REPORT ON THE HEALTH OF THE Borough of Lambeth DURING THE YEAR 1949 (93rd Annual Report) BY A. G. G. THOMPSON, M.A., M.D., B.C., D.P.H. Medical Officer of Health 2 Borough of Lambeth Public Health Committee (Appointed by the Council on the 25th May, 1949) HIS WORSHIP THE MAYOR (Mr. Councillor W. H. A. Porter, J.P.) Ex-Officio Aldermen: Mrs. Alderman E. S. Barnes, J.P. (Chairman) Mr. „ G. K. Rettie Councillors : Mr. Councillor W. W. Begley, F.R.Hist.S., L.R.I.B.A. Mrs. „ M. B. Brownett Mr. „ T. Cleasby Mrs. „ L. A. A. Evans „ „ B. M. Grantham Mr. . „ E. E. Harris A. H. Hopton Miss „ K. L. Jenner Mrs. „ M. Marock (Vice-Chairman) Mr. „ M. Modlyn „ „ F. R. Nice Mrs. „ J. Robinson 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lambeth. Your Worship, Ladies and Gentlemen, I have the honour to present to you the 93rd Annual Report on the health of the Borough of Lambeth. This sequence of reports does, in fact, refer throughout almost exactly to the same district because, unlike most Metropolitan Boroughs, the former Parish and the Borough of Lambeth were one and the same. As ray predecessor reported to you just under fifty years ago "the area changes are not serious, so that the old Parish of Lambeth and the new Borough of Lambeth practically correspond." The area is the same, but the conditions of life of the people have changed out of all recognition during those 50 years. Then the general death rate was 17.4 per 1,000 inhabitants; now it is 12.04. The birth rate was 28.2, now 17.91 per 1,000 population, and most remarkable the infantile mortality was 145 and now only 29 per 1,000 births. The population estimated to the middle of the year by the Registrar General is again a little higher at 229,400, an addition of 2,800. Since the new houses erected in the district during the year for which habitation certificates were requested numbered 686, at an average of five persons in each family occupying them, it will be readily appreciated that the overcrowding conditions remain more or less as they were a year ago. Fortunately again there has been no serious epidemic of infectious disease and, but for the disturbing fact that the incidence of pulmonary tuberculosis again increased slightly but definitely in each of the four quarters of the year, there would be little cause for anxiety. The greater risk from tuberculosis arises from two out of the three principal causes which have been known for many years. First, overcrowding increases the likelihood of exposure to infection ; second the lack of hospital beds prevents the segregation of the chronic cases which spread infection, but fortunately the third cause, inadequate nourishment, has been eliminated by the system of rationing in force. The first two causes show little sign of betterment. The waiting period for a sanatorium bed is often nine months or more and there is thus little opportunity of training sufferers to follow a course of life which will make their presence after discharge from hospital less of a danger to the community round them. In one lodging house alone, there are now twenty-one cases of tuberculosis whose chance of a hospital bed is almost nil and who, by their presence, are a constant menace to the 400 other lodgers with whom there is the usual contact. 4 Overcrowding is rife almost everywhere and there seems small hope of improvement in the near future. The public health, measured by statistics, remains good, but if the standard were related to happiness, as it should be, then the sense of frustration and almost of hopelessness of many people who have been seeking proper accommodation for years without success, would push the general level of the public health down lower than it was a year ago. From the many letters received begging for help there are many hundreds of families living with in-laws or sharing accommodation which ought to be private such as W.C. and bathroom with other families, or lacking bathrooms and hot water supplies, or having nowhere for the children to play outdoors except the street. There is little cause for surprise that parents lose heart and children get out of hand in a home which in such circumstances can hold so much bitterness. The two needs which cry out for satisfaction above everything are first and foremost more self-contained houses for occupation by one family, and a close second more playing fields in which children and young people particularly, can expend their natural energy without risk of being at variance with the law. To the Chief Officers of the Council and to the Public Health Staff, my thanks are again due as also to the Public Health Committee and other members of the Council, for their help and criticism. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, (Signed) A. G. G. THOMPSON. July, 1950. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT 31st DECEMBER, 1949 MEDICAL OFFICER OF HEALTH 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 H. P. WRIGHT CLERICAL STAFF A. W. Bayley, G. M. Conlon, V. W. Edgar, J. Ellis, J. Hatton, Mrs. G. Hopkins, N. Jupp, E. F. Mannerson, Mrs. J. Rose, Mrs. I. Warton 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) S. G. Starling, ,, „ (Meat and Other Foods) A. J. Hattersley, „ J. Smith, „ „ (Meat and Other Foods) E. E. Morgan, „ „ „ „ R. G. Cutler, „ „ A. E. French, „ „ (Meat and Other Foods) H. F. Bryan, „ „ T. Lloyd, „ „ (Meat and Other Foods) A. E. White, J. Baillie, „ „ „ 6 SANITARY INSPECTORS—continued (b) Food Inspectors: S. Bradley, Cert. S.I.E.B. (Meat and Other Foods) C. W. Idle, (c) Housing Inspectors: B. Good, Cert. S.I.E.B. „ „ F. J. Heffield, „ (d) Rodent Officer: S. F. Heal, Cert. S.I.E.B. „ „ (e) Women Inspectors: Miss L. E. Auger, Cert. S.I.E.B. S.C.M., H.V. Cert. Miss A. F. Crombie, „ „ „ DISINFECTING STATION Wan less Road, Loughborough Junction, S.E.5. Acting Superintendent: L. Brann GENERAL ASSISTANTS S. Metcalf, H. plggott Assistant Rodent Officer: W. Deamer Rodent Operative: L. Whiston 7 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, 3 Parliamentary Divisions, and 12 Wards. The Parliamentary Divisions and Registration Sub-Districts have been adjusted so that they and the Wards are co-terminus. Population—estimated, 1949—229,400 (226,600). Density—56.2 (55.5) persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore.) Births (corrected)—4,108 (4,311). Birth rate per 1,000 estimated resident population corrected 17.91 (19.02). Deaths (corrected)—2,736 (2,508). Death rate per 1,000 estimated resident population, *12.04 (11.07). Maternal mortality (corrected) per 1,000 total births (live and still), 0.00 (0.23). Infantile mortality, 29 (27). Zymotic Death-rate (corrected)—0.06 (0.13) per 1,000 population (total zymotic deaths, 15 (29) ). Marriages. Marriage rate per 1,000 population, 8.75 (9.66). Rateable Value at 1st April, 1949—£2,145,021 (£2,080,399) Sum represented by Id. rate—£8,650 (£8,901). Comparable rates for England, and Wales and London:— England and Wales London Birth rate 16.7 (17.9) 18.5 (20.1) Death rate 11.7 (10.8) 12.2 (11.6) Infantile mortality 32 (34) 29 (31) Puerperal causes 0.98 (1.02) not available * As adjusted by comparability factor. 8 Vital Statistics The population of the Borough of Lambeth for the year 1949 has been estimated by the Registrar General to be 229,400, which is greater by 2,800 than the official estimated population of 1948. 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 63 per cent. of the total deaths. The prolongation of life brings into greater prominence the difficulties facing old people who have lost their near at hand relatives and friends and are all alone in the world. Their numbers are still increasing year by year and their problems likewise. The plight of the aged who are sick makes sad reading. Old age is the prospect which faces us all but under present conditions the outlook for old people is. bleak and comfortless. Before the appointed day, the 5th July, 1948, the relieving officers of the Public Assistance authority were able to precept hospital beds for those incapable of receiving adequate medical attention at home. The district medical officer was available in their homes and he and the relieving officer were often their best friends. After the appointed day, in the general scramble to get ahead of others, the aged sick were thrust aside. Often they had no family doctor and nobody wanted to accept them on a panel. Hospital beds are naturally wanted for acute cases and their only hope now is to join the waiting list for admission which means in so many cases waiting for death to release a bed and often dying before the bed becomes empty. The best chance for the old in the present circumstances would seem to be to remain at work and active despite every incapacitating ill which fortune can deal and to go on " in harness " until