Lam 11 REPORT ON THE Vital and Sanitary Statistics OF THE BOROUGH OF LAMBETH During the Year 1916. I With an account (I) of the work done [a] at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, and {b) by the Male and Female Sanitary Inspectors and Health Visitors, and (2) of the proceedings taken under the Sale of Food and Drugs, the Factorv and Workshop, and the Housing Ads.] BY JOSEPH PRIESTLEY, B.A., M.D., D.P.H., Medical Officer of Health and Chief Executive Tuberculosis Officer, Metropolitan Borough of Lambeth. LONDON: Printed by Wightman & Co., Ltd., Regency Street, Westminster, London, S.W. 1. 1917. Public Health Department, Lambeth Towh Hall, Brixton Hill, S.W. May, 1917. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, Again I have the pleasure to submit a satisfactory Report — the Report for 1916 —dealing with the Vital Statistics of the Borough of Lambeth. The death rates are low, as are also the zymotic incidences, the latter fact being specially noteworthy having regard to war conditions that, unfortunately, still exist, necessitating the movements of large numbers of persons, who may be actually infected or " carriers " of infection between one country and another, or between one district and another. The small but steady decreases in the tuberculosis mortality rates during past years is noteworthy, allowance being made for improved methods of diagnosis, which tend to apparently increase the rates. One outstanding feature of the year was the widespread epidemic of measles and German measles as revealed by the compulsory notification of these two diseases under the new Public Health (Measles and German Measles) Regulations, 1915, which came into force on January Ist, 1916. Fortunately, the mortality has been low, despite the epidemic having been widespread. All notified cases have been officially visited. Another outstanding feature of the year was the inauguration by the Council of the Lambeth Maternity and Child Welfare Scheme. Depletion of clerical staff has made it necessary to reduce the clerical work as far as possible, whilst, on the recommendation of the Local Government Board, the present Annual Report of the Medical Officer of Health and Chief Executive Tuberculosis Officer has been further condensed, with the approval of the Council, so as to place on record only what is absolutely necessary for statistical purposes, thereby effecting economies in printing, paper, etc., without, however, disturbing the yearly continuity of the Reports of past years. My thanks are again due to the Public Health Staff, the Chief Officers of the various Departments, and to the Members of the Council for assistance given to me in the carrying out of my important duties. I am, Mr. Mayor and Gentlemen, Your obedient servant, Medical Officer of Health and, Chief Executive Tuberculosis Officer. 1. VITAL STATISTICS. The Estimated Civil Populations* of the Borough are as follows:— Estimated Civil Populations, 1916. I. Wards. Wards. Males. Females. Total. 9972 9999 19972 Marsh Bishop's 13984 15618 29602 Prince's 18597 21149 39746 Vauxhall 13831 15156 28987 Stockwell 13492 16992 30484 Brixton 18600 23688 42288 Herne Hill 14128 17610 31738 Tulse Hill 13077 16823 29900 Norwood 13150 17862 31012 Borough of Lambeth 128832 154897 283729 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. Lambeth Church 21282 22636 43918 Kennington 21272 24130 45402 Stockwell 27323 32148 59471 Brixton 32728 41298 74026 Norwood 26227 34685 60912 Borough of Lambeth 128832 283729 154897 *N.B.—The estimates of populations for 1916 are estimates of civilian populations only. These estimates are based upon the estimate for the whole Country (England and Wales) and on the number of persons in the Borough according to the Census 1911 and the National Register in 1916. III. Parliamentary Divisions (Old). Old Parliamentary Divisions. Males. Total. Females. North 23618 25329 48947 32060 67932 Kennington 35872 32227 40541 72768 Brixton 39589 51448 91037 Norwood Parliamentary Area of Lambeth 127494 153190 280684 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 Borough, 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. IV. Parliamentary Divisions {Adjusted). *Adjusted Parliamentary Divisions. New Wards. Total. North Marsh Bishop's 49574 Prince's Vauxhall 68733 Kennington Stockwell Brixton 72772 Brixton Herne Hill Tulse Hill Norwood 92650 Norwood * Adjusted Parliamentary Area of Lambeth - 283729 *N.B.—By the adjustment of the old Parliamentary Divisions so as to be co-tenninous with the Wards. Norwood Borough of Lambeth 255 2067 292 2139 258 1944 232 1830 1037 7980 *Including Lying-in Hospital (791 cases, of which 210 belong to Lambeth). f Including Workhouse (177 cases, of which 124 belong to Lambeth). §Including Maternity Hospital (900 cases, of which 215 belong to Lambeth). N.B. —The births are those of infants of (a) civilians and (b) non-civilians, and the population is that estimated by the Registrar-General for the Borough of Lambeth for the year 1916 for the purpose of calculating birth-rates, viz., 308,702, giving an uncorrected birth-rate of 25-8, and a corrected birth-rate (i.e..after deducting 1,319 non-Lambethian Institutional births) of 21 6 per 1,000 population. 1915 284188 7878 4653 683 1047 335 2550 1914 297094 8188 4269 728 1020 375 2204 1913 297139 8341 4280 733 369 2015 1094 1912 297550 8168 3925 598 917 287 1872 1911 297957 8405 4380 899 1336 569 1862 Averages— 1901-10 (Borough) 314566.8 8846.9 4709.6 1020.1 1503.5 475.1 1816.8 1891-1900 (Parish) 294049.7 9295.4 5405.3 1358.5 2070.2 700.4 1568.5 Note.—(a) Enumerated Population at Census 1901 was 301,895. (ft) Enumerated Population at Census 1911 was 298,058. (c) Families or separate occupiers = 70,887 (1901) and 70,827 (1911). N.B.—The estimated populations for 1915 and 1916 are the estimates of civil populations only, based upon the estimate for the whole country (England and Wales), and on the numbers of persons in the Borough of Lambeth according to the Census, 1911, and the National Register in 1915 and 1916 respectively. 1916 1915 1914 1913 1912 1911 Averages— 1901-10 (Borough) 1891-1900 (Parish) 25.8* 27.7 27.6 28.1 27.4 28.2 28.1 31.6 14.8 16.4 14.4 14.4 13.2 14.7 14.9 18.4 70.8 86.7 88.9 87.9 73.2 106.9 115.3 146.1 134.1 146.8 170.5 171.3 152.3 205.2 216.7 251.3 202.8 225.0 238.9 255.6 233.6 305.0 319.4 382.9 558.1 479.1 475.6 450.2 446.9 406.2 386.0 276.7 0.9 1.2 1.3 1.2 0.9 1.9 1.5 2.4 * N.B. —The birth-rate is calculated upon the special Borough population estimated for that purpose by the Registrar-General for the year 1916, viz., 308,702, an estimate of the total population based on the assumption that the ratio between the total and the civilian population is the same in the Borough of Lambeth as in England and Wales as a whole, the total population of England and Wales for this purpose having been calculated by adding to the published estimate for 1914 the natural increase up to the middle of the year 1916. BIRTHS, 1916. The total number of Births registered is 7,980, of which full details are set out in Table A. The birth-rate for Lambeth (Parish and Borough) has been recently slowly, but steadily, declining—a decline not peculiar to Lambeth, nor even to England, but to be found in nearly all civilised countries. Notification of Births Act. The Notification of Births Act, 1907, was adopted throughout the Borough, and came into operation on March 9th, 1908. Since the Act came into force, a total of 58,688 births have been notified up to the end of 1916, viz. : 3,473 in 1908 (10 months), 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, 7,336 in 1912, 7,158 in 1913, 7,397 in 1914, 7,091 in 1915, and 7,293 in 1916. The notified cases are visited, or such other measures taken in connection therewith, in the way of distributing pamphlets, etc., as are found necessary. In the cases of notified infants who are visited, the methods of feeding are carefully inquired into and instruction given as required, breast-feeding being encouraged wherever possible ; whilst the proper clothing and management of infants are also dealt with. Revisiting is carried out as far as is practicable with the staff at disposal. It is impossible to give satisfactory statistics of the educational value of the visiting of houses wherein births have been notified, but there is no doubt as to the existence of such value—a result that would, naturally, be increased by systematic re-visiting in addition to the first visiting. Returns of all Births (with addresses of mothers), registered in Lambeth, are obtained from the District Registrars week by week. A list of all notified births is sent to the London County Council weekly in pursuance of sub-section 5, of section 2, of the Act, and the Medical Officers of Health concerned • are written to in connection with babies born in Lambeth Public Institutions but belonging to Districts outside the Borough—similar information being obtained with regard to Lambethian babies born in institutions outside the Borough. The Registrar-General provides particulars of transferable births registered, and for 1916 his figures for the Borough of Lambeth are as follows :— 10 Inward Transfers. Outward Transfers. 29 631 Legitimate Males Legitimate Females 29 614 Illegitimate Males 18 205 Illegitimate Females 26 197 Totals 102 1647 The Registrar-General's corrected number of births is, t her fore, 6,435, differing slightly from the corrected number of births calculated locally and found in this Report, viz., 6,661. Lambeth Maternity and Child Welfare Scheme. During 1916 (April 13th) the Council approved the inauguration of the Lambeth Maternity and Child Welfare Scheme for amalgamating and co-ordinating with the Council's Official Public Health Work, the whole of the work of the various present and future non-official or voluntary agencies which are engaged in maternity and child welfare work throughout the Borough ; and, in connection with such scheme, sanctioned the appointment of an additional official Health Visitor*, to be attached to the Public Health Department. The special Report of the Medical Officer of Health dealing with the subject is as follows :— REPORT. Maternity and Child Welfare. (a) General Considerations. No more important subject could engage a Public Health Authority's attention at the present time than that of Maternity and Child Welfare. With the present War wastage of human life, and with the consequent shortage of available husbands and prospective fathers, it becomes the more necessary to adopt all available means, and to take all precautionary measures, to secure the health of mothers, and to conserve, if possible, the life *Nurse Annie Stirk was appointed Health Visitor on July 27th, 1916, commencing her duties on September Ist, 1916. of every child born, and, indeed, to go farther, and to endeavour to conserve also the life of every child unborn. With this object in view, the Local Government Board issued on 30th July, 1914, a Memorandum, outlining a Scheme for Maternity and Child Welfare. The Scheme is a complete one, dealing with— (1) Arrangements for the local supervision of Midwives; (2) Ante-natal arrangements for mothers; (3) Natal arrangements for mothers; and (4) Post-natal arrangements for mothers and young children. These four headings include the systematic home visiting of— (a) Mothers (before, during, and after confinement), and (b) Young children (up to school age), and the necessary provision of institutions (where such mothers and young children can obtain advice and treatment) or home help (for the same purposes). In other words, the Scheme outlines medical supervision and advice for expectant, and nursing, mothers, and for young children (up to school age), together with such treatment as may be necessary, at Maternity Centres, Ante-natal and Infant (or Baby) Clinics or Dispensaries, etc., the Board laying special stress upon the need for home visiting by properly qualified Health Visitors. Local Authorities and Voluntary Agencies are asked by the Board to co-operate together, so as to form, within the respective districts of such Local Authorities, comprehensive Schemes, dealing with the extension and systematisation of all measures hitherto adopted, to a greater or lesser degree, for the prevention of infantile morbidity and mortality, the welfare of children between the ages of 1 and 5 years, and the treatment of mothers before and at and after confinement. To encourage Local Authorities and Voluntary Agencies to embark upon Schemes for such purposes, grants in aid of expenditure are offered under certain conditions, both by the Local Government Board and the Board of Education, in respect of institutions or other provisions for maternity and child welfare, the latter Board restricting its grants to institutions and agencies of the nature of Schools for Mothers, i.e., such institutions and agencies as have primarily an educational object, e.g., the teaching (training and instructing) of mothers in the care and management of young children, and their supervision from birth to school age (without specific medical advice and treatment), as set out in that Board's Regulations of 6th July, 1915. The views of the Local Government Board as to its own particular grants are set out in Regulations dated 7th July, 1915, in the following words :— The Local Government Board will pay grants both to Local Authorities and to Voluntary Agencies during the financial year ending 31st March, 1916, in respect of the following services, such grants depending upon the adequacy and efficiency of the services provided, and being conditional, in the case of a Voluntary Agency, upon the work being co-ordinated, as far as practicable, with the public health, and the school medical, services of the Local Authority : — (1) The salaries and expenses of Inspectors of Midwives; (2) The salaries and expenses of Health Visitors; (3) The provision of a midwife, or doctor, for the aid in confinement of necessitous women; (4) The expenses of a Maternity Centre, i.e., an institution providing any, or all, of the following activities, viz., medical supervision and advice for expectant and nursing mothers, and for infant? and little children, and medical treatment for cases needing it. There may be cases in which it may be difficult to discriminate as to which Board application is to be made for a grant, or grants, as there must, of necessity, be a certain amount of overlapping in practice in the carrying out of the details of Schemes, e.g., to provide treatment presupposes previous inspection, which would naturally include some amount of supervision and teaching, etc. The bearing of general insanitation (municipal and domestic), impure water and milk supplies, bad housing, overcrowding, etc., must be remembered in connection with Schemes for Maternity and Child Welfare, as showing how necessary it is for Local Authorities, through their health departments, to take part in, and to arrange for, all Schemes, which are under Voluntary Agencies, within their respective districts, to be co-ordinated with their own administrations. Finally, the local medical profession can assist a good deal in making such Schemes successes. It may be added that the Notification of Births (Extension) Act, 1915, which came into force throughout the country on 1st September, 1915, will assist Local Authorities in the work of maternity and child welfare by making compulsorily notifiable all births within 36 hours of their occurrences, assuming, of course, that proper use is made of such information by subsequent administrative procedure and action on the part of such Local Authorities. (b) Local Considerations. So much for the general aspect of the subject, which now must be considered from the point of view of the particular requirements of the Borough of Lambeth. The question naturally arises, What has been done in Lambeth, in connection with this important subject of Maternity and Child Welfare, and what more (if anything) is needed, having regard to the new national conditions ? A most satisfactory answer can be given at once to the first half of the question by simply enumerating the known Agencies that are already at work within the Borough both Official, i.e., that are under the direct control of the Council, and Non-Official or Voluntary, i.e., that are already, in part, to a greater or lesser extent, amalgamated and co-ordinated, directly or indirectly, with the Council's work, under the Council's Medical Officer of Health, as follow : — 1. Official Agencies (The Borough Council). (a) The Infant Consultations Centre and Municipal Milk Depot at 66 York Road (established on 12th February, 1906), where, since that date (up to the end of 1915), a total of 2,465 infants and young children have been entered on the Register, and where general daily consultations (average, 5 to 6 consultations per day) and medical weekly consultations (average, 15 to 20 consultations per week) have been held; (b) An Official Health Visitor, attached to the Public Health Department (appointed on 3rd October, 1907), and the paying by her, since that date (up to the end of 1915), of a total of 19,272 official visits connected with infants and young children. N.B.—The Notification of Births Act, 1907, was adopted throughout the Borough on 9th March, 1908, and since that date (up to the end of 1915) a total of 51,394 births have been notified, of which 38,910 have been dealt with officially, as follow :— Infants visited ... ... ... ... 23,517 Pamphlets on infant feeding and management sent to the mothers ... 15,393 11. Non-Official or Voluntary Agencies. Inner Wards : 1. Mothers' Institute, 8 Johanna Street. 2. Institute, Royal Street (for Holy Trinity Parish). 3. North Lambeth Babies' Care, 147 Kennington Road (for St. Mary's Parish). 4. Moffat Institute Maiternity and Child Welfare Centre, Esher Street. 5. Mrs. Anstruther's Infant Clinic, 31 Ethelred Street. 6. Our Lady's Welcome (Roman Catholic Settlement), The Grove, Vauxhall. Outer Wards: 7. Wyndham Day Nurseries, 212 Camberwell New Road. 8. Brixton Infant Welfare Centre and School for Mothers, The Dispensary, 19 Water Lane. 9. The Creche, 5 Railton Road, Herne Hill. 10. West Norwood Maternity and Child Welfare Centre, Scott Memorial Hall, Rommany Road, West Norwood. 11. West Norwood Creche and Day Nurseries, Pilgrim Hill. N.B.