LAM 2 REPORT on the Vital and Sanitary Statistics of the BOROUGH OF LAMBETH During the Year. 1927. [Including an account (1) of the work done (a) at the two Tuberculosis Dispensaries under the Lambeth Municipal Tuberculosis Dispensaries Scheme, (b) at the Municipal Milk Depot and Infants Consultations Centre and under the Lambeth Milk Assistance Scheme and the Lambeth Maternity and Child Welfare Scheme, (c) at the Municipal Bacteriological Laboratory, (d) under the Lambeth Nursing (Infectious Diseases) Scheme, and (e) by the Male and Female Sanitary Inspectors and Health Visitors and the Disinfecting Staff; and (2) of the Proceedings taken under the Sale of Food and Drugs, the Factory and Workshops, and the Housing and other Special Acts; and the Public Health Meat Regulations, 1924.] by JOSEPH PRIESTLEY, b.a.. m.d., d.p.h.. (retired, from duties, October 31st, 1927), and A. G. G. THOMPSON, m.a., m.d., d.p.h., (commenced duties, November 31st, 1927). 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, 1927.) PUBLIC HEALTH COMMITTEE. His Worship the Mayor (Mr. Councillor W. J. Geary, j.p., a.c.i.s.) 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. Mrs. „ M. E. Hare. Mr. „ F. E. Hembling. „ „ W. Hunter. Miss „ K. Ker. Mr. „ F. Kinnaird. „ „ G. H. Mallinson, m a. „ „ F. W. Mills. „ „ R. S. Pearson, m.r.c.s., l.r c.p., d.p.h. „ „ S. Stranks. „ „ S. H. Stanley (Chairman). „ „ J. G. Turner (Vice-Chairman). Mrs. „ A. L. Wood. MATERNITY AND CHILD WELFARE COMMITTEE. The same as the Public Health Committee (see above) together with the following 4 co-opted Members nominated by the various Welfare Centres of the Borough (included in the Lambeth Maternity and Child Welfare Scheme):— Miss Cornwall Jones, 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. Borough of Lambeth. PUBLIC HEALTH DEPARTMENT. STAFF, 1927. *Medical Officer of Health: Joseph Priestley, b.a., m.d., d.p.h. A. g. G. Thompson, m.a., m.d., d.p.h. N.B—Dr. Priestley retired under the age limit on October 31st, 1927, and was succeeded by Dr. Thompson, who commenced his duties on November 1st, 1927. 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. Perrin f and A. B. CruttendenI; S. F. healjjf as acting Food Inspector from 12th May, 1927, during illness of W. J. Perrin; Mr. Perrin died on 2nd October, 1927. (b) Housing: W. W. Howes and W. Wallis. (2) District Sanitary Inspectors: J. Barfoot. J. S. Clements. C W. Idle.† T. H. Jackson. F. J. heffield.f T. H. Hooper. John Smith. J. S. Smith. W J. Lawrence. J. M. Scorrer. Benj. GooD†. G. T. Taverner. N B.—J. Barfoot retired on 31st October, 1927. (3) Female Sanitary Inspectors: Mrs. T. Robb. Miss A G. Simpson.‡ N.B.—Miss P. Reymond‡ J was appointed temporarily Female Sanitary Inspector on October 13th, 1927, vice Mrs. Robb (incapacitated from ill-health). (4) Health Visitors (Child Welfare): Miss L. Auger.§§. Miss L. Hoskin.§ Miss M. E. Jacobs.§§ Miss E. White. J *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, B.Sc. Health Visitors (Tuberculosis): Mrs. C. Small§§§; Miss W. E. Dyer.§§§§ N.B.—Miss L. Coleman‡ was appointed temporarily Tuberculosis Health Visitor on August 25th, 1927, vice Mrs. Small (resigned July 31st, 1927). 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 Depdt, Lambeth Maternity Home, Manageress: Miss V. Berkeley. Matron: Miss D. Newberry. N.B.—MissC B. Turner was appointed Matron on 3rd March, 1927, owing to the resignation of Miss Newberry. Disinfecting Department, Mortuary Keepers : Superintendent: W. Lockyear. (a) High Street Mortuary: R. Harriss. (b) Wanless Road Mortuary: J. Fazey. Bacteriological Laboratory: Bacteriological Assistant to the Medical Officer of Health: Miss F. M. Speakman (appointed 2nd June, 1927, and commenced duties on 1st November, 1927). 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 trom Exchequer Grants, t Meat Certibcate. ‡ 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. a2 4 Public Health Department, (1) Lambeth Town Hall, Brixton Hill, S.W. 2. March, 1928. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor, Ladies and Gentlemen, In presenting the Annual Report for the year 1927, it has been necessary for Dr. Thompson and myself to confer and agree as to the form in which the Report shall be presented. As the result of our mutual agreement, I would now remind the Council that this is the final Annual Report that I shall have the honour of presenting, officially, on the statistics (vital and mortal) for the Borough of Lambeth, as I retired (under the age-limit) from the position of Medical Officer of Health and Chief Executive Tuberculosis Officer on October 31st, 1927, after 32 years' service (vide farewell letter in Appendix). Fortunately, the statistics with which this official Report deals, the statistics for 1927, are satisfactory in every way, as in previous years. The Registrar-General's estimated Borough of Lambeth population for 1927 (middle of the year) is 307,700*, and, upon this basis, the various general and zymotic and special death-rates are based. Tuberculosis is gradually, though slowly, declining, whilst typhoid or “ enteric “ fever is, practically, a disease of the past, as is also typhus fever. Even the revised records for 1927 {i.e. revised on the RegistrarGeneral's new estimated populations) are well worthy of being set * This represents a considerable decrease for the year 1927 (viz.:—3,300) in the estimated population, and this fact (for which the Registrar-General is responsible) must be taken into consideration, when considering the 1927 statistics, which, otherwise, would have been even more favourable, statistically, on comparison with past years. 5 out in tabular form for future reference, comparison being made with the records of over a quarter of a century ago (1901), the first year of the existence of the new Borough of Lambeth :— Death-rate. 1927 1901 General death-rate 12.40 17.17 Zymotic death-rate 0.39 2.72 Measles death-rate 0.07 0.39 Whooping Cough death-rate 0.09 0.38 Typhoid Fever death-rate 0.009 0.076 Diarrhoea death-rate 0.10 0.91 Scarlet Fever death-rate 0.003 0.12 Diphtheria death-rate 0.10 0.16 Smallpox death-rate 0.00 0.01 Tuberculosis death-rates— (a) All forms 1.01 2.29 (b) Pulmonary or Phthisis or Consumption 0.85 1.63 Infantile Mortality death-rate (under 1 year of age) 37.92 139.38 Child Mortality death-rate (between 1 and 5 years of age) 8.72 22.81 The comparative rates for the Inner and Outer Districts of the Borough, are as follows :— Inner Districts— General death-rate 13.17 20.9 Zymotic death-rate 0.55 3.1 Outer Districts— General death-rate 11.92 13.9 Zymotic death-rate 0.29 1.2 N.B.—All death-rates are corrected as to the actual numbers of deaths, and expressed in terms per thousand of the populations (estimated by the Registrar-General 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 number of uncorrected births registered. The infantile mortality rates are again remarkable—the lowest records in the statistical records of the Borough or the Parish, whilst the child mortality (deaths of children between 1 and 5 years 6 per 1,000 of the estimated population) are, correspondingly and consequentially, equally remarkable. The Council's new Maternity Home at Milburn House, Knight's Hill, shews a fine record for the year 1927, as was anticipated would be the case, and the Council will have to consider at an early date in the future the advisability of adding an extra Wing or even Wings to the present buildings, to cope with the necessity for increased accommodation, to meet the requirements (the urgent requirements) of the Borough. The value of the work of the Council's newly-appointed Assessment Committee (to deal with fees to be paid by mothers) has been proved by the experience of the past year. I have again, as in previous years, 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, in which last-mentioned connection special mention may be made of the valuable services of Mr. A. E. Ruel, who, in addition to his own important work, took over that of Mr. A. L. Baxter during the latter's unfortunate absence from duty on account of illness. Mr. A. E. Ruel acted with efficiency as Chief Clerk to the Department of the Medical Officer of Health. My personal thanks are also again due, as in previous years, to the chiefs of other 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. 7 In conclusion, and on presenting to the Council my last official Report, I am in the fortunate position of being able to state that all my schemes, suggested during my 32 years of service, have been inaugurated by the Council, with the exception of the two following important subjects, the consideration of which, before final decisions by the Council thereon, have been adjourned for the opinions (official) of my successor (Dr. Thompson):— 1. The proposed appointment of a female assistant medical officer of Health for maternity and child welfare purposes (detailed work); 2. The provision of a new, up-to-date, much-needed Central Tuberculosis Dispensary, worthy of the Borough of Lambeth. I wish you all an official" good-bye." I am, Mr. Mayor, Ladies and Gentlemen. Your obedient Servant, JOSEPH PRIESTLEY, Medical Officer of Health and Chief Executive Tuberculosis Officer. 8 Public Health Department, (2) Lambeth Town Hall, Brixton Hill, S.W. 2. March, 1928. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Mr. Mayor, Ladies and Gentlemen, I have the honour of associating myself with the presentation of the Annual Report for 1927. This is the joint production of Dr. Priestley and myself, he being responsible for the first ten months of the year, and we have mutually agreed to the figures upon which the statistics have been based. While agreeing in general with this report, I beg to state that on certain matters Dr. Priestley has stated his definite opinion, whereas I do not feel yet that I am sufficiently well informed in local affairs, and, therefore, not yet competent enough to give a reasoned opinion. Such matters are starred, where this is the case, in the body of the Report. I should be ungrateful if I did not take this opportunity to thank you again for the honour—the very great honour—you have done me by appointing me to the responsible and important position which I now hold. It will be my endeavour at all times to carry out the duties involved to the best of my ability, and to give the highest satisfaction to you as the Borough Council as well as to each one individually. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. G. G. THOMPSON, Medical Officer of Health and Chief Executive Tuberculosis Officer. 9 INDEX page Introductory Letters 4-8 Vital Statistics 10-85 Estimated Populations, 1927 10-11 Births and Birth-rates 12-15 Notification of Births Act 15-16 Lambeth Maternity and Child Welfare Scheme 17-20 Lambeth Milk Assistance Scheme (Free or Aided Supplies) 20-21 Municipal Milk Depot and Infants Consultations Centre 21-22 Proposed appointment of Assistant Female Medical Officer of Health for Maternity and Child Welfare (detailed work) 23 Deaths and Death-rates (General, Infantile and Zymotic) 23-34 Lambeth Nursing (Infectious Diseases) Scheme 46-47 Infectious Diseases 35 (a) Notifiable 35-59 (b) Non-Notifiable 60-63 (c) Tuberculosis Regulations 47-53 Lambeth Municipal Tuberculosis Dispensaries Scheme 47-59 Public Health (Prev. of Tuberculosis) Regs., 1925 60 (id) Polio-Myelitis (polio-encephalitis), Cerebro-spinal Fever, Encephalitis Lethargia 64-65 Municipal Bacteriological Laboratory 66-68 Local Government Board, Old Tables A and B 70-75 Local Government Board, New Tables I., II., III., and IV. 76-81 Mortality Tables (Corrected deaths)— (a) Registration Sub-Districts (b) Age-Periods (c) Summary 82-84 Summary of Vital and Mortal Statistics, 1927 85 Sanitary Work 86-112 Notices served 86-88 (а) Infectious Diseases 86 (б) General Nuisances and Drainage Defects 86-87 Male Sanitary Inspectors (District Inspectors) 88-90 Registration of Cowhouses, Slaughterhouses, Common Lodging Houses and Milk Shops 90-91 Offensive Trades 92 Male Sanitary Inspectors (Food Inspectors) 88 Male Sanitary Inspectors (Housing Inspectors) 88 Female Sanitary Inspectors 92 94 Female Health Visitors 92-94 Factories and Workshops and Out-Workers 94-95 Housing Department 95-103 Disinfecting Department 104 Analysis of Food and Drugs and Water 105-106 Public Health (Milk and Cream) Regulations 106-107 Milk (Special Designations) Orders, 1922-23 108-111 Ice Cream Vendors Ill Mortuaries and Coroners'Courts Ill Public Health (Meat) Regulations. 1924 111-112 Rats and Mice (Destruction) Act, 1919 112 Appendices— I. Housing Conditions, 1927 (Ministry of Health Table) 113-114 II. Farewell letter from Dr. Priestley, addressed to the Council, on the occasion of his retirement from office on October 31st, 1927, and the action taken by the Council thereon 115-118 10 i. VITAL STATISTICS. The Registrar-General estimates the population of the Borough (up to the middle of 1927) at 307,700, 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 1927 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, 1927 (Middle of the Year.) I. Wards. Wards. Males. Females. Total. 1. Marsh 6,940 6,470 13,410 2. Bishop's 13,280 14,080 27,360 3. Prince's 13,030 14,090 27, 120 4. Vauxhall 14,990 15,980 30,970 5. Oval 12,130 13,360 25,490 6. Vassall 8,420 9,640 18,060 7. Angell 13,740 16,690 30,430 8. Stockwell 15,230 18,470 33,700 9. Town Hall 7,380 8,050 15,430 10. Heme Hill 7,440 8,430 15,870 11. Tulse Hill 15,020 18,650 33,670 12. Knight's Hill 16,170 20,020 36,190 Borough of Lambeth 143,770 163,930 307,700 11 II. Registration Sub-District's. Sub-Districts. Males. Females. Total. 1. Lambeth Church 21,430 21,950 43,380 2. Kennington 21,130 22,980 44,110 3. Stockwell 30,360 34,600 64,960 4. Brixton 38,940 45,980 84,920 5. Norwood 31,910 38,420 70,330 Borough of Lambeth 143,770 163,930 307,700 III. Parliamentary Divisions. * Adjusted Parliamentary Divisions. New Wards. Total. North• Marsh 67,890 Bishop's Prince's Kennington Vauxhall 74,520 Oval Vassall Brixton Angell 79,560 Stockwell Town Hall Norwood Heme Hill 85,730 Tulse Hill Knight's Hill Parliamentary Area of Lambeth 307,700 * By the adjustment of the 4 old Parliamentary Divisions so as to make them co-terminous with the 12 new wards. tc 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, 1927 (arranged Quarterly). Registration Sub-Districts. No. of Births. Total for the Year 1927. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Lambeth Church 536 567 508 524 2,135 Kenningtonf 242 267 244 242 995 Stockwell 311 372 338 354 1,375 Brixton§ 398 384 392 308 1,482 Norwood 252 273 277 227 1,029 Borough of Lambeth 1,739 1,863 1,759 1,655 7,016 * Including General Lying-in Hospital (999 cases, of which 250 belong to Lambeth), † Including Workhouse (438 cases, of which 412 belong to Lambeth). ‡ Including Clapham Maternity Hospital (652 cases, of which 178 belong to Lambeth). § Including King's College Hospital (679 cases, of which 174 belong to Lambeth). 13 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 1927, and the averages for the quinquennium 1922.1926 (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. 1927 307,700 7,016 3,818 266 431 121 2,264 1926 311,000 7,497 3,575 288 487 160 2,081 1925 311,100 7,663 3,764 343 509 154 2,220 1924 309,300 7,891 3,865 395 635 197 2,162 1923 308,500 8,344 3,482 357 535 141 1,986 1922 307,000 8,449 4,188 496 859 237 2,147 Average 1922-26 (5 years) 309,380 7,969 3,775 376 605 178 2.L19 Averages (10 years)— 1911.1920 (Borough) 286,786.4 8,027 1 4,282.5 619.7 958.6 326.8 2,506.5 1901.10 (Borough) 314,566 8 8,846 9 4,709.6 1,020.1 1,503.5 475 1 1,816.8 1891.1900 (Parish) 294,049.7 9,295 4 5,405.3 1,358.5 2,070.2 700.4 1,568.5 Note.—(a) Enumerated Population at Census 1901 was 301,895 (6) Enumerated Population at Census 1911 was 298,058. (c) Enumerated population at Census 1921 was 302,868. (d) Families or separate occupiers=70,887 (1901), 70,827 (1911) and 78,399 (1921). N.B.—In this and previous Reports, the estimated populations 1915, 1916, 1917, 1918, 1919, and 1920 are the estimates of civil populations only, and, for the same 6 years, the deaths do not include the deaths of members of the armed forces of Great Britain and other countries, all such deaths being excluded from the Registrar.General's published local returns. 14 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 Rates (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 1927 and the averages for the quinquennium 1922.1926 (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 Pouplation (corrected). Corrected Deaths of Children under 1 year per 1,000 total Births. Deaths of Children under 1 year per 1,000 Deaths (corrected). Deaths of Children under 5 years per 1,000 Deaths (corrected). Zymotic Death. Rate per 1,000 Population (corrected). Deaths in Public Institutions per 1,000 total Deaths (uncorrected) 1927 22.8 12.4 37.9 69.7 112.9 0.39 554.8 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 Average 1922-26 (5 years) 25.7 12.2 46.9 98.9 159.4 0.6 517.8 Averages (10 years)— 1911-20 (Borough). 27.9 14 9 77.2 144.5 223.1 11 499.8 1901-10 (Borough) 28.1 14 9 115.3 216.7 319 4 1.5 386.0 1891-1900 (Parish) 31.6 18.4 146.1 251.3 382 9 2.4 276.7 N.B.—In this and previous Reports, the birth rate is calculated upon the special Borough populations estimated respectively for that purpose by the Registrar-General for the years 1916, 1917, 1918, 1919, 1920, viz., 308,702, 303,245, 293,869, 294,097, and 294,303. These populations are the civil populations -plus all non-civilians enlisted from this country, whether serving at home or abroad, this non-civilian element being distributed over all the districts in the country in proportion to their estimated civilian population. 15 BIRTHS, 1927. The total number of Births registered (during the 52 weeks ended 31st December, 1927) is 7,016, of which details are set out in Table A, showing a birth-rate (un-corrected) of 22-8 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 also in nearly all civilised countries. There was a natural somewhat large post-war 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 1927 are sub-normal (or below the average). The Registrar-General's figures (total figures) for Lambeth Borough relate to the calendar year, whilst, in addition, the Registrar-General allows corrections, not only for outward transfers but also for inward transfers, as follows, giving a corrected number for the year (calendar year) of 4-971. Total registered. Inward transfers. Outward transfers. Corrected numbers. Legitimate Males 3,361 123 1,101 2,383 Legitimate Females 3,181 138 1,035 2,284 Illegitimate Males 232 25 106 151 Illegitimate Females 242 21 110 153 Totals 7,016 307 2,352 4,971 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 144,298 births have been notified up to the end of 1927, viz.: 3,473 in 1908 (10 months), 16 5,143 in 1909, 6,703 in 1910, 7,094 in 1911, 7,336 in 1912, 7,158 in 1913, 7,397 in 1914, 7,091 in 1915, 7,293 in 1916, 6,311 in 1917, 5,890 in 1918, 7,260 in 1919, 9,910 in 1920, 9,023 in 1921, 8,564 in 1922, 8,443 in 1923, 7,782 in 1924, 7,734 in 1925, 7,481 in 1926, and 7,212 in 1927. 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, the babies 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 official systematic 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 7,212 notified births, 4,227 took place in Institutions, and, of these 4,227 births, 1,922 belong to Lambeth and 2,305 to outside districts, thus:— Institutions.* Lambeth Cases. Strangers Totals. General Lying-in Hospital 259 727 986 St. Thomas's Hospital 249 407 656 Lambeth Workhouse 422 35 457 Clapham Maternity Hospital 244 455 699 King's College Hospital 197 523 720 Lambeth Council Maternity Home 358 — 358 Other Nursing Homes (private) 193 158 351 Totals 1,922 2,305 4,227 * 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. 17 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. 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, 37, Royal, Street.§ * Formerly North Marsh (Morley College), Webber Street. † 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 83, Lambeth Palace Road. 37, Royal Street was opened on 20th July, 1927. b 18 (b) Pilgrim Hill Creche, Pilgrim Hill, West Norwood.* 2. Infants' Clinics. (a) Mrs. Anstruther's Clinic, 53, Ethelred Street.