REPORT ON THE Vital and Sanitary Statistics OF THE BOROUGH OF LAMBETH During the Year 1919. Including an account (1) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, (b) at the Municipal Milk Depôt 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. Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. 2. March, 1920. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor, Ladies and Gentlemen, The War is now over, as are also the " carrying-on " days of the past five years (1915-19). The year 1919 may be regarded, from an administrative point of view, as the interim between War Stagnation and Peace Reconstruction, and regarded as such, the statistics for 1919 are very satisfactory. The general death-rate, the zymotic death-rate and the infantile mortality rate being exceptionally low, even after making due allowance for the difficulties in estimating populations. Mountains of arrears of work face you for the coming year 1920, and the first step will be the reconstruction of departments and the organisation (and enlargement) of staffs. The new Council is faced with an arduous task. The Report for 1919 has been again curtailed and condensed, as has been the case during the last few years, on the suggestion of the Local Government Board and the present Ministry of Health. To the Staffs and to the Chiefs of Departments, and 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 of Medical Officer of Health and Chief Executive Tuberculosis Officer of the Borough of Lambeth. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Medical Officer of Health and Chief Executive Tuberculosis Officer. INDEX. PAGE Vital Statistics 4—65 Estimated populations 4—5 Births and Birth-rates 6—8 Notification of Births Act 9-l0 Lambeth Maternity and Child Welfare Scheme 10—12 Municipal Milk Depot and Infants Consultations Centre 13—16 Deaths and Death-rates (General, Infantile and Zymotic) 16—29 Infectious Diseases 30—44 (a) Notifiable 30—43 (b) Non-Notifiable 44—48 (c) Tuberculosis 36—41 Lambeth Tuberculosis Dispensaries Scheme 40—41 (d) Polio-myelitis (polio-encephalitis) and Cerebro-spinal Fever 42—43 (e) Influenza 45—47 (f) " Contacts " and " Suspects " 48 Municipal Bacteriological Laboratory 49 Local Government Board, Old Table A. 50—53 Local Government Board, Old Table B. 54—55 Local Government Board New Tables I., II., III., and IV. 56—61 Mortality Tables (corrected deaths) 62—64 (a) Registration Sub-Districts 62 —63 (b) Age-Periods 62—63 (c) Summary 64 Summary of Vital and Mortal Statistics 65 Sanitary Work 66—82 Notices Served 66 (a) Infectious Diseases 66 (b) General Nuisances and Drainage Defects 66—67 Male Sanitary Inspectors 68—71 Registration of Cowhouses, Slaughterhouses, Common Lodging Houses and Milk Shops 70 Effluvium Nuisance 71 Pig Keeping 71 Female Sanitary Inspectors and Health Visitors 71—73 Factories and Workshops and Out-workers 73—75 Housing Department 76—78 Disinfecting Department 79 Analysis of Food and Drugs and Water 80 Public Health (Milk and Cream) Regulations 81 Rag Flock Act, 1911 82 Mortuaries and Coroners' Courts 82 Appendix (Housing in Lambeth) 83—104 1. VITAL STATISTICS. The Estimated Civil Populations* of the Borough are as follows:— Estimated Civil Populations, 1919. I. Wards. Wards. Males. Females. Total. 9934 Marsh 9939 19873 13926 Bishop's 15522 29448 Prince's 18525 21023 39548 Vauxhall 13777 15063 28840 Stockwell 13439 16890 30329 Brixton 18528 23544 42072 Heme Hill 14102 17505 31607 13027 16722 29749 Tulse Hill Norwood 13099 17757 30856 Borough of Lambeth 128357 153965 282322 II. Registration Sub-Districts. Sub-Districts. Total. Males. Females. Lambeth Church 21198 22499 43697 Kennington 21189 23986 45175 Stockwell 27215 31953 59168 Brixton 32630 41049 73679 Norwood 26125 34478 60603 Borough of Lambeth 128357 153965 282322 *N.B.—The estimates of populations for 1919 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. III. Parliamentary Divisions (Old). Old Parliamentary Divisions. Males. Females. Total. North 23467 25179 48646 Kennington 31856 35656 67512 Brixton 72323 40299 32024 Norwood 39351 51139 90490 Parliamentary Area of Lambeth 126698 152273 278971 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. Total. New Wards. North Marsh 49321 Bishop's Prince's 68388 Kennington Vauxhall Brixton Stockwell 72401 Brixton Herne Hill Norwood Tulse Hill 92212 Norwood * Adjusted Parliamentary Area of Lambeth - 282322 *N.B.—By the adjustment of the old Parliamentary Divisions so as to be co-terminous with the Wards. TABLE A. Giving number of Births and Birth-Rates in each Registration Sub-District of the Borough of Lambeth during 1919 (arranged Quarterly). No. of Births. Total for the Year 1919. Registration Sub-Districts. Ist Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. 507 570 722 Lambeth Church* 461 2260 Kennington 193 198 247 394 1032 Stockwell§ 422 516 690 423 2051 Brixton 267 252 288 431 1238 1919 1918 282322 262275 7596 6390 4192 4948 479 449 703 951 199 334 2567 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 294049.7 1891-1900 (Parish) 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, 1918 and 1919 are the estimates of civil populations only. 1919 25.8* 14.8 63.1 114.3 167.7 0.7 520.5 1918 21.7 18.9 70.3 90.7 192.2 1.3 564.0 1917 22.6* 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 88.9 170.5 238.9 1.3 475.6 1914 27.6 14.4 1913 28.1 14.4 87.9 171.3 255.6 1.2 450.2 73.2 152.3 233.6 446.9 1912 27.4 13.2 0.9 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, 1918 and 1919, viz., 308,702, 303,245, 293,869 and 294,097. 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 the country in proportion to their estimated civilian population. BIRTHS, 1919. The total number of Births registered is 7,956, 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 78,149 births have been notified up to the end of 1919, 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, and 7,260 in 1919. The notified cases are visited in the first instance by the Council's official Health Visitors, 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 by the staffs of the various voluntary centres. Systematic revisiting is important, and, in this connection, the large numbers of re-visits paid by the officers attached to the various Voluntary Welfare Centres are noteworthy. Full details of all these re-visits are kept at the offices of the Welfare Centres. 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 versâ. 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 1919 his figures for the Borough of Lambeth are as follows :— Inward Outward Transfers. 41 Transfers. Legitimate Males 41 847 Legitimate Females 43 825 Illegitimate Males 20 216 Illegitimate Females 27 152 Totals 131 2040 The Registrar-General's corrected number of births is 5,518, differing slightly from the corrected number of births calculated locally and found in this Report, viz., 6,057. Lambeth Maternity and Child Welfare Scheme.* During 1919, 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 respective areas allotted to them, such work being amalgamated and co-ordinated with the Council's Municipal Infants Consultations Centre and Public Health Department. During 1919 no new voluntary centre was approved. * 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 and 1919, put into force throughout the Borough the Milk (Mothers and Children) Orders, 1918 and 1919 respectively. At the end of 1919, the Lambeth Maternity and Child Welfare Scheme comprise the following Voluntary Centres, Creches or Day Nurseries, Infants Clinics and Maternity Home :— 1.—Voluntary Centres. (a) " The Barley Mow," 54, Oakley Street. (b) Holy Trinity Institute, Royal Street. (c) Babies Care, 147, Kennington Road. (d) Moffatt Institute, 2, Esher Street. (e) St. Anne's Welfare Centre, 44-46, Harleyford Road, Vauxhall. (f) The Springfield Welfare Centre, 48, Hartington Road, Vauxhall. (g) Loughborough Junction Centre, 39, Loughborough Park (h) Brixton Centre, " The Dispensary," 19, Water Lane, Brixton Hill. (i) West Norwood Centre, Hannen House, 12, Hannen Road, Knight's Hill, West Norwood. N.B. For administrative purposes, the Borough is subdivided into 12 areas for the establishment of 12 Voluntary Centres, and three of these areas are, as yet, unprovided with Voluntary Centres, viz : —North Marsh, Stockwell and North Brixton, though it is anticipated that these 3 new centres will be established and opened early in the year 1920. All the voluntary Centres are officered with qualified Medical Officers and Health Visitors, appointed by such Centres. 2. —Creches or Day Nurseries. (a) Wyndham Day Nurseries, 212, Camberwell New Road. (b) Brixton and Heme Hill Crèche, 71, Effra Road, Brixton. (c) Pilgrim Hill Crèche, Pilgrim Hill, West Norwood. 3.—Infants Clinics. (a) St. Thomas's Hospital Clinic, 107, Lambeth Palace Road. (b) Mrs. Anstruther's Clinic, 53, Ethelred Street. 4.—Maternity Homes. (a) West Norwood Maternity Home and Ante-natal Clinic, 106-108, Knight's Hill, West Norwood. In addition to the above-mentioned Centres, Crèfcches, Infants Clinics and Maternity Home, there are also included in the Lambeth Maternity and Child Welfare Scheme the following :— 1. The Maternity Departments of — (a) St. Thomas's Hospital (Westminster Bridge). (b) The General Lying-in Hospital (York Road). (c) The Clapham Maternity Hospital (Jeffrey's Road), N.B. In connection with (a) and (b) Infants Consultation Centres have been established at the Hospitals concerned MATERNITY WARDS FOR WOMEN SUFFERING FROM VENEREAL DISEASES. Arrangements have been made by the Local Government Board for suitable cases of the unmarried class, suffering from Venereal Diseases and pregnant, to be admitted under section 80 of the Public Health (London) Act, 1891, on the recommendation of Metropolitan Medical Officers of Health, into Thavies Inn Hospital (under the jurisdiction of the Metropolitan Asylums Board) in the same way as patients are admitted into the other hospitals of that Board. The accommodation is, however, somewhat limited at the present time, but will nevertheless prove of value—such an institution being needed for the proper treatment (ante-natal, post-natal and obstetric) of such cases. TRAINING OF MIDWIVES, MATERNITY AND INFANT WELFARE CENTRES AND DAY NURSERIES. Important Memoranda have been issued by the Ministry of Health during 1919 dealing with the proper and efficient training of Midwives, the establishment of Maternity and Infant Welfare Centres and the management of Day Nurseries, together with the giving of grants connected therewith. Municipal Milk Depot. (Inaugurated by the Council, 1903.) Record of Work carried out during 1919. 246 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk: — Under 3 months ... 102 9—12 months 35 52 3 —6 months Over 12 months and 21 6 —9 months 36 under 2 years 246 Of the 102 infants under 3 months, 35 were aged 14 days or under. These 246 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 141, weakly 13, wasting 66, diseased 26. The diseases from which the 26 infants and children were actually suffering at the time of being put upon the milk were : Hernia 1, rickets 1, influenza 1, ophthalmia 1, convulsions 1, diarrhoea and sickness 3, bronchitis 2, bronchitis and pneumonia 1, bronchitis and teething 1, tuberculosis 1, teething 1, measles 4, porrigo 2, eczema 1, and indigestion 5. An average of 134 infants and children (under 2 years) were fed per week at the Depot, necessitating the distribution for the year of 167,328 bottles of milk mixture, whilst, in addition, milk was also supplied as follows :— 1. Lambeth Infirmary—using 31,982 bottles of milk mixture ; 2. Lambeth Workhouse —using 1,720 bottles of milk mixture ; 3. Invalids—using 576 pint bottles of milk mixture ; 4. Nursing mothers —using 6,206 pint bottles of milk mixture ; 5. Expectant mothers —using 1,321 pint bottles of milk mixture. 6. Children over 2 years of age —using 2,955 pint bottles of milk mixture. A total of 12,937 gallons of milk and 476 pints of cream were used during 1919. Weekly medical consultations* with mothers were held at the Depôt, 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 Depôt, 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 Depôt, 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 Depôt 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 1919, being administered locally through the staffs of the various Voluntary Maternity and Child Welfare Centres, though part of the milk was supplied from the York Road Depôt in connection with applicants living within the immediate neighbourhood of such Depot. Much extra work has been thrown upon the different Voluntary Centres in consequence, but it is 'typically work for such Centres, which are, naturally, in touch with local needs and conditions. From an administrative point of view, this arrangement is a great success. * In connection with the Infants consultations at the Milk Depôt, the Ministry of Health has again given a financial grant in aid for the year 1919-20. These two orders were rescinded on the 22nd December, 1919, and in their places were issued the Milk (Mothers and Children) Order, 1919, and the Local Authorities Milk (Mothers and Children) Order, 1919, by the Food Controller and the Ministry of Health respectively under the powers conferred under the Defence of the Realm Regulations—these 2 latter orders re-enacting the 2 former Orders with the following modifications : — (1) The Order relates to milk only and not to food. (2) The power of the Local Government Board to require Local Authorities to make arrangements for the supplying of milk has been omitted. (3) Local Authorities are empowered to supply milk free, or at less than cost price, not merely in necessitous cases but also where such a supply is necessary because of the retail price of milk in any area. (4) The quantity of milk to be supplied is prescribed by the New Order as follows :— (a) For children under 18 months—1½ pints daily. (b) For children between 18 months and 5 years — 1 pint daily. (c) For expectant and nursing mothers —the quantity prescribed by the person certifying. The effect of the Order, therefore, is to empower Local Authorities to supply milk to expectant and nursing mothers and to young children without previously obtaining the consent of the Ministry of Health (as is required by the Maternity and Child Welfare Act of 1918 in respect of distribution carried out under that Act) free, or under cost price,where some person authorised by the Local Authority certifies this to be necessary by reason of the retail price of milk in its district. The Maternity and Child Welfare Grant distributed by the Ministry of Health is limited to the cases of milk supplied to necessitous cases, who are certified by the Medical Officer of the Welfare Centre, or by the Medical Officer of Health, to be in the need of such milk, so that separate accounts of milk supplied (if any) to non-necessitous applicants must be kept where the Order is in force, in those cases where application is to be made to the Ministry of Health for such a Grant for necessitous applicants. Much extra work will result from these modified Orders, which enlarge considerably the number of applicants who are now eligible for, and entitled to, the benefits under the Orders. DEATHS, 1919. The total number of deaths registered is 4,932. The deaths of all members of the armed forces of this or other countries are excluded and not only the deaths of those dying in Institutions as indicated in various tables throughout the body of the Report and in the special tables I. and 111. of the Local Government Board (vide Appendix). All death rates for 1919 are calculated upon civil population estimates. 1. —General Death-Rates. The uncorrected death-rate for Lambeth is 17-5 per 1,000 inhabitants. This rate is, however, uncorrected, and, on analysing the 4,932 total deaths registered, it is found that 1,371 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 631 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a net corrected number of deaths of 4,192, and a net corrected death-rate of 14-8 per 1,000 inhabitants. The general death-rates (corrected or uncorrected) for the Borough are again satisfactory for the year 1919 (the nineteenth year of the existence of the Borough). The figures* (corrected) for 1919 are : — (a) Inner Districts—l6.l (excluding influenza 15.1) per 1,000 population. (b) Outer districts —13.9 (excluding influenza 12.9) per 1,000 population. (c) Whole Borough —14.8 (excluding influenza 13.8) per 1,000 population. Age Periods of Corrected Deaths. The 4,192 corrected deaths during 1919 may be further analysed, and tabulated as follows :— 479, i.e., 11.4 per cent, of the total corrected deaths took place under 1 year of age. 224, i.e., 5-4 per cent, between 1 and 5 years. 703, i.e., 16.8 per cent, under 5 years. 270, i.e., 6.4 per cent, between 5 and 20 years 512, i.e., 12.2 per cent. 20 to 40 years. 903, i.e., 21-5 per cent. 40 to 60 years. 