death overtakes them. The 23 Clubs run by the Lambeth Old People's Welfare Association have made a wonderful difference to the life and interest of many old people, but so much remains to be done. The principal causes of death were heart disease which claimed 817 or 29.86 per cent. of the total deaths, and cancer 473 or 17.29 per cent., and influenza, bronchitis and pneumonia 366 or 13.38 per cent. 9 All ages 0-1 1-5 5-15 15-45 45-65 65 and over 2,736 119 21 19 207 646 1,724 100 4.35 0.77 0.69 7.57 23.61 63.01 per cent. per cent. per cent. per cent. per cent. per cent. per cent. During the year the number of live births corrected by inward and outward transfers was 4,108, giving a corrected birth rate of 17.91, compared with 19.02 in 1948, a decrease of 1.12 per 1,000 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 births. There were no maternal deaths for the first time in the borough's history. 10 Causes of, and Ages at, Death (Corrected) During the Year 1949 Mortality 12.04 (11.07) 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 1 1 — — — — 2 — 3. Scarlet Fever — — — — — — — — 4. Whooping Cough 1 1 — — — — — 2 5. Diphtheria — — — — — — — — 6. Tuberculosis, respiratory system — — 1 57 39 23 73 47 7. Other Tuberculosis — — 1 8 3 1 8 5 8. Syphilitic diseases — — — — 8 8 11 5 9. Influenza 2 — — 1 7 18 14 14 10. Measles — — — — — — — — 11. Ac. Poliomyelitis and Polioencephalitis — — 2 3 — — 2 3 12. Ac. Infectious Encephalitis (Lethargic) — — — — — — — — 13. Cancer, Buccal Cavity and Oesophagus (M.) — — 1 3 13 26 18 25 Uterus (F.) 14. Cancer, Stomach and Duodenum — — — 4 20 39 38 25 15. Cancer. Breast — — — 3 81 22 1 45 16. Cancer, all other sites — 1 — 19 109 172 178 143 17. Diabetes — — — — 1 13 4 10 18. Cerebral Vascular Lesions — — ' 1 6 49 195 104 147 19. Heart Disease — 2 — 26 134 655 362 455 11 20. Other Circulatory Diseases — — 4 3 38 121 81 81 21. Bronchitis 4 — - 5 53 150 131 81 22. Pneumonia 17 2 - 6 21 80 57 69 23. Other respiratory diseases 1 2 - 3 12 11 20 9 24. Ulcer, Stomach and Duodenum — — - 3 14 19 28 8 25. Diarrhoea (under 2 years) 12 1 - — — - 6 7 26. Appendicitis — — 1 2 1 5 4 5 27. Other Digestive diseases — — 1 5 16 28 18 32 28. Nephritis — — - 6 13 20 21 18 29. Puerperal and Post Abortive Sepsis — — — — — — — — 30. Other Maternal Causes — — — — — — — — 31. Premature Birth 28 — — - — 21 7 32. Congenital Malformations, Birth Injury, Infantile diseases 46 2 _ 4 2 1 33 22 33. Suicide — — . — 13 10 11 21 13 34. Road Traffic Accidents — 3 5 4 6 9 17 10 35. Other Violent Causes 5 2 2 6 6 19 21 19 36. All other causes 2 4 4 17 30 78 83 52 Total All Causes 119 21 19 207 646 1,724 1,377 1,359 † per 1,000 related births. 12 Birth-rates, Civilian Death-rates, Analysis of Mortality, and Case rates for certain Infectious Diseases in the year 1949 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 16.7† 18.7 18.0 18.5 17.91 Still Births 0.39† 0.47 0.40 0.37 0.35 Deaths : All Causes 11.7† 12.5 11.6 12.2 12.04 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Pneumonia 0.51 0.56 0.49 0.59 0.55 Whooping Cough 0.01 0.02 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 — Influenza 0.15 0.15 0.14 0.11 0.12 Smallpox 0.00 0.00 0.00 — — Tuberculosis 0.45 0.52 0.42 0.52 0.58 Acute Poliomyelitis and Polioencephalitis 0.01 0.02 0.02 0.01 0.02 Rates per 1.000 Live Births:— Deaths under 1 year of age 32‡ 37 30 29 29 Deaths from Diarrhoea and Enteritis under 2 years of age 3.0 3.8 2.4 1.7 3 2 • A dash (—) signifies that there were no deaths, † Rates per 1.000 total population. ‡ Per 1.000 related births. 13 Sanitary Circumstances of the Area Sanitary Inspectors. Total number of inspections 12,979 Total number of reinspections 33,847 Total number of intimation notices served 6,285 Total number of nuisance notices served 2,348 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 2,061 Total number of revisits, 342 Total number of intimation notices served 92 Total number of nuisance notices served 6 Workshops in which defects were found 124 House owners found conditions more adverse than ever before with rising costs of repairs, with property getting older and more worn, and with rents remaining unchanged. More owners are unable to finance repairs which are required by nuisance notices and the Council are now facing what may well grow to expensive proportions if, after the owner fails to comply with a Court order, they step in