LAM 66 REPORT on the VITAL AND SANITARY STATISTICS of the BOROUGH OF LAMBETH DURING THE YEAR 1912. [With an account of the work done by the Male and Female Sanitary Inspectors and the Health Visitor and also of the proceedings taken under the Sale of Food and Drugs, the Factory and Workshops, and the Housing Acts] by Joseph Priestley, B.A, ,.D., D.P.H.. Medical Officer of Health. Merser & Sons, Printers, Kennington Cross, S,E. LAM 66 3 Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. May, 1913. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, In presenting the Annual Report for 1912, dealing with the Vital Statistics of the Borough of Lambeth, I have the honour to draw attention to the fact that the various deathrates (general, zymotic and infantile mortality), taken together, are the lowest yet recorded in the annals of the new Borough or of the old Parish, the low infantile mortality rate calling for special remark. The bearing ot the figures, as showing the saving of life (and a corresponding amount of attendant illness), is best realised by comparing the averages (decennial) as follow:— Averages (decennial). 1912. 1901-10. 1891-1900. 1881-1890. General Death-Rate (corrected deaths per 1000 population) 13.2 14.9 18.4 20.1 Zymotic Death-Rate (corrected deaths per 1000 population) 0.9 1.5 2.4 2.8 Infantile Mortality Rate (corrected deaths under 1 year per 1000 total births) 73.2 115.3 146.1 143.1 Zymotic Incidence (notified cases per 1000 population) 4.5 6.1 9.04 — A serious attempt is now being made to grapple with tuberculosis throughout the Borough of Lambeth, and to 4 prevent its ravages, and the Borough Council is to be congratulated upon having adopted during 1912, the Lambeth Municipal Tuberculosis Dispensaries Scheme, including the establishment, for the present, of two tuberculosis Dispensaries: a central one at 73 Effra Road, Brixton, S.W., and a branch one at St. Thomas' Hospital (Out-Patient Department), each under the medical control of a whole-time fully-qualified tuberculosis officer with the Medical Officer of Health as the Chief (Administrative) Tuberculosis Officer, thereby ensuring an intimate relationship between the Tuberculosis Dispensaries and the general Public Health Administration of the Borough. During 1912, the Council decided to make Whooping Cough compulsorily notifiable throughout the Borough of Lambeth for a trial period of 5 years from January 1st, 1913. To the Chief Officers of the Council, and to the Public Health Staff, my thanks are again due, as also to the Members of the Council, for assisting me in carrying out my important duties as Medical Officer of Health for the Borough of Lambeth. I am, Mr. Mayor and Gentlemen, Your obedient Servant, Joseph Priestly Medical Officer of Health. 5 I. VITAL STATISTICS. The Estimated Populations of the Borough to the middle 1912 are calculated from the Enumerated populations of the two decennial censuses 1901 and 1911, as follow:— Estimated Populations. (Estimated, Middle 1912.) I. Wards. Wards. Males. Females. Total. Marsh 11268 10376 21644 Bishop's 15463 15712 31175 Prince's 20767 21494 42261 Vauxhall 15293 15225 30518 Stockwell 14864 17063 31927 Brixton 20126 23717 44143 Herne Hill 15424 17477 32901 Tulse Hill 14158 16739 30897 Norwood 14327 17757 32084 Borough of Lambeth 141990 155560 297550 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. Lambeth Church 23837 23150 46987 Kennington 23660 24431 48091 Stockwell 30158 32289 62447 Brixton 35850 41194 77044 Norwood 28485 34496 62981 Borough of Lambeth 141990 155560 297550 6 III. Parliamentary Divisions (Old). Old Parliamentary Divisions. Males. Females. Total. North 26375 25819 52194 Kennington 35655 36288 71943 Brixton 35416 40620 76036 Norwood 43094 51117 94211 Parliamentary Area of Lambeth 140540 153844 294384 N.B.— The Parliamentary Divisions have not been altered by the London Government Act, 1899, nor by the proceeding. that fixed the Boundaries of the Metropolitan Boroughs, so that the above figures do not agree with those for the borough as a whole, but are comparable with those of the old Parish of Lambeth given in previous Reports. IV. Parliamentary Divisions (Adjusted). *Adjusted Parliamentary Divisions. New Wards. Total. North Marsh 52819 Bishop's Kennington Prince's 72779 Vauxhall Brixton Stockwell 76070 Brixton Norwood Herne Hill 95882 Tulse Hill Norwood *Adjusted Parliamentary Area of Lambeth — 297550 *N B.— By the adjustment of the old Parliamentary Divisions so as to be co-terminous with the Wards. 7 TABLE A. Giving the number of Births and the Birth-Rates in each Registration Sub-District of the Borough of Lambeth during 1912 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1912. Rate per 1000 Inhabitants. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church* 620 608 622 586 2436 51.8 Kennington† 331 344 315 321 1311 27.3 Stockwell§ 482 446 526 462 1916 30.7 Brixton 370 400 376 319 1465 19.01 Norwood 256 241 264 279 1040 16.5 Borough of Lambeth 2059 2039 2103 1967 8168 27.4 *Including Lying-in Hospital (887 cases, of which 211 belong to Lambeth)—corrected rate (i.e., excluding all the Lying-in Hospital births) — 32.9. †Including Workhouse (189 cases, of which 163 belong to Lambeth)—corrected rate (i.e., excluding all the Workhouse births) = 23.3. §Including Maternity Hospital (543 cases, of which 160 belong to Lambeth)—corrected rate (i.e., excluding all the Maternity births) —21.9. Inner Districts, 37.4; Outer Districts, 20.1 per 1000—uncorrected (whole Borough=27.4). Inner Districts, 26.7; Outer Districts, 18.6 per 1000—corrected (i.e., excluding all Institutional births, whole Borough = 22.0). N.B.—The births in Stockwell new Sub-District are divided equally between the Inner and Outer SubDistricts of the Borough for the purpose of calculating comparative rates of such Sub-Districts. 8 TABLE B. Showing the Populations (Estimated), Uncorrected Births, Corrected Deaths, and Uncorrected Deaths in Public Institutions, in the Borough of Lambeth during 1912, and during the previous decennium 1901-10, together with the averages for the two decennia 1891-1900 (Parish) and 1901-10 (Borough). Year. Estimated Population. Number of Births Registered. Corected Numbers of Deaths. Deaths in Public Institutions in Lambeth (uncorrected) Total Ages. Under 1 Year. Under 5 Years. Deaths from 7 Chief Zymotic Diseases. 1912 297550 8168 3925 598 917 287 1872 1901 302533 9093 5197 1267 1840 627 1590 1902 305102 9067 5387 1155 1722 561 1822 1903 307711 9069 4664 1138 1625 498 1619 1904 310359 S059 4880 1243 1778 603 1728 1905 313045 8835 4646 1014 1455 431 1807 1906 315774 8972 4709 1088 1561 522 1925 1907 318538 8650 4652 941 1458 379 1923 1908 321344 8906 4341 829 1263 397 2011 1909 324188 8445 4540 830 1250 402 1994 1910 327074 8373 4080 691 1083 331 1749 Average 1901-10 314566.8 8846.9 4709.6 1020.1 1503.5 475.1 l8l6.8 1891-1900 294049.7 9295.4 5405.3 1358.5 2070.2 700.4 1568.5 Note.—(a) Enumerated Population at Census 1901 was 301.895. (b) Enumerated Populat on at Census 1911 was 298,058. (c) Families or separate occupier: = 70887 1901) and 70827 (1911). N.B.—The estimated population for 1911 is calculated from the 1901 and 1911 Censuses, and those for the decennium 1901-10 from the 1891 and 1901 Censuses. 9 TABLE C. Showing the Birth- and Death-Rates (corrected), and proportion of Deaths (uncorrected) in Public Institutions, in the Borough of Lambeth for the Year 1912, and for the 10 years 1901-1910, together with the averages for the two decennia 1891-1900 (Parish) and 1901-10 (Borough). The Year. Birth-Rate per 1000 Population. Corrected Death-Rate per 1000 Population. Corrected Deaths of Children under 1 year per 1000 total Births. Deaths of Children under 1 year per 1000 Deaths (corrected) Deaths of Children under 5 years, per 1000 Deaths (corrected) Corrected Zymotic DeathRate, per 1000 Population. Deaths in Public Institutions per 1000 total uncorrected Deaths. 1912 27.4 13.2 73.2 152.3 233.6 0.9 446.9 1901 30.1 17.2 139.3 243.8 354.1 2.7 395.4 1902 29.7 17.7 127.4 214.4 319.7 1.8 328.1 1903 29.5 15.2 125.8 243.9 348.4 1.6 333.6 1904 29.2 15.7 137.7 255.7 364.3 1.9 334.9 1905 28.2 14.8 114.8 218.3 313.2 1.4 369.1 1906 28.4 14.9 121.3 131.04 331.5 1.7 382.9 1907 27.2 14.6 108.8 202.3 313.4 1.2 309.4 1908 27.7 13.5 93.1 193.3 290.9 1.2 428.6 1909 26.4 14.0 98.3 182.8 275.3 1.2 408.9 1910 25.6 12.5 82.5 169.4 265.4 1.01 402.3 Average 1901-10 28.1 14.9 115.3 216.7 319.4 1.5 386.01 1891-1900 31.6 18.4 146.1 251.3 382.9 2.4 276.7 N.B —The rates for 1912 are calculated upon the population estimated from the 1901 and 1911 Censuses, and those for the decennia 1891-1900 and 1901-10 upon the populations estimated from the 1861, 1891 and 1901 Censuses respectively. 10 THE BIRTH RATE. The total number of Births registered during the year 1912 is 8,168. Of the total 8,168 births, 4,163 are males, and 4,005 females, showing an excess of 158 males. Of the total 8,168 births registered, 887 took place in the Lying-in Hospital (York Road), and of these 211 belong to the Borough; 189 took place in the Workhouse (Brook Street), and of these 163 belong to the Borough; whilst 543 took place in the Maternity Hospital (Jeffrey's Road), and of these 160 belong to the Borough. Thus, there are 1,085 births belonging to other districts. The Lying-in Hospital, the Workhouse and the Maternity Hospital tend to abnormally increase the birth-rates in Lambeth Church, Kennington and Stockwell Districts respectively, and the necessary corrections are, consequently, made in a footnote to Table A. The birth-rate for Lambeth is 27.4 per 1,000 inhabitants (29.3 for males, and 25.7 for females); whilst in the various Registration Sub-Districts the birth-rates work out as shown in Table A, from which it will be seen that the uncorrected birth-rate in the Inner Districts is 37.4, and that in the Outer Districts 20.1 per 1,000—the corrected birthrates (i.e., excluding (a) Non-Lambethian births and (b) all Institutional births) being respectively (a) 23.8 and (b) 22.0 for the whole Borough, (a) 30.3 and (b) 26.7 for the Inner, and (a) 19.0 and (b) 18.6 for the Outer, Districts. Tables B and C show, for comparison, the number of births, and the birth-rates, for 10 years (1901-1910) in the Borough. The birth-rate for Lambeth (Parish and Borough) has been recently slowly, but steadily, declining. As has been previously noted, this decline is not peculiar to Lambeth, nor 11 even to England, but is 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 29,749 births have been notified up to the end of 1912, viz.: 3,473 in 1908 (10 months), 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, and 7,336 in 1912. The notified cases are visited, or such other measures taken in connection therewith, in the way of distributing pamphlets, etc., as are found necessary. Methods of feeding are carefully inquired into and instruction given as required. Returns of all Births (with addresses of mothers), registered in Lambeth, have also been obtained from the District Registrars, and this information, in conjunction with that obtained from the Notification of Births Act, has again proved of great use in connection with the Borough Council's endeavours to lessen the mortality amongst infants (under 1 year of age). The maximum time allowed for birth registration is 42 days, but this delay is detrimental to satisfactory administrative procedure, and has been altered by the Notification of Births Act, 1907, which limits the time of notification to 36 hours from the time of birth, though, on the other hand, all births are not yet notified by those responsible under the Notification of Births Acts. 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. 1 2 The Registrar-General provides particulars of transferable births registered, and for 1912 his figures tor the Borough of Lambeth are as follow:— Inward Outward Transfers. Transfers. Legitimate Males 23 543 Legitimate Females 25 526 Illegitimate Males 10 111 Illegitimate Females 19 112 Totals 77 1292 The Registrar-General's corrected number of births for the year 1912 for the Borough is 6,952. THE DEATH-RATE. The total number of deaths registered during the year 1912 is 4,189, as compared with yearly averages of 5,669.5 and 4,971.5 respectively during the two decennia 1891-1900 and 1901-1910. Of the total 4,189 deaths registered during 1912, 2,161 are males and 2,028 females. The uncorrected death-rate for Lambeth is, therefore, 14.1 per 1,000 inhabitants (15.2 males and 13.0 females). These rates, are, however, uncorrected, and, on analysing the 4,189 deaths registered in the Borough, it is found that 823 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 559 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a corrected number of deaths for Lambeth during 1912 of 3,925, and a corrected death-rate of 13.2 per 1,000 inhabitants. 13 The yearly averages of corrected deaths within the Parish and Borough of Lambeth during the two decennia, 18911900 (Parish), and 1901-1910 (Borough), are, respectively, 5405.3 and 4,709.6. Deaths in Out-Lying Institutions. The Outside Institutions, etc., where the 559 Lambethians died during 1912 may be grouped as follows:— I. General Hospitals. Charing Cross 10 Middlesex 6 Guy's 28 St. Bartholomew's 14 Hampstead 1 St. George's 5 King's College 8 University 7 London 5 Westminster 45 II. Special Hospitals. Bethlem Royal 2 Gt. Ormond Street 5 Bolingbroke 4 Grosvenor 1 Bow Institution 10 Grove 14 Brompton 2 Heart, Soho 1 Cancer 3 Homœpathic 2 Catholic Nursing Institute 1 Home for Sick Children, Sydenham 2 Central London Sick 3 Hostel of God 4 Central London Throat and Ear 2 Infants', Vincent Square 24 Italian Hospital 1 Chelsea Hospital for Women 1 London Temperance Hospital 2 Chest, Bethnal Green 1 Metropolitan 5 City of London 2 National 3 Consumption, Kensington 4 New Hospital for Women 1 East London 2 North Western Hospital 1 Epileptic, Epsom 2 Park 12 Evelina 20 Poplar and Stepney Sick Asylum 2 Freidenheim 3 14 II. Special Hospitals—continued Queen's Hospital 1 St. Luke's House, Kensington 10 Queen Charlotte's 1 Queen Mary's 6 St. Mary's 1 Royal Chest 1 Samaritan Free 1 Royal Eye 1 South-Eastern 4 St. John & St. Elizabeth 3 Tooting Home 1 St. Joseph's, Hackney 1 Victoria 3 Western 9 III. Infirmaries and Workhouses. Belmont Workhouse 1 St. George's-in-theEast, Infirmary 4 Camberwell Infirmary 6 Islington Infirmary 2 St. Pancras Infirmary 1 Lewisham Infirmary 1 Southwark Infirmary 1 Marylebone Infirmary 1 Wandsworth Infirmary 1 St. George's Infirmary 4 IV. Asylums. Banstead 16 Hanwell 1 Camberwell House 1 Hotton 16 Cane Hill 18 Leavesden 3 Caterham 26 Long Grove, Epsom 20 Claybury 7 Manor 8 Colney Hatch 2 Peckham House 1 Darenth 1 Tooting Bec 55 Dartford 8 V. Unclassified Places. Covent Garden Market 1 River Thames 3 Lavatory, Lant Street Schools 1 Streets 7 Surrey Commercial Docks 1 Private Houses 27 15 Summary. I. General Hospitals 129 II. Special Hospitals 185 III. Infirmaries and Workhouses 22 IV. Asylums 183 V. Elsewhere (unclassifiable) 40 559 Whether the corrected or uncorrected death-rates for the Borough (as a whole) be taken, they are satisfactory for the year 1912 (the twelfth year of the existence of the Borough). Sub-dividing the death-rates according to Registration Sub-Districts, it is again shewn that the Inner Districts (Lambeth Church, Kennington, and inner part of Stockwell) have, collectively and individually, suffered more than the Outer Districts, e.g., outer part of Stockwell, Brixton and Norwood. So, too, if the deathrates be sub-divided amongst the Wards, it will be noted also that the Inner Wards, e.g., Marsh, Bishop's, Prince's and Vauxhall, have, collectively and individually, suffered more than the Outer Wards, e.g., Stockwell, Brixton, Heme Hill, Tulse Hill and Norwood. The reason for this difference is again to be noted in the fact that the Inner Districts are more congested than the Outer. The status of the inhabitants and the general conditions (sanitary and otherwise) under which they live, are also matters to bear in mind when dealing with this subject. Taking the Registration Sub-Districts (Table D (1)), and the Wards (Table D (2)), into which the Borough is subdivided, the corrected death-rates for 1912 will be found to vary between the Inner and the Outer Districts as follows: 16 1912. Registration Sub-Districts and Wards. Inner. Outer. General Death-rate (corrected) 16.9 10.5 Zymotic Death-rate (corrected) 1.5 0.6 Of the Registration Sub-Districts, Kennington has the highest general, and Lambeth Church the highest zymotic, death-rate, and Norwood the lowest general, and the lowest zymotic, death-rates; whilst, in the Wards, Prince's has the highest general, and Marsh the highest zymotic, death-rates, and Tulse Hill the lowest general, and Heme Hill, the lowest zymotic, death-rates. Tables E, F, and G show the uncorrected returns (male and female), registered during 1912, arranged as to Registration Sub-Districts, age-periods, and quarters respectively, and are given for comparison with similar tables in former Lambeth Reports, though uncorrected returns are not of much value. Age Periods of Corrected Deaths. The 3,925 corrected deaths during 1912 may be further analysed, and tabulated as follows:— 598, i.e., 15.2 per cent, of the total corrected deaths took place under 1 year of age. 3519, i.e., 8.1 percent, between 1 and 5 years. 917, i.e., 23.3 per cent, under 5 years. 168, i.e., 4.4 per cent, between 5 and 20 years. 465, i.e., 11.8 per cent. 20 to 40 years. 924, i.e., 23.6 per cent. 40 to 60 years. 1451, i.e., 36.9 pear cent. 60 and over. 3008, i.e., 76.7 per cent, over 5 years. 17 TABLE D (I). BOROUGH OF LAMBETH. STATISTICS FOR 1912. Registration Sub-Districts. Total number of Deaths (corrected). Death-Rates (corrected) per 1000 population. Total number of Deaths (uncorrected) Under 1 year. Infantile Mortality (uncorrected) per 1000 births. General. Zymotic. General. Zymotic. Lambeth Church 756 85 16.1 1.8 271 111.2 Kennington 921 69 19.1 1.4 107 81.6 Stockwell Inner 438 36 12.6 0.8 131 68.4 Outer 350 17 Brixton 846 49 10.9 0.6 150 102.4 Norwood 614 31 9.7 0.5 56 53.8 Borough of Lambeth 3925 287 13.2 0.9 715 87.5 Inner Districts 2115 190 16.9 1.5 443.5 94.3 Outer Districts 1810 97 10.5 0.6 271.5 78.4 N.B.—In calculating the infantile mortality rates, the uncorrected deaths and births registered in Stockwell Registration Sub-District are divided equally between the Inner Stockwell Sub-District (=Vauxhall Ward) and the Outer Stockwell Sub-District (= Stockwell Ward). 18 TABLE D (2). BOROUGH OF LAMBETH. STATISTICS FOR 1912. Wards. Total Number of Deaths (corrected). Death-Rates (corrected) per 1000 population. Total Notified Cases. Zymotic Incidence per 1000 population. General. Zymotic. General. Zymotic. Marsh 332 42 15.3 1.9 108 4.9 Bishop's 424 43 13.6 1.4 159 5.1 Prince's 921 69 21.8 1.6 206 4.9 Vauxhall 438 36 14.3 1.2 152 4.9 Stockwell 350 17 10.9 0.5 133 4.2 Brixton 494 37 11.2 0.8 175 3.9 Herne Hill 352 12 10.7 0.4 140 4.3 Tulse Hill 294 17 9.5 0.5 127 4.1 Norwood 320 14 9.9 0.4 132 4.1 Borough of Lambeth 3925 287 13.2 0.9 1332 4.5 Inner Districts 2115 190 16.9 1.5 625 4.9 Outer Districts 1810 97 10.5 0.6 707 4.1 21 TABLE E. Shewing the uncorrected Mortality (Male and Female) in the different Registration Sub-Districts of the Borough of Lambeth (arranged Quarterly) during the year 1912. Sub-District. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total 1912. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Lambeth Church 172 146 318 157 134 291 168 129 297 181 142 323 1229 Kennington 148 161 309 144 125 269 135 131 269 189 165 354 1201 Stockwell 92 86 178 78 75 153 6e 74 142 90 85 175 648 Brixton 91 91 182 73 83 156 59 63 122 95 90 185 645 Norwood 69 81 150 44 52 96 38 43 81 70 69 139 466 Totals 572 565 1137 496 469 965 468 443 911 625 551 1176 4189 20 TABLE F. Shewing the uncorrected Mortality (Male and Female) at various age-periods in the different Registration Sub-Districts of the Borough of Lambeth during the year 1912. Sub-District. Under 1 year. 1 to 5 years. 5 to 60 years. 60 years and upwards Total. 1912. M. F. Total M. F. Total. M. F. Total. M. F. Total. Lambeth Church 153 118 271 70 76 146 354 255 609 101 102 203 1229 Kennington 63 44 107 28 24 52 286 247 533 239 270 509 1201 Stockwell 66 65 131 68 39 107 103 113 216 91 103 194 648 Brixton 81 69 150 25 31 56 110 97 207 102 130 232 645 Norwood 32 24 56 8 9 17 70 73 149 105 139 244 466 Totals 395 320 715 199 179 378 929 785 1714 638 744 1382 4189 21 TABLE G. Shewing the uncorrected Deaths (Male and Female) at various age periods in the Borough of Lambeth (arranged quarterly) during the year 1912. Age-periods. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Under 1 year 116 78 194 77 93 170 89 75 164 110 77 187 715 Between 1 and 5 yrs. 53 57 110 51 40 91 45 44 89 53 35 88 378 Between 5 and 60 yrs. 233 198 431 227 192 419 206 166 372 263 229 492 1714 60 yrs. and upwards 170 232 402 141 144 285 128 158 286 199 210 409 1382 Totals 572 565 1137 496 469 965 468 443 911 625 551 1176 4189 22 23 TABLE H (I). TABLE H (I). Shewing the estimated populations and the number of Deaths, with Death-rates in each of the Registration Sub- Districts of the Borough during 1912. The Deaths are from all causes, and from the chief zymotic diseases, and are corrected by adding Lambethians who die outside the Borough, by omitting strangers who die within the Borough, and by re-distributing persons (who die in Public Institutions) into the Districts from which they have been removed during illness. A. Registration Sub-Districts. REGISTRATION SUB-DISTRICTS. Estimated Population (middle 1912). Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population (corrected). Zymotic Death-rate per 1000 of the Total Deaths (corrected). Diarrhœa Death-rate per 10000 of the Population. Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. Diarrhœa. Lambeth Church 46987 756 16.1 ... 31 2 4 15 ... 2 ... ... 31 85 1.8 112.4 6.6 Kennington† 48091 921 19.1 ... 23 1 7 12 ... 3 ... ... 23 69 1.4 74.9 4.8 Stockwell§ 62447 788 12.6 ... 24 2 5 9 ... 2 1 1 9 53 0.8 67.3 1.4 Brixton 77044 846 10.9 ... 12 4 7 12 ... 4 ... ... 10 49 0.6 57.9 1.3 Norwood 62981 614 9.7 ... 7 ... 6 7 ... 2 ... ... 9 31 1.5 50.5 1.4 Borough of Lambeth 297550 3925 13.2 ... 97 9 29 55 ... 13 1 1 82 287 0.9 73.1 2.8 Of the 788 deaths in Stockwell Registration Sub-District, 438 belong to the Inner and 350 to the Outer Slockwell Sub-District. Inner Registration Sub-Districts—death rates (general 16.9, zymotic 1.5). Outer Registration Sub-Districts—death rates (general 10.5, zymotic 0.6). N.B.—Of the total deaths (corrected), 35 shew no addresses, and have been included in Kennington Sub-District—having occurred in the Workhouse (14). or in the Workhouse Infirmary (21). 24 25 TABLE H (2). TABLE H (2). Shewing the estimated populations and the number of Deaths, with Death-rates, in each of the Wards of the Borough during 1912. The Deaths are from all causes, and from the chief zymotic diseases, and are corrected by adding Lambethians who die outside the Borough, by omitting strangers who die within the Borough, and by re-distributing persons (who die in Public Institutions) into the Districts from which they have been removed during illness. B. Wards. WARDS. Estimated Population (middle 1912). Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population (corrected). Zymotic Death-rate per 1000 of the Total Deaths (corrected). Diarrhoea Death-rate per 10000 of the Population. Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. Diarrhœa. Marsh 21644 332 15.3 ... 13 ... 3 6 ... 1 ... ... 19 42 1.9 126.5 8.8 Bishop's 34175 424 13.6 ... 17 3 1 9 ... 1 ... ... 12 43 1.4 101.4 3.8 Prince's 42261 921 21.8 ... 24 ... 7 10 ... 4 ... ... 24 69 1.6 74.9 5.7 Vauxhall 30158 438 14.3 ... 17 2 3 6 ... 1 ... 1 6 36 1.2 82.2 1.9 Stockwell 31927 350 10.9 ... 6 ... 2 3 ... 1 1 ... 4 17 0.5 48.6 1.2 Brixton 44143 494 11.2 ... 8 4 5 9 ... 3 ... ... 8 37 0.8 74.9 1.8 Herne Hill 32901 352 10.7 ... 5 ... 2 4 ... 1 ... ... ... 12 0.4 34.1 0.0 Tulse Hill 30897 294 9.5 ... 3 ... 4 6 ... 1 ... ... 3 17 0.5 57.8 0.9 Norwood 32084 320 9.9 ... 4 ... 2 2 ... ... ... ... 6 14 0.4 43.7 1.9 Borough of Lambeth 297550 3925 13.2 ... 97 9 29 55 ... 13 1 1 82 287 0.9 73.1 2.7 Inner Wards-death rates (general, 16 9; zymotic, 15). Outer Wards- death rates (general, 10.5; zymotic, 0.6). N.B.—Of the total deaths (corrected), 35 show no addresses and have been included in Bishop's and Prince's Wards, having occurred in the Workhouse Infirmary (21) or in the Workhouse (14) respectively. 26 Changes in Registration of Deaths. The Registrar-General decided to publish from January 1st, 1911, in his annual reports, an analysis of deaths according to administrative areas instead of registration areas as hitherto, and this decision necessitates a complete distribution of the deaths of persons dying away from their homes to the administrative areas in which they had previously resided. Reports were received quarterly during 1912 from the Registrar-General—a total of 75 deaths—on slips giving particulars of deaths assigned to the Borough of Lambeth, in addition to those occurring in London or in the Metropolitan Institutions, which are still reported as hitherto. The tables at the end of the Report (Appendix), known as the Local Government Board Tables, have been revised and modified, in consequence, and will give accurate corrected statistics of deaths within the Borough of Lambeth (differing slightly from the statistics in the body of the Report), the figures required for the necessary corrections being those supplied by the Registrar-General. These Registrar-General's figures for 1912 are as follow:— Age Periods. Males. Females. Totals all ages. 0—1 2 ... 2 1—2 ... ... ... 2—5 3 1 4 5—15 ... 2 2 15—25 4 ... 4 25—45 16 8 24 45—65 11 15 36 65 and upwards 7 6 13 Total all ages 43 32 75 27 Causes of Death. Causes of Death. Ages (in years). Male. Female. Measles 1 ... Whooping Cough 1 ... Phthisis (Pulmonary Tuberculosis) 5 4 Other Tubercular diseases ... ... Cancer, malignant disease 2 5 Heart disease 6 4 Bronchitis ... 2 Pneumonia 2 ... Broncho-Pneumonia 1 ... Pleuro-Pneumonia 1 1 Nephritis and Bright's disease 2 1 Violent deaths 7 4 Suicide 1 ... Appendicitis 2 1 Nervous diseases 8 3 Strangulated Hernia 1 1 Diabetes Mellitus ... 1 Diseases of Digestive System 1 4 Not classified above 2 1 43 32 INFANTILE MORTALITY, 1912. Of the 3,925 corrected deaths, 598 are infants under one year of age. The total number of registered births is 8,168, and, of these, 676 occurred at the Lying-in Hospital, and belong to districts outside Lambeth Borough, 26 occurred at the Workhouse, and belong to districts outside Lambeth 28 Borough, and 383 occurred at the Maternity Hospital and belong to districts outside Lambeth Borough. In this way, the corrected number of births for the Borough is 7,083*. The corrected infantile mortality (i.e., rate of corrected deaths under one year per 1,000 corrected births) is, therefore, 84.4. The annual average for the decennium 1901-10 (Borough), is 122.7. In calculating this corrected infantile mortality, it must be remembered that, whilst we subtract the births that belong to outside districts, we do not add the births of infants of Lambethian mothers who may happen to be residing outside the Borough at the times of such births. Taking the uncorrected births and the corrected deaths under 1 year, the infantile mortality rate is 73.2. The annual average for the decennium 1901-10 (Borough), is 114.8. Taking the uncorrected number of births (8,168) and the uncorrected number of deaths under 1 year of age (715), the uncorrected infantile mortality is 87.2. The annual average for the decennium 1901-10 (Borough) is 123.8, and that for the decennium 1891-1900 (Parish) is 150.5. The chief causes of the deaths were debility, atrophy and inanition, congenital malformations, measles, whooping-cough, bronchitis and other diseases of the respiratory organs, diarrhœa, and premature births. In the Registration Sub-Districts, the uncorrected infantile mortality varied from 111.2 per 1,000 births in Lambeth Church to 55.8 in Norwood (the low rates of 111.2 in Lambeth Church, 81.6 in Kennington, and 68.4 in Stockwell, being due to the fact that these Sub-Districts contain the General Lying-in Hospital, the Workhouse and the Clapham Road Maternity Hospital respectively), thus— * The Registrar-General returns the corrected number of births for the Borough during 1912 as 6 952. 29 Total No. of Births (uncorrected). Total Deaths under 1 year (uncorrected) Infantile Mortality per 1,000 births (uncorrected). Lambeth Church* 2436 271 111.2 Kennington† 1311 107 81.6 Stockwell‡ 1916 131 68.4 Brixton 1465 150 102.4 Norwood 1040 56 53.8 Lambeth 8168 715 87.5 Inner Districts—94.3, Outer Districts—78.4. *Excluding all the Lying-in Hospital births, the rate is 174.9. †Excluding all the Workhouse births, the rate is 95.4. ‡Excluding all the Maternity births, the rate is 95.4. 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. The Infantile Mortality is regarded as a sensitive index of the sanitary state of a District, and, judged by this index, Lambeth Borough again takes a good position amongst Sanitary Districts, a satisfactory fact to be able to state and one that is due to the precautionary measures that are taken. Systematic visiting and giving advice as to the feeding and management of infants and children, together with the free distribution of official pamphlets dealing with the same and kindred subjects, account in part for the decline in the infantile mortality-rate throughout the Borough, whilst the influence of the Milk Depot must not be forgotten. The Notification of Births Act, 1907, is valuable in connection with precautionary measures taken to prevent infantile mortality. Meteorological conditions were favourable during 1912 to a low infantile mortality-rate (vide Diarrhoea). A leaflet was distributed freely throughout the crowded Inner Districts of the Borough during 1912, dealing with preventive measures to be taken against Summer Diarrhoea (vide Appendix). 30 CLASS I. -ZYMOTIC DISEASES. Principal Zymotic Diseases. The principal zymotic diseases are seven in number, viz., smallpox, measles, scarlet fever, diphtheria (including membranous croup), whooping cough, "fever" (including typhus, typhoid or enteric, and simple, or relapsing, or continued), and diarrhœa; and the zymotic death-rate is made up from the total deaths from these diseases. In the Borough, during 1912, there are registered 343 deaths from the seven zymotic diseases, and of these 108 are strangers belonging to other districts, and 235 parishioners who died within the Borough. 52 parishioners, however, died from the seven principal zymotic diseases outside the Borough. Subtracting the strangers, and adding on the parishioners who died without the Borough, there is a corrected total of 287, giving a zymotic corrected death-rate of 0.9 per 1,000 inhabitants. The yearly averages of the numbers of deaths (corrected) from the 7 principal zymotic diseases for the two decennia 1891-1900 (Parish), and 19011910 (Borough), are respectively 679.6 and 475.1. As a test of the sanitary condition of a community, the zymotic death-rate is of approximate value, and in this respect Lambeth Borough stands well. The zymotic death-rates (corrected) for the different Registration Sub-Districts vary as shown in Tables D (1) and H (1) which, in addition, give the general death-rates. Lambeth Church shows the highest, and Norwood the lowest zymotic death-rates respectively. The corrected zymotic death-rate for the Inner Districts is 1.5, and for the Outer 0.6—a difference explainable, as before, by the crowding and absence of proper means of home isolation and nursing in the former, as compared with the latter districts. Crowded districts naturally suffer more in this respect than those more sparsely populated. 31 Similar conclusions are obtainable by comparing the zymotic death-rates (corrected) for the different new Wards, as shewn in Tables D(2) and H(2), from which it is seen that, of the 9 Wards into which the Borough is divided, Marsh shows the highest and Herne Hill and Norwood the lowest, zymotic death-rates. During the year 1912, under the Notification Clauses of the Public Health (London) Act, 1891, 1,332 cases of Infectious Diseases were reported, including the newly-notifiable cerebro-spinal meningitis 7, polio-myelitis acuta 10, and ophthalmia neonatorum 76. The yearly averages of notification certificates received during the two decennia 18911900 (Parish) and 1901-1910 (Borough) are respectively 2,658.4 and 1,912.5. Of the total 1,332 cases notified during 1912, 1,012, i.e., 72.9 per cent., were removed to the Hospitals of the Asylums Board or to other Hospitals, and 320, i.e., 24.1 per cent., remained under treatment at their homes. If the newly-notifiable diseases, cerebro-spinal meningitis, polio-myelitis acuta, and ophthalmia neonatorum be excluded, the percentage of cases removed to Hospital for isolation and treatment during 1912 was 80.9—a good average when compared with the following last 4 quinquennial averages (also exclusive of the special diseases mentioned above), since the compulsory notification of infectious diseases came into force under the Public Health (London) Act, 1891 1891-5, 31.5; 1896-1900, 54.7; 19011905, 67.9; and 1906-10, 82.8. Taking the total number of notified cases (1,332) of infectious diseases, the zymotic incidence throughout the Borough for 1912 is 4.5 per 1,000 population (4.9 Inner and 4.1 Outer Districts) as compared with two decennial averages 1901-1910 (Borough) and 1891-1900 (Parish) of 6.1 and 9.04 respectively. During 1912, the highest incidence rate is 5.1 (Bishop's), and the lowest 3.9 (Brixton). 32 Further, excluding the ophthalmia neonatorum cases, in connection with which no systematic sanitary examination was made, the number of infected houses, in which the remaining 1,256 notified cases occurred, was 1,167, and in each of these houses a systematic examination was made of the drains and sanitary arrangements with the following results:— (a) 89 (i.e., 7.6 per cent.) were found to have defective drains, i.e., gave results with the tests employed. (b) 575 (i.e., 49.3 percent.) were found to have defective traps, fittings and appliances. (c) 503 (i.e., 43.1 per cent.) showed no defects. These figures are comparable with the quinquennial averages for the Parish during 1891-95 and 1896-1900, and for the Borough during 1901-5 and 1906-1910, given in Table 1. Sub-divided according to the different notifiable diseases, the results for 1912 show as follow:— 33 Disease. No. of Infected Houses. Number shewing Defects as to Percentage shewing Total Defects. Percentage shewing no Defects. Drains. Traps, Fittings and Appliances. Total. Smallpox — — — — — — Cholera — — — — — — Diphtheria 311 23 178 201 64.7 35.3 Membranous Croup 5 — 4 4 80.0 20.0 Erysipelas 210 12 99 111 52.9 47.1 Scarlet Fever 538 44 253 297 55.2 44.8 Typhus — — — — — — Typhoid 61 6 25 31 50.8 49.2 Continued 1 — 1 1 100.0 0.0 Puerperal 24 3 9 12 50.0 50.0 Cerebro-spinal Meningitis 7 — 4 4 57.1 42.9 Anterior Poliomyelitis 10 1 2 3 30.0 70.0 Totals 1167 89 575 664 56.9 43.1 N.B.—75 ophthalmia neonatorum infected houses are omitted no systematic sanitary examinations being made in those cases. b 34 35 TABLE I. Shewing the number of Certificates for the Notifiable Zymotic Diseases received in the Borough of Lambeth during 1912, and during the decennium 1901-1910, together with the averages of the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). Disease. Borough of Lambeth. Annual Average, 1901-1910. (Borough.) Annual Average 1891-1900 (Parish). Total. 1912. 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 Cholera 1 1 — — — — — — — — 0.2 11.5 — Smallpox 54 350 72 23 — — — — — — 49.9 22.0 — Scarlet Fever 1041 1330 744 660 1025 1268 1481 1428 1164 910 1105.1 1331.3 604 Diphtheria 511 459 329 317 439 415 317 320 373 318 379.8 715.1 328 Membranous Croup 13 15 9 11 11 11 13 12 3 6 10.4 26.2 5 Typhus — — — — — — 1 — — — 0.1 1.1 — Typhoid or Enteric 147 213 133 101 77 89 56 63 49 77 100.5 189.6 61 Continued or Relapsing 6 10 7 4 9 1 6 3 1 1 4.1 25.7 1 Erysipelas 286 317 236 257 287 263 231 206 189 192 241.4 347.0 216 Puerperal 16 17 17 15 12 27 22 10 16 18 17.0 18.9 24 *Plague — — — — — — — — — — — — — *Cerebro-Spinal Meningitis — — — — — — 13 14 14 5 11.5 — 7 *Poliomyelitis acuta — — — — — — — — — — — — 10 *Ophthalmia Neonatorum — — — — — — — — — — — — 76 Totals 2025 2712 1547 1382 1853 2074 2140 2056 1809 1527 1912.5 2658.4 1332 Average per 1000 of population 6.7 8.9 5.03 4.5 5.9 6.6 6.6 6.4 5.6 4.7 6.1 9 04 4.5 The Health Department has also heard of, and dealt with, the following non-notifiable infectious diseases during 1812 Chicken-pox, 989; Measles, 1595; Whooping Cough, 757; Cancer, 42; other deases (e.g. Mumps influenza Scabies, etc.), 168. *Plague was made notifiable on September 19th, 1900; Cerebro-Spinal, Menigitis ("Spotted Fever") on March 12th, 1907; Poliomyelitis acuta on September 1st, 1911; and Ophthalmia Neonatorum on March 13th, 1911. M.B.-In addition to the above Chicken-pox was notifiable compulsorily as follows:-1902 (Feb. 7th to Dec. 31st), 1903 (Jan. 1st to 6th), 1904 (April 8th to Nov. 8th), and 1911 (March 22nd to June 22nd), the numbers of cases notified being respectively 1560 40 556 and 238. B 2 36 TABLE J. Giving number of Infected Houses, with percentages of (1) General Defects, and (2) Defective Drains, during 1912, together with the averages during the quinquennia 1891-1895 (Parish), 18961900 (Parish), 1901-1905 (Borough) and 1906-1910 (Borough). 1891-1895 (Average). 1896-1900 (Average). 1901-1905 (Average). 1906-1910 (Average). 1912 (Totals). Number of Infected Houses 2229.8 2262.4 1682.6 1719.2 1167 Number of Houses with defects found 1220.0 1096.0 911.2 1033.6 664 Number of Houses with defective drains found 510.0 366.6 214.6 166.6 89 Number of Houses with no defects found 1009.8 1166.4 771.4 685.6 503 N.B.—75 infected houses (wherein 76 cases of Ophthalmia Neonatorum occurred) are omitted from the 1912 figures, so that the results may be strictly comparable with those of previous years, i.e., before Ophthalmia Neonatorum was made a notifiable disease. 37 TABLE K. Shewing corrected zymotic seasonal (quarterly) variations in the number of deaths from the 7 principal zymotic diseases in the Borough of Lambeth in the different Registration SubDistricts during 1912. Registration Sub-District. 