REPORT on the HEALTH of the Borough of Lambeth DURING THE YEAR 1946 (90th 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 health of the Borough of Lambeth during the year 1946 has been generally satisfactory as is shewn by the statistics which appear in the report. The mid-year population was estimated by the Registrar General to be 209,910, an increase of 36.630 over the population of the previous year, while the number of ration books in use at the end of the year was 221,290, an indication that people are still coming to live in the district in spite of the difficult housing conditions due to overcrowding, dilapidation and war damage of dwellings. The birth rate 22.89 is the highest recorded for over twenty years and the infantile mortality 35 and maternal mortality 0.61 are each lower than at any time in the past. These are more than mere indications of the success achieved by the Ministry of Food in their scheme to insure that the most important section of the population is in fact getting enough of the scarcer foods to raise their average standard of health higher than it has been before. Difficulties increased during the year in the repair of insanitary houses due to shortages of many kinds of materials, of labour, and of staff. In spite of the disheartening effect upon so many of having homes in which they can take no pride, and of much serious overcrowding which leads to discomfort and quarrels, people put up and continue to put up with conditions of life which were the lot of only a few before the war whereas now practically all are affected alike in their different degrees. Everyday correspondence indicated a high sense of frustration among the younger people who are trying to start a home of their own and yet the general health still stands up to the economic storm. New homes for which water certificates were issued were 338, of which 246 were prefabricated temporary dwellings and 92 permanent flats and houses. There were some 12,500 applications for houses in Lambeth which were considered to be alive at the end of the year. Warm thanks are due to the Chief Officers for their help and to the Chairman and Members of the Public Health Committee for advice and criticism and principally to the staff of the Public Health Department. A.G.G.T. July. 1947. 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. Population–estimated, 1946—209,910 (173,280). Density.—51.41 persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore. Births (corrected)—4,805 (3,219) Birth rate per 1,000 estimated resident population corrected 22.89 (18.57). Deaths (corrected)—2,602 (2,587). Death rate per 1,000 estimated resident population, 12.87 (14.92). Maternal mortality (corrected) per 1,000 total births (live and still), 0.61 (1.82). Infantile mortality, 35 (46). Neonatal Mortality (corrected.)—72 deaths under one month, being 15 per 1,000 live births. Zymotic Death-rate (corrected)—0.12 per 1,000 population (total zymotic deaths, 27). Marriages. Marriage rate per 1,000 population, 10.03 (12.08). Rateable Value at 1st April, 1946—£2,207,445. Sum represented by 1d. rate—£8,236. Comparable rates for England and Wales and London: England and Wales London. Birth rate 19.1 (16.1) 21.5 (15.7) Death rate 11.5 (11.4) 12.7 (13.8) Infantile mortality 43 (46) 41 (53) Puerperal causes 1.43 (1.79) not available 4 5 Causes of, and Ages at, Death (Corrected) During the Year, 1946. Mortality 12.87 (14.92). 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 2 1 – – – – 3 — 3. Scarlet Fever - - - - - - - - 4. Whooping Cough 2 — 2 - - - 1 3 5. Diphtheria — - 1 - - - - 1 6. Tuberculosis, respiratory system — 3 - 78 52 14 86 61 7. Other Tuberculosis — 4 4 3 2 - 6 7 8. Syphilitic diseases — . - - 3 14 10 15 12 9. Influenza 4 - - 5 19 17 26 19 10. Measles - - 1 - - - 1 - 11. Ac. Poliomyelitis and Polioencephalitis - - - - - - 12. Ac. Infectious Encephalitis (Lethargic) - - - - - - - - 13. Cancer, Buccal Cavity and Oesophagus (M.) Uterus (F.) - - - 1 20 19 24 16 14. Cancer, Stomach and Duodenum - - - 7 25 31 33 30 15. Cancer, Breast - - - 2 17 18 - 37 16. Cancer, all other sites - - 1 16 107 114 139 99 17. Diabetes - - - 2 3 11 8 8 18. Cerebral Vascular Lesions - - - 6 57 162 104 121 19. Heart Disease - - - 21 118 563 340 362 20. Other Circulatory Diseases - 1 1 2 33 76 59 54 21. Bronchitis 8 1 - 7 53 109 110 68 22. Pneumonia 