CAM 22 London metropolitan Bororgb at Camberwell REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE; YEAR 1922 HOWELL W. BARNES, B A., M.8., B.ch., D.P.H. Printed by HENDERSON & SPALDING Ltd. Sylvan Grove, Old Kent Road, S.E. 15 Report of tbe Medical Officer of health. Public Health Department, 35, Brunswick Square, S.E. 5. June 1st, 1923. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Ladies and Gentlemen,—l have the honour to submit the annual report on the statistics and the activities of the Public Health Department for the year 1922. The report follows the lines laid down by the Ministry of Health, and the statistical tables prescribed by them are included. Whilst it is pleasing to report that the work of the Public Health services is well maintained, yet it is beyond dispute that the education of the public with regard to health matters leaves much to be desired, and instruction on such subjects as the causation and prevention of blindness, the early signs of cancer, the role of the teeth in health and disease, and the necessity for vaccination and re-vaccination, etc., is required. It. would seem that the only way that this could be done is by the aid of lectures and the distribution of leaflets on these and other public health matters, and if the Council could look for an Exchequer grant for this purpose, I would strongly urge a campaign on these lines. At the end of March, Dr. Francis Stevens, Medical Officer of Health, retired owing to ill-health, after twenty-nine years' service, and the Council appointed him as Consulting Medical Officer of Health of the Borough, in recognition of his past services. I should also like to take this opportunity to place on record my appreciation of his invaluable assistance and advice during my association with him. In conclusion, I have to express my indebtedness for the support and consideration extended to me by the Chairman and members of the Public Health, the Maternity and Child Welfare and Housing Committees, and to make public my appreciation of the work of the staff of the Public Health Department, who have at all times afforded me their ready assistance. I am, your obedient Servant, HOWELL W. BARNES, Medical Officer of Health. Staff of the Public Health Department at the end of 1922. *Hon. Consulting Medical Officer of Health. Francis J. Stevens, D.M. *Medical Officer of Health and Medical Officer, Maternity and Child Welfare. *Tuberculosis Medical Officer H. W. Barnes, 8.A., M.8., B.Ch., D.P.H. W. Brand, 8.A., M.8., C.M. *Assistant Tuberculosis Medical Officer Eleanor A. Gorrie, M.B. *Medical Staff at Municipal Infant Welfare Centres. The Medical Officer of Health and (Mrs.) Margaret Dunstan, M.8., B.Ch., D.P.H. Public Analysts Frank L. Teed, D.Sc., F.C.S., F.I.C., E. A. Pinchin, B.Sc., F.1.C., F.R.M.S., certified bacteriologist. *Inspector under the Food and Drugs Acts. George T. Dewey. * Sanitary Inspectors—Male. Dist. Dist. 1. Maurice Malins. 7. William R. Farmer. 2. William T. Worsfold. 8. William Eagle. 3. Richard F. Nash. 9. George G. Morley. 4. George W. Scudamore 10. William E. Groom. 11. Edwin R. Collins. 5. Henry C. Green. 6. Donald Glenday * Women Sanitary Inspectors. Miss F. O'Riordan. Miss M. Butcher. * Health Visitors. Miss A. M. Stoddart, Miss A. Duffield and Miss K. Jerrard. Clerks. H. K. Wright. H. N. Jones. D. J. Fenner. F. T. Harman. H. J. Hurst W. E. Wooldridge. F. H. Wetherall. F. Houghton. A. J. Hardiman. A. J. Baker (temporary). *C. T. Wilson (temporary). *Miss M. L. Thompson (temporary), part-time Milk Inquiries and part time at Infant Welfare Centres. Tuberculosis Dispensary. *Tuberculosis Nurses. Miss H. Chambers and Miss M. Thistleton. *Clerks. Miss J. M. Fry and H. W. Leonard. *Dispenser. Miss P. La Croix (part time). Disinfecting and Cleansing Station. Superintendent. William Sawyer. Assistant Superintendent. A. Franklin. Assistants. J. Knappett, E. Corby, A. Peppier (motor driver), Hickey, J. Smith, J. Conner. Women Assistants. For Cleansing of Children, etc. Mrs. A. Cork (temporary). Mrs. S. Herd (3 days per week) (temporary). Mortuary Keeper. A. E. A. Dennison. •Officers to whose salary contribution is made under the Public Health Acts, or by Exchequer grants. *Dr. Stevens was Medical Officer of Health until March 31st, 1922, at which date he retired owing to ill-health. 1. General Statistics. Area (acres) 4,480 Population (Census, 1921) 267,198 Do. (Estimated, 1922) 270,300 Number of inhabited houses (Census, 1921) 41,419 Do. do. do. (approximately, 1922) 41,700 Number of families or separate occupiers, 1921 66,104 Rateable value £1,395,946 Sum represented by a penny rate, about £5,680 Natural and Social Conditions of the District. Population.—The 1921 Census enumeration of the population of this Borough, according to the adjusted figures of the RegistrarGeneral, numbered 267,198 persons, 125,548 males and 141,650 females. The estimated population to the middle of the year 1922 was given by the Registrar-General as 270,300 and the calculations in this report are based on this figure. The area of the Borough is 4,480 acres, which gives a density of population of 60. This figure is apt to give a wrong impression, as a large part of the area of the Borough lying to the south of the road from Camberwell Green to Queen's Road Station consists of fields not yet built upon. The density figure per room, as shown on the last Census return, is more valuable, and varies from 0.69 in Addington Ward to 173 in the College Ward, the average for the whole Borough being 0.96. The estimated population of the different wards is as follows:— Population of Wards. Ward. Census 1921. Estimated 1922. 1 15,442 15,621 2 14,420 14,587 3 14,201 14,366 4 16,562 16,754 5 16,096 16,286 6 13,243 13,396 7 16,230 16,418 8 15,548 15,728 9 16,238 16,426 10 8,975 9,079 11 11,438 11,571 12 14,025 14,188 13 10,662 10,786 14 10,712 10,836 15 12,126 12,267 16 14,566 14,735 17 14,642 14,812 18 16,029 16,215 19 12,137 12,278 20 3,906 3,951 267,198 270,300 Extracts from, Vital Statistics of the Year. Total. M. F. Births Legitimate 5,626 2,875 2,751 Illegitimate 176 90 86 Birth Rate, 21.4 Deaths 3,635 Death Rate, 13.4 Number of women dying in, or in consequence of, childbirth :— From sepsis 7 From other causes 8 Deaths of infants under one year of age per 1,000 births 78 Legitimate, 427; Illegitimate, 27. Total 454 Deaths from Measles, all ages 84 Deaths from Whooping Cough, all ages 80 Deaths from Diarrhoea, under 2 years of age 37 Births.—During the year 5,421 were registered in the Borough. The corrected number of births was 5,802. This figure is obtained by adding 646 births which occurred outside the Borough, transferred by the Registrar-General as belonging to Camberwell, and deducting 265 births which occurred in the Borough and transferred to other districts by the Registrar-General. The annual birth rate was 21-4 per thousand of the population, as compared with a birth rate of 21-0 for London, and 20-6 for England and Wales. Notification of Births Act, 1907.—Under this Act the notification of a birth, within 36 hours of birth, is a statutory duty of the father of the child and of any person in attendance on the mother. During the year 5,256 births were notified, or 90 per cent, of the total number that were registered. Of the notifications 3,197 were received from midwives, 1,188 from medical practitioners, 58 from the Camberwell Infirmary and 813 from other persons. A letter was sent to parents, midwives or medical practitioners in each case where no notification had been received of a birth subsequent I 3' registered in the Borough. Still-Births.—Of the 5,256 births notified 135 were returned as born dead. Illegitimate Births.—The net illegitimate births for the year amounted to 176, equal to a rate of 30.3 per 1,000 registered births. Deaths.—The number of deaths registered during the year as having taken place in the Borough was 4,023. Adding 557 deaths of residents of this Borough transferred by the Registrar-General as having occurred in various parts of England, and deducting 945 deaths of non-residents which occurred in the Borough, the corrected number of deaths of residents registered was 3,635. The following comparative death rates are of interest:— Death Rates, 1922. England and Wales 12.9 London 13.4 Camberwell 13.4 Deaths Registered in the Sub-Districts of Camberwell. Year. Borough. Dulwich. East Dulwich. North- West Camberwell. Peckham. North Camberwell. Unattached 1921 1922 160 183 819 989 801 893 3,425 3,635 493 515 940 1,028 32 27 Deaths Re-distributed in the Sub-Districts. Borough. Dulwich. Peckham. North Camberwell. Year. East Dulwich. North-West Camberwell. 3,245 3,635 949 1,036 162 184 827 996 809 900 1921 1922 498 519 In comparing the deaths shown in Table 1 with those in 1921, it is found that there has been a marked increase of deaths from measles (84 as compared with 3), whooping cough (80 as compared with 29), influenza (158 as compared with 51). The deaths from disease of the respiratory organs, other than phthisis, show an increase, these being 802, as compared with 617. Cancer was responsible for 326 deaths, as compared with 343. TABLE No. 1—CAUSES OF, AND AGES AT, DEATHS DURING YEAR 1922. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 45 to 65. 65 and up. Total Deaths whether residents or non-residents in Institutions in the Borough. All ages. Under 1. 35 to 45. 1 to 2. Causes of Deaths. 4 - - - - 1 2 1 - - 1 Enteric Fever - - - - - - - - - - - - - Small-pox 11 - - - 20 5 5 - 1 - - - - 29 Measles 84 6 36 Scarlet Fever 22 2 - 2 8 4 2 2 1 1 - - - - 29 33 10 5 2 1 - — - - - - 43 Whooping Cough 80 3 14 10 1 15 10 2 - - - Diphtheria and Croup 63 8 - - Influenza 158 8 2 6 1 2 2 6 20 18 41 41 67 11 Erysipelas 4 5 - - — - - - - - - 2 3 - - 1 1 4 5 58 21 98 76 17 Phthisis (Pulmonary Tuberculosis) 282 - 1 94 28 7 - 2 3 5 2 1 2 - - 10 Tuberculous Meningitis 6 - 11 Other Tuberculous Diseases 4 1 - - 2 3 2 2 5 7 2 31 3 326 - 1 2 10 8 12 150 142 124 Cancer - 1 - - Rheumatic Fever - - - - 1 1 1 - 1 1 3 4 8 - Meningitis 2 - 4 2 3 1 2 - 1 8 20 4 1 - - - 1 6 8 15 18 22 112 181 94 Organic Heart Disease 367 4 - Bronchitis 38 1 - 2 - 1 6 8 90 266 109 417 5 - 434 28 14 6 9 5 6 10 20 70 89 139 Pneumonia, all forms 107 70 - 1 1 1 2 3 11 7 Other Diseases of Respiratory Organs - 3 26 - - - 31 - - - - - - - 1 2 17 Diarrhoea and Enteritis 41 - 6 - 1 - 1 2 1 - 2 6 1 5 Appendicitis, Typhlitis 14 - - 7 Cirrhosis of Liver - - - - - - - 1 12 5 18 - - Alcoholism - - - - - - - - - 2 - 2 - - 1 2 3 7 4 10 29 36 38 Nephritis, Bright's Disease 93 - - 1 - 6 Puerperal Fever 7 - - - 3 4 - - - - - - - Other Accidents and Diseases of Pregnancy and Parturition ... 8 - - - - - - 3 5 - - 4 - - Congenital Debility and Malformation, including Premature Birth 123 - - - - - - - - - 21 124 - 1 17 Violent Deaths 57 7 - 1 5 7 2 6 10 18 - - 1 - - - - - 1 1 4 8 5 4 Suicides 19 - - 312 5 1 7 2 10 11 10 72 178 512 Other defined Diseases 883 71 4 3 Diseases ill-defined or unknown - - - - - - 1 7 4 14 2 - - 1,174 83 48 44 68 68 126 115 296 813 1,335 Total 454 185 3,635 TABLE No. 2.—INFANTILE MORTALITY DURING THE YEAR 1922. Net Deaths from Stated Causes at Various Ages under One Year of Age. I Under 1 week. 1 to 2 weeks. 2to 3 weeks. 3 to 4 weeks. Total under 1 month. 1 to 3 months. 3 to 6 months. 9 to 12 months. 6 to 9 months. Cause of Death. Small-pox - - - - - - - - - Chicken-pox - - - - - - - - - Measles 2 - - - - 1 8 - - Scarlet Fever - - - - - - - - - Whooping Cough 9 - - 1 - 1 3 10 10 Diphtheria and Croup - 1 - - 1 - 1 - 1 Diphtheria and Croup - - - - - - - - - Tuberculous Meningitis 5 - - - - - 1 1 - Other Tuberculous Diseases - - - - - - 1 3 - Meningitis (not Tuberculous) - - - - 1 1 2 - - Convulsions - - 1 - - 1 3 3 - Laryngitis - - - - - - - - - Bronchitis 1 3 2 2 8 13 10 3 4 Pneumonia (all forms) 1 3 6 5 15 20 21 26 25 Diarrhoea - - - - - 2 5 - Enteritis - 5 - 2 1 - 3 7 8 1 Gastritis - - - - - - 3 - - Syphilis - - 1 1 1 1 4 - 2 Rickets - - - - - - - - 1 Suffocation (overlying) 1 - - 1 2 2 1 - - Injury at Birth 1 - - 1 - - - - - Atelectasis - - - - - - - - - Congenital Malformation 2 7 - - 7 7 5 - - Premature Birth 57 7 5 4 73 10 3 - 1 Atrophy, Debility and Marasmus 22 1 2 1 26 13 9 3 1 Other Causes 5 3 1 1 10 5 5 5 8 57 96 22 19 15 90 86 69 152 INFANTILE MORTALITY. An examination of the deaths from all causes under one year shows that the deaths under the headings of pneumonia and premature birth are too high, and should be capable of being reduced. It must be conceded that the conditions operating in the poorer parts of the Borough tend towards the deaths from pneumonia remaining at the present level, but much can be done, in addition to improving the economic conditions of the family, by the counsel of the health visitor in counteracting the ignorance of the mother in feeding and clothing her infant, and generally improving the resistive power of the child to attack, and by the assistance of a trained nurse in the early stages of the disease. It is, however, a much more difficult matter to grapple with the causes which lead up to premature births, a question which is engaging the serious attention of those who seek the prevention of infant deaths. A more systematic supervision of the mother during pregnancy is necessary, and I am not without hope of seeing a reflection of the work of ante-natal supervision resulting in a gradual decline in the number of deaths from this cause in the future. On the other hand, it is gratifying to report that the total deaths for the year from diarrhœa and enteritis numbered 31 only, as against 85 for the previous year. That the work of the health visitors is an important factor in the low mortality from this cause cannot be questioned. The advice given to the mother at the Centre, together with lectures on matters of feeding, personal and domestic hygiene, supported by visits to the home to obtain information with regard to the health of the infants, results in preventing this disease in a large number of cases. For, after all, the question of diarrhcea prevention becomes largely a matter of education in precautions, and for this purpose a leaflet is issued to every mother attending the Municipal Centres, and a copy is also left at each house in the area of the Centres where a birth takes place. It is interesting to note that during the summer period there was only one death in the Hollington Street area (No. 1 Ward). For the period July to October inclusive only 5 deaths were recorded in the whole Borough. NOTIFIABLE DISEASES. Small-pox. There were no cases of small-pox notified during the year, although there was an outbreak in London. A large number of known contacts were kept under observation, but fortunately none of these developed the disease. Owing to the fear of any case being missed in which there was a doubt as to the diagnosis, the Council decided to make chickenpox notifiable temporarily. The Medical Officer of Health is always available for consultation for any doubtful case, and Dr. Wanklyn, Consultant to the London County Council, whose services have been of considerable help in the diagnosis of this disease, can also be called upon if required. Diphtheria.