REPORT on the Vital and Sanitary Statistics of the BOROUGH OF LAMBETH During the Year 1917. [Including an account (1) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, (b) at the Municipal Milk Depot and Infants Consultations Centre under the Lambeth Maternity and Child Welfare Scheme, (c) at the Municipal Bacteriological Laboratory and (d) by the Male and Female Sanitary Inspectors and Health Visitors and the Disinfecting Staff, and (2) of the proceedings taken under the Sale of Food and Drugs, the Factory and Workshop, and the Housing and other Special, Acts.] BY JOSEPH PRIESTLEY, b.a., m.d., d.p.h., Medical Officer of Health and Chief Executive Tuberculosis Officer, Metropolitan Borough of Lambeth. Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. 2. May, 1918. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor and Gentlemen, The work of the year 1917 has been that of " carrying on," ensuring, on the one hand, as far as possible, the same high standard of sanitary administration being maintained throughout the Borough, but, on the other hand, avoiding the introduction of any new Schemes which would involve the Council in any serious increase of expenditure at the present time, under existing national (war) conditions. The statistical results for the year 1917, as set out in the Report, speak for themselves, the slight increases in the general and zymotic death-rates being more apparent than real, due to the estimated civil population being somewhat low. The infantile mortality rate is again further reduced for 1917. The tuberculosis death—and incidence—rates for 1917 deserve attention, the slight increases being, as in the cases of the general and zymotic rates, apparent rather than real, whilst the increase in the general tuberculosis (all forms) incidence rate is due to a larger number of patients being diagnosed as tubercular adenitis than formerly, chiefly noticeable in connection with the Outer Wards of the Borough. The typhoid fever (enteric fever), 1917, statistics, are as favourable as those for last year (1916), and better than those of any year previous to 1916-1917. The Staffs of the Department have worked well, both the inspectorial and clerical, the former with its additional work connected with Food Control, and the latter despite its temporary (in part) officers, who are taking the places of regular clerks who left the employ of the Council temporarily on war work. To the Staffs, and to the Chiefs of the Departments, as also to the Members of the Council, my thanks are due for assistance readily given at all times in connection with the carrying out of my important duties as Medical Officer of Health of the Borough. The Report has been further curtailed and condensed owing to the increased cost of production and the great scarcity of paper. I am, Mr. Mayor and Gentlemen, Your obedient Servant, Medical Officer of Health and Chief Executive Tuberculosis Officer. INDEX. PAGE Vital Statistics 4—55 Estimated populations 4— 5 Births and Birth-rates 6— 8 Notification of Births Act 9—10 Lambeth Maternity and Child Welfare Scheme 10—11 Municipal Milk Depot and Infants Consultations Centre 11 —12 Deaths and Death-rates (General, Infantile and Zymotic) 12—24 Infectious Diseases 25—38 (a) Notifiable 25—37 (b) Non-Notifiable 38 (c) Tuberculosis 30—35 Lambeth Tuberculosis Dispensaries Scheme 34—35 (d) Polio-myelitis and Cerebro-spinal Fever 36—37 (e) " Contacts " and " Suspects " 38 Municipal Bacteriological Laboratory 39 Local Government Board, Old Table A. 40—43 Local Government Board, Old Table B. 44—45 Local Government Board New Tables I., II., III., and IV. 46—51 Mortality Tables (corrected deaths) 52—53 (а) Registration Sub-Districts 52—53 (б) Age-Periods 52—53 (c) Summary 54 Summary of Vital and Mortal Statistics 55 Sanitary Work 56—68 Notices Served 56—57 (а) Infectious Diseases 56 (б) General Nuisances and Drainage Defects 56—57 Male Sanitary Inspectors 58—60 Registration of Cowhouses, Slaughterhouses, Common Lodging Houses and Milk Shops 59 Female Sanitary Inspectors and Health Visitors 61—62 Factories and Workshops and Out-workers 62—64 Disinfecting Department 65 Analysis of Food and Drugs and Water 66—68 Mortuaries and Coroners' Courts 68 4 1. VITAL STATISTICS. The Estimated. Civil Populations* of the Borough are as follows :— Estimated Civil Populations, 1917. I. Wards. Wards. Males. Females. Total. Marsh S092 9979 19071 Bishop's 12750 15586 28336 Prince's 16955 21106 38081 Vauxhall 12609 15125 27734 Stockwell 12301 16957 29258 Brixton 16958 23639 40597 Heme Hill 12881 17574 30455 Tulse Hill 11922 16789 28711 Norwood 11989 17826 29815 Borough of Lambeth 117457 154581 272038 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. Lambeth Church 19403 22590 41993 Kennington 19394 24081 43475 Stockwell 24910 32082 56992 Brixton 29839 41213 71052 Norwood 23911 34615 58526 Borough of Lambeth 117457 154581 272038 *N.B.—The estimates of populations for 1917 are estimates of civilian populations only. These estimates are based upon the estimate for the whole Country (England and Wales) and on the number of persons in the Borough of Lambeth according to the Census 1911 and the National Register in 1916, and on the number of persons registered under the Scheme for the rationins of Sugar. 5 III. Parliamentary Divisions (Old). Uid Parliamentary Divisions. Males. Females. Total. North 21532 25278 46810 Kennington 29228 35799 65027 Brixton 29381 40459 69840 Norwood 36093 51343 87436 Parliamentary Area of Lambeth 116234 152879 269113 N.B.—The Parliamentary Divisions have not been altered by the London Government Act, 1899, nor by the proceedings that fixed the Boundaries of the Metropolitan Borough, so that the above figures do not agree with those for the borough as a whole, but are comparable with those of the old Parish of Lambeth given in previous Reports. IV. Parliamentary Divisions (Adjusted). * Adjusted Parliamentary Divisions. New Wards. Total. North Marsh Bishop's 47407 Kennington Prince's Vauxhall 65795 Brixton Stockwell Brixton Heme Hill 69855 Norwood Tulse Hill Norwood 88981 * Adjusted Parliamentary Area of Lambeth — 272038 *N.B.—By the adjustment of the old Parliamentary Divisions so as to be co-terminous with the Wards. 6 TABLE A. Giving number of Births and Birth-Rates in each Registration Sub-District of the Borough of Lambeth during 1917 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1917. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church* 527 530 501 469 2027 Kennington† 226 262 204 201 893 Stockwell § 507 495 460 426 1888 Brixton 345 300 275 258 1178 Norwood 242 246 209 186 883 Borough of Lambeth 1847 1833 1649 1540 6869 *Including Lying-in Hospital (797 cases, of which 179 belong to Lambeth). † Including Workhouse (192 cases, of which 126 belong to Lambeth). §Including Maternity Hospital (890 cases, of which 203 belong to Lambeth). N.B.—The births are those of infants of (a) civilians and (b) non-civilians, and the population is that estimated by the Registrar-General for the Borough of Lambeth for the year 1917 for the purpose of calculating birth-rates, viz., 303,245, giving an uncorrected birth-rate of 22-6, and a corrected birth-rate (i.e.,after deducting 1,372 non-Lambethian Institutional births) of 18.1 per 1,000 population. table B Showing Populations (Estimated), Uncorrected Births, Corrected Deaths at all ages, under 1 year, under 5 years, and from the 7 chief Zymotic diseases and Uncorrected Deaths in Public Institutions, in the Borough of Lambeth during 1917, and for the years 1911-1916, 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. 1917 272038 6869 4168 516 873 295 3106 1916 283729 7980 4212 565 854 248 3078 1915 284188 7878 4653 683 1047 335 2550 1914 297094 8188 4269 728 1020 375 2204 1913 297139 8341 4280 733 1094 369 2015 1912 297550 8168 3925 598 917 287 1872 1911 297957 8405 4380 899 1336 569 1862 Averages— 1901-10 (Borough) 314566.8 8846.9 4709.6 1020.1 1503.5 475.1 1816.8 1891-1900 (Parish) 294049.7 9295.4 5405.3 1358.5 2070.2 700.4 1568.5 Note.—(a) Enumerated Population at Census 1901 was 301,895. (b) Enumerated Population at Census 1911 was 298,058 (c) Families or separate occupiers = 70,887 (1901) and 70,827 (1911). N.B.—The estimated populations for 1915 and 1916 are the estimates of civil populations only, based upon the estimate for the whole country (England and Wales), and on the numbers of persons in the Borough of Lambeth according to the Census, 1911, and the National Register in 1915 and 1916 respectively ; whilst the estimated population of 1917 is also theestimate of civil population only, based upon the estimate for the whole country (England and Wales), and on the numbers of persons in the Borough of Lambeth according to the Census, 1911, and the National Register in 1917, and on the number of persons registered under the Scheme for the rationing of Sugar. 8 TABLE c. Showing the Birth Rate (uncorrected) per 1,000 population the General and Zymotic Death Rates (corrected) per 1.000 population, the Infantile Mortality Rates (corrected) per 1,000 total Births and per 1,000 total corrected Deaths, the Death Rate (corrected) for children under 5 years of age per 1,000 total corrected Deaths and the proportion of Deaths uncorrected in Public Institutions per 1,000 total uncorrected Deaths, in the Borough of Lambeth for the Year 1917 and for the Years 1911-1916, together with the averages for the two decennia 1891-1900 (Parish) and 1901-10 (Borough). The'Year. Birth-Rate per 1,000 Population. (uncorrected). Death-Rate per 1,000 Population (corrected.) Corrected Deaths of Children under 1 Year per 1,000 total Births. Deaths of Children under 1 year per 1,000 Deaths (corrected) Deaths of Children under 5 years per 1,000 Deaths (corrected). Zymotic DeathRate per 1,000 Population. (corrected.) Deaths in Public Institutions per 1,000 total Deaths (uncorrected.) 1917 22.6* 15.3 75.1 123.8 209.4 1.1 577.9 1916 25.8* 14.8 70.8 134.1 202.8 0.9 558.1 1915 27.7 16.4 86.7 146.8 225.0 1.2 479.1 1914 27.6 14.4 88.9 170.5 238.9 1.3 475.6 1913 28.1 14.4 87.9 171 3 255.6 1.2 450.2 1912 27.4 13.2 73.2 152.3 233.6 0.9 446.9 1911 28.2 14.7 106.9 205.2 305.0 1.9 406.2 Averages— 1901-10 (Borough) 28.1 14.9 115.3 216.7 319.4 1.5 386.0 1891-1900 (Parish) 31 6 18.4 146.1 251.3 382.9 2.4 276.7 * N.B.—The birth-rate is calculated upon the special Borough populations estimated respectively for that purpose by the Registrar-General for the year 1916, and 1917, viz., 308,702, and 303,245, estimates of the total population based on the assumption that the ratio between the total and the civilian population is the same in the Borough of Lambeth as in England and Wales as a whole, the total population of England and Wales for this purpose having been calculated by adding to the published estimate for 1914 the natural increases up to the middle of the years 1916 and 1917. 