REPORT ON THE HEALTH OF THE BOROUGH OF LAMBETH During the Year 1937 (82nd 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 29 SANITARY CIRCUMSTANCES OF THE AREA 49 HOUSING 63 INSPECTION AND SUPERVISION OF FOOD 76 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 85 APPENDIX 102 INDEX 118 3 Borough of Lambeth. (I PUBLIC HEALTH COMMITTEE and (2) MATERNITY and CHILD WELFARE COMMITTEE [appointed by the Council on 9th November, 1937). PUBLIC HEALTH COMMITTEE. His Worship the Mayor (Mr. Councillor W. Hunter, j.p.), ex-officio. Aldermen : Mr. Alderman J. F. Evans, m.b.e. „ „ H. W. Wallace. „ „ C. H. Wilmot, m.a. {Chairman). Councillors: Mrs. Councillor A. J. Anstey, j.p. „ „ E. S. Barnes, j.p. (Vice-Chairman). Mr. „ L. L. S. Bickley, a.c.i.i. Mrs. „ E. L. Boltz. Mr. „ S. A. Brett (Senr.), f.a.i. „ „ W. J. Geary, a.c.i.s. Mrs. „ V. M. Jones. Mr. „ J. W. Mallinson, m.a. Mrs. „ A. B. Martin. Mr. „ W. H. Porter, „ „ G. K. Rettie. Mrs. „ D. G. Williman. MATERNITY AND CHILD WELFARE COMMITTEE. Mrs. Councillor E. S. Barnes, j.p. (Chairman). Mr. Alderman C. H. Wilmot, m.a. (Vice-Chairman). The same as the Public Health Committee (see above, but under different chairmanship), 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, a.r.r.c., j.p., representing the Brixton Parliamentary Division. Mrs. L. P. Young, 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. C. Puttock, A. W. Bayley, H F. Bryan (Cert, s.i.e.b.), F J. Cox, J. C. Richards, D. R. Eeles, S. W. Westbey, H. P. Wright, Miss E. Nye, A. H. Hagon (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). E. E. Morgan ,, „ A. E. French, „ „ R. G. Cutler, Cert, s.i.e.b. A. E. White, „ (Meat and other Foods). S. G. Starling, „ „ „ One vacancy. (b) Food Inspectors : S. Bradley, Cert, s.i.e.b. (Meat and other Foods). C. W. Idle, (c) Housing Inspectors : B. Good, Cert, s.i.e.b. (Meat and other Foods). F. Heffield, „ ,, W. J. Lawrence, „ (Overcrowding). (d) Women Inspectors : Miss L. Auger, Cert, s.i.e.b., c.m.b. & h.v. Cert. Miss A. G. Simpson, s.r.n.. Cert, s.i.e.b., c.m.b. & h.v. Cert. Health Visitors : Miss M. Butler, s.r.n., c.m.b., h.v. Cert. Miss A. F. Crombie, c.m.b.. Cert, s.i.e.b., h.v. Cert. Miss A. Richardson, s.r.n., c.m.b., h.v. Cert. Miss M. W. Thomas, c.m.b., h.v. Cert. Infant Life Protection Visitor : Miss J. M. Pople, s.r.n. Municipal Maternity Home : 210 Knight's Hill, S.E. 27. Medical Officer (part time) : Miss K. M. Cogan, m.d.(Lond.). Matron : Miss C. B. Turner, s.r.n., c.m.b. Sister : Miss E. Burgess, s.r.n., c.m.b. 5 Gynaecological Consultants (Puerperal Fever, etc., Regulations) J. H. 1jeel, 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. Tlomas'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 C. F. I.. Watson, s.k.n., h.v. Cert., t.b. Cert. Vaccination Department: Parliamentary district or hospital: Public Vaccinator: Vaccination Officer: Lambeth North R. Phillips, m.d., b.sc. (lond),d.p.h. Kennington M.I. Elliott, m.b., b.ch.. b.a.o. (belf.) Brixton E. L. M. Rusby, m.b.(lond)., m.r.c.s., l.r.c.p. H. J. Hart H.Snow Norwood H.P. Orchard, m.r.c.s., l.r.c.p. Lambeth Hospital P. J. Watkin, m.c., m.r.c.s., l.r.c.p. Norwood Schools H. P. Orchard, m.r.c.s., l.r.c.p. Hospital Diphtheria Prevention Clinics. (a) 212 Camberwell New Road, S.E. 5. G. W. J. Bousfield, m.d. (London). (b) 12 Hannen Road, S.E. 27. Miss M. H. Steven, m.b.b.s.(London), d.p.h. 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 has been satisfactory during the year, as is indicated by the statistics in the report. Apart from a small increase in the number of deaths attributed to influenza and a minor outbreak of Sonne dysentery in the autumn, there has been no material difference from what may be termed the average year. This year again the Registrar General has calculated a comparability factor for the district for the purpose of adjusting the local death rate, which will enable the crude death rate to be compared with that of the country as a whole and with that of any other local area whose crude death rate has been similarly modified. The population is estimated by the Registrar General to be 3,700 less than in the previous year, and it is now about the same as it was in 1885. The births, however, in 1937 numbered 3,873, giving a corrected rate of 14.14, compared with 9,143 births with a corresponding rate of 33.9 per 1,000 population in 1885. On the other hand, the infant mortality was 68 per 1,000 live births and the crude death rate 13.06 in 1937, compared with 129 and 18.6 in 1885. The natural increase in the population by excess of births over deaths was 257 in 1937, compared with 3,957 in 1885, which latter figure actually exceeds the total number of births registered in 1937. The steady addition of duties placed year by year upon the Public Health Department has been accelerated by the air raid precaution scheme, and in consequence of these as well as of the difficulties created by the enlargement of the Town Hall, there has been a regrettable but unavoidable delay in the preparation of this report. 7 Thanks are gratefully tendered to the 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 for their help and co-operation, to the chief officers of the Council, and principally to the staff of the Public Health Department, who have been working under a serious handicap due to the town hall alterations. A.G.G.T. July, 1938. 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, 1937—273,800 (males 129,290 and females 144,510). Density—67.05 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (corrected)—3,873, being 14.14 per 1,000 population. Marriages—2,712, being 9.9 per 1,000 population. Deaths (corrected)—3,616, being 13.06* per 1,000 population. Infantile Mortality (corrected)—266 deaths under 1 year, being 68 per 1,000 total live births. Neonatal Mortality (corrected)—103 deaths under one month, being 27 per 1,000 live births. Zymotic Death-rate (corrected)—0.33 per 1,000 population (total zymotic deaths, 92). Maternal Mortality (corrected)—8 deaths, being 2.06 per 1,000 live births. Number of structurally separate dwellings (census 1931)—48,873. Rateable Value (at 6th April, 1937)—£2,355,370. Sum represented by a penny rate (at 31st March, 1937)—£9,407. *As adjusted by comparability factor. 9 Social Conditions. There have been no noticeable alterations during the past year, apart from the rebuilding of large areas in the district which have been cleared by the County Council following compulsory purchase and clearance orders. The Tanswell Street area is now almost rebuilt, and a start will soon be made in the demolition of the buildings on the opposite side of Oakley Street, where the living conditions have in some instances beggared description. The difficulties which arise where there is any considerable lapse of time between the confirmation of a clearance order and the actual demolition seem to be insuperable. When dwellings have been declared to be unfit for human habitation and their condition confirmed by the Minister after inquiry, it is questionable whether a sanitary notice served under the Public Health (London) Act, 1936, upon the owner can in practice be enforced in a court of summary jurisdiction. Something can be done at times, perhaps, by persuading owners in such circumstances to effect repairs, but more often than not this is frankly out of the question. A leaky roof of old pantiles is likely to be made worse by patching, and the only remedy is often to strip and re-roof. This is expensive and a clear waste of money when the premises are to be demolished as soon as the alternative accommodation is available. A similar dilemma is experienced when old drains are found broken or obstructed and cannot be cleared. It will be realised, too, that areas likely in the near future to be represented as clearance areas are treated as lightly as possible for some time beforehand in order not to throw unfair financial responsibilities upon the owners, and this treatment tends to accentuate the embarrassment to be faced when there is delay in clearance after representation. Both the County and Borough Councils have in the past year come to realise that new blocks of fiats to replace the old unsanitary houses are not in themselves a satisfactory exchange, as the limitations imposed upon tenants either by the Council's letting agreements or by the public opinion of other tenants, are found so restrictive as not to permit a full enough social life to satisfy their aspirations and desires. A similar failure to satisfy the reasonable demands and expectations of tenants in other districts 10 has been redressed to some extent by the provision of community centres. Movements are afoot now to provide community centres on Council estates in the district with workshops for repairing footwear and furniture which, owing to noise cause nuisance in flats, as well as facilities for cultural and social recreations and amenities. Numerous minor changes in labour conditions are continually being made as small new factories are opened and others close. There is, however, a definite increase in the demand for cleaners for the large numbers of new offices erected or in process of building across the river in Westminster, which is largely met by the women population in Lambeth. It is a moot point to what extent the increase in the family income resulting from the early morning and late evening work done by the office cleaning mother is counterbalanced by the deleterious effect upon her vitality— reflected in the home—from prolonged hours of work and absence at important times. Unemployment. The following tables indicate the extent of unemployment among Lambeth residents:— (1) Average Number of Residents Registered as Unemployed in 1931, 1932, 1933, 1934, 1935, 1936, and 1937. Date Men Women Juveniles Total 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 1937 6,272 1,838 – 8,110 11 (2) Number of Residents Registered as Unemployed at Monthly Dates in 1937. Date Men Women Juveniles* Total 25th January 7,376 2,040 — 9,416 22nd February 7,153 2,031 — 9,184 15th March 6,881 1,862 — 8,743 19th April 5,938 1,720 — 7,658 24th May 5,945 1,777 — 7,722 21st June 5,476 1,666 — 7,142 26th July 5,519 1,765 — 7,284 23rd August 5,657 1,816 — 7,473 13th September 5,558 1,493 — 7,051 18th October 6,315 1,829 — 8,144 15th November 6,739 2,057 — 8,796 13th December 6,703 2,010 — 8,713 * Not available. 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 :— 1934—3,210 Children 1935—3,388 Children Good Average Below Normal Good Average Below Normal Children 622 2,363 2 25 587 2,430 362 Lambeth 19.4% 736% 7.0% 17.3% 71.7% 11.0% London 20.0% 75.9% 4-1% 16.4% 77.9% 5.7% 1936—3,123 Children 1937—3,016 Children Good Average Below Normal Good Average Below Normal Children 441 2,371 305 482 2,227 297 Lambeth 14.1% 75.9% 10.0% 16.0% 73.8% 10.2% London 15.1% 78.6% 6.3% 15.3% 78.5% 6.2% 12 Vital Statistics. The population of the Borough of Lambeth at the mid-year 1937, has been estimated by the Registrar General to be 273,800 which is less by 3,700 than the official estimated population of 1936. 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— 3,616 236 32 35 47 100 100% 7.36% 0.88% 0.97% 1.30% 2.77% 25— 35— 45— 55— 65— 75— 124 166 357 625 831 1033 3.43% 4.59% 9.87% 17.28% 22.98% 28.57% During the year the number of births corrected by inward and outward transfers was 3,873, giving a corrected birth rate of 14.14 compared with 13.94 last year, an increase of 0.20 per one thousand population. The principal causes of death arc again the same four: heart disease which claimed 1,046 or 28.92 per cent, of the total, cancer 498 or 13.77 per cent., diseases of the lungs 379 or 10.45 per cent., and tuberculosis 208 or 5.74 per cent. 13 Estimated Population, 1937 (Middle of the Year.) I. Wards. Wards Males Females Total 1. Marsh 5,680 5,060 10,740 2. Bishop's 10,640 11,050 21,690 3. Prince's 11,600 12,370 23,970 4. Vauxhall 13,800 14,370 28,170 5. Oval 11,040 11,810 22,850 6. Vassall 7,900 8,760 16,660 7. Angell 12,660 14,850 27,510 8. Stockwell 13,320 15,280 28,600 9. Town Hall 6,600 7,210 13,810 10. Heme Hill 6,350 7,450 13,800 11. Tulse Hill 13,810 17,110 30,920 12. Knight's Hill 15,890 19,190 35,080 Borough of Lambeth 129,290 144,510 273,800 II. Registration Sub-Districts. Sub-Districts Males Females Total 1. Lambeth, North 16,320 16,110 32,430 2. Princes 11.6C0 12,370 23,970 3. Lambeth, Central 45,400 49,790 95 190 4. Lambeth, South 55,970 66,240 122,210 Borough of Lambeth 129,290 144,510 273,800 III. Parliamentary Divisions. Parliamentary Divisions Wards Total North Marsh, Bishop's, Prince's 56 400 Kennington Vauxhall, Oval, Vassall 67,680 Brixton Angell, Stockwell, Town Hall 69,920 Norwood Heme Hill, Tulse Hill, Knight's Hill 79,800 Parliamentary Area of Lambeth 273,800 14 TABLE A. Giving Number of Live Births in each Registration Sub-District of the Borough of Lambeth During the Year ended 31sr December, 1937 (arranged Quarterly). Registration Sub-Districts No. of Births 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Lambeth, North* 476 440 448 466 Princes† 223 274 287 224 Lambeth, Central‡ 413 475 423 369 Lambeth, South§ 273 304 277 210 BOROUGH OF LAMBETH 1,385 1,493 1,435 1,269 TOTAL FOR BOROUGH OF LAMBETH—5,582. *Including General Lying-in Hospital (1,165 cases, of which 339 belong to Lambeth) and St. Thomas's Hospital (596 cases, of which 268 belong to Lambeth). †Including Lambeth Hospital (925 cases, of which 456 belong to Lambeth) ‡Including Clapham Maternity Hospital (556 cases, of which 126 belong to Lambeth). §Including King's College Hospital (674 cases, of which 178 belong to Lambeth). 15 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 1937, 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 1937 273,800 5,582 3,616 266 333 92 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 Averages (10 years)— 1921-1930 (Borough) 304,720 7,662 3,794 354 550 171 1911-1920 (Borough) 286,786 8,027 4,282 619 958 326 1901-1910 (Borough) 314,566 8,846 4,709 1,020 1,503 475 1891-1900 (Parish) 294,049 9,295 5,405 1,358 2,070 700 Note—Enumerated Population at Census 1901 was 301,895; at Census 1911 was 298,058; at Census 1921 was 302,868, an 1 at Census 1931 was 296,147. Families or separate occupiers = 70.887 (1901), 70,827 (1911), 78,399 (1921), and 83.777 (1931). 16 TABLE C. Showing the Birth Rate, the General and Zymotic Death Rates, the Infantile Mortality Rates for the Year 1937, and the ficures 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 1,003 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) 1937 20.38 13.06 68.68 73.56 92.09 0.33 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 Averages (10 years)— 1921-1930 (Borough) 25.1 12.4 51.4 93.4 145.1 0.5 1911-1920 (Borough) 27..9 14..9 77.2 144.5 223.1 1.1 1901-1910 (Borough) 28.1 14.9 115.3 216.7 319.4 1.5 1891-1900 (Parish) 31.6 18.4 146.1 251.3 382.9 2.4 17 TABLE D. Vital Statistics of the Borough of Lambeth During 1937 and Previous Five Years (1932-1936) Year Population estimated to Middle of each Year Births Total Deaths Registered in District Transferable Deaths Net Deaths Belonging to the District Uncorrected Number Net of non-residents registered in the District t of residents not registered in the District t Under 1 Year of Age At all Ages Number • Rate Number • Rate per 1,000 Net Number * Rate Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1936 277,500 5,542 3,871 13.94 3,661 13.19 1,639 1,459 230 59 3,481 12.41 Average 5 years 284,520 5,719 3,994 14.04 3,789 13.31 1,568 1,370 240 60 3,591 12.54 1932-1936 1937 273,800 5,582 3,873 14.14 3,703 13.52 1,558 1,471 266 68 3,616 13.06 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 (2,645 outward and 936 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 Column 8, and by the addition of the deaths under 1 included in the number ven in Column 9. †Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9 except in certain instances. In Column 8 the number of transferable deaths of "non-residents" which are deducted, and in Column 9 the number of deaths of "residents" registered outside the district which are added are stated in calculating the net death-rate of the Borough. Area of Borough in acres (including land and inland water), 4,083. Census, Average number of persons per separate dwelling, 6.05. 1931 Number of structurally separate dwellings, 48,873. Total population at all ages, 296,147. 18 TABLE E. Summary of Statistics Relating to the Metropolitan Boroughs for the Year, 1937. 