REPORT ON THE HEALTH OF THE BOROUGH OF LAMBETH During the Year 1938 (83rd Annual Report.) by A. G. G. THOMPSON, M.A., M.D., B.C., D.P.H., Medical Officer of Health. London : Truslove & Bray Ltd. Printers and Bookbinders West Norwood, S.E.27 2 CONTENTS. page PREFACE 6 STATISTICS AND SOCIAL CONDITIONS 8 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 28 SANITARY CIRCUMSTANCES OF THE AREA 50 HOUSING 64 INSPECTION AND SUPERVISION OF FOOD 71 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 82 INDEX 101 3 Borough of Lambeth. (I) PUBLIC HEALTH COMMITTEE and (2) MATERNITY and CHILD WELFARE COMMITTEE (appointed by the Council on the 9th November, 1938). PUBLIC HEALTH COMMITTEE. Hrs Worship the Mayor (Mr. Councillor W. Lockyer, J.p. l.c.c.), 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, J.P., 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 L. Agelasto, representing the North 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. E. Monckton, representing the Norwood Parliamentary Division. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Chief Executive Tuberculosis Of.icer 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. 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, E. F. Mannerscn, G. M. Conlon, Miss E. Nye, A. H. Hagon (temp.). Junior Clerks : C. Prior and G. H. Darkins. 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). F. S. Jolliffe ,, ,, ,, (temporary). E. E. Morgan ,, „ ,, R. G. Cutler, Cert, s.i.e.b. A. E. White, „ (Meat and other Foods). S. G. Starling, ,, „ „ A. E. French, „ „ „ (seconded for Air Raid Precautions Duty.) (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. Peel, m.a., b.m., f.r.c.s., m.c.o.g., j. m. wyatt, m.b., f.r.c.s. Obstetrical Consultants R. A. Brews, m.d., m.s., f.r.c.s., m.r.c.p , m.c.o.g. A. j. Wrigley, m.d., f.r.c.s., f.c.o.g. Tuberculosis Dispensaries Scheme (a) Central Tuberculosis Dispensary, 73 Effra Road, Brixton, S.W. 2. Tuberculosis Officer* :E. D. Richardson, m.r.c.s., l.r.c.p., d.p.h Secretary and Social Worker : Miss D. E. Cooper. Health Visitors (Tuberculosis) : Miss W. Dyer, s.r.n., c.m.b., h.v. and School Nurse's Certs. Miss M. E. Jacobs, c.m.b. Cert. s.i.e.b., h.v. Cert. Dispenser (part time): Miss F. M. Speakman. Caretaker Attendant: R. Browne. (b) Branch Tuberculosis Dispensary, St. Thomas's Hospital, S.E. 1. Tuberculosis Officer: G. T. Hebert, m.d. (Oxon.), f.r.c.p. Assistant Tuberculosis Officer (for visiting purposes) : F. A. Gaydon, m.d. (Lond.), m.r.c.p. Secretary: Miss P. Gilbert (Lady Almoner's Department). Visitor : Miss C. F. L. Watson, s.r.n., h.v. Cert., t.b. Cert. Vaccination Department: Parliamentary district Vaccination or hospital: Public Vaccinator: Officer: North R. Phillips, m.d., b.sc. (lond),d.p.h. Kennington M. I. Elliott, m.b., b.ch., b.a.o. (belf.) h.j.hart Brixton E. L. M. Rusby, m.b.(lond)., m.r.c.s., l.r.c.p. V 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 (b) 12 Hannen Road, S.E. 27. g.w.j.bousfield. m.d.(london). Mortuary: Wanless Road, S.E. 24 Mortuary Keeper : W. A. Adams Disinfecting Station: Wanless Road, Loughborough Junction - Superintendent: E. Lock year 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 inhabitants of the district has not been subjected to the disturbance of any unusual factor during the year and is generally satisfactory. The expected biennial epidemic of measles appeared a little later than in past years but this follows the general trend of recent years and whereas the late autumn was the usual time for it to begin, in 1938 the onset was not general until January. The increasing average age of the population can be gauged by the fact that no less than 52.65 per cent of all deaths occurred in the age period 65 years and over. While the number of children entering the primary schools has fallen from 3,388 in 1935 year by year to 2,845 in 1938. The drift evident in Lambeth is common to the population of the country as a whole and portrays a lugubrious future for the younger generations of supporting increasing numbers of aged people whose dead weight as non-producers must be borne on their shoulders. The population is estimated by the Registrar-General to be 1,000 less than in the previous year while the natural increase by excess of births over deaths is 587. The corrected death rate is 11.78 per thousand population, while the infantile mortality has never before reached the low record of 51 per thousand live births. The increasing importance of air raid precautions has laid such a burden upon every member of the public health department that it has become impossible to pay that adequate attention to detail which in the past has been found necessary for satisfactory service. It is fully realised that everyone should share in supporting the burden, but the limit has been nearly reached in the public health department on more than one occasion. The 7 somewhat abridged character of this annual report has been an inevitable result of the excessive A.R.P. duties which takes precedence over all others. The continuous changes in the casualty schemes have thrown much extra work upon the staff which by no means infrequently has been found to be entirely wasted effort a month or two after completion. Thanks are gratefully tendered to the members of the Public Health and Maternity and Child Welfare Committees, to the general practitioners for their help and co-operation to the chief officers of the Council and principally to the staff of the Public Health Department for their loyal support and willing assistance throughout a particularly trying year. A.G.G.T. July, 1939. 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, 1938—272,800 (males 128,840 and females 143,960). Density—66.81 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore). Births (corrected)—3,846, being 14.09 per 1,000 population. Marriages—2,652, being 9.7 per 1,000 population. Deaths (corrected)—3,259, being 11.78* per 1,000 population. Infantile Mortality (corrected)—196 deaths under 1 year, being 51 per 1,000 total live births. Neonatal Mortality (corrected)—86 deaths under one month, being 22 per 1,000 live births. Zymotic Death-rate (corrected)—0.28 per 1,000 population (total zymotic deaths, 77). Maternal Mortality (corrected)—7 deaths, being 1.82 per 1,000 live births. Number of structurally separate dwellings (census 1931)—48,873. Rateable Value (at 1st April, 1938)—£2,345,590. Sum represented by a penny rate (at 31st March, 1938)—£9,547. * As adjusted by comparability factor. 9 Social Conditions. There has been no marked change in the social conditions beyond the continued steady demolition of old cottage property and its replacement by blocks of flats. The excitement occasioned by the September crisis led to the purchase of unusual quantities of goods with money withdrawn from clubs and in consequence the extent of Christmas shopping was much reduced. Fortunately beyond rather trivial repercussions of this nature the air raid precautions have given rise to no effects whatever. Unemployment. The following tables indicate the extent of unemployment among Lambeth residents:— (1) Average Number of Residents Registered as Unemployed in 1932, 1933, 1934, 1935, 1936, 1937, and 1938. Date Men Women Juveniles Total 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 1938 7,209 2,563 — 9,772 10 (2) Number of Residents Registered as Unemployed at Monthly Dates in 1938. Date Men Women Juveniles* Total 17th January 7,805 2,212 - 10,017 14th February 8,101 2,478 — 10,579 14th March 7,995 2,488 — 10,483 4th April 6,747 2,609 — 9,356 16th May 6,609 2,604 — 9,213 13th June 6,297 2,560 — 8,857 18th July 6,247 2,327 — 8,574 15th August 5,961 2,519 — 8,480 12th September 6,455 2,539 — 8,994 17th October 7,931 2,850 — 10,781 14th November 8,328 2,896 - 11,224 12th December 8,028 2,680 — 10,708 * 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:— Children 1935—3,388 Children 1936—3,123 Children Good Average Below Normal Good Average Below Normal 587 2,430 362 441 2,371 30.5 Lambeth 17.3% 71.7% 11.0% 14.1% 75.9% 10.0% London 16.4% 77.9% 5.7% 15.1% 78.6% 6.3% Children 1937—3,016 Children 1938—2,845 Children Good Average Below Normal Good Average Below Normal 482 2,227 297 551 2,118 174 Lambeth 16.0% 73.8% 10.2% 19.4% 74.4% 6.2% London 15.3% 78.5% 6.2% 15.3% 78.2% 6.5% 11 b The population of the Borough of Lambeth at the mid-year 1938, has been estimated by the Registrar General to be 272,800 which is less by 1,000 than the official estimated population of 1937. 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 3,259 100% 0— 196 6.01% 1— 25 0.77% 2— 36 1.11% 5— 59 1.81% 15— 89 2.73% 25— 109 3.35% 35— 145 4.45% 45— 352 10.80% 55— 532 16.32% 65— 763 23.41% 75— 953 29.24% During the year the number of births corrected by inward and outward transfers was 3,846, giving a corrected birth rate of 14.09 compared with 14.14 last year, a decrease of 0.5 per one thousand population. The principal causes of death are again the same four: heart disease which claimed 968 or 29.7 per cent. of the total, cancer 505 or 15.49 per cent., diseases of the lungs 312 or 9.57 per cent., and tuberculosis 185 or 5.7 per cent. 12 Estimated Population, 1938 (Middle of the Year.) I. Wards. Wards Males Females Total 1. Marsh 5,750 5,130 10,880 2. Bishop's 10,790 11,220 22.010 3. Prince's 11,370 12,120 23,490 4. Vauxhall 13,800 14,370 28,170 5. Oval 11,040 11,790 22,830 6. Vassall 7,900 8,760 16,660 7. Angell 12,600 14,850 27,510 8. Stockwell 13,220 15,150 28,370 9. Town Hall 6,550 7,150 13,700 10. Heme Hill 6,300 7,400 13,700 11. Tulse Hill 13,700 16,980 30,f 80 12. Knight's Hill 15,760 19,040 34,800 Borough of Lambeth 128,840 143,960 272,800 II. Registration Sub-Districts. Sub-Districts Males Females Total 1. Lambeth, North 16,540 16,350 32,890 2. Prince's 11,370 12,120 23,490 3. Lambeth, Central 45,400 49,770 95,170 4. Lambeth, South 55,530 65,720 121,250 Borough of Lambeth 128,840 143,980 272,800 III. Parliamentary Divisions. Parliamentary Divisions Wards Total North Marsh, Bishop's, Prince's 56,380 Kennington Vauxhall, Oval, Vassall 67,660 Brixton Angell, Stockwell, Town Hall 69,580 Norwood Herne Hill, Tulse Hill, Knight's Hill 79,180 Parliamentary Area of Lambeth 272,800 13 TABLE A. Giving Number of Live Births in each Registration Sub-District of the Borough of Lambeth During the Year ended 31sr December, 1938 (arranged Quarterly). Registration Sub-Districts No. of Births 1st Quarter 2nd Quarter 3rd Quarter uarter Lambeth, North* 442 423 468 433 Prince's† 277 313 256 259 Lambeth, Central ‡ 431 455 456 414 Lambeth, South§ 256 259 270 248 BOROUGH OF LAMBETH 1,406 1,450 1,450 1,354 TOTAL FOR BOROUGH OF LAMBETH—5,660. * Including General Lying-in Hospital (1,130 cases, of which 311 belong to Lambeth) and St. Thomas's ' Hospital (628 cases, of which 275 belong to Lambeth). t Including Lambeth Hospital (1,022 cases, of which 532 belong to Lambeth) { Including Clapham Maternity Hospital (603 cases, of which 129 belong to Lambeth). § Including King's College Hospital (781 cases, of which 167 belong to Lambeth). 14 TABLE B. Showing Populations (Estimated), Uncorrected Registered Births, Corrected Deaths at all ages, under 1 year, under 5 years, and from the 7 chief Zymotic diseases, during 1938, 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[/'###] 1938 272,800 5,660 3,259 196 257 77 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 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, and at Census 1931 was 296,147. Families or separate occupiers = 70.887 (1901), 70,827 (1911), 78,399 (1921), and 83,777 (1931). 15 TABLE C. Showing the Birth Rate, the General and Zymotic Death Rates, the Infantile Mortality Rates for the Year 1938, and the figures for the Four Previous Years, together with the Averages for the Four Decennia 1891-1900, 1901-1910, 1911-1920, and 1921-1930. Year Birth-Rate per 1,000 Population (uncorrected) Death-Rate per 1,000 Population (corrected) Corrected Deaths of Children under 1 year per 1,000 total Births Deaths of Children under 1 year per 1,000 Deaths (corrected) Deaths of Children under 5 years per 1,000 Deaths (corrected) Zymotic Death-Rate per 1,000 Population (corrected) 1938 20.74 11.78 50.96 60.14 78.85 0.28 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 Averages (10 years)— 1921-1930 (Borough) 25.1 12.4 51.4 93.4 145.1 0.5 1911-1920 (Borough) 27.9 14.9 77.2 144.5 223.1 1.1 1901-1910 (Borough) 28.1 14.9 115.3 216.7 319.4 1.5 1891-1900 (Parish) 31.6 18.4 146.1 251.3 382.9 2.4 16 TABLE D. Vital Statistics of the Borough of Lambeth During 1938 and Previous Five Years (1933-1937) Year Population estimated to middle of each year 2 Births Total Deaths Registered in District Transferable Deaths Net Deaths Belonging to the District Uncorrected number 3 Net Number • 6 Rate 7 of non-residents registered in the district † 8 of residents not registered in the district t 9 Under 1 year of age At all ages Number * 10 Rate per 1,000 net births 11 Number * 12 Rate 13 Number 4 Kate 5 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 1937 273,800 5,582 3,873 14.14 3,703 13.52 1,558 1,471 266 68 3,616 13.06 Average 5 years 280,820 5,614 3,906 13.91 3,742 13.32 1,568 1,407 245 62 3,581 12.65 1933-1937 1938 272,800 5,660 3,846 14.09 3,450 ,12.64 1,586 1,395 196 51 3,259 11.78 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. *In Column 6 is included the whole of the deaths registered during the year as having actually occurred within the Borough. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by the addition of the deaths under 1 included in the number given in Column 9. † Columns 8 and 9 are prepared from the returns made by the local Registrars of Deaths in accordance with the rule in the next paragraph. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9 except in certain instances. In Column 8 the number of transferable deaths of "non-residents"which are deducted, and in Column 9 the number of deaths of "residents" registered outside the district which are added are stated in calculating the net death-rate of the Borough. Census, 1931 Area of Borough in acres (including land and inland water), 4,083. Average number of persons per separate dwelling, 6.05. Number of structurally separate dwellings, 48,873, Total population at all ages, 296,147. 17 TABLE E. Summary of Statistics Relating to the Metropolitan Boroughs for the Year, 1938. Cities and Boroughs Estimated Population to Mid-year 1938 Births Annual rate per 1,000 persons living Deathrate per 1,000 living Crude Deathrate per 1,000 living Adjusted Deaths of infants under 1 year per 1,000 births London 4,062,400 13.4 11.4 — 57 West Districts— Paddington 137,400 13.74 11.33 11.21 66 Kensington 174,100 12.8 11.7 10.9 78 Hammersmith 125,100 15.5 11.3 11.6 61 Fulham 137,700 14.2 11.6 11.7 51 Chelsea 56,050 10.2 13.5 11.5 80 City of Westminster 124,400 8.3 10.4 10.7 54.9 North Districts— St. Marylebone 90,680 8.84 11.12 11.00 60 Hampstead 90,480 11.7 11.4 10.7 57 St. Pancras 179,400 13.5 11.5 11.7 64 Islington 292,300 15.32 11.90 12.02 65 Stoke Newington 50,480 13.8 11.0 10.5 43.2 Hackney 205,200 13.4 10.7 11.2 56.46 Central Districts— Holborn 34,350 7.28 10.51 11.25 84 Finsbury 56,960 13.0 12.9 14.1 73 City of London 8,780 6.6 10.7 11.8 51.8 East Districts— Shoreditch 80,360 14.7 11.4 12.5 64 Bethnal Green 92,910 14.2 11.3 12.8 59.3 Stepney 200,500 13.06 11.05 12.92 60.7 Poplar 134,400 14.9 11.4 12.7 60 South Districts— Southwark 145,300 14.0 12.5 13.4 57 Bermondsey 97,420 14.8 11.0 12.54 45 Lambeth 272,800 14.09 11.9 11.7 51 Battersea 141,700 14.92 11.82 11.70 53.45 Wandsworth 340,100 11.92 11.17 10.38 46 Camberwell 222,400 13.97 12.27 12.27 61 Deptford 95,460 14.4 11.8 — 54 Greenwich 95,770 13.64 10.89 11.1 42 Lewisham 229,000 13.9 10.49 10.5 47 Woolwich 150,900 13.6 10.4 11.0 50 B 18 TABLE F. Birth-Rate, Death-Rate, and Analysis of Mortality During the Year 1938 (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 Diarrhoea & Enteritis (under two years) Total Deaths under one year Live Births Stillbirths England and Wales 15.1 0.60 11.6 0.00 0.00 0.04 0.01 0.03 0.07 0.11 5.5 53 126 County Boroughs and Great Towns, including London 15.0 0.65 11.7 0.00 - 0.05 0.01 0.03 0.07 0.10 7.8 57 148 Smaller Towns (Estimated Resident Populations 25,000-50,000 at Census 1931) 15.4 0.60 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.6 51 London 13.4 0.48 11.4 0.00 — 0.03 0.01 0.03 0.05 0.06 13.1 57 Lambeth 14.09 0.43 11.78 0.00 — 0.03 0.00 0.01 0.04 0.06 10.92 51 The maternal Mortality rates are as follows:— Puerperal Puerperal Sepsis Others Total Per 1,000 Total Births, Sepsis Others Total Per 1,000 Live Births, England & Wales 0.89 2.19 3.08 England & Wales 0.86 2.11 2.97 Lambeth 0.52 1.30 1.82 Lambeth 0.50 1.26 1.76 19 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 0.53 1.06 1.59 0.51 1.02 1.53 Kensington 0.9 1.3 2.2 0.9 1.3 2.2 Hammersmith 0.00 1.07 1.07 0.00 1.04 1.04 Fulham 0.51 0.00 0.51 0.49 0.00 0.49 Chelsea 3.5 1.7 5.2 3.4 1.7 5.1 Westminster 1.9 4.8 6.7 1.8 4.6 6.5 North Districts— St. Marylebone 0.00 2.49 2.49 0.00 2.41 2.41 Hampstead 0.00 0.94 0.94 0.00 0.91 0.91 St. Pancras 0.00 0.8 0.8 0.00 0.8 0.8 Islington 1.12 1.56 2.68 1.08 1.52 2.60 Stoke Newington 0.00 1.4 1.4 0.00 1.4 1.4 Hackney 0.36 0.00 0.36 0.35 0.00 0.35 Central Districts— Holborn 0.00 4.00 4.00 0.00 3.76 3.76 Finsbury 0.00 4.05 4.05 0.00 3.84 3.84 City of London 0.00 0.00 0.00 0.00 0.00 0.00 East Districts— Shoreditch 0.85 1.69 2.54 0.82 1.64 2.46 Bethnal Green 0.76 0.76 1.52 0.74 0.74 1.47 Stepney 1.145 1.145 2.29 1.11 1.11 2.22 Poplar 1.50 1.00 2.50 1.45 0.97 2.42 South Districts— Southwark 0.00 0.98 0.98 0.00 0.95 0.95 Bermondsey 0.00 2.75 2.75 0.00 2.71 2.71 Lambeth 0.52 1.30 1.82 0.50 1.26 1.76 Battersea 2.37 0.47 2.84 2.30 0.46 2.76 Wandsworth 0.49 2.71 3.20 0.47 2.63 3.11 Camberwell 0.32 2.25 2.57 0.31 2.18 2.49 Deptford * * * * * * Greenwich 0.00 1.5 1.5 0.00 1.4 1.4 Lewisham 1.56 0.62 2.19 1.52 0.61 2.13 Woolwich 0.00 0.48 0.48 0.00 0.47 0.47 * Information not available. 20 Deaths. The total number of deaths registered in Lambeth during the year is 3,450, of which 1,583 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 1,395. The number of deaths corrected, i.e., of all Lambethans who died both within and outside the district is 3,259. The corrected death rate is 11.78 per 1,000 living, based upon a population estimated to the middle of the year of 272,800 and adjusted with the comparability factor. Age Periods of Corrected Deaths The 3,259 corrected deaths during 1938 may be further analysed and tabulated as follows:— 196 6.01 per cent. of the total corrected deaths took place under 1 year of age. 61 1.88 per cent. between 1 and 5 years. 257 7.89 per cent. under 5 years. 148 4.54 per cent. between 5 and 25 years. 254 7.80 per cent. 25 to 45 years. 884 27.12 per cent. 45 to 65 years. 763 23.41 per cent. 65 to 75 years. 953 29.24 per cent. 75 years and over. 3,002 92.11 per cent. over 5 years. 21 TABLE G. Showing the corrected number of Deaths, with corrected Death-rates (general, zymotic and diarrhœal), in each of the Registration Sub-Districts of the Borough during 1938. 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. Diarrhœal Death-rate per 1,000 of the Population. Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhoid or Enteric Diarrhoea and Dysentery Lambeth, North 399 12.13 — 3 — 1 — - 11 15 0.45 0.33 Prince's 270 11.49 — 2 — 3 — — 6 11 0.46 0.25 Lambeth, Central 1,124 11.81 — 11 — 4 2 — 9 26 0.27 0.09 Lambeth, South 1,466 12.09 — 3 1 4 1 — 16 25 0.20 0.13 Borough of Lambeth 3,259 11.78 — 19 1 12 3 — 42 77 0.28 0.15 22 23 TABLE H. Causes of, and Ages at, Death (Corrected) During the Year, 1938. 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 1 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 3,259 196 25 36 59 89 254 884 763 953 Enteric Fever — — — — — — — — — — Measles 19 3 9 5 2 — — — — — Measles 1 — — 1 — — — — — — Whooping Cough 3 2 1 — — — — — — — Diphtheria 12 — —• 6 6 — — — — — Influenza 19 1 — 1 — — — 10 3 4 Encephalitis Lethargica 2 — — — — "— 2 — — Cerebro-Spinal Fever 5 — — — 1 1 3 — — — Tuberculosis of respiratory system 185 1 — — 2 36 64 67 13 2 Other tuberculous diseases 24 — 2 4 8 2 4 3 1 - Syphilis 14 — — — — 2 7 4 1 General Paralysis of the insane, tabes dorsalis 16 — — — — — 3 9 3 1 Cancer, malignant disease 505 — — 1 2 4 22 218 140 108 Diabetes 37 — — — — — 1 8 16 12 Cerebral Haemorrhage, etc. 169 — — — — 3 40 60 66 Heart Disease 968 — 1 — 2 10 34 209 277 435 Aneurysm 12 — — — — — 1 4 7 — Other circulatory diseases 131 1 — 1 — — 2 31 45 51 Bronchitis 79 4 — — — 1 1 29 14 30 Pneumonia (all forms) 209 40 4 3 6 3 15 55 44 39 Other respiratory diseases 26 — — 1 1 5 7 6 6 Peptic Ulcer 59 — — — — — 8 34- 8 t 10 Diarrhoea, etc. 50 38 4 — 1 1 2 — 1 2 Appendicitis 19 — — 3 1 1 3 4 3 4 Cirrhosis of Liver 8 — — — — — — 5 1 2 Other diseases of liver, etc. 22 — — — — — 1 7 7 7 Other digestive diseases 36 2 — 1 1 1 3 12 12 4 Acute and chronic Nepritis 83 1 — 2 4 3 8 27 20 18 Puerperal Sepsis 2 — — — — — 2 — — — Other puerperal causes 5 — — — — 2 3 — — — Congenital Debility, Premature Birth, Malformations, etc. 94 91 1 1 — 1 — — — Senility 100 — — — — — — — 12 88 Suicide 33 — — — — — 12 10 5 6 Other Violence 95 — 1 6 7 11 15 22 12 21 Other defined diseases 215 12 2 3 13 12 15 24 48 36 Causes ill-defined or unknown 2 — — — — — 1 — 1 — Deaths in Institutions in Lambeth Lambethans Strangers Totals 199 761 960 Voluntary Hospitals State-aided Hospitals 598 733 1,331 Homes for the dying, etc 53 13 66 24 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 1938 fell to 1.82, compared with 2.06 in the previous year. The seven maternal deaths all occurred in married women and the actual causes were sepsis following abortion (2), intracranial thrombosis (1), vomiting of pregnancy (1), cesarean section (1), antepartum haemorrhage (1), and acute inversion of the uterus (1). The maternal mortality based upon the 55 deaths and 27,688 births in Lambeth during the past seven years is 1.98. Infantile Mortality Rates The infantile mortality rate is based upon the number of deaths under one year of age per 1,000 live births registered. The corrected number of births was 3,846, a decrease of 27 compared with the number of births in the year previous. The corrected number of deaths was 196, giving an infantile mortality rate of 51. In the Registration Sub-Districts, the corrected infantile mortality varies thus:— Registration Sub-Districts Total No. of Births Total Deaths under 1 year Infantile Mortality per 1,000 Births Lambeth North 386 30 77 Prince's 317 17 53 Lambeth Central 1,416 64 45 Lambeth South 1,727 85 49 Borough 3,816 193 51 25 TABLE I. Infantile Mortality, 1938. 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 64 6 8 8 86 25 45 20 20 196 Measles — — — — — — 1 — 2 3 Whooping cough — — — — — — 2 — — 2 Nephritis — — — — — 1 — — — 1 Influenza — — — — — — — — 1 1 Tuberculosis, Pulmonarv — — — — — — — 1 — 1 Bronchitis — — — — — 1 — 3 — 4 Pneumonia (all forms) — — 2 2 4 7 14 7 , 8 40 Diarrhoea, etc. — — — — — 7 20 8 3 38 Circulatory diseases — — — — — — — 1 — 1 Digestive diseases — — — — — — 1 — 1 2 Congenital debility and malformation premature birth, etc 60 6 5 6 77 7 6 — 1 91 Other defined diseases 4 — 1 — 5 2 1 — 4 12 26 Stillbirths. The following particulars regarding stillbirths registered in Lambeth during 1938 have been received from the Registrar General:— Total legitimate and illegitimate : Males 73 Females 47 Illegitimate:— Males 6 Females 2 Mortality (All ages). The mortality rates from different diseases and groups of diseases are given in terms of total deaths per 1,000 of the estimated population, with the exception of the infantile mortality rate which is expressed in terms of the corrected number of births. Quinquennium 1938 1937 1936 1931-1935 Estimated Population 272,800 273,800 277,500 288,200 General death-rate 11.78 13.06 12.41 12.59 Zymotic death-rate 0.28 0.33 0.33 0.39 Measles death-rate 0.06 0.003 0.09 0.08 Whooping Cough death-rate 0.01 0.08 0.04 0.06 Diarrhœal death-rate 0.15 0.16 0.13 0.13 Typhoid Fever death-rate 0.00 0.003 0.003 0.004 Tuberculosis (all forms) deathrate 0.76 0.87 0.76 0.90 Tuberculosis (pulmonary) death-rate 0.67 0.75 0.69 0.80 Scarlet Fever death-rate 0.003 0.01 0.00 0.00 Diphtheria death-rate 0.04 0.07 0.05 0.09 Small-pox death-rate 0.00 0.00 0.00 0.00 Infantile Mortality rate 51 68 59 60 27 The total number of Births registered (uncorrected) is 5,660, of which details are set out in Table A. The corrected, number of births, however, is 3,846, showing a birth-rate of 14.09 per 1,000 of the estimated population. Corrected numbers. Legitimate Males 1,831 Legitimate Females 1,750 Illegitimate Males 144 Illegitimate Females 121 Total 3,846 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 5,886 notified births, 4,719 took place in Institutions, and of these, 1,853 belong to Lambeth, and 2,866 to outside districts, thus :— Institutions. Lambeth Cases Strangers Totals General Lying-in Hospital 311 819 1,130 St. Thomas's Hospital 275 353 628 Lambeth Hospital 532 490 1,022 " Annie McCall " Maternity Hospital 129 474 603 King's College Hospital 167 614 781 *Lambeth Council Maternity Home 379 4 383 Other Nursing Homes (private) 60 112 172 Totals 1,853 2,866 4,719 * 4 of the applicants moved out of the Borough after booking. 