REPORT ON THE HEALTH OF THE BOROUGH OF LAMBETH During the Year 1935 (80th Annual Report.) BY A. G. G. THOMPSON, M.A., M.D., B.C., D.P.H , Medical Officer of Health. London: Truslove & Bray, Ltd. Printers and Bookbinders West Norwood, S.E. 27 2 CONTENTS. page PREFACE 6 STATISTICS AND SOCIAL CONDITIONS 8 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 28 SANITARY CIRCUMSTANCES OF THE AREA 43 HOUSING 55 INSPECTION AND SUPERVISION OF FOOD 72 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 80 APPENDIX 97 INDEX 100 3 Borough of Lambeth. (x) PUBLIC HEALTH COMMITTEE and (2) MATERNITY and CHILD WELFARE COMMITTEE (appointed by the Council on 9th November, 1935). PUBLIC HEALTH COMMITTEE. His Worship the Mayor (Mr. Councillor L. L. S. Bickley, a.c.i.i., j.p.), ex-officio. Aldermen : Mr. Alderman J. F. Evans. „ „ W. J. Geary, a.c.i.s. Councillors • Mrs. Councillor A. J. Anstey, j.p. „ „ E. S. Barnes, j.p. Mr. „ S. A. Brett (Senr.), f.a.i. (Chairman). „ ,, T. Browne. ,, ,, S. J. Downham. ,, „ D. S. Flatman. „ „ W. Hunter. Mrs. „ C. Maule, m.d., b.sc. Mrs. ,, C. M. Pascoe. Mr. „ W. H. Porter. „ „ G. K. Rettie (Vice-Chairman). „ „ G. L. Williams. Mrs. „ D. G. Williman. MATERNITY AND CHILD WELFARE COMMITTEE. The same as the Public Health Committee (see above), together with the following 4 co-opted Members nominated by the various Welfare Centres of the Borough included in the Lambeth Maternity and Child Welfare Scheme ■— Miss C. Turner, representing the North Lambeth Parliamentary Division. Miss C. I. Sketchley, representing the Kennington Parliamentary Division. Mrs. H. L. Breese, j.p., representing the Brixton Parliamentary Division. Miss M, S, Meek, 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 (Cert, s.i.e.b.), H. Snow, J. C. Richards, A. C. Puttock, F. J. Cox, D. R. Eeles, Miss E. Nye, C. N. Swindlehurst (temp.). Junior Clerks : E. F. Mannerson and G. Rathbone. 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). J. Holland, „ (Meat and other Foods). H. E. Cassidy, „ J. Smith, „ (Meat and other Foods). A. E. French, „ ,, „ G. F. Taverner, Cert. Royal San. Inst. R. G. Cutler, Cert, s.i.e.b. A. E. White, „ (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 : B. Good, Cert, s.i.e.b. (Meat and other Foods). F. Heffield, „ „ W. J. Lawrence, „ (Overcrowding). 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 M. Butler, 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 A. Richardson, s.r.n., c.m.b., h.v. Cert. Miss M. W. Thomas, 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. gilliatt, 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., f.r.c.s., m.r.c.p 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 P. Gilbert (Lady Almoner's Department). Visitor : Miss E. A. B. George, s.r.n., c.m.b., h.v. Cert. Vaccination Department: District or Hospital : Public Vaccinator : Vaccination Officer: Lambeth Church M. i. Elliott, m.b., b.ch., b.a.o. (belf.) Kennington - R. Phillips, m.d., b.sc.(lond.), d.p.h. 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: A. Hamshere. * Dr. Richardson also acts for the Medical Officer of Health when required. 6 PREFACE. The health of the Borough of Lambeth during the year 1935 has been generally satisfactory, as will be seen from the statistics in the Report. The Registrar General's estimate of the population shows a further reduction of 4,000 to 279,900. The extensive rebuilding upon the sites of clearance areas as well as the erection of blocks of dwellings upon sites previously open or occupied by a relatively small number of dwellings will no doubt lead to a decided increase in the population in 1936 and subsequent years. The estimated population is now 16,247 less than at the census, 1931. The birth rate which rose slightly in 1934 to 14.21 has again declined to 13.65, a rate not appreciably higher than the lowest rate of 13.63 recorded in 1933, and the natural increase in the population by excess of births over deaths is only 421, compared with 1,528 in 1934. The Registrar General has again calculated a comparability factor for the Borough for the purpose of adjusting the local death rate, which will enable the crude death rate to be compared with the crude death rate of the country as a whole, or with that of any other local area whose crude death rate has been similarly modified. The adjusted crude death rate for the Borough is 12.02 per 1,000 population, which is the lowest recorded rate and compares favourably with the previous lowest rate of 12.4 in 1926, when the population was perhaps rather over-estimated to be 311,000. The number of deaths in the age groups 45 years and over was 78.39 per cent. of the whole, compared with 73.54 per cent. in 1934, indicating that the mortality among the younger members is lessening. Actually, more than 50 per cent. of the total deaths took place among the age groups from 65 years onwards. The zymotic death rate is 0.25 per 1,000 population, being approximately one-tenth of the rate experienced in the decennium, 1891-1900, but it should be noted that measles was practically absent and that the number of deaths was small from whooping cough, the greatest menace among the zymotic diseases to juvenile life. The dislocation of the work of the Public Health Department caused by the overcrowding survey under the Housing Act, 1935. 7 was considerable during the four months from 1st November, and with the effects of other recent legislation has led to delay in the preparation of this Report. Moreover, the fact that, apart from one of the three Tuberculosis Officers, the Medical Officer of Health is the only whole-time medical officer in the employment of the Council of a borough with a population of well over a quarter of a million is not without effect in causing delay. The Registration sub-districts were altered from five to four on 1st April, 1935, and are now co-terminous with the Wards. Thanks are gratefully tendered to members of the Maternity and Child Welfare and 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. July, 1936. 8 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 4 Registration Sub-Districts, 4 Parliamentary Divisions, and 12 Wards. The Parliamentary Divisions and Registration Sub-Districts have been adjusted so that they and the Wards are co-terminous. Population—estimated 1935—-279,900 (males 132,230 and females 147,670). Density—68.55 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (corrected)—3,823, being 13.65 per 1,000 population. Marriages—2,667, being 9.52 per 1,000 population. Deaths (corrected)—3,402, being 12.02 * per 1,000 population. Infantile Mortality (corrected)—225 deaths under 1 year, being 59 per 1,000 total live births. Neonatal Mortality (corrected) — 95 deaths under one month, being 24 per 1,000 live births. Zymotic Death-rate (corrected)—0.25 per 1,000 population (total zymotic deaths, 71). Maternal Mortality (corrected)—10 deaths, being 2.61 per 1,000 live births. Number of structurally separate dwellings (census 1931)—48,873. Rateable Value (at 1st April, 1935)—£2,313,770. Sum represented by a penny rate (at 31st March, 1935)—-£9,360. * As adjusted by comparability factor. 9 Social Conditions. There has been little perceptible alteration in the general conditions during the past year, with the exception of a great extension in being and in prospect of large blocks of flats by the County Council. Many expressions of dissatisfaction have been heard from the inhabitants of clearance areas at the prospect of being obliged to live in "the buildings." Many reasons were mentioned in the Annual Report for 1934, which account for the real dread experienced by the cottage dwellers when the approaching transfer to blocks of flats becomes imminent, and when parental control of children is lost from the moment they are outside the flat door. This lack of control leads inevitably to mischievous conduct which later tends to less pardonable lack of control, and still later is undoubtedly one factor to which may be attributed the increase of juvenile crime now so noticeable. Unemployment. The following tables indicate the extent of unemployment among Lambeth residents :— (1) Average Number of Residents Registered as Unemployed in 1930, 1931, 1932, 1933, 1934, and 1935. Date Men Women Juveniles 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 1934 7,629 1,707 224 9,560 1935 7,171 1,758 160 9,089 (2) Number of Residents Registered as Unemployed at Monthly Dates in 1935. Date Men Women Juveniles Total 28th January, 1935 8,241 2,186 290 10,717 25th February, ,, 8,117 2,230 267 10,614 25th March 7,609 2,121 178 9,908 15th April 7,126 1,814 92 9,032 20 th May 7,117 1,706 132 8,955 24th June 6,636 1,631 84 8,351 22nd July 6,454 1,426 123 8,003 26th August 6,451 1,449 218 8,118 23rd September ,, 6,691 1,413 175 8,279 21st October 7,302 1,684 120 9,106 25th November ., 7,361 1,787 131 9,279 16th December „ 6,948 1,648 112 8,708 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% 1934—3,210 Children 1935—3,388 Children Good Average Below Normal Good Average Below Normal Children 622 2,363 225 587 2,430 362 Lambeth 19.4% 73.6% 7.0% 17.3% 71.7% 11.0% London 20% 75.9% 4.1% 16.4% 77.9% 5.7% Vital Statistics. The population of the Borough of Lambeth at the mid-year 1935, has been estimated by the Registrar General to be 279,900, which is less by 4,000 than the official estimated population of 1934. 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 more than one-half the total deaths :— All Ages 0— 1— 2— 5— 15— 3,402 225 19 23 65 114 100% 6.61% 0.56% 0.68% 1.91% 3.35% 11 25— 35— 45— 55— 65— 75— 122 167 340 612 816 899 3.59% 4.91% 9.99% 17.99% 23.98% 26.43% During the year the number of births corrected by inward and outward transfers was 3,823, giving a corrected birth rate of 13.65 compared with 14.21 last year, a decrease of 0.56 per one thousand population. The principal causes of death are again the same four, heart disease which claimed 893 or 26.2 per cent. of the total, cancer 520 or 15.3 per cent., diseases of the lungs 326 or 9.3 per cent., and tuberculosis 218 or 6.4 per cent. Estimated Population, 1935 (Middle of the Year.) I. Wards. Wards Males Females Total 1. Marsh 6,290 5,600 11,890 2. Bishop's 11,780 12,250 24,030 3. Prince's 11,910 12,690 24,600 4. Vauxhall 13,610 14,170 27,780 5. Oval 10,890 11,640 22,530 6. Vassall 7,790 8,640 16 430 7. Angell 12,500 14,660 27,160 8. Stockwell 13,680 15,690 29,370 9. Town Hall 6,770 7,400 14,170 10. Heme Hill 6,520 7,660 14,180 11. Tulse Hill 14,180 17,560 31,740 12. Knight's Hill 16,310 19,710 36,020 Borough of Lambeth 132,230 147,670 279,900 12 II. Registration Sub-Districts Sub-Districts Males Females Total 1. Lambeth, North 18,070 17,850 35,920 2. Princes 11,910 12,690 24,600 3. Lambeth, Central 44,790 49,110 93,900 4. Lambeth, South 57,460 68,020 125,480 Borough of Lambeth 132,230 147,670 279,900 III. Parliamentary Divisions. Parliamentary Divisions Wards Total North Marsh Bishop's Prince's 60,520 Kennington Vauxhall Oval Vassall 66,740 Brixton Angell Stockwell Town Hall 70,700 Norwood Herne Hill Tulse Hill Knight's Hill 81,940 Parliamentary Area of Lambeth 279,900 13 TABLE A. Giving Number of Live Births in each Registration Sub-District of the Borough of Lambeth During the Year ended 31st December, 1935 (arranged Quarterly). Registration Sub-Districts No. of Births Registration Sub-Districts No. of Births 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Lambeth Church* 495 Lambeth, North* 453 462 447 Kennington 216 Princes 225 226 227 Stockwell 217 Lambeth, Central 410 394 335 Brixton§ 292 Lambeth, South§ 286 313 252 Norwood 243 BOROUGH OF LAMBETH 1,463 1,374 1,395 1,261 TOTAL FOR BOROUGH OF LAMBETH—5,493. * Including General Lying-in Hospital (1,136 cases, of which 304 belong to Lambeth) and St. Thomas's Hospital (605 cases, of which 269 belong to Lambeth). Including Lambeth Hospital (739 cases, of which 377 belong to Lambeth) Including Clapham Maternity Hospital (481 cases, of which 171 belong to Lambeth). § Including King's College Hospital (642 cases, of which 202 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 1935, 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 1935 279,900 5,493 3,402 225 267 71 1934 283,900 5,789 3,619 255 408 167 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 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. Showing the Birth Rate, the General and Zymotic Death Rates, the Infantile Mortality Rates for the Year 1935, and the figures for the Four 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) 1935 19.62 12.02 58.85 66.13 78.48 0.25 1934 20.45 12.65 63.38 70.46 112.73 0.59 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 Averages (10 years)— 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 1935 and Previous Five Years (1930-1934) 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 of residents not registered in the District 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 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 1933 289,000 5,667 3,941 13.63 4,056 14.03 1,604 1,337 249 63 3,789 13.11 1934 283,900 5,789 4,023 14.21 3,740 13.21 1,510 1,389 255 63 3,619 12.65 Average 5 years 293,200 6,392 4,430 15.02 4,129 14.07 1,296 994 269 60 3,826 13.04 1929-1933 1935 279,900 5,493 3,823 13.65 3,551 12.68 1,529 1,380 225 59 3,402 12.02 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 substracted from the total supplied by the local Registrar (2,437 outward and 767 inward transfers). * In Column 6 is included the whole of the deaths registered during the year as having actually occurred within the Borough. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph. Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9 except in certain instances. In Column 8 the number of transferable deaths of "non-residents" which are deducted, and in Column 9 the number of deaths of "residents" registered outside the district which are added are stated in calculating the 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, 1935. Cities and Boroughs Estimated Population to Mid-year 1935 Births Annual rate per 1,000 persons living Deathrate per 1,000 living Crude Deathrate per 1,000 living Adjusted Deaths of infants under 1 year per 1,000 births London 4,188,870 13.3 11.4 — 58 West Districts— Paddington 138,600 14.1 12.0 11.9 71 Kensington 178,300 12.4 12.1 11.3 79 Hammersmith 128,100 14.7 11.9 12.3 70 Fulham 143,600 13.8 11.6 11.7 51 Chelsea 57,320 10.2 12.6 10.7 59 City of Westminster 124,400 8.3 11.5 11.8 72 North Districts— St. Marylebone 92,200 9.7 11.8 11.7 56 Hampstead 90,600 11.0 11.2 10.5 49 St. Pancras 185,300 13.3 11.9 12.2 62 Islington 308,170 14.8 — 10.9 52 Stoke Newington 50,210 13.9 1ll 10.6 51 Hackney 210,600 14.0 10.6 11.1 47 Central Districts— Holborn 35,400 7.6 11.9 12.7 89 Finsbury 63,100 14.7 12.6 13.7 59 City of London 9,360 7.6 11.0 12.2 113 East Districts— Shoreditch 88,400 14.6 11.3 12.4 52 Bethnal Green 99,910 14.4 10.3 11.6 51 Stepney 211,500 14.3 11.3 12.8 63 Poplar 143,700 15.4 11.0 12.3 46 South Districts— Southwark 156,100 14.8 — 12.4 66 Bermondsey 102,700 14.5 11.7 13.3 69 Lambeth 279,900 13.6 12.1 12.0 59 Battersea 148,200 14.2 12.0 11.9 65 Wandsworth 343,300 11.0 11.0 10.2 55 Camberwell 234,400 13.4 11.8 11.8 60 Deptford 99,500 14.4 11.1 11.5 52 Greenwich 96,600 13.8 10.8 11.0 59 Lewisham 223,000 12.5 9.9 10.0 43 Woolwich 146,400 14.0 10.2 10.8 44 18 TABLE F. Birth-Rate, Death-Rate, and Analysis of Mortality During the Year 1935 (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 14.7 0.62 11.7 0.00 0.00 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns, including London 14.8 0.68 11.8 0.00 0.00 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (Estimated Resident Populations 25,000-50,000 at Census 1931) 14.8 0.64 11.2 0.00 0.00 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London 13.3 0.52 11.4 0.00 0.00 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 Lambeth 13.6 0.45 12.0 0.00 0.00 0.00 0.00 0.06 0.05 0.13 0.39 8.8 59 The maternal Mortality rates are as follows '— Puerperal Puerperal Sepsis Others Total Sepsis Others Total Per 1,000 Live Births, England & Wales 1.68 2.42 4.10 Per 1,000 Total Births, England & Wales 1.61 2.32 3.93 Lambeth 1.04 1.57 2.61 Lambeth 0.72 1.09 1.81 19 Deaths. The total number of deaths registered in Lambeth during the year is 3,551, of which 1,529 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 1,380. The number of deaths corrected, i.e., of all Lambethans who died both within and outside the district is 3,402. The corrected death rate is 12.02 per 1,000 living, based upon a population estimated to the middle of the year of 279,900 and adjusted with the comparability factor. Age Periods of Corrected Deaths The 3,402 corrected deaths during 1935 may be further analysed and tabulated as follows :— 225 6.61 per cent. of the total corrected deaths took place under 1 year of age. 42 1.24 per cent. between 1 and 5 years. 267 7.85 per cent. under 5 years. 179 5.26 per cent. between 5 and 25 years. 289 8.50 per cent. 25 to 45 years. 952 27.98 per cent. 45 to 65 years. 816 23.98 per cent. 65 to 75 years. 899 26.43 per cent. 75 years and over. 3,135 92.15 per cent. over 5 years. 20 TABLE G. Causes of, and Ages at, Death (Corrected) During the Year, 1935. 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 3,402 225 19 23 65 114 289 952 816 899 Enteric Fever 1 — — — — 1 - - - - Measles 2 1 — 1 — — — - - - Scarlet Fever — — — — — - - - - - Whooping Cough 18 10 6 1 1 - - - - - Diphtheria 16 2 - 9 3 1 - 1 - - Influenza 37 3 — - - 1 2 15 11 5 Encephalitis Lethargica 3 — — - — - 2 - 1 - Cerebro-Spinal Fever 2 — 1 — - - 1 - - - Tuberculosis of respiratory system 196 — — - 3 35 75 65 15 3 Other tuberculous diseases 22 2 — 1 5 7 5 2 - - Syphilis 11 2 — — — - - 7 2 - General Paralysis of the insane, tabes dorsalis 14 - - - - - - 5 7 2 Cancer, malignant disease 520 - — - - 3 32 230 172 103 Diabetes 30 — — — — 1 — 9 14 6 Cerebral Haemorrhage, etc 206 — — — — — 3 52 77 74 Heart Disease 893 — — — 6 11 43 224 257 352 Aneurysm 13 — — — — — — 8 4 1 Other circulatory diseases 126 — — — — — 2 24 45 55 Bronchitis 104 9 1 — — — 4 22 28 40 Pneumonia (all forms) 191 35 2 5 3 4 15 50 40 37 Other respiratory diseases 31 2 — — 1 — 5 15 4 4 Peptic Uleer 42 — — — — — 6 21 12 3 Diarrhoea, etc. 42 33 1 1 — — 2 1 1 3 Appendicitis AnnpnHiritis . ... ... 26 — — 2 3 2 8 7 2 2 Cirrhosis of Liver 9 — — — — — — 5 3 1 Other diseases of liver, etc. 22 1 — — 1 1 1 5 8 5 Other digestive diseases 71 6 1 1 1 3 7 24 17 11 Acute and Chronic Nephritis 107 — 2 — 3 4 8 35 29 26 Puerperal Sepsis 4 — — — — 2 2 — — — Other puerperal causes 6 — — — — 1 5 — — — Congenital Debility, premature birth, malformations, etc. 103 102 — — — 1 — — — — Senility 118 — — — — — — 1 13 104 Suicide 35 — — — — 1 7 19 6 Other Violence 111 5 1 1 12 18 18 22 17 17 Other defined diseases 267 12 4 1 23 17 31 80 54 45 Causes ill-defined or unknown 3 — — — — — — 1 2 — Deaths in Institutions in Lambeth Lambethans Strangers Totals Voluntary Hospitals 224 833 1,057 State-aided Hospitals 551 622 1,173 Homes for the dying, etc. 35 5 40 21 22 TABLE H. Showing the corrected number of Deaths, with corrected Death-rates (general, zymotic and diarrhœal), in each of the Registration Sub-Districts of the Borough during 1935. 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. Diarrhceal Death-rate per 1,000 of the Population. Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhoid or Enteric Diarrhoea and Dysentery Lambeth, North 429 11.94 — 1 — — 2 9 12 0.33 0.25 Princes 331 13.45 — — — 1 6 — 3 10 0.40 0.12 Lambeth, Central 1,114 11.86 — — — 7 7 1 13 28 0.29 0.13 Lambeth, South 1,528 12.17 — 1 — 8 3 — 9 21 0.24 0.07 Borough of Lambeth 3,402 12.02 — 2 — 16 18 1 34 71 0.25 0.12 23 Maternal Mortality. The maternal mortality rate cannot be expressed in a manner comparable with mortality rates from other causes. The rate should be expressed as the number of maternal deaths for each 1,000 of the female population exposed to risk, that is to say, per 1,000 pregnancies. Since, however, pregnancy is not notifiable, and in numerous cases would not be notified even if there were legal obligation to do so, the maternal mortality rate is expressed as the number of maternal deaths for each 1,000 live births. The rate as so expressed is purely arbitrary and is not strictly comparable with the rate in any other district, as no account is taken of such material factors as the social conditions. Reference to the statistics of the Metropolitan Boroughs will show that higher rates are found where a high proportion of the female population is residing away from home, at work as domestic servants, shop assistants, clerks, and the like, and low in the working-class boroughs. As in previous years, the Lambeth rate this year depends largely upon the number of unwanted pregnancies terminating in abortion. In classifying abortions among the various causes of death, the Registrar General has three choices. Where the woman herself brings about the abortion from which she dies the cause is, classed as suicide. Where the abortion is due to interference by others the cause is manslaughter. Where there is no evidence available pointing to active interference either by the woman herself or by others, then the death is deemed to be due to maternity. It will be realised from such a classification that much of the fear of death from ordinary maternity has been misplaced, and that the phobia fostered in recent years may do as much harm as good. There were 15 deaths following pregnancy in 1935, of which 6 were abortions. Two only of these are classed as maternal deaths, there being no evidence of criminal interference, while the other four were held to be due to causes other than maternity. For the purposes of the maternal mortality rate there were 10 deaths, giving a rate of 2.61 per 1,000 live births. The average rate for the past six years is 2.71, compared with an average for England and Wales of 4.26, which comparison is among others an indication of 24 the efficiency of the Council's services as a Maternity and Child Welfare Authority. It is a disheartening reward from the Central Government after all the care and thought expended and the excellent results achieved, to transfer such a large proportion of the maternity work from the Metropolitan boroughs to the hands of the County Council by the Midwives Bill this year. 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 3,823, a decrease of 200 below the number of births in the year previous. The corrected number of deaths wat. 225, giving an infantile mortality rate of 59. 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 North 541 37 68 Princes 269 17 63 Lambeth Central 1,464 76 51 Lambeth South 1,549 95 61 Borough 3,823 225 59 25 TABLE I. Infantile Mortality, 1935. 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 74 12 4 5 95 33 50 27 20 225 Measles — — — —_ — 1 — — — — Whooping cough 2 5 2 1 10 Diphtheria — — — — — 1 1 — — 2 Influenza — 1 2 — 3 Other tuberculous diseases 1 — 1 2 Syphilis — — — — — — 1 1 — 2 Bronchitis — — — — — 4 2 2 1 9 Pneumonia (all forms) 1 1 — 2 4 5 16 5 5 35 Other respiratory diseases 1 — — — 1 — 1 — — 2 Diarrhoea, etc. — — — 1 1 3 12 10 7 33 Other diseases of liver, etc. 1 — — 1 — — — 1 Other digestive diseases — — — — 1 2 1 2 6 Congenital debility and malformation, premature birth, etc 63 11 3 2 79 15 8 — — 102 Other deaths from violence 4 — — 4 1 — — — 5 Other defined diseases 4 — 1 — 5 — 4 3 12 26 Stillbirths. The following particulars regarding stillbirths registered in Lambeth during 1935 have been received from the Registrar General:— Stillbirths registered Inward transfers. Outward transfers Corrected totals Total legitimate and illegitimate : Males... 115 15 54 76 Females 91 9 50 50 Illegitimate :— Males 7 1 4 4 Females 7 — 5 2 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. Quinquennium 1935 1934 1933 1926-1930 Estimated Population 279,900 283,900 289,000 301,120 General death-rate 12.02 12.65 13.11 12.70 Zymotic death-rate 0.25 0.59 0.38 0.50 Measles death-rate 0.007 0.23 0.03 0.14 Whooping Cough death-rate 0.06 0.04 0.07 0.09 Diarrhoeal death-rate 0.12 0.13 0.16 0.11 Typhoid Fever death-rate 0.003 0.003 0.003 0.008 Tuberculosis (all forms) death-rate 0.78 0.94 0.94 1.07 Tuberculosis (pulmonary) death-rate 0.70 0.81 0.84 0.91 Scarlet Fever death-rate 0.00 0.01 0.01 0.01 Diphtheria death-rate 0.05 0.15 0.08 0.10 Small-pox death-rate 0.00 0.00 0.00 0.00 Infantile Mortality rate 59 63 63 59 27 Births, 1935. The total number of Births registered (uncorrected) is 5,493, of which details are set out in Table A. The corrected number of births, however, is 3,823, showing a birth-rate of 13.65 per 1,000 of the estimated population. Total Inward Outward Corrected registered transfers transfers numbers Legitimate Males 2,705 327 1,199 1,833 Legitimate Females 2,470 348 1,082 1,736 Illegitimate Males 140 45 65 120 Illegitimate Females 178 47 91 134 Totals 5,493 767 2,437 3,823 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 5,698 notified births, 4,307 took place in Institutions, and of these, 1,870 belong to Lambeth, and 2,437 to outside districts, thus:— Institutions. Lambeth Cases Strangers Totals General Lying-in Hospital 304 832 1,136 St. Thomas's Hospital 261 314 575 Lambeth Hospital 377 362 739 Clapham Maternity Hospital 171 310 481 King's College Hospital 202 440 642 *Lambeth Council Maternity Home 436 10 446 Other Nursing Homes (private) 119 169 288 Totals 1,870 2,437 4,307 * 10 of the applicants moved out of the Borough after booking. 28 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Nursing in the Home. (a) General. There are six 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 ; Southwark, Newington and Walworth ; Norwood and District; and the Catholic Nursing Institute. (b) Infectious disease. Pneumonia (all forms) Whooping Cough Chicken- Pox Influenza Bronchitis Scarlet Fever Mumps Visits paid to Children under 5 years of age 453 157 25 17 18 6 — Visits paid to Persons over 5 years of age 2,083 22 43 528 29 30 Total Visits 2,536 179 68 545 18 35 30 Measles OphthalmiaNeonatorum Conjunctivitis Impetigo Puerperal Fever Puerperal Pyrexia Visits paid to Children under 5 years of age 18 146 1,280 4 — — Visits paid to Persons over 5 years of age 41 — — — 122 43 Total Visits 59 146 1,280 4 122 43 A flat rate of 1/3 per visit is paid for the nursing of infectious disease. 29 Midwives. There are approximately 77 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 37 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 out-patient department. General Lying-In Hospital, York Road, S.E.I. For women, 76 beds. A Maternity and Child Welfare Centre is attached to the out-patient department, 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) County Council. 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, ambulances are available for the conveyance of women to institutions for confinement at all hours free of charge. 30 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.1. 2. Barley Mow, 52, Oakley Street, S.E.1. 3. Holy Trinity and North Lambeth, 121, Kennington Road, S.E.I 1.* 4. Moffat Institute, The Institute, Esher Street, S.E.11.*†† 5. The " Rose McAndrew," 48, Lansdowne Road, S.W.8. 6. St. Anne's, 44-46, Harleyford Road, S.E.11. 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.l.*† St. Thomas's Hospital (Main Building), S.E.1. — do — 37, Royal Street, S.E.1. 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, S.E. 27. (b) St. Thomas's Babies' Hostel, Cornwall Road, S.E.11. (c) The Cynthia Mosley Day Nursery, The Oval, S.E. 11.† * Regular Ante-Natal Clinics are held in connection with these Centres, † Dental Clinic. † Artificial Sunlight. 31 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 of 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 1918-19 (3 months) £ s. d. £ s. d. £ s. d. 232 15 3 69 4 3 301 19 6 3,151 1919-20 2,780 0 10 557 10 1 3,337 10 11 34,827 1920-21 13,836 7 3 1,564 7 3 15,400 14 6 160,703 1921-22 4,596 8 5 1,172 0 8 5,768 9 1 60,192 1922-23 3,553 15 4 1,064 19 5 4,618 14 9 48,196 1923-24 3,380 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 1933-34 3,405 19 11 — 3,405 19 11 40,987 1934-35 2,764 11 8 — 2,764 11 8 31,360 Totals 54,311 5 3 5,572 11 10 59,883 17 1 673,833 32 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. (b) That no reduction or alteration of such service is made without the consent of the Council. 