AC4383 REPORT OX THE HEALTH OF THE BOROUGH OF LAMBETH During the Year 1933 (76th Annual Report.) BY A. G. G. THOMPSON, M.A., M.D., B.C., D.P.H., Medical Officer of Health. Xondon: Truslove & Bray, Ltd. Printers and Bookbinders West Norwood, S.E.27 2 68625 CONTENTS. page PREFACE 6 STATISTICS AND SOCIAL CONDITIONS 7 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 27 SANITARY CIRCUMSTANCES OF THE AREA 41 HOUSING 49 INSPECTION AND SUPERVISION OF FOOD 58 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 67 / INDEX 90 3 Borough of Lambeth. (i) PUBLIC HEALTH COMMITTEE and (2) MATERNITY and CHILD WELFARE COMMITTEE (appointed by the Council on gth November, 1933). PUBLIC HEALTH COMMITTEE. His Worship the Mayor (Mr. Councillor H. Williman, J.P.), ex-officio. Aldermen : Mr. Alderman J. F. Evans. „ „ W. j. Geary, a.c.i.s. (Chairman). Councillors : Mr. Councillor L. L. S. Bickley (Vice-Chairman). „ „ A. Bloom. „ ,, S. A. Brett (Senr.), f.a.i. „ ,, P. W. Colenutt. „ „ R. S. Cooper. „ „ D. S. Flatman. Mrs. ,, B. R. Howell. Mr. „ F. J. Mills, m.p.s. F. W. Mills. „ „ G. K. Rettie. „ ,, S. H. Stanley. ,, „ J. G. Turner, j.p. „ „ G. L. Williams. 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 — Mrs. M. E. Hare, j.p., representing the North Lambeth Parliamentary Division. Miss C. ]. Sketchley, representing the Kennington Parliamentary Division. Mrs. H. L. Breese, j.p., representing the Brixton Parliamentary Division. Miss B. C. Wrigley, representing the Norwood Parliamentary Division. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Chief Executive Tuberculosis Officer : A. G. G. Thompson, m.a., m.d., b.c.(Cantab), d.p.h. Public Analyst (part time) : A. H. Mitchell Muter, f.i.c., f.c.s. Assistant Administrative Officer : A. E. Ruel, Cert, s.i.e.b. Clerical Staff: A. W. Bayley, H. F. Bryan (Cert, s.i.e.b.), A. I. Bell, H. Snow, J. C. Richards, A. C. Puttock, F. J. Cox, Miss E. Nye. Junior Clerks : D. R. Eeles and S. W. Westbey. Sanitary Inspectors : (a) District Inspectors : S. F. Heal, Cert, s.i.e.b. (Meat and other Foods). J. Bowers, „ (Meat and other Foods and Smoke). W. J. Lawrence, „ J. Holland, „ (Meat and other Foods). H. E. Cassidy, „ J. Smith, „ (Meat and other Foods). F. Heffield, „ ,, „ G. F. Taverner, Cert. Royal San. Inst. R. G. Cutler, Cert, s.i.e.b. A. E. White, Cert. „ (Meat and other Foods). S. Bradley, „ „ „ S. G. Starling, „ ,, „ (b) Food Inspectors : A. B. Cruttenden (Senior), Cert, s.i.e.b. (Meat and other Foods) C. W. Idle, „ „ „ (c) Housing Inspectors : J. M. Scorrer, Cert, s.i.e.b. B. Good, „ (Meat and other Foods). (d) Women Inspectors : Miss L. Auger, Cert, s.i.e.b., c.m.b. & h.v. Cert. Miss A. G. Simpson, s.r.n., Cert, s.i.e.b., c.m.b. & h.v. Cert. Health Visitors : Miss L. Coleman, s.r.n., c.m.b., h.v. Cert. Miss A. F. Crombie, c.m.b., Cert, s.i.e.b., h.v. Cert. Miss L. Hoskin, c.m.b., Cert, s.i.e.b. Miss M. Butler, s.r.n., c.m.b., h.v. Cert. Infant Life Protection Visitor : Miss J. M. Pople, s.r.n. Municipal Maternity Home : 210 Knight's Hill, S.E. 27. Medical Officer (part time) : Miss K. M. Cogan, m.d.(Lond.). Matron : Miss C. B. Turner, s.r.n., c.m.b. Sister : Miss E. Burgess, s.r.n., c.m.b. 5 Gynaecological Consultants (Puerperal Fever, etc., Regulations) : w. gllliatt, m.d., m.s., f.r.c.s. j. m. wyatt, m.b., f.r.c.s. Obstetrical Consultants : R. A. Brews, m.d., m.s., m.r.c.p., f.r.c.s. A. J. wrigley, m.d., f.r.c.s. Tuberculosis Dispensaries Scheme : (a) Central Tuberculosis Dispensary, 73 Effra Road, Brixton, S.W. 2. Tuberculosis Officer* : E. D. Richardson, m.r.c.s., l.r.c.p., d.p.h. Secretary and Social Worker : Miss D. E. Cooper. Health Visitors (Tuberculosis) : Miss W. Dyer, s.r.n., c.m.b., h.v. and School Nurse's Certs. Miss M. E. Jacobs, c.m.b. Cert, s.i.e.b., h.v. Cert. Dispenser (part time) : Miss F. M. Speakman. Caretaker Attendant : R. Browne. (b) Branch Tuberculosis Dispensary, St. Thomas's Hospital, S.E. 1. Tuberculosis Officer : G. T. Hebert, m.d. (Oxon.), f.r.c.p. Assistant Tuberculosis Officer (for visiting purposes) : F. A. Gaydon, m.d. (Lond.), m.r.c.p. Secretary : Miss I. Gordon (Lady Almoner's Department). Visitor : Miss O. Baggalay, s.r.n., c.m.b., Cert, s.i.e.b., h.v. Cert. Vaccination Department : District or Hospital: Public Vaccinator : Vaccination Officer : Lambeth Church - J. B. Taylor, b.a., m.b., b.ch.(dub.). ) „ an Kennington - - R. Phillips, m.d., b.sc.(lond.), d.p.h. I ° Stockwell - - H. P. Orchard, m.r.c.s., l.r.c.p. Brixton - - - E. L. M. Rusby, m.b.(lond.), ■ W. R. Cargill. m.r.c.s., l.r.c.p. Norwood - - - E. Smallwood, m.d.(brux.) - - J. Steer. Lambeth Hospital - P. J. Watkin, M.C., m.r.c.s., l.r.c.p. Norwood Schools Infirmary E. Smallwood, m.d.(brux.). Mortuaries and Coroner's Courts : High Street, Lambeth, S.E. 1 - - - Mortuary Keeper : R. Harriss. Wanless Road, S.E. 24 Mortuary Keeper : W. A. Adams Disinfecting Station : Wanless Road, Loughborough Junction - Superintendent: E. Lockyear Bacteriological Laboratory : Wanless Road, Loughborough Junction. Bacteriological Assistant to the Medical Officer of Health : Miss F. M. Speakman General Assistant : H. Matten. * Dr. Richardson also acts for the Medical Officer of Health when required. 6 PREFACE. The health of the Borough of Lambeth during the year 1933 has been generally satisfactory, as shown by the statistics which appear in the Report. The population estimated by the Registrar General is smaller than at any previous midyear in the present century apart from the War years, being 22,100 less than it was in 1925, and 7,147 less than at the census, 1931. The birth rate 13.63 is again the lowest ever recorded and barely exceeds the general death rate 13.11. The natural increase of the population by excess of births over deaths is only 152. The tendency to longevity in the inhabitants of the Borough is again remarkable, since almost half the total deaths at all ages, actually 49.36 per cent., occurred at ages of 65 years and upwards. The epidemic of scarlet fever which prevailed in the last quarter of the year was exceptionally mild, and the zymotic death rate, 0.38 per 1,000 population, is the lowest on record. Thanks are gratefully tendered to members of the Maternity and Child Welfare and the Public Health Committees for advice and criticism, to the general practitioners and other medical men working in the Borough, and principally to the Staff of the Public Health Department. A.G.G.T. May, 1934. 7 Borough of Lambeth. STATISTICS & SOCIAL CONDITIONS OF THE AREA. Summary of Vital and Mortal Statistics, &c. 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. The Parliamentary Divisions have been adjusted so that they and the Wards are co-terminous. Population—estimated 1933—289,000 (males 136,720 and females 152,280). Density—70.78 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (corrected)—3,941, being 13.63 per 1,000 population. Marriages—2,463, being 8.52 per 1,000 population. Deaths (corrected)—3,789, being 13.11 per 1,000 population. Infantile Mortality (corrected)—249 deaths under 1 year, being 63 per 1,000 total live births. Neonatal Mortality (corrected)—105 deaths under one month, being 26.64 per 1,000 live births. Zymotic Death-rate (corrected)—0.38 per 1,000 population (total zymotic deaths, 112). Maternal Mortality (corrected)—7 deaths, being 1.77 per 1,000 live births. Number of structurally separate dwellings (estimated)—49,805. Rateable Value (at 1st April, 1933)—-£2,302,719. Sum represented by a penny rate (at 31st March, 1933)—£9,326. 8 Social Conditions. The housing conditions in which the poorer population live do not materially alter, although recent representations to the County Council and to the Borough Council seem likely to lead in the near future to the demolition of some of the oldest insanitary dwellings in the district. There still remains almost untouched, the great difficulty due to lack of self-contained tenements. The subletting of each floor, and even room in some instances, to a separate family in a house originally constructed for the use of one family is the common practice in very many houses. There are, however, exceptions to be found often in the least likely neighbourhoods, both in small cottage property and in larger houses. The tendency to let property in separate tenements without making them self-contained is spreading, however, to areas where five years ago one family to the house was the rule. Families with children still find great difficulty in obtaining accommodation, partly because these divided houses are not converted into selfcontained tenements. Even as they are they are preferred, in many instances, to the large blocks of Council dwellings where privacy is reduced, the younger children on the higher storeys cannot be so easily and frequently taken out, and where infectious diseases are more easily disseminated, owing to the common entrance and staircase. From inquiries it would seem not to be financially economical for owners to carry out the necessary structural alterations to subdivide the larger houses into self-contained flats, since to the expected expenditure on the structure must be added unforeseen requirements to comply with the building and drainage bye-laws, the separate rating of each tenement, and liability to increased income tax. Whatever the validity of the reasons adduced, the number of houses which have been converted is small in proportion to the number occupied by two or more families. It is also improbable that the existing tenants could afford higher rents than they now pay. From the economic viewpoint the five-storey block dwelling would seem now to have become the fixed standard for central London into which, Procrustean fashion, families are obliged to fit themselves. Regarded from the point of view of the wishes of the families themselves, if separate houses are out of the question, then a half-way compromise between them and the five-storey block is preferable. Three-storey blocks of flats with separate entrances to the ground floor dwellings, the staircase serving two 9 dwellings only on each floor and so obviating the necessity for outside balconies would be more suited to the average needs. The rent forms so prominent a part of the family budget that its importance in connection with rehousing is paramount. The cost of lighting and warming two or three rooms is considerable, so it is not surprising to find in the colder months that families in new dwellings congregate in one room and leave the others vacant. This practice has been not infrequently noted when cases of infectious disease have been visited. A rent of 12s. to 18s. per week for one large room requiring one light and one fire is paid in Lambeth to-day by families who could not afford the same rent for a Council dwelling requiring several lights and more than one fire. In such instances to rehouse the family merely increases their poverty, which remains with them to stultify the benefit of the better housing conditions. Unemployment. The following tables indicate the extent of unemployment among Lambeth residents :— (1) Average Number of Residents Registered as Unemployed in 1930, 1931, 1932, and 1933. Date Men Women J u veniles Total 1930 5,112 1,430 250 6,792 1931 7,894 2,772 354 11,020 1932 9,771 2,173 419 12,363 1933 8,976 1,193 287 11,256 (2) Number of Residents Registered as Unemployed at Monthly Dates in 1933. Date Men Women Juveniles Total 23rd January, 1933 10,167 2,372 453 12,992 20th February, ,, 10,320 2,625 459 13,404 20th March, ,, 10,098 2,573 387 13,058 24th April, 9,655 2,094 461 12,210 22nd May ,, 9,412 2,086 325 11,823 26th June, „ 8,908 1,812 192 10,912 24th July, „ 8,391 1,999 260 10,650 21st August, „ 7,953 1,952 280 10,185 25th September, ,, 8,241 1,830 204 10,275 23rd October, „ 8,351 1,644 185 10,180 20th November, ,, 8,294 1,615 152 10,061 18th December, „ 7,922 1,315 90 9,327 10 The standard of nutrition of Lambeth children on entering the County Council Schools is of interest when read in conjunction with the unemployment figures in the preceding tables :— 1932—3,606 Children 1933—3,409 Children Good Average Below Normal Good Average Below Normal Children 867 2,528 210 733 2,431 244 Lambeth (%) 24% 70.2% 5.8% 21.5% 71.3% 7.2% London (%) 22% 73.5% 4.5% 20.5% 75.4% 4.1% Vital Statistics. The population of the Borough of Lambeth at the mid-year 1933, has been estimated by the Registrar-General to be 289,000, which is less by 3,300 than the official estimated population of 1932. The following Table shows both actual numbers and the percentage of total deaths in the various age groups. It is of interest to note that the number of deaths in the age period 65 and over was almost one-half the total deaths:— All Ages 0— 1— 2— 5— 15— 3,789 249 52 39 85 122 100% 6.57% 1.37% 1.03% 2.24% 3.22% 25— 35— 45— 55— 65— 75— 160 203 401 608 865 1,005 4.22% 5.36% 10.58% 16.05% 22.83% 26.53% 11 During the year the number of births corrected by inward and outward transfers was 3,941, giving a corrected birth rate of 13.63 compared with 14.75 last year, a decrease of 1.12 per one thousand population. In 1931 there was also a decrease of 0.53 compared with the rate in 1930. The principal causes of death are again the same four, heart disease which claimed 981 or 25.8 per cent, of the total, cancer 477 or 12.58 per cent., diseases of the lungs 391 or 10.3 per cent., and tuberculosis 274 or 7.2 per cent. The deaths from tuberculosis are less by seven than they were in 1932, but owing to the estimated population being 3,300 lower, the death rate per one thousand population is but slightly lower, being .94 compared with .96. Estimated Population, 1933 (Middle of the Year.) I. Wards. Wards Males Females Total 1. Marsh 6,670 5,940 12,610 2. Bishop's 12,540 13,060 25,600 3. Prince's 12,530 13,330 25,860 4. Vauxhall 13,960 14,520 28,480 5. Oval 11,150 11,930 23,080 6. Vassall 7,960 8,890 16,850 7. Angell 12,850 15,040 27,890 8. Stockwell 14,240 16,370 30,610 9. Town Hall 6,890 7,520 14,410 10. Heme Hill 6,790 7,900 14,690 11. Tulse Hill 14,570 17,830 32,400 12. Knight's Hill 16,570 19,950 36,520 Borough of Lambeth 136,720 152,280 289,000 12 II. Registration Sub-Districts Sub-Districts Males Females Total I. Lambeth Church 20,110 20,170 40,280 2. Kennington 20,320 21,720 42,040 3. Stockwell 28,420 31,030 59,450 4. Brixton 36,040 41,220 77,260 5. Norwood 31,830 38,140 69,970 Borough of Lambeth 136,720 152,280 289,000 III. Parliamentary Divisions. Parliamentary Divisions Wards Total North ( Mars 64,070 (Bishop's (Prince's Kennington (Vauxhall 68,410 (Oval (Vassall Brixton (Angell 72,910 (Stockwell (Town Hall Norwood (Heme Hill 83,610 ( Tulse Hill (Knight's Hill Parliamentary Area of Lambeth 289,000 13 TABLE A. Giving Number of Live Births in each Registration Sub-District of the Borough of Lambeth During the Year ended 31st December, 1933 (arranged Quarterly). Registration Sub-Districts No. of Births Total for the Year 1933 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Lambeth Church* 472 496 488 466 1,922 Kennington† 233 232 249 197 911 Stockwell‡ 227 212 214 137 790 Brixton§ 306 339 301 255 1,201 Norwood 209 217 210 207 843 BOROUGH OF LAMBETH 1,447 1,496 1,462 1,262 5,667 * Including General Lying-in Hospital (1,042 cases, of which 278 belong to Lambeth), f Including Lambeth Hospital (622 cases, of which 353 belong to Lambeth). J Including Clapham Maternity Hospital (446 cases, of which 118 belong to Lambeth). § Including King's College Hospital (654 cases, of which 207 belong to Lambeth). 14 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, during 1933, the 4 previous years and the averages for the four decennia 1891-1900, 1901 1910, 1911-1920, and 1921-1930. Year Estimated Population Number of Births Registered Corrected Numbers of Deaths All Ages Under 1 year Under 5 years Deaths from 7 Chief Zymotic Diseases 1933 289,000 5,667 3,789 249 340 112 1932 292,300 6,106 3,664 243 377 145 1931 295,900 6,490 3,748 273 369 85 1930 294,400 6,911 3,545 270 394 144 1929 294,400 6,786 4,387 313 499 165 Averages (10 years)—- 1921-1930 (Borough) 304,720 7,662.9 3,794.7 354.1 550.5 171.9 1911-1920 (Borough) 286,786.4 8,027.1 4,282.5 619.7 958.6 326.8 1901-1910 (Borough) 314,566.8 8,846.9 4,709.6 1,020.0 1,503.5 475.1 1891-1900 (Parish) 294,049.7 9,295.4 5,405.3 1,358.5 2,070.2 700.4 Note—(a) Enumerated Population at Census 1901 was 301,895 ; at Census 1911 was 298,058 ; at Census 1921 was 302,868, and at Census 1931 was 296,147. Families or separate occupiers = 70,887 (1901), 70,827 (1911), 78,399 (1921), and 83,777 (1931). 