10 5 4 17 71 2 ... 4 1 Jt" 1 ... ... ... 1 2 5 16 State of sanitary fitting's, &c. rood 8 8 3 1 2 5 2 4 9 5 6 14 67 bad 2 ... 6 1 ... ... 1 ... 1 1 ... 8 20 Soil pipe ventilated 4 4 1 1 2 5 2 1 6 5 5 8 44 not ventilated 1 ... 1 ... ... ... 1 3 2 1 ... 2 11 no soil pipe 5 4 7 1 ... ... ... ... 2 ... 1 12 32 Position of W.C. outside 4 5 6 ... 1 4 ... 1 4 1 1 11 38 inside 3 3 2 l ... 1 ... 1 4 1 1 5 23 outside & inside 2 ... ... ... 1 ... 3 2 2 4 2 6 22 No W.C. 1 ... 1 1 ... ... ... ... 1 ... ... ... 4 Separate W.C. accommodation (where required) Yes .. 9 7 8 1 2 5 3 4 9 6 6 21 81 No .. 1 1 1 1 ... ... ... ... 1 6 ... 1 6 Communication (direct) between W.C.'s & rooms Yes .. ... ... ... ... ... ... ... ... ... ... 1 1 2 No .. 10 8 9 2 2 5 3 4 10 6 5 21 85 H 2 116 III.—WORKSHOPS.—Full details as to overcrowding found. Nature of Workshop. No. of Workroom 4 overcrowded. No. of Employes at time of Inspection. No. of Employes allowed. Extent of Overcrowding (in persons). Male. Female. Total. Dressmakers 4 ... 18 18 12 6 Underclothiers 1 ... 3 3 2 1 Fancy Needleworkers 1 ... 7 7 4 3 Laundry 1 ... 7 7 5 2 35 persons (all females) were found to be working in a state of overcrowding—in a cubic space enough for only 23. 117 BAKEHOUSES. The Bakehouses have been inspected daring the year, and the necessary annual white-washing and cleansing carried out. One new bakehouse† (rebuilt) has been registered during 1899, and three have been demolished (14, Cornwall Road, 307, Coldharbour Lane, and 85, Walcot Square), whilst twenty-nine have been found temporarily empty and disused. LIST OF BAKEHOUSES IN LAMBETH. (* Means that Bakehouse is empty at present.) MARSH WARD:- Cornwall road, 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 roid, 59, 102 York road, 102 BISHOPS WARD: Bro id street, 13 Brook street, io5 China walk, 16 Crozier street, 12* Ethelred .streec, 107 Hercules road, 4#, 66 Lnmbeth 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 pi ice, 19 SUngate street, 32 Tracey street, 22 Upper Marsh, 18 Walnut Tree walk, 43 Westminster Bridge road, 189, 219 PRINCE'S WARD:- Auck'iand 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 /oad, 40,* 98,* 202 Kennington road, 334 Lower Kennington lane, 32, 84,* 122* 177 Newburn street, 10 Newington butts, 150 Prince's road, 19 Stannary street, 39 Trigon road, 4^ Tyer's street, 49 Upper Kennington lane, 19,76,107, 159, 199 Vauxha 1 street, 36, 85, 115,* 126, Vauxhall walk, i8a, 71, 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 Parad.se road, 30 South Lambeth road, 28, 108, 15S 175 * 184* Thorparch road, 1 Wandsworth road, 51,* 181, 227, 230, 250, 283 Wilcox road, 29, 44, 3 + 32, Stmgate Street. 118 STOCKWELL WARD - Acre lane, 120, 144 Bedford road, 29 Brixton road, 5b, 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:- AUerman 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, ! 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, 319,* 439 Cornwall road, 32, 76, 146 Denmark hill, 120 Dulwich road, ity Effra parade, 11 Elm park, 58 Hinton road, 51 Hurst street, 28 Kemerton road, 7 Lyham road, 159 Mi.kwood road, 6, 69 New Park road, 59 Probert road, 1 Railton road, 13,* 45, 64, 78, in, 205, 311 Shakespeare road, 84 Somer's road, 27 Sussex road, 75* Tulse hill, 5, 25, 182 Upper Tulse hill (The Exchar ge), 3 Water lane, 25, 87 NORWOOD WARD - Approach road, 6 Barnfirld road, 28 Chapel road, 2* Eden road, 7 Elder road, ia Gipsy hill, 53, 130, j$o Gipsy road, 305, 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 Rommanyroad, 191 Westow hill, 33 Wood street, 5 Woodland hill, 31* 119 MORTUARIES AND CORONERS' COURTS. The total number of bodies received at the two Mortuaries (High Street and Wanless Road) during 1899, was 483, as compared with 495 during 1898, 400 during 1897, and 373 during 1896. Of the 483 bodies, 365 were received at High Street and 118 at Wanless Road, shewing the need of this second Mortuary for the Parish. 24 bodies were brought in by the Police (7 to High Street and 17 to Wanless Road), and the rest by undertakers or private persons. 285 Post-mortems were conducted (233 at High Street and 52 at Wanless Road), as compared with 275, 281 and 253 respectively during the 3 preceding years, 1898-6. The Coroners' Court sat 107 times at Wanless Road, and 113 times at High Street. The need for the separate infectious room in connection with the new Mortuary at Wanless Road was shown by the fact that during 1899, 3 bodies (1 male and 2 females) dead of diphtheria, and 1 (male) dead of typhoid, were received there. Sunblinds have been fitted during the year outside all the windows of the Mortuary, and Post-Mortem room, in connection with Wanless Road. Mr, George Fazev, Junior, has been appointed Deputy Mortuary Keeper, vice Mr. George Morris. 120 Ages of bodies received at the Lambeth Mortuaries, 896-1899. Registered Ages of Bodies. 1899. Total 1899. Total 1898. Total 1897. Total 1896. High Street. Wanless Road. 0—1 84 37 121 160 101 121 1—5 35 9 44 50 39 22 5—10 20 2 22 17 9 12 10—20 12 1 13 8 18 9 20—30 25 4 29 26 26 24 30—40 12 7 59 45 35 35 40—50 50 17 67 64 48 37 50—60 38 15 53 42 59 46 60—70 25 22 47 39 30 35 70—80 18 1 19 32 20 22 80—90 5 3 8 5 . 9 7 90—upwards 1 — 1 1 — 3 Age not stated — — — 6 6 — Totals 365 118 483 495 400 373 121 Numbers of bodies received at the Lambeth Mortuaries during 1896-1899. 1899. January. February. March. April. May. June. July. August. September. October. November. December. Total 1899. Total 1898. Total 1897. Total 1896. High Street. Males 22 13 25 19 18 18 21 20 19 23 20 21 239 222 218 221 Females 18 14 3 11 11 6 9 10 12 9 9 14 120 143 109 152 Wanless Road. Males 9 6 6 3 6 3 9 4 3 5 8 9 71 72 41 — Females 4 2 8 4 3 1 2 3 5 5 4 6 47 58 32 — Totals 53 35 42 37 38 28 41 37 39 42 41 50 483 495 400 373 N.B.—Wanless Road Mortuary was opened on April 12th, 1897, and is under the superintendence of Mr. Joshua Fazey—High Street Mortuary being under Mr. Langston. Mr. Fazey, Junior, is Deputy Mortuary Keeper. 122 Particulars as to cases of Drowning, accidental death, and Suicide, during 1896-99. High Street. Wanless Road. Total 1899. Total 1898. Total 1897. Total 1896. M. F. M. F. M. F. M F. M. F. M. F. Drowning — — — 1 1 — 1 1 — 10 3 14 2 Suicides 2 5 7 5 1 7 6 7 3 6 1 12 1 Poisoning — 3 3 — 1 1 — 4 2 1 2 2 3 1 Hanging — — — 3 — — 3 — 6 3 — — 2 — Throat cutting 1 2 3 1 — 1 2 2 3 2 1 — 2 — Jumping off heights — — — — — — — — — — — — 2 — Throwing under Train — — — 1 — 1 I — — — — — — — Shooting 1 — 1 — — — 1 — 4 — 1 — 3 — Railway Accidents 3 — 3 1 — 1 4 — — — 1 — 3 — Accidental death — — — 1 — 1 1 — 8 4 — — — — Street Accidents 4 1 5 3 1 4 7 2 6 1 4 — 3 — Murder 1 1 2 — — — 1 1 — — 1 1 — 2 Burning 1 1 2 — — — 1 1 — 3 1 — — — Falling from heights 1 — 1 — — — 1 — 4 — 4 — — — Bicycle Accidents — — — — — — — — — — — — — — Strangulation and Suffocation — — — — — — — — 1 1 — — — — 3 bodies dead from diphtheria (1 male and 2 females), and 1 dead from typhoid (male), were admitted into the infectious Mortuary at Wanless Road. 123 INQUESTS. During the year 1899, 519 cases were submitted to the Coroner, who, in 78 instances, decided that no further inquiries were necessary; but, in the other 471 cases, held inquests with the following results :— I. Natural Causes 217 II. Accidental Causes 221 Burns and Scalds 31 Drowning 23 Run over 21 Falls, &c. 45 Suffocation 33 Alcoholism 17 Knocked down by Engine 6 Gunshot Wounds or Fractures 9 Rupture 2 Exposure 9 Misadventure 7 Kicked by Horse 2 Self Neglect 5 Blood Poisoning 0 Crushed 3 Executed 1 Shock from Electric Current 1 III. Homicidal Causes 33 Suicide 28 Murder 3 Manslaughter 2 IV. Open Verdicts — Found Drowned — Found Dead — Total 471 124 During the year 1899 Wm. Lcckyer, a permanent attendant at Hercules Road, died, and Wm. Baker (ihe temporary relief attendant a Brixton) was appoirted to fill the vacancy, but to take duty at Vauxhall, vice Mr. Holbrook, who was transferred to the Hercules. Fred Cooper {(for 12 years a Csrman in the Vestry's employ) was appointed temporary relief attendant at Brixton. There is a total of 15 employes connected with the 4 Underground Convenience?. 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, 1899 :— Receipts. Expenditure. Wages. Gas. Water. Rates, Soap, Toilet Papers Cleaning Materials, Repairs, Ac. Uniforms First Cost (prop'n.) Alterations, (prop'n.) Total. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d £ s. d. £ s. d. Vauxhall. Men only—3 paying, 1 free closet 184 8 1 176 10 4 13 9 5 29 0 I' 16 13 2 4 14 3 49 0 0 — 289 13 4 Hercules. Male side—4 paying, 1 free closet £292 17 2 Female side—3 paying, I free closet 201 0 8 — — 493 17 10 309 13 10 35 18 < 47 11 3 26 12 I 8 9 3 119 14 0 — 548 Brixton. Male side—3 paying, 1 free closet 266 16 9 Female side—3 paying, 1 tree closet 203 19 11 470 16 8 303 6 10 33 18 1] 94 14 6 36 15 2 8 9 3 151 0 0 12 8 2 646 12 10 Kennington Cross. Men only—3 paying, 1 free closet 133 7 1] 176 10 4 15 6 9 13 12 9 11 11 0 4 14 3 99 14 8 — 321 9 9 12S5 10 6 972 1 4 98 13 10 185 4 3 91 11 11 26 7 0 419 9 6 12 8 2 1805 16 0 125 BACTERIOLOGICAL LABORATORY. During the past year the Bacteriological Laboratory has been fitted up at Arlington Lodge, Wanless Road, Loughborough, and is proving highly satisfactory, much good work having been done in connection with the examinations of sputa, throat membranes and discharges, and samples of blood, as shown by the subjoined particulars. The Vestry, judging by the results of the first year's experience, are more than justified in having decided to establish in the centre of their district a local laboratory for the sole use of Medical Practitioners practising in Lambeth, and the medical men are to be congratulated in having responded so enthusiastically, and made such good use of the opportunities for bacteriological diagnosis offered to them by the Vestry free of cost. Tuberculosis. 90 samples of sputa from doubtful Tuberculosis cases have been examined during the year, and in 33 (i.e., 36.7%) tubercle bacilli have been found. The importance of Tuberculosis cases being diagnosed at as early a date as possible is now acknowledged by all physicians, as, in the early stages, this disease may be cured by proper treatment. In 57 instances (63.3%), no tubercle bacilli were found. Typhoid Fever. 81 samples of blood from suspected Typhoid cases have been examined during the year, and in 40 (i.e., 49.4%) the characteristic Widal reaction has been obtained, although in eight of the cases (i.e., 20%) this reaction was but slightly (or feebly) marked. The reaction depends on the fact that the specific (Eberth-Gaffky) bacilli of Typhoid 126 fever lose their power of movement, and become collected into clumps (or agglutinated, as it is called), in fluids containing the specific antitoxin of the disease, and this antitoxin is developed in the blood of all patients suffering from typhoid, very shortly after the invasion of the disease. When the reaction is well marked, and only a high dilution of the suspected blood-serum used (e.g., 1/60 to 1/100), this diagnostic method is exceedingly useful and most trustworthy. Practical proof has been shown of this in connection with some localised small outbreaks of Typhoid in Lambeth during the year. Doubtful, or suspected cases were heard of by means of house-to-house enquiries, ana the diagnosis only settled, in a large proportion of the cases, by this serum test. A ready means of differential diagnosis was much needed, as there were many cases of Influenza in and around the immediate neighbourhoods of the Typhoid outbreaks at the time. Diphtheria. 216 samples of throat membranes and secretions from doubtful Diphtheria cases have been examined during the year, and in 101 (i.e., 46.8%) the true (Klebs-Loeffler) bacilli have been obtained. In 52 instances (i.e., 51.5%) the Klebs-Lœffler bacilli were obtained in pure cultivation— i.e., without admixture with other bacilli, whereas in the remaining 49 (i.e., 48.5 %) the Klebs-Loeffler bacilli were found combined with other well-known bacilli as follows :— Klebs-Lceffler + Streptococci 33 i.e. 673% Klebs-Lceffler + Staphylococci. . 5 i.e. 10.2% Klebs-Lceffler + Streptococci + Staphylococci 8 i.e. 16.3% Klebs-Lceffler + Micrococci 1 i.e. 2.04% Klebs-Lceffler + Streptococci + Staphylococci + Oïdia 1 i.e. 2.04% Klebs-Lceffler 4 Pseudo-bacilli (Hoffman) +- Streptococci.. 1 i.e. 2.04% 127 In 115 (i.e. 53.2%) of the total number of throat samples examined the Klebs-Lœffler bacilli were not isolated, but other bacilli were as follow:— Streptococci 30 i.e. 26.1% Pseudo-bacilli 4 i.e. 3.5% Pseudo-bacilli + others 45 i.e. 39.1% Staphylococci 11 i.e. 9.6% Streptococci + Staphylococci 10 e. 8.7% Streptococci + Micrococci 3 i.e. 2.6% Staphylococci + Micrococci 1 i.e. 0.9% Micrococci 5 i.e. 4.8% Micrococci + Torulæ 2 i.e. 1.7% Streptococci + Torulæ + Micrococci 1 i.e. 0.9% Oidia + Streptococci 4+Staphylococci 3 i.e. 2.6% The pseudo-bacilli (Hoffman)were found in pure cultivation in four instances, but in only one case were pseudo-bacilli and true diphtheria (Klebs-Lœffler) bacilli found together. Pseudo-bacilli were found mixed with streptococci (16 samples), with staphylococci (4), with streptococci and staphylococci (19), with streptococci and oïdia (3), with staphylococci and oïdia (1), and with streptococci, staphylococci and oïdia (2). The pseudo-bacilli (Hoffman) are sometimes regarded as a modified form of the Klebs-Lœffler bacilli, and if this be so, the importance of isolating patients suffering with pseudo-diphtheritic throats becomes apparent. The Lambeth experience is that pseudo-throats are infectious, and in all cases, therefore, the usual precautions have been taken (viz., notification, isolation, disinfection, etc.), but as Medical Officer I have not felt justified in recommending removal to hospital, as I am not yet satisfied that it would 128 be right to place a pseudo patient in a ward full of acute Klebs-Lœffler patients. An outbreak of sore throats in a school in Lambeth was carefully investigated, and in very many cases pseudobacilli were isolated from the throats of the scholars, servants, and teachers ; whilst in 3 cases the true Klebs-Lœffler bacilli were isolated, pointing apparently to the two kinds of bacilli being related in some way. That the pseudo-throats were infectious and "catching," there was no room for doubt, whilst in one case (not connected with the school) true diphtheritic paralysis apparently supervened, though the true Diphtheria bacilli (Klebs-Lceffler) were not at any examination found. In connection with this particular school outbreak, inquiries elicited the fact that throat troubles had been more or less prevalent for many months past, though no case had been sufficiently marked in its clinical symptoms to justify the medical attendant in notifying it as Diphtheria. These throats had been apparently pseudo-throats and either proved finally a suitable nidus for the development of the true bacillus of Diphtheria, or gradually passed into the more serious and virulent Diphtheria attacks due to the Klebs-Lœffler (or true Diphtheria) bacilli. A further interesting feature of the outbreak was that on examining the slimy deposits in the waste-pipes of the lavatory basins in the dormitories and in the outlets of the open rectangular trough underneath the basins, a pure culture of the KlebsLceffler bacillus was obtained—a fact verified in another bacteriological laboratory. The slimy deposits were found to consist of organic and other debris (skin scales, washing from mouths, soap, &c.), and the warm water used for washing daily was continually passing over 129 them, thereby ensuring a suitable temperature for the growth of the bacillus which was apparently inoculated upon this most suitable medium from the throats of one or more of the scholars. The open troughs were of iron (galvanized) and wood, and their states, on examination, such as to leave no doubt in the minds of those who saw them that they had acted as a source of danger, and had doubtlessly helped to cause, or caused, the ill-defined throat troubles (for months past), and the recent subsequent outbreak of true Diphtheria. These open troughs were condemned and done away with—a course of action advisable for other schools that may be fitted with such appliances. The pseudo- and the true- Diphtheria patients were isolated, and the school closed, pending the remodelling and reconstructing of its sanitary arrangements, which were found defective and old-fashioned. Isolation of pseudo-throats has been practised in Lambeth with very good results, and the Lambeth example might, with advantage, be followed elsewhere, where this is not already done. It is common knowledge that the large increase in the number of Diphtheria cases appears to be due (in part) to the fact that slight cases of infectious throats are not detected, and consequently allowed to be a source of danger to others. All sanitarians are agreed, therefore, as to the necessity for frequent bacteriological examinations of swabs taken in all cases of doubtful throat complaints. The large number of swabs sent in for examination in Lambeth is cause for congratulation, and it is hoped that the Medical Practitioners will not hesitate to make as much use as possible of the opportunities offered by the Vestry. Bacteriological diagnosis is now a recognised necessity as an aid, especially in cases of suspected Diphtheria or other infectious throat complaints. I 130 Other examinations. One sample of urine was submitted and examined for tubercle bacilli, which were not found; whilst a scraping from a suspected charbon ulcer of the face did not shew the presence of anthrax bacilli, though many streptococci and oïdia were cultivated. Sputa. Tub. Bac. found. *Bloods. Typhoid reaction obtained. Throat Membranes and Discharges. Klebs-Loeffler bar. found. Other Exams. † Bacilli found. 