CAM 20 Camberwell Report of the medical Officer of health. In my report for the year 1919 I set out the physical features and general character of the district. I do not therefore propose to repeat them except in reference to changes which may have taken place since then. At the census of 1911 the enumerated population was 261,328, and that estimated by the Registrar-General for 1920 is 284,995, while that of the civilian population which is used for the calculation of the death rate is taken at 284,712. It is now ten years from the date of the late census; this coupled with the shifting and disturbances of the people which have taken place during that period render an estimation of extreme difficulty. I am still inclined to think that 284,000 odd is in excess of the true number, in the same way that I suspected an over-estimate last year; but by the time this report appears in print all conjecture will have passed away, the actual enumeration of figures will have appeared, and it will be possible to estimate the value of the various prophecies which have appeared. The difficulties arising in the consideration of the number of inhabitants of the Borough are accentuated when one comes to the Wards and Registration districts. I therefore propose to defer any reference to the populations of these divisions with the corresponding estimations of the birth and death rates till next year, when it will be possible to work on the figures of the recent census, rather than on a hazardous opinion accurate enough in 1911, but now quite unreliable. Only in the case of the infantile mortality, which is based on the relation between the actual number of births registered and that of the deaths of children under one year, is it possible to make a comparison which has any value. The total number of births registered in Camberwell was 7,205; adding on the excess of children of Camberwell mothers born outside, over those of non-Camberwell mothers born inside the Borough, there appears the grand total of 7,505, which is distributed among the various registration districts according to the following cable:— BIRTHS IN CAMBERWELL AND SUR-DISTRICTS. North-west Camberwell. North Camberwell. Year. East Dulwich. Borough. Dulwich. Peckham. 584 165 1,166 825* 1918 4,186 632-814 1,467 1919 186 1,398 1,360 5,183 772 7,505 237 2,064 2,080 1920 1,114 2,010 *South Peckham, North Peckham St. George's. It will thus be seen that in spite of all the gloomy views that prevailed in 1915 onwards, when to read many papers it would appear that the British race was doomed to an early extinction on account of the falling off of births, it is found that the number of births is greater than 1915, and the opinion expressed in the annual report for that year, that I did not share in those views, but rather held the opinion that after the war things would come back to the ordinary standard, was nearer the truth than many thought. It will be seen that there is a very considerable increase on last year's numbers, which were themselves so much ahead of those for 1918. In 1914 there were registered only 6,580 births, so that no one can complain of Camberwell not having borne a fair share in preventing the extinction of the population of England. 3,697 deaths were registered in the Parish, but only those of actual inhabitants of the Borough are taken into account, and to their number must be added the deaths of Camberwellians which took place outside the Borough boundaries. When this has been done, there results a total of 3,318, which has to be used in the calculation of the death rate. Coming to the individual registration districts, we obtain the following numbers:— Dulwich. East Dulwich. N.W. Camberwell. Peckham. N. Camberwell. Dist. Unknown. 166 520 905 947 764 16 The death rate assigned to Camberwell by the Medical Officer of the London County Council, in his comparative list of Metropolitan Boroughs, is 11.7. This list is valuable for the purposes of comparison, for errors affect other districts in much the same degree as they do ours, and it is therefore permissible to use this list as a means of viewing our position among our neighbours. Camberwell's place is eighth on the list, compared with seventh in 1919. But then the death rate in Camberwell was 12.6, so that it is still possible to show improvement. The Boroughs having a, lower death rate are Paddington, Fulham, Hampstead, Wandsworth, Lewisham, and Woolwich. Five of these were in the same relation to us in 1919, the new-comers being the first two in the above series. The death rate estimated for the County of London was 12.6. The Borough rate for 1919 was 12.6, and that for 1918, 18.3. The calculation of the death rate suffers from the drawback of hazard of population, but as the figures for the whole of London are based on those of the Registrar-General, for purposes of comparison, I have used them, although my own estimate for the population of Camberwell is 263,000 odd; this was prepared for a return on the housing needs of the Borough at the end of 1919, a figure which was subsequently altered by the Council to 278,000. Coming to the particular cause of death, I have first of all to report that no deaths took place from either small-pox or poliomyelitis. The deaths from influenza shrank from 218 to 58. It will be remembered that in the last report, were included fatalities occurring at the fag end of the great epidemic which raged with such seventy in the closing months of 1918. The incidence of deaths so marked on the adult population was maintained in 1920, for the majority then took place in the age period 25 to 65, but there was no small number in the group beyond this. The deaths from erysipelas were slightly in excess of those reported in past years, 7 having been certified. As is usual in this disease, they all occurred in persons over 25. There were 274 deaths from pulmonary tuberculosis, compared with 294 in 1919. The reduction is not so great as it was from 1918 to 1919, but is still 20 to the good. The reduction showed itself almost entirely among persons between 45 to 65. Other forms of tubercle caused 79 deaths, contrasted with 83 in the previous year. Those from meningitis dropped from 43 to 35, but fatal manifestation of this disease in other organs increased from 40 to 44. In the whole of London, the decrease behaves, so far as phthisis is concerned, in much the same manner; there is a considerable drop from 1918 to 1919, and another but of less magnitude from 1919 to 1920, the actual figures being 7,048, 5,332 and 4,791 respectively. The mortality from other forms of tuberculous diseases follows the same trend, there being a diminution tor the same period from 1,398 to 992, and in 1920 there were 954 deaths. The deaths from cancer numbered 318 compared with 336, a satisfactory figure so far as it goes, but it must not be inferred that this lessening means much more than chance. It seems as if the discovery of the cause or causes of this appalling disease were as far oft as ever, and I can only again, with all possible emphasis, warn all those to seek medical advice who should suffer from any sore or swelling which shows no tendency to heal or diminish, but on the contrary to extend or enlarge. Rheumatic fever and the ordinary forms of meningitis remained at about the same level as they occupied in the two preceding years. From organic heart disease there were 10 fewer deaths than in the previous year, and, as formerly, it showed a progressive increase in numbers from adult life onwards. Respiratory diseases showed a wider incidence so far as pneumonia is concerned, being an increase of 66 in the past year, the heaviest increased toll being exacted from the infant under one year and also from those in adult and middle life. There were 8 deaths from puerperal fever compared with 9 in 1919, and 6 from the diseases and accidents of parturition compared with 12 in the previous year. Cirrhosis of the liver was responsible for 5 deaths, alcoholism for 1. against 15 and 1 for 1919. 76 persons died a violent death, and there were 20 cases of suicide, against 100 and 20 respectively. TABLE I.—CAUSES OF, AND AGES AT, DEATH DURING YEAR 1920. Total Deaths whether of "Residents" or "non-Residents" in Institutions in the District. Net Deaths at subjoined ages of "Residents" whether occurring within or without the District. Causes of Death. 2 and under 5. Under 1 year. 1 and under 2. 15 and under 25. 25 and under 45. 45 and under 65. 5 and under 15. All Ages. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 1—4 3,298 517 96 122 143 141 428 750 Certified 1,101 All causes 9 Uncertified 20 1 1 ... ... 2 7 ... 1. Enteric Fever ... 2 1 6 ... 1 6 1 1 ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... 3. Measles 57 8 18 22 9 9 ... ... ... ... ... 2 8 2 1 4. Searlet Fever 13 ... ... ... ... 11 5. Whooping Cough 32 17 3 1 ... 11 ... ... ... 6. Diphtheria and Croup 62 4 2 23 29 3 1 ... ... ... 7. Influenza 58 1 1 2 3 16 18 15 9 2 7 1 2 1 3 7 8. Erysipelas ... ... ... ... 274 120 76 19 9. Phthisis (Pulmonary Tuberculosis) ... 9 50 98 ... ... 