15 TABLE C. 1 Showing the Birth Rate, the General and Zymotic Death Rates, the Infantile Mortality Rates for the Year 1933, and the figures for the Three Previous Years, together with the Averages for the Four Decennia 1891-1900, 1901-1910, 1911-1920, and 1921-1930. Year Birth-Rate per 1,000 Population (uncorrected) Death-Rate per 1,000 Population (corrected) Corrected Deaths of Children under 1 year per 1,000 total Births Deaths of Children under 1 year per 1,000 Deaths (corrected) Deaths of Children under 5 years per 1,000 Deaths (corrected) Zymotic Death-Rate per 1,000 Population (corrected) 1933 19.60 13.11 63.18 65.71 89.73 0.38 1932 20.88 12.53 56.34 66.32 102.89 0.49 1931 21.93 12.66 60.35 72.83 98.45 0.28 1930 Averages (10 years)— 23.47 12.04 56.83 76.16 111.11 0.48 1921-1930 (Borough) 25.1 12.4 51.4 93.4 145.1 0.5 1911-1920 (Borough) 27.9 14.9 77.2 144.5 223.1 1.1 1901-1910 (Borough) 28.1 14.9 115.3 216.7 319.4 1.5 1891-1900 (Parish) 31.6 18.4 146.1 251.3 382.9 2.4 16 TABLE D. Vital Statistics of the Borough of Lambeth During 1933 and Previous Five Years (1928-1932) Year Population estimated to Middle of each Year Births Total Deaths Registered in District Transferable Deaths Net Deaths Belonging to the District Uncorrected Number Net of non-residents registered in the District t of residents not registered in the District t Under 1 Year of Age At all Ages Number * Rate Number * Rate per 1,000 Net Births Number • Rate Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1928 298,100 7,088 5,017 16.82 3,925 13.16 1,015 757 307 61 3,667 12.30 1929 294,400 6,786 4,622 15.69 4,704 15.97 1,099 782 313 68 4,387 14.90 1930 294,400 6,911 4,751 15.76 3,839 13.04 994 700 270 57 3,545 12.04 1931 295,900 6,490 4,523 15.28 4,109 13.88 1,228 867 273 60 3,748 12.66 1932 292,300 6,106 4,313 14.75 3,937 13.46 1,559 1,286 243 56 3,664 12.53 Average 5 years 1928-1932 1933 295,020 6,672 4,645 15.66 4,103 13.90 1,179 878 281 61 3,802 12.88 289,000 5,667 3,941 13.63 4,056 14.03 1,604 1,337 249 63 3,789 13.11 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 (2,347 outward and 554 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. t Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph. " 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 death! 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 net death-rate of the Borough. Area of Borough in acres (including land and inland water), 4,083. Census, Average number of persons per separate dwelling, 6.05. 1931 Number of structurally separate dwellings, 48,873, Total population at all ages, 296,147. 17 TABLE E. Summary of Statistics Relating to the Metropolitan Boroughs for the Year, 1933. Cities and Boroughs Estimated Population to Mid-year 1933 Births Annual rate per 1,000 persons living Death-rate per 1,000 living Deaths of infants under 1 year per l,000 births London 4,303,130 13.2 12.2 59 West Districts— Paddington 141,900 13.41 13.36 85 Kensington 181,100 12.0 12.9 72 Hammersmith 131,400 13.9 12.9 65 Fulham 148,200 13.07 13.00 65 Chelsea 58,850 10.6 13.6 78 City of Westminster 126,300 8.7 12.4 68 North Districts— St. Marylebone 94,080 9.71 12.2 56 Hampstead 90,380 9.6 11.0 38 St. Pancras 190,900 13.6 13.7 58 Islington 319,100 14.35 12.40 63 Stoke Newington 51,120 12.6 12.3 46 Hackney 214,300 14.0 11.5 50.6 Central Districts— Holborn 36,050 9.49 13.48 70 Finsbury 66,640 15.1 12.8 50 City of London 9,830 7.7 10.9 65 East Districts— Shoreditch 93,550 16.0 13.0 74 Bethnal Green 104,200 14.3 12.5 66 Stepney 219,100 15.1 12.9 65.3 Poplar 149,300 15.4 12.4 54 South Districts— Southwark 164,700 14.2 13.9 63 Bermondsey 107,300 14.0 12.5 61 Lambeth 289,000 136 13.1 63 Battersea 154,000 14.7 12.49 49.49 Wandsworth 350,200 10.93 11.49 50 Camberwell 243,700 13.32 12.33 49 Deptford 102,800 14.8 12.1 54 Greenwich 97,830 13.7 11.9 66 Lewisham 221,100 12.2 10.2 39 Woolwich 146,200 12.6 11.18 62 18 TABLE F. Birth-Rate, Death-Rate, and Analysis of Mortality During the Year 1933 (Provisional figures). ] Rate per 1,000 Total Population Annual Death-rate per 1,000 Population Rate per 1,000 Births All Causes Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea & Enteritis ' (under two years) Total Deaths under one year Live Births Stillbirths England and Wales 14,4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 118 County Boroughs and Great Towns, including Eondon 14.4 0.67 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.49 9.4 67 132 Smaller Towns (Estimated Resident Populations 25,000 -50.000 at Census 1931) 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 London 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 Lambeth 13.6 0.50 13.1 0.003 0.00 0.03 0.01 0.07 0.08 0.51 0.39 12.4 63 The maternal Mortality rates are as follows:— Puerperal Puerperal Sepsis Others Total Sepsis Others Total Per 1,000 Live Births, England & Wales 1.79 2.63 4.42 Per 1,000 Total Births, England & Wales 1.71 2.52 4.23 Lambeth 1.27 0.50 1.77 Lambeth 1.22 0.49 1.71 19 The total number of deaths registered in Lambeth during the year is 4,056, of which 1,604 represents the deaths of strangers which occurred mainly in the large hospitals and other institutions in the district. The deaths of persons belonging to the Borough which were registered in other districts numbered 1,337, the number of deaths corrected, i.e., of all Lambethans who died both within and outside the district is 3,789. The corrected death rate is 13.11 per 1,000 living, based upon a population estimated to the middle of the year of 289,000. Age Periods of Corrected Deaths. The 3,789 corrected deaths during 1933 may be further analysed and tabulated as follows :— 249 - - 6.57 per cent, of the total corrected deaths took place under 1 year of age. 91 - - 2.40 per cent, between 1 and 5 years. 340 - - 8.97 per cent, under 5 years. 207 - - 5.46 per cent, between 5 and 25 years. 363 - - 9.58 per cent. 25 to 45 years. 1,009 - - 26.62 per cent. 45 to 65 ye.ars. 865 - - 22.82 per cent. 65 to 75 years. 1,005 - - 26.53 per cent. 75 years and over 3,449 - - 91.02 per cent, over 5 years. 20 21 TABLE H. Causes of, and Ages at, Death (Corrected) During the Year, 1933. Causes of Death Net Deaths at the Subjoined Ages of " Residents " whether occurring Within or Without 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 under 75 years 75 and upwards 1 2 3 4 5 6 7 8 9 10 11 All causes 3,789 249 52 39 85 122 363 1,009 865 1,005 Enteric Fever 1 — — — 1 — — — — Measles 11 3 2 5 1 — — — Scarlet Fever 4 — — 1 2 — 1 — — Whooping Cough 21 8 8 4 1 — — — Diphtheria 26 2 4 7 13 — — — — Influenza 150 3 2 1 — 2 25 54 31 32 Encephalitis Lethargica 4 - — — — — 1 2 1 — Cerebro-Spinal Fever 5 1 1 1 — 2 — — Tuberculosis of respiratory system 245 1 — 2 4 53 83 91 7 4 Other tuberculous diseases 29 1 1 2 6 3 5 7 4 — Syphilis 21 1 — — — — 4 12 3 1 General Paralysis of the insane, tabes dorsalis 17 — — — 1 3 12 1 — Cancer, malignant disease 477 — — — — 3 36 206 151 81 Diabetes 35 — — — 1 — 3 11 17 3 Cerebral Haemorrhage, etc. 142 — — — — — 2 36 56 48 Heart Disease 981 — 1 — 2 7 34 203 301 433 Aneurysm 16 — — — — — 4 6 5 1 Other circulatory diseases 134 — — — — 1 1 34 48 50 Bronchitis 139 4 — — — 1 5 36 23 70 Pneumonia (all forms) 252 34 18 3 5 6 27 57 50 52 Other respiratory deseases 33 1 — 1 2 — 5 13 7 4 Peptic Ulcer 48 — — 2 8 29 6 3 Diarrhoea, etc. 61 40 9 2 — 1 — 7 — 2 Appendicitis 28 — — 4 1 1 16 3 3 Cirrhosis of Liver 8 — — — —r 2 4 2 — Other diseases of liver, etc. 19 1 — — 3 8 5 2 Other digestive diseases 76 3 2 1 2 3 19 20 11 15 Acute and Chronic Nephritis 128 — — — 5 5 13 28 45 32 Puerperal Sepis 5 — — — — 1 4 — — — Other puerperal causes 2 — — — — — 2 — — — Congenital Debility, premature birth, malformations, etc 122 121 — — 1 — — — Senility 120 — — — — — — 11 109 Suicide 50 — — — 2 15 24 9 — Other Violence 115 8 2 2 11 10 23 27 18 14 Other defined diseases 262 17 2 6 25 18 33 66 49 46 Causes ill-defined or unknown 2 — — 1 — — — — 1 — Deaths in Institutions in Lambeth Lambethans Strangers Totals Voluntary Hospitals 247 776 1,023 State-aided Hospitals 624 738 1,362 Homes for the dying, etc. 36 9 45 22 TABLE I. Shewing the corrected number of Deaths, with corrected Death-rates (general, zymotic and diarrhceal), in each of the Registration Sub-Districts of the Borough during 1933. Registration Sub-Districts. Total Deaths General Death-rate per 1,000 of the Population. Total Deaths (corrected) from Total Zymotic Deaths. Zymotic Death-rate per 1,000 of the Population. Diarrhoea Death-rate per 1,000 of the Population. Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhoid or Enteric Diarrhoea and Dysentery Lambeth Church 561 13.92 — 4 - 6 9 — 15 34 0.84 0.37 Kennington 609 14.48 — 2 — 2 3 — 12 19 0.45 0.28 Stockwell * 716 12.04 — — 8 2 — 4 14 0.23 0.06 Brixton 1,035 13.39 — 2 2 6 3 1 9 23 0.29 0.11 Norwood 868 12.40 — 3 2 4 4 — 9 22 0.31 0.12 Borough of Lambeth 3,789 13.11 — 11 4 26 21 1 49 112 0.38 0.16 *Of the 716 deaths in Stockwell registration Sub-District, 359 belong to the Inner and 357 to the Outer Stockwell Sub-District respectively. Inner Registration Sub-Districts—death rates : general 13.71, zymotic 0.54, diarrhœal 0.25 per 1,000 population. Outer Registration Sub-Districts—death rates : general 12.73, zymotic 0.28, diarrhœal 0.11 per 1,000 population. 23 Maternal Deaths. There were only 7 fatalities during the year from child-birth compared with 10 last year. In consequence, the maternal mortality rate per one thousand live births was only 1.77, compared with a rate for England and Wales of 4.42. Five out of the 7 were due to sepsis, one to lobar pneumonia, and one to hydronephrosis. Infantile Mortality Rates. The infantile mortality rate is based upon the number of deaths under one year of age per 1,000 births registered. The corrected number of births was 3,941, a decrease of 372 below the corresponding number of births for the previous year. The corrected number of deaths was 249, giving an infantile mortality rate of 63, compared with 56 last year. In the Registration Sub-districts, the corrected infantile mortality varies thus:— Registration Sub-Districts Total No. of Births Total Deaths under 1 year Infantile Mortality per 1,000 Births Lambeth Church 647 55 85 Kennington 637 38 60 Stockwell 777 40 51 Brixton 1,117 67 60 Norwood 763 49 64 Borough 3,941 249 64 Inner Districts—70, Outer Districts—59. 24 TABLE J. Infantile Mortality, 1933. Net 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 87 8 5 5 105 46 44 30 24 249 Measles — — — — — 1 — 1 2 3 Whooping cough 4 1 2 8 Diphtheria 2 2 Influenza — — — — — — 1 — 2 3 Ccrebro-spinal meningitis — — — — — — 1 1 Tuberculosis of respiratory system — — — — — — — 1 — 1 Other Tuberculous diseases — — — — — — — — 1 1 Syphilis — — — — — 1 — — 1 Bronchitis — — — — — 2 — — 2 4 Pneumonia (all forms) — — — 1 1 9 7 9 8 34 Other respiratory diseases — — — -— — — — 1 3 1 Diarrhoea, etc. — — — 1 1 7 21 8 40 Other digestive diseases — — — — — 3 — — — 3 Other diseases of Liver, etc. — — — — 1 — — 1 Congenital debility and malformation, premature birth, etc. 80 8 4 2 94 19 4 4 — 121 Other deaths from violence 4 — — — 4 2 2 — — 8 Other defined diseases 3 — 1 1 5 3 3 3 3 17 25 Stillbirths. The following particulars regarding stillbirths registered in Lambeth during 1933 have been received from the Registrar General:— Stillbirths registered Inward transfers. Outward transfers Corrected totals Total legitimate and illegitimate: Males 115 11 53 73 Females 103 13 42 74 Illegitimate:— Males 7 2 3 6 Females 5 — 1 4 Mortality (All ages). The mortality rates from different diseases and groups of diseases are given in terms of total deaths per 1,000 of the estimated population, with the exception of the infantile mortality rate which is expressed in terms of the corrected number of births. 19330 1932 Quinquennium 1931 1926-1930 Estimated Population 289,000 292,300 295,900 301,120 General death-rate 13.11 12.53 12.66 12.70 Zymotic death-rate 0.38 0.49 0.28 0.50 Measles death-rate 0.03 0.13 0.003 0.14 Whooping Cough death-rate 0.07 0.07 0.09 0.09 Diarrhoeal death-rate 0.16 0.15 0.10 0.11 Typhoid Fever death-rate 0.003 0.01 0.003 0.008 Tuberculosis (all forms) death-rate 0.94 0.96 0.90 1.07 Tuberculosis (pulmonary) death-rate 0.84 0.84 0.85 0.91 Scarlet Fever death-rate 0.01 0.006 0.01 0.01 Diphtheria death-rate 0.08 0.11 0.06 0.10 Small-pox death-rate 0.00 0.00 0.003 0.00 Infantile Mortality rate 63 56 60 59 The Inner and Outer Districts vary as follows:— Inner Districts— General death-rate 13.71 13.23 13.43 13.60 Zymotic death-rate 0.54 0.62 0.35 0.69 Outer Districts— General death-rate 12.73 12.09 12.18 11.99 Zymotic death-rate 0.28 0.41 0.24 0.37 26 Births, 1933. The total number of Births registered (uncorrected) is 5,667, of which details are set out in Table A. The corrected number of births, however, is 3,941, showing a birth-rate of 13.63 per 1,000 of the estimated population. Total registered Inward transfers Outward transfers Corrected numbers Legitimate Males 2,688 285 1,099 1,874 Legitimate Females 2,645 221 1,038 1,828 Illegitimate Males 165 32 77 120 Illegitimate Females 169 42 92 119 Totals 5,667 580 2,306 3,941 Notification of Births Act. The Notification of Births Act, 1907, was adopted throughout the Borough, and came into operation on 9th March, 1908. Of the total 5,841 notified births, 4,153 took place in Institutions, and of these, 1,789 belong to Lambeth, and 2,364 to outside districts, thus — Institutions. Lambeth Cases Strangers Totals General Lying-in Hospital 300 772 1,072 St. Thomas's Hospital 240 391 631 Lambeth Hospital 354 291 645 Clapham Maternity Hospital 151 295 446 King's College Hospital 208 463 671 *Lambeth Council Maternity Home 400 9 409 Other Nursing Homes (private) 136 143 279 Totals 1,789 2,364 4,153 * 9 of the applicants moved out of the Borough after booking. 27 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Nursing in the Home. (a) General. There are five District Nursing Associations affiliated to the Queen's Institute of District Nursing and the Catholic Nursing Institute which between them cover the entire area. All are run upon provident lines, but none receive any grant for general nursing from the Borough Council. They are the Ranyard Nurses, Camberwell and District, South London, Brixton, Norwood and District Nursing Associations, and the Catholic Nursing Institute. (b) Infectious disease. Pneumonia (all forms) 1 Whooping Cough Chicken-Pox Influenza Diphtheria German Measles Visits paid to Children under 5 years of age ... 972 102 12 81 14 — Visits paid to Persons over 5 years of age 3,504 29 35 1,219 — 12 Total Visits 4,476 131 47 1,300 14 12 Measles Ophthalmia- Neonatorum Erysipelas Conjunctivitis Mumps Pemphigous Neonatorum Visits paid to Children under 5 years of age 156 283 — 920 8 30 Visits paid to Persons over 5 years of age 45 — 33 23 7 — Total Visits 201 283 33 943 15 30 A flat rate of 1/- per visit paid for the nursing of infectious disease, was increased to 1/3 per visit on the 25th of May, 1933. 