9 BIRTHS, 1917. The total number of Births registered is 6,869, of which full details are set out in Table A. The birth-rate for Lambeth (Parish and Borough) has been recently slowly, but steadily, declining—a decline not peculiar to Lambeth, nor even to England, but to be found in nearly all -civilised countries. Notification of Births Act. The Notification of Births Act, 1907, was adopted throughout the Borough, and came into operation on March 9th, 1908. Since the Act came into force, a total of 64,999 births have been notified up to the end of 1917, viz. : 3,473 in 1908 (10 months), 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, 7336 in 1912, 7,158 in 1913, 7,397'in 1914, 7,091 in 1915, 7,293 in 1916, and 6311 in 1917. The notified cases are visited, or such other measures taken in connection therewith, in the way of distributing pamphlets, etc., as are found necessary. In the cases of notified infants who are visited, the methods of feeding are carefully inquired into and instruction given as required, breast-feeding being encouraged wherever possible ; whilst the proper clothing and management of infants are also dealt with. Revisiting is carried out as far as is practicable with the staff at disposal. It is impossible to give satisfactory statistics of the educational value of the visiting of houses wherein births have been notified, but there is no doubt as to the existence of such value—a result that would, naturally, be increased by systematic re-visiting in addition to the first visiting. Returns of all Births (with addresses of mothers), registered in Lambeth, are obtained from the District Registrars week by week. A list of all notified births is sent to the London Countv Council weeklv 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 babie; born in Lambeth Public Institutions but belonging to Districts outside the Borough—similar information being obtained with regard to Lambethian babies born in institutions outside the Borough. 10 The Registrar-General provides particulars of transferable births registered, and for 1917 his figures for the Borough of Lambeth are as follows :— Inward Transfers. Outward Transfers. Legitimate Males 28 688 Legitimate Females 28 679 Illegitimate Males 14 170 Illegitimate Females 20 214 Totals 90 1751 The Registrar-General's corrected number of births is 5,232, differing slightly from the corrected number of births calculated locally and found in this Report, viz., 5,497. Lambeth Maternity and Child Welfare Scheme.* During 1917, the Lambeth Maternity and Child Welfare Scheme has continued to justify its inauguration on April 13th, 1916, the various voluntary centres carrying out useful work in the various areas allotted to them, such work being amalgamated and co-ordinated with the Council's Official Centre and Public Health Department. During 1917, a new voluntary centre was approved and opened in the Vauxhall Ward, known as the Springfield Maternity and Child Welfare Centre, whilst the Creche (or Day Nursery) at 5, Railton Road, has been removed to larger and more suitable premises at 71, Effra Road, Brixton, S.W., where it is anticipated the work will be capable of considerable extension, and, consequently, be of greater corresponding value. National Baby Week was celebrated within the Borough of Lambeth during 1917 (from July 1st to July 8th), by the formation of a Permanent Committee for the Borough, to be known as the Lambeth Maternity and Child Welfare Committee, such Committee to consist of representatives to be appointed by all the Voluntary Centres working within the Borough (one representative for each voluntary centre), the Mayor, for the time being, acting as Chairman. Arrangements were also made for the Voluntary Lambeth Centres to throw open to the public for inspection during the National Baby Week their premises, the Borough Council also arranging for the Municipal Milk Depot and the Infants Consultations Centre to be open also in the same way. These decisions were arrived at at a Conference which was called together by the Mayor for the purpose of ascertaining the views of the various Executive Committees of the * In connection with the Scheme, the Council approved, during 1917, of the principle of making financial grants out of the Rates to the Voluntary Centres under certain conditions—a sum of £400 being voted for the year 1917-1918, half of this grant to be refunded by the Local Government Board. 11 Voluntary Centres as to the nature of any celebration that was to be arranged in connection with the Borough during the National Baby Week, the Conference being practically unanimous in deciding against any official part being taken by Lambeth in connection with a public pageant, or procession, it being felt that such display would not benefit the cause of maternity and child welfare in the way desiied. Municipal Milk Depot. (Inaugurated by the Council, 1903.) Record of Work carried out during 1917. 198 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk :— Under 3 months 92 9—12 months 22 3—6 months 51 Over 12 months and 7 6—9 months 26 under 2 years 198 Of the 92 infants under 3 months, 12 were aged 14 days or under. These 198 infants and children (under 2 years) may be classified, as to their states of health at the time of being put upon the milk, as follows:—Healthy, i.e., showing no sign of wasting or disease, though generally below par constitutionally 120, weakly 9, wasting 53, diseased 16. The diseases from which the 16 infants and children were actually suffering at the time of being put upon the milk were : Diarrhoea 1, bronchitis 1, enlarged glands 1, tabes mesenterica 1, gastritis 1, measles 1, whooping cough 2, indigestion 7, and unclassified 1. An average of 109 infants and children (under 2 years) were fed per week at the Dep6t, necessitating the distribution for the year of 178,614 bottles of milk mixture, whilst, in addition, milk was also supplied as follows:— 1. Lambeth Infirmary—using 36,822 pint bottles of milk mixture ; 2. Lambeth Workhouse—using 1,612 pint bottles of milk mixture; 12 3. Invalids—using 2,446 pint bottles of milk mixture ; 4. Nursing mothers—using 769 pint bottles of milk ture ; 5. Children over 2 years of age—using 8,538 pint bottles of milk mixture. A total of 12,015| gallons of milk and 571 pints of cream were used during 1917. Weekly medical consultations* with mothers were held at the Depfit, the babies being weighed, the weights and other details tabulated in the Register, whilst the babies were visited also at their homes by the Health Visitors when required. Milk was distributed not only from the Depot, but also from the Moffatt Institute (Upper Kennington Lane), the latter branch depdt (distributing centre) being used for the convenience of the mothers living in the Vauxhall District. The most conclusive proof of the value of a Milk -Depot, in so far as the infants and children fed are concerned, is to be found in the medical histories of individual cases, which show again and again, in the case of the Depot, that those infants and children who appear to be seriously ill and wasting, if not moribund, as the result of improper or irregular feeding, at the time of commencing the milk, actually recover and become strong and healthy. The educational value, too, of a Milk Depot must not be lost sight of. DEATHS, 1917. The total number of deaths registered is 5,374. The deaths of all members of the armed forces of this or other countries are excluded and not only the deaths of those dying in Institutions as indicated in various tables throughout the body of the Report and in the special tables I. and III. of the Local Government Board (vide Appendix. All death rates for 1917 are calculated upon civil populations (estimates). *In connection with the Infants consultations at the Milk Depot, the Local Government Board has again given a financial grant in aid for the year 1917-18. 13 1.—General Death-Rates. The uncorrected death-rate for Lambeth is 19.7 per 1,000 inhabitants. This rate is, however, uncorrected, and, on analysing the 5,374 total deaths registered, it is found that 1,975 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 769 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a net corrected number of deaths of 4,168, and a net corrected death-rate of 15.3 per 1,000 inhabitants, the slight increase being apparent rather than real, due to the low estimated civil population. The different districts are set out as usual in tabular form. W hether the corrected or uncorrected death-rates for the Borough be taken, they are again satisfactory for the year 1917 (the seventeenth year of the existence of the Borough). The figures* (corrected) for 1917 are :— (a) Inner Districts—17.7 per 1,000 population. (b) Outer Districts—13.6 per 1,000 population. (c) Whole Borough—15.3 per 1,000 population. Age Periods of Corrected Deaths. The 4,168 corrected deaths during 1917 may be further analysed, and tabulated as follows :— 516, i.e., 12'4 per cent, of the total corrected deaths took place under 1 year of age. 357, i.e., 8 5 per cent, between 1 and 5 years. 873, i.e., 20'9 per cent, under 5 years. 233, i.e., 5"6 per cent, between 5 and 20 years. 391, i.e., 9'4 per cent. 20 to 40 years. 878, i.e., 21" 1 per cent 40 to 60 years. 1,793, i.e., 43 0 per cent. 60 and over. 3,295, i.e , 791 per cent, over 5 years. *N.B.—The rates are calculated upon the civil populations (estimated),, and the deaths of all members of the armed forces are excluded. 14 15 TABLE D (1). TABLE D (1). Shewing the corrected number of Deaths, with corrected Death- rates (general, zymotic and diarrhoeal), in each of the Registration Sub-Districts of the Borough during 1917. The deaths are from all causes, and from the 7 chief zymotic diseases, and are corrected by adding Lambethians who die outside the Borough, by omitting strangers who die within the Borough, and by re-distributing persons (who die in Public Institutions) amongst the Districts from which they have been removed into such Public Institutions for treatment. A. Registration Sub-Districts. REGISTRATION SUB-DISTRICTS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Small Pox. Measles. Scarlet Fever. Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population (corrected). Diarrhoea Death-rate 0000 of the Population (corrected). Diphtheria and Membranous Crouh. ..... Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. j Lambeth Church 748 17.8 — 41 — 11 8 — — — 19 79 19 4.5 Kennington 857 19.7 — 21 1 8 7 — 1 — — 22 60 14 5.1 Stockwell* 821 14.4 — 22 1 10 7 — 1 — — 20 61 1.1 3.5 Brixton 1007 14 2 — 9 4 7 8 — — 1 — 22 51 0.7 3.1 Norwood 735 12.5 — 15 — 12 8 — 1 — — 8 44 0.7 1.4 Borough of Lambeth 4168 15.3 108 6 48 38 — 3 1 91 295 1.1 3.3 *Of the 821 deaths in Stockwell Registration Sub-District, 400 belong to the Inner and 421 to the Outer Stockwell Sub-District respectively. Inner Registration Sub-Districts—death rates (general, 17 .7, zymotic, 1.5, diarrhoeal, 0. 5, per 1,000 population). Outer Registration Sub-Districts—death rates (general, 13.6, zymotic, 0.7, diarrhoeal, 0.2, per 1,000 population). N.B.—Of the total deaths (corrected), 117 shew no addresses, and have been included in Kennington Sub-District—having occurred in the Workhouse Infirmary (67), and in the Workhouse (50) respectively. 16 17 TABLE D (2). TABLE D (2). Shewing the corrected number of Deaths, with corrected Death-rates (general, zymotic and diarrhoeal), in each of the Wards of the Borough during 1917. The deaths are from all causes, and from the 7 chief zymotic diseases, and are corrected by adding Lambethians who die outside the Borough, by omitting strangers who die within the Borough, and by re-distributing persons (who die in Public Institutions) amongst the Districts from which they have been removed into such Public Institutions for treatment. B. Wards. B. Wards. WARDS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1000 of the Population (corrected). Diarrhoea Death-rate per 10,000 of the Population (corrected). Small Pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Cholera. Diarrhoea. Marsh 296 15.5 — 26 — 7 — — — — 7 40 2.1 3. 6 Bishop's 519 18.3 — 14 — 6 7 — 1 — — 11 39 1.4 3.9 Prince's 790 207 — 22 1 7 8 — — — 22 60 1.6 5 .8 Vauxhall 400 14 .4 13 1 3 6 — 1 — — 13 37 1.3 4.7 Stockwell 421 14.4 — 9 — 5 3 — — — — 7 24 0.8 2.4 Brixton 568 13.9 — 3 3 5 3 — — 1 — 14 29 0.7 3.4 Heme Hill 439 14.4 — 5 1 2 3 — — — — 11 22 0.7 3.6 Tulse Hill 356 12.4 — 7 — 2 5 — — — 2 16 0.5 0.7 Norwood 379 127 — 9 — 11 3 — 1 — — 4 28 0.9 1.3 Borough of Lambeth 4168 15.3 — 108 6 48 38 — 3 1 — 91 295 1.1 3.3 Inner Wards death rates per 1,000 population (general, 17.7; zymotic, 1.5; diarrhoeal, 0.5). Outer Wards—death rates per 1,000 population, (general, 13.6; zymotic, 0.7 ; diarrhoeal, 0.2). N.B. Of the total deaths (corrected), 117 show no addresses, and have been included in Bishop's and Prince's Wards, having occurred in the Workhouse Infirmary (67), and in the Workhouse (50) respectively. 