AC 4373 LAM 17 REPORT ON THE Vital and Sanitary Statistics OF THE BOROUGH OF LAMBETH During the Year 1923. [Including an account (1) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, (b) at the Municipal Milk Depôt and Infants Consultations Centre and under the Lambeth Milk Assistance Scheme and the Lambeth Maternity and Child Welfare Scheme, (c) at the Municipal Bacteriological Laboratory, (d) under the Lambeth Nursing (Infectious Diseases) Scheme, and (e) 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 Workshops, 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. REPORT on the Vital and Sanitary Statistics of the BOROUGH OF LAMBETH During the Year 1923. [Including an account (1) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, (b) at the Municipal Milk Depôt and Infants Consultations Centre and under the Lambeth Milk Assistance Scheme and the Lambeth Maternity and Child Welfare Scheme, (c) at the Municipal Bacteriological Laboratory, (d) under the Lambeth Nursing (Infectious Diseases) Scheme, and (e) 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 Workshops, and the Housing and other Special Acts.] by JOSEPH PRIESTLEY, B.A., M.d., d.p.h. Medical Officer of Health and Chief Executive Tuberculosis Officer, Metropolitan Borough of Lambeth. 2 Borough of Lambeth. PUBLIC HEALTH DEPARTMENT. STAFF, 1923. *Medical Officer of Health : JOSEPH PRIESTLEY, B.A., M.D., D.P.H. Public Analyst (part time) : A. H. MITCHELL MUTER, F.I.C., F.C.S. *Inspectorial Staff: (1) Special Sanitary Inspectors : (a) Food and Drugs :W.J. perrin.† (b) Housing: W. W. Howes and W.Wallis. (2) District Sanitary Inspectors : J. Barfoot. F. E. Baxter. J. S. Clements. A. B. Cruttenden† A. Farran. Benj. Good† T. H. Hooper. T. H. Jackson. W. J. Lawrence. J. M. Scorrer. J. S. Smith. G. T. Taverner. (3) Female Sanitary Inspectors : Miss F. M. Dawson. Miss A. G. Simpson.‡ (4) Health Visitors (Child Welfare) : Miss L. Hoskin.§ Miss T. McHugh.§ Miss K. A. Roe.§§ Miss A. Stirk. *Tuberculosis Department(Central Dispensary,73,Effra Road, Brixton) : Tuberculosis Officer: E. D. Richardson, M.R.C.S., L.R.C.P., D.P.H. Lady Secretary and Social Worker : Miss D. Scott Baker. Health Visitors (Tuberculosis) : Mrs. C. Small§§§ ; Miss W. E. Dyer.§§§§ Dispenser (part-time) : Miss F. M. Speakman. Milk Deppot (66, York Road, S.E. I). Manageress : Miss V. Berkeley. Disinfecting Department (Arlington Lodge, Wanless Road, S.E. 24). Superintendent: W. Lockyear. Mortuary Keepers : (а) High Street Mortuary : R. Harriss. (b) Wanless Road Mortuary : J. Fazey. Clerical Staff : (a) Senior Chief Clerk (A. L. Baxter§), (b) Chief Clerk (A. E. Ruel), (c) 5 Assistant Clerks (including one for Maternity 'and Child Welfare* and one for Tuberculosis*), (d) 2 Juniors. N.B.— The above-mentioned Officers are whole time except where otherwise stated. * Contributions from Exchequer Grants. † Meat Certificate. ‡ Central Midwives Board Certificate and the Health Visitor's Diploma. § Sanitary Inspector's Certificate. §§ Health Visitor's Diploma. §§§ L.G.B. (Scotland) Tuberculosis Certificate. §§§§ Central Midwives Board, Health Visitor's and School Nurses' Certificates. 3 Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. 2. March, 1924. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor, Ladies and Gentlemen, The vital and mortal statistics for the Borough for the year 1923 deserve special attention, in that the general and zymotic death-rates and the infantile mortality rate are the lowest ever registered in the annals of the present Borough or of the late Parish. There has been a great saving of life during the past year, especially in children under 5 years of age and in infants under 1 year of age, and this saving becomes enormous, if calculated over a period of 20-25 years, and comparing the present day figures with the averages of the decennia 1891-1900 (Parish), 1901-1910 (Borough), and 1911-1920 (Borough) respectively. Thus the Borough general death-rate and general zymotic death-rate for 1923 are 11.3 and 0.4 per 1,000 of the population, as compared with 18.4 and 2.4 respectively for the Parish (averages for decennium 1891-1900), whilst the infantile mortality rate is 42.7 per 1,000 of the uncorrected births as compared with 146.1 for the same period. The reduction in the total numbers of deaths amongst infants (under 1 year) and especially amongst young children (under 5 years) is unprecedented, and cannot be explained as due to meteorological conditions (low 4 ft. earth temperature) only. Other causes must be sought, and will be found in the Council's activities in child welfare work (the inauguration of the Lambeth Maternity and Child Welfare Scheme, the work of the Health Visitors and the Council's Milk Assistance Scheme and Milk Depot). Apart from general death-rates, the special death-rates for infectious diseases are correspondingly low, e.g., scarlet fever, diphtheria, measles, whooping cough, diarrhcea, typhoid fever, etc., whilst the death-rates for tuberculosis (both all forms and pulmonary) are specially noteworthy, in view of the Lambeth Municipal Tuberculosis Dispensaries Scheme, viz., 1.1 and 0.8, 4 as compared with 1.6 and 1.2 (averages for the last 10 years, for tuberculosis (all forms) and pulmonary tuberculosis respectively, per 1,000 of the population. The notifications (tuberculosis) received are even more significant, viz., 1.8 (all forms) and 1.5 (pulmonary) during 1923, as compared with 4.2 and 3.2 (the averages for the last 10 years), per 1,000 of the population. The tuberculosis deaths and notifications are the lowest on record. The Lambeth Nursing (Infectious Diseases) Scheme shews, by the records, good work done—a total of 5,594 visits paid by qualified and experienced nurses and a yearly average of 5,760 visits since the Scheme's inauguration (4 years ago). The Dental Treatment Scheme for tuberculosis or suspected tuberculosis patients was put into operation in September, 1923. The Registrar-General's estimated population for 1923 (middle of the year) is 308,500. The records of work done by the Food and Drugs Inspector, the Housing Inspectors, the district Sanitary Inspectors, the female Sanitary Inspectors, the Health Visitors, the staff of the Central Tuberculosis. Dispensary, the Milk Depot, and the Disinfecting Department, speak for themselves and reflect credit upon the officers concerned. To the chiefs of Departments, and also to the members of the Council, my thanks are due for assistance, readily given at all times, in connection with my duties as Medical Officer of Health for such an important district as the Metropolitan Borough of Lambeth. The Clerical Staff of the Department deserve much praise. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, JOSEPH PRIESTLEY, Medical Officer of Health and Chief Executive Tuberculosis Officer. 5 INDEX. page Official Staff (Public Health Department) 2 Introductory Letter 3-4 Vital Statistics 6-67 Estimated populations, 1923 6-7 Births and Birth-rates 8-10 Notification of Births Act 11-12 Lambeth Maternity and Child Welfare Scheme 12-14 Municipal Milk Depot and Infants Consultations Centre 15-16 Lambeth Milk Assistance Scheme (Free or Aided Supplies) 16-17 Deaths and Death-rates (General, Infantile and Zymotic) 17-27 Lambeth Nursing (Infectious Diseases) Scheme 29 Infectious Diseases 28-50 (a) Notifiable 28-47 (b) Non-Notifiable 48-50 (c) Tuberculosis Regulations 34-37 Lambeth Municipal Tuberculosis Dispensaries Scheme 38-43 (d) Dental Treatment of Tuberculosis Dispensary Patients 44 —45 (e) Polio-myelitis (polio-encephalitis), Cerebro-spinal Fever, Encephalitis Lethargica 46-47 (f) " Contacts " or " Suspects," " Carriers," &c. 50 Municipal Bacteriological Laboratory 51 Local Government Board, Old Table A 52-55 Local Government Board, Old Table B. 56-57 Local Government Board, New Tables I., II., III., and IV. 58-63 Mortality Tables (corrected deaths) 64-66 (a) Registration Sub-Districts 64-65 (b) Age-Periods 64-65 (c) Summary 66 Summary of Vital and Mortal Statistics, 1923 67 Sanitary Work 68-92 Notices served 68-70 (а) Infectious Diseases 68 (б) General Nuisances and Drainage Defects 68-70 Male Sanitary Inspectors 70-72 Registration of Cowhouses, Slaughterhouses, Common Lodging Houses and Milk Shops 72-73 Offensive Trades 74 Female Sanitary Inspectors and Health Visitors 74-76 Factories and Workshops and Out-Workers 77 Housing Department 77-86 Disinfecting Department 86-87 Analysis of Food and Drugs and Water 88-89 Public Health (Milk and Cream) Regulations 89-90 Milk (Special Designations) Orders, 1922-23 91-92 Ice Cream Vendors 92 Mortuaries and Coroners' Courts 92 Appendices— I. Housing Conditions, 1923 (Ministry of Health Table) 93-95 II. Housing Survey, 1919 and 1922 96-97 III. Housing Statistics (Empty Premises), 1923 98-101 6 1. VITAL STATISTICS. The Registrar-General estimates the population of the Borough (up to the middle of 1923) at 308,500, and it is upon this figure that the death and birth-rates are calculated throughout the Report, this estimated population being based on the adjusted 1921 figures, after allowance for the varying rate of natural increase as evidenced by the births and deaths in the Borough and of migration as indicated from other sources of information such as the changes in the numbers on the Parliamentary Register and the migration returns obtained by the Board of Trade. The various estimates to the middle of the year 1923 are as follow for the 12 Wards, the 5 Registration Sub-Districts and the 4 Parliamentary Divisions (the estimations having been made in the Registrar-General's Office) :— Corrected Estimated Populations, 1923 (Middle of the Year) I. Wards. Wards. Males. Females. Total. 1. Marsh 7,250 6,810 14,060 2. Bishop's 13,740 14,580 28,320 3. Prince's 13,690 14,840 28,530 4. Vauxhall 15,190 16,130 31,320 5. Oval 12,270 13,590 25,560 6. Vassall 8,300 9,530 17,830 7. Angell 13,370 16,260 29,630 8. Stockwell 15,210 18,310 33,520 9. Town Hall 7,330 7,980 15,310 10. Herne Hill 7,280 8,280 15,560 11. Tulse Hill 14,780 18,330 33,110 12. Knight's Hill 15,830 19,620 35,450 Borough of Lambeth 144,240 164,260 308,500 7 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. 1. Lambeth Church 22,630 23,100 45,730 2. Kennington 21,370 23,450 44,820 3. Stockwell 30,530 34,610 65,140 4. Brixton 38,480 44,940 83,420 5. Norwood 31,230 38,160 69,390 Borough of Lambeth 144,240 164,260 308,500 III. Parliamentary Divisions. *A djusted Parliamentary Divisions. New Wards. Total. North Marsh 70,910 Bishop's Prince's Kennington Vauxhall 75,010 Oval Vassall Brixton Angell 78,460 Stockwell Town Hall Norwood Heme Hill 84,120 Tulse Hill Knight's Hill Parliamentary Area of Lambeth — 308,500 *By the adjustment of the 4 old Parliamentary Divisions so as to make them co-terminous with the 12 new wards. 8 TABLE A. Giving number of Births and Birth-Rates in each Registration Sub-District of the Borough of Lambeth during the 52 weeks ended 29th December, 1923 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1923. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church* 605 607 593 516 2321 Kennington† 336 324 295 249 1204 Stockwell‡ 419 439 429 377 1664 Brixton § 504 492 499 476 1971 Norwood 300 315 302 267 1184 Borough of Lambeth 2164 2177 2118 1885 8344 * Including General Lying-in Hospital (908 cases, of which 258 belong to Lambeth). † Including Workhouse (448 cases, of which 372 belong to Lambeth). ‡ Including Clapham Maternity Hospital (686 cases, of which 203 belong to Lambeth). § Including King's College Hospital (727 cases, of which 175 belong to Lambeth). 9 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 1923, and for the five years 1918-1922, together with the averages for the three decennia 1891-1900 (Parish), 1901-1910 (Borough) and 1911-1920 (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. 1923 308500 8344 3482 357 535 141 1986 1922 307000 8449 4188 496 859 237 2147 1921 305700 8984 3656 506 693 232 2243 1920 293572 10456 3798 547 791 257 2252 1919 282322 7596 4192 479 703 199 2567 1918 262275 6390 4948 449 951 334 3559 Averages— 1911-1920 (Borough) 286786.4 8027.1 4282.5 619.7 958.6 326.8 2506.5 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. (6) Enumerated Population at Census 1911 was 298,058. (c) Enumerated population at Census 1921 was 302,868. (d) Families or separate occupiers = 70,887 (1901), 70,827 (1911) and 78,399 (1921). N.B.—In this and previous Reports, the estimated populations 1915, 1916, 1917, 1918, 1919, and 1920 are the estimates of civil populations only, and, for the same 6 years, the deaths do not include the deaths of members of the armed forces of Great Britain and other countries, all such deaths being excluded from the Registrar-General's published local returns. 10 TABLE C. Showing the Birth Rate (estimated) 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 1923 and for the five Years 1918-1922, together with the averages for the three decennia 1891-1900 (Parish), and 1901-10 (Borough) and 1911-1920 (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). 1923 27.04 11.3 42.7 102.5 156.5 0.4 516.1 1922 27.5 13.6 58.7 118.4 205.1 0.8 483.0 1921 29.4 11.9 56.3 138.4 189.5 0.7 534.7 1920 35.5* 12.9 52.3 144.0 208.3 0.9 519.8 1919 25.8* 14.8 63.1 114.3 167.7 0.7 520.5 1918 21. 7* 18.9 70.3 90.7 192.2 1.3 564.0 Averages— 1911-20 (Borough) 27.9 14.9 77.2 144.5 223.1 1.1 499.8 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.—In this and previous Reports, the birth-rate is calculated upon the special Borough populations estimated respectively for that purpose by the Registrar-General for the years 1916, 1917, 1918, 1919, 1920, viz., 308,702, 303,245, 293,869, 294,097, and 294,303. These populations are the civil populations plus all non-civilians enlisted from this country, whether serving at home or abroad, this non-civilian element being distributed over all the districts in the country in proportion to their estimated civilian population. 11 BIRTHS, 1923. The total number of Births registered (during the 52 weeks ended 29th December, 1923) is 8,344, of which details are set out in Table A. The birth-rate for Lambeth (Parish and Borough) has been slowly, but steadily, declining for years past—a decline not peculiar to Lambeth, nor even to England, but to be found in nearly all civilised countries. There was a natural large post-war temporary increase in the number of births registered (and notified) during 1920. This temporary increase is becoming normal (approaching the average) again. The Registrar-General's figures relate to the calendar year, and allowance is made not only for outward transfers but also for inward transfers, as follows, giving a corrected number for the year (calendar year) of 6,242 :— Total registered. Inward transfers. Outward transfers. Corrected numbers. Legitimate Males 4,039 110 1,137 3,012 Legitimate Females 3,835 87 1,021 2,901 Illegitimate Males 248 19 117 150 Illegitimate Females 269 17 107 179 Totals 8,391 233 2,382 6,242 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 114,089 births have been notified up to the end of 1923, viz. : 3,473 in 1908 (10 months), 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, 7,336 in 1912, 7,158 in 1913, 7,397 in 1914, 7,091 in 1915, 7,293 in 1916, 6,311 in 1917, 5,890 in 1918, 7,260 in 1919, 9,910 in 1920, 9,023 in 1921, 8,564 in 1922, and 8,443 in 1923. 12 All Lambeth notified cases are visited and revisited systematically, and the mothers are referred to the various voluntary Welfare Centres that are comprised in the Lambeth Maternity and Child Welfare Scheme. It is impossible to give statistics of the educational value of this visiting of houses wherein births have been notified, but there is no doubt as to the existence of such value—a result that will, naturally, be increased by systematic re-visiting, which is now being carried out, in addition to the first visiting. A list of all notified births is sent to the London County Council weekly in pursuance of sub-section 5, of section 2, of the Act, and the Medical Officers of Health concerned are written to in connection with babies born in Lambeth Public Institutions but belonging to Districts outside the Borough. Of the total 8,443 notified births, 4,019 took place in Institutions, and of these 4,019 births 1,721 belong to Lambeth and 2,298 to outside districts, thus :— Institutions. Lambeth Cases. Strangers. Totals. General Lying-in Hospital 271 683 954 St. Thomas' Hospital 215 387 602 Lambeth Workhouse 401 63 464 Clapham Maternity Hospital 244 452 696 King's College Hospital 181 556 737 West Norwood Maternity Home ... 231 12 243 Other Nursing Homes (private) 178 145 323 Totals 1721 2298 4019 Lambeth Maternity and Child Welfare Scheme. The Lambeth Maternity and Child Welfare Scheme was inaugurated by the Council on the 13th April, 1916, and, in connection therewith, for administrative purposes, the Borough is, with the approval of the Ministry of Health, sub-divided into 12 administrative welfare areas—each area administered by a separate voluntary welfare centre, as follows:— 1. North Marsh, Cornwall Road, New Cut.* 2. The Barley Mow, 52, Oakley Street. * Formerly North Marsh (Morley College), Webber Street. 13 3. Holy Trinity Institute, Royal Street. 4. Babies' Care, 121, Kennington Road. 5. Moffatt Institute, 2, Esher Street. 6. St Anne's, 44-46, Harleyford Road, Vauxhall. 7. The Springfield, 48, Lansdowne Road, Vauxhall.* 8. Stockwell, St. Andrew's Institute, 57, Stockwell Road. 9. North Brixton, Belgrave Hospital, 212, Camberwell New Road. 10. Loughborough Junction, the Sussex Arms, 109, Sussex Road.† 11. Brixton, The Dispensary, 19, Water Lane, Brixton Hill. 12. West Norwood, Hannen House, 12, Hannen Road, Knight's Hill, West Norwood. Comprised in the Scheme are also the following institutions dealing with maternity and child welfare:— 1. Crèches or Day Nurseries. (a) St Thomas's Hospital Day Nursery, 107, Lambeth Palace Road. ‡ (b) Cornwall Nursery Hostel, Princes' Road.§ (c) Brixton and Heme Hill Creche, 71, Effra Road.§§ (d) Pilgrim Hill Creche, Pilgrim Hill, West Norwood. 2. Infants' Clinics. (a) Mrs. Anstruther's Clinic, 53, Ethelred Street. 