LAM 19 E REPORT on the Vital and Sanitary Statistics of the BOROUGH OF LAMBETH During the Year 1925. [.Including an account (/) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, (b) at the Municipal Milk Deptt 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; and the Public Health Meat Regulations, 1924]. v 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 1925. [Including an account (i) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, (b) at the Municipal Milk Depdt 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; and the Public Health Meat Regulations, 1924]. 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 COMMITTEE and (2) MATERNITY and ''CHILD WELFARE COMMITTEE {appointed by the Council on November 9th., 1925) PUBLIC HEALTH COMMITTEE. His Worship the Mayor (Mr. Councillor Bascombe, f.i.c., i.p.) ex-officio. A Idcrmen: Mr. Alderman J. F. Evans. „ „ E. Rick, f.s.i. Councillors : Mr. Councillor E. Davies. ,, ,, W. J. Geary, a.c.i.s. (Chairman). Mrs. ,, M. E. Hare. Mr. „ F. E. Hembling. ,, „ W. Hunter. Miss „ K. Ker. Mr. „ F. Kinnaird. ,. „ G. II. Mai.linson, m.a. ,, ,, R. S. Pearson, m.r.c.s., l.r.c.p., d.p.ii. „ ,, S. Stranks. ,, ,, S. H. Stanley ( Vice-Chairman). „ „ J. G. Turner. Mrs. ,, A. L. Wood. MATERNITY AND CHILD WELFARE COMMITTEE. The same as the Public Health Committee (see above) together with the following 4 co opted Members nominated by the various Welfare Centres of the Borough (included in the Lambeth Maternity and Child Welfare Scheme):— Miss D. Shepherd, m.b., ch.b., representing the North Lambeth Parliamentary Division. Miss C. J. Sketchley, representing the Kennington Parliamentary Division. Mrs. E. Brittain, representing the Brixton Parliamentary Division. Mrs. L. E. Parsons, j.p., representing the Norwood Parliamentary Division. 3 Borough of Lambeth. PUBLIC HEALTH DEPARTMENT. STAFF, 1925. * Medical Officer of Health: JOSEPH PRIESTLEY, B.A., M.D., D.P.H. Public A nalyst (part time): A. H. MITCHELL MUTER, F.I.C., F.C.S. * Inspectorial Staff: (1) Special Sanitary Inspectors: \a) Food (including Sale of Food and Drugs Acts administration : \v. j. Prrrin+ and A. B. Cruttenden.† (b) Housing: . W.W. Howes and W. Wallis. (2) District Sanitary Inspectors: L Barfoot. T. S. Clements. A. Farran. Benj. Goon.f F. J. Heffield.† T. H. Hooper. C. W. Idle 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. Smai.l§§§; Miss W. E. Dyer.§§§§ Dispenser (part-time): Miss F. M. Speakman. * Tuberculosis Department (Branch Dispensary, St. Thomas' Hospital): Tuberculosis Officer : Dr. G. T. Herert. Assistant Tuberculosis Officer (visiting): Dr. A. J. G. McLaughlin. Lady Almoner's Department: N B.—The Branch Dispensary at St. Thomas' Hospital is under the control of the Governors of the Hospital, but is part of the Lambeth Municipal Tuberculosis Dispensaries scheme, and, consequently, attached to the Borough Council's Health Department, the Borough Council paying a yearly grant. Municipal Milk Dep6t [66, York Road, S E.i). Manageress : Miss V. Berkeley, Disinfecting Department (Arlington Lodge, Wattless Road, S.E.24). Superintendent: W. Lockyear. Mortuary Keepers: (a) 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 Female Assistant Clerk for Maternity and Child Welfare* and one Male Assistant Clerk for Tuberculosis*), (d) 2 Junior Clerks. N.B,—The above-mentioned Officers are whole time except where otherwise stated. * Contributions from Exchequer Grants, † Meat Ceitificate. ‡Central Midwives Board Certificate and the Health Visitor's Diploma. § Sanitary Inspector's Certi'icate. §§ Sanitary Inspector's Certificate and Health Visitor's Diplorr.a. §§§L.G.B. (Scotland) Tuberculosis Certificate. §§§§ Central Midwives Board, Health Visitor's and School Nurses' Certificates. A 2 4 Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. 2 March, 1926. To the May or, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor, Ladies and Gentlemen, Again it is ray privilege to be able to report most satisfactory statistics (vital and mortal) for the Borough for the year 1925, representing a great saving of life and illness, as a reward for the activities of the Council as a Health Authority, and as a justification for the money that has been expended out of the Rates—a maximum of good for a minimum of expenditure. The Registrar-General's estimated Lambeth population for 1925 (middle of the year) is 311,100, and, upon this basis, the various general and zymotic and special death-rates are low, and correspondingly, a credit to the Borough, as is also the infantile mortality rate, which, however, is expressed in terms of the total corrected deaths of infants under 1 year of age per 1,000 uncorrected births registered (not per 1,000 estimated population, as are the general, zymotic and special death-rates). The statistics for children under 5 years of age can only be described as remarkable in regard to lessened mortality—a result that was to be anticipated in view of the great decrease in the infantile mortality rate that has been registered during the last 25 years, even after making due allowance for the declining birth-rate. The Maternity and Child Welfare work of the old Parish and the new Borough (work hat is now co-ordinated and amalgamated under the newly instituted (1918) Welfare Scheme), the Milk Assistance Scheme, the Nursing (Infectious Diseases) Scheme and the Municipal Milk Depot have contributed to this satisfactory result. Tuberculosis is gradually, though slowly, declining, whilst typhoid fever is, practically, a disease of the past, as is also typhus fever. I have now had the honour of presiding as Medical Officer of Health, over the Health of the present Borough and the late Parish of Lambeth for 30 years, having been appointed to that responsible office on June 27th, 1895, and, as stated also in the last year's Annual Report of the Medical Officer of Health, the changes that I have seen, during that period, have been so much for the betterment of sanitary conditions that I feel justified in taking credit to myself as Medical Officer of Health, to be shared by the whole Public Health Staff as the working officials, and by the Council as the Sanitary Authority. Without the sympathy and support of the Council, and the energy and loyalty of the official Staff, my work as Medical Officer of Health could not possibly have achieved such results as are shown and proved, by the following statistics, extending over a period of 30 years:— 5 Death-Rates 1895 (year of Dr. Priestley's Appointment) 1925 Annual average 3 years 1895-1924 General death-rate Zymotic deat-rate Measles death-rate Whooping Cough death-rate Diarrhoeal death-rate Typhoid Fever death-rate Tuberculosis (all forms) death rate Tuberculosis (Phthisis or Consumption) death-rate Diphtheria death-rate Scarlet Fever death rate ... Smallpox ... 19.50 2.60 0.53 0.46 0.90 0.09 2.20 1.60 0.36 0.18 0.00 12.0 0.50 0.02 0.15 0.10 001 1.07 0.87 0.17 0.03 0.00 15.0 1.40 0.32 0.25 0.50 0.05 1.80 1.01 0.20 0.08 0.00 The Inner and Outer Wards or Districts vary as follow:— Inner Wards or Districts— General rate Zymotic rate Outer Wards or Districts— General rate Zymotic rate 26.5 4.4 16.6 1.7 13.7 0.8 11.1 0.3 18. 2.1 13.3 1.0 IN.is.—All aeatn-rates are corrected ana are expressed in terms per thousand of the population (estimated to the middles of the years). Infantile mortality (corrected) 152.00 44.80 113.70 per 1,000 registered births (uncorrected). I have, again, to put on record the valuable work of the Male Sanitary Inspectors (District and Special Inspectors), the Female Inspectors and the Health Visitors, the staffs of the Central and Branch Tuberculosis Dispensaries, the Milk Depot, and the Disinfecting Department, and, last but not least, the Clerical Staff. My personal thanks, are also again due to the chiefs of Departments, and to the members of the Maternity and Child Welfare and Public Health Committees, and of the Council generally, for assistance readily given at all times. The various voluntary Welfare Centres and their respective Committees have also rendered valuable help in welfare work. I am, Mr. Mayor, Ladies and Genllemen, Your obedient servant, JOSEPH PRIESTLEY, Medical Officer of Health and Chief Executive Tuberculosis Officer, 6 INDEX page Introductory Letter 4-5 Vital Statistics 7-79 Kstimated Populations, 1925 7-8 Births and Birth-rates 9-12 Notification of Births Act 12-13 Lambeth Maternity and Child Welfare Scheme 13-16 Lambeth Milk Assistance Scheme (Free or Aided Supplies) 17 Municipal Milk Depot and Infants Consultations Centre 18-24 Deaths and Death-rates (General, Infantile and Zymotic) 25-35 Lambeth Nursing (Infectious Diseases) Scheme 43 Infectious Diseases 36-62 [a) Notifiable 36-59 (b) Non-Notifiable 60-62 (1c) Tuberculosis Regulations 48-52 Lambeth Municipal Tuberculosis Dispensaries Scheme52—57 (1d) Polio-Myelitis (polio-encephalitis), Cerebro-spinal Fever, Encephalitis Lethargica . 58-59 Municipal Bacteriological Laboratory 63 Local Government Board, Old Tables A and B. 64-69 Local Government Board, New Tables I., II , III., and IV. 70-75 Mortality Tables (Corrected deaths'— (a) Registration Sub-Districts (£) Age-Periods (c) Summary 76-78 Summary of Vital and Mortal Statistics, 1925 79 Sanitary Work79-109 Notices served 80-82 (a) Infectious Diseases 80 (£) General Nuisances and Drainage Defects . 80-82 Male Sanitary Inspectors (District Inspectors) 82-84 Registration of Cowhouses, Slaughterhouses, Common Lodging Houses and Milk Shops 84-85 Offensive Trades 86 Male Sanitary Inspectors (Food Inspectors) 82 Male Sanitary Inspectors (Housing Inspectors) 82 Female Sanitary Inspectors 86-87 Female Health Visitors 88 Factories and Workshops and Out-Workers 88-89 Housing Department .89-98 Disinfecting Department 99 Analysis of Food and Drugs and Water 100-101 Public Health (Milk and Cream) Regulations 101-102 Milk (Special Designations) Orders, 1922-23 102-104 Ice Cream Vendors 104 Effluvium Nuisances 104 Mortuaries and Coroners'Courts 104 Public Health (Meat) Regulations, 1924 105-108 Rats and Mice (Destruction) Act, 1919 108-109 Appendices— I. Housing Conditions, 1925 (Ministry of Health Table) and 3 Addenda 110-114 II. Food Poisoning 115-121 7 1. VITAL STATISTICS. The Registrar-General estimates the population ot the Borough (up to the middle of 1925) at 311,100, and it is upon this figure that the death-rates and birth-rates are calculated throughout the Report, th s 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 1925 are as follow for the 12 Wards, the 5 Registration Sub-Districts and the 4 Parliamentary Divisions (the estimation having been made in the Registrar-General's Office):— Estimated Populations, 1925 (Middle of the Year.) 1. Wards. Wards. Males. Females. Total. 1. Marsh 7,160 6,690 13,850 2. Bishop's 13,530 14,360 27,890 3. Prince's. 13,440 14.500 27,940 4. Vauxhall 15,300 16,240 31,540 5. Oval 12,440 13,770 26,210 6. Vassall 8,420 9,660 18,080 7. Angell 13,730 16,670 30,400 8. Stock well 15,350 18,610 33,960 9. Town Hall 7,420 8,090 15,510 10. Heme Hill 7,470 8,490 15,960 11. Tulse Hill 15,050 18,720 33,770 12. Knight's Hill 16,070 19,920 35,990 Borough of Lambeth 145,380 165,720 311,100 8 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. 1. Lambeth Church 21,95° 22,530 44,480 2. Kennington 21,520 23,400 44,920 3. Stock well 30,890 35.100 65,990 4. Brixton... 39.i7o 46,280 8.5.45° 5. Norwood 3!>85° O M OO ro 70,260 Borough of Lambeth i45>38° 165,720 311,100 III. Parliamentary Divisions. * Adjusted Parliamentary Divisions. New Wards. Total. North ... | Marsh ... ... "j 69,680 ^Bishop's... ...I [Prince's... ...J [Vauxhall ...| Kennington J Oval ... ...l 75.83° (Vassall ... ..J I Angell ) Brixton ... J Stockwell ... I 79,870 [Town Hall ...J | Heme Hill ...1 Norwood -JTulse Hill ...V 85,72° [Knight's Hill ...J Parliamentary Area of Lambeth 311.100 * By the adjustment of the 4 old Parliamentary Divisions so as to make them co-terminous with the 12 new wards. 9 TABLE A. Giving number of Births and Birth-Rates in each Registration Sub District of the Borough of Lambeth during the 52 weeks ended 31st December, 1925 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1925. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church* 591 581 554 520 2246 Kennington† 286 274 253 238 1051 Stockwell‡ 376 412 428 373 1589 Brixton§ 458 463 417 402 1740 Norwood 255 275 287 220 1037 Borough of Lambeth 1966 2005 1939 1753 7663 * Including General Lying-in Hospital (920 cases, of which 252 belong to Lambeth), †Including Workhouse (358 cases, of which 319 belong to Lambeth). ‡ Including Clapham Maternity Hospital (655 cases, of which 162 belong to Lambeth). § Including King's College Hospital (698 cases, of which 174 belong to Lambeth). 10 TABLE B. Showing Populations (Estimated), Uncorrected Births, Corrected Deaths at all ages, under 1 year, under 5 years, anc from the 7 chief Zymotic diseases and Uncorrected Deaths in Public Institutions in the Borough of Lambeth during 1925, and for the quinquennium 1920 1924 (Borough), 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. 1925 311100 7663 3764 343 5°9 154 2220 1924 309300 7891 3865 395 635 197 2162 1923 308500 8344 3482 357 535 141 1986 1922 307000 8449 4188 496 859 237 2147 1921 305700 8984 3656 506 693 232 2 243 1920 293572 10456 3798 547 791 257 2252 Average 1920 24 (5 years) 304814.4 8824.8 3797.8 460.2 702.6 212.8 2158.O Averages (10 years)— 1911 1920 (Borough) 286786.4 8027.1 4282.5 619.7 958.6 326.8 2506.5 190110 (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 Notk. —(a) Enumerated Population at Census 1901 was 301,895. (i) Enumerated Population at Census 1911 was 298,058. (f) Enumerated population at Census 1921 was 302.868. (d) Families or separate occupiers = 70,887 (1901), 70,827 (1911) and 78,399 (1921). X. B. — In this anil 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 dtaths 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. 11 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 1925 and for the quinquennium 1920-1924 (Borough), together with the averages for the three decennia 1891-1900 (Parish), and 1901-10 (Borough) and 1911-1920 (Borough). ear. Birth-Rate per i, ocx) 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). 1925 24.6 12.1 44.8 91.1 135.2 0.5 539.3 1924 25.5 12.5 50.50 102.2 164.3 o.6 515.0 1923 27.04 11.3 42.7 102.5 156.5 0.4 516.1 1922 27.5 13.6 58.7 1 18.4 205.1 o.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 Average 1920-24 (5 years) 28.9 12.4 52.01 121.1 184.7 0.7 513.7 Averages(10 years)— 1911-20 (Borough) 27.9 14.9 77.2 144.5 223.1 1.1 499.8 190110 (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 ano 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. 1 2 BIRTHS. 1925. The total number of Births registered (during the 52 weeks ended 31st December, 1925) is 7,663, of which details are set out in Table A, showing a birth-rate (un-corrected) of 24.6 per 1,000 of the population, 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 London, nor 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. Since then, this temporary increase has again become practically normal (approaching the average): indeed, the figures for 1925 are sub-normal (or below the average). The Registrar-General's figures (total figures) for Lambeth Borough relate to the calendar year, whilst, in addition, the Registrar-General allows corrections, not only for outward transfers but also for inward transfers, as follows, giving a corrected number for the year (calendar year) of 5,543:— Total registered. Inward transfers. Outward transfers. Corrected numbers. Legitimate Males 3-765 114 1,147 2,732 Legitimate Females 3.431 110 1,019 2,522 Illegitimate Males 239 25 113 151 Illegitimate Females 228 15 105 138 Totals 7,663 264 2,384 5,543 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 129,605 births have been notified up to the end of 1925, viz.: 3,473 in 1908 (10 months), 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, 7336 in 1912, 7,158 in 1913, 7,397 in 1914, 7,091 in 1915, 7,293 in 1916,6,311 in 1917, 5,890 in 1918, 7,260 in 1919, 9,910 in 1920, 9,023 in 1921, 8,564 in 1922, 8,443 in !923» 7.782 in 1924, and 7,734 in 1925. 13 All Lambeth notified births are referred to the various voluntary Welfare Centres that are comprised in the Lambeth Maternity and Child Welfare Scheme, and, in connection therewith, are visited and re-visited systematically, the mothers attending at such Centres, if and when they wish to do so. It is impossible to give statistics of the educational \alue of this visiting of houses wherein births have been notified, but there is no doubt as to the existence of such value. 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 7,734 notified births, 4,047 took place in Institutions, and, of these 4,047 births, 1,760 belong to Lambeth and 2,287 t0 outside districts, thus:— Institutions.* Lambeth Cases. Strangers. Totals. General Lying-in Hospital 245 685 930 St. Thomas' Hospital 242 386 628 Lambeth Workhouse 348 47 395 Clapham Maternity Hospital 212 460 672 King's College Hospital 208 509 717 West Norwood Maternity Home 274 6 280 Other Nursing Homes (private) 231 194 425 Totals 1760 2287 4047 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 now, with the approval of the Ministry of Health, sub-divided into 12 administrative welfare areas—each area administered by a separate voluntary welfare centre committee, as follows:— 1. North Marsh, Cornwall Road, New Cut.f 2. The Barley Mow, 52, Oakley Street. *Vide also Special Report on the Maternity Needs of the Borough of Lambeth (Appendix III) of the 1924 Annual Report of the Medical Officer of Health. † Formerly North Marsh (Morley College), Webber Street. 14 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, Cainberwell New Road. 10. Loughborough Junction, the Sussex Arms, 109, Sussex Road.t 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. Creches or Day Nurseries. (а) St. Thomas's Hospital Day Nursery, 83, Lambeth Palace Road. J (b) Cornwall Nursery Hostel, Princes' Road.§ (c) Pilgrim Hill Crfeche, 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—to be removed in 1926 to 210, Knight's Hill (Millburn House), which has been purchased for the purpose, and to be known as the Lambeth Borough Council Maternity Home. In addition to the above, there are also included indirectly in the Scheme the following:— * Now incorporated (since April 1st, 1924), with the Babies' Care Welfare Centre, and administered by that Centre's Committee, † Formerly 39, Loughborough Park. ‡ Formerly 107, Lambeth Palace Road, which was temporarily closed as from April 1st, 1921, the new premises (83, Lambeth Palace Road) being opened on July 1st, 1925. § Permanently closed as from August 1st, 1924, as a voluntary Hostel, being taken over by the Governors of St. Thomas's Hospital as part of that Institution. The Hostel now no longer forms part of the Lambeth Maternity and Child Welfare Scheme. §§ Have not yet been given grants by the Borough Council (no applications having been received). 15 (1) The Maternity Wards of St. Thomas's Hospital, (Westminster Bridge). (2) The General Lying-in Hospital (York Road). (3) The Clapham Maternity Hospital (Jeffreys Road). N.B.—In connection with (1) and (2), Infants' Consultas tions Centres have been established at the Hospitalconcerned for their own particular mothers and their babies, which have been born in, or in connection with, such Hospitals. These Infants' Consultations Centres rank as Welfare Centres for grants directly under the Scheme, both from the Ministry of Health and the Borough Council, none from the latter being given to the Maternity Hospitals in connection with actual maternity work (lying-in wards). 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, and rank for Government grants under such 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 as approved during the past year —the Borough Council grants being dependent automatically 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. The statistics of work done by the voluntary Welfare Centres during the year 1925, are satisfactory, and include a large number of visits and re-visits paid by Health Visitors and are *During 1925 (calendar year), 280 mothers were confined at the Home (9 by doctors and 271 by midwives), whilst, in addition, 43 mothers were confined in the district by midwives connected with the Home. No case of puerperal sepsis and no case of ophthalmia neonatorum or other ophthalmia was reported, bin medical assistance was sought by the midwives in 34 cases (at the Home 33, on the District r). 16 specially noteworthy as showing what can be well accomplished by voluntary workers throughout a district such as the Borough, and how municipal and voluntary organisations can work together, with great value to the community. Voluntary help is a very valuable asset in Public Health Administration in so far as maternity and child welfare is concerned, and should be used to the utmost by a Sanitary Authority, subject, of course, to such voluntary work being properly organised. The difficulty is to obtain voluntary workers suitable for the purpose in sufficient numbers. Prior to the inauguration of the Lambeth Maternity and Child Welfare Scheme in 1916, welfare work had been accomplished for many years previously by voluntary organisations and general hospitals (maternity departments), not only within the new Borough of Lambeth but also within the old Parish of Lambeth. This voluntary work required to be consolidated and attached to the official general public health work of the District under the Medical Officer of Health, if the m aximum amount of benefit and advantage were to be obtained, This amalgamation of the work took time and was slow but sure, and finally was crystalised into a scheme, which was approved by the Ministry of Health as the Lambeth Maternity and Child Welfare Scheme, under the provisions of the Maternity and Child Welfare Act, 1918. It is to be hoped that such scheme will long continue in existence throughout the Borough—a scheme that has already more than justified itself by the results that have been actually obtained in welfare work (as shewn by statistics). Cornwall Nursery Hostel, Prince's Road. The Cornwall Nursery Hostel, Prince's Road, was permanently closed as an Institution under voluntary management on August 1st, 1924. This action had to be taken by the General Committee of Management, owing to the original founder of the Hostel having withdrawn her support (financial and otherwise) on account of the resignation of the Honorary Consulting Physician, due to a difference of medical opinion as to the value of the particular method of feeding and treatment of the infants and children admitted (vide Annual Report of the Medical Officer of Health for the Borough of Lambeth for 1924). The Hostel has been handed over to the Governors of St. Thomas's Hospital and is now part of that Hospital's medical administration, and was reopened as such to the public on November 1st, 1924, and is no longer under a local representative committee of management, and, consequently is no longer entitled to Borough Council grants as part of the Lambeth Maternity and Child Welfare Scheme, having been withdrawn from such Scheme by resolution of the Council on September 25th, 1924. Good and useful work is still being carried out at the Hostel, full details being set out in the Annual Report of the Institution that is published from St. Thomas's Hospital. 17 Lambeth Milk Assistance Scheme (Free or Aided Supplies). The Lambeth 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 on the ground ol 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 in Lambeth (and elsewhere). 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 for the purpose). The figures giving the cost of the Lambeth Milk Assistance Scheme (free or aided supplies) are interesting as showing the comparatively large amount of milk (ordinary milk and dried milk), which has been distributed under such Scheme, which first came into force on February 8th, 1918, under powers given by the Milk (Mothers and Children) Order. iqi8, and the Local Authority (Food Control Order (No. 1), 1918. (No. 1), 1918. The figures are as follow:— Years. (Financial) Cost of Milk distributed Total Cost. Total amount of Milk dis- ribtued in gallons (approximately;* Through Welfare Centres. Through Milk Depot.