— In addition to the above, the Borough of Lambeth is well supplied with the following maternity and other special hospitals or departments of hospitals, situated within the Borough, for the use of women and young children, e.g., General Lying-in, St. Thomas's, King's, Clapham Maternity, Royal Waterloo, Belgrave, etc. The second part of the question can be answered by the following suggestions, viz., that the Council should— (1) Amalgamate and co-ordinate still more with the Council's Official work, and bring into one comprehensive Scheme, the whole of the work of the various present and future Non-Official or Voluntary Agencies, and for such a purpose should (a) Pass a resolution approving such amalgamation and co-ordination, and authorising the Council's Officers to get into communication with the necessary Agencies; or, as an alternative, (b) Ask the Mayor to call a meeting at the Town Hall, and to invite representatives to be present from all the known Non-Official or Voluntary Agencies which are dealing throughout the Borough with the work of Maternity and Child Welfare for the purpose of inaugurating the comprehensive Scheme for the Borough, as set out, and (2) Appoint at once one additional Official Health Visitor to be attached to the Council's Public Health Department. The average yearly number of births notified within the Borough is 7,000-8,000, and one Official Health Visitor is not sufficient to carry out satisfactorily the work arising therefrom. By the appointment at once of one additional Official Health Visitor, the Borough might be divided, with advantage, into two administrative areas, viz., (a) Inner Wards and (b) Outer Wards, each area to be under the control of a separate official Health Visitor, who would be responsible to the Council, through the Medical Officer of Health, for securing amalgamation, and coordination, of work amongst the various Non-Official or Voluntary Agencies, and for ensuring systematic re-visiting of all houses at which births have been notified, such systematic re-visiting being, in my opinion, of the greatest value and importance. With reference to Grants in aid of expenditure, several of the Non-Official or Voluntary Agencies working within the Borough have already applied successfully either to the Local Government Board or to the Board of Education. These Grants have been voted by the latter Board on the certificate of the Borough Medical Officer of Health, thereby guaranteeing that the work carried out in connection with such Agencies is efficient and is co-ordinated with the work of the Council's Public Health Department, though, on the other hand, in connection with a Grant recently paid by the Local Government Board to the General Lying-in Hospital, no such certificate of the Medical Officer of Health of the District was required. From an administrative point of view, all applications for Grants should be made, in my opinion, through the Departments of the Medical Officers of Health of the various Sanitary Authorities, and, if granted, should be paid through such Sanitary Authorities. An application for a Grant has recently been sent to the Local Government Board by the Council in connection with the Council's official Infant Consultations Centre and Municipal Milk Depot at No. 66 York Road, including the salary and expenses of the Health Visitor, and a grant of £67 7s. has been made by the Board. The Board states that it has no power, under the Maternity and Child Welfare Regulations, to make grants in respect of the provision of milk or other food, so that all the Milk Depot expenditure has been excluded, and the grant has been based entirely upon the work connected with the Infant Consultations Centre at 66 York Road and the visiting at the homes of the mothers and infants by the Health Visitor. DEATHS, 1916. The total number of deaths registered is 5,515. The deaths of all members of the armed forces of this or other countries are excluded and not only the deaths of those dying in Institutions as indicated in various tables throughout the body of the Report and in the special tables I. and 111. of the Local Government Board (vide Appendix. All death rates for 1916 are calculated upon civil populations (estimates). 1. —General Death-Rates. The uncorrected death-rate for Lambeth is 19.4 per 1,000 inhabitants. These rates are, however, uncorrected, and on analysing the 5,515 total deaths registered, it is found that 1,929 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 626 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a corrected number of deaths of 4,212, and a corrected death-rate of 14.8 per 1,000 inhabitants. Whether the corrected or uncorrected death-rates for the Borough (as a whole) be taken, they are again satisfactory for the year 1916 (the sixteenth year of the existence of the Borough). Subdividing the death-rates according to Registration Sub-Districts, it is again shown that the Inner Sub-Districts (Lambeth Church' Kennington, and inner part of Stockwell) have collectively suffered more than the Outer Sub-Districts, e.g., outer part of Stockwell, Brixton and Norwood. So, too, if the death rates be sub-divided amongst the Wards it will be noted also that the Inner Wards, e.g., Marsh, Bishop's, Prince's and Vauxhall, have collectively suffered more than the Outer Wards, e.g., Stockwell, Brixton, Heme Hill, Tulse Hill and Norwood (vide Tables D (1) and D (2)). The reason for this difference is again to be noted in the fact that the Inner Districts are more congested than the outer. 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 subject. The figures* (corrected) for 1916 are (a) Inner Districts—l6.4 per 1,000 population. (b) Outer Districts—l3.7 per 1,000 population.. (c) Whole Borough—l4.8 per 1,000 population. Age Periods of Corrected Deaths. The 4,212 corrected deaths during 1916 may be further analysed, and tabulated as follows :— 565, i.e., 13'4 per cent, of the total corrected deaths took place under 1 year of age. 289, i.e., 6.9 per cent, between 1 and 5 years. 854, i.e., 20'3 per cent, under 5 years. 223, i.e., 5'3 per cent, between 5 and 20 years. 450, i.e., 107 per cent. 20 to 40 years. 912, i.e., 216 per cent. 40 to 60 years. 1,773, i.e., 421 per cent. 60 and over. 3,358, i.e., 797 per cent, over 5 years. Changes in Registration of Deaths. The Registrar-General decided to publish from January Ist, 1911, in his annual reports, an analysis of deaths according to administrative areas instead of registration areas as hitherto, and this decision necessitates a complete distribution of the deaths of persons dying away from their homes to the administrative areas in which they had previously resided. Reports were received quarterly during 1916 from the Registrar-General—a total of 67 deaths—on slips, giving particulars of outside deaths assigned to the Borough, in addition to those reported in the usual way as having occurred in Metropolitan Institutions, which are situated outside the Borough. The table for the year 1916 (and the previous 5 years) at the end of the Report (Appendix), known as the Local Government Board Table I, shews these corrected statistics of deaths within the Borough (differing slightly, in consequence, from the statistics in the body of the Report), the extra additional figures for the year 1916 being as follows :— Males. Females. Totals. Age Periods. 0 — 1 2 - 2 1 — 2 1 - 1 2 — 5 2 - 2 5—15 3 1 4 15—25 1 2 3 25-45 13 7 20 45—65 13 5 18 10 17 65 and upwards 7 Total all ages 45 22 67 TABLE D (1). Shewing the corrected number of Deaths, with corrected Death- rates (general, zymotic and diarrhceal), in each of the Registration Sub-Districts of the Borough during 1916. The deaths are from all causes, and from the 7 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) amongst the Districts from which they have been removed into such Public Institutions for treatment. A. Registration Sub-Districts. REGISTRATION SUB-DISTRICTS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Total Deaths (corrected) from Zymotic Death-rate per 1000 of the Population (corrected). Diarrhæa Death-rate per 10000 of the Population (corrected). Total Zymotic Deaths. Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Cholera. Typhus. Typhoid or Enteric. Continued Fever. Diarrhæa. Lambeth Church 681 - 11 - 12 - - - - 25 58 1.3 5.7 15.5 10 859 18.9 - 16 4 11 - - - - 28 66 14 6.2 Kennington 7 10 10 - - - - 23 54 0.9 39 Stockwell* 889 - 10 10 14.9 1038 14.0 - 11 1 Brixton 11 - - - - 18 50 0.7 9 2.4 Norwood 745 12.2 - 1 1 5 1 - 1 - 11 20 0.3 1.8 - 4212 14.8 - 49 7 45 - 1 - - 105 248 0.9 3.7 Borough of Lambeth 41 *Of the 889 deaths in Stockwell Registration Sab-District, 405 belong to the Inner and 484 to the Outer Stockwell Sub-District respectively. Inner Registration Sub-Districts—death rates (general, 16.4, zymotic, 1.4, diarrhoeal, 0.6, per 1,000 population). Outer Registration Sub-Districts—death rates (general, 13.7, zymotic, 0.5, diarrhoeal, 0.2, per 1,000 population). N.B.—Of the total deaths (corrected), 64 shew no addresses, and have been included in Kennington Sub-District—having occurred in the Workhouse Infirmary (39),and in the Workhouse (25) respectively. TABLE D (2). Shewing the corrected number of Deaths, with corrected of the Borough during 1916. The deaths are from all causes, Lambethians who die outside the Borough, by omitting strangers die in Public Institutions) amongst the Districts from which they Death-rates (general, zymotic and diarrhœal), in each of the Wards and from the 7 chief zymotic diseases, and are corrected by adding who die within the Borough, and by re-distributing persons (who have been removed into such Public Institutions for treatment. B. Wards. B. Wards. WARDS. Total Death (corrected) General corrected Deathrate per 1000 of the Population. Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population (corrected). Diarrhæa Death-rate per 10,000 of the Population (corrected). Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria and Membranous Croup. Typhus. Diarrhæa. Typhoid or Enteric. Continued Fever. Cholera. Marsh 179 8.9 - - - 4 - - - - 8 15 0.7 4.0 3 502 16.9 - 11 - Bishop's 10 - - - - 15 43 1.4 5.1 7 859 21.6 - 16 Prince's 4 10 - - - 30 66 7.5 - 6 1.7 405 - 12 - Vauxhall 13.9 3 - - - - 15 37 1.3 7 5.2 Stockwell 484 - - 15.9 1 2 5 - - - - 9 17 0.5 2.9 Brixton 598 14.1 - 6 - 7 7 - - - - 13 33 0.8 3.1 440 13.9 - 4 1 Herne Hill 4 5 - - - - 3 17 0.5 0.9 301 10.1 - - - Tulse Hill 1 - 1 - - 5 11 0.4 1.7 4 - - - - - 7 9 0.3 2.2 Norwood 444 14.3 - - 1 1 45 - 1 - - 105 248 0.9 3.7 Borough of Lambeth 4212 14.8 - 49 7 41 1-4; diarrhœal, 0-6). Outer Wards—death rates per 1,000 population, have been included in Bishop's and Prince's Wards, having (25) respectively. Inner Wards —death rates per 1,000 population (general, 16-4 ; zymotic, 13-7 (general, 13-7; zymotic, 0-5; diarrhœal, 0-2). N.B. —Of the total deaths (corrected), 64 show no addresses, and occurred in the Workhouse Infirmary (39), and in the Workhouse Causes of the 67 Outside Deaths Causes of Death. Male. Female. Whooping Cough 2 - Diphtheria 2 - Influenza 1 - Phthisis (Pulmonary Tuberculosis) 10 4 Other Tubercular diseases 1 1 Cancer, malignant disease 2 4 Heart disease 5 4 Bronchitis 1 1 Pneumonia 3 1 Broncho-Pneumonia - - Other Lung diseases - - Nephritis and Bright's disease 3 2 Diabetes mellitus 1 - Violent deaths 2 - Suicide 1 - Appendicitis 1 - Nervous diseases 4 1 Strangulated Hernia - - Diseases of Digestive System 2 - Syphilis - - Wound (gun shot, shrapnel or bomb) - - Not classified above 5 3 22 45 2.—lnfantile Mortality Rates. Of the 4,212 corrected deaths, 565 are infants under one year of age. The total number of registered births is 7,980, and, of these, 581 occurred at the Lying-in Hospital, and belong to districts outside the Borough, 53 occurred at the Workhouse and belong to districts outside the Borough, and 685 occurred at the Maternity Hospital and belong to districts outside the Borough. In this way, the corrected number of births (i.e., excluding all non-Lambeth and Institutional births) for the Borough is 6,661*. The corrected infantile mortality (i.e., rate of corrected deaths under one year per 1,000 corrected births) is, therefore, 84 -8, the annual average for the decennium 1901-10 (Borough) being 122-7. In calculating this corrected infantile mortality it must be remembered that, whilst the births, that belong to outside districts, are subtracted, the births of infants of Lambethian mothers who may happen to be residing outside the Borough at the times of such births are not *The Registrar-General returns the corrected number of births for the Borough during 1916 as 6435. added. Taking the uncorrected births and the corrected deaths under 1 year, the infantile mortality rate is 70.8, the annual average for the decennium 1901-10 (Borough), being 114'8. Taking the uncorrected number of births (7980), and the uncorrected number of deaths under 1 year of age (777), the uncorrected infantile mortality is 97.4. the annual average for the decennium 1901-10 (Borough) being 123.8, and that for the decennium 1891-1900 (Parish) 150.5. The chief causes of these deaths under 1 year are debility, atrophy, and inanition, congenital malformations, measles, whooping-cough, syphilis, bronchitis and other diseases of the respiratory organs, diarrhoea, and prematurity. In the Registration Sub-Districts, the uncorrected infantile mortality varied from 154'8 per 1,000 births in Kennington to 54'2 in Stockwell (the low rates of 88.6 in Lambeth Church, 154.8 in Kennington, and 54.2 in Stockwell, being due to the fact that these Sub-Districts contain the General Lying-in Hospital, the Workhouse and the Maternity Hospital respectively), thus — Total No. of Births (uncorrected) 1916. Total Deaths under 1 year (uncorrected). 1916. Infantile Mortality per 1000 births (uncorrected). 1916. Lambeth Church* 2235 88.6* 198 Kenningtont 1072 166 154.8† Stockwell‡ 2138 116 54.2‡ Brixton 1498 195 130.2 1037 Norwood 102 98.4 Lambeth 777 97.4 7980 § Inner Districts —96.4, Outer Districts —98.5. 3. —Zymotic Death-Rates. The zymotic death rate is made up of the total deaths from the seven principal zymotic diseases, viz., smallpox, measles, scarlet fever, diphtheria (including membranous croup) whooping cough, " fever " (including typhus, typhoid or enteric and simple continued or ill-defined) and diarrhoea. The total number of deaths registered from these diseases is 342 —126 strangers belonging to other districts and 210 parishioners who died within the Borough ; whilst, in addition, 32 parishioners 'Excluding all the Lying-in Hospital births, the rate is 137.2 †Excluding all the Workhouse births, the rate is 185.5. †Excluding all the. Workhouse births,the rate is 118.5. all the Maternity Hospital births, the rate is 93.7. §N.B. —The births and deaths in Stockwell Registration Sub-Districts are divided equally between the Inner and Outer Districts for the purpose of calculating infantile mortality rates for such Districts in this Table. died from these diseases outside the Borough. Subtracting the strangers and adding the parishioners who died outside the Borough, there is a corrected total of 248, giving a zymotic death-rate (corrected) of 0.9 per 1,000 inhabitants. As in the case of the general death-rates, the zymotic death-rates vary in the inner and outer, districts, viz., 1-4 as compared with 0.5 per 1,000 population respectively (vide Tables D. (1) and D (2)). The different rates of mortality from different diseases and groups of diseases during 1915 and 1916 are given in terms of the total deaths (corrected and uncorrected) in Tables F and G, whilst Table F gives also the deaths from the chief infantile diseases, expressed in terms of the infantile population (i.e., corrected number of births registered). The tuberculosis corrected death-rate for 1916 is 1 .7, i.e., 488 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis) death-rate, 1 .4, i.e., 387 deaths from pulmonary tuberculosis or consumption (phthisis) per 1,000 population. The details of the tuberculosis deaths in the various Registration Sub-Districts are :— Corrected Deaths from Registration Sub-Districts. Pul. Tub. or Phthisis (consumpt'n) Total Deaths Tuberculosis (all forms) Other Forms Tuberculosis. Phthisis-rate per 1,000 population. Tuberculosis rate per 1,000 population. Lambeth Church 75 20 95 1.7 2.2 Kennington 80 21 101 1.8 2.2 Stockwell 78 20 98 1.6 1.3 Brixton 91 27 118 1.2 1.6 Norwood 63 13 76 1.0 1.2 387 101 *1.4 Borough of Lambeth 488 †1.7 Rates for Inner Districts ... 1 . 6* and 2 .1 †. Rates for Outer Districts ... 1 . 2* and 1.5† During the five quinquennia 1891-1895 (Parish), 1896-1900 (Parish), 1901-1905 (Borough), 1906-1910 (Borough), and 1911-1915 (Borough), the yearly averages of total deaths from (a) pulmonary tuberculosis or consumption (phthisis), and (b) tuberculosis (all forms) were (a) 478.8, 496.8, 462.8, 421.6 and 386.8, and (b) 675.0, 690.0, 647.4, 567.4 and 500.0 respectively, representing a steady decline in the tuberculosis death-rates during the last 20 years. *† In calculating the death rates for the Registration Sub-Districts (Inner and Outer), the deaths registered in Stockwell Sub-District are divided equally between Inner and Outer Stockwell, as has been done in previous Reports. Scarlet Fever 8 9 14 16 17 7 31.4 48.8 Diphtheria 42 29 36 50 45 41 41.6 124.5 Croup 1 - 1 - - - 1.5 6.8 Fever Typhus - - - - - - 0.0 0.3 Typhoid or Enteric 12 13 7 15 9 1 16.7 34.7 Continued and Relapsing - 1 - - - - 0.7 1.7 Diarrhæa 323 82 166 196 124 105 172.9 196.5 Cholera 2 1 - - - - 1.3 8.8 Measles 113 97 98 58 91 49 110.4 145.6 Whooping Cough 68 55 47 40 49 45 91.8 143.7 569 287 369 375 335 248 475.1 706 .1 Borough of Lambeth TABLE F. Shewing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1915 and 1916. A. —Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease. Borough 1915. Borough 1916. No. of Deaths (corrected). Percentage of Total Deaths (corrected) . No. of Deaths (corrected). Percentage of Total Deaths (corrected). 1.—Zymotic Diseases 510 10.9 379 8.9 Seven Principal 335 7.2 248 5.9 Influenza 85 1.8 56 1.3 II. —Parasitic 1 0.02 1 0.02 III.—Dietetic 21 0.5 12 0.3 IV. —Constitutional 968 20.8 946 22.4 Cancer 360 7.8 370 8.8 Phthisis 413 8.9 387 9.2 Tubercular Diseases,excluding Phthisis 2.3 101 2.4 105 Rheumatism (Acute and Chronic) and Gout 24 0.5 22 0.5 V. —Developmental 376 8.1 353 8.4 Old Age 208 4.5 210 4.9 VI. —Local Diseases 2496 53.6 2264 53.7 Circulatory System 635 13.6 605 14.4 Bronchitis 531 11.4 376 8.9 Pneumonia and Broncho-Pneumonia 330 7.1 244 5.8 Pleurisy and Pleuropneumonia 2.4 94 2.2 113 Respiratory System.excluding Phthisis 1036 22.3 766 18.2 VII.— Violence 181 3.9 173 4.1 19 0.4 0.6 Suicide 24 101 2.2 1.9 VIII.—Other Causes 83 Diarrhæa 87 13.3 83 12.9 Convulsions 11 25 3.9 1.7 Respiratory Diseases 154 92 14.3 23.5 Premature Births 108 16.5 106 16. 5 Tubercular Diseases (including Phthisis) 21 3.2 11 1.7 Measles 19 2.9 6 0.9 Whooping Cough 25 3.8 21 3.3 Suffocation in Bed 11 1.7 4 0.6 Enteritis 11 1.7 11 1.7 8 12 1.9 Dentition 1.2 *N.B.—The above rates have been calculated upon the Registrar-General's corrected numbers of births. TABLE G. Shewing Classification of Certain Causes of Deaths (uncorrected) in the Borough of Lambeth during 1915 and 1916, given in percentages of the total uncorrected deaths. A. —Deaths at all Ages. Percentage of total Deaths (uncorrected). 1915. 1916. Causes of Deaths. 8.4 6.2 I. Principal Zymotics 1.6 0.9 Influenza Measles 1.9 1.2 Whooping Cough 1.0 0.9 3.2 2.4 Diarrhæa and Dysentery (including Cholera) II. Rheumatic Fever and Heart Rheumatism 0.3 0.3 11. 