and do the work, recouping themselves by collecting the rent. There are now a number of houses where the rent is collected one week for income tax, the next week for the rates and some the third week for the repairs. Scabies and Verminous Persons Cleansing Centre. At the end of the war the Council agreed, in principle, to adapt the disused montuary at Wanless Road for use as a cleansing station owing to the increased demand for facilities which had been, and still are, met through the good will of the adjoining Boroughs of Southwark and Battersea, whose premises are placed at the disposal of Lambeth residents. The service at both is free to the individual, the Lambeth Council defraying the expense. A total of 351 persons were treated at the cleansing station and given 487 treatments, compared with 630 persons treated in the previous year. 14 There has again been a noticeable fall in the number of cases of scabies notified, 68, compared with 125 in 1948, 310 in 1947, 758 in 1946 and 851 in 1945. More settled conditions of life and modern treatments have both conduced to this end. The demand for treatment for scabies and head lice is lessening steadily and like fleas and bed bugs, these parasites are becoming almost rare. National Assistance Act, 1948 Section 47. Removal to suitable premises of persons in need of care and attention. An aged woman suffering from chronic varicose ulceration of the legs was a nuisance to other tenants of the house in which she lived and gave cause to local shopkeepers for complaint. She refused to see a doctor or to take steps to keep herself clean and inoffensive. An order for her detention in Lambeth Hospital was obtained and she was discharged cured after nine weeks. She is now quite well, living happily in her house where she keeps herself clean. Section 50. Burial or Cremation of the Dead. Arrangements were made during the year for the burial of 56 cases, of whom 36 were males, 16 were females and 4 were still born. 37 were Lambeth cases and 19 were strangers. It is surprising how much is entailed in straightening the affairs of these people. Tracing relatives, applying for insurance moneys and disposing of effects are some of the more obvious duties each of which may and often does mean a good deal of correspondence. The net cost to the Council was £412. Rat Infestation During the year 1949, 910 complaints have been investigated. Of these, 651 were found to be brown (common) rats, 20 black ship) rats, 110 mice, and 129 were found to be not justified ; 1,065 baitings were carried out, and in 88 cases defective or disused drains were found to be the cause of infestations and were dealt with by the Borough Engineer and the Sanitary Inspectors. No major infestations have come to light during the year. There has been a further reduction in the number of black rat infestations, - and in no case has the infestation been of a serious character. This 15 type of rat is still confined to the northern end of the Borough. Once again, two separate sewer treatments with poison have been carried out by the Borough Engineer's department. The Borough Engineer's staff have continued to be most helpful in the examination of sewer and suspected defective drainage connexions, and many disused connexions have been sealed. The success of the staff in coping with rat infestations has been sustained by the happy relationship with the staff of the Borough Engineer's department, with whom there is close co-operation. Rehousing and Overcrowding 3,177 cases were examined and reports sent to the County Council with copies to the Borough Council's rehousing department. Of this number, 410 Orange forms (overcrowding) were forwarded to the County Council and 236 preferential forms on medical grounds. For the Council's housing department priority recommendations numbered 101 and no preference 196. Information upon 92 cases was forwarded to other districts. Cases not overcrowded and without need for preference numbered 955, deferred cases for which no immediate grounds for giving preference was possible were 280. The 413 remaining cases were those in which no change in circumstances was discovered on revisiting. As a result of these activities the County Council rehoused during the year 328 Orange forms and 166 preferential cases. 