1,804, i.e., 43.1 per cent. 60 and over. 3,489, i.e., 83-2 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. TABLE D (1). Shewing the corrected number of Deaths, with corrected Death- Sub-Districts of the Borough during 1919. The deaths are from by adding Lambethians who die outside the Borough, by omitting persons (who die in Public Institutions) amongst the Districts for treatment. TABLE D (1). rates (general, zymotic and diarrhoeal), in each of the Registration all causes, and from the 7 chief zymotic diseases, and are corrected strangers who die within the Borough, and by re-distributing from which they have been removed into such Public Institutions Sub-Districts. A Registration Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population (corrected). Diarrhoea Death-rate per 10000 of the Population (corrected). REGISTRATION SUB-DISTRICTS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Typhoid or Enteric. Continued Fever. Cholera. Diarrhoea. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Small Pox. Measles. Scarlet Fever. 10 4 - 2 - 52 1.2 5.04 - 22 Lambeth Church 692 15.8 - 13 - 1 - - - - 21 0.8 4.6 38 8 786 17.4 - 3 5 Kennington 1 - - - - 14 33 0.5 2.4 10 Stockwell* 876 14.8 - 3 5 5 - - - 50 1.9 14 0.7 21 1 1059 14.4 - 5 4 Brixton 1 - - 9 0.4 1.5 1 26 Norwood 12.8 - 2 1 12 - 779 12 - 4 - - 80 199 0.7 2.8 61 4192 - 26 14.8 16 Borough of Lambeth belong to the Inner and 455 to the Outer Stockwell Sub-District respectively, (general, 16-1, zymotic, 0-9, diarrhœal, 0.42, per 1,000 population). (general, 13-9, zymotic, 0-6, diarrhceal, 0-18, per 1,000 population). * Of the 876 deaths in Stockwell Registration Sub-District, 421 Inner Registration Sub-Districts—death rates Outer Registration Sub-Districts —death rates have been included in Kennington Sub-District—having occurred in Workhouse (6) respectively. N.B.—Of the total deaths (corrected), 16 shew no addresses, and the Workhouse Infirmary (10), and in the TABLE D (2,. TABLE D (2). Shewing the corrected number of Deaths, with corrected of the Borough during 1919. The deaths are from all causes, Lambethians who die outside the Borough, by omitting strangers die in Public Institutions) amongst the Districts from which they Death-rates (general, zymotic and diarrhœal), in each of the Wards and from the 7 chief zymotic diseases, and are corrected by adding who die within the Borough, and by re-distributing persons (who have been removed into such Public Institutions for treatment.) B. Wards. B. Wards. WARDS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Total I Deaths (corrected) from Zymotic Death-rate per 1000 of the Population (corrected). Total Zymotic Deaths. Diarrhoea Death-rate per 10,000 of the Population (corrected). Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. Diarrhœa. Small Pox. Measles. Marsh 323 16.3 - 6 - 1 - - 1.2 5.5 5 1 - 11 24 17.1 7 1 3 - - - 11 28 0.9 3.7 - 504 5 1 Bishop's 16.5 - 3 5 1 - - - 38 0.9 5.3 651 8 - 21 Prince's 421 14.6 - 1 3 - 2 - - - 7 13 0.4 2.4 Vauxhall - 15.0 - 2 2 1 455 8 - - - - 7 20 0.6 2.3 Stockwell 2 Brixton 626 149 - - 3 11 - 1 - - 11 28 0.7 2.6 3 - - - - 3 22 0.9 Herne Hill 433 13.7 - 5 1 10 0.7 6 - - - - 10 0.3 1.01 - - - Tulse Hill 330 11.1 1 3 6 - - 0.5 1.9 Norwood 449 14.5 2 1 1 6 16 - - - 4192 14.8 - 26 16 61 12 - 4 - - 80 199 0.7 2.8 Borough of Lambeth Inner Wards —death rates per 1,000 population (general, 16.1 ; zymotic, (general, 13.9; zymotic, 0.6; diarrhœal, 0.18). 0.9; diarrhœal, 0.42). Outer Wards—death rates per 1,000 population N.B. —of the total deaths (corrected), 16 show no addresses, and occurred in the Workhouse Infirmary (10), and in the Workhouse have been included in Bishop's and Prince's Wards, having (6) respectively. Changes in Registration of Deaths. The Registrar-General decided to publish from January Ist, 1 11, 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 1919 from the Registrar-Genera —a total of 40 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 1919 (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 1919 being as follows: — Males. Females. Totals. Age Periods. 1 3 4 0— 1 - - 1— 2 - 2—5 - - - 5—15 1 - 1 15—25 3 4 7 25—45 6 1 7 45—65 9 4 13 65 and upwards 5 3 8 Total all ages 25 15 40 Causes of the 40 Outside Deaths. Causes of Death. Male. Female. Cerebrospinal Fever - - Diphtheria - - Puerperal Fever - - Influenza 1 1 Phthisis (Pulmonary Tuberculosis) 3 2 Other Tubercular diseases 1 1 Cancer, malignant disease 2 2 Heart disease 4 1 Bronchitis - 1 Pneumonia - 1 - 1 Broncho-Pneumonia Other Lung diseases 2 1 Nephritis and Bright's disease - 1 Diabetes mellitus 1 - Violent deaths 4 - Suicide - - Appendicitis - - Nervous diseases 2 1 Strangulated Hernia - - Diseases of Digestive System - - Syphilis - - Wound (gun shot, shrapnel or bomb, mine or torpedo) - - 5 Not classified above 3 25 15 2. —Infantile Mortality Rates. Of the 4,192 corrected deaths, 479 are infants under one year of age. The total number of registered births is 7,596, and, of these, 728 occurred at the Lying-in Hospital, and belong to districts outside the Borough, 105 occurred at the Workhouse and belong to districts outside the Borough, and 706 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 6,057*. The corrected infantile mortality (i.e., rate of corrected deaths under one year per 1,000 corrected births) is, therefore, 79-1, the annual average for the decennium 1901-10 (Borough) being 122-7. In calculating this *The Registrar-General returns the corrected number of births for the Borough during 1919 as 5,518. 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 added. Taking the uncorrected births and the corrected deaths under 1 year, the infantile mortality rate is 63.1 per 1,000, the annual average for the decennium 1901-10 (Borough), being 114.8. Taking the uncorrected number of births (7,596), and the uncorrected number of deaths under 1 year of age (640), the uncorrected infantile mortality is 84'2, 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 years as compared with the decennium 1901-10. In the Registration Sub-Districts, the uncorrected infantile mortality varied from 54.6 per 1,000 births in Stockwell to 126 9 in Kennington, thus:— Total No. of Births (uncorrected) 1919. Total Deaths under 1 year (uncorrected). 1919. Infantile Mortality per 1000 births (uncorrected). 1919. Lambeth Church* 2260 181 80.1 1032 131 Kennington 126.9 Stockwell 2051 112 54.6 Brixton 1238 148 119.5 Norwood 1015 68 66.9 Lambeth 640 84.2 7596 § Inner Districts —85.2, Outer Districts—82.9. * Excluding all the Lying-in Hospital births, the rate is 138.3. Excluding all the Workhouse births, the rate is 175.6. Excluding all the Maternity Hospital births, the rate is 100.1. § 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. 3.—Zymotic Death-Rates. The zymotic death rate is made up of the total deaths from the seven principal zymotic diseases, viz., smallpox, measles, scarlet fever, diphtheria (including membranous croup) whooping cough, " fever " (including typhus, typhoid or enteric and simple continued or ill-defined) and diarrhœa. The total number of deaths registered from these diseases is 259 —98 strangers belonging to other districts and 161 parishioners who died within the Borough ; whilst, in addition, 38 parishioners 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 199, giving a zymotic death-rate (corrected) of 0-7 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., 0-9 as compared with 0-6 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 1918 and 1919 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 infantile population {i.e., corrected number of births registered). Tuberculosis Death Rates. The tuberculosis corrected death-rate for 1919 is I's, i.e., 417 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis) death-rate, 1.2, i.e., 342 deaths from pulmonary tuberculosis or consumption (phthisis) per 1,000 population. The details of the tuberculosis deaths in the various Registration Sub-Districts are:— Corrected Deaths from Pul. Tub. or Phthisis (consumpt'n) Other Forms Tuberculosis. Total Deaths Tuberculosis (all forms) Phthisis-rate per 1,000 population. Tuberculosis rate per 1,000 population (all forms). Registration Sub-Districts. Lambeth Church 69 14 83 1.6 1.9 Kennington 83 17 100 1.8 2.2 Stockwell 57 14 71 0.9 1.2 Brixton 87 15 102 1.2 1.4 Norwood 46 15 61 0.7 1.01 Borough of Lambeth 342 75 417 *1.2 †1.5 Rates for Inner Districts Rates for Outer Districts 0.9* and 1.2. Two of the total corrected deaths registered from tuberculosis phthisis or the pulmonary form) show no addresses and have been included in Kennington Registration Sub-District with the 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 number of tuberclosis deaths during that period of 25 years, and this decline has continued up to the end of 1919. * 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 TABLE E. Shewing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1918 and 1919. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Borough 1918. Borough 1919. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). Class of Disease. I. —Zymotic Diseases 1210 24.4 550 13.1 Seven Principal 334 6.7 199 4.7 Influenza 819 16.5 293 6.9 II. —Parasitic 2 0.04 1 0.02 III.—Dietetic 2 0.04 3 0.07 IV.—Constitutional 1013 20.5 888 21.2 Cancer 392 7.9 380 9.1 401 8.1 8.1 Phthisis 342 Tubercular Diseases,excluding Phthisis 75 1.8 137 2.8 Rheumatism (Acute and Chronic) and Gout 21 0.4 16 0.4 V.—Developmental 264 5.3 344 8.2 Old Age 169 3.4 180 4.3 VI.—Local Diseases 1427 28.8 51.5 2159 Circulatory System 571 11.5 611 14.6 Bronchitis 321 6.5 378 9.02 Pneumonia and Broncho-Pneumonia 7.9 276 6.6 393 Pleurisy and Pleuropneumonia 120 1.9 2.4 83 Respiratory System,excluding Phthisis 883 785 18.7 17.8 VII.—Violence 153 3.1 182 4.3 Suicide 25 0.5 35 0.8 VIII. —III-defined and not Specified Causes 54 1.1 1.5 65 From all causes 449 94.8 479 8.7 Diarrœa 35 7.4 64 1.1 Convulsions 17 3.6 7 0.3 Respiratory Diseases 90 18.9 88 1.6 Premature Births 72 15.2 130 2.3 Tubercular Diseases (including Phthisis) 16 3.4 15 0.3 Measles 25 5.3 2 0.04 Whooping Cough 22 4.6 5 0.09 Suffocation in Bed 1.3 6 3 0.06 Enteritis 18 3.8 2 0.04 Dentition - - 1 0.02 *N.B.—The above rates have been calculated upon the Registrar-General's corrected numbers of births 28 Disease. 1914. 1915. 1916. 1917. 1918. Total (corrected) Deaths in 1919. Annual average of ten years 1901-1910 (Borough). Annual average of ten years 1891-1900 (Parish). Smallpox - - - - - - 6.8 1.1 Scarlet Fever 16 17 7 6 11 16 31.4 48.8 Diphtheria 50 45 41 48 45 60 41.6 124.5 Membranous Croup - - - - - 1 1.5 6.8 Typhus - - - - - - 0.0 0.3 Typhoid or Enteric 15 9 1 3 5 4 16.7 34.7 Fever. Continued and Relapsing - - - 1 1 - 1.7 0.7 Diarrhœa 196 124 105 91 60 80 - 172.9 196.5 Cholera - - - - - 1.3 8.8 Measles 58 91 49 108 127 26 110.4 145.6 Whooping Cough 40 49 45 38 85 12 91.8 143.7 Borough of Lambeth 375 335 248 295 334 199 475.1 706.1 INFECTIOUS DISEASES. 1. —Notifiable Diseases. Under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 3,409 cases of infectious diseases (excluding tuberculosis) were reported, including small pox 1, cerebro-spinal fever 13, polimyelitis acuta 7, ophthalmia neonatorum 82, measles 979, and German measles 200. These 3,409 cases occurred in 3,061 infected houses, and of the 3,409 cases 1,542, i.e., 45.2 per cent., were removed to hospital, and 1,867, i.e., 54.8 per cent., remained under treatment in their homes. If the recently-added notifiable diseases be excluded so as to make the 1919 figures strictly comparable with those for previous years, the percentage of cases removed to hospital during 1919 was 76.3, 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 —a satisfactory record, having regard to the shortage of beds available at the M.A.B. Hospitals, off and on, during 1919. Full particulars of all the compulsorily notifiable infectious diseases are to be found in tabular form. Nursing in connection with Measles, German Measles, Whooping Cough, Ophthalmia Neonatorum and Epidemic Diarrhœa cases. The arrangements which were made by the Council with the South London District Nursing Association and the Ranyard Nurses for the nursing, free of cost, of patients notified or otherwise known to be suffering from Measles and German Measles, Whooping Cough, Opthalmia Neonatorum and Epidemic Diarrhœa if (and as) required by the Medical Officer of Health, and which came into force on June 1st, 1918, in connection with the Inner Wards of the Borough, proved so successful that similar arrangements were made with the Camberwell and Brixton Nursing Associations in connection the Outer Wards of the Borough, the list of the diseases to be nursed being increased both in the Inner and the Outer Wards of the Borough so as to include pneumonia and influenza as well as epidemic cerebro-spinal meningitis, acute polio-myelitis and polioencephalitis. 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.* 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 cases as required. * During 1919, 25 Schools (36 class rooms) were dealt with, 124 children being excluded from the Infants' Departments in connection with 69 Measles cases reported. 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 Fever 1011 16 1.5 866 927 85.6 Diphtheria 548 60 10.9 484 483 88.3 Membranous Croup 4 1 25.0 2 4 50.0 Typhus - - - - - - Typhoid or Enteric 16 4 25.0 13 16 81.2 Continued and Relapsing Fever 187 9 4.8 53 185 28.9 Erysipelas 187 9 4.8 53 185 28.9 Puerperal Fever 6 37.5 100.0 16 16 16 *Plague - - - - - - *Cerebro-Spinal Fever 13 7 53.9 13 11 100.0 1 14.3 4 7 57.1 *Poliomyelitis acuta 7 82 3.6 *Ophthalmia Neonatorum 82 - 0.0 3 *Whooping Cough - - - - - - *Measles 979 26 2.6 71 813 7.2 *German Measles 200 - 0.0 21 187 10.5 *Tuberculosis — ___ ... 656 342 52.1 - 656 - Pulmonary (primary) Non-pulmonary (primary) 224 75 33.5 - 224 - *Chickenpox - - - - - - N.B. In addition to the above, the following infectious diseases, made compulsorily notifiable during 1919, have been notified, the numbers of infected houses in which the diseases were notified being given in brackets after each disease:- Malaria 91 (91), dysentry 6 (6), primary pneumonia 74 (73), influenzal pneumonia 169 (154), and acute encephalitis lethargica 5 (5), 50 cases of primary pneumonia, 24 of influenzal pneumonia and 4 of acute encephalitis lethargica were removed to hospital. 3 cases of acute encephalitis lethargica died. * Plague was made compulsorily notifiable on September 19th, 1900, Cerebro-Spinal Fever on March 12th, 1907, Poliomyelitis and Polio-Encephalitis acuta on September 1st, 1911, Opthalmia Neonatorum on March 13th, 1911, and Tuberculosis (all forms) 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), the numbers of cases notified being respectively, 1,560, 40, 556, 238, 473 and 307. Whooping Cough was compulsorily notifiable from January 1st, 1913, to Dceember 31st, 1917, the numbers of cases notified being as follow:- 1913, 1428 ; 1914, 1,389 ; 1915, 1,607 ; 1916, 1,576 ; and 1917, 902. Measles and German Measles became compulsorily notifiable on January 1st, 1916. Acute encephalitis lethargica became compulsorily notifiable on Jan, 1st, 1919, and malaria, dysentery, pneumonia (acute primary and acute influenzal) and trench fever, on March 1st, 1919. 32 33 Disease. Borough of Lambeth. Annual Average, 1901-10 (Borough) 10 years. Annual Average, 1891-1900 (Parish) 10 years. 1914. 1915. 1916. 1917. 1918. 1919. Cholera - - - - - - 11.5 0.2 Smallpox - - - - 1 1 49.9 22.0 Scarlet Fever 1,745 900 501 340 549 1,011 1105.1 1331.3 550 434 432 563 484 548 379.8 715.1 Diphtheria Membranous Croup 6 4 4 7 9 4 10.4 26.2 Typhus - - - - - - 0.1 1.1 Typhoid or Enteric 32 48 19 17 15 16 100.5 189.6 Continued and Relapsing 2 - 19 3 - - 4.1 25.7 Erysipelas 231 177 122 130 105 187 241.4 347.0 Puerperal 23 26 20 14 16 16 17.0 18.9 *Plague - - - - - - - - *Cerebro-spinal Fever 5 44 38 31 23 13 11.5 - *Poliomyelitis acuta 10 4 12 9 11 7 - - *Ophthalmia Neonatorum 57 73 67 50 82 - - 83 *Whooping Cough 1,389 1,607 1,576 902 - - - - *Measles - - 2,548 2,721 979 - - 3,224 *German Measles - - 1,212 1,241 402 200 - - *Tuberculosis— Pulmonary (primary) 1,250 1,020 904 1,086 1,061 656 - - Non-pulmonary (primary) 298 362 361 - - 273 444 224 *Chickenpox - 473 - - 307 - - - *Malaria - - - - - 91 - - *Dysentery - - - - - 6 - - *Primary Pneumonia (Acute) - - - - - 74 - - *Influenzal Pneumonia (Acute) - - - - - 169 - - *Encephalitis Lethargica (Acute) - - - - - 5 - - *Trench Fever - - - - - - - - * Plague was made compulsorily notifiable on September 19th, 1900 ; Cerebro-Spinal Fever (" Spotted Fever ") on March 12tn 1907 ; Poliomyelitis and polioencephalitis acuta on September 1st, 1911 ; Opthalmia Neonatorum on March 13th, 1911; Pulmonary Tubercolusis (Poor Law cases) on Jan. 1st, 1909, Pulmonary Tuberculosis (Hospital cases) on May Ist, 1911, Pulmonary Tuberculosis (Private cases) on Jan. 1st, 1912, and Tuberculosis (Pulmonary and Non-pulmonary) on February 1st, 1913. Chickenpox 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; 1914,1,389; 1915,1,607; 1916,1,576; and 1917, 902. Measles and German Measles became compulsorily notifiable on January 1st, 1916. Acute encephalitis lethargica became compulsorily notifiable on January 1st, 1919, and malaria dysentery, acute primary and influenzal pneumonia and trench fever on March 1st, 1919. 