LAM 12 REPORT on the Vital and Sanitary Statistics OF THE BOROUGH OF LAMBETH During the Year 1918. [Including an account (/) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme,(b) at the Municipal Milk Depot and Infants Consultations Centre under the Lambeth Maternity and Child Welfare Scheme, (c) at the Municipal Bacteriological Laboratory and (d) by the Male and Female Sanitary Inspectors and Health Visitors and the Disinfecting Staff, and (2) of the proceedings taken under the Sale of Food and Drugs, the Factory and Workshop, and the Housing and other Special, Acts.] BY JOSEPH PRIESTLEY, b.a., m.d., d.p.h., Medical Officer of Health and Chief Executive Tuberculosis Officer, Metropolitan Borough of Lambeth. 2 Public Health Department, Lambeth Town Hall, Brixton Hill, S.W.2. March, 1919. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, The sanitary and administrative work of the year 1918, like that of the previous three years, 1915-17, has been that of "carrying on" during the war, and no new schemes have, consequently, been introduced. This "carrying on" work is, as shown in the Report, satisfactory. The statistical results for the year 1918, as set out in the Report, are equally satisfactory. The general death-rate is slightly raised on account of the influenza epidemic which raged throughout the Borough during the third and fourth quarters of the year, resulting in a total of 819 deaths (corrected) certified as having resulted from that particular disease, out of a total of 4,948 deaths (corrected), certified as having resulted from all diseases. The corrected general death-rate is 18.9 per 1,000 of the estimated civil population. Excluding the influenza deaths, the corrected general death-rate is 15.7, as compared with an average for the past four years 1914-17 (similar war period) of 15.2. The other corrected death-rates, compared with the averages for the same period of four years 1914-17, are as follow (the averages being given in brackets) zymotic 1.3 (1.1), typhoid 0.02 (.03), and diarrhoea 0.23 (0.45) per 1,000 of the estimated civil population respectively, and infantile mortality 71.4 (80.4) per 1,000 of the total births registered (uncorrected). To the Staffs and to the Chiefs of the Departments, as also to the Members of the Council, my thanks are due for assistance readily given at all times in connection with the carrying out of my important duties as Medical Officer of Health and Chief Executive Tuberculosis Officer of the Borough. The Report has been curtailed and condensed owing to war conditions, as has been the case during the last few years. I am, Mr. Mayor and Gentlemen, Your obedient servant, Medical Officer of Health and Chief Executive Tuberculosis Officer. INDEX. PAGE Vital Statistics 4—61 Estimated populations 4—5 Births and Birth-rates 6—8 Notification of Births Act 9—10 Lambeth Maternity and Child Welfare Scheme 10 Municipal Milk Depot and Infants Consultations Centre 11 —12 Deaths and Death-rates (General, Infantile and Zymotic) 12—24 Infectious Diseases 25—44 (a) Notifiable 25—37 (b) Non-Notifiable 38—44 (c) Tuberculosis 30—35 Lambeth Tuberculosis Dispensaries Scheme 34—35 (d) Polio-myelitis and Cerebro-spinal Fever 36—37 (e) Influenza 39—43 (f) " Contacts " and " Suspects " 44 Municipal Bacteriological Laboratory 45 Local Government Board, Old Table A. 46—49 Local Government Board, Old Table B. 50—51 Local Government Board New Tables I., II., III., and IV. 52—57 Mortality Tables (corrected deaths) 58—60 (а) Registration Sub-Districts 58—59 (b) Age-Periods 58—59 (c) Summary 60 Summary of Vital and Mortal Statistics 61 Sanitary Work 62—75 Notices Served 62—63 (a) Infectious Diseases 62 (b) General Nuisances and Drainage Defects 62—63 Male Sanitary Inspectors 64-67 Registration of Cowhouses, Slaughterhouses, Common Lodging Houses and Milk Shops 65 Pig Keeping 66—67 Flooding of Basements 67 Female Sanitary Inspectors and Health Visitors 67—69 Factories and Workshops and Out-workers 67—71 Disinfecting Department 72 Aalysis of Food and Drugs and Water 72—75 Public Health (Milk and Cream) Regulations 74—75 Mortuaries and Coroners' Courts 75 4 1. VITAL STATISTICS. The Estimated Civil Populations* of the Borough are as follows:— Estimated Civil Populations, 1918. I. Wards. Wards. Males. Females. Total. Marsh 8358 9959 18317 Bishop's 11722 15554 27276 Prince's 15588 21064 36652 Vauxhall 11590 15094 26684 Stockwell 11309 16923 28232 Brixton 15590 23591 39181 Heme Hill 11866 17539 29405 Tulse Hill 10960 16755 27715 Norwood 11022 17791 28813 Borough of Lambeth 108005 154270 262275 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. Lambeth Church 17838 22544 40382 Kennington 17830 24033 41863 Stockwell 22899 32017 54916 Brixton 27456 41130 68586 Norwood 21982 34546 56528 Borough of Lambeth 108005 154270 262275 *N.B—The estimates of populations for 1918 are estimates of civilian populations only. These estimates are based mainly upon the rationing returns placed at the Registrar-General's disposal by the Ministry of Food. 5 III. Parliamentary Divisions (Old). Old Parliamentary Divisions. Males. Females. Total. North 19799 25228 45027 Kennington 26876 35727 62603 Brixton 27017 40378 67395 Norwood 33190 51240 84430 Parliamentary Area of Lambeth 106882 152573 259455 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 45593 Bishop's Kennington Prince's 63336 Vauxhall Brixton Stockwell 67413 Brixton Norwood Herne Hill 85933 Tulse Hill Norwood *Adjusted Parliamentary Area of Lambeth — 262275 *N.B.—By the adjustment of the old Parliamentary Divisions so as to be co-terminous with the Wards. 6 TABLE A. Giving number of Births and Birth-Rates in each Registration Sub-District of the Borough of Lambeth during 1918 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1918. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church 480 528 470 503 1981 Kennington † 232 221 206 220 879 Stockwell§ 452 447 430 391 1720 Brixton 258 271 267 258 1054 Norwood 197 199 193 167 756 Borough of Lambeth 1619 1666 1566 1539 6390 * Including General Lying-in Hospital (862 cases, of which 219 belong to Lambeth). † Including Workhouse (265 cases, of which 147 belong to Lambeth). § Including Clapham Maternity Hospital (846 cases, of which 221 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 1918 for the purpose of calculating birth-rates, consisting of the civilian population plus all non-civilians enlisted from this country, whether serving at home or abroad, this non-civilian element being distributed over all the districts in the country in proportion to their estimated civilian population, viz., 293,869, giving an uncorrected birth-rate of 21.7, and a corrected birth-rate (i.e., after deducting 1,386 non-Lambethian Institutional births) of 17.03 per 1,000 population. 7 TABLE B Showing Populations (Estimated), Uncorrected Births, Corrected Deaths at all ages, under 1 year, under 5 years, and from the 7 chief Zymotic diseases and Uncorrected Deaths in Public Institutions, in the Borough of Lambeth during 1918, and for the years 1911-1917, together with the averages for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). Year. Estimated Population. Number of Births Registered. Corrected Numbers of Deaths. Deaths in Public Institutions in Lambeth (uncorrected). Total Ages. Under 1 Year. Under 5 Years. Deaths from 7 Chief Zymotic Diseases. 1918 262275 6390 4948 449 951 334 3559 1917 272038 6869 4168 516 873 295 3106 1916 283729 7980 4212 565 854 248 3078 1915 284188 7878 4653 683 1047 335 2550 1914 297094 8188 4269 728 1020 375 2204 1913 297139 8341 4280 733 1094 369 2015 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. (b) 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 1915, 1916, 1917 and 1918, are the estimates of civil populations only. 8 TABLE C. Showing the Birth Rate (uncorrected) per 1,000 population, the General and Zymotic Death Rates (corrected) per 1,000 population, the Infantile Mortality Rates (corrected) per 1,000 total Births and per 1,000 total corrected Deaths, the Death Rate (corrected) for children under 5 years of age per 1,000 total corrected Deaths and the proportion of Deaths uncorrected in Public Institutions per 1,000 total uncorrected Deaths, in the Borough of Lambeth for the Year 1918 and for the Years 1911-1917, together with the averages for the two decennia 1891-1900 (Parish) and 1901-10 (Borough). The Year. Birth-Rate per 1,000 Population (uncorrected). Death-Rate per 1,000 Population (corrected.) Corrected Deaths of Children under 1 Year per 1,000 total Births. Deaths of Children under 1 year per 1,000 Deaths (corrected) Deaths of Children under 5 years per 1,000 Deaths (corrected). Zymotic DeathRate per 1,000 Population, (corrected.) Deaths in Public Institutions per 1,000 total Deaths (uncorrected.) 1918 217 189 703 907 1922 1.3 564 .0 1917 226* 15.3 75.1 123.8 209.4 1.1 577.9 1916 25.8* 14.8 70.8 134.1 202.8 0.9 558.1 1915 27.7 16.4 86.7 146.8 225.0 1.2 479.1 1914 27.6 14.4 88.9 170.5 238.9 1.3 475.6 1913 28.1 14.4 87.9 171.3 255.6 1.2 450.2 1912 27.4 13.2 73.2 152.3 233.6 0.9 446.9 1911 28.2 14.7 106.9 205.2 305.0 1.9 406.2 Averages— 1901-10 (Borough) 28.1 14.9 115.3 216.7 319.4 1.5 386.0 1891-1900 (Parish) 31 6 18.4 146.1 251.3 382.9 2.4 276.7 * N.B.—The birth-rate is calculated upon the special Borough populations estimated respectively for that purpose by the Registrar General for the years 1916, 1917 and 1918, viz., 308,702, 303,245 and 293,869. These populations are the civil populations plus all non-civilians enlisted from this country, whether serving at home or abroad, this non-civilian element being distributed over all the districts in proportion to their estimated civilian population. 9 BIRTHS, 1918. The total number of Births registered is 6,390, 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 70,889 births have been notified up to the end of 1918, viz. : 3,473 in 1908 (10 months), 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, 7336 in 1912, 7,158 in 1913, 7,397 in 1914, 7,091 in 1915, 7,293 in 1916, 6,311 in 1917, and 5,890 in 1918. 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. Systematic revisiting of infants is important. 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 will, naturally, be increased by systematic re-visiting, which is now being carried out, 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, for the purpose of checking the notification returns and vice versa. 10 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. The Registrar-General provides particulars of transferable births registered, and for 1918 his figures for the Borough of Lambeth are as follows :— Inward Transfers. Outward T ransfers. Legitimate Males 55 963 Legitimate Females 63 847 Illegitimate Males 18 213 Illegitimate Females 21 194 Totals 157 2217 The Registrar-General's corrected number of births is 4,737, differing slightly from the corrected number of births calculated locally and found in this Report, viz., 5,004. Lambeth Maternity and Child Welfare Scheme.* During 1918, the Lambeth Maternity and Child Welfare Scheme has continued to justify its inauguration on April 13th, 1916, the various voluntary centres carrying out useful work in the various areas allotted to them, such work being amalgamated and co-ordinated with the Council's Official Centre and Public Health Department. During 1918 a new voluntary centre was approved and opened in the Heme Hill Ward, known as the Loughborough Junction Maternity and Child Welfare Centre, whilst the Johanna Street Institute and School for Mothers has removed to larger premises situated in Oakley Street and known as the Barleymow Maternity and Child Welfare Centre. * In connection with the Scheme, the Council approved, during 1917, of the principle of making financial grants out of the Rates to the Voluntary Centres under certain conditions, and, during 1918, put into force throughout the Borough the Milk (Mothers and Children) Order, 1918, which was issued by the Food Controller on February 8th, 1918, under the Defence of the Realm Regulations, and the Local Authorities (Food Control) Order (No. 1), 1918, which was issued by the Local Government Board on the same date. 11 Municipal Milk Depot. (Inaugurated by the Council, 190J.) Record of Work carried out during 1918. 