* 3. Maternity Homes. (a) Lambeth Council Maternity Home, 210, Knight's Hill, West Norwood. In addition to the above, there are also included, indirectly, in the Scheme the following:— (1) The Maternity Department of St. Thomas's Hospital (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, in so far as Lambeth residents are concerned, under the Lambeth Scheme, both from the Ministry of Health and from the Borough Council, no grants from the latter, however, being given to Maternity Hospitals in connection with actual maternity work (lying-in wards), used by Lambethian mothers. 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 * Have not yet been given grants by the Borough Council (no applications having been received). † Previously known as the West Norwood Maternity Home, and limited practically to residents in West Norwood District (the old Tulse Hill and Norwood Wards). 19 under certain conditions. It has been found, however, as was to have been anticipated, that the Milk Depot would not be so well patronised when the various administrative Welfare Centres got into working order, more especially as, in connection with each Centre, there is the Council's administration of the Milk Assistance (Lambeth) Scheme, under which milk (as required) is now obtainable locally by the mothers and others concerned. At the Council's Maternity Home, during 1927 (calendar year), 358 mothers were confined at the Home (13 by doctors and 345 by midwives). No case of puerperal fever and no cases of ophthalmia neonatorum were officially notified, but medical assistance was sought by the midwives concerned in 67 cases. Ante-Natal Clinics. No Welfare Centre is administratively complete without an ante-natal clinic, and, in this connection, the Lambeth Centres are suitably equipped. 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 1927—the Borough Council grants being dependent, automatically, on the Ministry of Health grants and fixed (at present) at 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 b1 20 premises, which are better suited 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 Lambeth Scheme (Maternity and Child Welfare) is completed, now that the Lambeth Borough Council Maternity Home at Knight's Hill has been inaugurated and opened to the Public; and the statistics of work done during 1927 are as satisfactory as those for many years past. The intimate inter-relationship between voluntary effort and public municipal administration is the secret of the Lambeth Maternity and Child Welfare Scheme's success in practical working. Each Centre has to provide locally 12½ per cent. of the total maintenance expenses and this is becoming more difficult year by year. It may be that, eventually, the Council and the Ministry will have to meet all expenses. Lambeth Milk Assistance Scheme (Free or Aided Supplies). The Lambeth Milk Assistance Scheme is still in existence, and proving of value, though not so valuable as it would be if the Ministry of Health's scale as to income limit were more generous. The Old Milk Orders and the unrestricted Milk Assistance Scheme had proved, beyond doubt, since 1918, the great value of milk as an accessory food for expectant and nursing mothers and for children under 5 years of age, not only in Lambeth Borough but elsewhere. The administration of the Lambeth Milk Assistance Scheme is carried out by the different Welfare Centres (including the Milk Depôt). The figures giving the cost of the Lambeth Milk Assistance Scheme (free or aided supplies) are interesting as showing the comparatively large amount of milk (ordinary milk and dried milk), which has been distributed under such Scheme, which first came into force on February 8th, 1918, under powers given by the Milk (Mothers and Children) Order, 1918, and the Local Authority (Food Control Order (No. 1), 1918. The figures are as follows:— 21 Total amount Cost of Milk distributed of Milk Years. Total Cost. distributed in (Financial). Through Through gallons Welfare Centres. Milk Depot.* (approximately)* 1918-19 232 15 3 69 4 3 301 19 6 3,151 (3 months) 1919-20 2,780 0 10 557 10 1 3,337 10 11 34,827 1920-21 13,836 7 3 1,564 7 3 15,400 14 6 160,703 1921-22 4,596 8 5 1,172 0 8 5,768 9 1 60,192 1922-23 3,553 15 4 1,064 19 5 4,618 14 9 48,196 1923-24 3,380 15 11 353 15 3 3,734 11 2 38,969 1924-25 2,977 19 8 137 17 7 3,115 17 3 31,543 1925-26 2,161 6 3 105 12 8 2,266 18 11 32,846 1926-27 2,209 6 1 189 4 4 2,398 10 5 32,012 1927 1,487 8 11 125 16 5 1,613 5 4 21,933 (9 months) Totals £37,216 3 11 £5,340 7 11 £42,556 11 10 464,302 gallons. Municipal Milk depot and Infants Consultations Centre. (Municipal Milk Depot, inaugurated by the Council, 1903.) Record of Work carried out during 1927. 82 new infants and children were entered upon the Register and fed, their ages being at the time of commencing the milk:— Under 3 months 30 9-12 months 9 3-6 months 17 Over 12 months and 6-9 months 16 under 2 years 10 Total 82 Of the 30 infants under 3 months, 6 were aged 14 days or under. These 82 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, 60; weakly, 14; wasting, 5; diseased, 3. The diseases from which the 3 infants and children were actually, or had recently been, suffering at the time of being * N.B.—See also the figures for the Milk Depot, dealing with milk supplied to all cases (necessitous and non-necessitous), representing for the 9 years 1918-1927 a net expenditure of £2,288 19s. 6d. (total expenditure £14,116 15s. 9d. less receipts from mothers of £11,827 16s. 3d.). 22 put upon the milk were bronchitis, 1; convulsions, 1; and spina bifida, 1. An average of 89 infants and children (under 2 years) were fed per week at the Depot, necessitating the distribution for the year of 79,137 bottles of milk mixture (4,678) gallons), whilst, in addition, milk was also supplied as follows:— 1. Lambeth Hospital—using 7,542 bottles of milk mixture (942½ gallons); 2. Nursing mothers—using 1,403 pint bottles of milk mixture (1753/8 gallons); 3. Expectant mothers—using 73 pint bottles of milk mixture (9£ gallons); 4. Children over 2 years of age—using 1,257 pint bottles of milk mixture (1571/8 gallons); 5. Invalids—using 13 pint bottles of milk mixture (1 5/8 gallons). A total of 5,621 gallons of milk and 215 1/2 pints of cream were used during 1927, distributed in 86,679 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 Depôt 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. As already stated, the inauguration and success of the Lambeth Milk Assistance Scheme are reducing the numbers of infants and children dealt with at the Municipal Milk Depôt; in fact, the Depôt has served its day, and proved, during the past 20 years, of the greatest value administratively (especially educationally). The decline in the Milk Depôt numbers was anticipated when milk became available locally in the various wards and districts of the Borough through the various Welfare Centres. 23 * Proposed Appointment of Assistant Medical Officer of Health for Maternity and Child Welfare Purposes. This important subject still awaits the decision by the Council, in reply to the enquiries that have already been received from the Ministry of Health. That the time is ripe (if not over-ripe) for such an appointment being made goes without saying, in view of the Lambeth statistics. DEATHS, 1927. The total number of deaths (uncorrected) registered is 4,081. All death rates for 1927 are calculated upon an estimated population of 307,700 (to the middle of the year). 1.—General Death-Rates. The uncorrected death-rate for Lambeth is 13.3 per 1,000 of the population. This rate is, however, uncorrected, and, on analysing the 4,081 total deaths registered, it is found that 1,014 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted, but, on the other hand, there are 751 deaths registered outside the Borough of persons belonging thereto, and these must be added, giving a net corrected number of deaths of 3,818 and a net corrected deathrate of 12.4 per 1,000 inhabitants.† The Inner (congested and crowded) Districts show, as a whole, a general corrected deathrate of 13.2 as compared with 11.9 for the Outer (less congested and less crowded) Districts, per 1,000 of the population. Age Periods of Corrected Deaths. The 3,818 corrected deaths during 1927 may be further analysed and tabulated as follows:— 266, i.e., 6.9 per cent. of the total corrected deaths took place under 1 year of age. 165, i.e., 4.3 per cent. between 1 and 5 years. 431, i.e., 11.3 per cent. under 5 years. 150, i.e., 3.9 per cent. between 5 and 20 years. 356, i.e., 9.3 per cent. 20 to 40 years. 832, i.e., 21.8 per cent. 40 to 60 years. 2,049, i.e., 53.6 per cent. 60 and over. 3,387, i.e., 88.7 per cent. over 5 years. * This is an expression of opinion of Dr Priestley. † The slight rise in the general death-rate is due to the drop of 3,300 in the estimated population for the Borough of Lambeth, prepared by the Registrar-General (vide also the introductory letter on p 4). 24 TABLE D. Shewing the corrected number of Deaths, with corrected DeathSub-Districts of the Borough during 1927. The deaths are from all adding Lambethians who die outside the Borough, by omitting (who die in Public Institutions) amongst the Districts from which A. Registration REGISTRATION SUB-DISTRICTS Total Deaths (corrected). General corrected Deathrate per 1,000 of the Population. Small Pox. Measles. Scarlet Fever. Lambeth Church 623 14.4 — 10 — Kennington 574 13.0 — 5 1 Stockwell§ 808 12.4 — 2 — Brixton 992 11.7 — 1 — Norwood 821 11.7 — 5 — Borough of Lambeth 3,818 12.4 — 23 1 * No death registered from membranous croup. †One death at an § Of the 808 deaths in Stockwell Registration Sub-District, 374 belong Inner Registration Sub-Districts—death rates Outer Registration Sub-Districts—death rates 25 TABLE D. rates (general, zymotic and diarrhœal), in each of the Registration 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 Total Zymotic Deaths. Zymotic Death-rate per 1,000 of the Population (corrected). Diarrhœa Death-rate per 10,000 of the Population (corrected). Diphtheria and *Membranous Croup. Whooping Cough. Typhus. † Typhoid or Enteric. Continued Fever. Cholera. Diarrhœa and Dysentery 10 5 — 1 — — 3 29 0.7 0.7 10 9 — 1 — — 4 30 0.7 0.9 3 5 — — — — 6 16 0.2 0.9 5 9 — 1 — — 9 25 0.3 1.05 5 1 — — — — 10 21 0.3 1.4 33 29 — 3 — — 32 121 0.4 1.0 Asylum outside the Borough (the patient being chargeable to Lambeth) to the Inner and 434 to the outer Stockwell Sub-District respectively. (general 13.2, zymotic 0.5, diarrhœal 0.06 per 1,000 population). (general 11.9, zymotic 0.3, diarrhœal 0.1 per 1,000 population). 26 Changes in Registration of Deaths. The Registrar-General decided to publish from January 1st, 1911, in his annual reports, an analysis of deaths according to administrative areas instead of registration areas as hitherto, and this decision necessitates a complete distribution of the deaths of persons dying away from their homes to the administrative areas in which they had previously resided. Reports were received quarterly during 1927 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 1927 (and the previous 5 years) at the end of the Report (Vital Statistics), known as the Local Government Board New Tables I., II., III., and IV., shew these corrected statistics of deaths within the Borough (differing slightly, in consequence, from the statistics in the body of the Report), the additional figures for the year 1927 being as follows:— Age Periods. Males. Females. Totals. 0— 1 - 6 6 1— 2 1 — 1 2— 5 — 2 2 5—15 2 1 3 15—25 4 4 8 25—45 8 6 14 45—65 9 9 18 65 and upwards 2 6 8 Total all ages 26 34 60 27 Causes of the 60 outside Deaths. Causes of Death. Male. Female. Whooping Cough - - Diphtheria 2 1 Diarrhœa — 1 Influenza 1 1 Phthisis (Pulmonary Tuberculosis) 9 5 Other Tubercular diseases 2 2 Cancer, malignant disease 2 4 Heart disease 2 2 Bronchitis — 1 Pneumonia 1 1 Broncho-Pneumonia 3 1 Pleuro-Pneumonia — — Other Lung Diseases — — Nephritis and Bright's disease — 1 Premature Birth — — Violent deaths 1 1 Suicide — 1 Nervous diseases — — Cirrhosis of Liver — 1 Diseases of Digestive System — — Diabetes — — Not classified above* 3* 14* Totals 26 34 2.—Infantile Mortality Rates. Of the 3,818 corrected deaths, 266 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 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. * Males—Laryngitis, senile decay, measles—3 cases in all. Females—Gangrenous appendicitis, arterio-sclerosis, acute naso-pharyngeal catarrh, congenital debility, convulsions, paratyphoid fever, acute rheumatism, internal hæmorrhage, erysipelas, cerebral hæmorrhage, embolism, and natural cause not precisely ascertained (3 cases)—14 cases in all. 28 The infantile mortality rate is based upon the number of deaths under 1 year of age per 1,000 births registered. Taking the 7,016 total registered uncorrected births during 1927 (52 weeks), and the 395 total uncorrected deaths of infants under 1 year of age, the infantile mortality rate is 56.3, as compared with annual average rates (uncorrected of 150.5, 123.8 and 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 quinquennium 1921-25 (Borough); whereas, if the corrected deaths of infants under 1 year are used, viz., 266, the infantile mortality rate is 37.9, 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 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, diarrhœa 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 18911900, and the quinquennium 1921-25. The figures for the year 1927 are the lowest ever recorded in the annals of the Borough or of the Parish. In the Registration Sub-Districts, the uncorrected infantile mortality varies from 33.0 in Norwood to 81.6 in Brixton, thus: Registration Sub-Districts. Total No. of Births (uncorrected) 1927. Total Deaths under 1 year (uncorrected) 1927. Infantile Mortality per 1,000 births (uncorrected) 1927. Lambeth Church 2,135 137 64.2 Kennington 995 57 57.3 Stockwell 1,375 46 33.4 Brixton 1,482 121 81.6 Norwood 1,029 34 33.0 Lambeth 7,016 395 56.3 Inner Districts—56.8, Outer Districts—55.6. N.B.—For the purposes of calculating infantile mortality rates in this table, the births and deaths in Stockwell Registration Subdistrict are divided equally between the Inner and Outer Districts. 29 Taking the number of registered deaths (corrected) of infants under one year of age for the year 1927, and comparing it with the number for the previous year (1926) and the average, figures during the past quarter of a century (25 years), arranged, quinquennially and decennially, the following statement is particularly noteworthy: 1927 (actual) 266 1926 (actual) 288 5 years 1921-1925 (Borough) 419.4 10 years 1911-1900 (Borough) 619.7 10 years 1901-1910 (Borough) 1020.1 Average for 25 years 1901-1925 686.4 N.B.—It may be added that the average figure for the Parish of Lambeth for the decennium 1891-1900 was 1358.5. 3.—Child Mortality (Deaths of Children between 1 and 5 years of Age). 165 corrected deaths were registered during the year 1927 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:— 1927 (actual) 165 1926 (actual) 199 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. N.B.—It may be added that the average figure for the Parish of Lambeth for the decennium 1891-1900 was 717.7. 4.—Total Mortality amongst Infants and Children under 5 Years of Age. Again, the decline in the total mortality figures for all infants and children under 5 years of age is remarkable—a total of 431 corrected deaths during the year 1927 amongst infants and children under five years of age, as compared with the following average yearly numbers during the past quarter of a century (25 years), arranged quinquennially and decennially:— 1927 (actual) 431 1926 (actual) 487 5 years, 1921-1925 (Borough) 646.2 10 years, 1911-1920 (Borough) 958.6 10 years, 1901-1910 (Borough) 1503.5 Average for 25 years, 1901-1925 = 1036.1. N.B.—It may be added that the average figure for the Parish of Lambeth for the decennium 1891-1900 was 2076.2. 30 5.—Mortality (all ages). The different rates of mortality from different diseases and groups of diseases during 1927 (and 1926) 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. 6.—Zymotic Death-Rates. The zymotic death-rate is made up of the total deaths from the seven principal zymotic diseases, viz.: smallpox, measles, scarlet fever, diphtheria (including membranous croup), whooping cough, "fever" (including typhus, typhoid and paratyphoid or enteric and simple continued or ill-defined) and diarrhœa. The total number of deaths registered within the Borough from these diseases is 110—50 strangers belonging to other districts and 60 parishioners who died within the Borough ; whilst, in addition, 61 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 121, giving a zymotic death-rate (corrected) of 0.4 per 1,000 inhabitants. As in the case of general death-rates, the zymotic death-rates vary in the inner and outer districts, viz., 0.5 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:— Smallpox, 0.0; measles, 0.07; whooping cough, 0.09; scarlet fever, 0.003; diphtheria, 0.10; "fever," 0.009; and diarrhoea, 0.10. 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 1927 is 12.4 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 deathrate (corrected) for the year 1927 is 0.39 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 during the same quinquennium. The lowest corrected death-rates ever recorded in the annals of the Parish or the Borough are 31 (a) General death-rate in 1923, viz.: 11.28 (b) Zymotic death-rate in 1927, viz. : 0.39. Tuberculosis Death-Rates. The tuberculosis corrected death-rate for 1927 is 1.01, i.e., 313 deaths from all forms of tuberculosis per 1,000 population, and the consumption (phthisis) death-rate, 0.85, i.e., 264 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 Pul. Tub. or Phthisis (consumpt'n) Other Forms Tuberculosis. Total Deaths Tuberculosis (all forms). Phthisis rate per 1,000 population. Tuberculosis rate per 1,000 population (all forms. Lambeth Church 58 16 74 1.3 1.7 Kennington 36 4 40 0.8 0.9 Stockwell 66 11 77 1.0 1.2 Brixton 66 10 76 0.8 0.9 Norwood 38 8 46 0.5 0.6 Borough of Lambeth 264 49 313 0.8* 1.0 † Rates for Inner Districts 1.06* and 1.20† Rates for Outer Districts 0.72* and 0.84† 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 (6) 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 1926 and 1927. A.—Total Deaths from all causes and at all ages with percentages of such deaths to total deaths (corrected). Class of Disease Borough 1927. Borough 1926. No. of Deaths (corrected) Percentage of Total Deaths (corrected). No. of Deaths (corrected). Percentage of Total Deaths (corrected). I.—Zymotic Diseases 283 7.4 275 7.7 Seven Principal 121 3.2 160 4.5 Influenza 113 2.9 57 1.6 II.—Parasitic 3 0.1 - - III.—Dietetic 9 0.2 5 0.1 IV.—Constitutional 907 23.7 909 25.4 Cancer 504 13.2 492 13.8 Phthisis 264 6.9 262 7.3 Tubercular Diseases, excluding Phthisis 49 1.3 60 1.7 Rheumatism (Acute and Chronic) and Gout 18 0.5 23 0.6 V.—Developmental 264 6.9 254 7.1 Old Age 173 4.5 160 4.5 VI.—Local Diseases 2,146 56.2 1,947 54.5 Circulatory System 733 19.2 677 18.9 Bronchitis 294 7.7 271 7.6 Pneumonia and BronchoPneumonia 193 5.05 176 4.9 Pleurisy and Pleuropneumonia 107 2.8 103 2.9 Respiratory System, excluding Phthisis 649 17.0 588 16.4 VII.—Violence 195 5.1 169 4.7 Suicide 43 1.1 43 1.2 VIII.—Ill-defined and not Specified Causes 11 0.3 16 0.4 33 TABLE E.—Continued. B.—Deaths (corrected) of Infants under One Year of age from the chief infantile diseases, and from all causes expressed in terms of 1,000 births (corrected). Borough 1927. Borough 1926 Total Deaths under One Year (Corrected). Proportion to 1,000 Births (Corrected).* Total Deaths under One Year (Corrected). Proportion to 1,000 Births (Corrected) *. From all causes 266 53.5 288 53.7 Diarrhœa 25 5.02 19 3.5 Convulsions 4 0.8 7 1.3 Respiratory Diseases 66 13.2 62 11.6 Premature Births 60 12.07 64 11.9 Tubercular Diseases (including Phthisis) 5 1.0 3 0.5 Measles 4 0.8 13 2.4 Whooping Cough 8 1.6 10 1.9 Suffocation in Bed 1 0.2 4 0.7 Enteritis 5 1.0 20 3.7 Dentition — — — - * N.B.—The above rates have been calculated upon the Registrar-General's corrected numbers of births for the calendar 0 years, 1926-27, viz. —5,359 and 4,971 respectively. 34 TABLE F. Shewing the number of Deaths (corrected) from the 7 principal zymot'c diseases in the Borough of Lambeth during 1927 and during the five previous years 1922-26 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 (Borough) Disease. Total (corrected) Deaths in 1927. 