—B2l cases were notified, as compared with 875 in 1921, of these 785 were admitted to the Isolation Hospitals, 4 of the cases were afterwards reported as not suffering from the disease. 63 deaths were registered. The following table sets out the corresponding figures for the years 1920 to 1922 : — Year. Cases Notified. Removed to Hospital. Deaths. 1920 937 839 62 1921 875 829 64 1922 821 785 63 Carrier Cases.—It is a recognised fact that a certain proportion of the community have the Klebs-Loeffler bacillus present in their nose or throat and never develop the clinical signs and symptoms which constitute the disease diphtheria These carrier cases, nevertheless, may, and in certain instances do, transmit this disease to their neighbours. They present a very difficult problem to the Health Department. It is essentially necessary to have them treated, and it is possible to isolate a certain number at home, but there are instances where it is necessary to remove them to hospital owing to the danger of other children becoming infected. The modern work in connection with diphtheria leads to hope that by treatment with toxin antitoxin mixtures it will be possible to render the whole population immune. Scarlet Fever. —1,083 cases were notified in 1922 as suffering from scarlet fever. Of these 4 cases were afterwards reported as not suffering from this disease. The number of deaths from scarlet fever for the year was 22. In the following table is set out the corresponding figures for 1919 to 1922 Year. Number of Deaths. Death rate per 1,000 population. Case Mortality I per cent. Percentage of cases removed to Hospital. Number of Notifications. 12 1.7 - 1919 700 0.04 0.9 81.1 1920 1,308 13 0.04 1.959 0.9 89.4 1921 19 0.07 1922 22 0.08 2.0 82.2 1,083 Scarlet fever shows a decrease in numbers notified as compared with last year. Fortunately the mortality has not been high, and it has been noticeable that the complications of this disease, which seriously affect the health in after years, are not so frequent as in the past. Owing to the mild character of the disease, cases were more likely to be missed, and consequently the amount of infection brought under control was only a small part of the total amount which existed at any moment. The result was that those susceptible ran more chances of becoming infected. Typhoid Fever (including Paratyphoid).—Eleven cases were notified in 1922, as compared with 19 in 1921. One case was afterwards reported as not having suffered from this disease. All the cases occurred in separate houses. Enquiries failed to elicit the source of infection in any case. The number of deaths among the cases notified was four. Puerperal Fever. During the year 1922 10 cases were notified, and the deaths numbered 7. Of the 10 cases notified 7 were treated in institutions and 3 nursed at home. Each case was the subject of an inquiry as to the source of infection, and the necessary disinfection carried out. Preventive measures for combatting this disease can only be effected by those who are brought into relation with cases of pregnancy fully realising their responsibility, not only at the time of labour and the lying-in period, but also the need of supervision during pregnancy to prevent any chance of bacterial invasion of the genital tract. Pneumonia. During the year there were 132 cases of acute primary pneumonia notified, and 165 of influenzal pneumonia. The number of deaths attributed to all forms of pneumonia were as follows:—Broncho-pneumonia, 277; pneumonia (type not stated), 50; acute influenzal, 67. and acute primary, 40. Nursing assistance was provided in all cases where the necessity arose. Cerebrospinal Meningitis.—Two cases of this disease were notified, as against 3 in the previous year. One case was removed to hospital. One death was registered. There was no connection between the cases and no source of infection was discovered. Year. Cases Notified. Fatal Cases. Case Mortality per cent. 1919 6 4 66 1920 6 2 33 1921 4 3 75 1922 2 1 50 Poliomyelitis.—During 1922 three cases were notified, two of these were admitted to the South-Eastern Hospital. No case was fatal, and no permanent deformities resulted. The necessity of following up cases of anterior poliomyelitis cannot be too strongly expressed. Neglect on the part of parents to provide the special care and treatment necessary gives rise to permanent deformities, which may so cripple the child that in after life it will be found that he cannot support, himself, and consequently becomes a dead-weight on the community as a whole. Malaria. —27 cases were notified during the past year, as compared with 40 in 1921. Dysentery.—B cases were notified. 4 of these occurred in a ward of a private institution. The infection was attributed to a previous case which was admitted from outside the Borough. Encephalitis Lethargica.—One case was reported and admitted to hospital. This case was still under treatment at the end of the year. No cases of Cholera, Plague, Typhus, Trench Fever, Anthrax. Relapsing Fever, Glanders, Rabies, or Continued Fever were reported in 1922. Ophthalmia Neonatorum. Cases treated. Deaths. Vision unimpaired. Vision impaired. Total Blindness. At Home. In Hospital. Notified. 21 - - - 21 15 6 Ophthalmia Neonatorum 21 cases were notified during the year, the incidence rate being 3-6 per 1,000 births. All the notifications received were from medical practitioners. It is gratifying to record complete recovery in every case. In addition to these, any infant brought to the Infant Welfare Centre found to be suffering with slight inflammation was subject to an enquiry from this department, and the facts brought to the notice of the London County Council. The need of early treatment of this disease cannot be too strongly emphasised, and this Council expressed agreement with the views of another Metropolitan Borough, which suggested that owing to the undue prevalence of ophthalmia neonatorum the Ministry of Health be requested to take steps to bring to the notice of medical practitioners the advisability of the routine application of a suitable silver nitrate preparation to the eyes of all newly-born children. Tuberculosis. 653 new cases of tuberculosis were notified during the year. The deaths of un-notified cases of tuberculosis numbered 83 and the total tuberculosis deaths 341. The ratio of un-notified tuberculosis deaths to the total tuberculosis deaths being 1 in 4. The question of the notification of this disease received considerable attention, and it was recognised that a considerable number of cases was not being notified before death, and that certain cases were notified at so short an interval before death that the Public Health Authority could not be of much assistance. The report of the Tuberculosis Medical Officer, Dr. William Brand, will be found on pages 17-28. NON-NOTIFIABLE DISEASES. Measles and German Measles. As these diseases are not notifiable in this Borough, we have to depend on the schools returns of absentees, health visitors and other agencies for information of cases. 84 deaths from measles were registered during the year There were no deaths from German measles. There is still much need of propaganda work to instil into the minds of mothers the serious complications that may arise in a case of measles. Every known case in the year under review has been visited by the women sanitary inspectors, who insisted on the strictest isolation as far as possible, and at the same time drew attention to the danger of lung complications, and advised that the private doctor be called in. BACTERIOLOGY. The bacteriological examinations required by the Borough of Camberwell were carried out by the Pathological Department of King's College Hospital, who have an agreement with this Council. The work carried out for 1922 was as follows : — 1st January, 1922, to 31st December, 1922. Swabs for examination for Diphtheria :— Positive 272 Negative 1,106 1,106 Examination of Sputum for T.B.:— Positive 229 Negative 1,828 Widal reaction:— Positive 2 Negative 1 15 Examination for Gonococci:— Positive 2 Negative 9 Examination of miscellaneous material, e.g., tinned meats... 19 Total 3,482 Antitoxin.—Diphtheria antitoxin is kept at the Town Hall, Dulwich Baths, and the Public Health Department, 35, Brunswick Square, for the use of medical practitioners attending cases in the Borough. All the medical men in the Borough were circularised that antitoxin, both in curative cases and for prophylactic purposes, were available at the above-named addresses. The quantity supplied during the year was 36,500 units. This amount is absurdly small taking into consideration the number of cases notified. 1—14 1-15 TABLE No. 3.— NOTIFIABLE DISEASES, 1922. Disease. Age Distribution Notifications and Deaths. Total Cases Notified. Admitted to Hospital. Under 1. 1 to 2. 2to 3. Total Deaths. 4 to 5. 5 to 10. 10 to 15. 20 to 35. 35 to 45. 45 to 65. 65 and up. 3 to 4. 15 to 20. Notifications. Deaths. Notifications. Notifications. Notifications. Deaths. Deaths. Deaths. Notifications. Deaths. Notifications. Notifications. Deaths. Notifications. Notidcations. Notifications. Notifications. Notifications. Deaths. Deaths. Deaths. Deaths. Deaths. Deaths. Small-pox - - - - - - - - - Cholera, Plague - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup 821 63 3 59 8 785 19 94 14 - - - - - - - - - - - - - - - - - - Scarlet Fever 63 10 73 1 267 15 10 1083 22 8 42 2 77 117 54 2 56 13 5 1 898 - - - - - - Enteric Fever 4 64 2 123 8 439 4 209 2 60 2 47 1 9 1 5 11 8 - - - - - - - - - Puerperal Fever 7 - 2 1 2 10 7 - - - - - - - 5 2 1 2 - - - - - - - - - Acute Influenzal 11 107 4 3 12 7 4 9 3 1 4 Pneumonia 297 64 - - - - - - - - - - - - - - Acute Primary 23 2 6 3 9 1 6 10 1 37 8 26 16 30 15 32 2 27 1 - - - 11 12 103 Erysipelas 36 5 6 1 2 15 5 8 2 3 5 3 1 - 2 3 7 16 1 9 - - - - - Cerebro-spinal Meningitis - 2 1 1 4 3 5 14 20 - 37 2 16 3 - - - - - - - - - - - Poliomyelitis - - - 1 3 1 - 1 2 - - - - - - - - - - - - - - - - - - - - - Malaria - - 27 - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 8 - - 1 16 6 - 4 - - - - - - - - - - - - - - - - - - - Chicken-pox 6 - 1 4 - - - 1 - - - - - - - - - - - - 3 1 - - - - - Encephalitis Lethargica 1 - - 2 1 1 1 - - - - - - - - - - - - - - - - - - - - Typhus Fever - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 6 - 21 - - 21 - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis :— - - - - - - - - - - - - - - - - - - M 234 258 F. 248 213 Pulmonary 506 1 - Total 447 282 1 1 - - 2 1 2 1 15 4 26 84 5 47 58 184 21 88 98 87 76 53 17 M. 28 j F. Non-Pulmonary 63 18 i 147 46 5 Total 59 6 11 9 4 1 3 2 2 3 28 7 24 5 25 3 30 4 6 5 11 7 3 2 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period January 2nd, 1922, to December 31st, 1922, in the Metropolitan Borough of Camberwell. Number of Notifications Age Periods. Notifications on Form A. Notification on Form B. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Form C. Number of Primary Notifications. Total Notifications on Form A. Total Primary Notifications. 5-10 10-15 Total Primary Notifications. 45 - 55 35-45 55-65 65 and upwards. Under 5. 0-1 1-5 15-20 20-25 25-35 5-10 10-15 206 8 Pulmonary— Males 16 255 2 1 3 1 63 4 10 15 31 45 3 59 353 6 70 - 7 240 - 45 1 6 8 Females 32 36 54 29 266 1 10 75 96 1 8 9 19 1 - 4 14 Non-Pulmonary— Males 6 81 - 8 17 13 3 14 1 112 3 3 4 6 22 - 1 - 1 2 2 62 3 2 67 2 3 15 Females 6 7 10 12 5 8 5 - Col. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1922. The Notification of Tuberculosis in 1922. Notification is the first essential in a Tuberculosis scheme. If notification is strictly carried out the officers of the local authority are enabled to deal with questions of infection and with conditions favouring infection. They are enabled to point out in each home where there is a case of tuberculosis what can be done to strengthen the resistance to infection. Further, the provision of sufficient and opportune means of treatment can be properly considered. We do not know fully why the tubercle bacillus produces disease in some and not in others, but we know that the disease it PRDUCES is COMMUNICABLE. We know how the bacilli escape from the diseased organs of man and animals. We know we can confine the organisms after their escape and then kill them. We know if this is not done that they may enter another human host and reproduce the disease. We know that a consumptive ignorant or careless of the way in which his cough should be controlled, and his sputum disposed of, is a menace, and we know that we can do much to make each intelligent and conscientious case of tuberculosis fairly harmless to his family and to others. For these reasons, and in order that no single case of the disease may remain in our community uncared for, we press for full observance of the Notification Act. It cannot be affirmed that the Public Health (Tuberculosis) Regulations, 1912, have failed to accomplish what was anticipated, because notification has not been fully carried out. We do not know the full extent of the failure to notify. We have reason to believe, from the information received from the certificates of death, that the defect is large. From a study of partial statistics—for we do not know the number of living cases of un-notified tuberculosis— the calculation is that every four years the number of un-notified cases of tuberculosis discovered in Camberwell exceeds the number of deaths from that disease in one year in the Borough. In 1922, 341 certificates in which the primary cause of death was tuberculosis were returned in Camberwell and 19 certificates in which tuberculosis was stated to be a contributory cause of death. 83 of these cases were not notified before death. 24 cases were notified for the first time within a week of death. 