LAM 6 Report on the VITAL AND SANITARY STATISTICS of the Borough of Lambeth, DURING THE YEAR 1903 [ With an Account of the work done by the Sanitary Inspectors, and of the Proceedings taken under the Food and Drugs, and Public Health, Acts'], by Joseph Priestley, B.A., M.D., D.P.H. MEDICAL OFFICER OF HEALTH. LONDON: Printed by Fredk.Tarrant & Son, IIO, Camberwell Road, S.E. Public Health Department, 333, Kennington Road, S.E. February, 1903. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, I have much pleasure in presenting you with my Annual Report 1903, dealing with the Vital ana Sanitary Statistics of the Borough of Lambeth, and, in doing so, would draw your special attention to the lowness of the death-rate from all causes, and the infantile mortality rate, the former being 15.2 per 1000 of the population, and the latter 125.8 deaths under one year per 1000 births. These figures are lower than any yet registered in the Borough or Parish of Lambeth, and augur well for the future, if the Council continues to pay the same strict attention to sanitary matters in the future as in the past, even making due allowance for the special meteorological conditions that obtained during 1903, and which were exceedingly favourable from the point of view of the Public Health generally and of the Infantile Mortality in particular. As matters calling for special comment during the year 1903, I may draw attention to the following:— 1. The Council, after careful consideration, decided in favour of the establishment for Lambeth Borough of a Municipal Milk Depot, from which could be obtained by the poorer classes, at a nominal cost, a supply of sterilised (humanised) milk, the use of which, it was felt, would help to materially lessen the large infantile death-rate that is noticeable chiefly in the Inner Wards of the Borough. The L.G.B. has officially decided, however, that, in London, money for such a purpose cannot legally, in the present state of the Law, be taken from the Rates—a most unfortunate decision as far as London is concerned, and an unjust one if Provincial Towns (such as Liverpool, St. Helen's, Glasgow, etc.) are to be allowed to spend their rates for such a purpose without let or hindrance. The Lambeth Council will have to attack the subject of excessive infantile mortal ity in other ways. 2. A small outbreak of Smallpox occurred at Rowton House, within the Borough, but by the energetic preventative measures that were immediately taken in connection therewith, the outbreak was limited to 25 cases (out of an average number of 300— 4 400 inmates), and that, too, practically without any interference with the liberty of the lodgers. 8. The systematic inspection by the Female Inspector of the work places of Out-workers throughout the Borough, and of the houses wherein deaths from Infantile Diarrhoea have occurred, has proved most satisfactory, and it remains for the Council to continue and extend this important branch of sanitary administration. 4. The decision of the Council to burn its house refuse (in part at least) in a Destructor instead of barging it away, thereby effecting a sanitary and economical improvement, is wise. 5- The alterations and improvements effected during 1903 in connection with the Underground Bakehouses situated within the Borough, thereby reudering them suitable for use as bakehouses, will benefit the health of a large number of workers. The Staff (individually and collectively) has worked well during the year, and this fact, coupled with the help and support that has, at all times, been readily forthcoming from the Members of the Public Health Committee, and of the Council generally, make my official work both personally pleasing and of the maximum value to the Borough. My thanks are due not only to the Members of my own immediate Staff, but also to the other Borough Officials (more especially the Heads of Departments), who have helped me from time to time in connection with my duties as Medical Officer of Health. I am, Mr. Mayor and Gentlemen, Your obedient servant, 5 I. VITAL STATISTICS. The Borough of Lambeth contains 4079.6 statute acres, exclusive of 821 tidal water, 0.8 inland water, and 31.1 foreshore, with an estimated total population of 307,711 persons to the middle of 1903, consisting of 145,585 males and 162,126 females, or an excess of 16,541 females. The total estimated increase (1902-1903) of the population is 2,609, but the " natural increment," i.e., the excess of births over deaths (uncorrected) is 4,216, so that an exodus of 1,607 in excess of those who came into the Borough during 1903 must be assumed. The estimated Populations of the Borough of Lambeth to the middle of 1903 may be tabulated as follow :— Estimated Populations. (Estimated, Middle 1903.) I. Wards. Wards. Males. Females. Total. Marsh Cannot be sub-divided with sufficient accuracy on account of the New Borough Wards differing from the Old Parish Wards. Cannot be sub-divided with sufficient accuracy on account of the New Borough Wards differing from the Old Parish Wards. 26939 Bishop's 32024 Prince's 48328 Vauxhall 31957 Stockwell 32906 Brixton 44371 Heme Hill 31618 Tulse Hill 28499 Norwood 31069 Borough of Lambeth 145,585 162,126 307,711 6 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. Waterloo 13722 13217 26939 Lambeth Church (1st) 9119 9267 18386 Lambeth Church (2nd) 19865 19993 39858 Kennington (1st) 26762 27145 53907 Kennington (2nd) 20031 23742 43773 Brixton 40005 47064 87069 Norwood 16081 21698 37779 Borough of Lambeth 145585 162126 307711 7 III. Age-Periods. Age-Periods. Males. Females. Total. 0—1 3723 3722 7145 1—5 12836 12765 25601 Total under 5 16559 16487 33046 5—20 42373 44305 86678 20—40 50854 57832 108686 40—60 26900 30267 57167 60—80 8405 12164 20569 80 upwards 494 1071 1565 Total over 5 129026 145639 274665 8 IV. Parliamentary Divisions (Old). Old Parliamentary Divisions. Males. Females. Total. North 29505 29443 58948 Kennington 39550 39901 79451 Brixton 35307 41317 76624 Norwood 40077 49721 89798 Parliamentary Area of Lambeth 144439 160382 304821 N.B.—The Parliamentary Divisions have not been altered by the London Government Act, 1899, nor by the Proceedings that fixed the Boundaries of the Metropolitan Boroughs, so that the above figures do not agree with those for the Borough as a whole, but are comparable with those of the old Parish of Lambeth given in previous Reports. V. Parliamentary Divisions (Adjusted). * Adjusted Parliamentary Divisions. New Wards. Total. North Marsh 58963 Bishop's Kennington Prince's 80285 Vauxhall Brixton Stockwell 77277 Brixton Norwood Herne Hill 91186 Tulse Hill Norwood * Adjusted Parliamentary Area of Lambeth 307711 * N.B.—By the adjustment of the old Parliamentary Divisions so as to be co-terminous with the new wards. 9 1903—Groups of Metropolitan Boroughs (corrected rates). Enumerated Population, 1891 (Census). Enumerated Population, 1901 (Census). Estimated Population, 1903 (middle of year). Birth-Rate. Death-Rate. Zymotic DeathRate. Deaths under 1 year to 1000 Births. London 4228317 4536541 4613812 28.4 15.2 18 129.7 South Group 1524472 1749956 1803787 29.01 14.5 11 126.3 West Group 770022 826985 841245 22.8 13.8 1.5 131.7 North Group 1013707 1056070 1067435 26.3 14.4 1.6 119.6 Central Group 214464 187791 182101 30.9 18.8 1.8 123.5 East Group 705652 715739 719244 35.7 18.3 2.4 147.4 N.B.—This table has been again added for purposes of comparison with previous Lambeth Reports, but is unsatisfactory on account of the differences between the boundaries of the old Sanitary Districts, and the new Cities and Boroughs, of the Metropolis. 10 Houses. At the time of the Census, 1901, there were within the Borough of Lambeth 41,511 inhabited houses and 1825 uninhabited (881 in occupation and 944 not in occupation), whilst 137 were in process of building. At the time of the 1891 Census, the inhabited houses numbered 38,899 The estimated number of inhabited houses to the middle of 1903 is 42,098, which, with an estimated population (to the middle of 1903) of 307,711 gives an average of 7'3 persons per inhabited house. The total number of tenements in Lambeth Borough at the time of the 1901 Census was 70,887, and of these, 44,495 were tenements of less thau five rooms, as follows:— One-roomed, 10,058; two-roomed, 12,311; three-roomed, 12,120; and fourroomed, 10,006. Rateable Value. The rateable value of the Borough for the year ending March 31st, 1903, was £1,897,711, and a Id. rate per £l is estimated to produce £7,590 net for the year ending March 31st, 1904. Statistics for London as a whole. The Registrar-General returns the estimated population of London for the middle of the year 1903 as 4,613,812 consisting of 2,178,213 males, and 2,435,599 females, and states that there were registered during the year 40,214 marriages, 130,906 births (66,591 males and 64,315 females), and 72,109 deaths (37,393 males and 34,716 females). There were registered, 8,166 deaths from the seven chief zymotic diseases. The excess of registered births over deaths, i.e., the natural increment, is 58,797, and the estimated increase of population from the middle of 1902 to the middle of 1903 is 34,702. 11 TABLE A- Giving the number of Births and the Birth-Rates in each Registration Sub-District of the Borough of Lambeth during 1903 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1903. Rate per 1000 Inhabitants. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Waterloo Road 1st 114 107 117 98 436 49.9 „ 2nd 255 215 228 211 909 Lambeth Church 1st 138 141 135 149 563 30.6 „ 2nd 398 363 387 361 1509 37.9† Kennington 1st 442 456 460 430 1788 33.2 „ 2nd 260 219 253 241 994 22.2 Brixton 553 517 515 475 2060 22.7 Norwood 204 218 211 177 810 21.4 Borough of Lambeth 7364 2236 2306 2142 9069 29.5 * Including Lying-in Hospital (499 cases, of which 124 belong to Lambeth)—corrected rate (i.e., excluding non-Lambethian births), = 36 01. †Including Workhouse (198 cases, of which 1G9 belong to Lambeth)—corrected rate (i..e., excluding non-Lambethian births), = 37.1. 12 TABLE B. Shewing the Estimated Populations, Numbers of Inhabited Houses, Marriages, Births, and Corrected Deaths in the Borough of Lambeth during 1903, and in the Parish of Lambeth for ten years (1891-1900). 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. New Boro 1903 307711 42098 2452 9069 4664 1138 1625 498 1619 Old Parish. 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 800048 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 11900 312152 41470 2454 9167 5430 1328 1884 497 1576 Average 1891-1900 294049.7 40052.4 2388 9295.4 5405.3 1358.5 2070.2 700.4 1568.5 Note.—(a) Enumerated Population for old Parish at Census 1896 was 295,033, and the enumerated number of inhabited houses at Census 1891 was 38,556. (b) Enumerated population for the new Borough at Census 1901, was 301,895, and the enumerated number of inhabited houses at the same Census, 41,511. 13 TABLE C. Shewing the number of persons per house, the Marriage-, Birth-, and Death-Rates, and proportion of Deaths in Public Institutions in the Borough of Lambeth for the Year 1903, and in the old Parish of Lambeth for ten years (1891-1900). The Year Estimated No. of Persons per house. Marriage-Rate per 1000 Population. Birth-Rate per 1000 Population. Death-Rate per 1000 Population. Deaths of Children under 1 year, per 1030 Births. Deaths of Children under 1 year, per 1000 Deaths. Deaths of Children under 5 years, per 1000 Deaths. Zymotic DeathRate, per 1000 Population. Deaths in Public Institutions per 1000 total uncorrected deaths. New Bore 1903 7.3 159 29.5 15.2 125.8 243.9 348.4 1.6 333.6 Old Parish. 1891 7.3 15.5 32.9 21.3 152.5 235.6 382.4 2.5 236.6 1892 15.0 32.9 19.5 135.5 229.1 383.2 2.5 272.4 1893 15.7 32.5 18.4 143.7 253.9 368.8 2.6 305.9 1894 15.4 32.1 10.8 132.5 252.8 400.3 2.4 284.7 1895 15.2 31.9 19.0 152.0 255.4 393.4 2.5 257.9 1896 16.5 32.4 17.2 136.9 257.6 401.1 2.4 295.7 1897 16.3 31.3 17.5 151.8 271.4 400.1 2.4 281.8 1898 17.0 30.4 17.9 154.1 262.6 384.7 2.4 277.1 1899 16.3 30.6 19.1 157.7 252.8 373.4 2.5 277.1 1900 15.7 29.4 17.4 144.9 244.6 346.9 1.6 282.5 Average 1891-1900. _7.3 15.9 31.6 18.4 146.1 251.3 382.9 2.4 276.7 NOTE.—(a) Enumerated number of Inhabited Houses for the old Parish at Census 1891 was 38,556. (b) Enumerated number of Inhabited Houses for the new Borough at Census 1901 was 41,511, 14 THE BIRTH-RATE. The total number of Births registered in the Borough of Lambeth during the year 1903 was 9069. Of the total 9069 births, 4618 were males, and 4451 females, showing an excess of 167 males. Of the total 9069 births registered in the Borough of Lambeth, 499 took place in the Lying-in Hospital (York Road), and of these, 124 belong to the Borough; whilst 198 took place in the Workhouse (Brook Street), and of these, 169 belong to the Borough. Thus, there are 404 births belonging to other districts, but these may be assumed to counteract in number the births amongst Lainbethians that have taken place outside the Borough, together with any unregistered births. The Lying-in Hospital and the Workhouse tend to abnormally increase the birth-rates in Waterloo Road and Lambeth Church Second Districts, and the necessary corrections are, consequently, made in a footnote to Table A (see p. 11), The birth-rate for Lambeth is 29.5 per 1000 inhabitants (31.7 for males, and 27.4 for females); whilst in the various Registration Sub-Districts the birth-rates work out as shown in Table A, from which it will be seen that the uncorrected birth-rate in the Inner Districts is 40T, and that in the Outer Districts 25.4, per 1000—the corrected birth-rates being respectively 28.2 for the whole borough, 35.4 for the Inner, and 25.4 for the Outer, Districts. Tables B and C show, for comparison, the number of births, and the birth-rates for 10 years (1891-1900) in the old Parish of Lambeth. Tne birth-rate for Limbsth (Parish aud Borough) has been recently slowly, but steadily, declining. This decline is not peculiar to Lambeth, nor even to England, but is to be found in nearly all civilised countries, and is greater in reality than would appear on the surface; for it must be remembered that pari passu with this declining birth-rate is a greater declining death-rate. 15 What will happen as time goes on, provided the birth-rate continues to decrease, will be that the death-rate will increase, as it is clear that a continuous lowering of the birth-rate will give an older population to be dealt with, i.e., one which naturally must have, on the whole, a higher death-rate, cceleris paribus, than a younger population. Many factors are bringing about, to a greater or lesser degree, this lowered birth-rate, viz., the higher average age at marriage, the prevention of child bearing, a reduction in the marriage-rate, a (suspected) diminishing fecundity of man, moral restraint, vice, increased struggle for existence, &c.; and there can be but little doubt that the condition of affairs to-day is serious and a menace to national prosperity. The rate of natural increase of population (which is based on the balance between births and deaths) is gradually declining. THE MARRIAGE RATE. The number of Marriages registered in the Borough of Lambeth during the year 1903 was 2452 as compared with 2548 during 1902, and a yearly average of 2338 in the old Parish of Lambeth for the 10 years 1891-1900. The marriage-rate for Lambeth Borough is, therefore, 15.9 per 1,000 inhabitants, as compared with 17.4 for London. Tables B & C show the number of marriages and the marriage-rates for the last ten years in the old Parish of 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 the Borough of Lambeth, during the year 1903, was 4853 as compared with 5553 during 1902, and a yearly average of 5716.7 in the old 16 Parish of Lambeth for the 10 years 1891-1900. Of the total 4853 deaths, 2153 were males and 2400 females, showing an excess of 53 males. The death-rate for Lambeth is, therefore, 15.8 per 1,000 inhabitants (16.9 for males and 14.8 for females), as compared with 15.6 for London (17.2 for males and 14.2 for females). These rates are, however, uncorrected, and, on analysing the 4853 deaths registered in the Borough of Lambeth, it is found that 648 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, oil the other hand, there are 459 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a corrected number of deaths for Lambeth during 1903 of 4,664, and a corrected death-rate of 15.2 per 1000 inhabitants, as compared with 15.2 for London (the total corrected number of London deaths beine 69737) The outside Institutions, &c., where 459 Lambethians died during 1903, may be grouped as follows :— I. General Hospitals Charing Cross 12 Middlesex 1 French 3 Royal Free 1 Guy's 25 St. Bartholomew's 14 Hostel of God 8 St. George's 4 King's 16 University 3 London 2 Westminster 54 II. Special Hospitals Bolingbroke Hospital 1 Hospital of St. John 1 Brompton 8 London Throat 1 Cancer 5 Mount Vernon Central London Sick 2 sumption 1 Children's Hospital, National Hospital 1 Paddington 1 Royal Chest 3 Evelina 23 St. Mary's 1 17 Friedenheim 4 St. Peter's 1 German Hospital 1 Temperance Hospital 2 Gt. Ormond Street 7 Victoria 1 Heart Hospital, Soho 1 Fever Fountain 9 Park 1 Grove 18 Western 1 Hospital Ships 4 III. Infirmaries and Workhouses Camberwell Infirmary 2 Southwark Infirmary 6 Greenwich 1 St. George's 3 Kensington 1 St. Pancras Marylebone 1 house 1 Newington Workhouse 1 Wandsworth Infirmary 8 IV. Asylums Banstead 10 Hanwell 3 Bethnal House Asylum 3 Horton Asylum, Camberwell House 3 Epsom 27 Caterham 24 IIford 1 Cave Hill 27 Leavesden 6 City of Loudon 2 Licensed Victuallers 2 Claybury 13 Mauor 5 Coluey Hatch 4 Peckham House 5 Darenth 7 Tooting Bee 10 Dartford 12 V. Unclassifiable Places Brought dead to Private Houses 10 Hospital 3 Post Office Depot, Clapham Common 1 Bedford bury 1 Pond, Clapham River Thames 10 mon 1 Streets 1 Denmark Hill Railway Waterloo Pier Police Station 1 Station 1 H.M. Prison, Penton- ville 1 B 18 Summary. I. General Hospitals 143 II. Special and Fever Hospitals 98 III. Infirmaries and Workhouses 24 IV. Asvlums 164 V. Elsewhere (unclassifiable) 30 459 Whether the corrected or uncorrected death-rates for the Borough of Lambeth (as a whole) be taken, they are very satisfactory for the year 1903, the third year of existence of the newly-formed Borough. Sub-dividing the death-rates amongst the several Registration Sub-Districts, it will be again noted that the Inner Districts, e.g., Waterloo, Lambeth Church 1st and 2nd, have, collectively and individually, suffered more than the Outer Districts, e.g., Kennington 1st and 2nd, Brixton and Norwood. So, too, if the death-rates be sub-divided amongst the 9 new Wards, it will also be noted that the Inner Wards, e.g., Marsh, Bishop's, Prince's, and Vauxhall, have, collectively and individually, suffered more than the Outer Wards, e.g., Stockwell Brixton, Herne Hill, Tulse Hill and Norwood.. The Inner Districts and Wards are more congested than the Outer, and as a general law it is found that the more congested a district (houses over area), the higher the mortality, and the greater the morbidity. The status of the inhabitants, and the general conditions (sanitary and otherwise) under which they live, are matters to bear in mind when dealing with this difference in. death-and sickness-rates in the Inner as compared with the Outer Districts and Wards of the Borough of Lambeth. Noefforts must be spared to lessen this difference (as it is practically impossible to obliterate it), and this can be best done (as I have often pointed out) by seeing that the crowded Inner Districts are kept in good sanitary condition by means of constant and 19 regular inspections. In this way, the evil effects arising from crowding and defective ventilation may be, in parr, counteracted. Taking the Registration Sub-Districts (Table D), and the new Wards (Table E), into which the Borough is sub-divided, the corrected rates for 1903 will be found to vary between the Inner and the Outer Districts as follows :— 1903. Registration Sub-Districts. New Wards. Inner. Outer. Inner. Outer. General Death-rate (corrected) 20.1 13.3 18.4 12.5 Zymotic Death-rate (corrected) 2.6 1.2 2.3 1.03 Of the New Wards, Tulse Hill has the lowest, and Bishop's the highest, general and zymotic death-rates, whilst, of the Registration Sub-Districts, Norwood has the lowest, and Waterloo the highest, general death-rate, and Norwood the lowest, and Lambeth Church 2nd the highest, zymotic death-rate. It is only by sub-dividing the rates up in this way that it is possible to see where the (sanitarily) unsatisfactory parts of the Borough are situated, and where, consequently, most care and attention are required at the hands of the Borough Council. In this connection, Table E deals with the new Borough Wards during 1902 and 1903, whilst on page 20 is given a similar comparison between the 1903 and the 1902 statistics for the Registration Sub-Districts of the Borough. 20 BOROUGH OF LAMBETH. COMPARISON BETWEEN STATISTICS FOR 1902 and 1903. Registration Sub-Districts. Death-Rates (corrected). Birth-Rates (uncorrected). Infantile Mortality (uncorrected). General. Zymotic. 1903. 1902. 1903. 1902. 1903. 1902. 1903. 1902. Inner Districts— 20.1 23.4 2.6 2.1 40.1 39.2 151.9 174.2 Waterloo 20.5 25.1 1.8 3.03 49.9 47.9 101.9 128.2 Lambeth Church 1st 18.8 22.1 2.4 2.9 30.6 32.8 266.4 320.7 Lambeth Church 2nd 20.4 22.9 3.2 2.6 37.9 36.2 153.8 154.3 Outer Districts— 13.3 15.4 1.2 1.4 25.4 20.02 119.4 110.4 Kennington 1st 14.9 16.8 1.8 1.7 33.2 33.9 110.7 114.5 Kennington 2nd 14.1 17.1 1.1 1.6 22.2 23.3 126.8 117.7 Brixton 12.9 14.9 1.1 1.3 23.7 24.5 124.8 107.2 Norwood 10.9 12.5 0.9 0.9 29.4 21.4 116.1 114.2 Lambeth 15.2 17.7 1.6 1.8 29.5 29.7 131.7 134.0 * Excluding the 499 Lying-in Hospital Births, the birth-rate is 31.4, and the infantile mortality rate 162.4, for 1903. †Excluding the 198 Workhouse Births, the birth-rate is 329, and the infantile mortality rate 176 9, for 1903. 21 Tables F, G, H and I shew the uncorrected returns (male and female) arranged as to Registration Sub-Districts, age periods, and quarters respectively, and are given for comparison with similiar tables in former Lambeth Reports. The place that the Borough of Lambeth takes amongst the Metropolitan Sanitary Districts is worthy of note, there being 17 other districts (out of 29) with a less death-rate, 15 with a less zymotic death-rate, and 11 with a less infant mortality. Taking the South Metropolitan Districts, Lewisham has a general deathrate per 1,000 of the population of 11.1, and Wandsworth 12.4, as compared with Lambeth 15.2, Bermondsey 18.4, and Southwark 18.1, respectively. London, as a whole, has a birth-rate of 28.5, corrected deathrate of 15.2, a zymotic (death ) rate of 1.76 per 1000 population and an infant mortality of 130 per 1000 births; and England and Wales a birth-rate of 28.4, a corrected death-rate of 15.4, a zymotic death-rate of 1.46 per 1000 population, and an infantile mortality of 132 per 1000 births; and the 76 great towns of England and Wales a birth-rate of 29.7, a corrected death-rate of 16.3. a zymotic death-rate of T89, per 1000 population, and an infantile mortality of 144 per 1000 births. Age-Periods of Corrected Deaths. The 4664 corrected deaths during 1903 may be furthur analysed, and tabulated as follow :— 1138, i.e., 24.4 per cent, of the total (corrected) deaths took place under 1 year of age. 487, i.e., 10.4 „ between 1 and 5 years. 1625, i.e., 34.8 „ under 5 years. 228, i.e., 4.9 „ between 5 and 20 years. 544, i.e., 11.7 „ 20 to 40 years. 952, i.e, 20.4 ,, 40 to 60 years. 1041, i.e., 22.3 „ 60 to 80 years 274 i.e., 5.9 „ 80 years and over. 3039, i c., 65.2 „ over 5 years. These results may be compared with those for London given in Table F, which shows the estimated mortalities per 1000 persons at each age-period for London during 1903 and the London averages for the 10 years 1881-90. 22 23 TABLE D. Shewing the number of Births and Deaths, with Birth- and Death-rates in each of the Registration Sub-Districts of the Borough during 1903. The Deaths are from all causes, and from the chief Zymotic Diseases, and are corrected by adding Lambethians who die outside the Borough, by omitting strangers who die within the Borough, and by re-distributing persons (who die in Public Institutions) into the Districts from which they have been removed during illness. REGISTRATION SUBDISTRICTS. Persons per Acre. Estimated Population (middle 1903). Total Births (uncorrected). Birth-rate per 1ooo of the Population. Total Deaths (corrected). General corrected Death- rate per 1ooo of the Population. Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1ooo of the Population (corrected). Zymotic Death-rate per 1ooo of the Total Deaths. Diarrhœa Death-rate per 10000 of the Population. Infantile Mortality per 1000 Births (uncorrected). Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Diarrhœa. Waterloo Road 1st 156.5 26939 436 49.9* 268 20.5 ... 10 1 2 7 ... 2 ... 8 30 1.8 88.7 4.5 101.9 „ „ 2nd 909 255 ... 5 3 ... 6 ... ... ... 4 18 Lambeth Church 1st 114.4 18386 563 30.6 330 18.8 ... 9 3 1 14 ... ... ... 17 44 2.4 129.1 9.2 266.4 „ „ 2nd 218.4 39858 1509 37.9† 797 20.4 2 28 6 7 33 ... 4 ... 46 126 3.2 155.8 11.5 153.8 Kennington 1st 109.9 53907 1788 33.2 788 14.9 1 43 1 4 30 ... 2 ... 17 98 1.8 121.5 3.2 110.7 „ 2nd 82.8 43773 994 22.7 603 14.1 1 10 4 5 6 ... 4 ... 19 49 1.1 80.1 4.1 126.8 Brixton 64.6 87069 2060 23.7 1106 12.9 ... 18 5 10 17 9 1 32 92 1.1 83.4 3.7 124.8 Norwood 31.6 37779 810 29.4 399 10.9 ... 4 ... ... 12 ... 3 ... 18 37 0.9 90.6 4.8 116.05 District not stated ... ... ... ... 118 ... ... 3 ... ... 1 ... ... ... ... 4 ... ... ... ... Borough of Lambeth 75.4 307711 9069 29.5 4664 15.2 4 130 23 29 126 ... 24 1 161 498 1.6 106.8 5.2 131.7 death-rates have been calculated on the assumption that these N.B.—In the 118 cases where the District is not stated, the Census 1901 Return gives the area of Lambeth as 4079.6 deaths were sub-divided equally in the eight Districts. water, and 31.1 foreshore). statute acres (exclusive of 82.1 tidal water, 0.8 inland he corrected rate = 31.4 per 1000. * Excluding all the Lying-in Hospital births he corrected rate = 32.9 per 1000. †Excluding all the Workhouse births 24 TABLE E. BOROUGH OF LAMBETH. COMPARISON BETWEEN STATISTICS FOR 1902 AND 1903—NEW WARDS. New Wards. Death-Rates (corrected). Zymotic Incidence per 1000 population.* 1903. 1902. Total Number of Deaths (corrected). Total Number of Cases. Zymotic 1903. General. 1903. 1902. Zymotic. 1903. 1902. General. 1903. Zymotic. 1903. Inner— 18.4 20.9 23 2.5 5.3 11.2 2556 325 742 Marsh 20.6 24.2 1.9 3.03 5.5 10.8 554 51 149 Bishop's 24.1 28.9 2.8 2.9 6.2 14.1 772 91 198 Prince's 14.3 14.9 2.2 2.3 5.1 10.6 690 105 245 Vauxhall 16.9 18.9 2.4 1.9 4.7 9.5 540 78 150 Outer— 12.5 14.9 1.03 1.3 4.3 6.9 2108 173 805 Stockwell 14.01 14.3 1.3 1.4 6.1 7.9 461 43 200 Brixton 12.9 16.9 1.01 1.6 5.4 8.4 574 45 241 Heme Hill 12.7 14.9 0.9 1.03 5.2 9.2 402 29 165 Tulse Hill 9.9 12.03 0.8 1.2 3.8 4.4 283 24 93 Norwood 12.5 15.2 1.03 1.1 3.4 3.7 388 32 106 Borough of Lambeth 15.2 17.7 1.6 1.8 5.03 8.9 4064 498 1547 *N,B.—The 40 Chicken-pox cases are excluded from this table. 25 TABLE F. Shewing Mortalities in Lambeth Borough at different Age-Periods during 1903, compared with (1) those for London 1903, and (2) the averages for London, for years 1881-90. Age-Periods. LAMBETH. LONDON. Estimated Populations (middle 1903). Mortality Rates per 1000 Population, 1903. Corrected. Uncorrected. Mortality Rates per 1000 Population, 1903 Uncorrected. Average of Ten Years, 1881-90, per 1000. 0—5 38046 51.8 40.9 51.04 68.4 5—20 86678 2.6 6.8 7.1 2.7 7.1 4.3 20—40 108686 5.01 5.5 7.7 40—60 57167 16.7 60.5 17.2 20.2 60—80 20569 50.6 59.4 53.9 62.8 63.3 80 and upwards 1565 175.1 180.8 206.3 *Under 1 year 7445 125.5 131.7 131.5 152.0 All Ages 307711 15.2 15.8 15.6 20.5 The Age-periods adopted in previous Lambeth Reports, are used for purposes of comparison, 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. 26 TABLE G. Shewing the Uncorrected Mortality (Male and Female) in the different Registration Sub-Districts of the Borough of Lambeth (arranged Quarterly) during the year 1903. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Total No. of Deaths in each District. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Waterloo Road 1st 18 42 60 16 20 36 19 16 35 15 21 36 167 „ 2nd 28 30 58 20 22 42 23 28 51 19 20 39 190 Lambeth Church 1st 139 89 228 131 103 234 131 77 208 105 78 183 853 „ 2nd 186 183 369 147 129 276 127 110 237 153 168 321 1203 Kennington 1st 81 80 161 64 76 140 74 60 134 79 103 182 617 2nd 63 69 132 43 55 98 50 47 97 61 76 137 464 Brixton 113 137 250 122 116 238 102 102 204 132 151 283 975 Norwood 55 72 127 43 44 87 51 34 85 43 42 85 384 Totals 683 702 1385 586 565 1151 577 474 1051 607 659 1266 4853 27 TABLE H. Shewing the uncorrected Mortality (i.e., including that of Strangers) at different Ages in each Registration Sub-Districts of the Borough of Lambeth during the year 1903. 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 27 38 65 7 18 25 26 33 59 8 10 18 167 „ 2nd 34 38 72 8 15 23 38 30 68 10 17 27 190 Lambeth Church 1st 79 71 150 48 52 100 311 186 497 67 39 106 853 „ 2nd 143 89 232 39 48 87 244 220 464 187 233 420 1203 Kennington 1st 97 101 198 44 33 77 80 74 154 77 111 188 617 „ 2nd 64 62 126 15 17 32 74 75 149 64 93 157 464 Brixton 145 112 257 69 49 118 139 158 297 116 187 303 975 Norwood 50 44 94 24 33 57 65 49 114 53 66 119 384 Totals 639 555 1194 254 265 519 977 825 1802 582 756 1338 4853 28 TABLE I. Shewing the uncorrected Deaths (i.e., Parishioners and Strangers) that have been registered in the Borough of Lambeth at various Age-Periods in each quarter during the year 1903. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Under 1 year 175 154 329 134 114 248 176 139 315 154 148 302 1194 Between 1 and 5 years 66 96 162 72 64 136 45 33 78 71 72 143 519 Between 5 and 60 years 273 204 477 243 218 461 227 181 408 234 222 456 1802 60 years and upwards 169 248 417 137 169 306 128 122 250 148 217 365 1338 Totals 683 702 1385 586 565 1151 577 474 1051 607 659 1266 4853 29 INFANTILE MORTALITY, 1903. Of the 4,664 corrected deaths, 1,188 were infants under one year of age. The total number of births is 9,069, and of these 375 occurred at the Lying-in Hospital, and belong to districts outside Lambeth Borough, and 29 occurred at the Workhouse,and belong also to districts outside Lambeth Borough. In this way, the corrected number of births for Lambeth Borough is 8,665. The corrected infantile mortality (i.e., rate of corrected deaths under one year per 1,000 corrected births) is, therefore, 131'3. In calculating this corrected infantile mortality, it must be remembered that, whilst we substract the births amongst persons who are not Lambethians, we do not add the births amongst Lambethians who may happen to be residing elsewhere at the time of such births. Taking the uncorrected births and the corrected deaths under 1 year, the infantile mortality rate is 125*5. Taking the uncorrected number of births (9,069), and the uncorrected number of deaths under 1 year of age (1,194), the uncorrected infantile mortality is 131*7, as compared with 134*0 during 1902, and an average of 150*5 for the old Parish of Lambeth during 10 years (1891-1900). The chief causes of these deaths were debility, atrophy and inanition, whooping cough, bronchitis and other diseases of the respiratory organs, diarrhoea, premature births, 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 266 4 per 1,000 births in Lambeth Church 1st to 79*2 in Waterloo Road 2nd (the rates of 79 2 in Waterloo Road 2nd and 153*8 in Lambeth Church 2nd being due to the fact that these Sub-Districts contian the General Lying-in Hospital and the Workhouse respectively), thus:- 30  Total No. of Births. Total Deaths under 1 year (uncorrected). Infantile Morality per 1,000 births (uncorrected). Waterloo Road 1st 436 65 149.3 ,, ,, 2nd 909 72 79.2* Lambeth Church 1st 563 150 266.4 „ „ 2nd† 1509 232 153.8† Kennington 1st 1788 198 110.7 „ 2nd 994 126 126.8 Brixton 2060 257 124.8 Norwood 810 94 116.05 Lambeth 9069 1194 131.7 N.B.—Waterloo Boad 1st and 2nd have been amalgamated by the General, and now form one District called Waterloo. ♦Excluding all the Lying-in Hospital births, the corrected rate is 175'6. tExcluding all the Workhouse births, the corrected rate is 176'9. The Infantile Mortality (like the deaths under 1 year of age) is regarded as a sensitive index of the Sanitary state of a District, and, judged by this index, Lambeth Borough takes a most satisfactory position amongst Sanitary Districts. Taking the Registrar-General's old 33 Large Towns of England and Wales, the uncorrected infantile mortalities vary from a minimum 108 Croydon, to a maximum 217 Burnley, London and Lambeth being 131. Lambeth ranks ninth lowest in such list, being bracketed with London, 24 Towns having higher infantile mortality rates. The corrected rate for Lambeth is 125, and of the 29 Metropolitan Sanitary Districts, 11 have lesser infantile mortality rates than Lambeth Borough ; and of the 10 South Metropolitan Districts, 4 only have lesser infantile morality rates, viz :—Lewisham, Woolwich, Wandsworth and Camberwell with 92, 108, 109, and 123 per 1,000 births respectively, as compared with 125 for Lf-mbeth Borough —the 2 highest rates being registered in Southwaik aud Bermondsey, viz., 148 and 158. 31 TABLE J. Shewing the Infantile Mortalities in the Registrar-General's old33 Large Towns of England and Wales (including London), and in Lambeth Borough, during 1903. Deaths under one year per 1000 Births. Average Ten Years, 1839—1902. England and Wales— (33 Large Towns.) .. .. Croydon 108 141 Brighton 114 156 Portsmouth 114 162 Bristol 116 144 Huddersfield 120 146 Halifax 122 148 Cardiff 122 159 Derby 128 154 London 131 158 Wolverhampton 141 188 Plymouth 144 172 West Ham 146 169 Bradford 148 168 Nonvich 150 181 Bolton 152 175 Leeds 153 179 Birkenhead 156 172 Sunderland 157 175 Blackburn 157 199 Gateshead 159 174 Liverpool 159 189 Birmingham 159 188 Oldham 160 177 Leicester 160 187 Preston 161 232 Hull 162 176 Swansea 165 165 Newcastle 165 173 Nottingham 165 185 Salford 167 202 Manchester 169 188 Sheffield 182 186 Burnley 217 210 London Districts— .. North 119 South 126 West 131 Central 123 East 147 Lambeth 125 N.B.—The rates for London Districts (including Lambeth) are corrected. The uncorrected rate for Lambeth is 131.7 32 CLASS 1—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 the Borough of Lambeth are very satisfactory for 1903, being 33.3 per cent, below the average (1891-1900). In the Borough of Lambeth, during 1903, there were registered 540 deaths from the seven zymotic diseases, and of these 82 were strangers belonging to other districts, and 498 parishioners who died within the Borough. 40 parishioners, however, died without the Borough. Subtracting the strangers, and adding on the parishioners who died without the Borough, there is a corrected total of 498, giving a zymotic corrected death-rate of 1.6 per 1,000 inhabitants, the corrected rate for London being 1.8, varying in the various Metropolitan Districts, as shown on page 9. The zymotic death-rates (corrected) for the different Registration Sub-Districts of the Borough of Lambeth vary also, as shown in Table D, which in addition gives the death-rates and birth-rates for comparison. Lambeth Church, 2nd and 1st, Waterloo Road and Kennington 1st, show the highest, and Norwood, Brixton, and Kennington 2nd the lowest, zymotic death-rates respectively. The corrected zymotic death-rate for the Inner Districts is 2.6, and for the Outer, 1.2—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 1; later, Districts. Crowded Districts naturally suffer more in this respect than those more sparsely populated.. 33 Similar conclusions are obtainable by comparing the zymotic death-rates and zymotic incidences for the different new Wards of the Borough, as shewn in Table E, from which it is seen that, of the 9 new Wards into which the borough is now divided, Bishop's, Vauxhall and Prince's show the highest, and Tulse Hill, Heme Hill and Brixton the lowest, zymotic rates; and Marsh, Bishop's, and Prince's the highest, and Norwood, Tulse Hill, and Herne Hill the lowest, zymotic incidences respectively. During the year 1903, under the Notification Clauses of the Public Health (London) Act, 1891, 1,517 cases* of Infectious Diseases have been reported, and of this number 993, i.e., 64.2 per cent. were removed to the Hospitals of the Asylums Board, or to other Hospitals, and 554, i.e., 35.8 per cent, remained under treatment at their homes. It is still satisfactory to note the large percentage of cases removed to Hospital, showing the growing favour with which the Isolation Hospitals are being looked upon, and pointing to the fact that it is coming to be more and more realised that infectious diseases cannot be properly isolated in the homes of the people. The percentage removed during 1903 is well above the average, though not so large as last year. Thus, since the introduction of the Public Health (London) Act, 1891, the percentages of notified infectious cases removed from Lambeth are as follow :— 1891—36.6, 1895—30.4, 1899—61.2, 1903—64.2 1892—33.7, 1896—43.0, 1900—64.5, 1893—23.0, 1897—49.0, 1901—66.1, 1894—33.9, 1898—55.9, 1902—70.3, *40 cases of Chicken-pox were also notified by Medical Practitioners during 1903, but no single case was removed to Hospital. For proper comparison with previous years, these Chicken-pox cases have been omitted, in dealing with the different Tables throughout the present Report, as was the ease in last year's Report (1902). Chicken-pox was compulsorily notifiable throughout the County of London from February 7th, 1902, to January 6th, 1903. C 34 Examining the removals more in detail (e.g., nature of disease), it is seen that during 1903 in the Borough of Lambeth, the following are the percentages:— Smallpox 100.0 Typhoid 69.2 Scarlet Fever 76.5 Puerperal 23.5 Diptheria 73.9 75.9 Erysipelas 1.7 Membranous o.o Croup It will be noted that all* the notified Smallpox patients, who were infectious, were removed to Hospital, whilst the large percentages of Scarlet Fever, Typhoid, and Diphtheria patients also removed to Hospital are again cause for congratulation. Yearly, more and more Typhoid patients are being removed to Hospital, where treatment is more satisfactory, and where proper precautions can be taken to prevent the spread of the disease—a practical impossibility in the crowded homes of the poor, or even in the homes of the middle-classes. The discharges from the bowels and kidneys are infectious, and many ways suggest themselves by which the germs can be transferred from infected to non-infected persons during nursing. Taking the total number of notified cases of infectious diseases (excluding Chicken-pox) during 1903, it will be noticed that the zymotic incidence throughout the Borough of Lambeth is less than it has ever been since the Notification Act, 1899, came into force (vide Table K), a fact to be explained in part by the favourable meteorological conditions that existed during 1908. The total number of notifications received during 1903 is 41.8 per cent. below the average (Parish) of the ten years (1891-1900), and less than those received during either 1901 or 1902. There is again a marked decrease in the number of Diphtheria certificates received during 1903, i.e., 53.9 per cent. below the * One patient (convalescent and free from infection when notified) was not removed to Hospital. 35 average of the statistics of the Parish of Lambeth for 10 years, and a decrease of 28.3 per cent. from those received in the Borough in 1902. The 329 Diphtheria cases occurred in 292 infected houses, and in only 15.8 per cent. of these were the drains, on testing, found defective. The Scarlet Fever notifications were 44.1 per cent. below the average of the Parish of Lambeth statistics for the 10 years 1891-1900. The cases occurred in 615 infected houses, and in 14.5 per cent. of these, the drains were, on testing, found defective. A small outbreak of Smallpox in connection with Rowton House (Vauxhall), and one or two introductions of the disease into the Borough from outside sources, during 1903, account for the 72 cases notified, and full particulars of these will be found on pages 49-55. There were 41 infected houses, and of these 4.9 per cent. showed defective drains, on testing with the chemical test. The Enteric Fever (or Typhoid) notifications received were 29.9 per cent. above the average for 10 years (Parish of Lambeth), and represent 123 infected houses, of which 17.9 per cent. of the drains were shewn, on testing with chemical, to be defective. No cases of plague, nor of suspected plague, nor of cholera have been notified during 1903, within the Borough. in the case of each of the 1,336 infected houses, an inspection was made, and the drains and the sanitary fittings tested with chemical, with the following results as tabulated :— (a.) 195 (i.e., 14.6 per cent.) were found to have defective drains. (b.) 473 (i.e., 35.4 per cent.) were found to have defective traps, fittings, or appliances. 668 (i.e., 50 per cent.) gave no results with the tests. 36 It will be noted that only 14.6 per cent. of the total infected houses showed, with the test, defective drains, no results being obtained from the tests in the other cases; and 35.4 per cent. shewed defective traps, fittings and appliances. Drains and sanitary fittings are tested, as a routine, in all infected houses, though it does not follow that, when defects are found, such defects are the causes of the diseases under investigation, They may indirectly be so. The test used is the chemical test (Kingzett's), and, when a result is obtained, the drain (tested) is defective, but, when no result is obtained, it would be unsafe to state that, therefore, the drain (tested) was sound. A negative result proves nothing with the chemical (or smoke) test. The hydraulic (water) and pneumatic (air) tests are the only reliable tests, but too severe for the routine testing of drains of old buildings. The pneumatic (air) test is comparatively new, and most delicate, but is not much used in London at the present day. Bearing this explanation in mind, the statistics are still useful as showing that, year by year, the number of defects found decreases. Taking the statistics for the Parish of Lambeth during 10 years (1891-1900), it will be noticed that the percentage of houses showing defective drains has decreased from 22.3 in 1891 to 14.3 in 1900, whilst the percentage of houses showing defective traps, fittings, and appliances has decreased from 41.4 to 30.2 per cent. during the same 10 years. Table L gives full particulars, with the averages for the 10 years worked out, and on comparing these (which relate to the old Parish of Lambeth) with those for 1903 (relating to the new Borough of Lambeth), it will be seen that the latter show a decrease of 25.1 per cent. be/ow the average in respect of defective drains. 37 Sub-divided according to the different notifiable diseases, the results show as follow:— Disease. No. of Infected Houses. Numbers shewing Defects as to Percentage shewing Total Defects. Percentage giving no Defects. Drains. Traps, Fittings and Appliances. Total. Smallpox 41 2 15 17 41.5 58.5 Cholera — — — — — — Diphtheria 292 46 105 151 51.7 48.3 Membranous Croup 9 3 3 6 66.7 33.3 Erysipelas 232 31 72 103 44.4 55.6 Scarlet Fever 615 89 220 309 50.2 49.8 Typhus Typoid 123 22 51 73 59.4 40.6 Continued or Relapsing 7 1 1 14.3 85.7 Puerperal 17 2 6 8 47.1 52.9 Totals 1336 195 473 668 50.0 50.0 N.B.—The 36 Chicken-pox infected houses shewed defective drains in 3; defective traps, fittings and appliances in 11; and no defects in 22. To keep the records comparable for the past years, Chicken-pox is omitted from the above table. 38 TABLE K. Shewing the number of Certificates for the Notifiable Zymotic Diseases received in the Borough of Lambeth during 1908, and in the old Parish of Lambeth for ten years since the introduction of the Notification Act, i.e., 1891-1900. Disease. Parish of Lambeth. Annual Average of 10 years 1891—1900 (Parish.) Borough of Lambeth. Notifications received during 1903. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 Smallpox 3 22 99 26 51 16 2 0 1 — 22.0 72 Cholera 4 26 23 10 16 6 18 7 3 2 11.5 — Diphtheria 330 504 789 521 614 652 704 813 1080 844 715.1 329 Membranous Croup 29 47 49 26 23 27 17 16 22 6 26.2 9 Erysipelas 258 420 587 315 355 352 325 294 330 284 347.0 236 Scarlet Fever 858 1832 2275 1198 1389 1550 1375 1009 1006 821 1331.3 744 Typhus 1 3 3 2 0 1 0 0 1 — 1.1 — Typhoid or Enteric 149 117 160 268 201 162 185 163 219 272 189.6 133 Continued or Relapsing 33 34 58 48 20 16 11 13 7 17 25.7 7 Puerperal 11 20 27 19 16 19 26 14 24 13 18.9 17 *Plague — — — — — — — — — — — — Totals 1676 3025 4070 2433 2685 2801 2663 2329 2693 2209 2658.4 1547 Average per 1000 of population 6.1 10.9 14.5 8.6 9.4 9.5 8.9 7.7 8.7 7.1 9.04 5.03 356 cases of Chicken-pox were notified during 1903 within the Borough of Lambeth (40 by Medical Practitioners, and 316 by others), this disease being made compulsorily notifiable on February 7th, 1902, and remaining so up to January 6th, 1903. The Health Department has also heard of, and dealt with, the following non-notifiable infectious diseases :—Measles, 1346 ; Whooping Cough, 325; Consumption, 269 ; Cancer, 13 ; Pneumonia, etc., 52. * Plague was made notifiable on September 19th, 1900. 39 TABLE L. Giving number of infected houses, with percentages of (1) General Defects, and (2) Defective Drains, throughout the Borough during 1903, and throughout the old Parish during ten years (1891-1900). 1891 1892 1893 1894 1895 1896 Number of Infected Houses 1417 2430 3179 2012 2111 2417 Number of Houses with defects found 903 =63.7% 1474 =60.7% 1641 = 15.6% 1089 = 54.1% 993 = 47.04% 1177 = 48.7% Number of Houses with defective drains found 316 =22.3% 720 = 24.7% 658 = 20.6% 464 = 23.06% 392 = 18.6% 428 = 17.5% Number of Houses with no defects found 514 =36.3% 956 = 39.3% 1538 =48.4% 923 = 45.9% 1118 = 52.96% 1240 = 51.3% N.B.—Only 14.6 per cent. of the houses in 1903 showed, with the test, defective drains, no results being obtained in the other cases. 40 TABLE L—continue.d Giving number of infected houses, with percentages of (1) General Defects, and (2) Defective Drains, throughout the Borough since 1903, and throughout the old Parish during ten years (1891-1900). 1897 1898 1899 1900 Average for ten years 1891-1900. 1903 Number of Infected Houses 2374 2094 2435 1992 2246.1 1336 Number of Houses with defects found 1210 = 50.9% 1044 =49.9% 1163 =47.5% 886 = 44.5% 1158.0 = 51.6% 668 = 50% Number of Houses with defective drains found 390 = 16.4% 351 = 16.9% 384 = 15.8% 285 =14.3% 438.3 = 19.5% 195 = 14.6% Number of Houses with no defects found 1164 =49.1% 1050 = 50.1% 1272 = 52.5% 1106 = 55.5% 1088.1 =48.4% 668 = 50% N.B.—Only 14.6 per cent. of the houses in 1903 showed, with the test, defective drains, no results being obtained in the other cases. 41 TABLE M. Shewing corrected zymotic seasonal variations (deaths) in the Borough of Lambeth in the different Registration Sub-Districts during 1903. Registration Sub-District. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year 1903. Zymotic Death-rate per 1000 inhabitants. Waterloo Road 1st 11 6 9 4 30 1.8 2nd 5 6 6 1 18 - Lambeth Church 1st 17 11 13 3 44 2.4 ,, ,, 2nd 44 22 38 22 126 3.2 Kennington 1st 30 16 15 37 98 1.8 „ 2nd 11 7 17 14 49 1.1 Brixton 22 11 29 30 92 1.1 Norwood 6 10 13 8 37 0.9 District not stated 2 1 — 1 4 — Borough of Lambeth 148 90 140 120 498 1.6 N.B.—In the case of the four zymotic deaths occuring in Districts which are not stated, they have been distributed equally amongst the eight sub-districts before working out percentages. Inner Districts 2.6; Outer Districts 1.2. 42 TABLE N. Shewing the total cases notified under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, in the Borough of Lambeth during 1903 (arranged Quarterly). 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total for 1903. Smallpox 29 35 8 72 Scarlet Fever 181 193 195 175 744 Diphtheria 89 65 76 99 329 Membranous Croup 5 2 1 1 9 Typhus — — — — — Typhoid 24 20 32 57 133 Continued Fever 3 1 1 2 7 Erysipelas 46 65 58 67 236 Puerperal 6 4 2 5 17 Cholera — — — — — Plague — — — — — Totals 354 379 400 414 1547 Chicken-pox (Compulsorily notifiable up to January 6th, 1903.) 40 — — — 40 N.B.—Chicken-pox was made, by special order of the London County Council, a compulsorily notifiable disease on February 7th, 1902, and remained so until January 6th, 1903. During 1903 (up to January 6th, 1903), 40 cases were compulsorily notified by medical men, and 316 other cases of the same disease were voluntarily notified also during the year. 43 TABLE O. Deaths from zymotic diseases (Strangers deducted). For the 4 weeks ending. January. February. March. April. May. June. July. August. September. October. November. December. Total. Smallpox — — — — 1 1 — — 2 — _ _ 4 Measles 13 16 16 12 15 8 5 3 4 14 14 10 130 Scarlet Fever 4 4 1 — 4 — 1 3 1 2 2 1 23 Diphtheria 5 4 2 1 1 — 2 1 1 3 3 5 28 Membranous Croup — — — — — — 1 — — — — — 1 Whooping Cough 27 18 19 12 10 9 4 3 6 3 5 10 126 Typhus — — — — — — — — — — — — — Enteric 3 3 — 3 3 — 1 1 1 3 3 3 24 Continued Fever — — — 1 — — — — — — — — 1 Diarrhoea* 2 4 10 2 3 3 10 37 53 25 8 4 161 Total of Seven Chief Zymotic Diseases 54 49 48 31 37 21 24 48 68 50 35 33 498 Erysipelas — 2 — 2 _ 1 1 1 3 — 1 1 12 Puerperal Fever — 1 — — 1 1 — — 1 1 — 1 6 * Including the one case registered from Cholera Nostras in September. 44 45 TABLE P. Shewing the number of Deaths from the 7 principal zymotic diseases in the old Parish of Lambeth and in London, in the ten years 1891-1900, and in the new Borough of Lambeth and in London during 1903. Disease. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 Annual Average of ten years 1891—1900 fold Parish). Proportion of Deaths to 1000 Total Deaths in 10 years. Total Deaths in 1903. Proportion of Deaths to 1000 Total Deaths 1903. Smallpox 0 1 5 1 2 2 — — — — 1.1 0.2 4 0.9 Diphtheria (and Membranous Croup) 78 127 172 138 103 140 145 115 159 103 127.6 23.6 29 6.2 Scarlet Fever 46 76 69 64 53 63 42 30 25 20 53.6 9.9 23 4.9 Typhus 1 0 1 0 0 1 — — — — 0.4 0.07 — — Fever Typhoid or Enteric 28 22 36 46 26 24 26 35 50 54 32. 6.1 24 5.1 Simple Continued 7 2 4 0 2 1 — — — 1 2.2 0.4 1 0.2 Measles 128 187 113 182 151 185 139 133 169 69 144.4 26.7 130 27.9 Whooping Cough 239 135 151 110 132 140 144 159 130 97 144.4 26.7 126 27.02 Diarrhœa 165 155 197 139 263 152 238 254 249 153 188.4 34.8 161 34.5 Borough of Lambeth 692 705 748 680 732 708 734 726 782 497 694.9 128.6 498 106.8 County of London 9675 11983 13223 11544 11467 14009 11525 12482 11147 10136 11575.3 130.8 8088 115.9 46 The seasonal mortality (corrected) from the different zymotic diseases during 1903 is well shown by arranging the deaths quarterly, thus:— 1903. Smallpox Measles. Whooping Cough. Scarlet Fever. Diphtheria. Membranous Croup. FEVER. Diarrhoea. Erysipelas. Puerperal Fever. Cholera.* Influenza. Total. Typhus. Typhoid. Continued. 1st Qr. — 44 63 8 11 — 6 — 16 2 1 — 29 180 2nd Qr. 2 36 31 4 2 — — 6 1 8 3 2 — 13 108 3rd Qr 2 12 13 5 4 1 — 3 — 99 5 1 i 5 151 4th Qr. —— 38 19 6 11 — — 9 — 37 2 2 — 5 129 Totals. 4 130 126 23 28 1 — 24 1 160 12 6 1 52 568 * The Cholera case was, in all probability, Epidemic Diarrhœa. Taking the zymotic diseases collectively, it is noticed that the 1st quarter shewed the highest mortality, and the 2nd quarter the lowest. Influenza, Measles, Whooping Cough and Scarlet Fever reached their maxima in the 1st quarter; Diarrhœa in the 3rd ; and Typhoid in the 4th. Diphtheria reached its maximum in the 1st and 4th quarters. 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 registered in the Borough of Lambeth from the seven principal zymotic diseases during 1903, and for ten years (1891-1900) in the old Lambeth Parish. For comparison, the deaths registered in London for the same period are also given 47 SMALLPOX. From August 5th, 1902, no further case of Smallpox was notified, within the Borough, until May 18th, 1903, when Harry T. (aged 58 years) and Dan E. (aged 23 years) were found to be suffering from Smallpox at Rowton House, Bond Street, Vauxhall, contracted (it was found on enquiry) from an unrecognised case of Smallpox which had existed at the same house for several days at the end of April, 1903. 