9 11.0 III. Diseases of Circulatory System 19.2 14.4 IV. Bronchitis, Pneumonia and Pleurisy Phthisis 7.9 9.4 6.2 10.0 V. Injuries B—Deaths under 1 Year of Age {per 1000 Births uncorrected). All Causes 108.0 97.4 INFECTIOUS DISEASES. 1. —Notifiable Diseases. Under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 6,567 cases of infectious diseases (excluding tuberculosis) were reported, including the newly notifiable cerebro-spinal fever, 38 ; polio-myelitis acuta, 12 ; ophthalmia neonatorum, 83 ; whooping cough, 1,576 ; measles, 2,548, and German measles, 1,212. These 6,567 cases occurred in 5,453 infected houses, and of the 6,567 cases 1,324, i.e., 20.2 per cent., were removed to hospital, and 5,243 i.e., 79.8 per cent., remained under treatment at their homes. If the newly notifiable diseases be excluded so as to make the 1916 figures strictly comparable with those for previous years, the percentage of cases removed to hospital during 1916 was 86-9, as compared with 82.8, 82.8, 67.9, 54.7 and 31 .5 for the five quinquennia 1911-15, 1906-10, 1901-5, 1896-1900 and 1891-5, respectively, i.e., since the compulsory notification of infectious diseases came into force under the Public Health (London) Act, 1891. Cerebro-spinal Fever (epidemic Cerebro-spinal Meningitis) or " Spotted " Fever and Acute Poliomyelitis (Acute Polioencephalitis). Particulars as to the cases of cerebro-spinal fever (epidemic cerebro-spinal meningitis) or " spotted " fever, and of acute poliomyelitis (acute polio-encephalitis) are set out in the Local Government Board's new Table V. (vide Appendix). Smallpox, Cholera, Plague, Typhus, Simple continued or ill-defined-Fever, Human Glanders, Anthrax, and Hydrophobia. No genuine cases of smallpox*, cholera, plague, typhus, simple continued † or ill-defined fever, human glanders, anthrax or hydrophobia were notified, and no deaths were registered as having occurred from such diseases. Whooping Cough. Whooping cough became compulsorily notifiable throughout the Borough on January Ist, 1913, by order made by the Borough Council on October sth, 1912, and approved by the Local Government Board on October 31st, 1912. The disease is compulsorily notifiable by both medical men and parents (or relatives) for a trial period of five years. * One doubtful smallpox case (soldier) proved to be chickenpox, and one doubtful continued fever case (child) proved to be influenza. The notifications received from medical practitioners have been as follow : 1913, 1,428 ; 1914, 1,389 ; 1915, 1,607 ; and 1916, 1,576. No whooping cough cases have been notified under the Order by private persons (not medical practitioners), but, through the medium of schools, in connection with absentees, the following numbers of cases have been voluntarily reported :—1913, 612 ; 1914, 581 ; 1915, 507 ; and 1916, 445. The 1,576 notifications received from medical practitioners during 1916 referred to 1,149 infected houses, and of these 1,576 cases 95 were removed to hospital, 45 deaths were registered from whooping cough during 1916, giving a case-mortality of 2-9 per 100. Every case of whooping cough notified is officially visited, and such precautionary measures are taken in connection therewith as may be required. Measles and German Measles. On January Ist, 1916, measles and German measles became compulsorily notifiable under the Public Health (Measles and German Measles) Order, 1915, and during the year (up to December 31st, 1916) a total of 3,760 notifications were received from medical practitioners—2,548 measles (including 27 military cases) and 1,212 German measles (including 20 military cases). The diseases are, under the Order, notifiable also by parents (or relatives), and 78 measles cases were in this way notified. In addition 594 cases of measles were reported voluntarily through schools, in connection with absentees, during 1916, as compared with the following numbers during the previous three years : 1913, 1,085 ; 1914, 1,531 ; and 1915, 1,880. The 2,548 and 1,212 notifications of measles and German measles received from medical practitioners during 1916 referred to 2,202 and 1,020 infected houses respectively, and of the 2,548 measles cases, 235 were removed to hospital ; 49 deaths were registered from measles during 1916, giving a case-mortality of 1 - 9 per 100. 64 schools (infants' departments) were dealt with during the year, representing 66 different class-rooms or grades, and a total of 818 children excluded for periods varying from a few days to a few weeks on account of outbreaks of measles in connection therewith (a total of 107 cases). 9 schools (78 class-rooms) were disinfected on account of measles. The epidemic has been general throughout the Borough. Every case of measles or German measles notified is officially visited, and such precautionary measures are taken in connection therewith as may be required, including the systematic exclusion of non-protected children (i.e., children who have not previously had the disease), and all children under 5 years of age from schools, or, if necessary and desirable, the closing of an individual class-room or class-rooms. There is no interference by the Council's officers with treatment, but in every case where a medical man is not already in attendance the parents, or other persons responsible, are urged to call in a medical practitioner, though this advice is not always taken, especially when the parents are poor. Measles and German measles require, as a rule, but simple medical treatment, but nursing is important, so as to prevent, as far as possible, any of the after-consequences arising, e.g., inflammation of the lungs, bronchitis, etc., and the Local Government Board have, in consequence, suggested the advisability of Health Visitors or nurses being appointed by Sanitary Authorities for that purpose. So important is nursing, in the opinion of the Board, that the Board has decided—a decision which may not be approved by all, to allow Health Visitors or nurses who are carrying out Maternity and Child Welfare work, to be used also for the purpose of visiting measles and German measles patients, provided, of course, proper precautionary measures are taken to prevent the infection being carried. Nursing is especially important for the poorer inhabitants of the Borough in houses in which there are children under 5 years of age, so as to prevent as far as possible the extension of the diseases to others and the development of their after-consequences, which are so aften dangerous and actually fatal to life. To secure suitable nursing throughout the Borough arrangements will have to be made by the Council for the employment of Health Visitors or nurses permanently attached to the Public Health Department, or to make temporary arrangements as required with some of the well-known nursing organisations. Typhoid Fever. During 1916 the incidence of typhoid or enteric fever in the Borough was small. 19 cases notified and 1 death registered ; 6 of the cases were traced definitely to sources outside the Borough (5 abroad and 1 at Sheerness), 3 proved not be suffering from the disease, and 5 were secondary, i.e., derived from previous cases unnotified and unrecognised). No case could be traced definitely and conclusively to infected ice creams, water, milk, fried or shell fish, or watercress, though in 2 instances there was a history of oysters having been consumed by the patients two or three weeks prior to their attacks. Tuberculosis. Details of the work carried out during 1916 at the two Dispensaries* connected with the Lambeth Municipal Tuberculosis Dispensaries Scheme are to be found in the Appendix in the form of fables I. to V., prepared by the Tuberculosis Officers at the Branch Dispensary (St. Thomas's Hospital), and the Central Dispensary (73, Effra Road), respectively, dealing with the clinical work, together with an Addendum by the Medical Officer of Health, who is the Chief Executive Tuberculosis Officer under the Scheme, dealing with the administrative work. The distribution of Tuberculosis as a disease throughout the Borough during 1916, can be gauged from the official notifications that have been received under the Public Health (Tuberculosis) Regulations, 1912, which came into force on Ist February, 1913, making all cases of tuberculosis (both pulmonary and other forms) compulsorily notifiable. The notifications received during 1916 are set out in Table H, specially prepared for the Local Government Board, and in the extra Tables H 1 and H 2, dealing with (a) Wards and (b) Registration Sub-Districts respectively. In each case notified, from whatever source, a visit is paid, unless the medical man is of opinion that such an official visit is undesirable, leaflets are distributed, instructions are given as to simple precautionary measures to be taken, and disfection is carried out as required, but with due regard to privacy, special instructions being given to the officers to avoid doing anything likely to cause pain or annoyance to the patients or their friends as the result of the official action taken on notification. Taking all the primary notifications of (a) tuberculosis (all forms) and (b) pulmonary tuberculosis (consumption or phthisis) received during 1916—totals of 1,298 and 904 respectively, the incidences upon the Inner and the Outer Districts (Registration Sub-Districts and Wards), are as follows (stated per 1,000 population) :— (a) Tuberculosis (all forms). 1. Wards— Inner—4.8, viz. : Marsh, 5.1 ; Bishop's, 5.6 ; Prince's 4.5 ; Vauxhall, 4.3. Outer—4.2, viz. : Stockwell, 5.2 ; Brixton, 4.3 ; Heme Hill, 3.9 ; Tulse Hill, 3.6 ; Norwood, 3.8. * Dr. A. D. Serrell Cooke was appointed by the Council on February 17th, 1916, as temporary part-time Assistant Tuberculosis Officer at the Central Dispensary, being attached to the Medical Officer of Health's Department, and commenced his duties on July Ist, 1916, Dr. Eleanor Gorrie having carried out the duties from November Ist, 1915, to June 30th, 1916, temporarily. 2. Registration Sub-Districts — Inner—4.8, viz. : Lambeth Church, 5.8; Kennington, 4.2 ; Inner Stockwell, 4.3. Outers.2, viz. : Outer Stockwell, 5.2; Brixton, 4.2 ; Norwood, 3.7. Borough of Lambeth =4.5. (b) Tuberculosis (Pulmonary). 1. Wards— Inner—3.s, viz. : Marsh, 4.0 ; Bishop's, 4.2 ; Prince's, 3.3 ; Vauxhall, 2.9. Outer—2.9, viz. : Stockwell, 3.6 ; Brixton, 3.3 ; Heme Hill, 2.6 ; Tulse Hill, 2.5 ; Norwood, 25. 2. Registration Sub-Districts — Inner—3.s, viz. : Lambeth Church, 4.4 ; Kennington, 3.1 ; Inner Stockwell, 2.9. Outer—2.9, viz.: Outer Stockwell, 3.6 ; Brixton, 3.0 ; Norwood, 2.5. Borough of Lambeth =3.2. METROPOLITAN BOROUGH OF LAMBETH. TABLE H. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications received during the period from Ist January, 1916, to the end of the week ending the 30th December, 1916. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Number of Notifications on Form A. Primary Notifications. (Medical.) *Total Notifications(i.e., including cases pre- viously notified by other Doctors). (Medical.) Primary Notifications (Medical.) †Total Notifications (i.e., including cases previously notified by other Doctors). (Medical.) Cases admitted to Poor Law Institutions. Sanatoria. (Medical.) Cases discharged from Poor Law Institutions. Sanatoria. (Medical.) Age-Periods. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 20 to 25. upwards. Total. 15 to 20. 25 to 35. 35 to 45. 45 to 55. 55 to 65 Under 5. 5 to 10. 10 to 15. Total. 125 - 40 Pulmonary— 3 1 4 4 125 13 1 3 12 9 31 33 154 117 40 15 500 629 Males 85 19 103 . 4 - 6 17 19 33 50 103 85 49 26 394 484 2 3 6 6 Females 6 1 79 1 10 Non-Pulmonary— 5 7 9 19 3 Males 36 28 14 5 7 12 3 4 179 191 4 65 1 1 12 Females 5 23 45 29 17 13 17 6 6 6 168 5 3 8 10 9 15 4 1 188 11 - * Re-notifications (Form A)=2l9 (males 129, females 90), pulmonary and 32 (males 12, females 20) non-pulmonary. † Re-notifications (Form B) = 4 (male 2), (female 2), non-pulmonary. N.B. —Pulmonary—353 private, 288 hospitals, 247 dispensaries, 6 Poor Law Officers and 10 schools=9o4 total primary notifications (Forms A and B). Non-Pulmonary—69 private, 111 hospitals, 167 dispensaries, 0 Poor Law Officers and 15 schools=362 total primary notifications (Forms A and B). , Marsh 78 90 2 2 3 7 2 5 20 20 2 2 - 4 1 3 Bishop's 124 145 - - 14 29 3 20 39 46 4 6 26 4 5 2 Prince's 129 158 2 2 6 21 - 24 48 56 1 1 - 7 1 3 Vauxhall 83 108 1 1 4 24 1 32 39 40 1 1 - 3 - 2 Total Inner Wards 414 501 5 5 27 81 6 81 146 162 8 26 18 7 10 10 Stockwell 110 157 - - 8 38 - 31 49 56 - - - 1 - 3 Brixton 137 176 2 2 8 35 3 29 42 46 1 1 - 3 - 4 Herne Hill 84 99 - - 6 28 1 24 39 43 3 5 - 1 - 3 Tulse Hill 74 88 1 1 5 25 1 20 32 32 - - - - - 1 Norwood 75 92 2 2 5 21 6 19 39 40 3 3 2 2 - 2 Total Outer Wards 480 612 5 5 32 147 11 123 201 217 7 9 2 7 - 13 23 Borough of Lambeth 894 1,113 10 10 59 228 17 204 347 379 15 19 28 25 7 Waterloo 78 90 2 2 3 7 2 20 20 2 2 - 4 1 3 5 26 4 5 2 Lambeth Church 112 133 - - 14 29 3 20 39 46 4 6 Kennington 141 170 2 2 6 21 - 24 48 56 1 1 - 7 1 3 Stockwell (Inner) 83 108 1 1 4 24 1 32 39 40 1 1 - 3 - 2 Total Inner Districts 414 501 5 5 27 81 6 81 146 162 8 10 26 18 7 10 Stockwell (Outer) 110 157 - - 8 38 - 31 49 56 - - - 1 - 3 Brixton 221 275 2 2 14 63 4 53 81 89 4 6 2 4 - 7 Norwood 149 180 3 3 10 46 7 39 71 72 3 3 2 2 - 3 480 612 5 5 32 147 11 123 201 217 7 9 2 7 - Total Outer Districts 13 59 228 17 204 347 379 15 19 28 25 7 23 Borough of Lambeth 894 1,113 10 10 B2 Diphtheria and Membranous Croup. 30 vials of antitoxin were distributed under the Antitoxin Order, 1910, free of cost to medical practitioners practising within the Borough. No school was closed for diphtheria. 4 cases of membranous croup were notified (no deaths). Puerperal Fever and Ophthalmia Neonatorum. The numbers of cases notified and deaths registered from these two diseases were, respectively, 20 and 83 (notified cases), and 9 and 0 (registered deaths). Having regard to the total number of births registered, the incidences of these two diseases are small. Both are preventible and caused through neglect or want of care on the part of those in charge of the mother during the puerperium and of the infant during the first few days or weeks of life. Erysipelas. 122 cases were notified and 3 deaths registered from erysipelas, a septic disease. The majority of the cases notified were of a mild type, and not such as were anticipated by the framers of the Notification Acts. Scarlet Fever. 501 cases were notified and 6 deaths registered from scarlet fever. No school outbreak of scarlet fever occurred, necessitating closure of classrooms. 2.—Non-Notifiable Diseases. Chickenpox. 492 cases of chickenpox were notified voluntarily. Diarrhœa There has been a marked decrease in the number of corrected deaths from diarrh œa 105 as comparedwith yearly averages of 191.6 219-4, 208.6 140.2 and178.2during the five quinquennia 1891-1895, 1896-1900, 1901-1905, 1906-1910 and 1911- 1915, respectively. Of the 105 deaths registered during 1916, 98, i.e., 93.3per cent., occurred amongst children under 5 years of age 83, i.e., 79.0,amongst infants under 1 year of age. The 4 ft. earth thermometer first registered 56° F. on June 29th, rising to a maximum of 62° F. on August 10th, and remaining at such maximum until August 19th, and sinking to 56° F. again on October 22nd. The readings of the 4 ft. earth thermometer were taken in Regent's Park, and the information was obtained through the courtesy of the the Secretary of theRoyal Botanical Society. 19 corrected deaths (11 infants under 1 year of age) were registered from enteritis. Practical measures were again taken to prevent epidemic diarrhoea (and other diseases) in infants and to promote hygienic conditions in their feeding and environment, as follows :— (a) Visiting of houses wherein births were notified under the Notification of Births Act, 1907, or wherein deaths were registered as having occurred from epidemic diarrhoea ; (b) Teaching of proper feeding and care and management of infants by the Council's officers at the Infants' Consultations held at 66, York Road ; (c) Issuing of special leaflets or posters during the summer, dealing with (1) precautions to be taken against summer diarrhoea, (2) the danger of the areas of infection and the contamination of food by flies, (3) the importance of removing at once all accumulations of refuse and other offensive matters from the neighbourhood of dwellings, (4) the value of cleanliness generally, &c. Epidemic Influenza. 56 corrected deaths were registered from epidemic influenza —22 in the first quarter, 6in the second, 2in the third, and 26 in the fourth, the annual averages for the two decennia 1891- 1900 (Parish) and 1901-1910 (Borough) being 107-5 and 53-2, respectively. 3. —" Contacts " or " Suspects " and " Convalescents " (Military). Many " contacts " or " suspects " and " convalescents " (military) were watched in connection with different diseases as follow :— (a) Smallpox. 18* " contacts " or " suspects," who arrived from abroad (Rangoon, Malta, Bombay and South Africa) per S.S. "Burma," "Kaisar- I-Hind," " Caledonia," and " Glengorm Castle," and per A.S. " Dover Castle," respectively ; and 10 connected with the War Belgian Refugees Camp at Earl's Court, where a case of smallpox (charwoman) had occurred. (b) Cerebrospinal or " Spotted" Fever (Epidemic Cerebrospinal Meningitis). 5 " contacts " or "suspects" who arrived from outside districts (military camps). (c) Diphtheria. 1 " contact " or " suspect " who arrived from an outside district (camp). (d) Enteric or Typhoid Fever. 28 " convalescents," who arrived on furlough for varying periods from outside districts (military hospitals). (e) Paratyphoid Fever A and B. 7 " convalescents," who arrived on furlough for varying periods from outside districts (military hospitals). (f) Dysentery. 18 " convalescents," who arrived on furlough for varying periods from outside districts (military hospitals). * 1 contact could not be traced. Cholera - - - - - - Smallpox - - - - - - Scarlet Fever 501 7 1.4 486 414 90.5 Diphtheria 432 41 9.5 398 379 92.1 Membranous Croup 4 - 0.0 3 4 75.0 (Typhus - - - - - - Typhoid or Enteric 19 1 5.3 18 17 94.7 Continued and Relapsing Fever - - - - - - Erysipelas 122 3 2.5 41 118 33.6 Puerperal Fever 20 9 45.0 8 20 40.0 *Plague - - - - - - 18 4.7 35 *Cerebro-Spinal Fever 38 35 92.1 - *Poliomyelitis acuta 12 0.0 5 12 41.7 *Ophthalmia Neonatorum 83 - 0.0 - 83 0.0 * Whooping Cough 45 2.9 1.576 95 1,149 60 *Measles 2,548 136 49 1.9 2,202 5.3 *German Measles 1,212 0.0 105 1.020 - 8.7 * Tuberculosis — Pulmonary (primary) 387 904 - 42.8 904 - Non-pulmonary (primary) 362 101 27.9 - 362 - *Chickenpox - - - - - - Totals 8.4 7,833 661 1,324 6,719 16.9 Smallpox - - - - - - 49.9 22.0 Scarlet Fever 604 1,745 900 501 1331.3 761 1,370 1105.1 Diphtheria 398 328 385 550 434 432 379.8 715.1 Membranous Croup 4 5 7 6 4 4 10.4 26.2 Typhus - - - - - - 0.1 1.1 Typhoid or Enteric 60 61 38 48 32 19 189.6 100.5 Continued and Relapsing - 1 2 2 - - 4.1 25.7 Erysipelas 241 216 206 231 177 122 241.4 347.0 Puerperal 21 24 25 23 26 20 17.0 18.9 *Plague - - - - - - - - *Cerebro-spinal Fever 9 7 7 5 44 38 11.5 - 9 6 10 4 12 - *Poliomyelitis acuta 10 - *Ophthalmia Neonatorum 69 76 57 57 73 83 - - 1,576 - *Whooping Cough - - 1,428 1,389 1,607 - *Measles - - - - - 2,548 - - *German Measles - - - - - 1,212 - - *Tuberculosis — .... r\r\ * \ Pulmonary (primary) 1,057 1,822 1,571 1,250 1,020 904 - - Non-pulmonarv (primary) - - 456 273 298 362 - - 238 473 - - *Chickenpox - - - - 2,868 3,154 5,558 5,589 5,092 7,833 1912.5 2658.4 Totals 43 N.B.