10. Tuberculous Meningitis 35 7 8 10 6 3 1 ... 18 ... 11. Other Tuberculous Diseases 44 4 2 8 5 13 4 8 18 ... 318 6 21 161 129 105 12. Cancer, Malignant Disease ... ... 1 ... 13. Rheumatic Fever 8 2 2 4 3 ... ... ... ... ... 14. Meningitis 18 7 1 3 1 2 2 4 2 ... 1 12 54 91 15. Organic Heart Disease 347 14 1 14 160 84 16. Bronchitis 332 45 6 3 4 1 13 68 192 91 17. Pneumonia (all forms) 348 93 29 27 17 9 53 63 57 108 18. Other Diseases of Respiratory Organs 3 3 ... ... ... ... ... ... ... ... 71 2 1 19. Diarrhœa and Enteritis 64 2 2 35 ... ... ... 20. Appendicitis and Typhlitis 18 2 4 4 5 1 2 3 ... ... 21. Cirrhosis of Liver 5 3 2 ... ... ... ... ... ... ... 1 1 21A. Alcoholism 1 ... ... ... ... ... ... ... 22. Nephritis and Bright's Disease 74 1 1 1 4 6 34 27 26 ... 23. Puerperal Fever 8 2 6 ... 4 24. Other Accidents and Diseases of Pregnancy and Parturition ... ... ... ... ... 6 ... 1 5 4 ... ... ... ... ... 25. Congenital Debility and Malformation, including Premature Birth 103 100 1 2 9 ... ... ... ... ... 26. Violent Deaths, excluding Suicide 76 5 2 1 14 8 11 23 12 15 1—5 27. Suicide 20 1 ... 4 12 3 2 ... ... ... 974 28. Other Defined Diseases 152 12 12 16 22 89 190 476 311 29. Diseases ill-defined or Unknown ... ... ... ... ... ... ... ... ... ... 3,318 526 97 123 143 141 752 428 1,108 976 14. Cerebro-spinal Meningitis 2 1 1 ... ... ... ... ... ... Sun- Entries included in above figures. ... 28. Poliomyelitis ... ... ... ... ... ... ... ... ... ... 47 Other Septic Diseases 4 1 4 5 4 19 7 3 20 Pleurisy 4 1 2 1 1 ... ... ... ... ... Mental Diseases 12 7 ... ... ... ... ... 3 2 2 Old Age 243 ... ... ... 243 108 ... ... ... ... TABLE 11.-INFANTILE MORTALITY DURING THE YEAR 1920. Nett Deaths from stated Causes at Various Ages under One Year of Age. Total under 1 month. 1 to 3 months. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. 3 to 6 months. Causes of Death. 6 to 9 months. Certified I I All causes Uncertified Small-pox ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... 1 ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... Whooping Cough 1 1 2 4 5 ... ... ... Diphtheria and Croup 1 ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... Tuberculous Meningitis 1 1 ... 5 ... ... ... ... Abdominal Tuberculosis 1 ... ... ... ... ... ... ... Other Tuberculous Diseases ... 2 ... ... ... ... ... Meningitis (not Tuberculous) ... 2 ... ... ... ... ... ... 5 Convulsions 2 1 2 3 ... 3 1 ... Laryngitis ... ... ... ... ... ... ... ... Bronchitis 4 1 3 8 19 11 5 ... Pneumonia (all forms) 1 3 4 3 11 25 21 18 Diarrhœa 6 2 1 9 13 17 8 ... Enteritis 2 2 4 5 4 ... ... ... Gastritis 1 1 2 ... ... ... ... Syphilis ... 1 1 2 ... 5 ... ... ... Rickets 2 ... 1 ... ... ... ... ... Suffocation, Overlying 2 2 2 2 ... ... ... ... Injury at Birth 2 1 3 ... ... ... ... ... Atelectasis 5 5 ... 12 ... ... ... ... ... Congenital Malformations 5 1 5 17 67 ... ... ... Premature Birth 11 6 5 1 6 90 2 39 Atrophy, Debility, and Marasmus 4 11 3 57 10 13 4 Other Causes 6 1 2 9 7 ... 9 ... 145 30 27 17 219 98 93 68 INFANTILE MORTALITY. The figures for infantile mortality are very interesting. Few will belittle the earnest efforts made by the Council in measures for its diminution. They come under the categories of payment of increased grants to voluntary centres, sympathetic and discriminating administration of the Milk Orders, grants to hostels and institutions whose especial care was for the well-being of the illegitimate mother and her infant, and the extended arrangements concluded with nursing associations, whereby aid in this direction was more readily available and over a larger area. There is, then, a decided reduction in the infantile deaths, and the enthusiasts of the Maternity and Child Welfare will not unnaturally take credit to themselves for some, if not all, of this. While not wishing to deprive them of <the satisfaction which is .apparently ehared by the majority of Medical Officers, they will have a much better case if, after a hot summer and a severe winter, there as still the improvement that they claim to be due to the widespread adoption of their ideals. The mortality for Camberwell per 1,000 births ie 71, compared with 82 in 1919 and 102 in 1918, taking into account the legitimate with the illegitimate. For the illegitimate births, of which there were 238, the mortality was 176. The rate for the County of London is given as 76 for all births. The difference ie often commented upon, but it seems unnecessary to express surprise that it should exist, for it must be admitted that the illegitimate child is unusually unwanted, and starts handicapped from the moment of conception. Compared with other Boroughs, Camberwell is bracketed with the City of London as tenth on the list. Last year it was equal to Fulham, and was then sixth. There were 526 deaths of children under 1 year, compared with 437 in 1919, but as there were some 2,000 more births, the mortality rate shows a decrease. In view of the claims that are made on all sides as to the value of the Infant and Mother Welfare Centres, it is interesting to compare some of the figures with last year, although, owing to the increased number of the infantile population, 1920 should be expected to have more deaths. Premature births caused 98 deaths, compared with the same number in 1919; atrophy, debility, &c., 88, against 57; bronchitis, 45, against 30; pneumonia, 93, against 54 ; diarrhœa and enteritis, 64, against 87. Tuberculous disease caused 11 deaths, being 7 less than in 1919. Measles and whooping cough, on the contrary, were both in excess of last year. Six deaths were ascribed to overlaying, a cause preventable in the true sense of the word. Number of births notified during the year 1920 under the Notification of Births Act, 7,707. Number sent in by the Registrar-General, 7,795. INFANTILE MORTALITY, 1920. Deaths under 1 year. Rate per 1,000 Births. Wards. Births. 109.3 1 494 54 483 39 80.7 71.0 2 3 352 25 4 662 40 60.4 5 608 38 62.5 6 444 27 60.8 26 47.0 7 553 456 36 78.9 8 9 466 37 79.4 10 255 20 78.4 11 317 15 47.3 12 349 35 100.2 51.5 13 194 10 17 60.7 14 280 15 387 17 43.9 16 345 22 63.7 17 492 25 50.8 18 329 23 69.9 19 182 14 76.9 20 59 3 50.8 Hospital Accommodation. The amount expended in Poor Law relief was £335,562. The chief institution for gratuitous medical relief is the Infirmary (828 beds) in Brunswick Square, to which all the more serious and acute cases are admitted, and which is usually well filled, 4,323 patients having been admitted during the year. Constance Road Institution (906 beds) and Gordon Road Institution (867 beds) are used more for the young, the aged and infirm, and for the chronic cases. King's College Hospital, although not situated within the Borough boundary, also receives many cases. St. Thomas's and Guy's also receive a considerable proportion of sick people. Closet Accommodation. So far as closet accommodation goes, little change has to be reported beyond the fact that in several instances, as the result of inspections either by our own Inspectors or by those of the Home Office, additional closets have been provided and older ones brought up to date. This has not infrequently become necessary as the result of reversion to ordinary conditions after the war. Questions arose especially as to the separation of the closets from the rest of the building: when it was found that conditions existed which would not be permissible under the by-laws, but were not a strong enough case to advise the Committee to take action under the Public Health Act. Scavenging. A weekly collection is made through the Borough, but in certain crowded districts, and in some of the large blocks of dwellings, where the conditions of refuse removal are, to use the mildest word, obsolete they are made more frequently, three times a week holding good in some of these. It is to be hoped that before long a daily collection will certainly be made in a ll the densely populated parts. One would like to especially commend to the Council the practice adopted so largely abroad, and also in certain parts of London, of taking the domestic rubbish and depositing it in boxes on the footway in front of the houses, where it is easy to shoot it into the carts, thereby saving the time of the dustmen in going through the house to fetch it. There are objections raised to this practice—children are supposed to play with the refuse, wind is described as scattering it about; and, again, this practice is not in accordance with the by-laws; but, on the other hand, it rids the community of a potent source of trouble in the way of accumulations of decaying animal and vegetable matter. Sanitary Inspection of the District. The number of inspections made by each inspector will be seen in the table, with the particulars of the premises that were visited and the cause. For the whole Borough there were 7,803 intimations and 3,197 statutory notices. It will be seen that there is a distinct increase on 1919. Various causes have contributed to this—the bringing up of the staff to its pre-war state, the appointment of an Assistant Medical Officer of Health, of