3. Maternity Homes. (a) West Norwood Maternity Home, 106-108 Knight's Hill, West Norwood. In addition to the above, there are also included in the Scheme the following:— (1) The Maternity Wards of St. Thomas's Hospital (Westminster Bridge). * Formerly 48, Hartington Road, Vauxhall. † Formerly 39, Loughborough Park. ‡ Temporarily closed as from April 1st, 1921. § The Hostel has wards for the accommodation of ailing infants and young children (as in-patients), who are suffering from dietetic diseases, the so-called deficiency diseases, the result of irregular or improper feeding, causing malnutrition, rickets, etc., i.e., minor acute illnesses, such as would not be suitable for admission to a general hospital ; whilst, in addition, there are 5 beds for nursing mothers (for re-establishing or increasing the mother's breast milk). The day nursery department has been discontinued. §§ Permanently closed as from June 24th, 1923. 14 (2) The General Lying-in Hospital (York Road). (3) The Clapham Maternity Hospital (Jeffreys Road). N.B.—In connection with (1) and (2) Infants' Consultations Centres have been established at the Hospitals concerned for their own particular mothers and their babies, which have been born in, or in connection with, such Hospitals. Last, but not least, is the Council's Municipal Milk Depot and Infants Consultations Centre (66, York Road, Westminster Bridge Road), which, naturally, also form an important part of the Scheme. Financial Grants in Connection with the Maternity and Child Welfare Scheme. The principle of making financial grants out of the Borough rates, which was adopted by the Council during 1917, is still being carried out, and grants have been made during the past year to the voluntary welfare centres, the creches or day nurseries and the infants' clinics that have received grants from the Ministry of Health—the Borough grants being dependent on the Ministry of Health grants and being 75 per cent, of such Government grants. In the case of the Maternity Home (West Norwood),* the Council makes a grant in the first instance, and the Ministry of Health repays to the Council up to 50 per cent, of such grant. In addition, the Council makes special donations towards inauguration (equipment, etc.), in connection with newly-started voluntary welfare centres, or centres that have removed to new premises, larger and better suitable for administrative purposes, subject to such being approved as part of the Council's Maternity and Child Welfare Scheme, and subject to the previous sanction of the Ministry of Health. During 1923 two Centres have removed to more suitable premises, viz., (1) Springfield from 48, Hartington Road to 48, Lansdowne Road ; and (2) Loughborough Junction, from 39, Loughborough Park, to the (late) Sussex Arms, 109, Sussex Road (formally opened on November 22nd, 1923). * During 1923 (calendar year), 243 mothers were confined at the Home (6 by doctors and 237 by midwives), whilst, in addition, 52 mothers were confined in the district by midwives connected with the Home. No case of puerperal sepsis was reported, but medical assistance was sought by the midwives in 30 cases (at the Home 30, on the District 0). 15 Municipal Milk Depot and Infants Consultations Centre. (.Municipal Milk Depot, inaugurated by the Council 1903.) Record of Work carried out during 1923.* 196 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk :— Under 3 months 91 9-12 months 15 3—6 months 35 Over 12 months and 6—9 months 32 under 2 years 23 Total 196 Of the 91 infants under 3 months, 30 were aged 14 days or under. These 196 infants and children (under 2 years) may be classified, as to their states of health at the time of being put upon the milk, as follows :—Healthy, i.e., showing no sign of wasting or disease, though often below par constitutionally, 149, weakly 31, wasting 9, diseased 7. The diseases from which the 7 infants and children were actually, or had recently been, suffering at the time of being put upon the milk were colic 1, diarrhœa and sickness 4, teething 1, and indigestion 1. An average of 221 infants and children (under 2 years) were fed per week at the Depôt, necessitating the distribution for the year of 172,490 bottles of milk mixture (11,671½ gallons), whilst, in addition, milk was also supplied as follows:— 1. Lambeth Hospital—using 9,678 bottles of milk mixture (1,210½ gallons) ; 2. Invalids—using 221 pint bottles of milk mixture (275/8 gallons) ; 3. Nursing mothers—using 6,653 pint bottles of milk mixture (8315/8 gallons) ; 4. Expectant mothers—using 532 pint bottles of milk mixture (66½ gallons) ; 5. Children over 2 years of age—using 3,299 pint bottles of milk mixture (4123/8 gallons). A total of 12,882 gallons of milk and 51l½ pints of cream were used during 1923, distributed in 182,168 bottles. * The decrease in the work carried out at the Milk Depot is chiefly due to the Ministry of Health having stopped the grants, except in necessitous cases, and to cover rent and maintenance costs connected with the Infants Consultations that are held at the Depot. 16 Attached to the Milk Depot is an Infants Consultations Centre, where consultations for mothers, infants and children (under 5 years of age) are held, with the Medical Officer of Health and one of the Council's Official Health Visitors in attendance. The babies are weighed and the weights and other details tabulated in the Register, and those mothers and infants and children (under 5 years of age) who require medical advice are examined by the Medical Officer of Health, visiting at the homes being carried out by a Health Visitor, as required. The Manageress also attends daily (Sundays excepted) between the hours of 12 (noon) and 2 p.m. at the Depot for the purpose of giving out the milk and of also consulting with mothers and others in regard to infant and child feeding and management. The Medical Officer of Health can also be seen personally by mothers by appointment at the Town Hall, or communicated with by telephone, the Town Hall and the Milk Depot being in telephonic communication. The most conclusive proof of the value of a Milk DepÓt, 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. Practically no medicines are used, reliance being placed upon what is known as percentage feeding, the giving of modified (humanised) cow's milk, of which the different composition varies according to the age and condition of the infant or child being fed. The percentages of protein, fat, carbohydrate and mineral matter are strictly in accordance (averages) with those to be found in mother's milk for the same age periods. The educational value of a Milk Depot and of unattached Infants Consultations Centre must not be lost sight of. Lambeth Milk Assistance Scheme (Free or Aided Supplies). The Milk Assistance Scheme is still in existence, but the amount of milk distributed thereunder, and the numbers of expectant and nursing mothers and children under 5 years of age benefited have been correspondingly reduced on account of the lowness of the present income-limit allowed by the Ministry of Health owing to the need for national economy. The old Milk Orders and the unrestricted Milk Assistance Scheme had proved, beyond doubt, since 1918, the great value of milk as an accessory food for expectant and nursing mothers and for children under 5 years of age. This value of milk as an accessory food is still being proved 17 in Lambeth (and elsewhere) but the numbers benefited are fewer.* The administration of the Lambeth Milk Assistance Scheme is carried out by the different Welfare Centres (including the Milk Depot), and much additional work has, consequently, been thrown upon the various administrative staffs concerned (in some instances, extra help having to be engaged). DEATHS, 1923. The total number of deaths registered is 3,848. All death rates for 1923 are calculated upon an estimated population of 308,500 (to the middle of the year). 1.—General Death-Rates. The uncorrected death-rate for Lambeth is 12.5 per 1,000 of the population. This rate is, however, uncorrected, and, on analysing the 3,848 total deaths registered, it is found that 951 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 585 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a net corrected number of deaths of 3,482, and a net corrected death-rate of 11.3 per 1,000 inhabitants. This is the lowest general death-rate ever recorded in the annals of the present Borough, or the old Parish, of Lambeth. The Inner (congested and crowded) Districts show, as a whole, a general corrected death-rate of 12.8 as compared with 10.2 for the Outer (less congested and less crowded) Districts per 1,000 of the population. Age Periods of Corrected Deaths. The 3,482 corrected deaths during 1923 may be further analysed and tabulated as follows:— 357, i.e., 10.3 per cent. of the total corrected deaths took place under 1 year of age. 178, i.e., 5.1 per cent. between 1 and 5 years. 535, i.e., 15.3 per cent. under 5 years. 152, i.e., 4.3 per cent. between 5 and 20 years. 349, i.e., 10.0 per cent. 20 to 40 years. 744, i.e., 21.3 per cent. 40 to 60 years. 1,702, i.e., 48.8 per cent. 60 and over. 2,947, i.e., 84.6 per cent. over 5 years. * A circular letter was issued on February 8th, 1924, officially by the Government, pointing to a probable relaxation of the existing present economic stringency in regard to child welfare (and certain other) activities by local authorities in the near future. 18 19 TABLE D. TABLE D. rates (general, zymotic and diarrhœal), in each of the Registration Shewing the corrected number of Deaths, with corrected Deathall causes, and from the 7 chief zymotic diseases, and are corrected Sub-Districts of the Borough during 1923. The deaths are from strangers who die within the Borough, and by re-distributing by adding Lambethians who die outside the Borough, by omitting from which they have been removed into such Public Institutions persons (who die in Public Institutions) amongst the Districts for treatment. Sub-Districts. A. Registration REGISTRATION SUB-DISTRICTS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Total Zymotic Deaths. Zymotic Death-rate per 1,000 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 and Dysentery. Lambeth Church 584 12.8 5 1 7 4 — 1 — 11 29 0.6 2.4 Kennington 626 13.9 4 3 14 2 — — — — 13 36 0.8 2.9 Stockwell§ 669 10.3 6 ­ 8 3 — — — — 14 31 0.5 2.1 Brixton 905 10.8 3 5 10 3 — — — — 4 25 0.3 0.5 • Norwood 698 10.06 — 3 2 9 2 — — — — 4 20 0.3 0.6 Borough of Lambeth ... 3482 11.3 — 21 11 48 14 1 — — 46 141 0.4 1.4 a death from paratyphoid fever. * No death registered from membranous croup. †This was chargeable to Lambeth Borough, but who had been inmates of such ♦ Including four deaths from dysentery of Asylum patients who are notified as Lambeth cases. Asylums for many years past. These 4 cases of dysentery were not to the Inner and 301 to the Outer Stockwell Sub-District respectively. § Of the 669 deaths in Stockwell Registration Sub-District, 368 belong (general, 12.8, zymotic, 0.7, diarrhoeal, 0.2, per 1,000 population). Inner Registration Sub-Districts—death rates (general, 10.2, zymotic, 0.2, diarrhoeal, 0.0, per 1,000 population). Outer Registration Sub-Districts—death rates 20 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 1923 from the Regis: trar-General—a total of 65 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 1923 (and the previous 7 years) at the end of the Report (Appendix), known as the Local Government Board New Tables I., II., III. and IV., shew these corrected statistics of deaths within the Borough (differing slightly, in consequence, from the statistics in the body of the Report), the additional figures for the year 1923 being as follows :— Age Periods. Males. Females. 1 T otals. 0— 1 1 1 2 1— 2 — — — 2—5 1 — 1 5—15 2 — 2 15—25 6 3 9 25—45 13 8 21 45—65 9 9 18 65 and upwards 3 9 12 Total all ages 35 30 65 21 Causes of the 65 Outside Deaths. Causes of Death. Male. Female. Enteric Fever Diphtheria — — Puerperal Fever — — Influenza — — Phthisis (Pulmonary Tuberculosis) 6 7 Other Tubercular diseases 4 1 Cancer, malignant disease 1 2 Heart disease 2 4 Bronchitis — — Pneumonia 1 — Broncho-Pneumonia 1 — Other Lung diseases 1 1 Nephritis and Bright's disease 2 1 Premature Birth — — Violent deaths 7 1 Suicide 3 Appendicitis — — Nervous diseases — 6 Cirrhosis of Liver — — Diseases of Digestive System 2 — Diabetes 2 2 Not classified above 3 5 Totals 35 30 2.—Infantile Mortality Rates. Of the 3,482 corrected deaths, 357 are infants under 1 year of age as compared with decennial yearly averages of 1358.5, 1020.1 and 619.7 for 1891-1900 (Parish) ; 1901-10 (Borough) and 1911— 1920 (Borough) respectively ; and 506 and 496 total deaths under 1 year of age for the years 1921 and 1922. Having regard to the large population of Lambeth Borough these figures mean an enormous saving of infantile life during the periods mentioned. The infantile mortality rate is based upon the number of deaths under 1 year of age per 1,000 births registered. Taking the 8,344 total registered births during 1923 (52 weeks), and the 518 total uncorrected deaths of infants under 1 year of age, the infantile mortality rate is 62.08, as compared with annual averages of 150.5, 123.8 and 97.5 respectively for the decennia 1891-1900 (Parish), 1901-10 (Borough) and 1911-20 (Borough); whereas, if 22 the corrected deaths of infants under 1 year are used, viz. : 357, the infantile mortality rate is 42.7, as compared with yearly averages of 146.1, 115.3 and 77.2 respectively for the same decennia. The chief causes of these deaths under 1 year of age are debility, atrophy and inanition, congenital malformations, measles, whooping cough, syphilis, bronchitis and other diseases of the respiratory organs, diarrhoea and prematurity. In whatever way the infantile mortality rate is expressed statistically, it shows a remarkable decline during recent years as compared with the previous decennia 1911-20, 1901-10 and 1891-1900. In the Registration Sub-Districts, the uncorrected infantile mortality varies from 41 .5 in Stockwell to 85.2 in Brixton, thus :— Registration Sub-Districts. Total No. of Births (uncorrected) 1923. Total Deaths under 1 year (uncorrected). 1923. Infantile Mortality per 1000 births (uncorrected). 1923. Lambeth Church 2321 141 60.7 Kennington 1204 78 64.8 Stockwell 1664 69 41.5 Brixton 1971 168 85.2 Norwood 1184 62 52.4 Lambeth 8,344 518 62.08 Inner Districts—58 .3, Outer Districts—66 .3. N.B.—For the purposes of calculating infantile mortality rates . in this table the births and deaths in Stockwell Registration Subdistrict are divided equally between the Inner and Outer Districts. 3.—Mortality amongst Children under 5 Years of Age. The decline in the number of deaths of infants under 1 year of age is remarkable, but that of children under 5 years of age is even more remarkable. During 1923, 535 corrected deaths amongst children under 5 years of age are registered, as compared with yearly averages of 2070.2, 1503.5 and 958.6 for the decennia 1891-1900 (Parish), 1901-1910 (Borough), and 1911-1920 (Borough) 23 respectively, and totals of 693 and 859 for the years 1921 and 1922. These figures, like the figures for deaths of infants under 1 year of age, also represent an enormous saving in young life (under 5 years of age). 4.—-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 paratyphoid or enteric and simple continued or ill-defined) and diarrhoea. The total number of deaths registered within the Borough from these diseases is 176—69 strangers belonging to other districts and 107 parishioners who died within the Borough ; whilst, in addition, 34 parishioners died from these diseases outside the Borough. Subtracting the strangers and adding the parishioners who died outside the Borough, there is a corrected total of 141, giving a zymotic death-rate (corrected) of 0.4 per 1,000 inhabitants, the lowest ever recorded. As in the case of the general death-rates, the zymotic death-rates vary in the inner and outer districts, viz., 0.7 as compared with 0.2 per 1,000 population respectively (vide Table D). Taking the zymotic diseases separately, the same decline is noticed, e.g., measles 0.07, whooping cough 0.04, diarrhoea 0.1, typhoid fever 0.0, diphtheria 0.15, scarlet fever 0.03, smallpox 0.0, per 1,000 of the population. The different rates of mortality from different diseases and groups of diseases during 1922 and 1923 are given in terms of the total deaths (corrected) in Table E, which gives also the corrected deaths from the chief infantile diseases, expressed in terms of the infantile population (i.e., the number of births registered as corrected by the Registrar-General). Tuberculosis Death Rates. The tuberculosis corrected death-rate for 1923 is 1.1, i.e., 329 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis) death-rate, 0.8, i.e., 264 deaths from pulmonary tuberculosis or consumption (phthisis) per 1,000 population. 24 The details of the corrected tuberculosis deaths in the various Registration Sub-Districts are :— Corrected Deaths from Registration Sub-Districts. Pul. Tub. or Phthisis (consumpt'n) Other Forms Tuberculosis. Total Deaths Tuberculosis (all forms). Phthisis rate per 1,000 population. Tuberculosis rate per 1,000 population (all forms). Lambeth Church 53 15 68 1.1 1.5 Kennington 37 13 50 0.8 1.1 Stockwell 54 7 61 0.8 0.9 Brixton 70 21 91 0.8 1.1 Norwood 50 9 59 0.7 0.8 Borough of Lambeth 264 65 329 0.8* 1.l† Rates for Inner Districts 0.9* and l.24† Rates for Outer Districts 0.8* and 0.96† During the six quinquennia 1891-1895 (Parish), 1896-1900 (Parish), 1901-1905 (Borough), 1906-1910 (Borough), 1911-1915 (Borough), and 1916-1920 (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, 386.8 and 367.6, and (b) 675.0,690.0,647.4, 567.4, 500.0, and 472.4 respectively, representing a steady decline in the total number of tuberculosis corrected deaths registered during that period of 30 years, and this decline has continued since, i.e., during 1921, 1922 and 1923, viz. :—(a) pulmonary tuberculosis or consumption (phthisis) and (b) tuberculosis (all forms) as follows :—(a) 275, 302 and 264, and (b) 342, 371 and 329 respectively. This is the more remarkable, having regard to the increase of the censal populations during that time from 278,393 in 1891 to 301,895 in 1901, 298,058 in 1911 and 302,960 in 1921, and the estimated populations for 1921, 1922 and 1923 of 305,700, 307,000 and 308,500 respectively. *† 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. 25 TABLE E. Shewing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1922 and 1923. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease. Borough 1923. Borough 1922. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). 1.—Zymotic Diseases 226 6.5 451 10.8 Seven Principal 141 4.05 237 5.6 Influenza 40 1.1 156 3.7 II.—Parasitic — — — — III.—Dietetic 3 0.09 7 0.16 IV.—Constitutional 818 2.3 925 22.1 Cancer 412 1.2 457 10.9 Phthisis 264 7.6 302 7.2 Tubercular Diseases, excluding Phthisis 65 1.9 69 1.6 Rheumatism (Acute and Chronic) and Gout 24 0.7 31 0.7 V.