33 (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 ;onsent of the Minister, terminate or make any reduction in the mnual contribution payable to an Association in respect of any :ervice on the ground that any of the foregoing conditions are not' fulfilled in the case of that service. In several instances supplementary grants have since been ipproved by the Council increasing the block grants to provide idditional facilities. The Maternity Home The Council's Maternity Home, at 210 Knight's Hill, has mainained its successful career during the year, and 446 cases were idmitted to the Home—a decrease of 12 below the previous year's otal. Since its inception in 1926, 3,787 women have been admitted :o the Home, with only two fatalities, which is a striking tribute )oth to the Home and to the value of the ante-natal work carried >ut at the voluntary welfare centres. 34 Applications dealt with during 1935. Welfare Centre Applications received Applications withdrawn, refused or cancelled North Marsh 1 Babies Care 3 1 Rose McAndrew 3 — North Brixton (Belgrave Hospital) 36 3 Stockwell 77 5 Brixton 120 3 Loughborough Junction 79 8 Norwood 183 8 Total 502 28 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 Welfaie Centres which they represent. The success of the Council's Home is due to the cordial spirit of co-operation displayed by all members in their work, and to the staff of the Home, which has ably supported their efforts. Parliamentary Area Applications received Applications withdrawn, refused or cancelled North 4 1 Kennington 19 2 Brixton 169 10 Norwood 310 15 Total 502 28 35 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 year ended the 31st December, 1935, now follows :— No. of Foster Mothers on Register 188 No. of Nurse Children on Register 302 No. of Visits and Re-Visits paid to Nurse Children 1,580 Year of Birth No. of Nurse Children No. of Visits 1935 43 152 1934 55 253 1933 43 203 1932 40 239 1931 22 116 1930 22 133 1929 23 150 1928 21 146 1927 21 127 1926 12 61 Totals 302 1,580 No. of Visits, including verifications and registering of homes 2,307 No. of Foster Mothers removed from Borough 9 No. of Nurse Children legally adopted by Foster Parents 1 No. of Nurse Children taken by National Children's Aid and Adoption Society with a view to adoption .3 No. of Nurse Children who attained the age of 9 years 10 No. of Deaths 2 No. of Legal Proceedings taken .1 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. 92 applications were received (6 subsequently cancelled), 28 being emergency cases. The expense to the Council was only £44 18s. 3d., and from every point of view the money could scarcely have been better spent. 36 (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 522 of these outfits were sold. The Council has sanctioned the issue of these outfits free or at reduced cost in cases of poverty. 28 applications (3 since cancelled) for assistance towards the purchase of these outfits from necessitous cases were received in the course ot the year at a cost to the Council of £3 4s. 1 Id (iii) Sterilization of Bed Linen, etc. During the year 25 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 liaison 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 caies 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. After the confinement every mother is followed up to insure attendance at the post-natal clinic. The total number of these cases (both ante-natal and post-natal) visited and reported upon during 1935 was 2,002, distributed as follows :— St. Thomas's Hospital 659 King's College Hospital 257 General Lying-in Hospital 344 f 1,686 Lambeth Hospital 426 " Westminster Hospital 54 Charing Cross Hospital 32 St. George's Hospital 9 Dulwich Hospital74 Middlesex Hospital 9 Institutions Elizabeth Garratt Anderson Hospital 3 outside the < Royal Free Hospital 7 316 Borough of Guy's Hospital 1 Lambeth St. Giles' Hospital 117 St. Mary's Hospital 2 Queen Charlotte's Hospital1 St. Mary Abbott Hospital 1 _St. Stephen's Hospital 37 (v) 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 25, as opposed to 8 last year, 61 in 1933, 64 in 1932, 83 in 1931, and 149 in 1930. Applications for assistance towards the payment of the midwife were received from 67 (3 cancelled) expectant mothers, of which 18 were emergency cases. The cost to the Council was £54 13s. Od. Compensation at the rate of 10s. per case is paid to those midwives whose cases after booking are confined on the advice of the clinic Medical Officer in institutions. Five applications were received from midwives during the year. (vi) Obstetrical Consultants. On two 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. The cost to the Council was £8 8s. Od. (vii) 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. (viii) 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. 38 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 Junction Stockwell Brixton West Norwood St. Thomas's Hospital (Main Building) St. Thomas's Hospital (37 Royal St.) General Lying-in Hospital Totals Total Numbers of Individual Cases Dealt With 206 348 90 248 85 160 319 354 258 343 695 74 487 3,722 2. Nursing Mothers 99 440 912 806 755 277 374 592 328 474 787 437 31 122 6,434 3. Infants (under 1 year) 103 441 1,056 570 939 237 379 848 562 681 606 496 123 7,041 4. Children (aged 1-5 years) 98 711 1,134 380 888 129 392 239 293 749 396 230 — 101 5,740 Total 355 1,798 3,450 1,846 2,830 728 1,305 1,998 1,537 2,162 2,132 1,858 105 833 22,937 Total Numbers op Sessions Held 1. Ante-natal |— — 49 26 — — 48 104 51 49 99 152 306 884 2. Medical " Consultations " 50 58 77 157 144 47 156 24 6 101 202 137 154 — 58 1,587 3. Dental — 25 — — — 55 — 24 46 100 — 51 301 4. Others 45 85 51 176 76 62 46 233 23 211 88 — 247 50 1,393 Total 9^ 143 177 384 220 109 250 638 175 486 370 406 247 465 4,165 Total Numbers of all Attendances at the Sessions (a) Ante-natal — — 217 214 — — 380 1,259 684 1,197 1,407 2,820 — 2,787 10,965 (6) Seen by Medical Officer 15 36 217 192 — — 1,395 — 783 1,010 — — — — 3,648 (c) Otherwise dealt with 33 17 — — — — 225 — 140 187 — — — — 602 90 245 71 275 765 (e) Others 128 110 256 34 376 229 96 91 393 659 2,372 Total 176 163 690 440 376 229 2,096 1,349 1,698 2,478 2,045 2,891 659 3,062 18,352 2. Nursing Mothers. (a) Seen by Medical Officer 365 1,139 1,111 2,190 3,051 1,042 2,792 2,271 1,088 2,021 2,917 1,544 — 909 22,440 (b) Otherwise dealt with 644 627 1,353 292 2,186 1,460 3,384 — 1,630 1,125 5,509 — — 53 18,263 (c) Dental 70 — — 682 — 77 138 14 — 53 1,034 (d) Others 253 1,995 230 719 340 424 100 — 25 212 548 — 719 112 5,677 Total 1,262 3,761 2,694 3,271 5,577 2,926 6,276 2,953 2,743 3,435 9,112 1,558 719 1,127 47,414 39 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 Totals Total Numbers of all Attendances at the Sessions 3. Infants (under 1 year). (a) Seen by Medical Officer 374 691 1,533 1,276 4,089 740 2,822 3,752 1,903 3,416 2,241 2,254 912 26,004 (b) Otherwise dealt with 660 504 1,875 — 2,812 1,239 3,254 4,303 2,637 3,278 — 53 21,100 (c) Dental (d) Others 253 991 — 182 — 36 — 3,288 81 432 154 — — — 5,417 Total 1,287 2,186 3,408 1,943 6,901 2,015 6,076 7,040 6,287 6,485 5,673 2,254 — 966 52,521 (a) Seen by Medical Officer 351 1,127 1,043 1,384 1,997 387 — — —s40 1 812 1,172 1,432 — 697 16,059 (b) Otherwise dealt with 741 349 1,233 252 1,844 606 — — 2,154 — 14,106 (c) Dental 10 210 — 83 67 17 387 (d) Others 327 634 — 1,601 — 111 — 2,720 89 896 75 — — — 6,453 Total 1,419 2,110 2,276 3,247 3,841 1,104 4,867 4,580 3,253 4,694 3,468 1,449 — 697 37,005 Visits and Re-visits Paid to Homes 1. Expectant Mothers. (a) First Visits 39 163 188 63 200 69 104 433 217 102 112 144 101 1,935 (b) Re-visits 184 465 305 94 757 217 63 983 256 349 94 — 880 331 4,978 Total Visits 223 628 493 157 957 286 167 1,416 473 451 206 — 1,024 432 6,913 2. Nursing Mothers. (a) First Visits 74 187 363 144 445 381 409 499 399 385 291 — 152 62 3,791 (b) Re-visits 707 5,571 1,035 934 1,971 3,637 977 1,611 675 718 1,973 — 1,553 834 22,196 Total Visits 781 5,758 1,398 1,078 2,416 4,018 1,386 2,110 1,074 1,103 2,264 — 1,705 896 25,987 (a) First Visits 74 168 — 143 503 205 412 522 466 405 488 135 72 3,998 (b) Re-visits 722 2,290 1,779 938 2,723 2,146 851 1,906 1,605 1,468 1,838 — 774 801 19,841 Total Visits 796 2,458 2,184 1,081 3,226 2,351 1,263 2,428 2,071 1,873 2,326 — 909 873 23,839 4. Children (aged 1-5 vears). (a) First Visits 55 63 76 66 446 209 193 340 136 123 43 — 127 91 1,968 (b) Re-visits 1,671 6,219 2,613 3,339 2,445 2,279 1,906 2,106 2,877 3,076 3,422 — 3,585 955 36,493 Total Visits 1,726 6,282 2,689 3,405 2,891 2,488 2,099 2,446 3,013 3,199 3,465 — 3,712 1,046 38,461 40 The Cynthia Mosley Day Nursery The Cynthia Mosley Day Nursery was opened on 3rd June, after prolonged negotiations between the voluntary committee and the Borough Council, and after overcoming much initial difficulty. The official opening and dedication by His Grace the Archbishop of Canterbury took place on 2nd July. The Nursery from the start has been a brilliant success, and the accommodation for 50 infants and toddlers was rapidly filled. The waiting list soon rose to over sixty, and no further names were taken. The building and equipment constitute a model of what is required in a day nursery, and no expense has been spared consonant with reasonable economy. The day nursery forms an integral part of the Maternity and Child Welfare Scheme, and is run in close conjunction with the Welfare Centres through which all parents apply for the admission of their children. By this means only those in real need are able to make use of it, and preference is given to those whose mothers are obliged to go out to work through the unemployment of the fathers. The staff, which is resident, consists of a matron with a staff nurse in charge of the infants, a nursery school teacher for the toddlers, and a cook trained in domestic economy, together with six probationer students who receive a year's training in the management of young children, in cooking, in sewing, and in mending and laundry work. The great demand for accommodation indicates the need for other day nurseries in the borough. Summary The table on pages 38-39 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. 41 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 20,746 10 7 63 44.2 1934 20,782 8 7 63 55.7 1935 Not available 59 57.1 Summary of Work carried out (Visits Paid) by the 4 Whole-time Official Health Visitors during 1934. Ante-natal Visits 1,284 Do. Re-visits 125 Births, 1st Visits 906 Do. Re-visits 238 Do. Stillborn 87 Ophthalmia, 1st Visits 89 Do. Re-visits 152 Infantile Deaths, Visits 32 Welfare Centre Attendances 568 Clinic Attendances 129 Visits—No result 1,206 Special Visits (Measles, Diphtheria Prevention, etc.) 771 42 Visits to Children 1-5 (included above) 313 Puerperal Pyrexia, 1st Visits 51 Do. Re-visits 37 Enlarged Tonsil and Adenoid Visits 63 Do. Re-visits 2 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. The number of notifications of Puerperal Fever and Puerperal Pyrexia received during the year was 60, of which 35 occurred in primiparae, 23 in multiparae, while the parity of the remaining 2 was not ascertained. The causes giving rise to the notifications are detailed in the following table:— Cause Primiparae Multiparae Ante-natal care Yes No Manual interference 10 1 8 3 Abortion 2 3 0 5 Caesarean section 0 3 3 0 Mastitis 2 3 5 0 Influenza, Bronchitis, etc. 4 4 8 0 Pyelitis cystitis 5 3 6 2 H. Streptococcal Infection 2 3 4 1 Tonsillitis 2 1 2 1 Local Uterine Sepsis 5 0 4 1 Various 3 2 3 2 Totals (58) 35 23 43 15 43 Four of the five cases of Haemolytic Streptococcal infection occurred in a small private nursing home where the only focus of infection common to all was the one night nurse. Each case had engaged her own doctor for the confinement, and the other members of the nursing staff did not come into contact with all the cases except the one night nurse who, incidentally, did not reside on the premises. She wore no mask when attending her patients, and harboured Haemolytic Streptococci in her pharynx for more than two months. 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 material alteration during the year in the arrangements for Public Cleansing. Sanitary Inspection of the Area. 5,450 Notices were served during the year 1935, as follows: — Public Health (London) Act, Metropolis Local Management Acts Housing Acts, etc. (a) District Sanitary Inspectors. Preliminary or Intimation Notices. (1) Male Inspectors 3,552 (2) Women Inspectors 104 3,656 Statutory Notices. (1) Male Inspectors. (a) P.H. Act 155 (b) Met. Man. Acts 10 (2) Women Inspectors - 165 Disinfection Notices 1,626 (b) Food Inspectors. (1) Public Health (Meat) Regulations 5 (2) L.C.C. (General Powers) Acts 9 14 44 (c) Housing Inspectors. Informal Schedules 145 Formal Notices 9 154 Total 5,450 7 Summonses were issued, with results as follows :— Public Health (London) Act, 1891. Convictions 2 Summons withdrawn on costs 1 3 Metropolis Management Acts. — — Food and Drugs (Adulteration) Act, 1928. Convictions — Summons withdrawn 1 Summons withdrawn on costs — Summons dismissed on costs 3 4 Total 7 Sanitary Staff. The Sanitary Inspectorial Staff consists of 11 district Sanitary Inspectors, 2 special Sanitary Inspectors (Food), 2 special Sanitary Inspectors (Housing), 1 special Sanitary Inspector (overcrowding), 2 women Sanitary Inspectors, 1 Infant Life Protection Visitor, 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 11 District Sanitary Inspectors during 1935. Inspections 11,168 Re-visits 28,911 Complaints received 4,953 Water Certificates issued (635 separate houses or tenements including 20 blocks of tenements) 97 Drains tested (with chemical, water or smoke test) 3,972 Sanitary Works completed 4,226 Sanitary Nuisances 12,639 45 1. Bath Waste: Totals (a) directly connected to drain 8 (b) improperly trapped or untrapped ; defective 51 2, Basement dwellings (a) inspections 2 (b) reinspections 4 3. Ceilings and Walls : defective 778 4. Chimney: defective 59 5. Copper : defective 100 6. Damp condition of premises 751 7. Dilapidated condition of premises 244 8. Door: defective 98 9. Drains : (a) defective 274 (b) fresh air inlet defective 148 (c) gulley defective 85 (d) manhole defective 63 (e) plunging eye defective 34 (f) soil pipe defective 106 (g) stopped 327 (h) trap insufficient 16 (i) ventilation insufficient 18 (j) vent pipe defective 115 10. Dustbins or Ashpits : (a) defective or dilapidated 662 (b) absence of 127 11. Fireplace : defective 328 12. Floors: defective 307 13. Lavatory Waste : directly connected to drain, improperly trapped or untrapped 26 14. Paving (yard or area) : (a) defective 290 (b) undrained 17 15. Rainwater Pipe and Gutters : (a) rainwater pipe defective 237 (b) gutters defective 353 (c) rainwater pipe directly connected to drain 25 16. Roof: defective 1,026 46 17. Sinks: Totals (a) defective 222 (b) directly connected to drain 18 (c) improperly trapped or untrapped 180 (d) waste defective 222 18. Stable : (a) absence of proper manure receptacle 3 (b) drain defective — (c) paving defective 2 (d) undrained 1 19. Washhouse : (a) roof defective 60 (b) paving defective 65 (c) undrained 3 20. Water Closet: (a) defective so as to be a nuisance 239 (b) improperly constructed so as to be a nuisance 36 (c) insufficient or improper accommodation 27 (d) pan and trap defective 257 (e) deficient or defective water supply 164 21. Water Supply : (a) cut off 45 (b) draw-off from main required 14 (c) no supply 28 (d) pipes, taps, etc., defective 57 (e) storage cistern defective or uncovered 15 (/) storage cistern so foul as to be a nuisance 7 (g) tenement houses supplied 5 22. Windows: defective 441 23. Animals : improperly kept 28 24. Bakehouses : (a) inspections 251 (b) reinspections 147 (c) dirty 55 25. Dirty Premises : (a) walls and ceilings of rooms dirty 2,004 (b) rooms, etc., verminous 467 (c) stable premises dirty 9 (d) washhouse walls and ceilings dirty 359 (e) water closet walls and ceilings dirty 305 (/) workshops and factories 28 26. Effluvium nuisance : (a) from industrial premises 20 (b) from private premises 23 27. Lighting and Ventilation : defective 26 47 Totals 28. Manure: accumulation or deposit injurious to health 19 29. Overcrowding 27 30. Rats infestation : (a) Industrial premises 23 (b) Private premises 152 31. Refuse accumulations 186 32. Smoke Nuisance : (a) from industrial premises 42 (b) from private premises 38 33. Stagnant Water : accumulation 30 34. Underground Rooms : occupied as a dwelling ... 