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 vear per 1,000 births London 4,095,100 13.3 12.3 — 60 West Districts— Paddington 138,300 13.65 13.05 12.91 66 Kensington 175,600 12.1 13.3 12.4 83 Hammersmith 126,500 15.1 12.6 13.0 68 Fulham 138,900 13.9 13.08 13.2 56 Chelsea 56,510 10.8 14.1 12.0 59 City of Westminster 124,300 8.2 11.5 11.8 58 North Districts— St. Marylebone 92,110 9.36 13.10 12.98 73 Hampstead 90,690 11.2 11.6 10.9 54 St. Pancras 181,900 13.0 12.7 13.0 62 Islington 295,400 15.25 12.9 13.02 66 Stoke Newington 50,250 14.9 12.5 12.0 37 Hackney 206,700 13.8 11.1 11.7 43 Central Districts— Holborn 34,600 8.09 11.85 12.68 79 Finsbury 58,700 13.8 14.6 15.9 71 City of London 8,980 6.1 11.2 12.4 36 East Districts— Shoreditch 82,240 14.86 12.47 13.72 54 Bethnal Green 94,560 13.3 12.5 14.1 54 Stepney 203,100 13.5 12.2 14.2 60 Poplar 136,800 15.5 12.6 14.0 61 South Districts— Southwark 147,400 14.7 13.6 14.1 64 Bermondsey 98,760 14.4 12.3 14.0 59 Lambeth 273,800 14.1 13.2 13.0 68 Battersea 143,500 14.94 12.89 12.76 70 Wandsworth 341,700 11.53 12.36 11.43 62 Camberwell 224,800 14.08 12.83 12.83 58 Deptford 96,580 15.1 11.8 12.3 45 Greenwich 95,890 13.88 12.03 12.27 50 Lewisham 226,000 13.9 10.8 10.9 46 Woolwich 149,400 14.2 11.1 11.7 40 19 TABLE F. Birth-Rate, Death-Rate, and Analysis of Mortality During the Year 1937 (Provisional figures). — Rate per 1,000 Total Population Annual Death-rate per 1,000 Population Rate per 1,000 Births All Causes Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea & Enteritis (under two years) Total Deaths under one year Live Births Still| births England and Wales 14.9 0.60 12.4 0.00 — 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 125 County Boroughs and Great Towns, including London 14.9 0.67 12.5 0.01 — 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 148 Smaller Towns (Estimated Resident Populations 25,000-50,000 at Census 1931) 15.3 0.64 11.9 0.00 — 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 0.54 12.3 0.00 — 0.01 0.01 0.06 0.05 0.38 0.51 12.0 60 Lambeth 14.14 0.52 13.06 0.00 — 0.00 0.01 0.07 0.07 0.42 0.36 11.61 68 The maternal Mortality rates are as follows r— Puerperal Puerperal Sepsis Others Total Sepsis Others Total Per 1,000 Live Births, England & Wales 0.97 2.26 3.23 Per 1,000 Total Births, England & Wales 0.94 2.17 3.11 Lambeth 1.29 0.77 2.06 Lambeth 1.24 0.74 1.98 20 TABLE F (i). Maternal Mortality. Borough or City Rate per 1,000 live births Rate per 1,000 total births (live and still) Puerperal sepsis Other causes Total Puerperal sepsis Other causes Total West Districts— Paddington 1.06 3.17 4.23 1.02 3.06 4.08 Kensington 0.9 2.3 3.3 0.9 2.3 3.2 Hammersmith 0.5 1.6 2.1 0.5 1.5 2.0 Fulham 0.0 3.1 3.1 0.0 2.9 2.9 Chelsea 0.0 0.0 0.0 0.0 0.0 0.0 Westminster 3.9 4.8 8.8 3.7 4.7 8.4 North Districts— St. Marylebone 2.33 2.33 4.66 2.23 2.23 4.46 Hampstead 0.98 1.97 2.95 0.956 1.91 2.87 St. Pancras 2.1 1.3 3.4 2.0 1.2 3.2 Islington 1.99 1.11 3.10 1.94 1.07 3.01 Stoke New ington 0.0 4.0 4.0 0.0 3.9 3.9 Hackney 0.34 1.04 1.39 0.33 1.01 1.34 Central Districts— Holborn 3.57 0.0 3.57 3.4 0.0 3.4 Finsbury 0.0 2.46 2.46 0.0 2.40 2.40 City of London 0.0 0.0 0.0 0.0 0.0 0.0 East Districts— Shoreditch 0.82 2.45 3.27 0.79 2.38 3.17 Bethnal Green 1.59 0.79 2.38 1.53 0.77 2.3 Stepney 0.72 1.8 2.5 0.69 1.74 2.4 Poplar 0.47 0.47 0.94 0.46 0.46 0.92 South Districts— Southwark 0.46 2.77 2.33 0.45 2.68 3.13 Bermondsey 0.0 0.70 0.70 0.0 0.68 0.68 Lambeth 1.29 0.77 2,06 1.24 0.74 1.98 Battersea 0.0 1.87 1.87 0.0 1.81 1.81 Wandsworth 0.76 2.53 3.29 0.73 2.45 3.18 Camberwell 0.95 0.95 1.90 0.92 0.92 1.84 Deptford 0.0 0.7 0.7 0.0 0.6 0.6 Greenwich 0.75 0.0 0.75 0.72 0.0 0.72 Lewisham 0.33 0.99 1.32 0.32 0.96 1.27 Woolwich 0.0 1.41 1.41 0.0 1.35 1.35 21 Deaths. The total number of deaths registered in Lambeth during the year is 3,703, of which 1,558 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 1,471. The number of deaths corrected, i.e., of all Lambethans who died both within and outside the district is 3,616. The corrected death rate is 13.06 per 1,000 living, based upon a population estimated to the middle of the year of 273,800 and adjusted with the comparability factor. Age Periods of Corrected Deaths The 3,616 corrected deaths during 1937 may be further analysed and tabulated as follows :— 266 - - 7.36 per cent, of the total corrected deaths took place under 1 year of age. 67 - - 1.85 per cent, between 1 and 5 years. 333 - - 9.21 per cent, under 5 years. 147 - - 4.07 per cent, between 5 and 25 years. 290 - - 8.02 per cent. 25 to 45 years. 982 - - 27.15 per cent. 45 to 65 years. 831 - - 22.98 per cent. 65 to 75 years. 1,033 - - 28.57 per cent. 75 years and over. 3,283 - - 90.79 per cent, over 5 years. 22 2.* TABLE G. Causes of, and Ages at, Death (Corrected) During the Year, 1937. 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 3,616 266 32 35 47 100 290 982 831 1,033 Enteric Fever 1 1 — — — — — — — — Measles 1 — 1 — — — — — — Scarlet Fever 4 — — 2 1 — — 1 — — Whooping Cough 21 12 6 2 1 — — — — — Diphtheria 20 1 2 5 11 1 — — — Influenza 116 1 — — 1 6 13 44 21 30 Encephalitis Lethargica 6 — — — — — 2 3 — — Cerebro-Spinal Fever 5 2 1 1 — 1 — — — 1 uberculosis of respiratory system 208 — — — 1 37 94 65 10 1 Other tuberculous diseases 31 3 2 5 5 4 6 5 1 Syphilis 17 1 — — — — 6 7 3 — General Paralysis of the insane, tabes dorsalis 13 — — — — — 5 6 1 1 Cancer, malignant disease 498 — — 1 — 4 24 204 156 109 Diabetes 47 1 — — — — 1 8 15 22 Cerebral Haemorrhage, etc. 151 — — — — 1 3 43 47 57 Heart Disease 1,046 — — — 2 5 17 247 307 468 Aneurysm 16 — — — — 1 8 5 2 Other circulatory diseases 128 — 1 — — — 2 23 48 54 Bronchitis 142 10 2 1 1 — 6 32 43 47 Pneumonia (all forms) 207 47 8 4 1 — 10 67 38 32 Other respiratory diseases 29 — — — 1 — 4 8 8 8 Peptic Ulcer 64 — — — — 9 30 19 6 Diarrhoea, etc. 53 42 3 1 — — 1 3 1 2 A nnpnHiritic 18 — 2 2 3 2 7 o __ Cirrhosis of Liver 12 — — — — 2 1 8 1 — Other diseases of liver, etc. 15 1 1 — — — 1 8 2 2 Other digestive diseases 56 3 — 3 — 2 4 19 13 12 Acute and Chronic Nephritis 84 — — — 1 2 10 32 21 18 Puerperal Sepsis 5 — — — — 1 2 2 — — Other puerperal causes 3 — — — — — 3 — — — Congenital Debility, Premature Birth, Malformations, etc. 112 112 — — — — — — — Senility 108 — — — — — — 1 9 98 Suicide 37 — — — — 6 11 17 2 1 Other Violence 101 5 3 2 6 13 15 23 12 22 Other defined diseases 239 24 3 5 13 12 35 62 46 39 Causes ill-defined or unknown 1 — — — — 1 Deaths in Institutions in Lambeth Lambethans Strangers Totals Voluntary Hospitals 198 785 983 State-aided Hospitals 668 688 1,356 Homes for the dying, etc 36 14 50 24 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 1937. 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. Diarrhoeal Death-rate per 1,000 of the Population. Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhoid or Enteric Diarrhoea and Dysentery Lambeth, North 453 13.96 — 3 3 — 7 13 0.40 0.21 Princes 293 12.22 — — — 3 1 — 3 7 0.29 0.12 Lambeth, Central 1,235 12.97 — 1 2 5 12 — 15 35 0.36 0.15 Lambeth, South 1,635 13.37 — — 2 9 5 1 20 37 0.30 0.16 Borough of Lambeth 3,616 13.06 — 1 4 20 21 1 45 92 0.33 0.16 25 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 1937 rose to 2.06, compared with 0.77 in the previous year. Of the eight maternal deaths, six were married and two spinsters. Three followed a septic abortion, two others became septicaemic after delivery, and one each were due to shock, anaesthesia and toxaemia. Of two other deaths connected with abortion but not classified as maternal deaths, one was from violence following the injection of a powerful corrosive into the pregnant uterus, and the other from misadventure due to the unintentional injection of a liquid into the pregnant uterus. In spite of the increase in the maternal mortality in 1937, the average rate for the 23,842 corrected births which have taken place in Lambeth during the past six years is only 2.01. 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 3,873, an increase of 2 over the number of births in the year previous. The correctcd number of deaths was 266, giving an infantile mortality rate of 68. In the Registration Sub-Districts, the corrected infantile mi >rtality varies thus :— Registration Sub-Districts Total No. of Births Total Deaths under 1 year Infantile Mortality per 1,000 Births Lambeth North 394 33 83 Princes 397 25 63 Lambeth Central 1,505 85 56 Lambeth South 1,577 123 78 Borough 3,873 266 68 26 TABLE I. Infantile Mortality, 1937. 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 81 7 9 6 103 52 58 37 16 266 Typhoid — — — — — 1 — — — 1 Whooping cough 2 6 4 — 12 Diphtheria — — — — — — 1 — — 1 Influenza 1 — — 1 Cerebro-spinal Fever — — — — — 2 — — — 2 Tuberculosis, Pulmonarv Other tuberculous diseases — — — — — — 1 1 1 3 Syphilis — — — — — 1 — — — 1 Diabetes — — — — 1 1 Bronchitis — — — 1 1 3 4 2 — 10 Pneumonia (all forms) 1 3 3 — 7 15 10 10 5 47 Diarrhoea, etc. — — — 1 1 11 13 12 5 42 Other diseases of Liver, etc. — — — — — — — 1 — 1 Other digestive diseases — 1 — — 1 1 1 — — 3 Congenital debility and malformation premature birth, etc 78 3 5 2 88 8 10 4 2 112 Other deaths from violence 2 — 1 — 3 1 — 1 — 5 Other defined diseases — — — 2 2 7 11 2 2 24 27 Stillbirths. The following particulars regarding stillbirths registered in Lambeth during 1937 have been received from the Registrar General:— Stillbirths registered Inward transfers. Outward transfers Corrected totals Total legitimate and illegitimate : Males lO6 22 56 72 Females 94 12 45 61 Illegitimate :— Males 6 3 3 6 Females 3 3 2 4 Mortality (All ages). The mortality rates from different diseases and groups of diseases are given in terms of total deaths per 1,000 of the estimated population, with the exception of the infantile mortality rate which is expressed in terms of the corrected number of births. 1937 1936 1935 Quinquennium 1931-1935 Estimated Population 273,800 277,500 279,900 288,200 General death-rate 13.06 12.41 12.02 12.59 Zymotic death-rate 0.33 0.33 0.25 0.39 Measles death-rate 0.003 0.09 0.007 0.08 Whooping Cough death-rate 0.08 0.04 0.06 0.06 Diarrhoeal death-rate 0.16 0.13 0.12 0.13 Typhoid Fever death-rate 0.003 0.003 0.003 0.004 Tuberculosis (all forms) deathrate 0.87 0.76 0.78 0.90 Tuberculosis (pulmonary) death-rate 0.75 0.69 0.70 0.80 Scarlet Fever death-rate 0.01 0.00 0.00 0.00 Diphtheria death-rate 0.07 0.05 0.05 0.09 Small-pox death-rate 0.00 0.00 0.00 0.00 Infantile Mortalitv rate 68 59 59 60 28 Births, 1937. The total number of Births registered (uncorrected) is 5,582, of which details are set out in Table A. The correctcd number of births, however, is 3,871, showing a birth-rate of 14.14 per 1,000 of the estimated population. Total registered Inward transfers Outward transfers Corrected numbers Legitimate Males ... 2,694 406 1,267 1,833 Legitimate Females 2,566 431 1,201 1,796 Illegitimate Males 180 61 99 142 Illegitimate Females 142 38 78 102 Totals 5,582 936 2,645 3,873 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 5,774 notified births, 4,541 took place in Institutions, and of these, 1 ,£61 belong to Lambeth, and 2,680 to outside districts, thus :— Institutions. Lambeth Cases Strangers Totals General Lying-in Hospital 339 826 1,165 St. Thomas's Hospital 268 328 596 Lambeth Hospital 456 469 925 Clapham Maternity Hospital 126 430 556 King's College Hospital 178 498 674 •Lambeth Council Maternity Home 414 6 420 Other Nursing Homes (private) 80 125 205 Totals 1,861 2,680 4,541 * 6 of the applicants moved out of the Borough after booking. 29 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (a) General. Nursing in the Home- 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 Impetigo Visits paid to Children under 5 years of age 578 128 17 50 6 — 1 Visits paid to Persons over 5 years of age 1,473 151 43 592 — 65 — Total Visits 2,051 279 60 642 6 65 1 Measles and German Measles OphthalmiaNeonatorum Conjunctivitis Puerperal Pyrexia Bronchitis Mumps | Septic Vaccination Visits paid to Children under 5 years of age 53 557 845 — 14 11 13 Visits paid to Persons over 5 years of age 9 — 16 26 16 40 — Total Visits 62 557 861 26 30 51 13 A flat rate of 1/3 per visit is paid for the nursing of infectious disease. 30 Midwives. There are some 40 to 50 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. Despite strenuous opposition by the Metropolitan Boroughs Standing Joint Committee, the Minister of Health adhered to his decision that the County Council should become the authority responsible for the domiciliary midwifery service under the Midwives Act, 1936. There was a considerable and understandable delay in the launching of the County Council scheme, as this involved a division of the county district into five areas, and in area D Lambeth is associated with Battersea, Wandsworth, Southwark and Bermondsey. Once the Minister's decision was known, every effort was made to co-operate with the Count}' Council in linking the domiciliary midwifery scheme with the Lambeth maternity and child welfare scheme, and when it was launched on the 1st January, 1938, there was and is now every expectation of its success. In the appendix will be found a report upon Ministry of Health circular 1622 upon Maternity Mortality, with which is bound up the scheme of the County Council for domiciliary midwifery. Many details still require minor amendment and alteration, and over others a decision has not yet finally been reached. Hospitals The following hospitals are situated within the district and offer accommodation to the inhabitants as well as to large numbers domiciled in other areas. (a) Voluntary. St. Thomas's Hospital, Albert Embankment, S.E.I, contains 640 beds and large out-patients' departments. A Maternity and Child Welfare Centre is included in the latter to which a grant is made by the Council. King's College Hospital, Denmark Hill, S.E.5, contains 384 beds and general and special out-patient departments. 31 Royal Waterloo Hospital, Waterloo Road, S.E.I. For women and children, 130 beds and out-patient department. Belgrave Hospital, 1 Clapham Road, S.W.9. For children, 76 beds and out-patient department. General Lying-In Hospital, York Road, S.E.I. For women, 76 beds. A Maternity and Child Welfare Centre is attached to the out-patient department, to which a grant is made by the Borough Council. " Annie McCall " Maternity Hospital, Jeffreys Road, S.W.8. For women, 50 beds and an out-patient department. (b) County Council. Lambeth Hospital, Brook Street, S.E.I 1. This is a general ho. pital, 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. 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 connexion therewith, for administrative purposes, the Borough is now, with the approval of the Ministry of Health, sub-divided into 11 administrative welfare areas—each area administered by a voluntary welfare centre committee, of which the Medical Officer of Health is a member, as follows :— 1. North Marsh, 120 Cornwall Road, S.E.I. 2. Barley Mow, 52 Oakley Street, S.E.I. 32 3. Holy Trinity and North Lambeth, 121 Kennington Road, S.E.I 1.* 4. Moffat Institute, The Institute, Aveline Street, S.E.I l.*|} 5. The " Rose McAndrew," 48 Lansdowne Road, S.W.8. 6. St. Anne's, 44-46 Harleyford Road, S.E.I 1.* 7. North Brixton (Belgrave Hospital), 212 Camberwell New Road, S.E.5.* 8. Loughborough Junction, " The Sussex Arms," 109 Sussex Road, S.W.9.*f 9. Stockwell, 70 Knowle Road, S.W.9.* 10. Brixton, The Dispensary, 19 Water Lane, S.W.2.*f} 11. West Norwood, Hannen House, 12 Hannen Road, S.E.27.*j (Branch Clinic, Gipsy Road, S.E.27.) In addition clinics are held daily at:— General Lying-in Hospital, York Road, S.E.I.*f St. Thomas's Hospital (Main Building), S.E.I. — do — 37 Royal Street, S.E.I. These are in all respects regarded as Voluntary Welfare Centres and integral parts of the Lambeth scheme, 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, Princes Road, S.E.I 1. (c) The Cynthia Mosley Day Nursery, The Oval, S.E. 11.} 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 which had been in force since 22nd August, 1922, was raised by the Council from the 1st July * Regular Ante-Natal Clinics are held in connexion with these Centres. 1 Dental Clinic, t Artificial Sunlight. 33 following consideration of Ministry of Health circular 1519 upon nutrition. Milk is now available within the income scale for expectant mothers throughout pregnancy, for nursing mothers for as long as two years after the birth if their medical condition requires it, and for infants up to the age of five years. The new scale of income is as follows :— Number in Family Free Half Cost 1 14s. alter deduction of rent... 12s. per head, after deduction of rent 16s. after deduction of rent 14s. per head, after deduction of rent 2 3 10s. do. 12s. do. 4 9s. do. 10s. do. 5 8s. do. 9s. do. 6 and over 7s. do. 8s. do. The figures giving the cost of the Lambeth Milk Assistance Scheme and the quantities distributed, both ordinary cow's milk as well as the various forms of dried milk since its inception on 8th February, 1918, are shown in the following table :— Years (Financial) Cost of Milk distributed Total Cost Total amount of Milk distributed in gallons (approximately) Through Welfare Centres Through Milk Depot 1918-19 (3 months) £ s. d. L s. d. £ s. d. 3,151 232 15 3 69 4 3 301 19 6 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 3,417 14 8 .—. 3,417 14 8 37,909 1936-37 3,751 14 7 — 3,751 14 7 48,100 T otals 61,480 14 6 5,572 11 10 67,053 6 4 759,842 c 34 The provision of cod liver oil free to supplement the issue of milk has been amplified and, in addition to oil, emulsion, and oil and malt, of guaranteed vitamin content, these preparations are also available in combination with iron if the medical officers consider them preferable to issue on medical grounds. 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, 1937, to 31st March, 1942, 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) 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 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 35 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. (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. The Maternity Home The Council's Maternity Home, at 210 Knight's Hill, has maintained its successful career during the year, and 413 cases were admitted to the Home—a decrease of 9 below the previous year's total. Since its inception in 1926, 4,622 women have been admitted to the Home, with only three 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. 36 Applications dealt with during 1937. Welfare Centre Applications received Applications withdrawn, refused or cancelled Babies Care 5 Moffat Institute 1 — Rose McAndrew 1 — North Brixton (Belgrave Hospital) 20 3 Stockwell 51 9 Brixton 120 12 Loughborough Junction 61 5 Norwood 163 16 Total 422 45 The Committee of Management of the Lambeth Council's Maternity Home includes four co-opted members, each representing the Voluntary Welfare Committees in one of the four Parliamentary Divisions of the Borough. The Management Committee is much strengthened by the inclusion of these four ladies who are in a position to explain at first hand the various points of view of the Welfaie Centres which they represent. The success of the Council's Home is due to the cordial spirit of co-operation displayed by all members in their work, and to the staff of the Home, who have ably supported their efforts. Parliamentary Area Applications received Applications withdrawn, refused or cancelled North 2 – Kennington 14 1 Brixton 125 19 Norwood 281 25 Total 422 45 37 Child .