27 3 1 7 31 66 79 56 23. Other respiratory diseases - - - 2 10 18 1 7 13 24. Ulcer, Stomach and Duodenum - - - 6 2 0 19 40 5 25. Diarrhoea (under 2 years) 20 1 - - - - 17 4 26. Appendicitis - 2 2 5 1 2 17 3 27. Other Digestive diseases 4 1 1 7 13 40 9 35 28. Nephritis - - - 7 18 39 31 29 29. Puerperal and Post Abortive Sepsis - — - 1 - - 35 1 30. Other Maternal Causes - - - 2 - - - 2 31. Premature Birth 43 - - - - — - 16 32. Congenital Malformations, Birth Injury, Infantile diseases 45 - - 4 3 - 27 23 33. Suicide - — - 14 7 2 29 5 34. Road Traffic Accidents - 1 5 8 3 5 18 10 35. Other Violent Causes 12 2 1 12 10 37 12 45 36. All other causes 5 2 4 18 38 92 29 90 69 Total All Causes 172 22 24 246 674 1,464 1,388 1,214 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, and Case rates for certain Infectious Diseases in the year 1946. 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 19.1† 22.2 21.3 21.5 22.89 Still Births 0.53† 0.67 0.59 0.54 0.60 Deaths: All Causes 11.5† 12.7 11.7 12.7 12.87 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.02 0.02 0.02 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.15 0.13 0.14 0.12 0.21 Smallpox 0.00 0.00 0.00 — — Measles 0.00 0.01 0.00 0.01 0.00 Rates per 1,000 Live Births:— Deaths under l year of age 43‡ 46 37 41 35 Deaths from Diarrhoea and Enteritis under 2 years of age 4.4 6.1 2.8 4.2 4.4 * 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 seven district nursing associations in the area are the Ranyard Nurses, Camberwell and District, South London, Brixton, Southwark, Newington and Walworth, Norwood and District and the Catholic Nursing Institute. A flat rate payment of 2s. 2d. a visit is paid to all cases including 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. The number of visits paid to children under 5 years of age was 3,900 and to persons over that age 2,818. Welfare Centres Total individual cases dealt with 20,865 (15,601) „ sessions held 3,352 (2,486) „ ante-natal cases 5,884 (3,422) „ post-natal cases 823 (678) „ nursing mothers 4,511 (3,527) ,, infants under 1 5,971 (4,588) „ children 1-5 3,676 (3,546) Visits paid to A/N cases 9,642 (6,990) „ „ P/N cases 4,212 (2,762) „ „ nursing mothers 22,277 (20,176) „ „ infants under 1 23,174 (18,882) „ „ children 1-5 39,300 (37,273) The increase in the population and the unusually high birthrate led to a general enlargement of the work of the welfare centres where extra sessions and new clinics were in demand in all districts. The Moffat and the Brixton Welfare Centres had to surrender their premises during the year and went out without any home in the case of the Moffat and an ill-sited inconvenient hall for the Brixton. The Moffat were forced to share the premises of the Babies' Care Centre which placed an intolerable strain upon both, but owing to the devastation in the area and the lack of any building in the neighbourhood which could be adapted, no other course was open. Brixton Welfare Centre was in almost as bad a case. Every centre 8 requires better premises but while housing needs are so urgent everything else must wait. It is hoped that the Brixton Centre will be housed before the end of 1947 in a block of flats on the County Council's Tulse Hill estate but that will only be a temporary home until a new one fitting into the scheme under the National Health Service Act is built. Most of the welfare centre buildings are old and in some cases have reached beyond the end of useful life so that it is uphill work trying by example to encourage hygiene in such unattractive outof-date premises. The plans for three new centres were in hand in 1939 and but for the war at least these would have been rehoused in modern buildings some years ago, yet the war not only put a stop to the erection of new premises but also to the normal upkeep which accounts for much of the drab, shabby appearance. So far as the health and welfare of mothers and children can be statistically recorded, the infantile mortality rate of 35 and the maternal mortality rate of 0.61, in each case much lower than ever before, are the two principal pointers. Whatever the discomforts and privations to which all are subject the most important sections of the population have been outstandingly healthier than in any previous period. The evacuation scheme for confinements outside London has relieved some of the strain upon the homes where room and convenience for childbirth were often non-existent. The number taking advantage of the scheme in 1946 was 481, compared with 729 in 1945, 643 in 1944 and 605 in 1943. Child Life Protection. 