a Pood and Drugs Inspector, and also of an additional woman inspector. The Committee have also favoured the policy of pressing on matters much faster than heretofore, and although this has often led to financial trouble in the case of the small houseowner, it has made for a greater amount of work to be done. Besides this, the difficulty of getting material and labour, which seems to be ignored by those who had not the onus of seeing to sanitary work in those difficult times, has now disappeared, together with the necessity of permits and all the restrictions of war time. For instance, in 1919 there were 73 summonses, while in 1920 there were 186. The result of such intimations, notices and of the summonses that had to be issued will be seen in the tabular statement of the work carried out. There were 41 inspections made of the six registered slaughterhouses. During the war a number of them were not used for any slaughtering, and the licensees seem to have given up the idea of applying again, hence the fall in the number from 85 in 1914 to that of this year. The cowsheds also show a diminution, there being now only two. The carrying on of the milk trade has now passed almost entirely into the hands of the various combines or trusts, who for their supplies depend on importation in bulk from the large milk farms. The difficulty, of course, in the case of the town cowhouse is possible nuisance to neighbours, and the requirements in terms of space if the cows are to live under healthy conditions. If only these obstacles could fee dealt with, the advantage of being able to get milk fresh would be a most important gain. Whether retailers in London are prepared to face the coat is doubtful, so we shall have to put up with the present source of supply. There were 272 inspections of ice cream shops, of which there are 270 on the register; in one instance this delicacy was found to be prepared in a dirty ill-paved yard, and a summons was issued, with the result Chat the manufacturer was fined. The number of houses let in lodgings on the register is 317, and with the return of normal conditions it will he possible to maker a detailed inspection to see whether the requirements of the by-laws as to the periodical white washing, &c., have been carried out in all cases. At the present time there is only one case on the books which comes within the definition of art Offensive Trade. No underground rooms were found to be illegally occupied. Schools. All the schools, both public and private, have been kept under observation during the year, 224 inspections having been made of the former and 171 of the latter. In addition to this there were more detailed inspections, involving the expenditure of at considerable amount of time, of the Datchelor School, and also of the school buildings and boarding houses connected with Dulwich College. So far as this Council are concerned, nothing has arisen which could call for them to take any action in the way of closing a school. Where this has taken place it has usually been the closing of a class room or two, and has been done on the instructions of the school medical officers. It has been necessary, however, on many occasions to visit the homes of children who have been excluded from school on account of the alleged presence of infectious disease in their families. Often it has been found that the message given to the school has not been in accord with the facts ascertained from personal enquiry at the home, but when need has arisen appropriate advice has been given. In the case of diphtheria, the practice was adopted of taking swabs from those in whom there was some doubt of their having the disease, from those who had been exposed to infection and who might be suffering from a latent form, and also when, from some reason of examinations or occupation, &c., it has been necessary to modify the time of exclusion. The cleansing station has been the subject of considerable discussion during the past year, and came in for a certain amount of adverse criticism. Various additions were made to the stores in the way of dressing gowns, &c., which, owing to the high prices ruling during the war, had got into a somewhat dilapidated condition. Early in the year the London County Council wrote pointing out that the number of cases requiring cleansing had much increased, and was likely to remain high for some years. The shelter was on these grounds considered inadequate, and there was enquiry as to whether additions could be made to the staff and the buildings. Negotiations were at once started by the Borough Council, and it was agreed that a dressing room should be provided, and that the maximum number of children attended to each day should not exceed 35 for scabies and 40 for others. Further, that the London County Council would guarantee an annual minimum of £500. A second bath was also provided later on at the order of the Public Health Committee, together with a new copper. It must be admitted, considering the wages bill, that the London County Council have not done badly in the bargain they made with Camberwell. The dual control, to which I drew attention last year, still exits. and it is devoutly to be hoped that before many years the cleansing stations for schools Will be run by the Education Authority. As is usually the case, there was a crop of requests to be relieved of some of the requirements of the London County Council by-laws. Each was considered on its merits, but as nearly all of them related to the weight of soil pipes proposed to be used where the supporting walls had seen their best days, they were usually granted. The question of the administration of the Rat Orders has come up in many ways, and I was appointed to represent the Council at the meeting at Birmingham of those concerned in the subject. The energies of this Council, however, have been chiefly directed towards the supply of poison to persons, in most cases gratuitously, who allege that they are suffering from the attentions of these pests. The Orders of course put the onus on the occupiers, but these are not, as in some riparian authorities, large wharfingers, etc., but are usually dwellers in small and old Weekly property. To the former some charge could be made, but to the latter it would be gratuitous, but only after the circumstances of the case had been investigated by the Inspector of the district. The appointment of a special officer does not seem the best way to deal with the subject, but rather the co-operation between this department and that of the Engineer in the way of repairing drains that are defective and old disused pipes, which so often provide nests for the animals. People have also been cautioned as to the attraction there is in food being left about, and in untidy and ill-swept conditions of rooms. It was left to two Councillors and myself to hold a rat week in the Borough; we duly met, but partly owing to my subsequent leave of absence the matter was postponed. The Borough Council was approached by the Chelsea authorities with a view of getting the London County Council to reinstate measles in the list of notifiable diseases, but after an adverse report from myself they decided to take no action. A decision which is rarer than it should be was taken in regard to an owner who was also the occupier of a house in Camberwell, He was not financially in a position to do the work, and made the offer that if the Council did the work he would pay for it by instalments. The Committee agreed to this. The cinemas received attention at the hands of Dr. Barnes, and a thorough inspection was made of all of them. In consequence of this the owners of several were informed that unless necessary Improvements in ventilation were instituted the Borough Council would make representations to the London County Council when the licences were under consideration. The result of the Committee's action resulted in amelioration, especially in the smaller establishments, where the existing means where much open to question. Food. The milk supply has presented no change except in the gradual absorption of the smaller dealer by the larger firms. From the health point this has its advantages in the easier way of inspecting and ensuring the best conditions in supply and distribution, but it tends to eliminate competition and to promote the formation of organisations which can dominate the whole field of milk production and sale. Municipal trading has well-recognised drawbacks, but they are not so groat as to put on one side the power it would put into the hands of the public and its representatives to prevent an unreasonable price for milk, which might easily come about if the supply were to be controlled by some gigantic trust. The cleanliness of the milk still leaves much to be desired. The few comparatively simple requirements in the way of protecting it in the process of milking and conveyance have not yet been brought home to the farmer and his men. It is true that the contamination has often no specific nature, and it is only occasionally that we get an epidemic, but the danger is