1922 1923 1924 1925 1926 Annual 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 0.2 0.0 6.8 1.1 Scarlet Fever 1 20 11 11 9 4 13.4 11.9 31.4 48.8 Diphtheria 33 50 48 51 55 43 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 0.3 Typhoid or Enteric and 3 7 1 1 4 2 2.6 7.0 16.7 34.7 Continued (Relapsing — — — — — — 0.0 0.3 0.7 1.7 Diarrhœa 32 35 46 23 33 22 52.2 127.8 172.9 196.5 Cholera - 0.0 0.3 1.3 8.8 Measles* 23 66 21 88 5 69 39.0 84.7 110.4 145.6 Whooping Cough 29 58 14 23 48 19 35.2 47.2 91.8 143.7 Borough of Lambeth 121 237 141 197 154 160 192.2 326.8 475.1 706.1 * One death registered from German Measles is included with the " Measles " deaths during 1926. 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, 3,311 cases of infectious diseases (excluding tuberculosis) were reported, including encephalitis lethargica 7, malaria 5, acute primary pneumonia 295, acute influenzal pneumonia 203, cerebrospinal fever 7*, anterior poliomyelitis 7, ophthalmia neonatorum 55, measles 940, and German measles 133. These 3,311 cases occurred in 3,010 infected houses and, of the 3.311 cases, 1,851, i.e., 55.9 per cent., were removed to hospital, and 1,460, i.e., 44.1 per cent., remained under treatment in their homes. If the recentlyadded notifiable diseases be excluded so as to make the 1927 figures strictly comparable with those for previous years, the percentage of ordinary infectious diseases cases removed to hospital during 1927 was 91.4 as compared with 91.8 for the quinquennium 1921-25, and 85.0, 82.8, 82.8, 67.9, 54.7, and 31.5 for the six quinquennia 1916-20, 1911-15, 1906-10, 1901-5, 1896-1900 and 1891-5, respectively, i.e., since the compulsory notification of infectious diseases came into force under the Public Health (London) Act, 1891—a satisfactory record. Full statistics of all the compulsorily-notifiable infectious diseases are to be found in tabular form. Smallpox. Several suspected cases of smallpox were reported, but, on being visited by the Medical Officer of Health, the persons were found not to be suffering from the disease suspected. No single case of smallpox was, officially, notified during 1927. 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—0.15 per cent. (1 death out of 659 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 * Including 1 case of post-basic meningitis. C1 36 to attribute the lessened incidence and virulence of the disease on the populations as due to the moneys expended in the past in systematic isolation and treatment hospitals for scarlet fever patients. These facts have been pointed out in previous Annual Reports by the Medical Officer of Health, from time to time. The Metropolitan Asylums Board has decided to pay more attention in future to the isolation and treatment in hospitals of more measles (and whooping cough) patients than hitherto in place of scarlet fever patients. The decision is noteworthy and the subsequent results will be watched with interest. Diphtheria and Membranous Croup. A total of 767 cases of diphtheria and 2 cases of membranous croup have been notified, but, bacteriologically, all these cases were not, necessarily, true cases. Even the bacillus diphtheria (Klebs-Loeffler), 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. In this connection, the Lambeth method is as follows:—If the Klebs-Lceffler bacilli found in pure cultivation are, on inoculation, found to be virulent to guinea pigs, precautionary measures are taken (notification, isolation, exclusion from schools, disinfection, &c.); whereas, if the Klebs-Loeffler bacilli found in pure cultivation are (on inoculation into guinea pigs) proved to be non-virulent, the above-mentioned precautionary measures are not insisted upon. The method is experimental, at present. Prevention of Diphtheria. In view of the statistics of Lambeth and other districts, the time has arrived for a serious consideration by the Council of the advisability or otherwise, of adopting systematically the Schick test, and toxin-antitoxin* inoculation (as a consequent and subsequent preventive measure.) The Medical Officer of Health has no hesitation in recommending the Council to try the experiment (if experiment it still be) within the Borough in so far as children under 5 years of age are concerned—children of school age being under the control of the London County Council as the educational authority. Beyond school age (i.e., adolescents and adults), the responsibility rests with the Borough Council. A statistical table has been prepared for Lambeth, dealing with the diphtheria-incidence and diphtheria mortality rates, during the past 32 years (vide p. 37). * See footnote on page 40. 37 DIPHTHERIA STATISTICS FROM 1895 to 1926 (inclusive). BOROUGH OF LAMBETH. Year. Population at decennial periods. Total No. of Diphtheria 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 mortality). No. of cases treated at Home. Percentage of Total Notifications. No. of Deaths. Percentage (case mortality). 1895 291,067 614 2.1 172 28.0 47 27.3 442 72.0 56 12.7 6 295,033 652 2.2 263 40.3 71 26.9 389 59.7 58 14.9 7 296,405 704 2.4 313 44.4 90 28.7 391 55.6 48 12.3 8 297,777 813 2.7 278 34.2 65 23.4 535 65.8 43 8.0 9 299,149 1,081 3.6 761 70.4 108 14.2 320 29.6 14.1 1900 300,521 844 2.8 598 70.9 77 12.9 246 29.1 26 10.6 1 301,895 511 1.7 383 74.9 36 9.4 128 25.1 11 8.6 2 301,512 459 1.5 347 75.6 38 10.9 112 24.4 11 9.9 3 301,129 329 1.1 250 75.9 18 7.2 79 24.1 10 12.7 4 300,746 317 1.05 242 76.3 25 10.3 75 23.7 8 10.7 5 300,363 439 1.4 359 81.8 24 6.7 80 18.2 13 16.3 6 299,980 415 1.4 332 80.0 38 11.4 83 20.0 12 14.5 7 299,597 317 1.05 267 84.2 46 17.2 50 15.8 1 2.0 8 299,214 320 1.1 283 88.4 38 13.4 37 11.6 6 16.2 9 298,831 373 1.2 346 92.8 57 16.5 27 7.2 2 7.4 1910 298,848 318 1.1 287 90.3 23 8.0 31 9.7 2 6..5 1 298,058 398 1.3 373 93.7 39 10.5 25 6.3 4 16.0 2 298,539 329 1.1 300 91.2 29 9.7 29 8.8 - - 3 299,020 385 1.2 334 86.8 32 9.6 51 13.2 4 7.8 4 299,501 550 1.1 476 86.5 47 9.9 74 13.5 3 4.1 5 299,982 434 1.4 393 90.5 41 10.4 41 9.5 4 9.7 6 300,463 432 1.4 398 92.1 41 10.3 34 7.9 - - 7 300,944 563 1.8 493 87.6 43 8.7 70 12.4 5 7.1 8 301,425 484 1.6 466 96.3 39 8.4 18 3.7 6 33.3 9 301,906 548 1.8 484 88.3 56 11.6 64 11.7 4 6.2 1920 302,397 705 2.3 676 95.9 70 10.3 29 4.1 7 24.1 1 302,868 543 1.8 524 96.5 43 8.2 19 3.5 1 5.0 2 303,349 640 2.1 603 94.2 45 7.5 37 5.8 5 18.5 3 303,830 580 1.9 568 97.9 48 8.4 12 9.1 - 18-5 4 304,311 589 1.9 571 96.9 48 8.4 18 3.1 3 - 5 304,792 831 2.7 814 97.9 55 6.7 7 2.1 - 16-6 6 305,273 716 2.3 705 98.5 43 6.1 11 1.5 - - 7 305,754 767 2.5 750 97.8 32 4.3 17 2.2 1 5.9 Membranous Croup cases are not included in the above table. N.B.—'The above table has been prepared for Diphtheria, to correspond with a similar table for Scarlet Fever that was prepared and issued in the Annual Report for 1926 (p. 37). 38 The prominent feature in the table is the lessening of the diphtheria-mortality rate during that period, viz., from 0.35 per 1,000 of the population in 1895 to 0.14 in 1926; or, expressed in averages, from 0.42 per 1,000 of the population during the five years 1895 to 1899, as compared with 0.15 during the twenty-seven years 1900 to 1926, i.e., a reduction of more than 60 per cent. During the same periods, the diphtheria-incidence rate has practically remained the same, so that, with an average increasing estimated population (291,067 in 1895, as compared with 305,273 in 1926), and despite present and recent improved methods of diagnosis, with the aid of bacteriology, the saving of deaths has been really even greater in fact than the figures set out in the statistical table appear to show. What is the explanation ? The explanation is, in the opinion of the Medical Officer of Health, to be found in the two following facts:— (a) the large numbers of patients removed yearly to the M.A.B. Hospitals for treatment since 1895; (b) the use of antitoxin as the sheet-anchor of diphtheria treatment in such Hospitals since 1900. The average percentages of patients removed to the M.A.B. Hospitals are 43.6 during the five years 1895 to 1899, and 88.2 during the twenty-seven years 1900-1926 respectively. 98 per cent, of the total notified cases in 1926 were removed to Hospital, as compared with only 28 per cent, in 1895! Antitoxin was first introduced in 1894, but did not come into general use until 1900, and into more general use with the introduction in 1910 of the Antitoxin Order, during the succeeding years up to date, especially in Hospitals and other Institutions. The ordinary well-known preventive methods have been in use during the whole of the 32 years, viz., notification, isolation, disinfection, etc., supplemented with improved (bacteriological) methods of diagnosis and more careful examinations of " contacts " during more recent years. Improved general sanitary conditions must also be allowed for. There can be little doubt but that antitoxin, as a chief form of treatment in diphtheria (in the early stages of the disease) has been the main factor in reducing the mortality-rate by approximately 60 per cent, during the past 32 years in the Parish and Borough of Lambeth, and this result has been brought about by virtue of the M.A.B. official decision to admit practically all cases, i.e., other than as well as Poor Law cases, and the energy that has 39 been displayed by the Public Health Staff in Lambeth in getting notified cases (practically all notified real cases) removed to Hospital, where antitoxin is used as a diphtheria routine (and chief) form of treatment. What applies to the use of antitoxin in Lambeth applies to its use in other Metropolitan Districts, and, of course, in other Provincial Districts also. The Schick Test and Toxin-Antitoxin Preventive Inoculation. The inestimable value of antitoxin in the treatment of early diphtheria in reducing the death-rate from that disease is now an acknowledged fact by all experts and others. The bacteriologists have proved to be correct, and their prophecy has come true as regards diphtheria treatment by antitoxin. Why should not their prophecy in regard to diphtheria-prevention by toxin-antitoxin inoculation prove to be equally true ? The bacteriological principle involved is the same. By means of what is known as the Schick test, susceptibility to diphtheria can be definitely discovered, and, where and when discovered, can be equally definitely combatted by the production of artificial active immunisation. Diphtheria is chiefly a disease of young children (pre-school and school children), and it follows, therefore, that the inmates of all schools and of all other institutions (dealing with such a highly sysceptible material) should be systematically Schick-tested, and all inmates, who are shown by that test to be susceptible, should be subsequently rendered artificially immune by treatment with what is known as toxin-antitoxin inoculation with an anti-diphtheria vaccine or artificial immuniser. It must not be assumed that all pre-school or school children will prove to be susceptible on the application of the Schick test. Some children (and other individuals) prove to be naturally immune —very young pre-school children from their mothers. The principle of the Schick test is easily understood. It consists of injecting intracutaneously a minute quantity (almost infinitesimal) of a standardised diluted diphtheria toxin (prepared from the diphtheria bacillus) into the fore-arm of a child (or other individual). The pain of the operation is negligible, as is also any problematical danger to the person operated upon, assuming that ordinary care and attention are exercised. Redness at the points of puncture in a few hours or a few days shows susceptibility to diphtheria, and diphtheria prophylaxis or artificial acute immunisation should follow, producible by the injection of a small amount of toxin-antitoxin (three successive doses at several days intervals), intra-muscularly or sub-cutaneously, into the upper arm or arms of the persons susceptible. Toxin-antitoxin*, as its name implies, consists of a mixture, duly standardised—a very small amount 40 of diphtheria toxin, to which has been added sufficient antitoxin to neutralise such toxin. In this way, artificial immunity is secured. Official effect is being given in Lambeth to the Schick test, and the subsequent artificial acute immunisation, by the Board of Guardians at the Norwood Schools, and the results are reported (up to date) to be proving satisfactory. These are the only Lambeth statistics that are officially available, but they are satisfactory as far as they go, and, as they have already appeared in print publicly, may be set on record as follows:— Since 1922, a total of 1,288, including 35 staff, have been tested, yielding 432 positives, and 380 have been immunised. Among 562 children in the Schools in 1924-5, there were no diphtheria cases, and in 1925-6 two cases, in children whose parents had refused consent; whereas, in the Schools Infirmary, where immunisation is not carried out amongst the inmates (number averaging 162), in 1924-5 there were 12 cases, and, in 1925-6, 19 cases, amongst children not admitted as diphtheria patients. Equally satisfactory reports have been issued from New York City, Glasgow, Edinburgh, Liverpool, etc.* The London County Council, as the Educational Authority, will have to make the decision, sooner or later, as to whether or not the thousands and thousands of diphtheria-susceptible school children in Lambeth, and in other Metropolitan districts, are to be Schicktested and, afterwards, rendered immune artificially against diphtheria, as in New York City. Such a simple and comparatively painless and harmless bacteriological preventive measure might certainly be tried by the London County Council, especially in view of the large saving of school children's lives that is promised therefrom. The Borough Council's responsibility in regard to diphtheriaprevention has reference to children under school age, and the population generally over the school age period. In connection with the former, the highest diphtheria mortality rate is amongst infants (under 1 year of age), children (1 year of age), and other children (2 to 4 years of age). The Medical Officer of Health (Dr. Priestley) presented a special report on the whole subject to the Council on September 22nd, 1927. * The most up-to-date improvement is to use toxoid instead of toxin— the toxoid being toxin which has been neutralised with the necessary amount of formalin solution. 41 Measles and German Measles. These diseases still remain compulsorily-notifiable throughout the Borough under the terms of the Public Health (Measles and German Measles) Temporary Regulations, 1919, which came into force on December 31st, 1919, continuing in force in certain Districts (set out in the Schedule) the provisions of the Public Health (Measles and German Measles) Regulations, 1915, until (in the case of the Borough of Lambeth) March 31st, 1920, and since, by further Order of the Ministry of Health. These temporary Regulations were necessary on account of the issuing of the Public Health (Measles and German Measles) Regulations, 1915, Rescission Order, 1919, rescinding the Public Health (Measles and German Measles) Regulations, 1915, as from December 31st, 1919. A fresh outbreak of these diseases began at the end of the year 1927, the preceding epidemic, 1925-1926, having died down at the end of 1926. Puerperal Sepsis. Much attention is still being paid to this disease, it being felt that, as a preventable disease, it should be non-existent. 22 cases of puerperal fever (7 deaths) were notified, 8 connected with abortions and miscarriages and 14 others out of 7,016 total births notified— a comparatively small percentage, especially having regard to the large lying-in Institutions and Maternity Departments of Hospitals that exist in the Borough. At the same time, this comparatively small number (27) of notified 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 are 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. Every effort is being made to reduce the yearly figure, small though it be in comparison with the large number of births that are annually notified officially in connection with Lambeth mothers. In this connection, the issuing of the Public Health (Notification of Puerperal Pyrexia and Puerperal Fever) Regulations, 1926, which came into force on October 1st, 1926, are proving of value— 57 cases of puerperal pyrexia having been notified during 1927. Under these Regulations, the Council has appointed Obstetrical Experts, viz. : Dr. Wyatt (for the Inner Districts) and Dr. Gilliatt (for the Outer Districts), with Dr. Bousfield as Expert Bacteriologist for the taking and examining of samples of lochia and blood as required. During 1927, the services of these experts had to be requisitioned on three separate occasions only. 42 43 TABLE G. Shewing the total numbers of cases (corrected) of infectious diseases notified compulsorily by Medical Practitioners under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, in the Borough of Lambeth, during 1927, together with the total numbers of deaths registered from the same diseases, the case mortality per 100 persons for each disease, the numbers of cases (with percentages) removed to hospital, and the numbers of infected houses. Cases notified. Deaths registered. Case Mortality per 100. Cases removed to hospital. Per cent. of cases removed. Infected houses. Cholera - - - - - - Smallpox — — - - - - Scarlet Fever 659 1 0.15 61 / 93.62 610 Diphtheria 767 33 4.30 750 97.78 695 Membranous Croup 2 — — 1 50.00 2 † Typus - - - . - - Typhoid or Enteric 23 3 13.04 20 86.95 23 Continued and Relapsing Fever - - — — — — Erysipelas 128 7 5.42 55 42.96 128 Puerperal Fever 22 7 31.81 19 86.36 22 *Puerperal Pyrexia 57 — 0.00 8 14.03 56 *Plague — — — — — - *‡Cerebro-Spinal Fever 7 4 57.14 7 100.00 7 *Polio-myelitis acuta 7 1 14.28 4 57.14 7 *Ophthalmia Neonatorum 55 1 1.81 6 10.90 55 *Whooping Cough — 29 - - - - *Measles 940 23 2.44 209 22.21 767 *German Measles 133 - - 1 0.75 132 *Tuberculosis— Pulmonary (primary) 471 264 56.05 - - - Non-pulmonary (primary) 100 49 49.00 - - - *Chickenpox - - - - - - *Malaria 5 - - - - 5 *Dysentery - - - - - - *Primary Pneumonia (Acute) 295 50 16.94 102 34.5 294 *Influenzal Pneumonia (Acute) 203 47 23.15 202 *Encephalitis Lethargica (Acute) 7 7 100.00 5 71.42 7 *Trench Fever - - - - - - *Anthrax 1 — — 1 100.00 1 *Plague was made compulsorily notifiable on September 19th, 1900, cerebro-spinal fever on March 12th, 1907, polio myelitis and polio-encephalitis acuta on September 1st, 1911, ophthalmia neonatorum on March 13th, 1911, glanders (human), anthrax (human), and hydrophobia (human), on April 26th, 1909, pulmonary tuberculosis (poor law cases) on January 1st, 1909, pulmonary tuberculosis (hospital cases) on May 1st, 1911, pulmonary tuberculosis (private cases) on January 1st, 1912, and tuberculosis (pulmonary and non-pulmonary), on February 1st, 1913. Chicken-pox was compulsorily notifiable as follows : 1902 (February 7th to December 31st).1903 (Jauary 1st to 6th), 1904(April 8th to November 8th), 1911 (March 22nd to June 22nd), 1915 (March 17th to June30th). and 1918 (March 27th June 30th), the numbersof cases notified being respectively 1,560, 40 556 238 473 and 307. Whooping Cough was compulsorily notifiable from Januarv 1st, 1913, to December 31st, 1917, the numbers of cases notified being as follows — 1913, 1,428 ; 1914, 1.389 ; 1915, 1,607 ; 1916. 1,576 ; and 1917, 902. Measles and German Measles became compulsorily notifiable on January 1st, 1916, acute encephalitis lethargica on January 1st, 1919, and malaria, dysentery, pneumonia (acute primary and acute influenzal) and trench fever on March 1st, 1919. Puerperal pyrexia became compulsorily notifiable on October 1st, 1926, under the Public Health (Notification of Puerperal Pyrexia and Puerperal Fever) Regulations, 1926. 9 measles cases were notified by parents (or relatives), in addition to the 940 notified cases (mentioned above). † Including 2 cases of paratyphoid fever, 1 case removed to hospital. ‡ Including 1 case of post-basic meningitis, which was removed to the hospital, and died. 44 45 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 1927, 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. 1927 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 - - 0.1 0.2 11.5 Smallpox — 0.6 0.2 49.9 22.0 Scarlet Fever 659 1184.6 904.1 1105.1 1331.3 Diphtheria 767 636.6 482.7 379. 