LAM 20 REPORT on the Vital and Sanitary Statistics of the BOROUGH OF LAMBETH During the Year. 1926. 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 Depot 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 Lnspectors 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. (1) PUBLIC HEALTH COMMITTEE and (2) MATERNITY and CHILD WELFARE COMMITTEE (appointed by the Council on November 9th, 1926.) PUBLIC HEALTH COMMITTEE. His Worship the Mayor (Mr. Councillor R. S. Pearson, j.p., m.r.c.s., l.r.c.p. d.p.h.) ex-officio. Aldermen : Mr. Alderman J. F. Evans. ,, ,, E. Rice, 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. Mallinson, m.a. F. W. Mills. ,, ,, 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 W elfare Centres of the Borough (included in the Lambeth Maternity and Child Welfare Scheme):— Miss L. Agelasto, 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, 1 926. * Medical Officer of Health : Joseph Priestley, b.a., m.d., d.p.h. Public Analyst (part time) : A. H. Mitchell, Muter, f.i.c., f.c.s. *Inspectorial Staff: (1) Special Sanitary Inspectors : (a) Food (including Sale of Food and Drugs Acts administration : W. J. PKRR1N+ and A. B. Cruttrnden,* (b) Housing : W.W. Howes and W. Wallis. (2) District Sanitary Inspectors: J. Barfoot. J. S. Clements. A. Farran. Benj. Goon.† F. J. heffield.† T. H. Hooper. C. W. Idle † T. H. Jackson. W. J. Lawrence. J. M. Scorrer. J. S. Smith. G. T. Taverner. N.B.—John Smith† was appointed Sanitary Inspector on April 22nd, 1926, vice A. Farran, deceased (March 4th, 1926). (3) Female Sanitary Inspectors : Miss F. M. Dawson. Miss. A. G. Simpson‡ N.B.—Miss T. McHugh (Nurse Robb), was appointed Sanitary Inspector on March 4th, 1926, vice Miss Dawson, resigned on the ground of ill-health (January 21st. 1926). (4) Health Visitors (Child Welfare) : Miss L. Hoskin.§ Miss T. McHugh.§ Miss K. A. Roe.§§ Miss A, Stirk. N.B.—Miss E. White (Health Visitors Diploma) was appointed Health Visitor on June 10th, 1926, vice Miss T. McHugh promoted to an appointment as Sanitary Inspector (March 4th, 1926). Miss L. Auger§§ was appointed Health Visitor on May 25th, 1926, vice Miss K. A. Roe, resigned (May 10th, 1926). Miss N. Jacobs§§, was appointed temporarily Health Visitor on November 5th, 1926, vice Miss A. Stirk (incapacitated from ill-health). * 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. Hebert. Assistant Tuberculosis Officer (visiting) : Dr. A. J. G. McLaughlin. Lady Almoner's Department : Municipal Milk Dep6t, Lambeth Alaternity Home, Manageress : Miss V. Berkeley. Matron : Miss D, Newbkrry. Disinfecting Department, Mortuary Keepers: Superintendent : W. Lockyear. (a) High Street Mortuary : R. Harriss. (b) Wan less Road Mortuary: J. Fazey. (succeded by H. Fazey from Oct., 14th 1926.) 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 Certificate. ‡ Central Midwives Board Certificate and the Health Visitor's Diploma. § Sanitary Inspector's Certificate. §§ Sanitary Inspector's Certificate and Health Visitor's Diploma. §§§ L.G.B. (Scotland) Tuberculosis Certificate. §§§§ Central Midwives Board, Health Visitor's and School Nurses' Certificates. a 9. 4 Public Health Department, Lambeth Town Hall, Brixton Hill, S.W. 2 March, 1927.. To the Mayor, Aldermen and Councillors o] the Metropolitan Borough of Lambeth. Mr. Mayor, Ladies and Gentlemen, Once again it is my privilege to be able to report most satisfactory statistics (vital and mortal) for the Borough for the year 1926, 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 Borough of Lambeth population for (926 (middle of the year) is 311,000, 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 again 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 30 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 that 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 Dep6t have all contributed to this satisfactory result. Tuberculosis is gradually, though slowly, declining, whilst typhoid or " enteric" fever is, practically, a disease of the past, as is also typhus fever. The infantile and child mortalities, are the lowest ever recorded in the Annals of the Borough or of the late Parish. 5 The records for 1926, are well-worthy of being set out in tabular form for future reference, comparison being made with the records of a quarter of a century ago (1901), the first year of the existence of the new Borough of Lambeth :— Death-Rate. 1926 1901 Estimated number of deaths saved in 1926, as compared with 1901 with percentage decreases. No. of Deaths saved in 1926. per cent. decreases. General death-rate 1 1.49 17.17 1766 33.06 Zymotic death -rate 0.51 2.72 687 81.12 Measles death rate 0.22 0.39 52 42.97 Whooping Cough death-rate 0.06 0.38 99 83.89 Typhoid Fever death-rate 0.006 0.076 21 91.30 Diarrhoea death-rate 0 07 0.91 261 92.22 Scarlet Fever death rate 0.01 0.1 2 34 89.47 Diphtheria death-rate 0.13 0.16 9 17.30 Smallpox death-rate 0.00 0.01 3 75.00 Tuberculosis death-rates— (a) All forms 1.03 2.29 391 54-83 (6) Pulmonary or Phthisis or Consumption 0.84 1.63 2 45 48 .32 Infantile Mortality death-rate (under 1 year of age) 38.41 139.38 749 72.22 Child Mortality death-rate (between 1 and5 years of age) 10.6 22.8 229 53.5 The rates for the Inner and Outer Districts of the Borough, are as follows:— Inner Districts— General death-rate 12.7 20.9 999 64.49 Zymotic death-rate 0.8 3.1 280 73.87 Outer Districts— General death-rate 10.7 13.9 605 23.00 Zymotic death-rate 0.3 1.2 170 73.59 N.B.—All death-rates are corrected as to the actual numbers of deaths, and expressed in terms per thousand of the populations (estimated to the middles of the various years), with the exception of the infantile mortality rates, which are expressed in terms per thousand of the total uncorrected births registered. 6 An outstanding feature of the year (1926) is the final equipment and opening, on June 19th, for the use of the Lambeth Ratepayers and others residing within the Borough, of the Council's Maternity Home, at Millburn House. This Council's Maternity Home, for which the Council is now entirely responsible, financially, takes the place, and is the outcome, of the West Norwood Maternity Home, which was inaugurated and has been carried on, voluntarily, at 106108, Knight's Hill, for the past seven years, and which was intended, primarily, for the use of West Norwood Residents only. The new Home is a model Maternity Home, both as to position and equipment, and may be regarded as, practically, completing the Lambeth Maternity and Child Welfare Scheme. I have, again, to put on record the valuable work of the Male Sanitary Staffs (Special Housing and Food and District Sanitary Inspectors;, the Female Sanitary Inspectors and the Health Visitors, the staffs of the Central and Branch Tuberculosis Dispensaries, of the Milk Depot, and of the Disinfecting Department, and, last but not least, the Staff of the Clerical Department. After all, it is the officers (the Sanitary Inspectors, Health Visitors, &c.,) who carry out the work and to whom the credit is due. 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—assistance without which no medical officer could carry out his duties satisfactorily. The various voluntary Welfare Centres and their respective Committees have also rendered valuable help in infantile and child welfare work in connection with the Council's well-known Maternity and Child Welfare Scheme. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, JOSEPH PRIESTLEY, Medical Officer of Health ar.d Chief Executive Tuberculosis Officer. 7 page Introductory Letter 4-6 Vital Statistics 8-87 Estimated Populations, 1926 8-9 Births and Birth-rates 10-13 Notification of Births Act I3-14 Lambeth Maternity and Child Welfare Scheme 14-16 Lambeth Milk Assistance Scheme (Free or Aided Supplies) 17-18 Municipal Milk Depot and Infants Consultations Centre 18-20 Proposed appointment of Assistant Medical Officer for Maternity and Child Welfare 20-21 Deaths and Death-rates (General, Infantile and Zymotic) 21-34 Lambeth Nursing (Infectious Diseases) Scheme 45 Infectious Diseases 35-64 {a) Notifiable 35-6i (b) Non-Notifiable 62-64 (c) Tuberculosis Regulations 50-54 Lambeth Municipal Tuberculosis Dispensaries Scheme 54-59 (d) Polio-Myelitis (polio-encephalitis), Cerebrospinal Fever, Encephalitis Lethargica 60-61 Municipal Bacteriological Laboratory 65-71 Local Government Board, Old Tables A and B. 72—77 Local Government Board, New Tables I., II,, III., and IV 78-83 Mortality Tables (Corrected deaths— (a) Registration Sub-Districts (b) Age-Periods (c) Summary 84-86 Summary of Vital and Mortal Statistics, 1926 87 Sanitary Work 88-112 Notices served 88-90 (a) Infectious Diseases 88 (b) General Nuisances and Drainage Defects 88-90 Male Sanitary Inspectors (District Inspectors) 90-92 Registration of Cowhouses, Slaughterhouses, Common Lodging Houses and Milk Shops 92-93 Offensive Trades 94 Male Sanitary Inspectors (Food Inspectors) 90 Male Sanitary Inspectors (Housing Inspectors) 90 Female Sanitary Inspectors 94-95 Female Health Visitors 96 Factories and Workshops and Out-Workers 96-97 Housing Department 97-3 Disinfecting Department 104-106 Analysis of Food and Drugs and Water 107-108 Public Health (Milk and Cream) Regulations 108-109 Milk (Special Designations) Orders. 1922-23 109-111 Ice Cream Vendors 112 Mortuaries and Coroners' Courts 112 Public Health (Meat) Regulations, 1924 112 Rats and Mice (Destruction) Act, 1919 112 Appendices— I. Housing Conditions, 1926 (Ministry of Health Table) 113-115 II. Tuberculosis Statistics Addendum (1925) 115-123 III. An unusual case of insect infestation 123-124 8 1. VITAL STATISTICS. The Registrar-General estimates the population ot the Borough (up to the middle of 1926) at 311,000, and it is upon this figure that the death-rates and birth-rates are calculated throughout the Report, this estimated population being based on the adjusted 1921 figures, after allowance for the varying rate of natural increase as evidenced by the births and deaths in the Borough and of migration as indicated from other sources of information such as the changes in the numbers on the Parliamentary Register and the migration returns obtained by the Board of Trade. The various estimates to the middle of the year 1926 are as follow for the 12 Wards, the 5 Registration Sub-Districts and the 4 Parliamentary Divisions (the estimations having been made in the Registrar-General's Office):— Estimated Populations, 1926 (Middle of the Year.) 1. Wards. Wards. Males. Females. Total. 1. Marsh 7,120 6,670 13.790 2. Bishop's 13,480 i4,330 27,810 3. Prince's 13,380 i4,450 27,830 4. Vauxhall 15.290 16,240 31,530 5. Oval 12,410 13,740 26,150 6. Vassal 8,440 9,670 18,110 7. Angell 13,760 16,700 30,460 8. Stockwell 15.360 18,620 33,98o 9. Town Hall 7,430 8,100 15,530 10. Heme Hill 7,480 8,490 i5,97o 11. Tulse Hill 15.070 18,730 33,8oo 12. Knight's Hill 16,100 19.940 36,040 Borough of Lambeth 145.320 165,680 311,000 9 II. Registration Sub-Districts. Sub-Districts. Males. Females. Total. 1. Lambeth Church 2 1,900 22,450 44,350 2. Kennington 21,450 23.,390 44,840 3. Stockwell 30,860 35.090 65.950 4. Brixton 39,210 46,300 85.510 5. Norwood 31,900 38,450 70.350 Borough of Lambeth I45.320 165,680 311,000 III. Parliamentary Divisions. * Adjusted Parliamentary Divisions. New Wards. Total. North Marsh 69.430 Bishop's Prince's Kennington Vauxhall 75.790 Oval Vassall Brixton Angell 79.970 Stockwell Town Hall Norwood Heme Hill 85,810 'Pulse Hill Knight's Hill Parliamentary Area of Lambeth 311,000 * By the adjustment of the 4 old Parliamentary Divisions so as to make them co terminous with the 12 new wards. 10 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, 1926 (atranged Quarterly). Registration Sub-Districts, No. of Births. Total for the Year 1926. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church* 589 556 541 591 2277 Kenningtonf 275 284 259 224 1042 StockwellJ 384 415 343 331 1473 Brixton§ 445 416 432 368 1661 Norwood 270 263 237 274 1044 Borough of Lambeth 1963 1934 1812 1788 7497 * Including General Lying-in Hospital (1,001 cases, of which 284 belong to Lambeth), † Including Workhouse (437 cases, of which 410 belong to Lambeth). ‡ Including Clapham Maternity Hospital (634 cases, of which 169 belong to Lambeth). § Including King's College Hospital (670 cases, of which 158 belong to Lambeth). 11 TABLE B. Showing Populations (Estimated), Uncorrected Registered Births, Corrected Deaths at all ages, under 1 year, under 5 years, and from the 7 chief Zymotic diseases and Uncorrected Deaths in Public Institutions, in the Borough of Lambeth, during 1926, and the averages for the quinquennium 1921 1925 (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. 1926 31 1000 7497 3575 288 265 160 2081 1925 311100 7663 3764 343 509 154 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 2243 Average 1921-25 (5 years) 308320 8266.2 3791 419.4 646.2 192.2 2151.6 Averages (10 years)— 1911 1920 (Borough) 286786.4 8027.1 4282.5 619.7 958.6 326.8 25065 190110 (Borough) 314566.8 8846.9 4709.6 10201 1503.5 475.1 1816.8 1891 1900 (Parish) 2940497 9295.4 5405.3 13585 2070.2 700.4 1568.5 Note, —(a) Enumerated Population at Census 1901 was 301,895. (A) Enumerated Population at Census 1911 was 298,058. (c) Enumerated population at Census 1921 was 302,868. (d) Families or separate occupiers = 70,887 (1901), 70,827 (1911) and 78,399 (1921). N.B.—In this and previous Reports, the estimated populations 1915, 1916, 1917, 1918, 1919, and 1920 are the estimates of civil populations only, and, for the same 6 years, the deaths do not include the deaths of members of the armed forces of Great Britain and other countries, all such deaths being excluded from the Registrar-General's published local returns. 12 TABLE C. Showing the Birth Rate (estimated) per 1,000 estimated population, the General and Zymotic Death Rates (corrected) per 1,000 estimated population, the Infantile Mortality Kates (corrected) per 1,000 total Births (uncorrected) 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 1926 and the averages for the quinquennium 1921-1925 (Borough), together with the averages for the three decennia 1891-1900 (Parish), and 1901-10 (Borough) and 1911-1920 (Borough). The Year. Birth-Rate per 1,000 Population (uncorrected.) Death-Rate per 1,000 Population (corrected). Corrected Deaths of Children under I year per 1.000 total Births. Deaths of Children under 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,ooo total Deaths (uncorrected). 1926 24.1 11.5 38.4 80.5 136.2 0.5 535.5 1925 24.6 12.1 44.8 91.1 135.2 0.5 539.3 1924 25.5 12.5 50.05 102.2 164.3 0.6 515.0 1923 27.04 11.3 42.7 102.5 156.5 0.4 516.1 1922 27.5 13.6 58.7 118.4 205.1 0.8 483.0 1921 29.4 11.9 56.3 138.4 189.5 0.7 534.7 Average 1921.25 (5 years) 26.8 12.3 50.5 110.5 170.1 0.6 517.6 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 and previous Reports, the birth Rate is calculated upon the special Borough populations estimated respectively for that purpose by the Registrar.General for the years 1916, 1917, 1918, 1919, 1920, viz., 308,702, 303,245, 293,869, 294,097, and 294,303. These populations are the civil populations plus all non.civilians enlisted from this country, whether serving at home or abroad, this non-civilian element being distributed over all the districts in the country in proportion to their estimated civilian population. 13 BIRTHS. 1926. The total number of Births registered (during the 52 weeks ended 31st December, 1926) is 7,497, of which details are set out in Table A, showing a birth-rate (un-corrected) of 24.1 per 1,000 of the estimated 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 to London, nor even to England, but to be found in nearly all civilised countries. There was a natural somewhat large postwar temporary increase in the number of births registered (and notified) during 1920, viz.: 35.5 per 1,000 of the estimated population. Since then, this temporary increase has again become practically normal (approaching the average): indeed, the figures for 1926 are subnormal (or below the averages). 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 5,359:— Total registered. Inward transfers. Outward transfers. Corrected numbers. Legitimate Males 3,542 110 1,099 2,553 Legitimate Females 3,479 135 1,130 2,484 Illegitimate Males 238 19 109 148 Illegitimate Females 238 22 86 174 Totals 7,497 286 2,424 5,359 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 137,086 births have been notified up to the end of 1926, 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 1923, 7,782 in 1924, 7,734 in 1925, and 7,481 in 1926. 14 All Lambeth notified births are referred to the various voluntary Welfare Centres which are now comprised in the Lambeth Maternity and Child Welfare Scheme (approved by the Ministry of Health), and, in connection therewith, are visited and re-visited systematically, the mothers attending at such Centres, if and when they wish, or can be persuaded, to do so. It is impossible to give statistics of the educational value of this visiting of houses wherein births have been notified, but there is no doubt as to the existence of such educational 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, which are born in Lambeth Public Institutions but which belong (for classification purposes) to Districts outside the Borough. Of the total 7,481 notified births, 4,111 took place in Institutions, and, of these 4,111 births, 1,759 belong to Lambeth and 2,352 to out side districts, thus :— Institutions.* Lambeth Cases. Strangers. Totals. General Lying-in Hospital 276 717 993 St. Thomas' Hospital 237 427 664 Lambeth Workhouse 288 29 31 7 Clapham Maternity Hospital 205 451 656 King's College Hospital 177 516 693 West Norwood Maternity Home 312 12 324 Other Nursing Homes (private) 264 200 464 Totals 1759 2352 411 1 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 voluntary welfare centre committee, as follows :— 1. North Marsh, Cornwall Road, New Cut.† 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. 15 3- Holy Trinity Institute, Royal Street.* 4. Babies' Care, 121, Kennington Road. 5. Moffatt Institute, 2, Esher Street, Upper Kennington Lane. 6. St. Anne's, 44-46, Harleyford Road, Vauxhall. 7. The Springfield, 48, Lansdowne Road, Vauxhall. 8. Stockwell, St. Andrew's Institute, 57, Stockwell Road. 9. North Brixton, (Belgrave Hospital), 212, Camberwell New Road. 10. Loughborough Junction, the Sussex Arms, 109, Sussex Road.† 11. Brixton, the Dispensary, 19, Water Lane, Brixton Hill. 12. West Norwood, Hannen House, 12, Hannen Road, Knight's Hill, West Norwood. Comprised in the Scheme are also the following Institutions, dealing with maternity and child welfare — 1. Creches or Day Nurseries. (a) St. Thomas's Hospital Day Nursery, 83, Lambeth Palace Road. ‡ (b) Pilgrim Hill Creche, Pilgrim Hill, West Norwood.§ 2. Infants' Clinics. (a) Mrs. Anstruther's Clinic, 53, Ethelred Street.§ 3. Maternity Homes. (a) West Norwood Maternity Home, 106-108, Knight's Hill, West Norwood — removed in 1926 to 210, Knight's Hill (Millburn House), which was purchased for the purpose by the Council, and is now 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 as part of the newlyamalgamated Centre. † 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. § Have not yet been given grants by the Borough Council (no applications having been received). 16 (1) The Maternity Department of St. Thomas's pital (Westminster Bridge). (2) The General Lying-in Hospital out-patients clinic (York Road). (3) The Clapham Maternity Hospital out-patients clinic (Jeffreys Road).* N.B.—In connection with (1) and (2), Infants' Consultations Centres have been established at the Hospitals concerned for their own particular mothers and their babies, which have been born in, or in connection with, such Hospitals. These Infants' Consultations Centres rank as Welfare Centres for grants directly under the Scheme, both from the Ministry of Health and from the Borough Council, none from the latter, however, 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, forms an important part of the Scheme, and ranks for Government grants under such Scheme under certain conditions. At the Council's Maternity Home, during 1926 (calendar year), 324 mothers were confined at the Home (15 by doctors and 309 by midwives), whilst, in addition, 33 mothers were confined within the district by midwives connected with the Home. No case of puerperal fever and no cases of ophthalmia neonatorum were officially notified, but medical assistance was sought by the midwives concerned in 36 cases (at the Home 34, on the District 2). Financial Grants in Connection with the Maternity and Child Welfare Scheme. The principle of making financial grants to the various voluntary Welfare Centres, out of the Borough rates, which was adopted by the Council in 1917, is still being carried out, and grants have been made, as approved, during the year 1926—the Borough Council grants * Has not yet been given grants by the Borough Council (no application having been received). † Outdoor district confinements were discor. tinned in connection with the Maternity Home on 29th September, 1926. 17 being dependent automatically on the Ministry of Health grants and being 75 per cent. of such Government grants. In the case of the Council's Maternity Home the Council pays the total expenses in the first instance, and the Ministry of Health repays to the Council up to 50 per cent. of such expenses (if approved). 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, which are better suitable for administrative purposes, or enlargement of existing centres' premises subject to such newlystarted or new or enlarged premises 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 1926, are satisfactory, and include a large number of visits and re-visits paid by Health Visitors and are specially noteworthy as showing what can be 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 especially 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 suitable voluntary workers 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 maximum 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 mote than justified itself by the results that have been actually obtained in welfare work (as shewn by statistics). 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 alleged ground of national economy. It is doubtful if that is the sort of economy that will pay the Nation. The Old Milk Orders and the unrestricted Milk Assistance Scheme had proved, beyond doubt, since 1918, the B 18 great value of milk as an accessory food lor 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). Administratively, the Scheme is acting satisfactorily (restricted, however, by the Ministry of Health's new income-scales). (No. 1), 1918. The figures are as follow :— Years. (Financial) Cost of Milk distributed Total Cost. Total amount of Milk distributed in gallons (approximately)* Through Welfare Centres. Through Milk Depot.* 1918-19 232 15 3 69 4 3 301 19 6 3,151 (3 m'ths.) 34,827 1919-20 2,780 0 10 557 10 1 3,337 10 11 1920-21 13.836 7 3 I,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 3,380 15 11 353 15 3 3.734 11 2 38,969 192425 2,977 19 8 137 17 7 3,115 17 3 31,543 1925-26 2,161 6 3 105 12 8 2,266 18 11 32,846 1926- 1,621 17 6 142 8 9 1,764 6 3 24,081 (9 m'ths.) Totals £35,141 6 5 £5.167 15 11 £40,309 2 4 434,438 gallons. Municipal Milk Depot and Infants Consultations Centre. (.Municipal Milk Depot, inaugurated by the Council 11)03 ) Record of Work carried out during 1926. 