— Of the patients removed to Hospital, the following were reported not to be suffering from the diseases notified : — Scarlet fever 61 ; diphtheria 22 ; typhoid or enteric 3 ; cerebrospinal fever 2 ; Measles 9 and Whooping Cough 2. *Plague was mad* compulsorily notifiable on September 19th, 1900, Cerebri) Spinal Fever (" Spotted Fever") on March 12th, 1907 Poliomyelitis acuta on September Ist, 1911; Ophthalmia Neonatorum on March 13th, 1911, Pulmonary Tuberculosis (Poor Law cases) on Jan. Ist, 1909, Pulmonary Tuberculosis (Hospital cases) on May Ist 1911. Pulmonary Tuberculosis (Private cases) on Jan. let, 1912, and Tuberculosis (Pulmonary ami Non-pulmonary) on February Ist, 1913, Whooping Cough on January Ist, 1913, and Measles and German Messles on January Ist, 1916, whilst Chicken-pox was compulsorily notifiable as follows -.— 1902 (February 7th to December 31st), 1903 (January Ist to 6th), 1904 (April Bth to November Bth), 1911 (March 22nd to June 22nd) and 1915 (March 17th to June 30th), the numbers of cases notified being respectively 1560, 40, 556, 238 and 473. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1916 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Mortality from all Causes at subjoined Ages. — — <n Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. (b) At all ages. (c) Under 1 year. (d) 1 and under 2 (e) 2 and under 5. (f) 5 and under 15. (g) 15 and under 25 (h) 25 and under 45. (i) 45 and under 65. (j) 65 and upwards. (k) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. (a) Diphtheria. Fevers. Measles. Whooping Cough. Diarrhæa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. Cerebro-Spinal Fever. Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. Scarlatina. Erysipelas. Influenza. Royal Infirmary (Women and Children) 99 35 20 13 13 2 5 10 1 Under 5 5 upwds. Under 5 5 upwds. - 1 - - - - 1 - - 18 - - - 3 - 35 68 10 - - - - - - - - - 4 2 2 - 1 - 1 21 31 King George Hospital 251 - - - - 127 119 5 - - - - - - - - - - - - - - - - - - - General Lying-in Hospital, York Road 23 18 - - 1 1 3 - - - - - - - - - - - 3 1 2 - 227 - 2 16 251 Under 5 5 upwds. - - - - - - - - - - 1 - - - - - 17 18 - - 3 - - - - - - - - - - - - - 2 5 589 69 30 34 64 71 135 142 44 Under 5 5 upwds. St. Thomas's Hospital ... - 2 - - - 2 1 15 1 - 18 - - 15 5 1 73 133 - 2 3 1 1 - 1 - 2 14 12 38 1 68 5 38 270 456 1 - - - - - 1 - - Under 5 5 upwards Under 5 5 upwds. 5th London General Hospital - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 Remainder of Lambeth Church 347 76 20 12 10 9 43 103 74 - - - - - 6 7 8 - - 24 - - 2 - - 61 108 - - - - - - - 1 1 30 63 46 2 22 1 - 73 239 - - - - - - - - - - - - - - - - 6 6 30 - - - - - 3 21 Under 5 5 upwds. Lambeth Workhouse 6 - - - - - - - - - - 12 9 - - - - 3 24 Lambeth Infirmary 1348 104 32 30 27 51 233 448 423 Under 5 5 upwds. - 2 - - - 11 8 33 - 1 30 - - 2 2 - 77 166 - - 5 - 3 - - - 3 262 129 157 1 42 3 3 574 1182 St. Peter's House 47 - - - - - - 1 46 Under 5 5 upwds. - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8 3 1 - - - 35 47 Remainder of Kennington 325 56 20 11 16 7 36 75 104 Under 5 5 upwds. - - - - - 9 7 - - 24 - - 3 1 - 36 87 7 - - - - - 4 - - 1 25 63 44 4 7 - - 90 238 125 16 40 36 8 2 - Under 5 5 upwds. South-Western Hospital 14 9 36 - - - 11 10 - - - 1 - - - 4 - 1 7 70 6 21 2 8 - - - - - 1 5 - - - 5 - 7 55 23 20 - - - 1 2 - - Under 5 5 upwds. - - - - - - - - - - 1 - - - - - 19 20 Clapham Maternity - - - - - - - 1 - - - - - 3 20 - - - 538 82 17 15 8 20 60 143 193 Under 5 5 upwds. - - - - - 5 8 - 1 25 1 - 3 - - 62 114 9 Remainder of Stockwell - - - - - 1 8 9 - 49 84 73 14 11 - - 192 424 TABLE K. [Local Government Board. Old Table A.] Table of DEATHS during the year 1916 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Mortality from all Causes at subjoined Ages. I — Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. (a) Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. 3 5 6 7 8 9 12 13 15 16 At all ages. (c) Under 1 year. (d) 1and under 2 (e) 2 and under 5. (f) 5 and under 15. (g) 15 and under 25. (h) 25 and under 45. (i) 45 and under 65. (j) 65 and upwards. (k) 1 2 4 10 11 14 17 18 Scarlatina. Diphtheria. Fevers. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis! Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cerebro-Spinal Fever. Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. - - - 1 - - 5 - 1 18 - - 5 2 1 57 91 - King's College Hospital 238 54 26 25 11 41 47 Under 5 5 upwds. 11 23 - - 3 - - - - - 2 7 6 14 - 40 - 4 71 147 Belgrave Hospital 95 53 13 17 12 - - - - Under 5 5 upwds. - - - - - - - - 16 - 2 1 - 2 3 - 48 83 11 12 - - - - - - - - - - - 1 - 2 - 1 8 - - - - - - - - - - - - - - - - - - 1st London General Hospital 45 - - - - 16 27 2 - Under 5 5 upwds. - - - - - - - - - 2 - 3 1 29 - - 10 45 - - - - - - - - - - - - - - - - 83 - - - - 24 51 7 1 Under 5 5 upwds. 4th London General Hospital - - - - - - - - - 15 4 3 - 28 1 - 1 31 83 - Remainder of Brixton 670 88 18 19 21 27 82 149 266 Under 5 5 upwds. - - - - - 7 9 5 - 1 29 - 1 3 - - 70 125 - - 3 - - 1 1 1 3 56 106 118 13 28 - - 215 545 63 38 9 9 6 1 - - - Under 5 5 upwds. - - - - - 1 17 - - 3 - - - - - 27 Lambeth Workhouse Schools 8 56 - - - - - - - - - 3 - - - - - - 4 7 British Home of Incurables 18 - - - - - 2 10 Under 5 5 upwds. 6 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - 16 18 - - - - - - 1 6 - - 18 - 1 4 - - 52 82 Remainder of Norwood 557 64 10 8 11 16 49 138 261 Under 5 5 upwds. - - - 1 - - 3 41 81 91 15 9 - - 233 475 - 1 Totals 5515 777 216 234 250 393 897 1281 1467 Under 5 5 upwds. 7 19 10 1 59 54 131 1 6 221 2 2 39 20 2 641 1227 41 6 23 19 10 4 6 2 3 15 512 576 605 53 515 15 50 1874 4288 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 626 50 17 10 19 37 115 171 207 Under 5 5 upwds. 1 3 - - - 3 5 9 - - 11 - - 1 1 - 43 77 - 7 - - - - - 4 2 56 51 113 6 37 1 1 271 549 450 5 - - - 19 15 42 - 4 72 1 - 15 12 2 245 1929 262 82 106 120 269 480 393 217 Under 5 5 upwds. Deaths occurring within the district among persons not belonging thereto 18 2 15 10 9 2 - 1 - 4 183 73 114 5 404 7 35 615 1479 48 49 TABLE L. Table of Civil Population, Total Registered Births and New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health (by notification), during the year 1916, in the Borough of Lambeth, classified according to Diseases and Localities. [Local Government Board Old Table B.] Registration Sub-Districts. (a) (d) Total Registered Births 1916. New Cases of Sickness in each the knowledge of the Medical Locality,coming to during Officer of Health Officer of Health 1916. Population at all Ages. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1916. 1 0 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 10 11 12 13 Census 1911. (b) 9 10 11 12 13 Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Cerebro-spinal Fever. Estimated 1916. [Civil Population.) (c) Polio-myelitis Acuta. Ophthalmia. Whooping Cough. Measles. German Measles. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Whooping Cough. Typhoid or Enteric. Continued & Relapsing. Puerperal. Typhoid or Enteric. Continued & Relapsing. Puerperal. Lambeth Church 112 6 47910 43921 2 - 2 37 376 91 5 - 1 2235 91 2 10 8 - 19 25 11 672 108 8 19 60 61 137 62 4 422 1 1 48609 45406 72 2 - 12 Kennington - 68 19 1072 7 1 304 2 - 2 5 - 25 19 399 201 59 7 - 16 62608 - 59469 90 4 18 Stockwell 1 - - 2138 1 4 4 224 376 88 1 1 7 - 18 27 21 179 58 76650 1 4 2 15 74024 138 36 8 6 Brixton 1498 1 - 14 1 262 384 - 15 25 8 3 16 - 27 187 133 112 1 14 1 18 62281 2 60909 4 110 - - 19 717 Norwood 1037 3 4 364 2 - 40 - 1 5 18 5 269 106 61 1 1 37 - 7980 Totals 283729 298058 486 398 3 432 4 19 - 20 122 38 12 2548 18 501 1576 41 95 136 1212 - 8 - 83 35 5 105 N.B. —In addition to the above new cases of infectious sickness coming to , . _ cation under the Notification Clauses of the Public Health (London) Act 1891 knowledge of the Medical Officer of Health by compulsory medical notinnotified voluntarily, viz.: Chicken Pox 728, Measles 1880 and Whooping' or the Orders and Regulations made thereunder, the following cases were r i Cough 507. BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1916. Area of Borough—4,080.4 statute acres (inclusive of land and inland water, but exclusive of tidal water 82.1 and foreshore 31.1 statute acres respectively), divided into 5 Registration Sub- Districts, 4 Parliamentary Divisions, and 9 Wards. The Parliamentary Divisions and Wards are not co-extensive but the Registration Sub-Districts and the Wards are. Civil Population —estimated 1916—283,729 (males 128,832, and females 154,897). *Density—69.5 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected) —7,980 being 25.8 per 1,000 population. Deaths (corrected) —4,212 being 14 -8 per 1,000 population. Infantile Mortality (corrected) —565 deaths (corrected) under 1 year being 70.8 per 1,000 total (uncorrected) births, or 84'8 per 1,000 total (corrected) births. Zymotic Death-rate (corrected) —0.9 per 1,000 population (total corrected zymotic deaths, 248). * The densities (based upon the estimated civil populations) vary in the different Registration Sub-Districts as follows —Lambeth Church (354-3 acres) 123.9, Kennington (398.3 acres) 113.9, Stockwell (583 acres) 102.0, Brixton (1026.6 acres) 72.1, and Norwood 1718.2 acres) 35.4 per statute acre respectively. II.-SANITARY WORK. (Dealing with the sanitary circumstances and administration of the Borough of Lambeth.) Return shewing the Number of Notices served in the Borough of Lambeth, from the 1st January to the 31st December, 1916. Number of Notices served 15,015 A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES* (Public Health (London) Act.) No. of Notices served 6567 No. of Infected Houses 5453 Scarlet Fever 414 Typhoid 17 Diphtheria 379 Membranous Croup 4 Puerperal Fever 20 Erysipelas 118 Cerebro-Spinal Fever 35 Acute Polio-Myelitis 12 Ophthalmia Neonatorum 83 Whooping Cough 1149 †German Measles 1020 B. GENERAL NUISANCES AND DRAINAGE DEFECTS. (Public Health (London) Act, and Metropolis Local Management Acts.) No. of Notices served 8448 Works, Structural— Drainage Defective 1284 Intercepting Traps with Fresh Inlets required 219 Ventilating Pipes required 272 Indoor Sinks connected with Drain 316 Rain Water Stacks connected with Drain 580 Bath Waste connected with Drain 217 Traps Defective, or of Obsolete Pattern 1002 Closet Pan and Connections Defective 1094 Water Supply to Closet Defective 2017 Closet Dilapidated 981 Draw-off Main for Drinking Purposes required 509 Dust Bins Defective 1092 Premises Dilapidated 1501 Ventilation under Floors required 316 Roofs Dilapidated 2001 Soil Pipes Defective 181 * Excluding tuberculosis, †Compulsorily notifiable from January Ist, 1916, 2202 †Measles Paving Defective 2056 Damp and Unwholesome Houses 319 Dung Receptacles required 26 Defective Water Pipes 176 No W.C. Accommodation 16 16175 Works, not Structural — Cisterns Dirty 499 Manure Accumulations 76 Underground Rooms occupied 38 Animals Improperly Kept 76 Stopped Drains 410 Overcrowding 58 Foul Urinals 17 Refuse Accumulations 317 No Water Supply or Defective Water Supply 1072 Dirty Premises 2088 4651 TABLE M. PARTICULARS OF SANITARY WORK CARRIED OUT BY THE SANITARY STAFF IN LAMBETH BOROUGH DURING 1916, AND DURING THE 5 PREVIOUS YEARS (1911-1915), TOGETHER WITH YEARLY AVERAGES FOR (a) THE 10 YEARS 1901- 1910 (Borough), and (b) the 24 Years 1877-1900 (Parish). Sanitary Works, Structural and Permanent. Sanitary Works, Not Structural. Year. Total Number of Notices (excluding those served under the Housing Acts). 1916 15015 16175 4651 1915 12752 9757 7731 1914 15109 10175 6478 1913 14397 9167 5154 1912 12506 8679 4044 1911 12440 8008 3103 Yearly Average for 10 Years 1901- 1910 (Borough) 9348.4 13108.4 3049.7 Yearly Average for 24 Years 1877- 1900 (Parish) 5944.6 4756.9 2135.9 MALE SANITARY INSPECTORS.* There has been no change in the personnel of the Male Sanitary- Staff. Details of the work carried out are to be found in Tables M. and N. Contravention of By-laws. 1. Drainage Cases. Several cautionary letters were sent to builders, who had carried out drainage work (a) without giving previous notice and without sending in plans, or (b) contrary to the requirements of the L.C.C. By-laws. In the latter case, the work was altered so as to comply with the requirements. 2. Removal of offensive matters. Several cautionary letters were sent to contractors whose employees had removed through the streets offensive matters during prohibited hours contrary to the requirements of the L.C.C. By-laws. The war caused a difficulty owing to vans and horses having been commandeered by the Government. Infected Houses and Drainage Defects Found. A sanitary inspection is made of infected houses, i.e., houses at which infectious disease is notified compulsorily, and the sanitary inspection includes, in the large majority of cases, the testing of the drains with the chemical test. Taking the ordinary notifiable infectious diseases, out of the †999 infected houses dealt with during 1916, the results are as follow :— (a) 51, i.e., 5.1 per cent, were found to have defective drams, i.e., a result was obtained with the chemical test employed. (b) 395, i.e., 39.1 per cent, showed defects in drains, traps,, fittings and appliances. (c) 604, i.e., 60.5 per cent, showed no defects. *There are 12 District Male Sanitary Inspectors, viz., F. E. Baxter, J. M. Jones, J. S. Smith, J. Barfoot, G. J. Gavin, T. H. Hooper, T. H. Jackson, W. Wallis, W. W. Howes, J. M. Scorrer, J. S. Clements and A. Farran, and one special male Inspector for Food and Drugs (W. J. Perrin). † The above statistics do not include ophthalmia neonatorum, whooping cough, measles and German measles, which have been omitted so as to keep the statistics comparable with those for past years. The figures for (a) whooping cough and <b) German measles and measles infected houses during 1916 are : (a) 97 and (b) 221 defective drains and (a) 515 and (b) 1314 ; defective traps and appliances, out of totals of (a) 1149 and (6) 3222 infected houses respectively. The number of houses notified in connection with the ordinary infectious diseases during 1916 is much smaller than during previous years. No testing of drains 1 out, as a routine, in the case of ophthalmia neonatorum and tuberculosis infected houses. For comparison, the yearly averages for the past 25 years may be stated. They are as follow : — Yearly Averages. 1891-1900. (10 years.) 1906-1910. (5 years.) 1911-1915 (5 years.) 1901-1905. (5 years.) Number of infected houses 2246.1 1682.6 1719.2 1623.2 Houses with defects found 1150.0 911.2 1033.6 798.6 Houses with defective drains 438.3 214.6 166.6 102.8 Houses with no defects found 1088.1 771.4 685.6 824.6 Unsound Food. Several consignments of unsound or damaged food (including 31 tons of barley, 10 tons of wheat, 4,424 boxes of dried plums, 137 boxes of dates, 148 bags of flour, 1 ½ tons of peas, 10 quarters of oats, 36 boxes of picnic hams, 2 crates of rabbits, 1 box of Irish fowls, and 90 casks of dirty and rancid butter), discovered within the Borough, were inspected, condemned and destroyed or otherwise dealt with under the supervision of the Sanitary Inspectors and the details reported to the Council at the time. In the case of the damaged flour, barley, oats, wheat and peas, the food was allowed to be made into poultry food or dog biscuits. Inspection of Market Thoroughfares. The market thoroughfares were under bi-weekly special inspections by the Sanitary Inspectors, 2 Inspectors being on duty at a time —Saturday night (9 to 12) and Sunday mornings (9 to 12). The market thoroughfares are Atlantic Road, Wandsworth Road New Cut, Lower Marsh, and Lambeth Walk. These systematic inspections are of value in securing wholesome food being exposed on stalls and in shops for sale. No official seizures under the Act were necessary. Outside Urinals of Public Houses. The outside urinals connected with public houses were under inspection, and notices were served as required. Male Public Conveniences. The male public conveniences situated within the Borough are under the supervision of the male Inspectors. House-to-House Inspections. House-to-house inspections are dealt with under the Housing Town Planning, etc., Act, 1909. Other Inspections. The work in connection with disinfection, smoke abatement inspection of factories and workshops and outworkers' premises bake-houses, restaurants, and dining (coffee) rooms, births , the milk depot, the tuberculosis dispensaries, etc., and the carrying out of Food and Drugs and Housing Acts, is dealt with under separate headings. Legal Proceedings. It is again satisfactory to note that, during 1916, in only 3 cases was it found necessary to resort to legal proceedings before the Court in connection with Sanitary work under the Public Health and Metropolis Management Acts, in two cases orders being made for the work to be done, and in the other the summons being adjourned sine die and the premises closed. These legal proceedings had reference to private houses, viz.:— (a) defective drains and (b) dirty and dilapidated premises, defective roofs and gutters, absence of dustbins, &c. TABLE N. SUMMARY OF WORK DONE BY THE MALE SANITARY INSPECTORS DURING 1916. Inspections 9253 Re-inspections 50298 Complaints attended to 2884 Water Certificates issued 35 Revenue Act Certificates dealt with 130 Drains tested (with chemical, water or smoke test) 5424 Sanitary Works completed 4454 Plans of drainage reconstructions received 164 Premises the Drains of which have been totally or partly reconstructed 192 Samples of Food and Drugs taken 1841 Notices — Public Health (London) Act, 1891 (Preliminary or Intimation 5594 and Statutory 2831) 8425 Metropolis Local Management Acts 23 Sanitary Nuisances abated— (a) Structural 16175 (b) Non-Structural 4651 Summonses issued — Public Health Act 3 Food and Drugs Acts 23 Convictions obtained — Public Health Act 3 †Food and Drugs Acts 12 FEMALE SANITARY INSPECTORS. J There has been no change in the personnel of the Female Sanitary Staff. Work of Female Sanitary Inspectors. The two Female Sanitary Inspectors continue to carry out duties in connection with the inspection of (a) Factories, Workshops (Work-places), Shops, Out-Workers' Homes, Laundries, Restaurants, etc., wherein women and girls are