715.1 Membranous Croup 2 3. 5. 10. 26.2 Typhus — — 0. 0. 1.1 †Typhoid or Enteric 23 15.2 31.9 100.5 189.6 Continued and Relapsing — 0.2 0.8 4.1 25.7 Erysipelas 128 115.8 175.0 241.4 347.0 Puerperal 22 31.4 21.8 17.0 18.9 *Puerperal Pyrexia 57 — — — — *Plague — — 0.0 0.0 0.0 *‡Cerebro-spinal Fever 7 6.2 18.2 11.5 *Poliomyelitis acuta 7 60 7.3 - - *Ophthalmia Neonatorum 55 55.2 72.8 - - *Whooping Cough - - 1380.4 - - *Measles 940 1897.0 2354.2 — — *German Measles 133 392.0 635.4 — — *Tuberculosis— Pulmonary (primary) 471 491.6 1112.4 - - Non-pulmonary (primary) 100 101.4 323.7 — — *Chickenpox — — - - - *Malaria 5 8.0 59.5 - - *Dysentery - 0.4 7.0 - - *Primary Pneumonia (Acute) 295 175.2 161.5 - - *Influenzal Pneumonia (Acute) 203 76.6 126.0 - - *Encephalitis Lethargica (Acute) 7 14.2 7.0 - - *Trench Fever - 0.2 0.0 - - *Anthrax (human) 1 0.2 0.1 - - * Plague was made compulsorily notifiable on September 19th, 1900 ; cerebro-spinal fever on March 12th, 1907 ; glanders (human), anthrax (human), and hydrophobia (human), on April 26th, 1909; polio-myelitis and polio-encephalitis acuta on September 1st, 1911; opthalmia neonatorum on March 13th, 1911 ; pulmonary tuberculosis (poor law cases) on January 1st, 1909, pulmonary tuberculosis (hospital cases) on May 1st, 1911 ; pulmonary tuberculosis (private cases) on January 1st, 1912, and tuberculosis (pulmonary and non-pulmonary) on February 1st, 1913. Chicken-pox was compulsorily notifiable as follows:—1902 (February 7th to December 31st), 1903 (January 1st to 6th), 1904 (April 8th to November 8th), 1911 (March 22nd to June 22nd), 1915 (March 17th to June 30th), and 1918 (March 27th to June 30th). Whooping Cough was compulsorily notifiable from January 1st, 1913, to December 31st, 1917, the numbers of cases notified being as follows :—1913, 1,428; 1914, 1,389; 1915, 1,607; 1916, 1,576; and 1917, 902. Measles and German Measles became compulsorily notifiable on January 1st, 1916, acute encephalitis lethargica on January 1st, 1919, and malaria, dysentery, pneumonia (acute primary and acute influenzal), and trench fever on March 1st, 1919. Puerperal pyrexia became compulsorily notifiable on October 1st, 1926, under the Public Health (Notification of Puerperal Pyrexia and Puerperal Fever) Regulations, 1926. N.B.—Of the patients originally notified during 1927, the following were found afterwards not to be suffering from the diseases notified :—Diphtheria, 3 ; Scarlet Fever, 3 ; Puerperal Fever, 3 ; Puerperal Pyrexia, 5 ; and " Typhoid " Fever, 2 ; and are not included in the above table. † Including 2 cases of paratyphoid fever. ‡ Including 1 case of post-basic meningitis. 46 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 also are rapidly becoming diseases of the past. There were registered, during the year 1927, 3 deaths from typhoid fever (1 being from paratyphoid fever). Ophthalmia Neonatorum. Great care is exercised in all cases of doubtful or suspected and real ophthalmia neonatorum, which is the chief cause of blindness. During the year 1927, 55 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 midwives as well as by medical practitioners with the result that many cases were "missed" and precautionary measures were consequently unable to be taken. 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.) This obligation has been carried out, as required, during the year. 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 PolioMyelitis, and Polio-Encephalitis and acute Encephalitis Lethargica, etc.).* The arrangements, which were made by the Council with wellknown Nursing Associations for the nursing, free of cost, of patients notified or otherwise reported to be suffering from Measles and German Measles, Whooping Cough, Ophthalmia Neonatorum (and other forms), Influenza, acute Pneumonia (primary and influenzal), Epidemic Diarrhoea, etc., if (and as) required by the Medical Officer of Health, and which came into force on June 1st, 1918, in connection with the old Inner Wards of the Borough, and on June 1st, 1919, in connection with the old Outer Wards of the Borough, have again 47 proved a success during 1927. The following statistics for the 8 years 1920-1927, setting out the total numbers of visits paid by nurses, speak for themselves:—measles and German measles, 728, 206, 722, 297, 518, 63, 939 and 206 ; whooping cough, 255, 273, 488, 400, 327, 264, 198 and 323 ; ophthalmia neonatorum (and other forms), 2,341, 1,764, 986, 1,093, 1,537, 1,379, 1,352 and 1,538 ; epidemic diarrhoea, 57, 232, 5, 36, 33, 30, 55 and 0 ; influenza, 343, 332, 474, 249, 487, 346, 430 and 644 ; acute primary and influenzal pneumonia, 1.870, 2,643, 3.586, 3,333, 4,164, 4,430, 4,764 and 4,703 ; other diseases, 114, 11, 16, 186, 187, 106, 116 and 274, making totals of 5,708, 5,461, 6,277, 5,594, 7,253, 6,618, 7,854 and 7,688 visits paid respectively.* Of the total visits (7,688) paid during 1927, 3,290 were visits to children under 5 years of age, i.e., 42-80 percent.; dealing with measles and German measles, 178; whooping cough, 223 ; ophthalmia neonatorum (and other forms), 1,538; acute primary and influenzal pneumonia (and other forms), 1,272; erysipelas 23; chickenpox, 46 ; and pemphigus 33. Tuberculosis. Tables H, H (1) and H (2), which are subjoined herewith, 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 sub-districts, with reference to pulmonary and other forms of tuberculosis. There has been a steady decrease of official notifications as there has been in connection with the deaths registered from the same disease. The numbers of cases of tuberculosis on the Lambeth Registers of Notifications on December 31st, 1927, were as follows:— Males. Females. Totals. Pulmonary 932 698 1,630 Non-pulmonary 272 222 494 1,204 920 2,124 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 St. Thomas's Hospital. *N.B.—Including 26 cases of notified puerperal pyrexia (compulsorily notifiable since October 1st, 1926). 48 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 1927, 46 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 1927, 203 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 £465 8s. 6d. 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. 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 closelv 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 working. The 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. *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. †The grant is £1,500 per annum (half repayable to the Council by the Ministry of Health and quarter by the London County Council). 49 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! Branch Tuberculosis Dispensary (St. Thomas's Hospital). With the approval of the Ministry of Health, at a Conference held on May 16th, 1927, certain administrative changes, in connection with St. Thomas's Hospital Branch Tuberculosis Dispensary, have been made, with a view to closer co-ordination with the Council's Public Health Department, and, to secure such, the Medical Staff at the Hospital, and the Nursing or Health-Visiting Staff carrying out the tuberculosis work, have been appointed officers of the Lambeth Borough Council (for the administration of the Tuberculosis Regulations)†; whilst definite arrangements have been made for the more systematic examination of "contacts" and patients or "suspects" at their homes by the Assistant Tuberculosis Officer (for visiting purposes), appointed by the Hospital Governors, with the approval of the Ministry of Health. All dispensary patients are visited at their homes by the Dispensary health visitors, including, also, first visits made on receipt of notifications, copies of which are supplied to the Tuberculosis Officers concerned. The original agreement with St. Thomas's Hospital Governors was entered into by the Borough Council on September 30th, 1924, and, by this agreement, the Governors undertook, inter alia, to appoint an adequate and experienced staff of Health Visitors, and the Borough Council to appoint them and the Tuberculosis Officer, officers of the Borough Council for the purposes of the Tuberculosis Regulations; and, further, that examinations of patients and "contacts" should be made by the Tuberculosis Officer at their homes in certain circumstances, and the place of residence of each dispensary patient visited by one of the Dispensary Health Visitors. *Dentures are paid for by the Council (wholly or partly) only when such are certified as essential for effective tuberculosis treatment). †These officers consist of Dr. G. T. Hebert (Tuberculosis Officer), Dr. A. I. G. McLaughlin (Assistant Tuberculosis Officer for Visiting Purposes), Miss Isobel Gordon (Secretary) and Miss Bertha Graveson (Tuberculosis Health Visitor). d 50 51 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 2nd January, 1927, to the 31st December, 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. *Total Notifications (i.e., including cases previously notified by other Doctors). (Medical). Primary Notifications (Medical.) †Total Notifications. (i.e. including cases previously notified by other Doctors). (Medical). Cases admitted to Cases discharged from 0 to 1. 1 to 5 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. upwards Total. Under 5. 5 to 10. 10 to 15. Total. Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. (Medical.) (Medical.) Pulmonary— Males — 1 4 6 23 31 65 43 69 24 13 279 385 - — - — — 2 264 5 217 Females — — 4 7 25 34 53 38 21 9 1 192 255 — — — — — 3 150 — 104 Non-Pulmonary— Males 1 13 5 9 7 10 4 3 1 1 — 54 60 - 3 2 5 5 1 40 - 32 Females 1 8 5 2 7 4 6 1 1 2 3 40 43 — — 1 1 1 1 35 2 31 * Re-notifications (Form A) = 169 (males 106, females 63), pulmonary and 9 (males) non-pulmonary. † Re-notifications (Form B)=0 (male 0, female 0), pulmonary and 0 (male 0, female 0) non-pulmonary. N.B.—Pulmonary—136 private. 157 hospitals, 178 dispensaries and 0 schools = 471 total primary notifications (Forms A and B, including 72 Poor Law cases under Form A (hospitals). Non-Pulmonary—17 private, 51 hospitals, 26 dispensaries and 6 schools=100 total primary notifications (Forms A and B), including 8 Poor Law Cases under Form A (hospital). D1 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 2nd, 1927, to December 31st, 1927. Registration Sub-Districts. Tuberculosis (All Forms). Pulmonary. Non- Pulmonary. 1927. 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 33 51 1 29 1 28 9 9 - - - 8 - 7 Lambeth Church 32 46 - - 2 27 — 26 10 10 — — — 10 1 9 Kennington 70 96 - - — 53 — 38 15 15 1 1 - 3 1 8 Stockwell (Inner) 51 63 - - 1 48 1 25 9 10 1 1 — 12 1 6 Total Inner Districts 186 256 — — 4 157 2 117 43 44 2 2 — 33 3 30 Stockwell (Outer) 69 91 - - - 51 - 45 12 13 - - - 4 - 5 Brixton 121 168 - - — 113 1 102 21 25 2 2 - 20 - 7 Norwood 95 125 - - 1 93 — 57 18 21 2 2 2 18 1 21 Total Outer Districts 285 384 — — 1 257 1 204 51 59 4 4 2 42 1 33 Borough of Lambeth 471 640 — — 5 414 3 321 94 103 6 6 2 75 4 63 53 METROPOLITAN BOROUGH OF LAMBETH. TABLE H (2). Addendum to Tables H and H (1). Summary of new cases of Tuberculosis reported during the period from the 2nd January, 1927, to the 31st December, 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 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 & Upwards Total cases Pulmonary— „ Males — — — 2 — — 3 6 5 3 1 20 „ Females — — — — 2 4 6 6 3 — — 21 Non-Pulmonary— „ Males 2 1 — — — — 1 — — 2 — 6 „ Females — — 2 — — 1 1 — — 1 1 6 2.—Registration Sub-Districts. Waterloo. Lambeth Church. Kennington. Stockwell (Inner) Total Inner Districts. Stockwell (Outer) Brixton. Norwood. Total Outer Districts. Borough of Lambeth. Pulmonary 3 11 7 3 24 5 8 4 17 41 Non-Pulmonar 1 2 1 3 7 1 2 2 5 12 N.B.—The above 53 cases are made up as follows:—Death Returns, 42 (Pulmonary, 31; Non-Pulmonary, 11); Other sources, 11 (Pulmonary, 10; Non-Pulmonary, 1). 54 Central Tuberculosis Dispensary (73 Effra Road) : Proposed Transference to King's College Hospital.* The premises of the Central Tuberculosis Dispensary at 73, Effra Road, Brixton, though conveniently situated, are, as regards structure and accommodation, unsuitable—a fact that is now generally admitted. New premises are urgently needed, and the Council will have to consider, at an early date, the whole subject and to come to some final decision on the subject. The Central Dispensary, under the Lambeth Scheme, is, as its name implies, the pivot, around which the whole Tuberculosis Scheme for Lambeth Borough should revolve, and it is, manifestly, therefore, the duty of the Council to provide suitable and adequate accommodation for the proper housing of the Central Dispensary Staff in a manner worthy of the Lambeth Council's Public Health administration. It is being suggested that the Council should delegate its important tuberculosis duties to King's College Hospital in regard to the Outer Districts of the Borough in the same way, and on the same terms, as the Council has already done to St. Thomas's Hospital in regard to the Inner Districts. The two cases are not comparable, and it is to be hoped that the Council will not consent to such a suggestion as has been made in regard to King's College Hospital and the Outer Districts of the Borough. The Council should reserve to itself the tuberculosis administration of the Borough and should not delegate to an outside authority or authorities such duties, which are specially important from the point of view of the Public Health. The ideal Scheme is a Central Dispensary for the whole of the Borough with a well-known General Hospital (e.g., St. Thomas's Hospital) attached to such Scheme for consultation and diagnostic purposes, for which purposes patients can be referred, as required, for expert opinions and treatments of a special nature, e.g., bacteriological and ex-Ray Examinations, artificial pneumo-thorax, and concomitant and consequential treatments (both medical and surgical). With regard to St. Thomas's Hospital, which is already attached to, and forms part of the Lambeth Scheme, the work of this Hospital is not only consultative and curative but also, in addition, administrative (as far as the Inner Districts of the Borough are concerned). This arrangement was deemed to be advisable at the time of the Lambeth Scheme being inaugurated because it was found that, at that time, administrative work was already being satisfactorily *This section of the Report sets out the official views of the retiring Medical Officer of Health (Dr. Priestley), and in no way pledges the new Medical Officer of Health (Dr. Thompson), who has been instructed by the Council to report fully on the whole subject during 1928. 55 and efficiently carried out by St. Thomas's Hospital Governors through the Lady Almoner's Department (Miss Cummins) in the Inner Districts of the Borough, and it was essential that such existing local organisation should, at that time, be incorporated within the proposed new Lambeth Scheme so as to secure the maximum success. The question is quite different in regard to the Outer Districts of the Borough upon the same terms and conditions as those that obtain at St. Thomas's Hospital. Such a proposed alteration in administration would really amount to the delegation of the whole of the Council's tuberculosis-prevention and tuberculosis-treatment power to outside administrative organisation. Such a proposed alteration is bad in principle and contrary to a Sanitary Authority's successful and efficient administration. Apart from that, the question of finance (in connection with such a change) must be considered, as it is clear that an additional financial burden would, necessarily, be involved, and that, too, with entire, or practically entire, loss of administrative control.* The matter is under joint consideration by the Ministry of Health and the Council, but its further discussion is held over until the newlyappointed Medical Officer of Health and chief executive tuberculosis officer (Dr. Thompson) has had an opportunity of reporting officially on the facts of the case. 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:— *The amount (at present suggested) is £1,500 per annum, to be paid to King's College Hospital, but such an amount would in no way meet the necessary expenditure. 56 (1) Death-rates (corrected deaths 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 1.2 1.6 1.6 2.1 0.9 1.2 1914 1.3 1.7 1.5 1.9 1.2 1.5 1915 1.4 1.8 1.9 2.3 1.2 1.4 1916 1.4 1.7 1.6 2.1 1.2 1.5 1917 1.5 2.02 203 2.7 1.1 1.5 1918 1.5 2.05 1.9 2.6 1.2 1.7 1919 1.2 1.5 1.5 1.8 0.9 1.2 1920 1.01 1.2 1.2 1.5 0.9 1.08 1921 0.9 1.1 1.2 1.4 0.7 0.9 1922 0.9 1.2 1.1 1.4 0.8 1.07 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 0.87 1.07 1.01 1.26 0.78 0.95 1926 0.84 1.03 1.00 1.24 0.73 0.89 Averages (14 years) 112 1.44 1.38 1.64 0.94 1.20 1927 0.85 1.01 1.06 1.20 0.72 0.84 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 2.8 3.5 1916 3.2 4.5 3.5 4.8 2.9 4.2 1917 3.9 5.6 3.9 5.5 3.9 5.7 1918 4.0 5.4 4.5 5.9 3.7 5.0 1919 2.3 3.2 2.5 3.2 2.2 3.1 1920 2.4 2.8 2.1 2.6 2.6 2.9 1921 1.8 2.1 1.9 2.4 1.6 1.9 1922 1.6 1.9 1.9 2.2 1.5 1.8 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 1.67 1.97 1.49 1.76 1926 1.43 1.75 1.65 2.10 1.29 1.00 Averages (14 years) 2.74 3.51 3.01 3.90 2.50 3.20 1927 1.53 1.85 1.55 1.93 1.51 1.80 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 Dispensaries 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 1927. 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 contact):- (a) Definitely tuberculous 112 76 5 1 6 11 11 10 118 87 16 11 (b) Doubtfully tuberculous - - - - - - - - 56 68 15 10 (c) Non-tuberculous - - - - - - - - 46 54 35 32 B.—Contacts examined during the year:— (a) Definitely tuberculous 9 10 1 — 1 1 — — 10 11 1 — (b) Doubtfully tuberculous — — — — — — — — 9 24 11 9 (c) Non-tuberculous - - - - - - - - 27 77 29 46 C.—Cases written off the Dispensary Register as- (a) Cured 7 11 6 10 2 5 10 5 9 16 16 15 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 107 191 84 93 D.—Number of Persons on Dispensary Register on December (a) Diagnosis completed 432 319 15 24 57 34 16 22 489 353 31 46 (b) Diagnosis not completed — — — — — — — — 27 18 6 4 1. Number of persons on Dispensary Register on January 1st, 1927 964 2. Number of patients transferred from other areas and of " lost sight of " cases returned 14 3. Number of patients transferred to other areas and cases " lost sight of"160 4. Died during the year 115 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded two months 29 6. Number of attendances at the pensary (including Contacts) 5,555 7. Number of attendances of monary cases at Orthopaedic Outstations for treatment or supervision — 8. Number of attendances at General Hospitals or other Institutions approved for the purpose of patients for— (a) " Light" treatment — (b) Other special forms of treatment 85 9. Number of patients to whom Dental Treatment was given at, or in connection with, the Dispensary 6 10. Number of consultations with medical practitioners :— (а) At Homes of Applicants 66 (b) Otherwise 820 11. Number of other visits by culosis Officers to Homes 227 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,089 13. Number of— (а) Specimens of Sputum, etc., examined 903 (б) X Ray Examinations made in connection with Dispensary work 346 14. Number of Insured Persons on pensary Register on the 31st December 566 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 509 16. Number of reports received during the year in respect of Insured Persons : (a) Form G.P. 17 9 (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 of Health Table—FORM AT. 53. Return (Prepared by the Tuberculosis Officer) as to Work carried out in connection with the branch dispensary for the year 1927. N.B.—The Branch Dispensary (St. Thomas's Hospital) was opened February 3rd, 1913. (b) BRANCH 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 106 73 — 3 12 13 14 11 118 86 14 14 (b) Doubtfully tuberculosis - - - - - - - - 5 5 4 5 (c) Non-tuberculous - - - - - - - - 182 294 92 99 B.—Contacts examined during the year:- (a) Definitely tuberculosis - 1 2 1 - - - - - 1 2 1 (b) Doubtfully tuberculosis - - - - - - - - - 2 2 2 (c) Non-tuberculous - - - - - - - - 32 84 65 75 C.—Cases written off the Dispensary Register as- (a) Cured — 2 — — — 1 8 10 — 3 8 10 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 227 399 165 184 D.