REPORT on the HEALTH of the BOROUGH OF LAMBETH during the year 1941 (86th Annual Report) By A.G.G. THOMPSON, M.A., M.D., B.C., D.P.H., Medical Officer of Health. PREFACE. The annual report has been still further curtailed on instruction to omit certain details which might be of use to the enemy, among them the population. The size of the report and the number of copies available have both been reduced in the effort to economise in paper. The year began with enemy night attacks still frequent and ended by contrast in a period of calm with scarcely ono alert during the latter six months. Administrative difficulties were not so kind and the complexities to be unravelled were if anything more tiresome than those in the previous year. Most of the permanent clerical staff had been called up and replaced by women by the end of the year but the willing readiness and unselfishness of all kept the machinery running. Grateful acknowledgment is made of the assistance received from the Mayor, Aldermen, and Councillors, and from the chief officers in particular because the exigencies of the times have caused departments to overstraddle each other in fashions which must have led to complication had thoy not beon met with so much understanding. Deep and cordial gratitude is tendered to every member of the staff of the Public Health Department for their loyalty and unselfishness throughout a most trying year. But for their cheerful acceptance of difficult situations often involving long hours of uncongenial work, the satisfactory results achieved could never have been attained. • A.G.G.T. July, 1942. 1. 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. Births. Birth rate per 1,000 estimated resident population corrected 14.56 (15.52) Notification of blrths. Total number of births notified 1,403 (3,674) Deaths. Death rate per 1,000 estimated resident population 20.83 (19.72) Prom puerperal causes per 1,000 total birth3 (live and still) 2.49 (1.97) Infantile Mortality rate 78 (47) Zymotic Death Rate (corrected) per 1,000 population 0.24 (0.09) Marriages. Marriage rate per 1,000 population 13.80 (15.52) Conparable rates for England and Wales and London. England and Wales London Birth rate 14.2 (14.6) 8.9 (13.7) Death rate 12.9 (14.3) 16.3 (17.8) Infantile mortality 59 (55) 68 (50) Puerperal causes 2.23 ( 2.16) (not available) 2. CAUSES OF. AND AGES AT, DEATH (CORRECTED) DURING THE YEAR. 1941 Mortality 20.83 (19.72) CAUSES OF DEATH AGES - BOTH SEXES Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards Totals M F 1. Typhoid and paratyphoid - - - - 1 - 1 - 2. Cerebro-spinal fever 3 - 2 4 1 - 6 4 3. Scarlet fever - - - - - - - - 4. Whopping Cough 9 - - - - - 5 4 5. Diphtheria - 2 1 - - - 1 2 6. Tuberculosis, Resp. Syst. - - 2 115 75 11 126 77 7. Other Tuberculosis 2 4 4 6 1 1 9 9 8. Syphilitic diseases _ - - 6 16 11 22 11 9. Influenza 1 - - 4 10 25 21 19 10. Measles 1 5 - - - - 5 1 11 . Ac. Poliomyelitis and Polioencephalitis - 1 - - - - - 1 12, Ac. Infectious Encephalitis (Lethargic) - - - - 3 - 1 5 13.Cancer, Buccal Cavity and) Oesophagus (M) ) Uterus (F) ) - - - 3 28 25 22 34 14. Cancer, Stomach and Duodenum - - - 2 25 31 33 25 15. Cancer, Breast - - - 2 18 13 2 31 16. Cancer, All other sites - 1 1 16 99 124 145 96 17. Diabetes - - 1 1 6 9 8 9 18. Corobral Vascular Lesions - - - 3 55 146 86 118 19. Heart diseases - - - 29 146 657 400 432 20. Other Circulatory diseases - - - 3 9 57 36 33 21. Bronchitis 3 - - 8 69 152 141 93 22. Pneumonia 18 3 1 20 39 87 87 81 23. Other Respiratory disoases 1 - - 4 8 4 11 6 24. Ulcer, Stomach and Duodenum - - - 9 21 16 36 10 25. Diarrhoea (under 2 years) 18 1 - - - - 10 9 26. Appendicitis - - 1 - 6 2 7 2 27. Other Digestive diseases 2 1 - 7 20 35 27 38 28. Nophritis - - - 12 24 30 36 30 29. Puorporal and Post Abortive Sepsis - - - 2 - - - 2 30. Other Maternal Causes - - - 4 - - ' - 4 31. Premature Birth 41 - - - - - 1 10 32. Congenital Halfornations, Birth Injury, Infantilo diseases 24 - - - - 3 11 16 33. Suicide - - - 4 11 3 13 5 34. Road-Traffic Accidents - 1 1 10 5 13 21 9 35. Other Violent Causes 8 15 23 198 142 78 264 200 36. All other causes 1 1 5 32 61 132 127 105 3. 