LAM 7 Report ON THE VITAL AND SANITARY STATISTICS OF THE Borough of Lambeth, during the year 1904 [ With an Account of the work done by the Sanitary Inspectors, and of the Proceedings taken under the Food and Drugs, Factory and Workshops, and Public Health, Acts], BY Joseph Priestley, B.A., M.D., D.P.H. MEDICAL OFFICER OF HEALTH. LONDON: Printed by Fredk. Tarrant & Son, 110, Camberwell Road, S.E. 1905. LAM 7 Public Health Department, 333, Kennington Road, S.E. February, 1905. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, Again I have the privilege of presenting you with a very satisfactory Annual Report, dealing with the Vital and Sanitary Statistics of the Borough of Lambeth during the year 1904. The mortality-rates are well below the averages, and the morbidity(or sickness-) rates have been, correspondingly, lessened during the year-more especially the zymotic incidence, which, for 1904, is the lowest yet recorded, either in the Borough, or in the old Parish, of Lambeth, viz., a rate of 4.5 per 1000 of the population, i.e., only one-half the average of 9.04 for the decennium 1891-1900. A somewhat serious local outbreak of Smallpox, introduced from a neighbouring Borough, during the year was quickly stamped out by the prompt methods taken, and so, what might have proved an epidemic, was prevented. The marked decrease in the Diphtheria-rates for the last few years in Lambeth is still maintained. The year 1904 will ever remain memorable for the public spirit shewn by the Lambeth Borough Council in having decided on July 14th, to establish, and maintain, within the Borough, an Infants Milk Depot, even though the expenses connected therewith will certainly, in the present state of the Law, be surcharged by the District Auditor, and the disallowance may not be afterwards remitted by the Local Government Board. It is, however, satisfactory to know that much good must, of necessity, accrue from the establishment, and maintenance, of such an Infants Milk Depot, if only from an educational point of view—one most important consideration (amongst many) in connection with the lessening of the infantile mortality, which exists, in an excessive amount, both in Lambeth and elsewhere, at the present time. Other matters during 1904 calling for comment are :— 1. The increase in the number of samples taken under the Sale of Food and Drugs Acts (a total of 1,200); 2. The very small number of cases (only 22), in which summonses have had to be taken out on account of noncompliance with notices served under the Public Health Acts, e.g., 0.2 per cent. of the total notices served ; 3. The large amount of disinfection carried out in connection with Tuberculosis, Measles and Whooping Cough; 4. The completion of the Stabling at Wanless Road fecting Station, where the horses and vans have been kept since January 1st, 1904, instead of at the Wharf (as formerly), with consequent administrative and financial benefits; 5. The continuing success of the Bacteriological Department (over 3,000 samples having been examined during the six years that the Laboratory has been in use). To the Sanitary Inspectors, and to the rest of the Staff of the Public Health Department, my thanks are due for the manner in which they have worked; as also to my Colleagues, the other Chief Officers of the Borough Council, for advice and help at all times readily given in connection with their own respective Departments. In conclusion, it is to the Members of the Borough Council (more especially the Public Health Committee) that credit is due for the ready support that they, at all times, give their Medical Officer of Health, thereby enabling the important work, detailed in this Report, to be carried out so successfully, and with such advantage to the Public Health of the Borough. I am, Mr. Mayor and Gentlemen, Your Obedient Servant, Joseph Priestly Medical Officer of Health. 5 I. VITAL STATISTICS. The Borough of Lambeth contains 4079.6 statute acres, exclusive of 82.1 tidal water, 0.8 inland water, and 31.1 foreshore, with an estimated total population of 310,359 persons to the middle of 1904, consisting of 146,868 males and 163,491 females, or an excess of 16,623 females. The total estimated increase (1903-1904) of the population is 2,648, but the "natural increment," i.e., the excess of births over deaths (uncorrected) is 3,901, so that an exodus of 1,253 in excess of those who came into the Borough during 1904 must be assumed. The estimated Populations of the Borough of Lambeth to the middle of 1904 may be tabulated as follow:— Estimated Populations. (Estimated, Middle 1904.) 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. 26762 Bishop's 31888 Prince's 48650 Vauxhall 32168 Stockwell 33160 Brixton 44772 Heme Hill 32248 Tulse Hill 28911 Norwood 31800 Borough of Lambeth 146868 163491 310359 6 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. Waterloo 13636 13127 26763 Lambeth Church (1st) 9113 9276 18389 Lambeth Church (2nd) 19895 20017 39912 Kennington (1st) 26960 27286 54246 Kennington (2nd) 20203 23967 44170 Brixton 40650 47650 88300 Norwood 16411 22168 38579 Borough of Lambeth 146868 163491 310359 7 III. Age-Periods. Age-Periods. Males. Females. Total. 0—1 3756 3754 7510 1—5 12951 12872 25823 Total under 5 16707 16626 33333 5—20 42747 44678 87425 20—40 51300 58319 109619 40—60 27137 30522 57659 60—80 8478 12266 20744 80 upwards 499 1080 1579 Total over 5 130161 146865 277026 8 IV. Parliamentary Divisions (Old). Old Parliamentary Divisions. Males. Females. Total. North 29373 29327 58700 Kennington 39839 40135 79974 Brixton 35611 41588 77199 Norwood 40915 50703 91618 Parliamentary Area of Lambeth 145738 161753 307491 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 58650 Bishop's Kennington Prince's 80818 Vauxhall Brixton Stockwell 77932 Brixton Norwood Heme Hill 92959 Tulse Hill Norwood *Adjusted Parliamentary Area of Lambeth - 310359 *N.B.—By the adjustment of the old Parliamentary Divisions so as to be co-terminous with the new wards. 9 1904—Groups of Metropolitan Boroughs (corrected rates). Enumerated Population, 1891 (Census). Enumerated Population, 1901 (Census). Estimated Population, 1904 (middle of year). Birth-Rate. Death-Rate. Zymotic DeathRate. Deaths under 1 year to 1000 Births. London 4228317 4536541 4648950 27.9 16.1 2.1 144 South Group 1524472 1749956 1827967 28.4 15.5 2.2 144 West Group 770022 826985 847755 22.7 14.6 1.8 145 North Group 1013707 1056070 1072691 25.8 15.3 1.7 130 Central Group 214464 187791 179601 30.9 19.8 2.1 129 East Group 705652 715739 720936 34.7 19.4 2.6 161 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 1904 is 42,359, which, with an estimated population (to the middle of 1904) of 310,359 gives an average of 7.3 persons per inhabited house. Rateable Value. The rateable value of the Borough for the year ending March 31st, 1904, was £1,907,908, and a 1d rate per is estimated to produce £7,025 net for the year ending March 31st, 1905, in both cases, inclusive of Government property. Statistics for London as a whole. The Registrar-General returns the estimated population of London for the middle of the year 1904 as 4,648,950 consisting of 2,194,638 males, and 2,454,312 females, and states that there were registered during the year 39,586 marriages, 129,335 births (65,716 males and 63,619 females), and 77,094 deaths (39,965 males and 37,129 females). There were registered, 9,990 deaths from the seven chief zymotic diseases. The excess of registered births over deaths, i.e., the natural increment, is 52,241, and the estimated increase of population from the middle of 1903 to the middle of 1904 is 35,138. 11 TABLE A. Giving the number of Births and the Birth-Rates in each Registration Sub-District of the Borough of Lambeth during 1904 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1904. Rate per 1000 Inhabitants. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Waterloo Road 1st 113 101 96 104 414 49.1* „ 2nd 209 217 233 242 901 Lambeth Church 1st 146 133 137 153 569 30.9 „ 2nd 379 389 361 396 1525 38.2† Kennington 1st 468 470 452 443 1833 33.8 „ 2nd 254 252 246 259 1011 22.9 Brixton 528 511 499 472 2010 22.8 Norwood 209 206 194 187 796 20.6 Borough of Lambeth 2306 2279 2218 2256 9059 29.2 *Including Lying-in Hospital (495 cases, of which 178 belong to Lambeth)—corrected rate (i.e., excluding non-Lambethian births),= 37.3. †Including Workhouse (190 cases, of which 161 belong to Lambeth)—corrected rate (i.e., excluding non-Lambethian births),=36.5. Inner Districts, 40.1; Outer Districts, 25.8 per 1000—uncorrected (whole Borough=29.2). Inner Districts, 36.01; Outer Districts, 25.8 per 1000—corrected (whole Borough=28.04). 12 TABLE B. Shewing the Estimated Populations, Numbers of Inhabited Houses, Marriages, Births, and Corrected Deaths in the Borough of Lambeth during 1904, 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' 1904 310359 42359 2480 9059 4880 1248 1778 603 1728 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 300048 40525 2445 9388 5251 1425 2096 734 1546 1898 304073 40840 2589 9256 5430 1426 2089 726 1543 1899 308108 41155 2523 9433 5886 1488 2198 782 1680 1900 312152 41470 2454 9167 5430 1328 1884 497 1576 Average 1891-1900 294049.7 40052.4 2338 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 (corrected), and proportion of Deaths in Public Institutions, in the Borough of Lambeth for the Year 1904, 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. Corrected Death-Rate per 1000 Population. Corrected Deaths of Children under 1 year, per 1000 Births. Corrected Deaths of Children under 1 year, per 1000 Deaths. Corrected Deaths of Children under 5 years, per 1000 Deaths. Corrected Zymotic DeathRate, per 1000 Population. Deaths in Public Institutions per 1000 total uncorrected deaths. New Boro' 1904 7.3 15.9 29.2 15.7 137.7 255.7 364.3 1.9 334.9 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 16.8 132.5 252.8 400.3 2.4 284.7 1895 15.2 31.9 19.0 152.0 255.4 393.4 2.5 257.9 1896 16.5 32.4 17.2 136.9 257.6 401.1 2.4 295.7 1897 16.3 31.3 17.5 151.8 271.4 400.1 2.4 281.8 1898 17.0 30.4 17.9 154.1 262.6 384.7 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 1904 was 9059. Of the total 9059 births, 4,590 were males, and 4,469 females, showing an excess of 121 males. Of the total 9059 births registered in the Borough of Lambeth, 495 took place in the Lying-in Hospital (York Road), and of these, 178 belong to the Borough; whilst 190 took place in the Workhouse (Brook Street), and of these, 161 belong to the Borough. Thus, there are 346 births belonging to other districts, but these may be assumed to counteract in number the births (amongst Lambethians) 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 29.2 per 1000 inhabitants (31.3 for males, and 27.3 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 40.1, and that in the Outer Districts 25.8, per 1000—the corrected birth-rates being respectively 28.04 for the whole borough, 36.01 for the Inner, and 25.8 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. The birth-rate for Lambeth (Parish and 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 15 would appear on the surface; for it must be remembered that pari passu with this declining birth-rate is a greater declining death-rate. Returns of all Births that occur in Lambeth are now obtained from the Registrar-General, and this information will be of great use in connection with the Borough Council's endeavours to lessen the high mortality amongst infants (under 1 year of age). The information will be useful, also, in dealing with humanised (sterilised) milk from the Council's Infants Milk Depot, which will be opened during 1905, at 66, York Road, Westminster Bridge Road. THE MARRIAGE-RATE. The number of Marriages registered in the Borough of Lambeth during the year 1904 was 2480 as compared with 2452 during 1903, 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 1000 inhabitants, as compared with 17.0 for London. Tables B and 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 from a sanitary stand-point. THE DEATH-RATE. The total number of deaths registered in the Borough of Lambeth, during the year 1904, was 5160 as compared with 4853 during 1903, and a yearly average of 5716.7 in the old Parish of Lambeth for the 10 years 1891-1903. Of the total 16 5160 deaths, 2711 were males and 2449 females, showing an excess of 262 males. The death-rate for Lambeth is, therefore, 16.6 per 1000 inhabitants (18.5 for males and 14.9 for females), as compared with 16.6 for London (18.3 for males and 15.2 for females). These rates are, however, uncorrected, and, on analysing the 5160 deaths registered in the Borough of Lambeth, it is found that 740 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 400 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a corrected number of deaths for Lambeth during 1904, of 4880, and a corrected death-rate of 15.7 per 1000 inhabitants, as compared with 16.1 for London (the total corrected number of London deaths being 74,555). The outside Institutions, &c., where 400 Lambethians died during 1904, may be grouped as follows:— I. General Hospitals. Charing Cross 20 Guy's 32 Hostel of God 5 King's 13 London 2 Middlesex 13 II. Special Hospitals. Royal London Ophthalmic 2 Brompton 9 Cancer 5 Central London Sick 1 Children's Hospital, Paddington 1 Royal Free 2 St. Bartholomew's 15 St. George's 0 University 0 Westminster 45 Hospital of St. John 2 London Throat 2 Queen Charlotte Hospital 1 National Hospital 1 Hospital for Incurables, Wandsworth 1 17 II. Special Hospitals—continued. Evelina 30 Grosvenor Hospital 1 St. Peter's 6 Temperance Hospital 2 Victoria Hospital 1 Seamen's Hospital, Greenwich 1 Fridenheim 6 German Hospital 3 Fever. Fountain 1 Grove 18 St. Mary's 2 N. W. Hospital 4 N. E. Children's Hospital 1 Gt. Northern Hospital 1 Hospital, Women, St. Pancras 1 Gt. Ormond Street 8 Heart Hospital, Soho 4 Western Hospital 1 Northern Hospital 1 III. Infirmaries and Workhouses. Bermondsey Infirmary 1 Camberwell Infirmary 2 City Infirmary 2 Southwark Infirmary 4 St. George s Infirmary 2 St. Pancras Infirmary 2 Southwark Workhouse 1 St. George's Workhouse 1 IV. Asylums. Aged Pilgrim's Asylum 2 Banstead 13 Bethnal House Asylum 4 Camberwell House 4 Caterham 13 Cave Hill 19 Colney Hatch 4 Darenth 6 Dartford 5 Grove Hall Asylum 1 Hanwell 2 Horton Asylum, Epsom 19 Ilford 5 Leavesden 5 Licensed Victuallers 2 Manor 6 Peckham House 6 Tooting Bec 17 London County Asylum 2 b 18 V. Unclassifiable Places. Brought dead to Hospital 3 Clapham Common 2 Honor Oak Railway Station 1 H.M. Prison, ville 1 Private Houses 16 River Thames 3 Streets 4 On Omnibus, Waterloo Bridge 1 Putney Railway Station 1 Streatham Common 1 Grand Hotel, Charing Cross 1 Summary. I. General Hospitals 159 II. Special and Fever Hospitals 117 III. Infirmaries and Workhouses 15 IV. Asylums 135 V. Elsewhere (unclassifiable) 34 460 Whether the corrected or uncorrected death-rates for the Borough of Lambeth (as a whole) be taken, they are very satisfactory for the year 1904, the fourth 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. Nor is this a matter for surprise when it is borne in mind that the Inner Districts and Wards are more congested than the Outer, and 19 that, 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 also 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. No efforts 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 regular inspections. In this way, the evil effects arising from crowding and defective ventilation may be, in part, 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 1904 will be found to vary between the Inner and the Outer Districts as follows:— 1904. Registration Sub-Districts. New Wards. Inner. Outer. Inner. Outer. General Death-rate (corrected) 20.7 13.8 18.9 13.2 Zymotic Death-rate (corrected) 3.2 1.5 2.8 1.3 Of the New Wards, Tulse Hill has the lowest general and zymotic death-rates, and Bishop's and Marsh the highest general and zymotic death-rates respectively, whilst, of the Registration Sub-Districts, Norwood has the lowest, and Waterloo the highest, general death-rate, and Brixton 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 20 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 1903 and 1904, whilst on page 21 is given a similar comparison between the 1903 and the 1904 statistics for the Registration Sub-Districts of the Borough. 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 in the Registrar-General's Returns amongst the Metropolitan Sanitary Districts is worthy of note, there being 15 other districts (out of 29) with a less general death-rate, 15 with a less zymotic death-rate, and 11 with a less infantile mortality-rate. Taking the South Metropolitan Districts, Battersea has a general death-rate per 1000 of the population of 14.5, and Camberwell of 14.9, as compared with Lambeth 15.7, Bermondsey 20.0, and Southwark 20.1, respectively. London, as a whole, has a birth-rate of 27.9, corrected deathrate of 16.1, a corrected zymotic (death-) rate of 2.1 per 1000 population, and an infant mortality (corrected) of 144 per 1000 births; and England and Wales a birth-rate of 27.9, a corrected death-rate of 16.2, a corrected zymotic death-rate of 1.94 per 1000 population, and an infantile mortality (corrected) of 146 per 1000 births; and the 76 great towns of England and Wales a birth-rate of 29.1, a corrected death-rate of 17.2, a corrected zymotic death-rate of 2.49, per 1000 population, and an infantile mortality (corrected) of 160 per 1000 births. 21 BOROUGH OF LAMBETH. COMPARISON BETWEEN STATISTICS FOR 1903 and 1904. Registration Sub-Districts. Death-Rates (corrected). Birth-Rates (uncorrected). Infantile Mortality (uncorrected). General. Zymotic. 1903. 1904. 1903. 1904. 1903. 1904. 1903. 1904. Inner Districts— 20.1 20.7 2.6 3.2 40.1 40.1 151.9 170.4 *Waterloo 20.5 21.9 1.8 3.1 49.9 49.1 101.9 123.9 Lambeth Church 1st 18.8 19.02 2.4 3.4 30.6 30.9 266.4 289.9 †Lambeth Church 2nd 20.4 20.3 3.2 3.03 37.9 38.2 153.8 165.9 Outer Districts— 13.3 13.8 1.2 1.5 25.4 25.8 119.4 132.2 Kennington 1st 14.9 15.8 1.8 1.9 33.2 33.8 110.7 124.9 Kennington 2nd 14.1 15.4 1.1 1.6 22.2 22.9 126.8 168.2 Brixton 12.9 13.1 1.1 1.3 23.7 22.8 124.8 133.8 Norwood 10.9 10.9 0.9 1.3 29.4 20.6 116.1 104.3 Lambeth 15.2 15.7 1.6 1.9 29.5 29.2 131.7 146.6 *Excluding the 495 Lying-in Hospital Births, the birth-rate is 30.6, and the infantile mortality rate 224.1, for 1904. †Excluding the 190 Workhouse Births, the birth-rate is 33.4, and the infantile mortality rate 189.5, for 1904. 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 1904. 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 1904). Total Births (uncorrected). Birth-rate per 1000 of the Population. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population (corrected). Zymotic Death-rate per 1000 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 Ist 155.5 26763 414 * 49.1 300 21.9 ... 14 5 3 2 ... ... ... 20 44 3.1 141.7 12.5 173.9 „ „ 2nd 901 271 ... 15 ... 5 6 ... ... ... 13 39 138.6 100.9 Lambeth Church Ist 114.4 18389 569 30.9 334 19.02 ... 27 ... ... 13 ... 1 ... 21 62 3.4 179.4 11.6 289.9 „ „ 2nd 218.7 39912 1525 38.2† 796 20.3 ... 31 4 3 25 ... 2 ... 55 120 3.03 148.8 13.9 165.9 Kennington Ist 110.6 54246 1833 33.8 843 15.8 ... 23 1 2 18 ... 2 ... 57 103 1.9 120.8 10.6 124.9 „ 2nd 83.6 44170 1011 22.9 666 15.4 ... 23 3 7 9 ... 2 ... 26 70 1.6 103.8 5.9 168.2 Brixton 65.4 88300 2010 22.8 1140 13.1 ... 22 3 11 25 ... 2 ... 47 110 1.3 95.9 5 .4 133.8 Norwood 32.2 38579 796 20.6 404 10.9 ... 7 ... 3 10 ... 2 ... 27 49 1.3 118.5 7.1 104.3 District not stated ... ... ... ... 126 ... ... 2 ... ... 1 ... ... ... 3 6 ... ... ... ... Borough of Lambeth 76.1 310359 9059 29.2 4880 15.7 ... 164 16 34 109 ... 11 ... 269 603 1.9 111.4 8.7 146.6 N.B.—In the 126 cases where the District is not stated, the death-rates have been calculated on the assumption that these deaths were sub-divided equally in the eight Districts. Census 1901 Return gives the area of Lambeth as 4079.6 statute acres (exclusive of 82.1 tidal water, 0.8 inland water, and 31.1 foreshore). * Excluding all the Lying-in Hospital births the corrected rate=30.6 per 1000. † Excluding all the Workhouse births the corrected rate=33.4 per 1000. 24 Age-Periods of Corrected Deaths. The 4880 corrected deaths daring 1904 may be further analysed, and tabulated as follow:— 1248, i.e., 25.6 per cent. of the total (corrected) deaths took place under 1 year of age. 530, i.e., 10.9 ,, between 1 and 5 years. 1778, i.e., 36.4 „ under 5 years. 212, i.e., 4.3 „ between 5 and 20 years. 559, i.e., 11.5 „ 20 to 40 years. 923, i.e , 18.7 „ 40 to 60 years. 1073, i.e., 21.9 „ 60 to 80 years 335, i.e., 6.8 ,, 80 years and over. 3102, i.e., 63.5 „ 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 1904 and the London averages for the 10 years 1881-90. 25 TABLE E. BOROUGH OF LAMBETH. COMPARISON BETWEEN STATISTICS FOR 1903 AND 1904—NEW WARDS. New Wards. Death-Rates (corrected). Zymotic Incidence per 1000 population.* Total Number of Deaths (corrected). Total Notified Cases. Zymotic General. Zymotic. General. Zymotic. 1903. 1904. 1903. 1904. 1903. 1904. 1904. 1904. 1904. Inner— 18.4 18.9 2.3 2.8 5.3 4.7 2632 381 656 Marsh 20.6 21.4 1.9 3.4 5.5 5.5 573 92 148 Bishop's 24.1 23.6 2.8 3.2 6.2 5.1 752 103 163 Prince's 14.3 15.2 2.2 2.3 5.1 4.5 737 112 217 Vauxhall 16.9 17.7 2.4 2.3 4.7 3.9 570 74 128 Outer— 12.5 13.2 1.03 1.3 4.3 4.3 2248 222 726 Stockwell 14.01 13.8 1.3 1.5 6.1 7.6 458 50 252 Brixton 12.9 14.7 1.01 1.5 5.4 3.9 659 69 175 Herne Hill 12.7 14.5 0.9 1.2 5.2 3.7 469 39 120 Tulse Hill 9.9 9.9 0.8 0.8 3.8 3.3 289 24 94 Norwood 12.5 11.7 1.03 1.3 3.4 2.7 373 40 85 Borough of Lambeth 15.2 15.7 1.6 1.9 5.03 4.5 4880 603 1382 *N.B.—The 556 notified Chicken-pox eases are excluded from this Table. 26 TABLE f. Shewing Mortalities in Lambeth Borough at different Age-Periods during 1904, compared with (1) those for London 1904, and (2) the averages for London, for years 1881-90. Age-Periods. LAMBETH. LONDON. Estimated Populations (middle 1904). Mortality Rates per 1000 Population, 1904. Mortality Rates per 1000 Population, 1904. Uncorrected. Average of Ten Years, 1881-90, per 1000. Corrected. Uncorrected. 0—5 33333 53.3 58.02 51.04 68.4 5—20 87425 2.4 6.7 7.02 2.7 7.1 4.3 20—40 109619 5.1 5.5 7.7 40—60 57659 16.01 17.2 20.2 60—80 20744 51.7 63.1 64.3 53.9 62.8 63.3 80 and upwards 1579 212.2 180.8 206.3 *Under 1 year 7510 137.8 146.6 131.5 152.0 All Ages 310359 15.7 16.6 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. 27 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 1904. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total No. of Deaths in each District. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Waterloo Road 1st 26 17 43 23 20 43 23 40 63 25 21 46 195 „ 2nd 28 20 48 24 23 47 29 18 47 35 28 63 205 Lambeth Church 1st 144 97 241 127 95 222 162 96 258 110 85 195 916 „ 2nd 176 154 330 144 125 269 166 150 316 166 124 290 1205 Kennington 1st 87 78 165 84 64 148 92 78 170 81 76 157 640 „ 2nd 97 81 178 55 71 126 65 67 132 76 79 155 591 Brixton 154 153 307 102 129 231 114 117 231 131 134 265 1034 Norwood 43 61 104 37 42 79 43 47 90 42 59 101 374 Totals 755 661 1416 596 569 1165 694 613 1307 666 606 1272 5160 28 TABLE H. Shewing the uncorrected Mortality (i.e., including that of Strangers) at different Ages in each Registration Sub-District of the Borough of Lambeth during the year 1904. 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 32 40 72 16 17 33 31 24 55 19 16 35 195 ,, 2nd 57 34 91 5 15 20 36 23 59 17 18 35 205 Lambeth Church 1st 84 81 165 64 67 131 323 182 505 72 43 115 916 „ 2nd 141 112 253 61 56 117 245 188 433 205 197 402 1205 Kennington 1st 127 98 225 41 28 69 83 74 157 91 98 189 640 „ 2nd 95 75 170 40 41 81 85 71 156 74 110 184 591 Brixton 143 126 269 67 57 124 160 169 329 131 181 312 1034 Norwood 43 40 83 18 13 31 45 52 97 60 103 163 374 Totals 722 606 1328 312 294 606 1008 783 1791 669 766 1435 5160 29 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 1904. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Under 1 year 166 131 297 133 115 248 259 222 481 164 138 302 1328 Between 1 and 5 years 88 62 150 100 84 184 75 89 164 47 61 108 606 Between 5 and 60 years 291 210 501 228 195 423 221 173 394 268 205 473 1791 60 years and upwards 210 258 468 135 174 310 139 129 268 187 202 389 1435 Totals 755 661 1416 596 569 1165 694 613 1307 666 606 1272 5160 30 INFANTILE MORTALITY, 1904. Of the 4,880 corrected deaths, 1248 were infants under one year of age. The total number of births is 9059, and of these 317 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 8713. The infantile mortality (i.e., rate of corrected deaths under one year per 1000 corrected births) is, therefore, 143.2. In calculating this infantile mortality, it must be remembered that, whilst we substract the births that belong to outside districts, we do not add the births amongst Lambethians who may happen to be residing outside the Borough at the time of such births. Taking the uncorrected births and the corrected deaths under 1 year, the corrected infantile mortality rate is 137.8. Taking the uncorrected number of births (9059), and the uncorrected number of deaths under 1 year of age (1328), the uncorrected infantile mortality is 146.6, as compared with 121.7 during 1903, 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, diarrhœa, 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 289.9 per 1000 births in Lambeth Church 1st to 100.9 in Waterloo Road 2nd (the rates of 100.9 in Waterloo Road 2nd and 165.9 in Lambeth Church 2nd being due to the fact that these Sub-Districts contain the General Lying-in Hospital and the Workhouse respectively), thus:— 31 Total No. of Births. Total Deaths under 1 year (uncorrected). Infantile Morality per 1,000 births (uncorrected) Waterloo Road 1st 414 72 173.9 „ „ 2nd 901 91 100.9 Lambeth Church 1st 569 165 289.9 „ „ 2nd† 1525 253 165.9 Kennington 1st 1833 225 124.9 „ 2nd 1011 170 168.2 Brixton 2010 269 133.8 Norwood 796 83 104.3 Lambeth 9059 1328 146.6 N.B.—Waterloo Road 1st and 2nd have been amalgamated by the Registrar- General, and now form one District called Waterloo. *Excluding all the Lying-in Hospital births, the corrected rate is 224.1. †Excluding all the Workhouse births, the corrected rate is 189.5. 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 (vide Special Report, Appendix pp. 70-71). Taking the RegistrarGeneral's old 33 Large Towns of England and Wales, the uncorrected infantile mortalities vary from a minimum 128 Halifax, to a maximum 229 Burnley, London and Lambeth being 146. Lambeth ranks ninth lowest in such list, being bracketed with London, 24 Towns having higher infantile mortality rates. The corrected rate for Lambeth is 137, and of the 29 Metropolitan Sanitary Districts, 11 have lesser corrected infantile mortality rates than Lambeth Borough; and of the 10 South Metropolitan Districts, 3 only have lesser corrected infantile mortality rates, viz.:—Wandsworth, Lewisham and Woolwich with 122, 123 and 135 per 1,000 births respectively, as compared with 137 for Lambeth Borough— the 2 highest corrected rates being registered in Bermondsey and Southwark viz., 172 and 174. 32 TABLE J. Shewing the uncorrected Infantile Mortalities in the Registrar-General's old 33 Large Towns of England and Wales (including London), and in Lambeth Borough, during 1904. England and Wales— (33 Large Towns.) Deaths under one year per 1000 Births. Average Ten Years, 1893—l903. Halifax 128 143 Croydon 130 136 Brighton 134 150 Bristol 134 142 Huddersfield 136 144 Portsmouth 142 157 Derby 143 152 Cardiff 146 154 London 146 154 Wolverhampton 155 181 Newcastle 156 172 Oldham 156 175 Sheffield 158 185 West Ham 162 167 Sunderland 164 172 Bradford 166 163 Leicester 167 181 Bolton 168 171 Plymouth 172 169 Gateshead 174 173 Swansea 174 164 Leeds 175 174 Nottingham 176 184 Hull 178 172 Norwich 180 176 Birkenhead 181 168 Preston 185 221 Manchester 187 185 Blackburn 191 191 Salford 192 198 Liverpool 196 184 Birmingham 197 184 Burnley 229 209 London Districts— Central 129 North 130 South 144 West 145 East 161 Lambeth 137.7 N.B.—The rates for London Districts (including Lambeth) are corrected. The uncorrected rate for Lambeth is 146.6. 33 CLASS 1.—ZYMOTIC DISEASES. Principal Zymotic Diseases. The principal Zymotic diseases are seven in number, viz., smallpox, measles, scarlet fever, diphtheria (including branous 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 1904, being 13.2 per cent. below the average (1891-1900). In the Borough of Lambeth, during 1904, there were registered 676 deaths from the seven zymotic diseases, and of these 113 were strangers belonging to other districts, and 563 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 603, giving a zymotic corrected death-rate of l.9 per 1,000 inhabitants, the corrected rate for London being 2.1, varying in the various Metropolitan Districts, as shown on page 9. The zymotic death-rates (corrected) for the different tration 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, 1st and 2nd, Waterloo 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 3.2, and for the Outer, 1.5—a difference explainable, as before, from the crowding and absence of proper means of home isolation and nursing in the former, as compared with the latter, Districts. Crowded Districts naturally suffer more in this respect than those more sparsely populated. c 34 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, Herne 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 1904, under the Notification Clauses of the Public Health (London) Act, 1891, 1,382 cases* of Infectious Diseases have been reported, and of this number 964, i.e., 69.8 per cent. were removed to the Hospitals of the Asylums Board, or to other Hospitals, and 418, i.e., 30.2 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 1904 is well above the average. Thus, since the introduction of the Public Health (London) Act, 1891, the percentages of notified infectious cases (excluding chicken-pox) 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, 1904—69.8 1893—23.0, 1897—49.0, 1901—66.1, 1894—33.9, 1898—55.9, 1902—70.3, *556 cases of Chicken-pox were also notified by Medical Practitioners during 1904, 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 case in the last two years' Reports (1902-3). Chicken-pox was, during 1904, compulsorily notifiable throughout the County of London from April 8th to November 8th (seven calendar months). 35 Examining the removals more in detail (e.g., nature of disease), it is seen that during 1904 in the Borough of Lambeth, the following are the percentages:— Smallpox 100.0 Typhoid 81.2 Scarlet Fever 81.9 Puerperal 20.0 Diphtheria } {82.6 } Erysipelas 19.9 Membranous } 80.8 Croup} { 27.3 It will be noted that all the notified Smallpox patients were removed to Hospital, whilst the large percentages (larger than last year) 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 of typhoid infected persons 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 1904, 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). The total number of notifications received in Lambeth during 1904 is 48.01 per cent. below the average (Parish) of the ten years (1891-1900), and less than those received during any previous year since the introduction of the Notification Act. There is again a marked decrease in the number of Diphtheria certificates received during 1904, i.e., 55.7 per cent. below the average of the statistics of the Parish of Lambeth for 10 years 36 (1891-1900), and a decrease of 26.8 per cent. from the average received in the Borough during 1901-3. The 317 Diphtheria cases occurred in 296 infected houses, and in only 16.6 per cent. of these were the drains, on testing, found defective. The Scarlet Fever notifications were 50.4 per cent. below the average of the Parish of Lambeth statistics for the 10 years 1891-1900. The 660 cases occurred in 511 infected houses, and in 11.5 per cent. of these, the drains were, on testing, found defective. One or two introductions of Smallpox into the Borough from outside sources, during 1904, account for the 23 cases notified, and full particulars of these will be found on pages 48-54. There were 19 infected houses, but in no instance were the drains found to be defective, on being tested with the chemical test. The Enteric Fever (or Typhoid) notifications received were 46.7 per cent. below the average for 10 years (Parish of Lambeth), and represent 98 infected houses, of which 12.2 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 1904, within the Borough. In the case of each of the 1,205 infected houses, an inspection was made, and the drains and the sanitary fittings tested with chemical, with the following results as tabulated:— (a.) 146 (i.e., 12.1 per cent.) were found to have defective drains. (b.) 521 (i.e., 43.3 per cent.) were found to have defective traps, fittings, or appliances. (c). 538 (i.e., 44.6 per cent.) gave no results with the tests. 37 It will be noted that only 12.1 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 43.3 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 12.1 in 1904. 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 1904 (relating the new Borough of Lambeth), it will be seen that the latter show a decrease of 37.9 per cent. below the average in respect of defective drains. 38 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 19 - 5 5 26.3 73.7 Cholera - — — — — — Diphtheria 296 49 132 181 61.2 38.8 Membranous Croup 11 3 4 7 63.6 36.4 Erysipelas 251 22 86 108 43.03 56.97 Scarlet Fever 511 59 252 311 60.9 39.1 Typhus — — — — — — Typhoid 98 12 41 53 54.1 45.9 Continued or Relapsing 4 – – – 0.0 o.0 Puerperal 15 1 1 2 13.3 86.7 Totals 1205 146 521 667 55.4 44.6 N.B.—The 476 Chicken-pox infected houses shewed defective drains in 40; defective traps, fittings and appliances in 225; and no defects in 211. To keep the records comparable for the past years, Chicken-pox is omitted from the above table. 39 TABLE K. Shewing the number of Certificates for the Notifiable Zymotic Diseases received in the Borough of Lambeth during 1904, and in the old Parish of Lambeth for the ten years 1891-1900. Disease. Parish of Lambeth. Annual Average of 10 years 1891—1900 (Parish.) Borough of Lambeth. Notifications received during 1904. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 Smallpox 3 22 99 26 51 16 2 0 1 — 22.0 23 Cholera 4 26 23 10 16 6 18 7 3 2 11.5 — Diphtheria 330 504 789 521 614 652 704 813 1080 844 715.1 317 Membranous Croup 29 47 49 26 23 27 17 16 22 6 26.2 11 Erysipelas 258 420 587 315 355 352 325 294 330 23.4 347.0 257 Scarlet Fever 858 1832 2275 1198 1389 1550 1375 1009 1006 821 1331.3 660 Typhus 1 3 3 2 0 1 0 0 1 — 1.1 — Typhoid or Enteric 149 117 160 268 201 162 185 163 219 272 189.6 101 Continued or Relapsing 33 34 58 48 20 16 11 13 7 17 25.7 4 Puerperal 11 20 27 19 16 19 26 14 24 13 18.9 15 *Plague – – – – – – – – – – – — Totals 1676 3025 4070 2433 2685 2801 2663 2329 2693 2209 2658.4 1382 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 4.5 861 cases of Chicken-pox were notified during 1904 within the Borough of Lambeth (556 by Medical Practitioners, and 305 by others), this disease being made compulsorily notifiable on April 8th, and remaining so until November 8th, 1904. The Health Department has also heard of, and dealt with, the following non-notifiable infectious diseases:—Measles, 1294; Whooping Cough, 380; Consumption, 659; Cancer, 20; Pneumonia, etc., 39. * Plague was made notifiable on September 19th, 1900. 40 TABLE L. Giving number of infected houses, with percentages of (1) General Defects, and (2) Defective Drains, throughout the Borough during 1904, 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% 423 =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 12.1 per cent. of the houses in 1904 showed, with the test, defective drains, no results being obtained in the other cases. 41 TABLE L—continued. Giving number of infected houses, with percentages of (1) General Defects, and (2) Defective Drains, throughout the Borough since 1904, and throughout the old Parish during ten years (1891-1900). 1897 1898 1899 1900 Average for ten years 1891-1900. 1904 Number of Infected Houses 2374 2094 2435 1992 2246.1 1205 Number of Houses with defects found 1210 =50.9% 1044 =49.9% 1163 =47.5% 886 =44.5% 1158.0 =51.6 667 =55.4% Number of Houses with defective drains found 390 =16.4%. 351 =16.9% 384 =15.8% 285 =14.3% 438.3 =19.5 146 =12.1% Number of Houses with no defects found 1164 =49.1% 1050 =50.1% 1272 =52.5% 1106 =55.5% 1088.1 =48.4 538 =44.6% N.B.—Only 121 per cent. of the houses in 1904 showed, with the test, defective drains, no results being obtained in the other cases. 42 TABLE M. Shewing corrected zymotic seasonal variations (deaths) in the Borough of Lambeth in the different Registration Sub-Districts during 1904. Registration Sub-District. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year 1904. Zymotic Death-rate per 1000 inhabitants. Waterloo Road 1st 4 7 30 3 44 3.1 „ „ 2nd 4 15 17 3 39 Lambeth Church 1st 10 24 27 1 62 3.4 „ „ 2nd 22 36 56 6 120 3.04 Kennington 1st 11 14 71 7 103 1.9 „ 2nd 16 18 34 2 70 1.6 Brixton 26 15 50 19 110 1.3 Norwood 8 5 33 3 49 1.3 District not stated – – 5 1 6 – Borough of Lambeth 101 134 323 45 603 1.9 N.B.—In the case of the 6 zymotic deaths occuring in Districts which are not stated, they have been distributed equally amongst the 8 sub-districts before working out percentages. Inner Districts 3.2; Outer Districts 1.5 per 1,000 inhabitants. 43 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 1904 (arranged Quarterly). 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total for 1904. Smallpox 5 18 - - 23 Scarlet Fever 116 141 158 245 660 Diphtheria 76 71 74 96 317 Membranous Croup 4 2 2 3 11 Typhus — — — — — Typhoid 21 18 37 25 101 Continued Fever — — 1 3 4 Erysipelas 53 60 61 77 251 Puerperal 3 2 3 7 15 Cholera — — — — — Plague — - — — - Totals 278 312 336 456 1382 Chicken-pox (Compulsorily notifiable up to January 6th, 1903.) — 319 158 79 556 N.B.—Chicken-pox was made, by special Order of the London County Council, a compulsorily notifiable disease on April 8th, 1904, and remained so until November 8th, 1904, and, during that period, 556 cases were compulsorily notified by medical men (305 other cases of the same disease being voluntarily reported also during the year 1904). 44 TABLE O. Deaths from zymotic diseases (Strangers deducted) 1904. For the 4 weeks ending. January. February. March. April. May. June. July. August. September. October. November. December. Total. Smallpox - - - - - - - - - - - - - Measles 15 14 16 14 29 26 22 16 3 7 1 1 164 Scarlet Fever 1 3 1 4 — 1 2 — 1 1 1 1 16 Diphtheria 1 6 2 3 2 2 1 3 3 4 1 5 33 Membranous Croup — 1 - - - - - - - - - - 1 Whooping Cough 13 1 11 18 15 12 13 12 5 1 1 7 109 Typhus — — — — — — — — — — — — — Enteric 2 2 1 — 1 — 1 — — 1 2 1 11 Continued Fever - - - - - - - - - - - - - Diarrhœa* 2 5 5 1 1 4 41 162 40 6 1 1 269 Total of Seven Chief Zymotic Diseases 34 32 36 40 48 45 80 193 52 20 7 16 603 Erysipelas 2 1 4 - - - 1 1 1 2 1 1 14 Puerperal Fever — — — 1 — — 1 — 2 1 1 2 8 * Including the four cases registered from Cholera Nostras in August (1) and September (3). 45 The seasonal mortality (corrected) from the different important zymotic diseases during 1904 is well shown by arranging the deaths quarterly, thus:— 1904. Smallpox Measles. Whooping Cough. Scarlet Fever. Diphtheria. Membranous Croup. FEVER. Diarrhœa. Erysipelas. Puerperal Fever. Cholera.* Influenza. Total. Typhus. Typhoid. Continued. 1st Qr. — 44 25 5 9 1 — 5 — 12 7 — — 10 118 2nd Qr. — 70 45 5 7 — — 1 — 6 — 1 — 3 138 3rd Qr. — 40 29 3 7 — — 1 — 239 3 3 4 4 333 4th Qr. — 10 10 3 10 — — 4 — 8 4 4 — 19 72 Totals. — 164 109 16 33 1 — 11 — 265 14 8 4 36 661 * The four Cholera Cases were, in all probability, Epidemic Diarrhœa. Taking the zymotic diseases collectively, it is noticed that the 3rd quarter shewed the highest mortality, and the 4th quarter the lowest. Typhoid and Erysipelas reached their maxima in the 1st quarter; Measles and Whooping Cough in the 2nd; Diarrhœa in the 3rd; and Influenza and Diphtheria in the 4th. Scarlet Fever reached its maximum in the 1st and 2nd 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 1904, 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. 46 47 TABLE P. 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 1904. Disease. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 Annual Average of ten years 1891—1900 (old Parish). Proportion of Deaths to 1000 Total Deaths in 10 years. Total Deaths in 1904. Proportion of Deaths to 1000 Total Deaths 1904. Smallpox 0 1 5 1 2 2 - - - - 1.1 0.2 - - Diphtheria (and Membranous Croup) 78 127 172 138 103 140 145 115 159 103 127.6 23.6 34 6.9 Scarlet Fever 46 76 69 64 53 63 42 30 25 20 53.6 9.9 16 3.3 Fever Typhus 1 0 1 0 0 1 — — — — 0.4 0.07 — — Typhoid or Enteric 28 22 36 46 26 24 26 35 50 54 32.8 6.1 11 2.3 Simple Continued 7 2 4 0 2 1 — — — 1 2.2 0.4 — — Measles 128 187 113 182 151 185 139 133 169 69 144.4 26.7 164 34.4 Whooping Cough 239 135 151 110 132 140 144 159 130 97 144.4 26.7 109 22.3 Diarrhœa 165 155 197 139 263 152 238 254 249 153 188.4 34.8 269 55.1 Borough of Lambeth 692 705 748 680 732 708 734 726 782 497 694.9 128.6 603 123.6 County of London 9675 11983 13223 11544 11467 14009 11525 12482 11147 10136 11575.3 130.8 9906 132.9 48 SMALLPOX. During 1904, 23 cases of genuine Smallpox were removed to hospital from Lambeth Borough; and of these the full particulars (as to sources of origin, &c.) are given below in tabular form. 2 were removed in January, 5 in March, 3 in April, 6 in May, and 7 in June. From the 23rd June to the end of the year 1904, no case of Smallpox was notified. Of the 23 cases 12 were males and 11 females. 17 had been vaccinated in infancy (1 stated to have been also revaccinated 12 years prior to being attacked with Smallpox); 5 were unvaccinated; and 1 had a doubtful history of vaccination. 5 were under 12 years of age; and 18 were adults (varying in ages from 16 to 64 years). 5 other cases of Smallpox were notified during the year 1904, but the patients proved to be suffering from other diseases (3 Chicken-pox, 1 Vaccinia, and 1 Measles), and were consequently returned from hospital, and do not, therefore, appear in the Returns for 1904 as Smallpox. No death from Smallpox was registered during 1904 as having occurred in Lambeth Borough. 18 Adults (over 12 years of age). 9 Males Vaccinated 7 Revaccinated 1 (12 years) Doubtful 1 Unvaccinated 0 9 Females Vaccinated 8 Unvaccinated 1 5 Children (under 12 years of age). 3 Males Vaccinated 0 Unvaccinated 3 2 Females Vaccinated 1 Unvaccinated 1 Ages of the 23 notified cases:— 2—Under 1 year of age (both unvaccinated). 1—Between 1 and 5 years (unvaccinated). 49 1—Between 5 and 10 years (unvaccinated). 4—Between 10 and 20 years (1 unvaccinated and 3 vaccinated). 11—Between 20 and 40 years (all vaccinated). 3—Between 40 and 60 years (1 doubtful, 1 revaccinated and 1 vaccinated). 