LAM68 REPORT ON THE Vital and Sanitary Statistics OF THE BOROUGH OF LAMBETH DURING THE YEAR 1914. [With an account of the work done by (a) the Tuberculosis Medical Officers under the Lambeth Tuberculosis Dispensaries Scheme, and (b) 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 and other Acts.] BY JOSEPH PRIESTLEY, B.a., M.D., D.P.H., Medical Officer of Health and Chief Executive Tuberculosis Officer. LONDON: Printed by Wightman & Co., Ltd., Regency Street, Westminster, London, S.W. 1915. 3 Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. April, 1915. Medical Officer of Health and Chief Executive Tuberculosis Officer. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, The details contained in the Annual Report for 1914, dealing with the Vital Statistics of the Borough of Lambeth, are again of a satisfactory nature, showing the success of the work carried out by the Council's Public Health Department. The death-rates are low, both general and zymotic, whilst the infantile mortality rate (deaths of infants per 1,000 births) is specially noteworthy in that respect. The Lambeth Municipal Tuberculosis Dispensaries Scheme has justified its inauguration last year (1913), the work carried out at the Council's two Tuberculosis Dispensaries during 1914 being set out in the Appendix. The details of this work speak for themselves. Extra work has been thrown upon the Public Health Department owing to the war and the consequent billeting and encamping of troops within the Borough. In this respect the consent of the Council, on September 24th, 1914, to the appointment of your Medical Officer of Health as a Sanitary Supervisor attached to the Sanitary Staff of the Deputy Director of Medical Services (London District) has proved of value, whilst the cordial relationship between the military and naval authorities and the Borough Council is worthy of special note from a point of view of administrative efficiency. 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 and Chief Executive Tuberculosis Officer for the Metropolitan Borough of Lambeth. I am, Mr. Mayor and Gentlemen, Your obedient Servant, 4 1. VITAL STATISTICS. The Estimated Populations* of the Borough to the middle of 1914 are as follows:— Estimated Populations. (Estimated, Middle 1914.) I. Wards. Wards. Males. Females. Total. Marsh 10985 10049 21034 Bishop's 15404 15649 31053 Prince's 20485 21212 41697 Vauxhall 15234 15184 30418 Stockwell 14862 17023 31885 Brixton 20488 23726 44214 Heme Hill 15562 17623 33185 Tulse Hill 14404 16840 31244 Norwood 14485 17879 32364 Borough of Lambeth 141909 155185 297094 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. Lambeth Church 23442 22718 46160 Kennington 23432 24195 47627 Stockwell 30096 32207 62303 Brixton 36050 41347 77397 Norwood 28889 34718 63607 Borough of Lambeth 141909 155185 297094 *The population of England and Wales is determined from the numbers of births and deaths and the balance of migration since Census date, and not on the assumption of continued increase by geometrical progression, as heretofore. From this enumerated population the Lambeth populations are estimated. 5 III. Parliamentary Divisions (Old). Old Parliamentary Divisions. Males. Females. Total. North 26014 25410 51424 Kennington 35313 35962 71275 Brixton 35497 40608 76105 Norwood 43607 51494 95101 Parliamentary Area of Lambeth 140431 153474 293905 N.B.—The Parliamentary Divisions have not been altered by the London Government Act, 1899, nor by the proceedings that fixed the Boundaries of the Metropolitan Boroughs, so that the above figures do not agree with those for the boroughs 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 52087 Bishop's Kennington Prince's 72115 Vauxhall Brixton Stockwell 76099 Brixton Norwood Herne Hill 96793 Tulse Hill Norwood *Adjusted Parliamentary Area of Lambeth - 297094 *N.B.—By the adjustment of the old Parliamentary Divisions so as to be co-terminous with the Wards. 6 TABLE A. Giving the number of Births and the Birth-Rates in each Registration Sub-District of the Borough of Lambeth during 1914 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1914. Rate per 1,000 Inhabitants. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church* 569 594 581 569 2313 50.1 Kennington† 283 318 288 288 1177 24.7 Stockwell § 509 477 491 490 1967 31.6 Brixton 403 393 382 363 1541 19.9 Norwood 283 308 309 290 1190 18.7 Borough of Lambeth 2047 2090 2051 2000 8188 27.6 *Including Lying-in Hospital (774 cases, of which 210 belong to Lambeth)—corrected rate (i.e., excluding all the Lying-in Hospital births) = 33.3. †Including Workhouse (135 cases, of which 112 belong to Lambeth)—corrected rate (i.e., excluding all the Workhouse births = 21.9. §Including Maternity Hospital (574 cases, of which 153 belong to Lambeth)—corrected rate (i.e., excluding all the Maternity births) =22.4. Inner Districts, 36.02; Outer Districts, 21.5 per 1,000—uncorrected (whole Borough =27.6).—Inner Districts, 26.4; Outer Districts, 19.8 per 1,000—corrected (i.e. excluding all Institutional births, whole Borough = 22.6., N.B.—The births in Stockwell new Sub-District are divided equally between the Inner and Outer Sub-Districts of the Borough for the purpose of calculating the comparative rates of such Sub-districts. TABLE B. Showing the Populations (Estimated), Uncorrected Births, Corrected Deaths and Uncorrected Deaths in Public Institutions, in the Borough of Lambeth during 1914, and during the previous decennium 1901-10, together with the averages for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). Year. Estimated Population. Number of Births Registered. Corrected Numbers of Deaths. Deaths in Public Institutions in Lambeth (uncorrected). Total Ages. Under 1 Year. Under 5 Years. Deaths from 7 Chief Zymotic Diseases. 1914 297094 8188 4269 728 1020 375 2204 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 9059 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 1816.8 1891-1900 294C49.7 9295.4 5405.3 1358.5 2070.2 700.4 1568.5 Note.—(a) Enumerated Population at Census 1901 was 301,895. (b) Enumerated Population at Census 1911 was 298,058. (c) Families or separate occupiers=70,887 (1901) and 70,827 (1911). N.B.—The estimated population for 1914 is calculated from the 1901 and 1911 Censuses, and those for the decennium 1901-10 from the 1891 and 1901 Censuses. 7 TABLE C. Shewing the Birth- and Death-Rates (corrected), and proportion of Deaths (uncorrected) in Public Institutions, in the Borough of Lambeth for the Year 1914, 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 1,000 Population. Corrected Death-Rate per 1,000 Population. Corrected Deaths of Children under 1 Year per 1,000 total Births. Deaths of Children under 1 year per 1,000 Deaths (corrected) Deaths of Children under 5 years per 1,000 Deaths (corrected). Corrected Zymotic DeathRate per 1,000 Population. Deaths in Public Institutions per 1,000 tota uncorrected Deaths. 1914 27.6 14.4 88.9 170.5 238.9 1.3 475.6 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 14.9 121.3 231.04 331.5 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 1.5 386.0 1891-1900 31 6 18.4 146.1 251.3 382.9 2.4 276.7 N.B. The rates for 1914 are calculated upon the population estimated from the 1901 and 1911 Censuses, and the decennial 1891-1900 and 1901-10 upon the populations estimated from the 1881, 1891 and 1901 Censuses. 8 9 THE BIRTH RATE. The total number of Births registered during the year 1914 is 8,188. Of the total 8,188 births, 4,166 are males, and 4,022 females showing an excess of 144 males. Of the total 8,188 births registered, 774 took place in the Lying-in Hospital (York Road), and of these 210 belong to the Borough; 135 took place in the Workhouse (Brook Street), and of these 112 belong to the Borough; whilst 574 took place in the Maternity Hospital (Jeffrey's Road), and of these 153 belong to the Borough. Thus, there are 1,008 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 27.6 per 1,000 inhabitants (29.4 for males and 25.9 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 un-corrected birth-rate in the Inner Districts is 35.2, and that in the Outer Districts 22.1 per 1,000—the corrected birth-rates (i.e., excluding (a) NonLambethian births and (b) all Institutional births) being lespectively (a) 24.2 and (b) 22.6 for the whole Borough, (a) 29.6 and (b) 26.4 for the Inner, and (a) 20.3 and (b) 19.8 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 even to England, but is to be found in nearly all civilised countries. 10 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 44,304 births have been notified up to the end of 1914, viz.: 3,473 in 1908 (10 months), 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, 7,336 in 1912, 7,158 in 1913, and 7,397 in 1914. The notified cases are visited, or such other measures taken in connection therewith, in the way of distributing pamphlets, etc., as are found necessary. In the cases of notified infants who are visited, the methods of feeding are carefully inquired into and instruction given as required. In all notified cases statistics are tabulated, and, taking the whole of the 44,304 births notified from the date the Act came into force on March 9th, 1908, up to the end of 1914, the statistics are as follows:— By whom Notified. Years. Totals.* Father Midwife Doctor Relative (а) Master of Workhouse or (б) Secretary of Hospital— 1. General Lying-in 2. Clapham Maternity 3. St. Thomas 1911. 1396 1754 2045 63 183 821 476 356 1912. 1375 1623 2289 73 195 903 496 382 1913. 1311 1627 2325 59 147 683 523 483 1914. 1161 1815 2376 34 123 820 562 506 1911-14. 5243 6819 9035 229 648 3227 2057 1727 1908-10. 3472 3241 6371 290 200 886 442 417 *The figures for 1908-1910 are added from the 1910 Annual Report for statistical comparison and so as to bring the figures up to date since the adoption of the Notification of Births Act throughout the Borough of Lambeth in 1908. 11 Of the total 28,985 births notified during 1911-1914, 854 were still-born, whilst 563 died within periods varying from a few mintues, a few hours, a few days, or a few weeks from birth, the causes of death being as follows:— Causes of Death. Years. Totals.* 1911. 1912. 1913. 1914. 1911-14. 1908-10. (1) Stillborn 175 215 229 235 854 291 (2) Dead since birth 142 132 144 145 563 219 (a) Prematurity, inanition, debility and wasting 73 62 71 73 279 127 (b) Convulsions 14 20 16 17 67 28 (c) Bronchitis, pneumonia & other lung diseases 19 8 18 21 66 18 (d) Heart failure or exhaustion 4 9 4 8 25 14 (e) Natural causes 1 - - - 1 4 (f) Infectious diseases 2 3 4 2 11 1 (g) Diarrhoea & enteritis 12 7 6 6 31 3 (h) Malformations (congenital) 4 5 10 3 22 3 (t) Other causes (not classified) 13 18 15 15 61 21 Of the 28,985 births notified, 14,294 were visited, but in 1,031 instances the parents were found to have removed or to be unknown, or the addresses given to be wrong. 854 cases were stillborn at the time of notification and the houses were not visited in consequence, and in 7,705 cases pamphlets were sent by post to the parents dealing with the proper method of feeding infants and young children instead of visits being paid, whilst in the remaining 6,132 cases no action whatever was taken, owing (a) to medical men or trained nurses being in charge of the infants and to the houses being in the better class residential parts of the Borough (2407 cases), or (b) to the mothers (though confined in Lambeth, at an *The figures for 1908-1910 are added from the 1910 Annual Report for statistical comparison and so as to bring the figures up to date since the adoption of the Notification of Births Act. 12 institution or hospital) living outside the Borough and the Medical Officers of Health of the various districts being advised by letter (3,725 cases). Of the 13,263 infants who were visited and in connection with whom particulars were tabulated, 12,320 were found at the time to be thriving, 373 in a fair condition and 570 unsatisfactory; 12,736 to be taking their food well and 527 badly; 12,799 to be sleeping well, and 464 badly. In 12,862 cases the mother's health was found at the time of the visit to be good, and in 401 bad, whilst in 12,745 instances the condition of the house was found to be good, and in 518 bad (the sanitary defects, e.g. dirty and dilapidated premises, dampness, etc., being attended to by the Sanitary Inspectors, and notices served as required). These details may be tabulated as follows: — Years. Totals.* 1911 1912 1913 1914 1911-14 1908-10 No action 1514 1503 1361 1754 6132 2817 Left or unknown 222 301 291 217 1031 354 Pamphlets sent 1711 2065 2116 1813 7705 5988 Condition of Infant. 1. General Health: Thriving 3232 3018 2898 3172 12320 5476 Fair 140 138 150 142 570 204 Not thriving 100 96 113 64 373 189 2. Feeding: Well 3366 3121 3006 3243 12736 5694 Ill 106 131 155 135 527 175 3. Sleeping: Well 3370 3146 3022 3261 12799 5678 Ill 102 106 139 117 464 191 Condition of Mother. General Health: Good 3385 3180 3047 3250 12862 5544 Bad 87 72 114 128 401 325 Condition of House Good 3415 3090 2992 3248 12745 5670 Bad 57 162 169 130 518 199 *The figures for 1908-1910 are added from the 1910 Annual Report for statistical comparison, and so as to bring the figures up to date since the adoption of the Notification of Births Act. 13 The methods of feeding were carefully inquired into, and the method that was found most general was breast feeding (supplemented occasionally with cow's milk or other artificial food), 95.4 per cent., but in a small proportion (4.6 per cent.) artificial feeding alone was being employed. The details are as follows:— 1. Natural (Breast) Feeding. Years. Totals.* 1911. 1912. 1913. 1914. 1911-14. 1908-10. (a) Breast entirely 2943 2640 2584 2851 11018 5138 (b) Breast and Cow's Milk 175 252 190 159 776 311 (c) Breast and others 183 220 258 199 860 251 2. Artificial (Hand) Feeding. (a) Cow's Milk 122 89 78 102 391 111 (b) Others 49 51 51 67 218 58 At the time of the first official visit 83.7 per cent. of the 1911-14 infants visited were found to be breast-fed entirely, as compared with 87.5 per cent. of the 1908-10 infants, and these large proportions are to be explained by the fact that the first official visit is made early after notification. Later it is found that this breastfeeding had been either replaced by artificial feeding or supplemented by artificial feeding, due to the mothers' milk diminishing or disappearing altogether on the mothers leaving their beds and getting about their houses, the mothers going out to work, &c., the change of feeding taking place generally about the second or third month. The nature of the artificial foods in use are interesting, as follows:— Artificial Foods. Years. Totals.* 1911. 1912. 1913. 1914. 1911-14. 1908-10 Patent foods 88 100 128 109 425 129 Condensed milk 144 171 181 157 653 180 Cow's milk 297 341 268 261 1167 422 *The figures for 1908-1900 are added from the 1910 Annual Report for statistical comparison and so as to bring the figures up to date since the adoption of the Notification of Births Act. 14 The patent foods in use were the usual one, viz., Allen & Hanbury (45), Ridge's (39), Savory & Moore (10), Neave's (10), Milo (3), Mellin (4), Frame (4), Vienna Food (2), Wheaten Flour (1), Horlick's Malted Milk (7), Benger (3), Biscuits, including Robb's, Brighton, Nursery, Bath, Rusks, &c. (123), Glaxo (56), Robinson's Mother Form of Barley (25) and others (6), whilst cornflour (2), arrowroot (2), oatmeal (31), boiled bread (in the form of crusts, "tops and bottoms," &c. (40), Virol (11), and Albulactin (11), and ordinary food (4) were also found to be in use*. The 653 condensed milks were as follows: Nestle (648), Milkmaid Brand (2), Goat Brand (1), Ideal (1), and Tip-top (1). In 25 cases the patent foods were in use with condensed milk. The mothers visited are pleased to receive advice as to the proper feeding, clothing, and management generally of their infants, and re-visits paid have shewn that such advice has been acted upon. The systematic re-visiting of newly-born infants is important. It is impossible to give satisfactory statistics of the educational value of the visiting of houses wherein births have been notified, but there is no doubt as to the existence of such value—a result that would, naturally, be increased by systematic re-visiting in addition to the first visiting. Returns of all Births (with addresses of mothers), registered in Lambeth, 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 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 so that the supplementary information, obtained from the District Registrar, is of use. 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. *Albumin water (4), peptone powders (1), sugar ana water (1), brandy and water (1), Sanatogen (1), and cod liver oil and malt (1) were also found to be in use. 15 The Registrar General provides particulars of transferable births registered, and for 1914 his figures for the Borough of Lambeth are as follows:— Legitimate Males Legitimate Females Illegitimate Males Illegitimate Females Inward, T ransfers. 19 18 18 18 Outward T ransfers. 469 482 169 119 Totals 73 1239 The Registrar-General's corrected number of births for the year 1914 for the Borough is 7032. THE DEATH-RATE. The total number of deaths registered during the year 1914 is 4,630 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 4,630 deaths registered during 1914, 2,386 are males and 2,244 females. The uncorrected death-rate for Lambeth is, therefore, 15.6 per 1,000 inhabitants (16.8 males and 14.5 females). These rates, are, however, uncorrected, and, on analysing the 4,630 deaths registered in the Borough, it is found that 1,008 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 647 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a corrected number of deaths for Lambeth during 1914 of 4,269, and a corrected death-rate of 14.4 per 1,000 inhabitants. The yearly averages of corrected deaths within the Parish and Borough of Lambeth during the two decennia, 1891-1900 (Parish), and 1901-1910 (Borough), are, respectively, 5,405.3 and 4,709.6. 16 Deaths in Out-Lying Institutions. The Outside Institutions, etc., where the 647 Lambethians died during 1914 may be grouped as follows:— I. General Hospitals. St. Bartholomew's 20 Charing Cross 15 Guy's 30 St. George's 9 King's College 1 University 5 London 5 Westminster 34 Middlesex 18 II. Special Hospitals. Bolingbroke 3 Hostel of God 4 Bow Institution 16 Infant's, Vincent Sq. 34 Brompton 5 Italian Hospital 1 Cancer 1 Joyce Green 1 Catholic Nursing Institute 1 Metropolitan 1 National 3 Central London Throat and Ear 1 Northern Fever Hospital 3 Orchard 1 Chest, Bethnal Green 2 Park 4 City of London 2 Queen Mary's 2 Cottage Hospital, Shooter's Hill 1 Royal Chest 1 Royal Free 3 Downs Sanatorium, Seaman's Hospital 1 Sutton 4 St. George's Home, Chelsea 2 Empire 1 Epileptic Colony 1 St. Joseph's, Hackney 2 Evelina 20 St. Peter's 2 Friedenheim 2 St. Luke's House, Kensington 6 French 1 German 4 St. Mark's, Chelsea 1 Gt. Ormond Street 6 South-Eastern 3 Gt. Northern 1 Southern 1 Grove 26 South-Western 1 Heart, Soho 3 Victoria 4 Homœpathic 2 Western 4 Home for Sick Children, Sydenham 1 West London 2 17 III Infirmaries and Workhouses. St. James' Infirmary (Battersea) 2 Belmont Workhouse 2 Camberwell Infirmary 2 Christ Church Workhouse (Southwark) 2 St. Pancras Workhouse 2 St. Pancras Infirmary 2 Holborn Workhouse 1 Southwark Infirmary 2 Lewisham Infirmary 2 Wandsworth Infirmary 2 Marylebone Infirmary 1 Westminster Infirmary 5 IV. Asylums. Banstead 17 Fountain (temporary) 5 Camberwell House 2 Horton 31 Cane Hill 32 Leavesden 2 Caterham 38 Long Grove, Epsom 18 Claybury 4 Manor 7 Colney Hatch 5 Peckham House 4 Darenth 2 Tooting Bec 74 Dartford 12 V. Unclassified Places. Carlton Hotel 1 Private Houses 17 Clapham Common 1 River Thames 5 George Public House, Strand 1 Streets 5 S.E. & C. Rly. Dulwich 1 Grand Surrey Canal 1 Victoria Embankment 1 Peckham 1 Wharf, Wandsworth Road 1 Holloway Prison 1 New River 1 Summary. I. General Hospitals 137 II. Special Hospitals 190 III. Infirmaries and Workhouses 25 IV. Asylums 258 V. Elsewhere (unclassifiable) 37 Total 647 18 Whether the corrected or uncorrected death-rates for the Borough (as a whole) be taken, they are satisfactory for the year 1914 (the fourteenth year of the existence of the Borough). Subdividing the death-rates according to Registration Sub-Districts, it is again shown 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 death rates be sub-divided amongst the Wards it will be noted also that the Inner Wards, e.g., Marsh, Bishop's, Prince's and Vauxhall, have, collectively 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 sub-divided, the corrected death-rates for 1914 will be found to vary between the Inner and the Outer Districts as follows:— 1914. Registration Sub-Districts and Wards. Inner. Outer. General Death-rate (corrected) 171 124 Zymotic Death-rate (corrected) 1.8 0.9 Of the Registration Sub-Districts, Kennington has the highest general and Lambeth Church and Kennington have the highest zymotic death-rates. Norwood the lowest general and Brixton the 19 lowest zymotic death-rate; whilst, in the Wards, Prince's has the highest general and zymotic death-rates, and Tulse Hill the lowest general and Stockwell and Herne Hill the lowest zymotic deathrates. Tables E, F, and G show the uncorrected returns (male and female), registered during 1914, arranged as to Registration SubDistricts, 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 4,269 corrected deaths during 1914 may be further analysed, and tabulated as follows:— 728, i.e., 171 per cent. of the total corrected deaths took place under 1 year of age. 292, i.e., 6.8 per cent. between 1 and 5 years. 1,020, i.e., 23.9 per cent. under 5 years. 232, i.e., 5.4 per cent. between 5 and 20 years. 497, i.e., 11.6 per cent. 20 to 40 years. 920, i.e., 21.6 per cent. 40 to 60 years. 1,600, i.e., 37.5 per cent. 60 and over. 3,245, i.e., 76.1 per cent. over 5 years. TABLE D (1). BOROUGH OF LAMBETH. STATISTICS FOR 1914. 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 801 82 17.4 1.8 231 99.9 Kennington 870 87 18.3 1.8 161 136.8 Stockwell Inner 450 52 13.8 1.3 150 76.2 Outer 413 28 Brixton 1040 64 13.4 0.8 245 158.9 Norwood 695 62 10.9 0.9 78 65.5 Borough of Lambeth 4269 375 14.4 1.3 865 1056 Inner Districts 2121 221 17.1 1.8 467 104.4 Outer Districts 2148 154 12.4 0.9 398 107.2 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 SubDistrict ( = Stockwell Ward). 20 TABLE D (2). BOROUGH OF LAMBETH. STATISTICS FOR 1914. 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 185 38 18.8 1.8 380 13.3 Bishop's 616 44 19.8 1.4 602 19.4 Prince's 870 87 20.8 2.1 645 15.5 Vauxhall 450 52 14.8 1.7 422 13.9 Stockwell 413 28 12.6 0.8 576 18.1 Brixton 618 38 13.9 0.9 299 6.8 Herne Hill 422 26 12.7 0.8 389 11.7 Tulse Hill 281 28 8.9 0.9 378 12.1 Norwood 414 34 12.8 1.04 375 11.6 Borough of Lambeth 4269 375 14.4 1.3 4066 13.7 Inner Districts 2121 221 17.1 1.8 2049 15.7 Outer Districts 2148 154 12.4 0.9 2017 9.7 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 1914. Sub-District. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals 1914. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Lambeth Church 162 141 303 158 102 260 142 115 257 159 140 299 1119 Kennington 158 156 314 130 144 274 150 151 301 187 187 374 1263 Stockwell 105 106 211 63 61 124 76 50 126 105 95 200 661 Brixton 151 167 318 110 108 218 140 131 271 149 107 256 1063 Norwood 67 81 148 47 57 104 57 68 125 70 77 147 524 Totals 643 651 1294 508 472 980 565 515 1080 670 606 1276 4630 22 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 1914. Sub-District. Under 1 year. 1 to 5 years. 5 to 60 years. 60 years and upwards. Totals 1914. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Lambeth Church 133 98 231 64 70 134 312 236 548 1ll 94 205 1119 Kennington 79 82 161 33 19 52 276 222 498 239 317 556 1263 Stockwell 84 66 150 54 32 86 121 98 219 91 115 206 661 Brixton 142 103 245 58 45 103 214 177 391 136 186 322 1063 Norwood 42 36 78 16 10 26 87 85 122 94 153 247 524 Totals 480 385 865 225 176 401 1010 818 1828 671 865 1536 4630 23 TABLE G. Shewing the uncorrected Deaths (Male and Female) at various age periods in the Borough of Lambeth (arranged quarterly) during the year 1914. Age-periods. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals 1914. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Under 1 year 112 92 204 89 61 150 143 125 268 136 107 243 865 Between 1 and 5 years 44 46 90 46 31 77 59 41 100 76 58 134 401 Between 5 and 60 years 265 226 491 237 197 434 213 199 412 295 196 491 1828 60 years and upwards 222 287 509 136 183 319 150 150 300 163 245 408 1536 Totals 643 651 1294 508 472 980 565 515 1080 670 606 1276 4630 24 25 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 1914 from the Registrar-General—a total of 98 deaths—on slips, giving particulars of outside deaths assigned to the Borough of Lambeth, in addition to those occurring in the Metropolis or in the Metropolitan Institutions (outside Lambeth), 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 specially supplied by the Registrar-General. These Registrar-General's figures for 1914 are as follows:— Age Periods. Males. Females. Totals all ages. 0—1 4 2 6 1—2 1 3 4 2—5 1 3 4 5—15 4 3 7 15—25 5 2 7 25—45 18 9 27 45—65 20 10 30 65 and upwards 7 6 13 Total all ages 60 38 98 26 27 TABLE H (1). Shewing the estimated populations and the number of Deaths, with Death-rates in each of the Registration Sub-Districts of the Borough during 1914. 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 1914). 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). Diarrhoœ 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 46160 801 17.4 - 9 4 6 17 - 4 - - 42 82 1.8 102.4 9.9 Kennington 47627 870 18.3 — 15 3 9 11 - 5 - - 44 87 1.8 100.0 9.2 Stockwell* 62302 863 13.8 — 19 4 9 4 - 1 - - 43 80 1.3 92.4 6.9 Brixton 77398 1040 13.4 — 10 4 14 5 - 2 - - 29 64 0.8 61.5 3.7 Norwood 63607 695 10.9 — 5 1 12 3 - 3 - - 38 62 0.9 89.2 5.9 Borough of Lambeth 297094 4269 14.4 — 58 16 50 40 — 15 - - 196 375 1.3 87.8 6.6 *Of the 863 deaths in Stockwell Registration Sub-District, 450 belong to the Inner and 413 to the Outer Stockwell Sub-District. Inner Registration Sub-Districts—death rates (general 17.1 zymotic 1.8). Outer Registration Sub-Districts—death rates (general 12.4, zymotic 0.9). N.B.—Of the total deaths (corrected), 57 shew no addresses, and the Workhouse Infirmarj -1). or in the have bee* lncluded in Kenn.ngton Sub-District-having occurred in Work1)'" 26) respectively. 28 29 TABLE H (2). Shewing the estimated populations and the number of Deaths, with Death.rates, in each of the Wards of the Borough during 1914. The deaths are from all causes, and from the chief zymoti disease and are corrected by adding Lambethians who die outside the Borough, by omitting strangers who die within the Borough, and by distributing persons (who die in Public Institutions) into the Districts from which they have been removed during illness. B Wards WARDS. Estimated Population (middle 1914). Total Deaths (corrected). General corrected Death. rate per 1000 of the Population Totals 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 10,000 of the Population. Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. Diarrhœa. Marsh 21034 185 18.8 — 6 1 3 6 - 1 - - 21 38 1.8 205.4 9.9 Bishop's 31053 616 19.8 — 3 3 3 11 - 3 - - 21 44 1.4 71.4 6.8 Prince's 41697 870 20.8 — 15 3 9 11 - 5 - - 44 87 2.1 100.0 10.6 Vauxhall 30418 450 14.8 — 13 3 3 3 - 1 - - 29 52 1.7 115.6 9.5 Stockwell 31885 413 12.6 — 6 1 6 1 - - - - 14 28 0.8 67.8 4.4 Brixton 44214 618 13.9 — 5 2 10 4 - 2 - - 15 38 0.9 61.5 3.4 Herne Hill 33185 422 12.7 — 5 2 4 1 - — - - 14 26 0.8 61.6 4.2 Tulse Hill 31244 281 8.9 — 4 — 4 1 - 2 — - 17 28 0.9 99.6 5.4 Norwood 32364 414 12.8 — 1 1 8 2 - 1 - - 21 34 1.04 82.1 6.5 Borough of Lambeth 297094 4269 14.4 — 58 16 50 40 - 15 - - 196 375 1.3 87.8 6.6 Inner Wards—death rates (general, 17.1; zymotic, 18). Outer Wards—death rates (general, 12'4; zymotic, 0'9). N.B.