1899. Yes. No. Total. Yes. No. Total. Yes. No. Total. Yes. No. Total. Jan. 2 1 3 2 — 2 1 — 1 — — — Feb. 1 — 1 2 — 2 — — — — — — Mar. 6 8 14 2 2 4 2 2 4 — — — April — 7 7 — 3 3 8 7 15 — — — May 5 9 14 — 3 3 6 1 7 — — — June 2 8 10 2 4 6 7 10 17 — — — July 3 2 5 1 2 3 5 8 13 — — — Aug. 1 2 3 1 2 3 4 b 9 — — — Sept. 4 2 6 3 10 13 13 8 21 — — — Oct. 4 6 10 6 10 16 25 20 45 — — — Nov. 2 6 8 11 5 16 21 28 49 — 1 1 Dec. 3 6 9 10 — 10 9 26 35 — 1 1 Total 33 57 90 40 41 81 101 115 216 — 2 2 * Slight or feeble reaction in five of the cases. † One was a case of suspected anthrax, and the other of suspected tuberculous kidney. 131 SEWER VENTILATION. The question of Sewer Ventilation is one that has engaged the special attention of the Vestry during 1899, and the following series of recommendations (jointly suggested by the Medical Officer of Health and the Surveyor) were adopted, to be carried out subject to the previous approval of the Vestry:— 1. The freer the ventilation of Sewers, the better, as by such means oxidation and dilution of Sewer gases are effected, and the sewer gases thereby rendered practically harmless. 2. Granted a Sewer in a fairly good condition, and situated in a fairly wide road, surface road ventilation is satisfactory, provided a sufficient number of open ventilating grids are supplied at regular, frequent intervals (the grids being not more than 100 feet apart) i.e., the greater the number of open ventilating grids, the less the nuisances arising from offensive smells. 3. Shafts may also, with advantage, be used, but only (as a rule) in addition to, and not instead of, open road ventilating grids. 4. There should be careful, regular and systematic flushing of Sewers, clearing out of deposits, with relaying of such Sewers as may be, at any time, found to be defective and worn out—a routine practically adopted, at present, by the Vestry. 5. The substitution of glazed pipe Sewers (with improved fall) in place of the small brick barrel Sewers (with little or no fall) which are to be found in great numbers in the lower level districts of Lambeth. 6. The closing of all open ventilating grids in narrow and crowded streets, courts, alleys and passage-ways, and the 132 substitution therefor of ventilating shafts of sufficient calibre (not less than 6")—one shaft being always taken, if practicable, from the highest point of the Sewer, which, if a stunted or dead end, should be tacked on to a neighbouring Sewer, to allow of free circulation of air. 7. The upward movement of air in shafts is increased by gas, which, when burning, acts as an exhaust; so that no difficulty should be placed in the way of the London County Council in their endeavour to relieve the pressure in the Sewers (over which they have jurisdiction), by erecting ventilating extraction shafts, which are in the form of large lamps placed upon street refuges. The proper ventilation of sewers is an important matter, and the middle course seems to be the best, i e., to avoid, on the one hand, the view that no ventilation at the street level is necessary, and, on the other, the view that sewer gas is perfectly innocuous, and can, therefore, be allowed to escape at any and every position in the public thoroughfares, irrespective of the width of such thoroughfares. Properly laid sewers, efficiently flushed, are a sine qua r.on. 133 The Clerical work in connection with the Department during 1899 deserves recognition, and will best be realised in the form of the following statement:— 1899. 1898. 1897. 1895. Letters, etc., received (entered in letter book) 9010 8974 8309 7625 *Letters, etc., sent out (entered in postal book) 26039 25892 24821 25980 Notices served Infectious Diseases 2435 2094 2374 2327 Public Health Preliminary 7676 8375 8714 6222 Acts Statu???ory 2427 2004 2018 1985 Housing of Working Classes Act 42 44 33 55 Cases entered in Inspectors' Report Books 9006 8725 8337 6767 Complaints entered in book 6079 5620 4915 3768 Copies of Infectious Diseases Notifications— (a) Entered in Notification Book 2693 2329 2663 3202 (b) Sen??? off to Asylums Board 2693 2329 2663 3202 Notices of Infectious Diseases sent to Schools 2435 2094 2663 2576 Workshops (with full particulars) entered up in Register 89 134 245 255 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 126 131 215 89 Disinfection Certificates given out 2689 2094 159 109 Stamps used 21256 19151 20141 20925 Reports to Committees (Fortnightly) 20 21 20 20 Reports to Vestry (Monthly and Quarterly) 17 17 17 17 Special Reports 13 6 12 6 There are 3 clerks—a chief (W. R. Lawrence), a second (A. L. Baxter), and a junior (W. 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. * 4,999 letters were tvped during the year 1899, as compared with 5,052 during 1898, 5,538 during 1897, and 4,350 during 1896 (8 months). J APPENDIX. J 2 2 3 Death-rates (General and Zymotic) for London and the Metropolitan Districts during 1899. Metropolitan Districts. Death-rate (corrected). Zymotic Deathrate (corrected). Infantile Mortality Rate. Diarrhoea Rate. Typhoid Fever Rate. Dipht???eria 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 19.3 2.46 1.66 0.92 0.17 0.43 0.09 1.82 East. West. Shoreditch 23.8 3.64 204 1.64 0.21 0.54 0.11 2.10 Paddington 16.1 1.55 151 0.83 0.07 0.23 0.04 1.15 Bethnal Green 22.8 3.1?? 174 1.21 0.30 0.46 0.07 2.36 Kensington 17.7 1.53 180 0.59 0.14 0.25 0.06 1.34 Whitechapel 21.1 2.12 147 0.57 0.18 0.33 0.02 2.39 Hammersmith 19.0 2.11 183 0.93 0.21 0.23 0.12 1.72 St. George-in-the-East 27.1 3.44 200 1.22 0.19 0.2??? 0.06 2.50 Fulham 19.2 3.23 189 1.40 0.19 0.45 0.25 1.83 Limehouse 25.6 3.78 216 1.21 0.38 0.58 0.02 2.30 Chelsea 19.6 2.13 164 0.66 0.19 027 0.08 1.79 Mile End Old Town 21.3 2.72 158 0.98 0.23 0.58 0.04 1.82 St. George's, Hanover Square 14.2 1.09 129 0.36 0.11 015 0.09 1.36 Poplar 22.1 3.41 176 1.45 0.22 0.45 0.0??? 2.14 St. Margaret and St. John, Westminster 22.3 1.64 207 0.75 0.17 0-19 0.10 3.31 South. St. James', Westminster 17.9 1.12 142 0.37 0.14 014 0.05 2.11 St. Saviour's 25.1 3.51 203 1.41 0.04 0.70 0.08 3.41 North. St. George-the-Martyr, Southwark 27.7 4.53 205 1.69 0.13 1.04 0.10 3.53 Newington 24.0 3.67 191 1.00 0.19 0.84 0.10 2.62 St. Marylebone 18.6 1.70 124 0.72 0.19 0.26 0.11 1.98 St. Olave 24.9 2.61 147 0.54 0.18 0.81 0.18 2.53 Hampstead 11.6 1.16 129 0.44 0.05s 0.19 0.07 0.84 Bermondsey 24.1 3.46 187 0.96 0.21 1.03 0.12 2.14 St. Pancras 20.3 2.69 178 0.95 0.17 0.46 0.10 2.01 Rotherhithe 21.1 2.80 170 0.78 0.27 0.78 0.27 1.83 Islington 18.1 2.30 160 0.74 0.14 0.36 0.10 1.59 Lambeth 19.2 2.65 158 0.93 o.16 0.51 0.08 1.75 Stoke Newington 12.7 1.33 103 0.54 0.14 0.17 0.09 0.88 Battersea 16.7 2.22i 162 0.66 0.22 0.36 0.08 1.59 Hackney 16.9 2.22 153 0.87 0.16 0.40 0.07 1.50 Wandsworth 15.3 1.89 153 0.84 0.09 0.33 0.04 1.21 Camberwell 17.4 2.52 158 0.90 0.12 0.61 0.07 1.53 Central. Greenwich 18.8 2.76 167 1.12 0.16 0.40 0.09 1.54 Lee 15.1 2.06 141 0.67 0.10 0.35 0.10 1.00 St. Giles 19.9 1.40 112 0.70 0.11 0.13 - 3.13 Lewisham (excluding Penge) 16.3 2.23 143 1.00 0.12 0.75 0.07 1.15 St. Martin's-in-theFields 15.6 1.07 203 0.50 0.0 0.08 - 1.82 Woolwich 21.2 2.44 163 1.09 0.12 0.51 0.10 2.46 Strand 22.7 1.30 189 0.74 - 0.30 0.04 2.70 Plumstead 14.3 1.35 124 0.80 - 0.25 0.09 1.47 Holborn 24.9 2.23 226 0.88 0.24 0.20 0.10 3.08 Clerkenwell 22.6 3.04 193 1.06 0.35 0.42 0.20 2.32 N.B.—These Returns are taken from the Registrar-General's Annual Summary. Where no Death occurred, — is inserted. St. Luke 28.1 3.03 149 1.45 0.15 0.25 0.20 2???3 City of London 21.5 1.36 144 0.32 0.43 0.25 0.04 2.19 4 Report on VENTILATION OF SEWERS. (Adopted by the Vestry on April 12th, 1899). The three Reports published by the London County Council, shewing the results of investigations conducted by Mr. J. Parry Laws and Dr. Andrews on the Composition and Bacteriologv of Sewer Air and Sewage, throw little, if any, further light on the dangers of sewer air in regard to the subject of sewer ventilation. It would appear from the Reports that sewer air is not quite so deadly as some have hitherto supposed, regarded, that is, from the standpoint of the germs it contains ; and that, though it is only circumstantial evidence that points to sewer air and zymotic disease being causally related, it may be that its danger in this respect is an indirect one, and due to some highly poisonous chemical substance (possibly of an alkaloidal nature) which with the CO2 (carbonic acid) in excess may produce a profound effect upon the general vitality. No evidence of this latter content ion is, at present, forthcoming however, but it would be still unwise to assume that sewer air is harmless because it may contain but few organisms, as shewn by bacteriological experiments. In Lambeth, considering the large number of open sewer ventilators in the roadways, complaints are comparatively few, and in only rare instances does any illness arise which can be fairly attributed in any degree to offensive emanations arising therefrom. It is presumable, therefore, that oxidation and dilution of sewer gases rapidly render them inert, and as a corollary it follows that the freer the 5 ventilation of the sewers, the better. The systematic blocking up and closing of road ventilators tends to prevent this free ventilation, and ought, therefore, to be discouraged ; nor is there any necessity for the closing of an open ventilator until other means have first been tried to abate any nuisance arising from offensive smells in connection therewith—e.g., careful flushing and cleansing of manholes; clearing away of sewer deposits, when found to exist; increasing the number of open ventilators; erection of shafts, but only in addition to, and not in place of, open manhole ventilators, &c. The necessity for diluting and oxidising sewer air as much as possible is admitted when it is remembered that putrefactive changes, taking place in the contents of sewers, give rise to the evolution of certain organic and other gases which, if allowed to accumulate under pressure, will tend to escape into (or near) houses from the points of least resistance, viz., defective house drains and traps, &c. It is true that the continued inhalation of these gases for any length of time in confined spaces tends to produce fever, anæmia, loss of appetite, depressed vitality, prostration, headache, sore throat, and general loss of health—a condition of things that may be produced by such gases escaping through openings into the sleeping and living rooms of houses, into narrow streets near to houses, courts or alleys; but not necessarily when escaping into a fairly wide thoroughfare (not less than 30 ft.)—the rapid dilution and oxidation making all the difference in this latter case. In sewers which are properly laid, carefully planned, well flushed and ventilated, these putrefactive gases are at a minimum; but at a maximum in sewers badly laid, defective, unflushed, and ill-ventilated. 6 The practical conclusions are obvious :— 1. In old, ill-kept, defective sewers—in so-called sewers of deposit, or elongated cesspools, open grids in narrow and crowded streets and courts or alleys must be more or less nuisances, and ought, therefore, to be closed, and suitable (adequate) compensatory ventilation by shafts (or otherwise) provided. In wider thoroughfares, however, the nuisance from open grids must be very much less, and the gases practically rendered harmless by oxidation and dilution as they issue therefrom. 2. In new, properly constructed sewers, with adequate fall, good flushing, and a fairly rapid flow, open grids may be disregarded from the point of view of nuisance, except, perhaps, in very rare instances, when they may prove temporarily to be so under certain atmospheric and other conditions, e.g., when inlets act as outlets ; when hot water or steam is sent into a sewer, thereby causing increased putrefactive changes with consequent increased evolution of gases ; when the open grids are too few in number and the distances between individual ones greater than, say, 50 yards, thereby preventing proper oxidation and dilution of the gases ; when waste products from factories, breweries, chemical works, &c., are run into the sewers, and the fumes arising therefrom given off from neighbouring open manholes, &c. The principle of thoroughly ventilating sewers is good, and granted a fairly wide thoroughfare, and a fairly good sewer, I do not think I should be justified in condemning the method by open manholes on the crowns of the sewers 7 in the centre of the roads. No open ventilating manholes should, however, I think, be allowed in courts, alleys, or narrow streets, but such manholes should be closed and ventilating pipes of sufficiently large calibre run up adjoining property—one at least from the top end of the sewer, where practicable. In conclusion, when a grid is complained of, let the inspector be satisfied as to the bona-fides of the complaint (for closed grids and shafts unconnected with sewers have in my experience, been complained of before now), and then let the offending grid be treated on its merits, on lines similar to those which I have laid down, e.g., by flushing, by removal of deposits, by making more openings into the same sewer or by erection of large-sized shafts for compensatory ventilation with or without closure of the manholes, as may be found necessary. I am not aware, speaking generally, that the open grids in Lambeth have proved a danger to the public health. Statistics would seem to point to the contrary. I append the conclusions arrived at by the Conference of Engineers and Surveyors of the various Metropolitan Vestries and District Boards, and the resume of the three Reports presented to the London County Council by Mr. J. Parry Laws and Dr. Andrews. Joseph Priestley, February 6th, 1899. Medical Officer of Health. Resume of Three Reports on Sewer Air Acting on the instructions of the Sanitary Committee, I have prepared an abstract of the three following Reports 8 presented to the Main Drainage Committee of the London County Council:— (a.) Sewer Air Investigations, I., by J. Parry Laws, F.I.C. (May, 1892). (b.) Sewer Air Investigations, II., by J. Parry Laws, F.I.C. (December, 1893). (c.) Investigations on the Micro-organisms of Sewage, by Messrs. J. Parry Laws, F.I.C., and Frederick W. Andrews, M.D. (December, 1894). (a.) The experiments were made in the King's Scholars' Pond Sewer, which runs from Piccadilly in the north to Buckingham Palace Road in the south, and was constructed 120 years ago. Conclusions drawn from Experiments. 