??? REPORT on the HEALTH of the B0R0UGH OF LAMBETH during the year 19 4 3 (87th Annual Report) ,; • By A.G.G. THOMPSON, M.A., M.D., B.C., D.P.H., Medical Officer of Health. ' v. PREFACE. The annual report on the health of the borough during 1943 is again short and also is again lacking in certain statistical information which might be useful to the enemy upon both of which aspects instructions have been given by higher authority. The calling up of staff continued on a much reduced scale merely because there were much fewer to call up but that did not deter other Government departments from asking for more work to be undertaken and more responsibility to be accepted. The longer hours worked coupled with a reduction in holidays had the anticipated effect of causing sickness to an extent which more than offset the extra time worked. All the knowledge acquired since 1918 about the effect of long hours, fatigue and output in industry was overlooked when the Ministry of Labour and National Service forced the introduction of longer hours upon the Council with intent to counteract reductions in staff due to call up. Over and above this the public health department suffered a great loss in the retirement on account of ill health of tho Chief Administrative Assistant, Mr. A.E. Ruel who had served the Council for forty years. For the whole year, the second in succession, the district suffered no damage from bombing and such alorts as there were, were both few in number and short. There wa3 on occasion a littl damage from A.A. shellfire which also caused one or two incidents. Cordial gratitude is due to the Mayor, Alderman, and Councillors for thoir assistance and forbearance during the year, while the friendly help and co-operation from the chief officers have been a welcome encouragement. The staff of tho public health department have struggled gamely against odds throughout the year despite the one-sided Government game of "put'and take". Putting extra duties upon the local authority and talcing away their staff have been carried tg a, point beyond, commonsense and it is a happy relief to know that the Council have approved the suggestion of the Joint Industrial Council to increase the annual holidays from a fortnight to three weeks. A.G.G.T. JUly, 1944. STATISTICS AND SOCIAL CONODITIONS. 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 Wards are co-terminous. Births. Birth rate per 1,000 estimated resident population corrected 18.97 (17.41) Notification of Births. ' Total number of births notified - 3,022 (2,504) _ ??? 3095 Deaths. Death rate per 1,000 estimated resident population 16.87 (16.24) Prom puerperal causes per 1,000 total births (live and still) 2.81 (0.36) Infantile Mortaility rate 60 (60) Zymotic Death Rate (corrected) per 1,000 population 0.38 (0.41) Marriages. . Marriage rate per 1,000 population 9.18 (12.41) Comparable rates for England and Wales and London. England and Wales. London. Birth rate 16.5 (15.8) 15.8 (14.0) Death rate 12.1 (11.6) 15.0 (13.9) Infantile mortality 49 (49) 58 (60) Puerperal causes not available CAUSES OF, AND AGES AT, DEATH (CORRECTED) DURING THE YEAR, 1943. Mortality 16.87 (16,24) 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 - - - - - - - - 2 .Cerebro-spinal fever - 1 - - 1 - - 2 3.Scarlet Fever - 1 - 1 - - 1 - 4.Whooping Cough 8 2 — - _ - 4 6 5.Diphtheria 1 2 2 - - - 2 3 6.Tuberculosis, Resp.Syst. - 1 4 90 64 18 118 59 7.Other Tuberculosis 1 3 2 4 2 2 7 7 8.Syphilitic diseases - _ 4 18 7 17 12 9.Influenza 1 _ 1 6 18 32 33 25 10.Measles 1 2 - - _ - 1 2 11.Ac. Poliomyelitis and Polioencephalitis - - - - - - - - 12.Ac. Infectious Encephalitis (Lethargic) - - - - 1 - - 1 13.Cancer, Buccal Cavity and Oesophagus (M) Uterus (F) ) - - - 4 28 36 40 28 14.Cancer, Stomach and Duodenum - - - 4 24 34 38 24 15.Cancer, Broast - - - 5 21 15 1 40 16.Cancer, All other sites - 1 - 19 103 130 158 95 17.Diabetes _ _ - 4 5 5 5 9 18.Cerebral Vascular" Lesions 1 - - 3 58 166 106 122 19.Heart Diseases - — 1 25 119 608 347 406 20.Other Circulatory diseases - - - 3 23 61 32 55 21.Bronchitis 4 1 1 4 47 133 104 86 22.Pnoumonia 39 5 - 11 41 82 99 79 23.Other Respiratory diseases - 1 - 4 11 16 19 13 24.Ulcer,Stomach and Duodenum - - - 6 19 12 23 14 25.Diarrhoea (under 2 years) 42 1 - - - - 26 17 26.Appendicitis - 1 - 2 4 3 5 5 27.Other Digestive diseases 5 3 1 9 21 24 40 23 28.Nephritis 1 - - 5 12 29 25 22 29.Puerperal and Post Abortive Sepsis - - - 5 - - - 5 30.Other Maternal Causes - - - 4 - - - 4 31.Premature Birth 46 — - - - - 27 19 32.Congenital Malformations, Birth Injury,Infantile diseases 28 - 1 2 1 - 16 16 33.Suicide - - - 5 7 4 12 4 34.Road Traffic Accidents - 2 2 2 5 5 14 2 35.Other Violont Causes 6 5 3 11 12 27 40 24 36.All other causes 3 3 4 23 43 87 89 74 TOTAL ALL CAUSES 187 35 22 264 708 1536 1449 1303 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 4,403 (3,762) and to persons over five years of age 1,671 (913). Wolfare Centres. Total individual casos dealt with 16,350 (16,140) " sessions held 2,573 (2,636) " ante-natal cases 3,235 (3,566) " post-natal cases 890 (888) " nursing mothers 3,402 (4,600) " infants under 1 4,797 (3,800) " children 1-5 4,114 (3,286) Visits paid to A/N cases 7,303 (7,232) " " 11 P/N cases 2,857 (2,377) " " " nursing mothors 22,225 (22,417) " " " infants undor 1 21,267 (19,564) " " " childron 1-5 41,752 (41,927) Welfare work has always laboured undor the two disadvantages that attendance at a welfare centre unlike that at school is voluntary and that the health visitor enters a home only by invitation. Before the war most mothers went to tho welfare centres as they do now becauso thoy believed the advice and help given was good for their children as well as for themselves. In present times with so many mothers at work attendance is in consequence loss regular and some who get the extra vitamins from a food control centre do so in preference to attending the welfare centre in order to avoid mooting the health visitor. There is still a good deal of movement of population from one area to another much of which cannot be followed so that many nursing mothers are counted twice or even more times corresponding to the numbor of changes of address requiring changes of welfare centre. The lack of voluntary help compared with pre-war days is a noticeable feature at all welfare centres , although a few voluntary workers are able to give their time and energy as freely now as ever they did before the war. The post natal clinic attendances continue their slow increase although this does not imply that tho attitude towards post natal care is apathetic since, most mothers attend the hospital whore thoy went to bo confined for post natal care and advice, and not necessarily the local wolfare centre. Child Life Protection. 1,142 visits and re-visits were made to foster mothers and nurse children. Foster mothers on Register at 31.12.43. 29 (34) Nurse children on Rogister at 31.12.43. 34 (41) The demand for foster mothers far outstrips tho supply because with part time factory employment so easy to obtain, there is a greater financial incentive for a woman to undertake work of national importance in a factory than the equally urgent work also of national importance in caring for tho children of these who are unable to look after them. Bombing also appears to bo a deterrent from undertaking the responsibility. Assistance towards cost of Midwives. (Nil) (Nil) Home Helps. 187 (151) applications and home helps provided- cost to Council £257.6s.2d. Again it is possiblo to record that thore has been no falling in finding a home help but the position is becoming Increasingly difficult and the rate of remuneration asked i3 much higher, up £3 for the fortnight compared with £l to £1.10.0. for the fortnight before the war. There has been much talk of home helps and a home help serv which obviously lacks a dotailed knowledge of what is required. A home help is needed to take the mother's place when she is confined either at home or in hospital, or is ill or for any other reason unable to look after the home and family. Among other duties the children have to be given breakfast and got ready for school, rations have to be purchased and so on which for all practical purposes limit a home help's activities to one family with children, as she cannot easily get two lots of children read for school at the same time in two separate homes. Again the home help has usually some domostic ties of her own or she would have been found employment by the Ministry of Labour long before. She will therefore desire to work near her home and incidentally be able to draw her own rations as well as her patier to avoid queueing twice. More important still if she shops as a stranger in a strange neighbourhood her chances of marketing well are likely to be poor. A whole time home help is not therefore the easy solution to a difficult problem which some would have people to believe. The best guarantee of