REPORT ON THE HEALTH OF THE I Borough of Lambeth DURING THE YEAR 1950 (94th 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 Lambeth Public Health Committee (Appointed by the Council on the 24th May, 1950) HIS WORSHIP THE MAYOR (Mr. Councillor J. W. Darsley, J.P.) Ex-Officio Aldermen: Mrs. Alderman E. S. Barnes, J.P. (Vice-Chairman) Mr. „ G. K. Rettie Councillors : Mrs. Councillor M. B. Brownett Mr. „ T. Cleasby (Chairman) „ „ R. S. Cooper Mrs. „ L. A. A. Evans Mr. „ E. E. Harris „ „ C. F. Hart Miss „ K. L. Jenner Mr. „ W. Laverick Mrs. „ M. Marock 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 94th Annual Report upon the health of the Borough of Lambeth. Again owing to the absence of serious epidemic disease the general health of the community has been good but it is becoming increasingly evident that too much is being taken for granted over the present day amenities and too little attention paid to the slender barriers which intervene between health and illness. Good safe water comes out when the tap is turned, the drains and dustbins take all our waste, food is by and large safe to eat and we are not unduly exposed to infection through the air we breathe, but how close the margin of safety is can be realised from the Brighton and Glasgow smallpox epidemics of the past two years, or the Croydon typhoid epidemic before the war. The trend of legislation since the end of the war has predisposed the general public to regard the treatment of their diseases as the principal aim and object of medical thought which in fact it is for most medical men. Prevention of disease was never spectacular, it was always an uphill struggle, and never more so than today when even the Parliamentary dice are loaded against hygiene and in favour of disease treatment. It is too easy to obtain expensive drugs for the treatment of a rare disease and though much easier it is still too difficult to get a bed for the isolation of a chronic case of respiratory tuberculosis who is risking the health of everyone with whom he is in contact and more particularly the children of his family. Because exposure to tuberculosis is not quickly followed by the infection of others, there is more than a tendency to forget that it is a dangerous infectious disease the seeds of which are sown today but may not result in the illness of others for months or years. The Registrar General has estimated the population to have been 231,000 at the middle of 1950, an increase of 1,600. The new dwellings completed during' the year were 631 so that the degree of overcrowding is not materially altered. Houses in general are getting older faster than new ones can be built to take their place and it follows therefore that the general standard of housing is slowly being lowered. There is no alternative but to accept this for all except the privileged few who become tenants of municipal accommodation. They are not then protected by the Rent and Mortgage Interest Restrictions Acts it is true, as local authorities, unlike other owners, can increase rents and obtain possession whenever they wish, but their rents are heavily subsidised by the other less fortunate ratepayers and taxpayers. The rents of 4 privately owned dwellings are pegged at a level below that at which the owner can " break even " after paying for the repair of dilapidations which now cost upwards of three times what they cost before the war. Many owners are old age pensioners or not far above that economic level and they have neither the ready cash to pay the bills nor the resources to raise it. It would be a relief to know that the solutions of problems such as these were being sought with the full intention of first ascertaining the remedy and then putting it into force. I am glad to record again the valuable work of the staff of the Public Health Department, so much of which passes unnoticed even by those who are most benefited. Again, too, it is a pleasure to be able to express gratitude to the Chief Officers of the Council and to thank the Public Health Committee and other members of the Council for their assistance and advice during the past year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, July, 1951. A.C.C.Thomson 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT 31st DECEMBER, 1950 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, V. W. Edgar, J. Ellis, Mrs. G. Hopkins, N. Jupp, J. D. Leeson, E. F. Mannerson, Mrs. J. Rose, Miss E. Yelverton, 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, A.J.Hattersley, J. Smith, E. E. Morgan, R. G. Cutler, A. French, H. F. Bryan, T. Lloyd, J. B. Sainsbury A. E: White, (Meat and Other Foods) (Meat and Other Foods) ,, ,, (Meat and Other Foods) (Meat and Other Foods) (Meat and Other Foods) 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 Wanless Road, Loughborough Junction, S.E.5. Superintendent : L. Brann GENERAL ASSISTANTS S. Metcalf, H.Piggott 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, 1950—231,000 (229,400). Density—56.6 (56.2) persons per statute acre (inclusive of land and inland water, but exclusive of tidal water and foreshore.) Births (corrected)—3,875 (4,108). Birth rate per 1,000 estimated resident population *15.60 (17.91). Deaths (corrected)—-2,725 (2,736). Death rate per 1,000 estimated resident population, *11.91 (12.04). Maternal mortality (corrected) per 1,000 total births (live and still), .25 (Nil). Infantile mortality, 28.6 (29). Ne-natal mortality, 20.39. Zymotic Death-rate (corrected)—0.04 (0.06) per 1,000 population (total zymotic deaths, 10 (15) ). Marriages. Marriage rate per 1,000 population, 8.19 (8.75). Rateable Value at 1st April, 1950—£2,157,123 (£2,145,021) Sum represented by 1d. rate—£8,805 (£8,650). Comparable rates for England and Wales and London:— England and Wales London Birth rate 15.8 (16.7) 17.8 (18.5) Death rate 11.6 (11.7) 11.8 (12.2) Infantile mortality 29.8 (32) 26.3 (29 Puerperal causes 0.86 (0.98) not available * As adjusted by comparability factor. 8 Vital Statistics The Registrar General has estimated that the population of Lambeth at the mid-year 1950 to be 231,000, which is 1,600 more than the previous year. The natural increase by births less deaths is 1,150. The following table shows the actual numbers and the percentages of deaths in various age groups and it will be observed that nearly 38 per cent, of all deaths were in the age group 75 years and over. Seeing that the value of the pensions looked forward to by almost everybody depends upon how much can be produced by the younger generations (pensions will not buy what is not for sale in the shops) and also seeing that the proportion of elderly to young is rising so fast, either the output by the young must increase in proportion or the elderly must remain at work after the pensionable age if the standard of living is not to fall. All experience shows that the old people are happier and live longer if they remain at work and so keep in touch with friends and work mates. It is the old who lose touch that cause so much trouble for themselves and all who wish to help them. The 23 clubs run on a voluntary basis by the Lambeth Old People's Welfare Association are primarily concerned in seeing that lonely old people have interests and friends outside the home, something to hold them back from taking the first step—the failure to keep themselves clean and tidy—which so soon ends in living in insanitary conditions and a complete inability to improve. A compulsory removal order and detention for three months in an institution is almost inevitably followed by death. Old people give up all desire to live when they lose their home—that is the personal belongings and furniture with which their lives have been so closely intertwined and so long. Like plants torn up by the roots and bedded in new surroundings they seldom thrive. Homes attractively furnished and decorated are not an alternative always welcome to the old. All ages 0-1 1-5 5-15 15-25 25-45 45-65 65-75 75 andover 2,725 111 17 9 22 160 650 729 1027 100 4.08 0.62 0.33 0.81 5.87 23.85 26.75 37.69 per cent, per cent. per cent. per cent. per cent. per cent. per cent. per cent. per cent. The principal causes of death were heart disease 917 (817) or 33.65 per cent. (29.86 per cent.) of the total deaths, cancer 485 (473) or 17.80 per cent. (17.29 per cent.), and influenza, bronchitis 9 and pneumonia, three causes of death which are to a great extent subservient to the weather. A combination of frost or wet and fog with the accompanying smoke from the burning of raw coal in open grates appears to be particularly death dealing. These three were the cause of 316 (366) deaths or 11.6 per cent. (13.38 per cent.). During the year the number of live births corrected by inward and outward transfers was 3,875, giving a corrected birth rate of 16.77, compared with 17.91 in 1949, a decrease of 1.13 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 was one maternal death during the year. Causes of, and Ages at, Death (Corrected) During the Year 1950 Mortality 11.91 (12.04) Causes of Death Ages—Both Sexes Totals Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 and upwards M. F. 1. Tuberculosis (respiratory) — — — 8 32 34 12 2 52 36 2. Tuberculosis (other) — 1 3 2 2 3 1 — 7 5 3. Syphilitic diseases — — — — 1 5 4 — 8 2 4. Diphtheria — — — — — — — — — — 5. Whooping Cough 4 1 — — — — — — 1 4 6. Meningococcal infections 2 — — — — — — — 1 1 7. Acute Poliomyelitis — — 1 1 — — — — 2 — 8. Measles — 1 - - — — — — 1 — 9. Other infective and parasitic diseases — 1 1 — 1 2 2 2 5 10. Malignant neoplasm, stomach — — — — 1 24 19 19 33 30 11. Malignant neoplasm, lung, bronchus — — — — 5 54 28 11 87 11 12. Malignant