REPORT on the HEALTH of the Borough of Lambeth DURING THE YEAR 1944 (88th 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 PREFACE. The annual report on the health of the borough in 1944 is short, but what a relief it is that this year no edict prevents the publication of any statistical facts for fear of giving away information useful to an enemy. There can be no question that 1944 was the most difficult and trying of all the war years. The 72 "doodlebugs" and one rocket which burst inside the borough boundaries during the year were the cause of far greater material devastation than anything which happened before. Nevertheless, the inhabitants as a body were in no way deterred by enemy action from carrying on their wartime life, although there were, of course, exceptional cases. The population was in fact more or less stationary between 1941 and 1944, being estimated at each mid-year to have been 157,510 in 1941, 157,200 in 1942, 163,100 in 1943, and 162,960 in 1944. Although tremendous efforts were made to repair the 34,000 homes which were damaged by the fly bombs, the prospect which faced the people at the beginning of the winter was, to say the least, frightening, for not only were there all these war-damaged houses to be put straight, but also an immense number of other houses not war-damaged but in sore need of repairs withheld perforce during the war years. These came a bad second to those war-damaged in being mended, although when roofs are leaking the cause should be of no importance compared with the misery of the occupants. Still, rightly or wrongly, war damage repairs came, and still come, a long, long way first. Again, deep gratitude is expressed to the members of the Public Health Committee for their forbearance, to the Chief Officers for their assistance and co-operation, and most of all to the still further reduced staff of the Department who so cheerfully carried on in spite of every discouragement. A.G.G.T. July 1945. 3 STATISTICS AND SOCIAL CONDITIONS. Summary of Vital and Mortal Statistics, &c. (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 SubDistricts have been adjusted so that they and the Wards are co-terminus. Births (corrected)—3,008. Birth rate per 1,000 estimated resident population corrected, 18.48 (16.87). Deaths (corrected)—2,863. Death rate per 1,000 estimated resident population, 17.56 (16.87). Maternal mortality (corrected) per 1,000 total births (live and still), 2.66 (2.81). Infantile mortality, 52 (60). Marriages. Marriage rate per 1,000 population, 9.15 (9.18). Comparable rates for England and Wales and London:— England and Wales. London. Birth rate 17.6 (16.5) 15.0 (15.8) Death rate 11.6 (12.1) 15.7 (15.0) Infantile mortality 46 (49) 46 (58) Puerperal causes 1.93 not available Causes of, and ages at, death (corrected) during the year, 1944. Mortality 17.56 (16.87) Causes of death Ages—Both Sexes Totals Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 45 years 45 and under 65 years 65 and upwards M. F. 1. Typhoid and Paratyphoid - - - - - - - 1 — - - 1 — 1 1 2. Cerebro-spinal Fever — — 3. Scarlet Fever - — - - - - 2 - — - 1 1 4. Whooping Cough - 1 2 - — - 3 — 5. Diphtheria 43 - - - 63 48 13 81 6. Tuberculosis, respiratory system 7 5 6 - 1 9 10 7. Other Tuberculosis - - - 4 15 7 16 10 8. Syphilitic diseases 2 - - 2 8 8 9 11 9. Influenza - - - - - 10. Measles — — — — - - - - 11. Ac. Poliomyelitis and Polioencephalitis - - - 1 - - 1 - 12. Ac. Infectious Encephalitis (Lethargic) — — — i - - - - 13. Cancer, Buccal Cavity and Oesophagus (M.) - - - 2 17 27 28 18 Uterus (F.) - - - 3 21 37 40 21 14. Cancer, Stomach and Duodenum - - - 1 22 21 — 44 15. Cancer, Breast - - - l 3 81 134 130 99 16. Cancer, all other sites - - l 2 5 11 5 13 17. Diabetes 1 4 52 164 85 136 18. Cerebral Vascular Lesions - - - 22 119 576 360 357 19. Heart Disease 20. Other Circulatory Diseases - - - 1 24 68 42 51 21. Bronchitis 9 4 — 7 53 108 125 56 22. Pneumonia 34 3 2 9 34 71 95 58 23. Other respiratory diseases 24. Ulcer, Stomach and Duodenum - - — 4 16 13 22 11 — — — 3 17 19 33 6 25. Diarrhoea(under 2 years) 26. Appendicitis 31 2 — — — - 20 13 27. Other Digestive diseases - — 1 4 2 2 7 2 6 1 — 7 16 22 28 24 28. Nephritis 29. Puerperal and Post abortive sepsis — — 1 8 5 29 21 22 30. Other Maternal Causes — — — 5 — - 5 31. permature birth — — — 4 - - - 4 32. Congenital Malformations, Birth Injury, Infantile diseases 49 — — - - - 33 16 29 2 1 3 3 2 28 12 33 suicide — - 2 6 2 8 2 34.Road Traffic Accidents - 3 1 5 5 9 5 35. Other Violent Causes 8 11 30 123 131 109 188 