28 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 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. The Lambeth Nursing (Infectious Disease) Scheme was inaugurated in 1918 as the result of a letter from the then Local Government Board with the object of providing facilities through district nursing associations for the domiciliary nursing of cases of measles, whooping cough, epidemic diarrhoea and enteritis, and ophthalmia neonotorum. The scheme has been amplified following a series of regulations made by the Ministry of Health to include acute primary and acute influenzal pneumonia, dysentery, malaria, poliomyolitis and encephalitis, puerperal pyrexia, etc. During the epidemic of measles a number of cases were visited from the district nursing associations for otitis media which is a frequent complication of measles but is not in itself an infectious disease. Other cases nursed have been of an infectious character requiring skilled nursing but not actually suffering from one of the notifiable infectious diseases. The Lambeth maternity and child welfare scheme with the approval of the Minister as required by section 251 of the Public Health (London) Act, 1936, includes provision for some nursing assistance to children under the age of five years and not attending a school recognised by the Board of Education, but the general nursing arrangements had not received the official approval of the Council apart from that when the Nursing (Infectious Disease) 29 Scheme was inaugurated. The Council, therefore, made a formal resolution, " To enable payment to be made to the several district nursing associations for all cases nursed which in the opinion of the Medical Officer of Health can properly be included in either the Lambeth Nursing (Infectious Diseases) Scheme or the Lambeth Maternity and Child Welfare Scheme and are certified to that effect by him." The number of visits paid to children under five years of age was 5,613, and to persons over five years was 1,579. A flat rate of Is. 3d. per visit is paid for all cases nursed. Midwives. There are some 60 to 70 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. The domiciliary midwifery scheme of the County Council under the Midwives Act, 1936, has worked in close co-operation with the welfare scheme of the Borough Council and, owing to the good sense of all concerned no contretemps has arisen in the course of the first year's working. There has naturally been a marked increase in the number of reports and in the correspondence between the Public Health Department, the welfare centres, the midwives and the County Council, but these have been reduced to the minimum. 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. 30 (a) Voluntary. St. Thomas's Hospital, Albert Embankment, S.E.I, contains 640 beds and large out-patients' departments. A Maternity and Child Welfare Centre is included in the latter to which a grant is made by the Council. King's College Hospital, Denmark Hill, S.E.5, contains 384 beds and general and special out-patient departments. Royal Waterloo Hospital, Waterloo Road, S.E.I. For women and children, 130 beds and out-patient department. Belgrave Hospital, 1 Clapham Road, S.W.9. For children, 76 beds and out-patient department. General Lying-In Hospital, York Road, S.E.I. For women, 76 beds. A Maternity and Child Welfare Centre is attached to the out-patient department, to which a grant is made by the Borough Council. " 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 hospital, fully equipped for all types of cases especially for the treatment of cancer by radium and X-rays. South Western Hospital, Landor Road, S.W.9. A hospital for infectious diseases, containing 323 beds. Ambulance Facilities. There are no ambulances belonging to the Borough Council. By arrangement with the County Council, ambulances are available for the conveyance of women to institutions for confinement at all hours free of charge. 31 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, Greet House, Frazier Street, S.E.I. 3. Holy Trinity and North Lambeth, 121 Kennington Road, S.E.11.* 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.11.* 7. North Brixton (Belgrave Hospital), 212 Camberwell New Road, S.E.5.* 8. Loughborough Junction, " The Sussex Arms," 109 Sussex Road, S.W.9.*† 9. Stockwell, 70 Knowle Road, S.W.9.* 10. Brixton, The Dispensary, 19 Water Lane, S.W.2.*†‡ 11. West Norwood, Hannen House, 12 Hannen Road, S.E.27.*† (Branch Clinic, Gipsy Road, S.E.27.) In addition clinics are held daily at:— General Lying-in Hospital, York Road, S.E.I.*† St. Thomas's Hospital (Main Building), S.E.l.*† — do — 37 Royal Street, S.E.I. These are in all respects regarded as Voluntary Welfare Centres * Regular Ante-Natal Clinics are held in connexion with these Centres, † Dental Clinic. ‡ Artificial Sunlight. 32 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, Prince's Road, S.E.11. (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 bulk of the milk supplied is in liquid form and pasteurised. Milk is now available within the income scale for expectant mothers throughout pregnancy, for nursing mothers for one year after confinement if their medical condition requires it, and for infants up to the age of five years. The scale of income is as follows :— Number in Family Free Hal£ Cost 1 14s. after deduction of rent 16s. after deduction of rent 2 12s. per head, after deduction 14s. per head, after deduction of of rent rent 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:— f Artificial Sunlight. 33 Years (Financial) Cost of Milk distributed Total Cost Total amount of Milk distributed in gallons (approximately) Through Welfare Centres Through Milk Depot £ s. d. £ s. d. £ s. d. 1918-19 (3 months) 232 15 3 69 4 3 301 19 6 3,151 1919-20 2,780 0 10 557 10 1 3,337 10 11 34,827 1920-21 13,836 7 3 1,564 7 3 15,400 14 6 160,703 1921-22 4,596 8 5 1,172 0 8 5,768 9 1 60,192 1922-23 3,553 15 4 1,064 19 5 4,618 14 9 48,196 1923-24 3,380 15 11 353 15 3 3,734 11 2 38,969 1924-25 2,977 19 8 137 17 7 3,115 17 3 31,543 1925-26 2,161 6 3 105 12 8 2,266 18 11 32,846 1926-27 2,209 6 1 189 4 4 2,398 10 5 32,012 1927-28 2,030 17 3 183 18 2 2,214 15 5 28,850 1928-29 1,546 17 5 137 19 7 1,684 17 0 23,321 1929-30 1,328 3 6 36 2 7 1,364 6 1 14,757 1930-31 1,645 7 3 — 1,645 7 3 21,007 1931-32 2,469 8 6 — 2,469 8 6 29,546 1932-33 3,391 4 9 — 3,391 4 9 41,566 1933-34 3,405 19 11 — 3,405 19 11 40,987 1934-35 2,764 11 8 — 2,764 11 8 31,360 1935-36 3,417 14 8 — 3,417 14 8 37,909 1936-37 3,751 14 7 —' 3,751 14 7 48,100 1937-38 5,556 15 8 — 5,556 15 8 68,481 Totals 67,037 10 2 5,572 11 10 72,610 2 0 828,323 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:— 34 (1) Voluntary Associations (Infant Welfare Centres, etc.) (2) Service in respect of which Contribution is payable (3) Amount of Annual Contribution Third fixed period (1937-42) North Marsh Infant Welfare Centre £ 365 Barley Mow Do. 720 North Lambeth Babies' Care Do. 995 Moffat Institute Do. 1,045 "Rose McAndrew" Do. 940 St. Anne's Do. 755 Loughborough Junction Do. 1,695 North Brixton Do. 1,225 Stockwell Do. 930 Brixton Do. 1,300 West Norwood Do. 1,495 St. Thomas's Hospital (Main building) Do. 945 St. Thomas's Hospital (37 Royal Street) Do. 750 General Lying-in Hospital Do. 650 St. Thomas's Babies' Hostel Ailing Babies' Home 1,030 Cynthia Mosley Day Nursery Day Nursery 300 Total £15,140 The conditions of the payment of the contributions to the Voluntary Associations under the Scheme are as follows :— (а) That the Council is satisfied with the efficiency of the Maternity and Child Welfare service provided by the Association, in respect of which the contribution is payable, and that such service is being used by a reasonable number of those persons for whom it is provided. (b) That no reduction or alteration of such service is made without the consent of the Council. (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 35 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 383 cases were admitted to the home—a decrease of 30 below the previous year's total. Since its inception in 1926, 5,005 women have been admitted to the home with only four 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. The one death which occurred during the year was due to acute inversion of the uterus and the verdict at the inquest rightly exonerated the staff from any blame. The admission rate is sensitive in a marked degree to the assessments made by the committee of management. There must inevitably be some variation in the charges made and whenever the general average is raised there is a drop in the number of applications for admission, resulting in more empty beds and a higher cost per patient week, since the overhead charges are largely independent of the number of beds occupied. 36 Applications dealt with during 1938. Welfare Centre Applications received Applications withdrawn, refused or cancelled Babies Care 7 1 Moffat Institute 1 — St. Anne's 3 — Rose McAndrew 4 — North Brixton (Belgrave Hospital) 21 2 Stockwell 65 4 Brixton 108 5 Loughborough Junction 81 10 Norwood 168 11 Total 458 33 The Committee of Management ot 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. Applications with- Parliamentary Area Applications drawn, refused or received cancelled North 4 — Kennington. 29 4 Brixton 141 13 Norwood 284 16 Total 458 33 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, 1938, now follows :— No. of Foster Mothers on Register 140 No. of Nurse Children on Register 220 No. of Visits and Re-Visits paid to Nurse Children 1,211 Year of Birth No. of Nurse Children No. of Visits 1938 32 107 1937 36 184 1936 36 200 1935 24 159 1934 15 79 1933 17 116 1932 25 161 1931 9 56 1930 12 86 1929 14 63 Totals 220 1,211 No. of Visits, including verifications and registering of homes 2,209 No. of Foster Mothers removed from Borough 7 No. of Nurse Children legally adopted by Foster Parents 4 No. of Nurse Children taken by National Children's Aid and Adoption Society with a view to adoption — No. of Nurse Children who attained the age of 9 years 14 No. of Deaths — No. of Legal Proceedings taken 2 No. of emergency orders obtained 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 100 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. 165 applications were received, 4 subsequently cancelled, 28 being emergency cases. The expense to the council was only £100 16s. 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 388 of these outfits were sold. The council has sanctioned the issue of these outfits free or at reduced cost in cases of poverty. 30 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 £3 5s. Od. (iii) Sterilization of Bed Linen, etc. During the year 34 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 post-natal clinic. The total number of these cases (both ante-natal and post-natal) visited and reported upon during 1938 was 3,256 distributed as follows:— St. Thomas's Hospital 746 2,272 King's College Hospital 276 General Lying-in Hospital 346 Lambeth Hospital 904 39 Institutions outside the Borough of Lambeth Westminster Hospital 41 984 Charing Cross Hospital 41 St. George's Hospital 11 Dulwich Hospital 755 Middlesex Hospital 9 Elizabeth Garratt Anderson Hospital 5 Royal Free Hospital 5 St. Giles Hospital 84 Oueen Charlotte's Hospital 7 St. Stephen's Hospital 3 St. Olave's Hospital 5 St. James' Hospital 10 South London Hospital 4 Mile End Hospital 1 Bethnal Green Hospital 1 _ Hammersmith Hospital 2 (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. In the county domiciliary scheme the municipal midwives refer their cases to the welfare centres and a closer liaison exists between the midwife and the health visitor. Applications for assistance towards the payment of the midwife were received from 63 expectant mothers, 3 of which were subsequently cancelled, and 14 were emergency cases. The cost to the council was £57 7s. 3d. This facility is, of course, only available where midwives in private practice are concerned and does not extend to the cases of the county council's midwives. Compensation at the rate of 10s. per case is paid to those midwives in private practice 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 five occasions only during the year was one of the council's two obstetrical consultants called upon in emergency by doctors 40 attending confinements in the district. The cost to the council was £21. (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. There is also a mercury vapour lamp at the Cynthia Mosley Day Nursery but its use is confined to the children there. (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 and the service is now 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. A dental clinic has now been established at the Belgrave hospital for conservative treatment and efforts are made at all welfare centres to induce parents to agree to treatment. Ignorant opposition and inertia, however, are delaying progress. 