23 other cases arose from Harry T. and Dan E. at Rowton House. In addition to these 25 Rowton House cases, 47 other Smallpox cases came to the knowledge of the Lambeth Borough Council up to the end of the year 1903, making a total of 72 cases for the whole year, and of these, 4 died. Two other cases, notified during 1903 as Smallpox, proved, on examination, to be Chicken-pox, and these cases do not appear, consequently, in the Returns. Of the 4 cases that died, the following are the particulars :— (1.) Harry T., aged 58 years, vaccinated (infancy), Rowton House. (2.) Frank E., aged 32 years, vaccinated (infancy), 61, South Island Place. (3.) Edward Wm. S., aged 3 years, unvaccinated, 7, Spring Gardens, Vauxhall. (4.) Frederick H. O., aged 36 years, ? vaccinated (infancy), 5, Spring Gardens, Vauxhall. Death took place on the 13th, 5th, 10th and 11th days of the disease respectively. Taking the 72 cases (notified), and the 4 deaths (registered), that have occurred during 1903 within the Borough of Lambeth, the particulars as to sex, age, vaccination and mortality may be tabulated as follows:— 48 63 Adults (over 12 years of age). 44 Males 19 Females Revaccinated 6 Vaccinated 32 (2 deaths) Doubtful 3 (1 death) Unvaccinated 3 Vaccinated 18 Unvaccinated 1 9 Children (under 12 years of age). 4 Males 5 Females Vaccinated 1 Unvaccinated 3 (i death) Vaccinated 0 Unvaccinated 5 72 Total cases notified. Further, of the 72 notified cases, the ages were :— 0—Under 1 year of age. 5—Between 1 and 5 years (all unvaccinated). 3—Between 5 and 10 years (1 vaccinated and 2 unvaccinated). 9—Between 10 and 20 years (6 vaccinated and 3 unvaccinated). 42—Between 20 and 40 years (4 revaccinated, 33 vaccinated, 3 doubtful and 2 unvaccinated). 12—Between 40 and 60 years (2 revaccinated and 10 vaccinated). 1—60 and over (vaccinated). 72 Total cases notified. 49 The small outbreak at Rowton House is of interest, and may be treated separately, the following being the particulars as to the 25 cases:— Rowton House Cases. Name. Age. Date of Sickening 1903. Date of removal to Hospital 1903. Date of recovery or Death R=recovery D= death 1903. State as to vaccination of patients. Harry T. 58 May 10 th May 18 th D May 23rd Vacc. Dan E. 23 „ 14th „ 18th R July 4th ? Unvacc. William B. 30 „ 26th „ 31st R August 1st Vacc.(? revac.) Richard E. 38 „ 27th „ 31st R ,, 1st Vacc. Arthur W. 38 „ 29th June 3rd R July 22nd Vacc. Alfred G. P. 35 June 1st „ 3rd R Aug. 12th Vacc. Thomas W. 47 May 31st „ 3rd R June 24th Vacc. Joseph C. 28 June 1st „ 3rd R July 22nd Vacc. William S. 36 „ 1st „ 3rd R „ 18th Vacc. Henry R. 59 May 31 st ,, 4th R August 5th Vacc. George P. 26 „ 30th „ 4th R July 15th Vacc. William H. 41 June 1st „ 4th R „ 18th Vacc. Richard P. 30 May 31st „ 4th R Aug. 15th Vacc.(? revac.) William H. 26 „ 31st „ 4th R July 4th Vacc. Arthur C. 52 „ 31st ., 5 th R „ 11th Revacc. (1872) John L. 39 June 2nd „ 5th R ,, 15th Vacc. Robert R. 45 „ 2nd „ 6th R „ 4th Vacc. Robert G. W. 18 „ 2nd „ 6th R „ 22nd Vacc. Christopher H. T. 26 „ 2nd „ 6th R „ 4th Vacc. Morris McE. 38 „ 15th „ 19th R Sept. 12 th Vacc. (? revac.) Charles K. 39 „ 13th „ 15th R Aug. 15th Vacc. William A. 33 „ 14th „ 2Jth R July 22nd Vacc.(?revac.) Alfred F. 38 „ 18th „ 20th R „ 22nd Vacc. William E. 32 „ 16th „ 22nd R „ 18th Vacc. Charles F. D. 45 „ 19th „ 21th R August 5th Revacc. (1883) Of the 25 cases, 24 had been vaccinated in infancy (2 were stated to have been re-vaccinated in 1872 and 1883 respectively, and 4 also many years ago), and 1 was unvaccinated (no marks visible). The case-mortality was per cent. d 50 Each individual case was traced to its sourse of infection, and the result is shewn in the accompanying diagram—the disease being introduced into Rowton House by a lodger of the name of Prior :— PRIOR (April 22-26). H.T. (May 10-18). D.E. (May 14-18). W.B. (May 26-30). R.E. (May 27-31). A.W. (May 29-June 3) A.G.P. (June 1-3). T.W. (May 31-June 3). J.c. (June 1-3). W.S. (June 1-3). C.K. (June 13-15) H.R. (May 31-June 4). G.P. (May 30-June 4). W.H. (June 1-4). R.P. (May 31-June 4). W.H. (May 31-June 4). M.McE. (June 15-19). W.B.A. (June 14-20). W.E. (June 16-22). A.C. (May 31 -June 5) J.L. (June 2-5). R.R. (June 2-6). R.G.W. (June 2-6). C.H.T. (June 2-6). A.F. (June 18-20) C.F.D. (June 19-2). N.B.—The cases fit into one another like a Chinese puzzle. 51 Shortly, the history of the outbreak is as follows:— A man (Prior) came to Rowton House, where he stayed from April 22nd to 26th, during which time he was suffering from unrecognised Smallpox. Directly from him arose 2 other cases, which were also unrecognised as Smallpox from May 10th to 18th, during which time these 2 patients mixed with the other inmates of Rowton House in the Common Rooms, e.g., Kitchen Dining and Smoke Rooms, Lavatories, and Dormitories, etc., with the result that 17 other cases arose directly therefrom during the following 2 to 3 weeks, and from these 17 a further batch of 7 cases (6 belonging to Rowton House and 1 outside). By careful and daily inspections, the 17 cases were weeded out, and removed at once to Hospital, with the result that only 7 further cases arose within the following 2 to 3 weeks, and these 7 cases in their turn were treated in the same way (i.e., isolated in Hospital at once), and no further case occurred. The value is well-shewn of prompt isolation of all cases, followed by immediate disinfection, and a careful daily Medical Inspection of all "Contacts" or "suspects." Taking the average number of lodgers at Rowton House as 300-400, and adding to these the 40 officers (superintendents, bedmakers, etc.), it is cause for congratulation that the outbreak did not assume larger proportions—a condition of affairs brought about by the picking out daily of the cases and their immediate removal to Hosptial. Re-vaccination was offered to the inmates free of cost, and even a gratuity of 2/- per man re-vaccinated added as an incentive, but in vain—59 lodgers only accepting the offer. The 40 officers had been re-vaccinated (in connection with previous outbreaks) and not one caught the disease, whilst enquiry elicited that (roughly) 25 of the lodgers had been previously re-vaccinated at intervals varying from 25 to 3 years ago, 7 had had smallpox previously, and 4 were unvaccinated. It is due to the Rowton House Company to state that a free hand in dealing with the outbreak was given to the officers of the Borough Council, and every suggestion offered readily, and at once, carried out by the Superintendent. 52 Closure of the House was not deemed necessary, the inmates being under daily supervision (medical), but during a period of 3 weeks no new lodger was taken in unless he had been previously re-vaccinated. During the scare, 50 lodgers left and went away to other Rowton Houses in London, or elsewhere, but the most careful enquiries failed to shew any spread of the disease in consequence throughout the other districts of London. The contacts were estimated at 350 (excluding 40 officers). Particulars as to the other 47 cases of Smallpox (exclusive of the Rowton House cases), that have been notified in Lambeth Borough during 1903, are as follows:— (1) Alice B., of 146, Prince's Road, aged 33 years, vaccinated in infancy, sickened May 31st, 1903, and was removed to Hospital on June 3rd, 1903. Alice B., contracted the disease at her work in the City (buttonhole making),. where other cases of Smallpox had already occurred. (2-3) Rose M,, aged 17 years, vaccinated in infancy, sickened on June 4th, 1903, at 30, Murphy Street, Oakley Street, and was removed to Hospital on June 10th, 1903. Rose M. caught her disease at a Music Hall, and infected her mother (Charlotte M.), aged 46 years and vaccinated in infancy, who sickened June 18th, 1903, and was removed to Hospital on June 20th, 1903. (4) Frank E., aged 32 years, vaccinated in infancy, sickened on June 16th, 1903, at 61, South Island Place, and was removed on June 20th, 1903, to Hospital, where he died on June 21st, 1903. Frank E., contracted his disease from Christopher H. T., of Rowton House, who sickened June 2nd, 1903, but was not removed to Hospital until four days afterwards, i.e., on June 6th, 1903, having visited Frank E , at 61, South Island Place, meanwhile. (56) Florrie L., aged 17 months, unvaccinated, sickened June 27th, 1903, and was removed to Hospital on July 2nd, 1903, from 75, Newburn Street. The source of infection could not be traced, but from this centre arose another case, i.e. Margaret B., aged 22 years, vaccinated in infancy, living at 53, Neville Street (near to 75, Newburn Street, which house she passed daily). Margaret B., sickened July 14th, 1903. and was removed to Hospital on July 17th, 1903. (7-8) Edward H., lodging at 5, Shepherd's Place, Upper Kennington Lane, suffered from an unrecognised attack of Smallpox, (sickening June 17th, 1903), and infected his wife (Florence M. H ), aged 22 years, vaccinated in infancy, who sickened June 30th, 1903, and was removed to Hospital on July 6th, 1903. Florence M. H., in her turn, infected the landlady, living in the same house, Lillie B., vaccinated in infancy, aged 29 years, who sickened July 16th, 1903 and was removed to Hospital on July 18th, 1903. It may be noted that, at the time of Edward H.s at'ack (June 16th to 30th), there were living and sleeping in the same room with him. his wife (vaccinated in infancy), aged 22 years, and 2 children, aged 4 and 2 years respectively and both well-vaccinated. The 2 children escaped. and the wife caught the disease. In the rest of the house were living at the same time, 5 adults (all vaccinated in infancy), and 3 children (all well-vaccinated); and of the 5 adults one (Lill e B.), aged 29 years, s:ckened with Smallpox, whilst the 3 well-vaccinated children escaped. 53 (9-30) At 12, Spring Gardens, Vauxhall, an unrecognised case of Smallpox (adult male) occurred, being treated for Chicken-pox for a period of 3 weeks (June 26th to July 17th, 1903). To this unrecognised centre, the following cases were traced:— (a) Elizabeth M., aged 32 years, vaccinated in infancy, of 11, Leopold Street, who sickened July 20th, 1903, and was removed to Hospital on July 28th, 1903. (b) Annie W., aged 28 years, vaccinated in infancy, of 105, Wickham Street, who sickened July 28th, 1903, and was removed to Hospital on July 31st 1903, after infecting Thomas K., aged 20 years, vaccinated in infancy, living in the same house, who sickened, August 12th, 1903, and was removed to Hospital on August 14th 1803, after infecting, in his turn, his cousin (George M.), aged 18 years, vaccinated in infancy, living at 2, Lilac Place, where he sickened August 27th, 1903, and whence he was removed to Hospital on August 29th, 1903. (c) William P., aged 20 years, vaccinated in infancy, living at 93, Vauxhall Mansions, Glasshouse Street, who sickened July 27th, 1903, and was removed to Hospital on August 1st, 1903. William P., infected (I.) James D., aged 14 years, vaccinated in infancy, living at 37, Vauxhall Mansions, who sickened August 9th, 1903, and was removed to Hospital on August 13th, 1903, and James D., in his turn, infected the following:— (a) Ellen D. (sister), aged 11 years, unvaccinated, sickened August 19th, 1903, removed to Hospital August 22nd, 1903. (b) William D. (brother), aged 9 years, unvaccinated, sickened August 23rd, 1903, removed to Hospital August 25th, 1903. (c) Thomas D. (brother), aged 16 years, unvaccinated, sickened August 22nd, 1903, removed to Hospital August 25th, 1903. (d) Julia Edith D. (mother), aged 32 years, vaccinated in infancy, sickened August 25th, 1903, removed to Hospital September 1st, 1903, after infecting Agnes G., aged 34 years, vaccinated in infancy, who sickened September 9th, 1903, and was removed to Hospital on September 13th, 1903. (e) Annie Edith D. (sister), aged 5 years, unvaccinated, sickened August 25th, 1903, removed to Hospital September 1st. 1903, after infecting:— (1.) Harry K., aged 34 years, vaccinated in infancy, living at 38, Vauxhall Mansions, who sickened September 13th, 1903, and was removed to Hospital on September 15th, 1903. (2.) Rose Emma B , aged 14 years, unvaccinated, living at 19, Goda Street, who sickened September 14th, 1903, and was removed to Hospital on September 17th, 1903. (3.) Emma K, aged 4 years, unvaccinated, living at 38, Vauxhall Mansions, who sickened September 17th, 1903, and was removed to Hospital on September 19th, 1903. (II.) Jane Elizabeth C., aged 18 years, vaccinated in infancy, of 3, Spring Gardens, Vauxhall, who sickened August 13th, 1903, and was removed to Hospital on August 15th, 1903, after having infected:— (a) Edward Wm. S., aged 3 years, unvaccinated, living at 7, Spring Gardens, who sickened September 3rd, 1903, and was removed on September 6th. 1903 to Hospital, where he died on September, 13th, 1903. 54 (b) Fred. H. O., aged 36 years, vaccination doubtful, living at 5, Spring Gardens, who sickened September 6th, 1903, and was removed on September 8th, 1903, to Hospital, where he died on September 17th, 1903. (III.) Louisa D., aged 30 years, vaccinated in infancy, of 14, Laud Street, who sickened August 28th, 1903, and was removed to Hospital on August 31st, 1903, after she had infected:— (a) Charles D., (her husband), aged 36 years, vaccinated in infancy, who sickened September 9th, 1903, and was removed to Hospital on September 12th, 1903. (b) Frank D. (son), aged 2½ years, unvaccinated, who sickened September 9th, 1903, and was removed to Hospital on September 12th, 1903. (c) George O. (lodger in the same house), aged 24 years, vaccinated in infancy, who sickened September 10th, 1903, and was removed to Hospital September 14th, 1903. (31-34) A series of cases cropped up at 36, Ely Place, Dorset Road, but the origin of infection could not be traced. Elizabeth Julia L., aged 24 years, vaccinate l in infancy, sickened July 25th, and was removed to Hospital on July 29th, 19 )3. At the time of her sickening, there were living in the same house (a two-roomed cottage) 5 others, viz., 2 adults (vaccinated in infancy) and 3 children (2 vaccinated and 1 unvaccinated), and of these 5 inmates, 3 a???terwards sickened, thus:— (a) Arthur S., aged 9 years, vaccinated, sickened August 9th, 1903, removed to Hospital August 11th, 1903. (b) Julia Edith L., aged 14 months, unvaccinated, sickened August 9th, 1903, removed to Hospital August 11th, 1903 (c) Louisa L., aged 70 years, vaccinated in infancy, sickened August 10th, 1903, removed to Hospital August 14th, 1903. (35-36) An unrecognised case was notified after convalescence at 44, Newburn Street, George H., aged 24 years, vaccinated in infancy, sickened July 26th, 1903, but was not removed to Hospital, and infected his mother, Mary H. (aged 45 years, vaccinated in infancy), who sickened August 13th, 1903, and was removed to Hospital on August 15th, 1903. (37) Florence G., aged 27 years, vaccinated in infancy, was notified as suffering from Smallpox at 21, Henry Street, having sickened August 14th, 1903, and was removed to Hospital on August 17th, 1903, and no other case arose from this centre. The source of Florence G.'s infection was an unrecognised case (Fred. J. B., who had "spots" on July 27th, 1903, at a house in Westminster, having caught them from the child of a fellow-servant, which child had, it was stated, contracted Smallpox from Arthur W. of Rowton House, who sickened May 29th, 1903). (38) Charles David W., aged 40 years, vaccinated in infancy, sickened at 87, Tyers Street, Vauxhall, on August 19th, 1903, and was removed to Hospital on August 21st, 1903. The source of infection was not definitely traced, but it is probable that he caught his disease at a Public House in the neighbourhood, where Smallpox infected persons were known to have visited. (39) Emily M., aged 26 years, vaccinated in infancy, living at 39, Model Dwellings, Albert Embankment, sickened September 28th, 1903, and was removed to Hospital on October 1st, 1903. The source of infection could not be traced in this case. 55 (40) George D., aged 23 years, vaccinated in infancy, sickened on October 17th, 1903, at 102, Lambeth Road, and was removed to Hospital on October 21st, 1903. George D. left Cardiff on October 7th, 1903, and must, therefore, have contracted the disease before leaving, though no case of Smallpox could be traced by the Medical Officer of Cardiff as having occurred there at that time. (41) Claude N., aged 17 years, vaccinated in infancy, was removed to Hospital from the Lambeth Infirmary on October 22nd, 1903, having sickened on October 18th, 1903. The source of Claude N.'s infection could not be traced definitely though he appears to have been tramping about amongst Metropolitan Common Lodging Houses during the previous 3 weeks, and may have contracted the disease in that way. (42) Celeste R., aged 20 years, unvaccinated, sickened on October 20th 1903 at 55, Lambeth Palace Road, and was removed to Hospital on October 26th, 1903. The source of infection was probably the Italian Quarter, Soho, where Smallpox had broken out previously. (43) Charles W., of 33, Methley Street, aged 42 years, vaccinated in infancy, sickened October 24th, 1903, and was removed to Hospital on October 27th, 1903. The source of contagion could not be ???raced. (44-46) Robert M., aged 35 years, vaccination doubtful, was removed from St. Thomas' Hospital on December 7th, 1903, having sickened on December 4th, 1903. He had previously (3 weeks) stayed at 55, Tyers Street and at a Coffee House (68, Vauxhall Walk), but the source of his contagion could not be traced. A fellow worker (William A.), aged 24 years, unvaccinated, sickened at 87, Tyers Street, Vauxhall, on December 14th, 1903, and was removed to Hospital on December 19th, 1903, so that, in all probability, the source of contagion was the same in both cases (at their work). Julia C., aged 48 years (vaccinated in infancy), was the keeper of the Coffee House (68, Vauxhall Walk), and sickened December 23rd, 1903, being removed to Hospital on December 23rd, 1903. He caught the disease from Robert M., who stayed at 68, Vauxhall Walk on December 4th to 7th, 1903. (47) An outbreak of Smallpox in connection with the out-patient department of Westminster Hospital gave rise to several cases throughout London. One case was notified in Lambeth Borough, at 25, China Walk (Mary M., aged 34 years, vaccinated in infancy). Mary M. sickened December 18th, 1903, and was removed to Hospital on December 22nd, 1903, after having infected her newly-born baby (Ada M.), aged 10 weeks, unvaccinated, who sickened December 31st, 1903, and was removed to Hospital on January 3rd, 1904, after having herself infected her own father (Henry M., aged 33 years, vaccinated in infancy), who kissed his daughter on January 3rd, 1904 (the date of her removal to Hospital), and sickened on January 16th, 1904 (i.e., 13 days afterwards), being himself removed to Hospital on January 21st, 1904. [N.B.—These 2 last-mentioned cases (Ada M. and Henry M.) are not included in the 1903 statistics.] Taking the 72 total cases of Smallpox, the sources of infection may be grouped as follows:—Rowton House (unrecognistd cases and contacts) 25; contacts with previous Lambeth cases 29; outside (non-Lambeth) contacts 8; unrecognised cases 6; unknown 4. The large number of Lambeth contacts is explainable by 3 small outbreaks (local), due to unrecognised cases, such cases being often answerable tor the spread of Smallpox not only in Lambeth but elsewhere. Indeed the disease may take on, at times, such a modified form as to be either unattended medically, or (if attended) erroneously diaguosed. 56 Up to the date of this Report being written (February, 1904), no further case of Smallpox has been notified in Lambeth Borough since the case of Henry M., who sickened January 16th, 1904, and was removed to Hospital January 21st, 1904. During the year, 18 suspicious cases of Smallpox were reported to the Medical Officer for confirmation, and. of these, 4 were diagnosed as variola (Smallpox) and removed at once to Hospital. The others were diagnosed as follow:—Chicken-pox 4, Lichen Urticatus 1, Porriginous Eczema 6, Copaiba Rash 1, Gouty Eczema 1, Diarrhœa 1. "Contacts," or "Suspects." In connection with the 72 Lambeth cases of Smallpox, a large number of inside (Lambeth) "Contacts," or "Suspects," were under observation, each "Contact" being watched for 16 days from the date of contact—a total of 769, of which 129 were under 10 years of age and 640 were 10 years of age and over, including the inmates of Rowton House (350 lodgers and 40 officers), who were under constant observation during the outbreak (a period of 8 weeks from May 18th to July 10th). The vaccination-states of all these "Contacts" were registered, and the results may be tabulated as follows:— Vaccination States. Number sickening with Smallpox. 769 640 Adults Re-vac. or had Smallpox 170 2 Vaccinated, 462 40 Unvaccinated, 8 4 129 Children Vaccinated, 83 1 Unvaccinated, 46 7 There were, in addition, 70 outside "Contacts," i.e., persons living in Lambeth, who had been in contact with Smallpox outside the Borough, and who had to be watched for a period of 16 days each. Their vaccinationstates may be tabulated as f ollows:— Number sickening with Smallpox. 70 50 Adults 20 Children Re-vaccinated, 10 0 Vaccinated, 40 0 Unvaccinated, 0 0 Vaccinated, 14 0 Unvaccinated, 6 0 Further, there were 2 Lambeth visitors to the "Ships," both adults and both re-vaccinated, and neither sickened with Smallpox. Taking all the "Contacts" together, inside and outside, the total numbers may be tabulated (with particulars as to their vaccination-states, etc.) as follows:— All "Contacts" Vaccination States. Number sickening with Smallpox. 841 692 Adults Re-vac. or had Smallpox, 182 2(1.1%) Vaccinated, 502 40 (8%) Unvaccinated, 8 4 (50%) 149 Children Vaccinated, 97 1 (1.03%) Unvaccinated, 52 7 (13.5% ) 57 A large amount of work was involved in watching these 841 "Contacts" or "Suspects," but the value of such quarantining is now acknowledged, for, had the 54 new Smallpox centres not been immediately discovered and dealt with, the outbreak would have been much larger. Taking the 10 years 1891-1900, the Smallpox statistics for the Old Parish of Lambeth show annual averages of 1.1 deaths and 22 notifications, as compared with, for the new Borough of Lambeth, during the years 1901, 1902 and 1903, 54, 350 and 72 notifications, and 4, 60 and 4 deaths, respectively. The London figures for 1901, 1902 and 1903 are:— 1901—1700 cases and 229 deaths. 1902—7796 cases and 1314 deaths. 1903—417 cases and 13 deaths. The Vaccination Returns of the Local Government Board for the Borough of Lambeth are to be found in Tables Q and R, dealing with the whole year 1902, and the first half of 1903, respectively, given, for comparison with the Reports of former years, both for the new Borough, and the old Parish, of Lambeth. The yearly Returns are not made up for the Local Government Board until the August of the following year, so that only the Returns for the first half of 1903 can be given in this Report. The total number of conscientious objectors who have obtained certificates during 1903, irrespective of the dates of birth of the children to which they relate, is 79, whilst the total numbers of successful primary vaccinations at all ages received during the years 1902 and 1903 are 8285 and 7185 respectively. 58 TABLE Q. VACCINATION RETURNS (LAMBETH BOROUGH), 1902. Registration Sub-Districts. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinated. Conscientious Objectors. Removed to other Parishes. Gone and not found. Waterloo 1303 928 3 87 13 109* 163* Lambeth Church 1st 606 375 2 84 4 16 125 Lambeth Church 2nd 1409 911 1 159 3 28† 307† Kennington 1st 1781 1270 2 152 18 156‡ 183‡ Kennington 2nd 991 730 5 84 12 54 100 Brixton 2074 1470 6 180 24 34 302 Norwood 913 761 2 50 15 12 46 Lambeth 9077 6445 21 796 89 409 1226 * Hospital Cases (195) included. †Workhouse (51) cases included. ‡Maternity cases (144) included. 59 TABLE R. VACCINATION RETURNS (LAMBETH BOROUGH) FOR THE FIRST HALF-YEAR, 1903. Registration Sub-Districts. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinated. Conscientious Objectors. Removed to other Parishes. Gone and not found. Waterloo 681 404 2 54 4 121* 98* Lambeth Church 1st 274 192 1 19 2 4 57 Lambeth Church 2nd 767 486 — 66 2 26† 187† Kennington 1st 897 638 1 57 7 85‡ 90‡ Kennington 2nd 502 378 2 34 7 30 43 Brixton 1058 739 2 92 13 14 134 Norwood 425 342 1 30 3 5 15 Lambeth 4604 3179 9 352 38 285 534 The Yearly Returns are not made up for the Local Government Board until the August in the following year. *Hospital cases (101) included. †Workhouse cases (28) included. ‡Maternity cases (73) included. 6o SCARLET FEVER. During 1903, in the Borough of Lambeth, 7-44 cases of Scarlet Fever were notified, and 23 deaths registered, giving a casemortality of 3"1 per cent.—S 6 for the Inner, and 1*8 for the Outer Districts. In 1902, there were 1330 cases notified and 48 deaths registered, i.e., a case-mortality of 3*6 per cent.—4 5 for the Inner, and 3'2 for the Outer Districts. The annual averages for 10 years (1891-1900) in the Old Parish of Lambeth are (1) notified cases 1331'3, and (2) deaths, 53*6. Of the 744 persons notified in the Borough of Lambeth during 1903, 569 (i.e., 76'5 per cent.) were removed to Hospital, and of these, 19 died (i.e., 3*3 per cent.), whereas 175 (i.e., 23'5 per cent.) were treated at home, and of these, 4 died (i.e., 2'3 per cent.). This difference in case-mortality as between Hospitaland home-treated patients is to be explained by the greater severity (as a rule) of the cases sent to Hospital. The attack-rate and death-rate of Scaret Fever per 1000 of the population have been steadily decreasing during the last few years in Larnbeth Parish, and are below the average during 1903 in the Borough—a satisfactory condition of things, which seems to point to the value of isolation (following notification) as the chief preventive measure in this disease. The age and sex incidence and mortality for the 744 Scarlet Fever cases notified in Lambeth Borough during 1903 are as follow :— 61 Age Number of Cases Notified. Deaths. Death Rate per 100. M. F. Total. M. F. Total. Under 1 year 6 7 13 — 1 1 7.7 1 to 2 14 12 26 4 1 5 19.2 2 to 3 23 20 43 2 3 5 11.6 3 to 4 33 35 68 1 2 3 4.4 4 to 5 46 40 86 2 1 3 3.5 5 to 6 30 48 78 — — — — 6 to 7 25 29 54 1 2 8 5.6 7 to 8 25 24 49 2 — 2 4.1 8 to 9 22 18 40 — — — — 9 to 10 38 37 75 — — — — Over 10 years 91 121 212 — 1 1 0.5 Total 353 391 744 12 11 23 3.1 It will be noted that, of the total 744 persons reported as suffering from Scarlet Fever during 1903 within the Borough of Lambeth, 236 (i.e., 31.7 per cent.) were under five years of age, and 532 (i.e., 71.5 per cent.) under 10 years of ages: whilst the mortality was greatest amongst those between the ages 1 to 5 years (viz., 69.6 per cent.). Of the 212 persons over 10 years of age, 1 (i.e., 0.5 per cent.) died. The distribution of the cases of, and the mortality from, Scarlet Fever amongst the different Registration Sub-Districts of the Borough of Lambeth during 1903 is seen from the following:— 62 Registration SubDistricts. Total No. of cases Notified. Cases treated at Home. Cases removed to Hospital. No. of Deaths. Case Mortality per 100. Rate of Persons Notified per 1000 Inhabitants. At Home. In Hospital. Total. Waterloo Road 1st 42 7 35 — 1 1 2.4 2.6 Waterloo Road 2nd 27 7 20 1 2 3 11.1 Lambeth Church 1st 73 27 46 1 2 3 4.1 3.9 Lambeth Church 2nd 56 3 53 — 6 6 10.7 1.4 Kennington 1st 105 7 98 — 1 1 0.9 1.9 Kennington 2nd 155 36 119 1 3 4 2.6 3.5 Brixton 204 53 151 1 4 5 2.5 2.3 Norwood 82 35 47 — — — — 2.2 Borough of Lambeth 744 175 569 4 19 23 3.1 2.4 Rate of Persons notified per 1,000 inhabitants—2.3 Inner Districts, and 2.3 Outer Districts. Of the 569 cases removed, 27.1 per cent, were from the Inner, and 72.9 per cent. from the Outer, Districts. In London, during 1903, there were registered 362 deaths out of a total of 12,536 cases of Scarlet Fever notified, giving a casemortality of 2.9 per cent. (uncorrected). As far as could be traced, no Scarlatinal Milk outbreak occurred in the Borough of Lambeth during 1903, and only one school (Licensed Victuallers) had to be closed on account of an outbreak of Scarlet Fever amongst the scholars. This outbreak at the Licensed Victuallers School in Upper Kennington Lane occurred during the 4th quarter of the year—a total of 26 cases as follows:— Dates of Notification. Boys. Girls. Totals. 1903. Sept. 3 — 3 Oct. 12 4 16 Nov. 2 4 6 Dec. 0 1 1 17 9 26 63 There had previously been 2 cases amongst the Girls—notified on March 31st and July 21st respectively. The School was closed on December 14th, and remained closed until after the Christmas holidays.* An inspection of the School premises was made, and a special report as to the insanitary conditions found sent on to the school authorities, with the result that the premises have been since put into proper sanitary order and condition—the sanitary fittings being brought up to modern requirements. A copy of this special Report is printed in the Appendix to this Report (pp. 71-73). At the same time, the old brick sewer at the rear of the Schools was abolished, and a 9-inch pipe sewer substituted, with proper manholes as required, at an estimated cost of £150. Several cases of Scarlet Fever occurred during the last quarter of 1903 in connection with Stockwell Orphanage—a total 25 cases, of which 4 occurred in September, 5 in October, 3 in November, and 13 in December. By careful isolation of the cases as they occurred—doubtful cases being isolated in the Infirmary belonging to the Orphanage, and all cases of definite Scarlet Fever being sent to the Hospitals of the Metropolitan Asylums Board, the outbreak has been, practically, stamped out. During 1903, "return" or "secondary" cases connected with Scarlet Fever have been carefully investigated—such investigation being now easy on account of the arrangement made with the Metropolitan Asylums Board for previous intimation of all discharged patients to be sent to the Medical Officers of Health of the Districts concerned. 527 such intimations have been received during 1903, dealing with all discharged Lambethian patients, who had been treated for Scarlet Fever, Diphtheria, &c., in the Hospitals of the Metropolitan Asylums Board. In no single case was there any cause for complaint. In the best regulated hospitals, a certain number of so-called "return" cases occurs. *At the time of writing this Report (February, 1904), only one further case (boy) of Scarlet Fever has occurred. 64 MEASLES AND WHOOPING COUGH. These two non-notifiable infectious diseases cause more deaths than all the notifiable infectious diseases together. In the Borough of Lambeth, during 1903, 130 and 126 deaths were registered from Measles and Whooping Cough, giving death-rates per 10,000 of the population of 4.2 and 4.1 respectively. In London, during 1903, there were registered 2,054 and 1,631 total deaths from Measles and Whooping Cough, giving corresponding death-rates of 4.5 and 3.5 per 10,000 of the population respectively. Taking the Lambeth Registration Sub-Districts, it will be seen that Kennington First and Lambeth Church Second suffered most, and Brixton and Norwood least, from Measles; whilst Lambeth Church Second and First suffered most, and Brixton and Kennington Second least, from Whooping Cough (vide pages 70). The Inner Districts suffered (deaths per 10,000 of the population) twice as much as the Outer Districts, thus:— Inner. Outer. Whooping Cough 7.1 2.9 Measles 6.3 3.4 Comparing the Borough statistics for 1903 with those for the old Parish for 10 years (1891-1900), it will be seen that there has been a saving during 1903 of 14 deaths from Measles over the average for that decennium, and a saving of 18 deaths from Whooping Cough over the average during the same period. Measles. With regard to Measles, extra precautions are taken in connection with disinfection of Measles-infected houses, exclusion of children (both infected children and also children from infected houses) from schools, the closing of classes or whole schools of 65 account of outbreaks of Measles, the distributing of leaflets and posters, and the educating of parents to regard Measles as a serious or dangerous infectious disease, and not as a trivial complaint of childhood. During 1903 (from April 1st), Measles has been included, by Order of the London County Council (dated January 20th, 1903), such Order having been approved by the Local Government Board, in the term "Dangerous Infectious Diseases" for the purposes set out in Sections 60-65, 68-70, 72-74 of the Public Health (London) Act, 1891, and this fact would appear to have prevented the usual spread of the disease (and its excessive mortality), more especially taking into consideration that the past year has been an epidemic year as far as Measles is concerned. Measles is not compulsorily notifiable, but, through Board Schools, a very large number of cases (1,623 during 1903) are reported to the Borough Council. Measles being chiefly a "School" Disease, this voluntary system of notification is most desirable, and will, it is hoped, be, in the future, extended. (Vide Appendix, p. 80.) Of the 130 deaths from Measles in Lambeth Borough during 1903, 129 (i.e. 99.2 per cent.) occurred amongst children under 5 years of age, shewing that it is a disease of young children, and especially fatal to such. 25 of the deaths (i.e. 19.2 per cent.) occurred amongst infants under 1 year of age. During 1903, in the Borough of Lambeth, disinfection has been carried out in connection with 1,346 Measles infected houses as compared with 364, 728, and 941 during 1902, 1901 and 1900 respectively. Measles is spread chiefly through Schools, especially Infants' Departments, and during 1903 special precautions have been taken in respect thereto, as follows:— Church Street (Clapham Road) School. Infants Department.— An outbreak of Measles amongst the infants attending class A, by which the attendance was reduced at the end of February from 51 to 33 (i.e. 35.3 per cent.), led to this class being closed for 14 e 66 days. The epidemic was a rapidly rising one, and the result of the closure of class A was a marked diminution in the number of cases not only in that particular class but also in others of the Infants' Classes. Class A was again closed for a fortnight at the end of May, the attendance having decreased 36.2 per cent. on account of Measles, with equally satisfactory results. St. John's School, Exton Street, Waterloo Road. Infants' Department.—On account of an outbreak of Measles in March (43.4 per cent, of the infants, 13.2 per cent. of the boys, and 12.1 per cent, of the girls being absent in consequence), the Infants' Department was closed from March 20th until April 17th. Result of closure was a rapid decline in the numbers of Measles cases. Salter's Hill Board School. Infants' Department.—On account of an outbreak of Measles, by which the average attendance of infants in class A was reduced during May from 75 to 66 (i.e. 12 per cent.), this class was closed on May 8th for a period of 3 weeks. This was a rapidly rising epidemic, and the result of the closure of class A was that the numbers of Measles cases declined throughout the Infants' Department as a whole, and the outbreak was stamped out. Johanna Street Board School. Infants' Department.—Owing to an outbreak of Measles in class A (44.2 per cent, of the infants being absent), this class was closed for a period of 14 days. The outbreak was a rising one, and the result of the closure of class A was that the outbreak therein declined. South Lambeth Road Board School. Infants' Department.— Owing to an outbreak of Measles, class C was closed for a period of 2 weeks, there being a decrease in the average attendance of 13.8 per cent. The outbreak was a rising one. Result of closure was a diminution in the numbers of cases of Measles not only in class C but also in others of the Infants' classes. 67 In all cases, where closure was resorted to, disinfection was carried out, followed by the cleansing of the classrooms concerned. Special investigations were also carried out in connection with other schools, which were not, however, closed, and the details may be grouped as follow:— Woodland Road Board School. Infants' Department.—An outbreak of Measles at above school was discovered in May, but was found to be a declining one, and, consequently, no action was taken in the way of closure. Gipsy Road Board School. Infants' Department.—An outbreak of Measles at this school proved, on investigation, to be a declining one, and no action was, consequently, taken in the way of closure. Priory Grove Board Schools. Infants' Department.—During March, an outbreak of Measles was investigated and found to be a rapidly declining one. As the Easter Holidays were approaching, the schools were not compulsorily closed, but remained closed for a period of 3 weeks for the Easter Vacation (instead of the usual 1 week). The majority of the cases of Measles were connected with an Orphanage in the District. Result of the action taken was that the outbreak gradually died out. Lyham Road Board School. Infants' Department.—At the end of November and the commencement of December, an outbreak of Measles was reported in connection with the Infants' Department of the Lyham Road Board School. On investigation it was found that the disease was thoroughly diffused throughout the various class-rooms, and in view of the near approach of the Christmas Holidays, no compulsory closure was deemed advisable. There was a total of 57 scholars absent out of an average attendance of 300 (i.e., 19 per cent.). Result of action taken was that the outbreak was found to have considerably diminished when the scholars re-assembled after the holidays. 68 Lambeth Schools, Elder Road, Norwood.—An unusually large number of deaths from Measles (8) were registered during January and February, 1903, as having occurred amongst the infants and children in connection with the Lambeth Schools, which are under the control of the Lambeth Guardians. Three deaths from the same disease had been registered during November and December 1902, making a total of 11 deaths from Measles during the 4 months November 1902 to February 1903, during which same period no single death from Measles had been registered in Norwood District (outside the Schools). The total number of cases of Measels that occurred during this period in the Norwood (Poor Law) Schools was 68, and, of these, 11 died, i.e., 16.2 per cent. 60 of the cases were amongst children under 5 years of age, and, of these, 11 died. A special investigation into the whole of the circumstances was made, and a serious state of affairs disclosed, of which full details will be found in the special Report, which was made to the Guardians and the Borough Council, and which is reprinted in the Appendix to this Report (vide pages 39-49). The disease spread from the Lambeth Schools into the Board Schools of the District, and a wide spread epidemic throughout Norwood District resulted. The sanitary arrangements of the Lambeth Schools were found most unsatisfactory, and the drains have been reconstructed, and the sanitary appliances remodelled, in consequence, and brought up to modern requirements, whilst important changes have been also effected in administration. The Lambeth experience during 1903 goes to prove that Measles is specially fatal amongst children living under insanitary conditions, and spreads rapidly through the medium of schools, more especially Infants' Departments. School-closure, or even class-closure, in connection with a rising epidemic is of the greatest value in stamping it out. The value of such closure is not so great when the epidemic is already disseminated throughout a school, or where such epidemic is a declining one. In connection with the closing of schools on account of epidemic 69 outbreaks, a retrograde step has been taken by the Education Board during 1903 in withdrawing Article 101* from the Educational Code, thereby doing away with the "Epidemic Grant," hitherto allowed to schools where the average attendance has been seriously diminished owing to the exclusion, under medical advice, of infected children, or children from infected houses. There can be no doubt but that, in Lambeth Borough (as in all other districts where it has been efficiently worked), Article 101* has been most advantageous to the Public Health, and its withdrawal must, therefore, be detrimental in two directions, first by causing the return to school of children not completely convalescent from acute infectious disease; and second, by making it increasingly difficult to exclude from attendance at school, children who, although in fair health, are capable of spreading infectious disease, either because they have suffered from slight attacks, or because they have been recently in contact with cases of such disease. There will now be danger of teachers (or officials) increasing the attendances at the risk of the scholars' health. Whooping Cough. Whooping Cough is also a serious disease, especially to young children. Of the 126 deaths registered in Lambeth Borough during 1903 from this disease, 121 (i.e., 96.03 per cent.) occurred in children under 5 years of age, and 65 of the deaths (i.e., 51.6 per cent.) occurred amongst infants under 1 year of age. It is therefore, a disease of childhood, and its prevention ought to be systematically attempted, chiefly in the way of disinfection of Whooping Cough-infected houses, exclusion of children (both infected and from infected houses), and the educating of parents up to the dangerous nature of the disease and the importance of careful nursing of the patients when suffering from this complaint. Unfortunately, Whooping Cough, like Measles, is regarded as a harmless complaint of childhood, and the ignorance 70 displayed, and the apathy shown, in regard to these diseases are well known to all who visit amongst the poorer classes. During 1903 in the Borough of Lambeth, disinfection has been carried out in connection with 325 Whooping Cough-infected houses, as compared with 110, 72 and 126 during 1902, 1901 and 1900 respectively; and leaflets (dealing with the dangers and treatment of this disease) left at all known whooping cough infected houses.* A Private School in Norwood was closed during 1903 (March 18th) on account of Whooping Cough, and afterwards disinfected, with the result that the outbreak was stamped out. Details of the incidences of Measles and Whooping Cough in the different Registration Sub-Districts of Lambeth Borough during 1908 are as follow:— 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 7 10 }4.9 5.7 Waterloo Road 2nd 6 5 Lambeth Church 1st 14 9 7.7 5.1 Lambeth Church 2nd 33 28 8.3 7.1 Kennington 1st 30 43 5.6 8.05 Kennington 2nd 6 10 1.4 2.4 Brixton 17 18 1.9 2.1 Norwood 12 4 3.2 1.2 District not stated† 1 3 — — Borough of Lambeth 126 130 4.1 4.2 * Whooping Cough is not a compulsorily-notifiable disease, but 392 cases were voluntarily notified by Board School Teachers (vide Appendix, p. 80). † Where the District is not stated, the deaths (or death) are divided equally amongst the other Districts before calculating percentages. 71 CHICKENPOX. This disease remained compulsorily notifiable from the end of 1902 up to January 6th, 1903, throughout the Administrative County of London (including Lambeth Borough), and during this period, as far as Lambeth Borough is concerned, 40 cases were compulsorily notified by Medical Practitioners, representing 36 infected houses. 496 other cases of Chickenpox were voluntarily notified during the year, 436 by Board School Teachers (Vide Appendix, p. 80), and of these, 316 were found to be genuine cases. The Infirmaries of three large Institutions were disinfected in connection with outbreaks of Chickenpox during th; year, 1903, viz., City of London Schools, Jews' Orphanage and Spurgeon's Orphanage. CHOLERA AND PLAGUE. In Lambeth Borough, during 1903, no case of Plague, suspected or otherwise, was notified. One death from Cholera (under 1 year of age) was registered, but this was a death from Epidemic Diarrhœa, or Cholera Infantum (Summer Diarrhœa) as it is called. No case of Cholera was notified. Four "Contacts" were watched in Lambeth Borough during 1903, in connection with outbreaks of Plague and Asiatic Cholera abroad (2 in contact with Plague, and 2 with Cholera). DIPHTHERIA. During 1903, 28 deaths were registered in the Borough of Lambeth from Diphtheria, and a total of 329 cases notified, giving a case-mortality of 8.5 per cent. Of the 329 cases notified, 250 (i.e., 75.9 per cent.) were removed to Hospital, and 18 died, giving a case-mortality of 7.2 per cent. amongst the patients treated in Hospital; whilst 79 (i.e., 24.1 per cent.) were treated at home, and 10 died, giving a case-mortality of 12.7 par 72 cent, amongst the patients treated at home. The difference in these case-mortalities is to be explained, in part, by the antitoxin treatment* that all Hospital-treated, and fewer home-treated patients, now have the advantage of having, and the greater care in nursing that is procurable in Hospital (whither the most severe cases are sent, as a rule). The case-mortality rate for the whole of the Borough of Lambeth during 1903 is low, pointing to the mildness of the majority of cases notified. The sudden decrease in the number of Diphtheria cases throughout the new Borough of Lambeth during 1903 is again remarkable', as it was during 1902 and 1901, and will be seen, on comparison with the yearly mortality average of the 10 years (1891-1900) for the old Parish of Lambeth. This yearly average is 128, so that during 1903 there has been a decrease in the mortality rate, in comparison, of 78.1 per cent. So, too, it the number of notifications received during 1903 in the Borough of Lambeth be compared with the yearly average of the 10 years (1891-1900) for the old Parish of Lambeth, i.e., since the Notification Clauses of the Public Health (London) Act, 1891, came into force, the same remarkable decrease will be noticed, viz., a decrease of 53.9 per cent. The yearly average of notifications for the old Parish is 715, and the number received for the Borough for 1903 is 329. Fortunately the comparison can be extended further, and made for many years past, as the statistics for Diphtheria have been worked out in connected with the old Parish, and are shown on the following page (73), as far as mortality is concerned. Even allowing for the slight fallacy that may arise from comparing statistics of the old Parish with those of the new Borough of Lambeth, the extraordinary sudden decrease in the mortality from Diphtheria is most remarkable, and, when taken in conjunction with the equally sudden decrease in the number of notifications of the same disease received, points to a sudden decline * 45 bottles of antitoxin have been gratuitously distributed in Lambeth Borough during 1903 with most satisfactory results. 73 Quinqueunial Period. Population (estimated). Number of Deaths. Death-Rate per million living. Old Parish of Boro' Lambeth. 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 1998—1900 924333 362 392 1901 302533 47 155 1902 305102 49 160 1903 307711 2 91 in the prevalence of Diphtheria throughout the Borough of Lambeth during 1903, as well as during 1902 and 1901, and that, too, although Diphtheria has been rising slowly but surely in epidemic proportions for the last 20 years. The statistics for London, as a whole, are no less remarkable. The age and sex incidence and mortality from Diphtheria cases notified in the Borough of Lambeth during 1908 are as follow :— Diphtheria. Ages. No. of Cases Notified. Deaths. Death Rate per 100. m. F. Total. M. F. Total. Under 1 year 6 8 9 1 1 2 22.2 1 to 5 51 56 107 8 7 15 14.02 5 to 10 55 56 111 6 0 11 9.9 10 to 20 28 25 53 — — — — 20 to 40 16 30 46 — — — — 40 to 60 3 — 3 — — — — 60 and over - - - - - - - Total 159 170 329 15 13 28 8.5 74 Mild and unrecognised cases cause the disease to spread, and in this way the advantage of bacteriological examinations must be apparent to all. In the report of the Bacteriological Laboratory (see page 186), it will be noted that, of the 227 examinations made in 1903, in only 41 (i.e., 18.1 per cent.) were the true bacilli of Diphtheria found. During 1903, no school had to be closed on account of Diphtheria. The distribution of the disease in the different Registration Sub-Districts of the Borough of Lambeth, together with the numbers of death amongst both hospital-, and home-, treated patients, etc., during 1903, are as follows:— Registration Sub-Districts. Total No. of Cases Notified. Cases treated at Home. Cases removed to Hospital. No. of Deaths. Case Mortality per 100. Rate of Persons Notified per 1000 Inhabitants. At Home. In Hospital. Total. Waterloo Rd. 1st 18 4 14 — 2 2 11.1 1.3 Waterloo Rd. 2nd 17 — 17 — — — — Lambeth Ch. 1st 27 1 26 — 1 1 3.7 1.5 Lambeth Ch. 2nd 44 8 36 3 3 6 13.6 1.1 Kennington 1st 32 — 32 2 2 4 12.5 0.6 Kennington 2nd 79 27 52 1 4 5 6.3 1.8 Brixton 91 23 68 4 6 10 10.9 1.05 Norwood 21 16 5 — — — — 0.6 Borough of Lambeth 329 79 250 10 18 28 85 1.7 The value of antitoxin* as a remedy for Diphtheria is now acknowledged, more especially when used in the early stages of the diseases, e.g., first or second days. Recognising the importance of this antitoxin treatment being early administered, and remembering that no untoward results have yet been noticed, or * Antitoxin first gratuitously distributed in Lambeth by the late Vestry on August 3rd, 1899. 75 reported, in cases where the remedy has been given to persons even when not suffering from Diphtheria, it is advisable to try this remedy at once, if necessary even before the diagnosis has been cleared up by bacteriological examination. Such early administration cannot possibly do any harm, and may do an immense amount of good, e.g., by saving life, etc. Antitoxin is found now to be useful, too, as a prophylactic, or preventative. Children and others exposed to Diphtheria may, with advantage, be injected with small doses of antitoxin, as also susceptible persons, who have been in close proximity to a Diphtheria patient, or may have to reside in a house where Diphtheria exists, owing to the patient, from any cause, not been removed to Hospital. Such persons under these conditions are less likely to catch the disease if protected by antitoxin. Antitoxin has been distributed gratuitously by the Borough Council for use both as a remedy and a prophylactic, throughout 1903, 45 vials having been so distributed within the Borough. "Return" Diphtheria cases in Lambeth Borough have been watched for during 1903, the arrangement made with the Metropolitan Asylums Board, by which previous intimation is sent of discharged patients to the Medical Officers of Health of the Districts concerned, rendering such investigations easy. All such intimations, which have been received during 1903, have beeu investigated. MEMBRANOUS CROUP. During 1903, in the Borough ot Lambeth, 9 cases were notified from Membranous Croup, and 1 death was registered, giving a case-mortality of 11.1 per cent. as compared with a yearly average of 26 cases notified and 8 deaths registered throughout the old Parish of Lambeth during 10 years (1891-1900). No case was removed to Hospital during 1903. 76 In London, during 1903, there were registered 752 deaths, out of a total of 7727 cases of Diphtheria and Membranous Croup notified, giving a mortality of 9.7 per cent.* (uncorrected). TYPHOID FEVER. During 1903, 24 deaths were registered in the Borough of Lambeth from Typhoid (Enteric) Fever, and a total of 133 cases notified, giving a case-mortality of 18.05 per cent. Of the 133 cases notified, 92 (i.e., 69.2 per cent.) were removed to Hospital, and 15 died, giving a case-mortality of 16 3 per cent, amongst the patients treated in Hospital; whilst 41 (i.e., 30'8 per cent.) were treated at home, and 9 died, giving a case-mortality of 21.9 per cent. amongst the patients treated at home. The case-mortality rate for the whole of the Borough of Lambeth during 1903 is low, pointing to the mildness of the majority of cases, and the probability that several of the cases diagnosed were not genuine cases of Typhoid Fever, due to the Eberth-Gaffky bacillus. If a comparison be made between the number of cases of Typhoid notified and the number of deaths from Typhoid registered in the Borough of Lambeth during 1903, and the yearly averages for 10 years (1891-1900) in the old Parish of Lambeth, it will be noted that there is a marked decrease. The yearly average of cases notified in the Parish is 189.6, and the yearly average of deaths registered is 32.8, as compared with 133 and 24 respectively as the numbers of notified cases and deaths in the Borough of Lambeth during 1903. The age and sex incidence and rmrtality for Typhoid cases notified in Lambeth Borough during 1903 are as follow:— * In London Statistics, Diphtheria and Membranous Croup are now grouped together by the Registrar-General. 