—Number of Persons on Dispensary Register on December 31st, 1927:— (a) Diagnosis completed 273 191 5 6 45 48 47 58 318 239 52 64 (b) Diagnosis not completed - - - - - - - - 15 26 2 13 1. Number of Persons on Dispensary Register on January 1st, 1927 701 2. Number of patients transferred from other areas and of " lost sight of " cases returned 21 3. Number of patients transferred to other areas and cases " lost sight of" 92 4. Died during the year 89 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded two months 14 6.Number of attendances at the pensary (including Contacts) 4,180 7. Number of attendances of monary cases at Orthopiedic Outstations for treatment or supervision — 8. Number of attendances at General Hospitals or other Institutions approved for the purpose of patients for— (a) " Light" treatment — (b) Other sDecial forms of treatment — 9. Number of patients to whom Dental Treatment was given at, or in connection with, the Dispensary 32 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants 14 (b) Otherwise 407 11. Number of other visits by culosis Officers to Homes 204 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,973 13. Number of— (a) Specimens of Sputum, etc., examined 541 (b) X Ray Examinations made in connection with Dispensary work 777 14. Number of Insured Persons on pensary Register on the 31st December 306 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 61 16. Number of reports received during the year in respect of Insured Persons : (a) Form G.P. 17 14 (b) Form G.P. 36 32 N.B.—Dr. G, T. Hebert was appointed Tuberculosis Officer (Branch Dispensary) on January 6th» 1920. An assistant Tuberculosis Officer (for visiting purposes) is also attached to the Branch Dispensary (since January 1st, 1924). 60 Public Health (Prevention of Tuberculosis) Regulations, 1925. It has not been found necessary to take any action under these regulations. 2.—Non-Notifiable Diseases. Chickenpox. 1,172 cases of chickenpox were reported voluntarily. Diarrhœa. The number of corrected deaths registered from diarrhœa is 32, 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 19211925 (Borough), respectively. All the 32 deaths registered during 1927 occurred amongst children under 5 years of age, and 25, i.e., 78.1 per cent., amongst infants under 1 year of age. This decrease in the number of registered diarrhœa deaths during 1927 is realised when thus compared with the quinquennial yearly averages during the past 35 years. During 1927, the 4 ft. earth thermometer first registered 56°F. on June 14th, rising to a maximum of 61.5°F. on August 16th, and remaining at such maximum for one day only, sinking to 56°F. again on October 7th. 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 diarrhœal diseases, being the temperature at which the particular germ or germs that are the cause or causes of diarrhœal diseases, especially of infantile zymotic, or summer, diarrhœa, take on virulence and become so fatal, chiefly to infants and young children.* Under such a theory, the deaths from *Adults also suffer from zymotic or summer diarrhoea, but rarely, if ever, fatally. 61 diarrhoea during 1927, 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 fact that the chief causes of an increased diarrhoeal rate are to be found in the improper and irregular feeding of infants and young children. 12 corrected deaths (5 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. 62 (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 diarrhœa, (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. The value of such practical measures is shewn by the various statistics in this Report, not only for the year 1927, 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 diarrhœa (in infants and children between the ages of 1 and 5 years) during the same period. Influenza. 113 corrected deaths were registered from Influenza during 1927, as compared with an average of 83.0 during the quinquennium 1921-1925. Of the 113 corrected deaths during 1927, 86 were registered in the 1st, 8 in the 2nd, 0 in the 3rd and 19 in the 4th quarters respectively. The full details of the age and sex distribution of the 113 deaths during 1927, 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 2 2 - - 1 3 3 - 1 1 1 2 1 4 4 63 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. 5 2 13 11 8 5 12 37 45 62 48 65 113 203 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, 30; and cholera and plague, 2. *295 cases of acute primary pneumonia were also notified during 1927. 64 65 TABLE J. Local Government Board Table. BOROUGH OF LAMBETH.—Particulars of cases of acute polio-myelitis (polio-encephalitis), cerebro-spinal fever (post basic meningitis) and encephalitis lethargica acuta notified within the Borough of Lambeth during 1927. 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 Paralvsis* Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis*| Cases. Deaths. Permanent Paralysis* Cases. Deaths Permanent Paralysis* Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis*| Cases. Deaths. Permanent Paralysis*| Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis* Cases. Deaths. Permanent Paralysis* Acute Polio-myelitis 7 1 – – – – – 3 – – 1 – – 1 – – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – Acute Polio-encephalitis – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Cerebro-Spinal Fever 6 – – – – – – – – – 1 1 – – – – 1 – – – – – – – – – – 1 1 – 1 1 – 2 – – – – – – – – Post-Basic Meningitis 1 – – – – – – 1 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Encephalitis Lethargica 7† – – – – – – – – – – – – _ _ _ _ _ _ 1 1 – 1 1 – _ – – 1 1 – 1 – – 1 2 – 1 1 – 1 1 – Number of Recovered, with permanent Paralysis of one or more groups of muscles removed to (slight paralysis of ciliary muscles and accommodation). Isolation Hospital. Acute Polio-myelitis 1 – 3 – – – – – – – – – – – Acute Polio-encephalitis – – – – – – – –– – – – – – – Cerebro-Spinal Fever – – – 1 – — – – – – 1 2 – – Post-Basic Meningitis – – 1 – – 1 – – – 1 – – – – Encephalitis Lethargica – – – – – – 1 1 – – 1 1 1 – † One female aged 23 and one female aged 55, who died during 1927, were notified in previous years. E 66 Municipal Bacteriological Laboratory. (Inaugurated by the late Vestry, 1899.) Table shewing the numbers of pathological samples examined (total 1,299), and the results obtained, at the Bacteriological Laboratory during 1927, and the previous 5 years (1922-1926), together with the averages for the two decennia 1901-1910 (Borough) and 1911-1920 (Borough) and the quinquennium 1922-1926 (Borough). Year. Sputa. Suspected Tuberculosis. Tub. Bac. found. Blood. Suspected Typhoid or Enteric Fever. Reaction obtained. Throat &Nose. Membranes and Secretions. Suspected Diphtheria. Klebs-Lœffler Bac. found. Other Sundry Samples. Result obtained. Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total Pos. Neg. Total 1927 28 199 227 1 5 6 28 1,036 1,064 — 2 2* 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 Average of 5 years 1922-1926 (Borough) Averages of 10 years 21 238.2 259.2 1 11.2 12.2 11.2 666.2 677.4 2 2.2 4.2 (a) 1901-1910 (Borough) 62.8 124.4 187.2 19.4 39.6 59.0 36.6 448.6 485.2 3.7 9.1 12.8 (b) 1911-1920 (Borough) 190.2 404.0 594.2 11.2 22.3 33.5 58.2 597.8 656.0 5.6 12.3 17.9 * Suspected B. Coli in urine (2 neg.). During 1927, 72 vials of antitoxin were distributed, free of cost, under the Antitoxin Order, 1910 (each vial containing 4,000 or 6,000 units in strength of antitoxin). N.B.—Since the Bacteriological Laboratory was inaugurated in 1899 (up to the end of the year 1927), 28,616 examinations have been conducted there in connection with the following suspected diseases, viz.:—Tuberculosis, 9,801 ; typhoid or enteric fever, 1,206; diphtheria, 17,282; and others, 329. 67 Changes in Administration at the Lambeth Municipal Bacteriological Laboratory. An important change was made by the Council during 1927 in connection with the administration of the Bacteriological Laboratory. Previously (since its inauguration in 1898) the Medical Officer of Health has been the Director, and, in addition, has carried out personally examinations. The Council has now appointed a properly qualified and well-trained bacteriological assistant. Miss Frances May Speakman (appointed June 2nd, 1927, and her duties to commence on November 1st, 1927). Miss Speakman, who has passed with honours the Senior Oxford local examination in 1913, was trained in bacteriological technique under Professor Hewlett, of King's College, and, since then has gained bacteriological experience practically in connection with the following appointments which she has held:— 1. Westminster (Charing Cross) Ophthalmic Hospital— Bacteriological Laboratory Assistant, 1918-1920, under the supervision of a Medical Bacteriologist (war time appointment). 2. Lambeth Central Tuberculosis Dispensary—Dispenser (the duties including, also, the examination of bacteriological specimens of sputa, etc.) 1921 to present date, under the supervision of the Council's Tuberculosis Medical Officer (post-war appointment). Miss Speakman has now been appointed by the Council as Bacteriological Assistant to the Medical Officer of Health for the whole of the Borough, and in that capacity will be responsible for the carrying out of all necessary detailed practical technical bacteriological examinations under the supervision of the Medical Officer of Health, who still remains the Director of the Laboratory and is responsible for all work that is carried out thereat. This detailed practical bacteriological work takes up much time, as the total numbers of examinations conducted at the Laboratory, year by year, testify; and the result of the change in E1 68 administration, and the election of an extra officer to carry out such examinations, will free the Medical Officer of Health for his outside duties. The change has the approval of the Ministry of Health in connection with the new Medical Officer of Health's appointment. Miss Speakman's remuneration for the new appointment has been fixed at a commencing inclusive consolidated salary of £300. rising by £10 annual increments to £350 per annum. Past records show an average (annually) of 1,000 samples of all kinds examined bacteriologically in connection with the Council's Municipal Bacteriological Laboratory by the Council's Medical Officer of Health personally ; and, in addition, an average (annually) of 1,000 samples of sputa examined bacteriologically by Miss Speakman at the Council's Central Tuberculosis Dispensary. Miss Speakman will still continue to carry out the Dispensary work in connection with the Council's Central Tuberculosis Dispensary, and under the supervision of the Council's Tuberculosis Medical Officer, as required—a duty requiring from 1 to 2 hours (approximately) daily, excepting Saturdays and Sundays. To this appointment (part-time) Miss Speakman was appointed by the Council originally on March 16th, 1916, out of 25 candidates who applied in reply to public advertisement, her dispensing experience having been obtained at the Westminster College of Chemistry, Pharmacy and Botany, Clapham Road ; The Miller (Greenwich) Hospital, under Miss Ranee, dispenser ; and with private medical practitioners. Miss Speakman holds the diploma of the Apothecaries Hall, 1914. 69 BOROUGH OF LAMBETH. YEAR 1927. LOCAL GOVERNMENT BOARD TABLES. (a) Old Tables A & B. (b) New Tables I., II., III. & IV. dealing with 1. Total Deaths, Classified according to Diseases, Ages and Locality. 2. Total Births and Infectious Illness, lation, Birth and Death Rates, to which are added Corrected Deaths Registered according to (a) Registration Districts. (b) Age Periods. 71 70 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1927 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 At all ages. Under i year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 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) 66 22 4 8 7 4 9 8 4 Under 5 –— — 1 — — — 1 — 7 — 1 11 — — 1 1 11 34 5 upwards. – – – – – – – – – 1 – – 3 1 1 – – 26 32 General Lying-in Hospital, York Road 18 16 — — — — 2 — — Under 5 – – – – – – – – – – – – – – 2 – – 14 16 5 upwards. – – – – – – – – – – – – – – – – – 2 2 St. Thomas's Hospital 562 72 21 22 31 36 116 196 68 Under 5 – – 2 – – 2 – 3 – – 19 1 – 11 1 4 72 116 5 upwards. – – 1 2 2 1 – – – 3— 7 20 31 4 23 2 9 342 447 Remainder of Lambeth Church 235 27 8 6 2 14 29 62 87 Under 5 – – 1 – – – 4 3 1 – – 17 – – 3 — — 12 41 5 upwards. – – – – – – – – – 1 14 48 41 4 20 – – 66 194 Lambeth Workhouse — Under 5 – – – – – – – – – – – – – – – – – – – 5 upwards. – – – – – – – – – – – – – – – – – – – Lambeth Infirmary 980 41 10 6 6 49 110 298 460 Under 5 – – 1 – – – 2 – 2 – – 22 – – 5 – – 25 57 5 upwards. – – – 5 2 2 – – – 3 89 97 122 24 62 – 9 508 923 St. Peter's House 41 — — — — — — — 41 Under 5 – – – – – – – – – – – – – – – — — – – 5 upwards. – – – – – – – – – – – 11 11 4 – – – 15 41 Remainder of Kennington 206 16 4 3 4 7 10 55 1071 Under 5 – – – – – – – 2 1 – – 8 – 1 2 — — 9 23 5 upwards. – – – – – – – – – 1 6 35 47 12 6 – – 76 183 South-Western Hospital 71 13 10 9 16 5 15 2 1 Under 5 – 2 6 – – – 4 12 – – – 2 – – 1 2 – 3 32 5 upwards. – 1 11 15 1 – – 1 – – – – – 1 – – – 9 39 Clapham Maternity Hospital 9 8 — — — — 1 — — Under 5 – – – – – – – – – – – 1 – – – – – 7 8 5 upwards. – – – – – – – – – – – – – – – – – 1 1 Remainder of Stockwell 386 25 6 4 3 12 33 87 216 Under 5 – – – – – – – – 4 – – 15 – 1 – — — 15 35 5 upwards. — – – – – – – – – – 23 87 60 19 3 – – 159 351 72 73 TABLE K. TABLE K. [Local Government Board Old Table A.] Table of DEATHS during the year 1927 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 Five Years of Age. At all ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Smallpox. Scarlatina. Diphtheria. Fevers Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia & 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 378 37 5 14 26 16 72 132 76 Under 5 – – – – – –– 2 – – – 5 – 1 6 1 2 39 56 5 upwards – – 1 – – 1 – – 4 5 15 26 1 48 2 9 212 322 Belgrave Hospital 98 58 18 16 6 — — — - Under 5 – – –1– – – – 1 1 11 — — 23 — — 7 2 1 45 92 5 upwards – – – – – – – – – – – – – – – – – 6 6 Ministry of pensions Hospital — — — — —/ Under 5 – – – – – – – – – – – – – – – – – – – 5 upwards – – – – – – – – – – – – – – – – – – – Remainder of Brixton 488 26 6 6 8 11 41 134 256 Under 5 – – – – – — — 4 3 — — 10 — 1 6 — — 14 38 5 upwards 1 — 1 25 78 80 9 13 — – 243 450 Lambeth Workhouse Schools 26 10 8 5 2 1 — — – Under 5 – – – – – – – 2 3 1 — 11 — 1 — — — 5 23 5 upwards – – – – – – – – – 1 1 – – – – – – 1 3 British Home for Incurables 15 – – – – – – 5 10 Under 5 – – – – – – – – – – – – – – – – – – – 5 upwards. – – – – – – – – – – – – 1 – – – – 14 15 Remainder of Norwood 502 24 3 3 4 13 42 126 287 Under 5 – – – – – – – – 2 – – 8 — 1 — — — 19 30 5 upwards. — — — 1 — 2 — — – 1 22 67 92 29 13 1 1 243 472 Totals 4081 395 103 102 115 168 480 1105 1613 Under 5 – 2 12 – – 2 12 26 37 1 1 152 1 6 44 6 8 290 600 5 upwards. – 1 13 23 5 6 — 2 — 16 192 458 514 108 187 5 28 1929 3481 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 751 41 24 22 22 40 115 203 284 Under 5 – – 10 – – – 17 15 10 – – 7 – 1 2 1 – 24 87 5 upwards. — — 8 — — 1 — — 1 2 85 51 70 9 48 1 3 385 664 Deaths occurring within the district among persons not belonging thereto 1014 170 40 46 53 56 187 289 173 Under 5 – 1 5 – – 1 6 13 16 – 1 42 1 1 18 5 2 144 256 5 upwards. – 1 5 16 2 1 – 1 – 8 13 32 61 10 68 3 12 525 758 74 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 1927, in the Borough of Lambeth, classified according to Diseases and Localities. (Local Government Board Old Table B.] Registration SubDistricts. Population at All Ages. Total Registered Births, 1927. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health during 1927. Census 1921. Estimated 1927 (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. Cerebrospinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. ‡ Anthrax. rperal Pyrexia. Typhoid or Enteric. Continued Fever. Encephalitis Lethargica. Puerperal. (a) (b) (c) (d) Lambeth Church 45,617 43,380 2,135 — 96 193 1 7 — — 2 37 1 2 11 364 12 56 17 1 1 13 Kennington 44,957 44,110 995 — 66 170 — 4 — — 5 18 1 — 8 113 32 62 752 1 — 6 Stockwell 63,806 64,960 1,375 — 139 97 1 3 — 4 6 22 2 20 171 20 74 31 1 — 13 Brixton 81,262 84,920 1,482 — 206 176 — 5 — 2 5 32 — 2 12 224 45 62 47 2 — 16 Norwood 67,318 70,330 1,029 — 152 131 — 4 — 1 4 19 4 1 4 68 24 41 36 — — 9 Totals 302,960 307,700 7,016 — 659 767 2 23 — 7 22 128 7 7 55 940 133 295 203 5 1 57 * Including 2 cases of paratyphoid lever † Including 1 case of post-basic meningitis. ‡ St. Thomas's Hospital case (patient's address, Cricklewood). § Notifiable compulsorily since October 1st, 1926. 75 TABLE L.—continued. Registration SubDistricts. Population at all Ages. Total Registered Births, 1927 Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital during 1927. Census 1921. Estimated 1927, (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. * Typhoid or Enteric. Fev ers. Puerperal. Erysipelas. †Cerebro-spinal Fever. Polio-myelitis Acuta. Ophthalmia. Measles. German Measles. Primary Pneumonia. Influenzal Pneumonia. Malaria. ‡ Anthrax. § Puerperal Pyrexia. Continued Fever. Encephalitis Lethargica. Lambeth Church 45,617 43,380 2,135 — 94 190 1 7 — — — 18 1 2 1 109 — 27 10 — 1 — Kennington 44,957 44,110 995 — 61 168 — 4 — — 5 12 1 — 1 31 — 16 13 — — 2 Stockwell 63,806 64,960 1,375 — 134 97 — 2 — 3 6 7 1 1 2 18 — 23 7 — — 4 Brixton 81,262 84,920 1,482 — 192 172 — 3 — 2 5 13 — 1 1 24 1 22 11 — — 1 Norwood 67,318 70,330 1,029 — 136 123 — 4 — — 3 5 4 — 1 26 — 14 6 — — 1 Total 302,960 307,700 7,016 — 617 750 1 20 — 5 19 55 7 4 6 208 1 102 47 — 1 8 * Including 1 case of paratyphoid fever, † Including 1 case of Post-basic meningitis. ‡ St. Thomas's Hospital case (patient's home address, Cricklewood). § Notifiable compulsorily since October 1st, 1926. N.B.—In addition to the above new cases of infectious sickness coming to the knowledge of the Medical Officer of Health by compulsory medical notification under the Notification Clauses of the Public Health (London) Act, 1891, or the Orders and Regulations made thereunder, the following cases were reported voluntarily, viz; Chicken Pox 1,172, Measles 206, Cancer 94, and Whooping Cough 507, 76 Local Government Board New Tables. TABLE I. VITAL STATISTICS OF THE BOROUGH OF LAMBETH DURING 1927 AND PREVIOUS FIVE YEARS (1922-26). Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in District. Transferable Deaths.‡ Nett Deaths belonging to the District. Uncorrected Number. 3 Nett. Number. * 6 Rate. 7 of Nonresidents registered in the District. † 8 of Residents not registered in the District. † 9 Under 1 Year of Age At all Ages. Number. * 10 Rate per l,000 Nett Births. 11 Number. * 12 Rate. 13 Number. 4 Rate. 5 * §1922 307,000 8,449 6,364 20.7 4,445 14.5 917 724 500 78.6 4,252 13.8 1923 308,500 8,344 6,195 20.1 3,848 12.5 951 650 359 57.9 3,547 11.5 1924 309,300 7,891 5,934 19.2 4,198 13.6 976 697 397 66.9 3,919 12.6 1925 311,100 7,663 5,543 17.8 4,116 13.2 998 734 353 63.7 3,852 12.4 1926 311,000 7,497 5,359 17.2 3,886 12.4 944 693 293 54.5 3,635 11.6 Average 5 years 1922-1926 309,380 7,968.8 5.879 19.0 4,098.6 13.2 957.2 699.6 380.4 64.3 3,841 12.4 1927 307,700 7,016 4,971 16.2 4,081 13.3 1,014 811 272 54.7 3,878 12.6 § N.B.—The population estimated for 1922 is the civil population onlv. 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 4 the Registrar-General has furnished a statement of the number of births needing to be added to or subtracted from the total supplied by the local Registrar (2,352 outward and 307 inward transfers). * In Column 6 is included the whole of the deaths registered during the year as having actually occurred within the Borough. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. †Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph. The RegistrarGeneral supplied the particulars of extra transferable deaths (60) to be entered in Column 9 ; and all such deaths are included in this Column, unless an error has been detected, and its correction has been accepted by the Registrar-General. " Transferable Deaths " are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9 except in certain instances. In Column 8 the number of transferable deaths of " non-residents " which are deducted, and in Column 9 the number of deaths of " residents " registered outside the district which are added are stated in calculating the nett death-rate of the Borough. Area of Borough in acres (including land and inland water) 4,083. Census, Average number of persons per house (estimated), 7*1. 