1—60 and over (vaccinated). 23 Total cases notified. Particulars as to the 23 genuine cases of Smallpox notified in Lambeth Borough during 1904, are as follows:— (1-2) Ada M., aged 10 weeks, unvaccinated, and her father, Henry M., aged 33 years, vaccinated in infancy, were removed from 25. China Walk, on January 3rd and January 21st respectively, the former having caught the disease from her mother (Mary M.), who was removed to Hospital on December 22nd, 1903, and had sickened on December, 18th, 1903. Henry M. sickened January 16th, 1904, i.e., 13 days from January 3rd, on which date he kissed his daughter, Ada M., prior to her removal to Hospital; and Ada M. sickened December 31st, 1903. (3) Stanley Edward M., aged 25 years, vaccinated in infancy, sickened on March 8th, and was removed to Hospital on March 14th, from 271, Brixton Road, suffering from Smallpox, which he had contracted at Port Said, where cases occurred on board the s.s. “Assaye,” in which boat Stanley Edward M. was returning to England. No other case occurred in connection with 271, Brixton Road. (4-6) Richard C., aged 52 years, sickened with Smallpox on March 10th, and was removed to Hospital on March 15th, from 187, Railton Road. There was a doubtful history of vaccination in infancy, but no marks of vaccination were visible. The source of Richard C.’s infection was the London Hospital (out-patient department), where he was attending for spinal trouble, and where several cases of Smallpox had recently occurred. From Richard C. 2 other cases arose, viz.: Ann B., aged 64 years, vaccinated in infancy, living at 187, Railton Road, and Mary Ann P., aged 38 years vaccinated in infancy, living at 138, Mayall Road, and visiting at 187, Railton Road. Ann B. sickened March 28th, and was removed to Hospital on March 30th, whilst Mary Ann P. sickened March 25th, and was removed to Hospital on March 29th. (7) Elizabeth G., aged 28 years, vaccinated in infancy, sickened with Smallpox on March 21st, and was removed to Hospital from 43, Newport Street, on March 24th, having caught the disease from Bertha B., at 17, Betterton Street (Westminster), where she visited Bertha B. on March 7th, i.e., 2 days prior to Bertha B. being removed to the Smallpox Hospital. No other case arose from 43, Newport Street. (8) James M., aged 20 years, vaccinated in infancy, sickened with Smallpox at 9, Farnham Royal, on April 7th, and was removed to Hospital on April 11th. It is supposed that he caught his disease whilst at work as a a plumber's mate in the City. No other case arose from 9, Farnham Royal. d 50 (9-23) Thomas Webster V., aged 47 years, vaccinated in infancy, and stated to have been revaccinated 12 years ago, sickened with Smallpox at 10, Ely Place, on April 5th, and was removed to Hospital on April 12th, having contracted his disease, in all probability, whilst at work as a lighterman working at Hays Wharf, in the neighbourhood of which there had been several cases of Smallpox. No other case arose at 10, Ely Place, though, at the time of the outbreak, there were 6 other inmates (3 adults and 3 children—all vaccinated) living in the same small house (3 rooms) during the 7 days that elapsed between the times of Thomas Webster V.’s sickening and removal to Hospital. Connected, however, with the outbreak at 10, Ely Place, 3 other cases arose directly in the neighbourhood as follows:— (а) Alice A., living at 7, Meadow Place (abutting on 10, Ely Place) aged 37 years, vaccinated in infancy, who sickened with Smallpox on April 27th, and was removed to Hospital on April 29th. (b) and (c) Thomas William H., and John Robert H., living at 22, Belmore Street, and visiting 10, Ely Place, aged 6 and 2½ years, both unvaccinated, who sickened with Smallpox, and were removed to Hospital on the same days, viz.: May 10th and 20th respectively. Indirectly, other cases arose. Thus, Alice A., of 7, Meadow Place, infected Margaret H., aged 10 years, vaccinated in infancy, living at 4, Stamford Buildings, South Lambeth Road. Margaret H., sickened May 7th, but was thought to be suffering from Chicken-pox. Consequently, she was not removed to Hospital until May 25th, having meanwhile infected (a) Beatrice Alice H., aged 14 years, unvaccinated, living at 4, Stamford Buildings, who sickened with Smallpox on May 22nd and was removed to Hospital on May 24th; (b) Emma Fanny H., aged 16 years, vaccinated in infancy, living at 4, Stamford Buildings, who sickened with Smallpox on May 20th and was removed to Hospital on May 26th; and (c) Ernest L., aged 27 years, vaccinated in infancy, living at 26, Landor Road and accustomed to visit at 4, Stamford Buildings, who sickened with Smallpox on May 30th and was removed to Hospital on June 2nd. Alice A., of 7, Meadow Place, also infected Charles W., aged 13 years, vaccinated in infancy, living at 8, Walton Terrace, South Lambeth Road, who sickened on April 22nd, but, the disease being diagnosed as Chicken-pox was not removed to Hospital. Charles W. infected (1) his brother, Walter W., aged 6 years, unvaccinated, who sickened on May 6th but was not removed to Hospital for the same reason that his brother was not; and (2) his mother, Cassie W., aged 38 years, vaccinated in infancy, who sickened on May 20th, but was not removed to Hospital, her disease being diagnosed by the Medical Attendant as Chicken-pox, though she infected with Smallpox her husband, Charles W., aged 39 years, vaccinated in infancy, who sickened June 5th and was removed to Hospital on June 9th. From 22, Belmore Street, 3 other cases arose directly, as follows:— (a) Amelia C., aged 32 years, vaccinated in infancy, living at 29, Conroy Street, who sickened with Smallpox on May 26th, and 51 was removed to Hospital on May 31st, having caught the disease at St. Thomas' Hospital, where she was attending with the children from 22, Belmore Street; (b) Arthur Walter H., aged 3 months, unvaccinated, living at 9, Richmond Place, Belmore Street, who sickened on May 31st and was removed to Hospital on June 6th, after infecting (1.) Frederick C., aged 52 years, vaccinated in infancy, who sickened with Smallpox at 9, Richmond Terrace on June 14th and was removed to Hospital on June 17th; (2.) Elizabeth Emma L., aged 19 years, vaccinated in infancy, living at 9, Vauxhall Mansions, Glasshouse Street, and visiting at 9, Richmond Terrace, who sickened on June 17th and was removed to Hospital on June 20th. (c) Charlotte C., aged 32 years, vaccinated in infancy, living at 13, Brookland Street, who sickened on June 5th and was removed to Hospital on June 9th, after having infected her husband, Edward Charles C., aged 27 years, vaccinated in infancy, who sickened on June 20th, and was removed to Hospital on June 22nd. The above 15 cases are all connected, directly or indirectly, one with the other, having started from Thomas Webster V. (case 9), and show how easily Smallpox spreads by contact from person to person, from house to house and even from locality to locality, until from one or two separate cases an outbreak or epidemic may arise, unless great care is taken in following up all “Contacts.” Notification (prompt), isolation (immediate), and disinfection (efficient), together with the following up carefully of all “Contacts,” and vaccination, are the means whereby Sanitary Authorities must be, at all times, prepared to battle with an outbreak of Smallpox—more especially in these present days of neglected vaccination and revaccination. 52 Diagrammatically, personal contact shows as the important factor in connection with the 15 cases mentioned above; thus:— All these cases fit in, one with another, like a Chinese Puzzle. N.B. * Not removed to Hospital. 53 Of the 23 cases, 15 were connected with the one outbreak (introduced from Southwark Borough), and the 8 other cases may be classified as follows:— (1.) Contacts with previous cases. (a) Lambeth 4. (b) Elsewhere 3. (2.) Introduced from abroad 1. Up to the date of this Report being written (February, 1905), no further case of Smallpox has been notified in Lambeth Borough since the case of Edward Charles C., who sickened June 20th, 1904, and was removed to Hospital on June 22nd, 1904. During 1904, 47 suspicious cases of Smallpox were reported to the Medical Officer for confirmation, and of these, 5 were diagnosed as Smallpox, 23 as Varicella (Chicken-pox), 9 as Scarlet Fever, 3 as Influenza, 2 as Porriginous Eczema, 2 as Purpuric Erythema, 1 as Porrigo, 1 as Acne, and 1 as Roseola. "Contacts'' or "Suspects." In connection with the 23 Lambeth cases of Smallpox, a number of inside (Lambeth) "Contacts" or "Suspects" were under observation, each "Contact" or "Suspect" being watched for 16 days from the date of contact—a total of 291, of which 78 were under 10 years of age, and 213 were 10 years of age and over. The vaccination-states of all these inside "Contacts" or "Suspects" were registered, and the results may be tabulated as follows:— Vaccination States. Number sickening with Smallpox. 291 213 Adults Re-vac. or had Smallpox, 39 1 Vaccinated, 169 8 Unvaccinated, 5 1 78 Children Vaccinated, 57 1 Unvaccinated, 21 3 There were, in addition, 36 outside "Contacts" or "Suspects," 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 vaccination states may be tabulated as follows:— Vaccination States. Number sickening with Smallpox. 36 36 Adults —Children Re-vac. or had Smallpox, 9 Vaccinated, 27 Unvaccinated, 0 Vaccinated, 0 Unvaccinated, 0 0 0 0 0 0 Further, there were 3 Lambeth visitors to the "Ships," all adults (1 revaccinated, and 2 vaccinated in infancy), but not one sickened with Smallpox. Taking all the "Contacts" or "Suspects" together, inside and outside, the total numbers may be tabulated (with particulars as to their vaccinationstates, &c.) as follows:— 54 All "Contacts" or "Suspects." Vaccination States. Number Sickening with Smallpox. 330 Adults 252 Re-vac. or had Smallpox, 49 1(2.4 per cent.) Vaccinated, 198 8(4.04 per cent.) Unvaccinated, 5 1(20.0 per cent.) Children 78 Vaccinated, 57 1(1.8 per cent.) Unvaccinated, 21 3(14.3 per cent.) A large amount of work was involved in watching these 330 "Contacts" or "Suspects" for a period of 16 days each, but such work was absolutely necessary, for had the 14 new Smallpox centres not been immediately discovered and dealt with, the disease must have spread, and assumed epidemic proportions. Careful and systematic quarantine is of the greatest importance in Smallpox cases. 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 1901-4, 54, 350, 72, and 23 notifications, and 4, 60, 4, and 0 deaths respectively. The figures for London as a whole are:— 1901—1700 cases and 229 deaths. 1902—7796 cases and 1314 deaths. 1903—417 cases and 13 deaths. 1904—492 cases and 25 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 1903, and the first half of 1904 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 August of the following year, so that only the Returns for the first half of 1904 can be given in this Report. The total number of conscientious objectors who have obtained certificates during 1904, irrespective of the dates of birth of the children to which they relate, is 109, whilst the total numbers of successful primary vaccinations at all ages received during 1903 and 1904 are 7,185 and 7,643 respectively. 55 TABLE Q. VACCINATION RETURNS (LAMBETH BOROUGH), 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 1345 842 - 1ll 7 179* 205* Lambeth Church 1st 563 396 1 49 3 25 89 Lambeth Church 2nd 1509 927 — 129 4 148† 311† Kennington 1st 1788 1345 1 154 23 118‡ 156‡ Kennington 2nd 994 735 1 91 14 50 106 Brixton 2060 1524 6 175 30 28 278 Norwood 810 660 1 59 9 12 39 Lambeth 9069 6429 10 768 90 560 1184 * Hospital Cases (263) included. †Workhouse (113) cases included. ‡Maternity cases (198) included. 56 TABLE R. VACCINATION RETURNS (LAMBETH BOROUGH) FOR THE FIRST HALF-YEAR, 1904. Registration Sub-Districts. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinated. Conscientious Objectors. Removed to other Parishes. Gone and not found. Waterloo 645 437 - 70 1 20* 108* Lambeth Church 1st 285 188 — 24 1 5 63 Lambeth Church 2nd 767 482 2 71 3 25† 168† Kennington 1st 939 667 — 101 10 74‡ 75‡ Kennington 2nd 507 391 — 35 5 25 39 Brixton 1042 767 2 99 20 10 115 Norwood 414 331 1 24 10 5 14 Lambeth 4599 3263 5 424 50 164 582 The Yearly Returns are not made up for the Local Government Board until the August in the following year. *Hospital cases (134) included. †Workhouse cases (57) included. ‡Maternity cases (87) included. 57 SCARLET FEVER. During 1904, in the Borough of Lambeth, 660 cases of Scarlet Fever were notified, and 16 deaths registered, giving a casemortality of 2.4 per cent.—4.9 for the Inner, and 1.5 for the Outer Districts. In 1903, there were 744 cases notified and 23 deaths registered, i.e., a case-mortality of 31 per cent.—6.6 for the Inner, and 18 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 660 persons notified in the Borough of Lambeth during 1904, 549* (i.e., 83.2 per cent. were removed to Hospital, and of these, 16 died (i.e., 2.9 per cent.), whereas 111 (i.e., 16.8 per cent.) were treated at home, and of these, none died. This difference in case-mortality as between Hospital-and hometreated 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 Scarlet Fever per 1000 of the population have been steadily decreasing during the last few years in Lambeth Parish, and are below the average during 1904 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 660 Scarlet Fever cases notified in Lambeth Borough during 1904 are as follow:— * Of the 549 cases of Scarlet Fever removed to Hospital, 50 proved not to be suffering from that disease. These 50 cases must, therefore, be deducted from the total 660 notified during 1904. 58 Age. Number of Cases Notified. Deaths. Death Rate per 100. M. F. Total. M. F. Total. Under 1 year - 2 2 - 1 1 50.0 1 to 2 12 11 23 — 1 1 4.3 2 to 3 14 16 30 2 1 3 10.0 3 to 4 23 31 54 1 — 1 1.9 4 to 5 18 35 53 1 1 2 3.8 5 to 6 37 35 72 2 1 3 4.2 6 to 7 28 31 59 — — — — 7 to 8 24 22 46 1 — 1 2.2 8 to 9 12 18 30 1 — 1 3.3 9 to 10 40 24 64 — — — — Over 10 years 116 111 227 2 1 3 1.3 Total 324 336 660 10 6 16 2.4 It will be noted that, of the total 660 persons reported as suffering from Scarlet Fever during 1904 within the Borough of Lambeth, 162 (i.e., 24.5 per cent.) were under five years of age, and 433 (i.e., 65.6 per cent.) under 10 years of age : whilst the mortality was greatest amongst those under 1 year of age and between the ages of 2 to 3 years, viz., 50 and 10 per cent. respectively. Of the 227 persons over 10 years of age, 3 (i.e., 1.3 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 1904 is seen from the following:— 59 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 54 7 47 - 5 5 9.3 2.9 Waterloo Road 2nd 25 2 23 — — — — Lambeth Church 1st 19 3 16 — — — — 1.03 Lambeth Church 2nd 84 17 67 — 4 4 4.8 2.1 Kennington 1st 72 1 71 - 1 1 1.4 1.3 Kennington 2nd 186 30 156 — 3 3 1.6 4.2 Brixton 171 35 136 — 3 3 1.8 1.9 Norwood 49 16 33 — — — — 1.3 Borough of Lambeth 660 111 549 — 16 16 2.4 2.1 Rate of Persons notified per 1,000 inhabitants—2.1 Inner Districts, and 2.1 Outer Districts. Of the 549 cases removed, 27.9 per cent. were from the Inner, and 72.1 per cent. from the Outer, Districts. In London, during 1904, there were registered 365 deaths out of a total of 13,435 cases of Scarlet Fever notified, giving a casemortality of 2.7 per cent. (uncorrected). As far as could be traced, no Scarlatinal Milk outbreak occurred in the Borough of Lambeth during 1904, and only one school (Stockwell Orphanage) had to be dealt with specially on account of an outbreak of Scarlet Fever amongst the scholars. The outbreak at Stockwell Orphanage was a somewhat serious one, the disease being introduced, in the first place, from without, and spreading afterwards by contact from scholar to scholar. The outbreak began in 1903 (last quarter), and continued during 1904, as follows :— 60 Cases Notified. 1903—September 5 October 4 November 4 December 10 Total 23 Cases Notified. 1904—January 4 February 1 March 5 April — May — June 13 July 19 August — September 3 October 30 November 9 December 7 Total 88 All the patients were removed to Hospital as soon as the Medical Attendant was satisfied that the disease was Scarlet Fever, and a preliminary isolation in the School Infirmary took place in all doubtful cases. This School Infirmary is, unfortunately, placed somewhat near to the Main Buildings (in which the boys and girls live)—the playground practically adjoining it. Further, a certain amount of inter-communication takes place in other directions between the Infirmary inmates and those in the Main Buildings, e.g., girls and boys who are in attendance at the Infirmary during the day, are allowed to return to the Main Buildings to sleep at night ; all inmates, who complain of illness, are seen by the Medical Superintendent at the Infirmary 61 (downstairs) and, after being examined or treated, return to the Main Buildings, unless suffering from symptoms of suspected infectious complaints, in which case they are isolated at the Infirmary (upstairs). The general arrangement of the Buildings may be described as a square. One side is made up by the entrance gates (in the centre) with the Dining Hall and Boys' School on the left, and the Staff Offices and the Girls' School on the right; whilst the two adjacent sides contain, on the right, the Girls' Blocks (6 in number), and, on the left, the Boys' Blocks (6 in number), and the fourth side (opposite the entrance gates) is formed by the Infirmary block and Swimming Bath. The pupils and staff live on the premises, but mix with the outside world on occasions, running, thereby, the usual risks of infection. There can be but little doubt that the first case was introduced from without into the Girls' blocks in September, 1903, and spread through the medium of mild unrecognised cases, causing a total of 23— 22 girls and 1 boy—from September 16th up to the end of the year 1903 (10 being notified in December). 10 further cases occurred in the Girls' blocks during the first quarter of 1904, and it was thought that the outbreak was stamped out successfully in that no single case was notified during the 2 following months (April and May). Unfortunately, the disease re-appeared in the Boys' Blocks in June, and cases occurred off and on until the end of the year 1904, both in the Boys' and the Girls' Blocks (chiefly the former)—a total of 91 cases (69 boys, 19 girls and 3 officers) for the year 1904.* Up to the end of 1904, the outbreak, which began in September, 1903, has consisted of 114 cases—70 boys, 41 girls and 3 officers, and, taking the average number of inmates of the Orphanage as 210 boys, 230 girls and 35 officers, the incidence percentages work out at 33.3 (boys), 17.8 (girls), and 8.6 (officers), respectively. * Up to the time of writing this Report (end of February), 5 cases (3 girls and 2 boys) have been notified during 1905. 62 The outbreak began in 1903 in the Girls' Blocks and spread, after 3 months, to the Boys' Blocks—every Block, 12 in number, being infected. The majority of the cases were mild and no single death occurred. The causes of the disease spreading may be tabulated as follow :— (a) Mild and unrecognised cases. (b) Aggregation of susceptible persons. (c) Proximity of Infirmary to playground and main buildings. (d) Intercommunication between inmates of Infirmary and those of main buildings. (e) Practical difficulties in closing the buildings and sending the inmates to their homes—many of the children having no homes to go to. (f) Intercommunication between the girls and boys in the dining room, etc. (g) State of drainage. The preventive measures taken were as follow:— (a) Prompt isolation, and removal to Hospital, of all cases ; (b) Efficient disinfection ; (c) Medical inspection (daily) of all children for suspicious throats, etc. ; (d) Limiting, as far as practicable, all intercommunication between the Infirmary and main buildings ; (e) Closing of the Schools. During 1904, "return" or "secondary" cases connected with Scarlet Fever have been carefully investigated—the Metropolitan Asylums Board giving previous intimation of all discharged patients. During 1904, such intimations have been received, 63 dealing with all discharged Lambethian patients, who had been treated for Scarlet Fever (as well as for Diphtheria, etc.) in the. Hospitals. In no single instance was any cause for complaint found—the Lambeth experience being that the Metropolitan Asylums Board take every precaution to minimise, as far as possible, the numbers of these so-called "return cases" (vide Special Report in the Appendix, pp. 43.4). In view of this fact, the Lambeth Borough Council decided on April 28th, 1904, not to support the Borough of Poplar in their letter of complaint (dated March 17th, 1904) of alleged mal-administration by the Metropolitan Asylums Board in prematurely discharging a Scarlet Fever patient, thereby causing a spread of the disease to others. 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 1904, 164 and 109 deaths were registered from Measles and Whooping Cough, giving death-rates per 10,000 of the population of 5.3 and 3.5 respectively. In London, during 1904, there were registered 2,261 and 1,507 total deaths from Measles and Whooping Cough, giving corresponding death-rates of 4.9 and 3.1 per 10,000 of the population respectively. Taking the Lambeth Registration Sub-Districts, it will be seen that Waterloo and Lambeth Church First suffered most, and Brixton and Norwood least, from Measles ; whilst Lambeth Church First and Second suffered most, and Kennington Second and Norwood least, from Whooping Cough (vide pages 68,100-1). The Inner Districts suffered (deaths per 10,000 of the population) twice and thrice as much respectively as the Outer Districts, thus :— Inner. Outer. Whooping Cough 5.5 2.8 Measles 10.1 3.4 64 Comparing the Borough statistics for 1904 with those for the old Parish for 10 years (1891-1900), it will be seen that there has been a loss during 1904 of 20 deaths from Measles over the average for that decennium, and a saving of 35 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 on 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. Measles is not compulsorily notifiable, but, through Board Schools, 1,929 cases (during 1904) were 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, pp. 72.3). Of the 164 deaths from Measles in Lambeth Borough during 1904, 158 (i.e., 96'3 per cent.) occurred amongst children under 5 years of age, shewing that Measles is a disease of young children, and especially fatal to such. 46 of the deaths (i.e., 28.05 per cent.) occurred amongst infants under 1 year of age. During 1904 in the Borough of Lambeth, disinfection has been carried out in connection with 1,294 Measles-infected houses as compared with 1,346, 364, 728, and 941 during 1903, 1902 1901 and 1900 respectively. Measles is spread chiefly through Schools, especially Infants' Departments, and during 1904 special precautions have been taken in respect thereto, as follows :— 65 Stockwell Road School (Infants' Department).—Classroom F. was closed on February 1st, 1904, for a period of 2 weeks on account of 3 cases of measles having occurred, and being (it was expected) the precursors of an outbreak. There had previously been an outbreak just before the Christmas Holidays, 1903 (8 cases in three days), but no action was taken at that time in regard to closure on account of the holidays. The usual disinfection was carried out. Result of closure was a decline in the number of cases of measles. Cormont Road School {Infants' Department).—Classrooms C. and B. were closed on February 4th, 1904, for a period of 2 weeks on account of 9 new cases of Measles having occurred, and being (it was expected) the precursors of an outbreak. Before the Christmas Holidays Measles had been rife in the Girls' Department, and since the return of the scholars after the vacation several cases had occurred in the Infants' Department, there being 3 cases during the week ending January 29th, and 12 during the week ending February 5th, 1904. The usual disinfection was carried out. Result of closure was a decline in the number of cases. St. Paul's School, Vauxhall Walk (Infants' Department).—The Infants' Department was closed for 21 days on February 19th, 1904, on account of an outbreak of Measles (rising epidemic)— 42 per cent, of the infants being absent on account of Measles. Usual disinfection was carried out. Result of closure was a decline (rapid) in the number of cases. Walnut Tree Walk School (Infants' Department).—Classroom B. was closed on March 26th, 1904, for a period of 2 weeks on account of 4 cases of Measles (a rising epidemic). The usual disinfection was carried out. Result of closure was a decline in the number of cases of Measles. Hackford Road School (Infants'' Department).—Classrooms A and C. were closed on April 29th, 1904, for a period of 2 weeks e 66 on account of 13 cases of Measles (a rising epidemic). The usual disinfection was carried out. Result of closure was a decline in the number of cases. St. Mary's School, Prince's Road (Infants' Department).—The Infants' Department was closed on May 6th, 1904, for a period of 3 weeks on account of an outbreak of Measles (with a few cases of whooping cough also), by which the attendance of scholars had been reduced 30 per cent. during the past few weeks (rising epidemic). The usual disinfection was carried out. Result of closure was a marked decline in the number of cases of Measles (and Whooping Cough). Priory Grove School (Infants' Department).—Classroom F. was closed on May 16th, 1904, for a period of 2 weeks on account of 10 cases of Measles (rising epidemic). The usual disinfection was carried out. Result of closure was a decline in the number of cases of Measles. Stockwell College (Infants' Department).—The Infants' Department (Classes I., II., and III.) was closed on June 1st, 1904, for a period of 3 weeks on account of an outbreak of measles (rising epidemic), by virtue of which the attendances of the scholars were reduced 30 per cent. in Class I., and 16 per cent. in Classes II. and III. The usual disinfection was carried out. Result of closure was a rapid decline in the number of case of Measles. Kennington Road School (Infants' Department).—Classrooms A. aud B. were closed on July 1st 1904, for a period of 2 weeks on account of 8 cases of Measles (rising epidemic). The usual disinfection was carried out. Result of closure was a decline in the number of cases of Measles. Efftra Parade School (Infants' Department).—Classroom C. was closed on November 1st, 1904, for a period of 2 weeks on account of 4 cases of Measles (rising epidemic). The usual disinfection was carried out. Result of closure was a decline in the number of cases. 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, officially closed, but simply disinfected and cleansed. The Lambeth experience during 1904 (as in previous years) 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, therefore, of the greatest value in stamping it out, though the value of such closure is not so great when the epidemic is already disseminated throughout a school. Where such epidemic is a declining one school closure is of little use. Whooping Cough. Whooping Cough is also a serious disease, especially to young children. Of the 109 deaths registered in Lambeth Borough during 1904 from this disease, 105 (i.e., 96.3 per cent.) occurred in children under 5 years of age, and 45 of the deaths (i.e., 41.3 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 from school 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, at present, regarded as a harmless complaint of childhood, and the ignorance displayed, and the apathy shown, in regard to these diseases are well known to all who visit amongst the poorer classes. 68 During 1904 in the Borough of Lambeth, disinfection has been carried out in connection with 380 Whooping Cough-infected houses, as compared with 325, 110, 72 and 126 during 1903, 1902, 1901, and 1900 respectively; and leaflets (dealing with the dangers and treatment of this disease) left at all known Whooping Cough infected houses.* No School nor Class was closed during 1904 on account of Whooping Cough. Details of the incidences of Measles and Whooping Cough in the different Registration Sub-Districts of Lambeth Borough during 1904 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 Waterloo Road 2nd Lambeth Church 1st Lambeth Church 2nd Kennington 1st Kennington 2nd Brixton Norwood District not stated † Borough of Lambeth 2 6 13 25 18 9 25 10 1 109 14 15 27 31 23 23 22 7 2 164 3.04 7.2 6.3 3.3 2.1 2.8 2.6 3.5 10.9 14.8 7.8 4.3 5.3 2.6 1.9 5.3 *Whooping Cough is not a compulsorily-notifiable disease, but 431 cases were voluntarily notified during 1904 by Board School Teachers (vide Appendix, p. 72). † Where the District is not stated, the deaths (or death) are divided equally amongst the other Districts before calculating percentages. 69 CHICKEN-POX. When the number of cases of Smallpox began to increase in London (East-end) in 1904 (March), the London County Council made an Order for the compulsory notification of Chicken-pox throughout the County of London for a period of 4 calendar months as and from April 8th, 1904; and this Order was extended for a further period of 3 calendar months as and from August 8th, 1904. In other words, Chicken-pox was compulsorily notifiable throughout the County of London (including Lambeth Borough) for a period of 7 calendar months during 1904, viz., from April 8th to November 8th, during which period 556 cases (representing infected houses) were notified in Lambeth Borough by medical practitioners as follows:- Ages of Cases of Chicken-Pox Notified Compulsorily by Medical Men in Lambeth Borough from April 8th to November 8th, 1904. Ages. Months—1904. Totals. April (from 8th) May June July August September October November (up to 8th) Under 1 year 12 8 16 8 6 4 5 2 61 1—2 14 4 5 8 6 1 2 2 42 2—3 4 16 8 6 4 2 4 1 45 3— 4 12 6 16 7 6 4 4 2 57 4—5 10 19 22 18 2 4 4 2 81 5—6 14 10 12 9 1 1 3 2 52 6—7 6 12 17 7 2 2 10 4 60 7—8 6 10 8 8 3 3 5 2 45 8—9 5 7 3 1 2 4 5 1 28 9—10 5 3 4 1 2 1 4 2 22 10—11 3 4 1 3 1 1 2 2 17 11—12 2 - 4 3 1 2 3 1 16 12 and over 5 10 7 2 1 3 1 1 30 Totals 98 109 123 86 37 32 52 24 556 70 In the whole of London, 10,940 cases of Chicken-pox were notified during the same period of 7 months by medical practitioners. In addition to the 556 cases of Chicken-pox compulsorily notified in Lambeth by medical practitioners from April 8th to November 8th, 1904, 525 cases were voluntarily reported during 1901, through the medium of schools. In all cases, disinfection was carried out as required. No school nor class had to be closed during 1904 on account of Chicken-pox. CHOLERA AND PLAGUE. In Lambeth Borough, during 1904, no case of Plague, suspected or otherwise, was notified; but 3 "contacts" or "suspects" were watched in connection with Plague abroad. 4 deaths from Cholera were registered during 1904 as having occurred within the Borough of Lambeth, but these were, probably, deaths from Epidemic Diarrhoea (3 in infants under 1 year of age), and have, consequently, been included amongst the Diarrhoea deaths (vide pp. 81-4). No case of Cholera was notified within the Borough during 1904, but "contacts" or "suspects" were watched in connection with Asiatic Cholera abroad. No case of Plague, but 1 case of Cholera (Kensington), was notified in London during 1904. DIPHTHERIA. During 1904, 33 deaths were registered in the Borough of Lambeth from Diphtheria, and a total of 317 cases notified, giving a case-mortality of 10.4 per cent. Of the 317 cases notified, 242* (i.e.,76.3 per cent.) were removed to Hospital, and 25 died, * Of the 242 cases of Diphtheria removed to Hospital, 27 proved not to be suffering from that disease. These 27 cases must, therefore, be deducted from the total 317 notified during 1904. 71 giving a case-mortality of 10.3 per cent. amongst the patients treated in Hospital; whilst 75 (i.e., 23.7 per cent.) were treated at home, and 8 died, giving a case-mortality of 10.7 per cent. amongst the patients treated at home. The case-mortality rate for the whole of the Borough of Lambeth during 1904 is low, pointing to (1) the mildness of the majority of cases notified, and (2) the great value of antitoxin* in the treatment of Diphtheria in the very early stages of the disease. The sudden decrease in the number of Diphtheria cases throughout the new Borough of Lambeth during 1904 is again remarkable, as it was during 1903, 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 1904 there has been a decrease in the mortality-rate, in comparison, of 74.2 percent. So, too, if the number of notifications received during 1904 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 55'7 per cent. The yearly average of notifications for the old Parish is 715, and the number received for the Borough for 1904 is 317. Fortunately the comparison can be extended further, and made for many years past, as the statistics for Diphtheria have been worked out in connection with the old Parish, and are shown on the following page (72), 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 * 69 Bottles of antitoxin have been gratuitously distributed in Lambeth Borough during 1904 as compared with 45 during 1903. 7 2 from Diphtheria is most remarkable, and, when taken in conjunction with the equally extraordinary and equally sudden decrease in the number of notifications of the same disease received, points to a sudden decline in the prevalence of Diphtheria throughout the Borough of Lambeth during 1904, as well as during 1903, 1902 and 1901; and that, too, although Diphtheria has been rising slowly but surely in epidemic proportions for the previous 20 years ending 1900. The statistics for London, as a whole, are no less remarkable. Quinquennial Period. Population (estimated). Number of Deaths. Death-Rate per million living. Old Parish of Boro' Lambeth. 1863—1867 1868—1872 1873—1877 1878—1882 1883—1887 1888—1892 1893—1897 1898—1900 1901 1902 1903 1904 902119 1021165 1132106 1245913 1313211 1367734 1443857 924333 302533 305102 307711 310359 148 96 184 255 365 537 683 362 47 49 28 33 164 94 163 205 278 393 483 392 155 160 91 106 The age and sex incidence and mortality from Diphtheria cases notified in the Borough of Lambeth during 1904 are as follow:— 73 Diphtheria. Ages. No. of Cases Notified. Deaths. Death Hate per 100. M. F. Total. M. F. Total. Under 1 year 3 2 5 - 2 2 40.0 1 to 5 66 46 112 10 8 18 16.1 5 to 10 45 52 97 4 6 10 10.3 10 to 20 21 42 63 — 1 1 1.6 20 to 40 8 19 27 1 — 1 3.7 40 to 60 3 10 13 — 1 1 7.7 60 and over - - - — — - — Total 146 171 317 15 18 33 10.4 During 1904, 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 deaths amongst both hospital, and home-treated patients, etc., during 1904, 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 12 - 12 - 4 4 35.3 }0.9 Waterloo Rd. 2nd 13 3 10 2 3 5 38.5 Lambeth Ch. 1st 15 2 13 — — — — 0.8 Lambeth Ch. 2nd 50 16 34 1 2 3 6.0 1.3 Kennington 1st 61 8 53 - 2 2 3.3 1.1 Kennington 2nd 70 29 41 2 5 7 10.0 1.6 Brixton 72 10 62 1 8 9 12.5 0.8 Norwood 24 7 17 2 1 3 12.5 0.6 Borough of Lambeth 317 75 242 8 25 33 10 4 1.02 74 190 swabs from suspected diphtheria throats were examined at the Laboratory during 1904, and, of these, 19, i.e., 10.0 percent., shewed the presence of the true klebs-Lœffler (diphtheria) bacilli. No "return" cases have been found during 1904 connected with the intimations of discharged Lambeth patients received from the Metropolitan Asylums Board. 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. During 1904, 69 vials have been distributed gratuitously in Lambeth Borough by the Council. MEMBRANOUS CROUP. During 1904, in the Borough of Lambeth, 11 cases were notified from Membranous Croup, and 1 death was registered, giving a case-mortality of 9.1 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). 3 cases were removed to Hospital. In London, during 1904, there were registered 729 deaths, out of a total of 7,224 cases of Diphtheria and Membranous Croup notified, giving a case-mortality of 10.1 per cent.† (uncorrected). TYPHOID FEVER. During 1904, 11 deaths were registered in the Borough of Lambeth from Typhoid (Enteric) Fever, and a total of 101 cases notified, giving a case-mortality of 10.9 per cent. Of the 101 * Antitoxin first gratuitously distributed in Lambeth by the late Vestry on August 3rd, 1899. † In London Statistics, Diphtheria and Membranous Croup are now grouped together by the Registrar-General. 75 cases notified, 73* (i.e., 72.3 per cent.) were removed to Hospital, and 9 died, giving a case-mortality of 12.3 per cent. amongst the patients treated in Hospital ; whilst 28 (i.e., 27*7 per cent.) were treated at home, and 2 died, giving a case-mortality of 7.1 per cent. amongst the patients treated at home. The case-mortality rate for the whole of the Borough of Lambeth during 1904 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-Gaftky 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 1904, and the yearly averages for 10 years (1891-1900) in the old Parish of Lainbeth, 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 101 and 11 respectively as the numbers of notified cases and deaths in the Borough of Lambeth during 1904. The age and sex incidence and mortality for Typhoid cases notified in Lambeth Borough during 1904 are as follow:— * Of the 73 cases of Typhoid Fever removed to Hospital, 19 proved not to be suffering from that disease. These 19 cases must, therefore, be deducted from the total of 101 notified during 1904. 76 Ages. Number of Cases Notified. Deaths. Deathrate per 100. M. F. Total. M. F. Total. Under 1 year - - - - - - - 1 to 5 4 1 5 — — — — 5 to 10 12 4 16 1 — 1 6.3 10 to 20 13 10 23 — — — — 20 to 40 27 22 49 5 4 9 18.4 40 to 60 3 4 7 — 1 1 14.3 60 and over 1 — 1 — — — - Total 60 41 101 6 5 11 10.9 It will be noted that there were no cases notified and no deaths registered, in infants under 1 year of age; no deaths registered amongst children between 1 and 5 years of age; and only 1 death registered in children between 5 and 10 years of age; 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 again be seen that the casemortality is lower in the Inner than in the Outer Districts, viz., 6'7 per cent., as compared with 14.3 per cent. The reason for this is not clear, as the contrary generally is the case, the casemortality being greater in the Inner, more congested, and less sanitary Districts. The incidence of the disease in the Inner and Outer Districts respectively during 1904 is as 2 to 1. Details as to the incidence of the disease during 1904 upon the different Registration Sub-districts of the Borough of Lambeth are as follow:— 77 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 5 1 4 — — — — }3.4 Waterloo Road 2nd 4 1 3 — — — — Lambeth Church 1st 7 — 7 — 1 1 14.3 3.8 Lambeth Church 2nd 29 7 22 — 2 2 6.9 7.3 Kennington 1st 13 5 8 — 2 2 15.4 2.4 Kennington 2nd 21 11 10 1 1 2 9.5 4.8 Brixton 17 2 15 1 2 3 17.7 1.9 Norwood 5 1 4 — 1 1 20.0 1.3 Borough of Lambeth 101 28 73 2 9 11 10.9 3.2 Of the 98 Typhoid-infected houses 53 (i.e., 54.1 per cent.) showed, on inspection, defective drains, traps, fittings or appliances. In 12 (i.e., 12.2 per cent.) the drains themselves were found to be defective. 16 cases were traced to sources outside the Borough, and 8 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 25 cases (24.7 per cent.) of shellfish having been eaten by the patients notified 1 to 3 weeks previous to the disease developing ; but in this connection the number of persons who eat shell-fish, and do not get Typhoid, must be remembered. 60 samples of blood were examined at the Bacteriological Laboratory during 1904 (see p. 176) for the Widal Reaction of Typhoid, and in 11 cases (i.e., 18.3 per cent.) such reaction was obtained. 78 In so far as Typhoid Fever is regarded as a sanitary index of a district, the statistics for Lambeth Borough during 1904 are, in that respect, of a most satisfactory character. In London during 1904 there were registered 296 deaths (uncorrected) out of a total of 1902 cases of Typhoid notified, giving an uncorrected case-mortality of 15.6 per cent. CONTINUED AND TYPHUS FEVERS. During 1904, 4 cases of Continued Fever were notified in the Borough of Lambeth, but no deaths were registered, as compared with yearly averages for 10 years (1891-1900) in the Parish of Lambeth of 25.7 and 2.2 respectively. In London, 28 cases were notified and 6 deaths registered from Continued Fever during 1904, 'giving a case-mortality of 21.4 per cent. (uncorrected). No case of Typhus was notified during 1904 in Lambeth Borough, but 3 cases were notified in London (no deaths). PUERPERAL FEVER. During 1904, in the Borough of Lambeth, 8 deaths were registered from Puerperal Fever (a disease of child-bed), and 15 cases notified, giving a case-mortality of 53.3 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 1903, 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. 9,059 births were registered in the Borough of Lambeth during 1904, and in only 15 cases was Puerperal Fever notified-—a most satisfactory 79 fact to be able to report. Of the 15 cases notified, 3 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 cautioned, but in no instance was it found necessary to take legal action against any Midwife. In London, during 1904, there were registered 198 deaths out of a total of 274 cases of Puerperal Fever notified, giving a case-mortality of 72.3 per cent. (uncorrected). ERYSIPELAS. During 1904, in the Borough of Lambeth, 251 cases of Erysipelas were notified, and 14 deaths registered, giving a casemortality of 5.6 per cent. Of the 251 cases, 50 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 1903, 236 cases were notified, and 14 deaths registered, from Erysipelas, within the Borough of Lambeth. In London, during 1904, there were registered 232 deaths out of a total of 4,952 cases of Erysipelas notified, giving a casemortality of 4.7 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 1904 are as follow:— 80 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 2 1 50.0 19 — 0.0 Waterloo Road 2nd — — — 9 4 44.4 Lambeth Church 1st 1 — 0.0 19 — 0.0 Lambeth Church 2nd 1 1 100.0 76 3 3.9 Kennington 1st 3 1 33.3 36 1 2.8 Kennington 2nd 2 2 100.0 25 2 8.0 Brixton 5 3 60.0 53 3 5.7 Norwood 1 — 0.0 14 1 7.1 Borough of Lambeth 15 8 53.3 251 14 5.6 81 DIARRHŒA. During the year 1904, there were registered, in the Borough of Lambeth, 269 deaths from Diarrhoea,* as compared with 160 during 1903 (vide p. 91, 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 1904 for the Borough are 40'7 per cent. more. Of these 269 deaths, 261 (i.e., 97'03 per cent.) were in children under 5 years, and 222 (i.e., 82.5 per cent.) in infants under 1 year of age. July, August and September were the most fatal months (see Table S). In this connection, it is again interesting to note that the mean monthly air temperature was in June, 58.5 deg.; in July, 66.2 deg.; in August, 62.4 deg.; in September, 55.8 deg.; and in October, 50.6 deg. ; whilst the 4-ft. earth thermometer registered 56 deg. F. on June 21st, rising to a maximum 64.0 deg. F. on several days between July 26th and August 12th, and sinking to 56 deg. F. again on October 6th. 56 deg. F. is the so-called "critical" earth temperature for Diarrhœa, i.e., the temperature at which the germs of this particular disease begin to multiply, and prove themselves dangerous.