REPORT on the HEALTH of the BOROUGH OF LAMBETH during the year 19 4 2 (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 on the health of the borough has again been curtailed to conform with the instruction of higher authority both in leaving out statistical information which might be of value to the enemy and by leaving out non essential matter which means an economy in paper. Throughout the year the ruthless pruning by the Government to obtain labour for the war industry ha3 meant the loss of staff specially trained to replace men already called up. In particular the loss of staff among firms engaged in the various branches of the building trade together with the scarcity of materials and difficulties over permits has meant a marked slowing in effecting repairs called for by sanitary notices. For the same reasons the opening of wartime nurseries has been postponed again and again. As may be imagined much exasperation ha3 been irritating nerves already at times a little frayed with wartime circumstances. By making allowances, and by anticipating goodwill mixed above all with the saving grace of English humour, officers in the department have 3een their v/ork progressing in all directions to a not unsatisfactory extent. Throughout the whole year the borough was spared the horrors of bombing and alerts were few and short. The period of waiting has been more than a little trying to many of the personnel especially those engaged either whole or part time in the casualty, home guard and fire watching services. Many could almost wish at times for active service to begin again or that something,anything, might happen to break the monotony of waiting and training. Warm thanks are again expressed for the assistance received from the Mayor, Aldermen and Councillors and especially from the chief officers. The staff of the public health department have worked for long hours and have had shorter holidays and have willingly accepted the altered conditions. Their steadfast cheerfulness in uninviting circumstances has enabled the work of the department to be maintained at a high level cf excellcnce. A.G.G.T. July, 1943. 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 Ward3 are co-terminous. Births. Birth rate per 1,000 estimated resident population corrected 17,41 (14.56) Notification of births. Total number of births notified 2,504 (1,403) Deaths. Death rate per 1,000 estimated resident population 16.24 (20.83) Prom puerperal causes per 1,000 total births (live and still) 0.36 (2.49) Infantile Mortality rate 60 (78) Zymotic Death Rate (corrected) per 1,000 population 0.41 (0.24) Marriages. Marriage rate per 1,000 population 12.41 (13.80) Comparable rates for England and Wales and London. England and Wales London Birth rate 15.8 (14.2) 14.0 (8.9) Death rate 11.6 (12.9) 13.9 (16.3) Infantile mortality 49 (59) 60.0 (68) Puerperal causes 2.01 ( 2.23) (not available) 2. CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR, 1942. Mortality 16.24 (20.83) CAUSES OF DEATH Under 1 year 1 and under 5 AGES - BOTH SEXES Totals 5 and under 15 15 and under 45 45 and under 65 65 and upwards M F 1. Typhoid and paratyphoid - - - - - - - - 2. Cerebro-spinal fever 1 - - 1 2 2 4 2 3. Scarlet Fever - - - - - - - - 4. Whooping Cough 8 4 - - - - 4 8 5. Diphtheria - 4 1 - - - 3 2 6. Tuberculosis, Resp. Syst. - 1 2 66 49 18 97 39 7. Other Tuberculosis 2 2 2 10 3 2 10 11 8. Syphilitic diseases - - - 5 17 10 28 4 9. Influenza - - - 2 5 6 7 6 10. Measles 4 2 - - - - 2 4 11. Ac. Poliomyelitis and Polioencephalitis - - - - - - - - 12. Ac. Infectious Encephalitis (Lethargic) - - - 1 1 - - 2 13. Cancer, Buccal Cavity and) Oesophagus (M) ) Uterus (F) ) - - - - 18 27 27 18 14. Cancer, Stomach and Duodenum - - - 3 26 30 28 31 15. Cancer, Breast - - - 2 22 18 - 42 16. Cancer, All other sites - 1 2 15 111 130 157 102 17. Diabetes - - - 1 - 12 6 7 18. Cerebral Vascular Lesions - - - 3 52 153 91 117 19. Heart diseases - — — 20 143 588 340 411 20. Other Circulatory diseases - - - 3 14 54 33 38 21. Bronchitis 5 — - 3 40 107 106 49 22. Pneumonia 22 4 - 11 35 58 79 51 23. Other Respiratory diseases - - - 1 8 19 17 11 24. Ulcer, Stomach and Duodenum - - - 6 16 13 28 7 25. Diarrhoea (under 2 years) 38 4 - - - - 24 18 26. Appendicitis - - - 4 3 3 5 5 27. Other Digestive diseases 1 - - 3 23 30 24 33 28. Nephritis - - - 10 18 25 25 23 29. Puerperal and Post Abortive Sepsis - - - 1 - - - 1 30. Other Maternal Causes — - - — - - - - 31. Premature Birth 43 - - - - - 25 18 32. Congenital Malformations, Birth Injury, Infantile diseases 34 - - 4 1 1 25 15 33. Suicide - - - 6 11 5 15 7 34. Road Traffic Accidents - 1 - 4 3 6 10 4 35. Other Violent Causes 1 - 3 12 15 23 39 15 36. All other causes 6 2 1 23 53 103 104 84 3. GENERAL PROVISIONS OF HEALTH SERVICES IN TUB AREA. Nursing in the Home. The number of visits paid to children under five years of age was 3,762 (3,151) and to persons over five years of age 913 (1,034). Welfare Centres. Total individual cases dealt with 16,140 (15,128) „ sessions hold 2, 636 (2,558) „ ante-natal cases. 