77 Number of Cases Death- Ages. Notified. Deaths rate Per 100 M. F. Total. M. F. Total. Under 1 year — — — — — — — 1 to 5 4 1 5 — — — — 5 to 10 6 6 12 1 1 2 16.7 10 to 20 21 20 41 2 2 4 9.8 20 to 40 31 32 63 9 7 16 25.4 40 to 60 8 4 12 1 1 2 16.7 60 and over — — — — — — — Total 70 63 133 13 11 24 18.05 It will be noted that there were no cases notified in infants under 1 year of age, no deaths registered amongst children between 1 and 5 years of age, and only 2 deaths registered in children between 5 and 10 years; whilst the greatest number of both cases and deaths occurred amongst adults between 20 and 40 years, and the mortality-rate was greatest also amongst persons at the same age periods. Sub dividing the Typhoid cases and deaths amongst the various Registration Sub-Districts, it will be seen that the casemortality is slightly lower in the Inner than in the Outer Districts, viz., 14.6 per cent., as compared with 19.6 per cent. The reason for this is not clear, as the contrary generally is the case, the case-mortality being greater in the Inner, more congested, and less sanitary Districts. The incidence of the disease in the Inner and Outer Districts respectively is practically the same. Details as to the incidence of the disease during 1903 upon the different Registration Sub-districts of the Borough of Lambeth are as follow:- 78 Registration Sub-Districts. Total No. of Cases notified. Cases treated at Home. Cases removed to Hospital. No. of Deaths. Case Mortality per 100. Rate of persons Notified per 10,000 Inhabitants. At Home. In Hospital. Total. Waterloo Road 1st 7 3 4 — 2 2 28.6 6.7 Waterloo Road 2nd 11 1 10 — — — — Lambeth Church 1st 16 4 12 — — — — 8.7 Lambeth Church 2nd 7 2 5 1 3 4 57.1 1.8 Kennington 1st 27 8 19 1 1 2 7.4 5.01 Kennington 2nd 21 3 13 1 3 4 19.05 4.8 Brixton 33 13 20 5 4 9 27.3 3.8 Norwood 11 2 9 1 2 3 27.3 2.9 Borough of Lambeth 133 41 92 9 15 24 18.05 4.3 Of the 123 Typhoid-infected houses, 73 (i.e., 59.4 per cent). showed, on inspection, defective drains, traps, fittings or appliances. In 22 (i.e., 17.9 per cent.), the drains themselves were found to be defective. 19 cases were traced to sources outside the Borough, and 9 were secondary cases, i.e., derived from previous cases in the Borough. No case could be traced definitely and conclusively to infected water, milk, oysters or other shell-fish, ice-creams, watercress, or other well known channels, through which Typhoid has been, again and again, stated to spread. There was a history in 20 cases (15 per cent.) of shellfish having been eaten by the patients notified 1 to 3 weeks previous to the disease developing. 25 of the Typhoid-infected blankets sent from South Africa were traced to places in Lambeth Borough and were disinfected, and afterwards returned to the owners. No Typhoid case arose in Lambeth Borough from this source, though cases arose elsewhere. The Lambeth Council during 1903 decided to support the City of Westminster in their endeavour to protect shell-fish from 79 sewage contamination, by calling for Legislation to prevent the laying down of all edible forms of shell-fish in sewage-polluted creeks, or other dangerous localities; and asking that all layings, gathering beds, storage beds, &c. (at present in use and known to be polluted) should be protected by law from pollution, either by any person or by a Sanitary Authority. The question of watercress being a carrier of Typhoid germs has been raised during 1903 in connection with an outbreak of the disease during June to August in the Hackney Borough, and the Lambeth Borough Council has, in consequence, asked the Local Government Board to make an enquiry as to the sources of watercress supplied to the Metropolis in relation to the possibility of this article causing disease. It will be remembered that an outbreak of typhoid in Lambeth during 1894 was traced to the consumption of typhoid-infected watercress (vide Annual Report, 1894, pp. 4-36). 90 samples of blood were examined at the Bacteriological Laboratory during 1903 (see p. 186) for the Widal reaction of Typhoid, and in 24 cases (i.e., 26.7 per cent.) such reaction was obtained. As Typhoid Fever in a District is a sanitary index, the Borough of Lambeth may be congratulated as far as the year 1903 is concerned. In London during 1903 there were registered 387 deaths (uncorrected) out of a total of 2,337 cases of Typhoid notified, giving an uncorrected case-mortality of 16.6 per cent. CONTINUED AND TYPHUS FEVERS. During 1903, 7 cases of Continued Fever were notified in the Borough of Lambeth, and one death was registered, as compared with yearly averages for 10 years (1891-1900) in the Parish of Lambeth of 25.7 and 2.2 respectively. The case- 80 mortality for 1908 is 14.3 per cent. 10 cases were notified during 1902, and 1 death was registered, from Continued Fever, in the Borough of Lambeth. In London, 40 cases were notified, and 6 deaths registered, from Continued Fever, during 1909, giving a case-mortality of 15 per cent, (uncorrected). No case of Typhus was notified during 1903 in the Borough of Lambeth, but 22 cases were notified in London, and 3 deaths registered, giving a casemortality of 13.6 per cent, (uncorrected). PUERPERAL FEVER. During 1903, in the Borough of Lambeth, 6 deaths were registered from Puerperal Fever (a disease of child-bed), and 17 cases notified, giving a case-mortality of 85.3 per cent. The annual averages for 10 years (1891-1900) in the Parish of Lambeth are (1) notified cases, 18.9; and (2) deaths, 11.5; whilst, in the Borough of Lambeth during 1902, 17 cases were notified, and 6 deaths registered. Puerperal Fever is a preventable disease, and is caused through want of care on the part of the nurse, or the medical practitioner, attending upon a lying-in woman. 9,069 births were registered in the Borough of Lambeth during 1903, and in only 17 cases was Puerperal Fever notified—a most satisfactory fact to be able to report. Of the 17 cases notified, 4 were removed to Hospital. In each case enquiries were made, and the Midwives (when in attendance) were visited at their homes, their rooms (or houses), and clothes, disinfected, and their other cases (being attended at the time) followed up and watched for periods varying from 2 to 3 weeks each. Four Midwives were 81 cautioned, but in no instance was it found necessary to take legal action against any Midwife. The New Midwives Act, 1902, came into force on April 1st, 1903. The L.C.C. is now the Supervising Authority, and has not delegated any of its duties under the Act to the Borough Councils—an action of the L.C.C. to be regretted in the cause of efficient and economical administration. In London, during 1903, there were registered 170 deaths out of atDtal of 231 cases notified, giving a case-mortality of 73.6 per cant. (uncorrected). ERYSIPELAS. During 1903, in the Borough of Lambeth, 236 cases of Erysipelas were notified, and 12 deaths registered, giving a case mortality of 5.1 per cent. Of the 236 cases, 4 were removed to Hospital. The yearly averages for the 10 years (1891-1900) in the Parish of Lambeth are (1) notified cases, 347; and (2) deaths, 17.5. During 1902, 317 cases were notified, and 10 deaths registered, from Erysipelas within the Borough of Lambeth. In London, during 1933, there were registered 183 deaths out of a total of 4376 cases notified, giving a case-mortality of 4.2 per cent, (uncorrected). 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. The details as to the incidence of the two diseases, puerperal fever and erysipelas, in the different Registration Sub-districts of Lambeth Borough during 1903 are as follow:— 82 Registration Sub-Districts. PUERPERAL FEVER. ERYSIPELAS. Number of Cases Notified. Number of Deaths. Case Mortality per 100. Number of Cases Notified. Number of Deaths. Case Mortality per 100. Waterloo Road 1st 1 — 0.0 18 1 5.6 Waterloo Road 2nd 1 — 0.0 12 3 25.0 Lambeth Church 1st 2 — 0.0 27 1 3.7 Lambeth Church 2nd 1 1 100.0 60 2 3.3 Kennington 1st 4 2 50.0 27 — 0.0 Kennington 2nd 1 1 100.0 31 3 9.7 Brixton 5 2 40.0 48 2 4.2 Norwood 2 — 0.0 13 — 0.0 Borough of Lambeth 17 6 35.3 236 12 5.1 83 DIARRHŒA. During the year 1903, there were registered, in the Borough of Lambeth, 160 deaths from Diarrhœa, as compared with 159 during 1902 (vide p. 85, deaths from Enteritis). Taking the statistics of the old Parish of Lambeth for 10 years (1891-1900), it will be seen that the annual average is 188.4, so that the figures for 1903 for the Borough are 15.1 per cent, less, which fact, considering the greater care exercised by medical practitioners in nomenclature, on the lines of the recommendations of the Report of the Royal College of Physicians of London, is highly satisfactory, though the small average heat, and other climatic conditions, during the summer months of 1903 must be remembered, and taken into account in connection therewith. Of these 160 deaths, 153 (i.e., 95.6 per cent.) were in children under 5 years, and 123 (i.e., 76.9 per cent.) in infants under 1 year of age. August and September were the most fatal months (see Table S), though the disease was prevalent also during October. In this connection it is again interesting to note that the mean monthly air temperature was in June, 56.9 deg.; July, 62.6 deg.; August, 66.5 deg.; September, 58.8 deg.; and October, 50.3 deg.; whilst the 4ft. earth thermometer registered 56 deg. F. on June 30th, rising to a maximum 60.4 deg. F. on several days between July 19th and 31st, and sinking to 56 deg. F. again on October 13th. 56 deg. F. is the so called "critical" earth temperature for Diarrhœa, the temperature at which the germs of this particular disease begin to multiply, and prove themselves dangerous* The 4ft. earth temperatures were taken in Regent's Park, and thanks are due to Mr. Win. Marriott, of the Royal Meteorological Society, 70, Victoria Street, S.W., for the information in connection therewith. 84 Age mortalities from Diarrhœa were as follow:— Age. Total Deaths. Percentage of Total Deaths from Diarrhœa. M. F. Total. Under 1 year 65 58 123 76.9 1 to 5 17 13 30 18.8 5 to 20 — — — 0.0 20 to 40 1 1 2 1.2 40 to 60 — — — 0.0 Over 60 4 1 5 3.1 Total 87 73 160 100.0 In London there were registered, during 1903, 2,958 deaths from Diarrhœa, giving an uncorrected rate of 6.2 per 10,000 living, and 4.1 per cent. of total deaths. The details as to the Diarrhœa incidence during 1903 upon the different Registration Sub-Districts of Lambeth Borough are as follow:— Borough of Lambeth. Registration Sub-Districts. Number of Deaths. Diarrhœa Death-rate per 10,000 Population. Inner. Waterloo Road 1st 8 4.5 Waterloo Road 2nd 4 Lambeth Church 1st 17 9.2 Lambeth Church 2nd 46 11.5 Outer. Kennington 1st 17 3.2 Kennington 2nd 18 4.1 Brixton 32 3.7 Norwood 18 4.8 Borough of Lambeth 160 5.2 85 In the Inner Registration Sub-Districts, the Diarrhœa deathrate per 10,000 inhabitants was 8.8 as compared with 3.8 for the Outer Districts i.e., 2 to 1. The Inner Districts of the Borough during 1903 have pro ratâ suffered less from Diarrhœa than the Inner Districts of the Old Parish during previous years. It will be noted that the 4-foot earth temperature had a very low register during 1903, and, as a natural consequence, the Diarrhœa deaths were very few in number. Under the heading of Diarrhœa may be classed the 1 death of Cholera registered, as there is no reason to regard it otherwise than as a death from "Summer Diarrhœa"; and also the 65 deaths registered from "Enteritis," which represent a decrease that is pro rata with the increase in the number of "Diarrhœa" deaths, and is due to more exact nomenclature. The yearly average number of deaths from Enteritis in the old Parish of Lambeth for the 10 years 1891-1900 is 101.8. Comparison must be made with the corrected infantile mortality rate for the Borough, which is 125 per 1,000 births (vide p. 29). The female Inspector has visited every house wherein a death has taken place from diarrhœa, with the result that valuable statistics are being tabulated in connection therewith, and from these statistics (when in sufficient numbers) important deductions may be able, hereafter, to be drawn. 86 TABLE S. Shewing the Diarrhœa Mortality in Lambeth Borough in each month during the year 1903. Registration Sub-Districts. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Waterloo 1st 1 — — — — — l 1 3 2 — — 8 Waterloo 2nd — — — — — — l 1 1 1 — — 4 Lambeth 1st — — 1 1 1 1 l 3 7 2 — — 17 Lambeth 2nd 1 3 1 — 1 — 9 16 11 7 4 — 46 Kennington 1st — — 1 — — — 1 3 7 1 2 2 17 Kennington 2nd — — — — 1 — 1 3 8 4 1 1 19 Brixton — 1 4 — — 1 2 5 12 5 1 1 32 Norwood — — 3 1 — 1 1 5 4 3 — — 18 Total 2 4 10 2 3 3 10 37 53 25 8 4 161 N.B.—One case of Cholera Nostras occurred in September in Kennington Second Registration District (Brixton Ward), and is added to the above table. 87 TUBERCULOSIS During 1903, 435 deaths were registered in Lambeth Borough as due to phthisis (tuberculosis of the lungs), 125 as due to tabes mesenterica and tubercular meningitis, and 79 as due to other forms of tuberculosis, making a total of 639 deaths from tuberculosis (all forms)—i.e., 13.7 per cent, of the total deaths (corrected) registered from all causes. The total deaths within the Borough during 1902 and 1901 from all forms of tuberculosis were 701 and 695 respectively. Sub-dividing the tuberculosis deaths during 1903 amongst the different Registration SubDistricts, it is found that the rates (per 1000 living) vary as follow:— Registration Sub-Districts. Deaths from Phthisis. Tabes. Mes. and Tub. Men. Other forms Tuberculosis. Total Deaths Tuberculosis. Rate per 1000 living. Waterloo 1st 25 10 — 35 2.9 „ 2nd 25 8 6 39 Lambeth Church 1st 36 15 10 i 61 3.4 „ 2nd 73 24 24 121 3.1 Kennington 1st 86 20 11 117 2.2 „ 2nd 49 13 12 74 1.7 Brixton 93 31 10 134 1.6 Norwood 37 4 5 46 1.3 District not stated 11 — 1 12 — Borough of Lambeth .435 125 79 639 2 1 Inner Districts=3.1 per 1000 living. Outer Districts=l.7 per 1000 living. 88 N.B.—In the case of the 12 deaths occurring in Districts which are not stated, they have been distributed equally amongst the Eight Sub-Districts before working out rates per 1000. In addition to the usual precautionary measures (disinfection, distribution of leaflets, etc.), the voluntary notification of consumption (with tuberculous expectoration) has been in vogue during 1903 (having been commenced by the Borough Council on June 1st, 1902). During 1903, 339 cases have been notified as compared with 315 during the seven months from June 1st to December 31st, 1902. In each case enquiries have been made, disinfection carried out as required, and leaflets distributed. Much valuable information is, in this way, being collected, and there is every reason to believe that much good will accrue from the measures taken, in preventing not only the spread of the disease but also its development in susceptible persons. 204 samples of sputum were examined bacteriologically during 1903, and in 31.8 per cent. tubercle bacilli were found. To secure uniformity of information, the subjoined report-form was drawn up:—Ward Inspector's Name Name of patient Sex Age Married or Single? Address Occupation How long ill ? Any other case of Consumption in family ? Date of Notification Name of Medical Attendant Number in family (a) over 12 years (male and female), (b) 12 years and under (male and female) Number of rooms occupied by family Number of rooms in house Number of persons in house Sanitary state of premises.................................General remarks Date In this way, a large amount of tabulated information is being obtained from which, it is expected, conclusions will be able to be drawn in regard to the etiology of Consumption, and measures taken to prevent its spread. The distribution of the disease in Lambeth Borough, judging by the voluntary notifications already received, will be seen from the following table:— 89 Consumption Notifications 1902-3 (Arranged in Wards so as to shew the varying Incidences.) Wards. 1902 1903 Total 1902-8 Incidence Rate per 1000 population. Marsh 62 45 107 3.9 Bishop's 64 101 165 5.2 Prince's 52 72 124 2.6 Vauxhall 34 45 79 2.5 Total Inner Wards 212 263 475 3.4 Stockwell 16 17 33 1.0 Brixton 33 25 58 1.3 Heme Hill 21 10 37 1.2 Tulse Hill 20 6 26 0.9 Norwood 13 12 25 0.8 Total Outer Wards 103 76 179 1.1 Borough of Lambeth 315 329 654 2.1 It will be seen that the disease appears to have a greater incidence on the Inner, than on the Outer, Wards, in the same way as the death-rate (per 1000 persons living) from this disease is, also, greater. This result was to be expected, bearing in mind the more crowded conditions (persons in houses or houses over area) that exist in the Inner, as compared with the Outer, Districts—the patients notified being chiefly of the artisan and working class. Sanatoria for Consumptives. The Council approved, during 1903, the Metropolitan Asylums Board supplying Sanatoria for the use of Metropolitan Consumptives, and for using, for that purpose, at least temporarily, the existing (at present disused) Smallpox accommodation at Gore Farm. The value of Sanatoria is admitted by all practical 90 Sanitarians, and to ensure their success (in the way of treatment and cure), such Sanatoria should be established in conjunction with farm colonies, to which the patients, when cured or improved, could be sent, instead of being sent back to their crowded and unsatisfactory homes. The Metropolitan Asylums Board, after carefully considering the subject, decided on November 28th, 1903, that "the question of the proposed establishment of Sanatoria for Consumptive patients is one of such vital and far-reaching importance to the community at large, and the proposal one, which, if adopted by the Managers, would entail so considerable an extension of their duties and responsibilities, and so large an increase in their expenditure, as to call for some authoritative expression of opinion by the Local Government Board, before the Managers are asked to take any definite action in the matter, or to make any further inquiries in regard thereto." The Lambeth Council, in view of this decision by the Metropolitan Asylums Board, communicated with the Local Government Board, asking the Board to hold an enquiry into the whole question of the provision of Sanatoria for the use of London Consumptives by the Metropolitan Asylums Board, or by some other Body. The need for Sanatoria, none will gainsay, and the good effects that would accrue from the taking away, at least temporarily, from crowded localities and houses, of cases of Consumption, which, at present, are a considerable danger to others, will be readily admitted by all. It is to be hoped that some practical steps will be taken at an early date. A Bye-law prohibiting spitting on the floor, side or wall of any public carriage, or of any public hall, public waiting room, or place of public entertainment (whether admission thereto be obtained upon payment or not), has been passed during 1903 (May 12th) by the London County Council, in pursuance of the provisions of Section 23 of the Municipal Corporation Act 1882 and Section 16 of the Local Government Act 1888. The Bye-law applies to the County of London, and includes the Borough of 91 Lambeth. Such a Bye-law is much needed, as it will be readily acknowledged that indiscriminate spitting is a filthy and dangerous practice, and ought, consequently, to be prohibited, or minimised. EPIDEMIC INFLUENZA. During 1903, 52 deaths were registered from Influenza in the Borough of Lambeth, as compared with 78 during 1902, and an average of 107.5 for ten years (1891-1900) in the old Parish of Lambeth. Of the 52 deaths, 29 were registered during the first, 13 during the second, 5 during the third, and 5 during the fourth quarter, of the year. In London, there were registered 644 deaths (uncorrected), from Influenza during 1903. Reviewing the past ten years' history of the old Parish of Lambeth in relation to Epidemic Influenza, it will be seen that the disease has been practically epidemic since 1891, rising to the maximum in 1892, 1895, 1899, and 1900. The yearly average for ten years (1891-1900) in the old Parish of Lambeth is 107.5, so that the 1903 statistics for the new Borough of Lambeth show a sub-epidemic state. Table shewing the number of deaths from Epidemic Influenza in Lambeth Borough, and London, during 1903, and during ten years (1891-1900) in Lambeth Parish and London. Old Parish of Lambeth. Average for 10 years. (1691-1901.) Borough of Lambeth. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1903 Lambeth 131 142 85 44 148 51 45 126 151 152 107.5 52 London (including Lambeth). 2336 2264 1526 750 2156 496 671 1283 1817 1950 1524.9 644 N.B.—The term "Influenza" is too indefinite in medical practice to permit of any satisfactory deductions being drawn from the above statistics. 92 The 46 deaths from venereal affections (Syphilis, etc.) is the only other point calling for note in the class of Zymotic Diseases. Classes II. and III.—Parasitic and Dietetic Diseases. 33 deaths were registered in the Borough of Lambeth in these classes from Alcoholism and Delirium Tremens. Class II/.—Constitutional Diseases. Of the total 1041 deaths under this class, 307 were due to Cancer, 435 to Phthisis and 204 to Tubercular Meningitis and other forms of Tuberculosis. Class V.—Developmental Diseases. The total number of deaths in this class was 297, consisting of 159 from Premature Birth, 100 from Old Age, and 38 from Atelectasis and Congenital Malformations. Class VI —Local Diseases. 1. Diseases of the Nervous System caused 408 deaths, including 49 from Convulsions, 198 from Apoplexy, and 25 from Epilepsy. 2. 534 deaths were due to diseases of the Circulatory System. 3. The diseases of the Respiratory Organs caused 727 deaths (370 from Bronchitis, and 118 from Pneumonia). 4. Diseases of the Digestive Organs caused 304 deaths, of which 65 ware due to Enteritis, 13 to Peritonitis, 27 to diseases of the Liver and 39 to Dentition. 5. Diseases of the Urinary System caused 200 deaths. 6. Diseases of the Reproductive System, Integumentary System, Locomotive System, Lymphatics, Organs of Special Senses, etc., caused together 76 deaths. 93 Class VII.—Deaths from Violence. 174 deaths in all, including 137 from Accidents, 15 from Burns and Scalds, 16 from Drowning, 30 from Suffocation in bed (28 being infants under 1 year), 36 from Suicide, and 1 from Homicide. Class VIII.—Other Causes. 175 deaths were registered in this class, consisting of deaths from Dropsy, Tumours, Haemorrhages, or other illdefined or non-specified causes. Different rates of mortality from different diseases and groups of diseases are given in terms of the total deaths (corrected and uncorrected) in Tables T and U ; 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 (vide Table U). Deaths amongst infants under 1 year are a sensitive index (amongst others) of the sanitary state of a Community, and in this respect the Lambeth Borough statistics, as a whole, are satisfactory. Table F is important, too, in this connection, as comparing the Lambeth Borough statistics with those for London as a whole, taken in different age-periods. 94 TABLE T. Shewing Classification of Causes of deaths in the Borough of Lambeth during 1902 and 1903. A.—Total Deaths from all causes and at all ages with percentages of deaths to total deaths (corrected). Class of Disease. Borough 1902. Borough 1903. No. of Deaths (corrected). Percentage of Total Deaths. No. of Deaths (corrected). Percentage of Total Deaths. I.—Zymotic Diseases 704 13.1 625 13.4 Seven Principal 561 10.4 498 10.7 Influenza 78 1.4 52 11.1 II.—Parasitic 4 0.08 12 0.3 III.—Dietetic 25 0.5 41 0.9 IV.—Constitutional 1137 21.1 1041 22.3 Cancer 329 6.1 307 6.6 Phthisis 521 9.7 435 9.3 Tubercular Diseases, excluding Phthisis 180 3.3 204 4.4 Rheumatism (Acute and Chronic) and Gout 38 0.7 41 0.9 V.—Developmental 342 6.4 297 6.4 Old Age 126 2.3 100 2.1 VI.—Local Diseases 2762 51.3 2299 49.3 Circulatory System 551 10.2 584 12.5 Bronchitis 529 9.8 370 7.9 Pneumonia and BronchoPneumonia 502 9.3 252 5.4 Pleurisy and Pleuro-Pneumonia 42 0.8 42 0.9 Respiratory System, excluding Phthisis 1139 21.1 727 15.6 VII.—Violence 201 3.7 174 3.7 Suicide 33 0.6 36 0.8 VIII.—Other Causes 212 3.9 175 3.8 95 TABLE T (Continued). B.-Deaths (corrected) of Infants under One Year age from the chief infantile discases, and from all Causes, expressed in terms of 1,000 births. Borough 1902. Borough 1903. Total Deaths under One Year (Corrected). Proportion to 1000 Births. Total Deaths under One Year (Corrected). Proportion to 1000 Births. From all causes 1155 127. 5 1138 125.5 Diarrhœa 121 13.4 124 13.7 Convulsions 46 5.1 46 5.1 Respiratory Diseases 225 24.8 186 20.5 Premature Births 173 19.1 159 17.5 Tubercular Diseases (including Phthisis) 66 7.3 89 9.8 Measles 9 0.9 25 2.8 Whooping Cough 50 5.5 65 7.2 Suffocation in Bed 32 3.5 28 3.1 Enteritis 38 4.2 27 2.9 Dentition 19 2.1 26 2.9 96 TABLE U. Shewing Classification of certain Causes of Deaths (uncorrected) in thr Borough of Lambeth compared with London during 1902 and 1903. A-Deaths at all Ages. Lambeth. London. Percentage of total Deaths (uncorrected) Percentage of total Deaths (uncorrected) 1902. 1903. 1902. 1903. I. Principal Zymotics 10.1 11.1 12.6 11.3 Influenza 1.4 1.1 1.3 0.9 Measles 1.5 2.7 2.9 2.8 Whooping Cough 2.1 2.6 2.3 2.3 Diarrhœa and Dysentery 2.9 3.3 3.03 4.1 II. Rheumatic Fever and Heart Rheumatism 0.3 0.4 0.4 0.3 III. Diseases of Circulatory System 9.9 11.7 9.0 12.5 IV. Bronchitis, Pneumonia and Pleurisy 14.8 13.6 18.2 15.5 Phthisis 9.4 8.6 9.2 10.2 V. Injuries 3.6 4.5 4.1 4.3 B.—Deaths under 1 Year of Age (per 1000 Births). All Causes 127.4 131.7 140.9 131.5 97 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, &c., FOR 1903. Area of Borough—4,080.4 statute acres (exclusive of tidal water 82.1, and foreshore 31.1, statute acres respectively) divided into 7 Registration Sub-Districts, 4 Parliamentary Divisions, and 9 New Wards. The Parliamentary Divisions and New Wards are not co-extensive. Population—estimated middle of 1903—307,711 (males, 145,585; females, 162,126). Density—75.4 persons per acre, Inhabited Houses—41,511 at Census, 1901. Rateable Value—,£1,897,711 (for year ending March 31st, 1903). Marriages—2,452, being 15.9 per 1,000. Births—9,069, being 29.5 per 1,000. Deaths (corrected)—4604, being 15.2 per 1,000. Infantile Mortality—1,138 deaths (corrected) under 1 year, being 125.8 per 1,000 births. Zymotic—Deatl -Rate, 1.6 per 1,000. Estimated lncrease of Population 2,609, but the natural increase or increment (i.e., excess of Births over Deaths) was 4,216 (uncorrected). g 98 99 TABLE V. Local Government Board Old Table A.] Table of DEATHS during the year 1903 in the Borough of Lambeth, 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. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Puerperal. Relapsing Continued. Enteric or Typhoid. Typhus. (a) (b) (c) (d) (e) (f) (g) (h) (i) Royal Informary (Women and Children) 17 3 5 5 ... 4 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... 5 8 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 6 9 Remainder of Waterloo Road First 150 62 20 5 6 48 9 Under 5 ... ... ... ... ... ... ... ... ... ... ... 7 7 6 ... ... 8 ... ... 4 ... ... 50 82 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 10 14 11 ... 3 ... ... 29 68 General Lying-in Hospital, York Road 24 21 ... ... 1 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... 18 21 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Remainder of Waterloo Road Second 166 51 23 3 6 65 19 Under 5 ... 1 ... ... ... ... ... ... ... ... ... 4 5 2 ... ... 12 ... ... 1 ... ... 49 74 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 12 20 8 1 10 ... ... 40 92 St. Thomas's Hospital 633 71 73 65 68 312 44 Under 5 ... ... 6 ... ... ... ... 5 ... ... 1 3 2 21 ... 4 24 3 ... 11 ... ... 69 144 5 upwds. ... 1 3 ... ... ... ... ... ... ... 7 ... ... ... 1 19 17 53 1 70 ... ... 312 489 Remainder of Lambeth Church First 220 79 27 7 9 69 29 Under 5 ... 1 ... ... ... ... ... ... ... ... ... 7 13 13 ... 1 13 ... ... 4 ... ... 54 106 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 21 l6 22 ... 13 ... ... 41 114 Lambeth Workhouse 125 2 ... ... ... 23 100 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 5 upwds. ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 16 63 7 1 ... ... 33 123 Lambeth Infirmary 623 48 17 2 21 351 184 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 17 2 4 ... 1 5 ... ... ... ... ... 25 65 5 upwds. ... ... ... ... 1 ... ... 3 ... ... 4 ... ... ... 1 116 57 103 2 22 ... ... 249 558 Remainder of Lambeth Church Second 455 182 70 15 10 130 48 Under 5 ... ... 1 1 ... ... ... ... ... ... ... 17 27 33 ... 2 46 3 ... 8 ... ... 114 252 5 upwds. ... ... 2 ... 1 ... ... 1 ... ... ... ... 2 ... 2 35 42 36 1 5 ... ... 76 203 Clapham Maternity 32 32 ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 31 32 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Peter's House 42 ... ... ... ... 7 35 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 8 ... ... ... ... 19 42 Remainder of Kennington First 543 166 77 11 14 156 119 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 37 29 15 ... 6 43 1 ... 8 ... ... 103 243 5 upwds. ... ... 1 ... 2 ... ... 1 ... ... ... ... 1 ... 2 43 46 51 7 10 ... ... l36 300 100 101 TABLE V.—continued. Local Government Baard Old Table A continued.] Table of DEATHS during the year 1903 in the Borough of Lambeth, 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 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis. Pneumonia and Pleurigy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Puerperal. Relapsing. Continued. Enteric or Typhoid. Typhus. (a) (b) (c) (d) (e) (f) (g) (h) (i) ... ... ... ... ... ... 1 ... ... ... ... ... ... -- ... ... ... 1 2 Belgrave Hospital 2 ... 2 ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... 1 ... 8 6 17 ... 1 28 1 1 4 ... ... 88 156 Kennington Second 462 126 30 10 15 153 128 Under 5 ... ... 1 ... ... ... ... 1 ... ... 2 ... ... ... 1 41 44 59 11 7 ... ... 139 306 5 upwds. ... 1 ... ... I ... ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... ... ... 2 54 South Western Hospital 85 8 46 10 9 12 ... Under 5 ... 20 23 ... ... ... ... 14 ... ... ... ... ... ... ... ... ... .1 ... ... ... ... 2 31 5 upwds. ... 9 5 ... ... ... ... ... ... ... ... 15 15 26 ... 7 62 1 2 6 ... ... 184 321 Remainder of Brixton 890 249 72 23 26 274 246 Under 5 ... ... 3 ... ... ... 1 4 ... ... 1 1 1 1 4 63 81 102 13 19 ... ... 273 569 5 upwds. ... 1 1 ... 2 ... ... ... ... ... ... 10 4 3 ... ... ... 1 ... ... ... ... 6 24 Lambeth Workhouse Schools 27 ... 24 3 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 3 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... British Home of Incurables 9 ... ... ... ... 6 3 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 8 9 . 5 upwds. ... ... ... ... ... ... ... ... ... ... ... 3 11 17 ... 2 30 ... 1 6 ... ... 57 127 Remainder of Norwood 348 94 33 14 14 100 93 Under 5 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 5 29 13 41 6 7 ... ... 118 221 5 upwds. ... ... ... ... ... ... ... ... ... 1 1 131 121 157 ... 26 276 10 4 53 ... ... 868 1713 Totals 4853 1114 519 173 198 1712 I657 Under 5 ... 28 36 1 ... ... 1 30 ... ... 15 1 5 4 18 393 882 558 49 167 ... ... 1486 3140 5 upwds. ... 12 12 ... 7 The subjoined numbers have also to be taken into account in judging of the above records of mortality. ... ... ... ... ... 1 2 1 7 ... ... 19 1 ... ... ... ... 36 79 Deaths occurring outside the district among persons belonging thereto 459 33 46 28 31 256 65 Under 5 1 9 2 ... ... ... ... 6 ... ... 1 ... ... 3 ... 42 23 70 1 27 ... ... 198 380 5 upwds. 3 2 4 ... ... ... ... ... ... ... ... 4 1 11 ... 3 14 1 ... 10 ... ... 82 167 Deaths occurring wi1 in the district among persons not belonging thereto 648 89 78 50 60 288 83 Under 5 ... 20 51 ... ... ... ... 12 ... ... 6 ... ... ... 1 23 22 54 2 63 ... ... 284 481 5 upwds. ... 8 5 ... 1 102 103 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 1903, in the Metropolitan Borough of Lambeth, classified according to Diseases and Localities. Local Government Board Old Table B.] Registration Sub-Districts. Population at all Age. Registered Births. New Cases of Sickness in each the knowledge of the Medical Locality, coming to Officer of Health. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census 1901. Estimated to middle of 1903. 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Fevers. Erysipelas. Chickenpox. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Chickenpox. Typhus. Typhoid or Enteric. Continued. Relapsing. Puerperal. Cholera. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Cholera. (a) (b) (c) (d) Waterloo Road lst 27440 26939 1345 — 42 18 — — 7 1 — 1 — 18 7 — 35 14 — — 4 — — 1 — 2 — Waterloo Road 2nd 3 27 17 — — 11 — — 1 — 12 — 3 20 17 — — 10 — — — — — — Lambeth Church 1st 18423 18386 583 4 73 27 — — 16 — — 2 — 27 8 1 46 26 — — 12 — — — — — — Lambeth Church 2nd 39818 39858 1509 31 56 44 2 — 7 3 — 1 — 60 3 31 53 36 — — 5 2 — 1 — — — Kennington 1st 53198 53907 1788 31 105 32 4 — 27 — — 4 — 27 12 31 98 32 — — 19 — — 1 — 1 — Kennington 2nd 42896 43773 994 3 155 79 1 — 21 1 — 1 — 31 2 3 119 52 — — 13 — — — — — — Brixton 84232 87069 2060 — 204 91 2 — 33 2 — 5 — 48 4 — 151 68 — — 20 1 — — — 1 — Norwood 35888 37779 810 — 82 21 — — 11 — — 2 — 13 4 — 47 5 — — 9 — — 1 — — — Totals 301,895 307,711 9069 72 744 329 9 — 133 7 — 17 — 236 40 72 569 250 — — 92 3 — 4 — 4 — 104 II. SANITARY WORK. Return showing the Number of Nuisances removed or abated in the Borough of Lambeth, from the 1st January to the 31st December, 1903. Number of Notices 13043 NOTIFIABLE INFECTIOUS DISEASES. † (Public Health, London, Act). No. of Infected Houses 1336 Smallpox 41 Scarlet Fever 615 Typhoid 123 Typhus — Continued Fever 7 Diphtheria 292 Membranous Croup 9 Puerperal Fever 17 Erysipelas 232 English Cholera — † Chickenpox remained a compulsory notifiable disease throughout Lambeth Borough (and the rest of the Administrative County of London) during 1903 from January 1st to January 6th, and during that period 40 cases were notified by medical men representing 36 infected houses. 105 PARTICULARS OF SANITARY WORK Carried out in Lambeth Borough during 1903, and for 24 years (1877-1900) in Lambeth Parish (for comparison). Year. Total Number of Notices (excluding those under Housing of the Working Classes Act). Sanitary Works, Structural and Permanent. Sanitary Works, not Structural Borough of Lambeth. 1903 13043 10448 3043 Old Parish of Lambeth. 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 Average for 24 years, 1877-1900 5944.6 4798.6 2135.1 N.B.—The increase in the numbers since 1896 is due to the increased Inspectorial Staff. 106 A. Public Health (London) Act and Metropolis Local Management Acts. Notices served (Preliminary and Statutory) 11707 Works Structural:— Drainage defective 1318 Intercepting Traps with Fresh Air Inlets required 321 Ventilating Pipes required 374 Indoor Sinks connected with the Drain 560 Rain Water Stack Pipes connected with the Drain 740 Bath Waste connected with the Drain 72 Traps Defective, or of Obsolete Pattern 990 Closet Pan and Connections Defective 941 Water Supply to Closet Defective 840 Closet Dilapidated 602 Draw-off from Main for Drinking Purposes required 842 Dust Bins Defective 760 Premises Dilapidated 261 Ventilation under Floors required 59 Roofs Dilapidated 376 Soil Pipes Defective 72 Paving Defective 1191 Damp and Unwholesome Houses 101 Dung Receptables required 28 Works not Structural:— Cisterns Dirty 149 Manure Accumulations 116 Underground Rooms occupied 72 Animals Improperly Kept 28 Stoped Drains 151 Overcrowding 74 Foul Urinals 56 Through Ventilation not provided — Refuse Accumulations 107 No Water Supply or Defective Water Supply 286 Dirty Premises 2004 13,491 B. Infectious Diseases Notification. Notices served 1336 107 SUMMARY OF WORK DONE BY THE SANITARY INSPECTORS DURING 1903. Inspections 8014 Re-inspections 56249 Infectious Houses visited 1886 Complaints attended to 6199 Cases of Infectious Disease notified 1547 (a) Cases under treatment at home 607 (b) Cases removed to Hospital 972 Cases of Non-Notifiable Diseases dealt with 2309 Houses disinfected 1484 Rooms disinfected 4012 Bedding, etc., disinfected 26957 Bedding, etc., destroyed 587 Dust Yards, Manure Depots and Brickfields, inspections of 348 Drains tested (with chemical, water, or both) 8411 Sanitary Works completed 4935 Plans of Drainage received and approved 307 Premises the drains of which have been totally or partly reconstructed 265 Articles procured for the Analyst— (a) Food and Drugs 1010 (b) Water 2 Special Smoke observations and enquiries 720 New Work-shops inspected and registered 163 Bakehouses inspected (including 91 underground) 226 Cowhouses inspected 20 Slaughter-houses inspected 32 Restaurants re-inspected 87 Out-Workers' Rooms visited *289 * Including 182 premises, wherein no Out-Workers were found employed at the time of visit. 108 Notices served— Sanitary Work (Preliminary and Statutory) *11707 Infectious Diseases (Public Health Act, 1891) 1336 Housing of Working Classes Act - Sanitary nuisances abated— (a) Structural 10448 (b) Non-structural 3043 Persons received at the Shelters - Summonses and Orders issued 95 Convictions obtained— Public Health Act 23 Food and Drugs Acts 56 INSPECTORIAL STAFF. No change has taken place during 1903 in connection with the Inspectorial Staff, which consists of 12 Male Inspectors (11 District Inspectors and 1 special Food and Drugs and Smoke Inspector) and 1 Female Inspector. Inspector Emblin's appointment has not yet been filled up. The Staff, individually and collectively, has worked well during 1903, and the details of this work, as set out in this Report, are satisfactory. Supervision of Drainage. A novel point has been raised during the year 1903 by the London County Council with reference to Sanitary Inspectors supervising the drainage of new buildings, i.e., supervising the original construction of drainage works. It is held that such a duty is not included in the General Order of the Local Government Board, dated December 8th, 1891, and is not, therefore, one of the duties of a Sanitary Inspector. Consequently, in connection with such work, the London County Council refuses to pay half the Salaries of Metropolitan Sanitary Inspectors. * Public Health Act (a) Preliminary 8248, (b) Statutory 3432; Metropolis Management Acts 27. 109 A conference of Borough Councils was held at Camberwell Town Hall, on July 13th, 1903, and, as a result, the Local Government Board was asked to amend its Order of the 8th December, 1891, making the supervision of the original construction of drainage works, one of the duties of a Sanitary Inspector for which half the salary can be claimed from the London County Council, and that, pending such amendment, the Board should authorize the payment, by the London County Council, of one moiety of the salaries for such work. The Board, however, replied "That they could not hold out any hope that any immediate alteration would be made in the Order" and, consequently, a further meeting of the Conference was held on October 20th, 1903, at which it was resolved to leave to each Borough Council the decision as to what proportion of the salary of each of the Sanitary Inspectors (engaged in supervising the drainage of new buildings) should be deducted from the moiety payable by the London County Council. The Lambeth Borough Council decided to offer the London County Council a deduction of per cent. as representing the proportion of salary of each Inspector that would cover the work in connection with drainage of new buildings; and to this offer, the London County Council has agreed. The matter is, therefore, temporarily settled, though it is to be regretted that the London County Council raised the question, seeing how important a duty of a Sanitary Inspector is the supervision of the drains of new buildings. In Lambeth Borough, the Sanitary Inspectors supervise the drainage of both new and old buildings, to the advantage not only of property owners and builders but also of the Ratepayers of the Borough generally. Combined Drainage. A large number of combined drains, which have been proved to be legally Sewers, have been relaid by the Council at the cost of the Ratepayer. This is a responsibility that the Borough Council cannot legally, nor morally, get out of in the existing 110 state of the Law. The estimated cost of this work, for the year 1903, is £1464 18s. 0d., though this sum does not represent the Council's total estimated liability and expenditure in connection with combined drainages, but merely the expenditure arising directly through the Sanitary Inspectors in the course of their daily routine duties during 1903. Legal Proceedings connected with Drainage. 1. Refusal to admit Inspector. On account of the existence of a nuisance at No. 16, Benedict Road, certain sanitary works were found to be necessary, and a notice, dated October 20th, 1903, was consequently served upon the owner, calling upon him to open up the drain for inspection and examination, but this he refused to do. Instructions were, therefore, given for the Sanitary Inspector to arrange for the Council's men to open up the drain, in accordance with Section 40 of the Public Health (London) Act, 1891, after giving the required 24 hours' notice to the occupier. The occupier refused, however, to admit the Council's men, and an application was, consequently, made on November 18th, to the Magistrate for a warrant, under Section 115 of the Act. The occupier was present in court, and promised the Magistrate that he would offer no further obstruction, and, under these circumstances, the application for a warrant was withdrawn, an examination afterwards made of the drains (which were found to be defective), and the usual notices served. The nuisance was satisfactorily abated. 2. Wilful obstruction of a Sanitary Inspector. At 15, Magee Street at 11.10 a.m. on June 29th, 1903, Inspector Hooper was refused admission over the premises for the purpose of inspecting the work that was being carried out in connection with the notice served. A summons was taken out against the builder's foreman, who obstructed, and a fine of £l (costs 2s.) inflicted. 111 3. Drainage work carried out without notice to the Authority. It was found that work (drainage) had been carried out at 44, Clapham Road, without notice having been given to the Council, and in such a way as to contravene the London County Council Bye-laws and to render such work a nuisance or injurious or dangerous to health. No summons was taken out on account of the Builder apologising, and making good all the work to the satisfaction of the Council. Similar breaches of the Bye-laws were made in connection with drainage alterations carried out at the Canterbury Music Hall, Westminster Bridge Road. In this case,. also, no summons was necessary as the Builders exposed the work, which they had carried out without supervision, and which was found to be in proper order and condition. The new London County Council Bye-laws (depositing of Drainage Plans) were passed on July 28th, 1903, by the London County Council, and approved by the Local Government Board on August 20th, 1903. These Bye-laws are made under the Metropolis Management Act 1855, Section 202, and the Metropolis Management Acts Amendment (Bye-laws) Act 1899, and make compulsory the depositing of proper plans shewing intended construction of pipes, drains, or other means of communicating with sewers; partial or total construction or re-construction of a drainage system, or addition to (or alteration of) the same. These Bye-laws are somewhat stringent, and put an additional expense upon Owners and Builders. They will, however, prove useful in securing for Metropolitan Authorities more complete records of the private drains of their respective Districts. The Bye-laws do not apply to the City. During 1903, in the Borough, 265 houses have been redrained throughout, or in part; whilst 307 plans (representing 590 houses) have been received, approved, and the work (as shewn thereon) carried cut under the personal supervision of the Sanitaiy Inspectors, and the d ainage work water-tested. 112 8411 tests (hydraulic or smoke) have been made by the Sanitary Inspectors during 1903. 520 Water Certificates have been issued during 1903 in accordance with Section 48 of the Public Health (London) Act, 1891; and in this connection, it is to be noted that a Water Certificate is not granted until all the drainage work is completed satisfactorily also. Other duties fall to the lot of an Inspector in addition to drain-testing and supervision, and, as fairly representing the work carried out by an Inspectorial Staff, the numbers of (1) notices served, and (2) inspections and re-inspections made, are a fair criterion. In Lambeth Borough, during 1903, 11,680 notices have been served under the Public Health Act (8,248 preliminary and 3,432 statutory), and 27 under the Metropolis Management Acts, making a total of 11,707, dealing with 10,448 structural, and 3,043 non-structural, defects. In only 25 instances (i.e., 0.7 per cent.) were summonses under the Public Health and Metropolis Management Acts taken out—the result of these summonses being penalties to the extent of £33 10s. Od. (with £7 3s. Od. costs), and the carrying out of the necessary works within specified times. The numbers of inspections and re-inspections carried out during 1903 by the Male Inspectors are 8,014: and 56,249 respectively, and to these must be added the summary of work carried out by the Female Inspector and Smoke Inspector (vide pages 115-122 and 141-145). Unsound Food. No seizures of unsound food were made during 1903, but the following goods were voluntarily surrendered to the Inspectors:— (1) 54 boxes of Plucks and 6 boxes of Kidneys on April 6th—the Plucks and Kidneys being putrid ; (2) A barrel of Herrings (1¾ cwts. in weight) on September 25th—the Herrings; being stale and offensive. A difficulty arose in connection with the destruction of the 54 boxes of Plucks and 6 boxes of Kidneys, which were found 113 to have been delivered at Nine Elms Goods Yard en route to a Firm in Bermondsey Borough. Application was made to the Lambeth Councils' contractors, but they could not, or would not, remove it in their barges. After an unfortunate delay, the food was destroyed in the Destructor of the City Corporation (situated in Commercial Road) by special arrangement. The Lambeth Council has no Destructor in which such unsound food, or trade refuse, etc., can be destroyed, and yet by Section 33 of the Public Health (London) Act 1891 it is compulsory upon such Council, as the Sanitary Authority, to remove all trade refuse on application by the owner or occupier of the premises, whereon such trade refuse exists, at the expense of such owner or occupier. Arrangements have been made during 1903 by which unsound food and trade refuse (to be dealt with in Lambeth) will be destroyed by the Westminster City Corporation in their Destructor (situated in Commercial Road, Lambeth) at a cost of 10s. per ton of refuse destroyed—an arrangement which, though satisfactory, must only be regarded as a temporary one, pending such time as the Lambeth Council may provide a Destructor, or Destructors, of its own. An enquiry was held at the Guildhall on April 21th and May 18th, 1903, by the Local Government Board, with regard to the suggested transference of the powers and duties of Riverside Sanitary Authorities (with respect to unsound food) to the Port Sanitary Authority of the City Corporation. Such a transference was strenuously opposed by the 15 Riverside Authorities concerned as being against the Public Health interests, and contrary to the trend of Municipal Legislation, and the opposition was, fortunately, successful in that the Board refused to make any such transference. The Medical Officer of Health of Lambeth gave evidence against the suggested transference. It was shewn to the Board's Inspector that there was no lack of supervision in inspection by any of the Riverside Authorities concerned so that there was no need for any change in the administration as at present carried out. h 114 Inspection of Market Thoroughfares. The Market Thoroughfares have been, during 1903, under bi-weekly special inspection by the Inspectors (2 being on duty at a time)—Saturday nights (9 to 12) and Sunday mornings (9 to 12). The Market Thoroughfares are Atlantic Road, Wandsworth Road, New Cut, Lower Marsh and Lambeth Walk. Greengrocers' Refuse. Greengrocers' shops have been specially inspected during 1903 with a view to preventing the occupiers from throwing their shop refuse into the public thoroughfares. As a deterrent to others, a summons was taken out against the occupier for throwing a quantity of refuse (vegetable) into the public road in front of 18, Mostyn Terrace, and a fine of 10s. (2s. costs) was inflicted upon the occupier by the Magistrate. This was the only case dealt with before the Magistrate during 1903. Ordinary shop sweepings (dust, etc.) are not allowed to be swept into the public roadways (vide New Bye-law of the London County Council made May 12th, 1903, for the Good Rule and Government of the County of London—the Police being the Authority for carrying out such Bye-laws). Paving of Private Courts. The paving of "No Thoroughfares" has to be done by freeholders of land adjoining, and it is suggested by the London County Council to get permissive powers for the Borough and City Councils to do the work, and to apportion amongst the various owners, as in the case of "Thoroughfares," under Section 99 of the Metropolis Local Management Act, 1855. This suggestion was approved by the Lambeth Council. Other Inspections. The work in connection with disinfection, smoke abatement, workshops, bakehouses, restaurants and dining (coffee) rooms, and the carrying out of the Food and Drugs Acts, is dealt with under special headings in this Report (vide post). 115 FEMALE SANITARY INSPECTOR. 1903 is another year's record of good work carried out by the Female Sanitary Inspector (Miss Gamble*) in connection with (a) Factories, Workshops, Work-places, Shops, Out-workers' Homes, Laundries, etc., wherein women and girls are employed, and (b) Underground Conveniences (belonging to the Council) and other Ladies' Sanitary Conveniences (Railway Stations, Hospitals, etc.). The year's work 1903 may be tabulated as follows:— Summary of work carried out by Female Sanitary Inspector during the year 1903, and during the preceding year 1902 (for comparison). Workshops visited and inspected— 1903 1902 (a) Dressmakers 157 142 (b) Milliners 12 20 (c) Laundries 72 70 (d) Tailors 22 14 (e) Upholsterers - 1 (f) Dyers 2 1 (g) Others 48 32 Workrooms inspected 669 325 Workshops re-inspected 163 333 Workrooms re-inspected 214 305 Restaurants re-inspected 87 118 Workshops: workrooms therein measured 450 318 Workshops removed from Register 19 29 Workshops reported to H.M. Inspector 19 48 Workshops reported by H.M. Inspector 46† 102 Workshops newly discovered and registered 152 3 †Premises visited, but no female hands found to be employed (including Out-workers) 231 80 * Miss Gamble was elected on October 3rd 1901. , †Houses where the business plate, or the local directory, or advertisements in newspapers, or other sources of information implied a probability that female workers would be employed, but at which none were found at the time of visit. 116 Female Conveniences visited and inspected— 1903 1902 Public (visits paid) 343 276 Private (visits paid) 5 35 Schools visited— Public 20 10 Private - 1 Special places visited and inspected— †(a) Restaurants and Hotels, etc. 22 220 (b) Private Houses 218 199 (c) Outworkers 107 - (d) Others 3 5 Written Intimations and Statutory Notices served 198 262 No. of Workshops, etc., in which no defects were found on inspection 553 382 No. of Workshops in which defects were found on inspection 292 322 Particulars of defects found. Workrooms— Overcrowded 16 4 Damp 13 7 Dirty 217 208 III-ventilated 5 7 Otherwise - 3 Defects— Yards 19 29 Floors 18 19 Roofs 13 7 Windows - 4 Ceilings 23 17 Rain Water Pipes 9 13 Premises generally 5 9 Sanitary Appliances: Waterclosets— Dirty 83 86 III-lighted - 1 Unventilated 16 5 Choked 3 15 Defective 51 44 Defective Flushing Tanks and Water supply 43 91 No separate suitable accommodation for the sexes 8 1 Drainage— Defective 7 9 † 9 others (in which men are employed) were reported also during 1903. 