REPORT ON THE HEALTH OF THE Borough of Lambeth DURING THE YEAR 1945 (89th 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.K.27 2 PREFACE. The health of the Borough of Lambeth has been satisfactory during the year ; the birth rate is higher and the death rate lower while other cardinal pointers indicate improved standards. The conspicuous dominant interest which has overshadowed all else besides has been the housing situation and prospects. The Registrar General estimated the mid-year population to be 173,280, but ration books in use in the district on the 22nd December numbered 193,703, a strong indication that during that six months there had been an influx of more than 20,000 people. In that second six months of the year, the new accommodation made available in the area was only 183 emergency and temporary huts, although it must be remembered that great numbers of damaged premises were, of course, repaired and made fit for occupation. The prospect of any large number of new houses being ready in the near future was not encouraging for the great numbers of young men, particularly Group 26, waiting for release in the early months of 1946. Most of these were either recently married and wanting to set-up house or waiting for demobilisation before marriage. Thanks are gratefully tendered to the Chief Officers for their unfailing help, to the members of the Public Health Committee for their advice and criticism and to the staff of the Public Health Department whose loyal co-operation throughout a difficult year is acknowledged with a due sense of appreciation. A.G.G.T, July, 1946. 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)—3,219 Birth rate per 1,000 estimated resident population corrected 18.57 (18.48). Deaths (corrected)—2,587. Death rate per 1,000 estimated resident population, 14.92 (17.56). Maternal mortality (corrected) per 1,000 total births (live and still), 1.82 (2.66). Infantile mortality, 46 (52). Marriages. Marriage rate per 1,000 population, 12.08 (9.15). Comparable rates for England and Wales and London :— England and Wales. London. Birth rate 16.1 (17.6) 15.7 (15.0) Death rate 11.4 (11.6) 13.8 (15.7) Infantile mortality 46 (46) 53 (61) Puerperal causes 1.79 not available 4 Causes of, and Ages at, Death (Corrected) During the Year, 1945. Mortality 14.92 (17.56). 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 - - - - - - - - 2. Cerebro-spinal Fever 5 1 - 1 - - 3 4 3. Scarlet Fever 1 - - - - — 1 — 4 Whooping Cough 3 1 - - - - - 4 5. Diphtheria - 1 - - - — 1 6. Tuberculosis, respiratory system - 1 - 88 51 18 109 49 7. Other Tuberculosis 1 4 2 4 2 — 8 5 8 Syphilitic diseases - - - - 11 2 9 4 9. Influenza 1 - - 4 4 7 10 6 10. Measles 1 - - - - - - 1 11. Ac. Poliomyelitis and Polioencephalitis 1 1 — 12. Ac. Infectious Encephalitis (Lethargic) - — - - 1 — 1 — 13. Cancer. Buccal Cavity and Oesophagus (M.) Uterus (F.) - - - 5 17 22 19 25 14 Cancer, Stomach and Duodenum — — — 5 21 33 - 31 15. Cancer, Breast — - — 3 18 18 — 39 16. Cancer, all other sites - - - 11 114 130 156 99 17. Diabetes — — - 1 9 7 3 7 18. Cerebral Vascular Lesions - — - 3 60 165 100 128 19. Heart Disease - — 1 23 99 600 353 370 5 20. Other Circulatory Diseases - - - 2 30 55 40 47 21. Bronchitis 8 1 — 7 58 113 116 71 22. Pneumonia 20 3 — 6 22 58 66 43 23. Other respiratory diseases 1 — — 1 14 13 24 5 24. Ulcer, Stomach and Duodenum — —. 4 14 19 30 7 25. Diarrhoea (under 2 years) 20 2 — — — — 13 9 26. Appendicitis — 1 1 2 4 1 6 3 27. Other Digestive diseases 1 — — 2 13 35 22 29 28. Nephritis — — 2 8 20 26 31 25 29. Puerperal and Post Abortive Sepsis — — — 2 — — — 2 30. Other Maternal Causes — — —. 4 — -— —, 4 31. Premature Birth 20 — — — 11 9 32. Congenital Malformations, Birth Injury, Infantile diseases 53 - - 1 6 1 40 21 33. Suicide - - - 5 4 6 9 6 34. Road Traffic Accidents 1 6 4 5 10 20 6 35. Other Violent Causes 8 2 13 29 39 44 63 72 36. All other causes 7 4 3 23 37 89 80 83 Total All Causes 150 22 28 249 666 1,472 1,372 1,215 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious Diseases in the year 1945. 