success in a home help is to get the friend or noighbour or relative who is prepared to stay away from work for a couple of weeks to look after the home, somebody well known to the applicant and somebody who must have monetary compensation towards her loss of wages. Whore no such friend, neighbour or relative is available there can usually be found in oach welfare district one or two older women known to the health visitor who aro ready in emergency "to oblige" The uniformed, well paid, whole time, official, home help envisaged by many is an expensive luxury for whom work of some sort must be found between the times when she is not doing the housework for the disabled mother. Whole time too means so many hours work a week, and who will be in a position to certify a wages sheet with scattered work, with such infinite possibilities of fraud and be able to satisfy the district auditor as well? Dentures for expectant and nursing mothers. 39 (22) applications received and dentures providodcost to Council £138.123.6d. The increase in the scale of assessment which entitles many more women to apply for help has led to a considerable interest on tho part of expectant and nursing mothers who aro gradually beginning to take advantago of tho generous assistance now provided. Sterile Maternity Outfits. Nil (Nil) Obstetric and Gynaecological Consultants. 1 call (No calls) Convalescent Home for children between 2 and 5 years of age. The Council's four beds at the Byfloot Home for toddlers have been kept full without any difficulty throughout the year. Now and again the home has been ih quarantine for infectious disease which fortunatoly has never meant an empty bed. There is a demand for an extension of the service to give mothers convalescence with children but there is little chance of this while the war continues. Wartime Nurseries. Wartime Nursery. Accommodation. Date opened. under 2 yrs. 2-5 yrs. Cowloy 20 40 14.7.1941 Tulso Hill 30 40 17.12.1941 Black Princo 20 40 4.2.1942 Elder Road — 40 30.3.1942 Annie McCall 36 39 5.8.1942 St.* John's 25 20 24.9.1942 Coldharbour Lane 40 40 12.7.1943 Oval 20 25 4.11.1943 Nursery places are always full and waiting lists are so long at the older nurseries that many will be too old before the place they have on the list is reached. Eight nurseries were open at the end of the year with three more getting ready and the total places in the eleven nurseries including tho 20% addition will number 808. The number of children in the district under 5 years of age on the 31st December was 12,600. Suggestions have appeared from various sources that nurseries such as these should be continued after the Year is over for the purpose of providing a safe and pleasant dumping ground where an overwrought mother or a mother wanting an afternoon off to shop or go to the pictures, could leave her child in safety till she returned for him. Such a scheme is not only thoughtlessly cruel to the child who is deliberately left with strangers but he is exposed to all manner of chance infections before he has acquired much immunity. In the normal routing a child is exposed to infection from a limited number of people outside the family, a few aunts and uncles and friends, but in a nursery the child is exposed to infection from say thirty to forty children and adults each of whom will have a few aunts and uncles and friends any or all of whom they may see when they go homo at night and whose infections are there to be taicen to the nursery next day. The extent of sickness is sufficient for the Ministry to permit a 20% addition to the net number of places available at each nursery because it is found that for various reasons, most of them sickness the average child is away for l/5th of the year. A healthy child of 15 months will catch cold after cold at a nursery ending with bronchitis or broncho-pneumonia and perhaps an acute mastoid as well. This sequence is tc frequent to pass unnoticed, the alleged cause being the early morning journey to the nursery. There would be a real danger to health if nursery places were made available for large numbers of mothers each to park their young children say for one half day a week while they had the time off. It is to be hoped that this kind of nursery will nover become popular as it may be a hot bed for catarrhal infections particularly, although gastro intestinal maladies as well as the notifiable infectious would doubtless not be wanting All children are immunised against