LAM 62 Report on the Vital and Sanitary Statistics of the Parish of Lambeth, during the year 1900 (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 Council, by MERSER & SONS, Printing Contractors, 270, Kennington Road, London, S.E. Public Health Department, 333, Kennington Road, S.E. February, 1901. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, The Report for 1900 contains the last record of the Vital and Sanitary Statistics of the Parish of Lambeth— the District over which the late Vestry of Lambeth has had control since 1855. It will be noted that this last record is, considering all things, the most satisfactory one that has ever been presented, as shewing what can be done by a Sanitary Anthority in lowering the death-rates, and lessening considerably the disease-incidence, amongst the people inhabiting a District. In the Appendix will be found a resume of the work done during the last five years, during which I have had the honour of being Medical Officer of Health to the late Vestry, and also full details of an outbreak in Vauxhall Ward of Typhoid Fever, which was traced to infected mangles, and which, by the prompt measures taken, was quickly stamped out. The London Government Act, 1899, which came into force on November 9th, 1900, alters the boundaries of the old Vestry Parish of Lambeth, and makes it necessary in next year's Report, to start anew a Statistical Record for the new Borough of Lambeth, which is under the jurisdiction of the new Borough Council, and such Record will not be comparable with those to be found in the present and previous Annual Reports. One of the last acts of the late Vestry was to open a branch office at Norwood, in connection with the Sanitary Department—an important administrative improvement carried out during 1900. The large amount of disinfection 4 carried out during 1900 in measles- and tuberculosisinfected houses, together with the decision to have the former disease included amongst the dangerous infectious diseases mentioned in the Public Health (London) Act, 1891, are also matters calling for favourable comment. During 1900, an outbreak of typhoid fever in the neighbourhood of the Wandsworth Road was successfully traced to infected mangles, and stamped out accordingly by strict isolation (all the cases being removed to Hospital), efficient disinfection, and the careful supervision (daily) of all contact cases. The outbreak is of interest, as being the first recorded one that has been traced to infected mangles, and also as proving the contagiousness of the disease directly from person to person—a method of spreading not sufficiently or generally recognised in connection with typhoid fever. My best thanks are again due to the Staff of the Public Health Department, who have during the past year helped me so well, as in former years, and who have, one and all, been re-appointed as the Officers of the new Council of the Borough of Lambeth, in which new appointments they will be able to continue the same valuable assistance. 1 am, Mr. Mayor and Gentlemen, Your obedient Servant, JOSEPH PRIESTLEY, B.A., M.D., D.P.H., Medical Officer of Health. 5 I.—VITAL STATISTICS. All the estimated populations are calculated upon the enumerated populations of the Censuses of 1891 and 1896, and made up to the middle of the year 1900. The Parish of Lambeth contains 4,059 statute acres, inclusive of 79 tidal water and 39 foreshore, with an estimated population of 312,152 persons to the middle of the year 1900, consisting of 147,441 males and 164,711 females, or an excess of 17,270 females. The total estimated increase of the population is 4,044, but the " natural increment," i.e., the excess of births over deaths, is 3,737, so that an entry of 307 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. 1900. Middle of Year. Waterloo Road First 14031 14186 14330 Waterloo Road Second 14644 14210 13853 Lambeth Church First 18075 18770 19377 Lambeth Church Second 39097 40994 42642 Kennington First 50586 52486 54146 Kennington Second 39708 43244 46289 Brixton 73405 81825 89057 Norwood 25657 29318 32458 Parish of Lambeth 275203 295033 312152 6 The Lambeth estimated population to the middle of 1900, may be sub-divided as follows:— A- As to Registration Sub-districts. Registration Sub-districts. Males. Females. Total. Waterloo Road First 7219 7111 14330 Waterloo Road Second 7097 6756 13853 Lambeth Church First 9775 9602 19377 Lambeth Church Second 21310 21332 42642 Kennington First 26561 27585 54146 Kennington Second 21114 24875 46289 Brixton 39890 49167 89057 Norwood 14175 18283 32458 Parish of Lambeth 147441 164711 . 312152 7 B. As to Parliamentary Divisions and New Wards. Parliamentary Divisions and New Wards. Males. Females. Total. Marsh North Division 31012 30873 61885 Bishop's Prince's Kennington Division 40680 41741 82421 Vauxhall Stockwell Brixton Division 40091 47555 87646 Brixton Tulse Hill Norwood Division 35658 44542 80200 Norwood Parish of Lambeth 147441 164711 312152 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 j88i and 1891. 8 C. As to Age.Periods. Age.Periods. Males. Females. Total. 0—1 4046 4027 8073 1—5 14565 14312 28877 Total under 5 18611 18339 36959 5—20 45901 48670 94571 20—40 49506 55784 105290 40—60 25073 28998 54071 60—80 7899 11915 19814 80 and upwards 451 1005 1456 Total over 5 128830 146372 275202 9 The estimated number of inhabited houses to the middle of the year 1900 is 41,470, and the rateable value of the Parish on October 6th, 1900, was £1,749,717, an increase of £12,419 on the previous year, as the following Table shews:— Yearly average for 10 years, 1890.1899, £1,607,658. The Registrar.General returns the estimated population of London for the middle of the year 1900 as 4,589,129, consisting of 2,174,343 males and 2,414,786 females, and states that there were registered during the year 40,499 marriages, 130,868 births (66,475 males and 64,393 females), and 86,007 deaths (44,676 males and 41,331 females). There were registered, too, 10,136 deaths from the seven chief zymotic diseases. The excess of registered births over deaths, i.e., the natural increment, is 44,861 and the estimated increase of population from middle of 1899 to the middle of 1900, is 42,377. * 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. Year. 1900 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 Rateable Value. 1,749,717 1,498,535 1,526,176 1,540,047 1,551,023 1,562,868 1,575,253 1,680,283 1,692,816 1,712,289 1,737,298 1900.—Sanitary Areas of the Metropolis. Enumerated Population, 1891 (Census). Enumerated Population, 1896 (Census). Estimated Population, 1900 (middle of year). Birth.Rate. Death.Rate. Zymotic Death. Rate. Deaths under 1 year 1000 Births London 4211743 4411710 4589129 28.6 18.3 2.2 158 South Districts 1524472 1642796 1749387 29.3 180 2 2 158 West Districts 728418 766203 801255 23.8 16.6 1.8 158 North Districts 993884 1040694 1079972 26.4 16. 7 2.0 145 Central Districts 259855 245683 234255 28.0 22.3 2. 2 158 East Districts 705114 716334 721260 35.6 21. 9 2.9 175 11 Table A. giving the number of Births and the Birth.Rates in each Registration Sub.District of Lambeth during 1900 (arranged quarterly). Registration Sub.Districts. No. of Births. Total for the Year 1900. Rate per 1000 Inhabitants. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Waterloo Road 1st 123 135 121 117 496 34.7 „ 2nd 214 228 226 184 852 61.5 Lambeth Church 1st 160 152 134 136 582 30.03 „ 2nd 408 391 401 343 1543 36.l† Kennington 1st 484 440 456 476 1856 34.3 „ 2nd 262 245 263 220 990 21.4 Brixton 543 550 539 480 2112 23 7 Norwood 178 188 207 163 736 22.7 Lambeth 2372 2329 2347 2119 9167 29.4 * Including Lying.in Hospital (448 cases, of which 103 belong to Lambeth)—corrected rate=29.2. † Including Workhouse (188 cases, of which 153 belong to Lambeth)—corrected rate=31.8. 12 Table B, shewing the Estimated Populations, Numbers of Inhabited Houses, Marriages, Births, and Corrected Deaths for the year 1900, and Ten Years preceding, in Lambeth Parish. The Year. Estimated Population. Estimated 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 Years. 1900 312152 41470 2454 9167 5430 1328 1884 497 1576 1890 273529 38319 2060 9017 5842 1369 2228 696 1320 1891 276162 38634 2140 9097 5886 1387 2251 692 1438 1892 280032 38950 2107 9226 5457 1250 2091 705 1578 1893 283956 39265 2233 9222 5219 1325 1925 748 1741 1894 287935 39580 2224 9232 4837 1223 1936 680 1484 1895 291970 39895 2220 9341 5559 1420 2187 732 1511 1896 296061 40210 2445 9592 5098 1313 2045 708 1588 1897 300048 40525 2445 9388 5251 1425 2096 734 1546 1898 304073 40840 2589 9256 5430 1426 2089 726 1543 1899 308108 41155 2523 9433 5886 1488 2198 782 1680 Note.—(a) Enumerated Population at Census 1896 was 295,033. (b) Actual number of inhabited houses at Census 1891 was 38,556. 13 THE BIRTH RATE. The number of Births registered in Lambeth during the year 1900 was 9167, as compared with 9433 for the year 1899. Of the total 9167 births, 4699 were males, and 4468 females, showing an excess of 231 males. The birth.rate for Lambeth is, therefore, 29 4 per 1,000 inhabitants (31.9 for males, and 27T for females), as compared with 30.6 for London (33.3 for males and 28.2 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, the birth.rate in Inner Districts is 38.5, and that in the Outer Districts 257, per 1000* In the Inner Wards (where the birth.rates are high) the high birth.rates help the high death.rates, owing to the great numbers of deaths amongst infants and children between 1 and 5 years of age so that a persistently high birthrate, instead of leading to a lower, causes a higher, death. rate, pointing 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. 11). The Lambeth birth.rate is slowly, but surely, declining. *The corrected birth.rate (i.e., after subtracting the non.Lambethian births occurring in the Lying.in Hospital and the Workhouse), is 28'2. (Inner Districts =34.3, and Outer Districts=25.9). 14 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 i year, per 1000 Births. Deaths of Children undei 1 year, per 1000 Deaths. Deaths of Childrer under 5 years, per 1000 Deaths. Zymotic Death. Rate, per 1000 Population. Deaths in Public Institutions per 1000 total uncorrected deaths. 1900 7.4 15.7 294 174 1449 2446 346.9 1.6 282.5 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 25 236.6 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 £2.1 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 ]898 17.0 30.4 17.9 154.1 262 6 384.7 2.4 277.1 1899 16.3 30.6 19.1 157.7 252.8 373.4 2.5 277.1 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. 15 THE MARRIAGE RATE. The number of marriages registered in Lambeth during the year 1900 was 2454, as compared with 2523 for the year 1899. The marriage.rate for Lambeth is, therefore, 15.7 per 1,000 inhabitants, as compared with 17.6 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 1900 was 5,578, as compared with 6,064 for the year 1899. Of the total 5,578 deaths, 2,843 were males and 2,735 females, showing an excess of 108 males. The death.rate for Lambeth is, therefore, 17.9 per 1,000 inhabitants (193 for males and 16 6 for females), as compared with 18.7 for London (20.5 for males, and 17.1 for females). These rates are, however, uncorrected, and on analysing the 5,578 deaths registered in Lambeth Parish, it is found that 606 represent deaths occurring within the Parish amongst persons not belonging thereto. These are to be deducted, but, on the other hand, there are 458 deaths registered outside the Parish of persons belonging thereto, and these must be added, giving a corrected number of deaths for Lambeth during 1900 of 5,430, and a corrected death.rate of 17.4 per 1,000 inhabitants, as compared with 18.3 for London (the total corrected number of London deaths being 83,732). 16 The Institutions, &c., where 458 Lambethians died during 1900 may be grouped as follows:— I. General Hospitals Greenwich Infirmary 1 Charing Cross 21 Newington Workhouse 1 French 1 Holborn Infirmary 1 Guy's 26 St. Olave's Infirmary 1 Hostel of God 5 St. Giles Workhouse 1 King's 15 St. Saviour's Infirmary 3 London 3 Shoreditch Infirmary 1 Middlesex 5 St. George's Infirmary 2 Royal Free 5 Wandsworth Infirmary 1 St. Bartholomew's 16 IV. Asylums St. George's 10 Aged Pilgrims Assoc. 1 University 3 Banstead 20 Westminster 55 Camberwell House 2 11. Special Hospitals Caterham 14 Belgrave 4 Cave Hill 24 Brompton 12 City of London 1 Cancer 5 Colney Hatch 5 Central London Sick 2 Darenth 5 Cheyne House 1 Dartford 5 Citv of London Chest 1 Hanwell 6 Cottage Hospital 1 H. M. Prison, Wormwood Convent Hospital 1 Scrubbs 1 Evelina 23 Ilford 14 Friedernheim 6 Leavesden 4 Gt. Northern Central 1 Manor 3 Gt. Ormond Street 4 Middlesex 1 Grosvenor Hospital 2 Norwood 1 Homoeopathic 2 Peckham House 2 Home for Sick Children 1 St. Luke's 1 Metropolitan Hospital 1 V. Unclassifiable Places Queens Jubilee 1 Gun & Shot Wharf, Royal Chest 2 Tooley Street 1 Royal Eye 1 L. & S. W. Railway 2 St. Mary's 3 River Thames 5 St. Peter's House 1 Private Addresses 6 Temperance Hospital 1 Pond, Clapham Common 1 Victoria 4 Police Station, ian Road 1 West London 1 Fever Station House, Rochester Fountain 17 Row 1 North.Western 1 Streets 5 Grove 33 Brought dead to Hospital 3 South.Eastern 3 Salvation Army Homes, Western 1 Hackney 3 Park Fever Hospital 5 Thames Engine Works, III. Infirmaries and Greenwich 1 houses Butchers' Almshouses 1 Total 458 17 Summary. I. General Hospitals II. Special and Fever Hospitals III. Infirmaries and Workhouses IV. Asylums V. Elsewhere (Unclassifiable) 165 141 110 13 29 458 Whether we take the corrected or uncorrected death.rates for Lambeth (as a whole), they are very satisfactory for the year 1900, whilst on examining the death.rates more closely, e.g., as to age.periods, and special diseases, we still find cause for much congratulation. If, however, we sub.divide the death.rate into the several Registration SubDistricts, 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 ; though, it must be noted, comparatively less, as shewn by the table of comparisons given on page 17, Norwood and Brixton have the lowest general death. rates, and Waterloo Road 1st and 2nd, the highest; whilst the lowest Zymotic rates are in Norwood, Biixton, Kennington 1st, and the highest in Waterloo Road 1st, Lambeth Church 2nd, and Waterloo Road 2nd. Compared with last year the general death.rate is much lower, a decrease more noticeable in the Inner than the Outer Wards ; whilst the Zymotic death.rate and infantile mortality are also considerably lowered, comparatively more in the Inner than the Outer Wards. R 18 COM PARISON BETWEEN STATISTICS FOR 1898, 1890, AND 1900. General Death.Rate. Zymotic. Birth.Rates. Infantile Mortality, (uncorrected) 18:8 1900 1900 1899 1899 1898 1900 1899 1898 1900 1899 1898 Inner Wards— Waterloo 1st 24.3 24.9 25.3 2.8 3.5 3.5 34.7 32.6 35.6 223.8 2253 185.0 * Waterloo 2nd 23.9 27.0 25.4 2.7 2.9 2.2 61.5 66.9 62.3 106.8 90.1 113.4 Lambeth Church 1st 21.9 22.7 22.9 1.9 3.2 3.3 39.03 35.7 30.4 262.9 240.8 301.2 tLambeth Church 2nd 19.7 24.8 20.4 2.8 4.4 2.9 36.1 35.9 38.5 172.4 207.6 164.3 Outer Wards— Kennington 1st 18.8 20.2 18.5 1.3 2.7 1.1 34.3 34.8 35.4 125.6 65.2 137.2 Kennington 2nd 15.8 17.8 16.2 1.5 2.1 0.8 21.4 23.9 22.5 124.2 141.4 139.7 Brixton 14.3 15.4 14.9 1.3 1.9 0.4 23.7 24.9 25.0 132.1 135.8 155.9 Norwood 140.3 13.5 14.0 1.02 1.8 0.2 22.7 23.7 20.7 127.7 150.3 124.8 Lambeth 17.4 19.1 17.9 1.6 2.5 2.4 29.4 30.6 30.4 147.3 161.9 156.3 * Excluding the 448 Lying..in Hospital Births, the birth.rate is 29 '2, and the infantile mortality rate 225.3. † Excluding the 188 Workhouse Births, the birth.rate is 318, and the infantile mortality rate 196.3. 19 The general death.rate in the Inner Wards for 1900 is 21.5, as compared with 24 7 during 1899, per 1000. representing a saving 288 general deaths during the year 1900. The zymotic death.rate in the Inner Wards for 1900 is 2.3, as compared with 3 8 during 1899, per 1000, representing a saving of 135 deaths from the principal zymotic diseases during the year 1900. In the Outer Wards the general and zymotic death.rates for 1900 are 15.7 and 1.3 per 1000 respectively, as compared with 17 2 and 2 03 for 1899, representing a saving of 332 and 155 deaths from general and zymotic diseases during the year 1900. The Infantile Mortality rate (i.e., deaths of infants under 1 year per 1000 births) is a delicate index of the sanitary state of a district, and the lowered rate (uncorrected) for Lambeth for 1900, viz. : 147.3 as compared with 161.9 per 1000 during 1899, is cause for congratulation. The corrected average birth.rates are, Inner Districts 34.3, Outer Districts 25.7, per 1000. One thing is specially noticeable, viz.: that 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. The congested condition under which the inhabitants live in the Inner Wards, as compared with those in the Outer Wards, explain in great part these differences. 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. b 2 20 TABLE D. TABLE D. Showing the number of Births and Deaths, with Birth. and Death.rates in each of the Registration Sub.Districts of the Parish during 1900. The Deaths are from all causes, and from the Zymotic Diseases, and are corrected by adding Lambethians who die outside the Parish, by omitting strangers who die within the Parish, and by re.distributing persons who die in Public Institutions in other Districts from which they have been removed during illness. Total Deaths from DISTRICTS. Persons per Acre. Estimated Population (middle 1900). Total Births. Birth.rate per 1000 of the Population. Total Deaths (corrected). General Death.rate per 1000 of the Population Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Diarrhæa. Total Zymotic Deaths. Zymotic Death.rate per 1000 of the Population. Zymotic Death.rate prr 1000 of the Total Deaths Diarrhæa Death.rate per 1000 of the Population. Infantile Mortality per 1000 Births (uncorrected Waterloo Road 1st 213.3 14330 496 34.7 327 24.3 ... 11 1 10 3 ... 2 ... 12 39 2.8 115.5 0.9 223.8 2nd 1394 13853 852 61.5 311 23.9 ... 7 ... 11 11 ... ... ... 7 36 2.7 111.9 0.5 106.8 Lambeth Church 1st 113.7 19377 £82 30.03 403 21.9 ... 1 1 6 8 ... 2 ... 19 37 1.9 9002 1.0 262.9 „ 2nd 226.6 42642 1543 36.1 820 19.7 ... 5 ... 17 18 ... 14 1 33 88 2.8 106.04 0.8 172.4† Kennington 1st 109.7 54146 1856 34.3 997 18.8 ... 6 5 13 9 ... 14 ... 21 71 1.3 70.8 0.5 125.6 „ 2nd 91.5 46289 990 21.4 711 15.8 ... 7 2 18 17 ... 7 ... 16 67 1.5 93.1 0.4 124.2 Brixton 61.1 89057 2112 23.7 1262 14.3 ... 22 7 23 29 ... 11 ... 26 118 1.3 92.9 0.3 132.1 Norwood 31.4 32458 736 22.7 435 14.03 ... 10 3 2 2 ... 2 ... 13 32 1.02 68.3 0.4 127.7 District not stated ... ... ... ... 164 ... ... ... 1 3 ... ... 2 ... 3 9 ... ... ... ... Lambeth 78.2 312152 9167 294 5430 17.4 ... 69 20 103 97 ... 54 1 153 497 1.6 91.5 0.5 147.3 N.B.—In the 164. 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 District Census 1891 Return gives the area of Lambeth as 3,941 statute acre exclusive of tidal water, and foreshore). * Excluding the Lying.Hospital births,the corrected rate.225.3 per 1000. † Excluding the Workhouse births the corrected rate.196.3 per 1000. 21 22 The 5,430 corrected deaths may be further analysed, and tabulated according to age.periods, as follows:— 1328 i.e. 24.5 per cent, of the total deaths took place under 1 year of age. 556 i.e. 10.2 „ „ „ between 1 and 5 years. 1884 i.e. 34.7 „ „ „ under 5 years. 252 i.e. 4.6 „ „ between 5 and 20 years. 657 i.e. 121 „ „ „ 20 and 40 years. 1067 i.e. 19.7 „ „ „ 40 and 60 years. 1244 i.e. 22 9 „ ,, „ 60 and 80 years. 326 i.e. 6.0 „ „ „ 80 years and over. 3546 i.e. 65.3 „ ,, ,, over 5 years. These results must be compared with those for London given in Table E, which shows the estimated mortalities per 1000 persons at each age.period for London during 1900, and the London averages for the 10 years 1881.90. Tables F, 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 16 other Districts (out of 43) with a less death.rate, 10 with a less Zymotic death.rate, and 12 with a less infantile morality 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, Battersea and Wandsworth alone having slightly lower death.rates. London as a whole, has a birth.rate of 28.6, corrected death.rate of 18.3, and Zymotic (death) rate of 219, per 1,000 population, and an infantile mortality rate of 158, per 1000 births. 23 TABLE E Giving corrected Death.rates, Zymotic Death.rates, and Zymotic Incidence.rates in the Parliamentary and New Wards, Division of Lambeth, during 1900. Parliamentary Divisions. North Division Kennington Division Hrixton Dvision Norwood Division Lambeth Ne.w Wards. Marsh Bishop's Prince's Vauxhall Stockvvell Brixton Tulse Hill Norwood Total Deaths. Death. Rate per 1,000 6361 910 6701 905 369 676 928 436 5430 Zymotic Diseases. Death Total , Rate per Deaths. 1,000 population 249 17 9 119 1701 174 Zimotic Incidence. Total Zymotic Casrs 64 75 71 78 46 58 85 20/ 497 2 2 1.8 1.2 1.3 1.6 8.9 71 5'7 7.2 7*1 270 279 259 323 232 270 442 136 2209 Incidence, per 1,000 of the population 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. 24 TABLE F. Showing Mortalities in Lambeth at different Age.Periods compared with (1) those for London 1900, and (2) the averages for London, for years 1881.90. Age.Periods. LAMBETH. LONDON. Estimated Populations (middle 1900). Mortality Rale* per 1000 Population, 1900. Mortality Rates per 1000 Population, 1900, Uncorrected. Average of Ten Years 1881—90. per 1000. Corrected Uncorrected. 0—5 86950 50 9 51.8 56.7 68.4 5—20 94571 2.7 7.8 32 8.6 4.3 20—40 105290 6.2 6.9 7.7 40— 60 51071 19.7 21.6 20.2 60—80 19814 63.3 73.8 66.3 77.01 63.3 80 and upwards 1456 223.9 232.5 206.2 *Under 1 year 9167 144.9 147.3 159.9 152.0 All Ages 312152 17 4 17.9 18.7 20.5 I have used the Age.periods adopted in previous Lambeth Reports, though it is considered more accurate to sub.divide as follows 1.5, 5.15, 15.25, 25.35, 35.45, 45.55, 55.65, 65.75, 75.85, 85 and over. * N.B.—The Rates under 1 year are given in terms of 1000 births. 25 TABLE G. Shewing the Uncorrected Mortality (Male and Female) in the different Districts, and a comparison of the nurr.ber of Deaths in each Quarter during the year 19co. Sub-District?. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total No. of Deaths in each M. F. Total. M. F. Total. M. F. Total. M. F. Total. Waterloo Road 1st 30 39 69 35 30 65 46 46 92 22 32 54 280 „ 2nd 34 35 69 28 12 40 34 28 62 18 30 48 219 Iambeth Church 1st 142 115 257 124 98 222 159 89 248 119 71 190 917 „ 2nd 221 177 398 150 121 271 171 150 321 141 130 271 1261 Kennington 1st 119 120 239 77 77 154 93 86 179 68 90 178 750 „ 2nd 87 116 203 68 51 119 61 50 111 48 80 128 561 Brixton 154 221 375 125 132 257 126 146 272 140 148 288 1192 Norwood 63 77 140 49 45 91 38 35 73 34 57 91 398 Totals 850 900 1750 656 556 1222 728 630 1358 610 638 1248 5578 26 TABLE H. Shewing the Uncorrected Mortality (i.e., including that of Strangers) at different Ages in each District of the Parish, 19CO. Sub-District. Under 1 year. 1 to 5 years. 5 to 60 years. 60 yrs. & upwards. total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Waterloo Road 1st 56 55 111 26 24 50 39 47 86 13 20 33 280 „ 2nd 51 40 91 15 17 32 33 32 65 14 17 31 219 Lambeth Church 1st 82 71 153 61 46 107 327 205 532 74 51 125 917 2nd 150 116 266 30 34 64 292 202 494 210 227 437 1261 Kennington 1st 138 95 233 43 30 73 104 117 221 92 131 223 750 2nd 65 58 123 29 24 53 36 102 188 84 113 197 161 Brixton 151 128 279 61 Si 145 194 203 397 139 232 371 1192 Norwood 54 40 94 24 15 39 49 63 112 57 96 153 398 Totals 747 603 1350 289 274 563 1124 971 2095 683 887 1570 5578 27 TABLE I. Shewing the Uncorrected Deaths (i.e., Parishioners and Strangers) at various Age-periods in each Quarter, 1900. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Under 1 year 185 154 339 144 111 255 249 197 446 170 140 310 1350 Between 1 and 5 years 85 73 158 68 71 139 74 69 143 63 60 123 563 Between 5 and 60 years 340 318 658 285 214 499 274 210 484 224 230 454 2095 60 years and upwards 240 355 595 159 170 329 131 154 285 153 208 361 1570 Totals 850 900 1750 656 566 1222 723 630 1358 610 638 1248 5578 28 INFANTILE MORTALITY, 1900. Of the 5430 deaths, 1328 were infants under one year of age, giving a proportion of 144.9 (corrected) per 1,000 births, the uncorrected rate being 147.3—an increase over last year. The chief causes of these deaths were debility, atrophy and inanition, bronchitis and other diseases of the respiratory organs, 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 262.9 per 1,000 births in Lambeth Church 1st to 106.8 in Waterloo Road 2nd (the rates of 106.8 in Waterloo Road 2nd and 172.4 in Lambeth Church 2nd being explainable by the fact that these Sub-Districts contain the General Lying-in Hospital and the Workhouse respectively), thus:— Total No. of Births. Total Deaths under 1 year (uncorrected). Infantile Mortality per 1,000 birth (uncorrected). Waterloo Road 1st 496 111 223.8 „ „ 2nd 852 91 106.8* Lambeth Church 1st 582 153 262.9 „ „ 2nd 1543 266 172.4† Kennington 1st 1856 233 125.6 „ 2nd 990 123 124.2 Brixton 2112 279 132.1 Norwood 736 94 127.7 Lambeth 9167 1350 147.3 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 225.3 † Excluding the Workhouse births, the corrected rate becomes 196.3. 29 TABLE J. Shewing the Infantile Mortalities in the Registrar-Gereral's 33 Large Towns of England and Wales (including London), and in Lambeth Parish, during 1900 Deaths under one year per 1000 Births. Average Ten Years, 1890—99. England and Wales (33 Large Towns.) 172 172 Huddersfield 132 156 Croydon 132 137 Halifax 132 158 Bristol 133 149 Cardiff 141 164 Bradford 141 174 Portsmouth 155 158 London 158 160 Birkenhead 160 171 Brighton 166 156 Sunderland 169 175 Gateshead 169 173 Newcastle 170 174 Bolton 171 180 Oldham 172 183 Derby 174 156 Plymouth 175 172 Swansea 175 165 Leicester 175 197 Norwich 178 180 Leeds 183 178 Hull 183 176 Liverpool 186 192 West Ham 189 164 Manchester 190 190 Nottingham 196 179 Birmingham 199 186 Sheffield 200 184 Wolverhampton 205 19l Burnley 205 212 Salford 207 203 Blackburn 220 201 Preston 236 236 *London Districts— North 145 South 158 East 175 West 158 Central 158 Lambeth I44.9 154 *The figures are corrected for the London Districts (including Lambeth). 80 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 diarrhœa; 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 specially satisfactory for 1900. In Lambeth during 1900 there were registered 517 deaths from the seven zymotic diseases, and of these 91 were strangers belonging to other parishes, and 426 parishioners who died within the Parish. 71 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 497, giving a zymotic corrected death-rate of 1.6 per 1,000 inhabitants, the corrected rate for London being 2.2, varying in the various Metropolitan Disticts, as shown on page 10. 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 2nd shew the highest, and Norwood, Brixton, and Kennington 2nd the lowest, zymotic death-rates respectively. The corrected zymotic death-rate average) for the whole of the Inner Districts is 2.3, and for the Outer, 1.3—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. 31 During the year 1900 under the Notification Clauses of the Public Health (London) Act, 1891, 2209 cases of Infectious Diseases have been reported, and of this number 1425, i.e. 64.5% were removed to the Hospitals of the Asylums Board, or to other Hospitals, and 784, i.e. 35.5% remained under treatment at their own homes. The percentages of removals is higher than in any previous year, during the last nine years, i.e., since the introduction of the Notification Act and the tabulation of cases removed to Hospital. In 1891, 36.6% of the total Zymotic cases notified were removed; in 1892, 33.7%; in 1893, 23%; in 1894, 33.9%; in 1895, 30.4%; in 1896, 43%; in 1897, 49%; in 1898, 55.97%; in 1899, 61.2%; whilst in 1900, the numbers removed form 64.5% of the total cases. During 1900, 23.1% puerperal fever, 47.0% erysipelas, 73.8% scarlet fever, 69.1% typhoid, 72.4% diphtheria, 17.7% continued fever and 50% membranous croup, were removed to Hospital respectively. Table K gives the averages of Notification Certificates received in Lambeth since 1890, and it will be seen that during 1900 the total number is less than the average— the greatest number of Notifications being received in 1893—whilst the incidence per 1000 of the population during 1900 is 2.0 below the average incidence for the ten years 1890-99 (i.e., since the introduction of the Compulsory Notification Act). The two cholera cases notified were probably cholera nostras (English cholera), or infantile diarrhoea. The diphtheria increase is not so serious—only a total of 844 notifications being received during the year 1900, i.e., 27.2% above the average for the last ten years. The cases occurred in 748 infected houses, and in only 13.5% of these were the drains, on testing, found detective. For fuller details as to this increase in diphtheria,.vide pp. 51-52. 32 TABLE K. Shewing the number of Certificates for the Notifiable Zymotic Diseases received in Lambeth since the introduction of the Notification Act, i.e., in the ten years, 1890-99, and in the year 1900. Disease. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 Annual average of 10 years 1890—99 Notifications received during 00 Lambeth. Small-Pox 15 3 22 99 26 51 16 2 0 1 23.5 - Cholera 7 4 26 23 10 16 6 18 7 3 12.0 2 Diphtheria 330 330 504 789 521 614 652 704 813 1080 663.7 844 Membranous Croup 46 29 47 49 26 23 27 17 16 22 30.2 6 Erysipelas 248 258 420 587 315 355 352 325 294 330 348.4 234 Scarlet Fever 26 858 1832 2275 1198 1389 1550 1375 1009 1006 1361.8 821 Typhus 0 1 3 3 2 0 1 0 0 1 1.1 — Typhoid or Enteric 150 149 117 160 268 201 162 185 163 219 177.4 272 Continued or Relapsing 41 33 34 58 48 20 16 11 13 7 28.1 17 Puerperal 13 11 20 27 19 16 19 26 14 24 18.9 13 Totals 1976 1676 3025 4070 2433 2685 2801 2663 2329 2693 2635.1 2209 Average per 1000 of population 7.2 6.1 10.9 14.5 8.6 9.4 9.5 8.9 7.7 8.7 9.1 7.1 The Health Department has also Loard of, and dealt with, the following non-notifiable infectious diseases:— Measles, 941; Whooping Cough, 126; Chicken Pox, 88; Consumption, 524, 33 The enteric fever (or typhoid) notifications were much above the average, and represent 254 infected houses, of which only 13.4 % of the drains were shewn, on testing, to be defective. The notifications received during 1900 were 273, as compared with 219 during 1899. This increase in the amount of typhoid in Lambeth during 1900 is explained on page 57 (vide also Appendix 455-65). In the case of each infected house, an inspection was made, and the drains and sanitary fittings tested, with the results that of the 1992 infected houses:— (a) 285 (i.e., 14.%) were found to have defective drains. (b) 886 (i.e, 44.5%) were found to have defective drains, or defective traps, fittings and appliances. (c) 1106 (i.e., 55.5%) gave no results with the tests. (d) 601 (i.e., 30.6%) were found to have defective traps fittings and appliances, but not defective drains. It will be noted that only 14.3% of the total infected houses shewed, with the test, defective drains, no results being obtained from the test in the other cases, and 30.6% defective traps, fittings and appliances. Table L 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 1900 is 5.5% below the average in respect of defective drains, and 1.0% below the average in respect of defective traps, fittings, drains and appliances. These percentages are becoming less and less as time goes on, notably in the case of defective drains, which have fallen from 24.7% in 1892, to 14.3% in 1900. Taking the different notifiable infectious diseases, the results as to defects found may be sub-divided and tabulated as follows:— C 34 Sub-divided according to the different notifiable diseases, the results are as follows :— Diesase. No. of Infected Houses. Numbers shewing Defects as to Percentage shewing Total Defects. Percentage giving no Defects. Drains. Traps, Fittings and Appliances. Total. Smallpox ... ... ... ... ... • •• Cholera* 2 ... 1 1 50.0 50.0 Diphtheria 748 101 231 332 44.4 55.6 Membranous Croup 6 ... 2 2 33.3 66.7 Erysipelas 231 33 76 109 47.2 52.8 Scarlet Fever 721 113 193 306 42.4 57.6 Typhus ... ... ... ... ... ... Typhoid 254 34 89 123 48.4 51.6 Continued or Relapsing 17 4 3 7 41.2 58.8 Puerperal 13 ... 