REPORT ON THE HEALTH OF THE Borough of Lambeth DURING THE YEAR 1947 (91 st 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 Borough of Hambetb Public Health Committee (Appointed by the Council on the 9th November, 1947) HIS WORSHIP THE MAYOR (Mr. Councillor J. W. Simpson, A.Inst.L.M., J.P.) Ex-Officio Aldermen: Mrs. Alderman E. S. Barnes, J.P. Mr. „ G. K. Rettie Councillors : Mr. Councillor T. Cleasby (Chairman) Mrs. „ A. W. Collins „ „ A. Coward, B.A. „ I. C. England Mr. „ A. W. Fisher Mrs. ,, C. E. Hall (Vice-Chairman) M. M. O'Connell „ „ F. L. Payne Dr. „ H. J. Powell, M.R.C.S., L.R.C.P., L.M.S.S.A. Mrs. „ R. Radley Mr. „ J. H. Waller „ „ G. Woodgate, J.P. Four co-opted Members nominated by the various Child Welfare Centres of the Borough : Miss E. Larken, representing the North Parliamentary Division. Miss P. Clowes, representing the Kennington Parliamentary Division. Mrs. E. M. Rogers, representing the Brixton Parliamentary Division. Mrs. F. W. Symons, representing the Norwood Parliamentary Division. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT 31st DECEMBER, 1947 MEDICAL OFFICER OF HEALTH AND CHIEF EXECUTIVE TUBERCULOSIS OFFICER A. G. G. THOMPSON, M.A., M.D., B.C. (Cantab), D.P.H. PUBLIC ANALYST (Part Time) A. H. MITCHELL MUTER, F.I.C., F.C.S. CHIEF ADMINISTRATIVE ASSISTANT A. C. PUTTOCK CLERICAL STAFF F. J. Cox, H. P. Wright, A. W. Bayley, S. W. Westbey, W. R. Watson, E. F. Mannerson, C. Prior, R. Strowger, G. M. Conlon, G. H. Darkins, H. Burnham, N. Jupp, Miss B. Devenish, Mrs. G. Hopkins, Mrs. M. Rudd, Mrs. I. Warten (temp.) SANITARY INSPECTORS (a) District Inspectors: S. G. Ford, Cert. S.I.E.B. (Meat and Other Foods) .J. Bowers, Cert. S.I.E.B. (Meat and Other Foods and Smoke) J. Holland, Cert. S.I.E.B. (Meat and Other Foods) S. G. Starling, ,, „ „ „ J. Smith, „ „ „ „ T. Lloyd, „ „ „ ,, R. G. Cutler, Cert. S.I.E.B. H. F. Bryan, ,, ,, A. E. White, „ ,, (Meat and Other Foods) J. Baillie, „ „ „ „ *A. E. French, „ „ „ „ *E. E. Morgan, ,, „ „ „ * Seconded for Re-housing. (b) Food Inspectors : S. Bradley, Cert. S.I.E.B. (Meat and Other Foods) C. W. Idle, „ „ „ „ 4 SANITARY INSPECTORS—(continued): (c) Housing Inspectors : B. Good, Cert. S.I.E.B. (Meat and Other Foods) F. J. Heffield, ,, „ „ „ (d) Rodent Officer: S. F. Heal, Cert. S.I.E.B.' (Meat and Other Foods) (e) Women Inspectors : Miss L. E. Auger, Cert. S-I E.B. S.C.M., H.V.Cert. Miss. A. F. Crombie, „ „ „ HEALTH VISITORS Miss M. Butler, S.R.N., S.C.M., H.V. Cert. Miss A. Richardson, S.R.N., S.C.M., H.V. Cert. Miss G. A. Kelly, S.R.N., S.C.M., S.R.C.N., H.V. Cert. Miss B. Thom, S.R.N., S.C.M., H.V. Cert. Miss Carty, S.R.N., S.C.M., H.V. Cert. Miss Selwood, S.R.N., S.C.M., H.V. Cert. DOMESTIC HELP SERVICE Organiser : Mrs. W. Mayhew Assistants : Mrs. L. Stedman and Miss W. Morley TUBERCULOSIS DISPENSARIES SCHEME (a) Central Tuberculosis Dispensary, 2 Effra Road, Brixton, S.W.2. Tuberculosis Officer: E. D. Richardson, M.R.C.S., L.R.C.P., D.P.H. Secretary and Social Worker: Miss D. E. Cooper Clerk : Mrs. J. Atkins Caretaker Attendant : R. G. Browne Health Visitors (Tuberculosis): Miss G. Roberts, S.R.N. Miss A. E. Williams, S.R.N. (b) Branch Tuberculosis Dispensary: St. Thomas's Hospital, S.E.I Tuberculosis Officer: G. T. Hebert, M.D. (Oxon.), F.R.C.P. Assistant Tuberculosis Officer: W. M. MacLeod, M.D., M.R.C.P. Lady Almoner: Miss P. Cresswell Visitor: Mrs. E. A. Wheeler 5 CHILD LIFE PROTECTION VISITOR Miss J. M. Pople, S.R.N. VACCINATION DEPARTMENT Parliamentary District Vaccination Officer North: M. Berkeley, M.R.C.S., L.R.C.P. Kennington: D. Croyden Smith, M.B., Ch.B. }H. J. Hart Brixton: E. L. M. Rusby, M.B., M.R.C.S., L.R.C:P. Norwood: R. H. Moon, M.R.C.S., L.R.C.P }H. W. Snow Lambeth Hospital: P. J. Watkin, O.B.E., M.C., M.R.C.S., L.R.C.P. DIPHTHERIA PREVENTION AND WHOOPING COUGH CLINICS (a) 212 Camberwell New Road, S.E.5}G. W. J. Bousfield, (b) 12 Hannen Road, S.E.27} M.D. (London) (c) 109 Sussex Road, S.W.9.—Mrs. P. M. Dobbs, M.B., B.Chir. (Cantab.) (d) 121 Kennington Road, S.E.11.—H. W. Swann, M.B., B.S. (Kieff) DISINFECTING STATION Wanless Road, Loughborough Junction, S.E.5. Superintendent : H. Wrigley BACTERIOLOGICAL LABORATORY Wanless Road, Loughborough Junction, S.E.5. GENERAL ASSISTANT H. plggott Assistant Rodent Officer: W. Deamer Rodent Operative: R. n. Redstone 6 PREFACE The health of the Borough of Lambeth during the year 1947 has been generally satisfactory as is borne out by the statistics in the report. The Registrar General's estimate of the population at the mid-year was 223,670, nearly 14,000 more than the estimated population in mid-1946, and 2,380 more than the number of holders of ration books at the end of 1946. The birth rate was 23.10, compared with 22.89 in the previous year, which was then the highest recorded for over twenty years and the infantile mortality of 32 is three lower than last year and is now the lowest recorded. The maternal mortality is a little