1. The micro-organisms in the sewer air are related to the micro-organisms in the air outside, and not to the micro-organisms of the sewage. 2. In the air both within and without the sewer, the forms of micro-organisms present are almost exclusively moulds and micrococci; on the contrary, the micro-organisms of sewage are for the most part bacilli. 3. That for purposes of deodorising, manganate of soda + sulphuric acid, and carbolic acid are more efficient than sulphurous acid or manganate of soda alone, and, setting aside the question of relative cost, the manganate of soda + sulphuric acid is decidedly the best, the disagreeable smell of the sewer air being removed completely thereby. (N.B.— The sewage was deodorised in each case for 24 hours previous to experiment.) 9 The principal, if not the only, source of microorganisms in sewer air, is the air without the sewer and not the sewage, and there is very little ground for supposing that the micro-organisms of sewage, in the absence of violent splashing, become disseminated in the sewer air. 5. The sewer air contained 2 to 10 times as much carbonic acid as the neighbouring fresh air (taken at the same time), and no sulphuretted hydrogen gas was found. (b.) The experiments were made with an air shaft erected at the Pimlico Pumping Station; an experimental sewer (9-in., 80 feet long), laid in the Pump Room at Pimlico Station ; and the Fulham Road sewer (400 yds. long), close to the Town Hall, Fulham—a sewer containing a large amount of heavy deposit, and being otherwise in a most filthy condition and unventilated. Conclusions drawn from Experiments. 1. Considerable increase in the velocity of the air current does not produce an increase in the number of micoorganisms found in the sewer air. 2. The conclusions obtained by experiment in a large sewer (the King's Scholars' Pond sewer) hold good for a small sewer (the experimental 9" sewer). 3. In an experimental sewer (9"), wherein the sewage was allowed to remain stagnant for several weeks (the pipe being filled to the extent of two-thirds of its sectional area), the sewer air was found to contain very many more micro-organisms (entirely moulds) than the air outside; at least, in two out of the six experiments made, a condition of things difficult of explanation, 4. In a filthy, unventila ed sewer (containing deposit), the 10 number of micro-organisms found in the sewer air was particularly low. 5. Micro-organisms found in sewer air appear to come from the fresh air outside (passing into the sewers by ventilation), and not from the sewage or sewer walls, and are chit fly moulds and micrococci (as found in fresh air) and not bacilli and moulds (as found in sewage), the ratio of micrococci to bacilli being, in the case of fewer air and fresh air, about five to one. Further, the bacillus coli communis and micrococcus ureœ are absent from sewer air, as are also, with very few exceptions, organisms capable of very rapidly liquefying gelatine, though all these organisms are found in immense quantities in sewage. 6. It is impossible to ignore the evidence, though it is on circumstantial, that sewer air in some instances has had some causal relation to zymotic disease—the danger of sewer air causing disease being, perhaps (though at present no evidence is forthcoming), an indirect one, e.g., the sewer air containing some highly poisonous chemical substance, possibly of an alkaloidal nature, which, though present in but minute quantities, may, nevertheless, produce, in conjunction with the large excess of carbonic acid, a profound effect upon the general vitality. (c.) Results of a detailed examination and cultivation of the various micro-organisms of sewage. Conclusions. 1. The study of the sewage bacteria fully confirms the conclusion given in the two previous Reports, viz., that there is no relationship between the organisms of sewer air and sewage. It is possible that some of the ill-effects which have been erroncously ascribed to sewer air may be due to 11 subsoil air derived from soil polluted by constant infiltration of excremental matter through a leaky drain—the ou er margin of the infiltrated area becoming sufficiently dry to give off micro-organisms to the subsoil air, which then may gain access to dwellings, either through the pressure of the wind on the surface of the ground, or from currents induced by wide differences between the exterior and interior temperatures. 2. Sewage does not form a medium in which much, if any, growth of the typhoid fever bacilli takes place under natural conditions, and the death of these bacilli takes place in a few days, or in, at most, one or two weeks — the interval allowing, however, of the disease being transferred from place to place by sewage. The air of sewers is extremely unlikely to convey typhoid fever. Joseph Priestley. Xonbon Counts Council. VENTILATION OF SEWERS. Report by Engineer as to the Result ok a Conference of Engineers and Surveyors of the several Vestries and District Boards of the Metropolis. To the Mail Drainage Committee— In accordance with the instructions of the Committee I issued two circular letters to the Engineers and Surveyors of the various Vestries and District Boards in the County, inviting them to a Conference on the subject of the Ventilation of Sewers, with a view to some uniform system being 12 adopted, if possible, for dealing with complaints of offensive emanations from gratings connected with both local and main sewers. In response to the invitation a meeting was held at the County Hall, on Friday, 25th February, at which upwards of forty of the gentlemen invited were present. A list of those who signed the attendance book, together with the names of the districts represented by them, is appended hereto. The discussion on the subject of the ventilation of sewers occupied a period of over two hours and resulted in the following resolutions being passed, namely— 1. That the closing of sewer ventilators in response to complaints increases the general evil, the diminution of w hich is to be attained by the multiplication of the ventilators at regular frequent intervals. 2. That in connection with any interceptor hereafter fixed on a main house drain it is advisable to carry up a ventilating pipe from the sewer side of the interceptor, up the front, side, or back of the house, to the satisfaction of the local sanitary authority, and that the outlet drain from the interceptor shall not be flap-trapped in sewer, unless required by the local sanitary authority. 3. That pipe ventilators up buildings, or otherwise where possible, should always be adopted, in addition to surface ventilation. It will be observed that the general result of the Conference has confirmed the action of the Committee and the Council in recent years, and that the remedy for sewer emanations is to be looked for from the maintenance of 13 more frequent ventilating openings, both at the street level and by means of pipes carried up houses and other buildings. I would suggest that, as the meeting was a very representative one, this report be printed, and that copies be sent to each member of the Council and to the Engineers and Surveyors of the District Boards and Vestries in the Metropolis. Alex. R. Binnie, Chief Engineer. Spring Gardens, S.W., 24th March, 1898. List of Engineers and Surveyors, together with the Districts represented— Name. District. Baker, H. Newington. Blair, W. N. St. Pancras. Botterill, C. Fulham. Burgess, S. E. Stoke Newington. Carline, J. Lcwisham. Dodd, P. Wandsworth. Dunch, T. H. Limehouse. Findlay, R. Eltham. Gow, W. C. Plumstead. Heckford, H. St. Luke's. Higgens, T. W. E. Chelsea. Killick, P. G. Clerkenwell. Livingstone, G. St. George's, Hanover Square. Lovegrove, J. Hackney. Lowe, C. H. Hampstead. Mair, H. Hammersmith. 14 Marten, H. J. Streatham and Tooting'. Mason, C. St. Mar;in-in-the-Fields. Monson, H. St. James, Westminster. Norrington, J. P. Lambeth. Oxtoby. W. Poplar. Pilditch, J. T. Battersea. Radford, J. C. Putney. Ross, D. J. City. Rowland, J. Old Charlton. Rush-Dixon, J. Shoreditch. Scorgie, N. Rotherhithe. Slater, F. T. Camberwell. Southam, A. Clapham. Sumner, F. Bermondsey. Thomas, H. O. Woolwich. Thompson, G. W. St. Olave. Ventris, A. Strand. Waddington, J. P. Whitechapel. Wallace, G. St. Giles. Weaver, W. Kensington. Wheeler, G. R. W. Westminster. Winter, O. E. St. George-the-Martyr,Southwark. Woods, H. Lee. 15 Report on NEW BYE-LAWS (DRAINAGE) Suggested by the London County Council (Adopted by the Vestry on July 20th, 1899). The amendments and extensions proposed in the new Bye-laws suggested by the L.C.C. are as follows:— (1.) Where soil-pipes of new Buildings are required, under the present Bye-laws, to be in all cases fixed outside, the proposed new Bye-laws insert the convenient, but elastic words "where practicable," a modification which applies to old buildings, both in the present Bye-laws and in the proposed new Bye-laws. Inside soil-pipes are, by the proposed new Bye-laws, to be made of drawn lead only, and not of drawn lead or heavy cast iron as allowed in the pres'ent Bye-laws ; whilst joints are to be properly wiped plumbers' joints, and the soil-pipes are to be easily accessible. (2.) In the case of iron soil-pipes being used outside, the proposed Bye-laws give certain thicknesses of iron, as well as weights, which are to be used, the present Bye-laws giving weights only ; whilst in addition, the joints in connection with the iron pipes will be required, by the proposed new Bye-laws, to be 2|-in. deep in sockets, and the actual spaces round the joints to be not less than J-in. wide for -in. and 4^-in. pipes, and not less than f-in. wide for 5-in. and 6-in. pipes. Further, in the event of flanged joints being used, they are to be securely bolted together with some suitable insertion. k 16 (3.) Anti-syphonage pipes (i.e., ventilating pipes taken off the out-goes of W.C. traps) are, by the proposed new Bye-laws, to be made either of drawn lead or of heavy cast iron, of certain weights and thicknesses, and of drawn lead only when such anti-syphonage pipes are inside buildings —conditions not mentioned in the present Bye-laws. (4.) Full details are given in the proposed new Bye-laws as to proper conneciions between— (a.) Lead soil-pipes and iron or stoneware drains; (b.) Stoneware W.C. traps and iron or lead soil-pipes (c.) Iron soil-pipes and stoneware drains. (5.) Both the proposed new Bye-laws and the present Bye-laws prohibit any connections between soil-pipes and (1) rain-water pipes, or (2) the wastes of baths or sinks, other than those provided for the reception of urine and other excremental filth, and also prohibit the use of traps in soil-pipes, or soil-pipes and any drains with which they are connected. Joseph Priesti.ey, Mcdical Officer oj Health. July lOih, 1899. 17 Report on ANTI-TOXIC TREATMENT of DIPHTHERIA. (Adopted by the Vestry on August 3rd, 1899.) It. is now generally admitted, by those best able to form an opinion, that the Anti-toxic treatment of Diphtheria gives the best results of all treatments, as shewn not only by the lowering of the mortality from, but also by the amelioration of the symptoms of, that particular disease. Statistics published by the Metropolitan Asylums Board shew that, if the Anti-toxin is injected in the very earliest stages of the disease, the mortality is reduced considerably, as follows : — Cases treated on first day, mortality reduced from 22.5 to 4.7 per cent. Cases treated on second day, mortality reduced from 27 to 12.8 per cent. Cases treated on third day, mortality reduced from 29'4 to 17.7 per cent. Cases treated on fourth day, mortality reduced from 31.6 to 22.5 per cent. Cases treated on fifth day, mortality reduced from 30.8 to 24.6 per cent. Of all the cases treated, the mortality has been reduced from 29.6 to 20.8 per cent. The results are more remarkable when examined from the point of view of the patients' ages. Thus: Under 5 years of age, the mortality has been reduced from 47.4 to 30.2 per cent. Under 10 years of age, the mortality has been reduced from 37.2 to 24.6 per cent. Under 15 years of age, the mortality has been reduced from 33.6 to 22.6 per cent. K 2 18 The last Report of the Metropolitan Asylums Board shews that 80 per cent, of the Diphtheria cases sent to hospital were treated with Anti-toxin, and it is only fair, therefore, that the same means should be adopted whereby all cases might be treated in the same way as early as possible, not only those cases that will eventually be removed to hospital, but also those remaining for treatment at their homes. The average dose for injection is 1,000 units, and the cost of ihis is Is., or slightly less. Taking the Lambeth statistics, the annual average of Notification Certificates received in respect of Diphtheria and Membranous Croup for the eight years 1890-7 is 588 ; whilst during last year, 1898, the total number of Notification Certificates received was 829, and 65-8 per cent, of these latter cases were removed into horpital. The corresponding annual average of deaths from the two diseases mentioned is 122, with a total of 115 during 1898. Assuming 600 as a fair average of cases notified yearly, the cost to ihe Vestry to supply (for the treatment of all the cases) Anti-tox c Serum gratuitously to the Medical Practitioners in Lambeth would be only £30, and I advise, accordingly, the gratuitous distribution to members of the Medical Profession (in Lambeth) of Anti-toxic Serum for the treatment of patients (living in Lambeth) notified as suffering from Diphtheria; whilst 1 also suggest that means should be adopted for the same Medical Practitioners to be supplied with Serum at a charge of Is. per 1000 units tube, for use in the treatment of their patients who do not reside in the Parish. Joseph Priestley, Medical Officer of Health. July 24th, 1899. 19 Report on LOCAL OUTBREAKS OF TYPHOID FEVER IN LAMBETH. (Adopted by the Vestry, November 23rd, 1899). There has been recently in Lambeth an increase in the number of cases of Typhoid Fever, i.e., over the Autumnal average, and in my investigations I have succeeded in tracing the source and spread of three local epidemics, the histories of which are interesting from an etiological point of view. Typhoid Fever is generally regarded as a water-, or milk-, or (recently) shellfish-borne disease, its spread by actual contact from person to person being considered somewhat rare, so that the subjoined details are noteworthy as shewing that in all probability Typhoid spreads by actual contact oftener than is generally supposed—difficulties in the latter case in collecting the facts and shewing their inter-relationship being considerable. The contagium is the Typhoid bacilli of Eberth, which pass from the patients in large quantities through the bowels and the kidneys, and so may infect other persons, directly by contact, or indirectly through food, thereby rendering extreme cleanliness of person amongst those attending upon the sick, of the greatest importance. The details are as follow :— Group I.-—Louisa J. (age 37 years), living at 7, M— Place, off the Wandsworth Road, was ill with obscure symptoms which were eventually shewn to be those of Typhoid Fever, and the case was, after the disease had run a few weeks of its course, notified, and the usual precautions then taken. It was too late, however, as the disease had already directly spread — 20 (1.) To a daughter, Ada J., 10 years of age, living at the same house ; (2.) To a friend's two children, Frank and Edith S., aged 4$ years and 11 years, living at 8 M— Place (this house being opposite to No. 7, in the same narrow and confined court), whilst Frank S., at 8, M— Place, gave the disease to his brother Fred (17 years of age), with whom he slept; (3.) To a friend, Ada M., aged 30, living at 5, M— Place, two doors removed from No. 7, and, of course, in the same narrow court. By means of a house-to-house enquiry, no more cases were found in the Court, and all the patients were removed to hospital, and the houses and their contents thoroughly disinfected, and the walls of the infected rooms, in each case, stripped. The roadway of the court was found to be in an unsatisfactory state, and has been attended to by the Surveyor; whilst the houses (14 in number) have been thoroughly inspected, and since registered by the Vestry under Houses Let in Lodgings. No further case has since occurred in this district—a satisfactory result, as there were at the time several centres of infection in a crowded court, consisting of 14 houses, containing 56 rooms, with 23 families, numbering in all 132 persons, 59 being children under 10 years of age—the conditions of the persons themselves, and their crowded and dirty surroundings, being such as to form a suitable nidus for the rapid growth of Typhoid germs. The exact source of the first case (Louisa J.) of Group I. could not be traced. 