974 visits and re-visits were made to foster mothers and nurse children. Foster mothers on Register at 31.12.46 32 (28) Nurse children on Register at 31.12.46 34 (32) Many inquirers are sent away unsatisfied because of the lack of women willing to become foster mothers owing to more remuneration and less arduous employment being readily available. 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 9 mother shall know to whom to turn immediately an emergency arises needing extra equipment, help in feeding the infant, and so on. Of the 321 premature children notified in the year, 85 were born at home and 236 in hospital. Of the former, 5 died in the first 24 hours, and 72 survived the first month. Of the 236 born in hospital, 20 died in the first 24 hours, 28 died later and 183 are known to have survived the first month. The remaining 5 were taken away by their parents who could not subsequently be traced. 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 108 unmarried mothers and their children, and to 30 married mothers and their illegitimate babies. As the result of the efforts of the Welfare visitors, no less than 67 girls were able to return home with their babies which is the best solution of the difficulty. Of the rest, 6 remained with co-habiting parents, 4 babies were cared for by foster mothers, 29 were adopted, 2 mothers found homes with friends for themselves and their babies, 8 to situations with mothers, 3 to lodgings with mothers, 2 in hostels with mothers, and 10 mothers made their own arrangements. The remaining 7 babies did not survive the year. Home Helps. 513 (229) applications and home helps provided—cost to Council, £922 15s. 0d. (£366 9s. 0d.), the rest of the gross cost of £1,484 11s. 0d. being paid by the applicants. The service is designed to help those women who find it impossible to arrange otherwise for their home duties to be performed without assistance during the lying-in period. Often a relative or friend is willing to act as home help but to do so must give up remunerative employment which she cannot afford. The Council's home help service covers just such cases and assistance towards a financial loss of up to as much as £3 a week was given during the year. The more general charge is from £2 to £4 for the fortnight. Again it is possible to record that no application was refused except in those cases where the income was £7 a week or more when financial assistance towards the cost was deemed not to be necessary. Domestic Helps. The domestic help scheme is run upon entirely different lines from the home help service. Here there is no time for making 10 any preparations for a known period months ahead, but sickness or accident or some other misfortune suddenly occurs which makes it impossible for the home to be maintained without help. All the domestic helps are employed on the basis of 1s. 9¾d. an hour, for up to a 47-hour week, plus bus or tram fares, increased to 1s. 11d. an hour from 1st December. Some can only give as little as two hours a day, but assistance was given to 116 distressed families during the year. A visit is paid immediately an application for help is received to assess the need—how many hours work a week will maintain the home—and how best it can be relieved—which domestic help is likely to get on well with the applicant. Payment is made by the applicant according to the agreed metropolitan scale. One visit a week is paid regularly for the time sheet of the domestic help to be certified by the applicant and at least one other surprise visit during the week to verify that no "ramp is being worked." Employment by the hour is well liked and well suited to the needs of both sides. Many women so employed can take a week off when they wish as there is no binding tie as would be the case if employed full time. On the other hand, none are sent far from their homes and if there is no employment for a week in their neighbourhood there is no obligation for them to go far away from home which to the woman with a home to maintain of her own might be a strain greater than she is prepared to bear. The staff employed for the service consists of a senior woman in the A.P.T. grade I and two juniors in the general division. The cost is reimbursed in full by the Ministry of Health. Dentures for Expectant and Nursing Mothers. 