higher, 1.51. The old people suffered rather more than is usual in the winter owing to the abnormal weather in the first quarter. Influenza, bronchitis and pneumonia, the trio responsible for so many deaths in the aged and infirm, are always more in evidence during the winter months and particularly during cold weather when associated with fog. Fog in London is invariably laden with the irritating acrid fumes caused by the burning of raw coal in open domestic fireplaces. When numbering the restrictions imposed upon so many of the daily activities of life, it is a source of surprise that there is none upon the burning of raw coal in the open grate of a dwelling house which can foul the air, which all must breathe, to any extent without let or hindrance. The fouling of the two other principal necessaries, food and water, is an offence but, strangely enough, not the fouling of air. The extent of the fouling can be gauged from the rate at which soot is deposited in Archbishop's Park, which is by some 30-40 tons per square mile each month. From the 1st January to the 5th April, 1947, deaths in London from the trio numbered 3,686 compared with 1,715 for the corresponding period in 1948, and but for the shortage of coal might well have been much higher. The death rate from all causes, however, was 13.04, but little higher than the previous year's 12.87, as the fine weather of the summer and autumn more than offset that experienced in the first four months. It was becoming more and more difficult for would-be householders to gain a foothold in the district in spite of the repair of damaged property and the erection of new houses, but still people managed to squeeze themselves in. Quite a number of instances occurred of a furnished room being taken by the father fpr himself and subsequently bringing the mother and several children to join him. The serious overcrowding thus caused had 7 to be relieved to the detriment of other less overcrowded families, some of whom had been waiting for years. Much of the work of the department lay under the shadow of the great change to be made so abruptly on the appointed day by the coming into force of the National Health Service Act, 1946; the general uncertainty about the future made for considerable restlessness among the staff and led to some resignations. Thanks are gratefully tendered to the chairman and members of the Public Health Committee, to the general practitioners for their help, and co-operation and to the chief officers of the Council, but it is the loyal support and willing assistance of the staff of the department which deserve so much appreciation. A.T. July, 1948. 8 STATISTICS AND SOCIAL CONDITIONS Summary of Vital and Mortal Statistics, etc. (The comparable figures for the previous year appear in brackets) Area of Borough.—4,083 statute acres (inclusive of land and inland water, but exclusive of tidal water and foreshore), divided into 4 Registration Sub-Districts, 4 Parliamentary Divisions, and 12 Wards. The Parliamentary Divisions and Registration SubDistricts have been adjusted so that they and the Wards are co-terminus. Population—estimated, 1947—223,670 (209,910). Density.—54.78 (51.41) persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore. Births (corrected)— 5,166 (4,805) Birth rate per 1,000 estimated resident population corrected 23.10 (22.89). Deaths (corrected)—2,917 (2,602). Death rate per 1,000 estimated resident population, 13.04 (12.87). Maternal mortality (corrected) per 1,000 total births (live and still), 1.51 (0.61). Infantile mortality, 32 (35). Neonatal Mortality (corrected)—74 (72) deaths under one month, being 14 (15) per 1,000 live births. Zymotic Death-rate (corrected)—0.14 (0.12) per 1,000 population (total zymotic deaths, 33. (27)) Marriages. Marriage rate per 1,000 population, 10.41 (10.03). Rateable Value at 1st April, 1947—£2,218 284 (£2,207,445) Sum represented by Id. rate—£8,662 (£8,236). Comparable rates for England and Wales and London :— England and Wales. London. Birth rate 20.5 (19.1) 22.7 (21.5) Death rate 12.0 (11.5) 12.8 (12.7) Infantile mortality 41 (43) 37 (41) Puerperal causes 1.17 (1.43) not available 9 Vital Statistics The population of the Borough of Lambeth for the year 1947 has been estimated by the Registrar General to be 223,670, which is greater by 13,760 than the official estimated population of 1946. The following table shows both actual numbers and the percentages of total deaths in the various age groups. It is of interest to note that the number of deaths in the age period 65 and over was more than 60 per cent. of the total deaths. The principal causes of death were heart disease which claimed 882 or 30.23 per cent. of the total deaths and cancer 458 or 15.70 per cent. and influenza, bronchitis and pneumonia, 419 or 14.3 per cent. All ages 0-1 1-5 5-15 15-45 45-65 65 and over 2,917 169 15 20 254 693 1,766 100 per cent. 5.79 per cent. 0.51 per cent. 0.69 per cent. 8.71 per cent. 23.76 per cent. 60.54 per cent. During the year the number of births corrected by inward and outward transfers was 5,166, giving a corrected birth rate of 23.10 compared with 22.89 in 1946, an increase of 0.21 per 1000, population. Maternal Mortality The maternal mortality is expressed as the number of deaths attributed to puerperal and post-abortive sepsis and other maternal causes for each 1,000 live births. Maternal deaths numbered 8, giving a rate of 1.51 compared with 0.61 in 1946. 