† Hence its importance statistically, in connection with this disease, which, though it kills chiefly young children, attacks persons of all ages—a fact not generally recognised. * Including 4 deaths registered from Cholera-Nostras. † The 4ft. earth temperatures were taken in Regent's Park, and thanks are due to Mr. Wm. Marriott, of the Royal Meteorological Society, 70, Victoria Street, S.W., for the information in connection therewith. f+6 82 Age mortalities from Diarrhœa were as follow:— Age. Total Deaths. Percentage of Total Deaths from Diarrhœa. M. F. Total. Under 1 year 127 95 222 82.5 1 to 5 16 23 39 14.5 5 to 20 — — — — 20 to 40 — 1 1 0.4 40 to 60 4 1 5 1.9 Over 60 — 2 2 0.7 Total 147 122 269 100.0 In London there were registered, during 1904, 4,801 deaths from Diarrhœa, giving an uncorrected rate of 10.4 per 10,000 living, and one of 6.2 per cent. of total deaths. The details as to the Diarrhoea incidence (mortality) during 1904 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 25 }13.8 Waterloo Road 2nd 12 Lambeth Church 1st 28 15.2 Lambeth Church 2nd 50 12.5 Outer. Kennington 1st 59 10.9 Kennington 2nd 30 6.8 Brixton 39 4.4 Norwood 26 6.7 Borough of Lambeth 269 8.7 83 In the Inner Registration Sub-districts, the Diarrhœa deathrate per 10,000 inhabitants was 13.5 as compared with 6.8 for the Outer Districts i.e., 2 to 1—a condition of things which is generally found to obtain, and which is readily understood when the crowded state of the Inner Districts is remembered. It will be noted that the 4-ft. earth temperature had a very low register during 1903, and, as a natural consequence, the Diarrhœa deaths were very few in number, exceptionally so. During 1904, the 4-foot earth temperature was reached, at a later date, but attained a higher maximum temperature, which it maintained for a longer period, with the result that the diarrhœa death-rate was increased from 5.2 to 8.7 per 10,000 population. Under the heading of Diarrhœa have been classed the 4 deaths of Cholera-Nostras registered, as there is no reason to regard them otherwise than as deaths from "Summer Diarrhœa"; and also the 89 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. During recent years there has been a marked improvement in the diagnosis of deaths from diarrhœal diseases, so that, to obtain comparable figures, attention should be paid not only to diarrhœa deaths certified, but also to all deaths arising from diseases of an enteritic nature, i.e., those in which the intestines are, more or less, congested. Comparison must be made with the corrected infantile mortality rate for the Borough, which is 137.8 per 1,000 births (vide p. 30). 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. 84 TABLE S. Shewing the Diarrhœa Mortality in Lambeth Bough in each mouth during the year 1904. Registration Sub-Districts. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Waterloo Road 1st 1 — — — — — 7 13 3 1 — — 25 Waterloo Road 2nd — — 1 — 1 — — 8 1 — 1 — 12 Lambeth Church 1st — 2 — 1 — — 4 18 2 1 — — 28 Lambeth Church 2nd 1 1 — — — — 14 24 10 — — — 50 Kennington 1st — 1 1 — — 2 10 39 6 — — — 59 Kennington 2nd — — — — — — 4 23 2 1 — — 30 Brixton — — 2 — — 2 — 23 10 1 — 1 39 Norwood — 1 1 — — — 2 14 6 2 — — 26 Total 2 5 5 1 1 4 41 162 40 6 1 1 269 N.B.—Including 4 cases registered from Cholera-Nostras in August (1), and September (3). 85 TUBERCULOSIS. During 1904, 447 deaths were registered in Lambeth Borough as due to phthisis (tuberculosis of the lungs), 93 as due to tabes mesenterica and tubercular meningitis, and 81 as due to other forms of tuberculosis, making a total of 621 deaths from tuberculosis (all forms)—i.e., 12.7 per cent, of the total deaths (corrected) registered from all causes. The total deaths within the Borough during 1903, 1902 and 1901 from all forms of tuberculosis were 639, 701 and 695 respectively. Sub-dividing the tuberculosis deaths during 1904 amongst the different Registration Sub-Districts, it is found that the rates (per 1,000 living) vary as follows : — Inner Districts—3.03 per 1,000 living. Outer Districts—1.61 per 1,000 living. Registration Sub-Districts. Deaths from Phthisis. rabes. Mes. and Tub. Men. Other torms Tuberculosis. Total Deaths Tuberculosis. Rate per 1,000 living. Waterloo 1st 27 5 5 37 „ 2nd 34 5 4 43 3.1 Lambeth Church 1st 31 7 8 4 6 2.6 „ „ 2nd 89 14 23 126 3.2 Kennington 1st 77 17 12 106 1.9 „ 2nd 53 16 7 76 1.1 Brixton 92 19 17 128 1.5 Norwood 33 9 5 47 1.3 District not stated 11 1 ... 12 ... Borough of Lambeth 447 93 81 162 2.001 86 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 1,000. In addition to the usual precautionary measures taken in connection with registered deaths from tuberculosis (disinfection, distribution of leaflets, etc.), the voluntary notification of consumption (with tuberculous expectoration) has also been in vogue during 1904 (having been commenced by the Borough Council on June 1st, 1902)—306 cases having been notified in 1904 as compared with 339 during 1903, and 315 during the seven months from June 1st to December 31st, 1902. In each notified 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 is accruing also from the measures taken in preventing not only the spread of the disease but also its development in susceptible persons. 188 samples of sputum were examined bacteriologically during 1904, and in 31.9 per cent, tubercle bacilli were found. The distribution of the disease in Lambeth Borough, judging by the voluntary notifications received during 1902.4, will be seen from an examination of Tables I. and II. following, dealing with (a) Wards and (b) Registration Sub-Districts:— 87 I.-CONSUMPTION NOTIFICATIONS, 1902-4. (Arranged in Wards so as to shew the varying incidences). Wards. 1902 1903 1904 Total 1902-4 Incidence Rate per 1000 population. Marsh 62 45 50 157 5.9 Bishop's 64 101 76 241 7.6 Prince's 52 72 66 190 3.9 Vauxhall 34 45 35 114 3.5 Total Inner Wards 212 263 227 702 5.03 Stockwell 16 17 15 48 1.4 Brixton 33 25 25 83 1.9 Herne Hill 21 16 27 64 1.9 Tulse Hill 20 6 4 30 1.04 Norwood 13 12 8 33 1.04 Total Outer Wards 103 76 79 258 1.5 Borough of Lambeth 315 339 306 960 3.1 88 II.-CONSUMPTION NOTIFICATIONS, 1902-4. (Arranged in Registration Sub-Districts so as to shew the varying incidences). Sub-Districts. 1902 1903 1904 Total 1902-4 Incidence Rate per 1000 Population. Waterloo Road 1st 32 23 19 74 5.9 Waterloo Road 2nd 29 23 31 83 Lambeth Church 1st 39 52 58 149 8.1 Lambeth Church 2nd 68 101 68 237 5.9 Total Inner Districts 168 199 176 543 6.4 Kennington 1st 44 63 52 159 2.9 Kennington 2nd 36 30 33 99 2.2 Brixton 55 36 37 128 1.4 Norwood 12 11 8 31 0.8 Total Outer Districts 147 140 130 417 1.9 Borough of Lambeth 315 339 306 960 3.1 It will be seen from the voluntary notifications received that the disease appears to have a greater incidence on the Inner than on the Outer Districts (whether Registration Sub-Districts or Wards), in the same way as the death-rate (per 1,000 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. It must be remembered, however, that the notification of consumption is voluntary, and that only a percentage of the cases are heard of. 89 Sanatoria for Consumptives. There is urgent need for the provision of Sanatoria for Metropolitan Consumptives, and it is to be hoped that the Local Government Board will authorise the Metropolitan Asylums Board to act as the Sanatorium Authority for London. The expenses connected with such a scheme will be great, more especially if all cases are to be dealt with—the disease in its early stages, when open-air treatment will do a maximum of good, and the disease in its late stages, when precautionary measures are so much needed to prevent the disease spreading to others. EPIDEMIC INFLUENZA During 1904, 36 deaths were registered from Influenza in the Borough of Lambeth, as compared with 52 during 1903, and an average of 107.5 for ten years (1891-1900) in the old Parish of Lambeth. Of the 36 deaths, 10 were registered during the first, 3 during the second, 4 during the third, and 19 during the fourth quarter, of the year. In London, there were registered 709 deaths (uncorrected), from Influenza during 1904. 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 1904 statistics for the new Borough of Lambeth show a sub-epidemic state. 90 Table shewing the number of deaths from Epidemic Influenza in Lambeth Borough, and London, during 1904, and during ten years (1891-1900) in Lambeth Parish and London. Old Parish of Lambeth. Average for 10 years. (1891-1900.) Borough of Lambeth. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1904 Lambeth 131 142 85 44 148 51 45 126 151 152 107.5 36 London (including Lambeth). 2336 2264 1526 750 2156 496 671 1283 1817 1950 1524.9 709 N.B.—The term "Influenza" is too indefinite in medical practice to permit of any satisfactory deductions being drawn from the above statistics. The 41 deaths from venereal affections (Syphilis, etc.) is the only other point calling for note in the class of Zymotic Diseases. The Council, on June 1 Oth, 1904, expressed the opinion that the diseases, physical and mental, resulting directly, or by inheritance, from venereal diseases are so serious, and so numerous, that it is desirable that there should be a full Government Enquiry into the matter, particularly in the direction whether there is adequate provision for the treatment of the poorer classes in the various stages of the disease ; and that all public Bodies connected with the health of the people should take action in this matter. Classes II. and III.—Parasitic and Dietetic Diseases. 38 deaths were registered in these classes from Alcoholism. Class IV.—Constitutional Diseases. Of the total 1,039 deaths under this class, 309 were due to Cancer, 447 to Phthisis, and 174 to Tubercular Meningitis and other forms of Tuberculosis. Class V.—Developmental Diseases. The total number of deaths in this class was 361, consisting of 172 from Premature Birth, 135 from Old Age, and 54 from Atelectasis and Congenital Malformations. 91 Class VI.—Local Diseases. 1. Diseases of the Nervous System caused 398 deaths, including 39 from Convulsions, 195 from Apoplexy, and 14 from Epilepsy. 2. 536 deaths were due to diseases of the Circulatory System. 3. The diseases of tha Respiratory Organs caused 842 deaths (423 from Bronchitis, and 150 from Pneumonia). 4. Diseases of the Digestive Organs caused 315 deaths, of which 89 were due to Enteritis, 12 to Peritonitis, 85 to diseases of the Liver and 21 to Dentition. 5. Diseases oj the Urinary System caused 177 deaths. 6. Diseases of the Reproductive System, Integumentary System, Locomotive System, Lymphatics, Organs of Special Senses, etc., caused together 94 deaths. Class VII.—Deaths from Violence. 173 deaths in all, including 144 from Accidents, 11 from Burns and Scalds, 11 from Drowning, 22 from Suffocation in bed (all being infants under 1 year), 26 from Suicide, and 3 from Homicide. Class VIII.—Other Causes. 135 deaths were registered in this class, consisting of deaths from Dropsy, Tumours, Haemorrhages, or other ill-defined or non-specified causes. Different rates of mortality from different diseases 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. 92 TABLE T. Shewing Classification of Causes of deaths in the Borough of Lambeth during 1903 and 1904. A.—Total Deaths from all causes and at all ages with percentages of deaths to total deaths (corrected). Class of Disease. Borough 1904. Borough 1903. No. of Deaths (corrected). Percentage of Total Deaths. No. of Deaths (corrected). Percentage of Total Deaths. I.—Zymotic Diseases 716 14.7 625 13.4 Seven Principal 603 12.4 498 10.7 Influenza 36 0.7 52 11.1 II.—Parasitic 6 0.1 12 0.3 III.—Dietetic 43 0.9 41 0.9 IV.—Constitutional 1039 21.3 1041 22.3 Cancer 309 6.3 307 6.6 Phthisis 447 9.2 435 9.3 Tubercular Diseases, excluding Phthisis 174 3.6 204 4.4 Rheumatism (Acute and Chronic) and Gout 46 0.9 41 0.9 V.—Developmental 361 7.4 297 6.4 Old Age 135 2.8 100 2.1 VI.—Local Diseases 2357 48.4 2299 49.3 Circulatory System 536 10.9 584 12.5 Bronchitis 423 8.7 370 7.9 Pneumonia and BronchoPneumonia 302 6.2 252 5.4 Pleurisy and Pleuro-Pneumonia 39 0.8 42 0.9 Respiratory System, excluding Phthisis 395 8.1 727 15.6 VII.—Violence 173 3.5 174 3.7 Suicide 26 0.5 36 0.8 VIII.— Other Causes 185 3.8 175 3.8 93 TABLE T (Continued). B.-Deaths (corrected) of Infants under One Year of age from the cheif infantile diseases, and from all causes, expressed in terms in terms of 1,000 births. Borough 1904. 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 1248 137.8 1138 125.5 Diarrhœa 222 24.5 124 13.7 Convulsions 36 3.9 46 5.1 Respiratory Diseases 206 22.7 186 20.5 Premature Births 172 18.9 159 17.5 Tubercular Diseases (including Phthisis) 71 7.8 89 9.8 Measles 46 5.1 25 2.8 Whooping Cough 45 4.9 65 7.2 Suffocation in Bed 22 2.4 28 3.1 Enteritis 40 4.4 27 2.9 Dentition 11 1.2 26 2.9 94 TABLE U. Showing Classification of certain Causes of Deaths (uncorrected) in the Borough of Lambeth, compared with London, during 1903 and 1904. A —Deaths at all Ages. Lambeth. London. Percentage of total Deaths (uncorrected) Percentage of total Deaths (uncorrected) 1904. 1903. 1904. 1903. I. Principal Zymotics 13.1 11.1 12.9 11.3 Influenza 0.7 1.1 0.9 0.9 Measles 3.3 2.7 2.9 2.8 Whooping Cough 2.1 2.6 1.9 2.3 Diarrhœa and Dysentery 5.4 3.3 6.2 4.1 II. Rheumatic Fever and Heart Rheumatism 0.4 0.4 0.3 0.3 III. Diseases of Circulatory System 10.9 11.7 12.3 12.5 IV. Bronchitis, Pneumonia and Pleurisy 15.1 13.6 17.01 15.5 Phthisis 8.0 8.6 10.04 10.2 V. Injuries 3.7 4.5 3.1 4.3 B.—Deaths under 1 Year of Age (per 1000 Births). All Causes 146.6 131.7 146.2 131.5 95 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, &c., FOR, 1904. Area of Borough—4080.4 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 1904—310,359 (males 146,868, females, 163,491). Density—76 persons per acre. Inhabited Houses—41,511 at Census, 1901. Rateable Value—£1,907,908 for year ending March 31st, 1904. Marriages—2,480, being 15.9 per 1,000. Births—9,059, being 29.2 per 1,000. Deaths (corrected)—4,880, being 15.7 per 1,000. Infantile Mortality—1,248 deaths (corrected) under 1 year, being 137.8 per 1,000 births. Zymotic—Death-Rate, 1.9 per 1,000 (total deaths, 603). Estimated increase of Population 2,648, but the natural increase or increment (i.e., excess of Births over Deaths) is 3,901 (uncorrected). 96 97 TABLE V. Local Government Board Old Table A.] Table of Deaths during the year 1904 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 shown as separate localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Puerperal. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Relapsing. Continued. Enteric or Typhoid. Typhus. (a) (b) (c) (d) (e) (f) (g) (h) (i) Royal Infirmary (Women and Children) 7 1 4 ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 2 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 Remainder of Waterloo Road First 188 71 29 4 6 53 25 Under 5 ... ... ... ... ... ... ... ... ... ... ... 11 2 10 ... 2 18 ... ... 8 49 100 5 upwds. ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 14 22 8 2 4 35 88 General Lying-in Hospital, York Road 37 36 ... ... ... 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 32 36 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Remainder of Waterloo Road Second 168 55 20 6 4 57 26 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 11 2 11 ... ... 12 ... ... 1 37 75 5 upwds. ... ... 1 ... ... ... ... ... ... ... 2 ... 1 ... 2 19 23 12 2 9 22 93 St. Thomas's Hospital 657 82 82 60 69 319 45 Under 5 ... ... 6 ... ... ... ... ... ... ... 4 1 2 29 ... 2 24 1 ... 13 82 164 5 upwds. ... ... 2 ... ... ... ... 8 ... ... 2 ... 1 1 1 6 18 59 ... 56 339 493 Remainder of Lambeth Church First 259 83 49 10 16 77 24 Under 5 ... ... ... ... ... ... ... ... ... ... ... 25 14 17 ... 1 32 ... ... 4 39 132 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 14 27 27 ... 19 39 127 Lambeth Workhouse 93 5 ... ... 1 19 71 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 9 63 ... ... 16 91 Lambeth Infirmary 633 61 33 4 27 316 192 Under 5 ... ... ... ... ... ... ... ... ... ... ... 15 9 20 ... 3 17 ... ... ... 30 94 5 upwds. ... ... ... ... 2 ... ... ... ... 1 5 ... ... 1 4 125 68 87 ... 20 226 539 Remainder of Lambeth Church Second 475 187 84 12 5 135 52 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 29 22 38 ... 1 51 ... ... 4 125 271 5 upwds. ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 39 36 39 5 2 78 204 Clapham Maternity 31 29 ... ... 1 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 28 29 5 upwds. ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 St. Peter's House 30 ... ... ... ... 7 23 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 8 2 ... 9 30 Remainder of Kennington First 581 196 69 12 19 159 126 Under 5 ... ... ... ... ... ... ... ... ... ... ... 19 15 48 ... ... 52 1 ... 6 124 265 5 upwds. ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 45 41 61 4 9 153 316 G 98 99 TABLE V.—continued. Local Government Board Old Table A continued.] Table of DEATHS during the year 1904 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 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) Belgrave Hospital 101 54 36 11 ... ... ... Under 5 ... ... 1 ... ... ... ... ... ... ... ... 2 ... 12 ... 2 17 ... ... 4 52 90 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... 1 6 11 Kennington Second 490 116 45 11 10 160 148 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 21 8 22 ... ... 27 1 1 1 79 161 ... ... 1 ... 1 ... ... 1 ... ... ... 1 ... ... 1 38 62 47 5 6 166 329 South Western Hospital 124 8 53 32 7 23 1 Under 5 ... 20 29 ... ... ... ... ... ... ... ... 6 ... ... ... 1 1 ... ... ... 4 61 5 upwds. ... 12 12 ... ... ... 1 11 ... ... 1 ... ... ... ... ... 3 1 ... ... 22 63 Remainder of Brixton 910 261 71 15 27 280 256 Under 5 ... ... 2 1 ... ... ... ... ... 2 ... 18 22 40 ... 3 54 1 2 11 176 332 5 upwds. ... ... ... ... 2 ... ... 2 ... ... 1 3 2 2 7 66 94 96 9 9 285 578 Lambeth Workhouse Schools 4 ... 4 ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 4 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... British Home of Incurables 8 ... ... ... ... 2 6 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... ... 3 8 Under 5 ... ... ... ... ... ... ... ... ... 1 ... 6 7 26 ... 3 17 ... ... 2 48 110 Remainder of Norwood 361 83 2'/ 7 16 96 132 5 upwds. ... ... 2 ... ... ... ... 1 ... ... 1 ... ... ... 2 25 31 51 4 1 133 251 Totals 5160 1328 606 184 208 1707 1127 Under 5 ... 20 41 1 ... ... ... ... ... 3 4 164 103 273 ... 18 330 5 3 54 915 1934 5 upwds. ... 12 18 ... 8 ... 1 23 ... 1 13 6 4 6 22 395 451 562 33 136 1535 3226 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto 460 46 41 20 34 248 71 Under 5 ... 2 6 ... ... ... ... ... ... ... ... 1 6 12 ... ... 20 ... ... 1 39 87 5 upwds. ... 4 3 ... 1 ... ... 4 ... ... ... ... 2 1 47 23 43 2 38 205 373 Deaths occurring within the district among persons not belonging thereto 740 126 117 60 60 279 98 Under 5 ... 14 26 ... ... ... ... ... ... ... 1 7 4 27 ... 4 27 1 ... 9 123 243 5 upwds. ... 8 9 ... 1 ... 1 16 ... ... 2 ... ... 1 1 9 33 73 2 47 294 497 100 101 TABLE W. Table of Population, Births, and of New Cases of Infections Sickness, coming to the knowledges of the Medical Officer of Health, during the year 1904, 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 Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census 1901. Estimated to middle of 1904. 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. Fever Fevers. Cholera. Erysipelas. Chickenpox. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Chickenpox. Typhus. Typhoid or Enteric. Continued Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) Waterloo Road 1st 27440 26763 404 - 54 12 - - 5 - — 2 — 19 17 — 47 12 — — 4 — — — — 4 — Waterloo Road 2nd 901 — 25 13 1 — 4 — — — — 9 12 — 23 10 — — 3 — — — — 1 — Lambeth Church 1st 18423 18389 569 3 39 15 — — 7 — - 1 — 19 37 3 36 13 — — 6 — — — — 15 — Lambeth Church 2nd 39818 39912 1525 — 64 50 1 — 29 3 - 1 — 76 66 — 52 44 — — 26 — — — — 8 — Kennington 1st 53198 54246 1833 15 72 61 — — 13 - 3 — 36 105 15 58 53 — — 10 — — 2 — 10 — Kennington 2nd 42896 44170 1011 — 186 70 3 — 21 — - 2 — 25 110 — 156 51 — — 14 — — — — 3 — Brixton 84232 88300 2010 5 171 72 5 — 17 — - 5 — 53 113 5 136 62 3 — 15 — — 1 — 8 — Norwood 35888 38579 796 — 49 24 1 — 5 — - 1 — 14 96 — 33 17 — — 4 — — — — 1 — Totals 301,895 310,359 9059 23 660 317 11 — 101 4 - 15 — 251 556 23 541 262 3 — 82 — — 3 — 50 — 102 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, 1904. Number of Notices 11,778* NOTIFIABLE INFECTIOUS DISEASES. † (Public Health, London, Act). No. of Infected Houses 1681 Smallpox 19 Scarlet Fever 511 Typhoid 98 Typhus — Continued Fever 4 Diphtheria 296 Membranous Croup 11 Puerperal Fever 15 Erysipelas 251 English Cholera — * Exclusive of 10 notices served under the Housing of the Working Classes Acts. † Chickenpox remained a compulsory notifiable disease throughout Lambeth Borough (and the rest of the Administrative County of London) during 1904 from April 8th to November 8th, and during that period 556 cases were notified by medical men representing 476 infected houses. 103 PARTICULARS OF SANITARY WORK Carried out in Lambeth Borough during 1904, 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. 1904 11778 8433 2975 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. 104 A. Public Health (London) Act and Metropolis Local Management Acts. Notices (Preliminary and Statutory) 10087 Works Structural :— Drainage defective 1063 Intercepting Traps with Fresh Air Inlets required 216 Ventilating Pipes required 281 Indoor Sinks connected with the Drain 472 Rain Water Stack Pipes connected with the Drain 670 Bath Waste connected with the Drain 51 Traps Defective, or of Obsolete Pattern 641 Closet Pan and Connections Defective 821 Water Supply to Closet Defective 763 Closet Dilapidated 508 Draw-off from Main for Drinking Purposes required 722 Dust Bins Defective 652 Premises Dilapidated 116 Ventilation under Floors required 50 Roofs Dilapidated 218 Soil Pipes Defective 78 Paving Defective 1011 Damp and Unwholesome Houses 86 Dung Receptacles required 14 Works not Structural :— Cisterns Dirty 87 Manure Accumulations 96 Underground Rooms occupied 26 Animals Improperly Kept 19 Stopped Drains 296 Overcrowding 48 Foul Urinals 116 Through Ventilation not provided — Refuse Accumulations 124 105 No Water Supply or Defective Water Supply 242 Dirty Premises 1921 11,408 B. Infectious Diseases Notification. Notices served 1681 SUMMARY OF WORK DONE BY THE SANITARY INSPECTORS DURING 1904. Inspections 8082 Re-inspections 59977 Infectious Houses visited 1681 Complaints attended to 6630 Cases of Infectious Disease notified 1938 (a) Cases under treatment at Home 1033 (b) Cases removed to Hospital 905 Cases of Non-Notifiable Diseases dealt with 2658 Houses disinfected 1581 Rooms disinfected 4455 Bedding, etc., disinfected 26357 Bedding, etc., replaced 1 Dust Yards, Manure Depots and Brickfields, inspections of 312 Drains tested (with chemical, water, or both) 8802 Sanitary Works completed 4988 Plans of Drainage received and approved 432 Premises the Drains of which have been totally or partly reconstructed 432 Articles procured for the Analyst— (a) Food and Drugs 1200 (b) Water 2 Special Smoke observations and enquiries 540 New Work-shops inspected and registered 82 Bakehouses inspected (including 79 underground) 214 106 Cowhouses inspected 20 Slaughter-houses inspected 32 Restaurants re-inspected — Out-Workers' Rooms visited 277* Notices— Sanitary Work (Preliminary and Statutory) 10087 Infectious Diseases (Public Health Act, 1891) 1681 Housing of Working Classes Act 10 Sanitary nuisances abated— (a) Structural 8433 (b) Non-structural 2975 Persons received at the Shelters — Summonses and Orders issued 109 Convictions obtained— Public Health Act 20 Food and Drugs Acts 43 MALE INSPECTORIAL STAFF. No change has taken place during 1904 in connection with the Inspectorial Staff. The salary of Mr. Bott has been increased from ,£180 to ,£200 as and from April 1st, 1904, and that of Mr. Perrinf (Food and Drugs and Smoke Inspector) from ,£170 to ,£180, to be further increased to £200 by two £10 yearly increments as and from April ist, 1904. These increases were sanctioned by the Local Government Board on June 8th, 1904. * Including 143 premises, wherein no Out-Workers were found employed at the time of visit. † Public Health Act—Preliminary 6624, Statutory 3463; Metropolis Management Acts 10. ‡ Mr. Perrin has passed the Special Examination for Meat Inspectors during 11(04. 107 The Staff, individually and collectively, has worked well during 1904, as shewn by the results of inspections, re-inspections, &c., tabulated throughout the Report. It is a matter for congratulation that in but very few cases (0.2 per cent, of the total notices) was it necessary to resort to legal proceedings before the Magistrate. These proceedings consisted of 25 Summonses, viz.:—defective drainage (or fittings) 12, defective paving 1, dampness 1, insufficient water supply 1, offensive accumulation 1, soakage of water into basement 1, overcrowding 1, dirty premises 5, and unsound meat 2. Four summonses were dismissed by the Magistrate, 3 connected with the same premises, on technical points, and, in connection with the other 21, orders were made for the nuisances to be abated (a closing order in 1 case), or penalties were inflicted to the extent of £21 (with £4 costs). Outside Urinals connected with Public Houses. During 1904 a special inspection has been made of all outside Urinals connected with public houses throughout the Borough, with the following results :— Ward. No. of Public Houses inspected. No. requiring Notices to be served. Defects found. Dirty. Defective or absent flushing arrangement. Defective or absent door or screen. Defective Paving. Marsh 17 6 6 3 — — Bishop's 20 14 12 5 5 — Prince's 30 16 13 4 2 1 Vauxhall 24 14 11 10 1 — Stockwell 12 6 6 4 — — Brixton 19 4 2 2 1 — Heme Hill 10 8 8 5 1 2 Tulse Hill 17 9 3 4 4 1 Norwood* 16 9 9 9 1 — Borough of Lambeth 165 86 70 46 15 4 * Norwood Ward has no public W.C. accommodation, and the only urinal upheld by the Council is the one in Park Road, so that the small urinals attached to public houses (as also certain of the quieter smaller streets) are used from time to time for W.C. purposes 108 The defects found have been since made good, and in 6 cases (Marsh 1, Bishop's 2, Tulse Hill 2, Norwood 1), the outside urinals have been re-constructed, and in 1 case (Stockwell) the urinal has been closed. Increased powers are now in the hands of Sanitary Authorities throughout the Metropolis for dealing with urinals which are a nuisance, or even, by virtue of their position, an offence against public decency (vide Sect. 22 of the London County Council General Powers Act, 1904). One such urinal has been dealt with during 1904 in this way with most satisfactory results, it having been re-constructed, enlarged and altered in position (the Hope Public House, West Norwood). Others are to be dealt with similarly during 1905. The Borough Council during 1904 has suggested to the Newington Petty Sessional Justices that they should enquire at the Licensing Sessions as to sanitary accommodation attached to public houses, e.g., sufficiency of urinal accommodation, and the manner in which the urinals are kept, &c. Unsound Food. The following legal seizures of unsound food have been made during 1904 by the Inspectors:— (1) 22 pieces of meat, weighing about 80 lbs., which were exposed for sale on a stall in the roadway in Wandsworth Road, on October Gth, 1904. The meat was being sold at the time at prices varying from l½d. to 3d. per lb., and on examination by the Medical Officer of Health was found to be unwholesome. It was taken to the Magistrate who condemned it, and ordered it to be destroyed—a destruction that was carried out at the Council's Wharf by the Sanitary Inspector. The owner of the meat was fined £2, with 10s. costs. (2) 11 bullock's hearts (frozen), 7 pieces of cooked beef (salted), 5 pieces of cooked pork (salted), and 5 bullock's 109 tongues (smoked), which were exposed for sale, or being prepared for sale, at 191, Gipsy Road, on October 27th, 1904. The meat, on inspection by the Medical Officer of Health, was found to be unwholesome and was, consequently, taken to the Magistrate, who condemned it, and ordered it to be destroyed—a destruction that was carried out at the Council's Wharf by the Sanitary Inspector. The owner of the meat was fined £50, aftei wards reduced to £15 (with 4s. costs), at the special request of the Council. In addition to the above legal seizures under Section 47 of the Public Health (London) Act, 1891, the following voluntary surrenders were made to the Inspectors :— (1) July 23rd (Saturday night) and July 24th (Sunday morning), at 160 and 205, Lambeth Walk, 235 and 248, Wandsworth Road, and a stall outside 257, Wandsworth Road, breasts of mutton and small pieces of beef (weighing approximately in all 8^ stones), which were found to have an unwholesome appearance, but not sufficiently so to warrant a seizure being made in the ordinary way. In view of the state of the meat and the abnormally hot weather, and having regard to the fact that the meat, if seized, could not be taken before a magistrate until the Monday, the occupiers of the premises upon which the meat was found were advised to voluntarily surrenderlit, and have it destroyed by the Inspectors—an offer that was accepted. The meat was saturated with carbolic acid (so as to prevent its future use as human food), and removed afterwards as trade refuse. (2) September 5th, at 6, The Pavement, Chapel Road, West Norwood, 3 baskets of tomatoes (weighing 36 lbs.), which were wet and pulpy, and unfit for human food. 110 The tomatoes were voluntarily surrendered to the Inspector by the owner and duly destroyed. (3) October 7th, at 191, Gipsy Road, a bullock's lungs, which were found on examination to be full of tuberculous nodules. Legal Proceedings Connected with Drainage. 12 summonses were taken out during 1904 against owners for defective drains and sanitary fittings, and 4 were dismissed by the magistrate on technical points. In the other 8 cases orders were made to do the work, or penalties were inflicted—a total of £2, and 18s. costs. An interesting damage case was decided during 1904 by Mr. Horace Smith, at Lambeth Police Court, on October 12th. A summons was taken out by the Council against the builder and surveyor (acting for the owner) for having reconstructed the drain at 29, Binfield Road, Clapham Road, without properly laying it on concrete, and without an efficient intercepting trap and ventilation, as required by the London County Council Byelaws. The summonses were dismissed, the magistrate holding that it was simply a "repair" and not a "reconstruction" of a drain, to which the Bye-laws did not apply, although, as a matter of fact, it was shown in evidence (and not disputed) that the drain had been relaid from front to back of the premises, a distance of 80 feet. The magistrate voluntarily expressed his willingness to state a case for the consideration of the High Courts, but the Borough Council decided that such an appeal was unnecessary, as it was clear that the magistrate, when giving his decision, was not in possession of the whole of the facts. Combined Drainage. Many combined drainages have been reconstructed by the Council during 1904, amounting to .£620 15s. (estimated), as 111 the direct result of inspections carried out by the Inspectors in the course of their daily routine duties. Where a combined drain is legally a sewer (i.e., when no record in the shape of a plan or application is in the possession of the Sanitary Authority, showing that approval was given to the drainage by a combined operation), the liability rests with the Sanitary Authority concerned. During 1904, the Lambeth Council has decided to support the St. Pancras Borough Council in their endeavour to obtain an alteration of the law so that it may be compulsory upon the owners where premises within one curtilage are sub-divided into premises within two or more curtilages, to provide and deposit with the Sanitary Authority concerned, plans showing not only the drainage of all the sub-divided premises, but also the whole of the drainage, previous to such alterations being carried out. Drainage of Lambeth Parish School at West Norwood. During 1904, the work connected with the drainage of the Norwood Schools (situated in Elder Road, West Norwood), which was condemned by the Medical Officer of Health in a special report, submitted to the Guardians on March 21st, 1903, has been satisfactorily completed, involving an entire or partial reconstruction of the drains, and a remodelling of sanitary fittings of several of the different blocks of buildings (which comprise what is known as the "Norwood Schools") as follows:— (a) Entire reconstruction of drainage. 1. New Schools (and Laundry attached). 2. Probation Wards. 3. Receiving Wards. 4. Infirmary. 5. Isolation Hospital (and Laundry attached). 6. Old Infants' School. 112 (b) Partial reconstruction of drainage. 1. Church (half of system relaid). 2. Two gully branches of 12 inch sewer at north side of Blocks C. and D. (few joints cemented). 3. Matron's House, Old Schools (two soil pipes constructed, and the branch drains connected therewith temporarily relaid). In view of the large expense involved in connection with the above (stated to be £12,982 12s. Id.), it was decided not to interfere, for the present, with the following systems of drainage (the Guardians taking all responsibility):— (а) Relief Station, and the main drain north of the same (taking also the Receiving Wards) ; (б) Lodge by the Old Schools ; (c) 12-in. sewer on the north side of Blocks C and D, receiving by means of 2 gullies the surface drainage of the path only (all joints of sewer being open, as also of the 2 gully branches, except about 6 cemented joints in each case as mentioned above); (d) Sewer to north of Old Schools ; (e) Main sewer running across part of grounds from Crown Lane to Elder Road (London County Council Sewer); (f) Certain disused drains and sewers (if any). Having regard to the large amount of supervisory work thrown upon the Sanitary Inspector (Mr. James Barfoot), the Guardians voted him an honorarium of £25. Routine Work of Inspectors. During 1904, in the Borough, 432 houses have been redrained throughout, or in part; whilst 432 plans (representing 560 houses) have been received, approved, and the work (as shewn thereon) 113 carried out under the personal supervision of the Inspectors, and the drainage work water-tested. The Sanitary Inspectors supervise all drainage work throughout the Borough—that of both new and old buildings. 8802 tests (hydraulic or smoke) have been made by the Sanitary Inspectors during 1904. 91 Water Certificates (representing 385 houses in blocks) have been issued during 1904 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. In addition to drain-testing and supervision, other duties fall to a Sanitary Inspector, and, as fairly representing the work carried out, the numbers of (1) notices served, and (2) inspections and re-inspections made, are a fair criterion. In Lambeth Borough, during 1904, 10,087 notices have been served under the Public Health Act (6,624 preliminary and 3,463 statutory), and 10 under the Metropolis Management Acts, making a total of 10,097, dealing with 8,433 structural, and 2,975 non-structural, defects. 6,630 complaints were attended to during 1904. The numbers of inspections and re-inspections carried out during 1904 by the Male Inspectors were 8,082 and 59,977 respectively, and to these must be added the summary of work carried out by the Female Inspector and Smoke Inspector (vide pages 115-120 and 136-140). Inspection of Market Thoroughfares. The Market Thoroughfares have been, during 1904, 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. 114 Paving of Bye-Roads and Private Courts. George Place, Wandsworth Road, a private roadway, has been paved and drained during 1904 by the freeholders, and a longstanding nuisance has been, thereby, abated. Providence Row, Gloucester Street (Tower Street)—a byroad, has also been paved and drained (a new sewer with 4 manholes being first provided) by the Council at a cost of (estimated) £530 19s. 6d., thereby effecting a great sanitary improvement. 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). Inspection of Crown Property. At present, Crown Property is exempt from inspection, &c., under the Public Health (London) Act, 1891, and the attention of the Council has been drawn, during 1904, to such an anomaly in connection with the Post Office at 42, Kennington Road, where a case of Typhoid Fever was notified, and where, on inspection (through courtesy), insanitary conditions of drains, &c., were found to exist (defective drains, old-fashioned fittings, cracked lavatory basins, insufficient ventilating pipes, unsuitable water supply, &c.) Such a case shews the importance of even Crown Property being at times inspected, and a representation has, accordingly, been forwarded to the Government. 115 FACTORIES AND WORKSHOPS.* During 1904, 82† new Factories and Workshops have been added to the Register,‡ consisting of the following :— Name of Trade No. of or Business. Workshops. Dressmakers 36 Laundries 8 Milliners 7 Waistcoat Makers 1 Babies' Dresses 3 Fancy Bootmakers 2 Dressing Gowns 1 Blouses 7 Ladies' Tailor 3 Tie Makers 1 Dyers and Cleaners 2 Druggists 1 Pinafores 1 Fly Papers 1 Hassocks 1 Bed Maker 1 Bag Makers 2 Perfumer (Toilet Soap) 1 Forge 1 Window Cleaners 1 Cycles 1 82 * The new Factory and Workshop Act, 1901, came into force on January 1st, 1902, and entails much extra work, e.g., outworkers, etc. † Including 6 factories, viz.:—1 laundry, 2 dyers and cleaners, 1 bed maker, and 2 bag makers. ‡ The Register contains (up to the end of 1904) a total of 1,139 workshops with 1,958 workrooms. 116 Full particulars concerning these 82 Workshops have been entered up in the Register, and it is found that there are connected therewith 107 workrooms, in which were working at the time of inspection 621 persons—20 males and 601 females (females alone being employed in 74 workshops). There were found being employed— M. F. Total. Children Young Persons 2 136 138 Adults 18 465 483 20 601 621 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). 26 Notices of occupation of 28 workshops have been received during 1904 by the Borough Council from the Factory Inspectors, as compared with 62 during 1903, 25 during 1902 and 32 during 1901, and 3, 32, 60, 31, and 29 received by the late Vestry during the five years 1886-1890 respectively. 10 written Notices have been received during 1904 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 1903, 1902 and 1901, were 9, 5 and 17, as compared with 16, 8, 27, 25 and 66 received by the late Vestry during the. five years 1886-1890 respectively. In connection with the 82 new workshops inspected during 1904, the following insanitary conditions were met with at the time of the inspections:— 117 1. As to Ventilation and Warming and Lighting. In 1 out of the 82 workshops (i.e., 1.2 per cent.) only was the ventilation unsatisfactory, and in all the workshops, the workrooms, at the time of inspection, were found to be reasonably warmed by open fireplaces, open or closed stoves, gas jets, steam pipes, etc., and sufficiently lighted. 2. As to Cleanliness. In 19 workshops (i.e., 23.2 per cent.) the workrooms were dirty and required cleansing. 3. As to Sanitary Appliances. In 16 (i.e., 19.5 per cent.), the sanitary fittings and appliances were bad. The w.c.'s were outside in 23.2 per cent., inside in 29.3 per cent., and outside and inside in 47.5 per cent. In no single case was separate closet accommodation for the sexes found to be wanting. The soil pipes were found to be unventilated, or insufficiently ventilated, in 7 cases (i.e., 8.5 per cent.), a condition of things which may, or may not, be a nuisance; but in no case was there found to be direct communication between w.c.'s and workrooms. 4. As to Dampness. In no workshop was any dampness found on inspection. 5. As to Overcrowding. The cubic capacities of the different workrooms were found to vary considerably, and in 4 workrooms (i.e., 3.7 per cent.) 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 Six factories were also inspected during 1904, to see if they complied with the requirements of the Acts as to w.c. accommodation for the employees. 118 119 WORKSHOPS:—Details as to Sanitary Conditions and Defects found during 1904. Details as to Sanitary Conditions and Defects found. Old Parish Districts, and the Inspectors in charge thereof. Totals. Marsh. Bishop's and Prince's. Vauxhall & Stockwell. Brixton. Tulse Hill, Norvv'd. Scorrer. Wallis. Hooper. Jones. Howes. Jackson. Baxter. Gavin. Bott. Smith. Barfoot. Ventilation satisfactory 1 5 7 16 7 1 9 18 5 10 2 81 not — 1 — — — — — — — — — 1 Cleanliness satisfactory 1 3 5 14 4 — 6 15 4 9 2 63 not — 3 2 2 3 1 3 3 1 1 — 19 Workrooms damp — — — — — — — — not 1 6 7 16 7 1 9 18 5 10 2 82 Workrooms warm 1 6 7 16 7 1 9 18 5 10 2 82 not — — — — — — — — — — — — State of sanitary fittings, &c. good 4 6 13 5 1 9 14 3 9 2 66 bad 1 2 1 3 2 — — 4 2 1 — 16 Soil pipe ventilated 1 4 6 6 1 8 13 3 5 2 49 not ventilated — 1 3 1 — — — 2 — 7 no soil pipe 1 5 2 7 — — 1 5 2 3 — 26 Position of W.C. outside 1 1 1 4 2 1 5 1 2 1 19 inside 4 9 1 3 3 2 2 24 outside and inside — 1 6 3 3 1 5 9 2 6 1 37 No W.C. — — — — 1 — — 1 — — — 2 Separate W.C. accommodation Yes 1 6 7 16 7 1 9 18 5 10 2 82 No — — — — — — — — — — — — Communication (direct) between W.C.'s & rooms Yes — — — — — — — — — — — — No 1 6 7 16 7 1 9 18 5 10 2 82 N.B.—The Wards of the old Parish of Lambeth are retained so that this Table may be comparable with those in previous Reports (1897-1901). The Workshops (with 6 exceptions) were inspected by the Female Sanitary Inspector. 1 20 WORKSHOPS REGISTERED DURING 1904. 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 1 1 — — — — — 1 — 1 1 Wallis 6 7 — — — 2 1 19 1 21 22 Bishop's Hooper 7 9 — — 1 7 5 15 6 22 28 Howes 7 7 — — — 42 75 117 117 Prince's Jones 16 27 — — — 7 8 239 8 246 254 Vauxhall Jackson 1 2 — — — 2 — 3 — 5 5 Stockwell Baxter 9 10 — — — 18 — 24 — 37 37 Brixton Gavin 18 23 — — 1 39 4 45 5 84 89 Bott 5 8 — — — 12 — 18 — 30 30 Tulse Hill Smith 10 11 — — — 7 — 21 — 28 28 Norwood Barfoot 2 2 — — — 5 — 5 — 10 10 Total 82 107 — — 2 136 18 465 20 601 621 N.B.