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 16.1† 19.1 19.2 15.7 18.57 Still Births Deaths : 0.46† 0.58 0.53 0.40 0.39 All Causes 11.4† 13.5 12.3 13.8 14.92 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 0.005 Whooping Cough 0.02 0.02 0.01 0.02 0.023 Diphtheria 0 02 0.02 0.02 0.01 0.005 Influenza 0.08 0.07 0.07 0.07 0.092 Smallpox — — — — — Measles 0.02 0.02 0.02 0.01 0.005 Rates per 1,000 Live Births :— Deaths under l year of age 46‡ 54 43 53 46 Deaths from Diarrhoea and Enteritis under 2 years of age 5.6 7.8 4.5 7.6 6.8 * A dash (—) signifies that there were no deaths. †Hates 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 2,924, and to persons over five years of age, 2,175. 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 15,601 (15,650) ,, sessions held 2,486 ( 2,552) „ ante-natal cases 3,422 ( 3,059) ,, post-natal cases 678 ( 718) „ nursing mothers 3,527 ( 3,281) „ infants under 1 4,588 ( 4,630) „ children 1-5 3,546 ( 4,063) Visits paid to A/N cases 6,990 ( 7,206) „ „ P/N cases 2,762 ( 2,822) ,, „ nursing mothers 20,176 (19,146) ,, ,, infants under 1 18,882 (19,232) „ „ children 1-5 37,273 (37,097) Welfare work increased steadily after V.E. Day, as more and more families were reunited, and the housing conditions, depressing enough for the reduced wartime population, rapidly worsened as the population returned from evacuation. The children attending the Welfare Centres are in better health than ever but the mothers were facing the prospect of continued rationing and longer queues with a forbearance and equanimity based upon the conviction that things must improve soon. Tempers were already on edge, 8 while the return of husbands has meant so many of the young people having to live with " in-laws " or friends, and much disillusion especially follows the birth of a child where the family have no home of their own. The evacuation scheme for confinements outside London has relieved some of the strain upon the homes where room and convenience for childbirth is often non-existent. The number taking advantage of the scheme in 1945 was 729, compared with 643 in the previous year and 605 in 1943. The lack of adequate accommodation through the overcrowding of so many homes made the prospect of a home confinement in many cases an intolerable burden. Lack of sufficient staff curtailed the number of beds in institutions which might have been available, so that perforce the evacuation scheme, which, in time of war was a safety precaution, was continued as a relief outlet to the acute shortage of all kinds of necessaries for the confinement of increasing numbers of expectant mothers. Child Life Protection. 1,043 visits and re-visits were made to foster mothers and nurse children. Foster mothers on Register at 31.12.45 28(26) Nurse children on Register at 31.12.45 32 (34) The demand for foster mothers far outstrips the supply, because factory employment is easy to obtain, and there is a greater financial incentive. 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 weighing 5½ lbs. or under 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. Of the 108 premature children notified in the year, 36 were born at home and 72 in hospital. Of the former, one died in the first 24 hours, two had to be admitted to hospital and 35 survived the first month. Of the 72 born in hospital, 7 died in the first 24 hours, two died later and 61 are known to have survived the first month. The remaining two were taken away by their parents who could not subsequently be traced. 9 Illegitimate Children. The Southwark Diocesan Association for Moral Welfare undertakes on the Council's behalf the Lambeth part of the joint London Scheme. The Council's grant to the Association was £233 ; Assistance was given to 125 unmarried mothers and their children, and to 40 unmarried expectant mothers. As the result of the efforts of the Welfare visitors, no less than 71 girls were able to return home with their babies which is the best solution of the difficulty. Of the rest, 7 babies were cared for by foster mothers, 15 went to residential nurseries, places were found for 6 in day nurseries while the mother went out to work and provided a home out of nursery hours, 15 were adopted, 6 mothers found homes with friends for themselves and their babies. The remaining 5 babies did not survive the year. One child only was provided with a foster mother under the guaranteed payment scheme during the year and then only for a few months as the mother was fortunately able later to make a home for her baby. Home Helps. 