18 Changes in Registration of Deaths. The Registrar-General decided to publish from January 1st. 1911, in his annual reports, an analysis of deaths according to administrative areas instead of registration areas as hitherto, and this decision necessitates a complete distribution of the deaths of persons dying away from their homes to the administrative areas in which they had previously resided. Reports were received quarterly during 1917 from the Registrar-General—a total of 62 deaths—on slips, giving particulars of outside deaths assigned to the Borough, in addition to those reported in the usual way as having occurred in Metropolitan Institutions, which are situated outside the Borough. The table for the year 1917 (and the previous 5 years) at the end of the Report (Appendix), known as the Local Government Board Table I, shews these corrected statistics of deaths within the Borough (differing slightly, in consequence, from the statistics in the body of the Report), the extra additional figures for the year 1917 being as follows :— Age Periods. Males. Females. Totals. 0—1 1 2 3 1— 2 — — 2—5 — 2 2 5—15 1 3 4 15—25 — — — 25—45 6 11 17 45—65 13 5 18 65 and upwards 13 5 18 Total all ages 34 28 62 19 Causes of the 62 Outside Deaths Causes of Death. Male. ' Female. Whooping Cough — 1 Scarlet Fever — 1 Influenza — — Phthisis (Pulmonary Tuberculosis) 7 8 Other Tubercular diseases — 2 Cancer, malignant disease 3 2 Heart disease 7 4 Bronchitis — — Pneumonia — 2 Broncho-Pneumonia — — Other Lung diseases — 1 Nephritis and Bright's disease 3 Diabetes mellitus — 1 Violent deaths 2 — Suicide 1 — Appendicitis — — Nervous diseases 4 5 Strangulated Hernia 1 — Diseases of Digestive System 1 — Syphilis 1 — Wound (gun shot, shrapnel or bomb) — — Not classified above 4 1 34 \ 28 2.—Infantile Mortality Rates. Of the 4,168 corrected deaths, 516 are infants under one year of age. The total number of registered births is 6,869, and, of these, 618 occurred at the Lying-in Hospital, and belong to districts outside the Borough, 66 occurred at the Workhouse and belong to districts outside the Borough, and 688 occurred at the Maternity Hospital and belong to districts outside the Borough. In this way, the corrected number of births (i.e., excluding all non-Lambeth Institutional births) for the Borough is 5,497*. The corrected infantile mortality (i.e., rate of corrected deaths under one year per 1,000 corrected births) is, therefore, 93.9, the annual average for the decennium 1901-10 (Borough) being 122.7. In calculating this corrected infantile mortality it must be remembered that, whilst the institutional births, that belong to outside districts, are subtracted, the births of infants of Lambethian mothers who may happen to be residing outside the Borough at the times of such births are not *The Registrar-General returns the corrected number of births for the Borough during 1917 as 5232. 20 added. Taking the uncorrected births and the corrected deaths under 1 year, the infantile mortality rate is 75.1 per 1,000, the annual average for the decennium 1901-10 (Borough), being 114.8. Taking the uncorrected number of births (6865)), and the uncorrected number of deaths under 1 year of age (728), the uncorrected infantile mortality is 105.9. the annual average for the decennium 1901-10 (Borough) being 123.8, and that for the decennium 1891-1900 (Parish) 150.5. The chief causes of these deaths under 1 year are debility, atrophy, and inanition, congenital malformations, measles, whooping-cough, syphilis, bronchitis and other diseases of the respiratory organs, diarrhoea, and prematurity. In the Registration Sub-Districts, the uncorrected infantile mortality varied from 182.5 per 1,000 births in Kennington to 72.6 in Stockwell (the rates of 89.8 in Lambeth Church, 182.5 in Kennington, and 72.6 in Stockwell, being diluted owing to the fact that these Sub-Districts contain the General Lying-in Hospital, the Workhouse and the Maternity Hospital respectively), thus— Total No. of Births (uncorrected) 1917. Total Deaths under 1 year (uncorrected). 1917. Infantile Mortality per 1000 births (uncorrected). 1917. Lambeth Church* 2027 182 89.8* Kennington† 893 163 182 .5† Stockwell‡ 1888 137 72.61‡ Brixton 1178 171 145.2 Norwood 833 75 84.9 Lambeth 6869 728 105.9 § Inner Districts—107 .01, Outer Districts—104. 6. 3.—Zymotic Death-Rates. The zymotic death rate is made up of the total deaths from the seven principal zymotic diseases, viz., smallpox, measles, scarlet fever, diphtheria (including membranous croup) whooping cough, " fever " (including typhus, typhoid or enteric and simple continued or ill-defined) and diarrhoea. The total number of deaths registered from these diseases is 389—150 strangers belonging to other districts and 239 parishioners who died within the Borough ; whilst, in addition, 56 parishioners *Excluding all the Lying-in Hospital births, the rate is 147.9 †Excluding all the Workhouse births, the rate is 232.5. ‡Excluding all the Maternity Hospital births, the rate is 137.4. §N.B.—The births and deaths in Stockwell Registration Sub-Districts are divided equally between the Inner and Outer Districts for the purpose of calculating infantile mortality rates for such Districts in this Table. 21 died from these diseases outside the Borough. Subtracting the strangers and adding the parishioners who died outside the Borough, there is a corrected, total of 295, giving a zymotic death-rate (corrected) of 1.1 per 1,000 inhabitants. As in the case of the general death-rates, the zymotic death-rates vary in the inner and outer districts, viz., 1.5 as compared with 0.7 per 1,000 population respectively (vide Tables D.(1) and D (2)). The different rates of mortality from different diseases and groups of diseases during 1916 and 1917 are given in terms of the total deaths (corrected) in Table E, whilst Table E gives also the corrected deaths from the chief infantile diseases, expressed in terms of the infantile population (i.e., corrected number of births registered). The tuberculosis corrected death-rate for 1917 is 2.02, i.e., 550 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis) death-rate, 1.5, i.e., 411 deaths from pulmonary tuberculosis or consumption (phthisis) per 1,000 population. The details of the tuberculosis deaths in the various Registration Sub-Districts are :— Registration Sub-Districts. Corrected Deaths from Pul. Tub. or Phthisis (consumpt'n) Other Forms Tuberculosis. Total Deaths Tuberculosis (all forms) Phthisis-rate per 1,000 population. Tuberculosis rate per 1,000 population. Lambeth Church 93 34 127 2.2 3 0 Kennington 198 31 129 2.2 2.9 Stockwell 78 21 99 1 .4 1.7 Brixton 80 32 112 1.1 1.6 Norwood 62 21 83 1.05 1 .4 Borough of Lambeth 411 139 550 *1.5 †2.02 Rates for Inner Districts 2.03* and 2.7†. Rates for Outer Districts 1.1* and 1 .5†. Fourteen of the total corrected deaths registered from tuberculosis (12 from phthisis or the pulmonary form) shew no addresses and have been included in Kennington Sub-District as Workhouse and Workhouse Infirmary deaths. During the five quinquennia 1891-1895 (Parish), 1896-1900 (Parish), 1901-1905 (Borough), 1906-1910 (Borough), and 1911-1915 (Borough), the yearly averages of total deaths from (a) pulmonary tuberculosis or consumption (phthisis), and (b) tuberculosis (all forms) were (a) 478.8, 496.8, 462.8, 421.6 and 386.8, and (b) 675.0, 690.0, 647.4, 567.4 and 500.0 respectively, representing a steady decline in the tuberculosis death-rates during the last 20 years. ' *† In calculating the death rates for the Registration Sub-Districts (Inner and Outer), the deaths registered in Stockwell Sub-District are divided equally between Inner and Outer Stockwell, as has been done in previous Reports. 22 TABLE E. Shewing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1916 and 1917. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease. Borough 1916. Borough 1917. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected) . Percentage of Total Deaths (corrected). I.—Zymotic Diseases 379 8.9 419 10.05 Seven Principal 248 5-9 295 7. 1 Influenza 56 1-3 56 1.3 II.—Parasitic 1 0 02 2 0 .05 III.—Dietetic 12 0-3 5 0.1 IV.—Constitutional 946 22-4 996 23.9 Cancer 370 8-8 363 8.7 Phthisis 387 9-2 411 9.9 Tubercular Diseases,excluding Phthisis ... 101 2-4 139 3 .3 Rheumatism (Acute and Chronic) and Gout 22 0-5 23 0.5 V.—Developmental 353 8-4 287 6 .9 Old Age 210 4-9 166 3 .9 VI.—Local Diseases 2264 53.7 2212 53.1 Circulatory System ... 605 14 4 636 15.2 Bronchitis 376 8.9 322 7.7 Pneumonia and Broncho-Pneumonia 244 5.8 297 7.1 Pleurisy and Pleuropneumonia 94 2.2 94 2.2 Respiratory System,excluding Phthisis 766 18.2 770 18.5 VII.—Violence 173 4.1 178 4.3 Suicide 24 0.6 22 0.5 VIII.—Other Causes 83 1.9 69 1.6 TABLE E.—continued. B.—Deaths (corrected) of Infants under One Year of age from the chief infantile diseases, and from all causes, expressed in terms of 1000 births (corrected). Borough 1916. Borough 1917. 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 565 87.8 516 98.6 Diarrhoea 83 12.9 56 10.7 Convulsions 25 3.9 11 2.1 Respiratory Diseases 92 14.3 111 21.2 Premature Births 106 16.5 89 17.01 Tubercular Diseases (including Phthisis) 11 1.7 17 3.2 Measles 6 0.9 18 3.4 Whooping Cough 21 3.3 10 1.9 Suffocation in Bed •4 0.6 12 2.3 Enteritis 11 1.7 6 1.1 Dentition 12 1.9 4 0.8 *N.B.—The above rates have been calculated upon the Registrar-General's corrected numbers of births. 23 TABLE F. Shewing the number of Deaths (corrected) from the 7 principal zymotic diseases in the Borough of Lambeth during 1917 and during the five previous years 1912-16, together with the yearly averages during the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). Disease. 1912. 1913. 1914. 1915. 1916. Total (corrected) Deaths in 1917. Annual average of tenyears 1901-1910 (Borough). Annual average of ten years 1891-1900 (Parish). Smallpox — — — 6.8 1.1 Scarlet Fever 9 14 16 17 7 6 31.4 48.8 Diphtheria 29 36 50 45 41 48 41.6 124.5 Membranous Croup — 1 — — — — 1.5 6.8 Fever. Typhus — — — — — — 0.0 0.3 Typhoid or Enteric 13 7 15 9 1 3 16.7 34.7 Continued and Relapsing 1 — — — — 1 0.7 1.7 Diarrhœa 82 166 196 124 105 91 172.9 196.5 Cholera 1 — — — — — 1.3 8.8 Measles 97 98 58 91 49 108 110.4 145.6 Whooping Cough 55 47 40 49 45 38 91.8 143.7 Borough of Lambeth 287 369 375 335 248 295 475.1 706.1 24 25 INFECTIOUS DISEASES. 1.—Notifiable Diseases. Under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 6,548 cases of infectious diseases (excluding tuberculosis) were reported, including cerebro-spinal fever, 31, poliomyelitis acuta, 9, ophthalmia neonatorum, 67, whooping cough, 902 measles, 3,224, and German measles, 1,241. These 6,548 cases occurred in 5,544 infected houses, and of the 6,548 cases 1,338, i.e., 20-4 per cent., were removed to hospital, and 5,210, i.e., 79-6 per cent., remained under treatment at their homes. If the included diseases mentioned be excluded so as to make the 1917 figures strictly comparable with those for previous years, the percentage of cases removed to hospital during 1917 was 80.1, as compared mith 82.8, 82.8, 67.9, 54.7 and 31.5 for the five quinquennia 1911-15, 1906-10, 1901-5, 1896-1900 and 1891-5, respectively, i.e., since the compulsory notification of infectious diseases camfe into force under the Public Health (London) Act, 1891. Full particulars of all the notifiable infectious diseases are to be found in tabular form. Nursing in connection with Measles, German Measles, Whooping Cough and Ophthalmia Neonatorum cases. The Council on April 26th, 1917, gave instructions for arrangements to "be made with Nursing Organisations, affiliated with the Central Council for District Nursing in London, for the nursing, free of cost, of patients notified or otherwise known to be suffering from Measles and German Measles, Whooping Cough and Ophthalmia Neonatorum, if (and as) required by the Medical Officer of Health and the necessary steps are being taken.