—With 6 exceptions, the Inspections were made in connection with the above 82 Workshops by the Female Inspector. 121 FEMALE SANITARY INSPECTOR. 1904 is another year's record of good work carried out by the Female Sanitary Inspector (Miss Gamble*) in connection with (a) Factories, Workshops (Work-placesf), 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, 1904, may be tabulated as follows:— Summary of work carried out by Female Sanitary Inspector during the year 1904, and during the preceding two years 1902-3 (for comparison'). Workshops† visited and inspected— 1904 1903 1902 (a) Dressmakers 80 157 142 (b) Milliners 14 12 20 (c) Laundries 37 72 70 (d) Tailors 7 22 14 (e) Upholsterers — — 1 (f) Dyers 2 2 1 (g) Others 23 48 32 Work rooms inspected 495 669 325 Workshops† re-inspected 98 163 333 Work rooms re-inspected 113 214 305 Restaurants re-inspected — 87 118 Workshops†: workrooms therein measured 265 450 318 Workshops† removed from Register 9 19 29 Workshops† reported to H.M. Inspector 31 19 48 Workshops† reported by H.M. Inspector 13 46 102 Workshops† newly discovered and registered 69 152 3 ‡Premises visited but no female hands found to be employed (including Out-workers) 135 231 80 * Miss Gamble was elected on October 3rd, 1901. † Workshops include Workplaces. ‡ Houses where the business plate, or the local directory, or advertisements in newspapers, or other sources of information implied a probability that females workers would be employed, but at which none were found at the time of visit. 122 Female Conveniences visited and inspected— 1904 1903 1902 Public (visits paid) 597 343 276 Private (visits paid) — 5 35 Schools visited— Public 13 20 10 Private 2 — 1 Special places visited and inspected— (a) Restaurants and Hotels, etc. — 22 220 (b) Private Houses 322 218 199 (c) Out-workers 2 77 107 — (d) Others — 3 5 Written Intimations and Statutory Notices served 200 198 262 No. of Workshops, † etc., in which no defects were found on inspection 508 371 382 No. of Workshops† in which defects were found on inspection 254 292 322 Particulars of defects found. Workrooms— Overcrowded 11 16 4 Damp 10 13 7 Dirty 184 217 208 Ill-ventilated 1 5 7 Otherwise — — 3 Defects— Yards 12 19 29 Floors 11 18 19 Roofs 6 13 7 Windows 1 — 4 Ceilings 9 23 17 Rain Water Pipes 5 9 13 Premises generally 4 5 9 Sanitary Appliances: Waterclosets— Dirty 64 83 86 Ill-lighted — — 1 Unventilated 1 16 5 Choked 3 3 15 Defective 28 51 44 Defective Flushing Tanks and Water Supply 35 43 91 No separate suitable accommodation for the sexes 1 8 - Drainage— Defective, unventilated, etc. 6 7 9 I23 Dustbins— 1904 1903 1902 Wanting 34 49 72 Defective 21 33 34 Lavatories— Defective — 2 8 Miscellaneous defects (not included above)— Animals improperly kept 1 1 3 Accumulations in yards 7 2 20 Sink wastes defective — — 8 Otherwise — 1 — Nuisance referred to M. O. H. for attention by Male Inspectors (defective drains, w.c.'s, etc.) 59 86 68 An inspection of a workshop or workplace takes up much time, as the different workrooms have to be 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, 597 visits having been paid thereto during 1904, whilst the Female Conveniences of Railway Stations, Hospital Out-patient Departments, Shops, etc., also come in for systematic supervision. Miss Gamble has again during 1904 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). It will be noted, in connection with the inspections and reinspections of factories, workshops, and workplaces (where women are employed), that the principle defects found are dirty workrooms, dirty sanitary appliances, defective flushing tanks to closets, defective closets, and defective dustbins. Overcrowding was only found in 11 cases—in each instance being slight. 124 Out-workers. The good work commenced by the Female Inspector in 1903, connected with the visiting and inspecting of out-workers' premises and homes (situated within the Borough of Lambeth), has been continued during 1904; and a Register has now been compiled. This is a special duty devolving upon the Borough Council under Sections 107-110 of the Factory and Workshop Act, 1901, under which an Order (known as the Home-work Order, 1901), has been made by the Home Secretary (vide Annual Report, 1903, pp. 118-122). During 1903, 107* out-workers' premises have been inspected, and during 1904, 134,* making a total of 241, connected with the following trades and businesses : 1903. 1904. 1903-4. Mantles 6 12 18 Blouses and Skirts 10 14 24 Ties and Belts 24 19 43 Baby Clothing 6 4 10 Children's Underclothing and Costumes 5 10 15 Women's Underclothing 5 2 7 Tailors 10 15 25 Upholsterers 1 — 1 Embroidery 9 3 12 Dressing Gowns 2 5 7 Shirts 13 7 20 Aprons 1 — 1 Waistcoats 4 3 7 Jerseys 2 — 2 Hosiery 1 — 1 * The total numbers of premises visited during 1903 and 1904 were 289 and 277 respectively, but in 325 cases no out-workers were found to be employed at the time of the inspector's visit. 125 The Wards in which the houses (wherein these 107 and 134 out-workers were found to be working) are situated, are as follow :— 1903. 1904. 1903-4. Marsh 12 14 26 Bishop's 10 16 26 Prince's 38 13 51 Vauxhall 12 4 16 Stockwell 18 9 27 Brixton 17 37 54 Heme Hill — 26 26 Tulse Hill — 10 10 Norwood — 5 5 Totals 107 134 241 Widows' Caps 1 — 1 Men's Caps 1 1 2 Vamp Beader 1 — 1 Wigs 2 — 2 Incandescent Mantles 1 — 1 Shoes 1 4 5 Umbrellas 1 — 1 Dressmakers — 9 9 Milliners — 2 2 Collars Makers — 5 5 Sack Maker — 1 1 Paper Bag Maker — 2 2 Box Making — 4 4 Mattress Making — 1 1 Lace Workers — 2 2 Pinafores — 1 1 Sheets — 4 4 Smocking — 2 2 Needlework — 1 1 Carpets — 1 1 Totals 107 134 241 126 Various sanitary defects were found on inspecting, and these have since been remedied, showing the importance of such places being inspected, and kept under regular inspection. DISINFECTING DEPARTMENT. During 1904, good work has been done in connection with the Disinfecting Department—4,455 infected rooms and 26,357 infected articles (bedding, etc.) having been disinfected, as compared with 4,012 and 26,957 respectively during 1903. The total number of notifiable infectious diseases that have been reported during the year 1904 is less than that registered in any previous year (Vestry or Borough), but a large amount of disinfection has also been carried out in connection with cases of Measles (1,294), Whooping Cough (380), Tuberculosis (659), Chickenpox (305), Verminous Houses (31), and Other Diseases (39). 20 Cancer cases have also been dealt with during 1904, as compared with 13 during 1903. Full details are to be found on page 124. Of the compulsorily notifiable diseases, 1938 have been dealt with, including 556 cases of Chicken-pox (which was notifiable from April 8th to November 8th, 1904). 11 public and 3 private Schools have been disinfected in connection with outbreaks of infectious disease, and the 23 Smallpox infected rooms have been stripped (after disinfection) by the Borough Council's men. Particulars as to disinfection carried out in the Borough of Lambeth during 1904. Total No. of rooms disinfected by Council 4455 Cases in which bedding has been disinfected at home 6 Do. do. do. at Chamber 3107 Do. do. do. destroyed 53 Bedding replaced by the Council 1 Premises disinfected and disinfectants supplied 12367 127 Infected cabs disinfected 0 No. of Cleansing Notices served in connection with infected houses 3909 Certificates of Medical Practitioners received in lieu of disinfection by the Council 113 Certificates of disinfection left with occupiers of disinfected premises 3707 Articles of bedding, etc., disinfected. Beds 1734 Bolsters 1526 Pillows 4574 Mattresses 969 Palliasses 260 Chair Cushions 1313 Clothing 6003 Blankets 3813 Rugs and Mats 137 Counterpanes and Eiderdown Quilts 1935 Carpets 230 Extras (not mentioned in above) 3863 Total 26357 Articles of bedding, etc., destroyed. Beds 21 Bolsters 5 Pillows 14 Mattresses 11 Palliasses 104 Chair Cushions 17 Clothing 44 Sundries 263 Total 479 128 Practically all the disinfection was carried out by the Council's officers — only 113 certificates being received from Medical Practitioners during 1904, as compared with 109 during 1903. Particulars as to the 113 certificates (received during 1904) 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 2 1 2 2 7 For Bedding only 4 1 — 1 6 For Rooms and Bedding 10 31 37 22 100 16 33 39 25 113 'Including 53 from Chicken-pox. 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 1904. Disinfecting Station. From January 1st, 1903, the whole of the disinfecting work has been carried out at Wanless Road, where, since January 1st, 1904, the horses and vans have also been kept, instead of at the Wharf as hithertc—stabling, etc., having been erected for that purpose. From an administrative point of view this new departure is a great improvement. There are 2 Equifex Machines in use, and these have given satisfaction during the year, no 129 complaints having been received as to damaged goods, etc. To one of these Equifex Machines, a simple and efficient (so it is stated) patent air-controller (working automatically), the invention of Mr. Wolf Defries, has been fitted during 1904 as an experiment, at a cost of £25. By this means, the patentee stated, the exact time can be registered when the last trace of atmospheric air has been driven out of the interior of the machine, by the incoming steam, and when, consequently, steam fills every nook and crevice of such interior. It is acknowledged that, to obtain the maximum efficiency from steam as a disinfectant, such steam must not be mixed at all with atmospheric air; but, hitherto, the difficulty has been to know when all the atmospheric air had been effectually expelled. Should the patent prove efficient in its practical working, the second Equifex Machine will be fitted with it, as also the Sterilising Machine. The Staff, which consists of the Superintendent, 4 Disinfecting Men, 4 Drivers, 1 Stove Assistant, and 1 Stableman, has, collectively and individually, given satisfaction. Two separate chemical examinations of the 40 per cent, formalin solution used for disinfection by spraying were made in 1904, and in both instances the solution was found to be up to the standard guaranteed. Spray disinfection is the method now chiefly used in Lambeth in dealing with infected rooms, instead of the old-fashioned method of burning sulphur in rooms previously sealed up. The latter method is troublesome, takes a long time,and is of doubtful scientific value, whereas the former is easily performed, is expeditious, and of scientific value. Further, in connection with the spraying method, the room can be used again within a short time of being sprayed— the odour of the formalin quickly and readily dispersing. A scented formalin solution is used in Lambeth. i 130 NON-NOTIFIABLE INFECTIOUS DISEASES, Etc. 1st q. 2nd Q. 3rd Q. 4th Q. Total. 1904. 1903. 1902. 1901. 1900. 1899. Yearly average 5 years (1899-1903). Measles 392 594 193 115 1294 1346 364 728 941 773 830·4 Whooping Cough. 101 169 47 63 380 325 110 72 126 58 138·2 Chicken-pox* 74 91 25 115 305 356 1625 78 88 21 433·6 Tuberculosis† 134 230 140 155 659 269 488 483 524 474 447·6 Cancer 4 7 7 2 20 13 34 15 23 13 19·6 705 1091 412 450 2658 2309 2621 1376 1702 1339 1869·4 †Tuberculosis voluntarily notifiable throughout the Borough since June 1st, 1902. *Chicken-pox compulsorily notifiable throughout the Borough (and the whole of the Administrative County of London) from April 8th, 1901, to November 8th, 1901—556 cases being notified compulsorily by medical men, and 305 other cases by others, during 1904, in Lambeth. N.B.—39 other diseases (not classified) i.e., Rheumatic Fever, Pneumonia, etc., and 31 Verminous Houses were also dealt with during 1904. 131 DISINFECTION STATISTICS. For eight years prior, and twelve years subsequent, to the passing of the Notification of Infectious Diseases Act; and for the year 1904. 1882. 1883. 1884. 1885. 1886. 1887. 1883. 1889. Yearly average for 8 years preceding the Notification Act. 1904. No. of Cases in which Bedding, etc., has been disinfected. At Home 332 258 278 10 62 52 7 144 143·6 6 At Chamber 85 56 162 509 236 722 902 951 460·4 3107 No. of Cases in which Bedding, etc., has been destroyed. 37 23 62 52 8 57 48 79 45·7 53 No. of Articles of Bedding, etc., disinfected. 1526 1437 1895 2275 916 3078 3121 3778 2253·2 26359 No. of Articles of Bedding, etc., destroyed. 63 104 114 144 59 92 61 267 113·0 479 Premises Disinfected and Disinfectants Supplied. 727 680 657 727 736 1276 1255 1277 916·9 12367 Infectious diseases dealt with. Notifiable† — — — — — — — — — 1938 Non-notifiable† — — — — — — — — - 2638 † vide footnote on page 126. 132 DISINFECTION STATISTICS—Continued. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 Yearly average for 14 yrs. succeeding the Notification Act. 1904 No. u cases in which Bedding, etc., has been disinfected. At Home 179 246 593 343 177 251 368 217 132 81 62 37 20 19 194·6 6 At Chamber 1391 1570 2540 3042 2206 2472 2447 2126 2424 2998 2450 3040 3702 3253 2547·2 3107 No. of Cases in which Bedding, etc., has been destroyed. 185 275 314 224 119 6 49 39 27 44 59 75 134 62 115·1 53 No. of Articles of Bedding, etc., disinfected. 3013 6747 9909 11513 8022 13516 20349 21487 21597 27923 27528 27265 41029* 26957 19061·1 26359 No. of Articles of Bedding, etc, destroyed. 333 467 605 674 544 186 178 162 126 326 1783 959 1006* 587 566·9 479 Premises disinfected and disinfectants supplied. 1722 1816 3157 5896 5742 7146 7210 8715 8441 9146 9124 9522 12607 10984 7230·6 12367 Infectious Diseases dealt with. Notifiable† - 1676 8025 4070 2433 2685 2801 2663 2329 2693 2209 2025 4273 1587 2651·5 1938 Non-Notifiablef — — — — - — 20 87 144 1339 1702 1376 1094 2269 1003-9 2638 * Including 26145 and 355 Smallpox articles disinfected and destroyed respectively. †The Notification Clauses of the Public Health (London) Act, 1891. came into force on January 1st, 1892, and previous to 1896 practically no attention was paid to disinfection in connection with the non-notifiable infectious diseases. N.B,—The Statistics for 1901-4 refer to the Borough Council; those for all previous years, to the late Vestry, 133 ANALYSIS OP FOOD AND DRUGS, WATER, Etc. 1. Food and Drugs. During the year 1904, 1,200 samples have been purchased through the Food and Drugs Inspector (Mr. Perrin) within the Borough of Lambeth, and submitted to the Public Analyst for analysis. Of the 1,200 samples, 79 (i.e., 6.6 per cent.) were reported by the Analyst to be adulterated, varying quarterly as follows :—1st quarter, 13.4 per cent.; 2nd, 9.4 per cent.; 3rd, 5.6 percent.; and 4th, 8.1 percent.; and 66 summonses were issued, with the result that 43 convictions were obtained, together with £80 19s. 6d. in penalties, and £39 17s. 6d. in costs. In 12 cases the vendors were cautioned. Full details are to be found on pp. 137—139, and in the Appendix (pp. 26—31). 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, 704 and 1,010 samples were taken during 1901, 1902 and 1903 respectively. It will be noted that 1200 samples have been taken by the Food and Drugs Inspector, and analysed by the Public Analyst, during 1904—the largest number ever taken by the Borough Council, or by the late Vestry, in any one 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 to be, in future, taken and analysed. The Analyst's 134 Salary is £400 per annum (payable quarterly) in connection with the analysis of the first 1,000 samples, whilst a fee of 10s. per sample is paid for every extra sample analysed over and above that number yearly. This is a satisfactory advance (one sample per 259 inhabitants), but a still larger number of samples in future must be taken in Lambeth, having regard to the size and population of the Borough. The Annual Report of the Local Government Board 1903-4 gives, as the average for London, one sample analysed for every 233 persons, i.e., 4.3 per 1000 population. No samples were received by the Public Analyst during 1904 from private purchasers in Lambeth Borough, though two samples of milk suspected to contain formalin were submitted on behalf of the Borough Council. Both contained traces of formalin. The various articles analysed during 1904 were as follows :— (a) Milk. 516 samples were taken, and of these 52 {i.e., 10.1 per cent.) were declared by the Analyst to be adulterated. 8 of the samples were purchased as " separated " milks, but none of these were declared to be adulterated. The 52 adulterations found were as follows :— (1) Added water (19), varying from a minimum 3 to a maximum 36 per cent. (2) Deficient in cream (31), varying from a minimum 5 to a maximum 30 per cent. (3) Both added water and deficient in cream (2), 5 per cent, added water and 10 per cent, deficient in cream, and 4 per cent, added water and 17 per cent, deficient in cream, respectively. In 44 cases summonses were taken out, and in 27 cases convictions were obtained, with penalties varying from a minimum 135 5s. (with 14s. 6d. cost) to a maximum £10 (with 20s. costs). In the remaining 17 cases the results of the summonses were as follows :— (a) summonses marked " no conviction " (10) ; (b) summonses dismissed (3)—warranty proved (2); offence disproved (1). (c) summonses not served within legal time limit (3); and (d) defendant absconded (1). In 8 cases no action was taken for the following reasons :— (a) bottles burst (6). (b) amount of adulteration too small (1). (c) sample too sour for satisfactory analysis (1). The total fines amounted to £61 5s., with £29 12s. costs. (b) Butter. 249 samples were taken, and of these 1G (i.e., 6.4 per cent.) were declared by the Analyst to be adulterated—the adulteratious consisting of (a) added margarine (15), varying from a minimum 85 to a maximum 100 per cent., and (b) added water (1), 25.6 per cent., i.e., 9.6 per cent, beyond the 16 per cent, allowed under the Sale of Butter Regulations. In 14 instances summonses were taken out, and 10 convictions obtained, with penalties varying from 10s. (with 12s. 6d. costs) to £3 (with 17s. 6d. costs). In 3 instances the defendants absconded, and in 1 the summons was dismissed on account of the defendant being fined at the same time for another (butter) offence. In 2 cases no action was taken—the butters being served in marked wrappers. The total fines amounted to £16 7s. 3d., with £6 14s. costs. 136 (c) Coffee. 87 samples were taken, and of these 9 (i.e., 10.3 per cent.) were declared by the Analyst to be adulterated with added chicory, varying in amount from a minimum 30 to a maximum 70 per cent, respectively. No action was taken in one case on account of the wrapper (in which the mixture was sold) being marked, and of the 8 summonses taken out, convictions were obtained in 6, with penalties varying in amount from 10s. (with 12s. 6d. costs) to 20s. (with 12s. 6d. costs); whilst the summonses were dismissed in 2 (marked wrapper being proved in the one, and absence of intent to defraud in the other). The total fines amounted to _£3 7s. 3d., with £3 11s. 6d. costs. (d) Sausages. 2 samples of sausages were declared by the Analyst to be adulterated with 20 and 25 grains of crystalised boracic acid per lb. respectively. The other samples of Food and Drugs (346 in number) taken by the Inspector 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 1904 amounted to £89 19s. l0d.—consisting of £28 18s. 9d. for samples, £22 4s. 0d. for Assistant (Deputy), £4 15s. 6d. for Witnesses, £4 0s. 6d. for Collecting Evidence, £26 17s. 0d. for Travelling Expenses, and £3 4s. 1d. for Sundries. The salary of the Food and Drugs Inspector (£120 rising by £10 annual increases to £200), and the cost of the summonses (£9 18s. 0d.), are not included in the above. 137 SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of Analyses, during the year 1904. Samples. Number Procured. Number Adulterated *Milk 516 52 Butter 249 16 Coffee 87 9 Mustard 27 — Pepper 46 — Whisky 22 — Lard 17 — Sago 15 — †Drugs 20 — Tea 13 — Ground Rice 18 — Oatmeal 21 — Sugar 10 — Olive Oil 21 — Arrowroot 20 — Baking Powder 8 — Flour 3 — Ground Almonds 3 — Pea Flour 28 — Vinegar 24 — Beer 12 — Tapioca 6 — Linseed Meal 4 — Eucalyptus Oil 3 — Chocolate Powder 3 — Sausages 2 2 Bacon 1 — Yeast 1 — Totals 1200 79 * Separated milk 8. † Cream of tartar 8, milk of sulphur 6, tartaric acid 6. 138 Particulars as to samples analysed, and proceedings taken, during 1904 (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. 1904 1200 79 6.6 66* 43 12 £. s. d. £. S. d. 80 19 6 39 17 6 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 1890 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. * 6 Summonses were dismissed, and 17 withdrawn, during 1904. 139 Shewing percentage of different adulterated Samples during 1904 (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. Aerated Waters. Drugs. Boro' Council 1904 10.1 6.4 10.3 0.0 0.0 0.0 0.0 5.7 0.0 — — — 0.0 0.0 — — 0.0 Late Vestry. 1900 14.2 11.0 17.8 — — 0.0 3.5 0.0 0.0 — — — 0.0 0.0 — — 0.0 1899 10.9 14.5 6.9 — — 0.0 2.7 0.0 21.4 33.3 — 0.0 20.0 — — 0.0 0.0 1898 13.0 14.5 10.3 — 0.0 0.0 0.0 0.0 11.1 — 0.0 50.0 5.9 — — — 18.8 1897 10.5 7.3 3.03 0.0 0.0 0.0 2.0 11.1 17.7 — 25.0 18.2 0.0 — — — 14.3 1896 11.06 17.7 15.1 0.0 0.0 — 0.0 0.0 0.0 0.0 0.0 0.0 0.0 — — 0.0 0.9 1895 21.05 14.7 26.4 — 0.0 0.0 0.0 16.6 16.0 — 12.5 25.0 — — 0.0 0.0 12.5 1894 27.6 22.4 30.0 — 0.0 0.0 5.3 0.0 0.0 0.0 0.0 0.0 0.0 — — — 0.0 1893 30.4 35.04 11.1 0.0 18.2 0.0 3.3 0.0 8.7 20.0 0.0 0.0 11.1 — — — 0.0 1892 31.3 36.4 18.4 — 66.7 0.0 2.1 0.0 0.0 0.0 0.0 0.0 — 0.0 — — 0.0 1891 47.8 5.0 3.8 0.0 — — 2.6 0.0 0.0 0.0 0.0 — 0.0 0.0 — 0.0 0.0 0 0 means that all samples were reported to be genuine and unadulterated. — means that no samples were taken during the year. 140 Full Analysis of Samples of Scotch Whiskey and Ordinary Beer. A full analysis has been made during 1904 for the information of the Council of samples of (a) Scotch Whiskey, and (b) ordinary Beer, with the following results :— (a) Sample of Scotch Whiskey. Parts per 100. Water 57.121 Absolute Alcohol 42.800 Acidity (as Acetic Acid) 0.004 Aldehydes (as Ethylic Aldehyde) 0.002 Furfural trace Ethers (as Ethyl Acetate) 0.020 Higher Alcohols 0.011 Total dry solid matter 0.042 100.000 This is a legally genuine, perfectly wholesome spirit, but cannot be described as first-class Malt Whiskey. (b) Sample of Ordinary Beer. Parts per 1000. Present Specific Gravity of Sample 1015.35 Ordinary Gravity of Wort . 1054.07 Water 900.2936 Absolute Alcohol 42.5000 Acetic Acid 0.9600 Higher Alcohols (as Amylic Alcohol) 0.0638 Compound Ethers (as Acetic Ether) 0.0221 141 Furfural 0.0005 Aldehydes trace Total dry solid matter 56.1600 Total 1000.0000 A further detailed analysis of the dried solid matter found in the sample of beer gave the following results:— Maltose 19.78 Dextrine 21.37 Albuminoids 5.66 Lactic Acid 1.08 Mineral Matter 3.88 Hop extract and colouring matter from malt 4.45 Total 56.16 The mineral matter was found to be made up as follows :— Potash 1.24 Soda 0.41 Lime 0.06 Magnesia 0.18 Sulphuric Acid 0.05 Phosphoric Acid 1.07 Chlorine 0.47 Silica 0.40 Total 3.88 The chlorine found was equivalent to 0.774 sodium chloride (common salt), i.e., the sample of beer contained 54.18 grains of common salt per gallon. The sample was quite free from arsenic or other deleterious ingredients. 142 II. Water. Two samples of suspected well water were examined during 1904, but in neither case was any organic (or other) contamination found. SMOKE ABATEMENT. During 1904 there have been made 540 special observations and enquiries in connection with smoke abatement throughout the Borough, as compared with 720, 679 and 620 during 1903, 1902 and 1901 respectively. This is an important duty, and one that a Sanitary Authority is right in carrying out rigorously. During 1904, 46 smoke notices have been served, and the nuisances abated. In no case was it found necessary to proceed to summonses. The following Firms have been under special observation weekly during 1904 by the Borough Council's Smoke Inspector:— 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, Westminster Bridge. 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. 143 Electric Light Works, Electric Avenue. Messrs. Clarke, Brixton. Messrs. Howell, Belvedere Road. Jews' Hospital, Knight's Hill Road. Messrs. Mumford, Albert Embankment. Messrs. Nightingale, Albert Embankment. Sharwood's Factory (rear of), 26, Handforth Road. Messrs. Crosse & Blackwell, Belvedere Road. Laundry (rear of), 115, Stockwell Park Road. L.C.C. Works, Belvedere Road. Messrs. Meredith & Son, Belvedere Road. Messrs. Causton, Clapham Road. Messrs. Barrett, Wandsworth Road. Messrs. Higgs & Hill, South Lambeth Road. Messrs. Holloway Bros., Belvedere Road. Bon Marche, Electrical Works, Nursery Road. City and South London Electrical Railway, Generating Station, Clapham Road. Messrs. Hyde, Harold Street. Oval Tavern, Harleyford Road. Lion Brewery Company, Belvedere Road. Messrs. Beattie, 39, Lower Kennington Lane. Messrs. Fremlin & Co., Dane's Road. South Metropolitan Gas Company, Works, Vauxhall. Messrs. Francis & Son, Brixton. Bonanza Bakery, 213, Lyham Road. South Loudon Electric Supply Company, Bengeworth Road. Lett's Wharf, Commercial Road. Messrs. Webb & Sons, Albert Embankment. Messrs. Brotherhood, Belvedere Road. 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 144 work carried out by the Borough's Smoke Inspector, the London County Council has, during 1904, written 19 letters to the Borough Council, drawing attention to smoke nuisances observed by their own officers as follow :— Messrs. Doulton & Co., Albert Embankment (4 occasions). Messrs. Stiff & Sons, Albert Embankment (7 occasions). City and South London Railway, Generating Station, Clapham Road. Jews' Hospital, Knight's Hill Road. Fife Laundry, 39, Southville. Hackford Road Board School. Cookson's Destructor, Tinworth Street. Messrs. Clarke, Brixton (2 occasions). Messrs. Mumford, Albert Embankment (3 occasions). 240, Coldharbour Lane (Bakery). Sunnybank Laundry, South Lambeth Road. 79, Vauxhall Walk (Bakery). Mr. Schmidt, 78, Brixton Road. Messrs. Hammerton & Co., Stockwell Brewery. 149, Hamilton Road, West Norwood (Laundry). Electric Light Station, Electr ic Avenue (5 occasions). Bakery, Treherne Road, Brixton. With one or two exceptions, the whole of these Firms reported by the London County Council were already under observation by the Borough Council's Officer at the time of the receipt of the complaints ; as also were the following Firms, reported to the Borough Council in the nine communications of the Coal Smoke Abatement Society, whose head offices are at CI, Godolphin Road, Shepherd's Bush, W. :— Lion Brewery (C occasions). Messrs. Drew, Bear & Co., Commercial Road. Messrs. Mumford, Albert Embankment (2 occasions). Messrs. Crosse & Blackwell, Belvedere Road (2 occasions). Messrs. Meredith & Son, Belvedere Road (4 occasions). 145 Messrs. Clowes & Sons, Duke Street. Messrs. Doulton, Lambeth (4 occasions). Charing Cross & Strand Electricity Corporation, Commercial Road (6 occasions). Messrs. McGaw, York Road (3 occasions). Messrs. Holloway Bros., Belvedere Road (3 occasions). Messrs. Webb & Sons, Albert Embankment. Messrs. Brotherhood, Belvedere Road (3 occasions). Fortnightly reports in connection with smoke have been presented by the Public Health Committee to the Council during the year 1904. The Act lays down that black smoke only is a nuisance liable to be dealt with summarily under Section 2 of the Act, and there is, consequently, great difference of opinion (at times) as to what is, and what is not, black smoke. Complaint was made in June, 1904, to the Council by the Smoke Abatement Society as to alleged nuisances from black smoke connected with the various manufactures situated on the south side of the Thames, along Belvedere and Commercial Roads. Consequently, special observations were ordered and taken daily from June 22nd to June 29th (inclusive), in connection with the business premises on the River frontage in the Borough of Lambeth, extending from Westminster Bridge to Broadwall— in which area are located the following Firms:—Messrs. Crosse & Blackwell, Peter Brotherhood, Howell, Holloway Bros., L.C.C. Works Department, Meredith & Co., Lion Brewery Co., Walker's, Parker, Seth Taylor, City of London Brewery Co., Charing Cross and Strand Electricity Supply Corporation, Clowes & Sons, McGaw, and the City & Waterloo Electric Railway Works. The observations were kept daily for periods of 4 and 5 hours (continuous), and the only cases of black smoke which were discovered during the whole of the time (7 days), were as follows:—Messrs. Howell's Granaries, June 23rd (4 minutes); Messrs. Meredith & Co., June 24th k 146 (3 minutes); Lion Brewery Co., June 24th, 27th and 28th (5, 3 and 4 minutes respectively); Messrs. Peter Brotherhood, June 28th (5 minutes); Messrs. McGavv, June 28th (2 minutes); and Messrs. Holloway Bros., June 29th (1 minute). Several complaints were received during 1904 with regard to 18, Belmore Street, Wandsworth Road, premises used as a marine stores. On inspection, it was found that the premises were in a dirty and dilapidated condition, with large quantities of filthy rags, and offensive decaying bones, deposited in the rooms and yard. A small dust sorting business is carried on there. REFUSE AND MANURE DEPOTS. The 13 public depots, situated in Lambeth Borough, have been under constant (daily during the summer months) supervision during 1904. Deposit of Refuse on St. John's Villa Estate, West Norwood. Complaint was received in February, 1904, as to the depositing of black slop on the St. John's Villa Estate, West Norwood, at the rear of houses in Casewick Road, thereby creating a nuisance. The black slop was found to be the dredgings of a pond in a neighbouring Borough, and its deposit in Lambeth Borough was stopped forthwith—a letter of apology being, at the time, received from the Contractor. Cookson's Wharf, Albert Embankment. Several complaints have been received during 1904 as to a nuisance arising in connection with Cookson's Wharf, Albert Embankment, where the slop and dust from the Holborn Borough is dealt with, e.g., transferred from the carts to the barges. The slop is deposited on the Wharf and left to drain, but no nuisance in this respect is found, though the slop is unsightly. 147 It was found, however, that the dust was also being temporarily deposited on the Wharf for the purpose of sorting (collecting the loose paper for burning in a Destructor, situated near the Embankment), thereby creating a nuisance to the neighbouring premises and the passengers on the public road. This depositing and sorting has been stopped—the dust being tipped direct into the barges. Conveyance of the Carcases of Dead Horses along Public Streets. Under Section 54 of the London County Council (General Powers) Act, 1903, bye-laws have been made, during 1904, with respect to the mode of conveying the carcases of dead horses through and along the public streets in the County (including Lambeth)—the bye-laws to be enforced by the different Metropolitan Borough Councils. The bye-laws provide for :— The use of a "vehicle constructed and closed in such manner that the carcase shall be completely concealed from public view," and that the body of the vehicle "shall be made of or lined with impervious material, so as to prevent any liquid or discharge " escaping therefrom. The carcase is to be conveyed along the public streets with all reasonable dispatch, and so as to prevent any nuisance arising therefrom. EFFLUVIUM NUISANCES. 1.—Dust Destructors belonging to Public Bodies. Complaints were received during 1904 as to a nuisance in connection with the Shot Tower Destructor, belonging to the Westminster City Council, and situated at their Wharf in Commercial Road, but the nuisance was a temporary one, and practically unavoidable, being due to a break-down in the overhead trolly apparatus, necessitating the cooling of the red-hot clinker at the furnace doors instead of at the end of the Wharf jetty. 148 2.—Dust Destructors belonging to Private Contractors. Several complaints were received during 1904 with reference to Clarkson's Destructor, situated in Tinworth Street, Albert Embankment, but in every instance it was found that the nuisance was due to negligence—the secondary coke fire (or fume cremator) not being lighted owing to the contractors having failed to supply the necessary coke for burning therein. On another occasion, sparks from the furnace set fire to a large quantity of paper, breeze, &c., which was stacked temporarily in the yard near to the Destructor awaiting burning. This Destructor, and others, are kept under constant official supervision, and the complaints received are few. 3.—South London Electricity Supply Corporation, Bengeworth Road. Special observations were taken during 1904 in connection with the effluvia proceeding (at times) from the chimney belonging to the works of the South London Electricity Supply Corporation, Bengeworth Road, the chief complaint being of "greasy blacks." These "greasy blacks" were analysed by the Public Analyst, who reported as follows: "The greasy black stains (on linen) consist of carbon in a fine state of division, embedded in an unsaponifiable greasy matter of a hydrocarbon nature, but, owing to the very minute quantity extractable, repeated attempts to further identify the hydrocarbon contained in it proved abortive. The spots may be simply described as ' greasy soot,' and are evidently the result of solid matters thrown out with the smoke from a chimney where imperfect combustion is going on in the fire beneath." The nuisance was chiefly complained of between 4 and 6 p.m., the time when increased work is put upon the boilers for the generation of the extra electricity needed when darkness sets in; and appeared to be due to the excessive draught in the flues 149 carrying out into the external air fine coal siftings—small coal sittings or screening being supplied at that time (so it was reported) to the works for burning after dark or at dusk. The Company was communicated with, and the nuisance ceased. No further action was therefore necessary, but the details show the danger of a nuisance arising at any time, unless strict care in the management of the furnaces is at all times enforced— Welsh steam coal only being used as fuel. The Company denied that any coal siftings or screenings were used at the time of the complaints, though there could be no doubt as to the "greasy blacks," which, it was stated, were found to be issuing from the chimney. 4.—Messrs. Hammerton's Brewery, Lingham Street, Stockwell. A memorial, signed by 51 owners and householders living in Kimberley and Kay Roads, and in the immediate neighbourhood, has been received during 1904,drawing attention to the "continual nuisance and inconvenience arising from the smoke and fumes of sulphur emitted from the shaft of Messrs. Hammerton's Brewery, Lingham Street, Stockwell, a nuisance which is (the memorialists allege) both detrimental to health and property." The complaint of the memorialists could not be substantiated by the Council's officials. 5.—Ballast Burning at Gipsy Road. An anonymous letter of complaint was received during 1904 (September) from the Gipsy Road Constitutional Club, drawing attention to a large ballast fire, burning in the Gipsy Road. On making enquiries it was found that the fire was lighted on September 29th on a large plot of land for the purpose of burning clean clay dug out of the footings from the two new houses being erected on the land, such clean clay being mixed with coal, and not with house refuse in any shape or form. A screen was found to have been erected so as to hide the ballast fire from the road—the nearest house, which is directly opposite, being 100 feet away, and the Gipsy Road Constitutional Club being 150 400 feet farther west. The fire was kept under the daily inspection of the Inspector (who had received no complaints from the surrounding inhabitants), and no nuisance could be discovered. HOUSES LET IN LODGINGS. The 372 registered houses have been visited regularly, but no new house has been registered, during 1904. Alterations to Bye-Laws. Legal decision given in the King's Bench Division (Divisional Court) on February 5th, 1904, by the Lord Chief Justice of England, Mr. Justice Wills and Mr. Justice Kennedy, in the two cases of Stiles v. Galinski and Nokes v. Mayor, etc., of Islington, have rendered it necessary to amend the present wording of the Bye-laws for Houses let in Lodgings. It has been held that it is necessary to serve a notice upon the responsible person before subjecting him to a criminal charge, e.g., annual cleansing of premises, *provision of 1 w.c. to every 12 lodgers, etc. Further, it has been suggested that it is desirable to extend the time within which the annual cleansing is to be carried out, viz., "the month of April," instead of "the first week of April." The Borough Council, on April 14th, 1904, decided to alter the Bye-laws in accordance with the ruling and suggestion of the High Court Judges. A difficulty in carrying out these Bye-laws is due to the "landlord" being liable for the annual cleansing and not the "owner" (vide Special Report, Appendix, p. 38). *This involves an alteration of the L.C.C. Bye-law 26, made under Section 39 (1) of the Public Health (London) Act, 1891—an alteration which the L.C.C. has already made (February, 1904). 151 COMMON LODGING HOUSES. There are 10 Common Lodging Houses (for men) situated within the Borough of Lambeth, and these have been licensed by the L.C.C. during 1904, at the Annual Licensing Meetings»held June 21th and 25th, 1904, and January 27th, 1905. 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 1 st 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. 145 Upper Kennington-lane Under the Common Lodging Houses Acts, 1853-5, the London County Council has control overall 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, 1890, was brought in. All Common Lodging Houses must be licensed by the London County Council annually (vide London County Council General Powers Act, 11)02, Part IX., Section 46). 152 HOUSING OF THE WORKING CLASSES. It has only been found necessary to condemn 15 houses during 1904, under the housing of the Working Classes Acts, and particulars of these (together with the reasons for their condemnation) are to be found on p. 147. Action under the Housing Acts is exceptional, as the majority of cases can be dealt with satisfactorily under the Public Health Acts, under which a closing order can be obtained in the case of a house that may be found to be, structurally or otherwise, unfit for human habitation. Conference on London Housing, Building, &c A Conference, convened by the Workmen's National Housing Council, was held on December 3rd, 1904, at Essex Hall, and many resolutions were passed thereat, dealing with the subjoined {inter alia) subjects :— 1. Protests against (a) existing high rents; (b) the tendency to build houses and rooms of small dimensions ; (c) continued existence of slums; and (d) the protracted shortage of house room, with the consequent unhealthy crowding. 2. Need for improved Municipal Housing Schemes by (a) empowering local authorities to issue non-interest bearing notes; (b) grants from the Imperial Exchequer; (c) tax on site values. 3. Need for proper definition of a "room," e.g., the air space not less than 1,200 cubic feet. 4. Need for improved means of transit and locomotion for London. An Order in Council has been issued, transferring all powers under the Housing Acts from the Secretary of State to the Local Government Board, as and from March 1st, 1904. 153 housing of the working classes acts. Details of Houses condemned during 1904. Date of representation of Medical Officer of Health to, and of resolution of, Borough Council. Address of Premises. No. of Houses. Date of Service of Notices. Result. Remarks. January 7th 8, Gordon Grove, Loughboro' Road i ... Rendered fit Dirty, damp & dilapidated March 17th 1—2, South Cottages, Warham St. 2 Apr. 13 Rendered fit Dirty, damp and dilapidated, and generally worn out, and drains defective June 2nd Gardener's Cottage, abutting on 30, Herne Hill 1 ... Rendered fit Damp, dilapidated, old, and the drains defective June 16th 18a, 18b, 18c, 18d, Kibworth Street 4 July 8 Closed Dirty, damp, dilapidated and old July 14th 422—424, Coldharbour Lane 2 July 28 Rendered fit Dirty, damp, dilapidated, and drains defective July 14th 32, Electric Lane 1 Sep. 19 Closed Situated over unpaved stables so that effluvia permeate into the living rooms through the open staircase and badlyfitting wooden floors November 10th 1, 2, 3, 4, Porter's Cottages, Coldharbour Lane 4 Rendered fit Dirty, damp & dilapidated 154 REVENUE ACT, 1903. During 1904, 494 Certificates under the Revenue Act, 1903, in connection with tenements (or dwellings) so constructed as to afford suitable separate accommodation for such of the families inhabiting the same, have been applied for, and, of these, 338 have been granted unconditionally; and 37 have been granted conditionally, i.e., on condition that certain alterations and improvements are carried out. In 119 cases, the certificates were refused. The limit of rent is extended by the Revenue Act, 1903, to £60, but a certificate from the Medical Officer of Health is only needed in the case of dwellings of an annual (gross rateable) value not exceeding £40. (a.) Certificates granted unconditionally. Address. Blocks or Houses. Tenements. Brockwell Mansions, Crowstone Road, Water Lane, 1-24 4 24 Coldharbour Lane, 131a-135b 6 18 Courtney Street, 19-35 (odd numbers) 9 18 Cowley Mansions, Cowley Road, Brixton, 1-48 6 48 Denmark Mansions, Coldharbour Lane, 1-22 3 22 Hackford Road, 8 1 6 Northlands Street, Coldharbour Lane, 2-32 and 5-23 26 78 St. Gothard's Road, West Norwood, 36 1 3 Springfield Terrace, Wandsworth Road, 1, 2, 3 3 6 Tower Street, 18 1 8 Ufford Street, New Cut, 30-53 (inclusive) 4 24 155 Vaughan Road, Coldharbour Lane, 46-88 and 51-59 27 81 Vauxhall Models, Albert Embankment, 10a, 10b (part of South Block, already certified) — 2 Totals 91 338 (6.) Certificates granted conditionally. Brading Road, 2, 2a 1 2 Clifton Mansions, Coldharbour Lane, 1-22 5 22 Lambeth Road, 101, 103 1 9 Priory Buildings, Priory Grove, 1-4 1 4 Totals 8 37 (c.) Certificates refused. Broad Street, 40, 42, 44 3 9 Granby Buildings, 6-15 (inclusive) 10 30 New Palace Building, Whitgift Street, 1-12 1 12 Salamanca Street, 25 1 3 Strathleven Road, Acre Lane, 40, 42, 81-99 (odd numbers) 16 32 Vauxhall Walk, 2, 6, 8, 10, 12, 14, 16 7 21 Wandsworth Road, 172, 178, 188, 192 4 12 Totals 42 119 156 BAKEHOUSES. There are 214 Bakehouses (135 above ground and 79* underground) situated within the Borough of Lambeth, and these have been inspected during 1904, and the necessary annual whitewashing and cleaning carried out. OFFENSIVE TRADES. During 1904, no nuisance has been reported in connection with 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, Black- man & Sons). 