10 11 Causes of, and Ages at, Death (Corrected) During the Year 1947 Mortality 13.04 (12.87) 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 — — — — — — 2. Cerebrospinal Fever — — — — — — — — 3. Scarlet Fever — — — — — — — — 4. Whooping Cough 2 — — — — — 2 — 5. Diphtheria 1 — — — — — — 1 6. Tuberculosis, respiratory system — 1 2 70 46 15 77 57 7. Other Tuberculosis — 1 1 11 2 3 7 11 8. Syphilitic diseases — — — 3 4 20 17 10 9. Influenza 2 —- — — 12 17 21 10 10. Measles — — — — — — — — 11. Ac. Poliomyelitis and Polioencephalitis — — — 3 — — 2 1 12. Ac. Infectious Encephalitis (Lethargic) — — — 2 — — 1 1 13. Cancer, Buccal Cavity and Oesophagus (M.) Uterus (F.) — — — 2 28 34 33 31 14. Cancer, Stomach and Duodenum — — — 6 19 43 40 28 15. Cancer, Breast — — — 7 23 21 — 51 16. Cancer, all other sites — 3 2 20 3 141 164 111 17. Diabetes — — — 1 56 9 5 8 18. Cerebral Vascular Lesions — — — 2 150 207 105 160 19. Heart Disease — — 1 35 17 696 412 470 20. Other Circulatory Diseases — — — 5 64 94 47 69 21. Bronchitis 2 1 1 5 64 182 149 106 22. Pneumonia 28 5 3 6 29 62 81 52 23. Other respiratory diseases — — — 8 12 18 22 16 24. Ulcer, Stomach and Duodenum — — — 3 29 17 41 8 25. Diarrhoea (under 2 years) 30 — — - — — 15 15 26. Appendicitis — — — 2 4 2 3 5 27. Other Digestive diseases 3 — 1 5 14 22 15 30 28. Nephritis 1 — — 6 11 28 22 24 29. Puerperal and Post Abortive Sepsis — — — 1 — — — 1 30. Other Maternal Causes — — — 7 — — — 7 31. Premature Birth 25 — — — — — 13 12 32. Congenital Malformations, Birth Injury, Infantile diseases 61 2 — 4 2 — 43 26 33. Suicide — — — 7 7 7 11 10 34. Road Traffic Accidents — — 4 6 6 8 19 6 35. Other Violent Causes 11 1 1 7 14 32 38 28 36. All other causes 3 1 4 20 32 88 75 72 Total All Causes 169 15 20 254 693 1,766 1,480 1,437 12 Birth-rates, Civilian Death-rates, Analysis of Mortality and Case rates for certain Infectious Diseases in the year 1947 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 20.5† 23.3 22.2 22.7 23.1 Still Births Deaths : 0.50† 0.62 0.54 0.49 0.47 All Causes 12.0† 13.0 11.9 12.8 13.0 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 0.03 0.02 0.02 0.01 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.09 0.09 0.08 0.08 0.14 Smallpox 0.00 0.00 0.00 — — Measles 0.01 0.02 0.02 0.01 — Rates per 1,000 Live Births :— Deaths under 1 year of age 41‡ 47 36 37 32 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 8.0 3.7 4.8 5.8 * A dash (—) signifies that there were no deaths. † Rates per 1,000 total population. ‡ Per 1,000 related births. 13 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 3,813 and to persons over that age 2,393. Welfare Centres Total individual cases dealt with 23,377 ( 20,865) „ sessions held 3,699 ( 3,352) ,, ante-natal cases 5,380 ( 5,884) „ post-natal cases 1,157 ( 823) ,, nursing mothers 5,391 ( 4,511) „ infants under 1 7,294 ( 5,971) ,, children 1-5 4,155 ( 3,676) Visits paid to A/N cases 8,326 ( 9,642) P/N cases 5,617 ( 4,212) „ „ nursing mothers 24,766 ( 22,277) „ ,, infants under 1 29,465 ( 23,174) children 1-5 38,490 ( 39,300) The Moffat Welfare Centre spent the entire year housed in the basement of the Babies' Care Centre premises and the confusion from this state of affairs was made worse by the increased birth rate and the extra general work which this entailed. Not until well into 1948 did the Moffat Centre find premises into which they could move as a temporary measure until better times arrive and the housing shortage is not so acute. The rate at which building was proceeding was so reduced by the frost in the first quarter that the premises on the ground floor of a block of flats on the County Council's Tulse Hill estate which were to have been ready for the Brixton Centre before the end of the year, are not likely now to be occupied much before the end of 1948, if then. 14 Throughout the year almost every centre was handicapped by the restrictions presented by their old, worn or inadequate premises. The continued postponement of any plans for new buildings is having the effect of lowering the value of the work done, but when new premises are possible the value of making welfare work one of the activities to be housed in the Health Centres, thereby linking it closely with the general practitioners' service, will not be overlooked. Meanwhile the existing premises barely suffice for the minimum requirements and can provide no accommodation for the