6 6 46.2 53.8 Totals 1992 285 601 886 44.5 5.55 *These were in all probability cases of Diarrhoea or Cholera Nostras. As years go on, it necessarily follows that the defects found, whether in drain pipes or in sanitary appliances, will become less and less in numbers, the methods of examination and the tests used being the same. On page 74 it is pointed out that, whilst the chemical (a smell) test is satisfactory, it is not thoroughly satisfactory, as when a negative result is obtained, the conclusion cannot be drawn therefrom that the drains are perfect, or in good order and condition. The late Vestry came to an important decision during the year as to drain-testing as usually carried out. (See page 74.) 35 TABLE L. Giving number of infected houses with percentages of (1) General Defects, and (2) Defective Drains, during 1900 and the Eight preceding years. 1892 1893 1894 1895 1896 1897 1898 1899 Average for last 8 years 1892-99 1900 Number of Infected Houses 2430 3179 2012 2111 2417 2374 2094 2435 2381 1992 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% 1156 =47.5% 1228 =51.4% 886 =44.5% Number of Houses with defective drains found 720 =24.7% 658 =20.6% 464 =23.1% 392 =18.6% 423 =17.5% 390 =16.4% 351 =16.9% 384 = 15.8% 473 =19.8% 285 =14.3% 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% 1279 =52.5% 1158 =48.6% 1106 =55.5% N.B.—Only 14.3 per cent. of the houses shewed with the test defective drains, no results being obtained in the other cases. 36 TABLE M. Showing Zymotic seasonal variations (deaths) in Lambeth in the different Registration Sub-districts during 1900. Registration Sub-Districts. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. Year 1900. Zymotic Death-rate per 1000 inhabitants. Waterloo Road 1st 10 6 19 4 39 2.8 Waterloo Road 2nd 11 8 11 6 36 2.7 Lambeth Church 1st 11 5 16 5 37 1.9 Lambeth Church 2nd 18 16 48 6 88 2.8 Kennington 1st 21 10 25 15 71 1.3 Kennington 2nd 13 13 22 19 67 1.5 Brixton 20 28 43 27 118 1.3 Norwood 9 5 14 4 32 102 District not stated 5 1 1 2 9 ... Lambeth 118 92 199 88 497 1.6 N.B.—In the case of the nine zymotic deaths occurring in Districts which are not stated, they have been distributed equally amongst the nine sub-districts before working out percentages. 37 The seasonal mortality from the different zymotic diseases is well shown by arranging the deaths quarterly, thus:— 1900. Smallpox. Measles. Whooping Cough. Scarlet Fever. Diphtheria. Membranous Croup. FEVER. Diarrhoea. Erysipelas. Puerperal Fever. Cholera. Influenza. Total. Typhus. Typhoid. Continued. 1st Qr. ... 32 28 3 38 ... ... 13 ... 4 3 2 ... 116 239 2nd Qr. ... 22 20 5 29 1 ... 12 ... 3 2 ... ... 17 111 3rd Qr. ... 12 23 3 22 ... ... 11 1 127 2 ... 2 7 210 4th Qr. ... 3 26 9 12 1 ... 18 ... 19 8 1 1 12 110 Totals ... 69 97 20 101 2 ... 51 1 153 15 3 3 152 670 Taking the zymotic diseases collectively, it is noticed that the 1st quarter shewed the highest mortality, and the 4th quarter the lowest. Influenza, Diphtheria, Measles and Whooping Cough reached their maxima in the 1st quarter; Diarrhoea and Cholera in the 3rd; and Scarlet Fever and Typhoid Fever in the 4th. Table M shews the zymotic seasonal variations in the different Registration Sub-districts, while Table O gives the monthly mortalities from the zymotic diseases. Table Q gives the deaths from the seven principal zymotic diseases during 1900, and for the ten previous years, not only in Lambeth Parish, but also (for comparison) in London. 38 TABLE N. Shewing the total cases notified under the Notification Clauses of the Public Health (London) Act in Lambeth during 1900 (arranged Quarterly). 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total for 1900 Small Pox - - - - - Scarlet Fever 159 194 207 261 821 Diphtheria 244 207 243 150 844 Membranous Croup 1 2 1 2 6 Typhus — — - — - Typhoid 61 39 72 100 272 Continued Fever 2 4 11 — 17 Erysipelas 52 51 46 85 234 Puerperal 7 1 2 3 13 Cholera - - 2 - 2 526 498 584 601 2209 39 TABLE O. Deaths from Zymotic Diseases (Strangers deducted). For the 4 weeks ending January. Feb. March. April. May. June. July. August. Sept. October. Nov. Dec. T otal. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 11 7 14 12 9 1 3 5 4 ... ... 3 69 Scarlet Fever 1 1 1 1 3 1 2 1 ... 2 5 2 20 Diphtheria 15 17 6 5 16 8 13 4 5 4 3 5 101 Membranous Croup ... ... ... ... 1 ... ... ... ... 1 ... ... 2 Whooping Cough 10 9 9 6 11 3 7 8 8 5 11 10 97 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 7 4 5 3 2 3 4 6 6 7 4 54 Continued Fever ... ... ... ... ... ... ... 1 ... ... ... ... 1 Diarrhœa ... 2 2 ... 1 2 20 60 47 14 2 3 153 Chief Zymotic Diseases Erysipelas 1 1 1 ... 1 1 1 1 ... 4 2 2 15 Puerperal Fever ... 1 1 ... ... ... ... ... ... ... ... 1 3 E. Cholera and Choleraic Diarrhœa ... ... ... ... ... ... ... 2 ... 1 ... ... 3 40 41 TABLE P. TABLE P. Shewing the number of Deaths from the principal Zymotic Diseases in the ten years 1890—99, and in the year 1900. Disease. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 Total Deaths in 1900. Proportion of Deaths to 1,000 total Deaths 1899. Annual Average of ten years 1890—99. Proportion of Deaths to 1000 total Deaths in 10 years. Smallpox 0 0 1 5 1 2 2 - - _ 1.1 0.2 Diphtheria (and Membranous Croup) 74 78 127 172 138 103 140 145 115 159 103 21.2 124.7 23.2 Scarlet Fever 57 46 76 69 64 53 63 42 30 25 20 5.5 57.3 11.7 Fever. Typhus 0 1 0 1 0 0 1 - - - - - 0.4 0.08 Typhoid or Enteric 31 28 22 36 46 26 24 26 35 50 54 6.4 30.5 5.7 Simple Continued 3 7 2 4 0 2 1 — — — 1 — 2.4 0.5 Measles 183 128 187 113 182 151 185 139 133 169 69 24.5 155.8 28.9 Whooping Cough 194 239 135 151 110 132 140 144 159 130 97 29.3 154.1 29.1 Diarrhœa 154 165 155 197 139 263 152 238 254 249 153 46.8 188.5 32.9 Lambeth 696 692 705 748 680 732 708 734 726 782 497 133.7 714.8 132.4 London 12270 9675 11983 13223 11544 11467 14009 11525 12482 11147 10136 152.2 11788.7 137.4 42 SMALLPOX. No case of Smallpox has been notified during the year 1900 in Lambeth, though in London there were *87 cases notified, and 4 deaths registered, giving a case-mortality (uncorrected) of 4.6 per cent. Tables Q and R give the vaccination statistics for the year 1899, and the first-half of 1900—those for the second half of 1900 not being ready in time for this report. It will be noticed that during 1899, only 0.8 per cent. (as compared with 7.9 per cent. for 1898) of the children born is unaccounted for as regards vaccination, and 61.8 per cent. were successfully vaccinated; whilst during the first half of 1900, 2.9 per cent. are unaccounted for, and 62.2 per cent. have been successfully vaccinated, returns that are satisfactory in themselves, and will prove more so when the whole year's statistics can be given in the next Annual Report. Taking the last ten years (1890—1899), the Smallpox statistics for Lambeth Parish are highly satisfactory, only annual averages of 1.1 deaths and 23.5 notifications, as compared with 45 deaths and 597 notifications for London as a whole, during the same decennium. The preventive measures now taken in connection with smallpox (viz., notification, isolation, disinfection, quarantining of contacts) are such as ought to secure the rapid stamping out of any outbreak or epidemic. Vaccination and re-vaccination, however, still call for attention as a certain means of preventing cases arising, and in this connection the vaccination statistics are becoming more satisfactory—the conscientious objectors slowly but surely disappearing. It would appear that the new Vaccination Act is not proving the great failure that was predicted by some members of the Public Health service. * Some of these cases proved not to be Smallpox. 43 TABLE Q.—VACCINATION RETURNS, 1899. Registration Sub-Districts. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinatcd. Conscientious Objectors. Postponed on Medical Certificate. Removed to other Parishes Gone and not found. 111 or not otherwise accounted for. Waterloo Road 1388 831 1 166 6 9 208* 166* 1 Lambeth Church 1st 627 377 — 91 5 18 18 120 3 Lambeth Church 2nd 1517 934 4 225 16 15 46† 270† 7 Kennington 1st 1872 1203 6 250 26 20 152‡ 212‡ 3 Kennington 2nd 1089 770 12 93 24 10 30 147 3 Brixton 2181 1240 20 262 26 35 61 489 48 Norwood 752 470 4 87 11 15 30 123 12 Lambeth 9426 5825 47 1174 114 117 545 1527 77 * Hospital Cases (227) included. † Workhouse Crises (41) included. ‡ Maternity Cases (142) included. TABLE R—VACCINATION RETURNS FOR THE FIRST HALF-YEAR, 1900. 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 699 400 ... 78 5 17 110* 83* 6 Lambeth Church 1st 312 169 2 45 4 19 16 50 7 Lambeth Church 2nd 799 459 ... 98 7 65 45† 110† 15 Kennington 1st 924 627 2 100 7 19 961 701 3 Kennington 2nd 507 366 ... 34 15 6 26 50 10 Brixton 1088 670 1 101 7 52 26 161 70 Norwood 366 228 ... 30 3 14 24 40 27 Lambeth 4695 2919 5 486 48 192 343 564 138 The Yearly Returns are not made up for the Local Government Board until the August in the following year. * Hospital cases (120) included. † Workhouse cases (47) included. ‡ Maternity cases (90) included. 44 45 SCARLET FEVEK. During 1900, 20 deaths were registered from Scarlet Fever, as compared with 25 during 1899, and an annual average of 573 for the last 10 years (1899-1900), 821 cases were notified, as compared with an annual average of 1361.8 for the 10 years 1890-99; and of these 821 patients, 604 were treated in hospital, and 217 at their own homes. The case mortality is, therefore, 2.4%, varying in different Registration Sub-districts (an average of 1.5 for the Inner as compared with 31 for the Outer), and from 3.7 to 1.9 according as the cases were treated at home or in hospital respectively. The age and sex incidence and mortality for scarlet fever cases notified in Lambeth during 1900 are as follows:— Ages. Number of Cases Notified. Deaths. Death rate per 100. M. F. Total. M. F. Total. Under 1 year 4 5 9 1 ... 1 1l.l 1 to 2 20 12 32 1 2 3 9.4 2 to 3 26 16 42 3 2 5 11.9 3 to 4 37 39 76 ... 1 1 1.3 4 to 5 41 31 72 3 ... 3 4.2 5 to 6 28 46 74 1 2 3 4.1 6 to 7 32 42 74 ... 1 1 1.4 7 to 8 30 29 59 1 ... 1 1.7 8 to 9 28 26 54 ... 1 1 1.9 9 to 10 37 37 74 ... ... ... ... Over 10 years 135 120 255 1 ... 1 0.4 Total 418 403 821 11 9 20 2.4 46 In London during 1900 there were registered 361 deaths out of a total of 13812 cases of scarlet fever notified, giving a case mortality of 2.6% (uncorrected). As far as could be traced no scarlatinal milk outbreak occurred in Lambeth during 1900, and no school had to be closed on account of an outbreak of scarlet fever amongst the scholars. It is satisfactory to record that 73.6% of the cases were removed to the hospital—83.4% from the Inner, and 69.3% from the Outer, Districts. The number of deaths (20) is very small, giving a death-rate per cases notified of only 2.4% . 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 1oo. Rate of Persons notified per 1ooo Inhabitants. Waterloo Road 47 3 44 1 1 2.4 3.3 1st Waterloo Road 39 1 38 ... ... ... 0.3 2.9 2nd LambethChurch 36 4 32 ... 1 1 3.1 1.9 1st LambethChurch 125 33 92 ... ... ... 0.1 2.9 2nd Kennington 1st 129 18 111 3 2 5 3.9 2.4 Kennington 2nd 136 76 60 ... 2 2 1.6 2.9 Brixton 228 45 183 2 5 7 3.1 2.5 Norwood 81 37 44 3 ... 3 3.8 2.5 District not stated ... ... ... ... 1 1 ... ... Lambeth 821 217 604 8 12 20 2.4 2.6* *Rate of persons notified per 1000 inhabitants—Inner Wards 2.7, Onter Wards, 2.6. 47 MEASLES AND WHOOPING COUGH. During 1900, 69 and 97 deaths were registered from Measles and Whooping Cough respectively, as compared with 169 and 130 during 1899, and annual averages of 155 8 and 1541 for the last ten years (1890-99). In London, during 1900, there were registered 1,936 and 1,948 total deaths from Measles and Whooping Cough, giving corresponding death-rates (uncorrected) of 4.2 and 4.2 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. There has been a saving of 86 deaths from Measles over the a"erage for the previous 10 years, giving a much lower death-rate than in any previous year in Lambeth. This decrease is most remarkable, and may be the result of the extra precaution taken by the late Vestry in connection with disinfection after Measles, the distributing of leaflets and posters, and the educating of the parents to regard Measles as a serious or dangerous infectious disease. The advisability of including Measles amongst the dangerous and infectious diseases for the purposes set forth in certain section of the Public Health (London) Act, 1891, without compulsory notification has been settled by the late Vestry during the year 1900 at their Meeting, held on March 1st, and the London County Council has been asked to take the necessary steps. Much will depend upon the decisions of the other Sanitary Authorities throughout London. The stricter the precautions taken against Measles, the better, as this disease is very fatal to young children, as may also be said of Whooping Cough. 48 Measles is spread through Schools especially Infants' Departments, and during 1900, as in former years, special precautions have been taken in respect thereto, as the following particulars shew:— Stockwell Training College (Infants' Department).— In January, 1900, the attendances in connection with the two Infants' Classes were lowered on account of an outbreak of Measles. In Class I. (with an average attendance of 50), 8 per cent. were absent, and in Class II. (with an average attendance of 40), 45 per cent. Class II. was ordered to be closed on February 1st, and remained closed for three weeks, i.e., from February 1st to February 23rd; whilst Class I. was also closed for the last two weeks of the period mentioned above. Total number on roll (in both classes together) 134, with an average attendance of 90, of whom 24.4 per cent. were absent at the time of closure. Disinfection and cleansing carried out. Result of closure was the dying-out of the epidemic. Chtist Church, Chapel Street, Brixton Road (Infants' Department).—Average attendance 95, and of these 40 per cent. were absent on account of Measles. The Infants' Department was closed by order, from February 14th to April 2nd, and during this time disinfection and cleansing was carried out, and sanitary defects (which had been discovered) made good. Result of closure was the diminution and stamping out of the epidemic. Gipsy Road Board School (Infants Department).— In March, 1900, attention was called to a slight outbreak of Measles in connection with the Infants' Department of Gipsy Road Board School, but enquiries showed that, of 423 on the roll, the following weekly absentees on account of Measles had resulted:— 49 Week ending March 17th 91 „ „ 24th 80 „ „ 31st 71 The outbreak being a declining one, no action as to closure was taken, but infected children, or children from infected houses, were kept from school. The outbreak gradually declined, showing the importance of only closing in connection with a rising outbreak or epidemic. A slight outbreak of Measles was also reported in connection with a private school in West Norwood, with an average attendance of 38. A total of 12 scholars contracted the disease during a period extending over six weeks, but no action was taken in respect of closure, the outbreak having been stamped out before the attention of the Medical Officer of Health had been called to the school. In connection with St. John's Infants' School, Warham Street, no action was taken as to closure, as it was found that of an average number on the roll of 320, only 6.6 per cent. were absent on account of Measles at one time Few precautions were taken in respect of Whooping Cough, though this too is a disease that levies a large deathtoll upon young children. Wherever the disease is known to exist, precautions are taken as to disinfection, etc., and the preventing of children, whether affected themselves with the disease or coming from infected houses, from attending school. When it is remembered that these two non-notifiable diseases cause more deaths, directly or indirectly, than all the notifiable infectious diseases added together, it will be readily understood how important it is that the strictest precautions should be taken. The Lambeth Statistics (sub-divided into Districts) are as follows:— d 50 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 3 11 2.1 7.7 Waterloo Road 2nd 11 7 7.9 5.1 Lambeth Church 1st 8 1 4.1 0.5 Lambeth Church 2nd 18 5 4.2 1.2 Kennington 1st 9 6 1.7 1.1 Kennington 2nd 17 7 3.7 1.5 Brixton 29 22 3.3 2.5 Norwood 2 10 0.6 2.9 District not stated* ... ... ... ... Lambeth 97 69 31 2.2 Of the 69 deaths registered from Measles, 22 were in infants under 1 year of age, 45 in children between 1 and 5, making a total of 67 in children under 5 years of age—39 males and 28 females. Of the 97 deaths registered from Whooping Cough, 45 were in infants under 1 year of age, 50 in children between 1 and 5, making a total of 95 in children under 5 years of age—41 males and 54 females. Both diseases are distinctly diseases of childhood. 51 DIPHTHERIA. During 1900, 101 deaths were registered in Lambeth from Diphtheria, as compared with 153 during 1899, and an annual average of 124.5 for the last ten years (1890 to 1899). 844 cases were notified during 1900. as compared with 1081 in 1899, and an annual average of 6637 for the ten years, 1890 to 1899. Of the 844 cases notified, 598 were removed to hospital and 246 were treated at their homes. The case mortality per cent. for the year is, therefore, 11.9, varying from 12.8 to 10.6, according as the cases were treated at hospital or at home respectively, a slight 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 Brixton, where the case mortality was 7.4% and 9.3% 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 469 cases that were submitted to bacteriological examination, true diphtheria bacilli were found in 20.3%. The age and sex incidence and mortality from Diphtheria cases notified in Lambeth during 1900, are as follow:— * 130 bottles of anti-toxin have been gratuitously distributed in Lambeth Parish during 1900, with moat satisfactory results. d 2 52 Ages. Number of cases Notified. Deaths. Death -Rate per 100. M. F. Total. M. F. Total Under 1 year 10 9 19 ... 3 3 15.8 1 to 5 145 135 280 29 34 63 22.5 5 to 10 134 145 279 10 16 26 9.3 10 to 20 64 91 155 2 4 6 3.9 20 to 40 29 69 98 1 2 3 3.1 40 to 60 4 6 10 ... ... ... ... 60 and over 1 2 3 ... ... ... ... Total 387 457 844 42 59 101 12.2 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 1900 312152 101 323 The increase in London, generally, has also been marked during the same quinquennia, but a satisfactory and complete explanation for the increase remains yet to be given. The large numbers of cases to be isolated, in London, have at times baffled the officials of the Asylums Board Hospitals, and rendered it necessary to refuse removal except in the very worst and most urgent cases, with the result that many cases have had to be treated at home. 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 Persons Notified per 1ooo Inhabitants. At Home. In Hospital. Waterloo Road 61 15 46 3 7 10 17.0 4.3 1st Waterloo Road 77 4 73 ... 11 11 14.8 5.6 2nd Lambeth Church 86 20 66 ... 6 6 7.4 4.4 1st Lambeth Church 92 18 74 ... 17 17 18.8 2.2 2nd Kennington 1st 120 39 81 6 7 13 11.1 2.2 Kennington 2nd 163 88 75 8 10 18 11.3 3.5 Brixton 222 54 168 8 15 21 9.3 2.5 Norwood 23 8 15 1 1 2 10.3 0.7 District notstated ... ... ... ... 3 3 ... ... Lambeth 844 246 598 26 77 101 11.9 2.7 During 1900, in Lambeth, 6 cases were notified from Membranous Croup, and 2 deaths were registered, giving a case mortality of 33.3, as compared with 22 cases notified, and 6 deaths registered during 1899. Three of the six Lambeth cases were removed to Hospital. In London, during 1900, there were registered 1,558 deaths out of a total of 11,998 cases of Diphtheria and Membranous Croup notified, giving a mortality of 12.9%* uncorrected). # In London Statistics, Diphtheria and Membranous Croup are now grouped together by the Registrar-General. 54 TYPHOID FEVER. During 1900, 54 deaths were registered in Lambeth from Typhoid (or Enteric) Fever, as compared with 50 during 1899, and an annual average of 30.5 for the last ten years (1890 to 1899). 272 cases were notified during 1900, as compared with 219 during 1899, and an annual average of 177.4 for the ten years, 1890 to 1899; and of the 272 cases notified, 188 (i.e., 69.1%) were removed to hospital, and 84 (i.e., 30.9%) were treated at home. The case mortality for the year is, therefore, 19.9, varying from 20.2 to 19.04, 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 to 5 5 7 12 2 — 2 16.7 5 to 10 13 20 33 — 1 1 3.03 10 to 20 48 53 101 6 7 13 12.8 20 to 40 64 38 102 17 11 28 27.5 40 to 60 13 10 23 4 5 9 39.1 60 and over — 1 1 — 1 1 l00.0 Total 143 l29 272 29 25 54 19.9 55 In London during 1900 there were registered 756 deaths out of a total of 4,309 cases of Typhoid notified, giving an uncorrected case mortality of 17'5% . Registration Sub-Districts. Total No. of Cases notified. Cases treated at Home. Cases removed to Hospital. Case Mortality per loo. No. of Deaths. Kate of persons Notified per 10,000 Inhabitants. At Home. In Hospital Total. Waterloo Rd. 1st 5 - 5 33.3 - 2 2 3.5 Waterloo ,, 2nd 15 7 8 36.4 — — — 10.9 Lambeth Ch. 1st 13 o Ci 11 23.8 1 1 2 6.7 Lambeth Ch. 2nd 54 12 42 250 3 11 14 12.7 Kennington 1st 73 1 72 20.0 2 12 14 13.5 Kennington 2nd 49 31 18 21.2 2 5 7 10.6 Brixton 43 18 25 20.8 7 4 11 4.8 Norwood 20 13 7 20.0 1 1 2 6.2 District not stated - - - - - 2 2 — Lambeth 2 72 84 188 I9.9 16 38 54 87 The case mortality was slightly higher in the Inner than the Outer Districts, viz., 21.8% as compared with 18.9%. The increase in the numbers notified during 1900 was due to an outbreak in Vauxhall Ward, traced to infected mangles. (See Appendix pp. 55-65.) CONTINUED AND TYPHUS FEVERS. During 1900, 17 cases were notified in Lambeth, and one death was registered from Continued Fever, as compared with 73 cases notified and 7 death registered (i.e., 9.6% uncorrected case mortality) in London. No case of Typhus was notified in Lambeth. 7 cases were notified in London, and 2 deaths registered, from Typhus during 1900, giving a case mortality of 28.6% (uncorrected). 56 PUERPERAL FEVER. During 1900 in Lambeth 3 deaths were registered from Puerperal Fever (a disease of child-bed), as compared with 12 during 1899, and an annual average of 12.7 during the last 10 years (1890—99). 13 cases were notified, as compared with 24 during 1899, and an annual average of 18 9 for the 10 years 1890-99. The case mortality for 1900 is 23.1% In London, during 1900, there were registered 169 deaths out of a total of 237 cases notified, giving a case mortality of 71.3% (uncorrected). Registration Sub-Districts. Number of Cases Notified. Number of Deaths. Case Mortality per 100. Waterloo Road 1st 1 - 0.0 Waterloo Road 2nd - - 0.0 Lambeth Church 1st — - 0.0 Lambeth Church 2nd 3 1 33.3 Kennington 1st 2 1 50.0 Kennington 2nd — — 0.0 Brixton 7 1 14.3 Norwood — - 0.0 Lambeth 13 3 23.1 57 ERYSIPELAS. During 1900, in Lambeth 15 deaths were registered from Erysipelas, as compared with 17 for 1899, and an annual average of 17.9 during the last 10 years (1890—1899). 234 cases were notified, giving a case mortality of 64% In London, during 1900, there were registered 182 deaths out of a total of 4,776 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 10 1 10.0 Waterloo Road 2nd 11 — 0.0 Lambeth Church 1st 16 1 6.3 Lambeth Church 2nd 36 2 5.6 Kennington 1st 25 — 0.0 Kennington 2nd 65 7 10.8 Brixton 54 4 7.4 Norwood 17 — 0.0 Lambeth 234 15 6.4 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. 58 DIARRHŒA. During the year 1900 there were registered in Lambeth 153 deaths from Diarrhoea, as compared with 249 during 1899, and an average of 196.9 for the last 10 years. Of these 153 deaths, 142 (i.e., 92 8 per cent.), were in children under five years, and 126 (i.e., 82.4 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, 59.5°; July, 66.8°; August, 60.6°; September, 57.9°; and October, 51.1°; whilst the 4-ft. earth thermometer registered 56° F. on June 16th, rising to a maximum 64.5° F. on July 29th, and sinking to 56° F. again on October 16th. 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 65 61 126 82.4 1 to 5 9 7 16 10.5 5 to 20 — — — — 20 to 40 1 1 2 1.3 40 to 60 1 2 3 1.9 Over 60 2 4 6 3.9 Total 78 75 153 1000 * The 4-ft. earth temperatures were taken in Regent's Park, and I beg to acknowledge my indebtedness to Mr. Wm. Marriott, of the Royal Meteorological Society, 70, Victoria Street, S.W., for the information in connection therewith. 59 In London there were registered during 1900, 3564 deaths from Diarrhœa, giving an uncorrected rate of 7.8 per 10,000 living, and 4.1% of total deaths. Registration Sub-Districts. Number of Deaths. Diarrhœa Death-rate per 10,000 Inhabitants. Waterloo Road 1st 12 8.6 Waterloo Road 2nd 7 5.3 Lambeth Church 1st 19 9.1 Lambeth Church 2nd 33 7.8 Kennington 1st 24 4.5 Kennington 2nd 16 3.5 Brixton 26 2.9 Norwood 13 4.1 District not stated 3 — Lambeth 153 4.9 In the Inner Wards the average Diarrhoea death-rate per 10,000 inhabitants was 8.04 as compared with 3.6 for the OuterWards, i.e., 2 to 1. The Inner Wards during 1900 have pro rata suffered less from Diarrhœa than during last year. Under the heading of Diarrhoea may be classed the 2 cases of cholera* notified, together with the 3 deaths registered, in Lambeth during the year, as there is no reason to regard any one case as "Asiatic Cholera"; and also the 151 deaths registered from " Enteritis." *15 cases of Cholera were notified in London. 60 TABLE S. Shewing the Diarrhœa Mortality in Lambeth in each month during the year 1900. Sub-Districts. Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Waterloo 1st ... ... ... ... ... ... 1 6 5 ... ... ... 12 Waterloo 2nd ... ... ... ... ... ... ... 2 2 2 ... 1 7 Lambeth 1st ... ... ... ... ... 1 3 7 6 2 ... ... 19 Lambeth 2nd ... ... ... ... ... ... 8 11 10 3 1 ... 33 Kennington 1st ... ... ... ... ... ... 4 10 5 3 ... 2 24 Kennington 2nd ... ... ... ... ... ... 1 6 4 4 1 ... 16 Brixton ... ... ... ... ... ... 3 11 12 ... ... ... 26 Norwood ... ... ... ... ... ... 1 6 6 ... ... ... 13 District not stated ... ... ... ... ... ... ... 3 ... ... ... ... 3 Total ... ... ... ... ... 1 21 62 50 14 2 3 153 61 INFLUENZA. During 1900, 152 deaths were registered from Influenza in Lambeth, as compared with 151 during 1899, and an average of 97.0 for the last ten years. Of these 152 deaths, 116 were registered during the first, 17 during the second, 7 during the third, and 12 during the fourth quarter of the year. In London there were registered 1950 deaths (uncorrected) from Influenza during 1900. Reviewing the past history ot 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, 1899, and 1900. The disease during 1900 has much above the average for he last 10 years. Table shewing the number of deaths from Epidemic Influenza during the last to years in Lambeth and London. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 Average for 10 years (1890-99.) 1900 Lambeth 47 131 142 85 44 148 51 45 126 151 97.0 152 London (including Lambeth). 652 2336 2264 1526 750 2156 496 671 1283 1817 1395.1 1950 62 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. 42 deaths were registered in Lambeth in these classes from Alcoholism and Delirium Tremens Class IV.—Constitutional Diseases. Of the total 1092 deaths under this class 288 were due to Cancer, 516 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 380' consisting of 175 from Premature Birth, 151 from Old Age, and 54 from Atelectasis and Congenital Malformations. Class VI.—Local Diseases. 1. Diseases of the Nervous System caused 545 deaths, including 77 from Convulsions, 253 from Apoplexy. and 23 from Epilepsy. 2. 437 deaths were due to diseases of the Circulatory System. 3. The diseases of the Respiratory Organs caused 1152 deaths (613 from Bronchitis, and 248 from Pneumonia). 4. Diseases of the Digestive Organs caused 418 deaths, of which 171 were due to Enteritis, and Peritonitis, 35 to diseases of the Liver, and 23 to Dentition. 5. Diseases of the Urinary System caused 151 deaths. 63 6. Diseases of the Reproductive System, Integumentary System, Locomotive System, Lymphatics, Organs of Special Senses, etc., caused together 77 deaths. Class VII.—Deaths from Violence. 195 deaths in all, including 168 from Accidents, 18 from Burns and Scalds, 14 from Drowning, 40 from Suffocation in bed (36 being infants under 1 year), 23 from Suicide, and 4 from Homicide. Class VIII.—Other Causes. 219 deaths were registered in this class, consisting or deaths from Dropsy, Tumours, Hæmorrhages, or other ill-defined or non-specified causes. Different rates of mortality from different diseases of groups of diseases (also sub-divided as to Districts) are given in terms of the total deaths in Tables T and W; whilst Table T gives also the deaths from the chief Infantile Diseases, expressed in terms of the infantile population (or number of births). Allowing for the slight differences between corrected and uncorrected death returns, it will be noted that, in regard to both infantile and other diseases, Lambeth again compares favourably with London. Deaths amongst infants under one year are a sensitive ndex (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. 64 TABLE T. Shewing Classification of Causes of Deaths in Lambeth during 1900, compared with 1899. A.—Total Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected). Class of Disease. Lambeth Parish. 1900. 1899. No. of Deaths (corrected). Percentate of Total Deaths. No. of Deaths (corrected). Percentage of Total Deaths. I.—Zymotic Diseases 714 13.1 1033 17.6 Seven Principal 497 9.2 782 13.3 Influenza 152 2.8 151 2.6 II.—Parasitic 4 00.7 2 00.3 III.—Dietetic 46 0.8 41 0.7 IV.—Constitutional 1092 20.1 1082 18.4 Cancer 288 5.3 261 4.4 Phthisis 516 9.5 525 8.1 Tubercular Diseases, excluding Phthisis 205 3.8 205 3.5 Rheumatism (Acute and Chronic) and Gout 32 0.6 41 0.7 V.—Developmental 380 6.9 396 6.7 Old Age 151 2.8 166 2.8 VI.—Local Diseases 2780 51.2 2919 49.6 Circulatory System 437 8.1 451 7.7 Bronchitis 613 11.3 661 11.2 Pneumonia and Broncho-Pneumonia 415 7.6 372 6.3 Pleurisy and Pleuropneumonia 30 0.5 34 0.6 Respiratory System, excluding Phthisis 636 11.7 1172 19.9 VII.—Violence 195 3.6 182 3.1 Suicide 23 0.4 24 0.4 VIII.— Other Causes 219 4.03 231 3.9 65 TABLE T (Continued). 3.—Deaths (corrected) of Infants under One Year of age from the chief infantile diseases, and from all causes, expressed in terms of 1,000 births. Lambeth parish 1900. 1899. Total Deaths under One Year (Corrected). Percentage to 1000 Births. Total Deaths under One Year (Corrected). Percentage to 1000 Births From all causes 1328 144.9 1488 157.7 Diarrhœa 126 13.7 198 20.9 Convulsions 64 6.9 49 5.2 Respiratory Diseases 240 26.2 229 24.3 Premature Births 175 19.1 184 19.5 Tubercular Diseases (including Phthisis) 81 8.8 98 10.4 Measles 22 2.4 43 4.6 Whooping Cough 45 4.9 59 6.3 Suffocation in Bed 36 3.9 33 3.5 Enteritis 96 10.5 114 12.1 Dentition 14 1.5 30 3.2 66 TABLE U. Shewing Classification of certain Causes of Deaths (uncorrected) in Lambeth, compared with London, during 1899 and 1900. A.—Deaths at all Ages. Lambeth. London. Percentage of total Deaths (uncorrected). Percentage of total Deaths (uncorrected). 1899. 1900. 1899. 1900. I. Principal Zymotics 12.9 ... 12.5 11.8 Influenza. 2.5 2.6 2.0 2.3 Measles 2.8 1.2 2.4 2.3 Whooping Cough 2.1 1.7 1.9 2.3 Diarrhœa and Dysentery 4.1 2.9 4.7 4.1 II. Rheumatic Fever and Heart Rheumatism 0.3 0.3 0.4 0.4 III. Diseases of Circulatory System. 7.6 7.8 8.6 8.5 IV. Bronchitis, Pneumonia, and Pleurisy 17.8 19.3 18.0 18.8 Phthisis 8.2 8.7 9.5 9.3 V. Injuries 3.8 4.1 4.2 4.3 B.—Deaths under 1 Year of Age (per 1000 Births). I. All Causes 161.9 147.3 167 159.9 67 LAMBETH PARISH. SUMMARY OF VITAL AND MORTAL STATISTICS, &c., FOR 1900. 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 1900—312,152 (males, 147,441; females, 164,711). Density—79.2 persons per acre. Inhabited Houses—38,556 at Census, 1891. Rateable Value—£1,749,717. Marriages—2,454, being 15 7 per 1,000. Births—9,167, being 29.4 per 1,000. Deaths (corrected)—5,430, being 17.4 per 1,000. Infantile Mortality—1,328 under 1 year, or 144.9 per 1,000 births. Zymotic—Death-Rate, 16 per 1,000. Estimated Increase of Population 4,044; but the natural increase or increment (i.e., excess of Births over Deaths) was 3,737. E 2 68 69 TABLE V. TABLE V. Local Government Board Table A.] Table of DEATHS during the Year 1900, in the Lambeth District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all causes, at subjoined Ages. 