—Of the total deaths (corrected), 57 show no addresses, and have been included in Bishop's and Prince's Wards, having occurred in the Workhouse Infirmary (31) or in the Workhouse (26) respectively. b 30 Causes of the 93 Outside Deaths Causes of Death. Male. Female. Diarrhoea and Dysentrv - 1 Diphtheria — — Membranous Croup 1 — Influenza — 2 Typhoid 1 — Measles — — Phthisis (Pulmonary Tuberculosis) 9 4 Other Tubercular diseases 2 3 Cancer, malignant disease 3 1 Heart disease 5 — Bronchitis 3 1 Pneumonia 1 1 Broncho-Pnuemonia — — Other Lung diseases — — Nephritis and Brirht's disease — — Violent deaths 10 4 Suicide 2 2 Appendicit's 4 — Nervous diseases 6 7 Strangulated Hernia — — Diabetes Mellitus 2 1 Diseases of Digestive System 2 1 Syphilis 1 — Rheumatic Fever — l Not classified above 8 9 60 38 INFANTILE MORTALITY, 1914. Of the 4,269 corrected deaths, 728 are infants under one year of age. The total number of registered births is 8,188, and, of these, 564 occurred at the Lying.in Hospital, and belong to districts outside Lambeth Borough, 23 occurred at the Workhouse, and belong to districts outside Lambeth Borough, and 421 occurred at the Maternity Hospital and belong to districts outside Lambeth Borough. In this way, the corrected number of births for the Borough is 7,180*. The corrected infantile mortality (i.e., rate *The Registrar.General returns the corrected number of births for the Borough during 1914 as 7032. 31 of corrected deaths under one year per 1,000 corrected births) is therefore, 101'4. The annual average for the decennium 1901.10 (Borough) is 1227. 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 88'9. The annual average for the decennium 1901.10 (Borough), is 114'8. Taking the uncorrected number of births (8,188) and the uncorrected number of deaths under 1 year of age (865), the uncorrected infantile mortality is 105.6. 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, diarrhcea, and premature births. In the Registration Sub.Districts, the uncorrected infantile mortality varied from 1589 per 1,000 births in Brixton to 65.5 in Norwood (the low rates of 99.9 in Lambeth Church, 136.8 in Kennington, and 76.2 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— Total No. of Births (uncorrected) 1914. Total Deaths under 1 year (uncorrected). 1914. Infantile Mortality per 1000 births (uncorrected). 1914. Lambeth Church* 2313 231 99.9 Kennington† 1177 161 136.8 Stockwell‡ 1967 150 76.2 Brixton 1541 245 158.9 Norwood 1190 78 65.5 Lambeth 8188 865 105.6 Inner Districts—104 4, Outer Districts—107.2. *Excluding all the Lying.in Hospital births, the rate is 1501. †Excluding all the Workhouse births, the rate is 154 5. ‡Excluding all the Maternity births, the rate is 107.7. N.B.—The births and deaths in Stockwell Registration Sub.Districts are divided equally between the Inner and Outer Districts for the purpose of calculating infantile mortality rates for such Districts in this Table. 32 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 mortalityrate 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 1914 to a low infantile mortality-rate (vide Diarrhoea). Leaflets were again distributed freely throughout the Borough during 1914, dealing with preventive measures to be taken against Summer Diarrhoea and the fly peril in connection therewith. Maternity and Child Welfare. A circular letter from the Local Government Board, dated July 30th, 1914, was received dealing with proposed grants to be distributed by the Board in aid of the expenditure of local authorities and voluntary agencies in respect of institutions and other provision for maternity and child welfare. Expenditure connected with clinics, dispensaries, and other institutions (medical and surgical advice and treatment, as well as the appointments of health visitors and other officers). Within the letter was enclosed a memorandum dealing with the subject, and suggesting as a complete scheme the following:— 1. Arrangements for the local supervision of midwives. 2. Arrangements for— Ante-Natal (1) An ante.natal clinic tor expectant mothers. (2) The home visiting of expectant mothers. (3) A Maternity Hospital or beds at a hospital, in which complicated cases of pregnancy can receive treatment. N atal. 3. Arrangements for— (1). Such assistance as may be needed to ensure the mother having skilled and prompt attendance during confinement at home. (2) The confinement of sick women, including women having contracted pelvis or suffering from any other condition involving danger to the mother or infant, at a hospital. 33 Post Natal. 4. Arrangements for— (1) The treatment in a hospital of complications arising after parturition, whether in the mother or in the infant. (2) The provision of systematic advice and treatment for infants at a Baby Clinic or Infant Dispensary. (3) The continuance of these clinics and dispensaries, so as to be available for children up to the age when they are entered on a school register, i.e., the register of a Public Elementary School, Nursery School, Creche, Day Nursery, School for Mothers, or other school. (4) The systematic home visitation of infants and of children not on a school register as above defined. The object of the Board is to secure an extension |and systema. tisation of all measures hitherto adopted (to a greater of lesser degree) for the prevention of infantile mortality and the general welfare of children will also be improved and the proper treatment of mothers (before, at, and after confinement) secured. For carrying out the work properly, the first step is the appointment of an adequate Staff of Health Visitors (properly qualified and experienced) and the establishment and maintenance of properly officered consultation centres, to be called Maternity Centres, and to act in conjunction with the Midwives,authorities, and maternity hospitals. Grants are also made to institutions of the nature of Schools for Mothers by the Board of Education, such institutions having primarily an educational object, viz., the training and instruction for mothers in the care and management of infants and little children, in the form of systematic classes, or home visiting, or infant consultations. In so far as the Borough of Lambeth is concerned, the work of the Public Health Department connected with the reduction of infantile mortality and the general improvement of infantile and child.health has been continued during 1914, but no steps have yet been taken with a view to amalgamating the Council's work and that of the many various Public Maternity and Women's and Children's Hospitals and other voluntary agencies, such as the North Lambeth Babies'Care, Johanna and Royal Streets' Institutes, Moffat Institute School for Mothers, Wyndham Day Nurseries, etc., under one comprehensive scheme. It may be mentioned that such voluntary agencies are working in conjunction with the Council's Health Department, many of the voluntary officials (Health Visitors, Nurses, etc.), reporting direct to the Medical Officer of Health of the Borough on the official forms in use in the Public Health Department. 34 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 diarrhcea; and the zymotic death.rate is made up from the total deaths from these diseases. In the Borough, during 1914, there were registered 444 deaths from the seven zymotic diseases, and of these 136 are strangers belonging to other districts, and 308 parishioners who died within the Borough. 67 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 375, giving a zymotic corrected death.rate of 1.3per 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 1901.1910 (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 and Kennington show the highest, and Brixton the lowest zymotic death.rates respectively. The corrected zymotic death.rate for the Inner Districts is 1.8, and for the Outer 0.9—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. 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, Prince's shows the highest and Stock. well and Heme Hill the lowest, zymotic death.rates. During the year 1914, under the Notification Clauses of the Public Health (London) Act, 1891, 4,066 cases of Infectious Diseases were reported, including the newly.notifiable cerebro-spinal fever 5, polio-myelitis acuta 10, ophthalmia neonatorum 57, and whooping 35 cough 1,389. The yearly averages of notification certificates received during the two decennia 1891.1900 (Parish) and 1901-1910 (Borough) are respectively 2,658.4 and 1,912.5. Of the total 4,066 cases notified during 1914, 2,315, i.e., 56.9 per cent., were removed to the Hospitals of the Asylums Board or to other Hospitals, and 1,751. i.e., 431 per cent., remained under treatment at their homes. If the newly.notifiable diseases, cerebro.spinal fever, poliomyelitis acuta, ophthalmia neonatorum and whooping cough be excluded, the percentage of cases removed to Hospital for isolation and treatment during 1914 was 86.5—a good average when compared with the following last 4 quinquennial averages (also exclusive of the special diseases mentioned above), i.e., 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; 1901-1905, 67.9; and 1906.10, 82.8. Taking the total number of notified cases (4,066) of infectious diseases, the zymotic incidence* throughout the Borough for 1914 is 13.7 per 1,000 population (15.7 Inner and 9.7 Outer Districts), as compared with two decennial averages 1901.1910 (Borough) and 1891-1900 (Parish) of 6.1 and 9.04 respectively. During 1914 the highest incidence rate is 19.4 (Bishop's), and the lowest 6'8 (Brixton). Further, excluding the ophthalmia neonatorum and whooping cough cases, in connection with which no systematic sanitary examination was made, the number of infected houses, in which the remaining 2,620 notified cases occurred, was 2,363, and in each of these houses a systematic sanitary examination was made of the drains and the traps, fittings and appliances with the following results:— (a) 130 (i.e., 5.5 per cent.) were found to have defective drains, i.e., gave results with the tests employed. (b) 1,007 (i.e., 42.6 per cent.) were found to have defective traps, fittings and appliances. (c) 1,226 (i.e., 51.9 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. *Whooping Cough, Ophthalmia Neonatorum, Polio.myelitis Acuta, and Cerebro.spinal Fever are included in the 1914 figures. Excluding them, the incidence rate for 1914 is 8.8 for the Borough. 36 Sub-divided according to the different notifiable diseases, the results for 1914 show as follow:— 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 493 27 227 254 51.5 48.5 Membranous Croup 6 — 2 2 33.3 66.7 Erysipelas 229 5 86 91 39.7 60.3 Scarlet Fever 1553 85 662 747 48.1 51.9 Typhus — — — — — — Typhoid 42 7 13 20 47.6 52.4 Continued and Relapsing 2 2 2 100.0 0.0 Puerperal 23 3 10 13 56.5 43.5 Cerebro-spinal Fever 5 1 2 3 60.0 40.0 Poliomyelitis Acuta 10 2 4 6 60.0 40.0 Totals 2363 130 1007 1137 48.1 51.9 N.B.—57 ophthalmia neonatorum and 1,030 whooping cough infected houses are omitted. 37 TABLE I. Giving number of Infected Houses, with percentages of (1) General Defects, and (2) Defective Drains, during 1914, together with the averages during the quinquennia, 1891-1895 (Parish), 1896-1900 (Parish), 1901-1905 (Borough) and 1906-1910 (Borough). 1891-1895 (Average). 1896-1900 (Average). 1901-1905 (Average). 1906-1910 (Average). 1914 (Totals). Number of Infected Houses 2229.8 2262.4 1682.6 1719.2 2363 Number of Houses with defects found 1220.0 1096.0 911.2 1033.6 1137 Number of Houses with defective drains found 510.0 366.6 214.6 166.6 130 Number of Houses with no defects found 1009.8 1166.4 771.4 685.6 1226 N.B.— 57 infected houses (wherein 57 cases of Ophthalmia Neonatorum occurred and 1,030 infected houses, wherein 1,389 cases of Whooping Cough occurred) are omitted from the 1914 figures, so that the results may be strictly comparable with those of previous years, i.e., before Ophthalmia Neonatorum and Whooping Cough were made notifiable diseases. b2 38 39 TABLE J. Shewing the number of Certificates for the compulsorily Notifiable Zymotic Diseases under the notification clauses of the Public Health (London) Act, 1891, received in the Borough of Lambeth during 1914, 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, 1914. 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 1745 Diphtheria 511 459 329 317 439 415 317 320 373 318 379.8 715.1 550 Membranous Croup 13 15 9 11 11 11 13 12 3 6 10.4 26.2 6 Typhus — — — — - - 1 - - - 0.1 1.1 - Typhoid or Enteric 147 213 133 101 77 89 56 63 49 77 100.5 189.6 48 Continued and Relapsing 6 10 7 4 2 1 6 3 1 1 4.1 25.7 2 Erysipelas 236 317 236 257 287 263 231 206 189 192 241.4 347.0 231 Puerperal 16 17 17 15 12 27 22 10 16 18 17.0 18.9 23 * Plague — — — — - - - - - - - - - *Cerebro-Spinal Fever - - - - - - 13 14 14 5 11.5 - 5 * Poliomyelitis acuta — — — — - - - - - - - - 10 *Ophthalmia Neonatorum — — — — - - - - - - - - 57 *Whooping Cough — — — — - - - — - - - — 1389 Totals 2025 2712 1547 1382 1853 2074 2140 2056 1809 1527 1912.5 2658.4 4066 Average per 1000 of population 6.7 89 503 45 5'9j 66 66 6'4 56 4"7 6.1 9.04 13.7 The Health Department has also heard of, and dealth with, the followingn on.notifiable infectious diseases during 1914:—Chicken.pox, 795; Measles, 1,531; Cancer, 66; other diseases (e.g., Mumps, Influenza, Scabies, etc.), 259,1523 primary notifications of tuberculosis (1,259 pulmonary and 273 non.pulmonary), notified under the Tuberculosis Regulations, have also been received and dealt with during 1914. * Plague was made compulsorily notifiable on September 19th, 1900; Cerebro.Spinal Fever (" Spotted Fever") on March 12th, 1907; Poliomyelitis acuta on September 1st, 1911; Ophthalmia Neonatorum on March 13th, 1911 and Whooping Cough on January 1st, 1913. N.B.—In addition to the above, Chicken.pox was compulsorily notifiable as follows:—1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), and 1911 (March 22nd to June 22nd, the numbers of cases notified being respectively 1560, 40, 556 and 238. 40 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 Sub.Districts during 1914. Registration Sub-District. 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. Year 1914. Zymotic Death.rate per 1000 inhabitants. Lambeth Church 17 13 29 23 82 1.8 Kennington 11 7 41 28 87 1.8 Stockwell 10 8 31 31 80 1.3 Brixton 7 9 42 6 64 0.8 Norwood 3 8 33 18 62 0.9 Borough of Lambeth 48 45 176 106 375 1.3 Inner Districts 1.8; Outer Districts 0.9 per 1,000 inhabitants. 41 TABLE L (1). Shewing the total cases notified compulsorily under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, in the Borough of Lambeth, during 1914 (arranged Quarterly). 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total for 1914. Cholera - - - Smallpox - - - - - Scarlet Fever 416 391 437 501 1745 Diphtheria 143 104 133 170 550 Membranous Croup — 3 — 3 6 Typhus — — — — — Typhoid or Enteric 17 14 9 8 48 Continued and Relapsing Fever — — 2 — 2 Erysipelas 51 44 49 87 231 Puerperal 10 8 4 1 23 *Plague — — — — — *Cerebro-Spinal Fever — 1 2 2 5 *Poliomyelitis acuta — 1 5 4 10 *Ophthalmia Neonatorum 14 13 15 15 57 *Whooping Cough 320 522 325 222 1389 Totals 971 1101 981 1013 4066 * Plague was made compulsorily notifiable on September 19th, 1900, Cerebro.Spinal Fever on March 12th, 1907, Poliomyelitis acuta on September 1st, 1911, Ophthalmia Neonatorum on March 13th, 1911, and Whooping Cough on January 1st, 1913. Chicken.pox was compulsorily notifiable as follows: 1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), and 1911 (March 22nd to June 22nd), the numbers of cases notified being respectively 1,560, 40, 556 and 238. 42 TABLE L (2). Shewing the total cases notified voluntarily in the Borough of Lambeth during 1914 (arranged quarterly), together with the yearly averages for the decennium 1901.10 (Borough). - 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. T otal, 1914. Y early average 10 years (1901-1910). Measles 130 378 243 780 1531 1376.4 Whooping Cough 150 205 141 85 581 429.6 Chicken Pox* 166 302 111 216 795 599.5 Consumption† 644 599 581 480 2304 668.6 Cancer 19 14 17 16 66 26.5 Total 1109 1498 1093 1577 5277 3100.6 * Chicken.pox compulsorily notifiable as follows 1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 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.—259 other diseases (not classified) e.g., Scabies, Influenza, Ringworm, etc., and Vermin infections (195 Houses and 386 persons' clothing) were also dealt with during 1914. 43 TABLE M. Showing corrected Zymotic seasonal (monthly) variations in the number of deaths from the principal Zymotic diseases, and from Erysipelas, Puerperal Fever, Cerebro-spinal Fever, Poliomyelitis Acuta, and Ophthalmia Neonatorum in the Borough of Lambeth during 1914. For the 4 weeks ending January. February. March. April. May. June. July. August. September. October. November. December. Total 1914. Smallpox - - - - - - - - - - - - - Scarlet Fever 1 4 1 - 2 1 - 2 - 3 9 16 Diphtheria 2 3 2 6 — 1 5 4 11 6 4 6 50 Membranous Croup - - - - - - - - - - - - - Typhus — — — — — — — — — — - - Typhoid or Enteric 2 1 — 4 — 2 2 — 1 2 1 — 15 Continued or Relapsing Fever — — — — — — — — — — - — — Diarrhœa (including Cholera) 5 5 7 3 4 3 10 42 81 24 5 7 196 Measles 2 1 1 3 1 4 2 1 1 8 11 23 58 Whooping Cough 2 3 6 4 4 2 5 3 3 .— 6 2 40 Total of Seven Chief Zymotic Diseases 14 13 20 21 9 14 25 50 99 40 30 40 375 Erysipelas 3 - - 3 1 - - 1 1 3 3 3 18 Puerperal Fever 2 3 — 1 1 - 1 — 1 - - - 9 Cerebro.spinal Fever — 1 — - — - 1 1 - 1 - 4 Poliomyelitis Acuta — — — 1 — - — 2 — - — - 3 Ophthalmia Neonatorum - - — - — - — - — - — - - 44 45 TABLE N. Shewing the number of Deaths (corrected) from the 7 principal zymotic diseases in the Borough of Lambeth during 1914 and during the decennium 1901-1910, together with the yearly averages during 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 1914. Smallpox 4 60 4 — — - - - - - 6.8 1.1 — Scarlet Fever 39 48 23 16 31 28 38 42 27 22 31.4 48.8 16 Diphtheria 47 49 28 33 37 49 47 44 57 25 41.6 124.5 50 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 15 Continued and Relapsing 3 1 1 — — 1 — — 1 — 0.7 1.7 — Diarrhœa 272 159 160 265 176 268 71 150 118 90 172.9 196.5 196 Cholera 2 — 1 4 2 4 — — — — 1.3 8.8 — Measles 119 84 130 164 96 77 107 101 104 122 110.4 145.6 58 Whooping Cough 115 118 126 109 79 71 111 50 85 54 91.8 143.7 40 Borough of Lambeth 627 561 498 603 431 522 379 397 402 331 475.1 706.1 375 46 The quarterly seasonal mortahty (corrected) from the whole of the different important zymotic diseases (i.e., principal and others) during 1914 is as follows:— 1914. 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. — 5 7 — — 4 — 17 — 4 11 3 6 16 73 2ndQr. — 3 8 — — 5 — 10 — 9 10 5 2 9 61 3rd Qr. — 4 19 — — 3 — 135 — 4 11 3 2 2 183 4th Qr. — 4 16 — — 3 — 34 — 41 8 8 — 6 120 Totals. — 16 50 — — 15 — 196 — 58 40 19 10 33 437 Taking the zymotic diseases collectively, it is noticed that the 3rd quarter showed the highest mortality, and the 2nd the lowest. Scarlet fever, puerperal fever and influenza reached their maxima in the 1st quarter; typhoid (or enteric) in the 2nd; diarrhoea and diphtheria in the 3rd; and erysipelas and measles in the 4th. Whooping cough showed the highest mortality in the 1st and 3rd quarters. Table K shews the zymotic seasonal variations in the different Registration Sub.Districts, while Table M gives the monthly mortalities from the zymotic diseases. Table N gives the deaths registered in the Borough of Lambeth from the seven principal zymotic diseases during 1914, and for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). SMALLPOX. During 1914 no single case of genuine smallpox was notified, nor was a single death from smallpox registered within the Borough. 47 One doubtful case (adult male) was reported in connection with the 4th London General Hospital (Denmark Hill), but proved not to be smallpox. The annual averages for smallpox 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 8 years. Twelve "contacts" were watched for 16 days each within the Borough during 1914, in connection with (a) persons arriving by vessels from abroad, such vessels coming from smallpox.infected places, or being themselves (?) smallpox.infected by cases on board, e.g., S.S. "Trader" (1), "Malwa" (4), "Arlanza" (2), and "Paris" (5). In view of the increased danger of smallpox being introduced through the movements of troops from district to district and from country to country in connection with the war, the Local Government Board re-issued a memorandum dealing with the measures to be taken to prevent the spread of the disease, consisting of notification, hospital isolation, disinfection and medical inspection of "contacts" or "suspects," with vaccination and re-vaccination as required—measures that have been adopted with success in Lambeth Borough for many years past. Vaccination. The Vaccination Returns of the Local Government Board for the Borough are to be found in Tables 0 and P, dealing with the whole year 1913 and the first half of 1914 respectively.* These Returns are obtained from the Vaccination Officers. The total number of conscientious objectors who obtained certificates during 1914, irrespective of the dates of births of the children to which they relate, is 1,952, whilst the total number of certificates of successful primary vaccinations, at all ages, received during 1913 and 1914 are 4,440 and 3,990 respectively. * 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 1914 can be given in this report. 48 TABLE O (1). VACCINATION RETURNS (LAMBETH BOROUGH), 1913. 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 2324 1103 170 303 714 25 Kennington 1222 599 — 87 221 289 18 Stockwell 1990 919 2 125 505 430 7 Brixton 1526 683 1 97 406 257 71 Norwood 1147 560 4 58 411 92 18 Lambeth 8209 2864 7 537 1846 1782 139 The Yearly Returns are not made up for the Local Government Board until the August in the following year. 49 TABLE O (2). VACCINATION RETURNS (LAMBETH BOROUGH) FOR THE FIRST HALF-YEAR, 1914. 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. Lambeth Church 1158 452 — 83 206 364 37 Kennington 590 252 1 50 137 115 28 Stockwell 963 428 1 59 232 214 22 Brixton 790 332 1 46 228 122 51 Norwood 590 273 2 31 222 28 20 Lambeth 4091 1737 5 269 1025 843 158 50 CEREBRO.SPINAL FEVER (EPIDEMIC CEREBRO.SPINAL MENINGITIS) OR " SPOTTED FEVER."* During 1914, 5 cases of cerebro.spinal fever were notified in the Borough, 2 in Lambeth Church, 1 in Stockwell, 1 in Brixton and 1 in Norwood Registration Sub.Districts, and, of the 5 cases notified, 4 died. The necessary precautionary measures were taken in each case, 3 of the patients being removed to Hospital (1 from Lambeth Church, 1 from Stockwell, and 1 from Norwood Sub.Districts). Particulars are set out in L.G.B. New Table V. (vide Appendix). ACUTE POLIO-MYELITIS. (ACUTE POLIO.ENCEPHALITIS).* During 1914, 10 cases of acute polio.myelitis were notified in the Borough, 6 in Lambeth Church, 1 in Kennington, 1 in Stockwell, 1 in Brixton and 1 in Norwood Registration Sub. Districts, and, of the 10 cases notified, 3 died. The necessary precautionary measures were taken in each case, 7 of the patients being removed to Hospital (4 from Lambeth Church, 1 from Stock. well, 1 from Brixton and 1 from Norwood Sub.Districts). Particulars are set out in L.G.B. New Table V. (vide Appendix). CHICKEN.POX. Chicken.pox was not compulsorily notifiable during 1914 in the Borough, but, through the head teachers of schools and voluntarily from other sources, 795 cases were reported to the Council, and in connection with these disinfection and other necessary precautionary measures were taken. SCARLET FEVER. During 1914 in the Borough, 1,745 cases of scarlet fever were notified, and 16 deaths registered, giving a case mortality of 0'9 per cent. The annual averages for 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. *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. 51 Of the 1,745 persons notified in the Borough during 1914, 1,649* (i.e., 94.5 per cent.), were removed to Hospital, and of these 13 died (i.e., 0.8 per cent.), whereas 96 (i.e., 5.5 per cent.) were treated at home, and of these 3 died (i.e., 3.1 per cent.). The age and sex incidence and mortality for the 1,745 scarlet fever cases notified in Lambeth Borough during 1914 are as follow: Age. Number of Cases notified. Deaths. Death-rate per 100 Notified. M. F. Total. M. F. Total. Total. Under 1 year 5 5 10 - - - 0.0 1 to 2 24 23 47 1 1 2 4.3 2 to 3 31 48 79 4 3 7 8.9 1 to 4 62 61 123 — 1 1 0.9 4 to 5 84 68 152 1 1 2 1.3 5 to 6 109 83 192 — 1 1 0.5 6 to 7 90 87 177 — — — 0.0 7 to 8 54 87 141 — — — 0.0 8 to 9 54 78 132 — — — 0.0 9 to 10 52 55 107 — — — 0.0 Over 10 years 252 333 585 — 3 3 0.5 Total 817 928 1745 6 10 16 0.9 It will be noted that, of the total 1,745 persons reported as suffering from scarlet fever during 1914, within the Borough of Lambeth, 411 (i.e., 23.6 per cent.) were under five years of age, and 1,160 (i.e., 6705 per cent.) under 10 years of age: whilst the case mortality was greatest amongst those between 2 and 3 years of age. Of the 585 persons over 10 years of age, 3 died (i.e., 0.5 per cent.). During 1914, outbreaks of scarlet fever were investigated in connection with 13 schools (infants' departments) and 14 absentees (10 doubtful cases of sore throat and 4 of suspicious" peeling") were visited and inquiries made in regard thereto, and the children not allowed to return to school until furnished with medical certificates. * Of the 1,649 cases of Scarlet Fever removed to Hospital, 113 proved at Hospital not to be suffering from that disease. 52 The distribution of the cases of, and the mortality from, scarlet fever amongst the different Registration Sub-Districts of the Borough during 1914, is 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 Hospial. Total. Lambeth Church 336 7 329 - 4 4 1.2 Kennington 308 8 300 1 2 3 0.9 Stockwell 321 28 293 — 4 4 1.2 Brixton 500 34 466 2 2 4 0.8 Norwood 280 19 261 — 1 1 0.4 Borough of Lambeth 1745 96 1649 3 13 16 0.9 Twelve Schools were disinfected during 1914 in connection with scarlet fever cases notified amongst the scholars. MEASLES AND WHOOPING COUGH. In the Borough, during 1914, 58 and 40 corrected deaths were registered from measles and whooping cough, giving corrected death-rates per 10,000 of the populations of 1'9 and 13 respectively. The Inner Districts suffered (deaths per 10,000 of the population) more than the Outer Districts, thus:— Inner. Outer. Whooping Cough 2.5 0.5 Measles 2.9 1.2 Of the Registration Sub-Districts, Kennington suffered most, and Norwood least, from measles, and Lambeth Church most, and Norwood least, from whooping cough. The annual average numbers of deaths from measles and whooping cough respectively during the two decennia 1891-1900 (Parish) and 1901-1910 (Borough), are 145.6 and 110.4 (measles) and 143.7 and 91.8 (whooping cough). 53 Measles. Of the 58 deaths from measles in the Borough during 1914, 47 (i.e., 8103 per cent.) occurred amongst children under 5 years of age, showing that measles is a disease of young children, and especially fatal to such. 16 of the deaths (i.e., 27.6 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 distributing 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. Further powers should be given to Sanitary Authorities to exclude from attendance at school all children from measles.infected houses and all children under 5 years of age, whether living in measles.infected houses or not. Measles is not compulsorily notifiable, but 1,531 cases (during 1914) 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 1,531 notified cases, 28 (i.e., 1.8 per cent.) were removed to hospital from the Borough, non.pauper as well as pauper cases being now received for treatment and isolation in hospital, under the new» Metropolitan Asylums (Measles) Order (August 9th). The small percentage was due to the order being temporarily suspended, the beds being required for scarlet fever cases. Measles is spread chiefly through Schools, especially Infants' Departments, and during 1914 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. 106 Schools (Infants' Departments) were dealt with, representing 121 different class.rooms or grades, and a total of 1,599 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 267 cases of measles). 8 Schools were disinfected in connection with outbreaks of measles. * "Unprotected" children only are excluded from Schools by the L.C.C. instructions issued by their Educational Department. 54 Whooping Cough.* Whooping cough became compulsorily notifiable on January 1st, 1913, and, during 1914, 1,389 cases were notified. 