always with us; and the large use made of condensed milk by those who live in the worst conditions is likely enough the explanation for such outbreaks being no more frequent than they are. To those who drink much fresh milk the nature of the tamination, if they only knew it, would do not a little to put them off. Up to April, 1920, the arrangements made during the war whereby the Sanitary Inspectors took it in turns to procure samples under the Sale of food and Drugs Acts continued in force. The Committee, however, came to the conclusion that the Acts would be more efficiently administered if the pre-war practice of having one Inspector for this duty were re-established. Applications were invited from among the Inspectors, and as a result Mr. G. T. Dewey, who has been in the service of the Council as a Sanitary Inspector over twenty years, was appointed. Whatever may be the result, it lias certainly worked for the benefit of the general sanitary inspection of the Borough, which was often prejudiced by the time taken in watching and detecting offenders who were particularly apt at evading the provisions of the Food and Drugs Acts. In pre war days it was found that when persons became known to shopkeepers as regular customers, they were more likely to be served with adulterated articles than the chance customer, who, as likely as not, might be the agent of the Inspector, Hence informal sampling was then carried out on a fairly extensive scale, and the practice has once more come into vogue. "Eighty-three informal and 1,115 official samples were takers during this period. The former consisted of butter, 27; margarine, 39; milk, 10; whisky, 2; and 1 each of rum, dripping, dried eggs, mustard and preserved peas. "Of these, 3 were found to be adulterated, the 2 whiskies and 1 milk."-Inspector Dewey's Report. As this method of sampling is still carried out it will be interesting to see at the end of 1921, if conditions approach nearer to the normal, whether the results of informal sampling show an improvement on the above. The total number of official milk samples taken during the year was 637, and of these 19 were found to be adulterated, giving a percentage of 2.8, compared with 6.9 in 1919 and 11.7 in 1918. The total of adulterated samples among the 1,115 taken was 54. The following articles were reported against. Samples taken. Adulterated. Remarks. Article. 19 637 18 Summonses and 1 caution. Milk 77 12 12 Summonses. Malt and Wood Vinegars Cocoa 47 1 1 Summons. Mustard 34 2 1 Summons. 2 Summonses. Camphorated Oil 30 3 Shredded Suet 4 4 3 Summonses. 2 Summonses. 3 Whisky 3 1 Summons. Coffee 26 1 11 Unstamped Wrappers. 10 Summonses. Margarine (Unstamped Wrappers) 14 - 50 Summonses. It is gratifying to be able to report that milkmen were in two instances sent to prison. With the present high price of milk it is more and more profitable to risk the chance of an occasional fine, trusting to an addition of water or abstraction of cream to more than make it good, and I feel sure that prison will be the only effective means of convincing some offenders that adulteration is best left alone. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912/17. Seven samples of cream were purchased and submitted to the Public Analyst during the year ending December 31st, 1920, and are set out as required by the Ministry of Health. (1) Milk and Cream not sold as Preserved Cream. Number of samples examined for the presence of a preservative. Number in which preservatives were reported to be present, and percentage of preservative found in each sample. Milk Nil 558 3 5 Cream Sample No. 98, Boric Acid 0.20 percent. Sample No. 116, Boric Acid 0.16 percent. Sample No. 161, Boric Acid 0.16 percent. (2) Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservative were correct : — (i) Correct statements made 2 (ii) Statements incorrect 0 2 (iii) Percentage of preservative found in each sample. Percentage stated on statutory label. Sample No. 102, Boric Acid 0.33 per cent. Not exceeding 4 per cent. Sample No. 175, Boric Acid 0.38 per cent. Not exceeding 4 per cent. (b) Determination made of milk fat in cream sold as preserved cream : — (i) Above 35 per cent. 2 (ii) Below 35 per cent. 0 2 (c) Instances where, apart from analysis, the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed:— Three samples of cream, Nos. 98, 116 and 161, were delivered to the purchaser in unlabelled receptacles, and the receptacles (containing the bulk) were also unlabelled. One sample, No. 102, was sold in a labelled cuplet, but the can containing the bulk was unlabelled. (d) Particulars of each case in which the Regulations have not been complied with, and the action taken: — Sample No. 98, Boric Acid 0.20 per cent. Sample No. 102, Boric Acid 0.33 per cent. Sample No. 116, Boric Acid 0.l6 per cent. Sample No. 161, Boric Acid 0.16 per cent. These are the four samples mentioned under paragraph (c). The retailers in question were asked to give, in writing, their reasons for not complying with the Regulations. The letters were read before the Public Health Committee and cautions were given in each case. (3) Thickening Substances. Thickeners were absent in each sample. The carrying out of these Regulations has been in the capable hands of Inspector Dewey. Milk (Mothers and Children) Order. At the beginning of 1920 arrangements were started of having two Sub-Committee meetings each week to deal with applications under this Order. It involved an individual investigation of each as regards means, number in family, rent, &c, There often were circumstances that required a personal interview of the household, and in the early days these were carried out by members of the Committee, but as the applicants increased so rapidly it was found to be absolutely necessary to have outside assistance. Miss A. Duffield, who for many years had been a practising midwife in Camberwell, was selected for the post of inquiry officer. At first I attended the meetings, but when Dr. Barnes entered on his duties he took over the task. Some idea of the magnitude of the work of these sub- Committees may be gathered from the number of the applications, Which Were 5,200. This, however, only represents a small part of the task, for there was the work of Miss Duffield, the issuing of orders to dairymen, the checking of their deliveries; and finally their accounts. Letters had also to be written in doubtful cases as to the wages of the applicants. So far as possible to avoid injustice we tried in all eases to give the order to the dairymen who had previously been supplying the family, but when this was not possible, the nearest purveyor of repute was communicated with. The staff engaged in the administration of the Order also included a temporary clerk, who devoted the whole of his time to the duties. Not only this, it had to be placed in charge of Mr. Harman, one of the regular clerks, who supervised the machinery, and at whose instance several means of saving time on the orders and receipts were carried out. At first the milkmen could not be paid until the recipients had acknowledged the receipt of the milk, Which not infrequently led to considerable delay and hardship through their being too careless to do so. The approximate cost of the milk supplied was £4,500, without any addition for administration expenses, which included the sum of the salaries of the temporary clerk and inquiry officer. On various grounds, about 10 per cent, of the applications for milk were not acceded to, but only after strict inquiries had been made. (b) Meat. No public abattoir has been established in the district, and, as has been previously noticed, the number of slaughter-houses tends to diminish. There are no means of ensuring the quality and wholesomeness of the meat slaughtered, as we have" no information when this takes place. No carcases have been officially condemned as tuberculous. (c) During the year there were several instances of unsound condensed milk being exposed for sale on stalls. Discoveries were also made of larger consignments, and it was often found that a visit to one store led to inquiries being made as to the original source, and so to an inspection being made of these premises In most of these it was by no means certain that the cases of milk were sorted out, and no proceedings were instituted, surrender being allowed. In the case of a very large consignment, the Committee were asked to allow it to be used for pig food; they agreed to this, provided that it was disposed of within the Borough. The negotiations, however, fell through, chiefly on account of price. There were several applications made for the sale of fresh and preserved meat in shops, some of which had been used for other purposes. As these involved various structural alterations an inspection was made, and the list of requirements forwarded to the applicants and to the Food Control Department. In most cases these requirements were Carried out. There were also several applications from the owners of stalls, but in these it was necessary to take into consideration the pro- Visions existing for