REPORT on the HEALTH of the BOROUGH OF LAMBETH during the year 1940 (85th Annual Report) By A.G.G. THOMPSON, M.A., M.D., B.C., D.P.H., Medical Officer of Health PREFACE The annual. report is again curtailed for reasons similar to those which obtained when the report for the year 1939 was drafted with the additional cause that the calling up of members of the permanent staff has made its preparation more arduous. The various rates are based upon the RegistrarGeneral's estimate of the resident population at the middle of the year of 210,650. The number of persons in the district holding ration cards was however below 160,000 towards the end of the year so that the value of the statistics for purposes of comparison is not great. In the first half of the year conditions were not strikingly abnormal but the sudden and remarkable changes which took place during the Battle of Britain both in population and in environment, conceal the facts concerning the first half of the year and at the same time even out the extremes of the second half. As can be woll imagined the work of the Public Health Department has been completely disrupted by the events of the autumn when all members of the staff were asked to undertake work quite outside the ordinary scope of their normal duties which were perforce left in abeyance. The change in policy forced upon the government with respect to the use of public shelters added many difficult problems to the extraordinary complexities with which the local authority were faced. More and more duties and instructions were constantly being added to the already almost intolerable responsibilities imposed by circumstances and by higher authorities so that there was little wonder to find urgent improvements in shelters, billets, war damage repairs and so on, lagging behind. The good will shewn by the staff of the department in cheerfully taking in their stride so much additional responsibility is a testimony to the resilience of the department. The additions to the peace time responsibilities of the department practically all of which still remain include (i) a large temporary staff on A.R.F. and allied services of some 800 made up of stretcher bearers, M.T.C. drivers, doctors, nurses, auxiliary nurses, cooks, cleaners and clerical staff whose pay, sick and accident pay, leave and so on present a formidable item, (ii) the six first aid posts, six medical aid posts in large shelters, three mobile first aid units, five stretcher party depots, two mobile cleansing units and five public cleansing stations, (iii) the A.R.P. casualty services store where some 500 principal kinds of equipment are held not counting the large numbers of accessory items, the tailoring and repair of uniforms and (iv) the four mortuaries in which war casualties are received. There are also (v) some 70 motor vehicles which were badly worn when purchased owing to the low maximum prices fixed by higher authority and these have always been a source of trouble, (vi) the checking of petrol issues, log books and repairs all add their quotas to the work and responsibilities which have to be shouldered. The really amazing feature of this heterogeneous combination of temporary and permanent staff is that, in spite of drawbacks such as lack of proper disciplinary powers and lack of any previous experience, it has remained a combination which has withstood all strains and maintained its cohesion. Great credit is due to the many who have cheerfully accepted long hours of work and extra responsibility without any added remuneration, and thus made success possible. There have been delays in action on some of the worst occasions and difficulties have arisen inseparable from being answerable to several higher authorities not apparently in close touch with each other but the public for whose safety and benefit the organisation has been erected have not been ill-served. It should not be forgotten also that home guard and fire watching duties fill up any spare overtime of the staff to which some departmental charge has not already been allotted. Thanks are gratefully tendered to the Mayor, Alderman and Councillors for much help and keen appreciation of difficulties, to the chief officers and their departments with whom relations have never been more cordial and especially- to the members of the staff of the Public Health Department who have all taken the rough with the smooth in their respective places in the team. July, 1941 A.G.G.T. STATISTICS AND SOCIAL CONDITIONS Summary of Vital and Mortal Statistics, Etc. (The comparable figures for the previous year appear in brackets) 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 Registrar-General's estimate resident population mid 1940 210,650 (270,800) Live Births Total M F Birth rate per 1,000 estimated Legitimate 3,039 1,549 1,490 resident population Illegitimate. 