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, 1937, now follows :— No. of Foster Mothers on Register 164 No. of Nurse Children on Register 224 No. of Visits and Re-Visits paid to Nurse Children 1,352 Year of Birth No. of Nurse Children No. of Visits 1937 26 106 1936 51 265 1935 48 247 1934 20 129 1933 17 131 1932 19 164 1931 9 66 1930 10 93 1929 13 114 1928 11 37 Totals 224 1,352 No. of Visits, including verifications and registering of homes 2,397 No. of Foster Mothers removed from Borough 9 No. of Nurse Children legally adopted by Foster Parents 2 No. of Nurse Children taken by National Children's Aid and Adoption Society with a view to adoption No. of Nurse Children who attained the age of 9 years 9 No. of Deaths — No. of Legal Proceedings taken 1 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 ICO per cent., which may be contrasted with the attendance of less than 25 per cent, before the Transfer of Powers Order was made. 38 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. 128 applications were received, 8 subsequently cancelled, 18 being emergency cases. The expense to the council was only £79 18s. 6d., and from every point of view the money could scarcely have been better spent. The number benefiting under this service has risen year by year since it began. (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 520 of these outfits were sold. The council has sanctioned the issue of these outfits free or at reduced cost in cases of poverty. 47 applications (3 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 £6 lis. lid. (iii) Sterilization of Bed Linen, etc. During the year 19 applications only were received from the whole area in connexion 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 Dost-natal clinic. The total number of these cases (both ante-natal and post-natal) visited and reported upon during 1937 was 2,936 distributed as follows :— St. Thomas's Hospital 783 2,403 King's College Hospital 332 General Lying-in Hospital 319 Lambeth Hospital 972 39 Institutions outside the Borough of Lambeth 'Westminster Hospital 46 530 Charing Cross Hospital 60 St. George's Hospital 11 Dulwich Hospital 244 Middlesex Hospital 8 Elizabeth Garratt Anderson Hospital 6 Royal Free Hospital 5 St. Giles' Hospital 124 Queen Charlotte's Hospital 6 St. Mary Abbott Hospital 1 St. Stephen's Hospital 3 St. Olave's Hospital 5 St. James' Hospital 7 South London Hospital 2 St. Alfeges' Hospital 1 Royal Northern 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 48, as opposed to 47 last year, 25 in 1935, 8 in 1934, 61 in 1933, 64 in 1932, 83 in 1931, and i49 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 life protection measures are supervised by the borough council in place of the county council (See page 37). In the county domiciliary scheme the municipal midwives will refer their cases to the welfare centres and the closest liaison will exist between the midwife and the health visitor. Applications for assistance towards the payment of the midwife were received from 94 expectant mothers, 3 of which were subsequently cancelled, and 11 were emergency cases. The cost to the council was £88 13s. 0d. 40 Compensation at the rate of 10s. per case is paid to those midwives whose cases after booking are confined on the advice of the clinic medical officer in institutions. Five applications were received from midwives during the year. It is anticipated that the private midwife will eventually be superseded almost entirely by the municipal scheme but until then it is not likely that the financial assistance service will be dropped. (vi) Obstetrical Consultants. On one occasion only during the year was one of the council's two obstetrical consultants called upon in emergency by doctors attending confinements in the district. The cost to the council was £4 4s. Od. (vii) Dentistry. Dental sessions are held at six of the welfare centres, and arrangements are in force whereby women and children in any area can obtain dental treatment. (viii) Ultra Violet Light, and Massage. At two welfare 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. (ix) In a number of cases Wasserman, etc., tests are carried out in ante-natal cases and in time it is hoped that such tests will be the normal routine for every woman as the education of the public proceeds. Toddlers. The arrangements made for the regular medical inspection of toddlers at special clinics held for the purpose and for the free treatment of minor ailments at the four voluntary hospitals in the borough are becoming increasingly popular. The Council have extended the provisional financial arrangements with the hospitals for a further year and it is hoped by then that the experience gained 41 will enable the service to be placed upon a permanent footing. Every effort is made to obtain the services of medical men and women in the consultant class in order that the standard of advice and medical examination of toddlers shall be as high as can be obtained. Particulars of the numbers receiving treatment now follow:— Number of Patients Receiving Treatment, and Cost, for Ten Months, March—December, 1937 (inclusive). Hospitals No. of Patients Cost f. s. d. Belgrave Hospital 117 38 0 6 King's College Hospital 57 18 10 6 St. Thomas's Hospital 27 8 16 6 Waterloo Hospital 9 2 18 6 210 £68 5 0 Cases referred by welfare centres Belgrave King's St. Thomas's Waterloo North Marsh — — — 5 Barley Mow — — 3 — Babies' Care 5 — 1 3 Moffat Institute 2 — 1 — St. Anne's 16 2 3 —. Rose McAndrew 12 1 9 — North Brixton 38 3 2 — Stockwell 4 5 — — Brixton 18 2 2 — Loughborough 11 29 1 1 Norwood 11 15 — — St. Thomas's — — 5 — 117 57 27 9 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 (Main Building' St. Thomas's Hospital (37 Royal St.) General Lying-in Hospital Totals Total Numbers of Individual Cases Dealt With 1. Ante-natal Cases 56 175 530 99 346 235 129 299 163 282 351 663 85 529 3,942 2. Post-natal Cases — — 16 4 — 161 5 102 39 108 115 392 — 204 1,146 3. Nursing Mothers 98 423 683 366 680 383 568 604 323 505 939 392 22 137 6,123 4. Infants (under 1 year) 100 425 937 205 908 302 568 811 532 — 623 447 — 139 6,660 5. Children (aged 1-5 years) 74 506 1,102 172 897 259 370 629 284 1,069 444 203 — 59 6,068 Total 328 1,529 3,268 846 2,831 1,340 1,640 2,445 1,341 2,627 2,472 2,097 107 1,068 23,939 Total Numbers op Sessions Held 1. Ante-natal — — 49 25 23 46 104 48 96 98 152 — 300 941 2. Medical "Consultations" 52 63 99 87 142 47 189 252 95 199 148 117 — 140 1,630 3. Nursing Mothers — — — 22 — — — 53 — 24 63 99 — 99 360 4. Toddlers 1 12 20 178 — 20 4 12 9 6 39 39 — 1,076 5. Others 44 87 38 18 88 44 46 193 — 191 96 181 50 406 Total 97 162 206 330 230 134 285 614 152 516 444 407 181 655 4,413 Total Numbers of all Attendances at the Sessions I. Ante-natal Cases: (a) Ante-natal — — — — — 285 252 — — — — — — 3,221 3,758 (b) Seen by Medical Officer 21 61 584 270 — — 1,846 1,182 601 1,345 1,485 3,098 — — 10,493 (c) Otherwise dealt with 35 14 — — — — 195 — 47 128 — — 419 (d) Dental — — — — — — — Ill — 88 265 84 — 270 818 (e) Others 112 120 — — 1,224 177 141 — 32 70 194 637 — 2,707 Total 168 195 584 270 1,224 462 2,434 1,293 680 1,631 1,944 3,182 637 3,491 18,195 Post-natal: (a) Seen by Medical Officer — — 3 4 113 15 124 41 132 119 392 288 1,231 (b) Otherwise dealt with — — — — — — 4 — — — — — — — 4 (c) Dental — — — — — — — — — 5 — 5 10 (d) Ohters — — — — — — — — — 109 75 — — 184 Total — — 3 4 — 113 19 124 41 246 194 397 — 288 1,429 2. Nursing Mothers : (a) Seen by Medical Officer 396 1,468 1,079 2,394 2,368 1,431 2,734 2,122 720 2,112 2,950 1,432 — 1,202 22,408 (b) Otherwise dealt with 681 568 1,191 2,058 2,238 2,132 3,885 — 1,564 970 6,529 — — 44 21,860 (c) Dental — — — 52 — — — 787 — 111 160 2 — — — (d) Others 259 1,030 636 374 — 873 — — 4 186 103 — 548 — 4,013 Total 1,336 3,066 2,906 4,878 4,606 4,436 6,619 2,909 2,288 3,379 9,742 1,434 548 1,302 49.449 43 WELFARE CENTRE North Marsh Barley Mow North Lambeth Babies' Care Moffat "Rose McAndrew" St. Anne| North Brixton Loughborough Junction Stockwell Brixton West Norwood St. Thomas's I Hospital (Mainl Building) St. Thomas's Hospital I (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 396 1,087 1,536 1,178 3,333 1,080 2,733 3,506 1,545 3.433 2,278 2,138 — 1,208 25,451 (b) Otherwise dealt with 681 406 1,672 740 2,826 1,814 3,889 4,682 2,679 4,227 — — 141 23,757 (c) Dental — — — — — — — — — — — — — — — (d) Others 259 439 — 71 152 — — — 239 260 — — — 1,420 Total 1,336 1,932 3,208 1,989 6,159 3,046 6,622 3,506 6,227 6,351 6,765 2,138 1,349 50,628 4. Children (aged 1-5 years): (a) Seen by Medical Officer 303 714 1,607 1,575 s,iai 556 l,«M 2,529 M 2,323 1,083 1,296 – 576 17,207 (b) Otherwise dealt with 524 299 1,264 756 2,083 619 3,088 — 1,956 2,497 1,953 — — 83 15,122 (c) Dental – – – 72 – – – 220 – 85 98 12 — — 487 (d) Others 371 725 – 1,401 – 653 – – 3 468 102 – – – 3,723 Total 1,198 1,738 2,871 3,804 4,246 1,828 4,747 2,749 2,782 5,373 3,236 1,308 – 659 36,539 Visits and Re-visits Paid to Homes Ante natal Cases: (a) First Visits 41 107 356 152 270 195 281 413 292 282 95 – 168 93 2,745 (b) Re-visits 246 448 655 190 891 862 92 1,280 123 388 179 – 958 340 6,652 Total Visits 287 555 1,011 342 1,161 1,057 373 1,693 415 670 274 – 1,126 433 9,397 1. Post-natal : (a) First Visits 37 – 26 224 – 244 385 392 25 330 442 — — 108 2,213 (b) Re-visits 12 —4 2 — – — — 72 — 132 — — — — 218 Total Visits 49 – 28 224 – 244 385 464 25 462 442 – – 108 2,431 2. Nursing Mothers (a) First Visits 65 126 374 424 202 385 480 344 265 13 — 133 108 2,919 (b) Re-visits 756 4,485 1,150 774 1,548 5,945 1,316 518 884 619 2,444 — 1,088 614 22,141 Total Visits 821 4,611 1,524 774 1,972 6,147 1,701 998 1,228 884 2,457 – 1,221 722 25,060 3. Infants (under 1 year) (a) First Visits 65 113 422 224 539 263 387 512 393 485 482 — 98 106 4,089 (b) Re-visits 762 1,861 2,477 773 2,064 2,804 1,357 1,640 1,834 1,737 2,326 — 521 730 20,886 Total Visits 827 1,974 2,899 997 2,603 3,067 1,744 2,152 2,227 2 222 2,808 – 619 836 24,975 4. Children (aged 1-5 years) (a) First Visits 63 41 105 200 505 256 160 217 77 626 44 — 95 55 2,444 (b) Re-visits 1,551 5,293 4,430 3,048 2,894 3,140 2,226 1,555 3,034 3,026 4,510 — 3,190 572 38,469 Total Visits 1,614 5,334 4,535 3,248 3,399 3,396 2,386 1,772 3,111 3,652 4,554 — 3,285 627 40,913 44 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 in the winter months, of whom 30 belong to the nursery school. There were 12,197 attendances during the year upon 254 working days, giving an average daily total of 48 children accommodated. The gross cost per child per day was two shillings and fivepence, of which the food represents ninepence farthing. 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. 45 Developments and Changes in the Maternity and Child Welfare Scheme during the Year (i) Institutional provision for Mothers and Children. One bed at the Zacchary Merton Convalescent Home, Rustington, maintained by the Borough Council, has been filled throughout the whole period from the time the home was opened on 28th April. The demand was greater than the accommodation could provide and the Council have therefore decided to maintain a second bed. Each bed includes accommodation for an infant and a toddler with the mother. (ii) Health Visitors. Largely owing to the increase of work connected with the toddlers' clinics there were the following additions to the number of health visitors employed by the voluntary organisations in the Lambeth scheme:—One part-time at each of the following: "Rose McAndrew," Brixton and Stockwell Welfare Centres ; one wholetime at St. Anne's Centre, and at North Brixton Centre the part-time Health Visitor was engaged whole-time ; in all the equivalent of three health visitors were added during the year. The health visitors directly in the employment of the Council are all placed in grade B of the London District Council scale, i.e., £215 rising by £15 per annum to £390 together with a uniform allowance of £10. Those employed by the voluntary organisations have been receiving salaries varying from £190 to £250 per annum, some with and others without uniform allowances, which varied from £10 to £25 a year. Others had residence or partial board. The discrepancies in emoluments and the lack of any uniform or satisfactory scale of increments had for some years been a source of dissatisfaction and led the Council to adopt the following uniform scale of salaries and emoluments which were agreed to by all the voluntary organisations employing health visitors:— Senior health visitors—£250, rising by annual increments of £12 10s. Od. to £300 per annum. Health visitors—£200, rising by annual increments of £10 to £250 per annum. together with a uniform allowance in each case of £10 per annum. 46 The voluntary committees also agreed (a) that the new scales should be applied from the 30th June, 1937, on the basis that every health visitor should receive a salary based on her present salary plus one increment, or the minimum salary of the newscheme, whichever is the greater, and that subsequent increments should be payable on the 1st April in each year ; (b) that part-time health visitors should be paid a salary at the same rates as above but calculated pro rata to the time worked ; (c) that in the cases of those health visitors who will not have completed one year's sei vice by the 30th June, 1937, and whose present salaries are not less than the minimum of the new scales, the first increment shall not be payable until the 1st April, 1938 ; (d) that in the case of new entrants to the service during the first half of any financial year, the first annual increment shall become payable on the 1st April following the appointment, and with regard to such entrants during the second half of any financial year, the first annual increment shall become payable on the 1st April next after the one following, thus conforming to the procedure adopted by the Council in connexion with appointments to their own staff. The health visitors of the welfare centres are also pensioned under the Federated Superannuation Scheme of Nurses and Hospital Officers (Contributory). Ten years ago salaries were as low as £150 a year with no regular increments, no uniform allowance and no pension, and it is therefore a great satisfaction to all concerned that so great a measure of success has been achieved in obtaining a satisfactory standard of salaries and emoluments. Summary The table on pages 42 and 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 47 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 01 defects :— Year Cost to the Borough Council (Financial Year) Infantile Mortality Percentage of children entering school with one or more physical defects £ s. d. 1918 713 6 1 105 37.7 1919 1,010 14 4 85 38.2 1920 1,664 14 2 69 32.8 1921 4,517 8 10 77 34.2 1922 4,820 18 8 79 32.7 1923 4,377 15 1 58 34.2 1924 3,382 15 7 67 38.3 1925 3,911 7 7 64 48.2 1926 4,073 5 9 55 53.1 1927 4,086 12 10 55 56.7 1928 4,274 19 8 61 51.1 1929 4,481 4 3 68 55.3 1930 17,329 1 9 57 55.0 1931 20,331 6 6 60 61.5 1932 20,147 16 7 56 47.9 1933 20,746 10 7 63 44.2 1934 20,782 8 7 63 55.7 1935 23,008 13 6 59 57.1 1936 22,651 17 1 59 46.3 1937 26,676 14 6 68 50.6 Summary of Work carried out (Visits Paid) by the 4 Whole-time Official Health Visitors during 1937. Ante-natal Visits 1,445 Do. Re-visits 105 Births, 1st Visits 1,157 Do. Re-visits 374 Do. Stillborn 77 Ophthalmia, 1st Visits 74 Do. Re-visits 104 48 Infantile Deaths, Visits 26 Welfare Centre Attendances 557 Diphtheria Prevention Clinic Attendances 99 Visits—No result 1,613 Visits to Children 1-5 (included above) 708 Puerperal Pyrexia, 1st Visits 46 Do. Re-visits 36 Post-natal Visits 876 Do. Re-visits 104 Scabies 1 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' connexion 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. 49 Puerperal Fever and Puerperal Pyrexia. The number of notifications of puerperal fever and puerperal pyrexia received during the year was 70, of which 30 occurred in primiparae, 34 in multiparae, while the particulars of the remaining 6 were not ascertained. The causes giving rise to the notifications arc detailed in the following table :— Cause Primiparae Multiparae Medical Ante-natal care Yes No Manual interference 4 6 9 1 Abortion 4 7 — 11 Caesarean section 1 2 3 Mastitis 2 1 3 — Influenza, Bronchitis, etc. 5 5 8 2 Pyelitis cystitis 3 7 8 2 Sepsis — 3 3 3 Various 6 3 8 1 Totals 30 34 44 20 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 disposed of by a system of controlled tipping. D 50 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 31s/ March, 1937. Item Particulars Total including Depreciation or Loan Charges Revenue Account— £ 1 Gross Expenditure 55,241 2 Gross Income 2,698 3 Net Cost 52,543 Unit Costs— s d. 4 Gross Expenditure, per ton 17 6 5 Gross Income, per ton 0 10 € Net cost, per ton 16 8 7 Net cost per 1,000 population £189.3 8 Net cost per 1,000 houses or premises from which refuse is collected £1,050.9 9 Total refuse collected 63,162 tons 10 Population : Midsummer, 1936 277,500 11 Area (statute acres) 4,083 12 Weight per 1,000 population per day (365 days to year) 12.4 tons 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 4 11 Container system (combination of mechanical and horse vehicles) 6 lorries and 23 containers 89 15 Method of disposal Controlled tipping 16 Average length of haul to point of disposal at wharf 1.86 miles 51 Street Cleansing. Table showing Costs for the Year ended 31s/ March, 1937. Item Particulars Street Sweeping and Watering Gully Cleansing Snow Removal £ £ £ Revenue Account—- 1 *Gross Expenditure 42,246 2,308 579 2 Gross Income 1,739 — — 3 Net cost 40,507 2,308 579 4 Unit Costs— Net cost per 10,000 square yards cleansed... 