16 35. Urinal: foul 15 In addition, the District Sanitary Inspectors carried out during 1935 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 men's 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 the Inspectors in connection with 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. Rent and Mortgage Interest Restrictions Acts, 1920-33. During the year 29 inspections were made and 23 certificates granted. It should be noted that since the 1933 Act a certificate, when applied for in accordance with the provisions of the Acts, must be granted. The administrative latitude previously permissible is now therefore curtailed. London County Council (General Powers) Act, 1928. Action taken under section 28. In three cases only was it necessary to obtain a magistrates' order under this Section. Several other old people were induced to enter the London County Council Hospital without the need for application for orders. 48 Home Office Table. Factories, Workshops and Workplaces. 1.—Inspection of Factories, Workshops and Workplaces (Including inspections made by Sanitary Inspectors or Inspectors of Nuisances) Premises (1) Number of Inspections (2) Written Notices (3) Occupiers prosecuted (4) Factories (Including Factory Laundries) 302 17 — Workshops (Including Workshop Laundries) 346 26 - Workplaces (Other than Outworkers' premises) 325 1 - Total 973 44 - 2.—Defects found in Factories, Workshops and Workplaces Particulars Number of Defects Number of offences in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Want of cleanliness 76 76 - - Want of ventilation 1 1 - - Overcrowding — — - - Want of drainage of floors 3 3 - - Other nuisances ... 6 6 - - Sanitary accommodation— Insufficient 6 6 - - Unsuitable or defective 26 26 - - Not separate for sexes 3 3 - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - Other offences - - - - (Excluding offences relating to outwork and offences under the Sec tions mentioned in the Schedule of the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) Total 121 121 - - * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 49 Outwork in Unwholesome Premises, Section 108. Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) Wearing Apparel— Making, etc 141 — — Cleaning and washing 1 — — Household linen 3 — — Lace, lace curtains and nets 7 — — Curtains and furniture hangings 3 — — Furniture and upholstery 1 — — Electro-plate — — — File making — — — Brass and brass articles , — — — Fur pulling — — — Cables and chains. — — — Anchors and grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, etc. — — — Artificial flowers — — — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags 16 — — Brush making — — — Pea picking — — — Feather sorting — — — Carding, etc., of buttons, etc. 2 — — Stuffed toys 3 — .— Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, etc. — — Textile weaving — — — Lampshades — — — Fancy articles, pin cushions, milk bottle covers, etc. 17 — — Total 194 — Summary of Work carried out by the Women Sanitary Inspectors during 1935. Workshops* visited and inspected 483 Workshops* : workrooms therein measured 28 Workshops* : newly discovered and registered 25 * Workshops include Work-places. D 50 Premises visited, but not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 845 Women's Conveniences visited and inspected, etc. (visits paid) 1,033 Special places visited and inspected : (a) Restaurants 384 (b) Housing enquiries 470 (c) Outworkers 206 (d) Complaints, Infectious diseases, etc 90 1,150 Re-inspections : (a) Restaurants 95 (b) Housing enquiries 103 (c) Outworkers 5 (d) Complaints, etc 26 229 Written Intimation and Statutory Notices served 104 No. of Workshops, etc., in which defects were found109 No. of Workshops, etc., in which no defects were found 1,392 Nuisances referred to M.O.H., for attention by Male Inspectors 8 Particulars of Defects found by Women Inspectors. Workshops, etc. :— Workrooms : Overcrowded, Damp, Dirty, etc. 1 Defective or Dirty: Yards, Floors, Roofs, Windows, Walls and Geilings, Rain Water Pipes, Sink Wastes, or Premises generally 66 Sanitary Appliances : Water Closets—Dirty, unventilated, choked, defective or with defective cistern or water supplies 45 Drainage-—Defective 2 Dustbins-—Wanting or Defective 14 Lavatories—Dirty or Defective 4 No separate suitable sufficient W.C. accommodation for the sexes 1 Miscellaneous Defects, Defective Chimneys, etc. 51 Factories and Workshops. Thirty-four new factories, 48 new workshops, and 82 new workplaces were added to the Register, dealing with various trades. Out-workers. Nine February and nine August lists were received, dealing with 150 and 170 out-workers respectively. Of the 320 out-workers 138 belonged to Lambeth and the remainder lived in other areas. Particulars of the latter were sent to the Authorities concerned, whilst, in return, 85 lists were received from various outside authorities dealing with 460 workers living in Lambeth. Of the total Lambeth out-workers reported 111 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. 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). 52 (b) Cow-houses. In 1882 there were 79 cow-houses licensed in the district. Since that date there has been a progressive reduction in the numbers and the last cow-house remaining was closed in September, 1934, although still registered. (c) Slaughter-houses and Slaughtermen. Three Slaughter-houses were licensed (renewals) as follows :— 207 Coldharbour Lane (A. J. Clark). 121 Norwood High Street (rear of) (W. Crouch). 60 Kennington Park Road (T. H. Grellier). Twelve slaughterer's licences were granted under the provisions of the Slaughter of Animals Act, 1933. (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 72.) (f) Ice Cream Vendors. At the end of the year there were 454 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. (g) Bakehouses. There are 134 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 75.) Smoke Abatement. Metal plates containing suggestions to avoid the unnecessary emission of smoke have 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 42 No. of intimation notices served 42 No. of observations made 80 Every effort is made to enlist co-operation with industry by the sanitary inspectors in order to reduce the waste and nuisance from smoke. 53 Shops Acts, 1934 Sixty inspections and ten re-inspections were made during the year in connexion with ventilation, temperature and sanitary conveniences. No legal proceedings were instituted, as all alterations required were carried out informally. Twenty-one exemption certificates were granted regarding the provision on the premises of sanitary conveniences owing to restricted accommodation or other special circumstances affecting the premises. Swimming Baths and Pools There are three bathing establishments in the district ; one indoors in Lambeth Road, S.E. 1, belonging to the Borough Council, is connected with the Baths and Washhouses ; another, " open-air," situated in Kennington Park, S.E. 11, belongs to the London County Council, and is fitted with continuous filtration and chlorination plant ; while the third is an open-air pool, without means of cleansing, in Brockwell Park, S.W. 2. The work is already in hand of constructing an open-air bath, with an adequate purification plant, to replace the old pool in Brockwell Park, which will then be closed for bathing purposes. Samples taken during the year from the Borough Council's indoor bath disclosed a degree of contamination which was reported as being serious and almost dangerous, seeing that the number of organisms capable of growing on standard agar in twenty-four hours at 37 degrees centigrade numbered from 200,000 to 300,000 per cubic centimetre, B. Coli being present in 1 cubic centimetre, and B. Welchii in 100 centimetres, the system of purification being fill and empty with chloros added. The following table is inserted for purposes of comparison, the figures for other baths being recent averages from various districts in the country, and the last column referring to the water supplied by the Metropolitan Water Board. The following table is inserted for purposes of comparison, the figures for other baths being recent averages from various districts in the country, and the last column referring to the water supplied by the Metropolitan Water Board. 54 Lambeth Baths : Fill and empty with Chloros added Other Baths : Fill and empty with Chloros added (last day before refill) Other Baths : Continuous purification M.W.B. water Men's Women's No. of organisms capable of growing on standard agar in 24 hours at 37° C. some 200,000 some 300,000 70,000 1—300 Ladies' day 3,500 4 B. Coli present in 1 c.c. 1 c.c. 1 c.c. Not found in 100 c.c. except Ladies' day Not found in 100 c.c. B. Welchii in 100 c.c. Yes + Yes + Yes No No 55 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 infections disease is concerned. Housing. Housing Act, 1930. Part 1. The London County Council made orders for the following clearance areas during the year. At those inquiries which have been held before the Inspector of the Ministry of Health, evidence was given by the Borough Medical Officer in support of that of the County Medical Officer. Dwelling-houses Persons displaced Norfolk Row 11 62 Pearson's Place 21 67 Additional 6 41 Dorset Road— (1, 2 and 4 Areas) 17 1,153 (3 Area) 193 Additional 65 288 Newburn Street (1) 222 1,118 Additional 58 419 Newburn Street (2) 9 40 Additional 1 8 Colwyn Street (1) 82 421 Additional 28 209 Colwyn Street (2) 2 15 Tinworth Street 53 317 Additional 22 140 Evans Cottages 20 95 810 4,393 Housing Act, 1930. Part 2. Following is the record of work done during the year, including that done by the Council's two Housing Inspectors :— (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 244 (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 145 56 (6) Schedules prepared for the purpose of Statutory Notices under Section 17 of the Housing Act, 1930 9 (7) Record Cards (Section 17) filed 145 (8) Surveys made under Section 19 of the Housing Act, 1930 14 (9) Record forms (Section 19) filed 14 (10) Surveys made under Section 20 of the Housing Act, 1930 (underground rooms and parts of buildings) 117 (11) Record forms (Section 20) filed 117 (12) Drain tests made (chemical, smoke, and wate) 425 (13) Total visits made (re-visits, 11,634) 11,907 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 :— Prince's Ward. Distin Street (5), Goding Street (1), Princes Road (5), Wood Street (12). Vauxha.ll Ward. Camellia Street (1), Larkhall Lane (1), Luscombe Street (13), Paradise Road (6), Riverhall Street (4), Thorncroft Street (1). Angell Ward. Knowle Road (1), Langton Road (4), Valentia Road (7). Stockwell Ward. Bellefields Road (15), Ferndale Road (2), Kepler Road (6), Lingham Street (7), Linom Road (1), Love Lane (2), Solon New Road (1), Southesk Street (5), Stockwell Park Road (1), Stockwell Park Walk (4). Town Hall Ward. Bonham Road (1), Branksome Road (4), Cornwall Road (3), Lyham Road (2), Torrens Road (2). Tulse Hill Ward. Dulwich Road (6), Elm Park (1), Thurlow Hill (1). Knight's Hill Ward. Clive Road (6), Hamilton Road (10), Hamilton Road, Burtwell Cottages (2), Woodland Hill (2). The actual work has been completed, or practically ccmpleted, 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) :— Prince's Ward. Upper Kennington Lane (Nos. 70, 72, 74). Vauxhall Ward. Hemans Street (Nos. 8, 10, 12, 14, 16, 18, 20, 22). 