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. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (e) (d) (e) (f) (g) (h) (i) Royal Infirmary (Women and Children) 60 23 18 7 2 10 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 7 ... 1 4 ... ... 2 26 41 5 upwds. ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 3 3 4 ... ... 8 19 Remainder of Waterloo Road First 220 88 32 5 2 68 25 Under 5 ... ... 2 ... ... ... ... ... ... ... ... 9 2 12 ... ... 35 ... ... 6 54 120 5 upwds ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... 1 17 28 12 1 4 34 100 General Lying-in-Hospital, York Road 14 13 ... ... ... 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 13 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Remainder of Waterloo Road Second 205 78 32 6 5 58 26 Under 5 ... ... ... ... ... ... ... ... ... ... ... 7 11 6 ... 1 27 ... ... 3 55 110 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 14 18 16 3 6 37 95 St. Thomas's Hospital 585 44 63 40 65 331 42 Under 5 ... ... 11 ... ... ... ... ... ... ... ... ... ... 4 ... 2 13 1 ... 24 52 107 5 upwds ... ... 2 ... ... 19 ... ... ... ... 1 ... ... ... 2 16 36 43 2 69 288 478 Remainder of Lambeth Church First 332 109 44 11 7 125 36 Under 5 ... ... ... 1 ... ... ... ... ... ... ... 1 8 18 ... 4 44 ... ... 5 72 153 5 upwds ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 1 36 44 18 4 14 58 179 Lambeth Workhouse 71 8 ... ... ... 13 50 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 8 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 29 8 6 ... 19 63 Lambeth Infirmary 684 43 13 2 29 355 242 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 7 ... ... 2 43 56 5 upwds ... ... ... ... ... 5 ... ... ... ... 4 ... ... 3 ... 140 126 83 5 17 245 628 Remainder of Lambeth Church Second 506 215 51 9 12 151 68 Under 5 ... ... ... ... ... ... ... ... ... ... ... 5 14 27 ... 2 49 4 ... 11 154 266 5 upwds ... ... ... ... ... 3 1 ... 1 ... ... ... ... 2 ... 37 68 28 8 7 85 240 Clapham Maternity 10 9 ... ... 1 ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 8 9 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 St. Peter's House 25 ... ... ... ... 2 23 under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 ... ... 17 25 Remainder of Kennington First 715 224 73 15 22 227 154 Under 5 ... 2 4 ... ... ... ... ... ... 2 ... 5 9 21 ... 3 59 5 2 9 176 297 5 upwds ... 1 2 ... ... 1 ... ... 1 1 ... ... ... 1 2 62 99 45 22 9 172 418 Kennington Second 561 123 53 53 18 189 159 Under 5 ... ... 3 ... ... ... ... ... ... ... ... 6 16 16 ... 1 31 ... 5 6 92 176 5 upwds ... ... 5 ... ... 2 ... ... ... ... 4 1 1 ... 1 35 79 54 30 7 166 385 70 71 TABLE V—continued. TABLE V—continued. Local Government Board Table A—continued. Table of DEATHS during the Year 1900, in the Lambeth District, classified acccording to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shown as separate localities. Mortality from all causes, at subjoined ages. Mortality from subjoined causes distinguishing Deaths of Children under Five Years of Age At all ages. Under 1 year. 1 and uuder 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croud. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) South Western Hospital 117 5 56 37 5 14 ... Under 5 ... 16 43 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 61 5 upwds. ... 4 26 ... ... 16 ... ... ... ... ... ... ... ... ... ... 4 1 ... ... 5 56 Remainder of Brixton 1075 274 89 23 45 350 294 Under 5 ... 1 2 2 ... ... ... ... ... ... 1 21 28 24 ... 8 60 2 5 7 202 363 5 upwds. ... 1 5 ... ... 8 ... ... 1 ... 2 ... 1 1 6 82 134 80 37 12 342 712 Lambeth Old Workhouse Schools 5 ... 3 2 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 3 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 British Home of Incurables 5 ... ... ... ... 1 4 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 4 5 Remainder of Norwood 388 94 36 17 12 103 126 Under 5 ... 2 ... ... ... ... ... ... ... ... ... 10 2 11 ... 2 29 ... ... 1 73 130 5 upwds ... 1 2 ... ... 1 ... ... ... ... ... ... ... 2 2 19 46 28 16 8 133 258 Totals 5578 1350 563 193 225 1998 1249 Under 5 ... 21 63 3 ... ... ... ... ... 2 1 64 91 150 ... 25 360 12 12 76 1031 1913 5 upwds ... 7 45 ... ... 57 1 ... 4 1 12 2 2 11 16 462 718 425 134 153 1617 3665 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 458 42 76 25 41 209 65 Under 5 ... 3 32 ... ... 2 ... ... ... ... 2 3 4 2 ... 4 14 ... ... 3 49 118 5 upwds. ... 3 8 ... ... 14 ... ... ... ... 2 ... ... ... ... 43 15 48 8 34 165 340 Deaths occurring within the district among persons not belonging thereto 606 64 83 56 54 279 70 Under 5 ... 11 31 1 ... ... ... ... ... ... ... ... ... 10 ... 2 12 ... ... 16 64 147 5 upwds. ... 3 16 ... ... 19 ... ... 1 ... 2 ... ... ... 2 16 37 48 2 55 258 459 72 73 TABLE W. TABLE W. Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1900, in the Metropolitan Sanitary District of Lambeth, classified according to Diseases and Localities. Local Government Board Table B.] Registration Sub-Districts. Population at all Ages. Registered Births. New Cases of Sickness in each Locality, coming to the knowledge of the Medical 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 1900. 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. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers Cholera. Erysipelas. Typhus. Ty phoid or Enteric Continued. Relapsing. Puerperal. English Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) Waterloo Road 1st 14186 14330 496 ... 47 61 ... ... 5 2 ... 1 ... 10 ... 44 46 ... ... 5 1 ... 1 ... 2 Waterloo Road 2nd 14210 13853 852 ... 39 77 ... ... 15 ... ... ... ... 11 ... 38 73 ... ... 8 1 ... ... ... 3 Lambeth Church 1st 18770 19377 582 ... 36 86 1 ... 13 ... ... ... ... 16 ... 32 66 1 ... 11 ... ... ... ... 2 Lambeth Church 2nd 40994 42642 1543 ... 125 92 ... ... 54 4 ... 3 1 36 ... 92 74 ... ... 42 1 ... ... ... 1 Kennington 1st Kennington 2nd 52486 43244 54146 46289 1856 990 ... ... 129 136 120 163 2 2 ... ... 73 49 4 1 ... ... 2 ... 1 ... 25 65 ... ... 111 60 81 75 1 1 ... ... 72 18 ... ... ... ... 1 ... ... ... ... 2 Brixton 81825 89057 2112 ... 228 222 1 ... 43 6 ... 7 ... 54 ... 183 168 ... ... 25 ... ... 1 ... 1 Norwood 29318 32458 736 ... 81 23 ... ... 20 ... ... ... ... 17 ... 44 15 ... ... 7 ... ... ... ... ... Totals 295,033 312,152 9167 ... 821 844 6 ... 272 17 ... 13 2 234 ... 604 598 3 ... 188 3 ... 3 ... 11 74 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, 1900. Number of Notices 10065* NOTIFIABLE INFECTIOUS DISEASE. (Public Health, London, Act). No. of Infected Houses (Notices served) 1992 Smallpox — Scarlet Fever 721 Typhoid 254 Typhus — Continued Fever 17 Diphtheria 748 Membranous Croup 6 Puerperal Fever 13 Erysipelas 231 English Cholera 2 Total 1992 *Excluding 23 Notices under the Housing of the Working Classes Act 1890. 75 PARTICULARS OF SANITARY WORK Carried out in Lambeth Parish during 1900, and for 23 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. 1900 10065 10291 2303 1899 10583 10042 2273 1898 10469 9905 2224 1897 11088 9058 1884 1896 7475 6702 982 1895 7645 8581 1104 1894 6975 7672 1911 1893 8769 9207 2046 1892 7173 6931 2190 1891 5557 7232 3173 1890 5588 5053 3251 1889 6854 4192 2662 1888 4891 2969 1922 1887 4565 2430 2135 1886 4504 2433 2071 1885 3567 1459 2108 1884 3727 1621 2106 1883 3000 1294 1766 1882 3239 1267 1972 1881 3730 1293 2437 1880 3259 1106 2153 1879 3075 960 2115 1878 3310 1169 2211 1877 3563 1299 2264 N.B.—The increase in the numbers since 1897 is due to the increased Inspectorial Staff. 76 A. Public Health (London) Act and Metropolis Local Management Acts. Notices served (Preliminary and Statutory) 8073 Works Structural:— Drainage defective 1318 Intercepting Traps with Fresh Air Inlets required 515 Ventilating Pipes required 607 Indoor Sinks connected with the Drain 501 Rain Water Stack Pipes connected with the Drain 658 Bath Waste connected with the Drain 46 Traps Detective, or of Obsolete Pattern 1000 Closet Pan and Connections Defective 872 Water Supply to Closet Defective 756 Closet Dilapidated 520 Draw-Off from Main for Drinking Purposes required 911 Dust Bins Defective 814 Premises Dilapidated 201 Ventilation under Floors required 89 Roofs Dilapidated 154 Soil Pipes Defective 56 Paving Defective 1058 Damp and Unwholesome Houses 59 Dung Receptacles required 156 Works not Structural— Cisterns Dirty 68 Manure Accumulations 76 Underground Rooms occupied 84 Animals Improperly Kept 47 Stopped Drains 176 Overcrowding 58 Foul Urinals 24 Through Ventilation provided 9 Refuse Accumulations 109 No Water Supply or Defective Water Supply 563 Dirty Premises 1089 12594 B. Infectious Diseases Notification. Notices served 1992 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 23 Nature of Work.—To put premises into proper order and condition, or to close and demolish them. 77 SUMMARY OF WORK DONE BY THE SANITARY INSPECTORS DURING THE YEAR 1900. Inspections 8617 Re-inspections 69264 Infectious Houses visited 1992 Complaints entered in complaint book 6988 Cases of Infectious Disease notified 2209 a. Cases under treatment at home 857 b. Cases removed to Hospital 1369 Cases of Non-Notifiable Diseases dealt with 1702 Houses disinfected 2296 Rooms disinfected 2809 Bedding, etc., disinfected 27528 Bedding, etc., destroyed *1783 Dust Yards, Manure Depots and Brickfields, inspections of 945 Drains tested (with chemical, water, or both) 8270 Sanitary Works completed 6226 Plans of Drainage received and approved 424 New Buildings, the drains of which have been completed 311 Premises, the drains of which have been totally or partly reconstructed 784 Articles procured for the Analyst— 652 (a.) Food and Drugs 604 (b.) Water 48 Summonses and Orders issued 121 New Workshops inspected and registered 19 Special Smoke Observations and enquiries 711 Cowhouses inspected 22 Slaughter-houses inspected 41 Notices served— Sanitary Work (Preliminary and Statutory) 8073 Infectious Diseases (Public Health Act, 1891) 1992 Housing of Working Classes Act 23 Special Smoke Notices 105 Sanitary Nuisances abated 12954 (a.) Structural 10291 (b.) Non-structural 2303 Persons received in Shelter at Wharf 3 at Wanless Road 1 Convictions obtained — Public Health Act †56 Food and Drugs and Margarine Acts 52 *Including 1236 articles of clothing from the Freemen's Orphanage Schools. †62 Summonses were issued, and of these 4 were dismissed, 1 withdrawn, and 1 adjourned sine die, for the following reasons:—tenant liable, Vestry liable, food not deposited for sale, financial state of defendant, Summons to be amended, household dust no longer to be burnt in Destructor. 78 INSPECTORIAL STAFF. No change in the personnel of the Sanitary Staff has taken place during the year, and the amount of work that has been carried out again calls for comment. 10,088 notices have been served, dealing with 10,314 structural, and 2,303 non-structural, defects, and the improved condition of houses, etc., consequent on such notices being carried out to the satisfaction of the Inspectors must have a beneficial effect upon the sanitary state of Lambeth Parish, and upon the health of the inhabitants. 784 houses have been re-drained throughout or in part, whilst the drains of 311 new buildings have been laid under the personal supervision of the Inspectors, who, in all cases, test with water such drains, not only in sections (as laid), but also as a whole (when completed). In connection with drain testings of infected houses, the small (comparative) percentage (14.3) of houses, in which the test gives a result, is noteworthy. This percentage is yearly becoming less, having dropped from 24.7% in 1892 to 14.3% in 1900, It must not, however, be forgotten that the smell test, as employed, is not wholly satisfactory, and cannot compare in value with either the water or the pneumatic test—the *pneumatic test having been recently introduced in connection with drain testings, as giving very delicate reactions. The late Vestry decided that, in order to prevent misunderstandings, where the smell (or chemical) test gave no result, a printed circular should, as required, be sent to the owner, or occupier, or others concerned, to the following effect:— *The late Vestry ordered a new Smoke Machine, which can be used for the pneumatic test when required. 79 Public Health Department, 333, Kennington Road, S.E. 190 Re Drains at No result has been obtained from the chemical test applied to the above drains. The Vestry wish to emphasise the fact (well known to all practical sanitarians) that, when no result is obtainable from the smoke or chemical test, the drains are not necessarily perfect. Practical experience shows that such a test may fail to give any result, even though the drains tested are known to be defective. 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 new drains. The Vestry will be prepared to apply such water test to the above drains on receiving the written consent of the Owner. (By Order) Vestry of Lambeth This method was adopted on account of complaints received that drains, which gave no results on the testing with the chemical (or smell) test, were afterwards, at times, found to be defective, and it was felt that such a condition of things should not be allowed without warning being first given to the parties concerned—the water test being too severe to apply without the written consent of the owner in the case of old buildings. The best (at present known) available ordinary test is employed for the iesting of old drains in Lambeth, and the water test is only applied to such at the owners' risk and with their consents. In the 80 case of new buildings, the water test is alone employed, this not only in sections, but to the drains as a whole when completed. Much good work is being accomplished by the systematic inspection of houses—both those registered under the Byelaws as to Houses let Lodgings, and others; and it cannot be too much insisted upon how important it is in crowded districts, to keep houses up to as fair a condition of sanitation as possible, instead of allowing them, year by year, to fall into worse repair, thereby rendering their ultimate closure absolutely necessary. The question of appointing a Female Sanitary Inspector* has been left to the new Borough Council, the late Vestry having decided to take no action in the matter—a decision to be regretted, as I have again and again, in my Annual Reports, emphasised the good work that such Female Sanitary Inspectors would be able to accomplish. Their work would be different from that which is carried out by the Male Sanitary Inspectors, and there is no reason why there should be any clashing of duties. During 1900, 424 plans (respecting 784 houses) have been received, and approved both by the Surveyor and myself, and the drainage work, as shewn, carried out under the personal supervision of the Sanitary Inspectors, and water-tested. The system, adopted by the Vestry on August 6th, 1896, of having all drainage (that of new as well as of old buildings) under the supervision and control of the Sanitary Inspectors, continues to give satisfactory results, and saves much inconvenience and expense to owners and others. *The new Borough Council decided at their Meeting held on Feb. 21st, that a Female Sanitary Inspector shall be appointed, but that such appointment shall not take place for 6 months. 81 An important step was taken by the late Vestry on September 27th, 1900, when it was decided to open a branch office at Norwood in connection with the Public Health Department. Inspector Barfoot, who has charge of Norwood Ward, had to attend at the Sanitary Offices (333, Kennington Road) every morning from 9 to 10 a.m., and afterwards had to go on to his district, arriving there about 11 a.m. By this arrangement much inconvenience, and trouble was caused to the Norwood residents, especially builders, and many complaints had been, from time to time, received in connection with the difficulty of communicating with the Norwood Inspector at the Kennington Office about the removal of infectious cades to hospital, drainage of new and old buildings, the carrying out of sanitary notices, etc.—the Kennington Office being about an hour's journey from Norwood. Much time was lost, both by the Inspector and by those who had to see him on business. The late Vestry was fortunate enough to secure an office centrally—the first floor front room at 30, Knight's Hill Road, West Norwood (opposite to the West Norwood Station) at an inclusive rent of 10s. 6d. per week (including rates and all outgoings and the weekly cleaning of the room). The Inspector attends at this branch office every morning (except Sunday) between 9 and 10 a.m., and is thus able to start on his rounds at 10 a.m. sharp. This branch office has proved of great use, and is already much appreciated by the Norwood residents, more especially the builders, who are able to consult the Inspector between 9 and 10 a.m. every morning about plans, drainage, etc. Norwood Ward covers a large area, and consequently, a branch office in the Ward is of great importance for efficient administration of the sanitary work there. F 82 DISINFECTING DEPARTMENT. Outside the ordinary routine work of this department in connection with Notifiable Infectious Diseases, it is noteworthy that the special work in connection with the Nonnotifiable Infectious Diseases (Tuberculosis, Measles, Whooping Cough), which was increased in 1899 and 1898, has been still more so during 1900, as shewn by the sub-joined table:— Non-notifiable Infectious Diseases, etc. 1st Q. 2nd Q. 3rd Q 4thQ. Total 1900. 1899. 1898. 1897. 1896. Measles 65 420 214 242 941 773 129 70 14 Whooping Cough 19 26 44 37 126 58 — — — Chicken-pox 11 31 29 17 88 21 4 1 — Cancer 4 7 3 9 23 13 7 5 4 Consumption 154 117 133 120 524 474 4 11 2 Infected Cabs 2 2 1 4 9 21 9 7 9 Dirty Premises, etc. 2 14 11 9 36 17 49 37 14 357 617 435 338 1747 1426 202 131 43 The Disinfecting work in Measles-infected houses is specially noteworthy, as the Measles statistics for the past year are the most satisfactory on record in the annals of the Vestry. Taking the statistics for the last 10 years, the number of deaths from Measles in the whole of the Parish 83 of Lambeth during 1900 is 56.7% lower than the decennial average. Such a satisfactory result is, in great part, to be attributed to the extra precautions now taken, and to the trouble (expense, etc.) expended in educating the people by means of circulars and posters, as to the serious aftereffects of Measles when not properly attended to. Even better results are to be expected when Measles is placed amongst the dangerous infectious diseases, so that the prevention sections of the Public Health (London) Act, 1891, may apply to this disease as they do in conection with Scarlet Fever, Smallpox, Diphtheria, etc. There is a marked difference in the number of consumption, infected houses disinfected during 1900 and 1899, as compared with previous years, viz., 524 and 474 respectively as compared with 4, 11 and 2 during 1898, 1897 and 1896, Much good is to be expected from these extra precautions that are now taken in connection with Tuberculosis, which is more and more, year by year, acknowledged to be an infectious disease, requiring special preventive measures. The Equifex machine (at Wanless Road) continues to give satisfaction, whilst the old Neville's machine (at the Wharf) has not broken down during the year, though it is hardly satisfactory from the point of view of modern requirements as to efficient disinfection. It is to be hoped that another Equifex machine in place of the old Neville's machine will shortly be purchased for use in the new Borough. A second (or duplicate) machine for disinfecting is required in the events of either a break-down at any time in one of them, or of extra pressure of work arising from epidemics. The staff, both collectively and individually, has given satisfaction during the past year as in former years. F 2 84 During 1900, 3 certificates as to efficient disinfection were received in respect of rooms, 3 of bedding and clothing, and 106 of both rooms and bedding, making a total of 112, as compared with 185 during 1899, and 162 during 1898. It is satisfactory to note that fewer certificates have been received during the past year, shewing that practically all disinfection work is carried out by the Vestry's own officers and to the satisfaction, therefore, of the Medical Officer of Health—a condition of things to be desired. 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 1 ... 1 1 3 For Bedding only 2 1 ... ... 3 For Rooms and ing 28 25 28 25 106 31 26 29 26 112 2209 cases of notifiable infectious diseases (see page 32 ) have been attended to during the year 1900, as compared with 2693, and 2329 during 1899 and 1898 respectively; and in each case, after disinfection, a certificate has been left with the occupiers of the premises as required. 5 Schools have been disinfected during the year 1900, as compared with 7 during 1899. 85 Particulars as to disinfection carried out in Lambeth Parish during 1900. Total No. of rooms disinfected by Vestry 2809 Cases in which bedding has been disinfected at home 62 Do. do. do. at Chamber 2450 Do. do. do. destroyed 59 Replaced by the Vestry (cases) 3 Premises disinfected and disinfectants supplied 9124 No. of Cleansing Notices served in connection with infected houses 2223 Certificates of Medical Practitioners received in lieu of disinfection by the Vestry 112 Certificates of disinfection left with, or sent to, occupiers of disinfected premises 2700 Articles of bedding, etc., disinfected. Beds 1774 Bolsters 1957 Pillows 2357 Mattresses 1458 Palliasses 554 Chair Cushions 1656 Clothing 9690 Blankets 3770 Rugs 179 Counterpanes and Eiderdown Quilts 1094 Carpets 974 Extras (not mentioned in above) 2065 Total 27,528 86 Articles of Bedding, etc., destroyed. Beds 22 Bolsters 1 Pillows 21 Mattresses 13 Palliasses 27 Chair Cushions 23 Clothing 1562* Sundries 114 Total 1783 The refuge at the Wharf has been used once during the past year—one adult and 2 children under 10 years of age, being accommodated during the disinfection of their diphtheria-infected house. The new refuge at Wanless Road was ready for use on January 1st, 1900, and has been used once during the year. Refuges are compulsory by the Public Health (London) Act, 1891, and Lambeth is now well supplied in the event of a serious epidemic breaking out at any time. There appears to be a prejudice against the use of such Refuges in Lambeth, as well as elsewhere, though it is doubtful if such prejudice would seriously affect the usefulness of such Refuges at times of epidemic, e.g., smallpox, typhus, etc. At such times the Refuges provided by the late Vestry will be found to be useful, even though they are at present but little used, and apparently a somewhat useless expense. * Including 1236 articles of clothing from Freeman's Orphan Schools. TABLE V. DISINFECTION STATISTICS. 87 For eight years prior, and ten years subsequent, to the passing of the Notification of Infectious Diseases Act; and for the year 1900. 1892 1883 1884 1885 1886 1887 1898 1889 Yearly average for 8 years preceding the Notification Act 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 Yearly average for 10 years succeeding the Notification Act 1900 No. of Cases in which Bedding At Home 332 258 278 l6 62 52 7 144 143.6 179 246 593 343 177 251 368 217 132 81 258.7 62 etc., has been disinfected. At Chamber 85 56 162 569 236 722 902 951 460.4 1391 1570 2546 3042 2286 2462 2447 2126 2424 2998 2329.2 2450 No. of Cases in which Bedding etc., has been destroyed. 37 23 62 52 8 57 48 79 43.7 185 275 314 224 119 67 49 39 27 44 84.3 59 No. of articles of Bedding, etc., disinfected. 1526 1437 1895 2275 916 3078 3121 3778 2253.2 3013 6747 9909 11513 8022 13516 20349 21487 21597 27923 14407.6 27528 No. of articles of Bedding, etc., destroyed. 63 101 114 144 59 92 61 267 113.0 333 467 605 674 544 186 178 162 126 326 360.1 1783* Premises Disinfected and Disinfectants Supplied. 727 680 657 727 736 1276 1255 1277 916.9 1722 1816 3157 5896 5742 7146 7210 8715 8441 9146 5899.0 9124 * Including 1236 articles of clothing from a large school in Lambeth. PARTICULARS AS TO REFUGE OR SHELTER AT THE WHARF. (First used November 12th, 1896.) District or Ward. Address. Nature of Disease. Date of Admission. Da te of Discharge. Adults. Children under 10 years. M. F. 1896 Marsh 25, Royal Street Scarlet Fever Nov. 12 Nov. 12 1 2 l Prince's 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 „ „ Nov. 3 Nov. 3 1 2 2 1898 Street 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, Stangate 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 1900 18, Mary's Buildings „ „ Oct. 27 Oct. 27 ... 1 2 88 The new extra Shelter or Refuge at Wanless Road, was ready for use on January 1st, 1900, and has been used once during the year 1900. 89 BAKEHOUSES. The Bakehouses have been inspected during the year, and the necessary annual white-washing and cleansing carried out. 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 road, 59, 102 York road, 102 BISHOP'S WARD:- Broad street, 13 Brook street, 106 China walk, 16 Crozier street, 12* Ethelred street, 107 Hercules road, 4*, 66 Lambeth road, 81 Lambeth walk, 17, 71,82, 115, 121, 126, 148*, 154, 191, 204 Lollard street, 124 Monckton street, 2 North street, 27 Prince's road, 101, 152 Saville place, 19 Stangate stree . Tracey street, 22 Upper Marsh, 18 Walnut Tree walk, 43 Westminster Bridge road, 189, 219 PRINCE'S WARD:- Auckland street, 1 Bonnington square, 13 Church street, 10, 25 Clapham road, 24 Cleaver street, 12 Glasshouse street, 60 Goding street, 1 Hurley road, 17 Kennington Park road, 40,* 98,* 202 Kennington road, 334 Lower Kennington lane, 32, 84,* 122,* 177 Newburn street, 50 Newington butts, 150 Prince's road, 19 Stannary street, 39 Trigon road, 46 Tyer's street, 49 Upper Kennington lane, 19,76,107, 159, 199 Vauxhall street, 36, 86, 115,* 126, Vauxhall walk, i8a, 79, 123 \\ hite Hart street, 24, 58 Windmill row, 10 VAUXHALL WARD:- Clapham road, 226,* 264, 324,* 360 Dorset road, 55, 129 Hartington road, 42, 58, 88,* 129 Larkhall lane, 63, 98 Lansdowne road, 74 Portland place south, 20 Paradise road, 30 south Lambeth road, 20, 108, 150 175,* 184* Thorparch road, 1 Wandsworth road, 51,* 181, 227, 230, 259, 283 Wilcox road, 29, 44, 3 † 32, Stangate Street. 90 STOCKWELL WARD:- Acre lane, 120, 144 Bedford road, 29 Brixton road, 56, 66a (late 78), 274, 468 Clapham road, 93, 247 Dalyell road, 46 Dorrell place, 11 Ferndale road, 118, 185,* (late 1, Shepherd's lane) Holland street, 22 Kepler road, 14 Lingham street, 76, 39 Landor road, 80, 99, 147 Russell street, 17* Santley street, 13 Stcckwell road, 63, 143, 150, 170 Sydney road, 26 Tasman road, 52 BRIXTON WARD:- Akerman road, 45 Atlantic road, 40 Beresford street, 271 Brixton road, 37, 231*, 267, 407,* 447* Camberwell New road, 167 Coldharbour lane, 76, 240, 326, 386 Cumberland place, 6* Denmark street, 25 Farmer's road, 127 Frederick terrace, 7 Garden grove, 9 Holland road, 1* Langton road, 30* Lothian road, 100 Loughborough road, 73*, 76 Normandy place, 8 St. Mark's road, 1 Treherne road, 12 Vassall road, 54, 75 Warham street (late Thomas street), 44, 81 Wyndham road, 140 TULSE HILL WARD:- Acre lane, 115 Atlantic road, 65, 74 Barnwell road, 91 Brixton hill, 72, 154, 232 Coldharbour lane, 203, 223, 319,* 439 Cornwall road, 32, 76, 146 Denmark hill, 120 Dulwich road, 167 Effra parade, 11 Elm park, 58 Hinton road, 51 Hurst street, 28 Kemerton road, 7 Lyham road, 159 Milkwood road, 6, 69 New Park road, 59 Probert road, 1 Railton road, 13,* 45, 64, 78, 111 205, 311 Shakespeare road, 84 Somer's road, 27 Sussex road, 75* Tulse hill, 5, 25, 182 Upper Tulse hill (The Exchange), 3 Water lane, 25, 87 NORWOOD WARD:- Approach road, 6 Barnfield road, 28 Chapel road, 2* Eden road, 7 Elder road, 1A Gipsy hill, 53, 130, 190 Gipsy road, 105, 193, 253 Hamilton road, 134 High street, 34 (rear of), 87,94,63* Knight's hill, 26, 49, 58, 190 Norwood road, 90, 202, 222, 427 Rommany road, 191 Westow hill, 33 Wood street, 5 Woodland hill, 31* 91 ANALYSIS OF FOOD AND DRUGS, WATER, Etc. During the year 1900, 603 samples have been purchased and submitted to the Public Analyst for analysis. Taking the average of the last ten years (1890-99), the annual number of samples taken is 471, of which 71 {i.e., 15.1 per cent.) were found on analysis to be adulterated. The annual number of summonses issued is 50, with 50 convictions (together with 16 cautions), and £97 14s. 6d. in penalties, and £32 14s. 2d. in costs, during the same decennium. Of the 603 samples taken during 1900, 73 (i.e., 12.1 per cent.) were reported by the Analyst to be adulterated; 57 summonses were issued, with the result that 52 convictions* were obtained, together with £104 10s. od. in penalties, and £42 6s. 6d. in costs; and in 10 cases the vendors were cautioned. Full details are to be found on pp. 92-94. Inspector W. J. Perrin has charge of this department, and the results of the year's work are satisfactory. The samples are purchased by deputy, as a rule. The results of the monthly examinations of the Water supplied to the Parish of Lambeth by the Southwark and Vauxhall and the I.ambeth Companies were satisfactory during 1900. Systematic examinations are also made and reported upon monthly independently, both by the London County Council and the Local Government Board, and it would appear, therefore, to be a somewhat useless expenditure for systematic examinations of water to be made also by the Lambeth Analyst. The money would be better expended if more samples of foods and drugs were taken by the Inspector and submitted to analysis, so as to bring the annual number of samples taken in a large parish like Lambeth up to 1,000. * 2 Summonses were withdrawn, 2 dismissed, and 1 adjourned sine die, for the following reasons:—Vendor not traceable, burst bottle, clerical error in Analyst's certificate, small amount of added water, defendant gone to South Africa. 92 SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of Analyses during the year 1900. Samples. Number Procured. Number Adulterated. Milk 239 34 Butter 209 23 Coffee 73 13 Mustard 5 — Pepper 19 — Whisky 5 — Beer 12 — Treacle 2 — Jam 4 — Lard 9 — Cream of Tartar 2 — Margarine (not labelled) 7 2 Sago 5 1 Linseed 4 — Tartaric Acid 1 — Milk of Sulphur 2 — Gregory's Powder 1 — Tea 4 — Sweetmeats 4 — Totals 603 73 N.B.—The samples of Beer, Jam, Treacle and Sweetmeats were carefully analysed for arsenic, but in no single instance was arsenic found. Shewing percentage of different adulterated Samples during 1900 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. 1900 14.2 11.0 17.8 — — 0.0 3.5 00 0.0 — — — 0.0 0.0 — — 0.0 1899 10.9 14.5 6.9 0.0 2.7 0.0 21.4 33.3 ___ 00 20.0 0.0 0.0 1898 13.6 14.5 10.3 - 0.0 0.0 0.0 0.0 11.1 — 0.0 500 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 21.05 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 00 5.3 0.0 0.0 0.0 0.0 0.0 0.0 — — — 0.0 1893 30.4 35.04 11.1 0.0 18.2 0.0 3.3 0.0 8.7 20.0 0.0 0.0 11.1 — — — 0.0 1892 31.3 36.4 18.4 — 66.7 0.0 2.1 0.0 0.0 0.0 0.0 0.0 — 0.0 — — 0.0 1891 47.8 5.0 3.8 0.0 — — 2.6 0.0 0.0 0.0 0.0 — 0.0 0.0 — 0.0 0.0 1890 19.3 12.1 23.3 0.0 0.0 - 5.0 0.0 57.1 100.0 66.7 - 50.0 0.0 - — - 93 0.0 means that all Samples were reported to be genuine and unadulterated. — means that no Samples were taken during the year. 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. £ s. d. £ s. d. 1900 603 73 12.1 57 52 10 104 10 0 42 6 6 1899 600 65 10.8 52 49 6 76 10 0 29 12 6 1898 602 74 12.3 57 54 6 68 0 0 34 9 0 1897 546 41 7.5 7 21 2 48 0 0 24 5 0 1896 549 66 1202 66 60 2 93 0 0 35 11 6 1895 500 87 17.4 64 62 23 149 15 0 41 18 0 1894 495 107 21.6 81 79 26 199 0 0 45 11 0 1893 498 120 24.09 79 79 41 207 17 0 48 19 0 1802 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 Average of 10 years 1890-99 471.4 71.3 15.1 50.4 50.1 16.1 97 14 6 32 14 2 94 Inspector Perrin commenced his duties on February 2lst, 1898, vice Inspector Wiggs, who did the work from August, 1892, to November, 1897. 