diphtheria and against whooping cough, and quarantine for all infectious disease has been cut out completely. Parents are informed when casos of whatever the infection may be have occurrcd and they are warned that they bring their children to the nursery at their n risk but that every care possible will be taken of their children if they are brought. Tho result ha3 been that no nursery has been closed or had empty places for quarantine reasons, during the whole year and moreover there has been no observable excess of infectious illness of any kind as the result. Every child is isolated the moment there is any sign of illness while the mother is sent for to take him home, which ha3 no doubt done something to limit the spread of infection, but experience seems to indicate that exclusion of contacts and other quarantine measures are not so important as they are ordinarily deemed to be. Hostel for nursery probationers. ' ' With the opening of nurseries came tho attondant 3taff difficulties and among thorn the accommodation needed for the probationers in the hutted n0rserie3. Fortunately the nurses home at the St. Thomas's Babies' Hostel was empty save for a welfare centre on the ground floor and, having 24 single bedrooms most of them with fitted wadibasins and ample bathing arrangements as well that difficulty was easily overcome. The finding after a few false starts of a suitable housekeeper prepared to shoulder the responsibility of caring for a group of girls from sixteen to eighteen or nineteen years was a stroke of good fortune and the hostel is happily a success. SUMMARY OF WORK DONE BY THE OFFICIAL HEALTH VISITORS. Ante-natal visits 1,052 Ante-natal re-visits 155 Births Ist visits 1,395 Births revisits 185 Births stillborn 65 Ophthalmia 1st visits 48 Ophthalmia re-visits 33 Infantile deaths visits 23 Welfare Centres attendances 197 Diphtheria prevention clinic attendances 162 Post-natal visits 1,488 Visits to children 1-5 years 304 Puerperal Pyrexia visits 21 Puerperal Pyrexia re-Visits 1 Special visits:- evacuation, scabies, etcl,387 One of the four official health visitors is still seconded for temporary duty in a reception area. SANITARY CIRCUMSTANCES OF THE AREA. Sanitary Inspectors. Total number of inspections (including war damage to property, etc.) 10,003 Total number of re-inspection 23,070 \ Total number of intimation notices served 2,611 Total number of nuisance notices served 335 7. Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.)2,167 Total number of revisits 170 Total number of intimation notices served 66 Workshops in which defects wore found 91 One male 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, 1935, Section 224. One application was made for an order for the compulsory removal of an aged person to hospital under this section. INSPECTION AND SUPERVISION OF FOOD. Unsound food. Approximately 31 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 and Drugs. 1,587 samples (1559 informal and 28 formal) were submitted to the Public Analyst and 2 samples wer9 examined bacteriologically in the Council's laboratory. In 1 case proceedings were instituted for contravention of the Food & Drugs Act, and a conviction was recorded. The trend of legislation enacted since the advent of the Ministry of Food has boen towards centralisation of control in that Ministry and away from the central authority of the Ministry of Health controlling the local administration of tha Food & Drugs Authority. The Defence (Sale of Food) Regulations 1943 clearly illustrate 'this new direction. They bestow upon the Ministry of Food powers equal to those of the Ministry of Health (whose powers under an Act cannot be altered by a regulation) and the latter ceases to employ its powers in deference to the Ministry of Food The latter Ministry by exercising its new powers is regulating the compositions of foods and is able to enforce them without necessarily making use of the Local Authority. The latter in fact may not without the prior consent of the Ministry of Food take legal proceedings in the case of any foods whoso composition has so far been the subject of a regulation. 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. Slaughtering. 