employed ; (b) the Female Underground Conveniences (belongingto the Council), and other Female Sanitary Conveniences (Railway Stations, Hospitals, etc.) ; (c) Houses wherein births occurred or deaths amongst infants under 1 year of age, or deaths from infantile diarrhcea ; (d) Schools wherein there were infectious disease outbreaks; (e) Houses wherein cases of tuberculosis or ophthalmia neonatorum were notified, etc. Work carried out by the Two Female Sanitary Inspectors during the Year, 1916, §Workshops visited and inspected— (a) Dressmakers 113 (b) Milliners 19 (c) Laundries 82 (d) Tailors 38 (e) Upholsterers 2 (f) Dyers (g) Blouses - 55 (h) Ties 4 (i) Others (e.g.), embroidery, toys, mineral waters, shirts, underclothing, boxes, munitions, &c. 112 Workshops §: workshops therein measured 151 Workshops§ newly discovered and registered 25 * 1 Summons adjourned sine die. the premises to be closed. † 10 Summonses withdrawn. ‡ There are 2 female Sanitary Inspectors, viz., Miss F. M. Dawson, and Miss M. Da vies. § Workshops include Work-places. * Premises visited, but not inspected, owing to the persons or patients concerned being out or, if employees, being no longer employed 1477 Female Conveniences visited and inspected — Public (visits paid) 302 Private - Schools visited — Public (visits paid) 68 Private - Special places visited and inspected — (a) Private Houses† 2498 (b) Outworkers 311 Outworkers and Private Houses ‡ re-inspected 455 Written Intimation and Statutory Notices served 131 No. of Workshops,§ etc., in which defects were found 135 No. of Workshops,§ etc., in which no defects were found 3167 Nuisances referred to M.0.H., for attention by male inspectors 6 Particulars of Defects Found. Workshops,§ etc. — Workrooms— Overcrowded 2 Damp 8 Dirty 37 Ill-ventilated - Badly-lighted - Insufficiently warmed 1 Otherwise - Defective or dirty — Yards 4 Floors 13 Roofs 14 Windows 1 Ceilings 12 Rain Water Pipes 4 Sink Wastes 2 Water supply - Premises generally 43 ‡Births (491). Workshops (261), Out-workers (252), Schools (4), Tuberculosis cases (398), and special Complaints (71). † Births (1374), Diarrhoea cases (19), Tuberculosis cases (1021). Puerperal fever (3), Ophthalmia cases (52), and special Visits (29). ‡ Births (131), Diarrhoea cases (23), Tuberculosis rases (243), Out-workers (5). Ophthalmia cases (53). and special Complaints (8). § Workshops include Work-places. Sanitary Appliances : Water Closets— Dirty 6 Ill-lighted - Unventilated 2 Choked 4 Defective 9 Defective Flushing Tanks and Water Supply 12 Sanitary Appliances : Drainage— Choked 4 Defective - Unventilated - Sanitary Appliances : Dustbins — Wanting 4 Defective 15 Sanitary Appliances : Lavatories — Dirty 1 Defective - * No separate suitable sufficient W.C. accommodation for the sexes 6 Miscellaneous defects, e.g., accumulations, personal uncleanliness, etc. 2 FEMALE HEALTH VISITORS.† Work of Female Health Visitor. The Council's 2 Health Visitors have been engaged in the visiting of houses wherein births had been notified, in looking after the milk depot children {at the depot and at their own homes), in supervising Infant Welfare Centres, in inspecting infants notified as suffering from ophthalmia neonatorum and houses wherein deaths from diarrhoea have occurred, and in making enquiries in connection with notified tuberculosis cases—this last-mentioned work being carried out on a separate day or days from those devoted to other visiting, etc. The work for 1916‡ may be summarised as follows, being visits and revisits made in connection with :— Births 2,070 Tuberculosis cases ... 259 Ophthalmia cases ... 163 Infant Welfare Centres 63 Diarrhoea cases... ... 44 Special cases ... ... 53 Depot children ... 38 Milk Depots- York Road ... 58 Moffat Institute ... 319 * The Sanitary Accommodation Order 1903 does not apply to the Metropolis. † There are two female health visitors, viz., Nurse T. McHugh and Nurse A. Stirk, the latter having been appointed by the Council on July 27th, 1916, and commenced her duties on September Ist, 1916. ‡ 691 visits were also paid to houses, but no one found at home. FACTORIES AND WORKSHOPS, 1916. Factories. 10 new factories were added to the Register, consisting of (a) engineering, 1 ; (b) munition making, 4 ; (c) war clothing, 1 ; (d) flour mills, 1 ; (e) box making, 1 ; (f) whisky distillery, 1 ; and(g) pickle and jam manufacturing, 1. The Inspection of Factories by the Sanitary Inspectors is limited to that of the sanitary accommodation provided for the workers (such accommodation to be separate, sufficient and suitable), and sanitary defects, when found, are reported by the Factory Inspectors to the Council for amendment by and under the supervision of the Council's officers (11 premises being reported during 1916). Workshops. 45 new workshops were added to the Register, consisting of the following : — Name of Trade or Business. No. of Workshops. Dressmakers 9 Milliners 3 Tailors 4 Blouses 10 Underclothing 1 Mantles 2 Children's Coats 2 Basket Making 2 Army Clothing 1 Overalls 1 Ties and Belts 1 Civil Service Supply Association 1 Not classified 8 Total 45 Full particulars concerning these factories and workshops were entered up in the Register shewing that, at the time of inspection, there were 110 workrooms, in which were working 1322 persons — 291 males and 1031 females, as follow :— M. F. Total. Children - - - Young Persons 2 24 26 Adults 289 1007 1296 OUT-WORKERS, 1916. Lists of out-workers require to be sent in to the Council by employers, engaged in the special trades scheduled in the Home Work Order, 1911, twice yearly, viz. : on or before February Ist and August Ist respectively. 9 February and 12 August lists were received, dealing with 82 and 137 out-workers respectively. Of the 219 out-workers, 84 belonged to Lambeth and 135 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 173 lists were received from various outside authorities dealing with the 1078 workers, of whom 1016 belonged to Lambeth and 62 to districts outside Lambeth. TABLE O. FACTORIES AND WORKSHOPS REGISTERED DURING 1916. Numbers of Rooms and Persons Employed. TOTALS. No. of Workrooms. Children. Young Persons. Adults. No. of Factories. No. of Workshops. F. M. F. Total. M. M. F. M. F 5 2 42 14 162 533 162 547 709 - - - 47 2 3 8 210 47 210 257 - - - - 2 3 14 1 59 134 59 135 194 - - - 3 6 2 12 8 14 8 22 - - - - 7 25 7 1 24 1 24 - - - - - 14 15 5 4 39 44 4 48 - - - - 5 4 1 23 1 23 24 - - - - - 8 29 9 4 4 2 25 2 31 - 1 - - - 11 1 1 1 11 12 - - - - 1031 - 10 45 110 - 2 24 289 1007 291 1322 Of the total 1100 Lambeth out-workers reported, 181 were new out-workers, i.e., out-workers not previously registered, as follow :— Furs 1 Mantles 11 Blouses and skirts 30 Millinery 12 Ties, belts, and braces 13 Dresses 5 Children's underclothing and costumes Nurses' Uniforms 1 2 Bag stringing 20 Women's clothing 20 Boxes and boxmaking 4 Button Making 4 Tailors 11 Embroidery 7 Brushes 8 Waistcoats 1 Artificial flowers 6 Shirts 3 Paper Bags 4 Fancy Goods 6 Sack Making 3 Button-hole Making 2 Printers 1 Boots and shoes 2 Corset Making 3 Knitting 1 Total 181 The Wards, in which the houses (wherein the 181 new outworkers were found to be working) are situated, are as follow : — Wards. No. Marsh 11 Herne Hill 21 Tulse Hill 16 Bishop's 10 Prince's 41 Norwood 11 Vauxhall 14 Stockwell 22 Borough of Lambeth 181 Brixton 35 DISINFECTING DEPARTMENT, 1916.* Details of work done in connection with the Disinfecting Department are subjoined. A total of 7833 cases of infectious diseases, notified compulsorily by medical men, was reported and dealt with, including cases of cerebro-spinal fever (38), acute polio-myelitis (12), ophthalmia neonatorum (83), measles (2548), German measles (1212), whooping cough (1576), and tuberculosis —pulmonary (904) and nonpulmonary (362), whilst the following diseases were, in addition, notified by school teachers and others, viz. : measles (594), chickenpox (492), cancer (74), whooping cough (445), verminous houses (212), verminous rooms (897), verminous bedding (7340 articles), or clothing (4983 articles), and others (742 †). 1324 patients were removed to hospital. * The Staff consists of 1 Superintendent (W. Lockyear), 4 Disinfectors, 4 Drivers, 1 Boiler Attendant, and 1 Yard and Stable Attendant. † Scabies, ringworm, blood poisoning, etc. c Summary of work carried out by the Disinfecting Department in the Borough of Lambeth during 1916. Total No. of rooms disinfected by Council 12280 Do. articles do. 31275 Cases in which bedding was disinfected at home* 5834 Do. do. do. at Chamber 2227 Do. do. do. destroyed (385 articles) 115 Premises disinfected and disinfectants supplied 17845 No. of Cleansing Notices served in connection with infected houses 1012 Certificates of Medical Practitioners received in lieu of disinfection by the Council 43 Schools disinfectedf (88 rooms) 10 Certificates of disinfection left with occupiers of disinfected premises 7939 Library books disinfected 898 Mattresses re-tabbed by Council 455 Articles of bedding, etc., disinfected. Beds 1892 Bolsters 1933 Pillows 4788 Mattresses 2446 Palliasses 87 Quilts 965 391 Chair Cushions Clothing (articles) 3071 Sheets 1698 Blankets 6932 Rugs and Mats 32 Carpets 17 Extras (i.e., articles not included above) 7023 Total 31275 * The number is increased, compared with previous years, owing to bedding no longer being removed to the disinfecting station in the cases of Measles, Chicken-pox and Whooping Cough. † Measles 9 (78 rooms), Cerebro-Spinal Fever 1 (10 rooms). ‡ 377 Public Library and 521 Private Library Books. Articles of bedding, etc., destroyed. Beds 30 Bolsters 7 Pillows 30 Mattresses 33 Palliasses 31 Quilts 6 Chair Cushions 14 Clothing (articles) 64 Sheets 8 Blankets 9 Rugs and Mats - Carpets 5 Extras (i.e., articles not included above) 98 Total 335 Practically all the disinfection was carried out by the Council's staff—only 43 certificates being received from Medical Practitioners during 1916, certifying that disinfection had been carried out to their satisfaction. The numbers of verminous houses and rooms disinfected and cleansed during 1916, and the seven previous years are :— Year. Houses. Rooms. Bedding. Clothing. 1909 148 387 - - 1910 207 646 - - 1911 268 535 - - 1912 580 1109 - 1913 649 927 - 1245 141 1914 195 935 1186 268 1915 621 1080 4165 431 1916 212 897 7340 4983 Refuge for Disinfection. The refuge for disinfection in the Borough, viz., at Wanless Road, has not been called into use during 1916. SMOKE ABATEMENT, 1916. A large number of observations were taken, 33 smoke notices were served, but no summons was taken out. The smoke nuisance increased owing to the difficulties arising out of the war (poor quality coal, &c.) The L.C.C. and the Coal Smoke Abatement Society reported nuisances in connection with several premises and the necessary proceedings were taken. UNDERGROUND CONVENIENCES * The conveniences were kept under regular supervision and inspection. ANALYSIS OF FOOD AND DRUGS, WATER, &c., 1916. 1. —Food and Drugs. (a) Formal Samples. 800 formal samples were purchased within the Borough, and submitted to the Public Analyst for analysis. Of the 800 samples 72 (i.e., 9 per cent.) were reported by the Analyst to be adulterated and 23 summonses were issued by the instructions of the Public Health Committee through the Town Clerk, with the result that 12 convictions were obtained. The annual averages of the two decennia 1891-1900 (Parish) and 1901-10 (Borough), are respectively: (1) Number of formal samples taken, 501 -9 and 1352-4, of which 74 -6 and 89• 1 (i.e., 14 -9 and 6-6 per cent.) were found on analysis to be adulterated ; (2) number of summonses taken out, 53-1 and 63-8, with 52-3 and 48-5 convictions. (b) Informal Samples. 1041 informal samples were purchased within the Borough and submitted to the Public Analyst for analysis. Of the 1041 samples 60 were reported by the Analyst to be adulterated. (c) Formal and Informal Samples. 1841 formal and informal samples were purchased within the Borough, and submitted to the Public Analyst for analysis. Of the 1841 samples 131 (i.e., 7 • 1 per cent.) were reported by the Analyst to be adulterated. Details of the 1841 articles submitted by the Food and Drugs Inspector are as follows :— (a) Milk. 1. Formal Samples. The 60 adulterations were as follows:- (1) Extraneous water 39, varying from a minimum 1 to a maximum 9½ per cent. (2) Deficiency in milk-fat 21, varying from a minimum 1 to a maximum 25 per cent. (3) Extraneous water and deficiency in milk fat, nil. In 50 cases no summonses were taken out for the following reason :— Amounts of adulteration too small, viz. (a) extraneous water (31) and (b) deficiency in milk fat (19). Of the 13 summonses issued there were 4 convictions and 9 summonses were withdrawn —5 by order of the magistrate (he being satisfied with the evidence for the defence in 4, and a warranty being proved in 1), and 4 by order of the Public Health Committee. 2. Informal Samples. No informal samples of milk were taken. (b) Butter. 1. Formal Samples. 191 samples of butter were taken, and of these 11 (i.e., 5-7 per cent.) were declared by the Analyst to be adulterated, the adulterations consisting of (1) added margarine (9), varying from a minimum 20 per cent, to a maximum 100 per cent. ; (2) preservatives present (2), viz., 0-04 and 0-06 per cent, crystallised boric acid respectively. In the 2 cases of boric acid preservative, no summonses were taken out, for the reason that the amounts of adulteration were too small. Of the 9 summonses issued, there were 8 convictions and 1 summons was withdrawn, the defendant having committed suicide. 2. Informal Samples. 753 samples were taken, and, of these, 49 (i.e., 6-5 per cent.) were declared by the Analyst to be adulterated. (c) Other Articles. Details are to be found in Table Q. Registration of Margarine Factories. During 1916, no new margarine factory was registered. Since the Margarine Act, 1837, came into force within the Borough the following premises have been registered in addition to the above: 233, Wandsworth Roard; 417, Brixton Road; 413, Norwood Road; 71, Robsart Street; 75, Atlantic Road; 114, Camberwell New Road; 32, Commercial Road; 14, Vassall Road ; 92, Lambeth Walk; 266, Brixton Road; 64, Stamford Street; 21, Lower Marsh; *11-13, Gray Street; |7, Juxon Street; 15, New Cut; 448 and 450, Brixton Road; Wessex House (Oakley Street) ; 22, Wilcox Road ; 58, Patmos Road ; 63, New Cut; 166, Norwood Road ; 13, Westow Hill; 66, Brixton Road ; 240, Brixton Road ; 23, Electric Avenue; 253, Wandsworth Road; 147, Lambeth Walk ; 55, New Cut; 44, Lower Marsh ; 218, Railton Road ; 220, Coldharbour Lane ; f 106, Lambeth Walk ; and 110 c, Brixton Hill. 2. Water. One sample of water was submitted for analysis. * Registration was withdrawn on May 29th, 1913. † Registration was withdrawn on Nov. 23rd, 1911, and renewed on July 13th, 1914. Public Health (Milk and Cream) Regulations, 1912. All samples of milk are examined by the Public Analyst, as a routine, for the presence of preservatives, and, of the total samples of milk taken during 1916 (558 formal), in no single instance were preservatives found. No samples of cream were taken formally, but 17 samples were taken informally (3 being adulterated). The action taken during 1916 under the Public Health (Milk and Cream) Regulations, 1912, may be tabulated as follows : — Headings of Report of Administration during 1916. 1. Milk ; and cream not sold as preserved cream :— (a) No. of samples examined for the presence of a preservative. (b) No. in which a preservative was reported to be present. Milk 558 - Cream - - Nature of preservative in each case in column (b) and action taken under the Regulations in regard thereto— Nil. 2. Cream sold as preserved cream :— (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct: — (1) Correct statements made (2) Statements incorrect ... ... — Total — (b) Determinations made of milk fat in cream sold as pre- served cream:— (1) Above 35 per cent. (2) Below 35 per cent — Total — (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed ... ... ... ... Nil. (d) Particulars of each case in which the Regulations have not been complied with and action taken ... ... Nil. 3. Thickening substances. Any evidence of their addition to cream or to preserved cream and action taken where found ... Nil. 4. Other observations (if any) ... ... ... ... Nil. TABLE Q. SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of the analyses, during the year 1916 :— Formal. Informal. Number Analysed. Number Adulterated. Number Adulterated. Number Analysed. Samples. 60 - - Milk 558 191 11 753 49 Butter - Lard 31 - - - Coffee - 16 - Margarine 6 - - - Mustard - - 23 - Pepper 25 - - - Arrowroot - - 13 - Vinegar † - 6 - - 8 Sago - - - - 9 - Oatmeal - 8 Ground Rice - - - - 7 Egg Powder - - 10 Cocoa - - Dripping - 12 - - - 53 4 Drugs* 2 1 19 4 Rice - - 8 - Olive Oil - - - 9 3 Tapioca - - Cheese - - Ground Ginger - - 7 - 3 Bread - - - - - 8 - Tea - Chocolate Powder - 1 Baking Powder - 17 - 4 - - Cream § - 17 3 Custard Powder - - 10 - Self-Raising Flour - 8 - - 72 800 1051 60 * The drugs (55) were : —Eucalyptus Oil (6), Epsom Salts (11), Gregory's Powder (5), Tartaric Acid (5), Ammoniated Tincture of Quinine (4), Boric Ointment (2), Cream of Tartar (16), Dandelion Coffee (1), and Bicarbonate of Soda (5). The adulterations being (a) formal (1) Epsom Salts containing 60 parts of lead per million and (6) informal (1) Cream of Tartar containing excess of arsenic and sugar, (2) Epsom Salts containing excess of lead, and (3) Ammoniated Tincture of Quinine deficient in Sulphate of Quinine. § The 3 adulterations were varying quantities of Boric Preservative. MUNICIPAL MILK DEPOT. The statistics for 1916 are subjoined. 