* 1918-19 (3 m'ths.) 232 15 3 69 4 3 301 19 6 3,151 1919-20 2,780 0 10 557 10 1 3,337 10 11 34,827 1920-21 13,836 7 3 1,564 7 3 15,400 14 6 160,703 1921-22 4,596 8 5 1,172 0 8 5,768 9 1 60,192 1922-23 3,553 15 4 1,064 19 5 4,618 14 9 48,196 1923-24 3,38o 15 11 353 15 3 3,734 11 2 38,969 1924-25 2,977 19 8 137 17 7 3,115 17 3 31,543 1925(9 m'ths.) 1,572 13 9 73 7 6 1,646 1 3 24,731 Totals £3,2930 16 5 £4,939 2 0 .£37,923 18 5 402,242 gallons. *N.B.—See also the figures for the Milk Depot, dealing with milk supplied to all cases (necessitous and non-necessitous), representing for the 7 years 1918-1925 a net expenditure of £2,752 4s. 6d. (total expenditure £13,427 16s. od. less receipts from mothers of £10,675 IIS* 6d.), B 18 Municipal Mii.k Dep6t and Infants Consultations Centre. (Municipal Milk Depot, inaugurated by the Council 1903 ) Record of Work carried out during 1925. 99 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk:— Under 3 months 31 9-12 months 11 3-6 months 29 Over 12 months and 6-9 months 15 under 2 years 13 Total 99 Of the 31 infants under 3 months, 5 were aged 14 days or under. These 99 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 signs of wasting or disease, though often below par constitutionally, 50; weakly 29, wasting 8, diseased 12. The diseases from which the 12 infants and children were actually, or had recently been, suffering at the time of being put upon the milk were diarrhoea and sickness 2, teething 1, scarlet fever 1, Rickets 1, bronchitis 1, constipation 1, whooping cough 1, broncho pneumonia 1, gastritis 1, and congenital malformation 2. An average of 103 infants and children (under 2 years) were fed per week at the Depot, necessitating the distribution for the year ol 106,231 bottles of milk mixture (5,788^ gallons), whilst, in addition, milk was also supplied as follows:- 1. Lambeth Hospital—using 6,809 bottles of milk mixture (852 gallons); 2. Nursing mothers—using 773 pint bottles of milk mixture (96⅝ gallons); 3. Children over 2 years of age—using 749 pint bottles of milk mixture (93! gallons). A total of 6,640½ gallons of milk and 375 pints of cream were used during 1925, distributed in 113,040 bottles. 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, 19 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 Dep6t for the purpose of distributing 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 Depot, in so fai 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 DepCt, 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 of the various infants fed, except in such cases as require one or other of the ingredients to be modified. The educational value of a milk depot must not be lost sight of. It is now over 20 years since the Municipal Milk Dep6t was first inaugurated (1903) and opened to the public (1906), and the history and the experience gained during that period are worthy of being put on record, as shewing what can be effected by well-directed municipal action. Twenty Years' Experience of the Lambeth Municipal Milk Depot. On 9th July, 1903 (Minutes 1903, pages 164-9), the Borough Council decided to establish a Municipal Milk Depot for the Borough of Lambeth, and, for that purpose, secured afterwards {Minutes 1904, pages 1686-7) the premises known as 66, York Road, Westminster B 2 20 Bridge Road, which had previously been in use (but considerably neglected) as a private hotel, and which, consequently, required to be redrained, reconstructed, and redecorated, and, afterwards, equipped for the purpose of a model up-to-date milk dep6t. The Borough Accountant's and Treasurer's Abstract respectively of the Lambeth Accounts show that the cost of these alterations, reconstructions, redecorations, and equipment was, naturally, considerable, amounting to £921 15s. 9d., but the altered premises proved an ideal object-lesson for the public generally, and for the milk trade and the medical profession in particular. Further, the same accounts show that the average maintenance cost since that time up to the end of March, 1925 (a period of 20 years) has been £1,763 14s. 1d. (nett) per annum, and grants have been available from the Local Government Board or the Ministry of Health, year by year, though, for several years, it was necessary for the Government Department formally to surcharge, or what was, practically, to surcharge, the Council (through the District Auditor), and to remit such surcharge, or otherwise to allow such payment, afterwards, under the Local Authorities (Expenses) Act, 1887, no legal power having been given directly at that time to a Local Authority to establish or inaugurate (and maintain) such an Instiution out of the rates within the County of London.* In this way, the Government have shown that, whilst there may have been no direct legal powers, their sympathy was in favour of such an inauguration and maintenance of a Municipal Milk Depot. In addition, the usual contributions have been received from parents and others responsible, as also rents for sub-lettings, etc. The nett cost out of the rates has been an average annual one of £453 15s. 10d. In view of the above-mentioned facts, the question will naturally arise as to whether or not the trouble and expenditure have been justified by the results obtained. Fortunately, the answer can be given at once in the affirmative, the results far more than justifying the Council's action—at least, as far as experience in Lambeth goes. It is interesting to set out in statistical form, for record, the details upon which such answer is based. In this connection, however, it must be emphasised that the most conclusive proof of the value of a Milk Depot is not to be found in dry statistics, but in the actual medical histories, or case-sheets, of infants and children (under two years of age), who have been fortunate to be fed from the Depot. These histories, or case-sheets, show, again and again, that infants and children, who appear to be seriously ill and wasting, if not moribund, as the result of improper and irregular feeding, at the time of commencing the milk, actually recover and become strong and healthy. *The necessary power was given by Section 12 of the Milk and Dairies (Consolidation) Act, 1915, which was passed on Julv 29th, 1915, and which came into operation on September 1st, 1925, by order of the Ministry of Health. 2 I The great value, too, of a Milk Depot from an educational point of view must not be lost sight of, such value being considerable. The best details are set out in tabular form as follows:— Year New Infants and Children entered upon the Register Under 3 months 3 to 6 Months 6 to 9 Months 9 to 12 months Over 12 months and under[ , 2 Years 1906 156 60 55 18 12 11 1907 260 128 69 21 25 17 1908 180 92 54 19 13 2 1909 219 108 64 19 19 9 1910 279 115 81 25 19 39 1911 258 121 72 35 24 6 1912 267 129 67 29 23 19 1913 246 135 73 23 8 7 1914 252 110 85 37 12 8 1915 314 109 70 43 54 38 1916 290 101 92 52 34 11 1917 198 92 51 26 22 7 1918 202 92 56 26 17 11 1919 246 102 52 36 35 21 1920 442 214 106 56 51 15 1921 423 189 86 42 58 48 1922 296 126 59 34 33 44 1923† 196 91 35 32 15 23 1924† 139 47 36 17 17 22 1925† 99 31 29 15 11 13 Totals 4962 2192* 1292 605 502 371 A0verage 20 years, 1906-1925 .2482 109.1 64.1 30.5 25.2 18.1 * Of the 2,192 infants under three months, 506 were aged 14 days or under. † N.B.—The decreases in the numbers since 1923 are apparent rather than real, and are owing to infants, children and mothers from the North Lambeth area fwithin which the Milk Dep6t is situated) being in part automatically transferred to the three Welfare Centres, which now control the welfare work of that particular area of the Borough, and which now administer (instead of the Milk Depot) the Lambeth Milk Assistance Scheme, and the distribution of milk as required in connection therewith. Of the 4,962 total new infants and children entered upon the register during the 20 years, the health-conditions of the individual 22 cases were classified, at the time of being put upon the milk, as follows:— 1. Healthy, i.e., showing no sign of wasting or disease, though often below par constitutionally 2,425 2. Weakly 560 3. Wasting 1,196 4. Diseased 789 The diseases in classification No. 4 were as follows:—Sickness and diarrhœa 137, bronchitis 91, indigestion 83, diarrhoea 93, sickness 35, rickets 34, lung disease 32, measles 24, whooping cough 23, pneumonia 25 hernia 18, consumptive bowels 13, convulsions 15, teething 13, gastritis 12, prematurity 12, congenital malformations 17, tuberculosis 12, and other diseases (not classified) 100. The total amount of bottles of milk mixture distributed at the Milk Depot during the 20 years has been 3,787,597 (infants under two years of age 3,618,745; and others, e.g., invalids, nursing mothers, expectant mothers, and children over two years of age, 168,852); whilst, in addition, milk was also distributed, during the same period, to Lambeth Guardians in 384,913 bottles. Expressed as milk and cream, the above totals of bottles represent an annual average of 13,126½ gallons of milk, and 625½ pints of cream respectively. The milk mixture is prepared under medical supervision, and for the infants is humanised so as to be of the composition of mothers' milk for the particular age-periods of the infants fed. This necessitates the addition of cream or butter fat, and milk sugar, and the abstraction of casein from the cows' milk, which is the basis of the Depôt mixture. Further, all infants and children who are fed upon the milk in connection with the Depôt are under medical supervision, in that they are seen personally by the Medical Officer of Health, who attends at the Depôt weekly for medical consultations as required, whilst the homes of the parents are visited as a routine by the Council's Health Visitor, who is attached to the Milk Depôt. If the death-rate is calculated upon the infants and children actually fed at the Milk Depôt, it is found to be very low in comparison with that of infants and children not so fed, and a similar remark applies in dealing with morbidity rates (or illness rates). There are, however, statistically, difficulties inseparable from calculating rates upon such a (comparatively) small population, but, even after allowing for 23 all these well-known technical difficulties, there is no doubt as to the main fact being incontrovertible, and, indeed, proved, viz., that infants and children who have been fed from the Milk Depot during the past 20 years have had an enormous advantage over those not so fed, whether from a mortality or from a morbidity point of view. On this conclusion, there can be no two possible opinions, as the individual medical histories (reported in the records of the Milk Depot) show again and again. Whilst it is impossible, therefore, to set out exactly in statistical form the actual saving in life (and illness) that has been effected directly as the result of the inauguration and maintenance of the Milk Depot, there are, as a fact, many hundreds of deaths that have been prevented, and many thousands of attacks of illness that have been avoided, thereby. This statement must be obvious to all who will trouble to examine the facts—facts that more than justify the original decision of the Council in 1903, when it was decided to inaugurate a Municipal Milk Depot for the Borough of Lambeth, and the subsequent expenditure, that, of necessity, has had to be incurred both in its inauguration and maintenance. It only remains to be added that the good influence of the Milk Depot, by virtue of its position in York Road, Westminster Bridge Road, at the northern end of the district, has been mainly restricted to that particular area (North Lambeth), but it is fair to assume that similar Milk Depots, or Branch Milk Depots, had such been established and maintained also on the same lines in other parts of the Lambeth District, would have given equally successful results from a point of view of the prevention of infantile and child morbidity and mortality. Such an extended Scheme, however, was never carried out on account of the initial (establishment) expenditure, but, fortunately, instead of such an extended Scheme, a new method of milk distribution for infants and children and mothers (expectant and nursing) was inaugurated in 1918. under the Milk (Mothers and Children) Orders, 1918 and 1919, and the Local Authorities (Food Control) Order (No. 1, 1918, and the Local Authorities (Mothers and Children) Order, 1919, respectively, and, finally, under the amended Milk Assistance Consolidated (Free and Aided) Supplies Order, which was inaugurated in 1919, under the Maternity and Child Welfare Act, 1918, this amended Order being now in working throughout the Borough of Lambeth as a whole, in connection with, and through, the different Welfare Centres, that are incorporated in the well known Lambeth Maternity and Child Welfare Scheme. Large quantities of milk are distributed daily to infants and children and to expectant and nursing mothers, and are effecting similar beneficial results over the whole of the Borough as the Milk Depot has effected for the past 20 years, and is still effecting, in North Lambeth—the work of the Milk Assistance Scheme and the Milk Depôt being the same or similar, except that in the latter case (Milk Depôt) the milk is modified under strict medical supervision, and distributed all ready for use in separate bottles, one for each feed. In both cases, infants and children and mothers (expectant and nursing) 24 receive milk as required, and that is the important point. At the same time, as was to be expected, the numbers of new cases now being registered (last few years) at the Milk Depot are decreasing, but these lessened and lessening figures must be read in conjunction with the figures tabulated under the Lambeth Milk Assistance (Free and Aided Supplies) Scheme, a large number of the infants and children and mothers having been automatically transferred from the Milk Depot Register to the Milk Assistance Scheme Registers connected with the three Welfare Centres, which are situated in the immediate neighbourhood of the Milk Depot (York Road), and which now have to administer the Lambeth Milk Assistance Scheme within their own three respective areas, instead of, as previously, such Centres obtaining their milk supplies from the Milk Depot direct. Whatever views may be expressed elsewhere, the Lambeth experi ence is very definitely in favour of the inestimable value of milk as the sole food for infants under the age of six months, and as an additional (or supplementary) food for infants between the ages of 6 and 12 months, and for children between the ages of 1 and 5 years. As to these facts there can be no doubt. Artificial feeding is only used when absolutely necessary. Every endeavour is made to encourage and maintain natural feeding in all cases if at all possible. As was to be expected, and as already stated, the inauguration of the Lambeth Milk Assistance Scheme (inaugurated with the approval of the Ministry of Health in 1918) has led to the lowering of the numbers of mothers and infants and children actually attending the Milk Depot, the milk being now obtainable more conveniently locally from one or other of the various milk retailers appointed by the Council in connection with the respective Welfare Centres, one of the many duties of which is to carry out, within their own areas, the provisions of the Lambeth Milk Assistance Scheme. The Milk Depot is still available for special cases, which require medically-prepared milk mixtures, which are obtainable thereat. The ideal Scheme would be for all milk to be issued from the Milk Depot and sent round to the various Welfare Centres as distributing branches, but the expenses connected with such a scheme would be considerable, and would be, doubtlessly, objected to by the Trade as municipal trading. It must be remembered that the Milk Depot has done pioneer work, justifying its inauguration in 1903, but, in the future, the Lambeth Milk Assistance Scheme will extend similar work to that of the Milk Depot throughout the Borough—work, which has been restricted in the past, to the immediate neighbourhood of the Depot (York Road, Westminster Bridge Road) at the extreme northern end of the District, and available only, practically, for North Lambeth (Marsh, Bishop's and Prince's Wards). 25 DEATHS, 1925. The total number of deaths registered is 4,116. All death rates for 1925 are calculated upon an estimated popula tion of 311,100 (to the middle of the year). 1.—General Death-Rates. The uncorrected death-rate for Lambeth is 13.2 per 1,000 of the population. This rate is, however, uncorrected, and, on analysing the 4,116 total deaths registered, it is found that 998 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 646 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a net corrected number of deaths of 3,764, and a net corrected death-rate of 12.1 per 1,000 inhabitants. The Inner (congested and crowded) Districts show, as a whole, a general corrected death-rate of 13.7 as compared with 11.06 for the Outer (less congested and less crowded) Districts per 1,000 of the population. Age Periods of Corrected Deaths. The 3,764 corrected deaths during 1925 may be further analysed and tabulated as follows:— 343, i.e., 9.1 per cent, of the total corrected deaths took place under 1 year of age. 166, i.e., 4.1 per cent. between r and 5 years. 509, i.e., 13.5 per cent. under 5 years. 177, i.e., 4.7 per cent. between 5 and 20 years 350, i.e., 9.3 per cent. 20 to 40 years. 811, ie., 21.5 per cent. 40 to 60 years. 1,917, i.e., 50.9 per cent. 60 and over. 3,255, i.e., 86.2 per cent. over 5 years. 26 27 TABLE D. TABLE D. Shewing the corrected number of Deaths, with corrected Death- rates (general, zymotic and diarrhœal), in each of the Registration Sub-Districts of the Borough during 1925. The deaths are from all causes, and from the 7 chief zymotic diseases, and are corrected by adding Lambethians who die outside the Borough, by omitting strangers who die within the Borough, and by re-distributing persons (who die in Public Institutions) amongst the Districts from which they have been removed into such Public Institutions for treatment. A. Registration Sub-Districts. REGISTRATION SUB-DISTRICTS. Total Deaths (corrected). General corrected Deathrate per 1000 of the Population. Small Pox. Measles. Scarlet Fever. Total Deaths (corrected) from Cholera. Diarrhoea and Dysentery. Total Zymotic Deaths. Zymotic Death-rate per 1,000 of the Population (corrected). Diarrhoea Death rate per 10,000 of the Population (corrected). Diphtheria and *Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. Lambeth Church 643 14.5 — 1 3 26 9 — 1† — — IO 50 1.1 2.2 Kennington 669 14.9 — — 2 I I 14 — 1† — — 6 34 0.7 1.3 Stockwellg 765 11.6 — 1 1 6 9 — 2 — — 5 14 0.4 0.7 Brixton 957 11.2 — 1 1 11 9 — — — — 5 27 0.3 0.6 Norwood 730 10.4 — 2 2 1 7 — — — — 7 19 0.3 1.0 Borough of Lambeth 3764 12.1 — 5 9 55 48 — 4 — — 33 154 0.5 1.0 *No death registered from membranous croup. †Cases of Paratyphoid Fever. §Of the 765 deaths in Stockwell Registration Sub-District, 362 belong to the Inner and 403 to the outer Stockwell Sub-District respectively. Inner Registration Sub-Districts—death rates (general, 13.7, zymotic, 0.8, diarrhœal, 0.2 per 1,000 population). Outer Registration Sub-Districts—death rates general, 11.06 zymotic, 0.3 diarrhœal, 0.06, per 1000 population). 28 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 1925 from the RegistrarGeneral—a total of 88 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 1925 (and the previous 5 years) at the end of the Report (Vital Statistics), known as the Local Government Board New Tables I., II., Ill, 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 1925 being as follows:— Age Periods. Males. Females. . Totals. 0— 1 6 4 10 1— 2 1 — 1 2—5 1 — 1 5— 15 4 4 8 15—25 7 3 10 25—45 13 12 25 45-65 9 7 16 65 and upwards 6 11 17 Total all ages 47 41 88 29 Causes of the 88 outside deaths. Causes of Death. Male Female. Whooping Cough 1 1 Diphtheria 1 1 Diarrhœa — 1 Influenza 1 — Phthisis (Pulmonary Tuberculosis) 12 7 Other Tubercular diseases 1 — Cancer, malignant disease 1 3 Heart disease 3 2 Bronchitis 2 2 Pneumonia 1 1 Broncho-Pneumonia 1 2 Pleuro-Pneumonia — 1 Other Lung Diseases 1 2 Nephritis and Bright's disease — 2 Premature Birth 1 1 Violent deaths 6 4 Suicide — 1 Nervous diseases 6 1 Cirrhosis of Liver 1 — Diseases of Digestive System 1 1 Diabetes — 4 Not classified above 6 5 Totals 46 42 2.—Infantile Mortality Rates. Of the 3,764 corrected deaths, 343 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 an average of 460.2 for the previous quinquennium 1920-24 (Borough). Having regard to the large population of Lambeth Borough, these figures mean an enormous saving of 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 7,663 total registered births during 1925 (52 weeks), and the 531 total uncorrected deaths of infants under 1 year of age, the infantile mortality rate is 69.3, as compared with annual average rates (uncorrected of 150.5, 123.8 and 97.5 for thedecennia 1891-1900 (Parish), 1901-10 (Borough) and 1911-20 (Borough), and an annual average 30 rate (uncorrected) of 70.2 for the previous quinquennium 1920-24 (Borough); whereas, if the corrected deaths of infants under 1 year are used, viz.: 343, the infantile mortality rate is 44.8, as compared with yearly average rates (corrected) of 146.1, 115.3 and 77.2 for the same decennia, and an average rate (corrected) of 52.01 for the previous quuinquennium 1920-24 (Borough) respectively. 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, and the previous quinquennium 1920-24. In the Registration Sub-Districts the uncorrected infantile mortality varies from 50.1 in Norwood to 88.5 in Brixton, thus: Registration Sub-Districts. Total No. of Births (uncorrected) 1925 Total Deaths under 1 year (uncorrected) 1925. Infantile Mortality per 1000 births (uncorrected) 1925. Lambeth Church 2246 177 78.8 Kennington 1051 68 64.7 Stockwell 1589 80 50.3 Brixton 1740 154 88.5 Norwood 1037 52 50.1 Lambeth 7.663 531 693 Inner Districts—69.6, Outer Districts—68.04. N.B.—For the purposes of calculating infantile mortality rates in this table the births and deaths in Stockwell Registration Sub-district 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 1925, 509 corrected deaths amongst children under 5 years of age are registered, as compared with 31 yearly corrected averages of 2070.2, 1503.5 and 958.6 for the decennia 1891-1900 (Parish), 1901-1910 (Borough), and 1911-20 (Borough) respectively and a yearly corrected average of 702.6 for the previous quinquennium 1920-24 (Borough). These figures, like the figures for the deaths of infants under 1 year of age, also represent an enormous saving in young life (under 5 years of age). 4.—Mortality (all ages). The different rates of mortality from different diseases and groups of diseases during 1924 and 1925 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 corrected infantile population (i.e, the number of births registered as corrected by the Registrar- General). 5.—Zymotic Death-Rates. The zymotic death rate is made up of the total deaths from the seven principal zymotic diseases, viz.: small-pox, measles, scarlet fever, diphtheria (including membranous croup), whooping cough, "fever" (including typhus, typhoid or paratyphoid or enteric and simple continued or ill-defined) and diarrhœa. The total number of deaths registered within the Borough from these diseases is 251—97 strangers belonging to other districts and 99 parishioners who died within the Borough; whilst, in addition, 55 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 154, giving a zymotic death-rate (corrected) of 0.5 per 1,000 inhabitants. As in the case of general death-rates, the zymotic death-rates vary in the inner and outer districts, viz., 0.8 as compared with 0.3 per 1,000 population (vide Table D). Taking the seven principal zymotic diseases separately, the corrected death-rates are:—Small-pox 0.00, measles, 0.02, whooping cough 0.15, scarlet fever 0.03, diphtheria 0.17, "fever" 0.01, and diarrhoea 0.10, per 1,000 of the population. Tuberculosis Death Ratbs. The tuberculosis corrected death-rate for 1925 is 1.07 i.e., 335 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis) death-rate, 0.87, i.e., 273 deaths from pulmonary tuberculosis or consumption (phthisis) per 1,000 population. 