neoplasm, breast — — — — 4 15 14 10 — 43 13. Malignant neoplasm, uterus — — — — 2 9 7 1 — 19 14. Other malignant and lymphatic neoplasm — 3 — 1 19 69 84 77 123 130 15. Leukaemia, aleukaemia — — — — 2 5 1 1 5 4 16. Diabetes — — — — 2 2 4 5 3 10 17. Vascular lesions of nervous System — — — — 3 65 81 127 123 153 Comnary diseases, angina — — — — 5 72 92 75 1 43 101 1.9. Hypertension with heart disease — — — — 2 30 47 48 69 58 20. Other heart disease — — — — 17 59 122 348 220 326 21. Other circulatory disease — — — — 4 14 22 46 37 49 22. Influenza 1 — — — 1 4 5 10 10 11 23. Pneumonia 9 3 1 1 5 23 29 38 50 59 24. Bronchitis 2 1 — — 3 38 59 83 123 63 25. Other diseases of respiratory system 1 — — — — 9 8 12 19 11 26. Ulcer of stomach and duodenum — — — — 4 12 14 8 28 10 27. Gastritis, enteritis and diarrhoea 3 1 — — — 2 3 2 6 5 28. Nephritis and nephrosis — 1 — 1 4 12 11 4 19 14 29. Hyperplasia of prostrate — — — — — 1 11 9 21 — 30. Pregnancy, childbirth, abortion — — — — 1 — — — — 1 31. Congenital malformations 16 3 — 1 2 9 — 2 20 13 32. Other defined and ill-defined diseases 70 1 2 3 20 48 43 58 136 109 33. Motor vehicle accidents — — — 1 5 2 1 3 8 4 34. AH other accidents 3 — 1 3 7 15 6 25 32 28 35. Suicide — — — 6 12 1 — 14 5 36. Homicide and operations of war — — — — — 1 — 1 1 1 Totals 1ll 17 9 22 160 650 729 1027 1404 1321 10 11 12 Birth-rates, Civilian Death-rates, Analysis of Mortality, and Case rates for certain Infectious Diseases in the year 1950 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 Population :— Live Births 15.8† 17.6 16.7 17.8 16.77 Still Births 0.37† 0.45 0.38 0.36 0.36 Deaths : All Causes 11.6† 12.3 11.6 11.8 11.91 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Pneumonia 0.46 0.49 0.45 0.48 0.47 Whooping Cough 0.01 0.01 0.01 0.01 0.02 Diphtheria 0.00 0.00 0.00 0.00 — Influenza 0.10 0.09 0.10 0.07 0.09 Smallpox — — — — — Tuberculosis 0.36 0.42 0.33 0.39 0.43 Acute Poliomyelitis and Polioencephalitis 0.02 0.02 0.02 0.01 0.00 Rates per 1,000 Live Births:- Deaths under 1 year of age 29.8‡ 33.8 29.4 26.3 28.6 Deaths from Diarrhoea and Enteritis under 2 years of age 1.9 2.2 1.6 1.0 1.03 * 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 12,346 Total number of reinspections 32,992 Total number of intimation notices served 5,405 Total number of nuisance notices served 2,339 Women Sanitary Inspectors. Total number of visits and inspections (factories, workplaces, infectious disease, etc.) 1,961 Total number of revisits 336 Total number of intimation notices served 56 Total number of nuisance notices served — Workshops in which defects were found 56 The present conditions for the ordinary property owner are now worse than ever before. Houses are filled to capacity with the increased wear and tear which naturally follows. Moreover, they are getting older and nearer the end of useful existence more quickly than new houses are being constructed. The cost of repairs—themselves increasing—is rising while rents are fixed at a level wholly out of keeping with realities. The exigency is one which demands serious attention. Old and worn houses patched over and over again cannot be expscted to last and may give way in numbers if subjected to severe gales. Scabies and Verminous Persons Cleansing Centre. A total of 231 persons were treated at the cleansing station and given 352 treatments, compared with 351 persons treated in the previous year. There has again been a noticeable fall in the number of cases of scabies notified, 40, compared with 68 in 1949, 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. 14 National Assistance Act, 1948 Section 47. Removal to suitable premises of persons in need, of care and attention. It is a relief to report that it was not necessary for any certificates to be made out for the removal and detention of any person during the year. Section 50. Burial or Cremation of the Dead. Arrangements were made during the year for the burial of 33 cases, of whom 21 were males, 9 were females and 3 were stillborn. 30 were Lambeth cases and 3 were strangers. The net cost to the Council was £293. The Prevention of Damage by Pests During the year 1950, 1,023 complaints have been investigated. Of these, 767 were found to be brown (common) rats, 18 black (ship) rats, 143 mice, and 95 were found to be not justified; 1,156 baitings were carried out, and in 110 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. Inspections 1,086 Re-visits 957 Intimation Notices served 2 Nuisance Notices served 1 Once again, two separate sewer treatments with poison have been carried out by the Borough Engineer's department during the year. The rodent officer and his staff have continued their efforts to wage a war of extermination against rats. Work at night is, of course, frequently necessary, more especially in shopping districts where apart from an occasional watchman, the rat has the place to himself. 