224 36. All other causes — 1 4 23 39 93 87 73 Total All Causes 171 32 51 .327 740 1,542 1,515 1,348 * s 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious Diseases in the year 1944. Provisional Figures based on Weekly and Quarterly Returns. England and Wales 126 C.Bs. and Great Towns including London 148 Smaller Towns Resident Population, 25,00050,000 at 1931 census London Administrative County Lambeth - * Rates per 1,000 Civilian Population:— Live Births 17.6† 20.3 20.9 15.0 18.4 Still Births 0.50† 0.64 0.61 0.42 0.47 Deaths: All Causes 11.6† 13.7 12.4 15.7 17.56 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.03 0.03 0.02 0.04 0.01 Diphtheria 0.02 0.03 0.03 0.01 0.01 Influenza 0.12 0.10 0.11 0.08 0.11 Smallpox 0.00 — — — — Measles 0.01 0.01 0.01 0.00 — Rates Per 1.000 Live Births:— Deaths under 1 year of age 46‡ 52 44 61 52 Deaths from Diarrhoea and Enteritis under 2 years of age 4.8 7.3 4.4 10.1 0.20 * A dash (—) signifies that there were no deaths. † Rates per 1,000 total population. ‡ Per 1,000 related births. 7 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, and to persons over five years of age, 1,671. The increase in salary of district nurses following the report of the Rushcliffe Committee has been met in so far as the Borough Council is concerned by an increase in the flat payment to 2s. 2d. per visit to all cases. This rate is paid for each visit of a district nurse from all the seven district nursing associations working in the area. The cases nursed are all those including sufferers from Tuberculosis requiring skilled nursing which in the opinion of the Medical Officer of Health can properly be regarded as coming within the scope of the Lambeth nursing (infectious disease) scheme or the Lambeth maternity and child welfare scheme. Welfare Centres. Total individual cases dealt with 15,650 (16,350) „ sessions held 2,552 ( 2,573) „ ante-natal cases 3,059 ( 3,235) „ post-natal cases 718 ( 890) ,, nursing mothers 3,281 ( 3,402) „ infants under 1 4,630 ( 4,797) „ children 1-5 4,063 ( 4,114) Visits paid to A/N cases 7,20 „ „ P/N cases 2,822 ( 2,857) ,, „ nursing mothers 19,146 (22,225) „ „ infants under 1 19,232 (21,267) „ „ children 1-5 37,097 (41,752) The renewal of enemy action caused much disturbance among the families with young children. The more fortunate were able to get out of London, but more remained behind to find their homes lost or damaged. It is natural, therefore, to find that the numbers attending the welfare centres are less than in the previous year. The Brixton Welfare Centre premises were destroyed, fortunately after hours without loss of life, and the centre found refuge in the crypt of St. Matthew's Church until other temporary 8 dation became available. The Loughborough Junction and Stockwell Centre premises suffered grievous damage, and for months work has been carried on under extreme difficulty. Scarcely any centre escaped entirely, but the work continued everywhere with the firm intention of the users and staffs that, whatever happened, the children should not suffer. The evacuation scheme for the confinement of expectant mothers in safety outside London was continued, and 643 mothers profited by it, compared with 605 in 1943, 415 in 1942 and 322 in 1941. Any children under five years belonging to the expectant mothers evacuated were accommodated in short stay nurseries outside London if no private arrangements could be made. The same facility was afforded to any mother entering hospital for any treatment or operation away from her home. Child Life Protection. 1,201 visits and re-visits were made to foster mothers and nurse children. Foster mothers on Register at 31.12.44 26 (29) Nurse children on Register at 31.12.44 34(34) The demand for foster mothers far outstrips the supply, because with part-time factory employment so easy to obtain, there is a greater financial incentive for a woman to undertake work in a factory. Bombing also was a strong deterrent from undertaking the responsibility. Care of Premature Infants. A space is provided in the notification of births card for the insertion of the child's weight, and all cases born in the district are followed up specially until they are one month old. Close co-operation is maintained between the hospitals and the public health department in order that on returning home the mother shall know to whom to turn immediately an emergency arises needing extra equipment, help in feeding the infant, and so on. It is of interest to report that of ten premature infants born in one area of the district, all the mothers had suffered from persistent anxiety or illness during pregnancy. Five were illegitimate, the father of one had deserted his wife, the father of another was missing, the family of another were bombed out several times, the mother of another had some nervous instability and had two children in one year, the last mother had high blood pressure, pyelitis and cardiac insufficiency. 