21 Group II.—Joseph H. (aged 22 years), living at 42, B— Street, sickened with obscure symptoms (which afterwards proved to be due to Typhoid Fever), with the result that the case was not at first notified, and the usual precautions were, therefore, not takt n, in the way of isolation, etc., until three or four weeks of the illness had gone, during which time the patient was a source of infection to others, as shewn by the disease spreading directly— (1.) To a lodger, Thos. M. (aged 29 years), living in the same house : (2.) To a sister, Annie H. (aged 15 years) living at 4, R—Place, a street close by; (3). To a friend, John T. (age 20 years), living at 49, BvStreet; (4). To a friend, William T. (aged 30 years), living at 67, B—Street, and he has since given the disease to his daughter, Clara T. (aged 9 years); (5.) To two other persons living in the same street, Ernest J. (aged 10 years), of 32, B—Street; and Harriet F. (age 30 years), of 71, B— Street; but a relationship between these cases and the others could not be definitely traced, though it was rendered highly probable by the histories as to dates of sickening, etc. Some of the above cases were discovered as the result of a house-to-house enquiry, and all the patients were removed to hospital, and the houses, and their contents, thoroughly disinfected, and the walls of the infected rooms, in each case, stripped. No further case has tince occurred in this district. 22 M— Place is a court opposite to R— Place, which is a short street, leading to B— Street, but no intercommunication could be proved between the cases of Group I. and those of Group II., except perhaps in the local public house, which was (so it is reported) frequented in common, as also a -general dealing shop at the corner of M— Place. The exact source of the first case (Joseph H.) of Group II. could not be traced. Group III.—John L. (age 26 years), living at a house in Lower Kennington Lane, sickened with obscure symptoms about August 12th, and eventually died without the Medical man in attendance recognising the disease as Typhoid Fever, although in all probability it was so, as shewn by subsequent events. During his illness and after death, his clothes, bedding, etc., were removed from time to time to be washed, to 59, W— Street,hismother-in-Iaw's house, and directly infected— (1.) His mother-in-law, Matilda J. (age 47 years), living at 59, W— Street; (2.) A brother-in-law, Harry T. (age 15 years), living at 59, W— Street; (3.) A sister-in-law, Sophia J. (age 24 years), living at 59, W— Street; [and Sophia J. gave the disease to a friend's child, Frank P. (age 4 years), living next door (61, W— Street);] (4.) His wife, Matilda L. (age 26 years), who, after her husband's death, went from the house in Lower Kennington Lane to live with her mother at 59, W— Street. 23 (5.) Alfred L. (age 14 years), living at 4, W— Street, a fellow schoolmate of Harry J. (See No. 2 above). The usual precautions were taken as to isolation, disinfection, etc., and the infected rooms, in each case, were stripped. No further case has occurred in this district, which is too far removed to have any connection with the districts mentioned in Groups I. and II. The first case (John L,) of Group III. appears to have become infected at New Shoreham, where he had been spending his holiday, the disease manifesting itself three days after his return to Lambeth. Careful enquiries failed to connect any of the cases of Groups I., II. and III., with infected water or milk, or even with oysters (or other shellfish), and by a process of exclusion I am driven to regard, therefore, the cause of the outbreaks as contact from person to person—(1) directly, or (2) indirectly, through infected clothes, food, etc. Further, the difficulties in diagnosing Typhoid Fever in the early stages of the disease are well known to all medical men of experience, and in some of the cases mentioned above, such difficulties have been the cause of the disease spreading locally. Fortunately, bacteriology has come to our aid with the Widal or Typhoid re-action test, which readily shows itself after the first week of the disease, so that there is less excuse now than formerly for errors in the diagnosis of Typhoid, and as the Vestry has provided free of cost such bacteriological methods for the use of medical men in Lambeth, the Vestry is justified in looking forward to the disappearance of localised Typhoid epidemics, such as I have described, and which are in the first place due to cases being undiagnosed in the early stages, when infection is well-known to exist. 24 The experience gained recently in connection with the above mentioned epidemics goes to show that the Widal test for Typhoid is invaluable as an aid to diagnosis—several of the cases having been discovered by this means. Typhoid is stated to be a disease of adult life (rarely affecting children or old people), but in the outbreaks mentioned above, there have been 15 adults (8 males and 7 females) and 6 children under 12 years of age (3 males and 3 females), making 21 cases in all, and of the adults, 5 died, the children escaping death. The ages of the adults vary from 15 to 47. Diagrammatically, the intT-relationships of the different cases is well shown, taking into account the approximate dates of sickening, as given in brackets, with the initials of the patients:— 25 Group I. (6 cases). 7, M. Place (L. J., Aug. ioth). 7, M. Place (A. J., Sept. 7). Group II. (6 cases). 8, M. Hlace (F. S„ Sept. 7). 8, M. Place (E. S., Sept. 7). 8, M. Place (F. S., Sept. 21). Lower Kennington Lane (J. L., Aug. 18). 5, M. Place (A. M., Aug. 24). 59, W. Street (M. L., Sept. 25). 59, W. Street (H. J., Sept. 20). 59, W. Street (M. J., Sept. 20.) 59, W. Street (S. J., Oct. 14). 4, W. Street (A. L., Oct. 14). 61, W. Street (F. P., Oct. 31). Group III. (8 cases). 42, B. Street (J. H., Aug. 14) 42, B. Street 49, B. Street 67, B. Street 4, R. Place (?) 71, B. Street (T. M., Sept. 7). (J. T., Aug. 31). (W.T., Aug.31). (A. H., Sept. 7). (H. F., Aug. 29). 67, B. Street (C. T., Oct, 24). (?) 32, B. Street (E. J., Sept. 14). The incubation period of Typhoid is two or three weeks, but in cases like the above (i.e., direct contact cases), the incubation period appears to t e slightly less, viz. : eight days to two weeks. Joseph Priestley, Meaical Officer of Health. Nov. 13th, 1899. 26 Report on INSANITARY AREAS and the HOUSING OF THE WORKING CLASSES. (Adopted by the Vestry, January 18th, igoo). When a Sanitary Authority decides to take action under the Housing of the Working Classes Act, 1890, there are practically two ways of doing so, for the Medical Officer of Health may condemn (or, in the words of the Act, represent) on the ground of danger to health, (I) a large sized area; or (2) an individual house, or collection of houses (forming a smaller area). The former course is the one that is at present finding undue (in my opinion) favour with the London County Council, and with several Metropolitan Sanitary Authorities, with the result that large numbers of persons are being displaced on account of old premises (dilapidated and insanitary) being pulled down, and in course of time re-built on improved lines, but at a very considerable cost (compensation and otherwise) to the general body of ratepayers of the County of London. Why does not Lambeth now also put forth claims, and so secure a grant or grants out of the general county fund ? Are there not in Lambeth insanitary areas that might, with advantage to the general public health of London as a whole, or of Lambeth in particular, be scheduled and dealt with in the same way as are areas (say) in the neighbouring Parish of St. Georgethe-Martyr? Are there not some black spots in the so-called inner (and congested) districts of the Parish of Lambeth that might, with advantage, be blotted out? Such are the types of questions which are heard, and I, as Medical Officer, 27 feel that the occasion has now arisen for a definite expression of opinion (approval or otherwise) by the Lambeth Vestry as to the line of action hitherto taken, and still being taken, by their Medical Officer of Health. As the official medical adviser to the Vestry, and with my local knowledge of the amount of congestion and crowding (whether of houses over areas, or of persons in houses), 1 have always felt that the necessary wholesale displacing of persons, consequent upon the clearing of a large insanitary area under Part I., or upon the closing of large numbers of separate houses under Part II., of the Housing of the Working Classes Act, 1890, must at all costs be avoided. Such action simply tends to increase the congestion or crowding in other immediately neighbouring parts, and so to create, by means of one Act of Parliament, serious nuisances, which it then becomes the duty of the Sanitary Authority to abate by the powers invested in them under another Act of Parliament—the Public Health (London) Act, 1891. Further, experience shows that where an area (large or small) is cleared on account of its so-called slumminess, neighbouring properties, which were previously (considering all things) passable, are apt to become rookeries, requiring in their turn to be dealt with. It is common knowledge that amongst the persons displaced there are those who must live in the immediate neighbourhood so as to be near their work, which may be of a casual or irregular kind, or for other equally cogent reasons, and they necessarily tend to still more crowd and over-crowd, and so perpetuate all the evils (sanitary and moral) attendant thereon. As houses become scarce, rents increase, and overcrowding consequently results from the sub-letting of rooms. In this way the difficulty is not overcome, but simply transferred from one district to another, or from one house to another, and so the continuity of the vicious circle is ensured. What applies to Lambeth applies to other Districts. This picture of overcrowding is not a fancy 28 one, as the Registrar-General's statistics taken at the Census, 1891, show that there was at that date in Lambeth a total of 63,454 tenements, of which 10,837 were one roomed and 11,485 two-roomed. Further, of the 10,837 one-roomed tenements, 3,120 had three or more occupants per room, and 543 had over four occupants per room; and of the 11,485 tworoomed tenements 5,828 had five or more occupants per tenement, and 653 over six occupants per tenement, whilst of the total number of tenements with less than five rooms, viz., 40,472, it was found that 7,747 had more than an average of two occupants per room. Taking the word "overcrowding" as meaning (roughly) more than two persons per room, it is seen that at the time of the 1891 Census, 28 per cent, of the one-roomed, 50 per cent, of the two-roomed, and 19 per cent, of the total tenements with less than five rooms, were overcrowded ; and there is every reason for believing that these numbers have much increased since that time, allowing for steady increase of population year by year, or an almost equally steady decrease of house accommodation, at least in the Inner Districts of Lambeth. What I have endeavoured to do in Lambeth has been to deal with houses, singly or in the form of courts or streets, and condemn them under Part II. of the Housing of the Working Classes Act as unfit for habitation, such condemnation leading to the houses in question being ordered to be either put into proper order and condition to the satisfaction of the Vestry, or closed, and afterwards demolished, by the owners. Fortunately, the owners, who under this particular Act are generally freeholders, or, at least, leaseholders, who have not less than 21 years' interest, adopt, as a rule, the former alternative, with the result that houses are put into sanitary condition, and the inmates are not permanently disturbed. Surely it is better for the houses in which people live to be made habitable and sanitary than for such houses to be closed and pulled down, and the tenants turned out and 29 left to look after themselves and get accommodation anywhere? It must be remembered that the Housing of the Working Classes Act need only be put into motion in exceptional cases, e.g., where the houses are unfit for habitation, owing to any, or all, of the following reasons:—(i) Want of proper site; (2) general dilapidation, and want of repair (from age, or otherwise); (3) defective construction of the houses, either as built originally, or as developed since; (4) the existence of serious sanitary nuisances, arising from defective drains, &c.; (5) the fact that short-termed leaseholders or owners are sometimes financially unable, or unwilling, to spend sufficient money on their properties; (6) the close proximity of obstructive buildings. In the larger (by far) majority of cases, it is found sufficient to proceed under the Public Health (London) Act, 1891, which also enables a Local Authority (if necessary) to apply for closing orders in connection with houses unfit for human habitation by reason of the existence therein of ordinary nuisances mentioned in that Act, without having resort to the more stringent Part II. of the Housing of the Working Classes Act, 1890—an important fact to be remembered when the full results obtained are taken into account. Thus, taking the averages since I have been Medical Officer, there have been served yearly under the Public Health (London) Act, 6,829 Notices,as compared with 37 Notices only under Part II. of the Housing of the Working Classes 1890 Act-the former dealing with 8,562 structural and 1,548 non-structural defects (total, 10,no), rendering the premises more or less unfit for habitation, and the latter with 49 houses, which were generally in such a dirty, damp, dilapidated and insanitary state as to be quite unfit for human habitation in their then conditions. Of the total 196 houses condemned under the Housing Act, 43 only have since been demolished, the resc having being either closed temporarily, prior to rebuilding, or at once put into proper order and condition, and so made fit for human 30 tation; whilst the 27,316 Notices served under the Public Health Acts have all been complied with, and the 40,440 defects made good. In some few instances it has been found impossible to render the houses fit for habitation, owing to their positions or conditions, and in these cases the houses have been closed, and afterwards demolished, e.g., Francis, Fountain and Paved Courts (off the Lambeth Walk', Commercial Buildings, Le Grand Place, Windmill Court, etc. A strict and constant supervision in the poorer and more congested parts of the Parish, ensuring the houses being kept up to a fair sanitary standard, is proving satisfactory, as far as the houses themselves are concerned, and I may even add, as tar as the tenants too are concerned, for experience shows that in sanitary matters, as in other matters, people are dependent upon their surroundings. Where houses are dilapidated and insanitary, the tenants show a tendency to become morally and physically the same, and vice versa— indeed, the apathy of tenants is remarkable, rendering frequent inspections of their houses by the Officers of a Sanitary Authority a sine qua non. In connection with these inspections of houses, the powers given under the Public Health (London) Act, 1891, for the Registration of Houses Let in Lodgings, may be found to be of great value and assistance, especially in the case of the worst properties—351 houses having already been registered in Lambeth under the new Bye-laws, which