95 SMOKE ABATEMENT. Special attention has been paid to the Smoke Nuisance during the year 1900, and 711 observations and enquiries have been made. In the cases where it has been found necessary to resort to proceedings before the Magistrate, exemplary fines have been imposed, e.g., the South London Electricity Supply Co., Limited, and the New London Brewery—in the former a total of £50 in penalties during the year and £13 in costs, and in the latter £17 10s. in penalties and 6s. in costs. 105 Smoke Notices have been served, and the nuisances abated without it being necessary to proceed to summonses. The result has been a marked improvement in connection with nuisances from black smoke in Lambeth Parish. The following Firms have been under special observation weekly by Inspector Perrin during 1900:— Charing Cross and Strand Electricity Supply Company, 85, Commercial Road. Messrs. Causton & Co., Clapham Road. Messrs. Clowes & Sons, Duke Street. City and 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. London County Council, Works Department, Belvedere Road. Messrs. McGaw, York Road. New London Brewery, Durham Street. St. Thomas's Hospital, Albert Embankment. Beulah Laundry, South Lambeth Road. Sunnybank Laundry, South Lambeth Road. Messrs. Doulton & Co., Albert Embankment. Messrs. Stiff & Sons, Albert Embankment. Arlington Laundry, Cambria Road. Lambeth Water Company Works, Brixton Hill. Messrs. Barrett, Wandsworth Road, Vauxhall. Electric Light Works, Electric Avenue. Messrs. F. & H. Higgs, Loughborough Junction. 96 Messrs. Mumford, Albert Embankment. Messrs. Nightingale, Albert Embankment. Marble Laundry, Clapham Road. Stockwell Brewer, Stockwell Park Crescent. Bon Marche, Brixton. Metropolitan Gas Company, Works, Vauxhall. Messrs. Francis & Son, Brixton. Bonanza Bakery, Lyham Road. Messrs. Oppenheimer & Co., Handforth Road. South London Electric Supply Co., Bengeworth Road. Lambeth Baths and Wash-houses, Kennington Road. Messrs. J. W. Clarke, Brixton Road. Mr. Cookson's Destructor, Tinworth Street. Mr. Clarkson's Destructor, Tinworth Street. City and Stockwell Railway. Farrier's Shop, Grindal Street. Messrs. Holloway Bros., Belvedere Road. Potteries, Norwood. 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. The London County Council has drawn the Vestry's attention to smoke nuisances observed by their own officers on 49 different occasions, as follows:— Mr. J. Law (Baker), 274, Brixton Road (2 occasions). Messrs. Doulton & Co., Albert Embankment (10 occasions). Messrs. Stiff & Sons, Albert Embankment (4 occasions). Messrs. Rogers & Cook, Beulah Laundry, South Lambeth Road (3 occasions). Sunnybank Laundry, South Lambeth Road. Messrs. Williamson, 201, Lyham Road (Bakery). Waterloo and City Railway Co., Generating Station, Launcelot Street (2 occasions). Messrs. Oppenheimer, Son & Co., 51, Handforth Road. Messrs. Barrett & Co., Bond Street, Vauxhall (2 occasions). Messrs. Seth Taylor, Belvedere Road. 97 Mr. J. Petry, 22, Tracey Street (Baker). Electric Lighting Station, Electric Avenue (2 occasions). South London Electric Lighting Destructor, Bengeworth Road (6 occasions). New London Brewery, Durham Street. Messrs. Clowes, Duke Street (2 occasions). Metropolitan Gas Company, Vauxhall (4 occasions). Lambeth Infirmary, Brook Street. Charing Cross and Strand Electricity Co., Commercial. Road (4 occasions). Messrs. Holloway Bros., Belvedere Road. With one or two exceptions, the whole of these Firms reported in the 23 letters from the L.C.C. were already under observation at the time of the receipt of the Council's complaints; as also were the following Firms, reported to the Vestry in the 10 communications of the Coal Smoke Abatement Society, whose head offices are at 31, Mailise Road, West Kensington:— Messrs. McGaw & Co., York Road. Messrs. Scrubbs & Co., Guildford Street. Messrs. Meredith, Belvedere Road. Lion Brewery, Belvedere, Road (4 occasions). Messrs Mumford, Albert Embankment (3 occasions). Messrs. Cockerill, Albert Embankment. Messrs. Denning, Belvedere Road. Frozen Meat Stores,. Commercial Road (2 occasions). Messrs. Seth Taylor, Commercial Road (4 occasions). Messrs. Newman and Ouston, Commercial Road (6 occasions), Messrs. Clowes & Sons, Duke Street (3 occasions). Messrs. Doulton, Lambeth (3 occasions). Messrs. Stiff, Lambeth. South Metropolitan Gas Works (2 occasions). Messrs. Nightingale, Albert Embankment (3 occasions). St. Thomas's Hospital (2 occasions). Nelson's Wharf, Commercial Road (2 occasions). Fortnightly reports have been presented by the Sanitary Committee to the Vestry during the year. G 98 The South London Electricity Supply Corporation, Limited, have given much trouble during the year, dense volumes of black smoke having been allowed, to belch forth from their Destructor chimney in Bengeworth Road, Loughborough Junction. The nuisance, which affected neighbouring authorities, was so persistent that daily observations had to be taken, extending over long periods of time. The result was that 16 summonses have been taken out during the past year, and £150 awarded to the Vestry as penalties together with a total of £13 costs. In connection with the last 10 convictions the Company has appealed.* In addition to smoke issuing from this destructor chimney, complaints) were received as to an effluvium nuisance also. Over 10 inhabitants in the neighbourhood complained in writing, and consequently by Section 21 of the Public Health (London) Act, 1891, the late Vestry was compelled to take action before the Magistrate against the Company. The electricity is produced by the burning of house refuse on the same principle as the Shoreditch and other Municipal Destructors, and the plant and machinery (being new) are, in every respect, up to modern ideas as to efficiency. The Magistrate decided, however, that the burning of house refuse was not necessary for the production of electricity, but that proper fuel (e.g. Welsh coal) was to be used; and no refuse has been burnt in the Destructor since. Considering that the Destructor was built purposely for the generation of electricity from the burning of house refuse, this decision has far-reaching effects, as the plant is no longer available for the special purpose for which it was originally planned and constructed. The Company have not appealed against the Magistrate's decision under this particular Section (21), and the decision is, therefore, evidently regarded as equitable and just by the Company's legal advisers. The decision, unless altered on appeal, may prove a serious one to Metropolitan and other Municipalities, who either have already erected or intend to erect, the combination plant by which electricity can be generated from the burning of household refuse. * The Appeal was dismissed with costs by the Lord Chief Justice on May 6th, 1901. 99 REFUSE AND MANURE DEPOTS. The improvement mentioned in the Annual Report for 1899, in connection with the condition of the various refuse and manure depots, has been continued during 1900, and this satisfactory state of affairs is due to their more regular and systematic inspection by the Sanitary Inspectors—daily during the hot summer months. No single complaint has been received in connection with the Heme Hill Siding Manure Depot during 1900, and in the case of the Nine Elms Siding the manure traffic was carefully supervised, with the result that, at no time, was there a nuisance with which the late Vestry could have dealt, at least with any propect of success, remembering the provisoes mentioned in the Public Health Act and the London County Council's Bye-laws. Commercial Road (at the north of the Parish) contains three Dust Depots belonging to neighbouring Sanitary Authorities, viz., Lett's Wharf (City of London), Shot Tower Wharf (Strand District Board), and Phoenix Wharf (Clerkenwell Vestry), and these have been kept under special observation so as to prevent, or at least minimise as far as possible any nuisance connected therewith. Such dust-yards, unless carefully attended to from day to day, become sooner or later a nuisance. In connection with Lett's and Phoenix Wharves, the house refuse is hand-sorted by men and boys, women and girls, and a more disgusting occupation it would be difficult to find—the workpeople at times standing waist-deep in offensive matters of all sorts. At Lett's Wharf, the City of London Corporation employ 60 women (and girls) and 40 men (and boys), the wages of the former being 12s. to 14s. per week, and the latter 12s. to 26s. per week, with sick pay in addition. At Phoenix Wharf, the Clerkenwell Vestry employs 12 women (and girls) and 9 men (and boys), the wages of the former being 3d. per hour (making an average of 2s. per day), and of the latter from 13s. to 26s. per week (with sick pay in addition). The refuse, consisting of household dust, ashes and cinders from fires, scraps of waste food and other refuse matters, is sorted and separated into—(1) breeze, consisting of cinders and small par- G 2 100 tices of coal; (2) hard core, consisting of bottles, bones, crockery, metal pots and pans, etc.; (3) soft core, consisting of animal and vegetable matters and textile substances. The breeze and the hard core are sold to brickmakers, builders, and others; whilst the soft core is chiefly burnt, in each case in a Destructor provided for the purpose, though at Lett's Wharf the paper and rags are also first carefully separated out and sold as such. The whole process is an exceedingly offensive one, and most degrading to the workpeople employed in it, especially the women and girls; whilst the foul odours which are given off during the process of sorting, and also from the heaps of refuse awaiting sorting, may, and often do become, a nuisance to the surrounding neighbourhoods. It is somewhat difficult to understand why the whole of this refuse is not burnt, seeing that each of the Depots is provided with a destructor, and there is consequently no sufficient reason, apparently, for such preliminary sorting. It is an anomaly, if not a disgrace, that the wealthiest Corporation, in the world should persist in carrying out what is recognised by all Sanitarians to be a most noxious and degrading business; and as such business is carried out in the Parish of Lambeth, it became the duty of the Medical Officer to report strongly in connection with the matter to the late Vestry, who not only approved the report, but sent a copy to the two authorities mentioned, with a suggestion that the practice complained of should be discontinued. The Clerkenwell Vestry have since then practically discontinued the handsorting; but the City Corporation goes on as before, apparently oblivious to the bad example they are setting to other lesswealthy authorities. There is always a difficulty in proving actual injury to health: from such offensive occupations as the sorting of refuse; but there can be no doubt as to such a trade process being dangerous to health, when one considers that the employees work half buried in offensive and more or less decomposing and fermenting organic refuse, the fumes of which surround them, and are being breathed and re-breathed continuously; and in my opinion representations should be made to the City Corporation. Hand-sorting of house refuse is also carried on in other parts of the Parish, viz., Cookson's and Clarkson's Yards, Tinworth 101 Street. At the former yard 15 women and 9 men are employed at average wages of 14s. and 24s. per week, respectively, without sick pay; whilst at the latter, 10 women (and girls) and 6 men (and a boy), at average respective wages of 14s. and 24s. per week, without sick pay. At these two yards in Tinworth Street the refuse-sorting is under a sub-contract. The Strand Board of Works have recently erected a Horsfall Destructor on their Wharf (Shot Tower) for the destructor (by burning) of refuse. It remains to be seen if any nuisance arises in connection with the working of such a destructor. At the end of the year action had to be taken against the tenant of some land on the east side of Elder Road, West Norwood, facing the new and old schools belonging to the Guardians, on account of refuse being shot thereon, and afterwards sorted and burnt—the hard core being used for a ballast fire, and the remaining light material being separately burnt. The contractor supplying the refuse was Mr. Clarkson. This nuisance from burning was stopped, as also the tipping of refuse on the land, except in the case of occasional loads used for digging into the land for gardening purposes. Road slop was shot also upon this land, but no nuisance could be found in connection therewith, and consequently no preventive measures were taken. HOUSES LET IN LODGINGS. During 1900, 26 houses have been selected by the late Vestry as follow:— 1 to 31 and 2 to 20, Broomsgrove Road, Stockwell Road, 26 houses, containing 156 rooms, in which were housed 52 families, consisting of 312 persons, of whom 112 were over ten years of age, and at rents averaging 5s. 6d. per week. The late Vestry have registered a total of 411 houses, containing 2,369 rooms, and these are under constant supervision by the Inspectors. 102 A difficulty is experienced in getting the annual cleansing done in accordance with Bye-law 15, which reads as follows:— "The landlord of a lodging-house shall, in the first week of the month of April in every year, cause every part of the premises to be cleansed. "He shall, at the same time, except in such cases as are hereinafter specified, cause every area, the interior surface of every ceiling and wall of every water-closet belonging to the premises, and the interior surface of every ceiling and wall of every room, staircase, and passage in the house to be thoroughly lime-washed. "Provided that the foregoing requirement with respect to the lime-washing of the internal surface of the walls of rooms, staircases, and passages shall not apply in any case where the internal surface of any such wall is painted or papered, or where the material of or with which such surface is constructed or covered is such as to render the lime-washing thereof unsuitable or inexpedient, and where such surface is thoroughly cleansed, and the paint, paper, or other covering is renewed, if the renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition." Where the owner is the landlord (or keeper) there is no difficulty, but in some cases, where the landlord lives on the premises and receive the rents from the different lodgers, it is found difficult to enforce the Bye-laws, the landlord declaring that he has no money to expend for such a purpose. It is suggested that an Amendment Act might, with advantage, be introduced, making the owner in all cases liable for the annual cleansing. Such a change is much to be desired. HOUSING OF THE WORKING CLASSES ACT, 1890. 23 houses have been represented to the late Vestry by the Medical Officer of Health, under Part II. of the Housing of the Working Classes Act, during the year 1900, as being unfit for human habitation, on account of the premises being dirty, damp, and dilapidated, drains and sanitary arrangements defective, etc. Details are as follow:— Date of representation of M.O.H. to, and of resolution of late Vestry. Address of Premises. No. of Houses. Date of service of Notices. Result. Remarks. Feb. 1st 4. Tinman Court, Lollard Street 1 Feb. 3rd Closed Dirty, damp and dilapidated Feb. 1st 16 St. Alban's Buildings 1 Feb. 3rd Rendered fit Mar. 1st 69, Dunbar Street, West Norwood 1 Mar. 8th Rendered fit Mar. 15th Susannah Cottage, Ivan's Place, Warham Street 1 April 6th Closed Dirty, damp and dilapidated, and drains defective Mar. 29th 2—14, Bloxham's Buildings, Camberwell Green 13 Mar. 31st Rendered fit Generally worn out May 10th 1, Lepine Cottages, West Norwood 1 Not served Rendered fit Damp and defective drains July 5th 3 and 5, Gilham's Cottages, New Park Road 2 July 9th Rendered fit Damp and defective drains and W.C's. Sept. 27th 82, Launcelot Street 1 Sept. 28th Rendered fit Dirty, damp and dilapidated Sept. 27th 30, Prince's Road ... 1 Sept. 28th Closed Sept. 27th Clifford House, Crown Hill 1 Sept. 28th Rendered fit 103 104 As years go on fewer and fewer houses will be found sufficiently bad to require action to be taken under Part II. of the Housing of of the Working Classes Act, more especially as a systematic supervision of houses is keeping them up to a better standard of sanitary repair. In judging of the work that is being done in connection with the Houses of the working classes, due regard must be given to the action taken under the Metropolis Local Management and Public Health Acts, as well as the special action taken in exceptionally bad cases, under Part II. of the Housing Act, 1890. Taking the statistics for the last five years, during which I have been Medical Officer, 261 houses have been condemned under Part II. of the Housing of the Working Classes Act, 1890, whilst under the Public Health and Metropolis Management Acts, during the same period, 49,680 Notices have been served, having reference to sanitary works of a structural (and permanent), or non-structural, character. Further 411 houses containing 2,369 rooms, in which were housed, at the time of registration, 4,093 workpeople, have been registered under the Bye-laws for Houses Let in Lodgings. The site in Lambeth Walk (Fountain, Francis, and Paved Courts) on which stood 27 houses, which were condemned under Part II. of the Housing Act, on December 12th, 1895, and afterwards closed and demolished, has now been converted into a builder's yard. The opportunity has, therefore, unfortunately gone by for securing this site as an open space, or a play-ground for children, as was suggested by the Medical Officer to the late Vestry in the Annual Reports for 1896, 1897, and 1898. An important duty is awaiting the new Borough Council in connection with the Housing of the Working Classes in Lambeth. A new Amendment Act has been passed and is now in force, by which power is given to the London County Council to adopt and carry out Part III. of the Housing Act, 1890, outside the districts over which they have jurisdiction, as well as inside. Further, the new London Government Act, 1899, has given similar powers (concurrently with the L.C.C.) to the new Boroughs of the Metropolis. Great things will be expected of the Lambeth Borough Council in connection with the adopting of Part III. of the Housing Act, 1890 (and as amended by the Housing Act, 1900), by which the 105 Council has power to deal with workmen's dwellings or lodginghouses—purchasing land and erecting dwellings (including cottages) thereon, or purchasing existing premises and converting them, or adapting them by reconstruction or otherwise, into tenemented houses for the working classes, These powers extend to land, or existing buildings, both within and without the Borough boundaries. At the time of writing this Report, I am happy to be able to state that the Borough Council of Lambeth is considering what action shall be taken as mentioned above. That there is much good work to be done on the lines mentioned above no one will gainsay who has had any practical experience of the Housing question in Lambeth (or elsewhere). The Inner Districts are overcrowded, and the Public Health Acts in respect thereof, practically in abeyance—it being rightly felt that no stringent action should be taken to prevent overcrowding in Lambeth until extra accommodation has been provided into which the displaced tenants can move, more especially when one remembers the amount of displacement that is nccessarily taking place in connection with the extension schemes of the London and South-Western Railway in North Lambeth, and the enlargements of business premises (factories, etc.). CUSTOMS AND INLAND REVENUE ACTS. During 1900, certificates (carrying exemption from, or abatement of, Inhabited House Duty) have been applied for in connection with 268 tenements, and of these 130 have been granted unconditionally, 138 have been granted conditionally, whilst in no single instance has a certificate been refused, although the sanitary standard required is a high one. 106 A. Certificates granted unconditionally— Houses or Blocks. Tenements Orsett Street, 23-35 7 14 Courtney Street, 12-20 5 IO Thurlby Road, West Norwood, 51-61 6 12 Abingdon Villas, West Norwood, 13-16 4 8 Durban Road, West Norwood, 23-45 12 24 ,, ,, 58-72 8 l6 Auckland Terrace, West Norwood, 7-16 10 30 Emily Mansions, Landor Road, 1-12 1 12 Abbey Mansions, Milkwood Road, 1-4 1 4 B. Certificates granted conditionally— Vauxhall Models, 1-62 2 62 Wolfington Road, West Norwood, 44-46 2 4 Comrie Road, 2-16 8 16 ,, 1-9 5 10 Thurlby Road, West Norwood, 39-43 3 6 Upper Tulse Hill, 23-29 4 8 New Clive Road, West Norwood, 77-101 13 26 Webber Street, New Cut, 6-8 1 6 C. Certificates refused— Nil. Nil. 92 268 SLAUGHTER-HOUSES. There were, at the end of 1899, 42 registered slaughter-houses, and of these, two (74, Stockwell Road, and 12, Vassall Road) have since been discontinued as slaughter-houses, whilst one (172, Lambeth Walk) that was closed last year, has been re-opened 107 and re-registered during 1900. 41 slaughter-houses came up for registration in 1900 before the L.C.C., and in all cases the necescary licenses were granted (the Vestry not opposing in any single case). The licensed premises are as follows : — 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, ,, ,, 172, ,, Prince's Ward 406, Kennington Road „ 6c, Kennington Park Road „ 171, Lower Kennington Lane „ 158, Newington Butts „ 4, Clapham Road ,, 36. ,, Vauxhall Ward 302, „ ,, 152. ,, „ 18, Paradise Road (rear of) „ 1, Lansdowne Road Stockwell Ward 97, Stockwell Road „ 27, Bedford Road Brixton Ward 58, Coldharbour Lane „ Near Railway Hotel Brewery (Electric Lane) „ 263, Brixton Road „ 136, Wyndham Road „ 10, Foxley Road „ Industry Terrace (yard leading to) 108 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 41 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, though the small number of such defects is cause for congratulation, as showing the satisfactory condition in which the Lambeth slaughter-houses have been found during the year:— Dirty Premises 11 Defective Roof 1 Defective Flushing Cistern 1 Dilapidated Dung Pit 1 Defective Gully 1 Defective Paving 3 In 27 of the slaughter-houses no sanitary defects were discovered, whilst the general condition of the premises in all was found to be satisfactory. In no single instance was a result obtained from the drain test, though in two slaughter-houses (10, Foxley Road, and 97, Stockwell Road) the drains were voluntarily relaid. 109 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 is (roughly) as follow:— Cattle 53 Sheep 768 Pigs 68 Total 889 Calves occasionally. COWHOUSES. There were, in 1899, 24 registered Cowhouses in Lambeth Parish, and of these two (Railway Arch, East Street, and 1, Change Alley, West Norwood) are 110 longer in use. During 1900, 22; applications have been received for renewal of licenses, and all were granted by the L.C.C., the Vestry objecting in no single instance. The licensed premises are as follow : — LIST OF REGISTERED COWHOUSES IN LAMBETH. No. of Sheds. No. of Cows kept. Ward. Marsh 6, Coral Street, Lower Marsh 1 10 Bishop's Cambria Cottage, Tracey Street 1 13 ,, 71, Ethelred Street 1 7 ,, 24, Distin Street 2 9 Prince's 30, Upper Kennington Lane 1 7 Vauxhall 38, Hartington Road 1 22 ,, 9, Dawlish Street 1 12 Stockwell 8, Moat Place 1 7 ,, 34, Ingleton Street 1 5 Brixton Vassall Mews 1 8 ,, 1, Elliot Road 2 9 Tulse Hill 4, Mill Lane, Brixton 1 2 ,, 67, Coldharbour Lane 1 7 110 Tulse Hill I, Lutheran Place, Upper Tulse Hill 2 34 11 56, Railton Road 1 5 11 329, Coldharbour Lane 1 8 Norwood 156, Hamilton Road 3 26 ,, 76 and 78, Gipsy Hill 3 27 ,, 67, Rosendale Road 1 10 ,, 93, Clive Road 1 4 ,, 196, Norwood Road 1 20 11 Elder Road, West Norwood 3 35 31 287 The above 22 Cowhouses have been inspected carefully during the year, and the following sanitary defects discovered, and since remedied: — Defective Paving 3 Dirty Premises 5 Dirty ,w.C. Pan 1 The small number of defects found shows the satisfactory state in which the Cowhouses of the Lambeth Parish are kept. In no single instance was a result obtained from the chemical test, which was applied in each case, whilst the general condition of the premises in all the Cowsheds was found to be satisfactory. MORTUARIES AND CORONERS COURTS. The total number of bodies received at the two Mortuaries (High Street and Wanless Road) during 1900, was 499, as compared with 483 during 1899, 495 during 1898, 400 during 1897, and 373 during 1896. Of the 499 bodies, 379 were received at High Street and 120 at Wanless Road, shewing the need of this second Mortuary for the Parish. 111 11 bodies were brought in by the Police (5 to High Street and 6 to Wanless Road), and the rest by undertakers or private persons. 267 Post-mortems were conducted (223 at High Street and 44 at Wanless Road), as compared with 285, 275, 281 and 253 respectively during the four preceding years, 1899-6. The Corcners' Court sat 109 times at Wanless Road, 119 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 1900, 3 bodies (1 male and 2 females) dead of diphtheria, and 2 (1 male and 1 female) dead of typhoid, and 1 (female) dead from puerperal fever, were received there. No provision has been made during the year in regard to an extra Mortuary for Norwood district, though it is clear that, considering the rapidity with which Norwood is growing, such a Mortuary is much wanted. The Vestry on May 14th, 1896. decided that a Mortuary should be provided for Norwood, and a site was obtained, and approved, on Dec. 10th, 1896. Unfortunately, a hitch occurred in the completion of the purchase, with the result that no further action was taken. I first reported as to the need for extra Mortuary accommodation for Norwood on May 4th, 1896. It will be sufficient for a small Mortuary to be provided, such building to be able to deal with (a) infectious cases and (6) other dead bodies. It is not only violent deaths that necessitate such a building, but the fact that at times bodies (dead from infectious or other diseases) should be removed from crowded centres, when awaiting burial. Ages of bodies received at the Lambeth Mortuaries, 1896-1900. Registered Ages of Bodies. 1899. Total 1900. Total 1899. Total 1898. Total 1897. Total 1896. High Street. Wanless Road. 0—1 94 39 133 121 160 101 121 1—5 36 11 47 44 50 39 22 5—10 11 1 12 22 17 9 12 10—20 12 5 17 13 8 18 9 20—30 22 9 31 29 26 26 24 30—40 34 9 43 59 45 35 35 40—50 60 20 80 67 64 48 37 50—60 51 10 61 53 42 59 46 60—70 40 10 50 47 39 30 35 70—80 13 3 16 19 32 20 22 80—90 3 3 6 8 5 9 7 90—upwards — — — 1 1 — 3 Age not stated 3 — 3 — 6 6 — Totals 379 120 499 483 495 400 373 112 Numbers of bodies received at the Lambeth Mortuaries during 1896-1900. 1900 January. February. March. April. May. June. July. August. September. October. November. December. Total 1900. Total 1899. Total 1898. Total 1897. Total 1896. High Street. Males 27 21 20 16 21 16 27 19 22 16 17 15 237 239 222 218 221 Females 21 15 14 13 12 11 15 6 3 10 10 12 142 126 143 109 152 Wanless Road. Males 8 3 7 4 5 8 3 4 3 5 4 4 58 71 72 41 — Females 9 6 10 3 7 3 5 3 2 5 4 5 62 47 58 32 — Totals 65 45 51 36 45 38 50 32 30 36 35 36 499 483 495 400 373 N.t.— Wanless Road Mortuary was opened 011 April 12th, lt97, and is under the superintendence of Mr. Joshua Fazey—High Street Mortuary being Mr. Langston. i Mr. Fazey, Junior, is Deputy Mortuary Keeper. 113 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 6 — 6 — — — — 1 1 — 10 3 14 2 Suicides 3 1 4 7 3 10 7 6 7 3 6 1 12 1 Poisoning 1 — 1 1 1 2 — 4 2 1 2 2 3 1 Hanging 1 — 1 2 1 3 3 — 6 3 — — 2 — Throat cutting 1 1 2 1 — 1 2 2 3 2 1 — 2 — Jumping off heights — — — 1 — 1 — — — — — — 2 — Cutting Arteries — — — — 1 1 1 — — — — — — — Shooting — — — 2 — 2 1 — 4 — 1 — 3 — Railway Accidents 3 — 3 1 — 1 4 — 1 — 1 — 3 — Accidental death — — — 4 2 6 1 — 8 4 — — — — Street Accidents 1 — 1 1 1 2 7 2 6 1 4 — 3 — Murder — — — — 1 1 1 1 — — 1 1 — 2 Burning 1 — 1 — — — 1 1 — 3 1 — — — Falling from cab — — — 1 — 1 1 — 4 — 4 — — — Bicycle Accidents — — — 1 1 2 — — 1 — — — — — Strangulation and Suffocation — — — — — — — — 1 1 — — — — 114 3 bodies dead from diphtheria (1 male and 2 females), 2 dead from typhoid (male and female), 1 (female) dead from Puerperal Fever were admitted into the infectious Mortuary at Wanless Road. 115 INQUESTS. During the year 1900, 600 cases were submitted to the Coroner, who, in 80 instances, decided that no further inquiries were necessary; but, in the other 520 cases, held inquests with the following results:— I. Natural Causes 223 II. Accidental Causes 262 Burns and Scalds 30 Drowning 16 Run over 25 Falls, &c. 55 Suffocation 45 Alcoholism 21 Knocked down by Engine 5 Gunshot Wounds or Fractures 16 Rupture 8 Exposure 5 Misadventure 10 Kicked by Horse 1 Self Neglect 3 Blood Poisoning 11 Crushed 9 Improper Feeding 1 Decapitated on Railway 1 III. Homicidal Causes 32 Suicide 27 Murder 2 Manslaughter 3 IV. Open Verdicts 3 Found Drowned 3 Found Dead — Total 520 H 2 116 In connection with the important subject of Death Certification, the late Vesty approved on July 5th, 1900, of the following principles:— 1. All Medical Certificates to be sent direct to the Registrar. 2. Fact of death to be certified by the Medical Man in attendance. 3. No death to be registered without the production of a certificate of death signed either (a) by a registered Medical Practitioner or (b) by a Coroner. The state of the law with respect to death certification is unsatisfactory, more especially as it affects the registration of uncertified deaths, and the suggested principles mentioned above as approved by the late Vestry, are practically those laid down by the Select Committee of the House of Commons, who reported in September, 1893, and by the London County Council at a Deputation, which waited upon the Lord Chancellor in Feb., 1895. 117 WORKSHOPS. 19 Workshops have been added to the register during the year 1900, consisting of the following:— Nature of Trade or Business No. of Workshops. Dressmaking 3 Tailors and Clothiers 1 Laundries 3 Manufacturing Chemist 2 Box Maker 2 Boot Maker 2 Boat Maker 2 Cabinet Maker 1 Builder 1 Mechanical Dentist 1 Underclothing Maker 1 19 The total number of known Workshops in the Parish of Lambeth is 740, all of which have been inspected, and the different 1,303 workrooms measured up, and plans drawn in connection therewith, showing cubic capacity (width, height, and length) and general shape. A total of 4324 persons (1,785 males and 2,539 females) were employed within the Workshops at the time of inspection, and of these three were children (1 male and 2 females), 508 young persons (134 males and 374 females), and 3,771 adults (1,632 males and 2,139 females). All the Workshops (with full particulars) have been entered up in the register. In connection with the 19 new Workshops (inspected and registered during 1900), it is found that there are 42 rooms, in which were working, at the time of inspection, 179 persons, 109 males and 70 females (females alone being employed in 13 Workshops). Further, 2 children (female) were found employed, and there 118 were 13 young persons, i.e., between 14 and 18 years of age (3 males and 10 females), and the rest were adults (106 males and 58 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, 1891, and Section 3 of the Factory and Workshops Act, 1891, from time to time, as he became aware of such being employed. The Vestry of Lambeth, as the Sanitary Authority, has received 3 notices of occupation of Workshops from the Factory Inspectors during 1900, as compared with 32, 60, 31, and 29 respectively in the previous 4 years. 16 written notices have been received from the Factory Inspectors with reference to contraventions of the Public Health Acts in connection with Factories or Workshops (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 four previous years, 8, 27, 25, and;66 written notices respectively have been received. In connection with the 19 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 19 Workshops (i.e., 15.8 per cent) was the ventilation unsatisfactory, and in 18 out of 19 Workshops (i.e., 94.7 per cent.) 