202 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk :— Under 3 months 92 9—12 months 17 3—6 months 56 Over 12 months and under 2 years 11 6—9 months 26 202 Of the 92 infants under 3 months, 9 were aged 14 days or under. These 202 infants and children (under 2 years) may be classified, as to their states of health at the time of being put upon the milk, as follows :—Healthy, i.e., showing no sign of wasting or disease, though often below par constitutionally 117, weakly 37, wasting 24, diseased 24. The diseases from which the 24 infants and children were actually suffering at the time of being put upon the milk were : Hernia 2, rickets, 1, otorrhoea 2, cleft palate 1, diarrhoea and sickness 1, diarrhoea 2, bronchitis 4. tuberculosis 1, measles 1, whooping cough 1, and indigestion 8. An average of 132 infants and children (under 2 years) were fed per week at the Depot, necessitating the distribution for the year of 218,338 bottles of milk mixture, whilst, in addition, milk was also supplied as follows :— 1. Lambeth Infirmary—using 43,977 bottles of milk mixture; 2. Lambeth Workhouse—using 3,078 bottles of milk mixture; 3. Invalids—using 1,554 pint bottles of milk mixture ; 4. Nursing mothers—using 3,430 pint bottles of milk ture ; 5. Children over 2 years of age—using 1,354 pint bottles of milk mixture. A total of 15,901 gallons of milk and 682 pints of cream were used during 1918. 12 Weekly medical consultations* with mothers were held at the Dept, 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 as required. 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. The Milk (Mothers and Children) Order, 1918 and the Local Authorities (Food Control) Order (No. 1), 1918 were in force throughout the Borough during 1918, from February 8th, when the Orders were issued, part of the milk being supplied from the Depot. DEATHS, 1918. The total number of deaths registered is 6,310. 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 III. of the Local Government Board (vide Appendix). All death rates for 1918 are calculated upon civil population (estimates). 1.—General Death-Rates. The uncorrected death-rate for Lambeth is 24.05 per 1,000 nhabitants. This rate is, however, uncorrected, and, on analysing the 6,310 total deaths registered, it is found that 2,158 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 796 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a net corrected number of deaths of 4,948, and a net corrected death-rate of 18.9 per 1,000 inhabitants, the increase being chiefly due to the "In connection with the Infants consultations at the Milk Depot, the Local Government Board has again given a financial grant in aid for the year 1918-19. 13 epidemic of influenza during the year (third and fourth quarters)—a total of 819 deaths from this disease being registered (first quarter 12, second quarter 11, third quarter 70 and fourth quarter 726). The diiferent districts are set out as usual in tabular form. Excluding the deaths from influenza, the death-rates (corrected or uncorrected) for the Borough are again satisfactory for the year 1918 (the eighteenth year of the existence of the Borough). The figures* (corrected) for 1918 are :— (a) Inner Districts—21.8 (excluding influenza 18.6 per 1,000 population). (b) Outer Districts—16.8 (excluding influenza 13.7 per 1,000 population). (c) Whole Borough— 18.9 (excluding influenza 15.7 per 1,000 population). Age Periods of Corrected Deaths. The 4,948 corrected deaths during 1918 may be further analysed, and tabulated as follows :— 449, i.e., 9.1 per cent.of the total corrected deaths took place under 1 year of age. 502, i.e., 10.1 per cent. between 1 and 5 years. 951, i.e., 19.2 per cent. under 5 years. 386, i.e., 7.8 per cent.between 5 and 20 years. 784, i.e., 15.8 per cent. 20 to 40 years. 1,003, i.e., 20.3 per cent. 40 to 60 years. 1,824, i.e., 36.9 per cent. 60 and over. 3,997, i.e., 80.8 per cent. over 5 years. *N.B.—The rates are calculated upon the civil populations (estimated), and the deaths of all members of the armed forces (whether serving at home or abroad) are excluded. 14 15 TABLE D (1). 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 1918. The deaths are from a11 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. Small Pox. Measles. Scarlet Fever. * Total Deaths (corrccted) from Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. j Diarrhcea. Total Zymotic Deaths Zymotic Death-rate p< 1000 of the Populatio (corrected). Diarrhoea Death-rate per 10000 of the Population (corrected) Lambeth Church 800 198 — 27 2 9 20 — 1 — — 20 79 1.9 4.9 Kennington 1036 247 — 33 5 7 13 — 1 — — 11 70 1.7 2.6 Stockwell* 1037 189 — 32 1 9 19 — 1 — — 12 74 1.3 2.2 Brixton 1215 17 .7 — 25 3 13 26 — 1 1 — 10 79 1.1 1.4 Norwood 860 14.1 — 10 — 7 7 — 1 — — 7 32 0. 5 1.2 Borough of Lambeth 4948 18.9 — 127 11 45 85 — 5 1 - 60 334 1.3 2.3 *Of the 1037 deaths in Stockwell Registration Sub-District, 538 belong to the Inner and 499 to the Outer Stockwell Sub-District respectively. Inner Registration Sub-Districts—death rates (general, 21.8, zymotic, 1.9, diarrhceal, 0 .39, per 1,000 population). Outer Registration Sub-Districts—death rates (general, 16.8, zymotic, 0.9, diarrhceal, 0.12, per 1,000 population). N.I3.—Of the total deaths (corrected), 64 shew no addresses, and have been include'd in Kennington Sub-District—having occurred in the Workhouse Infirmary (35), and in the Workhouse (29) respectively. 16 17 TABLE D (2). TABLE D (2). Shewing the corrected number of Deaths, with corrected Death-rates (general, zymotic and diarrhceal), in each of the Wards of the Borough during 1918. 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.) B. Wards. B. Wards. WARDS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Total Deaths (corrected) from Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. Diarrhoea. Total Zymotic Deaths. Zymotic Death-rate pel 1000 of the Population (corrected). Diarrhoea Death-rate per 10,000 of the Population (corrected). Marsh 383 19.8 — 16 2 3 9 — — — — 3 33 1.8 1.6 Bishop's 537 19.7 — 12 — 7 12 — 2 — — 13 46 1.7 4.3 Prince's 936 25.5 — 28 5 5 12 — — — — 20 70 1.9 5.4 Vauxhall 538 20.2 — 24 — 7 16 — — — — 6 53 19 2.2 Stockwell 499 17.7 — 10 1 3 3 — 1 — — 3 21 0.7 1.1 Brixton 722 18.4 — 14 1 6 9 — 1 1 — 6 38 0.9 6.5 Heme Hill 493 168 — 13 2 5 16 — — — — 5 41 1.4 1.7 Tulse Hill 434 157 — 5 — 4 6 — — — — 1 16 0.6 0. 4 Norwood 426 14.8 — 5 — 5 2 — 1 — — 3 16 0.5 1.0 Borough of Lambeth 4948 18.9 — 127 11 45 85 — 5 1 — 60 334 1.3 2.3 Inner Wards death rates per 1,000 population (general, 21.8, zymotic, 1.9; diarrhceal, 0.39). Outer Wards—death rates per 1,000 population {general, 16.8; zymotic, 0.9 ; diarræal, 0.12). N.B.—Of the total deaths (corrected), 64 show no addresses, and have been included in Bishop's and Prince's Wards, having occurred in the Workhouse Infirmary (35), and in the Workhouse (29) respectively. 18 Changes in Registration of Deaths. The Registrar-General decided to publish from January 1st, 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 1918 from the Registrar-General—a total of 82 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 1918 (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 1918 being as follows :— Age Periods. Males. Females. Totals. 0—1 1— 2 — — — 2—5 3 1 4 5—15 3 3 6 15—25 3 4 7 25—45 10 12 22 45—65 20 8 28 65 and upwards 8 7 15 Total all ages 47 35 82 19 Causes of the 82 Outside Deaths. Causes of Death. Male. Female. Cerebrospinal Fever — 1 Diphtheria 1 1 Puerperal Fever — 1 Influenza 5 2 Phthisis (Pulmonary Tuberculosis) 6 6 Other Tubercular diseases 1 1 Cancer, malignant disease 2 3 Heart disease 6 5 Bronchitis 1 2 Pneumonia 4 2 Broncho-Pneumonia 2 — Other Lung diseases 3 — Nephritis and Bright's disease 3 — Diabetes mellitus — — Violent deaths 1 2 Suicide 1 — Appendicitis — 1 Nervous diseases 1 3 Strangulated Hernia 1 — Diseases of Digestive System 4 — Syphilis — — Wound (gun shot, shrapnel or bomb, mine or torpedo) 2 1 Not classified above 3 4 47 35 2.—Infantile Mortality Rates. Of the 4,948 corrected deaths, 449 are infants under one year of age. The total number of registered births is 6,390, and, of these, 643 occurred at the Lying-in Hospital, and belong to districts outside the Borough, 118 occurred at the Workhouse and belong to districts outside the Borough, and 625 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 Institutional births) for the Borough is 5,004*. The corrected infantile mortality (i.e., rate of corrected deaths under one year per 1,000 corrected births) is, therefore, 89.7, 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 institutional 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 1918 as 4,737. 20 added. Taking the uncorrected births and the corrected deaths under 1 year, the infantile mortality rate is 70.3 per 1,000, the annual average for the decennium 1901-10 (Borough), being 114.8. Taking the uncorrected number of births (6,390), and the uncorrected number of deaths under 1 year of age (661), the uncorrected infantile mortality is 103.4. 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 whatever way the uncorrected infantile mortality rate is expressed statistically, it shows a remarkable decrease during recent year as compared with the decennium 1901-10. In the Registration Sub-Districts, the uncorrected infantile mortality varied from 59 9 per 1,000 births in Stockwell to 212 7 in Kennington, thus:— Total No. of Births (uncorrected) 1918. Total Deaths under 1 year (uncorrected). 1918. Infantile Mortality per 1000 births (uncorrected). 1918. Lambeth Church* 1981 142 71.7* Kennington† 879 187 212.7† Stockwell‡ 1720 103 59.9‡ Brixton 1054 154 1461 Norwood 756 75 99.2 Lambeth 6390 661 103.4 § Inner Districts—102 3, Outer Districts—105.05. 3.—Zymotic Death-Kates. 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 498—208 strangers belonging to other districts and 293 parishioners who died within the Borough ; whilst, in addition, 44 parishioners *Excluding all the Lying-In Hospital births, the rate is 126.9 †Excluding all the Workhouse births, the rate is 304.6. ‡Excluding all the Maternity Hospital births, the rate is 117.8. §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. 21 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 334, giving a zymotic death-rate (corrected) of 1.3 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., 1.9 as compared with 0.9 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 1917 and 1918 are given in terms of the total deaths (corrected) in Table E, whilst Table E gives also the corrected 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 1918 is 2.05, i.e., 538 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis) death-rate, 1.5, i.e., 401 deaths from pulmonary tuberculosis or consumption (phthisis) per 1,000 population. The details of the tuberculosis deaths in the various Registration Sub-Districts are:— Registration Sub-Districts. Corrected Deaths from Pul. Tub. or Phthisis (consumpt'n) Other Forms Tuberculosis. Total Deaths Tuberculosis (all forms) Phthisis-rate per 1,000 population. Tuberculosis rate per l,000 population. Lambeth Church 67 31 98 1.6 2.4 Kennington 97 29 126 2.3 3.0 Stockwell 92 18 110 1 .7 2.0 Brixton 97 36 133 1.4 1 .9 Norwood 48 23 71 0.8 1.2 Borough of Lambeth 401 137 538 *1.5 2.05 Rates for Inner Districts 1.9* and 2-6f. Rates for Outer Districts ... 