117 Dustbins— Wanting 49 72 Defective 33 34 Lavatories— Defective 2 8 Miscellaneous defects (not included above)— Animals improperly kept 1 3 Accumulations in yards 2 20 Sink wastes defective - 8 Otherwise 1 - Nuisances referred to M. O. H. for attention by Male Inspectors (defective drains, w.c.'s, etc.) 86 68 An inspection of a workplace takes up much time, as the different workrooms have to he measured up, a plan drawn of the premises, and a large number of enquiries made in connection with the filling up of the Register. The Female Public Conveniences are under constant supervision by the Female Inspector, 343 visits having been paid thereto durirg 1903, whilst the Female Conveniences of Railway Stations, Hospital Out-patient Departments, Shops, etc., also come in for systematic supervision. Miss Gamble has again during 1903 been engaged in visiting all houses wherein deaths from infantile (summer) Diarrhoea have been reported as having occurred, with a view to helping to further elucidate the predisposing causes of this disease; and in inspecting schools, and the homes of the scholars, in connection with outbreaks of disease (more especially Measles). This special work in connection with Diarrhoea is giving satisfactory results, being work that was much needed in Lambeth, as it is in other Districts. It will be noted, in connection with the inspections and reinspections of workplaces (where women are employed), that the principal defects found are dirty workrooms, dirty sanitary appliances, defective flushing tanks to closets, defective closets, and defective dustbins. Overcrowding was only found in 16 cases—in each instance being slight. 118 Out-workers. Special attention has been given by Miss Gamble during 1903 to Out-workers, and the houses and rooms wherein they carry out their work—duties devolving upon Sanitary Authorities under Sections 107—110 of the Factory and Workshop Act, 1901. The Home Secretary has made an Order (which is known as the Home-Work Order 1901, and which came into force on January 1st, 1902) to the following effect:— I. Section 107 of the Act (relating to lists of Out-workers) and Section 108 (relating to employment in unwholesome premises) shall apply to the following classes of work:— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto; the making, ornamenting, and finishing of lace and of lace curtains and nets; cabinet and furniture making and upholstery work; the making of electro-plate; the making of files; and fur-pulling. II. Section 110 (relating to the prohibition of homework in places where there is infectious disease) shall apply to the following classes of work:—The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto (as in the said Section specified); the making, ornamenting, and finishing of lace and of lace curtains and nets; upholstery work; and fur-pulling. The lists of Out-workers required to be kept by Section 107, and the copies thereof, are to be kept and made in the form and manner and with the particulars shown in the schedule annexed to the Order. The Order of March 23rd, 1898, relating to lists of Out-workers, is revoked. The object of the Order is to ensure work (in certain specially mentioned Trades) being carried out under sanitary conditions, and in places (including Laundries) free from notifiable infectious disease—Smallpox and Scarlet Fever being specially 119 mentioned in connection with the making, cleaning, or repairing of wearing apparel—processes which are prohibited under penalty (not exceeding £10) in Dwelling-Houses so infected; A Sanitary Authority may, by order, forbid work to be given out to any person living or working in any Dwelling-House (the whole of the house or any part thereof), where any notifiable infectious disease exists or has recently existed (the patient having been meanwhile removed to Hospital). Such Order may be served on the occupier of the Factory or Workshop whence the work is given out, or on the Contractor employed by such occupier, and must specify a definite period during which work is not to be given out, or is to be subject to the disinfection, to the satisfaction of the Medical Officer of Health, of that part of the house which is referred to in the Order, or to "other reasonable precautions" being taken. Contravention of any Order issued by the Sanitary Authority entails a penalty not exceeding £10. In case of urgency, the Order may be issued for the Sanitary Authority by any two or more of its members, acting on the advice of the Medical Officer of Health. Occupiers of Factories and Workshops, and Contractors employed by such occupiers, in connection with certain Trades mentioned in the Order are to keep lists (open to inspection by the Sanitary Authority) of the people working for them "outside the Factory or Workshop," together with the addresses of the places where such people work or are employed. Copies of such lists are, further, to be sent to the Sanitary Authority in whose District the Factory and Workshop concerned is situ ted "on or before" the 1st days of February or August in each Year. Where a list sent to a particular Sanitary Authority contains names and addresses of Out-workers living outside the District of that particular Authority, such names and addresses are to to be sent on by that Authority to the other Sanitary Authority or Authorities concerned, thereby ensuring complete intercommunication between various Sanitary Authorities. 120 Records of such lists and addresses are to be kept by the respective Sanitary Authorities, and to be open to inspection by the Factory Inspector. Should Out-workers' houses or rooms be found to be injurious or dangerous to the health of the persons employed therein, the Sanitary Authority may give notice to the occupiers of the Factory or Workshop for whom such work is done, or to the Contractors employed by such occupiers, and, after one month from the date of such notice, may apply to a Court of Summary Jurisdiction for a penalty (not exceeding £10), should work still be being given out to be done in such unhealthy houses or rooms. From the above summary, it will be seen that increased duties are put upon the Borough Council by the Factory and Workshop Act 1901 in regard to the systematic inspection and tabulation of Out-workers premises throughout the Borough. The following form has been drawn up by the Medical Officer for the use of the Female Sanitary Inspector:— Out-worktrs Premises. Trade Address Employer and Address Owner Date of Inspection Householder Notified by Head of Workers' Family Employed at Situation of Workrooms Cubic Capacities Used for Sleeping? Workers (a) Male (b) Female Overcrowding Ventilation Lighting Condition of Floors, Walls, and Ceilings No. of Floors in House Rooms Families Persons (a) under 10 years of age (b) 10 years and over Rooms occupied by Workers' Family No. of Persons in Family (a) under 10 years of age (b) 10 years and over Sanitary Conveniences Water Supply Drainage State of Yard 121 A Register of all Out-workers' Premises in Lambeth Borough is being compiled, with the headings mentioned on the form, and during 1903, 107* such premises have been inspected. These Out-workers are connected with the following Trades and Businesses :— Mantles 6 Blouses and Skirts 10 Ties and Belts 24 Baby Clothing 6 Children's Underclothing and Costumes 5 Women's Underclothing 5 Tailors 10 Upholsterers 1 Embroidery 9 Dressing Gowns 2 Shirts 13 Aprons 1 Waistcoats 4 Jerseys 2 Hosiery 1 Widow's Caps 1 Men's Caps 1 Vamp Beader 1 Wigs 2 Incandescent Mantles 1 Shoes 1 Umbrellas 1 Total 107 The Wards, in which the houses (wherein these 107 Outworkers were found to be working) are situated, are as follow:— * A total 239 premises were visited during 1903, but in 182 cases no Out-workers were being employed at the time of the Inspector's visit. 122 Marsh 12 Bishop's 10 Prince's 38 Vauxhall 12 Stockwell 18 Brixton 17 Heme Hill* - Tulse Hill* - Norwood* - Total 107 Various sanitary defects were found on inspection, and these have since been remedied, shewing the importance of such places being inspected, and kept under regular inspection. DISINFECTING DEPARTMENT. During 1903, good work has been done in connection with the Disinfecting Department—4,012 infected rooms and 26,957 infected articles (bedding, etc.) being dealt with, as compared with 5,857 and 42,035 respectively during 1902. The total number of notifiable infectious diseases that have been reported during the year 1903 is less than that registered in any previous year (Vesty or Borough), but a large amount of disinfection has also been carried out in connection with cases of Measles (1,346), Whooping Cough (325), Tuberculosis (269), and Chickenpox (316). 13 Cancer cases have been dealt with during 1903 as compared with 34 during 1902. Full details are to be found on pages 126-8. Of the compulsorily notifiable diseases, 1587 have been dealt with, including 40 cases of Chicken-pox (which was notifiable from January 1st to January 6th, 1903). 7 public and 1 private Schools, have been disinfected in connection with outbreaks of infectious disease, and 39 Smallpox infected rooms have been stripped (after disinfection) by the Borough Council's men. * Not yet inspected. 123 Particulars as to disinfection carried out in the Borough of Lambeth during 1903. Total No. of rooms disinfected by Council 4012 Cases in which bedding has been disinfected at home 19 Do. do. do. at Chamber 3253 Do. do. do. destroyed 62 Bedding replaced by the Council 3 Premises disinfected and disinfectants supplied 10984 Infected cabs disinfected 4 No. of Cleansing Notices served in connection with infected house 3089 Certificates of Medical Practitioners received in lieu of disinfection by the Council 109 Certificates of disinfection left with occupiers of disinfected premises 3036 Articles of bedding, etc., disinfected. Beds 1785 Bolsters 1572 Pillows 3590 Mattresses 1009 Palliasses 334 Chair Cushions 2293 Clothing 6988 Blankets 2575 Rugs and Mats 886 Counterpanes and Eiderdown Quilts 1541 Carpets 532 Extras (not mentioned in above) 3852 Total 26957 124 Articles of bedding, etc., destroyed. Beds 17 Bolsters 9 Pillows 32 Mattresses 14 Palliasses 121 Chair Cushions 24 Clothing 63 Sundries 307 Total 587 Practically all the disinfection was carried out by the Councils' officers—only 109 certificates being received from Medical Practitioners during 1908, as compared with 282 during 1902. Particulars as to the 109 certificates (received during 1903) are as follow:— Medical Certificates* accepted in lieu of Disinfection being carried out by the Borough Council. Nature of Certificate. 1st Q. 2nd Q. 3rd Q. 4th Q. Total. For Rooms only 3 — - - 3 For Bedding only - - 1 1 2 For Rooms and Bedding 17 42 24 21 104 20 42 25 22 109* *Including 64 from Non-Notifiable diseases. 125 Refuges. There are 2 Refuges in the Borough, one at Wanless Road, and the other at the Wharf, Belvedere Road. Neither refuge has been used during 1903. Disinfecting Station. From January 1st, 1903, the whole of the disinfecting work has been carried out at Wanless Road. There are 2 Equifex Machines in use, and these have given satisfaction during the year, no complaints having been received as to damaged goods, etc. The old machine (Neville's Patent) at the Wharf is no longer used for disinfecting purposes. Norris and Blake are responsible for the working of the machines, Norris also being General Superintendent of the Department. The Staff consists of the Superintendent, 4 Disinfecting Men, 4 Drivers and 1 Stove Assistant. Stables have been erected at Wanless Road during the year 1903, and will be ready for use at the beginning of 1904. The estimated cost is £888—the estimated cost for the extension of the Disinfecting Buildings (including the paving of the courtyard and the provision of a glass roof over the same) being £2,288. All this work has been carried out during the years 1902-3. Two new Disinfecting Vans were purchased during 1903 from Messrs. Dicks & Seaton, Clapham Road, at a cost of £45 per Van, and two of the old Disinfecting Vans were repainted at a cost of per Van. An extra (second) Equifex Disinfecting Sprayer has been purchased during 1903. 126 NON-NOTIFIABLE INFECTIOUS DISEASES, Etc 1st Q. 2nd Q. 3rd Q. 4th Q. Total. 1903. 1902. 1901. 1900. 1899. 1898. Yearly average 5 years (1898-1902). Measles 266 403 98 579 1346 364 728 941 773 129 587.0 Whooping Cough 91 78 33 123 325 110 72 126 58 - 91.5 Chicken-pox* 126 128 57 45 356 1625 78 88 21 4 363.2 Tuberculosis† 54 50 71 94 269 488 483 524 474 4 394.6 Cancer 2 4 2 5 13 34 15 23 13 7 18.4 539 663 261 846 2309 2621 1376 1702 1339 144 1436.4 †Tuberculosis voluntarily notifiable throughout the Borough since June 1st, 1902. *Chicken-pox compulsorily notifiable throughout the Borough (the whole of the Administrative County of London) from February 7th, 1902, to January 6th, 1903—10 cases being notified compulsorily by medical men, and 316 by others, during 1903. N.B.—32 other diseases (not classified) i.e., Rheumatic Fever, Pneumonia, etc., were also dealt with during 1903. DISINFECTION STATISTICS. For eight years prior, and twelve years subsequent, to the passing of the Notification of Infectious Diseases Act; and for the year 1903. 1882. 1883. 1884. 1885. 1886. 1887. 1888. 1889. Yearly average for 8 years preceding the Notification Act. 1903. No. of Cases in which Bedding, etc., has been disinfected. At Home 332 258 278 10 62 52 7 144 143.6 19 At Chamber 85 56 162 509 236 722 902 951 460.4 3253 No. of Cases in which Bedding, etc., has been destroyed. 37 23 62 52 8 57 48 79 45.7 62 No. of Articles of Bedding, etc., disinfected. 1526 1437 1895 2275 916 3078 3121 3778 2253.2 26957 No. of Articles of Bedding, etc., destroyed. 63 104 114 144 59 92 61 267 113.0 587 Premises Disinfected and Disinfectants Supplied. 727 680 657 727 736 1276 1255 1277 916.9 10984 Infectious discases dealt with. Notifiable† - - - - - - - - - 1587 Non-notifiable† - - - - - - - - - 2269 † vide footnote on page 128. DISINFECTION STATISTICS—Continued. 1890 1891 1892 1893 1894 1895 896 1897 1898 1899 1900 1901 1902 Yearly average for 13 yrs. succeeding the Notification Act. 1903 No. of cases in which Bedding, etc., has been disinfected. At Home 179 246 593 343 177 251 368 217 132 81 62 37 20 208.1 19 At Chamber 1391 1570 2540 3042 2206 2472 2447 2126 2124 2998 2450 3040 3702 2492.9 3253 No. of Cases in which Bedding, etc., has been destroyed. 185 275 314 224 119 6 49 39 27 44 59 75 134 119.2 62 No. of Articles of Bedding, etc., disinfected. 3013 6747 9909 11513 8022 13516 20349 21487 21597 27923 27528 27265 41029* 18453.7 26957 No. of Articles of Bedding, etc., destroyed. 333 467 605 674 544 186 178 162 126 326 1783 959 1006* 565.3 587 Premises disinfected and disinfectants supplied. 1722 1816 3157 5896 5742 7146 7210 8715 8441 9146 9124 9522 12607 6941.9 10984 Infections Diseases dealt with. Notifiable† - 1676 3025 4070 2433 2685 2801 2663 2329 2693 2209 2025 4273 2740.2 1587 Non-Notifiable† - - - - - - 20 87 144 1339 1702 1376 1094 821.7 2269 129 Proposed Ambulance Service (non-Infcctious Diseases) by the Metropolitan Asyulms Board. The Council, on April 23rd, 1903, approved of the proposal of the Ambulance Committee of the Metropolitan Asylums Board to extend the operation of the Board's Ambulance Service, so as to permit of the ambulance carriages being placed at the disposal of the public for the conveyance in London of medical cases, surgical cases, and persons of unsound mind; and resolved to support the application by the Managers of the Metropolitan Asylums Board to the Local Government Board for the necessary legal authority for giving effect to such a proposal. London is without any central public Ambulance Service for the conveyance of the classes of persons referred to—the pauper cases being, as a rule, provided for by the respective Boards of Guardians; and it is clear that economy and efficiency must result from all the ambulance arrangements of London being vested in a Central Authority with special experience. Such a Central Authority is the Metropolitan Asylums Board, whose telephone systems, clerical staff, existing ambulance plant, horses, attendants, carriages, &c., are already in existence, and could be used forthwith. Legal authority is needed before the Metropolitan Asylums Board can act in this way, their existing powers only having reference to infectious diseases. ANALYSIS OF FOOD AND DRUGS, WATER, Etc. 1. Food and Drugs. During the year 1903, 1010 samples have been purchased within the Borough of Lambeth, and submitted to the Public Analyst for analysis. Of the 1010 samples, 97 (i.e., 9.6 per cent.) were reported by the Analyst to be adulterated; 66 summonses (including one for refusing to sell to the Inspector a sample of milk, one for selling milk from a vehicle on which the name and address of the owner was not given, two against Farmers on " warranties ") were issued, with the result that 60 convictions 130 were obtained, together with £71 7s. 6d. in penalties, and £38 17s. Od. in costs.* In 16 cases the vendors were cautioned. Full details are to be found on pp. 131—135,and in the Appendix (pp. 26—32). Taking the average of 10 years (1891-1900), the annual number of samples taken in the old Parish of Lambeth is 501, of which 74 (i.e., 14.8 per cent.) were found, on analysis, to be adulterated; whilst the annual average number of summonses issued is 53, with 52 convictions and £104 5s. 5d. in penalties, and £35 0s. 3d. in costs. In 16 cases (average), the vendors were cautioned. In the Borough, 710 and 704 samples respectively were taken during 1901 and 1902. It will be noted that 1010 samples have been taken by the Food and Drugs Inspector, and analysed by the Public Analyst, during 1903—the largest number ever taken by the Borough Council, or by the late Vestry, in any one previous year. This is owing to the new arrangement made by the Council at the commencement of 1903, by which a minimum 1000 samples per year are taken and analysed. The Analysts' Salary is £400 per annum (payable quarterly) in connection with the analysis of the 1000 samples, whilst a fee of 10s. per sample is paid for every extra sample analysed over and above the 1000 yearly. This is a satisfactory advance, but a still larger number of samples must be taken in Lambeth if the Food and Drugs Acts are to be efficiently administered. The Annual Report of the Local Government Board 1902-3 gives, as the average for London, one sample analysed for every 252 persons. No samples were received by the Public Analyst during 1903 from private purchasers in Lambeth Borough. In one instance, the Food and Drugs Inspector was obstructed in the course of his duty, by being refused a sample of milk (for analysis) by a man with a barrow in Lyham Road on June 22nd. * Two milk summons were dismissed on account of the warranty being proved, and two fresh summonses taken out against the Farmers (one being dismissed and the other withdrawn); and one was withdrawn (the wrong man having been summoned). A coffee summons was dismissed (vide p. 131). In 35 cases, no summonses were taken out—the amounts of adulteration being too small, or the legal technicalities such as not, to promise convictions. 131 A summons was taken out against the man, who was fined £2 (and 2s. costs). In one instance, a man was summoned for selling milk from a milk barrow, which was not labelled and marked with the name and address of the vendor, and the man was fined 10s. with 12s. 6d. costs. The various articles analysed were as follows:— (a) Milk. 493 samples were taken, and, of these, 53 (i.e., 10.8 per cent.) were declared by the Analyst to be adulterated. Connected with these 53 adulterated samples, in 34, summonses were taken out and convictions obtained, viz: (a) added water (13), varying from 5 per cent. to 36 per cent.; (b) cream abstracted (18), varying from 7 per cent. to 18 per cent.; (c) both added water and abstracted cream (2), eg., 9 per cent. added water and 7 per cent. abstracted cream, and 8 per cent. added water aud 12 per cent. abstracted cream respectively; (d) mixed new and separated milk being sold as new milk (1). In connection with the remaining 19 adulterated samples, in 3, summonses were taken out, but dismissed in 2* (warranty proved), and withdrawn in 1† (wrong man summoned); whilst in the remaining 16, no action was taken for the following reason:— (1) amount of adulteration too small, e.g., (a) added water 4 per cent. (2 cases), (b) abstracted cream 7, 8, 4, 6, 7, 8, and 9 per cent. (7 cases), (c) added water and abstracted cream 4 per cent. and 7 per cent. respectively (1 case); (2) sample sold as separated milk with 90 per cent. of the cream deficient (1 case); (3) sample bottles retained by Inspector burst (3 cases); ‡ (4) vendors could not be found (2 cases). § In the 2 cases in which the warranty was proved, 2 summonses were taken out against the Farmers—one being dismissed with £2 2s. costs against the Council, and one withdrawn, on technical grounds. *Cream abstracted 12 and 13 per cent. respectively. †Cream abstracted 11 per cent. ‡Cream abstracted 11 per cent., water added 8 per cent., and cream abstracted and water added 39 per cent. and 7 per cent. §Cream abstracted 9 and 12 per cent. respectively. 132 (b) Butter. 199 samples were taken, and, of these, 12 (i.e., 6'03 per cent.) were declared by the Analyst to be adulterated. Connected with these 12 adulterated samples, a summons was taken out, and a conviction obtained, in each case. The adulterations varied from 45 per cent. to 95 per cent. of added Margarine. (c) Coffee. 63 samples were taken, and, of these, 4 (i.e., 6'4 per cent.) were declared by the Analyst to be adulterated with 25, 50, 54 and 60 per cent. added chickory respectively. A summons was taken out, and a conviction obtained, in three cases, but in the other case the summons was dismissed, the packet being labelled "Mixture." (d) Whisky. 80 samples were taken, and, of these, 18 (i.e., 22'5 per cent. were declared by the Analyst to be adulterated. The amounts of added water were stated by notices in the bars or so small, or the samples were taken specially for adulteration with Sulphuric acid which was found not to be present (see page 136), that in no single instance was a summons taken out. (e) Margarine. 9 samples were taken—8 being found to be not legally labelled, and 1 to contain more than the permitted amount of added butter fat (i.e., 10 per cent.). A summons was taken out, and a conviction obtained, in each case. (f) Sago. 7 samples were taken, and, of these, 1 (i.e., 14.3 per cent.) was declared by the Analyst to be tapioca. No summons was taken out—it being a custom of the Trade for tapioca to be sold as sago. (g) Others. The other samples of Foods and Drugs (159 in number) taken were declared by the Analyst to be unadulterated. The Expenses connected with the carrying out of the Food and Drugs Acts in Lambeth Borough during 1903 amount to 133 £81 0s. 5d.—consisting of £24 3s. 0d. for samples, £24 9s. 9d. for Assistant (Deputy), £7 13s. 0d. for Witnesses, £20 9s. 9d. for Travelling Expenses, and £4 5s. 2d. for Sundries. The salary of the Food and Drugs Inspector (,£120 rising by ,£10 annual increases to £180) is not included in the above. SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of Analyses, during the year 1903. Samples. Number Procured. Number Adulterated Milk 493 53 Butter 199 12 Coffee 63 4 Mustard 14 — Pepper 24 — Whisky 80 18 Lard 4 — Margarine 9 9 Sago 7 1 Drugs 15 — Tea 18 — Ground Rice 12 — Oatmeal 16 — Gin 3 — Sugar 3 — Olive Oil 6 — Arrowroot 8 — Rum 6 — Baking Powder 6 — Flour 6 — Bread 5 — Semolina 4 — Ground Almonds 3 — Pea Flour 3 — Cheese 3 — Totals 1010 97 134 Particulars as to samples analysed, and proceedings taken, during 1903 (Borough), and during the ten years 1891-1900 (Parish). 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. Borough Council. 1903 1010 97 9.6 66* 60 16 £ s d. £ s. d. 71 7 6 38 17 0 Late Vestry. 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 69 0 0 34 9 0 1897 546 41 7.5 7 21 2 48 0 0 24 5 0 1896 549 66 12.02 66 60 2 93 0 0 35 11 6 1895 500 87 17.4 64 62 23 149 15 0 41 18 0 1894 495 107 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 1892 332 65 19.5 43 43 22 66 8 6 32 9 0 1891 292 48 16.4 25 24 23 28 13 6 15 1 0 Average of 10 years 1891—1900. 501.7 74.6 15.1 53.1 52.5 16.1 104 5 5 35 0 3 Inspector Perrin commenced his duties on February 21st, 1898, vice Inspector Wiggs, who did the work from August 1892, to November 1897. *4 Summonses were dismissed and 2 withdrawn. 135 Shewing percentage of different adulterated Samples during 1903 (Borough), and in ten years 1891-1900 (Parish). 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. Boro' Council 1903 9.7 5.5 4.8 0.0 — o.o 1.1 0.0 20.2 — 0.0 0.0 22.5 — — — 0.0 Late Vestry. 1900 14.2 11.0 17.8 — — o.o 3-5 o.o o.o — — — o.o 0.0 — — 0.0 1899 10.9 14.5 6.9 — — o.o 2.7 0.0 21.4 33.3 — o.o 20.0 — — 0.0 0.0 1898 13.6 14.5 10.3 — 0.0 o.o 0.0 0.0 11.1 — o.o 50.0 5.9 — — — 18.8 1897 10.5 7.3 3.03 o.o o.o o.o 2.0 11.1 17.7 — 25.0 18.2 0.0 — — — 14.3 1896 11.06 17.7 15.1 o.o 0.0 — o.o o.o o.o o.o 0.0 0.0 0.0 — — 0.0 0.9 1895 21.05 14.7 26.4 — 0.0 0.0 o.o 16.6 16.0 — 12.5 25.0 — — o.o o.o 12.5 1894 27.6 22.4 30.0 — o.o o.o 5.3 0.0 0.0 o.o 0.0 0.0 o.o — — — o.o 1893 30.4 35.04 11.1 o.o 18.2 0.0 3.3 o.o 8.7 20.0 o.o 0.0 11.1 — — — o.o 1892 31.3 36.4 18.4 — 66.7 o.o 2.1 o.o 0.0 0.0 0.0 o.o — 0.0 — — 0.0 1891 47.8 5.0 3.8 0.0 — — 2.6 o.o 0.0 o.o o.o — 0.0 o.o — 0.0 o.o 0.0 means that all samples were reported to be genuine and unadulterated. — means that no samples were taken during the year. 136 Adulteration of Whisky. Special attention was given to the reported adulteration of Whisky and other spirits, with free Sulphuric acid (and other mineral acids). Sulphuric acid being chiefly, it was reported, used as an "improver" to Whisky, there was danger not only from the sulphuric acid itself, but also from the arsenic which commercial sulphuric acid at times contains. Consequently, a raid was made on the Whisky being sold within the Borough (31 samples being taken at once), and, of these 31 samples, the Analyst reported that in not one single instance was any "free" Sulphuric acid or any trace of arsenic to be found. The majority of the samples of Whisky examined were found to be slightly acid—due to the presence of Sulphate of Potash and a natural organic acid, which are contained in the Sherry, which is added to Whisky, to suit the public taste. Further, it is a common practice to mature Whisky in Sherry casks. Of the 31 samples taken for Sulphuric acid adulteration, 18 were found adulterated with water (small amounts), but no action was taken in regard to this form of adulteration owing to (1) notices of dilution with water being displayed in the bars, or (2) the amounts of added water (degrees below proof) being too small to secure convictions. Inadequacy of Fines. The inadequacy of the fines imposed again calls for attention— such fines being out of all proportion to the offences committed, and to the cost of the Council in procuring the samples. During 1903, the fines secured by the Lambeth Borough Council varied from 5s. to £5, the average being £1 4s. 0d., each fine. The total amount received during 1903 for penalties and costs in connection with offences under the Food and Drugs Acts, was £68 7s. 6d. penalties and £37 8s. 0d. costs, as compared with averages of £104 5s. 5d. penalties and £35 0s. 3d. costs during the 10 years 1891-1900 (late Vestry of Lambeth), the expenses 137 (excluding the Inspector's Salary), connected with the carrying out of the Food and Drugs Acts in Lambeth Borough during 1903, amounted to £81 0s. 5d. The Council decided to communicate with the Home Secretary on the subject of the inadequacy of these fines imposed. Warranties. One case, heard before Mr. Horace Smith at Lambeth Police Court, was dismissed (with £2 2s. 0d. costs against the Council), and one case withdrawn, on account of the legal difficulties in proving satisfactorily a false warranty. These difficulties in dealing with warranties under the Food and Drugs Acts are increasing, and the Council, in consequence, decided, during 1903, to draw the attention of the Local Government Board to the anomalous position of Local Authorities in regard to the use or abuse of warranties, asking the Board to promote legislation with a view to putting the Law in a clear and more equitable position. Sections 25 of the 1875 Act, and 20 of the 1899 Act, are the Warranty Sections, and it has been held that proceedings must be taken within 6 months from the date of the warranty, as decided recently in a case in the High Court (vide Whittaker v. Pomfret Brothers). Further, where there are successive warranties, proceedings must be taken in the district where such successive warranties are given (vide Manners v. Taylor, 1902). The difficulties in reaching the real offenders are apparent. Formerly, under Section 25 of the 1875 Act a written warranty was a good defence, provided the vendor satisfied the Court that he sold the substance in the same condition (nature, substance and quality) as he received it, and had no reason to believe that the commodity was otherwise than as warranted. Where a false warranty was given, proceedings could be taken (Section 27 of the 1875 Act), but only in the place where the contract or warranty was executed—a most expensive procedure, which was altered by Section 20 of the 1899 Act. By this last Act 1899, proceedings can be taken with respect to a false 138 warranty in the place where the sample was purchased, but here case-law steps in and decides that such proceedings shall only apply to the first or principal warranty given (other warranties, if any, to be dealt with in the place or places where executed), and must be taken within 6 months from the date of such warranty or warranties. Further, a label on a churn may be a warranty, and in such a case the date of the warranty is the date on which the milk is despatched in such churn. Alterations in Kept Samples of Milk. An important circular has been issued during 1903 (August 17th), by the Board of Agriculture, stating that, except in a limited number of exceptional cases, there is no practical difficulty in accurately inferring the composition of milk, when fresh, from the analysis of the milk when sour. The change which takes place in a sample of milk kept from contact with air, as in a bottle nearly full of the sample, and fitted with a good sound cork, sealed with wax, is, as a rule, comparatively slight—a loss only of from 0'2 to 0.3 per cent. in the case of samples properly preserved for a period varying from 3 to 6 weeks. This loss is due to alteration in composition of the nonfatty solids, more particularly the milk sugar, due to the first fermentation change—the so-called "lactic acid fermentation," with the formation of lactic acid, ethylic alcohol, and acetic acid. In connection with the second fermentation change—the so-called "butyric acid fermentation," the amount of free acid is so increased, and the casein is separated out in such a way, as to render any satisfactory analysis of samples (so affected) impossible. Fortunately, this second fermentation change rarely, if ever, takes place in the case of samples properly taken and kept by Inspectors. These results have been obtained from a large number of anaylses carefully made, and are most important from the point of view of the efficient carrying out of the Food and Drugs Acts. 139 Suggested New Regulations (Sale of Butter). The Council has, during 1903, written to the Local Government Board, and to the Board of Agriculture, asking that Regulations shall be framed under Section 4 of the new 1899 Food and Drugs Act, for determining what deficiency of the nominal constituents of butter, or what addition of extraneous matter, shall raise a presumption that the article is not genuine. Similar Regulations have already been framed by the Board of Agriculture in regard to inferior (but pure) milk as to the minimum amount of milk fat (and milk solids other than milk fat) such milk shall contain, and, in regard to Butter, as to the maximum amount of water such Butter shall contain. The reason for the Council's action is the fact that certain Russian and Siberian Butters, shewing on analysis 14 to 15 per cent. of foreign (animal) fat, have been declared analytically and legally to be pure and unadulterated butters, the so-called "foreign fat" being claimed to be the natural product of the cow. This decision opens the door to wholesale adulteration of Butter with small amounts (at least up to 15 per cent.) of foreign (animal) fats, and puts the superior English Butters into unfair competition with (say) inferior (Russian or Siberian) Butters. Pure English Butter contains on the average 83 per cent. of milk fat, i.e., fat derived from the milk of cream by churning. Pure Margarine is not allowed by the Food and Drugs Act, 1899, to have more than 10 per cent. of butter fat (derived, i.e., from the milk with which the animal fats are churned up for the purpose of making Margarine), whereas no mention is made of the amount of animal fat to be allowed in pure butter. Adulteration of Butter Bill. The Council decided during 1903 to ask the President of the Board of Agriculture to insert in the Adulteration of Butter Bill, clauses dealing with the following matters : — 1. The application of the provisions of the Sale of Food and Drugs Acts, 1875-1899, to samples of milk and butter 140 containing bacteria capable of producing disease in man as certified by a competent bacteriologist. 2. The granting of powers to Sanitary Inspectors to take samples, under the Food and Drugs Acts, at railway stations, whether or not within their own districts, at which milk is delivered for consignment within their districts. The Board of Agriculture, in reply, state that they have no such power, but that the Local Government Board would require to amend the general provisions of the Sale of Food and Drugs Acts for such purposes. 2.—Water. In June, on account of complaints, samples of the drinking water supplied by the Southwark and Vauxhall and Lambeth Water Companies in the Borough were analysed, and declared by the Analyst to be unfit for drinking purposes, on account of the increase of orgauic matter. This increased organic matter was due to the unprecedented heavy rains and floodings, the filters of the Water Companies being thereby overtaxed, and, consequently, rendered, for the time being, practically useless, whilst, in addition, the storm overflow weirs allowed flood water to pass directly into the mains. The Water Companies were communicated with. The Analysis shewed as follows :— Result of Analysis. Grains per gall. Chlorine 15 Ammonia 0.0022 Albuminoid Ammonia 0.012 Oxygen consumed by organic matter in 15 minutes 0.1458 Oxygen consumed by organic matter in 4 hours 0.3280 Colour in 2-ft. tube—deep greenish yellow. Odour at 100 degrees F.—slight. No case of illness was traced as due, directly or indirectly, to the drinking of this flood water within the Borough, though careful enquiries were made at the time. 141 SMOKE ABATEMENT. During 1903, there have been made 720 special observations and enquiries in connection with smoke abatement throughout the Borough, as compared with 679 and 620 during 1902 and 1901. This is an important duty, and one that a Sanitary Authority is right in carrying out rigorously During 1903, 60 smoke notices have been served, and the nuisances abated. In one case (Charing Cross and Strand Electricity Supply Company, Limited) it was found to be necessary to proceed to summonses, and a fine of £10 (with £2 2s. Od. costs) was inflicted by the Magistrate. The following Firms have been under special observation weekly during 1903:— Charing Cross and Strand Electricity Supply Company, 85, Commercial 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. Messrs. McGaw, York Road. New London Brewery, Durham Street. Beulah Laundry, South Lambeth Road. Sunnybank Laundry, South Lambeth Road. Messrs. Doulton & Co., Albert Embankment. Messrs. Hammerton & Co., Stockwell Brewery. Messrs. Stiff & Sons, Albert Embankment. Electric Light Works, Electric Avenue. Messrs. Clarke, Brixton. 52, Acre Lane (rear of). Messrs. Mumford, Albert Embankment. Messrs. Nightingale, Albert Embankment. 142 Messrs. Holloway Bros., Belvedere Road. Bon Marche, Electrical Works, Nursery Road. Dye Works, Lower Kennington Lane. Auxiliary Steam Power Company, Heron Road. City and South London Electrical Railway, Generating Station, Clapham Road. Messrs. Drew, Bear & Co., Commercial Road. 182, Newington Butts. Messrs. Hampton & Sons, 43, Belvedere Road. Lion Brewery Company, Belvedere Road. Messrs. Beattie, 39, Lower Kennington Lane. Mr. Schmidt, 71, Brixton Road. South Metropolitan Gas Company, Works, Vauxhall. Messrs. Francis & Son, Brixton. Bonanza Bakery, 213, Lyham Road. South London Electric Supply Company, Bengeworth Road. Phoenix Wharf, Commercial Road. Messrs. Webb & Sons, Albert Embankment. 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. In addition to this special work carried out by the Borough's Smoke Inspector, the London County Council has, during 1903, written 31 letters to the Borough Council, drawing attention to smoke nuisances observed by their own officers as follow :— Messrs. McGaw & Co., 77 York Road. Messrs. Causton, Clapham Road. Messrs. Holloway, Belvedere Road. Messrs. Howe & Sons, 72, Brixton Hill. St. Thomas Hospital, Embankment. Messrs. Doulton & Co., Albert Embankment (4 occasions). Messrs. Stiff & Sons, Albert Embankment (3 occasions). City and South London Railway, Generating Station, Clapham Road. 143 Mr. Schmidt, 78, Brixton Road (3 occasions). Mr. B. E. Nightingale, Glasshouse Street, Builder (2 occasions). Mr. V. Backes, 106, Brook Street (3 occasions). Messrs. Hammerton & Co., Stockwell Brewery (2 occasions). Messrs. Holloway Bros., Belvedere Road. Bonanza Bakery, 213, Lyham Road. 205, Railton Road (Bakery). Charing Cross and Strand Electricity Supply Co., 85, Commercial Road. Bakery, 93, Clapham Road (2 occasions). Bon Marche, Electrical Works, Nursery Road (2 occasions). 74, Atlantic Road (Bakery). Messrs. Wheeler & Co., Chrysell Road (2 occasions). Messrs. Cookson, Tinworth Street (3 occasions). Messrs. Drew, Bear & Co., Commercial Road. Suffrance Wharf, College Street, Belvedere Road. Messrs. Beattie, 39, Lower Kennington Lane. Messrs. Nelson, Commercial Road. Miles Street Laundry (2 occasions). Messrs. Beaton & Co., Norwood Brewery, Chapel Road. Messrs. Kremlin & Co., Danes Road, Brixton. Electric Light Station, Electric Avenue (6 occasions). With one or two exceptions, the whole of these Firms reported by the London County Council were already under observation at the time of the receipt of the Council's complaints; as also were the following Firms, reported to the Borough Council in the 9 communications of the Coal Smoke Abatement Society, whose head offices are at 61, Godolphin Road Shepherd's Bush, W.:— Lion Brewery (4 occasions). Lambeth Infirmary. India Stores, Belvedere Road (2 occasions). Messrs. Cookson, Tinworth Street. Messrs. Drew, Bear & Co., Commercial Road. Messrs. Ball & Co., 41, Lower Kennington Lane (2 occasions). Messrs. Mumford, Albert Embankment (6 occasions). 144 Messrs. Spiers & Pond, Waterloo Station. Messrs. Clowes & Sons, Duke Street (2 occasions). Messrs. Braby, Belvedere Road. Messrs. Doulton, Lambeth (4 occasions). Messrs. Magee, Vauxhall Walk. London County Council, Belvedere Road. New London Brewery, Durham Street (3 occasions). Finsbury Borough Council Wharf, Commercial Road (4 occasions). Charing Cross & Strand Electricity Corporation, Commercial Road (4 occasions). Messrs. Seth Taylor, Albert Embankment (3 occasions). Messrs. McGaw, York Road (2 occasions). Messrs. Holloway Bros., Belvedere Road. Sunnybank Laundry, South Lambeth Road (5 occasions). Messrs. Webb & Sons, Albert Embankment. Messrs. Brotherhood, Belvedere Road, (3 occasions). Messrs. Cockerell & Co., Albert Embankment. South Metropolitan Gas Company, Vauxhall. Fortnightly reports in connection with smoke have been presented by the Public Health Committee to the Council during the year 1903. The Act lays down that black smoke only is a nuisance liable to be dealt with summarily under the Nuisance Clauses, and there is, consequently, great difference of opinion (at times) as to what is, and what is not, black smoke. Further, is a Sanitary Authority justified in allowing a definite amount of black smoke, e.g., 5-10 minutes per hour? Most Authorities do, to cover stoking, etc. The Westminster City Council are petitioning for an alteration of the Act, by which the word "black" is to be omitted. The Lambeth Borough Council do not agree, holding that the present Act gives sufficient powers, if only enforced, in regard to not only "black" but any other smoke. The Lambeth Council, however, decided to ask the London County Council to undertake an enquiry into all methods of 145 cooking, so as to ascertain whether there is any form of apparatus which is smokeless, and, at the same time, practical and economical for general use. Such an enquiry is necessary in view of the damage to Health and Property caused by Coal Smoke emitted from private Dwelling Houses. REFUSE AND MANURE DEPOTS. In places where large quantities of manure have to be dealt with, much trouble is experienced, during the summer months, on account of the Contractors finding a difficulty in disposing of it to farmers and others. Consequently, the Bye-laws of the London County Council are from time to time infringed, in that the manure is not removed regularly within the prescribed times. In practice, it is found that the simplest way is to provide a wagon, and to have the manure, as it collects from time to time, placed therein direct. The wagon, when full, is then drawn away, and another (empty) wagon put in its place, thereby preventing any disturbing of the contents, such disturbance giving rise to a nuisance. This method is not exactly in conformity with the London County Council Bye-laws, but application has been made to the London County Council with a view to the Bye-laws being altered so as to legalise such a method (vide Appendix pp. 74-79). During 1903, owing to the absence of heat during the summer months, complaints have been few and far between, but special attention has been drawn by complaint to the following private premises:— 1. Messrs. Simmonds & Sons, Ranger Road, Westow Hill. 2. Mr. Morter, Beardell Street, Westow Hill. In both cases, an arrangement (such as is mentioned above) was made, and a galvanised iron receptacle (on wheels), and a small wooden receptacle (on wheels), respectively provided. There was no nuisance complained of afterwards. K 146 The Lambeth Council, in this connection, has suggested to the London County Council an addition to the Bye-laws, made under Section 39 of the Public Health (London) Act 1891, relating to dung receptacles, so as to legalise the use of wheeled receptacles (wagons) as mentioned above in place of the present receptacles and cages allowed. The suggested addition (proposed to be made to the Bye-law) reads as follows :— "And provided that a person who shall use in place of such receptacle, or metal cage, a wagon, or van, fitted on wheels, and removed (together with the contents) periodically as required, without in any way disturbing such contents, shall be deemed to have complied with the requirements of this Bye-law—the provision of such wheeled receptacle being compulsory in connection with buildings or premises wherein, or whereon, more than one cubic yard of litter is made, or accumulates, within any consecutive twenty-four hours." With regard to the removal of offensive matters in properly constructed receptacles, an alteration has also been suggested by the Lambeth Council of the Bye-laws made under Section 16 of the Public Health (London) Act 1891 altering the hours, during which such offensive matters are to be removed, so as to read as follows:— "Between 12 (midnight) and 8 a.m. all the year round, except that this Bye-law shall not apply to any person removing or carrying, or causing to be removed or carried, such faecal, or offensive, or noxious, matter, or liquid, deposited in an impervious air-tight receptacle, or receptacles, and removed or carried in the same impervious air-tight receptacle or receptacles, such receptacle or receptacles being cleansed periodically, as required." This altered Bye-law shall not apply to any person removing -or carrying manure in a wagon or van or other receptacle (fitted on wheels), into which such manure has been placed direct, and so removed and carried therein as not to be in any way disturbed thereby or previously. 147 It is clear that where impervious, or air-tight, receptacles are used for the removal of offensive matters, and provided such receptacles are moved with their lids on, there need be no restriction as to the time of day when such offensive matters should be removed. Under existing conditions, offensive matters should not be allowed to be removed after 8 a.m. At present, such offensive matters can be removed up to as late as 12 (noon), during the months of November, December, January and February, and even up to 10 a.m. during the other months of the year. In this way, by adopting 8 a.m. as the latest hour, the great nuisance connected with the removal of fish (and other) offal in a tank van just at the time when people are starting for business would be prevented. The present mode of removing in tank vans that are allowed to parade the streets up to 10 a.m. and 12 (noon) is, though technically within the four corners of the existing Bye-laws, undoubtedly a source of great nuisance, and any alteration in the existing Bye-laws, which will at any rate limit their use to the early hours of the morning, would be a distinct sanitary gain. There are 13 public depots situated in Lambeth Borough, and these have been under constant supervision during 1903 (daily during the summer months). In no instance has a nuisance been discovered calling for special attention by the Sanitary Department. Of the 3 Railway Sidings, used for manure traffic, complaints were received in connection with 2, viz., Tulse Hill and Nine Elms. In connection with the latter, arrangements were made with the London and South Western Railway Company to make good and level the roadways, concrete all the surfaces of the sidings between the railway lines, and provide additional drainage thereto, to effectually carry off the water. Special instructions were given by the Railway Companies in both cases to the effect that, after each loading of the trucks with manure, etc., the wastage on the roads was to be picked up, and the ground gone over, and cleared up, and cleansed, daily. The nuisance connected with this necessary business is, in this way, reduced to a minimum. 148 Dust Sorting by Hand. The question as to the danger from dust sorting by hand has been raised during 1903 in connection with proposed legislation by the London County Council in the Session 1904 (prohibiting the sorting and sifting of house refuse by hand in London). Formerly, in Lambeth District, several depots existed, wherein dust sorting by hand was carried on, and on account of the action taken by the late Vestry (on the advice of the Medical Officer of Health) such hand sorting was discontinued in connection with Lett's Wharf (Commercial Road) and Phoenix Wharf (Commercial Road). This action of the late Vestry has been approved by the present Borough Council during 1903, and the London County Council proposed Legislation supported—a wise decision, upon which the Borough Council is to be congratulated. It is true that there is always a difficulty in proving actual injury to health from such an offensive occupation as hand sorting of refuse, but there can be no doubt as to such a trade process being dangerous to health, when we consider that the employees work half buried in offensive, and more or less decomposing and fermenting, organic refuse, the fumes from which surround them, and are being breathed and re-breathed continuously. A copy of the special Report presented to the Borough Council on October 15th, 1903 is printed in the Appendix (pp. 68-70). Deposit of refuse on St. John's Villa Estate, West Norwood, A Contractor was found during June 1903 to be depositing refuse (clay, road sweepings, and other offensive market sweepings) on to the St. John's Villa Estate at the rear of houses in Casewick Road, West Norwood, thereby creating a nuisance. Action was taken, and the nuisance abated, such depositing (except of olay) teing prohibited for the future. 149 London County Council Allotments, Elder Road. Application was made for permission to shoot dust-bin refuse on the London County Council allotments for the purpose of making up two new roads. These allotments are let at a rental of 1s. 1d. per rod per annum by the London County Council to working men, who must construct the necessary roads, and who cannot for that purpose afford to use clean hard core at a cost of 4s. to 6s. per load, thereby adding an extra annual rent of 6s. 8d. per allotment. During 1903, the Council took action to prohibit the shooting of dust-bin refuse by a Contractor on land adjoining the allotments during the Summer months, but, on the advice of the Medical Officer, the permission asked for was only granted under the following strict conditions:— 1. The depositing of house refuse on the allotments in Elder Road, West Norwood, only to take place during the winter months (December, January, and February). 2. The refuse, when deposited, to be at once spread out and levelled—all animal and vegetable matters found being buried or burnt as required, and in such a way as not to be a nuisance. 3. This permission to be allowed as a special favour, as an encouragement for the use of allotments by working men, and not to be regarded in any way as a general permission for depositing refuse within the Borough of Lambeth, by the Lambeth Borough Council Contractor, or others. 4. The Borough Council's own Contractor alone to be allowed to deposit the dust required (at 1s. per load). 150 EFFLUVIUM NUISANCES. 1.—Dust Destructors belonging to Public Bodies. No complaints* have been received during 1903 with respect to the working of the destructors belonging (a) to the City of Westminster and situated at Shot Tower Wharf, Commercial Road; (b) to the City Corporation and situated at Lett's Wharf, Commercial Road. 2.—Dust Destructors belonging to Private Contractors (Messrs. Clarkson & Cookson), Tinworth Street. Several complaints were received during the year 1903, and were found to be due to neglect of management, e.g., coke (secondary) fire not kept alight, offensive (vegetable) matters being stacked in the yards adjoining, and not burnt at once when received, etc. These destructors are visited regularly and generally found to be in fair and satisfactory working order. Destructors (properly planned and managed) need not be a nuisance. 3.—Saw Mills, Dulwich Road. A Memorial (signed by 11 inhabitants of the neighbourhood) was received by the Council at the end of February, drawing attention to an alleged effluvium nuisance from a chimney in connection with Saw Mills, situated in Dulwich Road—the chief complaint referring to "blacks" falling on clothes, which are hung out to dry. No nuisance could be discovered by the Medical Officer nor by the Inspector of the District, and consequently no further action was taken on the Memorial. *On December 1st, 1903 a large quantity of breeze caught fire accidentally in Cookson's Yard, Tinworth Street, and the nuisance at the time was serious, but was abated within 48 hours. 151 4.—Messrs. Rogers & Cook, South Lambeth Road (Laundry). A Memorial (signed by 18 inhabitants of the District) was received by the Borough Council on April 18th, 1903, drawing attention to the serious nuisance arising from the noxious fumes and smoke allowed to issue from the chimney shafts of the laundry belonging to Messrs. Rogers & Cook, and situated in South Lambeth Road. By Section 21 (effluvium nuisance) of the Public Health (London) Act 1891,a Prosecution by the Council became necessary, and the Summons was issued and heard at Lambeth Police Court on July 8th and 15th, 1903, with the result that Messrs. Rogers & Cook were fined £2 and £10 10s. 0d. costs. Against this conviction the Defendants appealed, but the appeal was dismissed with costs by Mr. Loveland Loveland, K.C., on October 23rd, 1903. 5.—72, Brixton Hill (Bakehouse). A Memorial (dated July 2nd, 1903, and signed by 10 inhabitants) was received by the Council drawing attention to an effluvium nuisance in connection with the chimney of a bakehouse at the rear of 72, Brixton Hill. Before the receipt of the Memorial, the Medical Officer had already succeeded in persuading the owner to raise the height of the Bakehouse chimney 20 feet, making it 45 feet in height in all, so that no action under Section 21 of the Public Health (London) Act 1891 was necessary the nuisance (complained of) having been satisfactorily abated. 