5. Tripe Boilers—103, Lambeth Walk (Messrs. Bennett, Son & Co.) 6. Tripe Boilers—115, Lower Marsh (Messrs. Bennett, Son & Co.) During 1904, the Local Government Board confirmed the Order, made by the London County Council on March 29th, 1904, by which the business of a dresser of fish skins becomes an offensive business within the meaning of Section 19 (1) (b) of the Public Health (London) Act, 1891. No such business is at present carried on in Lambeth Borough, as far as is known. Fried fish shops have been complained of from time to time, but, unfortunately, a Sanitary Authority's power over such places is slight; care is taken to see that proper fuel and fat are * 72 have been certified as "suitable " for occupation as bakehouses. 157 used, and that the fish offal is removed regularly and in properly constructed tins. During 1904, the L.C.C. Bye-laws as to Offensive Trades have been under consideration with a view to their amendment and extension, and the Borough Council has approved of the suggestions made by the L.C.C. The most important amendment is to require, in future, that, in the case of every business, all offensive processes shall be conducted in a closed chamber—provision being moreover made for the adequate ventilation of such chamber and the destruction of offensive vapours. The amended draught bye-laws also differ from the existing bye-laws, in the following, amongst other respects :— (а) For the purpose of receiving and conveying away all scraps, litter, refuse and residues, there is to be provided in all cases a sufficient number of vessels or receptacles, furnished with tight and close-fitting covers. (b) All material emitting any offensive or noxious effluvium, vapour or gas, when delivered on to the premises across a public footway, is required to be conveyed in vessels properly constructed and covered. (c) In all cases where a closed chamber is to be provided, the cleansing of the floor of every such chamber and such part of the walls thereof as is covered with hard, smooth, and impervious material, is required at the close of each working day; and all vessels, receptacles, etc., are to be kept clean so as to prevent any offensive smell. (d) A copy of the Bye-laws and a plan of the premises are to be displayed in a conspicuous position. (e) Drains on all premises are to be maintained in good order and in efficient action. 158 (f) In some instances a requirement is made that all liquid refuse, before being discharged into any drain, shall be treated in such a manner as to prevent nuisance. (g) In the Bye-laws relating to the business of a Knacker, a provision has been inserted for the prevention of over-crowding of animals, and the cleansing of streets after the slaughter of horses by a licensed Knacker. (h) A provision that the parts of walls and ceilings not covered with hard, smooth, aud impervious materials shall be lime-washed between the first and tenth days of the months of March, June, September and December, has been inserted in each set of Bye-laws. The proposed Bye-laws as to the trade of fell-monger are new, there being no existing bye-laws dealing with such an offensive trade, and incorporate the points mentioned above. SLAUGHTER-HOUSES. There were within the Borough of Lambeth at the end of 1903, 32 registered Slaughter-houses, and at the annual Licensing of the London County Council, held on October 31st, November 1st and December 3rd, 1904, respectively, the licenses were renewed with the following exceptions :— 32, Chapel Road, West Norwood—No application for license made. 107, Hamilton Road, West Norwood—No application for license made. 159 LIST OF THE 30 LICENSED SLAUGHTER-HOUSES IN THE BOROUGH OF LAMBETH, 1904. Ward. Situation of Premises. Name of Licensee. Marsh 106, Lower Marsh Thomas, Robert Edwin „ 124, „ „ † Sharpe, John Wm. „ 99, „ „ * Holdstock, J no. 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 40G, 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. „ l,Lansdowne Road, Clapham Road Copeman, Walter George Stockwell 97, Stockwell Road Rooksby, Walter „ 27, Bedford Road,Clapham Rd. Pooley, John Pied 160 Ward. Situation of Premises. Name of Licensee. Brixton Near Railway Hotel Brewery, Electric Lane Elphick, Edwin „ 263, Brixton Road Copp, Albert „ 10, Foxley Road* Maiden, Robert Levers „ Industry Terrace (yard leading to), Canterbury Read Warren, James Edward Heme Hill 207, Coldharbour Lane Clark, Albert John „ 309, „ „ Ford, Hy. & Co., Ltd. „ 77, Dulwich Road Atkin, Jim Cook Tulse Hill 45, New Park Road Beaumont, Edith Mary (trading as Martin & Beaumont) „ 12, Lower Tulse Hill Haydon, Wm. Norwood 120, High Strect*† Bull, John „ 121, „ „ (rear of) Griffiths, Fredk. „ 60, Knight's Hill Road Crittall, Daniel Pearce „ 125, Hamilton Road Forss, Thomas Lionel * Small cattle only to be killed. † Special conditions laid down. Sanitarily, these 30 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 161 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 infringement of Bye-laws was dealt with during 1904:— 38, Walnut Tree Walk—general mismanagement, the premises being dirty and untidy. Occupier cautioned. Six slaughter-houses have changed hands during 1904, viz.:— 124, Lower Marsh ; 27, Bedford Road; 263, Brixton Road; 207, Coldharbour Lane ; 45, New Park Road ; and 125, Hamilton Road (West Norwood), and are now licensed to John William Sharpe, John Pied Pooley, Albert Copp, Albert John Clark, Edith Mary Beaumont, and Thomas Lionel Focss (formerly to William Mabbott, William James Mercer, Harry Knight, Morris Spindler, Henry Beaumont, and George Grant), respectively. COWHOUSES. There were, within the Borough of Lambeth, at the end of 1903, 20 registered Cowhouses, and at the Annual Licensing of the London County Council, held on October 31st, November 1st and December 3rd, 1904, respectively, the licenses were renewed with the following exceptions :— 8, Moat Place—License not applied for. 329, Coldharbour Lane—License not applied for. 71, Ethelred Street—Premises disused as a Cowhouse, and used as a Stable. LIST OF 17 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, 30, Tracey Street 1 13 „ 24, Distin Street 2 9 l 162 Prince's 30, Upper Kennington Lane 1 7 Vauxhall 38, Hartington Road 1 22 „ 9, Dawlish Street 1 12 Brixton 34, Ingleton Street 1 5 „ 1, Elliot Road 2 9 Herne Hill 67, Coldharbour Lane 1 7 „ 56, Railton Road 1 5 Tulse Hill 196, Norwood Road 1 20 Norwood 156, Hamilton Road, West Norwood 3 26 „ 76 and 78, Gipsy Hill 3 27 „ 67, Rosendale Road 1 10 „ 93, Clive Road, West Norwood 1 4 „ Elder Road Dairy, West Norwood 2 35 „ 15, Croxted Road, West Dulwich 1 3 24 224 Sanitarily, these 17 Cowhouses are in good condition, and they have been inspected carefully during 1904, and the drains in each case tested with the chemical test, without a result being obtained in any single instance. A tew minor sanitary defects were found during 1904, e.g., defective paving, defective walls and floors, &c., and in one instance a grain pit was being improperly used. One Cowhouse (38, Hartington Road) has changed hands during the year 1904, and is now licensed to William Davies Rees (formery T. Davies). The Borough Council is now responsible for the periodical inspection of the Cowhouses, and the due enforcement 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. During 1904 no action has been taken in regard to infringement of Bye-laws. 163 During 1904 a cow (Shorthorn) belonging to a dairy in Tulse Hill, was reported by the London County Council Veterinary Inspector as suffering from mastitis, and in view of the danger of such being tubercular the milk from that cow was not used for human consumption. DAIRIES, MILK-SHOPS AND MILK-STORES. Five new Milk-shops and Milk-stores have been registered during 1904, and all existing ones (468) have been under inspection, as required. Municipal Infants Milk Depot. The Borough Council is to be congratulated upon their public spirit in having decided on July 14th, 1904, to establish and maintain, in the Borough of Lambeth, an Infants Milk Depot, even though the expenses connected therewith will certainly be surcharged by the District Auditor, and the disallowance may not be afterwards remitted by the Local Government Board. The value of such a depot in assisting to lessen the infantile mortality of a district, is admitted by all, and such an institution must, therefore, claim the sympathy of all persons interested in disease-prevention. It follows, as a corollary, that Metropolitan Sanitary Districts, like outside (provincial) districts should be empowered by law to provide, at their discretion, out of the Rates, a depot for the preparation and sale of sterilised and humanised milk for the food of infants; and with such an end in view a Conference on the Administration of the Public Health (London) Act, 1891, held in London on July 7th and 18th, 1904, decided unanimously to request the London County Council to insert a clause in their next General Powers Bill to confer such power upon the Borough Councils of the Metropolis. The Local Government Board would appear to sympathise with Sanitary Authorities in this respect. The Borough Council 164 decided, on July 28th, 1904, to take on lease for 7, 14, or 21 years, for the purposes of a Milk Depot, the premises known as 66, York Road, Westminster Bridge Road, at a yearly rental of £70 per annum as and from September quarter, 1904. These premises are equidistant from three large Hospitals (Waterloo Road Hospital, Lying-in Hospital, and St. Thomas' Hospital), and the internal arrangement of the rooms is such as to be readily adapted for the necessary alterations. Instructions have been given for the necessary plant to be provided, and fitted up, in the premises at an initial cost of £250 (estimated) as follows :— £. s. d. One Steriliser 80 0 0 „ Boiler (3-horse power) 40 0 0 „ Rinsing Machine (bottles) 5 0 0 „ Washing Machine (bottles) 6 10 0 „ Tank for Cooling (bottles) 9 0 0 „ Tank for Washing (bottles) 3 0 0 ,, Bottle Filler 2 0 0 40 gross of Bottles at 18s. 6d. per gross 37 0 0 10 dozen large Baskets at 13s. per dozen 6 10 0 10 dozen small Baskets at 10s. per dozen 5 0 0 1 Baby-weighing Machine 1 0 0 2 Milk Churns at 30s. each 3 0 0 Milk Measures (various) . 1 10 0 1 Strainer 0 18 0 10 gross Rubber Teats at 32s. per gross 16 0 0 Extras (contingencies, &c.) 33 12 0 £25 0 0 It is further estimated that the annual expenses (for 100 children) will be (about) a net maximum annual charge upon the Rates for working expenses of £200, as follows:— 165 Annual Estimate (for 100 Children). £ Rent (house) 70 Rates and Taxes 30 Water and Lighting 25 Fuel (Boiler) 10 Wages (2 Attendants) 125 *Milk, Cream and Sugar 280 Contingencies (renewal of Bottles, etc.) 50 £590 †Receipts from sale of Milk (say) 390 Cost to the Rates £200 It is estimated that 63 gallons of milk per head per year will be required. It is interesting to note that a letter, dated November 9th, 1904, was received by the Council from the Rev. E. G. Maxted, enclosing the following resolution, which had been carried unanimously at a Public Meeting held in St. Anne's Lecture Hall, Miles Street, South Lambeth, on Tuesday, November 8th, 1904 :— That this meeting expresses its thankfulness for the establishment of a Municipal Milk Depot in York Road, and asks the Council to extend the Milk supply to other Wards by means of branch depots at the Public Libraries, as soon as possible. Should the Milk Depot in York Road prove a success, the suggestion contained in the resolution will doubtlessly be acted upon by the Council, such a provision having been already made by the Medical Officer of Health in the Lambeth scheme. * Milk at 9d. per gallon ; sugar—lactose at 63s. per ton, and cane sugar at 2¾d. per lb.; cream at 1s. 4d. per pint. † Milk (humanised and sterilised) at 1s. 6d., 2s. 0d., and 2s. 6d. per head per week, varying with the ages of the infants and children. 166 For purposes of future record, it may be stated that the Borough Council of Lambeth decided on July 9th, 1903, in favour of the establishment of a Municipal Milk Dep&t for the Borough (and elsewhere), provided the Local Government Board would allow the necessary expenses out of the rates. This the Board, uufortunately, refused to do, stating that there was " no legal authority for such an expenditure being charged upon the General Rates." The Board was again written to, asking if the Auditors' disallowance (when made in the case of Lambeth) would afterwards be remitted by the Board " in the exercise of the equitable jurisdiction conferred upon the Board," as has actually happened in the case of Battersea Borough Council. The subjoined was the official reply :— Local Government Board, Whitehall, S.W., 6th June, 1904. Sir, I am directed by the Local Government Board to advert to your letter of the 16th ultimo, with reference to the proposal of the Council of the Metropolitan Borough of Lambeth to establish a Depot for the supply of sterilized milk ; and to state that, if the Council charged any expenditure in connection with the matter in their accounts, it would come before the District Auditor in the first instance. The Board could not properly intimate beforehand what course they would take if the Auditor should make any disallowance or surcharge, and an appeal were made to them against his decision. They would, however, give due consideration to all the circumstances of the case in dealing with such an appeal. I am, Sir, Your obedient Servant, The Town Clerk, (Signed) Thos. Pitts, Lambeth. Assistant Secretary. The Public Health Committee discussed at their meeting, held on June 20th, 1904, as to whether or not this official reply of the 167 Board was a sufficient guarantee to warrant the Committee recommending the Council to "risk the surcharge," and the voting was—for 6, against 6 (the Chairman voting), such a recommendation. When this Report of the Public Health Committee came up before the Council at their meeting, held June 30th, 1904, an instruction was given to the Committee to "prepare and submit to the Finance Committee an estimate for the establishment of a Municipal Milk Depot for the Borough of Lambeth." This estimate* was duly prepared, and submitted to, and accepted by the Finance Committee and the Council, at their meetings held on July 8th, 1904 and July 14th, 1904,respectively. The Depot is to be under strict medical supervision, and to be used only for such cases as it is intended for (and not promiscuously for all comers); whilst great care will be taken to obtain a contract for as pure a milk as possible from some country farm, which is in a satisfactory sanitary condition, and where the cows are well looked after and groomed, and subjected from time to time to veterinary inspection. PURE MILK SUPPLY. The important subject of a pure milk supply for Lambeth (and London generally) has engaged the attention of the Council during 1904, in connection with a Special Report on the subject of Unclean Milk presented by the Medical Officer of Health on April 28th, 1904, and the Council decided as follows :— 1. To urge the Local Government Board and the Board of Agriculture to take steps to ensure the better enforcement of the Dairies, Cowsheds and Milk Shops Orders (and the regulations made thereunder) outside the Metropolis. 2. To urge the Local Government Board to carry out their statutory duties, as laid down in Section 28 of the * Estimated preliminary cost of fittings, £250 ; Annual net estimate for up-keep, £200. 168 Public Health (London) Act, 1891, in respect of the Metropolis, whereby the Board may make such general or special Orders as they may think fit for the following purposes, or any of them, that is to say,— (a) Registration of all dairymen; (b) Inspection of cattle in dairies; (c) Sanitary conditions of dairies; (d) Securing of the cleanliness of milk vessels; (e) Prescribing of precautions to be taken for the protection of milk against infection, or contamination; and (/) Authorising the L.C.C. to make Bye-laws for any (or all) of the above purposes. 3. To call the attention of the Railway Companies and the large Metropolitan Milk Societies or Organisations to the present need for more sanitary means of transit and storage of milk. 4. To suggest to the Local Government Board the ability of (a) all Milkshops and Milk Stores being required (under penalty) to be licensed annually, as is the case (at present) with all cow sheds ; and (b) no person or persons being allowed to sell milk unless the premises, at which such milk is sold or stored, have been previously certified as "suitable" by the Sanitary Authority for the District. OPEN SPACES. During 1904, the following action has been decided upon in regard to certain open spaces :— (a) Ufford Street—Recreation ground, which has been given over to the Borough by the Ecclesiastical Commissioners, to be paved, drained and fenced in at an estimated cost of £820 5s. 0d. 169 (b) Brixton Oval.—Open space, which has been laid out, and presented to the Borough, by Lady Tate, to be maintained for all time. (c) Brockwell Park Extension.—Six acres at the Southern end of the Park, towards the price of which the Borough Council has guaranteed to contribute £2,000, if, and when, the Extension Committee has raised £10,000, and conditional to a widening being made to the public way at the junction of the Norwood and Trinity Roads. The question of the provision of open spaces is an important one from a Public Health point of view, and the suggestion made during 1904 that land on Salter's Hill, or elsewhere in Norwood, should be secured for such a purpose, is one that should be supported, and carried into effect as soon as possible. MORTUARIES AND CORONER'S COURTS. The total number of bodies received at the two Borough Mortuaries (High Street and Wanless Road) during 1904 was 373, as compared with 437 during 1903, and an annual average for the old Parish of Lambeth for 5 years (1896-1900) of 450. Of the 373 bodies, 272 were received at High Street and 101 at Wanless Road. The total number (373) is 77 below the average for 1896-1900. 45 bodies were brought in by the Police (32 to High Street and 13 to Wanless Road), and the rest by undertakers or private persons. The Coroner's Court sat 47 times at Wanless Road, 272 times at High Street. Wanless Road Mortuary alone is provided with a separate room for bodies dead from infectious disease, and during 1904 one infectious body (diphtheria) was received there. 170 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). The number of post-mortems conducted for the Borough during 1901 is 205, as compared with 253, 281, 275, 285 and 267 respectively during 5 years (1896-1900) for the old Parish, i.e., 67 less than the yearly average (272.5) during the same quinquennium. Of the post-mortems, 50 took place at Wanless Road, and 155 at High Street. Unfortunately, it has again to be reported that the mortuary and post-mortem rooms at High Street still remain in an unsatisfactory condition. These buildings are totally inadequate, and quite unsuited to present day requirements, and it was hoped that a plan for their rebuilding and re-arrangement (with enlargement) would have been dealt with during 1904—the Council having voted £500 for such necessary work. Difficulties have, however, again arisen causing delay. Extra Mortuary Accommodation for Lambeth. A letter was received during 1901 from the Guardians drawing attention to the need for additional Mortuary accommodation being provided in the Borough of Lambeth, not necessarily for the reception of the remains of persons awaiting inquest, but where bodies of poor people, whose friends, or relatives, are unable to make adequate and sanitary arrangements at home, may be taken, pending interment. Such need is well-known, and it is unfortunate that a site in Norwood has not yet been obtained for the purposes of an extra Mortuary there (as approved by the Council on May 16th, 1901, and by the late Vestry on May 11th, 1896). 171 Numbers of bodies received at the Lambeth Borough Mortuaries during 1904 and at the Lambeth Parish Mortuaries during the five years (1896-1900). 1904. January. February. March. April. May. June. July. August. September. October. November. December. Total 1904 Total 1900 Total 1899 Total 1898 Total 1897 Total 1896 Yearly Average for l8961900. High Street— Males 16 16 15 10 13 16 13 19 11 13 13 19 174 237 239 222 218 221 227.4 Females 8 5 10 6 11 11 7 6 5 9 9 11 98 142 126 143 109 152 134.4 Wanless Road— Males 6 5 5 2 3 3 4 3 4 8 3 4 50 58 71 72 41 - 48.4 Females 9 3 5 3 6 3 3 2 3 3 4 7 51 62 47 58 32 - 39.8 Totals 39 29 35 21 33 33 27 30 23 33 29 41 373 499 483 495 400 373 450 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. 172 Particulars as to cases of Drowning, Accidental Death and Suicide that have occurred in the Borough of Lambeth during 1904, and in the old Parish during five years (1890-1900). High Street. Wanless Road. Boro' Parish of Lambeth. Average 5 years 18961900. Total 1904. Total 1900. Total 1899. Total 1898. Total 1897. Total 1896. M. F. Total. M. F. Total. Drowning - 1 1 - - - 1 6 1 1 13 16 7.4 Suicides - - - 3 1 4 4 14 13 21 6 13 13.4 Poisoning - - - - 1 1 1 3 4 3 4 4 3.6 Hanging - - - - - - - 4 3 9 - 2 3.6 Throat cutting - - - - - - - 3 4 5 1 2 3.0 Jumping off heights and in front of trains - - - 2 - 2 2 1 - - - 2 0.6 Cutting Arteries - - - - - - - 1 1 - - - 0.4 Shooting - - - 1 - 1 1 2 1 4 1 3 2.2 Railway Accidents - - - - - - - 4 4 1 1 3 2.6 Accidental Death (sudden) - - - - - - - 6 1 12 - - 3.8 Street Accidents (run over) - - - 1 1 2 2 3 9 7 4 3 5.2 Murder - - - - - - - 1 2 - 2 2 1.4 Burning (scalding) - 1 1 2 2 4 5 1 2 3 1 - 1.4 Falling - - - 5 1 6 6 1 1 4 4 - 2.0 Bicycle Accidents - - - - - - - 2 - 1 - - 0.6 Strangulation and Suffocation - - - 2 - 2 2 - - 2 - - 0.4 Found Dead - - - - - - - - - - - - - Bursting Blood Vessel - - - - - - - - - - - - - Killed 1 - 1 - - - 1 - - - - - - Manslaughter - - - - - - - - - - - - - Fits - - - - - - - - - - - - - N.B.—One body (dead from diphtheria) was admitted during 1904 into the special room provided for infectious bodies at Wanless Road Mortuary. Ages of bodies received at the Lambeth Borough Mortuaries, 1904, and at the Lambeth Parish Mortuaries during five years (1890-1900). Registered Ages of Bodies. 1904. Boro' Parish. Yearly Average for 1896-1900. High Street. Wanless Road. Total 1904. Total 1900. Total 1899. Total 1898. Total 1897. Total 1896. 0-1 48 35 83 133 121 160 101 121 127.2 1-5 22 10 32 47 44 50 39 22 40.4 5-10 8 - 8 12 22 17 9 12 14.4 10-20 21 2 23 17 13 8 18 9 13.0 20-30 19 5 24 31 29 26 26 24 27.2 30-40 29 6 35 43 59 45 35 35 54.2 40-50 38 9 47 80 67 64 48 37 59.2 50-60 38 10 48 61 53 42 59 46 52.2 60-70 23 12 35 50 47 39 30 35 40.2 70-80 18 5 23 16 19 32 20 22 21.8 80-90 8 5 13 6 8 5 9 7 7.0 90-upwards - 2 2 - 1 1 - 3 1.0 Age not stated - - - 3 - 6 6 - 3.0 Totals 272 101 373 499 483 495 400 373 450 173 174 INQUESTS. During the year 1904, within the Borough of Lambeth, 382 cases were submitted to the Coroner, who, in 42 instances, decided that no further inquiries were necessary; but in the other 340 cases, held inquests with the following results: — I. Natural Causes 182 II. Accidental Causes 123 Burns and Scalds 10 Drowning 6 Run over 14 Falls, etc. 40 Suffocation 23 Alcoholism 2 Fracture 11 Misadventure 7 Crushed 1 Blood Poisoning 6 Improper Feeding 1 Violent Blow 2 III. Homicidal Causes 31 Suicide 27 Murder 3 Manslaughter 1 IV. Open Verdicts 4 Found Drowned 4 Total ... 340 175 BACTERIOLOGICAL LABORATORY- The Bacteriological Laboratory, situated at Arlington Lodge, Wanless Road, Loughborough Junction, has again proved most useful during 1904—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 originally fitted up by the late Vestry in 1899, and since then (up to the end of 1904) 3,009* examinations have been made, viz:— Tuberculosis 957, Typhoid Fever 535, Diphtheria 1489, and Others 28 (ice-creams, urine, tumours, milk, etc.). During 1904, 447 examinations have been made, and the subjoined details are given in connection therewith :— Tuberculosis— 188 samples of sputa from doubtful tuberculosis cases have been examined, and in 60 (i.e., 31.9 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 128 instances (i.e., 68.1 per cent.), no tubercle bacilli were found. In no instance was the pneumococcus (of Friedlander) found. The increase in the number of samples of sputum submitted is due to the Council having made Consumption (with tuberculous expectorations) voluntarily notifiable throughout the Borough on (and after) Jnne 1st, 1902. Greater exactitude in diagnosis is being, in this way, secured in this disease. *1899—389 ; 1900—703 ; 1901—479 ; 1902—460 ; 1903—525 ; 1904— 447 ; Total—3009. Vide Special Report in Appendix. 176 Typhoid Fever— 60 samples of blood from suspected Typhoid cases have been examined, and in 11 (i.e., 18'3 per cent.) the characteristic Widal reaction was obtained, although in three of the cases (i.e., 27.3 per cent.) this reaction was but slightly (or feebly) marked. In 49 (i.e., 81.7 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. In this connection, the "paratyphoid" bacillus must be remembered—a bacillus (with many varieties) closely related to the bacillus typhosus. This bacillus causes the malady known as "paratyphoid" fever, affecting chiefly young adults, and the symptoms resemble closely those of typhoid fever, though less severe as a rule. The Widal reaction is absent (or but slightly developed) in paratyphoid patients- an important bacteriological diagnostic sign. Diphtheria— 190 samples of throat membranes and secretions from doubtful Diphtheria cases have been examined, and in 19 (i.e., 10 per cent.) the true (Klebs-Lœlfler) bacilli have been obtained. In 14 instances (i.e., 78.7 per cent.) the Klebs-Lœffler bacilli were obtained in pure cultivation—i.e., without admixture with other bacilli, whereas in the remaining 5 (i.e., 26.3 per cent.) the Klebs-Lœffler bacilli were found combined with other wellknown bacilli as follows :— Klebs-Loeffler † Staphylococci † Smegma 1 i.e., 5.3 per cent. Klebs-Lœffler -† Staphylococci 3 i.e., 15.9 per cent. Klebs-Lœffler † Streptococci 1 i.e., 5.3 per cent. 177 In 171 (i.e., 90 per cent.) of the total number of throat samples examined, the Klebs-Loefifler bacilli were not isolated, but other bacilli were as follow :— Streptococci 32 i.e., 18.7 per cent. Staphylococci 134 i.e., 78.4 per cent. Streptococci † Staphylococci 1 i.e., 0.6 percent. Staphylococci † Torulœ 3 i.e., 1.8 per cent. Streptococci † Sarcince 1 i.e., 0.6 per cent. Pseudo-bacilli (Hoffman) were not found in any single instance, neither alone nor mixed with other bacilli. Other Examinations. One sample of ham was examined for suspected trichinœ spirales, but none were found. One sample of faeces was examined for suspected bacilli tuberculosis, but none were found. One sample of milk specially examined shewed the presence of micrococci, dirt, hairs and pus cells, and was, consequently, declared to. be unfit to drink. Six samples of milk were examined bacteriologically, and quantitatively for the number of bacilli present with the following results Sample A 1,900,000 per c.c. Sample E 4,200,000 per c.c. „ B 4,700,000 per c.c. „ F 3,200,000 per c.c. „ C 5,200,000 per c.c. „ D 1,700,000 per c.c. 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 m 178 prophylactic, is being tried with marked results. The Borough Council distributes gratuitously antitoxin for this latter purpose also. 69 vials of antitoxin have been distributed gratuitiously during the year 1904 by the Borough Council. There can be no doubt as to the value of the laboratory from a scientific point of view, whilst financially there has been a great saving since it was fitted up in 1899, over what it would have cost the Council, had this work been done by outside Experts. Had a private firm or institution done the work (as is the case in the other Metropolitan Districts), the total 3,009 samples would have cost £752 5s. during the last 6 years (allowing 5s. per examination), i.e , an annual average cost of £125 7s. 6d. 1904. Sputa. Tub. Bac. found. *Bloods. Typhoid reaction obtained. Throat Membranes and Discharges. Klebs-Lœfiler bac. found. Yes No. Total. Yes. No. Total. Yes. No. Total. January 5 10 15 1 2 3 3 10 13 February 6 10 16 1 3 4 2 12 14 March 6 12 18 1 2 3 — 17 17 April 7 11 18 2 3 5 1 15 16 May 7 16 23 2 2 4 — 12 12 June 2 8 10 — 3 3 — 22 22 July 4 7 11 — 5 5 — 18 18 August 5 15 20 — 7 7 4 12 16 September 4 7 11 2 9 11 1 11 12 October 10 16 26 1 6 7 2 13 15 November 4 5 9 1 5 6 3 17 20 December — 11 11 — 2 2 3 12 15 Totals 60 128 188 11 49 60 19 171 190 * In 3 samples (i.e., 5 per cent.) of suspected Typhoid Fever blood, the reaction was slightly (or feebly) marked. N.B.—9 other samples (1 fæces, 1 ham, and 7 milks) were also examined during 1904. 179 UNDERGROUND CONVENIENCES. During 1904 there have been the following alterations and additions to the Staffs connected with the 7 Underground Conveniences (and the overground chalet at Vauxhall Park) :— 1. Loughborough (females)—Mrs. Davies, aged 47 years, appointed by the Council on October 27th, 1904, as permanent attendant, vice Mrs. Mason (resigned September 8th, 1904 ) 2. Vauxhall Park.—Mrs. Hardwick, aged 59 years, appointed by the Council on October 27th, 1904, as permanent attendant, vice Miss Bachelor (dismissed, November 18th, 1904). Both Mrs. Davies and Mrs. Hardwick had been previously temporarily employed by the Council, and had given satisfaction during consecutive 12 months. Miss Swift has been appointed as a temporary attendant. The Staff is as follows:— Conveniences. Attendants. Males. Females. Brixton Lester, C. Smith, Mrs. Parsons, F. Richards, Mrs. Hercules Holbrook, W. Burgess, Mrs. Frazey, H. Fletcher, Mrs. Stockwell Bennett, W. H. Hawkins, Mrs. Rodda, T. Porter, Miss. Kennington Cross Guerrier, E. Lewis, J. - Vauxhall Cross Cooper, F. Vass, E. - Loughborough Hazell, H. Davies, Mrs. Peck, T Swift, Miss. Stangate Cooper, G. Luckett, Mrs. Clark, W. Sinclair, Mrs. Vauxhall Park ... Hardwick Mrs. - Catterall, Mrs. 180 The Relief Attendants are :— Males :—Saunders, R., Willis, J. W. and Langley, G. Females :—Miss Ward and Mrs. Hulbert. No progress has been made during 1904 with the erection of the new Underground Convenience ordered by the Council on February 7th, 1901, to be placed at the corner of York Road and Waterloo Road—the delay being due to the fact that the Borough Council has been awaiting the decision of the London County Council as to the extension of the tram lines over Waterloo Bridge. The plans of the Convenience have, however, during 1904 been approved, and a specification ordered to be prepared, quantities taken out, and tenders invited. The accommodation is to be as follows :— Men.—8 w.c's., 12 urinal stalls, and 4 lavatory basins. Women.—5 w.c's., and 3 lavatory basins. Three other schemes have been under consideration during 1904, connected with suggested new Conveniences :— 1. Kennington Park (at Kennington Gate). 2. Kennington Road (near the " Horns" Public House.) *3. Brockwell Park (near Heme Hill Gate.) It has been decided during 1904 to provide a Female Convenience at Tooting Cemetery, near the gardener's lodge, and within the cemetery railways, at a cost of £276. The accommodation to be provided consists of 3 w.c's and 1 lavatory basin. During 1904, at the Brixton Convenience (males), new treads have been provided at an estimated cost of £18 (Mason's patent steel and lead, heavy pattern treads), and a lamp fixed to the * flans have been already prepared shewing 5 w.c's. and 11 urinal stalls for males, and 6 w.c's. for females. 181 staircase for the better lighting of the landing at an estimated cost of £10. New treads (Doulton's) have been ordered for the Hercules Convenience (males) at an estimated cost of £10 ; and at Vauxhall Park an extra light has been fixed over gateway in boundary wall in South Lambeth Walk (estimated cost £8). LAMBETH ELEMENTARY SCHOOLS. The transfer of the powers under the Education Acts to the London County Council (acting for the whole of London) has drawn attention to the Schools of Lambeth during 1904. These various Schools may be grouped as follows:— 1. Provided Schools. Parliamentary Divisions and Wards. Names of Schools. No. of Managers. No. of Departments. North Parliamentary Division. 9 Marsh 1. Addington Street 12 3 2. Johanna Street 3 3. Waterloo Road 3 Bishop's 4. Lollard Street 6 3 6 5. Walnut Tree Walk 3 Kennington Parliamentary Division. Prince's 6. Church Street, Clapham Road 12 3 12 7. Kennington Road 3 8. Upper Kennington Lane 3 9. Vauxhall Street 3 Vauxhall 10. Priory Grove, Priory Road 12 3 11. South Lambeth Road 4 12. Springfield, Wandsworth Road 3 Brixton Parliamentary Division. 6 3 6 Stockwell 18. Santley Street,Ferndale Road 14. Stockwell Road 3 Brixton 15. Cormont Road, Myatt's Fields 6 3 6 16. Hackford Road 3 182 Norwood Parliamentary Division. Heme Hill 17. Effra Parade 3 18. Jessop Road 12 3 9 19. Sussex Road 3 Tulse Hill 20. Lyham Road 6 3 21. Rosendale Road 1 6 2 5 Norwood 22. Gipsy Road 4 23. Salter's Hill 12 3 10 24. Woodland Road 3 Borough of Lambeth. 24 Schools. 73 2.—Non-Provided Schools. North Parliamentary Division. Marsh Ward. Cornwall Road (St. Patrick's). Roupell Street (St. Andrew's Higher Grade). Roupell Street (St. Andrew's Lower Grade). Stamford Street (61) (Benevolent Society of St. Patrick). Waterloo Road (St. John's with All Saints'). Bishops Ward. Carlisle Street (Holy Trinity). High Street (Archbishop Tenison). Lambeth Road (St. Mary, Boys'). Lambeth Road (St. Mary, Infants'). Lambeth Road (Wesleyan). Princes Road (St. Mary-the-Iess). Reedworth Street (Archbishop Sumner St. Philip's). 133 Kennington Parliamentary Division— Princes Ward. Anderson's Walk (St. Saviour's Salamanca, Girls). Gye Street (St. Paul). Harleyford Road (St. Ann). Kennington Oval (St. Mark). Regency Square (St. James). Sancroft Street (St. Mary-the-less). St. Oswald's Place (St. Peter). Vauxhall Ward. Devonshire Road (St. Barnabas). Dorset Road (St. Stephen). Gaskell Street (St. John Bowyer). Brixton Parliamentary Division— Stockwell Ward. Lingham Street (St. Andrew). Southesk Street (St. Andrew). Stockwell Road (Stockwell Practising). Brixton Ward. Bolton Street (St. Mark). Cancell Road (Christchurch, Boys'-Girls'). Cancell Road (Christchurch, Infants'). Canterbury Road (St. John). Camberwell New (S. John). Road and Warham Street Halstead Street (St. Michael's). Norwood Parliamentary Division— Heme Hill Ward. Church Road (St. Matthew). Denmark Hill (St. Matthew). Heme Hill Road (St. Saviour). Railton Road (St. Jude). 184 Tulse Hill Ward. Brixton Hill (Wesleyan). Trent Road (Roman Catholic). Norwood Ward. Eden Road (Wesleyan) Elder Road (St. Luke). Knights Hill Road (Jews Hospital and Orphan Asylum). The Borough Council, on December 8th, 1904, instructed the Medical Officer to have an examination made of the drainage of all the Public Elementary Schools in the Borough of Lambeth. Underfed Children. The important question of the proper feeding of children, whilst attending elementary (or other) schools, has engaged the attention of the Council during 1904, in connection with resolutions on the subject passed by the Bethnal Green, Hackney, and Battersea Borough Councils, and the Lambeth Borough Council has decided that the duty of providing food fof underfed children in elementary schools is one which should be carried out by the State, and that, for such a purpose, legislation is urgently required. At the same time, the Council expressed appreciation of the valuable work hitherto done by voluntary effort in connection with underfed children in elementary schools. 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 * Appointed by the Council permanently on February 14th, 1904. 185 1904 deserves recognition, and is again given in the form of the following Statement, shewing the work done in the Borough during 1901, 1902, 1903 and 1904, as compared with the yearly average for the old Parish of Lambeth during five years (1896-1900). Average 1904. 1903. 1902. 1901. 5 years (1896-1900) Borough. Parish. Letters, etc., received, (entered in letter book) 7476 7808 8760 9417 8611.4 Letters, etc., sent out (entered in postal book) 11427 16555 19504 21703 26096.6 Notices— Infectious Diseases 1681 1336 2430 1848 2290.2 Public Health Acts (Preliminary) 6624 8248 7812-0 Public Health Acts (Statutory) 3463 3482 12954 7195 2015.0 Metropolis Management Acts 10 27 — — Housing of the Working Classes Act 9 — 14 13 43.6 Cases entered in Inspectors' Report Books 8343 8372 8930 7821 8307.0 Complaints entered in book 6630 6199 4378 5421 5474.0 Copies of Infectious Diseases Notifications— (a) Entered in Notification Book 2023 1587 4426 2025 2619.2 (A) Sent off to Asylums Board 2023 1587 4426 2025 2619.2 Notices of Infectious Diseases sent to Schools 1492 2117 3410 2425 1953.6 New Workshops (with full particulars) entered up in Register 82 162 105 69 144.6 New Milkshops (with full particulars) entered up in Register 5 5 5 458 — New Cowsheds (with full particulars) entered up in Register — — — — 6.6 New Slaughter-houses (with full particulars) entered up in Register — — — — 9.2 New Bakehouses (with full particulars) entered up in Register — — — — 51.6 Water Certificates for new buildings given out 385 520 420 183 112.2 186 Average 1904. 1903. 1902. 1901. 5 years (1896-19001). Borough. Parish. Disinfection Certificates given out 3707 3036 5186 2710 1010.2 Stamps useil 13667 15426 17398 14274 19730.6 Reports to Committee (Fortnightly) 21 20 20 21 20.2 Reports to Vestry or Council (Quarterly) 4 4 4 4 4.0 Special Reports 13 13 15 12 12.2 Letters Typed 5052 4883 5816 4867 4905.4 Bacteriological Reports 447 525 466 479 546.0 Inland Revenne Certificates given out 375 715 2723 360 719.5 Summonses and Orders entered in Book 109 9r 50 72 98.6 APPENDIX. Local Government Board. (Table i.) VITAL STATISTICS OF LAMBETH BOROUGH DURING 1904, AND OF LAMBETH PARISH DURING 10 YEARS (1891—1900.). Year. Population estimated to Middle of each Year. Births. Total Deaths Regestered in the District. Total Dkatbs in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions, in tile District. Deaths of Residents registered in Public lustitutions beyond the District. Nktt Deaths at all Aqks belosoinq 10 the District. Number. Rate.® Under 1 Year of Age. At all Ages. Number. Rate.* Number. Bate per 1000 Births, registered. Number. Rate.4 1 2 3 4 5 6 7 8 9 10 11 12 13 Parish. 1891 276162 9097 32.9 1433 157.2 6078 21.9 1438 539 351 5886 2.13 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 9592 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 57167 19.4 1568.5 670.8 406.6 5405.3 18.4 Boro' 1904 310359 9059 29.2 1328 146.6 5160 16.6 1728 740 460 4880 15.7 2 * Rates in Columns 4, 8 and 13 are calculated per 1000 of estimated population. NOTE. The deaths included m Column 7 of this table are the whole of those registered during the year as having actually occurred within the Borough of Lambeth. J he deaths included in Column 12 are the numbers in Column 7, corrected by the subtraction of the numbers in Column 10 and the addition of the numbers in Column 11. By the term "Non-residents" is meant 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 Tables) are those into which persons are habitually received on account of sickness 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 (exclusive of area covered by water) 4079*6 Statute Acres. Total population at all ages 3 1895 Number of inhabited houses 41511 Average number of persons per house 7.3 At Census of 1901. Local Government Board. (Table ii.) VITAL STATISTICS OF REGISTRATION SUB-DISTRICTS OF LAMBETH BOROUGH DURING 1904, AND OF LAMBETH PARISH DURING 10 YEARS (1891—1900). Names op Localities. 1.—Waterloo. 2.—Lambeth Chorch 1st. 3.—Lambeth Church 2nd. Year. Population estimated to middle of eacb year. Births registered. Deaths at all Ages (corrected). Deaths under 1 year (unoorrected). Population estimated to middle of each year. Births registered. Deaths at all Ages (correeted). Deaths under 1 year (uncorrected). Population estimated to middle of each year. Biiths registered. Deaths at all Ases (corrected). Deaths under 1 year (uncorrected). Parish. a. b. c. d. a b. r. d. a. b. c. d. 1891 28657 1431 866 230 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 1105 691 203 18522 624 384 139 40331 1553 789 266 1895 28433 1516 755 212 18666 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 to 1900 ) 28413.2 14415 713.8 203.4 18739.3 610.3 4292 164.7 40908.0 1603.8 914.1 278.9 Borough 1904 26763 1315 603 163 18389 569 350 165 39912 1525 812 253 3 (Table ii.—continued.) Names of Localities. 4.—Kennington 1st. 5.—Kennington 2nd. 6.—Buixton. 7.—Nokwood. Year. Population estimated to middle of each year. Births registered. Deaths at all Aires (corrected). Deaths under 1 J ear (uncorrected). Population estimated to middle of each year. Births registered.' Deaths at 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). Population estimated to middle of each year. Birlhs registered Deaths at all Ages (corrected). Deaths under 1 year (uncorrected). Parish. 1 a. b. c. d. a. b. c. d. a. b. c. d. a. b c. d. 1891 50681 1722 1092 252 40065 1069 802 136 73707 2014 1335 291 25751 626 336 67 1892 51002 1733 1008 226 10695 1058 756 123 75431 2051 1305 297 26483 662 362 69 1893 51241 1759 953 270 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 1895 52201 1736 969 263 42222 1099 742 169 81967 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 53361 1888 989 259 44852 1009 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 46289 990 732 123 89057 2112 1283 279 32458 7361 456 94 Averages of ) Years 1891 to 1900) 53365.8 1811.2 984.0 250.5 42997.5 1066.1 743.0 136.9 81599.1 2090.1 1233.9 287.4 29026.8 672.4 387.3 82.1 Boro'. 1904 54246 1833 859 225 44170 1011 682 170 88300 2010 1155 269 38579 796 419 83 4 Notes—(a) Deaths of residents occuring in public institutions 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 are excluded. (See note on Table i. as to meaningof terms "resident" and "non-residents.") (6) Deaths of residents occuring in public institutions, 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, ahd 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. Local Government Board. Table iii. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1904. notifiable disease. cases notified in whole district. total cases notified in each localitt. no. of cases removed to hospital from each locality. At all Ages. At Ages—Years. Waterloo. Lambeth Church 1st. Lambeth Church 2nd. Kennington 1st. Kennington 2nd. Brixton. Norwood. Waterloo. .Lambeth Church 1st. Lambeth Church 2nd. 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 23 2 1 3 8 14 ... ... 3 ... 15 ... 5 ... ... 3 ... 15 ... 5 ... Cholera ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 317 5 116 146 26 24 ... 