15 Rehousing and Overcrowding 2,621 cases were examined and reports sent to the County Council with copies to the Borough Council's rehousing department. Of this number, 173 Orange forms (overcrowding) were forwarded to the County Council and 166 preferential forms on medical grounds. For the Council's housing department priority recommendations numbered 72 and no preference 169. Information upon 73 cases was forwarded to other districts. Cases not overcrowded and without need for preference numbered 974, deferred cases for which no immediate grounds for giving preference was possible were 309. The 343 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 201 Orange form and 141 preferential cases. Inspection and Supervision of Food This part of the report deals with the work carried out by the Food Inspectors under The Foods and Drugs Act, 1938, The Public Health (Meat) Regulations, 1924, The Milk (Special Designation) Regulations, 1949 and 1950, 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, 182 were of milk, 1 of which was adulterated (representing 0.55 per cent, of the number of formal milk samples procured). 3 samples of sal volatile, 3 of confectionery and 1 of tincture of iodine also were adulterated. Two samples were the subject of legal proceedings, particulars of which are set out below. Table I Sample No. Subject of Prosecution Nature of Offence Result of Prosecution Pines Costs £ s. d. £ s. d 55 Sal Volatile Deficient 55% Free Ammonia. Convicted 4 0 0 2 2 0 79 Sal Volatile Deficient 98% Free Ammonia and 62% Ammonium Carbonate. Discharged on payment of costs. - - - 2 2 0 16 (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 Ice Cream and Ice Cream Mix 57 †Ham, canned 3 †*Sausages 1 * Whale meat roll 2 *Tongue 2 *Milk 2 Milk Bottles 2 Cockles 1 *Fish Paste 1 *Finger Nail Swabs 2 *Faeces 2 Total 75 * These articles were suspected to have caused food poisoning. † Revealed the presence of organisms likely to cause food poisoning. Table 3 Milk Type of Test Samples No. procured No. passing test No. failing to pass test Methylene Blue 71 68 3 Phosphatase 64 61 (3 not tested) 17 2. Inspection of Food. (a) At the Slaughterhouse Carcases Inspected and Condemned Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed — — — 1 13 Number Inspected — — — 1 13 All diseases except tuberculosis, whole carcases condemned — — — 1 Carcases of which some part or organ was condemned - . 1 Percentage of the number inspected affected with disease other than tuberculosis - - - - 15.4 Tuberculosis only Whole carcases condemned - - - - - Carcases of which some part or organ was condemned - - - - - Percentage of the number inspected affected with tuberculosis - - - - - (6) 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 cwt. qrs. lb. Pig carcases and organs — 1 1 22 (ii) At shops, stores and factories. Fresh meat, fish, poultry, vegetables, prepared and canned foods 68 — — 26 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 the Council's Salvage Scheme. I called attention in my Report for 1949 to the number of complaints about food, and I included a table giving brief particulars of each complaint, which indicated that almost all arose from carelessness or lack of supervision. The number of similar complaints received this year is more than double the number received during 1949, and the following statement gives brief particulars. It is worthy of note that of 45 such complaints received 26 related to bread. The re-introduction of wrapped bread brought trouble in its train. The wrapping of bread in waxed paper, although protecting the bread from external contamination, does, however, tend to promote conditions encouraging the growth of moulds, and several of the bread complaints were due to this cause. Complaints received. 1. Medical plaster in bread. 2. Match stick in bread. 3. Bitumen in bread. 4. Pencil embedded in bread. 5. Splinter of wood in lemon curd. 6. Safety pin and beetle in Baby Food. 7. Drawing pin in cake. 8. Cockroach in bread. 9. Broken glass in bottle of milk. 10. Mouse excrement in bread. 11. Soda water bottle stopper contaminated with creosote. 12. Cockroach in bread. 13. Match stick in bread. 14. Cigarette end in bread. 15. Metal particles in bread. 16. Cockroach in bread. 19 17. Grease in bread. 18. Grease in bread. 19. Dirty milk bottle. 20. Dirty milk bottles (two). 21. String in bread. 22. Cordial containing flies and debris. 23. Mould in wrapped sliced bread. 24. Discoloration of bread. 25. Buttered bread roll containing meat with fly larvae. 26. Finger bandage in tin of diced carrots. 27. Dirt in milk bottle. 28. Ants in jam. 29. Sliced wrapped bread with mould. 30. do. 31. do. 32. do. 33. Cement in milk bottle. 34. Tobacco in bread. 35. Wrapped bread with mould. 