the storage of such articles, and it was not always possible to accede to the requests. A seizure was made of some condensed milk, and proceedings were instituted both against the person on whose premises the milk was deposited and the firm from which he purchased the stuff at a price of 10s. 6d. a case of 48 tins. The summons against the latter was dismissed on the ground that it was not proved to the satisfaction of the Magistrate that the milk was sold as for the food of man. The former, who had sold it at £1 per case to a third party, who sold it at 8d. per tin, was convicted and fined. Surrender was also allowed of some fruit pulp which had become unfit for food. Prevalence and Control over Infectious Disease. The prevalence of scarlet fever during the latter part of the year was widespread and great. It started towards the end of August, but instead of dying down at the end of autumn, it continued on right into 1921, although the maximum was reached in October. In all, there were 1,308 notifications of the disease, compared with 700 in 1919, but I feel sure that even this number by no means represents the true extent of the prevalence, because a large number of cases of desquamation after slight and non-characteristic indisposition were brought to one's notice ; and though some of these may not have suffered, I believe that the latter class would be far exceeded by mild cases of which nothing was heard, the symptoms having been hardly severe enough to call for more than a passing notice by the parents. Considering the amount of public money that has been spent on efforts at prevention, these recurring epidemics of a disease, which is sometimes referred to as preventable, are very disappointing. It is true that the mortality has diminished to a great extent, but how far this is due to the extent of segregation of the patients and the limiting of the infection in every way, or to a change in the type of the disease tending less to a fatal termination, it is impossible to say. The notifications were distributed amongst the registration districts in the following order : —37 to Dulwich, 82 to East Dulwich, 278 to North-West Camberwell, 431 to Peckham, and 480 to North Camberwell. Of these the large number of 1,161 were removed to isolation hospital, showing that the greater proportion of persons prefer to have these cases treated at the hospitals than kept at home under their own care. There were 12 return cases; those that seemed infectious at the time of our visit were either referred to their own doctors or the Asylums Board were communicated with. Antitoxin continues to be supplied by the Borough, and a supply is kept at the Town Hall, and it is further to be obtained at the Dulwich Baths after official hours and also on Sundays. During the year something like 228 phials were distributed. Of diphtheria there were 932 notifications, compared with 483 in 1919; of these 62 died, compared with 35, so that the mortality rate was a little lower. 1-17 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1920, Dulwich. E. Dulwich. N.W. Camberwell. Peckham. Nor th Camberwell. Return Cases. Total Cases removed to Hospital. Notifiable Disease. Small-pox ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 34 211 231 249 207 5 839 Erysiperas 1 16 37 43 51 42 ... Scarlet Fever 37 82 278 431 480 12 1,161 1 Typhus Fever ... 1 3 3 6 ... Enteric Fever 1 1 5 4 ... ... ... Relapsing Fever 1 ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... Puerperal Fever 1 5 7 4 3 13 2 ... Cerebro-spinal Meningitis 1 1 2 4 ... ... Poliomyelias ... ... ... ... ... ... ... Ophthalmia Neonatorum 1 2 17 11 13 11 61 ... Pulmonary Tuberculosis 5 167 166 147 ... ... Other forms of Tuberculosis 13 35 35 45 1 ... ... Pneumonia 4 15 29 93 89 31 ... Encephalitis Lethargica 2 1 .. 1 3 ... 2 ... Malaria 1 3 29 17 1 ... 1 6 2 Dysentery 1 ... ... ... 1 Anthrax 1 ... ... ... ... ... Trench Fever 1 1 ... ... ... ... ... The disease was fairly uniformly spread over the whole Borough, and no one district can be singled out in which there was a special incidence. The notifications from enteric were nearly all made under this title, no distinction having been made between the typhoid and paratyphoid infections, except two which were sent in as belonging to the para-typhoid B. group of infection. There were only six notification received, and three of these died ; the smallness of the former compared with the latter leads one to the idea that either a very severe type of this disease prevailed in those attacked or else that there were attacks of enteric not recognised as such. Anyway, there being only three deaths is a matter for gratification, for the presence or absence of this disease has ever been held to be the index of the sanitary condition of the community. One rare notification was received, namely, relapsing fever, in the case of a gas worker who had served in France. There were 52 notifications of malaria in soldiers who had served either in Egypt, Mesopotamia, India, Salonica, German East Africa and the West Indies. All of them were receiving proper medical attention. The single case of anthrax was that of a man who had bought a shaving brush while away on a holiday. The Medical Officer of Health of the district concerned was at once communicated with. A visit was paid by one of the London County Council Inspectors to the disinfecting station, but beyond this no further communication has been received in the way of providing a shelter for persons who have been in contact with cases of small-pox. My reasons against this have already been given at length, and nothing has occurred to cause a change of view.; but if the County Council are convinced of the necessity of a shelter, no one could blame them for taking Steps to provide one for the whole of London. It would Serve for ordinary occasions, and in times of epidemic it would be no more certain to break down than many of the shelters already provided. Tuberculosis. The tuberculosis administration in the Borough is centred in the dispensary in Brunswick Square, which, although helped to the extent of a subsidy of £225 from the Borough Council, was managed by a Committee on which the Council is represented. There is also a day sanatorium for children at 6, Grove Hill Road. The Staff at the middle of 1920 consisted of a tuberculosis officer, an assistant tuberculosis officer, three nurses, a dispenser, and two secretaries, one of whom is honorary. The cases requiring institutional treatment are taken into institutions under the control of the London County Council, the Board of Guardians, and to a much less extent Come under the care of the Various hospitals. No progress has as yet been made with regard to the provision of a home (not a hospital) for those whose home conditions are bad, and who are so ill that they are never likely to recover, but will drag on an existence devoid of all hope Or comfort. In previous reports this has been mentioned, not on account of the danger of infection to others, but by reason of the poverty brought about by the wants of the invalid and his inability in any way to earn a moderate proportion of his cost. No expensive premises or staff would be necessary, the only indispensable feature being that it should have so much of the characteristics of a home so as to attract rather than to repel. Co-operation exists with the school clinics whereby cases that have been examined by the School medical officers are Sent to the dispensary, and Camberwell patients are often referred to the same place from the general hospitals. The notified cases are visited where it seems advisable at regular intervals by the women sanitary inspectors. In cases where suspicious symptoms are found to have arisen, the persons affected are advised to consult their own doctors, or if too poor to be able to do this, to attend the dispensary. The Care Committee try to find employment for those suffering, but they are often unable on the spur of the moment to give the TUBERCULOSIS DISPENSARIES IN LONDON. Form R. Metropolitan Borough of Camberwell. RETURN AS TO WORK CARRIED OUT IN CONNECTION WITH THE TUBERCULOSIS DISPENSARY for The period from January 1st, 1920. to December 31st, 1920. Uninsured Insured. Adults. Females. Children under 16. Males. Males. Females. 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 367 156 756 40 275 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 141 52 27 18 55 (c) Number included under 1 (a) who were found to be suffering from non pulmonary tuberculosis 7 3 60 2 9 (d) Number included under 1 (a) who were found to be non-tuberculous 108 43 527 12 146 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 111 58 142 8 65 Insured. Uninsured. 