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. Year 1912. Zymotic Death-rate per 1000 inhabitants. Lambeth Church 24 20 29 12 85 1.8 Kennington 16 17 21 15 69 1.4 Stockwell 5 18 16 14 53 0.8 Brixton 16 14 11 8 49 0.6 Norwood 7 7 7 10 31 0.5 Borough of Lambeth 68 76 84 59 287 0.9 Inner Districts 1.5; Outer Districts 0.6 per 1000 inhabitants. 38 TABLE L (I). Shewing the total cases notified compulsorily under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, in the Borough of Lambeth, during 1912 (arranged Quarterly). 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total for 1912. Cholera – – – – – Smallpox – – – – – Scarlet Fever 160 99 144 201 604 Diphtheria 93 82 72 81 328 Membranous Croup — — 1 4 5 Typhus – – – — – Typhoid or Enteric 30 12 10 9 61 Continued or Relapsing Fever – 1 – – 1 Erysipelas 54 58 51 53 216 Puerperal 8 4 8 4 24 *Plague – – – – – *Cerebro-Spinal Meningitis 1 3 – 3 7 *Poliomyelitis acuta — 1 7 2 10 *Ophthalmia Neonatorum 21 22 21 12 76 *Chicken Pox — – — — — Totals 367 282 314 369 1332 *Plague was made compulsorily notifiable on Sept. 19th, 1900, Cerebro-Spinal Meningitis on March 12th, 1907, Poliomyelitis acuta on September 1st, 1911, and Ophthalmia Neonatorum on March 13th, 1911. Chicken-pox was compulsorily notifiable as follows: 1902 (Feb. 7th to Dec 31st), 1903 (Jan. 1st to 6th), 1904 (April 8th to Nov. 8th), and 1911 (March 22nd to June 22nd), the numbers of cases notified being respectively 1560, 40, 556 and 238. 39 TABLE L (2). Shewing the total cases notified voluntarily in the Borough of Lambeth during 1912 (arranged quarterly), together with the yearly averages for the decennium 1901-10 (Borough). — 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total, 1912. Yearly average 10 years (1901-1910). Measles 1ll 761 265 458 1595 1376.4 Whooping Cough 215 336 161 45 757 429.6 Chicken-pox* 292 278 98 321 989 599.5 Consumption† 593 429 428 459 1909 668.6 Cancer 16 6 9 11 42 26.5 Total 1227 1810 961 1294 5292 3100.6 *Chicken-pox compulsorily notifiable as follows:—1902 (Feb. 7th to Dec. 31st), 1903 (Jan. 1st to 6th), 1904 April 8th to Nov. 8th), and 1911 (March 22nd to June 22nd), the numbers of cases notified being respectively 1560, 40, 556 and 238. †Consumption voluntarily notifiable throughout the Borough since June 1st, 1902, and compulsorily (Poor Law cases) under the Public Health (Tuberculosis) Regulations, 1908, since January 1st, 1909, and compulsorily (Hospitals) under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, since May 1st, 1911. N.B.—168 other diseases (not classified) i.e., Mumps, Scabies, Influenza, Ringworm, etc., and 580 Verminous Houses and Clothing (469 persons) were also dealt with during 1912. 40 41 TABLE M. Shewing the number of Deaths (corrected) from the 7 principal zymotic diseases in the Borough of Lambeth during 1912, and during the decennium 1901—1910, together with the yearly averages for the two decennia 1891—1900 (Parish) and 1901— 1910 (Borough). Disease. 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 Annual average of ten years 1901—1910 (Borough). Annual Average of ten years 1891—1900 (Parish). Total (corrected) Deaths in 1912. Smallpox 4 60 4 – – – – – – – 6.8 1.1 — Scarlet Fever 39 48 23 16 31 28 38 42 27 22 31.4 48.8 9 Diphtheria 47 49 28 33 37 49 47 44 57 25 41.6 124.5 29 Membranous Croup 3 4 1 1 – 2 – 2 1 1 1.5 6.8 — Fever Typhus – – – – – – – – – – 0.0 0.3 — Typhoid or Enteric 23 38 24 11 10 22 5 8 9 17 16.7 34.7 13 Continued or Relapsing 3 1 1 – – 1 – – 1 – 0.7 1.7 1 Diarrhœa 272 159 160 265 176 268 71 150 118 90 172.9 196.5 82 Cholera 2 – 1 4 2 4 – — – – 1.3 8.8 1 Measles 119 84 130 164 96 77 107 101 104 122 110.4 145.6 97 Whooping Cough 115 118 126 109 79 71 111 50 85 54 91.8 143.7 55 Borough of Lambeth 627 561 498 603 431 522 379 397 402 331 475.1 706.1 287 TABLE N. Showing corrected Zymotic seasonal (monthly) variations in the number of deaths from the principal Zymotic diseases, and from Erysipelas, Puerperal Fever, Cerebro-spinal Meningitis and Poliomyelitis acuta, in the Borough of Lambeth, during 1912. For the 4 weeks ending January. February. March. April. May. June. July. August. September. October. November. December. Total 1912. Smallpox – – – – – – – – – – – – – Scarlet Fever 1 — 2 — 1 — 1 1 – 1 2 — 9 Diphtheria 3 2 4 1 3 2 2 3 2 2 4 1 29 Membranous Croup — — — — — — — — — — — – — Typhus — — — — — — — — — — — — — Typhoid or Enteric 4 2 1 — 1 — 2 — — 2 — 1 13 Continued or Relapsing Fever — — — — 1 — — — — — — — 1 Diarrhœa (including Cholera) 6 2 3 4 4 4 12 21 12 10 3 2 83 Measles 2 9 11 6 13 13 13 5 1 6 10 8 97 Whooping Cough 4 4 10 5 10 7 3 1 3 4 4 — 55 Total of Seven Chief Zymotic Diseases 20 19 31 16 33 26 33 31 18 25 23 12 287 Erysipelas 2 2 — — 2 1 — 1 1 2 1 1 13 Puerperal Fever 3 — 1 — 2 1 1 2 1 1 — 2 14 Cerebro-spinal Meningitis — — — 1 — — — — — — — 1 2 Poliomyelitis acuta — — — — — — — — — — — — — 43 The quarterly seasonal mortality (corrected) from the whole of the different important zymotic diseases (i.e., principal and others) during 1912 is as follows:— 1912. Smallpox. Scarlet Fever. Diphtheria. Membranous Croup. FEVER. Diarrhœa. Cholera. Measles. Whooping Cough. Erysipelas. Puerperal Fever. Influenza. Total. Typhus. Typhoid or Enteric. Continued or Relapsing. 1st Qr. – 3 9 — — 7 – 8 – 23 18 2 4 14 888 2nd Qr. — 1 6 — — 1 1 14 — 32 21 3 4 7 90 3rd Qr. — 2 6 — — 2 — 45 1 21 7 3 2 2 91 4th Qr. – 3 8 — — 3 — 15 – 21 9 5 4 17 85 Totals – 9 29 – — 13 1 82 1 97 55 13 14 40 354 Taking the zymotic diseases collectively, it is noticed that the 3rd quarter showed the highest mortality and the 4th quarter the lowest. Diphtheria and typhoid (or enteric) reached their maxima in the 1st quarter; measles and whooping-cough in the 2nd; diarrhoea and cholera in the 3rd; and erysipelas and influenza in the 4th. Scarlet fever reached its maximum in the 1st and 4th quarters; and puerperal fever in the 1st, 2nd and 4th. Table K shews the zymotic seasonal variations in the different Registration Sub-Districts, while Table N gives the monthly mortalities from the zymotic diseases. Table M gives the deaths registered in the Borough of Lambeth from the seven principal zymotic diseases during 1911, and for the two decennia 1891-1900 (Parish) and 19011910 (Borough). 44 SMALLPOX. During 1912, no single case of genuine smallpox wasnotified, nor was a single death from smallpox registered, within the Borough. Two doubtful cases (1 adult female and 1 boy) were reported at houses in Brixton and Tulse Hill respectively, but both proved not to be smallpox. The boy was sent to Hospital (observation wharf) and returned therefrom at onoe after re-vaccination. The annual averages lor small-pox for the decennium 1901-1910 are (1) notified cases 49.9, and (2) deaths 6.8, though no genuine case has been notified nor death registered within the Borough during the past 7 years. 35 "contacts"* were watched for 16 days each within the Borough during 1912, in connection with (a) persons arriving by vessels from abroad, such vessels coming from smallpox-infected places, or being themselves (?) smallpoxinfected by cases on board, e.g., S.S. "Maloja" (2), H.T. "Dongola" (16), H.T. "Plassy" (14), and S.S. "Medina" 3. Vaccination. The Vaccination Returns of the Local Government Board for the Borough are to be found in Tables O and P, dealing with the whole year 1911, and the first half of 1912 respectively.† These Returns are obtained from the Vaocination Officers. The total number of conscientious objectors who obtained certificates during 1912. irrespective of the dates of birth of the children to which they relate, is 1,532, whilst the total number of certificates of successful primary vaccinations at all ages received during 1911 and 1912 are 6,175 and 5,677 respectively. *2 of the "contacts" could not be traced, wrong addresses having been given to the Port Sanitary Authorities. †The yearly returns are not made up by the Local Government Board until August of the following year, so that only the Returns for the first half of the year 1912 can be given in this Report. 45 TABLE O. VACCINATION RETURNS (LAMBETH BOROUGH), 1911. Registration Sub-Districts. No. of Births. (uncorrected). Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinated. Conscientious Objectors. Removed to other Parishes (known or unknown). Postponed by Doctors. Waterloo 1363 663 ... 112 102 484 2 Lambeth Church 1007 547 6 81 90 272 14 Kennington 1383 866 ... 119 151 224 19 Stockwell 1977 1066 1 148 322 436 4 Brixton 1516 800 6 101 311 226 67 Norwood 1165 620 8 67 361 69 31 Lambeth 8411 4562 21 628 1337 1711 137 46 TABLE VACCINATION RETURNS (LAMBETH BOROUGH) FOR THE FIRST HALF-YEAR, 1912. Registration Sub-Districts. No. of Births (corrected). Successfully Vaccinated. Insusceptible to Vaccination. Dead Unvaccinated. Conscientious Objectors. Removed to other Parishes (known or unknown). Postponed by Doctors. Lambeth Church 1227 578 ... 64 108 432 33 Kennington 675 376 ... 50 73 140 27 Stockwell 928 486 4 39 171 194 27 Brixton 771 383 5 36 170 113 56 Norwood 497 260 3 21 167 28 11 Lambeth 4098 2083 12 210 689 907 154 The Yearly Returns are not made up for the Local Government Board until the August in the following year. 47 CEREBROSPINAL FEVER (EPIDEMIC CEREBROSPINAL MENINGITIS) OR "SPOTTED FEVER. "* During 1912, 7 cases of cerebrospinal fever were notified in the Borough, 2 in Lambeth Church, 2 in Kennington, 2 in Stockwell (Inner), and 1 in Norwood Registration SubDistricts, and, of the 7 cases notified, 2 died (=28.6 per cent.). The necessary precautionary measures were taken in each case, 5 of the patients being removed to Hospital (2 from Lambeth Church, 2 from Kennington and 1 from Stockwell Sub-Districts). ACUTE POLIO-MYELITIS (ACUTE POLIO-ENCEPHALITIS).* During 1912, 10 cases of acute polio-myelitis were notified in the Borough, 3 in Lambeth Church, 4 in Kennington, 2 in Stockwell (Inner), and 1 in Brixton Registration Sub-Districts, and, of the 10 cases notified, none died. The necessary precautionary measures were taken in each case, 3 of the patients being removed to Hospital, 1 from Lambeth Church and 2 from Kennington Sub-Districts. CHICKEN-POX. Chickenpox was not compulsorily notifiable during 1912 in the Borough, but through the head teachers of schools and voluntarily from other sources, 989 cases were reported to the Council and in connection with these disinfection and other necessary precautionary measures were taken. SCARLET FEVER During 1912, in the Borough, 604 cases of scarlet fever were notified, and 9 deaths registered, giving a case mortality of 1.5 per cent. The annual averages for *Made notifiable by orders of the London County Council from and including March 13th, 1912, throughout the Administrative County of London, such Orders having been duly approved by the Local Government Board. 48 the two decennia 1891-1900 (Parish) and 1901-1910 (Borough) are respectively (1) notified cases 1,331.3 and 1,105.1, and (2) deaths 48.8 and 31.4. Of the 604 persons notified in the Borough during 1912, 563* (i.e., 93.2 per cent.), were removed to Hospital, and of these 9 died (i.e., 1.6 per cent.) whereas 41 (i.e., 6.8 per cent.) were treated at home, and of these none died. The age and sex incidence and mortality for the 604 scarlet fever cases notified in Lambeth Borough during 1912 are as follow:— Age. Number of Cases notified. Deaths. Death Rate per 100 Notified. M. F. Total M. F. Total Total. Under 1 vear 3 3 6 – – – 0.0 1 to 2 15 11 26 2 – 2 7.7 2 to 3 14 16 30 3 – 3 10.0 3 to 4 23 24 47 1 – 1 2.1 4 to 5 30 28 58 1 – 1 1.7 5 to 6 38 30 68 1 1 2 2.9 6 to 7 25 27 52 – – – 0.0 7 to 8 26 35 61 – – – 0.0 8 to 9 17 19 36 – – – 0.0 9 to 10 16 15 31 – – – 0.0 Over 10 years 95 94 189 – – – 0.0 Total 302 302 604 8 1 9 1.5 It will be noted that, of the total 604 persons reported as suffering from scarlet fever during 1912, within the *Of the 563 cases of Scarlet Fever removed to Hospital, 40 proved at Hospital not to be suffering from that disease. 49 Borough of Lambeth, 161 (i.e., 26.6 per cent.) were under five years of age, and 415 (i.e., 68.7 per cent.) under 10 years of age: whilst the case mortality was greatest amongst those between 1 and 3 years of age. Of the 189 persons over 10 years of age, none died. During 1912, outbreaks of scarlet fever were investigated in connection with 2 schools (4 classrooms) and absentees were visited and enquiries made in regard to the illnesses for which the scholars were being kept away from school. Doubtful cases of "sore-throat" (10 in number) were excluded, but no school or class-room was closed. The distribution of the cases of, and the mortality from, scarlet fever amongst the different Registration SubDistricts of the Borough during 1912, is as follow:— Registration Sub-Districts. Total No. of Cases Notified. Casts treated at Home. Cases removed to Hospital. No. of Deaths. Case Mortality per 100. At Home. In Hospital. Total. Lambeth Church 111 – 1ll – 2 2 1.8 Kennington 82 3 79 – 1 1 1.2 Stockwell 119 8 111 – 2 2 1.01 Brixton 157 14 143 – 4 4 2.5 Norwood 135 16 119 – – – 0.0 Borough of Lambeth 604 41 563 — 9 9 1.5 Seven schools were disinfected during 1912 in connection with scarlet fever cases notified amongst the scholars. 50 MEASLES AND WHOOPING COUGH These two non-notifiable infectious diseases cause moredeaths than all the notifiable infectious diseases together. In the Borough, during 1912, 97 and 55 corrected deaths were registered from measles and whooping cough, giving corrected death-rates per 10,000 of the populations of 3.3 and 1.8 respectively. The annual average numbers of deaths from measles and whooping cough respectively during the two decennia 1891-1900 (Parish) and 1901-10 (Borough), are 145.6 and 110.4 (measles) and 143.7 and 91.8 (whooping cough). The Inner Districts suffered (deaths per 10,000 of the population) more than the Outer Districts, thus:— Inner. Outer. Whooping Cough 2.6 1.3 Measles 5.6 1.5 Of the Lambeth Registration Sub-Districts, Lambeth Church suffered most, and Norwood least, from bothmeasles and whooping cough. Measles. Of the 97 deaths from Measles in the Borough during 1912, 91 (i.e., 93.8 per cent.) occurred amongst children under 5 years of age, showing that measles is a disease of young children, and especially fatal to such. 19 of the deaths (i.e., 19.6 per cent.) occurred amongst infants under 1 year of age. With regard to Measles, extra precautions are taken in connection with disinfection of Measles-infected houses, exclusion of children (both infected children and also children from infected houses) from schools, the closing of classes or whole schools on account of outbreak of Measles, the *Made notifiable by orders of the County Council from and including March 13th, 1912, throughout the Administrative County of London, such orders having been duly approved by the Local Government Board. 51 tributing of leaflets and posters, and the educating of parents to regard Measles as a serious and dangerous infectious disease, and not as a trivial complaint of childhood. Measles is not compulsorily notifiable, but 1,595 cases (during 1912) were reported voluntarily (chiefly through schools) to the Borough Council. Measles being chiefly a "School Disease," this voluntary system of notification is valuable. Of the 1,595 notified cases, 278 (i.e., 17.4 per cent.) were removed to hospital from the Borough, non-pauper as well as pauper cases being now received for treatment and isolation, under the new Metropolitan By-laws (Measles) Order 1912 (August 9th).* Measles is spread chiefly through Schools, especially Infants' Departments, and during 1912 precautions were taken in respect thereto in the way of exclusion of all known cases of measles, and all "Unprotected" Children, i.e., those who have not previously had an attack of the disease, thereby securing the minimum interference with school attendance. 102 schools (Infants' Departments) were dealt with, representing 134 different class-rooms or grades, and a total of 1,731 children, excluded for periods varying from a few days to a few weeks on account of outbreaks of measles in connection therewith (a total of 467 cases of measles). 8 schools were disinfected in connection with outbreaks of measles. Whooping Cough. Whooping Cough is also a serious disease, especially to young children. Of the 55 deaths registered in the Borough during 1912 from this disease, 52 (i.e., 94.5 per cent.) occurred in children under 5 years of age, and 24 of the deaths (i.e., 43.6 per cent.) occurred amongst infants *Of the 278 cases of Measles removed to Hospital, 1 proved at Hospital not to be suffering from that disease. 52 under 1 year of ape. It is, therefore, a disease of childhood, and its prevention is being systematically attempted, chiefly in the way of disinfection of whooping cough-infected houses, exclusion from school of children (both infected and from infected houses), and the educating of parents up to the; dangerous nature of the disease and the importance of careful nursing of the patients when suffering from this complaint. Unfortunately, whooping cough, like measles, is, at present, regarded as a harmless complaint of childhood, and the ignorance displayed, and the apathy shown, is well known, to all who visit amongst the poorer classes. The disease is not oompulsorily notifiable, but 757 cases were voluntarily notified during 1912 by school teachers.* Of the 757 notified cases, 87 were removed to hospitalt from the Borough, non-pauper as well as pauper cases being now received for treatment and isolation, under the new Metropolitan Asylums (Whooping Cough) Order, 1912 (August 9th). Leaflets (dealing with the dangers and treatment of the disease) were left at all known whooping-cough infected houses. During 1912, 7 schools (9 classrooms) were dealt with on account of outbreaks of whooping cough—a total of 50 cases with 239 exclusions of "unprotected" scholars (i.e., children who had not previously had attacks of the disease) for periods varying from 2 to 5 weeks. In 2 instances, the classrooms were closed owing to the fewness of the scholars left in attendance after exclusions. Two schools were disinfected during 1912 in connection with outbreaks of whooping cough. Details of the incidences of measles and whooping cough in the different Registration Sub-Districts of Lambeth Borough during 1912 are as follow:— *The Council decided by Order on Oct. 3rd, 1912, to make Whooping Cough compulsorily notifiable by medical men and parents or relatives for a trial period of five years, commencing Jan. 1st, 1913, and the Order was approved by the Local Government Board on Oct. 31st, 1912. † Of the 87 cases of Whooping Cough removed to Hospital, 4 proved at hospital not to be suffering from that disease. 53 Registration Sub- Districts. Number of Deaths from Whooping Cough. No. of Deaths from Measles. Whooping Cough Deaths per 10000 Inhabitants, Measles Deaths per 10000 Inhabitants. Lambeth Church 15 31 3.2 6.6 Kennington 12 23 2.5 4.8 Stockwell 9 24 1.4 3.8 Brixton 12 12 1.5 1.5 Norwood 7 7 1.1 1.1 Borough of Lamteth 55 97 1.8 3.3 CHOLERA AND PLAGUE. In the Borough, during 1912, no case of plague, suspected or otherwise, was notified, and no death from plague was registered. No case of cholera was notified, but 1 death from cholera* was registered, during 1912. During the decennium 1901-10, no case of plague was notified and no death from plague was registered, within the Borough, but, during the same period, 2 cases of cholera were notified and 14 deaths from cholera registered—all cases probably of epidemic diarrhoea and cholera nostras or English cholera. 9 plague "contacts" arrived from abroad (from Bombay) and Were watched on arrival, but, in connection therewith, no case of plague developed. The 9 persons arrived by H.T. "Dongola" (7), S.S. "Umvoti" (1), and S.S. "Umsumbi" (1). *Probably a case of cholera nostras or English cholera, or epidemic diarrhœa. 54 DIPHTHERIA. During 1912, 29 deaths were registered in the Borough from diphtheria, and a total of 329 cases were notified, giving a case-mortality of 8.8 per cent. The annual averages for two decennia 1891-1900 (Parish), and 1901-10 (Borough) are respectively (1) notified cases, 685.2 and 379.8, (2) deaths 124.7 and 41.6. Of the 329 cases notified during 1912, 300* (i.e., 91.2 per cent.) were removed to hospital, and 29 died, giving a case-mortality of 9.9 per cent, amongst the cases treated in hospital; whilst 29 (i.e., 8.8 per cent.) were treated at home, and none died. The case-mortality rate for the whole of the Borough during 1912, is again low, pointing to (1) the mildness of the majority of the cases notified, and (2) the value of antitoxin in the treatment of diphtheria, especially in the very early stages of the disease.† The decrease in the number of diphtheria deaths throughout the Borough during 1912 is again noteworthy, as it has been during the four quinquennia 1891-5, 1896-1900, 1901-1905, and 1906-1910 when the yearly averages of the numbers of deaths were 123.2, 125.8, 38.8 and 44.4 respectively. So, too, if the 329 notifications of diphtheria received during 1912 in the Borough be compared with the yearly averages for the four quinquennia 1891-1895, 1896-1900, 1901-5, and 1906-1910, when the yearly averages were 551.6, 818.6, 513.7 and 348.6 respectively, a similar decrease will be noticed. Even allowing for the slight fallacy that may arise from comparing statistics of the old Parish with those of the new Borough, the decrease in the mortality from diphtheria is again noteworthy and, when taken in conjunction with the *Of the 300 cases of Diphtheria removed to Hospital, 23 proved at Hospital not to be suffering from that disease. †38 bottles of Antitoxin were distributed during 1912 under the new Antitoxin Order. 55 decrease in the number of notifications of the same diseasereceived, points to a marked decline in the prevalence of diphtheria during 1912, as well as during the past 10 years. The statistics for London, as a whole, are no less noteworthy. During 1912, no school was closed on account of diphtheria, but exclusion of "sore throats" was resorted to in the case of 6 schools (10 classrooms), wherein 11 cases of diphtheria occurred. 3 children suffering from "sore throat" excluded from school and were not allowed to resume attendance until certificates (based on bacteriological examination) had been furnished stating that they were free from infection. One school was disinfected during 1912 in connection with an outbreak of diphtheria. Quinquennial Period. Population (estimated). Number of Deaths. Death-rate per million living. Old Parish of Lambeth. 1863—1867 902119 148 164 1868—1872 1021165 96 94 1873—1877 1132106 184 163 1878—1882 1245913 255 205 1883—1887 1313211 365 278 1888—1892 1367734 537 393 1893—1897 1443857 683 483 1898—1900 924333 362 392 Borough 1901—1905 1538750 194 126 1906—1910 1606918 222 138 1911 297957 43 144 1912 297550 29 97 The age and sex incidence and mortality from diphtheria cases notified in the Borough of Lambeth during 1912 are as follow:— 56 Diphtheria. Ages. No. of Cases Notified. Deaths. Death Rate per 100. M. F. Total. M. F. Total. Under 1 year 2 1 3 1 2 3 100.0 1 to 5 50 59 109 10 7 17 15.6 5 to 10 52 80 132 2 4 6 4.6 10 to 20 28 29 57 2 — 2 3.5 20 to 40 6 17 23 1 — 1 4.3 40 to 60 2 3 5 — — — 0.0 60 and over – – – – – – – Total 140 189 329 16 13 29 8.8 The distribution of the disease in the different Registration Sub-Districts of the Borough of Lambeth, together with the numbers of deaths amongst both hospital- and home-treated patients etc., during 1912, are as follows:— Registration Sub-Districts. Total No. of Cases Notified. Cases treated at Home. Cases removed to Hospital. No. of Deaths. Case Mortality per 100. At Home. In Hospital. Total. Lambeth Church 49 1 48 – 4 4 8.2 Kennington 55 4 51 – 7 7 12.7 Stockwell 83 5 78 – 5 5 6.0 Brixton 69 10 59 – 7 7 10.1 Norwood 73 9 64 – 6 6 8.2 Borough of Lambeth 329 29 300 – 29 29 8.8 57 497 swabs from suspected diphtheria throats or noses were examined at the Bacteriological Laboratory during 1912, and, of these, 55 (i.e., 11.1 per cent.) showed the presence of the true Klebs-Lœffler (diphtheria) bacilli. In this connection, the point cannot be too well emphasised that a positive bacteriological result proves much, but that a negative result proves practically nothing. Several negative results must be obtained in succession before any trustworthy conclusions may be drawn as to the absence of a disease. MEMBRANOUS CROUP. During 1912, in the Borough, 5 cases were notified from membranous croup,* but no death was registered. 4 cases were removed to hospital, † The annual averages for the decennium 1901-10 are (1) notified cases 10.4, and (2) deaths 1.5‡. *Membranous Croup Notification Certificates received since the formation of the new Borough:—1901, 13; 1902. 15; 1903,9; 1904,11; 1905, 11; 1906, 11; 1907, 13 ; 1908, 12 ; 1909, 3 ; 1910, 6 ; 1911, 4. †Of the 4 cases of Membranous Croup removed to Hospital, 1 proved at Hospital not to be suffering from that disease. ‡In London Statistics Diphtheria and Membranous Croup are now grouped together by the Registrar-General. 58 TYPHOID FEVER During 1912, 13 deaths were registered in the Borough from typhoid (enteric fever), and a total of 61 cases notified, giving a case mortality of 21.3 per cent. The annual averages for the two decennia 1891-1900 (Parish) and 1902-11 (Borough) are respectively, (1) notified cases 189.7 and 91.8 (2) deaths 34.7 and 15.6. Of the 61 cases notified in the Borough during 1912, 46* (i.e., 75.4 per cent.) were removed to hospital, and 9 died, giving a case-mortality of 19.6 per cent, amongst the patients treated in hospital; whilst 15 (i.e., 24.6 per cent.) were treated at home, and 4 died, giving a casemortality of 26.7 per cent, amongst the patients treated at home. The age and sex incidence and mortality for typhoid cases notified in Lambeth Borough during 1912 are as follow:— Ages. Number of Cases Notified. Deaths. Deathrate per 100. M. F. Total. M. F. Total. Under 1 year – – – – – – – 1 to 5 – 1 1 — 1 1 100.0 5 to 10 4 2 6 1 – 1 16.7 10 to 20 6 8 14 – 1 1 7.1 20 to 40 10 15 25 2 3 5 20.0 40 to 60 8 6 14 3 1 4 28.6 60 and over 1 – 1 1 – 1 100.0 Total 29 32 61 7 6 13 26.3 It will be noted that (a) there was no case notified, and no death registered, in infants under 1 year of age; and (b) *Of the 46 cases of Typhoid Fever removed to hospital, 4 proved at hospital not to be suffering from that disease. 59 1 case was notified and 1 death registered, amongst children between 1 and 5 years of age; whilst the greatest numbers of both cases and deaths occurred amongst persons between 20 and 40 years of age. Details as to incidence of the disease during 1912 upon the Registration of Sub-Districts of the Borough are as follow:— Registration Sub-Districts. Total No. of Cases Notified. Cases treated at Home. Cases removed to Hospital. No. of Deaths. Case Mortality per 100. At Home. In Hospital. Total. Lambeth Church 6 1 5 1 1 2 33.3 Kennington 16 3 13 — 3 3 18.8 Stockwell 6 — 6 — 2 2 33.3 Brixton 16 3 13 2 2 4 25.0 Norwood 17 8 9 1 1 2 11.8 Borough of Lambeth 6l 15 46 4 9 13 21.3 16 cases out of the 61 were traced to sources outside the Borough and 10 were secondary cases, i.e., derived from previous cases (notified or unrecognised) in the Borough, as far as could be discovered. No case could be traced definitely and conclusively to infected ice-creams, water, milk, fried fish or watercress. Of the 61 typhoid-infected houses, 31 (i.e., 50.8 per cent.) showed, on inspection, defective drains, traps, fittings, or appliances, whilst in 6 (i.e., 9.8 per cent.), the drains themselves were found to be defective (i.e., gave a result with the test). 60 57 samples of blood were examined at the Bacteriological Laboratory during 1912 for the Widal reaction of typhoid, and of these, 31 (i.e., 54.4 per cent.) gave the re-action. In so far as typhoid fever is regarded as a sanitary index of a district, the statistics for the Borough during 1912 are of a satisfactory character. SIMPLE, CONTINUED, RELAPSING AND TYPHUS FEVERS. During 1912, 1 case of continued fever was notified, and 1 death from this disease was registered, in the Borough. The annual averages for continued fever for the decennia 1902-11 are (1) notified cases 3.7, and (2) deaths 0.4. No case of typhus was notified, and no death from the disease was registered, during 1912, in the Borough. One case of typhus has been notified in the Borough during the decennium 1901-10. PUEPERAL FEVER. During 1912, in the Borough, 14 deaths were registered from puerperal fever (a disease of child-bed), and 24 cases notified, giving a case-mortality of 58.3 per cent. 13 of the patients were removed to hospital, non-pauper as well as pauper cases being received for treatment and isolation by the new Metropolitan Asylums (Puerperal Fever) Order, 1912 (August 20th). The annual averages for the two decennia 1891-1900 (Parish) and 1902-1911 (Borough) are respectively (1) notified cases, 18.1 and 17.0 and (2) deaths 12.0 and 7.8. Puerperal fever is a preventable disease, and is caused through want of care on the part of the nurse, or the medical practitioner, attending upon a lying-in woman. 8,168 61 births were registered in the Borough during 1912, and in only 24 cases was puerperal fever notified—a satisfactory fact to be able to report. In each case enquiries were made, and the Midwives (when in attendance) were visited at their homes, their rooms (or houses) and clothes disinfected, and their other patients (being attended at the time) followed up and watched as required. ERYSIPELAS During 1912, in the Borough of Lambeth, 216 cases of erysipelas were notified and 13 deaths registered, giving a case-mortality of 6.0 per cent. Of the 216 cases notified, 76 (i.e., 35.2 per cent.) were removed to hospital. The annual averages for the two decennia 1891-1900 (Parish) and 1902-11 (Borough) are respectively (1) notified cases 347.0, and 140.8 and (2) deaths 18.2 and 12.4. The advantages from the notification of erysipelas are few, as the majority of cases notified as "erysipelas" are not such as were contemplated by the framers of the Notification Act. DIARRHŒA. During the year 1912, there were registered in the Borough, 82 deaths from diarrhoea, as compared with yearly averages of 196.7 and 177.9 respectively for the two decennia 1891-1900 (Parish) and 1902-11 (Borough). Taking the statistics of the Parish and the Borough for the 4 quinquennia 1891-95, 1896-1900, 1901-1905 and 19061910 respectively, when the yearly averages for diarrhoea (and cholera) were 191.6, 219.4, 208.6 and 140.2, a comparison may be made of the variations in the incidence of these diseases. 62 Of the 82 deaths registered during 1912, in the Borough, 73 (i.e., 91.5 per cent, were in children under 5 years, and 64 (i.e., 78.05 per cent.) in infants, under 1 year of age. July, August, September and October were the most fatal months, the numbers registered being 11, 21, 12 and 10 respectively, and, during this period of 4 months, the incidence of diarrhoea (deaths per 10,000 of the population) upon the Inner Districts was proportionally greater than that upon the Outer Districts. In this connection, it is interesting to note that the 4 ft. earth thermometer first registered 56 deg. F. on June 19th, rising to a maximum 61.2 deg. F. on July 23rd, remaining at that temperature until August 2nd, and sinking to 56 deg. F. again on September 29th. 56 deg. F. is the so-called "critical" earth temperature for diarrhoea, i.e., the temperature at which the germs of this disease begin to multiply, and prove themselves dangerous.* Hence its importance, statistically, in connection with diarrhœa, a disease which, though it kills chiefly young children, attacks at times persons of all ages—a fact not generally recognised. Age mortalities (corrected deaths) from diarrhœa were as follows:— M. F. Total. Percentage of total deaths. Under 1 year 33 31 64 78.1 1 to 5 8 3 11 13.5 5 to 20 1 1 2 2.4 20 to 40 1 2 3 3.6 40 to 60 ... 1 1 1.2 Over 60 ... 1 1 1.2 Total 43 39 82 100.0 *The 4-ft. earth temperatures were laken in Reeent's Park, and thanks are due to the Secretary of the Royal Botanic Society for the information in connection therewith. 63 The details as to the diarrhoea incidence (mortality) during 1912, upon the different Registration Sub-Districts and the Wards of Lambeth Borough are as follow:— Borough of Lambeth. Registration Sub-Districts. Number of Deaths. Diarrhœa Death-rate per 10000 Population. Lambeth Church 31 6.6 Kennington 23 4.8 Stockwell 9 1.4 Brixton 10 1.3 Norwood 9 1.4 Borough of Lambeth 82 2.7 N.B.—1 death from Cholera was also registered during 1912 in Stockwell (inner) Sub-District. Borough of Lambeth. Wards. N umber of Deaths. Diarrhœa Death Rate per 10,000 Population. Marsh 20 9.2 Bishop's 12 3.8 Prince's 23 5.4 Vauxhall 7 2.3 Stockwell 4 1.2 Brixton 9 2.04 Herne Hill – 0.0 Tulse Hill 3 0.9 Norwood 4 1.2 Borough of Lambeth 82 .7 N.B.—1 death from Cholera was also registered during 1912 in Stockwell Ward. 64 Taking the whole of the cases registered, during 1912,. the diarrhoea death-rate per 10,000 population in the Inner Registration Sub-Districts and Inner Wards is 4.9 as compared with 1.2 for the Outer Registration Sub-Districts and Outer Wards—a difference which is generally found to obtain, and which is understood when the crowded state of the Inner Registration Sub-Districts and Inner Wards is remembered. 18 deaths were registered during 1912 from "enteritis." During recent years there has been a marked improvement in the diagnosis of deaths from diarrhceal diseases, so that, to obtain comparable figures, attention should be paid not only to diarrhœa deaths certified, but also to all deaths arising from diseases of an enteritic nature, i.e., those in which the intestines are affected. A special leaflet was issued during 1912, dealing with precautions against summer diarrhœa in connection with irregular and improper feeding of infants, the value of the milk depot in relation thereto, the danger of contamination of food by flies, the importance of removing at once all accumulations of refuse and other offensive matters, uncleanliness generally, and other causes of the disease (vide Appendix). GLANDERS, ANTHRAX. ETC. During 1912, 9 notifications of animal glanders in the Borough were received under the London (Notification of Glanders) Order, 1907,* but no case of human glanders, anthrax or hydrophobia was notified. EPIDEMIC INFLUENZA. During 1912, 40 deaths were registered from influenza in the Borough. Of the 40 deaths, 14 were registered during the first, 7 during the second, 2 during the third, and 17 during the fourth quarter of the year. The annual averages for the two decennia 1891-1900 (Parish) and 1902-11 (Borough) are respectively 107.5 and 51.7. *The Order includes also Anthrax and Hydrophobia occurring in human beings. 65 OPHTHALMIA NEONATORUM (CONTAGIOUS OPHTHALMIA OF NEWLYBORN INFANTS). Ophthalmia neonatorum was made compulsorily notifiable in the Administrative County of London as from, and including, March 13th, 1911, by Order made by the London County Council and duly approved by the Local Government Board. During 1912, within the Borough, 76 infants were notified. Each case was visited by the Health Visitor and the necessary precautionary measures were taken, removal to hospital taking place in 2 instances.* All the infants recovered except one, whose left eye was destroyed. The London County Council Medical Inspectors under the Midwives Act report all cases of inflammation of the eyes of newly-born babies to the Medical Officers of Health of the various Metropolitan Districts, i.e., in addition to notifying cases of ophthalmia neonatorum as they occur. TUBERCULOSIS. During 1912, 381 deaths (corrected) were registered in the Borough as due to phthisis (tuberculosis of the lungs), 8 as due to tabes mesenterica and 32 as due to tubercular meningitis and hydrocephalus, and 59 as due to other forms of tuberculosis, making a total of 480 deaths from tuberculosis (all forms)—i.e., 12.2 per cent. of the total deaths (corrected) registered from all causes. During the four quinquennia, 1891-5 (Parish), 1896-1900 (Parish), 1901-5.) (Borough) and 1906-10 (Borough), the yearly *No special hospital accommodation for cases of ophthalmia neonatorum has been piovided in London, the general and special hospitals dealing with the cases in their out-patient and in-patient departments as required. c 66 averages of deaths from tuberculosis (all forms), were respectively 675.0, 690.0, 647.4 and 567.4, whilst, during the same quinquennia, the yearly averages of deaths from phthisis, or pulmonary tuberculosis, alone were respectively, 478.8, 496.8, 462.8 and 421.6. Sub-dividing the total tuberculosis (all forms) deaths during 1912 amongst the different Registration Sub-Districts it is found that the numbers of deaths vary as follow:— Registration Sub-Districts. Deaths from Phthisis. Tabes. Mes. and Tub. Men. Other forms Tuberculosis. Total Deaths Tuberculosis, (all forms). Lambeth Church 84 8 19 111 Kennington 100 12 13 125 Stockwell 74 9 13 96 Brixton 81 6 10 97 Norwood 37 5 4 46 No Address 5 — — 5 Borough of Lambeth 381 40 59 480 601 samples of sputum were examined at the Bacteriological Laboratory during 1912, and of these 296 (i.e., 49.2 per cent.) showed the presence of the tubercle bacillus. The distribution of consumption or pulmonary phthisis, or pulmonary tuberculosis, as a disease, can be gauged from the official notifications that have been received, viz.: 67 under (a) the voluntary Lambeth Notification (Consumption) Scheme, 1902,* which came into force on June 1st, 1902, (b) the compulsory Poor Law, Hospitals and Private Pulmonary Tuberculosis Schemes, known as Regulations, e.g., the Public Health (Tuberculosis) 1908, the Public Health (Tuberculosis in Hospitals) 1911, and the Public Health (Tuberculosis), 1911. All the sources of notifications received during 1912 are set out in Tables Q(I.), Q(II.), Q(III), Q(IV.), and Q(V.), dealing with (a) Wards and (b) Registration Sub-Districts. In each case notified, from whatever source, a visit is paid, unless the notifying medical man is of opinion that such an official visit is unnecessary, leaflets are distributed and disinfection is carried out as required, but with due regard to privacy, instructions being given to the officers to avoid doing anything likely to cause pain or annoyance to patients or their friends. Taking all the notifications received during 1912—a total of 1,920, the disease appears to have had a greater incidence upon the Inner than the Outer Districts (Registration SubDistricts and Wards), viz.: 1,173 to 747, i.e., 9.3 to 4.3 per 1,000 population due to (a) the more crowded conditions, persons in houses, and houses over area, and (b) the different (poorer) status of the inhabitants, in the former as compared with the latter. Taking the medical notifications of tuberculosis of the lungs (consumption) received under the Regulations, 1908 and 1911, but excluding the re-notifications, the incidence- *No notifications were received during 1912 under the Lambeth Notification (Consumption) Scheme 1902. c 2 68 rates of the disease per 1,000 of the populations in the Registration Sub-Districts and Wards during 1912, are as follow:— 1. Wards— Inner—8.5, viz.: Marsh, 7.1; Bishop's, 12.03; Prince's, 8.1; Vauxhall, 6.6. Outer—4.2, viz.: Stockwell, 3.5; Brixton, 4.9; Herne Hill, 4.4; Tulse Hill, 4.5; Norwood, 3.2. 