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 3,151 (3,884) and to persons over five years of age 1,034 (1,506) Welfare Centres. Total individual cases dealt with 15,128 (21,537) " sessions held 2,558 ( 2,620) " attendances A/N cases 8,105 (10,151) " " P/N cases 2,586 ( 2,179) " " nursing mothers 17,679 (33,694) " " infants under 1 25,125 (34,902) " " children 1 - 5 20,036 (23,071) Visits paid to A/N cases 5,382 ( 6,636) " " " P/N cases 1,603 ( 2,494) " " " nursing mothers 19,937 (22,323) " " " infants under 1 16,911 (20,471) " " " children 1-5 38,487 (37,681) The fall in numbers attending is due to evacuation, to the Government milk schcme and to the increasing number of mothers at work. Visits are reduced to some extent by the loan of health visitors to reception areas. In spite of the diminution in numbers the work and responsibilities have increased as the Government milk scheme is largely worked through the welfare centres and the distribution of fruit juices entirely so. These two items have added materially to the clerical work of the welfare centre staffs, who in some instances have voluntarily started savings associations in addition. Child Life Protection. 421 visits and re-visits were made to foster mothers and nurse children. Foster mothers on Register at 31.12.41 23 (28) Nurse children on Register at 31.12.41 27 (29) Assistance towards cost of Hidwives. Nil (23 cases) Home Helps. 103 (207) applications and home *.lps provided - cost to Council £l05.18s.0d. Dentures for expectant and nursing mothers. 4 applications received and dentures provided - cost to Council £l6.0s.0d. Sterile Maternity Outfits. Nil (19 provided) Obstetric and Gynaecological Consultants. No calls (1 call) 4. Wartime nurseries. The Cowley nursery was opened on the 14th July but it was not until December that the Tulse Hill nursery was ready and the Black Prince shortly after. Delays were due to innumerable and often irritating causes outside the Council's control but in spite of the obstacles these three Lambeth nurseries formed a high proportion of the total of 22 which hart by that time opened in London. Milk Assistance Scheme. l,101 (42,277) gallons of milk were provided free during the. Year indicating the extent to which the national milk scheme has taken the place of the local one. Summary of work done by the four official health visitors Ante-natal visits 823 Ante-natal re-visits 281 Births 131 visits 644 Births re-visits 227 Births stillborn 24 Ophthalmia 1st visits 30 Ophthalmia re-visits 32 Measles l3t visits 409 Measles re-visits 6 Infantile deaths visits 11 Welfare centres attendances 78 Diphtheria prevention clinic attendances 218 Post natal visits 694 Visits to children 1-5 years 399 Puerperal Pyrexia visits 13 Puerperal Pyrexia re-visits 1 Special visits;- refugees, evacuation, rest centres, shelters, scabies etc. 1,402 One of these health visitors is still seconded for temporary duty in a reception area. SANITARY CIRCUMSTANCES OF THE AREA Male Sanitary Inspectors Total number of inspections (including war damage to property, iron railings for salvage, etc.) 7,717 Total number of re-inspections 12,190 Total number of intimation notices served 761 Total number of nuisance notices served 61 Female Sanitary Inspectors Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 1,823 Total number of re-visits 77 Total number of intimation notices served 95 Workshops in which, defects were found 110 One sanitary inspector is still on loan to the billeting officer and is engaged in repairs to requisitioned billet3 among his many other duties. Public Health (London) Act, 1936, Section 224. Nine orders were applied for and granted for the compulsory removal of persons to hospital under this section. 5. INSPECTION AND SUPERVISION OF FOOD. Sampling. 1940 samples of food and drugs (Formal and Informal) were submitted for analysis to the Public Analyst and 44 samples of food were submitted for bacteriological examination. The public analyst reported adversely upon 97 and unfortunately in ten cases legal proceedings had to be instituted because the adulteration seemed to be with intent to defraud. The percentage of adulteration is 5%, 10 prosecutions under the Food and Drugs Act were instituted. In 7 cases fines were imposed, 2 cases were dismissed under the Probation of Offenders Act, on payment of costs, and in one case the summons was withdrawn. Unsound Food. 24 ton3 (approx.) of unsound food were condemned as unfit for human consumption. Very little of this was destroyed and where possible it was utilised for pig feeding, soap manufacture or manures. In addition