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 4 Workshops (i.e., 21.1 per cent.), 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 6 (i.e., 31.6 per cent.) were shown to be defective, 119 quiring partial or total reconstruction; whilst in 5 (i.e., 26.3 per cent.)the sanitary fittings and appliances were bad. The w.c.'s were outside in 32.6 per cent., inside in 31.6 per cent., and outside and inside in 15.8 per cent. Separate closet accommodation for the sexes was wanting in 1 case (i.e., 5.3 per cent.). The soil pipes were found to be unventilated, or insufficiently ventilated, in 10 cases (i.e., 52.6 per cent.), a condition of things which may, or may not, be a nuisance; and in 1 case (i.e., 5.3 per cent.) there was found to be direct communication between w.c.s and workrooms. 4. As to Dampness. In 1 workshop (i.e., 5.3 per cent.) a workroom was found, on inspection, to be damp. 5. As to Overcrowding. The cubic capacities of the different workrooms were found to vary considerably, and in 2 of the 42 workrooms (i.e., 4.8 per cent.) overcrowding was found to exist, though the overcrowding was limited to 1 and 2 persons in excess per workroom respectively, as will be seen on reference to the accompanying Table III. The appointment of a Female Sanitary Inspector was, unfortunately, not decided upon by the late Vestry, and the new Borough Council will, doubtlessly, rise to the occasion, and make good this deficiency.* That such an Inspector is needed must be admitted by all when it is remembered that in the 740 Workshops in Lambeth Parish, out of a total of 4,324 persons employed, 2,539 (i.e. 58.7 per cent.) are women and children (68.4 per cent, rf the Workshops employing enly female labour). Further, such a female Inspector would be of great use in— 1. Constantly supervising the female underground con veniences in the Borough. 2. Inspecting shops wh°re girls and women only are ployed ; * I have pleasure in recording that th» new Borough Council decided on February 21st to appoint a Female Sanitary Inspector. 120 3. Visiting infants' and girls' schools and colleges in tion with outbreaks of infectious disease; 4. Visiting the houses of the poor (especially in the Inner Districts), where the non-notifiable infectious diseases, which attack chiefly infants and children, e.g., measles, whooping cough, diarrhoea, etc., are known to exist, with a view to pointing out the proper preventative measures to be taken in connection therewith; 5. Working among the poor, especially in the Inner Wards of the Parish, and assisting in the! advising of mothers as to the feeding and caring of infants, and as to domestic sanitation generally; 6. Visiting regularly tenemented houses, or houses let in lodgings, which have been registered under the Byelaws; 7. Assisting in purchasing samples under the P'ood and Drugs and Margarine Acts; 8. Carrying out such other duties as may be required from time to time. The Metropolitan Authorities who have already appointed female Sanitary Inspectors are : —Kensington, St. Pancras, Southwark, Hackney, Islington, Marylebone, Poplar, and the L.C.C. It need only be added that a careful selection must be made to secure a suitable and efficient officer of experience and tact; and with this object in view, such a salary ought to be offered as to prevent such an officer being appointed as a cheap man. The higher the salary, the better chance of obtaining the services of a suitable and experienced officer. 121 I.—WORKSHOPS:—Number of Rooms and Persons employed. Districts, and Inspectors in charge thereof. No. of Workshops No. of Workrooms Children. Young Persons. Adults. TOTALS. M. F. M. F. M. F. M. F. Total Marsh Jackson ... ... ... ... ... ... ... ... ... ... ... Wallis 1 1 ... ... ... ... ... 6 ... 6 6 Bishop's Prince's Hooper 8 15 ... l 2 3 29 35 31 39 70 Howes 8 6 ... l 1 ... 16 6 17 7 241 Jones ... ... ... ... ... ... ... ... ... ... ... Vauxhall Stockwell Bowden ... ... ... ... ... ... ... ... ... ... ... Baxter ... ... ... ... ... ... ... ... ... ... ... Perrin ... ... ... ... ... ... ... ... ... ... ... Brixton Gavin 2 13 ... ...... ... ... 61 ... 61 ... 69 Bott 1 1 ... ... ... ... ... 6 .. . 6 ... Tulse Hill Smith 2 3 ... ... ... 7 ... 1 ... 8 ... Norwood Barfoot 2 3 ... ... ... ... ... 4 ... 4 84 19 42 ... 2 3 10 106 58 109 70 179 122 123 II.—WORKSHOPS:—Details as to Sanitary Conditions and Defects found. Details as to Sanitary Conditions and Defects found. Marsh. Distrirfe Totals Vauxhall and Stockwell. Bishop's and Brixton. Tulse Hill. Smith. Norwood. Barfoot. Jackson Wallis. Hooper J ones Howes. Bowden. Baxter. Perrin. Gavin. Bott. Ventilation satisfactory ... 1 7 ... 3 ... ... ... 1 1 2 1 16 not ... ... 1 ... ... ... ... ... 1 ... ... 1 3 Cleanliness satisfactory ... 1 6 ... 3 ... ... ... 1 1 2 1 15 not ... ... 2 ... ... ... ... ... 1 ... ... 1 4 Workrooms damp ... ... ... ... ... ... ... ... ... ... ... 1 18 not ... 1 8 ... 3 ... ... ... 2 1 2 1 18 Workrooms warm ... 1 7 ... 3 ... ... ... 2 1 2 2 1 not ... ... 1 ... ... ... ... ... ... ... ... Result of testing of drains no result ... 1 6 ... 2 ... ... ... 2 l 1 ... 13 defects found ... ... 2 ... 1 ... ... ... ... ... 1 2 6 State of sanitary fittings, &c. good ... 1 5 ... 2 ... ... ... 2 l 2 1 14 bad ... ... 3 ... 1 ... ... ... ... ... ... 1 5 Soil pipe ventilated ... 1 3 ... ... ... ... ... 1 1 2 1 9 not ventilated ... ... 2 ... ... ... ... ... ... ... ... ... 2 no soil pipe ... ... 3 ... 3 ... ... ... 1 ... ... 1 8 Position of W.C. outside ... 1 4 ... 2 ... ... ... 2 ... ... 1 1 10 inside ... ... 4 ... 1 ... ... ... ... ... ... ... 6 outside & inside ... ... ... ... ... ... ... ... ... 1 2 ... 3 _No W.C. ... ... ... ... ... ... ... ... ... ... ... ... ... Separate W.C. ac commodation Yes ... 1 2 ... ... ... ... ... ... ... 2 1 6 No ... ... 6 ... 3 ... ... ... 2 1 ... 1 13* Communication (direct) between W.C.'s & rooms Yes ... ... 1 ... ... ... ... ... ... ... ... ... 1 No ... 1 7 ... 3 ... ... ... 2 1 2 2 18 In only I case was separate w.c. recommendation really recuired. III.—WORKSHOPS.—Full details as to overcrowding found. Nature of Workshop. No. of Workrooms overcrowded. No. of Employes at time of Inspection. No. of Employes allowed. Extent of Overcrowding (in persons). Male. Female. Total. Military Tailors 1 ... 7 7 5 2 Mechanical Dentist 1 3 ... 3 0 1 10 persons (3 males and 7 females) were found to be working in a state of overcrowding—in a cubic space enough for only 7. 124 125 BACTERIOLOGICAL LABORATORY. During the past year, 1900, the Bacteriological Laboratory which was fitted up at Arlington Lodge, Wanless Road, Loughborough during 1899, ha? again proved 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 late Vestry, judging by the results of the first two years' 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, and in stil responding, so enthusiastically, and making such good use of the opportunities for bacteriological diagnosis offered to them free of cost. Tuberculosis. 118 samples of sputa from doubtful Tuberculosis cases have been examined during 1900, and in 43 {i.e., 36.4% ) 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 arrested, if not cured, by proper treatment. In 75 instances (63.6% ), no tubercle bacilli were found. Typhoid Fever. 115 samples of blood from suspected Typhoid cases have been examined during 1900, and in G8 (i.e., 59.1% ) the characteristic Widal reaction has been obtained, although in 40 of the cases (i.e, 34.8% ) this reaction was but slightly (or feebly) marked. The reaction depends on the act 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 again been shown of this in connection with a localised small outbreak of Typhoid in Lambeth during 1900. Doubtful, or suspected cases were heard of by means of house-to-house enquiries, and 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. 469 samples of throat membranes and secretions from doubtful Diphtheria cases have been examined during the year, and in 95 (i.e., 20.3%) the true (Klebs-Loeffler) bacilli have been obtained. In 74 instances (i.e., 77.9%) the Klebs-Lceffler bacilli were obtained in pure cultivation— i.e., without admixture with other bacilli, whereas in the remaining 21 (i.e., 22.1% ) the Klebs Lceffler bacilli were found combined with other well-known bacilli as follows:— Klebs-Lœffler+Streptococci 5 i.e., 5.3% Klebs-Lœffler+Staphylococci 5 i.e., 5.3% Klebs-Lœffler + Streptococci+ Staphylococci 3 i.e., 3.2% Klebs-Lœffler Streptococci+ Staphylococci+Oidia 2 i.e., 2.1% Klebs-Lœffler+Pseudo-bacilli 1 i.e.,1.05% 127 Klebs-Lœffler 4+Oidia 1 i.e., 1.05% KIebs-Lœffler+ Pseudo-bacilli + Streptococci 4- Staphylococci+thers 1 i.e., 1.05% Klebs-Lœffler+ Staphylococci + others 1 i.e., 105% Klebs-Lœffler 4- Streptococci 4- others 1 i.e., 105% In 374 (i.e., 70.7 %) of the total number of throat samples examined the Klebs-Lceffler bacilli were not isolated, but other bacilli were as follow:— Streptococci 18 i.e. 4-8 % Pseudo-bacilli 1 i.e. 03% Pseudo-bacilli4-others 162 i.e. 43'3 % Staphylococci 128 i.e. 34 2 % Streptococci4-Staphylococci 44 i.e. 11 "8 % Streptococci+ Oidia 2 i.e. 0~5 % Staphylococci + Oidia 7 i.e. 1*9 % Micrococci 2 i.e. 0 5 % Oidia 4- Streptococci 4- Staphy- locci 10 i.e. 2 7% The pseudo-bacilli (Hoffman) were found in pure cultivation in only one instance, but in only three cases were pseudo-bacilli and true diphtheria (Klebs-Loeffler) bacilli found together. Pseudo-bacilli were found mixed with streptococci (12 samples), with staphylococci (93), with streptococci and staphylococci (49), with streptococci and oidia (l),with staphylococci and o'idia (l),with streptococci, staphylococci and oidia (5). The pseudo-bacilli (Hoffman) are sometimes regarded as a modified form of the Kleb-Lceffler bacilli, and if this be so, the importance of isolating patients suffering with pseudo-diohtheritic throats becomes apparent. The Lambeth 128 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 still do not feel justified in recommending removal to hospital, as 1 am not yet satisfied that it would be right to place a pseudo patient in a ward full of acute Klebs-Lcefller patients. Other examinations. One sample of suspected hydatid liver was submitted and examined, and the hydatids were found. Sputa. Tub. Bac. found. *Bloods. Typhoid reaction obtained. Throat Membranes and Discharges. Klebs-Loeffler bac. found. Other Exams. † Bacilli found. 1900 Yes No. Total. Yes. No. Total. Yes. No. Total. Yes. No. Total. Jan. 5 9 14 5 2 7 7 25 32 - - - FEb. 4 12 16 9 3 12 7 20 27 — — - Mar. 1 8 9 10 1 11 10 19 29 — — - April 2 11 13 2 5 7 8 18 26 — — - May 5 7 12 6 1 7 7 26 33 — — - June 4 9 13 1 6 7 12 17 29 — — - July 6 4 10 — 7 7 9 25 34 — — - Aug. 6 5 11 3 8 11 11 18 29 — — - Sept. 2 3 5 7 5 12 7 38 45 — — - Oct. 1 4 5 8 3 11 7 67 74 — — - Nov. 3 2 5 7 3 10 5 82 87 1 — 1 Dec. 4 1 5 10 3 13 5 19 24 - — - Total 43 75 118 63 47 115 95 374 469 1 — 1 *Slight or feeble reaction in five of the cases. †A case of suspected hydatids in Liver. 120 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, 1900:— Expenditure. Receipts. 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 178 4 6 176 15 0 13 17 5 28 16 5 22 6 0 4 7 8 49 0 5 — 295 2 11 Hercules. Male side—4 paying, 1 free closet £295 9 6 Female side—3 paying, 1 free closet 221 6 5 516 15 11 308 15 4 46 6 10 30 17 3 22 11 7 8 2 7 117 1 0 - 533 14 7 Brixton. Male side—3 paying, 1 free closet 263 14 8 Female side—3 paying, 1 free closet 229 0 10 492 15 6 309 6 3 47 13 11 51 19 7 63 8 7 8 2 7 148 0 8 12 8 2 640 19 9 Kennington Cross. Men only 3 paying, 1 free closet 144 16 10 176 15 0 19 19 9 13 17 6 9 10 7 4 7 8 98 2 8 — 322 13 2 1332 12 9 971 11 7 127 17 11 125 10 9 117 16 9 25 0 412 4 9 12 8 2 1792 10 5 130 The Clerical work in connection with the Department during 1900 deserves recognition, and will best be realised in the form of the following statement:— 1900. 1899. 1893. 1897. 1805 Letters, etc., received (entered in letter book) 9139 9010 8974 8309 7625 *Letters, etc., sent out (entered in postal book) 27751 26039 25892 24821 27751 Notices served Infectious Diseases . 2221 2435 2094 2374 2327 Public Health 1 Preliminary 8073 7676 8875 8714 6222 Acts 1 Statutory 1641 2427 2004 2018 1985 Housing of Wording Classes Act 42 44 33 55 Cases entered in Inspectors' Report Books 8701 9006 8725 8337 6767 Complaints entered in book 6988 6079 5620 4915 3768 Copies of Infectious Diseases Notifications— (a) Entered in Notification Book 2209 2693 2329 2663 320 (b) Sent off to Asylums Board 2209 2693 2329 2663 3202 Notices of Infectious Diseases sent to Schools 2435 2094 2663 257 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 partKulars) entered up in Register - - 1 237 - Water Certificates for New Dweliings given out - 126 131 215 89 Disinfection Certificates given out — 2689 2094 159 109 Stamps used 17160 21256 19151 20141 20925 Reports to Committees (Fortnightly) 20 20 21 20 20 Reports to Vestry (Monthly and Quarterly) 17 17 17 17 17 Special Reports 15 13 6 12 15 *4,588 letters were typed during the year 1900, as compared with 4,999 duriag 1899,5,052 during 1898, 5 538 during 1897, and 4,350 during 1896 (8 months). 131 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. APPENDIX. 2 3 Death-rates (General and Zymotic) for London and the Metropolitan Districts daring 1900. Metropolitan Districts. Death-rate (corrected). Zymotic Deathrate (corrected). Infantile Mortality Rate. Diarrhœa Rate. Typhoid Fever Rate. Diphtheria Rate. Scarlet Fever Rate. Phthisis Rate. Metropolitan Districts. Death-rate (corrected). Zymotic Deathrate (corrected). Infantile Mortality Rate. Diarrhœa Rate. Typhoid Fever Rate. Diphtheria Rate. Scarlet Fever Rate. Phthisis Rate. Registration London 183 2.19 158 0.77 0.16 0.34 0.08 1.71 East. West. Shoreditch 21.6 3.02 186 1.26 0.2 0.47 0.13 1.86 Bethnal Green 22.6 2.76 168 0.82 0.14 0.49 0.09 2.12 Paddington 15.9 1.72 165 0.73 0.06 0.21 0.04 1.15 Whitechapel 19.4 1.73 139 0.60 0.11 0.23 0.13 2.31 Kensington 15.8 1.66 180 0.62 0.l0 0.16 0.02 1.18 St. George-in-the-East 24.4 261 162 1.03 0.21 0.29 0.12 2.63 Hammersmith 17.2 2.23 l62 0.86 0.15 0.25 0.06 1.68 Limehouse 26.1 4.10 228 1.11 0.12 0.29 0.22 2.47 Fulbam 17.3 2.86 147 1.07 0.13 0.49 0.17 1.54 Mile End Old Town 20.4 2.53 158 0.93 0.19 0.31 0.06 1.70 Chelsea 18.0 l.77 1.49 0.78 0.20 0.19 0.07 1.71 Poplar 22.3 3.34 192 1.27 0.28 0.67 0.05 1.79 St. George's, Hanover Square 13.8 0.78 107 0.21 0.14 0.14 0.07 1.36 South. St. Margaret and St. John, Westminster 20.6 146 189 0.43 0.17 0.16 0.02 2.41 St. Saviour's 25.2 2. 92 197 1.13 0.25 0.63 — 3.11 St. James', Westminster 16.1 1.08 154 0.33 0.14 0.19 0.05 1.64 St. George-the-Martyr, Southwark 27.3 3.53 209 1.46 0.20 0.38 0.1 8 3.66 North. Newington 21.9 2.85 171 0.95 0.17 0.56 0.09 2.21 St. Olave 21.2 1.85 120 0.28 — 0.28 0.09 2.67 St. Marylebone 18.8 1.86 125 0.63 0.09 0.29 0.09 1.99 Bermondsey 22.7 3.24 1.88 0.91 0.34 0.69 0.08 1.97 Hampstead 11.1 1.18 100 0.27 0.11 0.38 0.05 0.85 Rotherhithe 21.5 3.40 205 0.83 0.24 0.63 0.15 1.14 St. Pancras 18.9 2.88 160 0.82 0.26 0.29 0.04 1.93 Lambeth 17.4 1.66 145 05 7 0.17 0.32 0.07 1.67 Islington 16.3 1.90 145 0.51 0.14 0.30 0.07 1.59 Battersea 16.8 2.34 159 0.86 0.18 0.19 0.06 1.48 Stoke Newington 12.6 1.43 108 0.39 0.17 0.39 0.11 1.04 Wandsworth 14.8 1.65 144 0.67 0.12 0.20 0.08 1.16 Hackney 16.1 2.11 158 0.93 0.19 0.26 0.08 1.16 Camberwell 16.3 1.99 154 0.73 0.12 0.49 0.04 1.38 Central. Greenwich 18.0 2.27 161 0.80 0.12 0.35 0.08 1.49 Lee 15.1 1.40 156 0.49 0.10 0.47 — 0.96 St. Giles 18.2 1.67 118 0.52 0.14 0.22 0.11 2.99 Lewisham (excluding Penge) 15.7 2.14 131 0.81 0.15 0.34 0.10 1.11 St. Martin's-in-theFields 17.7 0.84 148 0.34 0.25 0.17 — 2.37 Woolwich 22.1 2.79 173 1.33 0.07 0.17 0.14 2.56 Plumstead 16.3 2.30 129 0.55 0.14 0.38 0.11 1.47 Strand 20.5 1.14 135 0.35 0.18 0.13 0.04 3.26 Holborn 26.5 2.37 240 0.82 0.14 0.17 0.14 2.85 N.B.— These Returns are taken from the Registrar-General's Annual Summary. Where no Death occurred, — is inserted. J 2 Clerkenwell 21.5 2.71 167 0.82 0.09 0.29 0.15 2.57 St. Luke 26 .8 3.25 138 1.13 0.15 0.32 0.05 3.16 City of London 22.0 0.89 176 0.15 0.07 0.22 019 2.50 4 SUMMARY OF WORK DONE BY THE SANITARY DEPARTMENT OF THE LAMBETH VESTRY, DURING THE FIVE YEARS, 1895—1900. I.—Reorganisation of Sanitary Staff. (a) Inspectorial Staff. Four additional Inspectors were appointed by the Vestry on April 16th, 1896, and one additional Inspector on July 21st, 1898, making a present total of 13 Inspectors in all (12 District Inspectors and one engaged principally in office work). One of the Inspectors, in addition to his district work, is also specially appointed for the carrying out of the Food and Drugs (Adulteration) Acts, and the Smoke Nuisance Clauses of the Public Health (London) Act, 1891. All the Inspectors are now placed under the Local Government Board in accordance with the Sanitary Officers (London) Order, 1891—the new ones by virtue of their appointments, and the old ones by special resolution of the Vestry on April 28th, 1898; whilst the salaries of the Inspectors have been raised to a maximum of £180 per annum (with uniform). There is no longer a Chief Sanitary Inspector, the Inspectors reporting to, and taking instructions from, the Medical Officer direct. (b) Disinfecting Department. This Department was re-organised and enlarged at the end of 1897, and now consists of the following permanent staff :— 4 disinfecting men, 4 drivers, 2 stove attendants. 5 All the salaries of the men engaged have been increased, owing to the nature and extent of their duties and the extra risk which they run in connection therewith, but no overtime is allowed, the men devoting their whole time to their duties. All the men are now attached permanently to the Sanitary Department, as also the horses and vans. A new disinfecting machine (Equifex) on the latest modern and most efficient principles was purchased by the Vestry on February 18th, 1897, and is placed in a special building (two separate rooms) erected for the purpose by the Vestry and situated centrally in the Parish at the bottom of the garden of Arlington Lodge—a house purchased by the Vestry in 1896, and handed over to the Sanitary Department in 1897, and since converted into a residence for the senior disinfecting officer of the Disinfecting Department, who takes charge of the disinfecting machine and station, an extra refuge for persons from infected houses, and a bacteriological laboratory. In 1896 two new disinfecting vans were purchased and the two old vans renovated, repainted, and altered so as practically to be new ones, making a total of 4, so that infected and disinfected goods are now kept quite distinct. Two refuges have now been provided, one at the Wharf in 1896 and one at Wanless Road, for the accommodation (if required) of inmates of infected houses whilst disinfection is being carried out, or even of suspected cases during epidemics of serious diseases. These refuges are furnished and fitted with all necessary appliances in the way of baths, etc., as required by Section 60 of the 1891 Act. The old disinfecting machine at the Wharf has also been fitted with new coils, and put in proper order and condition as far as is possible with a machine on old-fashioned principles. The amount of work carried out by the enlarged Disinfecting Department during the last five years may be summed up as follows:— 6 Premises disinfected and disinfectants supplied 49,966 Cases in which bedding, etc, has been disinfected or destroyed 17,417 Numbers of articles disinfected or destroyed 128,636 (c) Clerical Staff. The clerical staff consists of three clerks, assisted by one indoor Inspector, and although there has been no change in, or addition to, the personnel of the staff, the work has been reorganised and re-arranged, so that all the correspondence, etc., passes through the Medical Officer's hands, instead of each Inspector writing his own letters, etc., which used to be the case. A type-writing machine was supplied to the Department on April 16th, 1896, and a telephone on July 22nd, 1897, and have proved of great use. The salaries of the clerks have been raised. Full details of the clerical work carried out; are to be found in the Reports of the Medical of Health, 1895-1900. II.— Office Accommodation. The increased staff of Inspectors and disinfecting men necessitated the enlargement of the office accommodation at 333, Kennington Road, and this was carried out in 1896, by altering and re-furnishing the old offices, together with the building of an extra room at the rear of the main building for the sole use of the Disinfecting Department. The work in Norwood Ward, on account of new buildings, etc., is so much increased that the Sanitary Committee suggested that a Branch Office in connection with the Sanitary Department should be opened locally, and on 27th September, 1900, the Vestry approved the taking of a room at No. 30, Knight's Hill Road, opposite West Norwood Station, and this office has since been fitted up and is now in working order. III.— Reorganisation of Work. The Parish has been divided into twelve separate districts, each one under the charge of a separate Inspector, the present 7 districts being smaller, and therefore, better for efficient and systematic supervision, and allowing more time for house-to-house inspections. In 1896 the Sewers and Sanitary Committee was split up into two separate Committees, and on November 6th of the same year all drainage in connection with both new and old houses was transferred to the Sanitary Committee, thereby making one department responsible. It was also decided that in the event of any difficulty arising, there should be an appeal to a Committee, viz., if a new building, to the Sewers, and if an existing building, to the Sanitary Committee, for decision. It may be pointed out that in no single instance has an appeal been made to either one Committee or the other, thereby proving the advisability of such a change being made. Drainage of all houses, whether new or old, is supervised by the Sanitary Inspectors, and in each case water-tested in sections and as a whole before being passed; and as time goes on the good derived from such a strict supervision of all drainage work in the Parish must have a beneficial effect. It may also be pointed out that no complaints have been received by the Committee with respect to the carrying out of this drainage work, showing that there is an absence of friction, and that the ratepayers of the Parish, especially property owners, are satisfied. In this connection it may be mentioned that, as years go by, fewer and fewer houses are found to give a result with the test as generally applied by the Inspectors (the chemical test). Thus, 15 per cent. only of infected houses in 1899 gave a result with the test, as compared with 16.9 in 1898, 16.4 in 1897, 17.5 in 1896, and 18.6 in 1895; whereas, in the previous four years, the annual average is 23.9 per cent. The water test is applied in all cases in new buildings, but in the case of old buildings only with the consent of the owner, the chemical and smoke tests being usually applied. When no result is obtained from such smoke or chemical test, the owner is informed that the drains are not, therefore, necessarily perfect, or 8 even alright, and that with his consent the much more reliable water test will be applied. No reflection is cast upon the Surveyor's Department, but as a matter of policy the transference of the control of the drains to the Sanitary Department has been found of the greatest advantage. Since this new arrangement was inaugurated on November 1st, 1896, drainage plans of over 3,000 houses have been carried out under the supervision of the Sanitary Department, and over 40,000 drains have been tested with chemical, smoke, or water. The recommendations suggested by the conjoint Sub-Committee of the Sanitary and Wharf Committees and adopted by the Vestry on the 9th December, 1897, are fully set out on pages 1662-3 and 1689 of the 1897 Minutes. They have reference to all descriptions of Trade Refuse (excepting offal, builders' refuse, and manure) being moved at a uniform charge of twopence per basket, the Vestry's carman being supplied with a small book and counterfoil to act as a check for the quantity of refuse removed. Particulars of such removal were sent round by circular to grocers, provision dealers, etc.; whilst in respect of Trade Refuse left in the streets by costermongers, the recommendations provided for the removal of such refuse systematically by vans which go round the market thoroughfares once a day on ordinary days, and thrice a day on market days (Wednesday and Saturday). Mention may also be made of the action taken by the Vestry on April 28th, 1898, in connection with a Special Report by the Medical Officer on "The high death-rates in 1897 in certain districts in the Parish of Lambeth." Such action has led to much special sanitary work being carried out, as shown by the following:— 1. The cleansing and frequent sweeping of the streets and courts in the inner wards; channelling of streets not already channelled; provision of additional gullies where required; flushing and cleansing of sewers. 2. The paving or repairing of Cory Square. Commercial 9 ings, Brad Street, Mepham Street, Little Windmill Street, and other streets specially mentioned in the Report. 3. House-to-house inspections in the Inner Districts, with examination and testing of drains at regular intervals. 4. Securing of an open space in the Archbishop's Grounds. 5. Application of the Housing of the Working Classes Act to secure, if possible, houses being rendered fit for human habitation, without resorting to the extreme measure of closing them, 260 houses having been dealt with under this Act. 6. Greater attention to scavenging and the periodical cleansing of gullies. IV.—Mortuaries and Coroners' Courts. At the end of 1896 the administration of the Mortuaries was transferred to the Sanitary Department. There are two Mortuaries, two Inquest-rooms, and two Coroners' Courts now belonging to the Parish, the new one at Wanless Road having been erected by the Vestry during 1896 and formally opened on April 12th, 1897. There are two Mortuary keepers and a deputy keeper, who is on duty one half-day a week for each keeper, during the week's holiday, and during other times as required. The salary of the High Street Mortuary keeper has been increased, owing to the nature of his work, and yearly uniforms are now supplied to all. The High Street Mortuary was rebuilt, in part, during 1896, viz., the clothes stores, water closet, urinal, post-mortem floor; whilst female w.c. accommodation was also provided. In 1896 the Vestry decided that a Mortuary was needed in Norwood, and land was accordingly purchased by the Sanitary Committee (the purchase being afterwards ratified by the Vestry on Dec. 10th, 1896), but, unfortunately, a legal difficulty prevented this purchase being completed, and no other suitable site has as yet been brought forward. 10 V.—Underground Conveniences. On November 1st, 1896, the Vestry transferred to the Sanitary Department all the Underground Conveniences in the Parish, 6 in all, together with a staff of 15 attendants, 12 permanent and 3 temporary. Each Convenience is under the care of a Sanitary Inspector, who visits it regularly not less often than twice weekly. Time sheets are kept and check-books in connection with the distribution of towels, dusters, and stores generally. The administration of these Underground Conveniences bv the Sanitary Committee is most satisfactory. The attendants are provided with uniforms yearly. The Brixton Convenience was opened on March 16th, 1896, and the Kennington Cross Convenience on September 5th, 1898, and the Vestry has recently ordered a loan to be applied for in connection with a new Underground Convenience at Binfield Road, Stockwell. VI.—Special Technical Matters. (a) Bacteriological Examination in Infectious Diseases. A Bacteriological Laboratory was fitted up at Wanless Road at the beginning of 1899, and has been in constant use for about 18 months, during which time over 900 specimens have been examined by the Medical Officer in connection with doubtful cases of typhoid, diphtheria, tuberculosis, etc. The Laboratory is much appreciated and much used by the Medical Practitioners, who have been provided, free of cost, with the necessary outfits in which to send samples of blood, sputum, membranes, and discharges. Lambeth is the only Metropolitan Parish which possesses a properly equipped Bacteriological Laboratory of its own. (b) Tuberculosis and its Prevention. On December 8th, 1898, the Sanitary Committee brought up a Special Report which was adopted by the Vestry, and which contained the following recommendations:— 11 1. Systematic disinfection, free of cost, of all rooms (and contents) which were tuberculosis-infected. 2. Bacteriological examination, free of cost, of sputa of suspected patients. 3. Distribution of leaflets and letters amongst medical men, clergymen, district visitors, school teachers, etc., pointing out the danger of tuberculosis and the ready means at hand for its prevention. Over 3,000 leaflets and letters have been distributed, with the result that during 1899 and 1900 (up to date) 474 and 442 cases of consumption respectively have been reported (and precautions taken), as compared with 4 during 1898; whilst over 100 specimens of sputum have been examined bacteriologically. (c) Measles and its Prevention. On June 23rd, 1898, the Vestry decided to distribute, from house to house, leaflets, pointing out the after-effects of measles it not attended to, and explaining the general dangerous and infectious nature of the disease. 51,175 copies of the leaflet were distributed to the different (separate) families in the houses throughout the Parish, together with the posting up of a number of large and small posters. Since then, the Vestry on March 1st, 1900, decided, on the recommendation of the Sanitary Committee, to ask the County Council to include measles amongst the "Dangerous infectious diseases" for the purposes set forth in the Infectious Diseases Prevention Sections of the Public Health (London) Act, 1891. Compulsory notification of measles is not considered necessary. The result has been that during 1899 and 1900 (up to date) there have been reported to the Medical Officer 773 and 926 cases of measles respectively, as compared with 129 during 1898; and in every case the usual precautions as to disinfection, etc., have been enforced. (d) Antitoxin Treatment in Diphtheria. This valuable remedy in diphtheria is now being gradually admitted by all medical men of experience, and the Vestry, on 12 August 3rd, 1899, decided to distribute it, free of cost, to all Medical Practitioners practising in Lambeth for the treatment of their Lambeth patients. Patients have been treated with antitoxin with satisfactory results. (e) Housing of the Working Classes. On January 18th, 1900, the Vestry adopted a principle laid down in a report on "Insanitary Areas and Housing of the Working Classes," brought up by the Sanitary Committee, the principle being to the effect that, as far as Lambeth is concerned, condemnation under Part I. of the Housing of the Working Classes Act is unnecessary, and that better results are obtained from systematic house-to-house inspections of houses, with the carrying out of notices served under Part II. of the Housing Act, or under the Public Health Acts, and that, too, without any displacement of tenants. In the case of necessary displacement, e.g., by extension of business places, or railway companies, a pro rata amount of suitable accommodation, in or near the neighbourhood, ought to be insisted upon before any displacement of persons is allowed; and, further, that when new buildings have been erected the displaced tenants should have the first refusal of them. In this connection it may be mentioned that 260 houses have been condemned by the Vestry under the Housing of the Working Classes Act, and these have been closed and demolished, or rendered fit for human habitation; whilst under the Public Health Acts over 36,000 notices have been served, having reference to over 50,000 sanitary works of a structural (and permanent), or non-structural, character. Further, there have been registered under the Bye-laws for Houses Let in Lodgings over 400 houses, inhabited by over 4,000 of the working classes, containing over 2,300 rooms. These houses are under constant inspection, and great improvement is noticed in, their general condition. The Bye-laws were approved by the Vestry on January 21st, 1897, and confirmed by the Local Government Board on May nth, 1897. (f) Combined Drainage. On the 8th December, 1898, the Vestry adopted a series of important recommendations on Combined Drainage, which were 13 brought up by a conjoint Committee of the Sewers and Sanitary Committees. These recommendations are set out in full on pages 2148-9 of the 1898 Minutes, and practically approve of Combined Drainage for new buildings, under certain conditions, e.g., (a) all drains to be outside; (b) no more than six houses to be allowed to drain into one combined system, if only one interceptor from the main sewer is provided; (c) where more than six houses are approved, the main drain to be placed at the rear of the houses, and treated separately as to ventilation, etc., and into this back line of drainage each house to be drained separately, and separately intercepted and ventilated. (g) Sewer Ventilation. A series of recommendations (conjointly suggested by the Medical Officer and the Surveyor) were adopted by the Vestry on the 13th April, 1899. The recommendations were to be carried out subject to the previous approval of the Vestry, and will be found to be fully set out on pages 700-1 of the 1899 Minutes, and to have reference to the Free Ventilation of Sewers by means of sufficient surface road ventilation in wide roads, supplemented by shafts as may be necessary, together with a careful, regular, and systematic flushing of sewers, and the clearing away of all deposits, or the relaying of such sewers where found to be defective or worn out, together with the substitution of glazed pipes for brick barrel. The closing of all open grids in narrow and crowded streets, courts, alleys, and passages is insisted upon, with the substitution therefor of ventilating shafts of sufficient calibre (not less than six inches), one shaft being taken, if practical, 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. VII.