2. Registration Sub-Districts— Inner—8.5, viz.: Lambeth Church, 9.3; Kennington, 9.04; Inner Stockwell, 6.6. Outer—4.2, viz.: Outer Stockwell, 3.5; Brixton, 4.7; Norwood, 3.8. Borough of Lambeth=6.03. The corresponding death-rates from (a) tuberculosis of the lungs (consumption) and (b) tuberculosis (all forms) per 1,000 of the population living are for the Registration SubDistricts as follow:— (a) Tuberculosis of the lungs (consumption)— Inner 1.7,* viz.: Lambeth Church, 1.8; Kennington, 2.1; Inner Stockwell, 1.2. *In calculating these 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. 69 Outer—0.9,* viz.: Outer Stockwell, 1.2; Brixton, 1.1; Norwood, 0.6. Borough of Lambeth=1.3. (b) Tuberculosis (all forms)— Inner—2.2,* viz.: Lambeth Church, 2.4 Kennington, 2.6; Inner Stockwell, 1.5. Outer—1.1*, viz. : Outer Stockwell, 1.5; Brixton, 1.3; Norwood, 0.7. Borough of Lambeth=1.6. Tuberculosis Dispensaries. During 1912, the Council decided to establish and maintain a Municipal Tuberculosis Dispensary for the Borough. Full particulars will be found under the heading of the Lambeth Municipal Tuberculosis Dispensaries Scheme (pages 79-98). Voluntary Tuberculosis Dispensaries have already been established in the following Metropolitan Districts: Battersea, Bermondsey, Camberwell, Fulham, Kensington, Paddington, Poplar, St. Marylebone, Stepney and Woolwich. 70 71 TABLE Q (I.)— CONSUMPTION NOTIFICATIONS. Notification Certificates (Forms A, B, C and D), received during 1912 quarterly under the Public Health (Tuberculosis) Regulations, 1908. WARDS. Wards. 1912. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1908. 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. Total 1912. Form A. Form B. Form C. Form D. Total. Form A. Form B. Form C. Form D. Total. Form A.. Form B. Form C. Form D. Total. Form A. Form B. Form C. Form D. Total. Medical. Non-Medical. Total. Marsh 11 6 4 1 22 7 3 4 – 14 12 2 5 – 19 8 2 3 – 13 51 17 68 Bishop's 45 14 10 – 69 22 8 16 – 46 17 4 7 – 28 30 10 4 – 44 150 37 187 Prince's 29 24 2 – 55 18 11 8 – 37 13 13 5 – 31 20 26 2 – 48 154 17 171 Vauxhall 16 12 3 – 31 9 4 10 – 23 12 7 5 – 24 22 12 2 – 36 94 20 114 Total Inner Wards 101 56 19 1 177 56 26 38 — 120 54 28 22 – 102 80 50 11 — 141 449 91 540 Stockwell 5 3 2 – 10 1 1 1 – 3 3 3 – – 6 1 1 1 – 3 18 4 22 Brixton 7 7 3 – 17 7 1 2 – 10 4 – 3 – 7 9 1 2 – 12 36 10 46 Herne Hill 5 3 1 – 9 5 5 1 – 11 – 2 – – 2 3 3 1 – 7 26 3 29 Tulse Hill 7 5 2 – 14 2 – 2 – 4 5 3 2 – 10 3 3 – – 6 28 6 34 Norwood 7 1 – – 8 11 1 1 – 13 7 1 1 – 9 5 – 3 – 8 33 5 38 Total Outer Wards 31 19 8 — 58 26 8 7 – 41 19 9 6 – 34 21 8 7 – 36 141 28 169 Borough of Lambeth 132 75 27 1 235 82 34 45 – 161 73 35 28 – 136 101 58 18 – 177 590 119 709 N.B.—15 Re-notifications are included in the above Table. 72 73 TABLE Q (II.)—CONSUMPTION NOTIFICATIONS. Notification Certificates (Forms A, B, C, and D) received during 1912 quarterly under the Public Health losis) Regulations 1908. REGISTRATION DISTRICTS. Registration Sub-Districts. 1912. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS 1908. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total 1912. Form A. Form B. Form C. Form D. Total. Form A. Form B. Form C. Form D. Total. Form A. Form B. Form C. Form D. Total Form A. Form B. Form C. Form D. Total Medical. NonMedical. Total. Waterloo 11 6 4 1 22 7 3 4 — 14 12 2 5 — 19 8 2 3 — 13 51 17 68 Lambeth Church 21 10 3 — 34 12 7 7 — 26 8 4 4 — 16 15 10 4 — 29 87 18 105 Kennington 53 28 9 — 90 28 12 17 — 57 22 13 8 — 43 35 26 2 — 63 217 36 253 Stockwell (Inner) 16 12 3 — 31 9 4 10 — 23 12 7 5 — 24 22 12 2 — 36 94 20 114 Total Inner Districts 101 56 19 1 177 56 26 38 — 120 54 26 22 — 102 80 50 11 — 141 449 91 540 Stockwell (Outer) 5 3 2 — 10 1 1 1 — 3 3 3 — — 6 1 1 1 — 3 18 4 22 Brixton 12 10 4 — 26 12 6 3 — 21 4 2 3 — 9 12 4 3 — 19 62 13 75 Norwood 14 6 2 — 22 13 1 3 — 17 12 4 3 — 19 8 3 3 — 14 61 11 72 Total Outer Districts 31 19 8 — 58 26 8 7 — 41 19 9 6 — 34 21 8 7 — 36 141 28 169 Borough of Lambeth 132 75 27 1 235 82 34 45 — 161 73 35 28 — 136 101 58 18 — 177 590 119 709 N.B.—15 Re-notifications are included 74 75 TABLE Q (III.)—CONSUMPTION NOTIFICATIONS. Notification Certificates received during 1912 (Quarterly) under the Public Health (Tuberculosis in Hospitals) Regulations,1911 Public Health (Tuberculosis in Hospitals) Regulations, 1911. Wards and Registration Sub-Districts. Wards. 1st Q. 2nd Q. 3rdQ. 4th Q. Total 1912. Sub-Districts. 1st Q. 2nd Q. 3rd Q. 4th Q. Total 1912. Marsh 16 14 14 17 61 Waterloo 16 14 14 17 61 Bishop's 33 33 24 26 116 Lambeth Church 26 29 18 22 95 Prince's 28 25 23 20 96 Kennington 35 29 29 24 117 Vauxhall 18 13 21 14 66 Stockwell (Inner) 18 13 21 14 66 Total Inner Wards 95 85 82 77 339 Total Inner Wards 95 85 82 77 339 Stockwell 13 16 16 10 55 Stockwell (Outer) 13 16 16 10 55 Brixton 21 16 30 20 87 Herne Hill 17 11 18 8 54 Brixton 38 27 48 28 141 Tulse Hill 18 4 14 8 44 Norwood 29 16 21 11 77 Norwood 11 12 7 3 33 Total Outer Wards 8o 59 85 49 273 Total Outer Wards 80 59 85 49 273 Borough of Lambeth 175 144 167 126 612 Borough of Lambeth 175 144 167 126 612 N.B.—The Public Health (Tuberculosis in Hospitals) Regulations, 1911, came into force on May 1st, 1911. 76 TABLE Q (IV.)—CONSUMPTION NOTIFICATIONS. Notification Certificates (Forms A & B) received during 1912, quarterly, under the Public Health (Tuberculosis) Regulations, 1911. WARDS. Wards. 1st Qr. Form A. 2nd Qr. Form A. 3rd Qr. Form A. 4th Qr. Form A. Totals 1912. 1st Qr. Form B. 2nd Qr. Form B. 3rd Qr. Form B. 4th Qr. Form B. Totals 1912. Full Totals Forms A & B. Marsh 14 9 8 6 37 1 4 ... 2 7 44 Bishop's 39 24 14 31 108 2 2 ... ... 4 112 Prince's 30 19 21 16 86 3 2 ... 1 6 92 Vauxhall 13 14 6 5 38 1 ... 1 2 4 42 Total Inner Wards 96 66 49 58 269 7 8 1 5 21 290 Stockwell 19 9 4 10 42 ... 2 ... ... 2 44 Brixton 38 22 16 22 98 ... ... ... 2 2 100 Herne Hill 27 9 16 19 71 1 ... ... 1 2 73 Tulse Hill 30 14 9 16 69 2 ... ... 2 4 73 Norwood 14 8 4 13 39 ... 1 ... ... 1 40 Total Outer Wards 128 62 49 80 319 3 3 ... 5 11 330 Borough of Lambeth 224 128 98 138 588 19 11 1 10 32 620 N.B.—The Public Health (Tuberculosis) Regulations, 1911, came into force on January 1st, 1912. 77 TABLE Q (V.) —CONSUMPTION NOTIFICATIONS. Notification Certificates (Forms A & B) received during 1912, quarterly, under the Public Health Tuberculosis) Regulations, 1911. REGISTRATION SUB-DISTRICTS. Sub-districts. 1st Qr. Form A. 2nd Qr. Form A. 3rd Qr. Form A. 4th Qr. Form A. Totals 1912. 1st Qr. Form B. 2nd Qr. Form B. 3rd Qr. Form B. 4th Qr. Form B. Totals 1912. Full Totals Forms A & B. Waterloo 14 9 8 6 37 1 4 ... 2 7 44 Lambeth Church 37 21 13 27 98 2 2 ... ... 4 102 Kennington 32 22 22 20 96 3 2 ... 1 6 102 Stockwell (Inner) 13 14 6 5 38 1 ... 1 2 4 42 Total Inner Districts 96 66 49 58 269 7 8 1 5 21 290 Stockwell (Outer) 19 9 4 10 42 ... 2 ... ... 2 44 Brixton 65 31 32 41 169 1 ... ... 3 4 173 Norwood 44 22 13 29 108 2 1 ... 2 5 113 Total Outer Districts 128 62 49 80 319 3 3 ... 5 11 330 Borough of Lambeth 224 128 98 138 588 10 11 1 10 32 620 N.B.—The Public Health (Tuberculosis) Regulations, 1911, came into force on January1st, 1912. 78 TABLE Q (VI.)—CONSUMPTION RE-NOTIFICATIONS. Re-notification Certificates (Form A) received during 1912—quarterly under the Public Health (Tuberculosis) Regulations, 1908. WARDS AND REGISTRATION SUB-DISTRICTS. Wards. 1st Qr. Form A. Form B. 2nd Qr. Form A. Form B. 3rd Qr. Form A. 4th Qr. Form A. Total 1912. Sub-districts. 1st Qr. Form A. Form B. 2nd Qr. Form A. Form B. 3rd Qr. Form A. 4th Qr. Form A. Total 1912. Marsh ... ... 1 ... ... 1 2 Waterloo ... ... 1 ... ... 1 2 Bishop's 7 ... ... ... ... 1 8 Lambeth Church 1 ... ... ... ... 1 2 Prince's ... ... ... ... ... ... ... Kennington 6 ... ... ... ... ... 6 Vauxhall 3 ... ... ... ... ... 3 Stockwell (Inner) 3 ... ... ... ... ... 3 Total Inner Wards 10 — 1 — — 2 13 Total Inner Districts 10 — 1 — — 2 13 Stockwell ... ... ... ... ... ... ... Brixton ... ... ... ... ... ... ... Herne Hill 1 ... ... ... ... ... 1 Stockwell (Outer) ... ... ... ... ... ... ... Tulse Hill 1 ... ... ... ... ... 1 Brixton 1 ... ... ... ... ... 1 Norwood ... ... ... ... ... ... ... Norwood 1 ... ... ... ... ... 1 Total Outer Wards 2 – – – – – 2 Total Outer Districts 2 – – – – – 2 Borough of Lambeth 12 ... 1 ... ... 2 15 Borough of Lambeth 12 ... 1 ... ... 2 15 79 LAMBETH MUNICIPAL TUBERCULOSIS DISPENSARIES SCHEME. The State Campaign against Tuberculosis has drawn public attention to the disease, and the Borough Council, after considering the whole subject, came to the decision on July 25th, 1912, that the establishment and maintenance of a Municipal Tuberculosis Dispensary* for the Borough for the prevention and treatment of Tuberculosis would prove of advantage, and instructions were given to the Public Health Committee to bring up the necessary scheme and estimates, which were afterwards finally approved by the Council on October 3rd, 1912. The Scheme was generally approved on October 30th, 1912, by the Local Government Board, to whom plans and detailed particulars and estimates were submitted. The details of the Scheme, as approved were as follow:— 1. The Borough Council to provide, and be responsible for the maintenance of, the Lambeth Tuberculosis Dispensary Scheme, as a Municipal undertaking, in accordance with the suggestion of the "Astor" Departmental (1912) Committee on Tuberculosis (Interim Report). 2. The Tuberculosis Dispensary to be available for the whole of the inhabitants of the Borough, and, if and when approved by the Local Government Board, to be used also by the London County Insurance Committee and the Lambeth Local Insurance Sub-Committee, with the consent of the National Insurance Commissioners, for the purpose of administering, as required, "sanatorium" benefit under the National Insurance Act, 1911, for "insured" persons residing within the Borough. *Tuberculosis Dispensaries (for medical treatment and advice) may be provided by Metropolitan Sanitary Authorities out of the Rates under the powers given by the Public Health (London) Act, 1891, section 75. 80 3. The Tuberculosis Dispensary to be the centre of prevention, detection, and treatment of the disease, and of the education of the inhabitants of the Borough in the nature of the disease, its detection in the early stages being especially important. 4. The Tuberculosis Dispensary to be a receiving house and centre of diagnosis and curative treatment (both tuberculin injections and other equally important methods), as well as a clearing house for the (a) sending off of all persons suffering from tuberculosis within the Borough to institutions (sanatoria or hospitals), or (b) arranging for their domiciliary or dispensary treatment (including tuberculin treatment), as may be found necessary and practicable—not only "insured" persons under the National Insurance Act, 1911, by agreement with the National Insurance Commissioners, and the London County Insurance Committee, but also noninsured persons. 5. The Tuberculosis Dispensary to be linked up to existing public health and medical work of the Borough Council, so as to both supplement and centralise generally the public health administration of the Borough, the Tuberculosis Dispensary to be regarded as a central tuberculosis institution or clinic. 6. The Tuberculosis Dispensary to work, as far as practicable, in relationship and sympathy with the general medical practitioners practising within the Borough, more especially in regard to the domiciliary treatment of tuberculosis in "insured" persons under the National Insurance Act, 1911, as laid down in the General Order of the Local Government Board of 26th July, 1912, under such conditions and terms, as to fees, etc., as the National Insurance Commissioners and the Insurance Committees may decide. 7. The main Dispensary Building to be placed centrally within the Borough, near to the Town Hall, the Council's Health Department, and the Borough Bacteriological Laboratory, for the use of the Inner and Outer Wards, and arrangements to be made, if found to be necessary and otherwise practicable, for the additional use of the Inner Wards with (a) a Tuberculosis Out-patient Department of St. Thomas' Hospital, separate and distinct (administratively and otherwise) 81 from the Hospital, or (b) the Tuberculin Dispensary, situated at 263 Kennington Road, such premises, if used at all, to be used as branches (but only as branches) of the main Central Municipal Tuberculosis Dispensary and the Lambeth Borough Tuberculosis Scheme, and to be under the administrative control of the Council. 8. The main Central Dispensary building to consist of (1) two consulting-rooms, (2) two dressing-rooms, (3) one waiting-room, (4) dispensing or medicine room, and (5) caretaker's rooms. 9. The Dispensary Staff to consist of— (a) A whole-time Chief Executive Officer (administrative); N.B.—It is proposed to appoint the Medical Officer of Health of the Borough to the position of Chief Executive Administrative Officer, and to make him responsible to the Borough Council for the general administration and local execution of the Borough Tuberculosis Dispensary Scheme, with administrative control of the Central Dispensary and the Branch Dispensaries (if any); (b) A whole-time Tuberculosis Officer (clinical); N.B.—It is proposed that the Tuberculosis Officer (clinical) shall be attached to the Medical (Public Health) Department of the Council, shall act under the administrative control of the Medical Officer of Health (except as regards clinical work), shall receive a commencing salary of 300 per annum, and that his duties shall be such as appertain to such an officer, viz., (1) acting as consulting and diagnosing officer for the Dispensary and the Borough, assisting medical practitioners practising within the Borough in diagnosis and methods of treatment, if and when required; (2) treating cases, if necessary, and as required, at the Dispensary, especially those needing skill and experience (e.g., tuberculin injections; (3) visiting infected houses, with a view to discovering (a) unsuspected cases of the disease, e.g., "contacts," 82 pects," or "infects"; and (b) insanitary conditions, but not for the purpose of treatment, except at the request and with the consent of the medical practitioner in attendance, or, failing such a medical practitioner being in attendance, of the Medical Officer of Health; (4) acting as "Consulting Officer (tuberculosis)" of the Dispensary (when and if approved by the Local Government Board) under the General Order of the Local Government Board (Domiciliary Treatment of Tuberculosis) of 26th July, 1912, in regard to "insured" persons under the National Insurance Act, 1911, with the consent of the National Insurance Commissioners and the London County Insurance Committee; (c) A trained nurse, with special experience in tuberculosis work, and subject to the conditions of service approved by the Association for the conduct of nurses engaged by Nursing Associations; (d) A dispenser, properly qualified to carry on the business of a chemist and druggist under the provisions of the Pharmacy Act, 1868, as amended by the Poisons and Pharmacy Act, 1908, and duly registered with the Pharmaceutical Society. N.B.—In the event of general medical practitioners not dispensing their own medicines, arrangements may be made with a local chemist or chemists for this purpose, at fees to be decided upon after consultation with the Pharmaceutical Society—"drugs and medicines" to include such appliances as shelters, beds, etc., and such foods as milk, eggs, etc. ; (e) A clerk, qualified in shorthand and typewriting, for correspondence and statistical work (card index and otherwise); (f) A caretaker. 83 10.* Treatment (advice and medicine) at the Dispensary to be free, but registered general medical practitioners to have the power of recommending patients to the Dispensary for treatment, but no patient to be treated thereat if it be found on enquiry that such patient is able to pay for attendance, and is, at the time, or has recently been, under the care of a registered general practitioner, without the consent of such practitioner, or of the Medical Officer of Health. 11. The Dispensarv to work in close co-operation with all organisations and societies (voluntary or otherwise). 12. The Dispensary to be open at times suitable for the attendance of the working classes for the examination and treatment of all who come, or are sent, under the conditions and restrictions stated above. The following extracts from the Interim Report of the Departmental Committee on Tuberculosis bear upon the subject:— Interim Report of the Departmental Committee on Tuberculosis. (1) The anti-tuberculosis campaign scheme should provide for the detection and treatment of the disease, whilst existing knowledge of the disease must be increased by research. (Paragraph 4.) (2) The first unit in the scheme is the Tuberculosis Dispensary, and this unit must work in intimate relationship with the second unit of the scheme, viz., hospitals, sanatoria, farm colonies, open-air schools, etc. (Paragraphs 18 to 24.) (3) Special and systematic attention is to be paid to children, childhood affording an excellent period for detecting and dealing with the disease. (Paragraph 29.) *Clause No 10 shall not apply to "insured" persons under the National Insurance Act, 1911, referred to the Dispensaries by the Insurance Committee under arrangements with the Borough Council. 84 (4) Tuberculosis Dispensaries should be provided by the Metropolitan Borough Councils in so far as London is concerned. (Paragraph 34.) (5) With a view to encouraging the early provision and equipment of Tuberculosis Dispensaries, capital grants should be made up to four fifths of the amount required, provided that this sum should generally not exceed £1 per 750 population area, or an average of £240 per dispensary, and that for the provision of the additional sanatorium beds for adults required at the outset, capital grants should be made up to three-fifths of the cost per bed, provided that the total amount does not exceed an average of £90 per bed. (Paragraph 41.) (6) Special regard should be given for securing the co-operation of medical practitioners in working the scheme, particularly in relation to the early detection of the disease and its domiciliary (home) and dispensary (institutional) treatment. (Paragraph 42.) Arrangements have been satisfactorily and advantageously completed with St. Thomas' Hospital (Out-Patients' Department) for the establishment and maintenance there by the Hospital Authorities of a Branch Dispensary at the expense of the Hospital Governors, whilst the Central Dispensary is to be established and maintained by the Borough Council out of the Rates, at 73 Effra Road, Brixton, S.W., the premises being taken on Xovember 21st, 1912, for a period of 5 years from December Quarter at a rent of £45 per annum, to be structurally altered and equipped for the purpose. In this way, the Borough will be provided with two properly-equiped and officered Dispensaries (both for diagnosis and treatment), the Tuberculosis officers being 85 whole-time officers appointed by the Council (for the Central Dispensary) and by the St. Thomas' Hospital Governors (for the Branch Dispensary) respectively.* The Medical Officer of Health of the Borough is the Chief Executive Tuberculosis Officer responsible to the Borough Council for the general administration and local execution of the Scheme, with executive control over the Dispensaries and both Tuberculosis Officers act under his supervision, except in so far as clinical duties are concerned. N.B.—The Branch Dispensary is primarily intended for the treatment, on application, of all persons suffering from tuberculosis, or suspected tuberculosis, and living within the Inner Wards, or northern, half of the Borough, viz.: Marsh, Bishop's, Prince's and Vauxhall Wards; but is available also for all other persons suffering from tuberculosis, or suspected tuberculosis, and living within the Outer Wards, or southern half of the Borough, viz.: Stockwell, Brixton, Heme Hill, Tulse Hill, and Norwood Wards, on application by the Borough Council, through the Medical Officer of Health. The arrangement come to with the St. Thomas' Hospital Authorities for a Branch Dispensary in connection with the Out-Patient Department should prove of value to the inhabitants of the Borough, who will not only have the advantage of the professional skill and advice of the medical and surgical staffs (in consultation and otherwise), but also the use of the most modern and up-to-date chemical, pathological and bacteriological laboratories connected with the Hospital. Further, certain beds will also be reserved and be available at the Hospital for the purpose of observa- * Dr. Nicol Galbraith. m.b , b.c.h., d.p.h., has been appointed by the Council and is attached to the Public Health Department with charge of the Central Dispensary, and Dr. Rodolph Charles Wingfteld, b.a., m.b., b.ch. (oxon.) m.r.c.s., l r.c.p., by the St. Thomas's Hospital Governors, and is attached to the Medical Staff of the Hospital. 86 tion and treatment of suitable cases connected with tuberculosis. Financially, too, the arrangement come to should prove of advantage to the Borough, affecting a considerable saving. The subjoined letter from St. Thomas' Hospital crystalises the arrangements come to:— Treasurer's Offices, St. Thomas' Hospital, S.E. November 21st, 1912. Dear Sir, I beg to acknowledge the receipt of your letter of the 16th inst., and, having placed this before the meeting of my Committee, I am able to reply officially to your previous communications of the 18th and 19th October, and to the points which were raised at the informal conference which took place on the 29th ultimo between yourself and representatives of the Governors and Staff of St. Thomas' Hospital, as well as the various points which have been raised in interviews between you and myself. The Governors are prepared to associate themselves with the Lambeth Tuberculosis Dispensary Scheme, and, in connection with such Scheme, to establish and maintain, as suggested, a Branch Dispensary in connection therewith. The St. Thomas' Hospital Tuberculosis Department will be separate and distinct from the main Outpatient Department of the Hospital, and a whole-time Medical Tuberculosis Officer will be appointed to the Department at a salary of £500 per annum. The Governors of the Hospital will be responsible for all the expenses connected with the establishment and maintenance of this Department. This Branch Dispensarv will be under the control of the Governors and Staff of St. Thomas' Hospital, and independent of control of all outside bodies except such administrative control as devolves on you as Medical Officer of Health of the Borough of Lambeth 87 and Chief Executive Tuberculosis Officer of the Lambeth Municipal Tuberculosis Scheme. With reference to the various points to which you called attention:— (1) The Governors agree that the Branch Dispensary at St. Thomas' Hospital shall be worked in close relation to the general health administration of the Borough of Lambeth as regards tuberculosis, and, in accordance with your suggestion, will entirely serve the Inner Wards of the Borough of Lambeth, namely, Marsh, Bishop, Prince's and Vauxhall. (2) The Branch Dispensary will be open for the treatment of all persons, both those insured under the National Insurance Act, 1911, and those not so insured living within the Inner Wards of the Borough of Lambeth namely, Marsh, Bishop, Prince's and Vauxhall, and will be available for other persons living in other parts of the Borough of Lambeth on application by the Borough Council through the Medical Officer of Health, and, further, will be available for the treatment of all other suitable persons who may present themselves for treatment at St. Thomas' Hospital. (3) The St. Thomas' Hospital Medical Tuberculosis Officer will not visit houses in the Borough of Lambeth for the purposes of treatment, but will be available for consultation and diagnosis on application being made for his services by the Medical Officer of Health or medical practitioners practising within the Borough of Lambeth in connection with Tuberculosis Dispensary cases. (4) The services of St. Thomas' Hospital Consulting Staff will be available if requisitioned by the Medical Tuberculosis Officer of the St. Thomas' Hospital Tuberculosis Branch Dispensary. (5) There will be beds available in St. Thomas' Hospital for the treatment of suitable cases admitted by the St. Thomas' Hospital Medical Tuberculosis Officer. 88 (6) The Dispensary at St. Thomas' Hospital being approved by the Local Government Board as a Branch Dispensary of the Lambeth Municipal Tuberculosis Scheme, will be a recognised centre for the treatment of Tuberculosis. For some years past the authorities of St. Thomas' Hospital have devoted the utmost care to the treatment of cases of Tuberculosis, and the medical staff responsible for the clinical treatment have received most valuable assistance from the skilled staff of the highly-equipped laboratories of the Hospital; those laboratories will be available under the scheme. It is, further, the object of the Governors and the Staff to devote the full resources of the Hospital to secure the utmost efficiency in treating all patients who may attend in the St. Thomas' Hospital Tuberculosis Department. Yours faithfully, (Signed) G. Q. Roberts, Secretary. Dr. Priestley, Medical Officer of Health, Town Hall, Lambeth, S.W. This letter was submitted to the Local Government Board and approved bv them on December 20th, 1912, subject to the arrangements being properly related to the Public Health work and to the general scheme of the Borough for the treatment of persons suffering from tuberculosis. The Board afterwards approved of the appointment of Dr. Rodolph Charles Wingfield, B.A., M.B., B.CH. (Oxon)., M.R.C.S., L.R.C.P., by the St. Thomas' Hospital Governors as Tuberculosis Officer to the St. Thomas' Branch (Lambeth) Dispensary and Tuberculosis Department, and his qualifications are set out in the following letter:— Treasurer's Office, St. Thomas' Hospital, S.E. 16th January, 1913. Dear Sir, I beg to inform you that at a meeting of the Grand Committee of the Governors of this Hospital 89 day afternoon, Rodolph Charles Wingfield, B.A., M.B., B.CH. (OXON), M.R.C.S. ; L.R.C.P. ; was appointed Medical Officer in charge of the Tuberculosis Department at St. Thomas' Hospital. Dr. Wingfield is 27 years of age. He took his B.A. at Oxford in July, 1907, taking honours in Physiology. He began his work at the Hospital in October, 1908, and has been at work here ever since. He has held the position of House Physician to Dr. Hawkins, Assistant Demonstrator of Morbid Anatomy, Assistant Director of the Pathological Laboratories, and Pathologist responsible for post-mortem examinations on two days every week, with the demonstration of post-mortem methods and morbid anatomy to students. Since February, 1912, he has been the Louis Jenner Research Scholar. The Governors were induced to make this appointment by the unanimous report of the Medical Staff of this Hospital that, in their opinion, Dr. Wingfield was a man of commanding ability, with an accurate knowledge of clinical methods, and a thorough training in the application of bacteriology to the diagnosis and treatment of patients suffering from tuberculosis and other diseases. The Staff expressed the opinion that Dr. Wingfield was especially suitable for the post for which he was an applicant. Dr. Wingfield is prepared to take up the work at once, and such hours of work will be arranged by the Governors as will make the Department most useful to the patients who may be referred to it for treatment. The particular part of the Hospital which has been set apart for the special Tuberculosis Department is now ready in all respects for the reception of patients, and the treatment of the individuals can be undertaken as soon as the recognition of the Lambeth Scheme by the Local Government Board has been secured. Yours faithfully, G. Q. Roberts, Secretary. Dr. Priestley, Medical Officer of Health, Town Hall, Lambeth, S.W. 90 It must not be lost sight of that great advantage must accrue to the St. Thomas' Hospital Medical School by the establishment of this Branch Dispensary in connection with the Hospital Out-Patient Department. Sanatorium Benefit.* The "Sanatorium Benefit" under the National Insurance Act, 1911, came into force on July 15th, 1912, and has an important bearing upon the work proposed to be carried out throughout the Borough for the purpose of preventing and treating tuberculosis. The "Sanatorium Benefit" includes home or domiciliary treatment, as well as the provision and maintenance of (a) dispensaries, (b) sanatoria, (for the open-air treatment of early cases), and (c) other institutions, comprising (1) hospitals for acute cases, (2) convalescent homes, open-air schools and "atter-care" working colonies, and (3) homes for the incurable. The domiciliary, or home treatment, and the provision and maintenance of dispensaries fall to the City and Borough Councils, alone or in conjunction, whilst the other institutions will have to be provided and maintained for the whole of the County of London, by some Central Body, e.g., Metropolitan Asylums Board, London County Council, etc. These institutions will be fed by the dispensaries where the cases of tuberculosis will be classified and selected for treatment as required. In this way the dispensaries are "clearing," "sifting," or "classifying" organisations and centres of observation, diagnosis and treatment. Suspicious cases are also dealt with at the dispensaries, where they are sent as the result of domiciliary visiting—the so-called "suspects," "contacts" or "infects," or patients in the early stages of the disease when they are not likely to be notified in the ordinary way under the Public Health (Tuberculosis) Regulations. Lastly, the dispensaries will * Vide L.G.B. letters of Dec., 1910, and Nov. 16th, 1911. 91 also act as information bureaus and general educational centres for tuberculosis and must work in association with, all (a) voluntary organisations, (b) existing general dispensaries (treating tuberculosis patients), (c) special dispensaries (for inoculations with tuberculin), and (d) hospital out-patient (tuberculosis) departments—as off-shoots of the general Scheme, which must have the sympathy and approval of the Medical Profession. It is important to note that "sanatorium benefit" does not necessarily mean removal to a sanatorium, but may take the form of treatment at home or at a tuberculosis dispensary or by any other method that may be suitable to the medical needs of a patient. The following extracts from the National Insurance Act, 1911, ("Sanatorium Benefit") bear upon the subject:— National Insurance Act, 1911 ("Sanatorium Benefit"). (1) "Sanatorium Benefit" is defined to mean treatment of insured persons in sanatoria, or other institutions, or otherwise, when suffering from tuberculosis, or such other diseases as the Local Government Board, with the approval of the Treasury, may appoint, and power is given to extend this "sanatorium benefit" to the dependants of insured persons. (Sections 8 (1b) and 17 (1).) (2) An Insurance Committee has been formed for the County of London (with a proportion of women members) for making the necessary arrangements for providing the "sanatorium benefit." (Section 59 (1 and 2).) (3) District Insurance Committees for Metropolitan Boroughs are to be established, one for each Borough. (Section 59 (4).) (4) All necessary arrangements are to be made for providing for the treatment of insured persons (a) in and (b) otherwise than in, sanatoria, or other institutions, and for that purpose agreements may be made with persons or Local Authorities (other than Poor Law Authorities) having the management of sanatoria or other institutions approved by the Local Government Board or undertaking such treatment in a manner approved by the Local Government Board. (Section 16 (1).) 92 (5) The expenditure incurred in providing the "sanatorium benefit" is to be defrayed through the Insurance Commissioners and Insurance Committees by a grant of Is. 3d. per annum for each insured person, and by a further grant of Id. per annum for each such person from a Parliamentary grant, though, in this latter case the whole or any part may be retained by the Commissioners for the purpose of research. (Section 16 (2).) (6) Special financial arrangements (as a temporary provision pending the Act getting into proper working order) have already been made by which each Insurance Committee has been credited with the sum of about ^,4 5s. per 1,000 of the total population of its area, as from the commencement of the Act (15th July, 1912), for the expenditure necessary to provide such treatment for consumptives as can be given during the first six months of the Act being in force, viz., from 15th July, 1912, to 15th January, 1913, it being thought by the Commissioners that, during that period, the amount of money available will be less than the amount which would be available in a similar period after the Act is in full operation. (Memorandum dated 6th July, 1912, No. 112, of the National Insurance Commissioners.) Financial Considerations. A sum of 1/3 for each insured person per annum is allowed to the Insurance Commissioners and the Insurance Committees under the National Insurance Act, 1911, together with an extra Id. (Parliamentary Grant) for each insured person per annum; and, from the commencement of the Act (i.e., July 15th, 1912), a sum equivalent to about 5s. Od. per 1,000 of the total population of its area has been credited to each Insurance Committee, to cover the necessary initial expenses connected with the treatment of consumption during the first six months of the working of the Act, viz.: July 15th, 1912, to July 15th, 1913. As 93 far as the Lambeth area (i.e., Borough) is concerned, taking the estimated population (middle 1912) at 297,550 (297,000 in round numbers), and taking-, as an estimate, one-third* of this population as representing the "insured" persons, viz., 99,000, the sum of 1/3 allowed for each "insured" person per annum, should bring in (approximately) £"6,187, plus whatever proportion may be allowed from the Id. Grant (Parliamentary); whilst the amount credited to the Lambeth area for the first six months' initial working of the Act (July 15th, 1912, to January 15th, 1913) should be (approximately) 1,262, allowing £4 5s. Od. per 1,000 of the total population. Of the annual sum £,6,187 (estimated), it is reasonable to assume that £1,000 (a sixth) will be ear-marked for dispensary purposes, including domiciliary visiting, i.e., for purely local purposes. These estimates are, of course, for all purposes of "sanatorium benefit" under the National Insurance Act, 1911, and will include sanatoria, homes, hospitals, "aftercare" colonies, etc., as well as dispensaries and domiciliary visiting, and the grants will be paid through the County Insurance (London) Committee, who will retain certain money for their own uses (administrative and otherwise), transferring the balances to the different Metropolitan Borough and City Councils, with the approval of the Insurance Commissioners. It must be remembered that these estimates are for "insured" persons under the Act†— a third (estimated) only of the population, and that the Borough Council as the Sanitary or Public Health Authority must provide for similar treatment and benefits for the *This estimate is probably below the actual numbers, seeing that "insured" persons under the Act include all persons between 16 and 70 years of age, whose incomes do not exceed ,£160 per annum, and all manual workers of the same age period whatever their incomes. †Power is given under the National Insurance Act, 1911, to include the dependents of " insured " persons (sect. 8 (lb) and 17 (1)). 94 remaining two-thirds (estimated) of the population: otherwise, it would be a reflection upon the Borough Council's administration. It may be added that the Central Fund for the Promotion of the Dispensary Scheme for the Prevention of Consumption in London gives subsidies or grants* to Local Authorities connected with the establishment and maintenance of tuberculosis dispensaries provided such dispensaries are managed on voluntary lines so as to foster local effort and not to add to the demands made on the ratepayers. It may be that voluntary contributions will cease, or tend to become diminished, in amount, when the Insurance Act gets into working order. The Charity Organisation Society also is doing good work amongst the adult poor by providing, voluntarily, sanatorium treatment, making, at the same time, provision for the families of the workers whilst away and arranging for patients' "after-care" on their return. The Estimates approved on October 3rd, 1912, by the Council for the Borough Municipal Tuberculosis Dispensary (the Central Dispensary) were:— (a) For Establishment!, ;£200—£100 for alterations, furniture and fittings, and £100 for apparatus and appliances. (b) For annual maintenance, £671. *Subsidies or grants already paid vary from £260 for Marylebone (a rich district) to ^1000 to Stepney la poor district). †The Departmental Advisory Committee recommend ihe making of capital grants by the Local Government Board up to four-filths of the amount required with a view to encouraging the early provision and equipment of tuberculosis dispensaries, and this recommendation has been accepted by the Local Government Board, subject to the consent of the Treasury. 