6.—South London Electricity Supply Corporation, Bengeworth Road. Two Memorials have been received during 1903, drawing attention to the emission of "grease," "blacks" and smoke from the chimney belonging to the South London Electric Supply Corporation, Limited, situated at Bengeworth Road, Loughborough Junction. The 2 Memorials were dated October 3rd, 1903, and signed by 20 and 14 inhabitants respectively. 152 Since the Magistrate inflicted an exemplary fine upon this Electricity Supply Company (the Magistrate's decision being upheld in the Court of Appeal), there has been a great improvement in regard to the black smoke nuisance. Steam is now used in large quantities, which, mixing with the black smoke in the chimney, gives it a greyish, brownish or (at times) whitish appearance, thereby preventing black smoke appearing from the chimney shaft, and so rendering it impossible for further action to be taken under Section 24 (b) of the Public Health (London) Act 1891. The Memorialists complain not only of smoke but of unburnt carbon and grease coming out of the chimney, more especially towards the latter part of the afternoon, a condition of things that may be due to the class of fuel which is burnt in the furnaces about that time. Special observations are being made, and action will be taken during 1904 if, and as may be, found necessary. Flooding. The basements and back areas of houses in Arthur Road, Treherne Road, Elliott Road, and Bramah Road have been flooded during the heavy rain-storms of 1903, and the nuisance was so serious that the Council was petitioned by 30 of the residents, asking them to take such steps as will prevent the nuisance recurring. Additional ventilation was provided to the sewers in consequence, and the existing stunt-ends of sewers connected up,* but these measures have, apparently, not proved sufficient, and further measures will be, consequently, required. *The sewer in Eythorne Road was connected up to the sewer in Arthur Road for ventilation, by laying 110 feet of 9 inch pipes. A new 9 inch lamp hole with ventilating cover was provided to the sewer in Arthur Road at its junction with the sewer in Eythorne Road, and 2 ventilation manhole covers to existing manholes at the junction of Treherne Road and Akerman Road, and at the junction of Mostyn and Akerman Roads. (Estimated cost of total work £95 10s. 0d.) 153 The danger to health from the flooding of basements of living rooms will be acknowledged by all, when it is remembered that the sewage water (as it sinks) leaves a coating of filthy and offensive matter under the floors. In connection with Flooding generally in South London, a Conference was held at Southwark Town Hall on October loth, 1903, and at this Conference the Lambeth Borough Council was represented. The result of the Conference was that a Deputation waited upon the joint Highways and Main Drainage Committee of the London County Council on November l6th, 1903, and the question of the provision of a relief sewer was discussed. Many promises were made by the Chairman of the Joint Committee. HOUSES LET IN LODGINGS. One house has been registered during 1903 (March 5th):— 63, Upper Kennington Lane. A 9-roomed house, wherein were housed, at the time of registration, 21 persons, (12 adults, and 12 children 10 years of age and under) at rents varying from 6s. to 11s. 6d. per week per set of rooms. There are 372 registered houses in the Borough, and these are regularly inspected and kept in fair sanitary condition. In practice it is again found difficult to enforce the annual cleansing by the landlord, and the necessity for the Bye-law being altered, so as make the "owner,'' and not the "landlord," liable, has again been shown (vide Special Report, Appendix, pp. 50-53). 154 COMMON LODGING HOUSES. There are 9 Common Lodging Houses (for men) situated within the Borough of Lambeth, and these have been licensed during 1903, at the Annual Licensing Meetings held June 21th and 25th, and October 14th. They are as follows:— Date when registered. Situation. Authorised No. of Lodgers. Date of Approval of Premises. 18th July, 1900 108 Lambeth-walk (c.h.) (house in rear). 38 2nd April, 1889. 30th October, 1890 55 Belvedere-road 53 1st October, 1890. 16th October, 1901 161 Stamford-street 24 15th October, 1901. 21st December, 1883 92 Westminster-bridge-road 171 21st November, 1883. 28th December, 1898 24 Lower-marsh (c.h.) 19 30th June, 1890. 24th October, 1885 89 & 91 Wandsworth-road 216 7th October, 1885. 12th February, 1887 126 Wandsworth-road 149 20th January, 1887. 23rd June, 1894 65 Upper Kennington-lane 12 22nd February, 1892. Under the Common Lodging Houses Act, 1853-5, the London County Council has control over all the Common Lodging Houses situated within the Metropolis—a duty which the newly-formed City and Borough Councils might, with advantage, have had transferred to them when the London Government Bill, 1899, was brought in. All Common Lodging Houses must be licensed by the London County Council annually (vide London County Council General Powers Act, 1902, Part IX Section 46). No application was made for a renewal of the license during 1903 of 45, Lower Kennington Lane. 155 HOUSING OF THE WORKING CLASSES. No single house has been condemned under the Housing of the Working Classes Act, during 1903, such a stringent measure not having been found necessary. In this connection, it must be remembered that a very large number of Notices under the Public Health (London) Act 1891 have been served, and many structural and non-structural works carried out, thereby improving greatly the properties concerned. Great power is given to Sanitary Inspectors under the Public Health Act in this way, and, if necessary, under this Act, a closing order can be applied for, so that the more stringent powers conferred under the Housing Acts are not (except in rare and exceptional instances) called for. This is an important point to remember. Site for Working Class Dwellings. During 1903, the London County Council has acquired a freehold site (about 1 acre) for Working Class Dwellings on the West side of Brixton Hill, near the Avenue, under Part iii. of the Housing of the Working Classes Act 1890, at a cost of £7,000. The action of the London County Council was approved by the Borough Council on January 22nd, 1903, by 27 to 25 votes (on division). It is proposed to erect 3 blocks of 5 storied Dwellings to accommodate 620 persons in 60 tenements of 2 rooms, 50 of 3 rooms, and 10 of 4 rooms. Rents for tenements for compulsorily displaced tenants. The Home Secretary refused during 1903 to reconsider the rents to be charged by the London and South Western Railway Company for their Dwellings erected on Maudslay's site, Westminster Bridge Road. These Dwellings were erected under an obligation imposed upon the Company under their Private Act of 1899—to provide Dwellings for the persons displaced by its widenings, at such rents as these people can afford to pay, and quite apart from the question of an adequate financial return for the cost of providing the new Dwellings. 156 Site Values of Insanitary Areas. On February 5th, 1903 the Council decided to support the St. Pancras Borough Council and to petition Parliament praying that the Metropolitan Borough Councils shall be either relieved of the obligation to use particular sites of cleared insanitary areas for re-housing schemes, or that the difference between the market and the housing values of such sites may be repaid out of Imperial Funds. This is a much needed reform, as at present under demolition schemes a cleared site has to be paid for by a Local Authority out of all proportion to its real (market) value, having regard to the fact that such site was formerly occupied by slum property and is only to be used for the erection thereon of Workmen's Dwellings. Housing of the Working Classes Act 1903. The Housing of the Working Classes Act 1903 (passed August 14th) introduces important amendments, e.g. (1) extension to 60 and 80 years of the maximum period for the repayment of loans in connection with (a) erection of buildings and (b) purchase of freehold land respectively; (2) simplification of procedure for obtaining a Closing Order by rendering it unnecessary to serve a Notice on the owner requiring him to abate the nuisance; (3) transference of certain housing work from the Home Office to the Local Government Board by special Order in Council; (4) provision for re-housing displaced persons, whether displaced at the time or 5 years previously by the clearance of an insanitary area by a Local Authority, or by street improvements, and by Companies acting under compulsory powers ; etc. Alterations in the Inner Wards due to Railway Extensions. Marked changes are still taking place in the Inner Wards in connection with the further extensions of the London and South Western Railway (compulsory powers obtained under Private 157 Bills). During the last 3 years, in connection with widenings, this Railway Company has absorbed, or is about to absorb, the following whole streets:— Launcelot Street. Little York Street. Charlotte Place. Griffin Street. Chartley Place. Sapphire Place. Aubin Street. Barnes Terrace. Granby Place. Shrub Place. Granby Gardens. Frederick Place. This represents a very large displacement of persons, and an important alteration in the aspect of the District. CUSTOMS AND INLAND REVENUE ACTS. During 1903, 715 Certificates under the Customs and Inland Revenue Acts, in connection with tenements (or dwellings) so constructed as to afford suitable accommodation for each of the families inhabiting the same, have been applied for, and of these, 355 have been granted unconditionally; and 360 have been granted conditionally; i.e., on condition that certain sanitary improvements and alterations are carried out at once or within a reasonable time (say, six to twelve months). In no case was a certificate refused. (a.) Certificates granted unconditionally. Address. Blocks or Houses. Tenements. Campbell Buildings, Burdett Street 4 240 Connaugh Mansions, Coldharbour Lane, 36-45 1 10 Cranworth Gardens, 10, 12, 14, 16, 18, 20, 22, 24 8 48 Fitzalan Street, 50, 51. 52, 53, 54 5 15 Glenshaw Mansions, Brixton Road, 3-8 1 6 „ „ „ ,, 11-16 1 6 ,, ,, ,, „ 19-24 1 6 ,, „ ,, ,, 27-32 1 6 .,, ,, ,, ,, 35-40 1 6 Hackford Road, Brixton 8 1 6 Park House, Chaucer Road, 1-6 1 6 Totals 25 355 158 (b.) Certificates granted conditionally. Peabody Buildings, Duke Street, Stamford) Street, a, b, c, d, e, f, g, h, i, k, m, n, o, 16 P, Q, R 352 Rothschild Street, 35, 37, 39, 41 4 8 Totals 20 360 (C.) Certificates refused. Nil. The Revenue Act 1903, which was passed on August 14th, 1903 and came into operation on September 1st, 1903, contains in Section 11 important amending provisions with respect to the exemption from, or a reduction in, inhabited house duty (under conditions) in connection with houses, so far as such houses are used as dwelling-houses, for the sole purpose of providing separate dwellings, e.g. artisan's dwellings and houses let in tenements or flats. When the annual value of any dwelling is below £20, there shall be no duty payable; £20 and not exceeding £40, the duty shall be reduced from 9d. to 3d.; over £40 but not exceeding £60, the duty shall be reduced from 9d. to 6d, A Certificate from the Medical Officer of Health of the District is required in all cases of dwellings of an annual value (gross rateable) not exceeding £40, stating that such dwellings are each so constructed as to afford suitable accommodation for each of the families or persons inhabiting the same, and provided that due provision is made for their sanitary requirements (vide Section 26, Sub-section 2 and Section 4 of the Customs and Inland Revenue Acts 1890 and 1891 respectively, both of which Sections are now repealed except so far as the former is applied for the purposes of the new Act, and Section 5 of the Taxes Management Act 1880). 159 WORKSHOPS.* During 1903, 162 new Workshops have been added to the Register,† consisting of the following:— Name of Trade or Business. No. of Workshops. Dressmakers 68 Laundries§ 44 Milliners 3 Waistcoat Makers 4 Corsetieres 3 Mantle Makers 4 Embroiderers 1 Babies' Dresses 5 Fancy Bootmakers 1 Dressing Gowns 1 Blouses 6 Underclothing 2 Ticket Writer 1 Tailors 6 Cap Maker 1 Tie Makers 4 Collar Maker 1 Shirt Maker 2 Photographer 1 Dyers and Cleaners 1 Wardrobe Dealer 1 Quilt Makers 1 Watch Repairer 1 162 *The new Factory and Workshop Act, 1901, came into force on January 1st, 1902, and entails much extra work e.g., outworkers, etc. † The Register contains (up to the end of 1903) a total of 1057 workshops with 1851 workrooms. § 8 of the laundries are steam laundries, i.e., factories. 160 Full particulars concerning these 162 Workshops have been entered up in the Register, and it is found that there are connected therewith 282 workrooms, in which were working at the time of inspection 1272 persons—75 males and 1197 females (females alone being employed in 129 workshops). There were found being employed— M. F. Total. Children — — — Young Persons 3 191 194 Adults 72 1006 1078 75 1197 1272 Notices as to the "protected persons" (i.e., children, young persons, and women) were sent on to the Factory Inspectors, from time to time, as required (i.e., where no abstract was found to have been posted up). 62 Notices of occupation of 74 workshops have been received during 1903 by the Borough Council from the Factory Inspectors, as compared with 25 during 1902 and 32 during 1901, and 3,32, 60, 31, and 29 respectively received by the late Vestry during the five years 1886-1890. 9 written Notices have been received by the Borough Council from the Factory Inspectors with reference to contraventions of the Public Health Acts in connection with Factories and Workshops, 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. The number of notices received in 1902 and 1901 were 5 and 17, as compared 16, 8, 27, 25 and 66 respectively received by the late Vestry during the five years 1886-1890. In connection with the 162 new workshops, the following insanitary conditions were met with a' the time of the inspections:— 161 1. As to Ventilation and Warming and Lighting. In 2 out of the 162 workshops {i.e., 1.2 per cent.) only was the ventilation unsatisfactory, and in 160 out of 162 workshops (i.e., 98.8 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., and sufficiently lighted. 2. As to Cleanliness. In 33 workshops (i.e., 20.4 per cent.), the workrooms were dirty and required cleansing. 3. As to Sanitary Appliances. In 49 (i.e., 30.2 per cent.), the sanitary fittings and appliances wers bad. The w.c.'s were outside in 29.01 per cent., inside in 27.2 per cent., and outside and inside in 43.79 per cent. Separate closet accommodation for the sexes was wanting in 9 cases (i.e., 5.6 per cent.). The soil pipes were found to be unventilated, or insufficiently ventilated, in 32 cases (i.e., 19.8 per cent.), a condition of things which may, or may not, be a nuisance; and in 6 cases (i.e., 3.7 per cent.) there was found to be direct communication between w.c.'s and workrooms. 4. As to Dampness. In 4 workshops (i.e., 2.5 per cent.), dampness was found on inspection. 5. As to Overcrowding. The cubic capacities of the different workrooms were found to vary considerably, and in 5 workrooms (i.e., 1.8 percent.) over-crowding was found to exist. In addition to inspecting the above workshops wherein females were employed, the special work done by the Female Inspector is dealt with on pages 115—122. Six Factories were also inspected during 1903, to see if they complied with the requirements of the Acts as to w.c. accommodation for the employees. L 162 163 II. WORKSHOPS:- Details as to Sanitary Conditions and Defects found during 1903. Old Parish Districts, and the Inspectors in charge thereof. Details as to Sanitary Conditions and Defects found. Marsh. Bishop's and Prince' s. Vauxhall & Stockwell. Brixton. Tulse Hill, Norw'd. Totals. Scorrer. Wallis. Hooper. Jones. Howes. Jackson. Baxter. Gavin. Bott. Smith. Barfoot. Ventilation satisfactory 7 3 17 3 18 15 26 33 5 22 11 160 not — — — — — — 1 1 — — — 2 Cleanliness satisfactory 6 1 11 2 13 12 18 32 5 19 10 129 not 1 2 6 1 5 12 3 18 9 32 2 5 3 1 33 Workrooms damp 1 2 _ _ _ _ 1 _ 4 not 6 3 17 3 16 15 27 34 5 21 11 158 Workrooms warm 7 3 17 3 17 15 27 34 5 21 11 160 not _ _ _ _ 1 — — — — 1 — 2 State of sanitary fittings, &c good 6 3 11 3 17 9 5 28 5 16 10 113 bad 1 — 6 — 1 6 22 6 — 6 1 49 Soil pipe ventilated 7 1 6 9 6 20 24 3 19 9 104 not ventilated 1 6 2 4 4 4 8 1 1 1 32 no soil pipe — 1 5 1 5 5 3 2 1 2 1 26 Position of W.C. outside 3 1 5 7 11 5 7 2 2 4 47 inside 2 1 7 — 6 3 4 11 _ 8 2 44 outside and inside 2 1 5 3 5 1 18 16 3 12 5 71 No W.C. — — _ — — — — — — — — — Separate W.C. ac- Yes commodation No 5 3 17 2 16 15 25 34 5 20 11 153 2 — — 1 2 _ 2 _ _ 2 _ 9 Communication (direct) between W.C.'s & rooms Yes _ _ 2 _ 1 1 _ 1 _ 1 _ 6 No 7 3 15 3 17 14 27 33 5 21 11 156 N.B.— The Wards of the old Parish of Lambeth are retained so that this The Workshops (with 13 exceptions) were inspected. Table may be comparable with those in previous Reports (1897-1901). by the Female Sanitary Inspector. 164 I.— WORKSHOPS REGISTERED DURING 1903. Number of Rooms and Persons employed. New Wards 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 Scorrer 7 12 9 6 39 6 48 54 Wallis 3 4 — — — 3 1 11 1 14 15 Bishop's Hooper 17 36 — — 2 11 3 350 22 361 383 Howes 18 37 — — — 12 02 104 3 116 119 Prince's Jones 3 5 — — — 3 1 5 1 8 9 Vauxhall Jackson 15 29 — — — 9 7 92 7 101 108 Stockwell Baxter 27 46 — — — 23 7 107 7 130 137 Brixton Gavin 34 51 — — — 72 20 181 20 253 273 Bott 5 7 — — — 7 — 17 — 24 24 Tulse Hill Smith 22 40 — — — 35 6 69 6 104 110 Norwood Barfoot 11 15 — — 1 7 1 31 2 38 40 Total 162 282 — — 3 191 72 1006 75 1197 1272 N.B.— With 13 exceptions, the Inspections were made in connection with the above 162 Workshops by the Female Inspector. 165 BAKEHOUSES. There are 214 Bakehouses (135 above ground and 79 underground) situated within the Borough of Lambeth, and these have been inspected during 1903, and the necessary annual whitewashing and cleaning carried out. The Underground Bakehouses have also received special attention during 1903 in accordance with the requirements of Section 101 of the Factory and Workshop Act 1901. LIST OF OVERGROUND BAKEHOUSES IN LAMBETH BOROUGH. (*Means that Overground Bakehouse is empty and not in use at present). Marsh Ward:- Cornwall Road, 73 Lower Marsh, 43, 139 New Cut, 44 Roupell Street, 62 Tower Street, 5, 28 Westminster Bridge Road, 120 Webber Street, 43 Bishop's Ward:- Broad Street, 17 Brook Street, 106 Ethelred Street, 107 Lambeth Walk, 17,* 71, 82, 115, 191 Lollard Street, 124 North Street, 27 Prince's Road, 101* Stangate Street, 32 Upper Marsh, 18-20 Walnut Tree Walk, 43 Westminster Bridge Road, 189 Prince's Ward:- Church Street, 10, 25 Glasshouse Street, 60 Kennington Park Road, 202 Lower Kennington Lane, 32, 84, 177 Newburn Street, 20 Newington Butts, 150 Prince's Road 19*, 152 Stannary Street, 39* Trigon Road, 46 Tyer's Street, 49 Upper Kennington Lane, 76, 107, 159*' Vauxhall Street, 36, 86, 126 Vauxhall Walk, 18a, 79, 123 White Hart Street, 24, 58 Windmill Row, 10 166 Vauxhall Ward:- Clapham Road, 226 Dorset Road, 55, 129 Hartington Road, 42, 58 Lansdowne Road, 74 Portland Place South, 20 South Lambeth Road, 108, 158, 175, 198-200 Thorparch Road, 1 Wandsworth Road, 181, 227 230, 259, 283 Wilcox Road, 44 Stockwell Ward:- Acre Lane, 120 Bedford Road, 29 Clapham Road, 247 Lingham btreet, 76, 39 Stockwell Road, 63, 143 Sydney Road, 26 Brixton Ward:— Atlantic Road, 40 Brixton Road, 56, 66a, 267, 274 Camberwell New Road, 167 Clapham Road, 93 Coldharbour Lane, 76, 203, 326 Denmark Road, 133 Denmark Street, 25 Holland Road 1* Holland Street, 22 Loughborough Road, 76 Russell Street, 17* St. Mark's Road, 1 Vassall Road, 54, 75 Warham Street, 44, 81 Heme Hill Ward :— Atlantic Road, 74 Coldharbour Lane, 203, 223, 439*, 459 Denmark Hill, 120 Dulwich Road, 67 Effra Farade, 11 Hinton Road, 51 Hurst Street, 28 Kemerton Road, 7 Milkwood Road, 69 Sussex Road, 75 Tulse Hill Ward:- Acre Lane, 115 Cornwall Road, 32, 76, 146 Lyham Road, 159, 201-213 New Park Road, 59 Somers Road, 27 Water Lane, 25, 87 Norwood Road, 202 Norwood Ward:- Barnfield Road, 28 Eden Road, 7 Elder Road, 1a Gipsy Road, 193 Hamilton Road, 134 High Street, 63*, 87 Knights' Hill, 26, 49, 58, 190 Norwood Road, 427* Wood Street, 5 Rommany Road, 123 N.B.— 66 Hercules Road has been demolished during 1903, and not rebuilt. 167 In connection with Bakehouses generally, it is felt that Byelaws are needed, to ensure the proper administration of the provisions of the Factory and Workshops Act 1901, which have reference to Bakehouses. Such Bye-laws might, with advantage, deal with the following matters:— 1. Prohibiting alterations (structural and otherwise) except with consent of Sanitary Authority previously obtained. 2. Requiring sufficient light and ventilation to be provided and maintained in efficiency. 3. Requiring the Bakehouse to be kept and maintained at all times in a clean and proper state of repair. 4. Requiring all furniture and utensils to be kept properly cleansed and repaired. 5. Requiring all sweepings and refuse to be removed from the Bakehouse at the conclusion of each shift of work. 6. Requiring proper receptacles for same to be provided outside the Bakehouse. 7. To prevent misuse of a Bakehouse by urinating, expectorating etc., therein. 8. Prohibiting storing of Coal in a Bakehouse. 9. Prohibiting dressing elsewhere than in a dressing room, and prohibiting the keeping of clothes and boots in a Bakehouse. 10. Prohibiting the keeping of animals in a Bakehouse. 11. Prohibiting the use of a Bakehouse for laundry work, or any purpose other than for baking or the preparation of food. The Home Office was petitioned by the Borough Council with a view to such Bye-laws being framed, so as to secure uniformity of action by all Local Sanitary Authorities (Metropolitan and others). 168 UNDERGROUND BAKEHOUSES. There are 79 Underground Bakehouses situated within the Borough of Lambeth, and of these, 72 have been altered and constructed (as required) in accordance with the Requirements passed by the Council on November 27th, 1902 (vide Annual Report 1902 pp. 165-7), and since certified by the Council as "suitable in contruction, light, ventilation and in all other respects" for use as Underground Bakehouses (vide Section 101 of the Factory and Workshop Act 1901). These are now in use as Bakehouses. The remaining 7 Underground Bakehouses (marked with an asterick*) have not yet been altered and constructed, and, consequently, remain uncertified, and, therefore, cannot be used as Underground Bakehouses (in their present conditions) after January 1st, 1904. These are now closed as Bakehouses, and cannot again be used as such until certified by the Council as " Suitable." In 3 cases, the Underground Bakehouses have been closed, and Overground Bakehouses built in their places, viz.— 1. 13, Broad Street—demolished, and re-built Overground at 17, Broad Street. 2. 18, Upper Marsh—closed (ovens removed), and re-built Overground in the yards of 18 and 20, Upper Marsh. 3. 191, Lambeth Walk—closed, and re-built Overground at rear of 191, Lambeth Walk. 81, Lambeth Road has been demolished as an Underground Bakehouse, and not re-built Overground. The following 12 Underground Bakehouses were not in use as such at the passing of the Factory and Workshop Act 1901 (i.e., August 17th, 1901), and, consequently, cannot legally again be used at all as Bakehouses, but become permanently closed (vide Section 101 Sub-section 1 of the Act):— 169 Bishop's Ward:— Crozier Street, 12 Hercules Road, 4 Saville Place, 19 Lambeth Walk, 148 Stockwell Ward:- Ferndale Road, 185 Brixton Ward:- Brixton Road, 447 Coldharbour Lane, 386 Cumberland Place, 6 Loughborough Road, 73, Tulse Hill Ward:— Brixton Hill, 154 Cornwall Road, 76 Norwood Ward:—Woodland Hill, 31 This constructing and altering of Underground Bakehouses has involved a large amount of work and trouble, which have taken up the greater part of the year 1903, formal notice having been given by the Borough Council, at the commencement of 1903, to all the occupiers of the Requirements of the Council for Underground Bakehouses by virtue of Section 101 of the Factory and Workshop Act 1901. A Register has been compiled during 1903, shewing the states of the Underground Bakehouses before and after alteration, together with the cost of such alterations in each individual case— an interesting record as shewing what the carrying out of the New Factory and Workshop Act has entailed in respect of Underground Bakehouses throughout the Borough of Lambeth. The cost of alteration and construction has varied from a minimum £10 0s. 0d. to a maximum £850 0s. 0d. (the average being £80 0s. 0d. per Bakehouse) and it is cause for congratulation that the whole of the work involved has been carried out without friction, and without (in any one single instance) the Borough Council having to resort to the Magistrate for an Order for the work to be done. Section 101 (8) of the Factory and Workshop Act 1901 lays down that, where a dispute arises between the occupier and 170 owner of an Underground Bakehouse as to who is to be responsible and liable for the structural alterations required, application shall be made to the Magistrate, who shall apportion the cost between the occupier and owner, due regard being had to the terms of any contract between such parties. Up to the date of this Report being written, in only one instance (53, Gipsy Hill) has this power in the Act been requisitioned, and the Magistrate decided that, of the total expenses incurred, the owner was to pay £20 and the occupier £72, there being a term of years lease still to run. LIST OF UNDERGROUND BAKEHOUSES IN LAMBETH BOROUGH. (*Means that Underground Bakehouse is empty and not in use at present.) Marsh Ward:- Broadwall, 24 Cornwall Road, 64, 78 Doon Street, 22* Duke Street, 14 Lower Marsh, 14, 20, 49 New Cut, 81 Oakley Street, 26, 70 Waterloo Road, 59 York Road, 102 Bishop's Ward:— China Walk, 16 Lambeth Walk, 121, 126, 154, 204 Monckton Street, 2 Tracey Street, 22 Prince's Ward:— Auckland Street, 1 Bonnington Square, 13 Clapham Road, 24 Cleaver Street, 12 Holyoake Road, 74 Hurley Road, 17 Kennington Road, 334 Upper Kennington Lane, 19,* 199 Vauxhall Ward:— Clapham Road, 264 Hartington Road, 129 Paradise Road, 30* Wilcox Road, 3, 29 171 Stock well Ward:- Acre Lane, 144 Brixton Road, 466-8 Dalyell Road, 46 Dorrell Place, 11 Ferndale Road, 118 Kepler Road, 14 Landor Road, 80, 99, 147 Santley Street, 13 Stockwell Road, 150, 170 Tasman Road, 52 Brixton Ward:— Akerman Road, 45 Beresford Street, 271 Coldharbour Lane, 240 Gordon Grove, 9 Lothian Road, 100 Treherne Road, 12 Heme Hill Ward:- Atlantic Road, 65* Barnwell Road, 91 Milkwood Road, 6 Railton Road, 45, 64, 78,* 111, 205 Shakespeare Road, 84 Tulse Hill Ward:— Brixton Hill, 72 Elm Park, 58 Probert Road, 1 Tulse Hill, 5,* 25, 182 Upper Tulse Hill (The Exchange), 3* Norwood Road, 90, 222 Norwood Ward:— Approach Road, 6 Chapel Road, 2 Gipsy Hill, 53 Gipsy Road, 253 High Street, 34, 94 Rommany Road, 191 Westow Hill, 33 N.B.— Those Underground Bakehouses marked with an asterisk cannot be used as such until certified as "suitable" by the Borough Council. 172 OFFENSIVE TRADES. During 1903, no nuisance has been reported in regard to the 6 Offensive Trades, which exist in the Borough of Lambeth, and which are now under the supervision of the Borough Council:— 1. Fat Melters— Upper Marsh (Messrs. J. C. & J. Field). 2. Tallow Melters— 144, Broadwall (Messrs. Harris, man & Sons). 3. Soap Boilers— Upper Marsh (Messrs. J. C. & J. Field). 4. Soap Boilers— 144, Broadwall (Messrs. Harris, Blaekman & Sons). 5. Tripe Boilers— 103, Lambeth Walk (Messrs. Bennett, Son & Co.). 6. Tripe Boilers— 115, Lower Marsh (Messrs. Bennett, Son & Co.). SLAUGHTER-HOUSES. There were within the Borough of Lambeth at the end of 1902 33, registered Slaughter-houses, and at the Annual Licensing of the London County Council, held on October 26th and December 17th, 1903, respectively, the licenses were renewed with the following exception:— 158, Newington Butts— No application for license made. 173 LIST OF LICENSED SLAUGHTER-HOUSES IN THE BOROUGH OF LAMBETH, 1903. Ward. Situation of Premises. Name of Licensee. Marsh 106, Lower Marsh Thomas, Robert Edwin ,, 124, „ „ † Mabbott, Wm. ,, 99, „ „ * Holdstock, Jno. Thos. Bishop's 38, Walnut Tree Walk (rear of) Climpson, H. J. (trading as Climpson & Co.) ,, 151, Lambeth Walk Wright, Samuel ,, 165, „ „ Wright, Samuel ,, 172, ,, ,, Ward, Geo. Osborn Prince's 406, Kennington Road Parsons, W. B. ,, 60, Kennington Park Road Grellier, Frederick ,, 171, Lower Kennington Lane Clark, Arthur ,, 4, Clapham Road Holdsworth, Chas Vauxhall 302, „ ,, Holdsworth, Geo. ,, 152, „ ,, Lawrence Bros. ,, 18, Paradise Road (rear of) Smith, Wm. Geo. ,, 1, Lansdowne Road Copeman, Walter George Stockwell 97, Stockwell Road Rooksby, Walter ,, 27, Bedford Road Mercer, Wm. Jas. 174 Ward. Situation of Premises. Name of Licensee. Brixton Near Railway Hotel Brewery, Electric Lane Elphick, Edwin ,, 263, Brixton Road Knight, Harry ,, 10, Foxley Road* Maiden, Robert Levers ,, Industry Terrace (yard leading to) Warren, James Edward Herne Hill 207, Coldharbour Lane Spindler, Morris G. ,, 309, ,, ,, Ford, Hy. & Co., Ltd. ,, 77, Dulwich Road Atkin, Jim Cook Tulse Hill 45, New Park Road Beaumont, Hy. (trading as Martin & Beaumont) ,, 12, Lower Tulse Hill Haydon, Wm. Norwood 120, High Street*† Bull, John ,, 121, „ „ (rear of) Griffiths, Fredk. ,, 66, Knight's Hill Road Crittall, Daniel Pearce ,, 125, Hamilton Road Grant, George Ephraim ,, 32, Chapel Road Arnold, Jno. Daniel ,, 107, Hamilton Road (east side of) Barnett, Joseph * Small cattle only to be killed. † Special conditions laid down. Sanitarily, these 32 Slaughter-houses are in good condition, and the chemical test, which was applied to the drains in each case, failed to give a single result. Constant inspection of the Slaughter-houses within the Borough is now carried out, as the officers of the Borough Council are responsible for the due enforcement of all Bye-laws and Regulations made in pursuance 175 of the Slaughter-houses, etc. (Metropolis) Act 1874 and the Local Government Act 1888— an important duty, which was formerly carried out by the officers of the London County Council. The following infringements of Bye-laws were dealt with during 1903:— 121, High Street, West Norwood— leaving uncovered the receptacles used for storage and removal of offensive matters (trade refuse). Occupier cautioned. 107, Hamilton Road, West Norwood— leaving uncovered the reseptacles used for storage and removal of offensive matters (trade refuse). Occupier cautioned. 263, Brixton Road— Occupier Summoned (£2 penalty and 2s. costs). Two Slaughter-houses have changed hands during 1903, viz : 107 and 125, Hamilton Road, West Norwood, and are now licensed to Joseph Barnett and George Ephraim Grant respectively (formerly George William Millar, and John Herbert Newman trading as R. Casswell). The sanitary defects requiring to be dealt with in connection with the Slaughter-houses during 1903 were as follow:— Defective paving 4, defective soil pipe 1, defective roof 1, defective dung-pit cover 1. COWHOUSES. There are, within the Borough of Lambeth, 20 licensed Cowhouses, the licenses of which were renewed by the London County Council at the Annual Licensings held on October 26th and December 17th, 1903, respectively:— LIST OF LICENSED COWHOUSES IN THE BOROUGH OF LAMBETH. Ward. Situation of Premises. Sheds. No. of Cows kept No. of Marsh 6, Coral Street, Lower Marsh 1 10 Bishop's Cambria Cottage, 36, Tracey Street 1 13 ,, 71, Ethelred Street 1 7 ,, 24, Distin Street 2 9 176 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 Brixton 34, Ingleton Street 1 5 ,, 1, Elliot Road 2 9 Heme Hill 67, Coldharbonr Lane 1 7 ,, 329, Coldharbour Lane 1 8 ,, 56, Railton Road 1 5 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 ,, Elder Road Dairy, West Norwood 2 35 ,, 15, Croxted Road 1 3 27 246 Sanitarily, these 20 Cowhouses are in good condition, and they have been inspected carefully during 1903, and the drains in each case tested with the chemical test, without a result being obtained in any single instance. A few minor sanitary defect were found during 1903, e.g., defective paving (5 instances). One Cowhouse (56, Railton Road) has changed hands during the year 1903, and is now licensed by John Phillips (formerly Henry Richard Hayward). The Borough Council is now responsible for the periodical inspection of the Cowhouses, and the due inforcement of all Byelaws and Regulations which have been made in connection therewith under the Dairies, Cowsheds, and Milk-shops Orders, 1885-86-99. Such duties were carried out by the London County Council previous to the passing of the London Government Act, 1899. These duties, highly important, are better carried out by the different local Sanitary Authorities (acting for their respective 177 districts) than by the London County Council, acting for the whole of the administrative County of London. The inspections are more systematic, and more frequent, with the result that the states of the Cowhouses (at least as far as Lambeth Borough is concerned) are better as to cleanliness and general sanitation. No single summons has had to be taken out on account of contravention of a Bye-law. DAIRIES, MILK-SHOPS AND MILK-STORES. Several new Milk-shops and Milk-stores have been registered during 1903, and all existing ones have been under inspection. A Register has been completed during 1903. Proposed Municipal Milk Depot. The question of the establishment of a Municipal Sterilised Milk Depot for Lambeth has been under consideration during 1903 by the Borough Council, who decided on July 9th, 1903 in favour of the principle of the establishment of such, provided the Local Government Board would allow the necessary expenses out of the Rates. This the Local Government Board refused— there being no legal authority for such an expenditure being charged upon the General Rates, and so the question is, unfortunately, held, for the present, in abeyance. In view of the fact that Provincial Towns (e.g, Liverpool, St. Helen's, Glasgow, Manchester, etc.) are allowed to incur the necessary expenses out of the Rates, the Local Government Board has given, as regards London, a most unfortunate, and (it would seem) a most inequitable, decision. For the present at least, other means will have to be trusted to, for lessening the existing abnormal infantile mortality and morbidity, due to irregular and improper feeding. *In Battersea Borough, the Local Government Board has remitted the disallowance made by the Public Auditor, "in the exercise of the equitable jurisdiction conferred upon the Board," shewing that the Board has, apparently, sympathy with local authorities in their proposals to establish Municipal Milk Depots. M 178 Letters were received from the Royal Hospital for Children and Women (Waterloo Bridge Road), St. Thomas Hospital (Albert Embankment), and the General Lying-in Hospital (York Road) supporting the proposed scheme of a Municipal Milk Depot for Lambeth. Special Reports dealing with the subject of the proposed Milk Depot (presented to the Council) will be found in the Appendix (pp. 54-61). MORTUARIES AND CORONER'S COURTS. The total number of bodies received at the two Borough Mortuaries (High Street and Wanless Road) during 1903 was 437, as compared with 443 during 1902, and an annual average for the old Parish of Lambeth for 5 years (1896-1900) of 450. Of the 437 bodies, 318 were received at High Street and 119 at Wanless Road. 51 bodies were brought in by the Police (42 to High Street and 9 to Wanless Road), and the rest by undertakers or private persons. The Coroner's Court sat 48 times at Wanless Road, 128 times at High Street. Wanless Road Mortuary alone is provided with a separate room for bodies dead from infectious disease, but during 1903 no infectious bodies were received there. For comparison, details are given in tabular form of the work carried out by the late Vestry of Lambeth in connection with the Wanless Road and High Street Mortuaries during the five years (1896-1900). Taking an average, it will be seen that the total number of bodies received during 1902 in connection with the Borough is 7 less than the yearly average (450) received by the late Vestry during the preceding 5 years. The number of post-mortems conducted for the Borough during 1903 is 250, as compared with 253, 281, 275, 285 and 179 267 respectively during the 5 years (1896-1900) for the old Parish, i.e., 23.5 less than the yearly average (272.5) during the same quinquennium. Of the post-mortems, 48 took place at Wanless Road, and 202 at High Street. Unfortunately, the High Street Mortuary is not separately provided, as it might be, with such separate accommodation for infectious bodies, so that bodies from the Inner Wards have at present to be taken to Wanless Road, Loughborough. In other respects, too, the High Street Mortuary and Coroner's Court are inadequate for the needs of an important Borough like Lambeth. The Coroner's Court itself is suitable for the purpose for which it is intended, though an extra room is needed in connection therewith, wherein visitors, witnesses, etc., can wait, whilst a retiring room is also required into which the Coroner can retire with the Jury. The present Witnesses' Waiting Room, which leads off from the Coroner's Court, is appropriated by the Coroner as a Retiring Room for himself and Jury, leaving the visitors without any room to wait in— such persons having, consequently, to stand in the open air, and in the wet when it is raining. This small room which has been appropriated by the Coroner as a Retiring Room, is sufficient for the purpose for which it is now used. The present condition of the Mortuary and Post-Mortem Room is most unsatisfactory. These buildings are totally inadequate, and not up to present day ideas, and consequently bodies are crowded together at times and left exposed to the view of Jurymen and others, who may be visiting the buildings in connection with any particular Inquest. The nuisance arising from this state of affairs is much intensified when two or more bodies taken from the River, and in advanced stages of putrefaction, are on view. The amount of room at disposal admits only of one Container, which is a hermetically sealed tank in which can be deposited any body that is in a late stage of putrescence. The present Container itself being constructed many years ago, is not 180 up to modern ideas, with the result that it is extremely difficult to keep it thoroughly clean, so that there is a nuisance connected with it irrespective of it containing any body. At least three Containers (constructed on approved principles) are needed for the work connected with the High Street Mortuary, which is at times very heavy. The walls of the existing Mortuary are not covered with an impervious material (white-glazed bricks, tiles, etc.). From time to time necessary improvements (sanitary and other) have been carried out, as required, e.g., the providing of additional (separate) w.c. accommodation for females; the re-forming of the floor of the Mortuary; the re-building of the Clothes Stores, the water-closet buildings, and the urinal, etc., but what is really required is a new Mortuary and Coroner's Court on a new site or reconstruction of the existing Mortuary Buildings on the present site— a somewhat difficult operation, but one which the Public Health Committee is, at the time of the writing of this Report, seriously considering. Mortuary for Norwood Ward. This question has again been raised and the Borough Council has again emphasised the need for the provision of such a separate Mortuary for Norwood Ward— a small Mortuary for (1) infectious dead bodies and (2) other dead bodies. Bearing in mind how rapidly Norwood Ward is growing, and the fact that the crowded parts of the District are south of the Cemetery and far removed from Wanless Road Mortuary, the urgency of the matter will be readily admitted. A site for such a purpose is difficult to obtain but, fortunately, at the end of 1903 negotations are in progress for the acquisition of the Windsor Road site if such can be obtained for a fair value. The Mortuary at Wanless Road was repainted during 1903. The Mortuary Buildings are insured for £l,500. 8i Numbers of bodies received at the Lambeth Borough Mortuaries during 1903 and at the Lambeth Parish Mortuaries during the five years (1896-1900). 1903. January. February. March. April. May. June. July. August. September. October. November. December. Total 1903 Total 1900 Total 1899 Total 1898 Total 1897 Total 1896 Yearly Average for 18961900. High Street— Males 18 13 24 21 17 11 16 14 18 12 18 17 199 237 239 222 218 221 227.4 Females 10 14 13 9 11 10 5 7 7 12 6 15 119 142 126 143 109 152 134.4 Wanless Road— Males 10 3 5 4 5 6 4 3 6 6 6 8 66 58 71 72 41 — 48 4 Females 6 4 9 8 2 2 4 1 2 2 7 6 53 62 47 58 32 — 39.8 Totals 44 34 51 42 35 29 29 25 33 32 37 46 437 499 483 495 400 373 450 N.B.— The New Wanless Road Mortuary was opened on April 12th, 1897, and is under the superintendence of Mr. Joshua Fazey— High Street Mortuary being under Mr. S. G. Albin. Mr. Pierce is the Deputy Mortuary Keeper 182 Particulars as to cases of Drowning, Accidental Death and Suicide that have occurred in the Borough of Lambeth during 1903, and in the old Parish during five years (1896-1900). High Street. Wanless Road. Boro' Parish of Lambeth. Average 5 years 18961900. Total 1903. Total 1900. Total 1899. Total 1898. Total 1897. Total 1896. M. F. Total. M. F. Total. Drowning 5 1 6 - — - 6 6 1 1 13 16 7.4 Suicides 1 1 2 7 1 8 10 14 13 21 6 13 13.4 Poisoning — 1 1 — — — 1 3 4 3 4 4 3.6 Hanging — — — 3 — 3 3 4 3 9 — 2 3.6 Throat cutting — — — 3 1 4 4 3 4 5 1 2 3.0 Jumping off heights — — — — — — — 1 — — — 2 0.6 Cutting Arteries — — — — — — — 1 1 — — - 0.4 Shooting 1 — 1 1 — 1 2 2 1 4 1 3 2.2 Railway Accidents — — — 1 — 1 1 4 4 1 1 3 2.6 Accidental Death (sudden) 1 1 2 — — — 2 6 1 12 - — 3.8 Street Accidents (run over) — 2 2 2 1 3 5 3 9 7 4 3 5.2 Murder — — — — — — — 1 2 — 2 2 1.4 Burning — — — — — — — 1 2 3 1 — 1.4 Falling 1 — 1 5 1 6 7 1 1 4 4 — 2.0 Bicycle Accidents — — — — — — — 2 — 1 — — 0.6 Strangulation and Suffocation — — — — — — — — — 2 — — 0.4 Found Dead — — — 3 1 4 4 — — — — — — Bursting Blood Vessel — — — — — — — — — — - — — Killed 1 — 1 — — — 1 — — — — — - Manslaughter — — — — — — — — — — - — - Fits 1 — 1 — — — 1 — — — — — — N.B.—No body (dead from infectious disease) was admitted during 1903 into the special room provided for infectious bodies at Wanless Road Mortuary. 183 Ages of bodies received at the Lambeth Borough Mortuaries, 1903 and at the Lambeth Parish Mortuaries during five years (1896-1900). Registered Ages of Bodies. 1903. Boro' Parish. Yearly Average for 1896-1900. High Street. Wanless Road. Total 1903. Total 1900. Total 1899. Total 1898. Total 1897. Total 1896. 0—1 70 41 111 133 121 160 101 121 127.2 1—5 16 10 26 47 44 50 39 22 40.4 5—10 7 5 12 12 22 17 9 12 14.4 10—20 12 1 13 17 13 8 18 9 13.0 20—30 27 3 30 31 29 26 26 24 27.2 30—40 37 6 43 43 59 45 35 35 54.2 40—50 48 20 68 80 67 64 48 37 59.2 50—60 35 9 44 61 53 42 59 46 52.2 60—70 36 16 52 50 47 39 30 35 40.2 70—80 19 5 24 16 19 32 20 22 21.8 80—90 6 2 8 6 8 5 9 7 7.0 90—upwards 1 1 2 1 1 — 3 1.0 Age not stated 4 — 4 3 — 6 6 — 3.0 Totals 318 119 437 499 483 495 400 373 450 184 INQUESTS. During the year 1903, within the Borough of Lambeth 134 cases were submitted to the Coroner, who, in 57 instances decided that no further inquiries were necessary; but in the other 374 cases, held inquests with the following results:— I. Natural Causes 194 II. Accidental Causes 136 Burns and Scalds 12 Drowning 4 Run over 16 Falls, etc. 33 Suftocation 32 Alcoholism 2 Fracture 2 Misadventure 24 Crushed 2 Blood Poisoning 5 Improper Feeding 4 III. Homicidal Causes 37 Suicide 36 Murder — Manslaughter 1 IV. Open Verdicts 7 Found Drowned 7 Found Dead — Total 374 185 BACTERIOLOGICAL LABORATORY The Bacteriological Laboratory, situated at Arlington Lodge, Wanless Road, Loughborough Junction, has again proved most useful during 1903—having been much used by the Medical Practitioners practising within the Borough. All examinations are carried out free of cost to the Medical Practitioners. The Laboratory was orignally fitted up by the late Vestry in 1899, and since then (up to the end of 1903) 2,562* examinations have been made, viz:—Tuberculosis 709, Typhoid Fever 475, Diphtheria 1299, and others 19 (ice-creams, urine, tumours, etc.). During 1903, 525 examinations have been made, and the subjoined details are given in connection therewith:— Tuberculosis— 204 samples of sputa from doubtful tuberculosis cases have been examined, and in 71 (i.e., 34.8 per cent.) 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 133 instances (i.e., 65.2 per cent.), no tubercle bacilli were found. In 2 instances, pneumococci (of Friedlander) were found. The increase in the number of samples submitted is due to the Council having made Consumption (with tuberculous expectorations) voluntarily notifiable throughout the Borough on (and after) June 1st, 1902. Greater exactitude in diagnosis is being, in this way, secured. *1899—389; 1900—703; 1901—479; 1902—466; 1903—525; Total— 2562. Vide Special Report in Appendix. 186 Typhoid Fever— 90 samples of blood from suspected Typhoid cases have been examined, and in 24 (i,e., 26.7 per cent.) the characteristic Widal reaction was obtained, although in 8 of the cases (i.e., 8.9 per cent.) this reaction was but slightly or feebly marked. In 66 (i.e.. 73.3 per cent.) no reaction was obtained. Experience shows that, with a well-marked reaction obtained with a high dilution of the suspected blood-serum (1-60 to 1-100), the Widal, test is most trustworthy, and exceedingly useful, consequently in settling the diagnosis in doubtful cases of illness which have the appearance of Typhoid. It is not advisable to lay too much stress upon a feebly (slightly) marked reaction, unless accompanied by one (or more) of the well-known clinical symptons of typhoid in the patient from whom the sample of blood has been taken. Diphtheria— 227 samples of throat membranes and secretions from doubtful Diphtheria cases have been examined, and in 41 (i.e., 18.1 per cent.) the true (Klebs-Lœffler) bacilli have been obtained. In 24 instances (i.e., 58.5 per cent.) the Klebs-Lceffler bacilli were obtained in pure cultivation—i.e., without admixture with other bacilli, whereas in the remaining 17 (i.e., 41.5 per cent.) the Klebs-Lœffler bacilli were found combined with other well-known bacilli as follows:— Klebs-Lœffler + Staphylococci + Torulœ 1 i.e., 2.4 per cent. Klebs-Lœffler + Staphylococci 9 i.e., 21.9 per cent. Klebs-Lœer + Streptococci 7 i.e., 71.1 per cent. In 186 (i.e., 8T9 per cent.) of the total number of throat samples examined the Klebs-Lœffler bacilli were not isolated, but other bacilli were as follow:— Streptococci 45 i.e., 24.2 per cent. Pseudo-bacilli 2 i.e., 1.1 per cent. Pseudo-bacilli + Staphylococci 7 i.e., 3.8 per cent. 187 Pseudo-bacilli + Streptococci . 1 i.e., 0.6 per cent. Pseudo-bacilli + Staphylococci + Streptococci 1 i.e., 0'6 per cent. Staphylococci 123 i.e., 66.5 per cent. Streptococci Staphylococci 4 i.e., 2.2 per cent. Staphylococci + Torulæ 2 i.e., l.l per cent. Strephycycci + Torulœ 1 i.e, 0.6 per cent. The pseudo-bacilli (Hoffman) were found in pure cultivation in only two instances, and in no instance were pseudo-bacilli and true Diphtheria (Klebs-Lcefifler) bacilli found together. Pseudobacilli were found mixed with streptococci (1), with staphylococci (7), with streptococci and staphylococci (1). An outbreak of sore-throats in a School led to 44 examinations being made with the result that no Diphtheria bacilli were found, but only pseudo-bacilli (6), staphylococci (36), and streptococci and staphylococci (2). By strict isolation of the pseudo-diphtheria cases, the outbreak was stamped out. As to whether or not the pseudo-bacilli (Hoffman) are modified Klebs-Lœffler bacilli, or vice versa, is a question still under discussion, but the practice in Lambeth Borough is to regard pseudo-throats as infectious, and to take the usual precautions in regard to patients having such throats, viz., notification, isolation, and disinfection. Removal to hospital is not advised until separate accommodation is provided away from the true Diphtheria cases. Other Examinations— 2 separate samples of urine have been submitted for examination on account of the suspected presence therein of gonococci. The result of the bacteriological examinations was negative in each case. 1 specimen of gland and 1 of tumour were examined for the presence of tubercle, but in neither case were the tubercle bacilli found. 188 The value of the bacteriological laboratory to the Ratepayers is proved, and a large saving has been effected since its establishment. Had Lambeth followed the example of the other Metropolitan Boroughs and arranged for the bacteriological work of the Borough to be done by a Private Firm or Institution, the cost to the Borough for the last 5 years (allowing 5/- per examination) would have been ;£640 5s. 0d., or an annual average cost of £128 1s. Od. 1903. Sputa. Tub. Bac. found. *Bloods. Typhoid reaction obtained. Throat Membranes and Discharges. Klebs-I.ce filer bac. found. Yes No. 13 o H Yes. No. _ _ o H Yes. No. 13 o H January 9 9 18 4 | 3 7 7 24 31 February 8 7 15 2 G 8 2 14 16 March 14 18 32 — 4 4 1 18 19 April 7 8 15 — — — 2 13 15 May 5 9 ! 14 3 1 10 13 1 14 15 June 8 13 21 1 2 3 1 26 27 July 5 13 18 4 4 8 3 23 26 August 3 11 14 — 11 11 15 8 23 September 1 11 12 2 1 3 — 15 15 October 6 11 17 2 9 11 4 20 24 November 2 12 14 3 11 14 2 5 7 December 3 11 14 3 5 8 3 6 9 Totals 71 133 204 24 66 90 41 186 227 * In 8 cases (i.e., 89 per cent.) the reaction was slightly (or feebly) marked. 4 other samples (2 urines, 1 gland and 1 tumour) were also examined during 1903 189 Antitoxin— The Borough Council, following the example of the late Vestry, has continued to distribute, free of cost, to medical practitioners practising in Lambeth Borough, antitoxin for the treatment of Diphtheria cases, with most satisfactory results. The value of antitoxin in the treatment of Diphtheria (early in the disease) is now a fact, and its use, too, as a preventative, or prophylactic, is being tried with marked results. The Borough Council distributes gratuitously antitoxin for this latter purpose also. 45 vials of antitoxin have been distributed during the year. The walls at Arlington Lodge have been repointed, and the gutters and roof repaired, during 1903 at an estimated cost of £28 10s. Od. The Bacteriological Laboratory is now insured for £500. UNDERGROUND CONVENIENCES. The Public Underground Conveniences within the Borough of Lambeth are now 7 in number, and the accommodation is as follows:— W.C. Accommodation Paying. Free. Vauxhall—Men only 3 1 Kennington Cross—Men only 3 1 Hercules Road Men 4 1 Women 3 1 Brixton Men 3 1 Women 3 1 Stockwell Men 3 1 Women 2 1 Loughborough Men 3 1 Women 3 1 Stangate Men 8 1 Women 6 1 Totals 44 12 190 Two new Underground Conveniences were opened during 1903 (September 26th) in Lambeth Borough, viz., at Loughborough Junction and Stangate, and in connection with these, 10 new attendants have been appointed (8 permanent and 2 relief) as follows:—Messrs. J. T. Lewis, W. Clark, E. Vass,. R. Saunders, J. W. Willis, and Mesdames E. G. Burgess, M. Catterall, A. Fletcher, M. A. Sinclair, and Ida Sinclair. Miss Ida Sinclair withdrew, and in her place 2 temporary attendants (Mrs, Hardwick and Mrs. Davis) were appointed. During 1903, Messrs. Baker and Moody (2 permanent maleattendants) resigned and Mrs. Kimber (permanent female attendant) died, and in their places Messrs. Peck and Guerrier and Miss Porter were appointed respectively. The staff during 1903 (October 29th) was settled by the Council as follows:— Conveniences. Attendants. Males. Females. Lester, C. Smith, Mrs. Brixton Parsons, F. Richards, Mrs. Hercules Holbrook, W. Batchelor, Miss Frazey, H. Fletcher, Mrs. Stockvvell Bennett, W. H. Hawkins, Mrs. Rcdda, T. Porter, Miss Kennington Cross Guerrier, E. (Leu is, J. No female side. Vauxhall Looper, F. Vass, E. Loughborough Hazell, H. Mason, Mrs. Peck, T. Catterall, Mrs. Stangate Copper, G. Luckett, Mrs. Clark, W. Sinclair, Mrs. Each attendant works six days per week, so that in addition 3 male and 2 female relief attendants are required as follows 191 Relief Attendants. Male.