10s. Od. — — 5 Net cost per 1,000 gullies cleansed — £55.83 — 6 Net cost per 1,000 of population £145.97 £8.32 £2.09 * Including loan charges, depreciation, etc. 7 (a) Square yards of streets cleansed, inclusive of footpaths 2,095,227 (i) Number of square yards of streets cleansed multiplied by number of cleansings during year 608,520,000 8 (a) Total number of Gullies cleansed approx. 11,000 (ft) Number of gullies cleansed multiplied by number of cleansings during year 41,340 9 Total mileage of streets cleansed 142.21 10 Approximate mileage cleansed three times daily 10.7 „ „ „ twice „ 10.3 „ ,, „ once ,, 45.5 11 „ „ „ four times weekly 4.5 „ „ „ three „ „ 29.31 12 „ „ „ twice „ „ 41.90 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 52 Sanitary Inspection of the Area. 5,074 Notices were served during the year 1937, as follows :— Public Health (London) Act, 1936, Housing Acts, etc. (a) District Sanitary Inspectors. Preliminary or Intimation Notices. (1) Male Inspectors 3,630 3,745 (2) Women Inspectors 115 Statutory Notices. (1) Male Inspectors. P.H. Act 331 334 (2) Women Inspectors 3 Disinfection Notices 958 (b) Food Inspectors. (1) Public Health (Meat) Regulations, 1924 6 6 (2) Public Health (London) Act, 1936 — (c) Housing. Inspectors. Informal Schedules 19 31 Formal Notices 12 Total 5,074 6 Summonses were issued, with results as follows :— Public Health (London) Act, 1936. Convictions 4 5 Summons withdrawn on costs 1 Food and Drugs (Adulteration) Act, 1928. Convictions — 1 Summons withdrawn — Summons dismissed — Summons dismissed on costs 1 Total 6 53 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 1937. Inspections 10,490 Re-visits 26,313 Complaints received 5,085 Water Certificates issued (983 separate houses or tenements including 36 blocks of tenements) 80 Drains tested (with chemical, water or smoke test) 4,140 Sanitary Works completed 4,364 Sanitary Nuisances 14,050 1. Bath Waste : (a) directly connected to drain 3 (b) improperly trapped or untrapped ; defective 57 2. Basement dwellings : (a) inspections 15 (b) reinspections 8 3. Ceilings and walls : defective 852 4. Chimney : defective 75 5. Copper : defective 94 6. Damp condition of premises 1,013 7. Dilapidated condition of premises 215 8. Door: defective 130 54 9. Drains : (a) defective 293 (6) fresh air inlet defective 147 (c) gulley defective 133 (d) manhole defective 65 (e) plunging eye defective 39 (/) soil pipe defective 127 (g) stopped 331 (h) trap insufficient 8 (i) ventilation insufficient 23 (j) vent pipe defective 98 10. Dustbins or ashpits : (a) defective or dilapidated 440 (b) absence of 112 11. Fireplace : defective 404 12. Floors: defective 320 13. Lavatory waste : directly connected to drain, improperly trapped or untrapped 23 14. Paving (yard or area): (a) defective 253 (b) undrained 34 15. Rainwater pipe and gutters : (a) rainwater pipe defective 298 (b) gutters defective 409 (c) rainwater pipe directly connected to drain 15 16. Roof : defective 1,167 17. Sinks : (a) defective 248 (b) directly connected to drain 13 (c) improperly trapped or untrapped 171 (d) waste defective 294 18. Stable : (a) absence of proper manure receptacle 12 (b) drain defective 3 (c) paving defective 11 (d) undrained 4 55 19. Washhouse : (a) roof defective 80 (b) paving defective 50 (c) undrained — 20. Water closet: (a) defective so as to be a nuisance 261 (b) improperly constructed so as to be a nuisance 49 (c) insufficient or improper accommodation 30 (d) pan and trap defective 310 (e) deficient or defective water supply 243 21. Water supply: (a) cut off 54 (b) draw-off from main required 24 (c\ no supply 15 (d) pipes, taps, etc., defective 121 (e) storage cistern defective or uncovered 28 (f) storage cistern so foul as to be a nuisance 2 (g) tenement houses supplied 19 22. Windows : defective 492 23. Animals : improperly kept 26 24. Bakehouses : (a) inspections 211 (6) reinspections 133 (c) dirty 85 25. Dirty premises : (a) walls and ceilings of rooms dirty 2,368 (b) rooms, etc., verminous 494 (c) stable premises dirty 7 (d) wa;hhouse walls and ceilings dirty 336 (e) water closet walls and ceilings dirty 348 (/) work:-hops and factories 33 26. Effluvium nuisance : (a) from industrial premises 11 (b) from private premises 20 27. Lighting and ventilation : defective 31 28. Manure: accumulation or deposit injurious to health 13 29. Overcrowding 12 30. Rats infestation : (a) Industrial premises 50 (b) Private premises 204 56 31. Refuse accumulations 235 32. Smoke nuisance : (a) from industrial premises 43 (b) from private premises 38 33. Stagnant water : accumulation 40 34. Underground rooms : occupied as a dwelling 9 35. Urinal: foul 17 In addition, the district sanitary inspectors carried out during 1937 routine duties connected with the inspection of unsound and unwholesome food, the supervision of bakehouses, slaughterhouses, 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 connexion 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 21 inspections were made and 20 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. Action taken under section 224, Public Health (London) Act, 1936. In two 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. 57 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) 374 31 — Workshops (Including Workshop Laundries) 385 35 ~ Workplaces (Other than Outworkers' premises) 492 1 ~ Total 1,251 67 — 2.—Defects found in Factories, Workshops and Workplaces Particulars Number of Defects Number ol 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 131 131 – – Want of ventilation 3 3 – – Overcrowding — — – – Want of drainage of floors 6 6 – – Other nuisances 30 30 – – Sanitary accommodation— Insufficient 4 4 – – Unsuitable or defective 56 56 – – Not separate for sexes 5 5 – – 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) 8 8 Total 243 243 – – * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, a3 remediable under the Public Health Acts. 58 Outwork in Unwholesome Premises, Section 108. Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) Wearing Apparel— Making, etc 161 — — Cleaning and washing — — — Household linen 4 — — Lace, lace curtains and nets 3 — — Curtains and furniture hangings. — — — Furniture and upholstery 6 — — 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 3 — — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags 16 — — Brush making 2 — — Pea picking — — — Feather sorting — — — Carding, etc., of buttons, etc. 4 — — Stuffed toys 2 — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, etc. 2 — — Textile weaving — — — Lampshades — — — Fancy articles, pin cushions, milk bottle covers, etc. 22 — — Total 226 — — Summary of Work carried out by the Women Sanitary Inspectors during 1937. Workshops* visited and inspected 699 Workshops*: workrooms therein measured 5 Workshops* : newly discovered and registered 5 * Workshops include Work-places. 59 Premises visited, but not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 511 Women's Conveniences visited and inspected, etc. (visits paid) 1,069 Special places visited and inspected : (a) Restaurants 396 1,346 (b) Housing enquiries 621 (c) Outworkers 232 (d) Complaints, Infectious diseases, etc. 97 Re-inspections : (a) Restaurants 89 187 (b) Housing enquiries 60 (c) Outworkers 5 (d) Complaints, etc 33 Written Intimation and Statutory Notices served 118 Visits to Workshops, etc., in which defects were found 178 Visits to Workshops, etc., in which no defects were found ... 1,515 Nuisances referred to M.O.H., for attention by Male Inspectors 10 Particulars of Defects found by Women Inspectors. Workshops, etc. :— Workrooms : Overcrowded, Damp, Dirty, etc. 3 Defective or Dirty : Yards, Floors, Roofs, Windows, Walls and Ceilings, Rain Water Pipes, Sink Wastes, or Premises generally 104 Sanitary Appliances : Water Closets—Dirty, unventilated, choked, defective or with defective cistern or water supplies 35 Drainage—Defective 3 Dustbins—Wanting or Defective 7 Lavatories—Dirty or Defective 3 No separate suitable sufficient W.C. accommodation for the sexes 1 No W.C. accommodation 1 60 Factories and Workshops. Four new factories, 6 new workshops, and 35 new workplaces were added to the Register, dealing with various trades. Out-workers. Thirteen February and seventeen August lists were received, dealing with 131 and 158 out-workers respectively. 01 the 269 out-workers 137 belonged to Lambeth and the remainder lived in other areas. Particulars of the latter were sent to the Authorities concerned, while in return, 1(2 lists were received from various outside authorities dealing with 492 out - workers living in Lambeth. Of the total Lambeth out-workers reported 70 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 cates 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, 61 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 Gipsy Hill, 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). Eleven 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 76.) (f) Ice Cream Vendors. At the end of the year there were 407 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 131 bakehouses on the Register compared with 222, 214, 214 and 140 for the years 1901, 1911, 1921 and 1931 respectively ; 53 are underground, and machinery is installed in 104. (h) Food Premises. (See page 78.) 62 Shops Act, 1934 Sixteen inspections and four re-inspections were made during the year in connexion with ventilation, temperature and sanitary conveniences. No legal proceedings were instituted, as all alterations required were carried out informally. No exemption certificates were granted regarding the provision on the premises of sanitary conveniences owing to restricted accommodation or other special special circumstances affecting the premises. Smoke Abatement. Metal plates containing suggestions to avoid the unnecessary emission 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 43 No. of intimation notices served 43 No. of observations made 81 Every effort is made to enlist co-operation with industry by the sanitary inspectors in order to reduce the waste and nuisance from smoke. 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 also an open-air pool in Brockwell Park, S.W. 2, fitted with a continuous filtration and chlorination plant, and opened in July, 1937. 63 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, 1936. Part III. The progress of clearing the Hemans Street area represented in 1931, the inquiry held in November, 1933, and confirmation of the order received in January, 1934, was almost completed by the end of the year. Attention was drawn to the undesirable disfigurement previously ignored, of leaving between the Council's estate and the Wandsworth Road, a common lodging house and a piece of waste land used by caravan dwellers. Steps are in process of being taken to clear away these ugly conditions. Attention was also directed to the state of affairs in the adjoining Fount Street clearance area which was represented in 1936 and the inquiry held in March, 1937. From the time of representation of the Hemans Street area in 1931, it had been common knowledge that the Fount Street area would be cleared sooner or later and naturally the least possible sums were spent by owners upon the upkeep of the property. After the confirmation of the clearance order in June, deterioration of the premises was rapid and urgent measures were put in hand to house through the assistance of the County Council all those who wished to leave, and to patch up the other dwellings until alternative accommodation was ready on the adjoining site. 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. 64 Dwelling-houses Persons displaced Canterbury Mews 8 23 Clarewood Mews 14 37 Northall Street 11 46 Barnes Cottages 11 37 Ingleborough Place 12 40 Robsart Place (late Ann's Place) 11 40 Stockwell Cottages 10 38 Citron Place 5 3 Mayo's Cottages 4 13 Jaffray Place 4 12 Victoria Place 6 24 Eaton Cottages 3 14 East Place—No. 1 28 108 No. 2 3 17 Wood Street 27 110 Ethelm Street—No. 3 ... 57 348 Murphy Street—Nos. 1, 2, 3 and 4— and a building comprising 8 tenement dwellings 140 891 Lambeth Square Site ... 18 houses 175 Stones' Buildings (Hocking Buildings) 28 112 400 2,088 Housing Act, 1936. 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 III (Clearance Areas) of the Housing Act, 1936 Nil (2) Record forms (Clearance Areas) filed Nil (3) Notices of intention to survey issued under section 157 of the Housing Act, 1936, and served upon occupiers and owners 80 (4) Surveys or inspections made under the House Inspection Regulations of the Housing Acts, 1925 to 1936 19 (5) Provisional or informal schedules prepared under section 9 of the Housing Act, 1936 19 (6) Schedules prepared for the purpose of Statutory Notices under section 9 of the Housing Act, 1936 12 (7) Record Cards (section 9) filed 19 (8) Surveys made under section 11 of the Housing Act, 1936 47 (9) Record forms (section 11) filed 47 (10) Surveys made under section 12 of the Housing Act, 1936 (underground rooms and parts of buildings) 265 (11) Record forms (section 12) filed 265 (12) Drain tests made (chemical, smoke, and water) 420 (13) Total visits made (re-visits, 9,893) 10,326 65 PART II.—SECTION 9 (REPAIRS). During the period under review in the present report, the following roads and streets have been surveyed (wholly or in part)— the numbering of the individual houses being given in brackets after the name of each :— Princes Ward. Monkton Street (No. 12). Vauxhall Ward. Old South Lambeth Road (Nos. 99 and 101), Thorncroft Street (No. 35), Wandsworth Road (Nos. 60, 62 and 90). Vassall Ward. Frederick Crescent (Nos. 22, 24, 25, 26, 27 and 28). Angell Ward. Knowle Road (Nos. 59 and 64). Knight's Hill Ward. Clive Road (Nos. 23, 25, 27 and 29). The actual work has been completed, or practically completed, in the following houses, the numbering of the individual houses being given in brackets after the street or court :— (1) After Service of Notices (Legal Schedules) :— Princes Ward. *Goding Street (No. 31).. Vauxhall Ward. Cavendish Grove (Nos. 33 to 49, odd), Luscombe Street (Nos. 3, 5 and 7). Angell Ward. Conderton Road (Nos. 5, 7, 9, 13 and 17). Stockwell Ward. Stockwell Park Road (No. 129). (2) After Service of Provisional (Informal) Schedules :— Princes Ward. Princes Road (Nos. 114 to 118, consec.), Monkton Street (No. 12). Vauxhall Ward. Old South Lambeth Road (Nos. 99 and 101), Thorncroft Street (No. 35). Vassall Ward. Frederick Crescent (Nos. 22, 24 and 27). Angell Ward. Conderton Road (No. 15), Knowle Road (Nos. 11, 13, 63, 65 and 67) * The Council have carried out and completed the work. B 66 Stockwell Ward. Bellefields Road (Nos. 19 to 33, odd, and 39 and 41), Hubert Grove (No. 95), Stockwell Grove (Nos. 18, 20 and 22). Town Hall Ward. Blenheim Gardens (No. 79), late No. 39 Cornwall Road. Tulse Hill Ward. Dulwich Road (Nos. 22 to 28, even, and 32). 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 Ward. Wandsworth Road (Nos. 60, 62, 90). Knight's Hill Ward. Windsor Road (Canton Cottage). Twelve notices (legal schedules) have been served during the year in respect of the following houses :— Angell Ward. Knowle Road (Nos. 22 to 32, even, and 59, 61 and 64). Town Hall Ward. Bonham Road (No. 60). Knight's Hill Ward. Woodland Hill (Nos. 4 and 6). 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 connexion with houses, but the work has not yet been commenced. 123 representations were made under the Housing Acts, as follows:— (a) Section 11 (Demolition Orders—5 representations). Bishop's Ward. Lambeth High Street (No. 19, inspected 1936), Salamanca Street (Nos. 6 and 8). Vauxhall Ward. Priory Grove (No. 36a), Wandsworth Road (No. 60). (i) Demolition Orders Made. Bishop's Ward. Lambeth High Street (No. 19), Salamanca Street (Nos. 6 and 8). (ii) Demolition Orders Complied with. Bishop's Ward. Salamanca Street (Nos 6 and 8). 67 (b) Section 12 (Underground rooms and parts of buildings—118 representations). Marsh Ward. Addington Street (No. 16a), Coin Street (No. 4), Coral Street (Nos. 23, 27, 29, 31, 33, 35 and 37), Lambeth Square (No. 14), York Road No. 79—Inspected 1936). Bishop's Ward. Crozier Street (No. 11), Lambeth Road (No. 100), Newnham Terrace (No. 1), Paris Street (Nos. 32 and 37), Royal Street (No. 20), Upper Marsh (Nos. 35, 37, 39 and 41), Vauxhall Walk (Nos. 120, 140and 142). Prince's Ward. Aveline Street (No. 41), Bolwell Street (Nos. 15 and 22), China Walk (No. 5), Holyoak Road (Nos. 3, 7, 14 and 52), Hurley Road (No. 32), Kennington Lane (Nos. 186 and 202), W'incott Street (Nos. 26, 33, 60 and 78). Vauxhall Ward. Guildford Road (No. 38), Lansdowne Gardens (No. 27 inspected 1936), Miles Street (Nos. 18 and 20), Paradise Road (Nos. 47, 64, 80, inspected 1936, and 82), Studley Road (No. 39), St. Stephen's Terrace (No. 6), South Lambeth Road (No. 304), Wandsworth Road (Nos. 62, 103, 142, 144, 173, 175, 177a ; 184a and 186, inspected 1936). Oval Ward. Fentiman Road (No. 8), Richborne Terrace (Nos. 8, 100 and 111). Vassall Ward. Brixton Road (No. 179a), Durand Gardens (No. 33), Foxley Road (No. 20), Listowel Street (No. 17), Offley Road (No. 32, inspected 1936). Angell Ward. Akerman Road (No. 20), Angell Road (No. 42), Brixton Road (Nos. 249, 329 (basement), and 349), Coldharbour Lane (No. 298), Flaxman Road (No. 27), Knatchbull Road (No. 73), Knowle Road (Nos. 8 and 68), Luxor Street (No. 14), Mostyn Road (No. 35), Paulet Road (No. 94), Penfold Street (No. 7), Pomfret Road (No. 7), Wynne Road (No. 2). Stockwell Ward. Aytoun Road (No. 15), Bellefields Road (No. 34), Ferndale Road (" Rathcoole "), Medwin Street (No. 7), Stockwell Park Road (Nos. 46 and 91), Stockwell Road (No. 71). m Town Hall Ward. Allington Street (Nos. 2, 4 and 6), Branksome Road (Nos. 1, 3 and 9), Trinity Gardens (No. 15). Heme Hill Ward. Milkwood Road (No. 211), Somerleyton Road (Nos. 45 and 73, inspected 1936). Tulse Hill Ward. Brixton Hill (Nos. 159, 161, 163, 165 and 167), Christchurch Road (No. 29), Norwood Road (No. 293), Shakespeare Road (No. 2, inspected 1936), Upper Tulse Hill (No. 112). Knight's Hill Ward. Darlington Road (No. 14), Farquhar Road (Nos. 1, 3, 5, 7 and 9), Gipsy Hill (No. 26), Hannen Road (No. 3), Knight's Hill (No. Ill) 68 (i) Closing Orders Made. Marsh Ward. Addington Street (No. i6a), Broadwall (No. 64, represented 1936), Coin Street (No. 4), Lambeth Square (Nos. 14 and 24, represented 1936), York Road (No. 79). Bishop's Ward. Lambeth Road (No. 100;, Paris Street (Nos. 32 and 37). Radnor Buildings (No. 3, representea '936), Roval Street (No. 20), Upper Marsh (Nos. 35, 37, 39 and 41), YauxhaU Walk (No,. 