95 Alternative estimates for maintenance and up-keep per annum were submitted to the Council as follow :— A (Medical Officer s) B (Public Health Committee's) £ £ Rent 60 45 Rates and Taxes, Ligh Water and Fuel 40 30 Sundries 20 20 Medical Tuberculosis Officer 500 300 (Commencing) (Commencing) Trained Nurses 160 (two) 80 (one) Caretaker 50 50 Clerk 50 26 (boy clerk 10/rises to 20/- per week.) Medicines, &c. 100 100 Renewal of Apparatus 20 20 £1000 £671 As regards the necessary dispensing, it is proposed to make arrangements with a local chemist or chemists. The Report of the Medical Officer of Health, which led to the adoption by the Council of the Scheme, is as follows : Report. In the forthcoming State campaign against consumption, sanatoria will form a part of the scheme an important part, but only a part—and other organisations will be necessary if the campaign is to be successful. 96 A sanatorium is an institution chieflv for the openair treatment or hygienic treatment, of consumption —a place where the patients enjoy the best natural conditions (i.e., sunlight and fresh air), together with proper and suitable food, clothing, rest and graduated exercise. Tuberculin injections, or inoculations, would be used as required, at the sanatorium, under medical advice. Such lines of treatment are of the greatest value in connection with early cases of consumption, but, whilst such treatment may also benefit somewhat the advanced cases, the results are not anything like as satisfactory and there is the obvious drawback to "early" and "advanced" cases being treated together in the same institution. Further, another value of the sanatorium is the educational one, more especially to the patients themselves, showing them how disease can be prevented by simple means—not only prevented from infecting other persons, but also prevented from re-infecting the patients themselves. The early cases of consumption are practically the only suitable ones for sanatorium treatment, and other institutions (e.g., hospitals and infirmaries) connected with, and affiliated to, the sanatoria, are consequently necessary for dealing with the advanced cases, which are unsuitable in the majority of instances for open-air treatment, but which would derive benefit from a treatment based upon the same principles of proper and suitable food, clothing, rest, and graduated exercise, etc. The existing hospitals and infirmaries are best suited for the treatment of these advanced cases. No curative treatment has, at present, been found for dealing with these advanced cases, which pass on from bad to worse until death; but such advanced cases must be carefully segregated, as they are the most infectious to others living in the same house. It becomes necessary, therefore, that measures should be adopted whereby consumptive patients can be classified and suitable cases sent to the sanatoria for sanatorium-treatment and suitable cases sent to the hospitals or infirmaries for hospital and infirmarytreatment. To make such measures successful, a Tuberculosis Dispensary is necessary, an institution. 97 primarily established for the examination and treatment (including' tuberculin injections or inoculations) of patients suffering from consumption, but chiefly useful in the discovering of cases in the early stages of the disease—the so-called "contacts," by the Medical Officers and Nurses or Health Visitors, who, as part of their routine duties, would visit the homes of the patients. In other words, it is from the Tuberculosis Dispensaries that the sanatoria and the hospitals or infirmaries would be fed: indeed, a Tuberculosis Dispensary may best be described as a "sifting" or "classifying" organization. Compulsory notification of the disease is, of course, an absolute necessity, so as to bring to light the foci wherein such disease lurks, but, naturally, the information obtained from such compulsory notification must be regarded as strictly private and confidential, and the greatest tact must be exercised in connection with any visits that may be paid officially to the homes of the notified patients. There is no doubt that (1) consumption is, to a limited extent, an infectious disease, (2) that its spread to others can be prevented by simple measures, and (3) that the disease itself can be arrested, or even cured, if its nature is recognized early, and if proper means are taken for its treatment. These are three facts that cannot be too widely known, and patients who have, unfortunately, contracted the disease should not be allowed to become despondent and to regard their cases as hopeless, but, on the other hand, should be encouraged to regard their disease as curable. Tuberculosis Dispensaries are also of value educationally in the same way, but not to the same extent, as Sanatoria are, whilst the leaflets, dealing with simple precautionary measures, that would be distributed broadcast, would assist in the dissemination of simple knowledge as to the nature and prevention of the disease. The Borough of Lambeth is a wide area, and a large number of consumption cases occur annually. A Tuberculosis Dispensary, in my opinion, is therefore necessary, and should be established at an early date, either (1) bv the Council, as the Sanitary Authority, under the Public Health (London) Act, 1891, or (2) by voluntary effort and subscription. If this latter method be adopted, T would suggest the calling of a D 98 Town's Meeting by the Mayor, for the purpose of considering the establishment and maintenance of Tuberculosis Dispensaries for the Borough of Lambeth. Joseph Priestley. January 22nd, 1912. Sanatorium and Hospital Accommodation for Consumption. No arrangements have yet been made by the Borough Council within the Borough for any sanatorium or hospital accommodation in connection with early, intermediate or advanced cases of consumption (phthisis), nor has the Borough Council provided for the use of patients portable open-air shelters, or tents, in suitable cases, the Council being of opinion that, in all such cases as require sanatorium or hospital accommodation, any arrangements that are made should be made by a central authority, e.g., the Metropolitan Asylums Board, for the whole of the County of London. Poor Law cases (advanced cases) are removed to the Poor Law Infirmary by the Guardians' officers as required, and pocket spittoons are provided for patients on application by the Borough Council. No provision has, so far, been made by any Metropolitan Borough, apart from the Poor Law, for the institutional isolation and treatment of advanced and incurable cases, but 5 Boroughs have made arrangements with the Authorities of certain open-air sanatoria for the provision of beds for selected consumptive cases, though in no instance have more than 10 beds altogether been allocated to the requirements of any one Borough. Such accommodation is inadequate in amount. Under the National Insurance Act, proper provision is required for the "Sanatorium benefits." National Insurance Act, 1911—Lambeth Local Sub-Committee. A local Lambeth Sub-Committee was appointed during 1912 temporarily (10 members), for the immediate administration of the "Sanatorium Benefit" and the Chairman of the Public Health Committee and the Medical Officer of Health, (ex-officio) were appointed to serve thereon as the Council's representatives. The Sub-Committee was appointed pending the appointment of the District Committee under Section 59 of the National Insurance Act, 1911. 99 The 20 deaths from venereal affections (syphilis, etc.), are the only other point calling for note in the class 01 zymotic diseases. Classes 11. and III.—Parasitic and Dietetic Diseases. 23 deaths were registered from chronic Alcoholism, but 4 from Delirium Tremens. Class IV.—Constitutional Diseases. Of the total 930 deaths under this class 371 were due to Cancer, 381 to Phthisis, and 99 to Tubercular Meningitis and other forms of Tuberculosis. Class V.—Developmental Diseases. The total number of deaths in this class was 346, consisting of 124 from Premature Birth, 176 from Old Age, and 11 from Atalectasis and 35 from Congenital Malformations. Class VI.— Local Diseases. 1. Diseases of the Nervous System caused 341 deaths, including 12 from Convulsions, 193 from Apoplexy, and 14 from Epilepsy. 2. 553 deaths were due to diseases of the Circulatory System. 3. The diseases of the Respiratory Organs caused 763 deaths (361 from Bronchitis and 120 from Pneumonia, 141 from Broncho-Pneumonia, and 62 from Pleuro-Pneumonia). d2 100 4. Diseases of the Digestive Organs caused 210 deaths, of which 18 were due to Enteritis, 10 to Peritonitis, 69 to diseases of the Liver, 16 to Dentition, and 13 to Appendicitis. 5. Diseases of the Urinary System caused 161 deaths. 6. Diseases of the Reproductive System, Integumentary System, Locomotive System, Lymphatics, Organs of Special Senses, and Gland-like Organs of uncertain use, caused together 66 deaths. Class VII.—Deaths from Violence. 151 deaths in all, including 115 from Accidents or Negligence, 15 from Burns and Scalds, 8 from Drowning, 9 from Suffocation in Bed (all infants under 1 year), 34 from Suicide and 2 from Homicide (1 manslaughter and 1 murder). Class VIII.—Other Causes. 87 deaths were registered in this class, consisting of deaths from Dropsy, Tumours, Haemorrhages, Debility, Atrophy and Inanition, or other ill-defined or non-specified causes. Different rates of mortality from different diseases and groups of diseases are given in terms of the total deaths (corrected or uncorrected) in Tables R and S; whilst Table R gives also the deaths from the chief Infantile Diseases, expressed in terms of the Infantile population (or Number of Births). Allowing for the slight differences between the corrected and uncorrected death returns, it will be noted that, in regard to both infantile and other diseases Lambeth again compares favourably with London. 101 TABLE R. Shewing Classification of Causes of deaths (corrected) in the Borough of Lambeth during 1911 and 1912. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease. Borough. 1911. Borough 1912. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). I.—Zymotic Diseases 680 15.5 384 9.8 Seven Principal 569 12.9 287 7.3 Influenza 40 0.9 40 1.02 II.—Parasitic 1 0.02 1 0.02 III.—Dietetic 21 0.5 32 0.8 IV.—Constitutional 942 21.5 930 23.7 Cancer 333 7.6 371 9.4 Phthisis 384 8.8 381 9.7 Tubercular Diseases, excluding Phthisis 138 3.2 99 2.5 Rheumatism (Acute and Chronic) and Gout 29 0.7 19 0.5 V.—Developmental 344 7.9 346 8.8 Old Age 171 3.9 176 4.5 VI.—Local Diseases 2681 40.8 1994 50.8 Circulatory System 525 11.9 453 11.5 Bronchitis 334 7.6 361 9.2 Pneumonia and BronchoPneumonia 317 7.2 261 6.6 Pleurisy and Pleuro-Pneumonia 83 1.9 84 2.1 Respiratory System, excluding Phthisis 788 17.9 7631 19.4 VII.—Violence 166 3.8 151 3.8 Suicide 30 0.7 34 0.9 VIII.—Other Causes 145 3.3 87 2.2 102 TABLE R—continued. B.—Deaths (corrected) of Infants under One Year of age from the chief infantile diseases, and from all cause?, expressed in terms of 1000 births (corrected). Borough 1911. Borough 1912. Total Deaths under One Year (Corrected). Proportion to 1000 Births (Corrected).* Total Deaths under One Yeir (Corrected). Proportion to 1000 Births (Corrected).* From all causes 899 123.2 598 86.02 Diarrhœa 249 34.1 64 9.2 Convulsions 21 2.9 11 1.6 Respiratory Diseases 140 19.1 111 15.9 Premature Births 130 17.8 124 17.8 Tubercular Diseases (including Phthisis) 34 4.7 24 3.4 Measles 20 2.7 19 2.7 Whooping Cough 27 3.7 24 3.4 Suffocation in Bed 5 0.7 9 1.3 Enteritis 8 1.1 8 l.l Dentition 8 1.1 8 1.1 *N.R.—The Registrar-General gives the corrected Lambeth births for 1011 and 1912 as 7292 and 6952 respectively. 103 TABLE S. Shewing Classification of Certain Causes of Deaths (uncorrected) in the Borough of Lambeth, during 1911 and 1912 given in percentages of the total uncorrected deaths. A.—Deaths at all Ages. Lambicth. Percentage of total Deaths (uncorrected) 1911. 1912. I. Principal Zymotics 13.7 8.2 Influenza 0.8 0.9 Measles 3.3 2.1 Whooping Cough 1.2 1.1 Diarrhoei and Dysentery (including Cholera) 7.3 2.03 11. Rheumatic Fever and Heart Rheumatism 0.4 0.3 III. Diseases of Circulatory System 11.3 10.4 IV, Bronchitis, Pneumonia and Pleurisy 15.5 16.9 Phthisis 7.8 8.6 V. Injuries 3.6 4.2 B—Deaths under i Year oj Age (per 1000 Births uncorrected). All Causes 113.03 87.5 104 105 TABLE T. Local Government Board Old Table A Table of DEATHS during the year 1912 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Names or Localities adopted for the purpose of the;e Statistics, public in-, stitutions being shewn as At separate localities. ag At all ages Under 1 year. 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Scr'atina Diphtheria Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Krnnrhitis Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. .1 Appendicitis. All other Diseases. Total. Puerperal. Continued. hnteric or Typhoid. Typhus. (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Royal Infirmary (Women and Children) 112 57 14 17 6 4 3 10 1 under 5 ... ... ... ... ... ... ... 2 1 ... 4 ... 1 22 ... ... 2 ... 56 88 5 upwds. ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 ... 1 1 18 24 General Lying-in-Hos pital, York Road . 36 29 ... ... ... 2 5 ... ... under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 28 29 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 5 7 St. Thomas's Hospital 682 93 29 45 71 48 166 178 52 under 5 ... 7 ... ... ... ... ... 1 8 ... 13 ... 3 24 3 ... 13 2 93 167 5 upwds. 1 3 9 ... ... ... ... 3 ... ... 1 ... 11 47 45 ... 41 20 354 515 Remainder of Lambeth Church 399 92 26 15 6 10 59 114 77 under 5 ... ... ... ... ... ... ... ...... 18 12 15 ... 1 27 ... ... 6 ... 54 133 5 upwds. ... ... ... ... 1 ... ... ... 1 ... ... 2 28 72 40 4 27 ... 91 266 Lambeth Workhouse 30 7 ... ... ... ... 1 5 17 under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 7 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 6 12 ... ... ... 5 23 Lambeth Infirmary 705 30 5 5 7 36 159 233 230 under 5 ... ... ... ... ... ... ... ... 1 1 8 ... ... 6 ... ... ... ... 24 40 5 upwds. ... ... 5 ... 2 ... ... 5 ... ... 2 2 152 89 100 ... 20 3 285 665 St. Peter's House 45 ... ... ... ... ... ... 5 40 under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 19 1 2 1 ... 22 45 Remainder of Kennington 421 70 22 20 10 6 61 102 130 Under 5 ... ... ... ... ... ... ... ... 13 7 6 ... 1 34 ... ... 3 ... 48 112 5 upwds. ... ... 2 ... ... ... ... ... ... ... 2 ... 41 80 47 4 15 ... 118 300 South-Western Hospital 142 19 28 43 25 9 14 4 ... Under 5 10 21 ... ... 1 ... ... ... 51 4 ... ... ... 2 ... ... ... ... 1 90 5 upwds. 5 ...18 1 ... 12 1 ... ... 1 ... 1 ... ... 3 3 ... ... ... 7 52 Clapham Maternity 14 14 ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 13 14 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Remainder of stockwell 492 98 25 11 7 11 65 121 154 Under 5 ... .... ... 1 ... ... 1 ... 13 7 5 ... ... 27 2 ... 4 ... 74 134 5 upwds. ... ... 3 ... ... ... ... 3 1 ... ... 2 40 64 54 7 13 ... 171 358 106 107 TABLE T.- continued. Local Government Board Old Table A—continued. Table of DEATHS during the year 1912 in the Borough of Lambeth classified according to Diseases, Ages, and Localities. Mortality from all causes at subjoined Ages. 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. At all ages. Under 1 year. 1 and under j 2. 2 and under 5. 5 and under 15. 15 and under 25 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Scarlatina Diiphtheria Fevers. Cholera. Erysipelis. Meas'es. Whooping Cough. Diarrhœa and Dysentery. Rheumauc Fever Phthisis. Bronchitis. Pnemonia and pleurisy. Heart Disease. Influenza. Injuries. Appendicitis. All Other Deascs. Totals. Puerperal. 'Continued. Enteric or Typhoid. Typhus. (a) (b) (c) (d) (e) (f) (g) (h) (i) j k Belgrave Hospital 101 66 16 12 7 ... ... ... ... Under 5 ... 1 ... ... ... ... ... ... 1 1 17 ... 3 12 ... ... 1 ... 58 94 5 upwds. ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 4 7 Remainder of Brixton 541 84 15 13 14 15 70 122 211 Under 5 ... ... ... ... ... ... ... ... 6 9 6 ... 2 25 1 2 5 ... 56 112 5 upwds. ... ... 1 ... 2 ... ... ... 2 1 ... 2 50 84 50 8 12 1 219 432 Lambeth Workhouse Schools ... ... ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... British Home of Incurables 5 ... ... ... ... ... ... 3 2 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 Remainder of Norwood 461 56 9 8 8 13 50 107 210 Under 5 ... 1 ... ... ... ... ... ... 4 5 4 ... ... 13 ... ... 2 ... 45 73 5 upwds. ... ... ... ... 1 ... ... 1 1 1 ... 2 25 71 74 10 10 3 189 388 Totals 4189 715 189 18 161 154 653 1004 1121 Under 5 10 29 ... 1 1 ... 1 3 116 46 78 ... 11 192 6 2 38 2 557 1093 5 upwds. 6 22 22 ... 18 1 ... 12 6 2 6 11 348 516 430 35 140 28 1493 3096 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among sons belonging thereto | 559 64 31 27 27 28 101 154 127 Under 5 1 3 ... ... ... ... ... ... 17 9 15 ... ... 27 ... ... 2 ... 48 112 5 upwds ... 2 2 ... 1 ... ... 2 1 1 2 2 39 24 67 3 25 4 262 437 Deaths occurring within the district among persons not belonging thereto 823 181 49 68 72 54 163 174 62 Under 5 4 12 ... ... ... ... ... 2 42 3 18 ... 2 34 2 ... 10 2 167 296 5 upwds 4 15 10 ... 7 1 ... 2 1 ... 1 1 15 19 48 ... 44 19 338 525 108 TABLE U. Table of Population, Births and of New Cases of Infectious ol Health, during- the year 1912, in the Borough Diseases and [Local Government Board Old Table B.] Registration Sub-Districts. Population at all Ages. Registered Births 1912. New Cases of Sickness in each to the knowledge of the Medical during Census 1911. Estimated to middle of 1912. 1 2 3 4 5 8 7 scarlatina. Diphtheria Membranous Croup. Fevers. Cholera. IYphoid or Enteric. Continued. Puerperal. (a) (6) (c) (d) Waterloo 47910 46987 2346 39 23 1 3 ... 2 ... Lambeth Church 72 26 ... 3 ... 2 ... Kennington 48609 48091 1311 82 55 ... 16 ... 6 ... Stockweli. 62608 62447 1916 119 82 3 6 1 6 ... Brixton 76650 77044 1465 157 69 1 16 ... 3 ... Norwood 62281 62981 1040 135 73 ... 17 ... 5 ... Totals 298058 297550 8168 604 328 5 61 1 24 ... 109 TABLE U. Sickness, coming to the knowledge of the Medical Officer of Lambeth, classified according to Localities. Locality, coming Officer of Health 1912. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1912. 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Erysipelas. Cerebro-Spinal Meningitis. Poliomyelitis Acuta. Ophthalmia. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Cerebro-spinal Meningitis. Poliomyelitis Acuta. Ophthalmia. Typhoid or Enteric. Continued. Puerperal. 23 1 1 15 39 22 1 2 ... ... ... 8 1 ... 1 19 1 2 7 72 26 ... 3 ... 1 ... 6 1 1 ... 47 2 4 21 79 51 ... 13 ... 4 ... 17 2 2 1 52 2 2 12 111 78 3 6 ... 4 ... 24 1 ... ... 48 ... 1 20 143 59 ... 13 ... 1 ... 14 ... ... ... 27 1 ... 1 119 64 ... 9 ... 3 ... 7 ... ... ... 216 7 10 76 563 300 4 46 ... 13 ... 76 5 3 2 110 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1912. Area of Borough—4,030.4 statute acres (inclusive of land and inland water, but exclusive of tidal water 32.1 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. Population—estimated middle of 1912—297,550 (males 141,990, females 155,560). *Density—72.9 persons per statute acre (including land and inland water, but exclusive of tidal water and foreshore). Rateable Value—£1,885,269 for the year ending March 31st, 1912 (as settled at Quinquennial Valuation, and including Government property and alterations made by Provisional Valuation Lists). Births—8,168, being 27.4 per 1,000. Deaths (corrected)—3,925 being 13.2 per 1,000. Infantile Mortality—598 deaths (corrected) under 1 year, being 73.2 per 1,000 total (uncorrected) births. Zymotic—Death-rate, 0.9 per 1,000 (total corrected zymotic deaths, 287). * The densities vary in the different Registration Sub-Districts as follows—Lambeth Church (354.3 acres) 132.6, Kenninpton (398.3 acres) 120.5, Stockwell (583 acres) 107.1, Brixton (1026.6 acres) 75.01, and Norwood (1718.2 acres) 36.7 persons per statute acre respectively. 111 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, 1912. Number of Notices served 12,506 A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES. (Public Health, London, Act.) No. of Notices served 1332 No. of Infected Houses 1242 Smallpox - Scarlet Fever 538 Typhoid 61 Typhus — Continued Fever 1 Diphtheria 311 Membranous Croup 5 Puerperal Fever 24 Erysipelas 210 English Cholera - Cerebro-Spinal Meningitis 7 Acute Polo-myelitis 10 Ophthalmia Neonatorum 75 112 B. GENERAL NUISANCES AND DRAINAGE EFFECTS. (Public Health (London) Act, and Metropolis Local Management Act.) No. of Notices served 11174 Works, Structural— Drainage Defective 1062 Intercepting Traps wth Fresh Inlets required 87 Ventilating Pipes required 194 Indoor Sinks connected with Drain 251 Rain Water Stack Pipes connected with the Drain 654 Bath Waste connected with the Drain 96 Traps defective, or of Obsolete Pattern 585 Closet Pan and Connections Defective 907 Water Supply to Closet Defective 701 Closet Dilapidated 758 Draw-off Main for Drinking Purposes required 298 Dust Bins Defective 604 Premises Dilapidated 609 Ventilation under Floors required 172 Roofs Dilapidated 320 Soil Pipes Defective 69 Paving Defective 1051 Damp and Unwholesome Houses 196 Dung Receptacles required 20 Defective Water Pipes 41 No W.C. Accommodation 4 8679 113 Works, Not Structural:— Cisterns Dirty 151 Manure Accumlations 81 Underground Rooms occupied 14 Animals Improperly Kept 39 Stopped Drains 201 Overcrowding 26 Foul Urinals 56 Refuse Accumulations 74 No Water Supply or Defective Water Supply 351 Dirty Premises 3051 4044 114 PARTICULARS OF SANITARY WORK. carried out in lambeth borough during 1012, together with yearly averages FOR (a) the decennium 1901-10 (borough) and (b) the 24 years 1877-1900 (parish). Year. Total Number of Notices (excluding those served under the Housing of the Working Classes Act). Sanitary Works, Structural and Permanent. Sanitary Works, not Structural. 1912 12506 8679 4044 1911 12440 8008 3103 1910 12110 7341 3042 1909 12764 8219 3323 1908 14258 9561 3645 1907 14883 9902 3252 1906 14768 9650 2941 1905 13053 9447 2838 1904 11778 8433 2975 1903 13043 10448 3043 1902 15384 10631 3203 Yearly Average for 10 Years 19021911 (Borough) 134481 9164.3 3136.5 Yearly Average for 24 Years 18771900 (Parish) 5944.6 4756.9 2135.9 115 .SUMMARY OF WORK DONE BY THE MALE SANITARY INSPECTORS DURING 1912. Inspections 7867 Re-inspections 66968 Complaints attended to 6613 Cases of Infectious Disease notified 1332 Cases of Non-Notifiable Diseases dealt with 5292 Rooms disinfected 6656 Bedding, etc., disinfected 19315 Bedding, etc., destroyed 467 Drains tested (with chemical, water, or both) 8327 Sanitary Works completed 5684 Plans of drainage reconstructions received and approved 394 Premises the Drains of which have been totally or partly reconstructed 544 Samples of Food and Drugs submitted to Analyst 1800 Notices— Sanitary Work (Preliminary 6935 and Statutory 4223) 11158 Infectious Diseases (Public Health Act, 1891) 1332 Metropolis Local Management Acts 16 Sanitary nuisances abated— (a) Structural 8679 (b) Non-Structural 4044 Summonses issued— Public Health Act 5 Food and Drugs Acts 53 Convictions obtained— Public Health Act 2 Food and Drugs Acts 42 Vide also Section of Report dealing with Housing, Town Planning tic., Act, 1909. 116 MALE SANITARY INSPECTORS.* During 1912, there has been no change in the personnel of the Male Sanitary Staff. Work of Male Inspectors. During 1912, the following routine work Was carried out:— (1) 7,867 inspections and 66,968 re-inspections; (2) 544 houses re-drained throughout or in part (the drains being in every case water-tested); (3) 8,327 tests (hydraulic, smoke or chemical) made; (4) 83 Water Certificates (representing 126 houses (3 shops), separate or in block, and 29 tenements), issued, in accordance with section 48 of the Public Health (London) Act, 1891; (5) 6,613 complaints attended to; (6) 12,506 notices served—12,490 under the Public Health (London) Act, 1891 (6,935 Preliminary, 4,223 Statutory and 1,332 Infectious Diseases) and 16 under the Metropolis Local Management Acts, dealing with 8,679 structural and 4,044 nonstructural defects. The Male Public Conveniences situated within the Borough are under the supervision of the Male Inspectors. Unsound Food. During 1912, several consignments of unsound food, discovered within the Borough were inspected, condemned and destroyed, under the supervision of the Sanitary Inspectors, and the details reported to the Council at the time. *There are 12 District Inspectors, viz,. F. E. Baxter, J. M. Jones, J. S. Smith, J Barfoot, G. J. Gavin, T. H. Hooper, T. H. Jackson, W. Wallis, W. W. Howes, J. M. Scorrer, J. S. Clements and A. Farran, and one special Inspector for Food and Drups (W. J. Perrin). 117 In addition, the following damaged articles of food were dealt with on their arrivals within the Borough, notices having been forwarded from the Medical Officers of Health of the districts from which the food was dispatched:— (a) Damaged wheat (to be used, afterwards, for cattle feeding after being treated):— (1) 60 quarters, per S.S. "Londoner," consigned to Messrs. C. & J. Denny, Belvedere Road. (2) 95 quarters, per S.S. "Clydeburn," consigned to Messrs. C. & J. Denny, Belvedere Road. (3) 350 bags, per S.S. "Gothic," consigned to Messrs. Mumford & Sons, Vauxhall. (4) 50 quarters, per S.S. "Londoner," consigned to Messrs. C. & J. Denny, Belvedere Road. (5) 40 quarters, per S.S. "Celtic Pride," consigned to Messrs. C. &• J. Denny, Belvedere Road. (6) 40 quarters, per S.S. "Clydeburn," consigned to Messrs. C. & J. Denny, Belvedere Road. (7) 30 quarters, per S.S. "Clydeburn," consigned to Messrs. Osborne & Young, Coldharbour Lane. (8) 40 quarters, per S.S. "Londoner," consigned to Messrs. C. & J. Denny, Belvedere Road. (9) 120 quarters, per S.S. "Clydeburn," consigned to Messrs. C. & J. Denny, Belvedere Road. (b) Potatoes and figs (to be sorted before sale and doubtful portions voluntarily destroyed as trade refuse):— (1) 839 bags of potatoes and 6,000 boxes of figs, consigned to 178 and 180 Lambeth Walk. * Result of sorting was that 76 cwts of Potatoes and 9,000 boxes of Figs were voluntarily destroyed as trade refuse. 118 (2) 6,000 boxes of figs, consigned to 277 Wandsworth Road; (c) Hams (passed as fit for food):— (1) 20 boxes, per S.S. "Cestrian," consigned to Mr. David Greig, Ferndale Road. (2) 5 boxes, per S.S. "Cestrian," consigned to Messrs. Frost & Co., Stannary Street. Prosecution of Whoiesale Vendors of Unsound Food. Representations were made during 1912 to the Local Government Board, urging such amendment of the Public Health (London) Act, 1891, as may be necessary to secure the adequate protection of the public against the sale of unsound food by wholesale vendors, and asking the Board to introduce legislation accordingly. Section 47 (3) of the Public Health (London) Act, 1891, governs the point, and enacts as follows, viz. :— Where it is shown that any article liable to be seized under this Section, and found in the possession of any person was purchased by him from another person for the food of man, and when so purchased was in such a condition as to be liable to be seized and condemned under this Section, the person who so sold the same shall be liable to the fine and imprisonment above mentioned, unless he proves that at the time he sold the said article he did not know, and had no reason to believe, that it was in such condition. The legal difficulties are connected with the proving of "seizure" and "being found in possesson," etc. 119 Withdrawal of Water from Dwelling Houses by Water Board. From July 9th to July 13th, 1912, the three houses, 28, 30, 32 Old Paradise Street, were without a proper and sufficient water supply, the Water Board having withdrawn the water therefrom for an infringement of the Board's Regulations. The houses are tenemented—a total of 77 persons—and the action of the Water Board was condemned by the Borough Council as being a danger to health of such persons besides being a nuisance and inconvenience. Temporarily, a stand-pipe was provided by the Board at the suggestion of the Borough Council officials, to be used occasionally, i.e., once or twice a day for supplying water, as required, whilst the turn-cock was present—an unsatisfactory arrangement. Lambeth Infirmary Drainage. During 1912, an account of a stoppage in the drainage near to the cook's larder, due to the entrance of roots of trees into the pipes, the system was opened up and found to be defective and practically without fall not only at the point where the stoppage had taken place, but also in the immediate neighbourhood. The Guardians were written to, asking what action it was proposed to take as to the drainage of the Infirmary as a whole and at their meeting, held July 10th, 1912, it was decided by the Guardians to instruct their Surveyors to execute a plan of the present drainage, with a view to a complete scheme ol drainage reconstruction at an early date. The stoppage was dealt with by the laying of a new drain outside the provision store, through the cook's larder into the kitchen yard to a manhole so placed as to form part of a new drainage system. 120 Water Supply to Tenement Houses (London County Council General Powers Act, 1907). The London County Council General Powers Act, 1907, Part 12, section 78, gives power to the Local Authorities to require separate water supply to each floor to a tenement house, and these powers were made use of in connections with 2 to 26 (even Nos.) Waxwell Terrace (13 houses), the rooms of which were let out separately to separate familes. The only water supply was in the basements. Proceedings were taken before the Magistrate, who, in connection wilh Nos. 2 and 4 Waxwell Terrace, ordered an additional water supply to be fixed, together with a properly fitted, and undertrapped, sink on the halflanding, leading from the ground floor to the 1st floor. This work was satisfactorily carried out, but this extra water supply and sink proved to be of a greater nuisance than their absences, owing to the unsatisfactory habits of the tenants. On this account, it was decided to take no further action with respect to the remaining houses, viz. : 6 to 26 (even Nos.) Waxwell Terrace, although statutory notices had been served in connection therewith. Inspection oe Market Thoroughfares. During 1912, the market thoroughfares were under biweekly special inspections by the Sanitary Inspectors, 2 Inspectors being on duty at a time—Saturday nights (9 to 12) and Sunday mornings (9 to 12). The market thoroughfares are Atlantic Road, Wandsworth Road, New Cut, Lower Marsh and Lambeth Walk. These systematic inspections are of value in securing wholesome food being exposed, on stalls and in shops, for sale. No official seizures were necessary. 121 Outside Urinai.s of Public Houses. During 1912, the outside urinals connected with public houses were under inspection, and notices were served as. required. House-to-House Inspections. House-to-house inspections during 1912, are dealt with under the Housing, Town Planning, ctc., Act, 1909. Other Inspections. The work in connection with disinfection, smoke abatement, inspection of factories and workshops, bake-houses, restaurants, and dining (coffee) rooms, births, milk depot, tuberculosis cases, etc., and the carrying out of the Food and Drugs and Housing Acts, is dealt with under separate headings in the Report. Legal Proceedings. It is again satisfactory to note that during 1912, in but very few cases was it found necessary to resort to legal proceedings before the Court in connection with Sanitary work carried out under the Public Health and Metropolis Management Acts—5 summonses, which resulted in 8/0 costs, as follow: convictions 2; withdrawn (payment o( costs), 2; and adjourned sine die, 1. These legal proceedings had reference to (a) defective drain, (b) dirty premises, (c) want of water supply to w.c., and damp and defective walls. 122 Drainage Cases. Drainage and Sanitary Work carried out in contravention of the London County Council By-laws. (a) 75 Leigham Court Road. Certain sanitary works, e.g., reconstruction of existing manhole, insertion of new gully in area at side of the house, and the construction of an additional lavatory on the first floor, were carried out by the builders contrary to the by-laws, i.e., without giving notice to the Sanitary Authority. A cautionary letter was sent. (b) "Hero of Switzerland,"Loughborough Road. Certain sanitary works, e.g.. reconstruction of new w.c. and fitting up of a new bath, were carried out by the builder contrary to the by-laws and without giving notice to the Sanitary Authority. A cautionary letter 'was sent. Responsibility under By-laws. During 1912, the London County Council, with the approval of the Local Government Board, amended the by-laws made under Section 39 (1) of the Public Health (London) Act, 1891, in so far as they relate to the contruction of any water-closet, earth-closet, privy, ash-pit, cesspool, or receptacle for dung, and the proper accessories thereof, so as to make the builder as well as the owner or occupier of the premises liable to penalties provided in the by-laws. The same course was taken last year (1911) by the London County Council, with the approval of the Local Government Board, whereby, under the drainage by-laws and the by-laws as to the deposit of plans under Section 202 of the Metropolis Management Act, 1855, and the Metropolis Acts Amendment (By-laws) Act, 1899, the builder becomes responsible, as well as the owner. 'Builder' means the builder, contractor or person actually carrying out the work, but does not include a workman in the employ of such builder, contractor, or person. 123 Depositing of Plans ok L.C.C. Schools. During- 1912, the question has been raised as to the legality ot the London County Council refusing to deposit plans for the drainage of new school buildings within the Borough on the ground that such depositing is now unnecsary, having regard to the provisions of Section 3 of the Education (Administrative Provisions) Act, 1911, exempting school buildings from building by-laws where plans have been approved by the Hoard of Education. The question was raised in May in connection with the enlargement of the London County Council School in Cormont Road. The London County Council refused to g-ive way and the matter was referred to the Metropolitan Borough Councils' Standnig Joint Committee, with instruction to take such steps as may be deemed to be necessary bv such Committee. FEMALE SANITARY INSPECTORS.* During 1912, one of the Council's Female Sanitary Inspectors (Miss Gamble) died and her appointment was filled by the appointment of Miss Mary Elizabeth Davies, Sanitary Inspector of Derby. Work of Female Inspectors. The two Female Sanitary Inspectors carried out, during 1912, duties in connection with the inspection of (a) Factories, Workshops (Work-places), Shops, Out-Workers' Homes, Laundries, Retaurants, etc., wherein women and girls were employed; (h) the Underground Conveniences (belonging to the Council), and other Ladies' Sanitary Conveniences (Railway Stations, Hospitals, etc.); (c) Houses wherein births occurred or deaths amongst infants under 1 year of age, or deaths from infantile diarrhoea; (d) schools wherein there were infectious disease outbreaks; (e) Houses wherein cases of pulmonary tuberculosis (consumption) were notified, etc. *Miss Edith G Gamble (iied on Aupust 30th, 191X (having been appointed on November 1st, 1901), and Miss M. E. Duvies her successor, was appointed on October 17th, 1912, and comminred her duties on November 17th, 1912. 124 The year's work, 1912, may be tabulated as follows:— JVork carried out by the two Female Sanitary Inspectors during the year 1912.* Workshops! visited and inspected— (a) Dressmakers 51 (b) Milliners 10 (c) Laundries 17 (d) Tailors 22 (e) Underclothing 3 (f) Upholsterers - (g) Dyers - (h) Blouses 20 (i) Ties 4 (j) Others 30 Workrooms inspected 299 Workshops† re-inspected 9 Workrooms† re-inspected 16 Workshops† : workrooms therein measured 228 Workshops† removed from Register 9 Workshops† reported to H.M. Inspector 9 Workshops† reported by H.M. Inspector 8 Workshops† newly discovered and registered 46 Premises visited but no females found employed, or no workers, or no one found at home 941 Female Conveniences visited and inspected— Public (visits paid) 353 Private (visits paid) 211 Schools visited— Public 135 Private - * Miss Gamble and Miss Dawson up to August 30th, 1912, and Miss Dawson and Miss Davies afterwards, † Workshops include workplaces. 125 Special places visited and inspected— (a) Private Houses* 1990 (b) Out-workers 162 Out-workers and Private Houses! re-inspected 268 Written intimations and Statutory Notices served 21.1 No. of Workshops, etc., in which no defects were found on inspection 2225 No. of Workshops, etc., in which defects were found on inspection 220 Particulars of defects found. Work rooms— Overcrowded 7 Damp 17 Dirty 97 Ill-ventilated 3 Insufficiently warmed 2 Otherwise 1 Defects— Yards 10 Floors 7 Roofs 12 Windows - Ceilings 3 Rain Water Pipes 4 Sink Wastes 5 Water Supplies 4 Premises Generally 3 Sanitary Appliances: Waterclosets— Dirty 30 111 lighted Unventilated - Choked 11 * Births, 1048 ; Diarrhœa, 50 ; Tuberculosis, 865 ; others, 27. † Births, 108; Diarrhoea, 3; Tuberculosis, 144; others, 8. 126 Sanitary Appliances: Water Closets— Defective 32 Defective Flushing Tanks and Water Supplies 42 *No separate and suitable and sufficient sanitary accommodation 2 Drainage— Defective, choked, etc. 4 Dustbins— Wanting 10 Defective 22 Lavatories— Defective or Dirty 1 Miscellaneous defects (not included above)— Animals improperly kept 1 Accumulations in yards 2 Sink Wastes defective Otherwise 1 Nuisance referred to M.O.H. for attention by Male Inspectors (defective drains, w.c.'s, etc.) 34 The Female Inspectors during 1912 were engaged in visiting 50 houses wherein deaths from infantile (summer) diarrhoea were reported as having occurred, with a view to helping to further elucidate the predisposing causes of this disease; in inspecting schools (135) in connection with outbreaks of disease (more especially measles); in visiting 1,048 private houses, wherein births had been notified or registered, with a view to educating the mothers and others concerned how best to feed their infants; and in visiting 865 tuberculosis cases at their homes. Re-visits were paid to, and re-inspections made of, houses in connection with 108 births, 3 diarrhoea and 144 tuberculosis, cases. The Female Public Conveniences are under the supervisioni of the Female Inspectors. *The Sanitary Accommodation Order 1903 does not apply to the Metropolis. 