40 of the total 1,389 cases notified died [i.e., 2.9 per cent.). Whooping Cough is a serious disease, especially to young children. Of the 40 deaths registered in the Borough during 1914 from this disease, 38 (i.e., 95 per cent.) occurred in children under 5 years of age, and 17 of the deaths (i.e., 42.5 per cent.) occurred amongst infants under 1 year of age. It is, therefore, a disease of childhotxl, and its prevention is being systematically attempted, chiefly in the way of compulsory notification of the cases, disinfection of W hooping 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. Further powers should be given to Sanitary Authorities to exclude from attendance at School all children from Whooping Cough.infected houses and all children under 5 years of age, whether living in Whooping Cough.infected houses or not. Unfortunately, Whooping Cough, like Measles, is, at present, regarded as a harmless complaint of childhood, and the ignorance displayed and the apathy shown are well known to all who visit amongst the poorer classes. It is hoped that, by making the disease compulsorily notifiable, attention will be drawn to its serious nature, and the need that exists for taking precautionary measures in regard thereto. Of the 1,389 cases of Whooping Cough notified during 1914, 52 (i.e., 3 7 per cent.) were removed to hospital, non.pauper as well as pauper cases being received for treatment and isloation in hospital, under the new Metropolitan Asylums (Whooping Cough) Order, 1912 (August 9th). The small percentage was due to the Order being temporarily suspended, the beds being required for Scarlet Fever cases. 581 cases of the disease, in addition, were voluntarily notified through schools. Leaflets (dealing with the dangers and treatment of the disease) were left at all notified whooping cough.infected houses. During 1914 no classroom was closed, and no school nor classroom was required to be disinfected on account of an outbreak of whooping cough. * The Council, by Order, on October 3rd, 1912, made Whooping Cough compulsorily notifiable by medical men and parent or relatives from trial period of 5 years, commencing January 1st, 1913. The Order was approved by the Local Government Board on October 31st, 1912. † "Unprotected" children only are excluded from Schools by the L.C.C. instructions, issued by their Educational Department. 55 There is still a practical difficulty in securing proper home isolation of the notified cases of whooping cough in view of the generally held opinion that treatment in the open air is necessary. Even the hospitals (out-patient departments) are accustomed to tell parents and others to bring the whooping cough patients to the hospitals for further inspection and treatment from week to week, and this advice is acted upon in view of the fact that the parents and others in charge are not in a financial position to call in medical practitioners at the homes of the patients. The practical difficulty of securing efficient home isolation in crowded districts and tenements is well known. Details of the incidences of measles and whooping cough in the different Registration Sub-Districts of Lambeth Borough during 1914 are as follow:— Registration Sub-Districts. Number of Deaths from Whooping Cough. No. of Deaths from Measles. Whooping Cough Deaths per 10000 Inhabitants. Mealses Deaths per 10000 Inhabitants. Lambeth Church 17 9 3.7 1.9 Kennington 11 15 2.3 3.1 Stockwell 4 19 0.6 3.04 Brixton 10 0.6 1.3 Norwood 3 5 0.5 0.8 Borough of Lambeth 40 58 1.3 1.9 CHOLERA AND PLAGUE. In the Borough, during 1914, no case of plague, suspected or otherwise, was notified, and no death from plague was registered. No case of cholera was notified, and no death from cholera was registered during 1914. 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 diarrhœa and cholera nostras or English cholera. One suspected plague "contact" arrived from abroad (from India) per S.S. "Persia," in the hold of which were found dead rats, which proved on bacteriological examination to be suspicious of plague, but, in connection therewith, no case of human plague developed. 56 DIPHTHERIA. During 1914, 50 deaths were registered in the Borough from diphtheria, and a total of 550 cases were notified, giving a casemortality of 91 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 550 cases notified during 1914, 476* (i.e., 86.5 per cent.) were removed to hospital, and 47 died, giving a case-mortality of 9.9 per cent, amongst the cases treated in hospital; whilst 74 (i.e., 13.5 per cent.) were treated at home, and 3 died (i.e., 41 per cent.). The case-mortality rate for the whole of the Borough during 1914 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.† It will be noted that there has been a slight increase in the diphtheria rates in the Borough during 1914, but, allowing for the slight fallacy that may arise from comparing statistics of the old Parish with those of the new Borough, the general decrease in the mortality from diphtheria is again noteworthy, as also the general decrease in the number of notifications of the same disease received, thus:— Quinquennial Period. Population (estimated). Number of Deaths. Death-rate per million living. 1863-1867 902119 148 164 Old Parish of Lambeth. 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 1913 297139 36 121 1914 297094 50 168 * Of the 476 cases of Diphtheria removed to Hospital, 45 proved at Hospital not to be suffering from that disease. † 72 Bottles of Antitoxin were distributed during 1914 under the new Antitoxin Order. 57 The statistics for London, as a whole, are no less noteworthy. During 1914 no school was closed on account of diphtheria, but exclusion of "sore throats " was resorted to in the case of 13 schools (13 classrooms), a total of 40 children, of whom 28 shewed, on bacteriological examination, the presence of the true Klebs-Loeffler bacillus in the throat or nose, or both, and 12 the presence of the Hoffman (pseudo-diphtheria) bacillus. These 40 children were not allowed to resume attendance at school until certificates (based on bacteriological examination) had been furnished stating that they were free from infection. No school was disinfected during 1914 in connection with an outbreak of diphtheria. An outbreak of diphtheria (6 cases) in connection with the nursing staff of a General Hospital occurred during 1914, and was stamped out by isolation of the patients, disinfection and medical inspection of all the other nurses, together with bacteriological examinations. The source of the outbreak was not traced. The age and sex incidence and mortality from diphtheria cases notified in the Borough of Lambeth during 1914 are as follow:— Diphtheria. Ages. No. of Cases Notified. Deaths. Death Rate per 100. M. F. Total. M. F. Total. Under 1 year 7 6 13 2 — 2 15.4 1 to 5 89 51 140 15 6 21 15.0 5 to 10 118 109 227 12 12 24 10.6 10 to 20 52 57 109 2 — 2 1.9 20 to 40 12 41 53 — 1 1 1.9 40 to 60 3 5 8 — — — 0.6 60 and over - - — - - - - Total 281 269 550 31 19 50 9.1 58 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, &c., during 1914, 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 78 1 77 1 5 6 7.7 Kennington 91 7 84 — 10 10 10.9 Stockwell 129 25 104 — 9 9 6.9 Brixton 142 21 121 1 13 14 9.9 Norwood 110 20 90 1 10 11 10.0 Borough of Lambeth 550 74 476 3 47 50 9.9 MEMBRANOUS CROUP. During 1914, in the Borough, 6 cases of membranous croup* were notified, but no death was registered from the disease. 3 cases were removed to hospital. The annual averages for the decennium 1901-10 are (1) notified cases 10.4, and (2) deaths 1.5.† TYPHOID FEVER. During 1914, 15 deaths were registered in the Borough from typhoid (enteric) fever, and a total of 48 cases notified, giving a case-mortality of 31.4 per cent. The annual averages for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough) are respectively, (1) notified cases 189.7 and 100.5, and (2) deaths 34.7 and 16.7. Of the 48 cases notified in the Borough during 1914, 41J (i.e., 85.4 per cent.) were removed to hospital, and 14 died, giving a case-mortality of 34.1 per cent, amongst the patients treated in hospital; whilst 7 (i.e., 14.6 percent.) were treated at home, and 1 died, giving a case-mortality of 14.3 per cent, amongst the patients treated at home. * 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; 1912,5; 1913, 7; and 1914, 6. † In London Statistics Diphtheria and Membranous Croup are now grouped together by the Registrar-General. † Of the 41 cases of Typhoid Fever removed to hospital, 3 proved at hospital not to be suffering from that disease. 59 The age and sex incidence and mortality for typhoid cases notified in Lambeth Borough during 1914 are as follow:— Ages. Number of Cases Notified. Deaths Deathrate per 100. M. F. T otal. M. F. Total. Under 1 year 1 1 2 — — — 0.0 1 to 5 — 1 1 — 1 1 100.0 5 to 10 3 2 5 — 1 1 20.0 10 to 20 5 10 15 — 2 2 13.3 20 to 40 11 9 20 5 5 10 50.0 40 to 60 3 2 5 1 — 1 20.0 60 and over - - - - - - - Total 23 25 48 6 9 15 31.3 It will be noted that there were 3 cases notified, and 1 death registered, amongst children under 5 years of age, whilst the greatest number of both cases and deaths occurred amongst persons between 20 and 40 years of age. Details as to incidence of the disease during 1914 upon the Registration 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 18 - 18 - 4 4 22.2 Kennington 8 1 7 - 5 5 62.5 Stockwell 4 — 4 - 1 1 25.0 Brixton 11 4 7 1 1 2 18.2 Norwood 7 2 5 - 3 3 42.9 Borough of Lambeth 48 7 41 1 14 15 31.3 60 18 out of the 48 cases notified were traced to sources outside the Borough, 3 were found not to be suffering from the disease, and 6 were secondary cases, i.e., derived from previous cases (notified or unrecognised) as far as could be discovered. No case could be traced definitely and conclusively to infected ice-creams, water, milk, fried or shell-fish or watercress, but in 4 cases there was a history of shell-fish (cray-fish and oysters) having been consumed by patients 2 to 3 weeks prior to their attacks. Of the 48 typhoid-infected houses, 20 (i.e., 41.7 per cent.) showed, on inspection, defective drains, traps, fittings, or appliances, whilst in 7 (i.e., 14.6 per cent.) the drains themselves were found to be defective (i.e., gave a result with the test). In so far as typhoid fever is regarded as a sanitary index of a district, the statistics for the Borough during 1914 are of a satisfactory character. SIMPLE OR CONTINUED, RELAPSING AND TYPHUS FEVERS. During 1914, 1 case of continued fever and 1 case of relapsing fever were notified, but no death from these diseases was registered, in the Borough. No case was removed to hospital. The annual averages for the decennia 1901-10 are (1) notified cases 4.3, and (2) deaths 0.7. No case of typhus was notified, and no death from the disease was registered, during 1914 in the Borough. One case of typhus was notified in the Borough during the decennium 1901-10. i.e., an annual average of 0.1. PUERPERAL FEVER. During 1914 in the Borough, 10 deaths were registered from puerperal fever (a disease of child-bed), and 23 cases notified, giving a case-mortality of 43.5 per cent. 21 of the cases were removed to hospital, non-pauper as well as pauper patients being received for treatment and isolation at the Metropolitan Asylums Board Hospitals under the new Metropolitan Asylums (Puerperal Fever) Order, 1912 (August 20th). The annual averages for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough) are respectively (1) notified cases, 18.9 and 17.0, and (2) deaths 11.5 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. 8,188 births were registered in the Borough during 1914, and in only 23 cases was puerperal fever notified—a satisfactory fact to be able to report. In each case of puerperal fever notified, enquiries were made, and the midwives 61 (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 1914, in the Borough of Lambeth, 231 cases of erysipelas were notified, and 19 deaths registered, giving a case-mortality of 8.2 per cent. Of the 231 cases notified, 63 (i.e., 27.3 per cent.) were removed to hospital. The annual averages for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough) are respectively (1) notified cases 347.0 and 140.8, and (2) deaths 17.7 and 12.3. 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. DIARRH(EA. During the year 1914 there were registered in the Borough 196 deaths from diarrhœa, as compared with yearly averages of 196.7 and 173.0 respectively for the two decennia 1891-1900 (Parish) and 1901-10 (Borough). Taking the statistics of the Parish and the Borough for the four quinquennia 1891-1895, 1896-1900, 1901-1905, and 1906-1910 respectively, when the yearly averages for diarrhœa (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. Of the 196 deaths registered during 1914 in the Borough, 186 (i.e., 94.9 per cent.) were in children under 5 years, and 156 (i.e., 79.6 per cent.) in infants under 1 year of age. July, August, September and October were the most fatal months, and, during this period of 4 months, the incidence of diarrhœa (deaths per 10,000 of the population) upon the Inner Districts was proportionately greater than that upon the Outer Districts. In this connection, it is interesting to note that the 4ft. earth thermometer first registered 56 deg. F. on June 18th, rising to a maximum 62 deg. F. on August 16th, and remaining at such maximum until September 14th, and sinking to 56 deg. F. again on October 16th. 56 deg. F. is the socalled "critical" earth temperature for diarrhœa, 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. * The 4-ft. earth temperatures were taken in Regent's Park, and thanks are due to the Secretary of the Royal Botanic Society for the information in connection therewith. c 62 Age mortalities (corrected deaths) from diarrhœa were as follows:— M. F. Total. Percentage of total deaths. Under 1 year 91 65 156 79.6 1 to 5 13 17 30 15.3 5 to 20 1 1 2 1.02 20 to 40 1 2 3 1.5 40 to 60 — 1 1 0.5 Over 60 1 3 4 20.4 Total 107 89 196 100.0 The details as to the diarrhœa incidence (mortality) during 1914 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 10,000 Population. Lambeth Church 42 9.9 Kennington . 44 9.2 Stockwell 43 6.9 Brixton 29 3.7 Norwood 38 5.9 Borough of Lambeth 196 6.6 63 Borough of Lambeth. Wards. Number of Deaths. Diarrhœa Death Rate per 10,000 Population. Marsh 21 9.9 Bishops 21 6.8 Prince's 44 10.6 Vauxhall 29 9.5 Stockwell 14 4.4 Brixton 15 3.4 Heme Hill 14 4.2 Tulse Hill 17 5.4 Norwood 21 6.5 Borough of Lambeth 196 6.6 Taking the whole of the deaths registered during 1914, the diarrhœa death-rate per 10,000 population in the Inner Registration Sub-Districts and Inner Wards is 9.3, as compared with 4.7 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. 16 deaths (4 in infants under 1 year of age) were registered during 1914 from "enteritis." During recent years there has been a marked improvement in the diagnosis of deaths from diarrhœa 1 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. Practical measures were again taken to prevent epidemic diarrhœa (and other infectious diseases) in infants and to promote hygienic conditions in the feeding of infants, systematic visiting of houses wherein births were notified under the Notification of Births Act, 1907, and wherein deaths were registered as having occurred from epidemic diarrhœa, the teaching of proper feeding and care of infants by the Council's female staff, the work of the Milk Depot and the Infants' consultations in connection therewith, etc., may be tabulated as some of the measures taken during 1914 with success. In addition, a special leaflet was again issued during the year, dealing with precautions against summer diarrhœa in connection with irregular and improper feeding of infants and the value of the milk depot in relation thereto, the danger of contamination of food by 64 flies, the importance of removing at once all accumulations of refuse and other offensive matters, uncleanliness generally as a cause of diarrhœa, etc. The subject of Child Welfare Schemes is dealt with under Infantile Mortality. GLANDERS, ANTHRAX, ETC. During 1914, 4 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 1914, 33 deaths were registered from Influenza in the Borough. Of the 33 deaths, 16 were registered during the first, 9 during the second, 2 during the third, and 6 during the fourth quarter of the year. The annual averages for the two decennia 1891-1900 (Parish) and 1901-10 (Borough) are respectively 107.5 and 53.2. OPHTHALMIA NEONATORUM. (CONTAGIOUS OPHTHALMIA OF NEWLY-BORN 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. A further Order, dated February 5th, 1914, known as the "Public Health (Ophthalmia Neonatorum) Regulations, 1914, has been issued by the Local Government Board, extending the compulsory notification of the disease to every sanitary district in England and Wales, and requiring certain additional information† beyond that required in connection with notifications under the Infectious Diseases (Notification) Act. Certified midwives are also required to notify, under the new Order, children suspected to be suffering from the disease, unless already notified by a medical practitioner. The regulations came into force on April 1st, 1914. During 1914, within the Borough, 57 infants were notified as suffering from the disease. Each case was visited officially and the necessary precautionary measures were taken. No case was removed to hospital.t All the notified infants recovered. * The Order includes also Anthrax and Hydrophobia occurring in human beings. † Date of birth, name and address of the parent or other person (if any) having charge, and date of onset of the disease. ‡ No special hospital accommodation for cases of ophthalmia neonatorum has been provided in London, the general and special hospitals dealing with the cases in their out-patient and in-pattent departmenis as required. 65 The London County Council Medical Inspectors under the Midwives Act report all cases of inflammation of the eyes of newlyborn babies to the Medical Officers of Health of the various Metropolitan Districts, i.e., in addition to notifiying cases of diagnosed ophthalmia neonatorum as required by the Order. TUBERCULOSIS. Details of the work carried out during 1914 in connection with the Lambeth Municipal Tuberculosis Dispensaries Scheme are to be found in the Appendix. During 1914, 386 deaths (corrected) were registered in the Borough as due to phthisis (tuberculosis of the lungs), 4 as due to tabes mesenterica, 48 as due to tubercular meningitis and hydrocephalus, and 57 as due to other forms of tuberculosis, making a total of 495 deaths from tuberculosis (all forms)—i.e., 11.6 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 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 1914 amongst the different Registration Sub-Districts, it is found that the numbers of deaths vary as follow:— Registration Sub-Districts. Deaths from Total Deaths. Tuberculosis (all forms). Phthisis. Tabes. Mes. and Tub. Men. Other forms Tuberculosis. Lambeth Church 72 8 12 92 Kennington 75 7 14 96 Stockwell 70 9 11 90 Brixton 113 17 13 143 Norwood 50 11 7 68 No address* 6 — — 6 Borough of Lambeth 386 52 57 495 * N.B.—In the case of the 6 deaths amongst persons whose addresses were not given, these deaths have been divided equally between the 5 Registration Sub-Districts for the purpose of working out rates. 66 The distribution of tuberculosis, as a disease, can be gauged from the official notifications that have been received under the new Public Health (Tuberculosis) Regulations, 1912, which came into force on February 1st, 1913, all previous Regulations being then revoked. All the sources of notifications received during 1914 are set out in Table Q prepared for the Local Government Board and Tables Q (I) and Q (II) 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, instructions are given as to simple precautionary measures to be taken, and disinfection is carried out as required, but with due regard to privacy, instructions being given to the officers to avoid doing anything likelv to cause pain or annoyance to the patients or their friends. Taking all the primary notifications of pulmonary tuberculosis (consumption) received during 1914—a total of 1,250—the disease appears to have had an equal incidence upon the Inner and the Outer Districts (Registration Sub-Districts and Wards), viz.: 4.4 as compared with 4 04 per 1,000 population, as follows:— (a) Tuberculosis (Pulmonary). 1 Wards— Inner—4.4, viz.: Marsh, 3.6; Bishop's, 5.1; Prince's, 4.4; Vauxhall, 4.3. Outer—4.04, viz.: Stockwell, 3.3; Brixton, 4.3; Heme Hill, 4.5; Tulse Hill, 3.8; Norwood, 4.1. 2. Registration Sub-Districts— Inner—4.4, viz.: Lambeth Church, 4.9; Kennington, 4.1; Inner Stockwell, 4.3. Outer—4.04, viz.: Outer Stockwell, 3.3; Brixton, 4.4; Norwood, 3.9. Borough of Lambeth =4.2. Taking all the primary notifications of tuberculosis (all forms) received during 1914 under the new 1912 Regulations, the incidence rates of the disease per 1,000 of the populations are greater in the 67 Inner than in the Outer Districts (Registration Sub-Districts and Wards), as follows:— (b) Tuberculosis (all forms). 1. Wards— Inner—5.5, viz.: Marsh, 4.7; Bishop's, 6.1; Prince's 5.4; Vauxhall, 5.6. Outer—4.9, viz.: Stockwell, 4.4; Brixton, 5.2; Heme Hill, 5.3; Tulse Hill, 4.4; Norwood, 4.9. 2. Registration Sub-Districts— Inner—5.5, viz.; Lambeth Church, 5.9; Kennington, 5.1; Inner Stockwell, 5.6 Outer—4.9, viz.: Outer Stockwell, 4.4; Brixton, 5.2; Norwood, 4.7. Borough of Lambeth =5.1. The corresponding death-rates from (a) tuberculosis (pulmonary), and (b) tuberculosis (all forms) per 1,000 of the population living are for the Registration Sub-Districts as follow:— (a) Tuberculosis (Pulmonary)— Inner—1.5*, viz.: Lambeth Church, 1.6; Kennington, 1.6; Inner Stockwell, 1.2. Outer—1.2*, viz.: Outer Stockwell, 1.1; Brixton, 1.5; Norwood, 0.8. Borough of Lambeth = 1.3. (b) Tuberculosis (all forms)— Inner—1.9*, viz.: Lambeth Church, 2.02; Kennington, 2.04; Inner Stockwell, 1.5. Outer—1.5*, viz.: Outer Stockwell, 1.4; Brixton, 1.9; Norwood, 1.1. Borough of Lambeth = 1.7. * 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. 68 69 METROPOLITAN BOROUGH OF LAMBETH. TABLE Q. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications received during the period from 4th January, 1914, to the end of the week ending the 2nd January, 1915. Age-Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications. (Medical.) *Total Notifications (i.e., including cases previously notified by other Doctors). (Medical.) Primary Notifications (Medical.) †Total Notifications (i.e., including cases previously notified by other Doctors). (Medical.) Cases admitted to Cases discharged from 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and upwards. Total Under 5. 5 to 10. 10 to 15. Total. Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. (Medi cal.) (Medi cal.) Pulmonary— Males - 3 24 27 52 71 180 151 110 34 9 661 816 — 2 4 6 7 158 122 121 130 Females 2 3 13 60 52 75 164 129 50 17 12 577 666 - 3 3 6 8 71 96 48 108 Non-Pulmonary— Males 6 24 33 15 20 7 21 6 5 4 — 141 149 — 5 2 7 7 17 7 15 4 Females 6 20 23 24 13 8 10 6 4 1 1 116 119 - 3 6 9 9 14 8 0 10 * Re-notifications (Form A) = 244 (males 155, females 89), pulmonary and 11 (males 8, females 3) non-pulmonary. † Re-notifications (Form B) = 3 (males 1, females 2), pulmonary and 0 non-pulmonary. N.B. Pulmonary—502 private. 279 hospitals, 375 dispensaries. 82 Poor Law officers and 12 schools=1250 total primary notifications (Forms A and B). Non-Pulmonary—42 private, 169 hospitals. 29 dispensaries. 17 Poor Law officers and 16schools = 273 total primary notifications (Forms A and B). c2 70 METROPOLITAN BOROUGH OP LAMBETH. TABLE Q (1.) Public Health (Tuberculosis) Regulations, 1912. Summary of Notification Certificates, Forms A, B, C, D, received during the period from January 4th, 1914, to the end of the week ending January 2nd, 1915. I. WARDS. Wards. 1914. Tuberculosis (All Forms.) Pulmonary. Non-Pulmonary. A. B. C. D. A. B. C. D. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Marsh 74 100 2 2 24 8 20 15 21 22 2 2 2 3 2. 2 Bishop's 157 202 2 2 70 22 35 25 29 31 2 2 9 2 5 3 Prince's 182 220 3 3 48 27 34 35 35 37 4 4 12 3 6 2 Vauxhall 131 166 — — 27 24 23 22 35 39 3 3 4 2 2 3 Total Inner Wards 544 678 7 7 169 81 112 97 120 129 11 11 27 10 15 10 Stockwell 103 129 1 1 7 22 3 18 34 36 2 2 2 1 1 1 Brixton 190 216 1 1 28 31 11 38 35 37 2 2 1 1 - 1 Heme Hill 150 174 — 2 7 31 10 32 24 26 1 1 1 1 1 1 Tulse Hill 117 138 3 3 8 23 7 21 19 19 - - - - - 1 Norwood 134 147 — 1 10 30 26 32 25 26 — — — 2 3 — Total Outer Wards 694 804 5 8 60 137 57 141 137 144 5 5 4 5 5 4 Borough of Lambeth 1,238 1,482 12 15 229 218 169 238 257 273 16 16 31 15 20 14 71 METROPOLITAN BOROUGH OF LAMBETH. TABLE Q (II.) Public Health (Tuberculosis) Regulations, 1912. Summary of Notification Certificates (Forms A, B, C, D,) received during the period from January 4th, 1914, to the end of the week ending January 2nd, 1915. Registration Sub-Districts. 1914. Tuberculosis (All Forms). Pulmonary. Non-Pulmonary. A. B. C. D. A. B. C. D. Forms. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Waterloo 74 100 2 2 24 8 20 15 21 22 2 2 2 3 2 2 Lambeth Church 149 102 2 2 46 22 27 18 19 21 2 2 9 2 5 3 Kennington 190 320 3 3 72 27 42 42 45 47 4 4 12 3 6 2 Stockwell (Inner) 131 156 — — 27 24 23 22 35 39 3 3 4 2 2 3 Total Inner Districts 544 678 7 7 169 81 112 97 120 129 11 11 27 10 15 10 Stockwell (Outer) 103 129 1 1 7 22 3 18 34 36 2 2 2 1 1 1 Brixton 340 390 1 3 35 62 21 70 59 63 3 3 2 2 1 2 Norwood 251 285 3 4 18 53 33 53 44 45 — — — 2 3 1 Total Outer Districts 694 804 5 8 60 137 57 141 137 144 5 5 4 5 5 4 Borough of Lambeth 1,238 1,482 12 15 229 218 169 238 257 273 16 16 31 15 20 14 72 CHILDREN'S COUNTRY HOLIDAYS. The Local Government Board issued a circular letter, under date of June 25th, 1914, pointing out the dangers of infection being carried from Towns to Country districts in connection with the sending of children into the Country for holidays suggesting the principal ways in which precautionary measures can be taken as follows:— 1. Communication with the Medical Officer of Health in the Country district. 2. Inquiries as to infectious disease before the children are sent. 3. Cleanly condition of children before departure. 4. Detectipn of infectious disease in children when in the country. In connection with the Borough, a large number of children are dealt with, and the lines suggested in the Board's circular are those that have been adopted for many years past—no children being sent into the country by the philanthropic organisations or agencies concerned until the houses in which they reside have been declared officially free from infection, i.e., no infectious disease has been notified or is known to exist, officially, therein. The 26 deaths from venereal affections (syphilis, etc.), are the only other point calling for note in the class of zymotic diseases. Classes II. and III.—Parasitic and Dietetic Diseases. No deaths were registered from the Parasitic Diseases, but 20 deaths were registered from chronic Alcoholism, and 4 from Delirium Tremens amongst the Dietetic Diseases. Class IV.—Constitutional Diseases. Of the total 959 deaths under this class, 391 were due to cancer, 386 to Phthisis, and 109 to Tubercular Meningitis and other forms of Tuberculosis. Class V.—Developmental Diseases. The total number of deaths in this class was 378, consisting of 123 from Premature Birth, 196 from Old Age, 23 from Atelectasis and 36 from Congenital Malformations. 73 Class VI.—Local Diseases. 1. Diseases of the Nervous System caused 328 deaths, in- including 15 from Convulsions, 171 from Apoplexy, and 28 from Epilepsy. 2. 611 deaths were due to diseases of the Circulatory System. 3. The diseases of the Respiratory Organs caused 763 deaths (362 from Bronchitis and 125 from Pneumonia, 149 from Broncho-Pneumonia, and 67 from Pleuro-Pneumonia). 4. Diseases of the Digestive Organs caused 225 deaths, of which 16 were due to Enteritis, 11 to Peritonitis, 61 to diseases of the Liver, 9 to Dentition, and 16 to Appendicitis. 5. Diseases of the Urinary System caused 175 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 69 deaths. Class VII.—Deaths from Violence. 167 deaths in all, including 141 from Accidents or Negligence, 10 from Burns and Scalds, 8 from Drowning, 11 from Suffocation in Bed (all being infants under 1 year of age), 25 from Suicide and 1 from Homicide (murder). Class VIII.—Other Causes. 96 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. 74 TABLE R. Shewing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1913 and 1914. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease. Borough 1914. Borough 1913. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). 1.—Zymotic Diseases 473 11.1 494 11.5 Seven Principal 375 8.8 369 8.6 Influenza 33 0.8 67 1.6 II.—Parasitic — — — — III.—Dietetic 25 0.6 25 0.6 IV.—Constitutional 959 22.2 936 21.9 Cancer 391 9.2 369 8.6 Phthisis 386 9.04 370 8.6 Tubercular Diseases, excluding Phthisis 109 2.6 115 2.7 Rheumatism (Acute and Chronic) and Gout 22 0.5 22 0.5 V.—Developmental 378 8.9 350 8.2 Old Age 196 4.6 174 4.1 VI.—Local Diseases 2171 50.9 2195 51.3 Circulatory System 611 14.3 555 12.9 Bronchitis 362 8.5 373 8.7 Pneumonia and Broncho-Pneumonia 274 6.4 290 6.8 Pleurisy and Pleuropneumonia 77 1.8 89 2.1 Respiratory System,excluding Phthisis 763 17.9 806 18.8 VII.—Violence 167 3.9 181 4.2 Suicide 25 0.6 37 0.9 VIII.—Other Causes 96 2.2 99 2.3 75 TABLE R.—continued. B. —Deaths (corrected) of Infants under One Year of age from the chief infantile diseases, and from all causes, expressed in terms of 1000 births (corrected). Borough 1914. Borough 1913. Total Deaths under One Year (Corrected). Proportion to 1000 Births (Corrected).* Total Deaths under One Year (Corrected). Proportion to 1000 Births (Corrected).* From all causes 728 103.5 733 101.3 diarrhœa 156 22.2 131 18.1 Convulsions 13 1.8 20 2.8 Respiratory Diseases 125 17.8 149 20.6 Premature Births 123 17.5 130 17.9 Tubercular Diseases (including Phthisis) 22 3.1 22 3.04 Measles 16 2.3 23 3.2 Whooping Cough 17 2.4 21 2.9 Suffocation in Bed 11 1.6 10 1.4 Enteritis 4 0.6 10 1.4 Dentition 7 0.9 10 1.4 *N.B.—The Registrar-General gives the corrected Lambeth births for 1913 and 1914 as 7233 and 7032 respectively. 76 77 TABLE S. [Local Government Board Old Table A.] Table of DEATHS during the year 1914 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. | Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Scarlatina. Diphtheria. Fevers. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Royal Infirmary (Women and Children) 1 113 47 18 22 10 1 4 8 3 Under 5 - 2 - - 1 7 1 18 - 1 21 - - 1 - 35 87 5 upwds. - - - - - - - - - 1 1 2 - — - 22 26 General Lying-in Hospital, York Road 22 18 — — — — 4 — - Under 5 - - - - - - - - - - - - - - - 18 18 5 upwds. - - - - - - - - - - - - - - - 4 4 St. Thomas's Hospital 596 79 25 31 57 36 125 191 52 Under 5 - 3 - 1 - 1 1 22 1 1 23 2 - 7 - 73 135 5 upwds. - 4 5 3 1 — - 1 2 11 15 29 1 38 30 321 461 Remainder of Lambeth Church First 388 87 22 16 11 15 53 100 84 Under 5 - 2 - — - 5 13 14 — — 25 - 2 8 — 56 125 5 upwds. - — 1 — — 2 1 — 3 24 63 47 4 30 — 88 263 Lambeth Workhouse 28 7 - - - - - 4 17 Under 5 - - - - - 1 - - - - - - - - - 6 7 5 upwds. - — - - — — - — — - 3 12 — 2 — 4 21 Lambeth Infirmary 818 59 10 6 8 27 141 277 290 Under 5 - - - - 3 - 3 31 — - 5 - — 2 — 31 75 5 upwds. - — 1 4 8 — 1 — — 127 81 190 — 27 1 303 743 St. Peter's House 42 — — — — 1 — 3 38 Under 5 - - - - - - - - - - - - - - - - - 5 upwds. - - - - 1 - - - - 1 14 5 1 1 — 19 42 Remainder of Kennington 375 95 21 15 6 12 44 74 108 Under 5 - - — - 1 11 7 9 — - 50 - — 5 — 48 131 5 upwds. - - — - 1 2 — 1 - 29 63 51 2 9 — 84 244 South-Western Hospital 126 11 12 44 34 10 12 3 - Under 5 18 27 - - - 14 3 - — — 2 — — — — 3 67 5 upwds. 8 24 5 7 — 1 — - — 2 6 1 1 — 1 3 59 Clapham Maternity 17 15 — — — — 2 — - Under 5 - - - - - - - - - - 1 - - - - 14 15 5 upwds. - - 1 - - - - - - - 1 - - - - - 2 Remainder of Stockwell 518 124 14 16 12 9 62 112 169 Under 5 - - - - - 14 1 25 1 36 - — 6 — 71 154 5 upwds. — - - - 1 3 — 3 — 38 81 61 5 7 - 165 364 78 79 TABLE S. [Local Government Board Old Table A.] Table of DEATHS during the year 1914 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Scarlatina. Diphtheria. Fevers. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (K) King's College Hospital 248 42 10 17 31 16 45 69 18 Under 5 - 1 - - - - 3 11 - 1 5 - - 6 1 41 69 5 upwds. - - 2 - - - - - - 8 6 22 — 23 7 111 179 Belgrave Hospital 161 104 27 22 8 — — — Under 5 - 3 - - 1 - - 37 - 1 24 1 - 1 - 85 153 5 upwds. - - - 1 - - - - - - 1 - - - - 6 8 4th London General Hospital 10 — — — — 1 8 1 - Under 5 - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - - - - 9 — 1 10 1st London General Hospital 6 — — — — 1 5 — - Under 5 - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - - - - 6 - - 6 Remainder of Brixton 638 99 14 13 19 36 85 137 235 Under 5 - - - - 1 8 5 12 - 1 27 - 1 4 - 67 126 5 upwds. 2 1 1 1 1 1 - - 5 74 94 85 10 11 - 226 512 'Lambeth Workhouse Schools 5 — — 1 3 1 — — - Under 5 - - - - - - - - - - - - - - - 1 1 5 upwds. - - - - - - - - - 1 1 1 — — — 1 -4 British Home of Incurables 10 - - - - - - 4 6 Under 5 - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - - - - - - 10 10 Remainder of Norwood 509 78 12 13 14 8 64 111 209 Under 5 - 1 - - 1 3 3 27 - - 22 1 - 1 - 44 103 5 upwds. - — - 1 — 2 — 2 1 40 63 77 7 12 2 199 406 Totals 4630 865 185 216 213 174 654 1094 1229 Under 5 18 39 - 1 8 64 40 206 1 6 241 4 3 41 1 593 1266 5 upwds. 10 29 16 17 13 11 2 7 13 356 493 583 31 175 41 1567 3364 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto 647 68 24 28 46 32 129 169 151 Under 5 5 7 - - - 2 4 24 - - 17 - - 2 - 59 120 5 upwds. 2 17 2 3 1 — — 3 1 50 43 82 1 28 1 293 527 Deaths occurring within the district among persons not belonging thereto 1008 205 66 95 90 55 165 251 81 Under 5 11 24 - - 1 19 6 44 - 2 53 3 1 11 - 191 366 5 upwds. 8 18 8 6 2 - - - 1 24 28 55 1 68 27 396 642 80 81 TABLE T. Table of Population, Births and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health (by notification), during the year 1914, in the Borough of Lambeth, classified according to Diseases and Localities. [Local Government Board Old Table B.] Registration Sub-Districts. Population at all Ages. Registered Births 1914. New Cases of Sickness in each the knowledge of the Medical during Locality, coming to Officer of Health 1914. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1914. Census 1911. Estimated to middle of 1914. 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ohpthalmia. Whooping Cough. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalima. Whooping Cough. Typhoid or Enteric. Continued & Relapsing. Puerperal. Typhoid or Enteric. Continued & Relapsing. Puerperal. (a) (b) (c) (d) Waterloo 47910 46160 2313 168 34 — 3 - - — 24 - 3 5 143 163 34 - 3 - - - 9 - 2 - 4 Lambeth Church 168 44 1 15 - 3 — 22 2 3 9 231 166 43 1 15 — 3 — 11 1 2 - 9 Kennington 48609 47627 1177 308 91 1 8 — 6 — 47 — 1 11 276 300 84 — 7 — 6 — 13 — — — 22 Stockwell 62608 62302 1967 321 129 — 4 — 2 - 45 1 1 16 202 293 104 — 4 — 2 — 14 1 1 — 5 Brixton 76650 77398 1541 500 142 2 11 2 6 — 50 1 1 13 238 466 121 1 7 — 4 — 10 — 1 — 9 Norwood 62281 63607 1190 280 110 2 7 — 6 — 43 1 1 3 299 261 90 1 5 — 6 - 6 1 1 — 3 Totals 298058 297094 8188 1745 550 6 48 2 23 - 231 5 10 57 1389 1649 476 3 41 — 21 — 63 3 7 — 52 82 TABLE U. Shewing Classification of Certain Causes of Deaths (uncorrected) in the Borough of Lambeth during 1913 and 1914, given in percentages of the total uncorrected deaths. A.—Deaths at all Ages. Causes of Deaths. Percentage of total Deaths (uncorrected). 1914. 1913. I. Principal Zymotics 9.6 8.6 Influenza 0.7 1.3 Measles 1.6 2.1 Whooping Cough 0.9 0.8 diarrhœa and Dysentery (including Cholera) 4.6 3.9 II. Rheumatic Fever and Heart Rheumatism 0.3 0.3 III. Diseases of Circulatory System 12.7 10.9 IV. Bronchitis, Pneumonia and Pleurisy 15.9 16.2 Phthisis 7.8 7.1 V. Injuries 4. 4.2 B—Deaths under 1 Year of Age (per 1000 Births uncorrected). All Causes 105.4 99.6 83 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1914. Area of Borough—4,080 . 4 statute acres (inclusive of land and inland water, but exclusive of tidal water 82.1 and foreshore 31.1 statute acres respectively), divided into 5 Registration SubDistricts, 4 Parliamentary Divisions, and 9 Wards. The Parliamentary Divisions and Wards are not co-extensive but the Registration Sub-Districts and the Wards are. Population—estimated middle of 1914—297,094 (males 141,909, females 155,185). *Density—72.8 persons per statute acre (including land and inland water, but exclusive of tidal water and foreshore). Rateable Value—£1,869,963 for the year ending March 31st, 1914 (as settled at Quinquennial Valuation, and including Government property and alterations made by Provisional Valuation Lists). Births—8,188 being 27-6 per 1,000. Deaths (corrected)—4,269 being 14.4 per 1,000. Infantile Mortality—728 deaths (corrected) under 1 year, being 88.9 per 1,000 total (uncorrected) births. Zymotic—Death-rate, 1.3 per 1,000 (total corrected zymotic deaths, 375). * The densities vary in the different Registration Sub-Districts as follows Lambeth Church (354.3 acres) 130.3, Kennington (398.3 acres) 119.6, Stockwell (583 acres) 106.9, Brixton (1026.6 acres) 75.4 and Norwood (1718.2 acres) 37.02 per statute acre respectively. 84 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, 1914. Number of Notices served 15,109 A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES. (Public Health (London) Act.) No. of Notices served 4066 No. of Infected Houses 3450 Smallpox — Scarlet Fever 1553 Typhoid 42 Typhus — Continued Fever 2 Diphtheria 493 Membranous Croup 6 Puerperal Fever 23 Erysipelas 229 English Cholera — Cerebro-Spinal Fever 5 Acute Polio-Myelitis 10 Ophthalmia Neonatorum 57 Whooping Congh 1030 85 B. GENERAL NUISANCES AND DRAINAGE DEFECTS. (Public Health (London) Act, and Metropolis Local Management Act.) No. of Notices served 11043 Works, Structural— Drainage Defective 1051 Intercepting Traps with Fresh Inlets required 119 Ventilating Pipes required 220 Indoor Sinks connected with Drain 206 Rain Water Stacks connected with Drain 560 Bath Waste connected with Drain 102 Traps Defective, or of Obsolete Pattern 700 Closet Pan and Connections Defective 861 Water Supply to Closet Defective 916 Closet Dilapidated 691 Draw-off Main for Drinking Purposes required 221 Dust Bins Defective 863 Premises Dilapidated 963 Ventilation under Floors required 321 Roofs Dilpidated 702 Soil Pipes Defective 81 Paving Defective 1196 Damp and Unwholesome Houses 327 Dung Receptacles required 21 Defective Water Pipes 48 No W.C. Accommodation 6 10175 Works, not Structural— Cisterns Dirty 406 Manure Accumulations 39 Underground Rooms occupied 29 Animals Improperly Kept 36 Stopped Drains 221 Overcrowding 31 Foul Urinals 16 Refuse Accumulations 141 No Water Supply or Defective Water Supply 470 Dirty Premises 5089 6478 86 PARTICULARS OF SANITARY WORK carried out in lambeth borough during 1914, together with Yearly Averages for (a) the Decennium 1904-1913 (Borough) and (b) the 24 Years 1877-1900 (Parish). Year. Total Number of Notices (excluding those served under the Housing Acts). Sanitary Works, Structural and Permanent. Sanitary Works, Not Structural. 1914 15109 10175 6478 1913 14397 9167 5154 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 Yearly Average for 10 Years 19041913 (Borough) 13295.7 8840.7 3431.7 Yearly Average fer 24 Years 18771900 (Parish) 5944.6 4756.9 2135.9 87 SUMMARY OF WORK DONE BY THE MALE SANITARY INSPECTORS DURING 1914. Inspections 8183 Re-inspections 62237 Complaints attended to 4541 Cases of Infectious Disease notified 4066 Cases of Non-Notifiable Diseases Dealt with 5277 Rooms disinfected 9276 Bedding, etc., disinfected 5985 Bedding, etc., destroyed 60 Drains tested (with chemical, water or both) 7679 Sanitary Works completed 5224 Plans of drainage reconstructions received and approved 255 Premises the Drains of which have been totally or partly reconstructed 306 Samples of Food and Drugs submitted to Analyst 1841 Notices— Sanitarv Work (Preliminary or Intimation 7497 and Statutory 3505) 11002 Infectious Diseases (Public Health Act, 1891) 4066 Metropolis Local Management Acts 41 Sanitary Nuisances abated— (a) Structural 10175 (b) Non-Structural 6478 Summonses issued— Public Health Act *11 Food and Drugs Acts †39 Convictions obtained— Public Health Act 10 Food and Drugs Acts 29 Vide also Section of Report dealing with the Housing, Town Planning &c., Act, 1909. * 1 summons was withdrawn on defendant paying the cost, † Vide Summary of legal proceedings taken under the Sale of Food and Drugs Acts. 88 MALE SANITARY INSPECTORS.* During 1914, there has been no change in the personnel of the Male Sanitary Staff. Work of Male Sanitary Inspectors. During 1914, the following routine work was carried out:— (1) 8183 inspections and 62237 re-inspections; (2) 306 houses re-drained throughout or in part (the drains being in every case water-tested); (3) 7676 tests (hydraulic, smoke or chemical) made; (4) 93 Water Certificates (representing 105 houses, separate or in block, and 143 tenements), issued, in accordance with section 48 of the Public Health (London) Act, 1891; (5) 4541 complaints attended to; (6) 15109 notices served—11002 under the Public Health (London) Act, 1891 (7497 Preliminary, 3505 Statutory and 4066 Infectious Diseases) and 41 under the Metropolis Local Management Acts, dealing with 10175 structural and 6478 non-structural defects. The Male Public Conveniences situated within the Borough are under the supervision of the Male Inspectors. Contravention of By-laws. 1. Drainage Cases. Several cautionary letters were sent to builders, who had carried out drainage work (a) without giving previous notice, or (b) contrary to the requirements of the L.C.C. By-laws. In the latter case, the work was altered so as to comply with the requirements. 2. Removal of offensive matters. Several cautionary letters were sent to contractors whose employees had removed through the streets offensive matters during prohibited hours contrary to the requirements of the L.C.C. By-laws. The war caused a difficulty owing to vans and horses having been commandeered by the Government. *There are 12 District Male Sanitary Inspectors, viz., F. E. Baxter, J. M. Jones, J. S. Smith, J. Barfoot, G. J. Gavin, T. H. Hooper, T. H. Jackson, W. Wallis, W. W. Howes, J. M. Scorrer, J. S. Clements and A. Farran, and one special male Inspector for Food and Drugs (W. J. Perrin). 89 Unsound Food. During 1914, several consignments of unsound food (including 350 turkeys and 50 tons of damaged wheat), 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. Inspection of Market Thoroughfares. During 1914, the market thoroughfares were under bi-weekly 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 under the Act were necessary. Outside Urinals of Public Houses. During 1914, 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 1914, are dealt with under the Housing, Town Planning, etc., Act, 1909. Other Inspections. The work in connection with disinfection, smoke abatement, inspection of factories and workshops, bake-houses, restaurants, and dining (coffee) rooms, births, the milk depot, tuberculosis, etc., and the carrying out of Food and Drugs and Housing Acts, is dealt with under separate headings in this report. Legal Proceedings. It is again satisfactory to note that, during 1914, in but very few cases it was 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—11 summonses, which resulted in £2 Is. Od. costs, as follows: convictions, 10; withdrawn (payment of costs), 1. These legal proceedings had reference to (a) defective drains, (b) dirty premises, (c) dilapidated premises, (d) defective paving, (e) animals improperly kept, so as to be a nuisance. 90 Premises wherein Food for Human Consumption is Prepared. Special attention was paid to the premises wherein food for human consumption is prepared during 1914,in view of the extra work carried out therein in connection with War Office and Admiralty contracts. In one instance, a cautionary letter was sent, drawing attention to the unsatisfactory way in which the work was conducted, general uncleanliness and untidiness, mixing of mince meat by hand instead of by machinery, allowing refuse matters to accumulate in the various rooms instead of having it removed, or burnt forthwith, etc. The excuse offered by the firm was the disorganisation of Staff through enlistment, the consequent use of temporary employees. The decorative work was ordered to be done immediately after Christmas, it having been put oft from the Autumn owing to extra pressure of work on account of the War, in connection with Government contracts. Alleged Insanitary Condition of New Parcels Office and Mess-Room at Waterloo Station. During 1914, a complaint was received from the National Unionof Railwaymen respecting the alleged unhealthyand insanitary position of the Parcels Offices and Mess-Room at Waterloo Station, newly-constructed in the archways under the Station, it being alleged that the dampness of the walls and floors of the Parcels Offices and the consequent impure air caused an excessive amount of sickness amongst the employees, more especially in the form of rheumatism and carbuncles and that the mess-room was so placed as to be a danger to health, being approached through a lamp room and motor garage and being near to and directly overlooking the men's W.C's. and urinal. The premises were visited, and a letter was written to the Railway Company, which decided to have the following works carried out:— (a) Mess-room to be thoroughly washed down and tempered, the lighting arrangements altered and improved means of ventilation by means of a skylight provided; (b) Lighting of both the Up and Down Parcels Offices to be improved. The dampness of the walls of the Parcels offices was due to condensation water and the new building materials of which the offices were constructed. 91 Rag Flock Act, 1911. No samples were taken during 1914, owing to the administrative difficulties that have arisen, due to the High Court Decision, which practically makes the Rag Flock Act, 1911, in so far as "remakes" are concerned, a dead letter. The Council decided to support the suggestion to urge upon His Majesty's Government the need of amending the 1911 Act, so as to bring "remakes" within its scope, having regard to the decision given in the case of Lamble v. Jordon (Kings' Bench Division), May 8th, 1913), by which restuffing or remaking is no offence under the Act unless, any other flock is added—a decision upheld by the Local Government Board in a letter dated October 7th, 1913, in the following words:—"it was not intended that the Rag Flock Act, 1911, should apply to mattresses sent to be remade in cases where no new flock is added." The Sanitary Staff and the War. Towards the end of 1914, the administrative machinery was dislocated somewhat by the volunteering for military service by members of the staff of the Public Health Department. Permission was granted by the Council in all cases to the officers to volunteer for service, on the understanding that the full salaries (less military payments) were to be continued and the appointments kept open. Temporary appointments were made.* The Local Government Board issued a Circular under date of August 12th, 1914, drawing the attention of Local Authorities to the great importance of maintaining the efficiency of the sanitary service of the country and pointing out that there should be no relaxation of the activities of Local Authorities in the prevention and control of epidemic diseases, the protection of water supplies from contamination, and the promotion of child welfare, and in securing the wholesomeness of food supplies and the general sanitary condition of each area. The absences of members of the permanent staff and the instructions contained in the Board's Circular of August 12th, 1914, threw increased work upon the officials left at home, necessitating the working of overtime, even though temporary help was engaged, and this overtime will have to be continued so long as the War lasts. These increased services of the permanent staff are being given readily. * Miss Mary Evelyn Davies (Joint Board's Sanitary Inspectors' certificate and the certificate of the Central Midwives Board) was appointed by the Council, with the approval of the Local Government Board, temporarily in place of Miss Mary Davies, one of the Council's female inspectors, who left for France in November, 1914. 92 FEMALE SANITARY INSPECTORS.* During 1914, there has been no change in the personel of the Female Sanitary Staff, with the exception that from November, 1914, up to the end of the year, Miss M. Davies was allowed leave of absence to act as a nurse in France in connection with the war and her appointment was temporarily filled by Miss M. E. Davies, with the consent and approval of the Local Government Board. Work of Female Inspectors. The two Female Sanitary Inspectors carried out, during 1914, duties in connection with the inspection of (a) Factories, Workshops (Work-places), Shops, Out-Workers' Homes, Laundries, Restaurants, etc., wherein women and girls are employed; (6) 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 tuberculosis or ophthalmia neonatorum were notified, etc. The years' work, 1914, may be tabulated as follows:— Work carried out by the Two Female Sanitary Inspectors during the Year, 1914, Workshops visited and inspected— (a) Dressmakers 26 (b) Milliners 4 (c) Laundries 11 (d) Tailors 10 (e) Upholsterers — (f) Dyers — (g) Blouses 8 (h) Ties 6 (i) Others {e.g.), embroidery, shirts, bandeaux, leather work, beer bottling, scent bottling, etc. 17 Workrooms inspected 40 Workshops† re-inspected 9 Work rooms re-inspected 9 Workshops† workshops therein measured 240 Workshops† newly discovered and registered 17 * There are 2 female Sanitary Inspectors, viz., Miss F. M. Dawson, and Miss M. Davies. . †Workshops include Work-places. 93 Workshops* removed from Register 6 Workshops* reported to H.M. Inspector 8 Workshops* reported by H.M. Inspector 17 †Premises visited, but not inspected, owing to the persons or patients concerned being out or, if employees, being no longer employed 1426 Female Conveniences visited and inspected— Public (visits paid) 247 Private — Schools visited— Public (visits paid) 123 Private — Special places visited and inspected— (a) Private Houses ‡2826 (b) Outworkers 172 Outworkers and Private Houses§ re-inspected 475 Written Intimation and Statutory Notices served 197 No. of Workshops*, etc. in which defects were found 197 No. of Workshops*, etc., in which no defects were found 3008 Nuisances referred to M.O.H., for attention by male inspectors 7 Particulars of Defects Found. Work shops* etc.— Workrooms— Overcrowded 6 Damp 17 Dirty 55 Ill-ventilated 5 Badly-lighted — Insufficiently warmed — Otherwise — * Workshops include Work-places. †Births (591), Workshops (11), Out-workers (228), Diarrhoea cases (85), Schools (13), Tuberculosis cases (498), and Puerperal fever cases (3). ‡Births (1458), Diarrhcea cases (159), Tuberculosis cases (1116), Ophthalmia cases (48), and special complaints (42). §Births (103), Diarrhoea cases (2), Tuberculosis cases (228), Out-workers (14), Puerperal fever cases (6), Ophthalmia cases (1 ?), and special complaints (9). d 94 Defective or dirty— Yards 15 Floors 14 Roofs 31 Windows — Ceilings 14 Rain Water Pipes 2 Sink Wastes 4 Water supply 7 Premises generally 53 Sanitary Appliances: Water Closets— Dirty 9 Ill-lighted — Unventilated — Choked 5 Defective 17 Defective Flushing Tanks and Water Supply 16 Sanitary Appliances: Drainage— Choked 1 Defective — Unventilated 1 Sanitary Appliances : Dustbins— Wanting 11 Defective 17 Sanitary Appliances: Lavatories— Dirty — Defective 1 * No separate suitable sufficient W.C. accommodation for the sexes 2 Miscellaneous defects, e.g., accumulations, personal unclean liness, etc. 7 The Female Inspectors, during 1914, were engaged in visiting 159 houses wherein deaths from infantile (summer) diarrhœa were reported as having occurred, with a view to helping to further elucidate the predisposing causes of this disease; in inspecting schools (123), in connection with outbreaks of disease (chiefly measles); and in visiting (a) 1458 private houses, wherein births had been notified or registered, with a view to educating the mothers and others concerned in the proper feeding and management of their infants, and (b) 1116 private houses, wherein tuberculosis patients had been notified, with a view to educating the *The Sanitary Accommodation Order 1903 does not apply to the Metropolis. 95 patients and their relatives or friends in the nature of the disease, and the simple precautionary measures to be taken to prevent its spread to others, (c) 48 private houses, wherein infants suffering from ophthalmia neonatorum had been notified, with a view to educating the parents and others concerned in the proper treatment for that disease, (d) 3 private houses, wherein cases of puerperal fever had occurred and (e) 42 houses, in connection with special complaints. Revisits were paid to, and re-inspections made of houses in connection with 103 births, 2 diarrhoea cases, 228 tuberculosis cases, 113 ophthalmia cases, 6 puerperal fever cases and 9 special complaints. FACTORIES AND WORKSHOPS. Factories. During 1914, 6 new factories were added to the Register, consisting of (a) ice merchants, 1; (b) electrical apparatus, 1; (c) blouses and gowns, 1; (d) baby linen, 1; (e) babies neck-wear, 1; (/) sign and glass embossers, 1. The Inspection of Factories by the Sanitary Inspectors is limited to that of the sanitary accommodation provided for the workers (such accommodation to be separate, sufficient and suitable), and sanitary defects, when found, are reported by the Factory Inspectors to the Council for amendment by the Council's officers. Workshops. During 1914, 40 new workshops were added to the Register, consisting of the following:— Name of Trade or No. of Business. Workshops. Dressmakers 9 Laundries 5 Milliners 2 Tailors 5 Blouses 4 Jewellers 1 Mantles 2 Cycle Repairs 1 Ties and Belts 4 Stationers 1 Not classified 6 Total 40 96 Full particulars concerning these 40 workshops were entered up in the Register shewing that, at the time of inspection, there were 76 workrooms, in which were working 313 persons—23 males and 290 females, as follow:— M. F. Total. Children Young Persons Adults 23 290 313 8 Notices as to "protected persons" (i.e., children, young persons, and women) employed were sent on, during 1914, 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). 63 Notices of occupation (representing 64 workshops) were received during 1914 by the Borough Council from the Factory Inspector. 17 written Notices were received during 1914 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, if found necessary, and due notices sent to the Factory Inspectors as to the action taken in each case. In connection with 40 new workshops, inspected during 1914, 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 4 workrooms (i.e., 5.3 per cent.), overcrowding was found to exist. 97 WORKSHOPS REGISTERED DURING 1914. 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 2 5 - - - - 3 20 3 20 23 Bishop's 1 3 — — 94 94 94 Prince's 7 14 - - - - - 26 26 26 Vauxhall 3 7 - - 2 9 2 9 11 Stockwell 4 4 - - 2 5 2 5 7 Brixton 13 23 13 71 13 71 84 Heme Hill 4 5 - 20 20 20 Tulse Hill 2 7 38 38 38 Norwood 4 8 — - - — 3 7 3 7 10 Total 40 76 — — — — 23 290 23 290 313 98 99 WORKSHOPS:-Details as to Sanitary Conditions and Defects found in 1914. Details as to Sanitary Conditions and Defects found. Marsh. Bishop's. Prince's. Vauxhall. Stockwell. Brixton. Heme Hill. Tulse Hill. Norwood. Totals. Ventilation satisfactory 2 1 7 3 4 12 4 2 3 38 not — — — - - 1 - - l 2 Cleanliness satisfactory 1 1 7 3 4 12 4 2 4 38 not 1 — — - - 1 - - - 2 Workrooms damp - - - - - — — — — - not 2 1 7 3 4 13 4 2 4 40 Workrooms warm 2 1 7 3 4 13 4 2 4 40 not — — — - - - - - - - State of Sanitary fittings, &c. good 1 1 7 3 4 12 4 2 4 38 bad 1 — — — 1 - - - 2 Soil pipe ventilated 2 1 3 2 3 9 4 2 4 30 not ventilated - - - - - - - - no soil pipe — — 4 1 1 4 - - — 10 Position of W.C. outside — — 3 1 2 7 1 — 3 17 inside 1 — 1 - - 3 1 - l 7 outside and inside ... 1 1 2 2 2 3 2 2 — 15 no W.C — — 1 — — — — — — 1 Separate W. C. accommodation (sufficient and suitable . Yes 2 1 2 2 2 4 2 1 — 16 No - 5 1 2 9 2 1 4 24* Communication (direct) between W.C.s and rooms Yes — - — —- — — — — No 2 1 7 3 4 13 4 2 4 40 *In no case was separate W.C. accommodation required at the time of inspection-persons of one sex only being employed. 100 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 1914. 