35 34 METROPOLITAN BOROUGH OF LAMBETH. TABLE H. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications received during the period from 29th December, 1918, to the end of the week ending the 3rd January, 1920. Number of Notifications on Form B. Number of Notifications on Form A. Number of Notifications on Form C. Number of Notifications on Form D. Age-Periods. Primary Notifications. (Medical.) Total Notifications (i.e., including cases previously notified by other Doctors). (Medical.) Primary Notifications (Medical.) †Total Notifications (i.e., including cases previously notified by other Doctors). (Medical.) Cases admitted to Cases discharged from Poor Law Institutions. (Medical.) Sanatoria. Poor Law Institutions. (Medical.) 1 to 5. 5 to 10. 10 to 15. 15 to 20. 25 to 35. 45 to 55. 55 to 65. Total. Under 5. 5 to 10. 10 to 15. Total. upwards. 20 to 25. 0 to 1. 35 to 45. Sanatoria. I Pulmonary— 2 2 11 17 21 44 119 94 46 9 395 432 - - 1 1 6 135 14 Males 30 1 112 Females 1 3 10 17 34 35 58 52 37 6 8 261 292 - 1 2 3 4 4 87 72 5 Non-Pulmonary— I 43 21 6 8 1 2 1 116 118 - 6 5 11 11 7 - Males 5 5 18 6 9 5 48 14 5 6 13 1 1 - 5 108 112 5 2 7 7 7 12 Females 2 13 1 7 - * Re-notifications (Form A)=68 (males 37, females 31), pulmonary and 6 (males 2, females 4) non-pulmonary. † Re-notifications (Form B)=1 (male 0, female 1), pulmonary. N.B.—Pulmonary—l6l private, 271 hospitals, 224 dispensaries, 0 Poor Law Officers and 4 schools = 660 total primary notifications (Forms A and B). Non-Pulmonary — 27 private, 72 hospitals, 125 dispensaries, 0 Poor Law Officer and 18 schools = 242 total primary notifications (Forms A and B). Primary. Total. Primary Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Primary. Marsh 76 88 1 2 - 19 - 12 17 4 - 2 - - 15 4 Bishop's 79 89 - - 3 33 5 24 19 19 2 2 14 4 - 2 Prince's 86 96 1 1 - 30 4 31 18 19 8 1 3 2 8 - Vauxhall 58 65 - - 25 3 26 12 12 3 3 - 1 2 - 1 Total Inner Wards 299 338 2 3 3 107 12 93 64 67 17 17 16 11 - 5 Stockwell 82 86 1 1 27 28 - - - - - 1 23 1 18 - Brixton 112 120 - - 2 27 3 27 37 38 - - - 3 - 1 Herne Hill 73 81 1 1 1 22 1 16 35 35 - - - 3 1 4 18 Tulse Hill 44 48 - - 1 17 2 9 18 - - - - - 1 43 44 Norwood 46 51 - - 2 26 - 21 1 1 - 2 - 1 160 163 Total Outer Wards 357 386 2 2 7 115 7 91 1 1 - 1 7 8 Borough of Lambeth 656 724 4 5 10 222 19 184 224 230 18 18 16 19 1 12 Forms. Total. Primary. Total. Poor Law. Sanatorium. Sanatorium. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Poor Law. Primary. Waterloo 76 88 1 2 - 19 - 12 17 4 4 - 2 - 15 - Lambeth Church 49 59 - 1 3 29 4 21 10 10 2 2 14 4 - 2 Kennington 116 126 1 1 - 34 5 34 27 28 8 8 1 3 - 2 Stockwell (Inner) 58 65 - - - 25 3 26 12 12 3 3 1 2 - 1 Total Inner Districts 299 338 2 3 3 107 12 93 64 67 17 17 16 11 - 5 1 1 1 23 1 18 27 28 - - - - - - Stockwell (Outer) 82 86 Brixton 185 201 1 1 3 49 4 43 72 73 - 1 - 6 1 5 Norwood 90 99 - - 3 43 2 30 61 62 1 1 - 2 - 2 Total Outer Districts 357 386 2 7 7 91 160 163 1 1 - 2 115 8 1 7 656 724 4 5 10 222 19 184 224 230 18 18 16 19 1 12 Borough of Lambeth Central Dispensary. Branch Dispensary. Totals. Insured. Uninsured. Insured. Uninsured. Males. Females Childr'n under 16. Adults. Males. males. Males. Females Childr'n under 16. Adults. Males. Females. 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensaries 209 61 212 21 239 230 128 1364 150 96 18 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 107 17 10 25 96 38 8 363 16 13 33 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 3 2 107 - 2 16 47 6 194 10 1 (d) Number included under 1 (a) who were found to be non-tuberculous* 58 26 51 7 45 75 69 485 72 74 8 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 41 16 38 41 24 52 20 322 96 30 1 * N.B.—Central Dispensary (73, Effra Road, Brixton) opened July 23rd, 1913 : Branch Dispensary (St. Thomas's Hospital) opened February 3rd, 1913. 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) ) 2364 5430 3119 3715 14628 (b) Number of the above attendances at which systematic physical examinations and records were made 488 563 674 728 2453 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 "‡ - 246 312 15 78 2136 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 24 26 106 125 281 - - - - - 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 24 26 106 125 281 41 TABLE J. Local Government Board Table. BOROUGH OF LAMBETH. — Particulars of cases of acute polio-myelitis, (polio-encephalitis), cerebro-spinal fever and encephalitis lethargica acuta notified within the Borough of Lambeth, during 1919. Total number of Cases notified. NUMBER OF - CASES (excluding Military Cases). 1-5 years. 0-1 year. 10-15 years. 5-10 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. Permanent Paralysis. * Cases Permanent Paralysis.* Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Deaths. Deaths. Deaths. Cases. †Acute Polio-myelitis (Polio-encephalitis) 7 - - - - - - 2 - - 1 1 - 2 - - - - - - - - - 1 - - - - - - - - - - - 1 - - - - - - - Cerebro-Spinal Fever 10 - - - 1 1 - - - - 2 1 - - - 1 - 1 - - - - 1 - - - - - 1 - 1 2 - - - - - 1 1 1 - 2 - Encephalitis lethargica 5 - - - - - - - - - - - - - - - - - - 1 - 1 - - - 1 1 - - - - 2 1 - - - - 1 - - - - 1 Number of cases removed to Isolation Hospital. *i.e., Recovered with permanent Paralysis of one or more groups of muscles (slight paralysis of ciliary muscles and accommodation). † Acute Polio-myelitis (Polio-encephalitis) - - 1 1 1 1 - - - - - - - - Cerebro-Spinal Fever - - - 2 - 1 1 - 1 - 1 1 2 - Encephalitis Lethargica - - - - - - 1 - - - 2 - - - † The 7 cases of acute polio-myelitis were notified as such—not one as . acute polio-encephalitis. N.B.—There were, in addition, during 1919, 3 military cases of cerebrocases were treated in hospital, and 1 died. spinal fever (1 "carrier") notified —2 Privates and 1 V.A.D. All the military 2.—Non-Notifiable Diseases. Chickenpox. 743 cases of chickenpox were notified voluntarily. Diarrhœa. There has again been a marked decrease in the number of corrected deaths registered from diarrhœa —80, 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 1911-1915, respectively. Of the 80 deaths registered during 1919, 76, i.e., 95 per cent., occurred amongst children under 5 years of age and 64, i.e., 80 per cent., amongst infants under 1 year of age. The 4 ft. earth thermometer first registered 56°F. on June 11th, rising to a maximum of 62° F. on August 21st and remaining at such maximum until August 28th, and sinking to 56° F. again on October 9th. 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. 16 corrected deaths (2 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 diarrhœa ; (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; (C) Issuing of special leaflets or posters during the summer, dealing with (1) precautions to be taken against summer diarrhœa, (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. (a) Feeding of Infants and young children at the Municipal Milk Depôt, 66, York Road. Influenza. The epidemic, which began in the third quarter of 1918 and was at its height during the fourth quarter of 1918, continued during the first quarter of 1919 (causing, during that quarter, a total of 240 corrected deaths), considerably diminishing during the second quarter of 1919 (34 corrected deaths), and still further diminishing during the third and fourth quarters of 1919 (4 and 15 corrected deaths respectively), making a total of 293 corrected deaths for the whole year 1919. Of these 293 deaths, 24, i.e., 8.2 per cent., were in persons under 5 years of age, and 5, i.e., 1.7 per cent., in persons under 1 year of age. The highest mortality was in the age-period 25 to 40 years, viz., 82, i.e., 27.9 per cent.,whilst the age-periods 45 to 60 years and over 60 years also suffered severely, viz., 54 and 73, i.e., 18.4 per cent. and 24.9 per cent. respectively, as was the case during 1918. The full details of the age and sex distribution of the disease are as 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. 3 2 5 6 2 6 3 13 5 3 13 11 7 12 33 49 40 to 45 45 to 60 60 to 65 65 and over. All Ages. Over 5 Years. Total. m. f. f. m. f. f. f. f. m. m. m. m. 8 33 21 7 8 144 138 9 31 27 125 155 293 As was also the case during 1918, the sexes appear to have suffered equally, taking into consideration the estimated male and female populations (128,357 and 153,965 respectively), whilst the disease was widespread throughout the Borough generally, the Inner, more crowded, districts, and the outer, less crowded, districts, suffering equally, whether Registration Sub-Districts or Wards, with the Borough as a whole, viz. : a corrected influenza deathrate of 1.1 per 1,000 of the population. Finally, as was also the case during 1918, the disease during 1919 appeared in three forms: (a) Nervous, (b) Catarrhal (bronchitis and pheumonia) and (c) gastric—the catarrhal form being the commonest; and second attacks of the disease were rare. The Pfeiffer bacillus, the pneumococcus Friedlanderi and a streptococcus were isolated upon some of the patients, as was also the case last year. 169 cases of influenzal pneumonia were notified during 1919, this form of the disease being made compulsorily notifiable as from January 1st, 1919. The most fatal type of the disease was the pneumonic (a catarrhal type). The disease appeared to spread from person to person and to be at its height of virulence from the point of view of infection to others during the first 36 or 48 hours from its onset, several cases occurring in one house at one and the same time. The Public Health (Influenza) Regulations, 1918, and the Public Health (Influenza) Regulations (No. 2), 1918, which came into force on November 25th, 1918, were rescinded by the Order of the Local Government Board on May 6th, 1919. The usual precautionary measures were taken. The Influenza epidemic lasted for 12 months from the commencement of the third quarter of 1918 to the end of the second quarter of 1919, a total of 1,070 corrected deaths (registered), thereby shewing the serious ravages that an epidemic may cause in a district at any time. The disease was, undoubtedly, introduced from abroad and was pandemic over the World. DEATHS (CORRECTED) FROM INFLUENZA. (Arranged Weekly). 1919. Week-ending Jan. 4 4 July 5 - 11 3 12 1 18 2 19 - 25 2 26 - 7 Feb. 1 Aug. 2 - 8 5 9 - 18 16 15 1 22 41 23 1 30 - 60 Mar. 1 40 Sept. 6 8 1 15 28 13 - 16 20 - 22 29 14 27 - Oct. 4 April 5 4 1 12 3 11 - 19 4 18 2 26 3 25 1 Nov. 1 - May 3 5 10 6 8 2 17 1 15 - 24 1 22 1 31 - 29 3 2 Dec. 6 June 7 1 14 4 - 13 1 20 1 21 28 1 27 2 Total 293 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 sequelæ of Influenza. 3. —" Contacts " or " Suspects," " Carriers " and " Convalescents " (Military). Many " Contacts " or " Suspects," " Carriers " and " Convalescents " (military) were watched in connection with different diseases as follows:— (a) Cerebro-spinal or " Spotted " fever (epidemic cerebrospinal meningitis), 1. (b) Enteric or Typhoid Fever, 1. (c) Plague, 18. (d) Dysentery, 10. (e) Malaria, 28. (f) Smallpox, 56. (g) Typhus, 2. (h) General Infectious Diseases, 19.* In addition to the above military cases, the following civilian " contacts " were watched, viz.: 10 (Diphtheria) in connection with the Boys' Brigade and the Royal Naval Hospital Schools. * Civilian passengers and civilian prisoners of war from Copenhagen, Helsingfors and Rotterdam respectively. 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 1919 and the previous 8 years 1911-1918, 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-Lœffler Bac. found. Other Sundry Samples. Result obtained. Pos. Total Pos. Neg. Total Neg. Total Neg. Total Neg. Pos. Pos. 1919 45 315 360 7* 14 21 21 487 508 - 12† 12 1918 70 299 369 12* 14 354 - 2 10 368 2 2† 363 440 9 32 468 10 1917 77 4* 13 500 2 8 126 246 5 28 33 407 440 - 6 1916 472 23 6 1915 155 390 545 12 34 46 99 937 1036 8 24 32 1914 411 733 14 28 108 730 838 6 12 18 1144 42 614 1484 12 35 867 1913 870 47 130 997 18 19 37 1912 296 305 601 31 26 57 55 442 497 12 10 22 1911 87 139 226 | 22 33 55 78 589 7 21 28 667 Average of 10 years 1901-1910 (Borough) 62.8 124.4 187.2 19.4 39.6 59.0 448.6 485.2 3.7 12.8 9.1 36.6 * One of the cases was paratyphoid B. †Smearings for conococci, 6 ; Smearings of blood for malaria, 3; and samples of urine for tubercle bacilli, 3. 107 vials of antitoxin were distributed free of cost during 1919, under the Antitoxin Order, 1910. N.B.—Since the Bacteriological Laboratory was inaugurated in 1899 (up to the end of the year 1919), 22,016 examinations have been conducted there in connection with the following suspected diseases, viz.:- tuberculosis, 8,192 ; typhoid or enteric fever, 1,150 ; diphtheria, 12,348 ; and others, 326. TABLE K. TABLE K. [Local Government Board, Old Table A.] Table of DEATHS during the year 1919 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. (a) Mortality from all Causes at subjoined Ages. 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 10 18 At all ages. (b) (c) Under 1 year. (d) 1 and under 2 (e) 2 and under 5. (f) 5 and under 15. (g) 15 and under 25. (h) 25 and under 45. (i) 45 and under 65. (j) 65 and upwards. (k) Scarlatina. Diphtheria. Fevers 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. - - - - - - 11 - - 9 - 1 - - 24 66 30 7 8 4 4 8 1 Under 5 - 45 Royal Infirmary (Women and Children) 4 - - - - - - - 1 5 upwds. - - - 2 2 1 2 - - 13 21 - - - - - - - - - - - - - - - - King George Hospital 73 - - - - 28 46 2 - Under 5 - - - - - - - - 1 - 12 10 2 18 - 1 8 73 - 21 5 upwds. - - - - - - 3 - 1 - - - - 33 - - 2 27 General Lying-in Hospital, York Road 41 33 - - - - 8 - - Under 5 - - - - - - - - - 1 - 1 - - - - 6 8 5 upwds. 7 - St. Thomas's Hospital 561 67 20 29 53 130 166 53 Under 5 - - 1 2 - 11 - 1 15 1 1 12 1 3 61 116 43 3 3 5 upwds. - - - - - 2 - 9 19 17 18 44 6 31 293 445 - - Remainder of Lambeth Church 349 51 9 13 51 96 92 Under 5 - - - 7 1 1 - 1 16 1 4 6 - - 41 78 18 19 - 1 1 - - - - 32 53 50 33 28 1 - 72 271 5 upwds. - - - - - - - - - - - - - - - - - 19 - - - - - - 19 Under 5 - - Lambeth Workhouse - - - - - - - - - 5 upwds. - - - 8 9 - - - - 2 19 Lambeth Infirmary 1126 91 27 9 30 43 149 320 457 Under 5 2 - - 2 2 2 29 - 4 28 - 1 - 52 127 - 5 - - 1 - 8 1 - - 4 117 134 190 54 44 1 444 999 - 1 5 upwds. St. Peter's House 38 - - - - - - 1 37 Under 5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4 1 1 - - - 32 38 5 upwds. 1 Remainder of Kennington 40 6 9 12 44 73 95 Under 5 - - - 1 3 - - 14 - 1 - 36 57 - 1 - - 290 11 - - - - - 1 - - - 26 61 43 18 7 - - 77 233 5 upwds. 28 - - - - - - - 134 17 28 51 12 13 4 - Under 5 9 7 1 - - 2 7 54 South-Western Hospital 9 - - 11 35 3 7 - 1 - - - - 2 - 1 - 9 - 11 80 5 upwds. - - - - - - - - - 1 - - - 22 23 Clapham Maternity 26 23 - - - 1 2 - - Under 5 - - - - - - 5 upwds. - - - - - - - - - - - - - 3 3 - - - - - 1 2 - 1 30 - 5 - - 48 92 Remainder of Stockwell 516 72 11 9 9 73 115 203 Under 5 5 upwds. 1 4 24 - - - - - - - 1 1 28 88 67 61 11 - - 167 424 50 51 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1919 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. Mortality from all Causes at subjoined Ages. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. (a) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 18 19 20 At all ages. (b) (c) Under 1 year. (d) 1 and under 2. (e) 2 and under 5. (f) 5 and under 15. (g) 15 and under 25. (j) 65 and upwards. (k) 15 17 (h) 25 and under 45. (i) 45 and under 65. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cerebro-Spinal M. and Poliomyelitis Appendicitis. All other Diseases. Total. Puerperal. Continued. Enteric or Typhoid. - - - - - - - - 1 13 - - 6 - - 3 1 1 28 53 King's College Hospital 249 3 31 23 60 57 25 Under 5 12 38 - - - 1 - - 1 - - - 2 5 19 19 4 30 - 9 106 196 5 upwds. Belgrave Hospital 69 40 7 10 - - - Under 5 - - - - - - - - - 8 - - 16 - 1 2 3 1 28 59 12 - - - - - - - - - - - - - 3 - - - 1 6 10 5 upwds. - 1st London General Hospital 49 - - - 4 Under 5 - - - - - - - - - - - - - - - - - - - - 15 - 30 - - - - - - - - - - - 3 1 7 7 12 1 2 16 49 5 upwds. - - - - - - - - - - - - - - - - - - - - - 4th London General Hospital 77 - - - - 19 6 - Under 5 52 - - - - - - - - - - - 4 19 2 14 6 - 3 29 77 5 upwds. - - - - - - - 2 4 7 - 1 30 - 7 6 - - 41 98 Remainder of Brixton 646 70 15 12 76 147 287 Under 5 13 26 1 2 - 1 - - - 1 - - 1 47 121 107 53 22 - - 192 548 5 upwds. Lambeth Workhouse Schools 32 17 4 5 2 - - - - - - - - - - 3 - 10 - - 5 1 1 - - - 5 25 Under 5 4 - - - - 1 1 - - - 4 7 5 upwds. - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - British Home of Incurables - - - - 1 4 2 Under 5 - 7 5 upwds. - - - - - - - - - - - - 1 - - - - - 6 7 1 - - - 1 1 5 - 1 19 - 4 5 - - 37 76 Remainder of Norwood 564 51 10 11 70 127 264 Under 5 - 1 1 15 16 - 1 - - - 1 1 2 33 100 84 39 9 - - 218 488 5 upwds. - - - 9 39 1 - - - 4 25 11 103 - 9 1 91 3 29 43 7 5 457 4932 640 126 238 284 809 1130 1535 Under 5 936 170 Totals 12 41 - 10 - 9 10 5 4 11 317 645 602 323 236 18 48 1705 3996 5 upwds. - The subjoined numbers have also to be taken into account in judging of the above records of mortality. 