were unfortunately not confirmed by the Local Government Board until May nth, 1897. The result of constant supervision by house-to-house inspections (such inspections to take place periodically, i.e., once or twice a year, at least) is the gradual levelling up of the old, dilapidated and insanitary properties, more especially in the older and more congested parts of the Parish, without, in fact, any displacement. An important statement like this ought to be accompanied by proofs, and I give, therefore, the following list of courts, etc., in the (1) Inner, and (2) Outer 31 Wards, as examples of what has been, and is being still, accomplished in Lambeth, without such displacement of tenants as would necessarily have taken place, had areacondemnation been the line of attack:— I. Inner Wards. Addresses. No. of Houses. Victoria Place, Broadwall 12 Sidwell Place, Broadwall 12 Prince's Buildings, York Road 20 Cory Square, Commercial Road 21 Cage Place, Commercial R.oad 28 Cornwall Place, Cornwall Road, S.E. 39 Brad Street, Cornwall Road 12 Salutation Place, Cornwall Road 25 Peers Cooperage, Cornwall Road 5 Hammond Place, Cornwall Road 4 Wootton Place, Wootton Street 18 Bond Place, Bazon Street 32 St. Andrew's Place, Ethelm Street 11 Short, Mitre, Caffyn, Ufford, and Webber Streets 220 Crow, Abbey, Pennell and South Places 24 Waterloo Road 9 Asa Place, Webber Street 7 Cosham Place, Lower Marsh 11 Little Park Place, Hercules Road 9 Lambeth Square, Lower Marsh 50 Frazier, Grindall, Johanna, Murphy, Finck and Tanswell Streets 158 Waxwell Terrace, Boniface Street 21 Cottage Place, Stannary Street 4 Wake, Topaz, and Saunders Streets 104 Fountain Gardens, Lambeth Walk 16 St. Alban's Buildings, China Walk 26 Thrift Place, Topaz Street 5 L 32 Addresses. No. of Houses Walnut Tree Place, St. Alban's Street 35 Globe Court, Ethelred Street 9 Lollard Street, Kennington Road 130 Norfolk Place, Lambeth Road 12 Portland Cottages, Heman Street 11 Pascall Street, Wandsworth Road 22 Milton Place, Wandsworth Road 14 II. Outer Wards. Dugdale Street, Camberwell New Road 3 Industry Terrace, Cumberland Place and Cottages, Alder's Cottages 40 Houses, Denmark Street 12 Houses, Cornwall Road, Brixton Hill 7 Victoria Place, West Norwood 10 Change Alley, East Street, and East Place, West Norwood 49 Knight's Hill Square, West Norwood 23 Auckland Place, West Norwood 12 Paxton Yard, Gipsy Hill 14 Benton's Lane, Gipsy Hill 30 Etc., etc., etc. Large amounts of money have been spent by the owners to put and keep these houses in proper sanitary condition, and in this way the freeholders, or long leaseholders, are made to improve their own insanitary areas—a more satisfactory arrangement than if such owners were offered a premium for slum property, as is apt to be the case where a Sanitary Authority compulsorily purchases such property with a view to clearing an area under Part I. of the Housing Act. Further, the improved surroundings under which tenants live must have a distinctly educational value, though tenants vary considerably in their ideas as to the standards to be adopted in regard to cleanliness of person or house. 33 The working classes have their social grades, and it is more especially with the lower ones, including that section of the community that has been aptly called the "submerged tenth," that the necessity for constant and regular supervision is, in my opinion, so urgent, with a view to keeping the conditions under which they live as good, sanitarily, as possible. It is no good to build model dwellings for such people to go into after displacement; all that can be done is to endeavour to keep their present houses in such sanitary conditions as must eventually (at least, it is to be hoped so) re-act upon the tenants themselves, and so raise their sanitary standards. This is an important point to remember. It is easy to talk of the working classes going out into the suburbs to live and giving them facilities for so doing, by cheap railways, trams, etc., but such talk does not bring us one jot nearer solving the question as to proper accommodation for the poorer members of the working classes, who either cannot afford, or <lo not care, to be disturbed and removed from their present work centres. It may be that some of the (what I will call) better working class will take advantage of such facilities on the ground of health, and in that way relieve somewhat the present congestion, but the good effect is likely to be counteracted by the tendency of businesses, which are mostly central, to increase and displace from their houses the very people who ought to be catered for in the immediate neighbourhood. The crowding (even overcrowding) that consequently exists, and will exist, must be faced; it certainly cannot be prevented by any power possessed at present by Sanitary Authorities, who must be content, therefore, with minimising the evil results that may arise therefrom, by constant supervision. It is uphill work, but can be carried out, if trouble be only taken and the Inspectors (in sufficient numbers) encouraged to do their duties, and supported in the discharge of the same—a condition of things fortunately obtaining in Lambeth. 1. 2 34 The higher grades of the working classes (including the skilled artisans) look after, and are catered for by Artisans' Dwellings and after them other Companies, many of which have large blocks of models in various parts of Lambeth, and are doing a good work and supplying a much needed want. It is not with such, however, that this present Report deals. Any one who cares to inspect the districts mentioned above (or other districts in Lambeth), and at the same time will compare them with immediately adjoining districts belonging to some other Authorities, will be satisfied that the methods which have been adopted in Lambeth are giving better results than those obtained from area condemnations, and that, too, without displacement of tenants, and the spending of large sums of money out of the rates. Assuming that my views are workable (and my experience would seem to prove so) there are still important factors at work in the displacing of the working classes in Lambeth, as elsewhere. Thus, railway companies have proved to be important factors in the Lambeth Inner Districts, from a point of view of lessened house accommodation, and consequent overcrowding - large areas having been, and still being from time to time, voluntarily or compulsorily absorbed, slowly, but none the less surely, in connection with improvement and extension schemes. Then again, the necessary extensions of business premises (factories, workshops, etc.) in the Inner Districts of Lambeth, have led, and are still leading, to the voluntary closing and demolition of houses, followed by the displacement of tenants, together with consequent overcrowding of the houses in the immediate neighbourhoods. Finally, displacements may take place in connection with Metropolitan Improvement schemes (formation of new streets, widenings of approaches to bridges, &c.), but in this respect Lambeth has not been, as yet, much troubled. In the above-mentioned cases of areas compulsorily cleared, 35 a Sanitary Authority is powerless and can only insist (and ought to insist), that a pro rata amount of accommodation be provided before any displacement of persons is allowed to take place, and further, that such accommodation be suitable, as it is clearly necessary that the style of accommodation, as well as the cheapness of the rents, should suit those who have been displaced. Unfortunately, this is not at present the case, as it is quite the exception for displaced tenants to be rehoused in the houses provided, e.g., Russell Gardens (built by the S.E. Railway) in Felix Street, the new buildings having, as a rule, to be let at increased rents, as otherwise they would not give a sufficient monetary return for money expended in site, construction, etc. Displaced tenants have to seek accommodation elsewhere, as a consequence. What is wanted is a separate self-contained house (whether in form of tenements in blocks, flats, or cottages), and at a small rent of (maximum) 2s. per room, for the ordinary working classes, together with model lodging-houses for the very poor (male and female). Such are the kinds of dwellings that ought to be insisted upon before displacement, and in the same or immediate neighbourhood. It is clear that, with land at its present price, such accommodation can only be provided at a financial loss (more or less), whether the schemes be carried out by private owners (or companies), or by sanitary authorities, in which latter case the loss might be met out of the rates. Part III. of the Housing of the Working Classes Act gives power to the London County Council to erect dwellings or lodging-houses for the working classes, either by building on land (compulsorily or otherwise purchased), or by altering existing buildings. The above two conditions as to amount and kind of accommodation are very important, and in the future will, it is hoped, be in every case insisted upon. The former condition (as to a pro rata amount) certainly will be, owing to the firm 36 action that the Vestry of Lambeth has already taken in connection with the Extension and Improvement Scheme of the L. & S. W. Railway—a most important piece of work. Having insisted upon such conditions, these displacements due to Railway Extensions, Improvement Schemes, etc, become, unfortunately, necessary evils, and must, therefore, be accepted locally with regret—at least qud displacements. The case is a very different one, however, where it is proposed by the L. C. C. (for instance) to clear sites in Lambeth Parish (Salutation Place, Peers Cooperage, &c.) for the purpose of building thereon Artisans' Dwellings, which are for the use of persons displaced by an area condemnation in another Metropolitan district. What would happen in such a case? The tenants of such courts as Salutation Place, &c., would not, when displaced, go into model blocks—they prefer the independence of a selfcontained cottage, and, as they must remain in, or near, their present homes, on account of their work, or for other equally cogent reasons, the necessary result would be more overcrowding in the immediate neighbourhoods —a condition to be avoided, if possible. Before leaving this part of the Report, I may remind the Vestry that the Duchy of Cornwall—the ground landlord of a large portion of the Inner Districts of Lambeth—though outside the pale of the Housing of the Working Classes Act, has assisted me at all times in furthering sanitary reform, an assistance which was first promised in a letter sent by the Council of H.R.H. the Prince of Wales, stating that "they were at all times most desirous of complying with the spirit of any Act of Parliament, contemplating improvements on the score of the public health and in the interests of the working classes." The value of such a concession to Lambeth cannot be over-estimated, and has been the means of enabling great improvements (without trouble or legal proceedings) to be made, e.g., the closure and clearance Of 37 hopelessly insanitary property, such as Le Grand Place, Queen's Place, Isabella Row, etc., or the rebuilding of unsuitable or worn-out houses, such as those in Courtenay Street, etc. It will be seen from the above that I am not in favour of a large scheme being taken in hand in Lambeth, but prefer to advise the Vestry to continue the policy that has been adopted during the last few years with (what I think I am justified in stating) very satisfactory results, viz., constantly inspecting the houses occupied by the working classes, and keeping them up to fair sanitary conditions. There is, however, a small area—about a quarter of an acre—situated in the Lambeth Walk, and between that thoroughfare and Topaz Street, which might, with advantage, be taken over as a small open space or playground for children. The area is now practically vacant, the twenty-seven houses which I condemned on December 12th, 1895, having been closed, and since then demolished, and the displaced tenants (only thirtyseven in number) housed elsewhere. I have previously reported on this area (viz., as far back as October 15th, 1896), and the subject has not yet been finally voted upon by the Vestry (vide Minutes, November 11th, 1897, and March 10th, 1898), who, I hope, will see their way to carry out my suggestions, either alone, or in conjunction with the London County Council. The acquisition of a few more neighbouring houses (which, however, I am unable to condemn as unfit for habitation) would increase the site, and give an entrance in a main street (Topaz Street), thereby enabling a scheme for the erection of a block of Artisans' Dwellings to be carried out, if such a scheme were preferred Personally, I am of opinion, however, that the provision of an extra open space (small though it be), or playground for children, in what is a particularly crowded and congested area, would be of more permanent utility. The Vestry has been memorialised by the inhabitants of the district, asking for this site to be taken over as an open space, and in such a case local feeling cannot be disregarded. Joseph Priestley. December 11th, 1899. 39 OFFENCES UNDER THE FOOD AND DRUGS AND MARGARINE, AND FOOD AND DRUGS AND PUBLIC HEALTH ACTS DURING 1899. ADDRESSES OF OFFENDERS WITH NATURE OF OFFENCE, AND AMOUNT OF PENALTIES AND COSTS IN EACH CASE. 40 41 Summonses—Food and Drugs and Margarine Acts. Date. Address. Offence. Penalty. Costs. £ s. d. £ s. d. Jan. 5th 97, Milkwood Road Selling Coffee containing added Chicory to the extent of 50 per cent. 2 0 0 0 12 6 Jan.5th 91, Milkwood Road Selling Butter containing Margarine (not Butter) 38 per cent. 0 10 0 0 12 6 Jan. 5th 194, Coldharbour Lane Selling Butter containing Margarine (not Butter) 72 per cert. 1 0 0 0 12 6 Jan. 5th 135, Cornwall Road, S.W. Selling Butter containing Margarine (not Butter) 85 per cent. 1 0 0 0 12 6 Jan. 5th 75, Milkwood Road Selling Coffee containing added Chicory 72 per cent. 1 0 0 0 12 6 Jan. 19th 29, High Street, W. Norwood Selling Coffee containing added Chicory 37 per cent. 1 0 0 0 12 6 Feb. 2nd 93, High Street, W. Norwood Selling Milk containing added Water to the extent of 24 per cent. 1 0 0 0 12 6 Feb. 7th 30, Upper Kennington Lane Exposing a parcel of margarine by retail without having a lab 1 attached and marked in Capital Letters, 1½ ins. "Margarine" 0 10 0 0 12 6 Mar. 23rd 184, Lambeth Walk Expdsing a parcel of margarine by retail without having a label attached and marked in Capital Letters, 1½ ins. "Margarine" 0 10 0 0 12 6 Mar. 23rd 184, Lambeth Walk Exposing a parcel of Margarine by retail, without having a label attached and marked in Capital Letters, 1½ ins. "Margarine" 0 10 0 0 12 6 Mar. 29th 36, Cornwall Road, S.E. Exposing a parcel of Margarine by retail without having a label attached and marked in Capital Letters, 1½ ins. "Margarine" 1 0 0 0 12 6 Mar. 29th 6, Coral Street, Oakley Street Exposing a parcel of Margarine by retail, without having a label attached and marked in Capital Lettters, 1½ ins "Margarine" 1 0 0 0 12 6 Mar. 29th 56, Belvedere Road Selling Milk deficient in Cream to the ex'ent of 27 per cent. 2 0 0 0 12 6 April. 6th 48, Upper Tulse Hill Selling Milk containing added Water 8 per cent. 1 0 0 0 12 6 April. 6th 70, Elm Park . Selling Butter containing Margarine (not Butter) 62 percent. 2 0 0 0 12 6 April. 6th 170, Upper Kennington Lane Selling Butter containing Margarine (not Butter) 36 per cent. 1 0 0 0 12 6 April. 6th 57, Auckland Street Selling Butter containing Margarine (rot Butter) 85 per cent. 1 0 0 0 12 6 April. 6th 118, Lower Kennington Lane. Selling Butter containing Margarine (not Butter) 80 percent.. 2 0 0 0 12 6 April. 13th 57, Bend Street Selling butter containing Margarine (not Butter) 84 per cent. 2 0 0 0 12 6 Carried forward 22 0 0 11 17 6 42 43 Date. Address. Offence. Penalty. Cost. Brought forward £ s. d. £ s. d. 22 0 0 11 17 6 April 27th 38, Hartington Road Selling Milk containing added Water to the extent of 9 per cent 2 0 0 0 12 6 April 27th 31, Dorset Road Selling Butter containing Margarine (not Butter) 16 per cent. 2 0 0 0 12 6 April 27th 71, Hartington Road Selling Butter containing Margarine (not Butter) 50 percent. 