1 -2* and 1 l\. Ten of the total corrected deaths registered from tuberculosis (9 from phthisis or the pulmonary form) shew no addresses and have been included in Kennington Sub-District as Workhouse and Workhouse Infirmary deaths. 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 vears. *t 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. 22 TABLE E. Shewing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1917 and 1918. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease. Borough 1917. Borough 1918. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). I.—Zymotic Diseases 419 10.05 1210 24.4 Seven Principal 295 7.1 334 6.7 Influenza 56 1.3 819 16.5 II.—Parasitic 2 0 .05 2 0.04 III.—Dietetic 5 0.1 2 0.04 IV.—Constitutional 996 23.9 1013 20.5 Cancer 363 8.7 392 7.9 Phthisis 411 9.9 401 8.1 Tubercular Diseases, excluding Phthisis 139 3.3 137 2.8 Rheumatism (Acute and Chronic) and Gout 23 0.5 21 0.4 V.—Developmental 287 6.9 264 5.3 Old Age 166 3.9 169 3.4 VI.—Local Diseases 2212 53.1 1427 28.8 Circulatory System 636 15.2 571 11.5 Bronchitis 322 7.7 321 6.5 Pneumonia and Broncho-Pneumonia 297 7.1 393 7.9 Pleurisy and pleuropneumonia 94 2.2 120 2.4 Respiratory System,excluding Phthisis 770 18.5 883 17.8 VII.—Violence 178 4.3 153 3.1 Suicide 22 0.5 25 0.5 VIII.—Ill-defined and not Specified Causes 69 1 .6 54 1.1 23 TABLE E.—continued. B. — Deaths (corrected) of Infants under One Year of age from the chief infantile diseases, and from all causes, expressed in terms of 1000 births (corrected). Borough 1917. Borough 1918. Total Deaths under One Year (Corrected). Proportion to 1000 Births (Corrected).* Total Deaths under One Year (Corrected). Proportion to 1000 Births (Corrected).* From all causes 516 98.6 449 94.8 Diarrhoea 56 10.7 35 7.4 Convulsions 11 2.1 17 3.6 Respiratory Diseases 111 21.2 90 18.9 Premature Births 89 17.01 72 15.2 Tubercular Diseases (including Phthisis) 17 3.2 16 3.4 Measles 18 3.4 25 5.3 Whooping Cough 10 1.9 22 4.6 Suffocation in Bed 12 2.3 6 1.3 Enteritis 6 1.1 18 3.8 Dentition 4 0.8 — - *N.B.—The above rates have been calculated upon the Registrar-General's corrected numbers of births. 24 TABLE F. Shewing the number of Deaths (corrected) from the 7 principal zymotic diseases in the Borough of Lambeth during 1918 and during the five previous years 1913-17, together with the yearly averages during the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). Disease. 1913. 1914. 1915. 1916. 1917. Total (corrected) Deaths in 1918. Annual average of ten years 1901-1910 (Borough). Annual average of ten years 1891-1900 (Parish). Smallpox — — — - 6.8 1.1 Scarlet Fever 14 16 17 7 6 11 31.4 48.8 Diphtheria 36 50 45 41 48 45 41.6 124.5 Membranous Croup 1 — — - — — 1.5 6.8 Fever. Typhus — — — - — — 0.0 0.3 Typhoid or Enteric 7 15 9 1 3 5 16.7 34.7 (Continued and Relapsing — — — - 1 1 0.7 1.7 Diarrhœa 166 196 124 105 91 60 172.9 196.5 Cholera — — — — — — 1.3 8.8 Measles 98 58 91 49 108 127 110.4 145.6 Whooping Cough 47 40 49 45 38 85 91.8 143.7 Borough of Lambeth 369 375 335 248 295 334 475.1 706.1 25 INFECTIOUS DISEASES. 1.—Notifiable Diseases. Under the Compulsory Notification Clauses of the Public Health (London) Acts, 1891, and the Orders and Regulations made thereunder, 4,683 cases of infectious diseases (excluding tuberculosis) were reported, including small pox 1*, cerebro-spinal fever 23, poliomyelitis acuta 1, ophthalmia neonatorum 50, measles 2,721, and German measles 402. These 4,683 cases occurred in 4,200 infected houses, and of the 4,683 cases 1,188, i.e., 25.4 per cent, were removed to hospital, and 3,495, i.e., 74.6 per cent., remained under treatment in their homes. If the recently-added notifiable diseases be excluded so as to make the 1918 figures strictly comparable with those for previous years, the percentage of cases removed to hospital during 1918 was 88.4, 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 † Full particulars of all the compulsory notifiable infectious diseases are to be found in tabular form. Nursing in connection with Measles, German Measles, Whooping Cough, Ophthalmia Neonatorum and Epidemic Diarrhoea cases. Arrangements were made by the Council with the South London District Nursing Association and the Ran yard Nurses for the nursing, free of cost, of patients notified or otherwise known to be suffering from Measles and German Measles, Whooping Cough, Ophthalmia Neonatorum and Epidemic Diarrhoea, if (and as) required by the Medical Officer of Health, and came into force on June 1st, 1918, being limited for the present, as an experiment, to the Inner Wards of the Borough. Every case of Measles and German Measles and Ophthalmia Neonatorum, when notified, is officially visited and such precautionary measures are taken in connection therewith as may be found necessary, including, in the case of Measles and German Measles, the systematic exclusion of non-protected contact children (i.e., children who have not previously had the disease) and all contact children under 5 years of age from schools, or, if desirable, the closing of an individual class room or class rooms. 0135‡ There is no interference with medical treatment by the Council's Officers, but medical attendance is advised in all cases, and nursing, free of cost in suitable case* as required. * The smallpox case was a sporadic case (source not traced). † Arrangements have been made during 1918 for the reception and treatment of cases of Ophthalmia Neonatorum at St. Margaret's Hospital, Leighton Road, Kentish Town, N.W. 5. ‡ During 1918, 59 Schools (63 class rooms) were dealt with, 671 children being excluded from the Infants' Departments in connection with 80 Measles cases reported, and 1 Private School was closed owing to the same disease having broke out amongst the scholars. 26 27 TABLE G. Shewing the total numbers of cases of infectious diseases notified compulsory by Medical Practitioners jnder the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, in the Borough of Lambeth, during 1918, together with the total numbers of deaths registered from the same diseases, the case mortality per 100 persons for each disease, the numbers of cases removed to hospital, and the numbers of infected houses. Cases notified. Deaths registered. Case Mortality per 100. Cases removed to hospital. Infected houses. Per cent, of cases removed. Cholera - - _ — — — Smallpox 1 - 0.0 1 1 100.0 Scarlet Feve 549 11 2.0 511 477 93.1 Diphtheria 484 45 9.3 466 422 96.3 Membranous Croup 9 — 0.0 9 9 100.0 Typhus — — — — — — Typhoid or Enteric 15 5† 33.3 14 14 93.3 Continued and Relapsing Fever — 1 — — — — Erysipelas 105 4 3.8 32 99 30.5 Puerperal Fever 16 10 62.5 9 16 56.3 * Plague — — — — — — *cerebral-spinal Fever 23 10 43.5 17 17 73.9 *Poliomyelitis acuta % 1 0.0 1 1 100.0 *Ophthalmia Neonatorum 50 0.0 - 50 0.0 *Whooping Cough — 85 _ - — — *†Measles 2,721 127 4.7 117 2,471 4.3 *†German Measles 402 — 0.0 4 340 1.0 *Tuberculosis— - Pulmonary (primary) 1061 401 37.8 — 1,061 - Non-pulmonary (primary) 361 137 37.9 — 361 - *Chicken pox 307 - 00 7 283 2.3 N.B.—A case of Typhus (male, 2£ years) was removed to Hospital, where it was found to be a case of Zymotic Enteritis. * Plague was made compulsory notifiable on September 19th, 1900, cerebral-spinal Fever on March 12th, 1907, Poliomyelitis acuta on September 1st, 1911, Ophthalmia Neonatorum on March 13th, 1911, and Tuberculosis (all forms) on February 1st 1913. Chicken-pox was compulsory notifiable as follows : 1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), 1911 (March 22nd to June 22nd), 1915 (March 17th-to June 30th), and 1918 (March 27th to June 30th), the numbers of cases notified being respectively. 1,560, 40, 556, 238, 473 and 307. Whooping Cough was compulsory notifiable from January 1st, 1913, to December 31st, 1917, the numbers of cases notified being as follows:—1913, 1.428; 1914, 1,389 ; 1915, 1,607 ; 1916, 1,576 ; and 1917, 902. Measles and German Measles became compulsory notifiable on January 1st, 1916. † Including 24 Military Measles (21 soldiers and 3 nurses), and 13 Military German Measles cases (6 soldiers and 7 nurses). 40 Measles cases were notified by parents (or relatives), in addition to the above. I Including two deaths in outlying Institutions (Asylums), the cases not being notified to Lambeth as the disease (typhoid) was in each instance contracted at the Institution; away, from Lambeth. ¶ Death registered as due to "pyrexia" (origin uncertain), but classified by the Registrar-General as a case of "continued fever." The patient was not notified officially. 28 29 TABLE G (1). Shewing the number of medical Certificates for the compulsory Notifiable Infectious Diseases under the notification clauses of the Public Health (London) Act, 1891, or the Orders and Regulations made thereunder, received in the Borough of Lambeth during 1918 and during the five years 1913-1917, together with the averages for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). Disease. Borough of Lambeth. Annual Average, 1901-10 (Borough) 10 years. Annual Average, 1891-1900 (Parish) 10 years. 1913. 1914. 1915. 1916. 1917. 1918. Cholera - 0.2 11.5 Smallpox — — — — •— 1 49.9 22.0 Scarlet Fever 1,370 1,745 900 501 340 549 1105.1 1331.3 Diphtheria 385 550 434 432 563 484 379.8 715.1 Membranous Croup 7 6 4 4 7 9 10.4 26.2 Typhus - - - - - - 0.1 1.1 Typhoid or Enteric 38 48 32 19 17 15 100.5 189.6 Continued and Relapsing 2 2 — — 3 — 4.1 25.7 Erysipelas 206 231 177 122 130 105 241.4 347.0 Puerperal 25 23 26 20 14 16 17.0 18.9 * Plague - - * Cerebrospinal Fever 7 5 44 38 31 23 11.5 - * Poliomyelitis acuta 6 10 4 12 9 1 - - *Ophthalmia Neonatorum 57 57 73 83 67 50 - - *Whooping Cough 1,428 1,389 1,607 1,576 902 - - *Measles - 2,548 3224 2721 - - *German Measles - _ - 1,212 1241 402 - - *Tuberculosis— Pulmonary (primary) 1,571 1,250 1,020 904 1,086 1061 Non-pulmonary (primary) 456 273 298 362 444 361 *Chicken-pox - - 473 — — 307 - - * Plague was made compulsorily notifiable on September 19th, 1900; Cerebro Spinal-Fever ("Spotted Fever") on March 12th 1907; Poliomyelitis acuta on September 1st, 1911; Ophthalmia Neonatorum on March 13th, 1911; Pulmonary Tuberculosis (Poor Law-cases) on Jan. 1st, 1909, Pulmonary Tuberculosis (Hospital cases) on May 1st, 1911, Pulmonary Tuberculosis (Private cases) °n Jan 1st, 1912, and Tuberculosis (Pulmonary and Non-pulmonary) on February 1st, 1913. Chicken-pox was compulsorily notifiable as follows:—1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), 1911 (March 22nd to June 22nd), 1915 (March 17th to June 30th), and 1918 (March 27th to June 30th). Whooping Cough was compulsorily notifiable from Jan. 1st, 1913, to December 31st, 1917, the numbers of cases notified being as follows:—1913 1 428 1914, 1389; 1915,1607; 1916, 1,576 ; and 1917, 902. Measles and German Measles became compulsorily notifiable on January 1st 1916. N.B. -of the patients removed to Hospital, the following were reported not to be suffering from the diseases notified:- Scarlet fever 9 ; diphtheria 3 ; typhoid or enteric 2; cerebro-spinal fever 2 ; measles 1; and typhus 1. 30 METROPOLITAN BOROUGH OF LAMBETH. TABLE Public Health (Tuberculosis) Summary of Notifications received daring the period from the 28th Age-Periods. Number of Notifications on Form a. Primary Notifications. (Medical.) *Total Notifications (i.e., including cases previously notified by other Doctors). (Medical.) 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. upwards. Total. Pulmonary— Males 1 3 20 15 48 90 195 175 90 37 12 686 747 Females — 4 18 21 32 52 85 69 49 12 9 351 376 Non-Pulmonary— Males 3 23 64 23 20 20 16 14 5 3 191 196 Females 1 19 47 30 12 10 7 6 3 2 2 139 145 * Re-notifications (Form A) = 86 (males 61, females 25), pulmonary and 11 † Re-notifications (Form B) = 2 (male 0), (female 2), non-pulmonary. N.B.