47 cases were notified for the first time within a month of death. Only 140 cases were notified more than 6 months before death. Of 83 cases not notified before death, in 55 cases the death certificates were returned by institutions and in 28 cases by local practitioners. We have pointed out the opportunities opened up by notification It must be added that the act of notification is only a means to an end. Unless notification is followed up by suitable measures its value is a negative one. The notifications of tuberculosis in Camberwell in 1922 are set out in table form. They emphasise the well-known fact that pulmonary tuberculosis as seen in the adolescent and adult is comparatively uncommon in the child, and that other forms of tuberculosis are more common in children than in adults. The Work of the Tuberculosis Dispensary. The aim is to co-operate with the medical practitioners of the Borough of Camberwell (including the School, Hospital, Infirmary and District Medical Officers) to secure the diagnosis and treatment of every case of tuberculosis in the area and to prevent the spread of the disease. In planning its work the main function of the Dispensary as an organising centre should be remembered. Energy should not be mis-spent over certain portions of the work that, in a large population can only be fully carried out by a large body of medical practitioners. To give good service the Dispensary should have a proper working scheme for facilitating the diagnosis of every class of case — straightforward or difficult. The aids to diagnosis afforded by a large general hospital being available should be utilised. The Dispensary should co-operate closely with the public bodies responsible for residential schemes for dealing with tuberculosis, and should be cognisant of all means of obtaining residential treatment. The Dispensary should have knowledge of all general and local means of obtaining material assistance, so that it may be able to advise or to take steps to obtain such assistance in suitable cases when asked to do so. Medical practitioners should have no hesitation in bringing to the notice of the Dispensary any case where medical treatment is hampered through financial difficulties, bad housing, etc. The examination of contacts of notified cases has frequently revealed unsuspected cases of the disease. The Dispensary is desirous of making this important part of the work as complete as possible throughout the whole area and realises the immense importance of cordial co-operation with the medical practitioners in this connection. Summary of the Work of the Tuberculosis Dispensary in 1922. Number of new patients examined 1,656 Number examined at home for the first time and not re-examined at the Dispensary (healthy contacts 161 Number of old patients examined 1,602 Number of new patients sent by medical practitioners for consultation 607 Total attendances of patients at the Dispensary 10,587 Number of new contacts examined 922 Number of patients referred to hospital for consultation 213 Number of specimens of sputum examined in connection with the work of the Dispensary 1,474 Number of visits paid by tuberculosis officers 947 Number of visits of nurses to homes of patients 4,382 The Dispensary as a Centre of Diagnosis. During the last ten years medical men have sent, each year, on an average about 700 new patients to the Dispensary for diagnosis, During 1922 they sent 607 new patients for that purpose, as compared with 750 in 1920 and 662 in 1921. The drop in numbers, though considerable, does not apparently mean that this part of the work is less appreciated, as at the time of writing (May, 1923) the numbers for the first four months of 1923 show a marked increase. The above numbers are evidence of a fair amount of co-operation between the Dispensary and local practitioners. It may be mentioned in this connection that, apart from the above new patients, local practitioners sent hundreds of patients who had attended the Dispensary in previous years for further consultation. The function of the Dispensary as a centre of diagnosis has been mentioned above. The total number of new patients who came to the Dispensary for diagnosis in 1922 was 1,656, and a further 161 new contacts were examined at their homes and did not attend the Dispensary. Tuberculosis Officers are frequently faced with difficult and anomalous cases. In such cases the value of team work must not be forgotten. During 1922, 213 patients were sent to various departments of King's College Hospital for consultation, and we are indebted to the physicians and surgeons of that hospital for the help they gave. Other patients were admitted for diagnosis to observation beds in Brompton Hospital and the City of London Hospital, Victoria Park, under the London County Council Institutional Scheme. Patients were also admitted to Camberwell Infirmary for observation and to Orpington Hospital (Pensions Ministry cases) for the same purpose. During 1922 Camberwell ex-service men suffering from tuberculosis or suspected to be suffering from that disease were sent by the Pensions Ministry to the Dispensary for reports on diagnosis and progress of pensionable condition in connection with re-assessment of pensions. Tuberculous ex-service men were sent to the Dispensary by the Local War Pensions Committee for examination and report as to fitness for work or for treatment allowances. The Arrangements for following up Patients in Cases where the Diagnosis is doubtful. The Ministry of Health desire information on this point in reports on dispensary work. It is a root matter. If doubtful cases are not followed up until a definite decision is made the standard of the Dispensary as a centre of diagnosis must be considered as below par. It is true the following up process may fail, but the failure should be entirely on the part of the patient. A Blackwood's one day diary with the date of the next examination carefully recorded is satisfactory if the patient is given a card on which the date of the next visit is recorded. If the patient fails to attend, his absence can be noted and the matter passed on to the clerical or visiting staff, who deal with it and report back to the medical officers. The Dispensary as a Centre of Treatment. The primary object is that no single case of tuberculosis in the community should remain uncared for. It is intended that the Dispensary should be a centre for the organisation of treatment within its appropriate area. This function should be carefully interpreted. In the past, in some places, Dispensaries have not functionated to the best advantage, because, with a limited staff, they have over-reached in certain directions and have thus put the whole work on a lower level. Take, for example, the routine treatment of tuberculous patients while they are living at home. It is unwise of a Dispensary to attempt to give such treatment except on a strictly limited scale. There seems to be no reason why Tuberculosis Officers should attempt to treat large numbers of patients. General practitioners are qualified by education and experience to give, if they choose, the utmost care and skill in the home treatment of the tuberculous. It is all a matter of the intensive study of each case throughout the course of the disease. Suscessful treatment demands that, and it is essential that the Dispensaries should carry that out in their practice if they are to organise treatment. There are about 200 medical practitioners living in or coming into Camberwell. The distribution of the tuberculous patients in the Borough among so large a body of men and women allows of an intensive study of each case throughout the whole period of treatment. The position of Tuberculosis Officers in this part of the work should be mainly that of consultants. In connection with the provision of domiciliary treatment of tuberculous persons insured under the National Health Insurance Acts Tuberculosis Officers are the official consultants. Their services, in the same capacity, are available to the local practitioners in the case of any un-insured person. The patients chosen for dispensary treatment may include some requiring ordinary treatment and some requiring special treatment. In choosing patients for ordinary treatment the financial stress of the patient may be taken as one criterion. No patient should be treated at the Dispensary who is under a local medical man or hospital unless by arrangement. Where patients are not insured (N.H.I.) or are not able to pay for a private doctor, the district medical officers and the general and special hospitals are available. The special hospitals, however, should not attempt to treat such large numbers of tuberculous patients that the inevitable result is lack of full study of each case from want of time. Hospitals which undertake to treat tuberculous patients in their out-patient departments should make themselves acquainted with the condition of the homes of the patients. The almoners departments in some hospitals are fully alive to the importance of this. Arrangements should be made in the case of patients attending outpatient departments for treatment, to allow of their being medically visited at home at such times as they ought to be resting in bed or in the house. It is quite a common thing for patients to rise from the sick bed to visit the hospital on the day their attendance is due. In carrying out its function as a centre of treatment the Dispensary acts as a link between the local practitioner and the authorities giving residential treatment. Nearly all applications for residential treatment under the scheme of the London County Council are prepared and presented to the London County Council by the Tuberculosis Officers, who, in the large majority of cases, are consulted in the first place as to the advisability of each application for such treatment. Local practitioners, the Medical Superintendent of the Infirmary, and King's College Hospital use the Dispensary in this way, and thus contribute to the homogeneity of the whole scheme of residential treatment in the Borough. The services of the Tuberculosis Officers are available at any time to any practitioner who wishes to obtain residential treatment for a patient. If in consultation residential treatment was agreed on, it would be the duty of the Tuberculosis Officers to push the application for treatment with the available authorities responsible for the provision of such treatment. If the Tuberculosis Officers did not agree that such treatment was necessary, the views of the practitioner would still be made known to the authority responsible for residential treatment. In many cases the patient would be in a position to make private arrangements for residential treatment. The same co-operative idea applies to all measures auxiliary to treatment, e.g., if a practitioner on making an intensive study of his patient finds that certain things are neededmaterial things to make home treatment satisfactory—he is at liberty if he will—to consult with the Tuberculosis Officers on the needs of the case. It would then be the duty of the Tuberculosis Officers—with the consent of the practitioner and his patient— to bring the matter to the attention of the Care Committee with a view to helpful action. It is well to remember that even negative results have a definite value in the building up of a useful scheme of co-operation. It is only by constant pointing out of needs by those in charge of treatment that an effective Care work scheme will be reached. If the Tuberculosis Officers are to do justice to their work as consultants, and if they are fortunate enough to gain the confidence of their brethren, their time will be largely occupied in the work of home treatment. If, in addition, they attempt to take entire charge of more than a very limited number of patients, their usefulness will soon be over-reached, and other parts of their work will also suffer. The Provision of Trained Nurses to Cases of Advanced Consumption in their Homes. The visit of a trained nurse once or twice a day to a home where an advanced consumptive is confined to bed is of great importance to the patient and to those who are looking after him. Such visits, however, should never be considered as an alternative to removal to hospital, unless the patient is able to have a room to himself without inconvenience to the rest of the household, and unless proper nourishment can be provided. The provision of constant attendance by trained nurses is subject to similar restrictions. Apart from that it would be a costly Public scheme. A considerable amount of daily visiting of advanced consumptives is done in Camberwell by the district nurses. We are greatly indebted to them for charting temperatures in cases under observation for diagnosis. The Camberwell Day Sanatorium, 6, Grove Hill Road. The Day Sanatorium was started in 1917 by the Tuberculosis Dispensary. There is a lawn garden of over an acre in extent on the top of Dog Kennel Hill well exposed to the sun. There is one class limited to 30 children taught by a London County Council school teacher. Since November, 1921, the school has been under the control of the London County Council. It is intended to be an after-care effort on behalf of children who have completed residential treatment. All cases are non-infectious. The following is a summary of the work of the Day Sanatorium for 1922 : — Number on roll on 31/12/22 20 Number admitted during 1922 16 Number discharged during 1922 10 Reasons for discharge. Number fit for elementary school 1 Number fit for work 3 Number transferred to hospital or sanatorium 2 Number removed from district 1 Number discharged for other reasons 3 Gain or Loss in Weight of Children who have been in the School more than 12 Months. Number of children who showed a gain in weight 17 17 Average gain in kilos 3. 5 Number of children who lost weight or whose weight was stationary 1 Average loss in kilos - - The Care Work of the Dispensary. It is a great pleasure to be able to report that much Care Work of a helpful nature was accomplished during the year. Institutional (Residential) Treatment of Camberwell Patients in 1922. A. Through the London County Council. 