41 Particulars of the numbers receiving treatment now follow :— Number of Patients Receiving Treatment, and Cost, for Twelve Months, January—December, 1938 (inclusive). Hospitals No. of Patients Cost £ s. d. Belgrave Hospital 193 62 14 6 King's College Hospital 71 23 1 6 St. Thomas's Hospital 81 26 6 6 Royal Waterloo Hospital 8 2 12 0 353 £114 14 6 Cases referred by welfare centres Belgrave King's St. Thomas's Royal Waterloo North Marsh — — 1 5 Barley Mow — 28 — Babies Care 28 4 3 2 Moffat fnstitute 2 — — St. Anne's 28 7 5 Rose McAndrew 25 10 North Brixton 51 1 1 Stockwell 16 3 2 Brixton 22 2 1 — Loughborough 9 24 1 Norwood 11 30 3 St. Thomas's 1 — 26 — General Lying-in — — 1 — 193 71 81 8 42 summary relating to the work at welfare centres WELFARE CENTRE North Marsh Barley Mow North Lambeth Babies' Care Moffat " Rose Mc Andrew " 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 57 168 378 100 376 304 163 361 197 349 373 692 75 467 4,060 2. Post-natal Cases — — 20 1 — 154 5 56 47 131 106 396 99 241 1,256 3. Nursing Mothers 100 451 852 393 646 506 515 738 350 442 919 426 24 125 6,487 4. Infants (under 1 year) 102 452 1,096 336 909 308 515 924 588 760 629 483 — 125 7,227 5. Children (aged 1-5 years) 104 555 1,009 169 965 264 388 1,238 387 1,295 432 205 79 7,090 Total 363 1,626 3,355 999 2,896 1,536 1,586 3,317 1,569 2,977 2,459 2,202 198 1,037 26,120 Total Numbers op Sessions Held I. Ante-natal — — 49 27 — 43 50 107 57 96 100 151 — 303 983 2. Medical " Consultations " 52 50 99 86 94 48 200 245 97 215 148 103 148 1,585 3. Dental — 25 — — — 62 — 24 62 51 95 319 4. Toddlers 12 12 26 21 52 33 47 50 12 24 47 100 — 66 502 5. Others 44 82 33 182 90 42 50 232 — 199 93 — 190 51 1,288 Total 108 144 207 341 236 166 347 696 166 558 450 405 190 663 4,677 Total Numbers or all Attendances at the Sessions 1. Ante-natal Cases: (a) Ante-natal — — — — — 321 326 — — — — — — 2,918 3,565 (b) Seen by Medical Officer 21 65 309 305 — — 1,850 1,772 8 64 1,236 1,537 3,279 11,238 (c) Otherwise dealt with 22 36 — 177 — 43 383 — 661 (d) Dental — 441 77 254 52 233 1,057 (e) Others Ill 118 — — 862 194 135 — 41 45 141 649 2,296 Total 154 219 309 305 862 515 2,488 2,213 948 1,741 1,932 3,331 649 3,151 18,817 Post-natal: 11 154 82 (6) Otherwise dealt with 23 (c) Dental 71 96 7 174 (d) Others — — — — — — — 287 196 1,925 — 2.408 Total — — 11 4 — 154 31 82 52 553 398 403 1,925 333 3,946 2. Nursing Mothers : (a) Seen by Medical Officer 346 1,743 953 2,511 1,842 1,270 2,945 1,893 742 2,243 3,069 1,444 — 1,042 22,043 (6) Otherwise dealt with 493 805 1,238 2,407 1,701 1,962 3 831 — 48 (c) Dental — — — 65 — — — 505 43 32 — 103 748 (d) Others 225 1,025 484 504 — 760 — — 5 117 — — 390 — 3,510 Total 1,064 3,573 2,675 5,487 3,543 3,992 6,776 2,398 2,680 3,873 10,045 1,444 390 1,193 49.133 43 summary relating to the work at welfare centres-continued WELFARE CENTRE North Marsh Barley Mow North Lambeth Babies' Care Moffat " Rose McAndrew " St. Anne's North Brixton Loughborough Junction Stockwell Brixton West Norwood St. Thomas's ; Hospital (Main Building) St. Thomas's Hospital (37 Royal St.) General Lying-in Hospital Totals Total Numbers of all Attendances at the Sessions 3. Infants (under 1 year) : (a) Seen by Medical Officer 356 1,263 1,607 1,506 3,055 1,078 2,937 3,646 1,651 3,990 2,233 2,238 1,042 26,602 (b) Otherwise dealt with 506 514 1,713 748 2,143 1,665 3,850 — 5,172 2,961 3,932 — — 91 23,295 (c) Dental — — — 5 — — — — — — — — — — (d) Others 231 469 — 158 — — — — 12 438 232 — '— 1,540 Total 1,093 2,246 3,320 2,417 5,198 2,743 6,787 3,646 6,835 7,389 6,397 2,238 — 1,133 51,442 4. Children (aged 1-5 years) : (a) Seen by Medical Officer 477 1,260 1,535 1,333 1,880 1,199 1,827 2,702 1,137 2,059 1,174 1,254 — 768 18,605 (b) Otherwise dealt with 583 400 1,181 454 1,37 5 456 2,394 — 3,704 2,414 2,235 — — 105 15,301 (c) Dental — — — 16 — — — 226 — 102 105 14 ' — — 463 (d) Others 322 249 — 1,717 — — — — 33 549 138 — — — 3,008 Total 1,382 1,909 2,716 3,520 3,255 1,655 4,221 2,928 4,874 5,124 3,652 1,268 — 873 37,377 Ante-natal Cases : 49 93 285 143 297 194 303 341 194 228 114 147 77 2,465 (b) Re-visits 197 577 558 209 1,223 947 159 615 162 397 234 — 794 187 6,259 Total Visits 246 670 843 352 1,520 1,141 462 956 356 625 348 941 264 8,724 1. Post-natal : (a) First Visits 26 — 26 95 — 249 359 467 69 409 443 19 55 2,217 (b) Re-visits 17 — 1 — — — — — — 149 — — 52 — 219 Visits and Re-visits Paid to Homes Total Visits 43 — 27 95 — 249 359 467 69 558 443 — 71 55 2,436 2. Nursing Mothers : (a) First Visits 55 173 385 107 402 281 359 547 262 313 136 34 3,054 (b) Re-visits 693 4,160 1,368 723 1,664 6,405 1,146 659 836 747 2,483 — 1,122 618 22,624 Total Visits 748 4,333 1,753 830 2,066 6,686 1,505 1,206 1,098 1,060 2,483 1,258 652 25,673 3. Infants (under 1 year) : (a) First Visits 56 136 488 204 506 268 356 698 288 574 415 — 98 56 4,143 (b) Re-visits 713 1,639 2,857 928 2,383 3,020 1,141 1,869 2,029 1,873 2,561 — 452 650 22,115 Total Visits 769 1,775 3,345 1,132 2,889 3,288 1,497 2,567 2,317 2,447 2,976 — 550 706 26,258 4. Children (aged 1-5 years) : (a) First Visits 59 79 118 158 503 264 135 368 46 723 44 — 74 58 2,629 (b) Re-visits 1,595 5,153 4,390 3,089 2,935 3,387 2,454 1,814 3,877 2,631 4,840 — 2,755 1,007 39,927 Total Visits 1,654 5,232 4,508 3,247 3,438 3,651 2,589 2,182 3,923 3,354 4,884 — 2,829 1,065 42,556 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, and the plans of one in the Norwood division on the County Council's Tulse Hill estate are now practically complete. Incorporated in the one building besides the nursery are a welfare centre and a school clinic. 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 10,315 attendances during the year upon 248 working days, giving an average daily total of 41 children accommodated. The gross cost per child per day has risen to over three shillings and sevenpence compared with two shillings and five pence in 1937. The increase is due to a number of causes of which the cost of food is one, but the largest item is the rent and upkeep of a flat taken over in the middle of the year to enable the staff to be adequately housed. Proposals were made by the voluntary committee for the extension of the premises at a cost of some £5,000 earl}- in 1937. It had been found then that the staff accommodation was much below the standard in many other institutions and it was increasingly difficult to obtain and keep a happy and contented staff in the overcrowded conditions. The committee of the council deferred action for a year for various reasons and then were unable to put forward any recommendation to the Council for a grant towards the cost of building. The voluntary committee of the nursery were obliged to drop the extension scheme altogether and rented a flat to meet the urgent requirements. This course is by no means 45 so satisfactory as the extension but there was no other alternative. 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. Developments and Changes in the Maternity and Child Welfare Scheme during the Year (i) Institutional provision for Mothers and Children. One bed at the Zachary Merton Convalescent Home, Rustington, maintained by the Borough Council, has been filled throughout the whole period from the time the home was opened on the 28th April, 1937. The demand was greater than the accommodation could provide and the Council therefore decided to maintain a second bed from the 8th February, 1938. Each bed includes accommodation for an infant and a toddler with the mother. From the time the home opened until the end of December, 1938, the beds have been kept full and have accommodated 60 mothers with 56 babies and 15 toddlers. They usually stay for two weeks and exceptionally for one month. (ii) Free Meals. The Council agreed with the Invalid Kitchens of London to pay, with the consent of the Minister, a grant of £50 towards the establishment expenses of a kitchen and the charges for meals to expectant and nursing mothers, and children under the age of five 46 years sent to the kitchen from the welfare centres. The charge for an adult's meal is 8d., and for a child's 4d. During the twelve months the kitchen provided 7,001 meals, 4,145 for adults and 2,856 for children, at a cost of £ 185 15s. 4d, exclusive of the £50 grant. The kitchen has been of great use in the area within easy reach and while some few cases have been referred to the kitchen, which is situated at the north end of the borough in the Lambeth Road, from the centre of the borough, none at all have been able to avail themselves of it from the southern half of the borough owing to the distance from their homes. The suggestion of setting up a second kitchen to meet the needs of the southern half of the borough has not yet received consideration. Great care is exercised to ensure that only the necessitous are given free meals and then only upon the certificate of the medical officer of their welfare centre. The kitchen has been visited regularly by the health visitors and experience has shown that really good well-cooked food has always been served and has been consumed by the persons for whom it was intended. The addition of one regular good meal a day over a period has had a great influence upon the standard of nutrition and the addition to the diet has done much to ameliorate the circumstances of the necessitious recipients. The Council have approved the continuation of the financial arrangements with the Invalid Kitchens of London for a second year. 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 i ts 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 1938 30,219 7 1 51 47.2 Summary of Work carried out (Visits Paid) by the 4 Whole-time Official Health Visitors during 1938. Ante-natal Visits 1,588 Do. Re-visits 90 Births, 1st Visits 1,052 Do. Re-visits 420 Do. Stillborn 92 Ophthalmia, 1st Visits 78 Do. Re-visits 76 48 Infantile Deaths, Visits 21 Welfare Centre Attendances 534 Diphtheria Prevention Clinic Attendances 102 Visits—No result 1,436 Visits to Children 1-5 873 Puerperal Pyrexia, 1st Visits 36 Do. Re-visits 17 Post-natal Visits 1,366 Do. Re-visits 17 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 65, of which 34 occurred in primiparae, 26 in multiparae, while the particulars of the remaining 5 were not ascertained. The causes giving rise to the notifications are detailed in the following table:— Cause Primiparae Multiparae Medical Ante-natal care Yes No Manual interference 1 3 4 Abortion 3 6 9 Caesarean section 3 2 1 Mastitis 9 2 10 1 Influenza, Bronchitis, etc. 3 3 6 Pyelitis, cystitis 6 4 10 — Sepsis 6 6 9 3 Various 3 2 4 1 Totals 34 26 45 15 d 50 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. 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 31 si March, 1938. Item Particulars Total including Depreciation or Loan Charges 1 Revenue Account— Gross Expenditure £ 55,221 2 Gross Income 2,705 3 Net Cost 52,516 4 Unit Costs— Gross Expenditure, per ton s. d. 17 9 5 Gross Income, per ton 10 6 Net cost, per ton 16 11 7 Net cost per 1,000 population £191.8 8 Net cost per 1,000 houses or premises from which refuse is collected £1,050.3 9 Total refuse collected 62,223 tons 10 Population: Midsummer, 1937 ... 273,800 11 Area (statute acres) 4,083 12 Weight per 1,000 population per day (365 days to year) 12.45 cwts. 13 Number of houses and premises 50,000 approx. 51 14 Method of Collection No. of vehicles Percentage of refuse collected Horse vehicles Nil % Mechanical vehicles 3 lorries and 2 freighters with mechanical horses for portable refuse containers 13 Container system (combination of mechanical and horse vehicles) 6 lorries and 23 containers 87 15 Method of disposal Controlled tipping 16 Average length of haul to point of disposal at wharf 1.86 miles Street Cleansing. Table showing Costs for the Year ended 31s< March, 1938. Item Particulars Street Sweeping and Watering Gully Cleansing Snow Removal £ £ £ 1 Revenue Account— *Gross Expenditure 43,753 2,382 64 2 Gross Income 1,794 — — 3 Net cost 41,959 2,382 64 4 Unit Costs— Net cost per 10,000 square yards cleansed 10s. 4d. — — 5 Net cost per 1,000 gullies cleansed — £58.14 — 6 Net cost per 1,000 of population £155.25 £8.7 £0.23 * Including loan charges, depreciation, etc. 7 (a) Square yards of streets cleansed, inclusive of footpaths 2,093,625 (6) Number of square yards of streets cleansed multiplied by number of cleansings during year 609,188,000 52 8 (a) Total number of Gullies cleansed approx. 