—Developmental 293 8.4 315 7.5 Old Age 153 4.4 168 4.01 VI.—Local Diseases 1931 55.4 2263 54.03 Circulatory System 557 15.9 522 12.5 Bronchitis 323 9.2 433 10.3 Pneumonia and Broncho-Pneumonia 209 6.0 416 9.9 Pleurisy and Pleuropneumonia 84 2.4 101 2.4 Respiratory System.excluding Phthisis 656 18.9 1012 24.2 VII.—Violence 169 4.8 166 3.9 Suicide 40 1.1 37 0.9 VIII.—III-defined and not Specified Causes 42 1.1 61 1.4 26 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 1923. Borough 1922. 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 357 57.2 496 77.9 Diarrhœa 30 4.8 26 4.1 Convulsions 6 0.9 8 1.2 Respiratory Diseases 65 10.4 137 21.5 Premature Births 96 15.4 101 15.9 Tubercular Diseases (including Phthisis) 6 0 9 7 1.1 Measles 5 0.8 10 1.6 Whooping Cough 7 1.1 22 3.4 Suffocation in Bed 7 1.1 6 0.9 Enteritis 10 1.6 12 1.9 Dentition 4 0.6 3 0.5 * N.B.—The above rates have been calculated upon the Registrar-General's corrected numbers of births for the calendar years 1922-23. 27 TABLE F. Shewing the number of Deaths (corrected) from the 7 principal zymotic diseases in the Borough of Lambeth during 1923 and during the five previous years 1918-22, together with the yearly averages during the three decennia 1891-1900 (Parish), 1901-1910 (Borough) and 1911-20 (Borough). Disease. 1918. 1919 1920. 1921. 1922. Total (corrected) Deaths in 1923. Annual average of ten years 1911-1920 (Borough). Annual average of ten years 1901-1910 (Borough). Annual average of ten years 1891-1900 (Parish). Smallpox 1 0.0 6.8 1.1 Scarlet Fever 11 16 15 16 20 11 11.9 31.4 48.8 Diphtheria 45 60 77 44 50 48 47.3 41.6 124.5 Membranous Croup — 1 - - - - 0.3 1.5 6.8 Typhus — — — — - - 0.0 0.0 0.3 Typhoid or Enteric and 5 4 1 — 7 1 7.0 16.7 34.7 Continued Relapsing 1 — — — — — 0.3 0.7 1.7 Diarrhœa 60 80 51 124 35 46 127.8 172.9 196.5 Cholera — — — — — — 0.3 1.3 8.8 Measles 127 26 80 15 66 21 84.7 110.4 145.6 Whooping Cough 85 12 33 33 58 14 47.2 91.8 143.7 Borough of Lambeth 334 199 257 232 237 141 326.8 475.1 706.1 28 INFECTIOUS DISEASES. 1.—Notifiable Diseases. Under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 3,128 cases of infectious diseases (excluding tuberculosis) were reported, including encephalitis lethargica acuta 2, malaria 4, acute primary pneumonia 169, acute influenzal pneumonia 55, cerebro-spinal fever 7*, poliomyelitis acuta 10t, ophthalmia neonatorum 60, measles 1,103, and German measles 147. These 3,128 cases occurred in 2,773 infected houses, and, of the 3,128 cases, 1,671, i.e., 53.4 per cent., were removed to hospital, and 1,457, i.e., 46.5 per cent., remained under treatment in their homes. If the recently-added notifiable diseases be excluded so as to make the 1923 figures strictly comparable with those for previous years, the percentage of ordinary infectious diseases cases removed to hospital during 1923 was 91.3 as compared with 85.0, 82.8, 82.8, 67.9, 54.7, and 31.5 for the six quinquennia 1916-20, 1911-15, 1906-10, 1901-5, 1896-1900 and 1891-5, respectively, i.e., since the compulsory notification of infectious diseases came into force under the Public Health (London) Act, 1891—a satisfactory record. Full statistics of all the compulsorily notifiable infectious diseases are to be found in tabular form. Smallpox. No case of smallpox was recorded officially, but many smallpox " contacts " (with cases outside the Borough) have been reported and watched during the usual incubation period of the disease (14 days). Several suspicious cases were reported unofficially but were found not to be smallpox on inspection. Measles and German Measles. These diseases still remain compulsorily notifiable throughout the Borough under the terms of the Public Health (Measles and German Measles) Temporary Regulations, 1919, which came into force on December 31st, 1919, continuing in force in certain Districts (set out in the Schedule) the provisions of the Public Health (Measles and German Measles) Regulations, 1915, until (in the case of the Borough of Lambeth) March 31st, 1920, and since, by further Order of the Ministry of Health. These temporary Regulations were necessary on account of the issuing of the Public Health (Measles and German Measles) Regulations, 1915, Rescission Order, 1919, rescinding the Public Health (Measles and German Measles) Regulations, 1915, as from December 31st, 1919. Every case of Measles and German Measles, when notified is officially visited and such precautionary measures are taken in connection therewith as may be found necessary, including, in the case of both Measles and German Measles, the systematic exclusion of non-protected contact children (i.e., children who have not previously had the disease) and all contact children under 5 years of age from schools, or, if desirable, the closing of an * Including 3 cases of post-basic meningitis. † Including 1 case of polio-encephalitis acuta. 29 individual class room or class rooms. There is no interference with medical treatment by the Council's Officers, but medical attendance is advised in all cases, and nursing, free of cost, is provided by the Council in suitable cases as required under the Lambeth Nursing (Infectious Diseases) Scheme. Puerperal Sepsis or Fever. Much attention is being paid to this disease, it being felt that, as a preventive disease, it should be non-existent. 48 cases (8 deaths) were notified, 15 connected with abortions and miscarriages and 33 out of 8,443 total births notified-a comparatively small percentage, especially having regard to the large lying-in Institutions and Maternity Departments of Hospitals that exist in the Borough. At the same time, this comparatively small number (48) is above the averages (yearly) for the decennia 1891-1900 (18.9), 1901-1910 (17.0), and 1911-1920 (21.8), due to more exact notification and diagnosis and having regard to the fact that septicaemia following miscarriages and abortions (at all stages) are now notifiable as well as septicaemia arising after the births of viable infants. Lambeth Nursing (Infectious Diseases) Scheme. Nursing in connection with Measles, German Measles, Whooping Cough, Ophthalmia Neonatorum (and other forms), Epidemic Diarrhoea, Influenza, acute primary and influenzal Pneumonia, and certain other infectious diseases (epidemic Cerebrospinal Meningitis, acute Polio-Myelitis and Polio-Encephalitis and acute Encephalitis Lethargica, etc.). The arrangements which were made by the Council with wellknown Nursing Associations for the nursing, free of cost, of patients notified or otherwise reported to be suffering from Measles and German Measles, Whooping Cough, Ophthalmia Neonatorum (and other forms), Influenza, acute Pneumonia (primary and influenzal), Epidemic Diarrhoea, etc., if (and as) required by the Medical Officer of Health, and which came into force on June 1st, 1918, in connection with the old Inner Wards of the Borough, and on June 1st, 1919, in connection with the old Outer Wards of the Borough have proved a success. During 1923, this arrangement has proved again a success as in the previous 3 years. The following statistics for 1920-1923, setting out the total numbers of visits paid by nurses, speak for themselves :-measles and German measles, 728, 206, 722 and 297 ; whooping cough, 255, 273, 488 and 400 ; ophthalmia neonatorum (and other forms), 2,341, 1,764, 986 and 1,093; epidemic diarrhoea, 57, 232, 5 and 36 ; influenza, 343, 332, 474 and 249 ; acute primary and influenzal pneumonia, 1,870, 2,643, 3,586 and 3,333; other diseases, 114, 11, 16 and 186; making totals of 5,708, 5,461, 6,277 and 5,594 visits paid during the years 1920, 1921, 1922 and 1923 respectively. Of the total visits (5,594) paid during 1923, 2,904 were visits to children under 5 years of age, i.e., 51.9 per cent., dealing with measles and German measles, 287 ; whooping cough, 283 ; ophthalmia neonatorum (and other forms), 1,093 ; epidemic diarrhœa, 36 ; acute primary and influenzal pneumonia, 1,033 ; other diseases. 92. 30 31 TABLE G. Shewing the total numbers of cases (corrected) 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 1923, 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 (with percentages) removed to hospital, and the numbers of infected houses. Cases notified. Deaths registered. Case Mortality per 100. Cases removed to hospital. Per cent, of cases removed. Infected houses. Cholera - Smallpox — — — — — — Scarlet Fever 823 11 1.3 776 94.27 731 Diphtheria 580 48 8.27 568 97.93 525 Membranous Croup 4 — 0.0 4 100.0 4 Typhus — — — — — — † Typhoid or Enteric 8 1 12.5 5 62.5 8 Continued and Relapsing Fever — — — — — — Erysipelas 107 2 1.8 34 31.77 107 Puerperal Fever 48 8 16.6 47 97.91 48 *Plague — — — — — — *‡Cerebro-Spinal Fever 7 5 71.4 6 85.7 7 *§Polio-myelitis acuta 10 2 20.0 7 70.0 10 *Ophthalmia Neonatorum 60 — — 8 13.3 60 *Whooping Cough — 14 — — — - *Measles 1,103 21 1.9 148 13.4 925 *German Measles 147 — — 1 0.68 121 *T uberculosis— Pulmonary (primary) 459 264 57.7 — — — Non-pulmonary (primary) 108 65 60.2 — — — *Chickenpox — - — — — — *Malaria 4 - 0.0 — 0.0 4 *§§Dysentery — 4§ — -- — — *Primary Pneumonia (Acute) 169 69 30.8 51 30.17 166 *Influenzal Pneumonia (Acute) 55 15 27.27 54 *Encephalitis Lethargica (Acute) 2 1 50.0 1 50.0 2 *Trench Fever 1 — — — 0.0 1 *Anthrax - - - - - - * Plague was made compulsorily notifiable on September 19th, 1900, cerebro-spinal fever on March 12th, 1907, polio-myelitis and polio-encephalitis acuta on September 1st, 1911, ophthalmia neonatorum on March 13th, 1911, glanders (human), Anthrax (human), and hydrophobia (human), on April 26th, 1909, pulmonary tuberculosis (poor law cases) on January 1st, 1909, pulmonary tuberculosis (hospital cases) on May 1st, 1911, pulmonary tuberculosis (private cases) on January 1st, 1912, and tuberculosis (pulmonary and non-pulmonary),on February 1st, 1913. Chicken-Pox was compulsorily notifiable as follows : 1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), 1911 (March 22nd to June 22nd), 1915 (March 17th to June 30th) and 1918 (March 27th to June 30th), the numbers of cases notified being respectively, 1,560, 40, 556, 238, 473 and 307. Whooping Cough was compulsorily notifiable from January 1st, 1913, to December 31st, 1917, the numbers of cases notified being as follows:—1913, 1,428 ; 1914, 1,389 ; 1915, 1,607 ; 1916, 1,576 ; and 1917, 902. Measles and German Measles became compulsorily notifiable on January 1st, 1916, acute encephalitis lethargica.on January 1st, 1919, and malaria, dysentery, pneumonia (acute primary and acute influenzal) and trench fever on March 1st, 1919. 6 Measles cases were notified by parents (or relatives), in addition to the 1103 notified cases (mentioned above). Including 1 case of paratyphoid fever. † Including 3 cases of post-basic meningitis. ‡ Including 1 case of polio-encephalitis acuta, which proved fatal. §§ Deaths from dysentery in outside Institutions, the patients not having been notified as Lambeth cases during life. 32 33 TABLE G (1). Shewing the number of medical Certificates (corrected) 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 1923 and during the two years 1921-1922, together with the averages for the three decennia 1891-1900 (Parish), 1901-1910 (Borough), and 1911-1920 (Borough). Disease. Borough of Lambeth. • Annual Average, 1911-1920 (Borough) 10 years. Annual Average, 1901-10 (Borough) 10 years. Annual Average, 1891-1900 (Parish) 10 years.  1921. 1922. 1923. Cholera — — — 0.1 0.2 11.5 Smallpox — 1 — 0.2 49.9 22.0 Scarlet Fever 1,760 1,358 823 904.1 1105.1 1331.3 Diphtheria 543 640 580 482.7 379.8 715.1 Membranous Croup 4 4 4 5.5 10.4 26.2 Typhus — — — 0.0 0.1 1.1 †Typhoid or Enteric 6 18 8 31.9 100.5 189.6 Continued and Relapsing — — — 0.8 4.1 25.7 Erysipelas 125 119 107 175.0 241.4 347.0 Puerperal 29 31 48 21.8 17.0 18.9 *Plague — — — 0.0 0.0 0.0 ‡Cerebro-spinal Fever 9 7 7 18.2 11.5 - *§Poliomyelitis acuta 4 4 10 7.3 - - *Ophthalmia Neonatorum 76 57 60 72.8 - - *Whooping Cough - - - 1380.4 - *Measles 409 3,389 1,103 2354.2 - - *German Measles 215 227 147 635.4 - - *Tuberculosis— Pulmonary (primary) 547 502 459 1112.4 - - Non-pulmonary (primary) 111 102 108 323.7 - - *Chickenpox — — - - - - *Malaria 16 8 4 59.5 - - *Dysentery — 2 - 7.0 - - *Primary Pneumonia (Acute) 192 170 169 161.5 - - *Influenzal Pneumonia (Acute) 48 106 55 126.0 - - *Encephalitis Lethargica (Acute) 18 7 2 7.0 - - *Trench Fever - - 1 0.0 - - *Anthrax (human) — - - 0.1 - * Plague was made compulsorily notifiable on September 19th, 1900 ; cerebro-spinal fever on March 12th, 1907 ; glanders (human), anthrax (human), and hydrophobia (human), on April 26th, 1909 ; polio-myelitis and polio-encephalitis acuta on September 1st, 1911 ; ophthalmia neonatorum on March 13th, 1911 ; pulmonary tuberculosis (poor law cases) on January 1st, 1909, pulmonary tuberculosis (hospital cases) on May 1st, 1911 ; pulmonary tuberculosis (private cases) on January 1st, 1912, and tuberculosis (pulmonary and non-pulmonary) on February 1st, 1913. Chicken-pox was compulsorily notifiable as follows :— 1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), 1911 (March 22nd to June 22nd), 1915 (March 17th to June 30th), and 1918 (March 27th to June 30th). Whooping Cough was compulsorily notifiable from 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, acute encephalitis lethargica on January 1st, 1919, and malaria, dysentery, pneumonia (acute primary and acute influenzal), and trench fever on March 1st, 1919. N.B. Of the patients originally notified during 1923, the following were found afterwards not to be suffering from the diseases notified—Scarlet fever, 1 ; diphtheria, 3 ; typhoid or enteric, 4 ; cerebro-spinal fever, 1 ; puerperal fever, 1; acute primary pneumonia, 1 ; acute influenzal pneumonia, 1 ; and encephalitis lethargica acuta, 1, and are not included in the above table, †Including 1 case of paratyphoid fever. ‡ Including 3 cases of post-basic meningitis. § Including 1 case of polio-encephalitis acuta. 34 35 metropolitan borough of lambeth. TABLE H. Public Health (Tuberculosis) Regulations, 1912. (As amended by the Public Health (Notifications of Infectious Diseases) Regulations, 1918). Summary of Notifications received during the period from 31st December 1922 to the end of the week ending the 29th December, 1923. 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). 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. 5 to 10. 10 to 15. Total. Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. (Medical.) (Medical.) (Medical.) Pulmonary— Males 1 2 2 7 20 26 75 62 46 26 6 273 373 - - 4 249 2 195 Females 0 — 7 3 21 29 53 34 23 12 4 186 270 — — — — — 2 143 2 101 N on-Pulmonary— Males 4 7 13 6 7 6 6 7 1 3 2 62 68 1 1 2 2 2 34 3 30 Females 2 3 3 9 4 4 4 2 2 1 4 38 39 — 2 4 6 6 1 23 2 26 * Re-notifications (Form A)= 184 (males 100, females 84), pulmonary, and 7 † Re-notifications (Form B) = 0 (male 0, female 0), pulmonary, and 0 (male 0, (males 6, females 1) non-pulmonary. N.B.—Pulmonary—152 private, 181 hospitals, 126 dispensaries and 0 schools= female 0)non-pulmonary. Law cases under Form A (hospitals). 459 total primary notifications (Forms A and B), including 110 Poor Non-Pulmonary—18 private, 63 hospitals, 19 dispensaries and 8 schools = Law cases under Form A (hospitals). 108 total primary notifications (Forms A and B), including 18 Poor 36 METROPOLITAN BOROUGH OF LAMBETH. TABLE H (1). Public Health (Tuberculosis) Regulations, 1912. (As amended by the Public Health (Notifications of Infectious Diseases) Regulations, 1918). Summary of Notification Certificates (Forms A, B, C, D,) received during the period from December 31st, 1922, to the end of the week ending December 29th, 1923. Registration Sub-Districts. 1923. Tuberculosis (All Forms). Pulmonary. N on-Pulmonary. a. B. c. D. a. B. C. D. Forms. Primary. Total. Primary. j Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Waterloo 50 66 - - 1 25 1 15 7 7 - — 1 3 1 5 Lambeth Church 33 56 - - — 45 1 30 13 13 3 3 — 6 — 6 Kennington 62 92 - - 2 62 - 42 16 18 3 3 — 8 1 11 Stockwell (Inner) 43 61 - - - 37 -— 28 6 6 — — — 6 — 7 Total Inner Districts 188 275 — — 3 169 2 115 42 44 6 6 1 23 2 29 Stockwell (Outer) 46 57 - - - 50 52 10 12 1 1 1 8 2 6 Brixton 144 201 - - 3 103 - 75 30 31 - - — 19 — 14 Norwood 81 110 - - - 70 2 54 18 20 1 1 1 7 1 7 Total Outer Districts 271 368 — — 3 223 2 181 58 63 2 2 2 34 3 27 Borough of Lambeth 459 643 — — 6 392 4 296 100 107 8 8 3 57 5 56 37 METROPOLITAN BOROUGH OF LAMBETH. TABLE H (2). Addendum to Tables H and H (1). Summary of new cases of Tuberculosis reported during the period from the 31st December, 1922, to the 29th December, 1923, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations 1912, as amended by the Public Health (Notification of Infectious Diseases) Regulations, 1918, e.g., from death returns (patients unnotified before death), from verbal information, notifications furnished by Naval or Military Medical Authorities, outside Medical Officers of Health, etc. 1.—Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 & Upwards. Total, cases. Pulmonary—Males - - - - 5 3 7 10 7 3 - 35 „ Females — — — 1 1 2 2 4 3 — 1 14 Non-Pulmonary—Males — 2 — - 1 — — — 1 1 1 6 „ Females 1 1 — — 1 — — — 1 1 1 6 2.—Registration Sub-Districts. Waterloo. Lambeth Church. Kennington. Stockwell (Inner). Total Inner Districts. Stockwell (Outer). Brixton. Norwood. Total Outer Districts. Borough of Lambeth. Pulmonary 5 9 7 3 24 4 12 9 25 49 Non-Pulmonary 2 1 3 — 6 — 5 1 6 12 N.B.—The above 61 cases are made up as follows :—Death Returns, 47 (Pulmonary, 35 ; Non-Pulmonary, 12) ; Military, 7 (Pulmonary, 7 ; Non-Pulmonary, 0) ; Other sources, 7 (Pulmonary, 7 ; Non-Pulmonary, 0). 