* At present, the routine in Lambeth Borough is for every case of Measles and German Measles, Whooping Cough and Ophthalmia Neonatorum, when notified, to be officially visited and such precautionary measures taken in connection therewith as may be found necessary, including, in the case of Measles, German Measles and Whooping Cough, the systematic exclusion of non-protected contact children (i.e., children who have not previously had the disease) and all contact children under 5 years of age from schools, or, if desirable, the closing of an individual class room or class rooms.f There is no interference with medical treatment by the Council's Officers, but medical attendance is advised in all cases and nursing assistance offered in suitable cases and under certain conditions, free of cost, for the poorer inhabitants of the Borough. *Temporary arrangements have been made with the South London District Nursing Association (109, North Side, Clapham Common, S.W.), and the Ranyard Nurses (25, Russell Square, W.C.). Such arrangements to come into operation on June 1st, 1918. † During 1917, 78 Schools (80 class rooms) were dealt with, 875 children being excluded from the Infants' Departments in connection with 235 Measles cases reported. TABLE G. Shewing the total numbers of cases of infectious diseases notified compulsorily by Medical Practitioners under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, in the Borough of Lambeth, during 1917, together with the total numbers of deaths registered from the same diseases, the case mortality per 100 persons for each disease, the numbers of cases removed to hospital, and the numbers of infected houses. Cases notified. Deaths registered. Case Mortality per 100. Cases removed to hospital. Infected houses. Per cent. of cases removed. Cholera — — — — — Smallpox — — — — — — Scarlet Fever 340 6 1.8 312 304 91.8 Diphtheria 563 48 8.5 493 469 83.3 Membranous Croup 7 — 0.0 6 7 85.7 Typhus — — — — — — Typhoid or Enteric 17 3 17.7 14 16 82.4 Continued and Relapsing Fever 3 1 33.3 1 3 33.3 Erysipelas 130 4 3.1 21 123 16.1 Puerperal Fever 14 8 57.1 13 14 92.8 *Plague — — — — — — *Cerebro-Spinal Fever 31 16 51.6 24 29 77.4 *Poliomyelitis acuta 9 2 22.2 4 9 44.4 *Ophthalmia Neonatorum 67 — 0.0 — 67 — *Whooping Cough 902 38 40.1 45 698 4.9 *†Measles 3,224 108 3.3 378 2,775 11.7 *†German Measles 1,241 — 0.0 27 1,030 2.2 *T uberculosis— Pulmonary (primary) 1086 411 37.8 — 1,086 — Non-pulmonary (primary) 444 139 31.3 — 444 — *Chickenpox — — — — — — Totals 8,078 784 9.7 1,338 7,074 16.6 *Plague was made compulsorily notifiable on September 19th, 1900, Cerebro-Spinal Fever on March, 12th 1907, Poliomyelitis acutaon September 1st, 1911, Ophthalmia Neonatorum on March 13th, 1911, and Tuberculosis (all forms) on Februrary 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), and 1915 (March 17th to June 30th), the numbers of cases notified being respectively, 1,560, 40, 556, 238, and 473. Whooping Cough was compulsorily notifiable from January 1st, 1913 to December 31st, 1917, the numbers of cases notified being as follows:—1913, 1,428:; 1914, 1,389; 1915, 1,607; 1916, 1,576; and 1917, 902. Measles and German Measles became compulsorily notifiable on January 1st, 1916, † Including 50 Military Measles and 50 Military German Measles cases. 106 Measles cases were notified by parents (or relatives), in addition to the above. 26 27 TABLE G (1). Shewing the number of medical Certificates for the compulsorily Notifiable Infectious Diseases under the notification clauses of the Public Health (London) Act, 1891, or the Orders and Regulations made thereunder, received in the Borough of Lambeth during 1917 and during the five years 1912-1916, together with the averages for the two decennia 1891-1900 (Parish) and 1901-1910 (Borough). Disease. Borough of Lambeth. Annual Average, 1901 10 (Borough) 10 years. Annual Average, 1891-1900 (Parish) 10 years. 1912. 1913. 1914. 1915. 1916. 1917. Cholera — — — — — — 0.2 11.5 Smallpox — — — — — — 49.9 22.0 Scarlet Fever 604 1,370 1,745 900 501 3.10 1105.1 1331.3 Diphtheria 328 385 550 434 432 563 379.8 715.1 Membranous Croup 3 7 6 4 4 7 10.4 26.2 Tvphus — — —- — — — 0.1 1.1 Typhoid or Enteric 61 38 48 32 19 17 100.5 189.6 Continued and Relapsing 1 2 2 — — 3 4.1 25.7 Erysipelas 216 206 231 177 122 130 241.4 347.0 Puerperal 24 25 23 26 20 14 17.0 18.9 *Plague — — — — — — — — *Cerebro-spinal Fever 7 7 5 44 38 31 11.5 — *Poliomyelitis acuta 10 6 10 4 12 9 — — *Ophthalmia Neonatorum 76 57 57 73 83 67 — *Whooping Cough — 1,428 1,389 1,607 1,576 902 — — *Measles — 2,548 3224 — — *German Measles — — — — 1 212 1241 — *Tuberculosis— Pulmonary (primary) 1,822 1,571 1,250 1,020 904 1,086 — — Non-pulmonary (primary) — 456 273 298 362 444 — — *Chickenpox — — — 473 — — — — Totals 3,154 5,558 5,589 5,092 7,833 8,078 1912.5 2658.4 *Plague was made compulsorily notifiable on September 19th, 1900, Cerebro Spinal Fever ("Spotted Fever") on March 12th, 1907, Poliomyelitis acuta on September 1st, 1911; Ophthalmia Neonatorum on March 13th. 1911, Pulmonary Tuberculosis (Poor Law cases) on Jan. 1st, 1909, Pulmonary Tuberculosis (Hospital cases) on May 1st. 1911, Pulmonary Tuberculosis (Private cases) on Jan. 1st, 1912, and Tuberculosis (Pulmonary and Non-pulmonary) on February 1st, 1913, Whooping Cough on January 1st, 1913. and Measles and German Measles on January 1st, 1916, whilst Chicken-pox was compulsorily notifiable as follows:—1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), 1911 (March 22nd to June 22nd) and 1915 (March 17th to June 30th). ' N.B. Of the patients removed to Hospital, the following were reported not to be suffering from the diseases notified:— Scarlet fever 9; diphtheria 9; typhoid or enteric 4; cerebro-spinal fever 4 and Measles . 28 26 30 31 METROPOLITAN BOROUGH OF LAMBETH. TABLE H. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications received during the period from the 29th 31st December, 1916, to the end of the week ending December, 1917. 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. upwards. Total. Under 5. 1 5 to 10. 10 to 15. Total. Poor Law Institutions. (Medical Sanatoria. Poor Law Institutions. (Medical Sanatoria. Pulmonary— Males 2 6 27 25 52 102 190 141 92 43 12 692 792 Females — 13 25 28 31 42 111 69 33 17 15 384 453 — 3 2 5 5 4 127 10 115 N on-Pulmonary— — 3 2 5 5 2 102 7 78 Males 1 29 64 47 23 18 16 11 6 2 3 220 233 Females 3 22 60 45 16 11 20 7 4 3 6 197 215 — 13 5 18 18 18 15 9 12 — 5 4 9 11 7 23 4 24 * Re-notifications (Form A) = 169 (males 100, females 69), pulmonary and 31 † Re-notifications (Form B)=2 (male 0). (female 2), non-pulmonary. N.B.—Pulmonary—330 private, 426 hospitals, 320 dispensaries, 0 Poor Law A and B). Non-Pulmonary—60 private, 144 hospitals, 212 dispensaries, 1 Poor Law B). (males 13, females 18) non-pulmonary. Officers and 10 schools= 1086 total primary notifications (Forms Officer and 29 schools = 446 total primary notifications (Forms A and METROPOLITAN BOROUGH OF LAMBETH. TABLE H (1). Public Health (Tuberculosis) Regulations, 1912. Summary of Notification Certificates (Forms A, B, C, D,) received during the period from December 31st, 1916, to the end of the week ending December 29th, 1917. Wards. 1917. 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 120 129 — — — 7 4 12 42 45 7 7 — 4 — 4 Bishop's 125 144 1 1 2 29 5 20 43 48 2 2 22 7 11 6 Prince's 120 145 2 2 1 19 3 19 34 35 6 7 — 7 — 6 Vauxhall 83 94 — — — 18 — 22 29 29 6 6 — 3 — 3 Total Inner Wards 448 512 3 3 3 73 12 73 148 157 21 22 22 21 11 19 Stockwell 106 125 — — — 28 — 26 48 52 2 2 — 5 1 3 Brixton 206 235 2 2 1 42 3 30 53 58 1 1 — 4 — 4 Herne Hill 103 134 2 2 — 37 — 30 52 56 1 1 — 3 — 3 Tulse Hill 130 145 2 2 1 37 — 29 59 62 2 3 — 2 — 2 Norwood 83 94 1 1 1 12 2 5 57 63 — — 3 3 1 5 Total Outer Wards 628 733 7 7 3 156 5 120 269 291 6 7 3 17 2 17 Borough of Lambeth 1076 1,245 10 10 6 229 17 193 417 448 27 29 25 38 13 36 32 METROPOLITAN BOROUGH OF LAMBETH. TABLE H (2). Public Health (Tuberculosis) Regulations, 1912. Summary of Notification Certificates (Forms A, B, C, D,) received during the period from December 31st, 1916, to the end of the week ending December 29th, 1917. Registration Sub-Districts. 1917. 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 120 129 — 7 4 12 42 45 7 7 — 4 4 Lambeth Church 105 124 1 1 1 19 2 12 28 33 2 2 16 7 6 4 Kennington 140 165 2 2 2 29 6 27 49 50 6 7 6 7 5 8 Stockwell (Inner) 83 94 — — — 18 — 22 29 29 6 6 — 3 — 3 Total Inner Districts 448 512 3 3 3 73 12 73 148 157 21 22 22 21 11 19 Stockwell (Outer) 106 125 — — — 28 26 48 52 2 2 5 1 3 Brixton 309 369 4 4 1 79 3 60 105 114 2 2 — 7 — 7 Norwood 213 239 3 3 2 49 2 34 116 125 2 3 3 5 1 7 Total Outer Districts 628 733 7 7 3 156 5 120 269 291 6 7 3 17 2 17 Borough of Lambeth 1,076 1,245 10 10 6 229 17 193 417 448 27 29 25 38 13 36 33 34 35 TABLE I. Lambeth Municipal Tuberculosis Dispensaries Scheme. (Inaugurated, by the Council, 1912.) Local Govermnent Board Table FORM R. Return as to Work carried out in connection with the Two Tuberculosis Dispensaries (Central and Branch) for the Period from January 1st to December 31st, 1917. Central Dispensary. Branch Dispensary. Totals. Insured. Uninsured. Insured. Uninsured. Males. Females Childr'n under 16. Adults. Males. Females Childr'n under 16. Adults. Males Females Males. Females. 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensaries 311 79 233 63 I 158 209 138 232 27 142 1592 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 109 37 21 18 28 82 35 9 13 33 385 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 2 5 133 2 8 8 14 57 1 9 239 (d) Number included under 1 (a) who were found to be non-tuberculous* 72 10 50 9 56 71 58 100 6 67 499 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 128 27 29 34 66 48 31 66 7 33 469 Central Dispensary. Branch Dispensary. Totals. Insured. Uninsured. Insured. Uninsured. 2. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a)) 2892 5626 2458 2733 13709 (b) Number of the above attendances at which systematic physical examinations and records were made 618 860 983 833 2994 3. Number of visits to patients at their own homes by the Dispensary Medical Officers in connection with the supervision of home conditions” 19 90 - - 109 4. Number of visits to patients at their own homes by the Dispensary Nurses in connection with the supervision of home conditions and “following up”§ 604 - - 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 1029 1633 6. Number of consultations with the- (a) Medical Adviser of the Insurance Committee 15 10 103 112 240 (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated - - - — — (c) Practitioners at the homes of patients‡ - — - — - 7. Number of written reports concerning individual patients made to— 4 5 - — 9 (a) Public Authorities 445 182 362 89 1078 (b) Practitioners 310 99 211 69 689 8. Number of specimens examined 316 146 103 90 655 * From physical signs. †Under the Lambeth Scheme. the Tuberculosis Medical Officer connected with the Branch Dispensary (St. Thomas's Hospital) does not visi at the patients' own homes, such visit to be paid, as required, by the Medical Officer connected with the Central Dispensary (73 Effra Road, Brixton). § The number are approximate only, no exact figures for the Branch Dispensary being available, properrecord not having been kept during the' first half of the year 1917. Other visits, in addition, were made during 1917 by the Council,s Health Visitors to houses, wherein tuberculosis patients were notified, as following:-(a) area covered by the Central Dispensary, 1060; (i) area covered by the Branch Disoensirv 914;making a total of 1917. N.B.