11,000 (6) Number of gullies cleansed multiplied by number of cleansings during year 40,969 9 Total mileage of streets cleansed 142.34 10 Approximate mileage cleansed three times daily 10.7 „ ,, „ twice „ 10.3 „ ,, ., once „ 45.63 11 „ ,, four times weekly 4.5 » i. 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 168 Sanitary Inspection of the Area. 4,920 Notices were served during the year 1938, as follows:— Public Health (London) Act, 1936, Housing Act, 1936, etc. (a) District Sanitary Inspectors. Preliminary or Intimation Notices. (1) Male Inspectors 3,130 (2) Women Inspectors 267 3,397 Nuisance Notices. (1) Male Inspectors. P.H. Act 259 (2) Women Inspectors 1 260 Disinfection Notices 1,188 (b) Food Inspectors. (1) Public Health (Meat) Regulations, 1924 40 (2) Public Health (London) Act, 1936 — 40 Carried forward 4,885 53 Brought forward 4,885 (c) Housing Inspectors. Informal Schedules 21 Formal Notices 14 — 35 Total 4,920 7 Summonses were issued, with results as follows :— Public Health (London) Act, 1936. Convictions — Summons withdrawn on costs 1 — 1 Food, and Drugs (Adulteration) Act, 1928. Convictions 5 Summons withdrawn — Summons dismissed — Summons dismissed on costs — 5 Pharmacy Poisons Act, 1933. Convictions 1 — 1 Total 7 Sanitary Staff. The sanitary inspectorial staff consists of 11 district sanitary inspectors, 2 special sanitary inspectors (food), 2 special sanitary inspectors (housing), 1 special sanitary inspector (overcrowding), 2 women sanitary inspectors—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 1938. Inspections 12,670 Re-visits 23.206 54 Complaints received 3,620 Water Certificates issued (1,951 separate houses or tenements 107 including 56 blocks of tenements) Drains tested (with chemical, water or smoke test) 3,750 Sanitary Works completed 3,921 Sanitary Nuisances 13,356 1. Bath Waste : (a) directly connected to drain 2 (b) improperly trapped or untrapped ; defective 59 2. Basement dwellings: (a) inspections 24 (b) reinspections 6 3. Ceilings and walls : defective 1,206 4. Chimney : defective 92 5. Copper: defective 119 6. Damp condition of premises 875 7. Dilapidated condition of premises 110 8. Door : defective 152 9. Drains: (a) defective 265 (6) fresh air inlet defective 139 (c) gulley defective 137 (d) manhole defective 62 (e) plunging eye defective 41 (/) soil pipe defective 86 (,g) stopped 292 (h) trap insufficient 4 (i) ventilation insufficient 17 (j) vent pipe defective 72 10. Dustbins: (a) defective or dilapidated 61 (b) absence of 79 55 11. Fireplace : defective 355 12. Floors: defective 376 13. Lavatory waste: directly connected to drain, improperly trapped or untrapped 18 14. Paving (yard or area): (a) defective 218 (b) undrained 8 15. Rainwater pipe and gutters : (a) rainwater pipe defective 240 (b) gutters defective 305 (c) rainwater pipe directly connected to drain 7 16. Roof: defective 1,031 17. Sinks : (a) defective 241 (b) directly connected to drain 6 (c) improperly trapped or untrapped 144 (id) waste defective 245 18. Stable: (a) absence of proper manure receptacle 4 (b) drain defective 2 (c) paving defective 1 (d) undrained 2 19. Washhouse : (a) roof defective 56 (b) paving defective 53 (c) undrained 1 20. Water closet: (a) defective so as to be a nuisance 216 (b) improperly constructed so as to be a nuisance 34 (c) insufficient or improper accommodation 11 (d) pan and trap defective 298 (e) deficient or defective water supply 182 56 21. Water supply: (a) cut off 61 (b) draw-off from main required 5 (c) no supply 18 (d) pipes, taps, etc., defective 146 (e) storage cistern defective or uncovered 17 (/) storage cistern so foul as to be a nuisance 10 (g) tenement houses supplied 10 22. Windows : defective 566 23. Animals : improperly kept 29 24. Bakehouses: (a) inspections 196 (b) reinspections 95 (c) dirty 74 25. Dirty premises : (a) walls and ceilings of rooms dirty 2,717 (b) rooms, etc., verminous 522 (c) stable premises dirty 5 (d) washhouse walls and ceilings dirty 346 (e) water closet walls and ceilings dirty 424 (/) workshops and factories 25 26. Effluvium nuisance : (a) from industrial premises 11 (b) from private premises 19 27. Lighting and ventilation : defective 14 28. Manure: accumulation or deposit injurious to health 3 29. Overcrowding 2 30. Rats infestation : (a) Industrial premises 15 (b) Private premises 169 31. Refuse accumulations 158 32. Smoke nuisance : (a) from industrial premises 40 (b) from private premises 18 57 33. Stagnant water : accumulation 28 34. Underground rooms : occupied as a dwelling 9 35. Urinal: foul 15 In addition, the district sanitary inspectors carried out during 1938 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 wherein males are employed, common lodging-houses, 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, 1920-38. During the year 9 inspections were made and 9 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 eight 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. 58 Home Office Table. Factories, and Other Premises. 1.—Inspections for purposes of provisions as to health. Including inspections made by Sanitary Inspectors Premises (1) Number of Inspections (2) Written Notices (3) Occupiers prosecuted (4) Factories : With mechanical power 332 33 - Without mechanical power 296 28 - Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 414 1 i Total 1,042 71 - 2.—Defects found. Particulars Number of Defects Number of defects in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 123 107 — — Overcrowding (S. 2) — — — — Unreasonable temperature (S- 3) — — — — Inadequate ventilation (S. 4) 11 11 — — Ineffective drainage of floors (S. 6) 2 1 — Sanitary Conveniences (S. 7) : Insufficient — Unsuitable or defective 24 15 — — Not separate for sexes 6 5 — — Other offences 20 13 — (Not including offences relating to HomeWork or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921. and re-enacted in the Third Schedule to the Factories Act, 1937) Total 186 152 — 59 Outwork in Unwholesome Premises. Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) Wearing Apparel- Making, etc. 137 — — Cleaning and washing — — — Household linen — — — Lace, lace curtains and nets 2 — — Curtains and furniture hangings — — — Furniture and upholstery — — — 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 — — — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags 15 — — Brush making 2 — — Pea picking — — — Feather sorting — — — Carding, etc., of buttons, etc. 3 — — Stuffed toys 2 — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, etc. 1 — — Textile weaving — — — Lampshades — — — Fancy articles, pin cushions, milk bottle covers, etc. 5 — — Stringing cotton bags 13 — — Pot scourers 2 — — Total 183 — — 60 Summary of Work carried out by the Women Sanitary Inspectors during 1938. Factories visited and inspected 645 ,, workrooms therein measured 6 „ newly discovered and registered 6 Premises visited, but not inspected, owing to the persons or patients concerned being out, or, if employees, being no longer employed 456 Women's Conveniences visited and inspected, etc. (visits paid) 964 Special places visited and inspected : (a) Restaurants 395 (b) Housing enquiries 560 (c) Outworkers 180 (d) Complaints, Infectious diseases, etc 67 - 1,202 Re-inspections: (a) Restaurants 74 (b) Housing enquiries 53 (c) Outworkers 3 (d) Complaints, etc 19 - 149 Written intimation and nuisance notices served 268 Visits to factories in which defects were found 305 Visits to factories in which no defects were found 1,734 Nuisances referred to M.O.H., for attention by male inspectors 6 Particulars of Defects found by Women Inspectors. Factories:— Workrooms : Dirty, etc 2 Defective or dirty: Yards, floors, roofs, windows, walls and ceilings, rain water pipes, sink wastes, or premises generally 80 61 Sanitary Appliances : Water Closets—dirty, unventilated, choked, defective or with defective cistern or water supplies 18 Drainage—defective 1 Dustbins—wanting or defective 8 Lavatories—dirty or defective — No separate suitable sufficient W.C. accommodation for the sexes 1 No W.C. accommodation — Factories. Thirty-five new factories dealing with various trades were added to the register in the course of the year. Out-workers. Fifteen February and fourteen August lists were received, dealing with 137 and 109 out-workers respectively. Of the 246 out-workers 141 belonged to Lambeth and the remainder lived in other areas. Particulars of the latter were sent to the authorities concerned, while in return, 91 lists were received from various outside authorities dealing with 465 out-workers living in Lambeth. Of the total Lambeth out-workers reported 38 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 Act, 1937, of all places where female labour is employed. They visit regularly the kitchens, etc., attached to all restaurants and cafes where food is prepared and cooked, but in the case of public houses, however, it is found to be more convenient to leave the inspection of kitchens to the district sanitary inspectors. 62 Registrations Effected and Licences Granted. Under the Transfer of Powers (London) Order, 1933, dated March 9th, 1933, made by the Minister of Health, under Section 64 of the Local Government Act, 1929, certain functions hitherto exercisable by the London County Council were transferred to the various Metropolitan Boroughs from the 31st March, 1933. The Borough Council was given control over cow-houses, slaughter-houses, common lodging houses and offensive trades, and licences were granted and registrations were effected as 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) (F. J. Crouch). 60 Kennington Park Road (T. H. Grellier). Ten slaughterers' licences wjre granted under the provisions of the Slaughter of Animals Act, 1933. (d) Common Lodging-houses. Three common lodging-houses were licensed (renewals) as follows:— 19 Belvedere Crescent. 106 Wandsworth Road. 88, 90 and 92 Westminster Bridge Road. (e) Milk Shops. (See page 71.) (f) Ice Cream Vendors. At the end of the year there were 267 known vendors of ice cream in Lambeth. All premises used for the 63 facture 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 116 bakehouses on the Register compared with 222, 214, 214 and 140 for the years 1901, 1911, 1921 and 1931 respectively ; 43 are underground, and machinery is installed in 106. (h) Food Premises. (See page 74.) Shops Act, 1934 Thirteen inspections and two reinspections 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 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 40 No. of intimation notices served 40 No. of observations made 58 Every effort is made to enlist co-operation with industry by the sanitary inspectors in order to reduce the waste and nuisance from smoke. 64 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. Eighteen samples of water from the public swimming baths in the borough were submitted for bacteriological examination. There is at present no legal standard of cleanliness of such water but the results of the analyses of the samples taken may be regarded as satisfactory. 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 Repair, Maintenance and Sanitary Condition of Houses. Housing Act, 1936. Part II. Section 9. Surveys made during the year 21 „ „ but no action called for 9 Premises made fit after service of legal notices 28 „ „ „ by informal schedules 48 „ where works were outstanding on 31st December 7 Service of legal notices during the year 14 65 Section 10. Nos. 22 to 64 Knowle Road—-22 houses were repaired by the Council, and the costs recovered. Section 11. Representations (Demolition Orders) made during the year 20 Demolition Orders made (7), Undertakings accepted (3) 10 „ „ not made before 31st December 10 „ „ complied with 6 „ „ not yet complied with 3 Premises surveyed but not yet represented 10 „ „ but no action found to be necessary 14 Section 12. Representations made during the year 109 (a) Underground rooms (210) (b) Parts of buildings (27 rooms). Formal action. Closing Orders made (55).; Undertakings accepted (24) 79 „ „ not yet made 26 ,, „ determined (5); complied with (46) 51 „ „ or undertakings not yet complied with 24 Premises made fit after representation 52 „ vacated or closed after representation 36 „ surveyed but not yet represented 13 Informal action. Premises made fit after informal action 103 (a) Underground rooms (218). (b) Parts of buildings (14 rooms). Premises closed or vacated after informal action 46 „ where works are still outstanding after informal action 11 „ surveyed but no action found necessary 92 (а) Underground rooms (195). (б) Parts of buildings (5 rooms). Drain tests made (chemical, smoke and water) 408 Total visits (revisits 9,717) 10,112 66 Clearance Areas. Housing Act, 1936. Part III. The London County Council made an order for Reedworth Street clearance area 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. Abatement of Overcrowding. Housing Act, 1936. Part IV. 