3 - - - - 1 2 2 4 - 1 10 - - 1 1 - 40 Deaths occurring outside the district among persons belonging thereto 631 49 8 16 35 118 198 168 Under 5 73 8 39 1 12 - 3 - 2 1 2 - 2 2 82 30 85 20 36 1 7 272 558 5 upwds. 3 22 - - - - 3 7 1 31 3 43 1 14 6 3 164 Deaths occurring within the district among persons not belonging thereto 210 32 64 108 130 342 313 172 Under 5 - 5 306 1371 6 - 7 - 7 4 1 - 2 4 64 96 78 74 120 13 32 539 1065 5 upwds. 18 Population at all Ages. (d) Total Registered Births 1919. New cases of sickness in each locality, coming to the knowledge of the Medicial Officer of Health during 1919. Census 1911. (b) Estimated 1919. [Civil Population.) (c) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Registration Sub- Districts. (a) Small Pox. Diphtheria. Membranous Croup. Fevers. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. Dysentery. Scarlatina. Typhoid or Enteric. Puerperal. Encephalitis Lethargica. Lambeth Church 47910 43697 2260 - 225 167 - 2 1 2 41 5 1 11 223 31 10 27 25 2 Kennington 45175 1032 - - 3 - 4 2 100 18 7 27 14 48609 164 81 23 - 16 1 Stockwell 62608 59168 - 238 2 1 2 41 5 2 28 28 13 - 2051 87 - 86 21 40 Brixton 73679 1328 - 2 7 2 2 61 52 76650 252 134 5 51 - 18 266 17 25 2 Norwood 1015 1 132 79 2 2 1 3 31 1 2 9 304 69 12 23 14 1 62281 60603 282322 1011 16 16 187 979 91 298058 7596 1 548 4 5 7 200 6 Totals 13 82 74 169 Lambeth Church 47910 43697 2260 - 190 157 - 2 1 2 11 5 1 - 19 5 - - 11 6 Kennington 48609 1032 - 142 76 - 2 - 4 10 - - - 15 4 12 3 - - 45175 Stockwell 62608 59168 2051 - 21 1 77 - 2 1 2 11 5 2 - 12 4 16 7 - - 76650 1238 - 212 110 1 5 1 5 14 2 - - 11 3 9 - - RIXTON 73679 5 Norwood 62281 60603 1015 1 111 64 1 2 1 3 7 1 1 - 14 5 2 3 - - 298058 7596 4 - 71 21 50 24 - 282322 1 866 484 2 13 4 53 16 13 Totals - 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 notification 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 743, Measles 345, Cancer 78 and Whooping Cough 450. §1917 272038 6869 5208 19.1 5374 19.7 1975 831 519 99.6 4230 15.5 §1918 262275 6390 4296 16.5 6310 24.0 2158 878 449 104.5 5030 19.2 §1919 282322 7596 5687 20.1 4932 17.5 1371 671 483 84.9 4232 14.9 §N.B.-The populations estimated for 1915, 1916, 1917 1918, and 1919 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. 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. 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 (2040 outward and 131 inward transfers). *In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the Borough. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. † Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph. The Registrar-General supplied the particulars of extra transferable deaths (40) 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 Registrar-General. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances. In Column 8 the number of transferable deaths of "non-residents" which are deducted and in Column 9 the number of deaths of "residents" registered outside the district which are added are stated in calculating the nett death-rate of the Borough. Census 1911. Area of Borough in acres (exclusive of area covered by water), 40796. Average number of persons per house (estimated), 6.7. Number of inhabited houses, 44123. Total population at all ages, 298058. 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. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. At all Ages. At Ages—Years. 1 to 5. 25 to 45. Under 1. 5 to 15. 15 to 25. 45 to 65. 65 and upwds. 1 1 - - - - - - - - - 1 Small-pox - 1 - - Cholera - - - - - - - - - - - - 9 124 68 3 4 2 1 167 87 136 Diphtheria (including Membranous Croup) 525 314 81 81 486 2 5 16 13 54 66 31 41 23 41 51 31 Erysipelas 187 53 703 Scarlet Fever 1011 5 199 71 31 2 - 75 164 238 252 132 866 Typhus Fever - - - - - - - - - - - - - - 16 - 3 6 Enteric Fever 1 2 4 2 3 2 7 2 13 - Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - Puerperal Fever 16 - - 3 13 - - 2 4 2 5 3 16 - - - - - - - - Plague - - - - - - 55 134 119 125 Pulmonary Tuberculosis* 656 3 5 323 17 116 140 185 90 - 224 7 126 23 27 4 25 27 Other Forms of Tuberculosis† 31 6 39 72 61 - 2 Cerebro-spinal Fever 13 1 2 5 3 - - 5 - 5 2 1 9 Polio myelitis acuta 7 - 3 3 1 - - - 1 2 2 - 2 2 - 11 Ophthalmia Neonatorum 82 82 - - - 16 28 18 9 - - - 979 28 435 465 39 10 2 223 Measles - 100 86 266 304 71 200 5 49 111 25 9 1 31 18 21 61 69 German Measles § - 21 Malaria 91 - - - 22 65 4 25 14 13 25 14 - - 2 Dysentery 6 - - - 2 2 2 - 1 - 2 1 - 74 15 15 19 8 Primary Pneumonia 3 5 9 10 7 28 17 12 50 169 2 14 33 2 5 63 19 13 27 27 40 52 Influenzal Pneumonia 23 24 1 2 2 - 2 1 Encephalitis Lethargica 5 - - - 1 - 1 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 intectious diseases and (partly) Measles and hooping Cough. * Excluding all renotifications (68) of pulmonary tuberculosis, and notifications under Form C (232) and under Form D (203) of the 1912 Regulations. † Excluding all renotifications (6) of non-pulmonary tuberculosis, and notifications under Form C (35) and under Form D (13) 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 and are still compulsorily notifiable. All causes Certified (c) 4 1 92 Uncertified 94 113 143 183 540 1425 2567 3870 446 926 33 9 26 6 45 89 106 322 8 - Typhus Fever - - - - - - - - - Enteric Fever 4 - - - - - 2 1 1 4 - - - - - - - Continued Fever - - - - - - Small-pox - - - - - - - 2 10 8 6 - - - Measles 26 - - - Scarlet Fever 16 1 2 6 6 1 - - - Whooping Cough 12 5 3 4 - - - - - - - 61 3 20 32 Diphtheria and Croup (See note (d)) 3 2 1 - - 293 5 11 8 35 69 58 - Influenza 8 99 9 2 - - - - 2 2 3 - Erysipelas Cerebro-Spinal Fever 7 1 - 1 2 1 2 - - - Polio-myelitis acuta 1 - - - - - 1 - - - 25 11 - - - - 2 10 2 - Venereal Diseases Phthisis (Pulmonary Tuberculosis) 342 1 2 4 7 59 144 17 - 108 Tuberculous Meningitis (See note (e)) 28 4 5 6 9 2 2 - - - Other Tuberculous Diseases 47 10 2 2 8 5 10 8 2 - 2 Rheumatic Fever 9 - 2 3 2 - - - - - - 2 4 Cancer, malignant disease (See note (f)) 380 - 38 175 161 - Bronchitis 378 21 9 2 - 10 76 257 3 Broncho-Pneumonia 148 44 21 25 5 1 10 14 28 Pneumonia (all other forms) 203 18 11 6 14 15 37 57 45 Other diseases of Respiratory organs 56 5 - 3 2 2 12 19 13 13 Diseases of Circulatory System 611 1 - 1 6 47 166 377 338 12 3 3 2 5 38 103 172 Diseases of Nervous System Diarrhoea (See note (g)) 80 64 10 2 1 - - 2 1 Enteritis 16 2 - 1 - 1 2 4 6 5 Appendicitis and Typhlitis 25 - - 2 9 3 6 - Alcoholism (See note (h)) 3 - - - - - - 3 - Cirrhosis of Liver 20 - 2 9 9 - - - - Nephritis and Blight's Diseases 143 - - 1 5 7 17 54 59 Puerperal Fever (See note (i)) 6 - - - - 1 5 - - Other accidents and diseases of Pregnancy and Parturition - - - 11 - 3 8 - - Congenital Debility and Malformation, including Premature Birth (See note (j)) 225 222 1 2 - - - - - Violent Deaths, excluding Suicide 147 18 5 7 22 5 23 31 36 35 - - - - 2 17 14 2 Suicides Other Defined Diseases 487 27 7 4 19 18 49 81 282 Diseases ill-defined or unknown 4 1 3 - - - - - - 59 58 All Causes Uncertified 17 1 1 1 20 6 6 2 37 3 - - - - - - - - - - Chicken Pox - - - - - - - 1 - Scarlet Fever 1 - - - - - - Measles 2 - - 2 Diphtheria and Croup - - 1 - 1 1 - 3 1 - - - - - - Whooping Cough 1 3 1 - 5 Diarrhœa - 1 1 2 4 11 20 16 13 64 - - - - - - Enteritis (Epidemic) 1 1 - 2 Influenza 1 - - 1 - 1 2 1 5 - 1 - - Cerebro-Spinal Fever - - - - - - 1 Anterior Poliomyelitis - - - - - - - - - - Phthisis 1 - 1 - - - - - - - Tuberculous Meningitis - I I - - - 1 3 - 4 Abdominal Tuberculosis Other Tuberculous Diseases Congenital Malformations Premature Birth Atrophy, Debility and Marasmus Atelectasis Erysipelas Syphilis Rickets Meningitis (not Tuberculous) Convulsions Gastritis - - - - - Dentition - - - - - - Eczema 10 100 21 10 1 - - - - - - - - - - - - - 1 - - 3 9 6 2 - - 1 2 - 5 9 1 1 1 2 1 - 1 - 15 123 29 13 - - - - 3 2 3 6 12 - - - - - 2 - - - 6 2 2 6 1 2 - - 1 - - 5 12 2 - - - - - - - - - 1 - - - - - - - - 3 - 1 1 2 - - 1 - - 10 20 130 59 13 2 11 1 3 7 4 1 2 1 1 2 - 2 - - - - - - - (A.) REGISTRATION SUB-DISTRICTS. I. Specific Febrile,or Zymotic Diseases Sub-Districts. Sub-Districts. Kennington. Stockwell. No Address. Lambeth Church. Brixton. Norwood. All Ages. Total. M. F. M. F. M. F. M. M. F. M. F. M. F. F. 53 58 42 46 64 73 48 1 270 280 550 66 63 36 - II. Parasitic Diseases - - - - 1 - - - 1 - 1 1 - - - - - - - III. Dietetic Diseases - 1 1 - - - - - 2 1 3 86 60 IV. Constitutional Diseases 98 78 77 86 124 118 73 86 - 2 458 430 880 V. Development Diseases 29 28 29 56 24 149 37 39 30 41 31 - - 195 344 VI. Local Diseases 179 145 187 181 254 203 4 1086 1073 2159 207 255 295 241 8 VII. Deaths from Violence 29 12 29 9 25 25 19 15 10 - 1 123 59 182 8 VIII. Deaths from Ill-defined and not Specified Causes 9 3 - - 5 10 8 6 7 65 3 9 5 38 27 386 390 380 370 Totals 306 410 507 552 8 8 2065 4192 466 409 2127 (B.) AGE PERIODS. I. Specific Febrile or Zymotic Diseases AGE . PERIODS. Total. Under 1 Year. 1-2 2-5 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. F. M. M. M. F. M. F. M. F. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 37 18 19 103 84 60 25 28 23 33 7 17 22 32 167 3 15 37 58 11 9 46 7 10 33 196 270 280 550 II. Parasitic Diseases 1 - - - 1 - - - - - - - - - - - - - 1 - - - - - - - - 1 - - - - - - - - - III. Dietetic Diseases - 6 - - - - - - - - - 1 1 1 2 1 2 1 3 8 - - - IV. Constitutional Diseases 9 7 4 6 19 21 14 16 15 75 30 23 17 22 76 30 146 100 39 32 102 111 439 409 458 430 888 92 - - 72 - - V. Developmental Diseases 71 - 1 92 - - - - - - - - - - 1 1 56 122 57 123 149 195 344 VI. Local Diseases 72 53 24 23 24 24 120 100 28 33 25 9 8 42 29 95 73 468 21 65 83 235 159 566 966 973 1086 1073 2159 VII. Deaths from Violence 9 9 3 2 4 3 16 14 17 5 5 - 1 23 7 9 19 13 9 4 24 14 107 45 123 59 182 1 1 VIII. Deaths from Ill-defined and not Specified Causes 36 1 1 24 23 - - 37 - - - - - - - - - - - - 3 1 3 38 27 1 - - 65 50 279 200 52 59 63 388 315 82 29 Totals 87 49 295 683 52 59 201 223 92 69 447 153 120 848 1739 1750 2127 2065 4192 LAMBETH BOROUGH. Corrected Deaths registered from all causes during the year, 1919. Note. The Deaths of Non-Residents occurring in Public Institu tions in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included (C.) SUMMARY OF CORRECTED DEATHS. No. of Deaths. Total. No. of Deaths. Brought forward Total. M. F. 3720 M. F. I.— Specific Febrile or Zymotic Diseases. 1843 1877 197 224 421 1. Miasmatic Diseases 2 2 2. Diarrhœal „ 44 36 80 VI. —Local Diseases —continued. 3. Malarial „ 6. Diseases of Lymphatic System 4 4. Zoogenous „ 7. Diseases of Gland-like Organs of Uncertain Use - - 21 4 4 5. Venereal „ - - 4 - - 25 8 16 24 8. Diseases of Urinary System - 103 69 172 6. Septic „ 9. Diseases of Reproductive System II.- Parasitic Diseases (a) Diseases of Organs of Generation 1 1 - - 8 8 III.- Dietetie Diseases 2 3 (b) Diseases of Parturition 11 11 - 1 10 4 14 IV.- Constitutional Diseases 10. Diseases of Bones and Joints 458 430 880 11. Diseases of Integumentary System 8 4 12 V.-Developmental Diseases 195 344 64 149 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1919. Area of Borough—4,080.4 statute acres (inclusive of land and inland water, but exclusive of tidal water 82.1 and foreshore 31.1 statute acres respectively), divided into 5 Registration Sub- Districts,4 Parliamentary Divisions, and 9 Wards. The Parliamentary Divisions and Wards are not co-extensive but the Registration Sub-Districts and the Wards are. Civil Population-estimated 1919-282,322 (males 128,357, and females 153,965). *Density—69.2 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected)-7,596 being 25.8 per 1,000 population. Deaths (corrected)-4,192 being 14.8 per 1,000 population. Infantile Mortality (corrected)-479 deaths (corrected) under 1 year, being 63.05 per 1,000 total (uncorrected) births, or 79.1 per 1,000 total (corrected) births. Zymotic Death-rate (corrected)-0.7 per 1,000 population (total corrected zymotic deaths, 199). * The densities (based upon the estimated civil populations) vary in the different Registration Sub-Districts as follows-Lambeth Church (354.3 acres) 123.3, Kennington (398.3 acres) 113.4, Stockwell (583 acres) 101.5, Brixton (1026.6 acres) 71.1, and Norwood 1718.2 acres) 35.3 per statute acre respectively. II.—SANITARY WORK. (Dealing with the sanitary circumstances and administration of the Borough of Lambeth.) Return shewing the Number of Notices served in the Borough of Lambeth, from the 1st January to the 31st December, 1919. Number of Notices served 13,259* A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES† (Public Health (London) Act.) No. of Notices served 3409 No. of Infected Houses 3061 Small Pox 1 Scarlet Fever 927 Typhoid 16 Diphtheria 483 Membranous Croup 4 Continued Fever - Puerperal Fever 16 Erysipelas 185 Cerebro-Spinal Fever 11 Acute Polio-Myelitis 7 Ophthalmia Neonatorum 82 ‡Measles 813 ‡German Measles 187 §§Primary Pneumonia 73 §§Influenzal Pneumonia 154 §Encephalitis Lethargica 5 §§Malaria 91 §§Dysentery 6 §§Trench Fever - 3061 B. GENERAL NUISANCES AND DRAINAGE DEFECTS. (Public Health (London) Act, and Metropolis Local Management Acts). No. of Notices served*† 9850 Works, Structural- Drainage, Defective 515 * Including Measles and German Measles. † Excluding tuberculosis. ‡ Compulsorily notifiable from January 1st, 1916. § Compulsorily notifiable from January 1st, 1919. §§ Compulsorily notifiable from March 1st, 1919. Intercepting Traps with Fresh Inlets required 128 Ventilating Pipes required 201 Indoor Sinks connected with Drain 216 Rain Water Stacks connected with Drain 319 Bath Waste connected with Drain 161 Traps Defective, or of Obsolete Pattern 522 Closet Pan and Connections Defective 741 Water Supply to Closet Defective 1089 Closet Dilapidated 561 Draw-off Main for Drinking Purposes required 416 Dust Bins Defective 860 Premises Dilapidated 1016 Ventilation under Floors required 314 Roofs Dilapidated 1181 Soil Pipes Defective 172 Paving Defective 1482 Damp and Unwholesome Houses 274 Dung Receptacles required 27 Defective Water Pipes 191 No W.C. Accommodation 11 10,397 Works, not Cisterns Dirty 515 Manure Accumulations 61 Underground Rooms illegally occupied 42 Animals Improperly Kept 76 Stopped Drains 417 Overcrowding 68 Foul Urinals 11 Refuse Accumulations 419 No Water Supply or Defective Water Supply 971 Dirty Premises 1216 3,796 PARTICULARS OF SANITARY WORK carried out by the Male Sanitary Staff in Lambeth Borough during 1919, and during the 5 previous years (1914-1918), together with Yearly Averages For (a) the 10 Years 1901- 1910 (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. 3796 1919 13259 10397 15150 1918 16807 4933 16103* 1917 19023* 4721* 1916 15015† 16175* 4651* 1915 12752 9757 7731 10175 1914 6478 15109 Yearly Average for 10 Years 1901-1910 (Borough) 9348.4 13108.4 3049.7 Yearly Average for 24 Years 1877-1900 (Parish) 5944.6 4756.9 2135.9 *Including Measles and German Measles. †Excluding Measles and German Measles. 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 1919 by these various officers is set out in tabular form. Summary of Work Carried Out by the Male Sanitary Inspectors during 1919. Inspections 8199 Re-inspections 43044 Complaints attended to 3650 Water Certificates issued 1 Revenue Act Certificates dealt with 5 Drains tested (with chemical, water or smoke test) 2431 Sanitary Works completed 4489 Plans of drainage reconstructions received Premises the Drains of which have been totally or partly reconstructed Samples of Food and Drugs taken 2000 Notices— Public Health (London) Act, 1891 (Preliminary or Intimation 6397 and Statutory 3437) 9834 Metropolis Local Management Acts 16 Sanitary Nuisances abated— (a) Structural 10397 (b) Non-Structural 3796 Summonses issued — Public Health Act 4* Food and Drags Acts 23† Convictions obtained — Public Health Act 1* Food and Drugs Acts 21† N.B.— In addition to the above, the District Inspectors carried out during 1919 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, 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 * 3 Summonses withdrawn. † 5 summonses dismissed. ‡ 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. drainage with the chemical test.