28 Midwives. There are approximately 80 midwives practising in the area but the exact number is not known as they are supervised by the County Council and are not registered as practising in any sub-divisions of the County area. On page 35 will be found particulars of financial assistance towards payment of midwives in certain cases. Hospitals. The following hospitals are situated within the district and offer accommodation to the inhabitants as well as to large numbers domiciled in other areas. (a) Voluntary. St. Thomas's Hospital, Albert Embankment, S.E.I, contains 640 beds and large out-patients' departments. A Maternity and Child Welfare Centre is included in the latter to which a grant is made by the Council. King's College Hospital, Denmark Hill, S.E.5, contains 384 beds and general and special out-patient departments. Royal Waterloo Hospital, Waterloo Road, S.E.I. For women and children, 130 beds and out-patient department. Belgrave Hospital, 1, Clapham Road, S.W.9. For children, 76 beds and a well-attended out-patient department. General Lying-In Hospital, York Road, S.E.I. For women, 76 beds. A Maternity and Child Welfare Clinic is attached to the out-patient department and to which a grant is made by the Borough Council. Clapham Maternity Hospital, Jeffreys Road, S.W.8. For women, 50 beds and an out-patient department. (b) State-aided. Lambeth Hospital, Brook Street, S.E.I. This is a general hospital, fully equipped for all types of cases especially for the treatment of cancer by radium and X-rays. South Western Hospital, Landor Road, S.W.9. A hospital for infectious diseases, containing 323 beds. Ambulance Facilities. There are no ambulances belonging to the Borough Council. By arrangement with the County Council free ambulances are available for the conveyance of women to institutions for confinement between the hours of 11.0 p.m., and 8.0 a.m. The suggestion to extend the provision to a 24-hour service by the 29 County Council at the expense of the borough was not agreed upon after consideration, partly because the women themselves dislike the notoriety inseparable from such a conspicuous vehicle, and partly because the expense is greater than other means of conveyance readily available. 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 11 administrative welfare areas—each area administered by a voluntary welfare centre committee, of which the Medical Officer of Health is a member, as follows:— 1. North Marsh, 120, Cornwall Road, S.E.I. 2. Barley Mow, 52, Oakley Street, S.E.I. 3. Holy Trinity and North Lambeth, 121, Kennington Road, S.E.11.* 4. Moffat Institute, The Institute, Esher Street, S.E.ll.*†‡ 5. The " Rose McAndrew," 48, Lansdowne Road, S.W.8. 6. St. Anne's, 44-46, Harleyford Road, S.E.I 1. 7. North Brixton (Belgrave Hospital), 212, Camberwell New Road, S.E.5.* 8. Loughborough Junction, " The Sussex Arms," 109, Sussex Road, S.W.9.*† 9. Stockwell, The Institute, 57, Stockwell Road, S.W.9.* 10. Brixton, The Dispensary, 19, Water Lane, S.W.2.*†‡ 11. West Norwood, Hannen House, 12, Hannen Road, S.E.27.*f (Branch Clinic, Gipsy Road, S.E.19.) In addition clinics are held daily at:— General Lying-in Hospital, York Road, S.E.I.*‡ St. Thomas's Hospital, (Main Building), S.E.I.*‡ — do — 37, Royal Street, S.E.I. These are in all respects regarded as Voluntary Welfare Centres and integral parts of the Lambeth scheme. Included in the scheme are— (a) Lambeth Council Maternity Home, 210, Knight's Hill, West Norwood. (b) St. Thomas's Babies' Hostel, Cornwall Road, S.E.11. * Regular Ante-Natal Clinics are held in connection with these Centres. † Dental Clinic. ‡ Artificial Sunlight. 30 Lambeth Milk Assistance Scheme (Free & Aided Supplies). The Lambeth Milk Assistance Scheme continues to prove its usefulness in providing milk food in its most suitable form for young children whose parents are unable to secure it of their own resources. The scale of income is that recommended by the Ministry of Health on 22nd August, 1922, and is as follows:— Number in Family. Supply of Milk free of cost. Supply of Milk at half-cost. 1 13/0 after deduction of rent 15/0 after deduction of rent 2 10/6 per head, after deduction 12/6 per head, after deduction of rent of rent 3 8/6 „ „ „ 10/0 „ „ „ 4 7/6 „ „ „ 8/6 „ „ „ 5 7/0 „ „ „ 8/0 „ „ „ 6 6/6 „ „ „ 7/6 „ „ „ The figures giving the cost ot the Lambeth Milk Assistance Scheme and the quantities distributed, both ordinary cow's milk as well as the various forms of dried milk since its inception on 8th February, 1918, are shown in the following table:— Years (Financial) Cost of Milk distributed Total Cost Total amount of Milk distributed in gallons (approximately) Through Welfare Centres Through Milk Depot £ s. d. £ s. d. £ s. d. 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 1927-28 2,030 17 3 183 18 2 2,214 15 5 28,850 1928-29 1,546 17 5 137 19 7 1,684 17 0 23,321 1929-30 1,328 3 6 36 2 7 1,364 6 1 14,757 1930-31 1,645 7 3 — 1,645 7 3 21,007 1931-32 2,469 8 6 — 2,469 8 6 29,546 1932-33 3,391 4 9 — 3,391 4 9 41,566 Totals 48,140 13 8 5,572 11 10 53,713 5 6 601,486 The increased expenditure in 1932-33 was due to unemployment and part-time, but in the latter half of 1933 expenditure has appreciably fallen. 31 The co-operation in regard to the supply of milk between the Welfare Centres and the Public Assistance Committee of No. VII. Administrative Area was continued throughout the year. For particulars of the scheme of co-operation see Annual Report, 1928, pp. 115-118. Local Government Act 1929—Grants. The Scheme, made under section 101 (6) Local Government Act, 1929, which will be in operation for the four financial years, 1st April, 1933, to 31st March, 1937, provides that the Council shall pay by way of annual contribution to each of the Voluntary Associations named in column 1 of the following table in respect of the service mentioned in column 2 thereof the sum specified in column 3:— (1) Name of Association (2) Service in respect of which Contribution is payable (3) Amount of Annual Contribution North Marsh Infant Welfare Centre £ 320 Barley Mow Do. 665 North Lambeth Babies Care Do. 900 Moffat Institute Do. 900 "Rose McAndrew " Do. 740 St. Anne's Do. 595 Loughborough Junction Do. 1,495 North Brixton Do. 950 Stockwell Do. 850 Brixton Do. 1,165 West Norwood Do. 1,435 St. Thomas's Hospital Clinic (Main Building) Do. 850 St. Thomas's Hospital Centre (37 Royal Street) Do. 720 General Lying-in Hospital Do. 640 St. Thomas's Babies' Hostel Ailing Babies' Home 970 Total £13,195 The conditions of the payment of the contributions to the Voluntary Associations under the Scheme are as follows :— (a) That the Council is satisfied as to the efficiency of the Maternity and Child Welfare service provided by the Association, in respect of which the contribution is payable, and that such service is being used by a reasonable number of those persons for whom it is provided. 32 (b) That no reduction or alteration of such service is made without the consent of the Council. (c) That such service and any premises in which it is carried on are open to inspection at all reasonable times by any officer of the Council duly authorised by the Council and by any officer of the Ministry appointed for that purpose by the Minister. (d) That the Association sends to the Council each year a copy of its annual report on its Maternity and Child Welfare work for the previous year, together with a statement of accounts for that year relating to such work, and a copy of the Auditor's certificate thereon, and also furnishes the Council from time to time with such other information relating to the Maternity and Child Welfare service provided by the Association and the expenditure thereon as the Council may reasonably require. It is further provided that the Council shall not, except with the consent of the Minister, terminate or make any reduction in the annual contribution payable to an Association in respect of any service on the ground that any of the foregoing conditions are not fulfilled in the case of that service. The Maternity Home The Council's Maternity Home, at 210, Knight's Hill, maintained its successful career during the year although for a short period at the end of September the Home was closed owing to a minor outbreak of puerperal fever. Arrangements were made at the time with the County Council who accepted 15 cases into the municipal hospitals who would otherwise have entered the Home. The outbreak was due to the Streptococcus Haemolyticus. This organism was isolated from each of the four cases and as the result of examination of throat swabs, was also recovered from three of the eight members of the nursing staff. Scarlet fever was prevalent at the time among the general population and opportunities of picking up the organism by the staff were no doubt increased thereby. Thorough routine disinfection was carried out and no other cases occurred, but the successful suppression of the outbreak was undoubtedly due to placing off duty until free from infection, those members of the staff found to be harbouring the S. Haemolyticus. 33 Stringent care has been exercised since to prevent further outbreaks and more especially by insisting upon the use of masks by every member of the nursing staff while engaged in attending women during confinement and throughout the puerperium, whenever nursing duties permit the possibility of direct droplet infection from an infective pharynx to the vulva. The mask found most convenient consists of a rectangular linen pocket enclosing a stiff piece of grease-proof paper (easily removable) with tapes at each corner and arranged to cover both nose and mouth. During the year 409 cases were admitted to the Home excluding the 15 cases sent to the municipal hospitals. Since its inception in 1926, 2,883 women have been admitted to the Home with only two fatalities, which is a striking tribute both to the Home and to the value of the ante-natal work carried out at the voluntary welfare centres. Applications dealt with during 1933. Welfare Centre Applications received Applications withdrawn, refused or cancelled North Marsh 3 Babies Care... 5 1 Moffat Institute 3 — North Brixton (Belgrave Hospital) 29 4 Stockwell 86 8 Brixton 137 9 Loughborough Junction 79 6 Norwood 156 9 Total 498 37 The Committee of Management of the Lambeth Council's Maternity Home includes four co-opted members, each representing the Voluntary Welfare Committees in one of the four Parliamentary Divisions of the Borough. The Management Committee is much strengthened by the inclusion of these four ladies who are in a position to explain at first hand the various points of view of the Welfare Centres which they represent. The success of the Council's Home is largely due to the ungrudging pains with which they have worked on behalf of the Lambeth Scheme in co-ordinating the work of the voluntary centres with that of the Council. In the assessment of the capacity of applicants for c 34 admission to the Home to pay the fees asked, the first hand information which these ladies bring has led in a considerable degree to the fairness and justice of the Committee's findings. Parliamentary Area Applications received Applications withdrawn, refused or cancelled North 9 — Kennington 30 3 Brixton 147 14 Norwood 312 20 Total 498 37 Infant Life Protection. In accordance with the Transfer of Powers (London) Order, 1933, the administration of the provisions of the Children and Young Persons Acts, 1908 to 1933, was transferred to the Borough Council, and the summary of this work for the nine months ended the 31st December, 1933, now follows:— No. of Foster Mothers on Register from April 1st to December 31st. 202 No. of Nurse Children on register from April 1st to December 31st. 288 No. of Visits and Re-Visits paid to Nurse Children 1,408 Year of Birth No. of Nurse Children No. of Visits 1933 49 219 1932 55 320 1931 33 142 1930 38 171 1929 31 146 1928 24 135 1927 19 96 1926 14 81 1925 16 79 1924 9 19 Totals 288 1,408 No. of Visits, including verifications and registering of homes 1,959 No. of Foster Mothers removed from Borough 17 No. of Nurse Children legally adopted by Foster Parents 4 No. of Nurse Children taken by National Children's Aid and Adoption Society with a view to adoption 9 No. of Nurse Children taken by the Southwark Rescue Society 1 The death of one nurse child occurred due to heart failure, following Broncho-Pneumonia. No inquest was held. 35 Additional Facilities available at Welfare Centres. (i) Home Helps. The system of Home Helps inaugurated in May, 1928, by the Council has again proved its usefulness during the year. 84 applications were received (2 subsequently cancelled), 23 being emergency cases. The expense to the Council was only £41 9s. 3d., and from every point of view the money could scarcely have been better spent. (ii) Sterile Maternity Outfits. These outfits contain sterilised dressings, etc., and are sold at cost price at every Welfare Centre. In the course of the year 453 of these outfits were sold. The Council has sanctioned the issue of these outfits free or at reduced cost in cases of poverty. 23 applications (1 since cancelled) for assistance towards the purchase of these outfits from necessitous cases were received in the course of the year at a cost to the Council of £2 11s. 3d (iii) Sterilization of Bed Linen, etc. During the year 35 applications only were received from the whole area in connection with the service which is entirely free. (iv) Co-operation with Voluntary Hospitals. There is now an active liason between the almoners of the various hospitals in the Metropolis and the Public Health Department in respect of the Lambeth Mothers who apply for both in- and out-patient treatment for their confinements. Such cases are visited by the Council's Health Visitors, who refer mothers to their local Welfare Centre for advice for themselves, and for patterns of baby clothing, etc., and full reports are forwarded to the almoner of the hospital concerned. The total number of these cases visited and reported upon during 1933 was 1,850, distributed as follows:— Institutions outside the Borough of Lambeth St. Thomas's Hospital 827 King's College Hospital 206 General Lying-in Hospital 382 Lambeth Hospital 215 Westminster Hospital 71 Charing Cross Hospital 39 St. George's Hospital 14 Dulwich Hospital 64 Middlesex Hospital 5 Elizabeth Garratt Anderson Hospital 1 Royal Free Hospital 4 Guy's Hospital 1 University College Hospital 1 Queen Charlotte's Hospital 1 St. Giles' Hospital 18 220 36 (v) Free Medical advice to Midwives. By arrangement with the County Council, the responsible authority under the Midwives Acts (1902-1926), midwives practising in the borough can send their patients prior to confinement to the ante-natal clinics at the various Lambeth Welfare Centres for medical examination, and receive a written report of the case from the Medical Officer. Certain midwives sent all or nearly all their cases to the Ante-Natal Clinics for medical examination, but the great majority failed to take advantage either for themselves or their patients. The number of reports sent to midwives in response to the applications received was 61, as opposed to 64 last year, 83 in 1931, and 149 in 1930. (vi) Midwives. Applications for assistance towards the payment of the midwife were received from 57 expectant mothers, 3 of which were subsequently cancelled, while 12 others were emergency cases. The cost to the Council was £43 4s. 6d. (vii) Obstetrical Consultants. On 5 occasions only during the year were one or other of the Council's two obstetrical consultants called upon in emergency by doctors attending confinements in the district compared with 7 occasions in 1932. The cost to the Council was £21.0.0. (viii) Dentistry. Dental Sessions are held at six of the Welfare Centres, and arrangements are in force whereby women and children in any area can obtain dental treatment. (ix) Ultra Violet Light, and Massage. At two Weltare Centres—one in the inner and one in the outer wards—are carbon arc installations. Women and children are referred from the other centres to these two for light treatment and massage. The following table indicates the scope of the facilities available under the aegis of the Lambeth Maternity and Child Welfare Scheme and points to the success of the undertaking as a whole by the great numbers attending the clinics and in other ways making use of the diverse facilities provided. 