36. do. 37. Mouse excrement in bread. 38. Meat pie crust with mould. 39. Nut sweets infested with insects. 40. String in bread. 41. Grease in bread. 42. Mouse excrement in vanilla slice. 43. Lime sand in milk bottle. 44. Nail in mince pie. 45. Milk bottle containing glass. Legal proceedings were instituted in the under-mentioned cases, with the results shown. 10. Mouse excrement in bread. Fined £3. £2 2s. 0d. Costs. 14. Tobacco in bread Fined £5. No Costs. 16. Cockroach in bread. Case dismissed. 17. Grease in bread. Fined £2. £4 4s. 0d. Costs. 19. Dirty milk bottle. Fined £2. £2 2s. 0d. Costs. 21. String in bread. Fined £2. £2 2s. 0d. Costs. 42. Mouse excrement in vanilla Fined £5. £4 4s. 0d. Costs. slice. 20 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 245 and of these 139 have been approved as the premises comply with the requirements of the Association. The number of Certificates issued is 190 and the number of badges worn by employees is 324. Swabs are taken by the sanitary inspectors at irregular intervals of the fingers of employees who handle food in shops and restaurants and these are examined in the laboratory for Bacillus coli of faecal origin. The standard of cleanliness is high and nobody has been found guilty more than once. So far of the 243 swabs taken nine only have been found to yield a growth of faecal microbes. Food Poisoning Outbreaks An outbreak of food poisoning occurred in King's College Hospital due to Salmonella typhi-murium which was isolated from the faeces of two patients on the 6th September. On inquiry four more persons were found to be suffering from gastro-enteritis and later proved bacteriologically to have been infected with the same organism. The onset of the disease in these six cases was between September 2nd-3rd. The two nurses among these six contracted the disease when patients in the sick bay while the three hospital patients were in three different wards. This wide distribution, though only involving a few of the 700 at risk, directed suspicion to some central source of infection and the kitchen staff seemed the most profitable line of inquiry, but there was a contraindication in that the nurses Sick Bay is supplied mainly by a separate kitchen. Inquiries into all cases of diarrhoea in the hospital from whatever cause together with swabbing revealed a further 11 persons infected with the same organism, the onset in each case being between the 6th and 12th September. The distribution of cases now affected no less than 10 wards. Meanwhile careful inquiries were made concerning the health of the kitchen staff with particular emphasis upon any recent attacks of diarrhoea, and in addition they were all swabbed. Two of the kitchen staff engaged in the peeling of potatoes and the preparation of vegetables were found to be excretors of typhimurium and were immediately suspended from work. Unfortunately their duties had also included the preparation of salads which of course are not cooked or subjected to any form of heat before being consumed. Cases still continued to crop up as the result of infection transferred from those who had recovered and 21 so all those at risk in the ten wards, a total of some 400 persons, were swabbed with the result that a further number of patients and staff were found to be symptomless carriers. There were in all 27 people involved of whom thirteen patients, five nurses, a ward maid and two kitchen staff had symptoms while the remaining six had no symptoms. All cases were fortunately mild, only some abdominal pain and diarrhoea occasionally accompanied by blood and mucous. Nausea was uncommon and vomiting exceedingly rare. There were no deaths. The outbreak illustrates once again how readily infection can be spread by food handlers who from whatever cause, be it forgetfulness or sheer laziness, omit to follow the dictates of elementary cleanliness and prepare food for others without washing hands after using the W.C. The Bacteriological department of the hospital under the able direction of Dr. A. C. Cunliffe were responsible for the laboratory investigations and carried out the task of examining over 400 anal swabs with commendable speed and accuracy. Smoke Emission During the year complaints were received on 23 occasions of the nuisance caused by smoke from factory shafts. Observations were made on 74 occasions which were followed by the service of two intimation and one nuisance notices. Manufacturers have suffered under severe handicaps in past years since the war due to ageing plant for which permits for renewal could be obtained only with great difficulty, and from the poor quality of the fuel supplied over which they have had no control and little remedy. The chief offender in the emission of smoke however is the chimney of the private dwellinghouse which is specifically excluded from the ambit of the law. A start towards the reduction of smoke might well be made by prohibiting the installation in a new building of any fuel burning contrivance which does not consume any smoke which it may produce. But this would not prevent the production of sulphur dioxide which causes most of the damage to the stonework of buildings. Slaughterhouses Only one licenced slaughterhouse remains in the district and here slaughtering was carried out on seven occasions only on each of which an inspector was present on the receipt of the statutory notice of intention to slaughter. 