REPORT ON THE HEALTH OF THE BOROUGH OF LAMBETH During the Year 1936 (81st 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 47 HOUSING 60 INSPECTION AND SUPERVISION OF FOOD 71 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 79 APPENDIX 97 INDEX 124 3 Borough of Lambeth. (i) PUBLIC HEALTH COMMITTEE and (2) MATERNITY and CHILD WELFARE COMMITTEE (appointed by the Council on 9th November, 1936). PUBLIC HEALTH COMMITTEE. His Worship the Mayor (Mr. Alderman E. A. Mills, 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. ,, L. L. S. Bickley, a.c.i.i. „ „ S. A. Brett (Senr.), f.a.i. (Chairman). ,, „ V. C. T. Elliott. „ „ 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. J. 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 Ofiicer : 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.), H. Snow, J. C. Richards, A. C. Puttock, F. J. Cox, D. R. Eeles, S. W. Westbey, 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. Sjster : Miss E. Burgess, s.r.n., c.m.b. 5 Gynaecological Consultants (Puerperal Fever, etc., Regulations) J. H. Peel, m.a., b.m., f.r.c.s., m.c.o.g., 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. i H.Morgan 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.). Mortuary : 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 1936 has been generally satisfactory, as may be observed from the statistics in the report. The Registrar General's estimate of the population is reduced for the eleventh year in succession from the highest in 1925, when it was estimated to be 311,100 to 1936, for which the population is 277,500. The latter is less by 18,647 than that disclosed as a result of the census in 1931. It had been expected that the new dwellings, more of which were erected than in any preceding year, would have led to an increase rather than a decrease in the estimated population, but the effect may be reflected in future years. The birth rate was raised slightly over that of the previous year to 13.94 per 1,000 population, but the higher death rate reduced the natural increase by excess of births over deaths to 390 compared with 421 in 1935. The Registrar General has again calculated a comparability factor 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 England and Wales, and with that of any local area whose crude death rate has been similarly modified. The adjusted crude death rate for the Borough is 12.41 compared with 12.02 in 1935, and a little more than half the deaths occurred in the age groups from 65 years upwards. The dislocation of the work of the Public Health Department caused by the overcrowding survey in the early months of the year, was balanced by a similar dislocation in the latter months and the early part of 1937. These two periods of dislocation were linked by a plethora of new legislation with memoranda and circulars from the Ministry of Health. Apart from large temporary additions for particular work under the Housing Act, 1936, there has been no increase in the staff during the year which has been a material factor in causing delay in the publication of this report. The 7 difficulty has been the lack of adequate office accommodation which, however, will be overcome in the near future, now that the extension of the Town Hall has begun in earnest. 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, 1937. 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, 1936—277,500 (males 131,080 and females 146,420). Density—67.96 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (corrected)—3,871, being 13.94 per 1,000 population. Marriages—2,761, being 9.94 per 1,000 population. Deaths (corrected)—3,481, being 12.41* per 1,000 population. Infantile Mortality (corrected)—230 deaths under 1 year, being 59 per 1,000 total live births. Neonatal Mortality (corrected)—93 deaths under one month, being 24 per 1,000 live births. Zymotic Death-rate (corrected)—0.33 per 1,000 population (total zymotic deaths, 93). Maternal Mortality (corrected)—3 deaths, being 0.77 per 1,000 live births. Number of structurally separate dwellings (census 1931)—48,873. Rateable Value (at 6th April, 1936)—£2,343,067. Sum represented by a penny rate (at 31st March, 1936)—£9,440. * As adjusted by comparability factor. 9 Social Conditions. There has been little alteration perceptible during the past year apart from the clearance and rebuilding of large areas and the clearance of a number of small insanitary areas where the owners have been allowed to redevelop their land, upon lines subject to the approval of the County and Borough Councils. 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, 1935, and 1936. 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 1936 6,350 1,845 164 8,359 (2) Number of Residents Registered as Unemployed at Monthly Dates in 1936. Date Men Women Juveniles Total 20th January, 1936 7,752 2,260 292 10,304 24th February, „ 7,852 2,327 223 10,402 23rd March „ 7,079 2,145 162 9,386 27th April ,, 6,959 2,015 265 9,239 25th May „ 6,175 1,861 123 8,159 22nd June ,. 5,718 1,731 57 7,506 20th July 5,209 1,741 115 7,065 24th August „ 5,266 1,751 162 7,179 21st September ,, 5,279 l,828 167 7,274 26th October „ 6,279 1,543 215 8,037 23rd November ,, 6,404 1,528 114 8,046 14th December „ 6,238 1,409 72 7,719 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:— 1933—3,409 Children 1934—3,210 Children Good Average Below Normal Good Average Below Normal Children 733 2,431 244 622 2,363 2 25 Lambeth 21.5% 71.3% 7.2% 19.4% 73.6% 7.0% London 20.5% 75.4% 4.1% 20.0% 75.9% 4.1% 1935—3,388 Children 1936—3,123 Children Good Average Below Normal Good Average Below Normal Children 587 2,430 362 441 2,371 305 Lambeth 17.3% 71.7% 11.0% 14.1% 75.9% 10.0% London 16.4% 77.9% 5.7% 15.1% 78.6% 6.3% Vital Statistics. The population of the Borough of Lambeth at the mid-year 1936, has been estimated by the Registrar General to be 277,500 which is less by 2,400 than the official estimated population of 1935. 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— 3,481 230 41 37 36 109 100% 6.61% 1.18% 1.06% 1.03% 3.13% 25— 35— 45— 55— 65— 75— 114 167 354 622 825 946 3.27% 4.80% 10.17% 17.87% 23.70% 27.18% 11 During the year the number of births corrected by inward and outward transfers was 3,871, giving a corrected birth rate of 13.94 compared with 13.65 last year, an increase of 0.29 per one thousand population. The principal causes of death are again the same four: heart disease which claimed 1,018 or 29.2 per cent. of the total, cancer 507 or 14.5 per cent., diseases of the lungs 403 or 11.5 per cent., and tuberculosis 211 or 6.0 per cent. Estimated Population, 1936 (Middle of the Year.) I. Wards. Wards Males Females Total 1. Marsh 5,950 5,300 11,250 2. Bishop's 11,150 11,600 22,750 3. Prince's 11,680 12,450 24,130 4. Vauxhall 13,820 14,400 28,220 5. Oval 11,070 11,820 22,890 6. Vassall 7,920 8,770 16,690 7. Angell 12,690 14,880 27,570 8. Stockwell 13,530 15,510 29,040 9. Town Hall 6,690 7,310 14,000 10. Herne Hill 6,450 7,560 14,010 11. Tulse Hill 14,010 17,360 31,370 12. Knight's Hill 16,120 19,460 35,580 Borough of Lambeth 131,080 146,420 277,500 II. Registration Sub-Districts Sub-Districts Males Females Total 1. Lambeth, North 17,100 16,900 34,000 2. Princes 11,680 12,450 24,130 3. Lambeth, Central 45,500 49,870 95,370 4. Lambeth, South 56,800 67,200 124,000 Borough of Lambeth 131,080 146,420 277,500 12 III. Parliamentary Divisions. Parliamentary Divisions Wards Total North Marsh, Bishop's, Prince's 58,130 Kennington Vauxhall, Oval, Vassall 67,800 Brixton Angell, Stockwell, Town Hall 70,610 Norwood Herne Hill, Tulse Hill, Knight's Hill 80,960 Parliamentary Area of Lambeth 277,500 13 TABLE A. Giving Number of Live Births in each Registration Sub-District of the Borough of Lambeth During the Year ended 31st December, 1936 (arranged Quarterly). Registration Sub-Districts No. of Births 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Lambeth, North* 483 458 454 477 Princes† 235 207 212 218 Lambeth, Central‡ 404 414 437 378 Lambeth, South§ 291 302 313 259 BOROUGH OF LAMBETH 1,413 1,381 1,416 1,332 TOTAL FOR BOROUGH OF LAMBETH—5,542. * Including General Lying-in Hospital (1,179 cases, of which 330 belong to Lambeth) and St. Thomas's Hospital (595 cases, of which 245 belong to Lambeth). † Including Lambeth Hospital (758 cases, of which 383 belong to Lambeth) ‡ Including Clapham Maternity Hospital (517 cases, of which 149 belong to Lambeth). § Including King's College Hospital (705 cases, of which 232 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 1936, 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 1936 277,500 5,542 3,481 230 308 93 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 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 1936, 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) 1936 19.97 12.41 59.41 66.07 88.48 0.33 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 Averages (10 years)— 0.5 1921-1930 (Borough) 25.1 12.4 51.4 93.4 145.1 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 1936 and Previous Five Years (1931-1935) 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 l 2 3 4 5 6 7 8 9 10 11 12 13 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 1935 279,900 5,493 3,823 13.65 3,551 12.68 1,529 1,380 225 59 3,402 12.02 Average 5 years 288,200 5,909 4,125 14.30 3,879 13.45 1,486 1,252 249 60 3,644 12.59 1931-1935 1936 277,500 5,542 3,871 13.94 3,661 13.19 1,639 1,459 230 59 3,481 12.41 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 (2,532 outward and 861 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. Census 131 Area of Borough in acres (including land and inland water), 4,083. Average number of persons per separate dwelling, 6.05. 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, 1936. Cities and Boroughs Estimated Population to Mid-year 1936 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 4,143,800 13.6 12.5 — 66 West Districts— Paddington 139,200 13.8 12.9 12.8 72 Kensington 176,100 12.7 12.5 11.7 73 Hammersmith 127,700 15.1 12.5 12.9 60 Fulham 141,300 14.9 12.6 12.7 64 Chelsea 56,500 11.3 13.7 11.6 53 City of Westminster 124,100 8.5 11.1 11.4 65 North Districts— St. Marylebone 92,400 9.8 12.6 12.5 75 Hampstead 90,700 10.4 10.2 9.6 65 St. Pancras 183,900 13.0 13.5 13.8 79 Islington 304,100 15.2 12.4 12.5 61 Stoke Newington 50,350 13.7 11.4 10.9 44 Hackney 209,100 14.4 12.0 12.6 62 Central Districts— Holborn 34,850 8.2 11.9 12.8 62 Finsbury 60,800 13.8 14.0 15.3 81 City of London 9,100 7.5 11.4 12.6 147 East Districts— Shoreditch 85,400 14.9 12.8 14.1 75 Bethnal Green 96,900 13.5 12.7 14.3 98 Stepney 207,800 14.7 12.6 14.7 100 Poplar 140,300 15.0 12.5 13.8 72 South Districts— Southwark 152,200 14.8 13.1 — 59 Bermondsey 100,400 15.4 12.8 14.6 60 Lambeth 277,500 13.9 12.5 12.4 59 Battersea 145,500 14.6 13.0 12.9 59 Wandsworth 343,000 11.4 11.7 10.9 58 Camberwell 229,300 13.9 12.6 12.6 58 Deptford 98,900 15.7 12.2 12.6 50 Greenwich 95,900 13.8 11.3 11.5 49 Lewisham 224,000 13.0 10.8 10.9 55 Woolwich 146,500 13.8 11.2 11.8 59 18 TABLE F. Birth-Rate, Death-Rate, and Analysis of Mortality During the Year 1936 (Provisional figures). Rate per 1,00.0 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 14.8 0.61 12.1 0.01 0.00 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59 122 County Boroughs and Great Towns, including London 14.9 0.67 12.3 0.01 0.00 0.09 0.01 0.06 0.08 0.14 0.45 8.2 63 143 Smaller Towns (Estimated Resident Populations 25,000-50,000 at Census 1931) 15.0 0.64 11.5 0.00 0.00 0.04 0.01 0.04 0.05 0.15 0.39 3.4 55 London 13.6 0.53 12.5 0.01 0.00 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66 Lambeth 13.9 0.46 12.4 0.00 0.00 0.09 0.00 0.04 0.05 0.12 0.43 9.8 59 The maternal Mortality rates are as follows :— Puerperal Puerperal Sepsis Others Total Sepsis Others Total Per 1,000 Live Births, England & Wales 1.40 2.41 3.81 Per 1,000 Total Births, England & Wales 1.34 2.31 3.65 Lambeth 0.25 0.52 0.77 Lambeth 0.25 0.50 0.75 19 Deaths. The total number of deaths registered in Lambeth during the year is 3,661, of which 1,639 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 1,459. The number of deaths corrected, i.e., of all Lambethans who died both within and outside the district is 3,481. The corrected death rate is 12.41 per 1,000 living, based upon a population estimated to the middle of the year of 277,500 and adjusted with the comparability factor. Age Periods of Corrected Deaths The 3,481 corrected deaths during 1936 may be further analysed and tabulated as follows 230 6.61 per cent. of the total corrected deaths took place under 1 year of age. 78 2.24 per cent. between 1 and 5 years. 308 8.85 per cent. under 5 years. 145 4.16 per cent. between 5 and 25 years. 281 8.07 per cent. 25 to 45 years. 976 28.04 per cent. 45 to 65 years. 825 23.70 per cent. 65 to 75 years. 946 27.18 per cent. 75 years and over. 3,173 91.15 per cent. over 5 years. 20 21 TABLE G. Causes of, and Ages at, Death (Corrected) During the Year, 1936. 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 3,481 230 41 37 36 109 281 976 825 946 Enteric Fever 1 — — — - 1 - — — — Measles 26 5 11 7 1 1 1 — — — Scarlet Fever 1 — — — — 1 — — — — Whooping Cough 13 6 5 1 1 - — — — 5 Diphtheria 15 1 3 3 6 - 2 - - - Influenza 35 — - - - 1 2 16 11 - Encephalitis Lethargica 3 — - - - - 2 1 - - Cerebro-Spinal Fever 4 — - - 1 2 1 - - - Tuberculosis of respiratory system 194 1 1 1 - 36 74 72 8 1 Other tuberculous diseases 17 1 1 2 2 5 2 2 2 - Syphilis 9 4 - - - - 1 2 1 1 General Paralysis of the insane, tabes dorsalis 14 — — — — — 2 8 4 - Cancer, malignant disease 507 1 1 1 - - 28 221 165 90 Diabetes 35 — - - - - 1 12 15 7 Cerebral Haemorrhage, etc 157 — - - - - 1 41 63 52 Heart Disease 1,018 - - - 4 11 31 239 296 437 Aneurysm 9 - - - - - 2 5 - 2 Other circulatory diseases 117 - - - - - - 23 35 59 Bronchitis 145 11 2 - - 1 7 35 32 57 Pneumonia (all forms) 226 42 6 9 2 3 24 58 45 37 Other respiratory diseases 32 - 1 1 1 2 5 10 6 6 Peptic Ulcer 47 - - - - - 5 30 7 5 Diarrhoea, etc. 47 35 2 1 1 2 2 2 - 2 Appendicitis 14 - - 1 - 1 3 8 1 - Cirrhosis of Liver 11 - - - - - 4 3 4 - Other diseases of liver, etc. 18 - - - - - 2 7 6 3 Other digestive diseases 60 3 - 1 - 1 7 25 15 8 Acute and Chronic Nephritis 91 - - - - 3 11 34 21 22 Puerperal Sepsis 1 - - - - - 1 - - - Other puerperal causes 2 - - - - 2 - - - - Congenital Debility, premature birth, malformations, etc. 99 99 - - - - - - - - Senility 103 - - - - - - - 12 91 Suicide 37 - - - - 1 7 19 8 2 Other Violence 120 5 6 2 5 17 23 28 11 23 Other defined diseases 253 16 2 7 12 18 30 75 57 36 Causes ill-defined or unknown - - - - - - - - - - Deaths in Institutions in Lambeth Voluntary Hospitals Lambethans Strangers Totals 229 858 1,087 State-aided Hospitals 545 706 1,251 Homes for the dying, etc. 31 10 41 22 TABLE H. Showing the corrected number of Deaths, with corrected Death-rates (general, zymotic and diarrhceal), in each of the Registration Sub-Districts of the Borough during 1936. 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 434 12.76 7 1 2 3 — 6 19 0.55 0.17 Princes 336 13.92 — 2 — 4 2 — 4 12 0.49 0.16 Lambeth, Central 1,210 12.68 — 7 — 7 5 1 12 32 0.33 0.12 Lambeth, South 1,501 12.10 — 10 — 2 3 — 15 30 0.24 0.12 Borough of Lambeth 3,481 12.41 — 26 1 15 13 1 37 93 0.33 0.13 23 Maternal Mortality. The maternal mortality is expressed as the number of deaths attributed to puerperal sepsis and other accidents and diseases of pregnancy and parturition, for each 1,000 live births. The rate in Lambeth in 1936 was 0.77, whereas the previous lowest rate was that recorded in 1933, when it was 1.77. The rate for one year is not regarded as being of special importance, although a rate so low as 0.77 is significant when compared with that of England and Wales, which is almost five times as high at 3.81. The maternal mortality during the five years 1932 to 1936 has averaged 2.0 per 1,000 live births, based upon no less than 19,971 births. Over so long a period, and based upon a number of births little short of twenty thousand, the rate is a clear and significant indication of the success of the Lambeth Maternity and Child Welfare scheme. Each year has seen improvements and additions to the facilities offered since the publication of the interim report of the Departmental Committee on Maternal Mortality, and the co-operation between the various welfare centres and other institutions comprised in the Lambeth scheme, and the mothers, has led to a maternal mortality rate of less than one half that for England and Wales over the corresponding five-year period. The interim report of the Departmental Committee indicated that approximately one half of the maternal deaths were preventable. In Lambeth during the past five years on that assumption more than half the maternal deaths have been prevented. There is an active co-operation between all those who are connected with midwifery activities, except the practising midwives engaged in domiciliary midwifery. Representations have been made to the Minister of Health upon several occasions during the past fifteen years urging that the Borough Councils should be made the Local Supervising Authority of midwives instead of the County Council, but without the slightest measure of success. In fact the Midwives Act, 1936, not only confirms the County Council in their entrenched position, but has laid upon them the duty of drawing up a scheme for confirmation by the Minister, of domiciliary midwifery for the entire area of the County of London. It is unlikely that the municipal midwives to be employed by the County Council will make more use of the Borough Council's maternity and child welfare scheme than have the private practising midwives in the past. The story, however, does not end at this point. For the purposes of their domiciliary midwifery scheme the County Council propose to sub-divide the county area into five groups of Boroughs and to 24 co-ordinate the various welfare schemes of individual boroughs within those groups. The County Council have not yet been constituted a welfare council as provided by section 250 Public Health (London) Act, 1936, and the duties of such an authority cannot be transferred to them under the Local Government Act, 1929, as section 60 does not apply to London. Satisfactory co-ordination, however, cannot be obtained without new legislation to confer the powers of a welfare council upon the County Council and that presumably will be the next step. Dual control will result with all the evils of such a misfortune and only the usual bait of problematical advantages which never seem to accrue. The final result will inevitably be that the Borough Council will no longer be a Welfare Council and all activities will be under the direct, but distant, control of the County Council. The close touch between individual families and the various committees of the Borough Council will be lost—and it is upon that close touch that the success of the Lambeth scheme has been based—and be replaced by a vast and expensive County Council scheme of control into which all must fit the Procrustes' bed. It is to be hoped that the maternal mortality rate in Lambeth will not be raised as a result. 