57 (2) After Service of Provisional (Informal) Schedules :— Bishop's Ward. Carlisle Street (Nos. 35, 39, 41), Colwyn Street (No. 20), Wylie Place (Nos. 1, 2). Prince's Ward. Distin Street (Nos. 11, 12, 13, 14, 15), Kennington Road (Nos. 178, 182, 184, 186, 188, 190, 192, 194, 196, 198, 200, 202, 204, 206, 208, 210), Wood Street (No. 4). Vauxhall Ward. Cavendish Grove (Nos. 29, 31), Larkhall Lane (No. 74), Luscombe Street (Nos. 1, 2, 4, 6, 8, 9, 10, 11, 12, 13), Paradise Road (Nos. 15, 17, 19, 21), Riverhall Street (Nos. 6, 7, 8, 9, 12, 13, 14, 15, 16, 18, 22, 23, 24, 25, 26, 27, 29, 30, 31, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54), Thorncroft Street (No. 31), Wandsworth Road (No. 307). Oval Ward. Kennington Road (Nos. 290, 292, 294, 296, 298, 300, 302, 304, 306, 308, 310, 312, 314, 316), Upper Kennington Lane (Nos. 1, 3, 5, 7, 9, 11, 13, 15, 17, 19), Windmill Row (Nos. 1, 3, 5, 7). Vassall Ward. Frederick Crescent (No. 23), Myatt Road (Nos. 31, 33, 35). Angell Ward. Burton Road (No. 17), Coldharbour Lane (No. 320), Knowle Road (No. 3), Langton Road (No. 52). Stockwell Ward. Bellefields Road (Nos. 2, 6, 8, 10), Cottage Grove (No. 40), Ferndale Road (Nos. 94, 96), Kepler Road (Nos. 8, 10, 12, 14, 31), Lingham Street (Nos. 53, 55, 57, 59, 63, 65, 67), Linom Road (No. 4), Sidney Road (Grove House), Solon New Road (No. 45), Southesk Street (Nos. 9, 11, 13, 15, 17), Stockwell Green (Nos. 10, 11). Town Hall Ward. Branksome Road (Nos. 44, 56, 62, 70), Cornwall Road (Nos. 33, 35), Lyham Road (Nos. 39, 41, 147, 149, 151, 173, 175), Torrens Road (Nos. 8, 11). Tulse Hill Ward. Thurlow Hill (No. 39). Knight's Hill Ward. Benton's Lane (Nos. 27, 30, 33, 34), Burtwell Cottages, Hamilton Road (Nos. 1, 2), Hamilton Road (Nos. 20, 22, 24, 26, 135, 137, 139, 141, 143, 145), Surrey Mews, Hamilton Road (Nos. 1, 2, 3), Woodland Road (Nos. 55, 57, 59, 61, 63). Informal schedules held in abeyance owing to the houses being included in a rebuilding scheme or other arrangement :— Bishop's Ward. Carlisle Street (Nos. 43 to 53 odd), Vauxhall Walk (Nos. 78 to 88 even). . Vauxhall Ward. Cavendish Grove (Nos. 25, 27). 58 Oval Ward. St. Mark's Road (Nos. 12 to 64 even). Stockwell Ward. Belgrave Terrace (Nos. 1 to 6 consecutive). Knight's Hill Ward. Windsor Road (Canton Cottage). Nine Notices (legal schedules) have been served during the year in respect of the following houses :— Prince's Ward. Upper Kennington Lane (Nos. 70, 72, 74). Vauxhall Ward. Rutland Street (Nos. 21, 22, 23). Angell Ward. Padfield Street (Nos. 3 and 4). Tulse Hill Ward. Elm Park (No. 97). Work has also been started in many other cases, and is in various stages of progress, while, in addition, many provisional (informal) 1 schedules have been served in connection with houses, but the work has not yet been commenced. Forty-five representations were made under the Housing Acts, as follow :— (a) Section 19 (Demolition Orders—5 representations). Marsh Ward. College Street (No. 55), Waterloo Road (No. 179). Stockwell Ward. Brighton Terrace (Nos. 1, 3, 5). (i) Demolition Order Made. Marsh Ward. Waterloo Road (No. 179). (ii) Undertakings Carried Out. Marsh Ward. Broadwall (Nos. 40, 42). (Undertakings given in 1934.) (b) Section 20 (Underground rooms and parts of buildings—40 representations). Marsh Ward. Lambeth Square (No. 19, underground room), Lower Marsh (Nos. 83 and 84, rooms over shops), York Road (No. 80 underground room). Bishop's Ward. Crozier Street (No. 7, underground room), Oakley Street (No. 7, underground room), Old Paradise Street (No. 53, underground room), Vauxhall Walk (No. 130, underground room). 59 Prince's Ward. Ethelred Street (No. 70, underground room), Gilbert Road (No. 44, underground room), Holyoak Road (No. 50, underground room), Oakden Street (No. 22, underground room), Renfrew Road (No. 11, underground room), Wincott Street (No. 52, underground room), Vauxhall Street (No. 106, underground room). Vauxhall Ward. Brooklands Street (No. 7 underground room), Horace Street (No. 1, underground room). Oval Ward. Clapham Road (No. 112, underground room), Harleyford Road (No. 56, underground room), Kennington Road (No. 295, underground room), Methley Street (No. 41, part of a building), South Lambeth Road (No. 19, underground room). Vassail Ward. Camberwell New Road (Nos. 58, 64, underground rooms), Holland Street (No. 52, underground room), Offley Road (No. 44, under ground room). Angell Ward. Brixton Road (No. 361, underground room), Eastlake Road (No. 1, underground room), Knowle Road (No. 59, underground room), Overton Road (No. 24a, underground room), St. Lawrence Road (No. 52, underground room), Wynne Road (No. 32, underground room). Stockwell Ward. Stockwell Green (No. 11, underground room). Town Hall Ward. Brixton Hill (No. 182, underground room), Hayter Road (No. 30, underground room). Heme Hill Ward. Railton Road (No. 23, underground room). Tulse Hill Ward. Shakespeare Road (Nos. 4, 8, underground rooms), Spenser Road (No. 21, underground room), Upper Tulse Hill (No. 101, underground room). (i) Closing Orders Made. Marsh Ward. York Road (No. 80). Bishop's Ward. Crozier Street (No. 7), Oakley Street (No. 7), Old Paradise Street (No. 53), Vauxhall Walk (No. 130). Prince's Ward. Ethelred Street (No. 70), Vauxhall Street (No. 106). Vauxhall Ward. Cavendish Grove (No. 35, represented in 1934), Horace Street (No. 1). Oval Ward. Upper Kennington Lane (No. 185, represented in 1934). 60 Vassall Ward. Camberwell New Road (No. 58) Holland Streeet (No. 52). Angell Ward. Wynne Road (No. 32). Heme Hill Ward. Somerleyton Road (No. 23, represented in 1934). Tulse Hill Ward. Shakespeare Road (No. 8), Spenser Road (No. 21). The Closing Orders have been complied with in all cases except Nos. 80 York Road, 7 Oakley Street, 130 Vauxhall Walk, 70 Ethelred Street, 58 Camberwell New Road, and 58 Holland Street. In addition, the Orders made in 1934 respecting 52 Waterloo Road and 2 Radnor Buildings, have been complied with during 1935. (ii) Undertakings Received in Lieu of Closing Orders. Princes Ward. Holyoak Road (No. 18, represented in 1934), Wincott Street (No. 52). Vauxhall Ward. Aldebert Terrace (No. 13, represented 1934). Oval Ward. Kennington Road (No. 295). Angell Ward. Eastlake Road (No. 1). Tulse Hill Ward. Mayall Road (No. 34, represented 1934). (iii) Premises Found to be Vacated or Accommodation Rearranged after Service of Notices. Marsh Ward. Lambeth Walk (No. 19). Vauxhall Ward. Aldebert Terrace (No. 13, represented in 1934), Brooklands Street (No. 7), Clapham Road (No. 278a, represented in 1934). Oval Ward. Harleyford Road (No. 56), South Lambeth Road (No. 19). Vassail Ward. Camberwell New Road (No. 64). Angell Ward. Brixton Road (Nos. 273 (represented 1934) and 361), Knowle Road (No. 59), Overton Road (No. 24a). Town Hall Ward. Brixton Hill (No. 182). Tulse Hill Ward. Mayall Road (Nos. 17, 34, both represented in 1934). 61 (iv) Houses Represented, but Since Made Fit. Prince's Ward. Gilbert Road (No. 44), Oakden Street (No. 22). Vassail Ward. Offley Road (No. 44). Stockwell Ward. Stockwell Road (No. 198, represented 1934). Tulse Hill Ward. Shakespeare Road (No. 4), Water Lane (No. 44, represented 1934). (v) Houses Represented, but Orders not yet made. Lower Marsh (Nos. 83, 84), Holyoak Road (No. 50), Renfrew Road (No. 11), Clapham Road (No. 112), Methley Street (No. 41) Stockwell Green (No. 11), Hayter Road (No. 30), Railton Road (No. 23), Upper Tulse Hill (No. 101). (vi) Houses Represented, but no Further Action Taken by Council. St. Lawrence Road (No. 52). In addition to the premises represented as set out in (a) and (b), 9 and 77 premises respectively were inspected, with a view to action under Section 19 or 20. During the year, as the result of informal action, 12 underground basements were made fit, 4 were vacated or closed and undertakings given, and in 18 the work is in progress or about to begin, which will render them fit for human habitation. 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) . 11,444 (6) Number of Inspections made for the purpose* 40,545 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 145 (6) Number of Inspections made for the purpose* 1,015 * Total re-inspections during 1935. 62 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 40 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 4,246 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 145 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 11 (b) By Local Authority in default of owners B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 165 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 130 (b) By Local Authority in default of owners 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 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 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 16 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 Housing Act, 1935. Survey of Overcrowding. (a) The survey of overcrowding undertaken by the Council in accordance with the provisions of the Housing Act, 1935, was completed by the middle of January, 1936. The original estimate 63 of the number of dwellings to be surveyed was 40,000, but this proved lower than was expected and the actual number was 48,184. The clerical assistants began work on the 2nd October, entering particulars of dwellings on Form A from the rate books to prepare for the 40 enumerators who, with five supervisors, began the inquiry at the houses on the 1st November. The enumeration was practically completed in two and a half weeks, after which one enumerator was retained to investigate queries and to follow up cases where information was not obtained owing to families being away or at work at the time of the enumerators' previous visits. The first part of the survey divided the families into three categories :— (a) Those definitely overcrowded. (b) Those definitely not overcrowded. (c) Those not overcrowded in so far as the number in the family and the number of rooms were concerned, but who might be overcrowded if the floor area of the rooms were less than is required by Table 2 of the 1st Schedule of the Act. To obtain definite information regarding families in category (c), the measurement of the area of each room in accordance with instructions contained in the Provisional Regulations dated the 15th October, 1935, made by the Minister of Health under the Housing Acts, 1925 to 1935, was undertaken by the survey assistants (four of whom began work on the 8th November) and recorded on Form B. The number was increased to 13 by the 3rd December, and the measurement of 8,007 houses was completed by the 9th January, and entered on Form B. It will be realised that the bald statement of the work carried out hides a multitude of details which required careful attention at the time as well as much forethought to avoid pitfalls and difficulties. It says much for the administration and for the " field work " that no formal notices were required to be served on families who might have refused to tender the information informally requested. Three complaints only were received, but on investigation the cause was found to be the cantankerous nature of the individual well recognisable as anxious to see offence where none is intended. The readiness with which information of age and sex and rooms occupied, was tendered by the people, is a tribute to their common sense in aiding the temporary staff to carry out their arduous and monotonous inquiry. 64 Among the many details, arrangements were made for both enumerators and survey assistants to accept complaints regarding nuisances which were passed to the sanitary inspector of the district to follow up. This attention did undoubtedly smooth a difficult path at times. The results of the survey contained in the 56,191 forms, A and B, were then collated on Forms C, which give a clear picture of the degree of overcrowding as will be seen in the Form C for the whole borough, on pages 65-6. Briefly, the ordinates of the graph are the equivalent number of persons in the family and the abscissae the number of families occupying dwellings with specified accommodation. The graph is divided by a black line, and all families with adequate accommodation appear above it, while overcrowded families are entered below it. The summary in the lower right corner shows that the 48,184 houses surveyed provide dwellings for 76,924 families; of which only 3,881 are overcrowded, i.e., 5.04 per cent. The number of " equivalent persons " overcrowded is 19,798 and the proportion of the estimated total " equivalent population " overcrowded in the Borough is 7.5 per cent. 65 66 Form C. OVERCROWDING SURVEY.—SUMMARY, 1935 Equivalent number of persons in family Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families 1 1 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 Overcrowded Not Overcrowded Total l 99 5045 925 2385 395 — 1478 24 135 — 609 3 5 11 165 3 4 111 6 — 48 — 1 — 63 llllllllllllll llllllllllllll 11515 11515 1½ 21 7 24 115 18 — 75 3 7 — 16 — — 1 3 — — 1 — — 1 — — — 1 21 272 293 2 29 102 739 4674 1558 21 6843 146 866 14 3581 28 42 108 1193 7 7 597 11 — 267 2 5 — 341 131 21050 21181 2½ 2 91 67 79 1534 15 2531 70 397 5 1055 11 17 32 270 2 3 99 2 — 28 — — 2 28 160 6180 6340 3 2 57 55 105 1383 24 3792 134 745 21 3768 58 97 183 1643 14 31 909 36 — 418 3 5 2 490 219 13756 13975 3½ 2 11 14 268 214 5 860 42 245 4 820 15 27 54 281 4 2 146 5 1 42 — 1 — 34 509 2588 3097 4 — 6 7 311 239 49 90 132 1224 35 2412 48 89 203 1334 24 22 995 40 4 442 1 7 1 489 612 7592 8204 4½ — 1 7 89 49 7 24 32 296 27 484 17 23 38 252 7 8 169 8 — 64 3 3 — 56 177 1487 1664 5 — 3 7 109 68 16 56 74 461 20 1026 26 43 123 846 11 12 639 34 2 315 5 13 1 392 333 3969 4302 5½ — — 2 49 32 4 162 18 72 7 310 14 21 32 157 6 6 144 6 2 65 1 — — 47 339 818 1157 6 — 3 47 23 2 221 19 99 35 45 53 67 173 376 13 9 398 23 3 190 4 3 2 311 449 1670 2119 6½ — — — 19 14 2 74 10 31 13 28 28 31 54 102 2 7 88 2 2 35 1 2 — 55 191 409 600 7 — — 1 19 8 1 75 10 30 14 38 35 26 93 168 13 6 183 5 3 117 2 6 1 176 231 799 1030 7½ — — — 3 3 — 29 7 18 4 12 11 22 30 54 6 8 47 6 6 23 — — — 38 109 218 327 8 — — — 4 3 1 19 3 2 8 87 11 8 27 4 12 12 97 10 5 43 6 3 1 130 173 323 496 8½ — — — 2 1 — 10 — — 2 37 — 3 7 9 1 7 26 7 1 12 — — — 22 71 76 147 9 — — — 3 — 1 3 1 5 1 23 2 5 5 3 8 4 39 3 1 17 — 3 1 78 60 146 206 9½ — — — 1 1 — 3 — 1 — 15 — 1 3 3 2 3 1 2 — 6 — 1 — 20 33 30 63 10 — — — — 1 — 1 — — — 9 1 3 — 3 1 5 3 4 2 9 — — 1 36 27 52 79 10½ — — — — — — 1 — — — 3 — — — 2 — 1 1 — — 3 — 1 — 14 8 18 26 11 4 1 2 1 1 — — 1 1 1 — — 28 10 30 40 11½ — — — — — — — — 1 — — — — — 3 — 1 1 — 1 1 — — 1 7 8 8 16 12 — — — — — — — — — — — —— — — — — — — — — — — — 18 4 18 22 12½ — — — — — — — — — — — — — — — — — — — — — — — 2 2 2 4 13 — — — — — — — — — — — — — — — — — — — — — — — — 17 4 17 21 TOTALS OF DWELLINGS Overcrowded 56 271 163 1029 656 83 678 142 259 77 257 61 43 42 28 12 11 7 2 2 1 1 — — — 3881 llllllllllllll llllllllllllll llllllllllllll ////////////// llllllllllllll llllllllllllll Not Ovecrowded 99 5052 1688 7253 4888 65 15669 583 4376 133 14126 301 488 1135 6848 125 148 4689 210 32 2146 29 54 13 2893 llllllllllllll llllllllllllll llllllllllllll 73043 llllllllllllll llllllllllllll llllllllllllll Total 155 5323 1851 8282 5544 148 16347 725 4635 210 14383 362 531 1177 6876 137 159 4696 212 34 2147 30 54 13 2893 llllllllllllll llllllllllllll llllllllllllll llllllllllllll