38 Tuberculosis. Tables H, H (1) and H (2) set out the summary of the notifications (both compulsorily notified and voluntarily reported or heard of from other sources) received under (a) age periods and (b) registration sub-districts, with reference to pulmonary and other forms of tuberculosis. There has been a steady decrease of official notifications as there has been in connection with the deaths registered from the same disease (vide pp. 21-22). Lambeth Municipal Tuberculosis Dispensaries Scheme. The Lambeth Scheme was completed by the re-organisation and enlargement of the staff in connection with the Central Dispensary (73, Effra Road, Brixton), in 1920 (March-April). The statistics at the Central Dispensary form a satisfactory record of work done under the Council's (a) Tuberculosis Officer Dr. Richardson) and (b) Lady Secretary and Social Worker (Miss D. Scott Baker), and the rest of the staff. Miss Baker still carries out the " after care " organisation in the outer (Southern) Districts of the Borough. The work of the Branch Dispensary Staff under Dr. Hebert and Miss Cummins, the Lady Almoner at St. Thomas's Hospital, and the rest of the Staff, has also been satisfactory. This is work that the Borough Council is responsible for, and which, at present, is being carried out by the Governors of St. Thomas's Hospital at their own expense, such work being co-ordinated with the work of the Council's Public Health Department under the Lambeth Scheme. Miss Cummins is responsible for " after care " organisation of the Inner (Northern) Districts of the Borough. No tuberculosis "care" Committees, as such, have been formed. Arrangements have been completed (temporary arrangements) for the dental treatment of patients, who are suffering from tuberculosis or suspected tuberculosis, and who are recommended for such treatment by one or other of the tuberculosis officers, or by the Medical Officer of Health. These arrangements were not completed until towards the end of 1923 (September). 39 The Lambeth Municipal Tuberculosis Dispensaries Scheme still continues to justify its inauguration by the Council on 3rd October, 1912 (the Scheme being approved by the then Local Government Board in 1913), as shown by statistics; and it is interesting, therefore, to place on record the results up to date, as shown thereby for the whole of the Borough of Lambeth, since the inauguration of the Lambeth Scheme, in the form of (1) death rates, and (2) incidence rates from tuberculosis in the two classifications of (a) pulmonary tuberculosis and (b) tuberculosis (all forms) as follows:— (1) Death Rates (corrected deaths per 1,000 population) :— Borough. Inner Districts Outer Districts Years. Pulmonary Tuberculosis. Tuberculosis (all forms). Pulmonary Tuberculosis. Tuberculosis (all forms). Pulmonary Tuberculosis. Tuberculosis (all forms). 1913 1.2 1.6 1.6 2.1 0.9 1.2 1914 1.3 1.7 1.5 1.9 1.2 1.5 1915 1.4 1.8 1.9 2.3 1.2 1.4 1916 1.4 1.7 1.6 2.1 1.2 1.5 1917 1.5 2.02 2.03 2.7 1.1 1.5 1918 1.5 2.05 1.9 2.6 1.2 1.7 1919 1.2 1.5 1.5 1.8 0.9 1.2 1920 1.01 1.2 1.2 1.5 0.9 1.08 1921 0.9 1.1 1.2 1.4 0.7 0.9 1922 0.9 1.2 1.1 1.4 0.8 1.07 Averages (10 years) 1.2 1.6 1.5 2.0 1.0 1.3 1923 0.8 1.1 0.9 1.2 0.8 0.9 40 (2) Incidence Rates (notified primary cases per 1,000 population) :— Borough. Inner Districts Outer Districts Years. Pulmonary Tuberculosis. Tuberculosis (all forms). Pulmonary Tuberculosis. Tuberculosis (all forms). Pulmonary Tuberculosis. Tuberculosis (all forms). 1913 5.3 6.8 6.6 8.5 4.3 5.6 1914 4.2 5.1 4.4 5.5 4.0 4.9 1915 3.6 4.6 4.6 6.2 2.8 3.5 1916 3.2 4.5 3.5 4.8 2.9 4.2 1917 3.9 5.6 3.9 5.5 3.9 5.7 1918 4.0 5.4 4.5 5.9 3.7 5.0 1919 2.3 3.2 2.5 3.2 2.2 3.1 1920 2.4 2.8 2.1 2.6 2.6 2.9 1921 1.8 2.1 1.9 2.4 1.6 1.9 1922 1.6 1.9 1.9 2.2 1.5 1.8 Averages (10 years) 3.2 4.2 3.6 4.7 2.9 3.9 1923 1.5 1.8 1.5 1.9 1.4 1.8 The clerical work connected with the Tuberculosis Department is increasing on account of the different records, etc., that have to be kept. The systematic visiting of patients at their homes is in need of development at the Branch Dispensary, and negotiations by the Council with St. Thomas's Hospital Governors are in hand, with a view to the appointment of an additional officer, viz.: an Assistant Tuberculosis Medical Officer, for visiting purposes, for that Dispensary, in connection with which there is at present no home visiting of patients by the Tuberculosis Medical Officer. Consultations with medical practitioners during 1923 were held by the Tuberculosis Medical Officer of the Central Dispensary as follows:— Insured. Uninsured. Total. Consultations at patient's homes 47 23 70 Other consultations 134 69 203 Totals 181 92 273 41 With 10 exceptions (7 insured and 3 non-insured), the consultations had reference to patients living in the Outer (Southern) Districts of the Borough, the area over which the Central Tuberculosis Dispensary has jurisdiction, the 10 exceptions having reference to patients living in the Inner (Northern) Districts, 6 home consultations (5 insured and 1 uninsured) and 4 others (2 insured and 2 uninsured). With the appointment of an Assistant Tuberculosis Medical Officer to help the Tuberculosis Officer of the Branch Tuberculosis Dispensary (St. Thomas's Hospital), it is expected that systematic medical visits to the homes of the patients will be carried out, and that much valuable information will be obtained with regard to " contacts," and the conditions under which such " contacts " are living. This additional medical officer is found to be necessary owing to the original Lambeth Municipal Tuberculosis Dispensaries Scheme having exempted (at the request of the St. Thomas's Hospital Governors) the Tuberculosis Medical Officer at the Branch Tuberculosis Dispensary (St. Thomas's Hospital) from visiting the patients of the Inner Districts at their homes. In the early stages of the scheme it was thought that the Tuberculosis Medical Officer of the Central Dispensary would have time to visit all the patients throughout the Borough. As the scheme got working, this has been found not to be practicable. 42 42 TABLE I. Lambeth Municipal Tuberculosis Dispensaries Scheme. (Inaugurated by the Council, October 3rd, 1912.) Local Government Board Table—FORM R. (revised). Return (Prepared by the Tuberculosis Officer) as to Work carried out in connection with the central dispensary for the year 1923. N.B.—The Central Dispensary (73, Effra Road, Brixton) was opened July 23rd, 1913. Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examin'd for the first time during the year. Total Found to be— Under observation at the Dispensary on Dec. 31 pending diagnosis. Ceased atte'dance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tubercul'sis. Pulmonary. NonPul monary. (a) All persons (including " Contacts ") Adults M. 42 223 265 96 4 140 16 9 F. 15 214 229 63 142 18 6 Children under 15 M. 19 102 121 5 10 91 14 1 F. 10 89 99 2 10 71 14 2 Total 86 628 714 166 24 444 62 18 (b) " Contacts " (included in (a)). Adults M. 3 41 44 8 33 2 1 F. 10 95 105 14 • — 80 8 3 Children under 15 M. 8 57 65 1 1 53 10 — F. 5 51 56 1 3 41 9 2 («) Insured persons (included in (a)) { M. 38 185 223 73 2 125 15 8 F. 2 95 97 24 68 4 1 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 333 in respect of insured patients under domiciliary treatment during the year 4 7. Number of persons referred to affiliated hospital for consultation 70 2. Total number of attendances of patients at the Dispensary during the year— 8. Number of consultations with medical practitioners at the homes of patients— Insured Uninsured 1,857 3,138 Insured Uninsured ... 47* 23* 3. Number of persons placed during the year under observation at the Dispensary for 199 9. Number of other visits paid by Tuberculosis Officers to the homes of patients ... 80 4. Number of cases in which the period of observation at the Dispensary exceeded two months 35 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes ... 2,019 5. Number of insured patients under domiciliary treatment on December 31st ... 457 11. Number of specimens of Sputum examined in connection with the work of the Dispensary ... 729 6. Number of reports received from Insurance Practitioners N.B.—Dr. E. D. Richardson was appointed Tuberculosis Officer (Central Dispensary) on October 16th, 1919. * Including 6 patients (insured 5, uninsured 1) in the Inner Districts, connected with the Branch Dispensary. TABLE I. (Continued). 43 Lambeth Municipal Tuberculosis Dispensaries Scheme. (Inaugurated by the Council, October 3rd, 1912.) Local Government Board Table—FORM R (Revised). Return (Prepared bv the Tuberculosis Officer) as to Work carried out in connection with the branch dispensary for the year 1923. N.B.—The Branch Dispensary (St. Thomas's Hospital) was opened February 3rd, 1913. Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examin'd for the first time during the year. Total Found to be— Under observation at the Dispensary on Dec. 31 pending diagnosis. Ceased att'ndance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tubercul'sis. Pulmonary. NonPul monary. (a) All persons (including " Contacts ") Adults M. 7 244 251 91 14 140 5 1 F. 8 223 231 60' 8 161 2 — Children under 15 M. — 73 73 1 6 65 — 1 F. 2 58 60 2 6 51 — 1 Total 17 598 615 154 34 417 7 3 (b) " Contacts " (included in (a)) Adults M. - 30 30 4 2 24 - — F. — 62 62 4 — 58 — — Children under 15 M. — 36 36 — — 36 — — F. — 26 26 — — 26 — — (c) Insured persons (included in (a)) { M. 3 192 195 77 10 102 5 1 F. 2 75 77 27 4 45 1 - 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 407 in respect of insured patients under domiciliary treatment during the year 21 7. Number of persons referred to affiliated hospital for consultation 374 2. Total number of attendances of patients at the Dispensary during the year— 8. Number of consultations with medical practitioners at the homes of patients— Insured 1,971 Uninsured 2,953 Insured —* 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 113 Uninsured -* 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 4. Number of cases in which the period of observation at the Dispensary exceeded two months 3 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2,266 5. Number of . insured patients under domiciliary treatment on December 31st 67 11. Number of specimens of Sputum examined in connection with the work of the Dispensary 438 6. Number of reports received from Insurance Practitioners N.B.—Dr. G. T. Hebert was appointed Tuberculosis Officer (Branch Dispensary) on January 6th, 1920. * Six patients (insured 5, uninsured 1) were visited for consultation purposes by the Central Dispensary's tuberculosis medical officer. 44 Dental Treatment of Tuberculosis Patients. In September, 1923, arrangements were completed for the inauguration of the scheme for the dental treatment of tuberculosis patients, such treatment to be given with the consent of the Ministry of Health, on a co-operative system, in connection with certain of the Maternity and Child Welfare Centres, where Dental Clinics had already been established. Precautionary measures were taken to prevent any possible danger of infection being spread, though it was unfortunate that independent and separate dental clinics for tuberculosis patients could not be provided, on account of the need for national and local economy. The two particular Dental clinics chosen were those connected with (a) the Moffat Institute Welfare Centre (for the inner districts) and (b) the Brixton Welfare Centre (for the outer districts). Sessions are held fortnightly, separately and distinct, and on different days and at different hours, from the Welfare patients, and the tuberculosis patients treated are limited to those certified by a tuberculosis officer, or the Medical Officer of Health, as requiring dental treatment in connection with the particular disease from which they are suffering (tuberculosis). The Moffat Institute Welfare Centre Dental Clinic commenced work on the 10th September, 1923, and the Brixton Welfare Centre Dental Clinic on the 5th September, 1923. The fees to be charged are as follows :- Extraction (without gas) 2/6 per tooth Extraction (with gas) 5/0 „ Scaling 2/6 „ Filling (simple) 2/6 to 5/0 „ Filling (with root treatment) 12/6 „ Denture (upper or lower) £2 10 0 each denture. Denture (upper and lower) £4 4 0 to £5 5 0 complete set. The dental scheme for tuberculosis patients was approved by the Borough Council on the 21st September, 1922, and was finally 45 approved by the Ministry of Health on the 9th March, 1923, subject to the maximum payment of 5/- per case per attendance, with an additional 5/- when an anaesthetic is administered, for an experimental period of 12 months, on the condition that such records would be kept as would enable a comparison to be made between the cost proposed by the Ministry of Health and the scale as now fixed. The scale previously proposed by the Ministry of Health was a flat rate or uniform charge of 5/- per case per attendance, with an additional charge of 5/- when an anaesthetic is administered. The London County Council also approved the scheme for dental treatment of tuberculosis patients on the 19th March, 1923 on the same conditions and under the same terms as the Ministry of Health. 46 47 TABLE J, Local Government Board, Table. BOROUGH OF LAMBETH. - Particulars of cases of acute polio-myelitis (polio-encephalitis), cerebrospinal fever (postbasic meningitis) and encephalitis lethargica acuta notified within the Borough of Lambeth during 1923. Total number of Cases notified. NUMBER OF CASES. 0-1 year. 1-5 years. 5-10 years. 10-15 years. 15-20 years. 20-30 years. Over 30 years. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis.* Cases Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis.* Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis * Cases. Deaths. Permanent Paralysis.* †Acute Polio-myelitis (Polio-encephalitis) 10 — - - - - - 3 - 3 1 - 1 1 1 - - - - 1 - 1 2 - 1 - - - 1 1 - 1 - 1 - - - - - - - - Cerebro-Spinal Fever 4 - - 1 - - 2 2 - 1‡ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Post-Basic Meningitis 3 2 1 1 1 - - - - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Encephalitis lethargica 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Number of cases removed to Isolation Hospital. *i.e., Recovered. †Notified in 1922 ‡9 cases of acute with permanent Paralysis of one or more groups of muscles (slight paralysis of ciliary muscles and accommodation). (December), and died in 1923 (January). polio-myelitis and 1 of acute polio-encephalitis (fatal). Acute Polio-myelitis (Polio-encephalitis) — - 1 1 1 - 1 1 - 1 1 - - - Cerebro-Spinal Fever - 1 2 — — — - - - - - 1 - - Post-Basic Meningitis 2 - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - 1 - 48 2.—Non-Notifiable Diseases. Chickenpox. 820 cases of chickenpox were notified voluntarily. Diarrhœa. The number of corrected deaths registered from diarrhœa is 46, as compared with yearly averages of 191.6, 219.4, 208.6, 140.2, 178.2, and 77.4 during the six quinquennia 1891-1895 (Parish), 1896-1900 (Parish), 1901-1905 (Borough), 1906-1910 (Borough), 1911-1915 (Borough), and 1916-1920 (Borough) respectively. Of the 46 deaths registered, 41, i.e., 89.1 per cent., occurred amongst children under 5 years of age, and 30, i.e., 65.2 per cent., amongst infants under 1 year of age. The decrease in the number of diarrhœa deaths during 1923 is remarkable. The 4 ft. earth thermometer first registered 56°F. on July 2nd. rising to a maximum of 63.5°F. on August 18th, and remaining at such maximum only for three days, sinking to 56°F. again on October 14th. The summer of 1923 was a very late one, and the numbers of cases of summer diarrhœa and deaths therefrom were consequently and correspondingly reduced. The inter-relationship between this particular disease and the 4 ft. earth temperature has long been noted, and so much so that the latter is known as the critical earth temperature in connection with all diarrhœal diseases, being the temperature at which the particular germ or germs that are the cause or causes of diarrhœal diseases, especially of infantile zymotic, or summer, diarrhœa, take on virulence and become so fatal to infants and young children. Apart from meteorology, other causes of an increased diarrhœal rate are to be found in the improper and irregular feeding of infants and young children. The readings of the 4 ft. earth thermometer were taken in Regent's Park, and the information is obtained through the courtesy of the Curator of the Royal Botanic Society of London. 19 corrected deaths (10 infants under 1 year of age) were registered from enteritis. 49 Practical measures were taken to prevent epidemic diarrhœa (and other diseases) in infants and young children, 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 of children under 2 years of age were registered as having occurred from epidemic diarrhoea or other diseases. (b) Teaching of proper feeding and care and management of infants at the Infants Consultations Centre connected with the Municipal Milk Depot, 66, York Road, Westminster Bridge Road, and at the various Voluntary Consultations Welfare Centres, which are comprised within the Lambeth Maternity and Child Welfare Scheme, by the Medical Officers and Staffs attached thereto. (c) Feeding of Infants and young children at the Municipal Milk Depot, 66, York Road, Westminster Bridge Road, and through the various Voluntary Welfare Centres, in connection with the Council's Milk Assistance Scheme, approved by the Ministry of Health, under the Maternity and Child Welfare Acts, 1918. (d) Issuing of special leaflets on breast feeding and artificial feeding of infants, and of leaflets and posters during the summer dealing with (1) precautions to be taken against summer diarrhoea, (2) the danger of the areas of infection and the contamination of food by flies, (3) the importance of removing at once all accumulations of refuse and other offensive matters from the neighbourhood of dwellings, (4) the value of cleanliness generally, &c. (e) Voluntary notification of cases of diarrhœa and the free nursing of the patients as required under the Lambeth Nursing (Infectious Diseases) Scheme. (f) The work at the Cornwall Nursery Hostel (Prince's Road), which is provided with observation wards for ailing infants and young children, suffering from dietetic or nutritional diseases. 50 Influenza. 40 corrected deaths were registered from Influenza during 1923, as compared with 156, 59, 93, 293 and 819 during 1922, 1921, 1920, 1919 and 1918 respectively. The full details of the age and sex distribution of the 156 deaths are as follows :- Under 1 Year. 1 to 2 2 to 5 Under 5 Years. 5 to 15 15 to 20 20 to 25 25 to 40  m. f. m. f. m. f. m. f. m. f. m. f. m f. m. f. 3 2 - - - - 3 2 - - - 2 3 2 1 1 40 to 45 45 to 60 60 to 65 65 and over. Over 5 Years All Ages. Total. m. f. m f. m. f. m. f. m. f. m. f. 40 1 - 6 4 1 - 4 10 16 19 19 21 55 cases of acute influenzal pneumonia were officially notified.* 3.—"Contacts" or "Suspects," "Carriers," etc., from Abroad or from Districts outside Lambeth Borough. " Contacts " or " Suspects," " Carriers," etc., were watched in connection with different diseases as follows :-Smallpox, 21 ; cholera and plague, 2 ; plague, 10 ; and typhoid fever, 3. Outbreaks of Infectious Diseases in Institutions. During the summer 1923, two outbreaks of infectious disease occurred in holiday camps, viz., diphtheria in Surrey and scarlet fever in Kent—in the former 3 cases out of 26 and in the latter 3 cases out of 24. Both camps were broken up, disinfection was carried out, and the scouts, cubs and officers returned to Lambeth Borough, where they were kept under medical inspection during the respective incubation periods of the diseases. * 169 cases of acute primary pneumonia were also notified during 1923. 