32 The details of the corrected tuberculosis deaths in the various Registration Sub-Districts are:— Registration Sub-Districts. Corrected Deaths from Pul. Tub. or Phthisis (consumpt'n) father Forms Tuberculosis. Total Deaths Tuberculosis (all forms). Phthisis rate per i,o00 population. Tuberculosis rate per 1.000 population (all forms). Lambeth Church. 50 12 62 1.1 1.2 Kennington 41 13 54 0.9 1.2 Stockwell 66 9 75 1.0 1.1 Brixton 74 11 85 0.8 1.0 Norwood 42 17 59 0.6 0.8 Borough of Lambeth 273 62 335 0.87* 1.07† Rates for Inner Districts 1.01* and 1.26† Rates for Outer Districts 0.78* and 0.95† 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 the previous quinquennium 1920-24 (Borough), viz.:—(a) pulmonary tuberculosis or consumption (phthisis) and (b) tuberculosis (all forms) as follows:— (a) 283.4 and (b) 353.8. This is the more remarkable, having regard to the increase of the censal (enumerated) 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 average population for the quinquennium 1920-24 (Borough) of 304,814.4. *† 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. 33 TABLE E. Showing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1924 and 1925. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). ClAss of Disease. BOROUGH 1925. Borough 1924. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). I.—Zymotic Diseases 270 7.2 342 8.8 Seven Principal 154 4.1 197 5.09 Influenza 63 1.7 97 2.5 II.—Parasitic — — 3 0.07 III.—Dietetic 1 0.02 9 0.2 IV.—Constitutional 890 23.6 894 23.1 Cancer 463 12.3 455 11.7 Phthisis 273 7.2 279 7.2 Tubercular Diseases, excluding Phthisis 62 1.6 79 2.04 Rheumatism (Acute and Chronic) and Gout 29 0.8 21 0.5 V.—Developmental 259 6.8 261 6.7 Old Age 162 4.3 135 3.5 VI.—Local Diseases 2117 56.2 2145 55.5 Circulatory System 620 16.5 607 15.7 Bronchitis 426 11.3 442 11.4 Pneumonia and BronchoPneumonia 181 4.8 237 6.1 Pleurisy and pleuropneumonia 97 2.6 95 2.4 Respiratory System, excluding Phthisis 743 19.7 817 21.1 VII.—Violence 180 4.8 168 4.3 Suicide 36 0.9 34 0.9 VIII.—Ill-defined and not Specified Causes 47 1.2 43 1.1 c 34 TABLE E.—continued. r5.—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 1925. Borough 1924. 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 343 61.9 395 67.1 Diarrhoea 27 4.9 20 3.4 Convulsions 3 0. 7 1.2 Respiratory Diseases 74 13.3 l01 17.4 Premature Births 69 12.4 99 16.8 Tubercular Diseases (including Phthisis) 13 2.3 8 1.3 Measles — — 18 3.6 Whooping Cough 21 3.8 7 1.2 Suffocation in Bed 5 0.9 3 0.5 Enteritis 10 1.8 23 3.9 Dentition 1 0.2 1 0.1 *N-B.—The above rates have been calculated upon the Registrar-General's corrected numbers of births for the calendar years 1924-25, viz.:—5,587 and 5,543 respectively. 35 TABLE F. Shewing the number of Deaths (corrected) from the 7 principal zymotic diseases in the Borough of Lambeth during 1925 and during the five previous years 1920-24, together with the yearly averages during the previous quinquennium 1920-24 (Borough) and the three decennia 1891-1900 (Parish), 1901-10 (Borough) and 1911-20 (Borough). Disease. Total (corrected) Deaths in 1925. 1920 1921 1922 1923 1924 Annnual average of five years 1920-24 (Borough). Annual average of ten years 1911-20 (Borough). Annual average of ten years 1901-10 (Borough). Annual average of ten years 1891-1900 (Parish). Smallpox — — — 1 — — 0.2 0.0 6.8 1.1 Scarlet Fever 9 15 l6 20 11 11 12.6 11.9 31.4 48.8 Diphtheria 55 77 44 50 48 51 54.0 47.3 41.6 124.5 Membranous Croup — — — — — — 0.0 0.3 1.5 6.8 Fever Typhus — — — — — — 0.0 0.0 0.0 0.3 Typhoid or Enteric and 4 1 — 7 1 1 2.0 7.0 16.7 34.7 Continued (Relapsing) — — — — — — O.O 0.3 0.7 1.7 Diarrhœa 33 51 124 35 46 23 55.8 127.8 172.9 196.5 Cholera — — — — — — 0.0 0.3 1.3 8.8 Measles 5 80 15 66 21 88 54.0 84.7 110.4 145.6 Whooping Cough 48 33 33 58 14 23 32.2 47.2 91.8 143.7 Borough of Lambeth 154 257 232 237 141 197 212.8 326.8 475.1 706.1 36 INFECTIOUS DISEASES. i.—Notifiable Diseases. Under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 4,285 cases of infectious diseases (excluding tuberculosis) were reported, including encephalitis lethargica acuta 17, malaria 8, acute primary pneumonia 159, acute influenzal pneumonia 87, cerebro-spinal fever 3*, poliomyelitis acuta 6†, ophthalmia neonatorum 36, measles 798, and German measles 1,111. These 4,285 cases occurred in 3,904 infected houses, and, of the 4,285 cases, 2,095, i.e., 48.9 per cent., were removed to hospital, and 2,190, i.e., 51.1 per cent., remained under treatment in their homes. If the recently-added notifiable diseases be excluded so as to make the 1925 figures strictly comparable with those for previous years, the percentage of ordinary infectious diseases cases removed to hospital during 1925 was 92.86, as compared with 91.9 the previous quinquennium 1920-24, and 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. Two cases ‡ of smallpox were notified officially and the usual precautionary measures were taken. In addition, many smallpox "contacts" (in connection with cases outside the Borough) have been reported and quarantined during the usual incubation period of the disease (14 days). Fortunately, no further cases resulted. Several suspected cases of smallpox were also reported, but, on being visited by the Medical Officer of Health, were found not to be suffering from the disease suspected. The official history of smallpox in Lambeth is interesting epidemiologically, and, in connection therewith, the following statistics are placed on record for future reference, dealing with deaths registered and cases notified under the Notification of Infectious Diseases Act, for the last half-century:— *Including i case of post-basic meningitis. †lncluding 4 cases of polio-encephalitis acuta. ‡Father and daughter, the latter infecting the fo.mer. Source of daughter's infection was not traced. 37 Smallpox Statistics.—Lambeth (old Parish and new Borough). Table I. Year. Table II. Year. Deaths registered. Cases notified officially Deaths registered. Cases notified officially. Smallpox not compulsorily notifiable until 1889. 1889 — — 1865 63 1890 — 15 1866 47 1891 — 3 1867 80 1892 1 22 1868 37 1893 5 99 1869 22 1894 1 26 1870 28 1895 2 51 1871 937 1896 2 16 1872 182 1897 — 2 1873 5 1898 — — 1874 12 1899 — 1 1875 8 1900 — — 1876 221 1901 4 54 1877 138 1902 60 350 1878 42 1903 4 72 1879 13 1904 — 23 1880 13 1905 — — 1881 97 1906 — — 1882 17 1907 — — 1883 12 1908 — — 1884 25 1909 — — 1885 85 1910 — — 1886 3 1911 — — 1887 1 1912 — — 1888 — 1913 — — Average for 24 yrs. (1865-1888 87.O 1914 — — 1915 — — 1916 — — 1917 — — 1918 — 1 1919 — 1 1920 — — 1921 — — 1922 1 1 1923 — — I924 — Annual Average for 36 years (1889-1924) i.e., since the introduction of the Notification of Infectious diseases Act. 2.2 20.47 — 2 1925 — 2 N.B—The above figures are taken from the official figures published in the Annual Reports of the Medical Officers of Health (Drs. Puckle, MacCormack, Farr, Verdun and Priestley). 38 Diphtheria and Membranous Croup. A total of 831 cases of diphtheria and 5 cases of membranous croup have been notified, but, bacteriologically, all these cases were not, necessarily, true cases. Even the bacillus diphtheria (Klebs-Lceffler), when found in the throat or nose, without concurrent clinical symptoms, may be of the non-virulent type, and, correspondingly, harmless and negligible. 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 nonprotected contact children (i.e., children who have not previously had the disease) and all contact children under 5 years of age from schools, or, if desirable, the closing of an individual class 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. Towards the end of the year 1925 the Measles (and German Measles) outbreak became again a distinctly rising epidemic, and, during the first quarter of the coming year 1926, there will be a rapid upward movement in the number of cases notified, These rapid upward movements recur at short intervals, shewing the epidemicity of the diseases in question. Measles and German Measles became compulsoiily notifiable on January 1st, 1916 throughout the Borough, and it is interesting to learn the lessons (if any) to be drawn from the experience gained during the ten years 1916-1925. 39 The official figures are as follows (notified cases and corrected deaths registered):— Particulars of Notified Cases and Registered Deaths (with casemortalities) for (a) Measles, and (b) German Measles for the ten years 1916-25. (a) MEASLES. (6) GERMAN MEASLES. Year. Cases. Deaths. Case Mortality. Cases. Deaths. Case Mortality. 1916 2,548 49 1.9 1,212 0 0.0 1917 3,224 108 3.3 1,241 0 0.0 1918 2,721 127 4.7 402 0 0.0 1919 979 26 2.6 200 0 0.0 1920 2,299 80 3.5 122 0 0.0 1921 409 15 3.7 215 0 o-o 1922 3,389 66 1.9 227 0 o-o 1923 1,103 21 1.9 147 0 o-o 1924 3,786 88 2.3 260 0 o-o 1925 798 5 00.6 1,111 o-o Averages for 10 years, 1916-25 2125.6 58.5 2.75 513.7 0 o-o N.B—First cases of Measles and German Measles in one family (within 2 months) only are legally notifiable compulsorily, though this rule is not strictly observed by medical practitioners. 1.—Age Periods Affected. Age Periods. Cases Notified- Deaths Registered. Case Mortality (per cent.) Under 1 year 883 107 12.0 Between i and 5 years 9,492 429 4.5 Total under 5 years 10,375 536 5.16 Between 5 and 15 years 9,681 47 0.48 At other ages 1,200 2 0.16 2.—Localities Affected. (Registration Sub-Districts). Registration Sub-District, Cases Notified. Deaths Registered. Case Mortality (per cent.) Lambeth Church 4,181 160 3.82 Kennington 3,549 137 3.86 Stockwell 3,993 127 3.18 Brixton 5,050 97 1.92 Norwood 4,483 64 1.42 N.B.—The incidence-rates and death-rates per 1,000 of the populations are as follows:— (a) Incidence-rates.—Lambeth Church (8), Kennington (6), Stockwell (4), Brixton (3), and Norwood (2); (b) Death-rates.—Lambeth Church (21), Kennington (1.8), Stockwell (0.9), Brixton (0.8), and Norwood (0.4). 40 The large number of 10,375 notified cases of children under five years (i.e., 48.7 per cent, of the total) during the past ten years is explained by the fact that many children are infected at their homes by their older brothers and sisters, who have contracted the disease at school. School influence is, therefore, indirect, as well as direct, in connection with the spread of Measles (and, of course, of other infectious diseases). Compulsoiy notification of a disease is of value, according as it is accompanied by isolation accommodation in institutions and other preventive measures as required. Unfortunately, since Measles (and German Measles) became compulsorily notifiable in the Borough of Lambeth, there has been no adequate institutional isolation accommodation available for the patients notified. The information, however, obtained from these diseases being made compulsorily notifiable throughout the Borough as from January 1st. 1916, has been of value, in that the other preventive measures (excluding institution isolation) have been able to be taken in consequence of the knowledge so afforded, viz., notified cases have led to the visiting systematically of infected houses as soon as the notifications have been received. Again, in the absence of adequate isolation institutional accommodation, arrangements were made with nursing organisations for the visiting by nurses at the homes of notified patients, on instructions by the Medical Officer of Health, under the Lambeth Nursing (Infectious Diseases) Scheme. This visiting of infected houses by nurses has, undoubtedly been of value, in so far as the treatment of patients is concerned. Nursing is everything in a case of Measles, and many lives may be (and have been) saved, and much subsequent dangerous illness avoided by the timely assistance and help of the nurses employed. Further, the official visitings of the infected houses by the Sanitary Inspectors, and the ensuring of the exclusion from schools of both patients and "contacts" by the systematic sending of written communications to the head-teachers of the schools concerned, and the leaving at the infected houses of the official pamphlets and disinfectants, have been of the greatest use. Had efficient and adequate institutional accommodation been provided for the isolation and treatment of the notified cases, the outbreak of Measles (and German Measles) might have been prevented from 41 taking on epidemic proportions. Without such institution accommodation, it was inevitable that the epidemic would sooner or later become widespread and get out of hand. Schools (not only the public elementary and p'ivate schools, but also Sunday schools) have undoubtedly helped the spread of the diseases, which are, each, highly infectious in the very early stages, and before the appearances of any rashes. Further, there is the additional fact that parents and others regard these particular diseases (Measles and German Measles) as of no importance, and as sorts of diseases that every child must have, and the parents and others may argue, in consequence, that "the sooner, the better"; in fact, cases have been reported where parents have actually deliberately placed children, who had not shown any signs of the diseases, in rooms wherein were other children (brothers and sisters) who were, in fact, at the time suffering from such diseases. With regard to school attendances it is well known that, during an outbreak of Measles, or German Measles, the numbers of cases increase after the schools reassemble and decrease after the schools are closed for the holidays, or under the orders of the Medical Officers of Health. The dangers of infection spreading amongst school children playing about in the streets are trifling, compared with the danger of infection spreading amongst school children crowding in schools and class rooms, and crowding in school playgrounds, though the dangers of infection spreading through Sunday Schools, and picture palaces, and other places of amusement, or private parties, must not be forgotten That schools may play a consideiable part in spreading infectious diseases is now generally acknowledged, and suitable preventive measures should be taken. This, however, is a matter that concerns the Educational Authority (the London County Council), which still allows the attendances at schools ot children who have previously had, or are reported to have had previously, attacks of Measles. This may prove to be a somewhat dangerous regulation, as infection may be carried thereby, in the clothes of the scholars, even though the scholars may not themselves be suffering personally from the disease, or be likely to suffer from it a second time (second attacks being rare). All these facts show the difficulty of dealing satisfactorily with an epidemic of Measles and German Measles, and this difficulty, when it arises, under present conditions, is increased on account of 42 the diseases being compulsorily notifiable in some districts but not so in other (neighbouring) districts. This latter fact is particularly marked in the case of Lambeth, where the diseases are compulsorily notifiable, when compared (say) with Wandsworth, where the diseases are not compulsorily notifiable, even though certain streets and roads are shared by the two Boroughs. The precautionary measures that are taken in the Borough of Lambeth consist of compulsory notification, exclusion from school of all known infected scholars and "contact" cases, disinfection in connection with all houses that are known officially to be infected, visiting by nurses at the houses of infected patients (with treatment as required), and the general education of the parents and relatives and others by pamphlets setting out the dangers of the diseases, and, on the other hand, the simple precautionary measures that are alone necessary. Proper nursing is a sine qua non. It will be noted that, whilst the epidemic is becoming widespread, and the numbers of notified cases will shortly be enormous, the registered deaths should be proportionately few, judging by the past 10 years' experience. In this connection, German Measles is, practically, negligible, no single death having been registered therefrom during the past ten years (ending December 31st, 1925). During the same period, the notified cases of Measles were 21,256, and the deaths registered from that disease, 585, i.e. a case mortality of only 2.75 per cent. Arranged quinquenially, the case-mortality figures are 3.3 and 2.0 respectively, showing a decrease which is due, probably, to the systematic visiting of infected houses by Nurses under the Lambeth Nursing (Infectious Diseases) Scheme, etc. The figures for 1916-1925, which are quoted above, apply to Lambeth Borough, but such epidemics, as they arise, affect also neighbouring Boroughs and, indeed, the County of London as a whole. It is in no sense a question of a particular locality, such as one or more neighbouring Boroughs: it is really a pandemic over the whole of the County of London and neighbouring Counties,as the influences, at work causing the epidemic or pandemic, are general and widespread and do not affect any one district only. Schools are, undoubtedly, the chief factor. 43 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. 27 cases (5 deaths) were notified, 5 connected with abortions and miscarriages and 22 others out of 7,734 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 (27) is above the averages (yearly) for the decennia 1891-1900 (18.9), 1901-10 (17.0), and 1911-1920 (21.8), as is also the figure for the previous quinquennium 1920-1924, viz.: 32.6, results that are probably to be explained by more exact notification and diagnosis and 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 notfied 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 Diarrhœa, 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 again proved a success during 1925. The following statistics for the 6 years 1920-1925, setting out the total numbers of visits paid by nurses, speak for themselves :—measles and German measles, 728, 206, 722, 297, 518, and 63; whooping cough, 255, 273, 488, 400,, 327 and 264; ophthalmia neonatorum (and other forms), 2,341, 1,764, 986, 1,093, 1,537, and 1,379; epidemic diarrhœa, 57, 232, 5, 36, 33 and 30; influenza, 343, 332, 474, 249, 487, and 346; acute primary and influenzal pneumonia, 1,870, 2643, 3,586, 3,333, 4.164, and 4430; other diseases, 114, 11, 16, 186, 187, and 106, making totals of 5,708, 5,461, 6,277, 5,594, 7,253, and 6,618 visits paid respectively. Of the total visits (6,618) paid during 1925, 2,876 were visits to children under 5 years of age, i.e., 43.38 per cent., dealing with measles and German measles, 63; whooping cough, 234; ophthalmia neonatorum (and other forms), 1,379; epidemic diarrhœa, 30; acute primary and influenzal pneumonia (and other forms), 1,154; erysipelas 6; and chickenpox, 10. 44 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 1925, 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 2 — — 2 100.0 1 Scarlet Fever 1042 9 0.86 997 95.7 940 Diphtheria 831 55 6.61 814 97.9 751 Membranous Croup 5 — — 4 80.0 5 † Typhus — — — — — — Typhoid or Enteric 25 4 16.0 9 36.0 15 Continued and Relapsing Fever 1 — — 1 100.0 1 Erysipelas 127 3 2.36 60 47.2 126 Puerperal Fever 27 5 18.51 26 96.3 27 •Plague — — — — — — *‡Cerebro-Spinal Fever 3 2 66.66 1 33.3 3 45 §Polio-myelitis acuta 6 5 83.33 5 83.3 6 *Ophthalmia Neonatorum 36 — — 4 11.1 36 *Whooping Cough — 48 — — — — *Measles 798 5 0.62 52 6.5 723 *German Measles 1,111 — — 18 1.6 1,001 *Tuberculosis— — — Pulmonary (primary) 487 273 56.0 — — — Non-pulmonary (primary) 88 62 70.45 — — — *Chickenpox — 1 — — — — *Malaria 8 1 I2.55 — — 8 *Dysentery — — — — — — *Primary Pneumonia (Acute) 159 38 15.44 65 40.9 157 *Influenzal Pneumonia (Acute) 87 28 32.2 87 * Encephalitis Lethargica (Acute) 17 8 47.06 9 52.9 17 *Trench Fever — — — — — — *Anthrax — — — — — — *Plague was made compulsorily notifiable on September 19th, 1900, cerebro-spinal fever on March 12th, 1907, polio-myelitis atid polio encephalitis actua 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. 18 Measles cases were notified by parents (or relatives), in addition to the 798 notified cases (mentioned above). †Including 15 cases of paratyphoid fever, 2 cases removed to hospital, where they died. ‡Including 1 case of post-basic meningitis, which was removed to the hospital, and died. §Including 4 cases of polio-encephalitis acuta, 3 cases removed to hospital, where they died, and one case treated at home, where he died. 46 47 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 1925, together with the averages for the three decennia 1891-1900 (Parish), 1901-1910 (Borough), and 1911-1920 (Borough), and the quinquennium 1920-24 (Borough). Disease. 1925 Annual Average, 1920-24 (Borough) 5 years. Annual Average, 1911-1920 (Borough) 10 years. Annual Average 1901-10 (Borough) 10 years. Annual Average 1891-1900 (Parish) 10 years. Cholera — — 0.l 0.2 11.5 Smallpox 2 0.2 0.2 49.9 2 2.0 Scarlet fever 1,042 1228.2 904.1 1105.1 1331.3 Diphtheria 831 611.4 482.7 379.8 715.1 Membranous Croup 5 3.4 5.5 10.4 26.2 Typhus — — 0.0 0.1 1.1 †Typhoid or enteric 25 12.8 31.9 100.5 189.6 Continued and Relapsing 1 0.0 0.8 4.1 25.7 Erysipelas 127 117.4 175.0 241.4 347.0 Puerperal 27 32.6 21.8 17.0 18.9 *Plague — — 0.0 0.0 0.0 *‡Cerebrospinal Fever 3 6.6 18.2 11.5 — *§Poliomyelitis acuta 6 5.8 7.3 — — *Ophthalmia Neonatorum 36 70.8 72.8 — — *Whooping Cough — — 1380.4 — — *Measles 798 2117.2 2354.2 — — *German Measles 1,111 194.2 635.4 — — *Tuberculosis— Pulmonary (primary) 487 533.6 1112.4 — — Non-pulmonary (primary) 88 110.6 323.7 — — *Chickenpox — — — — — *Malaria 8 12.0 59.5 — — *Dysentery — 2.0 7.0 — — *Primary Pneumonia (Acute) 159 I93.2 161.5 — — * Influenzal Pneumonia (Acute) 87 79.8 126.0 — — *Encephalitis Lethargica (Acute) 17 12.6 7.0 — — *Trench Fever — 0.2 0.0 — — *Anthrax (human) — 0.2 0.1 — — *Plague was maue compulsorily notifiable on September 19th, 1900; cerebro spinal fever on March 12th, 1907; glanders (human), anthrax (human), and hydrophobia (human), on April 26th, 1909; poliomyelitis and polioencephalitis 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 nonpulmonary) on February 1st, 1913 Chicken-pox was compulsorily notifiable as follows 1—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 Tune 30th), and 1918 (March 27th1 to June 30th.) Whooping Cough was compulsorily notifiable from January 1st, 1913, to December 31st, 1917, the numbers of cases notified beingas follows:-1913 1,428; 1915, 1,389; 1915. 1.607; 1916, 1,576; and 1917, 902. Measles and German Measles became compulsorily notifiable on January ist, 1916, acute encephalitis lethargica on Januaiy 1st, 1919, and malaria, dysentery, pneumonia (acute primary and acute influenzal), and trench fever on March ist, 1919. N.B.—of the originally notified during 1925, the following were found afterwards not to be suffering from the diseases notified Diphtheria,8;paratyphoid, 1: and poliomyelitis acuta, 1, and are not included in the above table. †Including 15 cases of paratyphoid fever. ‡Including 1 case of post-basic meningitis. §Including 4 cases of polio-encephalitis acuta. 48 49 METROPOLITAN BOROUGH OP LAMBETH. TABLE H. Public Health (Tuberculosis) Regulations, 1912. (As amended by the Public Health (Notifications of Infections Diseases) Regulations, 1918.) Summary of Notifications received during the period from 4th January, 1925, to the 2nd January, 1926. Age-Periods Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications. (Medical). ♦Total Notifications {i.e., including cases previously notified by other Doctors). (Medical.) Primary Notifications (Medical.) †Total Notifications (i.e. including cases previously notified by other Doctors). (Medical). Cases admitted to Cases discharged from 0 to I. I to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45- 45 55- 55 to 65. upwards. Total. Under 5. 