104 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 15 3-6 months 29 Over 12 months and 6-9 months 13 under 2 years 16 Total 104 * N.B.—See also the figures for the Milk Depot, dealing with milk supplied to all cases (necessitous and non-necessitous), representing for the 8 years 1918-1926 a net expenditure of £2,412 14s. 8d. (total expenditure £ 13,701 1s. 11d. less receipts from mothers of £11,288 7s. 3d.). I he figures giving the cost ot 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, 1918, and the Local Authority (Food Control Order 19 Of the 31 infants under 3 months, 6 were aged 14 days or under. These 104 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, 58; weakly 29, wasting 3, diseased 14. The diseases from which the 14 infants and children were actually, or had recently been, suffering at the time of being put upon the milk were diarrhoea and sickness 3, scarlet fever 1, bronchitis 1, whooping cough 2, indigestion 4, erysipelas 1, and congenital malformation 2. An average of 94 infants and children (under 2 years) were fed per week at the Depot, necessitating the distribution for the year ot 91,351 bottles of milk mixture (5,142½ gallons), whilst, in addition, milk was also supplied as follows :— 1. Lambeth Hospital—using 8,118 bottles of milk mixture (1,014¾ gallons); 2. Nursing mothers—using 1,766 pint bottles of milk mixture (220¾ gallons); 3. Expectant mothers—using 59 pint bottles of milk mixture (7 gallons); 4. Children over 2 years of age—using 1,760 pint bottles of milk mixture (220 gallons). A total of 6,1574 gallons of milk and 316 pints of cream were used during 1926, distributed in 99,469 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, and those mothers and infants and children (under 5 years of age) who require medical advice are examined by the Medical Officer of Health, visiting at the homes being carried out by a Health Visitor, as required. The Manageress also attends daily (Sundays excepted) between the hours of 12 (noon) and 2 p.m. at the Depot for the purpose of 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 far as the infants and children fed are concerned, is to be found in the medical histories of individual cases, which show again and again, in the case of the Depot, that those infants and children who appear to be seriously ill and wasting, if not moribund, as the result of improper or irregular feeding, at the time of commencing the milk, actually recover and become strong and healthy. Practically no medicines are used, reliance being placed upon what is known as percentage feeding, b 2 20 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 dep6t must not be lost sight of. It is now over 20 years since the Municipal Milk Depot was first inaugurated (1903) and opened to the public ([906), 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. Proposed Appointment of Assistant Medical Officer of Health for Maternity and Child Welfare Purposes. The Lambeth Maternity and Child Welfare Scheme has grown by leaps and bounds, as shewn by the fact that there are now comprised in such Scheme fourteen Voluntary Centres, together with a Council Maternity Home and a Municipal Milk Depot. It is clear, therefore, that the efficiency of the work must suffer from lack of detailed coordination and personal supervision, which can only be effectively remedied by the appointment of a whole time Assistant Medical Officer of Health—preferably a lady Medical Officer, experienced in Maternity and Child Welfare work. Such an officer would be responsible for the detailed supervision of the Maternity and Child Welfare work in the Borough, under the direction of the Medical Officer of Health, who, by virtue of his many other duties, is quite unable, in practice,, to give such necessary detailed attention to what has now become a very large and important branch of the Borough's Public Health work. The Assistant Medical Officer of Health to be appointed should have complete control of the Council's new Maternity Home at 210, Knight's Hill, as Medical Officer thereto, and also of the various ante-natal clinics which are attached to the different Voluntary Welfare centres, so as to ensure uniformity and co-ordination of administration and treatment throughout the Borough—a most desirable objective from an official point of view. It might, even, be found practicable for the proposed Assistant Medical Officer of Health to act also as officiating Medical Officer of one or more of the antenatal clinics, thereby simplifying, considerably, the ante-maternity work of the Borough. This would depend, however, upon how her ordinary duties worked out in actual practice—ordinary duties of an advisory and supervisory nature over the whole of the existing Voluntary Welfare Centres, which are comprised, at the present time, within the Lambeth Maternity and Child Welfare Scheme. There can be no doubt as to the necessity for the appointment of an Assistant Medical Officer of Health to be responsible for all these detailed duties being adequately and efficiently carried out. Lambeth, of all districts, 21 with a Maternity and Child Welfare Scheme so well known and so complete, requires a responsible lady Assistant Medical Officer of Health in charge, acting directly under the Medical Officer of Health. Such an officer would have under her direct control all the officers (paid and unpaid) of the 14 various Voluntary Welfare Centres—a total of 16 Medical Officers, 11 Superintendents (or Secretaries) and 20 Health Visitors, in addition to the Council's four official Health Visitors and the Staff of the Council's Maternity Home The work of all these officers would be more valuable if co-ordinated and systematised under one responsible Assistant Medical Officer to be appointed by the Borough Council. This officer's salary would be refunded (up to 50 per cent.) out of the Exchequer grant DEATHS. 1926. The total number of deaths (uncorrected) registered is 3,886. All death rates for 1926 are calculated upon an estimated population of 311,000 (to the middle of the year). 1.—General Death-Rates. The uncorrected death-rate for Lambeth is 12.5 per 1,000 of the population. This rate is, however, uncorrected, and, on analysing the 3,886 total deaths registered, it is found that 944 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 633 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a net corrected number of deaths of 3,575, and a net corrected death-rate of 11.5 per 1,000 inhabitants. The Inner (congested and crowded) Districts show, as a whole, a general corrected death-rate of 127 as compared with 107 for the Outer (less congested and less crowded) Districts, per 1,000 of the population. Age Periods of Corrected Deaths. The 3,575 corrected deaths during 1926 may be further analysed and tabulated as follows:— 288, i.e., 8'05 per cent. of the total corrected deaths took place under 1 year of age. 199, i.e., 5 6 per cent. between 1 and 5 years. 487, i.e., 13*6 per cent under 5 years. 148, i.e., 4-1 per cent. between 5 and 20 years, 318, i.e., 8'9 per cent. 20 to 40 years. 809, i.e., 22-6 per cent. 40 to 60 years. 1,813, i.e., 50'7 Per cent. 60 and over. 3,088, i.e., 86-4 per cent. over 5 years. 22 TABLE D. Shewing the corrected number of Deaths, with corrected DeathSub-Districts of the Borough during 1926. The deaths are from all adding Lambethians who die outside the Borough, by omitting (who die in Public Institutions) amongst the Districts from which they A. Registration REGISTRATION SUB-DISTRICTS. Total Deaths (corrected). (General corrected Deathrate per 1000 of the Population. Small Pox. Measles, (including German Measles) Scarlet Fever. Lambeth Church 591 133 1 13 3 Kennington 591 13.2 — 11 — Stockwells 748 11.3 — 20 1 Brixton 957 11.2 — 9 — Norwood 688 9.8 — 16 — Borough of Lambeth 3575 11.5 1 69 4 * No death registered from membranous croup. † One death at an § Of the 748 deaths in Stockwell Registration Sub-District, 368 belong Inner Registration Sub-Districts—death rates Outer Registration Sub-Districts—death rates 23 TABLE D. rates (general, zymotic and diarrhceal), in each of the Regsitration causes, and from the 7 chief zymotic diseases, and are corrected by strangers who die within the Borough, and by re-distributing persons have been removed into such Public Institutions for treatment. Sub-Districts. Total Deaths (corrected) from Diphtheria and * Membranous Croup. Whooping Cough. Typhus. Typhoid or Enteric. Continued Fever. 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). 14 4 — — — 8 43 1.0 1.8 16 2 — 2 — — 5 36 0.8 1.1 3 4 — — — — 2 30 0.4 0.3 5 5 — — — — 3 22 0.2 0.3 5 4 — — — — 4 29 0.4 0.5 43 19 — 2 — — 22 160 0.5 0.7 Asylum outside the Borough (the patient being chargeable to Lambeth). to the Inner and 380 to the outer Stockwell Sub-District respectively, (general, 12.7, zymotic, 0.8, diarrhaeal, 0-l per 1,000 population), general, 10.7 zymotic, 0.3 diarrhoeal, 0.03, per 1000 population). 24 Changes in Registration ok 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 1926 from the RegistrarGeneral—a total of 60 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 1926 (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 1926 being as follows :— Age Periods. Males. Females. Totals. 0— 1 1— 2 1 4 5 2—5 5—15 3 1 4 15—25 2 2 4 25—45 9 3 12 45—65 9 9 18 65 and upwards 5 12 17 Total all ages 29 31 60 25 Causes of the 60 outside deaths. Causes of Death. Male Female. Whooping Cough — — Diphtheria — — Diarrhoea — — Influenza — — Phthisis (Pulmonary Tuberculosis) 8 1 Other Tubercular diseases — 1 Cancer, malignant disease — 1 Heart disease 4 6 Bronchitis — 1 Pneumonia 1 3 Broncho-Pneumonia — 1 Pleuro-Pneumonia — — Other Lung Diseases — — Nephritis and Bright's disease 1 1 Premature Birth — 2 1 Violent deaths 9 2 Suicide 1 — Nervous diseases — 4 Cirrhosis of Liver — 1 Diseases of Digestive System — — Diabetes — 1 Not classified above* 5 6 Totals 29 3i 2.—Infantile Mortality Rates. Of the 3,575 corrected deaths, 288 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 419.4 for the previous quinquennium 1921.25 (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 7,497 total registered uncorrected births during 1926 (52 weeks), and the 436 * Males—heart failure (1), mediastinal growth (1), intestinal obstruction (1), umbilical hernia (1), pernicious anosmia (1). Females—senile decay (1), heart failure (1), dentition (1), non-viable (1) chronic rheumatoid arthritis (1), purpura hoemorrhagica (1). 26 total uncorrected deaths of infants under I year of age, the infantile mortality rate is 58.15, as compared with annual average rates (uncorrected of 150 5, 123.8and 97.5 for the decennia 1891-1900 (Parish), 1901-10 (Borough) and 1911-20 ^Borough), and an annual average rate (uncorrected) of 69.8 for the previous quinquennium 1921-25 (Borough) : whereas, if the corrected deaths of infants under 1 year are used, viz.: 288, the infantile mortality rate is 38.4, 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 50.5 for the previous quinquennium 1921.25 (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 1921-25. In the Registration Sub.Districts, the uncorrected infantile mortality varies from 32.6 in Norwood to 85.5 in Brixton, thus : Registration Sub.Districts. Total No. of Births (uncorrected) 1926 Total Deaths under 1 year (uncorrected) 1926. Infantile Mortality per 1000 births (uncorrected) 1926. Lambeth Church 2277 137 60.2 Kennington 1042 66 63.3 Stockwell 1473 57 38.7 Brixton 1661 142 85.5 Norwood 1044 34 32.6 Lambeth 7.497 436 58.15 Inner Districts—57.2, Outer Districts—59 3. 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. 27 3.—Mortality Amongst Children under 5 Years of Age. The decline in the number of deaths of infants under I year of age is, again, remarkable, but that of children under 5 years of age is even more remarkable. Both sets of figures for the year 1926 are the lowest ever registered, or tabulated, in connection with either the Borough or the old Parish, and the following details are, consequently, worthy of permanent record : — 1.—Infantile Mortality (Deaths of In/ants under One Year of Age). 288 corrected deaths were registered during the year 1926 amongst infants under one year of age, as compared with the following average yearly numbers during the past quarter of a century (25 years), arranged quinquennially and decennially :— 5 years, 1921-1925 (Borough) 4194 10 years, 1911-1920 (Borough) 619.7 10 years, 1901.1910 (Borough) 1020.1 Average for 25 years, 1901-1925 = 686.4. The existing records, that are available, allow even a further comparison (beyond a quarter of a century ago) to be made, viz., for the decenniun 1891-1900, as follows:—10 years, 1891-1900 (Parish), 1,358.5 In other words, there has been during 1926 a drop of 58.1 per cent., as compared with the actual yearly average figures during the past 25 years, and a drop of 78.8 per cent., as compared with the average figures for 1891.1900 (Parish). Expressed in rates per 1,000 of the total births registered (uncorrected) for the same quinquennial and decennial periods, the results are as follows:— 1926, 38.4; 5 years, 1921.5 (Borough), 50.7; 10 years, 1911-1920 (Borough), 77.2; 10 years, 1901-1910 (Borough), 115.3 (average rate for the 25 years 1901-1925 = 81.0), and 10 years 1891. 1900 (Parish), 146.1, representing a drop of 53.1 per cent. in the rate for 1926, as compared with the average rates for the past 25 years, and a drop of 73.7 per cent. as compared with the average rate for 1891-1900 (Parish). These figures (in regard to infantile mortality) can only adequately be described as extraordinary, if not incredible, figures. 2.—Child Mortality {Deaths of Children between 1 and 5 Years of Age). 199 corrected deaths were registered during the year 1926 amongst children between 1 and 5 years of age, as compared with the following average yearly numbers during the past quarter of a century (25 years), arranged quinquennially and decennially :— 5 years, 1921-1925 (Borough) 226.8 10 years, 1911-1920 (Borough) 338.9 10 years, 1901-1910 (Borough) 483.4 Average for 25 years, 1901-1925 = 349.7. 28 The average yearly number for the Parish of Lambeth during the decennium 1891-1900 is 717.7. These figures represent decreases of 43.1 and 72.3 per cent. respectively when comparing 1926 with (a) the past 25 years, and (b) the 10 years 1891-1900 (Parish). Expressed in rates per 1000 of the estimated population of the particular age period (1.5 years), the results are as follows 1926, 10.6; 5 years, 1921-25 (Borough), 12.1; 10years, 1911-1920 (Borough), 16.5; 10 years, 1901-1910 (Borough), 20.4 (average rate for the 25 years, 1901-1925=16.3); and 10 years 1891-1900 (Parish), 27.9. representing respective decreases of 36.1 and 62.0 per cent. when comparing the rate for 1926 with the average rates for (a) the past 25 years, and (b) the years 1891-1900 (Parish). 3.— Total Infantile and Child Mortality (Deaths of Infants under one year of age and of Children between 1 and 5 years of age.) 487 total corrected deaths were registered during the year 1926 amongst infants under 1 year of age and children between 1 and 5 years of age, as compared with the following average yearly numbers during the past quarter of a century (25 years), arranged quinquennially and decennially :— 5 years, 1921-1925 (Borough) 646.2 10 years, 1911-1920 (Borough) 958.6 10 years, 1901-1910 (Borough) 1,503.s Average for 25 years, 1901-1925 = 1036.1. The average yearly number for the Parish of Lambeth during the decennium 1891-1900 is 2,070.2. There have been respective savings of 52.9 and 76.5 per cent. as between the 1926 figures and those for (a) the 25 years, 1901.-1925, and (b) the 10 years, 1891-1900 (Parish). From a statistical point of view it is not satisfactory to give the figures for the total infantile and child mortality based upon the average rates per 1,000 of the estimated population of the age.period under consideration (under 5 years) because the Registrar.General has laid down that rates calculated in connection with Infantile Mortality (deaths under one year of age) are to be calculated per 1,000 of the total numbers of registered births, whereas all other rates for all other age.periods are to be calculated per 1,000 of the estimated populations of such age.periods. The results, however, as a matter of fact, are practically the same, viz.:—respective drops of 50 per cent. and 70 per cent. as between the rates for 1926 and those for (a) the past 25 years, and (b) the years 1891.1900 (Parish). The figures (in regard to decreased general child mortality) are as startling as those relating to decreased infantile mortality. This was, however, to be expected, in view of expert prophecies, as the more infantile lives that are saved, the more children.s lives generally will be saved pari passu. The age.period under one year of age is the 29 most dangerous to life, and, if an impression can be made on such age.period in the way of reducing mortality (and, correspondingly, morbidity), it naturally follows that the immediately succeeding age. period, viz, 1 to 5 years, should be affected proportionately, this latter age period (1 to 5 years) being in no sense so dangerous to life as the former age.period (under 1 year of age). Taken over a stretch of years—and the wider the stretch of years the better—the figures are, as already stated, extraordinary, if not incredible. It used to be customary to regard an infantile mortality rate of 100 deaths (corrected) per 1,000 registered births (uncorrected) as the ideal to work up to, or down to, and experts used to make an ex cathedra statement to the effect that any lower figure could not be reasonably expected on account of the necessity for allowing a fixed and definite margin for infants that are born to die within 12 months of births from prematurity and marasmus, and such.like classified diseases (inherited, or constitutional and otherwise), from which that particular age.period (infants under one year) is liable to suffer, and to which the infants concerned succumb in very large numbers—or used to succumb in past years, not only in Lambeth Borough and Parish, but in other Metropolitan and Provincial cities and Boroughs. Few districts (if any) can show greater decreases than Lambeth Borough at the present day. These results (remarkable results) have only been obtained through the activities of the Borough Council in connection with maternity and child welfare work during the 25 years of the present Borough.s existence. Mention must be made of the help given by the many various Voluntary Welfare Centres that have now been amalgamated, and are comprised officially within the Lambeth Maternity and Child Welfare Scheme. Constant and unremitting energy has had to be displayed by the official and voluntary workers throughout the Borough, the latter (voluntary workers) having now been finally amalgamated practically as officers of the Borough Council under the provisions of the Lambeth Scheme, which was officially inaugurated as a scheme in 1918 under the powers of the Maternity and Child Welfare Act, 1918, although similar work had been carried out previously voluntarily. The healthy growth of the work has been secured by the fertilising benefits of the Borough Council.s monetary annual grants.in.aid, supplementing the grants of the Ministry of Health and the late Local Government Board and the Board of Education. The net saving infantile and child mortality (and morbidity) has been enormous within the Borough of Lambeth during the last 25 years, and can be approximately stated as a total saving of 11,275 lives amongst infantile and child life, of which 8,150 may be classified as infants under one year of age. May the good work long continue 30 4.—Mortality (all aGES). The different rates of mortality from different diseases and groups of diseases during 1926 (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 number .of births, which are taken as the infantile population (i.e, the total number of births registered and corrected by the Registrar General). Other tables, in the same way, deal with mortality rates (general) at all .ages per 1.000 of the estimated population. 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 and paratyphoid or enteric and simple continued or ill.defined) and diarrhoea. The total number of deaths registered within the Borough from these diseases is 154—65 strangers belonging lo other districts and 89 parishioners who died within the Borough ; whilst, in addition, 71 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 160, giving a zymotic death.rate (corrected) of 0.51 per 1,000 inhabitants As in the case of general death rates, the zymotic death.rates vary in the inner and outer districts, viz., o.8 in the former (congested and crowded) as compared with 0 3 in the latter (less congested and less crowded) per 1,000 population (vide Table D). Taking the seven principal zymotic diseases separately, the corrected death.rates per 1,000 of the estimated population are:— Small-pox 0.003, nieasles, 0.22. whooping cough o.6, scarlet fever 0 01, diphtheria 0.13, "fever" 0.006, and diarrhoea o.o.]. General and Zymotic Death.Rates. Whilst the statistics for the infantile and child populations can only be described as remarkable, the statistics for the population at all ages are most satisfactory and, practically, record the lowest mortality rates (both general and zymotic). The general corrected death.rate for the year 1926 is 11.5 per 1,000 of the estimated population, as compared with respective yearly averages of 18.4, 14.9, 14.9 during the decennia 1891-1900 (Parish), 1901-10 (Borough) and 1911-20 (Borough), and 12.3 during the quinquennium 1921-25 (Borough) ; whilst the zymotic death.rate (corrected) for the year 1926 is 0.5 per 1,000 of the estimated population as compared with respective yearly averages of 2 4, 1.5 and 1.1 during the same decennia, and 0 6 curing the same quinquennium. * One death registered from german measles is included amongst the "measles" deaths. 31 The lowest corrected death.rates ever recorded in the annals of the Parish or the Borough were (a) General death.rate in 1923 viz ; 11.3 (b) Zymotic death.rate in 1923 viz; 0.4. Tuberculosis Death.Rates. The tuberculosis corrected death.rate for 1926 is 1.03 i.e., 322 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis; death.rate, 0.84, i.e., 262 deaths from pulmonary tuberculosis or consumption (phthisis) per 1,000 estimated population. The details of the corrected tuberculosis deaths in the various Registration Sub.Districts are:— Registration Sub.Districts. Corrected Deaths from Pu1. Tub. or Phthisis (consumpt.n) Other Forms Tuberculosis. Total Deaths Tuberculosis (all forms). Phthisis rate per 1,oco population. Tuberculosis rate per 1,000 population (all forms). Lambeth Church 48 12 60 1.1 1.3 Kennington 50 10 60 1.1 1.3 Stockwell 51 15 66 0.8 1.0 Brixton 73 15 88 0.8 1.0 Norwood 40 8 48 0.6 0.7 Borough of Lambeth 262 60 322 084* 1.03† Rates for Inner Districts 1.00* and 1.24† Rates for Outer Districts 073* and 0.89† During the seven quinquennia 1891-1895 (Parish), 1896-1900 (Parish), 1901-1905 (Borough), 1906-1910 (Borough), 1911-1915 (Borough), 1916-1920 (Borough), and 1921-1925 (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, 367.6, and 278 6 and (b) 675.0, 690 0, 647 4, 567.4, 500.0, 472.4, and 347.0 respectively, representing a steady decline in the total number of tuberculosis corrected deaths registered during that period of 35 years. 