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 3,871, an increase of 48 over the number of births in the year previous. The corrcctcd number of deaths was 230, 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 445 36 81 Princes 371 23 61 Lambeth Central 1,501 83 55 Lambeth South 1,554 88 56 Borough 3,871 230 59 25 TABLE I. Infantile Mortality, 1936. 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 76 8 6 3 93 37 48 33 19 230 Measles — — — — — — 2 1 2 5 Whooping cough — — — — — 2 1 2 1 6 Diphtheria — — — — — — — 1 — 1 Tuberculosis, Pulmonary — — — — — — — — 1 1 Other tuberculous diseases — — — — — — — 1 — 1 Syphilis — — — — — 1 2 1 — 4 Cancer — — — — — — — 1 — 1 Bronchitis — — — 1 1 2 6 — 2 11 Pneumonia (all forms) — 2 1 1 4 6 16 10 6 42 Diarrhœa, etc. — — — — — 8 13 12 2 35 Other digestive diseases — — — — — 2 — — 1 3 Congenital debility and malformation, premature birth, etc. 74 3 3 1 81 14 2 1 1 99 Other deaths from violence 1 — — — 1 1 2 1 — 5 Other defined diseases 1 3 2 — 6 1 4 2 3 16 26 Stillbirths. The following particulars regarding stillbirths registered in Lambeth during 1936 have been received from the Registrar General:— Stillbirths registered Inward transfers. Outward transfers Corrected totals Total legitimate and illegitimate : Males 114 12 56 70 Females 96 10 48 58 Illegitimate :— Males 7 — 2 5 Females 5 — — 5 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. 1936 1935 1934 Quinquennium 1931-1935 Estimated Population 277,500 279,900 283,900 288,200 General death-rate 12.41 12.02 12.65 12.59 Zymotic death-rate 0.33 0.25 0.59 0.39 Measles death-rate 0.09 0.007 0.23 0.08 Whooping Cough death-rate 0.04 0.06 0.04 0.06 Diarrhoeal death-rate 0.13 0.12 0.13 0.13 Typhoid Fever death-rate 0.003 0.003 0.003 0.004 Tuberculosis (all forms) deathrate 0.76 0.78 0.94 0.90 Tuberculosis (pulmonary) death-rate 0.69 0.70 0.81 0.80 Scarlet Fever death-rate 0.00 0.00 0.01 0.00 Diphtheria death-rate 0.05 0.05 0.15 0.09 Small-pox death-rate 0.00 0.00 0.00 0.00 Infantile Mortality rate 59 59 63 60 27 Births, 1936. The total number of Births registered (uncorrected) is 5,542, of which details are set out in Table A. The corrected number of births, however, is 3,871, showing a birth-rate of 13.94 per 1,000 of the estimated population. Total registered Inward transfers Outward transfers Corrected numbers Legitimate Males 2,630 387 1,174 1,843 Legitimate Females 2,591 371 1,188 1,774 Illegitimate Males 157 55 77 135 Illegitimate Females 164 48 93 119 Totals 5,542 861 2,532 3,871 Notification of Births. Public Health (London) Act, 1936. The Notification of Births Act, 1907, was adopted throughout the Borough, and came into operation on 9th March, 1908. Of the total 5,700 notified births, 4,489 took place in Institutions, and of these, 1,885 belong to Lambeth, and 2,604 to outside districts, thus:— Institutions. Lambeth Cases Strangers Totals General Lying-in Hospital 330 849 1,179 St. Thomas's Hospital 245 350 595 Lambeth Hospital 383 375 758 Clapham Maternity Hospital 149 368 517 King's College Hospital 232 473 705 Lambeth Council Maternity Home 413 9 422 Other Nursing Homes (private) 133 180 313 Totals 1,885 2,604 4,489 * 9 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 Pemphigus Scarlet Fever Visits paid to Children under 5 years of age 490 31 — 48 6 — Visits paid to Persons over 5 years of age 1,869 — 25 388 — 30 Total Visits 2,359 31 25 436 6 30 Measles OphthalmiaNeonatorum Conjunctivitis Puerperal Pyrexia Erysipelas Visits paid to Children under 5 years of age 339 333 1,275 — — Visits paid to Persons over 5 years of age 468 — 20 17 15 Total Visits 807 333 1,295 17 15 A flat rate of 1/3 per visit is paid for the nursing of infectious disease. 29 Midwives. There are approximately 52 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 38 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.1, 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.1. 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.1. 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.11. 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.11.* 4. Moffat Institute, The Institute, Aveline 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, 70 Knowle 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.* † (Branch Clinic, Gipsy Road, S.E.27.) In addition clinics are held daily at :— General Lying-in Hospital, York Road, S.E.1.* † St. Thomas's Hospital (Main Building), S.E.l.* † — do — 37, Royal Street, S.E.1. These are in all respects regarded as Voluntary Welfare Centres and integral parts of the Lambeth scheme, and receive grants from the Council. 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, Frinces 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 of rent 12/6 per head, after deduction 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 £ s. d. £ s. d. £ s. d. 1918-19 (3 months) 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 1935-36 3,751 14 7 — 3,751 14 7 37,909 Totals 58,062 19 10 5,572 11 10 63,635 11 8 711,742 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 with 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 consent of the Minister, terminate or make any reduction in the annual contribution payable to an Association in respect of any service on the ground that any of the foregoing conditions are not fulfilled in the case of that service. In several instances supplementary grants have since been approved by the Council increasing the block grants to provide additional facilities. During the year the block grant made to each Welfare Centre and Institution was carefully reviewed and after consultation with the respective governing bodies, the grants were amended for the next period and submitted to the Minister for approval. The new scheme, which came into operation on 1st April, 1937 and will remain in force until 31st March, 1942, unless previousl determined, is as follows:— 34 (1) Voluntary Associations (Infant Welfare Centres, etc.) (2) Service in respect of which Contribution is payable (3) Amount of Annual Contribution Third fixed period (1937-42) £ North Marsh Infant Welfare Centre 365 Barley Mow Do. 720 North Lambeth Babies' Care Do. 995 Moffat Institute Do. 1,045 "Rose McAndrew" Do. 940 St. Anne's Do. 755 Loughborough Junction Do. 1,695 North Brixton Do. 1,225 Stockwell Do. 930 Brixton Do. 1,300 West Norwood Do. 1,495 St. Thomas's Hospital (Main building) Do. 945 St. Thomas's Hospital (37 Royal Street) Do. 750 General Lying-in Hospital Do. 650 St. Thomas's Babies' Hostel Ailing Babies' Home 1,030 Cynthia Mosley Day Nursery Day Nursery 300 Total £15,140 The Maternity Home The Council's Maternity Home, at 210 Knight's Hill, has maintained its successful career during the year, and 422 cases were admitted to the Home—a decrease of 24 below the previous year's total. Since its inception in 1926, 4,209 women have been admitted to the Home, with only two fatalities, which is a striking tribute both to the Home and to the value of the ante-natal work carried out at the voluntary welfare centres. 35 Applications dealt with during 1936. Welfare Centre Applications received Applications withdrawn, refused or cancelled Babies Care 1 1 Moffat Institute 1 — North Brixton (Belgrave Hospital) 18 1 Stockwell 74 9 Brixton 96 5 Loughborough Junction 65 4 Norwood 184 9 Total 439 29 The Committee of Management of the Lambeth Council's Maternity Home includes four co-opted members, each representing the Voluntary Welfare Committees in one of the four Parliamentary Divisions of the Borough. The Management Committee is much strengthened by the inclusion of these four ladies who are in a position to explain at first hand the various points of view of the Welfare Centres which they represent. The success of the Council's Home is 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 1 1 Kennington 19 2 Brixton 132 14 Norwood 287 12 Total 439 29 36 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, now consolidated in the Public Health (London) Act, 1936, was transferred to the Borough Council, and the summary of this work for the year ended the 31st December, 1936, now follows :— No. of Foster Mothers on Register 180 No. of Nurse Children on Register 262 No. of Visits and Re-Visits paid to Nurse Children 1,212 Year of Birth No. of Nurse Children No. of Visits 1936 53 148 1935 64 270 1934 26 124 1933 21 115 1932 23 150 1931 11 58 1930 14 94 1929 19 112 1928 17 101 1927 14 40 Totals 262 1,212 No. of Visits, including verifications and registering of homes 1,805 No. of Foster Mothers removed from Borough 16 No. of Nurse Children legally adopted by Foster Parents 6 No. of Nurse Children taken by National Children's Aid and Adoption Society with a view to adoption 2 No. of Nurse Children who attained the age of 9 years 10 No. of Deaths 1 No. of Legal Proceedings taken — A prime condition for registration of a foster mother is that she shall attend regularly at her local Welfare Centre with the foster child. The attendance is now 100 per cent., which may be contrasted with the attendance of less than 25 per cent. before the Transfer of Powers Order was made. 37 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. 97 applications were received, 25 being emergency cases. The expense to the Council was only £53 5s. 0d., and from every point of view the money could scarcely have been better spent. (ii) Sterile Maternity Outfits. These outfits contain sterilised dressings, etc., and are sold at cost price at every Welfare Centre. In the course of the year 498 of these outfits were sold. The Council has sanctioned the issue of these outfits free or at reduced cost in cases of poverty. 22 applications (1 since cancelled) for assistance towards the purchase of these outfits from necessitous cases were received in the course of the year at a cost to the Council of £2 9s. 9d. (iii) Sterilization of Bed Linen, etc. During the year 22 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 cases are visited by the Council's Health Visitors, who refer mothers to their local Welfare Centre for advice for themselves, and for patterns of baby clothing, etc., and full reports are forwarded to the almoner of the hospital concerned. 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 1936 was 2,159 distributed as follows :— St. Thomas's Hospital 696 King's College Hospital 233 General Lying-in Hospital 327 1,855 Lambeth Hospital ... 599 38 Institutions outside the Borough of Lambeth Westminster Hospital 43 Charing Cross Hospital 27 St. George's Hospital 16 Dulwich Hospital 59 Middlesex Hospital 4 Elizabeth Garratt Anderson Hospital 4 Royal Free Hospital 4 Guy's Hospital 1 304 St. Giles' Hospital 135 St. Mary's Hospital 1 Queen Charlotte's Hospital 2 St. Mary Abbott Hospital 1 St. Stephen's Hospital 1 Hammersmith Hospital 2 St. James' Hospital 3 ,South London Hospital 1 (v) Midwives. By arrangement with the County Council, the Local Supervising authority under the Midwives Acts (1902-1936). 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 47, as opposed to 25 last year, 8 in 1934, 61, in 1933, 64 in 1932, 83 in 1931, and 149 in 1930. Seeing that some seven to eight hundred confinements conducted by midwives take place yearly, the poor response of the midwives is significant, and may be compared with the present attendance of foster mothers at the Welfare Centres now that infant lifeprotection measures are supervised by the Borough Council in place of the County Council (See page 36). Applications for assistance towards the payment of the midwife were received from 70 expectant mothers, of which 14 were emergency cases. The cost to the Council was £56 18s. 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. Three applications were received from midwives during the year. 39 (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. 0d. (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. Toddlers. The receipt of Ministry of Health Circular No. 1550 (Children under school age), led to the consideration by the Council of the scope of its Maternity and Child Welfare scheme, with a view to amplification in several directions (see Appendix A). The following additions are now incorporated in the scheme. (i) Arrangements for the medical supervision and minor ailment treatment of toddlers from eighteen months to school age have been set up. (ii) A free issue of cod liver oil in the form of oil, emulsion, and oil and malt, is now made to all those receiving free and aided supplies of milk. (iii) The Council have agreed in principle to the inauguration of three more day nurseries which with the Cynthia Mosley Day Nursery, would provide one for each parliamentary division. Beyond this step no other has as yet been taken. 40 Toddlers' clinics have been set up in almost all the Welfare Centres, where none previously existed and the toddlers undergo a comprehensive medical examination intended to be repeated each year until of school age. The results of the examination and the medical history are recorded upon cards which are drafted upon lines similar to those used for children at school by the local education authority. Arrangements have been concluded with the voluntary hospitals in the district where toddlers are treated free of expense to the parents, and by a system of appointments are attended to with a minimum of delay. Full particulars may be found in appendix A. The Cynthia Mosley Day Nursery The day nursery has continued its successful career during the year, and the need for further nurseries is emphasised by the demand. Applications for admission are rather more than double the numbers which can be accommodated, and the disappointment caused to so many unsuccessful applicants renders the provision of other nurseries a matter of some urgency. The Council have agreed in principle to three more nurseries so that there shall be one in each of the four Parliamentary divisions, but the practical application of the principle is still under consideration. The day nursery forms an integral part of the Lambeth Maternity and Child Welfare scheme, and is now included in the scheme of the Minister of Health made under section 101 (6) Local Government Act, 1929. It has also been recognised by the Board of Education as a nursery school in respect of the toddlers' side. To meet the requirements of the Board the number of children accommodated has been reduced from 50 to 45, of whom 30 belong to the nursery school. There were 12,105 attendances during the 41 year upon 254½ working days, giving an average daily total of 47.5 children accommodated. The gross cost per child per day is under two shillings, of which the food represents less than eightpence. The medical officer in charge examines half the children each week and prescribes special treatment as required, such as ultra violet light, from the apparatus installed on the premises. Applications for admission are made at the welfare centres in order to insure that those most in need are accepted, and each must obtain a recommendation from the health visiting staff of the local welfare centre, who, naturally, have first-hand intimate knowledge of the home conditions. The administration is directed by an executive committee composed of representatives of the voluntary subscribers and of the Borough Council. 42 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 (M tin Building1 St. Thomas's Hospital (37 Royal St.) General Lying-in Hospital Totals Total Numbers of Individual Cases Dealt With 1. Ante-natal Cases 53 212 472 60 274 176 145 326 256 256 363 705 67 522 3,887 2. Post-natal Cases — — 29 1 — 130 12 239 80 66 60 430 — 70 1,117 3. Nursing Mothers 83 450 792 334 641 246 530 732 318 502 750 430 23 113 5,944 4. Infants (under 1 year) 83 452 1,168 212 878 247 530 1,289 517 667 591 499 — 115 7,248 5. Children (aged 1-5 years) 77 644 1,211 196 834 164 352 666 322 1,081 353 232 — 43 6,175 Total 296 1,758 3,672 803 2,627 963 1,569 3,252 1,493 2,572 2,117 2,296 90 863 24,371 Total Numbers of Sessions Held 1. Ante-natal — — 49 32 — 16 50 104 51 58 101 153 — 302 916 2. Medical "Consultations" 53 61 100 110 145 48 198 250 96 205 151 156 — 86 1,659 3. Dental — — — 31 — — — 52 — 24 54 101 — 54 316 4. Others 42 82 33 140 89 44 49 — — 202 96 — 189 64 1,030 Total 95 143 182 313 234 108 297 406 147 489 402 410 189 506 3,921 Total Numbers of all Attendances at the Sessions 1. Ante-natal Cases : (a) Ante-natal — — — 175 — 156 293 1,378 782 1,103 1,524 2,845 — 3,214 11,470 (6) Seen by Medical Officer 19 39 398 — — — 1,937 — — — — — — — 2,393 (c) Otherwise dealt with 29 8 — — — — 189 — 33 — — — — —> 259 (d) Dental — — — — — — — 98 — 33 319 89 — 315 854 (e) Others 108 108 — 5 — 179 137 — 51 — 438 — 609 — 1,635 Total 156 155 398 180 335 2,556 1,476 866 1,136 2,281 2,934 609 3,529 16,611 Post-natal : (a) Seen by Medical Officer — — 15 2 — 130 27 478 65 136 136 430 — 130 1,549 (b) Otherwise dealt with — — — — — — — — — 49 — — — — 49 (c) Dental — — — — — — — — — — 29 — — — 29 (d) Others — — — — — — — — — 160 92 — — — 252 Total — — 15 2 — 130 27 478 65 345 257 430 — 130 1,879 2. Nursing Mothers : (a) Seen by Medical Officer 360 1,306 1,168 2,185 2,957 1,229 2,833 1,754 848 2,283 2,934 1,308 — 1,055 22,220 (b) Otherwise dealt with 502 513 938 1,502 2,442 1,487 3,558 — 1,349 1,172 5,426 — — 120 19,009 (c) Dental — — — 63 — — — 733 — 71 102 6 — 79 1,054 (d) Others 204 1,814 487 183 — 695 — — 23 23 431 — 548 — 4,408 Total 1,066 3,633 2,593 3,933 5,399 3,411 6,391 2,487 2,220 3,549 8,893 1,314 548 1,254 46,691 43 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 360 910 1,612 1,181 3,761 915 2,836 3,530 1,685 3,482 2,261 2,045 - 1,077 25,655 (b) Otherwise dealt with 502 469 1,463 637 2,998 1,159 3,588 — 3,948 2,920 3,218 — — 150 21,052 (c) Dental — — — — — — — — — — — — — — — (D) Others 204 798 — 148 — 86 — — 46 363 177 - - - 1,822 Total 1,066 2,177 3,075 1,966 6,759 2,160 6,424 3,530 5,679 6,765 5,656 2,045 — 1,227 48,529 4. Children (aged 1-5 years) : (a) Seen by Medical Officer 276 734 1,409 1,581 2,044 551 1,705 2,028 847 1,773 1,010 1,262 — 723 15,943 (b) Otherwise dealt with 505 213 1,058 607 2,117 601 2,829 — 2,276 2,367 1,945 — — — 14,518 (c) Dental — — — 15 — — — 166 — 72 94 9 — — 356 (d) Others 240 806 — 918 — 197 — — 49 616 91 — — — 2,917 Total 1,021 1,753 2,467 3,121 4,161 1,349 4,534 2,194 3,172 4,828 3,140 1,271 — 723 33,734 Visits and Re-visits Paid to Homes Ante-natal Cases : (a) First Visits 46 154 267 103 221 156 265 655 203 166 116 — 105 166 2,623 (b) Re-visits 188 524 440 96 716 626 91 1,450 201 577 160 — 355 917 6,341 Total Visits 234 678 707 199 937 782 356 2,105 404 743 276 — 460 1,083 8,964 1. Post-natal (a) First Visits 25 — 29 116 - 213 262 483 37 429 331 — — — 1,925 \b) Re-visits 10 — — — — — — 1,806 5 56 — — — — 1,877 Total Visits 35 — 29 116 — 213 262 2,289 42 485 331 — — — 3,802 2. Nursing Mothers : (a) First Visits 54 189 356 30 430 187 380 469 389 231 114 — 90 145 3,064 (b) Re-visits 647 5,233 1,055 813 1,658 5,589 901 1,040 726 537 1,953 — 763 1,386 22,301 Total Visits 701 5,422 1,411 843 2,088 5,776 1,281 1,509 1,115 768 2,067 — 853 1,531 25,365 3. Infants (under 1 year) : (a) First Visits 64 179 398 137 553 262 363 495 403 570 457 — 88 115 4,084 (b) Re-visits 658 2,094 2,113 813 2,095 2,486 833 1,806 1,796 1,212 1,988 — 801 653 19,348 Total Visits 722 2,273 2,511 950 2,648 2,748 1,196 2,301 2,199 1,782 2,445 - 889 768 23,432 4. Children (aged 1-5 years) : (a) First Visits 49 45 156 123 505 221 163 339 185 225 53 — 41 126 2,231 (b) Re-visits 1,602 5,881 3,938 3,096 2,663 3,204 1,943 2,082 2,243 2,002 4,018 — 598 3,709 36,979 Total Visits 1,651 5,926 4,094 3,219 3,168 3,425 2,106 2,421 2,428 2,227 4,071 — 639 3,835 39,210 44 Superannuation Scheme for the Staffs of the Voluntary Welfare Centres All the welfare centres in the Lambeth Maternity and Child Welfare scheme are controlled by voluntary committees, and the staffs of the centres are in the employment of the committees. The Council's superannuation scheme is limited to their own direct employees, and the staffs of the welfare centres are not eligible to participate. These staffs were faced with retirement on small sums saved out of somewhat meagre salaries, which vary from £200 for the junior posts to £250 for the few senior posts. After consideration, the Council agreed in November, 1935, to permit the voluntary committees to adopt the Federated Superannuation Scheme for Nurses and Hospital Officers (Contributory), and to make the appropriate contributions towards the cost. The required arrangements were made individually by the welfare centres, and except in those few in which the superannuation scheme had already been adopted, initial contributions were made at the beginning of the year. For those health visitors who were over age and unable to benefit under the superannuation scheme, a sum corresponding to the centre's contribution is to be paid annually into a form of trust fund to accumulate and ultimately be given as a gratuity on retirement. Summary The table on pages 42-43 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. 