232 125 107 Corrected 15.52 (13.17) 3,271 1,674 1,597 Uncorrected 17.44 (17.88) Notification of births Total number of notified births 3,674 (4,844) Stillbirths Total M R (103) 114 60 54 Deaths (3,444)4,286 2,195 2,091 Death rate per 1,000 estimated average population as adjusted by comparability factor 19.72 (13.37) Deaths from puerperal causes Puerperal sepsis 3 (0) Rate per 1,000 total (live and Other puerperal causes 3 (4) still) births 1.97. (1.18) Infantile Mortality Rate 47 (57) Marriages 3,270 being 15.52 per 1,000 population Zymotic Death Rate (Corrected) 0.09 per 1,000 population (Total zymotic deaths 21) Rates for England and Wales and London England and Wales London Live Births 14.6 13.7 Deaths 14.3 17.8 Infantile Mortality 55 50 Puerperal Causes 2.16 (not available) 3 CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR, 1940 Total deaths = 4286 Mortality 1972 (1537) CAUSES OF DEATH AGES - BOTH SEXES Under 1 year l and under 5 5 under 15 15 and under 45 45 and uder 65 65 ana upwards Totals M F All causes 144 60 59 657 1248 2118 2195 201 1. Typhoid and paratyphoid - - - - - . 1 - 2. Cerebro-spinal fever 3 3 - 1 1 - 6 3. Scarlet fever — - - - - - - 4. Whooping Cough 1 - - - - - - 5. Diphtheria 1 3 3 - - - 3 6. Tuberculosis, Resp. Syst. 2 2 2 101 62 9 102 7. Other Tuberculosis - 6 - 15 3 2 15 8. Syphilitic diseases - - - 5 18 10 24 9. Influenza 2 - - 4 16 14 24 10. Measles 2 2 - . - - - 2 11. Ac. Poliomyelitis and Polioencephalitis - - - - 1 1 12. Ac. Infectious Encephalitis (Lethargic) - - - 4 1 - 3 13. Cancer, Buccal Cavity and) Oesophagus (M) ) Uterus (F) ) - - - 7 24 22 32 14. Cancer, Stomach and Duodenum _ - - 4 36 40 47 15. Cancer, Breast - - - 5 24 15 2 16. Cancer, All other sites - - 1 19 138 149 176 17. Diabetes - - - 2 9 15 10 18. Cerebral Vascular Lesions - - - 4 71 164 108 19. Heart diseases - - 1 42 181 847 482 20. Other Circulatory diseases - - - 5 33 60 45 21. Bronchitis 12 3 - 10 102 196 169 22. Pneumonia 15 12 1 20 65 121 126 23. Other Respiratory diseases 2 1 - 4 27 15 35 24. Ulcer, Stomach and Duodenum - - - 7 34 52 58 25. Diarrhoea (under 2 years) 8 - - - - - 2 26. Appendicitis - 1 1 6 1 2 4 27. Other Digestive diseases 6 3 1 16 40 42 57 28. Nephritis - - 3 12 19 26 33 29. Fuerperal and Post Abortive Sepsis - - - 3 - - - 30. Other Maternal Causes - - - 2 1 — - 31. Premature Birth 42 - - - - - 31 32. Congenital Malformations, Birth Injury, Infantile diseases 37 3 1 3 2 - 29 33 . Suicide - — - 12 19 7 26 34. Road Traffic Accidents - 1 - 11 6 14 22 35. Other Violent Causes 7 18 42 303 242 122 375 36. All other causes 4 2 5 32 74 193 146 GENERAL PROVISIONS OF HEALTH SERVICES IN THE AREA Nursing in the Home The number of visits paid to children under five years of age was 5,884 (5,012) and to persons over five years of age 1,506 (1,622) Welfare Centres Total individual cases dealt with 21,537 (22,517) " sessions held 2,620 ( 3,825) " attendances A/N cases 10,151 (16,235) " " P/N cases 2,179 ( 3,758) " " nursing raothers 33,694 (41,989) " " infants under 1 34,902 (46,449) " " children 1-5 23,071 (32,188) Visits paid to A/IT cases 6,636 ( 8,300) " " " P/lI cases 2,494 ( 2,217) " " " nursing mothers 22,323 (24,945) " " " infants under 1 20,471 (23,212) 11 " " children 1-5 37,681 (44,872) The fall in numbers attending is due to evacuation and to the Government milk scheme. Visits are reduced to some extent by the loan of health visitors to reception areas. The Voluntary Welfare Centres were faced with serious financial troubles and a number were obliged to ask for further help from the Council. This was readily granted and as a war measure subject to a closer financial control among other things they have agreed to a reduction in their voluntary status. They are however still administered by voluntary committees upon all of which the Council is represented. The movements of families due to destruction of dwellings has made the task of keeping in touch with them both difficult and time wasting. The duties of the staffs of the centres have been hard but contact with the population has been maintained well throughout the year by visits to the homes. Child