25 15 50 61 70 72 24 22 13 44 53 51 62 17 Membranous Croup 11 ... 7 4 ... ... ... 1 ... 1 ... 3 5 1 ... ... ... ... ... 3 ... Erysipelas 251 8 8 25 27 162 21 28 19 76 36 25 53 14 5 15 8 10 3 8 1 Senrbt Fever 660 2 160 398 76 24 ... 79 39 64 72 186 171 49 70 36 52 58 1 136 83 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 101 ... 5 25 23 47 1 9 7 29 13 21 17 5 7 6 26 10 14 15 4 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 4 ... ... 3 1 ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... Puerperal Fever 15 ... ... ... 6 9 ... 2 1 1 3 2 5 1 ... ... ... 2 ... 1 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox 556 61 225 253 10 7 ... 29 37 65 105 110 113 96 ... ... ... ... ... ... ... Totals 1938 78 522 857 172 287 22 173 121 290 306 417 441 190 104 73 130 148 224 230 55 Notes.—(a) The localities adopted for this table are the same as those in Tables ii. and iv. (b) Patients are removed to the Isolation Hospitals of the Metropolitan Asylums Board, one of which is situated in Brixton Registration Sub-district. N.B.—556 cases of Chickenpox were notified during 1904 (from April 8th to November 8th), but not one of these was removed to Hospital. 5 6 7 Local Government Board. (Table iv) CAUSES OF, AND AGES AT, DEATH DURING THE YEAR, 1904. Name of District—BOROUGH ) 0F LAMBETH. CAUSES OP DEATH. DEATHS IN' OR BELONGING TO WHOLE DISTRICT AT SUBJOINED AGES. DEATHS IN OR BELONGING TO REGISTRATION 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. Kennington First. Kenning- 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 — — — — — — — — — — — — — — — — Measles 164 46 112 5 — 1 — 29 27 31 23 23 22 7 2 24 Scarlet Fever 16 1 7 7 1 — — 5 — 4 1 3 3 — — 32 Whooping Cough 109 45 60 4 — — — 8 13 25 18 9 25 10 1 12 Diphtheria and Membranous Croup 34 2 20 10 — 2 — 8 — 3 2 7 11 3 — 50 Croup 2 — 2 — — — — — — 1 1 — — — — — (Typhus — — — — — — — — 1 — — — — — — — Fever Enteric 11 — — 1 2 7 1 — — 2 2 2 2 2 — 19 (Other Continued — — — — — — — 4 — — — — — — — 1 Epidemic Influenza 36 1 2 1 2 15 15 — — 6 4 6 11 4 1 2 Cholera Nostras 4 3 — — — 1 — — — — — — 2 1 1 1 Plague — — — — — — — 33 21 — — — — — — — Diarrhœa 265 219 39 — — 6 1 5 6 55 57 26 45 26 2 63 Enteritis 89 40 9 6 9 19 6 1 — 10 17 12 30 9 — — Puerperal fever 8 — — — 3 5 — 4 — 1 1 2 3 — — 3 Erysipelas 14 3 — — 1 6 4 2 — 2 1 2 3 1 1 12 Other Septic diseases 13 3 — 1 3 5 1 61 31 2 3 3 2 1 — — Phthisis 447 7 7 10 57 342 24 19 15 /89 77 53 92 33 11 143 Other Tubercular diseases 174 64 55 25 12 14 4 27 14 37 29 23 36 14 1 — Cancer, malignantdisease 309 1 2 2 5 197 102 60 32 27 50 55 90 34 12 — Bronchitis 423 105 40 1 4 110 163 22 15 70 69 55 104 22 11 182 Pneumonia 150 26 32 — 5 69 18 3 1 30 20 21 30 11 1 Pleurisy 14 2 1 1 — 8 2 1 2 3 4 — — Other diseases of Respiratory Organs 253 73 55 6 5 69 45 26 28 33 42 34 59 26 5 — Alcoholism 38 — — — — 34 4 7 5 8 6 4 6 2 — — Cirrho-is of Liver 62 — — — — 51 11 3 5 9 12 9 19 5 — — Venereal diseases 41 33 — — — — — 4 1 10 11 5 6 2 2 — Premature birth 172 172 — — — — — 19 12 31 23 18 52 11 1 — Diseases and Accidents of parturition 14 — — — 3 11 — — 2 2 4 2 1 93 3 — 223 Heart diseases 406 4 — 12 27 207 156 35 25 64 76 53 27 49 11 94 Accidents 144 31 12 11 9 60 21 20 1 7 23 33 16 7 4 4 — Suicides 26 — — — 2 22 2 3 2 3 4 6 1 — All other causes 1842 367 75 41 32 415 520 163 61 217 250 164 355 123 59 867 All causes 4880 1248 530 144 182 1676 1100 408 273 579 593 502 785 281 67 1728 8 9 LAMBETH BOROUGH.—Deaths Registered from all Causes during the Year 1904. 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 incluled. Sub-Districts. Sub-Districts. Waterloo Road 1st. Waterloo Road 2uil. Lambeth Church 1st. Lambeth Church 2nd. Kennington 1st. Kennington 2nd. Brixton. Norwood. No Address. All Ages. Total. I. Specific Febrile, or Zymotic Diseases M. F. M. F. M F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 716 21 SO 21 26 ."0 33 84 57 65 58 41 47 70 66 28 29 8 2 368 348 II. Parasitic Diseases 2 1 1 1 1 ... ... ... ... 4 2 6 III. Dietic Diseases 1 5 1 3 1 4 5 5 6 4 2 4 1 1 ... 11 32 43 IV. Constitutional Diseases 36 21 47 l(i 35 32 90 74 116 66 86 57 125 122 40 50 14 12 589 450 1039 V. Developmental Diseases 6 8 8 7 3 78 15 34 22 27 32 21 25 50 63 10 12 4 5 163 198 361 VI. Local Diseases 79 61 63 58 71 172 196 212 192 162 182 279 269 89 119 42 33 1176 1181 2357 VII. Deaths from Violence 7 9 6 4 11 8 22 4 27 ll 17 5 20 14 4 1 1 3 115 58 173 VIII. Deaths from Ill-defined and not Specified Causes 185 7 9 5 6 4 9 18 11 17 13 11 7 28 27 9 2 ... 2 99 86 Totals 157 143 151 120 162 172 427 369 465 378 339 327 574 566 181 223 69 57 2525 2355 4880 I.—Specific Febrile, or Zymotic Diseases. 1.—Miasmatic Diseases. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvascinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 Measles 4 10 5 10 13 16 15 12 11 14 9 15 7 4 .3 2 ... 85 79 Whooping Cough 2 ... 4 2 5 8 10 15 8 10 2 7 11 14 3 7 1 ... 46 63 109 Scarlet Fever 1 4 ... ... ... ... 3 1 1 ... 2 1 1 ... ... ... ... ... 10 6 16 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ll Enteric or Typhoid Fever ... ... ... ... 1 ... 2 ... 2 ... 1 1 ... 2 1 1 ... ... 7 16 Diphtheria 3 ... 4 1 ... ... 1 2 ... 2 3 4 5 5 1 2 ... ... 15 13 33 Mpmbranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Influenza 2 ... 1 1 ... ... 5 1 2 2 1 5 4 7 2 2 1 ... 18 18 36 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhceal Diseases. Cholera, Nostras ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 1 ... 3 1 4 Cholera, Asiatic ... ... ... ... ... 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 265 Diarrhoea, Dysentery 7 13 6 7 10 37 18 33 24 15 11 21 24 14 12 1 1 144 121 3.—Malarial Diseases. Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 4.—Zoogenous Diseases. Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. 2 Syphilis ... ... 2 1 ... 7 3 2 7 2 2 3 2 ... 1 2 ... 19 17 36 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... 2 ... 1 ... 1 ... 1 ... ... ... 5 ... 5 6.—Septic Diseases. 14 Erysipelas ... ... 1 3 ... ... 1 1 1 ... ... 2 2 1 1 ... ... 1 6 8 Pyfemia, Septicfemia ... 2 ... ... ... ... 2 ... 2 1 ... 3 2 3 1 ... ... 7 6 Puerperal Fever ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... ... 8 10 11 LAMBETH BOROUGH—Deaths Registered from all Causes during the Year 1904. 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. Total. II.—Parasitic Diseases. Sob-Districts. Lambeth Church 2nd. Kennington 1st. Kenningtou 2nd. Brixton. Norwood. No Address. All Ages. Waterloo Road 1st. Waterloo Road 2nd. Lambeth Church 1st. 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 2 ... 1 1 1 ... ... 1 ... ... ... ... 4 2 6 ... ... ... ... ... ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... III.—Dietetic Diseases. 2 ... ... ... ... ... ... ... ... ... ... ... 4 1 5 Want of Breast Milk, Starvation 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 Sourvy ... ... ... ... ... ... 3 5 ... 6 ... 4 2 4 1 1 ... ... 7 31 Chronic Alcoholism ... 5 ... 2 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Delirium Tremens ... ... ... ... ... ... IV.—Constitutional Diseases. ... 4 2 ... ... 1 1 7 4 ... ... ... 8 14 22 Rheumatic Fever ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism of the Heart ... ... ... ... ... ... ... 1 l 1 ... ... 1 1 ... ... ... ... 2 3 5 Rheumatism ... ... ... ... ... ... 1 ... 4 1 2 ... 5 ... 1 1 ... ... 17 2 19 Gout ... ... 1 ... 3 ... 2 ... 4 ... ... l 3 2 1 1 l ... 14 6 L'O Rickets 1 ... 1 l ] 1 11 16 26 24 24 31 34 56 14 20 9 3 141 168 309 Cancer, Malignant Disease 6 7 10 4 7 7 ... ... ... ... ... ... ... ... ... ... ... ... 26 15 41 Cancrum Oris (Noma) ... ... ... ... 2 ... 4 3 5 2 5 ... 5 4 2 2 ... ... Tabes Mesenterica 1 2 2 1 1 4 3 6 4 4 7 5 6 3 2 ... l 28 24 52 Tubercular Meningitis, Hydrocephalus 2 ... 2 ... 2 2 57 32 51 26 41 12 55 37 13 20 4 7 284 163 447 Phthisis 21 6 27 7 15 16 ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 2 Scrofula ... 2 ... ... ... ... 11 12 10 ... 6 l 11 6 2 3 ... ... 49 30 79 Other forms of Tuberculosis 3 2 2 4 4 ... ••• ... ... ... ... ... ... ... ... ... ... 1 2 3 Purpura, Hsemorrhagic Diathesis 1 2 ... ... ... ... ... ... 3 1 2 1 l 1 ... 1 ... ... 6 5 11 21 Anaemia, Chlorosis, Leucocythsemia ... 1 ... ... 1 1 ... ... 2 5 2 2 2 3 ... ... ... 1 9 12 Glycosuria, Diabetes Mellitus 1 ... 1 ... ... 3 1 1 ... 1 2 ... ... ... ... ... 3 6 8 Other Constitutional Diseases ... ... ... ... ... ... V.—Developmental Diseases. 10 23 8 18 10 10 8 30 22 4 7 1 ... 99 73 172 Premature Birth 4 7 7 1 2 5 7 ... ... ... 1 ... 1 ... ... ... ... 6 10 16 Atelectasis ... ... 1 1 ... ... ... 6 4 9 3 2 "2 5 2 ... ... ... 13 25 38 Congenital Malformations 2 ... ... 1 ... 2 6 1 5 13 8 14 18 35 4 14 3 5 45 90 135 Old Age ... l ... 4 1 3 VI.—Local Diseases. 1.—Diseases of Nervous System. 4 5 4 2 2 1 6 4 1 3 ... ... 23 21 44 Inflammation of Brain or Membranes 4 3 1 1 1 2 195 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 6 22 17 19 25 16 10 26 13 11 3 3 87 108 7 6 5 1 1 4 11 6 4 2 5 2 4 1 ... ... 6 3 31 15 46 Insanity, General Paralysis of the Insane ... 1 ... ... 1 ... 1 2 1 2 1 ... ... 2 ... ... 2 2 6 8 14 Epilepsy ... ... 1 ... ... ... 1 3 3 5 3 4 7 3 ... 1 ... ... 21 18 39 Convulsions 4 ... 3 1 ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... 3 3 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... 8 30 Disease of Spinal Cord, Paraplegia, Paralysis Agitans 3 1 3 1 3 4 5 ... 4 ... ... ... 22 3 1 ... ... 1 1 2 ... 1 ... 2 3 3 7 ... 2 ... ... 8 14 22 Other Diseases of Nervous System ... ... .. 1 ... 1 2.—Diseases of Organs of Special Sense. 3 1 ... ... .... •• 3 1 1 ... ... ... 9 4 13 (e.g., of Ear, Eya, Nose) 2 ... ... 2 ... ... 12 13 LAMBETH BOROUGH.—Deaths Registered from all Causes during the Year 1904. 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. Waterloo Road 1st. Waterloo Road 2nd. Lambeth Church 1st. Lambeth Church 2nd. Kenning ton 1st. Kennington 2nd. Brixton. Norwood. No Address. All Ages. 3.—Diseases of Circulatory System. M. F. M. F. M. 1 F. 1 M. P. M. P. M. P. M. F. M. F. M. F. M. F. Pericarditis ... ... ... ... 1 ... ... ... ... 2 3 3 3 6 Acute Endocarditis ... ... ... ... 1 1 1 1 ... 1 *** 1 1 1 1 Valvular Diseases of Heart 4 6 l 5 7 9 10 24 16 12 7 10 15 11 11 1 4 4 100 Other Diseases of Heart 2 4 6 7 3 3 11 18 27 20 14 21 24 37 11 23 4 100 137 Aneurism 1 ... 1 1 1 ... 2 ••• 1 2 4 1 2 13 3 Embolism, Thrombosis ... ... ... ... 1 1 2 2 1 1 2 3 ... 1 ... 10 1 Other Diseases of Blood Vessels 5 2 5 1 3 1 10 7 7 6 6 7 6 7 3 11 10 56 41 4.—Diseases of Respiratory System. ... ... 2 1 3 6 Laryngitis 1 ... ... ... 1 2 1 1 1 2 Croup ... ... ... ... ... *** 1 1 0 93 Emphysema, Asthma 1 ... 1 ... 2 1 1 8 1 6 9 1 1 0 0 Bronchitis 14 12 15 19 14 18 32 38 28 41 21 M 46 58 7 15 8 9 185 238 423 Pneumonia 9 5 6 2 12 3 15 15 13 7 11 10 0 15 15 6 5 1 88 62 150 Pleurisy 1 ... 2 ... ... 1 1 ... 1 1 - 4 ... 10 14 Bronchopneumonia 7 4 5 5 12 9 10 11 15 11 4 13 1 17 11 10 6 1 2 82 70 152 Pleuropneumonia ... ... ... ... 1 2 4 ... 4 1 3 1 1 0 2 1 1 91 1 17 Other Dis. of Respiratory System 2 ... l 3 ... 3 2 1 4 7 1 6 3 1 l 5.—Diseases of Digestive System. ... ... ... ... 1 2 1 1 91 Dentition ... ... 1 1 ... 6 4 3 1 2 ] 1 1 1 2 3 5 Sore Throat, Quinsy 1 ... ... ... ... 2 3 17 Q 6 9 1 10 Diseases of Stomach 1 1 l l ... 6 3 4 12 ( 5 2 O 7 23 7 4 5 55 34 89 Enterits 1 4 ... 4 6 1 5 3 2 1 4 Obstructive Diseases of Intestine 1 1 1 2 2 4 ... 1 4 6 3 3 1 ... 6 12 Peritonitis ... ... ... ... ... ... 3 2 ... Ascites ... ... ... ... 9 "' 3 Cirrhosis of Liver ... 2 1 ... 3 2 4 1 5 8 4 4 5 10 2 2 1 13 1 23 Jaundice and other Diseases of Liver ... 1 3 1 ... 2 2 1 1 ... 2 1 1 Diseases of the Pancreas ... ... ... ... ... 1 5 19 94 Other Diseases of Digestive System ... 1 ... ... ... 3 3 6 1 1 2 2 6.—Diseases of Lymphatic System. (r.g., of Lymphatics and of Spleen) ... 1 ... 1 l 1 1 1 1 2 3 2 8 14 7.—Diseases of Gland-Like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... 1 1 1 1 2 3 8.—Diseases of Urinary System. ... .... 1 1 9 2 9 1 4 2 9 14 23 Nephritis 1 ... ... 1 1 2 1 z 1 A 13 10 1 194 Bright's Disease, Albuminuria 6 3 2 4 2 4 8 15 9 9 14 6 7 1 1 Disease of Bladder or of Prostate 1 ... ... ... 1 1 1 1 1 1 1 9 2 2 1 1 1 4 2 4 Calculus (Stone) ... ... ... ... ... 1 1 1 1 1 1 2 4 6 Other Diseases of the Urinary System ... ... .... ... ... ... 9.—Diseases of Reproductive System. ... ... a. Of Organs of Generation. ... ... Male Organs ... ... ... ... ... 6 9 17 17 Female Organs ... 1 ... 1 ... 1 3 ... 2 14 15 LAMBETH BOROUGH.—Deaths Registered from all Causes during the Year 1904. 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. B. Of Parturition. Sub-Districts. Sub-Districts. Total. Waterloo Koad 1st. Waterloo Koad 2nd. Lambeth Ohurch 1st. Lambeth Cburch 2nd Kennington 1s Kennington 2nd. Brixton Norwood No Address. All Ages. 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 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prsevia, Flooding ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... 3 3 Other Accidents of Child Birth ... ... ... ... ... 2 ... 1 ... 3 ... 1 ... 1 ... 1 ... ... ... 9 9 10.—Diseases op Bones and Joints. Caries, Necrosis ... 1 ... ... ... ... ... ... ... ... 2 1 ... 3 ... ... ... ... 2 5 7 Arthritis, Ostitis, Periostitis ... ... ... 1 ... ... ... 1 ... 1 1 ... 3 ... ... ... ... ... 4 3 7 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 11.—Disease of Intbgcmentaey System. Carbunole, Phlegmon ... 1 ... 1 ... ... ... ... ... 1 2 ... 1 ... 1 ... ... ... 4 3 7 11 Other Diseases of Integumentary System ... 1 1 ... ... ... ... 1 3 ... 1 1 ... 1 1 ... ... 1 6 5 VII.—Deaths from Violence. 1.—accident ok Negligescb, 41 Fractures and Contusions ... ... ... 2 4 ... 12 1 5 1 1 2 5 3 1 1 1 2 29 12 Gunshot Wounds ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Cut, Stab ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Burn, Scald ... ... ... ... ... 2 1 1 1 2 2 ... ... 2 ... ... ... ... 4 7 11 Poison ... ... ... ... 1 1 ... ... 2 ... ... ... 1 1 ... ... ... ... 4 2 6 Drowning 1 1 ... l 2 1 2 ... 1 ... 1 1 ... ... ... ... ... ... 7 4 11 22 Suffocation 1 2 l ... ... 1 2 ... 2 1 1 ... 3 7 1 ... ... ... 11 11 Otherwise 4 2 5. ... 3 2 3 ... 12 5 6 2 5 ... 1 ... ... l 39 12 51 2.—Homicide. Manslaugther ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Murder 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 3.—Suicide. Gnnshot Wounds ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... 2 Cut, Stab ... l ... l ... ... 1 ... ... 1 2 ... 1 ... ... ... ... ... 4 3 7 Poison ... 1 ... ... ... 1 ... ... 2 ... 2 ... 1 1 1 ... ... ... 6 3 9 Drowning ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 ... 2 Hanging ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 1 2 Otherwise ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... 4 ... 4 4.—execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—Deaths from Ill-Defined and not Specified Causes. Dropsy ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Debility Atrophy, Inanition 7 9 5 6 4 9 17 9 15 13 9 7 26 25 9 1 ... 2 92 81 173 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... l ... 1 Abscess ... ... ... ... ... ... 1 ... 2 ... ... ... ... 1 ... 1 ... ... 3 2 5 Haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined ... ... ... ... ... ... ... 1 ... ... 2 ... 1 1 ... ... ... ... 3 2 5 16 17 Lambeth Borough.—Deaths Registered from all Causes during the Year 1904. Note.—The deaths of Non-Residents occurring in Public Institutions situated in the Distriot are excluded, and the Deaths of Residents occurring in Public Institutions situa ed beyond the limits of the District are inoluded. AGES. AGES. Total. Under 1 Year. 1-5 Under 5 Yeais. 5-10 10-15 15-20 20-25 25-40 40-60 60-65 65-80 80 & over Over 5 Years. All Ages. I. Specific Febrile, or Zymotic Diseases M F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 191 165 114 126 305 291 15 10 3 1 4 2 1 5 10 17 12 8 7 2 8 9 3 3 63 57 368 346 716 II. Parasitic Diseases 4 2 ... ... 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 2 6 III. Dirtic Diseases 1 1 ... ... 4 1 ... ... ... ... ... ... ... ... ... 6 5 21 1 1 1 3 ... ... 7 81 11 32 43 IV. Constitutional Diseases 42 37 49 31 91 68 18 9 7 9 12 13 37 15 109 8. 187 138 50 33 07 66 11 12 498 382 589 450 1039 V. Developmental Diseases 116 106 2 2 118 108 ... ... ... ... 2 1 10 26 33 63 45 96 163 198 361 VI. Local Diseases 206 175 99 87 305 262 20 20 10 9 24 8 24 26 90 95 271 236 95 106 271 285 66 134 871 919 1176 1181 2357 VII. Deaths from Violence 18 14 6 8 24 22 3 1 6 1 3 2 4 2 27 4 31 11 6 3 10 6 1 6 91 36 115 58 173 VIII. Deaths from Ill-Defined and Not Specified Causes 89 78 2 4 91 82 1 1 ... ... ... ... ... ... ... 2 1 ... ... 2 1 2 ] 8 4 99 86 185 Totals 670 578 272 258 942 836 57 41 26 20 43 25 66 48 236 209 508 415 162 146 369 396 116 219 1583 1519 2525 2355 4880 1.—Specific Febrile, or Zymotic Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1.—Miasmatic Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 28 18 54 58 82 76 2 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 3 ... 85 79 164 Whooping Cough 17 28 28 32 45 60 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 8 46 63 109 Scarlet Fever ... 1 4 3 4 4 4 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 6 2 10 6 16 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhi id Fever ... 1 ... ... 1 1 4 2 ... 1 ... ... 1 ... ... ... 7 4 7 4 11 Diphtheria ... 2 10 9 10 11 6 3 ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... 7 5 17 16 33 Membranous Croup ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Influenza ... ] ... ... 2 1 ... ... 1 ... 1 1 ... ... 2 3 2 3 4 1 4 7 2 2 16 17 18 18 36 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhceal Diseases. Cholera, Nostras 2 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 3 1 4 Cholera, Asiatic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 125 94 16 23 141 117 ... ... ... ... ... ... ... ... 1 3 1 ... 1 ... 1 ... ... 3 4 144 121 265 3.—Malarial Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 4.—Zoogenous Diseases. ... ... ... ... ... ... ... ... ... Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 16 17 ... ... 16 17 ... ... ... ... ... ... ... ... ... 9 ... 1 ... ... ... ... ... 3 19 17 36 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 ... ... ... 1 ... 5 ... 5 ... 5 g.—septic Diseases. Erysipelas 1 2 ... ... 1 2 ... ... ... ... ... ... 1 ... 3 1 1 1 ... 3 1 ... ... ... 6 6 8 14 Pyemia, Septicemia 2 1 ... ... 2 1 1 ... ... ... 3 ... ... ... 1 3 ... 1 ... ... ... ... ... 1 ... ... ... 6 13 Puerperal Fever ... ... ... ... ... ... ... ... ... ... 2 ... 5 ... ... ... ... ... ... ... ... ... ... ... 8 8 18 19 Lambeth Borough.—Deaths Registered from all Causes during the Year 1904—continued. 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. 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. Thrush and other Vegetable Parasitic Diseases 4 2 ... ... 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 6 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... III.—Dietetic Diseases. Want of Breast Milk, Starvation 4 1 ... ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 5 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 1 1 1 3 ... ... 7 31 7 31 38 Delirium Tremens ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—Constitutional Diseases. Rheumatic Fever ... ... ... ... ... ... 1 ... 1 4 1 ... ... ... 3 5 1 4 1 ... ... 1 ... ... 8 14 8 14 22 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... 1 ... ... ... 1 ... ... 2 3 2 3 5 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 ... 3 ... 5 2 2 ... 17 9 17 2 19 Rickets 4 1 10 4 14 5 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 14 6 20 Cancer, Malignant Disease ... 1 1 1 1 2 2 ... ... ... 1 ... 2 2 9 15 50 72 29 22 40 47 7 8 140 166 141 168 309 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 13 9 7 3 20 12 4 2 ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... 6 3 26 15 41 Tubercular Meningitis, Hydrocephalus 14 7 12 12 26 19 1 2 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 5 28 24 52 Phthisis 2 5 3 4 5 9 1 3 4 2 6 9 31 11 89 58 120 53 14 8 13 9 1 1 279 154 284 163 447 Scrofula ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 120 ... ... ... ... ... ... ... 1 ... 1 1 2 Other forms of Tuberculosis 8 12 15 6 23 18 9 2 1 1 2 1 3 2 5 3 2 1 1 1 3 1 ... ... 26 12 49 36 79 Purpura, Hæmorrhagic Diathesis 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 3 Anæmia, Chlorosis. Leucocytheemia ... ... 1 l 1 1 ... ... ... ... ... ... ... ... ... 2 ... 2 1 ... 4 ... ... ... 5 4 6 5 11 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 5 5 1 1 ... 4 1 ... 9 12 9 12 21 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 2 1 ... 2 3 5 3 5 8 V.—Developmental Diseases. Premature Birth 99 73 ... ... 99 73 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 99 73 172 Atelectasis 6 10 ... ... 6 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 10 16 Congenital Malformations 11 23 2 2 13 25 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 25 38 Old Age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 10 26 33 63 45 90 45 90 135 VI.—Local Diseases. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 12 6 8 7 20 13 ... 3 ... 1 ... 1 ... 3 1 ... 2 ... ... ... ... ... ... ... 3 8 23 21 44 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ••• ... 1 ... 1 ... ... ... ... ... 1 1 1 2 4 20 24 10 14 45 42 9 21 87 107 87 108 195 Insanity, General Paralysis of the Insane ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 2 15 5 2 2 5 4 ... 2 31 15 31 15 46 Epilepsy l l ... ... 1 1 l ... ... ... ... 1 ... ... 1 3 2 1 1 2 ... ... ... ... 5 7 6 8 14 Convulsions 20 16 1 2 21 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 18 39 Laryngismus Stridulus (Spasm of Glottis) ... 1 ... 2 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 ... 5 3 3 .1. 7 3 2 ... 22 8 22 8 30 Other Diseases of Nervous System 2 ... 1 2 3 2 1 2 l ... 1 ... ... ... ... 2 3 ... 3 ... 3 ... l 5 12 8 14 22 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) 3 ... 2 l 5 1 ... 2 ... 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... 4 3 9 4 13 20 21 Lambeth Borough.—Deaths Registered from all Causes during the Year 1904— continued. 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. Under 1 Year. 1-5 Under 5 Years. 5-10 10-15 15-20 20-25 25-40 40-60 60-65 65-S0 80 & over. Over 5 Years. All Ages. Total. 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 1 3 3 6 Acute Endocarditis ... ... ... ... ... l ... ... ... 2 1 ] 1 1 4 4 • 7 Valvular Diseases of Heart ... ... ... ... ... ... 1 2 ... 3 6 1 5 1 8 1] 2(i 26 9 14 14 22 1 9 64 92 64 92 156 Other Diseases of Heart 2 2 2 2 1 1 2 ... 4 3 8 8 31 31 15 19 26 46 13 25 98 135 100 137 237 Aneurism ... ... ... ...... ... ... ... ... ... ... ... ... 4 1 6 2 1 1 1 13 3 13 3 16 Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 1 2 3 3 6 8 6 8 14 Other Diseases of Blood-Vessels ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... 5 3 7 28 17 13 24 56 44 56 44 100 4.—Diseases of Respiratory ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... System. Laryngitis 1 ... 2 2 3 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... 6 Croup ... ... 1 1 1 ] ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Emphysema, Asthma ... ... 1 1 ... ... ... ... ... ... ... 7 3 1 2 7 2 15 7 15 8 23 Bronchitis 47 ... 2d 20 67 78 l ... ... 2 2 5 10 31 26 15 23 51 65 13 34 118 160 185 238 423 Pneumonia 14 12 19 13 33 25 ... ... ... 2 ... 1 2 14 7 23 13 s 7 9 7 1 1 55 37 88 62 150 Pleurisy 1 1 1 1 2 ... 1 ... ... ... ... 2 ... 3 ... 3 ... 1 1 9 2 10 4 14 Bronoho-pneumonia 33 34 28 16 61 50 1 ... l ... ... ... 2 1 6 6 4 1 5 6 2 4 21 20 82 70 152 Pleuro-pneumonia 1 2 3 3 3 1 ... ... ... 1 1 3 1 8 2 ... 2 15 18 7 25 Other Diseases of Respiratory System 3 1 ... 1 3 2 ... ... 2 ... 1 4 3 8 2 3 2 8 5 2 2 28 14 31 16 47 5.—Diseases of Digestive System. ... ... ... ... ... ... ...... ...... ... ... ... ... ... ... ... ... ... Dentition 8 3 7 3 15 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 6 21 Sore Throat, Quinsy ... ... ... 1 ... 1 ... l 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 2 2 3 5 Diseases of Stomach 10 a ... 2 10 13 1 ] C ... 1 2 4 1 3 4 6 13 16 26 42 Enteritis 25 15 ... 3 31 18 2 1 2 ... ... 1 2 6 2 3 3 3 2 1 24 16 55 34 89 Obstructive Diseases of Intestine 7 1 ... ... 7 1 2 1 ] 3 2 3 3 1 1 7 5 1 1 16 13 23 14 37 Peritonitis ... ... 2 1 1 1 1 1 ... ... ... 1 2 •• 2 6 6 6 6 12 Ascites ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ...... ... ...... ...... ...... 1 3 22 17 4 4 5 6 32 30 32 30 62 Jaundice and other Diseases of Liver 4 4 ... ... 4 4 2 ... ... ... ... 1 2 4 1 4 1 9 6 13 10 23 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System ... 2 ... ... 5 2 ... 1 ... ... ... ... ... 1 1 3 3 4 ... ... 2 1 1 7 10 12 12 24 6.—Diseases of Lymphatic System. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... (eg-, of Lymphatics and of Spleen) ...... 2 ... ... 1 2 1 ... 1 ... ... ... 1 2 2 3 ... 1 ... ... ... ... 5 6 6 8 14 7.—Diseases of Gland-Like ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Orgaxs of Uncertain Use. ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ...... ... ... ...... ... ... ... ... (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ...... ... 1 2 1 2 3 8.—Diseases of Urinary System. ... ... ... ... ... 1 ... ... ... ... ... Nephritis ... ... 2 2 2 2 1 1 ... ... 1 1 ... 1 ... 1 ... 3 ... ... 7 12 9 14 23 Bright's Disease, Albuminuria ... 1 1 1 1 ... 1 ... ... 7 ... 28 20 0 3 19 23 1 4 62 60 62 61 123 Disease of Bladder or of Prostate ...... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 11 2 3 ... 17 4 17 4 21 Calculus (Stone) ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 1 ... 2 2 2 2 4 Other Diseases of the Urinary System ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... 1 ... ... 2 4 2 6 9.—Diseases of Riproductive System. ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... a. Of Organt of Generation, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... 1 ... ... 4 ... 7 ... ... ... ... ... ... ... 16 ... 17 17 22 23 Lambeth Borough.—Deaths Registered from all Causes during the Year 1904—continued. 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. 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. Total. b. Of Parturition. M. F. M. F. M. F. M F. M. F. Abortion, Miscarriage ... M. F. M. F. M. F. M. F. M.. F. M. F. M. F. M. F. M. F. Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 Placenta praevia, Flooding ... ... ... ... ... ... ... ... ... ... Other Accidents of Child Birth ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... 6 ... 3 3 10.—Diseases of Bones and Joints. ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... Caries, Necrosis 1 1 1 ... ... ... ... ... ... ... ... ...... ...... ... ... ... ... ... ... ... Arthritis, Ostitis, Periostitis 2 1 3 1 1 ... ... ... ... ... 1 1 1 1 ... ... 1 2 4 2 5 7 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... 2 ... ... 4 ... 4 3 7 11.—Diseases of Integumentary System. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle, Phlegmon 2 ... 1 2 1 ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... Other Diseases of Integumentary System 1 4 1 ... ... ... ... ... 1 9 1 1 2 3 2 2 4 6 3 5 7 11 VII.—Deaths from Violence. ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... 1.—Accident or Negligence. Fractures and Contusions 2 1 2 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gunshot Wounds ... ... 7 7 3 6 6 1 21 11 29 12 41 Cut, Stab ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 Burn, Scald ... 2 3 2 3 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... Poison 1 1 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 2 Drowning 1 1 2 1 ... 1 2 1 ... ... ... ... ... ... 3 2 4 2 6 Suffocation 11 11 11 11 ... ...... ... ... 2 ... 1 1 ... ... ... ... 1 ... ... 5 4 7 4 11 Otherwise 4 3 1 2 5 5 1 2 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 11 11 12 22 2.—Homicide. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Manslaughter ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Murder 1 ... ... 2 1 2 ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... 1 ... 3.—Suicide. ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ...... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... Poison ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 4 6 ... Drowning ... ... ... ...... ... ... ... ... 1 8 3 2 6 8 6 3 9 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 2 ... 2 2 Otherwise ... ...... ... ... ... ...... ... ... ... 1 1 ... ... ... ...... ... ... 1 1 1 1 2 4.—Execution. ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... 4 ... 4 ... 4 Hanging ... ... ... ... ... ... ... ... ...... ... ... ...... ... ...... ... ... ... ... ... ... ... VIII.—Deaths from Ill-Defined and Not Specified Causes. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• Dropsy ... ... ... 1 ... ...... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... Debility, Atrophy, Inanition 87 77 9 4 89 81 ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... 1 1 1 Mortification ... ... ... ... ... ... ... ... ... ... ... 1 1 1 3 ... 92 81 173 Tumour ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• Abscess 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... Haemorrhage ... ... ... ... ... ... ... .. ...... ... ... ... ... ... ... ... 1... ... 1 1 ... ... 2 2 3 2 5 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• Causes not specified, or ill-defined i 1 ... 1 1 ... ... ... ... ... ... ... ...... ... ... ... ••• ... ... ... ... ... ... 1... ... ... ... ... ... 1 1 2 1 3 2 5 24 Summary of Total Corrected Deaths in Lambeth Borough during 1904. No. of Deaths. Total. No.of Deaths. Total. M. F. M. F. I.—Specific Febrile, or Zymotic Diseases Brought forward .. 2195 2069 4264 1. Miasmatic Diseases 183 187 370 2. Diarrhoeal 147 122 269 VI.—Local Diseases—continued. 3. Malarial 1 • •• 1 6. Diseases of Lymphatic System 6 8 14 4. Zoogenous 5. Venereal 24 17 41 7. Diseases of Gland-like Organs of Uncertain Use 1 2 3 6. Septic 13 22 35 8. Diseases of Urinary System 92 85 177 9. Diseases of Reproductive System ... ... ... II.—Parasitic Diseases 4 2 6 (a) Diseases of Organs of Generation ... 17 17 III.—Dietetic Diseases 11 32 43 (A) Diseases of Parturition ... 14 14 10. Diseases of Bones and Joints 7 8 15 IV.—Constitutional Diseases 589 450 1039 11. Diseases of Integumentary System. 10 8 18 V.—Developmental Diseases 163 198 361 VII.—Violence. VI.—Local Diseases 1. Accident or Ncgligoncc 95 49 144 1. Diseases of Nervous System 198 195 393 2. Homicide 1 2 3 2. Diseases of Organs of Special Sense 9 4 13 3. Suicide 19 7 26 4. Execution ... ... ... 3. Diseases of Circulatory System 240 290 536 4. Diseases of Respiratory 433 409 842 VIII.—Ill-Defined and not 99 86 185 5. Diseases of Digestive 174 141 315 fied Causes. Carried forward 2195 2069 4264 Total 2525 2355 4880 Offences under the Food and Drugs, and Public Health, Acts during 1904. nAture of offence and amounts of penalties and costs in each case. 26 27 SALE OF FOOD AND DRUGS AND MARGARINE ACTS.—SUMMONSES. Offences. Penalty. Costs. On 18th February, summonses were heard before Mr. Hopkins, a Lambeth Police Court, re selling Coffee containing added Chicory 70 per cent. £ s. d. £ s. d. 0 14 6 Re selling Coffee containing added Chicory 48 per cent. 1 14 6 Re selling Butter containing added water 25.6 per cent. On 31st 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 17 per cent. 0 10 0 0 17 6 Exposing a parcel of Margarine by retail without having a label attached and marked in capital letters l 1/2-in. " Margarine. 3 0 0 Re selling Milk containing added water 15 per cent. 3 0 0 Re selling Butter containing Margarine (not Butter) 96 per cent. 3 0 0 0 17 6 On 10th March, summonses were heard at Lambeth Police Court, before Mr. Francis, re exposing a parcel of Margarine by retail without having a label attached and marked in capital letters 14-in " Margarine," 0 12 6 Re selling Coffee containing added Chicory 56 per cent. 1 0 0 0 12 6 Re selling Butter containing Margarine (not Butter) 85 per cent. 1 0 0 0 12 6 On 17th March, 10 summonses were heard before Mr. Hopkins, at Lambeth Police Court, re selling Milk from which the Cream had been abstracted to the extent of 16 per cent., 10 per cent. 17 per cent., 12 per cent., 16 per cent., 17 per cent., 16 per cent., 16 per cent., 12 per cent., and 12 per cent., respectively. 5 0 0 10 0 0 Re selling Milk from which the Cream had been abstracted to the extent of 15 per cent and 9 per cent. 1 0 0 2 0 0 On 20th April, a summons was heard before Mr. Hopkins, at Lambeth Police Court, re selling Butter containing Margarine (not Butter) 90 per cent. 2 0 0 0 12 6 On 21st April, 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 14 per cent. 2 0 0 0 12 6 On 19th May, a summons was heard before Mr. Hopkins, at Lambeth Police Court, re selling Milk containing added water 8 per cent. 3 0 0 0 17 6 On 9th June, a summons was heard at Lambeth Police Court, before Mr. Horace Smith, re selling Milk containing added water 14 per cent. 0 10 0 0 12 6 Carried forward 26 14 6 19 2 0 28 29 Sale of Food and Drugs and Margarine Acts.—Summonses—continued. Offence. Penalty. Costs. £ s. d. £ s. d. Brought forward 26 14 6 19 2 0 On 9th June, a summons was heard before Mr. Smith, at Lambeth Police Court, re selling Coffee containing added Chicory 35 per cent. 0 10 0 0 17 6 On 23rd June, summonses were heard before Mr. Horace Smith at Lambeth Police Court, re selling Milk containing added water 7 per cent. 1 0 0 0 14 6 Re selling Milk from which the Milk Fat had been abstracted to the extent of 13 per cent. 0 10 0 0 14 6 Re selling Coffee containing added Chicory CO per cent. 0 10 0 0 14 6 Re selling Milk from which the Milk Fat had been abstracted to the extent of 22 per cent. 0 5 0 0 14 6 On 14th July, summonses were heard before Mr. Hopkins, at Lambeth Police Court, re selling Milk from which Milk Fat had been abstracted to the extent of 5 per cent. 5 0 0 1 1 0 Re selling Milk from which the Milk Fat has been abstracted to the extent of 14 per cent. 5 0 0 I I 0 On 21st'July, summonses were heard before Mr. Hopkins, at the Lambeth Police Court, re selling Butter containing Margarine (not Butter) 93 per cent. 2 0 0 2 1 6 Re selling Milk containing added water 5 per cent., and abstraction of Milk Fat to the extent ot 10 per cent. 2 0 0 Re selling Milk containing added water to the extent of £ per cent. 0 10 0 0 16 6 Re selling Milk containing added water 5 cent. 2 0 0 0 16 6 On 18th August, summonses were heard before Mr. Hopkins at the Lambeth Police Court, re selling Milk containing added water 13 per cent. 5 0 0 0 17 6 Re selling Milk containing added water 11 per cent. 3 0 0 0 17 6 On 8th September, summonses were heard before Mr. Hopkins at Lambeth Police Court, re selling Milk containing added water 6 per cent. 2 0 0 0 12 6 Re selling Milk from which the Milk Fat had been abstracted to the extent of 22 per cent. 0 10 0 0 12 6 Re selling Milk containing added water 5 per cent. 2 0 0 0 12 6 On 15th September, a summons was heard before Mr. Hopkins at Lambeth Police Court, re selling Milk containing added water 3 per cent. 10 0 P 1 0 0 Carried forward 68 9 6 33 6 6 30. 31 Sale of Food and Drugs and Margarine Acts.—Summonses—continued. Offence. Penalty. Costs. £ s. d. £ s. d. Brought forward 68 9 6 33 6 6 On 10th November, a summons was heard before Mr. Francis at the Lambeth Police Court, re selling Milk containing added water 5 per cent. 2 0 0 0 12 6 On 24th November, summonses were heard before Mr. Hopkins at Lambeth Police Court, re selling Milk from which the Milk Fat had been abstracted to the extent of 30 per cent. 2 0 0 0 14 6 Re selling Milk containing added water to the extent of 8 per cent. 1 0 0 0 14 6 Re selling Milk from which the Milk Fat had been abstracted to the extent of 12 per cent. 1 0 0 0 14 0 On 15th December, summonses were heard before Mr. Hopkins at Lambeth Police Court re selling Milk from which the Milk Fat had been abstracted to the extent of 22 per cent. 0 10 0 0 12 6 Re selling Coffee containing added Chicory to the extent of 53 per cent. 0 10 0 0 12 6 On 5th January, 1905, summonses were heard before Mr. Hopkins, at Lambeth Police Court, re selling Coffee containing added Chicory 70 per cent. • •• Summons dismissed, the Magistrate being unable to prove fraud by the addition of Chicory]. Re selling Milk, from which the Milk Fat was abstracted to the extent of 18 per cent. 1 0 0 0 12 6 Re exposing a parcel of Margarine, by retail, without having a label attached and maked in capital letters 1 1/2-inch, " Margarine." 2 0 0 0 12 G On 26th January, summonses were heard before Mr. Hopkins at Lambeth Police Court, re selling Milk containing added water to the extent of 16 per cent. 2 0 0 0 12 6 Re exposing a parcel of Margarine by retail, without having a label attached and marked in capital letters l 1/2-inch, "Margarine." 0 10 0 0 12 6 Total 80 19 6 39 17 6 32 33 PUBLIC HEALTH AND METROPOLIS MANAGEMENT ACTS.—SUMMONSES. Offence. Penalty. Cost. £ s. d. £ s. d. On 29th January, summonses were heard before Mr. Francis, at Lambeth Police Court, against the owner for non-compliance with Notice of Council to properly pave the yard at No. 7, Loughborough Street. 2 0 0 0 2 0 Against the Owner for non-compliance with Notice of Council to remedy damp state of premises at No. 5, Loughborough Street. Magistrate ordered the necessary work to be done within 11 days, the Defendant to pay 4s. costs. • •• 0 4 0 On lfith February, a summons was heard before Mr. Hopkins at Lambeth Police Court, against the owner for non-compliance with Notice of Council to repair drains and soil pipe at No. 1a, Viceroy Road. Order made to do work in 14 days and to pay 4s. costs. • • • 0 4 0 On 29th March, a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the owner for non-compliance with Magistrate's Order to make good defective drains at Gabriel's Yard, Sutton Street, 2 0 0 0 o 0 On 6th April, a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the occupier of 122, Loughborough Road, being an occupied dwelling house without a proper and sufficient supply of water. Magistrate made a closing order, and occupier to pay 4s. costs. 0 4 0 On 13th April, a summons was heard before Mr. Hopkins, against the owner for non-compliance with By-laws of L.C.C. under Section 202 of the Metropolis Local Management Act, 1855, re ventilating pipe of soil pipe inside house at 37, Pearman Street. The Magistrate dismissed the case with £1 Is. costs against the Council, holding that, though there had been a technical breach of the By-law, the matter was not one in connection with which he (as Magistrate) felt justified in inflicting a penalty. The By-law states that the Magistrate may inflict a penalty. On 2nd June, 3 summonses were heard before Mr. Francis, at Lambeth Police Court, against the owner for non-compliance with notice of Council to repair drains and W.C. at Nos. 14, 1C and 18, Luscombe Street. Magistrate made an order to do the work in one month, and Defendant to pay 4s. costs upon each summons; total 12s. . 0 12 — 0 Carried forward 4 0 0 1 8 0 34 35 Public Health (London) Act.—Summonses—continued. Offence. Penalty. Cost. Brought forward 4 0 0 1 8 0 On 2nd August, a summons was heard before Mr. Hopkins, against the owner for a nuisance of an accumulation of offensive vegetable refuse at 46, Brixton Road. Order made to abate the nuisance forthwith, and prevent a recurrence of same, Defendant to pay 4s. costs. ... 0 4 0 On 30th August, a summons was heard before Mr. Hopkins, against the owner for non-compliance with notice of Council to abate a nuisance of water soaking into basement of No. 18, Tower Street, and to provide a dust bin at No. 17, Tower Street. Defendant ordered to do work in 7 days, and pay 4s costs ..... 0 4 0 On 29th September, a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the owner for non-compliance with Notice of Council to cleanse walls and ceilings of staircase, kitchen and scullery, and to properly seal manhole cover at No. 59, Heyford Avenue. Defendant ordered to do the work in 7 days, and pay 6s. costs. ... 0 6 0 On 6th October, 6 summonses were heard before Mr. Hopkins, at Lambeth Police Court, against the owner for non-compliance with Notice of Council to cleanse ceilings and walls, provide dust bin, and make good defective drains and paving at Nos. 2, 4 and 6, Horace Street, and Nos. 20, 22 and 24, Luscombe Street. Order made for work to be done in two months, and Defendant to pay 4s. costs upon each summons ; total 24s. ... 1 4 0 On 12th October, 3 summonses were heard before Mr. Horace Smith, at Lambeth Police Court, against the owner for reconstructing drains without providing efficient intercepting trap and ventilation at 29, Binfield Road, i.e., contrary to London County Council drainage By-laws made under the Acts. Against same defendant for not causing plans to be first deposited with the Sanitary Authority. Against the Builder for reconstructing drains without providing efficient intercepting tray and ventilation at 29, Binfield Road, i.e., contrary to London County Council Drainage By-laws made under the Acts. The 3 summonses were dismissed, the Magistrate holding that "was simply a "repair" of drains, to which the By-laws did not apply although, as a matter of fact, it was shewn in evidence Carried forward 4 0 0 3 6 0 36 Public Health (London) Act.—Summonses—continued. Offence. Penalty. Cost. £ s. d. £ s. d. Brought forward 4 0 0 3 6 0 that the drain had been relaid from front to back of the premises, a distance of 80 feet. The Magistrate expressed his willingness voluntarily to state a case for the Appeal Court, but the Council decided not to appeal. ... ... On 5th October, a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the owner, for non-compliance with Notice of Council to provide proper water supply, watercloset, and cleanse and repair dirty and dilapidated condition of 18a, Kibworth Street. Magistrate ordered premises to be closed as unfit for human habitation. ... ... On 27th October, a summons was heard before Mr. Horace Smith, at Lambeth Police Court, against the occupier for exposing for sale on a stall in roadway, Wandsworth Road, certain articles of food, viz., 22 pieces of meat which were unwholesome and unfit for the food of man. t 2 0 0 0 10 0 On 15th November, a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the owner for non-compliance with Notice of Council to abate the overcrowding at No. 34, Lanfranc Street. Nuisance abated on 22nd November, 1904, prior to the hearing of the summons, which was consequently withdrawn. ... ... On 16th November, a summons was heard before Mr. Hopkins, at Lambeth Police Court, against the occupier of 191, Gipsy Road, for depositing for the purpose of sale, or preparation for sale, certain articles of meat, viz., 11 bullocks' hearts, 7 pieces of cooked beef, 2 pieces of cooked pork, and 5 smoked tongues, which were unsound and unfit for the food of man. Defendant was fined £50, which was afterwards reduced to £15, on the special application of the Town Clerk. 