—Pulmonary—262 private, 430 hospitals, 345 dispensaries, 0 Poor Law A and B). Non-Pulmonary—37 private, 105 hospitals, 188 dispensaries, 0 Poor Law B). 31 H. Regulations, 1912. 30th December, 1917, to the end of the week ending December, 1918. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications (Medical.) fTotal Notifications (i.e., including cases previously notified by other Doctors). (Medical.) Cases admitted to Cases discharged from J Under 5. j 5 to 10. 10 to 15. Total. Poor Law Institutions. Sanatoria Poor Law Institut ons. Sanatoria. (Medi cal ) (Medi cal.) i 11 1 13 13 2 135 2 109 — 7 4 11 11 4 85 1 92 3 10 3 16 16 6 6 3 7 — 12 3 15 15 10 20 8 11 (males 5, females 6) non-pulmonary. Officers and 24 schools = 1061 total primary notifications (Forms Officer and 31 schools = 361 total primary notifications (Forms A and 32 METROPOLITAN BOROUGH OF LAMBETH. TABLE H (1). Public Health (Tuberculosis) Regulations, 1912. Summary of Notification Certificates (Forms A, B, C, D,) received during the period from December 30th, 1917, to the end of the week ending December 28th, 1918. Wards. 1918. Tuberculosis (All Forms.) Pulmonary. Non-Pulmonary. A. B. C. D. A. B. C. D. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium.  Marsh 156 165 6 6 — 19 — 20 44 45 8 8 — 1 — Bishop's 111 118 6 6 2 13 — 19 41 42 7 7 13 9 5 8 Prince's 115 123 7 7 1 36 — 29 31 34 8 8 1 1 1 — Vauxhall 83 87 4 4 — 18 — 13 19 22 3 3 .— 1 — — Total Inner Wards 465 493 23 23 3 86 81 135 143 26 26 14 12 6 8 Stockwell 114 126 - - - 24 1 25 41 42 - - — 5 1 4 Brixton 191 204 1 1 1 34 1 32 45 46 1 1 2 5 1 2 Herne Hill 102 112 - - - 18 - 19 31 31 1 1 — 1 — 1 Tulse Hill 78 86 - - - 24 i 21 39 39 - - — 2 — — Norwood 87 102 - - 2 34 - 23 39 40 3 3 — 1 3 3 Total Outer Wards 572 630 1 1 3 134 3 120 195 198 5 5 2 14 5 10 Borough of Lambeth 1037 1,123 24 24 6 220 3 201 330 341 31 31 16 26 11 18 33 METROPOLITAN BOROUGH OF LAMBETH. TABLE H (2). Public Health (Tuberculosis) Regulations, 1912. Summary of Notification Certificates (Forms A, B, C, D,) received during the period from December 30th, 1917, to the end of the week ending December 28th, 1918. Registration Sub-Districts. 19180. Tuberculosis (All Forms). Pulmonary. N on-Pulmonary. A. B. C. D. a. B. C. D. Forms Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law Sanatorium. Waterloo 156 165 6 6 - 19 - 20 44 45 8 8 - 1 - - Lambeth Church 85 92 6 6 - 8 - 15 35 36 7 7 - 9 - 5 Kennington 141 149 7 7 3 41 - 33 37 40 8 8 14 1 6 3 Stockwell (Inner) 83 87 4 4 - 18 - 13 19 22 3 3 - 1 - - Total Inner Districts 465 493 23 23 3 86 - 81 135 143 26 26 14 12 6 8 Stockwell (Outer) 114 126 - - - 24 1 25 41 42 - - - 5 1 4 Brixton 293 316 1 1 1 52 1 51 76 77 9 2 2 6 1 3 Norwood 165 188 - - 2 58 1 44 78 79 3 3 - 3 3 3 Total Outer Districts 572 630 1 1 3 134 3 120 195 198 5 5 2 14 5 10 Borough of Lambeth 1,037 1,123 24 24 6 220 3 201 330 341 31 31 16 26 11 18 34 35 TABLE I. Lambeth Municipal Tuberculosis Dispensaries Scheme. (Inaugurated by the Council, 1912.) Local Government Board Table—FORM R. Return as to Work carried out in connection with the Two Tuberculosis Dispensaries (Central and Branch) for the Period from January 1st to December 31st, 1918. Central Dispensary. Branch Dispensary. Totals. Insured. Uninsured. Insured. Uninsured. Males. Females Childr'n under 16. Adults. Males. Females Childr'n under 16. Adults. Males. Females. Males. Females. 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensaries 289 75 146 69 108 259 158 333 40 131 1608 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 136 34 15 30 28 92 44 10 14 36 439 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 10 5 56 1 2 14 6 56 1 11 162 (d) Number included under 1 (a) who were found to be non-tuberculous* 61 9 55 10 41 69 40 67 16 43 411 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 82 27 20 28 37 84 68 200 9 41 596 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) ) 2358 5903 3058 3711 15030 (b) Number of the above attendances at which systematic physical examinations and records were made 555 762 1002 1434 3753 3. Number of visits to patients at their own homes by the Dispensary Medical Officers in connection with the supervision of home conditions † - - - - - 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 "‡ 220 371 989 984 2564 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 14 9 93 141 257 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 3 1 - - 4 (c) Practitioners at the homes of patients - 2 - - 2 7. Number of written reports concerning individual patients made to— (a) Public Authorities 517 226 706 177 1626 (b) Practitioners 471 183 172 118 944 8. Number of specimens examined 236 146 120 118 620 N.B.—The above table is prepared by the two Dispensary Tuberculosis Officers. * From physical signs. † Under the Lambeth Scheme, the Tuberculosis Medical Officer connected with the Branch Dispensary (St. Thomas's Hospital) does not visit at the patients' own homes, such visit to be paid, as required, by the Medical Officer connected with the Central Dispensary (73 Effra Road, Brixton). ‡ The figures for the Central Dispensary are visits paid by the Council's Official Tuberculosis Nurse attached to the dispensary, and those for the Branch Dispensary are visits paid by visitors attached to the Lady Almoner's Department of St. Thomas's Hospital in connection with Dispensary patients' homes. Other visits, in addition, were made during 1918 by the Council's Official Health Visitors to houses, wherein tuberculous persons were notified, as follows:—(a) area covered by the Central Dispensary. 934; (b) area covered by the Branch Dispensary, 832, making a total of 1766 (1360 visits and 406 re-visits). 36 J. TABLE Lccal Government Board Table. BOROUGH OF LAMBETH. - Particulars of cases of acute polio-myelitis, (polio-encephalitis) and cerebro-spinal fever, of Lambeth, during 1918. notified within the Borough Total number of Cases notified. CASES (excluding Military Cases). NUMBER OF 0-1 year. 1-5 years. 5-10 years. 10-15 years. 15-20 years. 20-30 years. Over 30 years. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 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 Paralvsis.* Cases. Deaths. | Permanent Paralvsis.* Cases. Deaths. | Permanent Paralysis.* Cases. Deaths. | Permanent Paralvsis.* Cases. Deaths. * in V) 'aj i-i PH +-» c <L> C a3 B t- o Cases. Deaths | Permanent Paralysis.* | Cases. Deaths. | Permanent Paralysis.* | Cases. Deaths. | Permanent Paralysis.* | †Acute Polio-myelitis (Polio-encephalitis) 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ‡Cerebro-Spinal Fever 15 1 1 - 2 2 - 1 1 - 4 2 - 1 1 - 2 1 - 1 1 — - - - - - - - - - 1 - - 1 1 - - - - 1 - - Number of cases removed to Isolation Hospital. *i.e.,Recovered with permanent Paralysis of one or more groups of muscles. †Acute Polio-myelitis (Polio-encephalitis) — — - 1 - - - - - - - - ‡Cerebro-Spinal Fever 1 1 1 3 1 2 1 - - - 1 1 - 1 spinal meningitis (4 " carriers ") notified. All the military cases were treated N.B. There were, in addition, during 1918, 8 military cases of cerebro- in hospital, and all recovered. 37 38 2.—Non-Notifiable Diseases. Chicken pox. 1,021 cases of chickenpox were notified voluntarily, in addition to the 307 cases notified compulsorily under the Act, during the period from March 27th to June 30th, 1918, inclusive. Diarrhœa. There has been a marked decrease in the number of corrected deaths registered from diarrhoea—60, as compared with yearly averages of 191.6, 219.4, 208.6, 140.2 and 178.2 during the five quinquennia 1891-1895, 1896-1900, 1901-1905, 1906-1910 and 19111915, respectively. Of the 60 deaths registered during 1918, 48, i.e., 80 per cent., occurred amongst children under 5 years of age and 35, i.e., 58.3 per cent., amongst infants under 1 year of age. The 4 ft. earth thermometer first registered 56° F. on June 14th, rising to a maximum of 61° F. on August 23rd and remaining at such maximum until September 3rd, and sinking to 56° F. again on October 4th. The readings of the 4 ft. earth thermometer were taken in Regent's Park, and the information was obtained through the courtesy of the Secretary of the Royal Botanical Society. 46 corrected deaths (18 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 at the Infants Consultations Centre held at 66, York Road, and at the various other Welfare Centres, which form the Lambeth Maternity and Child Welfare Scheme; 39 (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. (d) Feeding of Infants and young children at the Municipal Milk Depot, 66, York Road. INFLUENZA. A serious and wide-spread epidemic occurred throughout the Borough, especially during the 3rd and 4th quarters of the year, as shewn by a total of 819 deaths (corrected), certified as due to that particular disease. Arranged quarterly, the mortality figures, are:—1st Quarter, 12; 2nd Quarter, 11; 3rd Quarter, 70; 4th Quarter, 726; Total, 819. Of these 819 deaths, 75, i.e. 9.1 per cent., were in persons under 5 years of age, and 20, i.e. 2.4 per cent., in persons under 1 year of age. The highest mortality was in the age-period 25 to 40 years, viz., 267, i.e. 32.6 per cent., whilst the age periods 45 to 60 years and over 60 years also suffered severely, viz., 125 and 142, i.e. 15.3 per cent, and 17.3 per cent, respectively. The full details of the age and sex distribution of the disease areas follows:— Under 1 Year. 1 to 2 2 to 5 Under 5 Years. 5 to 15 15 to 20 20 to 25 25 to 40 m. f. m. f. m. f. m. f. m. f. m. f. m f. m. f. 15 5 8 8 21 18 44 31 33 23 19 38 17 43 19 166 40 to 45 45 to 60 60 to 65 65 and over. Over 5 Years. All Ages. Total. m. f. m f. m. f. m. f. m f. m. f. 819 15 22 61 64 14 21 42 65 302 442 346 473 40 The sexes appear to have suffered equally, taking into consideration the estemated male and female populations (108,005 and 154,270 respectively). The disease was wide-spread throughout the Borough generally, and the Inner, more crowded, districts practically suffered as much as the Outer, less crowded, districts, viz.:—3.2 as compared with 3.0 per 1,000 of the estimated population—the rate for the whole Borough being 3.1. The rates for the different Registration Sub-Districts are as follows:—Lambeth Church, 2.4; Kennington, 3.8; Stockwell, 3.8; Brixton, 2.9 and Norwood, 2.8. The rates for the different Wards are as follows:—Marsh, 2.2; Bishop's, 3.5; Princes', 3.3; Vauxhall, 3.5; Stockwell, 4.0; Brixton, 3.1; Heme Hill, 2.5 ; Tulse Hill, 3.3 and Norwood, 2.3. The weekly corrected deaths from Influenza are set out in tabular form. The disease appeared in three forms (a) nervous, (b) catarrhal (bronchitis and pneumonia), and (c) gastric, but the catarrhal form was the commonest. In several cases, the Pfeiffer bacillus, the pneumococcus and the streptococcus were isolated, and it is presumable that these particular germs, separately or together, were the causes of the disease, the fatal cases being chiefly due to the pneumonic form (one of the catarrhal forms). Second attacks of the disease were very few (if any) and infection appeared to be virulent during the first few hours (lasting in a less virulent form up to 2 days) of the disease, being spread from person to person as shewn by the many instances in which several members of the same household were affected at the same time, as well as many persons working together in the same business, factory or workplace. The disease is not compulsarily notifiable, so that no statistics are available as to the total number of cases of Influenza that has occurred during the year, but, judging from the number of deaths, the number of persons affected must have been very large. 