5 0 0 0 12 6 May 10th Moorcourt Farm, Marnhull, Bland ord, Dorset Selling Milk from which the Cream had been abstracted to the extent of 13 per cent. 1 0 0 0 13 6 May 18th 134, Wyndham Road Selling Butter containing Margarine (not Butter) 70 percent. 5 0 0 6 12 6 June 1st 23, Chapel Road Selling Butter containing Margarine (not Butter) 90 per cent. 3 0 0 0 2 0 June 1st 55, High Street, W. Norwood Selling Butter containing Margarine (not Butter) 75 per cent. 5 0 0 0 2 0 June 6th 173, Lambeth Walk Selling Butter containing Margarine (not Butter) 82 per cent. 2 0 0 0 12 6 June 6th 9, Dawlish Street Selling Milk from which the Cream had been abstracted to the extent of 12 per cent., the sample in the meantime having been submitted to Somerset House and returned as genuine. The Summons was dismissed with costs of 7/0 against the Vestry ... ... June 15th 73, Larkhall Lane For exposing a parcel of Margarine by retail, without having a label attached and marked in Capital Letters, 1½ ins. "Margarine" 2 0 0 0 12 6 June 15th 193, Wandsworth Road For exposing a parcel of Margarine by retail, without having a label attached and marked in Capital Letters, 1½ ins. "Margarine" 2 0 0 0 12 6 July 13th 1a, Pulross Road Selling Butter containing Margarine not Butter 90 per cent. 0 10 0 0 12 6 Sept. 1st 170, Upper Kennington Lane Selling Butter containing Margarine not Butter 82 per cent. 3 0 0 0 12 6 Sept. 1st 76, Railton Road Selling Butter containing Margarine (not Butter) 90 per cent. 3 0 0 0 12 6 Sept. 1st 44, Effra Parade Selling Milk containing added Water 10 per cent. 1 0 0 0 12 6 Sept. 1st 44, Effra Parade Selling Butter containing Margarine (not Butter) 65 per cent. 2 0 0 0 12 6 Sept. 1st 85, Lyham Road Selling Butter containing Margarine (net Butter) 84 percent. 2 0 0 0 12 6 Sept. 1st 75, Sussex Road Selling Milk containing added Water 10 per cent. 1 0 0 0 12 6 Nov. 7th 67, Milkwcod Road Exposing a parcel of Margarine by retail, without having a label attached and marked in Capital Letters, 1½ ins. "Margarine" 0 10 0 0 12 6 Carried forward 64 0 0 22 2 6 44 45 Date. Address. Offence. Penalty. Costs. Brought forward £ s . d. £ s. d. 61 0 0 22 2 6 Nov. 7th 89, Hackford Road Selling Butter containing Margarine (not Butter) 83 percent. 0 5 0 0 12 6 Nov. 7th 33, Mayall Road Selling Butter containing Margarine (not Butter) 55 percent. 0 5 0 0 12 6 Nov. 9th 72, Oakley Street Selling Whisky diluted with Water 10.4 degrees below the legal limit of 25 degrees under proof (Magistrate dismissed the Summons owing to a small label being upon the bottle, starting it to be a mixture of Water and Whisky.) ... ... Nov. 23rd 207, Railton Road Selling Coffee containing added Chicory to the extent of 37 percent 1 0 0 0 12 0 Nov. 23rd 149, Prince's Road Exposing a parcel of Margarine by retail, without having a label attached and marked in Capital Letters, 1½ins. " Margarine" ... 0 12 6 Dec. 5th 5, Lingham Street Selling Butter containing Margarine (not Butter) 88 percent. ... 0 12 6 Dec. 5th 36, Lingham Street Selling Coffee containing added Chicory, 70 per cent. (Summons dismissed as it was declared on the wrapper to be a mixture of Coffee and Chicory.) ... ... Dec 5th 36 Lingham Street Selling Butter containing Margarine (not Butter) 78 percent. 1 0 0 0 12 6 Dec. 5th 55 Old Town, Clapham Selling Milk containing added Water 10 per cent. 2 0 0 0 12 0 Dec. 6th 144, Hamilton Road Selling Coffee containing added Chicory 58 percent. 2 0 0 0 12 6 Dec. 19th 90, Cornwall Road, S.W. Selling Coffee containing added Chicory 34 percent. 1 0 0 0 12 6 Dec. 19th 49, Cornwall Road, S.W. Selling Milk containing added Water 11 per cent. 1 0 0 0 12 0 Dec. 19th 152, Landor Road Selling Butter containing Margarine (not Butter) 88 percent. 2 0 0 0 12 6 Dec. 19th 152, Landor Road Exposing a parcel of Margarine by retail,, without having a label attached and marked in Capital Letters, 1½ ins. "Margarine" 2 0 0 0 12 6 Totals 76 10 0 29 12 6 46 47 Summonses—Public Health Acts. Date. Address. Offence. Penalty. Costs. 1899. Jan. 19th 15, Church Street, Camberwell Non-compliance with Notice of Vestry to repair the defective roof and put the water closet into proper order and condition at No. 4, Cumberland Place, Brixton (Order made to do work in 7 days, and owner to pay 4/0 costs.) £ s. d. £ s. d. ... 0 4 Jan. 26th 15, Maiden Lane, Strand, W.C That at 85, Commercial Road, on January 3rd, 4th, 5th, 6th, 10th, 13th, 16th, 17th and 18th a chimney, not being the chimney of a private dwelling-house, did send forth black smoke in such a quantity as to be a nuisance (Defendant fined £5 on each Summons, and 10/0 costs on each summons.) The Vestry was represented by Mr. Bodkin. 45 0 0 4 10 0 Feb. 1st 100, Westminster Bridge Road Nuisance caused by petroleum effluvia from a manufactory at 100, Westminster Bridge Road (Summons withdrawn—gas engine having been provided meanwhile—on payment of 2/0 costs.) ... 0 2 0 Feb. 9th Duke Street, Stamford Street A chimney, not being the chimney of a private dwelling-house, did send forth black smoke so as to be a nuisance (Defendant fined £5 and 2/0 costs.) 5 0 0 0 2 0 Mar. 1st 349, Coldharbour Lane Non-complance with Notice of Vestry to put into proper repair the house roof and rain-water pipes, also cleanse and repair the dirty walls and ceilings at No. 12, Station Avenue. (Order made to do work in 7 days and pay 4/0 costs.) ... 0 4 0 Mar. 2nd 349, Coldharbour Lane Non-compliance with Notice of Vestry to make good defective drains at No. 62, Bonnington Square (The drainage of the house having been reconstructed, the Owner was ordered to pay 15/0 costs—13/0 for cost of Vestry opening up the drains for examination, and 2/0 cost of Summons.) ... 0 15 0 Mar. 16th Duke Street, Stamford Street That at certain premises in Duke Street, on 17th, 20th, 22nd, 25.h & 27th February, and 2nd & 3rd of March, a chimney, not being the chimney of a private dwelling-house, did send forth black smoke in such quantity as to be a nuisance (Defendant fined £10 and 2/0 costs on each summons.) 70 0 0 0 14 0 Apr. 10th 349, Coldharbour Lane Non-compliance with Magistrate's Order to repair the roof and rain-water pipes at 12. Station Avenue (Defendant fined £2 and 4/0 costs.) 2 0 0 0 4 0 Apr. 28th 4, Commercial Road Non-compliance with Notice of Vestry to abate a nuisance arising from the filthy condition of the top floor rooms at No. 4, Commercial Road (Summons withdrawn, owing to defendant receiving at the same time sentence of six weeks' imprisonment for cruelty to his children, on a summons issued by the N.S.P.C.C.) ... ... Carrieded forward 122 0 0 6 15 0 M 48 49 Date. Address. Offence. Penalty. Costs. £ s. d. £ s. d. Brought forward 122 0 0 6 15 0 June 6th 21, Ethelm Street For causing to be removed from an arch in Mepham Street, offensive matters, viz., saw dust refuse from fish shop, without using a suitable carriage, contrary to the Bye-laws of the L.C.C. (Defendant fined 10/0 and 2/0 cost.) 0 10 0 0 2 0 June 6th 45, Paris Gardens, Stamford Street For removing the above offensive matter (Defendant cautioned and to pay 2/0 costs.) ... 0 2 0 June 15th 2, Newnham Terrace, Hercules Road Depositing for sale in the roadway opposite No. 66, Lower Marsh, 74 sheep's plucks, 376 kidneys and 7 pieces of pork, which were unsound, unwholesome and unfit for the food of man; also for exposing for sale on same stall 33 sheep's plucks, which were unsound, unwholesome and unfit for the food of man (Defendant having failed to appear before Mr. Slade, the Magistrate granted a warrant for his arrest, upon the sworn information of the Inspector.) ... ... June 29th 12 & 14, Rymer Street Non-compliance with Notice of Vestry to put drains and W.C. into proper order and condition, to pave yard and wash-house and provide a Metal Dust Bin at Nos. 12 & 14, Rymer Street (The Magistrate made an Order for the work to be done within 7 da)s, and owner to pay 4/0 costs.) ... 0 4 0 July 13th 1a, Stoney Lane, Houndsditch Selling on 29th May, certain articles of Food, to wit: 23 tins of lobster, the same being unsound and unfit for the food of man (Defendant fined £10 and 4/0 costs, or in default one month's imprisonment.) 10 0 0 0 4 0 July 27th 17, Billiter Street For removing stinking bones and fat without using a suitable carriage contrary to the Bye-laws of the L.c.c. (Defendant fined £2 and 2/0 costs.) 2 0 0 0 2 0 July 27th 16, Orchard Place, Blackwall Removing as above (Defendant finad £2 and 2/0 costs.) 2 0 0 0 2 0 July 28th 94, Oakley Street The top floor room at 94, Oakley Street, so overcrowded as to be injurious or dangerous to health. (Order made to abate the overcrowding within 7 days and pay 2s. costs.) ... 0 2 0 Aug. 4th 155, Clapham Park Road For fixing in connection with a W.C. at 131, Acre Lane, a trap and ventilating shaft without giving notice to the Sanitary Authority (Defendant fined £l and 2/0 costs.) 1 0 0 0 2 0 Sept. 13th 87, Raymouth Road Removing fish offal (1) during prohibited hours; (2) in improperly constructed vans, contrary to the Byelaws cf the L.C.C (Defendant fined £1 and 4/0 costs.) 1 0 0 0 4 3 Carried forward 138 10 0 7 19 0 50 51 Date Address. Offence. Penalty. Costs. £ s. d. £ s. d. Brought forward 138 10 0 7 19 0 Oct. 4th 2, Neville Street Owing to a room occupied at No. 2, Neville Street, being so overcrowded as to be a nuisance and dangerous to health (The nuisance continuing, the defendant was fined 20/0 or 7 days) 1 0 0 ... Oct. 26th Corporation Chambers, Guildford Yard For failing to maintain in proper condition of repair the receptacle for dung, belonging to the premises 111, Upper Kennington Lane (Defendant fined £2 and 2/0 costs.) 2 0 0 0 2 0 Oct. 26th Corporation Chambers, Guildford Yard Failing to provide the premises at 111, Upper Kennington Lane with adust-bin (Defendant fined £2 and 2/0 costs.) 2 0 0 0 2 0 Oct. 27th South London Electric Supply Corporation, Bengeworth Road That at certain premises in Bengeworth Road a chimney, not being the chimney of a private dwellinghouse, did send forth black smoke in such quantity as to be a nuisance (Defendant fined £2 and 2/0 costs.) 2 0 0 1 0 0 Nov. 8th 15, Portland Cottages, Heman Street Exposing for sale certain articles of food, to wit: 48 pieces of pork, 66 pieces of pork, and 16 pieces of beef, deposited for the purpose of sale, which was unsound, unwholesome, and unfit for the food of man (Defendant fined £20) and 2/0 costs.) 20 0 0 0 2 0 Nov. 15th 33, Langton Road For detective drain, stack pipe connected to drain, no draw-off tap from main and iron D trap at 33, Langton Road (Order made to do work in one month and owner to pay 4/0 costs.) ... 0 4 0 Nov. 15th 158, Denmark Hill For defective roof and guttering, causing dampness at 27, Wiltshire Road (Order made to do work in 14 days and owner to pay 4/0 costs.) ... 0 4 0 Nov. 25th 26, Treherne Road For so constructing a water-closet and drain as to be a nuisance and injurious to health at 59, Arthur Road (Defendant fined £2 and 2/0 costs.) 2 0 0 0 2 0 Nov. 25th 5, Elliott Road For so constructing a water-closet and drain as to be a nuisance and injurious to health at 59, Arthur Road (Defendant cautioned and ordered to pay 2/0 costs.) ... 0 2 0 Totals £ 67 10 5 9 1 7 0 52 53 Lambeth Parish.—Deaths Registered from all Causes during the Year 1899. 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. 23 33 24 26 38 37 104 115 86 110 59 64 113 132 31 29 6 4 483 550 1033 11. Parasitic Diseases ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ] 2 III. Dietic Diseases 1 ... 1 ... 1 1 5 3 4 5 2 3 5 5 1 1 2 1 22 19 41 IV. Constitutional Diseases 30 34 36 33 37 38 113 78 96 66 74 75 127 136 39 34 21 12 576 506 1082 V. Developmental Diseases 7 7 12 7 12 8 36 20 46 40 24 32 55 57 18 18 1 2 205 191 396 VI. Local Diseases 85 87 112 72 103 104 244 249 263 273 211 205 253 343 93 103 64 55 1428 1491 2919 VII. Deaths from Violence 6 8 9 8 6 6 21 11 27 12 11 6 20 10 9 ... 7 5 116 66 182 VIII. Deaths from Ill-defined and not Specified Causes 10 4 9 5 13 10 18 8 23 15 12 11 38 25 17 13 ... ... 140 91 231 Totals 162 173 203 151 210 204 542 484 542 522 393 396 611 708 208 198 100 79 2971 2915 5886 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 9 2 8 3 6 20 15 16 21 9 7 21 26 4 3 ... ... 80 89 169 Whooping Cough 2 7 4 4 3 5 16 27 12 15 2 8 11 9 2 3 ... ... 52 78 130 Scarlet Fever 1 ... ... ... 1 1 2 3 1 1 1 1 5 2 3 3 ... ... 14 11 25 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever 1 2 2 2 4 1 5 3 4 6 3 4 6 5 2 ... ... ... 27 23 50 Diphtheria 2 4 5 4 7 9 15 13 12 7 12 11 22 21 3 2 ... ... 82 71 153 Membranous Croup ... ... ... ... ... ... ... 2 ... 1 ... 2 1 ... ... ... ... ... 1 5 6 Influenza 3 1 2 3 2 ... 5 5 13 18 7 10 25 40 5 10 2 ... 64 87 151 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera, Nostras ... ... ... ... ... 1 5 5 3 5 1 1 2 2 ... ... ... ... 11 14 25 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 9 7 7 3 14 8 29 35 20 30 11 18 15 21 9 6 3 1 117 132 249 Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... 2 1 3 Other Diseases (e.g., Hydrophobia Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... 2 ... 1 3 2 4 4 ... 1 2 ... 4 4 2 1 ... 3 15 18 33 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... 4 ... 4 Erysipelas ... ... 1 1 1 1 2 1 3 2 2 1 ... 1 1 ... ... ... 10 7 17 Pyæmia, Septicæmia ... ... ... ... ... 1 ... ... 1 1 2 ... ... ... ... ... ... ... 3 2 5 Puerperal Fever ... 1 ... ... ... 2 ... 2 ... 2 ... 1 ... 3 ... 1 ... ... ... 12 12 Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 1 2 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk, Starvation ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... 2 1 3 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... 1 ... 1 1 5 3 1 4 1 3 3 5 1 1 1 13 18 31 Delirium Tremens 1 ... ... ... ... ... ... ... 2 ... ... ... 2 ... 1 ... 1 ... 7 ... 7 Rheumatic Fever ... ... ... ... ... ... ... ... ... 1 2 1 6 2 3 1 1 ... 12 5 17 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 54 55 Lambeth Parish.— Deaths Registered from all causes during the year 1899. Sub-Districts Waterloo Road 1st. Waterloo Road 2nd Lambeth Church 1st. Lambeth Church 2nd. Kennington 1st. Kennington 2nd. Brixton. Norwood 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 ... ... ... 1 2 2 ... ... 2 4 2 .... ... 1 6 9 15 Gout 2 ... ... ... 1 ... 1 1 1 ... ... ... 1 2 ... ... ... ... 6 3 9 Rickets ... ... ... ... ... ... 2 ... 3 ... 1 1 2 2 ... 1 1 ... 9 4 13 Cancer, Malignant Disease 5 4 1 10 4 11 14 17 16 ... 19 29 22 53 10 17 4 4 95 166 281 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... 21 ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica ... ... ... 2 2 3 10 2 10 ... 2 2 5 9 ... ... ... ... 29 22 51 Tuberc-Meningitis, Hydrocephalus 3 3 3 1 5 3 10 9 4 4 2 3 13 7 2 3 1 ... 43 ??? 77 Phthisis 20 25 29 16 19 15 66 40 51 5 43 31 62 40 18 10 12 6 320 205 525 Scrofula ... ... ... ... 1 ... 3 1 2 22 1 ... 1 1 ... ... ... ... 8 4 12 Other forms of Tuberculosis ... 1 3 3 4 5 7 4 7 2 2 3 9 6 3 2 2 ... 37 28 65 Purpura, Hæmorrhagic Diathes's ... ... ... ... ... ... ... ... 1 4 ... ... 1 ... ... ... ... ... ... 2 2 Anæmia, Chlorosis, Leucocythæmia ... ... ... ... ... ... ... 1 ... ... ... ... ... 3 ... ... ... ... ... 6 6 Glycosuria, Diabetes Mellitus ... ... ... ... 1 ... ... ... ... 2 2 3 3 5 1 ... ... ... 7 9 16 Other Constitutional Diseases ... 1 ... ... ... 1 ... 2 2 1 ... 2 ... 2 ... ... ... 1 2 11 13 Premature Birth 3 4 10 2 9 6 21 10 ??? 2 7 11 30 17 9 5 ... ... 111 73 184 Atelectasis 1 ... 1 2 2 ... 6 2 4 18 1 1 1 ... ... ... ... ... 16 7 23 Congenital Malformations ... ... ... ... ... ... 4 2 1 2 2 1 6 2 3 ... ... ... 16 7 23 Old Age 3 3 1 3 1 2 5 6 ??? 18 14 19 18 38 6 13 1 2 62 104 166 Inflammation of Brain orMembranes 3 1 2 2 5 4 5 5 9 4 4 1 8 7 ... 1 ... ... 36 25 61 Apoplexy, Softening of Brain 3 5 7 8 4 8 14 17 16 ??? 16 20 23 35 7 12 9 10 ??? 135 237 Hemiplegia, Brain Paralysis Insanity, General Paralysis of Insane ... 1 3 ... ... 1 16 6 4 3 5 1 6 4 2 1 6 4 42 21 63 Epilepsy 1 ... ... 2 ... 1 ... 1 4 3 ... ... ... 3 ... 1 2 1 7 12 19 Convulsions 1 3 4 1 2 5 11 5 5 1 4 4 4 5 2 2 ... ... 33 26 59 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... 