127 FACTORIES AND WORKSHOPS Factories. During 1912, 10 new factories were added to the Register, consisting of (a) dyers 1; (b) engineers, 2; (c) waste paper, 2; (d) confectioner, 1; (e) casement maker, 1; (/) bookbinding, 1; (g) blouses, 1 ; and (h) robe making, 1. The Inspection of Factories by the Sanitary Inspectors is limited to sanitary accommodation for the workers (such accommodation to be separate, sufficient and suitable) and sanitary defects reported by the Factory Inspectors. Workshops. During 1912, 57 new workshops were added to the Register, consisting of the following:— Name of Trade No. of or Business. Workshops. Dressmakers 14 Laundries 1 Milliners 3 Tailors 5 Blouses 8 Scenic Artists 3 Mantles 2 Cabinet Making and Upholstery 1 Underclothing 1 Ties and Belts 4 Boots and Shoes 3 Babies' Linen 1 Engineers 2 Paper Bags and Boxes 1 Not classified 8 Total 57 128 Full particulars concerning' these 57 workshops were entered up in the Register, shewing that, at the time of inspection that there were 82 workrooms, in which were working 274 persons-59 males and 216 females, as follow M. F. Total. Children Young Persons 2 11 13 Adults 57 205 262 9 Notices as to "protected persons" (i.e., children, young persons, and women) employed were sent on during 1912, to the Factory Inspectors, from time to time, as required (i.e., where no Abstract under the Act was found to have been posted up in a work-place). 64 Notices of occupation (representing 66 workshops) were received during 1912 by the Borough Council from the Factory Inspector. 8 written Notices were received during- 1912 by the Borough Council from the Factory Inspectors with reference to contraventions of the Public Health Acts in connection with Factories and Workshops, and all such nuisances were abated, as found necessary, and due notices sent to the Factory Inspectors as to action taken in each case. In connection with the 57 new workshops inspected during 1912, the insanitary conditions found at the time of inspection are set out in the Table subjoined. The cubic capacities of the different workrooms were, naturally, found to vary considerably, and in 7 workrooms (i.e., 8.5 per cent.), overcrowding was found to exist. 129 w WORKSHOPS REGISTERED DURING 1912. Numbers of Rooms and Persons Employed. Wards. No. of Workshops. No. of Workrooms. Children. Young Persons. Adults. TOTALS. M F. M. F. M. F. M. F. Total. Marsh 3 7 ... ... ... ... 5 ... 5 ... 5 Bishop's 2 4 ... ... ... ... 3 4 3 4 7 Prince's 10 22 ... ... ... ... 19 7 19 7 26 Vauxhall 1 1 ... ... 2 ... 1 ... 3 ... 3 Stockwell 8 9 ... ... ... ... 7 29 7 29 36 Brixton 17 19 ... ... ... 5 19 39 19 44 63 Herne Hill 4 4 ... ... ... 2 ... 54 ... 56 56 Tulse Hill 10 14 ... ... ... 4 3 67 3 71 74 Norwood 2 2 ... ... ... ... ... 5 ... 5 5 Total 57 82 ... ... 2 11 57 205 59 216 275 130 131 WORKSHOPS:—Details as to Sanitary Conditions and Defects found in 1912. Details as to Sanitary Conditions and Defects found. Marsh. Bishop's. Prince's. Vauxhall Stockwell. Brixton. Heme Hill. Tulse Hill. Norwood Totsls. Ventilation satisfactory 3 2 9 1 8 17 4 10 2 56 not ... ... 1 ... ... ... ... ... ... 1 Cleanliness satisfactory 3 2 10 1 8 17 4 10 2 57 not ... ... ... ... ... ... ... ... ... ... Workrooms damp ... ... ... ... ... ... ... ... ... ... not 3 2 10 1 8 17 4 10 2 57 Workrooms warm 3 2 9 1 8 17 4 10 2 56 not ... ... 1 ... ... ... ... ... ... 1 State of Sanitary fittings, &c. good 3 2 9 1 8 17 4 9 2 55 bad ... ... 1 ... ... ... ... 1 ... 2 Soil pipe ventilated 1 2 6 1 8 15 4 8 2 47 not ventilated 2 ... 4 ... ... 2 ... 2 ... 10 no soil pipe. ... ... ... ... ... ... ... ... ... ... Position of W.C. outside 2 ... 4 1 1 4 ... 6 1 19 inside 1 1 2 ... 4 13 4 1 1 27 outside and inside • • • 1 4 ... 3 ... ... 3 ... 11 no W.C. ... ... ... ... ... ... ... ... ... ... Separate W.C. accommodation (sufficient and suitable) Yes ... 1 5 ... 4 3 1 4 ... 18 No 3 1 5 1 4 14 3 6 2 39 Communication (direct) between W.C.s and rooms Yes ... ... . . ... ... ... ... ... ... ... No 3 2 10 1 8 17 4 10 2 57 required—persons of one sex only being employed in the other 33 cases. * In only 6 of these 39 cases was separate W.C. accommodation K2 132 OUT-WORKERS The work commenced by the Female Inspectors in 1903 and continued since, connected with the visiting and inspecting of out-workers' premises and homes (situated within the Borough), was further continued during 1912. Lists of out-workers require to be sent in to the Council by employers, engaged in the special trades scheduled in the Home Work Order, 1911, twice yearly, viz.: on or before February 1st and August 1st respectively. During 1912, 35 February and 38 August lists were received, dealing with 315 and 286 out-workers respectively. Of the 601 outworkers, 260 belonged to Lambeth and 341 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 174 lists were received from various Authorities dealing with 1,008 workers, of whom 925 belonged to Lambeth and 83 to districts outside Lambeth. Of the total 1,185 Lambeth out-workers reported, 156 were new out-workers, i.e., not previously notified, as follows:— Mantles 6 Boots and shoes 11 Blouses and skirts 11 Millinery 7 Ties, belts, and braces 28 Dresses 5 Children's undercloth- Collars 5 ing and costumes. 2 Bag stringing 12 Women's clothiug 7 Boxes and boxmaking 5 Tailors 29 Pattern bookmakers 2 Embroidery 5 Brushes 3 Waistcoats 2 Artificial flowers 8 Shirts 1 Gloves 1 Printers 1 Chairmaker 1 Cap peak trimming 2 Military braiding 1 156 Corsets 1 133 The Wards, in which the houses (wherein the 156 new out-workers were found to be working during 1912) are situated, are as follows:— Wards. No. Wards. No. Marsh 6 Heme Hill 37 Bishop's 14 Tulse Hill 10 Prince's 25 Norwood 3 Vauxhall 8 Stockwell 25 Borough of Lambeth 156 Brixton 28 FEMALE HEALTH VISITOR Work of Female Health Visitor. The Council's Health Visitor has been engaged, during 1912, in the systematic visiting of houses wherein births have been notified, in looking after the milk depot children, in inspecting the infants notified as suffering from ophthalmia neonatorum, and in making enquiries in connection with tuberculosis cases. The work may be summarised as follow:— 1st Q. 2nd Q. 3rd Q. 4th Q. Total. Births visited. 376 349 415 395 1535 Ophthalmia cases inspected 52 72 54 38 216 Depot children visited 100 46 46 33 225 VisitstoMilk Depots— York Road ... 23 27 17 21 88 Moffat Institute* . 76 71 66 77 290 Births revisited 31 20 14 36 101 Special cases dealt with 7 3 16 9 35 Tuberculosis cases visited and revisited 90 98 66 108 362 Diarrhoea cases visited ... ... 6 ... 6 Premises visited but no one found at home 83 100 164 144 491 'Used as a branch (distributing) centre. 134 DISINFECTING DEPARTMENT Details of work done during 1912, in connection with the Disinfecting- Department, are subjoined. A total of 1,332 infectious diseases, notifiable compulsorily under the clauses of the Public Health (London) Act, 1891, were reported and dealt with, including cases of cerebro-spinal meningitis (7), acute polio-myelitis (10), ophthalmia neonatorum (76), whilst the following diseases were voluntarily notified by school teachers and others: measles (1,595),. whooping cough (757), chicken-pox (989), cancer (42)r verminous houses and clothing (580), and other diseasesf (168). 18 schools were disinfected in connection with outbreaks of infectious disease, viz.: measles, 8, scarlet fever 7,. diphtheria 1, and whooping cough 2. In addition, 1960 cases of pulmonary tuberculosis (consumption), were notified and dealt with—709 (15 renotifications), 612 and 620 respectively compulsorily under the Public Health (Tuberculosis) Regulations, 1908 (Poor Law), 1911 (Hospitals), and 1911 (Private). The houses were visited and pamphlets left, dealing with consumption and its prevention, and disinfection was carried out, as required, in the event of death or removal of a patient. A total of 6,656 infected rooms and 19,315 infected articles (bedding, etc.) were disinfected officially. The yearly averages are given in the Table of Disinfection; Work carried out during the past 29 years. Summary of work carried out by the Disinfecting Department in the Borough of I.amheth during 1912. Total No. of rooms disinfected by Council 6656 *The Staff consists of 1 Superintendent (W. Lockyear), 4 Disinfectors, 4 Drivers, 1 boiler attendant, and one yard and stable attendant. During; 1912, Samuel Fisher was appointed yard and stable attendant vice N. Stribling (resigned). †Mumps, scabies, ringworm, influenza, &c. 135 Cases in which bedding was disinfected at home* 2003 Do. do. do. at Chamber 2656 Do. do. do. destroyed 78 Premises disinfected and disinfecants supplied 16554 No. of Cleansing Notices served in connection with infected houses 1155 Certificates of Medical Practitioners received in lieu of disinfection by the Council 9 Schools disinfectedf (64 class-rooms) 18 Certificates of disinfection left with occupiers of disinfected premises 4574 Library books disinfected‡ 129 Mattresses re-tabbed by Council 618 Cabs disinfected 3 Motor Omnibus disinfected — S E. & C. Rly. carriages disinfected 1 Articles of bedding, etc., disinfected. Beds 1441 Bolsters 1187 Pillows 3321 Mattresses 1134 Palliasses 32 Chair Cushions 418 Clothing 3927 Sheets 1405 Blankets 2821 Rugs and Mats 29 Counterpanes and Eiderdown Quilts 1373 Carpets 33 Extras (i.e., articles not included above) 2194 Total 19315 * 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. †Scarlet Fever 7, Diphtheria 1, Measles 8, Whooping Cough 2. ‡110 Public Library and 19 Private Library Books. 136 Articles of bedding, etc., destroyed. Beds 36 Bolsters 13 Blankets 8 Pillows 41 Quilts and Counterpanes 2 Mattresses 36 Palliasses 18 Sheets 3 Chair Cushions 10 Clothing 137 Carpets 5 Extras (i.e., articles not included above) 158 Total 467 Practically all the disinfection was carried out by the Council's staff—only 9 certificates being received from Medical Practitoners during 1912, as follow:— Medical Practitioners' Certificates accepted in lieu of Disinfection being carried out by the Borough Council. Nature of Certificate. 1st Q. 2nd Q. 3rd Q. 4ih Q. Total. For Rooms only - - - 1 1 For Bedding only — — — — For Rooms and Bedding 3 1 4 8 Total 3 1 4 1 9 Refuges. There is one refuge in the Borough, at Wanless Road,, but it has not been called into use during 1912. 137 DISINFECTION STATISTICS. For eight years prior, and twenty-two years subsequent, to the passing of the Notification of Infectious Diseases Act; and for the year 1912. Yearly average for 8 years preceding the Notification Act, 1882-1889 (Parish). Yearly average for 11 years succeeding the Notification Act, 1S90-1900 (Parish). Yearly average for 11 years succeeding the Notification Act, 1901-10 & 1906-11 (Borough) 1912. 1901-5. 1906-11. No. of Cases in which At Home 142.8 240.8 16.6 1303.3* 2003 Bedding, etc., has been disinfected At Chamber 452.8 2333.3 2337.0 2911.7 2656 No. of Cases in which Bedding, etc., has been destroyed 45.7 121.6 74.2 47.5 467 No. of Articles of Bedding, etc, disinfected 2253.2 15600.4 34632.4 23077.7 19315 No. of Articles of Bedding, etc., destroyed . 113.0 489.4 710.0 306.0 467 Premises disinfected and disinfectants supplied 916.8 6191.7 11738.4 12933.7 16554 Infectious diseases dealt with Notifiable ... 2408.5 2335.2 1903.0 1332 Non-notifiable ... 299.3 2260.8 3873.8 5292 * This number is increased for 1906, 1907. 1908, 1909, 1910 and 1911, on account ot bedding no longer being removed to the Disinfection Station as a routine in connection with Measles, Whooping Cough and Chicken-pox. N.B.—The Statistics for 1901-1912 refer to the present Borough Council ; those for all previous years to the late Vestry, 138 Cleansing of Verminous Persons. No proper local arrangements have yet been made by the London County Council for the cleansing of verminous school children and occupiers of common lodging houses within the Borough—statutory obligations imposed upon the County Council by Parliament. Verminous premises are disinfected as required, but such disinfection is not satisfactory without the school children and the inmates of the common lodging houses, who are themselves verminous, being cleansed also at the same time. The numbers of verminous houses and rooms disinfected and cleansed during 1912, and the three previous years are:— Year. Houses. Rooms. 1909 148 387 1910 207 646 1911 268 535 1912 580 1109* Cleansing of Children. The London County Council, as the Educational Authority, have not yet carried out their statutory obligations and provided the necessary cleansing stations for verminous school children, but have again suggested during 1912 (letter dated July 24th†) that the Borough Councir should adopt cleansing stations under the Permissive Cleansing of Persons Act, 1897, the County Council to have the use of the same by agreement at stipulated charges, for the cleansing of verminous (a) school children, and (b) adults, e.g., inmates of common lodging houses, the stations being planned with separate entrances for children and * Bedding 1260 and clothing 356. †The matter was previously dealt with by the Council on April 2nd, 1908, and June 30th, 1910. 139 adults. The stipulated charge offered is 2/0 a child, such payment to cover any number of attendances bv the child at the station for cleansing within a period of one calendar month from the date of the first cleansing-. No stipulated charge is offered for adults. This suggestion of the County Council was not accepted by the Borough Council, who are of opinion that the provision of cleansing stations for verminous (a) school children and (b) inmates of common lodging houses, is a statutory obligation devolving upon the County Council, under whose jurisdiction schools and common lodging houses are. Meanwhile, Lambeth Borough remains unprovided with the required cleansing stations. SMOKE ABATEMENT. During 1912, observations and enquiries were made in connection with smoke abatement throughout the Borough and smoke notices were served as required. In no case was it found necessary to proceed to a summons. Delegates were appointed by the Council during 1912 to attend the International Smoke Abatement Exhibition and Conferences, held March 26th to 28th, 1912, in London. The L.C.C. and the Coal Smoke Abatement Society reported, during 1912, nuisances as follows:— 1. London County Council—8 letters dealing with alleged smoke nuisances connected with: Messrs. Howe & Son's bakery (72 Brixton Hill), Messrs. Clowes & Sons, Limited (Duke Street), 140 ick Laundry, Limited (Frederick Crescent, Vassall Road), Washington Laundry, Limited (30 Langton Road), Messrs. Schmidt's Bakery (66a Brixton Road), Messrs. Stiff & Sons (High Street), Messrs. Hammerton's Brewery, (Stockwell Green), and Messrs. Beattie & Co. (39 Lower Kennington Lane). 2. Coal Smoke Abatement Society—10 letters dealing with alleged smoke nuisances connected with :— Colonial Consignment and Distributing Company,. Limited (Nelson's Wharf), St. Thomas' Hospital (Westminster Bridge), Messrs. Meredith & Co. (Belvedere Road), Messrs. Walker, Parker & Co. (Belvedere Road), Messrs. McGaw & Co. (Belvedere Road), Messrs. Field & Co. (Upper Marsh), Messrs. Holloway Bros. (Belvedere Road), Lion Brewery (Belvedere Road), Messrs. Doulton & Co. (High Street), and Messrs. Stiff & Sons (High Street). Special observations were made during 1912 with reference to Messrs. Hayes & Sons, Limited (129 Coldharbour Lane), Penrith Place Laundry (West Norwood), Brewery (Crownstone Road), St. Thomas' Hospital (Westminster Bridge), Bakehouse (175 South Lambeth Road), Messrs. Rogers & Cook (South Lambeth Road), the City & South London Railway Company's Works (195 Clapham Road), Messrs. Beattie & Co. (39 Kennington Park Road), The Lion Brewery (Belvedere Road), The Belle Laundry (Vassall Road), the New London Brewery (Vauxhall), Messrs. Stiff & Sons, Limited (High Street), Messrs. Doulton & Co., Limited (High Street), Messrs. Howe & Sons (72 Brixton Hill), Sir Joseph Causton & Sons, Limited (Clapham Road), Frederick Laundry, Limited (Frederick Crescent, Vassall Road), Washington Laundry, Limited (30 Langton Road), Sunnybank Laundry (South Lambeth Road), and Messrs. Beaton & Co.'s Brewery (Chapel Road, West Norwood). 141 UNDERGROUND CONVENIENCES* The conveniences were kept under regular inspection and supervision during 1912—the male conveniences by the male inspectors and the female conveniences by the female inspectors. During 1912, Mrs. Fletcher and Mrs. Burgess (permanent female attendants) resigned, and their appointments were filled temporarily by Mrs. Clark and Mrs. Hawgwyn, whilst Mrs. Rouscher (temporary relief) also resigned, her appointment being filled by Mrs. May. The salaries of the male attendants were increased during 1912—a scale being adopted by the Council as follows :— (a) Attendants with less than 5 years' service, 28/0 per week. (b) Attendants with over 5 and less than 10 years' service, 29/0 per week. (c) Attendants with over 10 years' service, 30/0 per week. *The Staff consists of 19 male and 17 female attendants. There are 8 male and 7 female conveniences. ANALYSIS OF FOOD AND DRUGS, WATER, etc.† 1.—Food and Drugs During the year 1912, 1,800 samples were purchased within the Borough, and submitted to the Public Analyst for analysis. Of the 1,800 samples, 144 (i.e., 8 per cent.) were reported by the Analyst to be adulterated, †Dr. John Muter, F.R.S., Public Analyst for the Borough of Lambeth, died Jan. 5th, 1912, and was succeeded by Mr. A- M. Muter, F.I.C., who was appointed as Public Analyst for the Borough of Lambeth (part time appointment) on March 14th, 1912, the appointment being approved by the Local Government Board on April 18th, 1912. 142 varying quarterly as follows:—1st quarter, 9.1 per cent.; 2nd, 13.3 per cent; 3rd. 4.9 per cent.; and the 4th, 4.8 per cent.; and 53 summonses were issued, with the result that 42 convictions were obtained, together with £103 10s. Od. in penalties and £35 8s. 6d. in costs. The annual averages of the two decennia 1891-1900 (Parish) and 1901-1910 (Borough), tire respectively: (1) number of samples taken 501.9 and 1352.4, of wihich 74.6 and 89.1 (i.e., 14.9 and 6.6 per cent.) were found on analysis to be adulterated; (2) number of summonses taken out 53.1 and 63.8 with 52.3 and 48.5 convictions, and £104 5s. 5d. and £74 0s. 4d. in penalties and £35 0s. 3d. and £38 16s. 6d. in costs. During 1912, no samples were submitted to the Public Analyst by private purchasers, but 172 informal samples (31 adulterated) were takea by the Inspector, viz., 96 milks (6 adulterated), 5 butters (2 adulterated), 6 creams (4 adulterated), 55 drugs (16 adulterated), 4 jams (2 adulterated), and 6 other articles (1 adulterated). Particulars of the 1,800 articles submitted by the Food and Drugs Inspector during 1912 are as follow:— (a) Milk. 727 samples were taken, and of these 84 (i.e., 11.5 per cent.) were declared by the Analyst to be adulterated. Of the 727 samples, 4 were separated milk (1 adulterated, viz.: with 10 per cent, extraneous water), 1 was skim milk (adulterated, viz.: being deficient in milk fat to the extent of 88 per cent.), and 722 were ordinary milks (82 adulterated). These 84 adulterations were as follows :— (1) Extraneous water 27 varying from a minimum 1 to a maximum 27 per cent., viz., 1, 1, 1, 1, 1, 2, 2, 3, 3, 3, 3, 3, 3, 4, 4, 5, 6, 6, 10, 10, 10, 13, 15, 16, 21, 24, and 27 respectively. 143 (2) Deficiency in milk-fat 53 varying' from a minimum 1 to a maximum 88 per cent., viz. : 1, 2, 2, 2, 3, 3, 3, 3, 3, 3, 4, 4, 4, 4, 4, 5, 5, 5, 5, 5, 6, 6, 6, 6, 7, 7, 8, 8, 9, 9, 9, 10, 10, 11, 12, 12, 13, 13, 15, 15, 16, 16, 16, 16, 22, 23, 26, 26, 26, 27, 46, 51 and 88 respectively. (3) Extraneous water and deficiency in milk-fat (3), viz., 3 and 13, 3 and 2, 3 and 17 per cent., respectively. (4) Preservatives present (1) to the extent of 0.037 per cent, crystallised boracic acid, i.e., 3.2 grains per pint. In 46 cases, no summonses were taken out for the following reasons :— (1) The amounts of adulteration being too small (37) viz.: (a) extraneous water, 1, 1, 1, 1, 1, 2, 2, 3, 3, 3, 3 and 5 per cent, respectively; (b) fat deficiencies 1, 2, 2, 2, 3, 3, 3, 3, 3, 3, 4, 4, 4, 4, 4, 5, 5, 5, 5, 5, 6, 6, 6 and 7 per cent, respectively, and (c) extraneous water and fat deficiency 3 and 2 per cent, respectively. (2) The samples being taken informally (6) viz. : (a) fat deficiencies, 13, 15, 16, 16, 26 and 26 per cent, respectively. (3) Vendor absconded before summons could be served (1) viz. : 15 per cent, fat deficient. (4) Bottle burst (1) viz. : 10 per cent, extraneous water. (5) "Separated," sold as "skimmed" (1) viz. : 88 per cent, fat deficient. The total fines amounted to .£'60 10s. 0d., with ,£25 5s. costs. (b) Butter. 481 samples of butter were taken, and of these 31 (i.e., 6.4 per cent.) were declared by the Analyst to be 144 adulterated, the adulterations consisting of (1) added margarine (15), varying from a miniumum 15 per cent, to a maximum 100 per cent. viz.: 15, 31, 57, 62, 75, 90, 90, 90, 91, 95, 95, 95, 95, 100 and 100 respectively; (2) preservatives present (16), varying from a minimum 0.02 per cent, to a maximum 0.70 per cent, crystallised boric acid respectively. In 21 cases, no summonses were taken out for the following reasons: (1) amounts of adulteration being too small (17), viz.: (a) margarine 15 per cent., and (b) boric preservatives, viz.: 0.02, 0.05, 0.05, 0.07, 0.07, 0.08, 0.09, 0.25, 0.30, 0.53, 0.545, 0.545, 0.633, 0.633, 0.644 and 0.70 respectively; (2) Vendor absconded before summons could be served (1) viz.: 90 per cent margarine; (3) Paper wrapper found to be marked with the word "Margarine" (1), viz.: 100 per cent. Margarine; (4) The samples being taken informally (2), viz.: 95 and 95 per cent, margarine respectively. The total fines amounted to £43 with £10 3s. 6d. costs. (c) Margarine. 69 samples of margarine were taken, but none were declared by the Analyst to be adulterated. (d) Cream. 6 samples (one preserved) were taken, and of these 4 including the preserved cream (i.e., 66.6 per cent.), were declared by the Analyst to be adulterated, the adulterations consisting of the presence of preservatives, viz.: (a) ordinary cream 0.198, 0.227 and 0.285 per cent, of crystallised boric acid respectively; (b) preserved cream 0.045 per cent, of crystallised boric acid in excess of that declared upon the label. 145 No legal action could be taken, all the samples having been purchased informally for the purposes of a special report (vide infra). (e) Coffee. 39 samples of coffee were taken, but none were declared by the Analyst to be adulterated. (f) Mustard. 25 samples of mustard were taken, but none were declared by the Analyst to be adulterated. (g) Other Groceries. 8 samples of sago, 10 of chocolate powder, 29 of pepper, 1 of cayenne pepper, 5 of tapioca, 8 of cocoa and 4 of arrowroot were taken, but none were declared by the Analyst to be adulterated. (h.) Drugs.* 71 samples were taken and of these 16 (i.e., 22.5 per cent.) were declared by the Analyst to be adulterated as follows : 1 camphorated oil, devoid of camphor. 2 lime water, 12 and 32 per cent, deficient in lime. 1 boracic acid ointment, 5 per cent, deficient in boracic acid. 1 beeswax, 10 per cent, paraffin wax. 1 Seidlitz powder, 2 parts lead per million. 3 carbonate of magnesia, 4, 10 and 10 parts lead per million. 3 Epsom salts, 2, 4, 14 parts lead per million. 1 oxide of magnesia, 4 parts lead per million. * Consisting of eucalyptus oil, tinct. quin. am., orange quinine wine, Blaud's Pills, sweet spirit of nitre, compound liquorice powder, white precipitate ointment, beeswax, turpentine, Sal Volatile, boric ointment, zinc oxide, iodine, lime water, sulphur ointment, camphorated oil. 146 1 citrate or of magnesia, 1 parts lead per million. 2 effervescent citrate of magnesia, 4 and 12 parts lead per million. With the exception of lime water (12 per cent, deficient in lime), all the samples declared by the Analyst to be adulterated had been purchased informally for the purpose of Special Report (vide infra) and, consequently, no legal action was taken. In the case of the adulterated sample of lime water (12 per cent, deficient in lime), the amount of adulteration was too small to warrant proceedings. (i.) Lard. 183 samples of lard were taken, but none were declared by the Analyst to be adulterated. (f) Confectionery and Jams. 4 samples of red currant jelly were taken, and of these 2 (i.e., 50 per cent.) were declared by the Analyst to be adulterated, viz.: each contained a trace of a coal far dye, (k) Vinegar. 22 samples of vinegar were taken, and of these 6 (i.e., 27.3 per cent.) were declared by the Analyst to be adulterated, viz.: deficient in acetic acid (vide infra). Other Articles. 1 sample of baking powder, 1 of pea flour, 9 of oatmeal, 9 of ground rice, 2 of olive oil, 1 of wheaten flour, 33 of dripping, 1 of self-raising flour, 1 of rice, 3 of tea, 17 of spirits (1 rum, 2 brandy, 13 whiskey and 1 gin), 4 of ginger, 1 of preserved peas, 2 of washing soda, 2 of turpentine, 5 of ginger beer, 5 of kaola, 5 of soda water, and 5 of lemonade were taken, but none were declared by the Analyst to be adulterated. 1 sample of golden syrup was 147 taken and declared by the Analyst to be adulterated, viz.: wholly glucose syrup, but no action was taken, as the sample was labelled "refined syrup." Special Analyses made in connection with the carrying out of the food and drugs acts. Special analyses and reports were made during 1912 as follow, the samples being taken informally:— (a) Red Currant Jelly. 4 samples of red currant jelly were analysed with the following results :— Sample Sample Sample Sample A. B. C. D. Added Glucose None None None None Added Apple Jelly No evidence No evidence No evidence No evidence Phosphoric Acid Absent Absent Absent Absent Salicylic Acid Absent Absent Absent Absent Coal Tar Dye Present Absent Present Absent The preparations are found to be so carefully strained that it is impossible to find any structure characteristic of the fruit employed in their manufacture by means of the microscope. The absence of added glucose, added apple jelly, phosphoric acid and salicylic acid and coal tar dye (except traces in two of the samples) is satisfactory, and points to the articles being unsophisticated. It was not thought necessary to take further samples with a view to formal proceedings under the Sale of Food and Drugs Acts. 148 (b) Cream. 6 samples of cream were analysed with the followingresults :— Sample Sample Sample Sample Sample Sample A. B. C. D. E. F. Percentage of Fat 52.72 49.16 51.84 44.72 44.01 51.18 Percentage of Boric Acid. 0.227 0.198 0.545 0.223 0.186 0.285 Three of the samples were purchased as "preserved cream," and each bore a statement on the label to the effect that it contained a boron (boric) preservative not exceeding- 0.5 per cent.—a quantity exceeded in one sample to the extent of 0.045 per cent. In one of the samples of preserved cream, the label was not affixed to the side of the jar, but simply formed part of the covering, and was removable and actually removed on opening the jar. The firm was written to, pointing out the undesirability of such a practice, and recommending that the method adopted by the other firms should be adopted, viz.: the affixing of the label to the side of the jar, where it will remain after the jar has been opened. The other 3 samples were purchased as "pure cream," "cream" and "thick rich cream" respectively, and all of them contained varying proportions of a boron (boric) preservative, contrary to the regulations which come into force on 1st January, 1913. (c) Condensed Milk. 6 samples of condensed milk were analysed, the samples being typical of the varieties of condensed milk to be found on sale within the Borough, viz.:— 149 (1) Condensed whole milk, sweetened with cane sugar (3 samples); (2) Condensed whole milk, unsweetened (1 sample); (3) Condensed machine-skimmed milk, sweetened with cane sugar (2 samples). Each sample was specially examined for the presence of preservatives, but in no case were such found to be present. The results of the analyses are given in the form of Tables I. and II., shewing the analytical composition of the samples, together with the weight of the contents of each tin, the price per tin and the specific gravity of the milk at 15.5 degrees C. (Table I.) and the calculated composition of dilutions for infants, prepared by measure according to the directions given on the various labels, together, for comparison, the average composition of cows' milk and human milk and also the compositions of the dilutions recommended for cooking and general purposes (Table II.) It is to be noted that no specific instructions are given by the manufacturers as to how the condensed milks are to be diluted with water, e.g., by weight or by measure—a very important difference. The general method adopted in household practice is by measure, and that method has, consequently, been adopted in Table II., such method giving a dilution richer in milk Constituents than would have been the case had the method adopted been that by weight. Under the Sale of Food and Drugs Act, 1899 (Sections I. and II.), all condensed, separated, or skimmed milk imported into this country, and all such milk sold or exposed for sale, must bear a label on which the words "machineskimmed milk " or " skimmed milk," as the case may 150 require, are printed in large and legible type. Under Section 8 of the Sale of Food and Drugs Act, 1875, condensed milk, whether full cream, skimmed, or machineskimmed, if sweetened, must bear on the label a declaration as to the added sugar, whilst, if made abroad, under the Merchandise Marks Act, the origin must be declared. All these requirements had been complied with in the cases of all the six samples submitted, as shown by the labels and the analytical figures given in Table I., as also had the descriptions given on the labels, and the samples were, consequently, passed as "genuine." In the case of condensed milk, two important consideralions arise, viz.:— (a) Their use in infant feeding; (b) Economical considerations in comparison with the use of fresh milk. Speaking generally, the Tables would appear to shew, T)y the results of the analyses, that diluted condensed milks are (a) deficient in milk fat, (b) contain a different type of sugar (viz. : cane sugar) from that normally present in cow's milk (viz. : milk sugar), and (c) cost more, bulk for bulk, than cow's milk as ordinarily retailed at 4d. to 5d. a quart. 151 TABLE 1. Description of Sample. No. 754. Condensed Swiss Milk No. 755. Condensed Milk Unsweetened. No. 756 Condensed Full Cream Cows' Milk. No. 757. Machine skimmed Condensed Milk. No. 758. Condensed Milk. No. 759. Machine skimmed Condensed Milk. Weight of contents of tin 14.65ozs. 11.72ozs. 10.61OZS. 8.23OzS. 1453ozs. 8.76 ozs. Price per tin 6d. 5½d. 3½d. 2d. 6d. 2d. Specific Gravity at 15.5 C. 129 1.08 129 1.34 1.29 1.34 Analysis % by Weight. Milk fat 10.91 9.90 9.60 0.48 10.61 0.55 Proteins 9.31 8.62 8.70 9.19 9.68 10.74 Mineral Matters 1.97 1.90 1.99 244 1.88 2.34 Milk Sugar 13.60 13.10 13.28 15.84 12.65 16.00 Cane Sugar (by difference) 39.62 Nil 40.53 45.56 41.70 45.64 Water 24.59 66.48 25.90 26.49 23.48 24.73 100.00 100.00 100.00 100.00 100.00 100.00 TABLE II. Showing Composition of resulting Milk, when diluted according to recommendations on label. The dilutions are calculated for parts by measure, and the undermentioned figures show percentage Composition of the resulting Milks by weight. Description of Sample. No.754. Condensed Swiss Milk. No.755. Condensed Milk, Unsweetened. No.756. Condensed Full Cream Cows Milk. No.758. Condensed Milk. Cows' MilkAverage Composition. Human MilkAverage Composition. Dilution Condensed Milk 1 1 1 1 1 1 1 1 1 1 1 1 Water 4 5 2 3 4 5 7 14 4 5 7 14 Milk Fat 26.6 2.23 3.47 2.62 2.34 1.97 1.49 0.80 2.58 2.18 1.65 0.89 3.3 4.0 Proteins 2.27 1.91 3.02 2.28 2.12 1.78 1.36 0.73 2.35 1.98 1.51 0.81 3.5 1.5 Mineral Matters 0.48 0.40 0.64 0.51 0.49 0.40 0.30 0.16 0.45 0.38 0.29 0.16 0.7 0.2 Milk Sugar 3.32 2.78 4.58 3.47 3.24 2.72 2.07 1.11 3.08 2.58 1.95 1.06 4.5 6.5 Cane Sugar 9.66 8.12 Nil Nil 9.88 8.31 6.30 3.42 10.16 8.54 6.49 3.51 Nil Nil Water 81.61 84.56 88.29 91.12 81.93 84.82 88.48 93.78 81.38 84.34 88.11 93.57 88.0 87.8 152 53 (d) Vinegar. Several samples of vinegar were examined and analysed during 1912, and found to be deficient in acetic acid. There is at present no legal standard for acetic acid in vinegar, nor has the Local Government Board any power to frame definitions for vinegar or artificial vinegar. The Board has, however, suggested the following definition:— "Vinegar is a liquid derived wholly from alcoholic and acetous fermentations; it shall contain not less than 4 grammes of acetic acid (CH3 COOH) in 100 cubic centimetres of vinegar; it shall not contain arsenic in amounts exceeding 0.0143 milligrammes per 100 cubic centimetres of vinegar, nor any sulphuric or other mineral acid, lead or copper, nor shall it contain any foreign substances or colouring matters except caramel." Such a definition will, in all probability, to some extent at least, be considered authoritative by the Courts. It was decided by the Council that having regard to the above facts, no action should be taken against vendors in connection with the particular samples taken, but that vinegar vendors within the Borough should be circularised, drawing attention to the definition suggested by the Board, and warning them that, in future, if samples were found on analysis not to conform with such definition, legal proproceedings might be taken against them under the Sale of Food and Drugs Acts. The matter of a statutory standard for vinegar and artificial vinegar is being taken up by the London & County Vinegar Brewers' Association, Limited, of Ridler Place, Holland Street, Blackfriars, S.E. (Walter Davenport, Secretary), and it is hoped to obtain from the Government a short Act of Parliament dealing with the matter. 54 The detailed definitions suggested by the Board are:— A.—General Standard, for Vinegar. Vinegar is a liquid derived wholly from alcoholic and acetous fermentation; it shall contain not less than 4 grammes of acetic acid (CH3 COOH) in 100 cubic centimetres of vinegar; it shall not contain arsenic in amounts exceeding 0.0143 miligrammes per 100 cubic centimetres of vinegar nor any sulphuric or other mineral acid, lead or copper, nor shall it contain any foreign substance or colouring matter except caramel. Malt Vinegar is derived wholly from malted barley or wholly from cereals, the starch of which has been saccharified by the diastase of malt. B.—Artificial Vinegar. Artificial Vinegar is any vinegar, or substitute for vinegar containing, or derived from any preparation containing, any added acetic acid which is not wholly the product of alcoholic and subsequent acetous fermentation. It shall contain not less than 4 grammes of acetic acid CH3 COOH) in 100 cubic centimetres of the artificial vinegar . It shall not contain arsenic in amounts exceeding 0.0143 milligrammes per 100 cubic centimetres of artificial vinegar, nor any sulphuric or other mineral acid, lead or copper, nor shall it contain any foreign substance or colouring matter except caramel. (e) Drugs. 31 informal samples of drugs were taken and submitted to the Public Analyst for analyses for the presence of lead, and in several instances lead was found in quantities varying from 1 to 14 parts per million. The usualy accepted limit for lead in samples is 20 parts per milion, so that the results of the analyses were satisfactory, from the point of 55 view of the purity of the drugs offered for sale, and it became unnecessary to give instructions for formal samples to be taken of the same drugs. Summary of Legal Proceedings taken under the Sale of Food and Drugs Acts.* Of the total 53 summonses (38 milks and 15 butters) taken out, there were convictions in 42 cases, in 22 milks and 15 butters (5 under the Margarine Act), whilst in the remaining 11 (all milks), the results were as follows:— 11 summonses dismissed:— (a) Warranty proved, 2. (b) Contrary proved, 8. (c) Adjourned sine die, 1. Registration of Margarine Manufactories. During 1012, three margarine manufactories were registered viz.: 15 New Cut, 448 and 450 Brixton Road, and Wessex House, Oakley Street. Since the Margarine Act, 1887, came into force within the Borough, the following premises have been registered: 233 Wandsworth Road, 417 Brixton Road, 413 Norwood Road, 71 Robsart Street, 75 Atlantic Road, 114 Camberwell New Road, 32 Commercial Road, 14 Vassall Road, 92 Lambeth Walk, 266 Brixton Road, 64 Stamford Street, 21 Lower Marsh, 11-13 Gray Street and 7 Juxon Street. *38 milk summonses had reference to milks, (a) with extraneous water 14, (b) deficient in fat, 21, (c) both extraneous water and deficient in fat, 2, and (d) added preservative, 1. 156 Expenses of carrying out the Food and Drugs Acts. The total expenses connected with the carrying out of the Food and Drugs Acts in the Borough during 1912 amounted to £81 15s. 0d., and are made up as follow:— £27 10s. 9d. for samples, £19 19s. 0d. for assistant, £7 13s. 0d. for witnesses, £22 7s. l0d. for travelling expenses (including £13 6s. 6d. for cabs) and £4 4s. 5d. for sundries. The salary of the Food and Drugs Inspector (£120, rising by £l0 annual increases to £200), and the cost of the summonses (£66 16s. 0d), are not included. The annual averages for the last 9 years (1903-11) are (1) total expenses, £81 9s. 7d., (2) number of samples, 1545.4. 