41 Individuals have difficulties of preventive treatment in their homes, and Public Authorities have difficulties of administration, in dealing with an Influenza Epidemic, on account of the very short incubation period of the disease (48 hours) and the rapidity with which the disease spreads from person to person (through the secretions of the respiratory surfaces during the process of coughing, sneezing and even loud talking). The ordinary means of prevention do not apply in the sense that they apply to a disease like smallpox, or scarlet fever or diphtheria, viz.—(a) notification,) isolation in a hospital, (c) disinfection and (d) medical inspection of contacts. It must rather be left to the individual to apply such measures to himself or herself, and his, or her, immediate surroundings—what may be termed personal or individual preventive measures, leaving to the Public Authorities, the educational side and the preventing of overcrowding in public places, vehicles, schools, etc., as well as in private premises used as common lodging houses and dormitories, etc., and the arranging for the proper ventilation, at stated intervals, of all such public, or quasi-public, places. The Local Government Board introduced Orders, with a view to such ventilation being effected, known as the Public Health (Influenza) Regulations, 1918, and the Public Health (Influenza) Regulations (No. 2), 1918, under which it is provided that, where the public are admitted to a place of public entertainment (as defined in the Regulations), the entertainment shall not be carried on for more than 3 hours consecutively, except in the case of cinematograph exhibitions, where the period may be extended to 4 hours; and that there shall be an interval of not less than 30 minutes between any two entertainments given at a place of public entertainment (as defined in the Regulations) to which the Public are admitted, such interval to be for the purpose of the premises being effectually and thoroughly ventilated.* Power is given to a Public Authority to relax, on the written advice of the Medical Officer of Health, the Regulations in regard to the aforesaid provisions.) Further, the Regulations also provide (an important provision that, in the case of cinematograph exhibitions, children from a district wherein a public elementary school has been temporarily closed on account 42 of the prevalence of Influenza, shall not be admitted to such exhibition in that particular district during the continuance of the closure of any such school. The Regulations came into force on 25th November, 1918, and continue in force until revoked by Order of the Board, and apply to England and Wales, presumably only when Influenza is epidemic.* School closure, or exclusion of children from school, exclusion from or closure of places of public entertainment, exclusion from occupations, provision of proper nursing and medical assistance, and of the more recently introduced domestic assistance or home help, are also matters that fall amongst the duties of Public Authorities in connection with the carrying out of preventive measures to be taken in dealing with Influenza Epidemics. An authoritative statement by the Royal College of Physicians of London, dealing with Influenza, was issued under date of November, 1918, and adopted officially by the Local Government Board and circulated as such, together with certain other Papers on the same subject, amongst all Medical Officers of Health. The administrative measures set out above were those adopted in the Borough of Lambeth, during 1918, together with disinfection as/when required, though rigid measures of disinfection do not appear to be called for in this disease—the infection being unstable. Precautionary advice was freely distributed to the Public through the Press and otherwise. *A practical difficulty has arisen as to the carrying out of this" effectual and thorough" ventilation. Can it be carried out whilst the audience remains indoors, or must the room or rooms be cleared first ? Another difficulty is in connection with the interpretation to be put on the Regulations. Are they to be administered in a District wherein only a few cases of Influenza are officially known to exist? 43 DEATHS (corrected) from INFLUENZA. (Arranged Weekly). 1918. 1918. W eek-ending. Week-ending. Jan. 5 1 July 6 11 12 3 13 17 19 — 20 14 26 — 27 13 Feb. 2 — Aug. 3 5 9 — 10 3 16 — 17 3 23 — 24 — 31 2 Mar. 2 2 9 1 Sept. 7 1 16 2 14 1 23 1 21 30 2 28 — April 6 1 Oct. 5 13 2 12 3 20 — 19 20 27 2 26 68 May 4 1 Nov. 2 121 11 — 9 142 18 — 16 114 25 1 23 86 June 1 30 90 8 1 Dec. 7 43 15 — 14 23 22 — 21 12 29 3 28 4 Total 819 N.B.—It must be remembered that, on the one hand, amongst the deaths registered from Influenza, some are due to other causes as well, e.g., lung diseases, phthisis, heart disease, old age, etc., whilst, on the other hand, many deaths registered from lung diseases are, in reality, deaths due to the sequelae of Influenza. 44 Botulism. An outbreak of ill-defined infectious disease at the Lambeth Infirmary, during the early part of the second quarter of the year, gave rise to suspected botulism. Marked meningitic symptons appeared, but no micro-organisms were discovered. The outbreak was limited, fortunately, to 6 cases, brought to the Infirmary from various parts of the Borough. The initial symptoms were characterised by general malaise, fever, headache, vomiting and lethargy, pains in limbs, and marked sweating. The acute stage lasted 3 to 5 days and depression and weakness were marked after effects. 3.—" Contacts " or " Suspects " and " Convalescents " (Military). Many "Contacts" or "Suspects "and" Convalescents" (military) were watched in connection with different diseases as follows:— (a) Cerebro-spinal or "Spotted" fever (epidemic cerebrospinal meningitis), 2. (b) Enteric or Typhoid Fever, 1. (c) Plague, 2. (id) Dysentery, 21. (e) Malaria, 140. (/) Measles, 1. (g) Smallpox, 6. (h) Typhus, 1. (i) Geneial Infectious Diseases, 5.* * Civilian passengers and civilian prisoners of war from Russia, Norway and Germany respectively. 45 Municipal Bacteriological Laboratory. (Inaugurated by the late Vestry 1899.) Table shewing the numbers of pathological samples examined and the results obtained, at the Bacteriological Laboratory during 1918 and the previous 6 years 1912-1917, together with the averages for the 10 years 1901-1910 (Borough). Year. Sputa. Suspected Tuberculosis. Tub.Bac.found. Blood. Suspected Typhoid or Enteric Fever. Reaction obtained. Throat & Nose. Membranes and Secretions. Suspected Diphtheria. Klebs-Lceffler Bac. found. Other Sundry Samples. Result obtained. Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 1918 70 299 369 2 10 12* 14 354 368 — 2 2† 1917 77 363 440 4* 9 13 32 468 500 2 8 10 1916 126 346 472 5 23 28 33 407 440 — 6 6 1915 155 390 545 12 34 46 99 937 1036 8 24 32 1914 411 733 1144 14 28 42 108 730 838 6 12 18 1913 614 870 1484 12 35 47 130 867 997 18 19 37 1912 296 305 601 31 26 57 55 442 497 12 10 22 Average of 10 years 1901-1910 (Borough) 62.8 124.4 187.2 19.4 39.6 59.0 36.6 448.6 485.2 3.7 9.1 12.8 * Two of the cases were paratyphoid B. † 2 samples of urine for suspected tubercle bacilli (both negative). 43 vials of antitoxin were distributed free of cost during 1918, under the Antitoxin Order, 1910. N.B.—Since the Bacteriological Laboratory was inaugurated in 1899 (up to the end of the year 1918), 21,115 examinations have been conducted there in connection with the following suspected diseases, viz.:—tuberculosis, 7,832; typhoid or enteric fever,1,129; diphtheria, 11,840; and others, 314. 46 47 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1918 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Scarlatina. Diphtheria. Fever Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cerebro-Spinal and Poliomyel. Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. (a) (b) (c) (d) (e) (/) (g) (h) (i) (j) (k) Royal Infirmary (Women and Children) 82 36 10 13 4 5 8 5 1 Under 5 - - - - - 3 - 7 - - 16 - - 1 1 - 31 59 5 upwds. - - - - - - - - - 1 2 2 6 1 - - 11 23 King George Hospital 336 — — — 1 148 176 11 - Under 5 — - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - 9 11 3 75 216 1 21 336 General Lying-in Hospital, York Road 27 19 1 1 - - 6 - — Under 5 - - - - - - - - - - - - - 1 1 - 19 21 5 upwds. — - 1 - - - - - - - - - 1 - - - 5 6 St. Thomas's Hospital 553 41 26 36 69 49 135 136 61 Under 5 - 8 - _ - - 1 2 _ 1 19 - - 13 5 1 53 103 5 upwds. 7 2 1 1 14 36 22 18 63 - 27 259 450 Remainder of Lambeth Church 392 46 28 36 18 22 76 92 74 Under 5 - 1 - — - 18 6 4 — 1 34 - 9 8 — - 29 110 5 upwds. - — — — - 1 1 — — 23 60 40 63 29 — — 65 282 Lambeth Workhouse 71 — — — — 1 4 15 51 Under 5 - - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - l3 13 39 — — — 6 71 Lambeth Infirmary 1556 152 102 77 56 85 256 366 462 Under 5 _ 1 - - 2 61 62 30 - 3 81 _ 4 2 2 _ 83 331 5 upwds. - - 5 1 5 1 —- — 6 185 120 240 127 39 1 4 491 1225 St. Peter's House 74 - - - - - - 7 67 Under 5 - - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - 12 1 26 — — — 35 74 Remainder of Kennington 367 35 35 27 16 23 62 80 89 Under 5 1 - - - - 26 7 2 - - 30 _ 11 1 - _ 19 97 5 upwds. - - - - - 1 - - - 24 67 32 75 5 1 - 65 270 'South-Western Hospital 122 9 12 40 47 6 6 2 - Under 5 9 35 - - - 8 3 1 _ _ 3 _ - - - - 2 61 5 upwds 7 28 2 4 — 2 — - — — 3 — 3 — 7 — 5 61 Clapham Maternity 23 20 — — — 2 1 — - Under 5 - - - - - - - - - - 1 - - - - - 19 20 5 upwds. - - - - - - - - - - - - - - - - 2 3 Remainder of Stockwell 629 74 34 41 27 61 92 129 171 Under 5 - 1 - - - 18 13 7 - 1 40 - 24 1 1 - 43 149 5 upwds 1 1 — - — 1 2 - — 55 78 53 128 5 - 1 155 480 48 49 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1918 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cerebro-Spinal and Poliomyel Appendicitis. All other Diseases. Total. Puerperal. Continued. Enteric or Typhoid. (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) King's College Hospital 210 29 12 19 34 23 32 42 19 Under 5 - 1 1 - - - - - 3 10 1 1 8 - - 5 - - 30 60 5 upwds. - 1 - - - - - 1 - - 2 3 7 6 5 23 1 7 94 150 Belgrave Hospital 108 62 15 17 13 1 - - - Under 5 - - - - - - - - 1 7 - 2 24 - 1 1 - - 58 94 5 upwds. - - - - - - - - - - - - 2 2 1 1 - 2 6 14 1st London General Hospital 134 - - - - 51 80 3 - Under 5 - - - - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - - 18 4 1 22 81 - 1 7 134 4th London General Hospital 197 - - - - 95 96 6 - Under 5 - - - - - - - - - - - - - - - - - - - - 5 upwds. - - - - - 2 - - - - 1 14 83 4 12 52 1 3 25 197 Remainder of Brixton 752 63 30 39 35 48 130 166 241 Under 5 - 2. - - - - - 13 15 5 - - 42 - 12 2 - - 41 132 5 upwds. 1 - - 1 - 1 4 4 1 2 44 107 83 150 17 — 1 204 620 Lambeth Workhouse Schools 53 27 10 8 6 2 - - - Under 5 - - - - - - - - - 9 - 2 3 -_ 3 - - - 28 45 5 upwds. - - - - - - - - - - 1 2 2 1 1 — — — 1 8 British Home of Incurables 13 - - - - - - 8 5 Under 5 - - - - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - - - - - - - - - 13 13 Remainder of Norwood 611 48 18 28 21 39 111 129 217 Under 5 - - - - - - - 8 7 3 - - 23 2 11 3 - - 37 94 5 upwds. - 2 - 1 - - - 1 - 1 2 36 87 76 116 10 1 1 183 517 Totals 6310 661 333 382 347 661 1271 1197 1458 Under 5 10 49 1 - - - 2 155 118 87 1 11 324 2 75 38 10 1 492 1376 5 upwds. 9 39 - 11 1 8 6 12 7 2 15 428 694 579 868 542 12 48 1653 4931 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 796 36 23 20 33 52 183 230 219 Under 5 - 5 - - - - - 10 6 2 - - 12 - 4 3 - 1 36 79 5 upwds. - 5 - 4 - 4 - 2 - 10 - 92 82 88 59 36 - 3 332 717 Deaths occurring within the district among persons not belonging thereto 2158 248 117 139 143 406 620 316 169 Under 5 4 30 1 - - - 2 48 46 41 1 5 105 - 4 15 3 - 199 504 5 upwds. 