1 ... ... 2 2 4 Disease of Spinal Cord, Paraplegia Paralysis Agitans 1 1 2 ... 1 ... 2 ... 2 1 3 4 3 2 3 3 2 ... 19 11 30 Other Diseases of Nervous System 2 ... 1 2 ... 5 ... 4 2 3 4 ... 6 ... 2 ... ... 14 17 31 Diseases of Ear, Eye, Nose ... ... ... ... ... 1 1 1 ... 1 ... 1 ... 1 ... ... ... ... 1 5 6 Pericarditis ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... 2 1 3 Acute Endocarditis ... 1 ... ... ... 1 4 1 3 1 ... 3 ... 1 ... ... ... ... 7 8 15 Valvular Diseases of Heart 4 3 5 3 2 7 7 14 14 18 12 8 7 14 5 3 ... 4 56 74 130 Other Diseases of Heart 6 6 9 6 8 9 16 30 29 19 23 ??? 21 39 10 16 7 3 129 148 277 Aneurism 1 ... ... ... ... ... 1 ... ... 1 2 ... 2 1 ... ... ... ... 6 2 8 Embolism, Thrombosis ... ... ... ... ... ... ... 2 ... ... ... 1 ... 1 ... ... ... ... ... 4 4 Other Diseases of Blood Vessels 2 ... 1 ... 1 ... 1 1 1 2 ... ... 3 ... ... 1 ... ... 9 5 14 Laryngitis ... ... 1 ... 1 ... 1 ... 1 3 ... 2 ... ... 1 2 ... ... 5 7 12 Croup ... ... 1 1 ... ... 1 ... ... 1 1 ... ... 1 ... ... ... ... 3 3 6 Emphysema, Asthma ... ... 3 ... 1 2 2 1 1 2 7 6 4 3 ... 1 1 ... 19 15 31 Bronchitis 21 25 25 26 27 26 60 59 59 67 33 58 49 73 23 12 17 10 305 356 661 Pneumonia 10 8 11 ... 20 6 16 26 27 15 21 10 29 22 2 4 3 5 139 96 235 Pleurisy ... 1 ... ... 1 ... 3 ... 4 3 ... 1 2 4 ... ... ... 1 10 10 20 Bronchopneumonia 8 4 5 ... 5 4 26 18 17 11 6 4 13 8 4 3 ... 1 84 53 337 Pleuropneumonia 1 1 2 ... 1 ... 2 3 1 1 ... ... ... 1 1 ... ... ... 8 6 ??? Other Dis. of Respiratory System 2 2 3 1 3 1 3 2 5 9 1 7 2 8 1 ... 2 1 22 31 53 Dentition 2 ... 3 ... ... 5 5 7 7 3 ... 1• 5 1 3 3 ... ... 25 20 45 Sore Throat, Quinsy ... ... ... ... ... ... 2 ... ... 1 1 ... 1 1 ... ... ... ... 4 2 6 Diseases of Stomach 1 ... ... 1 1 4 3 1 ... 4 8 4 3 3 ... 1 ... 1 16 19 35 Enteritis 3 7 1 6 2 4 7 18 14 19 22 ??? 20 22 3 3 ... 3 72 94 166 N 56 57 Lambeth Parish.— Deaths Registered from all Causes during the year 1899. 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 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 ... 5 3 2 1 2 3 4 1 6 4 4 6 3 2 ... 1 27 21 48 Peritonitis ... ... ... ... 1 1 1 ... 1 3 ... ... 2 7 1 2 ... ... 6 13 19 Ascites ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 ... ... ... 1 2 3 Cirrhosis of Liver 3 4 5 1 2 ... 3 7 2 10 12 7 8 6 1 3 1 2 37 40 77 Jaundice and other Diseases of Liver 2 ... ... 4 3 3 4 3 6 6 6 3 7 9 1 2 2 ... 31 30 61 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System ... ... 2 ... ... ... 4 ... 7 8 2 2 7 2 11 12 1 2 34 26 60 Diseases of Lymphatics and of Spleen 1 ... ... ... ... ... ... ... ... 1 ... ... 1 2 ... 1 ... ... 2 4 6 Bronchocele, Addison's Dis. ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Nephritis 1 1 6 2 1 1 4 ... 2 4 2 1 3 3 ... ... 1 2 20 14 34 Bright's Disease, Albuminuria 5 6 4 3 6 6 4 10 9 7 6 7 13 15 4 4 5 3 56 61 117 Disease of Bladder or of Prostate 1 ... ... ... ... 1 1 ... 1 ... 3 ... 8 ... 2 ... ... ... 16 1 17 Calculus (Stone) ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Dis. of the Urinary System.. ... 2 2 ... ... ... 1 2 ... ... ... 1 1 5 1 1 2 ... 7 11 18 Male Organs ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Female Organs ... ... ... ... ... ... ... 1 ... 3 ... 1 ... 9 ... 1 ... 1 ... 16 16 Abortion, Miscarriage ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... 3 3 Puerperal Convulsions ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Placenta prævia, Flooding ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 2 Other Accidents of Child Birth ... 1 ... ... ... ... ... 1 ... 6 ... 2 ... 7 ... 2 ... ... ... 19 19 Caries, Necrosis 1 1 ... ... ... 2 1 ... ... ... 1 ... ... ... ... ... 1 ... 4 3 7 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 1 o Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... 1 ... ... 3 ... 1 ... ... ... ... 1 4 5 Carbuncle, Phlegmon ... ... ... 1 ... ... 2 ... ... ... 1 ... 1 ... 1 ... ... ... 5 1 6 Other Dis. of Integumentary System ... ... ... ... ... ... ... ... 2 3 ... ... 1 1 ... 1 2 ... 5 5 10 Fractures and Contusions 1 ... 3 1 1 2 4 2 7 1 3 1 2 1 1 ... 3 3 25 11 36 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald 1 1 1 ... ... 1 1 1 2 1 ... 2 1 1 ... ... ... 1 6 9 15 Poison ... ... ... ... ... ... 1 ... 1 ... ... ... 1 1 ... ... ... ... 3 1 4 Drowning ... 1 1 ...... 1 ... 5 2 ... ... 1 ... 1 1 ... ... 1 ... 10 4 14 Suffocation 4 1 4 1 2 1 2 3 3 2 1 4 3 2 ... ... ... 21 19 40 Otherwise ... ... 2 1 2 ... 1 2 11 3 5 2 6 2 2 ... 2 1 31 11 42 Manslaughter 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 3 Murder ... ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 3 3 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Cut, Stab ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 3 ... 3 Poison ... 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 3 4 Drowning ... 1 ... 1 ... ... ... 1 1 1 ... ... 1 ... ... ... ... ... 2 4 6 Hanging ... ... ... ... 1 ... 2 ... ... ... ... ... 3 ... 1 ... ... ... 7 ... 7 Otherwise ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... 3 ... 3 Dropsy ... ... ... ... 1 ... ... ...... ... ... ... ... ... 1 ... ... ... ... 1 1 2 Debility, Atrophy, Inanition 10 4 8 5 12 10 17 7 20 14 9 9 34 21 17 13 ... ... 127 83 210 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... 1 ... ... ... ... 1 1 ... 1 1 ... 1 ... ... ... ... 3 3 6 Abscess ... ... ... " ... ... 1 ... 1 ... 1 1 1 ... ... ... ... ... 4 1 5 Hæmorrhage ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined ... ... ... ... ... ... ... ... 1 ... 1 ... 3 2 ... ... ... ... 5 2 7 N 2 58 59 Lambeth Parish.— Deaths Registered 1 from all Causes during the Year 1899. AGES. AGES. Total. 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. 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. 180 194 153 176 333 370 33 40 12 7 4 10 11 10 19 22 36 28 7 10 16 33 12 20 150 180 483 550 1033 II. Parasitic Diseases 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 III. Dietic Diseases 2 1 ... ... 2 1 ... ... ... ... ... ... ... 1 7 9 8 8 3 ... 2 ... ... ... 20 18 22 19 41 IV. Constitutional Diseases 63 38 58 35 121 73 12 16 7 13 20 24 37 18 133 100 176 151 24 34 42 70 4 7 455 433 576 506 1082 V. Developmental Diseases 139 87 2 ... 141 87 ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 26 39 26 64 64 104 205 191 396 VI. Local Diseases 313 233 120 134 433 367 20 24 12 9 14 11 24 25 115 120 340 301 95 119 308 105 67 110 995 1124 1428 1491 2919 VII. Deaths from Violence 22 18 11 6 33 24 2 3 1 3 3 2 2 1 28 6 33 15 6 3 7 6 1 3 83 42 116 ??? 182 VIII. Deaths from Ill-defined and not Specified Causes 122 74 9 6 131 80 ... ... ... ... ... ... 1 ... 1 1 3 4 1 2 2 2 1 2 9 11 140 91 231 Totals 842 640 353 357 1195 1003 67 83 32 32 43 47 75 55 303 258 596 507 136 169 403 555 121 206 1776 1912 2971 2915 5886 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 21 22 57 61 78 83 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 6 80 89 169 Whooping Cough 30 29 21 48 51 71 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 52 78 130 Scarlet Fever 1 ... 5 6 6 6 5 3 1 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... 8 5 14 11 25 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 1 2 ... 2 1 ... 2 4 2 3 5 8 2 6 6 4 5 ... ... ... ... ... ... 25 22 27 ??? 50 Diphtheria 4 5 45 38 49 43 25 21 6 4 ... ... 1 1 1 ... ... 1 ... ... ... 1 ... ... 33 28 82 71 153 Membranous Croup ... ... 1 4 1 4 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 6 Influenza 4 3 3 5 7 8 ... 4 1 ... 1 2 1 2 9 4 22 20 6 6 12 25 5 16 57 79 64 87 151 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...| ... ... ... ... ... ... ... ... ... Cholera, Nostras 11 11 ... 2 11 13 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 11 14 25 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 90 108 19 11 109 119 ... 3 ... ... ... ... ... ... 1 ... 1 2 ... 4 1 3 5 1 8 13 117 132 249 Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Cowpox and effects of Vaccination 2 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 Other Diseases (e.g., Hydrophobia Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 13 13 ... 1 13 14 ... ... ... ... ... ... ... ... ... 2 1 ... 1 ... ... 1 ... 1 2 4 15 18 33 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... ... ... 4 ... 4 ... 4 Erysipelas 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 5 ... ... ... 2 2 2 2 9 ??? 10 7 17 Pyæmia, Septicæmia 2 ... ... ... 2 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 3 2 5 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 7 ... ... ... ... ... ...... ... ... ... 12 ... 12 12 Thrush, and other Vegetable Parasitic Diseases 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk, Starvation 2 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 9 5 8 2 ... 2 ... ... ... 13 18 13 18 31 Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... 1 ... ... ... ... ... 7 ... 7 ... 7 Rheumatic Fever ... ... 1 ... 2 ... 4 ... ... 1 1 1 2 ... 1 1 2 1 ... ... 1 1 ... ... 11 5 12 5 17 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 60 61 Lambeth Parish.— Deaths Registered from all Causes during the Year 1899. AGES. AGES. Total. 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 Rheumatism ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 3 l ... 2 2 3 ... ... 6 9 6 ... 15 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... 3 2 ... 1 6 3 6 9 Rickets ... 1 9 2 9 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 9 4 13 Cancer, Malignant Disease ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 6 15 43 72 15 22 27 49 8 6 95 166 95 166 261 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 19 17 8 2 27 19 ... ... ... ... 1 1 ... ... ... 1 1 1... ... ... ... ... ... ... 2 3 29 22 51 Tuberc-Meningitis, Hydrocephalus 19 11 19 15 38 26 3 7 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 5 8 43 34 77 Phthisis 4 1 13 3 17 4 3 5 2 8 14 18 33 14 120 79 115 67 9 6 7 4 ... ... 303 201 320 205 525 Scrofula 5 2 1 1 6 3 ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 8 4 12 Other forms of Tuberculosis 14 6 7 9 21 15 2 ??? 2 1 3 ... ... 2 4 4 4 3 ... ... 1 1 ... ... 16 13 37 28 65 Purpura, Hæmorrhagic Diathesis 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... 2 Anæmia, Chlorosis, Leucocythæmia ... ... ... 2 ... 2 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... 1 ... ... ... 4 ... 6 6 Glycosuria, Diabetes Mellitus 1 ... ... ... 1 ... ... 1 1 ... ... ... ... ... 1 ... 3 3 ... 1 ... 4 1 ... 6 9 7 9 16 Other Constitutional Diseases ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 2 2 ... 3 ... 5 ... ... 2 10 2 11 13 Premature Birth 111 73 ... ... 111 73 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 111 73 184 Atelectasis 16 7 ... ... 16 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 7 23 Congenital Malformations 12 7 2 ... 14 7 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 16 7 23 Old Age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 26 39 36 64 62 104 62 104 166 Inflammation of Brain or Membranes 12 11 13 11 25 22 1 1 ... ... ... ... 1 1 4 ... 3 ... ... ... 2 1 ... ... 11 3 36 25 61 Apoplexy, Softening of Brain, hemiplegia,brain paralysis 1 4 ... ... 1 4 ... 1 ... ... ... ... ... ... 3 5 34 29 12 15 37 68 12 16 98 134 99 138 237 Insanity, General Paralysis of Insane ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 10 3 16 6 3 ... 9 7 2 5 42 21 42 21 63 Epilepsy ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 3 6 1 ... 1 4 ... 1 7 12 7 12 19 Convulsions 25 24 6 2 31 26 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... 33 26 59 Laryngismus Stridulus (Spasm of Glottis) 1 2 1 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 4 Disease of Spinal Cord, Paraplegia, Paralysis Agitans 1 ... ... 1 1 1 1 ... ... ... 1 ... 1 ... 4 ... 6 4 1 1 3 3 1 2 18 10 19 11 30 Other Diseases of Nervous System 3 3 2 2 5 5 ... 1 ... ... ... 1 1 ... 2 4 5 4 ... ... 1 2 ... ... 9 12 14 17 31 Diseases of Ear, Eye, Nose ... 1 ... 2 ... 3 ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 5 6 Pericarditis 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 2 1 3 Acute Endocarditis ... ... ... ... ... ... ... 2 2 1 ... ... ... ... 3 4 2 1 ... ... ... ... ... 7 8 7 8 15 Valvular Diseases of Heart ... 1 2 ... 2 1 3 4 2 3 1 1 2 3 12 12 13 26 3 5 15 15 3 4 54 73 56 74 130 Other Diseases of Heart 3 3 1 1 4 4 2 1 ... 1 2 2 1 2 14 9 41 41 13 21 44 53 8 14 125 141 129 148 277 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 1 1 ... ... 1 ... ... 6 2 6 2 8 Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 ... ... ... 4 ... 4 4 Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 6 ... 1 ... ... 4 ... 1 9 5 9 5 14 Laryngitis 3 3 1 4 4 7 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 5 7 12 Croup ... ... 3 3 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 6 Emphysema, Asthma ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 8 4 3 6 5 4 1 1 19 15 19 15 34 Bronchitis 69 43 16 37 85 80 2 1 1 1 ... ... 1 ... 7 9 59 49 25 34 100 137 25 45 220 276 305 356 661 Pneumonia 30 13 20 21 50 34 ... 1 1 ... 2 ... 3 1 20 10 40 23 6 6 l6 l6 1 5 89 62 139 93 235 Pleurisy 1 2 3 1 4 3 ... 1 ... ... ... ... ... ... ... ... 6 3 ... 1 ... 2 ... ... 6 7 10 10 20 Bronchopneumonia 28 19 32 16 60 35 1 ... ... ... 2 1 2 ... 2 ... 8 2 3 4 5 8 1 3 24 18 84 53 137 Pleuropneumonia 1 1 1 ... 2 1 ... ... ... ... ... ... ... 2 1 1 5 1 ... ... ... 1 ... ... 6 5 8 6 14 Other Dis. of Respiratory System 8 8 1 1 9 9 ... ... ... ... ... 1 ... 2 4 2 5 6 ... 2 3 8 1 1 13 22 22 31 53 Dentition 19 11 6 9 25 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 20 45 Sore Throat, Quinsy 1 ... 1 1 2 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 4 2 6 Diseases of Stomach 7 1 ... 1 7 2 ... 1 ... ... 1 1 ... 3 2 2 2 7 1 1 2 2 1 ... 9 17 l6 19 35 Enteritis 59 55 3 13 62 68 1 1 3 ... 1 l 1 1 1 3 ... 7 ... 2 2 9 1 2 10 26 72 94 166 62 63 Lambeth Parish.—Deaths Registered from all Causes during the year 1899. 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. Totals. 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 4 2 1 7 5 ... 1 ... ... 2 1 1 ... 1 1 2 4 2 3 8 5 4 1 20 16 27 21 48 Peritonitis 2 ... ... 2 2 2 2 2 ... 1 ... 1 ... 1 2 2 ... 1 ... ... ... 3 ... ... 4 11 6 13 19 Ascites ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... 1 ... ... 1 2 1 2 3 Cirrhosis of Liver ... 1 ... ... ... 1 1 ... ... ... ... ... 1 ... 6 5 20 24 2 6 7 3 ... 1 37 39 37 40 77 Jaundice and other Diseases of Liver 8 5 ... 2 8 7 1 1 ... ... ... ... ... ... 3 3 9 9 4 1 5 9 1 ... 23 23 31 30 61 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 22 15 1 1 23 16 1 2 ... ... ... ... 2 2 2 i 3 2 2 1 ... 1 1 1 11 10 34 26 60 Diseases of Lymphatics and of Spleen ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 4 l ... ... ... ... ... ... ... 2 4 2 4 6 Bronchocele, Addison's Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 Nephritis ... ... 1 ... 1 1 ... ... ... ... ... ... 2 ... 2 3 9 5 1 1 5 4 ... ... 19 13 20 14 34 Bright's Disease. Albuminuria ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 4 11 18 16 7 6 24 22 2 6 55 61 56 61 117 Disease of Bladder or of Prostate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... 8 1 9 ... 16 1 16 1 17 Calculus (Stone) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 1 Other Dis. of the Urinary System.. ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 2 5 ... 1 4 3 ... ... 7 11 7 11 18 Male Organs ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Female Organs ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 ... 7 ... 1 ... 2 ... ... ... 16 ... 16 16 Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... 3 3 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Placenta prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... 2 2 Other Accidents of Child Birth ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 14 ... 3 ... ... ... ... ... ... ... 19 ... 19 19 Caries, Necrosis ... ... ... ... ... ... 1 1 ... 1 ... ... ... 1 2 ... ... ... ... ... 1 ... ... ... 4 3 4 3 7 Arthritis, Ostitis, Periostitis ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... l ... ... ... 1 1 1 2 Other Diseases of Bones and Joints ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... 1 3 1 4 5 Carbuncle, Phlegmon 1 1 1 ... 2 1 ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 ... 