2. Water. No sample of water was submitted for analysis during 1912. Public Health (Milk and Cream) Regulations, 1912. The new Regulations, known as the Public Health (Milk and Cream) Regulations 1912, were issued by the Local Government Board under date of August 1st, 1912. The Regulations are made under powers conferred by the Public Health (Regulations as to Food) Act, 1907, authorising measures to be taken for the prevention of danger arising to public health from the importation, preparation, storage, and distribution of articles of food or drink (other than drugs or water), intended for sale for human consumption. The Regulations have reference to the addition of preservatives and other foreign substances 157 to milk and cream, and are designed to secure that no such preservatives shall be added to (a) milk, or (b) cream containing less than 35 per cent. (by weight) of milk fat, at any stage from the place of production to that of delivery to the purchaser, but that, in the case of cream containing over 35 per cent. of milk fat, the addition of boric acid or borax, or a mixture of these preservative substances, or of hydrogen peroxide, shall be subject to a system of declaration, which is required to be followed by all persons dealing with such cream for the purpose of sale for human consumption. Further, the Regulations prohibit the addition of any thickening substance to cream or preserved cream. The Regulations take effect, as regards their main provisions, on and after 1st October, 1912, and as regards the necessary declaration of preservative in cream, on and after 1st January, 1913. Sale ok Milk Regulations, 1912. The new Sale of Milk Regulations, 1912, were issued by the Board of Agriculture and Fisheries under date of June 29th, 1912. These Regulations modify and repeal the previous Regulations that have been made by the Board of Agriculture and Fisheries in exercise of the powers conferred on them by Section 4 of the Sale of Food and Drugs Act, 1899. The Regulations are as follows:— 1.—Skimmed or Separated Milk. Where a sample of skimmed or separated milk (not being condensed milk) contains less than 8.7 per cent.* of milk solids other than milk fat, it shall be presumed, for the purposes of the Sale of Food and Drugs Acts, (*N.B.—In the previous Regulations it was "less than 9.0 per cent. of milk solids.) 158 1875 to 1907, until the contrary is proved, that the milk is not genuine, by reason of either the addition thereto of water, or the abstraction therefrom of milk solids other than milk fat. 2.—Revocation of Existing Regulation. Regulation 3 of the Sale of Milk Regulations, 1901,. is hereby revoked, but not so as to affect the validity of any certificate of analysis given before the commencement of these Regulations, or any legal proceedings in respect of any sample to which any such certificate relates. The Sale of Milk Regulations, 1912, came into operation on 1st September, 1912, and extend to England and Wales. Inadequacy of Penalties inflicted under the Sale of Food and Drugs Acts. The Secretary of State for the Home Department, during 1912 (January 10th) addressed a circular letter to the Justices of the Peace on the subject of the inadequate penalties, which are imposed for breaches of the Sale of Food and Drugs Acts, drawing attention also to a previous letter sent out from the Home Office on July 24th, 1902, dealing with the same subject. The penalties inflicted still continueat times to be too small to serve as deterrents. Sale of Milk with added Water for Human Food. During 1912, the Council decided to ask the Local Government Board and the Board of Agriculture and Fisheries to take such steps as may be necessary and insert 159 in the proposed Milk Bill a provision prohibiting by statute the sale of milk with added water for human food, thereby preventing the practice of selling milk and declaring it (if necessary) as "milk and water"-a practice which obtains in the trade. Notficaton to Traders of Results of Analyses. The question was again raised during 1912 by the London Retail Dairymen's Association as to the desirability of traders being at once notified, by letter or post-card, (a) as to the certified genuineness of samples taken under the Sale of Food and Drugs Acts, or (b) as to the certified adulteration, where the amount of adulteration is not sufficient to warrant a prosecution, thereby obviating unnecessary worry to the traders concerned, whose private analysts may have already reported privately to them to the same effect. It is suggested by the traders that the communication should be of a non-committal nature so as to avoid any chance of the communication being construed into a gratuitous advertisement. The Council, after consideration with the other Metropolitan Sanitary Authorities as to the various practices in vogue in the different districts, decided to take no action, following their previous decision arrived at in June, 1907. SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of the analyses, during the year 1912:— Samples. Number Analysed. Number Adulterated. Milk* 727 84 Butter 481 31 Lard 183 ... Coffee 39 ... *Including 4 separated milks, (1 adulterated) and 1 skim milk (adulterated). 16o Samples. Number Analysed. Number Adulterated. • Margarine 69 Mustard 25 Pepper 29 Arrowroot 4 Vinegar 2 (malt vinegar) 22 6 Chocolate Powder 10 Baking Powder 1 Pea Flour 1 Sago 8 Oatmeal 9 Ground Rice 9 Olive Oil 2 Flour (Wheaten) 1 Tapioca 5 Cocoa 8 Dripping 33 Drugs 71 16 Self-raising Flour 1 Rice 1 Tea 3 Whisky 13 Cayenne Pepper 1 Rum 1 Ginger 4 Cream 6 4 Red Currant Jelly 4 2 Brandy 2 Gin 1 Preserved Peas 1 Soda (washing) 2 Syrup 1 1 Turpentine 2 Ginger Beer 5 Kaola 5 Soda Water 5 Lemonade 5 Totals 1,800 144 161 Particulars as to samples analysed, and proceedings taken, during 1912 (Borough), together with the yearly averages for the two decennia, 1891-1900 (Parish) and 1902-11 (Borough) Year. No. of Samples analysed. No. of Samples adulterated. Percentage of Samples adulterated. No. of Summonses issued. No. of Convictions. Penalties. Costs. £ s. d. £ s. d. 1912 1800 144 8.0 53* 42 103 10 O 35 8 6 1911 1800 93 5.2 62 56 93 5 0 43 3 6 1910 1800 70 3.9 49 33 66 12 0 30 2 6 1909 1800 88 4.9 76 59 86 10 0 48 9 8 1908 1800 153 8.5 109 76 88 4 6 72 11 7 1907 1800 154 8.6 110 79 118 10 0 61 16 0 1906 1500 69 4.6 38 35 52 0 0 27 3 7 1905 1200 57 4.7 41 30 47 0 0 19 8 0 1904 1200 79 6.6 66 43 80 19 6 39 17 6 1903 1010 97 9.6 66 60 71 7 6 38 17 0 1902 704 51 7.2 21 19 14 5 0 16 5 6 Average of 10 years, 1902-1911 (Borough) 1461.4 91.1 6.1 63.8 49.0 71 17 4 39 15 5 Average of 10 years, 1891-1900 (Parish) | 501-7 746 151 531 52-5 104 5 5 35 0 3 Inspector Perrin commenced his duties on February 21st, 1898, vice Inspector Wiggs, who did the work from August, 1892 to November, 1897. *11 summonses were dismissed. 162 RAG FLOCK ACT, 1911 The Local Government Board on June 8th, 1912, issued an Order, making the following Regulations under Section 1, Sub-section (1) of the Rag Flock Act, 1911:— Article I.—Flock shall be deemed to conform to the standard of cleanliness for the purposes of Sub-section (1) of Section 1 of the Act, when the amount of soluble chlorine, in the form of chlorides, removed by thorough washing with distilled water at a temperature not exceeding 25 degrees Centigrade from not less than 40 grammes of a well-mixed sample of flock, does not exceed 30 parts of chlorine in 100,000 parts of the flock. Article II.—These Regulations may be cited as "The Rag Flock Regulations, 1912." and shall come into operation on the First day of July, One thousand nine hundred and twelve. Sub-section (1) of Section 1 of the Rag Flock Act, 1911, enacts as follows:— (1) It shall not be lawful for any person to sell or have in his possession for sale flock manufactured from rags or to use for the purpose of making any article of upholstery, cushions, or bedding, flock manufactured from rags, or to have in his possession flock manufactured from rags intended to be used for any such purpose, unless the flock conforms to such standard of cleanliness as may be prescribed by regulations to be made by the Local Government Board, and, if any person sells or uses or has in his possession flock in contravention of this Act, he shall be liable on summary conviction to a fine not exceeding, in the case of a first offence, ten pounds, or in the case of a second or subsequent offence fifty pounds. 163 HOUSES LET IN LODGINGS The 372 registered houses were under inspection during 1912, but no new houses were registered under the by-laws. Experience in Lambeth goes to show that the by-laws do not work out in practice as well as was anticipated when the by-laws were framed-the powers under the other Sections of the Public Health (London) Act, 1891, being more easily used in connection "with keeping of houses let in lodgings in proper order and condition. The Council is still considering alterations to the existing by-laws, power to do so being given under Section 16 of the Housing, Town Planning, etc., Act, 1909. BY-LAWS FOR HOUSES LET IN LODGINGS. Suggested new by-laws have been under consideration during 1912, to be framed under Section 16 of the Housing, Town Planning, etc., Act, 1909, in respect of lodging houses intended for the working classes. In these new by-laws it is suggested to impose any duty (being a duty which may be imposed by the by-laws and which involves the execution of work) upon the "owner" within the meaning of the Public Health Acts, in addition to, or in substitution for, any other person having an interest in the premises, and prescribing the circumstances and conditions in, and subject to, which any such duty is to be discharged. The existing by-laws (made by the late Vestry on April 26th, 1897, and allowed by the Local Government Board on May 11th, 1897) have been re-drafted on these lines and in accordance with the Housing, Town Planning, etc., Act, 1909, and submitted to the Board for observations, resulting in certain further amendments and alterations being incorporated. These suggested amended by-laws are still under consideration by the Board. 164 COMMON LODGING HOUSES. The 6 Common Lodging Houses (for men) within the Borough, were inspected during 1912, and the following defects were found to exist: 55 Belvedere Road (passage and staircase dirty), 108 Lambeth Walk (w.c. and drain and waste pipes defective), and 106 Wandsworth Road (defective paving of kitchen and washhouse and one w.c. connection defective). There defects were made good, and the 6 common lodging houses were again licensed by the London County Council at the Annual Licensing Meeting held June 27th, 1912, in accordance with the requirements of Section 46 of Part ix. of the London County Council (General Powers) Act, 1902:— Dates when registered originally. Situations of premises. Authorised No. of Lodgers. 27th January, 1905 10a Belvedere crescent 99 18th July, 1900 108 Lambeth walk (c.h. 39 (house in rear) 30th October, 1890 55 Belvedere road 49 21st December, 1883 90-92 Westminster bridge 197 road 24th October, 1885 89 & 91 Wandsworth road 188 12th February, 1887 106 Wandsworth road 133 165 REVENUE ACT, 1903 (And Section 35 of the Housing, Town Planning, etc., Act, 1909). During 1912, 235 certificates under the Revenue Act, 1903, in connection with tenements (or dwellings) so constructed as to afford suitable, separate accommodation for each of the families inhabiting the same, were applied for, and, of these, 119 were granted unconditionally, 100 were granted conditionally, i.e., subject to certain alterations and improvements being carried out, and 16 were refused. (1) Certificates granted unconditionally. Blocks or Houses. Tenements. 27 Belvedere Road 1 2 5 Benedict Road 1 2 1—20 (inclusive) Dover Mansions, Canterbury Road 2 20 108, 110, 112, 114, 116 Clive Road 5 10 60 Gipsy Hill 1 2 14, 15, 16 Kennington Oval 3 9 23 Mayflower Road 1 2 31, 33 Rosendale Road 2 8 12, 13, 14, 15 Rumsey Road 4 8 95, 97, 99, 101, 105, 107, 119, 121 Stamford Street 4 16 56, 58, 60, 62, 64 Stangate Buildings 3 9 64, 68, 72 Thorparch Road 3 6 10, 12, 14, 16, 18, 20,22, 24 Thurlow Hill 8 22 2, 3, 4 York Mansions (54 York Road) 1 3 39 119 166 (2) Certificates granted conditionally. Blocks or Houses. Tenements. 12, 13 Gloucester Street 2 4 3, 4, 5, 6, 7, 8, 9, 10, 11 Hamilton Terrace, Shakespeare Road 9 18 76, 78 Herne Hill Road 2 4 53, 55 Heyford Avenue 2 6 5, 6, 7, 8 Heyford Terrace 4 12 2 Langton Road 1 6 58, 61 Mervan Road 2 4 52, 54, 58 Pearman Street 3 9 1, 3, 5, 7, 9 Rushcroft Road 5 15 11, 22, 24 Victoria Road and calm, Salter's Hill 3 6 62, 66, 79 Thorparch Road 3 6 70 Thorparch Road 1 2 1, 3, 5, 7 Whiteley Road 4 8 41 100 (3) Certificates refused. Alfred Tenements, The Parade, Lambeth Walk 2 4 67, 69 Park Road 2 8 5,7, 9,10 Penrith Place 1 4 5 16 167 HOUSING OF THE WORKING CLASSES HOUSING, TOWN PLANNING, &c., ACT, 1909. House-to-House Inspections. These inspections are necessary under Section 17 of the Housing, Town Planning-, &c., Act, 1909, and under Regulations issued, as an Order, on September '2nd, 1910, with respect to the method in which such inspections of the district are to be made and records kept. During 1912, the Medical Officer of Health, as required toy Article 1 of the Regulations or Order, prepared the following lists of dwelling houses, the early inspection of which was, in his opinion, desirable, and such lists were duly approved by the Council:— Marsh Ward.—Asa Place, Broadwall, Grindal Street, Gray Street, Hammond Place, Johanna Street, Paris Gardens (Broadwall), St. Andrew's Place, Tower Street, and Victoria Place. Bishop's Ward.—Berkeley Street, Doris Street, Fountain Gardens, Goda Street, Old Paradise Street, Over Place, Pownall Terrace, Saville Place, Sidford Place, and Waxwell Terrace. Prince's Ward.—Beet Court, Bowling Green Street, Clayton Street, Dorset Road, Dunmow Place, Frank Street, Gunnell's Cottages, Gye's Buildings, Henry Street, Hunt Street, Keiller's Cottages (Dorset Road), Laud Street, Lilac Place, Lemon Place, Little Clayton Street, Oval Place, Palfrey Place, Mancroft Cottages, Salamanca Court, Shanklin Court, Spring Gardens and White Hart Street. Vauxhall Ward.—Albert Cottages (Neptune Street), Alfred Mansions (Dorset Road), Belmore Street, f 168 Dorset Road, Hemans Street, Hook's Cottages, Neptune Cottages, Neptune Street, Portland Cottages, Pascal Street, Simpson Street, Spring Gardens, Stamford Buildings (South Lambeth Road). Stock-well Ward.—Broomgrove Road, Fenwick Place, and Hargwynne Street. Brixton Ward—Alder's Cottages (Cumberland Place), Cranmer Road, Cumberland Cottages and Place, Industry Terrace, Ivan's Place, Lothian Road, Rose Cottages (Cumberland Place), Sellman's Cottages (Electric Lane), Stafford Road and Warham Street. Heme Hill Ward.—Anstey Road, Bredon Road, Cambria Road, Coldharbour Place, Effra Parade and Terrace, Hamilton Terrace, Kemerton Road, Mayo Cottages, Northway Road, Regent Road, Vining Street, and Wingmore Road. Tulse Hill Ward.—Branksome Road, Glenelg Road, Kildoran Road, Waterworks Place, and Stewart's Place. Norwood Ward.—Auckland Place, Benton's Lane, Change Alley, Cranfield Villas, East Place and Street, Gladstone Terrace, (Benton's Lane), Knight's Hill Square, Lepine Cottages, St. Cloud's Road, and Thomas Place. A total number of 1,576 houses have been systematically inspected during 1912, and in 124, i.e., 7.9 per cent., a result has been obtained from the test applied to the drains. A total of 4,257 nuisances were found to exist in 1,342 houses (i.e., 85.2 per cent. of the total houses inspected) but many were of a trifling nature and not in any sense dangerous to the health of the inmates of the houses concerned. 169 Summary. Number of houses inspected 1576 Number of houses in which a result was obtained from test (chemical) applied to drains 124 Number of houses in which nuisances were found to exist 1342 Number of houses in which no nuisances were found to exist 234 Nature of Nuisances found and dealt with under the Housing, Town Planning, etc., Act, 1909, or the Public Health (London) Act, 1891. Dirty premises (walls, ceilings, etc.) 784 Defective roofs, gutters, and rain-water pipes 543 Defective yard pavings 512 Defective flushing apparatus in w.c.s 91 W.C. pans foul 62 Drinking water taps defective 18 Drains stopped 24 Floors, windows, doors, and sash-cords defective 421 No dust bins (or dust bins defective or dilapidated) 110 Damp premises 460 Overcrowding 8 Defective w.c.s 73 Defective drains 124 Defective or deficient vent. or soil pipes 32 Defective sink wastes (or not under-trapped) 20l Defective manhole covers 4 Animals improperly kept 9 Cisterns uncovered, or improperly covered 21 Improper water supplies (not from main direct, etc.) 45 Forecourts insufficiently paved, or unpaved 123 W.C.s insufficiently lighted and ventilated 24 Want of ventilation under floors 242 Want of proper dung receptacles 6 f2 170 Underground rooms illegally occupied 9 Accumulations of manure 14 Defective traps and stopped gullies 37 Sinks connected direct to drains 16 Mica valves defective 28 Light and air spaces limited 201 Dilapidated Premises 95 Sundry minor defects, viz.: Defective fire-places (25), coppers (14) and chimneys (5) 44 Total 4381 Under the House-to-House Inspections Regulations, or Order, of 2nd September, 1910, certain classifications are adopted, so as to secure uniformity of statistics throughout the various districts and, adopting this classification, the results in connection with the 1,576 houses inspected during 1912 may be tabulated as follows:— i. Arrangements for preventing contamination of Water Supplies. (a) Drinking water from the main 1531 (b) Drinking water from cisterns 45 (c) Cisterns uncovered, or improperly covered 21 (d) Defective water taps 18 ii. Water Closet Accommodation. (a) Defective water closets 73 (b) Foul water closets 62 (c) Water closets insufficiently lighted and ventilated 24 (d) Defective water closet flushing apparatus 91 (e) Defective, or deficient, ventilating or soil pipes 32 171 iii. Drainage (with Results of Tests). (a) Results from chemical tests 124 (b) No results from chemical tests 1452 (c) Drainage stopped 24 (d) Defective manhole covers 4 (e) Defective mica valves 28 iv. Condition as to Light, Circulation of Air, Dampness and Cleanliness. (a) Light and circulation or air limited 201 (b) Damp premises 460 (c) Dirty premises 784 (d) Over-crowded premises 8 v. Paving, Drainage and Sanitary Condition of Yard or Out-Houses belonging to or connected with the Dwelling Houses. (a) Defective yard paving 512 (b) Insufficiently paved forecourts 123 vi. Arrangements for House Refuse. (a) No dust bins, or dust bins defective or dilapidated 110 (b) Want of proper dung receptacles 6 (c) Accumulations of manure 14 vii. Any Underground Rooms so dangerous or injurious to health as to be unfit for human habitation. (a) Underground rooms occupied in contravention of Section 17, Sub-section 7 9 viii. Defects or other matters tending to render houses dangerous or injurious to the other inmates. (a) Dilapidated premises 95 172 (b) Defective roofs, gutters, rain water pipes, etc. 543 (c) Defective floors, windows, doors, sash boards, fireplaces, coppers and chimneys 465 (d) Sink waste pipes connected direct to drain or defective or not under-trapped 217 (e) Want of air, or insufficient ventilation under floors 242 (f) Defective traps (gullies, etc.) and stopped gullies 37 (g) Animals improperly kept 9 ix. Action taken. Under the Housing, Town Planning, etc., Act, 1909, and the Public Health (London) Act, 1891, whilst in 33 cases, the dwelling-houses were closed by the Borough Council as the Local Authority under the Housing, Town Planning, etc., Act, 1909, as being unfit for human habitation, and have since been closed and demolished, closed, or put (or are being put) into proper order and condition so as to render them fit for human occupation. Representations and Closing Orders under Section 17. During 1912, the Medical Officer of Health made the following representations to the Council as the Local Authority under the Act, and Closing Orders were made by the Council in each case. 173 PREMISES. STATE. Date of Orders made by the Council. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Corsham Place, Frazier St., Lower Marsh 1, 2, 3, 4, 5, 6, 7, 8, Leman Place, Albert Embankment 1 Beet Court, Albert Embankment Generally not only dirty, damp and dilapidated, but also without proper light, and ventilation to the living rooms, which are, in addition, small in cubic capacity, being, on an average, less than 7 feet in height from floors to ceilings, and the ground floor rooms without proper ground ventilation under the floors, which are below the ground level, and the yards at the rears of the houses being very small and confined and the drains being leaky Generally speaking, dirty damp and dilapidated, and without proper spaces or ventilation beneath the ground floors Dirty, damp, and badly lighted and badly ventilated, and without proper ventilated spaces beneath the ground floors Jan. 18th, 1912 Feb. 29th 1912 Feb. 29th 1912 174 PREMISES. STATE. Date of Orders made by the Council. 1, 2, 3, 4, Gunnell's Cottages, Sala manca Street The dwellinghouses being, generally speaking diriy damp, dilapidated, badly lighted, Without through ventilation, without yards at rear, provided with dilapidated washhouses and watercloset buildings, without proper space and ventilation beneath the ground floors, etc. The dwellinghouses being generally dirty, damp and dilapidated without proper light and air circulation to living rooms, owing to the smallness and confined natures of the yards at the rears, and with ground floors below street level The dwellinghouse being generally dirty, damp and dilapidated and the living rooms being without through ventilation The dwellinghouses being generally dirty, and dilapidated, and being without through ventilation The dwellinghouse being dirty, damp and dilapidated. March 14th, 1912 Sept. 19th, 1912 Sept. 19th, 1912 Sept. 19th, 1912 Nov. 21st 1912 23, 25, 27, 29, 31. 33, 35 Grindal Street, and 4, 6, 8 Johanna Street, Lower Marsh 1 Dunmow Place, Newburn Street 1, 2 (double house), 3. 11, 12, 13, 14, Salamanca Court, Salamanca Street, Albert Embankment 186 Warham Street, Kennington Park. (late "Wagon and Horses" P.H.) 175 During 1912, 44 houses were dealt with by Closing Orders, and of these, 39 have since been demolished, 4 are being rendered fit for human habitation and 1 has not yet been dealt with owing to legal difficulties as to ownership. In connection with the closing of houses under the Housing, Town Planning, etc., Act, 1909, a total of 70 dwelling houses within the Borough have been represented by the Medical Officer of Health as being unfit for human habitation from the time the Act came into force (December 3rd, 1909) until the end of 1912, and Closing Orders have been made by the Borough Council, as the Local Authority, in connection therewith under Section 17 of the Act, "with the result that:— (a) 36 houses have been since demolished; (b) 26 houses have been closed; and (c) 8 houses have been, or are in process of being, rendered fit for human habitation (4 houses completed). In addition to the houses mentioned above, 27 houses have been dealt with under Section 15 of the Act, and voluntarily closed and since demolished by the owners. Comparison may be made with similar work (closure of dwelling houses) carried out under the Housing of the Working Classes Act, 1890, prior to the introduction of the Housing, Town Planning, etc., Act, 1909,—a period of 19 years—during which a total of 385 houses were dealt with by notices served by the late Vestry and the present Borough Council, under Section 32 of the Housing of the Working Classes Act, 1890, on the representation of the Medical Officer of Health that such dwelling houses were unfit for human habitation, viz.:— (a) 1891 to 1900 (10 years)—old Vestry 337 (b) 1901 to 1909 79 years)—Borough Council 48 Total 385 176 The Housing of the Working Classe Act, 1890, came into force on 18th August, 1890. In this connection, it must be remembered that the powers under the Housing, Town Planning, etc., Act, 1909, are wider than those under the Housing of the Working Classes Act, 1890, and deal with empty houses as well as with occupied houses; whilst Closing Orders under the former Act are made by the Borough Council, whereas under the latter Act such Closing Orders can only be made by a Magistrate, after taking evidence, in the usual way, in the Court. Housing in Waxwell Terrace. A petition, dated 25th July, 1912, and signed by 57 persons was received and considered by the Council during 1912. The petitioners described the houses in Waxwell Terrace as wholly insanitary and uninhabitable—a statement which could not be substantiated officially alter inspection by the Medical Officer of Health. Waxwell Terrace is under frequent inspection, notices having been served from time to time, as required. The houses are let out in tenements to persons whose personal habits are unsatisfactory, the houses themselves being, in so far as drainage and structure are concerned, in a fair condition. Several of the houses (odd numbers) on the south side of the Terrace have been re-constructed and re-arranged recently, so as to form practically part of the adjoining tenements belonging to the London & South Western Railway Company, with the result that a better class of tenant has been obtained in these particular houses, and the insanitary and otherwise undesirable conditions now no longer exist thereat. The rest of the houses are not in such a condition as to warrant Closing Orders being made by the Council as the Authority under the Housing, Town Planning, etc., Act, 1909. 177 Housing in Lambeth. During 1912, several communications were received by the Council from the London Workers' National Association, the Workmen's National Housing Council, the Moffatt Young Men's Conference and other Bodies, with reference to alleged insanitary houses (specially named*) to alleged slums within the Borough, and other matters dealing with the question of Housing. *Mancroft Cottages, Dunmow Place, Waxwell Terrace, Finck Street and 98 York Road. MUNICIPAL MILK DEPOT.* The new statistics for 1912 are subjoined. 267 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk:— Under 3 months 129 9—12 months 23 3—6 months 67 Over 12 months 19 6—9 months 29 — 267 Of the 129 infants under 3 months, 27 were aged 14 days or under, viz.:—1, 1, 1, 2, 3, 3, 7, 7, 7, 9, 9, 9, 10, 10, 10, 14, 14, 14, 14, 14, 14, 14, 14, 14, 14, 14 and 14 days respectively. These 267 infants and children 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 below par constitutionally 68, weakly 31, wasting- 124, diseased 44, total 267. The diseases from which the 44 infants and children were actually suffering at the time of being put upon the milk were : Diarrhoea 4, sickness 1, bronchitis 8, pneumonia 4, eczema 1, pulmonary tuberculosis 1, indigestion 9, convulsions 2, rickets 1, hernia 2, sickness and diarrhoea 4, measles 3, whooping cough 2, specific 1, and doubtful (? meningitis) 1. *The Staff consists of a Manageress (Mrs. Bourke), one permanent assistant (Miss Violet Berkeley), and one temporary assistant. 178 In 6 cases the infants were in a "moribund" condition. The periods during which the 268 infants and children continued to use the milk were:— 26 weeks and over 27 Under 4 weeks— 13—26 weeks 6—13 weeks 4—6 weeks 53 66 32 2—4 weeks 41 Under 2 weeks 48 267 54.5 per cent. used the milk for periods extending from 6 to 26 weeks and over, whilst 33.2 per cent. used the milk for short varying periods under 4 weeks. The reasons assigned for discontinuing the milk after varying intervals were:—(1) leaving the neighbourhood; (2) unable, or too far, to send; (3) by order of medical attendant; (4) unable to pay; (5) taken off by Relieving Officer; (6) unsuitable. In regard to (6), it is noteworthy that, of the 267 infants and children fed, in only 9 cases (i.e., 3.4 per cent.), was the milk stated to be unsuitable. An average of 95.2 infants and children were fed per week at the Depot, necessitating the distribution for the year of 142,846 bottles of milk mixture, whilst, in addition, milk was also supplied as follows:— 1. Lambeth Infirmary—a total of 963 (estimated) infants and children, using 11,780 pint bottles of milk mixture; 2. Lambeth Workhouse—a total of 117 (estimated) infants and children, using 1,082 pint bottles of milk mixture; 3. Invalids (including consumptives)—a total of 23 persons, using 2,441 pint bottles of milk mixture. Weekly medical consultations with mothers were held at the Depot, the babies being weighed, the weights and 179 other details tabulated in the Milk Register, and the babies were visited also at their homes by the Health Visitor. Milk was distributed not only from the Depot, but also from the Moffatt Institute (Upper Kennington Lane), the latter branch depot (distributing centre) being used for the convenience of the mothers living in the Vauxhall District. Of the 267 new infants and children fed, 7 died, and the periods (in days), during which they had been fed upon the milk prior to death, varied as follow:—2, 2, 3, 3, 4, 7 and 23 respectively. In other words:— Infants and children fed for 13 weeks and over 80 (0 deaths) Infants and children fed for 4 to 13 weeks 98 (0 deaths) Infants and children fed for periods under 4 weeks 89 (7 deaths) N.B.—Of the 7 deaths, all were in infants under 12 months, viz.: 14 days, 3 weeks, 7 months, 7 months, 8 months, 11 months and 15 months respectively. The mortality rates amongst the Depot-fed infants and children are lower than those registered in the Borough generally. As has been pointed out in previous reports in connection with these mortality-rates, allowance must be made for the difficulties of strictly comparing the rates amongst intants and children fed upon the milk and under observation for varying periods, with the rates for the whole, or portions, of the Borough, for a year or period of years. To be statistically correct, only those infants or children who have been fed upon the Depot milk for continuous lengthened 180 periods should be tabulated, whilst the numbers of deaths that occur during any given period less than a year should be increased pro rata, when dealing with rates for a year or period of years. It is assumed that the rates that are found to exist for short periods would be maintained during longer periods—an assumption that, in practice, is found to be warranted. It must be remembered that, as already stated, the infants who are placed upon the Depot milk are, as a rule, unhealthy and below par constitutionally, if not actually diseased, at the time of commencing the milk, and the longer they use the milk, the better their chances of life. If children die during the first month of taking the milk, it would be misleading to assume that all children would die at the same rate during the succeeding eleven months. The most conclusive proof of the value of a Milk Depot, in so far as the infants and children fed are concerned, is to be found in the medical histories of individual cases, which show again and again in the case of the Depot, that those infants and children who appear to be seriously ill and wasting, if not moribund, as the result of improper or irregular feeding, at the time of commencing the milk, actually recover and become strong and healthy. The educational value, too, of a Milk Depot must not be lost sight of. The net expenditure upon the maintenance of the Milk Depot, during the year ending December 31st, 1912, is stated by the Borough Accountant to have been £256 13s. lid., viz.:— (a) Expenditure £841 15 9 (b) Income 585 1 10 i.e., Expenditure in excess of Income £256 13 11 181 The net yearly expenditures since the Depot was opened are: 1906, £233 12s. 6d.; 1907, £206 0s. 0d.; 1908, £283 16s. 7d.; 1909, £315 8s. 8d.; 1910, £294 5s. 3d.; 1911, £214 18s. l0d.; 1912, £256 13s. 11d. The financial statistics must be considered with the good derived by the infants and children fed. The premises (66 York Road), have been assigned by Miss F. M. Crane to Mr. Ralph Edward Sapolin, of West Hill Cottage, Epsom (Agents, Messrs. P. & G. Geen). The salary of the Manageress (Mrs. Bourke) was increased during 1912 from 25/0 to 30/0 per week. BAKEHOUSES. There are, within the Borough, 214* Bakehouses (135 above ground and 79 underground), and these were inspected officially during 1912, and the /necessary annual whitewashing and cleaning carried out, as required. * 72 were certified during 1903-4 as "suitable" for occupation as underground bakehouses under section 101 Factory and Workshop Act, 1901. DAIRIES, MILKSHOPS AND MILK STORES. During 1912, 47 applications for registration were received and dealt with by the Council as follow:— 182 1.—Applicants not registered, the premises being "unsuitable" (i.e., not in accordance with the Council's requirements)—4. Wards and Addresses of Premises. Names of Applicants. Dates of Refusal by Council. MARSH. Nil BISHOP'S Nil PRINCE'S 110c Newington Butts Ayling, George July 25th 141 Vauxhall Walk Cook, George Ernest Dec. 19th VAUXHALL. Nil STOCKWELL. 3 Lingham Street Davies, Herbert D. May 9th BRIXTON. Nil HERNE HILL. 10 Mayall Road Beckling, H. C. H. S. Dec. 19th TULSE HILL. Nil NORWOOD. Nil 183 2.—Applicants registered, the premises being "suitable" (i.e., in accordance with the Councl's requirements) —42.* Wards and Addresses of Premises. Names of Purveyors Registered. Dates of Registration by Council. MARSH. 90 Broadwall Zubinena, Peter Dec. 19th 98 York Road Jones, Elizabeth Sept. 19th 67 York Road King, Mary July 25th BISHOP'S. 1 Berkeley Street Parker, Eliza Jan. 18th 1 Colwyn Street Stanger, Annie E. July 25th 4 Crezier Street Ernsting, John Apr. 25th 74 Ethelred Street Jessev, Edward Feb. 29th 154 Ethelred Street Blackley, A. Nov. 21st 80 Fitzalan Street Groom, Wiiliam Jan. 18th 10 Kennington Road Bedford, Richard Henry F. Feb. 29th 113 Lambeth Road ‡ Calver, Jane Feb. 1st 114 Lambeth Walk Smith, William David Jan. 18th 75 Lollard Street Cornell, A. W. July 25th 1 Old Paradise Street Ingram, Louise Feb. 1st 68 Walcot Square Ram, Walter Feb. 1st. PRINCE'S. 179 Lower Kennington Lane Pearce, Wm. W. July 11th 10a Magee Street ‡ Williams, Fred. Geo. S. Nov. 21st 123 Tyers Street Home, Midland and Western Counties Dairies Ltd. (Higg's Dairy Farms) June 13th * 3 A plications were withdrawn by the applicants after registration, and 5 were simply changes of occupiers. † Application withdrawn since registration. ‡ Change of occupier only. 184 Applicants registered, etc.—continued. Wards and Addresses of Premises. Names of Purveyors Registered. Dates of Registration by Council. VAUXHALL. 304 Clapham Road Welford's Surrey Dairies Jan. 18th 234 Clapham Road White, Frederick June 13th 36 Heyford Avenue † Wicks, Ernest A. Jan. 18th 29 Paradise Road † Breach, Alfred June 27th 44 Priory Grove Matthews, Emily Dec. 5th 161 South Lambeth Road Adams, & Co. June 13th STOCKWELL. 119 Ferndale Road Elland & Vincent Jan. 18th 20 Garden Row Enderby, John Thos. & Handsley, Walter May 23rd 10 Kepler Road Welford's Surrey Dairies Jan. 18th 23 Landor Road Pepper, Harold William June 27th 68 Landor Road Payne, James Jan. 18th 152 Landor Road Jones, Mary Mar. 14th 3 Lingham Street Davies, H. D. April 25th 1 Nealdon Street Pickford, Thomas H. Jan. 18th 1a Pulross Road Williams, Charles Jan. 18th 19 Santley Street Griffiths, John Hugh Jan. 18th 3 Sidney Road Watson, Wm. Henry Feb. 29th 56 Stockwell Road Lyddon, Walter Jan. 18th 126 Stockwell Road Davies, William L. Jan. 18th 164 Stockwell Road Evan, Thomas Jan. 18th 52 Tasman Road Strike, John Jan. 18th 4 Tunstall Road Woozley, John E. Jan. 18th BRIXTON. 1 Addison Place Lawrence, Florence J. July 11th 39 Akerman Road Jenkins, Evan July 11th † Applications withdrawn since registration. 185 Applicants registered, etc.—continued. Wards and Addresses of Premises. Names of Applicants. Dates of Registration by Council. BRIXTON— contd. 53 Chryssell Road Jenkins, Griffith July 11th 396 Coldharbour Lane† Langdon, H. July 25th 133 Denmark Road Morris, John July 25th 9 Gordon Grove Millin, Mrs. M. E. Nov. 21st 1 St. Mark's Road Carrington, Arthur Nov. 21st 2AWarham Street Mines, George Dec. 19th 23 Warham Street† Towler, F. May 23rd HERNE HILL. 32 Milkwood Road Butler, Alfred Ian. 18th 56 Railton Road Wraight, Drumbrill & Co. July 11th 131 Railton Road Williams, Joseph May 23rd 2 Vaughan Road* (2) Fowler, Alfred May 23rd Giffen, George Stanley Dec. 19th TULSE HILL. Nil. NORWOOD. 237 Gipsy Road Vowles, Walter George Dec. 19th 90 Hamilton Road Sewell, Wm. Lewis May 23rd 38 High Street Fellingham, Alice B. June 27th 61 Knights' Hill* (2) Holder, Charles Sept. 19th Lee, Thos. Johnson Nov. 21 st 46 Tivoli Road Knott, Wm. Thos. May 9th * Change of occupiers only. † Application withdrawn since registration. 186 MILK AND DAIRIES BILL. During 1912, the Council had under consideration the Milk and Dairies Bill and decided to bring to the notice of the Local Government Board and the London Members of Parliament, their objection to Clause 25 of the Bill, by which the provisions of the Bill are to apply to London, subject to such modifications as may be made by regulations of the Local Government Board—such regulations providing for any of the powers and duties of sanitary authorities and their Medical Officers of Health, under those provisions with respect to dairies, being exercised and' performed by the London County Council and their Medical Officer of Health. In the opinion of the Borough Council, such a change would lead to obvious clashing in the exercise of the duties of sanitary authorities under the Act and other Acts governing food and drugs throughout the Metropolis. COWHOUSES There were, within the Borough, at the end of 1911, 13 registered Cowhouses, and, at the Annual Licensing of the London County Council, held on October 28th and December 12th, 1912, the licenses were all renewed as follow:— 187 LIST OF THE 13 COWHOUSES LICENSED IN THE BOROUGH OF LAMBETH DURING 1912. Wards. Situation of Premises. No. of Sheds. Names of Licensees. Marsh 6 Coral Street, Lower Marsh 1 Owen, William. Bishop's 24 Distin Street 2 Vaughan, David. „ 36 Tracey Street 1 Evans, Anne. Prince's 30 Upper Kennington Lane 1 Davies, Thotnas. Vauxhall 9 Dawlish Street 1 Adams, John. „ 38 Hartington Road 1 Williams, John Morgan and Lewis David Brixton 34 Ingleton Street 1 Baker, Sarah Amelia & Frederick Norwood 93 Clive Road, W. Norwood 1 Wraight, Dumbrill & Co. Ltd. „ 15 Croxted Road, W. Dulwich 1 Wraight, Dumbrill & Co. Ltd. „ Eider Road Dairy, W. Norwood 2 Bacon, Charles. „ 156 Hamilton Road, W. Norwood 3 Grant, George Ephraim. „ 76 & 78 Gipsy Hill 3 French, Janus Thomas. „ 67 Rosendale Road 1 Bengafield, Sidney Adna. 188 The Borough Council is now responsible for the periodical inspection of the Cowhouses, and the due enforcement of all By-laws and Regulations, made in connection therewith, under the Dairies, Cowsheds, and Milkshops Orders, 1885, 1886, and 1899. Such duties were carried out by the London County Council previous to the passing of the Local Government Act, 1899. During 1912, no action was required to be taken before the Magistrate in regard to infringements of By-laws. SLAUGHTER HOUSES. There were within the Borough, at the end of 1911, 19 registered Slaughter-houses, and at the Annual Licensing of the London County Council, held on October 28th and December 12th, 1912, the licenses were all renewed as follow:— Wards. Situations of Premises. Names of Licensees. Marsh 99 Lower Marsh* Bacchus, James „ 106 „ Thomas, Robert Edwin Bishop's 151 Lambeth Walk Milton, Robert William Prince's 60 Kennington Park Road Grellier, Frederick „ 406 Kennington Road Parsons, Bernard William * Small cattle only to be killed. 