—Hercules, Vauxhall, Kennington Cross Saunders, R. Loughborough and Brixton Willis, J. W. Stockwell and Stangate Langley, J. Female.—Hercules and Stangate Mrs. Burgess. Brixton, Stockwell and Loughborough Mrs. Hardwick (temporary). Mrs. Davis (temporary). A new Ladies' Convenience (overground) has been erected during 1903 in Vauxhall Park (accessible both from the Park, and from the South Lambeth Road) at a cost of £731, and is to be opened to the Public at the beginning of 1904. During 1903, a suggestion has been brought forward to construct an Underground Convenience (for both sexes) at Westow Hill, near the Crystal Palace Parade (estimated cost £2,300). The Borough Council of Lambeth has approved of the Scheme, provided that the 4 Authorities, whose Districts meet at the point suggested for the position of the Convenience, viz: Lambeth, Camberwell, Croydon, and Penge, share the expense in equal proportions, irrespective of rateable value. The provision of an adequate number of Public Conveniences throughout a District is an important duty, and one to be encouraged even though a yearly expense out of the Rates in connection therewith be involved. From a Return prepared by the Borough Accountant, it appears that, for the year ending March 31st, 1903, the total expenses in connection with the Lambeth 5 Underground Conveniences (i.e., excluding Loughborough and Stangate) were £2,293 18s. 6½d. (inclusive of loan charges*), and the corresponding receipts (for the same period) £1,557 2s. 2d. In the cases of Brixton and Hercules Road Conveniences, the incomes and expenses practically balance. * Exclusive of loan charges, the total expenses were £1,861 12s. 4½d. 192 During 1903, new treads have been provided to the Kennington Cross Convenience, and the ventilation has been improved at the Brixton Convenience by the provision of a gas extractor. CLERICAL STAFF. The Clerical Staff consists of 3 Clerks — a chief (W. R« Lawrence), and two others (Messrs. A. L. Baxter and W. J. Lawrence), and a junior, or boy (Albert E. Ruel).* The Clerical work in connection with the Department during 1903 deserves recognition, and is again given in the form of the following Statement, shewing the work done in the Borough during 1901, 1902, and 1903, as compared with the yearly average for the old Parish of Lambeth during five years (18961900). 1903 1902. 1901. Average 5 years (1896-1900). Borough. Parish. Letters, etc., received (entered in letter book) 7808 8760 9417 8611.4 Letters, etc., sent out (entered in postal book) 16555 19504 21703 26096.6 Notices served— Infectious Diseases 1336 2430 1848 2290.2 Public Health Acts (Preliminary) 8248 7812.0 Public Health Act (Statutory) 3432 12954 7195 2015.0 Metropolis Management Acts 27 — — Housing of the Working Classes Act - 14 13 43.6 Cases entered in Inspectors' Report Books 8372 8930 7821 8307.0 Complaints entered in book 6199 4378 5421 5474.0 Copies of Infectious Diseases Notificaations— (a) Entered in Notification Book 1587 4426 2025 2619.2 (b) Sent off to Asylums Board 1587 4426 2025 2619.2 Notices of Infectious Diseases sent to Schools 2117 3410 2425 1953.6 193  1903. 1902. 1901. Average 5 years (1896-1900). Borough. Parish. Workshops (with full particulars) entered up in Register 162 105 69 144.6 Milkshops (with full particulars) entered up in Register - - 458 - Cowsheds (with full particulars) entered up in Register - - - 6.6 Slaughter-houses (with full particulars) entered up in Register - - - 9.2 Bakehouses (with full particulars) entered up in Register - - - 51.6 Water Certificates for new buildings given out 520 420 183 112.2 Disinfection Certificates given out 3036 5186 2710 1010.2 Stamps used — 17398 14274 19730.6 Reports to Committee (Fortnightly) 20 20 21 20.2 Reports to Vestry or Council (Quarterly) 4 4 4 4.0 Special Reports 13 15 12 12.2 Letters Typed 4883 5816 4867 4905.4 Bacteriological Reports 525 466 479 546.0 Inland Revenue Certificates given out 715 2723 360 719.5 Summonses and Orders entered in Book 95 50 72 98.6 * Appointed vice E. G. Wood, resigned. n APPENDIX. 2 Local Government Board. (Table i.) VITAL STATISTICS OF LAMBETH BOROUGH DURING 1903, AND OF LAMBETH PARISH DURING 10 YEARS (1891-1900.). Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Total Deaths in Public tion in the District. 9 Deaths of Nonresidents registered in Public Institutions, in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 Nett Deaths at all Ages belonging to the District. Number. 3 Rate.* 4 Under 10 Year of Age. At all Ages. Number. 12 Rate.* 13 Number. 5 Rate per 1000 Births, registered. 6 Number. 7 Rate.* 8 Parish. 1891 276162 9097 32.9 1433 157.2 6073 21.9 1438 539 351 5886 21.3 1892 280032 9226 32.9 1303 141.2 5794 20.7 1578 651 314 5457 19.5 1893 283956 9222 32.5 1415 148.5 6165 21.7 1741 811 338 5219 18.4 1894 287935 9231 32.1 1264 136.9 5213 18.1 1484 775 399 4837 16.8 1895 291970 9341 31.9 1470 157.4 5857 20.6 1511 702 404 5559 19.0 1896 296061 9593 32.4 1371 142.9 5370 18.1 1588 705 433 5098 17.2 1897 300048 9388 31.3 1459 155.4 5486 18.3 1546 664 429 5251 17.5 1898 304073 9256 30.4 1447 156.3 5567 18.3 1543 592 455 5430 17.9 1899 308108 9433 30.6 1527 161.9 6064 19.7 1680 663 485 5886 19.1 1900 312152 9167 29.4 1350 147.3 5578 17.9 1576 606 458 5430 17.4 Averages for years (1891-1900) 294049.7 9295.3 31.6 1403.9 151.03 5716.7 19.4 1568.5 670.8 406.6 5405.3 18.4 Boro' 1903 307711 9069 29.5 1194 131.7 4853 15.8 1619 648 459 4664 15.2 * Rates in Columns 4, 8 and 13 are calculated per 1000 of estimated population. NOTE. The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the Borough of Lambeth. 'I he deaths included in Column 12 are the numbers in Column 7, corrected by the subtraction of the numbers in Columa 10 and the addition of the numbers in Column 11. By the term "Non-residents" is meaut persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institution" (taken into account for the purpose of these Tatles) are those into which persons are habitually received on account of sickncss or infirmity, such as hospitals workhouses and lunatic asylums. A list of the Institutions in respect of the deaths in which corrections have been made, will be found on pp. 27,112-115 of the Report. Area of Lambeth Borough in acres 4072.6 Status Acres. (exclusive of area covered by water) ) Total population at all ages 301895 Number of inhabited houses 41511 Average number of persons per house 7.3 At Census of 1901. 3 Local Government Board. (Table ii.) VITAL STATISTICS OF REGISTRATION SUB-DISTRICTS OF LAMBETH BOROUGH DURING 1903, AND OF LAMBETH PARISH DURING 10 YEARS (1891—1900). Names of Localities. 1.—Waterloo. 2.—Lambeth Church 1st. 3.—Lambeth Chorch 2nd. Year. Population estimated to middle of eacb year. Births registered. Dea hs at all ages (corrected). Deaths under 1 year (uncorrected). Populalion estimated to midiile of each year. Births registered. Deaths at all Ages (corrected). Deaths under 1 year (uncorrected). Population estimated to middle of each year. Biiths registered Deaths at all Ages (corrected). I Deaths und r 1 year (uncorrected). Parish. 1891 a. b. c. d. a. b. c. d. a. b. c. d. 28657 1-131 8K6 230 18110 605 468 158 39191 1630 987 299 1892 28601 1473 687 179 18249 610 432 160 39571 1639 907 259 1893 28545 1521 688 222 18388 610 448 165 39951 1632 858 272 1894 28489 1505 691 203 18522 624 384 139 40331 1553 789 266 1895 28433 1516 755 212 18606 618 457 189 40711 1629 995 284 1896 28377 1445 642 201 18805 649 364 169 41091 1687 930 262 1897 28333 1397 683 203 18947 ' 597 442 188 41476 1595 934 301 1898 28282 1381 715 193 19090 581 438 175 41864 1613 853 265 1899 28232 1398 733 189 19234 627 436 151 42252 1517 1048 315 1900 28183 1348 678 202 19377 582 423 153 42642 1543 840 266 Averages of ) Years 1891 v [ to 1900 ) 28413 2 1441-5 713-8 203-4 18739-3 610-3 429-2 164-7 40908 0 1603-8 9141 278-9 Borough 1903 26939 1345 553 137 18380 563 345 150 39858 1509 812 232 4 (Table ii.—continued.) Names of Localities. 4.—Kennington 1st. 5.—Kennington 2nd. 6.—Brixton. 7.—Norwood. Year. Population estimated to middle of each year. Births registered. Deaths at all A 03 (corrected). Deaths under 1 year (uneorreoted). Populaion estimated to middle of each year. Deaths at all Ages (corrected). Deaths under (uncrrected). Population estimated to middle of each year. Girths registered. Deaths all Ages (corrected). Deaths under 1 year (uncorrected). Population estimated to middle of each year Births registered Deaths at all Ages (corrected). Deaths under 1 year (uncorrected). Parish. 1891 a. b. c. d. d. b. d. a. b c. d. 50681 1722 1092 252 40065 1069 802 136 73707 2014 1335 291 25751 626 336 67 1892 51002 1733 101 8 226 40695 1058 756 123 75431 2051 1305 287 26483 662 362 69 1893 51241 1759 1 53 270 41004 1059 719 127 77812 2002 1182 286 27015 639 371 73 1894 51721 1802 871 212 41713 1053 672 107 79507 2037 1050 258 27647 657 380 79 189 52201 1736 969 263 42222 1099 742 169 81267 2093 1259 276 28470 650 382 77 1896 52581 1886 902 232 43429 1125 747 157 82267 2139 1174 281 29511 662 339 69 1897 52971 1859 952 249 44136 1110 721 132 83946 2131 1135 286 30239 699 384 100 1898 53861 1888 989 259 44852 10 9 727 141 85647 2143 1274 334 30977 641 434 80 1899 53753 1871 1086 309 45570 1089 812 154 87350 2179 1342 296 31717 752 429 113 1900 54146 1856 1018 233 46329 990 732 123 89057 2112 1283 279 32458 736 456 94 Averages of Years 1891 to 1900 533658 1811.2 984.0 250.5 42997.5 1066.1 743.0 1369 81599.1 20901 1233.9 287.4 29026.8 672 4 387.3 82.1 Boro'. 1903 53907 1788 803 198 43773 994 618 126 87069 2060 1120 257 37779 810 413 94 Notes—(a) Deaths of residents occuring in public institution beyond the district are included in sub-columns c of this table, and those of the non-resident registered in public institutions in the district arc < eluded. (See note on Table i. as to meaning of terms "resident" and " non-residents.") (6) Deaths of residents occaring in public institution whether within or without the district, are alloted to the respective localities according to the addresses of the deceased. (c) Deaths under 1 year are not corrected, and the gross total of sub-columns d agrees with the total of column 5 in Table i. N B.—Where the District is not stated, the deaths are sub-divided equally amongst the Registration Sub-Districts. 5 Local Government Board. Table iii. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1908. notifiable disease. cases notified in whole district. total cases notified in each locality. no. of CASES REMOVED TO HOSPITAL FROM EACH LOCALITY. At all Ages. At Agesf—Years. Waterloo. Lambeth Church 1st. Lambeth Church 2nd. Kennington 1st. 2nd Brixton. Norwood. Waterloo. Lambeth Church 1st Lambeth Church 2ud. Kennington 1st. Kennington 2nd. Brixton. Norwood. Under 1 1 to 5. 5 to 15. 15 to 25 25 to 65. 65 and upwards Small Pox 72 ... 5 6 18 42 1 3 4 31 31 3 ... ... 3 4 31 31 3 ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 329 9 107 116 52 45 ... 35 27 44 32 79 91 21 31 26 36 32 52 68 5 Membranous Croup 9 2 5 1 ... 1 ... ... ... 2 4 1 2 ... ... ... ... ... ... ... ... Erysipelas 236 ... 11 14 31 144 36 30 27 60 27 32 48 13 2 ... ... 1 ... 1 ... Scarlet Fever 744 13 223 346 ... 74 1 69 73 56 105 155 204 82 55 46 53 98 119 151 47 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 133 ... 5 37 31 60 ... 18 16 7 27 21 33 ... 14 12 5 19 13 20 9 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 7 2 ... 1 3 1 ... 1 ... 3 ... 1 ... ... ... ... 2 ... ... 1 ... Puerperal Fever 17 ... ... ... ... 15 ... 2 ... 1 4 1 5 2 1 ... 1 1 ... ... 1 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox 40 5 11 26 ... ... 1 7 8 3 12 2 4 4 ... ... ... ... ... ... ... Totals 1547 31 367 540 228 382 39 165 157 207 242 295 389 133 106 88 128 182 187 241 62 Notes. (a) The Iocalites adopted for this table are the same as those in Tables ii. and iv. (b) Patients are removed to the Isolation Hospitals or the Metropolitan Asylums Board, one of which is situated in Brixton Registration Sub-dittrict. N.B. 40 case of Chickenpox were also notified during 1903 (from January 1st to 8th), but not one of these was removed to Hospital. 6 7 Local Government Board. (Table iv.) CAUSES OF, AND AGES AT, DEATH DURING THE YEAR, 1903. Name of District—BOROUGH OF LAMBETH. CAUSES OF DEATH. DEATHS IN OH BELONGING TO WHOLE DEATHS IN OR BELONGING TO REGISTRATION DISTRICT AT SUBJOINED AGES. SUB-DISTRICTS (AT ALL AGES). TOTAL DEATHS IN PUBLIC INSTITUTIONS IN DISTRICT. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Waterloo. Lambeth Church First. Lambeth Church Second. ton First. ton Second Brixton. Norwood. District not stated. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Small-pox 4 — 1 — — 3 — - - 2 1 1 - - - - Measles 130 25 104 1 — — - 15 9 28 43 10 18 4 3 33 Scarlet Fever 23 1 16 5 1 — - 4 3 6 1 4 5 — — 36 Whooping Cough 126 65 56 5 — — - 13 14 33 30 6 17 12 1 8 Diphtheria and Membranous Croup 29 3 15 11 - — - 2 1 7 4 5 10 - - 38 Croup 2 — 2 — — — - — 1 - — 1 — — — — Fever Typhus — — — — — — - - - - — — - - — — Enteric 24 — — 5 4 15 - 2 - 4 2 4 9 3 — 22 (Other Continued 1 — — — 1 — - - — - — - 1 - — — Fpidemic Influenza 52 3 1 2 2 16 28 1 1 4 9 12 15 7 3 10 Cholera Nostras 1 1 — — — — — — — - — 1 - - — — Plague — — — — — — — - — - — - - - — — Diarrhœa 160 123 30 — — 2 5 12 17 46 17 18 32 18 — 28 Enteritis 65 27 6 3 5 21 3 5 3 9 11 8 21 7 1 — Puerperal fever 6 — — — 1 5 — - — 1 2 1 2 - — 1 Erysipelas 12 2 — — 1 8 1 4 1 1 — 3 2 - 1 13 Oilier Septic diseases 8 3 2 — 2 1 - - 3 2 2 - 1 - — — Phthisis 435 8 15 7 63 328 14 50 36 73 86 49 93 37 11 147 Other Tuborculardisease 204 81 57 33 9 19 5 24 25 48 31 25 41 9 1 — Cancer malignatdisease 307 — 1 3 4 196 103 24 20 51 54 40 79 30 9 — Bronchitis 370 100 32 1 2 88 147 47 21 64 70 53 94 19 2 Pneamonia 118 17 20 5 21 53 2 19 7 22 17 17 29 3 4 140 Pleurisy 20 3 4 1 — 5 7 2 1 2 7 3 2 1 2 Other diseases of Respiratory Organs 219 66 58 6 4 49 36 24 14 35 31 30 55 26 4 - Alcoholism 33 — — — — 31 2 4 7 5 4 3 8 2 — — Cirrho is of Liver 54 — — — — 43 11 8 3 9 12 6 9 6 1 — Venereal diseases 46 39 — — — 4 3 4 7 15 8 2 8 1 1 — Premature birth 159 159 — — — — — 17 15 22 22 25 43 15 — - Diseases and Accidents of parturition 12 - - - 2 10 - 1 - 2 2 2 3 2 - - Heart diseases 584 6 4 14 19 291 250 57 39 89 101 84 139 54 21 232 Accidents 137 37 6 13 7 49 25 28 12 21 27 13 23 9 4 105 Suicides 36 — — 1 3 29 3 6 2 5 6 4 10 3 — — All other causes 1287 369 57 35 18 414 394 150 68 171 188 173 337 131 49 806 All causes 4664 1138 487 151 169 1680 1039 523 330 797 788 603 1106 399 118 1619 8 9 LAMBETH BOROUGH.—Deaths Registered from all Causes during the Year 1903. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Sub-Districts. Sub-Districts. Total. 1 2 3 4 5 6 7 8 No Address. All Ages. I. Specific Febrile, or Zymotic Diseases M. F. M. F. M F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 13 19 13 13 30 26 83 66 66 58 34 33 68 53 21 25 7 2 335 290 625 II. Parasitic Diseases ... ... ... ... ... 1 1 ... 1 3 1 3 2 ... ... ... ... ... 5 7 12 III. Dietic Diseases 1 1 1 2 ... 7 4 4 2 5 2 1 5 4 1 1 ... ... 16 25 41 IV. Constitutional Diseases 23 27 30 27 53 36 95 84 110 72 59 69 123 118 49 43 13 10 555 486 1041 V. Development Diseases 9 7 3 9 7 16 24 17 20 22 24 20 33 51 16 14 1 4 137 160 297 VI. Local Diseases 58 78 61 58 62 68 183 191 179 197 152 164 262 306 102 99 38 38 1100t 1199 2299 VII. Deaths from Violence 8 8 12 6 9 5 19 7 18 15 8 9 18 16 9 3 1 3 102 72 174 VIII. Deaths from Ill-defined and not Specified Causes 7 9 9 8 4 6 14 5 13 12 12 12 25 22 8 8 ... 1 92 83 175 Totals 119 149 132 123 165 165 423 374 409 379 292 311 536 570 206 19 60 58 2342 2322 4664 I.—Specific Febrile, or Zymotic Diseases. 1.—Miasmatic Diseases. Smallpox Vaccinated ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 2 Unvaccinated ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 No Statement ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Measles 3 7 2 3 3 6 13 15 25 18 7 3 8 10 2 2 1 2 6 65 130 Whooping Cough 2 5 2 4 8 6 22 11 14 16 1 5 9 8 2 10 1 ... 61 65 126 Scarlet Fever 1 ... ... 3 2 1 2 4 1 ... 1 3 5 ... ... ... ... ... 12 11 23 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simp Continued and Ill-defiaed Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Enteric or Typhoid Fever 1 1 ... ... ... ... 3 1 2 ... 2 2 4 5 1 2 ... ... 1 11 24 Diphtheria 1 1 ... ... 1 ... 4 2 3 1 3 2 3 7 ... ... ... ... 15 13 28 Membranous Croup ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Influenza ... ... 1 ... 1 ... 1 3 4 1 4 8 8 7 5 2 3 ... 27 25 52 Other Miasmatic Disease ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 3 ... 3 2.- Diarrhœal Diseases. Cholera Nostras ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœ Dysentery 5 3 2 2 9 8 22 24 8 ... 11 7 21 11 9 9 ... ... 87 73 160 3.—Malarial Diseases. Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 — Zoogenous Diseases. Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Veneral Diseases. Syphilis ... 1 2 2 3 4 10 5 4 1 2 ... 5 1 1 ... 1 ... 28 14 42 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... 4 ... 4 6.—Septic Diseases. Erysipelas ... 1 3 ... 1 ... 1 ... ... ... 1 2 2 ... ... ... 1 ... 9 3 12 Pyæmia, Septicæmia ... ... ... ... 2 1 2 ... 2 ... ... ... ... 1 ... ... ... ... 6 2 8 Puerperal Fever ... ... ... ... ... ... ... 1 ... 2 ... 1 ... 2 ... ... ... ... ... 6 6 10 11 LAMBETH BOROUGH.—Deaths Registered from all Causes during the Year 1903. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits if the District are included. Sub-Districts. Sub-Districts. Total. 1 2 3 4 5 6 7 8 No Address. All Ages. II.—Parasitic Diseases. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... 1 ... 1 3 1 3 2 ... ... ... ... ... 5 6 11 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 III.—Dietic Diseases. Want of Breast Milk, Starvation ... 1 ... ... ... ... 2 1 ... 3 ... ... 1 ... ... ... ... ... 3 5 8 Scurvy ... ... ... ... ... ... ... ... ... ... ... . .. ... ... ... ... ... ... ... ... ... Chronic Alcoholism 1 ... 1 2 ... 6 1 3 2 2 2 1 3 4 1 1 ... ... 11 19 30 Delirium Tremens ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... 2 1 3 IV.—Constitutional Diseases. Rheumatic Fever ... 1 ... ... ... ... 1 1 1 1 1 ... 2 3 4 2 ... ... 9 8 17 Rheumatism of the Heart ... ... ... ... ... ... Rheumatism ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 3 1 3 1 ... ... 1 5 7 12 Gout ... ... 1 ... 1 ... 1 ... 2 2 1 1 ... 1 2 ... ... ... 8 4 12 Rickets ... 1 ... ... 1 2 9 18 ... 1 1 1 ... 2 4 1 2 1 1 ... 9 Cancer, Malignant Disease 4 8 2 10 10 10 21 30 26 28 16 24 28 51 7 23 6 3 120 187 307 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenteriea 1 4 2 1 3 1 ... ... 4 4 6 2 2 3 5 ... ... ... 20 23 43 Tubercular Meningitis, Hydrocephalus 2 3 1 4 6 5 5 ... 10 5 4 3 48 34 82 10 4 6 7 2 16 7 1 ... ... Phthisis 15 21 23 13 435 40 33 59 21 24 2 56 37 26 11 5 6 269 166 Scrofula ... ... ... ... 2 ... 2 ... 2 ... ... Other forms of Tuberculosis ... ... 2 4 5 3 ••• ... ... ... ... ... ... ••• ... ... 47 ... 30 77 16 8 7 4 6 6 7 3 3 2 1 Purpura, Hæmorrhagic Diathesis 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 2 Anæmia Chlorosis, Leucocythæmia ... ... ... ... 1 ... ... 1 ... ... 1 ... 2 ... 2 1 ... ... 6 2 8 Glycosuria, Diabetes Mellitus ... ... 1 1 2 1 ... ... ... 2 2 4 5 1 ... ... ... 9 10 19 Other Constitutional Diseases ... ... 1 1 1 ... ... ... ... 1 1 1 ... 2 ... ... ... ... 2 5 7 V.—Developmental Diseases. Premature Birth 8 2 2 5 6 9 13 9 14 8 16 9 19 24 9 6 ... ... 87 72 159 Atelectasis ... 1 ... ... 1 ... 10 4 2 ... ... 1 ... 1 ... ... ... ... ... 7 3 Congenital Malformations 1 2 ... 3 ... 2 13 15 28 3 1 3 3 ... ... 4 4 2 ... ... ... Old Age ... 2 1 1 ... 5 30 70 100 4 5 7 11 9 23 5 8 1 4 3 11 VI.—Local Diseases. 1. —Diseases of Nervous System. Inflammation of Brain or Membranes 3 5 2 1 1 1 3 6 3 1 3 2 2 1 2 ... 1 ... 20 17 37 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 4 6 2 2 4 4 4 13 11 22 11 14 23 51 11 10 2 4 72 126 198 Insanity, General Paralysis of the Insane ... 1 1 ... ... ... 2 2 6 29 20 49 13 7 1 3 5 1 5 ... 2 Epilepsy ... ... ... 1 1 2 2 5 1 2 ... 1 1 2 ... 1 3 15 10 25 3 Convulsions 1 2 2 3 ... 3 26 23 49 7 2 2 1 4 2 10 6 ... 4 ... ... Laryngismus Stridulus (Spasm of Glottis) ... ... 1 ... ... 1 2 2 4 1 ... ... ... ... ... ... 1 ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans 1 ... ... ... 1 1 14 10 24 1 2 2 1 3 2 1 6 2 1 ... ... Other Diseases of Nervous System 1 1 ... ... 1 ... 1 8 14 22 4 4 ... 2 ... 3 2 2 ... 1 ... 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) 1 ... 1 1 ... ... 1 1 ... 1 2 1 1 1 ... 1 ... 1 6 7 13 12 13 LAMBETH BOROUGH.-Deaths Registered from all Causes during the year 1903. Note.- The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limited of the District are included. Sub-Districts. Sub-Districts. Total. 1 2 3 4 5 6 7 8 No Address. All Ages. 3.—Diseases of Circulatory System. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pericarditis ... ... ... ... ... ... ... 2 1 1 ... 1 ... 1 1 ... ... ... ... 1 ... 1 ... ... 1 3 4 Acute Endocarditis Valvular Diseases of Heart 6 7 5 3 6 15 1 ... 2 ... 1 ... 1 ... ... ... ... ... 6 4 10 Other Diseases of Heart 3 7 4 3 7 5 15 30 16 25 6 16 25 25 5 8 3 2 87 131 218 Aneurism 2 ... ... ... ... ... 13 9 14 22 23 22 27 37 18 18 6 2 115 125 240 Embolism, Thrombosis ... 1 ... 1 ... ... 3 2 5 ... 1 ... 2 1 ... ... ... ... 13 3 16 Other Diseases of Blood Vessels 2 2 3 4 4 1 2 ... 1 2 3 2 1 3 ... 2 ... 1 7 12 19 4.-Diseases of Respiratory System. 7 6 6 7 5 5 5 14 2 ... 4 3 38 39 77 Laryngitis ... 1 1 ... ... ... Croup ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 2 2 4 Emphysema, Asthma ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 2 Bronchitis 7 14 12 14 9 12 ... ... 1 3 1 1 3 2 2 2 ... ... 7 9 16 Pneumonia 5 7 6 1 2 5 34 30 34 36 22 31 43 51 9 10 2 ... 172 198 370 Pleurisy ... ... 1 1 1 ... 14 8 10 7 11 6 16 13 2 1 3 1 69 49 118 Bronchopneumonia 4 6 ... 1 4 3 2 ... 3 4 3 ... 2 ... 1 ... 1 1 14 6 20 Pleuroneumonia ... ... 2 1 1 1 17 11 7 10 7 10 16 14 9 13 2 ... 66 68 134 Other Dis. of Respiratory System 3 ... 2 2 2 2 2 3 2 1 ... ... 4 4 ... ... 1 ... 12 10 22 5.- Diseases of Digestive System. 1 1 3 4 2 7 2 9 ... ... ... 1 15 26 41 Dentition ... 1 2 3 1 2 Sore Throat, Quinsy ... ... ... ... ... ... 1 7 4 2 3 2 1 2 4 4 ... ... 16 23 39 Diseases of Stomach 2 1 2 ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Enterits ... 1 1 3 2 1 3 5 2 4 4 7 8 6 ... 1 1 ... 23 25 48 Obstructive Diseases of Intestine 1 ... ... ... ... 1 2 7 6 3 5 3 9 12 4 3 1 ... 32 33 65 Peritonitis ... 1 ... 1 ... ... 1 5 4 5 2 5 4 3 2 ... ... 1 14 17 31 Ascites ... ... ... ... ... ... 2 1 1 1 ... 1 ... 4 ... 1 ... ... 3 10 13 Cirrhosis of Liver 1 2 3 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Jaundice and other Diseases of Liver 1 ... ... 2 2 1 4 5 5 7 4 2 5 4 3 3 1 ... 29 25 54 Diseases of the Pancreas ... ... ... ... ... ... 1 2 1 ... 3 1 3 6 2 1 ... 1 13 14 27 Other Diseases of Digestive System 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Diseases of Lymphatic System 1 4 4 1 1 1 2 2 3 2 ... 2 14 12 26 (e.g., of Lymphatics and of Spleen) 2 ... 1 ... ... ... ... ... 1 1 1 ... 3 1 ... 1 ... ... 8 3 11 7.—Diseases of Gland-Line Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... ... 8. Diseases of Urinary System. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... 1 ... 1 ... 1 2 1 1 1 2 3 2 1 1 ... ... 9 8 17 Bright's Disease. Albuminuria 3 6 4 5 6 3 Disease of Bladder or of Prostate 14 11 14 10 8 7 19 15 9 5 4 6 81 68 149 ... 1 1 ... ... ... Calculus (Stone) 3 ... ... ... 3 1 2 ... 6 1 ... ... 15 3 18 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Diseases of the Urinary System ... 1 1 ... 2 ... 1 2 2 1 ... ... 1 3 ... 1 ... ... 7 8 15 9.—Diseases op Reproductive System. A. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... 2 ... ... ... 2 ... 2 ... 2 ... 4 ... ... ... ... ... 12 12 14 15 LAMBETH BOROUGH.- Deaths Registered from all Causes during the Year 1903. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Sub-Districts. Sub-Districts. Total. 1 2 3 4 5 6 7 8 No Address. All Ages. B. Of Parturition. m. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 2 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Accidents of Child Birth ... 1 ... ... ... ... ... 2 ... ... ... 2 ... 2 ... 2 ... ... ... 9 9 10.—Diseases of Bones and Joints. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Caries, Necrosis ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 1 ... 3 1 4 Arthritis, Ostitis, Periostitis ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... 2 2 4 Other Diseases of Bones and Joints ... ... ... ... ... ... ... 1 1 ... 1 ... 1 1 ... ... ... ... 3 2 5 11.—Disease of Integumentary System. Carbuncle, Phlegmon 1 ... 1 ... ... 1 ... ... ... 1 ... ... ... ... ... ... 2 1 4 3 7 Other Diseases of Intergumentary System 1 ... ... ... ... ... 1 ... 1 ... 1 1 3 ... ... ... ... ... 7 1 8 VII.—Deaths from Violence. 1.—Accident or Negligence, Fractures and Contusions 3 ... 4 2 2 ... 4 3 4 2 2 1 4 3 3 ... 1 2 27 13 40 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Seald ... 3 ... 2 ... 1 ... 1 ... 3 ... 4 1 ... ... ... ... ... 1 14 15 Poison ... ... ... ... 1 ... ... ... 2 2 ... ... 1 1 ... ... ... ... 4 3 7 Drowning 1 ... 3 1 1 1 5 ... 2 1 1 ... ... ... ... ... ... ... 13 3 16 Suffocation ... 2 1 ... 1 1 5 ... 3 3 1 3 2 3 3 2 ... ... 16 14 30 Otherwise 3 2 1 ... 2 2 ... 3 4 1 ... 1 5 3 1 ... ... 1 16 13 29 2.—Homicide. Manslaugther ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. Gnnshot Wounds ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... ... ... ... ... 4 ... 4 Cut, Stab ... 1 ... ... 1 ... 3 ... 2 1 1 ... 2 2 ... ... ... ... 9 4 13 Poison ... ... 1 ... ... ... 1 ... ... 2 ... ... ... ... 2 ... ... ... 4 2 6 Drowning 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 2 Hanging ... ... 2 ... ... ... ... ... ... ... 1 ... 2 1 ... 1 ... ... 5 2 7 Otherwise ... ... ... 1 ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... 2 2 4 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—Death from Ill-Defined and not Specified Causes. Dropsy ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... 1 Debility, Atrophy, Inanition 6 6 9 7 4 6 13 5 11 9 8 10 21 2 8 7 ... ... 80 71 151 Mortifteation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Tumour ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 2 Abscess ... 1 ... ... ... ... 1 ... 1 2 1 ... 1 2 ... ... ... ... 4 5 9 Hæmorrhage ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined 1 1 ... ... ... ... ... ... ... 1 3 1 3 ... ... ... ... ... 7 3 10 16 17 Lambeth Borough.—Deaths Registered from all Causes during the Year 1903. Note —The deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES. AGES. Total. Under 1 Year. 1-5 Under 5 Years. 5-10 10-15 15-20 20-25 25-4 0 40-60 60-65 65-80 80 & 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 Febkile, ok Zymotic Diseases 148 117 112 115 260 232 11 15 1 2 4 1 2 5 18 11 16 4 1 5 18 11 4 4 75 58 335 290 625 II. Parasitic Diseases 5 6 ... ... 5 6 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 5 7 12 III. Dietetic Diseases 2 5 ... ... 2 5 ... ... ... ... ... ... ... ... 6 3 5 15 1 2 2 ... ... ... 14 20 16 25 41 IV. Constitutional Diseases 54 45 49 32 103 77 16 18 10 8 20 17 24 20 101 88 190 137 38 35 49 75 4 11 452 409 555 486 1041 V. Developmental Diseases 106 90 1 ... 107 90 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 11 21 18 48 30 70 137 160 297 VI. Local Diseases 192 178 71 96 263 274 14 11 15 14 13 19 14 19 93 105 294 241 97 83 244 312 53 121 837 925 1100 1199 2299 VII. Deaths from Violence 17 20 3 3 20 23 7 4 3 ... 2 1 4 3 17 9 32 10 5 6 10 11 2 5 82 49 102 72 174 VIII. Deaths from Ill-Defined and Not Specified Causes 84 69 2 3 86 72 1 ... 1 ... ... ... 1 ... ... 1 1 6 1 ... ... 1 1 3 6 11 92 83 175 Totals 608 530 238 249 846 779 49 48 30 24 39 38 45 47 235 217 538 414 144 132 334 431 82 192 1496 1543 2342 2322 4664 1.—Specific Febrile, or Zymotic Diseases. 1.—Miasmatic Diseases. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... 2 ... 2 Unvaccinated ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Measles 14 11 50 54 64 65 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 60 66 130 Whooping Cough 38 27 23 33 61 60 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 61 65 126 Scarlet Fever ... 1 9 7 9 8 3 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 3 12 11 23 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Enteric or Typhoid Fever ... ... ... ... ... ... 1 1 1 2 1 ... ... 3 9 4 1 1 ... ... ... ... ... ... 13 11 13 11 24 Diphtheria 1 1 8 7 9 8 6 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 5 15 13 28 Membranous Croup 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Inlluenza 1 2 ... 1 1 3 1 1 ... ... 1 ... 1 ... 2 1 6 2 1 4 11 10 3 4 26 22 27 25 52 Other Miasmatic Diseases ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 3 ... 3 2.—Diarrhceal Diseases. Cholera, Nostras 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentry 65 58 17 13 82 71 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 3 1 1 ... 5 2 87 73 160 3.—Malarial Diseases. Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. Cowpox and effects of Vaccination Other Diseases (e.g., Hydrophobia, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. Syphilis 25 14 ... ... 25 14 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... 3 ... 28 14 42 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... ... ... 4 ... 4 ... 4 6.—Septic Diseases. Erysipelas 1 1 ... ... 1 1 ... ... ... ... 1 ... ... ... 3 ... 3 1 ... 1 1 ... ... ... 8 2 9 3 12 Pyaemia, Septicaemia 1 2 2 ... 3 2 ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 3 ... 6 2 8 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 ... ... ... ... ... ... ... ... ... 6 ... 6 6 18 19 Lambeth Borough.—Deaths Registered from all Causes during the Year 1903. Note.—The deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES. AGES. Total. Under 1 Year, 1-5 Under 5 Years. 5-10 10-15 15-20 20-25 25-40 40-60 60-65 65-80 80 & over. Over 5 Years. All Ages. II.—Parasitic Diseases. Thrush and other Vegetable Parasitic 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. Diseases 5 6 ... ... 5 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 6 11 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 III.—Dietetic Diseases. Want of Breast Milk, Starvation 2 5 ... ... 2 5 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 3 5 8 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 3 2 14 1 2 2 ... ... ... 11 19 11 19 30 Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 2 1 2 1 3 IV.—Constitutional Diseases. Rheumatic Fever ... ... ... ... ... ... 1 2 2 2 2 ... 1 1 1 1 2 2 ... ... ... ... ... ... 9 8 9 8 17 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 4 ... 1 2 2 1 ... 5 7 5 7 12 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 1 2 2 ... 1 8 4 8 4 12 Rickets 5 5 4 4 9 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 9 18 Cancer, Malignant Disease ... ... ... 1 ... 1 ... 2 1 ... 1 1 2 ... 5 20 53 70 21 27 35 57 2 9 120 186 120 187 307 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 15 15 3 4 18 19 ... 1 1 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 2 4 20 23 43 Tubercular Meningitis, Hydrocephalus 16 10 15 13 31 23 9 10 3 1 3 ... ... ... 2 ... ... ... ... ... ... ... ... ... 17 11 48 34 82 Phthisis 4 4 11 4 15 8 4 ... 1 2 12 13 20 18 84 62 118 52 8 4 7 7 ... ... 254 158 269 166 435 Scrofula ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Other forms of Tuberculosis 14 11 14 6 28 17 ... 3 2 2 2 2 ... 1 4 1 6 1 2 1 2 1 1 1 19 13 47 30 77 Purpura, Hæoorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 1 1 1 2 Anæmia, Chlorosis, Leucocythæmia ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 3 1 1 ... ... ... ... ... 6 2 6 2 8 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 2 2 2 1 1 4 ... ... 9 10 9 10 19 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 ... ... 2 ... ... 2 5 2 5 7 V.—Developmental Diseases. Premature Birth 87 72 ... ... 87 72 ... • •• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 72 159 Atelectasis 7 3 ... ... 7 3 ... • •• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 3 10 Congenital Malformations 12 15 1 ... 13 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 15 28 Old Age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 11 21 18 48 30 70 30 70 100 VI.—Local Diseases. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 9 6 6 7 15 l3 4 ... ... ... ... 2 ... 1 1 1 ... ... ... ... ... ... ... ... 5 4 20 17 37 Apoplexy, Softening of Brain, Hemiplegia. Brain Paralysis 1 ... ... 1 1 1 ... ... ... ... ... ... 1 ... 3 2 20 23 7 22 35 59 5 19 71 12 72 126 198 Insanity, General Paralysis of the Insane ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 2 12 12 2 1 3 4 ... 1 29 2 29 20 49 Epilepsy ... ... 1 ... 1 ... ... ... 2 ... 1 1 1 1 4 5 2 2 1 ... 3 1 ... ... 14 10 15 10 25 Convulsions 25 21 1 1 26 25 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 26 23 49 Laryngismus Stridulus (Spasm of Glottis) 2 2 ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 4 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 1 1 1 2 ... ... ... ... ... ... ... ... 2 1 4 2 3 ... 3 5 1 ... 13 8 14 10 24 Other Diseases of Nervous System 2 3 ... 1 2 4 ... ... ... 1 ... 1 ... 2 1 3 2 1 2 ... 2 ... 1 6 10 8 14 22 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) ... 2 ... 1 ... 3 1 ... ... ... 2 2 2 ... ... 2 1 ... ... ... ... ... ... ... 6 4 6 5 13 20 21 Lambeth Borough.—Deaths Registered from all Causes during the Year 1903. Note.— The deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES. AGES. Total. Under 1 Year. 1-5 Under 5 Years. 5-10 10-15 15-20 20-25 25-40 40-60 60-65 65-80 80 & over. Over 5 Years. All Ages. 3.—diseases of Circulatory System. 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. Pericarditis ... ... 1 ... 1 ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 3 4 Acute Endocarditis ... 1 ... 1 ... 2 ... ... ... 1 1 ... 1 1 1 ... 3 ... ... ... ... ... ... ... 6 2 6 4 10 Valvular Diseases of Heart 1 ... ... 1 1 1 2 1 1 5 3 3 1 2 7 12 43 49 12 12 15 37 2 9 86 130 87 131 218 Other Diseases of Heart 2 2 ... ... 2 2 ... 1 ... ... ... 2 1 3 8 10 40 32 16 12 36 42 12 21 113 123 115 125 240 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 7 2 4 ... ... 1 ... ... 13 3 13 3 16 Embolism, Thrombosis ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... 3 1 1 2 1 3 4 ... 2 7 11 7 12 19 Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 2 3 23 21 10 12 38 39 38 39 77 4.—Diseases of Respiratory System. Laryngitis ... ... 1 2 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 2 4 Croup ... ... 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Emphysema, Asthma ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 4 3 ... 1 1 2 1 1 7 9 7 9 16 Bronchitis 59 41 15 17 74 58 ... 1 ... ... 1 ... ... 1 8 5 22 28 11 14 46 62 10 29 98 140 172 198 370 Pneumonia 4 13 11 9 15 22 2 2 1 ... ... 2 2 ... 11 6 24 7 5 1 9 7 ... 2 54 27 69 49 118 Pleurisy 1 2 2 2 3 4 1 ... ... ... ... ... ... ... ... 1 3 ... 1 ... 5 1 1 ... 11 2 14 6 20 Bronchopneumonia 28 26 21 27 49 53 1 2 2 ... ... 1 ... ... 1 1 6 3 2 ... 4 5 1 3 17 15 66 68 134 Pleuroneumonia 1 ... ... 2 1 2 ... 1 ... ... ... ... ... 1 3 1 5 4 1 ... 2 1 ... ... 11 8 12 10 22 Other Diseases of Respiratory System 5 6 1 2 6 8 ... ... ... ... ... ... 1 ... 1 2 6 1 ... 2 1 5 ... 8 9 18 15 26 41 5.—Diseases of Digestive System. Dentition 11 15 5 8 16 23 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 23 39 Sore Throat, Quinsy ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Diseases of Stomach 9 10 1 ... 10 10 ... ... 1 ... ... 2 ... ... 3 4 7 5 ... ... 2 3 ... 1 13 15 23 25 48 Enteritis 14 13 ... 6 14 19 1 ... 2 ... 2 1 1 1 7 4 4 3 1 2 ... 3 ... ... 18 14 32 33 65 Obstructive Diseases of Intestine 3 1 1 ... 4 1 ... ... ... ... ... ... ... ... ... 1 4 8 2 ... 3 6 1 1 10 16 14 17 31 Peritonitis ... 1 ... 2 ... 3 ... ... ... ... ... ... ... 1 ... 2 2 4 ... ... 1 ... ... ... 3 7 3 10 13 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 6 16 11 4 3 6 5 ... ... 29 25 29 25 54 Jaundice and other Diseaces of Liver 4 5 ... ... 4 5 ... ... 1 ... ... ... ... ... ... 2 5 3 ... ... 2 3 1 1 9 9 13 14 27 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 6 4 ... ... 6 4 ... 1 ... 3 1 ... ... ... ... 1 3 1 3 ... 1 2 ... ... 8 8 14 12 26 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... 5 1 1 1 ... ... ... ... ... ... 8 3 8 3 11 7.—Diseases of Gland-Like Organs of Uncertain Use. (e.g.,Bronchocele, Addison's Disease) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of Urinary System. Nephritis ... ... ... 1 ... 1 1 ... ... ... ... ... ... 1 ... 1 6 4 ... ... 2 1 ... ... 9 7 9 8 17 Bright's Disease, Albuminuria ... ... 2 ... 2 ... ... ... 3 ... ... 1 2 2 5 11 28 18 13 4 25 24 3 8 79 68 81 68 149 Disease of Bladder or of Prostate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 1 ... 7 ... 3 1 15 3 15 3 18 Calculus (Stone) ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Other Diseases of the Urinary System 1 2 ... ... 1 2 ... ... 1 1 ... ... ... ... ... 2 2 1 1 ... 2 1 ... 1 6 6 7 8 15 9.—diseases of Reproductive System. a. Of Organs of Generation. ... Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 ... 2 ... 2 ... 3 ... ... ... 12 ... 12 12 22 23 Lambeth Borough.—Deaths Registered from all Causes during the Year 1903. Note.—The deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES. AGES. Total. Under 1 Year. 1-5 Under 5 Years. 5-10 10-15 15-20 20-25 25-40 | 40-60 60-65 65-80 80 & over. Over 5 Years. All Ages. B. Of Parturition. 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. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 2 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Accdents of Child Birth ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 7 ... 1 ... ... ... ... ... ... ... 9 ... 9 9 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 3 1 3 1 4 Arthritis, Ostitis, Periostits ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 1 2 2 4 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... 1 ... ... ... ... 3 2 3 2 5 11.—Diseases of Inegumentary System. Carbunc'e, Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ] 1 1 ... 4 3 4 3 7 Other Diseases of Integumentary System 4 ... ... ... 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 1 ... ... 3 1 7 1 8 VII.—Deaths from Violence. • 1.—Accident or Negligence. Fractures and Contusions ... ... 3 1 3 1 3 ... 1 ... 1 1 ... ... 4 1 8 2 2 ... 4 3 1 5 21 15 27 13 40 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald 1 1 ... 2 1 3 ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... 4 ... ... ... 11 1 14 15 Poison ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... 2 1 ... ... 1 ... ... ... 4 3 4 3 7 Drowning ... ... ... ... ... ... 2 ... 1 ... ... ... 1 ... 6 1 3 1 ... 1 ... ... ... ... 13 3 13 3 16 Suffocation 15 13 ... ... 15 13 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 16 14 30 Otherwise 1 6 ... ... 1 6 1 1 ... ... 1 ... ... ... 1 1 7 ... 1 5 3 3 1 ... 15 7 16 13 29 2.—homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... 1 ... ... ... ... ... 4 ... 4 ... 4 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 5 1 ... ... 1 1 ... ... 9 4 9 4 13 Poison ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 2 2 ... ... ... ... ... ... ... 4 2 4 2 6 Drowning ... ... ... ... ... ... ... ... ... .... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 1 1 1 2 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 2 ... ... ... ... ... ... 5 2 5 2 7 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... ... 2 2 2 2 4 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—Deaths from Ill-Defined and Not Specified Causes. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 Debility, Atrophy, Inanition 79 66 1 3 80 69 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 80 71 151 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 1 Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... 2 2 Abscess ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... 3 1 ... ... ... ... 1 3 5 4 5 9 Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or ill-defined 5 3 ... ... 5 3 ... ... l ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... 7 3 ... 24 Summary of Total Corrected Deaths in Lambeth Borough during 1903. No. of Deaths Total. No. of Deaths. Total. M. F. M. F. I.—Specific Febrile, or Zymotic Diseases Brought forward 2009 2043 4052 1. Miasmatic Diseases 200 192 392 VI.—Local Diseases—continued. 2. Diarrhœal ,, 88 73 161 3. Malarial ,, ... ... ... 6. Diseases of Lymphatic System 8 3 11 4. Zoogenous ,, ... ... ... 7. Diseases of Gland-like Organs of Uncertain Use ... ... ... 5. Venereal ,, 32 14 46 6. Septic ,, 15 11 26 8. Diseases of Urinary System 112 88 200 II.—Parasitic Diseases 5 7 12 9. Di eases of Reproductive System (a) Diseases of Organs of Generation ... 12 12 III.—Dietetic Diseases 16 25 41 (b) Diseases of Parturition ... 12 12 IV.—Constitutional Diseases 555 486 1041 10. Diseases of Bone??? and Joints 8 5 13 11. Diseases of Integumentary System. 11 4 16 V.—Developmental Diseases 137 160 297 VII.—Violence. VI.—Local Diseases 1. Accident or Negligence 77 60 137 1. Diseases of Nervous System 186 222 408 2. Homicide ... 1 1 2. Diseases of Organs of Special Sense 6 7 13 3. Suicide 25 11 36 4. Execution ... ... ... 3. Diseases of Circulatory System 267 317 584 VIII.—Ill-Defined and not Specified Causes. 92 83 175 4. Diseases of Respiratory „ 358 369 727 5. Diseases of Digestive „ 144 160 304 Carried forward 2009 2043 4052 Total 2342 2322 4664 25 Offences under the Food and Drugs, and Public Health, Acts, during 1903. NATURE OF OFFENCE, AND AMOUNTS OF PENALTIES AND COSTS IN EACH CASE. 26 27 Summonses—Sale of Food and Drugs (and Margarine) Acts. Offence. Penalty. Costs. On 21st January, 1903, summonses were heard before Mr. Horace Smith at Westminster Police Court, re exposing for sale a parcel of Margarine, the fat of which contained more than 10 per cent of butter fat. £ s. d. £ s. d. 0 5 0 0 2 0 Re selling Butter containing Margarine (not Butter) 91 per cent. 1 0 0 0 14 6 Re selling Butter containing Margarine (not Butter) 50 per cent. 1 0 0 0 14 6 Re selling Butter containing Margarine (not Butter) 90 per cent. 1 0 0 0 14 6 Re selling Butter containing Margarine (not Butter) 45 per cent. 0 10 0 0 14 6 Re exposing for sale a parcel of Margarine by retail without having a label attached and marked in capital letters, 1½-in. "Margarine." 1 0 0 0 14 6 On 22nd January, a summons was heard before Mr. Francis, at Lambeth Police Court, re selling Coffee containing added Chicory 50 per cent. 0 10 0 0 14 6 On 3rd February, an adjourned summons was heard before Mr. Garrett, at the South Western Police Court, re selling Milk containing added water to the extent of 9 per cent. 0 10 0 0 14 6 On 12th February, summonses were heard before Mr. Shiel, at Westminster Police Court, re exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½-in. "Margarine." 1 0 0 0 16 6 Re selling a sample of Milk, from which the Cream had been abstracted to the extent of 12 per cent. 2 0 0 0 16 6 On 19th March, summonses were heard before Mr. Hopkins, at Lambeth Police Court, re selling Milk from which the Cream had been abstracted to the extent of 12 per cent. 1 0 0 0 14 6 Re selling Butter containing Margarine (not Butter) 90 per cent. 3 0 0 0 14 6 Re selling Coffee containing added Chicory 25 per cent. 1 0 0 0 14 6 On 30th April, a summons was heard before Mr. Plowden, at Lambeth Police Court, re selling Milk containing added water 26 per cent. 0 5 0 0 14 6 On 9th June, a summons was heard before Mr. Garrett, at the South Western Police Court, re exposing a parcel of Margarine by retail, without having a label attached and marked in capital letters 1½-in. "Margarine." 0 10 0 0 12 6 Re selling Milk from which the Cream had been abstracted to the extent of 18 per cent. 1 0 0 0 12 6 Carried forward 15 10 0 10 19 6 28 29 Summonses— Sale of Food and Drugs (and Margarine) Acts.—continued. Offence. Penalty. Costs. £ s. d. £ b. d. Brought forward 15 10 0 10 19 6 On 10th June, a summons was heard before Mr. Hopkins, at Lambeth Police Court, re selling Milk to which water had been added to the extent of 8 per cent., and Cream abstracted to the extent of 12 per cent. 0 10 0 0 12 6 On 11th June, summonses were heard before Mr. Francis at Westminster Police Court, re selling Milk from which the Cream had been abstracted to the extent of 8 per cent. 1 0 0 0 12 6 Re selling Butter containing Margarine (not Butter) 92 per cent. 1 0 0 0 12 6 Re selling Butter containing Margarine (not Butter) 93 per cent. 2 0 0 0 12 6 Re selling Coffee containing Chicory to the extent of 54 per cent. 1 0 0 0 12 6 On 19th June, a summons was heard before Mr. Paul Taylor at the Southwark Police Court, re exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½-in. "Margarine." 1 0 0 0 12 6 On 9th July, summonses were heard before Mr. Hopkins, at Lambeth Police Court, re selling Butter, containing Margarine (not Butter) 93 per cent. 0 10 0 0 12 6 Re selling Milk containing added water 12 per cent. 0 10 0 0 12 6 Re selling Milk from which the Cream had been abstracted to the extent of 9 per cent. 0 10 0 0 12 6 Re selling Milk from vehicle or can without having conspicuously inscribed thereon his name and address. 0 10 0 0 12 6 On 23rd July, Summonses were heard before Mr. Hopkins, at Lambeth "Police Court, re selling Milk from which the Cream had been abstracted to the extent of 9 per cent. 0 10 0 0 12 6 Re selling Milk containing added water 8 per cent. 5 0 0 0 12 6 Refusing to sell an article of food, to wit, Milk exposed for sale in the street. 2 0 0 0 2 0 On 30th July, summonses were heard before Mr. Hopkins, at Lambeth Police Court, re selling New and Separated Milk mixed, not of the nature, substance, and quality demanded by the purchaser. 1 0 0 0 12 6 Re selling Milk containing added water 5 per cent. 1 0 0 0 12 6 Carried forward 33 10 0 19 16 6 30 31 Summonses—Sale of Food and Drugs (and Margarine) Acts—continued. Offence. Penalty. Costs. Brought forward £ s. d. £. s. d. 33 10 0 19 16 6 Re selling Milk from which the Cream had been abstracted to the extent of 7 per cent. 1 0 0 0 12 6 Re selling Milk from which the Cream had been abstracted to the extent of 7 per cent. 1 0 0 0 12 6 Re selling Milk containing added water 5 per cent. 1 0 0 0 12 6 Re selling Milk containing added water 12 per cent. 1 0 0 0 12 6 Re selling Milk from which the Cream had been abstracted to the extent of 7 per cent. 1 0 0 0 12 6 Re selling Milk containing added water 9 per cent., and from which the cream had been abstracted to the extent of 7 per cent. 2 0 0 0 12 6 On 13th August a summons was Heard before Mr. Francis, at Lambeth Police Court, re selling Milk from which the Cream had been abstracted to the extent of 18 per cent. 4 0 0 0 12 6 Re selling Milk containing added water 6 per cent. 2 0 0 0 12 6 On 20th August, an adjourned summons was heard before Mr. Horace Smith, at Lambeth Police Court, re selling Milk from which the Cream had been abstracted to the extent of 12 per cent. 0 10 0 0 17 6 On 27th August, summonses were heard before Mr. Horace Smith, at Lambeth Police Court, re selling Milk from which the Cream had been abstracted to the extent of 17 per cent. 0 10 0 0 19 6 Re selling Milk from which the Cream has been abstracted to the extent of 15 per cent. 0 10 0 0 19 6 Re selling Milk from which the Cream had been abstracted to the extent of 13 per cent. 0 10 0 0 17 6 Re selling Milk from which the Cream had been abstracted to the extent of 12 per cent. 0 5 0 0 12 6 Reselling Milk containing added water 13 per cent. 0 10 0 0 12 6 On 3rd December, summonses were heard before Mr. Francis, at Lambeth Police Court, re selling Butter, containing Margarine (not Butter) 93 per cent. 1 0 0 0 12 6 Re selling Milk, containing added water 5 per cent. 1 0 0 0 17 6 Re selling Milk, from which the Cream had been abstracted to the extent of 15 per cent. 1 0 0 0 17 6 Re selling Milk, containing added water 8 per cent. 1 0 0 0 17 6 On 12th November, a summons was heard before Mr. Francis, at Lambeth Police Court, re selling Milk containing added water to the extent of 36 per cent. 2 0 0 0 12 6 On 31st December, summonses were heard before Mr. Cluer, at Lambeth Police Court, re selling Butter containing Margarine (not Butter) 85 per cent. 3 7 6 0 12 6 Carried forward 58 12 6 34 5 6 32 Summonses—Sale of Food and Drugs (and Margarine) Acts—continued. Offence. Penalty. Costs. Brought forward £ s. d. £ s. d. 58 12 6 34 5 6 Re selling Milk containing added water 5 per cent. 2 0 0 0 12 6 Exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½ in., "Margarine." 2 7 6 0 12 6 Re exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½ in., "Margarine." 3 7 6 0 12 6 Re selling Butter containing Margarine (not Butter) 95 per cent. — 0 12 6 Re exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½ in., "Margarine." 2 0 0 0 12 6 On January 28th, l904, 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 10 per cent. 0 10 0 0 12 6 Be selling Milk from which the Cream had been abstracted to the extent of 14 per cent. 0 10 0 0 12 6 Be exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 1½ in., "Margarine." — 0 2 0 Re selling Butter containing Margarine (not Butter) 84 per cent. 2 0 0 0 2 0 Total 71 7 6 38 17 0 33 Summonses—Public Health (London) Act. Offence. Penalty. Costs. On March 4th, summonses were heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to make good defective drainage at No. 159, Loughborough Road. Order made to do work in 21 days, and owner to pay 4s. costs. £ s. d. £ s. d. ... 0 4 0 Against the occupier, for causing a quantity of vegetable matter to be thrown in front of No. 18, Mostyn Terrace. 0 10 0 0 2 0 On 29th April a summons was heard before Mr. Chapman, at Southwark Police Court, against the owner, for non-compliance with Notice of Council to intercept and ventilate drain at No. 99, Oakley Street. Order made to do work within 14 days, and Defendant to pay 5s. costs. ... 0 5 0 On 5th May a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with L.C.C. Bye-laws No. 2, with regard to a slaughter house at 263, Brixton Road. 2 0 0 0 2 0 Carried forward 2 10 0 0 13 0 34 35 Summonses—Public Health (London) Act.—continued. Offence. Penalty. Costs. Brought forward £ s. d. £ s. d. 2 10 0 0 13 0 On 1st May, a summons was heard before Mr. Shiel, at Westminster Police Court, against the owners, for non-compliance with Notice of Council to repair the defective drains at No. 201, Upper Kennington Lane. Order made to do work within 28 days, and Defendant to pay 6s. costs. ... 0 6 0 On 7th May, a summons was heard before Mr. Francis, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to repair soil pipe and under trap sink waste at 39, Knowle Road. Work completed. No costs allowed. On 28th May, a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to repair roof, &c., and ventilate soil pipe, at No. 29, Hayter Road. ... ... Order made to do work in 7 days, and Defendant to pay 4s. costs. ... 0 4 0 On 5th June, a summons was heard before Mr. Francis, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to cleanse interior of No. 7, Leopold Street. Order made to do work in 7 days, and Defendant to pay 4 s. costs. ... 0 4 0 On 10th June, summonses were heard before Mr. Baggallay, at Southwark Police Court, against the owner, for non-compliance with Notice of Council to repair defective drain and water closet, at No. 155, Stamford Street. Order made to do work in 10 days, and Defendant to pay 5s. costs. ... 0 5 0 Against the owner, for non-compliance with Notice of Council to cleanse dirty walls and ceilings at 61, Gray Street. Order made to do work in 14 days, and Defendant to pay 5s. costs. ... 0 5 0 On 11th June a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to make good defects in drains at Nos. 6a, 8 and 10, Willington Road. Order made to do work in 7 days, and Defendant to pay 4s. costs. ... 0 4 0 Carried forward 2 10 0 2 1 0 36 37 Summonses—Public Health (London) Act.—continued. Offence. Penalty. Costs. Brought forward £ s. 3. £ s. a. 2 10 0 2 1 0 On 2nd July, 5 summonses were heard before Mr. Hopkins at Lambeth Police Court, against the Secretary of the Charing Cross and Strand Electricity Supply Corporation Company, Limited, that a chimney, not being the chimney or a private dwelling-house, did on the 22nd, 23rd, 24th, 25th and 27th April last, send forth black smoke in such quantity as to be a nuisance. The Magistrate fined Defendant £10 and £2 2s. costs for nuisance committed on the 23rd April, and dismissed the 4 other summonses, it being understood that in all future cases against this Company the maximum penality would be imposed in every case. 10 0 0 2 2 0 On 7th July, before Mr. Hopkins, against the owner, for wilfully obstructing Inspector Hooper in execution of his duty from examining premises at No. 15, Magee Street. 