dental, foot, sunlight, and many other services which are needed. The standard of health of both mothers and children appears to have been maintained, if not improved, although proof of this is not statistically available. The infantile mortality rate of 32 (35) compared with 51 ten years ago and the neonatal mortality (death before the age of one month) rate of 14 (15) compared with 22 ten years ago are more than mere indications of the improvement which has taken place. The evacuation scheme for confinements to take place outside London was brought to an end in the middle of the year after 380 had been sent away. Child Life Protection 447 visits and revisits were made to foster mothers and nurse children. Foster mothers on Register at 31.12.46 28 (52) Nurse children on Register at 31.12.46 28 (34) 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. The Council's child life protection visitor retired during the year and the work which had fallen still further was divided between the four municipal health visitors and no new appointment was made. Care of Premature Infants A space is provided in the notification of birth card for the insertion of the child's weight, and all cases born in the district weighing 5£ 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 15 mother shall know to whom to turn immediately an emergency arises needing extra equipment, help in feeding the infant, and so on. Of the 296 premature children notified in the year, 71 were born at home and 225 in hospital. Of the former, 8 died in the first 24 hours, 4 died later and 59 survived the first month. Of the 225 born in hospital, 21 died in the first 24 hours, 9 died later and 190 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 83 unmarried mothers and their children, and to 19 married mothers and their illegitimate babies. As the result of the efforts of the Welfare visitors, no less than 54 girls were able to return home with their babies which is the best solution of the difficulty. Of the rest, 3 babies were cared for by foster mothers, 22 were adopted, 6 babies were cared for in homes and residential nurseries, 3 to situations with mothers, 4 in hostels with mothers, and 2 mothers made their own arrangements. The remaining 8 babies did not survive the year. Home Helps 633 (513) applications and home helps provided—cost to Council, £1,092 18s. Od. (£922 15s. 0d.), the rest of the gross cost of £1,955 13s. 6d. 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 £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 16 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, increased to 1s. l1d. an hour from 1st December, 1947, for up to a 47 hour week plus bus or tram fares. Some can only give as little as two hours a day but assistance was given to 201 distressed families during the year. The number of domestic helps employed month by month varied from 32 to 48, and the number of families relieved from 56 to 93, the average for the year being 41 domestic helps employed at any one time relieving 75 families. At the appointed day, 1948, 70 domestic helps were looking after 165 families in distress. 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 18 (7) applications were received and dentures provided for 15— cost to Council, £44 11s. Owing. 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). 17 Obstetric and Gynaecological Consultants Nil (Nil). Obstetric Unit for Blood Transfusion 8 calls (5). Each call costs 5 guineas which is paid by the Council to the London County Council who provide the service from their hospitals. Free Provision of Insulin Insulin was provided free by the Council under §227, Public Health (London) Act, 1936, to fifty-three persons at a total cost of £249 12s. 10d. 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. 23 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 included 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 Annie McCall (closed 12.11.47) 12.11.47) 36 39 5.8.1942 St John's 25 20 24.9.1942 Coldharbour Lane 40 40 12.7.1943 18 Day Nursery Accommodation Date opened under 2 years 2-5 years Cynthia Mosley 20 50 4.11.1948 Gipsy Hill 24 42 8.8.1944 Coral Street 23 48 5.6.1944 Knight's Hill 26 44 17.11.1947 Chestnut 40 40 10.3.1947 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 has been and still is as great as ever but the chance of vacancies occurring for new entrants between the ages of three and five years is now almost negligible. As children leave to go to school so the younger children move up from the age group below, filling all vacancies as they occur Preference is given on the Council's instructions to widows, unmarried mothers; and others obliged to go out to work and whose need is therefore greater. There is thereby created a selected community of children instead of a cross-section of the average, but the children appear to be too young for anything like an adverse effect to be noticed from such an artificial