5 to 10. 10 to 15. Total. Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. (Medical.) (Medi cal.) Pulmonary— Males — 3 4 5 28 24 62 68 6l 27 9 291 415 1 — 4 5 5 — 281 3 202 Females— — 2 1 5 23 46 50 31 21 10 1 190 262 — 1 — 1 1 3 149 5 99 Non-Pulmonary— Males 7 3 12 2 2 6 2 3 1 1 — 39 43 — 4 — 4 5 2 39 1 42 Females 2 4 9 3 6 3 9 3 3 1 1 44 46 — — 1 1 1 2 31 1 25 *Re-notifications (Form A) = 196 (males 124, females 72), pulmonary and 6 (males 4, females 2) non-pulmonary, †Re-notifications (Form B) = i (male i, female 0), pulmonary, and i (male i, female 0) non-pulmonary. N.B.—Pulmonary—147 private. 202 hospitals, 132 dispensaries and 6 schools= 487 total primary notifications (Forms A and B, including 98 Poor Law cases under Form A (hospitals). Non-Pulmonary — 9 private, 62 hospitals, 12 dispensaries and 5 schools = 88 total primary notifications (Forms A and B), including 5 Poor. Law Cases under Form A (hospitals). 50 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 January 4th, 1925, to January 2nd, 1926. Registration Sub-Districts. 1925. Tuberculosis (All forms). Pulmonary. Non-Pulmonary. A. B. C. D. A. B. C. D. Forms. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Primary. Total. Primary. Total. Poor Law. Sanatorium. Poor Law. Sanatorium. Waterloo 43 65 - - - 24 - 25 8 9 1 1 - 4 - 7 Lambeth Church 41 60 - - - 35 1 17 4 4 - - - 5 - 7 Kennington 78 116 - - - 43 - 25 11 11 - 1 - 2 - 4 Stockwell (Inner) 43 59 - - - 40 2 24 12 14 - - - 13 - 9 Total Inner Districts 205 300 - - - 142 3 91 35 38 1 2 - 24 - 27 Stockwell (Outer) 44 59 - - - 51 - 39 10 11 - - - 5 - 4 Brixton l36 190 3 3 - 128 1 101 20 20 1 1 1 18 1 21 Norwood 96 128 3 3 3 109 4 70 18 20 3 3 3 23 1 15 Total Outer Districts 276 377 6 6 3 288 5 210 48 51 4 4 4 46 2 40 Borough of Lambeth 481 677 6 6 3 430 8 301 83 89 5 6 4 70 2 67 51 METROPOLITAN BOROUGH OP LAMBETH. TABLE H (2). Addendum to Tables H and H (i). Summary of new cases of Tuberculosis reported during the period from the 4th January, 1925, to the 2nd January, 1926, otherwise than bj 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. i.—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 — — — — 4 7 16 6 7 2 — 42 „ Females 1 — — — 5 2 10 3 3 5 I 30 Non-Pulmonary— ,, Males 2 4 — — 2 1 1 — — 1 — 11 ,, Females 6 5 2 1 1 1 2 1 — — — 19 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 8 5 27 8 24 13 45 72 Non-Pulmonary 4 2 9 — 15 4 5 6 15 30 N.B.—The above 102 cases are made up as follows:—Death Returns, 82 (Pulmonary, 54; Non-Pulmonary, 28); Military, 3 (Pulmonary, 3; NonPulmonary, o); Other sources, 17 (Pulmonary, 15, ; Non-Pulmonary, 2). d 2 52 Tuberculosis. Tables H, H (i) and H (2) set out the summary of the notifications (both compulsorily notified and voluntarily reported or heard of from other sources under (a) age periods and (b) registration subdistricts, 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. 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), and consists of 2 Tuberculosis Dispensaries (a Central and a Branch). 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 is responsible for the "after care" organisation in the outer (Southern Districts)'of the Borough, necessitating, during 1925, 45 special personal visits being made by Miss Baker to the homes of patients.† Special interviews given to patients and relatives at the Central Dispensary in connection with assessment after-care, amount to large numbers. Thus, during 1925, 192 cases were personally assessed by Miss Scott Baker for the purpose of arranging sanatorium treatment through the London County Council, involving the actual collection and transmission to that body of a sum of £684 8s. 5d. The work of the Branch Dispensary Staff under Dr. Hebert as Tuberculosis Officer with the help of an assistant Tuberculosis Officer (for Home visiting), 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 is carried out by the Governors of St. Thomas's Hospital, hitherto at their own expense, but is now paid for by a Borough Council grant *(since January 1st, 1924), under a contract approved by † These personal visits are in addition to attendances made at the Committees of the Invalid Children's Aid Association, Emergency Help Fund Committee of the British Red Cross and Springwell House Committee, on ali of which Committees Mi-s Baker serves in an official.capacity. * The grant is £1500 per annum (half repayable to the Council by the Ministry of Health and quarter by the London County Council). 53 the Ministry of Health, such work being co-ordinated with the work of the Central Dispensary and of the Council's Public Health Department as laid down in the Lambeth Scheme. Miss Cummins is responsible for the "after care" organisation of the Inner (Northern) Districts of the Borough. This amended scheme with St. Thomas's Hospital was approved by the Ministry of Health, on Nov. 24th, 1924. No tuberculosis "care" Committee for the Borough has been appointed, the work being carried out by the Officers mentioned 011 behalf of the Council. Valuable assistance has been given to the work of the Council in connection with ex-service men (tuberculous) and their families by the Emergency Help Fund of the British Red Cross and the United Services Fund. Dental Treatment of Tuberculosis Patients. The new Scheme which came into operation on October 1st, 1924, is working satisfactorily. The fees payable are a flat rate of (not exceeding) 5s. per attendance, with an additional fee for anaesthetic of 5s. per attendance for extractions, scalings, fillings and other dental treatment, excluding dentures, which are charged for as follows:— Upper or lower dentures (not exceeding) £2 10s. each, upper and lower dentures (not exceeding) £5.* * Dentures are paid for by the Council (wholly or partly) only when such are certified as essential for effective treatment). • 54 Appointment of Assistant Tuberculosis Officer (for visiting the Homes of Patients) in connection with the Inner Districts of the Borough. Dr. A. J. G. McLaughlin has continued in office as Assistant Tuberculosis Officer (for visiting the homes of the patients) in connection with the Branch Tuberculosis Dispensary, St. Thomas's Hospital, for the Inner Districts of the Borough. Results from the Working of the Lambeth Scheme. 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 completed 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 i.8 1.9 2.3 1.2 1.4 1916 1.4 1.7 i.6 2.1 1.2 1.5 1917 1.5 2.02 2.03 2.7 1.1 1.5 1918 1.5 2.o5 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.o8 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 1923 o.8 1.1 0.9 1.2 0.8 0.9 1924 0.9 1.1 1.o 1.3 0.8 1.03 Averages (1 2 years) 1.16 1.50 1.45 1.85 0.97 1.24 1925 0.87 1.07 1.01 1.26 0.78 0.95 55 (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. 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 1923 .5 1.8 1.5 1.9 1.4 1.8 1924 1.5 1.8 1 .5 1.9 1.4 1.7 Averages (12 years) 2.94 3.80 3.24 4.21 2.69 3.50 1925 1.56 1.84 1.67 1.97 1.49 1.76 The clerical work connected with the Tuberculosis Department still continues to increase on account of the many different records, etc., that have to be kept. 56 TABLE I. Lambeth Municipal Tuberculosis Dispensary Scheme. (.Inaugurated by the Council, October 3rdy 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 1925. 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 aite'dance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis Pulmonary NonPul monary (a) All persons (including "Contacts") Adults M. 19 226 245 123 10 85 15 12 F. 17 268 285 83 5 164 13 20 Children under 15 M. 11 107 118 10 13 81 11 3 F. 6 89 95 6 8 75 5 1 Total 53 690 743 222 36 405 44 36 (b) "Contacts " (included in (a)). Adults m. 1 36 37 12 22 2 1 f. 4 91 95 12 1 73 4 5 Children under 15 m. 5 49 54 6 2 42 2 2 F. 3 41 44 1 4 37 2 — (c) Insured Persons (included in (a)) M 17 180 197 94 7 75 12 9 F 4 123 127 41 5 07 5 9 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 445 in respect of insured patients under domiciliary treatment during the year 18 7. Number of persons referred to affiliated hospital for consultation ... 77 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 1,860 Uninsured ... 3.493 Insured 60 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 170 Uninsured ... 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 35 199 4. Number of cases in which the period of observation at the Dispensary exceeded two months 65 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes... 2,022 5. Number of insured patients under domiciliary treatment on December 31st 599 11. Number of specimens of Sputum examined in connection with the work of the Dispensary 839 6. Number of reports received from Insurance Practitioners N.B.—Dr. E. D. Richardson was appointed Tuberculosis Officer (Central Dispensary) on October 16th, 1919. TABLE I (Continued) 57 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 branch dispensary for the year 1925. 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 diag. nosis. Examin'd for the first time during the year. Total Found to be— Under observation at the Dispensary on Dec. ii pending diagnosis. Ceased att'ndance before completio??? of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis Pulmonary Non- Pulmonary (a) All persons (including "Contacts") Adults M. 3 260 263 104 6 146 6 1 F. 4 285 289 63 6 216 4 — Children under 15 M. — 134 134 2 7 124 — 1 F. — 146 146 2 5 137 — 2 Total 7 825 832 171 24 623 10 4 (b) "Contacts " (included in (a) Adults M. — 43 43 2 — 41 — — F. — 57 57 1 — 56 — — Children under 15 M. — 41 41 — — 41 — — F. — 59 59 — — 59 — — (c) Insured persons (included in(a) M 3 208 211 85 4 116 5 1 F 1 123 124 26 1 96 1 — 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment on the 31st December 569 in respect of insured patients under domiciliary treatment during the year 23 7. Number of persons referred to affiliated hospital for consultation 685 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 2,178 Uninsured 2,704 1nsured 112 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 68 Uninsured 91 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 296 4. Number of cases in which the period of observation at the Dispensary exceeded two months 11 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2,265 5. Number of insured patients under domiciliary treatment on December 31st 70 11. Number of specimens of Sputum examined in connection with the work of the Dispensary 474 6. Number of reports received from Insurance Practitioners N.B.— Dr. G. T. Hebert was appointed Tuberculosis Officer (Branch Dispensary) on January 6th, 1920. An assistant Tuberculosis Officer is also attached to the Branch Dispensary (since January 1st, 1924). 58 59 TABLE J. Local Government Board Table. BOROUGH OF LAMBETH.— Particulars of cases of acute polio-myelitis (polio-encephalitis), cerebro-spinal fever (postbasic meningitis) and encephalitis lethargica acuta notified within the Borough of Lambeth during 1925. 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 6 — — — — — — 2 1 1 3 3 — — — — — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — (Polio-encephalitis) Cerebro-Spinal Fever 2 1 1 — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — Post-Basic Meningitis 1 — — — — — — — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Encephalitis Lethargica 17 — — — — — — 2 1 1 1 1 — — — — — — — 1 — — — — — 1 — 1 — — — — — — — — — 3 3 — 8 3 2 Number of Cases removed to Isolation Hospital. *i.e , Recovered, with permanent Paralysis of one or more groups of muscles (slight paralysis of ciliary muscles and accommodation). † 2 cases of acute polio myelitis (1 death) and 4 of acute polio encephalitis (4 deaths). Acute Polio-myelitis — — 1 3 — — 1 — — — — — — — Cerebro-Spinal Fever — — — — — — — — — — — — — — Post-Basic Meningitis — — — 1 — — — — — — — — — — Encephalitis Lethargica — — 2 1 — — — — 1 — 1 — 1 3 6o 2.--Non-Notifiable Diseases. Chickenpox. 1,250 cases of chickenpox were reported voluntarily. Diarrhoea. The number of corrected deaths registered from diarrhoea is 33, as compared with yearly averages of 191.6, 219.4, 208.6, 140.2, 178.2, 77.4, and 55.8, during the seven quinquennia 1891-1895 (Parish), 1896-1900 (Parish), 1901-1905 (Borough), 1906-1910 (Borough), 1911-1915 (Borough), 1916-1920 (Borough), and 1920-1924 (Borough), respectively. All the 33 deaths registered during 1925 occurred amongst children under 5 years of age, and 27, i.e., 81.8 er cent., amongst infants under 1 year of age. The slight increase in the number of registered diarrhoea deaths during 1925, as compared with 23 registered deaths during 1924, is insignificant and negligible, the average number for the past quinquennium (1920-24) for the Borough being 55.8, which represents a decrease (as compared with such quinquennium) of 59.1 per cent. During 1925, the 4 ft. earth thermometer first registered 56°F. on June 10th, rising to a maximum of 63.5°F. on July 27th, and remaining at such maximum for four days, sinking to 56°F. again on October 14th. The interrelationship between this particular disease and the 4 ft. earth temperature has long been noted, so much so that the latter is known as the critical earth temperature in connection with all diarrhoeal diseases, being the temperature at which the particular germ or germs that are the cause or causes of diarrhoeal diseases, especially of infantile zymotic, or summer, diarrhoea, take on virulence and become so fatal, chiefly to infants and young children*. Under such a theory, the deaths from diarrhoea during 1925, should have been larger in number in view of the readings of the 4 ft. earth thermometer. There were other counteracting influences at work, and it is reasonable and fair to attribute the decrease in diarrhoeal mortality (and corres * Adults also suffer from zymotic or summer diarrhoea but rarely, if ever, fatally. 61 ponding morbidity) to the Council's activities in maternity and child welfare work throughout the Borough, having regard to the recognised fact that the chief causes of an increased diarrhoeal rate are to be found in the improper and irregular feeding of infants and young children. 13 corrected deaths (10 infants under 1 year of age) were registered from enteritis. Practical measures were taken to prevent epidemic diarrhcea (and other diseases) in infants and young children, and to promote hygienic conditions in their feeding and environment, as follows:— (а) Visiting of houses wherein births were notified under the Notification of Births Act, 1907, or wherein deaths of infants and children were registered as having occurred from epidemic diarrhcea or other diseases of a similar nature. (b) Teaching of proper feeding and care and management of infants at the Infants Consultations Centre connected with the Municipal Milk Depot, and at the Voluntary Consultations Welfare Centres (14 in number), which are comprised within the Lambeth Maternity and Child Welfare Scheme, by the Medical Officers and Staffs attached thereto. (c) Feeding of necessitous infants and young children through the Municipal Milk Depot, and through the 14 Voluntary Welfare Centres, in connection with the Council's Milk Assistance Scheme, which has been approved by the Ministry of Health, under the Maternity and Child Welfare Act, 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 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 diarrhcea and the free nursing of infants and children (and others) obtainable under the Lambeth Nursing (Infectious Diseases) Scheme. 62 The value of such practical measures is shewn by the various statistics in this Report, not only for the year 1925, but also for many years past. The steady fall in the numbers of deaths registered amongst infants and children between the ages of 1 and 5 years for the past 30 years is remarkable, even after making allowances for the declining birth-rate. More remarkable is the decline in the deaths registered from diarrhoea (in infants and children between the ages of 1 and 5 years) during ihe same period. Influenza. 63 corrected deaths were registered from Influenza during 1925, as compared with an average of 89 during the quinquennium 1920-1924. The full details of the age and sex distribution of the 63 deaths during 1925, 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. — — — 2 1 1 1 3 2 — — 1 2 — 7 7 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. 63 2 — 10 6 2 1 9 10 34 25 35 28 87 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, 25; typhoid ever 2; and cholera and plague, 14. * 159 cases of acute primary pneumonia were also notified during 1925- 63 Municipal Bacteriological Laboratory. (Inaugurated by the late Vestry, 1899.) Table shewing the numbers of pathological samples examined (total 960), and the results obtained, at the Bacteriological Laboratory during 1925, and the previous quinquennium 1920-1924, together with the averages for the two decennia 1901-1910 (Borough)and 1911-1920 (Borough) and the quinquennium 1920-1924 (Borough). Year. Sputa. Suspected Tuberculosis. Tub. Bac. found. Blood. Suspected Typhoid or Enteric Fever. Reaction obtained. Throat & Nose. Membranes and Secretions. Suspected Diphtheria. Klebs-Lœffler Bac. found Other Sundry Samples. Result. obtained. Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 1925 20 239 259 2 9 11 14 672 686 2 2 4 1924 20 244 264 — 12 12 10 731 741 — 2 2* 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 Average of 5 years 1920 1924 (Borough) 23.0 243.0 266.0 1.0 13.0 14.0 11.8 678.6 690.4 2.0 3.2 5.2 Averages of 10 years (a) 1901-1910 (Borough) 62.8 124.4 187.2 194 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 * Smearing for gonococcus (1 negative and 1 positive) ; and suspected tuberculous pus (1 negative and 1 positive). During 1925, 71 vials of antitoxin were distributed, free of cost, under the Antitoxin Order, 1910 (each vial containing 4000 or 6000 units in strength of antitoxin). N.B.— Since the Bacteriological Laboratory was inaugurated in 1899 (up to the end of the year 1925), 27,854 examinations have been conducted there in connection with the following suspected diseases, viz.:—tuberculosis 9,781; typhoid or enteric fever, 1,231; diphtheria 16,486; and others, 356. 64 65 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1925 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 shown as separate localities. Mortality from all Causes at Subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under 5 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 '3 14 15 16 17 18 '9 I Smallpox. Scarlatina. Diphtheria. Fev ers Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia & Pleurisy Heart Disease. Influenza. Injuries. Cer.-Spin.,Polio. | and Encephalitis Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. (a) w w (') (/> (.?) W <0 </> <*) ' Royal Infirmary (Women and Children 1 98 S8 10 9 6 1 5 8 'I Under 5 5 upwards. i 18 16 1 41 77 2 — i 17 21 General Lying-in Hospital, York Road i 15 i '3 — — — — 2 — ~ I Under 5 5 upwards. 11 n ' 2 St. Thomas's Hospital... 563 78 >3 28 41 38 122 187 56 i Under 5 5 upwards. — 2 1 j I 3 1 18 1 Q 2 T 79 119 — — 4 I I — 2 7 23 }8 2 27 Q 330 444 Remainder of Lambeth ^ Church j252 28 3 4 8 13 34 7i 9. J Under 5 5 upwards. — — — — — 2 1 — 15 — 3 — ■ 3 3S 1 22 63 3° 3 2G — — 78 217 ( Lambeth Workhouse .. ) - i Under 5 5 upwards. Lambeth Infirmary 937 36 7 7 7 3s 120 29S 1 43° \ Under 5 5 upwards. — — 2 2 11 4 2 29 so •< St. Peter's House 41 1 I 40 J I — 2 2 3 — — — 3 79 '55 97 10 39 — 5 491 887 Under 5 5 upwards. — — — — — — — — — — — — — ^ Remainder of Kennington 267 32 5 7 3 13 21 73 1 »3 | '3 22 — — — — 6 41 Under 5 5 upwards. — — — — — — — 6 — — — '7 1 — 5 — — ■5 44 ! South-Western Hospital i07 17 n 34 28 s 6 4 - 18 61 43 5 12 — — 84 223 Under 5 5 upwards. ,s 22 — s 26 2 4 64 - Clapham Maternity 19 17 1 ~ 10 17 3 5 — 2 1 — — 1 — — — — — 3 43 Under 5 5 upwards. 16 17 | Remainder of Stockwell 402 46 2 3 4 9 30 104 \ 204 j 2 2 Under 5 5 upwards. 6 3 1 „ 3 27 51 2 32 87 5* 13 8 — — 151 35« 66 67 TABLE K. TABLE K. Local Government Board Old Table A.} Table of DEATHS during the year 1925 « the Borough of Lambeth, dassified tQ ^ and Names of Localities dopted for the purpose of hese 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. I 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. i 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 I Smallpox Scarlatina Diphtheria Fev ers Erysipelas Measles Whooping Cough Diarrhoea and Dysentery Rheumatic Fever Phthisis Bronchitis, Pneu- j monia & Pleurisy Heart Disease Influenza Injuries Cer.-Spin.,Polio, and Encephalitis Appendicitis All other Diseases Total Puerperal Enteric or Typhoid (a) (4) M (d) ') (/) If) W («) U) w ( Kings' College Hospital 271 34 5 7 16 14 45 104 46 I Under 5 5 upwards. — — — — — 3 3 6 2 s 2 25 46 1 Belgrave Hospital 125 87 9 21 8 — — — -i Under 5 5 upwards. 1 — 7 11 i 28 — 9 16s 215 4 14 1 1 26 — 4 i 2 64 117 | Ministry of Pensions Hospital ... 1 ( 4 8 V, Remainder of Brixton 500 33 5 9 5 19 44 126 259 J 1 5 1 — — 11 1 i 6 — — 2: 47 1 43 95 85 12 19 — — 198 4S5 1 1 9 1 3 _ i 1 7 24 1 2 1 6 -< British Home for Incurables ... | .4 5 91 Under 5 5 upwards. ^ Remainder of Norwood 475 39 2 3 3 ii 45 100 272 1 14 14 Under 5 5 upwards. — — — — — — — 4 3 — — 10 — 2 2 i 22 44 2 28 71 85 14 I i — 2 218 431 Totals ... 4116 S3i 80 '37 133 161 475 1078 1521 Under 5 5 24 — i 8 61 S8 2 3 ■47 5 s 44 8 ? >74 748 The subjoined numbers have also to be 11 17 '3 8 4 2 2 15 232 S77 470 60 166 1 20 1764 3^68 taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto... | 646 33 15 29 34 27 119 178 2„ } Under 5 5 upwards. 3 18 1 16 4 1 6 2 25 77 1 12 1 47 52 65 3 47 1 12 328 569 Deaths occurring within the district among persons not belonging thereto | 998 221 33 ! ^2 66 47 161 277 131! Under 5 5 upwards. , 4 9 , 4 29 29 1 42 2 r IS 2 177 316 7 7 5 4 1 2 2 2 9 36 43 4 64 1 15 480 682 68 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 1925, in the Borough of Lambeth, classified according to Diseases and Localities. [LocaI Government Board Old Table B.] Registration SubDistricts. Population at All Ages. Total Registered Births 1925 New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health during 1925 Census 1921. Estimated 1925 (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 Puerperal. Erysipelas. †Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. *Typhoid or Enteric. Continued Fever. Encephalitis Lethargica. (a) (b) (c) (d) Lambeth Church 45617 44480 2246 _ 228 332 1 4 1 1 6 19 1 1 7 276 219 35 9 — Kennington 44957 44920 1051 — 278 177 — 1 — 3 1 23 1 1 3 117 127 33 28 — Stockwell 63806 65990 1589 2 180 122 4 5 — 4 5 18 — 1 6 84 123 36 19 — Brixton 81262 85450 1740 — 238 139 — 1 — 3 13 36 1 — 16 205 475 31 19 8 Norwood 67318 70260 1037 — 118 61 — 14 — 6 2 31 — 3 4 116 167 24 12 — Totals 302960 311100 7663 2 1042 831 5 25 1 17 27 127 3 6 36 798 1111 159 87 8 * Including 15 cases of paratyphoid fever. † Including 1 care of post basic meningitis. ‡ Including 4 cases of polio-encephalitis acuta. CN vO TABLE L— continued. Registration SubDistricts. Population at all Ages. Total Registered Births 1925 Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1925. Census 1921. Estimated 1925. (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. Puerperal. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. *Typhoid or Enteric. Continued Fever. Encephalitis Lethargica. Lambeth Church 45617 44480 2246 — 223 328 1 3 1 — 5 14 — 1 — 15 11 19 3 — Kennington 44957 44920 1051 — 274 173 — 1 — 1 1 11 1 1 1 11 2 17 15 — Stockwell 63806 65990 1589 2 170 119 3 3 — 2 5 6 — — — 8 — 10 3 — Brixton 81262 85450 1740 — 222 137 — 1 _ 3 13 16 — — 2 9 3 10 6 — Norwood 67318 70260 1037 — 108 59 — 1 — 3 2 13 — 3 1 9 2 9 1 — Total 302960 311100 7663 2 997 816 4 9 1 9 26 60 1 5 4 52 18 65 28 — * Including 2 cases of paratyphoid fever. † Post-basic meningitis. ‡ Including 2 cases 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 1250. Measles 601, Cancer 86, and Whooping Cough 871. 