22 Offensive Trades Establishment Orders have been granted to two companies who carry on the offensive trades respectively of (a) fellmonger and (b) fatboiler. (a) Messrs Gaston Morrell, Ferndale Road ; (b) Messrs. Lepard, Wandsworth Road. These two orders are renewable annually and at no time has either business given rise to any complaint. Drainage Plans All plans are registered with the Borough Engineer but the Sanitary Inspectors are responsible for seeing that the work is carried out in accordance with the drainage by-laws. 31 plans of new buildings and 116 plans of alteration to existing drains were deposited. In addition combined drainage was carried out in 17 cases of which seven were cases of relaying defective combined drains for which no order had been made by the Council and no plans could be found, and which therefore were deemed to be sewers repairable by the Council. Rent and Mortgage Interest Restrictions Acts Applications were made accompanied by the statutory fee of one shilling for the issue of 34 certificates enabling the statutory tenant to withhold a portion of the rent and for the issue of 27 determining certificates to cancel corresponding enabling certificates previously issued. Dangerous Structures Information was forwarded to the District Surveyor on 170 occasions during the year of the presence of structures which were considered to be dangerous to life or limb. Registrations Under the Milk and Dairies Regulations, 1949, 172 distributors of milk and 28 dairies were registered. Under the Milk (Special Designation) (Raw Milk) Registrations, 1949 and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949, there were 162 registrations with 15 supplementary licences and two Pasteurisers licences. The number registered under the Pharmacy and Poisons Act, 1933 (Section 21) Part II was 199. 23 Street Markets Markets are held in The Cut, Lower Marsh, Lambeth Walk, and Wilcox Road, in the inner wards and in Popes Road, Electric Avenue and Brixton Station Road. All these are inspected regularly. Housing Act, 1936 (а) Closing Orders Two premises represented in 1949 and four in 1950 were dealt with during the year when five closing orders were made while the sixth was the subject of an undertaking. In addition one closing order was made by a Magistrate's Order under the Public Health (London) Act, 1936. (b) Demolition Orders Twenty-one premises were represented for the purpose of demolition orders during the year. Orders were-made in nine cases. Thirteen have been demolished, one has been made fit, two are still standing while the remaining five are still in abeyance. 24 Home Office Table Factories, and Other Premises. 1.—Inspections for purposes of provisions as to health Including inspections made by Sanitary Inspectors. Premises (1) Number on Register (2) Number of Inspections (3) Written Notices (4) Occupiers prosecuted (5) Factories : With mechanical power 413 361 31 — Without mechanical power 207 141 26 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 65 103 - - Total 685 605 57 — 2.—Defects Found Particulars (1) Number of Defects Number of defects in respect of which prosecutions were instituted. (6) Found (2) Remedied (3) Referred to H.M. Inspector (4) Referred by H.M. Inspector (5) Want of cleanliness (S. 1) 39 38 - 26 3 Overcrowding (S.2) 1 1 1 — — Unreasonable temperature (S.3) 1 1 - 1 - Inadequate ventilation (S.4) 1 1 - 1 - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) : Insufficient 2 2 - 1 - Unsuitable or defective 24 21 - 10 - Not separate for sexes 3 2 — 1 - Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) 31 29 1 1 - Total 102 95 2 41 3 25 Outwork in Unwholesome Premises Nature of Work Instances Notices served Prosecutions (I) (2) (3) (4) Wearing Apparel— Making, etc. 145 - - Cleaning and washing - - - Household linen 1 - - Lace, lace curtains and nets - - Curtains and furniture hangings - - - Furniture and upholstery - - - Electro-plate - - - File making - - - Brass and brass articles 1 - - Fur pulling - - - Cables and chains - Anchors and grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, etc. - - - Artificial flowers - - - Nets, other than wire nets - - - Tents - - - Sacks - - - Racquet and tennis balls - - - Paper, etc., boxes, paper bags. 45 - - Brush