1921. Number of inhabitated houses, 42,607. Total population at all ages, 302,868. 77 Local Government Board New Tables. table ii. CASES OF INFECTIOUS DISEASE NOTIFIED WITHIN THE BOROUGH OF LAMBETH DURING THE YEAR 1927. 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. Lambetn Church. Kennington. Stock well. Brixton. Norwood. Under 1 1 to 5. 5 to 15.| 15 to 25. 25 to 45 45 to 65. 65 and upwards Small-pox — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 769 12 318 319 59 57 4 — 194 170 98 176 131 751 Erysipelas 128 5 5 6 12 36 50 14 37 18 22 32 19 55 Scarlet Fever 659 7 203 362 51 32 4 — 96 66 139 206 152 617 Typhus Fever — — — — — — — — — — — — — — Enteric Fever (2 paratyphoid fever) 23 — 2 10 5 2 4 — 7 4 3 5 4 20 Relapsing Fever — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — Puerperal Fever 22 -— — — 5 17 — — 2 5 6 5 4 19 Puerperal Pyrexia§ 57 — — — 22 34 1 — 13 6 13 16 9 8 Plague — — — — — — — — — -~- — — — — Pulmonarv Tuberculosis* 471 — 1 21 113 199 123 14 65 70 120 121 95 — Other Forms of Tuberculosis† 100 2 21 27 28 14 5 3 19 16 22 23 20 — Cerebro-spinal Fever (1 post-basic meningitis) 7 — — — 22 34 1 — 1 1 1 — 4 7 Polio-myelitis acuta 7 1 6 — — — — — 2 — 2 2 1 4 Encephalitis Lethargica 7 — — 2 3 — 2 — — — 4 2 1 5 Ophthalmia Neonatorum 55 55 — — - — — — 11 8 20 12 4 6 Measles 941 64 653 202 14 7 — — 365 113 171 224 68 208 German Measles‡ 133 8 34 76 11 3 1 — 12 32 20 45 24 1 Malaria 5 — — — 1 1 3 — 1 1 1 2 — — Anthrax 1 — — — — 1 — — 1 — — — — 1 Primary Pneumonia Acuta 295 29 47 33 22 64 68 32 56 62 74 62 41 102 Influenzal Pneumonia Acuta 203 7 27 20 23 58 50 18 17 72 31 47 36 47 Isolation Hospitals, Name and Situtation.—Hospital of the Metropolitan Asylum Board (one.situated in the Stockwell Sub-District and Stockwell Ward of the Borough of Lambeth. Total available beds provided by (he Board—8,555. Number of Diseases that can be concurrently treated—All usual notifiable infectious dtseases and (partly) y tuberculosis, and notifications under Form C (419) and under Form D> (324) of the 1912 Regulations, t Excluding all rcnotifications (9) of non-pulmonary tuberculosis, and notifications under Form ( (77) and under Form D (67) of the 1912 Regulations. X Measles and German Measles became compulsorily notifiable within the Borough of Lambeth on January 1st, 1916, and are still compulsonly notifiable, § Notifiable compnlsorilv on October 1st, 1926, 78 79 Local Government Board New Tables TABLE III. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR 1927. BOROUGH OF LAMBETH. Causes of Death. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the District (a). Total Deaths whether of " Residents " or " Nonresidents " in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 3,878 272 88 80 87 160 422 1,037 1,732 - Uncertified — — — — — — — — — Typhus Fever – – – – – – – – – – Enteric Fever 4 – – – 1 1 1 1 – 5 Continued Fever — – – — – – – – – – Small-pox – – – – – – – – – – Measles 24 4 13 7 – – – – – 8 Scarlet Fever 1 — 1 — — – – – – 3 Whooping Cough 29 8 11 9 1 — – – – 18 † Diphtheria and Croup (See note (d) ) 36 6 4 7 17 2 – – – 24 Influenza 115 4 2 1 1 5 16 37 49 37 Erysipelas 8 1 — — — – – 5 1 6 Cerebro spinal Fever 4 — 2 — – 1 1 – – 6 Polio-myelitis acuta 1 — — — – 1 – – – 4 Encephalitis Lethargica 7 — — — 2 3 – 2 — – Venereal Diseases 18 1 — — – – 2 10 5 – Phthisis (Pulmonary Tubeclusis) 278 — — — 4 56 117 89 12 103 Tuberculous Meningitis (Se note (e) ) 28 1 5 8 8 4 2 – — – Other Tuberculous Disease 25 4 — 1 – 4 7 7 2 – Rheumatic Fever 19 — — 1 5 6 3 4 – 13 Cancer, malignant disease (See note (f)) 510 – 2 – 1 – 38 238 231 – Pneumonia (all other forms) 159 11 3 6 2 5 29 31 52 – Other diseases of Respiratory organs 56 — — — — 3 4 14 35 Diseases of Circulatory System 737 — — — 2 12 55 178 490 242 Diseases of Nervous System 279 11 — 5 5 6 25 83 144 – Diarrhoea (See note (g) ) 33 24 5 3 — — — 1 — 26 Enteritis 12 5 — — — — 1 2 4 — Appendicitis and Typhlitis 26 — 1 5 2 5 3 8 2 35 Alcoholism (See note (h)) 8 — — — — — 1 6 1 – Cirrhosis of Liver 21 — — — — — 2 11 8 – Nephritis and Bright's Diseases 142 1 — — — 3 12 53 73 — Puerperal Fever (See note (i) ) 10 — — — 1 3 6 — — 22 Other accidents and diseases of Pregnancy and Partuition 11 – – – – 4 7 — — — Congenital Debility and Malformation, including Premature Birth (See note (j) ) 91 90 1 – – – – – – – Violent Deaths, excluding Suicide 154 15 6 7 9 10 23 25 59 165 Suicides 43 — — — — 4 13 20 6 Other Defined Diseases 547 30 4 6 15 20 43 107 322 1,081 Diseases ill-defined or unknown 1 – – – – – – – 1 Notes to Table iii. (a) All " Transferable Deaths " of residents, i.e., of persons resident in the District who have died outside it, are included, with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term " transferable deaths " 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 Table III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as " Certified " ; all other deaths are to be regarded as " Uncertified." (d) This heading includes all deaths from croup except those certified as due to " spasmodic," " stridulous," " catarrhal " or " false," croup. (e) Under " Tuberculosis Meningitis" are included deaths from Acute Hydrocephalus. (/) Under " Cancer " are included deaths under such headings as Carcinoma Scirrhus, Epithelioma, Rodent Ulcer, Sarcoma, Cancer, and Malignant Disease. (g) Under this heading are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Choleraic diarrhoea, Cholera (other than Asiatic), Gastro-enteritis. Gastro intestinal catarrh, Muco-enteritis, Colitis, etc. Deaths from Diarrhoea secondary to some other well-defined disease are included under the latter. (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. , u . .. (i) Under " Puerperal Fever " are included deaths under such headings as Pyaimia, Septicaemia, Sapraemia, Pelvis peritonitis, Peri- and Endometritis occurring in the Puerperium. (j) Under this heading are included also deaths from Atrophy and Marasmus nf Infant's and want of Breast-milk, but not from Atelectasis. * Including Paratyphoid fever, Post-Basic Meningitis and Polio-encephalitis acuta respectively. t No deaths registered from Croup. 80 81 Local Government Board New Tables. TABLE IV. BOROUGH OF LAMBETH—INFANTILE MORTALITY, 1927. Nett Deaths from stated causes at various Ages under 1 Year of Age. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year All Causes Certified 90 11 8 2 111 46 33 47 35 272 Uncertified – – – – – – – – – – Chicken Pox – – – – – – – – – – Measles – – – – – – – 1 3 7 Diphtheria – – – – – 1 2 – 3 6 Whooping Cough – – – – – 1 – 3 4 8 Diarrhoea – – 1 – 1 9 9 2 6 24 Enteritis – 1 – – 1 3 – – 1 5 Influenza – – – – I 1 — 1 2 4 Cerebro-Spinal Fever – – – – – – – – – – Phthisis – – – – – – – – — — Tuberculous Meningitis – – – – – – – – 1 0 Other Tuberculous Diseases 1 – – – 1 – 1 – 2 4 Cerebral Haemorrhage 3 1 – – 4 – – – – 4 Congenital Malformation 5 1 1 1 8 3 – 4 – 15 Premature Birth 47 2 3 – 52 5 1 – 2 60 Atrophy, Debility and Marasmus 1 1 1 – 3 6 3 4 – 16 Atelectasis 10 1 – – 11 – – – – 11 Erysipelas – – – – – 1 – – – 1 Syphilis – – – – – – – 1 – 1 Rickets – – – – – – – – – – Meningitis (not Tuberculous) – 1 – – 1 1 1 4 – 7 Ulcerated Colitis – – – – – – – – – – Convulsions 4 1 – – 5 – – – – 5 Gastritis – – – – – 1 – – – 1 Intussusception (acute) – – – – – – – – 1 1 Dentition – – – – – – – – – – Pleurisy – – – – – – – – – – Bronchitis – – – – – 1 1 2 – 4 Pneumonia 2 – – – 2 1 – – – 3 Broncho-Pneumonia 1 – 1 – 2 8 11 18 13 52 Pleuro-Pneumonia 2 – – – 2 1 1 4 – 8 Arthritis (Pneumococcal) – – – – – 1 – – – 1 Want of attention at birth 3 – – – 3 – – – – 3 Suffocation, overlaying 1 – – – 1 – – – – 1 Accident, other than Suffocation 1 – – – 1 – 1 – – 2 Nephritis (Acute) – – – – – – – 1 – 1 Icterus Neonatorum 2 – – – 2 – – – – 2 Ophthalmia Neonatorum – – – 1 1 – – – – 1 Asphyxia 2 – 1 – 3 – 1 – – 4 Other causes not classified above 5 2 – – 7 2 1 2 – 12 Totals 90 11 8 2 111 46 33 47 35 272 82 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. Kennington M. F. M F. I.—Specific Febrile, or Zymotic Diseases 24 25 35 31 II.—Parasitic Diseases — 1 — — III.—Dietetic Diseases — — 1 — IV.—Constitutional Diseases 90 70 65 57 V.—Developmental Diseases 18 28 10 24 VI.—Local Diseases 179 155 168 153 VII.—Deaths from Violence 22 8 14 15 VIII.—Deaths from Ill-defined and not Specified Causes 2 1 1 — Totals 335 288 294 280 (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 or Zymotic Diseases 26 21 17 20 12 16 55 57 10 11 II.—Parasitic Diseases - - - - - - - - - - III.—Dietetic Diseases 1 - - - - - 1 - - - IV.—Constitutional Diseases 3 3 6 2 6 5 15 10 7 10 V.—Developmental Diseases 50 40 1 - - — 51 40 - - VI.—Local Diseases 49 48 17 18 15 17 81 83 19 18 VII.—Deaths from Violence 8 7 3 3 3 4 14 14 6 3 VIII.—Deaths from Ill-defined and not Specified Causes 6 4 — — — — 6 4 - — Totals 43 123 44 43 36 42 223 208 42 42 83 registered from all causes during the year 1927. 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. 17 30 29 26 28 38 133 150 283 — 2 — — — — 3 3 — 1 2 2 2 1 5 4 9 116 76 127 124 85 97 483 424 907 30 30 26 48 19 31 103 161 264 236 235 264 276 250 230 1,097 1,049 2,146 20 13 35 29 20 19 111 84 195 2 — — 4 1 — 6 5 11 421 387 483 509 405 416 1.938 1,880 3,818 PERIODS. PERIODS. Total. 15-20 20-25 25-40 40-45 45-60 60-65 65 and over. Over 5 Years. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 3 4 2 6 7 10 6 2 23 18 10 5 17 37 78 93 133 150 283 — — — — — 1 — 2 — — — — — — — 3 — 3 3 — — — — — 1 — — 1 2 2 1 1 — 4 4 5 4 9 10 19 23 15 51 57 34 20 151 99 55 51 137 143 468 414 483 424 907 — — — — — — — — — — — 1 52 120 52 121 103 161 ?64 IS 8 16 18 58 59 34 31 222 152 102 79 550 601 1016 966 1097 1049 2146 5 2 5 1 21 6 7 2 14 12 11 8 28 37 97 70 111 84 195 — — — — — — — — - — — — — 1 — 1 6 5 11 33 33 46 40 137 133 81 57 411 283 180 145 785 939 1715 1672 1938 1880 3818 F1 84 (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 1,679 1,668 3,347 1. Miasmatic Diseases 90 125 215 2. Diarrhœal „ 21 11 32 3. Malarial „ — — — VI.— Local Diseases—continued 4. Zoogenous „ — — — 6. Diseases of Lymphatic System 4 4 8 5. Venereal „ 14 4 18 7. Diseases of Gland-like Organs of Uncertain Use 2 7 9 6. Septic „ 8 10 18 8. Diseases of Urinary System 123 77 200 11— Parasitic Diseases — 3 3 9. Diseases of Reproductive System — — — (a) Diseases of Organs of Generation — 12 12 III.— Dietetic Diseases 5 4 9 (b) Diseases of Parturition — 11 11 IV.—Constitutional Diseases 483 424 907 10. Diseases of Bones and Joints 8 8 16 11. Diseases of Integumentary System 5 4 9 V.—Developmental Diseases 103 161 264 VII.—Violence. VI.—Local Diseases. 1. Accident or Negligence 85 66 151 1. Diseases of Nervous System 156 122 278 2. Homicide — — — 2. Diseases of Organs of Special Sense 5 13 18 3. Suicide 25 18 43 4. Execution — — — 3. Diseases of Circulatory System 349 384 733 5. Battle 1 — 1 4. Diseases of Respiratory System 336 313 649 5. Diseases of Digestive System 109 94 203 VIII.—Ill-defined and not Specified Causes 6 5 11 Carried forward 1,679 1,668 3,347 Total 1,938 1,880 3,818 85 BOROUGH OF LAMBETH. SUMMARY OF VITAL AND MORTAL STATISTICS, &c., FOR 1927. 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 1927—307,700 (males 143,770 and females 163,930). Density—75.3 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (uncorrected)—7,016, being 22.8 per 1,000 population. Deaths (corrected)—3,818, being 12.4 per 1,000 population. Infantile Mortality (corrected)—266 deaths (corrected) under 1 year, being 37.9 per 1,000 total (uncorrected) births, or 50.5 per 1,000 total (corrected) births.* Zymotic Death-rate (corrected)—0.39 per 1,000 population (total corrected zymotic deaths, 121). * Corrected as to outside institutional births only. 86 II.—SANITARY WORK. [Dealing with the sanitary circumstances and administration of the Borough of Lambeth.) Return shewing the number of Notices served in the Borough of Lambeth, from the 1st January to the 31st December, 1927. Number of Notices served 11,898* A. COMPULSORILY NOTIFIABLE INFECTIOUS DISEASES † (Public Health (London) Act, 1891.) No. of Notices served 3,311 No. of Infected Houses 3,010 Small-pox — Scarlet Fever 610 Typhoid and Para-Tvphoid Fever ‡ 21 Diphtheria 695 Membranous Croup 2 Continued Fever — Puerperal Fever 21 Erysipelas 128 Cerebro-Spinal Fever and Post-Basic Meningitis 7 Acute Polio-Myelitis 7 Ophthalmia Neonatorum 55 Measles 767 German Measles 132 Primary Pneumonia 294 Influenzal Pneumonia 202 Encephalitis Lethargica 7 Malaria 5 Dysentery — Trench Fever — Anthrax 1 Puerperal Pyrexia 56 B. GENERAL NUISANCES AND DRAINAGE DEFECTS. (Public Health (London) Act, and Metropolis Local Management Acts.) No. of Notices served*† 8,572 Works, Structural— Drainage, Defective 268 Intercepting Traps with Fresh Air Inlets required, or defective 133 * Including Measles and German Measles, but excluding notices under the Housing Acts. † Excluding Tuberculosis. ‡ 2 cases of Para-typhoid. § 6 cases of Cerebro-spinal Fever and 1 case of Post-basic meningitis. 87 Ventilating Pipes defective or wanting 84 Indoor Sinks defective or direct to Drain 350 Rain Water Stacks connected with Drain or defective 516 Bath Waste connected with Drain or defective 30 Closet Pan and Connections Defective 363 Water Supply to Closet Defective 253 Closet Dilapidated 155 Draw-off Main for Drinking Purposes required 6 Dust Bins Defective 505 Premises Dilapidated 346 Roofs Dilapidated 1,121 Soil Pipes Defective 83 Paving Defective 299 Damp and Unwholesome houses 500 Defective Water Pipes, Taps, &c 121 No. W.C. Accommodation 13 Copper, Fireplace, or Chimney, &c., defective 367 Manhole defective 40 Windows, Floors, Doors, &c., defective 606 Guilies, defective, or stopped 88 Cistern defective 35 Dung Receptacle required 5 Walls and Ceilings defective 908 Wash-houses dilapidated 86 Stables unsuitable 25 7,306 Works, not Structural— - Cisterns dirty 11 Manure accumulations 33 Underground Rooms illegally occupied 5 Effluvia and Smoke Nuisances 74 Animals improperly kept 51 Stopped Drains 325 Overcrowding 42 Foul Urinals 17 Refuse accumulations 124 No Water Supply or Defective Water Supply 104 Dirty premises 2,061 Stagnant Water accumulations 13 Rats Nuisance 122 Bakehouses dirty 145 Lighting and Ventilation insufficient 63 Plunging Eye defective 16 3,206 88 PARTICULARS OF SANITARY WORK carried out by the Male Sanitary Staff (District Inspectors) in Lambeth Borough during 1927, and during the 5 previous years (1922-1926), 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. 1927 11,898 7,306 3,206 1926 17,069 7,454 3,601 1925 14,052 7,769 3,628 1924 15,368 7,430 3,643 1923 12,921 7,901 3,615 1922 16,193 7,878 3,641 Yearly Average for 20 Years 19011920 (Borough) 14796.5 10569 9 4106.7 Yearly Average for 24 Years 18771900 (Parish) J 5944.6 4756 9 2135.9 SANITARY STAFF. The Sanitary Inspectorial Staff consists of 12 district male Sanitary Inspectors, 2 special male Sanitary Inspectors (Food) and 2 special male Sanitary Inspectors (Housing), 2 female Sanitary Inspectors, and 4 women Health Visitors—all whole-time officers. The work carried out by these various officers is set out in tabular form. Summary of Work Carried Out by the 12 District Male Sanitary Inspectors during 1927. Inspections 9,421 Re-inspections 38,988 Complaints attended to 6,256 89 Water Certificates issued* 120 Revenue Act certificates dealt with — Drains tested (with chemical, water or smoke test) 4,106 Sanitary Works completed 4,908 Samples of Food and Drugs taken 2,000 Notices— Public Health (London) Act, 1891 (Preliminary or Intimation 5,012 and Statutory 3,560) 8,572 Metropolis Local Management Acts 15 Sanitary Nuisances abated— (a) Structural 7,306 (b) Non-structural 3,206 Summonses issued— Public Health Act† 11 Food and Drugs Acts‡ 8 Margarine Acts§ 4 N.B.—In addition to the above, the 12 District Sanitary Inspectors carried out during 1927 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 public-houses, smoke, the male public conveniences, factories and workshops, and work-places wherein males are employed, common lodging-houses, offensive trades, effluvium nuisances, houses let in lodgings, exempted tenements (Revenue Act), refuse and manure depots, etc. No new houses were registered under the by-laws for houses let in lodgings. * Including 408 houses (51 being in blocks) and 408 tenements, † 8 convictions, 3 summonses withdrawn. ‡ 4 convictions, 4 summonses dismissed on costs. § 1 summons dismissed, 1 summons dismissed on costs, 2 summonses withdrawn. 90 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. 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 1,498 infected houses dealt with during 1927, the results are as follows, the averages being given in brackets for the past 25 years, 1891-1915:— (a) 21, i.e., 1.40 per cent. were found to have defective drains, i.e., a result was obtained with the chemical test employed (average = 14.3 per cent.). (b) 683, i.e., 45.46 per cent. showed defects in drains, traps, fittings and appliances (average = 53.1 per cent.). (c) 794, i.e., 53.00 per cent. showed no defects (average = 46.9 per cent.). Registration of Cow-houses, Slaughter-houses, Common Lodging-houses, and Milk Shops. During 1927, 2 Cow-houses†, 9 Slaughter-houses‡, and 3 Common Lodging-houses'§ licences were renewed by the London County Council. The applicants were registered by the Council as milk sellers or purveyors of milk at the following premises, which were certified * The above statistics do not include ophthalmia neonatorum, measles and German measles and tuberculosis, which have been omitted so as to keep the statistics for 1927 comparable with those for past years. The figures for measles and German measles infected houses during 1927 are:— 2 defective drains and 134 defective traps, fittings, and appliances, out of a total of 899 infectea houses inspected. No testing of drains is carried out as a routine in the case of ophthalmia neonatorum and tuberculosisinfected houses. †2 cow-houses—Elder Road Dairy and 76 and 78, Gipsy Hill. ‡9 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, 99, Lower Marsh, 106, Lower Marsh, 45, New Park Road. § 3 common lodging houses—19, Belvedere Crescent, 106, Wandsworth Road, 90-92, Westminster Bridge Road. 91 as "suitable," i.e., in accordance with the Council's requirements:— *93, Albert Embankment (London Wholesale Dairies, Ltd. Wholesale Deptô), 33, Auckland Street, *10, Barnfield Road (Jones, Inigo Ifor), *48, Cornwall Road (Lewis, Annie), *48, Coral Street, (Morgan, Fredk.), *23, Chapel Road, West Norwood (Hartley, Chas.), 17, Duke Street (2 separate applications by 2 different occupiers), Elder Road (house and shed), *57, Effra Parade (Harding, Kathleen), *206, Farmers Road (Taylor, Edwin), *237, Gipsy Road (Jones, Inigo Ifor), *71, Goding Street (English Dairies, Ltd.—Crewkerne, Somerset), 38, Hartington Road, 11, Jonathan Street, 75, Knowle Road (4 separate applications by 4 different occupiers), *66, Kenbury Street (Stevens, Herbert Stafford), *100, Kennington Park Road (Solomon, Alfred), *68, Landor Road (Davies, Evan), *6, Lanfranc Street (Adams, J.S.), 125, Landor Road. *45, Louden Road (Drury, William), *16, Milkwood Road (Express Dairy Co., Ltd.), 57, Oakley Street, *101, Oakley Street (Jarrett, Leonard Davis), *29, Oval Place (Moody, William Henry), 73, Oakley Street, *11, Oakley Street (Scarff, Lily Beatrice), *154, Old South Lambeth Road (Owen H. M.), 120, Oval Place (shop), *4, Rathgar Road (3 separate applications by 3 different occupiers), *126, Railton Road (Walters, H. Francis), *19 Santley Street (Jones, Joseph L.), 60, Stockwell Green (Clarke, Chas. Leonard), Tracey Street (James's Dairy), 43, Tulse Hill (shop), *138, Tyers Street (Jones, William Griffiths), *182, Wandsworth (Price, David Fredk.) N.B.—34 of the above were simply transfers of existing registrations, whilst also 7 were additional purveyors and 2 wholesale dealers. The applicant was refused registration by the Council as milk seller or purveyor of milk at the following premises:— Stall Reliance Arcade, Brixton. Revenue Act, 1903. (and. Section 35 of the Housing, Town Planning, etc., Act, 1909.) No certificates were applied for in connection with tenements (or dwellings). *Under the Milk and Dairies Order, 1926 (which came into force on October 1st, 1926, as regards registration), persons and "dairy" premises both 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. 