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 2,549 Number of families dwelling therein 2,549 Number of persons dwelling therein 13,179* b.—Number of New Cases of Overcrowding Reported During the Year :— 132 cases—584J persons concerned. C.—(1) Number of Cases of Overcrowding Relieved During the Year :— County Council 276 745 Borough Council 25 Otherwise relieved 444 (2) Number of Persons Concerned in such Cases :— County Council 1,372½ 3,566 Borough Council 119 Otherwise 2,074 D.—Particulars of any cases in which Dwelling-houses have become Overcrowded after the L.A. have taken steps for the abatement of overcrowding 4 67 1 No. 9 Benton's Lane, S.E. 27. Four rooms, permitted number 7½ units, family of 8J units rehoused on 8th November, 1937. Relet by owner to a family of 5 units in November but gradually other members of the family came to reside there until by April there were 8£ units coupled with a rag and bone business and considerable arrears of rent. The owner was requested to take steps to abate the overcrowding and the family then moved. 2 No. 27 Lambeth Walk, S.E. 11. Two rooms permitted number 3 units, family of 5½ units accommodated on 1st November, 1937. Relet by tenant to a family of 4 units. Owner requested to take steps to abate overcrowding which was effected by one member sleeping at the grandmother's home. 3 No. 37 Burdett Buildings, S.E. 1. Two rooms, permitted number 3 units, family of 4 units rehoused in September, 1936. Premises were relet in June, 1937, to a family of 3 units but after possession was taken five more boys, equalling 4 units, appeared in the family circle making 9 persons (7 units) in all. The owner gave notice to quit but nothing was done until on pressure the owner obtained a court order for possession and the family were rehoused by the County Council. 4 No. 101 Briscoe Buildings, S.W. 2. Three rooms, permitted number 5 units, family of 5½ units rehoused in June, 1936. Premises were relet in June, 1936, to a family of 5 units and became overcrowded in June, 1938, owing to one child attaining the age of ten years. Owing to the financial circumstances the family were unable to take a larger flat and were still overcrowded at the end of the year. A four-roomed flat was to be offered when opportunity arose. 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 overcrowding offences) and sections 4 and 68 of the Act is July 1st, 1937. Rehousing. During the year, 325 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 1,312. 274 families were rehoused during the year, and the total number of cases rehoused by the County Authority in connexion with the 68 abatement of overcrowding is 556. In a further 305 cases overcrowding has been abated by other means such as the family obtaining alternative accommodation. Rehousing other than overcrowded, cases. During the year 236 fresh applications for housing accommodation were received in the Public Health Department (mostly from the applicant in person), and of these 58 were sent forward to the county authority for attention or preferential treatment, while in addition, 49 applications were recommended for housing on the Lambeth Council Estates. The remaining 129 after careful scrutiny, could not be recommended for various reasons, such as insufficient income or other circumstances. Of the 107 cases referred to, 20 have been accommodated (16 by L.C.C. and 4 by L.B.C.) leaving 87 pending decision and allocation. The following table shows particulars of the 236 applications received. Housing Applications, 1938. Number of Persons in Family Number of Rooms Occupied Total Persons 1 2 3 4 5 6 1 1 1 — — — — 2 2 — 15 6 1 1 — 46 3 3 40 21 6 1 — 213 4 1 25 26 11 3 2 272 5 — 7 23 11 2 1 220 6 — — 9 7 — — 96 7 — — 3 6 1 — 70 8 — — — 1 — — 8 9 — — — — 1 — 9 10 — — — — — — — 11 — — — — — — — 12 — — — — — — — Total Families 236 5 88 88 43 9 3 Total Persons — — — — — — 936 69 Ministry of Health Table. 1—Inspection of Dwelling-Houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 13,065 (£>) Number of Inspections made for the purpose* 32,923 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations 21 (fc) Number of Inspections made for the purpose* 189 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 20 (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 109 2—Remedy of Defects during the Year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,710 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 14 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 28 (6) By Local Authority in default of owners 22 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 259 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 207 (b) By Local Authority in default of owners — * Total re-inspections during 1938. 70 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 7 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6 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 55 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 51 71 INSPECTION & SUPERVISION OF FOOD. (a) Milk Supply. 61 applications were approved by the Borough Council for registration under the Milk and Dairies Order, 1926. 29 of the applications were change of purveyor at registered premises, 57 were for the sale of milk in sealed bottles only. Special licences were issued in accordance with the Milk (Special Designations) Orders, 1936 and 1938, as follows:— Tuberculin Tested, 21; " Pasteurised " Milk, 34 (Pasteuriser's Licence 1, Dealer's Licence 33) (63 premises) ; Supplementary Licences, 11 ; Tuberculin Tested (Pasteurised), 3. (b) Meat and Other Foods. (a) Public Health {Meat) Regulations, 1924. (1) Number of *visits paid to slaughterhouses 102 (2) Number of 'visits paid to meat shops, meat stalls, and meat stores 809 (3) Number of actual slaughterings at which one or other of the food inspectors was present, consisting of sheep (502), pigs (200), and calves (8) 710 (4) Carcases, or portions of carcases, condemned 14 * Visits include re-visits also. 72 Carcases Inspected and Condemned Cattle (excluding) cows) Cows Calves Sheep and lambs Pigs Number killed — — 8 502 200 Number inspected — — 8 502 200 All diseases, except tuberculosis — — — — — Tuberculosis only (whole carcases condemned) — — — — — Carcases, of which some part or organ was condemned — — — — 14 Percentage of number inspected affected with tuberculosis — — — — 7 In addition to the above-mentioned carcases or parts of carcases, the following unsound food was condemned and destroyed :— Meat— tons cwts. qrs. lbs. Veal 0 0 0 22 Pork 0 7 3 27 Bacon and Ham 0 3 3 20 Rabbits (141) 0 3 1 2 Poultry— Ducks (15) 0 0 2 23 Fowls and Hens (219) 0 6 — 24 Turkeys (16) 0 1 1 26 Game—- Pheasant (1) 0 0 0 2 Wood pigeons (2) 0 0 0 2 Fruit and Vegetables— Pears 0 1 1 10 Plums 0 2 2 — Gherkins 0 — 2 — Beetroots 0 8 — — Potatoes 0 1 — — Fish— Cod Fillets 0 0 0 14 Haddock 0 0 2 24 Skate 0 0 0 21 Shrimps 0 0 0 9 Herrings 0 0 3 22 Dogfish 0 0 2 — * Canned Food and Groceries 5 2 0 8 * Including 2 tons 2 cwts. of canned food and groceries condemned and destroyed by order of Justices, in respect of which four summonses were issued against a firm of canned goods merchants for depositing unsound food for the purpose of sale, and fines totalling £20 with £5 5s. costs were imposed. 73 (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, condensed milk, pepper 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. 24 formal samples (4 of vinegar, 9 of condensed milk, 1 of borax, 1 of dripping, 2 of whisky and 7 of milk) or 3 per cent, of the number taken were reported by the Public Analyst to be adulterated. In 6 cases proceedings were instituted against the offenders, and in 9 cases letters were sent to the vendors pointing out the adulteration and warning them against a repetition of the offence. The remaining 9 adulterated samples were of unsweetened condensed milk forming part of a representative batch of samples from a consignment of approximately 26,000 tins which had been imported into this country and which were lying at a wharf in this borough. The tins of milk were not labelled in accordance with the provisions of the Public Health (Condensed Milk) Regulations, 1923, and although the tins were being relabelled to comply with the regulations a stop notice was placed on the goods until samples had been taken and the analyses had been received. Of 50 samples 9 were found to be below the required standard and, as a result, an arrangement was made with the owners of the milk to dispose of it for purposes other than for human consumption. 661 samples of milk were procured from various sources as set out in the following table :— From retailers 445 On delivery to retailers 27 ,, ,, ,, schools 27 ,, „ „ hospitals and institutions 108 At railway stations 54 Of the 445 samples of milk procured from retailers 347 were taken during the day time. 98 samples were obtained from roundsmen in the early morning. 74 Warning Letters. The number of formal samples found to be adulterated was 24. Legal proceedings were instituted in six cases, and warning letters were sent to the vendors of other samples as required. Police Court Proceedings. Following is the summary of proceedings at the Lambeth Police Court in respect of an offence against the Food and Drugs Act:— Case No Offence Result 53 Selling borax containing 170 parts per million excess arsenic Dismissed under Probation Act on payment of 3 guineas costs 266 Selling milk (to a retailer) containing 3 per cent, extraneous water and being 3 per cent, deficient in milk fat Dismissed under Probation Act on payment of 5 guineas costs 383 Selling whisky diluted with water 9.6° over legal limit £8 fine and £5 5s. costs 527 Selling milk (to an institution) 4 per cent, deficient in milk fat Fined £10 and 5 guineas costs 599 Selling milk 21 per cent, deficient in milk fat Dismissed under Probation Act on payment of one guinea costs 650 Selling milk (to an institution) containing 6 per cent, extraneous water Fined £30 and 5 guineas, 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. 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. 75 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. 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 343, 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 291 Milkshops 1,066 Ice cream premises 384 Restaurants, etc 469 Generally speaking, the conditions disclosed have been found satisfactory, and such alterations and cleansing found to be needed have been carried out as a rule without the service of notices. Merchandise Marks Act, 1926. No prosecutions have been instituted during the year for offences against this Act; the requirements of the Marking Orders have been generally observed by traders although the exercise of constant supervision has been necessary. With regard to the marking of imported eggs, however, suspicions have been entertained that there have been instances of imported eggs being offered for sale as "English" after removal of the marking on the shell. Owing to difficulty in obtaining positive evidence it has not been possible to institute proceedings but the matter is still receiving attention. 76 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.) Five samples of poison or of substances suspected of containing poison were submitted to the Public Analyst : two of oven cleaner (informal) ; two of strong ammonia (one formal and one informal); and one of Lysol B.P. (informal). The samples of strong ammonia did not comply with the requirements of the Poisons Act and Rules as to labelling, and type of container. As the vendor had been previously warned against a repetition of this offence proceedings were instituted and fines totalling £3 and 5 guineas costs were imposed. The results of samples of oven cleaner showed that they were exempt from the operation of the Act and the sample of lysol that the particulars on the container were correct. Periodical visits have been made to the premises of listed sellers of poisons. 