making - - - Pea picking - - - Feather sorting - - - Carding, etc., of buttons, etc. 11 - - Stuffed toys 2 - - Basket making — - Chocolates and sweetmeats — - - Cosaques, Christmas crackers, Christmas stockings, etc. 4 - - Textile weaving — - - Lampshades 34 - - Fancy articles, pin cushions, milk bottle covers, etc. - - - Stringing cotton bags - - - Pot scourers - - - Total 243 — — 26 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 649 (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 for 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, measles 1, and whooping cough 5. Poliomyelitis Although 28 notifications were received there were only 24 confirmed cases of poliomyelitis, the rate per 1,000 population being 0.10. Six of them were non-paralytic and only two died. Puerperal Pyrexia Of the 28 cases of puerperal pyrexia who could be followed up all had attended an ante natal clinic except one who fell and had an early abortion. Half were primiparae. The causes of the pyrexia were inflammation of the breast 8, stillbirth and abortion 4, adherent placenta 4, perineal damage 3, prematurity or induction 3, Rhesus factor 2, worry about the home 2, no cause found 2. Diphtheria Although there were six cases of diphtheria notified not one of these was confirmed. This is the first year since records were kept that the district has been entirely free from diphtheria. 27 Dysentery At the beginning of November several nurses at Kings College Hospital were notified to be suffering from Sonne Dysentery. The outbreak was at first mainly confined to the nursing staff, many of whom were living outside the hospital at various addresses in Lambeth and Camberwell. The one common focus from which the infection could have and most likely had been spread is the nurses' dining room where every nurse had at least one meal a day. The dining arrangements are on the self service cafeteria principle and some colour was given to a suggestion that mousse which had been decorated with butter cream was the vehicle conveying the infection. The epidemic however rapidly became widespread far beyond the original infection, so much so that the admission of more patients to the hospital had to be suspended. In all, there were 91 cases notified, of which no less than 61 were nursing staff, the remainder being nine administrative staff and 21 patients in the wards. Most of the secondary cases in the wards followed the primary cases among the nurses on duty in those wards, but this did not by any means occur everywhere. Some cases among the hospital patients, although notified later than the nurses, gave dates of onset on or about the first three days of November so that there is a great probability of the primary focus having been the hospital kitchen which supplies both the nurses' dining room as well as the wards. The fair inference to draw in reviewing the features of the epidemic is that all were infected from the kitchen and that infection from nurse to patient was unlikely although, of course, not entirely out of the question. There were no cases in the children's ward where ices are in greater favour than other dishes and it would appear that mousse was not eaten there. There was no case either in one of the surgical wards, despite the fact that cases occurred among the nurses on duty in both these wards. Swabs were taken from all those who had any symptoms as well as from the catering staff and in consequence a number of almost symptomless carriers were discovered. The strictest precautions to see that all food was safeguarded were adopted with notices reminding the users of all conveniences to wash their hands afterwards, but in spite of every care, cases continued to crop up daily, the onsets being from the 29th October to the 11th November and the date of notification from the 4th November to the 28th November, depending upon the time taken after swabbing before the dysentery bacillus could be isolated. 28 Date of onset No. 29.10.50 2 30.10.50 1 31.10.50 2 1.11.50 15 2.11.50 8 3.11.50 16 4.11.50 6 5.11.50 7 6.11.50 8 7.11.50 9 8.11.50 6 9.11.50 3 10.11.50 4 11.11.50 4 Total 91 Notification date No. 4.11.50 3 5.11.50 9 6.11.50 1 7.11.50 12 8.11.50 3 9.11.50 21 10.11.50 3 11.11.50 13 12.11.50 5 13.11.50 2 14.11.50 7 15.11.50 5 16.11.50 2 23.11.50 1 25.11.50 1 28.11.50 1 2.12.50 1 5.12.50 1 Total 91 So far as was possible with the rations, all meals which could be were served hot, but with the catering difficulties common everywhere at the present time, many dishes must of necessity be served cold. The Sonne bacillus is almost notorious in being difficult to control, and so swabs were taken of taps, door handles and W.C. chain handles to see if the transference of the bacillus from one user to another through these were possible. Faecal coli were to be found on all, and so bowls of