229 (160) applications and home helps provided—cost to Council, £366 9s. Od. (£"222 12s. 0d.), the rest of the gross cost £590 7s. 0d. being paid by the applicants. Again it is possible to record that there has been no failure in finding a home help, but the rate of remuneration asked is much higher, up to £4 for the fortnight, compared with £1 to £1 10s. 3d. for the fortnight before the war. The position is if anything slightly easier than in the previous year. The scheme does simplify matters considerably where a relative or friend gives up employment in order to act as home help. Domestic Helps. After a poor start with many applications for assistance but no offers of help, the first domestic help started in July assisting one applicant. This number increased by one more help each month until there were six domestic helps giving assistance to six distressed families at the end of the year. An increase in the rate of pay Is. 6d. an hour was considered in September as a greater inducement, but rather than break away from the Whitley scale the Council agreed to pay bus and tram fares instead. This rate is now increased to 1s. 9¾d. an hour. Two of the three original domestic helps are still in the Council's employment and the number is now 15 (July). Many more applicants could be assisted if more women would work for the Council. 10 The scheme works simply. The applicant who states the circumstances and financial position, verified later through the employer, is visited by the woman officer in charge who ascertains by personal inspection the hours of work required to cover the need. A domestic help is then introduced and both applicant and help sign the time sheet of hours worked during the week. W here possible applicants are accommodated the day the}' apply. The domestic helps, all of whom are part-time, are paid by the Council, either at the Town Hall or by post, while the applicant is covered according to the London scale and pays weekly the sum agreed to the officer when she calls for the time sheet. Dentures for Expectant and Nursing Mothers. 17 (20) applications were received and dentures provided for 16— cost to Council, £49 15s. Od. Sterile Maternity Outfits. Nil (Nil). Obstetric and Gynaecological Consultants. Nil (2 calls). Obstetric Unit for Blood Transfusion. Nil (3 calls). Free Provision of Insulin. Insulin was provided free by the Council under §227, Public Health (London) Act, 1936, to fortv -seven persons at a total cost of £188 4s. 5d. Convalescent Home Accommodation. The Byfleet Convalescent Home for toddlers closed on May 28, 1945, having treated 49 Lambeth children between 2 and 5 years of age since the first child was admitted on November 27, 1942. The Council undertook to maintain two beds at first, but owing to the demand this number was doubled six months later in April, 1943. As in most institutions for children, quarantine for various infectious diseases imposed a limit to the acceptance of new cases 11 for long periods. Ordinarily the length of convalescence is six weeks, but numbers were often retained for three months while prospective entrants had to wait for epidemics to die out before being accepted. The home did not reopen at Sevenoaks in June as expected, as the arrangements fell through. On September 11, the first Lambeth child was admitted to the new home at Hartsleap, Farnham. where the institution is now happily established and has taken 17 children to date (July). The Zachary Merton Convalescent Home for mothers and babies at which the Council have agreed to maintain four beds has not yet reopened its doors. Before the war the Council had two beds there for mothers which include cots for their infants and if needed accommodation for toddlers 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 23 40 8.8.1944 Coral Street 41 30 5.6.1944 The nurseries have been full during the whole year and although the demand for women's labour was less intense than in the previous year, yet the demands for nursery accommodation showed no signs of slackening. Requests poured in for names to be placed upon the waiting list long after the likelihood of a vacancy being offered before children reached the age of five became increasingly remote. On all sides there seemed unanimity of opinion that for all children except those still in arms, the nursery life and training is of real use and benefit. At present there is little chance of satisfying a demand which is likely to extend as fast as new nurseries can be opened. The children in the nurseries are so obviously well and happy that no other advertisement is needed, but the nine nurseries were expected to cost some £37,000 to maintain during the twelve months ending March 31, 1946, for an average daily attendance of 620 children. 