Life Protection 794 visits and re-visits were made to foster mothers and nurse children. Poster mothers on Register at 31.12.40 28 (39) Nurse children on Register at 31.12.40 29 (42) Maternity Home 417 (572) cases were admitted during the year. The home was closed in the autumn after severe damage when mercifully there were no casualties, and the staff now run the Home Farm Maternity Home,Tring, for the Herts. County Council. Assistance towards cost of Midwives 24 (35) applications - 1 cancelled 23 (35) midwives provided - cost to Council £30:10s:6d. Home Helps 207 (169) applications - 4(3) cancelled 203 (164) home helps provided - cost to Council £184:17s:6d. Sterile Maternity Outfits 21 (29) applications - 2 (2) cancelled 19 (27) sterile maternity outfits issued - cost to Council £2:ls:9d. Obstetric Concsultants Called once (1) Puerperal Fever and Pyrexia Consultants Nil (0) Milk Assistance Scheme 42,277 (63,107) gallons of milk were provided free during the year. Summary of work done by the four official health visitors Ante-natal visits 1,119 Ante-natal re-visits 274 Births 1st visits 777 Births- re-visits 283 Births stillborn 59 Ophthalmia 1st visits 83 Ophthalmia re-visits 71 Measles 1st visits 256 Measles re-visits 3 Infantile deaths visits 9 Welfare centres attendances 190 Diphtheria prevention clinic attendances 47 Post natal visits 967 Visits to children 1-5 years 317 Puerperal Pyrexia, visits 28 Puerperal Pyrexia re-visits 7 Tonsil and Adenoids visits 3 Special visits :- refugees, evacuation, rest centres, shelters, scabies etc. 1,944 Two of these health visitors were seconded for temporary duty in reception areas where they remained for sever months. They were recalled towards the end of the year to the regret of the reception authorities under whom they were working SANITARY CIRCUMSTANCES OF THE AREA Male Sanitary Inspectors Total number of inspections 4,047 Total number of re-inspections 10,857 Total number of intimation notices served 1,443 Total number of nuisance notices served 223 Female Sanitary Inspectors Total number of visits and inspections (factories, workplaces etc.) 1,920 Total number of re-visits 351 Total number of intimation notices served 161 Workshops in which defects were found 180 The sanitary inspectors were withdrawn at intervals ??? A.R.P. duties as they could be replaced and all but one are now ??? back with three still maintaining supervision over their first ??? posts and mobile units. The one not back has been lent to the billeting officer and is engaged in repairs to requisitioned billets among his many other duties. Public Health (London) Act, 1936. Section 224. Orders were applied for and granted for the compulsory??? removal to hospital of two persons under this section. 6. INSPECTION AND SUPERVISION OF FOOD 2,000 samples of food and drugs were submitted to the Public Analyst during the year of which 35 were adulterated. Unfortunately legal proceedings had to be instituted in six cases because fraudulent dealings seemed to be intentional. 33½ tons of unsound food were condemned during the year and utilised to the best advantage in various processes. SCABIES AND VERMINOUS PERSONS The incidence of scabies has materially increased during 1940 and 1941 but the arrangements made many years ago with the adjoining councils of Battersea and Southwark have copeds satisfactorily with the increased numbers. The spray baths at first aid posts for gas cleansing have been used on several occasions by refugees and other members of the public desirous of obtaining a hot bath. A total of 327 persons were treated at the cleansing stations and given 721 baths. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The incidence of no particular infectious disease calls for comment but the exceedingly small numbers of all kinds is puzzling when they received every encouragement to spread from environmental conditions of shelter life and black out. Notifications received during the year ended 31st December, 1S40. Scarlet Fever 184 (261) Diphtheria 117 (238) Typhoid Fever 4 ( 4) Erysipelas 85 ( 89) Puerperal Fever 16 ( 6) Puerperal Pyrexia 29 ( 42) Cerebro-spinal Fever 47 ( 10) Ophthalmia neonatorum 33 ( 37) Measles 448 (118) Whooping Cough 51 (896) Primary Pneumonia 88 (125) Influenzal Pneumonia 49 ( 64) Malaria 1 ( 0) Dysentery 4 ( 14) Food Poisoning 29 ( 8) Tuberculosis Notifications received during the year ended 31st December. 1940. Pulmonary 297 (446) Non-pulmonary 41 (74) Deaths certified 202 (241)