disinfectant were placed handy with notices asking the prospective user to rinse hands before touching a tap which might otherwise become contaminated and after the user had washed reinfecting him when turning off the tap and thence to a towel. After the introduction of the disinfectant it was not possible to isolate any faecal organisms so that dysentery microbes were never actually found on any taps or handles. This precautionary measure may well have been of no little use in 29 stemming the outbreak. Cases and symptomless carriers have been found among the catering staff, including the vegetable cleaner who was the probable cause of the typhimurium outbreak of food poisoning a month ago. She is a symptomless carrier. To illustrate some of the difficulties encountered in searching for the origin of such an outbreak, there are six girls employed on the internal telephone exchange, one of whom was notified by the family doctor to be suffering from dysentery. This girl had one meal only in the hospital during the previous two or three weeks before she was ill. This might well have provided a real clue at least to one meal at fault if she hadn't forgotten the date when she had it. She returned to work but was found to be a symptomless carrier. A few days after her return, one of her five colleagues was taken ill and confirmed, bacteriologically, to be a case of dysentery. The girls used to make tea for themselves, and all except the first girl to be ill, had regular meals in the hospital. Was the second telephonist infected by the first through the telephone instruments or even the tea, or was she infected by food taken in the hospital ? The indeterminate finding in this case was repeated over and over again so that it is impossible to say whether an early case introduced the disease or whether the early case was infected by a symptomless carrier. The search ended with its main object to isolate all the carriers, whether ill or not, rather than to find the defaulter. All the bacteriological investigations were admirably carried out under the direction of Dr. Cunliffe in the hospital laboratories. Approximately 1,500 separate bacteriological tests were undertaken which is some indication of the work entailed in carrying out an investigation of this kind, and further tests are necessary for a few carriers still under observation. 30 Tuberculosis Notifications received during the year ended 31st December, 1950 Respiratory 400 (433) Non-respiratory 31 (29) Deaths certified 100 (133) The notifications per 1,000 population for the past eight years (1943-50) have been 2.21, 2.28, 2.24, 1.16, 1.68, 1.63, 2.01, 1.87. Notifications received during the Year ended 31st December, 1950 Scarlet Fever 227 (250) Diphtheria 6 (22) Erysipelas 34 (30) Puerperal Pyrexia 32 (29) Ophthalmia Neonatorum 7 (8) Measles 1,640 (1,538) Whooping Cough 724 (235) Primary Pneumonia 63 (53) Influenzal Pneumonia 11 (42) Malaria (relapse) 2 (1) Dysentery 125 (16) Food Poisoning 83 (41) Scabies 40 (68) Typhoid 2 (1) Paratyphoid 1 (1) Polio-Myelitis Paralytic 20 (32) Non-Paralytic 7 Polioencephalitis 1 (1) Encephalitis Lethargica — (1) Meningococcal Infection 8 (2) 31 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 Population :— Notifications : Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Meningococcal Infection 0.03 0.03 0.02 0.03 0.03 Scarlet Fever 1.50 1.56 1.61 1.23 0.98 Whooping Cough 3,60 3.97 3.15 3.21 3.13 Diphtheria 0.02 0.03 0.02 0.03 0.02 Erysipelas 0.17 0.19 0.16 0.17 0.14 Smallpox 0.00 0.00 — — — Measles 8.39 8.76 8.36 6.57 7.10 Pneumonia 0.70 0.77 0.61 0.50 0.32 Poliomyelitis Paralytic 0.13 0.12 0.11 0.08 0.09 Non do 0.05 0.05 0.06 0.05 0.03 Food Poisoning 0.17 0.16 0.14 0.25 0.35 Rates per 1,000 Total Births (Live and Still):— (a) Notifications:— Puerperal Pyrexia 5.81 7.43 4.33 6.03 8.08 32 Disinfecting Department 3,480 rooms and 4,060 articles of bedding were disinfected during the year, among them being the rooms and articles used by the 486 cases of various forms of infectious disease taken to hospital; 307 certificates of disinfection were issued, and 85 library books dealt with from the 4,800 premises visited during the year. The clean van was used regularly for the delivery of scores to the day nurseries and sometimes to the Welfare Centres. 33 INDEX page Births 12 Clean Food 20 Committee 2 Dangerous Structures 22 Deaths 10 Disinfection 32 Drainage Plans 22 Dysentery 27 Factories 24 Food Inspection 15 Food Poisoning 20 Infectious Diseases 26 Markets 23 Maternal Mortality 9 Mortality Analysis 12 National Assistance Act 14 Notifications 30 Offensive Trades 22 Orders 23 Outworkers 25 Overcrowding 15 Prevention of Damage by Pests 14 Registrations 22 Rent Restrictions Acts 22 Sanitary Circumstances 13 Scabies 13 Slaughterhouses 21 Smoke 21 Staff 5 Statistics 7 Tuberculosis 30 Water 26