189 Wards. Situations of Premises. Names of Licensees. Vauxhall 152 Clapham Road Lawrence Bros. „ 18 Paradise Road (rear of) Elphick, Edwin Stockwell 27 Bedford Road, Clapham Road Pooley, John Peed Brixton Near Railway Hotel Brewery, Electric Lane, Brixton Ford, Henry, & Co., Ltd. „ 10 Foxley Road* Maiden, Robert Levers „ Industry Terrace (yard leading to), Canterbury Road Warren, Emma Sanders Heme Hill 207 Coldharbour Lane Clark, Albert John Heme Hill 309 Coldharbour Lane Ross, William Charles „ 77 Dulwich Road Atkin, Jim Cook Tulse Hill 12 Lower Tulse Hill Rooksby, Walter „ 45 New Park Road Beaumont, Edith Mary Norwood 125 Hamilton Road Forss, Thomas Lionel „ 120 High Street*† Griffiths, Frederic „ 121 „ „ Griffiths, Frederic * Small cattle only to be killed. † Special conditions laid down. 190 The Borough Council is now responsible for the periodical inspection of the Slaughter-houses and the due enforcement of all By-laws and Regulations made in connection therewith, under the Slaughter-houses, etc., Metropolis Act, 1874, and the Local Government Act, 1888. Such duties were carried out by the London County Council previous to the passing of the Local Government Act, 1899. During 1912, no action was required to be taken before the Magistrate in regard to infringement of By-laws. OFFENSIVE TRADES During 1912, no nuisance was reported in connection with the three offensive trades, which are registered as established within the Borough, and which are under the supervision of the Borough Council:— 1. Fat Melters—Upper Marsh (Messrs. J. C. & J. Field). 2. Soap Boilers—Upper Marsh (Messrs. J. C. & J. Field). 3. Tripe Boilers—103 Lambeth Walk (Messrs. nett, Son & Co.). During 1912, the tripe-boiling business at 115 Lower Marsh lapsed from disuse, by Section 19 (8) of the Public Health (London) Act, 1891, and the entry in the Register of Offensive Trades was cancelled, in consequence, by the London County Council. 191 Suggested New By-laws under Section 9 of the London County Council (General Powers) Act, 1908, for regulating the conduct of the businesses of a Fish Curer, Fried Fish Vendor, and Rag and Bone Dealer. Suggested by-laws under Section 9 of the London County Council (General Powers) Act, 1908, for regulating the conduct of the businesses of a fish curer, fried fish vendor and rag and bone dealer, framed by the London County Council, have again been considered during 1912, and objection has been taken, in connection therewith, to the suggested duality of administrative control sought to be established by the by-laws, for which dual control there appears to be no provision in the Act. A Public Enquiry was suggested prior to the confirmation of the by-laws. The Borough Council, further, again* suggested (a) the insertion in the by-laws of the word "dust-bins," so that the words "business of a rag and bone dealer" should be held to mean, in addition, "the business of a dealer in dust-bin refuse," and (b) that a definition should be laid down of the words "vendor of fried fish." Suggestion (a) has been incorporated, practically, in by-law No. 2, applying, however, only to "premises wherein; any infectious disease exists." The by-laws await the final confirmation of the Local Government Board. REFUSE AND MANURE DEPOTS The 13 Public Depots, situated in the Borough, were under constant (daily, during the summer months) supervision during 1912, and, in connection with the Destructors * The Council made the same suggestions in 1909. 192 and Dust Yards situated in Tinworth Street (Prince's Ward) and Commercial Road (Marsh Ward), a large number of visits were paid, but in no instance was a nuisance discovered with which the Council could deal, having regard to the provision in the by-laws, permitting of the depositing of refuse and offensive matters for a reasonable period of 12 hours during the process of removal. Cautionary letters were sent as required, but no action was taken before the Magistrate. Removal of House Refuse. During 1912, the question of the suggested alteration or amendment of the by-laws made under Section 16 (2) of the Public Health (London) Act, 1891, relating to the removal of house refuse, by which such refuse shall be collected from all premises more frequently than once a week. Power is at present given under the by-laws for (a) a weekly, or (b) a daily removal of house refuse, and in the Borough the weekly removal is in vogue with a few exceptions stated by the Engineer as follows:— (a) Twice a week: (1) The whole of the district to the north of Lambeth Road; (2) Certain large business premises and shops in various parts of the Borough, also blocks of dwellings, schools, and public buildings, such as Empress Theatre, Stockwell Hospital, Fire Station, Police Station, Stockwell College, St. Gabriel's College, (Cormont Road), Lambeth Public Baths, etc., etc. (b) Three times a week: Rowton House, Vauxhall; Campbell Buildings (Maudsley's site), Westminster Bridge Road; Shops in Atlantic Road, Electric Avenue and Station Road, Brixton. 193 (c) Daily: Princes Road Workhouse; St. Thomas's Hospital; Waterloo Road Hospital for Women and Children; Brook Street Infirmary; Renfrew Road Workhouse; York Hotel, and certain other business premises and coffee shops in the district to the north of Lambeth Road. The Council approved the present Lambeth arrangements for the collection of house refuse as being quite adequate for the needs of the Borough, and, further, agreed to to suggested amendments of the by-laws made by the London County Council under Sections 16 (2) and 39 (1) of the Public Health (London) Act, 1891, in so far as buildings of the warehouse type are concerned, was to secure the following improvement, viz.: the depositing in suitable receptacles by occupiers of refuse for weekly collection purposes in such conveniently accessible positions as the Borough Council might prescribe.* The difficulties, inconveniences and delays frequently experienced in securing the removal of house refuse are well known, particularly in the case of let-out premises of the warehouse type by the necessity for the scavengers to ascend high buildings (at times making two or three journeys) in order to obtain each separate lot of refuse from the various rooms or floors, no common receptacle being provided. Further, need exists for proper suitable receptacles being provided owing to the varied interpretations placed upon the words "moveable receptacle" mentioned in by-law 6 made under Section 16 (2) of the Public Health (London) Act, 1891. Hours of Removal of Refuse. During 1912, the London County Council replied on January 25th, objecting to the suggestion of the Lambeth * Suggested by Finsbury Borough Council in a letter dated Jan. 23, 1912. 194 Council that the by-laws as to the removal of offensive matters should be amended so as to permit of such removal being made between the hours of 12 o'clock midnight and 8 a.m. throughout the year. The ground for the objection was the fact that the present by-laws* were framed prescribing the removal of refuse during the daylight, was to exercise proper control over such removal. Further, the County Council expressed the opinion that the Local Government Board would not be likely to approve of the suggested amendment. EFFLUVIUM NUISANCES. (a) Railway Arch, 187 Hercules Road. Complaints were received during 1912, as to nuisance to the employees from the mixing of materials used for casehardening. On inspection, it was found that a small room was partitioned off the arch, constructed of painted canvas, nailed on wood frames, with a capacity of 12ft. wide by 20ft. long by 9ft. Gin. high, and was used for the purpose of mixing five different materials to make the material used for "case-hardening." The room was badly lighted (4 common tin paraffin lamps) and there were no means of ventilation, so that the employees were subjected, during work, to a danger to health on account of the large quantities of dust given off during the mixing of the materials. No respirators were provided for the use of the employees nor were there any means for washing near to the work, the tap being placed outside the arch in the yard. A notice was served upon the occupiers—a firm of engineers, who, in consequence, shut down the works at the arch. In the notice, a mechanical mixer and extractor of dust were suggested, together with the provision of respirators for the use of the employees whilst at work. * The present by-laws lay down the hours of 4 a.m. to 10 a.m. March to October (inclusive), and 6 a.m. to 12 noon November to February (inclusive). 195 BACTERIOLOGICAL LABORATORY. At the Bacteriological Laboratory during 1912, 1,177 examinations were carried out as compared with a yearly average for the decennium 1902-11 (Borough) of 843.2. The local and central position of the Laboratory at Wanless Road is advantageous, enabling the results of examinations to be quickly obtained at a minimum cost. The Laboratory was originally fitted up by the late Vestry in 1899, and since then (up to the end of 1912) *10,687 examinations have been made, viz.:—Tuberculosis 2907, typhoid fever 898, diphtheria 6,701, and others 181. The total 1,177 bacteriological examinations carried out during 1912 deal with 601 sputa (suspected consumption), 57 bloods (suspected typhoid fever), 497 throat and nose membranes and discharges (suspected diphtheria) and 22 other materials, e.g., hairs (2), pus (11), urine (9). Details are as follow: Tuberculosis— 601 samples of sputa from doubtful tuberculosis cases were examined, and in 296 (i.e., 49.2 per cent.) tubercle bacilli were found. Pneumococci were isolated in four samples. Pulmonarv consumption (with tuberculous expectorations) was made voluntarily notifiable throughout the Borough of Lambeth on (and after) June 1st, 1902, and pulmonarv consumption compulsorily notifiable under the Public Health (Tuberculosis) Poor Law Regulations, 1908, on and after Januarv 1st, 1909, under the Public Health (Tuberculosis) in Hospitals) Regulations, 1911, on and after May 1st, 1911, and under the Public Health (Tuberculosis) Regulations, 1911, on and after January 1st, 1912. By means of *1889—389; 1900—703; 1901-479; 1902—466; 1903—525; 1904—447; 1905—1874; 1906-761; 1907-786; 1908—718; 1909-781; 1910—605; 1911—976; 1912—1177; Total-10687. 196 bacteriological examinations, greater exactitude in diagnosis is secured. The large increase in the numbers of samples of sputum examined is due to the introduction of the Public Health (Tuberculosis) Regulations, and the carrying out of the "sanatorium benefit" under the National Insurance Act. Typhoid Fever. 57 samples of blood from suspected typhoid cases were examined, and in 31 (i.e., 54.4 per cent.) the characteristic Widal reaction was obtained, although in 11 cases but slightly marked. A high dilution of blood-serum was used (1-60 to 1-100). Diphtheria. 497 samples of throat and nose membranes and secretions from doubtful diphtheria cases were examined, and in 55 (i.e., 11.1 per cent.), the true Klebs-Loeffler bacilli were isolated. In 442 (i.e., 88.9 per cent.) of the total number of throat and nose samples examined, the Klebs-Loeffler bacilli were not isolated, but other bacilli were, e.g., staplylococci, streptococci, toruloe, micrococci, diplococci sarcinoe, and pseudo [Hoffmann) bacilli. The last-named, viz.: pseudo (Hoffmann) bacilli, were isolated in 4 cases—2 in pure cultivation and 2 mixed with true Klebs-Loeffler bacilli. 22 samples of other materials were examined, viz.: hairs (for tinea tonsurans), 2 (1 positive), pus (for gonococei) 11, (4 positive), urine (for phosphates and urates) 7 (all positive), urine (for gonococci) 1 (negative), and urine (for tubercle bacilli) 1 (negative). Antitoxin. The Borough Council distributed during 1912, free of cost to medical practitioners practising in the Borough, 38 vials of antitoxin under the Antitoxin Order, 1910. 197 1912. Sputa— Tub. Bac. found. Bloods— Typhoid reaction obtained. Throat and Nose Membranes and Discharges— Klebs. Lœffler Diphtheria Bac. found. Yes. No. Total. Yes. No. Total. Yes. No. Total. January 20 17 37 4 1 5 8 42 50 February 37 16 53 5 3 8 14 44 58 March 24 34 58 2 5 7 4 63 67 April 23 18 41 2 1 3 5 33 38 May 18 43 61 3 1 4 3 39 42 June 32 29 61 2 4 6 2 34 36 July 26 30 56 — 2 2 7 35 42 August 7 16 23 3 3 6 2 13 15 September 24 17 41 3 2 5 3 34 37 October 38 32 70 1 — 1 1 40 41 November 23 27 50 2 1 3 4 30 34 December 24 26 50 4 3 7 2 35 37 TOTALS 296 305 601 31 26 57 55 442 497 N.B.—20 other samples were also examined during 1912, viz.: Hairs (2), Pus (11), Urine (9). MORTUARIES AND CORONERS' COURTS* The 2 Coroners' Courts are under the jurisdiction of the London County Council—the Wanless Road one being the freehold of the County Council, and the High Street one being rented at a rent of £100 per annum by the London County Council from the Borough Council, the freeholders. *N.B.—The Wanless Road Mortuary and Coroner's Court was opened April 12th, 1897. The administration of the Mortuaries was transferred to the Medical Officer of Health's department at the end of 1896. The Council's Mortuary Keepers are:—Joseph Fazey (Wanless Road) and Robert William Harris (High Street), the latter being appointed vice S. G. Albin. who died Jan. 5th, 1912. There is, also, a Deputy Mortuary Keeper (John Walker). Each Mortuary Keeper is provided with rooms at or near the Coroners' Courts, with gas, coal and taxes free. A uniform is also provided. 198 The 2 Mortuaries (Wanless Road and High Street) are the freeholds of the Borough Council. The following are the details of work done during 1912 at the 2 mortuaries and corners' courts:— (a) Total number of bodies received, 357—270 at High Street and 87 at Wanless Road. (b) Post-mortem examinations conducted 195—139 at High Street and 56 at Wanless Road. (c) Coroners' court sat 160 times—121 at High Street and 39 Wanless Road. (d) Number of bodies brought in by the Police 49—33 to High Street and 16 to Wanless Road. (e) Number of bodies brought in by undertakers or private persons 308—237 to High Street and 71 to Wanless Road. (/) Infectious bodies received 2—0 at High Street and 2 (both enteric fever) at Wanless Road. There were 39 suicides investigated (11 drowning, 12 poisoning, 4 hanging, and 8 throat cutting), and 4 accidental deaths (1 railway, 1 street, and 2 suffocation from coal gas). Of the total 357 bodies received, 218 were males and 139 females. The yearly averages for the two decennia 18911900 (Parish) and 1902-11 (Borough) are respectively (a) bodies received 355.8 and 388.9, (b) post-mortems conducted 210.8 and 215.4, (c) sittings of coroners' court 194.0 and 176.0. The mortuary for Norwood has not yet been provided, but it has Been provisionally arranged on the plan for such a mortuary in connection with a small part of the freehold site (south-eastern corner) in Rommanv Road, which is being developed by the Council for a Dust Depot at Norwood. 199 The old Watch House (the residence of the High Street Mortuary Keeper) was condemned during 1912 on the ground of its dampness due to its unfavourable site and the absence of damp courses and concrete, etc., and a temporary residence was provided for the Mortuary Keeper at 206 Lambeth Road. During 1912, a new ambulance wagon for river bodies was provided. INQUESTS. During the year 1912, within the Borough of Lambeth, 309 Lambeth cases were submitted to the Coroner (who, in 15 instances, decided that no further inquiries were necessary, the deaths being due to natural causes). In the remaining 294 cases, inquests were held with the following result:— 1. Natural Causes 152 II. Accidental Causes 107 Burns and Scalds 12 Drowning 5 Run over 16 Falls, etc. 24 Suffocation 10 Fracture 18 Misadventure 15 Crushed 2 Blood Poisoning 5 III. Homicidal Causes 33 Suicide 32 Murder 1 Manslaughter — IV. Open- Verdicts 2 Found Drowned 2 Total 294 200 The yearly averages for the two decennia 1891-1000 (Parish) and 1902-11 (Borough) are respectively 350.0 and 341.9. REMOVAL OF INFECTED CHILD FROM THE COUNTRY H.B. (aged 12 years), of 99 Coronation Buildings, South Lambeth Road, went on a visit to Pulborough, where he contracted, and was notified on August 9th, 1912, as suffering from, scarlet fever. There being no isolation hospital at Pulborough, the mother brought the child home to Lambeth by train, and on arrival he was removed to the M.A.B. Fever Hospital, and the necessary disinfection afterwards carried out. The carriages of the train in which the patient travelled were disinfected. No legal proceedings were instituted against the parents who, apparently, acted in ignorance of their liabilities under the Acts, and did all in their power to prevent the spread of the disease under the circumstances. NOTIFICATION OF LEPROSY The Council, during 1912, decided to support the Greenwich Borough Council's application to the London County Council asking that an Order should be made making leprosy compulsorily notifiable throughout the Administrative County of London, so that the usual precautionary measures might be applicable to that disease. The London County Council refused the application on the ground that there was not sufficient evidence to warrant the inclusion of leprosy in the list of notifiable infectious diseases, but, having regard to the importance of the matter, drew the attention of the Local Government Board to the subject. 201 NEW DRAINAGE WORK AND SANITARY OFFICERS' SALARIES The London County Council have power to repay to Borough Councils from the Exchequer Contribution account, a full moiety of the salaries of the Sanitary Inspectors, under the terms of Section 108 (1) of the Public Health (London) Act, 1891. In 1903, the question was raised as to the repayment in connection with new drainage works carried out under the Metropolis Local Management Acts, the supervision of such new work not being, in the opinion of the County Council, the duty of a Sanitary Iuspector as prescribed by the Local Governmment Board's Order of December 8th, 1891, relating to the appointment and duties of sanitary inspectors. For Lambeth, per cent. was deducted for this particular work—a deduction that has been made yearly sincc 1903. An amendment of the Board's Order was suggested so that there might be no possible doubt as to the interpretation of such Order, but nothing has been done by the Board in connection with the suggestion. The question was again raised during 1912 and the Council decided to request the Board to take into consideration the question of the duties of sanitary inspectors under the provisions of the Sanitary Officers (London) Order, 1891, and to amend the Order so as to provide that the supervision of all drainage works shall be one of the prescribed duties of sanitary inspectors, and until the Order be so amended, to authorise the payment by the London County Council of the full moiety of the salaries without any deduction in respect of the supervision of new drainage works. To this request, the Board replied stating that as Section 75 of the Metropolis Management Act, 1855, requires that a new house shall have a drain constructed and provided to the satisfaction of the Surveyor, it is open to doubt whether the duty of supervising the construction of new 202 drains could be undertaken by sanitary inspectors as part of the work regularly devolving upon them. GOVERNMENT BUILDINGS AND PUBLIC HEALTH ACTS. During 1912, the Council again expressed the opinion that the exemption claimed by the Crown in respect of buildings used for Government purposes from the operation of the Public Health Acts requires amendment, in view of the danger to the public health caused thereby. CLERICAL STAFF The clerical staff consists of 1 Chief Clerk Class 1 (W. R. Lawrence); I Special Clerk to the Medical Officer of Health, to have the status of a Chief Clerk in Class 1 (A. L. Baxter); 2 Assistant Clerks, Class 2 (W. J. Lawrence and A. E. Ruel); and two Boy Clerks, Class 3 (W. E Crolev and T. M. Charlton). During 1912, a report was presented by the Medical Officer, pointing out that the clerical staff of the Public Health Department was under-staffed, when compared with other Public Health Departments, and suggesting that it should be increased and re-arranged, with the result that the staff was increased by the appointment of an extra Boy Clerk and rearranged by the raising of the second clerk (and Special Clerk to the Medical Officer) to the status of a Chief Clerk in Class 1, the abolition of the office of Register Clerk and the promotion of such clerk to the position of an Assistant Clerk (Class II.). This increase and re-arrangement of the clerical staff is shown as follows1:— 203 Old Staff. 1 Chief Clerk (Class I.). 1 Second Clerk and Special Clerk to the Medical Officer. New Staff. 1 Chief Clerk (Class I.). 1 Special Clerk to the Medical Officer (to have the status of a Chief Clerk in Class I.). 1 Assistant Clerk (Class II.). 1 Register Clerk (unclassed). 2 Assistant Clerks (Class II.). 1 Boy Clerk (Class III.). 2 Boy Clerks (Class III.). During 1912, there were 13,919 letters, etc., received (entered in letter book), 20,987 letters, etc., sent out (entered in postal book), 12,506 Notices issued, 7,241 letters typed, and 6,613 complaints entered in the complaint book. APPENDIX. a 2 Local Government Board New Tables. Table l. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1912 AND PREVIOUS FIVE YEARS (1907-11). Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in District. Transferable Deaths. ‡ Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. † of Residents not registered in the District. † Under 1 Year of Age. At all Ages. Number. * Rate. Number. * Rate per 1,000 Nett Births. Number. * Rate. Number. † Rate. 1 2 3 4 6 6 7 8 9 10 11 12 13 1907 318538 8650 7806 24.5 4926 15.5 748 474 941 1205 4652 14.6 1908 321344 8906 8035 25.0 4692 14.6 863 512 829 103.1 4341 13.5 1909 324188 8445 7578 23.4 4876 15.0 826 490 830 109.5 4540 14.0 1910 327074 8373 7344 22.5 4348 13.3 795 527 691 94.1 4080 12.5 1911 297957 8405 7292 24.5 4584 15.4 852 712 905 124.0 4444 14.9 1912 297550 8168 6953 23.3 4189 14.1 823 634 600 86.3 4000 13.4 Notes.—This Table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 the corrected rates are slightly different. The rates are calculated per 1000 of the estimated gross population, and no deductions have been made from the population for large Public Institutions for the sick or infirm. *In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the Borough. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. †Column 8 is prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph below; the Registrar-General supplied the particulars of deaths (75) entered in Column 9; and all such deaths are included in this Column, unless an error has been detected, and it6 correction has been accepted by the Registrar-General. For Column 4 the Registrar-General has furnished a Statement of the number of births needing to be added to or subtracted from the total supplied by the local Registrar 1-92 outward and 77 inward transfers). "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances under 3 (b) below. In Column 8 the number of transferable deaths of "non-residents" which are deducted and in Column Column 9 the number of deaths of "residents" registered outside the district which are added are stated in calculating the nett death-rate of the Borough. Census 1911. Area of Borough in acres (exclusive of area covered by water), 4079.6. Average number of persons per house (estimated) 6.7. Number of inhabited houses 441123. Total population at all ages, 298058. 3 Local Government Board. New Tables. Table II. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1912. notifiable disease. number of cases notified. total cases notified in each locality. (e.g. Parish or Ward) of the District. total cases removed to hospital. At all Ages. At Ages—Years. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. Under 11. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwds. Small-pox - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 333 3 111 178 22 17 2 - 50 55 85 70 73 304 Erysipelas 216 10 13 15 93 7? 57 26 49 47 52 48 27 76 Scarlet Fever 604 6 161 349 54 33 1 - 111 82 119 157 135 563 Typhus Fever - - - - - - - - - - - - - - Enteric Fever 61 - 1 12 15 22 11 - 6 16 6 16 17 46 Relapsing Fever - - - - - - - - - - - - - — Continued Fever 1 - 1 - - — — — — — 1 — — — Puerperal Fever 24 - - - 8 16 - - 4 6 6 3 5 13 Plague - - - - - - - - - - - - - — Phthisis Under Tuberculosis Regulations, 1908 709 - 4 53 55 341 217 39 173 253 136 75 72 — Under Tuberculosis (Hospitals) Regulations, 1911 612 2 7 36 156 3?9 81 1 156 117 121 141 77 - Under Tuberculosis Regulations, 1911 620 1 9 70 128 308 93 11 146 102 86 173 113 — Cerebro-spinal Meningitis 7 2 5 — — — — — 2 2 2 — 1 5 Polio myelitis acute 10 — 8 2 - — — — 3 4 2 1 — 3 Opthalmia Neonatorum 76 76 - - - — — — 22 21 12 20 1 2 Chicken-pox — — — — — — — — — — — — — — 3273 110 320 715 460 1138 462 77 715 705 628 704 521 1012 Isolation Hospitals, Name and Situation —Hospitals of the Metropolitan Asylums Board lone 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 notifiable infectious diseases and (partly) Measles and Whooping Cough. 4 5 Local Government Board New Tables. Table iii. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1912. BOROUGH OF LAMBETH. CAUSES OF DEATH. NETT DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT (a). TOTAL DEATH WHETHER OF "RESIDENTS" OR "NONRESIDENTS" IN INSTITUTIONS IN THE DISTRICT (b). All ages. Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 3706 557 160 137 97 116 574 915 1150 1872 Uncertified 294 43 11 15 21 16 41 95 52 Typhus Fever ... ... ... ... ... ... ... ... ... 1 Enteric Fever 13 ... ... 1 1 2 5 4 ... 15 Continued Fever 1 ... 1 ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Measles 98 19 42 31 6 ... ... ... ... 63 Scarlet Fever 9 ... 1 6 2 ... ... ... ... 16 Whooping Cough 56 24 15 14 3 ... ... ... ... 6 Diphtheria and Croup (See note (d)) 29 3 4 13 8 1 ... ... ... 51 Influenza 40 2 ... ... ... 1 5 14 18 2 Erysipelas 13 1 ... ... ... 2 3 2 5 11 Cerebro-Spinal Fever 2 1 ... 1 ... ... ... ... ... ... Polio-myelitis acuta ... ... ... ... ... ... ... ... ... ... Venereal Diseases 20 14 ... ... ... ... ... 4 2 ... Phthisis (Pulmonary Tuberculosis) 390 3 1 6 11 39 201 113 16 171 Tuberculous Meningitis (See note (e)) 32 8 6 7 9 1 1 ... ... ... Other Tuberculous Diseases 67 13 5 11 10 8 11 7 2 ... Rheumatic Fever 12 ... ... ... 1 3 4 3 1 3 Cancer, malignant disease (See note (f)) 378 ... ... ::: 2 3 47 188 138 ... Bronchitis 363 44 7 2 ... 2 13 83 212 211 Broncho-Pneumonia 142 47 42 20 5 1 3 7 17 Pneumonia (all other forms) 184 11 5 4 3 7 48 68 38 Other diseases of Respiratory organs 81 10 ... 3 2 3 11 28 24 ... Diseases of Circulatory System 463 3 ... 1 11 20 63 126 239 168 Diseases of Nervous System 352 24 4 4 8 11 40 117 144 ... Diarrhoea and Enteritis (See note (g)) 101 72 9 6 3 1 5 1 4 46 Appendicitis and Typhlitis 16 ... ... ... 5 3 2 4 2 26 Alcoholism (See note (h)) 27 ... ... ... ... ... 12 14 1 ... Cirrhosis of Liver 49 1 ... ... 1 ... 9 31 7 ... Nephritis and Bright's Diseases 136 ... 1 3 2 4 25 58 43 ... Puerperal Fever (see note (i)) 14 ... ... ... ... 4 10 ... ... 16 Other accidents and diseases of Pregnancy and Parturition 10 ... ... ... ... 1 9 ... ... ... Congenital Debility and Malformation, including Premature Birth (See note (j)) 246 239 6 ... ... 1 ... ... ... ... Violent Deaths, excluding Suicide 128 18 6 8 13 5 19 37 22 81 Suicides 35 ... ... ... ... 1 13 13 8 ... Other Defined Diseases 481 10 14 11 12 8 54 84 258 1185 Diseases ill-defined or unknown 12 3 2 ... ... ... 2 4 1 ... 4000 600 171 152 118 132 615 1010 1202 1872 Notes to Table iii. (a) All "Transferable Deaths" of residents, i.e., of persons resident in the District who have died outside it. are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e.. of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term "transferable deaths" see footnote to Table I. The total deaths in column 2 of Table III. equal the figures for the year in column 12 of Table I (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or non-residents, are entered in the last column of Table III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified": all other deaths are to be regarded as "Uncertified." (d) This heading includes all deaths from croup except those certified as due to 'spasmodic.' 'stridulous.' 'catarrhal.' or 'false croup. (e) Under "Tuberculous Meningitis" are included deaths from Acute Hydrocephalus (f) Under "Cancer" are included deaths under such headings as Carcinoma. Scirrhus. Epithelioma. Rodent ulcer. Sarcoma, Cancer, and Malignant Disease. (g) Under this heading are included deaths registered as due to Epidemic diarrhœa, Epidemic enteritis. Infective enteritis. Zymotic enteritis. Summer diarrhoea. Choleraic diarrhoea. Cholera (other than Asiatic). Gastro-enteritis. Gastro-intestinal catarrh. Muco-enteritis. Colitis, etc Deaths from Diarrhoea secondary to some other well-defined disease are included under the latter. For "Dysentery" see note at foot of Table III. (h) Under this heading are included deaths from Delirium tremens, acute and chronic alcoholism, etc.. but not those certified as due to organic disease attributed to alcoholism. The number of the latter may with advantage be stated separately, though this statement cannot be included in Table III. (i) Under "Puerperal Fever" are included deaths under such headings as Pyaemia, Septicaemia. Sapraemia, Pelvic peritonitis, Peri- and Endo-metritis occurring in the Puerperium. (j) Under this heading are included also deaths from Atrophy and Marasmus of Infants, and want of Breast-milk. but not from Atelectasis. 6 7 Local Government Board New Tables. Table iv. BOROUGH OF LAMBETH—INFANTILE MORTALITY, 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OF DEATH. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. All Causes Certified 125 39 31 27 222 95 87 91 60 555 Uncertified 10 . 4 2 6 22 11 9 - 1 43 Measles - - - 1 1 - 2 8 8 19 Diphtheria and Croup — — — — — — 1 1 1 3 Whooping Cough — — — 1 1 4 3 8 8 24 Diarrhœa — — 1 3 4 8 10 2 1 25 72 Enteritis (Epidemic) — 3 1 — 4 10 12 8 1 35 Enteritis - 1 1 - 2 3 3 2 2 12 Influenz - - - - - 1 - 1 - 2 Tuberculous Meningitis - - - - - 2 - 4 2 8 Abdominal Tuberculosis — - - - - - - 1 1 2 Other Tuberculous Diseases — 2 2 — 4 - 4 4 2 14 Congenital Malformations 5 4 3 2 14 9 5 3 3 34 Premature Birth 85 17 10 6 118 5 1 - - 124 Atrophy, Debility and Maramus 9 6 8 5 28 18 14 7 3 70 Atelectasis 9 2 - - 11 — — — — 11 Erysipelas - - - - - 1 — — — 1 Syphilis 2 1 1 4 8 6 — — — 14 Rickets - - - - - — — — 1 1 Meningitis (not Tuberculous) - - - - - — 1 3 3 7 Convulsions 4 2 1 1 8 1 — 2 — 11 Gastritis - - 1 - 1 2 1 — — 4 Dentition — — — — — — — 6 2 8 Laryngitis — — — — — — - 1 - 1 Bronchitis 1 1 —- 5 7 9 12 8 8 44 Pneumonia 1 — 1 — 2 2 3 1 2 10 57 Broncho Pneumonia 1 1 — — 2 10 10 14 10 46 Pleuro - - - - - — — 1 - 1 Suffocation, overlying 2 — 1 1 4 3 2 — — 9 Accident, other than Suffocation 4 1 — — 5 1 2 — 1 9 Other causes not classified above 12 2 2 4 20 11 10 6 2 49 135 43 33 33 244 106 96 91 61 598 8 Home Office Tables. BOROUGH OF LAMBETH, 1912. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection of Factories, Workshops and Workplace* including inspections made by sanitary inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries). 10 214 - Workshops (Including Workshop Laundries). 157 Workplaces (Other than Outworkers' Premises included in part 3 of this Report). - Total 167 214 - 9 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts":— Want of Cleanliness 97 97 - - Want of Ventilation 3 3 — - Overcrowding 7 7 — - Want of drainage of floors — — — — Other nuisances 143 143 — — Sanitary accommodations. insufficient 1 1 — — unsuitable or defective 135 135 — — not separate for sexes 1 1 — — Offences under the Factory and Workshops Act:— Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Totals 387 387 - - * Including those specified in Sections 2, 8, 7 and 8 of the Factory and Workshop Act, as remediable under the Public Health Acts. 10 11 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107, OUTWORK in UNWHOLESOME PREMISES Sections to8. OUTWORK IN INFECTED PREMISES Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions Instances. Notices served. Proaccutions Instances. Orders made (S. 110). Prosecutions (Section 109, 110). Sending Twice in the year. Sending Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists. List Outworkers.† List Outworkers. Contractors. Workmen. Contractors Workmen, (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— Nil Nil Nil Nil Nil Nil Nil (1) making, &c. 50 9 386 9 ... 37 38 8 (2) cleaning and washing ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... Furniture and upholstery 4 ... 10 ... ... ... 2 ... Electro-plate ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... Brass and brass articles ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... Cables and chains ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... Cart gear ... ... ... ... ... ... ... ... Locks, latches and keys ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... Sacks and bag stringing 2 ... 68 ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... Paper bags and boxes 2 ... 58 ... ... ... ... ... Brush making 2 ... 8 ... ... ... 1 ... Pea picking ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c. ... ... ... ... ... ... ... ... Stuffed toys ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... Printing 2 ... 28 ... ... ... ... ... Cigarette making 2 ... 6 ... ... ... 1 ... Total 64 9 564 9 ... 37 42 ... 1 ... ... ... 8 ... .... *If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. †The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of out-workers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual out-workers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 12 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year 1912. Number. (1) (2) Bakehouses 214 Restaurants 296 Laundries 193 Dressmakers 290 Tailors 125 Milliners and Mantle Makers 76 Blouse Makers 61 Other Businesses 356 Total number of workshops on Register 1611 5.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:- 9 Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 8 Reports (of action taken) sent to H.M. Inspector 8 Other - Underground Bakehouses (s. 101):— Certificates granted during 1912 — In use at the end of 1912 72 Note.—The Factory and Workshop Act, 1901 (s. 132) requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). If the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office the portions which do not relate to factories workshops, workplaces or homework. The duties of Local Authorities and the Medical Officer of Health under the Acts are detailed in the Home Office Memoranda, issued to all Districts, Councils and Medical Officers of Health. 13 Borough of Lambeth. Workplaces known to be in occupation within the Borough during 1912. Number of (a) Factories, (b) Domestic Workshops, (c) Ordinary Workshops, and (d) Outworkers. Wards. Factories.* Workshops.† No. of Workplaces. No. of Workrooms. Outworkers. No. of Factories. No. of Rooms. Ordinary No. of Workshops. Ordinary No. of Rooms. Domestic No. of Workshops. Domestic No. of Rooms. No. of Outworkers. No. of Rooms. Marsh 17 114 44 87 4 4 65 205 47 47 Bishop's 3 7 50 80 10 13 63 100 64 64 Prince's 28 145 60 107 6 7 94 259 137 139 Vauxhall 18 98 39 75 6 5 63 178 53 54 Total Inner Wards 66 364 193 349 26 29 285 742 301 304 Stockwell 5 22 98 165 5 5 108 192 81 82 Brixton 25 122 133 225 21 23 179 370 235 235 Heme Hill 8 51 59 95 9 11 76 157 101 101 Tulse Hill 14 47 59 93 13 18 86 158 45 46 Norwood 15 54 94 195 15 21 124 270 17 17 Total Outer Wards 67 296 443 773 63 78 573 1147 479 481 Borough of Lambeth 133 650 636 1122 89 107 858 1889 780 785 * Including 46 Laundries and 83 others, † Including Laundries (112), Dressmakers (179), Tailors (78), Milliners and Mantlemakers (46), Blouse Makers (32), others (254), 14 London County Council Table. SANITARY PROCEEDINGS DURING 1912. (Return prepared for the London County Council.) Premises. Number of Places. Number of inspections, 1912. Number of notices, 1912. Number of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Milk premises* 109 34 — 143 260 42 - Cowsheds 13 — — 13 26 2 — Slaughterhouses 19 - — 19 38 4 - Other offensive trade premises 4 — 1 3 8 2 - Registered houses let in lodgings 372 — - 372 744 - - Bakehouses 214 — - 214 428 - - Restaurant Kitchens 248 — — 248 26 8 — * During 1912, a total of 42 applications were received and approved, but 3 were withdrawn by the applicants after registration, and 5 were simply changes of occupiers. 15 Total number of Intimation Notices served for all purposes 6935 Overcrowding— Dwelling rooms overcrowded 8 Remedied 8 Prosecutions — Underground Rooms— Illegal occupation 9 Closed 9 Insanitary houses— Closed (under the Public Health (London) Act, 1891) — Closed (under the Housing of the Working Classes Acts, including the Housing Town Planning, etc., Act) 33 Verminous rooms cleansed 1109 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Persons accommodated — Houses for which applications were received 85 Tenements comprised therein 235 Tenements for which Certificates were (a) granted 119 ,, „ ,, (b) refused 100 „ „ „ (c) deferred 16 Common Lodging-houses—certificates granted — Number of prosecutions under By-laws, under Public Health Act, 1891— — Mortuaries — Number of bodies 357 (infectious cases 2). 