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 of defects:— 45 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 23,008 13 6 59 57.1 1936 22,651 17 1 59 46.3 Summary of Work carried out (Visits Paid) by the 4 Whole-time Official Health Visitors during 1936. Ante-natal Visits 1,259 Do. Re-visits 80 Births, IstVisits 96l Do. Re-visits 228 Do. Stillborn 98 Ophthalmia, 1st Visits 89 Do. Re-visits 124 Infantile Deaths, Visits 25 Welfare Centre Attendances 496 Clinic Attendances 134 Visits—No result 1,433 Special Visits (Measles, Diphtheria Prevention, etc. 1,509 Visits to Children 1-5 (included above) 884 Puerperal Pyrexia, 1st Visits 45 Do. Re-visits 31 Enlarged Tonsil and Adenoid Visits 16 Do. Re-visits — 46 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 52, of which 30 occurred in primiparae, 16 in multiparae, while the particulars of the remaining 6 were not ascertained. The causes giving rise to the notifications are detailed in the following table:— Cause Primiparae Multiparae Medical Ante-natal care Yes No Manual interference 5 - 4 1 Abortion — 6 — 6 Caesarean section 3 2 5 - Mastitis 2 1 3 - Influenza, Bronchitis, etc. 4 1 3 2 Pyelitis cystitis 7 2 8 1 Tonsillitis — 1 1 — Local Uterine Sepsis 5 1 5 1 Various 4 2 4 2 Totals 30 16 33 13 47 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, other than the purchase of 27 refuse containers (Scammell Lorries, Ltd.), for the collection of refuse from hospitals and other institutions belonging to the London Countv Council. ABSTRACT OF THE ANNUAL RETURN MADE TO THE MINISTRY OF HEALTH BY THE LOCAL AUTHORITY. House and Trade Refuse. Table showing Costs for the Year ended 31st March, 1936. Item Particulars Total including Depreciation or Loan Charges Revenue Account— £ 1 Gross Expenditure 55,776 2 Gross Income 2,754 3 Net Cost 53,022 Unit Costs— s. d. 4 Gross Expenditure, per ton 18 11 5 Gross Income, per ton 0 11 6 Net cost, per ton 18 0 7 Net cost per 1,000 population £189.4 8 Net cost per 1,000 houses or premises from which refuse is collected £1,060.4 9 Total refuse collected 60,402 tons House refuse only 58,916 „ 10 Population: Midsummer, 1935 279,900 48 11 Area (statute acres) 4,083 12 Weight per 1,000 population per day (366 days to year) 11.5 13 Number of houses and premises 50,000 approx. 14 Method of Collection No. of vehicles Percentage of refuse collected Horse vehicles Nil — Mechanical vehicles 3 9 Container system (combination of mechanical and horse vehicles) 6 lorries and 23 containers 91 15 Method of disposal Controlled tipping 16 Average length of haul to point of disposal at wharf 1.86 miles Street Cleansing. Table showing Costs for the Year ended 31st March, 1936. Item Particulars Street Sweeping and Watering Gully Cleansing Snow Removal £ £ £ Revenue Account— 1 *Gross Expenditure 41,463 2,392 272 2 Gross Income 1,826 — — 3 Net cost 39,637 2,392 272 Unit Costs— 4 Net cost per 10,000 square yards cleansed 8s. 6d. - - 5 Net cost per 1,000 gullies cleansed - £58.72 - 6 Net cost per 1,000 of popu lation £141.61 £8.55 £0.97 * Including loan charges, depreciation, etc. 7 (a) Square yards of streets cleansed, inclusive of footpaths 3,353,000 (6) Number of square yards of streets cleansed multiplied by number of cleansings during year 931,128,000 8 (a) Total number of Gullies cleansed approx. 11,000 (b) Number of gullies cleansed multiplied by number of cleansings during year 40,734 49 9 Total mileage of streets cleansed 143 10 Approximate mileage cleansed three times daily 10.7 twice 10.3 once 45.5 11 ,, „ ,, four times weekly 4.5 three „ „ 30.05 12 twice „ „ 41.95 13 once „ „ — 14 ,, „ ,, less than once weekly — 15 Average length of haul to point of disposal 1.5 miles 16 No. of employees, other than clerical :— Foremen 3 Others 165 Sanitary Inspection of the Area. 5,428 Notices were served during the year 1936, as follows :— Public Health (London) Act, Metropolis Local Management Acts Housing Acts, etc. (a) District Sanitary Inspectors. 3,549 Preliminary or Intimation Notices. (1) Male Inspectors 3,430 (2) Women Inspectors 119 Statutory Notices. (1) Male Inspectors. (a) P.H. Act 246 260 (6) Met. Man. Acts 14 (2) Women Inspectors - Disinfection Notices 1,275 (b) Food. Inspectors. (1) Public Health (Meat) Regulations 4 7 (2) L.C.C. (General Powers) Acts 3 (c) Housing Inspectors. Informal Schedules 19 42 Formal Notices 23 Total 5,133 d 50 11 Summonses were issued, with results as follows:- Public Health (London) Act, 1891. Convictions 3 Summons withdrawn on costs 1 - 4 Metropolis Management Acts. Summons withdrawn on costs 1 1 Food and Drugs (Adulteration) Act, 1928. Convictions — Summons withdrawn - Summons dismissed 2 Summons dismissed on costs 4 — 6 Total 11 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 1936. Inspections 12,661 Re-visits 24,878 Complaints received 4,813 Water Certificates issued (1,556 separate houses or tenements including 38 blocks of tenements) 155 Drains tested (with chemical, water or smoke test) 5,176 Sanitary Works completed 4,171 Sanitary Nuisances 13,289 1. Bath Waste Totals (a) directly connected to drain 3 (b) improperly trapped or untrapped ; defective 74 2. Basement dwellings : (a) inspections 3 (b) reinspections 4 51 Totals 3. Ceilings and Walls: defective 758 4. Chimney: defective 86 5. Copper: defective 99 6. Damp condition of premises 901 7. Dilapidated condition of premises 218 8. Door: defective 118 9. Drains : (a) defective 239 (b) fresh air inlet defective 138 (c) gulley defective 111 (d) manhole defective 61 (e) plunging eye defective 24 (/) soil pipe defective 122 (g) stopped 312 (h) trap insufficient 10 (i) ventilation insufficient 33 (j) vent pipe defective 125 10. Dustbins or Ashpits : (a) defective or dilapidated 465 (b) absence of 138 11. Fireplace: defective 388 12. Floors: defective 316 13. Lavatory Waste : directly connected to drain, improperly trapped or untrapped 25 14. Paving (yard or area) : (a) defective 293 (b) undrained 30 15. Rainwater Pipe and Gutters : (a) rainwater pipe defective 241 (b) gutters defective 455 (c) rainwater pipe directly connected to drain 19 16. Roof: defective 1,114 17. Sinks: (a) defective 228 (b) directly connected to drain 15 (c) improperly trapped or untrapped 188 (d) waste defective 27 52 18. Stable: Totals (a) absence of proper manure receptacle 5 (b) drain defective — (c) paving defective 4 (d) undrained 4 19. Washhouse : (a) roof defective 75 (b) paving defective 51 (c) undrained — 20. Water Closet: (a) defective so as to be a nuisance 258 (b) improperly constructed so as to be a nuisance 43 (c) insufficient or improper accommodation 32 (d) pan and trap defective 251 (e) deficient or defective water supply 216 21. Water Supply: (a) cut off 70 (b) draw-off from main required 14 (c) no supply 9 (d) pipes, taps, etc., defective 97 (e) storage cistern defective or uncovered 23 (f) storage cistern so foul as to be a nuisance 3 (g) tenement houses supplied 11 22. Windows: defective 419 23. Animals : improperly kept 28 24. Bakehouses : (а) inspections 225 (б) reinspections 110 (c) dirty 95 25. Dirty Premises : (a) walls and ceilings of rooms dirty 2,248 (b) rooms, etc., verminous 416 (c) stable premises dirty 8 (d) washhouse walls and ceilings dirty 365 (e) water closet walls and ceilings dirty 356 (/) workshops and factories 51 26. Effluvium nuisance : (a) from industrial premises 8 (b) from private premises 19 27. Lighting and Ventilation: defective 27 28. Manure: accumulation or deposit injurious to health 17 29. Overcrowding 14 53 Totals 30. Rats infestation : (a) Industrial premises 24 (b) Private premises 149 31. Refuse accumulations 214 32. Smoke Nuisance : (a) from industrial premises 46 (b) from private premises 32 33. Stagnant Water: accumulation 30 34. Underground Rooms : occupied as a dwelling 15 35. Urinal: foul 13 In addition, the District Sanitary Inspectors carried out during 1936 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 19 inspections were made and 18 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. Now Section 224, Public Health (London) Act, 1936. In four cases only was it necessary to obtain a magistrate's order under this Section. Several other old people were induced to enter the London County Council Hospital without the need for application for orders. 54 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 Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) Factories (Including Factory Laundries) 392 61 — Workshops (Including Workshop Laundries) 554 73 — Workplaces (Other than Outworkers' premises) 473 76 - Total 1,419 210 - 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 198 196 — — Want of ventilation 8 7 1 — Overcrowding — — — — Want of drainage of floors 6 6 — — Other nuisances 53 49 — — Sanitary accommodation— Insufficient 6 6 — — Unsuitable or defective 85 85 — — Not separate for sexes 2 2 — — 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 Sections mentioned in the Schedule of the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) - - - - Total 358 351 1 — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act. 1901. as remediable under the Public Health Acts. 55 Outwork in Unwholesome Premises, Section 108. Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) Wearing Apparel— Making, etc. 130 2 — Cleaning and washing — — — Household linen 1 — — Lace, lace curtains and nets — — — Curtains and furniture hangings. — — — Furniture and upholstery 2 — — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, etc. 1 — — Artificial flowers 1 — — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags 14 — — Brush making 2 — — Pea picking — — — Feather sorting — — — Carding, etc., of buttons, etc. 1 — — Stuffed toys 3 — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, etc. 1 Textile weaving — — — Lampshades — — — Fancy articles, pin cushions, milk bottle covers, etc. 20 — — Total 176 2 — Summary of Work carried out by the Women Sanitary Inspectors during 1936. Workshops* visited and inspected 585 Workshops* : workrooms therein measured 16 Workshops* : newly discovered and registered 52 * Workshops include Work-places. 56 Premises visited, but not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 461 Women's Conveniences visited and inspected, etc. (visits paid) 1,021 Special places visited and inspected : (a) Restaurants 393 (b) Housing enquiries 669 (c) Outworkers 177 (d) Complaints, Infectious diseases, etc 206 1,445 Re-inspections : (a) Restaurants 74 (b) Housing enquiries 110 (c) Outworkers 1 (d) Complaints, etc 42 227 Written Intimation and Statutory Notices served 119 No. of Workshops, etc., in which defects were found 137 No. of Workshops, etc., in which no defects were found 1,655 Nuisances referred to M.O.H., for attention by Male Inspectors 18 Particulars of Defects found by Women Inspectors. Workshops, etc.:— Workrooms : Overcrowded, Damp, Dirty, etc. — Defective or Dirty: Yards, Floors, Roofs, Windows, Walls and Ceilings, Rain Water Pipes, Sink Wastes, or Premises generally 18 Sanitary Appliances : Water Closets—Dirty,unventilated, choked, defective or with defective cistern or water supplies — Drainage—Defective — Dustbins—Wanting or Defective — Lavatories—Dirty or Defective - No separate suitable sufficient W.C. accommodation for the sexes - Miscellaneous Defects, Defective Chimneys, etc. — Accumulation of refuse 3 57 Factories and Workshops. Twenty-four new factories, 28 new workshops, and 46 new workplaces were added to the Register, dealing with various trades. Out-workers. Thirteen February and fourteen August lists were received, dealing with 141 and 237 out-workers respectively. Of the 378 out-workers 165 belonged to Lambeth and the remainder lived in other areas. Particulars of the latter were sent to the Authorities concerned, while in return, 82 lists were received from various outside authorities dealing with 461 out - workers living in Lambeth. Of the total Lambeth out-workers reported 176 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 58 and licences were granted and registrations were effected as follows:— (a) Offensive Trades. Three offensive trades are registered in Lambeth as follows :— 9 Old Paradise Street (tripe boiling). 15 Upper Marsh (fat melting). 15 Upper Marsh (soap boiling). (b) Cow-houses. 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, at 72-74 GipsyHill, 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 slaughterers' 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 71.) (f) Ice Cream Vendors. At the end of the year there were 404 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 187 of the Public Health (London) Act, 1936. (g) Bakehouses. There are 129 bakehouses on the Register compared with 222, 214, 214and 140 for the years 1901, 1911, 1921 and 1931 respectively; 30 are underground, and machinery is installed in 43. (h) Food Premises. (See page 74.) 59 Smoke Abatement. Metal plates containing suggestions to avoid the unnecessaryemission of smoke have been distributed to all firms using handand oil-fired boilers in the area. These have been fixed prominently in the stokeholds and are appreciated. No. of complaints received 46 No. of intimation notices served 46 No. of observations made 78 Every effort is made to enlist co-operation with industry by the sanitary inspectors in order to reduce the waste and nuisance from smoke. Shops Acts, 1934 Twenty-three inspections and eleven re-inspections were made during the year in connection with ventilation, temperature and sanitary conveniences. No legal proceedings were instituted, as all alterations required were carried out informally. Three 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 almost finished 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. 60 Schools. No schools in the district are under the control of the Borough Council, as the County Council is the Education Authority. Close touch is kept with the school authorities, however, in so far as infectious disease is concerned. HOUSING. Housing Act, 1930. Part 1. In appendix B will be found the report and representation to the Council of the Fount Street area. The inquiry was held in March, 1937, and the Minister was able to confirm the Council's order without amendment. Practically every house in the clearance area was infested with bugs when inspected, as was the case with the adjoining Hemans Street clearance area, but the authority declined to disinfect the old premises on vacation and prior to demolition. The furniture and effects of the displaced families, however, were treated in pantechnicons with hydrocyanic acid gas, while the bedding was disinfected by steam and delivered to the new homes in each instance. 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 Distin Street 39 331 Ethelred Street Over Place (1 and 2 Areas) Saunders Street— (1, 2 and 3 Areas) Reedworth Street Burdett Street 13 122 Waxwell Terrace 26 386 Peartree Street 5 15 83 854 61 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 126 (2) Record forms (Clearance Areas) filed 126 (3) Notices of intention to survey issued under section 127 of the Housing Act, 1925, and served upon occupiers and owners 85 (4) Surveys or inspections made under the House Inspection Regulations of the Housing Acts, 1925 to 1935 23 (5) Provisional or informal schedules prepared under section 17 of the Housing Act, 1930 19 (6) Schedules prepared for the purpose of Statutory Notices under section 17 of the Housing Act, 1930 23 (7) Record Cards (section 17) filed 23 (8) Surveys made under section 19 of the Housing Act, 1930 13 (9) Record forms (section 19) filed 13 (10) Surveys made under sections 20 and 84 of the Housing Acts, 1930 and 1935 respectively (underground rooms and parts of buildings) 301 (11) Record forms (sections 20 and 84) filed 301 (12) Drain tests made (chemical, smoke, and water) 463 (13) Total visits made (re-visits, 10,429) 10,892 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:— Part I. (Clearance Areas). Vauxhall Ward. Conroy Street (43), Crimsworth Road (11), Fount Street (47), Springfield Place (19), Thorparch Road (4), Wandsworth Road (2). Representation was made under the Housing Acts as follows :— Section I. (Clearance Areas).