-Nurse Mary S. Angus resigned her appoinment as tuberculosis nurse at the Central Dispensary during1917, and was succeeded by Nurse Cissy Small, appointed temporarily on April 26th, 1917, and permanentil on October 19th, 1917. 36 37 TABLE J. Local Government Board Table. BOROUGH OF LAMBETH.—Particulars of cases of acute , polio-myelitis (polio-encephalitis) and cerebro-spinal fever, notified within the Borough of Lambeth, during 1917. Total number of Cases notified. NUMBER OF CASES (excluding Military 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. i F. 1 — 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 * 1 Cases. Deaths. Permanent Paralysis * 1 Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis * 1 Cases. Deaths. Permanent Paralysis * 1 Cases. Deaths. Permanent Paralvsis * Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* †Acute Polio-myelitis (Polio-encephalitis) 8 - - - 2 1 1 - - - 3 - 3 1 - 1 - - - 2 1 1 - - - - - - - - - - - - - - - - - - - - - ‡Cerebro-Spinal Fever 25 4 2 - 4 4 - 3 2 - 7 4 - - - - 2 2 - 3 1 - - - - - - - - - - - - - 2 1 - - - - - - - Number of cases removed to Isolation Hospital. *i.e,Recovered With permanent Paralysis of one or more groups of muscles. †Acute Polio-myelitis (Polio-encephalitis) — 2 — 1 1 - 1 - - - - - - - - - - - ‡Cerebro-Spinal Fever 3 4 3 7 - 2 3 - - - - - - 2 - - - - N.B.—There were, in addition, during 1917, 7 military cases notified, 1 acute polio-myelitis (polio-encephalitis) case, and one cerebro-spinal fever case, † Not including a death of a female child (5 years of age), who died at with whom an inquest was held and a verdict registered by the Coroner previously or subsequently received from a medical man. ‡ Including a death of a female child (9 months old), who died at connection with whom an inquest was held and a verdict registered by the notified by the medical man in attendance upon the child during its life. polio-myelitis (polio-encephalitis) and 6 cerebro-spinal fever. The acute died. All the military cases were treated in hospital. St. Thomas's Hospital, suddenly, on February 14th, 1917, and in connection of " death from acute polio-myelitis," no notification certificate having been Belgrave Children's Hospital, suddenly, on December 30th, 1916. and in Coroner of " death from cerebro-spinal fever," the case being afterwards. 38 2.—Non-Notifiable Diseases. Chickenpox. 524 cases of chickenpox were notified voluntarily. Diarrhœa. There has been a marked decrease in the number of corrected deaths registered from diarrhoea—91, as compared with yearly averages of 191.6, 219.4, 208.6, 140.2 and 178.2 during the five quinquennia 1891-1895, 1896-1900, 1901-1905, 1906-1910 and 19111915, respectively. Of the 91 deaths registered during 1917, 71, i.e., 78.02 per cent., occurred amongst children under 5 years of age 56, i.e., 61.5, amongst infants under 1 year of age. The 4 ft. earth thermometer first registered 56° F. on June 12th, rising to a maximum of 61.8° F. on August 8th, on one occasion only, and remaining at such maximum, and sinking to 56° F. again on October 12th. The readings of the 4 ft. earth thermometer were taken in Regent's Park, and the information was obtained through the courtesy of the Secretary ol the Royal Botanical Society. 23 corrected deaths (6 infants under 1 year of age) were registered from enteritis. Practical measures were again taken to prevent epidemic diarrhoea (and other diseases) in infants and to promote hygienic conditions in their feeding and environment, as follows:— (a) Visiting of houses wherein births were notified under the Notification of Births Act, 1907, or wherein deaths were registered as having occurred from epidemic diarrhœa; (b) Teaching of proper feeding and care and management of infants at the Infants Consultations Centre held at 66, York Road, and at the various other Welfare Centres, which comprise the Lambeth Maternity and Child Welfare Scheme; (c) Issuing of special leaflets or posters during the summer, dealing with (1) precautions to be taken against summer diarrhœa, (2) the danger of the areas of infection and the contamination of food by flies, (3) the importance of removing at once all accumulations of refuse and other offensive matters from the neighbourhood of dwellings, (4) the value of cleanliness generally, &c. (d) Feeding of Infants and young children at the Municipal Milk Depot, 66, York Road. 3.—" Contacts " or " Suspects " and " Convalescents " (Military). Many " contacts " or " suspects " and " convalescents " (military) were watched in connection with different diseases as follows:— (a) Cerebro-spinal or " Spotted" Fever (Epidemic Cerebro-spinal Meningitis), 5. (b) Enteric or Typhoid Fever, 22. (c) Plague, 3. (d) Dysentery, 26. 39 Municipal Bacteriological Laboratory. (Inaugurated by the late Vestry. 1899.) Table shewing the numbers of pathological samples examined and the results obtained, at the Bacteriological Laboratory during 1917 and the previous 5 years 1912-1916, together with the averages for the 10 years 1901-1910 (Borough). Year. Sputa. Suspected Tuberculosis. Tub. Bac. found. Blood. Suspected Typhoid or Enteric Fever. Reaction obtained. Throat & Nose. Membranes and Secretions. Suspected Diphtheria. Klebs-Loeffler Bac. found. Other Sundry Samples. Result obtained. 1917 Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 77 363 440 4* 9 13 32 468 500 2 8 1 1916 126 346 472 5 23 28 33 407 440 - 6 6* 1915 155 390 545 12 34 46 99 937 1036 8 24 32 1914 411 733 1144 14 28 42 108 730 838 6 12 18 1913 614 870 1484 12 35 47 130 867 997 18 19 37 1912 296 305 601 31 26 57 55 442 497 12 10 22 Average of 10 years 1901-1910 (Borough) 62.8 124.4 187.2 19.4 39.6 59.0 36.6 448.6 485.2 3.7 9.1 12.8 * Two of the cases were paratyphoid B. † Swabs for meningococcus, 4 (negative); cerebro-spinal fluid for meningococcus, 4 (1 positive and 3 negative); emyoema pus for tubercle bacillus, 1 (negative); and faeces for tubercle bacillus, bacillus typhosus or Shiga bacillus, 1 (Shiga bacillus found). 40 vials of antitoxin were distributed free of cost during 1917, under the Antitoxin Order, 1910. N.B.—Since the Bacteriological Laboratory was inaugurated in 1899 (up to the end of the year 1917), 20364 examinations have been conducted there in connection with the following suspected diseases, viz. :—tuberculosis, 7,463; typhoid or enteric fevers, 1,117; diphtheria, 11,472; and others, 312. 40 41 TABLE K TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1917 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under • 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Scarlatina. Diphtheria. Fevers. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cerebro-Spinal and Poliomvel 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) 83 28 14 11 13 2 7 7 1 Under 5 - 2 - - - - 1 7 - 1 11 - - 3 2 - 26 53 5 upwds. - - - - - - — — 1 1 6 4 — — — — 18 30 King George Hospital 271 — — — — 115 146 10 - Under 5. - - - - - - - - - - — — — — — — — — 5 upwds. - - - - - - - - - 4 10 4 — 232 - 1 20 271 General Lying-in Hospital, York Road 36 29 — 1 1 1 4 — - Under 5. - - - - - - - - - — 1 - - 1 - - 28 30 5 upwds. - - 1 - - - — — — — — — — - — - 5 6 St. Thomas's Hospital 566 68 23 35 52 48 129 149 60 Under 5. - 6 - - - 3 1 8 - - 18 - - 14 7 - 71 128 5 upwds. - 1 3 1 - 1 - 2 — 18 16 37 — 62 8 23 266 438 Remainder of Lambeth Chilrch 343 57 33 20 19 13 43 74 84 Under 5 - - - - - - - - - — 28 — — 9 — - 40 110 5 upwds. - - - - - - - - 1 32 46 43 3 29 — — 75 233 Lambeth Workhouse 20 - - - - - - 2 18 Under 5. - — — - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - — 5 14 — — — 1 20 Lambeth Infirmary 1396 112 46 47 35 60 191 430 475 Under 5 - 1 - - 3 11 7 47 — 5 60 1 - 5 2 - 63 205 5 upwds. - - - - 4 1 1 — 1 251 106 235 — 26 3 2 555 1191 St. Peter's House 43 - - - - - - 2 41 Under 5 - — — - - - - - - - - - - - - - - - 5 upwds. - — — - - - - - - - 12 8 1 - - — 22 43 Remainder of Kennington 291 51 8 13 6 8 37 80 88 Under 5 - - — - - 11 5 8 - - 19 - - 2 - - 27 72 5 upwds. - - - - - - 1 - - 26 55 37 6 5 - - 89 219 South-Western Hospital 151 13 17 44 54 10 12 1 — Under 5 6 36 - - - 16 3 - - - 1 - - - 10 - 2 74 5 upwds. 12 27 6 3 — 1 1 - - 1 1 1 - 1 10 - 13 77 Clapham Maternity 40 35 - - — 3 2 - — Under 5 5 upwds. I 33 2 35 Remainder of Stockwell 479 89 24 13 9 11 47 116 170 Under 5 - - - - 12 4 5 - - 34 - 1 5 1 - 64 126 5 upwds. - - - 1 - 2 - 1 - 45 75 63 9 12 - 1 144 353 42 43 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1917 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 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 l 18 19 Fevers. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cerebro-Spinal and Poliomvel Appendicitis. All other Diseases. Total. 1 Scarlatina. Diphtheria. Puerperal. Continued. Enteric or Typhoid. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. (a) (fi) (0 (d) (*) 0 (s) (A) « (J) (A) King's College Hospital 206 33 12 16 32 18 33 40 22 Under 5 - 2 - - - - - - 8 - - 4 1 - 10 3 1 32 61 5 upwds. — 1 - - - - - - - — 5 5 15 — 41 1 7 70 145 Belgrave Hospital 89 58 11 10 10 — — — Under 5 - - - - - - 1 1 13 - 1 19 - - - 3 - 41 79 5 upwds. - - - - - - - - - - - 2 — — 1 1 2 4 10 1st London General Hospital 74 - — — — 24 46 4 - Under 5 - - - - - - - - - - - - - - - - - - - 5 upwds. — 1 — — — - 1 10 2 1 - 44 1 - 14 74 4th London General Hospital 73 — — — — 25 40 8 - Under 5 - - - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - 1 9 12 - 2 27 - 2 20 73 Remainder of Brixton 621 80 16 24 12 19 52 164 254 Under 5 - 1 - 1 - - 6 5 8 - - 29 - 2 5 - - 63 120 5 upwds. - - — - - 1 - 1 4 5 46 107 109 13 9 — — 906 501 Lambeth Workhouse Schools 52 24 12 12 4 — — — - Under 5 - - - - - - 7 - 9 - - 11 1 - - - - 20 48 5 upwds. - - - - - - - - - 1 - - - - — — — 3 4 British Home of Incurables 6 — — — — — — 4 2 Under 5 - - - - - - - - - - - - - - - - - - - 5 upwds. - - - - - - - - - - - - 1 - - - - 5 6 Remainder of Norwood 534 51 20 17 15 21 57 121 232 I Under 5 - 2 - - - - 12 6 3 - 1 22 1 - 2 - - 39 88 5 upwds. — 1 — — 1 - - 1 - 1 45 68 96 18 8 1 - 206 446 Totals 5374 728 238 263 262 378 846 1212 1447 Under 5 6 51 - 1 - 3 102 39 119 - 8 258 4 3 57 28 1 549 1229 5 upwds. 12 31 19 - 6 5 10 5 7 11 493 528 668 52 497 25 38 1738 4145 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 769 56 25 29 26 35 140 215 243 Under 5 1 7 - - - - 17 5 4 - 2 23 1 - 1 2 - 47 110 5 upwds. - 5 3 — 1 2 1 - 15 — 76 68 105 3 40 - 1 339 659 Deaths occurring within the district among persons not belonging thereto 1975 268 81 117 140 260 489 398 222 Under 5 4 28 - - - 3 21 9 52 - 4 76 3 - 17 17 1 231 466 5 upwds. 9 18 14 — 4 3 1 2 2 2 164 88 139 2 400 20 35 606 1509 44 45 TABLE L. L ABLE L Table of Civil Population, Total Registered Births and New Cases Infactious Sickness, coming to the knowledge of the Medical Officer of Health (by notification), during the year 1917, in the Borough of Lambeth, classified according to Diseases and Localities. [Local Government Board Old Table B.] Registration Sub- Districts. Population at all Ages. Total Registered Births 1917. New Cases of Sickness in each the knowledge of the Medical during Locality, coming to Officer of Health 1917. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1917. Census 1911. Estimated 1917. [Civil Population.) 