* Taking the ordinary notifiable infectious diseases, out of the 1650 infected houses dealt with during 1919, the results are as follows, the averages being given in brackets for the past 25 years, 1891—1915: — (a) 60, i.e., 3.6 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) 847, i.e., 51.3 per cent, showed defects in drains, traps, fittings and appliances (average 53.1 per cent.). (c) 803, i.e., 48.7 per cent, showed no defects (average = 46.9 per cent.). Registration of Cow-houses, Slaughter-Houses, Common Lodging-houses, and Milk Shops. During 1919 the Cow-houses and Slaughter-houses,and Common Lodging-houses licences were renewed by the London County Council with the following exception:— Common Lodging-house —89-91, Wandsworth Road. Cow-houses —Elder Road Dairy and 93, Clive 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:— l2l, Acre Lane, 173, Coldharbour Lane, 45, Dorset Road, 68, Landor Road, 45, Lowden Road, 8, Mawbey Street, 16, Milkwood Road, 74, Shakespeare Road, 6, Tower Street, 115, Vauxhall Street, 8, Windmill Row, and 10 Windmill Row (8 being simply transfers of existing approved licences). Revenue Act, 1903 (and Section 35 of the Housing, Town Planning, etc., Act, 1909). During 1919, 5 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 2* 2. Certificates granted conditionally 3. Certificates refused 3† * 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 1919 comparable with those for past years. The figures for measles and German measles infected houses during 1919 are:—65 defective drains and 265 defective traps and appliances, out of a total of 1,000 infected houses inspected. No testing of drains is carried out as a routine in the case of ophthalmia neonatorum and tuberculosis-infected houses. * Granted unconditionally. † Refused. Effluvium Nuisance. During 1919 a complaint and petition (signed by 23 inhabitants of the neighbourhood) were received with reference to an alleged effluvium nuisance in connection with 11, Penrith Place, Harpenden Road, West Norwood, premises used for drying oyster shells in a specially constructed furnace. A summons was taken out, and, on November 7th, 1919, an Order was made by the Court for the abatement of the nuisance and the prevention of its recurrence. Pig-Keeping. During 1919 a licence was granted by the Council for the keeping of pigs in connection with the following premises:- 15, Elder Road, West Norwood, 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. An application for a licence for the keeping of pigs in connection with 82, Central Hill, was refused by the Council on the ground that pig-keeping there would be a contravention of section 17 of the Public Health (London) Act, 1891. Summary of Work carried out by the Female Sanitary Inspectors during 1919.* Workshops visited and inspected— (a) Dressmakers 12 (b) Milliners 3 (c) Laundries 4 (d) Tailors 10 (e) Upholsterers 1 (f) Dyers - (g) Blouses 7 (h) Ties - (i) Others (e.g.), boudoir caps, toys, boxes, bags, hosiery, trunks, honey, underclothing, furs, telephones, brewery, bakery, &c. 18 Workshops†: workrooms therein measured 96 Workshops† newly discovered and registered 35 ‡Premises visited, but not inspected, owing to the persons or patients concerned being out or, if employees, being no longer employed 1279 Female Conveniences visited and inspected- Public (visits paid) 312 Private - * The Council's 2 Female Sanitary Inspectors act also as part-time Health Visitors and the above returns are to be read in conjunction with those given under the summary of work carried out by the Health Visitors. † Workshops include Work-places. ‡ Births (801), Workshops (10), Outworkers (115), Tuberculosis cases (291), Private Houses (62). Schools visited— Public (visits paid) 29 Private 7 Special places visited and inspected— (a) Private Houses* 2242 (b) Outworkers 104 Workrooms, Outworkers and Private Houses reinspected† 490 Written Intimation and Statutory Notices served 92 No. of Workshops,‡ etc., in which defects were found 92 No. of Workshops,‡ etc., in which no defects were found 2345 Nuisances referred to M.0.H., for attention by male inspectors 3 Particulars of Defects found by Female Inspectors. Workshops, § etc.— Workrooms— Overcrowded, Damp or Dirty 48 Defective or dirty- Yards, Floors, Roofs, Windows, Ceilings, Sink Wastes, or Premises generally 77 Sanitary Appliances: Water Closets— Dirty, unventilated, choked, defective or with defective tanks or water supplies 32 Sanitary Appliances: Drainage— Defective 3 Sanitary Appliances: Dustbins— Wanting or Defective 12 No separate suitable sufficient W.C. accommodation for the sexes 2 Miscellaneous defects, e.g., accumulations, personal uncleanliness, etc. 3 The Health Visitors' duties of the Female Sanitary Inspectors may be tabulated separately in the form of the following details of work done during 1919: — * Births (1,336), Diarrhœa cases (4), Tuberculosis cases (762), Ante-natal cases (10), Still births (33), Ophthalmia cases (46), Maternity Home (2), and special complaints (49). † Births (190), Tuberculosis cases (177), Out-workers (11), Ophthalmia cases (93), workrooms (10), and special complaints (9). ‡ Workshops include Work-places. Visits. Revisits. Total Births 1,336 190 1,526 Still-births 33 - 33 Expectant Mothers 10 - 10 Ophthalmia Neonatorum cases 46 93 139 Epidemic Diarrhœa cases 4 - 4 Tuberculosis cases 762 177 939 Maternity Home 2 - 2 Miss M. Davies, one of the Council's Female Sanitary Inspectors, left the employ of the Council on November 30th, 1919, to take up her new duties under the Ministry of Health (Housing Department). Summary of Work Carried Out by the Health Visitors during 1919. Births* 3,745 Ophthalmia cases* 274 Diarrhœa cases 29 Milk DepÔt (attendances) 52 Tuberculosis cases* 1,420 Depôt children (visits) 300 Welfare Centres 72 Day Nurseries 5 Maternity Home 19 Special cases 208 Expectant mothers (visits) 237 N.B. —In addition to the above, 1,136 visits were paid to houses, but no one was found to be at home. The above returns are to be read in conjunction with those given under the summary of work carried out by the Female Sanitary Inspectors, who act also as part-time Health Visitors. FACTORIES AND WORKSHOPS, 1919. Factories. 4 new factories were added to the Register, dealing with (a) boot repairing, 1 ; (b) electrical appliances, 1 ; (c) laundry, 1 ; (d) toys, 1. Workshops. 19 new workshops were added to the Register, dealing with : (a) dressmaking, 2 ; blouses, 5 ; bakers, 2 ; packers, 1 ; hosiery, 1 ; boot repairing, 1 ; leather goods, 1 ; honey refining, 1 ; wheelwright, 1 ; motor tyre repairing, 1 ; and tailoring, 3. * Including revisits, as follows :—Births, 1839, Ophthalmia neonatorum 207, Tuberculosis 846. OUT-WORKERS, 1919. 9 February and 10 August lists were received, dealing with 68 and 67 out-workers respectively. Of the 135 out-workers, 41 belonged to Lambeth and 94 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 136 lists were received from various outside authorities dealing with the 874 workers, of whom 848 belonged to Lambeth and 26 to districts outside Lambeth. Of the total 916 Lambeth out-workers reported, 27 were new out-workers, i.e., out-workers not previously registered, as follows : Mantles 2 Hand-bags 1 Blouses and skirts 6 Fancy Goods 1 Overalls 1 Flower Muslin 1 Children's underclothing and costumes Boots and shoes. 2 2 Millinery 1 Lamp shades 1 Brushes 1 Tailors 4 Artificial flowers 1 Embroidery 3 Total 27 The Wards, in which the houses (wherein the 27 new outworkers were found to be working) are situated, are as follow :— Wards. No. Marsh Heme Hill 4 - Bishop's - Tulse Hill - Prince's 2 Norwood 2 Vauxhall 2 Borough of Lambeth 27 Stockwell 8 Brixton 9 Bishop's - - - - - - 2 2 - 2 2 2 Prince's - - 26 1 38 Vauxhall 5 3 4 42 Stockwell 2 3 11 8 11 8 19 Brixton 5 12 1 28 1 28 29 3 4 5 3 5 3 8 Heme Hill 4 Tulse Hill 1 3 - - 1 - - - 3 38 4 41 45 2 3 3 40 3 43 46 Norwood - Total - - - - - - - - - - - - - - - - - - 74 78 264 186 4 19 40 4 19 167 75 1 1 - - - 2 - - 3 - - - - 12 - - HOUSING DEPARTMENT. Date of Orders made by the Council. Premises State. Representations and Closing orders under Section 17 of the Housing, Town Planning, etc., Act, 1909. The dwelling-houses being generally dirty, damp, dilapidated and worn out, and with defective drains and sanitary and water fittings. 26th June, 1919 (h) 2, 5, Bywell Place, Monkton Street, S.E. During 1919 the Medical Officer of Health made the following representations to the Council under Section 17 of the 1909 Housing Act and Closing Orders were made by the Council in each case :— The dwelling-houses being generally dirty, damp, dilapidated, and worn out, and with defective drains and sanitary and water fittings. 26th Jure, 1919 (i) 42, 55, Monkton Street, S.E. Date of Orders made by the Council. Premises State (a) 2, 3, 4, 5, 6, 7, 8, James Place, Murphy Street, Oakley Street, S.E. The dwelling-houses being generally dirty, damp, dilapidated and worn out, and with defective sanitary and water fittings. 26 June, 1919 26th June, 1919 The dwelling-houses being generally dirty, damp, dilapidated and worn out, and with badly placed sanitary conveniences, and defective sanitary and water fittings. (j) 16, 25. St. Alban's Buildings, China Walk, S.E. (b) 1, 2, 3, 4, Hammond Place, Cornwall Road, S.E. The dwelling-houses being generally dirty, damp, dilapidated and worn out, badly lighted and badly ventilated, and with unsuitably placed sanitary conveniences used in common, and with defective sanitary and water fittings. 26th June, 1919. The dwelling-houses being generally dirty, damp, dilapidated, and worn out, and with defective sanitary and water fittings. 26th June, 1919 (k) 20, 26, Neville Street, Tyers Terrace, Vauxhall St., S.E. The dwelling-houses being dirty damp, and dilapidated, with defective sanitary and water fittings, and with sanitary conveniences badly placed. 26th June, 1919 (1) 1, 2, 3, 4, Little Spring Place, Wilcox Road, Wandsworth Road, S.W. (c) 26, Albert Embank bankment, S.E. The dwelling house being generally dirty, damp, dilapidated, and worn out, and with defective sanitary and water fittings. 26th June, 1919. 15th Jan., 1920 (m) 29, 31, 33, Hackford Road, S.W. The dwelling-houses being generally dirty, damp, dilapidated and worn out, and with defective sanitary and water fittings. (d) 10, 12, Shanklin Court, Vauxhall Walk, S.E. The dwelling-houses being generally damp, dilapidated, and worn out, and with defective sanitary and water fittings. 26th, June, 1919 The dwelling-houses being generally dirty, damp, dilapidated and worn out, and with defective sanitary and water fittings. 15th Jan., 1920 (e) 2, 3, Bird Place, Monkton Street, S.E. The dwelling-houses being generally damp, dilapidated, and worn out, and with defective sanitary and water fittings. 26th June, 1919. (n) 18, 22, 24, Neville Street, Tyers Terrace, Vauxhall Street, S.E. (f) 4, Fram Place, Monkton Street, S.E. The dwelling-house being generally dirty, damp, dilapidated, and worn out, and with defective sanitary and water fittings. 26th June, 1919. (g) 4, 5, 6, Trowes Place, Monkton Street, S.E. The dwelling-houses being generally dirty, damp, dilapidated, and worn out, and with defective drains and sanitary and water fittings. 26th June, 1919. General Housing Matters. The housing question became specially acute during 1919, and the Council appointed a Housing Committee, to which it delegated its powers under the Housing Acts (financial powers excepted), leaving, however, to the Public Health Committee all duties connected with house-to-house inspections made under Section 17 of the 1909 Housing Act and the Regulationsor Orders(datedSeptember 2nd, 1910) made thereunder, and the advising of the Council as to the serving of Closing and Demolition Orders as required. The Housing Survey was drawn up by the Housing Committee and submitted to the Ministry of Health on October 31st, 1919, for approval by that Government Department.* The Medical Officer of Health submitted a Special Report on " Housing in Lambeth," under date of June 16th, 1919, and a copy of this Report is printed as an appendix to the present Report. Much preliminary work has been done during 1919 in connection with housing within the Borough, but much more still remains for the Council to accomplish during the coming years —a Herculean task having regard to arrears (the result of five years of war) that require to be made up. The help of all will be required, and much expense will be necessarily involved. The present Housing Committee has started well, despite the administrative and official difficulties that hamper its every movement. As regards the provision of new houses, or old houses reconstructed into flats, during 1919, the Holderness House site and lands adjoining and the piece of land adjoining 234-236 Knight's Hill have been purchased by the Council for the erection thereon of new houses, whilst 234-236 Knight's Hill have been purchased for conversion into flats. * Since provisionally approved by the Ministry of Health. † Since approved by the Council, including the conclusions or recommendations set out on pp. 100-104 of the Report, as reprinted in the Appendix. DISINFECTING DEPARTMENT, 1919. Details of work done in connection with the Disinfecting Department are subjoined. A total of 3409 cases of infectious diseases, notified compulsorily by medical men, was reported and dealt with, including cases of cerebro-spinal fever (13), acute polio - myelitis (7), acute primary pneumonia (169), influenzal pneumonia (74), encephalitis (5), malaria (91), dysentery (6), ophthalmia neonatorum (82), measles (979), German measles (200), and tuberculosis —pulmonary (656) and nonpulmonary (224), whilst the following diseases were, in addition, notified by school teachers and others, viz. : measles (345), chickenpox (743), cancer (78), whooping cough (450), verminous houses (137), verminous rooms (248), verminous bedding (1,073 articles) and clothing (79 articles), and others (976*), 1,542 patients were removed to hospital. Summary of work carried out by the Disinfecting Department during 1919. Total No. of rooms disinfected by Council 7450 Do. articles do. 21183 Cases in which bedding was disinfected at home † 5731 Do. do. do. at Chamber 2089 Do. do. do. destroyed (76 § articles) 151 Premises disinfected and disinfectants supplied 16745 Articles of bedding, etc., disinfected 21883 Articles of bedding, etc., destroyed (27 houses) 151 No. of Cleansing Notices served in connection with infected houses 1587 Certificates of Medical Practitioners received in lieu of disinfection by the Council 9 Schools disinfected‡ (124 rooms) 25 Certificates of disinfection left with occupiers of disinfected premises 850 Library books disinfected (public) 120 Mattresses re-tabbed by Council 502 * 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. § 9 certificates of medical practitioners received in lieu of official disinfection. ‡ Measles, 17 (48 rooms). ANALYSIS OF FOOD AND DRUGS AND WATER. Samples of Food and Drugs procured, together with the results of the analyses, during the year 1919, were as follows :— Formal. Informal. Samples. Number. Analysed. Number Adulterated. Number 1 Analysed. Number Adulterated. Milk 689 5 22 6 4 7 14 6 38 - - - 6 6 4 - - - - - 6 - - - - - 3 1 - - 3 - - - - 820 64 - - - - - - - 3 - - - - - 1 - - - - - - - - - - 3 3 - - - - - - - - 71 1 23 43 130 13 58 80 89 53 15 93 27 18 1 178 89 15 22 37 - 19 9 1 35 45 30 19 - 12 11 - 1 4 8 1 1.180 - - - - - 3 2 1 2 - - - 1 - 15 - - 1 2 - - - - - - - 4 - - - - - - - - 31 Butter Lard Coffee Margarine Mustard Pepper Arrowroot Vinegar Sago Oatmeal Ground Rice Flour Dripping Drugs* Rice Tapioca Baking Powder Self-Raising Flour Prescription Cocoa Jam Mustard Condiment Pea Flour Ground Ginger Tea Cornflour Whisky Cheese Bread Malt Vinegar Custard Powder Potted Fish Potted Meat Coffee and Chicory N.B. —26 summonses issued (21 convictions and 5 dismissals). * The drugs (182) were : —Eucalyptus Oil (19), Epsom Salts (10), Gregory's Powder (3), Ammoniated Tincture of Quinine (7), Cream of Tartar (21). Bicarbonate of Soda (12), Camphorated Oil (30), Milk of Sulphur (15), Boric Ointment (32), Olive Oil (2), Camphor in Oil (1), Friar's Balsam (3), Powdered Jalap (3), Crushed Linseed (6), Iron Pills (3), Mercury Pills (3), Liquorice Powder (3), Powdered Rhubarb (3), Oxymel of Squills (3), ana Sugar of Milk(3), No samples of water were analysed. During 1919 the following margarine factories and wholesale dealers in margarine were registered : — 63, New Cut; 262, Brixton Road ; 413, Norwood Road ; 233, Wandsworth Road ; and 61, South Island Place. Public Health (Milk and Cream) Regulations, 1912 and 1917.* 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 1919 (689 formal), in no single instance were preservatives found. No samples of cream were taken either formally, or informally. The action taken during 1919 under the Public Health (Milk and Cream) Regulations, 1912, may be tabulated as follows : — Headings of Report of Administration during 1919. 