—115 houses. Vauxhall Ward. Conroy Street (Nos. 15 to 61 odd and Nos. 2 to 38 even), Crimsworth Road (Nos. 2 to 12 even), Fount Street (Nos. 1, 3, 5, 5a to 29 odd, 35 to 57 odd and Nos. 2 to 38 even), Springfield Place (Nos. la, 1 to 23 odd and Nos. 24 to 29 cons.). The actual work has been completed, or practically completed, in the following houses, the numbering of the individual houses being given in brackets after the street or court:— 62 (1) After Service of Notices (Legal Schedules) :— Bishop's Ward. * Hercules Road (No. 49). Vauxhall Ward. Camellia Street (No. 18), Rutland Street (Nos. 21, 22 and 23). Angell Ward. Padfield Street (Nos. 3 and 4). Stockwell Ward. * Cottage Grove (No. 39). Tulse Hill Ward. * Elm Park (No. 97). * The Council have carried out and completed the work. (2) After Service of Provisional (Informal) Schedules :— Prince's Ward. Methley Street (Nos. 37, 39 and 41), Wood Street (Nos. 1, 2, 3, 5, 6, 7, 8, 9, 10, 11 and 12). Vauxhall Ward. Cavendish Grove (Nos. 25, 27 and 51), Paradise Road (Nos. 23 and 25), Riverhall Street (Nos. 17, 19, 20, 21, 28, 32, 33, 34, 35, 36, 37, 38 and 40). Angell Ward. Langton Road (Nos. 69, 71, 73, 75, 46, 48 and 50), Valentia Road (Nos. 9, 10, 11, 12, 13, 14 and 15). Stockwell Ward. Kepler Road (No. 53), Love Lane (Nos. 18 and 19), Stockwell Grove (Nos. 3, 5, 7, 9 and 11), Stockwell Park Walk (Nos. 1, 2 3 and 4). Town Hall Ward. Allington Street (Nos. 32, 34, 36, 38, 40 and 42), Lyham Road (Nos. 95 and 97), Torrens Road (No. 4). Tulse Hill Ward. Dulwich Road (No. 30). Knight's Hill Ward. Bentons Lane (Nos. 3, 4, 5, 6, 7 and 8), Clive Road (Nos. 2, 4, 6, 8, 10 and 12), Hamilton Road (Nos. 74, 91, 93, 95, 97 and 133). 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. Wandsworth Road (Nos. 171 to 177 odd). Knight's Hill Ward. Windsor Road (Canton Cottage). 63 Twenty-three notices (legal schedules) have been served during the year in respect of the following houses :— Bishop's Ward. Hercules Road (No. 49). Prince's Ward. Goding Street (No. 31). Vauxhall Ward. Camellia Street (No. 18), Cavendish Grove (Nos. 33, 35, 37, 39, 41, 43, 45, 47 and 49), Luscombe Street (Nos. 3, 5, and 7). Angell Ward. Conderton Road (Nos. 5, 7, 9, 13 and 17). Slockwell Ward. Bellefields Road (No. 4), Cottage Grove (No. 39), Stockwell Park Road (No. 129). Work has also been started in many other cases, and is in various stages of progress, while, in addition, many provisional (informal) schedules have been served in connection with houses, but the work has not yet been commenced. Ninety-four representations were made under the Housing Acts, as follows :— (a) Section 19 (Demolition Orders—1 representation). Vauxhall Ward. Wandsworth Road (No. 90). (i) Demolition Orders Made. Marsh Ward. College Street (No. 55). Town Hall Ward. Brighton Terrace (Nos. 1, 3, 5). (b) Sections 20 and 84.—Housing Acts, 1930, 1935 respectively. (Underground rooms and parts of buildings). Marsh Ward. Broadwall (No. 64), Coin Street (No. 36), Lambeth Square (No. 24), Lower Marsh (Nos. 57 and 58). Bishop's Ward. Burdett Buildings (Nos. 11, 23 and 24), Carlisle Street (No. 61), Lambeth Road (No. 196), Lambeth Palace Road (No. 35), Old Paradise Street (No. 31), Radnor Buildings (Nos. 3 and 8), Vauxhall Walk (Nos. 132, 134 and 136), Westminster Bridge Road (No. 69). Prince's Ward. Holyoak Road (Nos. 1, 34 and 58, inspected 1935), Kennington Road (No. 116), Monkton Street (No. 79), Prince's Road (Nos. 114, 115, 116, 117 and 118). Vauxhall Ward. Clapham Road (No. 282), Lansdowne Road (No. 37), Paradise Road (No. 63). 64 Oval Ward. Kennington Road (No. 337), Richborne Terrace (Nos. 44 and 81, No. 39, inspected 1935), St. Agnes Place (No. 48), St. Mark's Road (No. 53), The Grove (No. 58), Upper Kennington Lane (No. 127). Vassall Ward. Akerman Road (No. 125), Clapham Road (No. 163), Offley Road (Nos. 24 and 27). Angell Ward. Angell Road (Nos. 16, inspected 1935 and 92a), Brixton Road (Nos. 266, inspected 1935 and 316), Coldharbour Lane (Nos. 302 and 360), Hilda Road (No. 10), Knowle Road (No. 39), Paulet Road (Nos. 48 and 92), Stockwell Park Road (No. 103), Wiltshire Road (No. 34), Wynne Road (Nos. 11 and 23, inspected 1935). Stockwell Ward. Acre Lane (No. 82, inspected 1935), Bellefields Road (Nos. 19, 21, 23, 25, 27, 29, 31, 33, 39 and 41), Dalyell Road (No. 96), Ferndale Road (No. 156), St. Martin's Road (Nos. 11 and 27), Stockwell Road (Nos. 27, 35 and 37), Stockwell Park Road (Nos. 24 and 116, inspected 1935). Town Hall Ward. Acre Lane (No. 13), Church Road (No. 10), St. Saviours Road (No. 6). Heme Hill Ward. Milk wood Road (No. 217). Tulse Hill Ward. Dulwich Road (Nos. 43, 47 and 52), Hurst Street (No. 10), Shakespeare Road (Nos. 6 and 10), Tulse Hill (No. 150), Water Lane (No. 6). Knight's Hill Ward. Bloom Grove (No. 7), Camden Hill Road (No. 16a), Gipsy Hill (No. 24), Highland Road (No. 9), Knollys Road (No. 174). (i) Closing Orders Made. Marsh Ward. Lower Marsh (Nos. 83 and 84, represented 1935). Bishop's Ward. Burdett Buildings (Nos. 11, 23 and 24), Lambeth Road (No. 196), Lambeth Palace Road (No. 35), Radnor Buildings (No. 8), Westminster Bridge Road (No. 69). Prince's Ward. Holyoak Road (No. 50, represented 1935, Nos. 1, 34 and 58), Renfrew Road (No. 11, represented 1935). Vauxhall Ward. Clapham Road (No. 282). Oval Ward. Clapham Road (No. 112, represented 1935), Methley Street (No. 41, represented 1935), Richborne Terrace (No. 44), St. Marks Road (No. 53). 65 Stockwell Ward. Bellefields Road (Nos. 19, 21, 23, 25, 27, 29, 31, 33, 39 and 41). Town Hall Ward. Acre Lane (No. 13), Hayter Road (No. 30, represented 1935). Tulse Hill Ward. Shakespeare Road (Nos. 6 and 10). Knight's Hill Ward. Knollys Road (No. 174). The Closing Orders have been complied with in all cases except Nos. 34 Holyoak Road and Nos. 31 and 33 Bellefields Road. (ii) Undertakings Received in Lieu of Closing Orders. Marsh Ward. Coin Street (No. 36), Lower Marsh (Nos. 57 and 58). Bishop's Ward. Carlisle Street (No. 61), Old Paradise Street (No. 31). Prince's Ward. Monkton Street (No. 79), Prince's Road (Nos. 114, 115, 116, 117 and 118). Vauxhall Ward. Paradise Road (No. 63). Oval Ward. Kennington Road (No. 337), The Grove (No. 58). Vassall Ward. Offley Road (No. 27). Angell Ward. Coldharbour Lane (No. 302), Paulet Road (No. 92). Stockwell Ward. Stockwell Road (No. 194). Town Hall Ward. Church Road (No. 10), St. Saviours Road (No. 6). Tulse Hill Ward. Dulwich Road (Nos. 43 and 47), Hurst Street (No. 10), Tulse Hill (No. 150). Knight's Hill Ward. Bloom Grove (No. 7), Highland Road (No. 9), Knollys Road (No. 174). (iii) Premises Vacated or Closed after Representation or after Undertaking Received. Marsh Ward Broadwall (No. 64), Coin Street (No. 36), Lower Marsh (Nos. 57 and 58). Bishop's Ward. Old Paradise Street (No. 31). E 66 Vauxhall Ward. Lansdowne Road (No. 37), Paradise Road (No. 63). Oval Ward. Kennington Road (No. 337), The Grove (No. 58), Richborne Terrace (No. 81). Vassall Ward. Offley Road (No. 27). Angell Ward. Coldharbour Lane (No. 302), Paulet Road (No. 92), Brixton Road (No. 266). Stockwell Ward. Stockwell Road (No. 194). Town Hall Ward. St. Saviours Road (No. 6). Tulse Hill Ward. Dulwich Road (Nos. 43 and 47, back room only). Hurst Street (No. 10), Tulse Hill (No. 150). (iv) Represented, but Have Since Been Made Fit. Marsh Ward. Lower Marsh (No. 58). Bishop's Ward. Westminster Bridge Road (No. 69). Prince's Ward. Kennington Road (No. 116), Renfrew Road (No. 11, represented 1935), Wincott Street (No. 52, represented 1935). Vauxhall Ward. Lansdowne Road (No. 37), Paradise Road (No. 63). Oval Ward. Methley Street (No. 41, represented 1935). Richborne Terrace (Nos. 44 and 81), The Grove (No. 58), Upper Kennington Lane (No. 127). Vassall Ward. Akerman Road (No. 125), Offley Road (Nos. 24 and 27). Angell Ward. Angell Road (Nos. 16 and 92a), Brixton Road (No. 316), Coldharbour Lane (No. 302), Hilda Road (No. 10), Knowle Road (No. 39), Paulet Road (No. 48), Stockwell Park Road (No. 103), Wiltshire Road (No. 34), Wynne Road (No. 11). Stockwell Ward. Acre Lane (No. 82), Bellefields Road (Nos. 19, 21, 23, 25, 27, 29, 39 and 41), Dalyell Road (No. 96), Ferndale Road (No. 156), St. Martins Road (No. 11), Stockwell Green (No. 11. represented 1935). Stockwell Road (Nos. 27, 35 and 37), Stockwell Park Road (Nos. 24 and 116). Town Hall Ward. Hayter Road (No. 30, represented 1935). 67 Tulse Hill Ward. Dulwich Road (Nos. 43 and 47 front and back addition rooms). Hurst Street (No. 10), Upper Tulse Hill (No. 101, represented 1935). Knight's Hill Ward. Bloom Grove (No. 7), Camden Hill Road (No. 16a), Highland Road (No. 9). (v) Houses Represented, but Orders not yet made. Broadwall (No. 64), Lambeth Square (No. 24), Radnor Buildings (No. 3), Vauxhall Walk (Nos. 132, 134 and 136), Milkwood Road (No. 217), Water Lane (No. 6), Gipsy Hill (No. 6). (vi) Houses Represented, but no Further Action Taken. Oval Ward. St. Agnes Place (No. 48). Vassall Ward. Clapham Road (No. 163). Heme Hill Ward. Railton Road (No. 23, represented 1935). In addition to the premises represented in (a) and (b), 119 others were inspected, with a view to action under the Housing Acts. 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) 13,124 (6) Number of Inspections made for the purpose* 35,307 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 23 (6) Number of Inspections made for the purpose* 207 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 116 (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 94 * Total re-inspections during 1936. 68 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 4,011 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 23 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (а) By owners 6 (б) By Local Authority in default of owners 3 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 260 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (а) By owners 208 (б) By Local Authority in default of owners 6 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 3 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 34 (2) Number of separate tenements or underground rooms in-respect of which Closing Orders were determined, the tenement or room having been rendered fit 5 69 Abatement of Overcrowding. A.—Number of Dwellings Overcrowded at end of 1936 3,775 Number of families dwelling therein 3,775 Number of persons dwelling therein 19,215½ B.—Number of New Cases of Overcrowding Reported During the Year :— 105 cases—493 persons concerned. C.—(1) Number of Cases of Overcrowding Relieved During the Year :— County Council 199 Borough Council 5 211 Otherwise relieved 7 (2) Number of Persons Concerned in such Cases :— County Council 992 Borough Council 31½ 1,075½ Otherwise 52 D.—-Particulars of any cases in which Dwelling-houses have become Overcrowded after the L.A. have taken steps for the Abatement of Overcrowding Nil Lambeth was included in the Schedule to the Housing Act 1935, (Operation of Overcrowding Provisions) Order (No. 4), 1936, in which the appointed day for the purposes of section 6 of the Act (which provides for entry in rent books or similar documents of a summary in the prescribed form of certain provisions of the Act relating to overcrowding) is January 1st, 1937, and the appointed day for the purposes of sections 3 and 8 (which contain provisions relating to offences in relation to overcrowding) and sections 4 and 68 of the Act is July 1st, 1937. In order to obtain the information for which application may be made by owners and others, the Council decided to employ two temporary survey assistants in December who were engaged in preparing the ground for the sixteen other temporary survey assistants and clerks who were employed by arrangement with the County Council in 1937. 70 Rehousing. During the year 294 fresh applications for housing accommodation were received in the Public Health Department (mostly from the applicant in person), and of these 95 were sent forward to the county authority for attention or preferential treatment, while in addition, 43 applications were recommended for housing on the Lambeth Council Estates. The remaining 156 after careful scrutiny, could not be recommended for various reasons, such as insufficient income or other circumstances. Of the 138 cases referred to, 40 have been accommodated (33 by L.C.C. and 7 by L.B.C.) leaving 98 pending decision and allocation. The following table shows particulars of the 294 applications received. Housing Applications, 1936. Number of Persons in Family Number of Rooms Occupied Total Persons 1 2 3 4 5 6 1 _ 1 — — — 1 2 2 2 11 2 3 — 1 38 3 6 53 25 4 — — 264 4 4 39 26 7 1 — 308 5 — 18 29 7 1 — 275 6 1 5 15 8 — — 174 7 — 5 7 3 — — 105 8 — 3 3 4 — 1 88 9 — 1 1 4 — — 54 10 1 — 1 — — 20 11 — — — — — — — 12 — — — — — — — Total Families 294 13 127 108 41 2 3 Total Persons — — — — — — 1,328 71 INSPECTION & SUPERVISION OF FOOD. Milk Supply. 150 applications (including 18 additional) were approved by the Borough Council for registration under the Milk and Dairies Order, 1926. 67 of the applications were change of purveyor at registered premises, 61 were for the sale of milk in sealed bottles only, and 4 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, 13; "Grade A" (Tuberculin Tested), 21; "Grade A," 9 ; "Pasteurised" Milk, 35 (Pasteuriser's Licence 2, Dealer's Licence, 33) (61 premises) ; Supplementary Licences, 21. Meat and Other Foods. (a) Public Health (Meat) Regulations, 1924. (1) Number of *visits paid to slaughterhouses 116 (2) Number of *visits paid to meat shops, meat stalls, and meat stores 701 (3) Number of actual slaughterings at which one or other of the food inspectors was present, consisting of beasts (5), sheep (447), pigs (256), and calves (16) 724 (4) Carcases, or portions of carcases, condemned 19 * Visits include re-visits also. Of the 724 actual slaughterings, at which one or other of the food inspectors was present, and in connection with which 19 carcases or portions of carcases were condemned, the diseases necessitating such condemnation were as follows :— Pigs. 1 head (tuberculosis). 14 whole carcases and organs (swine 2 mesenteries (tuberculosis). fever) 1 liver (cirrhosis) Beasts. 1 head and tongue (tuberculosis) 72 In addition to the above-mentioned carcases or parts of carcases, the following unsound food was condemned and destroyed:— Fish— tons cwts. qrs. lbs. Coalfish 0 0 1 0 Cod 0 0 2 0 Kippers 0 1 0 14 Roes 0 0 2 20 Skate 0 1 0 8 Haddocks 0 0 1 7 Winkles (1 bushel) — — — — Fruit and Vegetables— Apricots (12 boats) — — — — Greens (4 bags) — — — — Pears (1 box) — — — — Tomatoes (1 tray) — — — — Poultry— Ducks 0 0 0 25½ Fowls 0 8 3 1 Goose (1) — — — — Turkeys 0 9 2 11 Game— Rabbits 0 6 0 16 Wood Pigeon (2) — — — — Meat and other products— Bacon 0 0 1 9 Beef 0 0 7 0 Ham 0 0 0 15 Ham, Tinned (10 tins) 0 1 1 19 Lamb Chops 0 0 0 5 Pork 0 4 1 11 Other food— Tinned Fruit (79 tins) — — — — Fish Paste (13 tins) — — — — Mincemeat 0 0 0 3 (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, 798 were taken with the formalities prescribed by the Act, while 1,202 were taken informally. The formal samples taken included milk, separated milk, butter, sausages, vinegar, lemonade powder and wine. 73 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. 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, 76 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 29 were reported by the Public Analyst to be adulterated, 7 of which were informal samples, compared with 32 and 19 last year. Warning Letters. The number of formal samples found to be adulterated was 22. Legal proceedings were instituted in six 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. 5 For selling milk deficient in milk fat to Summons dismissed the extent of 12 per cent. 210 For selling milk deficient in milk fat to Summons dismissed on the extent of 17 per cent. payment of 7s. 6d. costs 469 For selling milk containing 71.5 per Summons dismissed on cent, extraneous water payment of 10s. 6d. costs 475 For selling milk deficient in milk fat to Summons dismissed on the extent of 16 per cent. payment of 10s. 6d. costs 493 For selling milk containing 6 per cent. Summons dismissed on extraneous water payment of 10s. 6d. costs 576 For selling milk deficient in fat to the Summons dismissed extent of 12 per cent. 74 Bacteriological Samples. During the year, 32 samples of milk, 6 of ice cream, 1 of eggs, and 3 of sausages were submitted for bacteriological examination. Of the samples of milk, 6 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, they satisfied the requirements of the standard for pasteurised milk. (c) Inspection of Food Premises. During the year 1,441 food premises in the Borough have been inspected by the two sampling officers. 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, 34 premises were inspected and added to the ice-cream register. The total number of premises now registered is 502. 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 324, 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. 75 The special inspection of these premises for which applications for registration have been 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, restaurants, and public-houses, have been made during the year, as follows :— Bakehouses 335 Milkshops 1,189 Ice cream premises 1,211 Other food premises or stores 1,620 Restaurants, etc 467 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 Orders made under the above Acts relating to the marking of certain imported foods, and the manner in which that marking is to be applied receive constant attention, and all breaches of the Act or the Order made thereunder are brought to the notice of the persons responsible. (e) Artificial Cream Act, 1929. During the year no application for registration under the above-mentioned Act of premises used for the manufacture and sale of artificial cream was received. (/) Pharmacy and Poisons Act, 1933. On the 26th October, 1933, the Council appointed the two Food Inspectors as Inspectors under Part 2 of the Pharmacy and Poisons Act, which received the Royal Assent in that year. The operation of the Act was, however, suspended for the time being ; the commencing date was eventually fixed as the 1st May, 1936. Under the provision of the Act and of the Rules made thereunder, poisons are divided into two classes. Part 1 of the Poisons List and Part 2 of the List. Part 1 includes poisons that may only be sold by registered pharmacists. This is administered by the 76 Pharmaceutical Society, and does not come within the province of the Local Authority. Part 2 is administered by the Borough Council, and is concerned chiefly with poisons used mainly for household purposes, such as carbolic disinfectants, spirits of salts, ammonia, and caustic preparations. Also included in Part 2 are certain hair dyes, rat poison, and preparations used for horticultural purposes. Part 2 poisons may only be sold by persons (other than Registered Pharmacists, who may sell any poison) who, after making application to the Council, and upon payment of a prescribed fee, are placed upon the "Poisons List." Such persons are known as "Listed Sellers of Poisons." Since the operation of the Act 176 traders have applied and have been placed on the List, after the premises have been inspected and found suitable. Certain requirements must be observed with respect to the labelling of containers, etc., and visits are periodically made to insure that they ure being fulfilled. 