5 1 6 Other Dis. of Integumentary System 2 1 ... 1 2 2 ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 1 2 ... ... 3 3 5 5 10 Fractures and Contusions ... ... 1 ... 1 ... 1 ... ... 1 2 ... ... ... 6 l 12 2 1 1 2 1 ... 2 24 11 25 11 36 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald 1 ...... 5 3 6 3 ... 1 ... 1 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... 6 6 9 15 Poison ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 3 1 4 Drowning ... ... ... 1 ... 1 1 ... 1 ... 1 1 ... ... 6 1 1 1 ... ... ... ... ... ... 10 3 10 4 14 Suffocation 17 16 ... ... 17 16 ... ... ... 1 ... ... ... ... 1 ... 3 1 ... ... ... ... ... ... 4 3 21 19 40 Otherwise 4 ... 3 2 ... 2 ... ... ... ... ... 1 ... ... 7 2 10 2 3 1 3 1 1 1 24 9 31 11 42 Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... ... 2 1 2 1 3 Murder ... 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 3 3 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2, ... 1 ... ... ... ... ... ... ... 3 ... 3 ... 3 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 l 1 ... 1 ... ... ... ... 1 3 1 3 4 Drowning ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 ... ... ... ... ... ... 2 4 2 4 6 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 ... 1 ... ... ... 7 ... 7 ... 7 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... 3 ... 3 ... 3 Hanging (Execution) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... l ... 1 ... 1 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 1 1 2 Debility, Atrophy, Inanition 119 74 7 5 126 79 ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... 2 l 4 127 83 210 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 ... 1 ... 3 3 3 3 6 Abscess ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... 2 1 4 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 Sudden Death (cause not ascertained ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or III.defined 3 ... ... 1 3 3 ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 2 1 5 2 7 64 SUMMARY OF DEATH RETURNS. No. of Deaths. Total No. of Deaths. Total. M. F. M. F. Brought forward 2597 2610 5207 I.—Specific Febrile, or Zymotic Diseases. VI.—Local Diseases—continued. 1. Miasmatic Diseases 320 364 684 6. Diseases of Lymphalic System 2 4 6 2. Diarrhœal „ 128 146 274 3. Malarial „ 1 ... 1 7. Diseases of Gland-like Organs of Uncertain Use ... 1 1 4. Zoogenous 2 1 3 5. Venereal „ 19 18 37 8. Diseases of Urinary System 99 88 187 6. Septic „ 13 21 34 9. Diseases of Reproductive Systern— II.—Parasitic Diseases 1 1 2 (a) Diseases of Organs of Generation 1 16 17 III.—Dietic Diseases 22 19 41 (b) Diseases of Parturition ... 25 25 10. Diseases of Bones and Joints 6 8 14 IV.—Constitutional Diseases 576 506 1082 11. Diseases of Integumentary System 10 6 16 V.—Developmental Diseases 205 191 396 VII.—Violence. VI.—Local Diseases 1. Accident or Negligence 96 55 151 1. Diseases of Nervous System 252 252 504 2. Homicide 2 4 6 2. Diseases of Organs of Special Sense 1 5 6 3. Suicide 17 7 24 4. Execution 1 ... 1 3. Diseases of Circulatory System 209 242 451 4. Diseases of Respiratory „ 595 577 1172 VIII—III-Defined and not Specified Causes. 140 91 231 5. Diseases of Digestive „ 253 267 520 Carried forward 2597 2610 5207 Total 2971 2915 5886 INDEX. iii. INDEX OF TABLES. Page A. The number of Births and the Birth-Rates in each Registration Sub-District of Lambeth during 1890 (arranged quarterly) 10 B. The estimated Populations, numbers of Inhabited Houses, Marriages, Births, and corrected Deaths for the year 1899 and the ten years preceding, in Lambeth Parish 11 C- The number of Persons per House, the Marriage-, Birth- and Death-Rate, and the proportion of Deaths in Public Institutions per 1,000 persons, for the year 1899, 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 189;. "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. 20—21 E. Death-Rates, Zymotic Death-Rates and Zymotic IncidenceRates in the Parliamentary and New Wards, Divisions of Lambeth during 1899 22 F. Mortalities in Lambeth at different age-periods compared with (1) those for London, 1859, and (2) the averages for London for the years 1831.90 23 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 1899 24 H. The uncorrected mortality (i.e., including that of strangers) at different ages in each District of the Parish during 1899 25 I. The uncorrected Deaths (i.e., Parishioners and strangers) at various age-periods in each Quarter of the year 1899 26 J. The Infantile mortalities in the Registrar-General's thirtythree large Towns of England and Wales (including London), and in Lambeth Parish during 1899 28 K. Total cases notified under the Notification Clauses of the Public Health (London) Act, in Lambeth, during 1899 (arranged quarterly) 31 L. The number of Certificates for the notifiable Zymotic Diseases received since the introduction of the Notification Act (i.e., in the nine years 1890-98, and in the year 1899) 32 iv. M. The number of infected houses, with percentages of (i) General Defects, and (2) Defective Drains, during the years 1899 and the seven preceding years 34 N. Zymotic seasonal variations in the different Registration SubDistricts of Lambeth during 1899, with the Zymotic Death-Rate per 1,000 inhabitants 36 O. Deaths from Zymotic Disease (strangers deducted), 1899 37 P. The number of deaths from the principal Zymotic Diseases in the ten years, 1889-98, and in the year 1899 38 39 Q. Vaccination Returns, 1898 41 R. Vaccination Returns for the first half-year, 1899 42 S. The Diarrhœa Mortality in Lambeth in each month during the year 1899 61 T. The classification of causes of Deaths in Lambeth during 1899, compared with 1898— 65—65 (a.) Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected) 65 (b.) Deaths of infants under one year of age from the chief infintile diseases and from all causes, expressed in terms of 1,000 births 66 U. Table of Uncorrected Deaths during the years 1898 and 1899 classified according to Diseases, in Lambeth and London 67 V. Table of Deaths during the year 1899 in the Lambeth District, classified according to Diseases, Ages and Localities. {Local Government Board Table A.) 68-71 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 1899, in the Metropolitan Sanitary District of Lambeth, classified according to Diseases and Localities. (Local Government Board Table B.) 72—73 Table showing General and Zymotic Death-Rates, and Scarlet Fever, Diph'heria, Enteric, Diarrhoea, Phthisis, DeathRates for the forty-three different Metropolitan Sanitary Areas, for Registration London, and for Lambeth, 1899 Appendix Mortality Tables showing Deaths (corrected) from all causes in Lambeth during 1899 sub-divided— (a.) As to different Age-Periods Appendx (b.) As to Registration Sub-Districts Appendix V. GENERAL INDEX- Page Abatement of Nuisances 75—78 Accidental Deaths 64, 122 —123 Adulteration of Food and Drugs 89—94 Age Distribution of Diarrhœa 59 „ „ Diphtheria 51 „ „ Scarlet Fever 43 Typhoid 54 ,, „ Deaths 19,25 ,, „ Population (Lambeth) . 7,23 Air Temperature 59 Alcoholism—Deaths from 63 Analysis of Food and Drugs 89—94 Anthrax and Bacteriological Examination 130 Antitoxin in Diphtheria 52, Appendix 17—18 Antitoxin, Gratuitous Distribution of 52, ,, 17—18 Apoplexy - Deaths from 63 Are 1 of Parish of Lambeth 4,74 Arlington Lodge (Alterations) 86 Atelectasis 63 Bacteriological Laboratory 86, 125—130 Bakehouses 117—118 „ List of 117—118 Bedding, &c., Disinfected 85,87 ,, Destroyed 86,87 Births 10, 11, 20—21,72,74 Birth Rates in Sub-Districts 10, 12, 13, 20—21 Bodies received into Mortuaries 119—121 Bronchitis, Deaths from 63 Burns and Scalds, Deaths from 64 Bye-Laws (New) for Drainage Appendix 15 —16 Calf Lymph 40 Cancer, Deaths from 63 Cautions (Food and Drugs) 89, 92 Censal Populations (Lambeth) 4, 11 „ „ (London) . 9 Cholera 30, 33, 60 vi. Page Circulatory System, Diseases of 63 Clerical Work 133 Closure of Schools 44,46—48 Combined Drainage 80—81 Complaints 78,133 Conscientious Objectors 40 Congenital Malformations 63 Constitutional Diseases 63. Consumption (see Tuberculosis and Phthisis). Continued Fever 21,56 Convictions under Public Health Acts 78, Appendix 46—51 „ „ Food and Drugs and Margarine Acts 78,89,92 Appendix 40—45 Convulsions, Deaths from 63; Coroners' Courts 119 Costs, Food and Drugs 89,92 Cowhouses 78, 106—108 „ List of 107 „ Defects found in 107—108 Critical Temperature (Earth) 59. Customs and Inland Revenue Acts 103 Deaths and Death Rates 11—26 „ Inner and Outer Wards 16—18,29 Deaths (arranged quarterly) 24, 26, 35—36 Death Rates and Birth Rates—Inter-relationship 12 Deaths—corrected 11,14,16—23. 65—66,72—74 ,, uncorrected 14, 16, 23—26, 67—71 Deaths in Public Institutions 11,13, 15—16,68—71 „ Zymotics „ under 1 year 11,13,19,25—27 „ „ 5 years 11,13,19,25—27 Deaths from Violence 64 Deaths from Ill-defined and Non-specified Causes . 64 Delirium Tremens, Deaths from 03. Density, per acre (Lambeth) 20—21,74 Dentition, Diseases of 63 Depots (Refuse and Manure) 98—99 Developmental Diseases 61 Diagnosis (Bacteriological) 125—130- vli. Page Diarrhoea 21, 59—61 „ Age Distribution of 59 „ Monthly Mortality 61 „ Inner v. Outer Wards 60—5l „ and Infanti'e Mortality 21,59—60 Dietetic Diseases 63 Digestive System, Diseases of 63 Diphtheria 21,50—53 „ Age Distribution of 51 „ Antitoxin in 5', Appendix 17—18 „ Increase of 30,51—52,129 „ Bacteriological Examinations 50,126—129 ,, Outbreak in School 52, 123 „ Prevalence and Sore Throats 50, 128 —129 „ Pseudobacilli 127—128 Disinfection, Details of 85—86 „ Statistics 87 „ Certificates 83—35, 133 Disinfecting Department 82—88 „ Machines 82—83 „ Refuges 78, 86,88 Displacement of Tenants 101—102 Distribution (free) of Anitoxin 52 Drainage 79 Drain Testing 78—80 „ „ with water 79—80 Drainage, Combined 80—81 Drainage, Defects 33, 34,77 Drainage, New Bye-laws Appendix 15—16 Drowning, Deaths from 64,122 Dust Depots 98—99 Dust Destructor (Phoenix Wharf) 98—99 Earth Temperatures 59 Effluvia from Potteries 9} Enteric Fever (see Typhoid) 21, 30, 54- 56, Appendix 19—25 Enteritis 0,63 Epilepsy, Deaths from 63 Equifex Disinfecting Machine 82—83 Erysipelas 58 Execution, Death from 64 O viii. Page Female Inspector 111—112 Food and Drugs, Adulteration of 89—94 „ „ New Act 83,93—94 Food Seizures 81—82 Homicide, Deaths from 64,122—3 Houses Condemned 100 Houses let in Lodgings 99 House-to-House Inspections 79 Housing of the Working Classes Act 77, 100—102 „ „ „ and Displacement 101—102 „ „ „ and Insanitary Areas 101—102, Appendix 26—37 Increase of Population 1 (Lamleth) 4.74 „ „ (London) 8 Infantile Mortality 13,21,27—28,64,66,74 „ „ (London and 33 large Towns of England and Wales) 28 Infected Houses 33—34, 75, 85 „ and Drains 33—34 Infectious Cases removed 30,72—3,78 Infectious Diseases Inspection 78 Influenza 62 Inhabited Houses of Lambeth, 1899 8, 11, 13, 74 Inner and Outer Wards—Deaths and Births 12, 16—18, 29 Inquests 123 Insanitary Areas (Housing of Working Classes) 101 —102, Appendix 26—37 Inspections 78—79 Inspector, Female 111—112 „ Food and Drugs 89 „ Smoke 94 Institution Deaths 15—16, 68—71 Integumentary System, Diseases of 64 Introductory Letter 3 Lambeth Statistics 4—74 Lavatories (Underground) 124 Letters (sent and received) 133 Liver, Diseases of 63 Local Diseases Nervous System, Heart, Respiratory Organs, Digestive and Urinary Systems, and Reproductive System 63—64 ix. Page Locomotive System, Diseases of 64 Local Government Boar J, Tables A and B 68-73 London (County of), Vital Statistics, 1899 8 „ No. of Births, Deaths and Marriages, 1899 8, 14 „ Birth, Death and Marriage Rate.", 1899 9, 19, 23, Appendix 2—3 „ Zymotic Deaths 8—9 „ Zymotic Diseases Appendix 2—3 Lymphatic System, Diseases of 64 Manure Depόts 98—99 Market Thoroughfares 82 Marriage and Marriage Rates (Lambeth) 11 —14,74 Measles 21,45—49.82—84 Measles, as a dangerous Infectious Disease 45—46 Measles and School Closure 46—48 Membranous Croup. 21,53 Meningitis (Tubercular) 63 Mortality Rates— Different Age Periods (Lambeth and London) 23 Mortality Rates— Different Diseases 65—66 „ ,, (Lambeth, Quarterly) 35 Under 1 year of age (London and Lambeth) 23, 67 Mortality Tables Appendix 52—64 Mortuaries 119—122 „ Keepers of 119,121 Natural Causes, Deaths from 123 Natural Increment of Population (Lambeth) 4, 74 „ „ „ (London) 8 Nervous System (Diseases of) 63 Neville's Disinfecting Machine (old) 82—83 Notices Served 75—78,80, 133 Non-notifiable Infectious Diseases 78,84 Notifiable Infectious Diseases 25—32,72—3,75,77 Notification Certificates received, 1890—9 31—32 Nuisances abated 75—78 Old Age, Deaths from 63 Organs of Special Senses, Diseases of 64 Outer and Inner Districts— Deaths and Births 12, 16—18, 20 X. Page Parliamentary and New Wards (Lambeth) — General Diseases, Deaths 22 Population 6 Zymotic Diseases 22 Zymotic Incidence 22 Parasitic Diseases 63 Penalties—— Public Health Acts 78,05, Appendix 45—51 Food, Drugs and Margarine Acts 78, 89, 92, Appendix 40—15 Peritonitis, Deaths from 63 Persons, per House 13 „ „ Acre 20—21,74 Phthisis 63 Plans of Drainage 78—80 Pneumonia, Deaths from 63 Population of Lambeth, 1899 4—7, 11, 20, 72, 74 „ „ „ Sub-Districts 4, 5, 20 „ „ „ Parliamentary and New Wards 6 „ „ „ Age Periods 7 Population of London, 1899 8—9 „ „ „ Sub-Districts 9 Post Mortems 119 Potteries 98 Premature Births 63 Premises Disinfected 78, 85 Prosecutions— Public Health Acts 78, 80, 95 Food, Drugs, and Magarine Acts 78,89,92 Pseudobacilli and Diphtheria 127—129 Public Institution Deaths 11, 13, 15, 16 Puerperal Fever 57 Quarterly Returns (Lambeth)— Births 10 Deaths (Zymotic and General) 24,26,35—36 Notifiable Infectious Diseases 31 Non-notifiable Infectious Diseases 84 Disinfection Certificates 83 Railway Sidings and Manure 98—99 xi. Page Rateable Value of Lambeth, 1899 8, 74 Refuges for Infected Households 78, 86, 88 Refuse Depόt 98—99 Registration Sub-Districts (Lambeth) — General Diseases, Deaths 17, 20—1, 24—26, 68—71 Zymotic „ „ 17,20—1,36,61,68—71 Births and Birth Rates 10, 17, 2C —1, 72 Vaccination Returns 41—42 Re-inspections 78 Relapsing Fever (London) 56 Removal of Infectious Diseases 30, 73, 78 Reproductive System, Diseases of 64 Respiratory Diseases 61 Samples, Food and Drugs 89—94 Sanitary Defects 77 Sanitary Work 75, 133 „ Structural 75—77 „ Non-Structural 75—77 Scarlet Fever 21, 43—44 ,, Age Distribution 43 „ and School Attendance 44 „ and Milk 44 School Closure and Measles 46—48 Schools closed for Measles 46—47, 84 Sewer Ventilation 131—132, Appendix 4—14 Simple or Continued Fever 56 Slaughter-Houses 78, 104-106 „ List of 104—105 ,, Defects found in 105—106 ,, Number of Animals killed 106 Small-Pox 40 Smoke Nuisance and Abatement78,94—98 „ „ Penalties 95 Sore Throats and Diphtheria 50,128—129 Stamps used 133 Staffs- Clerical 133 Disinfecting 83 Inspectors 79—82 xii. Page Staff—continued. Mortuary Attendants 119,121 Underground Lavatory Attendants 124 Suffocation in Bed 64 Suicide and Homicide, Deaths from 64, 122—123 Summary of Vital Statistics (Lambeth), 1899 74 „ Sanitary Work 78 Summonses 78, 80, 89 Syphilis 63 Temperature (Air and Earth) 59 Testing of Drains 79 Tuberculosis, Deaths from 63 „ and its Prevention 82, 84 „ and Bacteriological Examinations 125, 130 Typhoid (see Enteric) 21, 30, 54—56 „ Age Distribution of 54 „ Bacteriological Examinations 56, 125—126 „ and Shellfish 56 „ Increase of, during 1899 55—56, Appendix 19—25 „ Personal infection in 55—56, Appendix 19—25 Typhus 21,56 Underground Conveniences 124 „ „ Receipts, 1899 124 Unsound Food, Seizure of 81—82 Urinary Diseases, Deaths from 63 Vaccination Returns 41—42 Vaccination Act, 1898 40 Venereal Diseases 63 Ventilation of Sewers 131—132 Violent Deaths 64 Vital Statistics London 8—9 „ Lambeth 4—74 „ Summary (Lambeth) 74 Water Supply 89 Water Certificates 133 Whooping Cough 21,45—49,82,84 Work of Sanitary Staff 75—78 Workshops 108—116 „ Defects found 110-111,114—115 xiii. Page Workshops, Female Inspector in 111—112 „ Overcrowding in 111—116 „ Protected Persons 103 „ Trades, &c. 108 Zymotic Diseases 29—63, 67 „ Deaths, Arranged Quarterly 35—36 „ Deaths, Arranged Monthly 37 „ Incidence in Parliamentary and New Wards 22 „ Principal Deaths (Lambeth) 11,21,29,38—39 „ „ „ (London) 8—9,38-39, Appendix 2—3