9 Illegitimate Children. The Council agreed to the scheme drafted by a joint committee representing the metropolitan Boroughs and the County Council and the various moral welfare organisations which cover the entire metropolitan area. The scheme adopted provides that a sum of money, depending upon the rateable value, is collected from the individual borough councils and divided between the moral welfare organisations. These latter provide and pay an adequate staff of moral workers and report as may be necessary to individual councils. In addition the foster mothers of illegitimate children receive a guaranteed payment from the local authority in which they reside, which is by arrangement collected from the local authority where the mother resides if not the same. Mothers are assessed according to a uniform formula. As soon as conditions render it possible an extension of hostel facilities will be carried out by the moral welfare societies with assistance from the County Council, who are the institutional authority in London. Home Helps. 160 (187) applications and home helps provided—cost to Council, £222 12s. 0d. Again it is possible to record that there has been no failure in finding a home help, but the position is becoming increasingly difficult and the rate of remuneration asked is much higher, up to £4 for the fortnight, compared with £1 to £1 10s. 0d. for the fortnight before the war. Domestic Helps. The influenza epidemic in December, 1943, gave indications of causing trouble of major importance. The local recources of the medical profession were strained unbearably, and arrangements were in hand to make use of doctors from the armed forces, including those of the United States. Coupled with the shortage of doctors was the shortage of domestic staff. Families who could manage for themselves in ordinary circumstances were faced with illness and nobody to look after them, to collect rations and so on. In peace time neighbours would have helped, but neighbours were themselves often in a like position. The W.V.S. offered to help provided the doctor certified the need, and a general pooling of resources from all quarters was being arranged when the outbreak began to decline rapidly. Deaths in London from influenza, bron- 10 chitis and pneumonia, which had risen in the week ending December 11th to 537, fell to 476, 357 and 271 in succeeding weeks and, of course, cases decreased proportionately in number. The full extent of the epidemic cannot be guaged, as influenza is not an entity, neither is it notifiable, but the hospital beds held all for whom nursing staff could be found, and it was primarily the inability to admit more to hospital which in turn thrust so hardly at the meagre nursing facilities in the home. From this the lack of domestic help among elderly people became a focus of public attention, and the Ministry of Health began to explore the possibilities of the local authority setting up a domestic help service for those who from age, incapacity or sickness were unable to manage their own homes. The lack of labour for the service has been the insurmountable block, and only now—mid 1945—is it a fact that a beginning has been made. • Dentures for Expectant and Nursing Mothers. ' 20 (39) applications received and dentures provided—cost to Council, £64. No other reason than enemy action can be adduced for the reduction in the numbers applying for assistance towards payment of dentures. Sterile Maternity Outfits. Nil (Nil). Obstetric and Gynaecological Consultants. 2 calls (1 call). Obstetric Unit for Blood Transfusion 3 calls (nil). Free Provision of Insulin. Insulin was provided free by the Council under §227, Public Health (London) Act, 1936, to forty persons at a total cost of £173. 