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 1914, 19 February and 15 August lists were received, dealing with 169 and 158 out-workers respectively. Of the 327 out-workers, 155 belonged to Lambeth and 172 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst in return, 161 lists were received from various outside authorities dealing with 952 workers, of whom 921 belonged to Lambeth and 31 to districts outside Lambeth. Of the total 1076 Lambeth out-workers reported during 1914, 141 were new out-workers, i.e., not previously registered, as follow:— Mantles 12 Blouses and skirts 18 Ties, belts, and braces 18 Children's underclothing and costumes 6 Women's clothing 16 Tailors 21 Embroidery 6 Waistcoats 1 Shirts 7 Printers 1 Button-hole Maker 1 Boots and shoes 4 Glove Making 1 Feathers 1 Millinery 3 Dresses 2 Collars 3 Bag stringing 5 Boxes and boxmaking 3 Smocking 1 Brushes 4 Artificial flowers 2 Paper Bags 1 Rubber Goods 1 Art Needlework 1 Hosiers 1 Army Holdalls 1 Total 141 The Wards, in which the houses (wherein the 141 new outworkers were found to be working) are situated, are as follow:— Wards. No. Marsh 12 Bishop's 8 Prince's 21 Vauxhall 14 Stock well 13 Brixton 44 Wards. No. Heme Hill 14 Tulse Hill 11 Norwood 4 Borough of Lambeth 141 101 FEMALE HEALTH VISITOR.* Work of Female Health Visitor. The Council's Health Visitor has been engaged during 1914 in the systematic visiting and re-visiting of houses wherein births had been notified, in looking after the milk depot children (at the depot and at their own homes), in inspecting infants notified as suffering from ophthalmia neonatorum, and in assisting in making enquiries in connection with tuberculosis cases—this last-mentioned work being carried out on a separate day or days from those devoted to infant visiting, etc. The work may be summarised as follows:— Visits and Revisits made 1st Q. 2nd Q. 3rd Q. 4th Q. Total. in connection with— Births 428 398 466 315 1607 Ophthalmia cases 20 25 29 31 105 Depot children 11 15 25 10 61 Milk Depots- York Road 13 12 19 16 60 Moffat Institute† 69 78 91 72 310 Special cases 3 16 3 8 30 Tuberculosis cases 111 89 77 74 351 Premises, but no one found at home 137 115 151 110 513 DISINFECTING DEPARTMENT.* Details of work done during 1914, in connection with the Disinfecting Department, are subjoined. A total of 4066 infectious diseases, notifiable compulsorily under the clauses of the Public Health (London) Act, 1891, were reported and dealt with, including cases of cerebro-spinal fever, (5), acute polio-myelitis (10), ophthalmia neonatorum (57), and whooping-cough (1389), whilst the following diseases were voluntarily notified by school teachers and others, viz.: measles (1531), chicken-pox (795), cancer (66), verminous houses (195), and bedding or clothing (386), and other diseases§ (259). 2315 cases were removed to hospital. *There is one female health visitor, viz., Miss T. McHugh. †Used as a branch (distributing centre) in connection with the Council's York Road Milk Depot. ‡The Staff consists of 1 Superintendent (W. Lockyear), 4 Disinfectors, 4 Drivers, 1 Eoiler Attendant, and 1 Yard and Stable Attendant. § Mumps, scabies, ringwcim, influenza, &c. d2 102 In addition, 1250 cases of pulmonary and 273 of non-pulmonary tuberculosis were notified and dealt with under the new Public Health (Tuberculosis) Regulations, 1912, the patients being visited; pamphlets left at the houses, dealing with tuberculosis and its prevention; and disinfection carried out, as required, in the event of death or removal of a patient. 20 schools were disinfected in connection with outbreaks of infectious disease, viz. : measles, 8, and scarlet fever, 12, A total of 9276 infected rooms and 30121 infected articles (bedding, etc.) were disinfected officially. The yearly averages are given in the Table of Disinfection Work carried out during the past 31 years. Summary of work carried out by the Disinfecting Department in the Borough of Lambeth during 1914. Total No. of rooms disinfected by Council 9276 Cases in which bedding was disinfected at home* 2661 Do. do. do. at Chamber 3324 Do. do. do. destroyed 60 Premises disinfected and disinfectants supplied 21647 No. of Cleansing Notices served in connection with infected houses 2330 Certificates of Medical Practitioners received in lieu of disinfection by the Council 18 Schools disinfected† (187 class-rooms) 20 Certificates of disinfection left with occupiers of disinfected premises 6703 Library books disinfected‡ 233 Mattresses re-tabbed by Council 976 Cabs disinfected 2 Railway carriages disinfected — Articles of bedding, etc., disinfected. Beds 2669 Bolsters 2288 Pillows 6235 Mattresses 2155 Palliasses 125 Chair Cushions 867 Clothing 4930 Sheets 2134 Blankets 4736 *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 20, Measles 8. ‡167 Public Library and 66 Private Library Books. 103 Rugs and Mats 147 Counterpanes and Eiderdown Quilts 1852 Carpets 143 Extras (i.e., articles not included above) 1840 Total 30121 Articles of bedding, etc., destroyed. Beds 37 Bolsters 17 Blankets 7 Pillows 25 Quilts and Counterpanes 2 Mattresses 36 Palliasses 20 Sheets 5 Chair Cushions 16 Clothing 97 Carpets 2 Extras (i.e., articles not included above) 29 Total 293 Practically all the disinfection was carried out by the Council's staff—only 18 certificates being received from Medical Practitioners during 1914, as follows:— Medical Practitioners' Certificates accepted in lieu of Disinfection being carried out by the Borough Council. Nature of Certificate. 1st Q. 2nd Q. 3rd Q. 4th Q. Total. For Rooms only 2 1 1 1 5 For Bedding only — — — — — For Rooms and Bedding 6 2 3 2 13 Total 8 3 4 3 18 Refuges. There is one refuge in the Borough, viz., at Wanless Road, but it has not been called into use during 1914. 104 DISINFECTION STATISTICS. For eight years prior, end twenty-two years subsequent, to the passing of the Notification of Infectious Diseases Act; and for the year 1914. Yearly average for 8 years preceding the Notification Act, 1882-1889 (Parish). Yearly average for 11 years succeeding the Notification Act, 1890-1900 (Parish). Yearly average for 13 years succeeding the Notification Act, 1901-5 & 1906-13 (Borough) 1914. 1901-5. 1906-13. No. of Cases in which Bedding, etc., has been disinfected At Home 142.8 240.8 16.6 1530.4* 2661* At Chamber 452.8 2333.3 2337.0 2960.1 3324 No. of Cases in which Bedding, etc., has been destroyed 45.7 121.6 74.2 103.6 60 No. of Articles of Bedding, etc., disinfected 2253.2 15600.4 34632.4 23457.8 30121 No. of Articles of Bedding, etc., destroyed 113.0 489.4 710.0 357.4 293 Premises disinfected and disinfectants supplied 916.8 6191.7 11738.4 14203.9 21647 Infectious diseases dealt with Notifiable Non-notifiable ... 2408.5 2335.2 2034.9 4066† ... 299.3 2260.8 4159.5 5277 *This number is increased for 1906 onwards, on account of bedding no longer being removed to the Disinfecting Station as a routine in connection with Measles, Whooping Cough and Chicken-pox. †Whooping Cough became compulsorily notifiable on January 1st, 1913, so that the figures for notifiable infectious diseases for 1913 and 1914 are increased. N.B.—The Statistics for 1901-1914 refer to the present Borough ; those for all previous years to the late Parish. 105 Cleaning 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 of Lambeth—statutory obligations imposed upon the County Council by Parliament. The London County Council, as the Educational Authority, have simply suggested that the Borough Council should provide cleansing stations under the Cleansing of Persons Act, 1897 (a permissive Act), and that the County Council should 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 to be planned with separate entrances for children and adults. The stipulated charge offered by the County Council is 2/0 a child, such payment to cover any number of attendances by 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 has not yet been 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 local cleansing stations, stations belonging to other Boroughs being used. Verminous premises are disinfected as required, but such disinfection is not satisfactory without the school children and inmates of the commoon lodging-houses, who are themselves verminous, being systematically cleansed also at the same time. Re-infection is apt to occur, being brought about in 3 ways:— (a) by some verminous article of clothing or bedding escaping disinfection at all, or, at least, efficient disinfection. (b) by some other inmate of the house—above or below school ages—being verminous; (c) by the purchase of verminous second-hand articles of clothing or bedding from second-hand clothing shops, coster's stalls, rag shops, pawnbrokers, re-make shops, etc. Legislation is required with a view to preventing the sale of verminous and filthy second-hand clothing. 106 The numbers of verminous houses and rooms disinfected and cleansed during 1914, and the five previous years are:— Year. Houses. Rooms. 1909 148 387 1910 207 646 1911 268 535 1912 580 1109 1913 649 927* 1914 195 935† SMOKE ABATEMENT. During 1914, 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, though the nuisances have increased owing to the coal strike and the difficulties arising out of the war, e.g., shortage of labour due to enlistments, delays in transporting coal, and inability to obtain the better class Welsh (steam) varieties, working of factories at high pressure on Government contracts, &c. The L.C.C. and the Coal Smoke Abatement Society reported, during 1914, nuisances as follows:— 1. London County Council—21 letters dealing with alleged smoke nuisances connected with: Doulton & Co., Ltd. (High Street), J. C. & J. Field, Ltd. (15, Upper Marsh), St. Thomas's Hospital (Westminster Bridge), Sharwood & Co. (Offley Road), Koet's Bakehouse (80, Landor Road), A. Beattie & Co. (39, Lower Kennington Lane), Holloway Brothers (Belvedere Road), Lion Brewery Co. (Belvedere Road), Clowes & Sons (Duke Street), New London Brewery Co. (Durham Street), Union Jack Club (Waterloo Road), Standard Fruit Preserving Co. (13, Gray Street), City and South London Electrical Railway (195, Clapham Road), South London Electricity Supply Co., Ltd. (Bengeworth Road), and Oakey & Son (Westminster Bridge Road). 2. Coal Smoke Abatement Society—3 letters dealing with alleged smoke nuisances connected with: Lion Brewery Co. (Belvedere Road), Meredith Bros. (Belvedere Road), Holloway Bros. (Belvedere Road), St. Thomas's Hospital (Westminster Bridge), and J. C. & J. Field (15, Upper Marsh). * Bedding 1245 and clothing 141, in addition. †Bedding 1186 and clothing 268, in addition. 107 Special observations were made during 1914 with reference to the premises belonging to St. Thomas's Hospital (Westminster Bridge), and in connection therewith a letter was received from the Governors admitting that the boiler plant was too small for the hospital requirements, and stating that instructions had been given to the architect "to prepare plans for a building to hold extra accommodation which will practically double the boiler capacity." It was stated in the letter, as an excuse for the nuisance, that, owing to the coal strike, inferior coal had had to be used and coke breeze mixed with the Welsh coal, which was used as a rule, with the result that grits were carried out and over to the houses adjoining, as well as to all the roofs and into the wards of the hospital itself. Special observations were also kept during 1914 with reference to the premises occupied by (a) the Bethlem Royal Hospital (Lambeth Road) and (b) Hammerton's Brewery (Stockwell). The former case was referred to the Southwark Borough Council, in whose district the hospital is situated, though the nuisance in part affected inhabitants living within the Borough of Lambeth, whilst, in the case of the latter (Hammerton's Brewery), the nuisance was found to be due to the fact that alterations had been carried out to the boiler-house roof so that the stokers were unable to see the chimney stack (as formerly) when stoking. A large mirror was erected to enable the stokers to see easily the top of the chimney whilst stoking, and weekly bonuses were offered for good stoking, such bonuses to be stopped and the defaulting stokers suspended in the event of any nuisances from black smoke occurring. UNDERGROUND CONVENIENCES.* The conveniences were kept under regular supervision and inspection during 1914—the male conveniences by the male inspectors and the female conveniences by the female inspectors. During 1914 there has been no alteration in the personnel of the attendants. ANALYSIS OF FOOD AND DRUGS, WATER, &c. 1.—Food and Drugs. (a) Formal Samples. During 1914, 801 formal samples were purchased within the Borough, and submitted to the Public Analyst for analysis. Of the 801 samples 73 (i.e., 9.1 per cent.) were reported by the Analyst to be adulterated, and 39 summonses were issued, with the result that 29 convictions were obtained, with £34 in penalties and £35 12s. in costs. *The Staff consists of 19 male and 17 female attendants. There are 8 male and 7 female conveniences. 108 The annual averages of the two decennia 1891-1900 (Parish) and 1901-10 (Borough), are respectively: (1) Number of formal samples taken, 501.9 and 1352.4, of which 74.6 and 89.1 (i.e., 14.9 and 6.6 per cent.) were found on analysis to be adulterated; (2) number of summonses taken out, 53.1 and 63.8, with 52.3 and 48.5 convictions, and £104 5s. 5d. and £74 0s. 4d. in penalties and £35 0s. 3d. and £38 16s. 6d. in costs. (b) Informal Samples. During 1914, 1040 informal samples were purchased within the Borough, and submitted to the Public Analyst for analysis. Of the 1040 samples 164 were reported by the Analyst to be adulterated. (c) Formal and Informal Samples. During 1914 a total of 1841 formal and informal samples were purchased within the Borough, and submitted to the Public Analyst for analysis. Of the total 1841 samples 237 (i.e., 12.9 per cent.) were reported by the Analyst to be adulterated, varying quarterly as follows:—1st quarter, 14.4 per cent.; 2nd, 12.2 per cent.; 3rd, 13.4 per cent.; and 4th, 11.1 per cent. Particulars of the total 1841 articles submitted by the Food and Drugs Inspector during 1914 are as follows:— (a) Milk. 1. Formal Samples. 550 samples were taken, and of these 46 (i.e., 8.4 per cent.) were declared by the Analyst to be adulterated. Of the 550 samples 5 were separated milk (none adulterated), and 545 were ordinary milks (46 adulterated). These 46 adulterations were as follows:— (1) Extraneous water 20, varying from a minimum 1 to a maximum 34 per cent., viz., 1, 1, 3, 4, 4, 4, 5½, 6, 6, 6, 8, 8, 9, 9, 10, 104, 12, 15, 28, and 34 respectively. (2) Deficiency in milk-fat 25, varying from a minimum 2 to a maximum 75 per cent., viz., 2, 3, 3, 4, 5, 6, 7, 8, 9, 9, 10, 11, 12, 14, 15, 16, 16, 17, 19, 20, 28, 26, 29, 36, and 75 respectively. (3) Extraneous water and deficiency in milk fat (1), viz., 9 and 23 per cent, respectively. In 22 cases no summonses were taken out for the following reasons:— Amounts of adulteration being too small (22), viz.: (a) extraneous water, 1, 1, 4, 4, 6, 10½. (b) Deficiency in milk fat, 2, 3, 3, 4, 5, 6, 7, 8, 9, 9, 11, 15, 16, 20, 26, 75. 109 Out of the 46 samples there were 18 convictions, 3 summonses were withdrawn on payment of costs, 2 summonses were dismissed on payment of costs, the Magistrate being satisfied with the evidence for the defence, and 1 summons was dismissed, a warranty being proved. The total fines amounted to £14 5s., with £25 12s. 6d. costs. 2. Informal Samples. No informal samples of milk were taken. (b) Butter. 1. Formal Samples. 207 samples of butter were taken, and of these 26 (i.e., 12.6 per cent.) were declared by the Analyst to be adulterated, the adulterations consisting of (1) added margarine (14), varying from a minimum 55 per cent. to a maximum 100 per cent., viz., 55, 60, 95, 95, 95, 98, 98, 98, 99, 99, 100, 100, 100, and 100 respectively; (2) preservatives present (12) varying from a minimum 0.4 per cent. to a maximum 0-62 per cent, crystallised boric acid, viz., 0-4, 0-5, 0 -5, 0-5, 0-6, 0-7, 0-7, 0-7, 0-8, 0-9, 0-18, 0-62 respectively. In 12 cases no summonses were taken out for the reason that the amount of adulteration (boric preservative) was too small, viz., 0.4, 0.5, 0.5, 0.5, 0.6, 0.7, 0.7, 0.7, 0.8, 0.9, 0.18, and 0.62 percent. respectively. Out of the 14 summonses taken out, there were 10 convictions (1 under the Margarine Act). 4 summonses were withdrawn by order of the Public Health Committee. The total fines amounted to £19 15s., with £8 18s. 6d. costs. 2. Informal Samples. 723 samples were taken, and, of these, 154 (i.e., 21.3 per cent.) were declared by the Analyst to be adulterated, viz.: (a) added margarine (139), (b) preservatives present (13), and (c) added margarine and preservatives present (2). (c) Margarine. 2 samples of margarine were taken formally. (d) Cream. No samples of cream were taken. (e) Coffee. 1 sample of coffee was taken formally (not adulterated), and 21 samples were taken informally (none adulterated). 110 (f) Mustard. 1 sample of mustard was taken formally (not adulterated), and 25 samples were taken informally (none adulterated). (g) Pepper. 1 sample of pepper was taken formally (not adulterated), and 25 samples were taken informally (none adulterated). (h) Other Groceries. 9 samples of arrowroot, 6 of cocoa, 3 of ground rice, and 39 of rice were taken informally, but none were declared by the Analyst to be adulterated. 8 samples of sago were taken informally, and, of these, 2 were declared by the Analyst to be adulterated, viz., with (a) 75 per cent, tapioca and 25 per cent, sugar, and (b) 10 per cent, tapioca. (i) Drugs. 4 samples were taken formally (1 adulterated, viz., Gregory Powder made with carbonate (not oxide) of magnesium), and 90 samples were taken informally (7 adulterated, viz. (a) 1 cream of tartar with 44 parts per million of excess lead (b) 2 bicarbonate of soda with 40 and 96 per cent. borax respectively; (c) 1 ammoniated tincture of quinine with 25 per cent. deficiency in quinine sulphate; and (d) 3 Gregory Powders, made with carbonate and not with oxide of magnesia. In the case of the adulterated formal samples, a summons was taken out, and a conviction obtained with 21s. costs. (j) Lard. 32 samples of lard were taken formally (none adulterated), and 3 samples informally (none adulterated). (k) Vinegar. 16 samples of vinegar were taken informally, and of these 1 (i.e., 6.3 per cent.) was declared by the Analyst to be adulterated, viz., deficient in acetic acid to the extent of 9 per cent. (l) Other Articles. 4 of bottle fruit, 9 of cheese, 1 of bread, 3 of baking powder, 6 of oatmeal, and 4 of wheaten flour, were taken informally, but none were declared by the Analyst to be adulterated. 3 samples of dripping were taken formally, but none were declared by the Analyst to be adulterated. 111 Summary of Legal Proceedings taken under the Sale of Food and Drugs Acts. Of the total 39 summonses taken out, viz., 24 milks, 14 butters, 1 Gregory Powder (drug), there were convictions in 29 cases, viz. in 18 milks, 10 butters (1 under the Margarine Act), and 1 drug (Gregory Powder), whilst in the remaining 10 the results were as follows :— (a) 3 summonses dismissed:— (1) Contrary proved, 2 and warranty proved, 1 (all milks). (b) 7 summonses withdrawn:— (1) On payment of costs, 3 (milks). (2) By order of Public Health Committee, 4 (butters). Registration of Margarine Factories. During 1914, 14 margarine manufactories were registered, viz., 55 and 63, New Cut; 166, Norwood Road; 13, Westow Hill; 66 and 240, Brixton Road; 23, Electric Avenue; 253, Wandsworth Road; 106 and 147, Lambeth Walk; 44, Lower Marsh; 218, Railton Road; 7, Juxon Street; and 220, Coldharbour Lane. Since the Margarine Act, 1887, came into force within the Borough the following premises have been registered in addition to the above: 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; |7, Juxon Street; 15, New Cut; 448 and 450, Brixton Road; Wessex House (Oakley Street); 22, Wilcox Road; and 58, Patmos Road. 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 1914 amounted to £96 9s. 3d., and are made up as follow:—£33 18s. 11d. for samples, £38 13s. 6d. for assistants, £1 6s. 6d. for witnesses, £19 8s. 4d. for travelling expenses (including £9 5s. for cabs), and £3 2s. for sundries. The salary of the Food and Drugs Inspector (£120, rising by £10 annual increases to £200), and the cost of the summonses (£5 8s.), are not included. The annual averages for the last 11 years (1903-13) are (1) total expenses, £83 0s. 9d. ; (2) total number of samples, 1597. 2. Water. No sample of water was submitted for analysis during 1914. * Registration was withdrawn on May 29th, 1913. † Registration was withdrawn on Nov. 23rd, 1911. 112 Public Health (Milk and Cream) Regulations, 1912. All samples of milk are examined by the Public Analyst, as a routine, for the presence of preservatives, and, of the total samples of milk taken during 1914 (550 formal), in no single instance were preservatives found. No samples of cream were taken during 1914. The action taken during 1914 under the Public Health (Milk and Cream) Regulations, 1912, may be tabulated as follows:— Headings of Report of Administration during 1914. 1. Milk ; and cream not sold as preserved cream:— (a) (b) No. of samples No. in which a examined for the preservative presence of a was reported preservative. to be present. Milk 550 Cream — — Nature of preservative in each case in column (b) and action taken under the Regulations in regard thereto—Nil. 2. Cream sold as preserved cream:— (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct:— (1) Correct statements made — (2) Statements incorrect — Total — (b) Determinations made of milk fat in cream sold as served cream:— (1) Above 35 per cent — (2) Below 35 per cent — Total — (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed Nil. (d) Particulars of each case in which the Regulations have not been complied with and action taken Nil. 3. Thickening substances. Any evidence of their addition to cream or to preserved cream and action taken where found Nil. 4. Other observations (if any) Nil. 113 Direct Appeal to the Cow. In connection with a summons taken out by the Wandsworth Eorough Council against a Lambeth cow-keeper, the defendant asked lor an appeal to the cow, stating that the milk had been served to the Wandsworth Inspector in the same condition as it was when it was drawn from the cow. Samples were consequently taken from the cows direct by the Lambeth Inspector at 5 a.m. and 3 p.m. on August 6th, 1914, and at 5 a.m. on August 7th, 1914—samples of (a) fore-milk, (b) strippings, and (c) mixed milk. On examination and analysis it was found by the Public Analyst that the samples varied, the fore-milk being below and the strippings above the standards for milk fat laid down under the Milk and Cream Regulations. The cow-keeper admitted that he had served the Wandsworth Inspector with fore-milk. The summons was dismissed by the magistrate and no further legal action was taken by the Lambeth Council, having regard to the results obtained on analysis of the milk drawn direct from the cows. The cow-keeper was cautioned, however, as to the necessity for care being taken to sell to the public the mixed milk and not the fore-milk only, the need for careful feeding of the cows, and the desirability of not using milk from too many freshly-calved cows at one time. The results of the analyses are interesting:— August 6th, 1914. 5 a.m. (5 samples). Fore-milk. Strippings. Mixed Milks. Milk fat 2.40 2.82 4.5 2.55 4.60 Solids not fat 8.94 8.92 8.5 8.81 8.69 Total solids 11.34 11.74 13.0 11.36 13.29 3 p.m. (5 samples). All samples well above the standards of 3 per cent, milk fat, 8.5 per cent. solids not fat, and 11.5 per cent. total solids. August 7th, 1914. 5 a.m. (4 samples). Fore-milk. Strippings. Mixed Milks. Milk fat 0.75 2.76 2.22 2.52 Solids not fat 9.35 9.07 9.10 8.96 Total solids 10.10 11.83 11.32 11.48 114 SALE OF FOOD AND DRUGS ACTS. Samples procured, together with the results of the analyses, during the year 1914:— Samples. Formal. Informal. Number Analysed. Number Adulterated. Number Analysed. Number Adulterated. Milk* 550 46 — — Butter 207 26 723 154 Lard 32 — 3 — Coffee 1 — 21 — Margarine 2 — — — Mustard 1 — 25 — Pepper 1 — 25 — Arrowroot — — 9 - Vinegar — — 16 1 Sago — — 8 2 Oatmeal — — 6 — Ground Rice — — 3 — Flour (Wheaten) — — 4 — Cocoa — — 6 — Dripping 3 — — — Drugs 4 1 90 7 Rice — — 39 — Olive Oil — — 6 — Tapioca — — 3 — Bottle Fruit — — 4 — Cheese — — 9 — Ground Ginger — — 6 — Bread — — 1 — Tea — — 8 — Spirits — — 6 — Jam - — 3 - Jelly - — 3 - Ale - — 3 — Chocolate Powder - - 3 — Baking Powder - — 3 — Fish (canned) - — 2 — Fish (potted) - — 1 — Meat (potted) - - 1 - 801 73 1040 164 * Includng 5 separated milks (none adulterated). 115 Particulars as to formal samples analysed, and proceedings taken, under the Sale of Food and Drugs Acts, during 1914 (Borough), together with the yearly averages for the two decennia, 1891-1900 (Parish) and 1901-10 (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. 1914 801 73 9.1 39 34 34 0 0 35 12 0 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 1901 710 73 10.3 62 51 114 15 0 33 14 0 Average of 10 years, 1901-1910 (Borough) 1352.4 89.1 6.6 63.8 48.5 74 0 4 38 16 6 Average of 10 years, 1891-1900 (Parish) 501.7 74.6 15.1 53.1 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. N.B.—During 1914, in addition to the 801 formal, 1040 informal samples were taken, and, of the informal samples, 164 (i.e., 15.8 per cent.) were declared by the Analyst to be adulterated. 116 COMMON LODGING HOUSES. The 6 Common Lodging Houses (for men) within the Borough were inspected during 1914, but the only defect found was a stopped w.c. at 106, Wandsworth Road, a defect that was remedied forthwith. The 6 common lodging houses were again licensed by the London County Council at the Annual Licensing Meeting held June 29th, 1914, in accordance with the requirements of Section 46 of Part ix. of the London County Council (General Powers) Act, 1902:— Authorised Dates when registered Situations of premises. No. of originally. 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 HOUSES LET IN LODGINGS. The 372 registered houses were under inspection during 1914, but no new houses were registered under the by-laws. Past experience in Lambeth goes to show that the old by-laws did not work out in practice as well as was anticipated when the by-laws were framed, owing, inter alia, to the definition of "landlord"— the powers under the other Sections of the Public Health (London) Act, 1891, being more useful in connection with the keeping of houses let in lodgings in proper order and condition. It may be different under the new By-laws made by the Council and approved by the Local Government Board on November 20th, 1913. Under these new By-laws, the "landlord" means the "owner" within the meaning of the Public Health (London) Act, 1891. 117 REVENUE ACT, 1903. (And Section 35 of the Housing, Town Planning, etc., Act, 1909). During 1914, 87 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, 56 were granted unconditionally, 13 were granted conditionally, i.e., subject to certain alterations and improvements being carried out, and 18 were refused. (1) Certificates granted unconditionally. Blocks or Houses. T enements. 37, 38, 39, Chester Street 3 18 395 (a, b, c, d,) Clapham Road 1 4 7, 7a, 8, 8a, 9, 9a, Dolland Street 3 6 117-119, Lambeth Walk 1 2 91,92,93,94,95,96, Lollard Street 6 12 60, 62, Upper Kennington Lane 2 12 28, Victoria Road 1 2 17 56 (2) Certificates granted, conditionally. Blocks or Houses. T enements. 145, 147, Clapham Road 2 7 23, 25, 27, St. Louis Road, West 3 6 Norwood — — 5 13 (3) Certificates refused. Blocks or Houses. Tenements. 65, Park Road, W. Norwood 1 4 69, 77,82, 86, Somerleyton Road 4 8 199, 205, Wandsworth Road 2 6 7 18 118 HOUSING OF THE WORKING CLASSES. HOUSING, TOWN PLANNING, ETC., ACT, 1909. House-to-House Inspections. These inspections are necessary under Section 17 of the Housing, Town Planning, etc., Act, 1909, and under Regulations issued, as an Order, on September 2nd, 1910, with respect to the method in which such house-to-house inspections of the district are to be made and records kept. During 1914, the Medical Officer of Health, as required by Article 1 of the Regulations or Order, prepared the following lists of dwelling houses, the early inspection of which was, in his opinion, desirable:— Marsh—Cornwall Road, Gilberts' Court. Bishop's—Nil. Prince's—Bonnington Square, Carraun Road, Durham Street Glasshouse Street, Montford Place, Newburn Street, Orsett Street. Vauxhall—Hemans Street, Old South Lambeth Road. Stockwell—Acre Lane, Fenwick Place. Brixton—Ann's Place, Clark's Row, Ingleborough Street. Heme Hill—Northway Road. Tulse Hill-—Branksome Road, Glenelg Road. Norwood—Jaffary Place, Rommany Road, Victoria Place. A total number of 358 houses have been systematically inspected during 1914, and in 9, i.e., 2.5 per cent., a result has been obtained from the test applied to the drains. A total of 723 other nuisances were found to exist in 279 houses [i.e., 77.9 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. In 79, i.e., 22.1 per cent., no nuisances were found on inspection. 