51 Municipal Bacteriological Laboratory. (Inaugurated by the late Vestry, 1899.) Table shewing the numbers of pathological samples examined (total 824), and the results obtained, at the Bacteriological Laboratory during 1923 and the previous 5 years 1918-1922, together with the averages for the two decennia 1901-1910 (Borough) and 1911-1920 (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.  Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 1923 17 218 235 1 14 15 7 564 571 1 2 3* 1922 26 248 274 — 11 11 15 682 697 5 2 7 1921 31 225 256 1 17 18 15 719 734 1 1 2 1920 21 280 301 3 11 14 12 697 709 3 9 12 1919 45 315 360 7 14 21 21 487 508 - 12 12 1918 70 299 369 2 10 12 14 354 368 - 2 2 Averages of 10 years (a) 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 (b) 1911-1920 (Borough) 190.2 404.0 594.2 11.2 22.3 33.5 58.2 597.8 656.0 5.6 12.3 17.9 * Smearings from eyes for gonococcus (2 negative), and uterine discharge for blood (1 positive). 78 vials of antitoxin were distributed free of cost, under the Antitoxin Order, 1910. N.B.-Since the Bacteriological Laboratory was inaugurated in 1899 (up to end of the year 1923), 25,875 examinations have been conducted there in connection with the following suspected diseases, viz. :-tuberculosis 9,258 ; typhoid or enteric fever, 1,208 ; diphtheria, 15,059 ; and others, 350. 52 53 TABLE K. TABLE K [Local Government Board Old Table A.] Table of DEATHS during the year 1923 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public in stitutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Smallpox. Scarlatina. Diphtheria. Fevers Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cer-Spin., Polio. and Encephalitis. 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) 77 41 14 7 4 1 2 7 1 under — — — — — — — — 10 1 1 15 1 — — — 1 33 62 5 upwds. — — — —— — — — — — — 1 — — — — — — 10 l5 General Lying-in Hospital, York Road 18 13 — — — 2 3 — Under 5 — — — — — — — — — — — — — — — — — 13 13 — 5 upwds. — — — 2 — — — — — — — — — — — — — 3 5 St. Thomas's Hospital 502 62 16 25 28 47 119 169 36 Under 5 — — — — — 2 — — 6 — 3 18 — — 9 2 2 61 103 5 upwds. — 1 2 1 — — — — 5 v 17 35 — 2b 2 13 290 399 Remainder of Lambeth Church 251 25 11 1 5 17 34 83 75 Under 5 — — — — — — 2 2 2 — — 8 — — 5 1 — 17 37 5 upwds. — — — — — — — — 1 — 18 51 39 4 28 — — 73 214 Lambeth Workhouse — — — — — — — — — Under 5 — — — — — — — — — — — — — — — — — — — 5 upwds. — — — — — — — — — — — — — — — — — — — Lambeth Infirmary 783 46 5 4 11 34 102 256 325 5 under — — 1 3 — 10 4 — — 1 36 55 5 upwds. — — — 8 — — — — — 4 85 120 108 4 40 — 4 355 728 St. Peter's House 28 — — — — — 2 26 Under 5 — — — — — — — — — — — — — — — — — — — 5 upwds. — — — — — — — — — — — 4 9 — — — — 15 28 Remainder of Kennington 256 32 6 3 4 7 21 80 103 5 under — — 1 1 2 — — 13 1 — 1 — — 22 41 5 upwds. — — — — — — — — — 2 11 59 48 6 7 — — 82 215 South-Western Hospital 108 8 19 33 31 6 9 2 — Under 5 — 11 27 — — — 13 4 1 — — 1 — — 1 1 — 1 60 5 upwds — 7 24 2 5 — — 1 — — — 1 1 1 — 2 — 4 48 Clapham Maternity 9 7 — — — — 2 — — 5 under — — 2 — — — — — 5 7 5 upwds. — — — — — — — — — — — 2 — — — — — — 2 Remainder of Stockwell 371 54 8 7 2 8 30 00 162| 5under — — — — — 4 — 9 — — 16 1 — 2 — — 37 69 5 upwds. — — — — — — — — — 2 27 69 65 7 5 1 1 125 302 54 55 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1923 in the Borough of Lambeth, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Smallpox. Scarlatina. Diphtheria. Fev ers. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis,Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. Cer.-Spin., Polio., and Encephalitis. Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) King's College Hospital 286 38 9 7 19 23 52 100 38 Under 5 — — 1 — — — — 1 5 1 1 4 - — 5 2 1 33 54 5 upwds. 13 — — Belgrave Hospital 108 78 16 7 7 — — — — Under 5 — — 2 1 1 — — — 1 2 1 12 30 — 11 158 232 5 upwds — — — — — — — — 8 — — 26 — — 2 2 — 63 101 Ministry of Pensions Hospital 7 — — — — 1 3 3 — Under 5 — — — — — — — — — — — — 2 — — — 1 4 7 5 upwds. — — — — — — — — — — — — — — — — — — — Remainder of Brixton 517 52 10 6 4 18 57 120 250 Under 5 — — — — — — 2 2 — — — 10 2 1 — 2 7 — — 3 46 7 68 5 upwds. — — — — — — — — — 4 40 98 89 7 12 — — 199 449 Lambeth Workhouse Schools 46 23 12 3 6 2 — — — Under 5 — — — — — — 1 1 10 — — 13 — — — — — 13 38 5 upwds. — — — — — — — 1 10 2 2 2 — — — — — 2 8 British Home for Incurables 14 — — — — — — 5 9 Under 5 — — — — — — — — — — — — — — — — — — — 5 upwds. — — — — 2 1 — — — 11 14 Remainder of Norwood 467 39 2 5 5 8 32 94 282 Under 5 — — — — — — 1 1 1 — — 7 3 1 3 — — 29 46 5 upwds. — — — — — — — — — 3 30 63 113 4 11 — 2 195 421 Totals 3848 518 128 108 126 174 466 1021 1307 Under 5 — 11 28 — 3 24 12 57 2 5 143 7 5 35 8 5 409 754 5 upwds. — 7 27 15 7 — — 1 2 24 222 498 1530 34 161 5 32 1529 3094 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 585 27 12 22 16 36 99 183 190 Under 5 — 3 7 — — — 5 6 2 — — 8 — — 2 — — 28 61 5 upwds. — 7 1 — — — — 4 1 58 39 81 2 43 — 11 277 524 Deaths occurring within the district among persons not belonging thereto 951 188 48 44 55 70 174 265 107 Under 5 — 6 14 — — 1 8 4 18 2 4 37 2 — 9 5 3 166 79 5 upwds. — 4 7 8 6 — — 1 1 3 17 35 59 1 63 3 15 449 672 56 TABLE L. Table of Civil Population, Total Registered Births and New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health (by notification), during the year 1923, in the Borough of Lambeth, classified according to Diseases and Localities. [Local Government Board Old Table B.] Population at all Ages. Total Registered Births 1923. (52 weeks) New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health during 1923. Registration SubDistricts. Census 1921. Estimated 1923 (middle of year). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. †Cerebro-spinal Fever. †‡ Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. Trench Fever. Typhoid or Enteric Encephalitis Lethargica. Puerperal. (a) (b) (c) (d) Lambeth Church 45617 45730 2321 — 124 120 — 3 1 8 27 — 1 8 342 32 27 8 — — Kennington 44957 44820 1204 — 80 123 — 1 1 12 19 1 — 8 181 22 26 3 — — Stockwell 63806 65140 1664 — 111 96 2 1 — 7 25 2 2 21 180 36 37 17 1 — Brixton 81262 83420 1971 — 315 127 1 1 — 17 24 4 5 19 208 46 46 19 2 1 Norwood 67318 69390 1184 — 193 114 1 2 — 4 12 — 2 4 192 11 33 8 1 — Totals 302960 308500 8344 — 823 580 4 8 2 48 107 7 10 60 1103 147 169 55 4 1 * Including 1 case of paratyphoid fever, † Including 3 cases of post-basic meningitis. ‡ Including 1 case of polio-encephalitis acuta. 57 TABLE L (continued). Population at all Ages. Total Registered Births 1923. (52 weeks) Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1923. Registration SubDistricts. Census 1921. Estimated 1923 (middle of year). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. †Cerebro-spinal Fever. ‡ Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. Trench Fever. Typhoid or Enteric. Encephalitis Lethargica. Puerperal. Lambeth Church 45617 45730 2321 — 122 120 — 2 — 7 10 1 1 50 — 12 6 — — Kennington 44957 44820 1204 — 77 119 — 1 1 12 6 1 — 1 15 — 8 — — — Stockwell 63806 65140 1664 — 104 94 2 1 — 7 7 1 2 1 15 — 13 5 — — Brixton 81262 83420 1971 — 295 127 1 — — 17 7 4 3 4 8 1 14 3 — — Norwood 67318 69390 1184 — 178 108 1 1 — 4 4 — 1 1 60 — 4 1 1 — Totals 302960 308500 8344 — 776 568 4 5 1 47 34 6 7 8 148 1 51 15 — — *Including 1 case of paratyphoid fever, † Including 2 cases of post-basic meningitis. ‡ Including 1 case of polio-encephalitis acuta. N.B.—In addition to the above new cases of infectious sickness coming to the knowledge of the Medical Officer of Health by compulsory medical notification under the Notification Clauses of the Public Health (London) Act, 1891, or the Orders and Regulations made thereunder, the following cases were reported voluntarily, viz.: Chicken Pox 820, Measles 320, Cancer 105, and Whooping Cough 441. 58 Local Government Board New Tables. TABLE I. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1923 AND PREVIOUS FIVE YEARS (1918-22). Births. Total Deaths registered in district. Transferable Deaths.‡ Nrtt Deaths belonging to the District. Year. Population estimated to Middle of each Year. Uncorrected. Number. Nett. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Nett Births. Number. Rate Number. Rate. 1 2 3 4 5 6 7 t 8 t 9 10 11 12 13 §1918 262275 6390 4296 16.5 6310 24.0 2158 878 449 104.5 5030 19.2 §1919 282322 7596 5687 20.1 4932 17.5 1371 671 483 84.9 4232 14.9 §1920 293572 10456 8089 27.5 4332 14.7 1177 702 554 68.5 3857 13.1 §1921 305700 8993 6644 21.7 4195 18.7 1164 684 511 76.9 3715 12.1 §1922 307000 8449 6364 20.7 4445 14.5 917 724 500 78.6 4252 13.8 1923 308500 8344 6195 20 1 3848 12.5 951 650 359 57 9 3547 11 5 §N.B.—The populations estimated for 1918, 1919, 1920 and 1921 are the civil populations only. Notes.—This Table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1000 of the estimated gross population, and no deductions have been made from the population for large Public Institutions for the sick or infirm. For Column 4 the Registrar-General has furnished a statement of the number of births needing to be added to or subtracted from the total supplied by the local Registrar (2382 outward and 233 inward transfers). *In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the Borough. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. † Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph. The Registrar-General supplied the particulars of extra transferable deaths (65) to be entered in Column 9; and all such deaths are included in this Column, unless an error has been detected, and its correction has been accepted by the Registrar-General. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances. In Column 8 the number of transferable deaths of "non-residents" which are deducted and in Column 9 the number of deaths of "residents" registered outside the district which are added are stated in calculating the nett death-rate of the Borough. Census, 1921. Area of Borough in acres (including land and inland water), 4083. Average number of persons per house (estimated), 71. Number of inhabited houses, 42607. Total population at all ages, 302868. 59 Local Government Board New Tables. TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1923. Number of Cases Notified. Total Cases Notified in each locality. (e.g., Parish or Ward) of the District. total cases removed to hospital. Notifiable disease. At all Ages. At Ages—Years. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwds. Small-pox — — — — — — — — — — — — — — Cholera — — — — — — —__— — — —_ — — Diphtheria (including Membranous Croup) 584 15 193 245 72 54 4 1 120 123 98 128 115 568 Erysipelas 107 3 7 9 12 25 39 12 27 19 25 24 12 34 Scarlet Fever 823 7 233 474 66 40 3 — 124 80 111 315 193 776 Typhus Fever — — — — — — — — — — — — — — Enteric Fever (1 paratyphoid fever) 8 — — 3 3 1 1 — 3 1 1 1 2 5 Relapsing Fever — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — Puerperal Fever 48 — — — 12 35 1 — 8 12 7 17 4 47 Plague — — — — — — — — — — — — — Pulmonary Tuberculosis* 459 1 2 19 96 224 107 10 83 62 89 144 81 — Other Forms of Tuberculosis † 108 6 10 39 21 19 7 6 23 19 17 30 19 — Cerebro-spinal Fever (3 post-basic meningitis) 7 4 2 — 1 — — — — 1 2 4 — 6 Polio myelitis acuta (1 polio-encephalitis acuta) 10 — 4 4 2 — — — 1 — 2 5 2 7 Encephalitis Lethargica 2 — — 1 — 1 — 1 1 — — — 1 Ophthalmia Neonatorum 60 60 — — — — — — 8 8 21 19 4 8 Measles § 1103 69 659 350 18 6 — 1 342 181 180 208 192 148 German Measles 147 14 43 75 12 3 — — 32 22 36 46 11 1 Malaria 4 — — — 2 1 1 — — — 1 2 1 — Trench Fever 1 — — — — — 1 — — — — 1 — — Primary Pneumonia 169 9 5 19 25 43 52 16 27 26 37 46 33 51 Influenzal Pneumonia 55 — 1 5 11 16 14 8 8 3 17 19 8 15 60 Local Government Board New Tables. Table III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1923. BOROUGH OF LAMBETH. Causes or 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. and under 15 years. 15 and under 25 years. 25 and under 45 years. 5 and under 65 years. 65 and up- wards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) Uncertified 3547 3531 356 92 87 89 149 411 955 1352 1986 16 3 — — — — 1 2 10 Typhus Fever 1 — — — — 1 — — — — *Enteric Fever 1 — — — — 1 — — — 7 Continued Fever — — — — — — — — — — Small-pox — — — — — — — — — — Measles 21 5 8 8 — — — — 18 Scarlet Fever 11 — — 8 2 — 1 — — 18 Whooping Cough 14 7 5 2 — — — — — 8 † Diphtheria and Croup (See note (d)) 48 1 2 18 25 — 2 — — 55 Influenza 40 5 — — — 7 3 11 14 10 Erysipelas 2 1 1 — — — — — — 2 *Cerebro-Spinal Fever 5 2 — 3 — — — — — 9 *Polio-myelitis acuta 2 — — — 1 1 — — — 2 Encephalitis Lethargica 1 — — — — 1 — 1 — — — Venereal Diseases 16 5 — — — — 5 5 — Phthisis (Pulmonary Tuberculosis) 277 — — 1 4 62 122 78 10 101 Tuberculous Meningitis (See note (e) 17 5 4 1 3 2 2 — — — Other Tuberculous Diseases 53 1 1 2 4 14 18 10 3 — Rheumatic Fever 23 — — — 6 4 8 3 2 15 Cancer, malignant disease (Set note (f) 415 — — 2 2 2 34 193 182 — Bronchitis 323 21 2 1 14 78 20' ^ 247 Broncho-Pneumonia 141 35 29 12 2 2 3 20 3{ Pneumonia (all other forms) 154 7 9 2 3 3 24 60 4( Other diseases of Respiratory organs 42 3 — 1 — — 7 18 K J ,,, Diseases of Circulatory System 563 4 — 1 7 13 48 163 32' 177 Diseases of Nervous System ... 322 9 3 3 6 2 27 95 17' — Diarrhoea (See note (g) 47 30 11 1 — — 1 2 2 44 Enteritis 21 10 1 — — — 1 4 Appendicitis and Typhlitis 30 — 1 1 4 6 5 10 3 34 Alcoholism (See note (h)) 4 — — — — — 1 3 — — Cirrhosis of Liver 22 — — — — — 1 11 10 — Nephritis and Bright's Diseases 111 1 1 — 1 3 18 46 4 15 Puerperal Fever (See note (i) 8 — — — — — 7 1 — Other accidents and diseases of Pregnecy and Parturiton 5 — — — — 1 4 — — — Congenital Debility and Malformation, in cluding Premature Birth (See note (i) ... 163 151 5 3 1 3 — — — Violent Deaths, excluding Suicide 137 15 4 10 4 11 21 38 34 115 Suicides 43 — — — — 1 11 24 — Other Defined Diseases 455 39 7 8 12 8 28 84 269 1109 Diseases ill-defined or unknown 10 2 — — — 1 1 2 Notes to Table iii. (a) All " Transferable Deaths "of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term" transferable deaths"see footnote toTable 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 Hvdrocephalus. (/) Under"Cancer" are included deaths under such headings as Carcinoma Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. (g) Under this heading are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Choleraic diarrhoea, Cholera (other than Asiatic), Gastro-enteritis, Gastro-intestinal catarrh, Muco-enteritis, Colitis, etc. Deaths from Diarrhoea secondary to some other well-defined disease are included under the latter. (h) Under this heading are included deaths from Delirium tremens, acute and chronic alcoholism, etc., but not those certified as due to organic disease attributed to alcoholism. The number of the latter may with advantage be stated separately, though this statement cannot be included in Table III. (i) Under "Puerperal Fever" are included deaths under such headings as Pyaemia, Septicaemia, Sapraemia, Pelvic peritonitis, Peri- and Endometritis 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. * Including Paratyphoid fever, Post-Basic Meningitis and Polio-encephalitis acuta respectively. † No deaths registered from Croup. 62 Local Government Board New Tables. TABLE IV. BOROUGH OF LAMBETH—INFANTILE MORTALITY, 1923 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 113 25 21 10 69 53 57 37 38 356 Uncertified 1 — — — 1 2 —" — — 3 Chicken Pox — — — — — — 1 1 3 2 Measles — — — — — — — — — 1 Diphtheria — — — — — — — 1 4 7 Whooping Cough — — — — — l 1 8 4 30 Diarrhoea — — 1 — — — — — — — Enteritis — — — — — 4 4 1 2 10 Influenza 1 1 — — — — — — — 5 Cerebro-Spinal Fever* — — — — — — 2 1 — 2 Phthisis Tuberculous Meningitis — — — 1 — 2 l 1 5 Other Tuberculous Diseases — — — — — — 1 — 1 1 Peritonitis (Pneumocosial) — — — — — 1 — — 1 i Congenital Malformations 10 3 3 1 17 4 2 1 26 2b Premature Birth 66 8 6 3 83 12 1 — — 96 Atrophy, Debility and Marasmus 9 1 2 2 14 6 7 l 1 29 Atelectasis 5 2 — — 7 1 — l — 9 Erysipelas — — 1 — 1 — — — — 1 Syphilis — 1 — — 1 3 1 — — 5 Rickets — — — — — — — — 1 1 Meningitis (not Tuberculous) — — — — — 1 — — — 1 Laryngitis — — — — — — — — 1 1 Convulsions 2 2 1 — 5 — — — 1 6 Gastritis 1 — — — 1 — 1 Intussusception (acute) — — — — — — 1 2 3 Dentition — — — — — — — 3 1 4 Dermatitis — 1 — — 1 1 — — — 2 Bronchitis 1 1 3 3 8 3 3 4 3 21 Pneumonia — — — — — — 1 — 1 2 Broncho Pneumonia 1 1 — — 2 6 12 9 6 35 Pleuro „ — — — — — 3 1 — — 4 Empyema — — 1 — 1 — 1 — — 2 Stomatitis — — — — — — 1 — — 1 Suffocation, overlaying 4 — — — 4 1 2 — — 7 Accident, other than Suffocation 3 — 1 — 4 — 1 1 — 6 Nephritis (Acute) — — — — — — — — 1 1 Icterus Neonatorum 2 2 — — 4 1 — — — 5 Septicaemia, Pyaema — — 2 — 2 — — — — 2 Otitis and Mastoiditis — — — — — 1 — 1 1 3 Other causes not classified above 9 2 — 1 12 1 — 1 2 16 Totals 114 25 21 10 170 55 57 37 38 359 * These are cases of post-basic meningitis. 64 65 LAMBETH BOROUGH.—Corrected Deaths registered from all causes during the year, 1923. Note—The Deaths of Non-Residents occurring in Public tions in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are inculed. (A.) REGISTRATION SIB-DISTRICTS. Sub-Districts. Sub-Districts. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. All Ages. Total. M. F. M. F. M. F. I. Specific Febrile,or Zymotic Diseases 17 24 24 33 M. F. M. F. M. F. II. Parasitic Diseases — — — — 22 24 22 26 18 16 103 123 226 III. Dietetic Diseases — — — 1 — — — — — — — — — IV. Constitutional Diseases 88 47 65 67 — — — — — 2 — 3 3 V. Development Diseases 18 19 32 27 74 79 110 117 78 93 415 403 818 VI. Local Diseases 183 142 174 173 35 42 31 49 17 23 133 160 293 VII. Deaths from Violence 26 16 15 8 198 154 242 244 204 217 1001 930 1931 VIII. Deaths from Ill-defined and not 23 10 26 20 lb 10 105 64 169 Specified Causes 2 2 5 2 4 4 12 6 2 3 25 17 42 Totals 334 250 315 311 356 313 443 462 334 364 1782 1700 3482 (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. 