—Routine Work. In addition to the special matters mentioned, there is the Daily Routine Departmental Work, as follows: — 1. Legal Proceedings: Over 36,000 notices have been served, but only in 183 instances (i.e., ½ per cent.) was it 14 necessary to resort to legal proceedings before the Magistrate, the works being satisfactorily completed in all the other cases. 2. Food and Drugs Adulteration Acts: Over 3,000 samples have been procured, and over £600 obtained in penalties and costs. 3. Smoke Observations: Over 700 special smoke nuisances have been dealt with. 4. Workshops: 721 workshops, with 1,261 rooms, in which work 4,145 persons (of whom 2,469 are females) are regularly inspected from time to time. 5. Registers: The Vestry possesses complete Registers of all Workshops, Bake-houses, Cow-houses, Slaughter-houses, Laundries, and Schools in the Parish of Lambeth. 6. Customs and Inland Revenue Acts: In connection with the granting of certificates for exemption from, or abatement of, inhabited house duties, the Medical Officer has personally inspected 448 blocks of houses containing 2,878 tenements, and a large amount of sanitary work has been carried out before certificates have been granted. In connection with No. 4, the Vestry did not adopt the recommendation of the Sanitary Committee to appoint a Female Sanitary Inspector. 15 REPORT ON 1,000 BACTERIOLOGICAL EXAMINATIONS MADE IN THE BOROUGH LABORATORY, BY DR. PRIESTLEY, MEDICAL OFFICER OF HEALTH. The Bacteriological Laboratory was opened last year (1899), at Arlington Lodge, Wanless Road, Loughborough. During the short time that the Laboratory has been in use, the number of examinations that have been made represents a large amount of good work, and fully justifies the late Vestry in having decided, on December 8th, 1898, to "Provide a local Bacteriological Laboratory for the sole use of Medical Men practising in Lambeth Parish." The specimens examined consist of (1) throat membranes and discharges from doubtful Diphtheria cases; (2) Sputa from suspected tuberculosis cases; (3) blood from doubtful typhoid cases, etc., and the details may be tabulated as follow:— Bacilla found or Re-action obtained. Yes. No. Total. Sputa 68 132 200 Blood 97 81 178 Throat Membranes and Discharges 191 429 620 Ulcer of Face (? Anthrax) — 1 1 Urine (? Tubercular) — 1 1 356 644 1000 T ubcrculosis. 200 samples of Sputa from doubtful Tuberculosis cases have been examined, and in 68 (i.e., 34 per cent.) Bacilli found. The great importance of early diagnosis in cases of Consumption needs 16 no comment, when it is remembered that the earlier the proper treatment, the greater the chance of permanent good (if not complete recovery); whilst the good that must accrue from being able to advise patients and their friends that the disease in dispute is not one of Tuberculosis (or Consumption) goes without saying. Typhoid Fever. 178 samples of blood from suspected Typhoid cases have been examined, and in 97 (54.5 per cent.) the characteristic Re-action of Widal has been obtained. This Re-action consists of the cessation of movement, and the agglutination (or clumping), of Typhoid germs, when treated with a drop of serum or blood taken from a patient actually suffering at the time, or previously having suffered, from Typhoid. The great value of this aid to diagnosis in Typhoid fever has been proved recently in connection with outbreaks of the disease that have occurred in Lambeth Parish— many doubtful cases having been discovered by this means, afterwards isolated in hospital, and the further spread of the disease thereby prevented. Several persons were proved to be suffering from Typhoid by means of the Bacteriological test alone (the clinical symptoms being negative); whilst others were shown by this test to be not suffering from Typhoid, though the clinical symptoms appeared to point to the opposite conclusion. Diphtheria. 620 samples of throat membranes and secretions from doubtful Diphtheria cases have been examined, and in 191 (i.e., 30.8 per cent.) the true Klebs-Loèffler Diphtheria-Bacilli obtained. In this way, on the one hand, patients suffering from true Diphtheria have been properly isolated in Hospital, and the necessary precautions taken to prevent the extension of the disease; whilst on the other hand, patients suffering from doubtful Diphtheria, have not been sent to Hospital, and thereby run the risk (an actual one at times) of contracting the real disease whilst there. Again, there are infectious sore throats other than diphtheritic, and by means of Bacteriological examinations such throats are, at times, found to be associated with the Pseudo-Bacilli of Hoffman. These pseudo-cases can be thus discovered and isolated, and the 17 disease prevented thereby from spreading from person to person. A serious outbreak of infectious sore-throats in connection with a school in Lambeth has been most successfully dealt with recently by means of bacteriological diagnosis, i.e., by finding out the cases (some exceedingly mild, and therefore unrecognisable without Bacteriology). Out of a total of 137 scholars, 57 suspicious throats were from time to time examined bacteriologically, with the result that 48 showed the presence of bacilli—4, the KlebsLoeffler (true Diphtheria) Bacilli and 38 the Hoffman (pseudodiphtheria) Bacilli. The 4 cases of Diphtheria were at once sent to the Hospital, whilst the 38 pseudo-patients were isolated in a special isolation house belonging to the school, but distinct and away from the main building, and not allowed to return to the main building until further bacteriological examination of their throats failed to show the pseudo-Bacilli. This necessitated a total of 145 Bacteriological examinations and re-examinations. Only one adult (the porter) was affected out of a total of 28 adults (teachers and servants) employed in the school. The sanitary state of the school premises is good, the drains have been recently re-laid and the sanitary arrangements remodelled under my own supervision, and in accordance with my own suggestions, and the outbreak goes to show in a marked degree that Diphtheria and pseudo-Diphtheria are not necessarily associated with, or the result of, defective drains and insanitary conditions. The preventive measures which I suggested, and which were strictly carried out by the Medical Attendant, may be mentioned. The scholars were carefully watched from day to day, suspicious throats swabbed and examined bacteriologically, and afterwards isolated, or not, according as such examinations gave positive or negative results. In this way the whole of the doubtful cases were separated out, and kept under observation in an isolated building, where they remained until such time as further bacteriological examinations shewed the scholars throats to be free from infection. Then, and not till then, were the scholars gradually drafted back into the school, after their clothes and persons had K 18 been efficiently disinfected. The result justified the means taken, as the outbreak of pseudo-Diphtheria has been stamped out; whilst, although pseudo-throats appear, in the light of our present knowledge, to form a suitable breeding-ground upon which true Diphtheria may at any time become ingrafted and spread rapidly (the pseudo-Bacilli apparently, at times, changing into the true Diphtheria Bacilli, and vice versâ), only one such true Diphtheria case developed, making a total of 5 Diphtheria cases altogether. It was not necessary to take the extreme measure of closing the school and distributing the scholars over various parts of London and elsewhere—a procedure that may have to be adopted at times e.g., when the school buildings are found to be insanitary, the school attendance much interfered with, etc. Investigation points to the cause of the outbreak of epidemic sore-throats (pseudo-Diphtheria) in connection with the school, being the introduction of the disease from without by some scholar or scholars, on returning from their summer holidays on September 3rd—the first case of sore-throats being noticed on September 7th, followed by 40 fresh cases during the month of September. Other Examinations. A doubtful cas,e of anthrax and a doubtful case of tuberculous urine were examined, but a negative result obtained in each. The value of a Bacteriological examination is as an aid to diagnosis ; it cannot take the place of a clinical examination. Remembering this important fact, the examinations that have been made have proved of the greatest value, not only in settling disputes in diagnosis and clearing up what would otherwise have remained doubtful cases, but also in preventing the spread of infectious diseases, by enabling all cases to be discovered, and outbreaks thereby stamped out, more quickly than could otherwise have been expected. 19 OFFENCES UNDER THE FOOD AND DRUGS, MARGARINE, AND PUBLIC HEALTH ACTS DURING 1900. NATURE OF OFFENCE, AND AMOUNT OF PENALTIES AND COSTS IN EACH CASE. K 2 20 21 Sale of Food and Drugs Act. Offence. Penalty. Costs. £ s. d. £ s. d. On 2nd January, 1900,a summons was heard before Mr. Hopkins, at Lambeth Police Court, re selling Milk containing added Water 10 per cent. 0 0 0 0 12 6 On 11th January, 1900, a summons was heard before Mr. Slade, at Southwark Police Court, re selling Milk from which the Cream had been abstracted to the extent of 43 per cent. 1 0 0 0 12 6 On 28th February, four summonses were heard before Mr. Hopkins, at the Lambeth Police Court, re selling Milk containing added Water 14 per cent. » 40 0 0 10 10 0 On 8th March, two summonses were heard before Mr. Slade, at Southwark Police Court, (a) re selling Milk containing added Water 19 per cent. 2 0 0 0 12 6 (b) Re selling Butter containing Margarine (not butter), 97 per cent. 2 0 0 0 12 6 On 10th April, two summonses were heard before Mr. Garrett, at the South Western Police Court, re selling Coffee containing added Chicory 50 per cent. 2 0 0 0 12 6 Re selling Butter containing Margarine (not butter) 90 per cent. 5 0 0 0 12 6 On 24th April, a summons was heard before Mr. Hopkins, at Lambeth Police Court, re selling Butter containing Margarine (not butter) 90 per cent. 0 12 6 On 25th April, three summonses were heard before Mr. Francis, at Lambeth Police Court, re selling Butter containing Margarine (not butter) 95 per cent. 2 0 0 0 12 6 Re selling Sago consisting of Tapioca granulated to resemble Sago in appearance. ... 0 12 6 Re selling Milk containing added Water 11 per cent. 1 0 0 0 12 6 On 26th April, a summons was heard before Mr. Paul Taylor, at Southwark Police Court, re selling Butter containing Margarine (not butter) 90 per cent. 5 0 0 0 12 6 A summons that was adjourned for sample of milk to be sent to Somerset House, was re-heard on 8th May, before Mr. Garrett, at the South-Western Police Court, re selling Milk containing added Water 8 per cent. The Authorities at Somerset House upheld the Analyst's Certificate. 5 0 0 0 12 6 On 30th May, eight summonses were heard before Mr. Francis, at Lambeth Police Court, re selling Coffee containing added Chicory 60 per cent. 1 0 0 0 12 6 Re selling Milk from which the Cream had been abstracted to the extent of 16 per cent. ... ... Summons was withdrawn, the occupier of the milk-shop having sold the business previously to the sample being taken by the Inspector, and the man who served the Inspector with Milk not having been traced. Re selling Coffee containing added Chicory 40 per cent. 1 0 0 0 12 6 Rs selling Butter containing Margarine (not butter) 35 per cent. 0 10 0 0 12 6 Re selling Milk from which the Cream had been abstracted to the extent of 20 per cent. 1 0 0 1 4 6 Re selling Milk from which the Cream had been abstracted to the extent of 15 per cent. 0 10 0 0 14 6 Carried forward 74 0 0 21 16 0 22 23 Offence. Penalty. Costs. £ s. d. £ s. d. Brought forward 74 0 0 21 16 6 Re selling Milk from which the Cream had been abstracted to the extent of 12 per cent. 0 10 0 0 14 6 Re selling Milk containing added water 5 per cent. In this case the Magistrate dismissed the summons. ... ... On 19th June three summonses were heard before Mr. Smith, at the South-Western Police Court, re selling Butter containing Margarine (not butter) 85 per cent. 0 5 0 0 12 6 Re selling Coffee containing added Chicory 45 per cent. 0 10 0 0 12 6 Re selling Butter containing Margarine (not butter) 97 per cent. 0 10 0 0 12 6 On 27th June three summonses were heard before Mr. Hopkins, at Lambeth Police Court, re selling milk from which the Cream had been abstracted to the extent of 14 per cent. (Summons withdrawn owing to burst bottle). ... ... Re selling Butter containing Margarine (not butter) 90 per cent. 2 0 0 0 12 6 Re selling Coffee containing added Chicory 63 per cent. 2 0 0 0 12 6 On 18th July, three summonses were heard before Mr. Hopkins, at the Lambeth Police Court, re selling milk from which the Cream had been abstracted to the extent of 12 per cent. ... 0 12 6 Re selling Coffee containing added Chicory 75 per cent. 0 10 0 0 12 6 Re selling Coffee containing added Chicory 75 per cent. ... 0 12 6 On 8th August four summonses were heard before Mr. Kennedy, at Southwark Police Court, re selling Coffee containing added Chicory 46 per cent. 0 10 0 0 12 6 Re selling Milk containing added Water 7 per cent. 5 0 0 0 12 6 Re selling Milk containing added Water, 6 per cent. 2 0 0 0 12 6 Re selling Butter containing added Margarine (not butter) 98 per cent. 4 0 0 0 12 6 On 20th September, two summonses were heard before Mr. Sheil, at Westminster Court, re selling Butter containing Margarine (not butter) 88 per cent. 0 10 0 0 12 6 Against the same defendant for selling Butter containing Margarine (not butter) 93 per cent. 0 10 0 0 12 6 On 25th October three summonses were heard before Mr. Sheil, at Lambeth Police Court, re selling Coffee containing added Chicory 25 per cent. 0 5 0 0 12 6 Re selling Coffee containing added Chicory 70 per cent. 0 5 0 0 15 6 Re selling Coffee containing added Chicory 60 per cent. 0 5 0 0 12 6 On 15th November, two summonses were heard before Mr. Sheil, at Westminster Police Court, re selling Milk containing added Water 5 per cent. 2 0 0 1 13 0 On 22nd November a summons was heard before Mr. Francis, at Lambeth Police Court, re selling butter containing Margarine (not butter) 88 per cent. 2 0 0 0 12 6 Carried forward 97 10 0 35 9 0 24 25 . Offence. Penalty. Costs. £ s d. £ d. Brought forward 97 10 0 35 9 0 On 29th November, two summonses were heard before Mr. Francis, Lambeth Police Court, (a) Re selling Butter containing Margarine (not butter) 95 per cent. 1 0 0 0 12 6 (b) Re selling sample of Milk from which the Cream had been abstracted to the extent of 12 per cent. Defendant gone to South Africa. Adjourned sine die. ... ... On the 12th December a summons was heard before Mr. Smith, at Westminster Police Court, re selling Milk containing added Water 11 per cent. 0 10 0 0 12 6 On nth December a summons was heard before Mr. Francis, at Lambeth Police Court, re selling Butter containing Margarine (not butter), 66 per cent. Summons dismissed owing to a clerical error in the Analyst's Certificate. ... ... Margarine Act, 1887. On 2 3rd January, a summons was heard before Mr. Hopkins, at the Lambeth Police Court, re exposing a parcel of Margarine for sale by retail, without having a label attached and marked in capital letters 1½in., "Margarine." 0 10 0 0 12 6 On 15th February an adjourned summons was heard before Mr. Slade, at Southwark Police Court, re exposing two parcels of Margarine by retail, without having a label attached and marked in capital letters ½in., "Margarine." On 30th May, five summonses were heard before Mr. Francis, at Lambeth Police Court, re exposing a parcel of Margarine by retail without having the parcel marked, in capital letters 1½in., "Margarine." 2 1 0 0 0 0 1 0. 6 12 0 6 Re selling Margarine by retail, and not wrapped in paper on which was printed in capital letters, not less than ½in. square, "Margarine." ... 0 12 6 Re exposing a parcel of Margarine by retail, without having a label attached, and marked in capital letters 1½in., "Margarine." 1 0 0 0 12 6 Re exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½in., "Margarine." 0 10 0 0 12 6 Re exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½in., "Margarine." ... 0 12 6 On December 12th a summons was heard before Mr. Smith at Westminster Police Court re exposing a parcel of Margarine by retail without having a label attached and marked in Capital Letters 1½in., "Margarine." 0 10 0 0 12 6 Total 104 10 0 42 6 6 26 Public Health (London; Act, 1891. Offence. Penaltv. Costs. £ s. d. £ s. d. On 10 January, two summonses were heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with Notice of Vestry to repair defective roof at 31, Wake Street. Order made to do work in seven days. ... 0 4 0 Against same Defendant, for non-compliance with Notice of Vestry to cleanse walls and ceilings and repair defective roof at 30, Wake Street. Order made to do work in 7 days. ... 0 4 0 On 15th January two summonses were heard before Mr. Hopkins, at Lambeth Police Court, against the owner, owing to defective paving, and water supply, and pan to W.C. and damp walls, at 6, Bloxam's Buildings. Order made to do the work in 14 days. ... 0 7 0 Against the owner, for non-compliance with Magistrate's Order to amend the defective house-roof and guttering at 27, Wiltshire Road. 1 0 0 0 4 0 On 31st January, against S. H. Webster, Secretary, South London Electric Supply Corporation,Ltd.,Bengeworth Road, owing to a chimney (not being the chimney of a private dwelling-house) on the 6th day of January, sending forth black smoke in such quantities as to be a nuisance. l0 0 0 0 2 0 Against the owner, for non-compliance with Notice of Vestry to cleanse the dirty basement walls and ceilings at 360, Coldharbour Lane. Summons dismissed, as the Magistrate considered that the tenant should have done the work; but no costs allowed. ... ... On 12th February, an adjourned summons was heard before Mr. Hopkins, at Lambeth Police Court, against the Owner, c/o Messrs. Inman & Brown, 7, Bedford Row, W.C., for non-compliance with Notice of Vestry to reconstruct the drain at Nos. 13, 14 and 15, Stockwell Green. Summons dismissed without costs, the Magistrate holding that the Vestry was liable, the combined drain being a sewer. ... ... On 2nd May, two Summonses were heard before Mr. Paul Taylor, at Southwark Police Court, against the owner, for non-compliance with Magistrate's Order to put into proper order and condition the roof and damp condition of the houses, Nos. 12 and 13, Sapphire Place. 8 0 0 0 4 0 On 10th April, 2 Summonses were heard before Mr. Paul Taylor, at Southwark Police Court, against the owner, for non-compliance with notice of Vestry to cleanse ceilings and walls, and repair roof and yard paving at Nos. 10 and 11, Sapphire Place. Order made for work to be carried out within 30 days. ... ... Against same defendant for non-compliance with Notice of Vestry to repair roof and gutter, and remedy damp state of walls at 12 and 13, Sapphire Place. Order made for premises to be closed and owner to pay 5s. costs. (Inspector was also instructed to take out summonses to recover penalties. ... 0 5 0 On nth April, 2 summonses were heard before Mr. Hopkins, at Lambeth Police Court, against S. H. Webster, Secretary, South London Electric Supply Corporation, Ltd., that at the Works, Bengeworth Road, on 9th and 19th March, 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. 10 0 0 2 2 0 Carried forward 29 0 0 3 12 0 27 28 29 Offence. Penalty. Costs. £ s. d. £ s. d. Brought forward 29 0 0 3 12 0 Against the Secretary of the New London Brewery Co., Ltd., Durham Street, Vauxhall, that on the 9th March 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. 7 10 0 0 2 0 Against Alfred Wall, Builder, 50, Walcot Square, repairing a drain and W.C. in such a manner as to be a nuisance, and a second summons for failing to give notice with reference to above. 0 5 0 0 2 0 On 29th June five summonses were heard before Mr. Francis, at Lambeth Police Court, against the owner of 104, Tyers Street, (a) For failing to provide a proper water supply to water closet at No. 104, Tyers Street. 0 10 0 0 2 0 (b) Against same defendant, for failing to provide a metal dust-bin at No. 104, Tyers Street. 0 10 0 0 2 0 (c) Against same defendant, for failing to provide a metal dust-bin at No. 102, Tyers Street. 0 10 0 0 2 0 (d) Against same defendant, for failing to put the drains into proper order and condition at No. 102, Tyers Street. (Order made to do work in fourteen days. ... 0 4 0 (e) Against same defendant, for failing to put the water closet into proper order and condition at 102, Tyers Street. 1 0 0 0 2 0 On 4th July, three summonses were heard before Mr. Hopkins, at Lambeth Police Court, against H. H. Boyer, Secretary, South London Electric Supply Corporation, Limited, that at the works, Bengeworth Road, on 3rd and 4th June, and 23rd May, 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. 30 0 0 0 6 0 On 18th July, 2 summonses were heard before Mr. Kennedy, at Southwark Police Court, 0 2 0 (a) Against the occupier, owing to a room on ground floor being so overcrowded as to be injurious to health at No. 2, Bond Place. ... 0 2 0 (b) Against the occupier of 2, Bond Place, for the same offence. Order made to abate nuisance. On 30th August, a summons was heard before Mr. Sheil, at Westminster Police Court, against the occupier, for depositing at 17, Wandsworth Road, for the purpose of preparation for sale, certain articles of food, to wit: 3 pieces of beef, 5 pieces of pork, and some sausage meat (23lbs. in all), which were unsound, unwholesome, and unfit for the food of man. Summons was dismissed, as there was not sufficient evidence that it was deposited for sale. ... ... On 31st August, 2 summonses were heard before Mr. Sheil, at Westminster Police Court, (a) Against the carter for removing offensive matter, viz., stinking bones, from 71A, Ehelred Street, contrary to the Bye-laws of the L.C.C. ... 0 2 0 (b) Against the employers of the carter for offence as above. The whole of the responsibility was accepted by Messrs. Makins. 2 0 0 0 2 0 On 5th September, 2 summonses were heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with Notice of Vestry to provide a water supply to the closet at No. 24, Coldharbour Lane. Order made to do work in 21 days. ... 0 4 0 Carried forward 71 5 0 5 6 0 30 31 Offence. Penalty. Costs. £ s. d. £ s. d. Brought forward 71 15 0 5 6 0 Against the owner, for non-compliance with notice of Vestry to repair closet and drain at No. 25, Burton Road. Order made to do work in 14 days. ... 0 4 0 On 6th September, 5 summonses were heard before Mr. Francis, at Westminster Police Court, against the owner, for non-compliance with Notice of Vestry to repair the gutter at No. 1, Tinman Court; to repair common dustbin in Tinman Court; to cleanse ceilings and repair flush cistern and yard paving at 26, Wake Street; to repair yard paving at 27, Wake Street; to cleanse walls and ceilings, repair flushing cistern, yard paving, and dustbin at 29, Wake Street. The Magistrate made orders in these 5 cases for the owner to do the work within 14 days. ... 1 0 0 On 7th September a summons was heard before Mr. Sheil, at Westminster Police Court, against the Secretary of the New London Brewerv Co., Ltd., Durham Street, owing to a chimney (not being the chimney of a private dwelling-house), on the 2nd day of August, 1900, sending forth black smoke in such quantity as to be a nuisance. Summons was withdrawn for the purpose of amendment. ... ... On 26th September a summons was heard before Mr. Francis, at Lambeth Police Court, against the owners, for non-compliance with Notice of Vestry to repair walls of W.C., and yard paving, etc., at No. 17, Brigton Terrace. Magistrate adjourned the summons for 21 days, owing to the work having been zarted. ... ... On 3rd October, a summons was heard before Mr. Francis, at Lambeth Police Court, against the owner, for non-compliance with Magistrate s Order to put the water-closets, rain-water and sink waste pipes into proper order and dition at 25, Burton Road. Summons' adjourned for 14 days to enable the owner to complete the works. ... ... On 18th October, a summons was heard before Mr. Sheil, at the Westminster Police Court, against the Secretary to the New London Brewery Ltd.,Durham Street, Vauxhall, owing to a chimney (not being the chimney of a private dwelling-house) on the 2nd day of August, at the Brewery, Dutham Street, sending forth black smoke in such quantity as to be a nuisance. 10 0 0 0 4 0 On 3oth October, a summons was heard before Mr. Slade at the Southward Police Court, against the owner, owing to the walls and ceilings of the ground back room at 26, Tanswell Street, being dirty and dilapidated. ... 0 2 0 On 18th October, a summons was heard before Mr. Sheil, at the Westminster Police Court, against the occupier, owing to the premises, 378, kennington Road, being an occupied dwelling-house without a water supply. Closing order made. ... 0 6 0 On 18th October, a summons was heard before Mr. Sheil, at the Westminster Police Court, against the owner, for non-compliance with notice of Vestry to put the drains into proper order and condition at No. no. Lambeth Walk. Order made to do the work within 21 days. ... 0 6 0 ON 31st October, a summons was heard before Mr. Hopkins, at the Lambeth Police Court, against H. H. Bover, Secretary of the South London Electrical Supply Corporation, Limited, Bengeworth Road, owing to a complaint from ten inhabitants of Lambeth, re Effluvium Nuisance at the Electrical Supply Works, Bengeworth Road. Action was taken under Sect. 21 Public Health (London) Act, 1891, the memorialists proving the nuisance. ... ... Summons adjourned sine die, the Defendants undertaking to burn no more refuse in the Destructor attached to the works. Carried forward 81 5 0 7 8 0 32 33 Offence. Penalty. Costs. £ s. d. £ s d. Brought forward 81 5 0 7 8 0 On 5th November, a summons was heard before Mr. Garrett, at the South Western Police Court, against the owner, owing to a complaint from ten inhabitants of Lambeth re effluvia from the Down Farm Stables, Knight's Hill Road, West Norwood. Action was taken under Section 21 Public Health (London) Act, 1891, the Vestry's officers proving the nuisance. Waggon was to be provided as suggested by the Medical Officer. 1 0 0 3 3 0 On 16th November, four summonses were heard before Mr. Sheil, at Westminster Police Court, (a) Against the occupier, for non-compliance with Magistrate's Order prohibiting use of dwelling-house at 378, Kennington Road, owing to there being no water supply. Magistrate declined to inflict any penalty and dismissed the Summons. (b) Against the occupier for exposing for sale, at 46, Wake Street Lambeth Walk, certain animals, viz.:-six rabbits intended for the food of man which were unsound, unwholesome, and unfit for the food of man. 0 10 0 0 5 6 (c) Against the occupier at 63, Paradise Street, exposing for sale certain articles intended for the food of man, viz. about five bushels of apples which were unsound, unwholesome, and unfit for the food of man. 0 10 0 0 5 6 (d) Against the owner of 30, Prince's Road for non-compliance with notice of Vestry to make the premises, 30, Prince's Road, fit for human habitation. Premises ordered to be closed. 0 6 0 On 12th December, ten adjourned summonses were heard before Mr. Hopkins, at Lambeth Police Court, against Mr. H.H. Boyer, Secretary to the South London Electric Supply Corporation, Limited, Bengeworth Road, for non-compliance with Notices of Vestry, to wit: A chimney (not being the chimney of a private dwelling-house) did, on the 1st, 2nd, 5th, 6th, 7th, 8th, 10th, 12th, 13th, and 14th of November last send forth black smoke in such quantity as to be a nuisance. 100 0 0 10 10 0 On 7th December a summons was before Mr. Shiel, at Westminster Police Court, against the occupier, for non-compliance with Magistrate's Order to provide a water supply at No. 378, Kennington Road. 2 0 0 0 2 0 185 5 0 22 0 0 34 35 Lambeth Parish.—Deaths Registered from all Causes during the Year 1900. 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. I. Specific Febrile, or motic Diseases 128 110 8 106 217 216 12 25 2 9 10 8 11 6 28 20 27 34 11 11 22 27 4 14 127 154 344 370 714 II. Parasitic Diseases 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 3 1 4 III. Dietic Diseases 4 ... ... ... 4 ... ... ... ... ... ... ... 1 ... 2 11 12 11 3 ... 1 1 ... ... 19 23 23 23 46 IV. Constitutional Diseases 39 46 55 54 94 100 16 13 10 7 12 17 24 24 131 97 194 148 33 40 56 62 5 9 481 417 575 517 1092 V. Developmental Diseases 135 92 2 ... 137 92 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 29 30 24 66 53 98 190 190 380 VI. Local Diseases 291 212 116 110 407 352 14 20 9 14 21 18 23 26 107 103 320 260 105 115 312 357 61 136 972 1049 1379 1401 2780 VII. Deaths from Violence 24 21 13 5 37 26 5 2 2 2 4 ... 4 2 24 10 37 15 4 1 7 7 1 5 88 44 125 70 195 VIII. Deaths from Ill-defined and not Specified Causes 106 87 3 3 109 90 ... ... ... ... ... ... ... 1 ... 2 ... 7 1 1 2 5 ... 1 3 17 112 107 219 Totals 730 598 278 278 1008 876 47 60 23 32 47 43 63 59 292 243 590 477 157 169 429 189 95 231 1743 1803 2751 2679 5430 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 14 8 85 20 39 28 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 39 30 69 Whooping Cough 24 21 17 33 41 54 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 41 56 97 Scarlet Fever 1 ... 7 5 8 5 2 4 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 3 4 11 9 20 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 Enteric er Typhoid Fever ... ... 2 ... 2 ... ... 1 ... 3 6 4 6 1 11 10 4 5 ... ... ... 1 ... ... 27 25 29 25 54 Diphtheria ... 3 29 34 29 37 10 16 2 3 ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... 13 22 42 59 101 Membranous Croup ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Influenza 4 4 ... 4 4 8 ... ... ... 3 2 2 3 3 11 5 19 21 8 8 15 23 4 13 62 78 66 86 152 Other Miasmatic Diseases ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Cholera, Nostras 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 2 3 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 65 61 9 7 74 68 ... ... ... ... ... ... ... 1 1 ... 1 2 ... 1 2 2 ... 9 4 7 78 75 153 Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 1 Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 17 11 ... ... 17 11 ... ... ... ... ... ... ... ... 