119 Summary. Number of houses inspected 358 Number of houses in which a result was obtained from test— (chemical) applied to drains 9 Number of houses in which other nuisances were found to exist 279 Number of houses in which no nuisances were found to exist 79 Nature of all 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.) 171 Defective roofs, gutters, and rain-water pipes, etc. 66 Defective yard pavings 87 Defective flushing apparatus in w.cs. 11 W.C. pans foul 4 Drinking water taps defective 7 Drains stopped 10 Floors, windows, doors, and sash-cords defective 35 No dust bins (or dust bins defective or dilapidated) 18 Damp premises 70 Overcrowding 5 Defective w.cs 7 Defective drains 9 Defective or deficient vent or soil pipes 5 Defective sink wastes (or not under-trapped) 42 Defective manhole covers — Animals improperly kept 1 Cisterns uncovered or improperly covered 1 Improper water supplies (not from main direct, etc.) 3 Forecourts insufficiently paved, or unpaved 11 W.Cs. insufficiently lighted and ventilated — Want of ventilation under floors 24 Want of proper dung receptacles — Underground rooms illegally occupied — Accumulations of manure 1 Defective traps and stopped gullies 4 Sinks connected direct to drains 15 Mica valves defective 6 Light and air spaces limited 58 Dilapidated Premises 23 Sundry minor defects, viz.: Defective fire-places (5), Sash cords broken (25), Coppers defective (8) 38 Total 732 120 Under the House-to-House Inspections Regulations, or Order, of 2nd September, 1910, certain classifications are required, so as to secure uniformity of statistics throughout the various sanitary districts, and, adopting this classification, the results in connection with the 358 houses inspected during 1914 may be tabulated as follows:— i. Arrangements for preventing contamination of Water Supplies. (a) Drinking water from the main 355 (b) Drinking water from cisterns 3 (c) Cisterns uncovered or improperly covered 1 (d) Defective water taps 7 ii. Water Closet Accommodation. (a) Defective water closets 7 (b) Foul water closets 4 (c) Water closets insufficiently lighted and lated — (d) Defective water closet flushing apparatus 11 (e) Defective or deficient ventilating or soil pipes 5 Hi. Drainage (with Results of Tests). (a) Results from chemical tests 9 (b) No results from chemical tests 349 (c) Drainage stopped — (d) Defective manhole covers (e) Defective mica valves 6 iv. Condition as to Light, Circulation of Air, Dampness and ness. (ia) Light and circulation of air limited 58 (b) Damp premises 70 (r) Dirty premises 171 (d) Overcrowded premises 5 v. Paving, Drainage and Sanitary Condition of Yard or houses belonging or connected with the Dwelling Houses. (a) Defective yard paving 87 (ib) Insufficiently paved forecourts 11 vi. Arrangements for House Refuse. (a) No dust bins, or dust bins defective or dilapidated 18 (b) Want of proper dung receptacles — (c) Accumulations of manure 1 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 — 121 viii. Defects or other matters tending to render houses dangerous o injurious to the other inmates. (a) Dilapidated premises 23 (b) Defective roofs, gutters, rain-water pipes, etc. 66 (c) Defective floors, windows, doors, sash boards, fireplaces, coppers and chimneys 73 (d) Sink waste pipes connected direct to drain or defective or not under-trapped 42 (e) Want of air, or insufficient ventilation under floors 24 (f) Defective traps (gullies, etc.) and stopped gullies 4 (g) Animals improperly kept 1 ix. Action taken. Under the Housing, Town Planning, etc., Act, 1909, and the Public Health (London) Act, 1891, whilst in 6 cases, the dwelling-houses (including 3 shops) were closed by the Borough Council as the Local Authority under the Housing, Town Planning, etc., Act, 1909, ab being unfit for human habitation, and have since been closed and voluntarily demolished. Representations and Closing Orders under Section 17 of the Housing, Town Planning, etc., Act, 1909. During 1914 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. Date of Orders Premises. State. made by the Council. 99, Stockwell Road ... The dwelling-house June 18th, 1914 being generally dirty, damp and dilapidated 44, 46, 50, Newburn The 6 dwelling-houses Nov. 26th, 1914 Street and 42, 44, 46, (including three shops) Orsett Street being dirty, damp, and dilapidated and generally worn out 122 Closing Orders were made in each case by the Council, and the 7 houses (including 3 shops) have since been demolished voluntarily. In connection with the closing of houses under the Housing, Town Planning, etc., Act, 1909, a total of 101 dwelling-houses within the Borough have been represented by the Medical Officer of Health as being unfit for human habitation from the time the Act came into force (December 3rd, 1909) until the end of 1914, and Closing Orders have been made by the Borough Council, as the Local Authority, in connection therewith under Section 17 of the Act, with the result that:— (a) 76 houses have been closed and since demolished ; (ib) 25 houses have been rendered fit for human habitation. 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, Section 32, from the date upon which it came into force (viz., August 18th, 1890) up to the introduction of the Housing, Town Planning, etc., Act, 1909—a period of 19 years—during which a total of 385 houses were dealt with by notices served by the late Vestry and the present Borough Council, under Section 32 of the Housing of the Working Classes Act, 1890, on the representation of the Medical Officer of Health that such dwelling houses were unfit for human habitation, viz.:— (a) 1891 to 1900 (10 years)—old Vestry 337 (b) 1901 to 1909 (9 years)—Borough Council 48 Total 385 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. 123 MUNICIPAL MILK DEPOT.* The statistics for 1914 are subjoined. 252 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk :- Under 3 months 110 9—12 months 12 3—6 months 85 Over 12 months 8 6—9 months 37 - 252 Of the 110 infants under 3 months, 15 were aged 14 days or under, viz. 1, 1, 2, 2, 3, 7, 7, 8, 9, 11, 12, 13, 14, 14 and 14 days respectively. These 252 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 147, weakly 33, wasting 30, diseased 42, total 252. The diseases from which the 42 infants and children were actually suffering at the time of being put upon the milk were: Diarrhoea 5, sickness 1, bronchitis 7, pneumonia 2, tabes mesenterica, 1, indigestion 4, convulsions 6, rickets 5, consumption 2, teething 1, sickness and diarrhœa 1, measles 1, whooping cough 1, abscess 1, hernia 3, and paralysis of legs 1. The periods during which the 252 infants and children continued to use the milk were:— 26 weeks and over 26 Under 4 weeks— 13—26 weeks 46 2—4 weeks 47 6—13 weeks52 Under 2 weeks 54 4—6 weeks 27 - 252 49.2 per cent, used the milk for periods extending from 6 to 26 weeks and over, whilst 50.8 per cent. used the milk for short varying periods under 6 weeks. 21.4 per cent. used the milk for short periods under 14 days. 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. * The Staff consists of a Manageress (Miss Paterson), one permanent Assistant (Miss Berkeley) and one temporary Assistant. Miss Paterson succeeded Airs. Burke (resigned) on April 24th, 1913. 124 In regard to (6), it is noteworthy that, of the 252 infants and children fed, in only 7 cases (i.e., 2.8 per cent.) was the milk stated to be unsuitable. An average of 96 infants and children were fed per week at the Dep6t, necessitating the distribution for the year of 221,891 bottles of milk mixture, whilst, in addition, milk was also supplied as follows:— 1. Lambeth Infirmary—a total of 503 (estimated) infants and children, using 12,059 pint bottles of milk mixture; 2. Lambeth Workhouse—a total of 376 (estimated) infants and children, using 5,389 pint bottles of milk mixture; 3. Lambeth Schools Infirmary—a total of 60 (estimated) infants and children, using 849 pint bottles of milk mixture; 4. Invalids—a total of 58 persons, using 3,061 pint bottles of milk mixture; 5. Children over 2 years of age:— («) Relieving Officers' cases—a total of 8, using 148 pint bottles of milk mixture; (b) Others—a total of 110, using 4,285 pint bottles of milk mixture. Weekly medical consultations with mothers were held at the Dep6t, the babies being weighed, the weights and other details tabulated in the Register, whilst the babies were visited also at their homes by the Health Visitor when required. Milk was distributed not only from the Depot, but also from the Moffatt Institute (Upper Kennington Lane), the latter branch dep6t (distributing centre) being used for the convenience of the mothers living in the Vauxhall District. Of the 252 new infants and children fed, 9 died, and the periods (in days), during which they had been fed upon the milk prior to death, varied as follows:—3, 3, 4, 7, 7, 7, 8, 20 and 119 respectively. In other words:— Infants and children fed for 13 weeks and over 72 (1 death) Infants and children fed for 4 to 13 weeks 79 (0 death) Infants and children fed for 2 to 4 weeks 47 (1 death) Infants and children fed for periods under 2 weeks 54 (7 deaths) 125 N.B.—Of the 9 deaths, all were in infants under 12 months, viz.:—1 month, 1 month, 1£ months, 2 months, 3 months, 3 months, 4 months, 5 months,' and 6 months respectively. The stated causes of death were:—measles 1, whooping cough 1, pneumonia 1, marasmus 5, and convulsions 1. 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 infants 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 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 some children died during the first month during which they were taking the milk, it would be misleading to assume that all children would die at the same rate during the succeeding period of 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, 1914, is stated by the Borough Accountant to have been £341 5s. 9d. £ s. d. (a) Expenditure 933 17 11 (b) Income 592 12 2 i.e., Expenditure in excess of Income £341 5 9 E 126 The net yearly expenditures since the Depot was opened are: 1906, £223 12s. 6d.; 1907, £206 0s. 0d.; 1908, £283 16s. 7d.; 1909, £315 8s. 8d.; 1910, £294 5s. 3d.; 1911, £214 18s. 10d.; 1912, £256 13s. 11d.; 1913, £306 0s. 2d.; 1914, £341 5s. 9d. The financial statistics must be considered with the good derived by the infants and children fed. BAKEHOUSES. There are, within the Borough, 214* Bakehouses (135 above ground and 79 underground), and these were inspected officially during 1914, and the necessary annual white-washing and cleaning carried out, as required. DAIRIES, MILKSHOPS AND MILK STORES. During 1914, 23 applications for registration were received and dealt with by the Council as follow:— 1.—Applicants not registered, the premises being "unsuitable" (i.e., not in accordance with the Council's requirements)—3 Wards and Addressesof Premises. Names of Applicants. Dates of Refusal by Council. MARSH Nil. BISHOP'S Nil. PRINCE'S. 21, Hanover Gardens Bosdet, Alfred E. July 27th 19, Vauxhall Walk Willoughby, Geo. Wm Mar. 15th VAUXHALL. 21, Beech Street Allen, Beatrice July 17th STOCKWELL Nil. BRIXTON Nil. HERNE HILL Nil. TULSE HILL Nil. NORWOOD Nil. *72 were certified during 1903-4 as "suitable" for occupation as underground bakehouses under section 101 Factory and Workshop Act, 1901. 127 2.—Applicants registered, the premises being "suitable" (i.e., in accordance with the Council's requirements)—20. Wards and Addresses of Premises. Names of Applicants. Dates of Registration by Council. MARSH. 64, Broadwall* Webb, Chas. James Feb. 26th BISHOP'S. 69, Hercules Road Haywood, Harriet Annie April 3rd 113a, Kennington Road Ambroso, Antonio Feb. 13th 30a, St. Mary's Square Price, Alice Elizabeth July 18th PRINCE'S. 40, Durham Street Long, Alice Jane May 28th 21, Hanover Gardens Bordet, Arthur E. Sept. 17th 2, Kennington Grove Hawkins, Frederick Oct. 24th 121, Upper Kennington Lane Jenkins, Margaret, and Davies, Janie Oct. 12th VAUXHALL. 37, Brooklands Street Brown, Fred May 29th 30, Cavendish Grove Patching, Florence Aug. 13th 117, Hartington Road Parry, Margaret July 31st 76, Lansdowne Road Davies, John Lewis June 2nd 8, Wilcox Road† Bunting, Percy Jan. 10th STOCKWELL. 98, Stockwell Road Davies, Philip April 3rd BRIXTON. 22b, Lothian Road* Hugh, Edward George May 7th 43, LoughboroughRoad Marshall, Murray & Co., Mar. 19th Ltd. 75, Robsart Street Dorman, George Henry May 18th * Change of occupier. † Since withdrawn. 128 Applicants registered, etc.—continued. Wards and Addresses of Premises. Names of Applicants. Dates of Registration by Council. HERNE HILL. 82, Effra Parade Lawrence, Kate June 8th 8, „ Woozley, John E. July 23rd TULSE HILL Nil. NORWOOD. 109, Hamilton Road Bacon, George Sept. 13th During 1914 the following applications have been withdrawn from the Register:— Addresses. Names of Applicants. Dates of Registration by Council. 256a, Brixton Hill Wraight, Dumbrill & Co.,Ltd. July 5th,1911 12, Stockwell Green Collett, Albert, and Squires, Samuel May 13th,1913 8, Wilcox Road Bunting, Percy Jan. 10th,1914 COWHOUSES. There were, within the Borough, at the end of 1913, 11 registered Cowhouses, and, at the Annual Licensing of the London County Council, held on October 26th and December 10th, 1914, the licences were renewed, with the following exception:— 9, Dawlish Street (no application made). 129 LIST OF THE 10 COWHOUSES LICENSED IN THE BOROUGH OF LAMBETH DURING 1914. 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. Vauxhall 38, Harrington Road 1 Williams, John Morgan, and Lewis, Davis Brixton 34, Ingleton Street 1 Baker, Frederick. Norwood 93, Clive Road, W. Norwood 1 Wraight, Dumbrill & Co., Ltd. „ 15, Croxted Road, W. Dulwich 1 Wraight, Dumbrill & Co., Ltd. „ Elder Road Dairy, W. Norwood 2 Bacon, Charles. „ 156, Hamilton Road, W. Norwood 3 Grant, George Ephraim. „ 76 & 78, Gipsy Hill 3 French, Frederick William. 130 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 1914 no action was required to be taken before the Magistrate in regard to infringements of the By-laws, but a cautionary letter was addressed to the occupier of the cowshed at 6, Coral Street, drawing attention to the unsatisfactory manner in which the manure was being dealt with on several occasions when the Inspector called, the dung being deposited in a cage inside instead of outside the cowhouse. During 1914 there were the following changes of licensees:— (a) 34, Ingleton Street—Frederick Baker vice Sarah Amelia and Frederick Baker. (b) 76 and 78, Gipsy Hill—Frederick William French vice James Thomas French. SLAUGHTER-HOUSES. There were within the Borough, at the end of 1913, 17 registered Slaughter-houses, and at the Annual Licensing of the London County Council, held on October 26th and December 10th, 1914, the licenses were renewed. List of the 17 Slaughter-Houses licensed in the Borough of Lambeth during 1914. Wards. Situations of Premises. Names of Licensees. Marsh 99 Lower Marsh* Bacchus, James „ 106 „ „ † Thomas, Robert Edwin * Small cattle only to be killed, † Special conditions laid down. 131 Wards. Situations of Premises. Names of Licensees. Bishop's 151, Lambeth Walk Milton, Robert William Prince's 60, Kennington Park Road Grellier, Frederick „ 406, Kennington Road Parsons, Bernard William Vauxhall 152, Clapham Road Lawrence Bros. Stockwell 27, Bedford Road, Clapham Road Pooley, John Peed Brixton Near Railway Hotel Brewery, Electric Lane, Brixton Ford, Henry, & Co., Ltd. „ Industry Terrace (yard leading to), Canterbury Road Warren, Emma Sanders Heme Hill 207, Coldharbour Lane Clark, Albert John „ 309, Coldharbour Lane Ford, Henry, & Co., Ltd. „ 77, Dulwich Road Atkin, Jim Cook Tulse Hill 12, Lower Tulse Hill Rooksby, Walter „ 45, New Park Road Spindler, Morris G. Norwood 125, Hamilton Road Forss, Thomas Lionel „ 120, High Street*† Crouch, William, and Dale, Albert „ 121 Hindle, Richard John * Small cattle only to be killed, † Special conditions laid down. 132 The Borough Council is now responsible for the periodical inspection of the Slaughter-houses and the due enforcement of all By-laws and Regulations, &c., made in connection therewith, under the Slaughter-houses, &c., 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 1914, no action was required to be taken before the Magistrate in regard to infringement of By-laws, but a cautionary letter was sent to the occupier of the Slaughter-house at 106, Lower Marsh, drawing attention to what the Inspector found at one of his usual inspections, viz.: (1) garbage stored in uncovered receptacle, (2) walls of pound dirty, and (3) periodical limewashing not carried out. During 1914, there were the following changes of licensees:— (a) 45, New Park Road—Norris, G. Spindler vice Edith Mary Beaumont. (b) 120, High Street—William Crouch and Albert Dale vice Frederick Griffiths. OFFENSIVE TRADES. During 1914, 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—15, Upper Marsh (Messrs. J. C. & J. Field). 2. Soap Boilers—15, Upper Marsh (Messrs. J. C. & J. Field). 3. Tripe Boilers—103, Lambeth Walk (Messrs. Bennett' Son & Co.). During 1914, certain structural alterations, and improvements* were effected at the premises of Messrs. J. C. & J. Field, Limited (Upper Marsh), with a view to bringing them more up-to-date and into accordance with the L.C.C. By-laws which were made on February 26th, 1907, for regulating the conduct of the business of a fat melter, it being held by the County Council's legal advisers during 1914 that the re-melting prior to saponification of the melted fat, brought from abroad in barrels to Messrs. J. C. & J. Field's premises, constituted "fat melting" as defined under such By-laws. * Provision of a closed melting chamber (properly constructed and ventilated in accordance with the By-laws), repairing of paving, etc. (By-laws Nos. 2, 9, and 10)—the consent of the London County Council being obtained first for the structural alterations as required by By-law No. 12. 133 REFUSE AND MANURE DEPOTS. The 13 Public Depots, situated in the Borough, were under constant (daily, during the summer months) supervision during 1914, and, in connection with the Destructors 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 had to deal before the Magistrate under the By-laws, having regard to (a) the provision in the By-laws, which permits of the depositing of refuse and offensive matters for a reasonable period of 12 hours during the process of removal, (b) the dislocation of business owing to the war (shortage of vans, horses and men and difficulties in barging and transport). Cautionary letters were sent, as required, in one or two instances. Disposal of House Refuse. Owing to the war conditions it was deemed advisable, in view of the difficulties that might arise in the near future with regard to the removal of house refuse throughout the Borough, to issue notices amongst the inhabitants requesting them to burn as much of their refuse as possible on account of the danger to health caused by keeping refuse near houses during the hot weather. These notices were issued during August, 1914. EFFLUVIUM NUISANCES. Messrs. Houston's Premises, Juxon Street. During 1914 a Petition*, signed by 27 inhabitants of the neighbourhood, was dealt with, the petitioners drawing attention to an effluvium nuisance caused in connection with the Juxon Street premises of Messrs. John Houston & Co., Ltd., contractors for distillers' and brewers' by-products, grains and makings collected under contract from breweries, being dried, and causing thereby a nuisance, which may be dangerous and injurious to health. An inspection was made of the premises and action taken, with the result that a new flue was provided for carrying the vapours from the dryer directly into the chimney shaft in place of the old flue, which was found to be defective. It was also suggested that a roof should be constructed over the pit on the land at the side of the premises, but as this structural alteration required the sanction of the landlords and the District Surveyor, it was decided not to use the pit for the purpose of placing any grain, and orders were given to secure that all material, on its arrival, should be dealt with forthwith. The result of the action taken was that the Petitioners made no further complaint. * The petition was received at the end of 1913. e2 134 BACTERIOLOGICAL LABORATORY. At the Bacteriological Laboratory, during 1914, 2,042 examinations were carried out as compared with a yearly average for the decennium 1904-13 (Borough) of 1069.0. 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 1914) *15,294 examinations have been made, viz.:—Tuberculosis 5,535, typhoid fever 987, diphtheria 8,536, and others 236. The total 2,042 bacteriological examinations carried out during 1914 deal with 1,144 sputa (suspected consumption), 42 bloods (suspected typhoid fever), 838 throat and nose membranes and discharges (suspected diphtheria) and 18 other materials, e.g., hairs (1), urine (1), stomach contents (1), smearings of pus (14), and skin scraping (1). Details are as follows:— T uberculosis— 1,144 samples of sputa from doubtful consumption cases were examined, and in 411 [i.e., 35.9 per cent.) tubercle bacilli were found. Pneumococci were isolated in 1 sample, and elastic tissue was found in 12 samples. Pulmonary consumption (with expectorations) was made voluntarily notifiable throughout the Borough of Lambeth on (and after) June 1st, 1902, and pulmonary consumption compulsorily notifiable under the Public Health (Tuberculosis) Poor Law Regulations, 1908, on and after January 1st, 1909 under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, on and after May 1st, 1911, under the Public Health (Tuberculosis) Regulations, 1911, on and after January 1st, 1912, and tuberculosis (both pulmonary and other forms) under the new Public Health (Tuberculosis) Regulations, 1911, on and after February 1st, 1913. *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; 1913,2565; 1914,2042; total, 15294. 135 By means of bacteriological examinations, greater exactness in diagnosis of tuberculosis is secured. The large increase in the numbers of samples of sputum examined during 1913 and 1914 is due to the introduction of the compulsory Public Health (Tuberculosis) Regulations, the carrying out of the "sanatorium benefit" under the National Insurance Acts, and the opening to the public of the Council's Tuberculosis Dispensary (Central) at 73, Effra Road, on July 23rd, 1913. Typhoid Fever. 42 samples of blood from suspected typhoid cases were examined, and in 14 [i.e., 33.3 per cent.) the characteristic Widal reaction was obtained, although in 11 cases the reactions were but slightly marked. A high dilution of blood-serum was used (1-60 and 1-100). Diphtheria. 838 samples of throat and nose membranes and secretions from doubtful diphtheria cases were examined, and in 108 [i.e., 12.9 per cent.), the true Klebs-Lceffler bacilli were isolated. In 730 [i.e., 87.1 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., staphylococci, streptococci, torulae, bacilli mesenterici, sarcinoe and pseudo (Hoffmann) bacilli. The last-named, viz.: pseudo (Hoffmann) bacilli, were isolated in 3 cases—1 mixed with staphylococci and streptococci, and 2 mixed with true Klebs-Lceffler bacilli. 18 samples of other materials were examined, viz.: hairs (for tinea tonsurans), 1 (negative), pus smearings (for gonococci) 11 (5 positive) pus smearings for spirochaetoe pallidoe 3 (all negative), urine (for tubercle bacilli) 1 (negative), stomach contents (for sarcinoe) 1 (positive), and skin scraping (for tinea tonsurans) 1 (negative). The pus smearings were from the urethra (3), and vagina (8). 136 1914. Sputa—Tub. Bac. found Bloods—Typhoid reaction obtained. Throat and Nose Membranes and Discharges—Klebs-Lœffier Diphtheria Bac. found. Yes. No. Total. Yes. No. Total. Yes. No. Total. January 46 98 144 - 2 2 6 61 67 February 53 92 145 2 4 6 10 55 65 March 40 105 145 2 2 4 6 81 87 April 39 82 121 2 1 3 — 50 50 May 38 65 103 1 5 6 2 46 48 June 47 53 100 1 1 2 2 45 47 July 28 52 80 - 2 2 - 49 49 August 27 27 54 — 2 2 2 35 37 September 39 35 74 1 6 7 25 94 119 October 25 48 73 1 2 3 20 78 98 November 19 36 55 2 2 10 78 88 December 10 40 50 2 1 3 25 58 83 TOTALS 411 733 1,144 14 28 42 108 730 838 N.B.—18 other samples were also examined during 1914, viz. : Hairs (1), Pus Smearings (14), Urine (1), Stomach contents (1), and skin scraping (1). Antitoxin. The Borough Council distributed during 1914 free of cost to medical practitioners practising in the Borough, 72 vials of antitoxin under the Antitoxin Order, 1910. 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. The 2 Mortuaries (Wanless Road and High Street) are the freeholds of the Borough Council. *The Council's Mortuary Keepers are:—Joshua Fazey (Wanless Road) and Robert William Harriss (High Street). There is also a Deputy Mortuary Keeper. 137 The following are the details of work done during 1914 at the two mortuaries and coroners' courts:— (a) Total number of bodies received, 435—300 at High Street and 135 at Wanless Road. (b) Post-mortem examinations conducted 206—136 at High Street and 70 at Wanless Road. (c) Coroners' court sat 173 times—128 at High Stree and 45 at Wanless Road. (d) Number of bodies brought in by the Police, 43—34 High Street and 9 to Wanless Road. (e) Number of bodies brought in by undertakers or priva persons 392 — 266 to High Street and 126 to Wanles Road. (f) No infectious bodies received either at High Street at Wanless Road. There were 44 suicides investigated (17 drowning, 1 poisonint by veronal, 2 poisoning by opium, 8 poisoning by coal gas 1 hanging, 6 throat cutting, 3 shooting, 1 bayonet wound 3 throwing themselves from windows, and 2 throwing themselves on railway tracks); and 129 accidental deaths—falls 40, crushing 1, overlying 9, burns and scalds 19, drowning 3, knocked down or run over 47 (viz.: by Horse Vehicles 7, Motor Cars 35, Tram Cars 3, Railways 2), Tetanus 5, Scaffold falling 3, Street Accidents 2. Of the total 435 bodies received, 257 were males and 178 females. The yearly averages for the two decennia 1891-1900 (Parish) and 1901-10 (Borough) are respectively (a) bodies received 355.8 and 399.8, (b) post-mortems conducted 210.8 and 218.4, (c) sittings of coroners' court 194.0 and 175.7. A separate mortuary for Norwood District has not yet been provided, but it has been provisionally arranged for such a mortuary on the plan in connection with a small part of the freehold site (south-eastern corner) in Rommany Road, West Norwood, which was purchased and is being developed by the Council for a Depot in that District. The old Watch House (the residence of the High Street Mortuary Keeper) was condemned during 1912 as unfit for human habitation on the ground of its dampness due to its unfavourable site and the absence of damp courses and concrete, etc., and was closed accordingly. A temporary residence was provided for the High Street Mortuary Keeper at 206 Lambeth Road. 138 INQUESTS. During the year 1914, within the Borough of Lambeth, 351 Lambeth cases were submitted to the Coroner (who, in 26 instances, decided that no further inquiries were necessary, the deaths being due to natural causes). In the remaining 325 cases, inquests were held with the following result— 1. Natural Causes 165 II. Accidental Causes 135 Burns and Scalds 11 Drowning 3 Run over 26 Falls, etc 35 Suffocation 11 Fracture 11 Misadventure 31 Crushed 3 Blood Poisoning 4 III. Homicidal Causes 20 Suicide 17 Murder 3 Manslaughter — IV. Open Verdicts 5 Found Drowned 5 Total 325 139 CLERICAL STAFF.