15 0 0 0 4 0 Total 21 0 0 4 0 0 37 38 RECENT LEGAL DECISIONS re BYE-LAWS FOR HOUSES LET IN LODGINGS. (Special Report presented to the Council on April 14th, 1904). I have to draw the attention of the Council to the recent important decisions given in the King's Bench Division (Divisional Court) on February 5th, 1904, by the Lord Chief Justice of England, Mr. Justice Wills and Mr. Justice Kennedy, in the two cases of Stiles v. Galinski, and Nokes v. Mayor, etc., of Islington. The Court held that the Bye-laws of Houses let in Lodgings relating to cleansing (annual) and to the provision of one w.c. for every 12 lodgers were unreasonable, because they did not provide for notices being served upon the person or persons responsible previous to such person or persons being subjected to a criminal charge. It was suggested also by the Court that perhaps the time (first week in April), in which the annual cleansing is to be done, might, with advantage, be extended. • The Bye-laws read as follows :— "No. 14.—The landlord of a lodging-house shall cause every common passage or staircase in such house to be thoroughly cleansed from time to time as often as may be requisite. "No. 15.—The landlord of a lodging-house shall, in the first week of the month of April in every year, cause every part of the premises to be cleansed. "He shall, at the same time, except in such cases as are hereinafter specified, cause every area, the interior surface of every ceiling and wall of every water-closet belonging to the premises, and the interior surface of every ceiling and wall of every room, staircase, and passage in the house to be thoroughly lime-washed. "Provided that the foregoing requirement with respect to the lime-washing of the internal surface of the walls of rooms, staircases, and passages shall not apply in any case where the internal surface of any such wall is painted or papered, or where the material of or with which such surface is constructed or covered is such as to render the limewashing thereof unsuitable or 39 inexpedient, and where such surface is thoroughly cleansed, and the paint, paper, or other covering is renewed, if the renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition. "No. 26.—The landlord or owner of any lodging-house shall provide and maintain, in connection with such house, watercloset accommodation in the proportion of not less than one water-closet for every ] 2 persons. Penalties. "Every person who shall offend against any of the Bye-laws shall be liable to a penalty," etc. The London County Council has already decided to alter the Bye-law having reference to the provision of w.c. accommodation for the inmates of houses let in lodgings (vide letter February 24th, 1904). With reference to the annual cleansing, the Bye-law deserves the attention of the Council, on account of the practical difficulty that at present exists, rendering such Bye-law practically a dead letter. Section 91 of 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. Bye-laws were adopted by the late Vestry on January 21st, 1897, and confirmed by the Local Government Board on May 11th, 1897, and since that time 411 houses have been registered by the late Vestry (and 2 houses since by the new Borough Council). With the re-arrangement of the Parish Boundaries to form the new Borough of Lambeth, certain houses (40) had to be transferred to other districts, leaving within the Borough at the present time 373 registered houses, containing 2,135 rooms. The Lambeth experience is that an Authority's hands are weakened, if anything, in respect of houses that are registered under the Bye-laws, due to the fact that under the Bye-laws the responsibility for the annual cleansing is transferred to the " landlord," who, under the definition laid down in the Bye-laws, is not the " owner " as defined by the Public Health (London) Act, under which such Bye-laws are made. What works out in practice is that the " landlord " is a person who has no money to expend on the p 40 necessary annual cleansing, and so the work is not done, and the rooms, passages and staircases become dirtier and dirtier, until they are in such a state as to be a nuisance, or injurious or dangerous to health. They can then be readily dealt with by the Inspectors under Section 2 of the Act. Bearing the above fact in mind, and having regard to the legal decisions quoted above, it would appear to be a suitable opportunity for amending the existing Bye-laws in such a way as to incorporate the Court's decision and suggestion with regard to the serving of a notice upon the person responsible before subjecting him to a criminal charge, and the extension of the time within which the annual cleansing of premises shall take place, so that the Bye-law may read " in the month of April " instead of " in the first week in April." I suggest, in addition, that the Bye-law should be altered so as to make the " owner," and not the " landlord," responsible in regard to this annual cleansing of houses let in odgings. Joseph Priestley. March 21st. 1904, 41 INFANTILE MORTALITY. (Special Report presented to the Council on April 28th, 1904). Much good work is being carried out in Lambeth Borough by the Female Inspector, and special attention may be called to the investigations in connection with deaths from infantile diarrhoea. It is of great importance that every means should be taken to lessen, if possible, the large infantile mortality that still takes place in Lambeth (and elsewhere), due, in great part, to the improper feeding of young children and infants. Taking the 1903 figures as an example, there were 9,069 births registered as taking place in the Borough of Lambeth, whilst 1,194 infants under 1 year of age, and 519 between the ages of 1 and 5, died in the Borough during the same period, making a total of 1,713 deaths in children under 5 years of age; and of these 1,713 deaths, 157 are certified as due to diarrhoea. Taking the Lambeth average infantile mortality rate as 150 per 1,000 births, i.e., 15 per cent., it may be estimated that 1,36C of the 9,069 infants born will die before reaching the age of 12 months. This is a serions mortality, and one that is, in part at least, preventable; and, if preventable, whv not prevented. Much good will accrue if the surroundings of the young children and infants are examined, and the conditions under which they pass the early years of their life kept sanitary and wholesome. The mothers, too, often need guidance and instruction. How can all this be best affected ? By the employment of an extra Female Inspector. The Lambeth Borough is too large in area to be efficiently worked by one Female Inspector, and, whilst the present one (Miss Gamble) is doing good work, there is, consequently, still room for another. Miss Gamble finds her time more than fully occupied with the inspection and re-inspection of workshops, workplaces, and outworkers' rooms, together with the other routine duties that fall to the lot of such an officer, leaving little or no time for the equally important work of investigating all deaths under 1 year of age, all deaths due to diarrhoea, all births, &c. Further, the visiting of houses wherein cases of consumption are notified is a duty eminently suited to a Female Inspector. For these special duties, the Borough might be divided into two divisions—the Inner and Outer Districts—each division to 42 be under the care of a separate Female Inspector, who would be responsible for carrying out such duties (outlined above) in her own respective district. I am satisfied that, judging by the work that has been done, and is being done, by the Borough's Female Inspector, much good would accrue from appointing an extra Female Inspector. I am of opinion that much good would be obtained, at the present time and under existing conditions, from the appointment of a Female rather than of a Male, Inspector. Miss Gamble was appointed October 3rd, 1901, at a salary of ;£100 per annum, rising by £10 yearly instalments, to £150. Joseph Priestley. April 18th), 1904. 43 "RETURN" CASES. (Special Report presented to the Council on April 28/A, 1904.) When a fresh case of Scarlet Fever (or other infectious disease) occurs in a house (previously infected) within a certain definite time (e.g., three weeks) of a patient being returned there from hospital convalescent from the same disease, it is known as a '' secondary," or " return" case, and is supposed to be, in some way or other, connected with the return home of the previous case. Such " return " cases are known to all Health Officers, and are attributed, generally, to maladministration (1) of the hospital authorities in prematurely discharging their patients, or (2) of the Sanitary Authorities in inefficiently disinfecting invaded houses and infected clothes and bedding. The former view is supported by Health Officers, who quote the fact that patients are, at times, discharged from hospital with " peeling " skins, discharging noses or ears, inflamed throats, etc.; whilst the'latter view is supported by Medical Superintendents of infectious Hospitals, who quote the fact that." return " cases often occur after some garment or some article of bedding or clothing has been brought out for the use of the particular patients on their return from Hospital—such articles having been put away in an inefficiently-disinfected state. The number of " return" cases varies considerably under different conditions, and may, even in a well-regulated, and carefully-administered Hospital, reach as high a figure as 3 to 5 per cent, of the total cases discharged. Theoretically, such cases should not occur at all ; practically, they do. It is, indeed, difficult to see how they are to be prevented, as they appear to depend on a variety of causes, e.g. :— 1. Premature discharge of patients with discharging ears or noses, " peeling " skins, sore throats, etc.; 2. Transference of convalescents direct from acute wards to their homes, thereby allowing the infected air. which fills the lungs of the returned patients, to infect others with whom they may come into contact—mechanical carriers of infection ; 3. Overcrowding in Hospital, leading to delayed elimination of poison from the patients, or the re-infection of the patients, or to other infecting conditions ; 44 4. Imperfect, or inefficient, disinfection — (а) By Hospital Authority. (б) By Sanitary Authority. 5. Unknown factors. Such are the generally accepted views as to the reason for " return " cases, but the more experience one has the more difficult such cases are to satisfactorily explain. It may be that other factors (not yet ascertained) play a part in connection with these so-called " return " cases. Personally, I am satisfied that in scarlet fever the late stages of desquamation are not infectious,and that, consequently, slight " peeling ' of the skin in a discharged patient does not necessarily mean danger to those with whom such patient may come in contact. I have never been able to satisfy myself that a patient with late peeling after scarlet fever had caused the disease to another or others. No patients with discharging ears, noses, etc., should be discharged without advising the Medical Officer of the district concerned. The Metropolitan Asylums Board now take great precautions before sending out their convalescents ; and about a year ago, at the suggestion of the Metropolitan Medical Officers of Health Society, even arranged to send previous intimation of the discharge of all patients to the Medical Officers of Health of the different districts concerned. This arrangement, as far as Lambeth is concerned, is working well, each house being visited and enquiries made as to the states of the patients sent home. 527 such cases have been visited and investigated during 1903, and in no instance has any real cause for complaint against the Metropolitan Asylums Board been found to exist. Bearing all these facts in mind, the difficulties connected with administration, the evident desire on the part of the Metropolitan Asylums Board to do all that is possible to lessen, as far as practicable, all cause for complaint, etc., I do not recommend the Lambeth Borough Council to act with the Poplar Borough Council, which alleges maladministration against the M.A.B. The best regulated Hospitals everywhere show "return" cases, but there is no sufficiently proved case to warrant the assumption that a " return" case is due necessarily to the returned patient to whom it is generally at once attributed. Joseph Priestley. April 18th, 1904. 45 UNCLEAN MILK. (Special Report presented to the Council on April 28th, 1904.) The question of milk supply has recently been brought prominently forward, and a feeling seems to be growing that steps should at once be taken with a view to ensuring the milk supply of the Metropolis being clean and wholesome (i.e., free from dirt), irrespective of the usual adulterations met with, and which are dealt with under the Food and Drugs Acts. I have taken, recently, half-a-dozen samples of milk from different parts of the Borough, and submitted them to examination. The samples show, in each case, a sediment, to a greater or lesser extent, and this sediment is found, on bacteriological and microscopical examinations, to consist of hairs, vegetable and cotton fibres, scales, bacteria, spores, etc. The sediments were brownish, greyish, whitish, and greenish. Each sample was, bacteriologically, carefully taken (i.e., in a sterilised bottle), and examined at once. The samples may be numbered A B C D E and F—the first three being taken from the Inner, and the last the from the Outer, Districts. Average No. of bacteria present per c.c. (i.e., 15 drops). Inner IVards— Sample A—Good-class shop 1,900,000 Sample B—Poor-class shop 4,700,000 Sample C—In the street . 5,200,000 Outer IVards— Sample D—Good-class shop 1,700,000 Sample E—Poor-class shop 4,200,000 Sample F—In the street 3,200,000 The medium in which the bacteria were cultivated was gelatine. The milk was diluted a thousand times with carefully sterilised water before inoculating the media. The kindsjof bacteria found were:—(1) lactic acid bacteria, ,(2) staphylococci, (3) streptococci, (4) sarcince, (5) diplococci, (6) micrococci, (7) bacillus coli, etc.; whilst pus cells, epithelial scales, debris, etc., were found also. No pathogenic germs were found. The bacteria 46 found come frcm the dust and dirt that gain entrance into the milk sold in Lambeth Borough (and elsewhere). 2 to 3 per cent, of the bacteria caused gelatine to liquefy. Some of the bacteria are harmless, or even beneficial; the rest harmful, and may be disease-producing. It must be emphasised that all bacteria are not harmful. The conclusions to be drawn from the bacteriological examinations are (1) that the number of bacteria found in Lambeth milk per c.c. was considerably above standard, and of these bacteria many were putrefactive in nature {i.e., liquefying gelatine) ; (2) that microscopical examination proved the presence of dust and dirt in the milk, the result of want of care. These few instances are sufficient to show the need for action being taken as far as Lambeth Borough is concerned, and what applies to Lambeth applies to other districts. It has been recently estimated that about 63,000,000 gallons of milk are consumed annually in London, whereas the total number of milch cows within the Metropolitan area is about 3,000 to 4,000. For the purposes of this Report, the Metropolitan inside (or local) supply of milk from these cowsheds may be neglected, though it is a point whether all Metropolitan cowsheds might not, with advantage, be abolished. To take milk for human consumption from cows that are kept in sheds for nine months of the year must be attended with more or less risk. As each cow gives, on an average, 500 galls, of milk per annum, it may be stated that only 1 to 3 per cent, of the milk consumed in London is produced locally (i.e., within the Metropolitan area), the remaining 99 to 97 per cent, being introduced from without (chiefly rural districts). The history of the milk that appears on the breakfast table every morning may be given as follows :— (а) Obtained from cows in country farms. (б) Carried in trains to towns. (c) Distributed to, and stored by, wholesale dealers or con- tractors. (d) Sold to and stored by— («) Retail dealers, and (b) Customers. 47 The distance travelled varies, but the milk may come from as far as Cornwall, Scotland, or even the Continent, so that it will readily be understood how contamination or deterioration of it may arise. The average distance that the Lambeth milk travels is from 100 to 200 miles, taking from 10 to 20 hours (or longer) before finally being distributed to the customers. Roughly, 800 churns of milk are received daily at Vauxhall and Waterloo Stations. (a) Country Farms wherein the Milk is produced. These farms may be, often are, from a sanitary point of view, most undesirable, whilst the conditions under which the milk may be collected are such as, at times, to baffle description. It is the country sources of the milk supplies that need control and supervision. A high standard of sanitation is required at the farms in the country, and this can only be secured by a rigorous carrying out of the Dairies, Cowsheds, and Milkshops Orders of 1885, 1880, and 1899, which are, .unfortunately, practically a dead letter—at least, in many rural districts. In this connection, the Local Government Board and the Board of Agriculture might, with advantage, be petitioned to take such steps as will ensure these Dairies, Cowsheds and Milkshops Orders being efficiently carried out by all Sanitary Authorities (more especially in rural districts), and, further, that in regard to the Metropolis, the Local Government Board might be urged to consider the advisability of the Board carrying out its statutory powers under Section 28 of the Public Health (London) Act, 1891, by virtue of which the Board may make such general and special Orders as the Board may think fit, dealing with the registration of dairymen, the inspection of cattle in dairies, the sanitary conditions of dairies, the securing of the cleanliness of milk-vessels, the prescribing of precautions to be taken for protecting milk against infection or contamination, and the authorising of the London County Council to make Bye-laws for any, or all, of the above purposes. It is somewhat anomalous that Section 28 of the London Public Health Act (which came into force on January 1st, 1892) should have remained in abeyance up to the present day (an interval of over 12 years), and that, consequently, the Metropolis should have been deprived of up-to-date Orders (to be made by the Local Government Board) and up-to-date Bye-laws (to be made by the London County Council). The Local Government Board having failed to make the Orders, the London County Council has been unable to make the subsequent Bye-laws ; and so the Metropolis is still dependent upon the Dairies, Cowsheds 48 and Milkshops Orders of 1885 and 1886, i.e., made nearly 20 years ago, and which are not up to modern requirements, nor in accordance with the scientific knowledge of to-day. The 1885 and 1886 Orders were made by the Privy Council under Section 34 of the Contagious Diseases (Animals) Act, 1878, and were carried out, in the Metropolis, by the old Metropolitan Board of Works and their successors—the present London County Council, until the London Government Act, 1899, transferred from the London County Council to the Borough Councils the registration of dairymen and the administration of the Bye-laws and regulations for the time being in force with respect to dairies and milk. The only regulations to be administered are those made 20 years ago (i.e., in 1885) under Article 13 of the 1885 Order of the old Metropolitan Board of Works. The annual licensing of Metropolitan cowsheds still rests with the London County Council, but, apart from this, practically the whole of the supervision of the milk trade is now in the hands of the Borough Councils—the Lambeth Borough Council, as far as Lambeth Borough is concerned. The London County Council has at present only power to act in default of a Borough Council. The Bofough Councils must do their duty. The Lambeth cowsheds (20 in number) are under careful inspection, and kept up to sanitary standard, but the small amount of milk (obtained therefrom) consumed within the Borough, may, for all practical purposes, be neglected in connection with this Report. (b). Transit of Milk by Rail to Towns. The existing conditions as to transit of milk by Rail are anything but satisfactory. Proper and suitable milk-vans (ventilated, cool, etc.) are required, and greater quickness of transit most desirable. All churns should be locked or sealed. Heat, motion, and lost time in transit are the three factors that act deleteriously upon the milk, causing a great increase in the number of bacilli found therein, so that any means that can be adopted to lessen such injurious effects are of the greatest importance, and should be encouraged (e.g., straining, cooling and protecting th3 milk). (c). Wholesale Dealers or Contractors. When milk is received from the country by the wholesale dealers in London, great care in handling is necessary, as also in storage, so as to protect the milk, as far as possible, from contamination by dust and dirt, the sun and motion. Quickness in delivery to the retailers is most important. 49 (d). Retail Dealers and Ordinary Customers. (a) Retail Dealers— What has been said in regard to wholesale dealers applies also with equal, or greater force, to retail dealers. In this connection, it will be remembered that, in a special Report in the Annual Report of 1901, details were tabulated as to the nature of the 458 known milk-shops and milk-stores situated in Lambeth Borough. Attention was drawn in the Report to the 277 general shops wherein a small quantity of milk (about 1 gallon a day) was stored for distribution in Id. and £d. worths to customers. This milk was found to be stored in pans and cans on the counters of shops—such vessels being uncovered and the milk, consequently, exposed to receive dust, dirt and flies; and in 119 cases {i.e., 26 per cenO in close proximity to paraffin and kerosene oils. In 47 per cent, of the milk-stores, sanitary defects were found to exist at the time of inspection— defective drains being found in 22 per cent. (b) Ordinary Customers— The unsatisfactory conditions under which milk is often stored in private houses (whether in the kitchen and scullery, or in the pantry and larder) are well known to all, and no emphasis is needed to satisfy all thinking people that these unsatisfactory conditions ought to be, at once, changed. Milk is known to be such a favourable medium for the culture of germs that every possible precaution should be taken to prevent its contamination with dust and dirt, and their concomitants, i.e., germs of various kinds. To sum up, it may be stated that the weak points in connection with a milk supply (Metropolitan or other) are to be found under the following headings :— 1. Condition of farms ; 2. Means of transit, and methods of distribution ; 3. Storage by (a) dealers, and (b) consumers. It must not be thought that the Lambeth milk supply is worse than, or even as bad as some of, the supplies of other Metropolitan districts, and it is only fair to add that many Lambeth milk dealers are most anxious to introduce such improvements as may be practicable. 50 Condensed milk is not dealt with in this Report, nor are infected and adulterated milks. The recommendations that I suggest are— 1. That the Local Government Board and the Board of Agriculture be urged to take such steps as will ensure the better enforcement of the Dairies, Cowsheds and Milkshops Orders (and the Regulations made thereunder) outside the Metropolis ; and that, in respect of the Metropolis, the Local Government Board be urged to carry out their statutory powers as laid down in Section 28 of the Public Health (Lcndon) Act, 1891, dealing with the registration of dairymen, the inspection of cattle in dairies, the sanitary conditions of dairies, the securing of the cleanliness of milk-vessels, the prescribing of precautions to be taken for protecting milk against infection or contamination, and the authorising of the London County Council to make B} e-laws for any (or all) of the above purposes. 2. That the attention of the railway companies and the large Metropolitan milk organisations be drawn to the more pressing need of more sanitary means of transit and storage of milk. 3. That all milk-shops and milk-stores within the Borough be carefully inspected regularly from time to time by the Inspectors, and that all such milk-shops and milkstores be required (under penalty) to be licensed annually, as is the case (at present) with cowsheds ; and that no one be allowed to sell milk unless the premises at which such milk is sold and stored have been previously certified as "suitable" by the Sanitary Authority of the District. 4. That united action amongst the Metropolitan Borough and City Councils be encouraged by communicating with them, stating the action that Lambeth Borough Council has taken. The need that exists for wholesome and clean milk will be admitted by all, when it is remembered that milk forms the chief diet of infants, young children and invalids. Joseph Priestley. April 18th, 1904. 51 Sanitary Congress at Folkestone. (Special Report presented to the Council on October 27th, 1904.) The Annual Congress of the Royal Institute of Public Health was held at Folkestone, under the Presidency of the Rt. Hon. the Earl of Radnor, from July 21st to July 20th, 1904. The work of the Congress was carried on under 7 Sections, as follows :— (a) Preventive Medicine and Vital Statistics. (b) Comparative Pathology, Bacteriology and Chemistry. (c) Engineering and Building Construction. (d) Child Study and School Health. (e) Ladies. (f) Tropical Medicine. (g) Military Hygiene. Clean Milk Supply. In the section of Preventive Medicine, the chief interest centred round the discussion on "A Clean Milk Supply." It was pointed out that the primary essential in the production of clean milk supplies was the education of the farmer and the cowman—the conditions to-day of some of the country cowsheds being a national disgrace. In this connection the Local Government Board was taken to task by some of the speakers for not enforcing more strictly the Dairies, Cowsheds and Milkshops Orders of 1885-1886. Public opinion should be brought to bear upon the subject of a pure milk supply by such being demanded, and its supply would naturally follow in time. Let the public decline to buy milk unless it was guaranteed to come from clean cows, to have been kept under clean conditions, and to have been milked by clean men and women, and Sanitary Authorities and Medical Officers of Health would be greatly helped in their endeavours to secure clean milk supplies. Cleanliness in collection, storage and distribution of the milk was essential, as also were more satisfactory and more rapid means of transit of milk from the country districts into towns. The distribution and sale of humanised and sterilised milk naturally came in for a large share of attention. Full particulars 52 were given by a Liverpool Councillor of the new Municipal Milk Depots at Liverpool, five in number—the first having been opened early in 1901. In addition, about 30 shops kept by dairymen in various parts of the city sell the municipal milk, a discount of 10 per cent. being allowed to the trade. Statistics were brought before the Congress shewing what were claimed as good results from the use of the municipal milk for the feeding of infants extending over a period of nearly three years. Of 6,295 infants fed upon the milk during the period named (the average age at the commencement of the feeding being 3½, months), "the infants thrived in the great majority of cases, increasing in weight and remaining perfectly healthy." Of a total 4,453 infants, fed from the depots direct (and carefully followed up), and in conditions of health below the average, the mortality was 78 per 1,000, as against 159 per 1,000 for the whole city. In addition to these figures, there was given the evidence of parents, of medical men, and of personal observation of officials—all strongly pointing to instances, repeated over and over again, in which to the use of the milk has been attributed the saving of the child's life. A large amount of circularising the people on the proper feeding of infants is also being carried out in Liverpool, There was, of course, a consensus of opinion that the high infantile mortality (met with in towns and elsewhere) was due to very many separate and distinct causes, and that, therefore, it was not to be expected that the establishment of municipal depots would wipe out such infantile mortality; 100 deaths per 1,000 births are, probably, unavoidable, being due to weakness at birth, general constitutional defects, etc. Before leaving the subject of milk, mention may be made of the strange (to use no stronger term) account given by the Sanitary Inspector of Folkestone of a typhoid outbreak due to polluted milk, in Folkestone itself, "by which it would appear that a certain milker, by some means, had been the probable cause of about 200 cases of typhoid spread over a period of eight years in that Boraugh. A certain cowman appeared to have the power of translating typhoid from place to place; indeed, to whatever farm he went, there typhoid appeared. So it went on until the cowman was found other work to do than of attending the cows." Your delegates regard themselves as fairly average men in common sense, but this method of explaining 95 per cent. of 53 Folkestone's typhoid cases during the past eight years appeared to put a somewhat greater strain upon common sense than could conveniently be borne. Infectious Hospitals. Infectious hospitals came in for some hard remarks against their usefulness, and a resolution was passed, during an afternoon sitting (poorly attended) of the Preventive Medicine and Vital Statistics section, to the following effect:— "That, as the hospital isolation of scarlet fever has been tried on a large scale for many years, and as some doubt exists as to whether the results obtained are commensurate with the cost, it is desirable, in the public interest, that a full and authoritative inquiry into the subject should be made." This, however, is but a pious opinion, and must not be taken to represent that of your delegates. Personal Hygiene. A popular lecture was given at the Pleasure Gardens Theatre, on Sunday night, on "The Personal Health of the Citizen in relation to National Efficiency"; whilst Dr. Hueppe (of Prague) gave an address on Monday morning on "Tuberculosis." Sanatoria for Consumptives. One of the results of the Congress was an important discussion upon the management, or mis-management, of what are known as the Jones's Homes for Tuberculosis Patients, at Sandgate, a suburb of Folkestone. These Homes consist of houses that form part of the main street of Sandgate, and have no grounds of their own. Further, they are not under constant medical supervision. The result of the discussion was that a resolution was finally passed to the effect that "Sanatoria for consumptives should stand in their own grounds in an isolated position, away from the general population, and that such Sanatoria should be placed under the absolute control of fully-qualified medical practitioners." It was stated in the discussion that the Homes were run for private profit—an unsatisfactory state of affairs, and one calculated to cause trouble sooner or later. 54 After the discussion, it is clear that those Boards of Guardians who are accustomed to send patients for treatment to the Sandgate Homes, will have just cause to seriously reconsider their decisions—it being the stated opinion of the Medical Officer of Health of Sandgate that such "Homes" are aptly described as the Sandgate scandal. Tropical Medicine. The Tropical Medicine Section is a new one for Congresses, and proved of interest, as showing what is being done abroad (more especially in India) to secure purity of water, air, food, and environment. The need that in India exists for sanitary organisation against malaria and other diseases was emphasized, and a resolution was passed by the Section "to lay before the Secretary of State for India the importance of a largely increased special Sanitary Service for India." A special lecture was given in this section on the disease known as Beri-beri, with a description of its signs, symptoms, and alleged causes, together with its geographical distribution and treatment. The disease has been recently brought into England (Liverpool). Ladies' Section, The Ladies' Section passed the following resolutions:— 1. "That it is desirable that steps be at once taken, either through the agency of the municipal corporations, or by some other means, of bringing home to the poor a knowledge of the principles of health. 2. "That municipal authorities should be empowered to erect and maintain day nurseries for the care of infants and young children of women employed in day labour, and that, for such a purpose, the Government should be requested to introduce an Adoptive Bill in the next Session." Minister of Public Health. The desirability of appointing a Minister of Public Health was insisted upon, and it was decided to endeavour to make this subject an official one in the programmes of all Congresses (International and others). 55 Emphasis was laid on the need for the physical education of children, including not only physical exercises and training, but also the careful supervision and selection of the conditions (at school and at home) under which the children live, with a view to improving the physique of the nation. We take this opportunity of thanking the Council for having appointed us their delegates. Charles F. Thwaite. October, 1904. Joseph Priestley. 56 Conference on the Administration of the Public Health (London) Act, 1891. (Special Report presented to the Council on October 27th, 1904.) We attended the Conference at Spring Gardens on July 7th and July 18th, 1904. A large number of subjects came up for discussion before the Conference, taking up two whole days, and the results are best shown by the subjoined resolutions, which were carried:— HOUSING. Houses Let in Lodgings. That the efficient administration of Section 94 of the Public Health (London) Act, 1891, relating to the registration and regulation of houses let in lodgings is a matter of extreme importance to the public health of London. That it is advisable that in bye-laws made in respect of houses let in lodgings there should be no rental limit of exemption, but that they should be so framed as to apply only to such houses as are registered by the sanitary authority. That the efficient enforcement of bye-laws relating to houses let in lodgings is the most effective method of dealing with overcrowding, but that inspections should from time to time be made during the early hours of the morning at other houses where overcrowding within the meaning of Section 2(1) (e) of the Public Health (London) Act, 1891, is suspected. Underground Rooms. That a single angle of light and air to underground dwelling rooms should be adopted in the enforcing of Section 96 of the Public Health (London) Act. That this Conference is of opinion that no underground room not complying with the conditions laid down by Section 96 of the Public Health (London) Act, 1891, should be used for sleeping. 57 Water Supply. That a draw-off tap from the rising main and a sink should be provided on every floor of a tenement house. Factories and Works/tops. That it is desirable that the sanitary authorities in enforcing Section 38 of the Public Health (London) Act, 1891, should adopt the following standards:— I. In factories and workshops where females are employed or in attendance there shall be 1 sanitary convenience for every 25 females, provided that in factories or workshops where the number of females employed or in attendance does not exceed 75, the following shall be the standard: One sanitary convenience where no more than 15 females are employed or in attendance. Two sanitary conveniences where from 15 to 40 females are employed or in attendance. Three sanitary conveniences where from 40 to 75 females are employed or in attendance. II. In factories or workshops where males are employed or in attendance, there shall be 1 sanitary convenience for every 25 males; provided that— (a) In factories or workshops where the number of males employed or in attendance does not exceed 50, and sufficient urinal accommodation is also provided there shall be 1 sanitary convenience where no more than 20 males are employed or in attendance, and 2 sanitary conveniences where from 20 to 50 males are employed or in attendance. (b) In factories or workshops where the number of males employed or in attendance exceeds 100, and sufficient urinal accommodation is also provided, it shall be sufficient if there is 1 sanitary convenience for every 25 males up to the first 100, and 1 for every 40 after. (c) In factories or workshops where the number of males employed or in attendance exceeds 500, and the district Inspector of Factories certifies in writing that, by means of a check system, or otherwise, proper supervision and control in regard to the use of the conveniences are exercised by officers specially appointed 58 for that purpose, it shall be sufficient if 1 sanitary convenience is provided for every 60 males, in addition to sufficient urinal accommodation. Any certificate given by an inspector shall be kept attached to the general register, and shall be liable at any time to be revoked by notice in writing from the inspector. (In calculating the number of conveniences required, any odd number of persons less than 15, 20, 25, 40, or 60, as the case may be, shall be reckoned as 15, 20, 25, 40, or 60). Shops. That it is desirable that power should be given to local authorities to inspect the sleeping accommodation in shops where the assistants are boarded in. FOOD. Premises where Food is prepared for Sale. That the London County Council be requested to insert in their General Powers Bill for the Session of 1905 a clause enabling them to make bye-laws for the regulation of the structure of premises where food is prepared for sale, and that no such premises should be used unless certified by the Borough Council to be suitable for the purpose. That the London County Council be requested to insert in their General Powers Bill for the Session of 1905 a clause enabling them to make bye-laws for the regulation of the conduct of the business carried on in premises where food is prepared for sale, such bye-laws to be confirmed by the Borough Councils. Abolition of Private Slaughter-houses. That the time has arrived when private slaughter-houses should cease to exist in London. Inspection of Meat killed in Private Slaughter-houses. That it is desirable that Borough Councils should endeavour to have all meat that is killed inspected. Inspection of Slaughter-houses, Cowhouses, Dairies, Milkshops, and Milkstores. That slaughter-houses, cowhouses, dairies, milkshops and milkstores should be frequently inspected. 59 Registration of Milkshops. That the London County Council be requested to take powers to enable the Metropolitan Borough Councils to refuse registration of premises as milkshops where, in their opinion, the premises are unfit for the purpose. Sale of Milk. That the London County Council be requested to introduce legislation providing for the penalising of persons selling filthy milk in London. Municipal Milk Depots. That, having regard to the declining birth-rate and the large infantile mortality rate of the Metropolis, it is desirable that the Metropolitan Borough Councils should be empowered, at their discretion, to provide in their respective districts depots for the preparation and sale of sterilised and humanised milk for the food of infants, and that the London County Council be requested to insert a clause in their General Powers Bill for the Session of 1905 to confer such power upon the said Borough Councils. Sale of Food and Drugs Act. (a) That, in the opinion of this Conference, the provisions of Section 25 of the Food and Drugs Act, 1875, and of Section 20 of the Food and Drugs Act, 1899, operate to the prejudice of the purchaser and of public health, and should be repealed. (b) That the London County Council be requested to make a communication, conveying the resolution of the Conference, to the President of the Local Government Board, with a view of his promoting legislation for this purpose. That the Local Government Board and the Board of Agriculture be asked to take such steps as may be necessary in order that a limit may be fixed as to the amount of boracic acid—that is, free or combined boracic acid—or other preservatives which may be mixed with food other than milk. That every registered milk seller in a Borough shall have his milk tested frequently. Cisterns. That, in cases where there is a constant water supply, cisterns should only be used in connection with hot water services and sanitary conveniences. 60 PREVENTION OF DISEASE. Disinfection. That this Conference is of opinion that disinfection should be carried out by the responsible officers of the sanitary authority without the intervention of a contractor. That the London County Council be asked to take measures to amend the law with regard to disinfection, so that disinfection should be carried out by the responsible officers of the sanitary authority without the intervention of a contractor, and that in all cases the disinfection should be to the satisfaction of the Medical Officer of Health. Provision of Laundry. That the provision of a laundry for use in connection with the disinfection of infected articles is essential. Provision of Permanent Shelter Accommodation. That at least one permanent shelter for temporary use should be provided in each Borough for the accommodation of persons during the disinfection of their homes. 30. That the word "accommodation" mentioned in Section 60, sub-Section 4 of the Public Health (London) Act, 1891, should, if and when necessary, include the expense of the supply of food. Precautionary Measures against Phthisis. That the system of voluntary notification of phthisis is desirable, and should be made general throughout London. That the sanitary authorities should disinfect the premises in which a person suffering from phthisis has died, or from which such a patient has removed or has been removed. Hospital Accommodation. That it is desirable to make provision of sanatoria for the isolation and treatment of persons suffering from consumption, for the Metropolis as a whole, and under one authority; and that, in the opinion of this Conference, the Metropolitan Asylums Board should be such authority. That the foregoing resolution be sent to the Local Government Board with the request that they give the matter their immediate consideration. 