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 a Informal r Number Analysed 1 Number Adulterated ( Number Analysed Number Adulterated Aerated Waters — — 8 — Apples — — 6 — Arrowroot — — 9 — Baking Powder — — 10 — Barley, Pearl — — 9 — Biscuits — — 10 — Black Pudding — 1 — Blanc mange powder — — 6 — Bread — — 21 — 77 Food and Drugs.—continued. Samples Formal A. Informal Number Analysed Number Adulterated ( Number Analysed Number Adulterated Bunflour - - 5 - Butter 36 — 166 1 Cake — 2 Cakes, Sponge — — 12 Cheese — — 12 Cheese, Wrapped — — 9 Chocolate Powder — 1 Cocoa — 26 Coconut, Degsiccated —. 4 - Coffee 18 Coffee and Chicory — — 3 Coffee and Chicory Extract — — 6 Confectionery — — 11 Cooking Fat — — 6 Corn Flakes — — 1 Cornflour — 6 Cream — 10 Cream, Tinned — 7 Curry Powder — — 9 3 Custard Powder — — 6 Dripping 1 1 18 — Drugs :— Acid, Boric — — 6 Acid, Citric — 6 Acid, Tartaric — — 3 Almond Oil — — 6 Alum — — 6 — Aspirin — — 6 — Borax 1 1 12 1 Camphorated Oil — — 6 — Castor Oil — — 3 — Cod Liver Oil 2 — 3 1 Cream of Tartar — — 4 — Epsom Salts — — 18 — Eucalyptus Oil — - 3 — Friars Balsam — —. 3 — Glauber's Salts — — 3 — Gregory's Powder — — 3 — Iodine Solution — — 1 1 Liniment Oil of Wintergreen — — 1 — Linseed Crushed — — 3 — Magnesium Carbonate — — 3 — Magnesium Citrate — — 3 — Ointment, Boric - - 6 1 78 Food and Drugs.—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Drugs—continued. Ointment, Iodine — 3 Ointment, Mercury — — 1 - Ointment, White Precipitate — — 1 - Ointment, Zinc 1 12 1 Paraffin, Liquid — — 3 - Powder, Liquorice Compound _ - 9 1 Rochelle Salt — — 3 Sal Volatile — 6 Soda bicarbonate — 7 Sulphur, Flowers of — — 4 Sulphur, Milk of — — 3 Sulphur Roll — — 2 Syrup of Figs — — 7 - Tincture of Arnica — 6 Tincture of Iodine — 4 Do. of Quinine (Ammon). — — 6 Vaseline — — 3 Wintergreen Oil — — 2 - Egg Substitute Powder — 5 Essence, Flavouring — 9 Fish Paste — 5 Fish, Tinned . 10 Flour 11 - Flour, Self-raising — 11 Fruit, Canned — 18 Fruit, Dried — 55 1 Ginger — — 3 Ginger, Crystallised — — 3 - Ginger, Ground — — 3 Grapefruit, Lemon, Lime and Barley Crystals - - 1 Herbs, Dried — 14 Honey — — 3 - Honey, Prepared — — 2 - Ice Cream 2 Jam and Marmalade 17 Jelly, Table — 13 Lard — 39 Lemonade Powder — 3 2 Lemon Syrup — — 1 — Lemon, Curd __ 6 Lentils — — 7 — 79 Food and Drugs—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Margarine - - 26 - Meat, Minced 6 - Meat Pie 6 - Meat 9 - Meat, Bacon — 3 - Meat Paste 5 - Milk 652 7 23 - Milk Condensed Full Cream 50 9 4 1 Milk, Condensed (Machine Skimmed) - - 6 - Mincemeat — 6 - Mustard — - 5 - Mustard Compound — — 4 - Oats, Flaked — - 2 - Oatmeal — — 9 - Olive Oil — — 9 - Peaflour — — 3 - Peel, Candied — — 6 - Pepper 1 — 9 - Pickles — — 5 - Pudding Powder — — 2 - Rice — — 6 - Rice, Flaked — — 3 - Rice, Ground — — 13 - Sago — — 9 1 Sauce — — 8 - Sausages — — 2 - Sausage, Breakfast — — 2 - Sausage, Preserved — — 1 - Sausage Rolls — — 5 - Sausage Saveloy — — 1 - Sausage, Smoked — — 1 - Sage and Onion Stuffing — — 1 - Salt — — 14 - Salad Cream — — 1 Sherbet — — 6 1 Soup Powder — — 7 — Soup, Tinned — — 6 — Spice, Mixed — — 5 — Sponge Mixture — — 1 — Spirits:— — — Whisky 10 2 4 — Suet, Shredded — — 6 — Sugar — — 15 — Syrup, Golden — — 2 — 80 Food and Drugs—continued. Samples Formal Informal Number Analysed Number Adulterated Number Analysed Number Adulterated Tapioca — — 6 — Tea — — 23 — Treacle and Syrup — — 3 — Vegetables, Dried — — 9 — Vegetables, Tinned. — — 22 — Vinegar 31 4 — — Vinegar, Non-brewed 10 — 1 — Vinegar, Spirit 3 — 1 — Wheat Preparations — — 11 — Wine — — 3 — Wine, British — — 1 — Yeast — — 6 — Totals 800 24 1,200 17 N.B.—6 summonses were issued (see page 74) Bacteriological Examinations. The following number of samples were submitted for bacteriological examination:— Milk 23 Ice Cream 18 Ham 4 Cheese 1 Butter 1 Gelatine 1 Fish Paste 1 Of the samples of milk four were procured from an institution, three from schools and the remaining 16 from vendors throughout the borough. In most cases the samples were taken after bottling and before delivery to the consumer, thus ensuring 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. 81 The reports of the bacteriologist show that in every case the milk attained a satisfactory standard of cleanliness. As the above table shows, the majority of the remaining samples were of ice cream. No legal bacteriological standard is laid down for this commodity, but the results of these examinations are useful in revealing sources of contamination in the various processes of manufacture. 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. F 82 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under the compulsory notification sections of the Public Health (London) Act, 1936, and the orders and regulations made thereunder 5,959 cases of infectious diseases (excluding tuberculosis) were reported during the year. This number is more than the number (1,990) reported in the previous year, a large proportion being attributable to measles. Measles has been a compulsorily notifiable disease in Lambeth since 1916 and although the desirability of making the disease compulsorily notifiable throughout the metropolis was first advocated in 1928 and subsequently on many occasions it was not until the County of London (Measles and Whooping Cough) Regulations made the disease notifiable in London on the 1st October, 1938 that the objective was achieved. 83 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 463 1.70 1 22 370 79.91 423 1056.5 Diphtheria 610 2.24 12 1.97 608 99.67 533 732.3 Membranous Croup 1 .003 — — 1 100.00 1 2.9 Typhus — — — — — — — — Enteric 8 .03 — — 8 100.00 8 18.4 Relapsing Fever — — — — — — — Erysipelas 109 .40 1 .92 65 59.63 108 123.2 Puerperal Fever 19 .07 2 10.53 15 78.94 19 28.7 Puerperal Pyrexia 46 .17 5 10.87 7 15.21 46 48.8 Plague — — — — — — — — Cerebro-Spinal Fever 18 .06 5 27.78 18 100.00 18 6.3 Polio-myelitis 5 .02 — — 4 80.00 5 5.4 Ophthalmia Neonatorum 50 .18 1 2.00 13 26.00 50 56.2 Measles 4,025 14.75 19 .47 784 19.47 3,483 2532.6 *German Measles 236 .86 — 58 24.57 183 425.1 Tuberculosis— Pulmonary (primary) 399 1.46 185 — — — — 507.6 Non-pulmonary (primary) 75 .27 24 — — — — 104.3 Malaria — — — — — — 6.2 Dysentery 18 .07 — — 17 94.44 18 1.3 Primary Pneumonia (Acute) 166 .61 69 41.57 82 49.39 164 228.2 Influenzal Pneumonia (Acute) 56 .21 1 1.29 6 10.71 56 123.0 †Encephalitis Lethargica — — — — — —. — 11.1 Trench Fever — — Anthrax — — — 0.2 ‡Food Poisoning 25 .001 — — 1 4.00 23 — § Whooping Cough 104 .381 3 2.88 23 22.11 87 — * Notification discontinued from the 30th September, 1938. † Deaths from Post Encephalitis Lethargica. ‡ Compulsorily notifiable from September, 1932. § Compulsorily notifiable from 1st October, 1938. N.B.—Of the cases originally notified during 1938, the following were found afterwards not to be suffering from the diseases notified:—Diphtheria, 64; Scarlet Fever, 11; Measles, 3; Whooping Cough, 1; Typhoid Fever, 2. 84 DISTRIBUTION OF CASES NOTIFIED DURINGTHE YEAR 1938 Notifiable disease Number of cases notified Total cases notified in each Registration Sub-District Total cases removed to hospital At all Ages At ages—years Lambeth North Princes Lambeth Central Lambeth South Lambeth North Princes Lambeth Central Lambeth South Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20 35 35-45 45-65 65 and upwards Small-pox — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — Diphtheria 610 9 21 47 39 59 279 70 26 47 9 4 - 77 46 207 280 75 46 207 280 Membranous Croup 1 — — — — — 1 — — — — — - — — — — — — 1 — Erysipelas 109 1 1 — 2 — 4 12 22 9 39 14 18 7 41 43 11 5 27 22 Scarlet Fever 463 8 27 30 50 39 182 67 20 31 8 1 38 10 191 224 31 9 163 167 Typhus Fever — — — — — — — — — — — — — — — — Enteric Fever 8 — — 1 — — 2 — — 3 1 1 — 4 — 2 2 4 — 2 2 Relapsing Fever — — — — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 19 — — — — — — — 1 13 5 — — 1 — 4 14 1 — 3 11 Puerperal Pyrexia 46 — — — — — — — 5 35 6 — — 9 — 15 22 1 — 5 4 Plague — — — — — — — — — — — — — — — — — — — Pulmonary Tuberculosis 398 2 1 — — — 11 8 36 149 73 101 17 42 48 167 141 — — — — Other forms of Tuberculosis 75 — — 6 3 2 15 12 8 23 4 1 1 6 7 30 32 — — — — Cerebro-spinal Fever 18 — 1 2 — 1 2 1 3 d 1 2 — 4 1 5 8 4 1 5 8 Polio-myelitis 3 — — 2 1 — 1 1 — — — — — 1 — 2 2 —- — 2 2 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 50 50 — — — — — — — — — — —- 11 6 13 20 — 1 4 8 Measles 4025 156 431 449 547 633 1599 127 37 42 3 1 — 456 319 1437 1813 137 75 316 266 German Measles 236 17 25 28 21 15 70 20 21 19 — — — 19 18 56 143 2 2 5 49 Malaria — — — — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — — — Primarv Pneumonia (Acute) 166 7 4 2 9 1 24 5 7 28 29 35 15 21 11 69 65 13 6 24 39 Influenzal ,,, (Acute) 56 1 4 5 2 4 5 3 6 5 6 11 4 16 6 16 18 1 — 2 3 18 2 1 2 2 — 4 — — 2 3 — 2 3 — S 7 2 —. 8 6 Food Poisoning 25 — — — — — — — 5 6 4 9 1 8 3 9 5 — — — 1 Whooping Cough 104 12 15 19 11 17 26 2 — — — 2 — 25 12 22 45 1 2 5 15 Isolation Hospitals. Name and Situation.—Hospitals of the London County Council (one situated in the Lambeth Central Sub-District and Stockwell Ward of the Borough of Lambeth). Number of Diseases that can be concurrently treated all usual notifiable infections deseases and whooping Cough. 85 Vaccination. Return showing the Numbers of Persons successfully vaccinated and re-vaccinated at the cost of the Rates by the Medical Officers of the County Council Institutions and the Public Vaccinators during the year, 1938. 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 80 1 81 15 12 Norwood Schools Dr. H. P. Orchard 8 26 34 — — North District Dr. R. Phillips 300 33 333 10 12 Kennington District Dr. M. I. Elliot 376 16 392 20 48 Brixton do. Dr. E.L. M. Rusby 403 23 426 17 — Norwood do. Dr. H. P. Orchard 400 34 434 43 9 Totals 1,567 133 1,700 105 81 F 86 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 103 more cases of diphtheria notified than in the previous year and the incidence per 1,000 population rose from 1.85 to 2.23 in 1938. The case mortality dropped from 3.94 per cent. to 1.96 per cent. a decrease of 50 per cent. The two diphtheria prevention clinics were better attended than in the previous year but the number immunised is still far too small to affect to an appreciable extent the incidence among the population. 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. One case was admitted to hospital with a sore throat of two days duration and a positive swab result after immunisation. Clinically the condition was a follicular tonsillitis with a temperature of 103°. The Dick reaction was positive but a striptococcal tonsillitis associated with a diphtheria carrier condition was excluded; antidiphtheritic serum was given as a precaution and the case cleared up in five days. The modified clinical picture and rapid disappearance of diphtheria bacilli were almost certainly attributable to the partial immunity resulting from the prophylactic injections. 87 Diphtheria Prevention—1938. Statistics for the year ended 31st December, 1938 * 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 13 138 60 144 47 19 421 First Test Positive 13 133 60 121 27 11 365 Negative. — 4 — 21 20 7 52 Tested Only — 1 — 2 — 1 4 ReTest Positive — Negative. 6 100 39 134 20 7 306 Tested Only — 4 2 — 1 7 Total Attendances 1,833. *B Clinic at 12 Hannen Road Under 1 Year 1 to 4 4 to 5 5 to 10 10 to 15 15 and over Totals Total Cases 7 156 44 176 37 15 435 First Test Positive 6 150 43 128 19 5 351 Negative 1 3 1 43 17 10 75 Tested Only — 3 — 5 1 — 9 Test * Positive 1 1 2 Negative 2 95 39 95 15 2 248 Tested Only — 8 3 7 — — 18 Total Attendances 1,548. Borough.—Total cases = 856, of whom 716 = 83.65 per cent. were positive and 127 = 14.84 per cent. negative, while 13 had been tested only, not yet having begun the course of immunisation. Total attendances = 3,381. Average attendance per week = (49 weeks) 69. Average attendance per session = (98 sessions) 34.5. * A commenced May 8th, 1928, and B commenced July 18th, 1928. 88 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 1938, 50 cases were notified as compared with annual averages of 72.8 and 56.2 for the 10 years 1911-1920 and 1921-1930 respectively. Formerly this disease was notifiable by midwives as well as by medical practitioners with the result that many cases were "missed" and precautionary measures were consequently unable to be taken. Cases Notified Treated At Home In Hospital Vision Unimpaired Vision Impaired Total Blindness Deaths 50 40 10 48 — — 2* * One death occurred on 12th January, 1939. Contacts, Suspects, etc. The Medical Officer of Health was called in consultation by medical practitioners to see 11 patients in their homes during the year. 