* During 1914 there has been no change in the personnel of the clerical staff. During 1914 there were 10,389 letters, etc., received (entered in letter book), 22,544 letters, etc., sent out (entered in postal book), 15,109 Notices issued, 7,748 letters typed, and 4,541 complaints entered in the complaint book. *The Clerical Staff consists of 2 Chief Clerks, Class I. (W. R. Lawrence and A. L. Baxter, the latter acting also as Special Clerk to the Medical Officer of Health), 2 Assistant Clerks, Class II. (W. J. Lawrence and A. E. Ruel), and 2 Boy Clerks, Class III. (W. E. Crowley and T. N. Charlton). APPENDIX. 2 Local Government Board New Tables. TABLE I. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1914 AND PREVIOUS FIVE YEARS (1909-13). Year. Population estimated to Middle of each Year. Births. Total Deaths registered in district. Transferable Deaths.‡ Nett Deaths belonging to the District. Uncorrected. Number. Nett. Number. * Rate. of Nonresidents registered in the District. † of Residents not registered in the District. † Under 1 Year of Age. At all Ages. Number. * Rate per 1,000 Nett Births. Number. * Rate Number. † Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 141 823 634 600 86.3 4000 13.4 1913 297139 8341 7238 24.4 4476 15.1 883 780 737 74.2 4373 14.7 1914 297094 8188 7022 28.6 4630 15.6 1008 745 734 104.5 4367 14.7 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 ot the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. †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 (98) entered in Column 9; and all such deaths are included in this Column, unless an error has been detected, and its correction has been accepted by the Registrar-General. 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 (1239 outward and 73 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 (6) below. In Column 8 the number of transferable deaths of " non-residents '' which are deducted and in Column 9 the number of deaths of " residents'' registered outside the district which are added are stated in calculating the nett death-rate of the Borough. Cencus 1911, I Area of Borough in acres (exclusive of area covered by water), 4079-6 Average number of persons per house (estimated), 6.7. Number of inhabited houses, 44123. Total population at all ages, 298058. Cencus 1911, 3 Local Government Board New Tables TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1914. NOTIFIABLE DISEASE. NUMBER OF CASES NOTIFIED. TOTAL CASES NOTIFIED IN EACH LOCALITY. (e.g.. Parish or Ward) of the District. TOTAL CASES REMOVED TO HOSTITAL. At all Ages. At Ages—Years. Lamlieth Church. Kennington. Stockwell. Brixton. Norwood. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65 65 and upwds. Small-pox - - - - - - - - - - - - - - Cholera - — — — — - — — — - - - — — Diphtheria (including Membranous Croup) 556 13 144 312 50 33 4 - 79 92 129 144 112 476 Erysipelas 231 11 8 16 17 75 75 29 46 47 45 50 43 63 Scarlet Fever 1745 10 401 1109 146 75 4 - 336 308 321 500 280 1649 Typhus Fever - — — — — — — — — — — — — — Enteric Fever 48 2 1 13 9 21 2 — 18 8 4 11 7 41 Relapsing Fever 1 - - - - 1 - - - - - 1 - - Continued Fever 1 - - - 1 - - - - - - - 1 — Puerperal Fever 23 — — — 2 21 — — 3 6 2 6 6 21 Plague — — — — —- — — — — — — — — — Pulmonary Tuberculosis* 1250 2 6 136 250 624 211 21 227 193 233 341 254 — Other Forms of Tuberculosis† 273 12 44 111 48 43 14 1 44 49 74 62 44 — Cerebro-spinal Fever 5 2 2 1 — —• — —- 2 — 1 1 1 3 Polio myelitis acuta 10 1 6 2 — 1 — — 6 1 1 1 1 6 Ophthalmia Neonatorum 57 57 - - - - - - 14 11 16 13 3 — Whooping Cough‡ 1389 201 737 438 5 7 - 1 374 276 202 238 299 52 Isolation Hospitals, Name and Situation—-Hospitals of the Metropolitan Asylums Board (one situated in the Brixton SubDistrict 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. *Excluding all renotifications (247) of pulmonary tuberculosis, and notifications under Form C (447) and Form D (407) of the 1912 Regulations. †Excluding all renotifications (11) of non-pulmonary tuberculosis, and notifications under Form C (46) and Form D (34) of the 1912 Regulations. ‡Whooping Cough became compulsorily notifiable within the Borough of L.ambeth on January 1st, 1913. 4 5 Local Government Board New Tables. TABLE III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1914. BOROUGH OF LAMBETH. Causes of Death. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the District (a). total Deaths whether of "Residents" or "Nonresidents" in institutions in the District (b). All ages. Under 1 year 1 and Under 2 years. 2 and Under 5 years. 5 and Under 15 years. 15 and Under 25 ycars. 25 and Under 45years. 45 and Under 65 years. 65 and up- wards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 4269 3955 672 139 156 101 140 819 869 1059 2202 Uncertified 314 56 17 19 17 15 71 59 60 Typhus Fever - - - - - - - - — — Enteric Fever 15 - - 1 2 3 9 — — 16 Continued Fever - - - - - - - - - — Small-pox - - - - - - - - - — Measles 58 16 16 15 11 — — — — 24 Scarlet Fever 16 - 2 10 3 — 1 — — 26 Whooping Cough 40 17 14 7 2 - — — — 12 Diphtheria and Croup (See note (d)) 50 1 3 18 27 — 1 — — 64 Influenza 33 2 — — — 2 12 9 8 3 Erysipelas 19 6 1 — — 1 2 6 3 15 Cerebro Spinal Fever 4 2 1 — 1 — — — — 8 Polio-myelitis acuta 3 - — — 2 1 —- — — 3 Venereal Diseases 26 14 1 — — — 3 6 2 — Phthisis (Pulmonary Tuberculosis) 386 — 1 3 12 54 187 107 22 155 Tuberculous Meningitis (See note (e)) 48 12 5 13 13 3 1 1 — — Other Tuberculous Diseases 61 10 4 4 8 6 15 9 5 — Rheumatic Fever 14 — —- 1 7 1 3 — 2 3 Cancer, malignant disease (See note (f)) 391 - 1 1 - - 43 211 135 1 - Bronchitis 362 46 11 5 1 1 14 62 222 210 Broncho Pneumonia 149 61 29 21 7 1 5 8 17 Pneumonia (all other forms) 192 15 5 9 7 9 39 60 48 Other diseases of Respiratory organs 60 3 4 6 3 — 6 20 18 — Diseases of Circulatory System 611 1 — — 15 26 69 185 315 265 Diseases of nervous system 328 24 4 8 10 13 52 92 125 — Diarrhœa (See note (g)) 196 156 22 8 2 1 3 4 120 Enteritis (See note (f)) 16 4 - - - - 5 3 4 — Appendicitis and Typhlitis 16 - - 1 5 3 5 1 1 40 Alcoholism (See note (h)) 24 - - - - 1 11 10 2 — Cirrhosis of Liver 43 - - - - - 6 24 13 — Nephritis and Bright's Diseases 145 — — 2 1 2 24 66 50 — Puerperal Fever (See note (i)) 10 — — — — 1 8 1 — 14 Other accidents and diseases of Pregnane and Parturition 14 - - - — 2 10 2 — — Congenital Debility and Malformation, ineluding Premature Birth (See note (j)) 240 236 1 1 1 1 — — — — Violent Deaths, excluding Suicide 142 20 5 7 14 7 37 28 24 123 Suicides 25 — — — - 3 10 9 3 Other Defined Diseases 520 72 11 8 1 1 9 47 86 276 1101 Diseases ill-defined or unknown 11 5 1 - 2 - - 3 - 4269 728 143 149 169 151 618 1012 1299 2202 Notes to Table iii. (a) All " Transferable Deaths " of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term "transferable deaths" sec footnote to Table I. The total deaths in column 2 of Table III. equal the figures for the vcar 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. (c) Under "Tuberculous Meningitis" are included deaths from Acute Hydrocephalus. (/) Under "Cancer" are included deaths under such headings as Carcinoma, Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. (g) Under this heading are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Choleraic diarrhoea, Cholera (other than Asiatic), Gastro-enteritis, Gastro-intestinal catarrh, Muco-enteritis, Colitis, etc. Deaths from Diarrhoea secondary to some other well-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, 1914. Nett Deaths from stated causes at various Ages under 1 Year of Age. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. All Causes Certified 123 37 33 26 219 142 156 84 71 672 Uncertified 25 2 1 — 28 17 5 5 1 56 Chicken Pox - Measles - - - - - - 1 6 9 16 Diphtheria and Croup - - - - - - — - 1 1 Whooping Cough - - - — - 1 7 5 4 17 Diarrhœa - 2 3 2 7 35 73 29 12 156 Enteritis (Epidemic) - - - - - 1 1 1 1 4 Influenza - — — — — — 1 1 — 2 Cerebro-Spinal Fever - - - - - - 1 — — 1 Ophthalmia Neonatorum - - - - - - - - - - Tuberculous Meningitis - - - - - 2 3 2 5 12 Abdominal Tuberculosis - - - - - 1 - - - 1 Other Tuberculous Diseases - - - - - 2 2 2 3 9 Congenital Malformations 11 3 - 3 17 6 6 2 1 32 Premature Birth 83 9 8 5 105 16 1 1 - 123 Atrophy, Debility and Marasmus 10 7 7 3 27 26 16 3 8 80 Atelectasis 15 3 2 1 21 2 — — — 23 Erysipelas - - - 1 1 3 - 1 1 6 Syphilis - 2 3 - 5 7 2 - - 14 Rickets - - - - - - - - 1 1 Meningitis (not Tuberculous) - 2 - - 2 2 2 3 - 9 Convulsions 2 2 4 1 9 3 - 1 - 13 Gastritis 1 - 1 2 4 3 3 - - 10 Dentition - - - - - - 1 2 4 7 Laryngitis — - — - - - - - - - Bronchitis — 1 2 1 4 22 10 6 4 46 Pneumonia - 2 - - 2 1 1 3 5 12 Broncho Pneumonia 1 2 - 5 8 15 15 13 10 61 Pleuro „ - - - - - 1 1 1 - 3 Suffocation, overlaying 8 — - — 8 1 2 — - 11 Accident, other than Suffocation 7 — - — 7 1 — — - 8 Other causes not classified above 10 4 4 2 20 8 12 7 3 50 148 39 34 26 247 159 161 89 72 728 8 9 TABLE v Local Government Board New Tables. BOROUGH OF LAMBETH.—Particulars of cases of acute polio-myelitis, and polio-encephalitis and epidemic cerebro-spinal meningitis, notified within the Borough of Lambeth, during 1914. Total number of Cases notified. NUMBER OF CASES. 0-1 year. 1-5 years. 5-10 years. 10-15 years. 15-20 years. 20-30 years. Over 30 years. M. F. M. F. M. F. M. F M F M F M F Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Acute Polio-myelitis 10 1 - 1 - - - 4 - 2 2 - 2 2 2 - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - Cerebro-Spinal Fever 5 1 1 - 1 1 - 2 1 1 - - — - - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - Number of cases removed to Isolation Hospital. *i.e., Recovered . with permanent Paralysis of one or more groups of muscles. Acute Polio-niyelitis — — 2 2 2 - - - - - 1 - - - Cerebro-Spinal Fever - 1 1 - — 1 — — — - - - - - Observations rln 2 of the polio-myelitis, and 3 ol the cerebro-spinal fever cases, there was some evidence of animals (catsand dogs) being connected, in some way or other, with the illnesses. N.B.—The usual preventive measures, that are taken in connection with other infectious diseases, were taken, together with the stripping of papers off the walls of infected rooms. 10 Home Office Tables. BOROUGH OF LAMBETH, 1914. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection of Factories, Workshops and Workplaces including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 6 197 — Workshops (Including Workshop Laundries) 82 Workplaces (Other than Outworkers' Premises included in Part 3 of this Report.) - Total 88 197 — 11 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspctr. Nuisances under the Public Health Acts*:— Want of Cleanliness 55 55 - - Want of Ventilation 5 5 - — Overcrowding 6 6 - — Want of drainage of floors — — - — Other nuisances 195 195 - — Sanitary accommodations Insufficient — — - — Unsuitable or defective 47 47 - — Not separate for sexes 2 2 - — 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 310 310 - — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, as remediable under the Public Health Acts. 12 13 3.—HOME * WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK in UNWHOLESOME PREMISES. Sections 108. 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. Prosecutions Instances. Orders made (S. 110) Prosecutions (Section 109,110) Failing to keep or permit inspection of Lists. Failing to send Lists. Sending Twice in the year. Sending Once in the year. Lists. Outworkers,† Lists. Outworkers. Contractors. Workmen- Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, &c. 22 10 143 5 - 30 — Nil. Nil. Nil. Nil. Nil. 8 Nil. Nil. (2) Cleaning and washing — — — — - — — - Household linen - - - - - - - - Lace, lace curtains and nets - - - - - - — - Curtains & furniture hangings - - - - - - - - Furniture and upholstery - - - - - - - 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 — 77 — - — — - Racquet and tennis balls — — — — - — — - Paper bags and boxes 2 — 34 — - — — - Brush making — — — — - — — - Pea picking - - - - - - - - Feather sorting - - - - - - - - Carding, &c., of buttons, &c. - - - - - - - - Stuffed toys - - - - - - - Basket making — — — — - — — - Printing 2 — 31 — - — — - Cigarette making — — — 1 - 2 — - Total 28 10 285 6 - 32 — — - — — - 8 - - * If an occupier gives out work of more than one of the classes specified of workers in each class of work, the list should be included among those the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into has been done. † The figures required in columns 2, 3 and 4 are the total number of the duty of sending two lists each year and of the entries of names of outnumbers, as there will be two lists for each employer—in some previous will usually be (approximately) double of the number of individual outthe same employer the same outworker's name will often be repeated. in column I, and subdivides his list in such a way as to show the number in column 2 (or 5 as the case may be) against the principal class on'.v, but their respective classes. A footnote should be added to show that this lists received from those employers who comply strictly with the statutory workers in those lists. The entries in column 2 must necessarily be even returns odd numbers have been inserted. The figures in columns 3 and 4 workers whose names are given, since in the February and August lists of 14 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year 1914. Number. (1) (2) Bakehouses 214 Restaurants 296 Laundries 208 Dressmakers 329 Tailors 142 Milliners and Mantle Makers 86 Blouse Makers 79 Other Businesses 391 Total number of workshops on Register 1745 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 8 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 17 Reports(of action taken) sent to H.M. Inspector 17 Other — Underground Bakehouses (s. 101):— Certificates granted during 1914 — In use at the end of 1914 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. 15 London County Council Table. SANITARY PROCEEDINGS DURING 1914. (Return prepared for the London County Council.) Premises. Number of Places. Number of Inspections, 1914. Number of Notices, 1914. Number of Prosecutions,' 14. On register at end of 1913. Added in 1914. Removed in 1914. On register at end of 1914. Milk premises* 198 20 3 215 1290 24 — Cowsheds 11 — 1 10 22 1 — Slaughter-houses 17 — — 17 204 5 — Other offensive trade premises 3 — — 3 72 1 — Registered houses let in lodgings 372 — — 372 4464 — — Bakehouses 214 — — 214 428 — — Restaurant Kitchens 248 — — 248 - - — * During 1914 a total of 23 new applications were received and 20 approved, but 1 was withdrawn by the applicant after registration and before taking up occupation, and 1 was simply a change of occupier. 3 new applications were refused, the premises being " unsuitable." 16 Total number of Intimation or Preliminary Notices served for all purposes 7497 Overcrowding— Dwelling rooms overcrowded 31 Remedied 31 Prosecutions — Underground Rooms— Illegal occupation 29 Closed — 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) 7 Verminous rooms cleansed 935 Shelters provided under Sec. 60 (4) of the Public Health [London) Act, 1891— Number provided 1 Persons accommodated — Revenue Act, 1903— Houses for which applications were received 29 Tenements comprised therein 87 17 Revenue Act, 1903, continued— Tenements for which Certificates were— (a) granted 56 ,, ,, „ (b) refused 18 „ „ „ (c) deferred* 13 Common Lodging Houses— Certificates granted 6 Number of Prosecutions under By-laws, under Public Health Act, 1891 — Mortuaries— Number of bodies 435 (infectious cases 0). "Certificates since granted, the necessary works having been carried out. F 18 19 LAMBETH BOROUGH.—Deaths registered from all causes during the year, 1914. Note.-The Deaths of Non-Residents occurring in Public Institu- tions situated in the District, are excluded, and the Deaths of Resi- nrrnrrinp 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. Al Ages. M F M. F M. F. M. F. M. F. M. F. M. F. I. Specific Febrile,or Zymotic Diseases 55 50 56 49 57 40 48 38 40 37 2 1 258 215 473 II. Parasitic Diseases - - - - - - - — — — — — — — — III. Dietetic Diseases 3 3 4 1 2 4 1 3 2 2 - — 12 13 25 IV. Constitutional Diseases 103 64 87 72 101 92 121 145 64 94 11 5 487 472 959 V. Developmental Diseases 37 20 40 59 37 37 41 44 23 40 — — 178 200 378 VI. Local Diseases 194 184 201 217 231 222 236 303 167 187 15 14 1044 1127 2171 VII. Deaths from Violence 24 13 20 18 16 11 28 12 13 5 5 2 106 61 167 VIII. Deaths from Ill-defined and not Specified Causes 12 8 11 9 7 6 12 8 9 12 I 1 52 44 96 Totals 428 342 419 425 451 412 487 553 318 377 34 23 2137 2132 4269 I—Specific Febrile or Zymotic Diseases. I.—Miasmatic Diseases. Smallpox Vaccinated - - - - - - - - - - - - - — — Un vaccinated - - - - - - - - - - - - - - - No Statement - - - - - - - - - - - - - - - Measles 5 4 5 10 14 - 6 4 3 2 - - 33 25 58 Whooping Cough 5 12 5 6 1 5 2 3 2 1 - - 15 25 40 Scarlet Fever 2 2 1 2 1 3 2 2 - 1 - - 6 10 16 Typhus - - - - - - - - - - - - — - - Simple Continued and Ill-defined Fever - - - - 1 - - 2 2 1 - - 6 9 15 Enteric or Typhoid Fever 1 3 2 3 6 3 8 6 8 4 - - 31 19 50 Diphtheria 3 3 6 3 - - - - - - - - - - - Membranous Croup — - - - 3 2 8 3 2 5 - - 19 14 33 Influenza 3 4 3 - — 1 — — — — — 1 2 2 4 Other Miasmatic Diseases 2 - - - 2.—Diarrhœal Diseases. Cholera Nostras - - - - - - - - - - - - - - - Cholera Asiatica - - - - - - - - - — — - - - Drarrhoea, Dysentery 25 17 24 20 22 21 17 12 19 19 - - 107 89 196 3,—Malarial Diseases. Remittent or Relapsing Fever - - - - - - - - - - - - - — — Ague - - - - - - - - - - - - - - - 4.—Zoogenous Diseases. Cowpox and effects of Vaccination - - - - - - - - - - - - - - - Other Diseases (e.g., Hydrophobia, Glanders,Splenic Fever) - - - - - - - - - - - - - - - 5.—Venereal Diseases. Syphilis 4 1 5 1 6 1 4 - - - - - 19 3 22 Gonorrhœa. Stricture of Urethra 2 - 1 - 1 - - - - - - - 4 - 4 6.—Septic Diseases. Erysipelas 1 1 4 3 2 1 2 - 2 2 1 - 12 7 19 Pyæmia, Septicæmia 2 - - - - - - 2 2 - - - 4 2 6 Puerperal Fever - 3 - 1 - - - 4 - 2 - - - 10 10 20 21 LAMBETH BOROUGH. Deaths registere from all Causes during the Year 1914—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 ot the District are included. Sub-Districts. 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 II.—Parasitic Diseases. Thrush, and other Vegetable Parasitic Diseases — — — — - - - - - - - - - - - Worms, Hydatids, and other Animal Parasitic Diseases — — — — - - - - - - - - - - - III.—Dietetic Diseases. Want of Breast Milk, Starvation - - - - 1 - - - - - - - 1 1 Scurvy - - - - - - - - - - - - - - - Chronic Alcoholism 3 3 3 l 2 2 - 2 2 2 - - 10 10 20 Delirium Tremens - - 1 - - 1 1 1 - - - - 2 2 4 IV.-Constitutional Diseases. Rheumatic Fever 1 3 3 1 - - 2 3 1 - - - 7 7 14 Rheumatism of the Heart - - - - - - - - - - - - - - - Rheumatism — - - — - - - 1 - 1 - - - 2 2 Gout 1 1 - - 2 - 1 1 - - - - 4 2 6 Rickets — - - - 1 - 2 - 1 - - - 4 - 4 Cancer, Malignant Disease 32 29 26 26 36 55 37 65 26 49 7 3 164 227 391 Cancrum Oris (Noma) - - - - — — — — — — — — — - - Tabes Mesenterica - - - 1 — 2 — — 1 — — — 1 3 4 Tubercular Meningitis, Hydrocephalus 34 18 44 31 5 2 10 7 7 3 — — 31 17 48 Phthisis 54 18 44 31 45 25 57 56 20 30 4 2 224 162 386 Scrofula - - - - - - - - - - - - - - - Other forms of Tuberculosis 6 6 6 8 9 2 8 5 4 3 — — 33 24 57 Purpura, Hæmorrhagic Diathesis - 1 9 - — — — — — 1 — — — 2 2 Ansemia, Chlorosis, Leucocythæmia 1 3 2 2 - 1 - 2 - 3 - - 3 8 11 Glycosuria, Diabetes Mellitus 2 2 1 3 4 3 4 3 3 - - 1 c oq Other Constitutional Diseases. 1 — — — 1 1 1 1 1 - - 1 o 3 I 3 3 zo 6 V.-Developmental Diseases. Premature Birth 19 10 12 10 18 13 20 9 4 8 - - 73 50 123 Atelectasis 5 1 - 1 - 1 3 5 4 3 - - 12 11 23 Congenital Malformations 6 1 3 6 7 3 4 2 3 i - - 23 13 36 Old Age 7 8 25 42 12 20 14 28 12 28 - - 70 126 196 vi.-Local Diseases. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 3 4 2 3 1 3 3 3 1 - - - 10 13 23 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 11 13 14 14 20 13 14 34 15 21 1 1 75 96 171 Insanity, General Paralysis of the Insane 4 1 11 4 4 1 5 3 10 1 i i 34 10 44 Epilepsy - 4 8 4 2 2 1 1 5 1 — - 16 12 28 Convulsions 2 1 1 2 3 1 2 3 - - - 8 7 15 Laryngismus Stridulus (Spasm of Glottis) 1 - - - - - - - - - - - 1 - 1 Disease of Spinal Cord, Paraplegia, Paralysis Agitans 2 - 4 2 3 1 4 6 4 2 - - 17 11 28 Other Diseases of Nervous System - 2 2 1 6 1 1 2 3 - - 11 7 18 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) - 1 - — 1 2 — 1 1 1 — — — 2 4 6 22 23 LAMBETH BOROUGH.—Deaths registered from all causes during the year, 1914. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of dents occuring in Public Institutions situated beyond the limits of the districts are inciuded. Sub-Districts. Sub-Districts. Total. Lambeth Church. Kennineton. Stockwell. Brixton. Norwood. No. Address. All Ages. 3.—Diseases of Circulatory System. M F M F M. F. M. F. M. F. M. F. M. F. Pericarditis 1 - - - - - 1 3 — 1 — — 2 4 6 Acute Endocarditis 2 7 1 2 3 4 — 3 3 1 — — 9 17 26 Valvular Diseases of Heart 12 16 12 26 12 21 20 33 16 22 1 — 73 118 191 Other Diseases of Heart 14 9 10 11 15 19 14 28 16 26 1 1 70 94 164 Aneurism 5 - - 1 2 1 7 — 2 — — — 16 2 18 Embolism, Thrombosis 2 2 2 6 3 2 4 7 4 2 — 1 15 20 35 Other Diseases of Blood Vessels 12 20 14 20 23 13 15 20 10 12 5 7 79 92 171 4.—Diseases of Respiratory System. Laryngitis - - 1 - 1 — 1 — — 1 — — 3 1 4 Croup - - - - - - - - - - - - — — — Emphysema, Asthma 2 - 1 - 1 2 5 6 — 1 — — 9 9 18 Bronchitis ... 34 26 31 53 42 42 32 53 16 31 1 1 156 206 362 Pneumonia ... 13 10 13 8 12 19 20 12 13 4 — 1 71 54 125 Pleurisy 5 - 3 - - — 1 — — 1 — — 9 1 10 Broncho-pneumonia 13 16 25 23 14 11 9 18 8 11 1 — 70 79 149 Pleuro-pneumonia 1 4 5 6 6 3 8 17 6 6 — 36 31 67 Other Diseases of respiratory 4 3 5 3 1 3 3 4 1 1 — — 14 14 28 5.Diseases of Digestive System. Appendicitis. 2 3 2 - — 1 2 1 3 2 — — 9 7 16 Dentition 1 - - 1 1 2 2 — 1 1 — — 5 4 9 Sore Throat, Quinsy - 2 - - 2 1 — — 1 1 — — 3 4 7 Diseases of Stomach 1 3 - 1 3 7 8 7 3 1 — — 15 19 34 Enteritis 1 2 2 1 1 5 1 — 1 2 — — 6 10 16 Obstructive Diseases of Intestine 1 7 3 3 6 2 2 1 — 7 1 — 13 20 33 Peritonitis - 3 - - — 3 2 3 — — — — 2 9 11 Ascites - - - - - - - - - - - - - - - Cirrhosis of Liver 6 1 7 3 6 2 5 8 2 2 - - 26 17 43 Jaundice and other Diseases of Liver - - - 1 3 4 2 1 4 3 - - 9 9 18 Diseases of the Pancreas - - - - - - - - - - - - - - - Other Diseases of Digestive System 4 2 5 3 3 5 8 4 3 - 1 - 24 14 38 6.-Diseases of Lymphatic System (e.., of Lymphatic and of Spleen) 2 2 - - 4 - 2 2 - - - - 8 4 12 7.—Diseases of Gland-like Organs of Uncertain Use. (e.g.. Bronchocele, Addison's Disease) 1 -- - 1 1 1 — 2 — — — — 2 4 6 8.—Diseases of Urinary System. Nephritis 2 2 - 1 — 4 2 2 2 — — — 6 9 15 Bright's Disease, Albuminuria 16 10 10 7 14 16 21 14 8 11 3 — 72 58 130 Disease of Bladder or of Prostate 4 - 4 - 5 — 5 2 3 — — 1 21 3 24 Calculus (Stone) - - 1 1 - - - - - - - - 1 1 2 Other Diseases of the Urinary System - - - - 2 — 1 — — — — 1 3 1 4 9.—Diseases of Reproductive System. A. Of Organs of Generation. Male Organs - - - - - - - - - - - - - - - Female Organs - 2 - - - 3 - - - 2 - - - 7 7 24 25 LAMBETH BOROUGH.—Deaths registered from all Causes during the year 1914—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. Sub-Districts. Sub -Districts Total[//###] Lambeth Church. Kennington. Stockwell Brixton. Norwood. No. Address. All Ages. b. Of Parturition. M. F. M. F. M F M F M F M F M F Abortion, Miscarriage — 2 — — - - - - - 1 - - - 3 3 Puerperal Convulsions — — — — - - - - - 1 - - - 1 1 Placenta prævia, Flooding — — — 1 - - - - - - - - - 1 1 Other Accidents of Child Birth — 1 — 3 - 2 - 1 - 2 - - - 9 9 10.— Diseases of Bones and Joints. Caries, Necrosis — — — 1 1 - - 1 - 1 - - 1 3 4 Arthritis, Ostitis, Periostitis — 1 1 — - — 1 2 1 1 - - 3 4 7 Other Diseases of Bones and Joints — — — — - - - - - - - - - - - 11.—Diseases of Integumentary System. Carbuncle, Phlegmon — 1 1 — 4 - 2 1 1 1 - - 8 3 11 Other Diseases of Integumentary System - — — - 1 - - 1 - - - 1 1 2 VII.—Deaths from Violence. 1.—accident or Negligence. Fractures and Contusions 7 4 6 10 4 2 10 6 5 1 2 1 34 24 58 Gunshot Wounds — — — — - - 1 - - - - - 1 - - Cut, Stab — — — — — - - - - - - - - - - Burn, Scald 1 3 1 1 - 1 - 2 - 1 - - 2 8 10 Poison 3 — 1 — 2 1 - 1 1 - 1 - 8 2 10 Drowning 4 — 2 — 1 1 - - - - - - 7 1 8 Suffocation — 2 2 3 1 2 1 - - - - - 4 7 11 Otherwise 4 2 4 4 3 3 8 3 4 1 1 - 24 13 37 Battle — — — - - - 6 - - - - 6 - 6 2.—Homicide. Manslaughter — — — — - - - - - - - - - - - Murder - - - - - - - - - - - 1 - 1 1 3.—Suicide. Gunshot Wounds — — — — - - 1 - - - 1 - 2 - 2 Cut, Stab 1 — 2 — 1 - 1 - 1 - - - 6 - 6 Poison 2 1 — — 2 1 - - 1 1 - - 5 3 8 Drowning 1 — 2 — 2 - - - - - - - 5 - 5 Hanging 1 — — - - - - - - - - - 1 - 1 Otherwise 1 - - - - - 1 1 - - 1 2 3 4.—Execution. Hanging — — — - - - - - - - - - - - - VIII.—Deaths from Ill-dellned and not specified Causes. Dropsy — — — — - - - - - - - - - - - Debility, Atrophy, Inanition 11 7 10 9 7 6 11 5 8 9 1 1 48 37 85 Mortification — 1 — — - - - - - 1 - - - 2 2 Tumour — — — — - - - - 1 - - - 1 - 1 Abscess 1 — — — - - - 2 - - - - 1 2 3 Hæmorrhage — — — — - - - - - - - - - - - Sudden Death (cause not ascertained) — — — — - - - - - - - - - - - Causes not specified, or ill-defined. — - 1 - - - 1 1 - 2 - - 2 3 5 f2 26 27 BOROUGH OF LAMBETH.—Deaths Registered from all Causes during the Year 1914. Note —The Deaths of Non-Residents occurring in Public Institutions situated are excluded- and the Deaths of Residents occuring in PublicInstitutions situated beyond the limits of the Districts are included. AGES. AGES. Total. Under 1 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 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 124 89 32 28 33 27 189 144 22 28 1 2 2 4 16 1 6 1 1 3 7 2 2 7 11 69 71 258 215 473 II. Parasitic Diseases — — — — — — — — — — - - - - - - - - - - - - - - - - - - - III. Dietetic Diseases — 1 - — - - - 1 - - - - 1 - 2 3 4 2 2 4 2 2 1 1 12 12 12 13 25 IV Constitutional Diseases 16 10 - 7 11 13 34 30 25 16 7 18 18 23 93 77 46 39 149 108 44 46 71 115 453 442 487 472 959 V. Developmental Diseases 104 / 4 1 - 1 - 106 74 1 - 1 - - - - - - - 1 - 2 3 67 123 453 442 487 472 959 VI. Local Diseases 101 04 37 22 30 27 168 153 25 34 14 16 14 19 84 85 49 48 220 179 105 81 365 511 876 976 1044 1127 2171 VII. Deaths from Violence 8 12 2 3 3 4 13 19 11 3 3 - 6 1 26 7 9 5 18 7 8 4 12 15 93 42 106 61 167 VIII. Deaths from Ill-defined and not Specified Causes 46 39 2 2 — — 48 41 2 1 1 - - - - - - - 1 2 - - - - 4 3 52 44 96 Totals 399 29 81 62 78 71 558 462 86 83 27 36 41 47 221 188 114 95 404 307 163 138 523 776 1579 1670 2137 2132 4269 1.—Specific Febrile or Zymotic Diseases. 1 —Miasmatic Diseases. Smallpox Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Unvaccinated - — — - - - - - - - - - - - - - - - - - - - - - - - - - - No Statement — — - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 9 7 12 4 8 7 29 18 4 7 - - - - - - - - - - - - - - 4 7 33 25 58 Whooping Cough 7 10 5 9 3 4 15 23 - 2 - - - - - - - - - - - - - - - 2 15 25 40 Scarlet Fever - - 1 1 5 5 6 6 - 3 - - - - - 1 - - - - - - - - - 4 6 10 16 Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Simple Continued and Ill-defined Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric or Typhoid Fever — — - - - 1 - 1 - 2 - 1 - 2 5 3 1 - - - - - - - 6 8 6 9 15 Diphtheria 1 - 2 1 13 5 16 6 15 12 - - - - - 1 - - - - - - - - 15 13 31 19 50 Membranous Croup - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Influenza - 2 - - - - - 2 - - - 1 1 - 7 1 4 - 4 4 - 1 3 5 19 12 19 14 33 Other Miasmatic Diseases - 1 1 - - - 1 1 1 - - - - - - - - - - - - - - 1 1 1 2 2 4 2.—Diarrhœal Diseases. Cholera Nostras — — — — - - - - - - - - - - - - - - - - - - - - - - - - Cholera Asiatica — — - - - - - - - — — — - - - - - - - - - - - - - - - - Diarrhoea, Dysentery 91 65 10 12 3 5 104 82 1 1 - - - 1 1 1 - 1 - - - - 1 3 3 7 107 89 196 3 —Malarial Diseases. Remittent or Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ague - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4 —Zoogenous Diseases. Cowpox and Eflects of Vaccination - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Other Diseases (e-g-, Hydrophobia, Glanders, Splenic Fever) - - - - - - - - - — - - - - - - - - - - - - - - - - - - - 5.—Venereal Diseases. Syphilis 13 1 1 - - - 14 1 - - - - - - 1 1 - - 3 1 - - 1 - 5 2 19 3 22 Gonorrhœa, Stricture of Urethra - - - - - - - - - - - - - - 1 - - - 2 - - - 1 - 4 - 4 - 4 6 —Septic Diseases. Erysipelas 3 3 - 1 - - 3 4 - - 1 - - - 1 - 1 - 3 1 2 - 1 2 9 3 12 7 19 Pyæmeia, Septicæmia - - - - 1 - 1 - 1 1 - - 1 - - - - - 1 - - 1 - - 3 2 4 2 6 Puerperal Fever - - - - - - - - - - - - - 1 - 8 - - - 1 - - - - - 10 - 10 10 28 29 BOROUGH OF LAMBETH.—Deaths Registered from all Causess during the Year 1914. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Resi- dents occurring in Public Institutions situated beyond the limits of the Districts are included. AGES. 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 Year A11 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 othr Vegetable Parasitic Diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Worms, Hydatids, and other Animal Parasitic Diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - III.—Dietetic Diseases. Want of Breast Milk, Starvation - l — — — — - 1 — - - - - - - - - - - - - - - - - - - 1 1 Scurvy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chronic Alcoholism - - - - - - - - - - - - - - 2 3 4 2 1 2 2 2 1 1 10 10 10 10 20 Delirium Tremens - - - - - - - - - - — - 1 - - - - - 1 2 - - - - 2 2 2 2 4 IV.—Constitutional Diseases. Rheumatic Fever - - - - - 1 - 1 5 2 1 - - - 1 1 - 1 - - - - - 2 7 6 7 7 14 Rheumatism of the Heart - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Rheumatism - - - - - - - - - - - - - - - - - 1 - 1 - 1 - - - 2 - 2 2 Gout - - - - - - - - - - - - - - - - 1 - 1 - 1 1 1 1 4 2 4 2 6 Rickets 1 — 1 — 2 — 4 — — — - - - - - - - - - - - - - - - - 4 - 4 Cancer, Malignant Disease - — — 1 1 — 1 1 — — - - - - 10 11 8 14 65 74 34 38 46 89 163 226 164 227 391 Cancrum Oris (Noma) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tabes Mesenterica - 1 1 - - - 1 1 — 1 - - - - - 1 - - - - - - - - - 2 1 3 4 Tubercular Meningitis, Hydrocephalus 8 4 3 2 6 7 17 13 10 3 - 1 2 - 1 - - - 1 - - - - - 14 4 31 17 4 Phthisis - - 1 — 1 2 2 2 4 8 6 15 13 20 72 59 34 22 75 24 5 3 13 9 222 160 224 162 386 Scrofula - — - — — — - — — — - - - - - - - - - - - - - - - - - - - Other forms of Tuberculosis 5 4 1 2 1 3 7 9 5 2 - 2 2 2 7 2 3 2 5 4 - - 4 1 26 15 33 24 57 Purpura, Hæmorrhagic Diathesis - - - 1 - - - 1 - - - - - 1 - - - - - - - - - - - 1 - 2 2 Anæmia, Chlorosis, Leucocythaemia 2 1 - 1 — — 2 2 — — - - - - - - - - 1 2 - 1 - 3 1 6 3 8 11 Glycosuria,Diabetes Mellitus - - - - - - - - 1 — - - 1 - 2 3 - - 1 3 4 1 4 8 13 15 13 15 28 Other Constitutional Diseases - - — — — — - — — — — - - - - - - - - - - 1 3 2 3 3 3 3 6 V.—Developmental Diseases. Premature Birth 73 50 - - - - 73 50 - - - - - - - - - - - - - - - - - - 73 50 123 Atelectasis 12 11 - - - - 12 11 - - - - - - - - - - - - - - - - - - 12 11 23 Congenital Malformations 19 13 1 - 1 - 21 13 1 - 1 - - - - - - - - - - - - - 2 - 23 13 36 Old Age - - - - - - - - - - - - - - - - - - 1 - 2 3 67 123 70 126 70 126 196 VI.—Local Diseases. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 2 7 - 1 1 2 3 10 4 1 - - - 1 2 - - - 1 - - - - - 7 3 10 13 23 Apoplexy, Softening of Brain Hemiplegia Brain Paralysis - - - - - - - - - - - - 1 1 5 - 1 4 15 20 7 12 46 59 75 96 75 96 171 Insanity, General Paralysis of the Insane - - - - - - - - - - 1 - 1 - 8 3 9 - 10 6 1 - 4 1 34 10 34 10 44 Epilepsy - - 1 - - 1 1 1 - 2 2 2 1 1 3 4 2 - 3 1 1 - 3 1 15 11 16 12 28 Convulsions 7 6 1 1 - - 8 7 - - - - - - - - - - - - - - - - - - 8 7 15 Laryngismus Stridulus (Spasm of Glottis) - - - - 1 - 1 - - - - - - - - - - - - - - - - - - 1 1 - 1 Disease of Spinal Cord, Paraplegia, Paralysis Agitans - - - - 1 - 1 - - - - - - - 4 1 - 2 6 2 1 - 5 6 16 11 17 11 28 Other Diseases of Nervous System 1 1 - - - 2 1 3 3 - 1 - 1 - 2 1 - 1 3 1 - 1 - - 10 4 11 7 18 30 31 from all Causes during the Year 1914. BOROUGH OF LAMBETH .-Deaths Registered Note.—The Deaths of Non-Residents occurring in Public Institu-tions situated in the District are excluded, and the Deaths of dents occuring in Public Institutions situated beyond the limits of the District are included. AGES. AGES. Total. 15-20 20-25 25-40 40-45 45-60 60-65 65 and over. Over 5 Years. All Ages. Under 1 Year. 1-2 2-5 Under 1 Years. 5-15 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. 2.—Diseases of Organs of Special Sense. — — — — — 1 1 — — 1 — — — — 1 4 2 4 6 (e.g., of Ear, Eye, Nose) 1 — — — — — 1 - - 2 3.—Diseases of Circulatory System. - 1 - - - - - - 2 - - - - - 2 3 2 4 6 Pericarditis — 1 1 — 2 1 3 1 2 2 5 2 2 3 — — — — 3 9 17 9 17 26 Acute Endocarditis - - - - - - - - - 2 4 3 3 6 7 18 2 9 27 24 9 19 20 34 73 118 73 118 191 Valvular Diseases of Heart - - - - - - - - 1 5 — 1 1 - 4 3 3 2 16 17 11 8 34 59 70 94 70 94 164 Other Diseases of Heart - - - - - - - - 1 4 — — — — 1 1 2 — 5 — 5 — 3 1 16 2 16 2 18 Aneurism - - - - - - - - - - - — — — — 4 — — 6 2 3 3 6 11 15 20 15 20 35 Embolism, Thrombosis - - - - - - - - - - - - - - - - 2 — 7 3 9 6 61 83 79 92 79 92 171 Other Diseases of Blood Vessels - - - - - - - - - - 4.—Diseases of Respiratory System. - - - - - - - - - - - - - - - - 3 1 4 Laryngitis — — — — 3 1 3 1 — — - - - - - - - - - - - - - - - - -q- - - Croup - - - - - - - - - - - - - - - — — 1 - -• 2 2 2 3 5 3 9 9 9 9 18 Emphysema, Asthma - — — — — — — — — — - 1 — — — 1 8 5 18 21 13 10 79 143 118 182 156 206 362 Bronchitis 26 20 9 2 3 2 38 24 — 1 3 — 1 1 8 5 1 3 23 10 6 3 16 15 61 41 71 54 125 Pneumonia 4 8 2 3 4 2 10 13 3 4 - — — — 1 — — — 1 1 2 — 2 — 6 1 9 1 10 Pleurisy - - 2 - 1 — 3 — — — - - - 1 1 2 - 2 6 1 — 1 8 9 20 18 70 79 149 Broncho-pneumonia 26 35 15 14 9 12 50 61 5 2 - 2 — 2 13 4 4 1 8 9 1 — 7 10 33 28 36 31 67 Pleuro-pneumonia 1 2 — - 2 1 3 3 — — — — — — 3 — — 1 3 2 1 1 2 6 10 12 14 14 28 Other Diseases of Respiratory System 1 2 2 — 1 — 4 2 1 2 5.—Diseases of Digestive System. 2 1 - - 2 1 1 1 - 1 — — 1 — 9 6 9 7 16 Appendicitis - - - - - 1 — 1 3 2 - - - - - - - - - - - - - - - - 5 4 9 Dentition 3 4 2 — — — 5 4 — — — — — — 2 1 — — — — — — — — 2 2 3 4 7 Sore Throat, Quinsy — 1 — — 1 1 1 2 — 1 — — — — 4 1 1 4 1 5 4 — — 4 10 14 _ 15 19 34 Diseases of Stomach 5 5 — — — — 5 5 — — — — — — — 4 — 1 — 2 1 — 2 2 3 9 6 10 16 Enteritis 3 1 — — — — 3 1 — — — — — — 1 1 — — 3 3 — 1 4 13 8 19 13 20 33 Obstructive Diseases of Intestine 4 1 1 — — — 5 1 — 1 — — — — — — — 1 — 3 — 1 — — — 8 2 9 11 Peritonitis 2 — — — — 1 2 1 — 3 - - - - - - - - - - - - - - - - - - - Ascites - - - - - - - - - - - — — — 1 3 1 1 11 5 5 3 8 5 26 17 26 17 43 Cirrhosis of Liver - - - - - - - - - - — — — — — — — — 2 4 — — 4 5 6 9 9 9 18 Jaundice and other Diseases of Liver 2 — — — 1 — 3 — — — - - - - - - - - - - - - - - - - - - - Diseases of the Pancreas 8 — — 1 — 1 — — — 7 1 2 1 2 4 13 6 24 14 38 Other Diseases of Digestive System 9 8 2 — — — 11 — - 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) 3 1 — 1 1 — 4 2 2 1 - - - - - - - - - 1 - - - - 4 2 8 4 12 7.—Diseases of Gland-like Organs of Uncertain Use. — — 1 — 1 2 — — — 2 — — — — 2 4 2 4 6 (e.g., Bronchocele, Addison's Disease) - - - - - - - - - - 8.—Diseases of Urinary System. - - - 2 2 - - 2 - 1 - — 2 3 5 8 6 9 15 Nephritis — — - - 1 1 1 1 — — — — — 4 5 6 5 26 20 12 7 24 21 72 58 72 58 130 Bright's Disease, Albuminuria - - - - - - - - - - - - - - - - 1 — 2 1 6 — 12 2 21 3 21 3 24 Disease of Bladder or of Prostate - - - - - - - - - - - — — — — — — — — — 1 1 — — 1 1 - 1 2 Calculus (Stone) - - - - - - - - - - - - - - 1 - - - 1 - - - 1 1 3 1 3 1 4 Other Diseases of the Urinary System - - - - - - - - - - 32 33 BOROUGH OF LAMBETH.—Deaths Registered ' from all Causes during the Year 1914. Note. The Deaths of Non-Residents occurring in Public Institu- tions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. AGES. AGES. Total. Under 1 Year. 1-2 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. 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. 9.—Diseases of Reproductive System. a. Of Organs of Generation. Male Organs . - - - - - - - - - - - - - - - - - - - - - - - - - - - - Female Organs - - - - - - - - - - - - - 1 - 1 - 1 - 2 - - - 2 - 7 - 7 7 b. Of Parturition. Abortion, Miscarriage - - - - - - - - - - - - - - - 2 - - - 1 - - - - - 3 — 3 3 Puerperal Convulsions - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - 1 1 Placenta praevia, Flooding - - - - - - - - - - - - - - 6 - - - 1 - - - - - 9 - 9 9 Other Accidents of Child Birth — — — — — — — — — - - 1 - 1 - - - - - - - - - - - - - - - 10.—Diseases of Bones and Joints. Caries, Necrosis - - - - - - - - - - — 1 — - — 1 — — — 1 1 — 1 4 1 3 1 3 4 Arthritis, Ostitis, Periostitis — — — — — — — — — - - - - - - - - - - - - - - - - - - - - Other Diseases of Bones and Joints - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11.—Diseases of Integumentary System. Carbuncle, Phlegmon 1 — — — — — 1 — — — — — 1 — — 1 2 — 2 1 — — 2 1 7 3 8 3 11 Other Diseases of Integumentary System — 1 - - - - - 1 - - - - - - - - - - - - - - 1 - 1 - 1 1 2 VII.—Deaths from Violence. 1.—Accident or Negligence. - - - 1 2 2 2 3 6 - 1 - 2 1 8 3 2 2 5 2 4 2 4 11 32 21 34 24 58 Gunshot Wounds - - - — — — — — — - - - - - - - - - - - - - - - - - - - - Cut, Stab - - - -- - - - - - - - - - - - - - - - - - - 1 - 1 4 2 8 10 Burn, Scald — — 1 2 2 1 4 - 2 - - 1 3 1 1 - 2 - 1 1 - - 8 2 8 2 10 Poison - - - - - - - - 2 - 1 - - - - - - 1 3 - - - - 1 - 7 1 7 1 8 Drowning - - - - - - - - - - - - - - - - - - - - - - - - - - 4 7 11 Suffocation 4 7 - - - - - - - 1 - - 1 - 10 1 2 1 3 2 2 - 3 4 24 9 30 13 43 Otherwise 4 4 1 - 1 - 6 4 3 1 2.—Homicide. Manslaughter - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 Murder — 1 — — — — — 1 - - - - - - - - - - - - - - - - - - - - - 3.—Suicide. Gunshot Wounds — — — — — — — — — — — — — 1 — — 1 — 1 — 1 — 2 — 2 — 2 Cut, Stab — — — — — - - - - - 1 - 1 - - - - 1 2 2 - 1 5 3 5 3 8 Poison - - - - - - - - - — - - 1 - 2 - 1 - 1 - - - - - 5 - 5 — 5 Drowning - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - 1 - 1 Hanging - - - - - - - - - - - - - - - 1 - - - - - 1 1 - 1 2 1 2 3 Otherwise — 4.—Execution. Hanging VIII.—Deaths from Ill-defined and not Specified Causes. Dropsy ... — 1 1 48 37 85 Debility, Atrophy, Inanition 4b 3o 1 — " 47 3G 1 i 1 2 Mortification — — — — — — — — — 1 Tumour... 1 ?, 3 Abscess 1 Haemorrhage ... Sudden Death (cause not ascertained) 2 2 3 5 Causes not specified, or Ill-defined ... '2 1 3 2 34 SUMMARY OF TABLE. No. of Deaths. Total. No. of Deaths. Total. M. F. M. F. I.—Specific Febrile or ZymoticDiseases. Brought forward 1853 1915 3768 1. Miasmatic Diseases 112 104 216 2. Diarrhœal „ 107 89 196 VI.—Local Diseases—continued. 3. Malarial „ — — — 6. Diseases of Lymphatic System 8 4 12 4. Zoogenous „ — — — 7. Diseases of Gland-like Organs of 5 Venereal „ 23 3 26 Uncertain Use 2 4 6 6. Septic „ 16 19 35 8. Diseases of Urinary System 103 72 175 9. Diseases of Reproductive System II.—Parasitic Diseases — — — (a) Diseases of Organs of Generation - 7 7 III.—Dietetic Diseases 12 13 25 (b) Diseases of Parturition - 14 14 10. Diseases of Bones and Joints 4 7 11 IV.—Constitutional Diseases 487 472 959 11. Diseases of Integumentary System 9 4 13 V.—Developmental Diseases 178 200 378 VII.—Violence. VI.—Local Diseases. 1. Accident or Negligence 86 55 141 1. Diseases of Nervous System 172 156 328 2. Homicide — 1 1 2. Diseases of Organs of Special Sense 2 4 6 3. Suicide 20 5 25 4. Execution - -- - 3. Diseases of Circulatory System 264 347 611 4. Diseases of Respiratory System 368 395 763 VIII.—Ill-defined and not Specified Causes 44 96 5. Diseases of Digestive System 112 113 225 52 Carried forward 1853 1915 3768 Total 2137 2132 4269 Metropolitan Borough of Lambeth. Lambeth Municipal Tuberculosis Dispensaries Scheme. REPORT For the Year ending December 31st, 1914, of Work carried out at the two Tuberculosis Dispensaries. by S. NICOL GALBRAITH, M.B., D.P.H., Tuberculosis Medical Officer, Central Dispensary, and R. C. WINGFIELD, B.A., M.D., M.R.C.P.(Lond.), Tuberculosis Medical Officer, Branch Dispensary. N.B.—The Report is in the form of tables (i. to viii.), as used in the first issued report for 1913, together with two extra additional tables (ix. and x.). 36 37 LAMBETH TUBERCULOSIS DISPENSARIES SCHEME. REPORT, 1914. Tables 1. to x. Central Dispensary. Branch Dispensary. Combined Totals Insured. Not Insured. Insured. Not Insured. Males. Females. Males. Females. Total. Males. Females. Males. Females. Total. TABLE 1. 1.—Total Attendances. (a) New Patients 249 164 239 470 1122 139 51 36 128 354 1476 (b) Old Patients 1451 1364 906 2332 6053 1304 767 497 1804 4372 10425 Totals 1700 1528 1145 2802 7175 1443 818 533 1932 4726 11901 II.—Particulars of New Patients. A.—Age Periods and Sex— (1) Under 15 — — 173 217 390 — — 20 37 57 447 ('2) 15 and over 249 164 66 253 732 139 51 16 91 297 1029 (a) 15—25 81 80 18 43 222 42 25 3 22 92 314 (b) 25—35 71 45 12 83 211 45 14 5 30 94 305 (c) 35—45 66 28 15 71 180 29 7 5 30 71 251 (d) 45—55 26 9 9 36 80 17 5 3 5 30 110 (e) 55—65 4 2 8 11 25 6 — — 1 7 32 (f) 65 and over 1 — 4 9 14 — — — 3 3 17 B—Lengths of Attendances — (1) One month and over 81 48 40 110 279 83 33 23 78 217 496 (2) Under one month* 168 116 199 360 843 56 18 13 50 137 980 TABLE II. C—Sources of Cases— (1) Medical men 137 77 30 56 300 57 16 2 8 83 383 (2) Charitable Societies — — 6 10 16 1 2 2 8 13 29 (3) Out Patients' Department (St Thomas's Hospital! - - 2 - 2 15 8 9 29 61 63 (4) Others (e.g., Public Health Departments, Patients, etc.) 75 48 88 207 418 21 10 6 26 63 481 (5) " Contacts " 37 39 113 197 386 45 15 17 57 134 520 TABLE III. D—Results of diagnosis— 1. Ordinary Patients — (a) Tuberculosis 139 70 42 109 360 60 22 16 43 141 501 (b) Suspected Tuberculosis 73 55 84 164 376 34 14 3 28 79 455 2. "Contacts"— (a) Tuberculosis 7 8 7 17 39 3 1 1 6 11 50 (b) Suspected Tuberculosis 30 31 106 180 347 42 14 16 51 123 470 3. Tuberculin— Diagnostic ... — - 101 110 211 - - - - - - Positive Reaction - - 34 43 77 - - - - - - Negative Reaction - - 67 67 134 - - - - - - *Including cases sent for opinion only, cases unfit or unsuitable to attend, cases classified as suspected tuberculous (including non-tuberculous or doubtful), " contacts," and cases belonging and transferred to other Districts. †Of the 551 cases diagnosed as Tuberculous (Pulmonary 507, non-pulmonary 44), 196. — i.e. 35.56 per cent. gave a family history of Tuberculosis—Central Dispensary 125 out of 399 (pulmonary 371, non-pulmonary 28), Branch Dispensary 71 out of 152 (pulmonary 136, non-pulmonary 16). 38 39 Tables i. to X,—continued. Central Dispensary Branch Dispensary Combined Totals. Insured Not Insured. Total. Insured. Not Insured. Total. Males. Females. Males. Females. J Males. Females. Males. Females. TABLE IV. E—Clinical Classfication of Pulmonary Tuberculous Cases. (a) Inman— Stage I. 1 4 1 4 10 19 2 2 13 36 46 " II 26 13 10 15 64 12 5 2 14 33 97 Ill 115 57 28 97 297 29 13 9 16 67 364 (b) Turban*- Stage I. 66 32 18 61 177 11 9 6 7 33 210 „ II 31 21 7 24 83 - 1 1 2 4 87 Ill 18 4 3 12 37 18 3 2 7 30 67 TABLE V. F—Nature of Treatment— 1. Routine (total cases treated one month and over) including— 81 48 40 110 279 83 33 23 78 217 496 2. Institutional— (a) Sanatoria (including Tuberculosis Hospitals) 40 27 6 11 84 13 2 3 7 25 109 (b) General Hospitals 1 - 3 - 4 - - 1 - 1 5 (c) Poor Law Institutions 6 1 3 2 12 16 2 4 7 29 41 3. Tuberculin— Remedial 9 3 1 7 20 1 — 1 3 5 25 TABLE VI. G—Results of Treatment— 1. Routine (Total cases treated one month and over)— (a) Fit for work 59 40 33 99 231 70 27 16 69 182 413 Fit for work and remaining so 35 26 26 91 178 64 23 15 67 169 347 Not fit for work but becoming fit 24 14 7 8 53 6 4 I 2 13 66 (b) Unfit for work 21 8 7 9 45 12 6 7 9 34 79 Fit for work but not remaining so 1 — — — 1 3 3 2 4 12 13 Not fit for work and remaining so 20 8 7 9 44 9 3 5 5 22 66 (c) Deaths 1 — — 2 3 1 — — — 1 4 2 Institutional (Sanatorium)— 90 (a) Fit for work 31 25 6 10 72 10 1 2 5 18 Fit for work and remaining so 15 13 2 10 40 7 1 3 11 51 Not fit for work but becoming fit 16 12 4 — 32 3 — 2 2 7 39 (b) Unfit for work 8 2 — 1 11 3 1 1 2 7 18 Fit for work but not remaining so - - - - - - - 1 2 3 3 Not fit for work and remaining so 8 2 — 1 11 3 1 — — 4 15 (c) Deaths 1 — — — 1 — — — — — 1 (3) Tuberculin- fa) Fit for work 9 3 1 7 20 1 — 1 3 5 25 Fit for work and remaining so 5 3 1 6 15 1 — 1 2 4 19 Not fit for work and becoming fit 4 — — 1 5 — — — 1 1 (b) Unfit for work — — — — — — — — — — — Fit for work but not remaining so - - - - - - - - - - - Not fit for work and remaining so - - - - - - - - - - - (c) Deaths — — — — — — — — — — — *N.B.—Cases of Stage III. of Inman only. 40 41 Tables i. to X.—continued. Central Dispensary Branch Dispensary Combined Totals Insured Not Insured. Total. Insured. Not Insured. Total. Males. Females. Males. Females. Males Females. Males. Females. TABLE VII. H-—Occupations of Tuberculous Patients— Baker 1 - - - 1 2 — - — 2 3 Bar Attendant 3 2 2 - 7 2 2 -' 2 6 13 Book-binder — — — 1 1 - - - - - 1 Box maker - 1 - - - - - - - - 1 Butcher 1 — - - 1 — — - — — 1 Carman 3 — - - 3 9 — - — 9 12 Carpenter 4 — - - 4 6 — - — 6 10 i Chaffcutter 1 4 - - 4 - 3 - - 3 7 Charwoman — 4 - - 4 - - - - - - Chauffeur 4 — - - 4 — — - - - 4 Clerk 22 4 2 1 29 8 — 1 2 11 40 Conductor 5 — — - 5 1 — - — 1 6 Decorator 7 — — - 7 8 - 2 - 10 17 Draughtsman 2 — 1 - 3 1 - - - 1 4 Dressmaker — 16 — 3 19 — 6 — 4 10 29 Engineer 7 — — — 7 8 — — - 8 15 Fishmonger — — — — — 1 — 1 — 2 2 Gardener 2 * 2 General Dealer - - - 2 2 3 - - - 3 5 Glazier - - 1 - 1 - - - - - 1 Hairdresser 2 - - - 2 - - - - - 2 Harness-maker 2 - - - 2 - - - - - 2 Housework - 5 — 77 82 - 7 - 26 33 115 Insurance Agent 1 — — — 1 — — — - - 1 Labourer 16 - 1 - 17 7 - - - 7 24 Laundry work - 7 - - 7 - 2 - - 2 9 Lavatory Attendant - - - 1 1 - - - - - 1 Musician - - - 1 1 - - 1 1 2 3 News Agent 1 - - - 1 1 - 3 - 4 5 Nurse - 1 - 1 2 - - - 1 1 3 Packer 2 2 - - 4 1 - - - 1 5 Police officer 1 - - - 1 - - - - - 1 Post Office Employees 2 - 2 - 4 - - - - - 4 Potter 1 — - - 1 - - - - - 1 Printer 15 2 1 — 18 2 — — - 2 20 Railway Employees 8 — — — 8 1 —. - - 1 9 School Children — — 23 28 51 — — 6 5 11 62 Servant 4 24 1 1 30 — 2 - - 2 32 Shoemaker 1 — 2 — 3 — — 1 - 1 4 Shop Assistant 11 3 1 - 15 1 1 - - 2 17 Tailor 1 1 — — 2 — - — — - 2 Teacher - — — 1 1 - - - - - 1 Theatre Attendant 3 1 — - 4 - - - - - 4 Traveller — — 3 — 5 - - - - - 5 Typist — 1 — — 1 — - - - - 1 Waiter or Waitress 2 3 - - 5 - - - 1 1 6 Warehouseman 9 1 - — 10 1 — — 1 11 No Occupation - - 9 9 18 - - 2 7 9 27 Totals 146 78 49 126 399 63 23 17 49 152 551 42 Tables i. to X.—continued. Central Dispensary. Branch Dispensary. Combined Totals. Dispensary Patients. Others. Total. Dispensary Patients. Others. Total. TABLE VIII. Ill—Visits paid to homes of Patients by Tuberculosis Officers. * (a) Medical Officer * 242 — 242 — — — 242 (b) Nurses or Visitors* 1,155 48 1,203 236 - 218 1,439 * N.B.—The Tuberculosis Medical Officer, attached to the Branch Dispensary, St. Thomas's Hospital, does not visit at patients' Homes. The Lady Almoner (connected with the Hospital) through her Staff visits the homes of patients attending the Hospital Branch Dispensary, reporting direct to the Medical Officer of Health on the official report cards. 43 Tables i. to X.—continued. Central Dispensary Branch Dispensary Combined Totals Insured Not Insured. Insured. Not Insured. Males. Females. Males. Females. Total. Males. Females. Males. Females. Total. TABLE IX. Total Number of Patients Treated during 1913 and 1914 56 44 42 80 222 75 42 26 113 256 478 Results of Treatment— (a) Fit for work 40 41 40 74 195 61 39 18 100 218 413 Fit for work and remaining so 24 22 33 62 141 60 36 18 100 214 355 Not fit for work but becoming fit 16 19 7 12 54 1 3 - - 4 58 (b) Unfit for work 14 3 2 5 24 11 3 7 10 31 55 Fit for work and not remaining so 7 1 - - 8 5 - 1 7 13 21 Not fit for work and remaining so 7 2 2 5 16 6 3 6 3 18 34 (c) Deaths 2 — — 1 3 3 — 1 3 7 10 2. Institutional (Sanatorium) 21 25 8 14 68 9 5 1 6 21 89 (a) Fit for work 17 25 8 14 64 7 5 1 5 18 82 J Fit for work and remaining so 8 11 5 8 32 6 5 1 5 17 49 Not fit for work but becoming fit 9 14 3 6 32 1 — — — 1 33 44 Tables i to X.—continued. Central Dispensary Branch Dispensary Combined Totals. Insured Not Insured. Insured. Not Insured. Males. Females. Males. Females. Total. Males. Females. Males. Females. Total. (b) Unfit for work 4 - - - 4 1 - - 1 2 6 Fit for work and not remaining so 3 — - — 3 1 - — — 1 4 Not fit for work and remaining so 1 — - — 1 — - — 1 1 2 (c) Deaths - - - - - 1 - - - 1 1 3. Tuberculin (Remedial) 18 10 4 14 46 10 2 3 9 24 70 (a) Fit for work 12 7 4 9 32 9 2 2 6 19 51 Fit for work and remaining so 5 5 3 8 21 9 1 2 6 18 39 Not fit for work but becoming fit 7 2 1 1 11 — 1 — — 1 12 (b) Unfit for work 1 1 — 2 4 — — 1 2 3 7 Fit for work and not remaining so — — — 1 1 — — — 2 2 3 Not fit for work and remaining so 1 1 — 1 3 — — 1 — 1 4 (c) Deaths — — — — — 1 — — 1 2 2 Total Cases found to be unsuitable lor Tuberculin 5 2 — 3 10 - - - - - 10 Cases sent to Poor Law Institutions 4 — — 1 5 2 — 1 3 6 11 Patients who were reported upon in 1913, and who have also attended during 1914 for treatment at the Dispensaries. 45 Tables i. to X.—continued. TABLE X. Shewing comparisons between Inman's Classification in 1913 and 1914. Central. Branch. 1913 1914 1913 1914 Inman Stage I. 3 8 8 15 " 11 30 31 27 8 " III 97 91 135 147 INDEX. (ii.) GENERAL INDEX. page Abatement of Nuisances 84 „ „ Smoke 106 Adulteration of Food and Drugs 107 Analysis of Food and Drugs 107 „ Water 111 Anthrax 64 Antitoxin, Distribution of 136 Area, Lambeth 83 Bacteriological Laboratory 134 Bakehouses 126 Bedding, etc., Disinfected 102 „ Destroyed 103 Births and Birth Rates 9 Births Notification Act 10 Bodies received at Mortuaries 137 By-laws, Contravention of 88 „ Houses Let in Lodgings 116 Censal Population (Lambeth) 80—81 Cerebro-Spinal Fever .. 50, Appendix 8—9 Certificates (Notification) received 34—35, 38—39, 41, 80—81 Appendix 3 Certificates (Revenue Act) 117 „ (Disinfection) 103 Children. Cleansing of 105 ,. Country Holidays 72' Cholera 55 Circulatory Diseases, Deaths of 73 Clerica) Staff 139 ,. Work 139 Closing Orders 121 Chicken-pox 50 Child Welfare 32 Common Lodging Houses 116 Complaints 88 Conscientious Objectors 47 Congenital Malformations 72 Constitutional Diseases 72 Consumption. (See Tuberculosis. Contacts (Suspects) 47, 55—56 Contagious Ophthalmia (Newly-born Infants) 64 Contravention of By-laws 88 Continued Fever ^0 Conveniences (Underground) 107 Coroners Courts 136 Country Holidays (Children) 72 Cowhouses 128 Critical Temperature (Earth) and Diarrhœa 61 Croup. (See Membranous Croup). (iii.) page Dairies. (See Milkshops.) Deaths and Death-rateb 15, Appendix—2 „ Inner and Outer Wards 18, 20—21 „ Corrected 15, 18—19,20—21 „ Uncorrected 22—24 „ In Outlying Institutions 16 , Zymotic 34, 40, 43 ,. Under I Year 30 Appendix 6—7 Depot (Milk) 123 Depots (Refuse and Manure) 133 Develonmental Diseases 72 Diagnosis (Bacteriological) 131 Diarrhoea 61 Dietetic Diseases 72 Diphtheria 56 Disinfection Certificates 103 Disinfecting Department 101 ,. „ Refuge 103 Dispensaries (Tuberculosis) Appendix 35—45 Drains and Infected Houses 35—37 Drainage Cases 88 Drain Testing 35—37 Drainage Legal Proceedings 89 Drugs 110 Dust Depots 133 Earth Temperatures and Diarrhœa 61 Effluvium Nuisances 133 Enteric Fever. (See Typhoid ) Enumerated Populations 80—81 Estimated Populations 4 Enteritis 63.73 Epidemic Cerebro-Spinal Meningitis (see Cerebrospinal Fever) Epidemic Influenza 64 Epidemic Summer Diarrhoea 61 Erysipelas 61 Exclusion of Children (Measles) 53 „ „ (Whooping Cough) 54 Expenses (Food and Drugs) Ill Factories 95 Female Sanitary Inspectors 92 Female Health Visitor 101 Food and Drugs, Adulteration of 107 ,, „ Expenses Ill „ ,, Legal Proceedings (Summary) Ill Food, Unsound 89 Glanders 64 Health Visitor 101 Home Office Tables (Factory and Workshops) Appendix 10—14 House to House Inspections 89, 118 Houses Let in Lodgings 116 „ „ ,, By-laws for 116 Housing of rhe Working Classes 118 Housing, Town Planning, etc., Act 118—122 Inspections of District 118 Representations and Closing Orders 121 G (iv.) PAGE Ill-defined causes (deaths from) 73 Incidence (Zymotic) 21, 38—39 Infantile Mortality 30, Appendix 6—7 Infected Houses and Drains 35—37 Infectious Diseases (rases removed) 35,80—81 „ (notifiable) 34—35, 38—39, 41, 80—81 Appendix 3 „ „ (non-notifiab'e) 42 Influenza (Epidemic) "4 Inquests 138 Inspections 88. Appendix 10 ,, House to House 89,118 Market Thoroughfares 89 Inspectors, Females 92 „ Males 88 „ Health Visitor 101 Introductory Letter 3 Laboratory (Bacteriological) 134 Lavatories (Underground) 107 Legal Proceedings 89, 111 Letter (Introductory) 3 Letters (sent and received) 139 Local Diseases—Nervous System, Heart, Respiratory Organs, Digestive and Urinary Systems and Reproductive System, etc. 73 Loral Government Board, Old Tables A and B 76—81 „ „ ,, New Tables i.. ii., iii., iv., v. Appendix 2—9 Lodging-houses''Common) 116 London County Council Table Appendix 15—17 Male Sanitary Inspertors 88 Manure Depots 133 Margarine Manufacturers (Registration) Ill Market Thoroughfares (inspection) 89 Maternity and Child Welfare 32 Measles 52 „ and Schools 53 Membranous Croup 58 Meningitis (Epidemic Cerebro Spinal) 50, Appendix 8—9 Milk and Cream Regulations 112 Milk Depot (Municipal) 123 Milk Stores (See Milk Shops.) MilkShops 126 Mortality (Infantile) 30, Appendix 6—7 Tables Appendix 2—7 „ Tables. Sub-Districts Appendix 18—25 „ Tables. Age Periods Appendix 26—34 Mortuaries 136 Natural Causes, Deaths from 138 Neonatorum, Ophthalmia 64 Notices Served 84 Non-notifiable Infectious Diseases Non-specified Causes (Deaths from) 73 Notification Certificates received 34—35. 38—39, 41, 80—81, Appendix 3 , of Births Act 10 „ of Whooping Cough 54 Nuisances, Abatement of 84 ,. Effluvium 133 (v.) page Offensive Trades 132 Ophthalmia Neonatorum (Contagious) 64 Orders (Closing) 121 Outlying Institutes (Deaths in) 16—17 Outside Urinals (Public Houses) 89 Outworkers 100 Parasitic diseases 72 Parliamentary Divisions (Populations) 5 Persons per Acre 83 Persons (Protected) in Workshops 96 Persons, Verminous 105 Phthisis. (See Tuberculosis) Plague 55 Populations, estimated (Lambeth) 4—5 Post Mortems 137 Premises Disinfected 102 Protected Persons (Workshops) 96 Polio-encephalitis Acuta 50. Appendix 8—9 Polio-myelitis Acuta 50, Appendix 8—9 Public Health Acts (Milk and Cream Regulations) 112 „ „ (Tuberculosis) Regulations, 1912 68—71 Public Houses, Outside Urinals of 89 Puerperal Fever 60 Quarterly Returns (Lambeth)— Births 6 Deaths (Zymotic and General) 22, 24, 40, 41. 46 Health Visitor 101 Notifiable Infectious Diseases 41 Non-Notifiable Infectious Diseases 4? Disinfection Certificates 103 Rag Flock Act, 1911 91 Rateable Value (Lambeth Borough) 83 Refuge (Infectious Diseases) 103 Refuse Depots 133 Registration of Deaths (changes) 25 Margarine Manufactories Ill Regulations Milk and Cream 112 Removal of Infectious Diseases cases 35 80—SI Re-inspections 87 Relapsing Fever 60 Reproductive System, Diseases of 73 Revenue Act (1903), Certificates 117 Samples, Food and Drugs 107 Sanitary Inspectors 88—95 „ „ Males 88 „ „• Females 92 „ Work 84,86 „ „ Structural 85 „ „ Non-Structural 86 Scarlet Fever 50 School Attendance and Measles 53 Simple or Continued Fever 60 Slaughterhouses 130 Smailpox 46 Smoke, Abatement of 106 (vi.) page Spotted Fever (See Cerebro-Spinal Fever) Staffs— Clerical 139 Inspectorial (Male) 88 (Female) 92 Health Visitor 101 Disinfecting 101 Mortuary Attendants 136 Underground Conveniences 107 Staff (Sanitary) and the War 91 Suffocation in Bed 73,75 S'licide and Homicide, Deaths from 73,138 Summary of Vital Statistics 83 „ Work of Sanitary Staff (Male) 87 (Female) 92—94 „ Legal Proceedings (Food and Drugs) Ill Suspects (Contacts) 47,55—56 Syphilis 72 Tables (Special- London County Council Appendix 15—17 Home Office (Factory and Workshop:) Appendix 10—14 Local Government Board (old) A and B 76—81 ., (new) i., ii., iii., iv., v. Appendix 2—9 Mortality (Lambeth)— Registration Sub-Districts Appendix 18—25 Age periods Appendix 26—34 Temperature (Earth) and Diarrhoea 61 Testing of Drains 35—37 Town Planning Act (See Housing, Town Planning, etc.. Act). Trades (Offensive) 132 Tubercular Meningitis, Deaths from 65 Tuberculosis 65 „ Dispensaries Appendix 35—45 „ Lambeth Municipal Tuberculosis Dispensaries Scheme :.. Appendix 35—45 „ Notifications and Re-Notifications 68—71 „ Regulations 1912 68 -71 Typhoid Fever 58 Typhus ••• 6b Underground Bakehouses 126 ,, Conveniences 107 Unsound Food 89 Urinals (Public Houses) .*.. 89 Urinary Diseases. Deaths from 73 • Vaccination Value, Rateable (Lambeth) 83 Varicella. 'See Chicken-pox.) Verminous Persons (Cleansing of) 105 Violence, Deaths, from 73 Visitor, Health 101 Vital Statistics (Summary) 83 Voluntary Notifications .. 42 vii. page War and Sanitary Staff 91 Water Analysis „ Certificates 8® Whooping Cough ®2 „ Notification of 54 Work (Male Inspectors) 88 „ (Female Inspectors) _ 92 „ (Health Visitor) 101 (Tuberculosis Officers) Appendix 35—45 Working Classes (Housing) 1'8 Workplaces. (See Workshops.) Workshops 95 Zymotic Diseases £4 „ Incidence 21,38 39