1. Milk ; and cream not sold as preserved cream : — (a) (b) No. of samples No. in which a examined for the preservative presence of a was reported preservative. to be present. Milk 689 Cream Nature of preservative in each case in column (6) 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 preserved cream:— (1) Above 35 per cent (2) Below 35 per cent Total (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed Nil. ( d) Particulars of each case in which the Regulations have not been complied with and action taken Nil 3. Thickening substances. Any evidence of their addition to cream or to preserved cream and action taken where found Nil. 4. Other observations (if any) Nil. *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," RAG FLOCK ACT 1911. During 1919 a circular letter (dated May 26th, 1919), was received from the Local Government Board, reminding sanitary authorities of their duties under the Rag Flock Act, 1911, and drawing attention to legal decisions given by the High Courts under the Act (a) as to the interpretation of the term " flock " manufactured from rags (Cooper v. Smith, 1914, 1 K. 8., 253), and (b) as to whether or not " remakes " came within the Act (Gamble v. Gordon, 1913, 3 K. 8., 149). It was held that (a) the word " rags " had a wide meaning and included rags other than those cut or torn from materials that had been used as a garment and had become foul by contact with the human body ; and ( b) the Act does not apply to genuine " remakes," i.e., taking flock out of a covering of a mattress and refilling the covering with the same and no other flock. Taking the Lambeth experience since the 1911 Act came into force, these legal interpretations had hampered the smooth working of the Act, and the Council had consequently, in previous years, expressed the view that an amending Act was necessary, especially on the point of " Remakes," which clearly should not be exempt under the Ac l, and advised the Board of its view at that time. Pending such an amending Act being passed, the administration of the 1911 Act has been practically held in abeyance owing to practical difficulties in carrying it out, but, having regard to the Board's letter, 10 samples of rag flock were taken during 1919, and, in connection therewith, 5 were found, on analysis, not to conform with the requirements of the Act in that the amount of chlorine in each sample was found to exceed the maximum amount permissible, viz., 30 parts of chlorine to 100,000 parts of flock, the amounts being 104, 75, 106, 59 and 116 parts of chlorine per 100,000 parts of flock respectively. One of the samples that did not comply with the requirements of the Act was a " Remake." Proceedings were ordered to be taken by the Council in regard to the 5 samples.* MORTUARIES AND CORONERS' COURTS. Details of Work carried out during 1919. (a) Number of bodies received, 446—271 at High Street and 175 at Wanless Road. (b) Post-mortem examinations conducted, 171 —108 at High Street and 63 at Wanless Road. (c) Number of inquests held, 437 —267 at High Street and 170 at Wanless Road. * 1 sample was claimed to be a " remake," and 2 were claimed to be " cotton flock," and these 3 were, consequently, held by the Council's legal adviser to be outside the terms of the Act. in the other 2 cases summonses were taken out, but were dismissed by the magistrate, the defendants establishing a defence under section 1 (4) of the Act in each case. These results appear to show the need for the Act being amended as stated in the body of the Report. APPENDIX. Metropolitan Borough of Lambeth. HOUSING IN LAMBETH. REPORT OF THE MEDICAL OFFICER OF HEALTH. There are two methods of dealing with the Housing Question, viz., from (a) the ideal standpoint and (b) the practical standpoint. All are agreed as to the former method (the ideal) being out of the question, entailing the pulling down of all old, dilapidated and wornout houses, and the replacing of them by up-to-date houses, forming part of a Garden City Scheme. At least, in regard to Lambeth Borough, this ideal method is out of the question, as it would involve a third, if not more, of the whole of the houses in the Borough —what are known as the Inner Wards—being pulled down. The latter method (the practical) is the alternative ; and even this method is beset with many difficulties, due to existing legislation, the present powers and duties of Sanitary Authorities, equity and (last but not least) finance. Hitherto the trend of legislation has been to give increased powers to Sanitary Authorities over owners, and recent legislation has endeavoured to simplify, and has succeeded somewhat in simplifying, the method to be carried out in regard to the closing by Sanitary Authorities of individual dwelling-houses, or small collections of dwelling-houses, which are unfit for human habitation, and the rendering of the same fit for human habitation by, and at the cost of, the owner, or owners, concerned. It must not be thought that the Lambeth Borough Council and its predecessor (the late Vestry of the Parish of Lambeth) have done nothing for the sanitary housing of the Lambeth people, nor must it be forgotten that assistance has been rendered in this same direction by Private Development Schemes which have been carried out in the past by such Owners as the Duchy of Cornwall, the Ecclesiastical Commissioners, the London and South Western and other Railway Companies, and certain Private Firms. The London County Council, as the Educational Authority, has also assisted by clearing sites for Schools. It may be well to put on record briefly, at the commencement of this Report, an account of what has actually been done, in so far as the Borough Council and the late Vestry are concerned, under the powers conferred by the Public Health (London) Act, 1891, the Housing of the Working Classes Act, 1890, and the Housing, Town Planning, etc., Act, 1909. Systematic house-to-house inspections have been made, amounting to a total of over 20,000 since the year 1895, when I was appointed Medical Officer of Health, and resulting in most of the dwelling-houses inspected being put into proper order and condition and rendered reasonably fit in all respects for human habitation, or (a) voluntarily closed (and afterwards demolished) by the Owners, rather than that such Owners should go to the expense of carrying out the sanitary notices served, or (b) officially closed (and afterwards demolished by the Owners), as the result of representations, made by the Medical Officer of Health, to the effect that the houses were in a state so dangerous or injurious to health as to be unfit for human habitation. Such representations were made in 513 instances— 385 under the Housing of the Working Classes Act, 1890 (section 32), and 128 under the Housing, Town Planning, etc., Act, 1909 (sections 15 and 17). Pari passu with this official work, either directly or indirectly as a consequence of it, or voluntarily, large Private Owners' Improvement Schemes have assisted in effecting a similar purpose by getting rid of dwelling-houses which were unfit for human habitation, being more or less dangerous or injurious to health, by virtue of their defective structure, planning, site, etc., and general insanitary conditions, amongst which are to be included dirt, dampness, dilapidations, bad lighting and ventilation, defective drains, defective or obsolete or badly placed sanitary conveniences, defective sanitary and water fittings, etc. Taking the Marsh Ward, where, up to the present, the greatest (in area) improvements have been effected, the following courts and alleys and cul-de-sacs and streets have been demolished (names arranged alphabetically) : —- (a) Between Belvedere Road and Tower Street : Arnold's Cottages, Aubyn Street, Barnes Terrace, Bell Court, Charlotte Place, Chartley Place, Commercial Buildings, Cosham Place, Cottage Place, Coxe's Buildings, Granby Buildings, Granby Gardens, Granby Place (part), Griffin Street, Hamilton's Yard, Holmes' Terrace, Launcelot Street (part), Little York Street, Pencutter Passage, Robert's Court, Samuel Place, Sapphire Place, Shrub Place and William Place ; (b) Between Commercial Road and Gray Street : Aquinas Street (part), Bond Place, Cage Place, Cornwall Mews, Cornwall Place, Cottage Place, Doon Place, Doon Street (part), Druce Place, Duke's Court, Elizabeth Place, Henry Place., James's Place, Le Grand Place, Mitre Place, Morpeth Place, Peers Cooperage, Perry Place, Prince's Mews, Prince's Square, Providence Place, Salutation Place, Sidwell Place, Windmill Court and Wootton Place (part). The Private Owners who have assisted the Sanitary Authority in its work in this way are as follows : — (1) The Duchy of Cornwall, in connection with the Cornwall Road, Stamford Street and Commercial Road Area —intersect- ing courts and alleys that have been cleared and the site used for the building of Government and other buildings, instead of being used, be it noted, for the re-building of dwelling-houses for the displaced tenants. From a financial or business point of view, no doubt, the method adopted was the better policy, but not from the point of view of the Housing Question in relation to the particular district (Marsh Ward) concerned and the tenants displaced. N.B.—This difficulty of displacing tenants, as a consequence of clearing areas, is a very serious one for a Sanitary Authority, as it leads to crowding and overcrowding of neighbouring houses and their subsequent deterioration sanitarily, causing consequentially serious nuisances and dangers to health. (2) The Ecclesiastical Commissioners, in connection with the New Cut Estate, which is bounded by the New Cut, Short Street, Ufford Street and Webber Street respectively. This area formerly comprised hundreds of dirty, damp, dilapidated and generally worn-out houses, which have now been demolished and model three-storeyed tenement houses and two-storeyed cottages erected in their places. (3) The London and South Western and other Railway Companies in connection with their widening and extension schemes, necessitating the demolition of many old, dilapidated and wornout houses (in streets and courts and alleys and cul-de-sacs), with the compulsory provision of housing accommodation in the immediate neighbourhood (due to clauses inserted in the Railways Acts at the instigation of the late Vestry), e.g., Campbell Buildings (Maudslay's site), Stangate Buildings and Russell Gardens (Felix and Boniface Streets site), and Coronation Buildings (South Lambeth Road and Miles Street site) —blocks of tenemented dwellings properly constructed and fitted up to modern ideas of sanitation. These large blocks of tenemented dwellings (with the exception of Coronation Buildings) were also built upon sites which previously contained old, wornout, dilapidated and insanitary houses (in streets and courts and alleys and cul-de-sacs). To the above may be added (a) the London County Council, as the Education Authority, in connection with the building of New Schools (Exton Street and Johanna Street, etc.), and (b) several Private Firms, in connection with the building of new or the extension of old business and other places (Messrs. Rayne, Royal Waterloo Hospital, Union Jack Club, etc.) within this same district (Marsh Ward). The transformation that has taken place during the past 20 years in the Marsh Ward has been very great, though little noticed year by year at the time that it was being actually effected. Going through the transformed district to-day, it can hardly be realised what the changes have been. Streets upon streets, courts upon courts, alleys upon alleys, and cul-de-sacs upon cul-de-sacs of old, worn-out and insanitary houses have gone, and their places been taken chiefly by palatial business premises and the rebuilt Waterloo Railway Terminus, but also, in part, by modern up-to-date tenemented blocks, tenemented houses (newly erected or converted old houses) and cottages. The beneficial results arising to the public health from these changes are shown by the lowered mortality amongst the persons still dwelling in that particular district (Marsh Ward), even allowing for the decreased population ; and to these mortality rates are added, for comparison, those for the Inner and Outer Wards as a whole, viz.:— Pre-War 1, Marsh Ward: 1895. 1914 *1918. (a) General death-rate 26.3 18.8 19.8 (b) Zymotic death-rate 4.4 1.8 1.8 Pre-War 2. Inner Wards: (a) General death-rate 26.9 17.1 21.8 (b) Zymotic death-rate 4.5 1.8 1.9 Pre-War 3. Outer Wards : (a) General death-rate 1.-3 12.4 16.8 (b) Zymotic death-rate 1.7 0.9 0.9 The estimated populations of Marsh Ward for the years 1895, 1914 and 1918 are 27,246, 21,034 and 18,317 respectively (the last being the civil population only). N.B.—Marsh Ward always had an unenviable notoriety for high death-rate (both general and zymotic), which now, after 20 years, compares favourably with those of the Inner and Outer Wards as a whole. The same principle has been at work on the Duchy of Cornwall Estate in Kennington (Prince's Ward), many old, dilapidated and worn-out houses (in the form of streets and courts or alleys and culde-sacs) having been demolished and replaced by modern, up-todate dwellings. The whole aspect of this district (Prince's Ward) also is being altered, and, indeed, an improvement area scheme is being carried out voluntarily, in so far as that particular district is concerned, by a large private Owner, instead of compulsorily, under Part I. of the Housing of the Working Classes Act, 1890, by the London County Council. It is true that the work is proceeding slowly, and it is equally true that it has had a serious set-back, on account of the War, during the last five years ; but war conditions are now beginning to disappear, labour and material may become more plentiful shortly, and the scheme will then, it is to be anticipated, be restarted once more. This scheme takes in areas on both sides of the Kennington Road, near Kennington Cross, and may be described as (a) the Courtenay and Newburn Streets area and (b) the * The increases in the mortality rates for 1918 are due to the Influenza Epidemic, which raged throughout the Borough during that year. Denny and Chester Streets area. These commencing model schemes in town planning deserve the attention of the Borough Council and of the inhabitants of the Borough generally, more especially as little, if anything, is seen of the improvements that have already been effected when viewed only from the main Kennington Road, in which there are many houses, belonging to the same owner, some of which are empty and dilapidated, e.g., Nos. 227 to 291, and which are suitable for conversion into separately contained flats or tenements, as is actually being tried, as an experiment, in the case of Nos. 273 and 275. Looking at these empty and dilapidated houses in the Kennington Road, it can hardly be realised that there is immediately behind them such a model scheme as Denny Street Crescent, in place of what used to be Chester Mews, Golden's Place, Denny Street and Mart Street, consisting of old, dilapidated and worn-out and dirty and insanitary houses. Another area belonging to the Duchy of Cornwall that is ripe for the proposed improvement scheme is what may be termed the Robert Raikes and Whitehart Street areas. Hundreds of old, dilapidated and worn-out houses have been closed, in the form of streets, courts and alleys and cul-de-sacs, e,g,. Whitehart Street (7 to 17, 43, 49 to 77, 4, 10 to 16, 20, and 24 to 28)), Whitehart Square (the whole of the houses with three exceptions), and Regency Place and Regency Square (the whole of the houses with a few exceptions), whilst the houses which were formerly known as Diamond Buildings and Cupar Cottages (Whitehart Street) have been demolished, as have also some of the houses in Whitehart Street (Nos. 30 to 62 and 79 to 91) and in Whitehart Square (Nos. 1 to 5, inclusive, and the Smithy). At this point of the Report it may be put on record that the result of official action (house-to-house inspections, etc.) in Prince's Ward, assisted by the three above-mentioned schemes, has been the demolishing of the following courts and alleys and cul-de-sacs and streets :— Albert Cottages (Randall Road), Beet Court, Chester Mews, Cottage Place (Cottington Street), Cottage Place and Rose Cottage (Stannary Street), Cupar Cottages, Denny Street (part), Diamond Buildings (Whitehart Street), Golden's Place, Isabella Row, Joan Place (Newburn Street), Lemon Court, Mart Street (part), Neville Street (part), Olive Place, Park Cottages, Queen Head Court, Queen's Place, Salamanca Cottages, Salamanca Court, Salamanca Place, Smith's Place, Sun Court, Vauxhall Cottages, Whitehart Square (part) and Whitehart Street (part). Similar remarks apply to the Ecclesiastical Commissioners in connection with their reported impending Improvement (Brixton) Scheme, which, unfortunately, owing to the war, is not yet started. This is known as the Scheme for the Wyke Estate, on which a valuable site for building has been left by the demolition of houses which were condemned officially by the Borough Council under the Housing, Town Planning, etc., Act., 1909, closed in consequence, and afterwards demolished, viz. : —2 to 16 (inclusive) Redan Terrace, Lilford Road, and 35 to 57 (odd numbers) Lilford Road. The rest of the Wyke Estate contains also many houses that are old and dilapidated and generally worn-out, and which, consequently, cannot be described as reasonably fit in all respects for human habitation, though much work has been done, and is still being done, in the way of " patching up," under sanitary notices served by the Borough Council, so as to meet the present temporary demand for housing accommodation in that particular district (Brixton Ward). Marsh and Prince's Wards have been dealt with in some detail as showing what can be and has been actually done by energetic action on the part of a Sanitary Authority under the powers which it already possesses under the Public Health (London) Act, 1891, the Housing of the Working Classes Act, 1890, and the Housing, Town Planning, etc., Act, 1909, aided by private owners' improvement schemes. It must not be assumed, however, that the other Inner Wards, and even the Outer Wards, of the Borough have been neglected. On the contrary, equally energetic action