70 Local Government Board New Tables. TABLE I. VITAL STATISTICS OF THE BOROUGH OK LAMBETH DURING 192s AND PREVIOUS FIVE YEARS (1920-24). Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in District. Transferable Deaths. ‡ Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District, † of Residents not registered in the District, † Under I Year of Age At all Ages. Number. Rate. Number. * Rate. Number. * Rate per 1,000 Nett Births. Number. * Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 §1920 293572 10456 8089 27.5 4332 14.7 1177 702 554 68.5 3857 13.1 §1921 305700 8993 6644 2I.7 4195 18.7 1164 684 511 76.9 3715 12.1 §1222 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 1924 309300 7891 5934 19.2 4198 13.6 976 697 397 66.9 3919 12.6 Average 5 years 1920-1924 304814.4 8826.6 6645.2 21.8 4203.6 14.8 1037 691.4 464.2 69.8 3858 62.6 1925 311100 7663 5543 17.8 4116 13.2 998 734 353 63.7 3852 12.4 § 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 1,000 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 l 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 (2384 outward and 204 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 tiansferable deaihs (88) 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 distiict which are added are stated in calculating the neti deathrate of the Borough. Census, 1921. Area of Borough in acres (including land and inland water 4083. Average number of persons per house (estimated), 7.1 Number of inhabited houses, 42007. Total population at all ages, 302808. 71 Local Government Board New Tables TABLE II* CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1925 Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality (e.g., Parish or Ward) of the District. Total Cases Removed to Hospital. At all Ages. At Ages—Years. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 45 45 to 65. 65 and upwards. Small-pox 2 — — — — — — — — — 2 — — 2 Cholera — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 836 13 270 425 70 47 1 1 — 333 177 120 139 61 8180 Erysipelas 127 — 11 9 7 34 43 23 19 23 18 36 31 60 Scarlet Fever 1042 9 342 579 68 40 3 1 228 278 180 238 118 997 Typhus Fever — — — — — — — — — — — — — — Enteric Fever (15 paratyphoid fever) 25 — 2 4 9 3 6 ??? 4 1 5 1 14 9 Relapsing Fever — — — — — — — — — — — — — — Continued Fever 1 — 1 — — — — — 1 — — — — 1 Puerperal Fever 27 — — — 7 20 — — 6 1 5 13 2 26 Plague — — — — — — — — — — — — — — Pulmonary Tuberculosis* 487 — 6 20 121 211 119 10 84 78 87 139 99 — Other Forms of Tuberculosis† 88 9 7 31 17 17 6 1 13 11 22 21 21 — Cerebro-spinal Fever (1 post-basic meningitis 3 1 1 1 — — — — 1 1 — 1 — 1 Polio-myelitis acute(4 polio encephalitis acuta) 6 — 5 1 — — — — 1 1 1 — 3 5 Encephalitis Lethargica 17 — 3 1 2 4 7 — 1 3 4 3 6 9 Ophthalmia Neonatorum 36 36 — — — — — — 7 3 6 16 4 4 Measles ‡ 798 25 346 361 45 17 4 — 276 117 84 205 116 52 German Measles ‡ 1111 27 259 672 115 36 2 — 219 127 123 475 167 18 Malaria 8 — — — 1 5 2 — — — — 8 — — Anthrax — — — — — — — — — — — — — — Primary Pneumonia Acuta 159 9 24 19 16 36 37 18 35 33 36 37 24 65 Influenzal Pneumonia Acuta 87 1 8 9 15 30 17 7 9 28 19 19 12 28 Unlit ion Hospitals Name and Situation—Hospitals of the Metropolitan Asylums Board (one situated in the Stockwell Sub-District and Stockwell Ward of the Borough of Lambeth). Total available beds provided by the Board—8555. Number of Diseases that can be concurrently treated—All usual notifiable infectious diseases and(partly) Measles and Whooping Cough. * Excluding all renotifications (196) of pulmonary tuberculosis and notifications under Form C (433) and under Form D (309) of the 1912 Regulations, † Excluding all renotifications (147) of non pulmonary tuberculosis, and notifications under Form C(74) and under Form D(69) of the 1912 Regulations ‡ Measles and German Measles became compulsorily notifiable within the Borough of Lambeth on January 1st, 1916, and are still compulsorily notifiab 72 I 73 Local Government Board New Tables. Table III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1925. BOROUGH OF LAMBETH. Causes of Death. Next Deaths at the subjoined Ages of "Residents " whether occurring within or without the District (a). Total Deaths whether of "Residents" or "Nonresidents" in Institutions in the District b All ages. Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 3852 3580 353 63 104 108 151 459 995 1617 — Uncertified 2 — — 1 — — — 1 Typhus Fever — — — *Enteric Fever 4 — — — — 2 1 1 — 8 Continued Fever — — — — — — — — — — Small-pox — — — — — — — — — — Measles 5 — 1 4 — — — — — 9 Scarlet Fever 9 — — 4 3 1 1 — — 16 Whooping Cough 50 25 16 9 — — — — — 40 † Diphtheria and Croup (See note (d)) 57 1 5 27 23 1 — — — 41 Influenza 64 — 2 2 2 3 16 20 19 15 Erysipelas 3 — — — — — — 2 1 5 *Cerebro-Spinal Fever 2 1 1 — — — — — — 5 * Polio-myelitis acuta 6 — 1 3 1 — — — 1 3 Encephalitis Lethargica 8 — — 2 — — — 6 — — Venereal Diseases 21 4 — — 1 — 3 6 7 — Phthisis (Pulmonary Tuberculosis) 292 1 1 1 2 63 133 79 12 92 Tuberculous Meningitis (Set note (e)) 26 10 — 7 6 2 1 — — — Other Tuberculous Diseases 38 2 2 — 2 8 19 4 1 — Rheumatic Fever 29 1 2 7 6 2 6 5 10 Cancer, malignant disease {See note (/*)) 467 < 37 207 221 Bronchitis 430 13 5 1 1 1 8 98 303 183 Broncho-Pneumonia 147 56 12 12 5 1 7 14 40 Pneumonia (all other forms) 138 7 4 3 3 2 22 53 44 Other diseases of Respiratory organs 41 — — — — 2 3 21 15 Diseases of Circulatory System 626 2 1 1 12 12 50 167 381 171 Diseases of Nervous System 298 7 — 4 4 4 29 100 150 — Diarrhoea (See note (g)) 34 27 4 2 1 — — — — 50 Enteritis 13 10 — 1 — — — — 2 — Appendicitis and Typhlitis 26 1 2 3 4 6 9 1 27 Alcoholism (See note (h)) 1 — — — — — — — — — Cirrhosis of Liver 23 — — — — — 4 12 7 — Nephritis and Bright's Diseases 109 1 — — — 4 9 44 5i — Puerperal Fever (See note (i)) 11 — — — 1 3 6 1 — 13 Other accidents and diseases of Pregnancy and Parturition 11 — — — — 3 7 — 44 Congenital Debility and Malformation, including Premature Birth (See note (j)) 131 139 1 1 — — — — — Violent Deaths, excluding Suicide I50 18 I 11 18 16 17 25 44 15 Suicides 37 — — — — 2 12 21 2 Other Defined Diseases 541 37 4 6 11 11 64 95 306 | ,5.. Diseases ill-defined or unknown — 1 — 2 3 5 Notes to Table iii. a) All "Transferable Deaths" of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2.10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term " transferable deaths" see footnote to Table I. The total deaths in column 2 of Table III. equal the figures for the year in column 12 of Table I. (f) Under "Cancer" are included deaths under such headings as Carcinoma Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. (g) Under this heading are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhœa. Choleraic diarrhœa, 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. (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. (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. (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. (i) Under "Puerperal Fever" are included deaths under such headings as Pyaemia, Septicæmia, Sapræmia, Pelvis peritonitis, Peri- and (e) Under "Tuberculosis Meningitis ' are included deaths from Acute Hydrocephalus. metritis occurring in the Puerperium. (j) Under this heading are included also deaths from Atrophy and Marasmus of Infants, and want of Breast-milk, but not from Atelectasis. * Including Paratyphoid fever Post-Basic Meningitis and Polio-encephalitis acuta respectively. † No deaths registered from Croup. 74 75 Local Government Board New Tables. TABLE IY. BOROUGH OF LAMBETH—INFANTILE MORTALITY, 1925. 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 89 23 8 l8 138 57 78 43 37 353 Uncertified — — — — — — — — — — Chicken Pox — — — — — — — — 1 1 Measles — — — — — — Diphtheria — — — — — — — — 1 1 Whooping Cough — — — I I 7 4 6 7 25 Diarrhœa — 2 — — 2 3 16 5 1 27 Enteritis — — — — — 1 7 2 — 10 Influenza — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — 1 — 1 Phthisis — — — — — — 1 — — 1 Tuberculous Meningitis — — — — — — 3 4 3 10 Other Tuberculous Diseases — — — — — — — 1 1 2 Cerebral Haemorrhage — — — — — — — — — — Congenital Malformation 9 2 1 — 12 6 2 2 — 22 Premature Birth 44 8 3 6 6l 6 4 — — 71 Atrophy, Debility and Marasmus 11 3 1 2 17 10 7 2 — 36 Atelectasis 3 1 — — 4 1 — — — 5 Epilepsy — — —- — — — — — — — Syphilis — 2 — — 2 2 — — — 4 Rickets — — — — — — — 1 1 2 Meningitis (not Tuberculous) 1 — — — 1 1 — — 1 3 Ulcerated Colitis — — — — — — — — — — Convulsions 2 1 — — 3 — — — — 3 Gastritis — 1 1 — 2 — 1 1 — 4 Intussusception (acute) — — — — — — 1 2 — 3 Dentition — — — — — — — 1 — 1 Pleurisy — — — — — — 2 — — 2 Bronchitis — 1 — 1 2 4 3 2 2 13 Pneumonia — 1 — — 1 — 1 — — 2 Broncho-Pneumonia 1 1 2 3 7 10 15 12 12 56 Pleuro-Pneumonia — — — — — — 1 — 2 3 Rheumatism — — — — — 1 — — — 1 Want of attention at birth 4 — — — 4 — — — — 4 Suffocation, overlaying 2 — — 1 3 2 — — — 5 Accident, other than Suffocation 7 — — 1 8 — 3 — 2 13 Nephritis (Acute) — — — — — — 2 — 1 3 Icterus Neonatorum 1 — — — 1 — — — — 1 Cirrhosis of Liver — — — — — — — — — — Otitis and Mastoiditis — — — — — 1 1 — 1 3 Other causes not classified above 4 — — 3 7 2 4 1 1 15 Totals 89 23 8 18 138 57 78 43 37 353 76, 77 LAMBETH BOROUGH.— Corrected Deaths registered from all causes during the year 1925 Note.— The Deaths of Non-residents occurring in Public Institu- tions in the District are excluded, and the Deaths 01 Residents occurring in Public Institutions situated beyond the limits of the District are included. (A) REGISTRATION SUB-DISTRICTS. Sub-Districts. Sub-Districts. Total. Lambeth Church. Kennington. Stockwell. Brixton. Norwood. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. I.—Specific Febrile, or Zymotic Diseases 35 31 34 23 25 22 32 24 20 24 146 124 270 II.—Parasitic Diseases — — — — — — — — — — — — — III. —Dietetic Diseases — — — — — — 1 — — — — — 1 IV.—Constitutional Diseases 72 70 71 74 104 90 100 116 97 96 444 446 890 V.—Developmental Diseases 11 21 15 21 25 28 28 52 21 37 100 159 259 VI.—Local Diseases 196 169 201 191 204 213 260 286 172 225 1033 1084 2117 VII.—Deaths from Violence 23 5 23 10 25 20 21 26 15 12 107 73 180 VIII.—Deaths from Ili-defined and not Specified Causes 5 5 6 — 6 3 9 2 7 4 33 14 47 Totals 342 301 350 319 389 376 451 506 332 398 1864 1900 3764 (B.) AGE PERIODS. AGE PERIODS. Total. Under i Year. 1-2 2-5 Under 5 Years. 5-15 15-20 20-25 25-40 40-45 45-60 60-65 65 and over. Over 5 Years. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. I.— Specific Febrile or Zymotic Diseases 35 23 16 14 25 28 76 85 17 12 1 3 2 4 8 15 4 1 17 10 6 2 15 12 70 59 146 124 270 II.—Parasitic Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — III.—Dietetic Diseases — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 — 1 IV.—Constitutional Diseases 9 7 1 3 4 6 14 16 8 10 18 23 14 21 64 58 41 18 114 102 51 44 120 154 430 430 444 446 890 V.—Developmental Diseases 52 43 — 1 — — 52 44 1 — — — — — — — — — — — 1 — 46 115 48 115 100 159 259 VI.—Local Diseases 75 45 10 15 12 17 97 77 21 16 8 15 11 7 54 65 40 36 214 165 113 90 475 613 936 1007 1033 1084 2117 VII.—Deaths from Violence 8 10 1 1 7 4 16 15 13 3 7 1 4 2 11 8 7 1 21 16 6 3 22 24 91 58 107 73 180 VIII.—Deaths from Ill-defined and not Specified Causes 25 11 — — 1 — 26 11 — — — — — — 2 — — — 2 1 — — 3 2 7 3 33 14 47 Totals 204 139 28 34 49 55 281 228 60 41 34 42 31 34 139 146 92 56 369 294 177 139 681 920 1583 1672 1864 1900 3764 78 (C.) SUMMARY OF CORRECTED DEATHS. No. of Deaths. Total. No. of Deaths. Total. M. F. M. F. I.— Specific Febrile or Zymotic Diseases Brought forward 1604 1697 3301 1. Miasmatic Diseases 102 98 200 2. Diarrhœal ,, 23 10 33 3. Malarial ,, 1 — 1 VI.— Local Diseases—continued. 4. Zoogenous ,, — — — 6. Diseases of Lympathic System 4 4 8 5. Venereal „ 16 5 21 7. Diseases of Gland-like Organs of 6. Septic ,, 4 11 15 Uncertain Use 1 9 10 8 Diseases of Urinary System 95 72 167 II.— Parasitic Diseases — — — 9. Diseases of Reproductive System — — — III.— Dietetic Diseases 1 — 1 (a) Diseases of Organs of Generation 1 10 11 (b) Diseases of Parturition — 10 10 IV.— Constitutional Diseases 444 446 890 10. Diseases of Bones and Joints 6 4 10 11. Diseases of Integumentary System 13 7 20 V.— Developmental Diseases 100 159 259 VII.— Violence. VI.— Local Diseases. 1. Accident or Negligence 79 62 141 1. Diseases of Nervous System 123 175 298 2. Homicide 2 — 2 2. Diseases of Organs of Special Sense 8 9 17 3. Suicide 25 11 36 4. Execution — — — 3. Diseases of Circulatory System 287 333 620 5. Battle 1 — 1 4. Diseases of Respiratory System 388 355 743 VIII.— Ill-defined and not Specified Causes 33 14 47 5. Diseases of Digestive System 107 96 203 Carried forward 1604 1697 3301 Total 1864 1900 3764 79 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1925. 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 1925—311,100 (males 145,380, and females 165,720). Density—76.2 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected)—7,663, being 24.6 per 1,000 population. Deaths (corrected)—3,764, being 12.1 per 1,000 population. Infantile Mortality (corrected)—343 deaths (corrected) under 1 year, being 44.8 per 1,000 total (uncorrected) births, or 57.7 per 1,000 total (corrected) births.* Zymotic Death-rate (corrected)—0.5 per 1,000 population (total corrected zymotic deaths, 154). * Corrected as to outside institutional births only. 80 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, 1925. Number of Notices served 14,052* A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES† (Public Health (London) Act, 1891). No. of Notices served 4285 No. of Infected Houses 3904 Small Pox c1 Scarlet Fever 940 Typhoid and Para-typhoid Fever† 15 Diphtheria 751 Membranous Croup 5 Continued Fever1 Puerperal Fever 27 Erysipelas 126 Cerebro-Spinal Fever and Post-Basic Meningitis § 3 Acute Polio-Myelitis §§ 6 Ophthalmia Neonatorum 36 Measles 723 German Measles 1001 Primary Pneumonia 157 Influenzal Pneumonia 87 Encephalitis Lethargica 17 Malaria 8 Dysentery — Trench Fever — Anthrax — B. GENERAL NUISANCES AND DRAINAGE DEFECTS. (Public Health (London) Act, and Metropolis Local Management Acts). No. of Notices served*† 9746 Works, Structural— Drainage, Defective 211 Intercepting Traps with Fresh Air Inlets required, or defective 126 * Including Measles and German Measles, but excluding notices under the Housing Acts, † Excluding Tuberculosis. ‡4 cases of Para-typhoid. § 2 cases of Cerebro spinal Fever and 1 case of Post-basic meningitis. §§ 4 cases of Polio-encephalitis acuta, and 2 cases of Polio-myelitis acuta. 81 Ventilating Pipes defective or wanting 82 Indoor Sinks defective or direct to Drain 432 Rain Water Stacks connected with Drain or defective 565 Bath Waste connected with Drain or defective 6 Closet Pan and Connections Defective 323 Water Supply to Closet Defective 311 Closet Dilapidated 140 Draw-off Main for Drinking Purposes required 16 Dust Bins Defective 435 Premises Dilapidated 483 Roofs Dilapidated 1054 Soil Pipes Defective 73 Paving Defective 335 Damp and Unwholesome houses 568 Defective Water Pipes, Taps, &c. 98 No W.C. Accommodation 29 Copper, Fireplace, or Chimney, &c., defective 406 Manhole defective 35 Windows, Floors, Doors, &c., defective 669 Gullies defective, or stopped 115 Cistern defective 25 Dung Receptacle required 7 Walls and Ceilings defective 1078 Washhouses dilapidated 144 Stables unsuitable 3 7,769 Works, not Structural— Cisterns Dirty 21 Manure Accumulations 33 Underground Rooms illegally occupied 7 Effluvia and Smoke Nuisances 87 Animals Improperly Kept 45 Stopped Drains 302 Overcrowding 46 Foul Urinals 18 Refuse Accumulations 134 No Water Supply or Defective Water Supply 101 Dirty Premises 2468 Stagnant Water Accumulations 24 Rats Nuisance 157 Bakehouses Dirty 128 Lighting and Ventilation Insufficient 43 Plunging Eye defective 14 3,628 f 82 PARTICULARS OF SANITARY WORK carried out by the Male Sanitary Staff (District Inspectors) in Lambeth Borough during 1925, and during the 4 previous years (1920-1924), together with Yearly Averages for (a) the 20 Years 1901-20, (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. 1925 14052 7769 3628 1924 15368 7430 3643 1923 12921 7901 3615 1922 16193 7878 3641 1921 16580 8093 3983 Yearly Average for 20 Years 19011920 (Borough) 147965 10569.9 4106.7 Yearly Average for 24 Years 18771900 (Parish) 59446 4756.9 2135.9 SANITARY STAFF.* The Sanitary Inspectorial Staff consists of 12 district male Sanitary Inspectors, 2 special male Sanitary Inspectors (Food) and 2 special male Sanitary Inspectors (Housing), 2 female Sanitary Inspectors, and 4 women Health Visitors—all whole-time officers. The work carried out by these various officers is set out in tabular form. Summary of Work Carried Out by the 12 District Male Sanitary Inspectors during 1925. Inspections 10062 Re-inspections 44633 Complaints attended to 5993 * Inspector A. B. Cruttenden was appointed Special Food Inspector on March 26th, 1925, his appointment being approved by the Ministry of Health on April 8th, 1915, and Inspector C. W. Idle was appointed as a District Inspector in place of Mr. "Cruttenden on April 23rd, 1925 (his appointment being approved by the Ministry of Health on June 1st, 1925). 83 Water Certificates issued* 150 Revenue Act certificates dealt with — Drains tested (with chemical, water or smoke test) 4677 Sanitary Works completed 5696 Samples of Food and Drugs taken 2005 Notices— Public Health (London) Act, 1891 (Preliminary or Intimation 5928 and Statutory 3818) 9746 Metropolis Local Management Acts 21 Sanitary Nuisances abated— (a) Structural 7769 (b) Non-structural 3628 Summonses issued— Public Health Act† 5 Food and Drugs Acts‡ 9 Margarine Acts§ 1 N.B.—In addition to the above, the 12 District Sanitary Inspectors carried out during 1925 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. * Including 207 houses (7 being in blocks) and 207 tenements. † convictions, and 1 summons withdrawn. ‡ 5 convictions, and 4 summonses dismissed. 1 conviction. f2 84 Extra 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. In fected 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 1,892 infected houses dealt with during 1925, the results are as follows, the averages being given in brackets for the past 25 years, 1891-1915:— (а) 30, i.e. 1.58 percent, were found to have defective drains, i.e. a result was obtained with the chemical test employed (average = 14.3 per cent.). (b) 962, i.e. 50.84 per cent, showed defects in drains, traps, fittings and appliances (average = 53.1 per cent.). (c) 900, i.e., 47.56 per cent. showed no defects (average = 46.9 per cent.). Registration of Cow-houses, Slaughter-houses, Common Lodging-houses, and Milk Shops. During 1925, three Cow-houses, †eleven Slaughter-houses,‡ and four Common Lodging-houses'§ licences were renewed by the London County Council. The applicants were registered by the Council as milk sellers or purveyors of milk at the following premises, which were certified * 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 1925 comparable with those for past years. The figures for measles and German measles infected houses during 1925 are:—3 defective drains and 308 defective traps, fittings, and appliances, out of a total of 1,724 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. 85 as "suitable," i.e., in accordance with the Council's requirements :— 117, Brixton Road (rear of)—2 separate applications by 2 different occupiers, Canterbury Road and Industry Terrace, 76, Coldharbour Lane, 18, Combermere Road,* 148, Cornwall Road, Brixton Hill, 149, Denmark Road, 53, Dorset Road (rear of)— -2 separate applications by 2 different occupiers, 125, Dulwich Road, 11, Effra Parade, 43, Ingleton Street, 94, Landor Road,* 152, Landor Road, Lansdowne Mews (Shed), 72, Larkhall Lane (rear of)—5 separate applications by 5 different occupiers, 20, Lilford Road (rear of), 59, Lilford Road, 36, Lothian Road, 97, Milkwood Road, 101, Oakley Street, 148, Old South Lambeth Road, 12, Priory Grove, 7, Priory Mews, 36, Portland Place South, 48, Railton Road, 76, Railton Road, 116, Railton Road, 4, Rathgar Road, 8, Robsart Street, 3a, Roupell Street, 78, St. Mark's Road, 97a, St. Mark's Road, 297, Shakespeare Road, 164, Stockwell Road,* 116, Sussex Road, 107, Tyers Street (rear of), 121, Upper Kennington Lane—2 separate applications by 2 different occupiers, 49, The Arches, Vauxhall Station, 104, Westminster Bridge Road, 52, Wilcox Road, 49, Willington Road. N.B.—15 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 :— 87, Bedford Road, 60, Bolton Street, 56, Bonnington Square, 9, Cambria Road, 18, Combermere Road,† 172, Ferndale Road, 56, Kennington Park Road, 94, Landor Road,† 163, Railton Road (rear of), 17, Santley Street, 164, Stockwell Road,t 71, Tasman Road, 52, Walnut Tree Walk. Revenue Act, 1903 (and Section 35 of the Housing, Town Planning, etc., Act, 1909.) No certificates were applied for in connection with tenements (or dwellings). * Premises on first applications were found to be " unsuitable " and the applications were refused (see below). + Since registered as " suitable " (see above). 86 Offensive Trades. There are three offensive trades registered, e.g., fat melting (15, Upper Marsh), soap boiling (15, Upper Marsh) and tripe boiling (103, Lambeth Walk). The premises at 15, Upper Marsh (soap boiling and fat melting) were enlarged during 1925 with the approval of the London County Council under section 19 of the Public Health (London) Act, 1891. Fat melting at Albert Mews (rear of 188, Clapham Road) lapsed through disuse in 1924. Summary of Work carried out by the Female Sanitary Inspectors during 1925. Workshops* visited and inspected— (a) Dressmakers 24 (b) Milliners 4 (c) Laundries 14 (d) Tailors 16 (e) Upholsterers 1 (f) Art Needlework 2 (g) Blouses 4 (h) Beer Bottling 1 (i) Children's-Clothing 2 (j) Florists 3 (k) Dressing Gowns 1 (l) . Furriers 1 (m) Gas Shades 1 (n) Metal Polishes 1 (o) Shirt-making 1 (p) Underclothing 3 (q) Valet service 4 (r) Waste Paper 1 (s) Toilet Requisites 1 (t) Others (e.g.), bag-making, trunks, foods, tobacco, &c. 10 Workshops* : workrooms therein measured 42 Workshops*: newly discovered and registered 24 †Premises visited, but not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 2 549 * Workshops include Work-places. † Births (4), Workshops (65), Tuberculosis cases (181), Private Houses (103), Outworkers (1935), Rheumatism cases (119), Tonsils and Adenoids cases (142). 87 Female Conveniences visited and inspected— Public (visits paid) 855 Private — Schools visited— Public (visits paid) 1 Private — Special places visited and inspected— (a) Private Houses* 648 (b) Outworkers 175 Workshops (o), Outworkers (5), and Private Houses (248)† reinspected 253 Written Intimation and Statutory Notices served 144 No. of Workshops‡, etc., in which defects were found 144 No. of Workshops‡, etc., in which no defects were found 775 Nuisances referred to M.O.H., for attention by Male Inspectors 5 Particulars of Defects found by Female Inspectors. Workshops‡, etc.— Workrooms— Overcrowded, Damp, Dirty, etc. 113 Defective or Dirty— Yards, Floors, Roofs, Windows, Ceilings, Rain Water Pipes, Sink Wastes, or Premises generally 100 Sanitary Appliances : Water Closets— Dirty, unventilated, choked, Defective or with Defective Tanks or Water supplies 41 Sanitary Appliances : Drainage— Defective 1 Sanitary Appliances : Dustbins— Wanting or Defective 18 Lavatories—Dirty or Defective 0 No separate suitable sufficient W.C. accommodation for the sexes 6 Miscellaneous Defects, e.g., Defective Chimneys 7 * Tuberculosis cases (227), Ophthalmia cases (i), School children (323, e.g., enlarged Tonsils and Adenoids 251 and Rheumatism 72), Housing Enquiries (7), and special complaints (90). † Tuberculosis cases (70), Investigations re Rheumatism (15), Enlarged Tonsils and Adenoid cases (19), and special complaints (144). ‡ Workshops include Work-places. 88 Summary of Work Carried Out (Total Visits Paid) by the 4 Whole-time Official Health Visitors during 1925. Births* 5644 Depot children (visits) 14S Still-births 171 Welfare Centres (attendances) 647 Ophthalmia neonatorum cases* 190 School children† 21 Epidemic diarrhoea cases 49 Expectant mothers (visits) 808 Milk Depot (attendances) 144 Special inspections§ 454 N.B.