3 1 1 1 1 ... ... ... ... ... 5 2 22 13 35 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 ... 2 Erysipelas 2 ... ... 1 2 1 ... ... ... ... ... 1 ... ... ... ... 2 2 1 2 3 1 ... ... 6 6 8 7 15 Pyæmia, Septicæmia ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 1 ... ... ... ... ... ... ... ... 4 1 4 1 5 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... 3 ... 3 3 Thrush, and other Vegetable Parasitic Diseases 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 Want of Breast Milk, Starvation 4 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 4 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 11 10 11 3 ... 1 1 ... ... 16 23 16 23 39 Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... 3 ... 3 ... 3 Rheumatic Fever ... ... ... ... ... ... 1 1 1 ... 2 ... 1 ... 1 5 1 1 ... ... ... ... ... ... 7 7 7 7 14 Rheumatism of the Heart ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 36 37 Lambeth Parish.—Deaths Registered from all Causes during the Year 1900. 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 ... 1 1 ... ... 1 2 ... 1 3 4 4 4 8 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 ... 2 1 1 ... 6 3 6 3 9 Rickets 1 1 5 3 6 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 4 10 Cancer, Malignant Disease ... ... 1 ... 1 ... 1 1 ... ... ... ... 2 2 8 18 48 72 16 25 38 47 1 8 114 173 115 173 288 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 10 17 5 8 15 25 ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 3 17 28 45 Tuberc-Meningitis, Hydrocephalus 10 15 22 18 32 33 6 6 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 7 7 39 40 79 Phthisis 6 3 11 7 17 10 1 1 3 4 10 13 18 20 109 65 132 68 12 13 11 8 1 ... 297 192 314 202 516 Scrofula 2 3 1 ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 6 Other forms of Tuberculosis 8 7 10 17 18 24 5 3 3 3 ... 1 1 1 10 3 2 1 ... ... ... ... ... ... 21 12 39 36 75 Purpura, Hæmorrhagic Diathes's 1 ... ... 1 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 2 2 4 Anaemia, Chlorosis, Leucocythæmia ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 1 ... ... ... ... ... 4 1 4 1 5 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... ... ... ... ... ... 1 2 1 1 4 6 1 1 1 2 1 2 ... 14 9 14 9 23 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... 1 1 2 2 ... ... 4 5 4 5 9 Premature Birth 106 69 ... ... 106 69 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 106 69 175 Atelectasis 14 7 ... ... 14 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 7 21 Congenital Malformations 15 16 2 ... 17 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 16 33 Old Age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 29 30 24 66 53 98 53 98 151 Inflammation of Brain or Membranes 9 15 11 7 20 22 1 ... 1 ... ... ... ... 1 1 2 3 ... ... ... ... 1 ... ... 6 4 26 26 52 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 3 1 ... 1 3 2 ... 2 ... ... 3 ... ... ... 2 6 26 33 7 17 58 53 10 31 106 142 109 144 253 Insanity, General Paralysis of Insane ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 8 7 19 7 1 3 10 13 3 4 42 35 42 35 77 Epilepsy ... 1 ... 2 ... 3 ... ... ... ... 2 1 1 1 ... 1 6 1 2 1 2 1 ... 1 13 7 13 10 23 Convulsions 37 27 7 3 44 30 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 45 32 77 Laryngismus Stridulus (Spasm of Glottis) 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 3 ... 6 1 3 ... 2 6 ... ... 14 7 14 8 22 Other Diseases of Nervous System 4 4 2 2 6 6 1 ... ... 1 1 ... 1 1 3 3 3 6 1 2 2 2 ... 1 12 16 18 22 40 Diseases of Ear, Eve, Nose ... 1 ... ... ... 1 ... 1 ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... 3 1 3 2 5 Pericarditis 2 1 ... ... 2 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... 4 1 5 Acute Endocarditis ... ... ... ... ... ... 1 ... 2 ... 1 2 ... ... 4 1 2 3 ... 1 ... 2 ... 1 10 10 10 10 20 Valvular Diseases of Heart ... ... ... ... ... ... ... 1 ... 5 1 3 1 3 14 6 16 18 7 7 13 16 2 2 54 61 54 61 115 Other Diseases of Heart 3 4 ... 2 3 6 ... 1 2 4 1 1 2 1 10 12 35 24 16 20 48 39 5 26 119 128 122 134 256 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 5 2 1 ... ... ... ... ... 8 4 8 4 12 Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 2 4 6 ... ... 5 9 5 9 14 Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 ... ... ... 2 3 10 5 10 5 15 Laryngitis ... ... 2 3 2 3 1 ... ... ... ... ... ... ... 1 ... 2 2 ... ... 1 ... ... ... 5 2 7 5 12 Croup ... ... 4 3 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 7 Emphysema, Asthma ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 5 3 1 7 4 1 2 11 12 12 12 24 Bronchitis 71 60 26 24 97 84 2 2 ... 1 ... ... ... 1 4 9 40 42 33 28 79 122 26 43 184 248 281 332 613 Pneumonia 20 16 14 16 34 32 1 2 2 1 3 ..... 7 ... 21 !8 64 26 5 6 13 17 2 4 118 64 152 96 248 Pleurisy 1 1 ... 1 1 2 ... ... ... ... ... ... ... ... 1 1 4 4 1 ... ... 2 ... ... 6 7 7 9 16 Bronchopneumonia 22 35 25 28 47 63 1 4 ... ... ... 1 1 ... 4 2 7 7 2 5 12 7 1 3 28 29 75 92 167 Pleuropneumonia ... ... ... 5 ... 2 ... ... ... ... ... ... ... 2 3 1 3 1 ] 1 ... ... ... ... 7 5 7 7 14 Other Dis. of Respiratory System 9 5 ... 2 9 7 ... ... ... ... ... ... ... ... 1 2 8 2 3 1 6 6 1 ... 19 16 28 23 51 Dentition 9 5 6 3 15 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 8 23 Sore Throat, Quinsy 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... 3 ... 3 Diseases of Stomach 7 3 4 ... 11 3 ... ... ... ... ... 2 ... ... 3 4 2 5 1 .. 1 1 ... ... 7 12 18 15 33 Enteritis 59 37 9 5 68 42 2 1 2 ... 2 1 1 2 4 5 2 9 .. 1 3 5 ... 1 16 25 84 67 151 38 39 Lambeth Parish.-Deaths Registered from all Causes during the year 1900. ages. Totals. Under 1 year. 1-5 Under 5 years. 5-10 10-15 15-20 20-25 25-40 40-60 60-65 65-80 80 and over. Over 5 Years. All Ages. M. F. m. F. M. F. M. F. M. F M. F. M. F. M. F. M. F M. F. M. F M. F. M. F. M. F. ... 1 1 ... 3 ... 2 4 ... 2 6 5 ... ... 12 13 16 17 33 Obstructive Diseases of Intestine 4 3 ... 1 4 4 ... 1 ... ... Peritonitis 2 ... ... 1 2 1 ... 1 ... ... 2 ... 1 4 ... 4 1 1 1 ... 2 ... ... ... 7 10 9 11 20 Ascites ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Cirrhosis of Liver ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 5 17 20 2 6 8 10 1 ... 29 41 30 41 71 Jaundice and other Diseases of Liver 3 1 ... 1 3 2 ... ... ... ... ... ... ... ... 1 3 6 7 ... 1 3 7 ... 2 10 20 13 22 35 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive Systen 16 13 2 ... 18 13 1 1 ... ... ... ... 1 ... 2 ... 2 3 1 ... 1 4 ... 1 8 9 26 22 48 Diseases of Lymphatics and of Spleer ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... 2 3 2 4 6 Bronchocele, Addison's Disease ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis 1 ... 1 ... 2 ... ... ... ... ... ... ... 1 1 ... 1 2 3 1 2 2 3 ... ... 6 11 8 11 19 Bright's Disease, Albuminuria ... ... ... 1 ... 1 1 ... ... ... ... ... ... 1 4 2 28 13 8 5 12 11 1 4 55 36 55 37 92 Disease of Bladder or of Prostate .. ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 6 2 6 1 13 3 13 3 16 Calculus (Stone) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 1 1 2 Other Diseases of the Urinary System 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 2 3 2 2 1 3 6 ... ... 9 12 10 12 22 Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 Female Organs ... ... ... 1 ... 1 ... ... ... ... ... 1 ... 1 ... 5 ... 2 ... 1 ... 1 ... ... ... 10 ... 11 11 Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 4 ... 4 4 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Placenta Prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents or Child Birth ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... 6 2 1 ... ... ... ... ... ... ... 12 ... 12 12 Caries, Necrosis ... 1 1 1 1 2 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... 2 ... ... ... 6 2 7 4 11 Anthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints ... 1 ... ... ... 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 3 1 4 5 Carbuncle, Phlegmon 2 ... ... ... 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 1 ... ... 2 3 4 3 7 Gther Dis. of Integumentary System 4 5 ... ... 4 5 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... 1 1 4 5 3 14 Fractures and Contusions ... 1 3 1 3 2 2 ... ... 1 1 ... 1 ... 6 2 11 1 1 ... 3 6 1 4 26 14 29 16 45 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... 18 Burn, Scald ... 1 5 1 5 2 ... 2 ... ... ... ... ... 1 1 1 3 2 ... ... ... 1 ... ... 4 7 9 9 7 Poison ...... ... 2 ... 2 ... 1 ... ... ... ... ... 1 1 ... 1 1 ... 1 1 ... ... ... ... 2 3 4 3 14 Drowning 1 ... ... ... 1 ... ... ... 2 1 ... ... ... ... 1 1 4 1 ... ... 1 ... ... ... 10 3 11 3 40 Suffocation 21 15 1 2 22 17 ... ... ... ... 2 ... 1 ... ... ... ... ... 2 ... 1 ... ... ... 1 ... 23 17 43 Otherwise 2 3 2 1 4 4 2 ... ... ... ... ... ... ... 10 3 10 3 ... ... 1 ... ... 1 28 7 3 11 1 Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Murder ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... 1 1 1 2 3 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... 2 2 2 2 4 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 ... ... ... ... ... ... 2 3 2 3 5 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 1 2 1 2 3 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... 1 ... ... ... 3 1 3 1 4 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... ... ... ... ... ... ...... 5 ... 5 ... 5 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 100 82 1 3 101 85 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 3 101 83 189 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... 3 ... 3 3 Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 1 Abscess ... 2 ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... 3 ... 5 5 Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined 6 3 2 ... 8 3 ... ... ... ... ... ... ... ... ... 2 ... 3 1 ... 2 1 ... 1 3 7 11 10 21 40 41 Lambeth Parish.—Deaths Registered from all Causes during the Year 1900. Sub-Districts 1 2 3 4 5 6 7 8 No Address. All Ages. Total. M. F M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. I. Specific Febrile, or Zv- moric Diseases 21 23 31 18 20 27 56 51 42 64 54 61 85 93 26 26 9 7 344 370 714 II. Parasitic Diseases ... ... ... ... ... ... 1 ... ... 1 2 ... ... ... ... ... ... ... 3 1 4 III. Dietic Diseases 1 1 ... 1 3 2 1 1 9 3 2 5 5 8 ... 1 2 1 23 23 46 IV. Constitutional Diseases 35 23 37 22 52 43 88 91 117 82 73 68 122 131 35 45 16 12 575 517 1092 V. Developmental Diseases 10 7 13 11 12 11 22 24 49 44 23 23 50 54 10 15 1 1 190 190 380 VI. Local Diseases 83 84 76 83 110 96 215 195 272 236 157 195 286 347 117 120 63 45 1379 1401 2780 VII. Deaths from Violence 14 6 7 6 5 5 21 10 31 14 20 5 18 15 7 5 2 4 125 70 195 VIII. Deaths from Ill-defined and not specified Causes 12 7 4 2 9 8 23 21 18 15 9 14 24 24 13 15 ... 1 112 107 219 Totals 176 151 168 143 211 192 427 393 538 459 340 371 590 672 208 227 93 71 2751 2679 5430 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 6 6 1 ... 1 3 2 2 4 2 5 13 9 8 2 ... ... 39 30 69 Whooping Cough 1 2 4 7 4 4 6 12 4 5 10 7 11 18 1 1 ... ... 41 56 97 Scarlet Fever 1 ... ... ... 1 ... ... ... 1 4 1 1 4 3 2 1 1 ... 11 9 20 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Enteric or Typhoid Fever 1 1 ... ... ... 2 8 6 8 6 4 3 6 5 ... 2 2 ... 29 25 54 Diphtheria 4 6 7 4 1 5 9 8 3 10 10 8 6 15 ... 2 2 1 42 59 101 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Influenza 2 ... 3 3 3 3 6 6 7 20 12 25 24 19 8 8 1 2 66 86 152 Other Miasmatic Diseases ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Cholera, Nostras ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 2 3 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 5 7 5 2 9 10 21 12 13 11 8 8 11 15 5 8 1 2 78 75 153 Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 1 5 1 1 1 1 2 2 1 3 1 6 2 2 2 1 2 22 13 35 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... 2 Erysipelas 1 ... ... ... 1 ... 1 1 ... ... 4 3 1 3 ... ... ... ... 8 7 15 Pyæmia, Septicæmia ... ... 1 ... ... ... 1 ... 1 ... ... ... 1 1 ... ... ... ... 4 1 5 Puerperal Fever ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 3 3 Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... 3 ... 3 Worms, Hydarids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Want of Breast Milk, Starvation ... ... ... ... ... ... ... ... 3 ... ... ... 1 ... ... ... ... ... 4 ... 4 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism 1 1 ... 1 2 2 1 1 6 3 2 5 2 8 ... 1 2 1 16 23 39 Delirium Tremens ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... 3 ... 3 Rheumatic Fever ... 1 ... 1 ... 1 ... ... 1 1 1 ... 3 3 2 ... ... ... 7 7 11 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 4 M 42 43 Lambeth Parish.—Deaths Registered from all Causes during the Year 1900. 1 2 3 4 5 6 7 8 No Address. 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 ... ... 1 1 1 1 1 1 ... ... 4 4 8 Gout ... ... ... ... ... ... 1 ... 2 ... 1 1 2 1 ... ... ... 1 6 3 9 Rickets ... ... ... 2 ... ... 1 1 1 1 1 ... 2 ... 1 ... ... ... 6 4 10 Cancer, Malignant Disease 4 5 9 3 8 8 16 23 16 25 19 30 29 53 10 22 4 4 115 13 288 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 1 2 ... 1 1 7 2 1 4 2 2 6 6 7 1 1 ... 1 17 28 45 Tuberc-Meningitis, Hyorocephalus 6 2 3 ... 3 2 3 11 10 4 4 8 7 13 3 ... ... ... 39 40 79 Phthisis 20 11 22 14 32 19 52 38 72 39 33 17 59 47 13 13 11 4 314 202 516 Scrofula ... ... ... ... 1 ... 2 2 ... 1 ... ... ... ... ... ... ... ... 3 3 6 Other forms of Tuberculosis 2 1 2 1 7 6 10 10 5 6 5 3 5 4 2 3 1 2 39 36 75 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... ... ... 2 2 4 Anæmia, Chlorosis, Leucocythæmia ... ... ... ... ... ... ... 1 1 ... 2 ... ... ... 1 ... ... ... 4 1 5 Glycosuria, Diabetes Mellitus 1 1 1 ... ... ... 1 2 2 1 3 ... 5 2 1 3 ... ... 14 9 23 Other Constitutional Diseases ... ... ... ... ... ... ... ... 2 1 ... 2 2 ... ... 2 ... ... 4 5 9 Premature Birth 5 3 10 5 7 6 13 10 21 15 14 6 31 19 5 5 ... ... 106 69 175 Atelectasis 1 1 2 2 3 ... 4 3 4 ... ... ... ... 1 ... ... ... ... 14 7 21 Congenital Malformations 2 16 ... 1 ... 1 1 1 8 9 2 1 3 2 1 ... ... ... 17 16 33 Old Age 2 2 1 3 2 4 4 10 16 20 7 16 16 32 4 10 1 1 53 98 151 Inflammation of Brain or Membranes 1 2 2 3 1 1 4 5 5 3 5 4 6 4 1 4 1 ... 26 26 52 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 6 6 4 6 3 8 10 11 23 19 15 23 30 50 14 16 4 5 109 144 253 Insanity, General Paralysis of Insane 1 2 1 2 2 ... 15 10 4 5 2 3 9 11 ... ... 8 2 42 35 77 Epilepsy ... ... ... 2 ... 1 4 1 4 1 1 ... 3 3 1 ... ... 2 13 10 23 Convulsions *3 3 4 8 3 2 11 2 4 4 8 4 6 8 6 1 ... ... 45 32 77 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Disease of Spinal Cord, Paraplegia, Paralysis Agitans 1 ... ... ... 2 ... 1 ... 1 ... 1 3 3 2 4 2 1 1 14 8 22 Other Diseases of Nervous System ... 2 ... ... ... ... 3 3 2 4 ... 3 10 5 3 2 ... 3 18 22 40 Diseases of Ear, Eye, Nose ... ... ... ... 1 ... ... ... 1 ... ... ... 1 1 ... 1 ... ... 3 2 5 Pericarditis ... ... ... ... ... ... 2 1 1 ... 1 ... ... ... ... ... ... ... 4 1 5 Acute Endocarditis 1 ... ... ... ... 1 3 1 3 2 1 2 ... 3 2 1 ... ... 10 10 20 Valvular Diseases of Heart 8 5 7 4 4 2 10 13 6 15 6 12 10 8 3 1 ... 1 54 61 115 Other Diseases of Heart 6 3 9 3 9 1 17 16 23 25 16 29 27 38 10 13 5 6 122 134 256 Aneurism 1 ... ... ... 1 ... ... 1 1 1 2 ... 2 ... 1 1 ... ... 8 4 12 Embolism, Thrombosis 1 ... ... ... ... 1 ... 1 ... 3 2 ... ... 2 ... ... 2 2 5 9 14 Other Diseases of Blood Vessels 1 ... 1 ... 1 1 1 ... 1 ... 3 ... 1 1 1 2 ... 1 10 5 15 Laryngitis ... 1 ... ... 1 ... ... 1 1 1 3 ... ... 2 2 ... ... ... 7 5 12 Croup ... 1 ... 1 ... ... ... ... 1 1 ... ... ... ... 3 ... ... ... 4 3 7 Emphysema, Asthma 1 ... 2 2 1 1 3 1 ... ... 3 2 1 4 1 2 ... ... 12 12 24 Bronchitis 20 29 12 17 32 25 49 46 51 54 27 49 53 80 22 25 15 7 281 332 613 Pneumonia 10 6 15 5 10 11 18 11 42 13 17 13 27 22 8 9 5 6 152 96 248 Pleurisy 1 1 ... ... 2 ... 1 2 ... 2 ... 2 2 1 ... ... 1 1 7 9 16 Bronchopneumonia 8 3 3 7 7 13 14 16 14 19 5 4 15 18 5 11 4 1 75 92 167 Pleuropneumonia ... ... 1 ... ... ... 2 ... 1 2 2 2 ... 3 1 ... ... ... 7 7 14 Other Dis. of Respiratory System ... 1 2 ... 3 4 5 4 9 3 2 5 5 3 ... 3 2 ... 28 23 51 Dentition ... 1 ... ... 2 ... 4 4 1 ... ... ... 5 2 3 1 ... ... 15 8 23 Sore Throat, Quinsy ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... 3 ... 3 Diseases of Stomach 1 3 ... ... ... ... 2 3 8 1 5 1 2 6 ... 1 ... ... 18 15 33 Enteritis 5 3 8 7 8 4 12 14 22 13 4 5 19 18 3 1 3 2 84 67 151 M 2 44 45 Lambeth Parish.—Deaths Registered from all Causes during the Year 1900. 1 2 3 4 5 6 7 8 No Address. 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 3 2 2 2 4 4 3 3 4 4 ... 1 ... ... 16 17 33 Peritonitis 1 ... ... 1 2 2 ... ... 1 2 1 2 3 1 1 2 ... 1 9 11 20 Ascites ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Cirrhosis of Liver 2 2 1 3 1 5 6 6 5 3 6 6 5 13 2 3 2 ... 30 41 71 Jaundice and other Diseases of Liver 2 ... ... 2 1 2 3 1 3 5 ... 3 3 4 ... 4 1 1 13 22 35 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System ... ... ... 2 3 2 1 1 2 9 3 3 7 5 9 ... 1 ... 26 22 48 Diseases of Lymphatics and of Spleen ... ... ... ... ... ... ... 1 ... ... 1 ... 1 2 ... 1 ... ... 2 4 6 Bronchocele, Addison's Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... 1 1 ... 1 ... 2 5 2 ... 1 2 4 ... ... ... ... 8 11 19 Bright's Disease, Albuminuria 1 3 1 3 4 4 7 4 12 7 9 7 11 6 6 1 4 2 55 37 92 Disease of Bladder or of Prostate ... ... ... ... ... ... 1 ... 3 3 1 ... 4 ... 2 ... 2 ... 13 3 16 Calculus (Stone) ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 2 Other Diseases of the Urinary System ... 3 ... ... ... 1 2 1 3 1 ... ... 2 3 1 2 2 1 10 12 22 Male Organs ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Female Organs ... ... ... ... ... ... ... 3 ... 1 ... 1 ... 3 ... 3 ... ... ... 11 11 Abortion, Miscarriage ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... 4 4 Puerperal Consulsions ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Placenta Prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents of Child Birth ... 2 ... 1 ... ... ... 2 ... 1 ... 1 ... 1 ... 4 ... ... ... 12 12 Caries, Neorosis 1 ... ... 1 1 ... ... 2 3 ... ... ... 2 1 ... ... ... ... 7 4 11 Anthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... 3 1 ... ... ... ... 1 ... ... 1 4 5 Carbuncle, Phlegmon ... ... 1 ... ... ... 1 1 ... 1 ... ... 2 1 ... ... ... ... 4 3 7 Other Dis. of Integumentary System ... 2 ... 1 ... ... ... 1 1 2 ... 1 3 2 1 ... ... ... 5 9 14 Fractures and Contusions 2 1 1 1 ... 1 5 1 9 3 5 ... 5 4 1 2 1 3 29 16 45 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald 1 ... ... 1 1 1 1 1 4 3 1 1 1 1 ... 1 ... ... 9 9 18 Poison 1 ... 1 ... ... ... ... ... ... 1 ... 1 1 1 1 ... ... ... 4 3 7 Drowning 2 ... 2 ... ... 1 2 1 4 ... ... ... ... ... 1 1 ... ... 11 3 14 Suffocation 2 4 1 3 1 2 7 4 4 2 3 1 4 1 1 ... ... ... 23 17 40 Otherwise 3 ... ... 1 2 ... 6 1 7 3 8 2 3 4 2 ... 1 ... 32 11 43 Manslaughter ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Murder 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 2 3 Gunshot Wounds 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 Cut, Stab 1 ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... 2 2 4 Poison ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... 1 ... ... 2 3 5 Drowning ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 2 3 Hanging ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... 3 1 4 Otherwise ... ... 2 ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 5 ... 5 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 12 6 3 2 9 8 21 18 15 12 8 10 23 18 10 13 ... 1 101 83 189 Mortification ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 3 3 Tumour ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Abscess ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 2 ... ... ... ... ... 5 5 Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined ... 1 1 ... ... ... 2 ... 3 1 1 2 1 4 3 2 ... ... 11 10 21 46 SUMMARY OF DEATH RETURNS. No. of Deaths. Total. No. of Deaths. Total. M. F. M. F. I.—Specific Febrile, or Zymotic Diseases. Brought forward 2407 2386 4793 VI.—Local Diseases—continued. 1. Miasmatic Diseases 228 269 497 6. Diseases of Lymphatic System 2 4 6 2. Diarrhœal „ 79 77 156 3. Malarial „ 1 ... 1 7. Diseases of Gland-like Organs of Uncertain Use ... ... ... 4. Zoogenous „ ... ... ... 5. Venereal „ 24 13 37 8. Diseases of Urinary System 87 64 151 6. Septic „ 12 11 23 9. Diseases of Reproductive System— II.—Parasitic Diseases 3 1 4 (a) Diseases of Organs of Generation 1 11 12 III.—Dietic Diseases 23 23 46 (b) Diseases of Parturition ... 17 17 10. Diseases of Bones and Joints 8 8 16 IV.—Constitutional Diseases 575 517 1092 11. Diseases of Integumentary System 9 12 21 V.—Developmental Diseases 190 190 380 VII.—Violence. VI.—Local Diseases 1. Accident or Negligence 109 59 168 1. Diseases of Nervous System 268 277 545 2. Homicide 1 3 4 2. Diseases of Organs of Special Sense 3 2 5 3. Suicide 15 8 23 4. Execution ... ... ... 3. Diseases of Circulatory System 213 224 437 4. Diseases of Respiratory „ 573 579 1152 VIII—Ill-Defined and not Specified Causes. 112 107 219 5. Diseases of Digestive „ 215 203 418 Carried forward 2407 2386 4793 Total 2751 2679 5430 47 SPECIAL REPORT ON THE "COMPULSORY NOTIFICATION OF MEASLES." (Presented to the Vestry, and adopted, on March 1st, 1900). With reference to the letter from the Vestry of Battersea advising that Measles shall be made a notifiable infectious disease in London, I have to state that I have nothing further to add to my Report, which was presented to, and adopted by, the Vestry on the 18th February, 1897 (Annual Report, 1898, page 18), a Report in which I pointed out that Notification was not advisable at present, the expense being out' of all proportion to the benefits likely to be gained, chiefly owing (1) to the want of proper hospital isolation accommodation; (2) to the infectious nature of the disease in its early stages; (3) the very young ages of the patients affected. I am, however, of opinion that much good would accrue from the inclusion of Measles in the term "Dangerous Infectious Diseases," in the Public Health (London) Act, 1891. By this means, the prevention "Sections of the Act (without notification), would apply to Measles, and would be the means of impressing upon the people its dangerous nature, and the importance of stringent measures being taken in connection therewith. It is a common experience in visiting Measles-infected houses, to find infected children out in the street, or at school, instead of being kept indoors to prevent the spread of the disease and the afterconsequences that arise through too early exposure to cold. In only a percentage of cases is it found that medical men are in attendance at all, thus shewing that at present, parents regard the disease as a trifling one, although Measles causes almost as many deaths as the whole of the Notifiable Infectious Diseases combined. Measles is a highly infectious disease, which attacks chiefly young children under the age of five years, amongst whom it causes a high rate of mortality. In Lambeth, during the last ten 48 years, there have been registered 1,570 deaths from measles, as compared with 2,551 deaths from all the notifiable infectious diseases. Measles is, therefore, a dangerous infectious disease, though not so included, as yet, in the Public Health (London) Act, 1891. The Prevention sections of the Act are, 60-66, 68-70, 72-74. By virtue of thes sections, the Vestry's officer's would have authority to prevent children suffering from Measles from exposing themselves, or from being exposed in the public streets, in omnibuses and tramcars, at school, etc., and the power to fumigate with sulphur infected rooms, and to steam-disinfect infected bedding and clothes; whilst parents would become educated to look upon this disease as requiring proper isolation and care to prevent its spread, and the development of its very serious aftereffects, if not death, which are apt to ensue. The prevention sections of the Act do not include the notification of the disease. As the inclusion of Measles within the term "dangerous Infectious Diseases" would not involve any, or but little, additional cost to the ratepayers, I advise the Vestry to approve of such being done, as there is no question but that much good would result. Joseph Priestley, 19th February, 1900. Medical Officer of Health. The Vestry recommended on the above report: — (i) That Measles be placed within the category of ous infectious diseases," but that notification be not made compulsory. (ii) That intimation to this effect be made to the Vestry of Battersea, and also to the London County Council. 49 SPECIAL REPORT ON "REMOVAL OF OFFENSIVE MATTERS." (Presented to, and adopted by, the Vestry on March 29th, 1900). In accordance with Section 114 of the Public Health (London) Act, 1891, which directs that in making Bye-laws which will have to be observed and enforced by any Sanitary Authority, the London County Council shall consider any representation made to them by that authority, I beg to draw attention to the following report made by the Public Health Committee of the London County Council to and adopted by the Council, on the subject of the Bye-laws for the removal of offensive matter, together with a copy of the proposed amended Bye-law. Extract from the Report of the Public Health Committee. We have from time to time received complaints that the hours prescribed by the Council's Bye-law No. 1, under Section 16 of the Public Health (London) Act, 1891, are unduly limited, and that as a consequence difficulties have been experienced in obtaining the collection of fish offal and of fat and bones from butchers' shops and their removal to premises outside the County of London. It has also, been pointed out to us that barges containing fish offal have had to remain in the Limehouse Cut for considerable periods, owing to the tides not serving during the hours prescribed by the Bye-law, and that nuisance has resulted. We think that a case has been made out for some alteration of the Bye-law, and we have been in communication with the Local Government Board on the subject. The Board do not see their way to allow removal either during the night or during the hours of the day when the streets are crowded (especially during the heat of summer), but they have intimated their willingness to agree to the following hours for removal by road: — 5 to 10 a.m., March to October, inclusive. 6 to 11 a.m., November to February, inclusive; and Two hours before sunset to one hour after sunset all the year round. 50 The existing hours are 4 to 10 a.m. from March to October, inclusive, and 6 a.m. to 12 noon from November to February, inclusive. As regards removal by water, the Board agree to the whole period between sunrise and sunset all the year round. We think that the extension of hours which the Board are prepared to approve will be of substantial benefit, although it will not remove all the difficulties to which our attention has been called. Indeed, they could only be overcome by allowing removal during the night, and to this the Board strongly object, as it is then impossible to see that the refuse is not slopped or spilled, and that the vehicles conveying it are properly covered. The existing Bye-law does not apply to the carriage of horse dung manure. Repeated complaints have been made to the Council of nuisance occasioned by the removal of peat moss littsr, and after careful inquiry we think that all manure, with the exception of that consisting only of horse dung and a sufficient proportion of straw, should be required to be removed in properlycovered receptacles. The Local Government Board are prepered to agree to this. The proposed alterations in time are shown in the following table:— Existing Hours. Suggested Hours. Removal by (a) Road, or (b) (a) Removal by Road. Water. a.m. to 10 a.m., March to 5 a.m. to 10 a.m. October. 6 a.m. to 12 noon, November 6 a.m. to u a.m., and to February. Two hours before sunset to one hour after sunset all the year round. (b) Removal by Water. The whole period between sunrise and sunset all the year round. 51 Further, the Bye-law, in its amended form, is to apply to the removal of all manure, with the exception of that consisting only of horse dung with a sufficient proportion of straw, or of manure consisting of horse dung and litter other than straw, in properly covered receptacles. With regard to the change of time in the morning for removal by road, there is no objection. Nor is there any objection to the extension of the hours during which offensive matter may be removed by water. The additional time suggested for removal by road, namely, from two hours before sunset to one hour after sunset all the year round, will be found to cause a nuisance—at least, if the present kind of receptacle (viz., a tank-van) is allowed. Storage receptacles, properly covered with tight-fitting lids, should be insisted upon in all cases, and such receptacles should be required to be removed with their lids on, duplicate receptacles being left in their places. The removal of offensive matters such as fish offal, butchers' refuse, etc., is so important that the Vestry would do well to oppose any alteration in the hours of removal that would allow such matters to be carted through the streets "two hours before sunset to one hour after sunset all the year round." I have already reported in full to the Vestry against the suggested inclusion of peat litter within the provisions of the Byelaw, and such report was adopted by the Vestry on the 4th August, 1898 (vide Minutes, 1898, pages 1442-3). In that report I pointed out that peat litter, when properly used, did not give rise to a nuisance sufficiently serious to warrant the adoption of the stringent measures then proposed, the important points being that such litter and manure should be removed at short intervals, and, where in any quantity, that such matter should be collected in vans or in receptacles fitted with wheels, so that such receptacles or vans could be removed when full without disturbing their contents. In conclusion, I recommend (1) that the alteration in the morning hours for removal by road be approved; (2) that the extension of the hours for removal by water be approved; (3) that the additional hours suggested in the evening for removal by road be not approved; and (4) that the Vestry's previous resolution with regard to the removal of peat litter be affirmed. Joseph Priestley. 