523 pigs (chiefly belonging to Pig Clubs) were inspected at the time of slaughter SCABIES AMD VERMINOUS PERSONS. The incidence of scabies appeared to be on the increase from 1935 onwards so far as could be ascertained from information from the school medical services, and skin departments of hospitals and was not an evil directly attributable to war conditions although doubtless aggravated by them. A total of 1,939 persons were treated at the cleansing station and given 4,121 baths compared with 1,467 persons treated in the previous year. 8. Scabies was made notifiable in 1943 in order that other members of a family night if infested be induced to undergo treatment at the same time and so prevent re-Infestation of a school child for example by a younger or older member of the family in whom the infestation was not suspected or was unnoticed. The trend of notifications is definitely on the downgrade partly due to the efficacy of the more modern treatment and also to the fact that it doos not seem necessary to upset the household by treating the bedding, which in the past has been one reason for hiding the malady. The County of London (Scabies) Regulations 1943, made scabies compulsorily notifiable from the 1st August and in the first four weeks 103 cases were so notified In the following month 162 were notified then month by month 113, 133 and 113 in December. The free issue of Lethano for head lico has been much less patronised and there seems little doubt that heads are much cleaner now than they were in 1942. Infestation with body lice is comparatively rare nowadays and almost confined to the tramp class. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The measles epidemic which started in the autumn of 1942 carried over until the end of May 1943, most of tho 1,533 cases being notified in the second half of 1942 and of the 1,288 in tho first half of 1943. Whooping cough cases also tended to rise. Scarlet fever caused a definite epidemic with howover but little morbidity and only one death among tho 716 cases notified. Diphtheria gave rise to 103 notifications compared with an average figure of some 800 in pre-war years. No child who had completed the full immunisation course not less than 12 weeks contracted the disease but of the 103 others who had not been treated and who contracted the desaese, five died. Tuberculosis. Notifications received during the year ended 31st December, 1943. Pulmonary 319 (311) Non-pulmonary 41 ( 26) Deaths certified 191 (159) Notifications received during the year ended 31st December, 1943. Scarlet Fever 716 (307) Diphtheria 103 (129) Erysipelas 52 (39) Puerperal Fever 14 (7) Puerperal Pyrexia 25 (21) Cerebro-spinal Fever 7 (22) Ophthalmia Neonatorum 16 (15) Measles 1,288 (533) Whooping Cough 469 (333) Primary Pneumonia 81 (109) Influenzal Pnoumonia 65 (33) Malaria (Induced-1) 2 (5) Dysentery 62 (10) Food Poisoning 8 (32) Anthrax 1 (-) Diphtheria Prevention. The following statistics relating to the campaign against diphtheria denote the meagre success which has attended the Council's efforts. 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 50th June, 1945. 801 807 1,608 Number of children who completed the full immunisation course between 1st July and 51st December, 1945. 782 645 1,425 Whereas the under-five population numbered 11,600 In the first half of the year, by new arrivals and returns from the provinces It had increased to 12,400 in the second six months while the over-fives increased similarly from 15,600 to 16,400. The percentage of children In Lambeth who are now immune is estimated to be the following:- Under 5 Between 5 and 15 years. Percentage age immunised by 50th June 23.66 55.73 Percentage a'go immunised by 31st December 24.12 49.63 What is happening is that although a few more children are immunisod under the age of five than enter as the new born, more immunised children over five are reaching the age of 15 and so passing out of the picture than enter the age group 5-14 or have been immunised during the year. Vaccination. The vaccination officer and his whole time assistant were fully occupied throughout the year as with the increased birthrate and the return to Lambeth of so many families the number of cases dealt with were moro than double those of 1941. The births registered in the past three years number 1,354, 2,428 and 2,978 which with returning families meant 2,016, 3,541 and 4,390 cases to be followed. Dr, Rusby, public vaccinator for the Brixton division was injured by enemy action and his work was undertaken by Dr, Phillips, public vaccinator for Kennington, during his ten weeks absence. When the public vaccinator for the Norwood district was called up in the autumn the difficulty of finding a successor was so great that the work fell seriously Into arrears. Eventually with the approval of tho Ministry of Health, Dr, Bennett, assistant M. O. H., was appointed public vaccinator for the Norwood district and the arrears could then be tackled. There were 1,475 successful primary vaccinations in infants and 39 in persons over the age of one year. Successful revaccinations numbered 27. The total number vaccinated was 1,541 compared with 1,390 in the previous year. Disinfecting Department. 