12 Every child as a routine on entering is prophylactically treated against diphtheria and whooping cough and no quarantine measures for infectious disease of any kind are observed. Parents are informed when a case of infectious disease occurs and the patient is either nursed at home or goes to hospital, depending upon circumstances, but no other children are excluded from the nursery. Any mother who wishes to keep her child away during an epidemic may do so with the knowledge that the place will be kept, but it is seldom that advantage is taken of this. Any vacancy which occurs is filled at once from the waiting list, the mother first being warned of the infection. The incidence of infection in the nurseries has shown no tendency to wax or wane as the result of pursuing this policy while from the nursery angle it is always kept full and never has to bother about quarantine measures. There have been occasional cases of enteritis but the practice when a case occurs of keeping bowls with Condy's fluid in which the staff rinse their hands before handling food and utensils in the kitchen or serving meals has again proved effective in preventing an epidemic. The bowls apart from the disinfectant are a reminder of the perpetual need for personal cleanliness. Summary of Work Done by the Official Health Visitors. Ante-natal visits 1,339 Ante-natal re-visits 132 Births, 1st visits 1,610 Births, re-visits 298 Births, stillborn 45 Ophthalmia, 1st visits 35 Ophthalmia, re-visits 21 Infantile deaths, visits 30 Welfare Centres attendances 160 Diphtheria prevention clinic attendances 220 Post-natal visits 1,698 Visits to children 1-5 years 282 Puerperal Pyrexia visits 25 Puerperal Pyrexia, re-visits 10 Special visits : evacuation, scabies, etc. 1,646 13 Sanitary Circumstances of the Area. Sanitary Inspectors. Total number of inspections (including war damage to property, etc.) 9,648 Total number of re-inspections 15,559 Total number of intimation notices served 3,714 Total number of nuisance notices served 3,232 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 1,991 Total number of re-visits 321 Total number of intimation notices served 122 Workshops in which defects were found 157 One male sanitary inspector is still lent to the billeting officer and is engaged in repairs to requisitioned billets among his manv other duties. Public Health (London) Act, 1936, Section 224 No application was made for an order under this section. Inspection and Supervision of Food. The year 1945 marked the end of hostilities, and consequently the end of many wartime diversions in connexion with the inspection of food which had occupied much of the time and the ingenuity of the Food Inspectors. Outstanding in these activities was the establishment in 1940, at the request of the Ministry of Food, of a Food Decontamination Service for the purpose of reconditioning food contaminated with war gases. Happily it was never necessary to put the scheme into operation. The service was disbanded in June, 1945, and the Vauxhall stand at Kennington Oval, where a Food Decontamination Centre had been established, was handed back to the owners. In the early part of the year damage was caused to food shops by sporadic flying bomb and rocket attacks. Food in damaged premises was inspected, sorted and disposed of according to its condition. Where food was found to be unfit for human consumption certificates were issued to owners for the purpose of establishing their claims with the War Damage Commission. One thousand, six hundred and sixty-two samples of food and drugs (1,640 informal and 22 formal) were submitted to the Public Analyst for analysis. The number of samples reported to be adulterated was very small. In one case (British Wine) legal 14 proceedings