37 SUMMARY RELATING TO THE WORK AT WELFARE CENTRES WELFARE CENTRE North Marsh Barley Mow North Lambeth Babies' Care Moffat "Rose McAndrew " St. Anne's North Brixton Loughborough J unction Stockwell Brixton West Norwood St. Thomas's Hospital (Main Building) St. Thomas's Hospital (37 Roval St.) General Lying-in Hospital Totals Total Numbers of Individual Cases Dealt With 1. Expectant Mothers 68 234 222 164 182 83 140 295 184 301 309 742 82 526 3,532 2. Nursing Mothers 136 873 848 383 441 279 497 507 323 415 854 487 48 114 6,205 3. Infants (under 1 year) 137 437 1,182 358 545 221 506 636 478 576 540 551 — 112 6,279 4. Children (aged 1-5 years) 118 750 898 119 378 105 500 361 340 618 415 239 — 80 4,921 Total 459 2,294 3,150 1,024 1,546 688 1,643 1,799 1,325 1,910 2,118 2,019 130 832 20,937 Total Numbers of Sessions Held 1. Ante-natal 49 28 49 104 51 48 100 151 — 348 928 2. Medical "Consultations" 52 49 89 165 99 46 148 242 99 202 153 154 — 97 1,595 3. Dental — — — 28 — — — 54 — 24 47 99 — 50 302 4. Others 42 81 82 186 57 38 70 186 13 185 93 — 187 51 1,271 Total 94 130 220 407 156 84 267 586 163 459 393 404 187 546 4,096 1. Expectant Mothers. (a) Ante-natal — — 132 324 — — 543 1,147 746 1,132 1,451 2,065 — 2,793 10,333 (h) Seen by Medical Officer 34 685 — 730 973 — — — — 2,448 (c) Otherwise dealt with 36 8 — — — — 248 — 42 159 — — — — 493 (d) Dental — — — 6 — — — 135 — 70 177 — — 299 775 (e) Others 179 205 305 70 726 116 — — — — 224 88 719 — 2,544 Total Numbers of all Attendances at the Sessions Total 241 247 437 400 726 116 1,476 1,282 1,518 2,334 1,852 2,153 719 3,092 16,593 (a) Seen by Medical Officer 518 1,815 890 2,457 1,856 1,072 3,004 2,271 635 2,493 1,714 1,809 — 1,148 21,682 (b) Otherwise dealt with 815 597 1,634 1,719 1,574 1,617 2,531 2,762 1,439 1,776 8,092 — — 54 24,610 (c) Dental — 107 — — 740 — 78 216 6 — 56 1,203 (id) Others 253 2,194 405 746 73 179 858 — 70 7 437 — 815 105 6,142 Total 1,586 4,606 2,929 5,029 3,503 2,868 6,393 5,773 2,144 4,354 10,459 1,815 815 1,363 53,637 [Continued overleaf 38 SUMMARY RELATING TO THE WORK AT WELFARE CENTRES—continued WELFARE CENTRE North Marsh Barley Mow North Lambeth Babies' Care Moffat "Rose McAndrew " St. Anne's North Brixton Loughborough Junction Stockwell Brixton West Norwood St. Thomas's Hospital (Main Building) St. Thomas's Hospital (37 Royal St.) General Lying-in Hospital s Visits and Re-visits Paid to Homes 3. Infants (under I year). (a) Seen by Medical Officer 538 1,147 1,273 1,391 2,549 880 3,056 3,683 1,529 3,584 2,181 2,654 — 1,148 25,613 (b) Otherwise dealt with... 923 429 2,188 1,209 2,245 1,488 2,658 3,154 3,189 2,951 — 54 20,488 (c) Dental — — — (d) Others 253 923 — 475 — 88 — 3,239 22 205 202 — — 5,407 Total 1,714 2,499 3,461 3,075 4,794 2,456 5,714 6,922 4,705 6,978 5,334 2,654 — 1,202 51,508 4. Children (aged 1-5 years). (a) Seen by Medical Officer 431 974 658 1,428 1,400 345 2,507 1,901 958 2,016 1,547 1,449 — 841 16,455 754 370 1,073 544 873 496 1,761 2,309 — — 12,860 (c) Dental 14 558 61 144 13 — — 790 (d) Others 408 632 — 1,184 — 107 — 2,199 18 773 323 — — — 5,644 Total 1,593 1,976 1,731 3,170 2,273 948 4,268 4,658 3,285 5,553 3,991 1,462 — 841 . 35,749 (a) First Visits 63 172 134 100 141 59 96 284 162 58 201 — 205 90 1,765 (6) Re-visits 213 547 154 86 750 181 78 731 151 133 199 — 922 248 4,393 Total Visits 276 719 288 186 891 240 174 1,015 313 191 400 — 1,127 338 6,158 (a) First Visits 83 204 423 240 292 205 273 506 357 429 644 — 167 91 3,914 (b) Re-visits 626 5,197 996 1,141 1,365 3,133 558 2,014 622 1,326 772 — 1,680 740 20,170 Total Visits 709 5.401 1,419 1,381 1,657 3,338 831 2,520 979 1,755 1,416 — 1,847 831 24,084 1. Infants (under 1 year). (<?) First Visits 75 175 431 241 351 188 318 528 541 432 666 — 146 91 4,183 (b) Re-visits 634 2,233 1,496 1,104 2,046 2,336 692 2,028 1,420 1,775 984 — 594 740 18,082 Total Visits 709 2,408 1,927 1,345 2,397 2,524 1,010 2,556 1,961 2,207 1,650 — 740 831 22,265 4. Children (aged 1-5 years). (a) First Visits 81 62 81 67 286 123 111 397 145 49 370 — 125 47 1,944 (b) Re-visits 1,542 6,237 2,583 3,637 2,769 1,730 1,552 4,697 3,215 2,890 2,260 — 3,778 1,172 38,062 Total Visits 1,623 6,299 2,664 3,704 3,055 1,853 1,663 5,094 3,360 2,939 2,630 — 3,903 1,219 40,006 39 The cost to the Local Authority of the Lambeth Maternity and Child Welfare Scheme since its inception in 1916, and the fall in the infantile mortality year by year are shown in the following table, together with the percentage of Lambeth children entering the County Council Elementary Schools afflicted with some physical defect or defects:— Year Cost to the Borough Council (Financial Year) Infantile Mortality Percentage of children entering school with one or more physical defects £ s. d. 1918 713 6 1 105 37.7 1919 1,010 14 4 85 38.2 1920 1,664 14 2 69 32.8 1921 4,517 8 10 77 34.2 1922 4,820 18 8 79 32.7 1923 4,377 15 1 58 34.2 1924 3,382 15 7 67 38.3 1925 3,911 7 7 64 48.2 1926 4,073 5 9 55 53.1 1927 4,086 12 10 55 . 56.7 1928 4,274 19 8 61 51.1 1929 4,481 4 3 68 55.3 1930 17,329 1 9 57 55.0 1931 20,331 6 6 60 61.5 1932 20,147 16 7 56 47.9 1933 Not available 63 44.2 Summary of Work carried out (Visits Paid) by the 4 Whole-time Official Health Visitors during 1933. Ante-natal Visits 1,208 Do. Re-visits 165 Births, 1st Visits 454 Do. Re-visits 515 Do. Stillborn 104 Ophthalmia, 1st Visits 83 Do. Re-visits 143 Diarrhoea Cases, 1st Visits 0 Do. Re-visits 0 Infantile Deaths (excluding Diarrhoea), visits 41 Welfare Centre Attendances 556 Clinic Attendances 124 Visits—No result 768 Special Visits (Measles, Diphtheria Prevention, etc.) 102 40 Visits to Children 1-5 (not included above) 605 Puerperal Pyrexia, 1st Visits 44 Do. Re-visits 25 Enlarged Tonsil and Adenoid Visits 40 Do. Re-visits 4 The work of the four health visitors is, in a sense, of a dual nature. They act as a link between the voluntary welfare centres and the Public Health Department on the one hand, and on the other are responsible, each in one Parliamentary Division for visits to notified cases of ophthalmia neonatorum and puerperal pyrexia, as well as for visiting all cases of measles not officially notified. In addition they visit and report upon the home conditions and preparations for the coming baby in all ante-natal cases applying for admission to the Council's Maternity Home, as well as for in-patient or out-patient treatment in confinement by any hospital or lying-in home whose lady almoner writes for the information. Their duties include the investigation of a number of stillbirths and the deaths of young children, and the rendering of help and advice generally in connection with cases of zymotic enteritis, and they pay innumerable other visits for various purposes of health instruction in the homes to those who do not fall into one or other of the above categories. Puerperal Fever and Puerperal Pyrexia. Inquiries were made into the circumstances surrounding the 69 cases of Puerperal Fever and Puerperal Pyrexia notified. In only 4 cases were particulars unobtainable and out of the remaining 65 cases 39 were primiparae and 25 multiparae. As previous records also show there appears to be greater danger to the mother with the first birth than with subsequent deliveries. The following groups of diseases were ascertained after investigation to be the cause of the Fever or Pyrexia. Uterine sepsis 23, manual interference forceps, etc., 11, pyelitis and cystitis 7 ; mastitis 6, septic abortion 5, dental caries 2, vaginal discharge during pregnancy 1,post-partum haemorrhage l,and coryza,influenza,etc., 13. The high proportion of uterine sepsis cases proved to be due to Streptococcus Haemolyticus, is to some extent accountable no doubt to the increase in the number of cases of scarlet fever notified. Health Propaganda. Throughout the year four thousand copies of "Better Health" (the Official Journal of the Central Council for Health Education) were distributed each month free to the Welfare Centres, the Public 41 Libraries and the Voluntary and Municipal Hospitals. A few copies were also sent to L.C.C. Schools for teaching purposes. There was no cost to the Council as the advertisements of local tradesmen defrayed expenses. At the end of the year the issue was discontinued as the publishers were unable to obtain sufficient advertisements to make the Lambeth issue an economic proposition, and the Borough Council decided not to give the financial assistance required. SANITARY CIRCUMSTANCES OF THE AREA. Public Cleansing. House refuse is collected weekly but in certain streets more often for special reasons. All refuse, both house and street, is loaded into barges and taken 40 miles down the Thames to Mucking, where it is systematically buried under a layer of earth with turf, first removed and then replaced over the refuse. There has been no alteration during the year in the arrangements for Public Cleansing. Sanitary Inspection of the Area. 5,873 Notices were served during the year 1933, as follows:— Public Health (London) Act, Metropolis Local Management Acts, Housing Acts, etc. (a) District Sanitary Inspectors. Preliminary or Intimation Notices. (1) Male Inspectors 3,830 (2) Women Inspectors 108 3,938 Statutory Notices. (1) Male Inspectors. (a) P. H. Act 157 (b) Met. Man. Acts 15 (2) Women Inspectors 2 174 Disinfection Notices 1,623 (b) Food Inspectors. (1) Public Health (Meat) Regulations 2 (2) L.C.C. (General Powers) Acts 10 (3) Merchandise Marks Act 7 19 42 (c) Housing Inspectors. Informal Schedules 117 Formal Notices 2 - 119 Total 5,873 17 Summonses were issued, with results as follows:— Public Health (London) Act, 1891. Convictions 6 Summons withdrawn — Summons withdrawn on costs 1 7 Food and Drugs (Adulteration) Act, 1928. Convictions 2 Summons withdrawn on costs 1 Summons dismissed on costs 2 5 Housing Acts, 1925 & 1930. Convictions 3 3 Merchandise Marks Acts. Convictions 2 2 Total 17 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 women 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 1933. Inspections 12,339 Re-visits 29,482 Complaints received 4,540 Water Certificates issued (525 separate houses or tenements including 16 blocks of tenements) 73 Drains tested (with chemical, water or smoke test) 3,789 Sanitary Works completed 4,498 Sanitary Nuisances— (a) Structural 7,960 (b) Non-structural 4,597 43 Structural. 1. Bath Waste : Totals (a) directly connected to drain 7 (b) improperly trapped or untrapped; defective 30 2. Basement dwellings : space below floor improperly or insufficiently ventilated 9 3. Ceilings and Walls : defective 665 4. Chimney: defective 61 5. Copper: defective 121 6. Damp condition of premises 542 7. Dilapidated condition of premises 234 8. Door: defective 97 9. Drains: (a) defective 321 (b) fresh air inlet defective 162 (c) gulley defective 89 (d) manhole defective 47 (e) plunging eye defective 34 (f) soil pipe defective 79 (g) trap insufficient 25 (h) ventilation insufficient 35 (i) vent pipe defective 115 10. Dustbins or Ashpits: (a) defective or dilapidated 998 (b) absence of 223 11. Fireplace: defective 298 12. Floors and Stairs: defective 266 13. Lavatory Waste : directly connected to drain, improperly trapped or untrapped 29 14. Paving (yard or area) : (a) defective 249 (b) drain or connections thereto defective 10 (c) undrained 6 15. Rainwater Pipe and Gutters : (a) rainwater pipe defective 202 (b) gutters defective 261 (c) rainwater pipe directly connected to drain 22 16. Roof : defective 681 44 Totals 17. Sinks : (a) defective 197 (b) directly connected to drain or defective 11 (c) improperly trapped or untrapped 208 (d) waste defective 206 18. Stable: (a) absence of proper manure receptacle 9 (b) drain defective 3 (c) paving defective 1 (d) undrained 0 19. Washhouse: (a) absence of 1 (b) roof defective 57 (c) paving defective 51 (d) undrained 0 20. Water Closet: (a) defective so as to be a nuisance 299 (b) improperly constructed so as to be a nuisance 34 (c) insufficient or improper accommodation 25 (d) pan and trap defective 152 (e) deficient or defective water supply 190 21. Water Supply: (a) draw-off from main required 17 (b) no supply 49 (c) pipes, taps, etc., defective 113 (d) storage cistern defective or uncovered 32 22. Windows: defective 387 7,960 Non-Structural. 23. Animals : improperly kept 37 24. Bakehouses : dirty 70 25. Dirty Premises : (a) walls and ceilings of rooms dirty 2,428 (b) rooms, etc., verminous 380 (c) stable premises dirty 15 (d) washhouse walls and ceilings dirty 400 (e) water closet walls and ceilings dirty 309 (/) workshops and factories 33 26. Drain : choked or stopped 339 45 Totals 27. Effluvium nuisance : (a) from industrial premises 48 (b) from private premises 11 28. Lighting and Ventilation : defective 12 29. Manure: accumulation or deposit injurious to health 22 30. Overcrowding 30 31. Rats infestation: (a) Industrial premises 29 (b) Private premises 143 32. Refuse accumulations 98 33. Smoke Nuisance: (a) from industrial premises 33 (b) from private premises 20 34. Stagnant Water : accumulation 25 35. Underground Rooms: illegally occupied as a dwelling 15 36. Urinal: foul 18 37. Water Supply: (a) cut off 73 (b) storage cistern so foul as to be a nuisance 9 4,597 In addition, the District Sanitary Inspectors carried out during 1933 routine duties connected with the inspection 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 abatement, the male public conveniences, factories and workshops, and workplaces wherein males are employed, common lodginghouses, offensive trades, houses let in lodgings, refuse and manure depots, etc. A great number of visits have been paid by these Inspectors in connection with the supervision of smallpox contacts, and also to all the premises in which infectious diseases are reported to have occurred. The opportunity afforded by such official notifications is taken for an inspection of the sanitary state of the property together with a test of the drains. 46 Rent and Mortgage Interest Restrictions Acts, 1920-33. During the year 12 inspections were made and 7 certificates granted. London County Council (General Powers) Act, 1928. Action taken under section 28. In four cases only was it necessary to obtain a magistrates' order under this Section. Several old people were induced to enter the London County Council Hospital without the need for application for orders Summary of Work carried out by the Women Sanitary Inspectors during 1933. Workshops* visited and inspected 427 Workshops* : workrooms therein measured 28 Workshops* : newly discovered and registered 20 Premises visited, but not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 948 Women's Conveniences visited and inspected, etc. (visits paid) 989 Special places visited and inspected : (a) Restaurants 205 (6) Housing enquiries 570 (c) Outworkers 206 (d) Complaints, Infectious diseases, etc 81 1,062 Re-inspections : (a) Restaurants 140 (b) Housing enquiries 151 (c) Outworkers 6 (d) Gorrmlaints. etc. 58 355 Written Intimation and Statutory Notices served 110 No. of Workshops, etc., in which defects were found 122 No. of Workshops, etc., in which no defects were found 1,216 Nuisances referred to M.O.H., for attention by Male Inspectors 14 * Workshops include Work-places. 47 Particulars of Defects found by Women Inspectors. Workshops, etc.:— Workrooms: Overcrowded, Damp, Dirty, etc. 1 Defective or Dirty: Yards, Floors, Roofs, Windows, Walls and Ceilings, Rain Water Pipes, Sink Wastes, or Premises generally 73 Sanitary Appliances: Water Closets—Dirty, unventilated, choked, defective or with defective tanks or water supplies 50 Drainage—Defective 2 Dustbins—Wanting or Defective 13 Lavatories—Dirty or Defective 2 No separate suitable sufficient W.C. accommodation for the sexes 1 Miscellaneous Defects, Defective Chimneys, etc. 12 Factories and Workshops. Five new factories and 19 new workshops were added to the Register, dealing with various trades. Out-workers. Eleven February and ten August lists were received, dealing with 182 and 233 out-workers respectively. Of the 415 out-workers 193 belonged to Lambeth and 222 elsewhere. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 85 lists were received from various outside authorities dealing with 488 workers living in Lambeth. Of the total Lambeth out-workers reported, 71 were new, i.e., not previously registered. The two women inspectors each work in one-half of the Borough, and are responsible for the inspection and supervision under the Factory and Workshops Acts, of all places where female labour is employed. They visit regularly the kitchens, etc., attached to all restaurants and cafes where food is prepared and cooked, but in the case of public houses, however, it is found to be more convenient to leave the inspection of kitchens to the district sanitary inspectors. 