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 13 1 Fevers. Polio-myelitis Acuta Ophthalmia. Whooping Coueh. Measles. German Measles. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Whooping Cough. Measles. German Measles. Scarlatina. Diphtheria. Membranous Croup. Typhoid or Enteric. Continued & Relapsing. Puerperal. Erysipelas. Cerebro-spinal Fever. Typhoid or Enteric. Continued & Relapsing. Puerperal. (a) (b) (c) (d) Lambeth Church 47910 41993 2027 74 168 2 3 2 30 15 4 21 155 707 326 74 159 2 2 — 2 6 10 3 — 10 51 4 Kennington 48609 43475 893 36 90 — 2 — 3 21 6 2 11 167 584 209 36 85 — 2 — 2 3 6 2 — 16 59 3 Stockwell 62608 56992 1888 79 96 2 5 — 2 21 3 1 12 206 599 199 75 90 1 4 - 3 4 8 - - 8 48 3 1 19 168 618 202 86 80 3 5 — 2 5 2 — — 7 207 14 Brixton 76650 71052 1178 103 104 3 6 — 3 41 4 Norwood 62281 55526 883 48 105 — 1 3 4 17 3 1 4 206 716 305 41 79 - 1 1 4 3 3 - - 4 13 3 Totals 298058 272038 6869 340 563 7 17 3 14 130 31 9 67 902 3224 1241 312 493 6 14 1 13 21 24 5 — 45 378 27 N.B. In addition to the above new cases of infectious sickness coming to cation under the Notification Clauses of the Public Health (London) Act, 1891, notified voluntarily, viz.: Chicken Pox 524, Measles 763 and Whooping the knowledge of the Medical Officer of Health by compulsory medical notifior the Orders and Regulations made thereunder, the following cases were Cough 368. Local Government Board New Tables. TABLE I. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1917 AND PREVIOUS FIVE YEARS (1912-16). 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. Number. * Rate per 1,000 Nett Births. Number. * Rate 1 2 3 4 5 6 7 † 8 † 9 10 11 12 13 1912 297550 8168 6953 23.3 4189 14.1 823 634 600 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 23.6 4630 15.6 1008 745 734 104.5 4367 14.7 1915 284188 7878 6573 23.1 5323 18.7 1313 762 685 97.6 4772 16.8 §1916 283729 7980 6435 22.7 5515 19.4 1929 693 567 88.1 4279 15.1 §1917 272038 6869 5208 19.1 5374 19.7 1975 831 519 99.6 4230 15.5 §N.B.—The populations estimated for 1915, 1916 and 1917 are the civil populations only. Notes.—This Table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 the corrected rates are slightly different. The rates are calculated per 1000 of the estimated gross population, and no deductions have been made from the population for large Public Institutions for the sirk 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 arc similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. †Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph ; the RegistrarGeneral supplied the particulars of extra transferable deaths (62) to be entered in Column 9; and all such deaths are included in this Column, unless an error has been detected, and its correction has been accepted by the RegistrarGeneral. For Column 4 the Registrar-General has furnished a statement of the number of births needing to be added to or subtracted from the total supplied by the local Registrar (1751 outward and 90 inward transfers). '' Transferable Deaths " are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances. In Column 8 the number of transferable deaths of " non-residents " which are deducted and in Column 9 the number of deaths of " residents" registered outside the district which are added are stated in calculating the nett death-rate of the Borough. Census, 1911. Area of Borough in acres (exclusive of area covt^ei, by water), 4079* 6 Average number of person.s*per house (estimated), 6-7. Niunh^r inhabited houses, 44123. Total population at all ages, 298058. 47 Local Government Board New Tables. TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1917. notifiable disease. number of cases notified. total cases notified in each locality. (e.g., Parish or Ward) of the District. total cases removed to hospital. At all Ages. At Ages—Years. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. Under 1. 1 to,5. 5 to 15. 15 to 25. 25 to 45. 45 to 65 65 and u pwds. Small-pox - - - - - - - - - - - - - - Cholera - - — - — - - — —- — — — - - Diphtheria (including Membranous Croup) 570 13 178 253 64 57 5 — 170 90 98 107 105 493 Erysipelas 130 3 4 9 18 28 46 22 30 21 21 41 17 21 Scarlet Fever 340 2 82 193 38 24 1 — 74 36 79 103 48 312 Typhus Fever — — — — — — - — — - — — - — Enteric Fever 17 - 3 3 3 8 - — 3 2 5 6 1 14 Relapsing Fever - - - - - - - - - - - - - - Continued Fever 3 - - - - - 2 - - - - - 3 1 Puerperal Fever 14 - — — 3 11 — — 2 3 2 3 4 13 Plague — — — — — — - — — - — — — — Pulmonary Tuberculosis* 1076 2 19 105 227 511 185 27 225 140 189 309 213 — Other Forms of Tuberculosis† 417 4 51 216 68 54 15 9 70 49 77 105 116 — Cerebro-spinal Fever 31 9 13 2 4 3 — — 15 6 3 4 3 24 Polio myelitis acuta 9 2 3 1 2 1 — — 4 2 1 1 1 4 Ophthalmia Neonatorum 67 67 - - - - - - 21 11 12 19 4 - Whooping Cough‡ 902 96 476 319 2 8 1 — 155 167 206 168 206 45 Measles§ 3224 99 1211 1742 95 72 5 — 707 584 599 618 716 378 German Measles § 1241 22 205 518 266 217 12 1 326 219 199 202 305 27 Islation Hospitals, Name and Situation—Hospitals ot the Metropolitan Asylums Board (one situated in the Brixton Sub-District and Stockwell Ward of the Borough of Lambeth). Total available beds provided by the Board—8555. Number of Diseases that can he concurrently treated- All usual notifiable infectious diseases and (partly) Measles and \N hooping Cough. * Excluding all renotifications (169) of pulmonary tuberculosis, and notifications under Form C (235) and under Form D (210) of the 1912 Regulations, † Excluding all renotifications (33) of non-pulmonary tuberculosis, and notificati< ns under Form'C (63) and under Form D (49) ot the 1912 Regulations, ‡ §Whooping Cough became compulsorily notifiable within the Borough of Lambeth on January 1st, 1913, for a period of 5 years. § Measles and German Measles became compulsorily notifiable within the Borough of Lambeth on January 1st, 1916. 48 49 Local Government Board New Tables. Table III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1917. BOROUGH OF LAMBETH. Causes of Death. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the District (a). Total Deaths whether of " Residents " or " Nonresidents " in Institutions in the District (b). All ages. Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 4168 3851 463 174 162 131 134 453 951 1383 3106 Uncertified 317 53 8 13 17 19 44 78 85 Typhus Fever - - - - - - - - - - Enteric Fever 3 - - - 1 - 1 — 1 4 Continued Fever 1 1 - - - - - - - - Small-pox - - - - - - - - - - Measles 108 18 41 39 9 1 — — - 42 Scarlet Fever 6 — 1 2 3 — — — 18 Whooping Cough 38 10 10 15 3 — — — - 15 Diphtheria and Croup (See note (d) 48 3 5 22 18 — — — - 77 Influenza. 56 1 1 1 1 2 3 16 31 3 Erysipelas 4 - - - - - 1 2 1 7 Cerebro-Spinal Fever 16 6 3 3 3 1 - — — 49 Polio-myelitis acuta 2 1 — — 1 — — — — 2 Venereal Diseases 36 18 2 1 — — 5 7 3 —; Phthisis (Pulmonary Tuberculosis) 411 2 1 3 10 62 175 133 25 302 Tuberculous Meningitis (See note (e) 60 8 10 15 17 6 2 2 - - Other Tuberculous Diseases 79 7 8 4 17 12 18 7 6 - Rheumatic Fever 9 — — — 2 3 1 2 1 4 Cancer, malignant disease (See note (f)) 363 - 1 1 - 1 38 188 134 - Bronchitis 322 29 9 2 - - 9 78 195 Broncho-Pneumonia 188 55 43 21 6 1 2 30 30 293 Pneumonia (all other forms) 187 19 12 11 4 5 28 53 55 Other diseases of Respiratory organs 73 8 4 3 4 4 7 19 24 - Diseases of Circulatory System 636 2 - - 7 13 57 172 385 356 Diseases of Nervous System 364 19 3 2 7 16 4 1 100 176 356 Diarrhœa (See note (g)) 91 56 10 5 - 1 3 10 6 - Enteritis 23 6 - 1 - 1 5 7 3 94 Appendicitis and Typhlitis 4 - - - 2 - 1 1 - 37 Alcoholism (See note (h)) 3 - - - - - 2 - 1 - Cirrhosis of Liver 22 - - - - - 2 16 4 - Nephritis and Bright's Diseases 155 - 2 2 3 4 14 57 73 - Puerperal Fever (See note (i)) 8 - - - - 2 6 - - 19 Other accidents and diseases of Pregnancy and Parturition 7 - - - - 2 5 - - - Congenital Debility and Malformation, including Premature Birth (See note (j)) 175 169 3 1 2 - - - - - Violent Deaths,[excluding Suicide 156 23 5 13 19 10 19 36 31 236 Suicides... 22 2 10 9 1 Other Defined Diseases 486 54 8 8 9 4 42 80 281 1548 Diseases ill-defined or unknown 6 1 - - - - - 4 1 Notes to Table iii. (a) All " Transferable Deaths " of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term " transferable deaths " sec footnote to Table I. The total deaths in column 2 of Table III. equal the figures for the year in column 12 of Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or non-residents, are entered in the last column of Table III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as " Certified "; all other deaths are to be regarded as " Uncertified." (d) This heading includes all deaths from croup except those certified as due to " spasmodic," " stridulous," " catarrhal," or " false " croup. (e) Under ' Tuberculous Meningitis" are included deaths from Acute Hydrocephalus. (/) Under " Cancer " are included deaths under such headings as Carcinomal Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. (/?) 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-entcritis, Colitis, etc. Deaths from Diarrhoea secondary to some other well-defined disease are included under the latter. (h) Under this heading are included deaths from Delirium tremens, acute and chronic alcoholism, etc., but not those certified as due to 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. (0 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. 50 51 Local Government Board New Tables. TABLE IV. BOROUGH OF IAMBETH—INFANTILE MORTALITY, 1917. 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 95 45 16 11 167 75 89 62 70 463 Uncertified 17 1 3 2 23 5 14 5 6 53 Simple Continued Fever - - - - - - - - 1 1 Measles - - - - - - 1 2 15 18 Diphtheria and Croup - - - - - 1 - 1 1 3 Whooping Cough - - - - - 1 1 4 4 10 Diarrhœa — — 1 2 3 12 29 10 2 56 Enteritis (Epidemic) — — 1 - 1 3 2 - - 6 Influenza — — — — - - — - 1 1 Cerebro-Spinal Fever - - - - - - 1 1 4 6 Anterior Poliomyelitis - - - - - - l - - 1 Tuberculous Meningitis - - - - - - 1 6 1 8 Abdominal T uberculosis - - - - - - - - - - Other Tuberculous Diseases 1 - - 1 2 1 3 - 3 9 Congenital Malformations 8 - 3 - 11 3 2 1 - 17 Premature Birth 57 19 4 2 82 5 2 - - 89 Atrophy, Debility and Marasmus 12 8 3 4 27 18 10 5 1 61 Atelectasis 7 3 - - 10 1 - - - 11 Erysipelas - - - - - - - - - 11 Syphilis 2 - 2 2 6 7 4 - 1 18 Rickets - - - 1 1 - 2 - 1 4 Meningitis (not Tuberculous) — - - - - 1 1 3 - 5 Convulsions 1 2 2 - 5 1 3 - 2 11 Gastritis — — - - - 1 - 1 - 2 Dentition - - - - - - - 4 - 4 Laryngitis - - - - - - - - 1 1 Bronchitis 1 2 1 - 4 4 9 3 9 29 Pneumonia 2 2 - - 4 4 2 4 2 16 Bronchopneumonia - 2 1 - 3 6 15 10 21 55 Pleuro - - - - - 1 1 - 1 3 Suffocation, overlaying 4 - 1 - 5 3 3 1 - 12 Accident, other than Suffocation 4 - - 1 5 2 1 1 1 10 Other causes not classified above 13 8 - - 21 5 9 10 4 49 Totals 112 46 .9 13 190 80 103 67 76 516 . 52 53 LAMBETH BOROUGH.—Corrected Deaths registered from all causes during the year, 1917. Note.—The Deaths of Non-Residents occurring in Public Institu- tions in the District are excluded, and the Deaths of Residents. occurring in Public Institutions situated beyond the limits of the District are included. (A.) REGISTRATION SUB-DISTRICTS. 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. I. Specific Febrile.or Zymotic Diseases 46 54 33 40 47 44 37 44 34 34 5 1 202 217 419 II. Parasitic Diseases — 1 — — - - 1 - - - - - 1 1 2 Ill Dietetic Diseases 1 — — 1 1 — — - - 2 - - 2 3 IV. Constitutional Diseases 112 84 111 80 • 93 86 127 110 78 96 11 8 532 464 996 V. Development Diseases 19 27 29 33 17 28 34 38 15 35 5 7 119 168 287 VI. Local Diseases 194 157 199 172 227 211 280 291 209 194 47 31 1156 1056 2212 VII. Deaths from Violence 31 12 18 11 31 12 22 15 15 9 2 - 119 59 178 VIII. Deaths from Ill-defined and not Specified Causes 6 4 8 5 18 6 3 5 10 4 - - 45 24 69 Totals 409 339 398 342 434 387 504 503 361 374 70 47 2176 1992 4168 (B.) AGE PERIODS. AGE. PERIODS. 