11 Convalescent Home Accommodation. The Council's four beds at the Byfleet Home for toddlers have been kept full during the year. On hearing that the Byfleet Home was likely to close in the early months of 1945, the Council agreed to transfer their interest in the four beds to the new home which the staff were to open outside Sevenoaks. Before the war the Council had two beds at the Zachary Merton Convalescent Home for mothers and young children at Rustington. On learning that the home, which had been put to other uses during the war, was expecting to reopen as soon as could be arranged, the Council agreed to take four beds for mothers, each of whom may be accompanied by an infant, and in some cases a toddler as well. Wartime Nurseries. Wartime Nursery Accommodation Date opened under 2 years 2-5 years Cowley 20 40 14.7.1941 Tulse Hill 30 40 17.12.1941 Black Prince 26 48 4.2.1942 Elder Road (closed 30.11.44) — 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 Gipsy Hill 27 30 8.8.1944 Coral Street 41 30 5.6.1944 The nurseries were full for the first six months of the year, but the fly-bombs led to the evacuation of large numbers of children. The average daily attendance fell from 435 in May to 365 in June, 209 in July and 186 in August. By September, when the fly-bomb attack from France had ceased, the number rose to 256, and more or less to normal for the rest of the year. The Elder Road nursery, which was situated in and manned by the personnel of the first aid post was closed with the post in November. The two nurseries opened at Coral Street and Gipsy Hill both had checkered histories. Coral Street was ready to open in March, but was damaged by enemy action and could not be repaired before July, when it opened with a daily average of 15 for the first two months, but progressed fairly rapidly after that. The ice had to be broken before the conservative customs in that area were changed and the idea of a nursery became acceptable. Gipsy Hill nursery was twice damaged and twice repaired, on each 12 occasion postponing the opening date, and then for some days there was only one child, but when the enemy action had ceased the nursery went ahead. Another nursery of the hut type was in course of erection when all labour was withdrawn for house repairs in June and it has never been finished. No one can doubt the great value of nursery life to the fortunate children who attend one, but the total accommodation of the nine nurseries is about enough for the odd hundreds only of the 12,650 children under five years old estimated to be residing in the district at the end of 1944. The tendency is for nursery accommodation to become limited more and more to those special cases where the mother is the breadwinner. The new Education Act has imposed the duty of providing nursery schools for children of two to five years upon the County Council the Local Education Authority. The hours that schools are open are insufficient to enable a woman to leave her child and do a full day's work. When the nursery school closes the child cannot be taken to a day nursery, because no child is allowed by law to attend one when attending the other. (Public Health (London) Act, 1936, §251.) The only way to overcome this is to combine the day nursery and the nursery school as they are in a wartime nursery, but, unhappily, such a solution appears to find no favour with the Ministry of Education. The wartime nurseries meanwhile are full, and there is a heavy waiting list. This demand emphasises more than any words can do the desire for their retention and, indeed, expansion by those mothers who are unwilling or unable to give up their work. Summary of Work Done by the Official Health Visitors. Ante-natal visits 1,106 Ante-natal re-visits 145 Births, 1st visits 1,168 Births, re-visits 219 Births, stillborn 40 Ophthalmia, 1st visits 32 Ophthalmia, re-visits 16 Infantile deaths, visits 39 Welfare Centres attendances 118 Diphtheria prevention clinic attendances 161 Post-natal visits 1,340 13 Visits to children 1-5 years 229 Puerperal Pyrexia visits 25 Puerperal Pyrexia, re-visits 5 Special visits : evacuation, scabies, etc. 1,528 One of the four municipal health visitors resigned during the year and her place has not been filled. Sanitary Circumstances of the Area. Sanitary Inspectors. Total number of inspections (including war damage to property, etc.) 13,047 Total number of re-inspections 17,070 Total number of intimation notices served 2,206 Total number of nuisance notices served 253 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 1,803 Total number of re-visits 204 Total number of intimation notices served 80 Workshops in which defects were found 84 One male sanitary inspector is still 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 No application was made for an order under this section. Inspection and Supervision of Food. A large proportion of the work of food inspection was devoted to the examination, salvage and disposal of food damaged by enemy, action in the spring raids and flying-bomb and rocket attacks later in the year. For obvious reasons no figures of the amount of food dealt with were made public. As soon as practicable after an incident occurred the premises were visited, the food therein examined and passed as fit for food or otherwise. In cases of severe damage arrangements were made in co-operation with the Food Executive Officer for persons registered with such shops to obtain their rationed foods from another source. 