selection. The opening of the Chestnut Nursery in March filled a long-felt want near the largest employer of women and girls in the borough, and it was rapidly filled. Building actually began in 1943, four years before it was finally ready for occupation, but many factors such as policy, wilful damage, lack of labour and materials, prevented its completion before. Knight's Hill Nursery, situated in the premises which before the war were occupied by the Maternity Home, opened in the middle of November. Here in addition to the nursery is the hostel in which 16 of the nursery probationers lodge, girls whose homes are in the provinces. The nursery was opened there because it was the only building available to replace the Annie McCall Nursery, so urgently required by its owners, the Mildmay Mission, for reopening as a maternity home. Arrangements were made for a coach to pick up the Annie McCall children and take them the three miles across the borough to the Knight's Hill Nursery and bring them back at night, calling both ways in Brixton to pick up other children. Members of the nursery staff accompany the party in both directions. These coaching arrangements have worked quite smoothly and have been singularly free from complaint. All the nurseries which have no resident staff are frequently broken into, usually over the week-ends, some as many as ten and more times in the year. Generally children are the culprits, at 19 other times adults, but on all sides it would seem that theft of this sort is coming to be regarded as of little consequence instead of as crime, and its perpetrators criminals. Immunisation against diphtheria is a condition of entry into any nursery and on the instructions of the Council, because the parents refused to allow this to be done, a child was excluded on the grounds that he was more liable to contract the disease and might thereby endanger the health of other children in the nursery. Morbidity from infectious disease has been low throughout the year among the nursery population. All members of the nursery staff have an X-ray photograph of the chest taken annually in order to exclude the possibility of a sufferer from pulmonary tuberculosis infecting the children. It is of interest to note that one girl who was free in January succumbed to the disease in May and died in October. Summary of Work Done by the Official Health Visitors Ante-natal visits 2,024 Ante-natal revisits 227 Births, 1st visits 104 Births, revisits 261 Births, stillborn 6 Ophthalmia, 1st visits 80 Ophthalmia, revisits 64 Infantile deaths, visits 2 Welfare Centres attendances 258 Diphtheria prevention clinic attendances 202 Post-natal visits 95 Visits to children 1-5 years 783 Puerperal Pyrexia visits 26 Puerperal Pyrexia, revisits 11 Special visits: evacuation, scabies, etc. 1,240 Sanitary Circumstances of the Area Sanitary Inspectors. Total number of inspections (including war damage to property, etc.) 15 854 Total number of reinspections 27 353 Total number of intimation notices served 8 653 Total number of nuisance notices served 8,520 20 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 2,103 Total number of revisits 238 Total number of intimation notices served 115 Workshops in which defects were found 154 The two vacancies in the staff of sanitary inspectors caused through seconding two inspectors to the Housing Committee for duties connected with the repairs and alterations of requisitioned property were filled in October and December respectively. The inspection of premises and the service of notices to remedy defects was carried through by a diminished staff to the best of their ability but the steady worsening of circumstances throughout the year made much of their work of little avail. Inability to obtain licences to comply with the requirements of notices led to much exasperation among owners who wanted to comply, and on the other hand there was an increasing tendency for other owners to sit back and do nothing, playing off in turn the War Damage Commission and the Licensing Department against the sanitary inspector's efforts. Towards the end of the year it became evident that house property was wearing out faster than replacements could be expected and it only required severe storm conditions to create an ugly position. Fortunately the weather was never so unkind, and later the improved position of materials and labour allowed some easement, but there are large areas in the district of worn-out property which cannot be expected to hold together longer than a few years more. The nuisances on open spaces as well as on derelict property and former static water tanks has continued to be the cause of complaint throughout the year. The fire service does help by pumping out accumulations of water but has no facilities for clearing the masses of waste and junk which are tipped by all and sundry. If the owner can be found he can be forced to abate the nuisance caused