1 0 0 0 2 0 On 15th September a summons was heard before Mr. Francis, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to cleanse walls and ceilings at No. 218, Kennington Road. 2 0 0 0 2 0 On l6th September against the owner, for removing fish offal in an improperly constructed carriage, contrary to the Bye-laws of the London County Council. 1 0 0 0 2 0 On the 26th November, a summons was heard before Mr. Francis, at Lambeth Police Court, against the owner for non-compliance with Notice of Council to put drain and soil pipe into proper order and condition at 15, Knowle Road. Order made to do work in 7 days, and pay 4s. costs. ... 0 4 0 On 1st December, summonses were heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to make good defective drains at Gabriel's Yard, Sutton Street. Order made to do work in 7 days, and pay 4s. costs. ... 0 4 0 On 1st December, against the owner, for non-compliance with Notice of Council to provide more w.c. accommodation, and cleanse and repair walls and ceilings, at No. 83 Stamford Street. Order made to do work in 14 days, and pay 5s. costs. ... 0 5 0 Against the owner, for non-compliance with Notice of Council to put the drain into proper order and condition at 16, Benedict Road. 2 0 0 0 15 0 On 22nd December, summonses were heard before Mr. Hopkins at Lambeth Police Court, against the owner for non-compliance with Notice of Council to put the drain into proper order and condition at No. 38, Pearman Street. Order made to do work in 14 days and pay 5s. cost. ... 0 5 0 Carried forward 18 10 0 6 2 0 38 Summonses—Public Health (London) Act.—continued. Offence. Penalty. Costs. Brought forward £ s. d. £ s. d. 18 10 0 6 2 0 On 1st of April, 3 summonses were heard before Mr. Hopkins at Lambeth Police Court, against the owner for permitting the newly erected dwellings-houses Nos. 21, 38 and 9 to 16, Cowley Mansions to be occupied as dwelling-houses without first obtaining the Certificate of the Sanitary Authority that they have a proper and sufficient water supply. 6 0 0 0 6 0 On 8th April, a summons was heard before Mr. Chapman at Southwark Police Court, against the owner, for non-compliance with Notice of Council to reconstruct drains at No. 6 Broadwall. 5 0 0 0 5 0 On 27th July, a summons was heard before Mr. Hopkins at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to cleanse and repair interior walls and ceilings and water closet at No. 4, Ridgway Road. 2 0 0 0 2 0 On 14th August, a summons was heard before Mr. Bagally at Lambeth Police Court, against the owner, for failing to cleanse dirty walls and ceiling at No. 4, Ridgway Road. ... 0 4 0 On 22nd October, a summons was heard before Mr. Hopkins at Lambeth Police Court, against the owner for non-compliance with Notice of Council to repair drain and water closet at No. 99, Holland Road. 2 0 0 0 4 0 Total 33 10 0 7 3 0 39 Out-Break of Measles at Lambeth. Schools, Norwood. (Special Report presented to the Council on April 23rd, 1903.) My attention has been drawn, through the Mortality Returns, to the unusually large number of deaths from Measles registered during January and February of the present year, as having occurred amongst the infants and children in connection with the Lambeth Schools under the control of the Lambeth Guardians, and situated in Elder Road, West Norwood. Taking the past year (1902) the following deaths have been registered from Measles in Norwood District:— 1902. Norwood District (excluding Schools). Schools. January — 2 (male, 12 mths., male, 3 yrs.) February 1 — March — — April 1— May — — June — — July — — August — — September — — October — — November — 1 (female, 2 yrs.) December — 2 (males, 2 yrs.) Totals 2 5 It may be mentioned that there was an outbreak of Whooping Cough, also, in the, Norwood District, during the first half of 1902, resulting in 12 deaths, 3 of which took place at the Lambeth Schools, thus: 40 1902. Norwood District (excluding Schools). Schools. January 1 – February 3 – March 4 – April 1 1 (M., 2 yrs.) May – 1 (F., 3 yrs.) June – 1 (M., 22 mths. Totals 9 3 Examining more in detail the Mortality Returns for the year 1902, I find that there have been, in addition, 11 deaths from non-infectious diseases amongst the boys and girls at the Lambeth Schools, viz.:—January, 1 (Dentition, male, 2 years); February 1 (Dentition, male, 2 yrs); May, 1 (Tabes Mesenterica, male 3 years); July, 1 (Tubercular Meningitis, female, 4 years); September, 1 (Tubercular disease of the lungs, female, 10 years); November, 1 (Struma, male, 10 years); December, 5(1, Dentition, male, 21 months; 3, Bronchitis, males, 2, 3 and 3 years respectively; and 1, Gastro-intestinal Catarrh, female, 4 years.) All these details are important, as indicating the weak constitutions of some of the children admitted into the Lambeth Schools. The ages at death are also noteworthy, viz., 17 (out of 19) under 5 years, 15 under 4 years, 10 under 3 years, and 3 under 2 years of age. The deaths during the winter months from lung troubles (bronchitis, etc.) may be in part explained by the absence of proper warming appliances in the Main Buildings, Probationary Wards, and Receiving Wards. The total number of deaths from all causes in the Schools during 1902 was 19, giving a very high mortality-rate of 31.7 per 1000, taking the average number of children in residence as 600, as compared with 17.7 per 1000 for the whole of the Borough, and 12.5 per 1000 for Norwood District as a whole. This is a most serious state of affairs. Taking the 3 deaths registered from Measles in connection with the Schools during November and December, 1902, I find that during the first two months (January and February) of 1903,8 more deaths from Measles have been registered among the children, making a total of 11, and as this is a high mortality, more 41 especially taking into account the fact that, during the same period, there had been no single death from Measles registered in the Norwood District outside the Schools, I decided to pay a visit to the Schools and make enquiries. In this connection, I have to thank the Medical Superintendent (Dr.Rugg), with whom I at once communicated previous to my vis'ts, and who accompanied me on my first visit, and gave me such information as I asked for. I also interviewed the Master (Mr. Fielder). Measles is a non-notifiable disease, so that I have no means (officially) of knowing the numbers of cases that have occurred in the Norwood District; but I find from the School Register that, since October, 1902, up to the end of February, 1903. 68 cases have occured in connection with the Lambeth Schools, and of these 11 have died, thus giving a high case mortality of 16.2 per cent. The ages of the-e 68 cases, and of the 11 deaths, are as follow:— Cases. Deaths. Case Mortality per 1000. 1-2 years 6 1 16.7 2-5 years 54 10 18.5 5-6 years 4 – 0.0 6-10 years 3 – 0 0 Over 12 years 1 – 0.0 Totals 68 11 16.2 In other words, 60 cases and 11 deaths were amongst children under 5 years of age, Measles being chiefly.a disease of infant and child life. Measles is a disease that, with proper care and attention, should give a very much lower mortality rate than this. Death generally results from the after-consequences, due to the patients catching a chill or cold during convalescence, giving rise to Bronchitis, Pneumonia, etc, which are the immediate causes of death. The importance of warmth, therefore, goes without saying. No child in a fair state of health ought to die from Measles, if properly nursed and attended to, and if living under satisfactory sanitary conditions. It is now admitted that insanitary surroundings tend to increa e the mortality from Measles (and other diseases), whilst the previous constitutional states of the children are also an important consideration to be taken into-account in dealing with mortality rates. Further, the younger the child, the greater the risk of death from Measles, and other infectious diseases. 42 With a view to investigating the reasons for the Lambeth Schools' increased mortality from Measles, [ directed special attention to the following headings:— 1. Nature of nursing and attention given. 2. States of Health of patients before attack. 3. Conditions (sanitary or otherwise) under which the patients lived before death. Heading No. 1 may be dismissed at once, as the nursing arrangements made by the Guardians under the supervision of the Medical Superintendent are in every way satisfactory; whilst the general condition (cleanliness and otherwise) of the Wards in which the patients are treated, was, at the time of my visit, all that could be wished for, and the Lambeth Schools Infirmary and Isolation Hospital would compare favourably with any Children's Hospital in London, or elsewhere. Indeed, I was struck with the cleanliness and the general satisfactory surroundings of the wards, themselves, and of the offices adjoining, showing that the Nurses do all they can to bring their patients back to health; whilst the buildings are so arranged that the wards are airy and light, and are furnished in a manner to show throughout brightness and comfort. The Medical treatment that the patients receive does not need dealing with such patients having the advantage of a fully-qualified Medical Superintendent who visits daily, and who is in residence near the Schools, so that he can be called at any time, and can be at once in attendance. With regard to Heading No. 2, an analysis of the 11 deaths shows, on inquiry, that the stamina of the patients, previous to their contracting Measles, were poor, and their constitutional states such as to render any illness, that they might contract, highly dangerous to life. In this connection, 2 of the children are registered as having died from tubercular disease of the lungs, in addition to Measles ; whilst the others appear to have been constitutionally debilitated before contracting Measles, as far as I could gather from the nurses, and judging by several patients, who had escaped death, and who were in the Wards at the time of my visit, and who proved, on physical examination, to be of low vitality, the result of rickets, want of proper attention in the early stages of their existence, etc. The ages at the time of death of the 11 patients who succumbed are important, and may, with advantage, be again tabulated, Thus, nine of the patients were 2 years of age; one, 3 years; and one, 18 months. Measles and other infectious diseases (as indeed any disease) are specially fatal to young children under (say) 3 or 5 years. 43 The immediate causes of death are registered as follows:— Tubercular disease of lungs 2 Broncho-Pneumonia 2 Pneumonia 1 Bronchitis 6 The obvious lesson is not to expose such weakly children of tender years to infection. With regard to Heading No. 3, the facts discovered are the most unsatisfactory reading. Speaking generally, whilst it is true that the sanitary appliances were clean, and the drains in working order, the conditions found point to the drainage systems being defective, old and obsolete, requiring immediate attention, with a view to such drains and appliances being made good, re-modelled, and brought up to modern requirements. A large number of chemical tests were applied to the drains of the 11 different blocks of buildings, and, practically, in every case, a result was obtained; whilst, in many instances, it was even unnecessary to trouble to test as it was easy to see by the eye that many of the joints of soil and waste pipes were defective, etc., allowing of the escape of sewer (or drain) gas around all the Buildings, which are, thereby, bathed in it night and day. Such a state of affairs might have been even more serious, had it not been that the evil effects have been in part counteracted by the fresh air, which blows around the Buildings on all sides at all times. The situation of the Schools is ideal. The insanitary condition in which I find the Lambeth Schools (vide Sanitary Inspector's Report,) would tend, in my opinion, to increase the mortality from Measles, and to lower the vitality of the children so as to render them more liable to contract any infectious disease. It is difficult to understand how such conditions have been allowed to remain, more especially as the defects found have reference to all buildings (Main Blocks, Infirmary, Probation and Isolation Wards, and the Receiving Blocks), for they must have been found at once, had the sauitary arrangements been supervised and examined at any time, not to mention periodically, as should be the case in all Public Institutions. The Old School Buildings and the Matron's House, being empty, were not inspected, though doubtless iu the same insanitary state. I append to this Report a summary of the sanitary defects found. 44 Cause of Outbreak and Spread of Measles in the Schools. Whilst the number of deaths (under 5 years) is excessive, the number of cases (under 5 years) that have occurred (60) is also excessive. Taking the average number (under 5 years of age) in residence as 100, the incidence of Measles is 60 per cent., and the Measles death-rate at that age-period per 1,000 living is 110, as compared with less than 2 for the whole of the Borough, and 0 for Norwood District alone, extending over a period of four months, and it becomes necessary, therefore, to trace how the disease has spread from scholar to scholar. It is true that children from an institution who attend daily at Board Schools run such risks of infection as do all children attending such Board Schools from different houses in the neighbourhood, but, during the period under investigation, Measles has not been, to any extent, epidemic in Norwood, as shown by thefact that during the last 12 months one death only has been registered from Measles throughout the whole of the distriot (excluding the Schools). Indeed, if we assume that Measles has been epidemic outside the Schools during the period under investigation, the alarming difference between the outside mortality from the disease and that within the School Buildings will have to be accounted for, bearing in mind the better nursing and other conditions that are supposed to exist in such Buildings as compared with those met with in the ordinary houses of the working classes. It is equally true that children from an infected Institution may spread the disease throughout the district in which such Institution is situated by means of Board Schools. It appears from my investigations that the disease has been brought into the Lambeth Schools, not from the Norwood District, but from the Inner Wards of the Borough, whence children are drafted to the Schools, and where Measles has been in an epidemic form during the period under investigation. From the Lambeth Schools the disease has spread into the Norwood district, where there is at present a commencing outbreak being spread through Gipsy Road, Woodland Road, Rockmount Road, and Salters' Hill Board Schools, where the children attend from tlie Lambeth Schools. To prevent, or at least to minimise, as far as possible, the spread of infectious diseases in the Lambeth Schools, the Guardians' Buildings have been planned in an exemplary way. The Schools consist of the Main Building, where boys and girls live; a Receiving Ward (a long distance away), into which the new arrivals from the Workhouses are received, and from which they are drafted to isolated Probation Wards (for a quarantine period of three weeks) prior to being admitted into the Main Buildings; whilst there is a detached Infirmary for the treatment of all the 45. sick children, as required, and, in addition, a separate small Isolation Hospital for the treatment of infectious casts as they occur. The arrangements made by the Guardians are, therefore, exemplary in theory, but I find that the uses to which these various buildings have been put, works out in practice unsatisfactorily. It is true that children have been admitted at the Receiving Wards, and drafted from there to the Probation Wards for a period of three weeks, prior to being admitted into the Main Building, but it is also true that the children in the Probation Wards have been allowed to go to the Board Schools in the Norwood and Croydon Districts, and whilst there to mix, not only with the Guardians' children from the Main Building, but also with other children from various parts of such districts. It seems anomalous that the Guardians should have arranged for Probation Wards with most praiseworthy intentions, but that the use of such Probation Wards should have been stultified by the fact that the children detail ed there have been allowed to mix with the children from the Main Building, both outside and inside the Guardians' premises—outside as already explained; inside, in the Church, situated within the Guardians' own premises, where children from the Receiving and Probation Wards attend with children from the Main Building for religious instruction and other purposes. Such an arrangement is thwart with danger, as by this means Measles (and what applies toMeasles applies to other infectious diseases) has been allowed to spread from the Probation Wards to the Main Buildings, and so the whole object of such Probation Wards has been lost. The idea of children from the Probation Wards joining children from the Main Buildings immediately outside the Guardians' premises, mixing with them going to school, at school, and coming back from school, being carefully separated and isolated afterwards when they arrive within the Guardians' premises would be amusing if such serious results had not obtained ! As showing how the Measles has spread, it is interesting to note, from the returns furnished to me, by the Head Nurse through Dr. Rugg, that, of the 68 cases that have occurred, 43 arose amongst children in the Main Buildings and 25 amongst children in the Infirmary, Probation Wards, and Receiving Wards. The Infirmary has helped to spread the disease. From the Inner Wards of the Borough of Lambeth, the Measles germs are passed into the Lambeth Schools at Norwood, first into the Receiving Wards, then into the Probation Wards, Infirmary, and Main Buildings, and so on from there to through the Board Schools into the Norwood and Croydon districts. No inter-communication whatever should be allowed to take place between the Infirmary and the Isolation Hospital, or between any neighbouring buildings which have been specially planned to avoid such. The disinfecting machine is old, inefficient and out of date. 46 The above Report, though exceedingly interesting from the point of view of showing the nature of Measles and its method of spreading, is serious reading, and calls for suggestions which, when carried out, will help to prevent a repetition of such a serious condition of affairs as is disclosed in the Report. My suggestions are as follow:— 1. Re-constructing of the drainage systems. 2. Re-modelling of the sanitary appliances. 3. Supervising periodically by a Sanitary Expert of such drainage systems and sanitary appliances, when reconstructed and re-modelled. 4. Reserving the Probation Wards strictly for the uses for which they were originally intended, and preventing the children whilst in such Wards from mixing, in any way, with the children from the Main Building (or other children), either at School or elsewhere, e.g., Church, Sunday School, Playground, &c. 5. Avoiding the sending of young children (at least, those under three years of age) to Norwood to the Lambeth Schools under existing arrangements (i.e., without being kept absolutely, and at all times, distinct and separate from all other children), as Measles and other diseases are specially fatal to children of such tender years. 6. Preventing any communication between (a) the Isolation Hospital and the Infirmary; (b) the Main Buildings (children and officials) on the one band, and the Receiving Ward, Probation Wards, the Infirmary, or the Isolation Hospital (children, patients, or officers) on the other hand—keeping the separate buildings carefully fenced off one from the other. In this connection, no children should be allowed to pass from the Main Buildings or from the Probation Wards to the Infirmary even for the purpose of having ointment, dressings, &c., applied. 7. Advising the Sanitary Authority in future of any break of Measles (or other non-notifiable infectious disease) amongst the inmates of the Lambeth Schools, . so that measures may at once be taken to prevent the disease spreading from such Schools into the Lambeth or neighbouring Boroughs, by closing tne Schools. 8. Supplying proper warming appliances for the Main Buildings, Receiving Ward and Probation Wards. 9. Supplying an efficient disinfecting machine. LAM 6 47 In connection with suggestion 5, it will be a matter for the serious consideration of the Guardians as to whether or not they are morally justified in sending young children (under five years of age) up to the Lambeth Sehools under present conditions. There is no getting away from the fact that, had there been no children in residence under five years of age, 60 out of the 68 cases of Measles would not have occurred, and not one of the deaths would have taken place. Even taking the deaths from all causes during the past year, 1902, the 19 deaths that have taken place amongst the inmates of the Schools would have been reduced to two, and the total death-rate per 1,000 reduced from 31.7 to 3.3. The writing on the wall is significant, and Nature's warning should not (and will not, I trust) be neglected. The danger (not to use a stronger term) of sending young children (under five years of age) into barracks at Norwood is proved in this Report. The Guardians would belie their name, if they continued such a pactice. It may be that, perhaps, any available room might, wth advantage, be used for the aged Poor, or (better still) for the open-air treatment of consumptives, if the Local Government Board will give their consent to such a scheme. Appendix. Summary of Sanitary Defects Found. 1. Broken drain-pipes. 2. Open and defective joints to soil pipes. 3. Ventilating pipes discharging below eaves gutters, or receiving rainwater from same. 4. Rain-water pipes directly connected to the drains. 5. Defectively constructed access chambers and covers. 6. Defective air in-lets. 7. Open traps at the foot of the soil-pipes near to entrance doors of dormitories in the playground. 8. Foul aud disgusting trough closets, coated with filth. 9. Water-closets opening direct, and ventilating, into Dormitories. 10. Improperly fitted and badly flushed slop-sinks. 11. Defective flushing cisterns. 12. No under-traps to baths and lavatory basins, and the in-let gullies in connection therewith not kept clean ; etc., etc., Joseph Priestly, Medical Officer of Health. March, 1903. The Report was sent (marked "private") to the Board of Guardians, and dealt with by them as follows Q 48 Guardians' Offices. Brook Street, March 26th, 1903. Dear Sir. re Outbreak of Measles at the Norwood Schools. I am directed by the Guardians to acknowledge the receipt of your letter of the 21st instant, enclosing your report with reference to this subject, and in reply to state that, at an Extraordinary Meeting of the Board held on Monday last for the purpose of taking into consideration the alleged insanitary condition of the Schools, the following Resolutions were unanimously agreed to, viz:— 1. That a Committee consisting of Captain Andrew, J.P., Mr. Bennett, Mr. Briant, Mr. Hawkey, and Mr. J. E. Turner, be appointed to at once remedy the defects pointed out by the Medical Officer of Health. 2. That the Committee be directed to enquire from those in authority how it has been possible to allow such a condition of affairs as that disclosed by the report of the Medical Officer of Health. 3. That the Committee be requested to take such steps as may be necessary to prevent its recurrence, and to report thereon to the Board. It was further resolved, That the thanks of the Board be accorded to Dr. Priestley, Medical Officer of Health of the Borough of Lambeth, for his advice and promised assistance in remedying the defective drainage at the Schools. The Guardians desire me to assure you that the suggestions contained in your report will be carried out forthwith in their entirety, and that no effort will be wanting on their part to render the sanitation of the School Buildings satisfactory to you in every respect. Yours faithfully, W. Thurnall, Clerk to the Guardians. Dr. Joseph Priestley. The Committee, mentioned in the Guardians' letter, met at the Schools on Tuesday, March 29th, and the Medical Officer attended and pointed out the various defects in connection with the drainage system of the various blocks of Buildings and in 49 nection with the administration of certain departments of the Schools. Orders were given at the meeting (such orders being confirmed by the Guardians on April 1st, 1903) for the re-construction of the drainage systems and the re-modelling of the sanitary fittings to be proceeded with forthwith (as follows). The other matters to receive prompt attention hereafter:— (а) To instruct Messrs. Doulton & Co., to forthwith remove the trough closets on both sides of the New Schools and to substitute up-to-date pan and trap W.C.'s. (b) To obtain from Messrs. Doulton & Co., Messrs. B. Finch & Co., and Messrs. G. Jennings, Ltd.. schedules of prices for sanitary appliances generally. (c) On the acceptance by the Guardians of the prices of one of these firms, to forthwith proceed with the re-construction of the drainage and fittings of the disused Infants' Block, forming part of the Old School premises and also one of the eight blocks of the New Schools. The latter will involve the displacement of 72 children, who, Mr. Fielder informs us, can be temporily distributed among the other blocks. (d) To succesively treat each remaining Block in a similar manner. (e) To arrange for the renovation of the disused Infants Block, so that on the completion of the drainage work in connection with that Block the building can be used as a temporary Infirmary. (f) To then proceed with the re-construction of the drainage of the Isolation Block, a portion of tht Infirmary, if necessary, being used as a temporary Isolation Ward. (g) On the completion of the re-construction work at the Isolation Block, to proceed with the re-construction of the drainage of the Infirmary. (h) To next proceed with the re-construction of the drainage of the Probation Wards, and the Receiving House as required. (i) To connect the drain from the Infirmary to the sewer in Crown Hill. (j) To instruct Messrs. Stenning & Son to proceed with the erection of a fence round the Infants' Block, in accordance with their tender already accepted by the Board. 50 Houses let in Lodgings. Special Report presented to the Council, May 5th, 1903. The Public Health (London) Act, 1891, makes it compulsory for every Metropolitan Sanitary Authority to make, and enforce, Bye-laws as to houses let in lodgings, or occupied by members of more than one family, A series of Bye-laws was adopted by the late Vestry on January 21st, 1897, and confirmed by the Local Government Board on May llth, 1897. Since the passing of the Bye-laws, houses have been registered as follow:— 1897 93 houses 1898 258 „ 1899 34 „ 1900 26 ., making a total of 411 houses (containing 2,369 rooms) registered by the late Vestry. With the re-arrangement of the Parish boundaries in connection with the formation of the new Borough of Lambeth, 40 of these houses (containing 252 rooms) were transferred to other districts, and there are now within the Borough of Lambeth 371 registered houses, containing 2,117 rooms, in which, at the time of registration, resided 3,644 persons, of whom 2,294 were over ten years of age. The ostensible objects aimed at in the Bye-laws are to ensure (1) absence of over-crowding, (2) periodical cleansing and limewhiting, and the instruction of the late Vestry was only to select for registration those houses which it was thought could not be satisfactorily inspected and supervised otherwise, and where there was reason to believe that over-crowding existed. The experience gained in connection with these houses registered under these Bye-laws has been, speaking generally, that a Sanitary Authoiry's Officers are hampered and their hands weakened instead of being strengthened. It is found that the Inspectors have greater powers under the house-to-house-inspection provisions of the Public Health (London) Act, 1891, than under such Bye-laws. There is a difficulty in getting the annual cleansing done under Bye-law 15, as a landlord of a lodging-house is responsible, and such landlord is defined in the Bye laws as being the person, whatever may be the nature or extent of his interest in the premises, by whom, or on whose behalf, such house, or part of a 51 house, is let in lodgings, or for occupation by members of more than one family, or who, for the time being, receives, or is entitled to receive, the profits arising from such letting. The landlord is, therefore, not the owner, and often pleads, what would appear to be true, viz., that he, or she, has no money to expend for such a purpose. When houses become so dirty as to be a nuisance under Section 2 of the Public Health (London) Act, 1891, there is no difficulty in at once getting the cleansing done by the Owner, but often in connection with the annual cleansing under the Byelaws there is no nuisance, but simply an offence against, or an infringement of, the Bye-laws, and in this case action must be taken against the landlord, and not against the owner. This annual cleansing has reference to the cleansing, by lime-washing, or otherwise, of every part of a house, viz., every area, interior surface of every ceiling and wall, of every water-closet, and the interior surface of every room, staircase and passage. For all practical purposes, therefore, it is better to proceed under the Public Health (London) Act, 1891, and to carry out a systematic house-to-house inspection under Section 1, than to register, wholesale, houses under the Bye-laws for Houses Let in Lodgings, made under Section 94 of the same Act. In either case, a large increase in the staff would be necessary, as the present division of the Inspectors' districts shows that in Lambeth Borough each Inspector has charge of (roughly) 25,000 to 35,000 persons and three to four thousand houses. With all the various duties which devolve upon a sanitary inspector there is but little time for anything approaching systematic house-to-house inspection, or for systematic registering of houses under the Bye-laws. It must be remembered that, in the Inner Wards more especially, to be consistent, the greater number of the houses should be registered. Existing congestion, and consequent high rent, compel occupiers to sub-let parts of their houses. Should such a systematic and wholesale registering of houses in Lambeth be adopted, there would be a distinct setting back, in respect to the sanitary state of such premises, as regards cleanliness, in that the liability under the Act would be transferred from a responsible owner under the Act to an irresponsible landlord under the Bye-laws. I have always felt that it would be vexatious to summon such landlords under the Bye-laws, as from my own personal experience such landlords are often persons whose financial status is such that I do not feel justified in proceeding against them for penalties as laid down under the Bye-laws ; more especially as I should have to proceed against them for premises whose state is such as not to be a nuisance or injurious or dangerous to health, but simply premises that are an offence against Bye-law 15, in the sense that the necessary annual cleansing has not been carried out. The landlord 52 is not in a financial position to cleanse his premises even when dirty, not to mention once every twelve months. With regard to over-crowding, the advice that I have hitherto given to the Council and the late Vestry is to the effect that, under existing conditions, the Sanitary Authority would not be justified in proceeding to extremes, with a view to abating all over-crowding, until extra suitable accommodation has been provided into which the legally displaced tenants could move and be housed Gross cases of over-crowding are dealt with under the Public Health (London) Act, 1891, but to systematically deal with over-crowding under the Bye-laws, where the cubic space is increased to 300 and 400 cubic feet per person respectively, would be a totally different matter, and in my opinion, an unjust and severe action for a sanitary authority to take under conditions such as at present exist, more especially in the Inner Wards of Lambeth Borough. From my experience in Lambeth, I am satisfied that the houses can be kept in better condition by systematic house-to-house inspections than by simply registering them under Bye-laws; but to enable a systematic house-to-house inspection to be carried out, a large increase to the existing Sanitary Staff would be rendered absolutely necessary. Even to carry out the Bye-laws in the sense that the London County Council would seem to suggest that such bye-laws should be carried out, would involve also a large augmentation to the existing Sanitary Staffs, and the practical results would not be commensurate with the extra expense incurred, though I am satisfied that many satisfactory results would accrue from systematic house-to-house inspection in the more congested and poorer parts of the District. I would remind the Council of the decision given in the Appeal Court by the Lord Chief Justice of England, in the case of Weatheritt versus Cautley, to the effect that tenemented houses built in blocks cannot be registered as houses let in lodgings. In conclusion, so far as my experience gained in Lambeth goes, whereas upon theoretical grounds much good was expected from the enforcing of the Bye-laws as to houses let in lodgings, in practice such expectations have not been realised, the Bye-laws being found to be unworkable, more especially in connection with their chief object, viz., the systematic and regular cleansing of premises. Joseph Priestlev. February 23rd, 1903. 53 Appendix. Numbers of houses registered up to date in the different Metropolitan Boroughs:— Chelsea — Hackney 442 Bethnal Green 9 Islington 533 Greenwich 19 Paddington 543 Lewisham 29 Holborn 596 Deptford 34 Finsbury 849 Battersea 39 Hampstead 911 Wandsworth 116 Marylebone 916 Woolwich 117 Southwark 1005 Stoke Newington 119 St. Pancras 1270 Shoreditch 190 Stepney 1353 Camberwell 191 Hammersmith 1359 Poplar 270 Westminster 2004 Fulham 329 Kensington 2063 Bermondsey 350 Lambeth 371 16433 City 396 N.B.—At the Census 1901 there were in Lambeth Borough, 41,511 inhabited houses and 70,887 tenements, of which latter 44,495 contained less than five rooms. 54 Municipal Milk Depots. Special Report presented to the Council on July 9th, 1903. No Sanitary Authority should be satisfied with the sanitary progress of its district whilst the deaths of infants under one year of age remain yearly as high as at present. This high infantile mortality is a disgrace to sanitary administration and preventive methods, and represents an enormous waste of life that is more or less preventable. If preventable, why not prevented? Taking England and Wales, as a whole, it appears that about 180,000 children are born every year to die before they are one year old. In London, the number may be roughly stated as 20,000. This is sad reading, but the sadness is intensified when the figures are read, and considered, pari passu with the birth rates, which are, unfortunately, slowly but surely declining both throughout England and Wales, and in London. The Lambeth Borough Council's immediate concern is with the Borough of Lambeth. For the two years 1901-2, during which the new Borough has been in existence, 2,509 children under one year of age have died; whilst in the old Parish of Lambeth during the 10 years 1891-1900, 14,039 children under one year of age died, and to this number may be added the 7,921 children (between 1 and 5 years) who died also. Taking an average, it may be stated that the uncorrected infantile mortality rate (i.e., the number of deaths of infants under one year of age per 1,000 births registered) for Lambeth is 151—that for the whole of London for the same period being 100. Subdividing Lambeth into Registration Sub-districts, great variations are notic'd in the different infantile mortality rates, thus:— Inner Districts— Rates per 1000 births (Uncorrected). Waterloo Road 141 (corrected 236) Lambeth Cnurch 1st 237 Lambeth Church 2nd 174 (corrected 185) Outer Districts— Kennington 1st, 138 Kennington 2nd 128 • Brixton 137 Norwood 122 LAMBETH 151 55 It is to be noted that these infantile mortality rates are uncorrected, and as Waterloo Road and Lambeth Church Second Districts contain respectively a Lying-in Hospital and a Workhouse, the rates (as given above) are deceiving, being much too small. If the necessary correction be made, i.e, by excluding from Waterloo Road District all the Lying-in Hospital births, and from Lambeth Church Second District all the Workhouse births, the rates become 236 and 185 per 10 0 births respectively. In other words, the average infantile mortality rate for the Inner Districts is 219 per 1,000 births as compared with 131 per 1,000 births for the Outer Districts. Special attention is, therefore, needed for the former, and it will be seen that Waterloo Road and Lambeth Church First Districts suffer most severely, viz., 80 per cent. more than the Outer Districts, taken as a whole, and 100 per cent more than (say) Norwood District. In other words, the chance of an infant under one year of age who lives in Norwood District celebrating its first birthday is double that of an infant living in Waterloo Road District. Examining more in detail the causes of these deaths in infants under one year of age, it is found that the greatest number is due to irregular and improper feeding. Mothers will not, or cannot, do their duty by their infants in regard to feeding, and the alternative methods adopted are unsuitable, as well as irregular, and, therefore, totally opposed to what nature not only dictates and requires, but must have if infants are to prosper. Maternal ignorance or carelessness, drunkenness, overcrowding, insanitary conditions, female labour, etc., are also factors that assist in making up this high mortality. Epidemic or Zymotic Diarrhoea alone (the so-called "Summer" Diarrhoea of children) carries off yearly in Lambeth an average of 160 infants, the Inner Districts suffering in this respect twice as much as the Outer. Since the appointment of the Female Inspector, special investigations have been made in regard to deaths from Diarrhœa, and the one fact that stands out prominently is that breast feeding is rapidly becoming a thing of the past, and that irregular and improper feeding of infants (the result of too early weming or hand-feeding) causes digestive disorders, and predisposes to death from Diarrhoea, as well as from other infantile diseases. Condensed milk (separated and other), sopped bread or biscuit, other farinaceous foods of different kinds, "ordinary" food, beeftea, meat. alcohol, tea, etc., are found to be given to Children of tender years by parents and others. Even when good cow's milk is used, the insanitary conditions under which such milk is, in many cases, collected and stored prior to use, are such as to ensure at times its contamination with dirt, and (may be) germs, thereby causing digestive troubles and Diarrhœa. 56 The above facts make out a case for interference, and admitting the difficulties surrounding the subject, and allowing for constitutional deficiencies in the parents, etc., I am satisfied that good will accrue from the establishment of a Milk Depot at which to provide, and from which to distribute, suitable sterilised wholesome milk for the feeding of infants, chiefly of the poorer classes, amongst whom ignorance and carelessness most abound, and whose children, unfortunately, are unable to secure Nature's food from Nature's supply. Whatever is done, it must be definitely understood that no artificial method can compare in any way with Nature's supply. In the opinion of some, it cannot be too much emphasised that a Municipality is not justified in underselling, or even entering into the slightest unfair competition with, private traders at the cost of the rates. What I propose is what the Trade has, practically, never offered to do, and there can, consequently, be no injury to any of its members. The establishment of a Milk Depot is most needed for the Inner Districts, and as Waterloo Road District is the greatest sufferer from infantile mortality, and as this particular district contains a Children's Hospital and a Lying-in Hospital, and is closely adjacent to a large General Hospital, I suggest that, for these reasons, such a Milk Depot should be established in that particular district. Further, such Milk Depot should be established under thestrict medical supervision of your Medical Officer of Health, and should also, if possible, be in touch with Benevolent Institutions and Hospitals, where children and infants attend for treatment, or other purposes. Indeed, with the help of one or two such Institutions or Hospitals, the financial, as well as other, success of the undertaking should be assured. I have already received written promises of support from the Royal Hospital for Women and Children, in Waterloo Road; St. Thomas's Hospital, on the Embankment; and the Lying-in Hospital, in York Road; so that the difficulties that had hitherto presented themselves to me, and which had held me back previously from reporting to, and advising, the Council, on the subject of the establishment of a Milk Depot, have disappeared. The experiment may now be tried in Lambeth with every prospect of success; but I suggest that we proceed cautiously, and on a small scale to commence with. A house, or separated part of a house, should be taken in the nieighberhood of the three Hospitals named (e.g., York Road), and fitted up with an approved sterilising apparatus, stock of bottles and wire baskets, apparatuses for washing out, rinsing, and filling the bottles, tank for mixing the milk, weighing machine, etc. Each basket should contain 6, 7, 8 or 9 bottles (according to the ages 57 of the infants), sufficient for one days' food—each bottle being enough for one "feed," or meal, and each bottle to be opened immediately before use, and the milk taken out directly therefrom without being transferred to any other vessel. Adjustable teats or nipples should be used for this purpose, one being applied as required to each bottle, and returned to, and changed at, the Depot each day. In this way, method in feeding, as well as proper and suitable food, will be secured. The price to be charged should be 3d. per day (i.e., for 9 bottles or one basket), or 1s. 6d. per week (i.e., for 63 bottles or seven baskets). The milk to be distributed must be altered in composition so as to be more alike to what nature intends for infants. This can be readily done by mixing fresh and pure cow's milk with cream, milk-sugar and whey, in such proportions as to secure the average composition of human milk, viz:— Water 88.00 Fat 2.90 Solids, not fat: Proteids 3.07 Milk Sugar 5.87 Salts .16 9.10 100.00 The educational influence of such a Municipal Milk Depot must not be lost sight of. The experiment has already been tried successfully in France, and in England at St. Helens, Ashton-under-Lyne, Liverpool, and Battersea, and I prophesy even greater success in Lambeth, if the scheme, as suggested above by me, be carried out, and the help of the Hospitals and Institutions named above prove as important as I anticipate. Joseph Priestley, Medical Officer of Health. May 25th, 1903. 58 Supplementary Report. In the first place, let me repeat that, in the opinion of some persons, a Municipality is not justified in under-selling, or even entering into the slightest unfair competition with, private traders at the expense of the rates. In the case of the proposed Milk Depot, however, there can be no question of unfair competition, or even of competition at all, with the trade. The trade has never attempted to supply this much needed want, at least for the poorer classes. Indeed, for reasons that are not difficult to surmise, the trade has practically stood aloof from this branch of the milk business, so that, unless its members adopt a "dog in the manger" attitude, it cannot oppose consistently. In Lambeth Borough, we are fortunately placed in having the matter of the establishment of a Milk Depot taken up by three large hospitals for the use of the thousands and thousands of infants and young children that come under the hands of physicians and surgeons in the Out-patients Departments. The difficuly hitherto has been that the necessary advice as to the feeding of infants with suitable food has been given to mothers, but the physicians and surgeons giving such advice have been unable to point to any place where such suitable food could be obtained at a cost within the means of the parents, or other persons concerned. . The consequence has been that the preparation of this suitable food has been left in the hands of the parents and others at their own homes, and rather than take the necessary trouble, other foods, totally unfit for the wants of infants, have been substituted with the results already stated in my former report. Taking the total number of deaths under one year of age, it may be stated that two-thirds are due entirely to the fact that infants are fed with unsuitable food, the other third being due to other causes, e.g., overcrowding, insanitary conditions, female labour, constitutional weakness, etc. Even assumming that only half of the total number of deaths of infants is due to irregular and unsuitable feeding, there are still about 600 deaths annually that are preventable, and preventable in the way I have foreshadowed in my former report, viz., by the establishment of a Milk Depot. and the education of mothers in the way of feeding infants. The Milk Depot will have a powerful educative influence, and the cases can be systematically followed up by a Female Sanitary Inspector. It is the poorer children that require the Council's assistance, and it is not proposed to cater for the rich, but merely assist those who cannot, or will not, for various 59 reasons, help themselves. All Sanitary Authorities in whose districts Milk Depots have been established are agreed that much good has accrued in lessening the mortality and morbidity amongst infants—St. Helens, Battersea, and Liverpool furnishing statistics that prove this point. Thus, taking St. Helens (the longest in existence), the infantile mortality rate has been reduced as follows:— 1899 157 to 103. 1900 188 to 102. 1001 175 to 105. i.e., a saving of life equal to 70 per 1,000. All Authorities, further, agree in their endeavours to cater for the infants of the poor, though it is found practically impossible to keep out entirely the middle classes who may be desirous of taking advantage of such an Institution. As to the probable cost of the undertaking, it is clear that no profit must be expected. Profits are not expected from other sanitary undertakings and preventive measures, e.g., the provision of Public Sanitary Conveniences, the removal of house refuse, the methods of sewage disposal, etc. The utmost that a Sanitary Authority can do is to endeavour to limit the expense as far as possible, provided such a limitation does not interfere with the usefulness and efficiency of the undertaking. To save life and to prevent ill-health is the reason for a Sanitary Authority's existence, and the establishment of a Milk Depot will accomplish this at a cost to the ratepayers which is merely nominal, when the good that must accrue to the public is considered. Taking the English Milk Depot that has been longest established, viz., that at St. Helen's, in Lancashire, it will be seen that the cost to the ratepayers has been about £3 per weak, as shown by the following statement of accounts, which I have obtained from the St. Helen's Corporation:— 6o 1899-1900 (8 months). 1900-1901 (12 months). 1901-1902 (12 months). £ s. d. £ s. d. £ s. d. Cost of Installation 225 2 5 123 7 1 32 8 7 Current Expenditure— Wages 63 11 0 115 11 5 119 2 2 Milk 160 11 9 272 9 2 185 5 10 Rent 18 0 0 18 0 0 18 0 0 Sugar 12 1 2 8 6 6 14 2 6 Fuel 4 8 2 9 4 0 9 19 10 Sundries 5 19 0 21 13 5 22 19 6 Renewal of Bottles — 25 18 8 33 6 5 264 11 1 471 3 2 402 16 3 Receipts from sale of Milk 187 0 0 328 9 5 245 16 3 Cost to the Rates 77 11 1 142 13 7 157 0 0 N.B.— The total sum of cost of Installation (extending over 8 years) is £390 18s. 1d., but this sum, though paid out of Revenue, may be really regarded as a capital charge, as it will not occur in future years. Battersea practically tells the same story, as also other places that are trying the experiment of a Milk Depot. Surely an expenditure out of the rates of £150 to £200 per annum ought not to be allowed to influence a Sanitary Authority in hesitating to carry out a scheme which is warranted to have far-reaching effects, and to do incalculable good, practically and educationally. To reduce the present Lambeth average of 150 deaths per 1,000 to, or under, 100, is a praiseworthy object for which the Lambeth Borough 61 Council, as a Sanitary Authority, might strive, and when accomplished, be justly proud of. To save 50 infantile lives per annum, not to mention the incalculable amount of ill-health amongst infants which would be prevented, justifies the expenditure out of the rates of £3 or £4 per week. The fact that the proposed Lambeth Depot is already receiving the approval of three large hospitals, gives every reason for believing that this small expense may be, in the case of Lambeth, reduced. The Lambeth Guardians can, and will it is hoped, also assist and materially help the success of the undertaking. I estimate that the cost of the installation would be the same as at St. Helen's (i.e., under £250 as a first outlay for sterilising plant, stock of bottles, arrangements for washing, rinsing, &c., &c.), and the money would, in my opinion, be well invested, even as an experiment. Joseph Priestley, June 15th, 1903. Medical Officer of Health. 62 Health Congress of the Sanitary Institute, held at Bradford, July 7th-llth, 1903. (Special Report presented to the Council on October 1st, 1903.) To the Mayor, Aldermen and Councillors of the Borough of Lambeth. Gentlemen, As one of your delegates appointed to attend the Congress at Bradford, held from July 7th to July 11th (inclusive), I have to report that, for various reasons, I was, unfortunately, unable to get to Bradford except for the latter half of the Congress. Thus, my attendance was rendered necessary at your Council Meeting held July 9th, more especially in connection with the important resolution that was brought up by the Health Committee, dealing with the proposed establishment within the Borough of Lambeth of a Municipal Milk Depot. For the same reason my co-delegate, Mr. Councillor Thwaite (Vice-Chairman of the Public Health Committee), found himself unable to visit Bradford at all. Further, a meeting of the Guardians, dealing with their final report on the insanitary state of the Norwood Schools and the outbreak of Measles there (in connection with which I had had a large amount of anxiety and trouble) was held on Wednesday, July 8th, and, as I was asked by the Guardians specially to attend, this meeting prevented also my visit to Bradford during the first half of the Congress. Fortunately, I was able to be present at the final meetings of the Congress, and had the pleasure of listening to the resume of the results of the labours of the three Sections, e.g. (1) Sanitary Science and Preventive Medicine; (2) Engineering and Architecture; (3) Physics, Chemistry and Biology; and of the various Conferences, e.g. (a) of Municipal Representatives; (b) of Medical Officers of Health; (c) of Sanitary Inspectors; (d) of Workers in Domestic, Industrial and School Hygiene, etc. This resume may be given as follows, including the resolutions (if any) that were adopted during the Congress:— 1. Appointment of a Minister of Public Health. It was resolved:—"That the Congress is of opinion that the national health would gain by the appointment of a Minister of Public Health, and the separation and enlargement of the Medical 63 Department of the Local Government Board into a Health Ministry; and that an inquiry be made by the Government as to the need for this suggested development and separation of the Medical Department of the Local Government Board in the light of the growth and complexity of Public Health administration." 