7 (17) applications were received and dentures provided for 6— cost to Council, £21 0s. 0d. Owing to the increased cost of living and higher wage rates the scale adopted by the Council in 1942 became out of touch with present conditions. The scale was revised in March, 1947. Sterile Maternity Outfits. Nil (Nil). Obstetric and Gynaecological Consultants. Nil (Nil). Obstetric Unit for Blood Transfusion. 5 calls (Nil). Each call costs 5 guineas which is paid by the Council to the London County Council who provide the service from their hospitals. 11 Free Provision of Insulin. Insulin was provided free by the Council under §227, Public Health (London) Act, 1936, to fifty-two persons at a total cost of £214 3s. 5d. Convalescent Home Accommodation. The four beds maintained for Lambeth children at the Hart's Leap convalescent home, Farnham, have been kept full during the year. 15 children were given prolonged periods of convalescence in the home and in every case returned to London much improved in health. Some children stay longer than three months but generally speaking the length of time spent by the majority is from six to twelve weeks. Information is sent to each mother every week by the matron concerning the well-being of the child, and one month after returning home the welfare centre doctor reports to the convalescent home the child's condition, weight, etc., so that the value of the convalescence in promoting the child's health can be assessed. 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. Day Nurseries. Day 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 (closed 10.8.46) 26 48 4.2.1942 Annie McCall 36 39 5.8.1942 St. John's 25 20 24.9.1942 Coldharbour Lane 40 40 12.7.1943 Oval 20 50 4.11.1943 Gipsy Hill 23 40 8.8.1944 Coral Street 41 30 5.6.1944 The nurseries have been full throughout the year because quarantine has never been put into practice in the nurseries at any time since it would appear to serve no useful purpose. The demand for places in the nurseries remains almost as intense as ever, and when the Black Prince nursery was closed because the owners wanted their premises back the mothers rose at once in 12 uproar which led to three special meetings of the Public Health Committee in one week during the summer recess. All the children from the nursery were eventually offered accommodation in other nurseries although many mothers had to make their own arrangements for the care of their children for several weeks. The hut at the Oval nursery would have been ready to open as a school-room in time to take most of the older children but efforts were dogged by misfortune which hindered completion. Similar difficulties were experienced in finishing the Chestnut nursery, the building of which had been abruptly stopped by the fly-bombs in 1944, and it was not ready for occupation until March, 1947, after exasperating delays. It might well have been ready at least six months before and relieved some of the pressure when Black Prince was closed. Permission to repair the Council's war-damaged maternity home at Knight's Hill to use as a hostel for the resident probationers and as a nursery to replace the Annie McCall nursery was received in the latter part of the year and at first it was hoped that it might be ready for occupation by the beginning of 1947. The Annie McCall nursery is housed in a badly needed maternity hospital but the premises cannot be vacated until Knight's Hill is ready to take the children owing to the serious dislocation which would follow some seventy mothers giving up their work in office, shop or factory. Diphtheria prevention is obligatory for all entrants to the nurseries and on leaving to go to school a " boosting " dose is given. Routine injections against whooping cough were given up following one or two sore arms and the uncertainty of the treatment giving any assurance of safety. The result of the immunisation endeavours at all the nurseries left an impression that some success had been achieved but as this could not be statistically confirmed the treatment was given up until a reliable prophylactic had been discovered. Morbidity has fortunately been low in all nurseries throughout the vear. Summary