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. 77 Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Apples — — — — Baking Powder — — 3 - Barley, Pearl — — 9 — Beverages Fruit (Cordial) — — 3 - Bread — - 12 - Butter 55 - 294 1 Cake Mixture - - 4 - Cakes, Sponge — — 17 - Candied Peel — — 3 — Cheese — — 12 — Cocoa — — 34 — Coffee - - 26 - Coffee and Chicory — — 1 - Coffee and Chicory Extract — — 3 - Confectionery — — 14 — Cooking Fat — — 3 - Cornflour ,— - 6 - Cream - - 6 - Cream, Tinned - - 6 - Curry Powder — — 3 1 Custard Powder — — 18 — Dripping — — 12 - Drugs:— Acid, Boric — — 3 — Acid, Citric - - 3 - Acid, Tartaric - - 3 - Aspirin — — 3 - Balsam, Friars — - 6 - Borax - — 6 - Camphorated Oil — — 3 - Castor Oil — - 9 - Cod Liver Oil - - 3 - Cream of Tartar - - 3 - Effervescing Saline — — 6 - Epsom Salts — - 3 - Eucalyptus Oil — - 3 - Glauber's Salts - - 6 - Glycerine — - 9 - Iodine, Spirit of — - 1 - Linseed (Crushed) - — 3 — Ointment, Boric - — 10 — Ointment, Zinc - - 8 — Powder, Liquorice, Compound — — 9 — Powder, Seidlitz - - 9 — Rhubarb Powder - - 3 — Sal Volatile - - 3 — Soda bicarbonate — — 9 — 78 Food and Drugs.—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterpated Drugs—continued. Sulphur, Flowers of — — 6 — Tincture of Iodine — — 11 — Do. of Quinine (Ammon). — — 6 — Tincture of Rhubarb — — 3 — Vaseline — — 6 — Essence, Colouring — — 1 — Fish Paste — — 6 — Fish, Tinned — — 17 2 Flour — — 21 — Flour, Self-raising — — 15 — Fruit, Canned — — 3 — Fruit, Dried — — 39 — Herbs, Dried — — 3 — Honey — — 2 — Honey, Prepared — — 1 — Horse Radish Cream — — 1 — Ice Cream — — 4 — Jam and Marmalade — — 9 - Jelly, Table — — 3 — Lard — — 23 — Lard Substitute — — 1 — Lemonade Powder 1 — 9 6 Lemon, Curd — — 12 — Lentils — — 6 — Margarine — — 27 — Meat — — 6 — Meat, Minced — — 3 — Meat Paste — — 3 — Milk 724 21 76 — Milk Condensed Full Cream — — 9 — Milk, Condensed (Machine Skimmed) — — 19 — Milk, Separated 1 — — — Mincemeat — — 6 — Mustard — — 3 — Mustard Compound — — 6 — Oatmeal — — 12 — Olive Oil — — 3 — Parrish's Food — — 6 — Pepper — — 14 — Pepper Compound — — 1 — Pickles — — 6 — Pudding Powder — — 2 — Rice — — 30 — Rice, Ground — — 3 — Sago — — 6 — 79 Food and Drugs.—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Salt (Table) — — 3 — Sauce — — 15 — Sausages 1 1 16 4 Sausages (Preserved) — — 2 — Sausage Rolls — — 4 — Sherbet — — 6 — Soup Powder — — 3 — Spice, Mixed — — 6 — Suet, Shredded — — 6 — Sugar — — 12 — Tapioca — — 12 — Tea — — 33 — Vegetables, Tinned — — 15 — Vinegar 15 — — — Wine, British — — 1 — Wine, Port 1 — — — Yeast — — 3 — Totals 798 22 1,202 14 N.B.—6 summonses were issued (see page 73). PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under the Compulsory Notification Sections of the Public Health (London) Act, 1936, and the Orders and Regulations made thereunder 5,389 cases of infectious diseases (excluding tuberculosis) were reported during the year. This number is more than the number (2,114) reported in the previous year, a large proportion being attributable to measles. 80 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 693 2.497 1 0.144 648 93.50 629 1056.5 Diphtheria 413 1.488 15 3.631 412 99.75 389 732.3 Membranous Croup — — — — — — — 2.9 Typhus — — — — — — — — Enteric 14 0.050 1 7.142 13 92.85 14 18.4 Relapsing Fever — — — — — — — — Erysipelas 109 0.392 4 3.669 55 50.45 109 123.2 Puerperal Fever 7 0.025 1 14.285 4 57.14 7 28.7 Puerperal Pyrexia 45 0.162 2 4.444 10 22.22 45 48.8 Plague — — — — — — — — Cerebro-Spinal Fever 7 0.025 4 57.152 5 71.42 7 6.3 Polio-myelitis 1 0.0003 — — 1 100.00 1 5.4 Ophthalmia Neonatorum 54 0.194 1 1.851 3 5.55 54 56.2 Measles 3,602 12.980 26 0.721 833 23.12 3.094 2532.6 German Measles 188 0.677 — — 22 11.70 178 425.1 Tuberculosis— Pulmonary (primary) 347 1.250 194 — — — — 507.6 Non-pulmonary (primary) 58 0.020 17 — — — — 104.3 Malaria 3 0.010 — — 1 33.33 3 6.2 Dysentery 14 0.050 — — 14 100.00 10 1.3 Primary Pneumonia (Acute) 151 0.544 65 43.046 66 43.70 149 228.2 Influenzal Pneumonia (Acute) 75 0.270 1 1.333 5 6.66 75 123.0 *Encephalitis Lethargica — — 3 — — — — 11.1 Trench Fever — — — — — — — — Anthrax — — — — — — — 0.2 ‡Food Poisoning 13 0.046 — — 1 7.69 12 — * Deaths from Post Encephalitis Lethargica. ‡ Compulsorily notifiable from September, 1932. N.B.—Of the cases originally notified during 1936, the following were found afterwards not to be suffering from the diseases notified Diphtheria, 52; Scarlet Fever, 13; Cerebro Spinal Meningitis, 1; Measles, 16; Dysentery, 1; German Measles. 2; Enteric. 1. 81 TABLE K. Distribution of Cases Notified During the Year 1936. 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 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox - - - - - - — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — Diphtheria 413 8 122 205 42 31 4 1 64 23 185 141 64 23 185 140 Membranous Croup — — — — — — — — — — — — — — — — Erysipelas 109 1 8 4 6 25 48 17 17 6 41 45 10 2 23 20 Scarlet Fever 693 8 185 367 82 47 4 — 88 39 241 325 85 38 225 300 Typhus Fever — — — — — — — — — — — — — — — — Enteric Fever 14 — 3 1 5 4 1 — 1 — 8 5 1 — 8 4 Relapsing Fever — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — Puerperal Fever 7 — — — 2 5 — — 2 — 2 3 — — 2 2 Puerperal Pyrexia 45 — — 1 19 25 — — 5 4 18 18 1 3 3 3 Plague — — — — — — — — — — — — — — — Pulmonary Tuberculosis 347 1 3 15 86 14 91 7 48 47 128 124 — — — — Other forms of Tuberculosis 58 — 7 22 8 17 1 3 5 4 21 28 — — — — Cerebro-spinal Fever 7 1 2 1 2 1 — — 2 1 2 2 2 1 2 1 Polio-myelitis 1 — — 1 — — — — — — — 1 — — — 1 Encephalitis Lethargica — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 54 54 — — — — — — 17 5 22 10 1 — — 2 Measles 3,602 163 1,777 1,581 60 19 2 — 441 287 1,225 1,649 158 92 273 310 German Measles 188 8 56 101 11 12 — — 14 16 80 78 1 1 9 11 Malaria 3 — — — — — — — — 1 1 1 — — — 1 Anthrax — — — — — — — — — — — — — — — — Primary Pneumonia (Acute) 151 1 11 20 16 52 40 11 22 9 47 73 18 2 15 31 Influenzal „ (Acute) 75 2 10 10 7 19 19 8 26 9 21 19 1 — 1 3 Dysentery 14 — 9 1 — 4 — — 2 1 1 10 2 1 1 10 Food Poisoning 13 — 1 2 1 2 6 1 — 2 10 1 — — — 1 Isolation Hospitals, Name and Situation.—Hospitals of the London County Council (one situated in the Lambeth Central Sub-District and Stockwell Ward of the Borough of Lambeth). Number of Diseases that can be concurrently treated—all usual notifiable infectious diseases and Whooping Cough. 82 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 1936. 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 89 4 93 14 15 Norwood Schools Dr. E. L. Smallwood 1 37 38 1 1 Lambeth Church District Dr. M. I. Elliot 171 15 186 7 25 Kennington do. Dr. R. Phillips 180 17 197 20 15 Stockwell do. Dr. H. P. Orchard 325 9 334 27 8 Brixton do. Dr. E. L. M. Rusby 356 37 393 18 3 Norwood do. Dr. E. L. Smallwood 207 11 218 49 30 Totals 1,329 130 1,459 136 97 83 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 1.63 in 1935 to 1.48 in 1936, there being 44 less cases, while the case mortality per 100 was raised from 3.50 to 3.63. 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. One case from a residential school was notified and removed to hospital as diphtheria, but was diagnosed there as tonsillitis in a temporary carrier. For the past two years one clinic has been using alum precipitated toxoid, while at the other toxoid antitoxin mixture with which both clinics started in 1928 has been the prophylactic. A comparison of the following numbers immunised indicates the different degrees of efficiency of the two materials, the retest for immunity being carried out four to five months after the original test. Retest after two injections of A.P.T. Positive 19 Negative 392 Retest after three injections of T.A.M. Positive 20 Negative 294 84 Diphtheria Prevention—1936. Statistics for the year ended 31st December, 1936. *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 10 95 42 130 27 10 314 First Test Positive 7 94 38 101 22 8 270 Negative 2 — 4 26 5 2 39 Tested Only 1 1 — 3 — — 5 ReTest Positive — 5 — 7 2 — 14 Negative 3 36 20 80 20 3 182 Tested Only 2 3 3 6 1 — 15 Total Attendances 1,387. *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 7 37 19 109 31 17 220 First Test Positive 6 35 15 79 15 4 154 Negative 1 1 4 28 15 12 61 Tested Only — 1 — 2 1 1 5 Re- Test Positive — 3 3 6 1 — 13 Negative 3 28 15 67 13 7 133 Tested Only — 1 — 1 1 — 3 Total Attendances 1,078 Borough.—Total cases = 534, of whom 424 = 79.4 per cent. were Positive and 100 = 18.73 per cent. Negative, while 10 had been tested only, not yet having begun the course of immunisation. Total Attendances = 2,465. Average attendance per week = (49 weeks) 50.31. Average attendance per Session = (97 sessions) 25.41. * A commenced May 8th, 1928, and B commenced July 18th, 1928. 85 Measles. Measles and German measles have been notifiable diseases (limited to the first case in the family within two months) in Lambeth since 1st January, 1916. In consequence few cases are now reported from schools of which information has not already been received from medical practitioners or parents. All cases can therefore be visited early in the course of the disease with the object of insuring that nursing facilities are provided through the district nursing associations, and extra nourishment, either through the Maternity and Child Welfare scheme or the Public Assistance, if required. Were information received informally through schools and other sources and not by notification, some delay at the onset of the disease would be unavoidable. Actually, the first intimation of 35 cases only was received from schools, the information of the remaining 3,628 cases which occurred during the epidemic coming to hand through notification prior to the reception of the school notices. Notification has undoubtedly impressed parents with the serious nature of the disease on the one hand, and on the other has given earlier and therefore more effective opportunity for the supervision of treatment. Outbreaks in St. Thomas's Hospital, King's College Hospital, and the Royal Waterloo Hospital were prevented by prophylaxis with measles serum supplied through the County Council. An outbreak among the nurses and children of the St. Thomas's Babies' Hostel afforded striking proof of the efficacy of measles serum to render a measles attack comparatively harmless. Dr. A. Boyne Bell, who is the physician in charge of the Hostel, writes :— "The first case of measles, before serum was given, occurred in a normal baby of six months, and she had an attack of moderate severity, losing weight markedly. Happily, recovery was eventually complete and without complication. The second case occurred after administration of serum, in a premature and underweight baby who was doing well. He developed a profuse rash, but seemed quite undisturbed by his illness and gained 12 ounces in weight during the fortnight of his attack. Further cases occurred among the children over one year in the lower ward, but none of them 86 were at all seriously ill, and their progress was in no way interrupted by the attenuated measles." As will be observed in Table J, the case mortality of the epidemic was only 0.72 per cent. 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 1936, 54 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 Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 54 51 3 — — — — Contacts, Suspects, etc. The Medical Officer of Health was called in consultation by medical practitioners to see 11 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 87 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. The proportion of specimens found to be positive out of all those submitted was 12.6 per cent. (in the previous year, 12.0 per cent). Nature of Specimen Result of Examination Total Negative Positive Swabs from nose and throat of suspected cases or carriers of diphtheria 1,684 161 1,845 Sputa from cases suspected of or suffering from pulmonary tuberculosis 728 124 852 Blood for Widal reaction and/or examination for presence of— B. Typhosus B. Paratyphosus A, B, and C B. Abortus 5 3 8 Miscellaneous 44 24 68 Totals 2,461 312 2,773 During 1936, 23 vials of antitoxin were distributed free of cost under the Antitoxin Order, 1910. Disinfecting Department, 1936. 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 (1,470), chicken-pox (708), cancer (51), whooping cough (559), mumps (365), and others (scabies, ringworm, etc.), not classified (1,069) ; 925 verminous houses (1,386 rooms) and verminous articles, bedding (1,904), and clothing (3,029), were also treated. Summary of work carried out by the Disinfecting Department during 1936. Cleansing Notices served 1,275 Total No. of Rooms disinfected by the Council 3,941 * Do. articles do. 12,465 Cases in which bedding was disinfected at home 1,328 Do. do. do. at Chamber 1,719 Premises disinfected and disinfectants supplied 20,923 Certificates of Medical Practitioners received in lieu of disinfection by the Council 1 Schools disinfected (5 rooms) 3 Certificates of disinfection left with occupiers of disinfected premises 1,317 Library books disinfected 382 Mattresses re-tabbed by Council 412 Tuberculosis Dispensaries— Shelters lent and erected — Shelters dismantled and removed — Bedsteads and mattresses delivered 6 Bedsteads and mattresses collected 5 Bacteriological Outfits (Swabs, etc.), delivered 2,291 Smoke machines collected and delivered 234 Cabs, etc., disinfected 4 Maternity parcels sterilised 51 6 families (246 articles) for L.C.C. (Slum Clearance). 10 „ (385 articles) for Church Army. * Including 60 „ (1,924 articles) for Lambeth Borough Council (Hemans Street Area). 4 „ (68 articles) for Duchy of Cornwall. Tuberculosis. The numbers of cases of tuberculosis on the Lambeth Register of Notifications on December 31st, 1935, were as follows:— Males Females Totals Pulmonary 1,181 955 2,136 Non-pulmonary 222 162 384 Totals 1,403 1,117 2,520 89 TABLE L. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications received during the period from January 1st, 1936, to December 31st, 1936. 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 — 2 6 3 19 19 48 45 46 29 7 224 315 Females 1 1 2 4 23 25 29 19 7 9 3 123 164 Non-Pulmonary— Males — 3 9 4 1 2 6 6 1 — — 32 36 Females — 4 5 4 2 3 3 2 — — 3 26 28 * Re-notifications (Form A) = 132 (males 91, females 41) pulmonary, and 6 (males 4, females 2) non-pulmonary. Pulmonary—71 private; 169 hospitals, 107 dispensaries = 347 total primary notifications. Non-pulmonary—11 private, 42 hospitals, 5 dispensaries = 58 total primary notifications. Institutional treatment.—Notifications were also received during the period stated above respecting 517 pulmonary and 38 non-pulmonary admissions, and 373 pulmonary and 40 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, 1936 to the 31st December, 1936, otherwise than by formal notification. 1.—Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total cases Pulmonary— Males — — 1 — 1 4 9 5 5 4 3 32 Females - 1 2 3 2 7 18 2 1 - - 36 N on-Pulmonary— Males — 1 4 1 — 1 1 1 — — — 9 Females — 1 3 1 2 2 1 1 — 1 - 12 2.—Source of Information. Pulmonary NonPulmonary Death Returns from local Registrars 10 4 transferable from R.G.O. 1 — Posthumous notifications 1 — "Transfers" from other areas 56 17 Other Sources — — Totals 68 21 The ratio of deaths of previously notified cases of tuberculosis to deaths due to tuberculosis not notified during life is 13 to 1 in the year under review. TABLE L (2). Public Health (Tuberculosis) Regulations, 1930. Summary of Notification Certificates, etc., received during the period from January 1st, 1936, to December 31st, 1936. 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 48 77 48 29 5 5 3 5 5 1 Princes 47 66 37 26 4 4 1 — 2 2 Lambeth Central 128 180 198 147 21 24 16 15 29 6 Lambeth South 124 156 234 171 28 31 18 20 32 12 Borough of Lambeth 347 479 517 373 58 64 38 40 68 21 91 92 Deaths from Tuberculosis. Age Periods 0 1 5 10 15 20 25 35 45 55 65 and upwards Total Pulmonary— Males 1 — — — 5 9 20 17 33 26 7 118 Females — 2 — — 4 18 20 17 7 6 2 76 Non-Pulmonary— Males — 1 — — 1 2 1 1 1 1 — 8 Females 1 2 2 - 1 1 - - - - 2 9 Totals 2 5 2 — 11 30 41 35 41 33 11 211 The details of the tuberculosis deaths in the various Registration Sub-Districts are :— Registration Sub-Districts Deaths from Pulmonary Tuberculosis Other Forms Tuberculosis Total Deaths Tuberculosis Tuberculosis rate per 1,000 population (Pulmonary) Tuberculosis rate per 1,000 population (all forms) Lambeth North 26 2 28 0.76 0.82 Princes 24 5 29 0.99 1.20 Lambeth Central 63 4 67 0.66 0.70 Lambeth South 81 6 87 0.65 0.70 Borough of Lambeth 194 17 211 0.69 0.76 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) 1913-1922 1.2 1.6 3.2 4.2 Average (10 years) 1923-1932 0.9 1.1 1.6 2.0 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 1936 0.69 0.76 1.25 1.45 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 1936. 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 Grand 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 65 47 2 2 3 8 3 4 68 55 5 6 385 (b) Diagnosis not completed — — — — — — — — 20 29 6 4 (c) Non-tuberculous - - - - - - - - 76 77 23 16 B.—Contacts examined during the year:- (a) Definitely tuberculous 11 10 — 1 1 — — 1 12 10 — 2 466 (b) Diagnosis not completed - - - - - - - - 15 24 17 7 (c) Non-tuberculous - - - - - - - - 65 170 58 86 C.—Cases written off the Dispensary Register as:— (a) Recovered 11 11 1 — 3 5 1 — 16 16 2 — 627 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) - - - - - - - - 152 253 83 105 D.