120, 132, 134 and 136, represented 1936, 140 and 142). Prince's Ward. Holyoak Road (Nos. 3, 14 and 52), Kennington Road (No. 202), Monkton Street (No. 70, represented 1936). Vauxhall Ward. Wandsworth Road (Nos. 103, 173, 175, 177a, 184a and 186). Vassall Ward. Brixton Road (No. 179a), Foxlev Road (No. 20), Offley Road (No. 32). Angell Ward. Akerman Road (No. 20), Brixton Road (No. 349), Coldharbour Lane (No. 298). Stockwell Ward. Bellefields Road (No. 34), Ferndale Road (" Rathcoole "), Stockwell Park Road (No. 46), Stockwell Road (No. 71). Town Hall Ward. Allington Street (Nos. 2, 4 and 6), Trinity Gardens (No. 15). Heme Hill Ward. Milkwood Road (Nos. 211 and 271, represented 1936). Tulse Hill Ward. Brixton Hill (Nos. 159, 161, 163, 165 and 167), Christchurch Road (No. 29), Shakespeare Road (No. 2). Knight's Hill Ward. Farquhar Road (Nos. 1, 3, 7 and 9), Gipsy Hill (No. 24, represented 1936), Hannen Road (No. 3). (ii) Closing Orders Complied With. Marsh Ward. Addington Street (No. 16a), Broadwall (No. 64), Lambeth Square (Nos. 14 and 24), York Road (No. 79). Bishop's Ward. Lambeth Road (No. 100), Paris Street (No. 37), Royal Street (No. 20), Upper Marsh (Nos. 35, 37 and 41), Vauxhall Walk (Nos. 120, 132, 134, 136, 140 and 142). Prince's Ward. Holyoak Road (Nos. 34, Closing Order made 1936, and 52), Kennington Road (No. 202), Monkton Street (No. 79). Vauxhall Ward. Wandsworth Road (Nos. 173, 175, 177a, 184a and 186). 69 Vassall Ward. Brixton Road (No. 179a), Foxley Road (No. 20), Offley Road (No. 32). Stochwell Ward. Bellefields Road (Nos. 31 and 33, Closing Orders made 1936, and 34), Stockwell Park Road (No. 46), Stockwell Road (No. 71). Town Hall Ward. Allington Street (Nos. 2 and 4), Trinity Gardens (No. 15). Heme Hill Ward. Milkwood Road (Nos. 211 and 217). Tulse Hill Ward. Brixton Hill (Nos. 159, 161, 163, 165 and 167). Christchurch Road (No. 29), Shakespeare Road (No. 2). Knight's Hill Ward. Farquhar Road (Nos. 1, 3, 7 and 9), Gipsy Hill (No. 24), Hannen Road (No. 3). (iii) Closing Orders Determined. Prince's Ward. Monkton Street (No. 79). Vauxhall Ward. Offley Road (No. 32). Stockwell Ward. Bellefields Road (Nos. 19, 21, 23, 25, 27, 29, 33, 39 and 41, Closing Orders made in 1936). Knight's Hill Ward. Farquhar Road (Nos. 1 and 3, upper basement rooms only), Gipsy Hill (No. 24, basement back and back addition rooms onlyj. (iv) Closing Orders Not Compiied With. Marsh Ward. Coin Street (No. 4). Bishop's Ward. Paris Street (No. 32), Radnor Buildings (No. 3), Upper Marsh (No. 39). Prince's Ward. Holyoak Road (Nos. 3 and 14). Vauxhall Ward. Wandsworth Road (No. 103). Angell Ward. Akerman Road (No. 20), Brixton Road (No. 349), Coldharbour Lane (No. 298). Stockwell Ward. Ferndale Road (" Rathcoole "). Town Hall Ward. Allington Street (No. 6). 70 (v) Undertakings Received in Lieu of Closing Orders. Marsh Ward. Coral Street (Nos. 25 to 37, odd). Prince's Ward. China Walk (No. 5). Vauxhall Ward. Miles Street (Nos. 18-20), Paradise Road (No. 47), St. Stephen's Terrace (No. 6), South Lambeth Road (No. 304), Wandsworth Road (No. 142, 144 and 173). (Closing Order subsequently made on No. 173.) Oval Ward. Richborne Terrace (No. 111). Angell Ward. Brixton Road (No. 329, lower part). Undertaking in respect of basement back left hand room only. Flaxman Road (No. 27), Penfold Street (No. 7). Town Hall Ward. Branksome Road (No. 1). Knight's Hill Ward. Darlington Road (No. 14), Farquhar Road (No. 5). (vi) Premises Vacated or Closed after Representation or after Undertaking Received. Prince's Ward. China Walk (No. 5). Vauxhall Ward. Miles Street (Nos. 18-20), Paradise Road (No. 47), St. Stephen's Terrace (No. 6), Studley Road (No. 39). Vassall Ward. Durand Gardens (No. 33). Angell Ward. Flaxman Road (No. 27), Knowle Road (No. 68). Stockwell Ward. Aytoun Road (No. 15). Town Hall Ward. Branksome Road (No. 1), Church Road (No. 10, represented 1936). Knight's Hill Ward. Farquhar Road (No. 5). (vii) Represented, but Have Since Been Made Fit. Prince's Ward. Aveline Street (No. 41), Bolwell Street (No. 15), Hurley Road (No. 32), Monkton Street (No. 79, represented 1936), Prince's Road (Nos. 114, 115, 116, 117, 118, represented in 1936), Wincott Street (Nos. 33, 60 and 78). 71 Vauxhall Ward. Lansdowne Gardens (No. 27), St. Stephen's Terrace (No. 6), Studley Road (No. 39). Oval Ward. Fentiman Road (No. 8), Richborne Terrace (No. 8). Vassall Ward. Durand Gardens (No. 33), Listowel Street (No. 17), Offley Road No. 32). Angell Ward. Angell Road (No. 42), Brixton Road (Nos. 249 and 329, lower part), Flaxman Road (No. 27), Knowle Road (Nos. 8 and 68), Luxor Street (No. 14), Mostyn Road (No. 35), Paulet Road (No. 92, represented 1936 No. 94), Penford Street (No. 7), Pomfret Road (No. 7). Stockwell Ward. Aytoun Road (No. 15), Bellefields Road (No. 33, represented 1936), Stockwell Park Road (Nos. 46, basement back only, and 91). Town Hall Ward. Branksorae Road (No. 9). Heme Hill Ward. Somerleyton Road (No. 73). Tulse Hill Ward. Tulse Hill (No. 150, represented 1936), Norwood Road (No. 293), Water Lane (No. 6, represented 1936). Knight's Hill Ward. Farquhar Road (Nos. 1, 3, 7 and 9, upper basements only), Gipsy Hill (No. 24, basement back and back additions rooms only, represented 1936), Knight's Hill (No. 111). (viii) Houses Represented, but Orders not vet made. Bolwell Street (No. 22), Holyoak Road (No. 7), Kennington Lane (No. 186) ; Branksome Road (No. 3) ; Crozier Street (No. 11), Newnham Terrace (No. 1) ; Gipsy Hill (No. 26) ; Guildford Road (No. 38), Paradise Road (Nos. 64 and 82), Wandsworth Road (No. 62) ; Knatchbull Road (No. 73), Wynne Road (No. 2) ; Medwin Street (No. 7) ; Richborne Terrace (No. 100) ; Somerleyton Road (No. 45) ; Upper Tulse Hill (No. 112). In addition to the premises represented in (a) and (b), 184 others were inspected, with a view to action under the Housing Acts. 72 Ministry of Health Table. 1—Inspection of Dwelling-Houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 10,923 (6) Number of Inspections made for the purpose* 36,206 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations 19 (6) Number of Inspections made for the purpose* 172 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 118 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 ... 4,081 3—Action under Statutory Powers during the Year. A.—Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 12 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 18 (6) By Local Authority in default of owners 1 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 331 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 271 (b) By Local Authority in default of owners 6 * Total re-inspections during 1937. 73 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 D.—Proceedings under Section 12 of the Housing Act, 1936. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 61 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 14 Abatement of Overcrowding. The appointed day on which the provisions of Part IV Housing Act, 1936, came into force was 1st July, 1937. A.—Number of Dwellings Overcrowded at end of 1937 3,162 Number of families dwelling therein 3,162 Number of persons dwelling therein 16,161 B.—Number of New Cases of Overcrowding Reported During the Year :— 268 cases—1,337 persons concerned. C.—(1) Number of Cases of Overcrowding Relieved During the Year :— County Council 126 881 Borough Council 27 Otherwise relieved 728 (2) Number of Persons Concerned in such Cases :— County Council 618 4,391 J Borough Council 168 Otherwise 3,605 D.—Particulars of any cases in which Dwelling-houses have become Overcrowded after the L.A. have taken steps for the abatement of overcrowding 1 74 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. A family were rehoused by the County Council from two rooms which were subsequently let by the owner who had been warned to be careful when reletting not to allow overcrowding to occur again. The new tenants consisted of a man, wife and one childSome time later three other children who had been staying elsewhere rejoined the family and the permitted number of 3 for the letting was exceeded by 2½ units. The owner's attention was directed to the re-overcrowding and an explanation asked, when it transpired that the tenant had given false information of the number in his family. Proceedings were taken by the owner and an order for possession obtained, but not before the tenant had written a letter of complaint to the Prime Minister. Six cases were reported where overcrowding had been caused after the appointed day (1st July, 1937). Overcrowding has been abated in five cases out of the six by the action of the owner in each case after his attention had been called informally to the circumstances. Rehousing (Abatement of Overcrowding—Housing Act, 1936). During the year, 484 cases of overcrowding were referred to the County Authority with a view to the provision of suitable alternative accommodation. The total number of cases submitted in this way since the beginning of 1936 is 988. 113 families were rehoused during the year, and the total number of cases rehoused by the County Authority in connexion with the abatement of overcrowding is 283. 75 Rehousing other than overcrowded cases. During the year 285 fresh applications for housing accommodation were received in the Public Health Department (mostly from the applicant in person), and of these 55 were sent forward to the county authority for attention or preferential treatment, while in addition, 56 applications were recommended for housing on the Lambeth Council Estates. The remaining 174 after careful scrutiny, could not be recommended for various reasons, such as insufficient income or other circumstances. Of the 111 cases referred to, 19 have been accommodated (10 by L.C.C. and 9 by L.B.C.) leaving 92 pending decision and allocation. The following table shows particulars of the 285 applications received. Housing Applications, 1937. Number of Persons in Family Number of Rooms Occupied Total Persons 1 2 3 4 5 6 1 1 — — — — — 1 2 1 27 1 — — — 58 3 1 59 17 8 — — 255 4 — 44 23 12 — — 316 5 — 10 33 9 1 — 265 6 — — 13 7 1 — 126 7 — — 3 5 1 — 63 8 — — — 4 1 — 40 9 — — — 2 — — 18 10 _— — — — — 1 10 11 _— — — — — — — 12 3 — — — — — — Total Families 285 3 140 90 47 4 1 Total Persons — — — — — — 1,152 76 INSPECTION & SUPERVISION OF FOOD. (a) Milk Supply. 53 applications were approved by the Borough Council for registration under the Milk and Dairies Order, 1926. 34 of the applications were change of purveyor at registered premises, 41 were for the sale of milk in sealed bottles only. Special licences were issued in accordance with the Milk (Special Designations) Order, 1936, as follows :— Tuberculin Tested, 27 ; " Pasteurised " Milk, 34 (Pasteuriser's Licence 1, Dealer's Licence 33) (60 premises) ; Supplementary Licences, 13; Tuberculin Tested (Pasteurised), 3. (b) Meat and Other Foods. (a) Public Health (Meat) Regulations, 1924. (1) Number of "visits paid to slaughterhouses 112 (2) Number of "visits paid to meat shops, meat stalls, and meat stores 987 (3) Number of actual slaughterings at which one or other of the food inspectors was present, consisting of sheep (494), pigs (221), and calves (13) 728 (4) Carcases, or portions of carcases, condemned 14 * Visits include re-visits also. Carcases Inspected and Condemned (excluding) cows) Cows Calves Sheep and lambs Pigs[/### Number killed — — 13 494 221 Number inspected — — 13 494 221 All diseases, except tuberculosis — — — — — Tuberculosis only (whole — — — — — cases condemned) — — — — — Carcases, of which some part or — — — — — organ was condemned — — — — 14 Percentage of number inspected — — — — 6.3 affected with tuberculosis — — — — 77 In addition to the above-mentioned carcases or parts of carcases the following unsound food was condemned and destroyed :— Fish— tons cwts. qrs. lbs. Dogfish 0 0 0 18½ Cod 0 1 0 0 Kippers 0 0 2 0 Cod Roe 0 0 2 2 Skate 0 0 1 0 Haddocks (dried) 0 0 1 0 Herrings (½-case) — — — — Prawns (tinned), 1 tin — — — — Roes (3 boxes) — — — — Fruit and Vegetables— Tomatoes (6 boats) 0 1 0 20 Poultry— Ducks 0 0 3 21* Fowls 0 3 0 14 Goose (1) 0 0 0 Hi Turkeys 0 3 1 21* Go me— Rabbits 0 10 1 24 Meat and other products— Bacon 0 0 3 2 Beef 0 1 1 26 Ham 0 2 0 18 Ham, Tinned (7 tins) 0 0 2 26 Pork 0 6 1 12 Other food— Loganberries (24 tins) — — — — Eggs (52) — — — — (c) Adulteration, etc. During the year under review 2,000 samples of food and drugs were submitted to the Public Analyst: of these 800 including milk, vinegar, butter, ice cream, skimmed condensed milk, Gregory's powder, minced beef and spirits were taken with the formalities prescribed by the Act. The remaining 1,200 samples were procured informally and consisted of a large variety of foods and a selection of drugs. 78 14 formal samples (1 of Gregory's powder and 13 of milk) or 1.75 per cent, of the number taken were reported by the Public Analyst to be adulterated. 776 samples of milk were procured from various sources as set out in the following table :— From retailers 594 On delivery to retailers 20 „ ,, ,, schools 24 ,, ,, ,, hospitals and institutions 96 At railway stations 42 Of the 594 samples of milk procured from retailers 490 were taken during the day time and 10 or 2.0 per cent. were found to be adulterated or not up to standard. 104 samples were obtained from roundsmen in the early morning and of these 3 or 2.9 per cent. were adulterated or below the legal standard. Warning Letters. The number of formal samples found to be adulterated was 14. Legal proceedings were instituted in one case, 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 an offence against the Food and Drugs Act:— Care No. 241 For selling milk deficient in fat to Summons dismissed on pay- the extent of 34 per cent. ment of £1 1s. costs Inspection of Food Premises. During the year all 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. 79 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, 39 premises were inspected and added to the ice-cream register. The total number of premises now registered is 407. 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 332, of which many come within the scope of the Public Health (Meat) Regulations, 1924, and are consequently inspected with the shops at which meat is sold. The special inspection of these premises for which applications for registration have been received has added considerably to the work of the Department. 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 344 Milkshops 1,131 Ice cream premises 1,222 Restaurants, etc 460 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. 80 Merchandise Marks Act, I926. Orders made under the above-mentioned Act are in force requiring the labelling with an indication of origin of the following foodstuffs:— Apples, bacon and ham, butter, currants, eggs, honey, maize, starch, meat, oat products, poultry, raisins, salmon and trout, salt, sultanas and tomatoes. The administration of the above-mentioned orders with the exception of the order relating to meat is carried out jointly by the district inspectors and the food inspectors. When the marking of imported produce was introduced, there was reluctance on the part of some shopkeepers and stallholders to carry out their obligations. Constant supervision and explanation of the orders to traders have resulted in a considerable improvement. 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. (Part II—Poisons.) In accordance with the provisions of the above-mentioned Act, 186 names of persons have been placed by the Council on the List of Sellers of Part II Poisons. The majority of these poisons sold are materials used for domestic purposes, such as hydrochloric acid (spirits of salts), caustic substances, carbolic disinfectants and ammonia solution which are dangerous to handle, and are therefore subject to certain restrictions when exposed for sale. The premises of listed sellers are visited periodically, and the stock of poisons is inspected. When it is found that the provisions of the Act and Poisons Rules are not observed by the seller, the matter is discussed with him and he is advised as to goods he is allowed to sell and the manner in which such goods must be labelled and sold. Two samples were submitted to the Public Analyst with a view to ascertaining their nature. The first, of disinfecting fluid, was 81 found not to contain a scheduled poison, and was therefore exempt from control. The second sample, of carbolic oil, proved to be a poison, and the attention of the seller was drawn to the fact that it had been sold in a manner contrary to the Poisons Rules. Chemical and Bacteriological Examination of Food Particulars of the 2,000 samples of Food and Drugs procured for analysis by the Public Analyst will be found in the following table. Samples Formal Informal f Number Analysed i Number Adulterated Number Analysed Number Adulterated Aerated Waters — — 3 — Almonds, Ground — — 3 — Apples — — 3 — Arrowroot — — 6 — Baking Powder — — 3 — Barley, Pearl — — 6 — Bread — — 21 — Butter 54 — 212 — Cakes, Sponge — — 21 — Candied Peel — — 3 — Cheese — — 8 — Cheese, Wrapped — — 1 — Cocoa — — 24 — Coffee — — 23 — Coffee and Chicory — — 1 —— Coffee and Chicory Extract — — 9 — Confectionery — — 24 — Cooking Fat — — 2 — Cornflour — — 9 — Cream — — 8 — Cream, Tinned — — 9 — Custard Powder — — 12 — Dripping — — 23 1 Drugs :— Acid, Boric — — 3 1 Acid, Citric — — 3 — Aspirin — — 6 — Borax — — 3 — Camphorated Oil — — 9 — Castor Oil — — 6 Cod Liver Oil — — 9 — Cream of Tartar — — 9 — Emulsion, Cod Liver Oil — — 3 — f 82 Food and Drugs.