llllllllllllll llllllllllllll llllllllllllll llllllllllllll 76924 67 Broadly speaking, the result of the survey showed that the degree of overcrowding is generally lower than was anticipated, but, naturally, a graph for the whole borough can give no indication of those parts of the area where the percentage of overcrowding is either high or low. A similar graph on Form C, therefore, was prepared for each Ward, for the Borough Council estates, for the County Council estates, and for the Corporation of London estate. The tabulated results are :— Number of Total Percentage Ward families number of of overcrowded families overcrowded Marsh 326 3,368 9.6 Bishops 940 5,283 17.7 Princes 642 6,197 10.3 Oval 373 6,218 5.9 Vassall 148 4,886 3.0 Vauxhall 443 7,550 5.8 Angell 275 8,218 3.3 Stockwell 209 8,868 2.3 Town Hall Ill 3,862 2.8 Heme Hill 117 4,076 2.8 Tulse Hill 156 9,726 1.6 Knight's Hill 141 8,672 1.6 Borough Council estates 64 829 7.7 County Council estates 142 1,292 10.9 City of London estate 2 48 4.0 The survey does not include every house in the Borough. Only those were the subject of inquiry which are occupied, or are of a type suitable for occupation, by that undefined portion of the population referred to in the Housing Acts as the " working classes," and excluded the City of London and Metropolitan Police estates, and certain Crown properties. It will be realised that great care was needed in the differentiation between those dwellings which should and those which should not be surveyed. Surprise may be expressed at the degree of overcrowding in the municipal estates, but it is due in part to the size of the rooms being a few square feet less than the standard room of 110 square feet, the families falling into category (c) rather than (a). Apart from municipal estates, the bulk of the overcrowding as was expected, is found in dwellings of one, two and three rooms and is greatest in the two-roomed dwellings, the percentages of the total number overcrowded being 12.6 per cent, one room, 43.4 per cent, two rooms, 29.9 per cent, three rooms, approximately 85.9 per cent, of the total. E 68 The survey was completed in less than the time arranged, and the expenditure was kept well within the estimate. The compilation and collation of the results of the survey were not easy with a large temporary staff, whose work required repeated checking and cross-checking in order to balance totals. As will be readily appreciated, considerable extra work has devolved upon the clerical staff of the Public Health Department, and it is a matter of congratulation that the survey has proceeded smoothly and swiftly, side by side with the routine duties, without any more than a slight temporary dislocation of work from time to time. (b) The number of families found to be overcrowded as the result of the survey is 3,881. Obviously it would not be necessary to provide dwellings for each of these families, as such a course would leave that number of dwellings empty, many of which would be available for re-letting, and, moreover, would not take into account those dwelling-houses which were found to be empty and presumably to be to let at the time of the survey. For the purpose of forming an estimate of the dwelling-houses required to abate the overcrowding in the area, it was assumed that the margin of permanently vacant accommodation caused by changes of tenancy and therefore not available for overcrowded families could be taken as 2 per cent, of the total accommodation in the Borough. The remaining accommodation vacant at the time of the survey, after subtraction of the 2 per cent, is not expected to be available to a greater extent than 10 per cent., and the requirements of the district are based in the main upon these two assumptions. It will be realised that a number of overcrowded families are at present living in the 1,800 houses situated in the large and small clearance areas which will be dealt with under Part I, Housing Act, 1930, as well as in those underground rooms, parts of buildings and individual unfit houses which it is intended shall be dealt with under Part II, Housing Act, 1930, and which now house some 1,728 families. On the basis of the survey the estimated number of overcrowded families in Part I houses is 148, .and in Part II houses, 86. The total number of overcrowded families who will be re-housed as the result of action taken under Parts I and II of the Housing Act, 1930, is therefore 234, and this number has been accounted for in the estimation of the number of dwellings which are required to abate overcrowding. The accommodation needed for re-housing under the Housing Act, 1930, specified in section 37, differs from the standard of accommodation of the Housing Act, 1935, laid down in Schedule I of the Act as the number of persons permitted to use a house for sleeping. In addition, the standard laid down in section 37, Housing Act, 1930, accounts for each member of a family as a person, 69 whereas in section 2, Housing Act, 1935, no account is taken of a child under one year old, and a child who has attained one year and is under ten years old is reckoned as one half of a unit. After negotiations between the London County Council and the Metropolitan Boroughs' Standing Joint Committee, it was agreed that the estimate of new accommodation to be erected to abate overcrowding should be based upon the standard of the Housing Act, 1930, and not that of the Housing Act, 1935. In order to make an accurate adjustment it would be necessary to determine the average proportion of children to adults in each size of dwelling. Having regard to the work which would be involved, it was also agreed that such a detailed adjustment should not be attempted. The estimation of new dwellings required has therefore been adjusted on the basis of 1J persons per room. The final result of the calculations after taking into account all the facts briefly outlined above, can best be appreciated from the following table (which is one of a series prepared for the County Council), but which in itself gives little idea of the difficulties overcome before its completion. 70 "Table H (Adjusted) " Additional dwellings required on the standard of Table I in the first Schedule to the 1935 Act (Table F) Additional dwellings required on the standard of 1 J persons a room (using the percentages in Table G) Size Number 3 rooms 4 rooms 5 rooms 6 rooms 7 rooms 8 rooms 9 rooms 10 rooms Total 3 rooms 565 452 85 28 — . — — — — 535 4 rooms 457 — 183 251 23 — — — 457 5 rooms 126 — 26 44 50 6 — — 126 6 rooms 10 — — — — 2 5 3 — 10 7 rooms 2 — — — — — — 2 — 2 Totals 1,160 452 268 305 67 52 11 5 — 1,160 71 It must be understood that the figure of 1,160 new dwellinghouses is an estimation of the required number based upon assumed postulates, and by no means necessarily represents the actual number, but it forms the basis of the proposals which the County Council, in agreement with the Borough Council, has submitted to the Minister to satisfy the requirements to abate overcrowding in Lambeth. Rehousing. During the year 276 fresh applications for housing accommodation were received in the Public Health Department (mostly from the applicant in person), and of these 133 were sent forward to the County Authority for attention or preferential treatment, while, in addition, 19 applications were recommended for housing on the Lambeth Council Estates. The remaining 124 after careful scrutiny, could not be recommended for various reasons, such as insufficient income or other circumstances. Of the 152 cases referred to, 23 have been accommodated (21 by L.C.C. and 2 by L.B.C.), and 3 refused (by the County Authority), leaving 109 pending decision and allocation. The following table shows particulars of 254 out of 276 applications received (information respecting the remaining 22 cases is not available owing to various causes, such as application withdrawn) :— Housing Applications, 1935. Number of Persons in Family Number of Rooms Occupied Total Persons 1 2 3 4 5 6 1 — — — — — — 2 2 3 4 — - 18 3 7 22 8 2 — — 117 4 13 34 10 12 — — 276 5 3 32 12 3 1 255 6 3 18 9 7 1 228 7 — 13 7 1 — 147 8 1 8 4 1 1 120 9 — 3 1 1 1 54 10 — 1 — — — — 10 11 — 2 1 1 — 44 12 — — 1 — — — 12 Total Families 254 29 136 57 28 2 2 Total Persons — — — — — — 1,281 72 INSPECTION & SUPERVISION OF FOOD. Milk Supply. 68 applications were approved by the Borough Council for registration under the Milk and Dairies Order, 1926. 25 of the applications were change of purveyor at registered premises, 41 were for the sale of milk in sealed bottles only, and 2 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, 15 ; " Grade A " (Tuberculin Tested), 25 ; " Grade A," 11 ; " Pasteurised " Milk, 30 (Pasteuriser's Licence 2, Dealer's Licence, 28) (57 premises) ; Supplementary Licences, 7. Meat and Other Foods. (a) Public Health {Meat) Regulations, 1924. (1) Number of * visits paid to slaughterhouses 140 (2) Number of "visits paid to meat shops, meat stalls, and meat stores 836 (3) Number of actual slaughterings at which one or other of the food inspectors was present, consisting of beasts (2), sheep (410), pigs (364), and calves (4) 780 (4) Carcases, or portions of carcases, condemned 16 * Visits include re-visits also. Of the 780 actual slaughterings, at which one or other of the food inspectors was present, and in connection with which 16 carcases or portions of carcases were condemned, the diseases necessitating such condemnation were as follows:— Pigs. 3 heads (tuberculosis). 1 side (tuberculosis). 7 mesenteries (tuberculosis). 1 whole carcase and organs (fever 4 plucks (tuberculosis). and emaciation). In addition to the above-mentioned carcases or parts of carcases the following unsound food was condemned and destroyed:— Fish— tons cwts. qrs. lbs. Fillets 0 0 0 14 Cod 0 1 1 0 Plaice 0 1 0 0 Skate 0 0 2 0 Haddocks 0 0 0 14 Whiting 0 0 2 14 Mussels (2 bags) — — — — 73 Fruit and Vegetables— Asparagus 0 0 0 2 Bananas (13 crates) — ' — — — Grapes (38 boxes) — — — — Peaches (88 boxes) — — — — Pears (14 boxes) — — — — Potatoes 13 3 0 0 Raspberries (83 baskets) — — — — Scarlet Runner Beans 0 0 1 12 Tomatoes (25 cases) — — — — Poultry— Fowls 0 5 1 25 Turkeys 0 5 0 15 Game— Dove (1) — — — — Partridge (1) - — - - Rabbits 0 4 3 19¼ Wood Pigeon (1) — — — - Meat and other products— Bacon 0 2 1 27 Beef 0 0 1 4 Cooked Meat 0 0 1 0 Ham 0 0 0 13½ Ham, Tinned (5 tins) — — — - Sheep's Kidneys (96) — — — - Pork 0 5 0 13 Uncooked Meat 0 8 3 0 Sausages 0 0 1 7 Other food— Apples (8 tins) — — — — Butter 0 0 0 24 Cherries (852 tins) — — — — *Cream (565 tins) 1 11 0 9 Dripping and Lard 0 0 0 17 Gooseberries (3 tins) — — — — Sauce (15 bottles) — •These tins of cream were seized from a vendor and taken before a Magistrate at Lambeth Police Court, who made an Order for their destruction. {b) 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, 790 were taken with the formalities prescribed by the Act, while 1,210 were taken informally. The formal samples taken included milk, skimmed milk, butter, broken biscuits, sausages, vinegar, minced beef and chocolates. The principal food sampled informally was butter. Nearly one hundred different varieties of other foods and a great number of drugs were sampled and submitted to the Public Analyst for analysis. 74 Following the usual practice, samples were taken systematically in all parts of the district, with the object of insuring that the food and drugs reported upon by the Analyst are representative of what is consumed by the public. Of the samples of milk, 24 were procured on delivery at railway stations, and 68 from various institutions. The high standard of quality of the food supply in the Borough mentioned in the last annual report is more than maintained, as shown by the fact that of the 2,000 samples procured only 32 were reported by the Public Analyst to be adulterated, 19 of which were informal samples, compared with 40 and 8 last year. Warning Letters. The number of formal samples found to be adulterated was 13. Legal proceedings were instituted in four cases, and warning letters were sent to the vendors of other samples as required. Police Court Proceedings. Following is the summary of proceedings at the Lambeth Police Court in respect of offences against the Food and Drugs Act:— Case No. 370 For selling milk deficient in fat to the Dismissed under Probaextent of 9 per cent. tion of Offenders Act on payment of £3 3s. costs 603 For selling milk deficient in fat to the Summons withdrawn extent of 9 per cent. 607 For selling minced beef containing a Dismissed under Proba- preservative ; tion of Offenders Act, 608 For selling minced beef containing a on payment of £1 Is. preservative J costs Bacteriological Samples. During the year, 30 samples of milk and 2 of water were submitted for bacteriological examination. Of the samples of milk, 4 were procured on behalf of the Minister of Health under the provisions of the Milk (Special Designations) Order, 1934, 5 from an institution, and the remainder from various vendors throughout the Borough. Notwithstanding that many of these milks were not sold under special designations, with but two exceptions they satisfied the requirements of the standard for pasteurised milk. Regarding the two exceptions mentioned above, one sample (of raw milk) was reported by the Bacteriologist to be infected with tuberculosis. The attention of the County Medical Officer of the district where the milk was produced was 75 drawn to the matter, who eventually sent information that the infected cows had been traced. The two samples of water referred to were procured from the Lambeth Baths. (c) Inspection of Food Premises. During the year most of the food premises in the Borough have been inspected. Special attention is paid during these visits to the general standard of cleanliness, especially in connexion with the storage of food. Where any sanitary defects are noticed on the premises, or any lack of suitable sanitary conveniences and cleansing facilities are apparent, such defects are noted and the information passed to the appropriate district sanitary inspector. Attention is also paid to see that the various Acts, Orders and Regulations governing food premises are being observed and that food is being stored, handled and marked in a satisfactory manner. Any defects noticed on these occasions that appear to concern the occupier are brought to his notice, and many improvements are thereby obtained. In addition to the shops, the market stalls are periodically inspected to see that the stall owners are carrying out the requirements of the various Acts, Orders and Regulations affecting their particular businesses. Additions have been made from time to time, and during the past year, 47 premises were inspected and added to the ice-cream register. The total number of premises now registered is 455. 