—Number of Cases on Dispensary Register on December 31st, 1936: (a) Definitely tuberculous 323 293 34 59 42 42 37 27 365 335 71 86 933 (b) Diagnosis not completed — — — — — — — — 19 28 20 9 1. Number of cases on Dispensary Register on January 1st, 1936 939 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 61 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 215 4. Cases written off during the year as dead (all causes) 76 5. Number of attendances at the Dispensary (including Contacts) 3,995 6. Number of Insured Persons under Domiciliary Treatment on December 31st 415 7. Number of consultations with medical practitioners:— (a) Personal 219 (b) Other 972 8. Number of visits by Tuberculosis Officer to Homes (including personal consultations) 687 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,303 10. Number of— (a) Specimens of Sputum, etc., examined 524 (b) X-Ray Examinations made in connection with Dispensary work 712 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 1 12. Number of " T.B. plus" cases on Dispensary Register on December 31st 408 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 1936. 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 Grand 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 52 23 - - 2 2 2 2 54 25 7 2 340 (b) Diagnosis not completed - - — — — - - - 5 2 2 — (c) Non-tuberculous - - - - - - - - 109 101 22 16 B.—Contacts examined during the year:- (a) Definitely tuberculous - 3 - - - - - - - 3 - - 231 (b) Diagnosis not completed — — — — — — — — — — 1 — (c) Non-tuberculous — — — — — — — — 66 93 30 38 C.—Cases written off the Dispensary Register as :— (a) Recovered 5 4 — — — 2 4 1 5 6 4 1 491 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) - - - - - - - - 175 194 52 54 D.—Number of Cases on Dispensary Register on December 31st, 1936: (a) Definitely tuberculous 261 156 2 5 16 12 19 17 277 168 21 22 517 (b) Diagnosis not completed — — — — — — — — 18 8 3 — 1. Number of cases on Dispensary Register on January 1st, 1936 529 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 25 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 64 4. Cases written off during the year as dead (all causes) 53 5. Number of attendances at the Dispensary (including Contacts) 2,235 6. Number of Insured Persons under Domiciliary Treatment on December 31st 118 7. Number of consultations with medical practitioners:— (a) Personal 21 (b) Other 731 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 208 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,478 10. Number of— (a) Specimens of Sputum, etc., examined 641 (b) X-Ray Examinations made in connection with Dispensary work 688 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 246 96 Public Health (Prevention of Tuberculosis) Regulations, 1925. It has not been found necessary to take any legal action under these regulations. Mortuary. Details of the work carried out in connection with the Lambeth Mortuary:— Wanless Road, S.E. 24 1935 1936 Bodies received 61 (M. 28, F. 33) 39 (M. 23, F. 16) Post-mortem examinations conducted 59 39 Coroner: A. Douglas Cowburn, Esq. The mortuary at High Street, S.E. 1, in which no bodies were received in 1935, was closed on 31st March, 1936. 97 Appendix A. Extract from the Minutes of the Council. Children under School Age: Ministry of Health Circular No. 1550. We have had before us at this and our previous meeting a circular communication, dated the 29th May, 1936, from the Ministry of Health, stating that the Minister has had under consideration the arrangements made by local authorities for the supervision of the health of toddlers, i.e., children between the ages of eighteen months and five years. The Minister understands that more than sixteen per cent. of the children entering school are found to require treatment for some disease or defect, and it is clear that in many cases these conditions could have been prevented from developing, or could have been quickly cured, if adequate supervision of the health of the children had been exercised throughout the pre-school years by systematic periodical health visiting. The Minister asks that the Council will review its existing welfare arrangements with a view to enlarging the scope thereof and calls attention to the fact that in some areas special arrangements have been made for the holding of toddlers' clinics at the infant welfare centres and for school clinics to be available for the treatment of minor ailments and of special defects in young children. In this latter connexion it is stated that it is desirable, wherever possible, that the medical officer who will supervise the health of these children alter they enter school should be responsible for this supervision during the pre-school years. Finally it is suggested that, if there are in the area of the Council any considerable number of mothers who are regularly employed away from home, or whose home conditions are such that their health would benefit as the result of their children receiving daily care and supervision, it would be well for the Council to consider the desirability of establishing day nurseries. It is pointed out that children can be admitted to these nurseries at an earlier age than that at which they are eligible for admission to nursery schools and they are usually kept for longer hours each day than is possible in the case of children attending nursery schools. At our previous meeting we requested the Medical Officer of Health to confer with the voluntary committees of the welfare: G 98 centres in the Borough on the Minister's suggestions, and we have now received from him the following detailed report on the matter. Report of Medical Officer Of Health. Before considering what alterations and improvements are required to give full effect to Circular 1550 from the Ministry of Health, it is necessary to appreciate the present extent of the Lambeth Maternity and Child Welfare Scheme, which consists of eleven centres, each controlled by a voluntary committee, together with three other centres incorporated with St. Thomas's Hsopital, and the General Lying-in Hospital. These fourteen centres are so arranged that no one has to travel more than ¼ mile from home who wishes to attend the local centre. At ten centres there are regular ante-natal clinics to attend which no expectant mother need travel more than ½ mile. At six there are regular dental clinics, and at three ultra violet light is available. In addition to these fourteen centres there is the St. Thomas's Babies' Hostel with 19 cots for children up to five years of age and three beds for mothers, as well as the Cynthia Mosley Day Nursery, which accommodates fifty children up to five years of age. The extent to which the arrangements made by the Council in its maternity and child welfare scheme are used by toddlers can be judged from the following:— (i) Number of Toddlers. A rough estimate of the toddlers aged 12 months to 5 years residing in the district based upon the number of births (corrected) in the years 1931 onwards is 15,950, in age groups— One year Two years Three years Four years 3,950 3,700 4,050 4,250 The number of toddlers under 5 years attending the elementary schools who are in the medical care of the Local Education Authority, and not in that of the Maternity and Child Welfare Authority, is 658. Of the 15,292 toddlers still in the care of the Lambeth Scheme, 5,740 attended the welfare centres in 1935, the number of attendances being 37,005 at the 1,888 sessions held during the year at which toddlers may attend. (ii) Medical Staff. The medical staff is entirely part time, and the number of doctors employed is 32, who held 1,587 sessions in 1935. (iii) Health Visiting Staff and Home Visits. The staff of health visitors employed in the scheme number 4 municipal and .30 directly employed by the voluntary welfare centres. From the following table can be observed the particulars of births, home visits and attendances at the voluntary welfare centres in the Lambeth scheme during the past six years:— 99 Year Births Numbers attending Attendances Home visits Infants Toddlers Infants Toddlers Infants Toddlers 1930 4,751 7,058 7,706 50,427 29,922 25,024 45,110 1931 4,523 7,968 5,916 57,269 35,452 22,946 48,831 1932 4,313 6,436 5,250 50,682 34,859 27,738 41,075 1933 3,941 6,279 4,921 51,508 35,749 22,265 40,006 1934 4,023 6,140 5,060 49,637 34,971 23,539 42,058 1935 3,823 7,041 5,740 52,521 37,005 23,839 38,461 When inquiring into these figures it must be remembered that there are roughly 2,000 strangers born each year in the Borough who are only temporary residents, but who in many instances attend once or twice before returning home, which accounts to some extent for the discrepancy between the number of births and the number of infants attending. Also, an infant is regarded as such throughout the year if under the age of one year on January the 1st of that year, which means, of course, that many toddlers up to nearly two years of age are actually counted as infants. In addition there is, of course, a considerable migration both inward and outward which cannot be estimated. The attendancies of infants are so regular compared with those of toddlers who outnumber them some three or more times, that many more home visits are paid to toddlers than to infants in an endeavour to maintain some supervision over many who have ceased to attend the welfare centre. (iv) Hospital Treatment. No regular treatment other than dental, light and massage is undertaken at welfare centres, although at times some treatment for minor ailments such as impetigo and the dressing of minor injuries resulting from accidents is carried out. Cases requiring orthopaedic treatment, the provision of spectacles, operation for tonsils and adenoids, etc., are referred to the family doctor or to one of the voluntary hospitals. No definite arrangements of this nature have been made, but each welfare centre sends its cases to one voluntary hospital unless the mother prefers a letter from the doctor to another hospital than the one with which the centre is informally linked. Advantage is, of course, taken of the facilities afforded by the County Council hospitals, though to a limited extent, and full use is made of the St. Thomas's Babies' Hostel which, with its 19 cots, is primarily intended for cases of malnutrition. (v) Minor Ailments. The treatment of these presents great difficulty unless and until they become major in character. On the one hand, many parents have too little money to engage the services of a family doctor, and on the other cannot afford the time to attend a voluntary hospital with its frequently prolonged periods of waiting. In consequence, it is often discovered that a child fails to get any skilled medical treatment at all. There is, of course, an arrangement with each of the seven District Nursing Associations for the home nursing of various infectious diseases, for which a flat rate of 1s. 3d. per visit is paid.' Nurses' visits paid to children under five numbered 2,124 in 1935. 100 Arrangements for in-patient and out-patient treatment could easily be arranged at the voluntary hospitals provided that a proper scheme were devised upon some financial basis so that toddlers could be sent at fixed times and days for treatment with a minimum of delay at the hospital. Moreover, such a scheme should work well, as the various departments of a voluntary hospital are each under the medical control of a specialist, and cases are readily referred if necessary directly from one to another. (vi) Dental Treatment. There are six part-time dentists who held 301 sessions during the year, at which there were 387 attendances of toddlers. The scheme for dental treatment is capable of considerable expansion. (vii) Convalescent Homes. There is no definire arrangement made by the Council in this connexion, but each welfare centre is in touch with various voluntary agencies like the Invalid Children's Aid Association, whereby many toddlers requiring a holiday at a convalescent home are sent away. It will be recalled that the Council agreed to maintain one bed at the Zachary Merton Convalescent Home (Rustington) when it had been erected (Minutes, 1933-4, page 604). It is anticipated that the home will be opened early next year for the reception of patients, and a letter has been received asking if the intention of the Council still holds good. (viii) Day Nurseries. There is one voluntary day nursery in the Oval Ward (the Cynthia Mosley Day Nursery) with accommodation for 50, of which rather more than 30 are toddlers. One other under private management in Norwood accommodates 20, but until recently it was not particularly successful, and has never been incorporated in the Lambeth Welfare Scheme. (ix) Nursery Classes. There is one nursery school in Norwood under the Education Authority, and it is hoped that a nursery class will be arranged for the toddlers at the Cyuthia Mosley Day Nursery under the auspices of the Board of Education. (x) Supply of Extra Nourishment. The Lambeth milk assistance scheme based on the scale of income recommended as necessitous by the Ministry of Health on 22nd August, 1922, has been in existence since the beginning of 1919, and through it nearly 700,000 gallons of milk have been distributed at a cost of approximately £60,000. In 1935, 31,360 gallons were distributed at a cost of £2,764. It will be recalled that the Lambeth Municipal Milk Depot was opened early in 1906, long before the welfare activities in the Borough were co-ordinated under the Maternity and Child Welfare Act, 1918. The provision of a safe supply of milk to the young children of inhabitants in the inner wards had a considerable influence upon infantile mortality many years before the first welfare centre was inaugurated. The Council has insisted that all wet milk supplied shall be pasteurised and sold under that special designation. Various forms of dried milk ate also issued for those cases where the Medical Officer directs. Cod liver oil, virol, and other similar preparations are sold at cost price at all welfare centres, but it will be remembered that the free issue 101 of cod liver oil (Ministry of Health Circular on Nutrition, No. 1290) to those in financial difficulty was, unfortunately, not agreed to by the Council (Minutes, 1932-3, page 102). It may be noted that the restriction upon the free issue of milk to toddlers from the ages of three to five years imposed by circular 185 dated 31st March, 1921, of the Ministry of Health, is still in force. In view of the recent advance in knowledge of the greater importance played by nutrition in the general standard of health, the attention of the Minister might well be directed to the advisability of rescinding that restriction. The Council will perceive that their maternity and child welfare scheme has a wide scope, and yet, unfortunately, the parents of toddlers do not take advantage of the facilities offered to anything like the extent necessary for the maintenance of a reasonable standard of health. The following table indicates how far the present standard of nutrition of Lambeth children entering the County Council schools falls short of what might be reasonably expected:— 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% The following appear to be the main objectives to which it is desirable that the Council's attention should be directed:— (i) Toddlers clinics. (ii) Treatment of minor ailments, etc. (iii) Day nurseries. (iv) Increase of facilities for dental treatment. (v) Provision for convalescent home treatment. (vi) Supply of cod liver oil, free in necessitous cases. (vii) Removal of restriction on free supply of milk to toddlers aged 3-5 years. In connexion with the free milk supply generally it would be a boon to all concerned if it were obtainable cheaply, as in the elementary schools through the Milk Marketing Board. 102 1. Toddlers Clinics. On the instructions of the Maternity and Child Welfare Committee, the welfare centres have been approached to obtain the views of the Committees upon the following points:— (а) What increase in the number of sessions either for toddlers alone or for toddlers and infants seen at the same clinic is required to give effect to the circular ? (b) What additional financial assistance would be necessary if the voluntary Committee were unable to raise the usual proportion of one-eighth of the expenditure ? (c) What increase in the health visitor staff would be needed to cope with the extra work entailed ? The following is a summary of the replies received:— North Marsh Infant Welfare Centre. Owing to the clearance schemes in progress in the area no extra session is required at present. If later on one should be needed, it should be for toddlers and infants, as mothers would resent the obligation to attend twice, leaving one or other child at home. Barley Mow Welfare Centre. The toddlers clinic now held monthly has been a definite success. No addition to the number of sessions is required at present owing to a large part of the area being included in rebuilding schemes, some of which are already in progress. North Lambeth Babies' Care Welfare Centre. A separate toddlers clinic would not be a success, as mothers prefer to bring their children together rather than to have to attend separately with each. Owing to the numbers at present attending an extra ordinary session to be held fortnightly is now needed, but so far as can be foreseen, no addition to the health visitor staff will be required at the moment. The Committee feel that they should be able to shoulder the additional financial burden of one-eighth the expenditure in order to preserve the voluntary feature. Moffat Institute Welfare Centre. The Committee have agreed that it would be willing to arrange a fortnightly clinic on the understanding that the Centre will bear one-eighth of the extra expenditure involved. St. Anne's Child Welfare Centre. The Committee are prepared to arrange for a toddlers clinic with a fortnightly or monthly session, and will themselves find one-eighth of the expenditure. Until the clinic develops it is considered that it is within the power of the existing staff to cope with the increased duties involved. Rose MacAndrew Infant Welfare Centre. No addition to the number of sessions now held is needed at the present time. North Brixton Infant Welfare Centre. A special toddlers clinic held fortnightly would be a great help in the area. The Committee are prepared to organise such a clinic and bear the one-eighth proportion of the additional expenditure. Any addition to the 103 health visitor staff must be reviewed when the clinic is organised, but the present staff can manage the extra work for the time being. Stockwell Mothers' and Babies' Welfare Centre. The Committee are unanimously of the opinion that a toddlers clinic with sessions at monthly intervals would meet the present requirements, and that the usual proportion of the expenditure could be raised from voluntary sources. The Committee feel that they are not in a position to make any suggestion regarding an increase in the health visitor staff until the scheme has materialised. Brixton Infant Welfare Centre and School for Mothers. The Committee are of the opinion that a special toddlers clinic with fortnightly sessions is needed, and that the services of an extra worker for one-half day a week would be sufficient to cope for the time being with the added duties entailed. The financial assistance of the Borough Council on the ordinary basis would be sufficient, as the Committee feel that they should be able to raise the one-eighth proportion from voluntary sources. The Loughborough Junction Maternity and Child Welfare Centre. The Committee do not feel that a toddlers clinic or an extra session is required at the present time. In the event of one being needed, the Committee are prepared to hold themselves responsible for finding one-eighth of the expenditure involved. West Norwood Maternity and Babies' Welfare Centre. A toddlers clinic is needed and would be successful, particularly if attendances were controlled by appointment. The Committee suggest that sessions at fortnightly intervals would be required at the start, and if, as thought likely, the numbers increased, a weekly session would in all probability then be necessary. Home visits would, of course, be reduced unless extra health visitor staff were employed, but until the scheme is working no estimation of the additional staff is practicable. The voluntary committee are prepared to shoulder the extra financial responsibility of one-eighth of the expenditure involved. St. Thomas's Hospital (Main Building) Welfare Centre. A weekly session of the toddlers clinic has been held for some years, and no increase in the facilities provided is needed now. General Lying-in Hospital Welfare Centre. A special toddlers clinic has been held weekly for a long time, and no addition to the existing facilities is needed at present. 