—-In addition to the above, 1,681 visits were paid to houses, but no one was found to be at home. The above returns are to be read in conjunction with the footnotes on the two previous pages, dealing with the work of the Female Sanitary Inspectors, who paid 113 visits to children between 1 and 5 years, viz. : rheumatism 4, enlarged tonsils and adenoids 99, tuberculosis 7, whooping cough 3. FACTORIES AND WORKSHOPS. Factories. 2 new factories were added to the Register, dealing with (a) Dress-making, 1 ; (b) Musical Instruments, 1. Workshops. 32 new workshops (including 2 Domestic workshops) were added to the Register, dealing with:—Art Needlework, 1 ; Blouses, 3 ; Cleaning and Pressing, 2 ; Costumes, 1; Dressing Gowns, 1 ; Dress-making, 3; Fruit Packing, 1 ; Furriers, 1 ; Laundry, 2; Millinery, 2; Motor Repairs, 4 ; Plaster Decorative Work, 1 ; Rag Dolls, 1; Scenic Painting, 2 ; Scenic Woodwork, 1 ; Table making, 1 ; Tailoring, 5; * Including revisits as follows:—Births 4,373 (of which 3,359 were paid to children between 1 and 5 years of age), Ophthalmia neonatorum cases 135. † Special enquiries re polio-myelitis (6), other infectious diseases ( †5). § Including housing enquiries, 134 (visits). 89 OUT-WORKERS, 1925. 5 February and 5 August lists were received, dealing with 40 and 29 out-workers respectively. Of the 69 out-workers, 28 belonged to Lambeth and 41 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 145 lists were received from various outside authorities dealing with 765 workers, of whom 749 belonged to Lambeth and 16 to districts outside Lambeth. Of the total Lambeth out-workers reported, 73 were new outworkers, i.e., out-workers not previously registered, as follows : Aprons 1 Lace Goods 1 Artificial Flowers 2 Lampshades 1 Baby Linen 2 Mantles 3 Bag Stringing 5 Millinery 7 Blouses 2 Neckwear 1 Boots 1 Outfitting 1 Boudoir Caps 0 Rag Dolls 1 Brush making 2 Shirts 1 Children's Dresses 1 Smocking 1 Collars 1 Tailors 12 Costumes 1 Tassel work 1 Dressing Gowns 1 Ties 5 Dress-making 5 Underclothing 3 Embroidery 1 Upholstery 1 Hats (Opera) 1 Wearing apparel 2 Knitted Articles 4 Woollen goods 3 Total 73 HOUSING DEPARTMENT. Representation under the Housing of the Working Classes Act, 1890 (Part I.) China Walk Area. The official " representation " of the Medical Officer of Health was made under date of September 25th, 1924, in connection with a London County Council Improvement Scheme for the County, and 90 the Public Enquiry was held at the Lambeth Town Hall by Mr H. A. Chapman, F.R. I.B.A., an Inspector of the Ministry of Health, on November 19th, 1925, lasting 3 days, during which a large amount of evidence was submitted. The Inspector of the Ministry of Health visited personally the Area afterwards. The Area includes a large number of insanitary houses, the result of their original ill-planning and their present ages, an Improvement Scheme in connection therewith, was much needed apart from the question of slum-clearances in the general acceptation of that term. There are 249 houses and buildings contained within the Area, and for the purposes of the Public Enquiry, approximately 1,000 visits have been paid for the collection and tabulation of information as to the sanitary and insanitary states of such houses and buildings, the preparation ot censuses and other statistical details (mortality and morbidity reports), lists of owners, &c. The Public Enquiry revealed no great difference of opinion as to the suitability of the Area for clearance and improvement purposes, but did show very clearly that, if the improvement of so-called slum areas by clearance for improvement schemes is to be generally adopted, in future, as a policy, some modifications of the present method of determining the terms of the compulsory acquisition of the sites and houses and buildings will require to be made, in fairness to the owners concerned, especially in the case of those owners who, in spite of the ages of the properties, endeavour to keep them reasonably fit in all respects for human habitation. Another question that came forward for serious consideration was the probable hardship that might result to small shopkeepers and other persons occupying business premises (with or without leases). Such are the views that have been held by the Lambeth Officials (Medical Officer of Health and Housing Inspectors) for some time past, and it was satisfactory, therefore, to have the points emphasised at the Public Enquiry by the legal advocates (and others) appearing for the owners or tenants. If, and when, the Provisional Order is made, the new buildings tobe erected on the Area, after clearance, are to be of the usual L.C.C. type of dwellings or tenements, arranged on five floors, with shops on the ground floors, and with a total capacity for accommodating about the same number of persons as will be eventually displaced (about 1,500 to 2,000 persons).* Representations and Closing Orders under Section 17 of the Housing, Town Planning, Etc , Act, 1909. During 1925, 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.† * Prince's Square was scheduled by Order of the London County Council for compulsory acquisition on July 28th, 1925, but the scheme has since been abandoned. † Section 17 of the 1909 Housing Act is now incorporated in the new Housing Act, 1925 (section 11). 91 General Housing Matters. The Council's two Housing Sanitary Inspectors have continued their special work of systematic house to house inspection of dwelling-houses, and drawing up schedules of works required to render 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, and now under Section 3 of the Housing Act, 1925. During the year 1925, 551 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. 402 Surveys or Inspections have been made, under the Housing Inspection Regulations of the Housing, Town Planning, etc., Act, 1909, and 397 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 Seetion 28 of the Housing, Town Planning, etc., Act, 1919. 402 Record Cards have been filed, 402 visits, and 13,276 re-visits made, and many interviews held at the Town Hall, or elsewhere, with owners, agents, builders and others concerned. 543 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 (1925), 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 : Prince's Ward. Bloomfield Place (4), Esher Street (51), Kennington Road (3), Leopold Street (25), Newburn Street (1), Vauxhall Street (141)- Brixton Ward. Farmers Road (79). 92 Stockwell Ward. Brighton Terrace (20). Norwood Ward. Auckland Place (16), Dunkirk Street (25), East Place (19), East Street (9), Jaffray Place (9). During the 12 months no legal schedules have been required to be served by the Council. 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 or notices. Marsh Ward. Johanna Street (No. 10), Linnett Street (Nos. 7, 8, 10, 11, 12, 14, 15, 19, 19½, 2i, 22, 23, 25, 28a, 28, 29, 29a), Mary's Buildings (Nos. 18 and 19). (2) After service of provisional (or informal) schedules Marsh Ward. Coin Street (Nos. 1, 1½, 3 to 10, and 29 to 39 consecutive), Ethelm Street (Nos. 71, 72), Johanna Street (Nos. 14 to 20 even), Starling Place (Nos. 6 to 14 even). Prince's Ward. Clayton Street (Nos. 2 to 8 even, 23 to 27 odd), Esher Street (Nos. 1 to 4, 11 to 16, 26a to 39, 41 to 46 consecutive), Frank Street (No. 6, 37, 39), Garden Cottages (No 1), Hunt Street (Nos. 20, 22, 24), Kennington Road (Nos. 253, 255, 269, 271), Leopold Street (Nos. 1, 6, 7, 9), Lower Kennington Lane (Nos. 119, 121, 137, 141, 143), Loughborough Street (Nos. 1 to 8, 8a, 8b, 8c, 9 to 30 consecutive), Newburn Street (Nos. 60, 61), St. Oswald's Place (Nos. 1 to 33, 43 to 55 odd, 8 to 22 even), Vauxhall Street (Nos. 5 to 25, 31 to 57, 67, 85 to 115, 121, 135, 135a, 141a odd, 36, 38, 60, 64, 76, 122, 130a, 184, 186, 188). Vauxhall Ward. Hemans Street (Nos. 10 to 22 even). Stockwell Ward. Garden Row (Nos. 6 to 11 consecutive). Brixton Ward. Baker Street (Nos. 2, 4), Farmers Road (2 to 22, 84 to 142, 150, 176 to 192, 200 to 210, 214, 218 even), Vassall Road (Nos. 9, 17, 21, 31 to 41 odd). Heme Hill Ward. Regent Road (Nos. 40 to 50, 54 to 60 even, 47 to 69 odd), Vining Street (Nos. 9, 21, 23, 27). 93 Tulse Hill Ward. Margate Road (Nos. 41 to 49 odd), Mauleverer Road (Nos. 8, 10). Norwood Ward. Dunbar Street (Nos. 10 to 16, 38 even, 15 to 21, 27 to 39, 43 to 47, 51, 53 odd), Dunkirk Street (Nos. 1 to 17, 21, 23, 27, 31 odd, 24 to 30 even), Durban Road (Nos. 58 to 72a even, 67 to 77 odd), East Place (Nos. 1 to 5 consecutive, 15, 16, 18, 19), East Street (Nos. 6, 7, 8, 9), Rommany Road (Nos. 31, 33, 37, 39, 153, X83 to 189, 201 to 213, 219 to 225, 249 to 263, 269, 279 to 287 odd, 114, 116, 120, 122, 166 to 2t2, 232, 238, 242 to 270 even), Maybank Cottages (Nos. 1 & 2). The following houses have been voluntarily closed, and since voluntarily demolished :— Marsh Ward. Coin Street (Nos. 22, 24, 25), St. Andrew's Place (Nos. 2, 3, 4, 5. 6, 7. 8, 9, 10, 11). Prince's Ward. St. Oswald's Place (No. 2), whilst the following house has been voluntarily closed, with a view to being demolished at an early date:— Prince's Ward. Lower Kennington Lane (No. 89). 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, Herne Hill, Tulse Hill, and Norwood Wards, whilst, in addition, many provisional (informal) schedules have been served during the year under report in connection with houses in the same 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 and served many months ago, legal schedules or notices will be required to be served in the usual way by the Council 94 (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. These four houses are the property of the Lambeth Board of Guardians, and are required in connection with the improvement of the existing Infirmary premises. Trowes Place (Nos. 4 and 5) are also the property of the Lambeth Board of Guardians, and Closing Orders are still outstanding on the houses which are occupied. These two houses also form part of the Guardians' Lambeth Infirmary Scheme. In this connection, the Borough Council has undertaken to re-house the occupiers of the above-mentioned houses as a condition of the Borough Council taking over the Prince's Road Workhouse as a building site for working-class dwellings. Fortunately, this Prince's Road Workhouse site has now been taken over by the Borough Council and the new dwellings or tenements will shortly be erected thereon (108 in number), with a fixed bath to be provided in a separate bathroom, in each case. (2) Private Development Schemes. (a) Duchy of Cornwall. There is nothing new to report during 1925. (b) Ecclesiastical Commissioners, There is nothing new to report during 1925. General Considerations. The new Housing Act, 1925, was passed on April 9th, 1925, and came into force on July 1st, 1925. Future systematic house tc house inspections and surveys, with the serving of schedules and notices under Section 28 of the old 1909 Housing Act, will be made under Section 3 of the new Housing Act, 1925. It may be useful therefore, to place on record the details of work carried out by the Housing Inspectors since their appointments up to and including December 31st, 1925, a period of 5—6 years, as follows 1. Inspections made 2966 2. Works completed or houses closed— (а) under provisional schedules 2385 (b) under legal schedules or notices 84 2469 3. Works not yet completed or not yet commenced— (а) under provisional schedules 472 (b) under legal schedules or notices 25 497 95 The houses for inspection and to be dealt with under the Housing Acts are, in the first instance, selected by the Medical Officer of Health, and afterwards approved by the Public Health Committee, as the Housing Authority, the worst houses being chosen for the purpose. It is obvious that by such an arrangement only the very worst houses can be dealt with by the present Housing Inspectorial Staff (i officers only), devoting their whole time. The above record of work done may be regarded as representing the maximum work that is to be expected proportionately, year by year, and, having regard to the numbers of houses within the Borough, it is clear that the question as to the appointment of extra Housing Inspectors must, naturally, arise in the near future, if the maximum good is to be obtained from the Housing Acts. It is certainly to the credit of the 2 officers (Housing Inspectors) that, despite the large numbers of houses dealt with, the work of repair and reconstruction has been, or is being, carried out by the owners concerned, except in a few instances, viz.:—(a) Monkton Street (Nos. 41, 43, 45, 53) and Margate Road (Nos. 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 35, 37, 39, 51), in connection with which statutory or legal notices were served by the Council on June 23rd, 1923, and February 13th, 1925, respectively; and (b) Durban Road, West Norwood (Nos. 2, 2a, 4, 4a, 6, 6a, 8, 8a, 10, 10a, 12, 12a, 14, 14a, 16, 16a, 18, 18a, 20, 20a, 22, 22a, 24, 24a, 26, 26a, 28, 28a, 30, 30a, 32, 32a, 34, 34a, 36, 36a, 38, 38a, 40, 40a, 42, 42a, 44, 44a, 46, 46a, 48, 48a, 50, 50a, 52, 52a, 54. 54a, 56, 56a), in connection with which provisional schedules only have been served on behalf of the Council on October 30th, 1923. Such a satisfactory condition of affairs may not always continue, and the Council, as the Housing Authority, must sooner or later face the statutory obligation of entering the premises and doing the necessary works and surcharging the owners. Persuasion cannot always be relied upon. Another interesting summary, to be tabulated in view of the new Housing Act, 1925, having come into force on July 1st 1925, is as follows (vide also Appendix I Addendum 3): — I. Closing Orders made by the Borough Council under Section 17 of the, Housing, Town Planning, &c., Act, 1909* 150 (a) Houses closed (houses afterwards demolished, 93) 107 (b) Houses repaired 3i (c) Houses still occupied and not repaired 12 II. Statutory, or legal, notices served by the Council under Section 28 of the Housing, Town Planning, &c., Act, 1919 109 N.B.—Total provisional (informal) schedules issued 2066 * Since 1914 the making of Closing Orders and the systematic closing of houses in connection therewith have practically been in abeyance, with the knowledge and approval of the Public Health Committee, acting on behalf of the Council as the Housing Authority. 96 For a period of over 20 years previous to the appointment of 2 special Housing Inspectors on February 12th, 1920, except during the War period (1914-20). systematic house-to-house inspections under the Public Health (London) Act, 1891, and the Housing of the Working Classes Act, 1890, and the Housing, Town Planning,&c., Act, 1909, were carried out year by year by the District Sanitary Inspectors and notices served as required under the Public Health (London) Act, 1891. These house-to-house inspections were made under the Housing (Inspection of District) Regulations (1910). Details of these systematic house-to-house inspections are to be found set out in the Medical Officer of Health's Annual Reports, amounting in numbers to thousands of inspections and leading to unfit houses being put into proper order and condition, or rearranged and rebuilt, or reconstructed or converted into flats. In this connection, courts and alleys and cul-de-sacs and streets have been demolished in connection with local improvements schemes, carried out by large private owners and several private firms, such as the Duchy of Cornwall, the Ecclesiastical Commissioners, the London and South Western Railway, and other Railway Companies, and the London County Council, and Messrs. Rayne, Greig, Boots, etc. Hundreds of dirty, damp, dilapidated and generally worn-out houses have been, in that way, voluntarily closed and demolished, and new model three-storey tenement houses, and two-storey cottages, or new or extended business premises erected in their place. It will be seen therefore, that, prior to the War, a large amount of housing work was carried out (voluntarily or as the result of notices served) on the principle ot reconditioning existing houses by individual owners, and this work, together with the aforementioned improvement schemes of private owners and firms, kept the Borough and the late Parish in a fair condition as regards the houses, and the total improvements effected have been pointed out from time to time in the Annual Reports or Special Reports issued by the Medical Officer of Health. Since the War, action has been restricted to Section 28 of the 1919 Housing Act, which also gives powers for reconditioning of unfit houses as opposed to slum clearances by demolition. House-to-house inspections are now carried out under the Housing Consolidation Regulations, 1925, made in pursuance of the New Housing Act, 1925. 97 Reconditioning v. Demolition of Unfit Houses. Much consideration is being given to the important question of improving slum areas otherwise than by the demolition of the unfit houses and the building of new houses on the cleared sites, the only method which is at present available for Local Authorities to carry out at the expense of the Public Funds under the existing Housing Acts. This adumbrated change of policy is particularly interesting to the Lambeth Borough Couuncil, as it is really the proposed adoption of the policy of such Council, and may be described as the " Lambeth policy," as carried out within the Lambeth area, as a routine, for more than 25 years, but more energetically and more in detail since the War, during the past six years, since the appointment of the two special Housing Sanitary Inspectors, who are' whole-time officers, who were appointed for the purpose when the Housing, Town Planning, etc., Act, 1919 (a post-War Statute), came into force. The " Lambeth policy " of keeping houses under official supervision and serving notices as required for defects found, upon the owners concerned, has proved a marked success, as shown by the well-known fact that there are practically no so-called "slum areas" (in the usual acceptation of the term) within the Borough, as there are in some neighbouring and other Metropolitan and provincial districts. This fact is worthy of re-emphasis, as it has been emphasized again and again in Lambeth Annual Reports and Special Housing Reports for many years past. Experience shows that many of the houses in "slum areas " can be modernised and made habitable—reconditioned, without the very heavy outlay that is involved by a demolition scheme. Capital must be available, however, and new legislative powers will have to be conferred upon Local Authorities if they are to have the necessary machinery to recondition rather than, or as well as, to demolish unfit houses on an area. At present, such work can only be done by private enterprise, but the necessary capital, and consequently the necessary labour and materials, are not forthcoming. If the Local Authorities are able to step in and finance or undertake similar work, there can be but little doubt that important improvements can be effected, and the present standard of housing conditions raised, and, subsequently and consequentially, also, the conditions of the tenants, who have responsibilities as well as the landlords, in regard to private property. Under existing procedure, an area, that is regarded as a slum area, must be compulsorily purchased by a Local Authority with the object of demolishing the houses, situated within such area, and afterwards of building new ones. The price paid is generally the site value, with practically nothing allowed for the houses, which, by virtue of being on the site, are ipso facto deemed to be insanitary and unfit. Such, however, is never the case in so far as all the houses are concerned, as there are always some houses that are more or less fit (structurally and sanitarily), but are crowded in with houses that are admittedly unfit, a 98 rendering it impossible to deal with the one set without dealing also with the other set by demolition, followed by rebuilding. This state of things appears to be unfair, however necessary it may be in practice, and powers should be obtained which will enable some compensation to be given for those individual houses which are more or less fit, found in a slum area. It is clear that powers to Local Authorities to recondition must be accompanied with powers also to demolish as required, with right of appeal to the Ministry of Health by the owners concerned. Again, another anomally is the fact that, when the Local Authority has compulsorily purchased the site and the houses (without paying for the latter), such Local Authority becomes the landlord and collects the rents until such time as the houses are demolished—it may be for a matter of years. This is obviously unfair to the late owners, and may also be described as farming insanitary houses at the expense of the tenants' health ! The law requires alteration in this respect, too. A reconditioning scheme, as opposed to a demolishing scheme, would necessitate, it is suggested, the Local Authority setting up a Housing Department, an Estates Management Commission, which might, it is suggested further, be financed out of Housing Bonds. This is not far removed from municipal trading, and will doubtless be opposed as such, before any suggested reconditioning scheme is officially approved in the same way as new municipal housing schemes (financed out of public funds) are sometimes opposed at times for a similar reason. As examples of what systematic reconditioning can do, the following Lambeth instances may be quoted: Ethelm Street (70),* Pascal Street (26), Hemans Street (54), Portland Cottages (11), Seaham Street (37), Simpson Street (25), Neptune Cottages (4), Spring Gardens (6), Neville Street (15), Loughborough Street (33), Wyndyard Terrace (11), Esher Street (51), Kennington Road (24), Chryssell Road (54), Vassall Road (69), Baker Street (51), Farrar Street (18), Russell Grove (24), Kenbury Street (91), Flaxman Road (38), Lilford Road (53), Addison Place (10), Normandy Place (14), Dugdale Street (25), Regent Road (73), Dunkirk Street (25), † East Street (9), † East Place (19), † These examples are taken from the records of work carried out by the Council's two Sanitary Inspectors (Housing) since their appointments in 1920. *The basements have not yet been dealt with, and are awaiting (a) "reconditioning" by being opened up, lighted and ventilated), or (b) allernatively, closed as dwelling-rooms (and converted into stores). † Dunkirk Street, East Street, and East Place form part of an area which has been under consideration from time to time for "representation" under the old Housing Act, 1890, but which has been greatly improved by " reconditioning" by the private owners under the new Housing Act, 1919. The waterlogging of the area has been improved by the L.C.C. sewerage works. 