16 Copy of Pamphlet distributed during 1912, dealing with Summer Diarrhoea and the Precautions to be taken in connection therewith. Metropolitan Borough of Lambeth. PRECAUTIONS AGAINST SUMMER DIARRHOEA. During the hot months of the year, diarrhoea in babies is often a common and fatal disease. The Bottle. It is much more common amongst babies fed from the bottle than amongst those who are breast fed. Mothers are urged, therefore, to make a great effort to suckle their babies, and to avoid weaning them till after the hot weather. If the baby must be bottle fed, be sure that the milk is fresh and that the bottle is kept scrupulously clean. Avoid bottles with long tubes, as they are very difficult to clean, and are, in consequence, a cause of ill-health to babies using them. Proper and regular feeding is necessary. Flies. Flies are a great source of danger, especially to babies, as through them the poisons generated during the hot weather in all sorts of filth get introduced into the baby's body through milk and other foods. Flies breed in decomposing matter (rubbish heaps, manure, etc.), and settle on 17 any kind of tilth, and then, with their legs and bodies covered with dangerous germs, they come and drink, and thereby infect, baby's milk or settle on baby's mouth. Diarrhoea is most prevalent when flies are most numerous. Keep the house free from flies, and keep baby's milk covered with gauze or muslin so that the flies cannot get to it. No dirt—no flies. Cleanliness. Keep baby clean and keep the house and surroundings clean. Remove all refuse from the neighbourhood of houses. Burn all animal and vegetable matters. The Lambeth Council's Infants Milk Depot (66 York Road, Westminster Bridge Road, S.E.) is specially useful in safe-guarding bottle-fed babies against getting diarrhoea. A special form of milk ("modified milk"), made under medical supervision, is supplied which does not turn sour like ordinary milk and is less likely to upset the digestion. It is kept in bottles where the flies cannot get at it. Babies like it and thrive on it. Apply to the Manageress at the Depot for further information. By Order, Medical Officer of Health. Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. 18 Metropolitan Boroughs' Standing Joint Committee. Report of Departmental Committee on Tuberculosis. Resolutions passed by the Council of the Metropolitan Boroughs' Standing Joint Committee on June 12th, 1912, and reported to the Borough Council on July 11th, 1912. (a) That in each Metropolitan Borough or City, the Local Council should be named as the Body responsible for the administration of the Local Tuberculosis Dispensary, and for the local execution of the Scheme. (b) That, subject to the provision contained in (c), the Medical Officer of Health should be named as the Officer responsible to the Local Council for the administration of the Local Tuberculosis Dispensary, and for the local execution of the Scheme. (c) That the chief Tuberculosis Officer of the Dispensary should be independent of control by any other medical man so far as his clinical duties are concerned, but that, in regard to the general conduct and administration of the Dispensary, he should act under the direction of the Local Medical Officer of Health. (d) That the Committee appointed by the Council of the Metropolitan Borough or City to manage a Local Dispensary should have power to co-operate as 19 members of the Committee persons who are not members of the Council of the Borough or City which the Local Dispensary serves. (e) That, wherever practicable, the medical practitioners in the district served by the Dispensary, or some of them, should be engaged to act as assistant Medical Officers to the Dispensary in rotation or some other agreed method. 20 21 LAMBETH BOROUGH.-Deaths Registered from all Causes during the Year, 1912. Note.-The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institution situated beyond the limits of the District are included. Sub-Districts. Total. Lambeth Church Kennington. Stockwell. Brixton. Norwood. No Address. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. I. Specific Febrile, or Zymotic Diseases 57 46 46 35 48 31 34 34 26 27 ... ... 211 173 384 II. Parasitic Diseases ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 III. Dietetic Diseases 9 3 2 8 3 1 ... 3 1 1 1 ... 16 16 32 IV. Constitutional Diseases 107 71 110 86 106 79 123 96 66 73 8 5 520 410 930 V. Developmental Diseases 25 32 38 37 35 45 25 51 24 34 ... ... 147 199 346 VI. Local Diseases 165 173 245 222 200 194 219 215 160 180 11 10 1000 994 1994 VII. Deaths from Violence 23 21 23 17 23 4 15 13 5 7 ... ... 89 62 151 VIII. Deaths from Ill-defined and not specified causes 14 10 12 5 11 8 7 11 8 1 ... ... 52 35 87 Totals 400 356 476 410 426 362 423 423 291 323 20 15 2036 1889 3925 I.—Specific Febrile or Zymotic Diseases. 1.—Miasmatic Diseases. Small-pox Vaccinated ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 16 15 16 7 17 7 8 4 2 5 ... ... 59 38 97 Whooping Cough 9 6 8 4 7 2 4 8 4 3 ... ... 32 23 55 Scarlet Fever 2 ... 1 ... 2 ... 4 ... ... ... ... ... 9 ... 9 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Enteric or Typhoid Fever 1 1 2 1 1 1 1 3 2 ... ... ... 7 6 13 Diphtheria l 3 3 4 5 ... 3 4 4 2 ... ... 16 13 29 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 3 1 3 3 4 5 5 5 6 5 ... ... 21 19 40 Other Miasmatic Diseases ... 1 1 ... 1 ... ... ... ... 1 ... ... 2 2 4 2.—Diarrhœal Diseases. Cholera Nostras ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Cholera Asiatica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa Dysentry 19 12 11 12 4 5 4 6 5 4 ... ... 43 39 82 3.—Malarial Diseases. Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ...... ... ... ... ... 1 ... 2 ... ... ... 3 ... 3 4.—Zoogenous Diseases. Cowpox and effects of Vaccination ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... 5.—Venereal Diseases. Syphilis 4 1 1 ... 4 2 3 1 1 ... ... ... 13 4 17 Gonorrhœa, Stricture of Urethra 1 ... ... ... 2 ... ... ... ... ... ... ... 3 ... 3 6. Septic Diseases. Erysipelas 1 1 ... 1 1 3 1 1 ... 4 ... ... 3 10 13 Pyaemia, Septicaemia ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 2 Puerperal Fever ... 3 ... 3 ... 4 ... 2 ... 2 ... ... ... 14 14 22 23 LAMBETH BOROUGH —Deaths Registered from all Causes during the year 1912—continued. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Sub-Districts. Sub-Districts. Total. Lambeth Church Kennington. Stockwell. Brixton. Norwood. No Address. All Ages. II.—Parasitic Diseases. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IIII.—Dietetic Diseases. Want of Breast Milk, Starvation ... 1 1 1 ... ... ... 1 ... ... 1 ... 2 3 5 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism 7 2 ... 6 3 1 ... 2 1 1 ... ... 11 12 23 Delirium Tremens 2 ... 1 1 ... ... ... ... ... ... ... ... 3 1 4 IV.—Constitutional Diseases. Rheumatic Fever 2 ... ... ... 1 2 3 2 1 1 ... ... 7 5 12 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... 1 ... ... ... ... 1 1 1 ... ... ... 2 2 4 Gout 1 ... ... ... ... ... ... ... 2 ... ... ... 3 ... 3 Rickets ... ... ... ... ... 2 1 ... ... 1 ... ... 1 3 4 Cancer, Malignant Disease 23 33 29 32 36 33 53 50 30 45 4 3 175 196 371 Cancum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 1 ... ... 9 1 1 ... ... 1 2 ... ... 3 5 8 Tubercular Meningitis, Hydrocephalus 5 2 7 3 4 3 4 2 1 1 ... ... 21 11 32 Phthisis 59 25 62 38 50 24 48 33 25 12 4 1 248 133 381 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 12 7 7 6 8 5 6 4 1 3 ... ... 34 25 59 Purpura, Hæmorrhagic Diathesis 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 2 Anæmia, Chlorosis, Leucocythæmia ... 2 2 1 3 2 ... 2 ... 3 ... ... 7 10 17 Glycosuria, Diabetes Mellitus 2 ... 2 4 3 3 7 ... 2 1 ... ... 16 8 24 Other Constitutional Diseases 1 ... 1 ... ... 4 ... 2 ... 4 ... 1 2 11 13 V.— Developmental Diseases. Premature Birth 15 15 11 9 15 20 9 10 10 10 ... ... 60 64 124 Atelectasis 3 3 2 2 • •• ... ... 1 ... ... ... ... 5 6 11 Congenital Malformations 4 5 6 1 4 2 4 5 1 3 ... ... 19 16 35 Old Age 3 9 19 25 16 23 12 35 13 21 ... ... 63 113 176 VI.—Local Diseases. 1.—Diseases of Nervous System. . Inflammation of Brain or Membranes 1 2 2 ... 4 ... 4 1 1 1 ... ... 12 4 16 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 6 15 17 26 19 24 24 27 12 19 2 2 80 113 193 Insanity, General Paralysis of the Insane 2 2 12 4 5 2 7 1 5 ... ... ... 31 9 40 Epilepsy 1 ... 4 3 1 ... 1 3 ... 1 ... ... 7 7 14 Convulsions 2 ... 1 ... ... ... ... 2 3 4 ... ... 6 6 12 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans 2 ... 2 2 4 3 2 2 3 1 ... ... 13 8 21 Other Diseases of Nervous System 3 7 2 5 8 4 2 5 6 3 ... ... 21 24 45 2. Diseases of Organs of Special Sense. (e.g., of Ear,Eye Nose) 1 3 2 2 2 2 ... ... 1 ... ... ... 6 7 13 24 25 LAMBETH BOROUGH Deaths Registered from all Causes during the Year 1912—continued. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Districts are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Sub-Districts. Sub-Districts. Total. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. No dress. All Ages. 3.—Diseases of Circulatory System. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pericarditis 2 1 ... ... 2 ... ... ... ... 3 ... ... 4 4 8 Acute Endocarditis ... ... 9 2 3 3 2 2 1 1 ... ... 8 8 16 Valvular Diseases of Heart 10 16 14 16 13 12 13 15 7 18 1 1 58 78 136 Other Diseases of Heart 4 12 13 11 14 21 7 18 14 28 ... ... 52 90 142 Aneurism 3 ... 6 2 ... ... 2 2 ... ... ... ... 11 4 15 Embolism, Thrombosis ... ... 4 1 ... 1 1 3 2 2 ... ... 7 7 14 Other Diseases of Blood Vessels 13 9 10 19 10 9 16 10 10 9 4 3 63 59 122 4.—Diseases of Respiratory System. Laryngitis ... ... ... 2 1 ... ... ... ... ... ... ... 1 2 3 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Emphysema, Asthma 1 2 4 2 5 ... 2 3 3 1 ... ... 15 8 23 Bronchitis 33 38 46 44 28 42 35 37 30 28 ... ... 172 189 361 Pneumonia 14 9 15 11 18 8 14 13 11 6 ... 1 72 48 120 Pleurisy 3 2 1 4 4 2 4 ... 1 1 ... ... 13 9 22 Bronchopneumonia 18 21 27 15 10 8 12 15 8 7 ... ... 75 66 141 Pleuropneumonia 10 2 6 10 8 7 5 5 3 4 1 1 33 29 62 Other Diseases of Respiratory System ... 2 5 2 5 3 3 6 3 2 ... ... 16 15 31 5.—Diseases of Digestive System. Appendicitis ... ... 2 1 2 ... 2 1 2 3 ... ... 8 5 13 Dentition 6 ... 1 1 2 2 1 1 1 1 ... ... 11 5 16 Sore Throat, Quinsy ... ... ... 2 1 ... ... 1 ... 1 ... ... 1 4 5 Diseases of Stomach 1 1 3 ... 3 2 4 5 ... 2 ... ... 11 10 21 Enteritis 3 ... 2 1 3 2 4 ... 1 2 ... ... 13 5 18 Obstructive Diseases of Intestine 2 5 6 1 1 4 4 5 ... 2 ... ... 13 17 30 Peritonitis 1 2 ... 1 2 ... 2 1 ... 1 ... ... 5 5 10 Ascites ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Cirrhosis of Liver 3 2 6 7 2 7 7 6 7 2 ... ... 25 24 49 Jaundice and other Diseases of Liver 1 1 1 3 1 ... 7 3 1 2 ... ... 11 9 20 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 3 4 1 3 3 4 ... 2 4 3 ... ... 11 16 27 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) 1 ... ... ... 1 ... 2 1 2 ... ... ... 6 1 7 7.—Diseases of Gland-like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... 1 1 ... ... ... ... 1 ... ... 1 2 3 8.—Diseases of Urinary System. Nephritis ... 1 4 1 4 2 1 2 1 1 1 ... 11 7 18 Bright's Disease, Albuminuria 9 9 10 12 4 14 21 12 9 13 2 ... 55 60 115 Disease of Bladder or of Prostate 1 ... 4 ... 2 ... 3 ... 6 1 ... ... 16 1 17 Calculus (Stone) ... ... ... ... ... 1 1 1 ... ... ... ... 1 2 3 Other Diseases of the Urinary System 2 ... 2 .... 2 ... 1 1 ... ... ... ... 7 1 8 9.—Diseases of Reproductive System. A. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... 1 ... 3 ... 2 ... 1 ... 2 ... 1 ... 10 10 26 27 LAMBETH BOROUGH Deaths Registered from all Causes during the Year 1912—continued. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Districts are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Sub-Districts. Total. Lambeth Church Kennington. Stockwell. Brixton. Norwood. No Ad- dress. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. B. Of Parturition. Abortion, Miscarriage ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Puerperal Convulsions ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Placenta praevia, Flooding ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Other Accidents of Child Birth ... 1 ... 1 ... 2 ... 1 ... 2 ... ... ... 7 7 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... 1 ... ... ... 1 ... ... ... ... ... 2 ... 2 Arthritis, Ostitis, Periostitis 1 ... 2 ... ... ... 1 ... 1 1 ... 1 5 2 7 Other Diseases of Bones and Joints ... 1 1 ... ... ... ... ... 1 ... ... ... 2 1 3 11.—Diseases of Integumentary System. Carbuncle, Phlegmon 1 ... 1 ... 1 ... 1 ... ... ... ... ... 4 ... 4 Other Diseases of Integumentary System 1 1 3 1 ... 1 ... ... ... ... ... ... 4 3 7 VII —Deaths from Violence. 1.—Accident or Negligence. Fractures and Contusions 7 7 6 5 7 ... 3 2 1 2 ... ... 24 16 40 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... 1 1 ... ... 1 ... ... ... ... ... 2 1 3 Burn, Scald 1 4 ... 5 1 ... 1 2 ... 1 ... ... 3 12 15 Poison l ... ... 1 l ... ... ... ... ... ... 2 1 3 Drowning 4 1 2 ... ... ... 1 ... ... ... ... 6 2 8 Suffocation 1 l 2 1 ... ... 3 1 ... ... ... 4 5 9 Otherwise 1 5 5 1 11 1 6 4 2 1 ... ... 25 12 37 2.—Homicide. Manslaughter ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Murder 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3.—Suicide. Gunshot Wounds 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Cut, Stab 1 ... 1 1 ] ... 1 ... ... ... ... ... 4 1 5 Poison ... 2 4 ... 1 3 2 1 ... 1 ... ... 7 7 14 Drowning 1 1 ... 1 ... ... ... ... ... 1 ... ... 1 3 4 Hanging 3 ... 1 ... 1 ... ... ... ... 1 ... ... 5 1 6 Otherwise ... ... 1 1 ... ... ... ... 1 ... ... ... 2 1 3 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—Deaths from Ill-Defined and not Specified Causes. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 13 9 11 5 8 7 5 10 7 1 ... ... 44 32 76 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... 1 ... ... 1 ... ... 1 1 ... ... ... 2 2 4 Abscess ... ... 1 ... 2 1 1 ... ... ... ... ... 5 1 6 Hæmorrhage ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 29 LAMBETH BOROUGH.—Deaths Registered from all Causes during the year 1912. Note.-The Deaths of Non-Residents occurring- in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES. Total Under 1 Year. 1-2 2-5 1 Under 5 Years. 5-15 15-20 20-25 25-40 40-45 45-60 60-65 65 and over. Over 5 Years. All Ages. M. F. M. F. M. F M. F. M. F. M. F. M. F. M. F. M. F. M. F M. F. M. F. M. F. M. F. I. Specific Febrile, or Zymotic Diseases 72 58 38 35 45 24 155 117 16 6 ...... 3 2 6 7 14 2 6 11 4 7 2 11 15 56 56 211 173 384 II. Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 III. Dietetic Diseases 1 2 ... ... ... ... 1 2 ... ... ... ... ... ... 5 4 ... 3 8 6 ... ... 2 1 15 14 16 16 32 IV. Consititutional Diseases 14 11 6 7 15 12 35 30 15 19 13 6 21 13 105 74 48 44 152 107 40 28 91 89 485 380 520 410 930 V. Developmental Diseases 84 85 ... ... ... ... 84 86 ... ... ... 1 ... ... ... ... ... ... ... 1 ... 2 63 110 63 114 147 199 346 VI. Local Diseases 106 74 43 28 23 23 172 125 21 26 11 15 17 15 82 77 57 33 202 188 104 72 334 443 828 869 1000 994 1994 VII. Deaths from Violence 9 9 3 3 4 2 16 14 5 8 1 2 2 ... 14 5 6 3 29 11 5 1 11 18 73 48 89 62 151 VIII. Deaths from Ill-defined and not specified causes 45 28 3 5 ... ... 48 33 ... ... ... ... ... ... 1 ... ... ... 3 ... ... 11 ... 1 4 2 52 35 87 Totals ... 3311 267 93 78 87 61 511 406 57 59 25 27 42 34 215 174 113 89 405 317 156 106 512 677 1525 1483 2036 1889 3925 1.—Specific Febrile or Zymotic Diseases. 1—Miasmatic Diseases. Small-pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 12 7 26 l6 16 14 54 37 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 59 38 97 Whooping Cough 14 10 4 l0 11 3 29 23 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 32 23 55 Scarlet Fever ... ... 1 ... 6 ... 7 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 9 ... 9 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued and Ill-defined Fever ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Enteric or Typhoid ... ... ... ... ... 1 ... 1 1 ... ... 1 1 ... 1 3 1 ... 2 1 1 ... ... ... 7 5 7 6 13 Diphtheria 1 2 1 3 9 4 11 9 4 4 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 5 4 16 13 29 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza. 1 1 ... ... ... ... 1 1 ... ... ... 1 ... ... 1 1 1 2 6 2 4 2 8 10 20 18 21 19 40 Other Miasmatic Diseases 1 1 1 ... ... 1 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 4 2.—Diarrhœal Diseases. Cholera Nostras ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Cholera Asiatica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa Dysentry 33 31 5 2 3 1 41 34 1 1 ... ... ... 1 1 1 ... 1 ... ... ... ... ... 1 2 5 43 39 82 3.—Malarial Diseases. Remittent or Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... 3 ... 3 4.—Zoogenous Diseases. Cowpox and effects of Vaccination ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Other Diseases (e.g.. Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. Syphilis 10 4 ... ... ... ... 10 4 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 3 ... 13 4 17 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 3 ... 3 ... 3 6. Septic Diseases. Erysipelas ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 1 1 ... 1 1 1 ... ... 1 4 3 9 3 10 13 Pyæmia, Septicæmia ... ... ... 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 8 ... 2 ... ... ... ... ... ... ... 14 ... 14 14 30 31 LAMBETH BOROUGH—Deaths Registered from all Causes during the Year, 1912 —continued. Note —The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the Districts are included. AGES. Total. Under 1 Year 1-2 2-5 Under 5 Year 5-15 15-20 20-25 25-40 40-45 45-60 60-65 65 and over. Over 5 Years. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F M. F M F M. F. M. F. II.-Parasitic Diseases Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... III.—Dietetic Diseases. Want of Breast Milk, Starvation 1 2 ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 3 5 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... 1... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 ... 3 7 5 ... ... 1 ... 11 12 11 12 23 Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 1 ... ... ... ... 3 1 3 1 4 IV.-Constitutional Diseases. Rheumatic Fever ... ... ... ... ... ... ... ... ... 1 1 1 1 ... 1 1 ... 2 2 ... 1 ... 1 ... 7 5 7 r. 12 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... 2 2 2 2 4 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... 3 ... 3 Rickets ... 1 ... 1 1 1 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 4 Cancer, Malignant Disease ... ... ... ... ... ... ... ... ... 2 2 ... ... ... 10 14 4 19 66 68 27 23 67 70 176 196 175 196 371 Cancum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica 1 1 ... 1 ... 1 1 3 ... ... 1 ... ... ... 1 1 ... ... ... 1 ... ... ... ... 2 2 3 5 8 Tubercular Meningitis, Hydrocephalus 7 1 3 3 4 3 14 7 5 4 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 7 4 21 11 32 Phthisis 1 2 1 ... 3 2 5 4 4 6 6 5 16 12 86 52 39 17 75 27 8 3 9 7 243 129 248 133 381 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 5 6 2 2 5 5 12 13 5 5 2 ... 4 1 4 1 1 3 5 1 ... ... 1 1 22 12 34 26 59 Purpura, Hæmorrhagic Diathesis ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 2 Anæmia, Chlorosis, Leucocythæmia ... .... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 3 2 ... ... 3 1 ... 1 4 6 10 7 10 17 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 2 2 2 3 1 8 1 16 8 16 8 24 Other forms of Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 ... ... 1 6 2 11 2 11 13 V. Developmental Diseases. Premature Birth 60 64 ... ... ... ... 60 64 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 60 64 124 Atelectasis 5 6 ... ... ... ... 5 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 6 11 Congenital Malformations 19 15 ... ... ... ... 19 15 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 19 16 35 Old Age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 63 110 63 113 63 113 176 VI.—Local Diseases. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 7 ... 2 1 1 2 10 3 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 12 4 16 Apoplexy, Softening of Brain, plegia, Brain Paralysis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 3 23 21 12 14 40 75 80 113 80 113 193 Insanity, General Paralysis of the sane ... ... ... ... ... ... .... ... ... ... ... ... 1 ... 7 2 5 1 13 2 2 1 3 3 31 9 31 9 40 Epilepsy ... ... ... ... ... ... ... ... ... ... 1 1 1 1 1 1 1 ... 1 4 1 ... 1 ... 7 7 7 7 14 Convulsions 6 5 ... 1 ... .... 6 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 6 12 Laryngismus Stridulus (Spasm of Glottis) ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... 4 2 3 ... 4 4 13 8 13 8 21 Other Diseases of Nervous System 5 ... ... ... 1 ... 6 ... 2 4 ... 1 2 1 1 2 1 3 2 8 1 1 6 4 15 24 21 24 45 2. Diseases of Organs of Special Sense. (e.g., of Ear,Eye Nose) ... 1 1 1 ... ... 1 2 1 3 1 ... ... ... 3 2 ... ... ... ... ... ... ... ... 5 5 6 7 13 32 33 LAMBEIH BOROUGH — Deaths Registered from all Causes during the Year 1912—continued. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Districts are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES. 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. 3.—diseases of Circulatory System. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pericarditis 1 ... ... ... ... ... 1 ... 2 3 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 3 4 4 4 8 Acute Endocarditis ... ... ... ... ... 1 ... 1 ... 1 ... 2 1 ... 4 2 1 ... ... 2 2 ... ... ... .8 7 8 8 16 Valvular Diseases of Heart ... ... ... ... ... ... ... ... 1 ... 3 2 3 4 6 11 7 7 11 18 3 5 24 31 58 78 58 78 136 Other Diseases of Heart 1 ... ... ... ... ... 1 ... 1 3 1 1 1 ... 3 9 ... ... 7 17 7 10 31 50 51 90 52 90 142 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 5 ... 2 ... 1 3 11 4 11 4 15 Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 2 1 ... 3 4 7 7 7 7 14 Other Diseases of Blood Vessels 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 1 ... 1 6 4 10 9 44 44 62 59 63 59 122 4.—Diseases of Respiratory System. Laryngitis ... 1 ... ... ... 1 ... 2 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 3 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Emphysema, Asthma ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 .... 5 3 3 1 5 4 15 8 15 8 23 Bronchitis 28 16 4 3 1 1 33 20 ... ... ... ... ... ... 5 2 5 1 19 29 22 11 87 125 139 169 172 189 361 Pneumonia 7 3 1 2 ... ... 8 5 1 2 1 ... 1 2 12 7 9 1 21 10 10 5 8 16 64 43 72 48 120 Pleurisy ... 2 ... ... 2 ... 2 2 ... 1 2 1 ... ... 1 1 2 ... 4 1 1 ... 3 3 11 7 13 9 22 Bronchopneumonia 22 24 25 17 11 9 58 50 3 2 ... ... 1 ... ... ... 1 2 3 3 1 ... 8 9 17 16 75 66 141 Pleuropneumonia ... 1 1 l 3 1 4 3 ... ... 1 ... ... 1 5 4 7 1 10 6 1 5 5 9 29 26 33 29 62 Other Diseases of Respiratory System 3 4 ... ... ... ... 3 4 ... 1 ... ... ... ... 2 4 ... ... 5 2 1 ... 5 4 13 11 16 15 31 5.—Diseases of Digestive System. Appendicitis ... ... ... ... ... ... ... ... 5 ... ... ... ... 3 ... ... ... ... 1 2 ... ... 2 ... 8 5 8 5 13 Dentition 4 4 7 ... ... 1 11 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 5 16 Sore Throat, Quinsy ... ... ... ... ... 3 ... 3 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 4 5 Diseases of Stomach 2 2 ... ... ... ... 2 2 ... ... ... ... ... ... 2 2 ... ... 3 3 2 ... 2 3 9 8 11 10 21 Enteritis 7 1 1 ... 1 1 9 2 ... 1 ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 2 4 3 13 5 18 Obstructive Diseases of Intestine 2 1 .... ... ... ... 2 l ... ... ... ... 1 ... 3 ... ... 1 2 7 ... ... 5 8 11 16 13 17 30 Peritonitis ... 1 ... ... ... ... ... l 1 2 ... ... ... 1 2 1 1 ... ... ... ... ... 1 ... 5 4 5 5 10 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 Girrhosis of Liver 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... 2 1 4 2 12 15 2 2 4 3 2'4 24 25 24 49 Jaundice and other Diseases of Liver 2 1 ... ... ... ... 2 1 ... ... ... 1 ... ... ... ... 1 ... 4 3 2 ... 2 4 9 8 11 9 20 Diseases of the Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 3 3 1 1 ... 1 4 5 ... ... ... ... ... ... 2 2 1 1 2 1 1 3 1 4 7 11 11 16 27 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... 1 .. ... 2 ... 2 1 ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... 1 ... 4 ... 6 1 7 7.—Diseases of Gland-like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... 1 2 1 2 3 8.—Diseases of Urinary System. Nephritis ... ... ... 1 1 2 1 3 1 1 ... ... ... ... 1 1 ... 1 3 1 3 ... 2 ... 10 4 11 7 18 Bright's Disease, Albuminuria ... ... ... ... ... ... ... ... ... ... 1 2 ... 1 5 9 4 4 24 16 6 3 15 25 55 60 55 60 115 Disease of Bladder or of Prostate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 13 ... 16 1 16 1 17 Calculus (Stone) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 2 1 2 3 Other Diseases of the Urinary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 ... 2 ... 1 1 7 1 7 1 8 9.—Diseases of Reproductive System. A. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .... ... ... Female Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 5 ... 1 ... 2 ... 10 ... 10 10 34 35 LAMBETH BOROUGH.-Death Regisiered from all Causes during the Year 1912—.continued. Note—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES Total. Under 1 Year 1-2 2-5 Undcr 5 Years. 5-15 15-20 20-25 25-40 40-45 45-60 60-65 65 and over Over 5 Year All Ages M F M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. B. Of Parturition. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 Placenta prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Accidents of Child Birth ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 ... 1 ... ... ... ... ... ... ... 7 ... 7 7 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 ... 2 ... 2 Arthritis, Ostitis. Periostitis 2 1 ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 3 1 5 2 7 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 1 2 1 3 11.—Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... 4 ... 4 ... 4 Other Diseases of Integumentary System 2 2 ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 2 1 4 3 7 VII —Deaths from Violence. 1.—Accident or Negligence. Fractures and Contusions ... ... ... ... 1 ... 1 ... 1 2 ... ... ... ... 5 1 3 ... 11 3 ... 1 3 9 23 16 24 16 40 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 2 1 2 1 3 Burn, Scald 1 ... 2 2 ... 1 3 3 ... 2 ... 1 ... ... ... ... ... 1 ... 2 ... ... ... 3 ... 9 3 12 15 Poison ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 ... 2 1 3 Drowning ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... 2 2 1 ... ... ... 6 2 6 2 8 Suffocation 4 5 ... ... ... ... 4 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5 9 Otherwise 4 4 1 ... 3 1 8 5 2 4 1 ... 2 ... 1 1 1 ... 7 ... ... ... 3 2 17 7 25 12 37 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 1 3.—Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Cut Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 1 ... 4 1 4 1 5 Poison ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 ... 2 3 ... ... ... 1 3 7 7 7 7 14 Drowning ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... 1 ... 1 3 1 3 4 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 ... ... 2 ... 5 1 5 1 6 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 2 1 2 1 3 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... VIII.—Deaths from Ill-Defined and not Specified Causes. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 43 27 1 5 ... ... 44 32 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 44 32 76 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... 1 2 2 2 2 4 Abscess 2 1 2 ... ... ... 4 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 5 1 6 Haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified, or Ill-defined ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 Summary of Total Corrected Deaths in Lambeth Borough during 1912. No. of Death Total. N o.of Death. Totals M. F. M. F. 1.—Specific Febrile, or Zymotic Diseases. Brought forward 1781 1692 3473 1. Maismatic Diseases 146 102 248 2. Diarrhœal „ 43 40 83 VI.—Local Diseases— continued 3. Malarial „ 3 3 6. Diseases of Lymphatic System 6 1 7 4. Zoogenous „ ... 1 1 7. Diseases of Gland-like Organs of Uncertain use 1 2 3 5. Venereal „ 16 4 20 6. Septic „ 3 26 29 8. Diseases of Urinary System 90 71 161 9. Diseases of Reproductive System II.—Parasitic Diseases 1 ... 1 (a) Diseases of Organs of Generation ... 10 10 III.—Dietetic Diseases 16 16 32 (b) Diseases of Parturition ... 10 10 10. Diseases of Bones and Joints 9 3 12 IV.—Constitutional Diseases. 520 410 930 11. Diseases of Integumentary System 8 3 11 V.—Developmental Diseases 147 199 346 VII.—Violence VI.—Local Diseases 1. Accident or Negligence 66 49 115 1. Diseases of Nervous System 170 171 341 2. Homicide 2 ... 2 2. Diseases of Organs of Special Sense 6 7 13 3. Suicide 21 13 34 4. Executed ... ... ... 3 Diseases of Circulatory System 203 250 453 4. Diseases of Respiratory System 397 366 763 VIII —Ill-defined and not Specified Causes 52 35 87 5. Diseases of Digestive System 110 100 210 Carried forward 1781 1692 3473 Total 2036 1889 3925 INDEX. (ii) GENERAL INDEX Page Abatement of Nuisances 1ll—113 „ „ Smoke 139-140 Adulteration of Food and Drugs 141—161 Analysis of Food and Drugs 141—161 „ Water 156 Anthrax 64 Antitoxin, Distribution of 54, 196—197 Area, Lambeth 110 Bacteriological Laboratory 195—197 Bakehouses 181 Bedding, etc, Disinfected 135 Bedding, etc, Destroyed 136 Births and Birth Rates 8—9, 10—12 Births Notification Act 11 — 12 Bodies received at Mortuaries 197—199 By-laws, Responsibility under 122 ,, Contravention of 122 ,, Houses Let in Lodgings 163 Censal Population (Lambeth) 108—109 Cerebrc-Spinal Meningitis 47 Certificates (Notification) received 34—35, 38 Certificates (Revenue Act) Granted 165—166 Certificates (Disinfection) 136 Children, Cleansing of 138—139 Cholera 55 Circulatory Diseases, Deaths of 99 Cleansing of Verminous Persons 138—139 Clerical Staff 202—203 Clerical Work 202-203 Chicken-pox 47 Common Lodging Houses 164 Complaints 115 Condensed Milk (Special Report) 148—152 (iii) Page Conscientious Objectors 44—46 Congenital Malformations 99 Constitutional Diseases 99 Consumption (See Tuberculosis) Contacts or Suspects 44, 55 Contagious Ophthalmia (Newly-born Infants) 65 Continued Fever 60 Conveniences (Underground) 141 Coroners' Courts 197—199 Cowhouses 186—188 Critical Temperature (Earth) and Diarrhœa 62 Cream (Special Report) 148 Croup (See Membranous Croup) Dairies (See Milkshops) Deaths and Death-rates 8—9, 12—107 Appendix 2, 4—7, 20—36 „ Inner and Outer Wards 15—16, 17, 18, 22—25 Corrected 12—13, 15—18, 22—25 „ Uncorrected 19—21 „ In Public Institutions 13—15 „ Zymotic 22—25, 30—99 „ Under 1 year 27—29 Appendix4—7 Depositing of Plans of LCC Schools 123 Depot (Milk) 177—181 Depots (Refuse and Manure) 191—194 Developmental Diseases 99 Diagnosis (Bacteriological) 195—197 Diarrhœa 61—64 Dietetic Diseases 99 Diphtheria 54—57 „ Antitoxin in 54, 196—197 „ Decrease of 54—55 „ Bacteriological Examination in 57, 196 „ and School Outbreaks 55 Disinfection Certificates 136 Disinfecting Department 134—139 „ Refuge 136 Dispensaries (Tuberculosis) 69, 79—98 „ „ Estimates 94—95 „ „ Sanatorium Treatment 90—94,98 (iv) Page Drains and Infected Houses 31—33,36 Drainage Cases 122 „ Lambeth Infirmary 119 Drain Testing 115, 116 Drainage, Legal Proceedings 121 Drugs 145—146,154—155 Dust Depots 191—194 Earth Temperatures and Diarrhœa 62 Effluvium Nuisances 194 Enteric Fever (See Typhoid) Estimated Populations (Lambeth) Enteritis 64,100 Epidemic Cerebro-Spinal Meningitis 47 Epidemic Influenza 64 Epidemic Summer Diarrhœa 61—64 Erysipelas 61 Exclusion of Children (Measles) 51 „ „ (Whooping Cough) 52 Expenses (Food and Drugs) 156 Factories 130 Factory and Workshops 127—131 Female Sanitary Inspectors 123—126 Female Health Visitor 133 Food and Drugs, Adulteration of 141—161 „ „ Legal Proceedings (Summary) 155 „ ,, Inadequacy of Penalties 158 Food, Unsound 116—118 Glanders 64 Government Buildings and Public Health Acts 202 Health Visitor 133 Home Office Tables (Factory and Workshops) Appendix 8—32 House Refuse, Removal of 192 -193 House to House Inspections 121,167—172 Houses Let in Lodgings 163 „ „ „ By-laws for 163 Housing of the Working Classes 167—177 Housing in Lambeth 177 Housing in Waxwell Terrace 176 (v) Page Housing, Town Planning, etc, Act 167—177 Housing in Lambeth 177 Inspections of District 167—172 Representations and Closing Orders 172—176 "Unfit" houses 172—176 Ill-defined causes (deaths from) 100 Incidence (Zymotic) 18,34—35 Infantile Mortality 27—29, 110 Appendix 6—7 Infected Child, Removal of from Country 200 Infected Houses and Drains 31—33, 36 Infectious Diseases (cases removed 31,108—109 „ „ notified 34—35,38,39,108—109 Appendix 3 Influenza (Epidemic) 64 Inquests 199—200 Inspections 115,116—121 Appendix 8, 14 „ House to House 121, 167—172 „ Market Thoroughfares 120 Inspectors, Females 123—126 „ Males 116—123 „ Food and Drugs 141—161 „ Health Visitor 133 Introductory Letter 3—1 Laboratory (Bacteriological) 195—197 Lambeth Infirmary, Drainage 119 Lambeth Statistics 3, 110 Appendix 2—7, 20—36 Lavatories (Underground) 141 Legal Proceedings 121,165 Leprosy, Notification of 200 Letter (Introductory) 3—4 Letters (sent and received) 208 Local I iseases— Nervous System, Heart, Respiratory Organs, Digestive and lUrinary Systems and Reproductive System, etc 99—100 Local Government Board, Old Tables A and B 104—109 „ „ „ New Tables i, ii, iii, iv Appendix 2—7 Lodging-houses (Common) 161 London County Council Table Appendix 14—15 Male Sanitary Inspectors 116—123 (vi) Page Manure Depots 191—191. Margarine Manufacturers (Registration) 155 Market Thoroughfares (Inspection) 120 Measles 50—53 ,, and Schools 50—51 Membranous Croup 57 Meningitis (Cerebro-Spinal) 47 Milk and Dairies Bill 186 Milk Depot (Municipal) 177—181 Milk Stores (See Milkthops) Milkshops 181—185 „ Applications Refused 182 ,, Applications Granted 183 — 185 Monthly Returns (Lambeth) Zymotic Deaths 42 Mortality (Infantile) 27—29 „ Tables Appendix 20—36 „ Tables, Sub-Districts Appendix 20—27 „ Tables, Age Periods Appendix 28—36 Mortuary, High Street 197—199 Wanless Road 197—199 „ for Norwood 198 Mortuaries 197—199 „ Keepers of 197 National Insurance Act, 1911 90 — 9498 Natural Causes, Deaths from 199 Neonatorum, Ophthalmia 65 Notices Served 1ll—113, 115 Non-notifiable Infectious Diseases 39 Non-specified Causes (Deaths from) 100 Notification Certificates received 34—35, 38, 39 108—109 Appendix 3 „ of Births Act 11—12 „ of Leprosy 200 „ of Whooping Cough 52 Nuisances, Abatement of 1ll—113 Offensive matters, Removal of 193—194 Offensive Trades 190—191 Opthalmia Neonatorum (Contagious) 65 Outside Urinals (Public Houses) 121 Outworkers 132—183 (vii.) PAGE Parasitic diseases 99 Parliamentary Divisions (Populations) 6 Penalties (Inadequacy of) 158 Persons per Acre 110 Persons (Protected) in Workshops 128,120 Persons, Verminous 138—139 Phthisis. (See Tuberculosis.) Plague 55 Plans of Drainage 115,116 Populations, enumeration (Lambeth) 108 Populations, estimated (Lambeth) 5—6,108 Post Mortems 198 Premises Disinfected 135 Protected Persons (Workshops) 128, 129 Polio-encephalitis Acuta 47 Polio-myelitis Acuta 47 Public Health Acts and Government Buildings 202 „ „ (Milk and Cream Regulations) 156—157 ,, ,, (Tuberculosis) Regulations, 1908 and 1911 66—67, 70—78 Public Houses, Outside Urinals of 121 Public Institution, Deaths in 8—9, 13—15 Puerperal Fever 60—61 Quarterly Returns (Lambeth)— Births 7 Deaths (Zymotic and General) 19, 21, 37, 43 Notifiable Infectious Diseases 38, 39 Disinfection Certificates 136 Tuberculosis Regulations, 1908, 1911 70,78 Rag Flock Act, 1911 162 Rateable Value (Lambeth Borough) 110 Red Currant Jelly (Special Report) 147 Refuge (Infectious Diseases) 136 Refuse Depots 191—194 Registration of Deaths (changes) 26-27 „ Margarine Manufactories 155 Regulations, Milk and Cream 156—157 „ Sale of Milk 157—158 Removal of Infected Child from Country 200 ,, Infectious Diseases cases 31,108—109 Re-inspections 115, 116 (viii ) PAGE. Removal of Home Refuse 192—193 „ Offensive Matters 193—194 Reproductive System, Diseases of 110 Responsibility (under By-laws) 122 Relapsing Fever 60 Revenue Act (1903), Certificates 165—166 Sale of Milk Regulations 157—158 Samples, Food and Drugs 141—161 Sanatorium Benefit (Tuberculosis) 90—94 Sanitary Inspectors 116—126 Males 116—123 „ „ Females 123—126 ., Work 114, 115 „ „ Structural 114, 115 „ „ Non-Structural 114, 115 Scarlet Fever 47—49 „ Outbreaks at School 49 "School Attendance and Measles 50—51 Simple or Continued Fever 60 Slaughterhouses 188—190 Smallpox 44 „ Contacts 44 Smoke, Abatement of 139—140 Spotted Fever (See Cerebral-Spinal Meningitis) Staffs— Clerical 202—203 Inspectorial (Male) 116 „ (Female) 123 Health Visitor 133 Disinfecting 134 Mortuary Attendants 197 Underground Conveniences 141 Suffocation in Bed 100 Suicide and Homicide, Deaths from 100 Summary of Viral Statistics (Lambeth Borough) 1912 100 „ Work of Sanitary Staff (Male)115 „ „ „ (Female) 126 „ Legal Proceedings (Food and Drugs) 155 Syphilis 99 (ix.) PAGE. Tables (Special)— London County Council Appendix 14-—15 Home Office (Factory and Workshops) Appendix 8—12 Local Government Board (old) A and B 104—109 „ ,, (new) i., ii., iii iv., Appendix 2 — 7 Mortality (Lambeth)— Registration Sub-Districts Appendix 20—27 Age periods Appendix 28—36 Tenement Houses (Water Supply to) 12G Town Planning Act (See Housing, Town Planning, etc. Act). Trades (Offensive) 190—191 Tubercular Meningitis, Deaths from 65—66,99 Tuberculosis 65—98 ,, Bacteriological Examination in 66, 195—196 ,, Dispensaries 69, 79—98 „ and Preventive Measures 66, 67, 79—98 „ Lambeth Municipal Tuberculosis Dispensaries Scheme 79—98 „ Notifications and Re-Notifications 70—78 „ Regulations, 1908 and 1911 66—67, 70-78 „ Sanatorium Benefit 90—94, 98 Typhoid Fever 58—60 „ Bacteriological Examinations in 60, 196 „ Sources of Infection 59 Typhus 60 Underground Bakehouses 181 „ Conveniences 141 Unsound Food 116—118 Urinals (Public Houses) 60—61 Urinary Diseases, Deaths from 100 Vaccination 44--46 Value, Rateable (Lambeth) 110 Varicella. (See Chicken-pox). Vinegar 146, 153-154 „ Special Report 153—154 „ Standard for 154 „ Artificial 154 Verminous Persons (Cleansing of) 138-139 Violence, Deaths from 100- (X.) PAGE. Visitor, Health 133 Vital Statistics (Lambeth) 5—110 Appendix 2—7, 20—36 „ „ Summary (Lambeth) 110 Water Analysis 156 „ Boards and Withdrawal of Water 119 „ Certificates 116 „ Supply to Tenement Houses 120 Whooping Cough 50—53 Withdrawal of Water from Houses 119 Work (Male Inspectors) 116 „ (Female Inspectors) 123 „ (Health Visitor) 133 Workplaces. (See Workshops) Workshops 123—126, 127—131, 132—133 Zymotic Diseases 30—99 „ Incidence 18, 34—35