290 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk:— Under 3 months 101 34 3—6 months 92 9—12 months Over 12 months 11 6—9 months 52 290 Of the 101 infants under 3 months, 14 were aged 14 days or under, viz.:-4, 5, 7, 7, 14, 14, 14, 14, 14, 14, 14, 14, 14, and 14 days respectively. These 290 infants and children may be classified, as to their states of health at the time of being put upon the milk, as follows: — Health} 7 , i.e., showing no sign of wasting or disease, though below par constitutionally 140, weakly 34, wasting 82, diseased 34. The diseases from which the 34 infants and children were actually suffering at the time of being put upon the milk were: Diarrhœa 6, bronchitis 3, pneumonia 1, broncho-pneumonia 1, tabes mesenterica 2, colitis 1, skin diseases 4, ophthalmia 3, parotitis 1, rickets 1, gastritis 6, whooping cough 4 and convulsions 1. The periods during which the 290 infants and children continued to use the milk were:— 26 weeks and over 41 Under 4 weeks — 2—4 weeks 51 13 —26 weeks 40 6—13 weeks 68 Under 2 weeks 56 4—6 weeks 34 290 An average of 118 infants and children were fed per week at the Depot, necessitating the distribution for the year of 199,008 bottles of milk mixture, whilst, in addition, milk was also supplied as follows: — 1. Lambeth Infirmary—using 20,730 pint bottles of milk mixture; 2. Lambeth Workhouse —using 3,168 pint bottles of milk mixture; 3. Lambeth Schools Infirmary —using 17,488 pint bottles of milk mixture; 4. Invalids —using 2,234 pint bottles of milk mixture ; 5. Nursing mothers —using 43 pint bottles of milk mixture ; 6. Children over 2 years of age —using 9,408 pint bottles of milk mixture. A total of 11,149 gallons of milk and 769½ pints of cream were used during 1916. Weekly medical consultations* with mothers were held at the Depot, the babies being weighed, the weights and other details tabulated in the Register, whilst the babies were visited also at their homes by the Health Visitors when required. Milk was distributed not only from the Depot, but also from the MofEatt Institute (Upper Kennington Lane), the latter branch depot (distributing centre) being used for the convenience of the mothers living in the Vauxhall District. The most conclusive proof of the value of a Milk Depot, in so far as the infants and children fed are concerned, is to be found in the medical histories of individual cases, which show again and again, in the case of the Depot, that those infants and children who appear to be seriously ill and wasting, if not moribund, as the result of improper or irregular feeding, at the time of commencing the milk, actually recover and become strong and healthy. The educational value, too, of a Milk Depot must not be lost sight of. "In connection with the Infants consultations at the Milk Depot, the Local Government Board has given a grant during 1916. BAKEHOUSES, 1916. There are, within the Borough, 214* Bakehouses (135 above ground and 79 underground), and these were inspected officially and the necessary annual white-washing and cleaning carried out, as required. DAIRIES, MILKSHOPS AND MILK STORES, 1916. 14 applications for registration were received and dealt with by the Council as follow: — 1. — Applicants not registered, the premises being "unsuitable" (i.e., not in accordance with the Council's requirements) —† 2. — Applicants registered, the premises being "suitable" (i.e., in accordance with the Council's requirements — 13.† 3. — Registrations withdrawn —nil. * 72 were certified during 1903-1904 as "suitable" for occupation as underground bakehouses under Section 101, Factory and Workshop Act. 1901. † Unsuitable. —173, Coldharbour Lane (afterwards made suitable). + Suitable.— 37, Belvedere Road ; 66, Bolton Street ; 86, Brandon Road; 173, Coldharbour Lane; 30, Cornwall Road (Brixton Hill); 115, Dorset Road; 18, Fitzalan Street; 2, Kennington Grove; 1, Howley Place; 11, Oakley Street; 3A, Roupell Street; 112A, Wands worth Road; and 9, Wyvil Road. C2 COWHOUSES.* There were, within the Borough, at the end of 1915, 7 registered Cowhouses, and at the Annual Licensing Meetings of the London County Council, held on October 24th and November 9th, 1916, the licences were renewed with the exception of 6, Coral Street, Lower Marsh, the renewal of the licence being refused on the ground that the premises are unsuitable for the keeping of cows, and that, in adidtion, no cows have been kept for some time therein. * The 6 registered cowhouses are: —36A, Tracey Street (Bishop's Ward); 38, Hartington Road (Vauxhall Ward); and the following 4 in Norwood Ward, viz., 93, Clive Road; Elder Road Dairy; 76 and 78, Gipsy Hill; and 156, Hamilton Road. SLAUGHTER-HOUSES.* There were within the Borough, at the end of 1915, 16 registered Slaughter-houses, and at the Annual Licensing Meetings of the London County Council, held on October 24th and November 9th, 1916, the licences were renewed with the exception of 121, High Street, West Norwood, the renewal of the licence being refused on the ground that the applicant is only an agent. * The 15 registered slaughterhouses are: —99 and 106, Lower Marsh; 151, Lambeth Walk; 60, Kennington Park Road; 406, Kennington Road; 27, Bedford Road; Electric Lane (near Railway Hotel); Industry Terrace; 207 and 309, Coldharbour Lane; 77, Dulwich Road ; 12, Lower Tulse Hill; 45, New Park Road; 125, Hamilton Road (West Norwood); and 120, High Street (West Norwood). HOUSING OF THE WORKING CLASSES, 1916. HOUSING, TOWN PLANNING, ETC., ACT, 1909. House-to-House Inspections and Closing-Orders. No house-to-house inspections were carried out on account of the war, and, consequently no representation for a Closing Order was necessary. In connection with the closing of houses under the Housing, Town Planning, etc., Act, 1909, a total of 101 dwelling-houses within the Borough have been represented by the Medical Officer of Health as being unfit for human habitation from the time the Act came into force (December 3rd, 1909) until the end of 1916, and Closing Orders have been made by the Borough Council, as the Local Authority, in connection therewith under Section 17 of the Act, with the result that:— (a) 76 houses have been closed and since demolished; (b) 25 houses have been rendered fit for human habitation. In addition to these 101 dwelling-houses, 27 others have been dealt with under Section 15 of the Act, and voluntarily closed and since demolished by the owners. Comparison may be made with similar work (closure of dwelling houses) carried out under the Housing of the Working Classes Act, 1890, Section 32, from the date upon which it came into force (viz., August 18th, 1890) up to the introduction of the Housing, Town Planning, etc., Act, 1909 —a period of 19 years—during which a total of 385 houses were dealt with by notices served by the late Vestry and the present Borough Council, under Section 32 of the Housing of the Working Classes Act, 1890, on the representation of the Medical Officer of Health that such dwelling houses were unfit for human habitation, viz.:— (a) 1891 to 1900 (10 years)—old Vestry 337 (b) 1901 to 1909 (9 years)— Borough Council 48 Total 385 COMMON LODGING HOUSES.* The 6 Common Lodging Houses (for men) within the Borough were inspected during 1916, but in no case was any sanitary defect found. Only 5 common lodging houses were licensed by the London County Council at the Annual Licensing Meeting held June 27th, 1916, in accordance with the requirements of Section 46 of Part ix. of the London County Council (General Powers) Act, 1902, the license for 55 Belvedere Road not being applied for. * The 5 licensed Common Lodging Houses (for men) are: —10A, Belvedere Crescent; 108, Lambeth Walk; 90-92, Westminster Bridge Road;39-91, Wandsworth Road (at present closed); and 106, Wandsworth Road. HOUSES LET IN LODGINGS, 1916. No new houses were registered under the by-laws which have been made recently by the Council under Section 94 of the Public Health (London) Act, 1891, as amended by section 16 of the Housing, Town Planning, &c., Act, 1909. 372 houses have been registered under the old by-laws in past years. REVENUE ACT, 1903. (And Section 35 of the Housing, Town Planning, etc., Act, 1909.) During 1916,130 certificates were applied for under the Revenue Act, 1903, and under Section 35 of the Housing, Town Planning, ctc., Act, 1909, in connection with tenements (or dwellings) so con- structed as to afford suitable separate accommodation for each of the families inhabiting the same, with the following results:— 1.—Certificates granted unconditionally—12*. 2.—Certificates granted conditionally—114†. 3.—Certificates refused—4‡. OFFENSIVE TRADES. No nuisance was reported in connection with the three offensive trades, which are registered as established within the Borough, and which arc under the supervision of the Borough Council, viz.: fat melting (15, Upper Marsh), soap boiling (15, Upper Marsh) and tripe boiling (103, Lambeth Walk). REFUSE AND MANURE DEPOTS. The 13 Public Depots, situated in the Borough, have been under constant (daily, during the summer months) supervision. Since the outbreak of war there has been great difficulty in disposing of refuse, partly owing to want of railway facilities and partly due to scarcity of horses and labour. Notices have been served and cautionary letters sent as required, but a liberal interpretation has had to be placed upon the By-laws governing the depositing of refuse and offensive matters during the process of removal at contractors' yards, wharves, &c. MORTUARIES AND CORONERS' COURTS. The 2 Coroners' Courts (High Street and Wanless Road) are under the jurisdiction of the London County Council and the 2 Mortuaries, which are attached thereto, are under the jurisdiction of the Borough Council. There are 2 Mortuary Keepers and a Deputy. The following are the details of work done during 1916 at the two mortuaries and coroners' courts: — (a) § Number of bodies received, 514 —297 at High Street and 217 at Wanless Road. (b) Post-mortem examinations conducted 202 —106 at High Street and 96 at Wanless Road. (c) Number of inquests held 491—279 at High Street and 212 at Wanless Road. * Granted unconditionally. —sB, 86, 116, Crimsworth Road and 91, 95, 97, Thorparch Road (6 houses and 12 tenements). † Granted conditionally .—17, 19, 21, 23, 79, 81, 83, 85, 87, 89, 54, 56, 60, 62, 64 74, 76, 78, 80, 82, 84, 88, 90, 92, 94, 96, 110, 112, 114, 118, 120, 122, 124, 126 128 130, Crimsworth Road ; 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, Goldsborough Road ; and 13, 15, 17, 19, 21, 23, 89. 93, 99, Thorparch Road (57 houses and 114 tenements). ‡ Refused. —53, Brooklands Road and 10, 10A, 10B, Peckford Place, Brixton (3 houses and 4 tenements). §No infectious bodies were received. BACTERIOLOGICAL LABORATORY. TABLE R. Shewing the numbers of pathological samples examined and the results obtained at the Bacteriological Laboratory during 1916 and the previous 5 years 1911-1915, together with the averages for the 10 years 1901-1910 (Borough). Throat & Nose. Membranes and Secretions. Suspected Diphtheria. Klebs-Lœffler Bac. found. Year. Sputa. Suspected Tuberculosis. Tub.Bac.found. Blood. Suspected Typhoid or Enteric Fever. Reaction obtained. Other Sundry Samples. Result obtained. Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 33 407 440 1036 1916 126 346 472 5 23 28 6 6* 838 12 14 99 937 1915 155 390 545 34 46 - 8 24 32 1914 1913 411 733 1144 28 42 108 730 997 6 12 18 1484 12 130 442 614 870 35 47 497 18 19 37 867 55 1912 296 305 601 31 26 57 12 10 22 667 589 1911 87 226 22 33 55 78 139 7 21 28 * Hair for tinea tonsurans 1 (negative), urine for tubercle bacillus, 1 (negative) and swabs from throats and noses for meningococcus 3 (negative), smearings from vagina for gonococcus 1 (negative). N.B. —The Bacteriological Laboratory was originally established and fitted up in 1899 by the late Vestry, and since then (up to the end of the year 1916), 19401 examinations have been conducted there, in connection with the following suspected diseases, viz. : tuberculosis 7023, typhoid or enteric fever 1,104, diphtheria 10,972 and others 302. 9.1 12.8 3.7 124.4 62.8 59.0 39.6 187.2 19.4 485.2 Average of 10 years 1901-1910 (Borough) 448.6 36.6 CLERICAL STAFF.* During 1916, there has been no permanent change in the personnel of the clerical staff, the two assistant clerks who joined the Army being still away and their places being temporarily filled by two girl clerks. Of the two boy clerks who joined the Army, one has been killed in action, and the other has resigned his position as boy clerk. The two vacancies have been filled temporarily. * The Clerical Staff consists of 2 Chief Clerks, Class I. (W. R. Lawrence and A. L. Baxter, the latter acting also as Special Clerk to the Medical Officer of Health), 2 Assistant Clerks, Class 11. (W. J. Lawrence and A. E. Ruel), and 2 Boy Clerks, Class 111. (appointments filled temporarily). APPENDIX. Local Government Board New Tables. TABLE I. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1916 AND PREVIOUS FIVE YEARS (1911-15). Births. Total Deaths registered in district. Transferable Deaths. ‡ Nett Deaths belonging to the District. Uncorrected. Number. 3 Nett. Population estimated to Middle of each Year. 2 Rate. 7 of Nonresidents registered in the District. † 8 of Residents not registered in the District. † 9 Under 1 Year of Age. At all Ages. Year. 1 Rate per 1,000 Nett Births. 11 Number. 10 Number. 6 Number. 12 Rate. 5 Rate 13 1911 1912 1913 1914 §1915 §1916 297957 297550 297139 297094 284188 283729 8405 8168 8341 8188 7878 7980 Number. † 4 7292 6953 7238 7022 6573 6435 4584 4189 4476 4630 5323 5515 852 823 883 1008 1313 1929 124.0 86.3 74.2 104.5 97.6 88.1 4444 4000 4373 4367 4772 4279 15.4 14.1 15.1 15.6 18.7 712 634 780 745 762 905 600 737 734 685 14.9 13.4 14.7 14.7 16.8 24.5 23.3 24.4 23.6 23.1 19.4 693 567 15.1 22.7 §N.B.—The populations estimated for 1915 and 1916 are the civil populations only. Notes. —This Table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 the corrected rates are slightly different. The rates are calculated per 1000 of the estimated gross population, and no deduction? have been made from the population for large Public Institutionsfor the Sick or infirm. *In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the Borough. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. †Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph ; the Registrar- General supplied the particulars of extra transferable deaths (G7) to be entered n Col umn 9 ; and all such deaths are included in this Column, unless an error has been detected, and its correction has been accepted by the Registrar- General. For Column 4 the Registrar-General has furnished a statement of the number of births needing to be added to or subtracted from the total supplied by thelocal Registrar (1647 outward and 102 inward transfers). " Transferable Deaths " are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances. In Column 8 the number of transferable deaths of " non-residents " which are deducted and in Column 9 the number of deaths of " residents" registered outside the district which are added are stated in calculating the nett death-rate of the Borough. Census, 1911. Area of Borough in acres (exclusive of area covered by water), 4079-6 Average number of persons per house (estimated), 6.7. Number of inhabited houses, 44123. Total population at all ages, 298058. Local Government Board New Tables. TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1916 TOTAL CASES NOTIFIED IN EACH LOCALITY. (e.g., Parish or Ward) of the District. TOTAL CASES REMOVED TO HOSPITAL. NUMBER OF CASES NOTIFIED. At Ages—Years. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. NOTIFIABLE DISEASE. At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65 65 and upwds. Small-pox - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - 16 129 210 49 30 2 114 60 62 138 62 401 Diphtheria (including Membranous Croup) 436 - 13 122 7 3 17 38 31 13 37 12 18 36 19 41 Erysipelas 25 72 Scarlet Fever 501 4 109 311 50 2 - 91 90 1381 110 486 109 - - - - 486 Typhus Fever - - - - - - - - Enteric Fever 19 5 6 2 - 6 2 1 8 2 - 2 4 18 Relapsing Fever - - - - - - - - - - - - - - - - - - - - 6 - Continued Fever - - - - - - 20 17 - 2 4 Puerperal Fever - 3 - 4 6 4 8 - - - 17 - - - - - - - - - Plague - - - 894 1 9 57 147 459 200 21 190 141 193 221 149 Pulmonary Tuberculosis* - 347 9 59 167 49 42 14 7 59 48 88 81 71 Other Forms of Tuberculosis† - 7 4 38 8 6 9 5 2 1 10 7 14 3 35 Cerebro-spinal Fever 3 4 5 Polio myelitis acuta 12 5 3 1 - - 2 1 4 1 - 83 83 - 11 19 21 5 Ophthalmia Neonatorum - - - - 27 - - Whooping Cough‡ 1576 121 803 637 3 8 4 - 422 304 224 262 364 95 139 136 2548 75 728 1189 107 6 1 672 399 376 384 717 Measles§ German Measles § 416 187 1212 53 887 98 58 3 - 376 201 179 269 105 Isolation Hospitals. Name and Situation —Hospitals of the Metropolitan Asylums Hoard (one situated in the Hnxton Sub-District and Stockwell Ward of the Borough of Lambeth). Total available beds provided by the Board—8555. Number of Diseases that can he concurrently treated—All usual notifiable intectious diseases and (partly) Measles and whooping Cough. * Excluding , all renotifications (232) of pulmonary tuberculosis, and notifications under Form C (389) and under Form D (422) of the 1912 Regulations. † Excluding all renotificatlona (19) of non-pulmonary tuberculosis, ami notifications under Form C (39) and under Form I) (38) of the 1912 Regulations. † Whooping Cough became compulsorily notifiable within the Borough of Lambeth on January 1st, 1913- § Measles and German Measles became compulsorily notifiable within the Borough of Lambeth on January Ist, 1916. Local Government Board New Tables. Table III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1916. BOROUGH OF LAMBETH. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the District (a). Total Deaths whether of " Residents " or " Nonresidents " in Institutions in the District (b). Causes of Death. 5 and under 15 years. 15 and under 25 years. 45 and under 65 years. All ages. 1 and under 2 years. 2 and under 5 years. 25 and under 45 years. 65 and upwards. Under 1 year 1 2 3 4 5 6 7 8 9 10 11 3885 327 524 41 135 16 119 19 123 26 122 39 501 31 988 71 1373 84 All causes Certified (c) Uncertified 4212 3078 - - - - - - - - - - Typhus Fever Enteric Fever 1 - 1 - - 9 - - - - - - Continued Fever - - - - - - - - - - - - Small-pox - - - - - - 49 6 24 13 6 - - - 32 Measles - 1 7 2 4 - - - - 13 Scarlet Fever - 1 - - Whooping Cough 45 21 12 11 - - 23 15 - 64 Diphtheria and Croup (See note (d)) 41 1 7 18 - - - 1 1 3 6 21 20 5 Influenza 56 - 4 2 3 1 - - - - 5 Erysipelas - - 3 1 Cerebro-Spinal Fever 18 4 1 4 2 - 3 33 - - - Polio-myelitis acuta - - - - - - - 1 1 3 5 4 Venereal Diseases 34 20 - - - 177 1 1 13 64 115 16 315 Phthisis (Pulmonary Tuberculosis) 387 - Tuberculous Meningitis (See note (e)) 46 6 6 11 19 2 2 - - - 55 8 5 4 Other Tuberculous Diseases 4 7 6 15 8 8 4 - Rheumatic Fever 14 1 4 3 2 8 - - 370 1 2 - 3 38 178 148 Cancer, malignant disease (See note (f)) - - 9 15 86 232 376 24 11 3 2 Bronchitis 23 280 6 7 13 134 48 21 16 Broncho-Pneumonia - 29 63 53 5 11 189 15 8 5 Pneumonia (all other forms) 24 5 7 2 - 2 12 15 - Other diseases of Respiratory organs 67 189 23 314 234 605 - 1 - 15 63 Diseases of Circulatory System 116 167 6 39 381 31 3 6 13 - 96 Diseases of Nervous System 3 2 3 1 1 105 83 12 - Diarrhœa (See note (g)) 2 11 1 - 3 - 19 2 - - Enteritis 3 4 52 6 3 - Appendicitis and Typhlitis 16 - - - 3 7 1 11 - - - - - - Alcoholism (See note (h)) 4 22 6 32 - - - Cirrhosis of Liver - 2 - 21 1 4 72 71 173 2 2 - Nephritis and Bright's Diseases - 8 - 16 - 1 - 9 - - Puerperal Fever (See note (i)) - 2 - - 8 - Other accidents and diseases of Pregnancy and Parturition 10 - - - - - - - 193 Congenital Debility and Malformation, including Premature Birth (See note (i)) 1 - 203 9 - - 41 10 26 4 15 6 36 462 Violent Deaths, excluding Suicide 149 11 2 7 24 11 1 14 Suicides - - - 75 13 39 81 312 565 14 19 12 1431 Other Defined Diseases 3 2 3 9 1 - Diseases ill-defined or unknown - - - Notes to Table iii. (a) All " Transferable Deaths " of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., a persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term " transferable deaths " see footnote to Table. The total deaths in column 2 of Table III. equal the figures for the year in column 12 of Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or non-residents, are entered in the last column of Table III. (c) All deaths certified by registered Medical Practitioners and all Inqufst cases are classed as " Certified " ; all other deaths are to be regarded (d) This heading includes all deaths from croup except those certified as due to " spasmodic," " stridulous," " catarrhal," or " false croup. (e) Under "Tuberculous Meningitis" are included deaths from Acute Hydrocephalus. (f) Under " Cancer " are included deaths under such headings as Carcinoma, Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. (g) Under this heading are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Choleraic diarrhoea. Cholera (other than Asiatic), Gastro-enteritis, Gastro-intestinal catarrh, Muco-enteritis, Colitis, etc. Deaths from Diarrhoea secondary to some other well-denned disease arc included under the latter. For " Dysentery " see note at foot of Table III. (h) Under this heading are included deaths from Delirium tremens, acute and chronic alcoholism, etc., but not those certified as due to organic disease attributed to alcoholism. The number of the latter may with advantage be stated separately, though this statement cannot be included in Table III. (i) Under " Puerperal Fever" are included deaths under such headings as Pyaemia' Septicaemia, Sapraemia, Pelvic peritonitis, Pen- and F.ndo-metritis occurring in the puerperium. (i] Under this heading are included also deaths from Atrophy and Marasmus of Infants, and want of Breast-milk, but not from Atelectasis. Local Government Board New Tables. TABLE IV. BOROUGH OF LAMBETH—INFANTILE MORTALITY, 1916. Nett Deaths from stated causes at various Ages under 1 Year of Age. 3-4 weeks. 