of Work Done by the Official Health Visitors. Ante-natal visits 2,631 Ante-natal re-visits 136 Births, 1st visits 920 Births, re-visits 205 Births, stillborn 57 Ophthalmia, 1st visits 72 Ophthalmia, re-visits 50 13 Infantile deaths, visits 18 Welfare Centres attendances 257 Diphtheria prevention clinic attendances 208 Post-natal visits 1,287 Visits to children 1-5 years 244 Puerperal Pyrexia visits 19 Puerperal Pyrexia, re-visits 7 Special visits: evacuation, scabies, etc. 2,218 Sanitary Circumstances of the Area. Sanitary Inspectors. Total number of inspections (including war damage to property, etc.) 14,234 Total number of re-inspections 28,651 Total number of intimation notices served 6,646 Total number of nuisance notices served 934 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 2,190 Total number of re-visits 231 Total number of intimation notices served 96 Workshops in which defects were found 136 A second male sanitary inspector was seconded to the Housing Committee for duties connected with the repairs and alterations of requisitioned property during the year. This left the outdoor work of sanitary inspection, already almost unmanageable; with two vacancies among the district sanitary inspectors. Difficulties of materials and labour coupled with the uncertainties of licences and permits already meant a great increase of work in maintaining the pressure to get much-needed repairs put in hand and the loss of the two men has meant that intimation notices cannot be followed up regularly. Moreover the increase in cases going to court wastes much valuable time of the inspector concerned and completes the full circle starting with the inability of the depleted staff to see that notices are in fact complied with. Nuisances on bombed sites are the cause of special difficulties which seem to be insuperable. The sites cannot be fenced for lack of materials nor can they be cleared because there is usually uncertainty regarding war damage repair or some disposal difficulty and they draw irresistibly every kind of unwanted rubbish in the neighbourhood. The same applies to the static water tanks still Infantile deaths, visits 18 Welfare Centres attendances 257 Diphtheria prevention clinic attendances 208 Post-natal visits 1,287 Visits to children 1-5 years 244 Puerperal Pyrexia visits 19 Puerperal Pyrexia, re-visits 7 Special visits : evacuation, scabies, etc. 2,218 Sanitary Circumstances of the Area. Sanitary Inspectors. Total number of inspections (including war damage to property, etc.) 14,234 Total number of re-inspections 28,651 Total number of intimation notices served 6,646 Total number of nuisance notices served 934 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 2,190 Total number of re-visits 231 Total number of intimation notices served 96 Workshops in which defects were found 136 A second male sanitary inspector was seconded to the Housing Committee for duties connected with the repairs and alterations of requisitioned property during the year. This left the outdoor work of sanitary inspection, already almost unmanageable; with two vacancies among the district sanitary inspectors. Difficulties of materials and labour coupled with the uncertainties of licences and permits already meant a great increase of work in maintaining the pressure to get much-needed repairs put in hand and the loss of the two men has meant that intimation notices cannot be followed up regularly. Moreover the increase in cases going to court wastes much valuable time of the inspector concerned and completes the full circle starting with the inability of the depleted staff to see that-notices are in fact complied with. Nuisances on bombed sites are the cause of special difficulties which seem to be insuperable. The sites cannot be fenced for lack of materials nor can they be cleared because there is usually uncertainty regarding war damage repair or some disposal difficulty and they draw irresistibly every kind of unwanted rubbish in the neighbourhood. The same applies to the static water tanks still 14 dotted about the area, but these are cleared out by the National Fire Service every now and again when they become nuisances. This type of nuisance can be lessened by palliative measures but the only real remedy is development of the site to some useful purpose and that seems as far off as ever. Public Health (London) Act, 1936, Section 224 One application was made for an order under this section. Inspection and Supervision of Food. The year 1946 brought a return to more normal conditions in so far as the inspection and sampling of food was concerned. Outstanding among renewed activities was the sampling of ice cream and the supervision of its manufacture. It was found difficult to effect all the desired improvements to food premises owing to the restrictions on the use of building materials except in cases where war damage or neglect over a period of years had rendered them unfit for the sale, storage or manufacture of food. 1. Sampling. The following samples were submitted:— (a) Food and Drugs Act, 1938. (i) For chemical analysis. 2,000 (1,527 informal and 473 formal). Of the formal samples, 11 were reported to be adulterated (milk 9, zinc ointment 1, non-brewed vinegar 1). (ii) For bacteriological examination. 100 (including 63 samples of ice cream). (b) Labelling of Food (No. 2) Order, 1944. 3 (2 formal and 1 informal). All three samples contravened the Order. (c) Milk (Special Designations) Regulations, 1936-46. Methylene Blue Test—35. 4 samples failed to satisfy the test. Phosphatase Test—23. All passed the test. 2. Inspection of Food. This was carried out:— (a) At Slaughterhouses—where 222 pigs, the property of pig clubs were dealt with. (b) At shops, stores and factories—where large quantities of food were examined. As a result of these inspections the following amounts of food were surrendered as unfit for human consumption and unsound food certificates were issued. 15 Tons cwts. qrs. lbs. (i) At the slaughterhouse. Pig carcases and organs — 6 3 19 (ii) At shops, stores and factories. Fresh meat, fish, poultry, vegetables, prepared and canned foods 36 5 — 4 Total 36 11 3 23 The following articles of food were seized and taken before magistrates who made orders for condemnation and disposal:— lbs. Fish 3 Horsefat 1 Horseflesh 1¾ Sausages ½ In appropriate cases the unsound food was disposed of for animal feeding either through the Salvage Division of the Ministry of Food or the Council's Salvage Scheme. 3. Inspection of Shops and Stores. Inspections have been directed to conditions of cleanliness rather than to structural improvements. In certain cases the necessary notices were served and licences obtained to carry out repairs to premises. Certificates were also issued to enable new chopping blocks to be provided. In March the London Wholesale Meat Supply Association's Depot in Stockwell Road from which all meat retailed in Lambeth (with the exception of Kosher meat) had been distributed, removed to the Central Meat Markets at Smithfield. 4. Ice Cream. Although there were no legal standards of quality or cleanliness for ice cream, 32 samples for chemical analysis and 63 for bacteriological examination were taken during the year. The object of this sampling was two-fold, firstly to ascertain to what extent in quality and degrees of cleanliness were present and, secondly, in so far as the bacteriological examinations were concerned to improve the standards of cleanliness where necessary. The results of the chemical analysis of samples of ice cream showed that the fat content ranged from 9.86 per cent. to 0.06 per cent., the average being 3.88 per cent. 16 The results of the bacteriological examinations of 63 samples showed that there were wide variations of contamination among some of the smaller manufacturers, although the results of samples examined from some of the long-established London Manufacturers showed that it is possible consistently to produce an ice cream reasonably free from contamination. A number of samples of food other than ice cream was submitted for bacteriological examination. In no case was any sample shown to be the cause of food poisoning. 