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 1921-25 (Borough) of 308.320. *† 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. 32 TABLE E Showing Classification of Causes of Deaths (corrected) in the Borough of Lambeth during 1925 and 1926. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease. Borough 1926. Borough 1925. No. of Deaths (corrected). Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). I.—Zymotic Diseases 275 7.7 270 7.2 Seven Principal 160 4.5 154 4.1 Influenza 57 1.6 6.3 1.7 II.—Parasitic - - — - III.—Dietetic 5 0.1 1 0.02 IV.—Constitutional 909 25.4 890 23.6 Cancer 492 13.8 463 12.3 Phthisis 262 7.3 273 7.2 Tubercular Diseases, excluding Phthisis 60 1.7 62 1.6 Rheumatism (Acute and Chronic) and Gout 23 0.6 29 08 V.—Developmental 254 7.6 259 6 8 Old Age 160 45 162 4.3 VI.—Local Diseases 1947 545 2117 56.2 Circulatory System 677 18.9 620 165 Bronchitis 271 76 426 11.3 Pneumonia and Broncho Pneumonia 176 4.9 181 4.8 Pleurisy and pleuropneumonia 103 29 97 2.6 Respiratory System, excluding Phthisis 588 164 743 19.7 VII.—Violence 169 47 180 4.8 Suicide 43 1.2 36 0.9 VIII.—=lll.defined and not Specified Causes 16 0.4 47 1.2 TABLE E.— continued. D.—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 1926. Borough 1925. 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 288 53.7 343 61.9 Diarrhoea 19 3.5 27 4.9 Convulsions 7 1.3 3 0.5 Respiratory Diseases 62 11.6 74 13.3 Premature Births 64 11.9 69 12.4 Tubercular Diseases (including Phthisis) 3 0.5 13 2.3 Measles 13 2.4 - - Whooping Cough t10 1.9 21 3.8 Suffocation in Bed 4 0.7 5 0.9 Enteritis 20 3.7 10 1.8 Dentition 1 0.2 *N.B.—The above rates have been calculated upon the Registrar.General.s corrected numbers of births for the calendar years 1925.26, viz:— 5.543 and 5,359 respectively. 33 OJ TABLE F. Shewing the number of Deaths (corrected) from the 7 principal zymotic diseases in the Borough of Lambeth during 1926 and during the five previous years 1921-25, together with the yearly averages during the quinquennium 1921-25 (Borough) and the three previous decennia 1891-1900 (Parish), 1901-10 (Borough) and 1911-20 (Borougn). Disease. | Total (corrected) Deaths in 1926. 1921 1922 1923 1924 1925 Annnual average of five years 1921.25 (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 - 1 - - - 02 0.0 0 6.8 1.1 Scarlet Fever 4 16 20 11 11 9 13.4 11.9 31.4 48.8 Diphtheria 43 44 50 48 51 55 49.6 47.3 41.6 124.5 Membranous Croup - - - - - - 0.0 0.3 1.5 6.8 Fever Typhus — — — — — — 0. 0.0 0.0 0.3 Typhoid or Enteric and 2 — 7 1 1 4 2.6 7.0 16.7 34.7 Continued (Relapsing).. — — — — — — 0.0 0.3 0.7 i.7 Diarrhoea 22 124 35 46 23 33 52.2 127.8 172.9 196.5 Cholera — — — — — — 0.0 0.3 1.3 8.8 Measles* 69 15 66 21 88 5 390 84.7 110.4 45.6 Whooping Cough 19 33 58 14 23 48 35.2 47.2 91.8 143.7 Borough of Lambeth 160 232 237 141 197 154 192.2 3268 475.1 7061 *One death registered from German Measles is included with the " Measles" deaths. 35 INFECTIOUS DISEASES. 1.—Notifiable Diseases. Under the Compulsory Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 7,32 1 cases of infectious diseases (excluding tuberculosis) were reported, including encephalitis lethargica acuta 14, malaria 6, acute primary pneumonia 108, acute influenzal pneumonia 114,cerebro-spinal fever 6*, poliomyelitis acuta 6+, ophthalmia neonatorum 53, measles 5149, and German measles 223. These 7,321 cases occurred in 6,401 infected houses, and, of the 7,321 cases, 1,873, i.e., 25 6 per cent., were removed to hospital, and 5,448, i.e., 74 4 per cent., remained under treatment in their homes. If the recently-added notifiable diseases be excluded so as to make the 1926 figures strictly comparable with those for previous years, the percentage of ordinary infectious diseases cases removed to hospital during 1926 was 93 0, as compared with 91.8 the previous quinquennium 1921-25, and 85.0, 82 8, 82.8, 67.9, 54 7, and 315 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. One case of small-pox (a woman, 42 years of age) was notified officially at 25, Johanna Street, and the usual precautionary measures were taken. The source of infection (which proved fatal to the patient) was traced to a hotel in St. Marylebone, where such patient worked as a charwoman ,and where, during work, she came into contact with an unrecognised case of small.pox (contracted in Paris). In addition, many smallpox "contacts" (in connection with cases outside the Borough) have been reported and kept under observation during the usual incubation period of the disease (14 days) Fortunately, no *Including 1 case of post.basic meningitis. †lncluding 1 case of polio.encephalitis acuta. C 2 36 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. Scarlet Fever. Scarlet fever is always present, and the reason for this is the mildness of some of the cases—so mild, indeed, in clinical symptoms, as not to need, in the opinion of parents and relations, the services of a medical man. The case mortality is very small—0.5 per cent (4 deaths out of 743 cases notified). This mildness of type and smallness of case.mortality may be the result of the systematic removals of patients to hospitals for isolation and treatment therein; or, of course, it may be simply epidemiological or cyclical in its manifestations, the result of epidemic waves of mildness or virulence over long periods or intervals. Whichever explanation be correct, sanitary authorities will be inclined to adopt the former view and to attribute the lessened inoidence and virulence of the disease on the populations as due to the moneys expended in the past in isolation and treatment hospitals for scarlet fever patients. The statistics for Lambeth for many years past (Parish and Borough), in so far as scarlet fever is concerned, may, therefore, with advantage, be put on record, more especially in view of the decision of the Metropolitan Asylums Board to pay more attention in future to the isolation and treatment in hospitals of more measles (and whooping cough) patients than hithertofore in place of scarlet fever patients. The experiment is noteworthy and will be watched with interest. These scarlet fever statistics deal with a total of 33,908 cases and 737 deaths spread over a term of 32 years. 37 SCARLET FEVER STATISTICS FROM 1895 TO 1926 (inclusive). BOROUGH OF LAMBETH. Year. Population at decennial periods. Total No. of Scarlet Fever cases notified. Attack Rate per 1.000. Cases sent to Hospital. Cases treated at Home. No. of cases admitted. Percentage of Total Notifications. No. of Deaths. Percentage (case mort. ality). No. of " Return Cases." Percentage (Ketm n case rate.) No. of cases treated at Home. Percentage of 1 otal Notifications. No. of Deaths. Percentagr (case mortality.) No. of " Return Cases." Percentaee (" Return case rate.") 1895 291067 1389 4.77 478 34.4 32 6.7 No special statistics kept as to " return " cases (hospital), which average in Lambeth Borough under 5% total cases removed to hospital. 911 65.5 21 2.3 No special statistics kept as to " retu. n " cases (home), which average in Lambeth Borough under 3% total cases treated at home. 6 295033 1550 5.25 834 53.8 51 6.1 716 46.2 12 1.7 7 296405 1375 4.03 904 65.7 36 4.0 471 34.2 6 i.3 8 297777 1009 3.38 666 66.o 26 3.9 343 34.o 4 1.2 9 299149 1006 3.36 728 72.4 17 2.3 278 27.6 8 29 1900 300521 821 2.73 604 73.6 12 1.9 217 26.4 8 3.7 1 301895 1041 3.44 789 75.8 30 3.8 252 24.2 9 3.6 2 301512 1330 4.41 1056 79.4 43 4.1 274 206 5 i.8 3 301129 744 2.47 569 76.5 19 3.3 .75 23.5 4 2.3 4 300746 660 2.19 549 83.2 16 2.9 111 16.8 — — 5 300363 1025 3.41 821 801 25 3.o 204 199 6 2.9 6 299Q80 1268 4.22 1115 87.9 25 2.2 .53 12.1 3 1.9 7 299597 1481 4.94 1357 9.7 36 2.6 124 8.3 2 1.6 8 299214 1428 4.77 1303 91.2 41 3.1 125 8.8 1 c.8 9 298831 1164 3.89 1088 93.5 25 2.3 76 6.5 2 2.6 1910 298848 910 3.04 853 93.7 22 2.6 57 6.3 — 1 298058 761 2.55 701 92.1 7 0.9 60 7.9 1 1.7 2 298539 604 2.02 563 93.2 9 1.6 41 6.8 — 3 299020 1370 4.58 1212 88.5 14 1.2 158 11.5 — — 4 299501 1745 5.82 1649 94.5 13 0.8 96 5.5 3 3.1 5 299982 900 3.oo 841 93.4 16 1.9 59 6.5 1.7 6 300463 501 1.66 486 97.0 7 1.4 15 3.o — — 7 300^44 340 1.12 312 918 6 i.9 28 8.2 — — 8 301425 549 1.82 511 93.1 10 19 38 6.9 1 2.6 9 301906 1011 3.34 866 85.6 15 1.7 145 4.3 1 0.7 1920 302387 1260 4.16 1160 92.1 .5 1.3 100 7.9 — — 1 302868 1760 £.81 1632 92.7 14 0.8 128 7.2 2 1.6 2 303349 1358 4.47 1272 93.7 20 1.6 86 6.3 — — 3 303830 823 2.70 776 94.3 11 1.4 47 5.7 — — 4 304311 940 3. 08 900 95.7 11 1.2 40 4.2 — — s 304792 1042 3 41 997 95.7 9 0.9 45 4.3 — — 6 305273 743 2.43 696 93.7 4 0.6 47 6.3 38 Diphtheria and Membranous Croup. A total of 716 cases of diphtheria and 9 cases of membranous croup have been notified, but, bacteriologically, all these cases were not, necessarily, true cases. Even the bacillus diphtheria (Klebs.Lœffler), when found in the throat or nose, without concurrent clinical symptoms, may be of the non.virulent type, and, correspondingly, harmless and negligible—at least in the opinion of some bacteriologists. The following is the method that is being adopted, at piesent, in Lambeth. 1( the Klebs.Lceffler bacilli found in pure cultivation are virulent to guinea pigs, the strictest precautionary measures are taken (notification, isolation, exclusion from schools, disinfection, &c.). If the Klebs.Loeffler bacilli found in pure cultivation are non.virulent to guinea pigs, the above.mentioned precautionary measures are not insisted upon. The method is experimental. 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, 191 5, 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 in connection with sequeloe. 39 The rising epidemic of Measles (and German Measles) at the end of 1925 continued during the first quarter of 1926, gradually abating during the remaining quarters of that year, as shewn by the returns:— 1926 Measles German Measles Totals 1st Quarter 4329 121 4450 2nd Quarter 732 70 802 3rd Quarter 63 2 1 84 4th Quarter 25 I I 36 Total Year 1926 5149 223 5372 1.—Age Periods Affected. Age Periods. Cases Notified. Deaths Registered. Case Mortality (per cent.) Measles German Measles Measles German Measles Measles German Measles Under 1 year 226 15 13 5.75 0.00 Between 1 and 5 years . 2509 69 49 1 1.95 1.44 Total under 5 years 2735 84 62 1 226 1.19 Between 5 and 15 years 2313 104 5 — 0.2 1 0.00 At other ages 101 35 1 0.99 000 2.—Localities Affected. (Registration Sub.Districts). Registration Sub.District, Cases Notified. Deaths Registered. Case Mortality (per cent.) Measles German Measles Measles German Measles Measles German Measles Lambeth Church 716 28 13 - 1.81 0.00 Kennington 816 26 11 — 1.34 0.00 Stockwell 1224 24 20 — 163 0.00 Brixton I403 75 9 — 0.64 o.oo Norwood 990 70 15 1 1.51 1.42 Borough 5149 223 68 1 1.32 0.44 40 N.B.—The incidence.rates and death.rates per 1,000 of the estimated populations are as follows :— Measles German Measles Incidence. rate Death.rate Incidence. rate Death.rate Lambeth Church 16.14 0.29 0.63 0.00 Kennington 1819 0.24 0.57 0.00 Stockwell 18.55 0.30 0.36 0.00 Brixton 16.40 0.15 0.99 0.00 Norwood 4.07 02 1 0.01 Borough 16.55 0.21 0.71 0.003 The comparative large number of 2,819 notified cases of children under five years (i.e., 52 47 per cent. of the total) during the year 1926 is again noticeable and 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). The Metropolitan Asylums Board have decided to offer more hospital accommodation for urgent Measles cases, reducing, proportionately, the Scarlet Fever accommodation. This decision is experimental and is based on the fact that the mortality amongst Measles patients is much higher than that amongst Scarlet Fever patients. The amount of isolation institutional accommodation for Measles is in no sense adequate, and arrangements have been 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 is, undoubtedly 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, from an educational standpoint. 41 Puerperal Sepsis. Much attention is being paid to this disease, it being felt that, as a preventive disease, it should be non.existent. 34 cases of puerperal fever (15 deaths) were notified, 11 connected with abortions and mis carriages and 23 others out of 7,497 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 (34) of puerperal fever cases 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 1921-1925, viz.: 31.4, results that are probably more apparent than real and 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. In this connection, the issuing of the Public Health (Notification of Puerperal Pyrexia and Puerperal Fever) Regulations, 1926, which came into force on October rst, 1926, will prove of value. It will be noted that a symptom—puerperal pyrexia—becomes compulsorily. notifiable as well as puerperal fever, and the definition of puerperal pyrexia (as laid down in the Regulations) is as follows —any febrile condition occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4°F. (38.0°C.) or more has been sustained during a period of 24 hours or has recurred during that period. Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. These Regulations represent a very decided advance in notification, and they have, apparently, been issued in an endeavour to stamp out Puerperal Sepsis (blood poisoning) in all its protean forms. This task may, however, prove a herculean one. For many years past it has been felt by the Ministry of Health and others responsible that Puerperal Sepsis or maternal morbidity (.and mortality) should, as preventible diseases, be prevented, such diseases being due (for the most part) to the want of cleanliness 011 the part of those connected with, and in attendance at, the confinements, the 42 insanitary conditions of houses and rooms where in many confinements have to take place, and personal insanitary conditions of the patients themselves and their clothing and bedding, &c. Under the Infectious Disease Notification clauses of the Acts, it is laid down that " Puerperal Fever " is compulsorily notifiable, but no definition is given as to what shall constitute " Puerperal Fever." The result has been that, in the past, only definite cases and serious cases of Puerperal Sepsis have come to the knowledge of the Sanitary Authority, and generally too late for treatment or preventive measures, and it has been felt, and practically known, indeed, that a very large number of other cases, more or less severe, have also taken place, but have not been notified as "Puerperal Fever." From an administrative point of view, the notification of " Puerperal Fever " has always been unsatisfactory, on account of no precise definition of the disease having been laid down, thereby leaving it to the Medical Practitioners concerned to decide the diagnosis in each individual case, with consequent varying medical standards. The symptoms which point to Puerperal Fever, as a result of puerperal infection, are often ill.defined, and the diagnosis is always, more or less, difficult, and there can be no reasonable doubt but that many cases of puerperal infection, or sepsis, occur that are not notified as " Puerperal Fever " to the Medical Officers of Health, and in connection with which, therefore, no preventive measures, or treatment, can be taken or given, as required—at least, in time to be of any value. It is to avoid this considerable leakage that the Ministry of Health has decided that in future (from istOotober, 1926) not only shall cases of puerperal fever (as generally understood by Medical Practitioners at the present time) be compulsorily notifiable under the Notification of Infectious Diseases clauses of the Acts, but that also all cases of Puerperal Pyrexia, which may be due to many different causes This decision of the Ministry practically means that cases of fever or temperature that take place during the period of a woman.s confinement (3 weeks), or that may occur during such period, are to be notified to the Medical Officers of Health concerned, with a view to preventive measures, and methods of treatment being adopted in those cases in connection with 43 which such preventive measures, or treatment, are necessary, and which, are set out on the notifications forms, as follows (i) to have a second opinion on the case ; (ii) to have a bacteriological examination of (a) lochia, and (6) blood ; (iii) to have the patient admitted to hospital ; (iv) to provide trained nurses. It is well.known medically that, during confinement, the nervous system is liable to periods of irritability, or high tension, and that, as the result, the slightest shock may cause the temperature to rise. Thus, on the third day, when the milk appears in the breasts, the temperature of the mother always rises, whilst any indiscretion (very slight indiscretion) in diet, moving, or otherwise, may also cause the temperature to rise. All cases, however, of pyrexia, or fever, or temperature, during the puerperium, are to be notified, apparently, irrespective of the cause or causes, to which such Pyrexia, or fever, or temperature, may be attributed. There may be many notificatons of puerperal pyrexia sent in officially under the Regulations, especially as miscarriages have to be dealt with as well as child births. No estimate is possible. The Regulations lay down that all Medical Practitioners residing, or practising, within the Borough of Lambeth must be communicated with, and informed of their new duties, and that new books of notification forms must be issued, as set out in the schedules to the Regulations. This has been done. The notification fees attached to these notifications are the same as for other infectious diseases, viz., 2s. 6d. (private) and is. public) for each notification certificate sent in, and are repayable by the Metropolitan Asylums Board. Typhoid and " Enteric " Fever. In the " enteric " group are included typhus, typhoid (and paratyphoid) fever, and continued or relapsing fever. These diseases are practically non.existent within the Borough but may be, sporadically, introduced from outside or from abroad. Typhus fever has been stamped out for many years, and typhoid (and paratyphoid) fever and continued (and relapsing) fever are rapidly becoming diseases of the past. 44 The statistics for the Borough and Parish of Lambeth are specially interesting and deserve to be put on record. During the past 35 years, the annual averages of notified cases of typhus and typhoid (or enteric) fever and continued (or relapsing) fever are as follow:— 1926 Average 10 yenrs Average 10 years Average 10 years Average 5 y«ars - - - - 1891-1500 1901-1910 1911-1920 1921-1925 (a) typhus fever - 1.1 0.1 0.0 0.0 (b) typhoid (or enteric) fever* 7 189.6 100.5 31.9 15.2 (c) continued (or relapsing) fever — 25.7 4.1 0.8 0.2 *N.B.—Paratyphoid fever cases are included. Of the 7 cases of typhoid fever notified during 1926. 3 were cases of paratyphoid. 3 were doubtful as to diagnosis, and 4 traced to the Continent. The mortality statistics are equally remarkable as follow : 1926 Average 10 years Average 10 years Average 10 years Averag e 5 years1! - - - — 1301.1900 1901.19x0 1911 1920 1921.1925 (a) typhus fever - 0.3 0.0 O.O O.O {b) typhoid (or enteric) fever* 2 34.7 16.7 70 2.6 (c) continued (or relapsing) fever - 1.7 0.7 0.3 0.0 *N. B.—Paratyphoid fever cases are included. The greater sanitary control exercised over shell.fish rearing and fish introduction or inportation may have contributed in part to this lessening of the typhoid fever incidense and mortality. Ophthalmia Neonatorum. Great care is exercised now in all cases of doubtful or suspected and real ophthalmia neonatorum, which is the chief cause of blindness. During the year 1926, 53 cases were notified as compared with annual averages of 72.8 and 55.2 for the 10 years 1911-1920 and the 5 years 1921-1925 respectively. Formerly this disease was notifiable by mid. wives as well as by medical practitioners with the result that many cases were " missed " and precautionary measures were consequently, unable to be taken. To prevent this happening in the future a new order has been issued and came into force on October 1st, 1926, known as the Public Health (Ophthalmia Neonatorum) Regulations, 1926, under which medical practitioners are solely responsible for notification of patients suffering from ophthalmia neonatorum, dual notification having been previously required in connection with that disease. Midwives still have the duty under the Midwives Board Regulations of calling in a medical practitioner on the first symptoms of anything being noticed to be wrong with the newly. born babies. eyes and also of reporting the fact to the supervising 45 authority—the London County Council as far as the Admisistrative County of London is concerned. The new 1926 Regulations amend the 1914 Regulations. An obligation is laid upon the medical officers of health of local authorities to forward copies of all notifications received under the Regulations to the County Medical Officers of Health of the districts or areas concerned (within 24 hours of the receipt of such notifications), and in the case of Metropolitan Medical Officers of Health to the Metropolitan Asylums Board also (within 12 hours of the receipt of such notifications.) 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 well. known Nursing Associations for the nursing, free of cost, of patients notified or otherwise reported to be suffering from Measles and German Measles, Whooping Cough, Ophthalmia Neonatorum (and other forms), Influenza, acute Pneumonia (primary and influenzal), Epidemic Diarr. hcea, etc., if (and as) required by the Medical Officer of Health, and which came into force 011 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 1926. The following statistics for the 7 years 1920-1926, setting out the total numbers of visits paid by nurses, speak for themselves :—measles and German measles, 728, 206, 722, 297, 518, 63 and 939 ; whooping cough, 255, 273, 488, 400, 327, 264 and 198 ; ophthalmia neonatorum (and other forms), 2,341, 1,764, 986, 1,093, 1,537 1,379 and 1,352; epidemic diarrhoea, 57, 232, 5, 36, 33, 30 and 55 ; influenza, 343, 332, 474, 249, 487, 346 and 430 ; acute primary and influenzal pneumonia, 1,870, 2,643, 3.586, 3.333. 4,164, 4430 and 4,764; other diseases, 114, 11, 16, 186, 187, 106 and 116, making totals of 5,708, 5,461, 6,277, 5.594, 7,253. 6,618 and 7,854 visits paid respectively.* Of the total visits (7,854) paid during 1926, 4,286 were visits to children under 5 years of age, i.e., 54 56 per cent., dealing with measles and German measles, 651; whooping cough, 94 ; ophthalmia neonatorum (and other forms), 1,352 ; epidemic diarrhoea, 55 ; acute primary and influenzal pneumonia (and other forms), 2,079 ; erysipelas 23 ; and chickenpox, 32. * N.B—Including 5 cases of notified puerperal pyrexia (compulsorily notifiable since October 1st 1926). 