48 Registrations Effected and Licences Granted. Under the Transfer of Powers (London) Order, 1933, dated March 9th, 1933, made by the Minister of Health, under Section 64 of the Local Government Act, 1929, certain functions hitherto exercisable by the London County Council were transferred to the various Metropolitan Boroughs from the 31st March, 1933. The Borough Council was given control over Cow-houses, Slaughter-houses, Common Lodging Houses and Offensive Trades, and licences were granted and registrations were effected as set out below :— (a) Offensive Trades. Three offensive trades are registered in Lambeth as follows:— 9, Old Paradise Street (tripe boiling). 15, Upper Marsh (fat melting). 15, Upper Marsh (soap boiling). (b) Cow-Houses. One Cow-House was licensed (renewal) viz.:—76 and 78, Gipsy Hill (The Express Dairy Co., Ltd.). (c) Slaughter-Houses. Four Slaughter-Houses were licensed (renewals) as follows:— 207, Coldharbour Lane (A. J. Clark). 77, Dulwich Road (R. C. Hammett, Ltd.). 121, High Street (rear of), W. Norwood (W. Crouch). 60, Kennington Park Road (T. H. Grellier). (d) Common Lodging-Houses. Three Common Lodging-Houses were licensed (renewals) as follows:— 19, Belvedere Crescent. 106, Wandsworth Road. 88, 90 and 92, Westminster Bridge Road. (e) Milk Shops, see page 58. (f) Ice Cream Vendors. At the end of the year there were 358 known vendors of Ice Cream in Lambeth. All premises used for the manufacture and/or sale of Ice Cream are registered in accordance with the requirements of Section 5 of the London County Council (General Powers) Act, 1932. 49 (g) Bakehouses. There are 132 bakehouses on the Register compared with 222, 214, 214 and 140 for the years, 1901, 1911, 1921 and 1931 respectively; 33 are underground and machinery is installed in 44. (h) Food Premises, see page 59. Smoke Abatement. Metal plates containing suggestions to avoid the unnecessary emission of smoke have now been distributed to all firms using hand- and oil-fired boilers in the area. These have been fixed prominently in the stokeholds and are appreciated. No. of complaints received 24 No. of intimation Notices served 14 No. of observations made 277 Every effort is made to enlist co-operation with industry by the sanitary inspectors in order to reduce the waste and nuisance from smoke. Schools. No schools in the district are under the control of the Borough Council as the County Council is the Education Authority. Close touch is kept with the school authorities, however, in so far as infectious disease is concerned. Housing. The co-operation with the London County Council in offering to provide accommodation for persons displaced through action by the Borough Council in making use of section 20 Housing Act, 1930, was extended in the early part of the year to action taken under section 19. In all, under the latter section, 109 houses were represented for demolition. With the alternative accommodation offered it has been possible during the year, to make demolition orders upon 14 houses which have since been demolished, while three others were demolished voluntarily after representation, and ten others have been voluntarily closed or demolished without the necessity for representation. In the remainder no proceedings were taken after the representations were made, and they are being held over by arrangement with the County Council as some were included in County Council schemes which have since been represented by the County Medical Officer and for the others the alternative accommodation which at one time had been offered was later, owing to unforeseen circumstances, found not to be available. Fifteen representations were made under section 20, during the year, respecting underground rooms used for sleeping purposes, and ten closing orders made were complied with. D 50 An inquiry was held in November regarding the Hemen's Street area represented in 1931 and the Minister confirmed the order in respect of 87 of the 99 houses included in the representation. During the year 449 fresh applications were received in the Public Health Department (mostly from the applicant in person), and of these 189 were sent forward to the County Authority for attention or preferential treatment, while, in addition, 15 applications were recommended for housing on the Lambeth Council Estates. The remaining 245 after careful scrutiny, could not be recommended for various reasons, viz., insufficient income or other circumstances. Of the 204 cases referred to, 78 have been accommodated (76 by L.C.C. and 2 by L.B.C.), and 14 refused (by the County Authority), leaving 112 pending decision and allocation. The following table shows particulars of 427 out of 449 applications received (information respecting the remaining 22 cases is not available owing to various causes, such as application withdrawn) :— Housing Applications, 1933. Number of Persons in Family Number of Rooms Occupied Total Persons 1 2 3 4 5 6 1 12 5 — 1 — — 18 2 11 32 2 2 — — 94 3 10 40 22 6 — — 234 4 15 44 21 10 — — 360 5 7 32 15 9 1 — 320 6 4 19 13 5 2 — 258 7 2 16 10 8 1 — 259 8 1 13 4 3 3 1 200 9 —— 4 7 2 3 — 144 10 \— — 1 3 1 1 60 11 — 1 — 1 — — 22 12 — — 1 — — — 12 Total Families 427 62 206 96 50 11 2 — Total Persons — — — — — — 1,981 In addition to the above, 542 applications from Lambeth residents, received by the County Authority direct, were dealt with ; 81 families being re-housed in Lambeth, and 461 families re-housed outside the Borough. 51 The record of work done during the year ended the 31st December, 1933, by the Council's two Housing Inspectors, is set out in tabular form as follows :— (1) Surveys or inspections made under Part I (Clearance Areas) of the Housing Act, 1930 Nil (2) Record forms (Clearance Areas) filed Nil (3) Notices of intention to survey issued under Section 127 of the Housing Act, 1925, and served upon occupiers and owners 281 (4) Surveys or inspections made under the House Inspection Regulations of the Housing Acts, 1925 and 1930 145 (5) Provisional or informal schedules prepared under Section 17 of the Housing Act, 1930 ... 117 (6) Schedules prepared for the purpose of Statutory Notices under Section 17 of the Housing Act, 1930 2 (7) Record Cards (Section 17) filed 145 (8) Surveys made under Section 19 of the Housing Act, 1930 226 (9) Record forms (Section 19) filed 226 (10) Surveys made under Section 20 of the Housing Act, 1930 (underground rooms and parts of buildings) 81 (11) Record forms (Section 20) filed 81 (12) Drain tests made (chemical, smoke, and water) 479 (13) Total visits made (re-visits, 10,019) 10,471 During the period under review in the present Report, the following roads and streets have been surveyed (wholly or in part)—the total number of houses being given in brackets after the name of each :— Marsh Ward. Stamford Street (15). Bishop's Ward. Canterbury Place (3), Juxon Street (3), Newport Street (2), Sellon Mews (2), Vauxhall Walk (6). Vauxhall Ward. Cavendish Grove (18), Clarence Street (27). Oval Ward. Ashmole Place (2), Kennington Road (16), Upper Kennington Lane (16), Windmill Row (4). Angell Ward. Gresham Road (1), Luxor Street (1). Stockwell Ward. Bedford Road (1), Landor Road (3), Love Lane (2), Sidney Road (2), Stockwell Green (1). Town Hall Ward. Branksome Road (5), Prague Street (8). Knight's Hill Ward. Berridge Road (7). 52 The actual work has been completed, or practically completed, in the following houses, the numbering of the individual houses being given in brackets after the street or court :— (1) After Service of Notices (Legal Schedules) :— Knight's Hill Ward. Eaton Cottages, Ernest Street (No. 4), Durban Road (Nos. 2, 2a, 6, 8, 8a, 10, 12, 28a, 30, 38a, 40, 52a, 54), Rommany Road (Nos. 87 (now 85), 97 (now 105), 155), St. Gothard's Road (Nos. 16, 18, 32, 34), Victoria Place (No. 2). Total, 22. (2) After Service of Provisional (Informal) Schedules :— Bishop's Ward. Colwyn Street (Nos. 16, 17, 18, 19), Canterbury Place (Nos. 54, 58), Crow Place (Nos. 1, 4, 5, 6, 7), Newport Street (No. 63), North Street (No. 28), Pennell Place (No. 3), Sellon Mews (Nos. 8, 9). Prince's Ward. Dante Road (No. 38). Vauxhall Ward. Clarence Street (Nos. 6, 8, 10, 12, 14, 16, 18, 20, 26, 13, 15, 17, 19, 21, 23, 25), Cavendish Grove (Nos. 17, 19, 21), Gaskell Street (Nos. 45, 47, 49, 51, 53, 55), Jeffreys Road (Nos. 14, 31a), Wheatsheaf Lane (Nos. 16, 17, 18, 19, 20). Oval Ward. Ashmole Place (Nos. 2, 4, 35, 37, 39, 41), Keiller's Cottages (Nos. 1, 2, 3), Kibworth Street (Nos. 5, 7), Kennington Road (Nos. 311, 313), Stannary Street (Nos. 10, 12, 14, 16), The Grove (No. 53), Upper Kennington Lane (No. 135). Vassail Ward. Clapham Road (No. 149), Lothian Road (Nos. 24, 26, 28). Angell Ward. Coldharbour Lane (Nos. 185, 284, 286), Gresham Road (No. 23), Padfield Street (No. 2), Wiltshire Road (No. 28), Wynne Road (No. 23). Stockwell Ward. Hubert Grove (Nos. 49, 51, 53, 55), Landor Road (Nos. 42, 44, 46), Lingham Street (No. 11), Love Lane (Nos. 20, 21), Stockwell Green (Nos. 6, 8), Swan Mews (Nos. 1, 2, 3, 4), Southesk Street (Nos. 2, 4, 6). Town Hall Ward. Branksome Road (Nos. 2, 4, 6, 8, 22), Sudbourne Road (No. 37). Heme Hill Ward. Coldharbour Lane (Nos. 343, 345, 347). Tulse Hill Ward. Appach Road (No. 45). 53 Knight's Hill Ward. Benton's Lane (Nos. 18, 19), Charlotte Place (Nos. 1, 2, 3, 4, 5), Curnick's Buildings (No. 2), Eden Road (No. 12), Ernest Place (Nos. 2, 3, 4), Ernest Street (Nos. 22, 24, 1, 39, 51, 53), Gipsy Road (Nos. 99, 101, 125, 127), Knight's Hill (No. 151), Lansdowne Hill (Nos. 15, 17), Woodcote Place (Nos. 27b, 28a, 28b, 30, 30a, 30b, 32a, 32b). Informal schedules held in abeyance owing to the houses being included in a rebuilding scheme or other arrangement:— Oval Ward. Kennington Road (Nos. 290 to 316, even), St. Mark's Road (Nos. 12 to 64, even), Upper Kennington Lane (Nos. 1 to 19, odd), Windmill Row (Nos. 1 to 7 odd). Stockwell Ward. Sidney Road (Burnley House and Grove House). Two notices (legal schedules) have been served during the year in respect of the following houses :— Vauxhall Ward. Clarence Street (Nos. 4, 24). Work has also been started in many other cases, and is in various stages of progress, while, in addition, many provisional (informal) schedules have been served in connection with houses, but the work has not yet commenced. 125 representations were made under the Housing Acts, as follows :— (a) Section 19 (109 representations). Marsh Ward. Broadwall (Nos. 38, 40, 42), Gray Street (Nos. 57, 59, 61, 65, 67, 69, 71, 73, 75, 77), Victoria Place, Broadwall (Nos. 1, 2, 3, 4, 5, 6), Wootton Place (Nos. 2, 3, 4, 5, 6, 7, 8, 9, 14, 15, 16, 17, 18). Bishop's Ward. Ado Place (Nos. 1, 2, 3), Cotford Place (Nos. 1, 2, 3, 4, 5, 6, 7), Grindal Street (Nos. 26, 28, 30), High Street (Nos. 5, 6), Lilac Place (Nos. 7, 9, 11, 13), Mary's Buildings (Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12), Providence Place, Pearman Street (Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10), Stevens Place, Tanswell Street (Nos. 1, 2, 3, 4), Wilder's Court (Nos. 1, 2, 3). Prince's Ward. Dunmow Place (Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11). Oval Ward. Evans' Cottages (No. 1), Lyric Place (Nos. 1, 2, 2a, 10). 54 Knight's Hill Ward. Knight's Hill Square (Nos. 11, 13, 15, 17, 19, 21, 14, 16, 18, 20, 22, 24), Lepine Cottages, Gipsy Road (No. 4). (i) Demolition Orders Made. Marsh Ward. Gray Street (Nos. 57, 59, 61, 65, 67, 69, 71, 73, 75, 77).* Bishop's Ward. High Street (Nos. 5, 6).* Oval Ward. Evans' Cottages (No. 1)*, Lyric Place (No. 1).* * Since demolished. (ii) Undertakings by Owners in Lieu of Demolition Orders. Oval Ward. Lyric Place (Nos. 2, 2a),* Lyric Place (No. 10). Knight's Hill Ward. Lepine Cottages, Gipsy Road (No. 4),* Knight's Hill Square (Nos. 11, 13, 15, 17, 19, 21),* Knight's Hill Square (Nos. 14, 16, 18, 20, 22, 24). * Undertakings since carried out. (iii) Houses Voluntarily Demolished after Representation. Bishop's Ward. Wilder's Court (Nos. 1, 2, 3). (b) Section 20 (Underground rooms and parts of buildings—16 representations). Marsh Ward. Frazier Street (No. 18, part of a building), Stamford Street (No. 138 Underground room), Belvedere Road (No. 128, Underground room). Prince's Ward. Ethelred Street (No. 52, Underground room), Hurley Road (No. 26 Underground room). Upper Kennington Lane (No. 154, Underground room). Vauxhall Ward. South Lambeth Road (No. 308, Underground room). The Grove (No. 55, Underground room). Oval Ward. Shepherd's Place (No. 6, Underground room). Upper Kennington Lane (No. 9, Underground room). 55 Vassail Ward. Holland Grove (No. 14, Underground room). Angell Ward. Lorn Road (No. 27, Underground room), Vaughan Road (No. 17, Underground room). Stockwell Ward. Sidney Road (No. 5, Underground room), Stockwell Park Crescent (No. 36, Underground room). Knight's Hill Ward. Knight's Hill (No. 219, Underground room). (i) Closing Orders made. Marsh Ward. Stamford Street (No. 138). Prince's Ward. Ethelred Street (No. 52), Upper Kennington Lane (No. 154). Vauxhall Ward. The Grove (No. 55), South Lambeth Road (No. 308). Vassail Ward. Holland Grove (No. 14). Stockwell Ward. Sidney Road (No. 5). Knight's Hill Ward. Knight's Hill (No. 219). The Closing Orders have been complied with in all cases except Nos. 138 Stamford Street and 308 South Lambeth Road. In addition, the Orders made in 1932 respecting Nos. 17 Gilbert Road and 102 Lambeth Road, have been complied with during 1933. (ii) Undertakings Received in Lieu of Closing Orders. Vauxhall Ward. The Grove, 53 (Represented 1932). (iii) Houses Represented but Orders not yet made. Hurley Road (No. 26), Lorn Road (No. 27), Shepherd's Place (No. 6), Stockwell Park Crescent (No. 36), Vaughan Road (No. 17). N.B.—With regard to Nos. 18 Frazier Street, 9 Upper Kennington Lane, and 128 Belvedere Road, no further action was taken during the year. In addition to the premises represented as set out in (a) and (b), 107 and 63 premises were inspected respectively, with a view to action under Section 19 or 20. 56 The following houses have been voluntarily closed in streets dealt with :— Prince's Ward. Holyoak Road (No. 6). Bishop's Ward. Carlisle Street (Nos. 37, 51), Wylie Place (No. 3). Oval Ward. Clayton Street (No. 15). The following houses have been voluntarily demolished in streets and courts dealt with :— Bishop's Ward. Juxon Street (Nos. 11, 15, 17). Oval Ward. White Hart Street (Nos. 3, 5). Concluding Remarks The following summary is the record of the work done under the Housing Acts, i.e., from June, 1920, up to the 31st December, 1933 :— (a) Total Inspections made (clearance areas, 527) 6,447 (6) Work completed, or houses closed and demolished :— (1) Under provisional (informal) schedules 5,116 (2) Under legal notices (China Walk area, 300) 590 5,706 (c) Underground rooms, parts of buildings and .other premises inspected, but no action taken under Housing Acts 229 (d) Hemans Street Area 227 (e) Work still outstanding :— (1) Under provisional (informal) schedules 256 (2) Under legal notices 29 285 Ministry of Health Table. 1—Inspection of Dwelling Houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 10,182 (6) Number of Inspections made for the purpose* 37,190 * Total re-inspections during 1933. 57 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 452 (b) Number of Inspections made for the purpose* 10,019 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 109 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 4,091 2—Remedy of Defects during the Year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,805 3—Action under Statutory Powers during the Year. A.—Proceedings under Sections 17, 18, and 23 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which notices were served requiring repairs ... 