1-2 weeks. 2-3 weeks. 9-12 months. Total Deaths under 1 year. Under 1 week. 1-3 months. 3-6 months. 6-9 months. Total under 1 month. All Causes Certified Uncertified 125 41 26 - 19 211 82 65 517 89 70 3 13 2 3 18 13 10 4 48 - German Measles - - - - - - 1 - - 2 Measles - 1 3 6 - - - - - 3 1 Diphtheria and Croup - 1 - - - - - - - 8 Whooping Cough 3 5 5 21 - - - - 2 1 2 5 18 25 16 19 83 Diarrhœa - 2 Enteritis (Epidemic) 1 3 1 5 1 1 11 - - Influenza 1 1 1 - - - - - - - - Cerebro-Spinal Fever - 2 4 - - - - - - Tuberculous Meningitis - 1 2 1 2 6 - - - - Abdominal Tuberculosis - 1 - 1 - - - - - - 1 Other Tuberculous Diseases - 4 - 3 - - - - - Congenital Malformations 1 6 1 11 6 1 2 21 4 - 1 106 11 5 5 98 7 - - Premature Birth 77 3 65 35 19 6 2 16 9 5 5 Atrophy, Debility and Marasmus - - 16 12 1 16 - 3 - - Atelectasis - 1 1 - - Erysipelas - - - - - 5 2 - 20 2 8 5 4 2 - Syphilis - - 1 2 1 - Rickets - 1 - - - 1 1 1 4 1 Meningitis (not Tuberculous) - - - 25 4 - 2 - 13 6 4 9 Convulsions - - 5 2 2 11 1 1 1 Gastritis - - - 5 6 12 1 - Dentition - - - - - - - - - - Laryngitis - - - - - 4 3 24 1 7 5 5 1 4 1 Bronchitis 5 1 4 1 13 2 1 - 48 Pneumonia - - 13 9 3 13 10 1 - 2 Broncho pneumonia - - - - 1 - 2 1 Pleuro - - - - 4 1 2 1 - 1 1 Suffocation, overlaying - 1 1 - 2 1 1 6 - Accident, other than Suffocation 4 5 1 - 5 15 47 1 - 10 6 5 22 229 Other causes not classified above 26 22 74 99 95 68 565 Totals 138 43 9 8 TABLE Local Government Board New Tables. poliomyelitis, and polio-encephalitis and cerebro-spinal fever, of Lambeth, during 1916. Total number of Cases notified. CASES (excluding Military Cases). I —I 15-20 years. 20-30 years. Over 30 years. 5-10 years. 10-15 years. 0-1 year. 1-5 years. M. F. M. F. M. F. M. F. M. F. F. M. F. M. Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis. Cases. 2 Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis. Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases Deaths. Permanent Paralysis.* 1 - 1 1 - - 1 - - 1 - - 1 - - - - - - - - - - - - - - - 1 - 1 2 - 2 4 - Acute Polio-myelitis 12 - 4 1 - 1 - - 1 - - 1 1 - - 1 3 - 2 - 1 - - 2 1 2 - - 2 2 - 1 1 - 3 2 - 1 Cerebro-Spinal Fever† ‡ 4 - 4 - 2 2 - 4 3 - 29 3 with permanent Paralysis of one or more groups of muscles. Number of cases removed to Isolation Hospital. - - - - - - - - - - 1 1 2 1 Acute Polio-myelitis 2 3 3 - 1 1 2 1 - 1 Cerebro-Spinal Fever 3 2 4 3 † There were, in addition, during 1916, 9 military cases notified, and of these 9,3 died.8 of the patients wewe removed to Hospital and 1 (dead) to the Mortuary (sudden death) for inquest. ‡ Included in the above 29 notified civilian cases is a Belgian refugee 11 or at home (? indirect infection), whilst 2 others were alleght of the 29 cases were the children of soldiers serving in the Army abroad, infection whilst visiting Camp and Barracks respectively. 10 11 LAMBETH BOROUGH.—Corrected Deaths registered from all causes during the year, 1916. Note.—The Deaths of Non-Residents occurring in Public Institu- tionsistrict are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. (A.) REGISTRATION SUB-DISTRICTS. Sub-Districts. Sub-Districts. I , . Lambeth Church. Total. Kennington. No Address. All Ages. Stockwell. Brixton. Norwood. F. M. I. Specific Febrile,or Zymotic Diseases M. F. F. M. F. M. F. F. M. F. M. 40 36 53 38 M. 176 379 21 22 4 203 46 39 39 41 - II. Parasitic Diseases 1 - 1 1 - - - - 1 - - - - - - III. Dietetic Diseases 1 2 2 - 7 5 12 1 1 2 - - IV. Constitutional Diseases 86 60 90 3 - - 946 63 122 97 11 4 498 448 105 96 128 84 28 22 33 65 32 1 198 353 V. Development Diseases 41 37 21 155 204 32 41 - VI. Local Diseases 155 215 182 195 1142 1122 2264 275 293 235 25 17 VII. Deaths from Violence 27 228 240 19 5 11 14 115 58 173 16 25 19 7 1 - VIII. Deaths from Ill-defined and not Specified Causes 29 12 12 10 55 29 84 3 9 6 1 8 6 13 4 - 391 290 364 431 Totals 22 2176 2036 4212 515 523 346 399 42 451 438 (B.) AGE PERIODS. I AGE. PERIODS. . . 1 Total. Under 1 Year. 1-2 2-5 Under 5 Years. 5-15 65 and over. Over 5 Years. All Ages. 40-45 45-60 60-65 15-20 20-25 25-40 M. M. F. M. F. M. F. F. M. F. M. F. F. F. F. M. F. M. F. I. Specific Febrile or Zymotic Diseases F. M. M. M. M. 379 M. F. M. F. 77 24 15 62 65 203 176 65 36 22 28 141 111 16 15 14 13 10 5 7 12 1 2 3 8 1 - 1 - 1 II. Parasitic Diseases - - - - 5 - - 1 - - - - - - - - - - - 1 - - - - - - - 1 - 5 7 5 12 III. Dietetic Diseases 1 - - - - - 1 - - - 3 1 6 - - 2 1 - - - - - 3 39 93 105 429 498 448 946 IV. Constitutional Diseases 12 1 6 10 16 8 34 19 20 26 35 103 45 464 12 24 18 27 101 70 41 89 54 - 89 54 134 66 144 66 144 155 198 353 V. Developmental Diseases - - - - - - - - - - - - - - - - VI. Local Diseases 112 77 36 28 21 135 - 109 100 438 532 973 987 1142 1122 2264 30 169 29 28 17 17 49 38 244 190 14 14 73 68 103 45 58 173 VII. Deaths from Violence 5 6 2 2 5 5 1 9 6 10 29 19 115 12 3 - 15 5 - 31 9 - - 146 2 1 2 VIII. Deaths from Ill-defined and not Specified Causes 44 4 1 - - 8 - 55 84 22 5 49 27 - - 1 2 - - 1 2 29 - 2 - 1 6 - 1 74 2176 340 225 67 71 67 495 359 47 817 1677 2036 4212 75 33 41 40 201 316 170 640 1681 Totals 84 162 96 427 73 (C.) SUMMARY OF CORRECTED DEATHS. No. of Deaths. Total. M. F. M. F. I.—Specific Febrile or Zymotic Diseases. 218 Brought forward 1859 1822 1. Miasmatic Diseases 118 100 218 2. Diarrhæal 60 45 105 IV.—Local Diseases—continued. 3. Malarial - - - 6. Diseases of Lymphatic System 7 2 4. Zoogenous 5 Venereal „ - 7. Diseases of Gland-like Organs of Uncertain Use - - 19 6 15 34 1 1 6. Septic 85 16 22 8. Diseases of Urinary System 123 II.—Parasitic Diseases 9. Diseases of Reproductive System (a) Diseases of Organs of Generation 1 - 1 2 9 III.— Dietetic Diseases 7 5 12 (b) Diseases of Parturition 10 10. Diseases of Bones and Joints 4 9 IV.—Constitutional Diseases 498 448 946 11. Diseases of Integumentary System 10 11 V.—Developmental Diseases 155 198 353 VII.—Violence. VI. —Local Diseases. 1. Accident or Negligence 94 54 1. Diseases of Nervous System 184 197 381 2. Homicide 1 - 2. Diseases of Organs of Special Sense 20 3. Suicide 4 7 7 14 4. Execution - - 3. Diseases of Circulatory System 315 290 605 5. Air raid - - 4. Diseases of Respiratory System 370 396 766 5. Diseases of Digestive System 119 105 224 VIII.— III-defined and not Specified Causes 55 29 Carried forward Total 1859 1822 3681 2176 2036 - London County Council Table. Borough of Lambeth. SANITARY PROCEEDINGS DURING 1916. (Return prepared for the London County Council.) Premises. Number of Places. Number of Inspections,l9l6. Number of Notices, 1916. Number of Prosecutions, '16. On register at end of 1915. Added in 1916. On register at end of 1916. Removed in 1916. Milk premises* 239 13 1512 42 - - 252 14 Cowsheds 7 1 6 2 192 Slaughter-houses 16 1 15 5 Other offensive trade premises Registered houses let in lodgings Bakehouses Restaurant Kitchens 36 3 3 2 4464 - 12 372 372 428 214 - 214 - - - 248 248 * During 1916, 13 new applications were received, 12 were granted and 1 was refused (the premises being " unsuitable "), but was afterwards granted (the premises being rendered " suitable " meanwhile). - - - - - - - - - - - - - - Total number of Intimation or Preliminary Notices served for all purposes 5594 Overcrowding — Dwelling rooms overcrowded 58 Remedied 58 Prosecutions — Underground Rooms — Illegal occupation 38 Closed — Insanitary houses — Closed (under the Public Health (London) Act, 1891) 1 Closed (under the Housing of the Working Classes Acts, including the Housing, Town Planning, etc., Act) — Verminous rooms cleansed 897 Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891 — Number provided 1 Persons accommodated — Revenue Act, 1903— Houses for which applications were received 66 Tenements comprised therein 130 Revenue Act, 1903, continued — Tenements for which Certificates were — (a) granted 12 (b) refused 4 (f) deferred* 114 Common Lodging Houses — Certificates granted Number of Prosecutions under By-laws, under Public Health Act, 1891 Mortuaries — Number of bodies 514 (infectious cases 0). *Certificates since granted, the necessary works having been carried out meanwhile. Home Office Tables. BOROUGH OF LAMBETH, 1916. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.— Inspection of Factories, Workshops and Workplaces including Inspections made by Sanitary Inspectors. Number of Premises. Written Notices. Prosecutions. Inspections. 10 425 131 - - Factories (Including Factory Laundries.) Workshops (Including Workshop Laundries) Workplaces (Other than Outworkers' Premises included in Part 3 of this Report.) 435 131 - Total 2. —Defects found in Factories, Workshops and Workplaces Number of Defects. No. of Prosecutions. Referred to H.M. Inspctor. Particulars. Found. Remedied. Nuisances under the Public Health Acts * :— I Want of Cleanliness 37 37 Want of Ventilation Overcrowding 2 2 Want of drainage of floors Other nuisances - 128 - Sanitary accommodations Insufficient Unsuitable or defective Not separate for sexes 33 33 6 6 Offences under the Factory and Workshops Act:— - Illegal occupation of underground bakehouse(S.101) - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - Totals 206 206 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, as remediable under the Public Health Acts. 128 - - - - - - - - - - - - - - - - - - - - - - - - - - - 18 19 3.—HOME WORK. OUTWORK in UNWHOLESOME PREMISES. Sections 108. OUTWORK IN INFECTED PREMISED. Sections 109, 110. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Prosecutions. Notices served on oc(8) cupiers as to keeping or sending lists. Sending Twice in the year. Sending Once in the year. NATURE OF WORK. (1) Failing to keep or permit inspection of Lists. (9) Orders made (S.110) (15) Prosecutions (Section 109,110) (16) Notices served. (12) Instances (11) Prosecutions (13) Instances. (14) Outworkers, † Outworkers. Failing to send Lists. (10) Lists. (2) Lists. (5) Contractors. (3) Workmen(4) (4) Contractors. (6) Workmen. (7) Wearing Apparel — i ' — — (1) Making, &c. 12 10 80 1 2 12 - - (2) Cleaning and washing Household linen - - - - - - - - - - - - - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - Curtains & furniture hangings - - - - - - - - - - - - - - - Furniture and upholstery - - - - - - - - Electro-plate - - - - - - File making - - I - - - - - - - - •• - Brass and brass articles - Fur pulling - - - - - - - - - - - - - - - - - - - Cables and chains - - - - Anchors and grapnels - - - - - - - - - - - - - . - Cart gear - - - - - - - - Locks, latches and keys - - Nil. Nil. Nil. Nil. Nil Nil. Nil Umbrellas, &c. - - - - - - - - - - - - - - Artificial flowers - - - - - - - - Nets, other than wire nets Tents - - - - - - - - - Sacks and bag stringing - - - - - - - - - - 1 49 - - - - Racquet and tennis balls - - - - - Paper bags and boxes - - - - - - 2 19 - - - - - - Brush making 2 9 - - - - - - Pea picking - - - - - - Feather sorting - - - - Carding, &c., of buttons, &c. - - - - - - - - - - - - - - Stuffed toys - - - - - - - - Basket making - 1 1 Printing - - - - - 2 49 - - - - - - Cigarette making - - - - - - - - 16 10 148 5 - 61 Total - - - - - 12 - - - If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. †The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of out- workers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 5.—Other Matters. Number. (2) Class. (1) Matters notified to H.M. Inspector of Factories : — Failure to affix Abstract of the Factory and Workshop Act (s. 133) 12 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s.5) Notified by H.M. Inspector 11 Reports(of action taken) sent to H.M. Inspector 11 Other Underground Bakehouses (s.101) : — Certificates granted during 1915 In use at the end of 1915 72 Note. —The Factory and Workshop Act, 1901 (s.132) requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). If the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office the portions which do not relate to factories, workshops, workplaces or homework. The duties of Local Authorities and the Medical Officer of Health under the Acts are detailed in the Home Office Memoranda, issued to all Districts, Councils and Medical Officers of Health. - - Metropolitan Borough of Lambeth. Lambeth Municipal Tuberculosis Dispensaries Scheme. REPORT For the Year ending December 31st, 1916, OF Work, carried out at the two Tuberculosis Dispensaries. N.B. —The Report is in the form of tables i. to v. and the L.G.B. Form R, prepared by the 2 Tuberculosis Officers, together with an Addendum by the Chief Executive Tuberculosis Officer. The actual forms of the tables i. to v. were suggested and drawn up by the two Tuberculosis Officers in their joint Report for 1913, and have been repeated every year since, for "purposes of uniformity and comparison. The forms are in no way complete or exhaustive, dealing only with the new patients examined and treated each year. The notes on special treatment of selected cases are introduced for the first time this year. LAMBETH MUNICIPAL TUBERCULOSIS DISPENSARIES SCHEME REPORT, 1916. Tables I. to V. Central Dispensary. Branch Dispensary. Not Insured, Insured. Not Insured. Insured. Females. Females. Females. Females. Total. Total. Males. Males. Males Males. 22 TABLE 1. 1. —Total Attendances. „. (a) New Patients 215 313 840 180 130 193 323 826 225 87 4664 1648 7582 1752 564 892 1456 1382 934 3618 (b) Old Patients 8422 1932 1085 1779 5490 1607 1021 1863 3931 694 Totals II.—Particulars of New Patients. A.—Age Periods and Sex — _. (1) Under 15 142 263 156 149 305 121 - 225 - 87 - 180 - 130 535 72 181 563 59 164 (2) 15 and over 134 37 49 12 56 77 49 219 46 27 (a) 15—25 176 40 60 142 22 16 20 2 49 32 10 12 89 52 (b) 25—35 49 61 18 11 141 50 45 15 124 (c) 35—45 24 6 25 4 9 10 48 (d) 45—55 24 2 - 3 9 1 27 7 1 2 - 4 11 13 1 (e) 55—65 1 4 10 3 5 (f) 65 and over B—Lengths of Attendances — I ._ I I . I I I I I I I I ... I (1) One month and over 99 409 56 141 191 85 103 385 77 42 (2) Under one month* 45 116 122 431 95 74 90 182 441 148 TABLE II. 357 54 25 C—Sources of Cases— (1) Medical men 67 36 185 - 50 68 105 233 (2) Charitable Societies 1 2 1 - 4 5 1 6 2 14 (3) Out Patients' Department (St. Thomas's Hospital) - - - 32 21 38 116 207 - (4) Others (e.g., Public Departments, Patients, etc.) 18 155 27 27 106 306 17 11 34 89 (5) " Contacts " or " suspects " 13 173 97 135 53 89 21 30 283 56 64 TABLE III. 18 43 295 373 D —Results of diagnosis— i 1. Ordinary Patients — (a) Tuberculosis (b) Suspected Tuberculosis 23 99 91 97 85 43 283 119 97 128 74 56 40 90 260 2. " Contacts " or "suspects"— (a) Tuberculosis (b) Suspected Tuberculosis including— 29 16 - 17 4 2 - 9 5 14 39 134 2 2 - 21 31 88 269 9 16 37 72 129 - - - 1 - - - - 1 - - 1 - - - 1 - - - - - - 3. Tuberculin, Diagnostic † Positive Reaction Negative Reaction - - - - - * Cases sent for opinion only (including recruits), cases unfit or unsuitable to attend, cases classified as suspected tuberculous (including non-tuberculous or doubtful), " contacts " or " suspects," and cases belonging and transferred to other Districts. † In one of these cases (a recruit), the clinical signs were indefinite and an X-zay examination proved negative, but the case was shewn to be a definite one of pulmonary tuberculosis by a series of test injections of old tuberculin given by the Tuberculosis Officer of the Central Dispensary. Tuberculin is rarely now used for diagnostic purposes at the Branch Dispensary. Tables I. to V.— continued. Branch Dispensary. Central Dispensary. Insured. Not Insured Insured. Not Insured. Females. Females. Total. Females. Females. Total. Males. Males. Males. Males. TABLE IV. *E—Nature of Treatment— 1. Routine (total cases treated one month and over) including— 24 42 85 77 99 191 409 56 103 141 385 2. Institutional — (a) Sanatoria (including Tuberculosis Hospitals) 15 7 78 5 33 39 11 21 10 3 4 1 9 8 22 (b) General Hospitals - 1 3 4 - 1 4 6 2 6 (c) Poor Law Institutions 1 1 2 1 †3. Tuberculin— Remedial - - 4 2 4 10 1 1 2 - TABLE V. F— Results of Treatment — 1. Routine (Total cases treated one month and over) — (a) Fit for work 63 44 40 90 180 354 37 86 116 302 19 12 54 85 170 51 33 70 109 263 Fit for work and remaining so Not fit for work but becoming fit 184 12 7 25 28 36 95 4 16 39 (b) Unfit for work 29 1 9 8 47 20 18 17 25 80 Fit for work but not remaining so Not fit for work and remaining so 3 17 12 2 7 11 10 14 42 - (c) Deaths, including— 17 1 7 5 30 7 7 11 38 13 4 1 3 8 2 1 3 - - - 2 Institutional (Sanatorium) — (a) Fit for work 18 7 7 18 50 7 5 5 16 33 12 5 7 3 5 9 17 - - - 7 Fit for work and remaining so Not fit for work but becoming fit 13 7 7 11 38 4 16 - 5 (b) Unfit for work 9 10 36 18 6 33 6 10 10 - 5 8 13 4 4 4 4 16 - - Fit for work but not remaining so Not fit for work and remaining so 10 1 9 2 6 6 6 20 - (c) Deaths 4 1 5 2 2 4 - - - - 9 (3) Tuberculin— (a) Fit for work 3 2 4 1 1 2 - - - - 1 1 2 1 1 - - - - Fit for work and remaining so Not fit for work and becoming fit 2 3 7 1 2 - - 1 - 1 - - (b) Unfit for work 1 25 - - - - - - - 1 1 - - - - - - - - - Fit for work but not remaining so Not fit for work and remaining so - - - - - - - - - (c) Deaths - - - - - - - - - - * 190 visits (insured persons 119, uninsured persons 71) were paid to patients' own homes by the assistant Tuberculosis Medical Officer, and 808 visits (insured persons 328, non-insured persons 480) by the Dispensary Nurse, in connection with the Council's Central Tuberculosis Dispensary. The Tuberculosis Medical Officer connected with the Council's Branch Tuberculosis Dispensary at St. Thomas' Hospital does not visit at the patients' own homes. † Other special treatments, e.g., I.K. (Immune Substances) therapy, pneumosan, succus allii or garlic juice (allyl sulphide), X-ray and mercury vapour light, induction of artificial pneumothorax, intravenous colloidal copper, nascent or intensive iodine, &c, are dealt within a short summary (abstracted from reports of the Clinical Tuberculosis Medical Officers) at the end of the Tables (vide pp. 28-29). 