has been taken by the late Vestry and the present Borough Council in the way of systematic supervision of the houses contained therein, with the subsequent serving and enforcing of sanitary notices and closing orders, with the result that the following courts and alleys and culde-sacs and streets .have been demolished, or closed with a view to demolition :— Inner Wards : Bishop's—Bird Place, Bywell Place, Cottage Place (Hercules Road), Fountain Court, Francis Court, Fram Place, Hercules Road (1 to 47), Monkton Street (38, 40, 44, 46, 48, 47, 49, 51, 53, 57), Mount Gardens (Hercules Road), Norfolk Place, Paved Court, Philadelphia Terrace, Strewan Place, Thrift Place, Tinman Court (Lollard Street) and Trowes Place. Vauxhall—Albert Cottages (Seaham Street), Albert Mews (Albert Square), Pascal Street (7, 9, 11) and Seaham Street (3, 5, 7, 9, 11). Naturally, in the case of the Outer Wards of the Borough, closure and subsequent demolition have had to be carried out in but few instances, comparatively, as follows :— Outer Wards : Stockwell—Acre Lane (176 to 188, inclusive). Brixton—Bloxham's Buildings (Denmark Hill), Lilford Road (35 to 57, odd numbers), Providence Place (Vassall Road), Redan Terrace (2 to 16, inclusive) and Russell Cottages (Russell Street). Heme Hill—Nil. Tulse Hill —Gilham's Cottages (New Park Road). Norwood —Eden Cottages (St. Gothard's Road). Intimately related to this rendering (and keeping) of dwellinghouses reasonably fit in all respects for human habitation, the policy of the Borough Council of asphalt-paving the side roads and streets (chiefly, at present, within the Inner Wards) is noteworthy and deserving of praise. These new asphalt-paved side roads and streets take the place of the old, more or less worn out and defective macadamised roads and streets, and the beneficial effects, sanitarily, of the former are specially evident to anyone who will traverse the districts abutting upon (a) the New Cut, (b) Oakley Street and the Lower Marsh, or (c) Lambeth and Vauxhall Walks. Marsh, Bishop's and Prince's Wards are well-provided in this respect, but not so (as yet) Vauxhall Ward, whose side roads and streets equally require the Council's attention in the same way. The result of this asphalt-paving in the Inner Wards is that what used to be a common sight is no longer to be seen, viz., children without shoes and stockings (or with apologies for such 1 ! sailing paper boats and sticks of used matches in collections of stagnant water (often green in colour), which were to be found in the defective macadamised streets and roads. As Medical Officer of Health, I have no hesitation in giving credit to the Council for carrying out in this way what I regard as an important health measure —the new " asphalt-paving " policy as opposed to the old " macadamising " policy, municipal cleansing being thereby greatly facilitated and more satisfactorily effected. So much for what has been done in Lambeth in the past. The question now is what is to be done in the present and in the future, having regard to the new order of things and the interest that is today being taken almost universally in the Housing Question ? It may be said at once, and the fact cannot be too much emphasised, for the information of the different Lambeth Housing Associations and of the inhabitants of the Borough generally, that, in the opinion of the Medical Officer of Health, nothing radical can be done. Existing old houses, more or less dilapidated and worn out, and, in that sense, insanitary and unsuitable for habitation, cannot be swept away wholesale and at once, and Lambeth, as a Borough and as an integral part of London, be suddenly converted into a Garden City by magic. Such an ideal cannot be attained in practice, however desirable it may be in theory. The Borough of Lambeth is simply part of the Administrative County of London, which must, if dealt with at all, either under Part I. of the Housing of the Working Classes Act, 1890, as an area condemnation scheme or schemes, or under Part III. of the Housing of the Working Classes Act, 1890, as a scheme or schemes for the provision of Workmen's Dwellings, be dealt with, as a whole, by the London County Council, the Housing Authority under such Act, though under Part III. the Borough Council has concurrent powers with the County Council. In either case, whether action be taken under Part I. or under Part III. of the Act, any scheme must include, as a necessary addendum, greater and cheaper (much cheaper) facilities in the way of transit to the dwellings (when provided) from the crowded and overcrowded inner and central districts, whether in the Administrative County of London generally or in the Borough of Lambeth in particular. As the Borough Council has concurrent powers with the London County Council under Part III. of the Housing of the Working Classes Act, 1890, dealing with the provision of Workmen's Dwellings within or without the Borough, a definite line of policy might, with advantage, be laid down by the Borough Council, so as to be ready in the event of its opinion being asked by the London County Council, which, as the Housing Authority for the whole of the Administrative County of London under the Act, would, in my opinion, require to give its consent prior to any local Lambeth scheme being adopted. The opinion, therefore, of the Medical Officer of Health of the Borough on the point should be definitely stated for the consideration of the Borough Council, and this I propose to do at this stage of the Report. Speaking generally, the securing of a building site or sites for the erection of new Workmen's Dwellings is not recommended within the confines of the Borough, certainly not within the Inner Wards. An exception may, perhaps, be made in the case of one of the outer Wards, situated on the outskirts of the Borough, viz., Norwood Ward, where there are, as a fact, three suitable sites available for such a purpose, viz. :—Portobello House, Holderness House and St. Gothard's Road estates, which, though comparatively small, would be sufficient for purely Lambeth needs, if the London County Council, or the London County Council and the Lambeth Borough Council concurrently, would erect new dwellings thereon like the Briscoe Buildings (Brixton Hill), or to some other design. This single exception does not disprove the general rule, viz., that any such scheme should be carried out outside, or, at least, on the very outskirts of, the Borough, so as to encourage people to live away from the business centres, provided satisfactory means of transit thereto exist. Take, as an example, the area of Bishop's and Prince's Wards, the large district lying between Kennington Road and the Albert Embankment. There are within that district the wellknown Doulton's Potteries and the more or less contiguous rubber, glass, motor, engineering, gas and mineral water works, railway junctions and permanent ways, dust yards and destructors, flour mills, box makers' manufactories and, last but not least, numerous rag and bone and bottle and jar dealers. Despite the greatest care in managenemt —and even were the newest appliances installed in connection with such businesses —the surrounding air must become, more or less, vitiated or polluted and unsuitable, in consequence, for workers to spend their nights in as well as their days. In the past, large tenemented buildings—the well-known " Blocks " —have been erected from time to time in the very midst of this manufacturing and business area, e.g., Guinness's Buildings, Murray Buildings, Model Dwellings, Surrey Lodge, Albert Buildings, Vauxhall Mansions, Granby Buildings, Cromwell and Shaftesbury Houses, Clayton Buildings (Lollard Street), etc. —some under private management, others under Philanthropic Trusts, Labourers' Duelling Societies or the Duchy of Cornwall. These large tenemented Blocks are, or were at the time when they were first erected, sanitarily constructed and sanitarily fitted, and otherwise up-to-date, to the standards then required. These standards have altered since, and been improved, with the result that the Blocks are not, unfortunately, to-day sanitarily up-to-date, and in many cases the management is unsatisfactory, and certainly not as it should be, requiring constant supervision at the hands of the Council's official Sanitary Staff. The Blocks are certainly not now " models " in any way, except in name, but, on the other hand, they meet an urgent local want, comparatively limited though it may be, viz., dwelling accommodation for workers near to their work, at times an important consideration. Contrast these Blocks with those that have been built by the Railway Companies for tenants whom such companies have displaced in connection with their widening and extension schemes. These latter Blocks are really " models," and Lambeth has reason to be proud of them. They are situated in Marsh, Bishop's and Vauxhall Wards, and are known as Campbell Buildings (Maudslay's site, Burdett Street), Stangate Buildings and Russell Gardens (Felix and Boniface Streets site), and Coronation Buildings (South Lambeth Road and Miles Street site). Briscoe Buildings (Brixton Hill site) and Peabody Buildings (Rosendale Road site) may also be mentioned as examples of real " models" situated in Tulse Hill and Norwood Wards respectively. It is unnecessary to remind the Council that new dwellings, when erected, are never inhabited by the actual displaced tenants for whom they were, presumably and legally, built, but by workers in a better grade of life. The personal element of tenants comes in, and the Owners, or their agents, select what they call " clean and respectable working classes with limited families." The word " cleanliness " is capable of many different interpretations by different people, and all people are not equally " clean," as shown by the states of newly decorated houses after they have been inhabited by certain members of the working classes for a few months, or even weeks. Not only are such tenants wanting in domestic and personal " cleanliness " (as generally understood by the word), but they are also equally destructive—at least some of them, if not all. From the " clean and respectable working classes with limited families " there are many graduations in a downward direction to the lower or lowest grades of the working classes with unlimited families. The fact remains, however, that all sorts and conditions of tenants must be catered for, even the lowest grade, the so-called " submerged tenth," or " undesirables," near whom the other (better class) workers will not live. This particular branch of the Housing Question —the housing of the " submerged tenth," or " undesirables " —would seem to call for attention at the hands of the Central Authority (the London County Council). Fortunately, it concerns but a comparatively small proportion of the population of Lambeth Borough, though in other Metropolitan Districts the proportion may be much larger. Cleanliness by Act of Parliament is not to-day a practical suggestion, and even the placing of baths in all dwelling-houses will not necessarily ensure their use as such if we may judge by the number of baths that are reported to be at present actually doing service as receptacles for coals, dirty clothes, old lumber, etc. The bearing upon the Housing Question of the " personal element " of tenants is well illustrated in Lambeth Borough by such colonies as Waxwell Terrace (Bishop's Ward), Pascal Street (Vauxhall Ward), Broomgrove Road (Stockwell Ward), and Langmead Square, Beadman Street, East Place and East Street (Norwood Ward). They are, undoubtedly, " black spots " in the Borough in the eyes of the public generally, but, officially, the houses cannot be condemned as " unfit for human habitation," taking the words as meant in the Housing of the Working Classes Act, 1890, and the Housing, Town Planning, etc., Act, 1909. In this connection, Waxwell Terrace may be compared with Finck Street —a small Street alongside the Terrace (parallel), and composed of similarly constructed and fitted houses, but inhabited by very different classes of tenants from the points of view of cleanliness and destructiveness; and Langmead Square, Beadman Street, East Place and East Street may be compared with Dunkirk Street (Change Alley), a small street in the same actual area, also composed of similarly constructed and similarly fitted houses, but inhabited by very different tenants from the points of view of cleanliness and destructiveness. The difference between the two sets of " colonies " is remarkable, and will be admitted at once by anyone who will visit the particular houses named, those in Finck Street and Dunkirk Street (Change Alley) being, in comparision with the others, inhabited by better class working classes. Despite the real " mode) " Blocks, to which reference has been made, no new Blocks should be allowed to be erected in the Bishop's and Prince's Wards, in the particularly unsuitable area with which this Report deals ; and this official advice is given in view of a rumour to the effect that a well-known Philanthropic Trust is in negotiation for a large site (in the neighbourhood of Broad and Tin worth Streets), upon which it is intended to erect blocks of tenemented dwellings. The Council should refuse its consent, if and when asked, to the erection of such Blocks in that particular crowded district. The real demand amongst the working classes of the Borough is, generally speaking, for cottage property of various sizes for separate occupation, or for joint occupation, preferably not more than two families to a house, or the small tenemented houses (not more than three-storeyed) —such dwellings (each separately contained) as have been, or are being, supplied by the Duchy of Cornwall and the Ecclesiastical Commissioners on their respective Kennington and New Cut Estates. Judging by the success of what has been done officially in the past by systematic house-to-house inspections and the serving of sanitary notices and closing orders under the Public Health (London) Act, 1891, the Housing of the Working Classes Act, 1890, and the Housing, Town Planning, etc., Act, 1909, and having regard to the private schemes that have been carried out and are at present in hand or under consideration, or should be under consideration, there does not appear to be any need for a wholesale area condemnation and clearance scheme by the London County Council in so far as the Borough of Lambeth is concerned. Indeed, the practical initial difficulty in connection with such a scheme would be to decide where to begin and where to end, as there still remain, within the Inner Wards of the Borough, houses and streets of houses and several (comparatively few) courts and alleys and cul-de-sacs, consisting of houses, which are old, dilapidated and worn-out, being in many instances a hundred years old or more. Further, the displacement of tenants that would naturally ensue, if such a wholesale scheme were carried out and the houses closed and demolished, would cause great inconvenience, and would prejudice the public health, i.e., the health of the occupiers of neighbouring houses and districts, which would become more crowded and overcrowded, with the accompanying serious consequential nuisances and dangers to health. What the Borough should do is to deal officially and systematically with these houses, individually or in small collections (i.e., courts and alleys and cul-de-sacs), with a view to stimulating Private Owners and Private Enterprise. Owners have a responsibility to the State, and the Borough Council has stringent legal powers for dealing with Owners in respect of insanitary or semi-insanitary property. Private Owners ought not to be relieved of their responsibility. Systematic house-to-house inspections offer a remedy, with the serving of the necessary subsequent and consequential sanitary notices, supplemented, as required, by closing orders, followed by demolition orders, or the rebuilding of the houses condemned, or their re-planning, in the case of larger houses, into tenements. Sections 15 and 17 of the Housing, Town Planning, etc., Act, 1909, give, respectively, the necessary powers over dwelling-houses (1) that are not reasonably fit in all respects for human habitation, and (2) that are, on the representation of the Medical Officer of Health, unfit for human habitation, i.e., in such a state as to be dangerous and injurious to health. The latter powers (under section 17) could not, in my opinion, be put into force in the case of dwelling-houses which are simply dilapidated and worn out through age. Insanitary conditions must also exist, due to defective sites, construction, drainage and sanitary fittings, etc., unsuitably plated sanitary conveniences and the want of proper light and ventilation (through ventilation). Dampness, too, of the walls of living-rooms also tends to render houses unfit for human habitation ; and this dampness may be due to faulty construction originally (absence of damp-proof courses and concreted sites, unpaved or improperly paved yards, etc.) or to defective roofs and gutterings