92 Offensive Trades. There are four offensive trades registered, e.g., fat melting (15, Upper Marsh), soap boiling (15, Upper Marsh) and tripe boiling (103, Lambeth Walk and 9, Old Paradise Street). 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 1927. Workshops* visited and inspected— (a) Dressmakers 62 (b) Milliners 9 (c) Laundries 36 (d) Tailors 29 (e) Upholsterers 4 (f) Dyers 2 (g) Blouses 6 (h) Ties 4 (i) Bottling 2 (j) Children's Clothing 3 (k) Florists 6 (1) Boxes and Bags 2 (m) Furriers 3 (n) Lamp Shades 3 (o) Metal, etc. Polishes 2 (p) Printers 2 (q) Underclothing 8 (r) Valet service 7 (s) Waste Paper 1 (t) Toilet Requisites 4 (u) Others {e.g.), bag-making, trunks, foods, tobacco, &c. 73 Workshops*: workrooms therein measured 59 Workshops*: newly discovered and registered 26 f Premises visited, but not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 1,642 *Workshops include Work-places. †Workshops (72), Tuberculosis cases (659), Private Houses (120), Out-workers (293), Restaurants (287), Tonsils and Adenoids cases (211). 93 Female Conveniences visited and inspected— Public (visits paid) 827 Private - Schools visited— Public (visits paid) - Private — Special places visited and inspected— (a) Restaurants 198 (b) Private Houses* 651 (c) Outworkers 176 Workshops (0), Out-workers (20), Restaurants (198) and Private Houses (570) t reinspected 788 Written Intimation and Statutory Notices served 312 No. of Workshops J, etc., in which defects were found 328 No. of Workshops}:, etc., in which no defects were found 955 Nuisances referred to M.O.H., for attention by Male Inspectors 16 Particulars of Defects found, by Female Inspectors. Workshops‡, etc.— Workrooms— Overcrowded, Damp, Dirty, etc. 31 Defective or Dirty— Yards, Floors, Roofs, Windows, Ceilings, Rain Water Pipes, Sink Wastes, or Premises generally 268 Sanitary Appliances : Water Closets— Dirty, unventilated, choked, Defective or with Defective Tanks or Water supplies 140 Sanitary Appliances: Drainage— Defective 7 Sanitary Appliances: Dustbins— Wanting or Defective 57 Lavatories—Dirty or Defective 3 No separate suitable sufficient W.C. accommodation for the sexes 2 Miscellaneous Defects, e.g., Defective Chimneys 45 *Tuberculosis cases (240), Ophthalmia cases (1), School children (enlarged Tonsils and Adenoids, 367), Housing Enquiries (2), special complaints (39), Expectant Mothers (2). †Tuberculosis cases (517), and special complaints (53). ‡Workshops include Work-places. 94 Summary of Work Carried Out (Total Visits Paid) by the 4 Whole-time Official Health Visitors during 1927. Births* 1,735 Welfare Centres and Still-births 129 Maternity Home Ophthalmia neonatorum dances) 568 cases* 374 School children† 2 Epidemic diarrhoea cases 30 Expectant mothers (visits) 1,022 Milk Depot (attendances) 92 Special inspections§ 1,314 Dep6t children (visits) 133 N.B.—In addition to the above, 1,302 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 117 visits to children between 1 and 5 years, viz. : Enlarged tonsils and adenoids, 78 ; tuberculosis, 39. FACTORIES AND WORKSHOPS. Factories. 10 new tactories were added to the Register, dealing with (a) Honey Refining, 1; (b) Dress-making, 3; (c) Boot Tips, 1; (d) Neckwear, 1; (e) Pleating, 1; (f) Tobacco, 1; (g) Wireless, 1; (h) Printing, 1. Workshops. 20 new workshops (including 3 Domestic workshops) were added to the Register, dealing with:—Boots, 1; Furrier, 1; Millinery, 1; Spice, 1; Dress-making, 11; Shoe Dyeing, 1; Ties, 1; Tailoring, 3 *Including revisits as follows Births, 1,405 (of which 813 were paid to children between 1 and 5 years of age); Ophthalmia neonatorum cases 253. t Special enquiries infectious diseases. § Including housing, 821 (visits); infantile deaths, 160 (visits); puerperal pyrexia, 34 (visits); [and others, 299 (visits). 95 OUT-WORKERS, 1927. 5 February and 5 August lists were received, dealing with 34 and 34 out-workers respectively. Of the 68 out-workers, 34 belonged to Lambeth and 34 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 104 lists were received from various outside authorities dealing with 651 workers, of whom 644 belonged to Lambeth and 7 to districts outside Lambeth. Of the total Lambeth out-workers reported, 46 were newout-workers, i.e., out-workers not previously registered, as follows :— Baby Linen 1 Mantles 2 Blouses 3 Neckwear 2 Children's Dresses 2 Needlework 2 Dressing Gowns 2 Rag Dolls 2 Dress-making 8 Tailors 5 Embroidery 1 Ties 3 Fancy Goods 1 Umbrellas 2 Hats 3 Underclothing 3 Lace Goods 1 Woollen Goods 3 Total 46 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, as an improvement scheme. The London County Council is the local Housing Authority for the area "represented" under the Act. The Order, dated May 2nd, 1927, was made by the Ministry of Health, as required under Part II. of the Housing Act, 1925, confirming the improvement scheme, and is known as the London County Council (China Walk, etc., Improvement Scheme) Order, 1927. The plan, accompanying the Order, shows (a) in pink, the areas whereon the premises are insanitary, or dangerous or injurious to health; and (b) in blue, the areas (and premises) included for the purpose only of making the scheme efficient, though the premises thereon are not themselves insanitary or dangerous or injurious to health. 96 The lands may be taken either by agreement or compulsorily, but under the Scheme the London County Council is not to demolish any occupied house in the areas until accommodation for a number of persons equivalent to the number of working-class occupants of such house is available in new dwellings to be erected by the County Council in pursuance of the Scheme, unless that Authority is satisfied that suitable alternative accommodation for such occupants is available elsewhere. It is estimated that there are approximately 1,800 people in the China Walk site, and of these it is proposed to re-house 1,360 in the new houses to be erected on the site. It is also proposed by the County Council to house on the Kennings Estate, White Hart Street, Kennington, a certain number of the people for whom it will not be possible to provide accommodation on the China Walk site. It is further provided under the Scheme that all lands upon which dwellings for the rehousing of persons displaced are erected on the site shall, for a period of 25 years from the date of the Order, be appropriated for the purpose of dwellings for persons of the working classes, except in so far as the Minister may dispense with such appropriation. The terms of the Order are in strict accordance with the wording of the Borough Medical Officer of Health's "representation" of September 25th, 1924, supplemented by the evidence given by him at the public inquiry which was held on November 19th, 1925. Two houses in the area have already been closed, viz., 34 and 35, Walnut Tree Place. Accommodation for many of the tenants who will be de-housed under the Scheme is already temporarily available in the form of the London County Council Tenements (in blocks), recently erected and to be erected in the White Hart Square and Street and Robert Raikes Street area, now known as the Kennings Estate. The new blocks of buildings to be erected upon the China Walk area site, when cleared, will accommodate 1,360 of the displaced tenants out of the estimated total of 1,800 to be displaced. In this way 440 tenants will require to be housed elsewhere permanently, e.g., on the Kennings Estate, which has a prospective accommodation for a total of 960 persons. Representations and Closing Orders under Section 9 of the Housing Act, 1925. During 1927 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.* * Vide foot note Annual Report, 1925, p. 95. 97 General Housing Matters. The Council's two Housing Sanitary Inspectors have continued their special duty ofsystematic house to house inspection of dwellinghouses, and drawing up provisional or informal as well as legal 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, representing a considerable amount of repairs and improvements. During the year 1927, 509 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. 395 Surveys or Inspections have been made, under the Housing Inspection Regulations of the Housing Act, 1925, and 393 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. 395 Record Cards have been filed, 395 visits, and 10,680 re-visits made, and many interviews held at the Town Hall, or elsewhere, with owners, agents, builders and others concerned. 496 drain tests have been made in connection with the official inspections. It must be again mentioned that the Council has only appointed, up to date, two housing inspectors. As has been pointed out, again and again, in previous Annual Reports, more housing inspectors are required to cope satisfactorily with the large numbers of houses in the Borough (approximately 40,000.) 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 (1927), the following roads, streets, and courts have been under survey (wholly or in part), the total number of houses being given in brackets after the name of each road, street, and court:— g 98 Marsh Ward. Little Windmill Street (3). Bishop's Ward. Ado Place (3), Boniface Street (8), Cotford Place (7), Goda Street (45), New Palace Buildings (11), Palace Buildings (20), Renton's Yard (2), Whitgift Street (33). Prince's Ward. Cricketers' Court (2), Duke's Head Passage (6), Kennington Park Road (5). Vauxhall Ward. Bolney Street (44). Brixton Ward. Clarks Row (22), Hackford Road (33), Russell Street (35). Tulse Hill Ward. Elm Park (1). Norwood Ward. St. Cloud Road (13), St. Gothard's Road (32), St. Louis Road (70). During the 12 months, 88 legal schedules or notices have been required to be served by the Council in respect of:— Marsh Ward. Little Windmill Street (Nos. 22, 23, 24). Princes Ward. Auckland Street (No. 1), Cricketers' Court (Nos. 1 and 2),* Fairford Grove (No. 5). Tulse Hill Ward. Elm Park (No. 85).f *Counter-Notices to close (instead of to repair or recondition) owing to reconstruction being necessary were given by owners under date of August 12th, 1927 and appeal was made to the Ministry of Health by the Borough Council under Section 3 of the Housing Act, 1925. †85 Elm Park—Surveyed 3rd May, 1927, no provisional schedule served, legal notice served 5th May, 1927 (time-limit given being 42 days), order to do work given by the Council, 1st December, 1927, tender (£50) accepted by the Council, 22nd December, 1927. 99 Norwood Ward. Auckland Place (Nos. 1 to 16 consecutive), Durban Road (Nos. 2 to 34a and 36a to 56a—55 houses), Jaffray Place (Nos. 5, 6, 7, 8, 10, 11, 12, 13, 14). 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. Tulse Hill Ward. Margate Road (Nos. 13 to 21 odd). Norwood Ward. Auckland Place (Nos. 1 to 16 consecutive), Durban Road (No. 46a). (2) After service of provisional (or informal) schedules. Bishop's Ward. Boniface Street (Nos. 11, 13, 15, 17, 8, 10, 12, 14), Goda Street (Nos. 1, 2, 3, 4, 7, 13, 16, 17, 18, 19, 25, 31, 32, 35 to 43 consecutive), New Palace Buildings (Nos. 1, 2, 4 to 12 consecutive), Waxwell Terrace (Nos. 1, 3, 17, 2 to 26 even). Prince's Ward. Anderson's Walk (Nos. 10 to 28 consecutive). Auckland Street (Nos. 4, 5, 6, 19, 20, 23, 34, 36, 37, 39, 40, 41, 49, 52, 55, 56), Cottington Street (No. 1), Duke's Head Passage (Nos. 1, 2, 3, 4, 5, 7,) Esher Street (Belmont Villas Nos. 1 and 2), Fairford Grove (Nos. la, 2a, 3a, 1 to 4, 6 to 24 consecutive), Goding Street (Nos. 33 to 47 odd), Hart's Cottages (Nos. 1 to 5 consecutive), Kennington Park Road (Nos. 104 to 112 even), Lower Kennington Lane (Nos. 123, 127), Rood Cottages (Nos. 1 to 6 consecutive), Vauxhall Street (Nos. 48 to 52, 88 to 112, 116, 118, 118a, 120, 190, 192 even, 61, 69, 73, 75 odd). Vauxhall Ward. Bolney Street (Nos. 1, la, 3, 5, 23 to 29 odd, 2 to 24 even). .Stockwell Ward. Brighton Terrace (Nos. 2, 4). g1 100 Brixton Ward. Clark's Row (Nos. 1 to 21 odd, 2a, 2b, 2 to 8, 8a, 8b, 10. 10a, 10b even), Farmers Road (Nos. 194 to 196), Hackford Road (Nos. 2, 4, 6, 39, 41), Russell Street (Nos. 7, 9, 11, 13, 19, 21, 27, 29, 31), Warham Street (Nos.. 4, 8 to 22, 54 to 60, 96b, 96c, 96d, 104, 106, 116 to 122, 128 to 158, 176 to 180, 190, 192, even, 27 to 45, 51 to 57, 61 to 75, 101 to 107, 143, 145, 151, 153, 157 to 167, 177, 179, 189 to 213, 217 to 243.) Heme Hill Ward. Vining Street (Nos. 2 to 12 even, 17, 19). Norwood Ward. Dunbar Street (Nos. 69, 71), East Street (Nos. 3, 4, 5),. Rommany Road (Nos. 54, 92, 214 to 230, 234, 236, 240 even, 81 to 89, 91, 95 odd), St. Cloud Road (Nos. 1, 7, 9, 17 to 25 odd), St. Gothard's Road (Nos. 2 to 12, 20, 36, 36a, 36b, 36c, 38 to 56 even, The Lodge), St. Louis Road (Nos. 1 to 13, 13a, 15 to 21, 21a, 29, 29a, 31, 31a, 33, 33a, 35, 35a, 37, 41, 41a 43, 43a, 47 odd, 2, 8 even). The following houses have been closed after service of closing orders:— Marsh Ward. Bishop's Ward. Trowes Place (Nos. 4, 5). Princes Ward. Shanklin Court (Nos. 10, 12). The following houses have been closed and demolished after service of closing order:— Marsh Ward. James Place (Nos. 3, 4, 5). The following houses have been voluntarily closed, and since voluntarily demolished:— Prince's Ward. Little Clayton Street (No. 4), White Hart Street (Nos. 19, 23, 27 to 33, 37 to 41, 45, 47 odd); whilst the following houses have been voluntarily closed, with a. view to being demolished at an early date :— Bishop's Ward. Monkton Street (Nos. 41, 43, 45, 53). 101 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. In all these cases, further particulars 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, legal schedules or notices will be required to be served in the usual way by the Council. Special Areas. Monkton Street Area. Owing to the provision of other accommodation it has now been found possible to close all the Board of Guardians' houses, upon which closing orders were, and have been for some considerable time, outstanding. 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, 1927, are as follows:— 1. Inspections made 3,775 2. Works completed or houses closed— (a) under provisional schedules 3,268 (b) under legal schedules or notices 129 3,397 3. Works not yet completed or not yet commenced— (a) under provisional schedules 307 (b) under legal schedules or notices 71 378 Need for Re-inspections of Houses Previously Dealt With under the housing act (repairing clauses). The two Housing Inspectors have been at work since June, 1920, and this period of 7 years has been sufficient to satisfy them of the need for re-inspections of houses previously dealt with a few years ago under the Housing Acts (Repairing Clauses). The works carried 102 out under schedules, served under the Housing Acts, last, approximately, 5 years—due to the rough user of the premises by the tenants, and the decayed and old and dilapidated condition structurally of the premises when re-conditioned under schedules. This is a real difficulty, and is well illustrated by the houses in Linnet Street (1 to 18 and 18£ to 30), and Providence Place (1 to 10), to which official attention has recently been specially drawn. These houses were scheduled in 1921-2 and dealt with at that time under Provisional Schedules to the satisfaction of the Housing Inspectors. A re-inspection has been made and the houses are found to be again, due to wear and tear, in an unsatisfactory condition—inside walls dilapidated and interiors of rooms dirty, with defective gutterings and rain water pipes and roofs and broken stoves. There are considerable arrears of rents owing and necessary repairs have been held in abeyance in consequence. The above property is old and decayed, so much so that it was suggested in 1924 (15th May) for representation for an improvement scheme (under the 1890 Housing Act) to the London County Council in place of the China Walk Area, and as an alternative (worse and more urgent) area. The London County Council, however, decided otherwise, and chose the China Walk Area. Linnet Street consists of 34 small houses, and Providence Place of 8 two-roomed cottages and one cottage of four rooms. The work now required at Linnet Street and Providence Place (and the same applies to other similar properties) is work that can be better carried out under the Public Health Act by the District Sanitary Inspectors, to whom such work is now being referred as required. Murphy Buildings (Murphy Street, Oakley Street) teach the same lesson. These houses were surveyed and dealt with by the Housing Inspectors in 1921, and the necessary work, at that time, under the Provisional Schedules of the Housing Act, was carried out satisfactorily. The wear and tear by the tenants is considerable. A re-inspection has been made, with the result that the premises are found to be dirty (requiring redecoration) and out of repair (dilapidated) almost as badly as they were in 1921. The attention of the owner was drawn to the matter by letter, and the buildings have now been again put into a fair state of decorative and general repair, although the badly-designed sanitary arrangements, necessarily, remain unaltered, as any such alterations would involve structural reconstruction, or rebuilding, even if such were practicable. Waxwell Terrace, Westminster Bridge Road. The Provision Schedules under the Housing Act, which were served in connection with Waxwell Terrace, which has always been a "black spot" in North Lambeth from a sanitary point of view— 103 both houses and tenants, have been complied with to the satisfaction of the Housing Inspectors, the necessary works having been completed. Waxwell Terrace is a good object-lesson of what can be done by reconditioning houses. Proposed Alteration of the Charing Cross Bridge. The subject of the proposed alteration of the Charing Cross Bridge and the suggested removal of the present Charing Cross Station to the South Side of the River will in all probability, so far as can be foreseen, inaugurate great changes in North Lambeth. It appears unwise to attempt large repairing schemes in the threatened area, owing to the enhanced value thereby given to property which may later have to be demolished. At the same time, the fact that several hundreds (perhaps thousands) of people may be dehoused as a result of the new approaches and alterations to the southern bridge-head in this neighbourhood, must not be forgotten; as (and when) practicable and expedient, a housing scheme will, no doubt, be evolved which will provide dwellings for those dispossessed. This will, when completed, ease the pressure of the crowding in dilapidated property which obtains at present in that particular neighbourhood. Other Factors at Work in Connection with Housing. There are other factors at work, insidiously, but none the less surely, in causing an increase of pressure additional to those other factors which are well known, viz., the erection of factories and workshops in place of dwellings, which provide work for more people, but at the same time diminish the available living accommodation, especially for those poorer classes who are unable to afford the travelling expenses entailed by living far from their work. It is to be hoped that it may not be necessary to treat the erection of new workplaces and factories in the same fashion as the establishment anew of offensive trades, but certainly more attention will have to be paid to what is now termed "zoning." London County Council (Lambeth Bridge) Act, 1924) Housing Scheme under the 5th Schedule of the Housing Act, 1925. The following properties have been acquired:— Lambeth Road (Nos. Ill, 113, 143, 145,) Norfolk Court (Nos. 1, 2). 