considerable work was entailed in sorting and examining food in shops and stores which had been damaged by enemy action. Meat Inspection. This has been carried out at the meat depot of the London Wholesale Moat Supply Association Ltd., Stockwell Road, as well as at retail shops. Owing to the centralisation of slaughtering only occasional killings have taken place in the Borough, these being entirely confined to pigs belonging to pig clubs. The number slaughtered and inspected was 64. Preparations for the Decontamination of Food. At the request of the Ministry of Food steps were taken to set up an organisation for dealing with food which might become contaminated in the event of the enemy using gas. This involved the acquisition and adaptation of a suitable site and the enrolment and training of volunteers to assist in the work. The service is now ready for operation. SCABIES AND VERMINOUS PERSONS, The incidence of scabies has materially increased during 1941 but the arrangements made many years ago with the adjoining councils of Battersea and Southwark have coped satisfactorily with the increasod numbers. A total of 709 persons v/ere treated at the cleansing stations and given 1,739 baths compared with 327 persons treated in 1940. 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. Tuberculosis Notifications received during the year ended 31st December, 1941. Pulmonary 301 (297) Non-pulmonary 44 (41) Deaths certified 221 (202) 6. Notifications received during the year ended 31st December, 1941. Scarlet Fever 137 (184) Diphtheria 115 (117) Typhoid Fever 18 ( 4) Erysipelas 62 (85) puerperal Fever 6 ( 16) Puerperal Pyrexia 19 ( 29) Cerebro-spinal Fever 41 ( 47) Ophthalmia Neonatorum 11 ( 33) Measles 455 (448) Whooping Cough 489 ( 51) Primary Pneumonia 86 ( 88) Influenzal Pneumonia 49 ( 49) Malaria (Induced) 1 ( 1) Dysentery 5 ( 4) Food Poisoning 12 ( 29) Anthrax 1 ( 0) Acute Poliomyelitis 1 ( 0) Diphtheria Prevention. Pour clinics were opened during the year while by arrangement with the divisional school nodical officer children were offered immunisation at school as an alternative and in addition all children in the large shelters were immunised by the doctors at the various medical aid posts. Children attending the wartime nurseries are of course immunised as a routine measure. In all, 3,292 children were immunised during the year but in peace time the births number some 4,000 a year,(proportionately less now with the smaller population), so that a much larger number must be immunised annually if the proportion is to reach 75% at which stage the disease is expected to begin dying out. Vaccination. Public vaccinators now number throe instead of four, not counting Lambeth Hospital, and one of the two vaccination officers has been called up the work being continued by the one remaining officer with clerical assistance. Numbers of births and vaccinations declined during the early part of the year but with the returning population later numbers increased. The movement of the population made the tracing of cases difficult and arduous but a fair measure of success resulted. In the more strenuous times vaccination officers gave material clerical assistance in the mortuaries for civilian war deaths as well as in other directions. There were 584 successful primary vaccinations in infants, and 24 over one year and 22 successful re-vaccinations. Disinfecting Department. There has been a marked fall in disinfection owing to the smaller numbers of infectious disease notifications but to counter balance this a large number of shelters were infested v/ith bugs and re-infested again and again In spite of all that could be done to prevent this happening. 12,731 articles were disinfected and on 8,931 occasions were promises visited for various purposes in connexion with disinfection. 7. Bacteriological Laboratory. During the year 1941 the following 1,211 samples were examined bacteriologically in the Laboratory at Wanless Road. Specimen Negative Positive Total. Swabs for or suspected cases of Diphtheria. 548 58 606 Sputum for suspected cases of Tuberculosis. 483 67 550 Blood for suspected eases of Typhoid or Paratyphoid fever - 2 2 Miscellaneous 16 37 53 1,047 164 1,211 The miscellaneous specimens consisted of a) urines, b) pleuritic fluid, c) smears from eye and vagina and special swabs for haemolytic streptococci and Vincents Angina. 8.