3,566 (2,496) „ post-natal cases 888 (438) „ nursing mothers 4,600 (3,360) „ infants under 1 3,800 (4,176) „ children 1-5 3,286 (4,658) Visits paid to A/N cases 7,232 (5,382) „ „ „ P/N cases 2,377 (1,603) „ „ „ nursing mothers 22,417 (19,937) „ „ „ infants under 1 19,564 (16,911) „ „ „ children 1-5 41,927 (38,487) The fall in numbers attending is due to evacuation, to the Government milk scheme and to the increasing number of mothers at work. In spite of the diminution in numbers compared with pre-war population the work and responsibilities have increased as the Government milk scheme is largely worked through the welfare centres and the distribution of vitamins 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. 599 visits and re-visits were made to foster mothers and nurse children. Poster mothers on Register at 31.12.42. 34 (23) Nurse children on Register at 31.12.42. 41 (27) Assistance towards cost of Midwives. Nil (Nil) Home Helps. 151 (103) applications and home helps provided cost to Council £223.10s.0d. These are becoming increasingly difficult to arrange as most women go out to work but so far no failure has been reported. Dentures for expectant and nursing mothers. 22 (4) applications received and dentures provided coat to Council £62.2s.6d. The scale of assessment was found to be too low and with the approval of the Ministry of Health there was an all round increase of four shillings which entitles many more women to apply for help. Sterile Maternity Outfits. 1 (Nil) 4. Obstetric and Gynaecological Consultants. No calls (No calls) Convalescent Hone for children between 2 and 5 years of age. The Council agreed at the end of November to maintain two beds at the Byfleet Home for toddlers requiring convalescence and the beds were occupied at once. In the short time the scheme has been working the accommodation was so much sought after that the Council agreed to take two more beds In April of this year. An extension of the service to take mothers as well as children as was the case in the Zacchary Merton Home before the war is not yet possible. Wartime Nurseries. Wartime Nursery. Accommodation. Date opened. under 2 yrs. 2-5 yrs. Cowley 12 8 14.7.1941. Tulse Hill 20 30 17.12.1941. Black Prince 20 40 4.2.1942. Elder Road - 30 30.3.1942. Annie McCall 36 39 5.8.1942. St. Johns 25 20 24.9.1942. The Council decided at the end of the year that premises for future wartime nurseries should be altered or erected by the Borough Engineer's department instead of the Public Health department. The Council with the approval of the Ministry of Health intend to open other wartime nurseries at one of which, Coldharbour Lane, work had begun at the end of the year'and which will open shortly. Other projected nurseries are at sites in Coral Street, S.E.1., the Oval, S.E.ll., Gipsy Hill, S.E.19., Chestnut Road, S.E.27. The difficulty of providing accommodation for the staff who desire to live in but work in hutted nurseries led the Council to suggest to the Ministry of Health that they might be allowed to open the Nurses' Home in Sancroft Street which was completed a year or so before the war and housed the nursing staff of the St. Thomas's Babies Hostel - as a hostel for the purpose. The ground floor of the building accommodates the Moffat Welfare Centre and the upper part of the building now the nurses' hostel is openand already half full. With several nurseries planned or building and not yet ready for occupation the spare bedrooms will soon be filled. The staffing, control and administration of the nurseries now open is no light or easy task more especially ajf■►administrative personnel are difficult to obtain and hard to"keep in the present circumstances. With the approval of the Board of Education the borough is divided so that a certificated nursery teacher is in charge of each district and is responsible for all the