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 310, 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 beer received has added considerably to the work of the Department. 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, 76 restaurants, and public-houses, have been made during the year, as follows :— Bakehouses 389 Milkshops 1,441 Ice cream premises 1,480 Other food premises or stores 1,911 Restaurants, etc 479 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. (d) Merchandise Marks Act, 1926, and Agricultural Produce Grading and Marking Act, 1928. The provisions of the Order requiring the marking of certain classes of meat came into operation early in the year. The basic requirement is that frozen and chilled beef, mutton, lamb and pork, shall be marked on the carcase prior to importation with an indication of origin. When, however, such meat is exposed for sale in retail shops the marking, where necessary, is done by tickets, and it is in this direction that the greatest need for supervision arises. This particular marking Order is one that entails more responsibility and work in its application than those made previously relating to other articles of food. It is satisfactory to report that the traders have co-operated in carrying out the requirements, with the net result that the origin of almost all meat sold or exposed for sale is clear to the purchaser. (e) Artificial Cream Act, 1929. During the year one application for registration under the above-mentioned Act of premises used for the manufacture and sale of artificial cream was received. 77 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 Number Analysed Number Adulterated Number Analysed Number Adulterated Apples - - 6 _ Arrowroot — — 9 - Bacon — — 3 - Baking Powder — — 6 - Barley, Pearl — — 9 - Biscuits 1 — — - Bread — — 14 - Butter 32 — 275 3 Cake — — 3 — Cake Mixture — — 6 — Cakes, Sponge — — 15 — Candied Peel — — 9 — Cheese — — 10 — Chocolate (Milk) 1 — — — Cocoa — — 16 — Coffee — — 18 — Coffee and Chicory — — 7 — Coffee and Chicory Extract — — 2 — Confectionery — — 21 — Cooking Fat — — 1 — Cornflour — — 15 — Cream — — 6 — Cream, Ice — — 3 — Cream, Tinned — — 6 — Custard Powder — — 22 — Dripping — — 21 — Drugs :— Acid, Boric — — 3 — Acid, Citric — — 3 — Acid, Tartaric — — 3 — Aspirin — — 3 — Balsam, Friars — — 6 — Borax — — 3 — Camphorated Oil — — 3 — Castor Oil — — 7 — Cod Liver Oil — — 2 — Cream of Tartar — — 9 — Epsom Salts — — 8 — Eucalyptus Oil — — 6 — Glauber's Salts — — 7 — Glycerine — — 5 — Iodine Paint — — 1 — Iodine, Spirit of — — 1 — Linseed — — 6 1 78 Food and Drugs.—continued. Samples Formal . Informal Number Analysed . Number Adulterated Number Analysed Number Adulterated Drugs—continued. Magnesia 6 Ointment, Boric 15 Ointment, Zinc 12 Petroleum Jelly 2 Powder, Liquorice, Com pound - - 12 - Powder, Seidlitz — 9 1 Soda bicarbonate 9 Sulphur, Flowers of — 6 Tincture of Iodine 7 Do. of Quinine (Ammon). — 6 1 Tincture of Rhubarb — 3 Vaseline - _ 1 Essence, Colouring . - 3 Fish Paste - 4 Fish, Tinned 6 Flour - — 15 Flour, Self-raising — 12 Fruit, Canned (Oranges) — _ 1 Fruit, Dried 54 Ginger, Ground - - 6 Herbs, Dried 6 Honey 3 — Ice Cream 8 Jam and Marmalade 7 - Jelly, Table 8 Lard 15 Lemonade Powder 9 8 Lemon, Curd 9 - Lentils 3 - Margarine 26 _ Meat, Minced 2 2 12 4 Meat Paste - - 4 - Milk 747 10 75 1 Milk Condensed Full Cream 15 - Milk, Condensed (Machine Skimmed) - - 15 - Milk, Butter - 1 - Mincemeat 12 - Mustard 7 - Mustard Compound — — 5 — 79 Food and Drugs.—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Oatmeal - - 15 - Olive Oil — 4 — Peas Canned — — 3 — Peas Split — — 4 — Pepper — — 12 — Pickles — — 6 — Rice — — 21 — Rice, Ground — — 6 — Sago — — 6 — Sauce — — 15 — Sausages 1 1 7 1 Sausages (Preserved) — — 2 — Sausage Meat — — 3 — Sausage Rolls — — 3 — Scones — — 6 — Sherbet — 6 Soup Powder — — 3 Soup, Tinned — — 3 — Spice, Mixed — — 6 — Suet, Shredded — — 3 — Sugar — — 6 — Tapioca — — 12 — Tea — -- 26 — Vegetables, Tinned — — 9 — Vinegar 6 — — — Water Ice — — 1 — Wheat Preparation — — 10 — Yeast — — 3 — Totals 790 13 1,209 20 N.B.—4 summonses were issued (see page 74). 1 sample of powder from an Electric cooker was examined. 80 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 2,114 cases of infectious diseases (excluding tuberculosis) were reported during the year. This number is less than the number (7,718) reported in the previous year, a large proportion of which was attributable to measles. 81 TABLE J. 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 — — — — - - 17.4 Scarlet Fever 865 3.09 — — 807 93.29 750 1056.5 Diphtheria 457 1.63 16 3.50 455 99.58 424 732.3 Membranous Croup 2 0.007 —. — 2 100.00 2 2.9 Typhus — — — -— — — — — Enteric 4 0.01 1 25.00 4 100.00 4 184 Relapsing Fever — — — — — — Erysipelas 130 0.46 9 6.92 72 55.38 130 123.2 Puerperal Fever 24 0.85 4 16.67 12 50.00 23 28.7 Puerperal Pyrexia 44 0.15 6 13.64 4 9.09 44 48.8 Plague — — — — — — — — Cerebro-Spinal Fever 3 0.01 2 66.67 3 100.00 3 6.3 *Poli-mvelitis 10 0.03 — — 10 100.00 10 5.4 Ophthalmia Neonatorum 41 0.14 — — 2 4.88 41 56.2 Measles 168 0.60 2 1.19 41 24.40 153 2532.6 German Measles 118 0.42 — — 2 1.69 117 425.1 Tuberculosis— Pulmonary (primary) 380 1.35 196 — — — — 507.6 Non-pulmonary (primary) 87 0.31 22 — — — — 104.3 Malaria 2 0.007 — — 2 100.00 2 6.2 Dysentery 5 0.01 — — 5 100.00 4 1.3 Primary Pneumonia (Acute) 148 0.52 51 34.46 72 48.65 145 228.2 Influenzal Pneumonia (Acute) 72 0.25 8 11.11 8 11.11 71 123.0 † Encephalitis Lethargica 2 0.007 3 — 2 100.00 2 11.1 Trench Fever — —- — — — — — — Anthrax 1 0.003 1 — 1 100.00 1 0.2 Food Poisoning 18 0.04 1 5.56 18 * Including 1 case of Polio Encephalitis. t Including 1 death from Post Encephalitis Lethargica. : Compulsorily notifiable from September, 1932. N.B.—Of the cases originally notified during 1935, the following were found afterwards not to be suffering from the diseases notified :—Diphtheria, 55 ; Scarlet Fever, 37 ; Measles, 10 ; Membranous Croup, 1. 82 TABLE K. Distribution of Cases Notified During the Year 1935. 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 North Princes Lambeth Central Lambeth South Lambeth North Princes Lambeth Central Lambeth South Under 1 1 to 5 J5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox - - - - - - - - - - - - - - - - Cholera — — — — — — - — — — Diphtheria 457 6 145 225 43 29 7 2 80 33 179 165 80 33 178 164 Membranous Croup 2 2 — — — _ 2 — — — 2 Erysipelas 130 1 3 12 14 26 53 21 18 19 47 46 12 10 24 26 Scarlet Fever 865 10 217 492 83 52 11 — 92 61 326 386 89 58 303 357 Typhus Fever — — — — — — — — — — — — — — — — Enteric Fever 4 — — 3 1 — — — 1 — — 3 1 — — 3 Relapsing Fever — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — Puerperal Fever 24 — — — 10 14 — — 4 2 10 8 1 — 6 5 Puerperal Pyrexia Plague 44 — — — 18 26 — — 1 3 15 25 — — 1 3 Pulmonary Tuberculosis 380 1 2 22 98 143 99 15 44 53 149 134 — — — — Other forms of Tuberculosis 87 1 13 29 22 17 3 2 12 6 35 34 — — — — Cerebro-spinal Fever 3 — — — — 2 1 — 2 — 1 — 2 — 1 — Polio-myelitis 10 1 4 3 1 1 — — 5 5 — — 5 5 Encephalitis Lethargica 2 — — — 1 1 — — — — — 2 — — — 2 Ophthalmia Neonatorum 41 41 — — — — — — 12 5 14 10 1 — 1 — Measles 168 18 86 58 3 3 — — 21 51 58 38 14 12 10 5 German Measles 118 10 37 57 9 5 — — 10 19 43 56 1 — 1 — Malaria 2 — — — — 1 1 — — — — 2 — — — 2 1 1 1 1 Primary Pneumonia (Acute) 148 1 12 24 22 47 30 12 19 16 52 61 111 6 23 32 Influenzal ,, (Acute) 72 — 12 8 7 16 19 10 14 14 20 24 1 — 1 6 Dysentery 5 — — — — 3 2 — 1 — I 3 1 — 1 3 Food Poisoning 18 — — — 2 11 5 3 2 7 6 — 1 Isolation Hospitals. Name and Situation.—Hospitals of the London County Council (one situated in the Lambeth Central Sub-District and Stock-well Ward of the Borough of Lambeth). Number of Diseases that can be concurrently treated—all usual notifiable infectious diseases and Whooping Cough. 83 Vaccination. Return showing the Numbers of Persons successfully vaccinated and re-vaccinated at the cost of the rates by the Medical Officers of the County Council Institutions and the Public Vaccinators during the Year 1935. 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 73 3 76 7 13 Norwood Schools Dr. E. L. Smallwood 3 110 113 — 1 Lambeth Church District Dr. M. I. Elliot 215 28 243 4 19 Kennington do Dr. R. Phillips 186 20 206 8 12 Stockwell > do Dr. H. P. Orchard 353 18 371 7 9 Brixton do Dr. E. L. M. Rusby 427 28 455 10 6 Norwood do Dr. E. L. Smallwood 208 11 219 47 13 Totals 1,465 218 1,683 83 73 84 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 attack rate per 1,000 population decreased from 2.81 in 1934 to 1.63 in 1935, there being 340 less cases, while the case mortality per 100 was lowered from 5.64 to 3.50. The Council's two diphtheria prevention clinics continue their useful function and are well attended. The number immunised is still too small a proportion of the population to influence materially the incidence of the disease apart from the closed communities in the residential schools, from which diphtheria has been conspicuously absent since immunisation there was completed several years ago. 85 Diphtheria Prevention—1935. Statistics for the year ended 31s< December, 1935. *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 5 69 34 155 60 16 339 First Positive 5 64 29 122 31 5 256 Test Negative — 3 2 30 26 8 69 Tested Only — 2 3 3 3 3 14 Re- Positive 1 1 2 1 5 Test Negative 6 49 23 96 29 7 210 Tested Only — 3 2 10 1 1 17 Total Attendances 1,629. *B 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 3 37 13 136 54 26 269 First Positive 3 35 12 96 32 19 197 Test Negative — 2 1 39 21 7 70 Tested Only — — — 1 1 — 2 Re- Positive 1 4 1 1 7 Test Negative 1 28 9 S8 29 6 161 Tested Only — 2 — 5 2 — 9 Total Attendances 1,294 Borough.—Total cases = 608, of whom 453 = 74.51 per cent. were Positive and 139 = 22.86 per cent. Negative, while 16 had been tested only, not yet having begun the course of immunisation. Total Attendances = 2,923. Average attendance per week = (49 weeks) 59.65. Average attendance per Session = (98 sessions) 29.83. * A commenced May 8th, 1928, and B commenced July 18th, 1928. F* 86 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 1935, 41 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 Treated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home In Hospital 41 36 5 — — — Contacts, Suspects, etc. The Medical Officer of Health was called in consultation by medical practitioners to see 5 patients in their homes during the year. This small number compares favourably with the 748 such patients seen in 1929 at the time of the smallpox epidemic. 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. 87 The proportion of specimens found to be positive out of all those submitted was 12.01 per cent, (in the previous year, 13.33 per cent). Nature of Specimen Result of Examination Total Negative Positive Swabs from nose and throat of suspected cases or carriers of diphtheria 1,699 157 1,856 Sputa from cases suspected of or suffering from pulmonary tuberculosis 741 152 893 Blood for Widal reaction and/or examination for presence of— B. Typhosus B. Paratyphosus A, B, and C V B. Abortus 3 1 — Miscellaneous 55 31 86 Totals 2,498 341 2,839 During 1935, 50 vials of antitoxin were distributed free of cost under the Antitoxin Order, 1910. Disinfecting Department, 1935. 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 (137), chicken-pox (655), cancer (71), whooping cough (749), and others (scabies, ringworm, etc.), not classified (1,671) ; 846 verminous houses (1,153 rooms) and verminous articles, bedding (1,303), and clothing (1,661), were also dealt with. 88 Summary of work carried out by the Disinfecting Department during 1935. Cleansing Notices served 1,626 Total No. of Rooms disinfected by the Council 4,416 * Do. articles do 16,505 Cases in which bedding was disinfected at home1,301 Do. do. do. at Chamber 1,767 Premises disinfected and disinfectants supplied 17,062 Certificates of Medical Practitioners received in lieu of disinfection by the Council — Schools disinfected (38 rooms)11 Certificates of disinfection left with occupiers of disinfected premises1,383 Library books disinfected 46 Mattresses re-tabbed by Council 507 Tuberculosis Dispensaries— Shelters loaned and erected — Shelters dismantled and removed 1 Bedsteads and mattresses delivered 8 Bedsteads and mattresses collected 7 Bacteriological Outfits (Swabs, etc.), delivered 2,132 Smoke machines collected and delivered 230 Cabs, etc., disinfected 5 Maternity parcels sterilised 41 * Including 78 families (1,255 articles) for L.C.C. (Slum Clearance). 20 „ (635 articles) for Church Army. Tuberculosis. The numbers of cases of tuberculosis on the Lambeth Register of Notifications on December 31st, 1935, were as follows:— Males Females Totals Pulmonary 1,155 975 2,130 Non-pulmonary 229 167 393 Totals 1,384 1,142 2,526 89 TABLE L. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications received during the period from January 1st, 1935, to December 31st, 1935. 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 2 2 8 16 30 45 43 16 31 10 234 333 Females — — 8 4 18 31 39 16 11 11 5 146 213 Non-Pulmonary— Males — 8 9 9 5 3 3 4 — 2 1 44 49 Females 1 5 3 8 8 6 5 5 — 1 1 43 51 * Re-notifications (Form A) = 166 (males 99, females 67) pulmonary, and 13 (males 5, females 8) non-pulmonary. N.B.—Pulmonary—81 private; 183 hospitals, 116 dispensaries = 380 total primary notifications. Non-pulmonary—11 private, 59 hospitals, 17 dispensaries = 87 total primary notifications. Institutional treatment.—Notifications were also received during the period stated above respecting 545 pulmonary and 46 non-pulmonary admissions, and 460 pulmonary and 48 non-pulmonary discharges. 