14 A large quantity of food was salvaged from shops and stores which had been seriously damaged, and after inspection that which was fit for food was handed over to the Ministry of Food Salvage Division for disposal. Food which was fit only for animal feeding was diverted to that use and food which was totally unfit was destroyed. Considerable assistance in these salvage operations was rendered by the Light Rescue Parties. One thousand, four hundred and sixty-six samples of food and drugs (1,407 informal and 59 formal) were submitted to the public analyst for analysis. The majority of these were of the staple articles of diet, such as rationed foods, and it is of interest to note that among the rationed foods not one instance of adulteration occurred. Although at times it may have been felt the quantity was not excessive, the quality was beyond reproach. Approximately 23 tons of food, excluding war damage mentioned above were certified as being unfit for human consumption; all unsound food suitable for animal feeding was diverted to that purpose. Three hundred and eighteen pigs were inspected at the time of slaughter and one pig and a small amount of offal were certified as diseased and unfit for food and were destroyed. These pigs in nearly every case were the property of pig clubs, and while there is no legal authority for them to be inspected as they were not for sale, it has been mutually agreed in every case with the clubs that post-mortem inspection should be carried out. A small number of "casualty" pigs were inspected on behalf of the Ministry of Food; these were pigs which had been slaughtered either owing to the animal having met with an accident or some other reason necessitating immediate slaughter. Scabies and Verminous Persons. Cleansing Centre. For many years past there have been agreements with two adjoining boroughs for the use on payment of their cleansing centres for Lambeth residents. The Public Health Committee agreed in principle to the conversion of premises adjoining the disinfecting station into a cleansing centre, but the impossibility of gaining permission to do the work, even if labour and materials were available, has held up the project for the time being. A total of 1,913 persons were treated at the cleansing station and given 3,659 baths, compared with 1,939 persons treated in the previous year. 15 Rat Infestation. During the year 540 infestations were dealt with. Of these 506 were brown rat infestations and 34 ships' rats. In only 1 case (rag yard) was the infestation of major character. In 307 cases houses were affected, 95 were food premises and 138 other industrial premises. Four hundred and ninty-two premises were baited, 25 were ferretted, and in the remaining 23 cases advice only was given. Sixty-five infestations resulted directly from defective or disused drains and were dealt with accordingly. In December, 1943, the first part of the sewer baiting treatment was carried out, and the second part was completed in January of this year. In November a further treatment was put in hand and 1,990 points were baited. Throughout the year the numerous cleared sites and derelict houses were inspected, and where necessary, baits were laid. In a few cases premises have been baited to destroy mice, but in the majority of cases enquirers have been advised to deal with the nuisance by baiting or trapping. Full instructions as to the method to use in poisoning have been given. Prevalence and Control Over Infectious and Other Diseases. The low incidence throughout the year of all infectious disease is an indication perhaps of the high standard of nutrition. Certainly, the table summarising the incidence of tuberculosis, quarter by quarter for the years 1941-44, indicates that there was no significant change in the numbers notified during the period, notifications per thousand population being in the four years 2.19, 2.14, 2.21 and 2.28 respectively. The corresponding number of notifications per 1,000 population in the four war years, 