3,981 rooms and 10,434 articlo3 of bedding wore disinfected during the yoar among them being the rooms and articles used by the 1,474 cases of various forms of infectious disease taken to hospital; 633 certificates of disinfection were issued, and 367 library books dealt with from the 11,609 premises visited during the year. Bacteriological Laboratory. During the year 1943 the following 2,005 samples were oxamined bacteriologically in the Laboratory at Wanless Road. Specimen Negative Positive Total Swab for or suspected cases of Diphtheria 1,072 74 1,146 Sputum for suspected cases of Tuberculosis 624 84 708 Blood for suspcctod cases of Typhoid or Paratyphoid fever 28 1 29 Miscellaneous 93 29 122 1,817 188 2,005 The miscellaneous specimens consisted of 40 urines, 23 swabs for Vincent's Angina, 40 swabs for haemolytic streptococci, 12 swabs or smears from eye or vagina for Gonorrhoea and 27 faeces Rat Infestation. In September, 1942 the Council decided to appoint a team to deal with the growing menace of rats which followed on the heels of damage to houses, drains and sowers. A large measure of success was attained although the restrictive effects of the Rats & Mice (Destruction) Act, 1919 limited the success and would have rendered much of the efforts abortive if no latitude had been permitted. The general policy was to ask occupiers by whose fault rats were present to find the cost of clearance and not to ask occupiers to pay where the fault clearly lay elsewhere. In this way by the end of May, 1943, 450 cases of rat infestation had been dealt with to thb general satisfaction of all affected. During the year measures wore taken against 546 cases of infoatation Of which 328 were private dwelling houses, 97 were promises where food is stored or prepared or sold and 121 were industrial premises other than food premises. Regular inspection are made of all war damaged dereliet properties and cleared sites and where necessary baits are laid, The practice of seeing that disused drains are sealed has meant few infestations of these sites and properties. The reservoir of rat infestations is the sewerage and drainage system and in 84 cases tho source was defenitelyt raced to defective or Msused drains. In sixteen cases black rats were found and all but two of these were confined to an area near Westminster Bridge. During December the baiting of the sewers was carried out by the Borough Engineer acting under the instructions of the Ministry of Food and according to the formula (1 ounce of poison bait taken is equivalent to 2½ dead rats) led to the destruction of 4,395 rats. Free Provision of Insulin On receiving Circular 2734 from the Ministry of Health, the Council decided to supply insulin free with the consent of the Minister under Section 227, Public Health (London) Act, 1936, to certain classes of persons who find that the increase which has occurred in the cost of insulin since the beginning of the war is a substantial burden, and for whom no public provision is made apart from poor relief e.g. the dependants of Insured persons, widows and spinsters engaged in household duties and merchant seamen on foreign-going ships. The policy of the Council was welcomed widely and 30 persons now obtain a regular supply which has oost the Council during the year £94.3s,7½sd. One case of diabetes insipidus in a school child controlled by injections of pituitary extract did not fall within the ambit of the scheme and could not be allowed to do so without opening the door to a wide variety of cases. Definitely the Ministry of Health had no powers to grant the admission of this case to the scheme, but the County Council as Education and Social Welfare Authority were able to overcome the hardship laid upon the family. Had this case been treated with any variety of insulin, the free provision of the required material would of course have been available under the scheme, which is for the free provision of insulin and not for the free treatment of diabetes. 12.