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. Total. I. Specific Febrile or Zymotic Diseases M. F. M. F. M. F. M. F. m. F. M. F. m. F. m. F. m. F. m. F. m. F. m. F. M. F. M. F. 59 66 31 42 41 47 131 145 18 21 2 1 2 2 7 9 3 - 11 13 6 6 22 ?0 71 72 202 217 419 II. Parasitic Diseases - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 1 2 III. Dietetic Diseases 1 1 - - - - 1 1 - - — — — — — 1 — 1 — - - - 1 - 1 2 2 3 5 IV. Constitutional Diseases 14 8 11 12 15 1 40 31 24 25 16 24 24 20 94 73 39 38 155 96 50 49 90 108 492 433 532 464 996 V. Developmental Diseases 60 57 — 1 — - 60 59 2 - - - - - - - - - - 1 - l 57 107 59 109 119 168 287 VI. Local Diseases 113 62 34 44 27 21 174 126 18 21 16 19 8 7 65 53 46 38 230 161 107 93 492 538 982 930 1156 1056 2212 VII. Deaths from Violence 15 8 3 2 5 8 23 18 15 4 4 3 3 2 1 1 9 7 2 30 3 11 1 15 17 96 41 119 59 178 VIII. Deaths from Ill-defined and not Specified Causes 41 21 1 1 — - 42 22 — — — — — — - - - - 2 1 1 - - 1 3 2 45 24 69 Totals 303 213 80 102 88 87 471 402 77 71 38 47 37 31 177 146 95 79 429 275 175 150 677 791 1705 1590 2176 1992 4168 54 (L.)SUMMARY OF CORRECTED DEATHS. No. of Deaths. Total. Brought forward No. of Deaths. Total. M. F. M. F. I.—Specific Febrile or ZymoticDiseases. 1871 1798 3669 1. Miasmatic Diseases 133 145 278 2. Diarrhœal „ 38 53 91 VI.—Local Diseases—continued. 3. Malarial „ — — 6. Diseases of Lymphatic System 3 4 7 4. Zoogenous „ — — —* 7. Diseases of Gland-like Organs of Uncertain Use 1 5 6 5 Venereal „ 27 9 36 6. Septic „ 4 10 14 8. Diseases of Urinary System 123 78 201 9. Diseases of Reproductive System (a) Diseases of Organs of Generation 1 8 9 II.—Parasitic Diseases 1 1 2 III.—Dietetic Diseases 2 3 5 (6) Diseases of Parturition - 7 7 10. Diseases of Bones and Joints 5 3 8 IV.—Constitutional Diseases 532 464 996 11. Diseases of Integumentary System 8 6 14 V.—Developmental Diseases 119 168 287 VII.—Violence. VI.—Local Diseases. 179 185 364 1. Accident or Negligence 105 47 152 1. Diseases of Nervous System 2. Homicide 1 2 3 2. Diseases of Organs of Special Sense 5 4 9 3. Suicide 12 10 22 4. Execution — — — 3. Diseases of Circulatory System 312 324 636 5. Air raid 1 — 1 4. Diseases of Respiratory System 423 347 770 5. Diseases of Digestive System 96 85 181 VIII.—Ill-defined and not Specified Causes 45 24 69 Carried forward 1871 1798 3669 Total 2176 1992 4168 55 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1917. Area of Borough—4,080-4 statute acres (inclusive of land and inland water, but exclusive of tidal water 82.1 and foreshore 31.1 statute acres respectively), divided into 5 Registration SubDistricts, 4 Parliamentary Divisions, and 9 Wards. The Parliamentary Divisions and Wards are not co-extensive but the Registration Sub-Districts and the Wards are. Civil Population—estimated 1917—272,038 (males 117,457, and females 154,581). *Density—66.7 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected)—6,869 being 25.2 per 1,000 population. Deaths (corrected)—4,168 being 15.3 per 1,000 population. Infantile Mortality (corrected)—516 deaths (corrected) under 1 year, being 75.1 per 1,000 total (uncorrected) births, or 93'9 per 1,000 total (corrected) births. Zymotic Death-rate (corrected)—1.1 per 1,000 population (total corrected zymotic deaths, 295). * The densities (based upon the estimated civil populations) vary in the different Registration Sub-Districts as follows—Lambeth Church (354.3 acres) 118.5, Kennington (398.3 acres) 109.02, Stockwell (583 acres) 97.7, Brixton (1026.6 acres) 69.2, and Norwood 1718-2 acres) 34.1 per statute acre respectively. II.—SANITARY WORK. [Dealing with the sanitary circumstances and administration of the Borough of Lambeth.) Return shewing the Number of Notices served in the Borough of Lambeth, from the 1st January to the 31st December, 1917. Number of Notices served 19,023* 56 A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES† (Public Health (London) Act.) No. of Notices served 6548 No. of Infected Houses 5543 Scarlet Fever 304 Typhoid 16 Diphtheria 469 Membranous Croup 7 Continued Fever 3 Puerperal Fever 14 Erysipelas 123 Cerebro-Spinal Fever 29 Acute Polio-Myelitis 9 Ophthalmia Neonatorum 66 Whooping Cough 698 ‡Measles 2775 ‡German Measles 1030 B. GENERAL NUISANCES AND DRAINAGE DEFECTS. (Public Health (London) Act, and Metropolis Local Management Acts.) No. of Notices served* 12475 Works, Structural— Drainage Defective 1191 Intercepting Traps with Fresh Inlets required 198 Ventilating Pipes required 281 Indoor Sinks connected with Drain 296 Rain Water Stacks connected with Drain 485 Bath Waste connected with Drain 201 Traps Defective, or of Obsolete Pattered 976 Closet Pan and Connections Defective 1011 Water Supply to Closet Defective 2110 Closet Dilapidated 784 Draw-off Main for Drinking Purposes required 602 Dust Bins Defective 1101 Premises Dilapidated 1408 Ventilation under Floors required 409 Roofs Dilapidated 2019 Soil Pipes Defective 201 *Including Measles and German Measles. † Excluding tuberculosis. ‡ Compulsorily notifiable from January 1st, 1916. 57 Paving Defective 2161 Damp and Unwholesome Houses 411 Dung Receptacles required 31 Defective Water Pipes 209 No W.C. Accommodation 18 16103 Works, not Structural— Cisterns Dirty 511 Manure Accumulations 81 Underground Rooms illegally occupied 49 Animals Improperly Kept 84 Stopped Drains 411 Overcrowding 76 Foul Urinals 21 Refuse Accumulations 411 No Water Supply or Defective Water Supply 1101 Dirty Premises 1976 • 4721 PARTICULARS OF SANITARY WORK carried out by the Male Sanitary Staff in Lambeth Borough during 1917, and during the 5 previous years (1912-1916), together with Yearly Averages for (a) the 10 years 19011910 (Borough), and (b) the 24 Years 1877-1900 (Parish). Year. Total Number of Notices (excluding those served under the Housing Acts). Sanitary Works, Structural and Permanent. Sanitary Works, Not Structural. 1917 19023* 16103* 4721* 1916 15015† 16175* 4651* 1915 12752 9757 7731 1914 15109 10175 6478 1913 14397 9167 5154 1912 12506 8679 4044 Yearly Average for 10 Years 19011910 (Borough) 13108.4 9348.4 3049.7 Yearly Average for 24 Years 18771900 (Parish) 5944.6 4756.9 2135.9 *Including Measles and German Measles, † Excluding Measles and German Measles. 58 SANITARY INSPECTORIAL STAFF. The Sanitary Inspectorial Staff consists of 12 district male Sanitary Inspectors and 1 special male Sanitary Inspector for Food and Drugs, 2 female Sanitary Inspectors (who also act as part-time Health Visitors*), and 3 female Health Visitors. t The work carried out during 1917 by these various officers is set out in tabular form. Summary of Work Carried Out by the Male Sanitary Inspectors During 1917. Inspections 8357 Re-inspections 42587 Complaints attended to 2208 Water Certificates issued 14 Revenue Act Certificates dealt with 31 Drains tested (with chemical, water or smoke test) 3340 Sanitary Works completed 3995 Plans of drainage reconstructions received 98 Premises the Drains of which have been totally or partly reconstructed 115 Samples of Food and Drugs taken 1829 Notices- Public Health (London) Act, 1891 (Preliminary or Intimation 8767 and Statutory 3704) 12471 Metropolis Local Management Acts 4 Sanitary Nuisances abated— (a) Structural 16103 (b) Non-Structural 4721 Summonses issued— Public Health Act 2 Food and Drugs Acts 40 Convictions obtained— Public Health Act 1 Food and Drugs Acts 33 N.B.—In addition to the above, the District Inspectors carried out, during 1917, routine duties connected with the inspecting of unsound and unwholesome food; the supervision of bakehouses, slaughter-houses, cow-houses, dairies, milk shops and milk stores, the market thoroughfares, outside urinals of public-houses, smoke, the male public conveniences, factories and workshops, and work places wherein males are employed, common lodging-houses, offensive trades, effluvium nuisances, houses let in lodgings, exempted tenements (Revenue Act), refuse and * Re-arrangement of duties of the 2 female Sanitary Inspectors, who are now designated " Female Sanitary Inspectors and Health Visitors," was approved by the Local Government Board on February 9th. 1917. † Miss Lillie Hoskin was appointed as an additional Health Visitor by the Council on April 26th, 1917 (temporarily), and on October 18th, 1917 (permanently). 59 manure depots, etc. No new houses were registerd under the by-laws for houses let in lodgings, and no routine house-to-house inspections were carried out under the Housing, Town Planning, etc., Act, 1909, the latter fact being on account of the war. Extra duties were thrown upon the 12 male district Sanitary Inspectors under the Local Authorities (Food Control) Order (No. 1), 1917, under which they were appointed to act by the Council on May 24th, 1917. Infected Houses and Drainage Defects found by Male Inspectors. A sanitary inspection made of infected houses, i.e., houses at which infectious disease is notified compulsorily, and the sanitary inspection includes, in the large majority of cases, the testing of the drainage with the chemical test. Taking the ordinary notifiable infectious diseases, out of the 974* infected houses dealt with with during 1917, the results are as follow, the averages being given in brackets for the past 25 years, 1891—1915:— (a) 34, i.e., 3.5 per cent. were found to have defective drains, i.e., a result was obtained with the chemical test employed (average = 14.3 per cent.). (b) 509, i.e., 52.2 per cent. showed defects in drains, traps, fittings and appliances (average = 53.1 per cent.). (c) 465, i.e., 47.8 per cent. showed no defects (average=46.9 per cent.). Registration of Cow-Houses, Slaughter-Houses, Common Lodging-Houses, and Milk Shops. During 1917, the Cow-houses and Slaughter-houses, and Common Lodging-houses licences were renewed by the London County Council, with the following exceptions:— (a) Cow-house—156, Hamilton Road, West Norwood; (b) Slaughter-house—125, Hamilton Road, West Norwood; whilst the applicants were registered by the Borough Council as milk-sellers or purveyors of milk at the following premises, which were passed as "suitable," i.e., in accordance with the Council's requirements 23, High Street (West Norwood), 2, Kennington Grove, 77, Larkhall Lane, and 75, Robsart Street. The following application was withdrawn:—20, Cornwall Road, Brixton Hill (Edward Richards). * The above statistics do not include ophthalmia neonatorum, whooping cough, measles and German measles and tuberculosis, which have been omitted so as to keep the statistics for 1917 comparable with those for past years. The figures for (a) whooping cough and (b) measles and German measles infected houses during 1917 are:—(a) 41 and (A) 251 defective drains, and (u) 327 and(b) 1,587 defective traps and appliances, out of totals of (a) 698 and (A) 3,805 infected houses inspected, respectively. No testing of drains is carried out as a routine in the case of ophthalmia neonatorum and tuberculosis-infected houses. 