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 200 Number procured informally 1,800 Of the 200 formal samples, 185 were of milk, 1 of which was adulterated (representing 0.54 per cent. of the number of formal milk samples procured). 16 One sample was the subject of legal proceedings, particulars of which are set out below. Table I Sample No. Subject of Nature of offence Result of Prosecution Fines Costs Prosecution £ s. d. £ s. d. 215 Milk 23 per cent. added water Convicted 10 0 0 5 5 0 (b) For bacteriological and other examinations. The following tables show the number and types of samples submitted for bacteriological and other examinations:— Table 2 Bacteriological Examinations Milk Bottles 12 Ice Cream and Ice Cream Mix 99 Crab Paste 1 Milk, Condensed 1 *Finger Nail Swabs 5 Fruit Lollie 1 *Meat, Cooked 1 *Cake 4 *Fruit Juice 1 Total 125 * These articles were suspected to have caused food poisoning, but no food poisoning organisms were isolated from any of them. Table 3 Milk Type of Test Samples No. procured No. passing test No. failing to pass test Methylene Blue 60 54 6 Phosphatase 54 53 1 17 2. Inspection of Food. (a) At the Slaughterhouse Carcases Inspected and Condmned Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed — — — — 77 Number Inspected — — — — 77 All diseases except tuberculosis, whole carcases condemned - - Carcases of which some part or organ was condemned - - 1 Percentage of the number inspected affected with disease other than tuberculosis - - - - 1.3 Tuberculosis only Whole carcases condemned - - - - Carcases of which some part or organ was condemned - - 5 Percentage of the number inspected affected with tuberculosis — — — — 6.5 (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. 18 (i) At the slaughterhouse. Tons cwts. qrs. lb. Pig carcases and organs — — 2 16 (ii) At shops, stores and factories. Fresh meat, fish, poultry, vegetables, prepared and canned foods 43 11 1 1¾ In appropriate cases the unsound food was disposed of for animal feeding either through the assistant Divisional Food Officer (Warehousing) of the Ministry of Food, or this Council's Salvage Scheme. Inspection and Supervision of Food The introduction, during the year, of legislation concerning the sale of milk and the control of dairies has resulted in a higher standard of suitability, as regards dairies, being achieved. It is interesting to note that the focus on offences relating to food has shifted from common adulteration, such as watering milk and adding margarine to butter, the latter almost entirely a thing of the past, to offences arising from carelessness and lack of supervision'. Among these, the commonest is perhaps the presence of foreign bodies such as mouse excrement, pieces of string and cigarette ends in loaves of bread. The table below shows the incidence of this type of occurrence and is a statement of complaints received in the department during the year:— 1. Cigarette end in bread. 2. Stringy material embedded in bread. 3. Nail in bread. 4. Glass in packet of national butter. 5. Mouse excrement in bread. 6. Mouse excrement in bread. 7. Dirty milk bottle. 8. Milk bottle containing pieces of broken glass. 9. Soft drink containing fly in suspension. 10. Bottle of milk containing foil cap. 11. Beetle in bread. 12. Dark coloured objects inside milk bottle. 13. Nail in bread. 14. Dark coloured objects inside milk bottle. 15. Screw, about 1 in. long, in cake. 16. Mouse excreta in crust at bottom of loaf. 17. Fly embedded in turkish delight. 18. Mouse excrement in bread. 19. Black coloured object at top of inside of milk bottle. 20. Sand in cake. 21. Dirty milk bottle. 22. Fine film of what appeared to be dust on inside of upper part of milk bottle. 19 Clean Food Campaign There has been a steady improvement in the standard of cleanliness in food premises during the year. Applications to join the Lambeth Clean Food Association have now reached 235 and of these 125 have been approved as the premises comply with the requirements of the Association. The number of Certificates issued is 158 and the number of badges worn by employees is 261. There is a body of evidence available of the satisfaction that these certificates and badges give to their possessors who are proud of them and keen to maintain the prestige which they give. The sanitary inspectors take swabs of fingernails at irregular intervals as a check upon following the Code of Practice and so far of the 150 taken only one has yielded faecal colt. The cost of installing water heaters to