1. Adults. Number of applications for treatment during 1922 309 Number who received residential treatment 241 Number who did not receive residential treatment: Not recommended 33 Failed to enter 17 Treatment not commenced during year of record 18 68 Classification of Residential Treatment Cases. Early pulmonary tuberculosis 40 Moderately advanced pulmonary tuberculosis 102 More advanced pulmonary tuberculosis 65 Surgical tuberculosis 19 Diagnosis of tuberculosis 13 Not classified 2 Total 241 Home Conditions of Residential Treatment Cases. Good 125 Indifferent 74 Bad 15 No information at time of application 27 Total 241 The London County Council used beds in the following Institutions for Camberwell adult patients:- Hospitals. Sanatoria. Homes. All Saints. Benenden. Bishopsbourne. City of London (Chest). Danewood. (Bournemouth). Colindale. Downs. Cranbrook (Convalescent). Consumption (Brompton). Frimley Seaview (St. Leonards). Grosvenor. Eversfield (Chest). St. George's (Chelsea). King's College. St. Michael (Axbridge). Gt. Baddow. Northern. Hermitage. The Firs (Bournemouth). Seamen's (Greenwich). Holy Cross. St. Anthony's (Cheam). King Edward VII. Colonies. St. Luke's. King George V. St. Thomas's. Maltings Farm. Papworth. Nayland. Preston Hall. Pinewood. Royal National. The average duration of Residential treatment given by the London County Council in 1922 to 267 adults and children (see Children below) who commenced treatment in that year was 3.4 months. It may be noted that at the time of writing (May, 1923) the average duration of treatment given to the same patients was 4.75 months, and many were still undergoing treatment. The average would have been much higher if all the patients had completed the course of Residential treatment as advised. No note is made here of patients who commenced Residential treatment prior to 1922 and whose treatment was continued in 1922. What of sanatorium treatment in pulmonary tuberculosis? A just attempt to judge the value of the results can only be made if the difficulties are fully appreciated. The financial group of difficulties —patients' and Authorities' —are many and intricate. If they were removed a formidable group would remain that has nothing to do with lack of money or other material difficulties, such as bad housing conditions. In this connection there are two outstanding features of tuberculosis. The first is that the disease is often well established before the symptoms of ill-health are appreciated by the patient. Hence many cases of late diagnosis and refusal of early treatment. The second is that with sanatorium treatment the symptoms of ill-health disappear before the disease is really arrested in the organs affected. Hence the shoal of sanatorium patients who give up treatment before results of any permanency have been obtained. In spite of many disappointments the value of sanatorium treatment properly applied is firmly established. A steadfast patient, guided by a careful medical adviser, in the hands of intelligent Institutional Authorities, can look forward with reasonable hope to successful treatment provided he is not smitten from the onset by an overwhelming attack of the disease. But pulmonary tuberculosis is not like a broken leg. There is no short period of rigid and enforced observance of medical orders with complete freedom at the end of it—on the contrary, there is a long and at times very lonely personal struggle that may cut right into the joys of family and social life. It is little wonder that many failures are recorded. 2. Children.— Number of applications for treatment during 1922 31 Number who received residential treatment 28 Number who did not receive residential treatment — Failed to enter 3 Classification of Residential Treatment Cases. Early pulmonary tuberculosis 6 Moderately advanced pulmonary tuberculosis 3 Advanced pulmonary tuberculosis 2 Tuberculosis of knee joint 7 Tuberculosis of hip joint 2 Tuberculosis of glands 4 Tuberculosis of peritoneum 1 Tuberculosis of spine 1 1 Tuberculosis of tibia 1 Lupus 1 Total 28 Home Conditions of Residential Treatment Cases. Good 15 Indifferent 9 9 Bad 4 The London County Council used beds in the following institutions for Camberwell children :— Hospitals. Sanatoria. Homes. Alexandra (Hip). High Wood Alton (Lord Mayor Cheyne (Brentwood). Treloar's). East London. Nayland. Victoria (Margate). Gt. Ormond Street. At Brighton. Heatherwood (Ascot). Broadstairs. King's College. Cold Ash. Princess Mary's (Margate). Seaford. Queen Mary's (Carshalton). The experience in Camberwell is that there is no difficulty in obtaining suitable residential treatment for children suffering from tuberculosis. Looking at the lists given above, the cases of spine, hip and knee disease may be taken for closer analysis in support of this statement, which is true of all cases. Spine.—The total number of primary notifications of tubercle of the spine in children under 16 years of age in 1922 was 5. Four of these were sent by the Guardians to Queen Mary's Hospital, Carshalton. One case was sent by the London County Council to hospital (prior to treatment out of London). At the end of a fortnight however the parent made other arrangements of a satisfactory nature for the further treatment of the child. Hip.—The total number of Primary Notifications of tubercle of the hip joint in children under 16 years of age in 1922 was 7. Four of these were sent by the Guardians to Queen Mary's Hospital, Carshalton. Two were sent by the London County Council to the Cheyne Hospital and to Princess Mary's Hospital, Margate. One child was notified for the first time after residential treatment was completed and the disease arrested. Knee.—The total number of Primary Notifications of tubercle of the knee joint in children under 16 years of age in 1922 was 7. Two were sent by the Guardians to Carshalton. Four were sent by the London County Council to the following institutions: —Queen Mary's Hospital, Carshalton; Princess Mary's Hospital, Margate; Heatherwood Hospital, Ascot, and the Victoria Home, Margate. One child was notified for the first time on discharge from residential treatment with arrested disease. One child who commenced treatment in 1922 at Margate under the London County Council Scheme was notified for the first time in December, 1921. In former days children suffering from tuberculosis of Bones and Joints, etc., were kept too long in the wards of London Hospitals and Infirmaries. In some cases they were even treated as outpatients over prolonged periods. Nowadays, the great aim is to send them out of London as soon as possible after diagnosis. They are sent to special hospitals in the country or at the seaside, and are kept there until, in satisfactory cases, the disease is arrested. I In connection with the results of such treatment the following figures are of interest. They are taken from a table of the results of treatment of children suffering from surgical tuberculosis (spine, hip, knee and other forms) at the Lord Mayor Treloar Cripples Hospital at Alton, from the opening of the Hospital in September, 1908. to January 31st, 1921. Number treated 2,487 Number discharged 2,197 Number in whom disease was arrested 1,931 Number improved only 62 Number unimproved 31 Number removed or transferred 23 Number who died 56 Average stay in days 416 Mortality percentage 2.54 Mortality percentage due directly to tuberculosis (i.e., excluding deaths due to intercurrent diseases) 2 The case of lupus recorded under the classification of children's cases on a previous page was discovered when limited to a single patch of the disease about the size of a threepenny bit on one leg. The lupus was entirely removed by operation (excision) and the child was cured in a few days. B. Through the Guardians. 213 cases of pulmonary tuberculosis and 18 cases of acute miliary tuberculosis received treatment in the wards of Camberwell Infirmary during 1922. A large number of cases of Surgical tuberculosis were also dealt with. 86 beds are used exclusively for pulmonary tuberculosis, including 18 beds in shelters on the roof. Residential Treatment was arranged for at the following Institutions: — The Royal Sea Bathing Hospital, Margate. Queen Mary's Hospital, Carshalton. Millfield Convalescent Home, Littlehampton. Princess Mary's Hospital, Margate. High Wood Hospital, Brentwood. St. Anne's, Heme Bay. Rustington. The Millfield Convalescent Home near Littlehampton has 120 beds and is used to enable children from hospitals like Carshalton and High Wood to be transferred to a dry marine climate where the annual sunshine record is high. C. Through Private Arrangements. A considerable number of patients did not ask the above public bodies to assist them in arranging for Residential treatment. The Residential Treatment of Advanced Cases of Consumption in Camberwell in 1922. . During the year 199 Camberwell patients died of tuberculosis in Institutions. 122 were males and 77 were females. The number who died in Institutions in relation to the total number of deaths in the Borough from tuberculosis was 59.89 per cent. males and 50.34 per cent, females. It appears, therefore, that considerable provision is made for the Institutional treatment of advanced cases 113 patients died in Camberwell Infirmary. Comfort is provided in this Institution for dying patients, and as relatives are allowed to be with them day and night, the fact that the Infirmary is local and easily accessible is one of first importance. By way of contrast let us consider Colindale Hospital, Hendon. This Hospital, opened in 1920 by the Metropolitan Asylums Board, has 300 beds for advanced pulmonary cases in males. It is well situated, practically in the country, and is made as attractive and comfortable as possible. The hospital is in charge of a well-known expert in tuberculosis. It, however, is not easy of access from Camberwell in the case of patients who are dying. Relatives have frequently mentioned this drawback. It is also a consideration in the removal of patients to the hospital when in an extremely weak state. 18 Camberwell patients died there in 1922. St. George's Home, Chelsea, with 50 beds for advanced disease in females, is comfortable, but not as accessible as the local Infirmary, and the same applies to the Northern Hospital, Winchmore Hill, where 50 beds are set apart for cases of advanced disease in women. Looking at the general question of dealing with advanced cases, small Homes —" Homes for the Dying"—remain in favour with some. Reasons can be found against their systematic use. Patients —not rarely—come out of them alive and wonder why they were put through so severe a spiritual ordeal. Many patients while in these Homes have a mental struggle to maintain the "spes phthisica " that adds so much to their comfort and to their chances of improvement. The most suitable place in which to treat very advanced cases would appear to be a local' general hospital or infirmary, in which tuberculosis of all varieties and in all stages is treated. The popular estimation of treatment of tuberculosis in such a hospital is affected favourably in that curable cases are treated as well as incurable ones. This induces patients to enter, and their friends urge them to enter. Once inside, if the treatment is punctilious and in the hands of those judged to be experts, patients feel it is worth their while to remain, even at the expense of separation from their families, and their relatives urge and support this decision. There is no essential reason why a hospital should conjure up an undesirable feeling of Institutionalism. A hospital can be made as homely as a small Home. A ward may contain 30 beds or may be so small that it can only hold one bed. By having wards of different sizes, all cases can be met as far as possible. It is remarkable, however, how gregarious invalids frequently are. In such a hospital the comfort of a large number of patients can be arranged for uniformly, and this is of importance in any scheme. Bright wards, beds the last word in comfort, food daintily prepared and of sufficient variety can, and must be, provided. Medical treatment should be carefully planned so that relief and comfort can be given by those most qualified to give it. Take a common example, advanced tuberculous disease of the larynx. Everyone knows the agony of a patient in that condition, and of the relief that may be given by skilful treatment, and by cunningly devised meals, and the methods of taking them. The advice of a specialist in throat diseases should be available at any moment, and this can be most easily arranged on a large scale in such a hospital. A central Institution for a large area appears to be a sounder proposition from the point of administration and convenience of access than collections of beds scattered here and there, many of them removed far from the area they are serving. Frequent changing of Nursing Staff is possible in a large General hospital, and this is very desirable in the nursing of advanced consumption. WILLIAM BRAND. MATERNITY AND CHILD WELFARE. The extent of the Maternity and Child Welfare scheme operating in Camberwell is represented by the following activities: — 1. The provision of 3 Municipal Infant Welfare Centres, and the subsidisation of 5 Voluntary Schools for Mothers. In addition a School for Mothers exists in the Cobourg Road area of the Borough, but is not subsidised by the Council. 2. The provision of a Municipal Ante-Natal Clinic. 3. The subsidisation of 2 Homes for Unmarried Mothers. 4. The subsidisation of a Day Nursery. 5. The payment for home nursing services of maternity and infectious disease cases arising out of maternity, and for illnesses in young children under 5 years. 6. The supply of milk to necessitous mothers (nursing and expectant) and young children. 7. The provision of convalescent treatment in special cases for mothers after confinement, and for some conditions in young children. 8. The payment of midwives' fees for services rendered to necessitous mothers. 9. Dental treatment. Work of the Infant Welfare Centres. The following table presents at a glance the scope of the work of the municipal and subsidised Infant Welfare Centres, and whilst I do not deem it necessary to make comparisons of the work of any one Centre with that of another, the critical eye will discern a marked difference in the number of visits made by the officers of the Voluntary Centres, compared with those made by the Municipal officers. The explanation, however, is not far to seek when it is noted that the whole of the visiting in the Municipal areas is done by the health visitor, whereas most of the Voluntary Centres have the assistance of more than one helper in this work. Ante-Natal. The prevention of still-births remains a vexed one, and the co-operation of the medical practitioners and midwives in the Borough is being sought with a view of obtaining information which would be helpful in removing, where possible, the causes of abortion? and still-births. MUNICIPAL AND SUBSIDISED INFANT WELFARE CENTRES. RETURN OF WORK, 1922. Consultations. Children —Attendances at Consultations. Mothercraft Classes. Analysis of Visits. Post-Natal Mothers, First Attend - ances. Subsequent Attendances. Total Attendances. Doctor's Consultations. Superintendent's Consultations. Doctor's Consultations and Weighings. Weighing only. Expectant Mothers. Children Attending Centre. After Notification of Birth. Before attending Centre. Miscellaneous and other Visits not defined. Visits by Voluntary Helpers. Health Talk. Sewing class and Health Talk. Expectant Mothers. Sewing Class. First Visits. Total Visits. First Visits. Infant Welfare Centre. Under 1 year. Over 1 year. Under 1 year. Subsequent Visits. Over 1 year. Total. Subsequent Visits. Camberwell Municipal, 140, Camberwell Road. 130 77 44 1455 2283 - 1652 2283 598 36 - 211 79 538 535 96 - - 33 88 743 475 1505 1654 451 - - 129 2111 - *Dulwich Municipal, 114, Lordship Lane 16 268 142 1242 459 2111 328 - 55 42 104 612 525 171 1509 - 156 17 265 53 24 144 24 265 239 9 14 13 40 37 49 309 *Peckham Municipal, St. Jude's Hall, Meeting House Lane. - 73 - - - - - 3369 136 - 5674 849 Bird-in-Bush Voluntary, 601, Old Kent Road. 376 423 63 3933 1255 5674 77 2228 - - 111 136 78 774 1016 526 1702 4343 2306 45 3041 915 941 118 1329 393 1024 763 3989 Cambridge House, 6, Addington Square. 