were instituted : the summons was dismissed owing to a technicality in the wording of the summons arising out of a decision of the High Court some weeks previously. Three samples (of meat and fish) were submitted for bacteriological examination. At the request of the Ministry of Food, 18 samples of milk were tested for the presence of Phosphatase and 18 samples underwent the Methylene Blue test. The Phosphatase test is applied to pasteurised milk, and its absence proves that the pasteurising process has been efficiently carried out. The Methylene Blue test is applied to " designated " milk, including pasteurised milk, for the purpose of determining keeping quality. Five samples were reported as unsatisfactory' and the results were communicated to the Ministry of Food. Legal proceedings were taken in two cases against restaurant proprietors for supplying horse flesh contrary to the provisions of the Food and Drugs Act. Fines, amounting in the first case to £2 and £4 4s. costs and in the second case to £20 and £5 5s. costs, were imposed. Approximately 18 tons of food (excluding that damaged by enemy action) was certified as being unfit for human consumption. Any unsound food which was considered suitable for animal feeding was disposed of for that purpose, so that only a small quantity was actually destroyed. Two hundred and fourteen pigs were inspected at the time of slaughter. Three whole pigs and two heads were found to be diseased and were destroyed. All the pigs were the property of pig clubs. While there is no legal authority for these to be inspected, the owners have agreed that it is in the common interest that inspection should be carried out. 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 1,883 persons were treated at the cleansing station and given 3,288 baths, compared with 1,913 persons treated in the previous year. 15 Rat Infestation. During the year 731 infestations have been dealt with. Of these 676 were Brown (common) rat, 39 Black (ship) rat and 16 mice infestations. Of the premises affected 483 wens dwellinghouses, 100 food premises and 148 other industrial premises. In 662 cases baiting was carried out, in 43 trapping or ferr ting was r sorted to and in the remaining 26 cases advice only was given. In 69 instances defective drainage was found to be the source of the trouble, and these were dealt with by the Sanitary Inspectors. The sewers throughout the borough were baited by the Borough Engineer's staff during June and December. Although the numbers of infestations have increased slightly over last year, this does not mean that the general situation has deteriorated; on the contrary, there have been no " major" infestations and a very large number of the minor infestations have been cases of stray rats. This is only to be expected having regard to the large amount of demolition and rebuilding of derelict properties that has gone on throughout the year. The black (ship) rats are still confined to the northern end of the borough, although the area affected now extends to Lambeth Walk. This rat is not such a gross feeder as the brown rat, nor are its habits so fixed, and, in consequence, the system of pre-baiting used in dealing with the brown rat is not so effective in the case of the black rat, and it is often necessary to combine baiting with trapping. The amount of structural damage caused by this rat is usually so slight and his habits so different from those of the brown rat. that his presence is often unsuspected for a considerable time. His climbing abilities are so great that he is able to travel from one building to another—often through the roof space—with great rapidity and with little trace. It is probable that with the decrease in numbers of the brown rat, infestations of black rats may increase. Baiting for mice has been carried out where there are large numbers in industrial properties, but so far as house infestations are concerned the most suitable and effective method is to trap, now that there is a good supply of cheap and efficient traps on sale. The whole of the baiting has been carried out by one operative, and the results achieved are entirely due to the exceptional ability and energy with which the rodent officer and the operative work together as a team. The Borough Engineer's sewer staff carry out a considerable amount of work in examining drainage and sewerage and remedying defects found, and this is of great help in putting defects right without delay. 