90 TABLE L (1). Summary of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the 1st January, 1935 to the 31st December, 1935, 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 - — - — 2 1 13 3 4 5 2 30 Females - - - - 3 4 1 3 3 1 2 17 Non-Pulmonary— Males - 1 2 1 - - 2 - - - - 6 Females — 1 1 — - 3 — 1 — — — 6 2.—Source of Information. Pulmonary NonPulmonary Death Returns from local Registrars 9 2 transferable from R.G.O 3 — Posthumous notifications 2 " Transfers " from other areas 33 10 Other Sources — — Totals 47 12 The ratio of deaths of previously notified cases of tuberculosis to deaths due to tuberculosis not notified during life is 14 to 1 in the year under review. 91 TABLE L (2). Public Health (Tuberculosis Regulations, 1930 Summary of Notification Certificates, etc., received during the period from January 1st, 1935, to December 31st, 1935. Registration Sub-Districts Formal Notifications (Table L) Others (Table L 1* 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 North 44 67 43 33 12 15 8 4 5 — Princes 53 77 46 45 6 6 4 3 7 Lambeth Central 149 210 218 176 35 39 15 19 16 7 Lambeth South 134 192 238 206 34 40 19 22 19 5 Borough of Lambeth 380 546 545 460 87 100 46 48 47 12 92 Deaths from Tuberculosis. Age Periods 0 1 5 10 15 20 25 35 45 55 65 and upwards Total Pulmonary— Males — — — 1 a 10 21 30 21 27 12 127 Females — — — 2 5 15 9 15 8 9 6 69 Non-Pulmonary— Males — 1 2 1 2 1 2 — 1 — — 10 Females 2 — 1 1 4 3 1 — — 12 Totals 2 1 3 5 16 23 35 45 31 36 18 218 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 (Pulmonarv) Tuberculosis rate per 1,000 population (all forms) Lambeth North 31 3 34 0.86 0.94 Princes 29 3 32 1.17 1.30 Lambeth Central 57 7 64 0.60 0.68 Lambeth South 79 9 88 0.62 0.70 Borough of Lambeth 196 22 218 0.70 0.78 93 Death-rates and incidence-rates (primary cases) per 1,000 population:— Years Borough Mortality Borough Incidence Pulmonary Tuberculosis Tuberculosis (all forms) Pulmonary Tuberculosis Tuberculosis (all forms) Average (10 years) 1.2 1.6 3.2 4.2 1913-1922 Average (10 years) 0.9 1.1 1.6 2.0 1923-1932 1931 0.85 0.90 1.63 1.91 1932 0.84 0.96 1.59 1.90 1933 0.84 0 94 1.50 1.47 1934 0.81 0.94 1.56 1.77 1935 0.70 0.78 1.36 1.67 94 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 1935. N.B.—The Central Dispensary (73 Effra Road, Brixton), was opened July 23rd, 1913. 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 76 61 4 3 11 6 6 3 87 67 10 6 23 28 2 3 (c) Non-tuberculous — — — — — — — — 86 86 19 11 B.—Contacts examined during the year :— (a) Definitely tuberculous 13 15 2 — — 1 2 1 13 lb 4 1 (6) Diagnosis not completed — — — — — — — 14 16 7 9 (c) Non-tuberculous — — — — — — — — 53 113 56 67 C.—Cases written off the Dispensary Register as:— (a) Recovered — 2 — — 1 — — — 1 2 — — (b) Non-tuberculous (including any — — — —— — — — — — — — such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) — — — — — — — — 197 256 80 83 D.—Number of Cases on Dispensary Register on December 31st, 1935 :— (a) Definitely tuberculous 326 318 33 54 59 37 34 22 385 355 67 76 (6) Diagnosis not completed 20 23 5 8 1. Number of cases on Dispensary Register on January 1st, 1935 1,046 8. Number of visits by Tuberculosis Officer to Homes (including personal consultations) 692 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 32 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,405 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of 254 10. Number of— (a) Specimens of Sputum, etc., examined 534 (b) X-Ray Examinations made in connection with Dispensary work 608 4. Cases written off during the year as dead (all causes) 63 5. Number of attendances at the Dispensary (including Contacts) 3,970 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 4 6. Number of Insured Persons under Domiciliary Treatment on December 31st 478 7. Number of consultations with medical practitioners:— 12. Number of " T.B. plus" cases on Dispensary Register on December 31st 370 (a) Personal 184 (b) Other 1,028 95 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 1935. N.B.—The Branch Dispensary (St. Thomas's Hospital) was opened February 3rd, 1913. 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 54 32 — 1 5 5 5 5 59 37 5 6 10 is (c) Non-tuberculous — — — — — — — — 104 86 12 14 B.—Contacts examined during the year:— (a) Definitely tuberculous 2, 3 2 3 (b) Diagnosis not completed — — — — — — — — — — — — —— — 1 — (c) Non-tuberculous — — — — — — — — 42 62 72 70 C.—Cases written off the Dispensary (a) Recovered 26 9 4 1 3 4 3 29 13 7 1 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) — — — — — — — — 146 148 84 84 D.—Number of Cases on Dispensary (a) Definitely tuberculous 258 151 3 6 16 14 21 16 274 165 24 22 (b) Diagnosis not completed — — — — — — — — 15 19 3 5 1. Number of cases on Dispensary Register on January 1st, 1935 531 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 216 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 28 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,267 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of 62 10. Number of— (a) Specimens of Sputum, etc., examined 625 4. Cases written off during the year as dead (all causes) 56 (b) X-Ray Examinations made in connection with Dispensary work 686 5. Number of attendances at the Dispensary (including Contacts) 2,921 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 2 6. Number of Insured Persons under Domiciliary Treatment on December 31st 125 7. Number of consultations with medical practitioners:— 12. Number of " T.B. plus" cases on Dispensary Register on December 31s 268 (a) Personal 19 (b) Other 701 96 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 Bodies Received 1934 1935 1934 1935 1934 1935 14 (M. 11 F. 3) — 85 (M. 38 F. 47) 61 (M. 28 F. 33) 99 61 Post-mortem examinations conducted 13 — 80 59 93 59 Inquests held — — — — — — Court sittings Coroner : A. Douglas Cowburn, Esq. * Since closed. 97 Appendix A. Diphtheria Prevention. The Medical Officer of Health was instructed by the Public Health Committee to report upon " the measures in force in the Borough of Lambeth for the prevention of Diphtheria and for improving them." Extract from the Minutes of the Council. We have received the following report from the Medical Officer of Health on the above matter which we submit for the information of the Council:— Report. There are two clinics in the district where Schick testing and immunizing injections are available free, one at 212 Camberwell New Road at 2.30 p.m. on Tuesdays and the other at Hannen House, Hannen Road, West Norwood, at 10.30 a.m. on Fridays. The clinics were inaugurated in May and July, 1928, respectively, and both have continued since without a break, although the numbers attending have varied considerably depending as they do almost entirely upon the success of propaganda and upon individual fear of infection. The Council's Notice Boards have "been made use of on various occasions for posters, while over fifty-five thousands of leaflets have been distributed during the last seven years through Welfare Centres, at London County Council Schools (by permission of the Education Authority), by the disinfecting staff to all premises for whatever cause they may be visited, through the Tuberculosis Dispensaries, through the Libraries, from the Town Hall, and once at a Church where the Vicar had made a request for a supply. The suggestion of a personal letter to each individual head of a family from the Medical Officer of Health would doubtless lead to an increase in the numbers attending the Clinics for immunization, but the actual work entailed in sending such a letter to the 83,777 families in the Borough would be prodigious and quite impossible for the present existing staff of the Public Health Department to carry out. Meanwhile, the propaganda in the daily papers has had a marked effect on the numbers attending the Clinics. So much so that on one occasion applicants were turned away as all the prophylactic material in hand had been used up. Owing to the increasing numbers, with the consent of the Chairman and as a matter of urgency, the Medical Officer of Health has made arrangements for an additional 98 medical practitioner to assist at the Clinic held on Tuesday afternoons at 212 Camberwell New Road. The numbers attending both Clinics have been mounting rapidly in the past two or three weeks and unless applicants are to be turned away some such increase in the facilities available becomes obligatory. An increase in the annual expenditure is unavoidable, and a provision has been suggested in the estimates for next year as well as for the current quarter. There is, however, another aspect of the question which the Council has not yet considered. The local medical practioners have upon numerous occasions voiced their wish to co-operate in some way with the Council in improving the health of the community by raising the standard of immunity to diphtheria. There is every hope that in practice the employment indirectly of the local medical practitioners would lead to the immunization of much larger numbers than the Council's present Clinics could possibly deal with. A scheme of this kind has been in operation in other districts in and around London, which is proving successful. Medical practitioners are paid a sum of ten shillings by the Local Authority for every person immunized by them, the cost of material, visits, etc., being borne entirely by the doctor concerned. Moreover, the Public Medical Service for London still further encourages and assists its members by supplying them with materials at reduced prices. The scheme of co-operation briefly outlined above should receive the earnest consideration of the Council, as calculated both to popularise immunization by securing the goodwill of the medical profession and to improve the co-operation which already exists between the family doctor and the Medical Officer of Health. A. G. G. Thompson, m.d. Medical Officer of Health. 4th February, 1935. Received Appendix B. Anthrax. Extract from the Minutes of the Council, 26th September, 1935. A case of anthrax was officially notified on the 9th July last, together with the news that the patient had unfortunately died two days previously. From inquiries made it appears that the malignant pustule was noticed on the cheek on the 3rd July, but, unfortunately, the 99 family doctor was not called in until the 6th July, and on his arrival the patient was moribund and died from Anthrax Septicaemia. The patient's shaving brush was found to contain anthrax spores and bacilli, and had been purchased, according to the widow, two years or more previously. The brush was somewhat similar to, but, owing to its worn condition, not definitely identifiable as, the brush missing from a consignment of twelve seized in June, 1932 (Minutes 1931-2, pages 696-7). At that time the hospitals in the district were warned to be on the look out for malignant pustule in order that no time should be lost before the serum was given, but as no case occurred it was believed that the customer was not a Lambeth resident. The patient, aged 50 years, was a cobbler with his own small business and had purchased some leather on the 2nd July. As the leather was tanned and dressed ready for the repair of boots it did not appear a likely source of infection, but samples were nevertheless taken with the expected negative result. He almost invariably shaved himself and the last time he was shaved by a barber was at least a fortnight before the onset of his illness, and after enquiry no suspicion was attached to the barber's utensils. The man's shaving brush seems to have been the obvious source of the disease, but its prolonged use without giving rise to infection is amazing from a medical point of view. We desire to place on record an appreciation of the thorough manner in which the Medical Officer of Health has carried out his investigations in connection with the foregoing. Received. 100 INDEX. Page Ambulance facilities 29 Ante-Natal Clinics 30 Anthrax 98 Area of Borough 8 Artificial Cream 76 Bacteriological Laboratory 86 Bakehouses 52 Bed Linen (Sterilization) 36 Births 27 Births in Institutions 13 Births in Registration Sub-districts 13 Births, Legitimate and Illegitimate 27 Births, Notification Act 27 Birth-rates 15 Census figures 14 Closing Orders 59 Common Lodging Houses 52 Condemned Food 72 Consultants (Obstetrical) 37 Contacts 86 Cowhouses 52 Day Nursery 40 Deaths 19, 20 Deaths, Infantile . 15 Deaths in Institutions 21 Death-rates 15 Demolition Orders . 58 Density 8 Dentistry 37 Diphtheria 84, 97 Diphtheria Prevention Clinics 85 Disinfecting Department 87 Drains tested 44 Factories, Workshops and Workplaces 48, 51 Food and Drugs Adulteration 73, 77 Food Inspection and Supervision 72 Food Premises Registered 75 101 Page Grants, L.G. Act, 1929 32 Health Visitors 41 Home Helps . 35 Hospitals 29 Housing Statistics 55 Housing Applications 71 Housing Conditions (M. of H. Table) 61 Housing Inspectors 55 Ice Cream 52, 76 Infant life Protection 35 Infantile Mortality 24 Infectious Diseases 80 Licences 51 Light Treatment 37 L.C.C. (General Powers) Act, 1928 47 Marriage Rate 8 Massage 37 Maternity and Child Welfare Committee 3 Maternity and Child Welfare Scheme 30, 38 Maternity Home 33 Maternal Mortality 18, 23 Maternity Outfits (Sterile) 36 Meat Regulations (Details of Work) 72 Merchandise Marks Act 76 Midwives . 29, 37 Milk Assistance Scheme 31 Milk Supply 72 Mortality Rates 8, 26 Mortuaries 96 Neonatal Mortality 8 Notices Served 43 Notifiable Diseases 81 Nuisances 44 Nursing 28 Offensive Trades . 51 Ophthalmia Neonatorum 86 Outworkers 49, 51 Overcrowding Survey 62 102 Page Populations 11 Public Cleansing 43 Public Health Committee 3 Puerperal Fever and Puerperal Pyrexia 42 Registrations 51 Rent and Mortgage Interest Restrictions Acts 47 Representations 58 Restaurants 76 Sanitary Inspectors 44 Sanitary Work 44 Schools 55 Shops Acts 53 Slaughterhouses and Slaughtermen 52 Smoke Abatement 52 Social Conditions 9 Staff 4 Still-births 26 Summary of Vital and Mortal Statistics 8 Summonses 44, 74 Suspects 86 Swimming Baths and Pools 53 Tuberculosis 88 Tuberculosis, Death Rates 92 Tuberculosis Dispensaries Scheme 94 Tuberculosis Incidence Rates 93 Tuberculosis, Notifications 89 Tuberculosis (Prevention) Regulations, 1925 96 Unemployment 9 Vaccination 83 Vital Statistics 10 Voluntary Hospitals 36 Water Certificates 44 Welfare Centres, etc. 30 Woman Sanitary Inspectors 49 Workshops 51 Zymotic Deaths 22 Zymotic Death Rate 22