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. 89 The proportion of specimens found to be positive out of all those submitted was 13.8 per cent. (in the previous year, 135 per cent). Nature of Specimen Result of Examination Total Negative Positive Swabs from nose and throat of suspected cases or carriers of diphtheria 1,898 224 2,122 Sputa from cases suspected of or suffering from pulmonary tuberculosis 679 120 799 Blood for Widal reaction and/or examination for presence of— B. Typhosus 11 3 14 B. Paratyphosus A, B, and C B. Abortus Miscellaneous 58 79 137 Totals 2,646 426 3,072 During 1938, 14 vials of antitoxin were distributed free of cost under the Antitoxin Order, 1910. Disinfecting Department, 1938. 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 (1,762), chicken-pox (1,107), cancer (43), whooping cough (219), mumps (178), and others (scabies, ringworm, etc.), not classified (1,307); 869 verminous houses (1,312 rooms) and verminous articles, bedding (2,135) and clothing (4,596), were also treated. 90 Summary of work carried, out by the Disinfecting Department during 1938. Cleansing notices served 1,188 Total no. of rooms disinfected by the council 3,890 * do. articles do. 11,917 Cases in which bedding was disinfected at home 1,467 do. do. do. at chamber 1,573 Premises disinfected and disinfectants supplied 25,879 Certificates of medical practitioners received in lieu of disinfection by the council 4 Schools disinfected (25 rooms) 10 Certificates of disinfection left with occupiers of disinfected premises 1,199 Library books disinfected 456 Mattresses re-tabbed by council 302 Tuberculosis Dispensaries— Shelters lent and erected 3 Shelters dismantled and removed 2 Bedsteads and mattresses delivered 14 Bedsteads and mattresses collected 5 Bacteriological outfits (swabs, etc.), delivered 2,469 Smoke machines collected and delivered 220 Cabs, etc., disinfected 12 Maternity parcels sterilised 34 * Including 97 families (5,917 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, 32; other houses, 837. (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 91 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. Nuisance from Pigeons. Owing to complaints from many parts of the district of the nuisance and damage to property caused by pigeons, the Council reversed their previous decisions and agreed to the employment of a trapper under the provisions of section 121 Public Health (London) Act, 1936. It is unfortunate that the metropolitan boroughs standing joint committee were unable to find any unanimity for concerted action on the part of the borough councils, as it is well known that the birds travel considerable distances from their nests to feeding grounds. Trapping in one borough is likely therefore to improve conditions in neighbouring districts whose councils ought to bear their share. The council agreed to the trapping of 500 pigeons at first and then agreed to an expenditure for the year of not more than £50. The trapper was successful in catching 1,250 birds during the year which were painlessly destroyed under supervision at the council's wharf and disposed of as refuse since there is no sale for them. The cost to the council at sixpence each was £31 5s. 92 Tuberculosis. The numbers of cases of tuberculosis on the Lambeth register of notifications on December 31st, 1938, were as follows :— Males Females Totals Pulmonary 1,061 904 1,965 Non-pulmonary 162 139 301 Totals 1,223 1,043 2,266 93 TABLE L. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications received during the period from January 1st, 1938, to December 31st, 1938. 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 65 and upwards Total Pulmonary— Males — — 6 4 18 20 52 49 37 37 13 236 302 Females 2 1 5 4 18 25 52 24 17 10 4 162 203 Non-Pulmonary— Males — 5 12 6 6 3 4 2 1 — — 39 42 Females — 6 3 6 2 4 12 2 — — 1 36 39 * Re-notifications (Form A) = 107 (males 66, females 41) pulmonary, and 6 (males 3, females 3) non-pulmonary. Pulmonary— 97 private, 195 hospitals, 106 dispensaries = 398 total primary notifications. Non-pulmonary—10 private, 57 hospitals, 8 dispensaries = 75 total primary notifications. Institutional treatment.—Notifications were also received during the period stated above respecting 545 pulmonary and 38 non-pulmonary admissions, and 423 pulmonary and 46 non-pulmonary discharges. 94 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, 1938 to the 31st December, 193S, otherwise than by formal notification. 1.—Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total cases Pulmonary— Males — — — — — 2 3 6 3 3 1 20 Females — — — 1 1 5 13 3 1 1 1 26 Non-Pulmonary— Males _ 2 — 1 1 _ 1 — — — 1 6 Females — — — 3 1 1 — 2 — — — 7 2.—Source of Information. Pulmonary NonPulmonary Death Returns from local Registrars 2 4 transferable from R.G.O. 5 1 Posthumous notifications — — "Transfers" from other areas 39 8 Other Sources — — Totals 46 13 The ratio of deaths of previously notified cases of tuberculosis to deaths due to tuberculosis not notified during life is 16 to 1 in the year under review. 95 TABLE L (2). Public Health (Tuberculosis) Regulations, 1930. Summary of notification certificates, etc., received during the period from January 1st, 1938, to December 31st, 1938. 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 42 55 45 21 6 7 4 2 6 Prince's 48 66 49 29 7 8 5 4 4 1 Lambeth Central 167 218 251 197 30 31 14 16 19 8 Lambeth South 141 166 200 176 32 35 15 24 17 4 Borough of Lambeth 398 505 545 423 75 81 38 46 46 13 96 Deaths from Tuberculosis. Age Periods 0 1 5 10 15 20 25 35 45 55 65 and upwards Total Pulmonary— Males — — — 1 6 10 20 20 21 34 10 122 Females 1 — — 1 8 12 17 7 6 6 5 63 Non-pulmonary— Males ... — 2 2 1 2 — 2 1 3 — 1 14 Females — 4 1 4 — — 1 — — — — 10 Totals 1 6 3 7 18 22 40 28 30 40 16 209 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 25 3 28 0.76 0.85 Prince's 18 1 19 0.76 0.80 Lambeth Central 79 9 88 0.83 0.92 Lambeth South 63 11 74 0.52 0.61 Borough of Lambeth 185 24 209 0.67 0.76 97 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 1938 0.68 0.77 1.46 1.73 98 Lambeth Municipal Tuberculosis Dispensaries Scheme. (Inaugurated by the Council, October 3rd, 1912.) Ministry of Health Table—FORM T. 145 (Memo. 37T. 1st Schedule). Return (Prepared by the Tuberculosis Officer) of the Work carried out in connexion with the Central Dispensary for the Year 1938. 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):— 105 70 2 7 9 3 5 4 114 73 7 11 492 (b) Diagnosis not completed — — — — — — — — 29 34 5 2 (c) Non-tuberculous — — — — — — — — 85 106 16 10 B.—Contacts examined during the (a) Definitely tuberculous 20 29 2 3 — 2 1 1 20 31 3 4 641 (b) Diagnosis not completed — — — — — — — — 23 37 18 17 (c) Non-tuberculous — — — — — — — — 93 194 110 91 C.—Cases written off the Dispensary Register as:— (a) Recovered 3 6 — — 1 2 1 — 4 8 1 — 902 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) — — — — — — — — 233 386 150 120 D.—Number of Cases on Dispensary (a) Definitely tuberculous 375 351 22 22 69 71 42 23 444 422 64 45 1055 (b) Diagnosis not completed — — — — — — — — 32 28 12 8 1. Number of cases on Dispensary Register on January 1st, 1938 1,079 8. Number of visits by Tuberculosis Officer to Homes (including personal consultations) 698 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 47 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,546 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of" 205 10. Number of— (a) Specimens of Sputum, etc., examined 536 (b) X-Ray Examinations made in connexion with Dispensary work 781 4. Cases written off during the year as dead (all causes) 97 5. Number of attendances at the Dispensary (including Contacts) 4,504 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 7 6. Number of Insured Persons under Domiciliary Treatment on December 31st 609 7. Number of consultations with medical practitioners:— 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 416 (a) Personal 203 (b) Other 1,028 99 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 1938. 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 (a) Definitely tuberculous 57 34 1 — 3 2 5 3 60 36 6 3 355 (b) Diagnosis not completed — — — — — — — — 9 5 2 1 (c) Non-tuberculous — — — — — — — — 85 98 24 26 B.—Contacts examined during the year:— (a) Definitely tuberculous — — — — — — — — — 1 — — 212 (b) Diagnosis not completed — — — — — — — — 1 — — — (c) Non-tuberculous — — — — — — — — 66 80 24 40 C.—Cases written off the Dispensary (a) Recovered 6 4 — — 4 1 1 2 10 5 1 2 475 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as Tuberculous) — — — — — — — — 157 182 55 63 D.—Number of Cases on Dispensary (a) Definitely tuberculous 227 140 2 5 17 11 18 17 244 151 20 22 490 (b) Diagnosis not completed — — — — — — — — 25 20 3 5 1. Number of cases on Dispensary Register on January 1st, 1938 482 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 211 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous year 21 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,037 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 58 10. Number of— (a) Specimens of Sputum, etc., examined 651 4. Cases written off during the year as dead (all causes) 47 (b) X-Ray Examinations made in connexion with Dispensary work 668 5. Number of attendances at the Dispensary (including Contacts) 2,263 6. Number of Insured Persons under Domiciliary Treatment on December 31st 167 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A {b) above — 7. Number of consultations with medical practitioners:— 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 234 (a) Personal 12 (b) Other 832 100 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 1937 1938 Bodies received 60 (M. 35, F. 25) 32 (M. 18, F. 14) Post-mortem examinations conducted 59 32 Coroner : A. Douglas Cowburn, Esq. 101 INDEX. Page Ambulance facilities 30 Ante-natal clinics 31 Area of borough 8 Artificial cream 76 Bacteriological laboratory 88 Bakehouses 63 Bed bugs 90 Bed linen (sterilization) 38 Births 27 Births in institutions 13 Births in registration sub-districts 13 Births, legitimate and illegitimate 27 Births, notification 27 Birth-rates 15 Census figures 14 Child life protection 37 Cod liver oil 33 Closing orders 65 Common lodging houses 62 Condemned food 72 Consultants (obstetrical) 39 Contacts 88 Cowhouses 62 Day nursery 44 Deaths 20 Deaths, infantile 15 Deaths in institutions 23 Death-rates 15 Demolition orders 70 Density 8 Dentistry 40 Diphtheria 86 Diphtheria prevention clinics 87 Disinfecting department 89 102 Page Drains tested 54 Factories, workshops and workplaces 58-61 Food and drugs adulteration 73-76 Food inspection and supervision 71 Food premises 74 Grants, L.G. Act, 1929 33 Health visitors 47 Home helps 38 Hospitals 29 Housing applications 68 Housing conditions (M.O.H. table) 69 Housing inspectors 64 Ice cream 62 Infantile mortality 24 Infectious diseases 82 Licences 62 Light treatment 40 Marriage rate 8 Massage 40 Maternity and child welfare committee 3 Maternity and child welfare scheme 31 Maternity home 35 Maternal mortality 24 Maternity outfits (sterile) 38 Meat regulations (details of work) 71 Merchandise Marks Act 75 Midwives 29 Milk assistance scheme 32 Milk supply 71 Ministry of Health Circulars 98-99 Mortality rates 8-26 Mortuary 100 Neonatal mortality 8 Notices served 52 Notifiable diseases 82 Nuisances 54 Nursing 28 Nutrition 81 Offensive trades 62 103 Page Ophthalmia neonatorum 88 Outworkers 59-61 Overcrowding 66 Pharmacy and Poisons Act, 1933 76 Populations 12 Public cleansing 50 Public health committee 3 Puerperal fever and puerperal pyrexia 49 Registrations 62 Removal of infirm persons 57 Rent and Mortgage Interest Restrictions Acts 57 Representations 65 Restaurants 75 Sanitary inspectors 52 Sanitary work 52 Schools 64 Shops acts 63 Slaughterhouses and slaughtermen 62 Smoke abatement 63 Social conditions 8 Staff 4 Still-births 26 Summary of vital and mortal statistics 9 Summonses 53 Suspects 88 Swimming baths and pools 64 Toddlers 40 Tuberculosis 92 Tuberculosis, death rates 96 Tuberculosis dispensaries scheme 98 Tuberculosis incidence rates 97 Tuberculosis, notifications 93 Tuberculosis (Prevention) Regulations, 1925 100 Unemployment 9 Vaccination 85 Vital Statistics 11 Voluntary hospitals 38 Water certificates 54 104 PAGE Welfare centres, etc. 31 Women sanitary inspectors 60 Workshops 58 Zymotic deaths 21 Zymotic death rate 21