16 Prevalence and Control Over Infectious and Other Diseases. Apart from a small part of an epidemic of measles which extended into 1946 the incidence of infectious disease was lower than the previous year, which itself was exceptional. \ot only so, but the mortality was light, as deaths from scarlet fever were 1, diphtheria 1, cerebro-spinal fever 7, measles 1, whooping cough 4 and typhoid fever 0. Sixty years ago in Lambeth, in 1888, a better year than 1885 or 1887, scarlet fever deaths numbered 56, diphtheria S6, measles 137, whooping cough 196 and typhoid fever 29. Cerebrospinal fever was not recognised as a separate disease and the deaths were attributed to various causes. The table summarising the incidence of tuberculosis, quarter by quarter for the years 1941-45, indicates that there was no significant change in the numbers notified during the period, notifications per thousand population being in the five years 2.19, 2.14, 2.21, 2.28 and 2.24 respectively. Tuberculosis. Notifications received during the year ended 31 st December, 1945 Pulmonary 347 (334) Non-pulmonarv 41 (49) Deaths certified 171 (142) 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 1941 Popn., 157,510 Private 8 V 15 15 6 13 10 12 4 2 6 46 1 2 3 — 1 1 — — — 1 — 1 5 51 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 1942 Popn., 157,200 Private 7 3 10 8 5 13 6 3 9 3 8 11 43 1 1 — — — — 1 1 — 1 1 3 46 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 1943 Popn., 163,100 Private 10 1 11 7 7 14 8 2 10 5 3 8 43 — — — 1 1 2 1 1 — — — 3 46 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 1944 Popn., 162,960 Private 7 4 11 9 5 14 5 1 6 5 3 8 39 — — — — — — — 1 1 — — — 1 40 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 11 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 60 33 93 51 36 87 33 17 50 57 47 104 334 6 5 11 7 5 12 5 5 10 8 8 16 49 383 945 Popn., 173,280 Private 5 5 10 5 6 11 3 5 8 5 2 7 36 — — — — — — 1 — 1 — — — 1 37 Hospitals 35 23 58 31 19 50 23 12 35 30 13 43 186 4 2 6 7 1 8 2 11 13 5 2 7 34 220 Dispensaries 22 21 43 12 26 38 9 9 18 11 15 26 125 — 1 1 — 1 1 2 1 3 1 — 1 6 131 Totals 62 49 111 48 51 99 35 26 61 46 30 76 347 4 3 7 7 2 9 5 12 17 6 2 8 41 388 18 The T.B. Allowance Scheme: Memo. 266/T. The operating of the scheme continues to work smcothly and easily as co-operation with the social welfare officers of the County Council and those of the local exchange of the Ministry of Labour and National Service is excellent. The scheme in itself as a scheme is essentially bad as it is based upon the fallacious principle that it is possible to divide all cases of pulmonary tuberculosis into two groups, those who shall benefit and those who shall not, because the first group are likely to return to work while the second group are not. There is the early case, obviously, in the first group who goes off to sanatorium relieved of financial worry and, unhappily, dies from a hemoptysis or unaccountably does not benefit and goes downhill. He is to be compared with the chronic case who has had, perhaps, one or two periods in sanatorium before and is put into the second group. He does not benefit from the scheme but comes out improved and goes to work again for months and even years before breaking down. . It is not difficult to understand the unfairness of a scheme in which such happenings are not only possible but actually, in varying degree, quite frequent. There is nothing good to be said for the arbitrary division, and bearing in mind the infective character of the disease, every case who gives up work on the advice of the tuberculosis officer should be eligible for the benefits of the scheme on the grounds that he has voluntarily given up his work in order not to imperil the health of his workmates. The alternative course most commonly followed is to keep at work until forced to give up rather than to apply for public assistance before it has become an absolute necessity. 