nurseries in the district while a warden is in charge of each nursery 3cJiool under the nursery teacher. Milk Assistance Scheme. Only 607-| (1,101) gallons of milk were provided free during the year compared with 42,277 gallons in 1940 which indicates the'extent to which the national milk scheme has taken the place of the local one. 5. Summary of work done by the official health visitors. Ante-natal visits 1,157 Ante-natal re-visits 199 Births 1st visits 1,043 Births re-visits 195 Births stillborn 42 Ophthalmia 1st visits 46 Ophthalmia re-visits 36 Measles 1st visits 571 Measles re-visits - Infantile deaths visits 20 Welfare centres attendances 126 Diphtheria prevention clinic attendances 513 Post-natal visits 1,115 Visits to children 1-5 years 319 Puerperal Pyrexia visits 17 Puerperal Pyrexia re-visits 2 Special visits:- evacuation, scabies, etc. 1,654 One of the four official health visitors is still seconded for temporary duty in a rocoption area# SANITARY CIRCUMSTANCES OF THE AREA. Sanitary Inspectors. Total number of inspections (including war damage to property, iron railings for salvage, etc,) 11,477 Total number of re-inspections 21,891 Total number of intimation notices served 2,381 Total number o'f nuisance notices served 264 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 2,769 Total number of re-visits 149 Total number of intimation notices served 81 Workshops in which defects were found 100 One sanitary inspector is still on loan to the billeting officer and is engaged in repairs to requisitioned billets among his many other duties. Public Health (London) Act, 1936, Section 224. No application was made for orders for the compulsory romoval of parsons to hospital under this section compared with nine in the previous year. INSPECTION AND SUPERVISION OF FOOD. Unsound Food. Approximately 19 tons of food was certified as unfit for human consumption. In accordance with the procedure now adopted very little of this amount was wasted, as much as possible being used for animal feeding. Sampling of Food & Drugs. 1,658 samples (1,600 informal and 58 formal) were submitted to the Public Analyst and 30 samples were examined bacteriologically in the Council's laboratory. In 7 cases proceedings were instituted for contraventions of the Food & Drugs Act; in 4 cases convictions were recorded; in 2 cases the summonses were dismissed under the Probation of Offenders Act and the remaining case was dismissed. 6. Decontamination of Food. Fortunately the need for the utilisation of this service has not yet arisen. The Food Treatment Centre at Kennington Oval is equipped and ready for action and in accordance with a suggestion of the Ministry of Food an application was made to the National Service Officer for a number of persons to be directed into the Food Treatment Service in a part-time capacity in order to augment the number of volunteers already available. About 50 people (men and women) were so directed and training commenced oarly in 1943. SCABIES AND VERMINOUS PERSONS. The incidence of scabies has materially increased during 1942 but the arrangements made many years ago with the adjoining councils of Battersea and Southwark have coped satisfactorily with the increased numbers. A total of 1,467 persons were treated at the cleansing stations and given 3,698 baths compared with 709 persons treated in 1941. A special hair oil containing 50$ of Lethane was issued to all welfare centres in bottles of one ounce sufficient to treat a family of six persons for head-lice. The issue was made free to all applicants and a letter was delivered to all the hairdressers in tho district asking their co-operation in directing all their customers found to be in need of help to their local v/elfare centre. This assistance was readily forthcoming and coupled with advice from health visitors and others it has led to 490 bottles being distributed in the first nine months. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. t A measles epidemic began towards the end of the latter half of the year, rather oarly for the ordinary biennial epidemic#and continued until May, 1943. Scarlet fever was more in evidence but maintained its mild character. Notifications for diphtheria were slightly higher than the previous year but no child who had completed tho immunisation course not less than twelve weeks contracted the disease. The incidence of other infectious diseases has been low and the diseases themselves mild in character. These exhibitions arc puzzling when environmental conditions generally favoured epidemics. Testimony from all welfare centres points to children under five being in better health and condition than ever before evidonce that tho nutrition standard has been improved and is better than it was before tho Ministry of Food rationed foods in favour of those who need them most. Tuberculosis. Notifications received during the year ended 31st December, 1942. Pulmonary 311 (301) Non-pulmonary 26 ( 44) Deaths certified 157 (221) 7. Notifications received during the year ended 31st December, 1942. Scarlet Fever 307 (137) Diphtheria 129 (113) Typhoid Fever 3 (18) Erysipelas 39 (62) Puerperal Fever 7 (6) Puerperal Pyrexia 21 (19) Cerebro-spinal Fever 22 (41) Ophthalmia Neonatorum 15 (11) Measles 1,533 (455) Whooping Cough 333 (489) Primary Pneumonia 109 (86) Influenzal Pneumonia 33 (49) Malaria (Induced - 2) 5 (1) Dysentery 10 (5) Food poisoning 32 (12) Anthrax - (1) Acute Poliomyelitis - (1) Encephalitis Lethargica 2 (- ) Diphtheria Prevontion. The following statistics relating to the campaign against diphtheria denote the success which has attended the Council's efforts during the second half of 1942, but nevertheless much still remains to be done:- Under 5 years. 5 yrs. and over but under 15 yrs. Total. Number of children who completed the full immunisation course between 1st January and 30th June, 1942. 445 694 1,139 Number of children who completed the full immunisation course between 1st July and 31st December, 1942. 1,522 2,547 4,069 Where as the under-five population numbered 9,427 in the first half of the year, by now arrivals and returns from tho provinces it had increased to 12,500 in the second six months while the over-fives increased similarly from 12,650 to 14,450. The percentage of children in Lambeth who are now immune is estimated to bo the following:- Under 5. Between 5 and 15 years. Percentage ago immunised by 30th June 20.7 33.4. Percentage ago immunised by 31st December 29.10 47.96. The Public Health Committee members assisted largely in the success of the campaign in the second half of the year by talks and by the distribution of pamphlets. Twice the results of the campaign have been given special prominence in the local press and this no doubt was a great help. The numbers Immunised in the first half of the present year however do little if anything beyond keep pace with the birth rate. 8. Vaccination. Owing to the continued lull in air raids on London the mothers did not avail themselves of the Evacuation Scheme to any great extent, also as the raid damaged houses were repaired more families returned to live in Lambeth, and the number of births in England and Wales in 1942 was the highest for 14 years. As a result the work increased and in December, 1941, the single Vaccination Officer was given 2 hours clerical assistance a day. In April, 1942, this assistance was found to be insufficient and it has been necessary to employ a whole time assistant to the Vaccination Officer since the 4th May, 1942, There were 1,242 successful primary vaccinations in infants and 84 in persons over the age of one year. Successful revaccinations numbered 64. The total number vaccinated was 1,390 compared with 630 in the previous year. Disinfecting Department, There has been a marked fall again in disinfection owing to the smaller.numbers of infectious disease notifications. Early in the year a team composed of medical officers, sanitary inspectors, health visitors and disinfectors was formed to deal with louse borne typhus fever. The team of 17 were immunised and special protective clothing was obtained for their use, 9,029 articles were disinfected and on 3,465 occasions wore premises visited for various purposes in connexion with disinfection compared with 12,731 articles from 8,931 premises in the previous year. Bacteriological Laboratory. During the year 1942 the following 1,547 samples were examined bacteriologically in the Laboratory at Wanless Road. Specimen Negative Positive Total Swab for or suspected cases of Diphtheria. 785 41 826 Sputum for suspected casos of Tubercwlosis. 549 59 608 Blood for suspected cases of Typhoid or Paratyphoid fever. 1 2 3 Miscellaneous. 58 52 110 1,393 154 1,547 The miscellaneous specimens consisted of 44 urines, 31 swabs for Vincent's Angina, 25 swabs for haemolytic streptococci, 7 swabs or smears from eye or vagina for Gonorrhoea, 2 faeces and 1 cerebro-spinal fluid. 9.