46 TABLE G. Shewing the total numbers of cases (corrected) of infectious diseases notified comfiulsorily 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 1926, 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 1 1 100.00 1 100.0 1 Scarlet Fever 743 4 0.53 696 93.7 689 Diphtheria 716 43 6.00 705 98.5 630 Membranous Croup 9 — — 9 1OO.O 8 Typhus — — — — - — † Typhoid or Enteric 7 2 28.56 6 85.7 7 Continued and Relapsing Fever — — — — — — Erysipelas 86 4 4.65 37. 43.0 86 Puerperal Fever 34 15 44.11 31 91.2 35 * Puerperal Pyrexia 44 - — 3 6.8 32 * Plague — - — — — — * Cerebro-Spinal Fever 6 4 66.66 4 66.7 6 47 *§ Polio.myelitis acuta 6 - — 4 66.7 6 *Ophthalmia Neonatorum 53 - — 5 9.4 51 *Whooping Cough - 19 — - - - *Measles 5,149 68 1.32 287 56 4,393 *German Measles 223 1 0.44 1 0.4 215 *Tuberculosis— Pulmonary (primary) 446 262 58 74 — — — Non.pulmonary (primary) 101 60 59.40 — — — *Chickenpox — — — — . *Malaria 6 — - — — 6 *Dysentery 1 — - — — 1 *Primary Pneumonia (Acute) 108 47 43.5 107 *Influenzal Pneumonia (Acute) 114 55 24.7 7 1 29 25.4 114 *Encephalitis Lethargica (Acute) 14 5 35.71 8 57 1 .4 *Trench Fever - — — — . * Anthrax .. — — — — * Plague was made compulsorily notifiable on September 19th, 1900, cerebro.spin?l fever on March 12th, 1907, polio myelitis and polio encephalitis acuta on September 1st, 1911, ophthalmia neonatorum on March 13th, 1911, glanders (human), Anthrax (human), and hydrophobia (human), on April 26th, 1909, pulm .nary 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 8tn 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 no ifiable from January 1st. 1913, to December 31st, 1917, the numbers of cases nolifiecl being as follows:—1913, 1,428; 1914, 1,389; 1915, 1,607; 1916, 1,576; and 1917,902. Me isles 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 (in March 1st, 1919. Puerperal pyrexia became compulsorily notifiable on October , 1st, 1926, under the Public Health (Notification of Puerperal Pyrexia and Puerperal Fever) Regulations, 1926 77 Measles cases were notified by parents (or relatives), in addition to the 5149 notified cases (mentioned above). + Including 3 cases of paratyphoid fever, 2 cases removed to hospital. t Including 1 case of p .sl.basic meningitis, which was removed to the hospital, and died. § Including 1 case of polio.encephalitis acuta, which was removed to hospital. .t* co 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 1926, together with the averages for the three decennia 1891.1900 (Parish), 1901 -1910 (Borough), and 1911-1920 (Borough), and the quinquennium 1921-25 (Borough). Disease. 1926 Annual Average, 1921-25 (Borough) 5 years. Annual Average, 1911-1920 (Borough) 10 years. Annual Average 1901-1910 (Borough) 10 years. Annual Average 1891-1900 (Parish) 10 years. Cholera - - O.l 0.2 11.5 Smallpox 1 0.6 0.2 49.9 22.0 Scarlet Fever 743 1184.6 904 .1 1105.1 1331.3 Diphtheria 716 636.6 482.7 379.8 715.1 Membranous Croup 9 3.4 5.5 104 26.2 Typhus — — O.O O.l 1.1 †Typhoid or Enteric 7 15.2 3.9 1005 189.6 Continued and Relapsing — 0.2 0.8 4.1 25.7 Erysipelas 86 115.8 175.0 241.4 347.0 Puerperal 34 31.4 21.8 17.0 18.9 *Puerperal Pyrexia 44 - — — — *Plague — - O.O 0*0 O.O *†Cerebro.spinal Fever 6 6.2 l8.2 11.5 — 49 *§Poliomyelitis acuta 6 6.0 7.3 — — *Ophthalmia Neonatorum 53 55.2 72.8 — . — *Whooping Cough — — 1380.4 — — *Measles 5,149 1897.0 2354.2 — — *German Measles 223 3920 635.4 — — *Tuberculosis— Pulmonary (primary) 446 491.6 1112 .4 — - Non.pulmonary (primary) 101 101.4 323.7 — — *Chickenpox — — — — — *Malaria 6 8.0 59.5 — —. *Dysentery 1 0.4 7.0 — — *Primary Pneumonia (Acute) 108 175.2 161.5 — — *Influenzal Pneumonia (Acute) 114 76.6 I 26 .0 — — *Encephalitis Lethargica (Acu:e) 14 14.2 7.0 — — *Trench Fever — 0.2 0.0 — — * Anthrax (human) - 0. 2 O.l - - *Plague was made compulsorily notifiable on September 19th, 1900; cerebro spinal fever on March 12th, 1907; glanders (human), anthrax (human), and hydrophobia (human), on April 26th, 1909; polio.myelitis and polio.encephalitis acula on September 1st, 1911 ; ophthalmia neonatorum on March 13th, 1911 ; pulmonary tuberculosis (poor law cases) on January 1st, 1909, pulmonary tuberculosis (hospital cases) on May 1st, 1911 ; pulmonary tuberculosis (private cases) on January 1st, 1912, and tuberculosis (pulmonary and non. pulmonary) on February 1st, 1913. Chicken.pox was compulsorily notifiable as follows:—1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), 1911 (March 22nd to June 22nd), 1915 (March 17th to June 30th), and 1918 (March 27th to June 30th. j 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 Januaiy 1st, 1919, and malaria, dysentery, pneumonia (acute primary and acute influenzal), and trench fever on March 1st, 1919. Puerperal pyrexia became compulsorily notifiable on October, 1st 1926, under the Public Health (Notification of Pueperal Pyrexia and Puerperal Fever) Regulations, 1926. N.B.—Of the patients originally notified during 1926, the following were found afterwards not to be suffering from the diseases notified —Diphtheria, 1 ; Scarlet Fever, I ; Puerperal Fever, 2 : and Cerebro Spinal Meningitis, I ; and are not included in the above table. _ + Including 3 cases of paratyphoid fever. J Including 1 case of post.basic meningitis. j Including 1 case of polio.encephalitis acuta. 50 Si METROPOLITAN BOROUGH OF LAMBETH. TABLE H. Public Health (Tuberculosis) Regulations, 1912. (As amended by the Public Health (Notifications of Infectious Diseases) Regulations, 1918.) Summary of Notifications received during the period from 3rd January, 1926, to the 1st January, 1927. 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). *TotaI Notifications (i.e., including cases previously notified by other Doctors). (Medical.) Primary Notifications (Medical.) †Total Notifications (i.e. including cases previously notified by other Doctors). (Medical). Cases admitted to Cases discharged from 0 to 1. 1 to 5. S to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. upwards. Total. Under 5. 5 to 10. 10 to I 5. Total. Poor Law Institu. Sanatoria. Poor Law Institu. Sanatoria. (Medi cal.) (Medi cal.) Pulmonary— Males — 2 4 5 13 17 53 70 56 28 8 256 352 — — — — — 1 269 3 201 Females— 1 1 I 14 22 4. 59 23 13 13 2 190 260 — — — .- — 1 139 2 122 Non.Pulmonary— Males 2 20 8 4 3 4 8 1 1 1 — 52 56 — 1 2 3 3 — 52 i 25 Females .. — 11 7 | 12 2 2 S 2 — 1 — 45 48 — 1 — 1 1 31 1 19 * Ke.notifications (Form A)=l66 (males 96, females 70), pulmonary and 7 {males 4, females 3) non.pulmonary. †Re.notifications (Form B) = o (male o, female o), pulmonary, and o (male o,female o) non.pulmonary. N.B.—Pulmonary—119 private. 197 hospitals, 130 dispensaries and o schools = 446 total primary notifications (Forms A and B, including 114 Poor Law cases under Form A (hospitals). Non.Pulmonary —11 private, 62 hospitals, 24 dispensaries and 4 schools = 101 total primary notifications (Forms A and B), including 1: Poor. Law Cases under Form A (hospitals). n 2 52 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 3rd, 1926, tc January 1st, 1927. Registration Sub-Districts. Tuberculosis (All forms). Pulmonary. Non-Pulmonary. 1926. 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 45 62 - - 1 30 - 19 7 7 2 2 - 7 - 3 Lambeth Church 31 43 - - - 31 4 25 1 17 1 1 - 13 - 6 Kennington 78 15 - - - 48 - 37 20 21 1 1 - 13 - 2 Stockwell (Inner) 48 61 - - - 35 - 32 9 10 - - - - - - Total Inner Districts 202 281 - - 1 144 4 113 50 55 4 4 - 43 - 17 Stockwell (Outer) 40 49 - - - 40 1 34 10 10 - - - 12 - 8 Brixton 133 180 - - - 145 - 106 21 22 - - - 14 - 12 Norwood 71 102 - - 1 79 - 70 16 17 - - - 14 2 7 Total Outer Districts 244 331 - - 1 264 1 210 47 49 - - - 40 2 27 Borough of Lambeth 446 612 - - 2 408 5 323 97 104 4 4 - 83 2 44 53 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 3rd January, 1926, to the 1st January, 1927, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations 1912, as amended by the Public Health (Notification of Infectious Diseases) Regulations, 1918, e.g., from death returns (patients unnotified before death), from verbal information, notifications furnished by Naval or Military Medical Authorities, outside Medical Officers of Health, etc. 1.-Age Periods. 0 to 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 - - - 1 5 5 9 7 7 4 2 40 ,, Females - - - - 3 4 12 6 3 1 2 31 Non-Pulmonary- ,, Males 2 - 2 3 - 2 2 1 - 1 1 14 ,, Females - 10 2 1 2 - - - 1 1 1 18 2.-Registration Sub-Districts. Waterloo. Lambeth Church. Kennington. _ . _. Stockwell (Inner) Total Inner Districts. Stockwell (Outer). Brixton. Norwood Total Outer Districts. Borough of Lambeth. monary 4 7 7 9 27 7 22 15 44 71 monary 6 1 2 6 15 4 9 4 17 32 N.B.-The above 103 cases are made up as follows:-Death Returns, 88 (Pulmonary, 59; Non-Pulmonary, 29); Military, 3 (Pulmonary, 2; Non Pulmonary, 1); Other sources, 12 (Pulmonary, 10, ; Non-Pulmonary. 2) 54 Tuberculosis. Tables H, H (1) and H (2) set out the summary of the notifications (both compulsorily notified and voluntarily reported or heard of from other sources 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). There are 2 Tuberculosis Dispensaries (a Central and a Branch), the former being under the direct control of the Council and the latter of the Governors of Sc. Thomas's Hospital. 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 1926, 60 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 and after-care, amount to large numbers. Thus, during 1926, 210 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 £.527 12s. 3d. The work of the St. Thomas's Hospital 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 her assistants, has also been satisfactory. This is work that the Borough Council is responsible for, and has been carried out by the Governors of St. * 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 all of which Committees Miss Baker serves in an official capacity. 55 Thomas's Hospital, hitherto at their own expense, but now supplemented by a Borough Council grant *(since January 1st, 1924), under a contract approved by the Ministry of Health, such work being more closely 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, whereby a grant from the Borough Council becomes payable, was officially approved by the Ministry of Health, on November 24th, 1924. No separate and distinct tuberculosis "care" Committee for the Borough is appointed, such a "care" Committee having been found to be unnecessary, as the result of experience and practical workingThe work of assessment, &c., is done by Miss Scott Baker (Southern districts) and Miss Cummins (Northern districts), acting under the Medical Officer of Health as Chief Executive Tuberculosis Officer. 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, connected with the dental departments of King's College and St. Thomas's Hospital respectively, which came into operation on October 1st, 1924, is still working. 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† Judging by numbers, this new Scheme is not proving very attractive to patients, who appear to prefer going to private dentists rather than to make use of the two dental centres at King's College and St. Thomas's Hospitals. Students at Hospitals are not appreciated ! * The grant is £1500 per annum (half repayable to the Council by the Ministry of Health and quarter by the London County Council). † Dentures are paid for by the Council (wholly or partly) only when such are certified as essential for effective tuberculosis treatment). 56 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 (6) tuberculosis (all forms) as follows:- (1) Death-rates (corrected deaths per 1,000 population):— Borough Inner Districts Outer Districts Years. Pulmonary Tuberculosis Tuberculosis (all forms). Pulmonary Tuberculosis Tuberculosis (all forms). Pulmonary Tuberculosis Tuberculosis (all forms). 1913 1.2 1.6 1.6 2.1 0.9 1.2 1914 1.3 1.7 1.5 1 .9 1 .2 1.5 1915 1.4 1.8 1.9 2.3 1.2 1.4 1916 1.4 1.7 1.6 2.1 1 .2 1.5 1917 1.5 202 2.03 2.7 1.1 1.5 1918 1.5 2.05 1.9 2.6 1.2 1.7 1919 1.2 1.5 1.5 1.8 0.9 1.2 1920 1.01 1.2 1.2 1.5 0.9 1.08 1921 0.9 1.1 1.2 1.4 0.7 0.9 1922 0.9 1.2 1.1 1.4 08 1.07 1923 0.8 1.1 0.9 1.2 0.8 0.9 1924 0.9 1.1 1.0 1.3 0.8 1.03 1925 087 1.07 1.01 1.26 0.78 0.95 Averages (13 years) 1.14 1.47 1.41 1.82 0.96 1. 2 1926 0.84 1.03 1.00 1.24 0.73 0.89 57 (2) Incidence Rates (notified primary cases per 1,000 population).— Years. Borough. Inner Districts Outer Districts 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 28 3.5 1916 3.2 4.5 3.5 4.8 2.9 4.2 1917 3.9 5.6 3.9 5.5 3.9 5.7 1918 4.0 5.4 4.5 5.9 3.7 5.0 1919 2.3 3.2 2.5 3.2 2.2 3.1 1920 2.4 2.8 2.1 2.6 2.6 2.9 1921 1.8 2.1 1.9 2.4 1.6 1.9 1922 1.6 1.9 1.9 2.2 1.5 1.8 1923 1.5 1.8 1.5 1.9 1.4 1.8 1924 1.5 1.8 1.5 1.9 1.4 1.7 1925 1.56 1.84 1.76 1.97 1.49 1.76 Averages (13 years) 284 3.65 3.12 4.04 2.59 3.37 1926 1.43 1.75 1.65 2.10 1.29 1.00 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. 58 TABLE I. Lambeth Municipal Tuberculosis Dispensary Scheme. {Inaugurated by the Council, October 3rd, 1912). Ministry of Health Table—FORM T. 53. Return (Prepared by the Tuberculosis Officer) as to Work carried out in CONNECTION WITH THE CENTRAL DISPENSARY FOR THE YEAR 1926. N.B.—The Central Dispensary (73, EfFra Road, Brixton), was opened July 23rd, 1913. (a) CENTRAL DISPENSARY (73, Effra Road, Brixton). Diagnosis. Pulmonary. Non-Pulmonary Total. Adults. Children Adults. Children Adults. Children M. F. M. F. M. F M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):- (a) Definitely tuberculous 85 69 4 7 8 15 9 11 93 84 13 18 (b) Doubtfully tuberculous - - - - - - - - 31 32 6 6 (c) Non-tuberculous - - - - - - - - 66 78 42 35 B.—Contacts examined during the year:— (a) Definitely tuberculous 17 21 3 3 1 2 2 1 18 23 5 4 (b) Doubtfully tuberculous - - - - - - - - 5 12 3 5 (c) Non-tuberculous - - - - - - - - 31 63 39 35 C.—Cases written off the Dispensary Register as— (a) Cured 7 5 6 1 5 2 3 5 12 7 9 6 (b) Diagnosis not confirmed or non-tuberculous (including concellation of cases notified in error) - - - - - - - - 290 379 233 99 D.—Number of Persons on Dispensary Register on December 31st 1926:- (a) Diagnosis completed 413 283 23 32 59 27 40 21 472 310 63 S3 (b) Diagnosis not completed - - - - - - - - 2.3 29 6 8 1. Number of persons on Dispensary Register on January 1st 1926 1,491 9. Number of patients to whom Dental Treatment was given at, or in connection with, the Dispensary 9 2. Number of patients transferred from other areas and of "lost sight of" cases returned 17 10. Number of consultations with medical practitioners:- (a) At Homes of Applicants 53 3. Number of patients transferred to other areas and cases "lost sight of' 136 (b) Otherwise 707 11. Number of other visits by culosis Officers to Homes 235 4. Died during the year 120 12. Number of visits by Nurses or Health Visitors to Homes for Dispensery purposes 2,2IO 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded two months 56 13. Number of— (a) Specimens of Sputum, etc., examined 892 6. Number of attendances at the Dispensary (including Contacts) 5,327 (b) X Ray examinations made in connection with Dispensary work 371 7. Number of attendances of non-pulmonary cases at Orthopaedic Outstations for treatment or supervision - 14. Number of Insured Persons on Dispensary Register on the 31st December 426 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 389 8. Number of attendances at General Hospitals or other Institutions approved for the purpose of patients for— 16. Number of reports received during the year in respect of Insured Persons: (a) " Light" treatment 16 (a) Form G. P. 17 11 (b) Other special forms of treatment 56 (b) Form G.P. 36 - N.B.—Dr. E. D. Richardson was appointed Tuberculosis Officer (Central Dispensary) on October 16th, 1919. 59 TABLE I (Continued) Lambeth Municipal Tuberculosis Dispensaries Scheme (.Inaugurated by the Council, October 3rd, 1912). Ministry uf Health Table—FORM T. 33. Return (Prepared by the Tuberculosis Officer) as to Work carried out in connection with the branch dispensary for the year 1926. N.B.—The Branch Dispensary (St. Thomas's Hospital) was opened February 3rd, 1913. (b) BRASCH DISPENSARY {St. Thomas's Hospital). Diagnosis. Pulmonary. Non-Pulmonary Total. Adults Children Adults. Children Adults. Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):- (a) Definitely tuberculous 97 54 i - 13 6 11 6 110 60 12 6 (b) Doubtfully tuberculous - - - - - - - - 9 7 i 4 (c) Non-tuberculous - - - - - - - - 211 310 114 112 14.—Contacts examined during the year:— (a) Definitely tuberculous - 2 - - - - 1 1 - 2 1 1 (b) Doubtfully tuberculous - - - - - - - - - - 4 4 (c) Non tuberculous - - - - - - - - 14 23 48 63 C.—Casks written off the Dispensary Register as— (a) Cured 3 3 - - 1 - 3 4 4 3 3 4 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 233 350 167 187 D.-Number of Persons on Dispensary Register on December 31st 1926:- (a) Diagnosis completed 250 175 3 3 40 41 45 53 290 216 48 56 (b) Diagnosis not completed - - - - - - - - 28 41 2 19 1. Number of persons on Dispensary Register on January 1st 1926 663 9. Number of patients to whom Dental Treatment was given at, or in connection with, the Dispensary 25 2. Number of patients transferred from other areas and of "lost sight of" cases returned 18 10. Number of consultations with medical practitioners:- (a) At Homes of Applicants 10 3. Number of patients transferred to other areas and cases '' lost .sight of" 77 (b) Otherwise 500 11. Number of other visits by Tuberculosis Officers to Homes 161 4. Died during the year 68 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded two months 14 2.305 13- Number of— (a) Specimens of Sputum, etc , examined 493 6. Number of attendances at the Dispensary (including Contacts) 4,195 (b) X Ray examinations made in connection with Dispensary work 25' 7. Number of attendances of non-pulmonary cases at Orthopaedic Outstations for treatment or supervision 29 14. Number of Insured Persons on Dispensary Register on the 31st December 281 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 65 8. Number of attendances at General Hospitals or other Institutions approved for the purpose of patients for— 16. Number of reports received during the year in respect of Insured Persons : (a) " Light " treatment 68 (a) Form G. P. 17 17 (b) Other special forms of treatment 64 (b) Form G.P. 16 21 N.B.—Dr. G. T. lleb ert was appointed Tuberculosis Officer (Branch Dispensary) on January 6th,I 1920. An assistant Tuberculosis Officer (for visiting purposes) is also attached to the B anchl Dispensary (since Tanuary 1st, 1924). 60 61 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 1926. 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 Paralalyasis* Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis* Acute Polio-myelitis 5 - - - - - 2 - 1 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Polio-encephalitis 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cerrbro-Spinal Fever 5 - - 1 1 - 2 1 - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - Post-Basic Meningitis 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica ... 14 - - - - - - - - - - - - 1 - - - - - 1 - - 1 - - - - - 1 - - - - - 1 - - 5 2 - 4 3 - Number of Cases removed to Isolation Hospital. Recovered, with permanent Paralysis of one or more groups of muscles (slight paralysis of ciliary muscles and accommodation). Acute Polio-myelitis - - 1 - 1 - - - - - - 1 - - Acute Polio-encephalitis Cerebrospinal Fever — - 2 1 - - - - - - - — — — Post-Basic Meningitis 1 - — - — - - - - - - — — Encephalitis Lethargica - - - - 1 - 1 1 - 1 - - 2 2 62 2..0Non.Notifiable Diseases. Chickenpox. 824 cases of chickenpox were reported voluntarily. Diarrhoea. The number of corrected deaths registered from diarrhoea is 22, as compared with yearly averages of 191.6, 219.4, 208.6, 140.2, 178.2, 77.4, and 52.2, during the seven quinquennia 1891.1895 (Parish), 1896 1900 (Parish), 1901-1905 (Borough), 1906-1910 (Borough), 1911-1915 (Borough), 1916-1920 (Borough), and 1921-1925 (Borough), respectively. All the 22 deaths registered during 1926 occurred amongst children under 5 years of age, and 19, i.e., 86.4 per cent., amongst infants under 1 year of age. The large decrease in the number of registered diarrhoea deaths during 1926 is realised when thus compared with the quinquennial yearly averages during the past 35 years. During 1926, the 4 ft. earth thermometer first registered 56°F. on June 19th, rising to a maximum of 62.5°F. on September 3rd, and re. mainingat such maximum until September 2oth,sinkingto 56°F.again on October 21 st. The inter relationship 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 diarrhœal 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 1926, 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 diarrhœal mortality (and corresponding morbidity) to the Council's activities in maternity and child welfare work throughout the Borough, having regard to the recognised * Adults also suffer from zymotic or summer diarrhoea, but rarely, if ever, fatally. 63 fact that the chief causes of an increased diarrhceal rate are to be found in the improper and irregular feeding of infants and young children. 27 corrected deaths (20 infants under 1 year of age) were registered from enteritis. Practical measures were taken to prevent epidemic diarrhoea (and other diseases) in infants and young children, and to promote hygienic conditions in their feeding and environment, as follows:— (a) Visiting of houses wherein births were notified under the Notification of Births Act, 1907, or wherein deaths of infants and children were registered as having occurred from epidemic diarrhoea 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 diarrhoea and the free nursing of infants and children (and others) obtainable under the Lambeth Nursing (Infectious Diseases) Scheme. 64 The value of such practical measures is shewn by the various statistics in this Report, not only for the year 1926, 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. 57 corrected deaths were registered from Influenza during 1926, as compared with an average of 83.0 during the quinquennium 1921I925. The full details of the age and sex distribution of the 57 deaths during 1926, 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. 1 — 1 - — 1 2 1 - - 1 - — — 3 2 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 3 4 8 5 6 1 9 12 3° 24 S2 25 57 114 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, 6; and cholera and plague, 12. * 108 cases of acute primary pneumonia were also notified during 1926. 65 Municipal Bacteriological Laboratory. (.Inaugurated by the late Vestry, 1899.) Table shewing the numbers of pathological samples examined (total 973), and the results obtained, at the Bacteriological Laboratory during 1926, and the previous 5 years (1921-1925), together with the averages for the two decennia 1901-1910 (Borough) and 1911 -1920 (Borough) and the quinquennium 1921-1921; (Borough). Year. Sputa. Suspected Tuberculosis. Tub. Bac. found. Blood. Suspected Typhoid or Enteric Fever. Reaction obtained. Throat & Nose. Membranes and Secretions. Suspected Diphtheria. Klebs-Loeffler Bac. found Other Sundry Samples. Result, obtained. Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 1926 22 242 264 2 10 12 10 682 692 2 3 5* 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 Average of 5 years 1921-1925 (Borough) Averages of 10 years 24.8 234.* 257.6 0.8 12.6 13.4 12.2 673.6 685.8 1.8 1.8 3.6 (a) 1901-1910 (Borough) 62.8 124.4 187.2 19.4 39.6 59.° 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 neg. and 1 pos.); suspected tuberculous urine (1 neg. and 1 pos.) ; and malaria spores in blood (1 neg). During 1926, 60 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 1926), 27,319 examinations have been conducted there in connection with the following suspected diseases, viz.:—tuberculosis 9,574; typhoid or enteric fever, 1,200; diphtheria 16.218 ; and others, 327. 66 Lambeth Municipal Bacteriological Laboratory : Record of Work Carried Out during 28 Years, 1899-1926. On 8th December, 1898, the late Vestry of the Parish of Lambeth resolved to "provide a local Bacteriological Laboratory for the sole use of medical men practising in Lambeth Parish," and a room at the Wanless Road Disinfecting Station was fitted up and equipped for the purpose, and opened for work on January 1st. 1899, in connection with the routine bacteriological diagnosis of doubtful cases of tuberculosis, typhoid or enteric fever and diphtheria, and with other special bacterio logical examinations as the Medical Officer of Health might decide, During 1899, 389 samples were examined, and the yearly numbers increased as follows during the succeeding years :— No. of No. of No. of No. of. Year. Samples. Year. Samples. Year. Samples. Year. . Samples 1900 7.3 1907 786 1914 2,042 1921 1,010 1901 479 1908 718 1915 1,659 1922 989 1902 466 1909 781 1916 946 1923 824 1903 525 1910 603 1917 963 1924 1,019 1904 447 1911 976 1918 75i 1925 960 1905 1,874 1912 1,177 1919 901 1926 973 1906 761 1913 2,565 1920 1036 The growth of the work is best shown by comparing the separate yearly figures for the first four years (since the inauguration of the Laboratory) 1899-1902 (inclusive) and those for the last four years 1923-1926 (inclusive) with the average separate yearly figures for the intervening years 1903-1922 (inclusive) calculated decennially thus :— 1899. 389; 1900. 703; 1901, 479; I9°2y 466 ; Decennial Averages— 1903 to 1912 (inclusive) ... 864 8 1913 to 1922 (inclusive) ... 1,286-2 1923, 824; 1924, 1,019 ; I925» 96° : i9«6. 973- The totals of examinations made may be tabulated under the following separate headings as regards different suspected diseases :— Tuberculosis 9,574 Typhoid or " Enteric " Fever 1,200 Diphtheria 16,218 Others (Sundry or Special) 327 27,3 19 Full details are set out in the Table accompanying this Report. 67 The samples of sputum increased with the coming into force of the various sets of Tuberculosis Regulations, viz., the Public Health (Tuberculosis) Poor Law, 1908 (pulmonary iub(rculosis), which came into force on January 1st, 1909; the Public Health (Tuberculosis) Hospitals, 1911 (pulmonary tuberculosis), which came into force on May 1st, 1911; the Public Health (Tuberculosis) Private Cases, 1911 (pulmonary tuberculosis), which came into force on January 1st, 1912; and the Public Health (Tuberculosis) Consolidated, 1912 {allforms of tuberculosis), which came into force on February 1st, 1913. The nstitution of the " Sanatorium benefit"' (1911) for insured persons also increased the number of sputums examined at the Laboratory as well as at the two Tuberculosis Dispensaries. Pulmonary Tuberculosis, or consumption, had been voluntarily notifiable throughout the Borough of Lambeth since June 1st, 1902, and such voluntary notification became compulsory under the Tuberculosis Regulations—pulmonary tuberculosis (or consumption) under the 1908 and 1911 Regulations, and all forms of tuberculosis under the 1912 Regulations. The diminishing numbers of samples of blood submitted in recent years in connection with suspected " Enteric " fever are to be explained by the comparative rarity of the disease (typhoid or paratyphoid) within the Borough ; indeed, this particular disease may be regarded as practically non-existent, in so far as Lambeth Borough is concerned, though it is liable to be introduced sporadically from outside districts, or from abroad. Where the yearly numbers of doubtful diphtheria samples markedly exceed the averages, this fact is to be explained by the existence of sporadic outbreaks of diphtheria, or pseudo-diphtheria, in connection with the Norwood Schools (Poor Law), or other institutions, necessitating large numbers of systematic bacteriological examinations of "contacts," e.g., during the years 1900, 1905, 1912, 1913, 1914, and 191S- Outside the ordinary routine daily examinations for suspected germs of tuberculosis, typhoid or enteric fever, and diphtheria, other sundry or special examinations were connected with a variety of other cases, and may be grouped as follows -.— Tinea tonsurans (in hairs or skin), tubercle bacillus (in urine, pus, glands, tumours, pleuritic effusion), gonococcus (in urine, pus, uterine and vaginal discharges), malaria spores (in blood), sarcina ventriculi (in vomit), trichina spiralis (in ham), hydatid (in liver), spirochceta pallida (in pus), meningococcus (in cerebrospinal fluids, throats, and noses), anthrax bacillus (in skin discharges), o'idium albicans (in mouth), typhoid or Shiga bacillus (in foeces), staphylococcus and or streptococcus (in urine). e j 68 Urines were also examined microscopically and chemically for pus phosphates, oxalates, blood, albumen, and casts. Since the opening of the Lambeth Municipal Bateriological Laboratory, several very interesting special investigations have been carried out by the Medical Officer of Health, in addition to the ordinary daily routine departmental work. These special investigations are worthy of being recorded as follows 1. An outbreak of skin disease, known medically as Javus amongst three children of a family living in Coldharbour Lane, was traced to the same disease in mice, two of which were caught and examined, the infection being proved bacteriologically to be due to the achorion Schonleinii (favus skin disease). The cat in the same house was. also found to be suffering (round its mouth) from the same disease. It was found that the children were accustomed to play with mice of which some were infected and which were sufficiently tame to be accustomed to feed from the children's hands in the front of the fire in the dusk of the evenings. In that way, the children were directly infected. The cat had evidently had some closer relationship (mouth relationship) with an infected mouse,, or mice, to account for its own particular local infection 2. An outbreak of food poisoning (paratyphoid B bacillus) in connection with a large family in Brixton was traced to its source to a "carrier" of that particular disease-germ, the mother of the household, who in cooking the Sunday's joint, had, unknowingly, infected or inoculated, indirectly, the whole of the inmates of such household, nine persons in all, of whom two died, in connection with whose autopsies the particular germ (the paratyhoid B bacillus) was found in various organs, The actual infecting medium was proved to be gravy, which was served hot with the joint of beef (the Sunday joint). It may be added that, in the course of the inquests, the Coroner complimented the Borough Council's officials upon the energetic and careful way in which the bacteriological investigations had been carried out. 3. In connection with an outbreak of diphtheria and pseudo- diphtheria at a large lesidential institution for boys and girls situated in Ferndale Road, and belonging to the City of London Corporation, the deposit from the bath wastes was found on microscopical and bacteriological examination to consist of skin scales, soap, hairs, and dirt, together with the following germs, which were isolated, after cultivation with portions of the deposit upon nutrient plates:—Pseudo- 69 diphtheria bacilli (large numbers), Klebs-Loeffler diphtheria bacilli (a few), staphylococci, streptococci, torulce, sarcince, etc. 4. A detailed bacteriological examiniation of a bath brush-head, in use at Public Baths, was conducted by request of the Baths Committee. The following germs, actually found, after cultivation upon nutrient plates, made a museum, viz.: Proteus Zenkeri, bacillus prodigiosus, proteus vulgaris, bacillus fluorescens, bacillus liquefaciens, micrococcus, sarcina, torula, staphylococcus pyogenes aureus, streptococcus, bacillus coli, bacillus subtilis, various different moulds, etc. It is satisfactory to be able to report that no specific pathological germs, such as those of diphtheria, tuberculosis, typhoid, or enteric, etc., were found. The germs that were isolated were found to be thriving in a mixture of dirt, soap, hairs, debris, skin scales, organic matter, etc., surrounding (and in) the roots of the tufts of hairs or bristles of the brush, which are fixed into holes in the wooden framework of the brush-head, by means of wire, and on the inside of the thin wooden casing which is nailed on the back of the brush-head, the whole forming an excellent breeding ground for the germs, which were (a) liquefying (or putrefactive) bacteria, and (b) non-liquefying bacteria. It is clear that the ideal brush-head (sanitary), for public baths especially, should be made of an impermeable material, so as to be readily cleansible and capable of efficient disinfection from time to time. 5. Samples of soda water made from (a) Metropolitan Water Board water, and (b) deep artesian well water from a well in the grounds of a well known Lambeth manufacturer, showed the latter to be purer than the former, viz : 35 to 78 colonies of germs (on cultivation) per 1 cc. and 1 to 2 colonies of germs liquefying gelatine, as compared with 112 to 144 colonies per 1 cc. and 8 to 11 colonies of germs liquefying gelatine in the former, respectively. The deep artesian well water taken direct from the well was found to be purer still, viz : less than 10 colonies of germs per 1 cc. and no colonies of gelatine liquefying germs. 6. A raid was made upon ice-creams, and in several instances, the bacillus coli (a germ associated with sewage) was isolated therefrom; whilst a raid was also made upon tinned, canned, and otherwise preserved foods throughout 70 the Borough, but in one instance only (out of 31 samples) were the contents found to be non-sterile. 7. Samples of milk distributed for consumption throughout the Borough were, from time to time, taken and examined bacteriologically. They were found to contain germs ranging in numbers from 20,000 (lowest) to 5,200,000 (highest) per cubic centimetre, obtained after cultivation on nutrient plates, No pathological germs were found e.g., diphtheria, typhoid or "enteric" fever, or tubeiculosis. The need for the establishing and maintaining of bacteriological laboratories in large towns is now acknowledged, and the success of the Lambeth Bacteriological Laboratory is due to its local and central position and the fact that it is provided and maintained for the sole use of the Borough, thereby securing quickness of results for local practitioners, and that, too, at a mimimum of cost. Certain cases of infectious disease are so mild that clinical symptoms are, apparently, absent. These are the cases in which bacteriology comes to the help of diagnosis, but simply as an aid to diagnosis, and, in this connection, it must be remembered that, per contra, many thousands of " throat " patients in the case of suspected diphtheria are shown bacteriologically to be not suffering "from diphtheria. Similar remarks apply in the cases of patients suspected to be suffering from tuberculosis or from other doubtful infectious diseases, as the case may be Such results are invaluable, and save, at the same time, many notification fees to the Local Authority. Without the Lambeth medical practitioners making full use of the local Laboratory, its success would not have been so marked; indeed, the unexpectedly large extent to which the Lambeth Laboratory has been used has shown the superiority, in practice, of a local institution for the Borough (Lambeth Borough Council) as compared with a central institution for the whole of London (London County Council), the results being obtained, in the former case, more quickly and at a cheaper rate than would have been obtained in the latter case. These are facts that cannot be disputed. It has, however, always been realised by the Medical Officer of Health, and the opinion was stated very definitely in 1898. and has been repeated since, that, in the event of the Lambeth Bacteriological Laboratory proving a great success, which it has done, a specially trained bacteriological assistant would, sooner or later, be required to assist the Medical Officer of Health in the practical work. This has now proved to have become necessary at the present time. 7i LAMBETH MUNICIPAL BACTERIOLOGICAL LABORATORY. (Inaugurated by the late Vestry on December 8th, 1898). Table showing the numbers of pathological samples examined, and the results obtained at the Laboratory, during the four separate years, 1899, 1900, 1901, and 1902, with the yearly averages for the two decennia 1903-1912 (inclusive), and 1913-1922 (inclusive), and during the four separate years 1923, 1924, 1925, and 1926, together with the yearly averages for the 28 years, 1899-1926 (inclusive). Year. Sputa. Suspected Tuberculosis. Result of Examination. Bloods. Suspected Typhoid or " Enteric" Fever. Result of Examination. Throats and Noses (Membranes& Secretions) Suspected Diphtheria. Result of Examination. Other Sundry Samples and Special Examinations. Result of Examination, 1899 Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 33 57 90 40 41 81 101 115 216 — 2 2 1900 43 75 118 68 47 115 95 374 469 1 — 1 1901 52 93 145 50 48 98 48 185 233 1 2 3 1902 108 104 212 34 57 91 16 138 154 4 5 9 Averages 10 years: 1903-1912 85.1 149.1 234.2 163 35.0 51.3 43.5 5.94 562.9 6.1 10.3 164 1913-1922 57.6 406.9 564-5 6.0 I9.2 25.2 479 634.8 682.7 43 91 13.4 1923 17 218 235 1 14 5 7 564 571 1 2 3 1924 20 244 264 - I 2 12 10 731 741 — 2 2 x925 20 239 259 2 9 11 14 672 686 2 2 4 1926 22 242 264 2 10 1 2 10 682 692 2 3 5 Average 28 years: 1899 1926 97.9 2440 34.4 15.0 27.8 42.8 434 535.8 5792 4.1 7.6 11.7 N.B.—Since the Laboratory was inaugurated in 1898 (up to the end of 1926)—a period of 28 years—27,319 Examinations have been conducted in connection with the following suspected diseases, viz.:—Tuberculosis, 9,574; typhoid or "enteric" fever, 1,200; diphtheria 16,218 ; and others (sundry and special), 327 ; giving an annual average of 975.6 total samples. 72 73 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1926 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. I and under 2. 2 and under 5. 5 and under i5. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 '3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Smallpox. Scarlatina. Diphtheria. Fevers Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia & Pleurisy Heart Disease. Influenza. Injuries. Cer.-Spin., Polio, and Encephalitis Appendicitis. All other Diseases. Total. Puerperal. Enteric or Typhoid. (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Royal Hospital (Women and Children 82 32 7 6 5 1 10 18 3 Under 5 - - - - - - - - 9 - - 16 - - 3 - - 17 45 5 upwaros. - - - - - - - 1 - 1 - 1 5 - - - 1 28 37 General Lying-in Hospital, York Road 19 18 - - - - - 1 - Under - - - - - - - - - - - - - - - - - 15 18 5 upwards. - - - - - - - - - - - - - - - - - 1 1 St. Thomas's Hospital 473 59 22 17 21 30 95 165 641 Under 5 - - 2 - - - 1 - 8 - 1 17 - - 10 - 1 58 98 5 upwards. - - - 5 1 2 - - 1 - 11 17 31 - 22 - 11 274 375 Remainder of Lambeth Church 256 28 9 4 5 11 32 78 89 Under 5 - - - - - - 3 2 2 - - - - - 2 - - 17 41 5 upwards. - - - - - - - - - - 21 48 40 7 25 - - 73 215 Lambeth Workhouse - - - - - - - - - Under 5 - - - - - - - - - - - - - - - - - - - 5 upwards. - - - - - - - - - - - - - - - - - - - Lambeth Infirmary . 902 43 14 7 5 47 119 293 374 Under 5 - - 1 - - - - - 4 - 1 15 1 - - 2 - 37 64 5 upwards. - - 1 10 - 1 - - - 5 87 99 88 6 43 - 5 493 838 St. Peter's House 31 - - - - - - - 31 Under 5 - - - - - - - - - - - - - - - - - - - 5 upwards. - - - - - - - - - - 2 1 3 - - - - 15 31 Remainder of Kennington 248 23 11 6 6 11 19 63 399 Under 5 - - - - - - 8 - 4 1 - 11 - 2 3 - - 11 40 5 upwards. - - - - - - - - - - 19 44 35 9 18 - 1 72 198 South-Western Hospital 75 8 11 20 19 4 10 3 - Under 5 - 7 16 - - - 4 6 - - - 2 - - - 1 - 3 39 5 upwards. 4 11 7 1 - 1 - - - 1 - - 1 - 2 - 8 30 Clapham Maternity 19 17 - - - - 2 - - Under 5 - - - - - - - - - - - 3 - - - - - 14 17 5 upwards. - - - 1 - - - - - - - - - - - - - - 2 Remainder of Stockwell 368 32 5 3 8 12 20 103 185 Under 5 - - - - - - 7 - - - - 11 1 - 5 - - 16 40 5 upwards. - - - - - 1 1 - - 1 20 81 65 9 5 1 144 328 74 75 TABLE K. TABLE K [Local Government Board Old Table A.] Table of DEATHS during the year 1926 in the Borough of Lambeth, classified according to Diseases, Ages and Localities. Names ok Localities adopted for the purpose of these Statistics, public institutions being shewn as separate localities. Mortality from all Causes at subjoined Ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under I 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Smallpox Scarlatina Diphtheria Fe Vers 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) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Kings' College Hospital 315 27 4 13 18 20 53 130 50 Under 5 - - - - - - - 1 3 - 1 8 - 1 4 - - 26 44 Belgrave Hospital 119 79 19 14 7 - - - - 5 upwards. - - - 1 - 1 - - - 1 7 8 16 - 29 - 8 200 271 Under 5 - - 1 - - - 3 2 15 - - 20 1 - 1 2 - 17 112 Ministry of Pensions Hospital — - - - - - - - 1 5 upwards. - - - - - - - - - - - - - - - - - 7 7 Under 5 - - - - - - - - - - - - - - - - - - - 5 Upwards - - - - - - - - - - - - - - - - - - - Remainder of Brixton 490 36 7 7 6 7 40 127 260 Under 5 - - - - - - 3 2 1 - - 15 - - 4 - - 25 50 5 upwards. - - - - - 1 1 - - 1 76 102 13 15 - - 198 440 Lambeth Workhouse Schools 34 11 11 5 4 1 - 1 1 Under 5 - - - - - - 3 - 1 - - 12 - - - - - 11 27 5 upwards. - - - - - - - - - - 1 3 - - - - - 3 7 British Home for Incurables 12 - - - - - - 7 5 Under 5 - - - - - - - - - - - - - - - - - - - 5 upwards. - - - - - - - - - - - - - - - - - 12 12 Remainder of Norwood 453 23 6 4 5 12 26 117 260 Under 5 - - - - - - 4 4 1 - - 6 - 1 4 - - 13 33 5 upwards. - - - - - - - - - 3 24 58 87 10 9 1 1 225 420 Totals 3886 436 126 106 109 156 427 1105 1421 Under 5 - 7 20 - - - 37 17 48 1 0 152 3 4 41 5 1 229 668 5 upwards. - 4 12 25 2 6 s 1 1 12 226 437 482 55 166 3 28 1753 3218 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto 633 29 26 25 31 41 80 186 215 Under 5 - - 15 - - - 30 6 3 - - 6 - - 2 - - 17 80 5 upwards. 1 2 10 1 1 1 2 - - 58 33 70 1 41 - 8 324 553 Deaths occurring within the district among persons not belonging thereto 944 177 36 48 54 48 164 274 43 Under 5 - 7 8 - - - 4 4 29 - 2 48 2 1 13 2 1 140 261 5 upwards. 3 6 11 1 3 1 1 1 3 23 30 52 2 68 2 10 466 683 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 1926, in the Borough of Lambeth, classified according to Diseases and Localities. \ Local Government Board Old Table £.] Population at All Ages. Total Registered Births 1926 New Cases of Sickness in each Lorality, coming to the knowledge of the Medical Officer of Health during 1926. Registration SubDistricts. Census 1921. Estimated 1926 (middle of year). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. M easles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. Dysentery. § Puerperal Pyrexia. * Typhoid or Enteric. Continued Fever. Encephalitis Lethargica. Puerperal. (a) (b) (c) (d) Lambeth Church 45617 44350 2277 1 u8 207 2 — — 1 12 21 2 1 12 716 28 30 16 — 1 16 Kennington 44957 44840 1042 — n8 181 3 1 — 1 3 – 1 — 2 816 26 18 50 3 — 5 Stocknvell 63806 65950 1473 — 192 124 3 — — 3 8 17 1 — 13 1224 24 45 19 1 — 7 Brixton 81262 85510 1661 — 195 125 — 5 — 6 7 18 1 3 16 1403 75 6 19 2 - 13 Norwood 67318 70350 1044 — 120 79 1 1 — 3 5 19 1 2 10 990 70 9 10 — - 3 Totals 302960 31iooo 7497 1 743 716 9 7 — 14 35 86 6 6 53 5149 223 108 114 6 1 44 76 * Including 3 cases of paratyphoid fever, † Including 1 cabe of post basic meningitis. § Notifiable compulsorily since October 1st, 1926. ‡ Including 1 case of polio-encephalitis acuta. TABLE L—continued. Registration SubDistricts. Population at all Ages. Total Registered Births 1926 Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1926. Census 1921. Estimated 1926. (middle of year). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Erysipelas. f Cerebro-spinal Fever. I l'olio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. Dysentery rperal Pyrexia. * Typhoid or Enteric. Continued Fever. Encephalitis Lethargica. Puerperal. Lambeth Church 45617 44150 2277 1 113 205 2 — — 1 10 10 1 1 — 50 1 20 6 — — — Kennington 44957 44840 1042 114 179 3 1 — 1 3 9 1 – — 28 – 13 10 — — Stockweli. 63806 659 so 1473 — 185 120 3 — 5 4 1 — — 46 — 8 8 — — 1 Brixton 81262 85510 1661 — 175 123 — 4 — 3 8 5 1 1 3 27 — 3 4 — — 2 Norwood 67318 7035° 1044 — 109 78 1 1 — 3 5 9 — 2 2 136 - 3 1 — — — Total 302960 3iigoo 7497 1 696 705 9 6 — 8 31 37 4 4 5 287 1 47 29 – — 3 77 * Including 2 cases of paratyphoid fever. § Notifiable compulsorily since October 1st, 1920. t Including 1 case ol Post-basic meningitis. J Including 1 case of polio-encephalitis acuta. N.B.—In addition to the above new cases of infectious sickness coming to the knowledge of the Medical Officer of Health by compulsory medical notification under the Notification Clauses of the Public Health (London) Act, 1891, or the Orders and Regulations made thereunder, the following cases wete reported voluntarily, viz, : Chicken 1'ox 824. Measles 1496, Cancer 96, and Whooping Cough 508 Local Government Board New Tables. TABLE 1. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1926 AND PREVIOUS FIVE YEARS (1921–25). Year. Population estimated to Middle of each Y ear. Births. Totai. Deaths Registered in District. Transferabi e Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. * Rate. of Nonresidents registered in the District, † of Residents not registered in the District, † Under 1 Year of Age At all Ages. Number. * Rate per 1,000 Nett Births. Number. Rate, Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 §1921 305700 8993 6644 21.7 4195 18.7 1164 684 511 76.9 3715 I2.1 §1922 307000 8449 6364 20.7 4445 14.5 917 724 500 78.6 4252 13.8 1923 308500 8344 6195 20.1 3848 12.5 951 650 359 57.9 3547 11.5 1924 309300 7891 5934 19.2 4198 13.6 976 697 397 66.9 3919 12.6 1925 311100 7663 5543 17.8 4116 13.2 998 734 353 63.7 3852 12.4 Average 5 years 1921-1925 308320 8268 6136 19.9 4l60.4 14.5 1001.2 697.8 424 68.8 3857 12.5 1926 311000 7497 5359 17.2 3886 12.4 944 693 293 54.5 3635 116 78 § N.B.