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 22 (b) By Local Authority in default of owners nil. B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 159 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 154 (6) By Local Authority in default by owners nil. C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which Demolition Orders were made 14 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 D.—Proceedings under Section 20 of the Housing Act, 1930. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 8 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 8 * Total re-inspections during 1933. 58 INSPECTION & SUPERVISION OF FOOD. Milk Supply. 125 applications were approved by the Borough Council for registration under the Milk and Dairies Order, 1926. 63 of the applications were change of purveyor at registered premises, 56 were for the sale of milk in sealed bottles only, and 1 for wholesale and retail trade in the borough by firms resident outside the borough. Special licences were issued in accordance with the Milk (Special Designations) Order, 1923, as follows :— " Certified " Milk, 14; " Grade A " (Tuberculin Tested), 25 (including one bottling licence); " Grade A," 10; " Pasteurised " Milk, 42 (Pasteuriser's Licence 2, Dealer's Licence 40); Supplementary Licences, 4. Meat and Other Foods. Public Health (Meat) Regulations, 1924. (1) Number of visits paid to slaughterhouses* 368 (2) Number of visits paid to meat shops, meat stalls, and meat stores* 1,629 (3) Number of actual slaughterings at which one or other of the Food Inspectors was present, consisting of beasts (55), sheep (1,273), pigs (1,304), and calves (15) 2,647 (4) Carcases, or portions of carcases, condemned 154 * Visits include re-visits also. Of the 2,647 actual slaughterings, at which one or other of the Food Inspectors was present, and in connection with which 154 carcases or portions of carcases were condemned, the diseases necessitating such condemnation were as follows :— BEASTS : 1 head (tuberculosis). 2 lungs (tuberculosis). 2 lungs (abscess). 1 liver (melanosis). 17 livers (flukes). SHEEP: 55 lungs (strongylus). 5 lungs (adenoma). 1 liver (adenoma). PIGS : 1 whole carcase and organs (tuberculosis). 44 heads (tuberculosis). 7 quarters (tuberculosis). 5 plucks (tuberculosis). 2 lungs (tuberculosis). 4 lungs (pleurisy). 1 whole carcase and organs (peritonitis). 5 livers (cirrhosis). 1 head (bruising). 59 In addition to the above-mentioned carcases or parts of carcases the following unsound food was condemned and destroyed :— Fish— cwts. qrs. lbs. Fillets 1 2 0 Herrings (1 box) — —— — Haddocks 2 2 14 Kippers — 1 14 Rock Salmon — 1 14 Sardines (39 tins) — — — Sprats 1 0 0 Fruit and Vegetables— Grapes 2 0 18 Pears (1 box) — — — Tomatoes — 1 22 Poultry— Ducks 1 0 18 Fowls 4 3 19¼ Turkeys — 2 23½ Game— Pheasants (14) — — — Rabbits — 2 15 Skinned Rabbits — 2 4 Meat and other products— Beef — 3 9 Bacon — 1 12 Hams 5 0 10 Ham, Tinned (5 tins) — — — Pork — 3 6 Pork Kidneys — — 15 Sweetbreads — — 6 Eggs (94) — — — Jordan Almonds 4 1 16 Sultanas 4 0 5 Sweets — 2 5 Tomato Paste (1,000 tins) — — —— lomato boup (190 large and 218 small tins) — —— Shop Inspection. The systematic inspection of butchers' shops and meat stores has been continued during the year, and the general condition of these premises was found to be satisfactory. Owing to the hot summer experienced in 1933, particular attention was paid to the condition of the meat exposed and deposited for sale, and it is satisfactory to report that little trouble was experienced in this direction. This is largely attributable to the efficiency of modern methods of refrigeration and to the policy of exposing a minimum amount of meat in the shop during the warm part of the day, the greater portion, and in some cases the entire stock, being kept in cold storage. 60 Slaughter of Animals Act, 1933. The Slaughter of Animals Act, 1933, received the Royal Assent on the 27th April, 1933, and came into force on the 1st January, 1934. Section 1 of the Act provides for the humane slaughtering of animals (except sheep) by mechanically operated instruments. Section 2 directed Local Authorities to consider within twelve months, the question of passing resolutions applying instantaneous slaughtering or stunning to sheep and lambs. Section 3 provides that no animal shall be slaughtered or stunned by any person who is not a holder of a licence granted by a Local Authority ; and certain provisions are laid down with regard to the granting of licences. During 1933 no resolution as is contemplated in Section 2 of the Act, was passed by the Council, but it was decided to charge a fee of 2s. for a slaughterman's licence, and Is. for every renewal. Twelve licences were granted at the end of the year, each for a period of one year, expiring on the 31st December, 1934. Adulteration, etc. Food and Drugs (Adulteration) Act, 1928. During the year under review, 2,000 samples of food and drugs have been procured for analysis. Of these, 805 were taken with the formalities prescribed by the Act, while 1,195 were taken informally. The formal samples taken included Milk, Milk Powder, Reconstituted Milk, Ice Cream, Water Ice, Butter and Vinegar. The principal food sampled informally was Butter. A large variety of other foods and drugs was secured, and altogether 84 different kinds of food and 32 of drugs were submitted to the Public Analyst for examination. In order to ensure that the sample submitted for analysis should be as representative as possible of the various articles of foods and drugs consumed by the public, the usual procedure has been followed and samples obtained from as many business premises throughout the Borough as has been practicable. Of the formal samples of Milk, 59 were procured at various institutions in the Borough, and 48 were procured on delivery at Waterloo and Vauxhall Railway Stations. Of these, one only was found to be adulterated. In addition to the 2,000 samples procured for this Council, five samples were procured at the request of the Fulham Borough Council in accordance with the provisions of Section 21 of the Food and Drugs (Adulteration) Act, 1928, at Vauxhall Station in course of transit to a dealer in that Borough. 61 Warning Letters. During the year 20 formal samples were reported by the Public Analyst to be adulterated. Legal proceedings were instituted in five cases, and warning letters were sent to the vendors of other samples as required. Police Cmirt Proceedings. Following is the summary of proceedings at the Lambeth Police Court in respect of offences against the Food and Drugs Act :— Case No. 412 For selling milk deficient in milk fat to the extent of 33 per cent. Dismissed under Probation of Offenders Act on payment of costs. 440 For selling milk deficient in milk fat to the extent of 21 per cent. Do. do. 531 For selling milk deficient in milk fat to the extent of 12 per cent. Summons withdrawn. 590 For selling milk deficient in milk fat to the extent of 29 per cent. Fined £3 and costs. 770 For selling butter containing 40 per cent, margarine. Fined £3 and costs. London County Council (General Powers) Acts. By the powers given to Local Authorities under the above Acts, it is now possible not only to regulate the methods adopted in the preparation and manufacture of food generally, but also to improve the premises in which food is manufactured and stored, etc. Additions have been made from time to time, and during the past year 46 premises were inspected and added to the ice-cream register. The total number of premises now registered is 358. Further, the requirements as to registration include premises used for the preparation or manufacture of sausages, or potted, pressed, pickled, or preserved meat, fish or other food intended for sale. The total number of such premises registered is now 289, of which many come within the scope of the Public Health (Meat) Regulations, 1924, and are consequently inspected with the shops at which meat is sold. The special inspection of these premises for which applications for registration have been received has added considerably to the work of the Department, but it is a pleasure to be able to report that no difficulties, other than those of a minor nature, have been encountered, and in no instance has trade suffered interference or even inconvenience. 62 In addition to the special inspections reported above, the usual routine inspections of all other known food premises such as bakehouses, milkshops, general stores, the kitchens of shops, hotels, restaurants, and public-houses, have been made during the year as follows :— Bakehouses 321 Milkshops 1,632 Ice cream premises 603 Other food premises or stores 2,260 Restaurants, etc 345 Generally speaking, the conditions disclosed have been found satisfactory, and such alterations and cleansing found to be needed have been carried out as a rule without the service of notices. Merchandise Marks Act, 1926, and Agricultural Produce (Grading and Marking) Act, 1928. No additions to the list of imported articles of food required to be labelled with the country of origin in accordance with the abovementioned Act have been made during the past year. The observance of the various Marking Orders is a matter to which particular attention is given during the general inspection of food shops. One sample of eggs was procured under this Act in respect of which proceedings were instituted for selling imported eggs not marked with the indication of origin as required by the Order in Council. In this case not only the vendor, but also her Manager was prosecuted. The vendor was fined £2 and costs, and the Manager £3 and costs. Artificial Cream Act, 1929. During the year no applications for registration under the abovementioned Act have been received for the manufacture and sale of Artificial Cream. Pharmacy and Poisons Act, 1933. The Council's two Sampling Officers under the Food and Drugs (Adulteration) Act, 1928, have been appointed Inspectors for the purpose of Sub-section 5 of Section 25 of the Pharmacy and Poisons Act, 1933. Concluding Remarks. The effect of the statutory obligations on the vendors of food for human consumption, and the knowledge that inspections and sampling are being effectively carried out, has led to considerable improvements in the treatment of all foods before they reach the consumer, noticeable even from year to year. The honest trader 63 has benefited by the curtailment of the activity of his less-honest competitor, but should any relaxation of effort for any reason ensue, the high standard now reached would not be maintained. Chemical and Bacteriological Examination of Food. Particulars of the 2,000 samples of Food and Drugs procured for analysis by the Public Analyst will be found in the following table. Samples Formal Informal A Number Analysed > Number Adulterated Number Analysed Number Adulterated Apples 6 Arrowroot 12 Basis Wine 1 Baking Powder 9 Barley, Pearl 9 Beef, Corned 1 Beef, Minced 3 Blanc Mange Powder 3 Bread 15 Bun Flour 3 Butter 2 1 258 3 Cake 10 Cake Mixture 2 Cakes, Sponge 12 Candied Peel 9 Cheese 6 Cocoa 20 Cocoa, Sweetened 1 Coffee 22 Coffee and Chicory 2 Confectionery 19 Cornflower 15 Cream 15 Custard Powder 21 Dripping 12 Drugs:— Acid, Boric 4 Acid, Citric 3 Acid, Tartaric 3 Almond Oil 3 Aspirin 3 Balsam, Friars 3 Borax Purified 2 Camphorated Oil 9 Castor Oil 3 Cod Liver Oil 6 Cream of Tartar 9 Epsom Salts 12 1 Eucalyptus Oil 6 64 Food and Drugs.—continued. Samples Formal A Informal A. r Number Analysed Number Adulterated t Number Analysed 1 Number Adulterated Glauber's Salts — — 9 — Glycerine — — 3 — Ipecacuanha Wine — — 3 — Linseed Meal — — 3 — Magnesia — — 3 — Ointment, Boric — — 9 — Ointment, Zinc — — 6 — Paraffin, Liquid — — 6 — Paregoric — — 3 — Parrish's Chemical Food — — 3 1 Powder, Gregory's — — 6 4 Powder, Liquorice, Compound — — 9 — Powder, Seidlitz — — 3 — Quinine, Ammoniated — — 1 — Soda bicarbonate — — 9 — Sulphur, Milk of — — 6 — Tincture of Iodine — — 3 — Do. of Quinine (Ammon) — — 8 — Tincture of Rhubarb — — 3 — Vaseline — — 6 — Essence, Colouring — — 1 — Essence, Flavouring — — 2 — Fish Paste — — 9 — Flour — — 11 — Flour, Self-raising — — 13 — Fruit, Dried — — 45 — Fruit, Tinned — — 7 — Ginger, Ground — — 9 — Honey — — 10 — Honey, Prepared — — 2 — Ice Cream 11 — — — Jam — — 9 — Jelly, Table — — 12 — Lard — — 24 — Lemonade Powder — — 11 1 Lemon, Curd — — 9 — Lentils —— — 2 —— Margarine — — 21 — Meat Paste — — 6 — Meat Pie —— — 6 — Milk 782 19 53 1 Milk, Condensed (Full Cream) — —— 8 — Milk, Condensed (Machine Skimmed) — —— 7 — Milk, Dried, Separated 1 —— — — Milk Powder (in water) 1 —— — — 65 Food and Drugs.—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Mincemeat — — 6 — Mustard — — 11 2 Mustard Compound — — 4 — Oatmeal — — 15 — Olive Oil — — 3 — Orangeade Powder — — 1 — Peaflower — — 6 — Peas, Split — — 2 — Peas, Tinned — — 9 — Pepper — — 12 — Pickles — — 3 — Pudding Mixture — — 5 — Pudding Powder — — 3 — Rice — — 20 — Rice, Ground — — 6 — Sago — — 10 — Sardines — — 3 — Sauce — — 3 — Sausages — — 5 1 Sausages (Preserved) — — 1 — Sausage Meat — — 6 — Sausage Rolls — — 3 1 Scones — — 11 — Semolina — — 9 — Sherbert — — 6 — Soup, Dessicated — — 1 — Soup Powder — — 9 — Soup, Tinned — — 2 — Spice, Mixed — — 9 — Sponge Mixture — — 1 — Suet, Shredded — — 12 — Sugar — — 12 — Tapioca — — 17 — Tea '— — 27 — Treacle — — 3 — Vegetables, Tinned — — 12 — Vinegar 7 — — — Water Ice 1 — — — Yeast — — 3 — Totals 805 20 1,195 — 15 N.B.—5 summonses were issued (see page 61). One sample of a consignment of blown tins of ham was examined in the Council's laboratory, for the presence of food poisoning or other organisms. E 66 Cultures were made (a) from the jelly surrounding the meat which was not liquefied, (b) from scrappings off the ham surface, (c) from the centre of the ham by means of a sterile cork borer, in:— Litmus milk (anaerobic), Glucose agar (stab), Glucose broth, McConkey's bile salt broth, Nutrient agar slope. In no case was a growth obtained. It is possible that the "blowing" was due to hydrogen caused through electrical action due to fracture or other deficiency in the tin plating. 67 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under the Compulsory Notification Sections of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 4,610 cases of infectious diseases (excluding tuberculosis) were reported during the year. This number is less than the number (6,894) reported in the previous year, in which a large proportion was attributable to measles. 68 TABLE L. Statistics of Notifiable Diseases. Cases notified Attackrate per 1,000 Deaths registered Case mortality per 100 Cases removed to hospital Per cent, of cases removed Infected houses Annual Average of cases notified 1921-1930 Cholera — — — — — — — — Smallpox 126 0.436 — — 101 80.15 71 17.4 Scarlet Fever 1,332 4.609 4 0.30 1,254 94.14 1,206 1,056.5 Diphtheria 556 1.924 26 4.68 551 99.10 480 732.3 Membranous Croup 1 0.0035 — — 1 100.00 1 2.9 Typhus — — — — — — — — Enteric 9 0.031 1 11.11 9 100.00 6 18.4 Relapsing Fever — — — — — — — — Erysipelas 167 0.578 9 5.39 104 62.27 166 123.2 Puerperal Fever 22 0.061 5 22.73 21 95.45 22 28.7 Puerperal Pyrexia 47 0.163 2 4.26 32 68.04 46 48.8 Plague — — — — — — — — •Cerebrospinal Fever 11 0.038 5 45.45 11 100.00 11 6.3 Polio-myelitis 5 0.017 — — 5 100.00 5 5.4 Ophthalmia Neonatorum 30 0.104 1 3.33 6 20.00 30 56.2 Measles 546 1.889 11 2.01 97 17.76 485 2,532.6 German Measles 1,262 4.367 — — 126 9.98 1,125 425.1 Tuberculosis— Pulmonary (primary) 435 1.505 245 — — — — 507.6 Non-pulmonary (primary) 82 0.284 29 — — — — 104.3 Malaria 1 0.0035 — — — — 1 6.2 Dysentery 5 0.017 — — 4 80.00 — 1.3 Primary Pneumonia (Acute) 245 0.848 45 18.37 95 38.77 244 228.2 Influenzal Pneumonia (Acute) 211 0.731 61 28.91 45 21.32 207 123.0 | Encephalitis Lethargica 2 0.0069 4 — 1 50.00 2 11.1 Trench Fever — — — — — — — 0.1 Anthrax — — — — — — — 0.2 J Food Poisoning 32 0.111 — — 4 12.50 30 — * Including 1 case of Post-basic Meningitis. † ncluding 2 deaths from Post Encephalitis Lethargica. ‡ Compulsorily notifiable from September, 1932. N.B.