1914-15-1617, were 4.2, 5.8, 5.8 and 6.2, years in which the general standard of nutrition was definitely falling. Tuberculosis. Notifications received during the year ended 31st December, 1944 Pulmonary 334 (319) Non-pulmonary 49 (41) Deaths certified 142 (191) Summary of T.B. Cases (Both Forms) for Years Commencing 1941. Pulmonary Non-pulmonary First. Quarter Second Quarter Third Quarter Fourth Quarter Total for Year First Quarter Second Quarter Third Quarter Fourth Quarter Total for Year Totals all Forms Year m. F Total m F, Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total Private 8 7 15 7 6 13 10 2 12 4 2 6 46 1 2 3 — 1 1 — - — 1 — 1 5 51 1941 Popn., 157,510 Hospitals 34 13 47 36 14 50 33 13 46 13 8 21 164 3 2 5 5 2 7 4 5 9 3 8 11 32 196 Dispensaries 11 11 22 11 11 22 15 15 30 10 9 19 93 — 2 2 1 — 1 2 — 2 — — — 5 98 Totals 53 31 84 54 31 85 58 30 88 27 19 46 303 4 6 10 6 3 9 6 5 11 4 8 12 42 345 Private 7 3 10 8 5 13 6 3 9 3 8 11 43 - 1 1 - 1 1 1 1 3 46 1942 Popn., 157,201) Hospitals 35 17 52 29 20 49 32 18 50 27 10 37 188 — 1 1 7 2 9 1 4 5 3 1 4 19 207 Dispensaries 9 11 20 12 7 19 12 10 22 9 10 19 80 — — — 1 1 2 — 1 1 — 1 1 4 84 Totals 51 31 82 49 32 81 50 31 81 39 28 67 311 - 2 2 8 3 11 1 6 7 3 3 6 26 337 Private 10 1 11 7 7 14 8 2 10 5 3 8 43 - - - 1 1 2 1 1 — — 3 46 1943 Popn., 163,100 Hospitals 29 14 43 40 22 62 28 17 45 36 15 51 201 6 5 11 4 4 8 5 7 12 5 1 6 37 238 Dispensaries 12 13 25 4 7 11 3 13 16 15 8 23 75 - - - - - - - - - - 2 2 2 77 Totals 51 28 79 51 36 87 39 32 71 56 26 82 319 6 5 11 5 5 10 5 8 13 5 3 8 42 361 Private 7 4 11 9 5 14 5 1 6 5 3 8 39 - - - 1 1 — — 1 40 1944 Popn., 162,960 Hospitals 39 15 54 28 19 47 20 7 27 38 19 57 185 4 5 9 7 5 12 4 4 8 6 5 1l 40 225 Dispensaries 14 14 28 14 12 26 8 9 17 14 25 39 110 2 — 2 — — — 1 — 1 2 3 5 8 118 totals 69 33 93 51 36 87 33 17 50 57 47 104 334 6 5 11 7 5 12 5 5 10 8 8 16 49 383 17 The T.B. Allowance Scheme: Memo. 266/T. There is a close co-operation between the officers of the two dispensaries and the social welfare officers of the County Council in the administration of the scheme. So far as its limited scope permits the scheme is working satisfactorily, but there is, and there is bound to be, some divergence of opinion over many cases in the interpretation of Memo. 266/T. Deciding who is eligible to participate and who is not is tantamount to labelling one who will improve at least sufficiently to return to work as likely to recover, and the other as one who will go downhill. The former has much of his financial troubles dispersed, is co-operative, and has faith in his chances of recovery. The latter is conscious of a difference between himself and the next man, and is resentful at what appears to him gross unfairness. He becomes still more embittered when he finds in hospital in the next bed perhaps one who is in no better shape than himself, but who comes from another dispensary district and a different medical opinion has given him the benefits of the scheme. It would appear equally necessary for the safety of home contacts and fellow workers to make the same allowances for all cases of pulmonary tuberculosis and to do away with the present artificial division. The argument that this step would open the door to all other forms of chronic sickness becoming eligible for similar allowances does not hold water, when it is realised that the welfare of the sufferer is incidental to the prime object of safeguarding the health of others. The prevention of infection should be the guiding principle in the scheme and not the future fitness of the sufferer for employment. If not widened to include all cases of pulmonary tuberculosis the scheme might still be amplified to fill gaps such as the married woman who is advised to give up a gainful occupation but is ineligible to participate in the scheme because she is regarded as the dependent of her husband, or the pregnant wife who must wait for her child to be born before becoming eligible for any extra financial help from any source, unlike the wives of Service men who get an ante-natal grant. Cases occur where the pregnant woman works right up to the last in order to provide for the baby because there is no provision for assistance under the scheme. 