—The populations estimated for 192 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 1 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 (2424 outward and 280 inward transfers). *In Column 6 are included the whole of the deaths registered daring the year as having actually occurred within the Borough. In Column ]2 is entered the number in Column (j, corrected by subtiaction 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. t 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 and 1922 are the civil populations only. Regibtrar-General supplied the particulars of extra transferable deaths (tjO) 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 nett deathrate of the Borough. Census, 1921. f Area of Borough in acres (including land and inland water 408S. ' Average number of persons per house (estimated), 7*1 I Number of inhabited houses, 42007. [Total population at all ages, 3028G8. Local Government Board New Tables TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF 1-AMBETH DURING THE YEAR 1926 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. Kenningicn. Stockwell. Brixton. Norwood. Under 1 to 5. 5 '0 I5- 15 to 25- 25 to 45- 45 to 65. 65 and upwards. Small-pox 1 — — — — — — — — — — — — 1 holera — — — — — — — — — — — Diphtheria (including Membranous Croup) 725 11 249 360 59 39 7 — 209 184 127 125 80 716 Erysipelas 80 3 5 6 6 23 28 15 21 11 17 18 19 37 Scailet Fever 743 4 207 443 58 28 3 — 118 118 192 195 120 696 Typhus Fever — — — — — — — — — — — — Enteric Fever (3 paratyphoid fever) 7 — — 1 3 2 t — 1 — 5 1 6 Relapsing Fever — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — Puerperal Fever 35 — — — 10 25 — 12 3 8 7 5 31 Puerperal Pyrexia § 44 — — 10 34 — 16 5 7 13 3 3 Plague — — — — — — — — — — — Pulmonary Tuberculosis* 446 1 3 24 93 205 110 io 76 78 88 133 71 — Other Forms of Tuberculosis ioi 2 — 35 11 19 3 24 21 19 21 16 — Cerebro-spinal Fever (1 post-basic meningitis) 6 2 2 — 1 — 1 2 1 1 1 1 4 Polio-myelitis acuta (1 polio-encephalitis acuta) 0 — 4 1 1 — — 1 — — 3 2 4 Encephalitis Lethargica 14 — — 3 1 4 5 i 1 1 3 6 3 8 Ophthalmia Neonatoiuin S3 53 — — — — — — 12 2 13 16 10 5 Measles 5149 226 2509 2313 70 27 4 716 816 1224 1403 990 287 German Measle 223 15 69 104 26 9 — 28 26 24 75 70 1 Malaria 6 — — — — 5 1 — 3 1 2 — — Dysentery 1 — — — — 1 — 1 — — — — — Primary Pneumonia Acuta 108 12 31 16 9 18 12 10 30 18 45 6 9 47 Influenzal Pneumonia Acuta 114 4 18 11 18 30 26 7 16 50 10 19 10 29 79 Isolation Hospitals, Name and Situation—Hospitals of the Metropolitan Asylums Board (one situated in the Stockwell Sub-District and Stockwell Waid 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 ^notifications (16(3) ot pulmonary tuberculosis, and notifications under Form C (410) and under Form D,(328) of the 191- Regulations, † Excluding all renotifications (7) of non pulmonary tuberculosis, and notifications under Form C (83) and under Form D (46) of the 1912 Regulations. ‡ Measles and German Measles became compulsorily notifiable within the Borough of Lambeth on January 1st, 1916, and are still compulsorily notifiable $ Notifiable compulsorily on October 1st, 1926. Local Government Board New Tables. Table III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1926. BOKO UGH OF LAMBETH. Causes or Death. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the District (<i). Total Deaths whether of " Residents " or " Nonresidents " in Institutions in the District 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 ar*d under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 3635 3635 293 116 83 90 153 355 1033 1511 Uncertified — — — — Typhus Fever — — — — — — — — *Enteric Fever 2 — — — 1 1 2 Continued Fever — — — — — — — — — Small-pox 1 — — — — 1 — — — Measles 68 13 35 14 5 — — 1 — 12 Scarlet Fever 4 1 2 1 — — — 11 Whooping Cough 19 10 6 3 — — — — 10 f Diphtheria and Croup (ee note (d)) 43 1 12 14 15 — — 1 — 32 Influenza 57 1 1 1 1 12 20 21 8 Erysipelas 4 — — — — — — 2 2 4 *Cerebro-Spinal Fever 4 2 — 1 1 — — — 7 * Polio-myelitis acuta — — — — — — — — – Encephalitis Lethargica 5 — — — — 2 3 — — Venereal Diseases 23 5 — — — 3 11 4 — Phthisis (Pulmonary Tuberculosis) 272 1 — 5 62 103 87 14 112 Tuberculous Meningitis (See note (e)) 34 3 5 11 7 7 — 1 — Other Tuberculous Diseases 26 5 1 5 4 2 6 3 — Rheumatic Fever 23 — — 1 3 2 8 6 3 7 Cancer, malignant disease (See note (/)) 493 — — — 3 2 29 233 226 8c Bronchitis 272 1 6 3 2 — 8 64 178 Broncho-Pneumonia 122 41 18 14 3 2 5 16 23 269 Pneumonia (all other forms) 154 9 6 2 3 3 18 50 54 Other diseases of Respiratory organs 47 1 — — — — 5 16 25 — Diseases of Circulatory System 688 1 — 1 6 12 35 180 453 155 Diseases of Nervous System 251 9 5 2 2 7 20 87 119 — Diarrhoea (See note (g)) 22 19 3 — — — — — — 41 Enteritis 27 20 2 1 — — 1 2 1 — Appendicitis and Typhlitis 26 — — — 2 4 2 12 6 26 Alcoholism [See note (h)) 5 — _ — — — 1 2 2 — Cirrhosis of Liver 19 — — — — — 5 11 3 — Nephritis and Bright's Diseases 122 2 — 1 4 3 7 39 66 — Puerperal Fever (See note (i)) 21 — — — — 8 10 2 1 24 Other accidents and diseases of Pregnancy and Parturition 9 — — — 9 — — Congenital Debility and Malformation, including Premature Birth (See note (j)) 10 3 98 — — 4 1 — — — — Violent Deaths, excluding Suicide 137 20 2 8 12 13 19 31 32 135 Suicides 44 — — — — 3 16 21 4 Other Defined Diseases 485 25 9 4 7 16 33 1 120 271 1216 Diseases ill-defined or unknown 3 2 — — — — — — 81 Notes to Table iii. a) All " Tiansferable Deaths" of lesidents, i.e., or persons resident in the Dislrict who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term " transferable deaths" see footnote to Table I. The total deaths in column 2 of Table III. equal the figures for the year in column 12 of Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or non-residents, are entered in the last column of Tabic III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as 4* Certified " ; all other deaths are to be regarded as '• Uncertified." d) This heading includes all deaths from croup except those certified as due to "spasmodic," "stridulous," " catarrhal." or ' false," croup. (e) Under "Tuberculosis Meningitis" are included deaths from Acute Hydrocephalus. (f) Under "Cancer" are included deaths under such headings as Carcinoma Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. (g) Under this heading are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Choleraic diarrhoea, Cholera (other than Asiatic), Gastro-enteritis, Gastro-intestinal catarrh, Muco-enteritis, Colitis, etc. Deaths from Diarrhoea secondary to some other well-defined disease are included under the latter. (h) Under this heading are included deaths from Delirium tremens, acute and chronic alcoholism etc., but not those certified as due to organic disease attributed to alcoholism. The number of the latter may with advantage be stated separately, though this statement cannot be included in Table III. (i) Under ''Puerperal Fever" are included deaths under such headings as Pyaemia, Septicaemia, Sapraemia, Pelvis peritonitis, Peri- and Endometritis occurring in the Puerperium. (J) Under this heading are included also deaths from Atrophy and Marasmus of Infants, and want of Breast-milk, but not from Atelectasis. * Including Paratyphoid fever Post-Basic Meningitis and Polio-encephalitis acuta respectively. † No deaths registered from Croup. F Local Government Board New Tables. TABLE IV. BOROUGH OF LAMBETH—INFANTILE MORTALITY, 1926. 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 1-3 months. 3-6 months. 6-9 months. 9 12 months. Total Deaths under 1 year. All Causes Certified 94 15 12 10 131 58 34 40 30 293 U ncertified — — — — — — — Chicken Pox — — — — — — — — — — Measles — — — — — — — 3 10 13 Diphtheria — — — — — — — 1 — 1 Whooping Cough — — — — — 2 3 3 2 10 Diarrhoea — I I 1 3 4 4 6 2 19 Enteritis — 2 1 3 8 6 3 — 20 Influenza ... — — — 1 — — 1 Cerebro-Spinal Fever — — — — — — 1 — 1 2 Phthisis — — — — — — — — — — Tuberculous Meningitis — — — — — 1 — 1 1 3 Other Tuberculous Diseases — — — — — — — — — — Cerebral Haemorrhage 2 — — — 2 — — — — 2 82 Congenital Malformation 8 3 — It 5 1 1 1 16 Premature Birth 54 4 i I 6o 6 — — — 66 Atrophy, Debility and Marasmus 2 i 2 2 7 3 1 1 — 12 Atelectasis 4 — I 5 1 — — 1 7 Epilepsy — — — — — — Syphilis — — I I 2 2 1 — — 5 Rickets — — — — — — Meningitis {not Tuberculous) — — 1 — 1 — 2 Ulcerated Colitis — — — — — — — Convulsions 3 i 4 1 — 1 1 7 Gastritis — — — — 1 — — 1 Intussusception (acute) — — — 2 — 1 — 3 Dentition — — — — — 1 — 1 Pleurisy — — — — — — — — Bronchitis i i I 3 3 3 1 1 11 Pneumonia i i I 3 1 1 1 6 Broncho-Pneumonia 2 — 2 4 12 9 8 8 41 pleuropneumonia — 1 1 1 — 1 — 3 Rheumatism — — — — — — Want of attention at birth 3 — 3 — — — — 3 Suffocation, overlaying 3 i 4 — — — — 4 Accident, other than Suffocation 2 — I 3 — — 1 — 4 Nephritis (Acute) — — — — — — 1 1 — 2 Icterus Neonatorum 2 1 3 — — — — 3 Cirrhosis of Liver Asphyxia 4 — 4 1 1 — — 6 Other causes not classified above 3 1 1 1 6 3 2 4 1 16 Totals 94 15 1 2 10 131 58 34 40 30 293 831 84 LAMBETH BOROUGH.—Corrected Deaths Note.—The Deaths of Non-residents occurring in Public Instituoccurring in Public Institutions situated beyond the limits of the (A) REGISTRATION Sub-Districts. Lambeth Church. Svemiiiigton. m. F. m. F i.—Specific Febrile, or Zymotic Diseases 33 29 31 26 II.—Parasitic Diseases — — — — III. —Dietetic Diseases — — — — IV.—Constitutional Diseases 69 59 70 79 V.—Developmental Diseases 18 25 16 26 VI.—Local Diseases 171 145 149 169 vii.—deaths from Violence 26 11 14 9 VIII.—Deaths from Ill-defined and not Specified Causes 5 — 1 2 Totals 322 269 280 311 (B.) AGE AGE Under 1 Year. 1-2 2-5 Under 5 Years. 5-15 M. F. M. F. M. F. M. F. M. F. I.—Specific Febrile ok Zymotic Diseases 37 14 32 26 18 16 87 56 15 7 II.—Parasitic Diseases — — — — — — — — — — III.—Dietetic Diseases — — IV.—Constitutional Diseases 3 1 7 6 3 10 1.3 17 12 12 V.—Developmental Diseases 41 49 — — -- — 41 49 2 2 VI.—Local Diseases 57 8 S2 2S 20 20 8 ico 80 17 10 VII.—Deaths from Violence 12 1 1 6 2 15 15 7 2 VIII.—Deaths from Ill-defined and not Specified Causes 9 5 — — — — 9 5 — Totals 155 133 63 53 47 36 265 222 53 33 85 registered from all causes during the year 1926 tions in the District are excluded, and the Deaths of Residents District are included. SUB-DISTRICTS. Sub-Districts. Total. Stockwell. Brixton. Norwood. All Ages. M. F. M. F. M. F. M. F. 35 23 32 23 25 18 156 119 275 1 2 1 1 — — 2 3 5 102 1 oh 124 135 66 99 431 478 909 18 28 19 49 21 35 91 163 254 209 187 245 285 194 193 968 979 1947 24 10 26 12 24 13 114 55 169 1 2 3 2 — — 10 6 16 390 358 450 507 330 358 1772 1803 357 5 PERIODS. PERIODS. Total. 15-20 20-25 25-40 40-45 45-60 6065 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. 3 1 2 6 4 12 7 6 17 12 8 4 13 15 69 63 156 119 275 — — — — 1 1 — 1 1 2 3 2 3 5 14 20 17 28 43 55 25 18 125 119 50 59 132 150 418 461 431 478 909 — — — — — — — — — — — — 48 112 50 114 91 163 254 10 6 15 12 40 55 28 18 21 i 172 125 61 420 565 868 899 968 979 1947 5 2 5 2 16 4 8 2 28 9 10 3 20 16 99 40 114 55 169 — 1 — — — — — — — — — — — — 7 1 10 6 16 32 30 39 48 104 127 68 44 384 313 193 127 634 859 1507 1581 1772 1805 3575 (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 1541 1615 3156 I. Miasmatic Diseases 117 88 205 2. Diarrhoeal ,, 17 5 22 3. Malarial „ — VI.—Local Diseases—continued. 4. Zoogenous ,, — — — 6. Diseases of Lymphatic System 4 3 7 5. Venereal „ 18 s 23 7. Diseases of Gland-like Organs of 6. Septic „ 4 21 25 Uncertain Use 1 8 9 8. Diseases of Urinary System 96 80 176 II.—Parasitic Diseases — — — 9. Diseases of Reproductive System — — — III.—Dietetic Diseases 2 3 5 (a) Diseases of Organs of Generation — 16 16 (b) Diseases of Parturition — 9 9 IV.--Constitutional Diseases 431 478 909 10. Diseases of Bones and Joints 3 5 8 11. Diseases of Integumentary System 3 6 9 V.—Developmental Diseases 91 163 254 VII.—Violence. VI.—Local Diseases. 1. Accident or Negligence 81 45 126 1. Diseases of Nervous System 124 124 248 2. Homicide — — — 2. Diseases of Organs of Special Sense 12 4 16 3. Suicide 33 10 43 4. Execution — — 3. Diseases of Circulatory System 310 3b7 677 5. Battle — — 4. Diseases of Respiratory System 308 280 588 5. Diseases of Digestive System 107 77 184 VIII—Ill-defined and not Specified Causes 10 6 16 Carried forward 1541 1615 3156 Total 1772 1803 3575 86 87 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, etc., FOR 1926. 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 1926—311,000 (males 145,320, and females 165,680). Density—76^2 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected)—7,497, being 241 per 1,000 population. Deaths (corrected)—3,575, being 11-5 per 1,000 population. Infantile Mortality (corrected)—288 deaths (corrected) under 1 year, being 38 4 per 1,000 total (uncorrected) births, or 49-8 per 1,000 total (corrected) births.* Zymotic Death-rate (corrected)—0-5 per 1,000 population (total corrected zymotic deaths, 160). * Corrected as to outside institutional births only. 88 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 ist January to the 31st December, 1926. Number of Notices served ... ... 17,069* A. COMPULSORILV NOTIFIABLE INFECTIOUS DISEASES! (Public Health (London) Act, 1891). No. of Notices served 7321 No. of Infected Houses 6401 Small Pox 1 Scarlet Fever 689 Typhoid and Para-typhoid Fever 7 Diphtheria 630 Membranous Croup 8 Continued Fever — Puerperal Fever 35 Erysipelas 86 Cerebro-Spinal Fever and Post-Basic Meningitis § 6 Acute Polio-Myelitis§§ 6 Ophthalmia Neonatorum 51 Measles 4393 German Measles 215 Primary Pneumonia 107 Influenzal Pneumonia 114 Encephalitis Lethargica 14 Malaria 6 Dysentery 1 Trench Fever Anthrax — Puerperal Pyrexia 32 B. GENERAL NUISANCES AND DRAINAGE DEFECTS. (Public Health (London) Act, and Metropolis Local Management Acts). No. of Notices served*† 9736 Works, Structural— Drainage, Defective 246 Intercepting Traps with Fresh Air Inlets required, or defective 112 * Including Measles and German Measles, but excluding notices under the Housing Acts, t Excluding Tuberculosis. 3 cases of Para-typhoid. § 5 cases of Cerebro spinal Fever and 1 case of Post-basic meningitis. §§ I case of Polio-encephalitis acuta, and 5 cases of Polio-myelitis acuta. Works, not Structural— Cisterns Dirty ... ... ... ... ... ... 5 Manure Accumulations ... ... ... ... 32 Underground Rooms illegally occupied ... ... ••• . 7 Effluvia and Smoke Nuisances... ... ... ... ••• 5^ Animals Improperly Kept ... ... ... ... ••• 28 Stopped Drains ... ... ... ... ... ■ • • ■ • • 34° Overcrowding ... ... ... ... ... ... 29 Foul Urinals ... ... ... ... ... ••• ••• IO Refuse Accumulations ... ... ... ... ... ... 13° No Water Supply or Defective VVater Supply... ... ... 53 Dirty Premises ... ... ... ... ... ••• • •• 2494 Stagnant Water Accumulations ... ... ••• 22 Rats Nuisance ... ... ... ... ••• '77 bakehouses Dirty ... ... ••• ••• M3 Lighting and Ventilation Insufficient ... ... ... ... 64 Plunging Eye defective... ... ... ... 9 3,601 89 Ventilating Pipes defective or wanting 118 Indoor Sinks defective or direct to Drain 477 Rain Water Stacks connected with Drain or defective 551 Bath Waste connected with Drain or defective 8 Closet Pan and Connections Defective 315 Water Supply to Closet Defective 287 Closet Dilapidated 122 Draw-off Main for Drinking Purposes required 7 Dust Bins Defective 506 Premises Dilapidated 162 Roofs Dilapidated 1099 Soil Pipes Defective 70 Paving Defective 367 Damp and Unwholesome houses 652 Defective Water Pipes, Taps, &c 115 No W.C. Accommodation 5 Copper, Fireplace, or Chimney, &c., defective 425 Manhole defective 27 Windows, Floors, Doors, &c., defective 678 Gullies defective, or stopped 106 Cistern defective 24 Dung Receptacle required 6 Walls and Ceilings defective 937 Washhouses dilapidated 31 Stables unsuitable 1 7,454 9° PARTICULARS OF SANITARY WORK carried out by the Male Sanitary Staff (District Inspectors) in Lambeth Borough during 1926, and during the 5 previous years (1921-1925), 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. 1926 17069 7454 3601 1925 14052 7769 3628 1924 15368 7430 3643 1923 12921 1901 3615 1922 16193 7878 3641 1921 16580 8093 3983 Yearly Average for 14796-5 105699 41067 20 Years 1901- 1920 (Borough) Yearly Average for 5944-6 4756 9 21359 24 Years 1877- 1900 (Parish) 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 1926. Inspections 12083 Re-inspections 38590 Complaints attended to 5534 91 Water Certificates issued* 157 Revenue Act certificates dealt with — Drains tested (with chemical, water or smoke test) 4399 Sanitary Works completed 5878 Samples of Food and Drugs taken 2000 Notices- Public Health (London) Act, 1891 (Preliminary or Intimation 5835 and Statutory 3901) 9736 Metropolis Local Management Acts 12 Sanitary Nuisances abated— (a) Structural 7454 (b) Non-structural 3601 Summonses issued— Public Health Actt 4 Food and Drugs Acts 13 Margarine Actsg 1 N.B.—In addition to the above, the 12 District Sanitary Inspectors carried out during [926 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 265 houses (43 being in blocks) and 265 tenements. † 4 convictions. 1 conviction, 11 summonses dismissed, and 1 summons not heard owing to death of defendant. 1 summons dismissed. 92 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. Infected Houses and Drainage Defects found by Male Inspectors. 4 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 1,482 infected houses dealt with during 1926, the results are as follows, the averages being given in brackets for the past 25 years, 1891-1915 :— (a) 22, i.e. 148 percent, were found to have defective drains, i.e. a result was obtained with the chemical test employed (average = 14-3 per cent.). (b) 645, i.e. 43-52 per cent, showed defects in drains, traps, fittings and appliances (average = 53-1 per cent.). (c) 815, i.e., 54-99 per cent, showed no defects (average = 46-9 per cent.). Registration of Cow-houses, Slaughter-houses, Common Lodging-houses, and Milk Shops. During 1926, three Cow-houses,t ten Slaughter-houses, J 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 foi 1926 comparable with those for past years. The figures for measles and German measles infected houses during 1926 are:—3 defective drains and 678 defective traps, fittings, and appliances, out of a total of 4,608 infected houses inspected. No testing of drains is carried out as a routine in the case of ophthalmia neonatorum and tuberculosis-infected houses. t 3 cow-houses—Elder Road Dairy, 76 and 78, Gipsy Hill, and 38, Hartington Road, J 10 slaughter-houses—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, 4 S, New I 'ark Road. § 4 common lodging houses—19, Belvedere Crescent, 108, Lambeth Walk, 106, Wandsworth Road, 90-92, Westminster Bridge Road. 93 as " suitable," i.e., in accordance with the Council's requirements :— *43, Bowling Green Street, (Fricker, Jessie K. and Thomas), 14, Brooklands Street, 31, Carnac Street (rear of), 322B, Ccldharbour Lane, 430, Coldharbour Lane, 3A, Dolland Street, 101, Dorset Road, * 18, Fraziei Street, (Donald, Robert Morris), 197, Gipsy Road, *117, Hartington Road, (Wilcox Farm Dairies, Ltd.), *129, Hartington Road (Wilcox Farm Dairies, Ltd,), 89, Landor Road, 72, Larkhall Lane (rear of)—7 separate applications by 7 different occupiers, 73, Larkhall Lane, 61, Lingham Street, *45, Lowden Road (Fulker, George F.), 16, Meadow Road, i6a, Meadow Road, 67, Milkwood Road, *76, New Cut (Evans, Thomas John), *118/120, Norwood Road (Curtis Bros., & Dumbrill, Ltd.), 29, Osborne Terrace (rear of), *16, Pearman Street (Ball, John), *36, Portland Place South (Bastow, Mrs. Annie J.), *Priory Mews off Priory Grove (Enderby, John Thomas), Priory Mews off Priory Grove, 116, Railton Road, 126, Railton Road, *i03A, Rosendale Road (Curtis Bros. & Dumbrill, Ltd.), 59A, St. Agnes Place (rear of), 5, Stockwell Green, *58, Stockwell Green (Bond Henry), 3, The Pavement, West Norwood, *23, Tower Street (Williams, Annie Jane), 95, Upper Kennington Lane, *3, Upper Tulse Hill (Curtis Bros, & Dumbrill, Ltd.), 35, Vauxhall Street, *52, Walnut Tree Walk (Rowling, Joseph J.J.), 9, Westow Hill. N.B.— 20 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 :— 28, Barnfield Road, 119, Strathleven Road. Revenue Act, 1903 (and Section 33 of the Housing,, Town Planning, etc., Act, IQ09.) No certificates were applied for in connection with tenements (or dwellings) * Under '.he Milk and Dairies Order 1926 (which came into force on October 1st 1926, as regards registration) persons and "dairy" premises botn require registration by the Local Authority and, consequently, the names of the persons registered are given above in brackets after each " dairy " premises, so registered. 94 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 licence for 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 1926. Workshops* visited and inspected— (a) Dressmakers 67 (b) Milliners 17 (c) Laundries 34 (d) Tailors 35 (e) Upholsterers 6 (f) Dyers 1 <g) Blouses 5 (h) Ties 9 (i) Bottling 8 (j) Children's Clothing 4 (k) Florists 5 (1) Boxes and Bags 10 (m) Furriers 2 (n) LampShades 1 (o) Metal etc. Polishes 4 (p) Printers 11 (q) Underclothing 3 (r) Valet service 6 (s) Waste Paper 2 (t) Toilet Requisites 2 (u) Others {e.g.), bag-making, trunks, foods, tobacco, &c. 40 Workshops*: workrooms therein measured 53 Workshops*: newly discovered and registered 40 t Premises visited, but. not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 1120 * Workshops include Work-places. i Births (57), Workshops (143), Tuberculosis cases (192), Private Houses (118), Outworkers (484), Rheumatism cases (4), Tonsils and Adenoids cases (122). 95 Female Conveniences visited and inspected— Public (visits paid) 830 Private 1 Schools visited— Public (visits paid) — Private — Special places visited and inspected— (a) Private Houses* 740 (b) Outworkers 145 Workshops (o), Outworkers (4), and Private Houses (225)† reinspected 229 Written Intimation and Statutory Notices served 122 No. of Workshops‡, etc., in which defects were found 122 No. of Workshops‡, etc., in which no defects were found 1024 Nuisances referred to M.O.H., for attention by Male Inspectors 14 Particulars of Defects found by Female Inspectors. Workshops‡, etc.— W orVrooms— Overcrowded, Damp, Dirty, etc. 9 Defective or Dirty— Yards, Floors, Roofs, Windows, Ceilings, Rain Water Pipes, Sink Wastes, or Premises generally 85 Sanitary Appliances : Water Closets— Dirty, unventilated, choked, Defective or with Defective Tanks or Water supplies 58 Sanitary Appliances : Drainage- Defective 4 Sanitary Appliances : Dustbins— Wanting or Defective 6 I.avatories—Dirty or Defective 0 No separate suitable sufficient W.C. accommodation for the sexes 3 Miscellaneous Defects, e.g., Defective Chimneys 8 * Tuberculosis cases (260), Ophthalmia cases (6), School children (281, e.g., enlarged Tonsils and Adenoids 278 and Rheumatism 3), Housing Enquiries (16), special complaints (31), Expectant Mothers (69). Births (61) and Stillbirths (16) † Tuberculosis cases (46), Investigations re Ophthalmia Neonatorum (4), Enlarged Tonsils and Adenoid cases (13), Expectant Mothers (7), Births (96;, Housing (3), and special complaints (56). ‡ Workshops include Work-places. 96 Summary of Work Carried Out (Total Visits Paid) by thk 4 Whole-time Official Health Visitors during 1926. Births* 3030 Welfare Centres and Maternity Home attenddances) 695 Still-births 133 Ophthalmia neonatorum cases* 298 School children 38 Epidemic diarrhoea cases 44 Expectant mothers (visits) 891 Milk Depot (attendances) Special inspections 596 Depot children (visits) 174 N.B.