4 23 - 5 - 7 2 4 - - 3 125 173 98 183 451 9 34 533 1654 50 51 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 1918, in the Borough of Lambeth, classified according to Diseases and Localities. [Local Government Board Old Table B.] Registration SubDistricts. Population at all Ages. Total Registered Births 1918. New Cases of Sickness in each the knowledge of the Medical during Locality, coming to Officer of Health 1918. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1917. 1 Census 1911. Estimated 1918. [Civil Population.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. ! German Measles. Chicken Pox. Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Chicken Pox. Typhoid or Enteric. Continued & Relapsing. Puerperal. Typhoid or Enteric. Continued & Relapsing. Puerperal. (a) (b) (c) (d) Lambeth Church 47910 40382 1981 — 83 137 3 5 — 5 28 4 — 13 485 84 32 — 80 135 3 5 — 4 11 4 — — 34 1 5 Kennington 48609 41863 879 — 122 75 — 1 — 1 14 4 — 8 545 91 43 — 117 74 — 1 — 1 4 4 — 23 — — Stockwell 62608 54916 1720 — 127 91 — 4 — 3 19 3 — 10 694 57 115 — 120 85 — 4 — 2 4 2 — — 32 — — Brixton 76650 68586 1054 1 141 104 5 5 — 4 34 11 — 17 596 81 48 1 127 98 5 4 — 1 11 6 — — 25 3 1 Norwood 62281 56528 756 — 76 77 1 — — 3 10 1 1 2 401 89 69 — 67 74 1 — — 1 2 1 1 — 3 — 1 Totals 298058 262275 6390 1 549 484 9 15 — 16 105 23 1 50 2721402 307 1 511 466 9 14 — 9 32 17 1 — 117 4 7 N.B.—In addition to the above new cases of infectious sickness coming to the knowledge of the Medical Officer of Health by compulsory medical cation under the Notification Clauses of the Public Health (London) Act 1891, or the Orders and Regulations made thereunder, the following cases were notified voluntarily, viz.: Chicken Pox 1021, Measles 460, Cancer 85, and Whooping Cough 818. 52 Local Government Board New Tables. TABLE I. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1918 AND PREVIOUS FIVE YEARS (1913-17). Year. Population estimated to Middle of each Year. Births. Total Deaths registered in district. Transferable Deaths‡ Nett Deaths belonging to the District. Uncorrected. Number. Nett. Number. * Rate. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of*Age. At all Ages. Number. * Rate per 1,000 Nett Births. Number. * Rate Number. † Rate. 1 2 3 4 5 6 7 † 8 † 9 10 11 12 13 1913 297139 8341 7238 24.4 4476 15.1 883 780 737 74.2 4373 14.7 1914 297094 8188 7022 23.6 4630 15.6 1008 745 734 104.5 4367 14.7 §1915 284188 7878 6573 23.1 5323 18.7 1313 762 685 97.6 4772 16.8 §1916 283729 7980 6435 22. 5515 19.4 1929 693 567 88.1 4279 15.1 §1917 272038 6869 5208 19. 5374 19.7 1975 831 519 99.6 4230 15.5 §1918 262275 6390 4296 16.4 6310 24.0 2158 878 449 104.5 5030 19.2 SN.B—The populations estimated for 1915, 1916, 1917 and 1918, 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 deductions have been made from the population for large Public Institutions for 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 RegistrarGeneral supplied the particulars of extra transferable deaths (82) to be entered in Column 9; and all such deaths are included in this Column, unless an error has been] detected, and its correction has been accepted by the RegistrarGeneral. 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 the local Registrar (2217 outward and 157 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 Census, 1911. Area of Borough in acres (exclusive of area covered by water), 40796. Average number of persons per house (estimated), 6.7. Number of inhabited houses, 44123. Total population at all ages, 298058. 53 Local Government Board New Tables. TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1918. notifiable disease. number of cases notified. total cases notified in each locality. (e.g., Parish or Ward) of the District. total cases removed to hospital. At all Ages. At Ages—Years. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. Under 1. 1 to 5. 5 to 15 15 to 25. 25 to 45. 45 to 65 65 and upwds. Small-pox 1 — — — — 1 — — — — — 1 — 1 Cholera — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 493 7 145 225 59 52 5 — 140 75 91 109 78 475 Erysipelas 105 4 2 7 14 29 27 22 28 14 19 34 10 32 Scarlet Fever 549 6 128 323 61 29 2 — 83 122 127 141 76 511 Typhus Fever — — — — — — — — — — — — — — Enteric Fever 15 — — 3 5 7 — — 5 1 4 5 — 14 Relapsing Fever — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — Puerperal Fever 16 — — — 6 10 — — 5 1 3 4 3 9 Plague — — — — — — — — — — — — — — Pulmonary Tuberculosis* — — — — — — — — 4 — — — — — Other Forms of Tuberculosis† — — — — — — — — — — — — — — Cerebro-spinal Fever 23 2 6 3 4 7 1 — 4 4 3 11 1 17 Polio myelitis acuta 1 — — 1 — — — — — — — — 1 1 Ophthalmia Neonatorum 50 50 — — — — — — 13 8 10 17 2 — Measles 2721 114 1264 1232 78 30 3 — 485 545 694 596 401 117 German Measles § 402 12 118 187 54 31 — — 84 91 57 81 89 4 Isolation Hospitals, Name and Situation—Hospitals of the Metropolitan Asylums Board (one situated in the Brixton Sub-District and Stockwell Ward of the Borough of Lambeth). Total available beds provided by the Board—8555. Number of Diseases that can be concurrently treated—All usual notifiable infectious diseases and (partly) Measles and Whooping Cough. * Excluding all renotifications (169) of pulmonary tuberculosis, and notifications under Form C (235) and under Form D (210) of the 1912 Regulations. †Excluding all renotifications (33) of non-pulmonary tuberculosis, and notifications under Form C (63) and under Form D (49) of the 1912 Regulations. ‡ §Whooping Cough became compulsorily notifiable within the Borough of Lambeth on January 1st, 1913, for a period of 5 years § Measles and German Measles became compulsorily notifiable within the Borough of Lambeth on January 1st, 1916. 54 55 Local Government Board New Tables. Table III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1918. BOROUGH OF LAMBETH. Causes of Death. 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). All ages. Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Certified (c) 4710 426 228 251 220 292 793 1051 1449 3559 All causes uncertified 4948 238 23 11 12 17 15 41 60 59 Typhus Fever — — — — — — — — — — Enteric Fever 5 — — — — — 1 4 — 8 Continued Fever 1 — — — — — 1 — — — Small-pox — — — — — — — — — — Measles 127 25 48 44 9 1 — — — 76 Scarlet Fever 11 1 1 4 3 2 — — — 16 Whooping Cough 85 22 36 20 7 — — — — 70 Diphtheria and Croup (See note (d)) 45 2 8 14 18 1 2 — — 82 Influenza 819 20 16 39 56 117 304 160 107 344 Erysipelas 4 — — — — — — — 4 7 Cerebro-Spinal Fever 10 3 3 1 2 1 — — — 19 Polio-myelitis acuta — — — — — — — — — — Venereal Diseases 27 14 2 1 — 1 1 5 3 — Phthisis (Pulmonary Tuberculosis) 401 1 1 4 9 76 179 107 24 255 Tuberculous Meningitis (See note (e)) 58 9 11 18 15 3 1 1 — — Other Tuberculous Diseases 79 6 6 9 19 15 16 6 2 — Rheumatic Fever 12 — — — 5 2 4 — 1 12 Cancer, malignant disease (See note (/)) 392 — — — 2 3 41 179 167 — Bronchitis 321 17 13 5 4 2 10 80 190 Broncho-Pneumonia 231 55 49 44 10 2 8 20 43 450 Pneumonia (all other forms) 272 16 14 18 16 21 49 72 66 j Other diseases of Respiratory organs 59 2 4 5 1 1 7 17 22 Diseases of Circulatory System 571 1 — 1 8 15 58 134 354 295 Diseases of Nervous System 346 18 5 5 12 10 46 108 147 — Diarrhoea (See note (g)) 60 35 5 8 1 — 5 5 1 66 Enteritis 46 18 2 2 — — 4 13 7 — Appendicitis and Typhlitis 19 — — 2 8 2 4 3 — 46 Alcoholism (See note (A)) 2 — — — — — 2 — — — Cirrhosis of Liver 21 — — — 1 1 2 12 5 — Nephritis and Bright's Diseases 134 — — 1 3 4 18 47 61 — Puerperal Fever (See note (t)) 10 — — — — 4 6 — — 10 Other accidents and diseases of Pregnancy and Parturition 8 — — — — 1 7 — — Congenital Debility and Malformation, including Premature Birth (See note (j)) 133 129 4 — — — — — — — Violent Deaths, excluding Suicide 128 14 3 9 15 6 17 33 31 499 Suicides 25 — — — — 4 10 9 2 Other Defined Diseases 464 39 8 9 11 12 25 95 265 1304 Diseases ill-defined or unknown 11 1 — — 1 — 3 3 3 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., of 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 " sec footnote to Table I. 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 111. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as " Certified " ; all other deaths are to be regarded as " Uncertified." (d) This heading includes all deaths from croup except those certified as due to " spasmodic," " stridulous," " catarrhal," or " false " croup. >c?) Under "Tuberculous Meningitis" are included( deaths from Acute Hydrocephalus. (/) Under " Cancer " are included deaths under such headings as Carcinomal 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-defined disease are included under the latter. (h) Under this heading are included deaths from Delirium tremens, acute and chronic alcoholism, etc., but not those certified as due to organ c 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, Peri- and Endo-metritis occurring in the Puerperium. (;) Under this heading are included also deaths from Atrophy and Marasmus of Infants, and want of Breast-milk, but not from Atelectasis. 56 57 Local Government Board New Tables. TABLE IV. " BOROUGH OF LAMBETH—INFANTILE MORTALITY, 1918. Nett Deaths from stated causes at various Ages under 1 Year of Age. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. All Causes (Certified 76 16 21 12 125 60 91 63 76 415 (Uncertified 12 — 1 1 14 12 3 3 2 34 Chicken Pox — — — — — — — — 1 1 Scarlet Fever — — — — — — — — 1 1 Measles — — 1 3 9 12 25 Diphtheria and Croup — — — — — — — — 2 2 Whooping Cough — — — — — 1 8 4 9 22 Diarrhoea — 1 — 1 2 7 15 6 5 35 Enteritis (Epidemic) — — — — — 9 7 1 1 1 18 Influenza — — — — — 1 5 9 5 20 Cerebro-Spinal Fever — — — — — — 1 1 1 3 Anterior Poliomyelitis — — — — — — — — — — Phthisis — — — — — — 1 1 Tuberculous Meningitis — — — — — 2 2 — 5 9 Abdominal Tuberculosis — — — — — 1 1 1 — 3 Other Tuberculous Diseases — — — — — 1 1 1 3 Congenital Malformations 6 2 2 — 10 2 2 - 2 16 Premature Birth 51 7 8 3 69 3 — - - 72 Atrophy, Debility and Marasmus 5 3 5 3 16 8 5 5 7 41 Atelectasis 5 — 5 — — - - 5 Erysipelas — — — — — - - - Syphilis 4 — 1 5 5 3 1 - 14 Rickets — — — — — 1 - 1 Meningitis (not Tuberculous) — — — — — — - - - Convulsions 1 2 1 4 4 4 2 3 17 Gastritis — 1 — 1 1 - - 2 Dentition — — — — — - - - Laryngitis — — — — — - - - Bronchitis 2 — — 2 3 5 6 1 1 7 Pneumonia 2 1 3 3 3 2 2 13 Bronchopneumonia 2 1 3 8 14 14 16 55 Pleuro „ — — — — — — - - - Suffocation, overlaying — 1 1 3 2 - - 6 Accident, other than Suffocation 3 — — 3 1 2 - - 6 Other causes not classified above 4 i 2 1 8 10 10 3 3 34 Want of Attention at Birth 5 — — 5 — — - - 5 Murder 2 — — — 2 — — — - 2 Totals 88 16 22 13 139 72 94 66 78 449 58 59 LAMBETH BOROUGH.—Corrected Deaths registered from all causes during the year, 1918. Note.—The Deaths of Non-Residents occurring in Public Institutions in the District 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. Total. Lambeth Church. Kenknington. Stockwell. Brixton. Norwood. No Address. All Ages. m. f. m. f. m. f. M. f. m. f. m. f. m f I. Specific Febrile,or Zymotic Diseases 88 103 114 120 130 164 126 160 76 119 2 8 536 674 1210 II. Parasitic Diseases — - - - — — — 1 — - 2 2 III Dietetic Diseases — - 1 — — — 1 — — - 2 - 9 IV. Constitutional Diseases 89 68 105 75 112 97 150 136 77 92 9 3 542 471 1013 V.Development Diseases 18 23 18 33 22 24 31 36 24 32 2 1 115 149 264 VI. Local Diseases 186 183 248 215 224 228 257 272 189 213 22 13 1126 1124 2250 VII. Deaths from Violence 17 12 22 - 19 7 22 14 13 14 2 6 95 58 153 VIII. Deaths from Ill-defined and not Specified Causes 5 8 5 6 4 6 4 5 7 4 — — 25 29 54 Totals 403 397 513 459 511 526 591 624 386 474 37 27 2441 2507 4948 (B.) AGE PERIODS. age. PERIODS. Under 1 Year. 1-2 2-5 1 Under 5 Years. 