30 30 15 12 16 24 61 66 10 18 II. Parasitic Diseases — — — — — — — — — — 1 3 4 2 1 13 2 1 11 7 3 — 10 13 42 57 103 123 226 III. Dietetic Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — IV. Constitutional Diseases 2 5 3 4 5 4 10 13 10 10 — — — — — 1 — — — 2 — — — — — 3 — 3 3 V. Developmental Diseases 71 60 2 2 1 73 63 — 1 13 21 18 26 68 57 27 28 120 93 46 41 103 114 405 390 415 403 818 VI. Local Diseases 67 47 31 18 16 8 114 73 23 11 2 — 1 — — — — — — — — 1 57 95 60 97 133 160 293 VII. Deaths from Violence 6 8 1 3 8 2 15 13 3 1 14 6 6 12 57 57 29 21 199 149 116 91 443 510 887 857 1001 930 1931 VIII. Deaths from Ill-defined and not 3 2 3 2 10 10 7 1 31 13 13 1 20 21 90 51 105 64 169 Specified Causes 20 11 1 2 — — 21 13 — — — — 1 — — — 1 1 1 1 3 4 4 25 17 42 Totals 196 161 51 41 47 39 294 241 46 41 oo 32 33 42 136 138 66 51 362 265 178 134 634 756 1488 1459 1782 1700 3482 oo 66 (C.) SUMMARY OF CORRECTED DEATHS. No. of Deaths. Total. No. of Deaths. Total. M. F. M. F. I.—Specific Febrile or Zymotie Diseases. Brought forward 1542 1534 3076 1. Miasmatic Diseases 62 83 145 2. Diarrhceal „ 23 23 46 VI.—Local Diseases—continued. 3. Malarial „ — — — 6. Diseases of Lymphatic System 2 5 7 4. Zoogenous „ — — — 7. Diseases of Gland-like Organs of Uncertain Use 1 2 3 5. Venereal , 10 5 15 6. Septic „ 8 12 20 8. Diseases of Urinary System 93 58 151 II.—Parasitic Diseases — — — 9. Diseases of Reproductive System (a) Diseases of Organs of ration — 3 3 III.—Dietetic Diseases 0 — 3 3 (6) Diseases of Parturition — 5 5 10. Diseases of Bones and Joints ... 5 4 9 IV.—Constitutional Diseases 415 403 818 11. Diseases of Integumentary System 9 8 17 V.—Developmental Diseases 133 160 293 VII.—Violence. VI.—Local Diseases. 1. Accident or Negligence 77 50 127 1. Diseases of Nervous System 158 158 316 2. Homicide — 1 1 2. Diseases of Organs of Special Sense 10 6 16 27 13 40 1 — 1 3. Diseases of Circulatory System 272 285 557 5. Battle — — — 4. Diseases of Respiratory System 352 304 656 VIII.—III-deOned and not Specified Causes 25 17 42 5. Diseases of Digestive System 99 92 191 1542 1534 3076 Carried forward Total 1782 1700 3482 67 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1923. Area of Borough—4,083 statute acres (inclusive of land and inland water, but exclusive of tidal water and foreshore), divided into 5 Registration Sub-Districts, 4 Parliamentary Divisions, and 12 Wards (in place of the 9 Old Wards). The Parliamentary Divisions have been adjusted so that they and the Wards are co-terminous. Population—estimated 1923—308,500 (males 144,240, and females 164,260). Density—75.5 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected)—8,344, being 27.04 per 1,000 population. Deaths (corrected)—3,482, being 11.2 per 1,000 population. Infantile Mortality (corrected)—357 deaths (corrected) under 1 year, being 42.7 per 1,000 total (uncorrected) births, or 54.2 per 1,000 total (corrected) births. Zymotic Death-rate (corrected)—0.4 per 1,000 population (total corrected zymotic deaths, 141). * Corrected as to institutional deaths. 68 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, 1923. Number of Notices served 12,921* A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES! (Public Health (London) Act, 1891.) No. of Notices served 3128 No. of Infected Houses 2773 Small Pox — Scarlet Fever 731 Typhoid and Para-typhoid Fever ‡ 8 Diphtheria 525 Membranous Croup 4 Continued Fever — Puerperal Fever 48 Erysipelas 107 Cerebro-Spinal Fever and Post-Basic Meningitis § 7 Acute Polio-Myelitis§§ 10 Ophthalmia Neonatorum 60 Measles 925 German Measles 121 Primary Pneumonia 166 Influenzal Pneumonia 54 Encephalitis Lethargica 2 Malaria 4 Dysentery — Trench Fever 1 Anthrax — B. GENERAL NUISANCES AND DRAINAGE DEFECTS (Public Health (London) Act, and Metropolis Local Management Acts.) No. of Notices served*† 9,793 Works, Structural— Drainage, Defective 299 Intercepting Traps with Fresh Air Inlets required, or defective 112 * Including Measles and German Measles, but excluding notices under the Housing Acts. † Excluding Tuberculosis. ‡ 1 case of Para-typhoid. § 4 cases of Cerebro-spinal Fever and 3 cases of Post-basic meningitis. §§ 1 case of Polio-encephalitis acuta. 69 Ventilating Pipes required 79 Indoor Sinks defective (248) and connected with Drain (76) 324 Rain Water Stacks connected with Drain or defective 522 Bath Waste connected with Drain or defective 14 Closet Pan and Connections Defective 298 Water Supply to Closet Defective 305 Closet Dilapidated 181 Draw-off Main for Drinking Purposes required 8 Dust Bins Defective 582 Premises Dilapidated 521 Roofs Dilapidated 1115 Soil Pipes Defective 62 Paving Defective 433 Damp and Unwholesome Houses 562 Defective Water Pipes, Taps, &c 121 No W.C. Accommodation 23 Copper, Fireplace, or Chimney, &c., defective 334 Manhole Cover defective 47 Windows, Floors, Doors, &c., defective 708 Gullies defective, or stopped 79 Cistern defective 39 Dung Receptacle required 14 Walls and Ceilings defective 982 Washhouses dilapidated 132 Stables unsuitable 4 Petrol Interceptor required 1 7,901 Works, not Structural— Cisterns Dirty 15 Manure Accumulations 25 Underground Rooms illegally occupied 3 Effluvia and Smoke Nuisances 92 Animals Improperly Kept 42 Stopped Drains 328 Overcrowding 44 Foul Urinals 18 Refuse Accumulations 134 No Water Supply or Defective Water Supply 144 Dirty Premises 2,361 Stagnant Water Accumulations 35 Rats Nuisance 150 Bakehouses Dirty 139 Lighting and Ventilation Insufficient 75 Plunging Eye defective 10 3,615 70 PARTICULARS OF SANITARY WORK carried out by the Male Sanitary Staff in Lambeth Borough during 1923, and during the 5 previous years (1918-1922), together with yearly averages for (a) the 20 years 19011920 (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. 1923 12921 7901 3615 1922 16193 7878 3641 1921 16580 8093 3983 1920 16958 6211 3043 1919 13259 10397 3796 1918 16807 15150 4933 Yearly Average for 20 Years 19011920 (Borough) 14796.5 10569.9 4106.7 Yearly Average for 24 Years 18771900 (Parish) 5944.6 4756.9 2135.9 SANITARY STAFF. The Sanitary Inspectorial Staff consists of 12 district male Sanitary Inspectors, 1 special male Sanitary Inspector (Food and Drugs), and 2 special male Sanitary Inspectors (Housing), 2 female Sanitary Inspectors (who also act as part-time Health Visitors), and 4 women Health Visitors (whole time). The work carried out by these various officers is set out in tabular form. Summary of Work Carried Out by the Male Sanitary Inspectors during 1923. Inspections 9552 Re-inspections 44742 Complaints attended to 4950 71 Water Certificates issued* 85 Revenue Act Certificates dealt with 8 Drains tested (with chemical, water or smoke test) 4535 Sanitary Works completed 5748 Samples of Food and Drugs taken 2000 Notices— Public Health (London) Act, 1891 (Preliminary or Intimation 5841 and Statutory 3942) 9783 Metropolis Local Management Acts 10 Sanitary Nuisances abated— (a) Structural 7901 (b) Non-Structural 3615 Summonses issued— Public Health Act† 10 Food and Drugs Acts‡ 11 Margarine Act§ 1 N.B.—In addition to the above, the District Sanitary Inspectors carried out during 1923 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, ice-creameries, the market thoroughfares, outside urinals of publichouses, 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 manure depots, etc. No new houses were registered under the by-laws for houses let in lodgings. Routine house-to-house inspections were carried out under the Housing, Town Planning, etc., Acts, by the newly-appointed Housing Sanitary Inspectors, who commenced their duties on May 1st, 1920 (vide Section on Housing). Extra * Including 105 houses (2 being in blocks), and 115 tenements † 9 convictions and 1 summons withdrawn. ‡ 4 convictions, 6 summonses dismissed, and 1 summons withdrawn. § 1 conviction (non-labelling). 72 duties were thrown upon the 12 male district Sanitary Inspectors under the Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1923,' and the Rats and Mice (Destruction) Act, 1919. Infected Houses and Drainage Defects found by Male Inspectors. A sanitary inspection is made; of infected houses, i.e., houses at which infectious disease is notified compulsorily, and the sanitary inspection includes, in the large majority of cases, the testing of the drainage with the chemical test.* Taking the ordinary notifiable infectious diseases, out of the 1,443 infected houses dealt with during 1923, the results are as follows, the averages being given in brackets for the past 25 years, 1891—1915:— (a) 28, i.e., 1.9 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) 668, i.e., 46.3 per cent. showed defects in drains, traps, fittings and appliances (average = 53.1 per cent.). (c) 775, i.e., 53.7 per cent. showed no defects (average = 46.9 per cent.). Registration of Cow-houses, Slaughter-houses, Common Lodging-houses, and Milk Shops. During 1923 three Cow-houses †, eleven Slaughter-houses, ‡ and four Common Lodging-houses'§ licences were renewed by the London County Council. *The above statistics do not include ophthalmia neonatorum, measles and German measles and tuberculosis, which have been omitted so as to keep the statistics for 1923 comparable with those for past years. The figures for measles and German measles infected houses during 1923 are:—6 defective drains and 286 defective traps, fittings, and appliances, out of a total of 1,046 infected houses inspected. No testing of drains is carried out as a routine in the case of ophthalmia neonatorum and tuberculosis-infected houses. † 3 cow-houses—Elder Road Dairy, 76 and 78, Gipsy Hill, and 38, Hartington Road. †11 slaughter-houses—27 Bedford Road, 207, Coldharbour Lane, 77, Dulwich Road, 120, High Street, and 121, High Street (West Norwood), Industry Terrace (Canterbury Road), 60, Kennington Park Road, 151, Lambeth Walk, 99, Lower Marsh, 106, Lower Marsh, 45, New Park Road. § 4 common lodging houses—19, Belvedere Crescent, 108, Lambeth Walk, 106, Wandsworth Road, 90-92, Westminster Bridge Road. 73 The applicants were registered by the Council as milk sellers or purveyors of milk at the following premises, which were certified as "suitable," i.e., in accordance with the Council's requirements:— 121, Acre Lane, 24, Belmore Street, 134, Belvedere Road, 6, Bishop's Terrace, 15, Bonnington Square, 9, Bowden Street, 383/385, Brixton Road, 506, Brixton Road, 24, Broadwall, 34, Brooklands Road, 45, Camberwell New Road, 2/6, Canterbury Road, 304, Clapham Road, 67, Coldharbour Lane, 148, Cornwall Road (Brixton Hill), 15, Croxted Road, 24, Distin Street, 3a, Dolland Street, 115, Dorset Road, 57, Effra Parade, 71, Ethelred Street, 6, Frazier Street, 72/74, Gipsy Hill, 9, Gordon Grove, 66, Kenbury Street, 30, Kepler Road, 61, Knights Hill, 114, Lambeth Walk, 63, Larkhall Lane, 73, Larkhall Lane, 59, Lilford Road, 61, Lingham Street (2 separate applications by 2 different occupiers), 43, Loughborough Road, 179, Lower Kennington Lane, 10, Lower Marsh, 56, Lower Marsh, 16, Milkwood Road, 50, Monkton Street, 2, Morton Place, 28, Oakley Street, 20, Old Paradise Street, 58, Patmos Road, 34a, Priory Grove, 16, Pearman Street, 56, Railton Road, 10, Renfrew Road, 3a, Roupell Street, 61, Roupell Street, 20, St. Albans Street, 96, St. Marks Road, 42, Thorne Road, 87, Thorparch Road, 29, Tower Street, 138, Tyers Street, 36, Upper Marsh (2 separate applications by 2 different occupiers), 35, Vauxhall Street, 68, Walcot Square, 182, Wandsworth Road, 212, Waterloo Road, 106, Westminster Bridge Road, 191, Westminster Bridge Road, 73, Westow Hill, 8/10, Windmill Row, 35, Wyvil Road. N.B.—8 of the above were simply transfers of existing registrations. The applicants were refused registration by the Council as milk sellers or purveyors of milk at the following premises:— 164, Broadwall, 23, High Street (Lambeth), and 40, Osborne Terrace (rear of).* * 40, Osborne Terrace (rear of), was certified by the Medical Officer of Health as "suitable," i.e., in accordance with the Council's requirements, but the Council refused the application on the ground that such premises were, in the Council's opinion, unsuitable. 74 Revenue Act, 1903 (and Section 35 of the Housing, Town Planning, etc., Act, 1909). 8 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 conditionally* 8 Offensive Trades. There are four offensive trades registered, e.g., fat melting (15, Upper Marsh and Albert Square Mews), and soap boiling (15, Upper Marsh) and tripe boiling (103, Lambeth Walk). Summary of Work carried out by the Female Sanitary Inspectors during 1923. † Workshops‡ visited and inspected— (a) Dressmakers 4 (b) Milliners — (c) Laundries — (d) Tailors 1 (e) Upholsterers — (f) Blouses 3 (g) Others (e.g.), lamp shades, wireless instruments, dressing gowns, drapery, collars, cleaning material, beadstringing, underclothing, and weaving and spinning 10 Workshops ‡: workrooms therein measured 24 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 1,627 * 49, Jeffrey's Road, 24, 24a, Lunham Road, 148, Wandsworth Road, and 4, Woodland Road, Westow Hill. †The Council's 2 Female Sanitary Inspectors act also as part-time Health Visitors, and the above returns are to be read in conjunction with those given under the summary of child welfare and tuberculosis work carried out by the whole-time Health Visitors. Miss K. M. Roe's appointment as Health Visitor was made permanent (with the approval of the Ministry of Health) on November 1st, 1923. ‡ Workshops include Work-places. § Births (1,103), Workshops (5), Tuberculosis cases (16), Private Houses (359), Outworkers (144). 75 Female Conveniences visited and inspected— Public (visits paid) 817 Private — Schools visited— Public (visits paid) 1 Private 1 Attendances at Welfare Centres 90 Special places visited and inspected— (a) Private Houses* 1,391 (b) Outworkers 26 Workshops (2), Outworkers (2), and Private Houses (1,208) † 1,212 reinspected Written Intimation and Statutory Notices served 55 No. of Workshops‡, etc., in which defects were found 55 No. of Workshops‡, etc., in which no defects were found 1,382 Nuisances referred to M.O.H., for attention by male inspectors 3 Particulars of Defects found by Female Inspectors. Workshops‡, etc.— Workrooms— Overcrowded, Damp, Dirty, etc. 38 Defective or dirty— Yards, Floors, Roofs, Windows, Ceilings, Rain Water Pipes, Sink Wastes, or Premises generally 32 Sanitary Appliances: Water Closets— Dirty, unventilated, choked, defective or with defective tanks or water supplies 2 Sanitary Appliances: Drainage— Defective — Sanitary Appliances: Dustbins— Wanting or Defective 3 Lavatories—dirty or defective — No separate suitable sufficient W.C. accommodation for the sexes — Miscellaneous defects, e.g., defective chimneys 2 * Births (1.045), Tuberculosis cases (77), Ante-natal cases (108), Still births (22), Ophthalmia cases (16), Diarrhœa cases (6), School children (83), Milk cases (5), Housing Enquiries (2), and special cases (27). † Births (1,093), Tuberculosis cases (33), Ophthalmia cases (34), Antenatal cases (5), Milk cases (21), Diarrhoea cases (1), and special complaints (21). ‡ Workshops include Work-places. 76 The Health Visitors' duties carried out by the Female Sanitary Inspectors may be tabulated separately in the form of the following details of work done during 1923 (already included above):— Visits. Revisits. Total. Births 1,045 1,093 2,138 Still-births 22 22 Expectant Mothers 108 5 113 Ophthalmia Neonatorum cases 16 34 50 Tuberculosis cases 77 33 110 Epidemic Diarrhœa cases 6 1 7 *School Children 83 — 83 Attendances at Welfare Centres 90 — 90 Special cases visited (including milk cases, 26), and housing enquiries, 2 34 42 76 N.B.—Of the 1,093 re-visits paid in connection with births, 755 were paid to children between 1 and 5 years of age. Summary of Work Carried Out (Total Visits Paid) by the 4 Whole-time Official Health Visitors during 1923. Births† 7,265 Depot children (visits) 155 Still-births 126 Welfare Centres Ophthalmia neonatorum 255 dances) 582 cases† School children‡ 195 Epidemic diarrhœa cases 69 Expectant mothers Milk Depot (attendances) 89 (visits) 375 Tuberculosis cases† 309 Special inspections§ 28.1 N.B.—In addition to the above, 2,105 visits were paid to houses, but no one was found to be at home. The above returns are to be read in conjunction with those given under the summary of child welfare and tuberculosis work carried out by the Female Sanitary Inspectors, who act also as part-time Health Visitors. * Special enquiries re rheumatism (16), and enlarged tonsils (67). † Including revisits as follows:—Births 4,309 (of which 2,210 were paid to children between 1 and 5 years of age). Ophthalmia neonatorum cases 186, Tuberculosis cases 84. ‡ Special enquiries re enlarged tonsils (145), diarrhœa (28), other infectious diseases (22). § Including housing enquiries, 13 (visits). 77 FACTORIES AND WORKSHOPS. Factories. 5 new factories were added to the Register, dealing with:— (a) clothes pressing, 2; (b) wireless instruments, 1; (c) dried fruits, 1 ; and (d) fruit boiling and bottling, 1. Workshops. 10 new workshops were added to the Register, dealing with:— (a) millinery, 1; (b) tailoring, 1; (c) cleaning material, 1; (d) dressmaking, 3; (e) motor repairs, 1; (j) bakery and confectionery, 1; (g) weaving and spinning, 1; and (h) wireless parts assembling, 1. OUT-WORKERS, 1923. 7 February and 7 August lists were received, dealing with 69 and 40 out-workers respectively. Of the 109 out-workers, 62 belonged to Lambeth and 47 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 131 lists were received from various outside authorities dealing with 830 workers, of whom 808 belonged to Lambeth and 22 to districts outside Lambeth. Of the total 870 Lambeth out-workers reported, 8 were new out-workers, i.e., out-workers not previously registered, as follows: Bag Stringing 5 Paper Bags 1 Tailors 2 Total 8 HOUSING DEPARTMENT. Representations and Closing Orders under Section 17 of the Housing, Town Planning, etc., Act, 1909. During 1923 the Medical Officer of Health made no representations to the Council, under Section 17 of the 1909 Housing Act, and, consequently, no Closing Orders were made by the Council. General Housing Matters. The Council's two Housing Sanitary Inspectors have continued their special work of systematic house to house inspecting of dwelling-houses, and drawing up schedules of works required to render 78 such dwelling-houses reasonably fit in all respects for human habitation, under the powers conferred upon the Borough Council, as the Local Housing Authority, under Section 28 of the Housing, Town Planning, etc., Act, 1919. During the year 1923, 735 Notices of Intention to Survey have been issued, and sent or given to the occupiers, and to the owners, of the houses selected by the Medical Officer of Health, and approved by the Public Health Committee on behalf of the Council, as required under Section 36 of the Housing, Town Planning, etc., Act, 1909. 