—In addition to the above, 1,414 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 158 visits to children between 1 and 5 years, viz. : Births 72, enlarged tonsils and adenoids 72, tuberculosis 14. FACTORIES AND WORKSHOPS. Factories. 6 new factories were added to the Register, dealing with (a) Children's Dresses, 1 ; (b) Dress-making, 1 ; (c) Ink and Wax Manufacturing, 1 ; (d) Laundry Work, 2 ; (e) Pleating, 1. Workshops. 38 new workshops (including 3 Domestic workshops) were added to the Register, dealing with:—Baby Linen, 1; Bakeiy, 1 ; Box-making, 1 ; Cleaning and Pressing, 1 ; Dress-making, 11 ; Embroidery, 2 ; Engineering, 2 ; Essence-making, 1 ; Florist, 1 ; Glass goods, 1 ; Lace goods, 1 ; Mantles, 2 ; Neckwear, 1 ; Polishes, 1 ; Shoes, 1 ; Tailoring, 7 ; Theatrical Clothing, 1 ; Upholstery, 1 ; Wireless apparatus, 1. * Including revisits as follows:—Births 2,462 (of which 1,472 were paid to children between 1 and 5 years of age), Ophthalmia neonatorum cases 208. † Special enquiries infectious diseases. § Including housing, 308 (visits); infantile deaths, 167 (visits); tuberculosis, 68 (visits); and puerperal pyrexia, 15 visits. 97 OUT-WORKERS, 1926. 6 February and 6 August lists were received, dealing with 41 and 38 out workers respectively. Of the 79 out-workers, 33 belonged to Lambeth and 46 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 132 lists were received from various outside authorities dealing with 760 workers, of whom 754 belonged to Lambeth and 6 to districts outside Lambeth. Of the total Lambeth out-workers reported, 57 were new outworkers, i.e., out-workers not previously registered, as follows : Baby Linen 1 Blouses 4 Chamois Leather 1 Children's Dresses 2 Dressing Gowns 1 Dress-making 3 Embroidery 3 Fancy Goods 1 Hats 2 Lace Goods 2 Mantles 1 Neckwear 3 Needlework 1 Nursery Boots 1 Nurses Uniforms 1 Pattern Cards 1 Rag Dolls 2 Shoe Trimmings 1 Tailors 8 Ties 4 Umbrellas 1 Underclothing 2 Wearing apparel 6 Woollen goods 5 Total 57 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, but no approval has yet been given by the Ministry of Health in regard thereto Representations and Closing Orders Section 9 of the Housing Act, 1925. During 1926, no representations to the Council under Section 9 of the 1925 Housing Act were made and, consequently, no Closing Orders were issued by the Council.* V ide foot note Annual Report 1925 p. 95. 98 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 3 of the Housing Act, 1925. During the year 1926, 676 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 127 of the Housing Act, 1925. 414 Surveys or Inspections have been made, under the Housing Inspection Regulations of the Housing Act, 1925, and 413 Provisional (or Informal) Schedules prepared, as suggested by the Ministry of Health in its Manual on Policy and Practice (Volume I, Chap. 6, paragraph i), setting forth the work required to render the houses fit in all respects for human habitation, under Section 3 of the Housing Act, 1925. 414 Record Cards have been filed, 414 visits, and 11,691 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 (1926), 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 : Bishop's Ward. VVaxwell Terrace (16). Prince's Ward. Andersons Walk (19), Auckland Street (50), Burnett Street (12), Clayton Street (1), Fairford Grove (27), Goding Street (24), Harts Cottages (5), Kennington Boad (2), Pheasant Cottages (7), Tiflis Cottages (12). Brixton Ward. Warham Street (209). 99 Stockivell Ward. Brighton Terrace (29), Fulross Road (1). During the 12 months 1 legal schedule has been served by the Council (21, Pulross Road), and the work has since been carried out by a Contractor, acting on behalf of 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 IVard. Linnett Street (Nos. i8i, 20, 24, 26, 27, 30). Stockivell Ward. Pulross Road (No. 21). Heme Hill IVard. Margate Road (Nos. 23, 25, 27, 29, 31, 33, 35, 37, 39, 51). (2) After service of provisional (or informal) schedules Marsh IVard. Johanna Street (Nos. 22 to 28 even), Starling Place (No. 13}. Prince's IVard. Auckland Street (Nos. 2, 3, 7 to 18, 21, 22, 24, 31, 32, 33, 35, 38, 42 to 45, 50, 51, 54, 58 consecutive), Bloomfield Place (Nos. 1, 2, 3, 4, Burnett Street (Nos. 1 to 12 consecutive), Clayton Street (Nos. 5, 7, 34, 36, 58), Esher Street (Nos. 5 to 8, 17 to 26, consecutive, and 40), Coding Street (Nos. 1 to 31 consecutive), Kennington Road (Nos 233> 235> 257> 259), Leopold Street (Nos. 2, 3, 4, 5, 8, 10 to 25 consecutive), Lower Kennington Lane (Nos. 113, 115, 117, 125), Pheasant Cottages (Nos. 1 to 7 consecutive), Tiflis Cottages (Nos. 1 to 9, 9a, 10, 11, 12 consecutive), Vauxhall Street (Nos. 18 to 34, 40 to 46, 62, 66 to 74, 78 to 86, 114, 124 to 140, 172 to 182 even. 59, 63, 65, 71, 77 to 83, 119, 123 to 131, 133a, 137a, 139a odd). Stockwell Ward. Brighton Terrace (Nos. 1 to 17, 21 to 37 odd, 16 (6 separate flats), 18 (6 separate flats), 18a (6 separate flats), 24 to 44 even), Northall Street (No. 4). *21, Pulross Road.—Surveyed 2/2/26, no provisional schedule served, legal notice served, 10/2/26 (time-limit given being 42 days), order to do work by the Council given 13/5/26, tender {£77) accepted by the Council 1/7/26. 6 2 IOO Brixton Ward. Farmers Road (Nos. 144 to 184, 152 to 174, 198, 212, 216 even), Warham Street (Nos. 1, ia, 2, 2a, 3 to 25, 47, 49, 77. 79. 85 to 99, 137 to 141, 147, 149, 155, 169 to 175, 181 to 187, 215 odd, 6, 24 to 48, 62 to 80, 96a, too, 102, 124, 126, 148, 148a, 148b, 160, 162, 188 even). Tulse Hill Ward. Mauleverer Road (Nos. 15, 17). IS/orivood Ward. Dunbar Street (Nos. 37, 61, 63), Dunkirk Street (Nos. 19, 25, 29, 33- 35. 38. 40. 42). Durban Road (Nos. 1 to 7, 17 to 25, 31 to 65 odd, 36), East Place (Nos. 6 to 14 consecutive, 17), East Street (Nos. 1, 2), Rommany Road (Nos. 6, 8, 12 18 to 24, 66, 68, 72 to 84, 96, 118, 124 to 130, 138 to 156, 240a, 272 even, 151, 259a, 277, 277a). The following house has been closed and demolished after service of closing order .— Marsh Ward. James Place (No. 7). The following houses have been voluntarily closed, and since voluntarily demolished :— Prince's Ward. Cottington Street (Nos. 16, 18 and 46). whilst the following houses have been voluntarily closed, with a view to being demolished at an early date :— Prince's Ward. White Hart Street (Nos. 21, 25, 35). 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, Heme 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 101 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. 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 are being erected thereon (108 in number), with a fixed bath provided in a separate bathroom, in each case. General Considerations. The new Housing Act, 1925, was passed on April 9th, 1925, and came into force on July 1st, 1925. The details of work carried out by the Housing Inspectors, since their appointments in 1920, and up to and including December 31st, 1926, are as follows :— 1. Inspections made 3380 2. Works completed or houses closed— (a) under provisional schedules 2818 (6) under legal schedules or notices 101 2919 3. Works not yet completed or not yet commenced— (a) under provisional schedules 452 (b) under legal schedules or notices 9 461 102 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 (2 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 is still pressing, if the maximum good is to be obtained from the Housing Acts. In only one instance (21, Pulross Road) has it been necessary for the Council to do the work on behalf of the owner and to surcharge the property (vide ante). The present shortage of new houses (municipally or through private enterprise) is such as to render an obligation upon the Council to do the next best thing, viz., to render reasonably fit for human habitation in all respects the houses which at present exist, and which, owing to existing over-crowding and crowding, tend to become, and do, as a fact, actually become seriously dilapidated, fair wear and tear doing their worst under present conditions of usage. Another point that is to be emphasized is the necessity, in the opinion of the Medical Officer of Health, for the Council, as the Housing Authority, to exercise its full powers, and within reasonable time, as set out in the Housing Acts, so as to secure the work being done by the Council and the premises surcharged in all cases in which the owners fail to comply with the legal notices served. The Courts have decided that the time limit must be "reasonable," and it cannot be said that the Lambeth routine practice in any way goes against this decision ; on the contrary, in lambeth more than "reasonable" time is allowed in every case. First comes the official survey by the Housing Inspector (due notice of the survey having previously been given to the owners and occupiers concerned), followed by the service of the preliminary or informal schedule of work required to be done. The time limit allowed for these schedules to be commenced is three to six months, often extended to twelve months. Then comes the service of the legal notice (served through the Town Clerk, on behalf of the Council), with an additional time limit, within which the work is to be completed. This is the point at which, in the opinion of the Medical Officer of 103 Health, the Council should be prepared to step in and carry out, as required, the obligations which are definitely imposed by the Housing Acts upon the Council, viz., to enter upon the premises, to do the necessary work, and to surcharge the owner or owners concerned, the expenses (reasonable expenses), being a first charge upon the property. As it is at present in Lambeth, the Housing Inspectors are left to persuade, as best they can, the owner or owners to start and carry out the works required, and this persuasion is carried on by interviews, letters, etc. The waste of time involved is shown by the intervals that elapse between the ends of the time limits stated on the legal notices and the completions of the works. The facts, as far as Lambeth is concerned, are as follows (since the appointment of the two Housing Inspectors):— Total houses dealt with (legal notices) 111 (а) Completed cases 52 weeks. (b) Uncompleted cases 79 weeks. These figures, which are averages and only approximate, are more than, "reasonable" but involve extra unnecessary work in constant supervision that is required, again and again, from the Housing Inspectors on account of the slowness of the progress of the work, preventing also, as a natural result, a larger amount of new inspections and surveys being carried out. It would certainly simplify the work considerably, and save much of the Housing Inspectors' time, which would consequently, then be available for further new surveys and inspections—time that is, at present, practically wasted in revisits and reinspections for the purpose of seeing if the works connected with the requirements of the Council have yet been commenced, and, if so, at what rate such works are progressing. Owners would realise, as they ought to do, what is laid down in the Housing Acts, viz., that they must be prepared to put the necessary works in hand before, or immediately after, the additional time limits, given in the legal notices, have expired. Administratively, the matter is important, and deserving of the attention of the Council. Reconditioning of old unfit houses (as opposed to closing and demolishing) has come to stop, and housing authorities will have to arrange to undertake the work systematically, both by the appointment of a sufficient number of efficient Inspectors and by using all the powers that the legislature has bestowed upon them by statute. Speaking generally, Lambeth owners are in no sense hostile : there are, however, unfortunately, exceptions to this general rule. 104 DISINFECTING DEPARTMENT, 1926 Details of work done in connection with the Disinfecting Department are subjoined: 7,868 cases of infectious diseases, notified compulsorily by medical men, were dealt with, including cerebro-spinal fever and post-basic meningitis (6), acute polio-myelitis and encephalitis (6), acute primary pneumonia (108), acute influenzal pneumonia (114), acute encephalitis lethargica (14), malaria (6), ophthalmia neonatorum (53), measles (5,149), german measles (223), and tuberculosis—pulmonary (446), and non-pulmonary (101), whilst the following diseases were, in addition, reported by school teachers and others, viz.: measles (1,496), chicken-pox (824), cancer (96), whooping cough (508), and others not classified (444)*, 197 verminous houses (361 rooms) and 1,220 verminous articles, viz.: bedding 936, and clothing 284, were also dealt with. Summary of work carried out by the Disinfecting Department during 1926. Total No. of Rooms disinfected by Council 1 2637 Do. articles do. 17930 Cases in which bedding was disinfected at home† 8681 Do. do. do. at Chamber 2329 Do. do. do. destroyed — Premises disinfected and disinfectants supplied 30150 Articles of bedding, etc., disinfected 17930 Articles of bedding, etc., destroyed — Ambulances, &c., disinfected 5 No. of Cleansing Notices served in connection with infected houses 1669 Certificates of Medical Practitioners received in lieu of disinfection by the Council 13 Schools disinfected‡ (40 rooms) 10 Certificates of disinfection left with occupiers of disinfected premises 1723 Library books disinfected (public) 207 Mattresses re-tabbed by Council 516 * Scabies, ringworm, diseases not stated, etc. † Bedding not removed to the Disinfecting Chamber for disinfection in cases of Measles and German Measles ‡ Measles, 6 (27 rooms); Scarlet Fever, 3 (11 rooms) ; Diphtheria, 1 (2 rooms). 105 Filthy or Verminous Articles and Premises. The London County Council (General Powers) Act, 1922, Part 111, Sections 9 to 14 inclusive, set out, in consolidated form, the statutory powers to be exercised by Metropolitan Sanitary Authorities, in regard to filthy or verminous articles and premises, and it will be noticed that, in each case, a report from the Medical Officer of Health is necessary, certifying that such verminous articles and premises are a danger or injurious to health. These statutory powers are permissive and require, in the first instance, the above-mentioned certificate, which, in the large majority of cases, cannot be given with any degree of equity—at least, in the opinion, and as the result of the experience) of the Lambeth Medical Officer of Health. Verminous articles and premises are not, necessarily, qud vermin, dangerous or injurious to health, nor are such verminous articles and premises also necessarily filthy. It is well known that articles and premises which cannot, possibly, be classified as "filthy," but, on the contrary, may be classifiable as "clean," are found to be verminous. In such cases (and there are many such cases), a certificate of a Medical Officer of Health would not be justified, or, at least would not be able to be justified before a Court of Law. The difficulties, therefore, in administering sections 9 to 14 of the London County Council (General Powers) Act, 1922, from a practical point of view, go without saying. The same remarks apply to the newly-passed (August 4th, 1926) London County Council (General Powers) Act, 1926, section 44 of which extends the powers of the London County Council (General Powers) Act, 1922, in regard to filthy or verminous articles and premises, " to any articles which are offered or exposed for sale, or stored or deposited with a view to sale in or upon any stall, space, street, or place, and to any covers or wrappers of any such articles." It will be noticed that the powers are still permissive, and contingent upon a certificate from the Medical Officer of Health. The same difficulties in administration, therefore, remain in strictly carrying out, in practice, the new powers, which are now conferred upon Metropolitan Sanitary Authorities. It must not be supposed, however, that the Lambeth Sanitary Staft is not alive to its duties in regard to dealing officially (by disinfection 106 or destruction) with filthy or verminous articles and premises, and is not carrying out its statutory duties connected therewith. not carrying out its statutory duties connected therewith. On the contrary, the following records show that such is not the case, numbers of verminous premises (rooms) and articles being set out in full :— Years Verminous Premises (rooms) Verminous Articles Bedding Clothiing 1926 197 (361) 936 284 1925 369 (442) 1,332 52 1924 326 (390) 2,178 105 1923 342 (372) 1,584 558 1922 278 (352) 1,764 1,123 1921 307 (460) 1,761 114 1920 154 (262) 620 234 1919 137 (248) 1,073 79 1918 307 (539) 1.947 608 1917 126 (465) 2,126 1,244 1916 212 (897) 7.340 4,983 1915 627 1080) 4,165 431 1914 195 (935) 1,186 268 1913 649 (927) 1,245 141 Average for 14 years (1913-1926) 301 (552) 2,089 730 Destruction had to be officially resorted to in very few instances, in which cases new bedding or clothing was provided as required. Since the passing of the London County Council (General Powers) Act, 1926, on August 4th, 1926, the Sanitary Inspectors have made special visits to the stalls in Lambeth and Vauxhall Walks, etc., personally warning the owners of the provisions of the new Act in regard to filthy or verminous articles exposed on stalls for sale or for preparation for sale. The Medical Officer of Health does not anticipate that legal proceedings will be necessary in the future any more than they have been in the past, but is of opinion that the owners of the stalls will voluntarily comply with his official requests made through the Sanitary Inspectors. The Town Clerk, as the Council's legal adviser, holds the opinion that, so long as the report which is referred to in the London County Council (General Powers) Acts, is in the name of the Medical Officer, it is not necessary for such Medical Officer of Health personally to inspect the subject matter of such report. 107 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. -S Number Adulterated. Number Analysed. N Number Adulterated. Milk 711 32 1 - Butter 36 1 535 9 Lard 22 - 18 - Coffee 12 — 35 1 Milk (Separated) 1 — - — Baking Powder — — 11 — Mustard - - 35 2 Pepper - - 35 - Arrowroot 3 — 24 — Vinegar 21 - 8 1 Sago - - 8 - Oatmeal - - 12 — Ground Rice 3 - 18 - Dripping - - 6 - Drugs* - - 155 2 Rice - - 36 — Tapioca - - 3 — Self-Raising Flour - — 40 — Cheese - — 6 - Cocoa — - 18 - Sugar - - 4 - Bread — - 5 — Corn Flour — - 6 - Flour — - 13 - Tea — — 18 - Sausages - - 2 2 Whisky 6 - — — Wine (British) 1 - — — Gin 1 - - - Custard Powder - - 35 — Lemonade Powder - - 6 5 Apples (? arsenic) - - 6 - Cakes, Sponge - - 22 3 Eggs Substitute - - 6 - Mincemeat - - 8 - * The drugs (155) were :—Epsom Salts (12), Gregory's Powder (5), Ammoniated Tincture of Quinine (4), Cream of Tartar (23), Bicarbonate of Soda (27), Camphorated Oil (8), Milk of Sulphur (6), Boric Ointment (9), Tartaric Acid (9), Zinc Ointment (13), Friars Balsam (4), Iron Pills (3), Acid Citric (4), Acid Boric (14), Eucalptus Oil (5), Glycerine (5), Flowers of Sulphur (4). 2 samples of Boric Ointment were adulterated. 108 Analysis of Food and Drugs and Water—continued. Samples. Formal. Informal. Number Analysed. Number Adulterated. Number Analysed. Number Adulterated. Malt Vinegar 12 — — Cream — — 11 8 Preserved Cream — — 4 - Margarine 1 — — - Fruits (Dried) — — 16 - Jam — — 4 — 830 35 1170 33 N.B.—14 summonses (14 adulterations) were issued (1 conviction, 12 dismissals, 1 not heard owing to death of defendant). Water. No sample of water was submitted to the Analyst for analysis. 2 samples of so-called flour whiteners or " improvers" were analysed and found to consist of— (а) calcium phosphate 88 parts, benzoyl peroxide 12 parts, and (б) ammonium persulphate, 100 parts. Persulphate of ammonium and benzoyl ,peroxide are both known as being used for decolourising flour, and, in small quantities, are not injurious to health. Calcium phosphate is simply a diluent. 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 713 samples of milk taken during 1926 (712 formal, and 1 informal), in no single instance were preservatives found. 11 samples of cream (all informal), and 4 samples of preserved cream (all informal), were also taken with the results set out below. The action taken under the Public Health (Milk and Cream) Regulations, 1912 and 1917, may be tabulated as follows : Headings of Report of Administration. 1. Milk ; and cream not sold as preserved cream :— (a) No. of samples examined for the presence of a preservative. (b) No. in which a preservative was reported to be present. Milkt 713 — Cream 11 8 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." † Including separated milk (1). 109 2. Cream sold as preserved cream :— (a) Instances in which samples have been submitted for analysis, to ascertain if the statements on the label as to preservatives were correct:— (1) Correct statements made 4 (2) Statements incorrect - Total 4 (b) Determinations made of milk fat in cream sold as preserved cream:— (1) Above 35 per cent. 4 (2) Below 35 per cent. - Total 4 {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 ist 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 required to licence certain specially designated milks, while the Ministry of Health is required to licence producers of certain designated milks. With regard to pasteurised milk, the special conditions stated in the Orders in regard to that particular form of milk did not come into force until the 1st July, 1923. During 1926, the following special licences have been issued in regard to the Borough of Lambeth :— 1. "Certified" Milk. (a) *W. H. Hill, 5A, Cambria Road (producer, Brig-Gen. F. A. Buzzard, Hacksted Farm, Edenbridge, Kent). * Renewal of Licences. 110 (b) *W. Hardie, 12, Heme Hiil Road (producer G. V. Baxendale, Framfield Place, Uckfield). (e) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill, 118, Norwood Road, 9, Westow Hill, (4 producers, J. & H. Robinson, I ford, Sussex, Mrs. Ponsonby, Little Dormans, Sussex, Maj. Gen Longbourne, Losleey Park, Guildford, and E. C. Lovell, Hatherden). (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, Westminster Bridge Road, 67, Coldharbour Lane, 304, Clapham Road, 96, St. Marks Road, 118, Denmark Hill (producer E. C. Lovell, Hatherden, near Andover). (e) *Express Dairy Co., Ltd., 279, Rosendale Road (producers, selves from Finchley). (f) *David Jones, n, Russell Street (producer, G. V. Baxendale, Framfield Place, Uckfield). (g) *C. R. Cotching, 45 Camberwell New Road (producer, count Astor, Cookham) (h) *Thos. French & Co., 72/74, Gipsy Hill (producers, Express Dairy Co., Finchley). (i) D. Williams, 11a, Victoria House, South Lambeth Road (producer, G. V. Baxendale, Framfield Place, Uckfield). (J) J. E. Mason, 18, Clapham Road (producer, Lord Astor, Cookham). 2. "Grade A" (Tuberculin Tested) Milk. (а) *Express Dairy Co., Ltd., 279, Rosendale Road (4 producers, selves at Finchley, Lord Rayleighs Dairies Ltd., Hatfield Peverell, Essex, G. V. Baxendale, Uckfield, and Farmers Clean Milk Dairies Ltd., Reading). (b) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276. Knight's Hill, 118, Norwood Road, 9, Westow Hill, (9 producers, J. R. Burge, Itchen Abbas, Admiral Henderson, Ropley, Dr. Scott, Lymington, H. J. Watson, Raynards, R. G. Hecks, Glynde, Sir Henry Hoare, Bart., Gillingham. T Bowden, Basingstoke, Lord Lymington, Basingstoke, A.S.A. Westropp, Sway). (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, 151, Westminster Bridge Road, 67, Coldharbour Lane, 304, Clapham Road, 96, St. Marks Road, 118. Denmark Hill, (producer, The Lord Wandsworth Agricultural College, Basingstoke). * Renewal of Licences. † Licence for Bottling also issued in connection with 2 to 6, Canterbury Road. 111 (d) *David Jones, 11, Russell Street (producer, G. V. Baxendale, Franifield Place, Uckfield). 