5-15 15-20 20-25 25-40 40-45 45-60 60-65 65 and over. Over 5 Years. All Ages. Total. I. Specific Febrile or Zymotic Diseases M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M F M F M F M 1 F M p 63 60 64 35 67 64 194 179 52 45 22 38 17 50 104 176 16 25 66 71 17 22 48 68 342 495 536 674 1210 II. Parasitic Diseases — 1 - - - 4 - 1 - - - 1 - — —- — — — — — — — — 1 - 2 2 III. Dietetic Diseases — — - - - - - - - — — - — — — 9 — — 2 - 2 - 2 IV Constitutional Diseases 14 4 10 10 19 13 43 27 19 32 25 28 24 24 94 71 41 39 137 93 47 42 112 115 499 444 5426 471 1013 V Developmental Diseases 43 48 — - — - 45 50 - - — — - — — — — — — 1 9 69 97 70 99 115 149 264 VI. Local Diseases 89 69 48 48 44 47 181 161 36 38 14 17 14 22 76 88 35 43 217 176 98 77 461 502 945 963 1126 1124 2250 VII. Deaths from Violence 8 6 2 1 5 4 15 11 9 6 2 2 2 4 13 8 3 3 24 8 8 2 19 14 80 47 95 58 153 VIII. Deaths from Ill-defined and not Specified Causes 20 22 1 1 — — 21 23 — — — — 1 — — 2 1 — — 3 — — 2 1 4 6 25 29 54 Totals 239 210 125 114 135 128 499 452 116 121 63 86 58 100 281 345 98 110 444 351 171 145 711 797 1942 2055 2441 2507 4948 60 (C.) SUMMARY OF CORRECTED DEATHS. I.—Specific Febrile or ZymoticDiseases. No. of Deaths Total. No. of Deaths. Total. M. F. M. F. Brought forward 2201 2323 4524 1. Miasmatic Diseases 487 618 1105 2. Diarrhoeal ,, 26 34 60 VI.—Local Diseases—continued. 3. Malarial „ — — — 6. Diseases of Lymphatic System 3 1 4 4. Zoogenous „ — — — 7. Diseases of Gland-like Organs of Uncertain Use 3 I 6 9 5 Venereal „ 19 8 27 6. Septic „ 4 14 18 8. Diseases of Urinary System 98 66 164 9. Diseases of Reproductive System (a) Diseases of Organs of Generation — 6 6 II.—Parasitic Diseases — 2 2 III.— Dietetic Diseases 2 — 2 (b) Diseases of Parturition — 8 8 10. Diseases of Bones and Joints 4 7 11 IV.—Constitutional Diseases 542 471 1013 11. Diseases of Integumentary System 12 3 15 V.—Developmental Diseases 115 149 264 VII.—Violence. VI.—Local Diseases - 1. Accident or Negligence 79 45 124 1. Diseases of Nervous System 171 175 346 2. Homicide 2 2 4 2. Diseases of Organs of Special Sense 5 3 8 3. Suicide 14 11 25 4. Execution — — — 3. Diseases of Circulatory System 275 296 571 5. Air raid — — — 4. Diseases of Respiratory System 442 441 883 5. Diseases of Digestive System 113 112 225 VIII.—Ill-defined and not Specified Causes 25 29 54 Carried forward 2201 2323 4524 Total 2441 2507 4948 61 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1918. 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 SubDistricts, 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 1918—262,275 (males 108.005, and females 154,270). *Density—64.3 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected)—6,390 being 21.7 per 1,000 population. Deaths (corrected)—4,948 being 18.9 per 1,000 population. Infantile Mortality (corrected)—449 deaths (corrected) under 1 year, being 70.3 per 1,000 total (uncorrected) births, or 89.7 per 1,000 total (corrected) births. Zymotic Death-rate (corrected)—1.3 par 1,000 population (total corrected zymotic deaths, 334). * The densities (based upon the jestimated civil populations) vary in the different Registration Sub-Districts as follows—Lambeth Church (354.3 acres) 113.9, Kennington (398.3 acres) 105.1 Stockwell (583 acres) 94.2, Brixton (1026.6 acres) 66.8, and Norwood 1718.2 acres) 32.9 per statute acre respectively. 62 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, 1918 Number of Notices served 16,807* A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES] (Public Health (London) Act.) No. of Notices served 4683 No. of Infected Houses 4200 Small Pox 1 Scarlet Fever 477 Typhoid 14 Diphtheria 422 Membranous Croup 9 Continued Fever Puerperal Fever 16 Erysipelas 99 Cerebro-Spinal Fever 17 Acute Polio-Myelitis 1 Ophthalmia Neonatorum 50 ‡Measles 2471 ‡German Measles 340 §Chicken Pox 283 B. GENERAL NUISANCES AND DRAINAGE DEFECTS (Public Health (London) Act, and Metropolis Local Management Acts). No. of Notices served*† 12124 Works, Structural— Drainage, Defective 999 Intercepting Traps with Fresh Inlets required 174 Ventilating Pipes required 249 Indoor Sinks connected with Drain 271 Rain Water Stacks connected with Drain 422 Bath Waste connected with Drain 189 Traps Defective, or of Obsolete Pattern 748 Closet Pan and Connections Defective 968 Water Supply to Closet Defective 2010 Closet Dilapidated 761 Draw-off Main for Drinking Purposes required 576 Dust Bins Defective 1059 Premises Dilapidated 1373 Ventilation under Floors required 416 * Including Measles and German Measles, † Excluding tuberculosis. ‡ Compulsorily notifiable from January 1st, 1916. § Compulsorily notifiable from March 27th to June 30th, 1918 (inclusive). 63 Roofs Dilapidated 2011 Soil Pipes Defective 193 Paving Defective 2078 Damp and Unwholesome Houses 398 Dung Receptacles required 40 Defective Water Pipes 201 No W.C. Accommodation 14 15150 Works, not Structural— Cisterns Dirty 641 Manure Accumulations 76 Underground Rooms illegally occupied 58 Animals Improperly Kept 96 Stopped Drains 501 Overcrowding 84 Foul Urinals 16 Refuse Accumulations 521 No Water Supply or Defective Water Supply 1092 Dirty Premises 1848 4933 PARTICULARS OF SANITARY WORK carried out by the Male Sanitary Staff in Lambeth Borough during 1918, and during the 5 previous years (1913-1917), together with Yearly Averages for (a) the 10 years 19011910 (Borough), and (b) the 24 Years 1877-1900 (Parish). Year. Total Number of Notices (excluding those served under the Housing Acts). Sanitary Works, Structural and Permanent. Sanitary Works, Not Structural. 1918 16807 15150 4933 1917 19023* 16103* 4721* 1916 15015† 16175* 4651* 1915 12752 9757 7731 1914 15109 10175 6478 1913 14397 9167 5154 Yearly Average for 10 Years 19011910 (Borough) 13108.4 9348.4 3049.7 Yearly Average for 24 Years 18771900 Parish)) 5944.6 4756.9 2135.9 *Including Measles and German Measles, †Excluding Measles and German Measles. 64 SANITARY STAFF. The Sanitary Inspectorial Staff consists of 12 district male Sanitary Inspectors and 1 special male Sanitary Inspector for Food and Drugs, 2 female Sanitary Inspectors (who also act as part-time Health Visitors), and 3 women Health Visitors. The work carried out during 1918 by these various officers is set out in tabular form. Summary of Work Carried Out by the Male Sanitary Inspectors during 1918. Inspections 8432 Re-inspections 40712 Complaints attended to 2281 Water Certificates issued 5 Revenue Act Certificates dealt with 45 Drains tested (with chemical, water or smoke test) 2651 Sanitary Works completed 4147 Plans of drainage reconstructions received 73 Premises the Drains of which have been totally or partly reconstructed 80 Samples of Food and Drugs taken 1296 Notices— Public Health (London) Act, 1891 (Preliminary or Intimation 8237 and Statutory 3874) 12111 Metropolis Local Management Acts 13 Sanitary Nuisances abated— (a) Structural 15150 (b) Non-Structural 4933 Summonses issued— Public Health Act — Food and Drugs Acts 29 Convictions obtained— Public Health Act — Food and Drugs Acts 20 N.B.—In addition to the above, the District Inspectors carried out, during 1918 routine duties connected with the inspecting of unsound and unwholesome food*, the supervision of bakehouses, slaughter-houses, cow-houses, dairies, milk shops and milk stores, the market thoroughfares, outside urinals of public-houses, smoke, the male public conveniences, factories and workshops, and workplaces wherein males are employed, common lodging-houses, offensive trades, effluvium nuisances, houses let in lodgings, exempted tenements (Revenue Act), refuse and manure depots, etc. No new houses were registered under the by-laws for houses let in lodgings, *In dealing with unsound and unwholesome food care was taken that surrendered, condemned or damaged foodstuffs were utilised for the production of animal foodstuffs or fertilisers, or, in the case of meat, used for the extraction of fat therefrom, in accordance with the terms of the Damaged Foodstuffs Order, 1918, and the requirements of the National Salvage Council. 65 and no routine house-to-house inspections were carried out under the Housing, Town Planning, etc., Act, 1909, the latter fact being on account of the war. Extra duties were again thrown upon the 12 male district Sanitary Inspectors under the Local Authorities (Food Control) Order (No. 1), 1917, under which they had been appointed to act by the Council on May 24th, 1917. Infected Houses and Drainage Defects found by Male Inspectors. 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 drainage with the chemical test.* Taking the ordinary notifiable infectious diseases, out of the 1055 infected houses dealt with during 1918, the results are as follows, the averages being given in brackets for the past 25 years, 1891—1915:— (a) 29, i.e., 2.7 per cent. were found to have defective drains, i.e., a result was obtained with the chemical test employed (average = 14.3 per cent). (b) 493, i.e., 46.7 per cent. showed defects in drains, traps, fittings and appliances (average = 53.1 per cent.). (c) 562, i.e., 53.3 per cent. showed no defects (average =46.9 per cent.). Registration of Cow-houses, Slaughter-Houses, Common Lodging-houses, and Milk Shops. During 1918 the Cow-houses and Slaughter-houses, and Common Lodging-houses licences were renewed by the London County Council, with the following exception:— Slaughter-house—209, Coldharbour Lane. A new Common Lodging-houses licence was granted in regard to 11-13, York Road, Westminster Bridge Road. The applicants were registered by the Borough Council as milksellers or purveyors of milk at the following premises, which were passed as "suitable," i.e., in accordance with the Council's requirements:—102, Brixton Hill, 114, Brixton Road, 15, Bonnington Square, 67 and 173, Coldharbour Lane, 304, Clapham Road, 45, Camberwell New Road, Canterbury Road (Head Office), 118, Denmark Hill, 141, High Street (West Norwood), 30, Kepler Road, 27, Larkhall Lane, 43, Loughborough Road, 118 and 196, Norwood Road, 56, Railton Road, 96, St. Mark's Road, 4, Tulse Hill, 131, Vauxhall Walk, and 191, Westminster Bridge Road (15 being simply transfers of existing approved licences). *The above statistics do not include ophthalmia neonatorum, measles and German measles and tuberculosis, which have been omitted so as to keep the statistics for 1918 comparable with those for past years. The figures for measles and German measles infected houses during 1918 are:—158 defective drains and 1.123 defective traps and appliances, out of a total of 2,811 infected houses inspected. No testing of drains is carried out as a routine in the case of ophthalmia neonatorum and tuberculosis-infected houses. 66 Revenue Act, 1903. (and Section 35 of the Housing, Town Planning, etc., Act, 1909) During 1918, 45 certificates were applied for in connection with tenements (or dwellings) so constructed as to afford suitable separate accommodation for each of the families inhabiting the same, with the following results:— 1. Certificates granted unconditionally 3* 2. Certificates granted conditionally 39† .3. Certificates refused 3‡ Effluvium Nuisance During 1918 a petition, signed by 20 inhabitants of the neigh bourhood, was received with reference to an alleged effluvium nuisance in connection with premises in Over Place, Prince's Road, used for bacon drying and bacon curing by means of smoke obtained from the combustion of fine creosoted sawdust. A summons was taken out, and eventually adjourned sine die, the nuisance being abated meanwhile by the collection and washing by sprays of water of the effluvia before allowing them to pass into the outside air through the chimney shaft. Pig-Keeping. During 1918, licences were granted by the Council for the keeping of pigs in connection with the following premises:—West Norwood Golf Club, 53, Park Road, West Dulwich (rear of), Casewick Road and Canterbury Grove Allotments, Broxholme Road Allotments. 