—Of the cases originally notified during 1933, the following were found afterwards not to be suffering from the diseases notified : -Diphtheria, 77; Scarlet Fever, 60; Measles, 16; German Measles, 3; Puerperal Fever, 1; Puerperal Pyrexia, 1. 69 TABLE M. Distribution of Cases Notified During the Year 1933. Notifiable Disease Number of Cases Notified Total Cases Notified in each Registration Sub-District Total Cases Removed to Hospital At all Ages At Ages—Years Lambeth Church Kennington Stockwell Brixton Norwood Lambeth Church Kennington Stockwell Brixton Norwood Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards | Small-pox 126 1 7 44 44 16 11 3 72 42 — 10 2 52 38 — 9 2 Cholera — — — — — — — — — — — — — — — — — — Diphtheria 556 19 168 281 52 33 3 — 125 80 134 104 113 124 80 134 104 109 Membranous Croup 1 1 — — — — — — — 1 — — — — 1 — — — Erysipelas 167 4 7 10 14 39 65 28 41 32 45 27 22 31 23 20 17 13 Scarlet Fever 1,332 10 354 780 115 63 10 — 223 204 353 339 213 220 191 331 316 196 Typhus Fever — — — — — — — — — — — — — — — — — — Enteric Fever 9 — — 2 1 2 4 — — — 3 3 3 — — 3 3 3 Relapsing Fever — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — Puerperal Fever 22 — — — 5 17 —. — 3 3 4 7 5 2 3 4 7 5 Puerperal Pyrexia 47 — — — 23 24 — — 9 6 4 17 11 5 5 3 13 6 Plague — — — — — — — — — — — — — — — — — — Pulmonary Tuberculosis 435 — — — — — — — — — — — — — — — — — Other forms of Tuberculosis 82 — — — — — — — — — — — — — — — — — Cerebro-spinal Fever 11 1 4 1 4 1 — — 4 4 — 2 1 4 4 — 2 1 Polio-myelitis 5 — 1 3 1 — — — — 1 1 1 2 — 1 1 1 2 Encephalitis Lethargica 2 — — — — 1 1 — — — — 2 — — — — 1 — Ophthalmia Neonatorum 30 30 — — — — — — 8 — 4 12 6 3 — — 3 — Measles 546 56 250 208 19 13 — — 125 71 112 157 81 20 11 14 18 34 German Measles 1,262 30 280 781 127 42 2 — 206 240 288 424 104 64 9 5 9 39 Malaria 1 — — — 1 — — — — 1 — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — Primary Pneumonia (Acute) 245 5 30 29 20 60 61 40 41 38 49 55 62 12 12 21 25 25 Influenzal Pneumonia (Acute) 211 1 13 17 16 72 63 29 25 56 32 63 35 4 7 7 12 15 Dysentery 5 — — 2 3 — — — 2 2 — 1 — 1 2 — 1 — Food Poisoning 32 2 2 — 6 19 2 1 5 10 5 10 2 1 — 1 2 — Isolation Hospitals, Name and Situation.—Hospitals of the London County Council (one situated in the Stockwcll Sub-District and Stockwell Ward of the Borough of Lambeth) Number of Diseases that can be concurrently treated—all usual notifiable infectious diseases and Whooping Cough. 70 Smallpox. The type of small pox, variola minor, which has been endemic in the district now for six years, is mild and it has all along bred true, i.e., mild cases, give rise to mild cases only and never to the toxic or virulent form. Age Groups Vaccinated and Revaccinated Vaccinated in Infancy Unvaccinated Totals 0—1 — — 1 1 1—5 — — 6 6 5—15 — — 45 45 15—25 — 1 39 40 25 and over — 17 17 34 All Ages — 18 108 126 The protection afforded by vaccination can be gauged from the table showing the vaccination state of the 126 cases notified. In the latter part of the year the epidemic died away and no further cases were notified. So far as can be gauged the proportion of the population unprotected and therefore at risk was greater and not less than before, since vaccination is now practised to a less extent than a year and more ago, when the disease was prevalent. There was reason to suppose that the disease would continue to spread unchecked, but on the contrary it did not. There have been a few sporadic cases in adjoining districts since, but so far as is known the disease has for the time being vanished from Lambeth. 71 Vaccination. Return showing the Numbers of Persons successfully vaccinated and re-vaccinated at the cost of the rates bv the Medical Officers of the County Council Institutions and the Public Vaccinators during the Year 1933. Name of Institution or Vaccination District Name of the Medical Officer or Public Vaccinator Numbers of successful primary vaccinations of persons Number of successful re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time Number of unsuccessful vaccinations or re-vaccinations of persons Under one year of age One year and upwards Total Lambeth Hospital Dr. P. J. Watkin 24 16 40 14 15 Norwood Schools Dr. E. L. Smallwood — 21 21 1 — Lambeth Church District Dr. J. B. Taylor 266 48 314 12 12 Kennington do. Dr. R. Phillips 205 89 294 22 36 Stockwell do. Dr. H. P. Orchard 359 34 393 6 93 Brixton do. Dr. E. L. M. Rusby 418 46 464 11 16 Norwood do. Dr..E. L. Smallwood 242 35 277 4 77 Totals 1,514 289 1,803 70 249 72 Public Health (Smallpox Prevention) Regulations, 1917. No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. Diphtheria. " The incidence of diphtheria had been slowly and steadily increasing from 1921 to 1930, when the number of cases notified was 957 and the incidence or attack rate per one thousand population was 3.25. In 1931 the notifications fell to 469, with an incidence of 1.58. In 1932 the corresponding numbers were 440 and 1.50. Sudden drops in the incidence of epidemic diseases are usually followed by a considerable increase both in the incidence and the virulence. In other words, more cases are to be expected, which will be more severe in character and the mortality per 100 cases greater." This forecast extracted from the Annual Report of last year is being justified. There were 116 more cases notified in 1933 than in the previous year and although the number of deaths was less the incidence and the mortality are now both rising. In the first quarter of 1933 there were 94 cases, only four of which were fatal, while in the first quarter of 1934 there were 188 cases of which 15 were fatal, i.e., double the number of cases, but practically four times the number of deaths. It would seem that the " mitis " type of the disease is being supplanted by the " gravis." The immunisation carried out at the Council's two diphtheria clinics continue to remove the possibility of diphtheria from a considerable number of individual children, but the numbers immunised are still so small compared with the population exposed to the risk that no reduction of the incidence of the disease can be expected from this source. The disease, however, continues to be conspicuous by its entire absence from the residential institutions in the Borough in which all entrants are immunised and the standard of immunity maintained at 100 per cent. 73 Diphtheria Prevention—1933 Statistics for the year ended 31st December, 1933. *A Clinic at 212 Camberwell New Road Under 1 Year 1 to 4 4 to 5 5 to 10 10 to 15 15 and over Totals Total Cases 2 54 16 72 19 90 253 First Positive 1 53 16 47 14 21 152 Test Negative — 1 — 18 5 49 73 Tested Only . 1 — — 7 — 20 28 Re- Positive — 1 1 4 — 5 11 Test Negative 7 27 14 32 15 41 136 Tested Only 2 2 4 4 — 14 26 Total Attendances 1,090. * Clinic at 12 Hannen Road Under 1 Year 1 to 4 4 to 5 5 to 10 10 to 15 15 and over Totals Total Cases 2 29 13 121 30 18 213 First Positive Test Negative — 27 13 82 18 4 144 1 — 31 9 13 54 Tested Only 2 1 — 8 3 1 15 Re- Positive Test Negative 1 1 1 11 1 2 17 1 27 15 104 33 14 194 Tested Only — 4 1 9 6 2 22 Total Attendances 1,192. Borough.—Total cases = 466, of whom 296 = 63.52 per cent. were Positive and 127 = 27.25 per cent. Negative, while 43 had been tested only, not yet having begun the course of immunisation. Total Attendances = 2,282. Average attendance per week = (49 weeks) 46.57. Average attendance per Session = (100 sessions) 22.82 *A commenced May 8th, 1928, and B commenced July 18th, 1928. 74 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 1933, 30 cases were notified as compared with annual averages of 72.8 and 56.2 for the 10 years 1911-1920 and 1921-1930 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. Cases Notified 30 Treated At Home 24 In Hospital 6 Vision Unimpaired Vision Impaired Total Blindness Deaths 28 — — 2 Contacts, Suspects, etc. The Medical Officer of Health was frequently called in consultation by medical practitioners to see patients in their own homes, in hospitals and schools. 107 such individual patients were examined during the year, of which 37 were variola minor, 6 missed cases of variola minor nursed at home as chicken pox or overlooked until convalescent, 24 were chicken-pox and the rest other infectious diseases, insect bites, scabies, impetigo, seborrhœa urticaria, appendicitis, tuberculosis, etc. In addition, 220 examinations of children were made for the detection of possible carriers of diphtheria. Municipal Bacteriological Laboratory. The subjoined table shows in some detail the nature of the work carried out at the laboratory, which is equipped for practically all routine and special examinations except those which entail the use of living animals. All examinations of samples submitted are carried out free of charge and the necessary outfits for taking the specimens are also supplied free on demand as required. Among the miscellaneous samples are specimens of various body fluids, pathogenic discharges, etc., as well as samples of food suspected of containing various food poisoning organisms. 75 The proportion of specimens found to be positive out of all those submitted was 16.89 per cent.; (in the previous year, 11.65 per cent). Nature of Specimen Result of Examination Total Negative Positive Swabs from nose and throat of suspected cases or carriers of diphtheria 1,756 165 1,921 Sputa from cases suspected of or suffering from pulmonary tuberculosis 596 295 891 Blood for Widal reaction and/or examination for presence of— B. Typhosus B. Paratyphosus A, B, and C B. Abortus 2 3 5 Miscellaneous 31 22 53 Totals 2,385 485 2,870 During 1933, 24 vials of antitoxin were distributed free of cost under the Antitoxin Order, 1910. Disinfecting Department, 1933. Details of work done in connection with the Disinfecting Department are subjoined. In addition to the cases of infectious diseases dealt with, notified compulsorily by medical men, the following diseases were reported by parents, school teachers and others, viz.: measles (650), chicken-pox (537), cancer (69), whooping cough (639), and others (scabies, ringworm, etc.), not classified (1,007); 594 verminous houses (1,041 rooms) and 591 verminous articles, bedding (423), and clothing (168), were also dealt with. 76 Summary of work carried out by the Disinfecting Department during 1933. Cleansing Notices served 1,623 Total No. of Rooms disinfected by the Council 5,514 Do. articles do. 16,698 Cases in which bedding was disinfected at home 1,685 Do. do. do. at Chamber 2,432 Premises disinfected and disinfectants supplied 21,534 Certificates of Medical Practitioners received in lieu of disinfection by the Council 0 Schools disinfected (37 rooms) 6 Certificates of disinfection left with occupiers of disinfected premises 1,646 Library books disinfected 782 Mattresses re-tabbed by Council 565 Tuberculosis Dispensaries— Shelters loaned and erected 0 Shelters dismantled and removed 1 Bedsteads and mattresses delivered 12 Bedsteads and mattresses collected 14 Bacteriological Outfits (Swabs, etc.), delivered 2,035 Smoke machines collected and delivered 187 Tuberculosis. The numbers of cases of tuberculosis on the Lambeth Register of Notifications on December 31st, 1933, were as follows:— Males Females Totals Pulmonary 1,149 963 2,112 Non-pulmonary 233 173 406 Totals 1,382 1,136 2,518 77 TABLE N. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications received during the period from January 1st, 1933, to December 31st, 1933. Age Periods Formal Notifications Number of Primary Notifications of new cases of Tuberculosis *Total Notifications (i.e., including cases previously notified) 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 Pulmonary— Males — 1 4 8 13 38 57 41 45 35 9 251 352 Females — 2 3 5 31 37 43 33 15 11 4 184 249 Non-Pulmonary— Males — 6 5 9 5 5 8 4 3 1 1 47 51 Females — 5 6 2 6 5 4 1 2 4 — 35 37 *Re-notifications (Form A)=166 (males 101, females 65) pulmonary, and 6 (males 4, females 2) non-pulmonary. N.B.—Pulmonary—109 private. 181 hospitals, 145 dispensaries=435 total primary notifications. Non-pulmonary 6 private, 63 hospitals, 13 dispensaries=82 total primary notifications. Institutional treatment. Notifications were also received during the period stated above respecting 572 pulmonary and 52 non-pulmonary admissions, and 421 pulmonary and 39 non-pulmonary discharges. 78 TABLE N (1). Summary of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the 1st January, 1933, to the 31st December, 1933, otherwise than by formal notification. 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 and upwards Total cases Pulmonary— Males — — 1 — 2 4 7 6 7 5 1 33 Females — — — — 3 3 7 3 2 2 — 20 Non-Pulmonary— Males. 1 — — 1 1 — — — — 1 — 4 Females — — — — — 1 1 1 — — — 3 2.—Source of Information. Pulmonary NonPulmonary Death Returns from local Registrars 6 1 transferable from R.G.O. 2 — Posthumous notifications 1 1 "Transfers" from other areas 44 5 Other Sources — — Totals 53 7 The ratio of deaths of previously notified cases of tuberculosis to deaths due to tuberculosis not notified during life is 24 to 1 in the year under review. 79 TABLE N (2). Public Health (Tuberculosis) Regulations, 1930. Summary of Notification Certificates, etc., received during the period from January 1st, 1933, to December 31st, 1933. Registration Sub-Districts Formal Notifications (Table N) Others (Table NI) Pulmonary Non-Pulmonary Pulmonary NonPulmonary A. I. II. A. I. II. Forms Primary Total Sanatorium, etc. Sanatorium, etc. Primary Total Sanatorium, etc. Sanatorium, etc. Lambeth Church 58 72 68 43 17 17 8 10 4 2 Kennington 86 125 89 67 15 15 10 8 9 — Stockwell (Inner) 39 61 48 42 10 10 5 5 5 — Total Inner Districts 183 258 205 152 42 42 23 23 18 2 Stockwell (Outer) 42 54 66 52 5 6 4 7 Brixton 117 165 190 141 19 22 19 9 16 4 Norwood 93 124 111 76 16 18 9 4 12 1 Total Outer Districts 252 343 367 269 40 46 28 17 35 5 Borough of Lambeth 435 601 572 421 82 88 51 40 53 7 80 Deaths from Tuberculosis. Age Periods 0 1 5 10 15 20 25 35 45 55 65 and upwards Total Pulmonary— Males 1 — — 2 8 12 30 21 42 29 9 154 Females — 2 1 1 14 19 16 16 11 9 2 91 Non-Pulmonary— Males 1 1 3 1 — — 1 2 2 3 4 18 Females — 2 2 — 1 2 1 1 2 — 11 Totals 2 5 6 4 23 33 48 40 55 43 15 274 The details of the tuberculosis deaths in the various Registration Sub-Districts are:— Registration Sub-Districts Deaths from Pulmonary Tuberculosis Other Forms Tuberculosis Total Deaths Tuberculosis Tuberculosis rate per 1,000 population (Pulmonary) Tuberculosis rate per 1,000 population (all forms) Lambeth Church 46 6 52 1.14 1.29 Kennington 32 6 38 0.76 0.90 Stockwell 50 5 55 0.84 0.92 Brixton 67 7 74 0.86 0.95 Norwood 50 5 55 0.71 0.78 Borough of Lambeth 245 29 274 0.84 0.94 81 (1) Death-rates 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) Average (10 years) 1913-1922 1.2 1.6 1.5 2.0 1.0 1.3 Average (10 years) 1923-1932 0.9 1.1 1.0 1.2 0.8 0.9 1931 0.85 0.90 1.01 1.20 0.75 0.82 1932 0.84 0.96 0.89 1.04 0.81 0.90 1933 0.84 0.94 0.94 1.08 0.78 0.86 (2) Incidence Rates (notified primary cases per 1,000 population):— Borough Inner Districts Outer Districts Years Pulmonary Tuberculosis Tuberculosis (all forms) Pulmonary Tuberculosis Tuberculosis (all forms) Pulmonary Tuberculosis Tuberculosis (all forms) Average (10 years) 1913-1922 3.2 4.2 3.6 4.7 2.9 3.9 Average (10 years) 1923-1932 1.6 2.0 1.7 2.1 1.6 1.8 1931 1.63 1.91 1.66 1.95 1.62 1.89 1932 1.59 1.90 1.72 2.05 1.52 1.80 1933 1.50 1.47 1.82 2.01 1.41 1.64 82 Lambeth Municipal Tuberculosis Dispensaries Scheme. (Inaugurated by the Council, October 3rd, 1912.) Ministry of Health Table—FORM T.. 145 (Memo. 37T. 1st Schedule). Return (Prepared by the Tuberculosis Officer) of the Work carried out in connection with the Central Dispensary for the Year 1933. N.B.—The Central Dispensary (73 Effra Road, Brixton), was opened July 23rd, 1913. (a) CENTRAL DISPENSARY (73 Effra Road, Brixton). Diagnosis Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts:- (a) Definitely tuberculous 87 71 1 4 9 7 4 3 96 78 5 7 (b) Diagnosis not completed — — — — — — — — 16 17 5 8 (c) Non-tuberculous — — — — — — — — 126 98 27 23 B.