2. Treatment of Minor Ailments, etc. Again on the instruction of the Maternity and Child Welfare Committee, the welfare centres have been approached to ascertain their views with regard to co-operation with the County Medical Officer of Health for the various school clinics to be made available for the treatment of cases referred to them from the welfare centres. The replies from the Committees are unanimous in suggesting a definite scheme of co-operation with the voluntary hospitals or other institutions for the purpose, which would be an extension of the unofficial and rather unsatisfactory voluntary linking which obtains at present, rather than to make use of the school clinics. It will be remembered that 104 there are the following voluntary hospitals in and adjacent to the Borough to which the great majority of cases now find their way—St. Thomas's Hospital, Royal Waterloo Hospital for Women and Children, Belgrave Hospital for Children, King's College Hospital, the Clapham Maternity Hospital, and the Brixton Dispensary. Where school clinics are readily accessible these might well be utilised, but it should be remembered that many schoolchildren who are found to require treatment at the school clinics are later transferred to the voluntary hospitals which have a scheme of co-operation with the County Council for their treatment. Seeing that the Borough is so well situated for making arrangements at so many readily accessible hospitals where advice and treatment of the highest order is available, the suggestion in the circular of co-operation in the use of the County Council school clinics only would seem inapplicable except in Norwood where there is no other place so readily accessible. An informal and tentative approach has been made in the direction of a scheme of co-operation with the voluntary hospitals who would be likely to welcome the suggestion if it were put before them, when a really comprehensive scheme to cover the detection and early treatment of every ailment and disease could be expected to mature. 3. Day Nurseries. On the instructions of the Maternity and Child Welfare Committee, who envisaged the addition of three day nurseries which with the Cynthia Mosley Day Nursery should provide one for each Parliamentary Division of the Borough, a survey of the expenditure involved and of possible sites has been undertaken. First, the cost of maintaining some of the municipal day nurseries in and near London has been ascertained, but the comparative costs vary within such wide limits that it is difficult to form a just appreciation. The costs differ between different types, whether in converted or adapted houses, or in premises specially erected for the purpose, and also largely depend upon the numbers of children who can be accommodated. In more than one instance the Medical Officer of Health approached was so uncertain of the comparative value of the statistics he sent that he advised application to the Cynthia Mosley Day Nursery—which is, of course, the most up-to-date and finished institution of its kind in London—not realising that it is situated in Lambeth. The following tabulated statement gives an outline of the costs in a number of municipal day nurseries, and the cost of the Cynthia Mosley Day Nursery which was approximately {5,700, and the total cost per child per day, 1s. 10d., including the cost of food 7½d., is here inserted for comparison. 105 Municipal Day Nurseries District Type Initial cost Staff Income Expenditure Net cost per child per diem Accommodation provided £ £ s. d. Southwark Converted building — Matron, 5 probationers, cook and charwoman 128 1,095 2 6 25 Tottenham — £1.650 1 matron, 1 nurse, 2 assistant nurses 284 1,529 3 9 35 Brentford Specially erected — — 397 867 1 11 42—45 Finsbury converted dwelling (unsuitable) conversion and equipment, £800 1 matron, 3 probationers, 1 nurse, 1 cook and 1 charwoman 124 1,226 4 5 21 Edmonton Converted house £1,550 1 matron, 1 staff nurse, 5 assistant nurses, 1 cook, 1 housemaid, 2 charwomen 260 1,400 1 10 41 (approx.) Wood Green Converted building Rented 1 matron, 1 nurse, 2 probationers, 1 cook 184 866 2 10¼ 30 Acton Converted building Rented, £78 p.a. 1 matron, 1 sister, 1 staff nurse, 3 probationers 248 903 3 3 28 The opinion is general that converted dwellings are not satisfactory in operation and are more expensive to maintain than premises specially erected for the purpose. 106 The site of the mortuary and coroner's court (now closed) in Lambeth High Street is eminently suitable for a day nursery for the North Parliamentary Division, and no doubt some portion of the existing buildings could be included in the structure of a day nursery. With regard to the other two sites, buildings now used as dwellinghouses could be acquired and converted, but unless care is taken the expense of acquisition and conversion may be greater than the erection of new premises. Until the Council has itself decided upon the financial extent to which it will be prepared to commit itself, no useful purpose would be served by publishing the addresses of suitable premises and sites. 4. Increase of Facilities for Dental Treatment. The extent to which dental treatment is available at the welfare centres is much below that required. The facilities can be improved by an increase in the number of welfare centres where dental clinics are held and by co-operation with school clinics and the voluntary hospitals to make use of the facilities provided by them. 5. Provision for Convalescent Home Treatment. The present inadequate arrangements of the welfare centres with various voluntary agencies could be extended if additional financial assistance were provided by the Council. Greater value would be obtained for the money expended by co-operation with the welfare centres on lines to extend the present schemes rather than by the Council itself making direct arrangements. There should, however, be no difficulty, if the Council prefer that course, to the inauguration of a scheme somewhat similar to those already in existence for assistance in connexion with the employment of midwives and home helps. The more direct measure of control by the Council would doubtless commend itself. The one bed in the Zacchary Merton Convalescent Home can be kept fully occupied by cases from the Council's maternity home together with such others recommended by the welfare centres, who are unable to make any payment towards the cost of this treatment. Nominations for the bed will be under the direct control of the Council and available for emergency. 6. Supply of Cod Liver Oil free in necessitous cases. The Council may care to reconsider the recommendation of the Maternity and Child Welfare Committee which was not approved in December, 1932 (Minutes, 1932-3, page 102) bearing in mind the prime importance above all other considerations of an adequate balanced diet to the general standard of physical and mental fitness. 7. Supply of Free Milk. There are two lines upon which the Council may be inclined to take action in this connexion :— (a) To approach the Minister of Health with a view to the removal of the general restriction upon the supply of milk to toddlers between 3 and 5 years of age, except in special circumstances. (b) To approach the Ministry of Health with the object of gaining the consent of the Central Government to an extension of the supply of cheap milk to schools to include welfare centres. 107 It may be noted, as a matter of interest, that the toddlers do patronise the Council's two diphtheria prevention clinics and no increase in clinics is required, but much more could have been done in this direction had the Council decided to take action upon the report submitted to it in 1935. (Minutes, 1934-5, page 391). Paragraph 7 in the circular, although not at the moment applicable to London contains material to give food for thought. It seems to give a direct encouragement to the transfer of powers under the Maternity and Child Welfare Act to the Local Education Authority where the latter are not also the Maternity and Child Welfare Authority. If deemed advisable that such a course should be pursued in London a short section in a future L.C.C. (General Powers) Act would be followed by the Borough Council being obliged to hand over its entire welfare scheme to the administration of the London County Council. A procedure on such lines would no doubt be followed by uniformity in the Metropolis, but if centrally administered in its entirety the close touch so necessary in work of this nature would tend to become buried under the avalanche of reports and the suppression of local initiative inseparable from a central detailed administration. If the County Council were content with the central matters of policy and delegated the detail of administration to Local Authorities, then some form of order might well appear in the confusion of powers and responsibilities which now exists, not only in Maternity and Child Welfare and in the other aspects of public health as between the County Council and the Borough Council, but also in the different degrees to which individual Borough Councils exercise their powers and the different means adopted for their administration. A. G. G. Thompson, m.d., Medical Officer of Health. 7th September, 1936. We have considered the Ministry's circular in the light of the information given by the Medical Officer of Health and agree, in principle, with the suggestions made by the Minister for improving the supervision of the health and welfare of toddlers, and it is hoped that the Council will see its way in due course to give full effect thereto. We have requested the Medical Officer to get in touch with the voluntary hospitals and, where necessary, with school clinics, with a view to his submitting to us in due course proposals whereby the welfare centres may be enabled more closely to co-operate with and to make greater use of the facilities provided by such institutions for the treatment of minor ailments and for dentistry. We have also appointed a sub-committee to consider the question of investigating proposals for the establishment of three additional day nurseries, one in each of the North Lambeth, Brixton and Norwood Parliamentary Divisions of the Borough. The Council is, of course, aware that the Cynthia Mosley Day Nursery is already functioning in the Kennington Division. To this sub-committee we have also referred for consideration and report to us the 108 question of extending existing arrangements for the provision of convalescent home treatment, and we hope to submit proposals with regard to both these matters for the Council's consideration and approval at a later date. In the meantime, we are of opinion that the Council should give its approval to the following proposals, namely (a) that an additional session for toddlers should be held at those centres where the voluntary committees have expressed their preparedness to make the necessary arrangements; and (b) that provision should be made for a free and aided supply, during the seven winter months of the year, of cod liver oil for expectant and nursing mothers and infants attending the welfare centres. With regard to (b), as mentioned by the Medical Officer in his report, the Council at its meeting on the 22nd December, 1932, negatived a similar proposal, but in bringing the matter again before the Council we would emphasise the fact that, both for the prevention and cure of rickets and to insure a proper development of the teeth, the diet of pregnant and nursing mothers and of infants and young children must contain a sufficient supply of vitamin D, and this can be provided, for those cases where, for financial reasons, nutritious foods cannot be purchased, by the regular administration of cod liver oil. If effect is given to the foregoing proposals the estimated annual cost to the Council will be for (a) £228 and for (b) £250. We are in agreement with the suggestion made by the Medical Officer of Health that the Ministry should be approached to remove the restriction upon the supply of free milk to certain toddlers, and to an extension of the arrangements for the supply of cheap milk to schools to include welfare centres. We have expressed our thanks to the Medical Officer of Health for the comprehensive report he has submitted to us on the Minister's circular and for the able manner in which he has assisted us in our consideration thereof. We recommend— (a) That the Council do approve the holding of the following additional sessions either for toddlers alone or for toddlers and infants together at the welfare centres set out hereunder, subject to the satisfactory conclusion of arrangements for the treatment of minor ailments. Weekly session West Norwood Mothers' and Babies' Welfare Centre. 109 Fortnightly session Brixton Infant Welfare Centre and School for Mothers. North Brixton Infant Welfare Centre. Moffat Institute Welfare Centre. St. Anne's Child Welfare Centre. North Lambeth Welfare Centre. Monthly session Stockwell Mothers' and Babies' Welfare Centre. Adopted. (b) That the Council do approve of the proposal for the free and aided supply during the seven winter months of the year of cod liver oil for expectant and nursing mothers and for infants under five years of age attending the welfare centre; on condition that the oil supplied to applicants in receipt of public assistance shall be paid for by the Public Assistance Committee and that all recipients shall pay for the necessary containers. Adopted. (c) That representations be made to the Ministry of Health with a view to obtaining the consent of the Government to the arrangements for the supply of cheap milk to schools being extended so as to include welfare centres. Adopted. 110 Copy of letter from the Medical Officer of Health to the Secretary of each voluntary Welfare Centre. 24th February, 1937. Children under School Age (Circular 1550) Minor Ailments. Dear Sir (or Madam), The Council at its last meeting agreed to a temporary arrangement with the following hospitals lor the treatment of minor ailments:— Belgrave Hospital, No. 1 Clapham Road, S.W.9. King's College Hospital, Denmark Hill, S.E.5. St. Thomas's Hospital, Westminster Bridge, S.E.1. Royal Waterloo Hospital, Waterloo Road, S.E.1. Will you be good enough therefore to arrange as soon as possible for your toddlers' clinic to work in conjunction with the hospitals. In general the procedure to be adopted will be as follows:— (1) Every parent whose child requires treatment and who wishes to make use of the facilities offered should be informed of the hospital, the day and the time at which the child will be expected to attend. Every effort should be made to send the child to the nearest hospital to his or her home, but otherwise a free choice should be offered. Enclosed is a list of the times, etc., at which the hospitals are prepared to receive the children. (2) Each parent should be given a card to take to the hospital and the card will be surrendered there at the first visit as a voucher to support the hospital's account which will be rendered monthly to me. No child must be given more than one card in any one year. Every card must be signed by the doctor, otherwise the case will not receive treatment. (3) Arrangements should be made to carry out treatment for cases such as impetigo, small abrasions, etc., at the welfare centre in order to avoid congestion at the hospitals. (4) Each week a list of cases referred for treatment should be sent to the Lady Almoners of the hospitals concerned so that any who fail to attend may be followed up by your 111 Health. Visitor. This list should reach the Lady Almoner on the Saturday morning before the week to which the appointments refer. (5) If possible the cases may well be met at the hospital by one of your Health Visitors, who can be of material assistance both to the patients as well as to the hospital in many directions. This, however, may not be possible with existing staff. (6) Difficulty will be experienced in connexion with dental cases because the prime object for them is conservative treatment and that will not be possible to obtain at all the hospitals. The greatest use should therefore be made of the dental clinics at the various welfare centres. If needed the Council should be approached through this office for provision of dental clinics at those welfare centres where they do not already exist and for extra sessions where a dentist is already employed. (7) Cases requiring spectacles will be expected to pay the hospital for them although refraction and any treatment will, of course, be free. (8) Each welfare centre will keep one new