and rain-water pipes. The former powers (under section 15) would include, inter alia, defective brickwork, broken floors, dilapidated staircases and banisters, decayed sashes and frames of windows, broken grates, unhinged doors, broken locks and fastenings, etc. —conditions that do not come strictly within the powers of the Public Health Act or of section 17 of the Housing, Town Planning, etc., Act, 1909, but do make, or tend to make, dwelling-houses " not reasonably fit in all respects for human habitation " (the words used in section 15 of the Housing, Town Planning, etc., Act, 1909). Where such " unfit " houses are in the form of courts and alleys and cul-de-sacs, they should be done away with, especially where the sanitary conveniences provided are used in common and, in addition, are unsuitably placed. All courts and alleys and cul-de-sacs, simply as such, cannot be officially condemned and closed, and afterwards demolished, under existing legal powers, though they might be removed voluntarily as local improvement schemes, either by the owners or by the Borough Council, or by both by arrangement. For instance, the following are some cases which, in my opinion, show the limitations of the official powers of Medical Officers of Health and Sanitary Authorities, though voluntary local improvement schemes in connection therewith readily suggest themselves (a) Inner Wards—Abbey Place, Ado Place, Anderson's Walk, Asylum Cottages, China Square, China Walk, Cotford Place, Colwyn Place, Cricketer's Court, Crow Place, Fountain Gardens, Globe Court, Horrend's Cottages, Karl Place, Lilac Place, Little Park Place, Manning's Place, Milton Place, Neptune Cottages, Norfolk Row, North Court, Over Place, Park Place, Pearson's Place, Pennell Place, Pheasant Cottages, Portland Cottages, Prince's Buildings (York Road), Providence Place, Robert's Court, Stone's Buildings, Spring Gardens, St. Alban's Buildings (part), St. Andrew's Place (Ethelm Street), St. Mary's Buildings, South Place, Stamford Buildings, Tiflis Cottages, Victoria Place (Broadwall), Waxwell Terrace, Wilder's Court, Wooton Place, Wylie Place, etc. (b) Outer Wards —Alder's Cottages, Auckland Place, Beadman Street, Beehive Place, Bedford Court, Benton's Lane, Bricknell Cottages, Broomgrove Road, Change Alley (Dunkirk Street), Clarence Cottages (Fenwick Place), Cumberland Cottages, Cumberwell Place, East Place, East Street, Fenwick Place, Garden Row, Industry Terrace, Knight's Hill Square, Lepine Cottages, Langmead Square, Love Lane, Moat Place, Paxton Yard, Porter's Cottages, Rose Cottages, Stockwell Cottages, Tandridge Place, Victoria Place (West Norwood), etc. Further, in addition to the strictly official action suggested, private development schemes must be at once re-started, or commenced in the case of new schemes. Whilst appreciative of the help which these private schemes have given in the past in connection with the bettering of the sanitary conditions of the respective districts concerned, the Council might, with advantage, insist upon the urgent necessity for the immediate resumption of building operations on the sites which have already been cleared, or are in process of being cleared, of the dilapidated and worn-out houses which formerly existed, and still exist, thereon. The Duchy of Cornwall Kennington Estate calls for immediate and energetic renewed action, as does also the Ecclesiastical Commissioners' Brixton Estate, as war conditions are now subsiding and labour and materials will, it is expected, become comparatively easier to obtain. The schemes should be proceeded with at once, but only by emptying and demolishing the remaining old, worn-out houses in proportion as new houses are erected, or old houses re-planned into separately contained tenemented houses, and become ready for occupation, thereby avoiding displacement of tenants. Unfortunately, due to the War, there has been a serious set-back during the last five years, and the dilapidated and worn-out houses have become more dilapidated and more worn out. During the same period, house-to-house inspections have been practically in abeyance, by order of the Council, which, in addition, has had to show a certain amount of unavoidable leniency towards Owners owing to labour and materials difficulties. The policy adopted by the Council and the late Vestry of making Owners keep their existing properties in repair and in a reasonably habitable condition has been applied throughout the whole of Lambeth, but, naturally, chiefly in the Inner Wards, where such a policy is most wanted. The success of the policy is shown by the improved health statistics of the whole of Lambeth district for the past 20 years, the statistics being, cœteris paribus, as satisfactory as those for the Marsh Ward and the Inner Wards of the Borough generally. I am still strongly of opinion that the larger houses which are at present standing empty, or which are so old, dilapidated and worn out as to be ripe for closure or demolition, should be re-modelled and replanned and converted into separately contained flats or tenements. Many houses in the Kennington Road and Kennington Park Road, and on the Wyke Estate (Brixton), and in Northall Street (Stockwell), and elsewhere throughout the Borough, call for such alterations, but whether this work should be left to private enterprise or should be undertaken by the Borough Council, with the previous consent and approval of the London County Council (after compulsory purchase of the sites at the land values) as a Municipal Enterprise, or by Public Utility Societies and Housing Trusts, is a matter for the Borough Council itself to decide in the first instance. It should certainly be done by somebody, so as to relieve the present temporary shortage of house accommodation, which is due to the neglect of Owners during and owing to the War. This view of the Housing Question has been suggested by the Medical Officer of Health in a previous Report (vide Minutes, November, 1917, pages 106-107). Suffice it to mention the following instances (amongst others) to show the practicability and success of such conversions_ Inner Wards : Berkeley Street (14 and 15), Brook Street (2 to 120), Chester Street (1, 2, 3, 6, 7, 8, 9, 10, 11, 30 to 36, 37, 38, 39, 47 to 60, all inclusive), Courtney Street (7 to 17, 12 to 20), Doris Street (42 and 43, 17A and 17B), Fitzalan Street (40 to 46, 84 to 94, 73 to 77), Goda Street (42 and 43), Kennington Park Road (94), Kennington Road (273 and 275), Lollard Street (61 to 73), Old Paradise Street (22 to 36), Orsett Street (23 to 35, 26 to 36), Prince's Road (97 and 98), and Topaz Street (2 and 4). Outer Wards : Alexandra Road (3, 7, 13, 21, 25, 42, 66), Arlingford Road (44), Auckland Hill (3 to 9, 171, 179, 183), Brixton Road (38, 68 to 86, 350 to 360), Central Hill (10, 36, 38, 54, 56, 60, 62, 67, 76, 80), Chapel Street (1 to 36 Cleveland, 1 to 18 Glencoe and 1 to 42 Aigburth Mansions), Christchurch Road (128), Clapham Road (161 and Bellevue Gardens), Eastcote Terrace (1 to 8), Ferndale Road (58), Gipsy Hill (42, 44, 60, 62, 67), Hackford Road (43 to 61, 8, 30 to 94 and Cleveland House), Hawke Road (4, 6, 8), Highland Road (8, 10, 16, 18, 22), Lingham Street (42 and 42A), Lunham Road (6 to 24, 1 to 25), Northall Street (17 to 21), Rosendale Road (168), Salter's Hill (" Montcalm " and "Dominic"), Thurlow Park Road (110 and 112), Tulse Hill (154, 191), Victoria Road (2, 14 to 30, 36, 11 to 19, 31, 57, 59) and Woodland Road (3, 6 to 20). Conclusions. The conclusions at which I have arrived, as Medical Officer of Health of the Borough, with over twenty years' official knowledge of the Borough and the late Parish of Lambeth, may be set out as follows :— (1) Under Part I. of the Housing of the Working Classes Act, 1890, no large area scheme to be carried out, such a scheme being unnecessary, and proving in practice dilatory in procedure and costly, not to mention the great inconvenience to the large numbers of tenants who would be displaced, and the crowding and overcrowding that would necessarily ensue consequentially in the neighbouring areas. (2) Under Part 111. of the Housing of the Working Classes Act 1890, (a) lodging-houses for the working classes to be erected preferably beyond the area of Inner London, and consequently outside the Lambeth Borough boundaries, except, perhaps, in the case of Norwood Ward, where three suitable sites are available in connection with what are known as Portobello House, Holderness House and St. Gothard's Road Estates, which might be utilised for the erection of dwellings for Lambeth inhabitants, or (b) empty or derelict large houses within the Borough to be reconstructed and converted into flats or tenements (self-contained), as lodging-houses for the working classes of Lambeth Borough. (3) Under Part 11. of the Housing of the Working Classes Act, 1890, or, rather, under the Housing, Town Planning, etc., Act, 1909, which repeals the section of the Housing Act, 1890, relating to condemnation and subsequent demolition of houses (individually and in small collections) that are unfit for human habitation, action to be systemati- cally and energetically carried out, such action involving the following administrative measures (a) Systematic house-to-house inspections, with an increased inspectorial staff, as times become more normal; (b) the subsequent and consequent serving and carrying out of sanitary notices, together with the making of closing orders (followed by demolition orders, if required) in connection with houses which, individually or in the form of courts and alleys and culde sacs, are represented by the Medical Officer of Health to be in such a state, so dangerous or injrious to health, as to be unfit for human habitation. (4) Private development schemes to be forthwith commenced, or, if already commenced, but stopped on account of the War, re-started by the Owners concerned, and such pressure brought to bear upon such Owners as may prove effective towards that end, e.g., by the Council opening up negotiations with the Owners concerned, or in any other way that may be thought to be advisable. (5) The Council's policy of asphalt-paving side roads and streets to be continued in the Inner Wards of the Borough (more especially Vauxhall Ward). Conclusion (1) concerns the London County Council as the Housing Authority under Part I. of the Housing of the Working Classes Act, 1890, as does also Conclusion (2), with the proviso, in the latter case, that the Borough Council has concurrent powers with the County Council, but such concurrent Powers could only be used after consultation with, and with the approval of, the London County Council. Conclusion (3) is entirely a matter for the Borough Council itself—to call upon the Owners to carry out their responsibilities by the serving and enforcing of sanitary notices by which insanitary houses can be rendered reasonably fit in all respects for human habitation, or closed and afterwards demolished under closing and demolition orders. This closing of unfit individual houses, or small collections of houses, e.g., courts or alleys, would cause a minimum amount of displacement of tenants, and, consequently, a minimum amount of inconvenience. Where the condemned houses that have been closed and afterwards demolished are in the form of a small court or alley or cul-de-sac, the Borough Council would be in a position, if it thought fit, to compulsorily purchase (at the land value) the cleared sites for small local open spaces, or play-grounds, or for small local improvement schemes, but the London County Council might in such cases, in my opinion, require to concur with the Borough Council's proposed action. In the event of the Council deciding not to deal itself with the cleared sites, such sites might be left to be dealt with by private enterprise, or through public utility bodies or housing trusts. To give a few examples of the kinds of areas (small areas) to which the above remarks apply, mention may be made of :— (a) Monkton Street site, where there are six courts (entered from Monkton Street), and, in connection with which, speaking generally, the houses are dirty, damp, dilapidated and worn out, with defective drains and defective sanitary and water fittings. These courts are known as Strewan, Fram, Trowes, Bird, Bywell, and Longhope Places, and should be all closed and demolished. (b) China Walk site, consisting of St. Alban's Buildings and Karl Place, which are two courts built practically back to back. The houses in St. Alban's Place, which abut on Karl Place, are numbered 15 to 25, and consist of houses which are dirty, damp, dilapidated and worn out with defective and badly placed sanitary conveniences and defective sanitary and water fittings. These houses should be all closed and demolished, or partly demolished only, if their complete demolition should prove dangerous to the stability of the houses in Karl Place. In that way, proper " through " ventilation for the Karl Place houses might be secured. (c) Hammond Place, Cornwall Road, S.E., where there are 4 houses which are old, dilapidated and worn out, damp and dirty, with sanitary conveniences in common and badly placed, with defective sanitary and water fittings, whilst the houses themselves are badly lighted and badly ventilated, being overshadowed on all sides by large buildings. The houses should be all closed and demolished. (d) James Place, Murphy Street, Lower Marsh, a court containing 8 houses, which are dirty, damp and dilapidated, the court itself being badly paved. These houses should be all closed and demolished. (e) Spring Gardens, Vauxhall Walk—a court containing 15 houses, which are dirty, damp and dilapidated, and generally worn out, with defective sanitary and water fittings. These houses should be all closed and demolished. (f) Asa Place, Webber Street —a small court, with 6 cottages, which are old, dilapidated, and generally worn out, without proper light or ventilation owing to adjacent high buildings on all sides of the court. These houses should be all closed and demolished. Under Conclusion (4) come the following private development schemes:— (a) Duchy of Cornwall Estate in Kennington (Prince's Ward) — the Courtnay and Newburn Streets area, and the Robert Raikes and Whitehart Streets area for Town Planning Schemes, and the conversion into separately contained flats or tenements of the empty and dilapidated houses in Kennington Road (Nos. 227 to 291). (b) Ecclesiastical Commissioners' Estate in Brixton Ward —the Wyke Estate, to be remodelled, and the old basement or semi-basement dilapidated and worn-out large houses (structurally and sanitarily unfit for human habitation in their present condition, and as at present occupied by 2 or 3 families, or sub-let as furnished apartments) closed and demolished, and, in their places, new up-to-date separate non-basement houses provided, cottages or tenemented houses (not exceeding 2 or 3 storeys respectively in height), on the lines of the Ecclesiastical Commissioners' New Cut Area Scheme, an object lesson in housing. N.B.—This proposed scheme should be gradually carried out so as to reduce displacement of tenants to a minimum. During and pending the carrying out and completion of such Private Schemes, the Borough Council, as the Sanitary Authority, must continue to see that the houses comprised in such Schemes, and which will eventually be demolished, are, if inhabited as dwellings, kept, in the meantime, in such a state as to be " reasonably fit, in all respects, for human habitation." Conclusion (5) concerns the Borough Council itself. The question of principle as to whether, or not, the Borough Council is justified in taking over ownership and becoming a municipal landlord, in certain selected small areas or individual houses, is not a branch of the Housing Question upon which I feel called upon officially to advise as Medical Officer of Health. That matter may be left with confidence to the decision of the Borough Council itself, which has but one object in view—the betterment of the home conditions of the inhabitants who comprise the large and important Metropolitan Borough of Lambeth. No mention has been made throughout this Report of the new Housing, Town Planning, etc., Bill, 1919, as its various sections do not, in my opinion, necessitate any alteration of policy by the Borough Council in regard to the Housing Question in the Borough, though, perhaps, the Council's hands may be forced into declaring its policy within the next few months for the information of, and approval (or otherwise) by, the Local Government Board, to which is entrusted stringent supervision over Sanitary Authorities, which, in their turn, have powers of delegation to Public Utility Societies and Housing Trusts, under certain conditions. Further, Part 111. of the Housing of the Working Classes Act, 1890, is amended in the new Bill so that a Metropolitan Borough Council becomes the Authority for providing workmen's dwellings within the area of such Borough, if for the sole use of its inhabitants [vide Conclusion (2)]. Joseph Priestley, Medical Officer of Health. 16th June, 1919.