161 238 41 1458 1304 3041 400 - 335 - 160 202 160 67 § 657 - 1040 1884 - - - 620 50 486 120 1594 500 450 3360 ‡Cobourg, Kempshead Hall, Kempshead Road. 50 108 12 - 1884 - 1439 593 2397 830 4111 - 111 Nunhead, 29, Nunhead Grove 52 12 231 14 4111 2329 1782 - 542 104 239 1060 228 3165 - - 2932 St. Luke's, 2, Commercial Road 284 38 2720 1813 4855 1923 4855 597 905 121 202 33 2753 609 1114 1089 5921 93 106 - - - United Girls' School, 17, Peckham Road. 26 124 1260 538 1586 -†† 3316 4902 276 371 239 692 456 9417 485 135 11424 372 39 4902 - - - 2217 949 Totals 479 2208 482 15649 7437 29126 13050 477 3545 10827 29126 1788 3113 1868 1360 18319 4412 4250 4367 35525 839 * Additional Session opened Nov. 1922. † Opened 7/9/22. ‡ Not subsidised by the Council. § Not spread ver ages group. †† 2,693 weighings not spread over ages group. The practice of following up all such notifications by enquiries of the mother had to be discontinued, as it was found that the information thus obtained was, in the majority of cases, quite unreliable. The total attendances at the ante-natal clinics number 479, but this figure is by no means an index of the extent of the medical supervision in the Borough of the mother during pregnancy. A considerable amount of the work which might reasonably be expected would be done at the ante-natal clinics is carried out by the general hospitals adjacent to the Borough boundaries, a fact which undoubtedly had some bearing on the decision to close the clinic at the United Girls' School Settlement School for Mothers during the year, where a small attendance was' recorded. It must not be thought, however, that the closing of the clinic in question deprives any mother living in this area from receiving medical supervision if required, as the Council asked the authorities of the School to co-operate with them by sending their cases to the Municipal ante-natal clinic at 140, Camberwell Road. The advent of the ante-natal clinic only dates a few years, but its importance cannot be over-estimated. I do submit that such a high still-birth rate as at present prevailing would not continue if a more general use were made of the facilities available for the mothers of to-day. Homes for Unmarried Mothers. As in the case of the other voluntary institutions subsidised by the Council, the annual grants were renewed to the Southwark Diocesan Association for Preventive and Rescue Work Home, 24, De Crespigny Park, and the National British Women's Temperance Association Hostel for Mothers and Babies, 201, Camberwell Grove. Both institutions provide accommodation for the unmarried mother and her infant, and the total number of cases received in the Homes during the year was 62, at each institution the number of cases recorded as dealt with being 31. Day Nursery. The Council have continued to subsidise the Peckham, Nunhead and District Day Nursery, 109, Gibbon Road, and in July last, acting on a report, of the Council's representative on the Committee of the Institution, an additional grant of £100 was made to further the work of the creche, and to enable adjustments to be made to the wages paid to the staff. The usefulness of the Institution was well maintained, providing daily accommodation for infants and young children whose mothers are obliged to engage in daily work, and although the nursery was closed for a period of one month owing to illness of the staff, and on another occasion due to an outbreak of measles, 2,657 attendances were recorded for the year. Nursing. The nursing arrangements of the Borough provide for the assistance of skilled nurses in the treatment of maternity cases and infectious disease cases arising out of maternity, and for illness in children under 5 years of age, and also for patients suffering from pneumonia, malaria, dysentery and other diseases specified in the Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919, and other approved cases. Such nursing is carried out by the Ranyard Nursing Association, Camberwell District Nursing Association, Rotherhithe District Nurses, and the East Dulwich and Dulwich Village Nursing Society, the majority of the work falling in the areas of the two former Associations. A charge is made by the two first-named Associations for each visit, which prior to April was at the rate of eightpence for certain cases and fourpence for others, afterwards altered to a flat rate of one shilling for each visit. The total expenditure on this service for the year amounted to £234 15s. 4d., representing 4,859 visits, the Ministry of Health paying a grant in aid of half the expenditure incurred in respect of cases chargeable to Maternity and Child Welfare, viz., £223 9s. 8d. Milk. Grants of milk in accordance with the following conditions provided by the Ministry of Health Circular No. 185 were continued to be made to:— (a) Nursing mothers. (6) Expectant mothers in the last three months of pregnancy, and; (c) Children up to 3 years of age, and exceptionally to children between 3 and 5 years of age. The quantity of milk to be supplied at less than cost price must not ordinarily exceed one pint per day per person, but in the case of infants between o months and 18 months, in exceptional cases 1½ pints a day may be supplied. The total number of applications received was 8,206, of which 7,987 conformed to the income scale laid down by the Council and approved by the Ministry of Health. The gross cost of the grants made was approximately £3,900, of which sum the Ministry pay one half. Every individual application was carefully examined by the Milk Applications Committee, and in cases where a doubt existed regarding the applicant's statement of his earnings enquiries were made before a grant was authorised. In only one instance was it necessary to request the attendance of the applicant before the Committee to offer an explanation of the conflicting information relating to circumstances. It is significant that only 219 applications were refused, owing to the incomes, less rent, fares and insurances, divided by the number in the family exceeding the basic figure allowed per head. At the end of the year the Council adopted the revised scale of income suggested by the Ministry of Health regulating the supply of milk, which provides an income figure per head after the deduction of rent. For comparative purposes the original and revised income scales are set out hereunder. Original Scale. Free. Half price. No in family. Income per head. No in family. Income per head. s. d. s. d. 1. 16 0 1. 18 0 2. 13 0 2. 14 6 3. 10 6 3. 11 6 4. 9 6 4. 10 6 5. 8 6 5. 9 6 6. 8 0 6. 9 0 REVISED SCALE. 1. 13 0 1. 15 0 2. 10 6 2. 12 6 3. 8 6 3. 10 0 4. 7 6 4. 8 6 5. 7 0 5. 8 0 6. 6 6 6. 7 6 Convalescent Treatment. The Ministry of Health grant is available for approved expenditure for the convalescent treatment of mothers for recovery after confinement, and for some conditions in young children. During the period covered by this report 18 children, 2 mothers, and 3 mothers with their infants were sent to a convalescent home for a period usually extending to 28 days. Midwives' Fees. After due consideration by the Maternity and Child Welfare Committee payment was authorised in three instances of the accounts of midwives for services rendered to indigent mothers in confinement. Dental Clinic. A dental clinic exists at the Cobourg School for Mothers, Kempshead Hall, Kempshead Road, to which expectant and nursing mothers may be referred who are in need of treatment. Many mothers from the Municipal Centres have been sent for treatment during the year, and it is only fitting to acknowledge the public-spirited action of the authorities of the School for readily accepting any case sent by other Infant Welfare Centres in the Borough, thus co-operating in the all-important work of the care of the teeth of the mother during and after pregnancy. Maternity Beds. The subject of the welfare of the mother before, during, and after the birth of the child is a matter of great concern, and one which is deserving of every consideration. It is significant that the maternal death rate due to childbirth has varied very little for a great number of years. An obvious duty is to make maternity as safe as possible for the mother and child, and to reduce to a minimum the results accruing from inattention at birth. In a memorandum on the subject from the Ministry of Health two classes of patients are specifically mentioned: — 1. Patients showing some abnormality either during pregnancy or at the time of labour which calls for special medical treatment and skill. 2. Patients whose domestic conditions are unfavourable for confinement in their own homes, even where a normal labour may be expected. The provision of homes or accommodation at hospitals where the best possible skill and treatment are available for the mother who comes under one of the above-mentioned classes is necessary. The need for such provision is intensified by the present housing conditions, which prevent proper accommodation and reasonable privacy being obtained on this account, and it is not surprising to find that many women are desirous of being confined away from their homes. The Maternity and Child Welfare Committee considered this question some months ago with a view of trying to find suitable premises that could be adapted for the purpose of a Home, but their efforts did not meet with success. The matter was again considered last October when the Maternity and Child Welfare Committee endeavoured to obtain beds in a general hospital, but the scheme did not mature, as it was felt that the financial aspect of the proposed arrangement was not satisfactory. Further negotiations are proceeding, however, with the authorities of another Institution. SANITARY ADMINISTRATION. Sanitary Inspection of District. Visits to complaints numbered 3,843, compared with 3,657 in 1921, and the number of house inspections following complaints was 2,474. House to house inspections showed a considerable increase (2,129 in 1922, compared with 1,773 in 1921), due to the appointment of two temporary inspectors for a period of three months in the summer. Inspections following tuberculosis were very much fewer than in 1921, being 307 in 1922, compared with 2,405. This was mainly due to the resignation of one of the three women inspectors, part of whose duties was the inspection of the homes of notified cases of tuberculosis and the making of enquiries in relation to contacts. A report was submitted as to the desirability of the women inspectors being relieved of all duties in connections with tuberculosis and of an additional tuberculosis nurse being appointed to take up this work. This report was adopted, but the appointment was not made during the year. More houses-let-in-lodgings were inspected than in the previous year, but there is still much leeway to be made up. New bye-laws for this type of house were drawn up by the London County Council, but at the close of the year these had not received the approval of the Minister of Health. Offensive Trades. There were 8 premises coming within this category, 1 a soap- boiling factory, and the other 7 dressers of fur-skins. For the latter trade the London County Council issued bye-laws, which received the approval of the Minister of Health on March 22nd, 1922. 25 visits were made to the offensive trade premises, and the requirements of this department were carried out without difficulty. One place in the Borough where large quantities of rabbit and hare skins are received, dried and re-sold was the subject of a complaint by a number of residents of adjoining houses to the Medical Officer of Health, and a summons was issued in accordance with Section 21 of the Public Health (London) Act, 1891, against the proprietor of the business. The case was adjourned for three months to allow of certain alterations and improvements being effected by the owner. At the end of that period it was reported that no nuisance existed, and the case was adjourned sine die. Particulars of the inspections of factories and workshops will be found in the Tables on pages 54 and 55. Tables showing the whole of the inspections made by the sanitary inspectors will be found on pages 56 and 57. FOOD. (a) Milk Supply. The bulk of the milk supply for the inhabitants of Camberwell is imported, only a very small quantity being produced locally. There is in the Borough only one licensed cowshed. This cowshed was regularly visited and no occasion arose for any objection to be made to the renewal of the licence issued by the London County Council. During the year applications were received from 88 persons for registration as milk-sellers. 85 applicants were registered— 35 in respect of premises not already on the register, the remainder representing changes of proprietorship of premises already on the register. In some cases it was necessary to ask for certain alterations and repairs to be carried out before the premises could be considered suitable for the trade. In one case the premises were considered unsuitable and the application was not persisted in; in another, certain alterations required were not completed at the end of the year under review; and in yet another, the application was withdrawn, the applicant having secured more suitable premises in an adjoining Borough. The total number of milk-sellers on the register in Camberwell at the close of the year was 450. 1,164 inspections of milkshops and dairies were made, and the drains of all dairies were tested during the year and any defects found were remedied. 665 samples of milk, were taken by the Food and Drugs Inspector. 13 were found to be adulterated, and 13 summonses were issued. Particulars of the legal proceedings will be found in the report on the administration of the Food and Drugs Acts. The Milk and Dairies (Amendment) Act, 1922, gave the Local Authority power to refuse to register, or to remove from the register, retailers of milk in certain circumstances; prohibited the addition of colouring matter, water, dried or condensed milk or any fluid reconstituted therefrom, or any skimmed or separated milk, to milk intended for sale; and also imposed penalties for knowingly selling milk of cows suffering from tuberculosis of the udder. In the latter end of the year the Ministry of Health issued, under the Milk and Dairies (Amendment) Act, the Milk (Special Designations) Order. This Order was due to come into force on January Ist, 1923, so that no action had been taken under the Order during the year under review. (b) Meat. Very nearly the whole of the meat supply of Camberwell is obtained from the London markets, where it is subject to inspection by a staff of veterinary and meat inspectors. A very small amount of slaughtering takes place at the five private slaughter-houses remaining in the Borough. These slaughterhouses were inspected at frequent and irregular intervals, 88 visits being made by the inspectors during the year. The licence for one slaughter-house, where no killing had taken place for a long period, was not renewed by the London County Council. No meat liable to seizure as diseased or unsound was found in the slaughter-houses. One parcel of meat (ox cheek) and two parcels of tinned rabbit were seized at retail shops, details of which will be found in the following Table of proceedings. The attention of the sanitary inspector was called by a butcher to the carcase of a pig, which was examined and found to be tuberculous and was destroyed at the Council's Depot. The following quantities of foodstuffs were surrendered by the owners, being unsound:— 6 cwt. 1 qr. 10J lbs. of meat. 14 „ 2 „ 20 „ offish. 