—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Drugs—continued. Epsom Salts — — 12 — Eucalyptus Oil — — 6 — Glauber's Salts — — 9 — Glycerine — — 6 — Gregory's Powder 1 1 3 1 Iodine, Paint — — 1 — Magnesia — — 6 — Ointment, Boric — — 6 — Ointment, Mercury — — 3 — Ointment, Zinc — — 3 — Paraffin, Liquid — — 6 — Petroleum Jelly — — 4 — Powder, Liquorice, Compound — — 9 — Powder, Sejdlitz — — 3 2 Powder, Soothing — — 2 — Soda bicarbonate — — 9 — Sulphur, Flowers of — — 3 — Sweet Spirit of Nitre — — 3 1 Tincture of Arnica — — 3 — Tincture of Iodine — — 6 1 Do. of Quinine (Ammon). — — 3 — Tincture of Rhubarb — — 3 — Vaseline — — 2 — Essence, Colouring — — 2 — Essence, Flavouring — — 4 — Fat, Edible (for Ices) — — 1 — Fish Paste — — 9 — Fish, Tinned — — 12 — Flour — — 21 — Flour, Self-raising — — 21 — Fruit, Canned — — 3 — Fruit, Dried — — 39 — Ginger, Ground — — 6 — Herbs, Dried — — 3 — Honey — — 3 — Ice Cream 8 — — — Jam and Marmalade — — 3 — Jelly, Table — — 9 — Lard — — 54 — Lemonade Powder — — 6 4 Lemon, Curd — — 3 — Margarine — — 31 — Meat, Minced 1 — 15 2 Meat Pie — — 9 - Meat, Potted — — 3 \ — 83 Food and Drags.—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Milk 719 13 57 1 Milk Condensed Full Cream — — 15 — Milk, Condensed (Machine Skimmed) 1 — 10 — Mincemeat — — 9 — Mustard — — 6 — Mustard Compound — — 9 — Oatmeal — — 9 — Olive Oil — — 3 — Peaflour — — 3 — Pepper — — 15 — Pepper, Cayenne — ' — 3 — Pickles — — 6 — Pudding Powder — — 3 — Rice — — 21 Rice, Ground — — 7 — Sago — — 3 — Sauce — — 12 — Sausages — — 7 2 Sausage Rolls — — 3 — Scones — — 3 Soup Powder — — 3 — Soup, Tinned — — 3 — Spice, Mixed — — 12 — Spirits '— Brandy 2 — — — Gin 2 — — — Rum 2 — — — Whisky 2 — — Suet, Shredded — — 9 — Sugar — — 18 — Syrup, Golden — — 11 — Tapioca — — 24 — Tea — — 39 1 Vegetables, Tinned — — 6 — Vinegar 8 — — — Wheat Preparations — — 6 — Wine, Red — — 3 — Yeast — 9 — Totals 800 14 1,200 17 N.B.—1 summons was issued (see page 78 84 Bacteriological Examinations. Twenty-seven samples of milk and one of cooked meat were submitted for bacteriological examination. Of the samples of milk, 5 were procured from an institution, 2 from schools, and the remaining 20 from vendors throughout the borough. In most cases the samples were taken after bottling and before delivery to the consumer, thus insuring control, not only over the milk as delivered by the wholesaler, but also over the cleanliness of the apparatus and general methods of distribution by the retailer. The reports of the bacteriologist upon the 26 milks submitted show that the number of bacteria present ranged from 1,000 per c.c. to 80,000 per c.c., the average count being under 11,000 per c.c. Although the majority of the samples taken were of pasteurised milk, the greater number were not sold under the designation "Pasteurised" : the maximum number of organisms permissible in 1 c.c. of pasteurised milk is 100,000, and it will be noted that in every case a satisfactory standard of cleanliness was attained. Nutrition. No steps have been taken to increase the knowledge of the general public on the subject by means of lectures, films, etc., but talks are regularly given to the mothers attending all the welfare centres upon the marketing and preparation of food, and, of course, in the individual homes by the health visitors. The borough council co-operated to the fullest extent with the Central Council for Health Education in the national health campaign planned by the Minister of Health and the President of the Board of Education. Arrangements were made to display the posters on the council's notice boards throughout the borough and at the welfare centres, libraries, and other premises belonging to the council. Many thousands of leaflets were distributed and advantage taken to impress the importance of the campaign upon families in their homes through the health visitors. A handbook was also issued upon the health services in Lambeth and arrangements made for the distribution of 50,000 copies. 85 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 1,990 cases of infectious diseases (excluding tuberculosis) were reported during the year. This number is less than the number (5,389) reported in the previous year, a large proportion of which was attributable to measles. 86 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 533 1.95 4 .750 485 90.99 493 1056.5 Diphtheria 507 1.85 20 3.944 505 99.60 471 732.3 Membranous Croup — — — — — — — 2.9 Typhus — — — — — — — — Enteric 10 0.04 1 1000 9 90.00 10 18.4 Relapsing Fever — — — — — — — — Erysipelas 113 0.41 3 2.65 71 62.83 113 123.2 Puerperal Fever 20 0.07 5 25.00 14 70.00 20 28.7 Puerperal Pyrexia 50 0.18 — — 12 24.00 49 48.8 Plague — — — — — — — — Cerebro-Spinal Fever 8 0.03 5 62.50 8 100.00 8 6.3 Polio-myelitis 6 0.02 — — 6 100.00 6 5.4 Ophthalmia Neonatorum 55 0.20 — — 5 9.90 54 56.2 Measles 283 1.03 1 .35 86 30.38 257 2532.6 German Measles 82 0.29 — — 15 18.29 75 425.1 Tuberculosis— Pulmonary (primary) 377 1.38 208 — — — — 507.6 Non-pulmonary (primary) 81 0.29 31 — — — — 104.3 Malaria 6 0.02 — — 6 100.00 6 6.2 Dysentery 19 0.07 — — 9 47.36 15 1.3 Primary Pneumonia (Acute) 144 0.52 41 28.46 71 49.30 144 228.2 Influenral Pneumonia (Acute) 139 0.51 14 10.07 17 12.23 137 123.0 *Encephalitis Lethargica — — 6 — — — — 11.1 Trench Fever — — — — — — — — Anthrax — — — — — — — 0.2 {Food Poisoning 15 0.05 — — 1 6.66 15 — * Deaths from Post Encephalitis Lethargica. ‡ Compulsorily notifiable from September, 1932. N.B.—Of the cases originally notified during 1937, the following were found afterwards not to be suffering from the diseases notified :—Diphtheria, 68 ; Scarlet Fever, 34 ; Measles, 2 ; German Measles, 1. 00 vj Table Distribution of Cases Notified During the Year 1937. Notifiable disease Number of cases notified 1 total cases notified in each Registration Sub-District Total cases removed to hospital At all Ages At ages—years 65 and upwards Lambeth North Princes Lambeth Central Lambeth South Lambeth North Princes Lambeth Central Lambeth South Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — Diphtheria 507 8 25 43 46 37 206 70 30 31 7 4 — 77 48 229 153 77 48 228 152 Membranous Croup — — — — — — — — — — — — — — — — — — — — Erysipelas 113 2 1 3 — — 2 5 7 14 11 48 20 12 7 49 45 10 5 31 25 Scarlet Fever 533 5 25 38 49 37 221 66 25 53 9 5 — 76 37 203 217 74 37 193 181 Typhus Fever — — — — — — — — — — — — — — — — — — — — Enteric Fever 10 1 — — — — 1 — 1 6 — 1 — 1 1 2 6 1 1 2 5 Relapsing Fever — — — — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 20 — — — — — — — — 15 5 — — — 2 5 13 — 1 4 9 Puerperal Pyrexia 50 — — — — — — — 3 37 9 1 — 8 3 15 24 1 2 2 7 Plague — — — — — — — — — — — — — — — — — — — — — Pulmonary Tuberculosis 377 — — 2 1 1 6 9 39 153 64 88 14 38 33 142 164 — — — — Other forms of Tuberculosis 81 3 2 5 2 1 7 17 4 25 6 8 1 2 9 30 40 — — — — Cerebro-spinal Fever 8 3 — — — — — — — 4 1 — — 1 — 6 1 1 — 6 1 Polio-myelitis 6 — 1 1 1 — 2 1 — — — — — — 1 1 4 — 1 1 4 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 55 55 — — — — — — — — — — — 15 5 27 8 1 — 2 2 Measles 283 28 19 31 56 49 79 7 6 7 — 1 — 41 15 157 70 14 7 45 20 German Measles 82 11 11 8 7 3 23 9 6 3 1 — — 15 6 29 32 3 2 3 7 Malaria 6 — — — — — — — 1 2 3 — — 1 — 2 3 1 — 2 3 Anthrax — — — — — — — — — — — — — — — — — — — — Primary Pneumonia (Acute) 144 12 10 5 8 5 13 8 10 17 16 31 9 21 5 79 39 14 3 31 23 Influenzal ,,, (Acute) 139 4 5 3 2 3 12 6 6 23 12 41 23 27 14 49 49 5 2 3 7 Dysentery 19 — 1 2 2 4 2 1 1 4 — 1 1 2 — 4 13 1 — 3 5 Food Poisoning 15 — — — 1 — — — 1 — 5 5 3 2 4 3 6 — — 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 ^^^treate^^^l^sua^jotifiablynfectiou^disease^an^^Vhoopinfi^oueh^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ 88 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 three quarters ended 30th September, 1937. 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 77 2 79 1 21 Norwood Schools Dr. E. L. Smallwood 7 30 37 — — Lambeth Church District Dr. M. I. Elliot 146 7 153 — 18 Kennington do. Dr. R. Phillips 135 15 150 11 1 Stockwell do. Dr. H. P. Orchard 272 13 285 12 9 Brixton do. Dr. E. L. M. Rusby 270 17 287 13 8 Norwood do. Dr. E. L. Smallwood 190 15 205 55 10 Totals 1,097 99 1,196 92 67 89 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 Publc Vaccinators during the December quarter, 1937. 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 14 — 14 — — Norwood Schools Dr. H. P. Orchard 2 13 15 — — Lambeth North District Dr. R. Phillips 74 12 86 9 3 Princes do. Dr. M. I. Elliot 85 4 89 — 3 Lambeth Central do. Dr. E.L. M. Rusby 99 5 104 4 1 Lambeth South do. Dr. II. P. Orchard 124 5 129 4 — Totals 398 39 437 17 7 90 Vaccination. One of the three vaccination officers who was also registrar of births and deaths tendered his resignation to the Council early in June, and shortly after one of the five public vaccinators also resigned. The public vaccinators' districts were not coterminous with those of the vaccination officers nor with the four registration districts into which the borough is divided. The dual post of vaccination officer and registrar of births and deaths was unsatisfactory, seeing that part of the duties were performed under the supervision of the town clerk and the remainder under that of the medical officer of health. Advantage was therefore taken of the two resignations to reorganise the whole of the administrative arrangements for vaccination and with the approval of the Minister of Health, two new appointments of vaccination officers were made to replace the remaining two transferred officers from the late Board of Guardians, and the districts of the four remaining public vaccinators so altered that one vaccination officer should serve two public vaccinators. The redistribution of areas and duties has replaced an awkward and unsatisfactory contusion by a simple workable scheme. 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. There were 94 more cases of diphtheria notified than in the previous year and the incidence per 1,000 population rose from 1.48 to 1.85 in 1937. The case mortality was also raised from 3.63 per cent. to 3.94 per cent. The two diphtheria prevention clinics were considerably better attended than in the previous year but the number immunised is 91 still far too small to affect to an appreciable extent the incidence among the population. In the closed communities like the residential schools, however, diphtheria has now been conspicuous by its entire absence for several years with the one exception, D.H. mentioned later on. In view of the greater efficiency of alum precipitated toxoid compared with toxoid antitoxin mixture shown in the annual report of 1936, both clinics now use the former almost exclusively. The following cases are recorded who, after immunisation, were admitted to hospital suffering from diphtheria. R.P., male, aged 7 years. Admitted in June three days after the onset with the diagnosis of modified diphtheria in a partially immune subject. The condition was resolving naturally but after serum the throat was clear in 24 hours. The child was immunised in 1931 and the retest was negative in August, 1931, when he was under 2. C.B., female, aged 3 1/12 years, admitted with notification of diphtheria. The diagnosis was altered to tonsillitis as cultures were negative with no clinical signs of diphtheria. Immunisation had been completed and the retest was negative two months before. D.H., female, aged 16 years, a typical case who cleared up within 24 hours after 40,000 units of anti-diphtheria serum had been given intravenously. She had been schick tested nine years previously and found then to be immune. Ten days after the administration of the serum a virulence test of the organisms proved positive and a week later she suffered from an attack of tonsillitis and 20,000 more units of serum were given. J.M., male, aged 8 years, admitted with the diagnosis "a mild case of genuine diphtheria." The attack cleared up rapidly with serum treatment. The child had been immunised and on retest was negative two months only before admission to hospital. These four cases are examples of the possibilities now generally realised which may occur in those who have been treated and are believed to be immune. 92 Diphtheria Prevention—1937. Statistics for the year ended 31st December, 1937. *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 19 145 60 220 38 17 499 First Test Tested Positive 19 140 55 177 27 8 426 Negative - 5 5 42 10 7 69 Only - - - 1 1 2 4 Test Tested Positive - - - - - - - Negative 6 98 43 161 21 4 333 Only 1 6 2 2 1 - 12 Total Attendances 2,049. *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 5 62 16 119 17 19 238 First Test Tested Positive 4 59 13 85 13 10 184 Negative 1 3 2 33 4 9 52 Only - - 1 1 - - 2 ReTest Tested Positive - - - - - - - Negative 1 45 8 69 20 9 155 Only - 2 1 1 - 1 5 Total Attendances 1,113 Borough.—Total cases = 737, of whom 610 = 82.77 per cent. were positive and 121 = 16.42 per cent. negative, while 6 had been tested only, not yet having begun the course of immunisation. Total attendances = 3,162. Average attendance per week = (49 weeks) 64.53. Average attendance per session = (97 sessions) 32.26. *A commenced May 8th, 1928, and B commenced July 18th, 1928. 93 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 1937, 55 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 55 49 6 55 - - - Sonne Dysentery. In the early autumn a number of cases of diarrhoea enteritis or dysentery were reported and it became clear that an outbreak of a mild form of dysentery was in progress. From a few cases here and there the Sonne bacillus was recovered from the faeces, but the number constituted a small fraction of those who suffered with like symptoms of varying degrees of severity with no bacteriological confirmation. Among the staff of one large hospital from three cases only the bacillus was recovered, fifteen others were off duty for short periods, many others reported sick but carried on, while a still larger number were suspected of having had mild symptoms but did not report sick. The picture of the hospital epidemic seemed to describe more or less what was happening among the general population among whom occasional cases are still occurring. It may be interpolated that bacteriological confirmation is by no means easy and failure is frequent, so that a negative report is of 94 little value in diagnosis. The ages of the confirmed cases varied from 2 years to 66 years and the sick generally were drawn from all classes. The common means of dissemination of diseases of this nature is through consuming infected food, and the standard of crude personal hygiene of all engaged in handling food, whether in restaurant, shop or home, would appear to be far below what should be reasonably expected nowadays with soap and water readily available everywhere for washing hands. Contacts, Suspects, etc. The Medical Officer of Health was called in consultation by medical practitioners to see 10 patients in their homes during the year. Municipal Bacteriological Laboratory. The subjoined table shows in some detail the nature of the work carried out at the laboratory, which is equipped for practically all routine and special examinations except those which entail the use of living animals. All examinations of samples submitted are carried out free of charge and the necessary outfits for taking the specimens are also supplied free on demand as required. Among the miscellaneous samples are specimens of various body fluids, pathogenic discharges, etc., as well as samples of food suspected of containing various food poisoning organisms. 95 The proportion of specimens found to be positive out of all those submitted was 13.5 per cent. (in the previous year, 12.6 per cent). Nature of Specimen Result of Examination Total Negative Positive Swabs from nose and throat of suspected cases or carriers of diphtheria 1,768 244 2,012 Sputa from cases suspected of or suffering from pulmonary tuberculosis 860 153 1,013 Blood for Widal reaction and/or examination for presence of— B. Typhosus B. Paratyphosus A, B, and C 13 2 15 B. Abortus Miscellaneous 78 26 104 Totals 2,719 425 3,144 During 1937, 22 vials of antitoxin were distributed free of cost under the Antitoxin Order, 1910. Disinfecting Department, 1937. Details of work done in connexion 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 (174), chicken-pox (806), cancer (62), whooping cough (586), mumps (784), and others (scabies, ringworm, etc.), not classified (827); 703 verminous houses (1,155 rooms) and verminous articles, bedding (845), and clothing (989), were also treated. 