wash basins near water . closets and particularly the purchase tax on them are definitely serious drawbacks as in difficult times like the present many cannot afford the initial expenditure and postpone application for membership owing to the cost. The standards required by the Clean Food Association are those of Section 13, Food and Drugs Act, 1938, that is to say, standards enforceable under statute, but like overcrowding, not capable of amelioration for some time to come yet. Improvement is steady, however, and the Clean Food Association helps. Food Poisoning outbreaks There were no food poisoning outbreaks during the year. The 41 notifications all referred to isolated cases not connected with each other. 20 Home Office Table Factories, and Other Premises. 1.-Inspections for purchases of provisions as to health Including inspections made by Sanitary Inspections. Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) Factories : With mechanical power 337 349 20 - Without mechanical power 200 207 10 Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 52 87 - - Total 589 643 30 - 2.—Defects Found Particulars Number of Defects Number of defects in respect of which prosecutions were instituted. Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 97 80 4 Overcrowding (S.2) 1 1 - - - Unreasonable temperature (S.3) 1 1 - - - Inadequate ventilation (S.4) 6 5 - 1 - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) : Insufficient 3 3 2 - Unsuitable or defective 47 42 - 6 - Not separate for sexes 4 4 - 3 - Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories andWorkshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) 38 37 - - - Total 197 173 - 16 — 21 Outwork in Unwholesome Premises • Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) Wearing Apparel— Making, etc. 123 — — Cleaning and washing — — — Household linen . — — — Lace, lace curtains and nets — — — Curtains and furniture hangings — — — Furniture and upholstery — — — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, etc. — — — Artificial flowers 3 — — Nets, other than wire nets — — — Tents — — — Sacks - — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags 26 — — Brush making — — — Pea picking — — — Feather sorting — — — Carding, etc., of buttons, etc. 4 — — Stuffed toys 1 — — Basket making — -— — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, etc. 4 — — Textile weaving. — — — Lampshades 31 — — Fancy articles, pin cushions, milk bottle covers, etc. - _ ___ Stringing cotton bags — - — Pot scourers — — — Total 192 — — 22 Water Section 95, Public Health (London) Act, 1936 The number of new dwellings for which applications were received for certificates that a proper and sufficient supply of water had been installed was 686. The water supply for the area is provided almost entirely by the Metropolitan Water Board, but there are a few deep wells of which Some supply water for purposes other than human consumption, while in a tew cases the supply is used for potable purposes both for drinking on the premises as well as for the manufacture of beverages and for similar trade purposes. In these latter cases a comprehensive examination of the supply both bacteriological as well as chemical is made every three months at least, which is deemed sufficient tor ample warning of any serious changes to be observed before there is danger to health. Prevalence and Control Over Infectious and Other Diseases The mortality from infectious disease was again almost negligible, scarlet fever 0, diphtheria 0, measels 0, and whooping cough 2. There is little to be said about infectious diseases beyond an expression of thankfulness that they have played such an insignificant part in the health of the population. The following quotation is taken from the Annual Report of my predecessor for 1862, only eighty-seven years ago :— "Epidemic diseases caused 939 deaths, being 25 per cent. of the entire mortality. Scarlatina contributed as usual the greatest number, 368 deaths. Typhus caused 154 deaths. ... This disease which is so closely connected with overcrowding was, as might be expected, most fatal in the Lambeth Church and Waterloo Road Districts, where in consequence of the removal of so many houses for the construction of railways, the poorer classes are crowded together in an unprecedented manner." During that year there were 116 deaths from measles, the same number from diarrhoea mainly in