5. Legal Proceedings. The following table shows the outcome of prosecutions heard at the Lambeth Magistrate's Court. Subject of Prosecution Nature of alleged offence Result of Prosecution Fines Costs £ £ s. d Milk 19 per cent. added water Convicted 5 l 1 0 do. 9 do. do. 2 2 2 0 do. 7 do. do. 4 1 1 0 do. 16 do. do. 10 3 3 0 do. 6 do. do. 12 3 3 0 do. 10 do. do. 15 5 5 0 Fish Unfit for human consumption do. 2s. 7 7 0 Horsefat do. do. 1 1 1 0 Horseflesh do. do. 10 5 5 0 Non-brewed vinegar 46 per cent. deficient in acetic acid do. 3 2 2 0 Zinc Ointment 36 per cent. deficient in zinc oxide Dismissed P.O.F. — 15 15 0 Savouries Failure to comply with labelling requirements Dismissed — — — — Scabies and Verminous Persons. Cleansing Centre. The scheme for adapting one of the Council's disused mortuaries as a cleansing station is still in abeyance owing to the direction of all labour and materials to the housing need. Lambeth cases are cleansed either at the Battersea or Southwark cleansing station on 17 payment by the Lambeth Council. The service is free to the individual. A total of 1,690 persons were treated at the cleansing station and given 3,285 baths, compared with 1,883 persons treated in the previous year. Rat Infestation During the year 1946, 858 infestations have been dealt with. Of these 783 were brown (common) rat, 66 black (ship) rat and 29 mice infestations. 590 infestations were dealt with in dwellings, 120 in food premises and 148 in other properties. 796 baitings were carried out, 13 infestations were trapped or ferretted, and in 49 cases advice was given. 93 defective or disused drains were found to be the source of infestations and were dealt with by the Borough Engineer and the District Sanitary Inspectors. The sewers throughout the Borough were baited by the Borough Engineer's staff in June and December, and throughout the year a very large number of disused drains have been sealed in the sewers and under footpaths by the sewers staff. Much help has been given by the Borough Engineer's Department in searching for disused or suspected defective drains whenever necessary, and the satisfactory state of the Borough is largely the result of this work. Although the number of brown rat infestations is large, the number of serious infestations was few and most were of stray rats and minor infestations. The black rat is still confined to the northern end of the borough and is almost entirely restricted to business premises. The 29 cases in which baiting was carried out to destroy mice were in business premises in which the infestations were heavy and in a few exceptional dwelling house cases. Very many complaints have been received of rat infestations in which the source of the nuisance is found to be mice, but it is not always practicable to bait and suitable advice is given. Until November, the whole of the work was carried out by one operative, but consequent upon the Council's acceptance of the Ministry of Food's circular N.S.12, a further operative was engaged. This has enabled the Council's first operative to carry out house-tohouse inspections throughout the Borough. It is too early to express an opinion as to the value of this course of action, which is on the lines suggested by the Ministry, but on a very restricted scale. 18 Prevalence and Control Over Infectious and Other Diseases. The mortality from infectious disease was again comparatively insignificant, scarlet fever, 0, diphtheria 1, measles 1, and whooping cough 4. The number of notifications shewed little change over the previous year, but the degree of morbidity has fortunately been even lighter than before. The table summarising the incidence of tuberculosis for the years 1942-46 indicates that the trend downwards which was practically continuous between the wars has been resumed now that some of the war privations and difficulties are less. The notifications per 1,000 population during these years were 2.14, 2.21, 2.28, 2.24 and 1.16 respectively. Tuberculosis. Notifications received during the year ended 31st December, 1946 Pulmonary 324 (347) Non-pulmonary 26 (41) Deaths certified 160 (171) PULMONARY Total for Year Totals all Forms First Quarter Second Quarter Third Quarter Fourth Quarter Total for Year First Quarter Second Quarter Third Quarter Fourth Quarter 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 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 1945 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 36 125 – 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 1946 Popn., 209,910 Private 7 5 12 7 9 16 8 4 12 3 3 6 46 – – – – – – — — — — — — — 46 Hospitals 20 22 42 31 12 43 17 20 37 23 17 40 162 4 6 10 3 5 8 — 1 1 2 1 3 22 184 Dispensaries 4 21 25 11 11 22 13 16 29 24 16 40 116 1 – 1 — — — — 1 1 — 2 2 4 120 Totals 31 48 79 49 32 81 38 40 78 50 36 86 324 5 6 11 3 5 8 – 2 2 2 3 5 26 350 20 The T.B. Allowance Scheme: Memo. 266/T. The operation