104 DISINFECTING DEPARTMENT, 1927. Details of work done in connection with the Disinfecting Department are subjoined: 3,882 cases of infectious diseases, notified compulsorily by medical men, were dealt with, including Cerebro-spinal fever and post-basic meningitis (7), acute poliomyelitis (7), acute primary pneumonia (295), acute influenzal pneumonia (203), acute encephalitis lethargica (7), malaria (5), ophthalmia neonatorum (55), measles (941), german measles (133), and tuberculosis—pulmonary (471), and non-pulmonary (100), whilst the following diseases were, in addition, reported by school teachers and others, viz.: measles (206), chicken-pox (1,172), cancer (94), whooping cough (507), and others not classified (508)*, 374 verminous houses (464 rooms) and 636 verminous articles, bedding and clothing, were also dealt with. Summary of work carried out by the Disinfecting Department during 1927. Total No. of Rooms disinfected by the Council 7,255 Do. articles do. 17,733 Cases in which bedding was disinfected at homef 4,211 Do. do. do. at Chamber 4,034 Do. do. do. destroyed — Premises disinfected and disinfectants supplied 16,195 Articles of bedding, etc., disinfected 17,733 Articles of bedding, etc., destroyed - Ambulances, etc., disinfected 6 No. of Cleansing Notices served in connection with infected houses 1,507 Certificates of Medical Practitioners received in lieu of disinfection by the Council 8 Schools disinfected J (47 rooms) 7 Certificates of disinfection left with occupiers of disinfected premises 1,557 Library books disinfected (public) 154 Mattresses re-tabbed by Council 672 *Scabies, ringworm, diseases not stated, etc. †Bedding not removed to the disinfecting Chamber for disinfection in cases of Measles and German Measles. ‡Scarlet Fever, 2 (3 rooms); Diphtheria, 5 (44 rooms). 105 ANALYSIS OF FOOD AND DRUGS AND WATER. Food and Drugs. Samples of Food and Drugs procured, together with the results of the analyses, were as follows:— Samples. Formal. Informal. Number Analysed. Number Adulterated. Number Analysed. Number Adulterated. Milk 764 26 4 — Butter 16 2 370 5 Lard — — 48 — Coffee — — 12 — Fish Paste — — 3 — Baking Powder — — 32 — Mustard — — 23 1 Pepper — — 27 — Arrowroot — — 12 — Vinegar 10 — 5 — Sago — — 18 — Oatmeal — — 10 — Ground Rice — — 19 — Dripping — — 11 — Drugs* — — 89 1 Rice 8 — 40 — Tapioca — — 28 — Self-Raising Flour — — 15 — Cheese — — 12 — Cocoa — — 25 — Sugar — — 6 — Bread — — 4 — Meat Paste — — 8 — Flour — — 19 — Tea — — 12 — Sausages — — 33 — Whisky — — 6 — Wine Extracts — — 3 — Gin — — 6 1 Custard Powder — — 37 — Semolina — — 4 — Cakes, Sponge — — 11 — Eggs Substitute — — 5 1 Mincemeat — — 11 — Ginger, Ground — — 10 — Honey — — 9 — Sausage Seasoning — — 3 — *The drugs (89) Epsom Salts (5), Tincture of Iodine (7), Tincture of Quinine (6, 1 of which was adulterated), Cream of Tartar (9), Bicarbonate of Soda (9), Glauber's Salts (6), Boric Ointment (4), Camphorated Oil (17), Zinc Ointment (10), Acid Boric (10), Flowers of Sulphur (6). 106 Analysis of Food and Drugs and Water—continued. Samples. Formal. Informal. Number Analysed. Number Adulterated. Number Analysed. Number Adulterated. Milk Condensed (Full Cream) - - 5 - Milk Condensed (Machine Skimmed) - - 7 - Mustard Compound - - 1 - Peaflour - - 6 - Sausage Colouring - - 2 - Confectionary and Jam - - 15 - Chocolate Powder - - 3 - Currants - - 6 - Ham - - 3 - Lemon Curd - - 6 - Rasins - - 6 - Sultanas - - 6 - Meat Potted - - 5 1 Cream 1 1 5 3 Preserved Cream - - 7 - Margarine 1 - 117 - Olive Oil - - 7 2 Meat Preservative - - 3 - 800 29 1,200 15 N.B.—12 summonses were issued (5 convictions, 5 dismissals, 2 summonses withdrawn). Water. No sample of water was submitted to the Analyst for analysis. 1 sample of home-made brawn was analysed and no chemical foreign matter was discovered. 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 768 samples of milk taken during 1927 (all formal), in no single instance was a preservative found. 6 samples of cream (1 formal and 5 informal), and 7 samples of preserved cream (all informal), were also taken with the results set out below. *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." 107 The action taken under the Public Health (Milk and Cream) Regulations, 1912 and 1917, may be tabulated as follows:— Headings of Report of Administration. 1. Milk; and cream not sold as preserved cream:— (a) (b) No. of samples No. in which a examined for the preservative presence of a was reported preservative. to be present. Milk 768 — Cream 6 4 Nature of preservative in each case in column (b) and action taken under the Regulations in regard thereto—Boric Acid (no action). 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 7 (2) Statements incorrect — Total 7 (b) Determinations made of milk fat in cream sold as preserved cream:— (1) Above 35 per cent. 7 (2) Below 35 per cent. — Total 7 (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. 108 Margarine Dealers and Margarine Factories. No premises were registered in connection with wholesale dealers in margarine. The Milk (Special Designations) Orders, 1922-1923. Under Section 3 of the Milk and Dairies (Amendment) Act, 1922, sellers of milk under special designations, such as "Certified," "Grade A," or "Pasteurised" milk, must be licensed as from 1st January, 1923, for that purpose, under the provisions of the Orders made by the Minister of Health, and known as the Milk (Special Designations) Order, 1922, and the Milk (Special Designations) Amendment Order, 1922, and the Milk (Special Designations) Order, 1923. Under the Orders, the Lambeth Borough Council, as a Sanitary Authority, is 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 1927 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, Hackstead Farm, Edenbridge, Kent). (b) *W. Hardie, 12, Heme Hill Road. (Producer, G. V. Baxendale, Framfield Place, Uckfield). (c) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road; 60 and 276, Knight's Hill; 118 and 196, Norwood Road; 9. Westow Hill; 103a, Rosendale Road; 3, Upper Tulse Hill. (3 producers, J. & H. Robinson, Iford, Sussex; Brig.-Gen. Longbourne, Loseley 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. Mark's Road; 118, Denmark Hill. (Producer, E. C. Lovell, Hatherden, near Andover). (e) * Express Dairy Co., Ltd., 279, Rosendale Road; 16, Milkwood Road. (Producers, selves at Finchley). *Renewal of Licences. 109 (f) *David Jones, 11, Russell Street. (Producer, G. V. Baxendale, Framfield Place, Uckfield). (g) *C. R. Cotching, 45, Camberwell New Road. (Supplied by Retail Dairymen's Mutual, Ltd., Paddington). (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, C. M. Robarts, Eastcote, Middlesex). (k) S. Davies, 97, Acre Lane. (Supplied by Retail Dairymen's Mutual, Ltd., Paddington). 2. "Grade A" (Tuberculin Tested) Milk. (a) *Express Dairy Co., Ltd., 279, Rosendale Road; 16, Milkwood Road. (5 producers, selves at Finchley; Lord Rayleigh's Dairies, Ltd., Hatfield Peverel, Essex; G. Borlase, Henley-on-Thames; Sir. G. Watson, Sulhampstead, near Reading ; and F. Martin, Kingham, Oxon.). (b) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road; 60 and 276, Knight's Hill; 118 and 196, Norwood Road; 9, Westow Hill; 103a, Rosendale Road; 3, Upper Tulse Hill. (8 producers, J. R. Burge, Itchen Abbas; Admiral Henderson, Ropley; Dr. Scott, Lymington; Whatley Bros., Wroughton, Wilts.; Sir Henry Hoare, Bart., Stourton Zeals, Wilts.; 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; 191, Westminster Bridge Road; 67, Coldharbour Lane; 304, Clapham Road; 96, St. Mark's Road; 118, Denmark Hill. (Producer, The Lord Wandsworth Agricultural College, Basingstoke). (d) *David Jones, 11, Russell Street. (Producer, G. V. Baxendale, Framfield Place, Uckfield). (e) W. L. Davies, 126, Stockwell Road. (Producer, Lord Ravleigh, Hatfield Peverel, Essex). * Renewal of Licences. † Licence for Bottling also issued in connection with 2 to 6, Canterbury Road. 110 (f) D. Williams, 11a, Victoria House, South Lambeth Road. (Producer, G. V. Baxendale, Framfield Place, Uckfield). (g) J.D. Thomas, 430, Coldharbour Lane. (Supplied by Retail Dairymen's Mutual, Ltd., Paddington). (h) J. E. Mason, 18, Clapham Road (supplied by Retail Dairymen's Mutual, Ltd., Paddington). 3. "Grade A" Milk. (a) *David Jones, 11, Russell Street, Brixton. (Producer, G. V. Baxendale, Framfield Place, Uckfield). (b) *C. R. Cotching, 45, Camberwell New Road. (Supplied by Retail Dairymen's Mutual, Ltd., Paddington). (c) *†R. Higgs & Sons' Dairies, Ltd., 2 to 6, Canterbury Road; 43, Loughborough Road; 121, Acre Lane; 102, Brixton Hill; 114, Brixton Road; 4, Tulse Hill; 30, Kepler Road; 56, Railton Road; 15, Bonnington Square; 191, Westminster Bridge Road; 67, Coldharbour Lane; 304, Clapham Road; 96, St. Mark's 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 and 196, Norwood Road; 9, Westow Hill; 103a, Rosendale Road; 3, Upper Tulse Hill. (Producers, selves at Norbury). (e) *Mrs. A. Richardson, 8, Robsart Street. (Supplied by Retail Dairymen's Mutual, Ltd., Paddington). (f) W. L. Davies, 126, Stockwell Road. (Producer, Lord Rayleigh's Dairies, Ltd., Hatfield Peverel, Essex). (g) D. Williams, 11a, Victoria House, South Lambeth Road. (Producer, G. V. Baxendale, Framfield Place, Uckfield). (h) S. Davies, 97, Acre Lane. (Supplied by Retail Dairymen's Mutual, Ltd., Paddington). 4. "Pasteurised" Milk. 1. Pasteurisers' Licence. (a) *†R. Higgs & Sons' Dairies, Ltd., 2 to 6, Canterbury Road. (b) Express Dairy Co., Ltd., 279, Rosendale Road. 2. Dealers' Licences. (a) *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, * Renewal of Licences. † Licence for Bottling also issued in connection with 2 to 6, Canterbury Road. 111 Bonnington Square; 191, Westminster Bridge Road; 67, Coldharbour Lane; 304, Clapham Road; 96, St. Mark's Road; 118, Denmark Hill. (b) *Curtis Bros. & Dumbrill, Ltd., 15, Croxted Road, 60 and 276, Knight's Hill; 118 and 196, Norwood Road; 9, Westow Hill; 103a, Rosendale Road; 3, Upper Tulse Hill. (c) *Express Dairy Co., Ltd., 279, Rosendale Road, 16, wood Road. (d) D. Williams, 11a, Victoria House, South Lambeth Road. (e) Ebenezer Davies, 56, Lower Marsh. 5. Supplementary Licences (premises outside the Borough of Lambeth). *Curtis Bros. & Dumbrill, Ltd., 304, Brixton Hill (Wandsworth), and 31, Westow Street (Croydon).— All grades. 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, 168 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, 470—291 at High Street and 179 at Wanless Road. (b) Post-mortem examinations conducted, 265—134 at High Street and 131 at Wanless Road. (c) Number of inquests held, 403—281 at High Street and 122 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 1927:— (1) Number of visits paid to slaughter houses, 701; * Renewal of Licences. 112 (2) Number of visits paid to meat shops and meat stores, 843; (3) Number of visits paid to meat stalls, 635; (4) Number of actual slaughterings at which one or other of the Food Inspectors was present, 6,064, consisting of beasts (317), sheep (3,353), lambs (974), pigs (1,301), hogs (8), and calves (111); (5) Carcases, or portions of carcases, condemned, 242. Of the 6,064 actual slaughterings, at which one or other of the Food Inspectors was present, and in connection with which 242 carcases or portions of carcases were condemned, the diseases necessitating such condemnation were as follows:—2 tuberculous whole beasts, 5 tuberculous livers (beasts), 3 tuberculous heads (beasts), 2 septic livers (beasts), 1 tuberculous spleen (beast), 2 tuberculous viscera (beasts), 5 tuberculous lungs (beasts), 28 flukeinfected livers (beasts), 1 tuberculous stomach (beast), 1 septic liver (beast), 15 septic lungs (pigs), 139 strongylus-infected lungs (sheep), 1 fluke-infected liver (sheep), 1 bruised whole sheep, 1 pneumoniainfected lungs (sheep). 2 inflamed offal (pig), 16 tuberculous heads (pigs), 5 tuberculous plucks (pigs), 3 tuberculous viscera (pigs), 2 pleuritic lungs (pigs), 2 tuberculous lungs (pigs), 3 tuberculous spleens (pigs), 2 extensively bruised forequarters (beast). In addition the following unsound carcases, or portions of carcases, were condemned:—16 stone of leg and shin of beef (decomposition), 4 stone of breast of mutton (decomposition), 40 lb. of pork (decomposition), 1 crate of fowls (decomposition), 104½ lb. of bacon (unsound), 3 rabbits (cœnurus cerebralis), 25 lb. beef (decomposition), 30 lb. pork (unsound). 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, 1927. General Statistics. Area (acres) 4,083 Population 307,700* Number of inhabited houses 42,607† Number of families or separate occupiers 78,399† Rateable value £2,228,622 Sum represented by a penny rate £9,128 Housing. Number of new houses erected during the year:— (a) Total 408‡ (b) As part of a Municipal Housing Scheme 230‡§ (49 blocks) I.—UNFIT DWELLING HOUSES. I.—Inspection. (1). Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9,816§§ (2). Number of dwelling-houses which were spected and recorded under the Housing (Consolidated Regulations, 1925 395 (3). Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4). Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 393 * Estimated 1927. † Census figures 1921. ‡ Representing 178 and 230 tenements respectively § In addition, 2 blocks representing 64 tenements were erected during the year. These tenements are included in (a) only. §§ 9,421 Public Health (London) Act, 1891, and 395 Housing Acts. 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 1,889* III.—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 88 (2). Number of dwelling-houses which were dered fit— (a) by owners 22 (b) by Local Authority in default of owners - (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 3,560† (2). Number of dwelling-houses in which defects were remedied— (a) by owners 3,079† (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 (2). Number of dwelling-houses in respect of which Closing Orders were made nil. (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. * 1,452 under the Public Health (London) Act, 1891 (intimation notices), and 437 under the Housing Acts (provisional or informal schedules) † Statutory notices under the Public Health (London) Act, 1891. 115 APPENDIX II. Farewell Letter to the Council from Dr. Priestley, Medical Officer of Health and Chief Executive Tuberculosis Officer, addressed to the Council, on the Occasion of his Retirement from Office on October, 31st, 1927, and the Action taken by the Council Thereon. (a) Letter. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Lambeth. Dear Mr. Mayor, Ladies and Gentlemen, Thursday, October 13th, 1927, is the last occasion upon which I shall have the privilege of being present at a Council Meeting as Medical Officer of Health of the important Metropolitan Borough of Lambeth. I should not like the occasion, a very momentous occasion to me, to go by without a letter of farewell. Everything in this world comes to an end—even the official career of a Medical Officer of Health. I shall be in that position on October 31st, 1927, when, at the hour of midnight, my appointment passes to another. I have been very happy officially since my appointment on June 27th, 1895 (a period of 32 years), and I am fortunate in being unable to recall a single case of misunderstanding or disagreement with any Committee, or Committees, with which I have had to deal. That means much in a period of 32 years of official life. I have given work of my best, and my reward is shown by the results, of which I am naturally proud. Taking the official mortality figures, as published for the year 1895, when I first commenced my duties as Medical Officer of Health for the Parish of St. Mary's, Lambeth, and comparing these official figures with those published for the year 1926 (the last full year of my appointment, as Medical Officer of Health, for the Borough of Lambeth), the decreases, when given in percentage rates, can only adequately be described as extraordinary. The same remarks practically apply pari passu if a comparison be made between the 1895 figures and the yearly averages for the thirty-two years (1895-1926), during which I have held the position of Medical Officer of Health for the old Parish of St. Mary's, Lambeth, and of the new Borough of Lambeth. The figures speak for themselves, and are set out as a record for the Council's Minutes as follow:— 116 1895 (one year) 1926 (one year) Percentage decreases 1926 as compared with 1895 Yearly averages 32 years (1895-1926) Percentage decreases 1895-1926 (32 years' averages) as compared with 1895 Death Rates. General 19.50 11.49 41.0 15.04 22.9 Zymotic 2.60 0.51 80.4 1.39 46.5 Measles 0.53 0.22 58.4 0.30 43.4 Whooping Cough 0.46 0.06 86.9 0.24 47.8 Diarrhœa 0.90 0.07 92.2 0.47 47.8 Typhoid Fever 0.09 0.006 93.3 0.047 47.8 Tuberculosis (all forms) 2.20 1.03 53.1 1.75 20.4 Tuberculosis (Consumption) 1.60 0.84 47.5 1.00 37.5 Diphtheria 0.36 0.13 63.8 0.19 47.2 Scarlet Fever 0.18 0.01 94.4 0.07 61.1 Small Pox 0.007 0.003 57.1 0.007 0.000 Infantile and Child Mortality. Infantile (under one year) 152.00 38.41 74.7 109.2 28.1 Child (one to 5 years) 30.00 10.60 64.7 18.8 37.4 Birth-rate 31.9 24.1 24.4 28.25 11.4 N.B.—The above rates are calculated per 1,000 of the estimated population, with the exception of the Infantile Mortality Rate, which is per 1,000 of the total registered births. With regard to the lessened birth-rate, I take no credit and no responsibility; all I have been able to do has been to counteract the bad effects of this lessening of the birth-rate by a corresponding greater lessening of the mortality-rates amongst infants and children between 1 and 5 years of age, leaving a net balance to the good, as far as the district of Lambeth is concerned. I leave the district of Lambeth in a very much better condition sanitarily, and from a public health point of view, than when I took over the reins of office, and I can honestly boast that there is no Metropolitan District and no extra-Metropolitan or Provincial District with a better organised Sanitary or Public Health Department, or one doing better work. In this connection, I have only 117 to make mention of the Council's Maternity and Child Welfare Scheme (with the model Maternity Home at Knight's Hill), the Tuberculosis Dispensaries administration, the work of the Council's Housing Inspectors and their carrying out of the Housing Acts generally, the Municipal Milk Depôt, and the Lambeth Bacteriological Laboratory, to satisfy everybody as to the justice of my claim. I have always kept before me a high public health ideal, and this ideal, I think, I have been able to attain. However, it is the present Borough Council, and the late Vestry, of Lambeth, naturally, that must take the credit. Without their respective approvals and agreements, as the Sanitary Authorities, of my various suggestions, my expert advice, as Medical Officer of Health, would have been so much wasted energy; whereas on the contrary, it has been productive of much permanent and lasting good for the benefit of the District. As the Latin motto of the Lambeth Borough Coat of Arms so pithily puts it—Spectemur agendo. I wish you all, Mr. Mayor, Aldermen and Councillors, an affectionate as well as an official farewell, as I pride myself that our relationship of Officer to Sanitary Authority and Sanitary Authority to Officer has been more than a purely official one. It is, nevertheless, very sad to have to part, when the end really comes. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, Joseph Priestley, Medical Officer of Health. 13th October, 1927. (b) Action taken by the Council as shown by the subjoined Abstracts from the Minutes:— "We feel sure that the Council, collectively and individually, would not like the severance of the long relationship between its Members and the Medical Officer of Health to take place without placing on record its high appreciation of the great services which Dr. Priestley has rendered to the Borough during his tenure of the Medical Officership for the past 32 years, and we accordingly unanimously recommend— That the following Resolution be passed by the Council:— That this Council of the Metropolitan Borough of Lambeth, in open Council assembled, desires to place on record its high appreciation of the services rendered by Dr. Joseph Priestley, 118 for thirty-two years as Medical Officer of Health of the Borough, during which long period he has uniformly displayed high professional and organising ability, combined with indefatigable zeal in promoting the health and welfare of the Borough— services which have placed it in the forefront of the large Boroughs with regard to efficiency in sanitation and the lessening of the mortality rates. Further, that in also thanking Dr. Priestley for his constant courtesy to the Members of the Council and others with whom he has been brought into contact, the Members desire individually to assure him of their regard for his personal qualities, and to express the hope that he will carry into his retirement those pleasing recollections of past relations with them which they will ever feel towards him. Given under the Seal of the Council this 13th day of October, 1927." The above Resolution was unanimously adopted by the Council, inscribed on vellum and forwarded to Dr. Priestley by the Town Clerk.