61 Offensive Trades. That the business of a marine store dealer should be added to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891. That the business of a fried fish shopkeeper should be added to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891. That the London County Council be requested to make an order to carry out these resolutions. House Refuse. That this Conference is of opinion that dust collection should be carried out by the responsible officers of the sanitary authority without the intervention of a contractor. That the daily removal of house refuse in suitable districts is advisable. That improved dust carts should be adopted so covered as to minimise annoyance caused to passers-by dnring collection of house refuse, especially in crowded thoroughfares. That the method of destruction of house refuse by fire should be universally adopted in London. Collection of Fish Offal and other Offensive Trade Refuse. That the collection of fish offal and other offensive trade refuse should be undertaken by the sanitary authorities at the expense of the producers. SANITARY INSPECTION. That Female Inspectors should be employed in each Borough. MISCELLANEOUS Municipal Creches. That, having regard to the declining birthrate and the large infantile mortality rate of the Metropolis, it is desirable that the Metropolitan Borough Councils should be empowered at their discretion to establish creches for the reception of young children during the hours their mothers are employed in work away from home, and to make reasonable charges for the accommodation so provided and for the food of the children, and that the London County Council be requested to insert in their General Powers Bill for the Session of 1905 a clause to confer such power upon the said Borough Councils. 62 Smoke Nuisances. That, in the opinion of this Conference, it is desirable that the provisions of the Public Health (London) Act, 1891, as to nuisances arising from the emission of smoke, should be applied to property in the possession of the Crown. Metropolitan Ambulance Service. That the Conference, taking note that the Metropolitan Asylums Board are prepared to extend the operations of their ambulance service so as to include the transport of medical, surgical, and mental cases, respectfully requests the Local Government Board to obtain for the managers the requisite legal authority to enable them to do so. That the Conference desires to express the opinion that should the London County Council not be able to provide for a Street Ambulance Service, the duty should be undertaken by the Metropolitan Asylums Board. Application of Acts to Government Property. That all provisions of the Public Health and Sanitary Acts should apply to Government property. Vote of Thanks. That the Conference do pass a hearty vote of thanks to its Chairman for his able conduct of the business of the Conference. At the commencement of the Conference, a certain procedure of debate was agreed to, and it was also resolved that all delegates (including officers) should have equal rights of voting. Twenty-four out of 28 Metropolitan Borough Councils were represented at the Conference (74 representatives in all), as was also the Metropolitan Asylums Board (1 representative). Thirteen members of the London County Council (together with the Clerk and the Medical Officer) were also present, but did not vote as such. The Chair was occupied by Mr. Henry Jephson, Chairman of the Public Health Committee of the London County Council. October, 1904. Charles F. Thwaite. Joseph Priestley. 63 Conference on the Spread of Infectious Disease by Vagrants. (Special Report presented to the Council on December 8th, 1904.) We attended the Conference at Spring Gardens on November 10th, 1904. The Conference was very largely attended by Medical Officers of Health and other delegates, representing County Councils and County and Metropolitan Borough Councils, etc., and the following resolutions were finally adopted:— General Measures for the Prevention of the spread of Infectious Disease by Vagrants. 1. (a) That this Conference of Urban and Sanitary Authorities of England and Wales recognises the increasing amount of habitual vagrancy as the cause of wide-spread and disastrous consequences to the public health, and is of opinion that much more effective measures than are at present adopted should be taken for preventing the spread of infectious diseases by vagrants, and for effectually dealing with this great and growing danger. (b) That the evil can only be met by conferring further powers upon the local authorities, viz., the Sanitary Authority, the Board of Guardians, and the Magistracy. 2. That means should be provided for the detention and isolation of any vagrant found wandering ill a public place, if reasonably suspected of being liable to convey infectious disease. 3. That this Conference is of opinion that it is desirable that— (a) Parliamentary powers should be sought for the compulsory vaccination and re-vaccination of all vagrants unable to produce proof of being sufficiently protected against Smallpox on entering casual wards or common lodging houses, who, in the opinion of the Sanitary Authority, have been exposed to the infection of Smallpox, and also that Sanitary Authorities should have power to grant such compensation as they think necessary to persons vaccinated or re-vaccinated at their request who may be prevented on that account from work. 64 (b) It should be an offence to withhold information or make false statements to the Sanitary Authority in carrying out its powers with respect to the disease. 4. That in order to deal effectually with the transmission of notifiable infectious diseases by tramps, power should be given to County Councils to enforce the existing laws in all cases where Sanitary Authorities in the County refuse or neglect to do so. 5. That the Local Government Board should obtain powers to secure weekly returns of all cases of infectious disease from all central authorities throughout the country, and circulate the same. 6. That it is desirable that in districts comprising groups of counties and county boroughs, intelligence bureaux should be established, to which information should be sent from Sanitary Authorities and workhouses in the district, of persons of the wandering class who have been exposed to the infection of Smallpox; and that a printed copy of such information should be distributed from the bureaux to every Sanitary Authority and Board of Guardians in the district, and that the expense of working the bureaux should be met by contributions from the County Councils and County Boroughs forming the district. 7. That this Conference is of opinion that the Port Sanitary Authorities should be authorised to take more stringent precautions to prevent the importation of disease by persons arriving by vessel at the ports who are suffering from Smallpox, or who have been exposed to infection by that disease. Common Lodging-Houses and Casual Wards. 8. That the Local Authority should have increased control over common lodging-houses, their keepers, and occupants. Thus the Local Authority should have power:— (a) To medically examine the inmates. (b) To detain and isolate persons exposed to infection and to disinfect them and their clothes. (c) To temporarily close a common lodging-house in whole or in part, compensation to be given to the keeper of the house. 65 9. That the Local Authority should have power to order the keeper of a common lodging-house, in which there has been infectious disease, to refuse fresh admissions for such time as may be required by the Authority. 10. That the Local Authority should be empowered to require medical examination and disinfection of all persons entering casual wards. 11. That the Local Sanitary Authority should have power to require the removal and isolation of any inmate of a casual ward who may reasonably be suspected of being liable to convey infectious disease. 12. That the Local Authority should have full power to require the cleansing of the person and the disinfection of the clothes of any person in a casual ward, whether infected or exposed to infection. Labour Bureaux. 13. (a) That the time has arrived when the Local Government Board should promote legislation for the establishment of labour bureaux in the areas of every County Council and every county Borough Council. (b) That this Conference is also of opinion that it is desirable that a national voluntary agency should be formed for assisting bona fide working men while travelling through the country in search of work, and that such agency should be worked on the same lines as the Inter-Cantonal Union of Switzerland for the relief of poor travellers. 14. That the unemployed travelling bona fide in search of work, not being habitual vagrants, should not be treated as vagrants, but as far as possible be assisted to obtain employment. Labour Colonies. 15. That the time has arrived when the Local Government Board should promote legislation for the establishment of labour colonies for the compulsory detention of habitual vagrants until they have acquired power to work and self restraint. 16. That this Conference approves and affirms the resolutions passed by the Executive Council of the Association of Poor Law Unions in England and Wales at their meeting in September, 1903, as follows:— 66 (a) That Boards of Guardians should be grouped in suitable areas to provide labour colonies for vagrants (b) That such colonies should be established and governed by the joint committees of the Boards of Guardians of the Unions in the said areas. (c) That habitual vagrants should be sent to such labour colonies by Magistrates. (d) That the expenses of each colony should be spread over the unions in the areas served by such colonies. Children of Vagrants. 17. That the powers of the Poor Law Guardians under the Poor Law Acts of 1889 and 1899, to assume and exercise, in certain circumstances, parental rights over the children of pauper parents should be extended so as to confer similar rights over the children of habitual vagrants. Generally. 18. That, in order to give practical effect to the foregoing resolutions, the Conference is in favour of uniting with the County Councils Association, the Association of Municipal Corporations, the Association of Metropolitan Borough Gouncils, the Magistracy, and the Association of Poor Law Unions of England and Wales for the following purposes, viz.:— (a) To enlist the sympathy and co-operation of Members of Parliament. (b) To appoint representatives to wait on the Local Government Board. (c) To give evidence before the Inter-Departmental mittee of the Government on the Vagrancy Question. (d) To take such other measures as may be thought sirable in support of the resolutions arrived at by the Conference. A Committee was appointed to give effect to this resolution. 19. That the best thanks of the Conference be accorded to the Chairman for his conduct in the Chair. (Signed) C. F. Thwaite. Joseph Priestley. November 28th, 1904. 67 Sanitary Condition of Lambeth Elementary Schools. (Special Report presented to the Council on January 19th, 1905.) On November 17th, 1904, the Education Committee of the Borough Council passed the following resolution, which was referred to, and agreed to by, the Council on November 28th, 1904:— "That the attention of the Public Health Committee of the Council be drawn to the Report, dated 2nd November, 1904, of the Education Committee of the London County Council, as to the condition of certain Non-provided Schools, with the suggestion that the Public Health Committee instruct the Medical Officer to have an examination made, as early as possible, of the drainage of all Public Elementary Schools in the Borough." Instructions were given to the Medical Officer by the Council on December 8th, 1904, to carry out the necessary examination of the drainage of all Public Elementary Schools in the Borough, and to bring up a report on the subject. Accordingly, the Medical Officer made the necessary arrangements to carry out the inspections and examinations of the drains and sanitary fittings of the Non-provided Schools throughout the Borough, selecting the Christmas holidays, and the usual Saturhalf-holidays, as the most suitable times for such inspections and examinations to be made. It now appears that, meanwhile, the London County Council, on December 13th, 1904, passed the following resolution "That the estimate of £850 be approved, and that expenditure, not exceeding that amount, be sanctioned in connection with the investigation of the condition of the drains in the Non-provided Schools, and the reporting thereon not later than February, 1905, and that authority be given for the employment of a sufficient number of skilled assistants for the purpose." The result is that double inspections are taking place throughout Lambeth and other Boroughs, and the powers and duties of 68 the Local Sanitary Authorities are being usurped by the London County Council, without previous (official) notice thereof having been received from the Clerk of the Council, or other responsible Chief Officer concerned. Putting aside the questionable conduct of the London County Council in acting in this manner, and having regard to the fact that the Loudon County Council has no statutory powers by which its officers can enter upon private premises for the purpose of examining and testing drains and sanitary fittings (except in default of a Sanitary Authority), a communication might, with advantage, be sent to the London County Council, protesting against their action. It will be noted that in connection with the London County Council and the examination of drains, instructions have been given to the officers to water test the drains—a most severe test. The Borough Council, and the late vestry, have always held (rightly, I think) that, though the water test is undoubtedly a trustworthy test, it is severe, and therefore should not be applied indiscriminately to all drains—at least, not without the written consent of the owner or owners concerned. There are but few new drain that would be found to stand such a severe test, and it is even questionable if the London County Council Schools would stand such an one. It goes without saying, therefore, that I he majority (if not all) the drains of the Non-provided Schools will be found wanting, and large financial outlays will result in consequence of their relaying and reconstruction. It may be even that the water test itself will make defects in the drains of certain of the Schools, as it is well known that such a test has the power of bursting joints and even cracking, at times, pipes. The London County Council's position legally may be a matter for future consideration by the Courts should any Mauagers raise the question as to alleged trespass, and damage (if any) done. Time alone will show this. I feel it my duty, as Medical Officer of Health, to lay the full facts before the Borough Council, and to ask for instructions. It will probably be stated by some that the London County Council decided to act in this way on account of certain Sanitary Authorities in London failing, or being likely to fail, to carry out the duties required of them, but such an argument does not apply to Lambeth Borough, whose Council is, at all times, desirous of keeping abreast of the times in sanitary 69 matters, and to carry out, in a reasonable manner, all its statutory duties as a Metropolitan Sanitary Authority. The action of the London County Council is to be regretted, even if it is not hereafter proved to be ultra vires and culpable. It certainly is unreasonable, and ought to be appealed against. Joseph Priestley, January 9th, 1905. Medical Officer of Health. 70 71 DEATH-RATES (CORRECTED) IN METROPOLITAN BOROUGHS DURING 1904 PER 1,000 PERSONS LIVING. Births. All Causes. Principal Epidemic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia (origin uncertain). Diarrhœa. Phthisis. Deaths under one year to 1 ,000 Births registered. County of London 27.9 16.1 2.14 0.01 0.49 0.08 0.16 0.32 ... 0.06 0.00 1.02 1.62 144 WEST— Paddington 22.5 13.8 1.56 0.01 0.27 0.07 0.13 0.11 ... 0.07 ... 0.90 1.20 136 Kensington 19.3 14.3 1.45 0.01 0.38 0.03 0.10 0.11 ... 0.03 0.01 0.78 1.44 150 Hammersmith 26.9 15.7 2.53 ... 0.91 3.05 0.19 0.31 ... 0.04 ... 1.03 1.38 152 Fulham 32.3 15.4 2.49 ... 0.42 0.03 0.15 0.38 ... 0.04 ... 1.47 1.43 153 Chelsea 20.9 16.5 1.49 ... 0.34 0.08 0.07 0.35 ... 0.03 ... 0.62 1.82 156 City of Westminster 16.4 13.5 0.87 ... 0.13 0.05 0.04 0.10 ... 0.06 0.01 0.48 1.52 125 North— ... St. Marylebone 30.4 16.2 1.51 ... 0.38 0.07 0.11 0.10 ... 0.02 ... 0.83 1.68 94 Hampstead 16.6 10.2 0.66 ... 0.20 0.02 0.05 0.09 ... 0.06 ... 0.24 0.83 113 St. Pancras 26.0 17.4 2.01 ... 0.54 0.11 0.16 0.35 ... 0.07 ... 0.78 1.88 150 Islington 26.1 15.4 1.75 0.00 0.53 0.10 0.09 0.25 ... 0.05 ... 0.73 1.55 129 Stoke Newington 21.8 13.3 1.13 ... 0.13 0.06 0.15 0.23 ... 0.06 ... 0.50 1.72 114 Hackney 27.3 14.9 2.13 ... 0.34 0.09 0.24 0.24 ... 0.12 ... 1.10 1.39 142 Central— Holborn 28.6 18.5 1.80 0.04 0.74 ... 0.07 0.16 ... 0.07 ... 0.72 2.86 109 Finsbury 36.4 21.3 2.57 0.03 0.59 0.17 0.16 0.28 ... 0.09 ... 1.25 2.39 140 City of London 14.8 16.7 0.60 ... ... 0.04 0.09 0.30 ... ... ... 0.17 1.58 104 East— Shoreditch 32.1 20.4 3.20 0.02 0.69 0.11 0.15 0.54 ... 0.07 ... 1.62 2.18 188 Bethnal Green 34.9 19.3 2.95 0.05 0.69 0.14 0.36 0.40 ... 0.05 ... 1.25 2.16 157 Stepney 37.0 19.4 2.84 0.01 0.57 0.11 0.30 0.42 ... 0.10 ... 1.38 2.12 155 Poplar 32.7 18.6 3.37 0.02 0.54 0.14 0.50 0.48 ... 0.08 ... 1.61 1.74 154 South— Southwark 31.6 20.1 3.13 0.00 0.92 0.06 0.13 0.57 ... 0.09 ... 1.36 2.36 174 Bermondsey 32.5 20.0 3.52 ... 1.05 0.14 0.12 0.53 ... 0.12 ... 1.55 2.12 172 Lambeth 29.3 15.8 2.10 ... 0.53 0.05 0.11 0.35 ... 0.04 ... 1.02 1.45 138 Battersea 27.7 14.5 2.02 ... 0.34 0.06 0.08 0.34 ... 0.07 ... 1.13 1.42 147 Wandsworth 27.0 13.4 1.73 ... 0.41 0.05 0.16 0.19 ... 0.04 ... 0.88 1.12 122 Camberwell 27.1 14.9 1.90 ... 0.41 0.06 0.08 0.37 ... 0.06 ... 0.92 1.37 144 Deptford 28.8 16.1 2.46 ... 0.67 0.09 0.14 0.43 ... 0.03 ... 1.10 1.42 145 Greenwich 25.9 14.4 2.26 ... 0.39 0.03 0.11 0.55 ... 0.09 ... 1.09 1.33 142 Lewisham 25.6 12.0 1.41 ... 0.18 0.05 0.09 0.26 ... 0.01 ... 0.82 0.90 123 Woolwich 28.7 14.3 2.40 ... 0.24 0.13 0.24 0.45 ... 0.05 ... 1.29 1.67 135 N.B.-0.00 indicates that the deaths were too few to give a rate of 0.005; where no death occurred, ... is inserted. The above table is taken from the Registrar-General's Annual Summary, and the rates for Lambeth Borough differ slightly from those given in this Report. R 72, 73 73 1904. 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. Influenza. Ophthalmia. Croup. Smallpox. TOTAL. Addington Street, L.C.C. 1 4 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 7 Aristotle Road, L.C.C. 2 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 4 Beresford Street, L.C.C. 2 ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 5 Bolton Street, St. Mark's 6 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 7 Brixton Hill, Wesleyan ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Cancell Road, Christ Church 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Christchurch Road, Christ Church 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Church Street, L.C.C. 116 27 27 7 5 6 3 ... ... 1 ... ... ... ... ... ... 192 Cormont Road, L.C.C. 151 28 24 7 3 22 2 ... ... ... ... ... ... ... ... ... 3 Dulwich Hamlet, L.C.C. 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 Devonshire Road, St. Barnabas 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 Eflra Parade, L.C.C. 38 22 1 2 6 4 3 ... ... ... ... ... ... ... ... ... 5 Eden Road, Wesleyan ... 1 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... 3 Elder Road, St. Luke's ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Faunce Street, L.C.C. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 George Street, L.C.C. 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 299 Gipsy Road, L.C.C. 92 70 44 3 34 42 6 ... 1 ... 1 ... 4 2 ... 7 Gye Street, St. Paul's 1 ... ... ... 5 ... ... ... 1 ... ... ... ... ... ... ... 5 Gaskell Street, St. John's ... ... 4 ... 1 ... ... ... ... ... ... ... ... ... ... ... 221 Hackford Road, L.C.C. 144 13 40 1 12 7 ... ... ... ... 2 ... 2 ... ... ... 3 Horseferry Road, L.C.C. 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Hazelrigge Road, L.C.C. 1 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 72 Heatherfield Road, L.C.C. 36 35 ... 1 ... ... ... ... ... ... ... ... ... 116 Hatfield Street, L.C.C. 93 3 9 5 ... 3 ... ... 1 2 ... ... ... ... ... ... 7 Herne Hill Road, St. Saviour's 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Halstead Street, St. Michael's ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 4 Jessop Road, L.C.C. 98 3 39 ... 5 1 ... ... ... ... ... ... ... ... ... ... 146 Johanna Street, L.C.C. 100 4 77 1 2 5 ... ... 2 10 ... ... ... ... ... ... 201 Kennington Road, L.C.C. 59 21 9 2 1 3 ... ... ... 1 ... ... ... ... ... ... 97 Lyham Road, L.C.C. 34 54 7 ... ... ... 1 ... ... ... ... ... ... ... ... ... 96 Lollard Street, L.C.C. 40 6 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 47 Larkhall Lane, L.C.C. 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Leipsic Road, L.C.C. 5 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... 9 Lingham Street, St. Andrew's ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Marlboro' Street, L.C.C. 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 New Road, L.C.C. 21 8 6 ... 1 1 ... ... ... ... ... ... ... ... ... ... 37 New Park Road, L.C.C. 44 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 Old Kent Road, L.C.C. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Priory Grove, L.C.C. 62 8 3 1 20 2 ... ... ... ... ... ... ... ... ... ... 96 Pocock Street, L.C.C. 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Rosendale Road, L.C.C. 64 7 1 2 3 1 ... 1 ... ... ... ... ... ... ... ... 79 Reedworth Street, St. Philip's 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Santley Street, L.C.C. 43 18 37 5 5 12 1 ... 1 ... ... 1 ... ... ... ... 123 Salter's Hill, L.C.C. 10 12 3 6 13 ... ... ... ... 3 ... ... ... ... ... ... 47 Springfield, L.C.C. 104 20 8 11 4 11 10 ... ... ... ... ... ... ... ... ... 168 Sussex Road, L.C.C. 29 10 4 1 10 49 2 1 ... ... ... ... ... ... ... ... 106 Stockwell Road, L.C.C. 103 30 7 5 1 1 3 ... ... ... ... ... ... ... ... ... 150 South Lambeth Road, L.C.C. 66 46 23 2 1 16 2 ... ... ... ... ... ... ... ... ... 156 Sayer Street, L.C.C. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Stockwell Road, Practising ... 28 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 29 Stamford Street, St. Patrick's ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Tenison Street 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Upper Tulse Hill, Holy Trinity 11 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 12 Upper Kennington Lane, St. Peter's 8 1 ... 1 1 1 2 ... 1 1 ... ... ... 1 ... ... 17 Upper Kennington Lane, L.C.C. 54 4 5 ... ... 1 2 ... ... ... ... ... ... ... ... ... 66 Vauxhall Street, L.C.C. 146 5 27 6 4 3 ... 1 1 4 2 ... ... ... ... ... 199 Woodland Road, L.C.C. 1 4 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... 9 Westminster Bridge Road, L.C.C. 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Walnut Tree Walk, L.C.C. 44 12 4 1 1 1 2 ... ... 1 1 ... ... ... ... ... 67 Waterloo Road, L.C.C. 50 ... 19 1 5 ... 1 ... ... ... 1 ... ... 3 ... ... 80 TOTAL 1929 525 431 74 152 202 42 3 8 23 6 3 2 8 2 1 3411 74 Home Office. METROPOLITAN BOROUGH OF LAMBETH, 1904. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 6 203 ... Workshops (Including Workshop Laundries.) 169 Workplaces Homeworkers' Premises 277 Total 452 203 ... 75 2.— Defects Found. Particulars. Number of Defects Number of Prosecutions. Found. Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts*:- Want of Cleanliness 186 186 ... ... Want of Ventilation 1 1 ... ... Overcrowding 11 11 ... ... Want of drainage of floors ... ... ... ... Other nuisances 63 63 ... ... Sanitary accommodations insufficient ... ... ... ... unsuitable or defective 138 138 ... ... not separate for sexes 1 1 ... ... Offences under the Factory and Workshop Act:— ... ... ... ... Illegal occupation of underground bakehouse (S. 101) Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ... ... ... ... Failure as regard lists of outworkers (S. 107) ... ... ... ... Giving out work to be done in premises which are unwholesome (S. 108 ... ... ... ... infected (S. 110) ... ... ... ... Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S. 109) ... ... ... ... Other offences ... ... ... ... Total 400 400 ... ... * Including those specified in Sections 2, 3, 7 and 8, of the Factory Act as remediable under the Public Health Acts. 76 3.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 31 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Notified by H.M. Inspector 13 Reports (of action taken) sent to H.M. Inspectors 13 Other ... Underground Bakehouses (S. 101):— In use during 1903 79 Certificates granted in 1903 72 in 1904 ... In use at the end of 1904 72 Number of Homework:— Lists. Outworkers. List of Outworkers (S. 107):— Lists received 2 17 Addresses of outworkers forwarded to other Authorities ... ... received from other Authorities 139 277 Wearing Apparel. Other. Homework in unwholesome or infected premises:— Notices prohibiting homework in unwholesome premises (S. 108) ... ... Cases of infectious disease notified in homeworkers' premises ... ... Orders prohibiting homework in infected premises (S. 110) ... ... Workshops on the Register (S. 131) at the end of 1904 72 Important classes of workshops, such as workshop. bakehouses, may be enumerated here. Bakehouses Underground Above ground 135 Restaurants 242 Other Workshops 1,139 Total number of workshops on Register 1,588 INDEX. Index of Tables. PAGE. A The number of Births and the Birth - Rates in each Registration Sub-District of Lambeth Borough during 1904 (arranged quarterly) 11 B The estimated Populations, numbers of Inhabited Houses, Marriages, Births, and corrected Deaths for the year 1904 in Lambeth Borough, and for the ten years 18911900 in Lambeth Parish 12 C The number of persons per House, the Marriage, Birth and Death - Rates, and the proportion of deaths in Public Institutions per 1,000 persons, for the year 1904 in Lambeth Borough, and for the ten years 1891-1900 in Lambeth Parish 13 D The number of Births and Deaths with Birth and DeathRates in each of the Registration Sub-Districts of the Borough during 1904. [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-Rates, Zymotic Death-Rates and Zymotic IncidenceRates in the new Wards of Lambeth Borough during 1904 25 F Mortalities in Lambeth Borough during 1903 at different age-periods compared with (1) those for London, 1904 and (2) the averages for London for the years 1881-90 26 (iii.) PAGE 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 1904 27 H The uncorrected mortality (i.e., including that of Strangers) at different ages in each District of the Lambeth Borough during 1904 28 I The uncorrected Deaths (i.e., Parishioners and Strangers) at various age-periods in each Quarter of the year 1904 29 J The Infantile mortalities in the Registrar-General's old thirty-three large towns of England and Wales (including London), and in Lambeth Borough during 1904 33 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 1904 39 L The number of infected houses, with percentages of (1) General Defects, and (2) Defective Drains, in Lambeth Borough during the year 1904, and in Lambeth Parish during the ten years 1891-1900 40—41 M Zymotic seasonal variations in the different Registration Sub-Districts of Lambeth Borough during 1904, with the Zymotic Death-Rate per 1000 inhabitants 42 N Total cases notified under the Notification Clauses of the Public Health (London) Act, in Lambeth Borough during 1904 (arranged quarterly) 43 O Deaths from Zymotic Diseases (strangers deducted), 1904 44 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 1904 46—47 Q Vaccination Returns (Lambeth) 1903 55 R Vaccination Returns (Lambeth) for the first half year 1904 56 (iv.) page. S The Diarrhœa Mortality in Lambeth Borough in each month during the year 1904 84 T The Classification of Causes of Deaths in Lambeth Borough during 1904, as compared with 1903 (a) Deaths from all causes and at all ages, with percentages of deaths to total deaths (corrected) 92 (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 93 U Table of Uncorrected Deaths during the years 1903 and 1901, classified according to Diseases, in the Borough of Lambeth and in London 94 V Table of Deaths during the year 1904 in the Lambeth Borough, classified according to Diseases, Ages, and Localities. (Local Government Board old Table A) 96—99 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 1904 in the Metropolitan Borough of Lambeth, classified according to Diseases and Localities. (Local Government Board old Table B) 100—101 Four new Tables of the Local Government Board, giving the— (i.) Vital Statistics of Lambeth Borough during 1904, 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 1904 and of the Parish of Lambeth in the ten years 1891—1900 Appendix 3—4 (iii.) Cases of Infectious Disease notified within the Borough of Lambeth during the year 1904 Appendix 5 (iv.) Causes of, and ages at, death during 1904, within the Borough of Lambeth Appendix 6—7 (v.) PAGE. Mortality Tables showing Deaths (corrected) from all causes in Lambeth Borough during 1904 sub-divided— (а) As to Registration Sub-Districts Appendix 8—15 (b) As to different Age-periods Appendix 16—24 Offences (with amounts of penalties and costs) Food and Drugs Acts Appendix 26—31 Public Health and Metropolis Management Acts Appendix 32—37 Death-rates (corrected) in Metropolitan Boroughs during 1904, per 1,000 persons living Appendix 70—71 Cases of illness (infectious) notified from Board Schools to the Medical Officer of. Health during 1904 Appendix 72—73 Cases of illness notified by Schools Appendix 72—3 Factory and Workshops Acts—Home Office Tables— (i.) Inspection Appendix 74 (ii.) Defects found Appendix 75 (iii.) Other matters Appendix 76 General Index. PAGE. Abatement of Nuisances 102—6 Accidental Deaths 91, 172, 174 Adulteration of Food and Drugs 133—141 Age-Distribution of Diarrhoea 82 „ „ „ Diphtheria 73 „ „ „ Scarlet Fever 58 „ „ „ Smallpox 48—49 „ „ „ Typhoid Fever 76 „ „ „ Deaths 24, 26, 28—29 „ ,, „ Population (Lambeth) 7 Air Temperature and Diarrhoea 81 Alcoholism, Deaths from 90 Ale (Adulteration of) 140—141 Analysis of Food and Drugs 133—141 „ „ Water 142 Antitoxin, Gratuitous Distribution of 177—8 Apoplexy, Deaths from 91 Area (Lambeth) 5, 95 Atelectasis 90 Bacteriological Laboratory 175—178 Bakehouses 156 Ballast Burning 149—150 Bedding, etc.. Disinfected 126—128 „ „ Destroyed 126—128 Births and Birth Rates 11, 14—15, 21, 95, 100—101 Birth Rates in Sub-Districts 11, 22—23 Bodies received in Mortuaries 171—173 Bronchitis, Deaths from 91 Burns and Scalds, Deaths from 91, 172 Bye-laws (offensive trades) 157—158 „ (carcases of dead horses) 147 Cancer, Deaths from 90 Carcases of dead horses 147 Cautions (Food and Drugs) 133, 138 (vii.) PAGE. Censal Population (Lambeth) 100 Censal Population (London) 9 Cholera 36, 70, 81 Circulatory Diseases, Deaths of 91 Clerical Work 184—186 Closure of Schools (Measles) 64—67 Chickenpox 69—70 „ Notification of 69—70 Children (underfed) 184 Common Lodging Houses 151 Combined Drainage 110—111 Complaints 105, 113 Conferences— Administration of Public Health Act Appendix 56—62 Vagrants and Infectious Disease Appendix 63—66 Control of Drainage (supervision) 113 Conscientious Objectors 54—56 Congenital Malformations 90 Constitutional Diseases 90 Congress, Folkstone Appendix 51—55 Consumption (See Tuberculosis and Phthisis), Continued Fever 78 Convictions under Public Health Acts Appendix 26—31 „ ,, Food and Drugs Acts Appendix 32—37 Convulsions, Deaths from 91 Coroners' Courts 169—174 Costs, Food and Drugs Appendix 32—37 ,, Public Health Acts Appendix 26—31 Courts, paving of Cowhouses 161 163 „ List of 161—162 Critical Temperature (Earth) and Diarrhœa 81 Crown Property (inspection of) 114 Croup (See Membranous Croup). Customs and Inland Revenue Acts (See Revenue Act). Dairies (See Milkshops). Deaths and Death-rates l5—101, Appendix 70—71 „ Inner and Outer Wards 18—21 ,, (arranged quarterly) 27, 29 „ Metropolitan Boroughs Appendix 70—71 (viii.) PAGE. Deaths, Corrected 16, 19—23, 24, 95 „ Uncorrected 15, 27—29, 96—99 „ in Public Institution 12—13, 16—18 „ Zymotic 12—13, 33—90, 95 ,, Under 1 year 12—13, 30—33, 95 ,, Under 5 years 12—13, 28 „ from violence 91, 172, 174 „ from ill-defined arid non-Specified causes 91 Density, per acre (Lambeth) 22—23, 95 Dentition, Diseases Of 91 Depositing (refuse) 146—147 Depots (Refuse and Manure) 146—147 Destructors 147—14 Developmental Diseases 90 Diagnosis (Bacteriogical) 175—178 Diarrhœa 81—84 „ Age Distribution of 82 ,, Monthly Mortality 84 ,, Inner and Outer Wards 83 ,, and Infantile Mortality 83 ,, Registration Sub-Districts 82 Dietetic Diseases 90 Digestive System, Diseases of 91 Diphtheria 70—74 ,, Age Distribution of 73 „ Antitoxin in 74 „ Decrease of 71—72 Mild Cases 71 „ Bacteriological Examination in 74, 176—7 „ Registration Sub-Districts 73 ,, School Closure in 73 „ Pseudo-Bacilli 177 Disinfection, details of 126—132 „ Statistics 126, 132—133 „ Certificates 128 Disinfecting Department 126—132 „ Machines 128—129 „ Refuges 128 „ Station 128 Distribution (free) of Antitoxin 177—178 (ix.) PAGE. Drain Testing 37, 40—41, 105, 113 ,, ,, with water 105, 113 Drainage Defects 37—41, 104—105 „ Control of (supervision) 113 „ Comb ned 110—111 „ Legal Proceedings 110 Drowning, Deaths from 91, 172 Dust Depdts 146—7 Dust Destructor 147—9 Earth Temperatures and Diarrhœa 81 Effluvium Nuisances 147—150 Elementary Schools in Lambeth (See Schools). Enteric Fever (See Typhoid). Enteritis 83, 91 Epilepsy, Deaths from 91 "Equifex" Disinfecting Machines 128—9 Erysipelas 79—80 Factory and Workshops 115—126 Home Office Tables Appendix 74—76 Female Inspector 121—126 Food and Drugs, Adulteration of 133—141 „ „ Convictions 133, Appendix 26—31 Food Unsound 108—110 Homicide, Deaths from 91, 174 Home Office Tables (Factory and Workshops) Appendix 74—76 Houses (Lambeth) 10 „ condemned 153 „ let in Lodgings 150, Appendix 38—40 „ of the Working Classes 152—3 Increase of Population (Lambeth) 5, 95 „ „ (London) 10 Infantile Mortality 1904 30—33, 95, Appendix 41—42 „ „ (London and 33 large Towns of England and Wales) 33 Infected Houses 35—38, 102 „ ,, and Drains 35—38 Infectious Cases removed 34—35, 100—101 „ ,. notified 39, 100—101, Appendix 72—73 Infectious Cases notified by Schools Appendix 72—73 Infectious Diseases Inspection 35—38 (X.) PAGE. Influenza (Epidemic) 89—9& Inhabited Houses of Lambeth Borough 10, 95 Inner and Outer Districts and Wards—Deaths and Births 18—21 Inquests 174 Inspections 103—108 Inspector, Female 121—126 „ Males 106—121 „ Food and Drugs 133—141 „ Smoke 142—146 Institution Deaths 12—13, 16—18 Integumentary System, Diseases of 91 Introductory Letter 3—4 Laboratory (bacteriological) 175—178 Lambeth Statistics 5—101 Appendix 2—24 Lavatories (Underground) 179—181 Legal Decisions re Bye-laws as to Houses let in Lodgings Appendix 38—40 Letters (sent and received) 185 Liver, Diseases of 91 London County Council Bye-laws (offensive trades) 157—158 „ „ „ (carcases of dead horses) 147 Local Diseases—Nervous System, Heart Respiratory Organs, Digestive and Urinary Systems and Reproductive System 91 Locomotive System, Diseases of 91 Local Government Board, Old Tables A and B 96—101 „ „ ,, New Tables i., ii., iii., iv. Appendix 2—6 Lodging-houses (common) 151 London (County of) Vital Statistics, 1904 9—10 „ No. of Births, Deaths and Marriages, 1904 10 „ Zymotic Deaths, 1904 46—47 Lymphatic System, Diseases of 91 Manure Depots 146—147 Market Thoroughfares (inspection 113 Marriage and Marriage Rates (Lambeth) 12, 13, 15, 95 Measles 63—68 ,, Registration Sub-Districts 68 „ Compulsory Notification of 64 „ and School Closure 64—67 Membranous Croup 74 Meningitis (Tubercular) 90 (xi.) PAGE. Milk (clean and unclean) 167—8 Appendix 45—50 „ (Bacteriological Examinations) 177 Appendix 45—50 „ Depot (municipal) 163 7 ,, Stores (see Milkshops) Milkshops 163 Milk Supply (pure) 167—8 Appendix 45—50 Mortality Rates, 1904 13, 15—101 „ Different Age Periods (Lambeth and London) 24, 26 ,, Different Diseases (Lambeth Borough) 92—94 „ Different Diseases (Lambeth and London) 94 „ Under 1 year (London and Lambeth) 12—13, 30—31, 94 Mortality Tables Appendix 8—24 „ „ Sub-Districts „ 8—15 ,, „ Age Periods ,, 16—24 Mortuary, Norwood 170 „ High Street 170 Mortuaries 169—174 ,, Keepers of 171 „ Extra for Lambeth 170 Natural Causes, Deaths from „ Increment of Population (Lambeth) 5,95 „ ,, ,, ,, (London) 10 Nervous System, Diseases of 91 New Wards (Lambeth Borough) 5, 8 ,, General Diseases, Deaths 25 „ Population (estimated) 5 ,, Tuberculosis 87 „ Zymotic Diseases 25 „ Zymotic Incidence 25 Norwood Schools (drainage of) Ill—112 Notices served 102—106, 112—113, 185 Non-notifiable Infectious Diseases 130 Notification Certificates received, 1904 39, 100—101 Appendix 72—3 „ „ „ (Quarterly), 1904 43 „ (voluntary) of Consumption 86—88 Nuisances Abated 102—106 Observations (smoke) 142—146 Offences, Public Health Acts Appendix 32—37 „ Food and Drugs Acts „ 26—31 S (xii.) PAGE. Offensive Matters, removal of 146—147 „ Trades 156—158 „ „ Bye-laws 157—158 Old Age, Deaths from Open Spaces 168—9 Organs of Special Senses (Diseases of) 91 Outer and Inner Wards, Deaths and Births 18—21 Outworkers 124—126 Parasitic Diseases 90 Parliamentary Divisions 8 Paving Courts, &c. 114 Penalties Appendix 25—37 Public Health Acts ,, 32—37 Food and Drugs Acts „ 26—31 Peritonitis, Deaths from 91 Persons per House 10, 95 „ Acre 22, 95 Phthisis, Deaths from 85—89, 90 „ Voluntary notification of 86—88 ,, Open-air treatment (Sanatoria) 89 Plague 70 Plans of Drainage 112—113 Pneumonia, Deaths from 91 Population of Lambeth Borough, 1904 5, 95 „ „ „ „ Sub-Districts 6 „ „ „ „ Parliamentary and New Wards 5, 8 „ „ „ „ Age Periods 7 Population of London, 1904 9—10 „ „ Sub-districts 9 Post-Mortems 169—174 Premature Births (deaths from) 90 Premises Disinfected 126 Prosecutions Appendix 26—37 Public Health Acts 4, 106 ,, 32—37 Food and Drugs Acts 106, 133 ,, 26—31 Protected Persons (Workshops) 116 Provided Schools (see Schools) Pseudo-Bacilli and Diphtheria 177 Public Institutions, Deaths 12—13, 16—18 Public Health Acts (Convictions) Appendix 32—37 (xiii.) PAGE. Puerperal Fever 78—79, 80 Pure Milk Supply 167—8 Appendix 45—50 Quarterly Returns (Lambeth)— Births 11 Deaths (Zymotic and General) 27, 29, 42, 45 Notifiable Infectious Diseases 43 Disinfection Certificates 128 Rateable Value (Lambeth Borough) 11 Refuges 128 Refuse Depots 146—147 Refuse depositing of 146—147 Registration Sub-Districts (Lambeth Borough)— „ ,, Births 11, 21, 22—23 „ „ „ Population (estimated) 6 ,, „ „ General Diseases, Deaths 21, 22—23, 27—28, 96—101 „ ,, „ Infantile Mortality 30—32 „ „ ,, Tuberculosis 85, 88 „ „ „ Zymotic 21, 22—23, 42, 96—101 ,, „ ,, Vaccination Returns 55—56 Re-Inspections 10R, 113 Removal of Infectious Diseases 34—35, 100—101 Reproductive System, Diseases of 91 Respiratory Diseases 91 "Return" Cases Appendix 43—44 Revenue Act, 1903 154—155 Samples Food and Drugs 133—141 Sanatoria for Consumptives 89 Sanitary Defects 103—105 „ Work 102—186 „ „ Structural 103—104 „ „ Non-structural 103, 104—5 Scarlet Fever 57—63 „ Age Distribution 58 „ Registration Districts 59 ,, Return Cases 62—63 Appendix 43—44 „ and School Attendances 59 „ and Milk 59 „ Outbreak at School 59—62 (xiv.) PAGE. Schools (Lambeth) 181—184 Appendix 67—69 (a) Provided 181—182 „ 07—69 (b) Unprovided 182—184 „ 67—69 School Closure and Measles 64—67 Simple or Continued Fever 78 Slaughterhouses 158—161 „ List of 159—160 „ Infringement of Bye-laws 161 Smallpox 48—54 Details of Cases 49—53 Preventive Measures 51 Vaccination-states 53—4 Quarantining 53—4 Contacts 53—4 Smoke Nuisance and Abatement 142—146 „ Observations 142—146 Special Reports 38—69 Elementary Schools (Lambeth) Appendix 67—69 Houses let in Lodgings (Recent decisions) „ 38—40 Infantile Mortality ,, 41—42 Sanitary Congress at Folkstone, 1904 „ 51—55 Conference on Public Health Administration „ 56—62 Unclean Milk „ 45—50 Conference on Vagrants and Infectious Disease „ 63—66 " Return" cases ,, 43—44 Cases of Illness notified from Schools ,, 70—73 Stamps used 186 Staffs— Clerical 184—6 Inspectorial (male) 106—114 „ (female) 121—126 Disinfecting 126 Mortuary Attendants 171 Underground Conveniences 179—181 Suffocation in Bed 91 Suicide and Homicide, Deaths from 91, 172, 174 Summary of Vital Statistics (Lambeth Borough), 1904 95 „ „ Sanitary Work 105—6 „ ,, Work by Female Inspector 121—3 „ ,, Death Returns Appendix 24 (XV.) PAGE. Summonses 106 Appendix 26—37 Supervision (drainage) 113 Syphilis 90 Tables (special)— Local Government Board (old) A and B 96—101 ,, ,, ,, (new) i., ii., iii., iv. Appendix 2—7 Home Office (Factory and Workshops) „ 74—76 Mortality (Lambeth)— Registration Sub-Districts „ 8—15 Age periods „ 16—24 Temperature (Air and Earth) 1 Testing of Drains 37, 113 Tuberculosis, Deaths from 85—89 ,, and Bacteriological Examinations 86, 175 ,, Registration Sub-Districts and Wards 85, 87—88 ,, and Preventive Measures 86 „ Notification (voluntary) 86—88 Typhoid. 74—78 „ Age Distribution of 76 „ Bacteriological Examinations 77, 176 „ Registration Sub-Districts 77 „ Inner and Outer Wards 76 Typhus 78 Unclean Milk Appendix 45—50 Underground Bakehouses 156 „ Conveniences 179—181 Underfed Children (schools) 184 Unprovided Schools (See Schools). Unsound Food 108—110 Urinals of Public Houses 107—8 Urinary Diseases, Deaths from 91 Vaccination "Returns 55—56 Varicella (See Chickenpox). Venereal Diseases 90 Violent Deaths 91 Vital Statistics, London 9t 10 „ „ Lambeth 5—101, Appendix 2—24 „ „ Summary (Lambeth) 95 Wards (Lambeth) 24 ,, Deaths and Death-Rates 24 (xvi.) PAGE. Wards Zymotic Incidence 24 Water Analysis 142 „ Certificates 113, 185 Whisky (Adulteration of) 140—141 Whooping Cough 63—68 „ „ Registration Sub-Districts 68 Work of Sanitary Staff 102—186 Workshops 115—126 „ Defects found 118—119, 121—3 „ Female Inspector in 121—126 „ Outworkers 124—126 „ Overcrowding in 122 ,, Home Office Tables Appendix 74—76 Workshops, Persons employed in 116 „ Protected Persons 116 „ Trades, etc. 115, 124—5 Zymotic Diseases 32—90, 95 „ Deaths, arranged Quarterly 42, 45 „ Deaths, arranged Monthly 44 „ Incidence in New Wards 25 „ Incidence in Registration Sub-Districts 22—3, 42, 100—101 „ Principal Deaths (Lambeth) 46—47 „ Principal Deaths (London) 46—47 „ Seasonal Variations 42