1 „ 1 „ 8 „ of poultry. 8 tons 16 „ 1 24J „ of tinned foods. 1 „ 2 „ 1 ~ 9 „ of fruit. Total. 11 tons 1 cwt. 0 qrs. 15 J lbs. These foodstuffs were destroyed at the Council's Peckham Park Road Depot. Licensed Slaughter-houses in the Borough of Camberwell. In 1914. In January, 1922. In December, 1922. 10 6 5 There is no public abattoir in the Borough. (c) Other Foods. 656 inspections of foodstuffs were made by the sanitary inspectors in 1922, resulting in 10 seizures of unsound food. 12 summonses were issued in respect of the above-mentioned seizures, particulars of which are as follow:— Feb. 14 Exposing for sale 9 tins of unsound tomato soup. Inspector Worsfold. Fine £2. Costs £1 1s. „ 14 Depositing for the purpose of sale 5 tins of unsound tomato soup. Inspector Worsfold. Fine £2. Costs £1 1s. „ 16 Depositing for the purpose of sale 23 tins of unsound jam. Inspector Morley. Fine 1s. Costs £2 2s. „ 16 Exposing for sale 4 tins of fig jam and 10 tins of condensed milk in an unsound condition. Inspector Morley. Fine 1s. Costs £1 1s. „ 22 Exposing for sale 40 tins of unsound rabbit in jelly. Inspector Nash. Case transferred to Sessions and there dismissed. No costs. „ 22 Exposing for sale 37 tins of unsound rabbit in jelly. Inspector Malins. Fined 5s., in respect of 1 tin. No costs. Mar. 1 Exposing for sale 57 tins of unsound condensed milk. Inspector Nash. Pleaded guilty. Dismissed. £1 1s. costs. „ 1 Depositing for the purpose of sale 41 tins of unsound condensed milk. Inspector Nash. Pleaded guilty. Dismissed, £1 1s. costs. „ 1 Selling 98 tins of condensed milk to defendant in above two cases, knowing the same to unsound. Dismissed. Costs £5 5s. against Council. „ 30 Depositing for the purpose of sale 62 tins of condensed milk, 4 tins of strawberry jam, and 3 tins of marmalade in an unsound condition. Inspector Farmer. (Two summonses. two defendants.) One case dismissed, the other withdrawn, Sept. 14 Exposing for sale 7½lbs. of ox cheek in an unsound condition. Inspector Collins. Pleaded guilty. Dismissed. Costs £5 5s. In addition to the summonses set out above, the following were issued in 1922 in respect of seizures made in the latter end of 1921: — Jan. 11 Exposing unsound tinned sardines for sale. Inspector Nash. Fine £5. Costs £5 5s. „ 11 Selling unsound sardines to defendant in above case. Inspector Nash. Fine £5. „ 18 Depositing for sale 144 tins of unsound jam. Inspector Green. Fine £8. Costs £3 3s. „ 18 Depositing for sale 42 tins of unsound jam. Inspector Dewey. (Two summonses.) Fine £3. Costs £3 3s. „ 21 Selling 42 tins of unsound jam to defendant in above case. Inspector Dewey. Fine £4. Costs £3 3s. Feb. 14 Depositing unsound beef, mutton and bacon for sale in a van. Inspector Collins. Fine £10. Costs £3 3s. Another case, arising out of a seizure of meat made by Inspector Green in 1921, was tried at the Newington Quarter Sessions and the defendant was sent to prison for six months. Throughout the year a regular inspection of street markets and shops has been carried out by the Sanitary Inspectors on Saturday nights. The Inspectors' routine duties render it impossible for them to devote as much time to the very important work of food inspection as is, in my opinion, desirable, and during the year a report was submitted to the Public Health Committee urging the appointment of an inspector to be engaged solely on food inspection. The Committee did not adopt the suggestion made in the report. Bakehouses. — There were 127 bakehouses on the register, to which the sanitary inspectors paid 462 visits. 15 intimations were served and complied with. As the result of an Order issued by the Home Office, certain powers in connection with factory bakehouses (both wholesale and retail) under Sections 97, 99 and 100 of the Factory and Workshop Act were transferred from the Home Office to the Ministry of Health, and the latter decided that local sanitary inspectors should deal with the sanitary condition of bakehouses, whether power was in use therein or not. Eating Houses (including fried fish shops). There were 149 of these premises on the register, to which 187 visits were made, special attention being paid to the cleanliness of kitchens, etc. 22 intimations were served and complied with. Ice Cream Sellers. — There were 321 on the register and the inspectors made 460 visits. 21 intimations were served and complied with. Four samples were submitted for bacteriological examination, two being unfavourably reported on. Special attention has been paid to the premises and the conditions under which the cream is made and sold in these two cases. Retail Distribution of Milk and Other Foodstuffs. The distribution and sale of foodstuffs in general — milk, bread, meat, confectionery, etc. — are not carried on in as satisfactory a manner as is desirable. It would appear that the dangers to which the community is exposed are either not fully understood or are ignored by those dealing in these commodities. In the case of milk, delivery takes place in the street or at the house doors from open cans to jugs or other open vessels and the milk is exposed to pollution from dust and other impurities in the air. The ideal solution is for milk to be drawn from the cows at the farm under the best possible hygienic conditions and despatched in sealed containers, to be delivered unopened to the consumer. The almost universal practice of distributing bread without wrappers leaves much to be desired, and renders the article liable to contamination from many sources before it is eaten. The practice of changing stale bread for new is also open to strong objection, and should be stopped. The continuation of the exposure to dust, etc., of meat, confectionery (largely consumed by children), and other foodstuffs in open shops and on stalls is highly objectionable. It does not appear that much improvement can be effected without legislation. It would seem necessary that further powers should be granted to Local Authorities to enable them to deal with this matter. ADMINISTRATION OF THE FOOD AND DRUGS ACTS. The report of the Food and Drugs Inspector for the year 1922 is appended. The continuation of the practice of having one inspector entirely engaged on this important work has undoubtedly been productive of very satisfactory results. It will be seen from the report of the inspector that the number of samples returned " not genuine " was a very small percentage of those taken. Public Health Department. 35, Brunswick Square, Camberwell, S. E. 5. May 3rd, 1923. To the Medical Officer of Health, Camberwell. Sir, — I herewith beg to report on the work carried out under (1) the Sale of Food and Drugs Acts, (2) the Margarine Acts, (3) the Public Health (Milk and Cream) Regulations, and (4) the Sale of Food Order during the year ended 31st December, 1922. The formal or official samples obtained total 1,069. These are set out in detail under Table "A," which will also show the percentage of adulterations and the action taken with regard to the adulterated samples. The extent and nature of the adulterations and the result of proceedings are set out in Tables "C" and "D." Table "E" deals with samples taken under the Public Health (Milk and Cream) Regulations, 1912-1917. (Signed) GEORGE T. DEWEY, Food and Drugs Inspector. TABLE "A." OFFICIAL SAMPLES, 1922. Article. Number taken. Genuine. Not Genuine. Percentage not Genuine. Summonses. Cautions. Other Remarks. Milk 665 652 13 1.95 13* *An additional summons in respect of milk was taken out under the Public Health (Milk and Cream) Regulations, 1912-1917, the sample containing a preservative. See Table "E." - Butter 72 72 - - - - Vinegar 44 4 48 8.3 2 2 1 Malt Vinegar 33 31 2 6.0 1 33 Lard 33 - - - - Mustard 23 - 23 - - - - Margarine 22 22 16† 6† †Sold in unstamped wrappers. - Golden Syrup 14 2 12 14.2 2 - Cocoa 14 14 - - - - Camphorated Oil 12 11 1 8.3 1 - Coffee 11 11 - - - - Arrowroot 8 7 1 12.5 1 - 7 Ground Almonds 7 - - - - Borax 7 4 3 42.8 3 - Custard Powder 7 7 - - - - Tinned Peas 6 6 - - Self-Raising Flour - - 6 6 - - - - Baking Powder 5 5 - - - - Sausages 5 5 1 - - - Whisky 5 3 2 40.0 1 1 5 Dripping 5 - - - - Separated Milk 4 4 - - - - Treacle 4 4 - - - - 4 Pepper 4 - - - - 4 Bicarbonate of Soda 4 - - - - 3 3 Boric Acid Ointment - - - - 3 Rice 3 - - - - Ground Rice 2 2 - - - - 2 2 - Amber Syrup - - - 2 Black Currant Jam 2 - - - - 2 Cane Syrup 2 - - - - 2 1 1 50.0 1 Raspberry Jam - 2 - Lemonade Powder 2 - - - 100.0 2 - Egg Self-raising Flour 2 2 - 1 1 Egg Substitute Powder - - - - - Cheese 1 1 - - - Cream Cheese 1 1 - - - - 1 1 Marmalade - - - - 1 1 White Pepper - - - - Demerara Sugar 1 1 - - - - 1 1 Sponge Flourr - - - - 1 1 - - - Ice Cream Soda - Full Cream Condensed Milk 1 1 - - - - 1 1 Cornflour - - - - 1 Sherbet 1 - - - - 1 - Olive Oil 1 - - - 1 1 Blane Mange Powder - - - - 1 1 Citrate of Magnesia - - - - 11 1,027 31 2.9 42 Totals 1,058 Ten samples of cream and one sample of milk were taken under the Public Health (Milk and Cream) Regulations (see separate table), making a total of 1,069 official samples. Milk.— 665 formal samples of milk and four samples of separated milk were analysed, of which 13, or 1.95 per cent. were reported against. Table "B " shows the percentage of adulterations for the past five years. TABLE "B." Year 1918 1919 1920 1921 1922 Percentage 6.9 2.8 1.95 11.7 1.95 Table "C" gives the particulars of the adulterated samples and the result of the legal proceedings. TABLE "C." Deficiency of Fat per cent. Added Water per cent. Sample No. Result of Proceedings. No. 864 No. 972 Dismissed. £1 1s. Costs. Fine £1. £2 2s. Costs. No Fine. £1 1s. Costs. 13 - 8 - No. 1,065 6 - 7 Dismissed. £2 2s. Costs. No. 16 - No. 161 10 Dismissed on warranty. Appeal made to High Court and same allowed and case sent back to Magistrate to convict. Fined £20 and £5 5s. Costs (previous convictions). - No. 282 - 6 Fined 10s. £1 1s. Costs. No. 283 - 8 Fined 10s. No Costs. Same defendant as No. 282. No. 392 - 6 Dismissed on warranty. No. 437 6 Dismissed. Costs 10s. 6d. - No. 440 - 6 Dismissed. Costs 10s. 6d. No. 452 - 18 Dismissed on warranty. No. 631 4 - Dismissed. Costs 2s. No. 768 39 Fined £2 2s. £1 1s. Costs. - The two following cases might be specially mentioned: — Milk Sample No. 161. — This summons was in respect of a sample of milk which was certified to be 10 per cent, deficient in fat. A warranty defence was set up and the learned Magistrate dismissed the summons. A case was stated for the High Court. The appeal was upheld on the grounds that the contract or warranty simply specified "New Milk" and that the words "New Milk" might mean "New Separated" "New Skimmed," etc. The label on the churn of this particular consignment bore the words "(Guaranteed pure unskimmed milk with all its cream," but there was nothing to connect the label with the stipulations in the agreement. What was required was a guarantee that the milk satisfied the requirements of the Statute. The words "New Milk" did not constitute such a guarantee. The guarantee did not therefore satisfy the Statute. The case was sent back to the learned Magistrate to convict. Obstruction of Inspector.— During the interval pending the hearing of the above-mentioned appeal, another sample of milk was obtained from this vendor. At the same time a sample was demanded from another receptacle. This was refused and both the inspector and his assistant were obstructed and assaulted. A summons was issued for the obstruction, the defendant being fined £5 and £5 5s. costs. Milk Sample No. 768.— This sample of milk was certified to be deficient in fat to the extent of 39 per cent. Three informal samples had previously been taken showing respectively 14, 22, and 13 per cent, deficiency in milk fat. All the samples were purchased late in the evenings. "Appeal to Cow" Samples.— No "Appeal to Cow" samples have been taken, the necessity so far as this Borough is concerned never having arisen. Milk and Dairies (Amendment) Act y 1922. — No proceedings were taken under this Act. For the year ending December 31st, 1921, the number of summonses was 22, the fines amounting to £62 10s. and the costs to £46 35., making a total of £108 13s. For the present year (1922) the number of summonses under the Sale of Food and Drugs Acts and Margarine Acts were 42, the fines amounting to £44 15s. and the costs to £45 175., making a total of £90 12s. In addition there was one summons under the Public Health (Milk and Cream) Regulations in respect of milk containing a preservative, which was dismissed on payment of £2 2s. costs by the defendant (see table "E"), and summons under the Merchandise Marks Acts, which resulted in a fine of £1 1s. and £5 5s. costs (sample No. 132, Table "D"). With respect to the cases that have come before the Court (in addition to the Milk cases previously referred to) the following might be stated:— Borax.— Seven samples of borax were obtained, all being purchased at chemists' shops. Four were at the rate of 1s. per pound, and the others 1s. 4d., 1s. 2d. and 8d. per pound respectively. Four samples complied with the requirements of the British Pharmacopoeia standard of not more than five parts of arsenic per million parts and three failed in this respect. Proceedings were ordered to be taken against the vendor in each instance. The first summons, Sample No. 943 (retailed at Is. per pound), was dismissed on payment by the defendant of £1 Is. costs. The second summons, No. 971 (also retailed at 1s. per pound), was, after five adjourned hearings, dismissed with costs against the Council on the ground that the article had not been demanded in accordance with the terms of the British Pharmacopœia, viz., "Purified Borax." It was pointed out to the Court that the "B.P." was for the guidance of chemists and that very few of the outside public, if any, asked for '* Purified Borax, and were, in fact unaware that such a standard existed. The summons in respect of Sample No. 990 was withdrawn. Sample No. 1032. Egg Self-raising Flour.