by an accumulation, but it will recur again and again unless the property is adequately fenced—a matter of no small difficulty with labour and materials as they are, quite apart from the expense. The only permanent cure would seem to be the erection of new buildings, a slow process which has been started on a few only of the many vacant sites. Public Health (London) Act 1936, Section 224 One application was made for an order under this section for the compulsory removal to an institution and detention therein 21 for a period of three months. In only one instance during the past twenty-one years since the powers were given to local authorities by the L.C.C. (General Powers) Act, 1927, has the aged person removed survived the forcible uprooting from home for the full three months. Almost always they are decent folk who from incapacity and loneliness have let things slide until they are unable to fend for themselves, and owing to their insanitary surroundings, nobody is prepared to look after them. The Darby and Joan clubs, the voluntary visitors, the meals to the homes services, and many other efforts can do and are doing a great work in lending a hand to the old and particularly to the lonely who are in need of moral support. With it stays hope, but without it there is nothing but a drift downhill to another section 224 case. Inspection and Supervision of Food This part of the report deals with the work carried out by the Food Inspectors under The Food and Drugs Act, 1938, The Public Health (Meat) Regulations, 1924, The Milk (Special Designations) Regulations, 1936-1946 and The Ice Cream (Heat Treatment, etc.) Regulations, 1947. 1. Sampling of Food and Drugs. (a) For chemical analysis. Number procured formally 182 Number procured informally 1818 Of the 182 formal samples, 164 were of milk, 7 of which were adulterated (representing 4.3 per cent. of the number of formal milk samples procured). Two samples were the subject of legal proceedings, particulars of which are set out below. In the remaining cases the degree of adulteration was slight and warning letters were sent to the persons responsible or further samples were procured. Sample No. Table 1 Subject of Prosecution Nature of offence Result of Prosecution Fines Costs £ £ s. d. 99 Milk 29 per cent. added water Convicted 15 7 7 0 251 Milk 18 per cent. added water • Convicted 5 2 2 0 22 (b) For bacteriological and other examinations The following tables show the number and types of samples submitted for bacteriological and other examinations:— Table 2 Food other than milk Ice cream and Ice cream Mix 123 Ice cream plant rinsings 12 Milk bottle rinsings 5 Flour 1 Gum Tragacanth 1 *Canned Bacon Canned Beef 1 Bread 1 Calves' foot jelly 1 *Fish cake I *Meat 3 *Winkles 1 8Pineapple 1 Total 153 * The articles marked with an asterisk were suspected to have caused food poisoning but in no case was a food poisoning organism isolated. It is of interest to note that on the 1st April the Ice Cream (Heat Treatment, etc.) Regulations, 1947, came into operation. At about this time also the Ministry of Health suggested that experimental examinations of ice cream might be carried out, using a modified form of the methylene blue test at present in use for milk, and this form of test has been adopted. In addition, for the purpose of providing a check, the recommended form of test for the presence and degree of concentration of coliform bacilli has been carried out on each sample of ice cream and ice cream mix. These examinations have been a great help in the campaign against unclean and careless production and handling of ice cream, and a glance at Table 3 below will show to what degree improvements were effected as the season progressed. 23 Table 3 Month Satisfactory Samples Unsatisfactory Samples May 4 10 June 7 19 July 1 6 August 5 19 September 13 19 October 12 4 November and December 4 nil 46 77 Table 4 Type of Test Milk Samples. Number procured Number passing test Number failing to pass test Methylene Blue 48 37 11 Phosphatase 24 24 Nil All the unsatisfactory samples were procured during hot weather. The results of the tests served to emphasize the necessity for exercising scrupulous cleanliness in the production, processing and distribution of milk, and reducing to a minimum the time between its production and consumption. 2. Inspection of Food. (a) At the slaughterhouses 170 pigs. (b) At shops, stores and factories Large quantities of food of all varieties. As a result of these inspections the following amounts of food were surrendered as unfit for human consumption and unsound food certificates were issued. (i) At the slaughterhouses Tons cwts. qrs. lb. Pig carcases and organs — 1 — 7 (ii) At shops, stores and factories Fresh meat, fish, poultry, vegetables, prepared and canned foods 40 9 3 12 Bread containing a beetle in the crumb was seized and taken before a magistrate who made an order for condemnation and disposed. 