infants; diphtheria caused 28 deaths, smallpox 6. At that time there was a constant piped supply of water to a small fraction only of the area, while the water being drawn from the Thames and poorly filtered was cloudy and had a decided 23 deposit after stormy weather. Many shallow wells were in use and a common complaint was of offensive or overcharged cesspools, which leaked into them. It is little wonder that infectious diseases were rife in such an environment. The only infectious disease which now gives real cause for anxiety is respiratory tuberculosis. The number on the register per 1,000 population was as high at 10.4 for the fourth quarter of the year, which is worse than in the last quarter of 1944, when circumstances were exceptional. Blame has been placed for this upon the policy at the beginning of the war in emptying hospital beds of the chronic cases in anticipation of war casualties. These chronic cases are the main sources of infection of new cases which the mass miniature radiography units are intended to pick out for early treatment. They have never been segregated again. The average waiting time for a sanatorium bed is now over nine months and for a hospital bed it is just chance whether a particular case ever gets a bed. The pattern of the National Health Service is planned for the treatment of the sick and there is inevitably small place in it for preventive medicine. Prevention of respiratory tuberculosis is now a farce without the means to remove the cause. Until beds in numbers are available for the training of early cases in sanatoria, and hospitals are prepared to segregate the chronics from the population, it is unlikely that the incidence of respiratory tuberculosis will fall. While overcrowding in the homes is the rule rather than the exception, there would appear to be no reason why the incidence should not continue to rise. Quarter by quarter for the past five years the number of cases on the register has risen from 1,676 to 2,390, and since the 5th July, 1948, the availability of beds is much less than before that date. 24 Tuberculosis Notifications received during the year ended 31st December, 1949 Respiratory 433 (344) Non-respiratory 29 (25) Deaths certified 133 (135) The notifications per 1,000 population for the past seven years (1943-9) have been 2.21, 2.28, 2.24, 1.16, 1.68, 1.63, 2.01. Notifications received during the Year ended 31st December, 1949 Scarlet Fever 250 ( 371) Diphtheria 22 ( 46) Erysipelas 30 ( 57) Puerperal Fever ( 2) Puerperal Pyrexia 29 ( 19) Cerebro-spinal Fever 2 ( 8) Ophthalmia Neonatorum 8 ( 12) Measles 1,538 (2,250) Whooping Cough 235 ( 590) Primary Pneumonia 53 ( 65) Influenzal Pneumonia 42 ( 17) Malaria (relapse) 1 ( 5) Dysentery 16 ( 9) Food Poisoning 41 ( 57) Scabies 68 ( 125) Typhoid 1 ( 2) Paratyphoid 1 ( 3) Polio-Myelitis 32 ( 7) Polioencephalitis 1 ( —) Encephalitis Lethargica 1 ( -) 25 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 :— Notifications : Typhoid Fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid Fever 0.01 0.02 0.01 0.01 0.00 Cerebro Spinal Fever 0.02 0.03 0.02 0.02 0.01 Scarlet Fever 1.63 1.72 1.83 1.46 1.09 Whooping Cough 2.39 2.44 2.39 1.70 1.02 Diphtheria 0.04 0.05 0.C4 0.07 0.J0 Erysipelas 0.19 0.20 0.19 0.17 0.13 Smallpox — — — — — Measles 8.95 8.91 9.18 8.54 6.70 Pneumonia 0.80 0.91 0.65 0.55 0.41 Poliomyelitis 0.13 0.13 0.12 0.18 0.14 Polioencephalitis 0.01 0.01 0.02 0.01 0.00 Food Poisoning 0.14 0.16 0.14 0.19 0.18 Rates per 1.000 Total Births (Live and Still):— («) Notifications:— Puerperal Pyrexia 6.31 8.14 5.30 6.82 6.92 26 Disinfecting Department 3,502 rooms and 10,728 articles of bedding were disinfected during the year, among them being the rooms and articles used by the 534 cases of various forms of infectious disease taken to hospital; 340 certificates of disinfection were issued, and 115 library books dealt with from the 5,420 premises visited during the year. The dean van was used regularly for the delivery of stores to the day nurseries and sometimes to the Welfare Centres. 27 I N D E X page Births 12 Burials 14 Clean Food 19 Committee *2 Deaths 10 Disinfection 26 Factories 20 Food Inspection 15 Food Poisoning 19 Infectious Diseases 22 Maternal Mortality 9 Milk 16 Mortality Analysis 12 Outworkers 21 Overcrowding 15 Rats 14 Removal to Hospital 14 Sanitary Circumstances 13 Scabies 13 Staff 5 Statistics 7 Tuberculosis 24 Water 22