99 DISINFECTING DEPARTMENT, 1925. Details of work done in connection with the Disinfecting Department are subjoined : 4,860 cases of infectious diseases, notified compulsorily by medical men, were dealt with, including cerebro-spinal fever and post-basic meningitis (3), acute polio-myelitis and encephalitis (6), acute primary pneumonia (159), acute influenzal pneumonia (87), acute encephalitis lethargica (17), malaria (8), ophthalmia neonatorum (36), measles (798), eerman measles (1,111), and tuberculosis—-pulmonary (487), and non-pulmonary (88), whilst the following diseases were, in addition, reported by school teachers and others, viz.: measles (601), chicken-pox (1,250), cancer (86), whooping cough (871), and others not classified (484)*, 369 verminous houses (442 rooms) and 1,384 verminous articles, viz.: bedding 1,332, and clothing 52, were also dealt with Summary of work carried out by the Disinfecting Department during 1925. Total No. of Rooms disinfected by Council 8953 I)o. articles do. 10943 Cases in which bedding was disinfected at hornet 4998 Do. do. do. at Chamber 2918 Do. do. do. destroyed — Premises disinfected and disinfectants supplied 20083 Articles of bedding, etc., disinfected 17603 Articles of bedding, etc., destroyed — Police Ambulance disinfected 3 No. of Cleansing Notices served in connection with infected houses 2128 Certificates of Medical Practitioners received in lieu of disinfection by the Council 11 Schools disinfected‡ (100 rooms) 9 Certificates of disinfection left with occupiers of disinfected premises 3138 Library books disinfected (public) 148 Mattresses re-tabbed by Council 627 * Scabies, ringworm, diseases not stated, etc. † Bedding not removed to the Disinfecting Chamber for disinfection in cases of Measles nnd German Measles ‡ Measles, 5 (18 rooms); Scarlet Fever, I (6 rooms); Diphtheria, 2 (62 rooms); not classified I (14 rooms). a 100 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 661 40 3 — Batter 67 1 345 1 Lard 19 — 16 — Coffee — 61 — Condensed Milk (Full Cream) — — 2 — Condensed Milk (Machine Skimmed) — — 3 — Milk (Separated) 1 — — Baking Powder — — 22 — Mustard 7 — 3.1 — Pepper 7 — 32 — Arrowroot — — 42 1 Vinegar 8 — 24 — Sago 6 — — — Oatmeal 6 — 12 — Ground Rice 9 — 11 — Dripping — 43 1 Drugs* 1 i 163 7 Rice — — 46 1 Tapioca 6 — 12 — Self-Raising Flour — — 23 1 Cheese — — 11 — Cocoa — — 29 — Sugar — — 9 — Olive Oil — — 8 — Pea Flour — — 23 — Flour — — 18 — Tea — — 8 — Honey — — 14 — Whisky 3 — 2 — Rum 2 — — — Gin 3 — 2 1 Confectionery — 6 — Custard Powder — — 25 — Lemon Squash — — 3 1 Apples — — 6 2 Cakes, Sponge 1 1 16 2 Eggs Substitute — — 4 — Mincemeat — — 4 — Semolina — — 18 — * The drugs (164) were :—Epsom Salts (8), Gregory's Powder (9), Ammoniated Tincture of Quinine (20), Cream of Tartar (8), Bicarbonate of Soda (22), Camphorated Oil (15), Milk of Sulphur (13), Boric Ointment (13), Tartaric Acid (8), Zinc Ointment (17), Friars Balsam (4), Iron Pills (5), Rochelle Salts (5), Acid Boric (6), Acid Phosphate (1), Glycerine (10). 2 samples of Milk of Sulphur, formal and 1 informal, 1 sample of Camphorated Oil, 1 sample of Gregory's Powder, 1 sample of Boric Ointment, 1 sample of Bicarbonare of Soda, 1 sample of Acid Phosphate and 1 sample of Friars Balsam, were adulterated. 101 Analysis of Food and Drugs and Water— continued. Samples. Formal. Informal. Number Analysed. N umber Adulterated. Number Analysed. Number Adulterated. Malt Vinegar 16 — — — Cream — — 14 3 Preserved Cream — — 23 — Margarine — — 19 — Fruits (Dried) — 18 — Jam — 6 1 Fish Paste — — 4 — Cherries in Syrup — — 1 — 825 43 182 22 N.B.—10 summonses (9 adulterations) were issued (6 convictions, and 4 dismissals). Water. 1 sample of water (from underneath the semi-basement of a private dwelling-house) was submitted to the Analyst for analysis, and found to be sewage-contaminated. 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 670 samples of milk taken during 1925 (662 formal, and 8 informal), in no single instance were preservatives found. 14 samples of cream (all informal), and 23 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) (b) No. of samples examined for the presence of a preservative. No. in which a preservative was reported to be present. Milk† 670 — Cream 14 3 Nature of preservative in each case in column (b) and action taken under the Regulations in regard thereto—Boric Acid (no action). * 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.'' t Including condensed milk (5), and separated milk (1). 102 2. Cream sold as preserved cream:— (a) Instances in which samples have been submitted for to ascertain if the statements on the label as to pre were correct:— anal servat ysis ives (1) Correct statements made 23 (2) Statements incorrect — Total 23 (b) Determinations made of milk fat in cream sold as cream:— preserved (1) Above 35 per cent. 23 (2) Below 35 per cent. Total 2 3 (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. No premises were registered in connection with wholesale dealers in margarine. 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, and 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 equired to licence certain specially designated milks, while the Ministry jf 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 1925, the following special licences have been issued in regard to the Borough of Lambeth :— 1. "Certified" Milk. (a) *VV. H. Hill, 5A, Cambria Road (producer, Brig-Gen. F. A. Buzzard, Hacksted Farm, Edenbridge, Kent). * Renewal of Licences. 103 (b) *W. Hardie, 12, Heme Hill Road (producer G. V. Baxendale, Framfield Place, Uckfield). (c) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill, and 118, Norwood Road (producers, J. & H. Robinson, Iford, Sussex) (d) *R. Higgs & Sons' Dairies, Ltd., 2 to 6, Canterbury Road, 43, Loughborough Road, 121, Acre Lane, 102, Brixton Hill, 114, Brixton Road, 4, Tulse Hill, 30, Kepler Road, 56, Railton Road, 15, Bonnington Square, 191, Westminstei Bridge Road, 67, Coldharbour Lane, 304, Clapham Road, 96, St. Marks Road (producer E. C. Lovell, Hatherton, near Andover). (e) *Express Dairy Co., Ltd., 279, Rosendale Road (producers, selves from Finchley, and Ridgland Farm, Ltd., Newick, Sussex). (f) David Jones, 11, Russell Street (producer, G. V. Baxendale, Framfield Place, Uckfield). (g) C. R. Cotching, 45, Camberwell New Road (producer, G. V Baxendale, Framfield Place, Uckfield). (h) Thos. French & Co., 72/74, Gipsy Hill (producers, Express Dairy Co., Finchley). 2. "Grade A" (Tuberculin Tested) Milk. (a) *D. Williams, iia, Victoria House, South Lambeth Road (producer, G. V. Baxendale, Framfield Place, Uckfield). (b) 'Express Dairy Co., Ltd., 279, Rosendale Road (producers, selves at Finchley, and Ridgland Farm, Ltd., Newick, Sussex). (c) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill, and 118, Norwood Road (producers, Ridgland Farm, Ltd., Newick, Sussex). (d) *R. Higgs & Sons' Dairies, Ltd., 2 to 6, Canterbury Road, 43, Loughborough Road, 121, Acre Lane, 102, Brixton Hill, 114, Brixton Road, 4, Tulse Hill, 30, Keplerj Road, 56, Railton Road 15, Bonnington Square, 191, Westminster Bridge Road, 67, Coldharbour Lane, 304, Clapham Road, 96, St. Marks Road (producer, E. C. Lovell, Hatherton, near Andover). (e) David Jones, 11, Russell Street (producer, G. V. Baxendale, Framfield Place, Uckfield). 3. " Grade A " Milk. (a) *David Jones, 11, Russell Street, Brixton (producer, G. V. Baxendale, Framfield Place, Uckfield). (b) *C. R. Cotching, 45, Camberwell New Road (producer, count Astor, White Place, Cookham, Berks). * Renewal of Licences. 104 (c)*†R. Higgs & Sons Dairies, Ltd., 2 to 6, Canterbury Road, 43. Loughborough Road, 121, Acre Lane, 102, Brixton Hill, 114, Brixton Road, 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 (producer, E. C. Lovell, Hatherton, near Andover). (.d) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill, and 118, Norwood Road (12 producers, J. .K. Burge, itchen Abbas, T. Bowden, Basingstoke, Rev. L. Corbett, Alresford, Sir Henry Hoare, Bart., Gillingham, R. G. Hecks, Glynde, Admiral Henderson, Ropley, W. W. Smith, Midhurst, Dr. Scott, Lymington, Tisbury Farm Co., Tisbury, H. J, Watson, Baynards, A. S. A. Westropp, Sway, Earl of Castlestewart, Hartfield). (e) Mrs. A. Richardson, 8, Robsart Street (producers, Retail Dairymans' Mutual, Ltd., Paddington). 4. " Pasteurised" Milk. (a)*tR. Higgs & Sons' Dairies, Ltd., 2 to 6, Canterbury Road. (b) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill, and 118, Norwood Road. (c) F. J. Taylor, 129, Cornwall Road, Brixton Hill. 5. Supplemental Licences (premises outside the Borough of Lambeth). *Curtis Bros. & Dumbrill, Ltd., 304, Brixton Hill ( Wandsworth), and 31, Westow Street (Croydon). 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. Effluvium Nuisances. The 2 following effluvium nuisances were dealt with :— (a) Walsall Fancy Leather Company, premises at 79, St. Mark's Road (incinerator), (b) Royal Arsenal Co-operative Society, Limited, premises at Acre Lane (Bacon Smoking Stoves). MORTUARIES AND CORONERS' COURTS. Details of Work carried out. (a) Number of bodies received, 388—298 at High Street and 90 at Wanless Road. (b) Post-mortem examinations conducted, 195—143 at High Street and 52 at Wanless Road. (c) Number of inquests held, 366—286 at High Street and 80 at Wanless Road. * Renewal of Licences. † Licence for Bottling also issued (new Licence) in connection with 2 to 6, Canterbury Road. 105 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. The Public Health (Meat) Regulations, 1924, were issued on December 20th, 1924, and came into force on April 1st, 1925. The Public Health Committee reported to the Council that the Regulations had been handed over (formally) to the Medical Officer of Health, as the official officer thereunder appointed, to carry them out, at the Council Meeting held on 14th May, 1925, when it was resolved by the Council to appoint also two Food Inspectors to assist the Medical Officer of Health in connection with the new duties arising out of such Regulations. The Council has duly authorised under the Regulations the above-mentioned officers and also the Council's 12 District Sanitary Inspectors. A series of suggestions was drawn up by the Medical Officer of Health as to the best practical way of carrying out the intentions of the Legislature as set out in the Public Health (Meat) Regulations, 1924,* but it was not intended that the suggestions were to be rigidly applied to all cases, but only so far as was reasonably necessary, having regard to the practical requirements of the meat trade. On the other hand, however, every endeavour was to be made by all concerned to prevent the serious and dangerous contamination of meat that, at present, undoubtedly may take place in the ordinary course of business methods that prevail generally in the trade to-day. Such are the principles to which the Medical Officer of Health adheres, in connection with all requirements that have been, or are being, made on behalf of the Council. The administration of the Public Health (Meat) Regulations, 1924, as carried out within the Borough of Lambeth by the Medical Officer ' of Health and the Council's two Food Inspectors, may be tabulated as follows :— « 1. A circular letter, signed by the Medical Officer of Health, was sent to each owner, or occupier, of every known (a) slaughter-house, (b) meat shop (or meat store) and (e) meat stall, situated within the Borough, setting out the respective provisions tabulated in the Regulations with regard to such slaughter-houses, meat shops (or meat stores) and meat stalls, and stating that an inspection would be made officially by the Council's officers, as required. 2. An official inspection is being made of all known slaughter-houses, meat shops (or meat stores) and meat stalls, and an official form filled in, registering, in each case, details of conditions found to exist at the time of inspection, together with particulars of any new requirements (also needed under the Public * What applies to meat applies with equal force to other foods, e.g. fish, sweets, vegetables, fruit, &c., and it is probable (and desirable) that these other foods should also be dealt with by Regulations to be made by the Ministry of Health. 106 Health (Meat) Regulations, 1924, in each case), such requirements being regarded as requirements or notices under such Regulations. N.B.—This work is proceeding slowly and what has been done in the way of providing glazed shop fronts, &c., is a definite improvement and has proved to have been quite reasonable and practical suggestions. The Trade is beginning to realise this fact, but it will, naturally, take time. It may be stated, that, in reply to the many circular and other letters (mentioned above), that have been sent out, very few objections have been received from the respective individual owners or occupiers of the slaughter-houses, meat shops (and meat stores) and meat stalls concerned. The ideals of the Regulations may be summed up in the two phrases — (1) scrupulous cleanliness; and (2) freedom (as far as possible) from contamination, or risk of contamination, (a) by flies, or (b) from dust, dirt, mud, filth or other contaminating substances being splashed or blown on to the meat. How best can these ideals be effected? With regard to the first (scrupulous cleanliness), nothing more need be said. Such an ideal must appeal to all, but there are practical difficulties surrounding the second (freedom, as far as possible, from contamination by or from dirt, &c.), whilst, in addition, there is the question of expense. It is always to be borne in mind, however, that whatever is required to be done must be "reasonably necessary" to attain the object desired. The provision of a glazed front to a shop seems an easy and obvious way out of the difficulty, as a protection against flies, dirt, dust, &c., in most cases, at least, but, unfortunately, the Council has no power to prescribe such fronts or any other methods, and must be content, therefore, with suggestions only. Many such glazed shop fronts have already been provided, and satisfaction is expressed on all sides, not only by the trade but also by the public. The meat trade should be, and, as a fact, speaking generally, is as desirous as the Sanitary Authority to fall in with any practical suggestions, which are only made with one object, viz.: to keep meat (1) scrupulously clean and (2) free, as far as possible, from contamination by flies, dirt, dust, &c. Even the Ministry of Health is satisfied that meat should not be allowed to project outside the limits of the wall or screen of the shop or stall, and that, where meat is kept near to an open window, the general rule should be that such meat should be covered with clean muslin or other suitable material (except at times of brisk trade). Much is being done by persuasion, and the Council's Food Officers are well aware of the difficulties that surround them. Nothing is done except under the written signature of the Medical Officer of Health, and no unreasonable or impracticable requests are made, but, on the other hand, the particular meat trade involved are asked to make suggestions—practical suggestions. 107 The Meat Regulations must be carried out and not allowed to become a "dead letter" within the Borough of Lambeth. This is the more necessary, as the Ministry of Health has already considerably narrowed the scope and usefulness of the Regulations by laying down (by letter dated June 12th, 1925) that such Regulations do not apply to "cooked meats, lard or sausages, or other preparations of or containing meat," in connection with which, as a fact, Regulations are even more necessary than they are for raw butcher's meats. The recent food poisoning outbreaks in Lambeth Borough have emphasised the truth of such a statement, proving, practically conclusively as they have, the great need that exists for scrupulous cleanliness and the prevention (as far as possible) of contamination by flies or otherwise. Here again, the value of clean muslin or other suitable material as a covering, and of glazed shop fronts, cannot be gainsaid. Any criticism of the Council's requirements as suggested by the Medical Officer of Health of the Borough, should be constructive and not destructive, and, as such, would at all times be welcomed by the Medical Officer of Health himself with a view to helping the trade as well as improving the public health.* The following is a tabulation of the work carried out by the Council's two Food Inspectors in connection with the Public Health (Meat) Regulations, 1924, representing 9 months work up to December 31st, 1925, the special Inspectors having been appointed on 12th February, 1925, and having commenced their duties on April 1st, 1925: (1) Number of visits* paid to slaughter houses, 507; (2) Number of visits* paid to meat shops and meat stores, 325; (3) Number of visits* paid to meat stalls, 115; (4) Number of actual slaughterings at which one or other of the Food Inspectors was present, 2,797, consisting of beasts (196), sheep (1,422) lambs (497), pigs (636), hogs (18), sows (2), and calves (26) ; (5) Carcases, or portions of carcases, condemned, 26. Of the 2,997 actual slaughterings, at which one or other of the Food Inspectors was present, and in connection with which 25 carcases or portions of carcases were condemned, the diseases necessitating such condemnation were as follows:—1 tuberculous liver (beast) 11 flukeinfected livers (beasts), 1 septic liver (sheep), 2 septic lungs (sheep), 1 septic head (sheep), 4 strongylus-infected lungs (sheep), 2 tuberculous whole plucks 'pigs), 1 tuberculous-infected carcase and offal (beast), 1 actinomycosis-infected head (beast), 1 inflamed heart (sheep). In addition, was condemned, 1 septic hindquarter (beast), in connection with a retail meat shop in Brixton. Further, 38 premises have been altered and improved and the works completed as the result of the Inspectors' visits, and, in many more premises, the works necessary to comply with the provisions of the * A deputation from the Union of London Meat Traders Incorporated attended before the Public Health Committee on 7th December, 1925. 108 Public Health (Meat) Regulations, 1924, are in hand or under consideration. Such works have reference to (i) the provision of new shop fronts (glass), marble slabs, mechanical ventilators, proper and suitable covered receptacles for offensive matters, etc., and (ii) alterations to positions of w.c.'s, etc. RATS AND MICE (DESTRUCTION) ACT, 1919. Much good work has been carried out by the officers duly appointed, viz.: the Borough Surveyor and the 12 District Sanitary Inspectors. Attention is specially noteworthy in connection with the Brixton Arcade (Market), 457-461, Brixton Road, about which serious complaints were received as to the existence of rats caused or encouraged by such market premises, chiefly a market for food The complaints became so serious that a special enquiry was instituted by the Medical Officer of Health. The Market Arcade consists of stalls and shut-up shops, and extends between Brixton Road and Electric Lane. Complaints were first received with regard to rats at the commencement of the year 1925, with the result that an inspection was made of the market, and an Intimation Notice served under the Public Health (London) Act, 1891, under the date of the 13th of January, 1925, upon the owner, Mr. W. Cooper, of 18, Savoy Street, Strand, W.C. 2, who is also an occupier in the market, whilst, at the same time, notice was given to the Council's Borough Engineer, so that such precautions might be taken as might be deemed necessary by Mr. Cooper (owner and part occupier), on behalf of the occupiers in connection with the premises and by the Council's Borough Engineer in connection with the sewers, as probable sources of the rats. The Market Arcade, etc., are cleaned up thoroughly each night, and refuse is carted away daily. The groundwork throughout is all concreted over. Virus and other poisons in quantities were tried by the owner. A watchman was appointed to keep watch during the night and he reported that rats were seen nightly crossing the roads into the market, from the old buildings, etc., in the rear of Electric Lane. A professional rat catcher, was also employed as well as ferrets and nets (in addition to the poison baiting and ordinary trapping). The ground upon which the Market stands is paved (Granolithic Pavement) and surface-drained towards, and on to, the neighbouring roadways, so that such ground can be readily hosed down. No noticeable improvement-at-least, permanent improvement, was the result, and a statutory notice was served upon the owner on March 14th, 1925, under the Public Health (London) Act, 1891. It was decided to carry out systematic testings of the drainages in connection with the arcade and the premises adjoining (on both sides and at the rear). Smoke testing (under pressure) was employed, with the following results. 109 1. Number of premises, the drainages of which were tested 56 2. Results obtained;— (a) Negative 40 (b) Positive 16 3. Action taken:— Notices served under the Public Health (London) Act, 1891 25 The defects found were made good by the owners. Separate w.c. accommodation is provided for the occupiers cf the lock-up shops and stalls—4 w.c.'s in all (2 for men and 2 for women), whilst, in addition, the Brixton Public Conveniences (Male and Female) are alongside and adjacent to the Market. The result of the special investigation proved that the rat infestation was not quite as serious as reported, and the effect of the notices served under the Public Health (London) Act, 1891, and also under the Rats and Mice (Destruction) Act, 1919, served upon the owners and occupiers not only of the arcade, but also of the premises adjoining (on both sides and at the rear), was satisfactory in that no complaints as to rats have been received since. The Medical Officer of Health is of the opinion that nothing short of the removal of the Market, or of the restriction of such market to dealingwith goods that are not foods or food-stuffs, will prevent entirely complaints being received with regard to rats. The Medical Officer of Health is not, however, prepared to state that the Market, as private premises, is rat infested to such an extent as to justify him in reporting the case to the Town Clerk, as a specific and special nuisance under the Rats and Mice Destruction Act, 1919, having regard to the fact that everything is being done that is necessary and reasonably practicable, not only by the Owner on behalf of the occupiers, but also by the Borough Engineer on behalf of the Council, in the way of poison-baiting, trapping, ferreting and netting, or otherwise catching or killing rats as they appear from time to time, due to the user of the premises and the particular foods and food-stuff that are displayed for sale, together with the refuse from trimmings of meat, poultry, fish, vegetables, etc., which results. Further, empty boxes, crates, sacks, baskets, straw, sawdust and other litter may also act their parts as enticements to the rats from the neighbouring premises for rat-runs, food storage and nesting purposes, and should be done away with (or limited) as far as possible. The strictest precautionary measures and methods of cleanliness must be employed in connection with the Market, at all times. The great danger to the public that might occur were fire to break out when the Market is crowded is a matter that is not under the control of the Borough Council, but is nevertheless, a serious matter, and has been referred to the Authority concerned. No old brick barrel sewers or drains in the immediate neighbourhood of the Arcade were reported by the Borough Engineer. 110 APPENDIX I. MINISTRY OF HEALTH TABLE Borough of Lambeth. HOUSING CONDITIONS. Year ended 31st December, 1925. GENERAL STATISTICS. Area (acres) 4,083 Population 311,100* Number of inhabited houses 42,607† Number of families or separate occupiers 78,399† Rateable value £2,022,819 Sum represented by a penny rate £8,291 HOUSING. Number of new houses erected during the year:— (a) Total 207+ (b) As part of a Municipal Housing Scheme 56+ (7 blocks) 1. —UNFIT DWELLING HOUSES. 1.—Inspection. (1). Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 10,4 64§ (2). Number of dwelling-houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 402 (3). Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation nil. (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 402 *Estimated 1925. †Census figures 1921. ‡ Representing 151 and 56 tenements respectively. §10,062 Public Health (London) Act, 1891 and 402 Housing Acts. 111 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 2,607* III.—Action under Statutory Powers. A.—Proceedings under Section 28 of the Housing, Town Planning, &, Act, 1919. (1). Number of dwelling-houses in respect of which notices were served requiring repairs nil. (2). Number of dwelling-houses which were rendered fit— (a) by owners 19 (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 3,884† (2). Number of dwelling-houses in which defects were remedied— (a) by owners 1,884† (b) by Local Authority in default by owners nil. C.