alphabetical register of names of children to whom cards are issued, together with the date, name of hospital, and minor ailment for which to be treated. The register, if desired, may of course be composed of the record cards, if indexed. A copy of the record card which will be issued will be found attached hereto. These cards should be retained at the Centre with the infant welfare cards until the toddler goes to school when the complete medical history should be returned to me. In the ordinary course of events no child should require a complete examination more often than once a year. Nor should attendance at the clinic be required more than say, four times a year, subject, of course, to the wishes of the medical officer in charge. For any extra notes the follow-up card should be used, copy attached hereto. (9) It is expected that there will be some cases upon which your medical officer would like a report. No doubt he or she will in that event write a note for the parent to take to the hospital with the card, or get in touch with the consultant in some other way. 112 (10) Equipment will be required for anthropometric measurements, i.e., for height, and for weight up to say 50 lbs., also sight-testing cards with pictures instead of letters of the alphabet, spatulas, dressings, ointments, etc., the cost of which will be borne by the welfare centre. There will no doubt be considerable difficulties arising from time to time but it is hoped that no definite friction will occur. Being a new scheme the administrative details will be sure to need alteration as time goes on, but if the work is carried out with the health of the toddler as the main object and with as little rigidity as possible the scheme should be successful. Please report any difficulties to me which cannot be overcome. Yours faithfully, Medical Officer of Health. Enclosures:— (а) Hospital times. (b) Hospital Card. (c) Weekly list to Lady Almoner. (d) Record card. (e) Follow-up card. 113 BOROUGH OF LAMBETH. (a) Lambeth Council Maternity and Child Welfare Scheme. Minor Ailment Treatment. Hospital Times. Belgrave Hospital King's College Hospital St. Thomas's Hospital Royal Waterloo Hospital Dental Wednesday, 9.30 a.m. Friday, 9.30 a.m. — Tuesday, 9 a.m. Saturday, 9.30 a.m. Eye Tuesday, 2.30 p.m. Thursday, 9.30 a.m. Monday to Friday, 10.30 a.m. Thursday, 9 a.m. Ear, Nose and Throat Friday, 10 a.m. Monday, 9.30 a.m. Monday, Tuesday, Thursday and Friday, 2 p.m. Wednesday, 10 a.m. Medical Monday to Friday, 10.30 a.m. Monday, 1.30 p.m. Week-days, 9 a.m. Monday, Tuesday, Wednesday and Friday, 12 noon. Thursday, 11 a.m. Orthopaedic Monday, 10.30 a.m. Wednesday, 1.30 p.m. Tuesday, 2 p.m. Thursday, 9.30 a.m. Thursday, 12 noon. Skin Wednesday, 2.30 p.m. Friday, 1.30 p.m. Tuesday and Friday, 2 p.m. Monday, 12 noon. Surgical Tuesday, Thursday and Friday, 10.30 a.m. Friday, 1.30 p.m. Week-days, 9 a.m. Tuesday and Wednesday, 12 noon. 114 LAMBETH MATERNITY AND CHILD WELFARE SCHEME Public Health Department (b) MINOR AILMENT TREATMENT Welfare Centre Name Address Minor Ailment Time Date Hospital Date Stamp Hospital Date This card must be returned with the Hospital Monthly Account to the Medical Officer of Health Signature M.O. I/C. Clinic. 115 Borough of Lambeth (c) LAMBETH MATERNITY & CHILD WELFARE SCHEME PUBLIC HEALTH DEPARTMENT Welfare Centre Weekly List of Toddlers Referred to Your Hospital names • addresses ailment hospital time and date Secretary To Lady Almoner, Hospital Please Inform me of any of the above cases who Fail to Attend 116 LAMBETH MATERNITY AND CHILD WELFARE SCHEME PUBLIC HEALTH DEPARTMENT (d) Welfare Centre Name Date of Birth (Surname first) Address (1) (2 ) (3 ) II. Personal History (a)* Previous illnesses of child:— Measles Scarlet Fever Diphtheria Whooping Cough Chicken Pox Mumps Other Illnesses (b) Family Medical History (if relevant) (c) Whether immunised against Diphtheria or not III. Dental Inspection:— Date Dental Officer's Reports Minor Ailments Treated.* Date Ailment Hospital Remedial Exercises and Other Matters. e.g., Special Diets, etc., and general mental and physical development. Date Name of School Date of entry * To be kept up-to-date as child attends. Th is Card, together with any following-up card made out, to be returned to the Medical Officer of Health, when the child leaves the Centre or goes to school. TODDLER'S RECORD CARD [P.T.O, 117  1 2 3 4 Date of Inspection Age of Child Vaccinal State (number of marks) Clothing and Footgear Height Weight Nutrition Disease of Skin Cleanliness—Head „ Body Teeth | Nose & Throat Tonsils Adenoids Glands of Neck Other Defects External Eye Disease Vision R Vision L Ear Disease Hearing Speech Mental Condition Heart and Circulation Lungs Tuberculosis Rickets Deformities Infectious Disease (not skin) Rheumatism Other Disease or Defect Ascaris, Oxyuris Following-up Card Medical Officer's Initials Toddler's Record Card (reverse) 118 FOLLOWING-UP CARD LAMBETH MATERNITY AND CHILD WELFARE SCHEME Public Health Department (e) WELFARE CENTRE Name Address Date of Birth (Surname first) Date Comments of Medical Officer and Health Visitor, dates of visits, any other matters 119 APPENDIX B Extract from Minutes of the Council, 2nd July, 1936. Housing Act, 1930: Fount Street Area. It will be recalled that the Council, at its meeting on the 30th April last (Minutes, page 648), adopted our recommendation that notice should be served upon the London County Council under section 16 (5) of the Housing Act, 1930, to the effect that the Borough Council was about to take into consideration a proposal that the Fount Street Area should be declared by the Borough Council to be a clearance area, and that an assurance should be given to the central authority that the arrangements for the clearance and development of the area would be carried through within a reasonably short time. This notice was duly given to the County Council, together with the assurance referred to, and that authority intimated that if the necessary resolutions following upon the official representation by the Medical Officer of Health were passed by the Borough Council on the 2nd July the former would itself refrain from dealing with the area. We have now received from the Medical Officer of Health his official representation and report, which we herewith submit for the information of the Council:— Report. The Council will remember that the Fount Street Area, as it is now termed, was originally included in the Hemans Street Area, but that as the two areas, together consisting of some 200 houses, were considered too large for the Council to declare at the same time, it was agreed that the Hemans Street Area should be represented first and the Fount Street Area later. The Hemans Street Area was represented on the 7th September, 1931, and it is understood that the rebuilding of that area has now advanced sufficiently for the Fount Street Area to be represented. The latter area was mentioned in a previous report (Minutes, 1929-30, page 1193) drawn up to assist the County Council in the preparation of their proposals to the Minister in accordance with the provisions of the Housing Act, 1930, Sections 25 and 31. During the autumn of 1935, the County Council arranged to represent the Fount Street Area, and for that purpose the entire area was surveyed, all details required were ascertained, and a map of the official representation was prepared. The Borough Council then approached the County Council, and, after negotiation, agreement was reached to the area being declared by the Borough Council in place of the County Council. The area was therefore 120 surveyed again under the direction of the Medical Officer of Health of the Borough and, as was to be expected, the second survey was not made easy by the inhabitants, who naturally objected to what was considered by them to be a useless and unnecessary second invasion of their privacy. However, by tact and persuasion, every house has been minutely surveyed without recourse to compulsion, although much time was wasted in the process. The Fount Street Area is situated on the north side of Wandsworth Road, immediately to the west of the Hemans Street Area. The ground is low lying and waterlogged to a few feet below the surface and the subsoil consists largely of river mud. The dwelling-houses are badly arranged in that, although the width of the streets other than Springfield Place is adequate, yet the site of each house is small, with the result that the houses are badly congested and some in principle are back to back. The backyards are in general below the standard of the London Building Act, causing a lack of air space and ventilation at the rear of the houses as well as darkness. There is an entire absence of horizontal damp-proof courses in the houses, and in consequence in such a low-lying position, rising dampness in the ground-floor rooms is prevalent. Moreover, the houses are badly arranged inside with unventilated and unlighted passages and staircases ; the water closets are in almost all cases approached from the house through the yard, and are unlighted and inadequate ; the sinks are unsuitable in many instances; there is no accommodation for personal washing, and that for the washing and drying of clothes in many is inadequate ; the facilities for preparing and cooking food are meagre, and there is almost an entire absence of wellventilated stores for food. In addition, every house is infested with cimex lectularius, the bed- or house-bug. The brickwork is generally worn, decayed and bulged, with many settlements and the roofs also are old and defective, with consequential penetrating dampness. Externally and internally the woodwork in general is worn and decayed. The principal grounds from which the conclusion is reached that the dwelling-houses are unfit for human habitation are:— (1) Bad arrangement on the site. (2) Bad internal arrangement. (3) Sanitary defects :— (а) Lack of air space. (b) Lack of ventilation. (e) Darkness. (d) Dampness. (e) Inadequate and not easily accessible water supply and washing accommodation. (f) Inadequate and defective outdoor sanitary accommodation. (g) Absence of adequate store for food. (h) Yard paving defective. (4) Disrepair:—. (a) Externally : Brickwork, woodwork, roof. (b) Internally : Ceilings, floors, woodwork in general. (5) The houses are infested with vermin, many seriously. 121 The number of persons who will be displaced by the clearance of the area is 794, comprised in the 181 families who were living in the 115 houses in the area on 8th June, 1936. A. G. G. Thompson, m.d., 8th June, 1936. Medical Officer of Health. Representation made by the Medical Officer of Health. Housing Acts, 1925, 1930, 1935 Fount Street Area, Lambeth. I, Ashley George Gyton Thompson, m.d. Medical Officer of Health for the Metropolitan Borough of Lambeth, do hereby represent pursuant to the provisions of the Housing Acts, 1925, 1930, and 1935, that, in my opinion, within the area known as the Fount Street Area (approximately 2.4 acres), in the Metropolitan Borough of Lambeth, the dwelling-houses:— Conroy Street—Nos. 15 to 61 (odd Nos.) = 24 buildings ; Nos. 2 to 38 (even Nos.) = 19 buildings. Fount Street—Nos. 2 to 38 (even Nos.) = 19 buildings; Nos. 1, 3, 5, 5a, 7 to 29 (odd Nos.), 35 to 57 (odd Nos.) = 28 buildings. Springfield Place—Nos. la, 1 to 23 (odd Nos.) = 13 buildings; Nos. 24 to 29 (consec.) = 6 buildings. Crimsworth Road—Nos. 2 to 12 (even Nos.) = 6 buildings; are unfit for human habitation by reason of disrepair or sanitary defects or are by reason of their bad arrangement or the narrowness or bad arrangement of the streets dangerous or injurious to the health of the inhabitants of the area; and that the most satisfactory method of dealing with the conditions in the area is the demolition of all the buildings in the area. A. G. G. Thompson, m.d., 8th June, 1936. Medical Officer of Health. The area of the land available for building, including parts of streets, is 2.6 acres. It is proposed that surplus accommodation on the completion of the Hemans Street scheme shall be used for the first displacements from the Fount Street area, and it is anticipated that it will be possible to erect on such area four blocks, comprising some 157 dwellings (approximately 456 rooms), providing accommodation for about 684 persons, on the basis of one-and-a-half persons per room, of the approximately 800 persons to be displaced. The erection of one of the blocks partly on the site of Fount Street is dependent upon arrangements being made with the County Council for the existing entrance building to the Springfield School in that 122 street being demolished and for alternative facilities by Springfield Place being provided, and we have referred to the Housing Committee this question and that of acquiring any other additional properties adjoining the clearance area which that Committee may consider necessary for the satisfactory development or user of the area. The estimated cost of acquisition, clearance and redevelopment of the represented area is £100,900, and we are advised by the Borough Treasurer that, after allowing for the usual outgoings, i.e., loan charges, repairs, supervision, etc., and the estimated income which will be obtained from the Government grant and from rents (which it is proposed shall be similar to those provisionally approved by the Council in respect of the Hemans Street Area), the net cost to the Council will not exceed £1 17s. 6d. per dwelling for 40 years, i.e., one-half of the statutory rate contribution the remaining half being contributed by the County Council. The scheme will be self-supporting after the expiry of the subsidy period. We recommend— (a) That the Council, with respect to an area known as the Fount Street Area, Wandsworth Road, upon consideration of an official representation, dated the 8th June, 1936, by Ashley George Gyton Thompson, m.a., m.d., d.p.h., the Medical Officer of Health for the Borough, being satisfied— (i) that the dwelling houses in that area are, by reason of disrepair or sanitary defects, unfit for human habitation or are, by reason of their bad arrangement or the narrowness or bad arrangement of the streets, dangerous or injurious to the health of the inhabitants of the said area, and that the other buildings in the said area are for a like reason dangerous or injurious to the health of the said inhabitants; and (ii) that the most satisfactory method of dealing with the conditions in the said area is the demolition of all the buildings therein. has caused the said area to be defined and indicated by pink colour on a map (No. 950) in such manner as to exclude from the said area any building which is not unfit for human habitation or dangerous or injurious to health; and also being satisfied, (iii) that in so far as suitable accommodation available for the persons of the working classes who will be displaced by the clearance of the said area does not already 123 exist, it can provide such accommodation in advance of the displacements which will from time to time become necessary as the demolition of buildings in the said area, or in different parts thereof, proceeds ; and (iv) that its resources are sufficient; hereby declares the said area to be a clearance area, that is to say, an area to be cleared of all buildings in accordance with the provisions of section 1 of the Housing Act, 1930. Adopted. (b) That the Council do purchase the lands comprised in the clearance area referred to in the foregoing resolution (a). Adopted. (c) That, in pursuance of the provisions of Part I of the Housing Act, 1930, and of the Second Schedule thereto as amended by the Housing Act, 1935, a compulsory purchase order be made for the acquisition of the lands comprised in the said area, and that the order be submitted to the Minister of Health for confirmation. Adopted. (d) That the Council undertakes to provide, in connexion with any action taken by it for dealing with the clearance area referred to in the foregoing resolution (a), such rehousing accommodation as the Minister of Health considers necessary and within such time as the Minister may specify. Adopted. (e) That the Common Seal of the Council be affixed to such maps and documents in the matter as may be necessary. Adopted. 124 INDEX. Page Ambulance facilities 29 Ante-Natal Clinics 30 Area of Borough 8 Artificial Cream 75 Bacteriological Laboratory 86 Bakehouses 58 Bed Linen (Sterilization) 37 Births 27 Births in Institutions 13 Births in Registration Sub-districts 13 Births, Legitimate and Illegitimate 27 Births, Notification 27 Birth-rates 15 Census figures 14 Closing Orders 64 Common Lodging Houses 58 Condemned Food 72 Consultants (Obstetrical) 39 Contacts 86 Cowhouses 58 Day Nursery 40 Deaths 19, 20 Deaths, Infantile 15 Deaths in Institutions 21 Death-rates 15 Demolition Orders 63 Density 8 Dentistry 39 Diphtheria 83 Diphtheria Prevention Clinics 84 Disinfecting Department 87 Drains tested 50 Factories, Workshops and Workplaces 54, 57 Food and Drugs Adulteration 72, 77 Food Inspection and Supervision 71 Food Premises Registered 74 Grants, L.G. Act, 1929 32 125 Page Health Visitors 44 Home Helps 37 Hospitals 29 Housing Statistics 60 Housing Applications 70 Housing Conditions (M.O.H. Table) 67 Housing Inspectors 61 Ice Cream 58, 75 Infant life Protection 36 Infantile Mortality 24 Infectious Diseases 79 Licences 57 Light Treatment 39 Marriage Rate 8 Massage 39 Maternity and Child Welfare Committee 3 Maternity and Child Welfare Scheme 30, 42 Maternity Home 34 Maternal Mortality 18, 23 Maternity Outfits (Sterile) 37 Measles 85 Meat Regulations (Details of Work) 71 Merchandise Marks Act 75 Midwives 29, 38 Milk Assistance Scheme 31 Milk Supply 71 Mortality Rates 8, 26 Mortuary 96 Neonatal Mortality 8 Notices Served 49 Notifiable Diseases 79 Nuisances 50 Nursing 28 Offensive Trades 58 Ophthalmia Neonatorum 86 Outworkers 55, 57 Overcrowding 69 Pharmacy and Poisons Act, 1933 75 Populations 11 126 Page Public Cleansing 47 Public Health Committee 3 Puerperal Fever and Puerperal Pyrexia 46 Registrations 57 Removal of Infirm Persons 53 Rent and Mortgage Interest Restrictions Acts 53 Representations 63 Restaurants 75 Sanitary Inspectors 49 Sanitary Work 49 Schools 60 Shops Acts 59 Slaughterhouses and Slaughtermen 58 Smoke Abatement 59 Social Conditions 9 Staff 4 Still-births 26 Summary of Vital and Mortal Statistics 8 Summonses 50, 73 Superannuation 44 Suspects 86 Swimming Baths and Pools 59 Toddlers 39 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 82 Vital Statistics 10 Voluntary Hospitals 37 Water Certificates 50 Welfare Centres, etc. 30 Women Sanitary Inspectors 55 Workshops 57 Zymotic Deaths 22 Zymotic Death Rate 22