18 Notifications received during the Year ended 31st December, 1944. Scarlet Fever 361 (716) Diphtheria 66 (103) Erysipelas 56 (52) Puerperal Fever 11 (14) Puerperal Pyrexia 19 (25) Cerebro-spinal Fever 10 (7) Ophthalmia Neonatorum 16 ( 16) Measles 442 (1,288) Whooping Cough 354 (469) Primary Pneumonia 76 (81) Influenzal Pneumonia 24 (65) Malaria (Induced—1) 4 (2) Dysentery 64 (62) Food Poisoning 4 (8) Anthrax — (1) Scabies 1,002 (624) (six months) Typhoid 1 (-) Paratyphoid 2 (-) 19 England and Wales 126 C.Bs. and Great Towns including London 148 Smaller Towns Resident Population, 25,00050,000 at 1931 census London Administrative County Lambeth Notifications: Rates per 1,000 Civilian Population:— Typhoid Fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid Fever 0.01 0.00 0.01 0.01 0.01 Cerebro Spinal Fever 0.05 0.06 0.04 0.06 0.05 Scarlet Fever 2.40 2.41 2.67 1.57 2.13 Whooping Cough 2.49 2.49 2.29 2.90 2.09 Diphtheria 0.58 0.67 0.69 0.31 0.39 Erysipelas 0.29 0.32 0.28 0.37 0.33 Smallpox 0.00 0.00 0.00 0.00 - Measles 4.16 4.51 3.94 2.98 2.61 Pneumonia 0.97 1.13 0.82 0.93 0.44 Rates per 1,000 Total Births (Live and Still):— (a) Notifications:— Puerperal Fever 10.34 13.13 9.25 3.61 3.65 Puerperal Pyrexia 14.14* 9.97 * Including Puerperal Fever. 20 Diphtheria Prevention. It will be readily understood that the statistics do not by any means give a clear picture of the degree of success achieved during the year. The numbers immunised were far lower than in 1943, particularly in the second half of the year. 5 years and Under over, but Total 5 years under 15 years Number of children who completed the full immunisation course between 1st January and 30th June, 1944 699 (801) 548 (807) 1,247 (1,608) Number of children who completed the full immunisation course between 1st July and 31st December, 1944 334 (782) 21 (643) 355 (1,425) In the first two quarters the under five population numbered 12,400, but in the third quarter the number fell rapidly as the children were taken out of London, and even at the end of the year the returned children only raised the number to 9,600, and much the same happened to the children from five years to fifteen, who numbered 15,800 at the mid-year and 11,900 at the end. Vaccination. The air raids by piloted aircraft in the first half of 1944 and the flying bombs in the second half of the year caused additional work, mainly because of the extra efforts required to trace the new addresses of mothers and babies moving in and out of London. It is to be noted that in several cases, after having found the new addresses and having sent the information to the Vaccination Officers for the districts concerned, the parents have returned to London with the babies unvaccinated, although they asked for vaccination to be done whilst they were away, but did not wait for it to be arranged. Set out hereunder are figures relating to the years 1942, 1943 and 1944 for comparison:— 1942 1943 1944 Number of births in Lambeth registered during the year 2,428 2,978 2,581 Total number of cases requiring the Vaccination Officers' attention during the year 3,541 4,390 4,092 21 The number of cases dealt with continued to increase up to the end of July, 1944. Lambeth Hospital received a direct hit by a flying bomb early in that month when the maternity wing had to be closed. The effect of this was added to the general exodus of the young population causing the numbers to fall. Disinfecting Department. 2,082 rooms and 2,922 articles of bedding were disinfected during the year, among them being the rooms and articles used by the 855 cases of various forms of infectious disease taken to hospital; 474 certificates of disinfection were issued, and 250 library books dealt with from the 5,343 premises visited during the year. The clean van was used regularly for the delivery of stores to the wartime nurseries which reached the Town Hall in bulk from the various firms supplying the Ministry of Health. Bacteriological Laboratory. During the year 1944 the following 1,538 samples were examined bacteriologically in the Laboratory at Wanless Road. Specimen Negative Positive Total Swab for or suspected cases of Diphtheria 694 28 912 Sputum for suspected cases of Tuberculosis 598 94 692 Blood for suspected cases of Typhoid or Paratyphoid fever 4 1 5 Miscellaneous 98 31 129 1,394 154 1,538 The miscellaneous specimens consisted of 40 urines, 77 swabs for hæmolytic streptococci, 10 swabs or smears from eye or vagina for gonorrhœa, and 2 fæces. INDEX page Births 6 Child Life Protection 8 Convalescence 11 Deaths 4 Dentures 10 Diphtheria Prevention 20 Disinfection 21 Domestic Helps 9 Food Inspection 13 Home Helps 9 Illegitimate Children 9 Insulin 10 Laboratory 21 Notifications 18 Nurseries 11 Nursing 7 Premature Infants 8 Rats 15 Sanitary Circumstances 13 Scabies 14 Statistics 3, 6 Tuberculosis 15 Vaccination 20 Welfare Centres 7