60 Revenue Act, 1903 (and Section 35 of the Housing, Town Planning, etc., Act, 1909). During 1917, 31 certificates were applied for in connection with tenements (or dwellings) so constructed as to afford suitable separate accommodation for each of the families inhabiting the same, with the following results:— 1. Certificates granted unconditionally 25* 2. Certificates granted conditionally 4† 3. Certficates refused 2‡ Effluvium Nuisances. During 1917, 3 effluvium nuisances were dealt with, viz.: (1) 39-41, Dunbar Street, West Norwood, a factory used for preparation of food for soldiers and sailors, vegetables (including onions) being dried and packed; (2) Royal Arsenal Co-operative Society's Bakery, Brixton Hill, a factory used for baking on a wholesale scale for civilians (the premises being in occupation for that purpose from 8 a.m. to 8 p.m.), and for military authorities (the premises being in occupation for that purpose from 8 p.m. to 8 a.m.), and causing chiefly a nuisance from noise and vibration of machinery ; and (3) 25, Broad Street, a factory in the occupation of Corebind, Limited, of 5, Castle Street, Finsbury, the corebind, which is used as an improvement in casting, being made from liquid pine resin, which is evaporated in a vacuum boiler, poured into shallow trays and then placed in a drying gas oven to solidify, giving off effluvia at times during these processes, and being afterwards ground up with other materials (the trade secret) in a closed-in mixer or disintegrator. Petitions were received by the Council in connection with Nos. (1) and (2), necessitating action being taken under Section 21 of the Public Health (London) Act, 1891. A summons was taken out in regard to No. (1), the nuisance being due to the onion oil (allyl sulphide) escaping into the neighbourhood, was heard at Lambeth Police Court on July 25th, 1917, and was adjourned sine die on August 22nd 1917, the nuisance being, meanwhile, abated by ceasing the cutting up and drying of onions and the burning of the onion refuse; but no legal action was taken in connection with No. (2), the nuisance from noise and vibration not being one with which the Council could deal, and the premises being also found to be an exempted building (in the occupation of the military). The nuisance in connection with No. (3) was abated. * Granted unconditionally—144 144a, Denmark Hill, 17, Effra Road, 26-28, Rosendale Road, 14-16, Victoria Road (West Norwood), and 53, Wilcox Road. + Granted conditionally—2.4, Cranmer Road. ‡ Refused—39, Tulse Hill 61 Summary of Work carried out by the Female Sanitary Inspectors during 1917. §Worksbops visited and inspected— (a) Dressmakers 26 (b) Milliners 3 (c) Laundries 7 (d) Tailors 8 (e) Upholsterers 2 (f) Dyers 1 (g) Blouses 23 (h) Ties 4 (i) Others (e.g.), embroidery, toys, mineral waters, brushes, underclothing, overalls, munitions, &c. 39 Workshops § : workshops therein measured 104 Workshops§ newly discovered and registered 8 * Premises visited, but not inspected, owing to the persons or patients concerned being out or, if employees, being no longer employed 1645 Female Conveniences visited and inspected— Public (visits paid) 263 Private — Schools visited— Public (visits paid) 81 Private — Special places visited and inspected— (a) Private Houses † 2520 (b) Outworkers 209 Outworkers and Private Houses ‡ re-inspected 703 Written Intimation and Statutory Notices served 73 No. of Workshops,§ etc., in which defects were found 73 No. of Workshops,§ etc., in which no defects were found 2852 Nuisances referred to M.O.H., for attention by male inspectors 5 * Births (830), Workshops (45), Out-workers (241), Softools (7), Tuberculosis cases (443), and special Complaints (79). † Births (1583), Diarrhoea cases (21), Tuberculosis cases (832). Puerperal fever (1), Ophthalmia cases (34), and special complaints (49). ‡ Births (143), Diarrhoea cases (1), Tuberculosis cases (425), Out-workers (7), Ophthalmia cases (120), and special Complaints (7). § Workshops include Work-places. 62 Particulars of Defects found by Female Inspectors. Workshops, § etc.— Workrooms— Overcrowded, Damp or Dirty 36 Defective or dirty— Yards, Floors, Roofs, Windows, Ceilings, Sink Wastes, or Premises generally 41 Sanitary Appliances: Water Closets— Dirty, unventilated, choked, defective or with defective tanks or water supplies 29 Sanitary Appliances: Drainage— Defective 1 Sanitary Appliances: Dustbins— Wanting or Defective 7 No separate suitable sufficient W.C. accommodation for the sexes 2 Miscellaneous defects, e.g., accumulations, personal uncleanliness, etc. 3 Summary of Work Carried Out by the Female Health Visitors* during 1917. Births† 3,555 Tuberculosis cases 717 Ophthalmia cases 205 Dep6t children visited 216 Diarrhoea cases 34 Infant Welfare Centres Milk Depot (visits)— and Day Nurseries 28 York Road (central) 58 Special cases 46 Moffatt Institute (branch) 318 N.B.—In addition to the above, 1,115 visits were paid to houses, but no one found to be at home. FACTORIES AND WORKSHOPS. 1917. Factories. 17 new factories were added to the Register, dealing with (a) Marconi appliances, 1; (b) carpentry, 1; (c) soap and candle, 1; (d) mineral waters, 1; (e) cartridge boxes, 1; (f) compasses, 1 ;,(g) book-binding, 1. Workshops. 16 new workshops were added to the Register, dealing with : (a) dressmaking 2, tailoring 2, blouses 7, mantles 2, and not classified 3. * Miss L. Hoskin commenced her duties as an additional Health Visitor (temporarily) on May 7th, 1917. † Revisits, 1,327: 63 OUT-WORKERS, 1917. 13 February and 9 August lists were received, dealing with 143 and 121 out-workers respectively. Of the 264 out-workers, 129 belonged to Lambeth and 135 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 137 lists were received from various outside authorities dealing with the 998 workers, of whom 926 belonged to Lambeth and 72 to districts outside Lambeth. Of the total 1055 Lambeth out-workers reported, 112 were new outworkers, i.e., out-workers not previously registered, as follow:— Mantles 9 Feathers 1 Blouses and skirts 9 Millinery 3 Ties, belts, and braces 8 Dresses 3 Children's underclothing and costumes 6 Nurses' Uniforms — Bag stringing 10 Women's clothing 7 Boxes and boxmaking 6 Tailors 17 Button Making 1 Embroidery 5 Brushes 2 Waistcoats 2 Artificial flowers 2 Shirts 4 Paper Bags 6 Fancy Goods 1 Sack Making — Button-hole Making — Printers 4 Boots and shoes 1 Corset Making — Collars 2 Cigarettes 2 Hosiery 1 Total 112 The Wards, in which the houses (wherein the 112 new outworkers were found to be working) are situated, are as follow:— Wards. No. Wards. No. Marsh 7 Heme Hill 16 Bishop's 8 Tulse Hill 9 Prince's 21 Norwood 5 Vauxhall 7 Stockwell 15 Borough of Lambeth 112 Brixton 24 64 FACTORIES AND WORKSHOPS REGISTERED DURING 1917. Numbers of Rooms and Persons Employed. WardB. No. of Factories. No. of Workshops. No. of Workrooms. Children. Young Persons. Adults. TOTALS. M. F. M. F. M. F. M. F. Total. Marsh 2 1 9 — — — — 80 52 80 52 132 Bishop's 1 — 6 — — 20 20 160 70 180 90 270 Prince's 2 3 12 — — — 18 24 71 24 89 113 Vauxhall — 1 4 — — — 2 — 9 — 11 11 Stockwell — 3 3 — — — — 2 13 2 13 15 Brixton — 3 3 — — — — 1 10 1 10 11 Heme Hill — 1 1 — — — — — 3 — 3 3 TulseHill 1 4 5 — — 1 7 4 9 5 16 21 Norwood 1 — 2 — — — — 18 2 18 2 20 Total 7 16 45 — — 21 47 289 239 310 286 596 65 DISINFECTING DEPARTMENT, 1917. Details of work done in connection with the Disinfecting Department are subjoined. A total of 8078 cases of infectious diseases, notified compulsorily by medical men, was reported and dealt with, including cases of cerebro-spinal fever (31), acute polio-myelitis (9), ophthalmia neonatorum" (67), measles (3,224), German measles (1,241), whooping cough (902), and tuberculosis —pulmonary (1,086) and non-pulmonary (444), whilst the following diseases were, in addition, notified by school teachers and others, viz.: measles (763), chicken-pox (524), cancer (73), whooping cough (368), verminous houses (126), verminous rooms (465), verminous bedding (2,126 articles), or clothing (1,244 articles), and others (948*). 1,338 patients were removed to hospital. Summary of work carried out by the Disinfecting Department during 1917. Total No. of rooms disinfected by Council 13132 Do. articles do 24988 Cases in which bedding was disinfected at home† 5666 Do. do. do. at Chamber 2195 Do. ' do. do. destroyed (428§ articles) 53 Premises disinfected and disinfectants supplied 18381 Articles of bedding, etc. disinfected 24988 Articles of bedding, etc. destroyed 428 No. of Cleansing Notices served in connection with infected houses 1003 Certificates of Medical Practitioners received in lieu of disinfection by the Council 97 Schools disinfected‡ (83 rooms) 13 Certificates of disinfection left with occupiers of disinfected premises 7919 Library books disinfected (public) 234 Mattresses re-tabbed by Council 407 * Scabies, ringworm, diseases not stated, etc. † The number is increased, compared with previous years, owing to bedding no longer being removed to the disinfecting station in the cases of Measles, Chicken-pox and Whooping Cough. § 97 certificates of medical practitioners received in lieu of official disinfection. ‡ Measles 12 (82 rooms), and diphtheria 1 (1 room). 66 ANALYSIS OF FOOD AND DRUGS AND WATER. Samples of Food and Drugs procured, together with the results of the analyses, during the year 1917:— Samples. Formal. Informal. Number Analysed. Number Adulterated. Number Analysed. Number Adulterated. Milk 666 80 5 3 Butter 80 4 642 68 Lard 18 1 — — Coffee 1 — 21 — Margarine 8 — 50 — Mustard — — 42 2 Pepper — — 32 — Arrowroot — — 4 - Vinegar 2 1 18 2 Sago — — 5 — Oatmeal — — 5 — Ground Rice — — 5 — Flour — — 26 — Dripping 21 — — — Drugs* — — 76 9 Rice — — 24 — Olive Oil — — 10 — Tapioca — — 4 2 Sugar — — 2 /— Syrup — — 1 — Tea — — 1 — Egg Powder — — 6 — Baking Powder — — 17 — Cream — — 27 12 Self-Raising Flour — — 4 — Prescription 2 — 2 — Cooking Fat 2 — — — 800 86 1029 98 N.B.—40 summonses issued (33 convictions and 7 dismissals). *The drugs (76)were:- Eucalyptus Oil(5), Epsom Salts (11), Gregory's Powder (17),Tartaric Acid (4), Ammoniated Tincture of Quinine (15), Boric Ointment (4), Cream of Tartar (4), Boric Acid (12), and Bicarbonate of Soda (4). Two samples of water were analyser and two margarine factories and wholesale dealers in margarine were registered, viz. Wessex House (Oakley Street) and 159, Westminster Bridge Road, butter-blending establishments. 67 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 1917 (666 formal), in no single instance were preservatives found. No samples of cream were taken formally, but 27 samples were taken informally (12 being adulterated). The action taken during 1917 under the Public Health (Milk and Cream) Regulations, 1912, may be tabulated as follows:— Headings of Report of Administration during 1917. 1. Milk ; and cream not sold as preserved cream :— (a) No. of samples examined for the presence of a preservative. . (b) No. in which a preservative was reported to be present. Milk 666 — Cream — — Nature of preservative in each case in column (6) and action taken under the Regulations in regard thereto—Nil. 2. Cream sold as preserved cream:— (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct:— (1) Correct statements made — (2) Statements incorrect — Total — (b) Determinations made of milk fat in cream sold as served cream:— (1) Above 35 per cent — (2) Below 35 per cent — Total — *The Amendment Order (February 8th, 1917) came into operation on April 2nd, 1917, and lays down a maximum of 0.4 per cent. of Boric Acid added to cream, such cream to be sold as preserved cream and to be labelled with the words, " Cream containing boric acid is unsuitable for infants and invalids." 68 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed Nil. (d) Particulars of each case in which the Regulations have not been complied with and action taken Nil. 3. Thickening substances. Any evidence of their addition to cream or to preserved cream and action taken where found Nil. 4. Other observations (if any) Nil. MORTUARIES AND CORONERS' COURTS. Details of Work Carried Out During 1917. (a) Number of bodies received, 500—280 at High Street and 220 at Wanless Road. (b) Post-mortem examinations conducted, 204—122 at High Street and 82 at Wanless Road. (c) Number of Inquests held, 482—267 at High Street and 215 at Wanless Road. Wightman & Co., Ltd., "Old Westminster Press," London, S.W. 1.