—Proceedings under Sections 77 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. *21 to under the Public Health (London) Act, 1891 (intimation notices), and 497 under the Housing Acts, (provisional or informal schedules), †Statutory notices under the Public Health (London) Act, 1891. 112 (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. ADDENDA 1. Families occupying (a) one room, and (b) two rooms (1921 Census Returns). No. of persons in family. No. of families occupying one room. No. of families occupying two rooms. 1 5462 1901 2 2776 5111 3 1268 3636 4 409 2159 5 120 1095 6 26 543 7 9 256 8 2 100 9 1 46 10 1 8 11 — 2 Total private families 10074 14857 Population in private families 17308 43508 Rooms occupied 10066 29706 2. Basement rooms (approximate).* (a) No. of basements used for dwelling purposes 10250 (b) No. of basement dwellings with ceilings at or below street level 533 (c) No. of basement dwellings in which the width of the area in street does not exceed 3 feet 6979 (d) No. of basement dwellings in which the width of the area in street does not exceed 4 feet 1393 * N.B.- -Return made without an internal inspection of the basements. 113 3. Houses, on which Closing Orders* have been made by the Borough Council under section 17 of the Housing, Town Planning, etc., Act, 1907 (since that Act came into force on December 3rd, 1909, and up to the time of the passing of the New Housing Act on April 9th, 1925, and its coming into force on July 1st, 1925):— Years. Address. Remarks. 1909-10 Nil — 1911 Oct. 26th Gilham's Cottages, New Park Road (Nos. 3, 4, 5, 6) Demolished Oct. 26th Bird Place, Monkton Street( Nos. 4,5,6) Nos. 4, & 6, demolished, and No. 5, reconditioned (and known now as 30, St. Mary's Square). Nov. 9th Cox's Buildings, Belvedere Road (Nos. 1 to 12 consecutive) Demolished. Nov. 9th Wood Street West Norwood (Nos. 21, 23. 25, 27, 29, 31, 33. 35) Reconditioned. 1912 Jan. 18th Corsham Place, Lower Marsh (Nos. 1 to 11 consecutive) Demolished. Feb. 29th Lemon Place, Albert Embankment (Nos. 1 to 8 consecutive) Demolished. Feb. 29th Beet Court, Albert Embankment (No. 1) Demolished. Mar. 14th Gunnall's Cottages, Salamanca St (Nos. 1, 2, 3, 4) Demolished. Sept. 19th Grindal Street, Lower Marsh (Nos. 23,25,27,29,31,33,35) Demolished. Sept. 19th Johanna Street, Lower Marsh (Nos. 4, 6, 8 Reconditioned. (Owner—L.C.C.). Sept. 19 th Dunmow Place, Newburn Street (No 1) Reconditioned. Sept 19 th Salamanca Court (Nos. 1, 2, 3, 11, 12, 13, 14) Demolished. Nov. 21 st Warham Street (No. 186) Demolished. 1913 May 29th Wigton Place, Milverton Street Nos. 1, 2, 3, 4, 5, 6, 7, 8) No. 1 reconditioned and now occupied as a dwelling-house and workshop, and Nos. 2, 3, 4. 5, 6, 7, 8, closed as occupied dwellinghouses and now used onlyasbusiness premises (stores, &c). * N.B.—No single Demolition Order was made under the Act, the work of demolition being in every case voluntary. H 114 Years. Address. Remarks. July 10th Albert Square Mews (No. 19) . Closed as occupied dwelling-house and used only for business purposes (store, &c.). Nov. 27th Wickham Street (No. 1, 3, 5, 7, 14, 16, 63, 67, 69, 113, 115, 117, 119, 121, 123) Nos. 1, 3, 5, 7, 14, 16, 63,67, 69, reconditioned and Nos, 113, 115,117, 119,121,123, demolished. 1914 June 18 th Stockwell Road (No. 99) Demolished. Nov. 26th Newburn Street (Nos. 44,46.50) Demolished. Nov. 26th Orsett Street (Nos. 42, 44, 46) Demolished. 1915-1918 Nil War period. 1919 June 26th James Place (Nos. 2,3,4,5,6,7,8) Nos. 3, 5, 6 closed but Nos. 2, 4, 7, 8, still in occupation as dwelling houses (not reconditioned. June 26th Hammond Place, Cornwall Road (Nos. 1, 2, 3, 4) Demolished. June 26th Albert Embankment (No. 26) Reconditioned. June 26th Shankhn Court, Albert Embankment (Nos. 10 and 12) Still in Occupation as dwelling house (not reconditioned). June 26th Bird Place, Monkton St. (No. 2,3) Demolished. June 26th Exam place. Monkton St. (No. 4) Demolished. June 26th Trowes Place, Mockton St. (Nos. 4, 5, 6) Nos. 4 and 5 still in occupation as dwelling houses (not reconditioned) but No. 6 demolished. June 26th Bywell Place, Monkton Street (Nos. 2, 5) Demolished. June 26th Monkton, Street (Nos. 42, 55) Demolished. June 26th St. Albans Buildings, Kennington (Nos. 16, 25 Reconditioned. June 26th Neville Street (Nos. 20, 26) Reconditioned. June 26th Little Spring Place, Willcox Road (Nos. 1, 2, 3, 4) No. 2 closed and Nos. 1, 3, 4 still in occupation as dwelling houses (not reconditioned). 1920 Jan. 15 th Hackford Road (Nos. 29, 31, 33) N.B. Closing Order on No. 33, Hackford Road, was not served Nos 29, 31 closed but No. 33 still in occupation as a dwelling house (not reconditioned). Jan. 15 th Neville Street (Nos. 18, 22, 24) Reconditioned. June 17th Monkton Street (Nos. 35, 37, 49, 51, 57, 46, 48) Demolished. June 17th Bywell Place, Monkton Street, (Nos. 1, 2, 3, 4, 6) Demolished. N.B.—Closing Order on No. 2, Bywell Place already served (see above June 26th, 1919). 1921-1925 Nil Post-War Period. 115 APPENDIX II. FOOD POISONING. (a) On November 20th, 1924, information was received that Alice H. (37 years of age), of Peabody Square, Blackfriars Road, Southwark, had died the previous day at the Southwark Hospital from food poisoning, and it was alleged that the cause of death was due to crab, which had been eaten by the deceased seven days previously, the crab having been obtained (so it was stated) from a well-known Oyster Bar in Waterloo Road, Lambeth. Enquiries shewed that the Oyster Bar was well conducted, and kept, at all times, in a sanitary condition. The trade from this Bar is considerable, but no other suspicious case of food poisoning was reported amongst the customers, who number hundreds, in fact thousands, a week. Officially, it was decided from the evidence, and after making special investigations, that the particular Oyster Bar in Waterloo Road, and the suspected crab, were not to blame. The result of the bacteriological examination of the body of the deceased, made by Dr. Creed, of King's College Hospital, (as reported at the Coroner's inquest), was as follows:— "Samples were taken from the peritoneal exudate, the gastric contents, contents of the small intestine, blood from the spleen, blood from the heart and contents of the large intestine; various bacterial culture media were inoculated with these materials, and then incubated under aerobic and under anaerobic conditions; whilst special methods were adopted to determine whether any sporing bacteria were present. In some cases, inoculations were made into animals. The result of the cultures was that no sporing bacteria and no significant anaerobic bacteria were isolated from any of the above-mentioned materials, and there is no reason for supposing that the death was due to the baccilus botulimis. Neither the bacillus Enterilides Gaërlneri nor the bacillus Aërtrycke was isolated. The bacillus coli and the bacillus proteus were isolated from all the materials mentioned above, with the exception of the blood from the heart, which was found only to contain the bacillus proteus. The strain of the bacillus proteus that was isolated proved to be exceptionally virulent to the guinea pig and to the mouse." In view of the bacteriological findings and the other evidence, the Coroner's verdict was as follows;—" Acute peritonitis following gastroenteritis caused by infection of the bacillus proteus, but how such bacillus proteus gained access to the deceased, there is not sufficient evidence to shew. Death from natural causes." Clearly, a sporadic case. There is considerable difference of opinion as to the bacillus proteus being a cause of death, even when found in the body of a deceased person. It is a bacillus that is ubiquitous in all dead 116 matter, and may, therefore, be the result, and not the cause, of death. A definite expert opinion from the Ministry of Health on the subject is needed. (NIB.—The above report on a suspected case of food poisoning should have been included in the 1924 Annual Report of the Medical Officer of Health, but was not so included pending further investigations). (b) Outbreak of Food Poisoning in South Lambeth. The Medical Officer of Health's attention was drawn to three cases of illness in a house in South Lambeth, which appeared to be caused, in the opinion of the medical practitioner in attendance, by infected food. The shop from which the suspected food had been obtained was visited, and enquiries made throughout the immediate district, with the result that 26 more cases of similar illnesses were discovered in connection with the persons who had partaken of the same consignment of food, making a total of 29 cases in all (as far as could be discovered). The history was gone into in connection with each individual case, and suspicion pointed to infected pork and beef—15 patients having partaken of beef, 2 of pork, and 3 of both beef and pork. Of the 29 persons affected, 26 were adults over 15 years of age, and 3 were children under 15 years of age (4, 6, and 11 years respectively). The 29 infected persons lived at 10 separate houses in the neighbourhood. The cases occurred during May, 1925. On inspecting the shop from which the pork and beef had been purchased, it was found that the business was that of a retail butcher, who also, for the convenience of some of his customers, is accustomed to boil, on his premises, joints of salted beef and joints of salted pork, which are afterwards boned and trimmed and pressed between layers of gelatine, selling the same in small portions across the counter. The illnesses have been traced by evidence to boiled pressed salt pork and beef prepared on the 13th May, 1925, and it is found that, whilst the shop, as a retail butcher's, leaves nothing to be desired in the way it is conducted, the conditions under which the boiling, trimming, and pressing of the salt beef and pork take place were, at the time of inspection, found to be unsatisfactory, the boiling being carried out in a portable copper in a small yard at the rear of the premises in close proximity to a w.c., to a large and fixed dirty dust receptacle or ashpit, and to two large fat and trimmings and other refuse cupboards, equally dirty, which have been built in the yard and are constructed of brick, with wooden doors, open at the tops and bottoms. Large numbers of flies (chiefly of the bluebottle type) were noticed to be passing freely from the insides of the cupboards to the dust receptacle or ashpit, and from the dust receptacle or ashpit to the insides of the cupboards, as was to be expected, having regard to the fact that such cupboards contained trimmings of fat and meat waiting for removal by the 17 tractor and more or less tainted, whilst the dust receptacle or ashpit was full of the usual household and shop refuse. The distances for the flies to travel were only six feet. After salting the beef and pork joints in the brine tubs, which are kept in the basement (cellar), the boiling is carried out in the yard, in a portable copper, and, after boiling, the portions of the joints are pressed between layers of gelatine and are allowed to cool on a movable table in the yard—the joints being cut up before being boiled, and afterwards boned and trimmed before being pressed. The flies have free access to the meat during these boning, trimming, pressing and cooling operations, and, no doubt, take full advantage of their opportunities. The fiies were proved, on bacteriological examination, to be actual "carriers" of the same kinds of germs as were found on and in the pressed meats as sold. There was no reason, from the evidence available, to suspect that the two attendants, who are employed in the actual boiling and the pressing, are human "carriers," but there is every reason for suspecting that the bluebottles were "carriers" of germs that caused the attacks of food poisoning, carrying such germs from the dust receptacle or ashpit or from the two large fat and trimmings and other refuse cup. boarus directly to the cooked meat after it had been cooked and during the process of pressing between gelatine layers and cooling. There is no evidence pointing to the raw meat, with which the shop chiefly deals as a retail butcher's, being contaminated. The bacteriological examinations of the samples of the portions of the cold salted beef and pork prepared on the 13th May, 1925, which were obtained not only at the shop (the remains of the suspected joints), but also at one or two of the infected houses, show such samples to have been grossly contaminated with ordinary bacteria (perhaps foecal in origin) and with the bacillus proteus, though the specific causative germ or germs of food poisoning (the Gaërtner or Salmonella group of bacteria) were not traced. The bacteria discovered were sufficient to account for the illnesses, which occurred, and the causative germs were probably crowded out and hidden by the many other bacteria which were actually found. An interesting point in the investigations is the fact that a dog (a puppy), to which a portion of the cooked salted pork was given, was also attacked with symptoms which were the same as those of the human beings attacked. These symptoms consisted of acute gastric and intestinal disturbances, with vomiting, diarrhoea, cramps in the abdomen and elsewhere, fever, together with extreme prostration and a tendency to heart failure and collapse. These symptoms took place in each case within three or four hours of the infected meats being consumed, and the incidence of the disease upon the consumers of the 118 infected meats was very great—only 4 persons, who partook of the infected meats, escaping infection out of a total of 28 who have been traced and proved to have actually partaken of the beef or pork or both. No herpes or other skin eruptions were noticed. The unsatisfactory arrangements which were found to exist in connection with the process of preparation of the cooked meats have been altered, and the two fat and trimmings and other refuse cupboards, and the fixed dust receptacle or ashpit have been done away with, and other more sanitary appliances substituted; whilst other precautions are also being taken in the way of carrying on the cooking and pressing of meats under proper cleanly conditions which will prevent any future outbreak of food poisoning due to contamination such as is described in this report. There can be but little doubt that the poison in this outbreak was exaggerated and became more virulent by virtue of the recent spell of abnormally hot weather, with the result that (as already stated) 29 persons out of a total of 33, who actually partook of the poisoned food, were effected—the large proportion of 87.9 per cent. of the cases actually traced. Fortunately, no death has been reported. The layers of gelatine were a most suitable breeding ground, or nidus, for the germs found. The great lesson to be learned from the outbreak is the need for scrupulous cleanliness being enforced in connection with all trades dealing with foods prepared for human consumption, and the great value of bacteriological examination in investigating food poison outbreaks. The Report of the outbreak emphasises also two methods of enquiry that should be available in all such investgations and that are dependent upon (1) Circumstantial evidence ; (2) Bacteriological and serological investigations. (1) Ciriumsiantial evidence. This evidence was very definite, all pointing to a distinct source of infection on one special date, and in connection with one special cooking and preparation of joints of salted beef and pork on May 13th, 1925. The particular shop involved was old-established, and for many years past had cooked and prepared salted beef and pork, and sold the same to hundreds and thousands of customers without a single instance of food poisoning in connection therewith having been officially reported, although the actual conditions under which the salting, cooking, and preparations of the beef and pork were carried out were, as far as the neighbouring w.c., dust receptacle or ashpit and fat and other refuse cupboards were concerned, in every way identical with those of previous years, with the sole exception of the abnormally 119 hot weather and high shade temperature that existed at the particular time (May). These facts show that meat, infected with the bacillus coli group from putrefaction and fermentation, may, on the one hand, be consumed with apparent impunity for many years, but, on the other hand, may cause a " flare up " on the accidental introduction of a food poisoning germ or germs, or an alteration in virulence of the bacillus coli exactly in the same way that polluted water (polluted with fcecal matter) may be partaken of for many years with apparent impunity until accidentally contaminated with the typhoid or cholera or other specific germ, or an alteration in virulence of the bacillus coli, which is generally associated with fcecal pollution (putrefaction and fermentation). A total of 29 victims were traced as the result of house enquiries in the neighbourhood, and the symptoms reported were in all cases the same, exactly the same, as also the incubation periods (3-4 hours after consuming the suspected beef and pork). These facts narrow the enquiry down to a specific date—viz., the 13th May, 1925—when something untoward must have happened and a virulent poison have been introduced into the cooked beef and pork that was sold on the following days (the 14th to 16th May), but that had been cooked and prepared on the 13th May, 1925. On circumstantial evidence, the particlar joints of salted beef and pork (cooked and prepared on the 13th May, 1925) were definitely found guilty of poisoning 29 persons in Lambeth—26 adults and 3 children under 15 years of age (4, 6, and 11 years respectively), and the virulence of the poison was shown by the fact that only 4 persons escaped out of a total of 33 who were traced as having actually partaken of the suspected foods. (2) Bacteriological and Serological Investigations. The bacteriological investigations proved interesting, but were not conculusive in discovering the well-known specific germs of food poisoning—-the Gaertner or Salmonella group of bacteria. The inability to discover these well known specific germs does not prove that such germs did not exist in the meat. It may be that they were crowded out by other commoner germs, which were actually found in the beef and pork in large quantities —viz., the bacillus Coli group and the bacillus Proteus. Serological (agglutination) tests of victims' blood proved positive in re-action (macroscopic) in dilutions of 1 in 25, and 1 in 50, both to the bacillus Coli and also to the bacillus Proteus. The former result was somewhat unexpected, and certainly uncommon. It is difficult to understand how the bacillu Coli group (or its toxin) could have gained access into the victims' blood as a poison (with consequent serious acute symptoms of food poisoning and subsequent formations within the victims' blood of agglutinins or anti-bodies) unless the intestinal tracts of the affected persons were abnormal, permitting of the passage of the bacillus Coli group (or its toxin) 120 through the mucosa, a condition that rarely, if ever, occurs in the case of a mucosa that is intact and healthy. It may have been that, on account of the exceptionally hot weather at the time of the outbreak (the 13th to the 16th May, 1925), the abnormal growth of the bacillus Coli group in the layers of gelatine, which were placed between the layers of beef and pork during the process of pressing (after salting and cooking) caused such bacilli to take on virulence and to alter their morphology), as appears to be the explanation also in the case of summer or epidemic diarrhoea—a sort of mass infection with altered virulence during hot weather. In the case of the bacillus Proteus that was isolated, the matter is different. This is a germ that has occasionally been found to be present in cases of food poisoning, which have, consequently, been ascribed to such cause, though, in most of the instances, there has been a difference of opinion amongst the bacteriologists concerned. The conclusions to be drawn from the circumstantial evidence, and from the bacteriological and serological investgations, in connection with the outbreak of food poisoning under investgation, are that such outbreak was due to (1) the bacillus Proteus : or (2) one or other of the well-known specific food-poisoning germs which are included in the Gaërtner or Salmonella groups— crowded out by the bacillus Coli and the bacillus Proteus, so as to prevent the Gaertner or Salmonella well-known specific germs being isolated by the usual bacteriological methods of investigation and technique; or (3) the bacillus Coli group—mass infection and altered virulence, due to the exceptionally hot weather and the probable action of such hot weather on the layers of gelatine which were used in preparing the pressed salted beef and pork (layers of gelatine being placed between the layers of meat), and which were inoculated with the bacillus Coli and other germs. The bacillus Coli and the bacillus Proteus were actually isolated from the beef and pork, which were under suspicion, whilst serological re-actions with some of the victims' bloods were positive macroscopically (in dilutions of 1 in 25 and 1 in 50) to strains of the same two bacilli. Unfortunately sufficient blood serum from the victims was not available to allow systematic serological investigations to be conducted with strains of the different well-known specific Gaertner or Salmonella groups of bacilli of food poisoning. The circumstantial evidence is complete: the bacteriological evidence is incomplete, but suggestive. 121 Whatever was the real nature of the poison that suddenly infected the beef and pork with such virulence, the medium by which such poison gained entrance into the meat was definitely proved to be flies, which were caught and were themselves also submitted to bacteriological examination, with the result that the same germs were found on the suckers, legs and wings as were found (1) in the actual beef and pork that caused the outbreak, and (2) in the coated dirty deposits of putrefactive and fermenting materials (fat, vegetables, meat, etc.), on the insides and outsides of the refuse cupboards and the fixed dustbin, or ashpit, which were situated in a small yard at the rear of the shop. The flies also showed, in addition, on bacteriological examination, the presence of the bacillus staphylococcus citreus on their bodies (suckers, legs or wings). (c) During October, 1925, a death occurred from suspected poisoning from the consumption of sausage, which was reported upon bacteriologically as follows:— Different portions of sausage were macerated in nutrient broth and cultured for 24 hours. Subcultures from these tubes were then made on plates of McConkey's neutral lactose agar One or two colourless colonies were obtained, and these were picked off and sub-cultured. The sub-cultures consisted of gram negative motile bacilli, and sugar fermentations were then done with glucose, nannite and lactose McConkey's media. The former two produced acid and gas, but not the lactose. So far the organism resembled Bacillus paratyphosus B, bacillus enteritidis of Gaertner on Aertrycke, but agglutinations performed with the standard sera of the above organisms proved negative. In view of the close resemblance to these very pathogenic members, but a typical behaviour of the organism in litmus milk tubes it was then deemed necessary to feed mice and guinea pigs on the organism. None of these animals died as a result of this, though one mouse had slight diarrhoea, from which it recovered. As animals of this order are very susceptible to this group of food poisoning organism, it was clear that the organism in question had no direct bearing on the woman's death. No other pathogenic organism was found in the material, and the one isolated can hardly be deemed to be pathogenic. It would be best described as a non-lactose fermenting-variant of Bacillus Coli, but this classification is used to embrace a number of organisms that are of doubtful significance and somewhat unusual behaviour. Hadden, Best & Co., Ltd., Printers, 5, West Harding St., London, E.C.