52 SPECIAL REPORT ON "DRAINTESTING," (Presented to, and adopted by, the Vestry on May 24th, 1900). I have to report that there are three methods of testing drains: 1. With water under pressure—the hydraulic or water test; 2. With smoke under pressure—the smoke test; 3. With odorants or chemicals—the smell or chemical test. The only trustworthy test is the hydraulic or water test, and, theoretically, such is the only test that ought to be used, whether dealing with old or new drains. There are, however, many practical difficulties in the way of systematically carrying out such a test, e.g., the necessary opening up of the drain in front, when there is no manhole; the severity of the test, especially when applied to a length of drainage, etc. Such practical difficulties have stood in the way of this water or hydraulic test being used indiscriminately, at least, in connection with old drains, of which few, if any, would stand the trial, either in Lambeth or elsewhere. In Lambeth, since I have been Medical Officer, the hydraulic test is the only one used in connection with new drains, and this is applied to the drains, not only in sections as they are laid, but as a whole when completed and filled in. Even with such strict precautions, however, it is found in practical experience that a drain which is water-tight when laid, does not necessarily remain so afterwards for any length of time, at least, when earthenware pipes are used and are subjected, as they may be, to the cracking and twisting influences of concrete or cement, to subsidences or shiftings in the ground, vibrations from railways, and other causes, etc. 53 Facing these difficulties, the Sanitary Department has adopted a rule to the effect that such a test as the hydraulic test shall not be applied to old drains as a routine, except with the written consent of the owner. Consequently, the smoke or chemical test is the one used by the Inspectors in their routine examinations of drains of old houses in connection with house-to-house inspections, visits to infected premises, etc. Unfortunately, the smoke and chemical tests are not wholly satisfactory, and are only used on the definite understanding that when a result is obtained from such test we can be sure that the drains are defective, but where a result is not obtained, we cannot state that the drains are, therefore, all right or perfect. Considering all things, the chemical test, as used as a routine in Lambeth, gives fairly satisfactory results, though, of course, the water or hydraulic test is the only thoroughly reliable one. I cannot, however, too strongly emphasise that a negative result from the smoke or chemical test must not be taken as meaning that the drains are satisfactory; as it is a matter of experience that a negative result may be obtained where the drains are known to be defective, which negative result may be due to (1) varying states of the atmosphere; (2) condition as to flow of the sewer into which the drain under examination enters; (3) nature and depth of the soil in which the drain is embedded, etc. Such was the case with the drain at No. 62, I.eigham Vale. I know of no Metropolitan or other Parish that employs, as a routine, the water test in all cases, at least, in connection with drains of old houses. The chemical tests at present in use in Lambeth are Kingzetts' (No. 1) drain tests, made by the Sanitas Company, and give off a very pungent odour when ignited. Joseph Priestley. May 14 th, 1900. The Vestry decided to recommend that the following principle, enunciated in another case, and affirmed, at its meeting held on the 21 st July, 1898 (Minutes, page 1325), should be re-affirmed by the Vestry, namely : — 54 "With regard to the effectiveness, or otherwise, of the test used, the Committee are of opinion that the best available ordinary test was (and is, in fact, invariably) employed by the Lambeth Sanitary Department. The most reliable test is, of course, the water test; but bearing in mind the probable consequences of applying, as a routine, that test to old drains, there has been a long-standing rule of the Sanitary Department that this particular test is only to be applied to old drains at the owner's risk, and with his consent, so that no responsibility shall afterwards rest with the Vestry." 55 SPECIAL REPORT ON THE OUTBREAK OF TYPHOID FEVER IN VAUXHALL WARD. (Presented to, and adopted by, the late Vestry on Oct. 25th, 1900). As the present Vestry is evidently desirous of having the details of the outbreak of typhoid that has recently taken place, I beg to report fully as far as the outbreak has at present gone, though I would remind the Vestry that we must not cry out before we are out of the wood, sufficient time not having yet elapsed since the removal of the last cases to warrant the definite statement that the outbreak has been completely stamped out. The outbreak, however, is well under command. The outbreak of typhoid fever was in Vauxhall Ward (Fountain Street, Conroy Street, Crimsworth Road, and Springfield Place). The one case in Richmond Place was traced from Fountain Street, whilst the one case in Thorparch Road may be placed in Crimsworth Road, the infected house being in both streets. Fountain Street, Springfield Place, and Crimsworth Road are three) parallel roads following in rotation and leading from the Wandsworth Road, in a north-westerly direction to the western boundary of the Parish, and towards the river, being about 500 yards therefrom, a small portion of Battersea Parish intervening. Conroy Street is a branch street turning out of Fountain Street at its top end, and, after running parallel, joining Fountain Street again at the bottom end. Thorparch Road is a street running at right angles out of Crimsworth Road on the left-hand side, near the. top; whilst Springfield Place opens out at its bottom end into Crimsworth Road, opposite Thorparch Road. There have been 41 cases—16 males and 25 females, there being 20 over, and 21 under, twelve years of age. The 41 cases occurred in 24 houses—6 in Fountain Street, 8 in Conroy Street, 8 in Springfield Place, 1 in Crimsworth Road, 1 in Thorparch Road, and 1 in Richmond Place. Four deaths have occurred. The first case was notified on September 7th, followed by one case on September 10th, one on September 12th, four on 56 tember 14th, two on September 15 th, one on September 16th, three on September 17 th, one on September 19th, four on September 20th, five on September 21st, two on September 22nd, three on September 25th, and one each on September 26th, 27th, 28th, and 30th respectively; whilst during October there have been nine more cases notified. Each house has been visited by me personally, and as a result of investigation, it has been found that intervals varying from days to weeks have elapsed between the cases sickening and being notified, and during those intervals infected centres have exis-ted in the area, which is a crowded one, and one in which there is considerable daily; and hourly inter-communication between persons and families living in different houses. In 3 cases the interval was three to four weeks; in 3 cases two to three weeks; in 19 cases one to two weeks ; and in 17 cases one to seven days. A further means of inter-communication (and a most important one, as it has been proved since) is in connection with the mangling of clothes. It is found that many of the people living in this area (as elsewhere) after washing their clothes take them to some neighbour or neighbours who possess a mangling machine, to have them mangled or wrung, and the present outbreak shows pretty conclusively that such mangles may be the means of spreading a particular disease like typhoid fever, which is infectious and contagious by reason of the germs that are voided in large numbers from patients whilst suffering from the disease, and even during convalescence, through the bowels and the kidneys. Stains on bedding, underclothing, etc., would be especially dangerous, and if such stained and infected clothes or bedding were taken from an infected house or houses and mixed with non-infected clothes and bedding from other houses, it is readily understood how the disease might be propagated from person to person, and from house to house. Such has apparently been the mode of spread in the present outbreak, as by working out the dates of sickening of the infected persons, it is found that the different cases fit one into another like a Chinese puzzle. Another important factor in the outbreak is the difficulty in diagnosing exactly typhoid fever in its early stages. 57 logical examination is found to be of the greatest assistance, and the means (free of cost) offered to Medical Practitioners practising in Lambeth Parish by the Vestry are being more and more used Unfortunately, in connection with this particular outbreak, the early doubtful cases were not bacteriologically examined. The result has been that several known centres of typhoid have existed, and been the means of spreading the disease, either directly from person to person, or indirectly through the medium of clothes during the process of mangling. Four definitely infected mangles have been traced, vizi, 14, S. Place; 22, C. Street; 28, C. Street; and 10, C. Road, and from these houses have arisen, directly or indirectly, 26 cases. Thus: — N 58 In addition, there was reason to suppose that there had been inter-communication between these four houses possessing mangles, as inquiry showed that when it was found that fever ha J broken out, or even inquiries were being made at a particular house where mangling was done, the customers, or at least some of them, got alarmed, and took their clothes elsewhere, thereby spreading the disease and forming fresh centres, which had to be traced out, and in connection with which precautions had to be taken. Interesting though the outbreak is, as being, so far as I am aware, the first on record of such a medium of infection in typhoi 1 as mangled clothes, the preventive measures taken are the matters of importance for a Sanitary Authority. The first step was to find out all the cases—the whole extent of the damage, and this was done by means of a careful house-to-house inspection. In this way several cases were discovered, which were either unattended altogether by medical men, or being attended as cases of other diseases which are somewhat difficult to differentiate from typhoid fever in its early stages. These unrecognised typhoid cases appear to have started the outbreak, the after- 59 history of several patients who were treated as suffering from influenza, or infantile diarrhoea, proving unmistakably that they were suffering from typhoid fever. In this connection the following details are interesting: — 1. Lizzie H., age two years, of 13, F. Street, sickened about the middle of August, and was treated as suffering from infantile diarrhoea, a disease common amongst infants and children as a rule during the month of August, but especially prevalent during August of the present year, owing to the excessive hot weather of July. The clothes from this unknown (?) infected house were washed and afterwards sent to be mangled at 14, S. l'lace, where a large mangle was kept, and much appreciated by the neighbours, who sent their washing there to be mangled. The clothes from 13, F. Street, if infected, would infect the clo'hes from different houses at 14, Springfield Place, where an unrecognised case (No. 2) was also spreading infection as well. 2. William B., age 21, of 14, S. Place, sickened at the end of August, but the disease was not properly diagnosed (the Medical Attendant regarding it as a case of Influenza) until September 15th, when the patient was removed to hospital. For about three weeks this patient] was suffering from typhoid at a house where clothes were taken in to be mangled or wrung, and where the neighbours were practically in and out all day. Twelve cases were directly traced to this infected house (14, S. Place). It is probable that William B. was infected from Lizzie H., of 13, F. Street (vide No. 1 above). 3. Florence G., age 28 years, of 28, C. Street, sickened on September 24th, the Medical Man in attendance treating the case as one of Influenza. For a period of two weeks this house was infected without it being known, and during the whole of this time washing was being brought from different neighbours' houses to be mangled or wrung, a mangle being kept on the premises for the purpose. To this source six, cases were traced. 4. William K., age seven years, of 53, F. Street, sickened with typhoid about August 29th, but was not removed to Hospital until September 20th. the Medical Attendant being of opinion N 2 60 that the case was one of Influenza. For three weeks this house was infected, and gave rise to three cases. 5. Clara B., age 11 years, of 8, F. Street, sickened with typhoid on August 22nd, but was not removed to Hospital until September 17th, the Medical Attendant regarding the case as one of Influenza. The house was infected for over three weeks without it being known, and three cases arose from this centre, in the same house, together with five cases at 35, F. Street, making a total of eight cases spread directly or indirectly from Clara B., who was left in a crowded locality suffering from typhoid fever for a period of 26 days. The first one to sicken at 35, F. Street, was Alfred H., age one year, and he appears to have been treated for simple diarrhoea, though he was undoubtedly suffering from typhoid fever, as proved by his being removed on 2nd October to Hospital (where he afterwards died from typhoid fever), 32 days after he sickened, during the whole of which time he was a source of danger to his brothers and sisters, as shown by the fact that four of them have since sickened in the same house with the same disease. It is probable that the four cases connected with the house, 53, F. Street, were also derived from Clara B., at 8, F. Street, the first one sickening being William K., who was nursed by, and directly infected, his mother (Harriet K.) and her lodger (Mary H.), and indirectly through his aunt, living at 14, C. Street, infected a girl at 4, R. Place (Ellen W.) 6. Mrs. B., age 50 years, of r, T. Road, sickened on September 3rd, but was treated for Influenza, and not removed to Hospital until September 25th. For over three weeks an unknown case of typhoid was at 1, T. Road, and the washing was sent to be mangled at 10, C. Road, where other clothes from other houses were also sent. Two cases of typhoid fever and one of (notified) continued fever were traced to this source. Again, so-called secondary cases form a large portion of the outbreak, accounting for 17—nine of the infected houses having secondary cases, viz.:— Addresses. No. of secondary cases. 35, F.-Street 4 8, F-Street 3 53 and 13. F-Street 14, S-Place 2 each. 61 148, W-Road (corner of F- Street 36,C-Street 45, C-Street 7, S-Street 1 each Secondary cases arise in infected houses at the end of the known incubation period of the disease (two to three weeks), and are due to infection from previous patients before they are removed to Hospital and properly isolated, and before the disinfection of the premises has been carried out. It follows, as a natural corollary, that the sooner typhoid cases are removed from crowded houses, the less chance there is of these so-called secondary cases occurring. The large number met with in the present outbreak is due to the fact that cases of typhoid were undiagnosed, and left in crowded centres for longer or shorter intervals (e.g., one to four weeks), during which infection spread from person to person, not) only in the same house, but also in neighbouring houses. A startling example of this is to be found in the series of thirteen cases met with at 8, 35, and 53, F. Street, and which are supposed (as already stated) to have arisen from Clara B., at 8, F. Street, thus: — 62 It proved that Clara B. was left at 8, F. Street suffering from an infectious disease, which was unrecognised, for a period of 26 days, viz., from August 22nd to September 17th, and the three cases which first arose from infection from her (Emma B., Alfred H., and William K.) were in their turns also left unisolated, the nature of the disease beng undiagnosed for periods of 13, 32, and 22 days respectively, with the natural result that nine more cases caught the infection, making a total of 12 secondary cases arising from one infected person, whose illness had not been diagnosed, and in connection with whom, consequently, no precautions in the way* of isolation and disinfection had been taken. Bacteriology would have undoubtedly cleared up the diagnosis in the early stages in the case of Clara B., who could have been forthwith isolated, and the 12 secondary cases thus avoided. A satisfactory feature of the outbreak is the fact that of the 41 cases, three only have not been traced to their sources, viz., Edward W., aged 19 years, living at 14, F. Street, and two children (Mabel and Lilian S.), aged 14 and 12 years respectively, living at 148, W. Road, which is at the corner of F. Street. In the first casei (Edward W.), there was a distinct history of the patient having eaten large quantities of ice-cream; whilst the other two, living at the corner of an infected street, down which they had to go daily to and from school, may have become infected from children who, though suffering from typhoid, were not isolated, owing to the nature of their diseases not being diagnosed in the early stages, or who, though not suffering themselves from typhoid, came from infected houses. Having discovered all the cases, they were notified, all removed to Hospital, and the disinfection of rooms (to include the scraping of walls and whitewashing of ceilings), Bedding, clothes, etc., thoroughly carried out. The mangles, more especially the rollers, were specially treated with a strong formaldehyde disinfectant solution. Watch was kept daily for any secondary cases occurring at recently infected houses, and these were removed to Hospital at once when found, and further disinfection carried out. To sum up, the preventive measures taken were as follow: Discovering of all cases by house-to-house inspection. 63 Notification of all cases to the Vestry. Isolation of all cases in Hospital. Thorough disinfection of all premises (including the suspected mangles). Quarantining of suspected persons over the incubation period. Thorough flushing of the gullies in the infected area. It cannot be too strongly emphasised how desirable it is to have exact diagnosis, and how important it is to isolate in Hospital all cases of typhoid—home isolation (at least, in such a neighbourhood as the one being dealt with in this Report) being practically impossible. Careful inquiries were made in all cases as to infection through the well-known channels, e.g., milk, water, defective drains (the drains being tested in each case), eating of oysters, mussels, and other shellfish, fried fish, ice-creams, watercress, etc. There was no reason for supposing that the schools had been in any way concerned in spreading the disease, though it is clearly important to keep children from typhoid-infected houses away from school. Further, the houses in the streets mentioned are in fair condition, whilst, strange to say, houses in neighbouring streets which have been condemned, are free from typhoid, proving that the origin of the outbreak is at least not due to the state of the houses themselves. The neighbouring streets are Pascal Street and Portland Cottages, where 58 houses have been condemned as unfit for human habitation, and are now in process, slow though it be, of being made habitable, 21 houses having been (up to date) satisfactorily completed. The results of inquiries as to the ordinary well-known channels of infection proving negative (except, perhaps, the one case already mentioned, viz., Edward W.), I was driven to find some other source of infection which, I think, is satisfactorily proved by the details given in the Report—at least, as far as such inquiries admit of proof. Praise is due to the Inspectors engaged on the work of houseto-house inspection and inquiry, as also to the Medical Men in attendance, for allowing me to examine doubtful cases of illness 64 (some of which proved to be typhoid, and were consequently removed), and to the owners of the infected premises who carried out all suggested necessary work, e.g., stripping off of paper from walls, etc. Joseph Priestley. October 15 th, 1900. Supplemental Report of Medical Officer. Presented to, and adopted by, the late Vestry, Nov. 22nd, 1900. I have to report that no fresh case has occurred during the last four weeks in the infected area, and the outbreak has been, therefore, effectually stamped out by the methods adopted, and explained at length in the Special Report presented to the Vestry on October 25th, 1900 (Minutes, page 1401 el seq.). The total number of cases has been 41, occurring in 24 houses, viz., 16 males and 25 females, there being 20 persons over and 21 persons under 12 years of age. Seven deaths have occurred, viz., 3 males, aged 1, 3, and 21 ; and 4 females, aged 6, 19, 34, and 55 years respectively. For the benefit of the new members of the Council, it may be re-iterated that the preventive measures taken were as follows : — 1. Discovering of all cases by house-to-house inspection; 2. Notification of all cases; 3. Isolation of all cases in Hospital; 4. Thorough disinfection of all premises (including the special disinfection of the four mangles which were suspected of having caused the outbreak); 5. Quarantining of suspected persons over the incubation period of the disease. The outbreak has emphasised the great difficulty of diagnosing typhoid fever in the early stages! of the disease, and the consequent great importance of bacteriological examinations being made in connection therewith, such examinations being provided, free of cost, to Medical Practitioners in the Borough of Lambeth. 65 Addendum to the Report by the Council. The only remark which the Council would desire to add to the Medical Officer's report is that if the medical gentlemen engaged in the earlier stages of the outbreak had availed themselves of the facilities offered by the late Vestry and the present Council for the bacteriological examination of doubtful or suspected cases of typhoid, there would, in all probability have been no more than one or two isolated cases of typhoid, and certainly not so many as could be described in any sense as an outbreak. INDEX. iii. INDEX OF TABLES. PAGE.. A The number of Births and the Birth-Rates in each Registration Sub-District of Lambeth during 1900 (arranged) quarterly) 11 B. The estimated Populations, numbers of Inhabited Houses, Marriages, Births, and corrected Deaths for the year 1900, and the ten years preceding, in Lambeth Parish 12 C. The number of Persons per House, the Marriage-, Birth-, and Death-Rates, and the proportion of Deaths in Public Institutions per 1,000 persons, for the year 1900 and ten years preceding. 14 D The number of Births and Deaths, with Birth- and DeathRates in each of the Registration Sub-Districts of the Parish during 1900. [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 1900 23 F.. Mortalities in, Lambeth at different age-periods compared with (1) those for London, 1900, and (2) the averages for London for the years 1881-90 24 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 1900 25 H The uncorrected mortality (i.e., including that of strangers) at different ages in cach District of the Parish during 1900 26 iv. PAGE. I. The uncorrected Deaths (i.e., Parishioners and strangers) at various age-periods in each Quarter of the year 1900 27 J. The Infantile mortalities in the Registrar-General's thirty three large Towns of England and Wales (including London), and in Lambeth Parish during 1900 29 K. Total cases notified under the Notification Clauses of the Public Health (London) Act, in Lambeth, during 1900 (arranged quarterly) 32 L. The number of Certificates for the notifiable Zymotic Diseases received since the introduction of the Notification Act (i.e., in the ten years 1890-99, and in the year 1900) 35 M The number of infected houses, with percentages of (1) General Defects, and (2) Defective Drains, during the years 1900 and preceding years 36 U- Zymotic seasonal variations in the different Registration Sub-Districts of Lambeth during 1900, with the Zymotic Death-Rate per 1,000 inhabitants 38 O. Deaths from Zymotic Disease (strangers deducted), 1900 ... 39 p. The number of deaths from the principal Zymotic Diseases in the ten years, 1890-99 and in the year 1900 40—41 Q. Vaccination Returns, 1899 43 R Vaccination Returns for the first half-year, 1900 44 S. The Diarrhoea Mortality in Lambeth in each month during the year 1900 60 T- The classification of Causes of Deaths in Lambeth during 1900, as compared with 1899 64—65 (a) Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected) ... 64 (b) Deaths of Infants under one year of age from the chief infantile diseases and from all causes, expressed in terms of 1,000 births 65 u Table of Uncorrected Deaths during the years 1899 and 1900, classified according to Diseases, in Lambeth and London 66 V- Table of Deaths during the year 1900 in the Lambeth District, classified according to Diseases, Ages, and Localities. (Local Government Board Tatle A). 68—71 V. 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 1900, 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, Diphtheria, Enteric, Diarrhoea, Phthisis, DeathRates for the forty-three different Metropolitan Sanitary Areas, for Registration London, and for Lambeth, 1900. Appendix 2—3 Mortality Tables showing Deaths (corrected) from all causes in Lambeth during 1900, sub-divided— (a.) As to different Age-Periods Appendix 34—39 (b.) As to Registration Sub-Districts Appendix 40—45 VI. GENERAL INDEX. PAGE. Abatement of Nuisances 74 Accidental Deaths 63 Adulteration of Food and Drugs 91—94 Age—Distribution of Diarrhoea 58 „ „ „ Diphtheria 52 ,, „ „ Scarlet Fever 45 „ „ „ Typhoid Fever 54 „ „ „ Deaths 22—24 „ „ „ Population (Lambeth) 8 Air Temperature 58 Alcoholism—Deaths from 62 Analysis of Food and Drugs 91—94 Antitoxin in Diphtheria 51 Antitoxin, Gratuitous Distribution of 51 Apoplexy, Deaths from 62 Area (Lambeth) 67 Atelectasis 62 Bacteriological Laboratory 125—128 Bacteriological Examinations (1,000 cases) ... Appendix 15—18 Bakehouses 89—90 „ List of 89—90 Bedding, etc., Disinfected 85 ,, Destroyed 86 Births 12,13,14, 67 Birth Rates in Sub-Districts 11 Bodies received in Mortuaries 110,112—113 Bronchitis, Deaths from 62 Burns and Scalds, Death from 63 Cancer, Death from 62 Cautions (Food and Drugs) 91,94 Censal Population (Lambeth) 5 „ ,, (London) 10 Cholera 31,59 Circulatory Diseases, Deaths of 62 Clerical Work 130 Closure of Schools 48—49- vii. PAGE. Complaints 130 Conscientious Objectors 42—44 Congenital Malformations 62 Constitutional Diseases 62 Consumption (See Tuberculosis and Phthisis) Continued Fever 55 Convictions under Public Health Acts 77, Appendix 26—33 „ „ Food and Drugs and Margarine Acts 77, 91, 94, Appendix 19—25 Convulsions, Deaths from 62 Coroners' Courts 110 114 Costs, Food and Drugs 91,94 Cowhouses 109—110 „ List of 109—110 „ Defects found in 110 Critical Temperature (Karth) 58 Customs and Inland Revenue Acts 105—106 Deaths and Death-Rates 15—67 ,, Inner and Outer Wards 17, 18, 19 „ Metropolitan Districts Appendix 2—3 Deaths (arranged quarterly) 25—27,36—37 Death Rates and Birth Rates—Inter-relationship 13 Deaths—corrected 15, Appendix 34—45 ,, Uncorrected 15 Deaths in Public Institutions 16—17 ,, Zymotics 28 „ Under 1 year 28 „ Under 5 years 28 Deaths from Violence 63 Deaths from ill-defined and non-specific causes 63 Delirium Tremens, Deaths from 62 Density, per acre (Lambeth) 67 Dentition, Diseases of 62 Depots (Refuse and Manure) 99—101 Developmental Diseases 62 Diagnosis (Bacteriological) 125—128 Diarrhoea 58—60 ,, Age, Distribution of 58 ,, Monthly Mortality 60 ,, Inner and Outer Wards 59 ,, and Infantile Mortality 28 Dietetic Diseases 62 Digestive System, Diseases of 62 Diphtheria 51—53 „ Age Distribution of 52 ,, Antitoxin in 51 „ Increase of 52 O viii. PACK. Diphtheria, Bacteriological Examinations 51, 126—8 „ Prevalence and Sore Throats 51 „ Pseudo-Bacilli 126—8 Disinfection, details of 85—87 „ Statistics 87 „ Certificates 84 Disinfecting Department 82—88 „ Machines 83 „ Refuges 86,88 Displacement of Tenants ... 105 Distribution (free) of Antitoxin 51 Drain Testing 78—80 ,, „ Special Report on Appendix 52—54 „ ,, with water 79—80 Drainage, Defects 33—34 Drowning, Deaths from 63 Dust Depots 99—101 Dust Destructor* (Shot Tower Wharf) 101 Earth Temperatures 58 Enteric Fever (see Typhoid) Enteritis 59,62 Epilepsy, Deaths from 62 " Equifex" Disinfecting Machine 83 Erysipelas 57 I'emale Inspector 80,119—120 Food and Drugs, Adulteration of 91—94 „ „ Convictions Appendix 20—25 Homicide, Deaths from 63 Houses Condemned 102—103 Houses Let in Lodgings 101—102 Housing of the Working Classes Act 76,102—105 „ ,, „ „ and Displacement 105 Hydatids 128 Increase of Population (Lambeth) 5,67 » » (London) !) Infantile Mortality 28—29, 67 ,, ,, (London and 33 large Towns of England and Wales) 29 Infected Houses 33—34 „ „ and Drains 35 Infectious cases removed 31 Infectious Diseases Inspection 33,77 Influenza 61 Inhabited Houses of Lambeth 67 Inner and Outer Wards—Deaths and Births 18 Inquests 115—116 IX. PAGE. Inspections 77 Inspector, Female 80, 119—120 „ Food and Drugs 91,94 ,, Smoke 95 Institution Deaths 10 Integumentary System, Diseases of 63 Introductory Letter 3—4 Lambeth Statistics 5—73 Lavatories (Underground) 129 Letters (sent and received) 130 Liver, Diseases of 62 Local Diseases—Nervous System, Heart, Respiratory Organs Digestive and Urinary Systems, ana Reproductive System 62 Locomotive System, Diseases of 63 Local Government Board Tables A and B 68—73 London (County of), Vital Statistics, 1900 9—10 ,, No, of Births, Deaths, and Marriage Rates, 1900 10 ,, Zymotic Deaths, 1900 9—10 „ Zymotic Diseases, 1900 10 Lymphatic System, Diseases of 63 Mangles (infected) and Typhoid Fever 55 Manure Depots 99 101 Margarine Act (Convictions) Appendix 24 25 Marriage and Marriage Rates (Lambeth) 15, 67 Measles 47 50 Measles (compulsory notification of) , Appendix 47—48 Measles as a Dangerous Infectious Disease 4i Measles and School Closure 48—49 Membranous Croup 53 Meningitis (Tubercular) 62 Mortality Rates 3 Different age periods (Lambeth and London) 24 Mortality Rates— Different Diseases 64—66 ,, „ (Lambeth Quarterly) 64 Under 1 year of age (London and Lambeth) 65 Mortality Tables 34 45 Mortuaries 110— 114 ,, Keepers of 113 Natural Causes, Deaths from 115 Natural Increment of Population (Lambeth) 5,67 (London) 9 Nervous System, Diseases of 62 Neville's Disinfecting Machine (old) 83 Notices served 76 Non-notifiable Infectious Diseases 82 Norwood (branch office) 81 X. PAGE. Notification Certificates Received 1890—1900 32, 38 Nuisancjs Abated 74 Old Age, Deaths from 62 Organs of Special Senses (Diseases of) 63 Outer and Inner Wards- Deaths and Births 17—19 Parliamentary and New Wards Lambeth)— General Diseases, Deaths 23 Population 7 Zymotic Diseases 23 Zymotic Incidence 23 Parasitic Diseases 62 Penalties— Public Health Acts Appendix 26—33 Food, Drugs, and Margarine Acts Appendix 19— 25 Peritonitis, Deaths from 62 Persons, per House 14 „ „ Acre 67 Phthisis 62 Plans of Drainage 77,80 Pneumonia, Deaths from 62 Population of Lambeth, 1900 5—8, 67 „ „ Sub-Districts 6 „ Parliamentary and New Wards ... 7 „ Age Pe-iods 8 Population of London, 1900 9—1 „ „ Sub-Districts 10 Post Mortems . Ill Premature Births 62 Premises Disinfected 85 Prosecutions — Public Health Acts Appendix 26—33 Food, Drug and Margarine Acts ... . Appendix 19—25 Paeudo-bacilli and Diphtheria 126—128 Public Institution, Deaths 16 Public Health Acts (Convictions) Appendix 26—33 Puerperal Fever 56 Quarterly Returns (Lambeth)— „ Births 11 XI. PAGE. Quarterly Returns,Deaths (Zymotic and General) 25—27 n Notifiable Infectious Diseases 38 „ Disinfection Certificates 84 Railway Sidings and Manure 99 Rateable Value (Lambeth) 9, 67 Refuse Depots 99—101 Registration Sub-Districts (Lambeth)— General Diseases Deaths 20—21 Zymotic „ „ 20—21 Births and Deaths Rates 11,18, 20—21 Vaccination Returns 43—14 Re-Inspections 7 Removal of Infectious Diseases 31 Reproductive System, Diseases of 63 Respiratory Diseases 62 Samples Food and Drugs 91 — 94 Sanitary Defects 33—3o Sanitary Work 74—129 „ Structural 75 „ Non-Structural '5 Scarlet Fever 45—46 ,, Age Distribution 45 „ and School Attendance 46 „ and Milk 46 School Closure and Measles 48 — 49 Simple or Continued Fever 55 Slaughttr-houses 106—109 ,, List of 107 — 108 M Defects found in 108 t| No. of Animals killed 109 Small Pox 42—44 Smoke Nuisance and Abatement 95—98 „ ,, Penalties 95, Appendix 26—33 Sore Throats and Diphtheria 51 Special Reports— Notification of Me3s!es Appendix 47—48 Offensive Matters Appendix 49—51 Drain Testing Appendix 52 —54 Typhoid and Infected Mangles Appendix 55—65 Stamps used . 130 xii. FAGK Staffs— Clerical 130 Inspectors 78—8t Disinfecting 82—88 Mortuary Attendants 113 Suffocation in bed <>3 Suicide and Homicide, Deaths from 03 Summary of Vital Statistics (Lambeth), 1500 67 „ Sanitary Work 77 „ Death Returns Appendix 40 „ Work done, 1895—1900 Appendix 4—14 Summonses Appendix 19—33 Syphilis 62 Temperature (Air and Earth) 58 Testing of Drains 77—80 Tuberculosis, Deaths from 62 ,, and Bacteriological Examinations 125 Typhoid 54—55 „ Age Distribution of 54 „ Bacteriological Examinations 125—6 ,, Increase of, during 1900 55 „ Personal Infection in 55 ,, and Infected Mangles Appendix 55—65 Typhus 55 Underground Conveniences 129 „ „ Receipts, 1900 129 Urinary Diseases, Deaths from 62 Vaccination Returns 43—44 Vaccination Act, 1898 42 Venereal Diseases 62 Violent Deaths 63 Vital Statistics, London 9—10 „ Lambeth 5—73 „ Summary (Lambeth) 67 Water Supply 91 Water Certificates 130 Whooping Cough 47—50 Work of Sanitary Staff 74—77 Workshops 117—124 „ Defects tound 118—119,122—121 Xlll. PAGE. Workshops, Female Inspector in 119—120 „ Overcrowding in 119—124 „ Protected Persons 121 „ Trades, &c. 117 Zymotic Diseases 30—62 „ Deaths arranged Quarterly 36—37 „ „ m Monthly 29 „ Incidence in Parliamentary and New Wards 23 „ Principal Deaths (Limbeth) 40 -41 , „ „ (London) 40—11