2. (a) Total attendances at the Dispencary (including attendanoes at the Dispensary of persons included under 1 (a) 5,638 9,747 (b) Number of the above attendances at which systematic physical examinations and records were made 3,413 4,728 3. Number of visits to patients at their own homes by the Dispensary Medical Officers in connection with the supervision of home conditions 334 560 4. Number of visits to patients at their own homes by the Dispensary nurses in connection with the supervision of home conditions and "following up" 4,827 10,515 *5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 132 289 6. Number of consultations with the:— (a) Medical Adviser of the Insurance Committee ─ ─ (6) Consulting Physicians at the Hospital to which the Dispensary is affiliated ─ ─ No record. No record. (c) Practitioners at the homes of patients 7. Number of written reports concerning individual patients made to: — (a) Public Authorities 4,847 2,197 493 271 (b) Practitioners 353 8. Number of specimens of sputum examined 886 (Signed) WILLIAM BRAND, March 3rd, 1921. Medical Officer of Dispensary. * Exclusive of cases sent to Hospital—6 as for diagnosis and bronchitis. definite opinion that an employer would wish to know, namely, as to how much work a given patient would be able to do in a day, and the kind that will do him no harm. The question of dental treatment was brought up to the Public Health Committee by myself, and information was collected as to the possibilities; it was, however, adjourned indefinitely. No arrangements have been made by the Council for nursing, or the provision of extra nourishment. The main difficulties that have arisen have been those due to the lack of accommodation. This applies especially to the poorer class, many of whom are in houses not overcrowded for people in full health, but entirely unsuitable for conditions of disease. It has not always been a question of inability to pay for more accommodation, but rather the difficulty in finding a place where a large family is not considered a drawback. This lack of houses applies in a special sense to those who have been away in a sanatorium, and have to return to unsuitable conditions. In consequence of apprehended difficulty in continuing the tenancy of the dispensary in Brunswick Square, the Committee considered the Utility of a house in the immediate neighbourhood Which belonged to the Council. In justice to myself I have to remark that the Selection and recommendation neither emanated from nor were approved of by me; moreover, its consideration was mainly responsible for the adjournment of the question of the provision for dental treatment. The number of cases attending the dispensary in 1920 was (a), insured 1,116; (b) uninsured 2,442; (c) contacts examined 1,206. There were 52 deaths reported from phthisis, of whose existence we only became aware of through seeing the entry in the death returns, and 46 from other forms of tuberculosis. MATERNITY AND CHILD WELFARE. The grants in the following instances have been increased, that of St. Luke's from £150 to £350, of the United Girls' School Settlement from £150 to £350, of the Nunhead Centre from £150 to £200, of the Cambridge House from £125 to £150, and that of the Bird-in-Bush Centre from £100 to £150. The grant to the Peckham Day Nursery was not renewed, but one of £30 for the Cheltenham College Day Nursery was sanctioned. There is no change to report in the way of provision of lying-in homes beyond the three mentioned below, which are designed for the reception of unmarried mothers—The Moorings, Champion Park; Home of Hope, Grove Lane; 24, De Crespigny Park, and also the Home of Help, Camberwell Grove, for the mother and her infant. Although no other provision has as yet been made, several homes were surveyed, but for one reason or another were not considered suitable. From the figures given above it will be seen that there is a very great increase from 1919 to 1920 in the work carried out, and I see no reason to change a favourable opinion as to the advisabilty of continuing to subsidize the existing agencies rather than to establish purely municipal centres, but the proviso that the Borough Council should always have a reasonable share in their control must always be strictly maintained. No progress has been made in the way of home helps, although there is much to be said for their inclusion in any scheme of Mothers' Welfare. Thee difficulty, however, of finding someone who could undertake the duties without trouble, friction or jealousy seems to be very great, and has, I understand, led to abandonment of the idea of appointing them in many districts. To the Voluntary Centres alone can one look for help in this direction, for with their more personal acquaintance with possible future helps they might well try the experiment at no distant date. In all there were 20 notifications of puerperal fever, and in three of these there appeared to be a common source of infection. These were not in the practice of a midwife, but originated in one of the institutions. The procedure of past years of dealing with all those who had come in contact with the patient has been followed out. Of ophthalmia neonatorum there were 44 official notifications, and of these 11 were removed to hospital, In addition, we received a considerable number of names of those who Were alleged to be suffering from a discharge from the eyes, two of these being after- Wards officially reported. None of those who were notified as suffering from this disease hate suffered any permanent injury to the eyes. Each of them were visited by the women inspectors for the district, and steps taken to ensure the proper treatment of the eyes. The nursing arrangements are not carried out by the Borough Council direct, but by the various nursing associations, of else by nurses who are connected with one or other of the philanthropic agencies in the Borough. And by arrangement with Bermondsey it is possible to secure attendance in a small district which is not covered by the above agencies. The amount expended for the year was £122 l3s. 8d., but prejudice against a nurse's help I fear still lasts, and usually exists in homes where they are most needed This will in time, when the people at large have come to recognise their value, no doubt disappear. The Borough Council have not appointed any health visitors, but at the beginning of April, 1918, the Council began to subsidize four of the principal schools for mothers Working in the Borough, viz., St. Luke's School for Mothers, 2, Commercial Road, Peckham ; The Camberwell (Cambridge House) School for Mothers. 6, Addington Square; The United Girls' School Settlement School for Mothers, 19, Peckham Road ; The Nunhead Mothers' Welcome, 31, Nunhead Grove ; and in May, 1919, the Council began to subsidise the Bird-in-Bush School for Mothers, 601, Old Kent Road, S.E. All these do health visiting, and I give below a summary of their work for 1920, and for purposes of comparison that of 1919. 1920. 1919. First attendances at doctor's clinic—mothers 1,419 780 Do. do. expectant mothers 304 232 Do. do. babies 2,726 1,485 Total attendances at doctor's clinic—mothers 2,765 3,488 Do. do. expectant mothers 409 475 Do. do. babies 19,916 12,285 First home visits to expectant mothers 922 578 Do. mothers 1,349 482 Do. babies 4,822 1,501 Total home visits to expectant mothers 1,836 1,335 Do. mothers 2,248 2,160 Do. babies 1,629 10,567 First attendance at sewing class 143 213 Total Do. do. 2,274 2,189 First attendance at maternity lectures 571 557 Total Do. do. 4,643 3,479 Other centres are conducted by the Mothers' and Babies' Welcome, Kempshead Hall, Kempshead Road, S.E., and the East Dulwich Branch of the National Women's Association School for Mothers, 114, Lordship Lane, East Dulwich, S.E. STAFF. The question of the appointment of an Assistant Medical Officer of Health, which had been left over from the previous Council, came again under review at the beginning of 1920, and resulted in the appointment of Dr. H. W. Barnes, who took up office in March, 1920. Although his duties were especially in connection with the maternity and child welfare schemes, in which he had considerable experience in Yeovil, he was able to render valuable help in the general work of the department. At the same time a third woman inspector was appointed in the person of Miss Margaret Mackenzie. This appointment has enabled the heavy work of the inspection of that part of the Borough to the North side of the Peckham Road to be divided into two districts, and to set Miss Butcher free for the South side. The vacancy caused by the appointment of Mr. Dewey as Food and Drugs Inspector was tilled by the appointment of Mr. Worsfold, who had been in the department since 1898. Mr. Chadderton, the chief clerk, was taken ill in April, and it was found necessary to relieve him of much of his work by detailing Mr. Wright to take on the duty, and so obviating the chaos that otherwise must have inevitably occurred. Mr. W. E. Wooldridge, who had been a temporary clerk for the past nine years, was permanently appointed to the staff. The permanent staff now numbers one Assistant Medical Officer of Health, ten Inspectors one Food and Drugs Inspector, three female Inspectors and six clerks. There is also the disinfecting staff, consisting of a chief and others. With this number it is obvious that the present accommo- dation is insufficient, and it has been necessary to distribute