500 Surveys or Inspections have been made, under the Housing Inspection Regulations of the Housing, Town Planning, etc., Act, 1909, and 500 Provisional (or Informal) Schedules prepared, as suggested by the Ministry of Health in its Manual on Policy and Practice (Volume I., Chap. 6, paragraph i.), setting forth the work required to render the houses fit in all respects for human habitation, under Section 28 of the Housing, Town Planning, etc., Act, 1919. 500 Record Cards have been filed, 500 visits, and 13,196 re-visits made, and many interviews held at the Town Hall, or elsewhere, with owners, agents, builders and others concerned. 677 drain tests have been made in connection with the official inspections. The preparation of the Provisional or Informal Schedules involves a large amount of work and technical knowledge, as the properties selected for systematic inspection during the year were in a very bad state of repair, owing to neglect during the war (and since), and, consequently, a large number of items had to be tabulated, so as to avoid anything essential being omitted. The old Wards of the Borough have again been used, so as to keep the present records in conformity with the previous records. During the period of 12 months under review (1923), the following roads, streets, and courts have been under survey (wholly or in part), the total numbers of houses being given in brackets after the name of each road, street, and court:— Marsh Ward. Coin Street (31), Gilbert's Court (7), Lanfranc Street (21), Prince's Buildings (20). 79 Prince's Ward. Kennington Road (4), Loughborough Street (1). Vauxhall Ward. Alfred Court (5). Brixton Ward. Dugdale Street (25), Gordon Grove (15), Warham Street (4). Stockwell Ward. Bedford Court (6), Bricknell Place (6), Garden Row (18), Stockwell Cottages (8). Tulse Hill Ward. Mandrell Road (21), Margate Road (54), Mauleverer Road (41). Norwood Ward. Dunbar Street (58), Durban Road (126), Wood Street (35). During the 12 months, legal notices have been required to be served by the Council in respect of:— Marsh Ward. Linnett Street (Nos. 1 to 18 consecutive), Mary's Buildings (Nos. 1 to 12 consecutive and 17 to 20 consecutive), Steven's Place (Nos. 1, 2, 3, 4). Bishop's Ward. Monkton Street (Nos. 9 to 29 (odd), 41, 43, 45, 53). N.B.—The legal notices were ordered to be served by the Council on March 1st, 1923. Work has been completed, or practically completed, in the following houses, the numbering of the individual houses being given in brackets after the road, street, or court:— (1) After service of legal schedules:— Marsh Ward. Johanna Street (No. 12), Mary's Buildings (No. 11). Bishop's Ward. Monkton Street (Nos. 9 to 29 odd). Prince's Ward. Hampshire Street (Nos. 1, 2), Opal Street (Nos. 19 to 25 odd). Brixton Ward. Kenbury Street (Nos. 45, and 73 to 79 odd). 80 (2) After service of provisional (or informal) schedules:— Marsh Ward. Ethelm Street (Nos. 10, 13, 15, 27, 30, 35, 37, 38, 40-53 consecutive, 59, 63, 64, 66-70 consecutive), Gilbert's Court (Nos. 2-8 consecutive), Grindal Street (Nos. 1-21 odd, 4-18 even), Johanna Street (Nos. 41-47 odd), Lanfranc Street (Nos. 2, 3, 4, 5, 6, 9, 10, 25-38 consecutive), Murphy Street (Nos. 12, 13, 14, 16-20 consecutive), Prince's Buildings (Nos. 1-20 consecutive), Wootton Place (Nos. 4, 6, 7, 9). Bishop's Ward. Longhope Place (Nos. 1, 2, 3), Monkton Street (Nos. 34, 36, 38), St. Alban's Buildings (No. 15). Prince's Ward. Clayton Street (Nos. 17, 33, 35, 37, 46-52 even), Frank Street (Nos. 1-35 odd, 41, 43, 2, 4, 10, 14, 16, 20-36 even), Garden Cottages (Nos. 1, 2, 3, 4, 5, 8), Hunt Street (Nos. 7, 9, 2-18 even), Kennington Road (Nos. 245, 279), Newburn Street (Nos. 33, 35, 41-49 odd, 57, 62-70 even, 76, 78, 96, 98), Opal Street (Nos. 2-18 even, 1-17 odd), Tate Street (Nos. 4, 6, 20, 22). Vauxhall Ward. Alfred Court (Nos. 7-11 consecutive), Hemans Street (Nos. 26-40 even), Pascal Street (Nos. 6, 8, 10, 16, 18, 22, 24, 41-53 odd). Stockwell Ward. Northall Street (Nos. 7, 9, 11, 13, 17, 19, 21, 6, 10, 18, 20, 22). Brixton Ward. Baker Street (Nos. 1-27 odd, 31-47 odd, 38-54 even), Chryssell Road (Nos. 1, 25, 27, 53-59 odd, 38, 40, 48), Dugdale Street (Nos. 3, 5, 7, 29-37 odd, 22-34 even), Farrar Street (Nos. 1-9 odd, 2), Flaxman Road (Nos. 80-90 even, 125-151 odd), Gordon Grove (Nos. 2-18 even, 22, 5-11 odd), Kenbury Street (Nos. 40-56 even, 74, 76, 7, 11, 17, 25-43 odd), Normandy Road (Nos. 2, 3, 4, 5, 11, 12), Vassall Road (Nos. 3, 59, 73-87 odd, 8, 12, 14, 16, 22a, 24-40 even, 44-52 even, 60, 62, 62a), Warham Street (Nos. 108-114 even). 81 Tulse Hill Ward. Mandrell Road (Nos. 23-31 odd), Margate Road (Nos. 26-44 even, 50, 52, 54), Mauleverer Road (Nos. 1-11 odd), 19, 21, 23, 23a, 35-49 odd, 2, 4, 12). Norwood Ward. Dunbar Street (Nos. 1, 67, 4, 6, 8, 20, 24), Durban Road (Nos. 79, 105, 105a), Wood Street (Nos. 3-31 odd, 35, 8-34 even). The following house has been repaired and reconstructed after a Closing Order, which was made by the Council some time back:— Prince's Ward. Albert Embankment (No. 26). The following house has now been closed after a Closing Order, which was made by the Council some time back:— Vauxhall Ward. Little Spring Place (No. 2). The following house has been voluntarily demolished, after closure under a Closing Order, which was made by the Council some time back:— Bishop's Ward. Trowes Place (No. 6). The following houses have been voluntarily closed, and since voluntarily demolished:— Prince's Ward. Kennington Road (Nos. 258,260), Whitehart Street (No. 1); whilst the following houses have been voluntarily closed, with a view to being demolished at an early date:— Marsh Ward. Coin Street (Nos. 22, 41), St. Andrew's Place (Nos. 2; 5, 7, 10). Work has also been started in very many other cases, and is in various stages of progress in Marsh, Bishop's, Prince's, Vauxhall, Stockwell, Brixton, Tulse Hill, and Norwood Old Wards; whilst, in addition, many provisional (informal) schedules have been served during the year under report in connection with houses in the same 82 Wards, but the work has not yet been commenced, although some of the informal (provisional) schedules were prepared and served many months ago. In all these cases, particulars of the addresses will be given in future reports, when the work has been completed, or practically completed, to the satisfaction of the Housing Inspectors. In a comparatively few of the cases, in which no work has yet been started, although the informal (provisional) schedules were prepared, submitted to the Committee, and served many months ago, legal schedules will require to be served in the usual way by the Council. These houses are 18 in number, viz.:—18½, 19, 19½, 20, 21, 22, 23, 24, 25, 26, 27, 28, 28a, 29, 29a, 30 Linnett Street, and 12, 14, Tate Street.* (1) Special Areas. Monkton Street Area.—There is nothing new to report in connection with this area. Nos. 41, 43, 45 and 53, Monkton Street, are still occupied, though no rents are being collected by the owners; whilst Nos. 9-29 (odd, inclusive) have been put into habitable repair, as the result of the legal schedules served by the Council. All these houses are the properties of the Lambeth Board of Guardians, and it is reported that Nos. 41, 43, 45, 53, Monkton Street, will be closed and demolished as soon as vacant possession is obtained. Closing Orders are still outstanding upon Nos. 4 and 5, Trowes Place, Monkton Street (also the properties of the Lambeth Board of Guardians). N.B.—Great changes have taken place in this Monkton Street area since, and as a result of, the Council's Housing Policy. The six small Courts known as Bird, Bywell, Longhope, Trowes, Strewan, and Fram Places, together with the immediately adjoining houses in Monkton Street, have been practically demolished† after compulsory or voluntary closure. Nos. 31, 33, 35, 37, 39, Monkton Street, have been closed and demolished, and the following houses in the same * Notices served by the Council on 6th March, 1924. † 53, Monkton Street, is still occupied (awaiting closure and demolition), as are also 4 and 5, Trowes Place, whilst 1, 2, 3, Longhope Place, have been put into proper repair, and are, consequently, fit for human habitation (at present occupied). 83 street put into habitable repair, viz., Nos. 2-30 (even), 34, 36, 38, 7-29 (odd). All this represents a large amount of work, necessitating the supervision and constant attention of the Housing Inspectors. (2) Private Development Schemes. (a) Duchy of Cornwall. The Duchy of Cornwall have continued and completed their building programme (18 new houses on the Sancroft Street Estate at Kennington) and, in addition, have completed the repairs at the following houses in connection with which provisional (informal) schedules had previously been prepared under Section 28 of the Housing, Town Planning, etc., Act, 1919, by the Housing Inspectors: Clayton Street (8 houses), Kennington Road (2 houses), and Opal Street (9 houses). The White Hart Street area is undergoing a transformation. The Duchy of Cornwall has sold a large site of land at the rear of White Hart Street and Kennington Park Road, the site being bounded by Cottington Street, Kennington Park Road, White Hart Street, and Lower Kennington Lane to the Army, Navy and Air Force Institute, and upon the site have been erected large business premises, approached from White Hart Street, Kennington Park Road and Cottington Street respectively. The business premises have naturally displaced a large number of tenants, who have had to be accommodated elsewhere. The remainder of the site is reported to be for sale, and would be suitable for the erection thereon of working class dwellings in the form of small blocks of tenement houses by the Borough Council, it being assumed that the price of the land is not too heavy, and that the Duchy is prepared to sell for such a purpose. This remaining portion of the site includes what is known as White Hart Square (38 houses, of which 30 have been demolished, and the other 8 are in a dilapidated condition, and in use as a builders' stores), together with a further rectangularshaped piece of land with a frontage to White Hart Street, and extending back to Prince's Square Houses, and bounded on the other two sides by Kennington Park Road and Lower Kennington Lane houses respectively. 84 (b) Ecclesiastical Commissioners. The lack of alternative accommodation has prevented further progress of the Commissioners' Rebuilding Scheme, but a considerable amount of work has been carried out under provisional (informal) schedules under Section 28 of the Housing, Town Planning, etc., Act, 1919, in Marsh Ward, viz.:—Ethelm Street (30 houses), and in Brixton Ward, viz.:—Baker Street (32 houses), Chryssell Road (10 houses), Farrar Street (6 houses), Flaxman Road (20 houses), Gordon Grove (4 houses), Kenbury Street (22 houses), and Normandy Road (6 houses). At the corner of Ethelm Street and Cornwall Road a new small block of tenement buildings has been built and opened by the Commissioners, containing 6 tenements of 3 rooms each. The scheme of reconstruction for the whole of Ethelm Street and neighbouring streets and courts is reported to have been settled by the Commissioners and will be carried out as soon as alternative accommodation for the present occupiers of the existing houses can be obtained. With regard to Brixton Ward, 20 new houses have been erected by the Commissioners in Cancell Road (Nos. 7 to 45 odd inclusive). General Considerations. It is satisfactory to be able again to report that owners generally, throughout the Borough, are doing their best to carry out the Council's Housing Inspectors' requirements, which are framed with a view to avoiding any unnecessary or unreasonable expenditure. This is an important point to emphasise, and represents a principle which has been much appreciated by the owners concerned, in spite of the fact that, in many instances, the necessary expense involved has proved to be considerable. The practice of a certain type of owner to acquire property mainly on borrowed money, relying on a balance being left after the interest and all expenses have been paid, is a fruitful cause of trouble, when such properties happen to be situated in streets or courts, which are scheduled for inspection. The value of Section 28 of the Housing, Town Planning, etc., Act, 1919, from an administrative point of view cannot be gainsaid. 85 The result of the local enquiry, which was held by the Ministry of Health on the 11th December, 1922, with regard to the Notices served under Section 28 of the Housing, Town Planning, etc., Act, 1919, in connection with Nos. 73, 75, 77 and 79 Kenbury Street, was issued in the form of an Order, dated 2nd March, 1923, as follows:— 1. The Minister hereby confirms the said Notices, subject to the following modification:— The Notice relating to No. 73, Kenbury Street shall be varied by the omission of so much of the specification of works as required the Appellant to strip, repair and re-decorate the walls, wash off, stop and whiten the ceiling, and clean the paint of the front basement room. 2. The Minister hereby certifies the amount of the costs incurred by him in relation to the said inquiry to be the sum of £3, and hereby directs that the said sum shall be paid to him by the appellant. 3. The Minister further orders that the parties to the Appeal shall bear their own costs in the matter. The modification laid down in the Minister's letter was necessitated owing to the fact that the particular work had been done to the front basement room of No. 73, Kenbury Street, between the date when the instruction was given for the service of the legal notice, under Section 28 of the Housing, Town Planning, etc., Act, 1919, and the date on which the notice was actually served. Although the success of the Housing Inspectors in getting work done is noteworthy, and justifies the Council's appointments of Housing Inspectors, the Council must be reminded that there is still a small percentage of the properties inspected which it is impossible to get put into a good state of repair by persuasion, and the serving of provisional (informal) schedules or legal notices. These properties must remain in their present condition, unless the Council decides to carry out the work itself, surcharging the expenses upon the properties, as laid down in the 1919 Housing Act—a procedure that has not yet been tried within the Borough of Lambeth. 86 There is great need for new housing accommodation for the working classes (new additional houses). Houses and tenements, let at weekly rentals, are becoming fewer in numbers, as the result of business premises being built or enlarged on sites which formerly were covered with dwelling-houses, e.g., the Stamford Street and White Hart Street areas, which are being transformed from residential areas into business areas. The last published 1921 Census Returns show that the RegistrarGeneral's decreasing Lambeth population (estimated from previous censuses) requires amendment—the present population being an increasing one. The Lambeth Housing Needs require also consequential amendment, and the Lambeth Housing Survey (published in 1919) has accordingly been amended, so as to bring it up to date, to show Lambeth's Housing Needs of to-day, in so far as workingclass dwellings are concerned, houses or flats (vide also Appendix to this Report). There are suitable building sites available within the Borough. It is the Inner Wards or Districts that require special attention at the present time, and the cheaper the houses are to rent, the better, subject, of course, to such houses being sanitarily and constructionally fit and large enough for people with families. DISINFECTING DEPARTMENT, 1923. Details of work done in connection with the Disinfecting Department are subjoined: 3,695 cases of infectious diseases, notified compulsorily by medical men, were dealt with, including cerebro-spinal fever and post-basic meningitis (7), acute poliomyelitis and encephalitis (10), acute primary pneumonia (169), acute influenzal pneumonia (55), acute encephalitis lethargica (2), malaria (4), ophthalmia neonatorum (60), measles (1,103), german measles (147), and tuberculosis—pulmonary (459) and non-pulmonary (108), whilst the following diseases were, in addition, reported by school teachers and others, viz.: measles (340), chicken-pox (820), cancer (105), whooping cough (441), and others not classified (379)*. 342 verminous houses (372 rooms) and 2,142 verminous articles, viz.: bedding 1,584, and clothing 558, were also dealt with. * Scabies, ringworm, diseases not stated, etc. 87 Summary of work carried out by the Disinfecting Department during 1923. Total No. of rooms disinfected by Council 6330 Do. articles do. 15435 Cases in which bedding was disinfected at home* 2414 Do. do. do. at Chamber 2306 Do. do. do. destroyed — Premises disinfected and disinfectants supplied 14580 Articles of bedding, etc., disinfected 15435 Articles of bedding, etc., destroyed — No. of Cleansing Notices served in connection with infected houses 1351 Certificates of Medical Practitioners received in lieu of disinfection by the Council 5 Schools disinfected† (66 rooms) 19 Certificates of disinfection left with occupiers of disinfected premises 1386 Library books disinfected (public) 206 Mattresses re-tabbed by Council 534 * Bedding not removed to the Disinfecting Chamber for disinfection in cases of Measles and German Measles. † Measles, 1(11 rooms); Scarlet Fever, 10(34 rooms); Chicken-pox, 2(3 rooms); Diphtheria, 4(9 rooms); not classified 2(9 rooms). 88 ANALYSIS OF FOOD AND DRUGS AND WATER. Food and Drugs. Samples of Food and Drugs procured, together with the results of the analyses, were as follows:— Samples. Formal. Informal. Number Analysed. Number Adulterated. Number Analysed. Number Adulterated. Milk 558 18 - - Butter 51 1 440 14 Lard 45 — — — Coffee 38 — 42 1 Condensed Milk — — 1 — Margarine 1 — 1 — Mustard 18 — 23 2 Pepper 21 — 19 — Arrowroot — — 28 — Vinegar 18 — 7 — Sago — — 11 — Oatmeal — — 21 — Ground Rice 6 — 20 — Flour — — 5 — Dripping — — 28 — Drugs* 2 1 158 7 Rice 1 — 71 2 Tapioca — — 11 — Baking Powder — — 19 — Self-Raising Flour — — 34 — Suet — — 2 — Cocoa — — 100 3 Sugar — — 1 — Olive Oil 10 — — — Pea Flour — — 12 — Ground Ginger — — 6 — Tea — — 12 — Honey — — 4 — Whisky 2 — — — Rum 3 — — — Mincemeat — — 4 — Ground Almonds — — 6 — Custard Powder — — 14 — Potted Fish — — 3 — Peas (Tinned) — — 2 1 Cakes, Sponge — — 31 8 Eggs Substitute — — 8 — Lime Juice — — 4 4 Semolina — — 17 — * The drugs (160) were:—Epsom Salts (13), Gregory's Powder (11), Ammoniated Tincture of Quinine (22), Cream of Tartar (13), Bicarbonate of Soda (15), Camphorated Oil (13, of which 2 were formal), Milk of Sulphur (8), Boric Ointment (14), Tincture of Iodine, fort. (8), Tartaric Acid (13), Tincture of Iodine (4), Zinc Ointment (8), Friars Balsam (9), Iron Pills (4), Rochelle Salts (5). 