19 Notifications received during the Year ended 31st December, 1945. Scarlet Fever 266 ( 361) Diphtheria 65 ( 66) Erysipelas 29 (56) Puerperal Fever 7 (11) Puerperal Pyrexia 28 (19) Cerebrospinal Fever 10 (10) Ophthalmia Neonatorum 13 (16) Measles 1,809 ( 442) Whooping Cough 255 ( 354) Primary Pneumonia 62 ( 76) Influenzal Pneumonia 13 ( 24) Malaria (Induced—2) 5 ( 4) Dysentery 33 ( 64) Food Poisoning 22 ( 4) Anthrax - - Scabies 851 (1,002) Typhoid 2 ( 1) Paratyphoid — ( 2) Polio-Myelitis 4 - 20  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 0.00 — Cerebro Spinal Fever 0.05 0.05 0.05 0.06 0.05 Scarlet Fever 1.89 2.02 2.03 1.57 1.53 Whooping Cough 1.64 1.65 1.47 1.25 1.47 Diphtheria 0.46 0.52 0.56 0.31 0.37 Erysipelas... 0.25 0.28 0.24 0.31 0.16 Smallpox 0.00 0.00 — 0.00 — Measles 11.67 10.89 11.19 9.03 10.43 Pneumonia ... 0.87 1.03 0.72 0.78 0.43 Rates per 1,000 Total Births (Live and Still) :— (a) Notifications :— Puerperal Fever 9.93 12.65 8.81 3.60 2.12 Puerperal Pyrexia 15.87* 8.51 * Including Puerperal Fever. 21 Diphtheria Prevention. The remarkable fall in the number of cases of diphtheria which has taken place in recent years would not appear to be due entirely to prophylactic measures, although protection has been available free to all in Lambeth since 1928 but has not been accepted to any appreciable extent. In the four quarters of 1938 the cases notified numbered 109, 148, 165 and 187. The corresponding numbers for the next year, 1939, were 81, 67, 39 and 19. The intensive Government campaign began in the spring of 1943, and the numbers for the quarters of that year were 26, 27, 27 and 11. Since then the highest figure for any quarter was in the third of 1945, when it rose to 17. The fall from the peak figure of 187 in the fourth quarter of 1938 to 19 in the fourth quarter of 1939 happened almost entirely before war was declared, and the incidence remained below that of the mid year, 1939, for the four years which followed before the Government campaign began. The graph for London follows much the same line as the Lambeth pattern. 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, 1945 595 (699) 274 (548) 869 (1,247) Number of children who completed the full immunisation course between 1st July and 31st December, 1945 953 (334) 204 (21) 1,157 (355) The number immunised during the year, 2,026, while greater than the previous year, is still not sufficient to maintain the position, since the births numbered 3,219. It is, however, a fact that every death from diphtheria in Lambeth was of a child whom the parents had failed to protect. Vaccination. For many years no legal compulsion has been used in Lambeth, and in fact vaccination has been purely voluntary. The difficulty (luring the year has been to arrange vaccination for those who desired it rather than the reverse. 22 Set out hereunder are figures relating to the years 1943, 1944 and 1945 for comparison :— 1943 1944 1945 Number of births in Lambeth registered during the year 2,978 2,581 2,183 Total number of cases requiring the Vaccination Officers' attention during the year 4,390 4,092 4,011 Disinfecting Department. 3,026 rooms and 6,504 articles of bedding were disinfected during the year, among them being the rooms and articles used by the 704 cases of various forms of infectious disease taken to hospital ; 352 certificates of disinfection were issued, and 75 library books dealt with from the 4,443 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 1945 the following 1,917 samples were examined bacteriologically in the Laboratory at Wanless Road. Specimen Negative Positive Total Swab for or suspected cases of Diphtheria 968 42 1,010 Sputum for suspected cases of Tuberculosis 644 91 735 Blood for suspected cases of Typhoid or Paratyphoid fever 3 3 Miscellaneous 129 40 169 1,744 173 1,917 The miscellaneous specimens consisted of 40 urines, 5 faeces, 5 smears and 119 special swabs for gonococci streptococci, Vincent's angina, etc. INDEX PAGE Births 6 Child Life Protection 8 Convalescence 10 Deaths 4 Dentures 10 Diphtheria Prevention 21 Disinfection 22 Domestic Helps 9 Pood Inspection 13 Health Visitors 12 Home Helps 9 Illegitimate Children 9 Insulin 10 Laboratory 22 Notifications 19 Nurseries 11 Nursing 7 Obstetric Consultants 10 Obstetric Unit—Blood Transfusion 10 Premature Infants 8 Rats 15 Sanitary Circumstances 13 Scabies 14 Statistics 3 Sterile Maternity Outfits 10 Tuberculosis 16 Vaccination 21 Welfare Centres 7