2. Infantile Mortality, and Municipal Infants' Milk Depots. It was resolved:— "That the high death-rate of infants urgently calls for special inquiry, and the appointment by the Sanitary Institute of a Special Committee on the subject is recommended." This resolution arose out of a discussion on Municipal Infants' Milk Depots. It was, by all present, admitted that the present high infantile mortality (which is, in fact, as high as it was 50 years ago) is due, more or less directly, to improper feeding, and that, consequently, what is wanted, in addition to educating mothers, is the provision by a Municipality for infants and young children of a nutritious, digestible food, free from chemical (or other) preservatives and from pathogenic organisms, and kept free from home contamination. This much-needed want can, and will, be most easily fulfilled by the establishment of Milk Depots, where pure milk (sterilised and humanised), to be distributed in hermetically sealed bottles (each bottle sufficient for one meal and 110 more), can be secured. Such Depots would, in the opinion of the Congress, have an important educative value, but are to be regarded as additional to the other ordinary educational methods in use (distribution of handbills, appointment of female inspectors or women health visitors, etc.). Bradford has recently opened a Municipal Milk Depot, which I visited and inspected. 8. Notification of Consumption, and the provision of Sanatoria It was resolved:—"That the time Las arrived for systematic statutory notification of consumption," i.e., for compulsory (in place of voluntary) notification. The educative value of sanatoria, as distinct from their value as curative institutions, was much emphasised, and the Brighton Corporation, for instance, is doing much useful work in that connection by receiving consumptive patients for a month's sojourn into a separated portion of the Corporation's Isolation Hospital, which is suitably situated on the Downs. 4. Epidemic Grant for Schools, Section 101* of th$ Code. It was resolved "That it is desirable to recognise the Code regulations for the payment of grants (Section 101*) in cases where the absence of scholars is due to epidemic disease, as this regulation has been a sanitary influence of great practical use in the past." r 64 5. Tramps and Smallpox. It was resolved:—"That, in view of the recurrent outbreaks of Smallpox, largely contributed to by a certain class of society, the Government be requested to take into consideration the necessity for legislation to deal more effectively with those resorting to common lodging-houses and workhouse tramp-wards as a constant and dangerous element in the propagation and dissemination of Smallpox." 6. Preservatives in rood. It was resolved:—"That, whenever preservatives are added to food, their presence, nature and maximum amount should be indicated on the label, or otherwise declared." 7. Efficiency of Disinfectants. It was resolved:—"That a Committee be appointed to enquire into the desirability of establishing a standard bacteriological method for determining the efficiency of disinfectants, and to take such steps as may be necessary for ensuring the legal control of disinfectants" —an important resolution, when it is remembered that thousands of different disinfectants are on the market, and that the large majority of these are worthless, if not actually dangerous, owing to the false security that their use gives rise to. 8. Control of House Drainage. The disadvantages arising from dual control in regard to house drainage were brought forward, and the consequent necessity for all drains of new buildings being laid in under the supervision of the same set of officers (viz., Sanitary Inspectors), as will have to supervise, and deal with them at a later date, i.e., when the buildings are occupied. One department is alone responsible, and efficient administration thereby obtained. [This is the experience of the late Vestry and the present Council of Lambeth since November, 1896, when the drainage of new buildings was transferred to the Sanitary Inspectors, so that the whole of the drainage works connected with new and old buildings have been, since that date, under their supervision; and unnecessary expenses to owners, and friction between two separate departments have been thus avoided.] 9. Combined Drainage. It was resolved:—"That the Government be approached with a view to obtaining an extended definition of the term 'drain' as provided in Section 42 of the West Ham Corporation Act, 1898, which reads as follows:— 65 42. In and for the purposes of Section 41 of the Act of 1893 the word " drain " shall be deemed to include any sewer or drain, whether constructed before or after the passing of this Act, with which two or more houses or premises (whether belonging to the same or different owners) are, at the date of the passing of this Act, or may at any time thereafter be connected, or which is used or capable of being or intended to be used for the conveyance of the drainage of such houses or buildings directly, or by means of any other sewer or drain to any public sewer situate under a street repairable by the inhabitants at large. but shall not include any sewer which has been constructed to the satisfaction of the Corporation under Section 152 of the Public Health Act, 1875, or any sewer which has been constructed by the Corporation for the effectual drainage of the Borough. 10. Insect-borne Parasites. Major Donald Ross gave a popular lecture on the subject of insects, and the parts they play, more especially in the spread of Malaria. Destroy the deadly mosquito, and Malaria will disappear —a prophecy that is to-day being practically realised at Ismailia, on the Suez Canal, where the methods suggested by Major Ross are being put to-day to the practical test. The Health Exhibition. A most important part of the Congress is the Exhibition of Sanitary Appliances, which is held in connection therewith. This Exhibition I was able to examine carefully, spending several hours there, the time being well spent. Bradford can hardly be congratulated upon its Health Exhibition, as the area devoted to it was restricted, with stalls crowded together, so that many of the exhibits unless specially looked for, were missed. The important exhibits may be tabulated as follows:— 1. Destructors. The Horsfall Destructor Co., of Leeds and London, showed a portable refuse destructor, for use in small and scattered districts, consisting of a combined furnace and boiler on wheels. For this exhibit a silver medal was awarded. This Firm showed two sample bricks made from destructor clinker and lime upon the patented process of Dr. Schulthess, of Zurich, consisting of finely ground clinker and perfectly slaked lime, pressed and moulded and steam dried, maturing in 48 hours instead of two to three months 66 in the ordinary way. Bradford is provided with three separateDestructor Installations errected by the Horsfall Destructor Co., Ltd. 2. Cast-iron Drain Pipes and Fittings. Messrs. Burn Bros., of Glasgow and London, obtained a silver medal for their exhibit of iron drains and fittings (glass enamelled on the insides). Iron drains appear to be coming more into use in connection with drainage work, and are found especially useful underneath houses or buildings, in soils that "give," etc. Square gully plugs were also a feature of the exhibit of Messrs. Burn Brothers. 3. Milk Sterilisation. Messrs. Pale's & Barnes' Milk Purifier was exhibited by Messrs. Defrics, of London. This is a new method, consisting of a single run of coils, through which the milk is passed and (a) heated and afterwards (b) cooled. In this way, the milk is raised to a temperature of 100 deg. C. (nearly) without any alteration in its flavour, or digestibility, due to the fact that the milk is never exposed to the air until after sterilisation is completed, i.e., until after the milk in the coils has been both heated and cooled—by means of steam and cold water applied respectively to the outsides of such coils. The insides of the coils can be easily cleansed daily by running water (or water and Soda) through them, the water being heated as required by steam applied to the outsides of the coils. This steriliser is a great improvement, and will be considered more at length, should the establishment of the Lambeth Depot be under consideration by the Health Committee. The exhibit was awarded a bronze medal. 4. Saturated Steam Disinfedors. A new apparatus was shewn by Messrs. Defries for the giving of efficient control over steam disinfectors by getting rid of all residual air out of the chamber before passing in the steam. The apparatus is simple, and can be readily attached to existing destructors at a small cost. 5. Covered Dust-Vans. The Champion dust-van, for which the London County Council awarded a premium of £25 as being the best vehicle designed for the collection and removal of dust and house refuse, was much in evidence at the stall of Messrs. Glover & Sons, Limited, of Warwick. The van is fitted with patent wind-guards and sliding 67 covers, and 30 vans were stated to have been ordered by the Westminster City Council, the vans being also fitted with a rack and pinion-tipping gear, tipping at any angle. The same firm showed the Warwick Water Sprinkler, regulating width of spread and volumn of water distributed by means of foot leavers, thus leaving the driver's hand free for driving. A silver medal was awarded to this Firm for their van. 6. Treatment 'of Sewage. Sewage purification works, patent automatic sprinklers, septic tanks, bacteria beds, etc., came in for much attention by the different well-known firms, e.g., Mather & Platt, of Manchester; Septic Tank Co. of Exeter and London; etc. 7. Sanitary Fittings. Messrs. Doulton, Shank, Twyford, Cliff, Claughton and Puckett, had their usual exhibits of W.C.'s, baths, lavatories, etc., but nothing new was to be seen, finality being apparently reached in this class of goods. 700 delegates (representing 335 Local Authorities) attended the Congress. I thank the Council for sending me as its delegate to Bradford. I am, Mr. Mayor, Yours faithfully, Joseph Priestley, September, 1903. Medical Officer of Health. 68 Hand Sorting of Refuse. (Special Report presented to the Council on October 15th, 1903). The history of the action taken by the Lambeth Sanitary Authority with reference to the question of the occupation of refuse sorting by hand in connection with several Yards and Depots in Lambeth may be tabulated as follow:— February 1st, 1900.—Medical Officer was instructed by the Vestry, on the recommendation of the Sanitary Committee, to report on the employment of women for sorting the rubbish at Phoenix and other Wharves, situated in Lambeth.—Minutes, 1900, page 104. February 15th, 1900.—Medical Officer's Report was presented to, and adopted by, the Vestry, and a copy of the Report was ordered to be sent to the City Corporation and to the Clerkenwell Vestry, suggesting that the practice of hand sorting of refuse should be discontinued.—Minutes, 1900, pages 177-8. March 29th, 1900.—Letter in reply from the Vestry Clerk of the Clerkenwell Vestry, stating that "the Vestry are unable to find a single instance in which the health of the women sifters has been affected by the process of dust sifting, and that in view of the fact that in November next St Luke's will be amalgamated with Clerkenwell, when other arrangements could possibly be made, they are not prepared to make any alteration in their system at present."—Minutes, 1900, page 477. October 11th, 1900.—Report was presented to the Vestry, stating that the Clerkenwell Vestry had, on reconsideration of the matter, discontinued the sorting of dust by women at their Phoenix Wharf. Report of Medical Officer, presented to the Vestry on February 15th, 1900. The refuse, consisting of household dust, ashes, and cinders from fires, scrape of waste food, and other refuse matters, is sorted and separated into—(1) breeze, consisting of cinders and small particles 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 69 purpose, though at Lett's Wharf the paper and rags are also first carefully sorted 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, who are to be seen standing with the refuse up to their waists, if not higher; 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 surronding neighbourhoods. It is somewhat difficult to understand why the while 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 his recognised by all sanitarians to be a most noxious and d grading business; and as such business is carried out in the Parish of Lambeth, I feel it my duty to report strongly in connection with the matter. Clerkenwell is unfortunate in following the City's bad example. 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 from which surround them, and are being breathed and re-breathed continuously; and in my opinion representations should be made to the City Corporation and the Clerkenwell Vestry with a view to the discontinuance of the sorting forthwith. Joseph Priestley, Medical Officer of Health. October 5th, 1903. 70 supplementary report. (Special Report presented to the General Purposes Committee). "The refuse sorted consists of household dust, ashes and cinders from fires, scraps of waste food, and other offensive matters, and this refuse is sorted and separated into (1) breeze, consisting of cinders and small particles of coal; (2) hard core, consisting of bottles, tins, crockery, metal pots and pans, etc.; and (3) soft core, consisting of animal and vegetable matters and texile 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. The whole process is an exceedingly offensive one, and most degrading to the workpeople employed in it, especially women and girls, who are to be seen standing with the refuse up to their waists, if not higher; 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 neighbourhood. This business of hand sorting is recognised by all Sanitarians to be a most noxious and degarding business, though (here is always a difficulty in proving actual injury to health from such an offensive occupation. There can be no doubt, however, 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 from which surround them, and are being breathed and re-breathed continuously." I have already reported to the same effect, with the result that action was taken against the City Corporation and the Clerkenwell Council with reference to the hand sorting of refuse that was being, at that time, carried on in connection with their Wharves, situated in Lambeth, and, as the result of such action, hand sorting of refuse at these particular Wharves was discontinued. The Lambeth Sanitary Authority having taken this action, I venture to ask the General Purposes Committee to pause before opposing the proposed legislation by the London County Council during the Session of 1904, with a view to preventing the hand sorting of dust in future in London. As Medical Officer of Health, I have no hesitation in certifying that such a trade process is dangerous to the health of those employed therein, though it is difficult to prove actual injury to their health; more especially on account of the persons employed being what are known in statistics as "picked lives." Joseph Priestley. September 23rd, 1903. 71 Schools, Upper Kennington Lane. (Special Report presented to the Public Health Committee on October 19th, 1903.) I have to report that I have made an inspection and examination of the sanitary arrangements in connection with the Licensed Victuallers Schools, Upper Kennington Lane. The premises are old, and the planning of the sanitary arrangements correspondingly, old-fashioned, and not up to modern sanitary ideas. From time to time the sanitary arrangements have been altered and attempts made to modernise them, with the result that, whilst improvements have been effected, the schools, as a whole, are not in a satisfactory sanitary condition such as is expected to-day of schools wherein a large number of boys and girls are not only educated, but also boarded. As a result of the inspection, the following defrcts have been found to exist:— A. Boys' Side:— (1) Large dormitory—Foul and offensive urinal, badly supplied with water for flushing, and totally unnecessary in the position in which it is placed, causing offensive smells to ventilate continuously into the dormitory, which is, judging by the number of beds, overcrowded. (2) New dormitory—'w.c. (provided with foul wash-out pan closet) directly approached from the dormitory, and inefficiently and insufficiently ventilated. (3) Lavatory—A room provided with lavatory basins, properly undertrapped, and connected with waste pipes, apparently satisfactory from a plumbing point of view (all such plumbing work being exposed to sight and readily accessible), but used in a most extraordinary double manner, viz., as a bath-room once a week for the boys, in addition to its use as a lavatory during the whole week. Hot water is admitted into the lower part of the room, which is, for that purpose, watertight, and in this hot water a large number of boys wash and bathe. The waste water, mixed with dirt and scales from the bodies of the boys, together with the soap that has been used in washing, &c., is allowed to run away by means of a waste pipe situated at the lower end of the room, with the result that there is a copious deposit of offensive matters left on the outsides of all the different pipes and other fittings connected with the lavatary basins, and which are, as already stated, 72 exposed. This deposit can be with ease scraped off the outsides of the pipes, and is found, on examination, to consist of skin scale3, dirt, soap, &c. This deposit is allowed to remain until the next bathing day (an interval of a week), during which time the room reverts to its ordinary use as a lavatory, used frequently daily by the boys—a condition of things more extraordinary and more insanitary it would be difficult to conceive of, not to mention find. Further, the waste from a small bath is not properly disconnected from the drain. B. Girls' Side:— (1) Dormitories—Provided with urinettes inefficiently and insufficiently ventilated, thereby allowing offensive smells to ventilate directly into the dormitories, which are, judging by the number of beds, overcrowded. (2) W.C. on top floor not properly ventilated. (3) W.C.'s on ground floor-Manhole cover not properly sealed. (4) Lavatories—Insufficiently lighted and ventilated. (5) Bath room—Linings of baths are loose, allowing of the accumulating of offensive matters. C. Officers' and Visitors' Rooms:— (1) Visitors' (male) Lavatory—Soil pipe defective and not properly ventilated, and the wash-out pan of w.c. cracked. (2) Visitors' (female) Lavatory — Sink wastes not trapped. (3) Masters' Lavatory—Waste pipe from wash basin not properly disconnected from drain. D. Swimming Bath (erected 1890):— Soil pipe rot properly ventilated; urinal waste both defective and foul; w.c. and urinal not properly ventilated. E. Basement:— Subject to flooding, and a manhole cover (on drain) not properly sealed. F. Ashpit:— Too much enclosed, and in a dark position, preventing the dustmen from satisfactorily cleaning up after each removal of dust. 73 G. Defective Sewer (belonging to the Council):— Running alongside the School buildings. [This sewer is being relaid.] The drains have been tested with chemical, but no result obtained inside the premises. I visited the Schools with Dr. Fletcher Little, the Consulting Medical Officer to the Schools, on October 6th. The sanitary arrangements require rearranging and bringing up to modern requirements, whilst the (what can only be described as a mo;t extraordinary) arrangement of combined lavatory and bathrooms must be stopped forthwith. All suspicion of overcrowding must be removed. Joseph Priestley. October 19th, 1903. 74 L.C.C. Bye-Laws made under Sections 16 and 39 of the Public Health (London) Act, 1891. (Special Report presented to the Council on January 7th, 1904.) I have carefully considered the existing Bye-laws of the London County Council, made under Sections 16 and 39 of the Public Health (London) Act, 1891, and, in connection therewith, suggest, as the result of practical experience in the daily carrying out of such Bye-laws, the following amendments:— (a) Bye-laws under Section 16 (2). The hours stated in Bye-law 1 might be altered so as to read as follows:— "Between 12 (midnight) and 8 a.m. all the year round, except that this Bye-law shall not apply to any person removing, or carrying, or causing to be removed or carried, such fæcal, or offensive, or noxious matter, or liquid, deposited in an impervious air-tight receptacle, or receptacles, and removed or carried in the same inpervious air-tight receptacle, or receptacles, placed in a suitably closed van or vans—such van or vans, and such receptacle or receptacles, being cleansed periodically, as required." It is clear that, where impervious, or air-tight, receptacles are used for the removal of offensive matters, and provided such receptacles are moved with their lids on, and in suitably closed vans, there need be no restriction as to the time of day when such offensive matters are to be removed. At present such offensive matters can be removed up to as late as 12 (noon), during the months of November, December, January and February, and even up to 10 a.m. during the other months of the year (including Summer). Under existing conditions, I am of opinion that offensive matters should not be allowed to be removed after 8 a.m. Indeed, by adopting 8 a.m. as the latest hour, the great nuisance connected with the removal of fish (and other) offal in a tank van just at the time when people are starting for business will be prevented. The present mode of removing in tank vans that are allowed to parade the streets up to 10 a.m. and 12 (noon) is, though technically within the four corners of the existing Bye-laws, undoubtedly a source of great nuisance, and any alteration in the 75 existing Bye-laws, which will at any rate limit the use of such tank vans to the early hours of the morning, will be a distinct sanitary gain. Manure placed direct into a wheeled wagon or van, or other receptacle and removed therein without being in any way disturbed, causes little, if any, nuisance; and an addition to the Bye-laws might, with advantage be made so as to allow of manure being deposited, and afterwards removed or carried, in such a manner. Removal of House Re/use. In connection with the removal of house refuse, Bye-law 8, which gives power to a Sanitary Authority to arrange for the daily removal of such house refuse in their districts, if they decide so to do, might be made compulsory in the case of blocks of workingclass dwellings, in connection with which it is clear that the house refuse should not be allowed to accumulate for seven days in each small tenement, as is the practice at present, the overflowing dustbins being often kept in living rooms. With regard to the removal of house refuse throughout a sanitary district, Bye-law 9 might be altered so as to read "twice in every week" instead of "once in even week." House refuse contains quantities of decaying (animal and vegetable) matters, which give rise, more or less, to a nuisance, and it is found, in practice, that the removal of such refuse throughout a district once a week is not sufficient for the abating of such a nuisance. Further, a new Bye-law is, in my opinion, needed, preventing the obstruction of dustmen by occupiers. To meet this case, a new Bye-law to the following effect might be adopted:— "The occupier of any premises shall give free access to the Sanitary Authority, or to other person, or persons, acting on behalf of such Sanitary Authority, for the purpose of the removal of house refuse." (b) Bye-laws under Section 39 (1). In connection with Bye-law 1, the words "equally efficient" require to be inserted between the words "other" and "materials," in line 15, in connection with the solid wall or partition of brick that is required where a water-closet abuts on a room intended for hnman habitation, or used for the preparation, manufacture or storage of food for man. As the Bye-law is at present, lath and plaster partitions are sometimes put up, and such partitions do not effect the object for which the Bye-law was evidently intended, 76 viz., to prevent offensive smell passing from the water-closet into a living-room or workshop. Further, where a lobby, or corridor, leading to a water-closet, is constructed, such lobby, or corridor, should be required to be ventilated to the outside air and efficiently lighted. With regard to Bye-law 2, "air-bricks" should be required as additional means of ventilation in water-closets, and not "at least one air-brick," as stated in the existing Bye-law. In connection with this Bye-law, too, an addendum might be added to the following effect:— "Provided always that where this Bye-law cannot be carried out in practice, a window or skylight in the roof of a water-closet, or earth-closet, situated on the ground or top floor of a building—such window, or skylight, in the roof being of the required dimensions, and opening directly into the external air—shall be deemed to comply with the requirements cf this, and the preceding, Bye-law, with regard to the construction of a window in one of the external walls." The difficulties in connection with complying with the existing Bye-law in this respect are well known, and, by allowing a window, or skylight, in the roof, as suggested, matters would, from a construction point of view, be simplified, and the sanitary conditions of water-closets, not in any way interfered with. With regard to Bye-law 3, the cistern that is required for flushing a water-closet should be of an approved pattern, so as to prevent the use, as at present, of exceedingly flimsy and unsatisfactory ones, and the down pipe from such flushing cistern in connection with the water-closet might, with advantage, be made of a minimum size of 1½ins., instead of, as at present, 1¼ins.; and, further, the flushing cittern might be placed at a height of not less than 4 feet above the level of the flushing rim of the pan or basin of the water-closet. In this way the best flushing power would be obtained from the small quantity (2 gallons) of water at present allowed by the Water Companies. In connection with this same Bye-law, the use of trough closets, which sooner or later become a nuisance, should be prohibited. A new Bye-law is needed between existing Bye-laws 17 and 18, to prevent the construction hereafter of dust-shoots in connection with new buildings—existing shoots for dust having proved to be sources of nuisance (more or less). With regard to Bye-laws 24 and 25, dealing with receptacles for dung, an addendum is needed to meet the case of a wagon or 77 van, fitted on wheels, being used in place of the prescribed receptacle, or metal cage. Where there is a large accumlation of manure (e.g., Mewses, Bus-yards, etc.), it is found (as already explained) that a most efficient way of minimising, if not preventing, all nuisance in connection with the removal of manure is to have such manure placed directly from the stables into a wagon or van, or other receptacle, fitted on wheels. Such a wheeled receptacle is to be removed without its contents being disturbed, and another empty one put its place. The addendum that I suggest is as follows:— "And provided that a person who shall use in place of such receptacle, or metal cage, a wagon, or van, fitted on wheels, and removed (together with the contents) periodically as required, without in any way disturbing such contents, shall be deemed to have complied with the requirements of this Bye-law—the provision of such wheeled receptacle being compulsory in connection with buildings or premis's wherein, or whereon, more than one cubic yard of litter is made, or accumulates, within any consecutive twenty-four hours." In conclusion, it is found that, in certain districts, the Bye-laws have not been strictly enforced, or have been waived or dispensed with (wholly or in part), or, if enforced have been rendered ineffectual by subsequent structural alterations or additions to existing buildings, etc., so that an additional Bye-law appeal's to be necessary to safeguard such conditions of things happening in the future. The London School Board may be cited as an offender in this respect. I suggest the following:— "None of the foregoing Bye-laws shall be altered, nor any prescribed provisions and conditions mentioned therein waived or dispensed with, wholly or in part, or in any way rendered ineffectual by any Sanitary or other Authority, or other person or persons, without the previous consent of the London County Council and of the Local Government Board." To sum up, I suggest the following alterations and additions, as explained in the report:— (a) Bye-laws under Section 16 (2). 1. Suggested alteration to existing Bye-1 aw 1. Between 12 (midnight) and 8 a.m., all the year round, except that this Bye-law shall not apply to any person removing or carrying, or causing to be removed or carried, such fœcal or offensive or noxious matter or liquid, deposited in an impervious air-tight receptacle or receptacles, and 78 removed or carried in the same impervious air-tight receptacle or receptacles, placed in a suitably closed van or vans— such van or vans, and such receptacle or receptacles, being cleansed periodically as required. 2. Suggested addendum to existing Bye-taw 1. and shall not apply to any person removing or carrying manure, consisting of horse dung mixed with straw or other litter, in a waggon or van or other receptacle (fitted on wheels), into which such manure has been placed direct, and so removed or carried therein as not to be in any way disturbed. 3. Sugyested alteration to existing Bye-law 9. The word "once" to be altered to " twice." 4. Suggested new Bye-law to he read between existing Bye-laws and 10. The occupier of any premises shall give free access to the Sanitary Authority, or to other person, or persons, acting on behalf of such Sanitary Authority, for the purpose of the removal of house refuse. (b) Bye-laws under Section 39 (2). 5. Suggested alteration to existing Bye-law 1. The insertion of the words "equally efficient" between " other " and "materials," in line 15. G. Suggested alteration to existing Bye-law 2. "air bricks" to be read for "at least one air brick." 7. Suggested addendum to existing Bye-law 2. Provided always that where this Bye-law cannot be carried out in practice, a window or skylight in the roof of a watercloset, or earth-closet, situated on the ground or top floor of a building—such window, or???skylight, in the roof being of the required dimensions, and opening directly into the external air—shall be deemed to comply with the requirements of this, and the preceding, Bye-law, with regard to the construction of a window in one of the external walls. 8. Suggested alteratim to existing Bye-law 3. The words "an approved" before the word "cistern" in line 2: and the word "quarter" to be altered to " half" in line 15 79 9. Suggested addendum to existing Bye-law 3. and that such flushing cistern shall not be less than 4 feet above the level of the flushing rim of the pan, basin or other suitable receptacle. 10. Suggested new Bye-law to form part of existing Bye-law 3. No trough closets to be constructed hereafter. 11. Suggested new Bye-law to be inserted between existing Bye-laws 17 and 18. No person, or persons, shall, after the date of the confirmation of these Bye-laws, construct, or cause to be constructed, any dust-shoot, or dust-shoots, in connection with any building or buildings. 12. Suggested addendum to existing Bye-law 25. and provided that a person wno shall use in place of such receptacle, or metal cage, a wagon, or van, fitted on wheels, and removed (together with the contents) periodically as required, without in any way disturbing such contents, shall be deemed to have complied with the requirements of this Bye-law—the provision of such wheeled receptacle being compulsory in connection with buildings or premises wherein, or whereon, more than one cubic yard of litter is made, or accumulates, within any consecutive twenty-four hours. 13. Suggested new Bye-law to be placed at the end of the existing Bye-laws. None of the foregoing Bye-laws shall be altered, nor any prescribed provisions and conditions mentioned therein waived, or dispensed with, wholly or in part, or in any way rendered ineffectual, by any Sanitary Authority, or other person or persons, without the previous consent of the London County Council and of the Local Government Board. Joseph Friestley. December, 1903. s 80 1 9 O 3. 'CASES OF ILLNESS NOTIFIED FROM BOARD SCHOOLS, &c., TO MEDICAL OFFICER OF HEALTH. Schools. Measles. Chicken-pox. whooping Cough. Scarlet Fever. Ringworm. Mumps. Diphtheria. Typhoid. Eczema. Blight. Itch. Erysipelas. Ophthalmia. Influenza. Total. Addington Street 4 1 ... ... ... ... ... ... ... ... ... ... ... ... 5 Beresford Street 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Church Street 68 11 2 3 3 19 ... ... 1 ... 1 ... ... ... 108 Cormont Road 24 19 44 3 11 ... 1 ... ... ... ... ... ... 102 Dulwich Hamlet 1 2 ... ... 1 ... 1 ... ... ... ... ... ... ... 5 Effra Parade 121 32 10 2 19 5 ... 1 ... ... ... ... ... ... 190 Faunce Street 6 ... ... ... ... 1 ... ... ... ... ... ... ... ... 7 Gipsy Road 131 24 50 6 29 6 1 ... 6 ... 2 ... ... ... 255 Hackford Road 5 29 2 ... ... ... ... ... ... ... ... ... ... ... 36 Hazelrigge Road 42 3 ... 1 ... ... ... ... ... ... ... ... ... ... 46 Hitherfield Road ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Hatfield Street 69 7 ... ... 1 8 ... ... ... 2 ... ... ... ... 87 Jessop Road 21 6 ... 3 ... ... ... ... ... ... ... ... ... ... 30 Johanna Street 30 4 ... 8 ... ... ... ... ... ... .. ... ... ... 42 Kennington Oval ... 13 4 1 1 3 1 ... ... ... ... ... ... ... 23 Kenningtn Road 40 4 ... ... ... 2 1 ... ... ... ... ... ... ... 47 Larkhall Lane 30 1 1 ... ... ... ... ... ... ... ... ... ... ... 32 Lyham Road 79 17 33 ... 3 7 ... ... ... ... ... ... ... ... 139 Lollard Street 19 1 1 ... 1 2 ... ... ... 2 ... ... ... ... 26 Marlboro' Street 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 New Road 32 14 11 ... ... 1 ... ... ... ... ... ... ... 58 New Park Road 14 5 ... ... ... ... ... ... ... ... ... ... ... ... 19 Priory Grove 53 26 19 1 22 18 ... ... ... 1 1 ... ... ... 141 Rosendale Road 15 34 21 3 4 1 ... ... ... ... ... ... ... ... 78 St. Peter's, Vauxhall 29 2 ... ... ... ... ... ... ... 1 ... 1 ... ... 33 St. Mary's, Newington ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Sunnyhill 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Sussex Road 24 16 20 ... 3 4 2 2 2 ... ... ... ... ... 73 Salters Hill 75 20 45 ... 4 ... 1 ... ... ... ... ... ... ... 145 South Lambeth Road 81 13 1 ... ... 4 ... ... ... ... ... ... ... ... 99 Stockwell Road 82 74 1 ... 1 4 2 ... ... ... ... ... ... ... 164 Santley Street 162 9 60 3 8 54 ... ... ... ... 1 ... ... 2 294 Springfield 193 3 6 1 ... 4 ... ... ... ... ... 1 1 ... 209 Upper Kennington Lane 55 30 34 1 1 16 ... ... ... ... ... ... ... ... 137 Vauxhall Street 20 9 22 ... 1 5 ... ... ... ... ... ... ... ... 57 Westminster Bridge Road 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Waterloo Road 17 5 ... ... ... ... ... ... ... ... ... ... 1 ... 23 Woodland Road 33 ... 5 1 1 ... ... ... ... ... ... ... ... ... 40 Walnut Tree Walk 39 ... ... ... ... ... ... ... 1 ... ... ... ... ... 39 Totals 1623 436 392 37 109 163 11 3 9 6 5 2 2 2 2800 N.B.—All the above were not genuine eases, so that the numbers do not tally with those given in other parts of the Report. INDEX. Index of Tables. PAGE. A The number of Births and the Birth-Rates in each Registration Sub-District of Lambeth Borough during 1903 (arranged quarterly) 11 B The estimated Populations, numbers of Inhabited Houses, Marriages, Births, and corrected Deaths for the year 1903 in Lambeth Borough, and for the ten years 1891-1900 in Lambeth Parish 12 c The number of persons per House, the Marriage, Birth-, and Death-Rates, and the proportion cf deaths in Publio Institutions per 1,000 persons, for the year 1903 in Lambeth Borough, and for the ten years 1891 -1900 in Lambeth Parish 13 D The number of Births and Deaths with Birth- and Rates in each of the Registration Sub-Districts of the Borough during 1903. [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 re-distributing persons who die in Public Institutions into the Districts from which they have been removed during illness.] 22—23 E Death-Rites, Zymotic Death-Rates and Zymotio lncidence-Rates in the new Wards of Lambeth Borough during 1903 24 F Mortalities in Lambeth¦ Borough during 1903 at different age-periods compared with (1) those for London, 1903 and (2) the averages for Lodon for the years 1881-9) 25 G The uncorrected mortality, Male and Female, in the different Districts, and a comparison of the number of Deaths in each Quarter within Lambeth Borough during the year 1903 26 (ii.) PAGE. H The uncorrected mortality (i.e., including that of Stringers) at different ages in each District of the Lambeth Borough during 1903 27 I The uncorrected Deaths (i.e., Parishioners and Strangers) at various age-periods in eaoh Quartar of the year 1903 28 J The Infantile mortalities in the Registrar-General's old thirty-three large t)WD3 of England and Wales (including London), and in Lambeth Borough during 1903 31 K The number of Certificates for the notifiable Zymotic Diseases received since the introduction of the Notification Act (i.e., for Lambeth Parish in the ten years 1891-1900, and for the Lambeth Borough in the year 1903) 38 L The number of infected houses, with percentages of (1) General Defects. and (2) Defective Drains, in Lambath Borough daring the year 1903, and in Lambeth Parish daring the ten years 1891-1900 39—40 M Zymotic seasonal variations in the different Registration Sub-Districts of Lambeth Borough during 190,!, with the Zymotic Death-Rate per 1000 inhabitants 41 N Total cases notified under the Notification Clauses of the Public Health (London) Act, in Lambeth Borough during 1903 (arranged quarttriy) 42 O Deaths from Zymotic Diseases (strangers deducted), 1903 43 P The number of deaths from the principal Zymotic Diseases within Lambeth Parish in the ten years, 1891-1900, and within the Lambeth Borough in the year 1903 44—45 Q Vaccination Returns (Lambeth) 1902 58 R Vaccination Returns (Lambeth) for the first half year 1903 59 S The Diarrhoea Mortality in Lambeth Borugh in each month during the year 1903 86 (iii.) page. T The Classification of Causes of Deaths in Lambeth Borough during 1903 as compared with 1902 94—95 (a) Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected) 94 (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" 95 U Table of Uncorrected Deaths during the years 1902 and 1903, classified according to Diseases, in the Borough of Lambeth and in London 96 V Table of Deaths during the year 1903 in the Lambeth Borough, classified according to Diseases, Ages, and Localities. (Local Government Board old Table A) 98—101 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 1903, in the Metropolitan Borough of Lambeth, classified according to Diseases and Localities. (Local Government Board old Table B) 102—103 Four new Tables of the Local Government Board, giving the— (i.) Vital Statistics of Lambeth Borough during 1903, and of Lambeth Parish during the 10 years 1891-1900 Appendix 2 (ii.) Vital Statistics of Registration Sub-districts of the Borough of Lambeth in 1903, and of the Parish of Lambeth in the ten years 18911900 Appendix 3—4 (iii.) Cases of Infectious Disease notified within the Borough of Lambeth during the year 1903 A ppendix 5 (iv.) Causes of, and ages at, death during 1903, within the Borough of Lambeth Appendix 6—7 Mortality Tables showing Deaths (corrected) from all causes in Lambeth Borough during 1903 sub-divided— (a) As to Registration Sub-Districts Appendix 8—15 (b) As to different Age-periods Appendix 16—23 Offences (with amounts of penalties and costs) Food and Drugs Acts Appendix 26—32 Public Health Acts Appendix 33—38 Cases of illness (infectious) notified from Board Schools to the Medical Officer of Health Appendix 80 (iv.) General Index. Page. Abatement of Nuisances 104—108 Accidental Deaths 93, 182, 184 Adulteration of Food and Drugs 129—140 „ „ Butter Bill 139—140 Age-Distribution of Diarrhœa 84 „ „ „ Diphtheria 73 „ „ „ Soarlet Fever 61 „ „ „ Smallpox 48 „ „ „ Typhoid Fever 77 ,, „ „ Deaths 21, 25, 27 „ „ „ Population (Lambeth) 7 Air Temperature and Diarrhoea 83 Alcoholism, Deaths from 92 Ambulance Service 129 Analysis of Food and Drugs 129—140 Antitoxin, Gratuitous Distribution of 74, 75, 189 Apoplexy, Deaths from 92 Area (Lambeth) 5, 97 Atelectasis 92 Bacteriological Laboratory 185—189 Bakehouses 165—171 Overground 165—166 Last of underground 170—171 „ Underground 4, 168—171 „ ,, Requirements 4, 169 Bedding, etc., Disinfected 123, 127—128 „ Destroyed 124,127—128 Births and Birth Rates 11—14, 22, 97, 102—103 Birth Rates in Sub-Districts 11, 22 Bodies received in Mortuaries 181—183 Bronchitis, Deaths from 92 Burns and Scalds, Deaths from 93 Butter, Sale of (Regulations) 139 Bye-laws (plans) 111 „ (offensive matters) 146—147, Appendix 74—79 Cancer, Deaths from 92 (v.) page. Cautions (Food and Drugs) 130, 134 Censal Population (LambeLh) 102—103 Censal Population (London) 9 Cholera 71 Circulatory Diseases, Deaths of 92 Clerical Work 192—193 Closure of Schools (Measles) 65—69 „ „ (Diphtheria) 74 Chickenpox 71 „ Notification of 38, 71 Common Lodging Houses I54 Combined Drainage 109—110 Complaints 107—108, 192 Control of Drainage (supervision) 108—109 Conscientious Objectors 57—59 Congenital Malformations 92 Constitutional Diseases 92 Congress, Bradford Appendix 62-67 Consumption (See Tuberculosis and Phthisis), Continued Fever 79—80 Convictions under Public Health Acts Appendix 33—38 „ „ Food and Drugs Act Appendix 26—32 Convulsions, Deaths from 92 Coroners' Courts 178—184 Costs, Food and Drugs Appendix 26—32 „ Public Health Acts Appendix 33—38 Courts, paving of 114 Cowhouses 171—173 „ List of 171—172 Critical Temperature (Earth) and Diarrhœa 83 Croup (See Membranous Croup). Customs and Inland Revenue Acts 137—158 Dairies (See Milkshops). Deaths and Death-rates 15—103 „ Inner and Outer Wards 18—20 „ (arranged quarterly) 26,28 Death-rates and Birth-rates—Inter-relationship 14—15 Deaths, Corrected 12, 16, 21, 97 „ Uncorrected 16, 26—28 „ in Public Institution 12—13, 16—18. (vi.) PAGE. Deaths, Zymotic 12, 32—46, 97 „ Under 1 year 12, 25, 93, 95, 97 „ Under 5 years 12, 25, 27 „ from violentce 93 „ from ill-defined and non-speoified causes 93 Delirium Tremens, Deaths from 92 Density, per acre (Lambeth) 22, 97 Dentition, Diseases of 92 Depositing (refuse) 148—149 Depots (Refuse and Manure) 145—149 Destructors 4, 150—154 Developmental Diseases 92 Diagnosis (Bacteriogical) 185—189 Diarrhœa 83—86 „ Age Dtstribution of 84 „ Monthly Mortality 86 „ Inner and Outer Wards 85 „ and Infantile Mortality 29,85 „ Registration Sub-Districts 22—23, 84 Dietetic Diseases 92 Digestive System, Diseases of 92 Diphtheria 71—76 „ Age Distribution of 73 „ Antitoxin in 74—75, 189 „ Decrease of 72—73 „ Mild Cases 74 „ Pacteriological Examination in 74, l86—187 „ Registration Sub districts 74 „ School Closue in 74 „ Preudo-Bacilli 186—187 Disinfection, details of 123—124 „ Statistics 127—128, 193 „ Certificate 123, 124 Disinficting Department 122—129 „ Machines 125 „ Refuges 125 ,, Station 125 Distribution (free) of Antitoxin 74—75, 189 Drain Testing 33—49, 107, 111—112 „ with Water 107, 111-112 (vii.) PAGE. Drainage Defects 35—40, 105—106 „ Control of (supervision) 108—109 „ Combined 109—110 „ Legal Proceedings 110—111 Drowning, Deaths from 93, 182 Dust Depots 145 Dust Destructor 4, 150—152 „ Sorting (by hand) 148, Appendix 68—70 Earth Temperatures and Diarrhœa 83 Effluvium Nuisances 150—152 Enteric Fever (See Typhoid). Enteritis 85, 92 Epilpepsy, Deaths from 92 "Equifex" Disinfecting Machines 125 Erysipelas 81—82 Fines (inadequacy of) 136—137 Female Inspector 115—122 Flooding 152—153 Food and Drugs, Adulteration of 129—140 „ Convictions 130, 134 Appendix 26—32 „ Warranties 137—138 Food Unsound 112—113 „ Enquiry held 113 Greengrocers, Nuisance from Vegetable Refuse 114 Hand Sorting (refuse) 148, Appendix 68—70 Homicide, Deaths from 93, 184 Houses (Lambeth) 10, 97 Houses condemned 155 Houses let in Lodgings 153, Appendix 50—53 Houses of the Working Classes 155—157 Inadequacy (fines) 136—137 Increase of Population (Lambeth) 5, 97 Increase of Population (London) 10 Infantile Mortality 1903 29—31, 97 „ (London and 33 large Towns of England and Wales) 31 Infected Houses 35—37, 104 and Trains 35—40 Infectious Cases removed 33—34, 102—103 Infectious Cases notified 38, 102—103, Appendix 5 (viii.) PAGE. ctious Cases notified by Sohools Appendix 90 Infectious Diseases Inspection 35, 104 Influenza (Epidemic) 91 Inhabited Houses of Lambeth Borough 10, 97 Inner and Outer Districts and Wards—Deaths and Births 19—20 Inquests 184 Inspections 106—108, 112 Inspector, Female 115—122 „ Males 108—114 „ Food and Drugs 129—140 „ Smoke 141—145 Institution Deaths 12—13, 16—18 Integumentary System, Diseases of 92 Introductory Letter 3—4 Kept Samples Milk 138 Laboratory (bacteriological) 185—189 Lambeth Statistics 5—103, Appendix 2—24 Lavatoties (Underground) 189—192 Letters (sent and receive!) 192 Liver, Diseases of 92 London County Council Bye-Laws (plans) 111 „ „ (offensive matters) 146—147, Appendix 74—79 Local Diseases—Nervous System, Heart Respiratory Organs, Digestive and Urinary Systems and Reproductive System 92 Locomotive System, Diseases of 92 Local Government Board, Old Tables A and B 93—103 „ New Tables i., ii., iii., iv., Appendix 2—7 Lodging-houses (common) 154 London (County of) Vital Statistics, 1903 9—10 ,, No. of Births, Deaths and Marriages, 1903 10 „ Zymotic Deaths, 1903 44—45 Lymphatic System, Diseases of 92 Manure Depots 145—149 Market Thoroughfares (inspection) 114 Marriage and Marriage Rates (Lambeth) 12, 13, 15,97 Measles 64—69 „ Norwood Schools 68, Appendix 39—49 „ Registration Sub-Districts 70 (ix.) PAGE. Measles (Compulsory Notification of) 65 „ as a Dangerous infectious Disease 65 „ and School Closure 65—69 Membranous Croup 75—76 Meningitis (Tubercular) 92 Midwives Act, 1902 84 Milk Depot (municipal) 3, 176—177, Appendix 54—61 Milk Stores (see Milkshops) Milkshops 177—178 Mortality Rates, 1903 13, 18—24 „ Different Age Periods (Lambeth and London) 21, 25 „ Different Diseases (Lambeth Borough) 94—95 „ Different Diseases (Lambeth and London) 96 „ Under 1 year (London and Lambeth) 96 Mortality Tables Appendix 8—24 ,, Sub-Districts ,, 8—15 „ Age-periods „ 16—23 Mortuary, Norwood 180 „ High Street 179 Mortuaries 178—183 „ Keepers of 181 Natural Causes, Deaths from 181 Natural Increment of Population (Lambeth) 5, 97 „ „ „ (London) 10 Nervous System, Diseases of 92 New Wards (Lambeth Borough) 5, 8 „ General Diseases, Deaths 21 „ Population (estimated) 5 ,, Zymotic Diseases 24 „ Zymotic Incidence 21 Norwood Schools (measles at) 68, Appendix 39—49 Notices served 104—107, 112, 192 Non-notifiable lnfectious Diseases 126 Notification Certificates received, 1903 38, 102—103, Appendix 5 ,, „ (Quarterly), 1903 42 „ (voluntary) of Consumption 88—91 Nuisances Abated 104—107 Observations (smoke) 111—142 Offences, Public Health Acts Appendix 33—38 Pood and Drugs Acts „ 26—32 (X.) PAGE. Offensive Matters, removal of 115—14, Appendix 7479 „ „ Bye-Laws 146-147, „ 71—79 Offensive Trades 171 Old Age, Deaths from 92 Organs of Special Senses (Diseases of) 92 Outer and Inner Wards, Deaths and Births 19, 20 Outworkers 4, 118—122 Parasitic Diseases 92 Parliamentary Divisions 8 Paving Courts 114 Penalties Appendix 25—38 Public Health Acts „ 33—38 Food and Drugs Acts ,, 26—32 Peritonitis, Deaths from 92 Persons per House 10, 97 „ Acre 22, 97 Phthisis, Deaths from 87—91, 92 „ Voluntary notification of 88—91 ., Open-air treatment (Sanatoria) 89—91 Plague 71 Plans of Drainage 107, 111 Pneumonia, Deaths from 92 Population of Lambeth Borough, 1903 5, 97, 102—103 „ „ „ „ Sub-districts 6, 102—103 „ ,, „ „ Parliamentary & New Wards 5, 8 „ ,, „ „ Age Periods 7 „ „ „ „ Estimation of 5 Population of London, 1903 10 „ „ Sub-districts 9 Post-Mortems 178—179, 183 Premature Births (deaths from) 92 Premises Disinfected 123 Prosecutions Appendix 25—38 Public Health Acts 11, „ 33—38 Food and Drugs Acts 11, „ 26—32 Protected Persons (Workshops) 160, 164 Pseudo-Bacilli and Diphtheria 186—187 Public Institutions, Deaths 12—13, 16—18 Publio Healths Acts (Convictions) Appendix 33—38 Puerperal Fever 80—81, 82 (xi.) PAGE. Quarterly Returns (Lambeth)— Births 11 Deaths (Zymotic and General) 26—28, 41, 46 Notifiable Infectious Diseases 42 Disinfection Certificates 124 Railway Sidings and Manure 147 Rateable Value (Lambeth Borough) 10, 97 Refuges 125 Refuse Depots 145—149 „ (Greengrocers) 114 „ sorting by hand 148, Appendix 68—70 Refuse depositing of 148—149 Registration Sub-Districts (Lambeth Borough)— „ ,, „ Births 11, 20, 22—23 „ „ „ Population (estimated) 6 „ „ „ General Diseases, Deaths 20, 22—23, 26—28, 98—103 „ „ „ Infantile Mortality 29—31 „ „ ,, Zymotic 20,22—23, 44, 98—103 „ „ „ Vaccination Returns 57—59 Regulations (Sale of Butter) 139 Re-Inspections 107,112 Removal of Infectious Diseases 33—34, 102—103 Reproductive System, Diseases of 92 Respiratory Diseases 92 Rowton House (Smallpox outbreak) 49—52 Revenue Act, 1903 158 Sale of Butter Regulations 139 Samples Food and Drugs 129—140 Sanatoria for Consumptives 89—91 Sanitary Defects 104—108 Sanitary Work 104—193 „ Structural 106, 107 „ Non-structural 106, 107 Scarlet Fever 60—63 „ Age Distribution 61 „ Registration Districts 22—23, 62 ., Return Cases 63 „ and School Attendances 62—63 „ and Milk 62 Outbreak at School 62—63 (xii.) PAGE. School Closure and Measles 65—69 Simple or Continued Fever 79—80 Sites (working class dwellings) 155—156 Slaughterhouses 171—174 „ List of 172—173 „ Infringement of Byelaws 174 Smallpox 3—4, 47—59 Details of Cases 49—55 Rowton House outbreak 49—52 Preventive Measures 49—57 Vaccination-states 47—48 Quarantining 56—57 Contacts 56—57 Smoke Nuisance and Abatement 141—145 „ Observations141—142 Special Reports 39—79 Outbreak of Measles at Lambeth Schools Appendix 39—49 Houses let in Lodgings „ 50—53 Municipal Milk Depots ,, 54—61 Health Congress at Bradford, 1903 „ 62—67 Hand Salting of Refuse „ 68—70 Byelaws of L.C.C. „ 74—79 Schools, Upper Kennington Lane „ 71—73 Stamps used 193 Staffs— Clerical 192 Inspectorial 108—114 Female Inspector 115—122 Disinfecting 125 Mortuary Attendant 181 Underground Conveniences 190—191 Suffocation in Bed 93 Suicide and Homicide, Deaths from 93, 182, 184 Summary of Vital Statistics (Lambeth Borough), 1903 97 „ „ Sanitary Work 107 „ „ Work by Female Inspector 115—117 „ „ Death Returns Appendix 24 Summonses 108, „ 25—38 Supervision (drainage) 103—109 Syphilis 92 (xiii.) PAGE. Temperature (Air and Earth) 83 Testing of Drains 35, 107, 111—112 Tuberculosis, Deaths from 87—91, 92 „ and Bacteriological Examinations 83, 185 „ Registration Sub-Districts and Wards 87,89 „ and Preventive Measures 87—91 „ Notification (voluntary) 88—91 Typhoid 76—79 „ Age Distribution of 77 „ Bacteriological Examinations 76,186 „ Registration Sub-Districts 22—23, 78 „ Inner and Outer Wards 77 Typhus 79—80 Underground Bakehouses 4,168—171 Underground Conveniences 189—192 Unsound Food 112—113 Urinary Diseases, Deaths from 92 Urine and Bacteriological Examinations 187 Vaccination Returns 58—59 Varicella (see Chickenpox) Venereal Diseases 92 Violent Deaths 93, 182 Vital Statistics, London 9, 10 „ „ Lambeth 5—103, Appendix 2—24 „ „ Summary (Lambeth) 97 Wards (Lambeth) 24 „ Deaths and Death-Rates 24 „ Zymotic Incidence 24 Warranty (Food and Drugs Acts) 137—138 Water Supply 140 Water Certificates 112, 193 Whisky (Adulteration of) 136 Whooping Cough 64, 69—70 „ „ Registration Sub-Districts 70 Work of Sanitary Staff 104—193 Workshops 115—122, 159—164 „ Defects found 115—117, 161—163 „ Female Inspector in 115—122 „ Outworkers 118—122 „ Overcrowding in 161 (xiv.) PAGE. Workshops Persons employed in 160, 164 „ Protected Persons 160, 164 „ Trades, etc., 121, 159 Zymotic Diseases 32—91, 97 „ Deaths, arranged Quarterly 41 46 „ Deaths, arranged Monthly 43 „ Incidence in New Wards 24 „ Incidence in Registration Sub-Districts 22—23, 102—103 „ Principal Deaths (Lambeth) 44—15 „ Principal Deaths (London) 44—15 „ Seasonal Variations 46