— A sample of this commodity was obtained and submitted to the Public Analyst, who in his report stated that the article was a self-raising flour, tinted with coloured potato starch and contained no e gg- Proceedings were ordered to be instituted. The vendor was defended by the Trade Association. The prosecution contended that as the article contained no egg it was sold to the prejudice of the purchaser, more particularly as there was on the market a genuine dried egg in powder form, and that an egg self-raising flour containing genuine egg was also obtainable. After two hearings, the contention of the defence that this article had been known to the public for many years as not containing egg was accepted. The summons was dismissed with costs against the Council. Another sample of Egg Self-raising Flour (No. 132) was obtained, and in addition to the words describing it, a picture of an egg also appeared on the bag in which the official sample was sold. The Public Analyst certified that the article consisted of flour and baking powder and no egg. Proceedings were ordered to be taken, and the Public Health Committee invited the Ministry of Agriculture and Fisheries to proceed under the Merchandise Marks Acts on the ground that a false trade description had been given. To this the Ministry agreed, and two summonses were issued, one under the Merchandise Marks Acts and the other under the Sale of Food and Drugs Act. After the official sample had been purchased the firm in question issued fresh bags with the word *'substitute " added to the original description. Many trade and expert witnesses were called on behalf of the defendants, and after two hearings a conviction was obtained under the TABLE "D." Particulars or Adulterated Samples, other than Milk, and including Samples taken under the Margarine Acts. Number. Article. Result of Analysis. Result of Summons and other action taken. No fine. £1 1s. Costs. 796 Vinegar 15 per cent. deficiency in Acetic Acid Vendor cautioned. 812 Margarine 100 per cent. of Margarine. Article sold in an unstamped wrapper 831 Vinegar 15 per cent. deficiency in Acetic Acid Fined £10 and £5 5s. Costs. Sample taken in the course of delivery from wholesale firm that supplied retailer of Sample No. 796. Golden Syrup 86 per cent, of Glucose Syrup 851 Fined 1s. and £1 1s. Costs. 856 Margarine 100 per cent, of Margarine. Article sold in an unstamped wrapper Vendor cautioned. 894 Malt Vinegar Vinegar other than Malt Dismissed. £1 1s. Costs. 923 Margarine 100 per cent. Margarine. Article sold in an unstamped wrapper do. I - 44 943 Borax 100 parts of Arsenic per million do. Raspberry Jam 90 per cent, of other Jam Vendor cautioned. 948 958 Golden Syrup 90 per cent, of Glucose Syrup Dismissed. £2 2s. Costs. 967 Margarine 100 per cent, of Margarine. Article sold in an unstamped wrapper Dismissed. 10s. 6d. Costs. 971 Borax 50 parts of Arsenic per million Dismissed. £5 5s. Costs against Council. 974 Margarine 100 per cent, of Margarine. Article sold in an unstamped wrapper Fined £1 and £1 1s. Costs. 990 Borax 100 parts of Arsenic per million Withdrawn. £3 3s. Costs against Council. 995 Margarine 100 per cent, of Margarine. Article sold in an unstamped wrapper Fined £1 and £1 1s. Costs. Egg Self-raising Flour 1032 Tinted with coloured potato starch. Contained no egg Dismissed. £2 2s. Costs against Council. 1056 100 per cent, of Margarine. Article sold in an unstamped wrapper Margarine Vendor cautioned. 1061 do. do. do. do. Fined 10s. No Costs. 17 do. 52 Defendant absconded. do. do. 99 Vinegar 8 per cent, deficiency in Acetic Acid Vendor cautioned. TABLE "D" (continued). Article. Result of Analysis. Result of Summons and other action taken. Number. Egg Self-raising Flour Flour and Baking Powder. No egg Summons issued under the Merchandise Marks Acts. Vendor fined £1 and £5 5s. Costs. Summons under the Sale of Food and Drugs Acts, withdrawn. £3 3s. against Council. 132 100 per cent, of Margarine. Article sold in an unstamped wrapper Margarine Fined £1. £1 1s. Costs. Vendor cautioned. 139 Whisky 36.1 degrees under proof 203 No Fine. £1 1s. Costs. 100 per cent, of Margarine. Article sold in an unstamped wrapper 304 Margarine No Fine. £1 1s. Costs. 316 do. do. do. do. do. do. do. Summons withdrawn. Vendor paying 12s. 6d. Costs. 334 do. do. do. do. do. do. do. do. 338 Vendor cautioned. do. do. do. do. 406 do. do. do. No Fine. £1 1s. Costs. 453 do. Vendor cautioned. do. do. do. 457 do. Malt Vinegar Vinegar other than Malt and 31 per cent, deficiency in the amount of Acetic Acid that should have been present do. 513 Vinegar 28 per cent. deficiency in Acetic Acid do. 523 100 per cent, of Margarine. Article sold in an unstamped wrapper 604 Margarine Summons withdrawn. Vendor paying 12s. 6d. Costs. do. do. do. do. do. do. do. 622 No Fine. £1 3s. Costs. 31 per cent, deficiency in Camphor. 658 Camphorated Oil Margarine 100 per cent, of Margarine. Article sold in an unstamped wrapper 678 Summons withdrawn. Vendor paying 12s 6d. Costs. Arrowroot 100 per cent, of Tapioca Starch Fined £2 2s. No Costs. 686 100 per cent, of Margarine. Article sold in an unstamped wrapper Dismissed. £1 1s. Costs. 741 Margarine Whisky No Fine. £2 2s. Costs. 767 40.2 degrees under proof Merchandise Marks Acts, and a fine of £1 and £5 5s. costs inflicted. The Borough Council then requested to be allowed to withdraw the summons under the Sale of Food and Drugs Act, but were only permitted to do so on payment of £3 3s. costs to the defendants. Sample No. 680, Arrowroot. — This sample was certified by the Public Analyst to consist wholly of tapioca starch, an article much cheaper than that demanded. Proceedings were taken and the vendor convicted and fined. (See Table "D.") Informal Samples.— Fifty-two informal samples were submitted to the Public Analyst. These consisted of Milk 23, Butter 22, Whisky 2, Borax 1, Lard 1, Coffee 1, Cocoa 1 and Vinegar 1. With the exception of three milks, obtained from one vendor (official sample No. 768, Table "C"), all the articles were reported as genuine. Many samples were purchased informally solely with a view to the agent being recognised as a regular customer. The samples submitted for analysis, particularly in the case of butter, depended largely upon the place from which the article was served (from butter block or out of sight of the purchaser). Judging from the results of informal buying in pre-war and post-war days, it would appear that there is a considerable improvement in the class of article now sold. This may be due to (1) the work for years past carried out under the Sale of Food and Drugs Acts, (2) the high prices, and (3) the better education and taste of the public. Margarine.— One hundred and twenty-one informal samples of margarine were obtained, of which 27 failed to comply with the Regulations as to stamping the wrappers. These were dealt with officially. (See Table "D.") Sale of Food Order. — In connection with that part of the Order dealing with the labelling of imported butchers' meat, it was necessary to caution 33 tradesmen where it was found that "Imported" labels were not exhibited. With regard to the marking of imported eggs 33 cautions were given where eggs other than English were exposed for sale bearing the words "new laid" or "fresh" without the word "imported" being a part of the description, or the country of origin stated. From observations since made from time to time, the cautions given have apparently had the desired effect. TABLE "E." Public Health (Milk and Cream) Regulations, 1912-1917.— Ten formal samples of cream were purchased and submitted to the Public Analyst during the year ended December 31st, 1922, and the details are set out below in the form prescribed by the Ministry of Health Memorandum. All samples of milk taken under the Sale of Food and Drugs Acts are analysed for preservatives. Number in which preservative was reported to be present and percentage of preservative found in each sample. (B.) Action taken. One. (No. 443.) 0.0016 per cent, of Formaldehyde No conviction, defendant to pay £2 2s. Costs. 670 Official. 22 Informal. - 692 - 7 6 Sample No. 176 Boric Acid 0.05 per cent. Caution, Public Health Committee do. do. do. do. 289 do. 0.40 do. do. do. do. do. 295 do. 0.29 do. do. do. do. do. 375 do. 0.44 do. do. do. do. do. 376 do. 0.48 do. do. do. do. do. 383 do. 0.26 do. It will be seen that Samples Nos. 375 and 376 exceeded the statutory amount. Number of Samples examined for the presence of a Preservative. (A.) (2) Cream sold as Preserved Cream.— (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct:- (1) Correct statements made 3 (2) Statements incorrect - 3 (3) Percentage of Preservatives found in each sample. Percentage stated on label. Sample No. 179 Boric Acid 0.34 per cent. Not exceeding 0.4 per cent. do. 261 do. 0.39 do. do. do. do. 319 do. 0.32 do. do. do. (b) Determinations made of milk fat in cream sold as preserved cream. (1) Above 35 per cent 3 (2) Below 35 per cent - 3 (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 Regulations have not been observed: — (d) Sample No. 261 Cream. Vessel containing bulk Caution. Public Health unlabelled. Committee. do. 289 do. do. do. do. do. do. 295 do. do. do. do. do. do. 383 do. do. do. do. do. In all cases where the Regulations had not been complied with explanations from the vendors were requested. These were duly received and were considered by the Public Health Committee and by their instructions letters of caution were sent in each instance. (4) Thickening Substances.— No thickening substances were found in any of the samples. SMOKE ABATEMENT. Following the issue of a report by the Departmental Committee on Smoke and Noxious Vapours Abatement in December, 1921, the question of smoke abatement received considerable attention during the past year, with the result that public opinion is beginning to realise the injurious effect of a smoke-laden atmosphere both upon health and property. Diseases such as bronchitis and pneumonia are more prevalent during the occurrence of foggy weather. The pollution of the atmosphere by smoke is an unnecessary evil, and, apart from the health aspect, the wastage of coal and the damage to property involved, represent many millions of pounds annually. Let us not forget that two of the main essentials for the prevention of disease are fresh air and sunlight. Schools. Although the supervision of the public elementary schools is carried out by the London County Council, yet it has been the custom of the Department to keep them under observation in addition to the private schools. Combined action has been taken, when and where necessary, with a view to preventing the spread of infectious disease. Form 84, stating the reason and period of exclusion of school children, is received daily from the teachers. In all cases of alleged infectious disease the homes are visited and the parents urged to obtain medical advice for the children. The medical inspection and treatment of children in elementary schools in Camberwell is carried out by the London County Council independently of the Borough Council. The system of dual control whereby one Authority looks after the health of the children at school and another supervises the home conditions is not such that the best results are likely to be obtained. Cleansing Station. The London County Council has an agreement with this Authority for the cleansing of school children affected with vermin and scabies and the work is carried out at the Cleansing Station, Peckham Park Road. The following table sets out the work which was carried out during 1922: — Men. Women. Children under 15 years. Total. Vermin 89 — 2,532 2,621 Scabies 4 3 734 741 DISINFECTING STATION, PECKHAM PARK ROAD DEPOT. The work done by the Disinfecting Staff for the year 1922 is shown in the following Table:- May June. Aug. Oct. Dec. Total. July. Articles Disinfected. Jan. Feb. Mar. April. Sept. Nov. Beds 205 72 128 87 116 121 116 1,374 77 86 122 125 119 680 Blankets 392 521 280 462 392 535 410 459 557 432 430 5,550 Bolsters 146 64 78 73 101 93 85 91 60 71 93 93 1,048 8 31 Books, Public Library 40 44 37 23 36 9 10 18 35 34 325 Cushions 40 12 24 37 39 35 21 37 22 22 30 30 349 Curtains (pairs) 1 - 1 1 3 - - - - - 3 9 - Carpets 17 2 4 14 2 - - - 5 3 47 - - Mattresses 87 56 65 62 93 77 65 55 36 85 63 64 808 Palliasses 2 7 2 2 6 7 - - - - 26 Pillows 222 - - 451 216 292 223 301 252 193 186 279 277 281 3,173 Quilts 221 83 145 120 145 113 104 73 79 152 155 133 1,523 Wearing Apparel (Suits, etc.) 1,197 2,477 1,085 1,624 2,167 1,724 2,072 598 2,291 2,723 2,387 2,162 22,507 I—so Total 3,512 2,100 3,812 1,996 3,454 2,843 3,264 1,528 3,237 4,039 3,602 3,352 36,739 Mattresses re-tabbed 87 56 65 93 62 77 65 55 36 85 63 64 808 Palliasses re-tabbed 2 - - - - 7 2 2 6 7 26 - - Cushions, retabbed 40 12 37 24 39 35 21 37 22 22 30 30 349 Total 127 102 64 114 93 94 1,183 68 86 134 119 88 94 Mattresses and Palliasses destroyed 12 19 68 93 163 91 61 36 828 37 62 78 108 Miscellaneous articles destroyed 6 2 - - 8 - - - - - - - - Total 12 68 93 80 163 108 91 36 43 62 19 61 836 Houses visited 599 256 410 366 295 383 357 341 414 540 289 416 4,666 Rooms disinfected 313 130 188 177 222 128 176 149 142 214 187 171 2,197 Total 912 386 598 518 636 431 630 570 528 6,863 494 716 444 HOUSING. The census of 1921 gave 66,104 private families occupying 41,419 "structurally separate dwellings," the number of rooms occupied being 248.529—an average of 375 rooms per family (rooms including living rooms, bedrooms, and kitchens). These figures show conclusively that there is a large number of houses, originally intended for one family, now occupied by two or more families. In 1922 the shortage of houses for the working classes was not remedied to any extent owing to the private builder not finding it remunerative to erect such houses. The Camberwell Housing Scheme, comprised 448 houses, 296 of which were completed by the end of 1921, a further 140 were completed by the end of 1922, and 12 were in course of erection at the close of the year. During 1922 the Council applied for powers to enable them to build more houses, but the application was not granted. About 65 houses were built by private enterprise in 1922, but these houses were built for sale and did not alleviate the position so far as the working-class housing problem was concerned. Altogether 253 new houses and flats came into occupation during the year. The census of 1921 revealed, inter alia, the following facts concerning density of occupation in Camberwell:— 1587 families consisting of 2 persons living in 1 room 903 do. do. 3 do. do. do. 271 do. do. 4 do. do. do. 74 do. do. 5 do. do. do. 26 do. do. 6 do. do. do. 3692 do. do. 2 do. do. 2 rooms 3023 do. do. 3 do. do. do. 1593 do. do. 4 do. do. do. 885 do. do. 5 do. do. do. 360 do. do. 6 do. do. do. For the purpose of illustration let us consider the figures for families living in one room, adopting as a standard 400 cubic feet of air space for each adult and 200 cubic feet for each child for living and sleeping,. On this basis two adults and two children would require 1,200 cubic feet of air space, i.e., they would need a room considerably over 12 feet square and 8 feet 6 inches high to accommodate themselves and their furniture. Experience shows that rooms over the size mentioned are not frequently found in houses in our more crowded areas, and in many instances the rooms are considerably smaller. Now consider the case of the 1,593 families of four persons occupying two rooms. In a large proportion of these families the two children are adolescent, and either the whole family sleeps in one room, retaining the other for living purposes, or else the parents occupy one room as a bedroom and the children the other, one room being used both as a living room and a bedroom. Apart from the question of cubic space, in the case of the family occupying one room for all purposes there can be no possibility of privacy or commondecency, and in both the above-mentioned cases the exigencies of space and other factors would generally involve children of different sexes (often well past the age of infancy) occupying the same room, and very often the same bed. The far-reaching moral and physical effects of such conditions are very serious, and, as the census figures indicate, there are many instances far worse than those that have been suggested. One could multiply examples of this kind, but sufficient has been said to indicate that considerable overcrowding existed at the time of census. There is no reason to believe, bearing in mind the increase of births over deaths, and the limited number of houses erected in the year, that this overcrowding has diminished, and this state of affairs may be expected to continue until the overcrowding of London has been dealt with as a whole. Notices were served in 14 cases of overcrowding, but no legal proceedings were taken, owing to the known difficulty of finding other accommodation. Unhealthy Areas.