20 LOCAL GOVERNMENT BOARD—FORM R.* Record required to be kept, by order of the Local Government Board given in their letter of Feb. 29th, 1916. METROPOLITAN BOROUGH OF LAMBETH. Return AS TO Work CARRIED OUT IN CONNECTION WITH THE Two Tuberculosis Dispensaries (Central and Branch) FOR THE Period from April Ist, 1916, to December 31st, 1916. Central Dispensary. Branch Dispensary. Insured. Uninsured. Insured. Uninsured. Totals. Females Childr'n under 16. Adults. Females Childr'n under 16. Adults. Males. Males. Females. Females. Males. Males. 26 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensaries 191 66 215 51 122 153 78 201 47 105 1229 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 17 5 75 31 11 15 41 62 17 28 302 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 4 2 59 1 10 12 11 63 13 14 189 (d) Number included under 1 (a) who were found to be non-tuberculous† 10 11 3 27 19 51 36 87 18 40 302† (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 101 30 118 25 5 2 28 14 34 11 23 436 Central Dispensary. Branch Dispensary. Totals Insured. Uninsured. Insured Uninsured 2. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a)) 4511 1583 1625 9789 2070 (b) Number of the above attendances at which systematic physical examinations and records were made 854 2450 601 458 537 3. Number of visits to patients at their own homes by the Dispensary Medical Officers in connection with the supervision of home conditions‡ 70 - - 60 130‡ 4. Number of visits to patients at their own homes by the Dispensary Nurses in connection with the supervision of home conditions and " following up "§ 265 311 1107 2625 § 942 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 4 89 107 206 27 6 6. Number of consultations with the — (a) Medical Adviser of the Insurance Committee - - - - - - (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated (c) Practitioners at the homes of patients‡ - - - - 1 7. Number of written reports concerning individual patients made to— (a) Public Authorities - 5‡ 4 - 105 98 474 202 69 338 (b) Practitioners 120 72 101 45 567 8. Number of specimens examined 146 73 67 281 * Form R for the year 1916 is only a 9 months' record (April Ist to December 31st, 1916), but for subsequent years will be a 12 months' record. † From physical signs. , . . ‡Under the Lambeth Scheme, the Tuberculosis Medical Officer connected with the Branch Dispensary (St. Thomas Hospital) does not visit at the patients' own homes. § These numbers are approximate only, no exact records being available. N.B. —Cases under special treatments are dealt with at the end of the Tables (vide pp. 28-29) NOTES ON SPECIAL TREATMENT OF SELECTED PATIENTS CARRIED OUT DURING 1916 (abstracted from the reports of the Clinical Tuberculosis Medical Officers). A.—Central Dispensary. 1. Tuberculin (intensive method) —*19 patients (*l7 pulmonary and 2 non-pulmonary or surgical) treated showed considerable improvement, with 2 exceptions (both pulmonary cases), the improvement consisting of increased energy, increased strength, increased weight, diminution (or absence) of cough and sputum, together with a clearing up (or diminishing) of active physical signs in many cases. 2. I.K. (immune substances) therapy —12 patients (9 pulmonary and 3 non-pulmonary or surgical) treated showed very considerable improvement, with 4 exceptions (all pulmonary cases), although the large majority of the patients (8 pulmonary cases) were in a relatively advanced stage of the disease, the action of the I.K. (immune substances) therapy being both antitoxic and bacteriolytic. 3. Pneumosan—3 patients (2 pulmonary and 1 non-pulmonary or surgical) treated showed satisfactory results. 4. Succus allii or garlic juice (allyl sulphide)—l42 patients (138 pulmonary and 4 non-pulmonary or surgical) treated showed beneficial results, with 12 exceptions (all pulmonary cases), the inhalation of the Succus allii causing thinning of the sputum which is thereby more easily expectorated, with subsequent diminished cough, reduction of temperature (if present), and lessened night sweats. The Succus allii acts through its active principle (allyl sulphide), which is a lymphagogue and indirectly a bacteriolytic agent (not an antiseptic agent only). B. — Branch Dispensary. 1. Tuberculin (ordinary method) —no longer used in pulmonary cases, and its value of doubt in non-pulmonary or surgical cases. The experience in past years has led to tuberculin treatment in pulmonary lesions being discontinued, the results, even in selected cases, being no better than those obtained by other methods, whilst, in gland and skin cases, in which tuberculin treatment has given the most promising results, in those cases where the local lesion and its activity can be accurately watched and estimated, it appears doubtful if the improvement noted is to be ascribed only to the tuberculin. 2. X-ray and Mercury Vapour light—the great success attending the treatment of suitably selected cases of tubercular adenitis and skin lesions with X-ray applications has been very encouraging and is, perhaps, one of the most striking points as regards treatment this year (1916), the combination of Mercury * One patient treated with tuberculin for diagnostic purposes only (Army Recruit). Vapour light and X-ray application giving equally splendid results in the treatment of lupus and skin lesions in early cases and even holding the disease in check in the old extensive cases, so that it is hoped that the usual disfigurements caused by this disease are now things of the past. 3. Nascent or Intensive lodine—uncertain in its effects, but in certain cases it has appeared to be extraordinarily successful. 4. Intravenous injections of colloidal copper—some encouraging results have been obtained, but it is too early to make any definite statement as to its efficacy in the treatment of pulmonary tuberculosis. 5. Inductions of artificial pneumo-thorax—a wider use is made of this method of treatment in suitable cases and the results have been consistently successful. ADDENDUM. By the Chief Executive Tuberculosis Medical Officer. 1. Treatment of Patients. The treatment of patients at the two Dispensaries is left entirely in the hands of the Clinical Tuberculosis Medical Officers, whose views, based upon their respective experiences, differ as to the values of special treatments employed. It will be noted from these two Officers' reports that there is a marked difference of opinion between them as to the remedial value (if any) of tuberculin. The experience gained at the Branch Dispensary (St. Thomas's Hospital) is against its use, whilst that gained at the Central Dispensary (73, Effra Road) is for its use, favourable results, in many respects, being tabulated by the Tuberculosis Officer at the latter Institution In this connection, it is to be noted that the Dispensary Records show that the patients treated lost weight (or, at least, their weights remained stationary or below the average) during tuberculin treatment, and that, too, despite the fact that several patients were being treated concurrently, so the Dispensary Records show, by the more usual orthodox methods of treatment, viz., the administration of cod liver oil, hypophosphites, etc. Increases of of weight were to be expected under the circumstances in such cases.* 2. " After Care " of Patients. Both Clinical Tuberculosis Medical Officers agree as to the value and need of " after-care " in tuberculosis cases, and in this connection the work of the Lambeth Interim Tuberculosis Care Committee, which meets weekly alternately at the two Dispensaries, is noteworthy. This Care Committee was provisionally appointed†for Lambeth Borough by the London County Council under powers granted for the purpose under the National Insurance Acts, 1911-13, and the Public Health (Treatment of Diseases) Act, 1913, subject to the approval of the Local Government Board, and similar Care * Similar remarks apply to the patients treated with I.K. (immune substances) and with pneumosan. † Feb. 22nd, 1916. Committees have been appointed in other Metropolitan Districts throughout the Administrative County of London. Representatives of different Public Bodies, together with Medical Officers of Health, Tuberculosis Medical Officers and Health Visitors (or Nurses) engaged in connection with tuberculosis work, as representing the Borough and City Councils, have been appointed on these provisional Care Committees pending the formation, after the War, of permanent Tuberculosis Care Committees.* The decisions and recommendations of these provisional Care Committees are subject to confirmation by the Public Health Committee of the London County Council. The establishment of these Interim Tuberculosis Care Committees with experienced Lady Almoners or Social Workers acting as Honorary Secretaries or serving on the Committees renders unnecessary appointments of similar officials by the various Borough and City Councils. In the case of Lambeth Borough, the two Tuberculosis Officers, in their joint annual report for 1913, suggested the appointment for the Outer Districts of the Borough of such a special official tuberculosis lady almoner or social worker with a department on the lines of the Lady Almoners' special tuberculosis department at St. Thomas's Hospital (in connection with the Tuberculosis Branch Dispensary), which serves the Inner Districts of the Borough. Under the circumstances, this suggestion has, since the appointment of the Interim Lambeth Tuberculosis Care Committee, proved to be unnecessary —at least for the present. 3. General Administrative Measures. The Public Health Committee is the Dispensary Committee for the Borough, rendering it unnecessary to appoint a special Dispensary Committee, ad hoc, as should be and has been done in districts where the Dispensaries are voluntary, and not,as in Lambeth, municipal, and under the administrative control of the Council. During 1916, the Council, on the recommendation of the Public Health Committee, decided to appoint a part-time assistant tuberculosis officer at the Central Dispensary, and experience has shown that this decision was wise, the work at the Central Dispensary only being at present sufficient for the services of a part-time officer, due regard being paid to systematisation of clinical work, including the arranging for the attendances of the patients at the Dispensary punctually at the appointed hours. The decision of the Council was approved by the Local Government Board. It must be remembered that, in this respect, the Borough is fortunate in having two Dispensaries, one for the Inner and more congested Districts, and one for the Outer and less congested Districts, the tuberculosis work of the Borough being divided (with the consent and approval of the Local Government Board) into two halves, each half being served by a separate Dispensary and a separate Clinical Medical Officer, with attendances daily on five days a week for a few hours. Dr. R. C. Wingfield, B.A., M.D. (Oxon.), M.R.C.P. (London), was * Approved by the London County Council on June 15th, 1915, for the purpose of organising measures auxiliary to treatment. appointed Clinical Tuberculosis Officer in connection with the Branch Dispensary at St. Thomas's Hospital by the Governors of the Hospital on January 15th, 1913, and Dr. S. Nicol Galbraith, M.B. (Glas.), D.P.H. (Camb.), Assistant Clinical Tuberculosis Officer (whole time), in connection with the Central Dispensary at 73, Effra Road, by the Council on February 27th, 1913, both appointments being approved by the Local Government Board. Dr. Galbraith resigned on November Ist, 1915, and the vacancy was filled temporarily by the appointment of a part-time officer (Dr. Eleanor A. Gorrie, M.B. (Edin.), from November Ist, 1915, to June 30th, 1916, and Dr. A. D. Serrell Cooke, M.B. (Edin.), from July Ist, 1916, to date). A lady dispenser has been appointed (part time appointment), in connection with the dispensing at the Central Dispensary. In regard to the dispensary nurse attached to the Central Dispensary, one only is at present necessary, now that the duties of visiting tuberculosis-infected houses have been re-arranged and allotted amongst the Council's Health Visitors,who assist materially, thereby freeing the special dispensary nurse for her purely dispensary work. Further, arrangements are being made, by which the clinical work connected with the patients at the Central Dispensary will be better organised, securing their more punctual attendances for examination and treatment at the official hours stated, and so as to enable the dispenser to regulate her time. These administrative changes are working satisfactorily and economically, with the result that it has been found possible for the Council to amend its estimates, which provided for two nurses if required, and to provide now only for one dispensary nurse, in compliance with the suggestion of the Local Government Board. The clerical work at the Central Dispensary (temporary boy clerk), like that at the Public Health Department generally, has been strained to its utmost on account of the War, and the consequent absence on military duties of two of the permanent clerks of the Public Health Department, but administrative changes are being introduced by which this strain will be lessened and by which it will be found possible to " carry on " with efficiency with the present temporary staff. 4. Conclusions. As a Borough, Lambeth is to be congratulated upon the inauguration by the Council in 1913 of the Lambeth Municipal Tuberculosis Dispensaries Scheme, with the opening to the Public of the Central and Branch Dispensaries for the use of the inhabitants of the Borough. The scheme, which is working well in practice and doing much good, has been justified. Indeed, in this respect, Lambeth, as a Metropolitan Borough, ranks as a pioneer, the Lambeth Scheme being the first Scheme approved by the Local Government Board, and the Scheme upon which other Schemes for other Districts have been framed. The records of work done in the prevention and treatment of tuberculosis in the Borough of Lambeth, since the inauguration of this Scheme in 1913, speak for themselves, and, whilst statistics must be read with caution, there seems justification to attribute the lessening of the tuberculosis rates, especially in the Inner (more congested) Districts, to the measures that the Council is taking. Thus, the tuberculosis death rates and incidence rates (notifications) per 1,000 of the population for (a) pulmonary tuberculosis and (b) tuberculosis (all forms) from 1913 to 1916, i.e., from the year when the Lambeth Tuberculosis Dispensaries were first opened to the Public to the end of 1916, are as follows :— Death Rates. Incidence Rates. Year. Pulmonary Tuberculosis. Tuberculosis (all forms). Pulmonary Tuberculosis Tuberculosis (all forms). 2.1 1913 Inner Districts Outer Distrcits Boorugh 1.6 6.6 8.5 0.9 1.2 1.2 4.3 5.6 6.8 1.6 5.3 1914 Inner Districts Outer Districts Borough 1.5 1.9 4.4 5.5 1.2 1.5 4.0 4.9 1.3 1.7 4.2 5.1 1915 Inner Districts Outer Districts Borough 1.9 2.3 4.6 6.2 1.4 1.2 2.8 3.5 1.4 1.8 3.6 4.6 Averages, 1913-14-15 Inner Districts Outer Districts Borough 2.1 1.6 5.2 6.7 1.1 1.4 3.7 4.7 1.7 1.3 4.4 5.5 2.1 Inner Districts 1916 Outer Districts Borough 1.6 3.5 4.8 1.2 1.5 2.9 4.2 1.7 1.4 3.2 4.5 N.B.—These figures are noteworthy having regard to the following facts : (1) the low estimated populations for 1915 and 1916 (civil populations only) : (2) the more exact methods of diagnosis introduced in connection with the opening of the Lambeth Tuberculosis Dispensaries as centres for diagnosis and consultation as well as treatment in 1913 (February 3rd and July 23rd respectively), and (3) the introduction of the Public Health Tuberculosis Regulations, 1912, which came into operation on February Ist, 1913, making all cases of tuberculosis compulsorily notifiable. The incidence rates (notifications) are specially noteworthy. The slight increase in the death rates is apparent only, due to more exact certification and the 1914 and 1915 lessened estimated populations (civil). INDEX. (ii.) GENERAL INDEX. PAGE Introductory letter 3 Vital Statistics 4—50 Estimated populations 4—5 Births and Birth-rates 6— 9 Notification of Births Act 9-10 Lambeth Maternity and Child Welfare Scheme 10-15 Deaths and Death-rates 15—28 (a) General 15-22 (6) Infantile 22—23 (c) Zymotic 23—25 Infectious Diseases 29 —43 (o) Notifiable 29—38,40—43 (b) Non-Notifiable 38—39 (c) " Contracts " and " Suspects " 39 Local Government Board, Old Table A. 44—47 Local Government Board, Old Table B. 48 —49 Summary 50 Sanitary WORK 51—74 Notices Served 51 (a) Infectious Diseases 51—52 (b) General Nuisances and Drainage Defects 51—52 Male Sanitary Inspectors 53—56 Female Sanitary Inspectors 56—58 Female Health Visitor 58 Factories and Workshops 59—60 Outworkers 59—61 Disinfecting Department 61-63 Smoke Abatement 63 Underground Conveniences 64 Analysis of Food and Drugs, &c. 64-67 Public Health (Milk and Cream) Regulations 66 Milk Depot 68—69 Bakehouses 69 Dairies, Milkshops and Milkstores 69 Cowhouses 70 Slaughterhouses 70 Housing of the Working Classes 70-71 (a) House to House Inspections 70 (6) Closing Orders 70 —71 (iii.) PAGE Common Lodging Houses 71 Houses let in Lodgings 71 Revenue Act, 1903 71-72 Offensive Trades 72 Refuse and Manure Depots 72 Mortuaries and Coroners' Courts 72 Bacteriological Laboratory 73 Clerical Staff 74 Appendix 2-32 Local Government Board, New Tables i., ii., iii., iv., v. 2-9 Mortality Tables (corrected deaths) 10—12 (a) Registration Sub-Districts 10-11 (6) Age Periods 10 —11 (c) Summary 12 London County Council Table 13-15 Home Office Tables, 1, 2, 3, 4, 5 16—20 Lambeth Municipal Tuberculosis Dispensaries Scheme— Report for 1916 of the work carried out at the two Tuberculosis Dispensaries 21-32 Tables i. to v. 22-25 L.G.B. Form R 26—27 Notes on special treatment of selected patients carried out during 1916 :— Central Dispensary 28 Branch Dispensary 28-29 Addendum by the Chief Executive Tuberculosis Medical Officer 29—32