24 In appropriate cases the unsound food was disposed of for animal feeding either through the Salvage Division of the Ministry of Food or this Council's Salvage Scheme. 3. Inspection of Shops and Stores. It has not yet been found possible to revert to frequent routine inspections of butchers' shops and food stores which were a feature of the work prior to 1939. This is due mainly to increases in the amount of food requiring inspection, the increase in sales and manufacture of ice-cream necessitating additional sampling and following-up work. Nevertheless, spot inspections have been carried out and, where, during inspections of food there is evidence of unsatisfactory conditions in premises, a thorough inspection of the premises has been made. In one instance the Council cancelled the registration of a purveyor of milk. An appeal by the defendant was struck out, the purveyor having later disposed of his business. 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 payment by the Lambeth Council. The service is free to the individual. A total of 1,076 persons were treated at the cleansing station and given 1,884 baths, compared with 1,690 persons treated in the previous year. There has been a noticeable fall in the number of cases of scabies notified, 310, compared with 758 in 1946 and 851 in 1945. More settled conditions of life and modern treatments have both conduced to this end. Head lice are now much less commonly found owing to the comparative ease with which infestation can be combatted with preparations of D.D.T. and the like. Body lice infestation is now rare outside the tramp class who can, it seems, always be relied upon if specimens are wanted. Rat Infestation During the year 1947, 829 complaints have been dealt with. Of these, 538 were found to be brown (common) rats, 36 black (ship) rats, 124 mice and 1.31 were found to be not justified. 963 baitings were carried out and in 97 cases defective or disused 25 drains were found to be the cause of infestations and were dealt with by the Borough Engineer and the Sanitary Inspectors. In only one instance was an infestation found to be of a major character and in this case, a ratting company had been employed for many years before the trouble was brought to the notice of the department and the infestation cleared. Indeed, it is safe to say that there need be no major infestations in the borough to-day except in cases where there is a failure to enlist the aid of the Council's staff. The black rat is still confined to the northern end of the borough and in far fewer instances than in previous years has its presence been confirmed. The sewers throughout the borough were baited by the Borough Engineer's staff in June and December, and throughout the year the practice of sealing disused drains has been continued by the sewer staff. In consequence of the co-operation that has existed between the two departments since the commencement of the present scheme, the position in the borough is really satisfactory, and in addition to the immediate results obtained, the work of a permanent character that is now being carried out will prevent future infestations. The means by which rats are successfully controlled are much less ambitious in character and much less expensive than those encouraged by the Ministry of Agriculture. Prevalence and Control Over Infectious and Other Diseases The mortality frorh infectious disease was again comparatively insignificant, scarlet fever, 0, diphtheria 1, measles 0, and whooping cough 2. The number of notifications shewed little change over the previous year, but the degree of morbidity has fortunately been even lighter than before. The one case of diphtheria was an infant aged two weeks who was registered as having died from laryngeal diphtheria. Measles is much less of a danger to life than it was between the wars. In 1938 there were 19 deaths and in 1928 no less than 61 deaths, while the single death in the last two years occurred in 1946. Whooping cough on the other hand seems to retain much of its virulence, the deaths in the ten years 1928-37 averaging 23.4 every year, highest 58 in 1929, and lowest, 2 in 1930. 26 The table summarising the incidence of tuberculosis for the years 1943-47 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 2.21, 2.28, 2.24, 1.16 and 1.68 respectively. Tuberculosis Notifications received during the year ended 31st December, 1947 Respiratory 339 (324) Non-respiratory 34 (26) Deaths certified 152 (160)  First Quarter Quarter Third Quarter Fourth Quarter Total for Year First Quarter Second Quarter Third Quarter Fourth Quarter for Year all Forms Year Private M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total 10 1 11 7 7 14 8 2 10 6 3 8 43 — — — — 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 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 Private 5 5 10 5 6 11 3 5 8 5 2 7 36 — — — — — — 1 — 1 — — — 1 37 1945 Popn., 173,280 