of the scheme continues to work smoothly but the unfair division between those who shall benefit and those who shall not still causes much heartburning. It is to be hoped that this arbitrary separation of sufferers into two groups will cease when national health service schemes are in action. Notifications received during the Year ended 31st December, 1946. Scarlet Fever 234 (266) Diphtheria 53 (65) Erysipelas 59 (29) Puerperal Fever 3 (7) Puerperal Pyrexia 17 (28) Cerebro-spinal Fever 9 (10) Ophthalmia Neonatorum 20 (13) Measles 1,633 (1,809) Whooping Cough 398 (255) Primary Pneumonia 54 (62) Influenzal Pneumonia 26 (13) Malaria 4 (5) Dysentery 22 (33) Food Poisoning 10 (22) Anthrax — (—) Scabies 758 (851) Typhoid 2 (2) Paratyphoid 1 (–) Polio-Myelitis — (4) 21 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 Hates per 1,000 Civilian Population:— Notifications : Typhoid Fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid Fever 0.02 0.02 0.01 0.01 0.00 Cerebro Spinal Fever 0.05 0.05 0.04 0.06 0.04 Scarlet Fever 1.38 1.51 1.33 1.42 1.11 Whooping Cough 2.-28 2.48 2.05 2.22 1.89 Diphtheria 0.28 0.32 0.31 0.24 0.25 Erysipelas 0.2 0.25 0.22 0.27 0.28 Smallpox 0.00 0.00 0.00 0.00 — Measles 3.92 4.73 3.70 7.35 7.77 Pneumonia 0.89 1.02 0.74 0.75 0.38 Rates per 1,000 Total Births (Live and Still):— (a) Notifications:— 1.62 0.60 Puerperal Fever 8.50 10.35 7.63 Puerperal Pyrexia 9.68* 3.44 * Including Puerperal Fever. 22 Diphtheria Prevention. Under 5 years 5 years and over, but under 15 years Total Number of children who completed the full immunisation course between 1st January and 30th June, 1946 929 (595) 291 (274) 1,220 (869) Number of children who completed the full immunisation course between 1st July and 31st December, 1946 1,096 (953) 736 (204) 1,832 (1,157) The number immunised during the year, 3,052, while greater than the previous year, is still not sufficient to maintain the position, since the births numbered 4,805. It is, however, a fact that every death from diphtheria in Lambeth since 1928 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 during the year has been to arrange vaccination for those who desired it rather than the reverse. The repeal of the Vaccination Acts by the National Health Service Act may lead to more parents wishing to protect their children. Set out hereunder are figures relating to the years 1943, 1944, 1945 and 1946 for comparison:— 1943 1944 1945 1946 Number of births in Lambeth registered during the year 2,978 2,581 2,183 5,467 Total number of cases requiring the Vaccination Officers' attention during the year 4,390 4,092 4,011 7,223 23 Disinfecting Department. 3,044 rooms and 7,783 articles of bedding were disinfected during the year, among them being the rooms and articles used by the 562 cases of various forms of infectious disease taken to hospital; 354 certificates of disinfection were issued, and 103 library books dealt with from the 5,890 premises visited during the year. The clean van was used regularly for the delivery of stores to the day nurseries which reached the Town Hall in bulk from the various firms supplying the Ministry of Health. Bacteriological Laboratory. During the year 1946 the following 1,918 samples were examined bacteriologically in the Laboratory at Wanless Road. Specimen Negative Positive Total Swab for or suspected cases of Diphtheria 870 34 904 Sputum for suspected cases of Tuberculosis 824 108 932 Blood for suspected cases of Typhoid or Paratyphoid fever 3 — 3 Miscellaneous 49 30 79 1,746 172 1,918 In addition to the above, 100 samples were received from the Food Inspectors, consisting of:— Ice cream, Mussels, Mutton, Corned Meat, Milk, Condensed Milk, Dried Skimmed Milk Powder, Tinned Salmon, Cooked Meat, Cabbage, Bloater Paste and milk bottles for bacteriological test of cleanliness. INDEX page Births 6 Child Life Protection 8 Convalescence 11 Deaths 4 Dentures 10 Diphtheria Prevention 22 Disinfection 23 Domestic Helps 9 Food Inspection 14 Health Visitors 12 Home Helps 9 Illegitimate Children 9 Infectious and Other Diseases 18 Insulin 11 Laboratory 23 Notifications 20 Nurseries 11 Nursing 7 Obstetric and Gynaecological Consultants 10 Obstetric Unit for Blood Transfusion 10 Premature Infants 8 Rats 17 Sanitary Circumstances 13 Scabies 16 Statistics 3 Sterile Maternity Outfits 10 Tuberculosis 18 Vaccination 22 Welfare Centres 7