96 Summary of work carried out by the Disinfecting Department during 1937. Cleansing notices served 958 Total no. of rooms disinfected by the council 3,620 * do. articles do. 10,542 Cases in which bedding was disinfected at home 1,092 do. do. do. at chamber 1,586 Premises disinfected and disinfectants supplied 20,341 Certificates of medical practitioners received in lieu of disinfection by the council 1 Schools disinfected (9 rooms) 5 Certificates of disinfection left with occupiers of disinfected premises 1,031 Library books disinfected 456 Mattresses re-tabbed by council 399 Tuberculosis Dispensaries— Shelters lent and erected 1 Shelters dismantled and removed - Bedsteads and mattresses delivered 12 Bedsteads and mattresses collected 14 Bacteriological outfits (swabs, etc.), delivered 2,545 Smoke machines collected and delivered 242 Cabs, etc., disinfected 8 Maternity parcels sterilised 58 1 family (61 articles) for Church Army. * Including 11 families (677 articles) for Lambeth Borough Council (Hemans Street Area). Eradication of Bed-bugs. (1) The number of houses found to be verminous and disinfested during the year was:— Council houses, 5; other houses, 698. (2) The method employed for disinfesting verminous rooms is to strip the wall paper, to loosen architraves, skirtings and picture rails, and to apply a blowlamp to the back of the removed mouldings and to the walls where they were fixed. The room is then thoroughly 97 sprayed with "Slatford." All bedding is taken away and treated in the steam disinfector. After fumigation holes are filled and the walls distempered or lime washed and the repapering left until all signs of infestation have disappeared. Recently "Keritox" has been used without the preliminary removal of mouldings with good effect. (3) When families are removed from verminous houses in clearance areas their goods are all treated with hydrogen cyanide in a pantechnicon under the careful supervision of a sanitary inspector, with the exception of the bedding, which is treated in a steam disinfector. (4) The cyanide part of the process is carried out by contractors. (5) After disinfestation occupiers are warned to be on the look out to prevent reinfestation. Tuberculosis. The numbers of cases of tuberculosis on the Lambeth register of notifications on December 31st, 1937, were as follows:- Males Females Totals Pulmonary 1,061 891 1,952 Non-pulmonary 181 137 318 Totals 1,242 1,028 2,270 98 TABLE L. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications received during the period from January 1st, 1937, to December 31st, 1937. 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 - 3 3 5 14 2 51 39 5 27 12 221 318 Females 1 3 4 25 5 45 25 9 7 2 156 209 Non-Pulmonary- Males 1 8 3 9 2 6 10 2 3 1 - 45 48 Females 2 2 4 8 2 2 7 4 2 2 1 36 40 * Re-notifications (Form A) = 150 (males 97, females 53) pulmonary, and 7 (males 3, females 4) non-pulmonary. Pulmonary—78 private, 183 hospitals, 116 dispensaries = 377 total primary notifications. Non-pulmonary—6 private, 66 hospitals, 9 dispensaries = 81 total primary notifications Institutional treatment. Notifications were also received during the period stated above respecting 548 pulmonary and 22 non-pulmonary admissions, and 415 pulmonary and 34 non-pulmonary discharges. 99 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, 1937 to the 31st December, 1937, otherwise than by formal notification. 1.-Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total cases Pulmonary— Males - - 1 2 5 5 2 3 3 2 23 Females - - 1 2 3 6 1 2 - 15 Non-Pulmonary— Males - 1 1 - - - - 2 Females - - 1 - 1 2 1 1 1 - 7 2.—Source of Information. Pulmonary NonPulmonary Death Returns from local Registrars 5 1 transferable from R.G.O. 2 - Posthumous notifications 2 - "Transfers" from other areas 29 8 Other Sources - - Totals 38 9 The ratio of deaths of previously notified cases of tuberculosis to deaths due to tuberculosis not notified during life is 23 to 1 in the year under review. 100 TABLE L (2). Public Health (Tuberculosis) Regulations, 1930. Summary of notification certificates, etc., received during the period from January 1st, 1937, to December 31st, 1937. 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 38 58 27 21 9 5 3 3 3 - Princes 33 50 42 30 9 9 1 - 5 - Lambeth Central 142 205 217 154 30 31 5 11 18 1 Lambeth South 164 214 262 210 40 43 13 20 12 8 Borough of Lambeth 377 527 548 415 81 88 22 34 38 9 101 Deaths from Tuberculosis. Age Periods 0 1 5 10 15 20 25 35 45 55 65 and upwards Total Pulmonary- Males - - - - 5 5 2 8 31 25 31 7 132 Females - - - 1 10 17 24 11 4 5 4 76 Non-pulmonary- Males 1 5 - 2 2 1 1 2 2 - 1 17 Females 2 2 2 1 - 1 2 1 1 2 - 14 Totals 3 7 2 4 17 24 55 45 32 38 12 239 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 33 4 37 1.01 1.14 Princes 18 4 22 0.75 0.91 Lambeth Central 84 6 90 0.88 0.94 Lambeth South 73 17 90 0.59 0.73 Borough of Lambeth 208 31 239 0.75 0.87 G* 102 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 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 1937 0.76 0.87 1.38 1.67 103 Lampeth 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 connexion with the Central Dispensary for the Year 1937. 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 93 60 1 2 7 11 7 2 100 71 8 4 495 (b) Diagnosis not completed - - - - - - - - 29 35 5 3 (c) Non-tuberculous - - - - - - - - 117 89 22 12 B.—Contacts examined during the year:— (a) Definitely tuberculous 14 21 8 2 - - 1 2 14 21 9 4 565 (b) Diagnosis not completed - - - - - - - - 21 44 ?4 11 (c) Non-tuberculous - - - - - - - - 74 162 98 83 C.—Cases written off the Dispensary Register as:— (a) Recovered 1 2 1 - 1 2 - - 2 4 1 - 695 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) - - - - - - - - 199 271 121 97 D.— Number of Cases on Dispensary Register on December 31st, 1937: (a) Definitely tuberculous 341 321 48 63 58 61 53 43 399 382 101 106 1079 (b) Diagnosis not completed - - - - - - - - 26 42 15 8 1. Number of cases on Dispensary Register on January 1st, 1937 933 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 44 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 145 4. Cases written off during the year as dead (all causes) 118 5. Number of attendances at the Dispensary (including Contacts) 4,338 6. Number of Insured Persons under Domiciliary Treatment on December 31st 446 7. Number of consultations with medical practitioners:- (а) Personal 211 (b) Other 1,438 8. Number of visits by Tuberculosis Officer to Homes (including personal consultations) 702 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,596 10. Number of— (a) Specimens of Sputum, etc., examined 626 (b) X-Ray Examinations made in connexion with Dispensary work 719 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (6) above 3 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 426 104 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 connexion with the Branch Dispensary for the Year 1937. 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 34 - - 8 3 4 1 60 37 4 1 347 (b) Diagnosis not completed - - - - - - - - 11 13 2 2 (c) Non-tuberculous - - - - - - - - 91 90 19 17 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 2 - - - - - - 1 2 - - 258 (b) Diagnosis not completed - - - - - - - - 1 3 3 1 (c) Non-tuberculous - - - - - - - — 75 96 37 39 C.—Cases written off the Dispensary Register as:- (a) Recovered 5 2 - - - 4 1 2 5 6 1 2 483 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) - - - - - - - - 168 187 57 57 D.—Number ot Cases on Dispensary Register on December 31st, 1937: (a) Definitely tuberculous 226 137 4 8 14 11 16 14 240 148 20 22 482 (b) Diagnosis not completed - - - - - - - - 23 19 8 2 1. Number of cases on Dispensary Register on January 1st, 1937 517 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 7 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 62 4. Cases written off during the year as dead (all causes) 102 5. Number of attendances at the Dispensary (including Contacts) 2,266 6. Number of Insured Persons under Domiciliary Treatment on December 31st 151 7. Number of consultations with medical practitioners:— (a) Personal 16 (b) Other 796 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 201 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,801 10. Number of— (a) Specimens of Sputum, etc., examined 660 (b) X-Ray Examinations made in connexion with Dispensary work 684 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 239 105 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 connexion with the Lambeth Mortuary:— Wanless Road, S.E. 24 1936 1937 Bodies received 39 (M. 23, F. 16) 60 (M. 35, F. 25) Post-mortem examinations conducted 39 59 Coroner : A. Douglas Cowburn, Esq. 106 Appendix A. Extract from the Minutes of the Council, 28th January, 1937. Children under School Age: Ministry of Health Circular No. 1550. A letter, dated the 28th October last, has been received from the Secretary of the Ministry of Health, expressing the Minister's satisfaction with the Council's proposals to extend the scope of their existing arrangements for child welfare (Minutes 1935-6, page 1015). Regarding the Council's representation as to the removal of the general restriction upon the supply of milk to toddlers between the ages of three and five years, except in special circumstances, the Minister calls attention to his circular No. 1072, dated the 12th February, 1930, under which it is competent for the Council to extend their arrangements for the supply of milk to expectant and nursing mothers, and to children under the age of five who are not being educated in schools recognised by the Board of Education, in such a manner as they think desirable without any further approval on the part of the Minister. The Council's further representation as to the supply of milk to maternity and child welfare authorities at reduced prices is, it is stated, being considered by the Ministry. The Minister awaits the result of the Council's consideration of extending existing arrangements with regard to (a) the establishment of additional day nurseries, (b) convalescent home treatment, and (c) the treatment of minor ailments. The matters referred to in (a) and (b) are still receiving our attention and we shall submit reports thereon to the Council in due course. With regard to (c)—the treatment of minor ailments—we have had before us at our present meeting the following report from the Medical Officer of Health:— Report. The Medical Officer of Health has after much unavoidable delay and several interviews obtained the opinions of the voluntary hospitals in the district upon the question of the provision of treatment for toddlers with 107 minor ailments referred to them from the toddlers' clinics already authorised by the Council. As the Council are aware these clinics have not yet been started as it is clearly futile to do so until arrangements for treatment have been completed. In obtaining the views of the respective voluntary hospitals management committees, it will be appreciated that no data are available regarding numbers, and every hospital has therefore been approached in so far as financial considerations are concerned on the premise that any agreement must be of a temporary character and that payment must be on a per capita basis. It was pointed out to the hospitals that they are in all probability treating as out-patients without payment a number of cases which when the scheme is in force would be sent through a toddlers' clinic, and on the other hand some cases which would otherwise go to the hospital might well be dealt with at the welfare centres. Clearly therefore the voluntary hospitals could not expect that the full charges for every case would be met by the Council. The hospitals are, however, anxious to assist the local authority to the utmost, and are prepared to carry out minor ailment treatment for each case however many attendances of the individual are required at the rate of 6s. 6d. each per annum. For this sum cases referred will received priority treatment, if individual appointments are not made, with the object of reducing to a minimum any period of waiting which may be unavoidable. There is likely to be a difficulty in connexion with dental work as the necessity for conservative treatment has been regardedas of prime importance, and if arrangements are insufficiently elastic to cope with demands it may be necessary for the welfare centres to increase the number of dental sessions or to inaugurate new dental clinics in some of those welfare centres where none now exists. For eye cases, parents will be expected to pay for the spectacles, while the refraction and any treatment will, of course, be covered by the 6s. 6d. In so far as administration is concerned, the following brief outline will serve to indicate how the scheme will work if put into operation. The parents of a child found to require minor ailment treatment at a toddlers' clinic will be given the choice of any of the four voluntary hospitals in the scheme. Whichever is chosen the parent will be given a card of introduction to that hospital by the doctor in charge of the toddlers' clinic on which the name and address of the child will be inserted, the medical condition for which the child is referred, and the time to attend the hospital clinic. The hospital will retain the card as a voucher in support of its account. A list will also be made of all cases referred to each hospital by the welfare centre in order that defaulters may be traced and followed up by the health visitor. It is impossible to pretend that any estimate of probable expenditure can be put forward. The Council should bear in mind that minor ailment treatment only is being arranged, the bulk of which will be for teeth, ears, eyes, and for some orthopaedic cases. Such things as accidents, cases requiring in-patient treatment and so on are clearly excluded and the agreements with the four institutions, St. Thomas's Hospital, King's College Hospital, the Belgrave Hospital, and the Royal Waterloo Hospital should be so drafted. The Medical Officer of Health is of opinion in the light of requirements which can be foreseen that the accounts of the four hospitals will not exceed 108 £300 during the year of the temporary arrangement. After the trial period is over it may be possible to arrange for block grants to cover all expenditure which would materially reduce clerical and accountancy work. A. G. G. Thompson, m.d. Medical Officer of Health. 4th January, 1937. We are of opinion that the proposals with regard to the provision of hospital treatment for toddlers suffering from minor ailments as outlined in the foregoing report of the Medical Officer of Health should be adopted by the Council for an experimental period of twelve months, and that the matter should then be reviewed by us in the light of the experience gained. We have requested the Finance Committee to submit the necessary estimate to cover the approximate cost of £300, and we recommend— That the Council do adopt the proposals above referred to, that the same be put into operation for an experimental period of twelve months, and that the Town Clerk be authorised on behalf of the Council to sign such agreements with the authorities of the respective hospitals concerned in the matter as may be considered necessary. Adopted. 109 Appendix B. Extract from the Minutes of the Council, 24th June, 1937. Nutrition : Ministry of Health Circular No. 1519- We have received the following report from the Medical Officer of Health, which we submit for the information of the Council:— Report. The circular refers to the recently issued First Repbrt of the Advisory Committee on nutrition, and requests the Council to take an early opportunity of reviewing its arrangements under section 251 (1) of the Public Health (London) Act, 1936. In so far as the extra nourishment is concerned, the Council's scale of income for free and aided supplies of milk is identical with that in use in Camberwell, Hammersmith, Hampstead and Wandsworth, and is as follows:— Borough No. in family Scale Free Half cost s. d. s. d. Camberwell 1 13 0 15 0 Rent deducted Hammersmith 2 10 6 12 6 Hampstead 3 8 6 10 0 Lambeth 4 7 6 8 6 Wandsworth 5 7 0 8 0 6 and over 6 6 7 6 There are, however, frequent cases of hardship in which free milk is required, and in which it cannot be supplied, but which would be covered if the scale were raised to that ruling in Bermondsey, Bethnal Green and Shoreditch, which is as follows.- Borough No. in family Scale Free Half cost Bermondsey 1 s. d. s. d. Rent deducted, also contributions for state insurances for health, unemployment and pensions; and voluntary contributions for hospital treatment. 14 0 16 0 Bethnal Green 2 12 0 14 0 Shoreditch 3 10 0 12 0 4 9 0 10 0 5 8 0 9 0 6 and over 7 0 8 0 It may be noted that suggestions have been received from medical officers of the welfare centres that the scale should be raised on account of these cases of hardship. 