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 Private 7 5 12 7 9 16 8 4 12 3 3 6 46 — — — — — — — — — — —% — — 46 1946 Popn., 209,910 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 I — 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 Private 7 8 15 9 4 13 5 3 8 4 6 10 46 — — — 1 3 4 — — — — 1 1 5 51 1947 Popn., 223,670 Hospitals 23 8 31 32 11 43 21 17 38 15 10 25 137 4 1 5 1 5 6 8 5 13 - 4 4 28 165 Dispensaries 18 10 28 18 23 41 16 33 49 22 16 38 156 — — — — 1 1 — — — — — — 1 157 Totals 48 26 74 59 38 97 42 53 95 41 32 73 339 4 1 5 2 9 11 8 5 13 - 5 5 34 373 28 The T.B. Allowance Scheme: Memo. 266/T The strict adherence to the terms of the memorandum creates so unfair a difference in the treatment meted to similar cases that it was a relief to know that the scheme would come to an end on the 5th July, 1948. In anticipation of this the tendency to give some little latitude and benefit to the individual case became more general during the year which did ease some of the bitterness expressed by the less fortunate. Notifications received during the Year ended 31st December, 1947 Scarlet Fever 331 ( 234) Diphtheria 73 ( 53) Erysipelas 32 ( 59) Puerperal Fever 4 ( 3) Puerperal Pyrexia 28 ( 17) Cerebro-spinal Fever 14 ( 9) Ophthalmia Neonatorum 11 ( 20) Measles 875 (1,633) Whooping Cough 615 ( 398) Primary Pneumonia 64 ( 54) Influenzal Pneumonia 31 ( 26) Malaria 4 ( 4) Dysentery 8 ( 22) Food Poisoning 32 ( 10) Anthrax — (-) Scabies 310 ( 758) Typhoid 2 ( 2) Paratyphoid — ( 1) Polio-Myelitis 68 (-) Polio-Encephalitis 2 ( -) Encephalitis Lethargica 1 ( -) 29  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 0.00 0.01 0.01 Paratyphoid Fever 0.01 0.01 0.01 0.01 — Cerebro Spinal Fever 0.05 0.06 0.05 0.05 0.06 Scarlet Fever 1.37 1.54 1.37 1.31 1.48 Whooping Cough. 2.22 2.41 2.02 2.80 2.75 Diphtheria 0.13 0.15 0.14 0.14 0.33 Erysipelas 0.19 0.21 0.18 0.22 0.14 Smallpox 0.00 0.00 0.01 0.00 — Measles 9.41 9.13 9.58 5.29 3.91 Pneumonia 0.79 0.89 0.68 0.64 0.42 Rates per 1,000 Total Births (Live and Still):— (a) Notifications:— Puerperal Fever 7.16 8.99 6.27 1.21 0.76 Puerperal Pyrexia 6.94* 5.31 * Including Puerperal Fever. 30 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, 1947 762 (929) 128 (291) 890 (1,220) Number of children who completed the full immunisation course between 1st July and 31st December, 1947 1,114 (1,098) 175 (736) 1,289 (1,832) The number of children immunised, 2,179, is not sufficient to keep the disease at bay. At least 75 per cent. of the number of births should be treated each year and 2,179 is well under half the number of births—5,166. Although cases of diphtheria still occur in the district, yet no immunised child has died of diphtheria since the clinics were started in 1928. Only pne death and that in an infant under one month was recorded during the year. Vaccination For many years there has been no legal compulsion in Lambeth and in fact vaccination has been voluntary. There has been no case of smallpox in the district since 1934. The repeal of the Vaccination Acts which takes effect on the 5th July, 1948, will have no particular effect, but it seems likely that without compulsion a larger proportion of children will be vaccinated from the trend of inquiries and the following table. Set out hereunder are figures relating to the years 1944, 1945, 1946 and 1947 for comparison:— 1944 1945 1946 1947 Number of births in Lambeth registered during the year 2,581 2,183 5,467 6,657 Total number of cases requiring the Vaccination Officers attention during the year 4,092 4,011 7,223 8,868 31 Disinfecting Department 3 843 rooms and 8,318 articles of bedding were disinfected during the year, among them being the rooms and articles used by the 613 cases of various forms of infectious disease taken to hospital; 488 certificates of disinfection were issued, and 159 library books dealt with from the 7,156 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 1947 the following 1,936 samples were examined bacteriologically in the Laboratory at Wanless Road. Specimen Negative Positive Total Swab for or suspected cases of Diphtheria 1,067 18 1,085 Sputum for suspected cases of Tuberculosis 765 66 831 Blood for suspected cases of Typhoid or Paratyphoid fever 2 1 3 Miscellaneous 10 7 20 1,844 92 1,936 The miscellaneous specimens consisted of 9 urines, 8 faeces and 3 bloods. INDEX page Births 8 Child Life Protection 14 Convalescence 17 Deaths 10 Dentures 16 Diphtheria Prevention 30 Disinfection 31 Domestic Helps 15 Food Inspection 21 Health Visitors 19 Home Helps 15 Illegitimate Children 16 Infectious and Other Diseases 25 Insulin 17 Laboratory 31 Notifications 28 Nurseries 17 Nursing 13 Obstetric and Gynaecological Consultants 17 Obstetric Unit for Blood Transfusion 17 Premature Infants 14 Rats 24 Removal to Hospital 20 Sanitary Circumstances 19 Scabies 24 Statistics 8 Sterile Maternity Outfits 16 Tuberculosis 26 Vaccination 30 Welfare Centres 13