—Contacts examined during the year:— (a) Definitely tuberculous 5 14 5 2 — — — 1 5 14 5 3 (b) Diagnosis not completed — — — — — — — — 10 14 13 11 (c) Non-tuberculous — — — — — — — — 41 128 53 46 C.—Cases written off the Dispensary Register as:— (a) Recovered 1 — — — — — — — 1 — — 1 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) — — — — — — — — 198 250 98 85 D.—Number of Cases on Dispensary Register on December 31st, 1933:— (a) Definitely tuberculous 456 387 38 59 66 51 22 31 522 438 60 90 (b) Diagnosis not completed — — — — — — — — 15 23 10 9 Number of cases on Dispensary Register on January 1st, 1933 1,113 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 42 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 96 4. Cases written off during the year as dead (all causes) 108 5. Number of attendances at the Dispensary (including Contacts) 4,022 6. Number of Insured Persons under Domiciliary Treatment on December 31st 574 7. Number of consultations with medical practitioners:— (а) Personal 113 (б) Other 1,117 8. Number of visits by Tuberculosis Officer to Homes (including personal consultations) 645 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,319 10. Number of— (a) Specimens of Sputum, etc., examined 508 (b) X-Ray Examinations made in connection with Dispensary work 570 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 428 83 Lambeth Municipal Tuberculosis Dispensaries Scheme. (Inaugurated by the Council, October 3rd, 1912.) Ministry of Health Table—FORM T. 145—(Continued). Return (Prepared by the Tuberculosis Officer) of the Work carried out in connection with the Branch Dispensary for the Year 1933. 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 (a) Definitely tuberculous 84 46 2 1 2 3 6 2 86 49 8 3 (b) Diagnosis not completed — — — — — — — — 6 3 — 1 (c) Non-tuberculous — — — — — — — — 114 118 17 14 B.—Contacts examined during the year:— (a) Definitely tuberculous — 1 — — — — — — — 1 — — (b) Diagnosis not completed — — — — — — — — — 1 1 — (c) Non-tuberculous — — — — — — — — 56 88 80 81 C.—Cases written off the Dispensary (a) Recovered 5 2 — 2 — — 5 4 5 2 5 6 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) — — — — — — — — 171 207 99 97 D.—Number of Cases on Dispensary Register on December 31st, 1933:— (a) Definitely tuberculous 255 156 8 4 21 19 17 15 276 175 25 19 (b) Diagnosis not eompleted — — — — — — — — 15 9 7 7 1. Number of cases on Dispensary Register on January 1st, 1933 522 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 27 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 67 4. Cases written off during the year as dead (all causes) 84 5. Number of attendances at the Dispensary (including Contacts) 3,471 6. Number of Insured Persons under Domiciliary Treatment on December 31st 100 7. Number of consultations with medical practitioners:— (а) Personal 21 (b) Other 713 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 241 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,522 10. Number of— (a) Specimens of Sputum, etc., examined 598 (b) X-Ray Examinations made in connection with Dispensary work 763 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 2 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 277 F* 84 Public Health (Prevention of Tuberculosis) Regulations, 1925. It has not been found necessary to take any legal action under these regulations. Mortuaries and Coroner's Courts. Details of the work carried out in connection with the two Lambeth Mortuaries:— High Street, S.E. 1. Wanless Road, S.E. 24. Totals 1932 1933 1932 1933 1932 1933 Bodies Received 180 125 100 107 280 232 (M. 117 (M. 73 (M. 40 (M. 55 F. 63) F. 52) F. 60) F. 52) Post-mortem inations conducted 86 77 97 104 183 181 Inquests held 131 74 — — 131 74 Court sittings 65 28 — — 65 28 Coroner: A. Douglas Cowburn, Esq. 85 Appendix. The following letter was received from the Ministry of Health in connection with the survey of the public health services of the Borough Council. Ministry of Health, Whitehall, S.W.I. IIIA/730/4201/1, 19th July, 1933. Sir, I am directed by the Minister of Health to state that he has had under consideration the report made by his officers after their survey of the public health services of the Borough Council. It appears that, so far as can be judged from a general survey, a reasonable standard of efficiency and progress is being maintained by the Council in the discharge of their functions relating to public health. The Minister is pleased to learn of the comprehensive nature of the Maternity and Child Welfare arrangements, and of the interest in this work displayed both by voluntary workers and by the municipal staff and the staffs of the hospitals and centres. He notes the satisfactory extent to which the facilities provided are utilised by mothers and infants. Whilst observing that much is also done for children between the ages of 1 and 5 years, there would appear to be some scope for endeavouring to increase the amount of home visiting of children of this age group and the attendances of these children at the Centres. The Minister does not desire at the present time to press the question of the appointment of an Assistant Medical Officer for Maternity and Child Welfare work, which has been brought to the notice of the Borough Council on previous occasions, but he thinks that the question is one which should be borne in mind for further consideration as opportunity offers. The only other matter to which the Minister thinks it necessary for him to refer is the need for examination of ordinary milk on sale for the presence of tubercle bacilli, and for some general bacteriological examination of milk from time to time, and I am to suggest that arrangements should be made 86 for samples to be taken for these purposes. Where licences to bottle Grade A (Tuberculin Tested) or Grade A milk are issued by the Council special attention should be paid to the bacteriological condition of the milk. I am to express the Minister's appreciation of the assistance which was rendered to his officers during the course of the survey. I am, Sir, Your obedient Servant, J. N. Dark. The Town Clerk, Lambeth Town Hall, Brixton Hill, S.W.2. The Minister has on three previous occasions suggested the appointment of an assistant Medical Officer to exercise detailed control over the Maternity and Child Welfare section of the public health services and also to act as medical officer of the Maternity Home. The Council, however, still adheres to its original conclusion of 1923, that having regard to the large number of Medical Officers of high qualifications and experience attached to the various Child Welfare Centres such an appointment is not essential in order to secure adequate medical supervision of the Maternity and Child Welfare Scheme. The suggestion of the Minister, however, appears to be directed to detailed administrative, rather than to medical, supervision. With regard to the penultimate paragraph of the letter, the following report was drawn up at the request of the Public Health Committee. Report. The Milk and Dairies Act, 1915, and the Acts amending it, together with the Milk (Special Designations) Order, 1923, have resulted in a marked improvement in the quality of the milk supply, particularly in London. So much so that in Lambeth the bulk of the wet milk retailed is graded according to the Order of 1923, only a small proportion being ungraded. 87 The Graded Milks are classified as (i) Certified, (ii) Grade A (Tuberculin Tested), (iii) Grade A (Pasteurised), (iv) Grade A, and (v) Pasteurised. The first two may not be treated with heat at any stage before reaching the consumer, while both forms of pasteurised milk may only be treated with heat once and then by the holder process, the milk being held at a temperature not less than 145° F. for half an hour. The maximum number of micro-organisms each grade may contain is laid down in the Order. In contrast ungraded milk may contain any number of organisms as it has no bacterial qualifications whatever. The pathogenic or disease-producing organisms which may be found in milk fall broadly into two main divisions, those from the cow and those from outside sources of human origin introduced by human agency in the processes of milking, transport and marketing. Organisms from the cow are principally the Bovine Tubercle Bacillus, the Bacillus Abortus (Undulent Fever in man), and streptococci and staphylococci from inflamed udders and teats which may give rise to epidemic, sore throats, etc. Foot and mouth disease is but rarely contracted by human beings from infected milk. The principal disease direct from the cow is, of course, the disease of bones and joints mainly occurring in children and caused by the Bovine Tubercle Bacillus; the others are rarities in comparison. Disease-causing organisms of human origin introduced by human agency are principally the streptococcus hsemolyticus, the cause of scarlet fever or modified and variant forms of that disease, the diphtheria bacillus, human tubercle bacillus, organisms causing gastro-intestinal diseases such as the enteric group and the bacillary dysenteries, and the gaertner, aertryche and salmonella group which causes food poisoning. All these disease organisms, whether bovine or human in origin, are killed by the holder process of pasteurisation. The letter from the Minister suggests that ordinary milk on sale should be examined for the presence of tubercle bacilli. In actual practice there is no short cut in this examination. The only certain method known is by animal inoculation, and the absence of tubercle bacilli in the milk cannot be accepted as definitely proved in less than three weeks, the guinea pig not showing definite proof in less time. When a positive result is obtained, useful action is limited to tracing the infected cow, which, after such a period, is 88 exceedingly difficult, if not impossible. Particularly is this so when it is realised that all milk coming into Lambeth is bulked; not only is the milk of cows from one farm mixed, but also the milk from several producers. In consequence, seeing how widely spread is the infection among the milch cows in the country generally, it is comparatively rare to obtain a sample of milk from a large consignment which is free from tubercle bacilli, the milk from one tuberculous cow infecting all milk with which it is subsequently mixed. There can be little surprise, therefore, at the pronouncement in favour of pasteurisation in the latest report of the Chief Medical Officer to the Ministry of Health. The general bacteriological examination of milk, the second need expressed in the Minister's letter, raises an entirely different question. It is not a practical possibility to examine milk with a view to isolating the widely varied pathogenic organisms with which it may be infected other than the tubercle bacillus, so that a total count (a) of all organisms, whether harmful or harmless, and the count (b) of the number of bacillus coli, made according to the methods laid down in the Ministry of Health Memorandum 139/Foods, are the two criteria upon which the degree of cleanliness of the milk is based. Quite apart from natural criticisms of the value of such a count as (a), there are technical difficulties. It is impossible to get a fair sample of the contents of a churn of milk, even after vigorous stirring, as experiments have proved that a different count is obtained from samples taken from different levels in the churn. The introduction of a plunger in itself may also add to the contamination of the milk. Even if what is considered a fair sample be examined, different counts will be obtained if the media upon which the microbes are grown, are made up according to the same formula, but the constituents are manufactured by different firms. One firm's peptone, for example, will give one count and another firm's peptone another. Not only so, but no two counts on the same media made from the same sample give the same result. With regard to (b) the bacillus coli count appears to be the one likely to give the surest criterion of contamination, because it is much more accurate and seeing that the ultimate source of the organisms is the intestine of some living creature, some indication of the possibility of the presence of pathogenic organisms of gastro intestinal diseases can be obtained. There being no legal standard of the bacterial content of other than graded milks, the most contaminated milk, namely, ordinary 89 milk, is outside control in this respect, and the value to be obtained from the expenses of its examination would appear problematical. It may be noted that on one occasion only in 1923 were three bacteriological examinations of milk made in Lambeth. The cost of each animal inoculation examination, which cannot be done in the Council's Bacteriological Laboratory, is one guinea. If more than a few samples are to be examined for the total count, these could not be carried out without greater facilities in the Council's Laboratory than at present exist. The charge made outside for each total count examination would be half a guinea. A. G. G. Thompson, m.d., Medical Officer of Health. 2nd October, 1933. As rather more than 90 per cent. of the milk sold in the Borough is sold as pasteurised under licence, the Council were not prepared to sanction expenditure for general bacteriological examinations of milk. On receiving a further communication from the Ministry, the Council agreed to examinations being made of the small quantity of ungraded milk sold in the Borough. 90 INDEX. Page. Ambulance facilities 28 Ante-Natal Clinics 29 Area of Borough 7 Artificial Cream 62 Bacteriological Laboratory 74 Bakehouses 49 Bed Linen (Sterilization) 35 Births 26 Births in Institutions 13 Births in Registration Sub-districts 13 Births, Legitimate and Illegitimate 26 Births, Notification Act 26 Birth-rates 15 Census figures 14 Closing Orders 55 Common Lodging Houses 48 Condemned Food 58 Consultants (Obstetrical) 36 Contacts 74 Coroner's Court 84 Cowhouses 48 Deaths 14, 19, 20 Deaths, Infantile 15 Deaths in Institutions 21 Death-rates 15 Demolition Orders 54 Density 7 Dentistry 36 Diphtheria 72 Diphtheria Prevention Clinics 73 Disinfecting Department 75 Drains tested 42 Factories and Workshops 47 Food and Drugs Adulteration 60 Food Inspection and Supervision 58 Food Premises Registered 61 91 Page. Grants, L.G. Act, 1929 31 Health Propaganda 40 Health Visitors 39 Home Helps 35 Hospitals 28 Housing Statistics 50 Housing Applications 50 Housing Conditions (M. of H. Table) 56 Housing Inspectors 51 Ice Cream 48, 61 Infant life Protection 34 Infantile Mortality 23 Infectious Diseases 67 Licences 48 Light Treatment 36 L.C.C. (General Powers) Act, 1928 46 Marriage Rate 7 Massage 36 Maternity and Child Welfare Committee 3 Maternity and Child Welfare Scheme 29, 39 Maternity Home 32 Maternal Mortality 23 Maternity Outfits (Sterile) 35 Meat Regulations (Details of Work) 58 Merchandise Marks Act 62 Midwives 28 36 Milk Assistance Scheme 30 Milk Supply 58 Mortality Rates 7, 25 Mortuaries 84 Neonatal Mortality 7 Notices Served 41 Notifiable Diseases 68 Nuisances 42 Nursing 27 Offensive Trades 48 Ophthalmia Neonatorum 74 Outworkers 47 Pharmacy and Poisons Act, 1933 62 92 Page. Populations 11 Public Cleansing 41 Public Health Committee 3 Puerperal Fever and Puerperal Pyrexia - 36, 40 Registrations 48 Rent and Mortgage Interest Restrictions Acts 46 Representations 53 Sanitary Inspectors 42 Sanitary Work 42 Schools 49 Slaughter of Animals Act, 1933 60 Slaughterhouses 48 Small-pox 70 Smoke Abatement 49 Social Conditions 8 Staff 4 Still-births 25 Summary of Vital and Mortal Statistics 7 Summonses 42 Suspects 74 Survey, Ministry of Health 85 Tuberculosis 76 Tuberculosis, Death Rates 80 Tuberculosis Dispensaries Scheme 82 Tuberculosis Incidence Rates 80 Tuberculosis, Notifications 77 Tuberculosis (Prevention) Regulations, 1925 84 Unemployment 9 Vaccination 71 Vital Statistics 16 Voluntary Hospitals 35 Water Certificates 42 Welfare Centres 29 Welfare Centres, Work of 37 Woman Sanitary Inspectors 46 Workshops 47 Zymotic Deaths 22 Zymotic Death Rate 22