110 The circular removes any limitations there have been to the supply of milk to expectant mothers throughout pregnancy, to nursing mothers, and to infants and children under the age of 5 years. It is not ordinarily to be expected that a nursing mother will require milk when her infant reaches the age of twelve months. No milk is, however, supplied in any circumstances unless the medical officer of the welfare centre certifies that it is necessary on grounds of health. The views of the medical officers of the welfare centres have been obtained upon suggested additions to the free issue of milk such as butter, eggs and cheese, and, as was expected, they vary to some extent regarding the provision of extra nourishment apart from milk. Although it is generally agreed that butter and eggs would be a useful addition in many cases, yet there are no practical means of insuring that the person for whom the extra nourishment is supplied will in fact consume it apart from the provision of the food in the form of free meals. From unofficial inquiry it has been ascertained that official sanction would not be likely to be given to any scheme where such a safeguard was not in operation. The provision of further extra nourishment would seem, therefore, to be confined to the supply of meals eaten away from home at some place similar to those belonging to the "Invalid Kitchens of London." All the officers of the welfare centres in the inner wards have suggested that a kitchen to supply free meals would be a useful asset in improving the nutritional state of the mothers and children who attend them, and the Medical Officer of Health has, therefore, approached the Association with a view to discovering the financial liability in the event of the Council asking for a kitchen to be installed in the inner wards. A reply has been received, stating that the Camberwell and Southwark Councils pay 8d. per meal for adults and 4d. for children under 5 years. The question of a kitchen in Lambeth will, it is stated, be placed before the Committee of the Association at its next meeting, but no further information has as yet been received. It may be noted that all arrangements previously made in Lambeth for providing free meals have been given up owing to the diminishing demand after the novelty had worn off. A. G. G. Thompson, m.d., Medical Officer of Health. 31st May, 1937. We propose further to consider the question of the installation of a food kitchen in the inner wards of the Borough and will report on the matter at a later date. In the meantime, we have to state that we are in sympathy with the suggestion that the Council's scale of income of recipients of free and aided supplies of milk at present in use should be raised and bearing in mind the view of the Minister of Health that the scale adopted for this purpose should be so framed as not to render it difficult for any mother to take advantage of the Council's arrangements, we are of opinion that the following scale should be applied:— 111 Number in family Free Half cost 1 14s. after deduction of rent 16s. after deduction of rent 2 l2s. per head, after deduction of rent 14s. per head, after deduction of rent 3 10s. do. 4 9s. do. 5 8s. do. 6 and over 7s. do. 12s. do. 10s. do. 9s. do. 8s. do. We recommend— That the foregoing scale of income of recipients of free and aided supplies of milk be adopted by the Council on and after the 1st July, 1937, and that the Ministry of Health and the committees of the various welfare centres be so informed. Adopted. 112 Appendix C. Extract from the Minutes of the Council, 24th June, 1937. Maternal Mortality : Ministry of Health Circular No. 1622. We have received the following report from the Medical Officer of Health, which we submit for the information of the Council:— Report. The circular calls attention to the report of the Departmental Committee on Maternal Mortality, and under the several following heads indicates the means by which the maternal mortality rate can be reduced. (1) The importance oj team work. This aspect has received the close attention of the committee for many years and there is now active co-operation between the public health department and the voluntary hospitals, the municipal hospitals, and all the voluntary organisations associated with the Lambeth Maternity and Child Welfare Scheme. Every expectant mother applying for medical aid at any hospital, whether for confinement at home or in the institution is reported to the department by the hospital for the purpose of ascertaining the home conditions and preparations for the coming baby. The woman is visited by a health visitor who invites her to attend her local welfare centre for advice at sewing classes, for instance, and if necessary for extra nourishment. Cases which do not attend the ante-natal clinic at the hospital are followed up. There is a similar active liaison between the municipal hospitals and the welfare centres but it is carried one stage further. Where a normal confinement is probable' the expectant mother is transferred to the antenatal clinic of her local welfare centre for supervision until the 34th week, when she is returned to the hospital ante-natal clinic. By this arrangement the ante-natal clinics of the hospitals are relieved of congestion, and as in most instances the welfare centre is more accessible from the woman's home, travelling is reduced. The only class of case which does not attend an ante-natal clinic is the one who books directly with a practising midwife. Were supervision of the latter vested in the Borough Council there would be a close co-operation which is now almost entirely lacking. A parallel to this can be cited in the case of infant life protection. Before these duties were transferred to the Borough Council, not one-quarter of the foster children attended the Lambeth welfare centres. Since the transfer it is a condition of registration of a foster mother that she shall take the foster child regularly to a welfare centre and in consequence 100 per cent, now attend. In so far as medical team work is concerned, the position is one of difficulty as in one part of the circular the local authority, i.e., the 113 Borough Council, are asked to obtain full co-operation with the general practitioners in the neighbourhood, while in another part it is the local supervising authority, i.e., the County Council. In this respect, the County Council's scheme under the Midwives Act, 1936, is still under consideration and any action might well be left until the discussions are finished and the duties to be undertaken by each body clearly defined. (2) Consultant Services. The Council have appointed two consultants for the assistance of general practitioners under the Puerperal Fever and Puerperal Pyrexia Regulations, 1926, and two other consultants who may be called in at any time by any general practitioner who finds himself faced with a complicated labour. These latter were appointed upon the publication of the interim report of the Departmental Committee on Maternal Mortality, and have been called in to many cases. The general practitioners in the district are fully aware of the facilities for the service of consultants, and no further action is required to be taken by the Council as the existing service is now adequate. (3) Emergency Units. It is suggested that arrangements should be made for an emergency unit consisting of consultant and nurse with all necessary equipment for attendance at short notice when summoned by a doctor. A call for such a unit in Lambeth must be unusual, as no case is known to have occurred during the past nine years where a unit of this kind has been required. (4) Maternity Accommodation. No action is required to be taken by the Council to provide for further maternity beds. The hospitals and maternity homes in and near the district already provide an adequate number of available beds. (5) Ante-natal Services. The welfare centres and hospitals have at the moment sufficient ante-natal clinics and no woman need travel more than half a mile from her home to the nearest clinic. The demand is slowly increasing and, as the Council are aware, has been met from time to time by the inauguration of new clinics or the provision of extra sessions at clinics already in existence. The number of expectant mothers who do not attend clinics is almost confined to those booking practising midwives for domiciliary confinements. In this connexion a little is done by refusing financial assistance towards the payment of a midwife unless there has been attendance at an ante-natal clinic. Moreover, compensation is paid by the Council when the midwife loses her case owing to the clinic advising against domiciliary confinement. (6) Post-natal Clinics. As stated generally in the report, it is true that in Lambeth the postnatal attendances have not kept pace with the ante-natal. Post-natal cases are already seen at every ante-natal clinic as advised in the circular, and no cases requiring treatment are unable to obtain it. Owing to the close collaboration of the ante-natal clinics with the many institutions in and around the borough, it can be stated that there is no need, in so far as Lambeth is concerned, for the establishment of a new gynaecological clinic at a woman's hospital or a general hospital. 114 (7) Ancillary Services. Incorporated in the Lambeth Maternity and Child Welfare Scheme are the following ancillary services:—(1) home helps; (2) financial assistance towards the payment of midwives; (3) sterile maternity outfits; (4) dental treatment, including provision of dentures; (5) extra nourishment in the form of pasteurised milk, cod liver oil, and dried milk in certain instances; (6) convalescent home treatment; (7) sterilisation of bed linen; (8) ultra-violet light. The provision of free meals is still under the consideration of the committee. (8) Records. Full records are kept which are transferred as occasion arises and no action is required to be taken by the Council. (9) Education. Every opportunity is taken at the welfare centres and in the homes by the medical officers and health visitors employed in the Lambeth Scheme, to enlighten the general public upon the importance of antenatal and post-natal supervision. Opportunity will be taken of the circular to impress upon all officers the necessity of emphasising the grave risks attending interference with the course of pregnancy. It is doubtful, however, whether there are any women in Lambeth who are " unaware that any interference with the product of conception with intent to procure a miscarriage is a criminal offence." (10) General. The Council have assured that the best local obstetric skill is available in all cases in which midwives are required to call in a doctor, but not being the local supervising authority, the Council can do nothing beyond providing it for such use as midwives and the doctors they call in care to make of it. The circular concludes with the statement that the Minister is arranging for further research to be undertaken (a) with a view to discovering reliable prophylactic treatment for puerperal sepsis, and (6) into the possible influence of the dietary upon child bearing. A third subject, abortion, is under the consideration of the Home Secretary and the Minister, who have appointed a committee to inquire into the matter. It may be noted that of the 40 maternal deaths in the past 5 years from which the maternal mortality rates of Lambeth have been calculated, 10 have been due to abortion. It should be realised that deaths from abortion are classified by the Registrar General under three headings :— (1) Suicide, when the abortion is brought about by the activities of the woman herself. (2) Violence, when the abortion is induced by others. (3) Maternal death, when the cause of the abortion is not ascertained.- Only abortions classified under the last heading are included in the number for ascertaining the maternal mortality. In spite of deaths due to abortion, the average maternal death rate of 2.0 for the past five years, based upon 19.971 live births, is surprisingly good when compared with the rate for England and Wales, which has varied between 4.1 and 4.6. 115 The Council have every reason to congratulate themselves upon the efficiency of the Lambeth Welfare Scheme. A. G. G. Thompson, m.d., Medical Officer of Health. 31st May, 1937. The Minister of Health asks that he might be informed of the action which the Council propose to take upon their consideration of the Departmental Committee's report, and We recommend— That the foregoing report of the Medical Officer of Health be adopted, and that a copy thereof be forwarded to the Ministry of Health. Adopted. 116 Appendix D. Extract from the Minutes of the Council, 23rd September, 1937. Prevention of Blindness : Ministry of Health's Circular No. 1621. We have to report that a circular communication (No. 1621), dated the 6th August, 1937, has been received from the Ministry of Health, calling the attention of maternity and child welfare authorities to the importance of taking all practicable steps to prevent blindness and impaired sight, and in this connexion reference is made to the report on the prevention of blindness which was issued last year by the Standing Committee of the Union of Counties Associations for the Blind. This report (inter alia) stresses the importance of a comprehensive and adequate system of ante-natal supervision, the proper cleansing of a baby's eyes at birth, the necessity for the speedy treatment of ophthalmia neonatorum, and the treatment of suitable cases at hospitals. With regard to children under school age, the Standing Committee suggest that a critical survey by medical officers of health of the existing arrangements, especially with regard to the early diagnosis and treatment of serious eye defects, might be fruitful in its results, and that the desirability of further measures being taken for the ascertainment of young children with eye conditions which may lead to impairment or loss of sight is indicated. In this latter connexion, the Ministry call attention to the fact that their circular No. 1550 of the 29th May, 1936 (Minutes, page 1015 et seq.), emphasises the necessity for improving and extending the Council's arrangements for the supervision of the health of children under school age, and it is suggested that a further review thereof should be made in the direction above mentioned. The Medical Officer of Health has informed us that the Council's arrangements for ante-natal supervision of expectant mothers, and for the care of their infants at the welfare centres are so systematic and thorough that no alteration of the present organisation is needed. 117 The following details will indicate the success of the Council's scheme during the past few years in so far as ophthalmia neonatorum the commonest cause of blindness in this country—is concerned:— Year Cases notified Treated At home In hospital Vision impaired Total blindness Deaths  1933 30 24 6 nil nil 2 1934 33 25 8 nil nil nil 1935 41 36 5 nil nil nil 1936 54 51 3 nil nil nil By arrangement with the London County Council, all cases requiring in-patient treatment are admitted, with or without the mother, according to circumstances, to St. Margaret's Hospital. In so far as children under school age are concerned, the Council will recall that extensive arrangements have been concluded with the voluntary hospitals in Lambeth for the treatment of all eye cases discovered at the toddlers' clinics and no alteration is needed now to improve the services provided by the Council (Minutes, page 244). The treatment of the eyes of newly-born infants by midwives is a matter, of course, entirely for the County Council, who are the local supervising authority, but every care is taken at the Council's maternity home to insure the proper cleansing of every baby's eyes at birth. We agree with the view expressed by the Medical Officer of Health and are of opinion that, so far as the Council are concerned therein, no action is required to be taken on the matters referred to by the Ministry, but we submit this report for the information of the Council. Received. 118 INDEX . Page Ambulance facilities 31 Ante-natal clinics 31 Area of borough 8 Artificial cream 80 Bacteriological laboratory 84, 94 Bakehouses 61 Bed bugs 96 Bed linen (sterilization) 38 Births 28 Births in institutions 14 Births in registration sub-districts 14 Births, legitimate and illegitimate 28 Births, notification 28 Birth-rates 16 Census figures 15 Child life protection 37 Cod liver oil 34 Closing orders 6.8 Common lodging houses 61 Condemned food 77 Consultants (obstetrical) 40 Contacts 94 Cowhouses 61 Day nursery 44 Deaths 21,22 Deaths, infantile 16 Deaths in institutions 23 Death-rates 16 Demolition orders 66 Density 8 Dentistry 40 Diphtheria 90 Diphtheria prevention clinics 92 Disinfecting department 95 Drains tested 53 Dysentery 93 Factories, workshops and workplaces 57,60 Food and drugs adulteration 77,81 119 Page Food inspection and supervision 76 Food premises 78 Grants, L.G. Act, 1929 34 Health visitors 47 Home helps 38 Hospitals 30 Housing statistics 64 Housing applications 75 Housing conditions (M.O.H. table) 72 Housing inspectors 64 Ice cream 61 Infantile mortality 25 Infectious diseases 85 Licences 60 Light treatment 40 Marriage rate 8 Massage 40 Maternity and child welfare committee 3 Maternity and child welfare.scheme 31,42,45 Maternity home 35 Maternal mortality 19, 20, 25 Maternity outfits (sterile) 38 Meat regulations (details of work) 76 Merchandise Marks Act 80 Midwives 30, 39 Milk assistance scheme 32 Milk supply 76 Ministry of Health Circulars 102,105,108, 112 Mortality ratep 8,27 Mortuary 105 Neonatal mortality 8 Notices served 52 Notifiable diseases 85 Nuisances 53 Nursing 29 Nutrition 84 Offensive trades 61 Ophthalmia neonatorum 93 Outworkers 58, 60 Overcrowding 73 Pharmacy and Poisons Act, 1933 80 120 Page Populations 13 Public cleansing 49 Public health committee 3 Puerperal fever and puerperal pyrexia 49 Registrations 60 Removal of infirm persons 56 Rent a,nd Mortgage Interest Restrictions Acts 56 Representations 66 Restaurants 79 Sanitary inspectors 52 Sanitary work 52 Schools 63 Shops acts 62 Slaughterhouses and slaughtermen 61 Smoke abatement 62 Social conditions 9 Staff 4 Still-births 27 Summary of vital and mortal statistics 8 Summonses 53 Suspects 94 Swimming baths and pools 62 Toddlers 40 Tuberculosis. 97 Tuberculosis, death rates 101 Tuberculosis dispensaries scheme 103 Tuberculosis incidence rates 102 Tuberculosis, notifications 98 Tuberculosis (Prevention) Regulations, 1925 105 Unemployment 10 Vaccination 87 Vital Statistics 12 Voluntary hospitals 38 Water certificates 53 Welfare centres, etc. 31 Women sanitary inspectors 58 Workshops 60 Zymotic deaths 24 Zymotic death rate 24