some of them about the Town Hall. The unsuitability of the present rooms in point of overcrowding is only equalled by the deficiencies in the matter of light, heat and ventilation. HOUSING. At a meeting of the Housing Committee a complaint from an outside body was made as to the bad condition of certain houses in Delaford Road. Councillors Ashby and Swales were appointed to go over the property, and the Housing Committee further ordered that notices should be served under Sec. 28 of the 1919 Act. The two Councillors duly reported to the effect that the property was in a bad condition and should be demolished as not tit for habitation, that the repairs were unsatisfactory, and that the attention of the Loudon County Council should be called to the matter. The London County Council and their Surveyor were duly communicated with, and the latter reported that if the property were properly maintained, the houses were no worse than many others. It must be remarked that on account of their not being of the best types in building construction, to maintain them properly would cost more than they are worth. No progress has been made with the improvement of Hampton's Avenue. This property is situated on berth sides of a road. That on the North side is not only badly designed, but the structure is so defective that most of it has had to be strengthened ; but on the South side, which overlooks the gardens of the small houses in Brisbane and Chiswell Streets, although much is dilapidated, there is a fair amount of solid material which I believe could be turned into a number of habitable tenements. Perhaps it is due to the fascination exerted on the Council by those who have taken up the idea of a new area in this locality that this authority has been lured away from treatment, which is perhaps not so showy or ambitous, but a good deal more practical. At the present time the best that can be said for these houses is that they supply a roof but not necessarily walls to those who but for this shelter might be in a sorry condition. Carpenter's Place, another part, which especially calls for attention, has been surveyed, and notices served to put into repair have been sent under Section 28 of the Housing Act, which were not complied with within the required time. A joint survey by the Borough Engineer and myself was carried out and a price was given as to the expenditure which must be incurred by the Borough Council should they wish to exercise their powers under the Act. This sum, however, seemed a greater expense than the Housing Committee could recommend and the conditions remain as they were. The four houses are all of the same age and type, but the different conditions in which they are affords a striking object lesson on the influence of good or bad tenants. They, however, form but a part of an area, including Blue Anchor Lane, &c., which must be taken in hand at an early date. II. Various reports were made by the sanitary inspectors with regard to overcrowding, and in view of the shortage of houses, we were driven to rely on re-arrangements of families. When this was insufficient the difficulty was sometimes got over by the Guardians taking over the care of the children. Overcrowding complaints have not been so numerous as in the past, probably owing to the fact that while the present difficulties in the way of house-room exist it is useless to expect any action to be taken. Those that have been received in great measure have come from other tenants and occupers of the house who were anxious to increase their own accommodation. It has often arisen by the admission of tenants stating that they have a family of a certain number, which when they have entered on a tenancy suddenly increases. No action in the way of ejecting a tenant has been taken, but where it has been possible to arrange for extra accommodation by re-arranging the sleeping rooms this has been insisted on, and even right visits have been paid tor this purpose. The causes of overcrowding are in the main due to two causes, desire on the part of the inhabitants to live near their work and inability to pay for a requisite number of rooms. Fitness of Houses. III. As mentioned above, the general standard has been much improved owing to the greater care with which repairs can be carried out and the disappearance of hindrances to the supply of material. The ordinary defects were, apart from defective roofs, floors and windows out of repair, chiefly those of dilapidated walls and ceilings. In other words, decorative repairs which usually appeal to the uninitiated so much more strongly than the more serious ones of damp and of defect in drains. These were aggravated by the fact that they exist either in old or worn-out houses, and also in many such as exist in the newer-built part of the Borough, ranging from 50 to 40 years old. It is difficult to say how far they are due to lack of proper supervision. This often exists in the case of absentee landlords, also in those when provision in the way of house property has foolishly been bequeathed to dependents who have no other source of income, and who are unable to meet the extra financial strain. There is the class of landlord who is bent on making as much as he can out of his houses. But the tenants can by no means be held blameless, for one finds that houses that have been put into condition have soon become as bad as ever. By an irony of fate the bad landlord seems to get the good tenant and vice versa. In consequence of a notice, an owner had stripped a room and refused to do anything further. The stripping itself was not good, but it was pointed out that the absence of paper, however unsightly and uncomfortable it might be, did not render rooms unhealthy. A small sub-committee was, however, appointed, and after long discussion decided to call on the owner under Sec, 28 of the Housing Act. 1919. A return was sent to the Ministry of Health replacing my estimate of the population of 263,047 by 278,780, this latter figure, on a basis of five to a house, after making certain deductions, gives 2,183 as the number of houses to be built if the housing needs of the Borough are to be met. Early in the year a number of sites were considered as being suitable for the erection of houses. These included land in the Newlands, Forest Hill, Casino House grounds and other sites in the Dulwich area. Negotiations were at once started for the building of houses on the first two of these sites, and at the end of the year some 30 were ready for occupation, and by the end of 1921 this number will have largely increased. With this an increase of population will inevitably occur in Peckham, Dulwich and East Dulwich, but the rest of the Borough will probably decrease as the result of factories taking the place of dwelling-houses and the demolition of certain overcrowded areas. APPENDICES. Housing Conditions. STATISTICS, YEAR ENDED 31ST DECEMBER, 1921. 1. GENERAL. (1) Estimated population (Registrar-General's Estimate) 284,712 (2) General death rate 11.7 (3) Death rate from tuberculosis 1.24 (4) Infantile mortality 71 (5) Number of dwelling-houses of all classes 61,697 (6) Number of working-class dwelling-houses - (7) Number of new working-class houses erected 30 2. UNFIT DWELLING-HOUSES. I. Inspection. (1) Total number of dwelling-houses inspected for housing defects under Public Health or Housing Acts 7,263 (2) Number of houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 None (3) Number of dwelling houses found to be in a state so dangerous to health as to be unlit for human habitation 44 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably tit for human habitation 4,959 II. Remedy of defects without service of formal notice. Number of defective dwelling-houses rendered fit in consequence of informal action by the local authority of their officers None III. Action under statutory powers. (a) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919 :— *(1) Number of dwelling-houses in respect of which notices were served requiring repairs 25 (2) Number of dwelling-houses which were rendered fit:— (a) By owners 19 (b) By local authority in default of owners 1 (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close None *A number of small requirements which really came within the scope of Section 28 were included in the Public Health notices. (b) Proceedings under the Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5,003 (2) Number of dwelling-houses in which defects were remedied:- (a) By owners - (Except in a few cases, all the notices mentioned in (1) had been complied with in their entirety by the owners.) (b) By local authority in default of owners 1 (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc , Act, 1909 :- (1) Number of representations made with a view to the making of closing orders None (2) Number of dwelling-houses in respect of which closing orders were ma de None (3) Number of dwelling-houses in respect of which closing orders were determined, the dwelling-houses having been rendered fit (4) Number of dwelling-houses in respect of which demolition orders were