3. " Grade A " Milk. (а) *David Jones, 11, Russell Street, Brixton (producer, G. V. Baxendale, Franifield Place, Uckfield). (b) *C. R. Cotching, 45, Camberwell New Road (producer, count Astor, White Place, Cookham, Berks). (c)*†R- Higgs & Sons Dairies, Ltd., 2 to 6, Canterbury Road, 43 Loughborough Road, 121, Acre Lane, '02, 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, 118, Denmark Hill (producer, The Lord Wandsworth Agricultural College, Basingstoke). (d) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill, 118. Norwood Road, 9, Westow Hill (4 producers, selves, Norbury, Tisbury Farm Co., Tisbury, Earl of Castlestewart, Hartfield, R. H. Rhodes, Everton, S. P. Keevil, Hassocks, Sussex, Mrs. A. P. Sealey, Ringmer, Sussex). (e) *Mrs. A. Richardson, 8, Robsart Street (producers, Retail Dairymans' Mutual, Ltd., Paddington). (/) W. L. Davies, 1 26, Stockwell Road (producer, Lord Rayleighs Dairies Ltd., Hatfield, Peverell. Essex). 4. "Pasteurised" Milk. 1. Pasteurisers Licence. (a)*†R. Higgs & Sons' Dairies, Ltd., 2 to 6, Canterbury Road. 2. Dealers Licence. (b) *R. Higgs & Sons' Dairies, Ltd., 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, 118, Denmark Hill (b) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill, 118, Norwood Road, 9, Westow Hill. (c) Express Dairy Co., Ltd., 279, Rosendale Road. 5. Supplemental Licences (premises outside the Borough of Lambeth). *Curtis Bros. & Dumbrill, Ltd., 304, Brixton Hill (Wandsworth), and 31, Westow Street {Croydon). * Renewal of Licences. + Licence for Bottling also issued in connection with 2 to 6, Canterbury Road. i i 2 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. MORTUARIES AND CORONERS' COURTS. Details of Work carried out. (a) Number of bodies received, 427—321 at High Street and 106 at Wanless Road. (b) Post-mortem examinations conducted, 203—142 at High Street and 61 at Wanless Road. (c) Number of inquests held, 413—306 at High Street and 107 at Wanless Road. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. 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, during 1926:— (1) Number of visits* paid to slaughter houses, 725 ; (2) Number of visits* paid to meat shops and meat stores, 821 ; (3) Number of visits* paid to meat stalls, 507 ; (4) Number of actual slaughterings at which one or other of the Food Inspectors was present, 5,892, consisting of beasts (378), sheep (3,128), lambs (1,106), pigs (1,154), hogs (17). and calves (109); (5) Carcases, or portions of carcases, condemned, 136. Of the 5,890 actual slaughterings, at which one or other of the Food Inspectors was present, and in connection with which 136 carcases or portions of carcases were condemned, the diseases necessitating such condemnation were as follows:—3 tuberculous livers (beasts), 3 tuberculous heads (beasts), 3 tuberculous tongues (beasts), 1 tuberculous spleen (beast), 1 tuberculous heart (beast), 2 tuberculous lungs (beasts), 32 fluke-infected livers (beasts), 1 cirrhotic liver (beast), 1 septic lungs (beast), 1 septic liver (beast), 5 septic lungs (sheep, 63 strongylus-infected lungs (sheep), 3 fluke-infected livers (sheep), 8 fluke infected whole plucks (sheep), 1 cirrhotic liver (sheep), 1 pleuritic whole pluck (pig), 1 septic whole pluck (pig), 1 septic head (pig), 1 septic lungs (pig), 1 echinoccus infected liver (pig), 1 septic liver (calves), 1 extensively bruised forequarter, and 1 extensively bruised hindquarter (beasts). In addition, 700 calves' "breads" (weighing 3 cwt.) were condemned, on account of advanced states of decomposition. RATS AND MICE (DESTRUCTION) ACT, 1919. Action has been taken as required in conjunction with the Borough Engineer's Department in connection with reported nuisances from rat-infestation. 113 APPENDIX I. MINISTRY OF HEALTH TABLE Borough of Lambeth. HOUSING CONDITIONS. Year ended 31st December, 1926. GENERAL STATISTICS. Area (acres) 4,083 Population 311,000* Number of inhabited houses 42,607† Number of families or separate occupiers 78,399† Rateable value £2,035,086 Sum represented by a penny rate £8,332 HOUSING. Number of new houses erected during the year :— (a) Total 265‡ (b) As part of a Municipal Housing Scheme I28‡ (43 weeks.) I. — UNFIT DWELLING HOUSES I.—Inspection. (1). Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 12,497§ (2). Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 414 (3). Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4). Number of dwelling-houses (exclusive of those referred to under the preceding sub heading) found not to be in all respects ably fit for human habitation 414 * Estimated 1926. ‡ Census figures 1921. ‡ Representing 137 and 128 tenements respectively. § 12,083 Public Health (London) Act, 1891 and 414 Housing Acts. h 114 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 2,360* 111.—Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925. (1). Number of dwelling-houses in respect of which notices were served requiring repairs (2). Number of dwelling-houses which were dered fit— (a) by owners 16 (b) by Local Authority in default of owners 1 (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 3.901† (2). Number of dwelling-houses in which defects were remedied— (a) by owners 3,441† (b) by Local Authority in default by owners nil. C.—Proceedings under Sections 9 and 11 of the Housing Act, 1925. (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. * 1934 under the Public Health (London) Act, 1891 (intimation notices), and 426 under the Housing Acts, (provisional or informal schedules), † Statutory notices under the Public Health (London) Act, 1891 115 (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. APPENDIX II. METROPOLITAN BOROUGH OF LAMBETH Tuberculosis Exit a Statistics 1925 (Survey Year) dealing with the Lambeth Municipal Tuberculosis Dispensaries Scheme, in accordance with the instructions, or suggestions, set out under the headings Nos. (/) to (XVII) inclusive, of the Ministry oj Health's Circular 648 {England), under date of December, 10th, 1925 (omitted from the 1925 Report of the Medical Officer of Health.)* (i) Central and Branch Dispensaries. Vide pp. 3 and 52-57 of the Medical Officer of Health's 1925 Annual Report, the remaining details, with regard to institutions, to be obtained from the L.C.C. as the duly appointed Institutional Tuberculosis Authority for the Metropolis. Lambeth Borough has no separate Institutions for tuberculosis patients (isolation or treatment). (ii) Central and Branch Dispensaries. The Borough Council and the London County Council work together and in intimate relationship daily by correspondence and telephone, in connection with institutional and occupation treatment in institutions—the London County Council being the institutional authority (tuberculosis) for the Metropolis. * Vide Annual Report 1925 p. 52. 116 (iii) Central Dispensary. Special facilities are afforded for X-Ray examinations and artificial pneumo-thorax treatment at St. Thomas's Hospital also for Light and Artificial Sunlight Treatment at St. Thomas's Hospital and King's College Hospital. Surgical cases in general are referred to St. Thomas's Hospital as the General Hospital attached to the Scheme, but, where such cases are passed to the Central Dispensary from other Hospitals for residential treatment under the L.C.C., such cases are referred back to their own hospitals (general and special) after such treatment, subject to general supervision of subsequent treatment and after care from the Central Dispensary. All school children attending the Central Dispensary are reported on at cessation of treatment to the L.C.C. District Medical Officer on special Form M.O. 333. Branch Dispensary. When examinations and investigations are necessary which cannot be carried out at the Branch Dispensary, the patients are referred to the Out-patient Physicians and Surgeons, St. Thomas's Hospital, with whom in nearly every instance the Tuberculosis Officer has a personal consultation. Periodical enquiries are made about patients attending other institutions, eg., Brompton. (iv) Central Dispensary. Report are sent in all cases to private Medical Practitioners who refer patients, and also to all panel doctors. No treatment involving the giving of medicines is undertaken by the Central Dispensary in cases of panel patients, but constant consultation with panel practitioners on this point is carried out where necessary. Reports are sent to private and panel practitioners after all Sanatorium or Hospital treatment of patients, and, subsequently, wherever necessary, and consultations are arranged with medical practitioners, wherever desirable, at the homes of patients. Branch Dispensary. The model forms Z are not used Forms G P. 17 are rarely used, practitioners generally prefering to write letters. 117 (v) Central Dispensary, Where diagnosis is doubtful, such patients are kept under observation until the diagnosis has been cleared up. A special register is kept of such doubtful cases, and examination dates and times are recorded in appointment diary for such cases and follow up letters are sent to the patients or their medical practitioner in order to prevent the patients lapsing before completion of diagnosis. No cases, therefore, lapse except at refusal of patient to re-attend, or at his removal from the Borough. In the latter event, if the new address is known, the tuberculosis officer of the new area is advised of the case as one of? tuberculosis. Branch Dispensary. Cases presenting special difficulty can be admitted to the Tuberculosis Ward of the Hospital for a period of observation. Occasionally this period of observation is arranged through the London County Council at one of the Chest Hospitals. Cases regarded at the Branch Dispensary as provisionally non-tuberculous can attend in the Out-patient Department of St. Thomas's Hospital if they have symptoms needing treatment; otherwise, periodical enquiries by the Lady Almoner or visits by her Visitor are made at the homes of such cases. (vi) Central Dispensary. When a case has been notified, the home is visited and special appointment for examination given to "contacts," either at the time of such home visit or afterwards through the patient, when attending at the Central Dispensary. All such appointments are booked and followed up, if not kept. When a "contact" has been examined, if suspicious, such "contact" is followed-up in manner stated under heading No. (v), but, if not suspicious, the case is booked for re-examination at a later date, 3 or 6 months, and then again at a later date still. Branch Dispensary. The examination of "home contacts of patients attending the Branch Dispensary and found to be tuberculous is advised. It is urged strongly in the cases of "home contacts" who appear to be delicate and such cases are followed up for several years, by 118 enquiries and visits, Two special sessions are set apart at the Branch Dispensary for examination of "home contacts" (and for a small number of non pulmonary cases). (vii) Central Dispensary. No special methods of diagnosis beyond those afforded by Hospital observation through the L.C.C in cases where history and clinical findings are suspicious but where repeated sputum, and the X-ray examination, reports are negative. Special light and artificial pneumo thorax treatment is arranged as stated under heading No. (ii). During 1925, 19 cases were admitted to Hospital for special observation and diagnosis. 6 cases received artificial sunlight treatment and 5 cases received artificial pneumothorax treatment. Branch Dispensary. X-ray examinations for diagnosis and aid in treatment 481 Artificial pneumo-thorax treatment 6 Sanocrysin treatment 8 Tuberculin treatment 4 (viii) Central Dispensary. Light treatment has been found of great benefit in cases of surgical tuberculosis and lupus. Artificial pneumo-thorax treatment has had valuable results in early cases where such treatment is suitable, and also in certain cases of a chronic nature, where adhesions do not exist. Vide also p. 53 of the Medical Officer of Health's 1925 Annual Report. Branch Dispensary. Results of artificial pneumo-thorax treatment in selected cases are very good. It is being used, with caution, in some moderately early cases in the hope of avoiding the relapses which are very common in patients who have undergone ordinary sanatorium treatment. Tuberculin treatment is used for cases of renal tuberculosis, occasionally for glandular, but never for pulmonary tuberculosisVide also p 53 of the Medical Officer of Health's 1925 Annual Report. 119 (ix) Central Dispensary. Arrangements are now in force by which dental treatment is provided at King's College Hospital (Out-patient Department) for patients from the Central Dispensary. Payment is made at an agreed rate by the Lambeth Borough Council to the Hospital, and contributions are collected at the Dispensary from such patients as are able to afford to contribute, and where possible, from Approved Societies, etc. During 1925, 9 patients were referred for such dental treatment, at a net cost to the Borough Council of £15 for the year in connection with 5 extractions and 4 full dentures. N.B.—This statement does not represent the whole of the dental work afforded to tuberculosis patients in attendance at the Central Dispensary, as it does not include those patients who go to private dentists rather than attend at an out-patients dental department of a General Hospital. Branch Dispensary. All patients recommended for dental treatment by the Tuberculosis Officer are seen in the Dental Department of the Hospital (St. Thomas's), and dentures (partial or complete) are provided after approval by the Dental Surgeon. A grant towards the cost is given by the Borough Council when necessary, and this grant amounted to a net sum of £16 for the year 1925 in connection with 5 extractions (one with anaesthetic) and 4 full dentures. N B. — This atatement represents the total net expenditure for the year 1925, but does not represent the whole of the dental work afforded to tuberculosis patients at St. Thomas's Hospital dental department), as separate records were not available for the whole of the year 1925. but will be so for future years. Hospital dental treatment (out-patients department) is not favoured by patients. (x) Central Dispensary. Patients who are confined to bed in their own homes are referred to local Nursing Institutions for attendance by nurses, and are visited, also, by the Council's Tuberculosis Nurses, as required. 120 Extra nourishment is provided under the Lambeth Borough Council scheme (as certified by the Tuberculosis Officer to be necessary) to patients awaiting admission to Sanatorium, or discharged and waiting to start work, etc., and also in cases where poor-law relief is already being given, but where extra nourishment is required. Branch Dispensary. The District Nurse is asked to visit patients in their homes when necessary, and all patients, who are ill at home, are visited regularly by the Tuberculosis Visitor, and, as required, by the Assistant Tuberculosis Medical Officer for visiting purposes. Extra nurishment (Milk, Eggs, Butter) is provided by the Borough Council when necessary, in suitable cases, on the recommendation of the Tuberculosis Officer. (xi) Central Dispensary. Non-pulmonary tuberculosis is treated by means of residential treatment through the L.C.C. where necessary, and, as there is no surgical apparatus at the Central Dispensary and the premises are entirely unsuitable for any form of surgical treatment, cases needing ordinary out-patients treatment are referred as a general rule to St. Thomas's Hospital, as the hospital connected with the Lambeth Scheme, or, in special instances, to other General or Special Hospitals, as the Tuberculosis Officer may decide. Branch Dispensary. Cases of tuberculosis of bones and joints, not needing institutional treatment, attend at the Branch Dispensary, or in the Orthopaedic Department of St. Thomas's Hospital when a consultative opinion is desired. The money for necessary Surgical Appliances is obtained in suitable cases by the Lady Almoner either from the patients or from different Charitable Societies (wholly or in part), or from both. (xii) Central Dispensary. Particulars of all home conditions and difficulties of tuberculosis patients are recorded at the Central Dispensary, and by means of a close co-operation with the United Service Fund, 121 Emergency Help Fund, Royal Naval Benevolent Trust Fund Masonic Lodges, the Charity Organisation Society, the Lambeth Guardians etc., and also the working of the Borough's Extra Nurishment and Dental Schemes, together with private gifts of clothing, etc., by those interested in tuberculosis work at the Central Dispensary, no patient is allowed to suffer real hardship through want of food, or clothing, etc., during and after treatment, unless unwilling to make application to sources indicated, or to accept the relief offered. These arrangements are working smoothly over the entire area covered by the administration of the Central Dispensary, Branch Dispensary. Care and after-care of patients is carried on from the Almoner's Department of St. Thomas's Hospital, with the assistance of a full-time Visitor (provided by that Department). (xiii) Central Dispensary. An attempt was made with the Local Employment Exchange specially to promote employment for tuberculosis patients, but proved abortive, owing to existing labour difficulties. The official arrangements indicated by the Ministry of Health with the Ministry of Labour have been followed but have not proved very successful except where the juvenile patients are concerned. In co-operation with the Juvenile Advisory Committee and such societies as the Friends of the Poor, etc., employment has been more successfully found for younger patients, and, in certain cases, for adults, through the King's Roll branch of the British Legion. Each case for employment is treated as far as possible on its individual merits, and enquiries and appeals to private individuals have resulted in employment in certain suitable cases. Branch Dispensary. The assistance of Employment Exchanges and King's Roll is invoked on behalf of patients, but with very little result. (xiv) Central Dispensary. Shelters are in use for patients and are loaned in suitable cases and the homes visited from the Central Dispensary to supervise such shelters where in use. 122 Branch Dispensary. Shelters for the use of patients are obtainable, as required, from the Borough Council and one patient has actually had a shelter in use for the last twelve years, but, as a rule, it is found that the use of shelters in this district is impracticable, owing to lack of space and the fact that any yards and gardens which might be suitable for this purpose are very much overlooked by neighbouring houses and the patients are, consequently, not willing to sleep in the shelters. (xv) Central and Branch Dispensaries. The more congested areas of the Borough suffer from a greater tuberculosis incidence than the less congested areas, vide also 1925 Annual Report of the Medical Officer of Health, pp. 32, 54, 55. Certain special occupations, e.g., tailors, printers engravers, cinema attendants, clerks, &c., appear to recur as the stated occupations of notified tuberculosis patients. The home conditions of many of the notified tuberculosis patients are lound, on inspection, to be defective as regards ordinary sanitary defects, more especially the want of air and sunlight and crowding of persons in houses, and unsuitable or lack of suitable food, etc. It is noticed, also, that children of country people, who migrate to congested London town life, appear to be more liable to contract tuberculosis than those whose families are old Lambeth residents, and, as such, more or less immune (probably from previous attacks). Employees in Doulton's Pottery Works do not appear to be more liable to tuberculosis, though several have extensive radiological changes in their lungs from the inhalation of the dust. (xvi) Central and Branch Dispensaries. Tuberculosis being a disease mainly due to modern industrial civilisation and general social and economic conditions, it would appear that its prevention is mainly dependent upon (a) better social and economic and housing conditions, good food, steadiness of employment, etc., and (b) care of infected cases to avoid spreading the disease from person to person. All patients 123 attending the Dispensary are instructed, both at the Dispensary and at their own homes, as to hygienic methods of disposal of sputum, etc. Bedsteads and mattresses are, also, loaned in order that the patient may sleep alone. Every effort is made to cooperate with the Lambeth and the London County Council Housing Schemes, to ootain better housing for tuberculosis patients. Close co-peration with the Council's Public Health Department and the Sanitary Inspectors is also maintained to ensure the remedying of defects that may be found to exist in houses of tuberculosis patients. (xvii) Central and Branch Dispensaries. Special Difficulties Encountered (a) Early diagnosis of cases of tuberculosis and sanatorium treatment for such early cases (prolonged treatment). (b) Homes for advanced cases of tuberculosis—to be provided within the Borough, so as to be readily accessible for visitation by friends and relations (as opposed to Institutions outside the Borough), the beds provided by the L.C.C. being too small in numbers, and patients disliking the idea of entering Poor Law Hospitals. (c) The pressing need for a new, more adequate and up-todate Central Tuberculosis Dispensary. (d) Shortage of housing accommodation and relative height of rents (to incomes of patients) necessary to be charged, on economic grounds, for Borough and L.C C. houses and flats. APPENDIX III. 0 An Unusual Case of Insect-Infestation. A house in West Norwood was found to be insect-infested, and the infesting insect proved to be the Silver Fish, Lapisma Saccharina, one of the Thysanura—a species that may be found in houses that have been built for some time, but whose presence may not be suspected by the occupants until a room is entered at night and the light turned suddenly on, or until a specimen happens to get caught amongst food-stufifs or in a cooking utensil. The usual hiding-places during the day of these 124 insects are in the chinks and crannies around fireplaces, in cupboards near a fireplace, and underneath the skirting boards, but, fortunately, the damage that these insects do normally is really infinitesimal, and the nuisance can be readily abated by means of freshly prepared Keating's powder, or, failing that, a spray solution of an efficient disinfectant. Hadden, Best & Co., Ltd.. Printers, G, West Harding St., London, E.C