1 formal sample of Camphorated Oil was adulterated. 89 Analysis of Food and Drugs and Water—continued. Samples. Formal. Informal. Number Analysed. Number Adulterated. Number Analysed. Number Adulterated. Malt Vinegar 25 — — — Cream — — 11 — Preserved Cream — — 12 — Cinnamon — — — — Gin 1 — — — Fruits (Dried) — — 9 — Orange Wine — — 2 1 Raisin Wine — — 1 1 800 20 1,200 44 N.B.—11 summonses (adulterations) were issued (4 convictions, 6 dismissals, and 1 withdrawal), 1 summons under the Margarine Act (non-labelling) was also issued (conviction). Water. 1 sample of water (private house) was submitted to the Analyst for analysis. Public Health (Milk and Cream) Regulations, 1912 and 1917.* All samples of milk are examined by the Public Analyst, as a routine, for the presence of preservatives, and, of the total samples of milk taken during 1923 (558 formal), in no single instance were preservatives found. 11 samples of cream (all informal), and 12 samples of preserved cream (all informal), were also taken with the results set out below. The action taken under the Public Health (Milk and Cream) Regulations, 1912 and 1917, may be tabulated as follows:— Headings of Report of Administration. 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 558 — Cream 11 — Nature of preservative in each case in column (b) and action taken under the Regulations in regard thereto—Nil. *The Amendment Order (February 8th, 1917) came into operation on April 2nd, 1917, and lays down a maximum of 0.4 per cent. of Boric Acid added to cream, such cream to be sold as preserved cream and to be labelled with the words, "Cream containing boric acid is unsuitable for infants and invalids." 90 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 12 (2) Statements incorrect — Total 12 (b) Determinations made of milk fat in cream sold as served cream:— (1) Above 35 per cent. 12 (2) Below 35 per cent. — Total 12 (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. Margarine Dealers and Margarine Factories. The following premises in connection with wholesale dealers in margarine were registered:—252, Wandsworth Road. Public Health (Condensed Milk) Regulations, 1923, and Public Health (Dried Milk) Regulations, 1923. The Public Health (Condensed Milk) Regulations were issued by the Ministry of Health under date of the 1st May, 1923, and came into operation on the 1st October, 1923, excepting in so far as such Regulations have reference to the sale of condensed milk in the country by retail. In this latter instance, the Regulations came 91 into operation on the 1st November, 1923. Similar Regulations, known as the Public Health (Dried Milk) Regulations, 1923, have also been issued by the Ministry of Health, but these Regulations do not come into force until the 1st May, 1924. The Milk (Special Designations) Orders, 1922-1923. Under Section 3 of the Milk and Dairies (Amendment) Act, 1922, sellers of milk under special designations, such as "Certified," "Grade A," or "Pasteurised" milk, must be licensed as from 1st January, 1923, for that purpose, under the provisions of the Orders made by the Minister of Health, and known as the Milk (Special Designations) Order, 1922, the Milk (Special Designations) Amendment Order, 1922, and the Milk (Special Designations) Order, 1923. Under the Orders, the Lambeth Borough Council, as a Sanitary Authority, is required to licence certain specially designated milks, whilst the Ministry of Health is required to licence producers of certain designated milks. With regard to pasteurised milk, the special conditions stated in the Orders in regard to that particular form of milk did not come into force until the 1st July, 1923. During 1923, the following licences have been issued within the Borough of Lambeth:— 1. "Certified" Milk. (a) W. H. Hill, 5a, Cambria Road (producer, Brig.-Gen. F. A. Buzzard, Hacksted Farm, Edenbridge, Kent). (b) W. Hardy, 12, Herne Hill Road (producer, Brig.-Gen. F. A. Buzzard, Hacksted Farm, Edenbridge, Kent). (c) Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road (producer, J. & H. Robinson, Iford, Sussex). (d) F. White, 234, Clapham Road (producer, Express Dairy Co., Ltd., College Farm, Finchley). (c) R. Higgs & Sons' Dairies, Ltd., 1 to 6, Canterbury Road, 43, Loughborough Road, 121, Acre Lane, 102, Brixton Hill, 4, Tulse Hill, 30, Kepler Road, 56, Railton Road, 15, Bonnington Square, 191, Westminster Bridge Road, 67, Coldharbour Lane, 304, Clapham Road, 96, St. Marks Road (producers, E. C. Lovell, Hatherton, near Andover). (d) Adams & Co., 161, South Lambeth Road (producer, Elveden, Hoebridge Farm, Old Woking). 92 2. "Grade A" (Tuberculin Tested) Milk. (a) D. Williams, 11a, Victoria House, South Lambeth Road (producer, W. Buckley, Mounds Mere, Manor Farm, Basingstoke). 3. "Grade A" Milk. (a) J. Rees, 17, Duke Street (producer, Viscount Astor, White Place, Cookham, Berks.). (b) David Jones, 11, Russell Street, Brixton (producer, count Astor, White Place, Cookham, Berks.). 4. "Pasteurised" Milk. (a) Adams & Co., 8, South Lambeth Road. Ice Cream Vendors. The ice-cream manufacturers and vendors throughout the borough have been visited and their premises inspected by the Sanitary Inspectors. There are, at present, 165 known vendors and manufacturers whose premises are reported to be suitable for the purpose. BYE-LAWS AS TO RAG AND BONE DEALERS. The London County Council issued Bye-Laws on the 19th June, 1923, under Section 9 of the London County Council General Powers Act, 1908. These Bye-Laws were approved by the Ministry of Health on the 18th September, 1923, and by the Home Office, in so far as factories and workshops are concerned on the 26th September, 1923, and came into operation on the 26th September, 1923. Copies of the Bye-Laws were sent to all the known rag and bone dealers within the Borough of Lambeth (29 in number), and the premises were inspected for registration purposes. MORTUARIES AND CORONERS' COURTS. Details of Work carried out. (a) Number of bodies received, 430—256 at High Street and 174 at Wanless Road. (b) Post-mortem examinations conducted, 183—99 at High Street and 84 at Wanless Road. (c) Number of inquests held, 419—249 at High Street and 170 at Wanless Road. A new system of lighting and heating of the Mortuary and Coroner's Court, High Street, Lambeth, has been installed. 93 APPENDIX I. MINISTRY OF HEALTH TABLE. BOROUGH OF LAMBETH. HOUSING CONDITIONS. Year ended 31st December, 1923. GENERAL STATISTICS. Area (acres) 4,083 Population 308,500* Number of inhabited houses 42,607† Number of families or separate occupiers 78,399‡ Rateable value £1,989,290 Sum represented by a penny rate £8,032 HOUSING. Number of new houses erected during the year:— (a) Total 105‡ (2 blocks) (b) As part of a Municipal Housing Scheme 1‡ (and office) I.—UNFIT DWELLING HOUSES. I.—Inspection. (1). Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) (2). Number of dwelling-houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 (3). Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4). Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 10,052§ 500 nil 500 *Estimated 1923. † Census figures, 1921. † Representing 115 and 1 tenements respectively. § 9,552 Public Health (London) Act 1891 and 500 Housing Acts. 94 II.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,400* III.—Action under Statutory Powers. A.—Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1). Number of dwelling-houses in respect of which notices were served requiring repairs 53 (2). Number of dwelling-houses which were dered fit (a) by owners 24 (b) by Local Authority in default of owners nil (3). Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close nil B.—Proceedings under Public Health Acts. (1). Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3,942† (2). Number of dwelling-houses in which defects were remedied— (a) by owners 1,933† (b) by Local Authority in default by owners nil C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1). Number of representations made with a view to the making of Closing Orders nil (2). Number of dwelling-houses in respect of which Closing Orders were made nil * 1899 under the Public Health (London) Act, 1891 (intimation notices), and 501 under the Housing, Town Planning, etc., Act, 1919 (provisional or informal schedules), †Statutory notices under the Public Health (London) Act, 1891. 95 (3). Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit nil (4). Number of dwelling-houses in respect of which Demolition Orders were made nil (5). Number of dwelling-houses demolished in pursuance of Demolition Orders nil 96 APPENDIX II. HOUSING SURVEY (LAMBETH BOROUGH). 1919 and 1922. Table shewing the Housing needs of the Borough of Lambeth, (a) the estimated figures in 1919 for a period of three years, and (b)the actual figures at the end of that period, December, 1922 (vide also Annual Report, 1920, pp. 100-107):— Estimated October, 1919. Actual. December, 1922. 1. Working class houses required during the next three years to— (a) Meet the unsatisfied demand for houses (taking account of growth of population, over-crowding, etc.) 420 1,906 (b) Re-house persons to be displaced by the clearance of unhealthy areas and (c) Re-place other dwellings which are unfit for human habitation and cannot be made fit 104 247 (d) Re-place obstructive or other buildings (now inhabited and not included under heading (c) which should be demolished nil nil (e) Re-place other houses, which although they cannot, at present, be regarded as unfit for human habitation, fall definitely below a reasonable standard 336 413 (f) Meet anticipated deficiencies, e.g., arising from new industrial development nil 36 860 2,602 97 2. Deduct— Estimated. October, 1919. Actual. December, 1922. (a) Working class houses which it is anticipated will be set free during the next three years, as the result of any probable decrease in the population 225 nil (b) Working class houses likely to be built during the next three years by persons other than the Local Authority 236 234 Number of houses built by Council – 246 461 480 Net estimate of number of houses required 399 2,122 Details of figures given in reply to question 2(b)— Public Utility Societies 100 79 Housing Trusts Industrial Undertakings, or Business Firms Private Persons Others not included above— Court of Common Council (Hercules Road, in Bishop's Ward) 48 48 Duchy (Kennington Road, in Prince's Ward) 44 31 Duchy (Courtenay Square, in Prince's Ward) 44 44 Ecclesiastical Commissioners — 32 236 234 98 APPENDIX III. HOUSING STATISTICS (EMPTY PREMISES) 1923. [Report presented to the Public Health and Housing Committees by the Medical Officer of Health.] The latest published statistics issued by the Borough Treasurer, and presented to the Council on November 29th, 1923, have reference to September Quarter, 1923 (at September 30th, 1923), and shew a total number of 250 unoccupied dwelling-houses in rating (19 dwelling-houses with shops). The Borough Treasurer has also furnished the Medical Officer of Health with a list of unoccupied premises out of rating. This is a useful classification for the purpose of the Housing Committee's Reference to the Public Health Committee. The former class (in so far as dwelling-houses are concerned) include dwelling-houses, which may be dealt with under the Housing, Town Planning, etc., Act, 1919, either under Section 22 (by the owners by loans for re-construction, enlargement or improvement), under Section 28 (by the Borough Council, subject to such dwellinghouses being not in all respects reasonably fit for human habitation, short of re-construction). The latter class (in so far as both dwellinghouses and other premises are concerned) deals with dilapidated, derelict and demolished (wholly or in part) premises—practically site values only, the premises being incapable of being made fit for occupation. In the opinion of the Medical Officer of Health, the Public Health Committee is concerned only with dwelling-houses in Class (1), and instructions were given for a survey by the Housing Inspectors to be made. This was done, and the results were tabulated as set out herewith, though, in very many instances, it was found that, since the Borough Treasurer's report was drafted, the dwellinghouses had already been sold or let, or were being prepared, for occupation (after repairs), or for demolition (for the extension of business premises). 99 The information available up-to-date is that the beforementioned 250 dwelling-houses, which were unoccupied, but still in rating at the time of the preparation of the Borough Treasurer's Report, may now be classified as follows:— 1. Occupied or being prepared for occupation 125 2. Suitable for occupation (probably with slight repairs), but for sale only (with occupation) 23 3. Fit for demolition (if not actually demolished) 22 4. Suitable for business purposes, or for occupation with business 20 5. Acquired for commercial or institutional (extension, etc.), purposes (in most cases for demolition) 25 6. Dwelling-houses, which, without re-construction, will probably remain unoccupied, and which, in some cases (but in some cases only), can be adapted for use as flats or tenements 28 7. Dwelling-houses, which, wholly or in part, require considerable repairs to render them in all respects reasonably fit for human habitation 7 Total 250 Classes 1, 3, 4 and 5 explain themselves, and do not come within the purview of this Report, whereas Classes 2, 6 and 7 do— Class 2, concerning the Housing Committee, and Classes 6 and 7, the Public Health Committee, in the opinion of the Medical Officer of Health. Some of the dwelling-houses tabulated in Classes 6 and 7, can be dealt with under Section 28 of the Housing, Town Planning, etc., Act, 1919. In this connection, however, the works required under Schedules or Notices that may be served to render the dwellinghouses in all respects reasonably fit for human habitation may include works of re-construction, thereby bringing such dwellinghouses as may require re-construction outside the provisions of that particular Section of the Act (Section 28). 100 The Owners have been communicated with, with the result that, in connection with Class 2, the houses are being, or are to be in the immediate future, dealt with by the Owners by sale or letting, with a view to occupation, etc., whilst, in the case of Classes 6 and 7, the same practically obtains. There are only a few exceptions, and these dwelling-houses have been inspected and schedules prepared, by the Housing Inspectors. Previous consent for access to survey had to be obtained (the premises being unoccupied), and informal letters were written accordingly to the Owners, some of whom have not yet replied thereto. With regard to unoccupied premises (out of rating), many of these represent dwelling-houses that have been closed (a) compulsorily (by Closing Orders made by the Council), or (b) voluntarily (by the Owners). The large majority of these premises are dilapidated and derelict, if not demolished (wholly or in part), and, consequently, represent "site values" only, upon which new dwellinghouses for the working-classes could be erected by the Council, should the Council so decide; otherwise, it would be a matter for private enterprise with financial assistance from the Council, in accordance with the terms of Section 22 of the Housing, Town Planning, etc., Act, 1919—a matter for the consideration of the Housing Committee. Personally, the Medical Officer of Health is not in favour of such a Scheme being carried out by the Council itself, viz., the Council to purchase the sites, and to build new dwelling-houses thereon, as a Housing Scheme. Such a Scheme would be piecemeal and unsatisfactory, and unworthy of an important Sanitary District such as the Borough of Lambeth. It would be more dignified, in the opinion of the Medical Officer of Health, for the Council to deal with small crowded and ill-planned areas, such as, and similar to, those which are set out in the Medical Officer of Health's Housing Report, 1919, and the Council's Housing Survey, 1919, e.g., Monkton Street area (in hand), China Walk Site (in hand), Hammond Place (closed), James Place (partly closed), Spring Gardens (repaired under Schedules under Section 28 of the Housing, Town Planning, &c., Act, 1919), and Asa Place (closed). The Medical Officer of Health emphasises the need, the urgent need, for new additional houses being now built, so as to relieve the 101 present housing shortage in Lambeth Borough. There are new suitable sites available upon which could be built houses for the working classes, at an expenditure considerably below what it cost in 1920-22, when the Norwood Houses and Redan Terrace Houses were erected, and when building materials and labour were more expensive. The time is fast approaching when the house shortage in Lambeth Borough will become even more urgent, on account of the extension of buildings of existing, or of new, business premises. In the Inner Districts especially, the need for additional dwelling-house accommodation will be felt, in view of the business changes that are taking place. An economic, though not necessarily (owing to existing conditions) an economical, building Scheme should be attainable in the Borough, where (as elsewhere) the provision of dwelling-houses for the working classes is needed. No report on Housing within the Borough of Lambeth would be complete without reference to the Estates of the Duchy of Cornwall and the Eccelsiastical Commissioners, and the assistance that is being rendered to the Council's Housing Problem by those two Bodies—the former in connection with the Marsh and Kennington Districts, and the latter in connection with the Marsh and Brixton Districts. It is true that actual building and re-construction are proceeding very slowly, but everything helps in a crisis, such as the Housing Crisis through which London is passing at the present time. It may be noted that the Duchy Policy in the Stamford Street and Whitehart Street areas is, indirectly, increasing the house shortage in those particular districts, in that large business premises are displacing dwelling-houses, e.g., Government and other printing works in Stamford Street area, and the Navy, Army and Air Force Institute in Whitehart Street area. Wightman & Co., Ltd., "Old Westminster Press," Regency Street, S.W. 1