made None (5) Number of dwelling-houses demolished in pursuance of demolition orders None 3. UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I., or (b) Part II., of the Act of 1890:- Nil. In conclusion, I have to thank the Council for their many concessions to me in the way of leave; Dr. Barnes for valued help always cheerfully given ; Mr. Wright who has acted as chief clerk during the absence of Mr. Chadderton ; the Inspectors and Clerks, who have ever been ready and willing to give me any help that they could. I am, Mr. Mayor, Ladies and Gentlemen, your obedient servant, FRANCIS STEVENS. FACTORY AND WORKSHOP ACT. In accordance with the Factory and Workshops Act, I have to submit a report on its administration in Camberwell. So far as the number of inspections and the defects found is concerned, there is no very startling change, except that the number of the former have gone up with a co-existing decrease of the second. The work, however, has been more important, for with the return of normal times, many irregularities of which no notice was taken during the war are receiving attention. As already mentioned under the heading of closet accommodation, the officers have had to visit premises where defects were alleged to exist by the Factory Inspector. In cases where, in the opinion of the Inspector, confirmed by my own views, it was not possible to enforce any alterations, the Committee decided on no action being taken. The number of lists sent of outworkers has diminished, but there is little change in the number of workmen, except a slight diminution. Owing probably to the appointment of an additional female Inspector, the inspections have been greater, with the result that in 36 cases outwork was found being carried on in unwholesome premises, compared with 2 in 1919. In each case the appropriate notices were served. The number of workshops registered is 2,005, some 200 more than were in use in 1919, the increase existing mainly in those for clothing and for the preparation of food. Underground bakehouses are fewer, some 12 of these being now used for other purposes. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Number of Premises. Inspections. Written Notices. Prosecutions. - Factories (including Factory Laundries) 532 1,842 48 Workshops (including Workshop Laundries) 54 - Workplaces (other than Outworkers' Premises, included in Part 3 of this Report) 1,807 - - 4,181 102 - Total (Continued on page 31.) 1-28 1—29 RETURN OF WORK PERFORMED IN THE SANITARY DEPARTMENT DURING THE 52 WEEKS ENDING Ist JANUARY, 1921. Inspectors. Totals. Morley. Farmer. Dewey. MaMns. Jones. Nash. Wo rsfold Miss O'Riordan Miss Butcher Miss McKenzie Description of Work. Eagle. Scudamore. Collins. Green. Groom. Visits to complaints 211 479 10 75 394 103 209 246 4 - - 2,755 24 325 309 366 172 380 139 297 198 21 198 7 - - - 2,248 House inspections following on complaints 369 86 317 64 255 128 96 360 144 324 143 360 - - - 2,260 House-to-house inspections 88 78 150 134 11 - 46 19 38 120 19 1 - 344 Tenement inspections 78 - - 12 5 - - - - - - - 1 81 - - 87 Houses let in lodgings inspections - - 6 - 7 - - - - 1 - - - 23 1 2 1 - Housing and town planning inspections - 5 4 ─ 867 - 516 41 10 10 50 ─ ─ 36 ─ Visits to new buildings 71 52 43 34 2 3 7 6 4 4 ─ ─ 67 1 2 ─ No of inspections re overcrowding 21 4 9 4 1 ─ ─ ─ ─ ─ ─ 2 ─ ─ 41 Do. do. of slaughterhouses ─ 3 12 23 23 ─ ─ 48 42 20 18 40 30 15 ─ ─ 355 Do. do. bakehouses 22 18 16 63 ─ ─ ─ ─ ─ ─ ─ 16 ─ 5 ─ ─ Do. do. cowhouses ─ 9 2 143 24 72 99 53 ─ 779 ─ 41 53 99 ─ ─ Do. do. milk shops and dairies 52 27 65 51 23 11 20 14 13 ─ 6 ─ ─ 122 Do. do. eating houses ─ 5 16 9 5 18 46 5 35 13 29 20 ─ ─ ─ 272 Do. do. iee cream shops ─ 11 39 22 34 ─ ─ ─ 199 137 ─ ─ ─ ─ ─ ─ ─ Do. do. railway stations 12 ─ 50 39 96 48 60 101 101 105 ─ 9 39 17 70 802 Do. do. workshops 24 46 47 36 52 50 ─ 6 34 13 104 49 109 519 Do. do. factories ─ 5 23 ─ 5 38 11 54 7 31 16 ─ ─ 252 ─ 29 50 ─ Do. do. urinals, public 21 23 61 4 1 39 96 101 2 ─ ─ 1,607 328 433 17 108 Do. do. private 118 131 89 84 23 24 16 15 43 6 26 14 ─ ─ ─ 224 Do. do. schools, public 8 14 13 22 5 ─ 25 1 ─ ─ 2 39 9 171 34 ─ Do. do. do. private 20 3 2 31 4,510 3,608 1,027 3,398 4,245 2,788 2,429 2,507 52 ─ 12 35,913 Re-inspections 2,784 3,335 2,126 3,092 576 357 561 269 201 1,743 1,418 1,174 165 28 219 7,160 Miscellaneous 57 141 92 159 207 307 173 167 64 348 102 166 ─ ─ 1 2,274 Infectious cases visited and houses inspected 116 168 111 345 22 42 102 41 72 110 106 81 7 ─ 910 ─ Do. do. or inquiries 199 36 52 40 ─ ─ ─ ─ 2 397 450 322 4 ─ ─ 1,182 Tuberculosis cases visited and houses inspected 3 1 1 2 1 ─ ─ ─ ─ 4 ─ ─ 830 626 758 2,224 Do. do. or inquiries 2 ─ ─ 3 ─ ─ ─ ─ ─ ─ 27 2 18 Visits to verminous premies ─ ─ 48 1 ─ ─ 239 950 936 709 789 646 ─ 624 522 60 15 ─ 7,803 Intimations 474 673 531 635 384 573 301 235 242 2 3,197 219 159 47 ─ ─ Statutory notices 193 254 288 300 ─ ─ 169 8 ─ ─ ─ ─ ─ 194 Notices, houses let in lodgings ─ 15 ─ ─ 13 ─ 2 17 1 9 ─ ─ 7 11 4 Infectious disease contacts 45 13 156 ─ 1 22 13 6 5 2 8 ─ ─ ─ ─ ─ ─ 29 Seizures of unwholesome food 3 3 ─ ─ 2 1 627 ─ ─ ─ ─ ─ ─ ─ 645 542 1,815 Outworkers ─ ─ ─ ─ 2 ─ ─ ─ 1 7 7 1 18 Measles ─ ─ ─ ─ ─ ─ ─ ─ ─ 21 4 40 ─ ─ ─ ─ ─ ─ 65 Scabies ─ ─ ─ ─ 12 11 ─ 8 22 ─ 32 ─ ─ ─ 85 Housing and Town Planning Act, Section 28 Visits ─ ─ ─ ─ ─ ─ 8 ─ ─ ─ ─ 8 Do. Do. Do. Section 29 do. ─ ─ ─ ─ ─ ─ ─ ─ ─ ─ ─ ─ 3 16 6 ─ ─ ─ ─ 25 Opthalmia Neonatorum ─ ─ ─ ─ ─ 3 .—Home Work. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises Sections 109,110 Outworkers' Lists, Section 107. The figures relating to home work do not call for much special mention except for an increase in the number of contractors and a diminution in the number of workmen outworkers. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Prosecutions. Orders made. (Sec. 110.) Prosecutions. (Secs.109, 110.) NaturS of Work. Instances. Instances. Once in the year. Failing to send lists. Twice in the year. Failing to keep or permit inspection of lists. Notices served. Outworkers. Outworkers. Lists. Lists. Contractors Workmen. Workmen. Contractors Wearing Apparel— i I .. I I I I I II I .. I I I I I 148 61 (1) Making, &c. 53 1,036 28 373 125 36 36 7 — — — — — (2) Cleaning and washing — — — — — — — — — — — — — — — Household linen — — — — — — — — — — — - - - — — — — Lace, lace curtains and nets — — — — — — — — — — — — Curtains and furniture hangings 1 — — — — — — — — — — — — — — Furniture and upholstery — — — — — — — — — — — — — — — Electro-plate — — — — — — — — — — — — — — — File making — — — — — — — — — — — — — — — — — - Brass and brass articles — - — - — — — — — — — — - Fur pulling 7 — — — — — - — — — — — — — — Cables and chains — — — — — — — — — — — — — — Anchors and grapnels - — — — — — — — — — — — — — — Cart gear — — — — - — — — — — — — — — — Locks, latches and keys — — — — — — — — — — — — — — — Umbrellas, &c. — — — — — — — — — — — — — — — Artificial flowers 8 — — — — - — — — — — — — — — Nets, other than wire nets — — 1 — — — — — — — — — — — — — Tents — — — — - — — — — — — — — Sacks — — — — — — - — — — — — — — — Racket and rubber balls 4 — — — — — — — — — — — — — — Paper, &c., boxes, paper bags 10 20 — 2 — — — — — — — — — — — 20 Brush making 2 — — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — Feather sorting 2 — — — — — — — — — — — — — — Carding, &c.; of buttons, &c. -2 — - — — — — — — — — — — — — 4 Stuffed toys - 1 — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — Chocolates and sweetmeats — — — — — — — — — — — — — — — Cosaques, Christmas crackers, Christmas stockings, &c. — — - - — — — — — — — — — — — Textile weaving — — — — — — — — — - — — — — — Total 150 53 1,091 64 397 — — — — 28 125 36 36 7 — 2.—DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H. M. Inspector. - Nuisances under the Public Health Acts:—* 35 Want of Cleanliness 3 35 Want of Ventilation 1 1 - - - 2 Overcrowding 2 - - - - Want of Drainage of Floors - - Other Nuisances - - - - Sanitary Accommodation— Insufficient 2 2 - - 62 - Unsuitable or Defective 62 - Not separate for Sexes - - - - Offences under the Factory and Workshop Acts:— Illegal Occupation of Underground Bakehouses (s. 101) - - - - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) - - - - Other Offences (excluding Offences relating to Outwork which are included in Part 3 of this Report) - - - - Total 102 - 102 - * Including those specified in Sections 2, 3, 7, and 8 of the Factory and Work. shop Act, 1901, as remediable under the Public Health Acts. 4, —REGISTERED WORKSHOPS. Workshops and Workplaces on the Register (s. 131) at the end of the year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Laundries 88 Clothing (wholesale and private) 415 Preparation of food 341 Building trades 68 Bakehouses 162 Miscellaneous 931 Total number of workshops on Register 2,005 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 27 2 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s, 5, 1901) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector 2 - Other 54 Underground Bakehouses (s. 101):— _ In use at the end of the year FRANCIS STEVENS, Medical Officer of Health.