30, Central Hill (bottom of garden), 32b, Herne Hill, 114, Tulse Hill, Arches at rear of Fisher Bookbinder Co.'s premises, Norwood Road, Hern; Hill, Provide no Place, Vassell Road (land at rear), Norwood Brewery, Chapel Road, West Norwood, lilder Road Farm, West Norwood, Elder Road Allotments, West Norwood, 88, High Street, West Norwood (stables in rear), and 32, Herne Hill. The licences were granted subject to the following conditions:— (1) That the permission apply only for the duration of the war; (2) that the pigs be housed to the satisfaction of the Council's officers as to construction of styes, paving, drainage, etc.; whilst the Medical Officer further advised that, in the case of allotments, the pig-keeping might, with advantage, be carried out on the co-operative principle, rather than that such pig-keeping should be carried out by any individual holder on any individual allotment. *Granted, unconditionally—154, Tulse Hill. †Granted conditionally—10, 12, 14, 16, Bonnington Square; 18, 20, 24, 26, 44, 46, 60, Martell Road, West Norwood; 24, Park Road, West Norwood; St. Andrew's House (Roupell Street), and 50, 54, 56, 58, Tritton Road, West Norwood. ‡Refused—26, Brixton Road. 67 No licence was granted in connection with premises on which the pig-keeping would be a contravention of Section 17 of the Public Health (London) Act, 1891, and, consequently, the applications for the two following premises were refused:—206a, Brixton Road (rear of), and 235, Wandsworth Road (rear of); and, for the same reason, the Council decided to take no action in regard to a proposal that land in the Acre Lane (a disused field adjoining the Acre Lane, Brixton, allotments and facing houses in Ashmere Grove and Plato Road respectively) should be taken over for Pig-keeping. Flooding of Basements and Ground Floors. A severe thunderstorm on July 17th, 1918, caused a flooding of basements and ground-floor rooms of a serious nature in various parts of the Borough, e.g., especially Herne Hill, Loughborough Junction, and low-lying parts of West Norwood—2 to 5 ft. being registered in some cases as the height of the flood water in some of the cellars, basements and lower storeys of the houses. The rapidity with which the water rose prevented bedding and carpets being moved to a place of safety, or even furniture. As far as could be ascertained, little or no injury to health results in the flooded areas, though the inconvenience was considerable. Fortunately, the storm water quickly subsided, and, though it was contaminated with sewage matter from the overflows from the sewers and drains, such contamination was slight and well diluted with the large volumes of storm (rain) water ; and these facts probably explain the absence of injury to health amongst the occupiers of the affected houses. Lime was freely used under the floorings of rooms after the removal of the silt and other débris left by the storm. Summary of Work carried out by the Female Sanitary Inspectors during 1918. Workshops visited and inspected— (a) Dressmakers 11 (b) Milliners 3 (c) Laundries 3 (d) Tailors 3 (e) Upholsterers — (f) Dyers 1 (g) Blouses 16 (h) Ties — (i) Others (e.g.), embroidery, toys, mineral waters, brushes, underclothing, overalls, munitions. &c. 15 68 Workshops§: workshops therein measured 274 Workshops§ newly discovered and registered 6 *Premises visited, but not inspected, owing to the persons or patients concerned being out or, if employees, being no longer employed 1317 Female Conveniences visited and inspected— Public (visits paid) 294 Private — Schools visited— Public (visits paid) 68 Private — Special places visited and inspected— (a) Private Houses† 2065 (b) Outworkers 215 Outworkers and Private Houses‡ re-inspected 507 Written Intimation and Statutory Notices served 80 No. of Workshops, § etc., in which defects were found 80 No. of Workshops, § etc., in which no defects were found 2320 Nuisances referred to M.O.H., for attention by male inspectors 4 Particulars of Defects found by Female Inspectors. Workshops, § etc.— Workrooms— Overcrowded, Damp or Dirty 29 Defective or dirty— Yards, Floors, Roofs, Windows, Ceilings, Sink Wastes, or Premises generally 46 Sanitary Appliances: Water Closets— Dirty, unventilated, choked, defective or with defective tanks or water supplies 31 Sanitary Appliances: Drainage— Defective 4 Sanitary Appliances: Dustbins— Wanting or Defective 15 No separate suitable sufficient W.C. accommodation for the sexes 1 Miscellaneous defects, e.g., accumulations, personal uncleanliness, etc. 1 *Births (646), Workshops (10), Outworkers (253), Tuberculosis cases (302), and Restaurants (106). †Births (1328), Diarrhoea cases (4), Tuberculosis cases (648), Ante-natal cases (6), Still births (7), Ophthalmia cases (38), and special complaints (34). ‡Births (200), Tuberculosis cases (151), Out-workers (21), Ophthalmia cases (126), and special complaints (9). § Workshops include Workplaces. 69 Summary of Work Carried Out by the Health Visitors during 1918. Births* 4955 Tuberculosis cases* 967 Ophthalmia cases* 124 Depot children (visits) 502 Diarrhoea cases 33 Infant Welfare Centres and Day Nurseries 63 Milk Depot (visits)— York Road (central) 55 Special cases 84 Moffatt Institute (branch) 229 Expectant mothers (visits) 31 N.B.—In addition to the above, 1033 visits were paid to houses, but no one found to be at home. FACTORIES AND WORKSHOPS, 1918. Factories. 2 new factories were added to the Register, dealing with (a) electrical appliances, 1; (b) embroidery, 1. Workshops. 11 new workshops were added to the Register, dealing with: (a) dressmaking, 3; blouses, 3; box-making, 1; wine and spirit bottling, 1; chemists' sundriesman, 1; and unclassified, 2. OUT-WORKERS, 1918. 11 February and 9 August lists were received, dealing with 134 and 112 out-workers respectively. Of the 246 out-workers, 137 belonged to Lambeth and 109 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 152 lists were received from various outside authorities dealing with the 1000 workers, of whom 939 belonged to Lambeth and 61 to districts outside Lambeth. *Including revisits, as follows:—Births, 2404, Ophthalmia neonatorum 98, Tuberculosis 255. 70 Of the total 1171 Lambeth out-workers reported, 116 were new out-workers, i.e., out-workers not previously registered, as follows: Mantles 10 Hosiery 2 Blouses and skirts 11 Feathers 3 Ties, belts, and braces 6 Millinery 8 Children's underclothing and costumes 5 Dresses 2 Bag stringing 9 Women's clothing 12 Boxes and boxmaking 9 Tailors 9 Button-making 1 Embroidery 2 Brushes 1 Shirts 6 Artificial flowers 2 Fancy Goods 1 Paper Bags 2 Button-hole Making 2 Printers 2 Boots and Shoes 3 Corset Making 1 Collars 6 Cigarettes 1 Total 116 The Wards, in which the houses (wherein the 116 new outworkers were found to be working) are situated, are as follow:— Wards. No. Wards. No. Marsh 2 Heme Hill 17 Bishop's 12 Tulse Hill 6 Prince's 23 Norwood 2 Vauxhall 14 Borough of Lambeth 116 Stockwell 15 Brixton 25 71 FACTORIES AND WORKSHOPS REGISTERED DURING 1918. Numbers of Rooms and Persons Employed. Wards. No. of Factories. No. of Workshops. No. of Workrooms. Children. Young Persons. Adults. TOTALS. M. F. M. F. M. F. M. F. Total. Marsh - - - - - - - - - - - - Bishop's - - - - - - - - - - - - Prince's 1 3 17 - - 70 16 148 82 218 98 316 Vauxhall - 2 3 - - - - 2 8 2 8 10 Stockwell - - - - - - 8 - - - - - Brixton 1 3 5 - - - - - 16 - 24 24 Heme Hill - 1 1 - - - - - 2 - 2 2 Tulse Hill - 1 1 - - - - - 3 - 3 3 Norwood - 1 1 - - - - - 4 - 4 4 Total 2 11 28 - - 70 24 150 115 220 139 359 72 DISINFECTING DEPARTMENT, 1918. Details of work done in connection with the Disinfecting Department are subjoined. A total of 4683 cases of infectious diseases, notified compulsorily by medical men, was reported and dealt with, including cases of cerebro-spinal fever (23), acute polio-myelitis (1), ophthalmia neonatorum (50), measles (2721), German measles (402), and tuberculosis—pulmonary (1031), and non-pulmonary (361), whilst the following diseases were, in addition, notified by school teachers and others, viz.: measles (460), chicken-pox (1021), cancer (85), whooping cough (818), verminous houses (307), verminous rooms (539), verminous bedding (1947 articles) and clothing (608 articles), and others (1162*); 1188 patients were removed to hospital. Summary of work carried out by the Disinfecting Department during 1918. Total No. of rooms disinfected by Council 12023 Do. articles do. 19321 Cases in which bedding was disinfected at home† 5620 Do. do. do. at Chamber 2936 Do. do. do. destroyed (76§ articles) 29 Premises disinfected and disinfectants supplied 16084 Articles of bedding, etc., disinfected 19235 Articles of bedding, etc., destroyed (29 houses) 86 No. of Cleansing Notices served in connection with infected houses 1042 Certificates of Medical Practitioners received in lieu of disinfection by the Council 28 Schools disinfected‡ (132 rooms) 22 Certificates of disinfection left with occupiers of disinfected premises 2129 Library books disinfected (public) 200 Mattresses re-tabbed by Council 365 *Scabies, ringworm, diseases not stated, etc. †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. § 28 certificates of medical practitioners received in lieu of official disinfection. ‡Measles, 16 (86 rooms). 73 ANALYSIS OF FOOD AND DRUGS AND WATER. Samples of Food and Drugs procured, together with the results of the analyses, during the year 1918, were as follows:— Samples. Formal. Informal. Number. Analysed. Number Adulterated. Number Analysed. Number Adulterated. Milk 764 85 2 - Butter 4 - 56 1 Lard 1 - 13 1 Coffee - - 147 - Margarine 1 - 3 - Mustard - - 63 2 Pepper - - 85 - Arrowroot - - 62 1 Vinegar 11 2 29 5 Sago - - 4 1 Oatmeal - - 100 - Ground Rice - - 25 - Flour - - 14 - Dripping 2 - - - Drugs* 13 6 234 26 Rice - - 124 - Olive Oil - - 3 - Tapioca - - 8 - Egg Powder 1 - 23 1 Baking Powder - - 29 - Self-Raising Flour - - 11 - Prescription 2 - 10 6 Rolled Oats - - 12 - Flaked Rice - - 11 - Pearl Tapioca - - 2 - Starch - - 2 1 Cocoa - - 49 - Jam - - 4 1 Cocoa Butter - - 19 - Coffee Mixture - - 3 - Mustard Condiment 1 - 2 - Pea Flour - - 20 - Ground Ginger - - 34 - 800 93 1203 46 N.B.—29 summonses issued (20 convictions and 9 dismissals). *The drugs (259) were:—Eucalyptus Oil (18), Epsom Salts (21), Gregory's Powder (10), Ammoniated Tincture of Quinine (16), Cream of Tartar (45), and Bicarbonate of Soda (20), Prescriptions (12), Sal Volatile (29), Linseed (17), Camphorated Oil (23), Milk of Sulphur (22), Boric Ointment (20), and Castor Oil (6). Three samples of water were analysed. 74 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 1918 (764 formal), in no single instance were preservatives found. No samples of cream were taken either formally, or informally. The action taken during 1918 under the Public Health (Milk and Cream) Regulations, 1912, may be tabulated as follows:— Headings of Report of Administration during 1918. 1. Milk : and cream not sold as Dreserved cream:— (a) No. of samples examined for the presence of a preservative. No. in which a preservative was reported to be present. Milk 764 — 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 — *The Amendment Order (February 8th, 1917) came into operation on April 2nd, 1917, and lays down a maximum of 0.4 per cent. of Boric Acid added to cream, such cream to be sold as preserved cream and to be labelled with the words, "Cream containing boric acid is unsuitable for infants and invalids." 75 (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. MORTUARIES AND CORONERS' COURTS. Details of Work carried out during 1918. {a) Number of bodies received, 462—292 at High Street and 170 at Wanless Road. (b) Post-mortem examinations conducted, 185—104 at High Street and 81 at Wanless Road. (c) Number of Inquests held, 442—277 at High Street and 165 at Wanless Road. Wightman & Co., Ltd., "Old Westminster Press," London, S.W. 1.