— Several areas were inspected with a view of Improvement Schemes, and five such areas were eventually represented to the Council in July, 1922. The Council approved the reports of the Medical Officer of Health and the matter was brought to the notice of the Ministry of Health. The Ministry decided to hold a Local Inquiry into the matter, and this was fixed to take place early in 1923. The areas mentioned were as follow:— (1) Name of Area 1. Woodland Cottages. 2. Tiger Yard. 3. Joiners' Arms Yard. 4. Mayhew's Buildings. 5. Levant Street— Island Site. (2) Acreage 1. .258 2. .173 3. .045 4. .188 5. .124 .788 (3) Number of working class houses in area 1. 10 2. 17 3. 6 4. 14 5. 18 65 (4) Number of working-class persons to be displaced, 341 approx. In addition to the unhealthy areas referred to above, another area (Shard Square and Greenhundred Road) was inspected, but, after taking into consideration all the circumstances of the case, including the difficulty of rehousing the occupants, it was decided not to represent this property, and the houses are being dealt with under the Public Health Act. Hampton's Avenue, which has long been the subject of attention from this Department, was, as mentioned in the Medical Officer's report for 1921, acquired by a firm carrying on business in the neighbourhood, and the tenements are being slowly but surely put into habitable condition. Action was generally taken under the Public Health Act, in preference to the Housing Acts, and only 11 Notices were served under Section 28 of the Housing Act of 1919. STATISTICS- HOUSING CONDITIONS. Number of New Houses Erected during the Year. (a) Total 253 (b) As part of a municipal housing scheme 188* *140 Camberwell Housing Scheme and 48 tenements erected in the Borough of Camberwell as part of the Housing Scheme of the City Corporation. Unfit Dwelling- Houses. I. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,642 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District Regulations) — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation— (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 6,110 11. Remedy of defects without service of formal notices. Number of dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,352 III. Action under Statutory Powers. (a) Proceedings under Section 28, Housing, Town Planning, etc., Act, 1919:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 11 (2) Number of dwelling-houses which were rendered fit— (a) By owners 8 (6) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close Nil (6) Proceedings under Public Health Act:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6,103 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 6,101 (6) By Local Authority in default of owners 2 (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909 Nil INSPECTION OF FACTORIES AND WORKSHOPS. INSPECTIONS MADE BY THE SANITARY INSPECTORS. Premises. Number of Prosecutions. Inspections. Written notices. Factories (including laundries) Workshops (including laundries) and workplaces 512 100 - 1,566 2,078 100 - Bakehouses. Prosecutions. Number in use. Inspections. Written notices. 127 462 15 - DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— I 32 32 - Want of cleanliness - Want of ventilation 2 2 - - Overcrowding - - 1 - - Want of drainage of floors 1 - - Other nuisances 44 44 - - Sanitary accommodation:— 1 Insufficient 1 - - Unsuitable or defective 36 36 - - Not separate for sexes 1 1 - - Offences under Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97-100) 18 18 - - Other offences - - - - 135 135 - - I - 54 Outworkers. In accordance with Section 107, lists of persons employed as outworkers were received from 76 persons carrying on business in the Borough, in addition to those forwarded by other Boroughs from persons in business therein. 1,710 visits were made to the homes of outworkers during the year. Registered Workshops, etc. Eating houses 149 Bakehouses 127 Laundries 30 Clothing 55 Preparation of foodstuffs 67 Building trade 83 Sawmills, joinery works, etc. 61 Engineering and allied trades 121 Miscellaneous 685 1,378 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 12 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act:— Notified by H.M. Inspector 17 Reports (of action taken) sent to H.M. Inspector 7 Other matters reported to H.M. Inspector 6 Underground Bakehouses:— Certificates granted during the year - In use at the end of the year 50 1-57 I—56 SUMMARY OF INSPECTIONS, ETC., 1922. Inspectors. DESCRIPTION OF WORK. W. R. Farmer. M. Malins. H. C. Green. R, F. Nash. D. Glenday. Miss F. O'Riordan. Miss M. Butcher. T. F. Morgan.* Totals. W. E. Groom. W. Eagle. G. W. Scudamore. G. G. Morley. E. R. Collins. W. T. Worsfold. Miss Mackenzie. H. J. Green.* 479 22 5 362 593 8 3 - 35 29 291 255 419 236 3,843 Visits to complaints 267 327 314 5 141 161 87 232 497 - - - 18 2,474 House inspections following complaints 267 24 281 127 329 305 115 264 159 269 57 - - - 188 220 2,129 85 139 136 222 64 211 House to-house inspections - - 102 - - 119 - - - 224 466 Tenement inspections — 21 - - - - - - - - - - - - 122 Houses let in lodgings inspections 3 119 - - - - - - 26 - 81 - - 175 Housing and Town Planning inspections 10 23 35 - - - - - - - - 61 771 136 23 24 83 - - - - - - 2,249 Visits to new buildings 244 44 863 - 10 5 7 - - - Visits re overcrowding 5 - 8 - 1 36 - - - - - - - 8 21 22 - - - - - - 88 Slaughterhouses 3 34 - - - 46 52 53 38 44 21 47 27 - - - - 462 Bakehouses 33 33 68 - - - - - - 4 Cowhouses 3 1 - - - - - - - - - 82 19 1,164 98 92 137 55 113 80 131 69 96 - - - - Milkshops and dairies 192 9 22 22 22 19 21 - - - - - 187 Eating houses 12 23 13 11 13 42 14 89 - - - 460 21 55 24 63 35 33 45 39 - - Ice cream shops - - 4 37 134 - - - - - - - - Railway stations 9 2 - - 47 217 39 65 141 62 100 104 12 0 133 25 2 9 1,379 114 78 123 Workshops 19 2 512 Factories 14 - 23 1 58 48 47 52 86 93 68 1 - - 118 - 206 73 332 406 123 120 139 83 - - - - 1,860 Urinals, private 104 156 - 50 28 - 24 12 - - - - 226 Do. public 16 26 - 70 - - 3 - - 21 - 34 - 9 - - - - Schools, L.C.C. 1 - - - - 108 25 4 2 - 1 - - 6 70 - - - Do. private - - - - 2,906 2,958 3,710 4,281 3,186 3,870 3,426 5,816 12 1 1,490 1,508 43,620 Re-inspections 3,106 3,698 3,646 - 154 257 313 167 1,941 653 402 46 4 46 125 80 160 147 351 165 5,011 Miscellaneous 105 220 300 37 11 4 197 111 99 238 144 17 7 2,035 Infectious houses visited and houses inspected 196 193 156 127 - 62 26 41 64 61 117 39 69 1 11 825 Do. do. or enquiries 64 45 54 44 55 2 307 - - - - 189 58 Tuberculosis cases visited and houses inspected 2 1 - - - - - - 3 - - 282 186 74 - - - - 54 7 Do. do. or enquiries 2 - - - - - 13 - - - - 46 8 - - 67 Complaints, verminous children, visits - - - - - - - - 29 42 64 16 - - - 309 40 11 - 48 14 38 - Infectious disease contacts 7 77 - - 7 24 71 11 100 102 60 76 125 - - 656 Inspections of foodstuffs 3 - - 1 2 - - - - - 10 Seizures Do. - 1 2 1 - 3 - - - - - 963 105 - 1,716 1 - - - 647 - Outworkers - - - - 512 2,150 - 1 - - 619 1,015 - - Measles 1 1 1 - - - - - - 17 17 5 - - 39 Scabies - - - - - - - - - - 14 16 30 - - - - - - Ophthalmia Neonatorum, visits - - - - - - - - 1 21 1 - 2 4 9 4 - - - - Smoke observations - - - - 1 - - - - 2 - 1 - - - - Do. nuisances - - - - - 735 666 624 17 1 181 - 6,421 476 499 448 606 367 557 405 37 Intimations 441 154 - 225 230 191 252 282 88 367 - 104 56 2,567 Statutory notices, Public Health 204 167 247 - 190 - - - - - Notices, houses let in lodgings 2 - - - - - 192 - - - - Do. Section 28, Housing and Town Planning Act - - 1 1 - - - - - - - 11 5 4 - - - 18 9 7 - 25 - - 9 137 14 8 14 4 21 - Do. Section 29 do. do. - 8 6,675 8,955 4,147 3,377 1,218 2,090 2,478 84,837 5,446 6,366 7,408 6,972 6,437 7,052 4,951 5,324 5,941 Number of summonses issued during 1922 in respect of nuisances 106 * Temporary appointment for 3 months only. Number of summonses issued during 1922 in respect of disobedience of Magistrates' orders 2 Number of summonses issued during 1922 in respect of unsound food 19 1-57 INSPECTIONS, ETC., 1922. Inspectors. D. Glenday. Miss F. O'Riordan. Miss M. Butcher. H. J. Green.* Totals. Miss Mackenzie. T. F. Morgan.* W. R. Farmer. H. C. Green. W. T. Worsfold. M. Malins. R. F. Nash. 419 236 593 8 362 479 225 3 35 29 3,843 - 329 305 497 161 87 232 - - 18 5 2,474 - 64 211 264 159 269 57 - - 188 220 2,129 - - 102 - - 119 - - - 466 224 - - - 119 - - - - - - 122 26 - - - 23 35 - - 81 - - 175 - - - - 136 23 24 83 - - - - 2,249 - - 1 10 5 7 - 8 - 36 - - - - 22 - - - - 88 - - - - - - 68 38 44 21 47 27 - - - 462 - - - - - - - - - 4 - - - - 113 131 80 69 96 82 - 19 1,164 - - - 22 22 22 13 21 - 19 - - 187 - - 35 45 14 33 39 89 - 460 - - - — - - - - - - - - - - 186 62 - 65 123 141 100 104 120 133 25 2 9 1,379 1 47 58 48 52 86 93 68 19 1 2 512 118 139 406 123 120 83 - - - 1,860 - - - 28 - 12 - 50 24 - - 226 - - 9 - 3 - - - 21 - - 34 - - 1 - 2 - - 6 70 - - 108 - 3,426 5,816 - 4,281 3,186 3,870 2,906 12 1 1,496 1,508 43,620 - 154 351 165 167 257 313 1,941 653 402 46 4 5,011 99 105 238 144 220 300 37 17 11 7 2,035 4 44 41 64 61 117 39 69 127 11 - 1 825 - 189 - - - - 58 55 2 - 307 - - - 3 - - 282 186 - 547 - 74 - - - - - 46 - - 13 8 - 67 14 - 38 42 16 29 64 - - 309 - - - 100 60 77 102 76 125 - 7 - - - 656 1 1 - 3 2 - - - - 10 - - - - - 105 - - - 647 963 - 1,716 - - 1 - - - 619 11,015 512 - 2,150 - - - - - - - - 17 - 5 - 39 - - - - 14 - 16 - - 30 - - - 9 2 4 4 - - - - 1 - - 21 1 1 - - - - - - - 2 557 - - 367 735 405 666 624 1 361 37 17 181 6,421 191 252 282 367 154 - - 88 104 56 2,567 - 190 - - - - - - - - - 192 - - - - - - 1 - 11 - - - - 25 4 9 7 - 21 9 18 137 - - - 6,972 6,437 6,675 8,955 4,147 3,377 1,218 2,090 2,478 84,837 7,052 4,951 * Temporary appointment for 3 months only. SUMMARY OF SANITARY Description of Work. W. E. Groom. W. Eagle. Cleanse and repair 275 311 Repair roof, guttering, etc 136 199 127 Provide damp-proof course, etc. 150 Abate overcrowding 1 2 23 21 Abate smoke nuisance Repair stoves, coppers, etc. 13 31 56 Repair windows, sash lines, etc. 27 21 23 Repair flooring, stairs, etc. 3 7 Light and ventilate staircase, etc. Provide dustbin 89 87 Remove accumulation of refuse, etc. 9 8 Pave, level and drain yard 78 97 Provide or repair manure pit - 2 Provide sufficient water-supply 2 7 Provide cistern or render accessible - - Repair, cover, or cleanse cistern, etc. 15 5 4 4 Clear premises of rats, etc. Provide, cleanse, repair or remove closets, pans, etc. 46 34 Provide water-supply to closet, repair flushing apparatus 33 60 91 85 Ventilate and remove to outside soil-pipes; cleanse, repair and trap drains or sinks 15 12 Disconnect rainwater pipes, sinks and other wastes 6 2 Animals to be kept clean or removed - - 1 6 Public conveniences, cleanse, supply with water, etc. - Private conveniences, do. do. - 46 68 Miscellaneous 1 Drains, total reconstruction 5 2 11 Do. partial reconstruction WORK FOR THE YEAR 1922. Inspector. G. W. Scudamore. E. R. Collins. G. G. Morley. W. R. Farmer. M. Malins. H. C. Green. R. F. Nash. W. T. Worsfold. D.tilenday. T. F. Morgan.* H. J. Green.* Totals. 266 146 46 3 6 35 46 47 1 43 8 70 3 5 - 11 12 35 38 45 13 5 - 1 - 77 3 3 207 110 84 - 9 30 52 39 4 46 - 71 1 7 - 7 - 20 24 44 9 1 - 2 - 50 8 35 353 227 158 1 21 29 76 41 2 71 3 74 - 10 10 19 3 42 51 81 19 1 - - - 65 5 - 251 136 128 1 18 41 87 43 4 46 10 64 - 5 3 10 7 43 64 71 17 4 - 1 - 99 4 8 423 292 47 5 61 100 196 108 9 132 17 85 11 6 6 23 7 58 92 86 27 4 1 1 - 203 6 15 395 242 75 2 18 66 61 90 4 80 1 104 2 15 - 17 11 43 44 66 24 3 - - - 88 5 15 341 177 98 5 32 39 82 33 1 71 13 79 - 2 - 6 10 38 42 57 5 2 - - - 90 10 2 520 176 111 1 37 66 231 146 7 86 2 100 1 4 1 7 - 67 49 78 11 2 - - - 124 16 1 419 296 148 5 33 87 118 140 9 85 9 187 1 10 20 20 1 88 65 94 25 1 - 3 - 339 6 39 153 142 26 - 2 78 46 95 18 8 - 50 - - - 2 - 39 44 55 3 - - - - 52 2 7 291 143 70 - 1 72 222 107 4 25 4 22 - 7 1 6 1 36 38 23 - - - - - 36 - - 4,205 2,422 1,268 26 282 687 1,300 933 73 869 84 1,081 21 80 21 148 60 589 644 876 180 31 1 15 - 1,337 71 138 * Temporary appointment for 3 months only. INDEX. PAGE Ante-natal 28 Antitoxin, Diphtheria 13 Area, Borough 3 Bacteriology 13 Bakehouses 37 Birth Rate 4 Births, Number of Registered 4 Births, Notifications of Number 4 Cancer Cerebro-Spinal Meningitis 11 Death Rate 4 Deaths, Number of 4 Deaths, Table, Causes of, and Ages at 6-7 Dental Clinic 32 Diarrhœa, Deaths from 4-9 Diphtheria 10 Diphtheria, Anti-toxin 13 Disinfecting Station, Table of work done 50 Dysentery 12 Eating Houses 37 Encephalitis Lethargica 12 Factories and Workshops, Inspections of 54 Food— Meat 35 Milk Supply ... ... ... 34 Other Foods 36 Food and Drugs Acts, Report of Inspector 39-48 Housing 51-53 Housing Statistics 53 Housing, Unhealthy Areas 52 Ice Cream 37 Infantile Mortality 9 Infantile Mortality, Table of stated causes 8 Infant Welfare Centres 29 Influenza 5 Inhabited Houses 3 Malaria 12 Maternity and Child Welfare 28-33 PAGE Maternity Beds 33 Measles 13 Measles, Deaths from 4 Meat 35 Mid wives' Fees 32 Milk- Circular No. 185 31 Distribution 38 Supply 34 Non-Notifiable Diseases 13 Notifiable Diseases, Table 0f ... 14-15 Nursery: Peckham, Nunhead and District 30 Nursing 31 Offensive Trades 34 Ophthalmia Neonatorum 12 Outworkers 55 Poliomyelitis 11 Pneumonia 11 Population 3 Puerperal Fever 11 Rateable Value 3 Respiratory Diseases 5 Sanitary Administration 33 Sanitary Inspections, Summary of, Tables 56-59 Scabies 49 Scarlet Fever 10 Schools 49 Slaughterhouses 35 Small-pox 9 Smoke Abatement 49 Staff 2 Statistics, General 3 Tuberculosis 12 Tuberculosis, Notifications of, Table 16 Tuberculosis, Report of Tuberculosis Officer 17-28 Typhoid Fever 11 Unmarried Mothers, Homes for 30 Vermin 49 Whooping Cough, Deaths from 4